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HomeMy WebLinkAbout022-1058-50-000 a c -0 ° CD tr a w C T w 0 N j y y N O _ o a L n O C E rn� 2— C O a I I k > C C � o 00 C VN a) N C >_ _O y co coxE a N y C Ch a@o0) 0- z CD Z���� n z C M OZ N = U. O N L tL co I O U V C •3 O E < CL L) u u E N I N I F p p `m m `L m N d a m I I O I O Z g c c y Z ° c c o I N H r rn Z E c E v E U m M ` N N O N d c o y N co O C � I D • a a OL m O o a) ¢ o d Q N zmz z z z I W cv 0 £ A E C O. O E C L r Ia lC r C M CL m t D N yr d � N F " 0 0 N 'c c a ° d o C G a m N Z N J N N N N > j N N N r- o Z z o WAWA IL IL CL IL CL CL �. a LL C N @ 0 0 y ` m OW N J U LL a) m j rn rn Z M N C) I > 0 0 .-� N E Q p m m a) m y 00 p E 0 S h e o w c �' 0 0 U F O — O ° ° y N N O O C O N V O C L .S C t1 d p O -2 o (IJ i� � C E C CO O ? C C C C N U �'I M N - 0 Z N ICI cv N C _ co .`�.. 7 O` E a) M • O N Y= Z 'L' 2 H I M O Z N Z (n 0 2 r 0. 37104? CERTIFIED SURVEY MAP \' JAMES HILL Part of the Southeast 1/4 of the Southeast 1/4 of Section 20, Township 28 North, Range 18 West, Town of Kinniekinnic, St. C County, Wisconsin. E I/4 COR. SEC. 20 T28 N, R 18W,: COUNTY SURVEY W MONUMENT) OM W 0 0 = H N E COR. SE 1/4 S E 1/40 N W . M o 3 0 w --- - - �66' TOWN ROAD O W— 644.21 _ S 89° J " E 1304 'n .21 J z O NL_ -- -- M - -- 660.0 -r— - N W 0 90. 644.26 — "0 0 6'�'T00 ❑ I I J Q F 0 M 04'39, o LOT 2= 5.00 ACRES I W O M_ M_ N E T = 4.275 ACRES I I d' W o a =N 1i O LOT 1 a 4.88 ACRES W o o❑ 0100 I W F- e o NET = 4.39 ACR = o ti0 owo N + 1 o N FARMSTEAD C3 0 M W ~ z 0 i 0 N I M 12 ti <L O p I WOO O 0 \ / /0� I J ir 2 � %^ I N, W 0 89.8`S 644.69' 0 627.00' 4 W U) N, 0 N 89 59' 39 "W 1304.69' Z )- LOT I n 212,668 SO. FT. aQQ LOT 2 a 217,800 SO. FT. W 66' TOWN ROAD m= J> J0 Qy SCALE 1"--200' DESCRIPTION That certain parcel of land located in the Southeast 1/4 of the Southeast 1 / of Section 20 Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows; Commencing at the East 1/4 corner of said Section 20, thence S 00° 00' 00" E (assumed bearing along the East line of the Southeast 1/4 of said Section 20) a distance of 1321.93' to the Northeast corner of the Southeast 1/4 of the Southeast 1/4 of said Section 20 and the POINT OF BEGINNING of the parcel to be herein described; thence continue S 00° 00' 00" E 330 .00 1 ; thence N 89 59' 39" W 1304.69`; thence N 00° 05' 00" E 330.00 thence S 89 59' 39" E 1304.21' to the POINT OF BEGINNING, containing 9.88 acres, more or less, being subject to easement over the Northerly and Easterly 33' thereof for Town Road purposes. APPROVED � MAY2 o1981 ST. CROIX COUNTY COMPREHENSIVE PARKS PLANNING= State of Wisconsin) AND ZONING COMMITTEE County of Pierce) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, James Hill, I have surveyed and divided the lands shown hereon-in accordance with official records, Chapter 236 of Wisconsin Statutes and the Ordinances of St. C County; and that the above map and description are a true and correct representation thereof, 40\!' G O .. y Dated: 22 April 1981 JAMES L 's Vol. Page 1061 MURPHY '1 C Survey Maps James L. Murphy s $ ®�; St. Croix County, Wisconsin. Registered Land Surveyor ~ � rj' g AS BUILT SANITARY SYSTEM REPORT y �7r TOWNSHIP k SEC. T N, R W _� . ?. ADDRESS ST. CROIX COUNTY, WISCONSIN MTVISIO;d L0'L._' LO`f' 5ILB ll � PLAN VIEW Distances dimension : to meet r equi.rements of 1162.20 S HOW EVE WITH 100 FEET OF SYSTEM b a p � iN LET Ta TAA)K I • I r WEL e >Iba `TIC TANK(S) MFGR. V�✓( CONCRETFt STEEL NO of rings on cover Depth DRY WELL ,NCHES NO. of width length area no. of lines width lof length .7 area_ '` dept to top o£ pipe REGATE _ 'K RATE AREA REQUIRED _ AREA AS BUIL "claimer: The inspection of this system by St. Croix County does not imply complete pliance with State Administrative Codes. There are. otter areas that it is not possible inspect at this point of construction. St. Croix County , .issumes no liab.i.lity for tem operation. However, if .failure is noted the County will make every effort to s!rmine cause of failure. ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ..-- 'INSPECTOR DATED v` O PLtrMBER ON JOBS LICENSE NtTRBEI2 a } 4 413 REPORT ON INSPECTION OF SANITARY PERMIT # q 7 5 (1 Name and A dress of Permit Holder Person /Persons at Site (2 )Date of Inspection Name,- ress icense NO. OT InsTaning lumber Time of Inspection (3 )INSTALLATION CONSISTS F: ❑ Septic Tank ❑ Seepage Trench [:]Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank []Fill System N ermanen reference Point) escri e: 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? 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? []YES ❑ 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 TRENCH: 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 8 Signature of Inspector REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM SanitaAy P2Ami X0 State Septic NAME Tawn.S hip SZ. CAOi x Coun Loca,t n Section Lot # — f 4- � Subdivision SEPTIC TANK Size /d p p ga.2.2onb NumbeA o6 compaA,tment.5 Di,6 ance bAOm: Glee �Gd >f Building Z 3. !> 1,2% .6tope HighwateA PUMPING CHAMBER Size gatton4 __ .P �nu6actuAeA Model Numbers HOLDING TANK Size ga.E.2anb N m e CompaAtmen -t/s ` Pumpers aAm Sybtem Di6tance 6Aom: Wett BuiZdting 12% 6tope_ HighwateA ABSORPTION SITE Bed TAench ViAtance Atom: Wett roo - r *p Building 1.2% stope HighwateA ABSORPTION SITE DIMENSIONS h Wi dth o t At Req u-%Aed area !� /,S At Length o6 each tine _St Depth ob A ock below Cite. in NumbeA ob ti-nens Q Depth ob Aock oven tite in Totat .length o6 U.nes �� Depth ob tite below gAade � tin Di6tance between tines Stop o6 tkench in. pen 100 At y Totat ab6mption anea `j 6t Type ab Coven: Pape o 6tAaw ri PIT DIMENSIONS Numb eA o6 pit.6 GAavet aAound pi t5 yes no Outside diameteA 6t Depth below intet At Totat ab6oAptkon area At A A ea Aequti At I N S P E - TITLE APPROVED `�7� " DATE 19 8 REJECTED DATE 198 REASON FOR REJECTION p ��' �� State and County State Permit # 3 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: � S ML—C— Z ar �4�Oa B. LOCATION: 5E ' / 4 -56 ' /4, Section �Q, T 9T N, R /? E (or) © Lot# City Subdivision !Name, nearest road, lake or landmark Blk# Village Township (MHl( It /NN[ C. TYPE OF OCCUPANCY: * Commercial *Industrial *Other (specify) Variance Single family Duplex No. of Bedrooms 3 No. of Persons _ D. SEPTIC TANK CAPACITY X000 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 xC 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 �c Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: � Length .J Z Width W Depth —Tile depth (top) 20 No. of Line .Z Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land a% Distance from critical slope WATER SUPPLY: Private 54 Joint ❑ Community ❑ Municipal ❑ Owners nam as li on EH 115 if other than present owner: I, 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 0. C.S.T. # E S — ,5D ,— ) and other information obtained from own /builder). _ Plumber's Signature 4dl'P /MPRSW# z2 Phone # �l� a5'��,[C Plumber's Address PLAN V I EW: 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. • - . - t�i � E , . E , Ae 000 W E m, u j t i L = t e s E � y IC 3 E , s , • 1 ( i F [ x 3 i Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY of Application 7-��f��J Fees Paid: State County Da 1 it Issued /Re'ected (date) Issuing Agent Name n.. 1 on Yes No State Valid# Date Recd 2 y (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 ,pink copy) 4. plumber (canary copy) Revised Date 7/1/78 EH 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: `'� %, " ;< %,Section Z- ,TIN,RLG-#a;;OW, Township or -AA +erryeFity �G►NN1Glcl�Nlc Lot No. C�l+.�t��N t 1'Rbp�rL - cY tN�`.,o�C ��t - no - >; "A • $ o ,��Block No. County e- R `�� ` �A ` L- Subdivision Name Owner's/Buyers Name: �J �- �- Mailing Address: IL S. Z 4 'e \ v�►c EAU �} \'K . S 4- t3ZZ- TYPE OF OCCUPANCY: Residence X No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT k ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS -7- l -7- Bp PERCOLATION TESTS 14OM n G�bu��n SOIL MAP SHEET �' NAME OF SOIL MAP UNIT "^ �~ 611 PERCOLATION TESTS TEST DEPTH CHARACTER OF. SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTEF INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P No YG rLLcr tL IXT N `7C-r: LvllgvL B . 5.N Q)OY I L c> T�,a P- R \ rJ G � C-� h L�+ t� r -- t I L. n t. U I P- - pew— . 14 1 L-% •r � N S t. • Yo 20 • J 1 Al c � � S Y� 1 u t2. P- 9 l' rL L. 0 L'IL3Y% o " K� C >� IS 2 5 A' W w/ - r o 1 D LA P L- P- 1 N c 1•} . P - J C L.YNSS 5 I\." . 1- v R S 1 S � - K - - C- 1)i'L oK P- pA L.l ;>IT Y NL1.1 v¢ ZUS S �; » ?, Vk" rL PW- 13i'n SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 1 - 7 - L our 7 - 7Z" q'' 1�s - 71 B- -L - 7 7 - �� FJ� -1 2 � S O t S Z g G £� Cs." vv C B— 's "72 lvo N� > � B- B- B- 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. T rt <, P c� c. E t�� ti ti >a 1? � p iLw") = 3,c ZePS= (o) S 5 4) D L � r iz1� et iL\ V 33° 3 1 s ` 3 z r � 1 —' �A�� _ P _ .. _ . C) _ e . m (� e TaitB� - SPr! .z `��ee� _ �wQ__ .. _ a �� f s _ k4 Z 0 0�0,�( _ } _ T kw pm pt,viM -S e e [ s r s L l _ t3Z q� 1 a E - ._--- .»........mn.®. tee.. -�- �...w«3..m _— ,.�...._�.�....�.�m .A...� ...»,.. a...w_ -S ..... ,�, .. s.m... ,._ 4_ s_._., »-.. .. �e .®......mm.�.......... A,.�«».,.a.«_. a...� ......k.. -. ».....'. � e. .-� 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. P ime ( rint) L V R p u Certification - tress 3 l �- ►d "?� "'- 5 - r' , i2 ul= >� ;9n. Lb V�DI S S4vZ -? of installer if known Co, CST Signatur — Local Authority CA= r 1 � Y ' ,1 ... , ; S.I �. 1 i � R t c v: , i, - �� 9� � . .. .. � _.,. .. �_ .. _.. � - 6. .. .. . .. � ,. .. ., .. ... .. .. __. . �. 1. � _.q '... �..2 . - �, ....... t - - a ) . � . l _ _ �� J ' f ST. CROIX COUNTY ZONING DEPARTMENT r AS BUILT SANITARY REPORT/". Owner Property Address l. City /State S i 0;4 ^� C: tit Legal Description: ''� I Lot Block — Subdi ision/CSM # af '/< ' /4, Sec. r2, T N -RW, Town of G << I SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer �<'��C�/,UP 1 e�'� 9 ize(ST P C No / Setback from: House Well ��� P/L '�S G � Pump manufacturer Model 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: � 6 � ly , Width 3 Length Number of Trenches Setback from: House -0' e, Well P/L ' Vent to fresh air intake ELEVATIONS >ee � �-Spo rcP`(k Description of benchmark le Elevation /� Description of alternate benc ark % Elevation/e- Building Sewer ST HT Inlet - l / ST Outlet , "` PC Inlet PC Bottom Heade Top of ST/PC Manhole Cover Distribution Lines ( ) � / ' � O ( ) Bottom of System( ( ) Final Grade () () ( ) Date of installatiow , / / Permit number 3 -5 State plan number Plumber's signature �� License number Date Inspector Complete plot plan 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. ;f' r v c PLAN VIEW e sem� �0. �o p �� y' Y 8 P i rt INDICATE NORTH ARROW M010 • Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353148 Permit Holder's Name: ❑ City ❑ Village ❑ of: State Plan ID No.: Moe er John Town of Kinnickinnic CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 022- 1058 -50 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1? O 0 Benchmark v Z f .Q F � Alt. BM +� 0 er Bldg. Sewer H St Ht Inlet Z, 0 y TANK SETBACK INFORMATION 03 / Ht Outlets 3. TANKTO P/L WELL BLDG. A to iri ntake ROAD Bt I n l et Ar Septic 7 Sf jro ZZ� NA r > Sf ;>So If Z / NA Header/ Man. /t.30 a . A Dist. Pipe E H g Bot. System r, ' z � PUMP/ SIPHON INFORMATION Final Grade Manufacturer %GP St cover Z_0 0- Model Numbe T Lift Friction S stem TDH Ft oss ad Forcemain Length Dia. I SOIL A RPTION SYSTEM BED / EN ;H) width Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME O �Z_ I DIM EN 1 N Manu acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM o INFORMATION Type O Moe umber: System: - /dQ / >' wb M I B T DISTRIBUTION SYSTEM Header Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Lengt.. Dia. / Length I v Dia. ,4/, Spacing N 00 � 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 E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:10 /t /41 Inspection #2: Location: 1097 River Drive, / River Falls, WI (SE1 /4, 1/4, Section 20 T28N- ��R18W) - 20.28.18.320C 5 4 L, Al- Om ` yl1'!�� b� 5"w, D �'k(/ v uti. () (W Was "f 44 AV � a.�a. <.0 a /d SyS�e� 3 Z 33 — •r,. 4e e*> o ge �+- des 0 is, h A � . l D - -f °?3 (� 9 Z b 6CrS t-J lr t � /'t�C S� f/ha/C/ •�/ � 4 ^ Plan revision required? ❑ Ves ❑ No 9 Use other side for additional information. SBD -6710 (R.3/97) Da Inspector nature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , p f r � a e 7 » q t _ e e ! F c r p L p .. E € TT a 1401J e � , E , Atop I . NL`1 `a e e i 3 € { , m., » r e q= i 1 , e i # # i t ate» A�mm .._...q.,.. .,e..d�...� -.. 33333 v i e «. x � t a B M e � a E a a e - a 3 t .., m_ , » 4 Safety and Buildings Division �*I. S ANITARY PERMIT APPLICATION 201 Box Washington Avenue 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 e ii r lop l ess County than 8 1/2 x 11 inches in size. � � � �-�- • See r everse side for instructions for completing this State Sanitary Permit Number Personal information you provide may be used for secondary purpos Check it revision t b previous application [Privacy Law, s. 15.04 (1) (m)]. $Mate Plan I.D. Number Ln I. APPLICATION INF RMATION -PLEA E PRIN @ MAT Property Owne m e Location �y D h ft eq e U III i4 ti %; T ' R E (ol9 Property qwnjr 's Mailin odress J Lot Nu r Block V t^ i O Sr City tate , Zip C e P e u ber Me,, s lJl oaf ( )k e1� II. TYPE OF B ILD N : (check one) ❑ State Owned (/ o v Ila a //� New Road p Public 1 or 2 Family Dwelling - No. of bedrooms _L_ n 1�f1/ 1 d(t t 111 BUILDING USE: (If building type is public, check all that apply) 11t ' ° ��, �jZo C' 1 ❑ Apartment/ Condo iv"RA 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. RReplacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an System System Tank Only Existing System Existinq System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 121] Seepage Trench ^avU 22 ❑ In- Ground ressure r 42 Pit Privy 13 ❑Seepage Pit Ni � � 1-��,/ � Vault Privy 14 E] System -In -Fill 9 ,♦° I�G (6YS 4k U�7 VI. ABSORPTION SYSTEM INFORMATION / off 1. Gallons Per Day 2. Absorp. Area 3. Abs rp. rea 4. Loading Rate 5. Perc. Rate 6. Sims em ,lev. 7. Final Grade n Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft_) (Min. /inch) , S of Ele n b r d 0d 4)0 3 0 k°e eet 41DC A' 7 AQt Capacity VII TANK in Ca gallo s Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons an 7anufacturer's Narpe Concrete Con Steel glass App. New Existing / structed T nks Tanks tic T oTfvtdir,�Tarrk < < w PS !e kS ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage m shown on the attached plans. Plumb is Name: (Print) Plu er Signature: (No amps) M PRSW Business Phone Numb r: 7A o AAA 9 ff Plu ber's dyes Str et City, St Zi Code t IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater r a Issuing Agent Signature (No Stamps) Approved [] Owner Given Initial * 7 Zed Surcharge Fee) Adverse Determination . X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: u 4; SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber r ` s 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 appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ll a � �y6`f �r i �vtt� �ivs�S�I� 9 919 SF- E - Sao r�tN OW rn� q6.� To p „ woo d Fhc e fos jnSta. �l 61A0 f r isft *)j 106D c�AlSept�c � 30 •y a �3 5P P�i 1 ©wt��Pv�S 3 — 3`x lop trene�eS �' 8.1rn�1 /oo.o oh Tc l oo d Felgo e eos 1` Wiscpnsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Divisibn 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 i i inches in size. Plan must include, but - S -F C20� not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and Ibcation and distance to nearest road. ' o'L z-- tip S g - S p• APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R D Y DATE to S PROPERTY OWNER: PROPERTY LOCATION 1/4 S E 1 /4,S 20 T ZS ,N,R 1 B E (or W PROPERTY OWNER':S MAILING ADDRESS. LOT # BLOCK # I SUBD. NAME OR CSM # _ �0) RZ1\)ez U��LUE - — CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 9FOWN ' NEAREST ROAD ZtU�'12. �YL�S,�11 S OZ-Z. (7tS) �LZS_°tl0£i � R�U�1Z b�tv�• (] New Construction Used] Residential / Number of bedrooms L 4 (J Addition to existing building bQ Replacement () Public or commercial describe Code derived daily flow 61117 gpd Recommended design loading rate - bed, gpd/ft . trench, gpd/ft Absorption area required - bed, ft 1Obt3 trench, ft Maximum design loading rate S bed, gpd/ft • � trench, gpd/ft Recommended infiltration surface elevation(s) — ft (as referred to site plan benchmark) Additional design / site considerations S n; KbTe 'M ) N S 7'Pt2.l ez 0 t 1 GCS 3 Parent material slf h"4 - OV�'t�Jt�S N Flood plain elevation, if applicable ly A . It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FlLL HOLDING TANK U = Unsuitable for stem (R'S ❑ U ®S ❑ U I$ S ❑ U ®S ❑ U ®S ❑ U EI S ® 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 ITmrich •S `22 3 L i S 1 es off$ Z tiu�z �•S Yp- 31V — 1s esb oQs i;� - -� •� Ground 3 32. -13 -1- Lt IZ y/3 — -�s D S Gg S •�° elev. 01�1 - 13ft. 1 4 1 - 13- 18 Z.S 'I _y Depth to limiting factor � �g Remarks: Boring # 0 -12 7 SLfR_ 31Z - lS 1 �sblz cQ S eg - - Gh 3 Ground so -6�; ' ycy � Depth to limiting c o factor f r f 68" sT R01x :'o_ . / ING.OFFICE r' Remarks: �. CST Name: - Please Print Z Arthur L. We erer Phone: 715- 425 -01 dress: _ . egerer Soil Testing & Design Service - P.D. Box 74 River.Falls,WI 540227' Signature: Date: CST Number: .l. l8 220254 PROPERTY OWNER ��Ge-Z SOIL DESCRIPTION REPORT Page?- of PARCEL LD.# O�Z.,�2.- IOSg SO Boring # Horizon Depth Dominant Color Mottles P- Z Texture Structure GPD /ft Bed in. Munsell Qu. Sz. Cont. Color Consistence Bogy Roots Gr. Sz. Sh. T �....: 3 1• S `'t 3 l rerrfi )S ................. Z 13 - S2. �.s U tz y 13 -- TS d S9 c�.1 eg 5 • � Ground 3 SZ -lZ 1.$ t� /� G'^ %I- ow, elev. — a8 S ft. Depth to limiting factor Remarks: • I Boring # t Ground i elev, r ft. Depth to — limiting 1 factor ! r Remarks: Boring # ;:<O t Ground elev. ft. Depth to limiting i factor Remarks: 3oring # ...........:... around ;lev. ft. )epth to imiting actor Remarks: PLOT PLAN Page 3 of 3 SCALE 1 " =30' � amtk-2 Na , q6 0 h 'tpP of 5� ZIA. woUp �w Ck D097•. LZLOI F12 I a•3 �. fit. 9 8 S I _�U °/ 3.1 F-rL l °_ $'"")#'1 - �'L_L,U.p` ON `TUP of S`Dt�, 1 STmL Zn0 Ll�v - Few OF 3' itjtD(E Tjr_Q�\jo- t=il/ 'lGF) WttilbZ1t T1tE T)r-lE O)- - ccd a -2, p z (715 ) 42� -nj65 INEMP CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page Labor and Human Relations g Of 3 Division of Safety t: Buildings in accord with ILHR 83.05, WI Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S r• C2p� not limited to vertical and horizontal reference point (SM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ' ()Z APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION [REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION SO 't� O E �2 S tE 1/4 S tr 1/4,S 20 T ZS ,N,R 1 S E (00F PROPERTY OWNER':S MAILING ADDRESS. LOT # 8 # SUBO. NAME OR CSM # 10°t`l R1.ULSZ — CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE QTOWN ' NEAREST ROAD IR-U� 'F. _ S, 'J I 5 O Z_Z (SIS) 4 LZS_GLO£i I `r'.,1tvf.11C (J New Construction UselC) Residential /Number of bedrooms L4 [ J AdditiQn to existing building bQ Replacement (J Public or commercial describe Code derived daily flow 60o gpd Recommended design loading rate — bed, gpd/ft • trench, gpd/ft Absorption area required — bed, ft t Ob t3 trench, ft Maximum design loading rate • ` S bed, gpd/ft ` 6 trench, gpd1ft Recommended infiltration surface elevation(s) -- It (as referred to site plan benchmark) Additional design /site considerations S { Parent material OU 'rKjrrS N Flood plain elevation, if applicable M A . It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FlLL 71 OLDING TANK U= Unsuitable fors stem ®'S 0 ®S ❑U LA'S ❑U ®S ❑U ®S ❑U S ®U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft in. Munsell D Boring # Horizon Texture Consistence Botndary Roots Bed Trerldl Ia. Sz Cont Color Gr. Sz. Sh. z tiu-az - )•s Lrp- S ti �s - •� Ground 3 3Z. -13 -1 •S 1- tR y/1 `�s D S9 elev. c1 .oft 4• 1. �•s y2 y7 Depth to limiting factor 2 Remarks: Boring # r1 o -L2 S�rZ 3LZ �S a&Ob L & Q -s - L -� z l2 -Su "��S�tR qL- G�: OS9 c� 1 �-S _ . S •� Ground elev. C Z.o ft. Depth to limiting 6 Remarks: CST Name: Please Print Phone: Arthur L. We erer 715- 425 -0165 ergerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI 54022 . Signature: Date: CST Number: 220254 PROPERTYOWNER "13� GP SOIL DESCRIPTION REPORT Page ? of 3 PARCEL I.D.k 02..2., lOS£3 SO Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Consistence Bwxknry Roots Gr. Sz. Sh. Bed -:Trench s �S _ ,� •� Z 13 -52 -).SLirz 5 Ground 3 SZ 12 1.S `� li �/ /y Gt^ s - or,., elev. s 1 e sb r31s1� es .S ft. Depth to limiting factor I 3 Remarks: Boring # 3 : :: : . . • '. • '. ' ': Ground i elev. ft. Depth to limiting factor Remarks: Boring # f# lei? i Ground elev. It. f Depth to limiting factor I Remarks: 3oring # around } i ?lev. ft. )epth to imiting actor Remarks: _ r - - PLOT PLAN Pa of 3 SCALE 1 "= 30 ' cE � Z L , C) .z' o�j 1pp OF S' ZIA >09T_ Z p ez..a Svt�pt'QI..E I g.3 )0 / �l 3 •\ 'UP 01= S DIt}- WOOD 1 Po ���'Ce - �`C�( e14 AEU "t0 Aj S ))r T} e '1")m E a _ .Cdv S?5?L4T1 U L a -2.'p L� )),��� � � / zz.oZ. y +�► �•" +'Y+ �r� ( 715 ) 425 —Oi 6s CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND _ OWNERSHIP CERTIFICATION FORM Z OwnerBuyer w Z Mailing Address _ / / /rl nr, Property Address _�! () �� �S /✓ °� (Ver required from Planning Department for new construction) City/State 0 j e U 1, G A � (, Parcel Identification Number LEGAL DESCRIPTION Property Location ' /a, S ' /., Sec. 2L , T oA - N -R � W, Town of Subdivision Lot # Certifted Survey Map # volume �� , Page # i Warranty Deed �/.�? Volume _� Page # G Spec house ❑ yes JK no Lot lines identifiable IN 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, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SI �ATUREF AP IC p E 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. NATURE OF LIC 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 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify th I have inspected the septic tank presently serving the M m ^ D residence located at: � ;, Secti C90 T o N, R W, Town of 'ALA L 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: Did fl back occur from absorption system? OD Yes No (If no, skip next line) Approximate volume or length of time: 1 ,; 2 66 gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer: (If known): Age of Tank (If known): za (Signature) (Name) � P i lease print 06 Ai�aC fG Z/` W (Title) (License Number) 1� ' � 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 baffl Name �� /r� 1( �z� Signature MP/ PRS19 t HUM l ' iecudw Mo: *TA" "It Gnr -ro=ar a +Y' ^^ 4� TNts MAC! FAINIVAD VON VACOROIMB DATA r Q Tsai OM. SO& batw@a. hsr Denis R. Getzie and Sal X. 3T. CM CO., WIL wif e- Recd fa Rd lli Grantor O ••��•• Ju l 19,,,• 1 :30 F Grant.@, Wi t a a a s @ t h r That the said Grantor, for a valuable consideration –"" 1 1 To emweya to Great** the following described real estate in St. CroiX _ Cotaaty, Star@ of Wisconsin: Part of Southeast Quarter of Saitheast Quarter of Section 20, Township 28 North, Range 18 West described Tax Key No as follows: Lot Two (2) of Certified Survey Map filed Nay 26, 1981, in `i 31use ••4r•, Page 1064, in the office of the Register of Deeds for St. Croix Cotanty, Wisconsin. j FAN Sa b • a FEE Thi is homestead property. Together with all and sin tar the hereditaments and appurtenances thereunto belonging; A Dalnis R Getzre ad Sharon K Getzie husband and wife warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except eaSeMentS, reservations and restrictions of retard= and will warrant and defend the same. Bated this 12th day of _ Jule , 1986. (SEAL) (SEAL) • a aagjis R. (SEAL) (SEAL) * • K. Getzie AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this_ _day of STATE OF WISCONSIN )? 1 19— } as. PIE RCE County. ) Personally came before me, this 12th day of * June, 1986, the above named Dennis R. TITLE: MEMBER STATE BAR OF WISCONSIN Getzie and Sharon K. Getzie, husband (If not, authorized by § 706.06, Wis. Stets.) and Wife, This instrument was drafted by -- Char E. White Attorney at Law ..0 Jr/ 1 4 . me - known to be the person � who executed the fore- � 'e S�✓ �f , lnstru ed the same. Rive Falls, Wisconsin 54022 .v 99 ent and ack owl g (Signatures may be authenticated or acknowlidA. wa m * Doris E. DeiSS are not necessar t. Croix Y•) ✓:' © J �r�ej� Public County, Wis. �ommis :ion " •Names of persons signing in any capacity must be t;N 4, or printed "14 their signatures. WARRANTY DEED —STATE BAR OF WISCONSIN FORM NO. 1 -1977 3'104? CERTIFIED SURVEY MAP JAMES HILL Part of the Southeast 1/4 of the Southeast 1/4 of Section 20, Township 28 North, Range 18 West, Town of Kinnickinnic, St. C County, Wisconsin. E 1/4 COR. SEC. 20, T28N,RI8W, COUNTY SURVEY W MONUMENT) O jq W O m = • F- N E COR. SE 1/4 S E 1/40 N w M o 3 o— co --- - - �66' TOWN ROAD _ - - ^ —^ o W- � __ _ cn z _ S 89° 59' 39 E 13 T 644.21 M 660.00 _ -� m w ° o - -7- 644.26 -- -- a - -- 6'f'TOOr - --- p 1 aN= ro 0 4 ► T o LOT 2= 5.00 ACRES � I W o N E T = 4.275 ACRES I I d w o - N o = O W ° = S M 0 o o LOT I 4.88 ACRES • , o ti NET = 4.39 ACRES W ti �I ° • I a) o o N ° o N FARMSTEAD AIM I W F"W z � tz 00 0 cl Z w 0 0 J e O Z\ O I d' W O .54 644.69' 0 69 N 627.00' 3 W N 89 59' 39 "W 1304.69' z H N ° LOT I : 212,668 SO. FT. �Qa LOT 2 = 217, 800 SO. FT. w 66 w TOWN ROAD W m J � J O Q N DESCRIPTION SCALE I"=200' That certain parcel of land located in the Southeast 1/4 of the Southeast 1/4 of Section 20 Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows; Commencing at the East 1/4 corner of said Section 20 thence S 00° 00' 00" E (assumed bearing along the East line of the Southeast 1/4 of said Section 20) a distance of 1321.93' to the Northeast corner of the Southeast 1/4 of the Southeast 1/4 of said Section 20 and the POINT OF BEGINNING of the parcel to be herein described; thence continue S 00° 00' 00" E 330.00'; thence N 89° 59' 39" W 1304.69 thence N 00° 05' 00" E 330 .00'; thence S 89 59' 39" E 1304.21' to the POINT OF BEGINNING, containing 9.88 acres, more or less, being subject to easement over the Northerly and Easterly 33' thereof for Town Road purposes. 3 4 APPROVED P� s W p MAY 2 01981 � ' s X81 — y SL CROIX COUNITY 0 .6 State of Wisconsin) COMPREHENSIVE PARKS PLANNING � AND ZONING COMMITTEE b . County of Pierce) a I. James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, James Hill, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236 of Wisconsin Statutes and the Ordinances of St. Croix County; and that the above map and description are a true and correct representation thereof. \ �t1g1N111116tpq,� O ,YS �/� y �i Dated: 22 April 1981 v •� '' . a .LAMES L /Vol. 106 M!lt�PH Y � Page � a S - Certified Survey Maps /Registered mes L. Murphy 6>ME IF = St. Croix County, Wisconsin Land Surveyor '��"