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HomeMy WebLinkAbout022-1099-20-010 i 0 6 g r § 0 � % )k \ k $ ]$ @§ \ o � & z �5 § ] Ek ) 7 / @8 kam co ■ 5 � >_ � 2kCL 2 . � __ t A k E 2 ; , 0 ® } . 7 / z a 2 § \ - 2�f c z 7 7 , y I � § I '� � / � 0 k z z ; _ ��� C 04 £ i Elk « 2 k 2 k 2 8 � a %C-4 z k / k k FL x �b 7 000 ° a a a t 2 2 } 2 2 ; » cc 6 2 \ � \ § = / k q � 2 % ; ; \ w } c g § § 6 « & o 0 ) / ■ . k / / £ 0 ) / ( § § ■ _ ) o ui { -0 - § \ { :j § 0 z / 3 U . . ■ . % k zk E E $ \ a , £ » a . a CL & / IL 2 k 0 . ST. CROIX COUNTY ZONIWDkPARTMENT AS BUILT SANPI'ARY REPORT, Owner IeILI k h a� ryl Property Address 9 I J City /State 54azz Legal Description: Lot S Block -- Subdivision/CSM # S3 s 36 v l i i-L 1 I G o 2: N LW t / 4 l� o '/4, Sec. 3 4 , T N -R 0 W, Town of e „,tit. K �:��; -� T IsIN # tj.�,j . - 10 It 9 - o - a SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION Tank m a n u f a c t u r e r r d 4 e ! 1 f i P C ✓ � � Size ST/PC l o o p /7 Setback from: House PO Well _ S_ ' PAL :) b I Pump manufacturer G- o 1 d Model 3695 } r- a� � Alarm location b a s, m , H, (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: m u wP, Width 9 Length 4Z— Number of Trenches � ►� Setback from: House a o ' Well > 1a o " P/L -> fa - ' Vent to fresh air intake i o a ELEVATIONS Description of benchmark 7 r n. , n, o P Elevation 00 0 0 Description of alternate benchmark l o w ., .r (i Elevation )o - s. q Building Sewer j 4 s ST/HT Inlet 9 , 3, 41, ST Outlet G 3 :2 3 PC Inlet 93 J ST PC Bottom Pf. 7� 4 Header/Manifold 9 8.7 S Top of ST/PC Manhole Cover ?c- L- Distribution Lines () 9 () ( ) Bottom of System Final Grade Date of installation S /3 /Qa Permit number 4 I State plan number 4q as4 Plumber's signature � ���� License number , Ss'4 Date 3 /3v Inspector Complete plot plan X 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. PLAN VIEW Y, -0051 b 3 ° A� o J N i ? 5 o E INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM 1 Safety and Buildings Division / Coun!9T . CROIX INSPECTION REPORT « 1,1 GENERAL INFORMATION (ATTACH TO PERMIT) Sanitajyf4rp*V Personal information you provice may be used for secondary purposes [Privacy kew, s.15.04 (1)( ( )l . Permit Holder's Name: UNDHOLM, JEAN kbffi IJ1a lilL7own of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Descriptign: /� II Parce larg>24C 1099-20-01 TANK INFORMATION ELEVATION DATA A9900007 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. f , . Bend z� /D 7/` { 0, Dosing �/� P' fe rG_ - 7 Sr> 1 f , (_y'.f �07 l :5 2 -q D Aeration _ _ Bldg. Sewer (67./ 12 .(oy 9 Holding - St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 071 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet / c //� Air Intake /07 Septic Z r ' /,� NA Dt Bottom 1v7141-7 3 �� Dosing ;{ 1 NA Header /Man. Aeration _ _ NA Dist. Pipe C.L44,, Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St w; ,l ( .f.,, Model Number GPM �t ;� t , j. x :�� T, o " 7 -7 L TDH Lift ffr ction System TDH Ft Forcemai n Length 5j p 1 Dia. 2 Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER mo Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil [] Yes E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) ? .3 LOCATION: KINNICKINNIC 34.28.18,NW,NW 1205 RIFLE RANGE ROAD — LOT 1`__T r P�, t T R} H n Tc=pzn •r _ ��I v�(.ir CQ�. �' Q -t �✓w� 1 w° 1"o-F lje-lcveerf t.+j6�j C i' VI& V _ 1 46C 1- rvun pre r /naYuc rcc�na.v c� /�r ��ue d Plan revision required? E] Yes a No e. Use other side for additional information. 7 j '1 f SBD -6710 (R.3/97) Date Inspector's Signa ure Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Av Z 0 V isco ns iSANITARY PERMIT APPLICATION 201E W B ngto o Aves n In accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1n x 11 inches in size. ST_ r • See reverse side for instructions for completing this application State Sanit PPerr rt Nu mber The information y ou p rovide may be used b other overnmenta a gency programs Check if TeVis "ion to revious a lication Y P Y Y 9 9 YP 9 ❑ P PP (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION 4 4 R S4.' Property Owner Name 0 Property Location Tea L tt.9 �p 1,n ryW114 VV 1/4, S -3 " ! Block o7 , N, R It E (or Property Owner's Mailing Address Lot Number II Number 7os W 17,vtSt i y, State Zip Code Phone Number Subdivision Name or CSM Number Q L ICJ, aoz c 1� 4�s -�2q4 5 s os ! 300 II. TYPE F BUILDING: (check one) ❑ State Owned C it y Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 o pd To age wn OF L - tc� IN c 1¢ �� t lzi To III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 2 � 45 2-[�,� 1❑ Apartment /rondo ) 0 q ` 0- old ✓T 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. ❑ Replacement 3. E] Replacement of 4_ [] Reconnection of 5. ❑ Repair of an SystemSystem 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,N Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 Q System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1_ Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate lev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch Elevation 450 375 3 I. 2 — Q8 • eet d 0.64 Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete st on steel glass Plastic App Tanks Tanks _ Septic Tan r Holding Tank /0 006 a, Fe^ ! , .,7 4 ❑ ❑ ❑ ❑ ❑ ift Pump Tank iphon Chamber 7 $d $ �` �� ❑ ❑ ❑ ❑ El . R PONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb is Signature: (No Stamps) M o.: Business Phone Number: 71 4as Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBo-6M (R 11{96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber I 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 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. Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 isconsin Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Departme of C ommerce December 28, 1998 CUST ID No.220554 ATTN.• POWTS INSPECTOR ZONING OFFICE CARL P HEISE ST CROIX COUNTY 1042 S MAIN ST 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 12/28/2000 Identificat Numbers Transaction ID No. 202327 Site ID No. 165236 SITE• Please refer to both identification numbers, Site ID: 165236 above, in all correspondence with the agency St Croix County, Town of Kinnickinnic NW 1/4, NW 1/4, S34, T28N, R1 8W Jean Lundholm FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 442545 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, _ DATE RECEIVED 12/15/1998 C FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us Uri MAR ectd MOVE THE EARTH ¢ :: CARL HEISE EXCAVATING s— i 1042 South Main RIVER FALLS, WI 54022 -• CARL P. HEISE (715) 425 -2175 Owner MOUND SYSTEM FOR BEDROOM RESIDENCE LOCATED IN THE IyVA OF.THE _�,y OF SECTION 3, T RjW TOWN OF COUNTY,WI SCONSrAECEIVE® INDEX DEC 15 M PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTCON PIPE LAY -OUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED.TOR -- TEAN : LU Npi! 01 M 105 W. PIVIS10m) Sr P.®.W.T.S. RIVE R FA LI<S W1. S4022 Conditionally . X15 4 25 -7 11 O 1! E U [ATARI mt. NT OF COMMERCE p!Vl5iC�N FIT A D B DINGS 1 PR ARE BY SEE CORRESP DENCE � Carl P. Heise CST 3314 MPRS 3378_.^ 22-6 5.5.9 1042 South Main Street River•Falls,Wl 54022 I I PL0 J pl AN P 51 04 ' 13 9Q gCKr Q��c FL SGbIE 1 4 C ,f (� a n0111VT Q�i��.a� N pr 132 Gd.�.p f oo N v IS 6.qL Pk,n 74wK 3 Pv c f i {aril loP �4 � � QVG � OGP� �c1C�w w �`r`% 1...I E 6L,lon No n. p I a �r {i W 7v c 2Si 7rvrh - 5, T., 4 t ' i I r Designee No Date Non -Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric 'Disiribulion Pip ASTM C -33 Sand -- \� H G Topsoil D , i Z'Y. Slope \ Bed Of IY 2 % Force Main � Drain Rock From Pump Layer D Cro Section Of A Mound System Using E 1 - A Bed For The Absorption Area F --o- G A_ Ft. h E 4"7 Ft. I Ft.. J �_ Ft. K _Lp__ F t . PtVlTawe Position L ]' - Ft. of Force Main W 2(,, Ft. 1 L „ 4 J 1406servation Pipe -� A 1 -- - - -- - -------------------------------------- 1 o ain cn W to _ -- .- -_ —_ -- rom P p 3 p Distribution Bed Of %2 * - 2 Pipe Drain Rock 4 Observotion Pipe Permanent Morker Pipe or Rods t Plon View Of Mound Usln A Bed For The Absorption Areo 0 D PACE O r" Porfo P1 t Do ( A J E n virr'!' ( Ole 6 r� Eno Cor- ��{, PVC P►pt ` ► 1, oc01 td Grp 6o11om, sue; I Orr E ouoll Spoctd s' PVG f61ct'Idoln From Pump �4 y PVC Monifolo Pips ,C Prpr Holt Should Eit ` � '•loft I '(o End Cop I , Vnd Cnn niclribulion Plot L,oYoul p 1 2 Y ' Hole Diameter inch Manifold ?. Inches. t Force Main'" 2 inches` Lateral _ Inch( , Holes -per feral 1p•� I �bp'' 1 , .:2 `120 " /n/o q l,. / /.�„:.,. ' T I; { L ": r :a •.� - SX, i r r z Jf • k .rr.... n ..•. ,ram:• h }, r PUMP CHAMBER .CROSS. SECTION. AND SPECIFICATIONS ven t cap 4" Vent Pipe weather proof approved locking 10' from door, manhole cover & .ndow or fresh function box I warning_ label .r intake 12" min I I grad 1 4" min t _ _ conduit �\ 18 min 18" min inlet provide li -•- airtight seal I II -Z - I )roved join A p t II t hole t � VALARI .ending 3' approved o solid soil .' B joints i xtending 3' C 1 ON . G nto solid pump OFF � Bl ..5 . - -� p oil D EL, Q concrete b oc 3" Approved Bedding Under Tank SPECIFICATIONS ;4a and se Tanks Manufacturer: I'�� P rccas ' _ Number of Doses: r per day ,Tank Size': 7s0, Gallons _ Min Dose Volume: CIS ')g gallons 1IO.s Capacities- , 3•tiP Alarm Manufacture's': �ec,"Tov A= q 5 inches j78.9 4allons Model Number: T7L y B= 2 inches: 3q gallons Switch .Type: C- Sq4 inches' =gallons Pump Manufacturer:}. _ D'= _� inches'll gallons Model Number: fig$ wFpa L NOTE: PUMP AND ALARM ARE TO BE Switch Type: r Pump Discharge Rat INSTALLED ON SEPARATE CIRCUITS Z8 OS GPM 48.41 -�. 5: 0 18.41 - 67, S :tical Difference Between Pump 0 f and Distribution Pipe I1.41 . feet capacity 4inimum Network-Supply Pressure .......................... Z O fwed gal /in _ 1 F.e.e.t. Of. For.cd. Main X 1 '58 f V- 10.o..ft Fx.i.c.tion F.a.c.t f e e t . Total Dynamic Head = 14.11 feet ternal Dimensions of Tank: Length Width Liquid Depth 3 L r Signed No. Date Gutdds Eff Went Pump min= 3885 • CANADIAN STANDARD ASSOCIATION GA APPLICATIONS • Three phase:'' /2 HP — FEATURES Motor: Fully submerged in Specifically designed for the 1 %2 HP 200/230/460 V. lubrication and efficient heat high -grade turbine oil for 60 Hz, 3500 RPM. Class B Impeller: Cast iron, semi- following uses: non-clog u • Homes insulation, overload open, non pump- I transfer. 4 g with • Farms protection must be out vane, for mechanical seal • Trailer courts provided in starter unit. protection. Balanced for Designed for Continuous • Motels • Shaft: threaded, 400 series smooth operation. Silicon Operation: Pump ratings are stainless steel. bronze impeller available as within the motor manufacturer's Schools Hospitals Bearings: pall bearings an option. recommended working imits, • • Industry upper and lower. Casing: Cast iron volute can be operated continuously • Effluent systems • Power cord: 20 foot type for maximum efficiency. without damage. standard length (optional 2" NPT discharge adaptable Bearings: Upper and lengths available). for slide rail systems• lower heavy duty ball bearing SPECIFICATIONS Single phase:'' /2 and %2 HP Mechanical Seal: Silicon construction. Pump: —16/3 SJTO with three carbide vs. silicon carbide Power Cable: Severe duty • Solids handling capabilities: prong plug. Y4 -1'/2 HP sealing faces. Stainless steel rated, oil and water resistant. '/: maximum. —14/3 STO with bare leads. metal parts, BUNA -N Epoxy seal on motor end • Discharge size: 2' NPT. Three phase:'' /2 -1 % 2 HP elastomers. provides secondary moisture • Capacities: up to 128 GPM. —14/4 STO with bare Shaft: Corrosion - resistant barrier in case of outer jacket • Total heads: up to 123 feet leads. On CSA listed damage and to prevent oil stainless steel. Threaded TDH. models — 20 foot length design. Locknut on three wicking. • Mechanical seal: silicon SJTW and STW are phase models to guard 0 -ring: Assures positive carbide - rotary seat/silicon standard. t carbide - stations seat 300 against component damage sealing against contaminants ry on accidental reverse rotation. and oil leakage. series stainless steel metal parts, BUNA -N elastomers. • Temperature: 104°F (40 °C) continuous METERS FEET - 90 — r —j—� -- �— 140 °F (60 °C) Intermittent. ( _ _ ..� __. ._.. _.._ _.._....._.. __.... , .__. ,........ � - ....... sERIES: sass l .......... L ....L...�.. •Fasteners: 300 series 25 SIZE;' /i SOLIDS 80 E1 H • — RPM: VARIOUS stainless steel. — - ►- t—S GPM *.Capable of running dry 70 Et H — 5 F — without damage to 20 -_.. — _ __.. -- -._.., .. _ _._ ...... __ __ .... components. 60 x — E07 - -• --- — Motor: 15 50 • Single phase: 1 /3 HP, 115 or 230 V 60 Hz, 1750 RPM; IS 40 E01 H - Y2 HP, 115 V. 60 Hz, a 3500 RPM; %2 HP —1'/2 HP, 2 10 30 - 230 V, 60 Hz, 3500 RPM. 0 L Built -in overload with 20 EO automatic reset. 10 Class B Insulation. l f 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 130GPM _ ,. � 0 1 • I 10 CAPACITY 20 30 m /h • ©1994 Goulds Pumps, kb. Elleclive May, 1994 11 8_3.885 f - Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page N of 3 Labor and Human Relations Divisibn of Safety 8 Buildings In accord with IL Wis. Adm. Code �1 I COUNTY Attach complete site plan on paper not less than 8112 1 s in size. 11 it s ' ude, but not limited to vertical and horizontal reference point ( t� ' ectio`�d % of slop�'�Se or PARCEL I.D. # dimensioned, north arrow, and location and distanc are APPLICANT INFORMATION- PLEASE PRIN IN IA ` REVIEWED BY DATE � PROPERTY OWNER: C�O�l.l1J� Q S lz � �� A�T`IION4 UW 1 /4,S � T - 2 ,N,R L6 E (ore PROPERTY OWNER':S MAILING ADDRESS 4T OCK # SUBD. NAME OR CSM # SOS W . DlU \Sluhl ST- ?V t?04ft U" CITY, STATE ZIP CODE PHONE N ILLAGE R TOWN NEAREST ROAD TZa UL 2. Fl LS W I S , 4 o 2.Z ()IS) t_[ - W ry 1Q - YQ AJU 1C RtFLC. Rw6e_ R [ New Construction Use [ Residential / Number of bedrooms 3 [ ] AddiibQn to existing building [) Replacement [ ] Public or commercial describe Code derived dairy flow \- �'QJ and Recommended design loading rate o bed, gpd/ft 0• S trench, gpdtft Absorption area required 3 S bed, ft 3Z3 trench, ft Maximum design loading rate °_bed, gpd/ft 0. S trench, gpd/ft Recommended infiltration surface elevation(s) 0� q • 10 ft (as referred to site plan benchmark) Additional design/ site considerations hWINJ�) VJ /8'kq'l' WM 1`11k)- t `ol< SVr" FI LL. Parent material — Flood plain elevation, if applicable 13 • q . ' ft S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT - GRADE SYSTEM IN RLL HOLDING TANK. U = Unsuitable fors stem EIS OU ZI S ❑ U EIS ®U ❑ S RU [J S MU I ❑ S IOU SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bordary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTrench 0 -i 10`1 tZ Z L Z L Z mac. S o S o tZ '-5t.3 - �s s c s - �1 Ground 3 3b -\[ � �•SHR 3! - _ t� �, �.. � [ a � o elev. - q 'o ft. Depth to limiting factor Remarks: Boring # ' a -� s 1 Z,>vt s bk m v a.S Lp`22 3 ro �S o s wt l cs - o•s . itii.....-ry l k- btt — Ground elev. X 1,0 ft. Depth to 1 limiting factor Remarks: CST Name:— Please Print Phone: Arthur L. We erer 715 - 425 - 0165 A4 d ress: egerer__S.oil_ & Ile ig.n,Service -P.0. Box _74_River Falls WI 54022 Signature: Date: CST Number: 6 - 2� -95 M00576 PROPERTY OWNER _ SOIL DESCRIPTION REPORT Page?�of 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 Trench 0- v 10 2 ztz — s 1 Z s� ,� v�� ck s o s 2:M1 K: L - �g O S 9 yn Ground 3U -�!O L� `> R �! 2 S p y k� i� — elev. i 0 [�_ ft. Depth to limiting factor 3 y ' Remarks: Boring # 5 .ii Ground elev, ft. Depth to limiting factor Remarks: Boring # Ground elQv. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1 "= 1 4C ' 0 Q � Da �voT canpR�T' �- o otZ O t sT�,tt -8 4 0 B.Z 0 l�l6H, 3lc( DIH, �� Ic-*I1%3 C P t P L '-J/LIYW i oPkE-i".3 NnTz-: W 0 vU Lb 1`'cov S TU I� k ►"rT Lm3T Z s , F—Ixo►-I m au►vD . k %- ., It so L-ur �-> r�>?s 'to %)F-- kr U� r Zs C/� 71 -5 ) 42 — MQ 576 . CST Signature - v Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3. Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNT" 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 (BN% 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 BV` ILINL: SLse(1�� LUtvQ `I� GBVT -LOT 'N1 114 MW 1/4,S 3YT ZB ,N,R la E(a w PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # )QoS w. - %tU�SIL ! 1 s T' 1 — ?tLt?q,Sft Uhl CITY, STATE ZIP CODE PHONE NUMBER OCITY E]VILLAGE ®TOWN MlFu REST ROAD TZI U L Z ROLLS, w ( S q O 2.Z C l S) '-L ZS- -2917 tw 1 ttJ -\-4 Nlv I(! RA ID 6t+ R*D [4 New Construction Use [,' Residential) Number of bedrooms 3 [) AddibQn to existing building L ) Replacement [ ) Public or commercial describe Code derived daily flow `DSO gpd Recommended design loading rate 0-� bed, gpd/ft 0- _ 9 trench, gpd/ft Absorption area required 3� S bed, ft2 3 trench, ft Maximum design loading rate L bed, gpolft O , S trench, gpd1ft Recommended infiltration surface elevations) ,� q • ti it (as referred to site plan benchmark) Additional design /site considerations '-J /8'X -q1' RAE , fitly• l n OF SWk p f=t t L_. Parent material - Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN RLL HOLDING TANK: U = Unsuitable for s stem [I S t�U El S U O S O U ❑ S C$U ❑ S [XjU O S 0 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence eotxtdary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench lo`LtzzLz L Zsbh m`�t- g o s o.l X' Z 8 -30 lc) `ttZ l_3 — �'s�s1 l�ab1� -osg yn1.�� Ground 3 30 y 1� `l �- 2 o It 6 11 - elev. ' -b tt Depth to limiting Remarks: Boring # ov8 2 _ '� a-S o •S o- 6 <} Z AREA t4.x.:i lY c z.S`2Q3fy - 3 28 - 5� lo�tZ 31Z , E� I 6!t _ Ground elev. I 7.o It 1 Depth to limiting Z_ Remarks: CST Name: - Please Print Arthur L. We erer Phone: 715-425-0165 Address: _egerer_,_So- i1__Testiug. &,Design Service-P.O..-Box 74_ Ri -ver Fa12s,WI 5402 Srgna�ure ._ _ T _ .. Yf3ata: CST Number _ G1S ILL 6 —�� 9S M Od5'76 PROPERTYOWNER ZSh'R SOIL DESCRIPTION REPORT Page? of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T cZ s 1 Zm sb 3 L O S9 �"'� C S Ground 1 - s4.a 3 3V —�10 t {Z �!Z � S elev. 6' q ft. s Depth to 9 limitingx factor Remarks: Boring # f' j Ground elev. ft. Depth to f limiting factor ni , Remarks: Boring # i, Ef;d Ground elev. i u ft. I (, Depth to limiting factor Remarks: Boring # N. Ground a „ ft. Depth to limiting factor 1-7 Remarks.: I SBO- 8330 (R.05 /92) A '� TT PLOT P Page 3 of 3 a SCALE 1 "= 1 40 ' L FLE , 4 Q � � �o ►`ion cAr �- � o t 5 1 sltiR -9 d � 7 DoT OR �, q m 6�• N'/ 9� 8. 3 \ � M Z 0/ " 0 !}t6E4, 3lt(� Dt�l. T-19� Phi C Pt P �' wl�►'m'1 oPe Nn W uuib h - �..ur - CST Signature Date Signed Telephone No. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer C�ect, -1 u 0 h o Mailing Address 705 1l ,6i 'V/'S "o A Property Address _ 12 5 W' - 'ele -- 7"a h qe- (Verification required from Planning Department for new construction) ' City /State v e l Fa // hl,— Parcel Identification Number D as — /D 9 - Z D _ D/D LEGAL DESCRIPTION Property Location /l�ll /�, /1 Sec. , T ? N -R Town of /z �� h'�hr a r, c/ o/ Ye a 7 Subdivision , Lot # Certified Survey Map # .53 5300 , Volume Page # 3 0© Warranty Deed # 3 b �a a "� , Volume Z Page # Spec house ❑ yes N no Lot lines identifiable Al 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, join neyman pluniber, resth icted 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. 1 /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 tlhal 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 0 IATURE O , APPLICANT DATE O WNER CERTIFICATION I (we) certify that all statements oil this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the properly described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG FURE OF A'PPLICAN'T DATE pQA * * * * ** Any information that is iris- represented may result in the sanitary permit being revoked by (lie Zoning Department. * * * * ** ** inr•tide with tills 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 a 7`�fi�2ti STATE BAR OF WISCONSIN FORM 1 1982 WARRANTY DEED DOCUMENT NC YI'L 1149pA,: 432 ST. C ROIX Chi., � I d This Deed, made between --- NOV 1 1 ,996 Adeline J. Peskar, a _wi.dow_ _ _ ___ _ _ _ __ - - -- -- -- ___- 9:30 A.; ; Grantor. and .1PSi1 K. LiII]dhD1lIl, a single perSOil 3 Grantee. - -- _ - — - -- Witnesseth That the said Grantor, for a valuably consideration - -_ THIS 'Ti SPAC E IR SERVED FOR RECORDING DATA off._ doll4. and - other good - -& -valuable consi der8tian ___ waurE aµ0 RETURN ADDRESS conveys to Grartee the following described real estcte in to �jr p�� County, Star: of wiscona;n: t o . l - 6 LOT ONE (1) OF CERTIFIED SURVEY MAP IN VOLUME ELEVEN (11) OF CERTIFIED SURVEY MAPS, PAGE 3004, M AS DOCUMENT NUMBER 535300, FILED IN ST. CROIX _ -- - - -._ COUN'T'Y REGISTER OF DEEDS OFFICE ON OCTOBER 24, 1995, BEING LOCATED IN THE NORTHWEST QUARTER OF THE NORTHWEST QUARTER (NW', OF NW'k) OF SECTION THIRTY (Parcel Identification Number) FOUR (34) AND IN INE 3OUTHWFST QUARTER OF THE SOUTHWEST QUARTER (SW's OF SWU OF SECTION TWENTY SEVEN (27), ALL IN TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF KINNICKINDIIC. Subject to Rifle Range Road right- of-way over the Northerly 33 feet as shown. Adeline J. Peskar is also known as Adeline Peskar. $ 1 RFER This __ -i3 not- _ -._._ homestead property. (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And - _ grantor - _ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except Restrictions, reservations and covenants, if any, of record, highway rights -of -way. I and will warrant and defend the same. Dated this ___. - _ -- - -- - - - - -- - - - -- - - -- etta day Dr Nov - - - -- - - ber - -- -- 95 . (SEAL) • _ -. _ _ -- _ -- -- - - -- _ Adeline -J. Peskar - - - -- -- -- - - - -- S (EAL) - - -- — — - - -- ----- - - - - -- (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) _--- _._ STATE OF WISCONSIN Adeline J. Peskar - ST. -- - -- -- County. authenticated this __ .. day of __Ndvember_..____ , 19 -45_ Personalh came before me this ___ _1eo day of November 19 95 the above n imed -- - -- - - -- - - - - -- — -- - - - -- Adeline J. Peskar • Edward F. Vlack - - - -- -- - - - -- -- -- - -- -- - - - - -- TITLE: MEMBER STATE BAR OF WISCONSIN If not. -- -._ - - - -- --- - -- authorized by §706.06 Wis. Stats.) to me known to br. executed the .1� � fe-egoin i �Ih aC1M 'tbe same.. THIS INSTRUMENT WAS DRAFTED 9Y Davison and Vlack,_200 East .Elm St. _ River Falls, Wisconsin 54022 • ._ �t� E� � �� Q � s - - - Notary PublA r 1 A County. Wis. fSignalures may be authenticated or acknowledged. Both are not My coromrssaig stab expiration date: necessary.) �Na • N'mc. of per,on .Pgmng m in% �apacio .hould M r% pod or primed helnw Ihdr agnalure'. wARRA.Nry D1:FD TATE BAR OF WISCONSIN WIsc OAS -n LPga; kb!ank C FOkM No. 1 — 1982 bLina:.:k.:ae Wis KAI HLEEN K WALSH R� i Icr d Decds G \ St. Cluix Co., WI /j 53�30U :% �� � •� CERTIFIED SURVEY MAP LOCATED IN THE NWIi4 OF THE NW 1i4 OF SECTION 34 AND IN THE SW 1i4 OF THE SW I/4 OF SECTION 27, IN T28N, R18W, TOWN OF KINNICKINNIC, ST.CROIX CO. ,WI. WI /4 COR.OF SEC.27. _S�SO °00'00 "E PREPARED FOR: ADELINE PESKAR t'. ( COUNTY MON. FOUND) Ln ..... SOUTH LINE OF THE SW Ii4 OF SECTION 27. "J _ _ N 00 00' 00" E �3 .,`........ M • ..............S ` g 76.27 . ........... ... . ............._.._ �� : = .............. 0' 5!5- 3E 47 _ NW CORNER OF M a ' � 4 �—° 5 � 0" O04 AD O O E - -• SECTION 34. p to 25 (COUNTY MONUMENT a M iD FOUND). th ,• BUILDING SETBACK FROM HIGHWAY IS G.... M ••V•QL, ,.••5,•••PAG�• 133 FROM THE "' NOTE: BEARINGS ARE Sf.. t. 1387 C EN T ER L INE o f RIFLE RANGE ROAD REFERENCED TO THE WEST L R OF THE NW 1/4. ( BASED ON _............. ........... _ .... ............... . {{ RECORD BEARINGS). , I , zI U 0 LOT 13.99 ACRES (609, 392 SO. FT) ,,^^ c�0 13.62 AC . EXCLUDING R.O.W. co z: !.)I,( v- , (593,232 SO. FT.) -" Q N J. __...._. tr) 0 N W: N a �: OU =. • / .... 'G) : 1 n O :K SOO ° 36' 45 "W •o 2631.69' a O RECORDED AS S02.'02' I I'E WEST LINE OF THE NW -� SOUTH LINE OF THE NW-NW cD I i 4 RECORDED AS N89' 16' 61' E N 89 55' 2 W 440. 00' �- --- -- `� s 0 o W 1/4 CORNER OF " JAMES M. �( qR SECTION 34. ( COUNTY S E9 MONUMENT FOUND). SPRING VALLEY W I8. f n . l Parcel #: 022- 1099 -20 -010 12/13/2005 04:34 PM PAGE 1 OF 1 Alt. Parcel M 34.28.18.534E 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 JEAN K LUNDHOLM O - LUNDHOLM, JEAN K 1205 RIFLE RANGE RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH V Legal Description: Acres: 13.990 Plat: N/A -NOT AVAILABLE SEC 34 & SEC 27 T28N R18W PT NW NW SEC Block/Condo Bldg: 34 & PT SW SW SEC 27 BEING LOT 1 CSM 11/3004 13.99 ACRES Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 34- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1149/432 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 88900 259,200 Valuations: = st Changed: 08/1112005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.990 65,000 197,100 262,100 NO ENTERED BEFORE'05 CLOSE W8 10.000 25,000 0 25,000 NO Totals for 2005: General Property 3.990 65,000 197,100 262,100 Woodland 10.000 25,000 25,000 Totals for 2004: General Property 3.990 32,000 144,700 176,700 Woodland 10.000 25,000 25,000 Lottery Credit: Claim Count 1 Certification Date: Batch M 221 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 FEL D t;' OCT 2 4 1995 00- �0 2 1995 KATHLEEN H.VIALSH R.(;I of Deeds St. ti. oi oix Co., WI 1� 535300 ,�, sr cROix courlm SURVEYOR'S RE CERTIFIED SURVEY MAP LOCATED IN THE NWI /4 OF THE NW 1/4 OF SECTION 34 AND IN THE SW 1/4 OF THE SW 1/4 OF SECTION 27, ALL IN T28N, RI8W, TOWN OF KINNICKINNIC, ST.CROIX CO. ,WI. WI /4 COR.OF SEC.27. SO°OO'00 "E PREPARED FOR: ADELINE PESKAR ( COUNTY MON. FOUND) S ra " 'VOL •...10 '^ PAGE 291 g SOUTH LINE OF THE SW N 00 00' OWE Q "' •.........S� �— 1/4 OF SECTION 27. 76.27 . ............... ...........................;... 80 55' 3�+p . o `.......... 2 S 80° E 24 0 NW CORNER OF M 0) 4 5 L_3 0" E ---. ; OA _Q O SECTION 34. C5 M 25 • 95' ( COUNTY MONUMENT d' iO - FOUND) U ILD ING SETBACK th ,/Q� FROM HIGHWAY IS r4) G''S'•M'••• 133' FROM THE th NOTE: BEARINGS ARE �38� CENTERLINE of RIFLE ......... RANGE ROAD, REFERENCED TO THE WEST LINE I OF THE NW I /4. (BASED ON _.__....._____..._...........1 RECORD BEARINGS). Z of LOT 13.99 ACRES �,• " i (609,392 SO. FT) N : 13.62 AC. EXCLUDING R.O.W. a cl; r (593,232 SO. FT.) N a: I N J: ... ............. «..I U.) �v 3 0. d N �' :w rnl V� 0O Z: -A� 'm _ ...... _ :< 1 / o o 0 C -) m � n N S00 36' 45" W •••• . 263 1. 69' °— < RECORDED AS S02 0 02' I I "E ,O WEST LINE OF THE NW E SOUTH LINE OF THE NW -NW (D 1/4 RECORDED AS N89 I6' 51" E N 89 55' 2�y W 440. 00' _� rn „�.. <' o �i 0 W 1/4 CORNER OF ,� JAMES M. ` "A SECTION 34. (COUNTY WESER MONUMENT FOUND). / S-1804 SPRING VALLEY W IS. f �• 0 "SET 1" X 24" IRON PIPE WEIGHING 1.13 4 LBS• LINE FOO T. iRON PIPE FOUND 1 " . - 1 • SuRV���,, cc JAMES M. WEBER S -1804 NELSEN -WEBER LAND SURVEYING 95 -81 THIS INSTRUMENT DRAFTED BY JIM WEBER DATED THIS— DAY OF a-J�–_ SHEET I OF 2 1995. R���a•2o ��- �'i - °1 S' 0 VOL. 11 PAGE 3004 MAY A Yy` ST. CROIX COUNTY SLIRVEYOWS RECORD n � 9� ST COX C OUNTY ZOfV1 NGOFFC,, MAP OF SURVEY OF LOT I OF A CERTIFIED SURVEY MAP RECORDED IN VOLUME I1, PAGE 3004, LOCATED IN THE NW 114 OF THE NW 114 OF SECTION 34 AND IN THE SW 1 OF THE SW 114 OF SECTION 27, ALL IN T. 28N. , R. 18W. , TOWN OF K I NN I CK I NN I C, ST. CRO I X COUNTY, WI SCONS IN CURVE RADIUS LENGTH DEL TA CHORD CH. BEAR 1 NG TANGENT BEARINGS 1 -2 958.00' 243.23' 14 242.58' S 73 ° 39' 05' E AT I- S66 ° 22' 40" E 3 -4 991. 00' 237.23' 13 42' 56' 236.66' S 74 04' 02' E AT 2 8 4- S80 55' 30 E AT 3- S67' 12' 34 "E V \ Noo76 s __ 0" E--�� PREPARED FOR ® JEAN L UNDHOL M w " 35.96' w -`�-.. 247. 0O NORTHWEST CORNER $ 40.37' 0 SECTION 34 - FOUND a , z5 930 "E w io COUNTY MONUMENT 5 w w APPROX. 3' WEST l. I � 13.99 ACRES OF N/S Fi v 609,392 SQ. FT. 13.62 ACRES EXC. R/W v I 593,232 SO. FT. U 1 A WEST LINE OF THE NW 114 I �_ 1 r C� ' LEGEND z I� • - FOUND I IRON PIPE y O - SET I "X24" IRON PIPE WE I GH 1 NG 1. 13 L BS- I N. F T. at � C r � V ' flu W ' N � p I U I O W 1 fT �v „f ,...� 4 a'➢ 1 ° r R ,;w A aILMI , I � I I SOUTH LINE OF THE NW—NW N89 55' 28" W 440.00' SURVEYOR'S CERTIFICATE 1, James M. Weber, Registered Land Surveyor, BEARINGS REFERENCED TO THE EAST hereby certify: .That I have surveyed and mapped the shown parcel of land and that L I N E OF LOT 1, CERTIFIED SURVEY MAP RECORDED IN VOL. 11, PG. 3004. this mop t a correct representation of the RECORDED AS SOO ° 36' 45 "W. boundary thereof. 1" - 200 , _acv .ca �.� • i9z __ James M. Weber, S -1804 0 100 200 400 April 12, 1999 NEL SEN —WEBER LAND SURVEYING, INC. 98301 SHEET I OF I so