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HomeMy WebLinkAbout022-1006-40-000 ST. CROIX COUNTY ZONING DEPARTME r.` =� AS BUILT SANITARY REPORT Owner cr&e Address 11 91 City/State IV G OFF Legal Description: Lot Block Subdivision/CSM # 1 u 'A N 0 '/, 6 us , Sec. J—, T2LN -11 i e W, Town of �'{ ' IN # d oh a - /a / p 5 4 a u r► SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC /o ,, o / 8°o Setback from: House / Well /Op P/L / / Y Pump manufacturer . Model N 9 8 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: _VY) Width a 7 Len � Well > Boa � � Number of Trenches Setback from: House �_ ` P2 a 7 . s' Vent to fresh air intake a S ELEVATIONS Description of benchmark / Vy t 5 j"Y! # a . p Elevation Description of alternate benchmark A Elevation Building Sewer t4, /4 ST/HT Inlet ST Outlet/ lo o b b PC Inlet PC Bottom 9 a , to x Header/Manifold lo o s' b Top of ST/PC Manhole Cover A - 4, , -e Ad- Distribution Lines (I) Bottom of System Final Grade O _ ! o a, - 7 O ( ) Date of installation /Z / 78 Permit number P S 9 o o State plan number A 9 a Plumber's signature LZ License number 22-'1 ' Date 9 /Z/ 9 8 Inspector complete plot plan r � NOTICE: Plcasc 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. t PLAN VIEW N /oc 57 - 33, 5 a r INDICATE NORTH ARROW Wisconsin Department of Commerce + PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT ST . CROIX GENERAL INFORMATION (ATTACH TO PERMIT) San ita%P ".: Personal information you provice may be used for secondary purposes [Privacy LJWV, s.15.04 (1)(m)]. ICKLE def ORRT l ikN R Q1R'LQwn of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel tF`2�'1006 - 40 - 000 loy —`` 1 tl • tOn . 1 TANK INFORMATION ELEVATION DATA A9800286 TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV_ Septic 1� �-� ( f 6 0D Benchm r (,�, (� G'( 100,27 osi n 7 O . Aeration Bldg. Sewer f Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet 9.� 0740 3 Air Intake Septic ( �4>j lo i� NA Dt Bottom Dosing 6Y 77 ( NA Header/Man. 5-43 /04) Aerati NA Dist. Pipe /06. (p Holding Bot. System 6 G -cZ °l f gq PUMP /SIPHON INFORMATION Final Grade Manufacturer 2 0 t Demand C-oveA Model Number �iPM d1 0;5. 33 TDH Lif I Friction zlr System TDF�Q T L oss Tin I Forcemain Length Dia. Fin Dist. To Well SOIL ABSORPTION SYSTEM -aED THE Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Li Dt N DIMEN I N SETBACK SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEAC G Manu acturer: INFORMATION TypeO ( r 9a1 !�f ,� OR UNIT R M umber: Syste Q DISTRIBUTION SYSTEM Header/Manifold �I Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake l/ „ d Length Dia. Length Dia. Spacing '1 Fj SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over {{ p, It Depth Over r xx Depth Of 4 xx Seeded 1 Sodded xx Mulched Bed /Trench Center l V Bed /Trench Edges �a' Topsoil Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ` ' 15 i f LOCATIO KINNICKINNIC 3.28.18.42B,NW,SW 1191 CTY RD r� - r J t 5r�,K,f(C 10711 D e6q f4. 7� Plan revision required? ❑ Yes 16 No Use other side for additional information. 1 !}- SBD -6710 (R.3/97) Date Inspector's ignature CC Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 E. Washington Ave. ` �sVVnsln 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 8 112 x 11 inches in size. 5+_ okr� X • See reverse side for instructions for completing this application state sanitary Permit Number vt5att The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. s /y n State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION ; 1 7. 1 � 1 _ Propert Owner Name P opert Location 4L)-- �' G k 1 l- qA /4 W 1/4,S T AIS . N, R / S E ( o r la Property Owner's Mailing Address Lot Number 7 i 9 c- R D Al City� tate f Zip Code Phone Number Subdivision Name or CSM Number v b k Y Lt.9 4 - S "o ,2 3 ( -r1 S) 71 6" II. TYPE ILDING: (check one) ❑ State Owned ❑ It r Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 K Tow o� + Gk7 hn C /� III. BUILDING USE (If building type is public, check all that app Parcel Tax Number(s) ZL 1 [] Apartment/Condo �- A D - 1 g• ` �� �,Q Q 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, E3 Replacementof 4 [] Reconnection of 5. E] Repair of an System ystemTank 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 %4 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade L1 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) (� Elevation 1 0 2' g 6 .5 /� - i �1 ?CFeet j01. 50 4 � ' Feet Cap acit y VII. TANK i Ca allon n Total # of Prefab. Site Fiber- Eer- INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic Ap New Existin structed Tanks Tanks Septic Tank or Holding Tank pp p f o0 (9 f� O.Q- ♦ C- 62 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ~ e, O O kA t-r ❑ ❑ 1 ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's Signature: (No Stamps) MP / MPR a SW N o.: Business Phone Number: 0a.!fe. A/ec,1,v, 11e I :Z;2-7 - ► t o 7 <s' zsl 33 Plu b dress jStreet, City, State; Zip Cocle) IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issui g Agent Signature (No Stamps) X Approved ❑Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: V k SBD -6398 (R.11/96) 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/ 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 s PO BOX 7162 MADISON WI 53707 -7162 �sconsin J Tommy G . Thompson, Governor William J. McCoshen, Secretary Department of Commerce January 15, 1998 CUST ID No.259518 ULBRICHT & ASSOCIATES 655 O'NEIL RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL Transaction ID No. 2972 APPROVAL EXPIRES: 01/15/2000 SITE: Site ID: 1841 ST CROIX County, Town of KINNICKINNIC NWI /4, SWl/4, S3, T28N, R18W t N ICKLER, ROBERT O RJG A L FOR: Description: MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 3102 Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code. This system is not reviewed for the code requirements set forth in chapter Comm 82 or in chapters Comm 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire in two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. When making an inquiry or submitting additional information, please refer to Transaction ID No. in the regarding line. Sincere , DATE RECEIVED 01/14/1998 'l! r ( FEE REQUIRED $ 180.00 PETER E PAGEL, PO PLAN REVIEWER II FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE S 0.00 (608)266 -2889, M - F, 0745 - 1630 HRS ULBRICHT & ASSOCIATES CO. 655 O'Neil hoad • Hudson, WI 54016 Reg. Designers of Engineering Systems CEIVED 715- 386 -8185 Private Sewage Consultants .IAN 08 PROJECT INDEX l SAFETY & B106S. DIV. , DILHR Plan I.D. # 2972 Date Jan. 16, 1998 Cqa Owner Robert Ickler Phone 715 - 749 -358 Address 1191 Cty. Rd. N, Roberts, Wis. 54023 J CQ Legal Description a A 2.0 acre parcel, #022- 1010 -50 -0.0 but part of a larger farm parcel. NW1 /4, SW1 /4, Sec.3, T28N, R18W. Town of Kinnickinnic County St. Croix C.S.T. Robert Ulbricht CSTM2482 Installer Local Authority/ Supervision St. Croix County Zoning Dept. - PROJECT DESCRIPTION Replacement system, for an existing 3 bedroom home with a failing ingrounB drainfield from the 1980 The existing septic tank, 1000 gals, precast (Weeks Concrete Co. New Richmond Wis.) shall be examined by the installer for code.compliance prior to re -use. The existing system shall be abandoned. Soils in the nearby replacement area are permiable (.5/.6 GPD /FT2) but seasonally saturated at 31" as evidenced by soil mottling. Limestone dolomite was encountered beneath the saturated horizons at a depth of 55" (backhoe pit #3). Proposed: a long narrow mound system using 12" sand fill. �c 0,708 ULBRICHT +� a 71YS, M W. D1160 HUDSON, WI 1 w >I�' . ... ............. .. ......... I;!, I T r Pg .1 PLOT PLAN VI EWS � "° 1 Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS Pg.3 PIPE LATERAL LAYOUT Pg.4 DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS This design for installation is based entirely on measurements, elevations, :0nd'Acape conditions (slopes etc.) and soil suitability provided by CSTM The accuracy of his specs, as reported, shall remain the sole responsibility of the CSTM. i Any use of this POWTS 4esign by any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, substitution or selection of any components not specified, or any assumptions by the plumt.er that any unspecified components ^ are state approved or proper, or the effects of poor judgement if working under adverse damaging weather conditions (wet /frozen 11 �) by any such parties or persons. 1V: f � O N Nl- O ' O c -v o m cn � Z m� y 'fl V 2 � o a r O 011 c�nmNp� �Q Z tz O cn m o I � n Clo b b I c NI i r � I d ►° n� a y VIP L �y N �.- J m `' 4� `� 1 \ \ \ amp • \ IN � � ,� \ • to \ FAST PPOP- ♦ \�/e � � 11 � � t 0 Pi z Of S CRO SECT10 or M OUAJ D T ti 'f3ED Qtv OF „ T'o 1 i y A 594 t -SATE w 'Di ST Ri(SuT�o,V G , T ckrs FS 9 pip rN (r s sreo o r T °P ISO (L Y E l+i 1 a 97 9S 00 i FORM To E qr N 1-I'A) E �- - plow Eo TopSOt' L ��� u u i Fo N R J ol SIoQE F ORCE" ►� EIMOAT1 0 UuOE4Z 7 Bee -T) /,O T. MLEVAPo►J S E /.2- Fr. INv6Rr OF 2 IATERA(S /00• q,5 IO FT• . • T oP of Rock /0 G /� � FT• u H / ' FT T °F �' IATERA IS PLA VIEW OF Moo-OD wi rti 13E D FvRcE MA A FT. I -- -- - - - -- . I B '76 F r Ell /o Fr w I ' ---- - - - - -L-%A FT K - >� r r_ W Z 7 l Fr —j Be r7 F To 1 1 " pRpp �CT pPPROV�C Pvc. oAPpeD G Rp�ND p [3 5ERV/ET ioN A 99REjATE pER P1.UMA ABOVE AAEASI n touts TANKS & SYSTEM NS1M ' Pipes FROM pmAG l Ap w MEETIN MUST BE SCH . STANDA , p OR D266 PERMhN @uT M hR KERS R E(Q uiRED (3ASAl- AQIFA - 'D - y �h Fl ow - SOIL 1010TRnTIOE s 5 4. F1', C AIPhci ry PRoposEd BASM AReN = B X ( A t Z + 1 L S Q . r T. �cN autFoLp Di5TR;f30Too&) PI UE T - WOR k ToT'AL V.VLU,' or LATE JV �1'lvo t� ��•�4 S. T D, S R 1 130T I .� LANERAI• ENO cAp iL _---- ---- -- - K ` X 2 I I x I Y pUG V=oRCE ,�- M A i u LAST NOTE S HA II 13E NEf-T To AND CAP VOID VoluMt FoR 35 F�• 10,JERT' dF 2 F- ce MAW 5.7 Q A 1S, PERFoRArED PIPE DETAi L Nole_s �t�cATED o� • . , G v1rr0m SH A11 Be I ' Y - I vAt A61-t_ y e (Rv1\11y SN/NCED. Dt 5 TANcE p 72- t= r H OI E Di AKIR TE R L ATE L 2 - - N /� (o s R MAO% FOLD iN. y X iN�ht s r MAW Z IN• Y �B tucl,ES 417 op (iol D157Ri t3uTtoN D�gc.hARC, e RATE E ZZ, Z3 ,� P R LA rE-R�L Gal� M iu. TOTAL. 'D 5 Gk AR v E PATE / NEB -woR k 2--2-.73 / GA L PUMP CHAMBER CROSS SECTIOM AND SPECIF'ICATIOMS P,4 J E f or- 5 VEMT CAP 4"C.I. VENT PIPE WEATHER, PROOF APPROVED LOCKING JLIUCTIOIJ BOX M&WHOLE COVER 25 FROM DOOR, 12 "MIU. w/ 4 AX,0lo6 1 A/3- WIIJDOW OR FRESH I AIR INTAKE ����� rleti ^T /OA/ GRADE I yn MIN. o I I ..yy 18" MIIJ. �• �� COUDUIT -- - - - - -- �� u � ---- - - - - -- 77 � INLET PROVIDE - -- AIRTIGHT SEAL r - T i APPROVED JOINT A y,I{� K .1� I I ( APPROVED JOIMTS w/ - I. PIPE IN "{ U� i ( III W /C.I. PIPE EXTENDIIJG 3' O�� I II ALARM E%TEWDIWG 3' " � DIJ70 SOLID SOIL, ONTO SOLID SOIL 3�i 3.2 I I OIJ E.LEV. F7 PUMPS - -� " OFF f i0 DO1� 6- N K 'fie S�tNIJ �� 6 V!1 �✓ BLOCK €G�ivG" 0 nom' S RISt EXIT PERMITTED OIJL4 IF TAIJK MANUFACTURER HAS SUCH APPROVAL. / SEPTIC E .5 PECIFICATIOUS DOSE CUE S CeV TAWKS MAMUFACTURER: IJ UMBER OF DOSES: PE R OAy TAWK SIZE ; �d� GG ,�AeL��LOMJAS DOSE I VOLUME U j ALARM MAAIUFACTURER; UE L ��/1/"� 'C/ INCLUDIMG BACKFLOW: J � GALLONS MODEL MU MBER : _-D 1 01 L CAPACITIES: A = INCHES OR 3� GALLOU5 SWITCH TYPE: 1'l y FlOT" g = 2' INCHES OR -Z_ GALLONS S.4o PUMP MANUFACTURER: " u / [� ' C= 7 INCHES OR GALLONS MODEL NUMBER: YZ' LTA• D= I � INCHES OR GALLONS SWITCH TYPE: ?joAyBA(_9 kr=:M. ROA< NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 30 GPM INSTALLED OU SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWELU PUMP OFF ARID DISTRIBUTION PIPE.. 7. 5' FEET -VAAl S PEC S MINIMUM METWORK SUPPLY PRESSURE // - . . . . .. . . 2.5 FEET EAGIA. �, O + 35 FEET OF FORCE MAIN X �.sy F /ooF T. FRICTIOU FACTOR.. `' FEET - 40 0 = TOTAL 1391JAMIG HEAD = FEET INTERMAL DIME.IJSIONS OF TANK: LEM&TH -7 z�- -;WIDTH • ;LIQUID DEPTH PER PLUMBING PRODUCT APPROVAL CODES, ALL ABOVE- GROUND PVC PIPING (FROM TANKS & SYSTEM AREAS) MUST BE SCH.40 PVC MEETING ASTM D1785 OR D2665 STANDARDS. w HEAD CAPACITY CURVE a 7/8 0 MODEL "99' 1 s/a 2 3 TT s /e e • \ O 15 . � A 1 3/10 10 2 1 1/2 -11 1/2 NPT J 4 0 U.S. GALLONS to 2 ao 10 so so 7o eo trr�tts so 1e0 210 0 FLOW PER MINUTE TOTAL DYNAMIC NEWIOW ►Erl tu.nrTE Errlt01W AUG WWATEIYNO CAPACITY 12 HUD UNITS/MIN s FEET METERS Z8 LIn$ e Ld2 72 P70 10 0.00 of 271 + 1E 1.07 14 170 20 ato 26 95 S /le tarkVdw � CONSULT FACTORY FOR SPECIAL APPLICATIONS* • Electrical altemsiors, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. *; Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for Without. alarm stvNchea• variable level long cycle controls. SELECTION GUIDE Standard all mode - Weight 39 lbs. - '/s ue H.P. t V a m operated 2 po.chanka1.wkeh, no externalO0j*OI eyulred. fa tells$ 2. 84►"1* pi00Ybeck mercury Mow switch or doubt P129yback mercury. Mow de Model Y .Ph Mode ffAm Control Ssleetlon switch. neler to FM0477. tlm bx Du Isx 2 ee f MechanlcW 411 0111001' 411 0111001' 10-0072 or 10-0071, M90 11 S 1 1 og t 0. B M0712, la o0rred model of EMcWA All malor, "E•Pak" !.. Mercury senw float switch lotm Do0 id acgvitw 230 1 0 4.R 1 or 1 R 7 duplex (3I at (y Moat system, q a ItorNrol 'AMY 290 1 Non t,1 ;2 4r. Z 1+ 4 e Ft?Tx,(q hole "J Pak ". iuncgpl box, for WlefdOM tionradlon or wired•ln son- -plix or du *raUR 1.0002 plex opo0. a 7. Two P) hole "J•Pak ", for wwe111gM oonrw.__., ar spli" dd OMW 60110 p(odueb role to C&IW" en Combint do n Slaner, FM0011; CAUTION f PlMb = 0o^ on ak MOMMY swheMs, FMG77; Ebctrlul Aftemmor, FMoW; Muehankel ANerna1w, AN Nslsibllon N s *0* p10106don'40wes and wk4 ekovld be Iran WOW. Alarm P by �"0' F1640732. aokepe, fM0610; Oum00wape tasty FM047; and Rimplex Conad tlox, "M leant NN (lend 11901114 Code p1EC�) WA IAe OW. NualA AGO (0e14A1, old RESERVE POWERED DESIGN For•unusual conditions a reserve safety factor 1a dngineered into the design Of o,iery Zoeller pump. -�- - - ................. _. `. AIAK TO-7-P.O. 00K 16317 Q WfviE9.W 10236.0317 Manufacturers of.. iNIP 10:3 60 04 Migas tarrc N N 2731 a xr Ic21s Qa,1u�r vs s'wcE /9.�9 (SOl) 778- ?73l ;e FAC 002) 771.3621 Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page / of 3 Division of Safety and Buildings in accordance with S ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 5"77. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # o Z 2 - /O /0 APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner �D�3E2 r T G el- Property Location 1 Govt. Lot /UA) 1/4 5 W1 14,S 3 T - O,N,R E (or )(D Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# //9/ G' t . ;P ItI9 ti City State Zip Code Phone Number _ / Nearest Road w .54ZO z3 (7!f ) 7 �7 . �f ❑ itY. q Village L7 Town C T }/ �V / X C it/ L New Construction Use: esidential / Number of bedrooms 3 Addition to existing building ❑ Replacement ,J El Public or commercial - Describe: Code derived daily flow Y�o gpd Recommended design loading rate ' s bed, gpd trench, gpd/1`1 Absorption area required 3 bed, ft 3 trench, n Maximum design loading rate bed, gpd /ff? trench, gpd/ft Recommended infiltration surface elevation(s) - pa • 3 It (as referred to site plan benchmark) Additional design /site considerations J`i ?E ,PE .u0APE LO.vlr /Vl fjPi�Q4� /�10U�1� SYST. Parent material Amass dy�� -e'9 Ur ,// • Flood plain elevation, if applicable - ft S = Suitable for system Conventional 13-S Mon In- Ground ,Prresssu e AT- Grade / System in Fill Holding Tank U = Unsuitable for system ❑ S Z U ❑ U El S L7 U E3 & U El a ❑ S B SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD / tt 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench /o yR 313 t 2,. ,rAX /»1f,P C's 21 Skt Ground 3 .31 /O y elev. Depth to S YR limiting ; factor 55S Remarks: Boring # O- y 10R ,313 L S,0�, hM7�E' e s f7` •S .� z 9. 13 /a VR 3IZ L 2,rn s he /,7/? es / o f 3 3.3 / p Y Y S L 1 �6 / .� / v�iE' Ground s /Q y� C 2 SG L / T $ /!!1 U�/ • /V N .12 elev. s y k 516 - Depth to limiting S YR 51 F factor L In. Remarks: CST Name (Please Print) Signature Telephone No. ;RO&ER7 ?e,48,p< e 715 3811 • e / e s Address Date CST Number 12 -16 X� e57 Ulb richt & Associates Private Sewage Consultants 655 O'Neif Rd. Hudson, Wis. 54016 0 ���1N Al. PROPERTY OWNER C/� /e SOIL DESCRIPTION REPORT Page Z 3 of PARCEL 1.04 02 2, — /0 /0 ' s O 0 Boren # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 D- /d /O y l e 313 L 21Hsje ~75P G'S If --s ' G s 0 •z/ /o 11 h e ^,7e e eo lic . s :. e, Ground 3 3 �� - f54e lw a It) q , . S elev. ApynG ✓1J1(fl/ Gtr, N 'N Depth to limiting factor �55 Remarks: Boring # I , K .x kE i Ground elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GP /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. n Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) I ❑ O 3 O y 1 0 W o L � I � I 0 . o � N M ° c M v �� w �t F O` EAST PROP. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ obe r + I 1 e �/, der 2 7 Barba ro, :Y Zc-K ler Mailing Address Q �e � yj Property Address Q N (Verification requi row Planning Departrncat for new construction) City/State O be _ , . ,( J Parcel Identification Nupiber 10 —50- GY00 LEGAL DESCRIPTION Properly Location N w /., Sw %., Sec. _W, Town of 4< n Eck; K i. Subdivision _ N� . Lot # Certified Survey Map # Volume to �o. d� , Page # Warranty Deed # 4383 995 Volume Zo 63 Page # SY Spec House ❑ yes 15'no Lot lines identifiable CR yes ❑. no SYSTEM. MA Il V' f E N A NC E consists Qlmgtmper use and maiauaance of ym septio systan could r=h in, its pnematm�c failme to handle wastes. Proper mamt enaace puoving out die scPhc tamti evaY do years or sooner; if needed a licensed can affect dw function of the P 3"D0 i nto, W system tank a t stage is the avastcdisposalsystem. . Tie PmPedY owner agras to submit to St. Croix Zau s Department a certification foam, signed by the owner and by a ma.ster plumbe4jomeymariplumber, mst ictedplumluror a licensedPu nTervecifyiag that (1) the on-citb wastewaterdisposal system is m PoPer oPeratmg condition and/or (2) after inspection and p=ping.(if necessary), the septiataak is less than 1/3 full of sludge. Uwe, the wed have read the above required and agree to miatain du private sewage disposal system with the standards set fm tk herein, 'as set by the Dgwtauat of Commerce and the Department of Natural stating ea yam. �c system has ban muse be Rcsourxs; State of Wisconsin.. Certification days of the three cawided and returned to the St. Croix County Zoning'bffice within 30 year *ration date. SIM&ITJRE OF APPLICANT DATE OWNER. CERTIFICATION I (we) certify that all statements on this form are tau to the best of m ) edge. I (we) am (are) the owner(s) of the d 'bed a ve, by virtue of a Y (Our) Deeds Of � ' warranty deed recorded in Register of Deeds Office. ° O� SI TURB OF APPLICANT S / 1�4/ ` DATE « « « « «« Any information that is mis- represented may result in the sanitary permit being revoked b the Zoning « « « « «s Y wag Depaitm ent. «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is wade in the warranty deed VOL 663 PA, 38 RIDER attached to Warranty Deed Ickler to Ickler: -EAWAM) IGKI.rai i I L of rd' Lt:(- .4n2 Iwa 1, 1,1ii 3nu thwp!l t, 1/• or leption 3 Pownshi IP of .;t. W1/4 COX SEC 3. Y28N,Rj8W, o 1!v!; I" x 24" iron pipe wir.!,irip, (CCUMYY SuRqfyop•s Mom I IL E,1W t/ 4 L INE 0 87 •4 4 4 0 " 223 so twoo'oo" 0293 rA 89-20.20. 22 20' IL ? ♦ .% 0 j? 0 0 I.- z UNPI.ATTED F3 316. so, • LA NDS LOT 1 2.297 ACRES At 00,032 SO. FT. 1411T • 1.022 ACRES -0. 364 so. FT. 0 UNPLAtTED LANDS 39 O 0 O MOBILE HOME 0 (TO BE REMOV 01 APPROVED 4; SHE04PORTABLE I TO Of MOVED M TO-ELIMINATE SHOW ZNCROA SCALE 1"- 100• "86'30-37-1 82-00.37. 342,is• UNPLATTED LAND 0 so 100 200 300 AtID SW COR SEC-3. T28N,RI8W, (CO•4TY SURVEYOR'S; MONA % - ( ' . c; ! L, I: t ': of th( "ou t,hea t 1/4 n .;cc i -)n t",- - .-,rthwrvs t, 1/4 nt *.hp S t 1 -0 i011 !:01'th, 7 "CW11 ;t. Croix vlor'. Cul!" (!#-L;cri1wd 'i;; :*ol o-';.-.; 1 t, 11 1, 1 NJ; 1 "': ID" pa I to b2 thericp 1% 1,4) 0(i' (-Kj" lire 3,cd i .;f-c ticn it a .."o ; " . of thfnce Wi' 101 GI ; :: - v 7 { :1 ? , •1 ; - �' t"O-ncr i W" 4(14.ii.41 " 40 ori sa.Ld n: a jist.ance r;V Z25.1)01 t.iw i,)EJ ()!' r-•(•ni ;,. - �,, -i 1 6 I I y r d 'IS I FlUi: a t tho t 1/4 ,,.i Lie i o n s the-ce N" ; 00" 2?.201 to III( !:011 F h, to Ly LE: red .! ti;o lit—ction of th- G-wn-r, i� -r.arxl ick'-•r, I rave !1rv(Cy—i .!I.! iiv: the ( t. i.cw.-i tit r--n :z� :�I"pbr of . ;rltllt reap azd a 't!:'! 10 10 d5 -tALJRFNCE*. • m W ; MURPHY cc S 1713 C(! RWEP FA " or L L;...- ti i 'A .. --X ............ c 0 dl LAND 0% • Stec No. 13001 oocueaw NO. — 5TAT8 BAR OF Wt8CO*Wt —FO1tM 1 VOL WAiNtAMff DeW 66 PAU"f 38 T HIS SPACE PEMV10 f0A 114coaa 1416 0AT4 5 THIS DEED, made between LPQ na d L, T�k1 +°r and Marie F REC-4STMS Of CE - kl ar H r ba lld and Wife ST. C CIX CO., WC anc1 a _h in hi and. her own right Reed. for Record tH 19th and I v Grantor dcly of Apr il A.D. 19 93 rGhan niNart- and Wi Tenants n Co>ranon�an Q i g A M. Bar redivided one -half interest each ., Grantee, Wi t o s a t Th the aid G a r�pr for aluahle cor�iFterafio ~� D ollar �r (M ier tool an� la'luatYe ono eras o asrtar To conveys to Grantee the following described real estate in St. Cr IIix — Leo A. Beskar County, State of Wisconsin: Rodli, Beskar Sl Boles, S.4;. 219 North Main St. See Rider attached for real estate description. River Falls, WI 54022 Tax Key No. M . 41 ifii� �jw ..�• j .. � f i C This is homestead property. ( I (is) (is not) Together with all a n ula a her -d' me is and a ourt a thereunto belonging; G And Leonar: er an� N�arie 'c�c`er i warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions and rights -of -way of record, if any and will warrant and 9efend the same. /`` i Dated this � —day of Ap ril 19 83 p � (SEAL) (S£AL) rat_ « _ ._L eon a rd L. Ickler (SEA[.) _ (SEAL) Ma F. Ickler AUTHENTICATION I� ACKNOWLEDGMENT Signatures authenticated this _ AA y of STATE OF WISCONSIN ' i as. County. ) Personally came before me, this day of R eo A. Beskar the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, W authorized by 4 706.06, Wis. Stats.) This instrument was drafted by Leo A. Beskar, Attorney - { 244— Nor Mai St. to me known to be the person_ who executed the fore- River Falls, WI 54022 going instrument and acknowledged the same. 3 (Signatures may be authenticated or acknowledged. Both " - - - -- - -- - are not necessary.) Notary Public _, County, Wis. , My Commission is permanent. (If not, state expiration dater ---- - - - - -- — 19 - -.) *Names of persons signing in any capacity must be typed or printed bel ^w their signatures. WARRANTY DEED —STATE BAR OF ''WISCONSIN, FORM NO 1 -1977 } ° \ C) / ) / � \ 0 2 � 2 � $ � ƒ � A � � \ � $ � C % z 2 \ § � » CN � / j E & � z = ; 2 « § z a m q \ 2 \ z $ 7 7 E 7 \ & § v \ ) k } / E } a o It k > ° \ k z } • #I a 2 a E 2 &a 2] v/ f f G w j / § 0) 3 § / E � _ / r g � k § 0 k IL 7 AE _ c 2 2 c = / § \{ 0 / 2 5 c I j 2 & m k } 7 cq $ k k{ 7$ - \ B k 2 '2 p a z$ 2/ \ 2 CL — , " a . E ) a k a § / J a 2 3 v Parcel #: 022 - 1010 -50 -000 03/27/2006 09:41 AM PAGE 1 OF 1 Alt. Parcel #: 4.28.18.61 D 022 - TOWN OF KINNICKINNIC Current [X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - ICKLER, ROBERT L & BARBARA J ROBERT L & BARBARA J ICKLER 1191 CTY RD N ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1191 CTY RD N SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.820 Plat: N/A -NOT AVAILABLE SEC 4 T28N R18W 1.820 AC IN NE SE AS Block/Condo Bldg: DESC IN 663/38 & 39 ASSM'T INC 022- 1006 -40 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 04- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 143043 173,700 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.820 30,000 145,600 175,600 NO Totals for 2005: General Property 1.820 30,000 145,600 175,600 Woodland 0.000 0 0 Totals for 2004: General Property 1.820 20,000 108,100 128,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 222 Specials: User Special Code Category Amount i Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • AS BUILT SANITARY SYSTEM REPORT !NER . A , TOWNSHIP &' T A SEC." _ T - N, R� ,0. ADDRESS , ST. CROIX COUNTY, WISCONSIN. ','BDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4r- la X 45 DM 'TIC TANK(S) _ MFGR. I,�. ;d.. 1000 Q,&P ; CONCRET3 -STEEL NO. of rings on cover p epth �� DRY WELL NCHES NO. of width length area no. of lines width length area l jo kt , depth to top of pipe „192 JREGATE J y K RATE A AREA REQUIRED 7 � 0 AREA AS BUILT '78'0 _.claimers The inspection of this system by St. Croix County does not imply complete pliance. with State Administrative Codes. There are other areas that it is not possible '-Z inspect at this point of construction. St. Croix County assumes no liability for ;tem operation. However, if failure is noted the County will make every effort to . :_ermine cause of failure. _]ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. R -WLTED � -' � ' 7 � PL61BER ON JOB LICENSE NUMBER z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itany Penm.it - State Septic`? NAME �L�'JZ�2�i � `�� Township St. Croix County Location " % o6 -- Section T N,R SEPTIC TANK Size / gattons. Number o6 Compantmentz I Distance From: Wett Z_i ( —Z� 6t. 12% on greaten zZope Bu.itd.ing bt. Wettands —" 6t. H.ighwaten 6t. DISPOSAL SYSTEM Distance F)to Wett K, 6t. 12% on greaten ztope °' 6t. Bu.itd.ing Ll_ 6Z. Wettands F t. H.ighwaten 6t. FIELD DIMENS Width o6 xnench 1 6t. Depth o6 rock below Cite l .in. Length of each tine 6x. Depth o6 rock oven Cite .i n. Number, ob tines Depth o6 tite be.Eow grade .in. Totat .Eength o6 tines _�_�;� Slope of tneneh .� in pen 100 6t. Distance b etween tines " t. Depth to bedro Totat absonbtion area 768 6t2 Dept to g ' 6t. Required area `? 6t2 PIT DIMENSIONS: �~ Number o5 pits GxaveZ around pits ye.a no Outside diameter 6t. Dep below .intet 6t. Totat abdorbtion area bx A Area requ.ined t rn INS T: / ''' -� (°� , J TITLE APPRO El , DATE 4:1 2 �' 19 7_ REJECTED ,DATE 197^ EH 115 A*; WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES t DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 ` REP�Ob � REPORT %6 BORINGS AND PERCOLATION TFS `- LOCATION i V ' Y , . " _ E _ x , Section , MN, R O L E (or)(OTownship or Municipality � N I C K I N IJ I Lot No. , Block No. County S Re Su ' io N me Owner's Name: • Mailing Address: j TYPE OF OCCUPANCY: Residence NN Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT ^� DATES OBSERVATIONS MADE: SOIL BORINGS 1 q PERCOLATION TESTS " -U E ) SOIL MAP SHEET 66A IFf' r) � SOILTYPE � � t � 4 ] .p -p 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 AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P _ r I fl I �E C- c�o R� 6 kf NTA o� Nx �E 3 0 { c P _ 1alt �� ► �i o� Nato S o ' b y/i 8. P _ 3 g ► !� , �� j� a4 � OME 3 0 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) _ H t A+�O by AID B it Na 9 6 t I �-11 tr C 8 N L a (s it S L. Ohm B- Gt No > GL a 7 it S C L t C9 L `Fit ND 0 > b r r� 't L. , R 4 ` t J 1, PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and squar fee f suitablyareas.• n 'sate umber of sgrare feet of absorption area needed for building type and occupancy. (a ho p � I p n , dicate scale or distances. Give horizontal and vertical r erence poin s. Indicate slope. ITZV PT (j,Igl�1•F 1l / C R or- t R t N R A t 1 � t - E �- t i p R I t V 1 0 � L � l 84C a+ frlN� xTC—#\) o R r oZb AL S I, the undersigned, hereby certify that the soil tests reported on this form were made by me in ac cor 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 owledgge and belief. Name (print) ^ A K Certification No. y�_S Q 00 v 0 Address R o x � I Q C 1 ` 57+574 — 7 Name of installer if known COPY A —LOCAL AUTHORITY CST Signature PLB � 7 State and County State Permit # � Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Add �i C' G IC..G 1C.. B. LOCATION: Niq % Y4, Section T�N, RY I-- (or) W Lot# City_ Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCU ANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms ° No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder — YES X NO # of Bathrooms-t*2N(Z, Automatic Washer _YES NO Other (specify) E. SEPTIC TANK CAPACITY /000 gallons No. of tanks _ 0A1 *Holding tank capacity Total gallons No. of tanks New Installation X Addition _ Replacement _ Prefab Concrete x *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2),2 oral Absorb Area sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length 6.5' Width Depth Tile Depth �g d No. of Lines p Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope 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 Certifie it Tester NAME 7 p�. C.S.T. and other information obtained from (owner /builder). p Plumber's Signatur MP /MPRSW # ^' ` f � Phone # fi e 3 7a Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). X Cv V � T /moo AIL i 0 eo2-e. Ales I_ a of l Q P © i .RK �_ - Sexj C, M a ig le A R iL /4 i rvo+ To 5c l-1 e I Do Not Write in Space Below 1�9R DEPARTMENY USE ONLY � o c) Date of Application ���� Fees Paid: State G d� Couy�t �? .' Date -�7— 7 Permit Issued /Rejected (date) 7 — // –1 2 � 5 _Issuing Agent Name Inspection Yes o f Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76