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HomeMy WebLinkAbout022-1044-30-000 V ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT \� 9�� . + Owner k,'N.v , /V l o w h \4 ► Propert Address a 9 e uv%� V s 1 V0 City /State P,' vcv FA\ \s W t S 4 u ' ST Legal Description: zn u Lot �_ Block Subdivision/CSM # OF 4 t/4 S f- ' /a, Sec. T 6 N -R . Town of ; .vy ,'.v N: c P - 3 n - P SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer , FF V T Size ST/PC � / t1A Setback from: House 37 Well ]Q P/L Ed Pump manufacturer A V y 5 � Model R y Alarm location i - i , 1 7 v P we N i e- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: oiint - Width Length Number of Trenches Setback from: House �_ Well �D? P!L Vent to fresh air intake ELEVATIONS Description of benchmark 7'0 P o S IN , P V Elevation 1 06 Description of alternate benchmark To P c7 r 1 7 y r p� t'� Elevation R 9 , 7 Building Sewer ST/HT Inlet " i t ST Outlet PC Inlet PC Bottom l . Header/Manifold Top of ST /P anhole Cover Distribution Lines O j ®1, q a1 O O I 7S ~ �� Bottom of System () 16 1, Z I () ( ) Final Grade () �d► () ( ) Date of installation Permit number 3885 State plan number Plumber's signature License number TP00 Date Inspector ®Y1 � Z Y 1r1 hAR Complete plot plan Q r l 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 *V F=t vnn W T A4.to�d 101' 1 C 3 CO s � c b � Q � \ RT �. INDICATE NOH ARROW I Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Coun INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: ST. CRC IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338851 Permit Holder's Name: ❑ City ❑ Village IN Town of: State Plan ID No.: TOWN OF KINNICKINNIC KINNICKINNIC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: o vp 3 `' 022— 1044— �r —i�GO TANK INFORMATION ELEVATION DATA `k—� TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Con�bv moo b( enchmark /VC) Y s Dosing 00 Aerati Bldg. Sewer Holding &/ t Inlet TANK SETBACK INFORMATION S0"tlet TANKTO P/L WELL BLDG. Air to i ntake ROAD f�det ir Septic 4,-5- 35( S NA t�Bottom O k Dosing ± 5 ��� ��-' NA Header / Man. Z, c( /d�. Aerati NA Dist. Pipe 2,�"Q p Holding Bot. System 3, Z , Z PUMP/ SIPHON INFORMATION `��(� Final Grade Manufacturer r 3� Demand SU� r Model Number S(Z G _ .` 7 15PM Friction S stem TDH Lift �.� L . 5 m Z,� TDH qI Ft 8 ' 3 Forcemain Length 93 I Dia.'i� Dist. To Well p SOIL ABSORPTION SYSTEM BED N Width Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I 4- 3 b DIMENSION SETBACK SYSTEM TO P / L I BLDG I WELL LAKE/STREAM LEACHING manuf acturer: INFORMATION Ty �uU peO �} / D/ y �S / /� T CHAMBER Model Number: System: 10 DISTRIBUTION SYSTEM Header /Manifold r/ 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 ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION* KINNICK 15.28. N`14, SE 1271 COUNTY ROAD J l�C �p i / vim ��U��Z �,p � • CO `` S - �/`� is c�r6p�0�Gr-lo " lQS4 ls"' Hbarr y2 ccver o � Coc akrr �' /„ 99,E f k 5(V('1CArr(- Fr0g, G1cr' ,S6er f' IMCk (Ifl0f 6u6o x,07 I1©n� NKt JO // �L I // - �cu..do���0, 41 of W dkor.. / � G�'i ad l l% WP�' Jar '�s + �1lld GCt �IDW�w R� y ��e �oaY�ti y — GK6u Gl 7 h C a Plan revisiofi required? ❑ Yes E] No Use other side for additional information. SBD -6710 (R.3/97) Date nspector's Signatur Cert No. e ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: F # i aa 'n i 3' c i p .,..., s. 4 e. € � p F T d a < 4 [4- f ... w . mss h �a C E x a e f a � 3 d k a..e ®. .4 —1-- <<.,,.. ..,. ..e. — . T .> z i 1 4 7 +11—A ........ i 3 — .P, .. ...,..,.a WA A-1 id V -n-+ f °s. f 3 i E g , a e d € c 1-14, 1- 4.4. 1 . .. , @ �e l a 1 F € � ..� e j I ( t t a e_ --- i e VV S , 9... .,. ..4.— ,. .,..k e a r � € 4 . E E F Al l; 3 »,. t a �s I ._ w .. t�. ne «1 4, a ', tt- fi { jjj ..,. .,e .. ...e..,._ . s _ i € t 7 nt i 1 1 SCKE' x Safety and Buildings Division �� ■I`tnr• SANITARY PERMIT APPLICATION Bureau of Building Water Systems 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 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous appli ation [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pr rty Owner Name Property Location 0 i C �. Si W 1 /4 1/4, S I S' T '� , N, R f (or )@ P opert Owner's Mailing Address Lot Number Block Number I C City, State ` Zip Code Phone Number Subdivision Name or M Num ,p �i&a �r44 1 � 0J5 ) .Zi' 1 996 S� yOLV, ���3 JPIC - 54, D II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Ne$ rest Road r- Yf Public E] 1 or 2 Famil Dwellin ❑ Vil l age - No. of bedrooms Town of �Ji C r C III. ' BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 15. 1.1. 1 T . -2 38 A 1 ❑ Apartment /Condo b Z1- by -- SD – 601D 2 4 Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales / Repairs 11 ❑ Restaurant/ Bar/ 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel/ Motel 9 K] Office/Factory 13 W Other: specify INN JAL IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 New 2. ❑ Replacement 3 ❑ Replacement of 4_ E] Reconnection of 5 E] 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 1 1 ❑ Seepage Bed 21 WIVIound 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 Req 'red (sq ft.) Proposed (s . ft.) (Gals/day /sq. ft.) (Min. /inch) Elevayn - 5 0 Z 0 ) � �, , �– 3 Feet �. - D Feet Ca a It VII TANK in g all o ns Total # Of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New r — xistin strutted Tanks Tanks Septic Tank or ""' .� Tank - r L' e l` 10 0i� (,v ! (- 5 l ^,`L Ci r tLd'� % El El ❑ ❑ ❑ ❑ Lift Pump Tank /SiplaerrEha 4er C ' r �, �? /� �'w 1 ( S C,� (y. f•ft', ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbers m¢: (Print) PlumbeShat�;.�(Nmps) MP /MPRSW No.: Business Phone Number. / Al Plum bet's Addr s (Street, City, State, Zip ode): r / G.. C 7 , " ✓ Z r j" /1 x,11 ��� s l y ie5+ IX. COUNTY / DEPARTMENT USE ON VY ❑ Disapproved anitary Permit Fee (Includes Groundwater dte SSUe Issuing ent Signature (No Stamps) Approved ❑Owner Given Initial urcharge Fee) Adverse Determination 32s Ia0 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: sk ic /6 Lmid Im 'Or�zj I SBO -6398 (R. 05194) DISTRI UTION: Original to County, One copy To: Safety & Ruildings Divi ion, Owner, Plumber , f 1 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 -3815. 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 8 1/2 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, Igration 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 I sconsi Tommy Thompson, Governor Brenda J . Blanchard, Secretary Department of Commerce March 03, 1999 . CUST ID No.267341 , TTN: POWTS INSPECTOR WEGERER SOIL TESTING & DE��GI ZOtTN G OFFICE 421 N MAIN ST ST �'ROIX COUNTY SPIA PO BOX 74 r ? 1101 CARMICHAEL RD RIVER FALLS WI 54022 S O SON WI 54016 �'.NIiNGC:FFIGt. / I RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 03/03/2001 "� -�-- Identificaton.Numbers f \ c� Transaction ID No. 213425 SITE• Sit ID No. 1 Site ID: 166942 Please refer to both identification numbers, St. Croix County, Town of Kinnickinnic above,;in all correspondence ,With the agency. NW1 /4, SE1 /4, S15, T28N, R18W Facility: Kinnickinnic Town Hall FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 453059 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. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. 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 02/26/1999 t FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 6erard 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 MOUND SYSTEM Page 1 of - 1 FOR `R 11.►�J lC hlfu �J 1 C '�w vz LOCATED IN THE " /4 OF THE Stz: 1/4 OF SECTION 'S , T Z N, R It W, TOWN OF CCz y, COUNTY, WISCONSIN- INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 of 7 PROJECT DATA PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 FLAN VIEW —CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 DOSE CHAMBER PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR - mt -JQ O� `cz �lv�l 1C kt �►ry 1 C Q-/0 GPti-D. E. U_J'Z.50 CVt" lditton RECEIVED FM 2 6 1999 ` O pN SAFETY & BLUbS, DIV N see GO�� Sp PREPARED BY ` § C0)v 'T ♦�0' LAlEGEF:ZER SO I L TEST I PI C-3 ,,° �.•• �' AND l� G T f 4 ® f ! � DES I C3 t\1 :E3 E= - : �I I C 6 WEGEREL4 ® Q 0.915 P i ELLSWORTH, F.O. BUT 74 421 K. KAIK ST. `� , 1 _ RIV0.. FALLS. VI 54022 715'415 -0165 °® '~•• I G JOB NO. q9 -30 PROJECT DATA Page 2 Of 7 This system will serve a proposed Town Hall building with 1 employee, 1 floor drain and an anticipated maximum of 60 persons at meetings. ANTICIPATED WASTEWATER employees 1 at 20 gpd = ----------------- - - - - -- 20 gpd floor drain 1 at 50 gpd = --------------- - - - - -- 50 gpd assembly hall 60 persons at 2 gpd = ----- - - - - -- 120 gpd TOTAL = 190 gpd A mound designed for 250 gpd with a 3' by 70' trench is proposed to fully utilize the septic tank capacity. ( 1000 -750= 250 ) A 1000/600 gallon combination tank by Wieser Concrete Products will be installed. rt,Ul "JIUv Page 3 of _Z Scale 1 "= Sp ' sai l - ido• o►v_ -7 *46Nf 31y PVC - PlpI� , w/L b►")�Z - . -L�, X9.'1' k $r << k _ ,� � � -- v y J I r 3 G 00 h ��g his ,� ti�. U)C 5 , Q v � 'li � p� �� �^-- P(SZ�u�. -lr PLD►v1hIG..0E-._`_��_.. 8 • V v�y Qe 5 ►TN pct' L�3'T lZ a �L�p x\s5 of htOv�N 8. z /� 8.3 L- - - S iZ °L°t 3 � o tl S Z3 LuT Ll W � SUL'h U� NOTES .1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( z required) 4. - Septic tank to be lboo 1 6ho gallon capacity manufactured by W ����2 Cc�C� pRoUUe� - S w L�-T -1C,0o 5. Bench Marks Std "CA) e! 6. Divert surface water around system to prevent.ponding at the uphill side. Page LI of 7 Approved Synthetic Covering �s�M c 33 Distribution Pipe Medium Sand H - � G To F Elev*. Zpt.3 3 E b \ % Slope Force Main Plowed Trench of -,"-2k" From Pump Layer Aggregate Undisturbed D Z -o Ft. Soil E 0 3 Ft. Cross Section Of A Mound System Using F o E3 Ft. Trench For The Absorption Area G Ft. A 3 Ft. H I- S Ft. B -1 0 Ft. T \ S Ft. Linear Loading Rate= 3-b GPD /LN FT j Ft. Design Loading Rate= e,ZGPD /SQ FT K �`� Ft. L Ot6 Ft. r1i e nat D sit inn of FnrG Meri —\r W Z q Ft. L Force"` B — K Main , A q- - 1sRS W Distribution Trench Of Pipe Aggregate f 1 Permanent J Observation Markers Pipes (Anchor securely) Mound Using 1 Trench For Absorption Area page S Of =1 Perforated Pip Dctotl 0 J End View Perforated End Cop. ' PVC Pipe t • � �" as Install permanent at end of each lateral Holes Located On eottom, Are Equally Spaced Q End Cap P �1. * PVC Force Main Di0r.bution Pipe Lost Hole Should Be Next To End Cap Distribution Pipe Layout P 33 y Ft. X 3 Z Inches Y 3 -Z Inches Hole Diameter t ry Inch Lateral 11r Inches) Manifold Inches I Force a' Z e in Inches # of holes /pipe `3 Invert Elevation of Laterals lbl• Ft. V3k \-)= \S "Z1 x Z- 30.vv GNP" Place 1st hole 16 � from tee with succeeding holes at 32 � intervals. Last hole to be next to the end cap. Combination Sep_t�,c� Tank and PUMP CHAMBER CROSS SECTION AIJD SPECIFICATIONS ' PAGE 6 OF 7 C�. -VE1JT CAP WEATHER PROOF JUUCTIOU 8OX 4'C.I. VENT PIPE APPROVED LOCKING FROM OOOF4 MAWHOLE COYER A- •,iINDOW OR FRESH wAR►.�1U6 Ll46EC -. A!K IIJTAKE T tj S IV ---- - - - - -- II3 "IKIIJ. ---- - - - - -- y "lusr�e�ro►� Pli�t - ll� ---- PROVIDE I - - - -- UJLE T AIRTIGHT SEAL APPROVED JOIAIT A I I ( APPROVED JOIIJTS W /C.T. PIPEaR Tank construction i I W /c.=. PIPE�pOC shall comply with - I ALARM ILHR 1',3.15 and 83.20 a I I C ) i a3 -o0 I ELEV. PUMP -_j �. OFF D COIJCRLTC L ��1 g2 .v0 BLOCK 5 3" APPFN . KISCR EXIT PERMITFED OIJLtJ IF TAUK M AIJUFACTURLR HAS SUCH APPROVAL BEDDING SEPTIC f SPECIFIC ATI0KJS DOSE y TA,MK MA►JUFACTU : K: 'E a r '� 1 �` 1lUMfSER OF DOSES: 3 ' Z PER D" TAWK :,IZC : 1 ! oa GALLOIJS DOSE VOLUME I ALARM lMAUUFACTURER: S`1L1\S_M IMCLUDIM& 5ACKFLOW: 100.0 (,ALLOI.IS MODEL ►DUMBER: CAPACITIES: A= II IUCHESOK SJ ` GALLOWS SWITCH T7PE: " UR'Y B = Z I►JCHES OR Z R , L G( LLOUS BUMP NIAUUFACTURCK: C- 7 IWCHES OR \,ZSL O CALLOUS MODEL DUMBER: S a D = 2 - INCHES OR 111 S CALLOUS 610 Z 5WITCH TYPE: `�2Y u OTE: PUMP AMD AL R ARE TO 5E 3O IN5TALLED ON SEPARATE CIRCUITS MIIJIMUM DlSC1iARGE RATE GPM VERTICAL DIFFERENCE DETWCEU PUMP OFF AI,ID.DISTRIBUTIOU PIPE- FEET t M METWORK SUPPLY PRESSURE 2 -50 FEET loS Fr FEET OF FORCE MA X �' �ori FRICTIOU FACTOR_. T R FEET TOTAL Dy1JAMIC HEAD = 13 Z6 FEET Pump chamber DIAMETER IUTERUAL DIMLWSIOWJ B OF TAWK: L-EAI&TH ;WIDTH -LIQUID DEPTH BOTTOM AREA — 231= _ GAL /INCH AS PER MANUFACT[IRF.R = 1`l.?_Q GAL /INCH - Combination Septa c; Tank and PUMP CHAMBER CROSS SECTIOM. ARID SPECIFICATIOMS ' PAGE 6 OF } •VEIJT CAP WEATHER PROOF JUIJCTIOW 90X 4'C.I. VENT PIPC APPROVED LOCKING �:. 10' FROM DOOR, MANHOLE COVEK wCM - .iIIJDOW OR FRESH wARnal►J6 LABEL.. ALIWTAKE S COWDUIT_ tj C 6 "MA-x. - "r,tN. I `f"MIIJ. `� ---- - - - - -- y�►uS�t�rttala PIPt PROVIDE ( - ---- L T AIRTIGHT SEAL ' APPROVED JOIruT SA��S A I I i ( APPROVED JOIIJTC W C.I. PI J 1 I I W /C.I. PIPE�w / Tank construction I II ALARM shall comply with •I ILH1 (83.15 and 33.20 a I I I I o1J C I I q, 3.o I LLIV. FT. PUMP,, - -J . � OFF D CO eZ q Z. 00 BLOCK 3" APPRC>vFi RISER EXIT PERMITTED OULU IF TAWK MAIJUFACTURF�R HAS SUCH APPROVAL. gE041NG� SEPTIC E SPECIFIGATI�LIS DOSE TAWK MAIJUFACTU1LCK: 23"011ZM WLVAbER OF DOSES: 3 ' 0 PE.R DAU TAWK 51ZL: 0 CA) 1 60Q) GALLOWS, DOSE VOLUME l ALARM MANUFACTURER: S'S•Q -mow C21SC2I INCLUDIIJC, OACK ►LOW: 1,40• GALLONS MODEL MUMBEK: (, CAPACITIES: A= IUCHCS OR z ' b, ' S CALLOUS � 1 IWCHE!' LLOU5 33 "� G swITCH TyPC: B = � HUMP MANUFACTUREK' C= IU[HES OR � CALLOUS MODEL ►DUMBER: SZ D- INCHES OR Z �'�' GALLOMS SWITCH TYPE: y'��ztac�R`1 MOTE: PUMP AMD ALARM RE TO 5E MI AI IMUM DISCHARGE RATE 30'yZ GPM INSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEAI PUMP OFF AUD..DISTRIBUTIOM PIPE.. K &b FEET + mimIMUM METWORK SUPPLY PRESSURE . , . . . .. . . . . 2 -5O FLCT + '0S F EET OF FORCE MAIN X ���, FYo rT.FRICTIOU FACTOR_. l .C � b FEET _... TOTAL DtIIJAMIG HEAD = � FEET Pump chamber DIAMETER - 3b �I IIJTERIJAL DIMLIJSIOWJ OF TAiJK: L_EAIGTH ;WIDTH ;LIQUID DEPTH BOTTOM AREA — 231= - GAL /INCH AS PER MANUFACTURER = i 6 Z GAL /INCH of TOTAL HEAD IN FEET 46" 9/-VS" ' O cn O v1 O Cfl O O O O 0 � o N O m O D D w o C7 O tv -{ C7 ci) O 0) H Z ° c t N U 3 m ° N H -P, Z O H m Z o C N - i m m O OD O w N O CO O W O O O O — N W P Ul 01 v m co TOTAL HEAD IN METERS Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT - Page 1 of 3 Labor and Human Relations _. (jsion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2'x 11 inches in size. Plan'rnust include, but not limited to vertical and horizontal` reference point (BM), direction and % of slope, scale or PARCEL I 4 i , dimensioned, north arrow, and location and distance to nearest road. p 2."Zlr 2.Z 1 10 4 - 3U APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION RE D' Y, DATE PROPERTY OWNER: $�- C� �'l �.2 C $ tv S PROPERTY LOCATION O l ll+ .�YCk1mo 1C �AVT -LBT- M W 1/4 SQE 1/4,S �5T Z� ,N,R 1p� €( W �OV4MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #, CITY, STATE ZIP CODE PHONE NUMBER []CITY QVILLAGE OFOWN NEAREST ROAD i;P,\v e12 F-+O-LS, we' syo zZ hLS) 1 4 7,5 -305 �cl IC :t/ju l e c " S s,h (>t[ New Construction Use [ J Residential / Number of bedrooms (] AdditiQn to existing building [ ] Replacement bQ Public or commercial describe Tt�owt\3 l�Wcu_ Code derived daily flow - L S O gpd m Ay- • Recommended design loading rate bed, gpft ' I trench, gpd/ft Absorption area required - bed, ft Z trench, ft Maximum design loading rate of bed, gpd/ft ' Z trench, gpd1ft Recommended infiltration surface elevation(s) I O l - 3 ft (as referred to site plan benchmark) Additional design /site considerations mzo jr - V yv /3 -� 0' - TTUav- c t f . 1 j tj . 7,y "oF Std From(_ Parent material 0yk!21 t u 0\3 Lam. `DUt_.UM I Flood plain elevation, if applicable t l A ft S = Suitable for system CONVENTIONAL I MOUND I IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem O S IOU ®S ❑ U ❑ S ®U ❑ S ®U [IS RU EIS E! U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bouldaly Roots Bed Trtldt s'byt Z t 2 lD L Sl i Zwt `M �'�- C.S _ S •� Ground 3 Zg -u Ikf \'4 v cs _ `a • S elev. Fs a s >z ctg.3 L J \to -loo h , v f - run . Depth to C_uvv y'jZ < So ° I LvI \-` 6 6 LI I wE PlZft G S limiting factor Remarks: Boring # 2- w1�h s ti off >�u:::. Z L3 - 3 0 l 0 `1 R 31 s i I Z vn s U Ground 3 3D` �- S�r1Z3lyr — s� \esbk \�vf�. •�I `•S elev. (4 S_yy LO l9- 6/L R `' .. _ t ,� r✓1� P -1 ft Depth to limiting factor Remarks: G ` CST Name: - Please Print Phone: Arthur L. We erer 715 - 4 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 5 022 Sgnature: / Date: 1r jc,)Leo CST Number: -u._917 220254 PROPERTY&W*R___ OF \7-1wJWJ Mr -JNw1 e SOIL DESCRIPTION REPORT P.0 _'f PARCEL I.D. # D ZZ - y(SM = n Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots Bed Trerxh in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 3 O -tD ��-t2 CZ Sil 2.'� P1.F�. �LV • Z Z I p�i� lO` tZ 31 L 1 Sl ( Z> ►n 6 bk 1M'�' -- � S — . S , � Ground ; 3 Z� - 7 -SYR 31 s 1 1 S1�h y� i cs �1 • S eiev. S S� NP i •Z gq.S fc• . 3y�SY �o�►Z �� — 9�\ v� w��r ew Depth to LS aR limiting factor Remarks: bring # Ground � bk In \3 C ti" - - \4 s el ev. 9 ft. � 3� -SE3 �O`11z 6l(, LS B R - ti� lip Depth to- limiting factor 30" Remarks Boring # 13 Ground elev. ft. Depth to limiting factor 7 'Remarks: Boring # 13 Ground elev. ' ft Depth to limiting :. factor Remarks: 4Rh'- R3�niR n5mo� c i PLOT PLAN Page 3 of 3 . SCALE 1 "= So Bw+dL t.1oo•a gN. "DiA PUC PLAN wjL" t w av t t tv 6 1O 13E PrT LLYAsT - ZS' Fil-&i M oukA) , wSZL `rb _12.F Pit' LET So' F: -Izz m MOVK p, n 3 J i t� VI D 10 '�. b0 IvvT CZY'IP1`�tI UAZ I �LSC� Tt�1 S t�R�A Ln `-13 C vi 1 < / � 5 � �cS , � qs -alb (715 ) 4 2,5 —n1 h5 1:4 00576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer - 1 ow,n o o h,c Li c- Mailing Address 32S Nom, 2►uey R. oa.c] Property Address (Verification required from Planning Department for new construction) City /State &ec Ca /(S W l Parcel Identification Number D Z Z- l oV V - 30 - Oo 6 LEGAL DESCRIPTION Property Location N U '/4, S F- '/4, Sec. ( S . T Z & N -R 1$ W, Town of Subdivision , Lot #- Certified Survey Map # 1`I 6, 7� f , Volume I , Page # 3 6 CO Warranty Deed # Sg1 `I Sze , Volume /`/ // , Page # 7 6 L..) vi Hal Lot lines identifiable E 'yes 0 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, journeyman plumber, 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. X /13 / 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. x p q / /' 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 n vaaatn yr tmaaa w.:. `» , VOL 141.1PACf148 STATE BAR OF WISCONSIN FORM 1 =1982 S9�3t$23 WARRANTY DEED KATHLEEN H. MALSH REGISTER OF DEEDS DOCUMENT NO. I ST. CROIX CO,, MI RF.CEI49 FOR KM This Deed, made between Jeffrey V. Christensen and ' Q3- 17.1999 9t30 A!1 j Nancy A. r steTlsen bated and wife as vffAm NO ' marital property EM FEE: W V. i G "t tO � I f�PY FEE I! an d Town of Rinnickinnic. St Croix County, � FM: 119.00 Wis con RErAft9 EE: 12.00 ! .., s E t Grantee, Witnesseth Thar dte said Gtaamc; for a valuable ow leridan one A llar and other good and valuable consideration d cwweys to Grantee the folowing dcxribed real estate in St. Croix TH $PI nfS6RYE0 FDA RECORDING DATA f County State of 1 , Ascondn: IRESS f I Edward F. Vlack Davison & Vlack { ! 200 East Elm St. I ,I River Falls, WI 54022 022- 1044- 30-000 PARCEL 106NTIFICATI011 NUM9ER � PART OF THE NORTHWEST QIIA = OF = SWnWT QUARTER (NW 1/4 OF SE 1/4), OF SECTION FIFTEEN (15), TOWNMP THEM EIGHT (28) NORTH, RANGE EIGHT (18) WEST, TOM OF KINNICKINNIC, described as follows: Lot One (1).of Certified Survey Map in Vol 13 of Certified Survey Maps, page 3600, as Document No. 596746, filed in St. Croix County Register of j Deeds Office on January 29, 1999. r i * See attached Covenants. Tbis is not homestead progeny. .. (it) (ts nod j Together with all and singda the hereditaments and appuncnmw thereunto belonging; 1 And _ Alltrna warrants that the title is good, indefeasible In fee simple and free and clear of encumbrarxns cttcepE easements, restrictions, reservations, and covenants if any of record, and highway I rights of way and will warrant and defetld the same. r I Dated this f / 'S day of March . 19 99 V (SW (SEW , VV V jeffray V. Chriqtqpe , (j (d TA ..._ (SSW (SEAL) N6qyrAt Chri stensen AUTHENTICATION ACKNOWLEDGMENT i effr V. Christensen an -Stat Wisconsin, $ignaNte(S) e o ' sea. Nanof A. Chri stensen Count y i eve is 0 19 99 patsonslly came before me this _ day of i I} T 19 , the above tamed j ._ Edward F. Vlack t I TITLE: MEMBER STATE BAR OF WISCONSIN 1 (I (If not. u authatind by *706.06, Wis. Sens.) to me known to be the penort who executed the foregoing Ii I� t instrument and acknowledge d)e same. �I THIS INSTRUMENT WAS DRAFTED SY Ij Ed ward F. Vlack, Davison & Vlack i River Fails, WI 54022 Notar Public _.__ county,ww t (Slgttatures may be authenticated or admowledgcd. Bah arc na My commission is permanent. (If not, sate expiration date: ii I� necewary•) h �I •Nam.. of ?I "t^7tls iA say apathy sh"Id by "W M printed blew twe slgautres I STATE a" OF WISCONSIN VII lea,' a** Co.. kc, �I � WARRANTY DEED Pena No. I - 1001 Uk"LA ro. Wit. YOL 1.41.I PAa149 Grantor: Jeffrey V. Christensen, and Nancy A. Christensen Grantee: Town of Kinnickinnic Also, the following Covenants run with the land until the adjacent property is no longer owned by Grantors, nor their descendants: a) Unless federal, state, or other regulations require otherwise, any building constructed on the property described herein shall be limited to one story. b) Unless federal, state, or other regulations require otherwise, the roof on any building constructed on the property described herein shall be at a pitch no greater than 6' x 12'. C) Unless federal, state, or other regulations require otherwise, any lighting on the site or building on the property described herein shall be restricted to ground lighting not greater than 6' off the ground and soffit or wall lighting on any building structure on the site, which shall not be higher than the elevation of the building. i Parcel #: 022 - 1044 -50 -100 04/29/2008 05:03 PM PAGE 1 OF 1 Alt. Parcel #: 15.28.18.238D 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - TOWN OF KINNICKINNIC, TOWN HALL TOWN HALL TOWN OF KINNICKINNIC 1271 CTY RD J RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ` 1271 CTY RD J SC 4893 RIVER FALLS ,- SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 8.213 Plat: 3600 -CSM 13 -3600 SEC 15 T28N R18W NW SE BEING LOT 1 CSM Block /Condo Bldg: LOT 1 13/3600 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 03/17/1999 599523 1411/148 WD 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/10/2001 Description Class Acres Land Improve Total State Reason OTHER X4 8.213 0 0 0 NO Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I q acres (71 co CERTIFIED SURVEY MAP Jeffrey Christensen Part of the Northwest 114 of the Southeast 114 of Section 15, T. 28 N., R 18 W., Town of Kihnickinnic. St. Croix County, Wisconsin OWNER'S ADDRESS- '" 323 N. RIVER RD, RIVER FALLS, W/. BEARINGS ARE REFERENCED r0 THE EASr•WEST /A4 L /NE OF Swr /ON 13, r. 28 N., R. /a W., ASSUMED AS N87•32'/6 "E. SCALE /N FEE /" +200' O so /00 t00 400 .. N07•Jt'l6 "f f304.77''- escc7/oNu/� V „ L�,Y�_� Nsc+a►.Nwuv -ssv4 p•CYR /W C.N.. ✓� --.-• 3430' •• Y1 rm . � N 17• as' /s" [ '" "'- � N 87•32'/6"E N 87.30 00 "E • 309.32 I EAST 114 CORNER °o ;^� I SECT /ON 13, r. 28 N., R. 18 W. . WEST //4 'CORNER, ���,,,,,, !COUNTY SURVEYOR MON.I SEC. /3, r. 28 W. a lo;v _ � � !COUNTY SURVEYOR maw +~ _ b 11 /00' tv/LO/NB siFe K e ?� LOT / �i i • ,JI ' J `.;S 1 CoNrA/NS 337, nB sa FIC �I � i I s � i OR &t /3 AC.. W( s3 b 13/8, /63 $0.n. OR k't 7.304 AC. EXCLUD/NO r l • .I Dated! December 23, 1998 ROAD R/GJ/r Of WAYJ) wt L1� I ° 0 9 yl I hl 30.3/ -- `J 3/4.92 S 88.07800 0W 343.23' 'V� °i LL E_ `� ••• � �' i �Y' , fi r Imo /CATES / "X 24 " IRON P /PE SET LAV �"�GE� !M /N. WT. /. /3 LB. /L.f.J = W M RPHY . 0° /NO/CATES COUNTY SURVEYOR MONUMENT .. N ` V °•,p N.N. F� LAND oP rence W. Murphy Registered Land Surveyor I , rH /S /NSTR LD L . ��u►�oN SMc ET / OF 2 j CE D SURVEY MAP Jeffrey Christensen Part of the Northwest 114 of the Southeast 114 of Section 15, T 28 N, R 18 W, Town of KInnickinnic, St. Croix County, Wisconsin A nES -CRT rTI That certain parcel of land located in the Northwest 1/4 of the Southeast 1/4 of Section 15, T 28 N, R 18 W, Town.of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows: Commencing at the West quarter corner of said Section 15; thence N 87'52' 16" E (assumed bearing on the East -West quarter section line of said Section 15), 3426.20' to the Point of Beginning of the parcel to be herein described; thence, continuing along said quarter section line, N 87 16" E, 545.30 to the Northeast corner of said Northwest 1/4 of the Southeast 1/4; thence, along the East line of said Northwest 1/4 of the Southeast 1/4, S W13 E, 657.64; thence S 8907' 00" W, 545.23; thence N 00'13' 35 ".W, 655.31'to the Point of Beginning, containing 357,778 square feet or 8.213 acres, being subject to roadway easements for C.T.H. 'T' over northerly portions of this parcel and C.T.H. "IT' over easterly portions of this parcel as shown on this map, and any other easements of record. NOTE: Each parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc,). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and appropriate Town Board for advice. State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby cer* that by direction of the Owners, Jeffi ey and Nancy Christensen, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of Wisconsin Statutes and the Ordinances of 'St. Croix County and that this map and description are a true and correct representation thereof. Dated: December 23, 1998. ,0 0IIIIllftfll \ Sco/v N)" 10 This Instrument Drafted by Jerald L. Larson. LAURE % s W M Y cc 13 , '°. V FALLS, f 4 WIS LAND S,•!`� Laurence W. Murphy Re stered band Surveyor SHEET 2 OF 2 Ago,