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HomeMy WebLinkAbout022-1041-10-000 S 'I'. CROIX COUNTY ZONING AS BUILT SANITARY REPORT t Owner ///o Address 39 C r f City /State r ST CROIX. COUNTY ZJi�iNGOFFIC� r Legal Description: Lot Block Subdivision/CSM tt - - -- ' /4 l� S ec.l � , T2,7N -R_W, Town of �- -�� PIN SEPTIC TANK —DOSE CLAMBER — FOLDING TANK INFORMATION: Tank manufacturer u- Size ST/PC % '8etback from: House " 6 Pump manufacturer 61 Alarm P/L �' � � S' Model Alarm location _ -�� � (BOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Meter location Water Line Alarm location SOIL ABSORPTION SYSTEM: Type of system: A:rCY/W- e Width ' 7 /J 0 Length - - 1 - 2 — Number of Tenches / 7 X i D n Setback from: Douse J am_ Well !p0 P/I# Vent to fresh air intake ELEVATIONS: Description of benchmark fn A Fx 3%,,, -P P ,r, � -c e41:� i� Z,a Tip Elevation Description of of alternate benchmark T Elevation Building Sewer e� .Z, �S Inlet ST Outlet - `� PC Inlet O PC Bottom z—� Header/Manifold 2 Top of ST/PC Manhole Cover -ell 7r d2 Distribution Lines Bottom of System ( Final Grade Date of installation / / Permit number 3 /,S �5) State plan number Plumber's signature -- License number ! / <�� Date 3 /t /r Inspector o Complctc plot plan 1_ - Y Y NOTICE: Please providc 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. r' PLAN VIEW E l� J l � j INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count 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)]. 315957 Permit Holder's Name: ❑ Cit ❑❑ Village Town of: State Plan ID No.: STANAITIS, RICK & MARY KI &TCKIN IC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ��0� 100 To of y" P ( H; 022 - 1041 -10 -000 TANK INFORMATION ELEVATION DATA A9800345 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. ptic w _ (2S C> Benchmark 2•S 102.5 (Op Dosin ( '7 SC> c-a, g� 1 ' 02 ' 1dl•y8 Aeration Bldg. Sewer 1 Gl'•$ 2•SS Holding /Yjk inlet /o, 1 12.0/ TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air In ROAD Dt Inlet -ter Septic Sv N Il ��'� NA Dt Bottom Dosin � k l,, " jZ,' NA Header / Man. 4 0 . 7 1 8W Aeration NA Dist. Pipe g. 2-3 Hol Bot. System 10 Z• PUMP/ SIPHON INFORMATION (�� r ,, t k . --X-A Final Grade I Manufacturer 1jU( 5 Demand SA l+o / S 1 - 7 LQ� Model Number V6GPM v Z `� /oz•Nb i cv TDH Lift mwj F H Friction 5,38 System � TDHlB•67Ft L oss Forcemain Length 1 Dia. Z," Dist. To Well SOIL ABSORPTION SYSTEM B RENCH Width _, No. Of Trenches PIT No. Of Pits Inside Dia. Liquid De h DIMENSIONS l�T 1 to DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING nufacturer: INFORMATION Type Of I NJ CHAMBER Model Nu r: System: �� / OR UNIT DISTRIBUTION SYSTEM Header/ M�ifold Distribution Pi e(s) x Hole Si e x Hole Spacing Vent To Air Intake Q i Length ( Dia �� Length A.1 Dia. 11� Spacing - 30 N 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 (0 Bed /Trench Edges IZ�' Topsoil (oN K1 Yes []No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Z'6" Z -S I c Z u- 1`101, 1"J' Pov,1a�r. 5j' S vg G1 42 Font ®V� LOCATION: KINNICKINNIC 15.28.18.225A,NE,NE 394 CEMETERY ROAD �Cra►�.lour Wes r oha -� �o,�Mstote — Vtril�e� - (-1•,a,f syste►•► is 3-ti►i j„ +�yr�l0.�ee,.` We-IX r%ok rAe.- &1l%eA ak 'iv^pec+ivn . CP P L4. (fM -Za� 4wVtr ,vNO�e y -, U +GC'g rb�K Plan revision required? ❑Yes � m o Use other side for additional inforation. SBD -6710 (R.3/97) Date Inspect Signature ert. No� ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Fl A ° r 3 E a { ° 1, 1-7 ° ° 3 e Y 3 j .. -..... :q T-707 te t x d t E 3 E �w ° e. ° E ° ° E E a } t °.. ° ° °. em. as ` ,. .. In t o E 3 ,. Ar ..e ,.. .... , .� _.._.. 4 —, .. .°., ° SANITARY PERMIT APPLICATION Safe w SIgtonAve lion Vscons 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 8112 x 11 inches in size. � C- fO • See reverse side for instructions for completing this application State sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous ap I cation [Privacy Law, s. 15.04 (1) (m)). 3 y a � . State Plan I.D. Number 1. APPLICATION INF RMATION - PLEAS PRINT IN RMATION I I 1 & Prope Owner Name ye pert pkation N, R < E (Or) Ti !J/.1 /4 /: 1/4, S t,,5T �� , g Property Owner's MailinA Address Lot Number T 1 Block Number L , I L', a City, State Zip Code Phone Number Subdivision Name or CSM Number .3 g 11. TYPE Or (check one) ❑ State Owned ❑ it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms [3 Volag OF n ������� � � T >Q 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo J5- a$.I$•a54 ©22- / off/ - �p -ood 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 j 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. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System _______ _____________ Tank Only______________ Existing System ____�___ Existin�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 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure i 42 ❑ Pit Privy 13 ❑ Seepage Pit AT 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/da y /s . ft.) (Min.!' ) Elevation 4 / * I I / 4";�) v / Q L- Feet I eet Capacit VII. TANK in a g allo ns Total # of Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete st on- steel glass Plastic App Tanksl Tanks 11Z I Septic Tank kolding Tank ❑ ❑ ❑ ❑ Lift Pump Tank iphon Chamber J ❑ 1 ❑ 1 ❑ ❑ ❑ NSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: t Sta ps) MP /MPRSW No.: Business Phone Number: 55 F /(�� Plumber's Address (Street, City, Stat Ip Code): �'j , _ � IX. COUNW7 DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Age S' ure (No Stamps) ` A roved S rcharge Fee) pp ❑Owner Given Initial cao • Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (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 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. l VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. -----------------------------------------------------------------------------------=---------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings N PO BOX 7162 MADISON WI 53707 -7162 Visconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary July 20, 1998 CUST ID No.267341 ATTY.- POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN 421 N MAIN ST ��......�f PO BOX 74 ;� '. RIVER FALLS WI 54022 1,7r RE: CONDITIONAL APPROVAL ,dlt Identification Numbers APPROVAL EXPIRES: 07/20/2000 *n ri saction ID No. 118027 C01 T,_ D No. 15116 SITE: ` opp /CE f ,% w � ease refer to both identification numbers, Site ID: 15116 ove, in all correspondence with theagency. ST CROIX County, Town of KINNICKINNIC; 4 l r , HUDSON 54016 NE 1/4, NE 1/4, S15, T28N, R18W Lot: 1, Subdivision: CSM VOL. 12 PAGE 3459 Facility: RICK & MARY STANAITIS 403 HIGHWAY 35, HUDSON 54016 FOR: Description: AT -GRADE DWELLING 600 GPD Object Type: POWT System Regulated Object ID No.: 32699 P.O.) C o e submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes 1. n d and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. r DEPARTMEN The following conditions shall be met during construction or installation and prior to occupancy or use: prVlSION OF SAF • This system is to be constructed and located in accordance with the enclosed approved plans and with the Wisconsin At -Grade Soil Absorption System Manual(Pub. 15.21). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard SEE CORR by discharge of partially treated or untreated liquid wastes to ground surface or into surface waters or groundwater of the state, the owner will employ a properly licensed plumber to repair, modify or replace this system (including the possibility of installation of a holding tank with proper disposal) with such action approved by the Division and appropriate local officials. • 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, oz� DATE RECEIVED 07/16/1998 FEE REQUIRED $ 180.00 AMES B QUINLAN , FEE RECEIVED S 180.00 Integrated Services BALANCE DUE $ 0.00 (608)266 -3937 Page - of 6 AT -GRADE SYSTEH FOR A BEDROOM RESIDENCE jo, , � ® 4%) d 3,0 LOCATED IN THE N 1/4 OF THE ti(r- 1/4 OF SECTION NS , T 7 - % N, R It W' TOWN OF COUNTY, WISCONSIN. INDEX PAGE T LE 1 'of 6 IT SHEE T PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER ' PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR '�Ztck. ftk"Q� �lp-�y -ntv� n-rrl s V.T.S. u o :�" 1- Jw 4 2s "T k1l `ionally 5Lf (31(, ,0Nf E 1) OF D BU RLWNG3 ESNNDENCrz PREPARED BY �a WECEFZEF;Z SO I L TEST I NG AND DES = GN S1 I CE % sco S� •• •.•• NN NM� F.O. BOT 74 421 K. KAIK ST. , �•'� �'+� RIVER. FALLS. WI 54022 Z' AUA L. 715- 425AI65 E , W � JOB NO. + �, 2:: , ...,.,, ��:, die..:: A ,. 5' �` �< �� �� . ,� \,, PLOT PLAN Page Z of Scale 1 "= YD ' r �- `ZO $ F K U!'"1 Sv F 4M pup P LEYrTr , LS ' FtiZ -dwt lvy"ks . e � C7 dl . \ a °19.0 0 !� i 1 S / / J— i r ` NEST LQr U►Je s e-L. \00 .0 or-,3 6' RIG '' t v C ' �T4 , 3 s4.6' av) i� IRo� 0 ly � R. P wl��tl, F�C� PosT. NOTES •1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( 2- required) 3. Install 4" observation pipes with approved caps. ( 3 required) 4. - Septic tank to be\. IlSO gallon capacity manufactured by 5. Bench Marks se PMOUe 6. Divert surface water around system to prevent.ponding at the.uphill side. Page 3 of b L 5' B ? 5' >5 1 2' w A ) � T� -- 0 o — —o > 5 4 1/6 B 1 1 /6 B 1/28 A= \S Feet [? B= 100 Feet Linear Loading Rate= 6.o GPD /LN FT L= X00 Feet Design Loading Rate= o.y GPD /SQ FT W= Z1 Feet Fabric Distribution - Lateral Observation---- Jr-� , Soil Cover Well 12 o 1 ? 5 A 2' > 5' Plan View and CYoss Section of Wisconsin At -grade Unit with a Single Absorption Area on a Sloping Site Page y Of _ Perforated .Pipe DetoU 0 ' End View ) Perforated End Gap) PVC Pipe 40 Install permanent at end of each lateral Holes Locoted On Bottom Are Equally Spaced Q End Cop Q �-t * PVC force Main Distnoution Pipe Lost Hole Should Be Next To End Cap Distribution Pipe Layout P i /$ -�S 7 Ft. X 30 Inches Y 3O Inches Hole Diameter J 'Y Inch Lateral 11 ) / A Inch(es) Manifold Inches Force Main Z Inches of holes /pipe ZO Invert Elevation of Laterals '! Ft. ZQX t • l7 = 'Z3'y K 2 - - 46.80 6P1" Place lst hole from tee with succeeding holes at _ 304 intervals. Last hole to be next to the end cap. Combination Sept*..c ;Tank and _... __. P:1f!!'1P Ctl��!I�ER `GRASS SEC �I01!+17,i�10.,: SPCLFICATf0A1S . PAGE S Q 6 -VE T CAP WEATHEK PROOF Ju►JCTIOLI 8OX 4'C.I. VENT PIPE + APPROVED LOCKIMG 10' FROM DOOR, MAIJHOLE COVER ivl'M - JWDOW OR FRESH WARtUI�G Ll40EL. AL_IAITAKE S T XJD4j1 r tj c s y�1"Specna" PIPt PROVIDE LET AIRTIGHT SEAL I III V I I I A PPROVE JOINT A I I (I A pt" JOINT: A I II W /C.I. PIPE' W/C.I. PIPEaR Tank construction I° II 1 with ALARM shall comply Y I II ILHR 1;3.15 and 83.20 a I I C I I LLEY. FT PUMP -� - -jI OFF D COAJCRETE f_rLELJ • x0. BLOCK 3" APPR -s K15ER EXIT PERMIT(ED OULU IF TAWK MAWFACTURE.R HAS SUCH APPROVAL BEDDING SEPTIC SPCGIFICATIDKIS f OOSE T/oNK MAWU FACT URCR: IN1�5��, CpIJ C�Z�TE WUMBER OF DOSES: 3 • S Z PER DAy TAWK :,IZE : \ SO GALLOWS DOSE VOLUME e S S. _ S`LST �"IS INCLUDINCa 5AGKFL0W: 'q3'�o GALLONS ALARM PkAIJUFACTURI`R: MODEL IJUMBER: LO l CAPACITIES: A= 2 S IWCHE50R �O 3 ' 3 GALLOy5 SWITCH TJPC: B= z IAICHES"OR Z' 3 G(ILLOAIS PUMP MANUFACTURER —S C = �Z ILKHES OR ' 4 O GALLOIJS MODEL NUMBER: M E D = INCHES OR ' O CALLOUS SWITCH TYPE: CU\ZY IJOTE: PUMP AMD ALARM ARE TO 15L MIM DISCHARGE RATE q .b GPM IN5TALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEIJ PUMP OFF A►JO.DISTRIBUTION PIPE.. g FEET t MIIJIMUM METWORK SUPPLY PRESSURE . . . . . . . . . . . 2.50 FEET + L4 —F EET OF FORCE M IM X Y "1Y FYorr.FRICTIO►J FACTOR._ S-3c3 FEET .._ TOTAL DyUAMIG HEAD = � FEET Pump chamber DIAMETER _ IIJTLKUAL DttALWStoklt Of TAIJK: LEn1(7TH _ ;WIDTH ;LIQUID DEPTH BOTTOM AREA — - 231 = GAL /INCH AS PER MANUFACTURER — GAL /I i ME40 Series 4/10 HP Effluent and Drain Water Pumps. Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 N W 30 W L W H 25 8 E Z QQ N = 6 d 16.63 15 Q 0 4 O H 10 u6•Eo F- 5 2 0 1 1 1 1 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. l Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of Lapor and Human Relations Divrswn ofSafety & Builclirgs 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 ST` CAZZ 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. C3 Z-Z - t04]- to - lOb APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWYD BY D TE s�� PROPERTY OWNERS PROPERTY LOCATION S-NN t S 6AV E@T �1E 1/4 N 1/4,S LS T Z Qj ,N,R 1$ E (or W) PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # `103 VW 3s 1 - 0-sm Von- \Z, prtc,� 3ySq CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD v� SQgkj I.v I S OlV BLS) qZS.- g Zb k\ 1Jvj t: \--I ►.._ltv I " cam, P_311�N_1_y \Z� New Construction Use [,� Residential / Number of bedrooms [ ]Addition to existing building [ ] Replacement (] Public or commercial describe Wr GtZf�p Code derived daily flow b 00 gpd Recommended design loading rate o y bed, gp - trench, gpd/ft Absorption area required 1 S op bed, ft - trench, 111: Maximum design loading rate o • �L bed, gpd/ft - trench, gpd/ft Recommended infiltration surface elevation(s) 9!a . S cAhhovR ft (as referred to site plan benchmark) Additional design / site considerations ''T- G 1Z S S`lc�ri W / \ S ' x I Z O r$ � P o z 1'1i uV'j y� r' Parent material 6 L t\ c k Ti L 0 u i k^ s \! Flood plain elevation, if applicable t • fN - ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FlLL HOLDING TANK U= Unsuitable fors stem O S ®U ®S ❑ U ❑ S ]g 0S ❑ U ❑ S OU [IS O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed rRunch '-':i O � J I � ♦ 4 ti ff{ ' '•�� • to `1 P- 31 c, - s i 1 Z sbk wti �N s _ b - Ground 3 �-� -� S S `t R 31 y - s 1 1 s b>2 ,.n 0 h r> _ . y _ elev. ° t9n ft. �1S -�S l��tVz �! 16 � -S R Sly • 4` o n. yn _ b - Depth to limiting factor 1— Remarks: Boring # , 1 0 - 10`1Q 3 t 3 S Z`F wt�h �S •b Z < 2 8 Z-3 1 o1-t 2 31(, _ s ; Z Sbk v*L'�h - Ground _ elev. ft UU -63 t0`1Nz- Sl(, - �•SkR 51$ � m S �� Depth to -C�tJ of: ►o `i �. a P limiting factor :. � �•[ 1 . - t ' . to �:. , Remarks: n , CS T Name-Please Pn t Phone: , Arthur L. We erer 715 -425- Ad dress: Soi Testing & Design Service-P.O., Box 74 River Fa11s,WI 54022 Signature: �if qa `L Z � Date: _) _ ] ` g C9 CST Number: u2:r. t M00576 PROPERTYOWNER 4 `; ^ " SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. # 0 Z �I Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bourxtary Roots � in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench El o - t0 tZ' �z 313 — si 1 z�s�1� m cs • f, _ Z 10 - Ground 3 zs 39 - I • S y R y/y s 1 cS b1T Yn V CS -4 ° - elev. 1 ft. 39 - �.Stitiz � ��.SKR 5 43 Sc1 pw� w►�i — ►JF Depth to S bZ_69 l0`[ R V /L limiting factor G H S mJz — c i i Remarks: Boring # 13 i Ground elev. ft. Depth to limiting factor Remarks: Boring # L73 Ground elev. ` ft. Depth to limiting factor Remarks: Boring # E3 Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PLOT PLA Page 3 of 3 SCALE 1 "= �+c1z v� Y SrwriN - VI s �, PLO � oZZ_LDy� - t0 - too HUvJS Tb P?�_ L"ST ZS' Or - S'ZSTE" _ 1 m ' n �? B.z.. .r r� 0 � J I I � I 1 ®Y L - Lr . wo.o' ory 4 "HIGH, Q 84�6'o�v ) ' 314" vi v-,-- W / sT L ( ?, I � c �Z,d � l � �` t (715 ) 425 -n� r;5 M 00576 CST Signature Date Signed Telephone No. CST # wsaonsi, Department of lndusay SOIL AND SITE EVALUATION REPORT P of Labor and Human <Relations Division of Safety & Buildirgs in accord with ILHR 83.05, Is. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but vertical and horizontal reference point BM direction and % of slope, not limited to v po ( ), scale or PARCEL I.D. # dimensioned, north arrow and location and distance to nearest road. ZZ - 1.041 ltJ - 1 m APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVI BY DATE Ob PROPERTY OWNERS PROPERTY LOCATION 691FF:{9T ME 1/4 NE 1 k T 2. R ,N,R 1% E ( W �ztic�. .0 � � � tv i� 1. t s °� PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # \A 0 3 \w` 1­L 3 S _ C SM Vot_ \-, Qnc : yg CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN I NEARESTROAD v� SOf.j I tj 1 S wC nLS) LLIS:- 9 V6 1,Nu 1. \m) QJ J New Construction Use Residential / Number of bedrooms [ I Additi( r? to eAsting building (I Replacement [ I Public or commercial describe 'STt' - 6R,PCp Code derived daily flow b oo gpd Recommended design loading rate 9 • y bed, gpd/ft - trench, gpoltt '�'- 6���. 2 0 2 - 2 area re 1 S oo bed P - trench ft Maximum design bad rate _gi bed, gpd/ft trench, gpdAft Absorption eq 9 n9 Recommended infiltration surface elevation(s) 9 i3 - S cZhTtovR ft (as referred to site plan benchmark) Additional design/ site considerations �'fT- G 2Wtj S 4 S`rO 1 W / \S "X 1 Z o" PfBS o Z-l-ll uvJ I�IgA Parent material (S Lf1c k V) L 0 U T %&^a 'V� Flood plain elevation, if applicable N - A - It 7MUnsVuitW1b Suit able em CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLING TANK ❑ S ®U ® S ❑ U ❑ S [gU O S El ❑ S oU [3 S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundlay Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tTwIch CS zY'� < >�<�� Z 8 - ►o `1 cL .31(, - s i l 2 � sblz v� `�1- c S _ • b - Ground y - elev. aft. 4 l qs - - �. \b - A V 16 �� -S k R Sl . ,�` o,�r, v�v ►� - • b - Depth to limiting factor •� S Remarks: Boring # SLR z�sb� W-A- eS •toi - Z o- Z g -Z3 lo�ctZ 31 - s;I - y> 3 z - )'S`m yly - al ��bk mv `�►- cg \4:: - Ground c el Oft y Uy -63 1o��z sl(, -�.S� -tR s/g `Fs o� mv`�1- Depth to limiting factor Remarks: CS T Name: Please Print Arthur L. We erer Phone 715 - 425 -0165 ress: egerer Soilk Testing & Design Servic 74 River Fa11s,WI 54022 Signature: q g ` Date: CST Number: 1tT✓ 4 '7 1 �9 M00576 i PROPERTY OWNER S ^c.� " 3 SOIL DESCRIPTION REPORT Pa Z- f 3 Page o 9 — PARCELIA# 0'ZZ - Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Baxxkyy Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. . Bed Tmr& 13 Z lO ZS Izm ft- 3/6 Ground 3 25 - I , S `v R y/y S 1 cS b1T Yn U `F h cS -- • `f elev. 0 16.1 ft. 39 -6Z -Sti1Z y/y 71 .SyR S��3 Sc` ptih w��i _ ►JP Depth to S 6-.-69 1 O`2 R- y /t, — limiting factor — E Remarks: Boring # f i I Ground i elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: Boring # i I Ground i elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) P L O T P LA N Page 3 of 3 SCALE 1 "= Nvo V ozz - - to - I oo �1v� ti� PiA' S ST z. PI cnz 4 sYS7�x_m - I1 1 a n 0 13 -L i� PlP� = qa. e - L�l9� �•� o'� i s 1 Cl am i1 _L �, wu.o' ory 6t�ittGN, qL, sq.(.'ory )' /y'`1Ro� 0 3f y`' �1R. Svc P1v� Ptpe w /smzeL. ° ( 715 ) '42.5 -C_j fi5 14 00576 CST Signature Date Signed Telephone No. CST # wisconsin Dop artrnenl of Col-1 SOIL AND SITE EVALUATION Div,isiryt of Salety and Buildings Page of Bureau -of Integrated Service; in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than B 112 x 11 inches in size. Plan must County I, include, but not limited to: vertical and horizontal reference point (BM), direction and 'S4 6ro� percent slope, scale or dimensions, north arrow and location and distance to nearest road. parcel I.D. # o� - /0j I -- APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may he used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). — — Pro rty Owner / Property Location it M Govt. Lot 1/ 1/4,S l �T o 28 ,N,R �g E (or) W Property Owner's Mailing ddress Lot # BI k# Subd. Name or CSM# ty State Zip C de Phone Num er FV No rest Road ❑ City ❑Village Town New Construction Use: ❑ Residential / Number of bedrooms 3. `t' Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: / Code derived daily flow gpd Recommended design loading rate _ bed, gpde ' to trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpd/fl trench, gpolft Recommended infiltration surface elevation(s) ft (as referred to site plan b7ch mark) Additional design /site considerations N r0 lo 2 (j r ir Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S 9J U M S ❑ U ❑ S 5�v �aS ❑ U ❑ S 1 4 U ❑ S &1U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft Texture Consistence Boundary Roots a in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground S G elev. ft. Depth to IbVk limiting facjW Remarks: v 6 A �, w/ li-hla�ht J v q�_t A AAtS ' k' SAFETY AND BUILDINGS DIVISION 291 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 Visconsin Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary At -Grade System Qnsite Verification Report Are the soil and landscape features accurately reported on the Soil. and Site Evaluation Form yes no If no, provide a further description by including an onsite report, which may consist of a soil profile report, or provide a brief explanation below. If yes, what other type of Private Owned Waste Treatment System (POWTS) could be used? 6900 k j e O 11' a 4 1 1; i/ -/( _ a- County Officio7signature Date A��Ii �\W' �(/ , kc- IL 16V Property Location 'q�, �ajX C00V'7 a � 6'�\ ' " J Landowners Name SBD- 10513(N.11/96) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buycr T. 17 '� Mailing Address Property Address 3 94 C 2 (Verificatioa required from Planning Department for a w coastcuction) City/State AA Parcel Identification Number ;1L - j 4 4/1 -16 -- O 6r) L EGAL DESCRU ON Property Location `V Sec. �2 � � T � N -R W, Town of Subdivision Lot # J�© Cerffied SSaiv Ma # S� c l % �l 1. 2- 3 eY P Volume _ , Page 9 yS Wxrzaatp Decd # - 5 7 7-P Volume _ / 3 3 � . Page # Spec house 0 yes'm no Lot lines identifiable J@ yes 0. no �!b'1E1���IN�NANCE - DO " = d of3m s ys tcmcoddresultisitspm= tcuicfaff =tohn&cwastes.Proper=nt=we o of pampmg out the UP& tank cvay gmoc yc= or tooncr if needed by a hoensad pamper. What you pat inato systan eaa affoct.tbc fiumction of gee septic fimk a bestmeat � .ia gee vraste disposalsystCtu, Tbc properw-owns ap= to urlttnrit to St: C rok T.caimZ Dcpuft cat a eaffumlica form, signed by the ow= and by a �Tkm*cr7onmeyomP mstdcWpb=baoraUc = cdpmmpave fyiagt bat( i)& Co n-siterivasGcaPatcrcspasatsgst ism PwPez op=ting oondit,'on audlor (2) after mVcctioa rued pwnxpM (if necessary). gee septic tan(cis I= than In 'full of sludge. Uw"-' ge =mdaxignedliM - &e above regnirememts and a&= to maiatsin gee WM to sewage d4oal sysOcm wigs gee steaduds $ct f i. b=ia. gas set by tie t of oomma:oe and &c Dcpartmeat of Natmd Rcso=cs; State of Wi9ooasiu. 0a04cati6a :tasting 69 your SRAC system has been maintained most be eompIcted and rearmed to tErc St. Croix Camny Zoning Office wiitbia 30 days- gee a= year expiration date, SIGNA F APPLICANT 7l V / f t DATE Off• CELtZTRIC MON I (wc) oatify that all statcmcnts on this form an true to &c best of my (our) Iaiowledgc. I (we) am (arc) the owner(:) of 6mccbed abort by virtue of a sfa nmy deed recordod in Register of Deeds Offi ll= APPLICANT DATE ssssss Ay W om mim that is mis-rqtrscaW=y tarujf in the sanitary pcnmit bdug rovokad by the Zon Department. ssssss s. Indade with this application: a stamped warranty doed fiom the Register of Deeds office a copy of the certifiod survey reap if scfcma4N^ is made L- t , warm itt ; decd } DOCUMENT NO. w:sarlrr DRED Gerald ltz and Jean E. Emholtz, husband and wife, Graotaw. conveys and warrants to Rick e. Stanaitis and Mary V. Stanai.tis, _ husband and wife as survivorship marital property, Grantee, the - following described real estate in St. Croix County, State ofBjIt W16 � Wisconsin: its? Gzt ri Gn k.eewl That part of NE 1/4 NE 1/4 Sec. 15- T28N -R18W described as follo+es= Lot 1 of Certified Sury -.y Nap recorded in vol. 12 of Certified Survey leaps, 1 4 A page 3459 as Doc. No. 579996. J UL ♦ 9:30 q { T � • Oa y � NAMS 1100RBS8 .d / i / e )• L • � a DAVID J. ESTREEN 304 LOCUST ST. HUDSON. W1 Wj 6 022 - 1041-20 -000 Pazcel This is not homestead property. IdentificaL on Number (PIN Exception to warranties: All easements, restrictions and rights - of - ray of record, if any - Dated this day of June, 1998. (SEAL) (SEAL) tz (SEAL) (SEAL) jvh S. Eeho to ADTHR ICATION ACKNOWLED0IZR Signatu -4(a) STATE or WISCONSIN ) as. COUNTY ) authenticated this day of 19_ ly !ame before me this _ day of 19 jLbove named ;eradd o tz awn Jean B. tz . husband e a a e ton(a) who executed the • IFOXV90 s! in d ledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, Y authorize by 4706.06, W e. Stets IRIS INSTRDNEWT WAS DRAFTED M Notary Publi C" County, Win. Joseph D. Boles My c saisston 11a peVhanent. (IP not, ration date: _ � Rodli, Beaker, Boles c Krueger, S.C. P.O. Box 138 a River Palls, WI 54022 �_ 7 FILED J U N 1 1998 2i n 00 A KATHLEEN H. WALSH 31 Register of De:ds SL Croix Co., W1 JUN 2 5 P C ER TIFIED S UR VE Y MAP GERALD EIVIHOLTZ St. CROIX COUNTY SURVEYOR'S RECORD Pare of iheA / -4 of [he Noriheasl 1,14 ol'Section 15, 7�)ijwship 28 North, flange 18 West, Town of KiwliCkilMk, Si. 0 ( '011111y, WiSCOtUill. N E C OR. SEC. / 5, r 2 8N. R /S N // 4 CD R. y C c. / 5, r 2a N , UIVPLA rrED LANDS t2 " IRON P/P.- FOUND) R I & W. I "IRON R/Re FOUND) I --X / 0 78. 0 3' --"— 2 FENCE N 88 07'07 "E 2676. 9 N LINE NE 114 �`� 538.03 33.02' 140. 17/. 33 33 6 1563.89, 5 of L 0 7' LOr2 ILrl 00 ,/00' 1.590 ACRES N 243 506 N 4.101 ACRES N , � O� I �� q b I V ti 01 so.rr. 78, 820 so. rr. 5. 464 ACRES EXC. ROAD CAscmEmrs 3.869 ACRE'S FXC. ROAD EASEmEm r'T (n 6 8, 52 6 SO. F r. 238, 028 so. Fr. 5J9.23 1 4 3 72.2 N -j Lw 50 N87-53'57"E M2.59, (k L.� N 5 539. 4 0. 09' 5 3 9. O 572. 50 /079 L074 N a J. 713 ACRES > L 0 7' 3 - N 161, 7.28 SO. F cp— y 8 7 - 5F3 N 1 , 103. 1r 5.533 ACRES 00 3,531 ACRES FXC.ROA0 170.56'33.02' 1 24 025 SO. Fr. 4 O EASEMENTS 1. ACRES EXC. ROAD EASEMENTS 1 z , /13,806 so.r r. 1�.-70 235, 539 50. Fr. 3 I:i , "E 4. (�6- 8. MeJ 0 G) (D 10 0.1 5 8 7 7 W 4 40 0 /o/.Oz, 0 0 N 89'3 "W Zq 6.18 8 7 .53'57 "W 460. 50 R I N 09 • 3 8'W) UNPLA r7 LANDS Dated: December 10, 1997 "Revised this 22nd day of May, 1998." Owner's Address: 4j 1250 C.T.H. "J" E //4 COR. sec. 15, r2-8H, R18W River Falls, WI 54022 tcoulyrr SURVEYOR'S MONJ LEGEND: Ro Previously recorded data. 0 1" X 24" iron pipe weighing 1.13 lbs./lin. ft. set. R • 0 1" iron pipe found. L A U 1 0 , , *. = Z RrF, ro THE w - 1y W A LL 8EARIIIGS CA s r L lIve or rH E M CD N E // or s c c. 1 5, r 28 &, S 13 R I R W, ASSUMED RIVER FALLS 00 j F9 w I S C. This instrument drafted by Laurence W. Murphy N SCALE I" r 200' aurence W. Murphy 0 io 100 200' 300" 4 00' 500• 600, Registered Land Surveyor CURVE DA 7 I/NG CHORD DIST. A RC D1sr. R A 0 1 U S ce N rR A L ANG 15 r TAN. BEA RING 2ND rAN. BEA 90. 77' 9/.37' 2 DO. 00' 26'/3'57 S87'53 '.17"W 561'40'00"W 128.88 130.0/' 283.97' 26• /3'57" S'61 * 40'00 "W S 07'53 '57"W .9d. 93 99.80 2/ 7.97' 26'/ 3 ' 5 7" IV 6 7 '53 '57 "C M61 *40'00"C 120.71 2 /. 79' 266,00' 26 N6 /'40'00 "E N87 V 5HEE7' / OF 2 0a OL 12 PAGE 3459