HomeMy WebLinkAbout022-1062-30-000 ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner 6 1.
i
Property Address e;'�
City /State I 15 (.0 a a
^g:
Legal Description:
Lot — Block — Subdivision/CSM # 6
'/4 ' /4, Sec. 2 T -RJW, Town of PIN # (1Z 166d - 3woo
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer l.I J/ ,P C Size ST/PC �2 5 ✓ from: House Z 7 Well 7�Dap 7
Pump manufacturer /X 6 Ls Model
Alarm location Ad k
DING TANKS O Y )
(HOLDING
Setbacks: Service ad Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
2
Type of system: Width J Length /rO_ Number of Trenches
Setback from: House ; Sa Well WOD P/L 7 sd Vent to .fresh air intake 75
ELEVATIONS
Description of benchmark �c P /PLC Elevation �� O
Description of alternate benchmark J-r) J�d L0 ra"OA -+-c o n/ Elevation l0 z 3
Building Sewer 93.3 4 ST/HT Inlet 9W 7 ST Outlet PC Inlet
PC Bottom g g ° Header/Manifold �� o ° Top of ST/PC Manhole Cover l ��
/ �n z
Distribution Lines ( 0 / y s ' (z) s ( )
Bottom of System (() (7) ( )
i
Final Grade
J
Date of installation // ermrt number 9q S tate p lan number
Plumber's signature A "n License number ZP q q Date L lf,01 `91
Inspector
Complete plot plan or
i
I
NOTICE Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
N
L ��L�
Z1
'2y �n y
o �
Z�
(O
� 6y
U� N�f T
INDICATE NORTH ARROW
r
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y
Safety and Buildings Division
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)]. 353194
Permit Holder's Name: ❑ City ❑ Village ❑ of: State Plan ID No.:
Town of Kinnickinnic
CST BM ev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
0o -o &0. " 1 54�� 0 22-1062-30-000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 10 h Benchmark Q �ps;}p ey,D f
Dosing L57 Alt. BM 00- 30
Aeratio Bldg. Sewer 42,3 cl , �o
Holding St/ Ht Inlet d.93 4a -T�-
TANK SETBACK INFORMATION
TANK TO P/ L S ELL BLDG. Ae Intake ROAD
Septic )3 �fdro' NA Dt Bottom
Dosing ?I'w « 3 NA Header/ Man. .�• p
,oa.2a
Aeration A Dist. Pipe
Holding Bot. System • 10 9$, G O
PUMP/ SIPHON INFORMATION Final Grade o pd,
Manufacturer !�S Demand St cover
(� Model Number A E 1 0 GPM
TDH Lift Zength2o' Friction System TDH jj..`� t oss 1. mead
Forcemain I Dia. Z Dist. To Well
SOIL ABSORPTION SYSTEM
AMC/TRENCH AMC QTRENCHNS Width r Length , No f renches PIT No. Of Pits Inside Dia. Liquid Depth
IM too I a DIMENSION
SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING M ( red
INFORMATION Typeof CHAMBER M d e I Numb
System: C A FKV 7 0 '�- D '�— OR UNIT - &li �
DISTRIBUTION SYSTEM
Header / Mini old G I Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length / Dia. Length ia. 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 fjNo, ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection # : I / I / Iq Inspection #2•
Location: 1157 River Drive, River Fall a wx- 1/4, SE1 /4, Section 21 T28N -R18W) - 21.28.18.P335A
e .
1.) Alt BM Description =
2.) Bldg sewer length = Z7 -o
- amount of cover =
Plan revision required? ❑ Yes 14 No ,
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
I
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: '
....
t
r e
ti
d Y
i
a
e �
6
i 1 [
?
.. _
€
e
e
gg �
1 - 0 - 4 1 ......,m.»,»n... - ... .....».,.w.,......�' ,��.�m.�_..�., .........,.._ . .......n., ..,....�.,,,� �.,
I €
I
V IA_
e c 3 I
4 € P
Safety and Buildings Division
14 PERMIT APPLI ATION 201 W. Washington Avenue
n _ -. P O Box 7302
Department of Commerce In accord with ILHR 83.05, A e.
` Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the sy P een p ert less County
than 8 vi x 11 inches in size. O 1)4-
• See reverse side for instructions for completing this appl c_ on 0 State Sanitary Permit Number
�.� ._ � 3539
Personal information you provide may qe used for secogdary purp QC l ack if revision to pr vious application
[Privacy Law, s. 15.04 (1) (m)]. 1 C'� K , /� y � C State Plan I.D. Number
1 V t=-i' �';
I. APPLICATION INFORMATION - PLEASE PR
Property Owner N m q Prope y Lpcai
1/14 30LLtiv�, Vii/ Z ( TZ SE (or)4D
Property Owner's Mailing Address Block Number
City, S a e Zip Code Phone Number Subdivision Name or CSM Number
VM, II. TYPE OF BUILDING: (check one) ❑ State Owned ea
Ity Nrest Road
Public 1 or 2 Family Dwellin - No. of bedrooms ° Tow of e/Nele- kr7Af ZVL )e 104-
III. BUILDING USE (If building type is public, check all that apply n Parcel Tax Nber(
Z I . - um '& 5 , , 3 35
1 ❑ Apartment/Condo OZZ Dip 2 - 0
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 X New 2. ❑ 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
125?Seepage Trench 22 ❑ In- Ground Pressure r r 42 ❑ Pit Privy
13 ❑ Seepage Pit ( � 3 I 43 ❑ Vault Privy
14 ❑ System -In -Fill 3 Z A / -- cAr / rr l ea . B c, 4 . 1 ,
VI. ABSORPTION SYSTEM INFORMATION:
1_ Gallons Per Day 2. Absorp. Area 3. Abso rp A 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
��
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) o / Elevation
9� 6 Fee Feet
VII. TANK
Capacit
in allo s Total # of Prefab. Site Fiber- Exper-
INFORMATION New Existing Tanks Manufacturer's Name Concrete strutted Steel glass Plastic App
Tanks Tanks
Septic ng ank f Z V I ❑ ❑ ❑ ❑ ❑
Lift Pump Tank tuber " 1 1 L GdyjZ ❑ 1 ❑ I ❑ I ❑ ❑
NSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
PlumbeW'ame:(Print) Plumber's Signature: tamps) MP/fd0XFA Business Phone Number:
/ 44 AZI
Plumber's Address (Street, City, State, Zip Code):
f W072- -�� w
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate issued Iss Agent Signature (No Stamps)
[Approved [:]Owner Given Initial Surcharge Fee)
Adverse Determination /�'Z7 �C d
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
i
SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1- A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3_ All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and .
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. - Plumber must,sign application form.
IX, *County /.pepartment 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, 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.
l ' '
3 0
�bd
°
U
\ v
(� 3
4�,
I . . . ..
. �
� \ \
�JGw m £ z
e k § 2 -
•Q / % 6 -
am c I
k /�k
g e / Zo = {
m? CO
x Q
>, 0 0 o 2
_ o —
a �k a) E x CO
% -0 E / Rq
c72> U nC\j
2 \ a —
®• o §:
$ CL .2
k \'_ k
. ?§2 £ Z w @
. x / 0 2 0 CO Q a ai
@ § § o a- - 0 `!
2 2 7 \}
D�nE
L C Q o £ x
} 2 / § i ca 2 o 6.2 @
- Tr % 0 O Z_ H N k k }{
j !#
\\
I � .r
1 7 F
± ( r \}
TT Ml
f
e /
- ■ 0 k -b \/
�. 2 § 2 \
0 U- \{
CY) 0 - \\
� : � � • # § $1
_ .co i I L
cz ' 2$ \
- .6
t�
»!
7 _ !
§ ) }}
� \k
Combination Sep.t.ic; Tank and
PUMP CHAMB CR055 SEC AMD 5PECIFICA'fOMS
"dffi� �M SDI rtN� VCQT CAP WEATHER b0.X
�u►JCTIOA.1 0ox
`1'C.I. vCKuT PIPC ,, APPROVED LOCKIKIG
FROM DOOR f MAIJFfOLE COVER
'+.woow FRESH 2 �ARt.)1>J6 �Pv6�L
A!K IMT ^KE
l
y I PI;� `� }
I/JLET PROVIDE
AIRTIGHT SEAL. I Ii
APPROVED JOIfJT A I I APPROYi:D OI,JTr
W /C'T. PIn0F'1' Tank construction r;PEop7jc
shall comply with AL&RM
83.15 and 83.20 I II
I I o►J
C I t
PUMP - -� �-�
o OFF
D
S�! - lL_tLC C U 1J G R E t[
�("V • 6 L 0 C I<
ti
RISEN EXIT PERMITTED G1JLy IF TAWK i"1AQUFACTLIRC-R HAS SUCH APPROVAL 3 kP 7cnc
aEpplNr�
SEPTIC E SP1= CIFICATIDJS
DOSE
i tILKI MALIUFACTUR OINb[71�J 1MbEA OF DCSF5: _
PER C�.,�;.
TA1-JK SIZE : � ?S6 GALLOQ , 005� VOLUME
ALAKM P AIJU FACT UR.C.iZ: S_ '�� �CI�.D ��ST��3 )K'CLUCIJ -I , OACkFLOW: - &- -o
MODEL ►DUMBER: » �w _ CAPACITIES: A =
�AJCHCS OK GALL DJJ
SWITCH 2 ti
- WCHES OR � vy L.LDU5
PUMP MAIJU FACT URCR: �..t� -S
Z .s.�AICHES OR ?� ,hLLUtJS
MODEL IJLIMBER: }�� q'. )
SWITCH T J P E : �/ ��=
D c INCHE5 OR -�&AA,LLD1,;5
� L�1ZC'-LJR -Y � � PUMP AMID ALA '�NL TO 5L _
MIWMUP'1 DISCHARGE RATE -,A - -__ GPM INSTALLED OQ 5EPARATE CIRCUITS
VERTICAL QIfFERENCE DETWCEU PUMP OFF A PI PC- tE
DO
+ M' JIMUM METWORK SUPPLY PRESSURE -_ FGET
+ FEEl OF FORCE MAIti X /ioo!jFRICI - 10W
FACTOR. li rEET
TOTAL Dy QAMIC HLA0 T 1a' t J /6, /Z (O
Pump chamber DIAMETER
13JTERMAL DIMLWSIOh1� OF TA1JK: L.EA1GT'H _-WIpTH ___ �'tl
L IgUID QEPT _..... »•..r
BOTTOM AREA ; 23.1 = GAL /INCH
l '�
M E40 series
"
41 HP Effluent
and Drain Water wraps
Performance Curve
MODEL ME40 EFFLUENT PUMP
CAPACITY LI TERS PER MINUTE
0 50 100 1!O 200 250 300 350
40
12
35
10 �
30
Z 25 8
Z
►-r
20
15
O 4
10
F-
5 ( -2
0
f
0 10 20 30 40 50 60 70 eO 90 IO 0
10()
CAPACITY GALLONS PE MINUTE
G If W)
F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923
419/289-1144 FAX 419/269 -$668 Telex 98 -7443
K3326 7/91
Printed in U.S.A.
Wisconsin Department of Industry SOIL AND SITE E�,��►�? REPORT Page 1 of 3
labbr and Human Relations
Division of Safety & Buildings in accord with 05 , Wis. e
COUNTY
ST• -taj V(
Attach complete site plan on paper not less than 81/2 x 11 ncltes in size . nclu J
not limited to vertical and horizontal reference point (BM) on ai d 1 5agf slope, scale or PARCEL I.D. # //
dimensioned, north arrow, and location and distance to neara s st road 0 �fo ✓D �d
888 REVIEWED BY DATE
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION 7 9
^`
MA
PROPERTY OWNER: PN N
���N 1rCL1� SIJI .Ulm 1/4 S1` 1 /4,S Z T z ,N,R L8 E(or)(
PROPERTY OWNER'S MAILING ADDRESS K # I SUBD. NAME OR CSM #
6 V Z 1�4.14Z.e— ST. —
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN INEAREST ROAD
RWn FALLS WI Sv.oZZ 01s) uzs_ s46Z 1 lW01_C I N`z.wek Robb
New Construction Use VQ Residential / Number of bedrooms 3 [ ] Addikn to existing building
Replacement [ ] Public or commercial describe
Code derived dairy flow y SO 9Pd Recommended design loading rate o . S tied, gpolil _ j -
b trench, gpW
Absorption area required goO bed, ft 1 S O trench, ft Maximum design loading rate O . 5 bed, gpd/ft o • 6 trench, gpolft
Recommended infiltration surface elevation(s) q $ - 6 ft (as referred to site plan benchmark)
Additional design/ site considerations \z' Y. 1S` QFD o12 Z 11 Q04WS, CkCli s')' W/ DoSi� �uwhp.
Parent material s ft -J WI oQTw k1TH Flood plain elevation, if applicable N ft
S = Suitable for System CONVENT10NA1 MDUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TA
U= Unsuitable fors stem W S ❑ U ®S ❑ U ®S ❑ U NK
® S ❑ U W S ❑ U ❑ S o il
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color mot1� Texture Structure Y Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Texture Sz. Sh. Bed rt hcfl
13� o -vZ totiR 3i7- — sI 1wl sb ,Mwjj- C,w - o. o•S
2 IZ - 2,L] ,.. s `7 a y ! � - S� Z � S blsZ � k) f�- 0- k - 0• S o. L
Ground 3 Zi -6S 1r� Ya- Sly _ S O S vn C. 5 - b.7 0
elev. i-Z -- I .S`!R S /f3
lo y 6S -�o lD `1R 3 )y hu Y� 6!3 S S v►� J - =
Depth to Z c o ti N NACA � - SftAJ Nt1 Z r- PE 1'I'S
l
Remarks:
Boring # o.Y o. S
0 -13 \o�-l� 3tz - s 1 1w►sby� w►u'�H ctti
E t3 -30 S `tfz Y[Y - S } Zw� sb k wt V `Ft. C S - o. S o• 6
3 30-67 b1J 4 R SLy - S u g9 y►t - o•� °
Ground
elev.
l.0 b ft
Depth to
limiting a
fac tor 9 "
Remarks:
T Name: - Please Print Phone:
Arthur L. We erer 715 - 425 -0165
egerer Soil Testing & Design Service -P.0. Box 74 River Falls,WI 54022
Signature: Date: CST Number:
C l 1=x$.2 [q9S M00576
PROPERTY OWNER S C) L-U y l SOIL DESCRIPTION REPORT Page ? 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
sbk u, vJ� (2L,, - t -14 0:5
x i Z ZS
- 1.S 49 Wy - s) Lyn S�>r wr S O•S o.
Ground 3 ZS_ 1z� EXI S p S o , �
elev.
to
Depth to
limiting
factor
7Z3 ��
Remarks:
Boring #
>. I o - �Z � 3 1z — s � � 1 SDk CA,
, ? Z l -Zb -S�t1Z Sl — S) Z�'nsbk V'�- CS — a•5 .�. L
Ground 3 Z6 -�4 U0'-M S/y — S p S5 0.46
elev.
l bI•1 ft.
Depth to
limiting €
factor i
Remarks:
Boring #
K
\4 j
1p`t�.- 3[Z _ s �� b�4c v+nv`�1� Cw _ o ' o•s
11_t n.Sy2y/ — S) Lw,s�k 1nv'F�. a u•s ia-L
to 4 Q S /Y
Ground C� 9 1vl J o •'� o. B
elev.
10t, - 9 ft.
i
Depth to
limiting
factor
Remarks:
Boring #
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
PLOT PLAN Page 3 of 3
SCALE 1 "= 3p '
ex,c�T As s�towN
-
0
N
$r'1WI -trL•100.0� ON Lot
31tf`` QUC �
a,
N 6 O �.
!' d0 I 0 „ ' n
w / M
�l s•s
t /Ar— H\.Z-ffT kT� Beb
I
w I °i
2 '
�_ s•3
to lope 0 t'L 10a�
"OUSE 'To 8E PtT L k S`T ZS' Ft2.014
1W ErLL
- Z__ -mou cam, eKN S' X s' wQ C. F PM 3q 1 u s 1 u SvrD of 'a eb s
,Fsi- O0_sE Pv "P lwA `Ttgljvt- w��L 6E
9s -oz
��• Z� t9.9 S (715 ) 425 -0169 i'400576
CST Signature Date Signed Telephone No. CST #
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor 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 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
_ "tV 14 \-C-1 S O L_%,3M G91� S W 1/4 S F 1I4,S - I T Z 8 ,N,R 8 E (ar�V
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBO. NAME OR CSM #
6 t 2 t+N7_eL 5T. -
CITY, STATE ZIP CODE PHONE NUMBER [:]CITY ❑VILLAGE ®TOWN NEAREST ROAD
Ztun FtLLS WI Sv. ozZ 0 1S) t4 Z5- S4 (, z \-r- MV-1tQ c r-1 0VQ R oht )
New Construction Use (JC] Residential / Number of bedrooms 3 [ ] Add'ikn ID epsting building
[ ] Replacement [ ] Public or commercial describe
Code derived daffy flow Lk SO 9Pd Recommended design loading rate o . S bed, gpolft 0 b trench, gpd/ft
Absorption area required aoo bed, ft2 -) S O trench, ft Mabmum design loading rate o • S bed, gpolft L • _ 6 trench, gpdfit
Recommended infiltration surface elevation(s) 9 a. ( _., ft (as referred to site plan benchmark)
Additional design/ site considerations WY—')S' tam o2 'Z S'x w/ DoSg �uriP,
Parent material s ft" \" , )4 ovTw kSH Rood plain elevation, if applicable N • R • ft
S = Suitable for system COMIENTIOI�& MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN IILL HOLDIJG TANK
U = Unsuitable for stem EIS ❑ U ®S ❑ U IR S ❑ U ® S ❑ U Ig S ❑ U CIS ® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure BDUrtd3y Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed TlenCh
_ti to ti Q 3 i i — s 1 wt s b rv,v`�y. c w - o• y o S
Z IZ - ).S`1R- ylV — s 1 bv 'v ft- o. l
Ground krs m Sly _ S O 35 yn C. S o • �
elev. i-2 - I S`!R sIg
l y 6S - do `iR Sl �t to Y R s!3 S D S v►1� - -
Depth to z c o N A, Zit C Er SfrAJ16 f= IttL PE ITS
limiting.
factor
6S''
Remarks:
Boring #
0 -13 YO`1R- '! - L - s lm Slow VA CL, - 0.'1 o. S
Z Z 13 -30 � • S `iR- Y! — s � Z w� sbk wf V �I• C S - o. S � o• 6
3 30 -69 l0 4 R 3L�(
Ground
elev.
Lo • t3 ft
Depth to
limiting
factor
> (,Cl
Remarks:
T Name: - Please Print Arthur L. We erer Phone: 715-425-0165
egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022
Signature: Date: CST Number:
[q95 M00576
PROPERTY OWNER S O L.0 M SOIL DESCRIPTION REPORT Page of 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend,
3� o - \Z �Z4 31t — S) 1 Sb u'Ft- C — o.V 0,5
•,•`„ #<v Z 1 Z - 7 S E!< S Zwl S 1M \)ii- CS V.S 0. L
Ground 3 2S_ 73 to `I R S JCl S O S ►,� J — O. o .
elev.
1.o L •� ft.
Depth to
limiting `
factor j
Remarks:
Boring #
O - � L 1 �3 `' Z- 3 J t S) 1ta S bk �n v `FIB C c.`, o. y i o, S
1 \ - L - - ZL - I-SLt1Z Vly — s) Zv"Ak Nil C — 0.5 :'•u. L
Ground 3 x-
elev.
1 -1 ft.
Depth to
i
limiting t
factor I
i
Remarks:
Boring #
3 t z s \� �k W► U'�t� �k, _ o . �{ a . s
��YY t•.:.
Z 1 I. Z 1. S' 2 y/ S Z vh 5 �h I
Ground 3 1 O 4 IL S 1 y — $ Cj S 9 lvl J — o • `1 ; o. 8
elev.
lot ft.
i
Depth to
limiting
- -1 7
i
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
PLO P LAN Page 3 of 3
l
SCALE I"= 3p '
ex ce�'Z t�S S ttowlJ
_
0
N
Br'111 i - trL• koo .O o r-j LF. Lo t
34kI'` o, ft pv c.
P t P
IF w lIAM --� _ a `
L=l. lbOO `3 1 t
A r -- 7
v� 6' o
� e�S �
��. too `� Imo'' ►l �- TCI�.t�.! li B
IJI ' 0 /
I e
J. F3
Ll 1op 9 t'L 1O1,
Sly" Pv C P tpk w/ LA-Fn4
sous E 'To to P1 - T LvahS`T Z S' F Z4M R Q't S . _
W ELL- t, 8, S p' :. 1. - -
?_ mp—H S ` x S' Loo G M Pty 3E 1 l S" fftLLCA 11� Slt'M� O F $ ErU S
,. iO� sE Pv w1 P pf - mvvt - 6E
T:'N?-0Po s m joust e 0 IUG FrT R LOW( � LEUA-T'c (W .. - - -- -
Q 5 —O?
l9. S ( 715 ) 425 — L1 Li M00576
CST Signature Date Signed Telephone No. CST #
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer t 1- A51 A-1 S 4L a x A
Mailing Address 6�� / A ZCL 5� 41VCR
Property Address m/Z_ D2, t V&
(Verification required from Planning Department for new construction) -
City /State Parcel Identification Number / Z 7 /0 7. 30 Oo b
LEGAL DESCRIPTION
Property Location S '' / 5� '/4, Sec. �, T�N -R�W, Town of ft/ /4/lcfC/ A fe
Subdivision , Lot #
Certified Survey Map # ----- , Volume , Page #
Warranty Deed # _ j Z q3 7 ,Volume _Z ,Page #
Spec house O yes 9 no Lot lines identifiable O yes O 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 licensedpumper 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.
SIGNATURE OF AVCA NT 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 .erty describe above, y virtue of a warranty deed recorded in Register of Deeds Office.
SI NATURE 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
DOCUMENT NO. STATE BAR OF WISCONSDI FORM I-1M T ' s "s mmurve" Pva lascom'" ",r,%
524347 WARRANTY DEED
REGISTER'S OFFICE
This Deed made between ST. CROIX CO., Wo
R%'d W Record
................ ..................... ......................................................... . . . . .........
........................................................................................ Grantor. DEC 15 1994
and --- at -A 'M
.... husbancl.and ... wif e ... as --- survivoxship-marltaL . .........
Ir
... property ..................................................... .............
..........
............................................. I ........................................... Graxt�e% I &
Witnesseth, That the said Grantor, for & T&IU"k COUSidWSti" ......
....................... ......................................................................... . . . ......... PAII I $TATE SAW
convoys to Grantee the following described real estate in ..S.t -t --- crvix .......... PASWO
County, State of Wisconsin: No I" VA amt
The West 6.5 acres of Southeast Quarter of
Southeast Quarter (SEk of SEk) of Section T&z Pared No-
Twenty One (21), Township Twenty Eight (28)
North, Range Eighteen (18) West, Town of
Kinnickinnic, being a strip of land 214.5 feet in width across said
forty.
South Half of Southeast Quarter (S� of SEk) of Section Twenty One
(21), Township Twenty Eight (28) North, Range Eighteen (18) West,
EXCEPT East 1105 feet thereof and EXCEPT West 214.5 feet of Southeast
Quarter of Southeast Quarter (SEk of SEk) and EXCEPT South 120.5
feet of West 722.99 feet thereof.
Q,
V eo LAW 40-1k-�
Thi ..... is.-nzt ......... boniestand property. -
64 i :-.. 1;�4 11 � 0. wo
Together with ingular the b"Itaments a unto Winging;
an'- " L & p r I ry - D
And .... A0kq ... " ... and re
.........................................
warrants that the title is good, indefeasible in a' li'd fr I A c * o , f encumbrance@ #xcept
easements, restrictions, and rights-of-vay of record, if any,
and will warrant and defend the -V 4 -4 f,
I P
Dated this .............................. 9 ... t.h. D b r 94
............. d o f ............. -- ..........
..................................................................... (SEAL) . ..... ... .. . .............. ........... (SJUL)
Brucle M. K* k t ' k
.................................................................. PA ... ] Ur-
;,Z� - --- /
..................................................................... (SEAL) (SRAL)
0 . Laurel �
.................................................................. ------ . ........ r ................................................
AUTERNTICATION AOXNOWLADGURNT
SrATZ OF WISCONSIN
Signature(s) --------------------------- . ................................
... . ........................................ . ...................... . ......... S L ........ . . county.
authenticated this ........ day of ......................... # 19 ...... n By came before me thin --- day of
a"
.D-ceicAmb.er ..... tbe above nansed
................................................................ --------------- b rurap— It- K i r-k PA I r- i!r..k
0 ..............................................................................
TITLE: MEMBER STATE BAR OF WISCONSIN —.-Husband.A.W-Ye
- - -----------
(If ................... . ........... . ................
"th%%wwf iiak Stats.)
to Mel to be the person.— W�! ted the
trument and the .*
4e-
THIS INSTRUMENT WAS DRAIFTED BY le
.....................
............
Nelti-y Public .................. ..... .. ....... . W
(Signatures may be authenticated or scAnowledr-d. Both My lComoutission Is permaneuL 'Po a ties
are not necessary.)
date: . . .........................................
* Ma— of persons shMing In any capacity xbould be typed or printed bdo Their aigunsurell,
WARRANTY DRED STATE BAR OF U19MU� wkeavain IMMI BL-- P I
FORM Nft Ii —no 11111w.akee. Will.
C."t - vi ' A , At
N� 334B M 334A
I
I
I
269.93'
I
w
N 333C
I
664 _ ROAD _ _ 269.93'
as l 3 �
o p a 4 gsp 89
I Q:� r o� t
ati
top to
SW 114 SE 114
I
�
I
335A 336B
I
W
I
R
I
0 722.99' b
0 335B 0
722.99 � 214.50'
S t/4 .
I