HomeMy WebLinkAbout022-1075-60-300 . t .
ST. 0WIX COUNTY TONING DEPARTMENT
AS GUILT SANITARY REPORT ^�
Ownerk CE
Address City /State ) t
UN'ry r`
g '.�1NGOHFjCr-
Le al Descri �.
Lot Block — Subdi ision
��
/CSM #
IV Iff '/, SC '/, 1 Sec. 2!Z, T N -R R W, Town of rrt PIN #
S�
SEPTIC TANK -- DOSE CHAMBER — HOLDING TANK INFORMATION:
Tank manufacture �I d�J� Y dl$ize ST/P& .9661 ��6Setback from: House R6 Well P/L
Pump manufacturer 660 Model f6
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: A + lh k Width G G Length Number of Trenches
Setback from: House 2�! Well - P/L Vent to fresh air intake ;> 35'
ELEVATIONS:
Description of benchmark 1`R i 3c> �p� /bG,� �Dd� / S �l� Elevation
Description of alternate benchm k a a r i° Elevation Ato.
Building Sewer 7 7� �� ST/HT Inlet 9, 0 01 ST Outlet PC Inlet
PC Bottom 2 S � W Header/Manifold Top of ST/PC Manhole Cover AI)c2f 3
Distribution Lines(
Bottom of System () () ( )
Final Grade ( ) ( ) ( )
Date of installation 1 /G�Permit number rs State plan number Fqr7`�
Plumber's signature License number 9 / Date 7 J/
Inspector
comploc plot plan +
y
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
.�.�► io" Dta �uee
o?o'- a�1M
qeu ?it I.? P
jaoogal se�t«
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)]. 315999
Permit Holder's Name: ❑ Cit �� pp Villa e Town of: State Plan ID No.:
SPEAR, GARY & BETTY KINNICKI IC
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
16D ( pp 6l�( 022- 1075 -60 -300
TANK INFORMATION ELEVATION DATA A9800391
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ; �v�u 12 oza Benchm 5 5 Jos -(� / oo .i
0,61v\, gyp ?
Aeration Bldg. Sewer b of q SS
Z r' •
Holding gt Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet
irl
eptic I g' �'jc� NA Dt Bottom
Dosing 37' NA Header / Man. x, �Oa
Aeration A Dist. Pipe
Holding Bot. System 3 g ,
PUMP/ SIPHON INFORMATION r , 1 Final Grade
Manufacturer C�ou a Demand
Model Number -71 �j � GPM
TDH Lift Lriction S Syetem2r DH () U�t ad
Forcemain Length 7�r Did. 7 Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width lo Length No. Of Trenches PIT is Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SETBACK
SYSTEM TO P/ L BLDG I WELL LAKE/ STREAM EACHING Manu r:
INFORMATION Type Of d/ �/ CH mber:
Y
S stem:�f OR UNIT
DISTRIBUTION SYSTEM
Header/ Mani old Distribution Pip (s) ,� x Hole Size x Hole Spacing — Vtn fo Air Intake
� i �� ,
Length _ Dia - Length Z 7. g Dia. f
I ' 1.1 Spacing -- J 3
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 ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: KINNICKINNIC 27.28.18,NE,SE 149 COUNTY ROAD1
C ql,2�
P
lr�v vision required? ❑ Yes Aq No
Use other side for additional information. ?� /
SBD -6710 (R.3/97) Date Inspec is Signature Cert. No
i
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i e
r
w.
F
e
E
i Y
a
Safety and Buildings Division
V SCO/1S %/1 SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, Wl 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less county
than 81/2 x 11 inches in size. ST C�'vZ�
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for secondary purposes T E] Check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)). / C''fy. . A RC1 . JUT State Plan I.D. Number /I
I. APPLICATION INFORM � - / LEASE • P RINT ALL INFORMATION — S�1'/ 7
Prope Owner NairnjD "7 Propert LAation (�
6ak e '4t r14 1/4, S T9? , N, R/ E (o W
Property Ow is Ma Ang Addr s L t N mb Block Num r
C 6tate 1 Zip 0 F Q�yeJ.lurt] i Subdivision Name or CSM Number
(� /
II. TYPE OF BUILDING: (check one) ❑ State Owned o C a Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms Town of r2 t � 11�'I EC
III BUILDING USE: (If building type is public, check all that apply) Parcels lyy�rn6��
1 E] Apartment/ Condo A7. O1 l9 4 a o D OJJ
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.((°°)I New 2. E] Replacement 3, [] Replacement of 4. E] Reconnection of 5. C] Repair of an
...... System ........ System _____________ Tank_ Only______________ Existing System _________ExistingSystem
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 30IRSpecify Type 41 ❑ Holding Tank
12 []Seepage Trench 22 ❑ In- Ground Pressure __11 42 ❑ Pit Privy
13 ❑ Seepage Pit ` 43 ❑ Vault Privy
14 ❑ System -In -Fill 10' A /oo
VI. ABSORPTION SYSTEM INFORM of
ON: 102-1 C
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
L OD Re�itg(�q. ) r osed (sq. ft.) (Gals/dy/ (Min. /inch) Elevation
v2- ��(( 6aD v� / X, oc 2, Feet Feet
1t a
VII. TANK in Ca allo
g Total # of Prefab. Site Fiber Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanksl Tanks
Septic Tank o olding Tank Qa ` 4t>T / 1:1 El 11 1:1 E]
Lift Pump Tank phon Chamber ❑ 1 ❑ 1 ❑ ❑ I ❑ ❑
V NSIBILITY STATEMENT
I, the undersigned, assume responsibilit f r installation of the onsite set shown on the attached plans.
tier's Name: (Print) PI ignature: (NQ S s) MP /MPRSW No. Business Phope
lumber's ddr a Ci Zi Code):
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuinja Signature (No Stamps)
A roved
® Pp ❑Owner Given Initial ?J�o Surcharge fee) � > gl2�j
Adverse Determination /!
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11197) DISTRIBUTION: Original 10 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.
11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
Ill. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.—.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 81/2 x 11. inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on? 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
n LA CROSSE WI 54603 -1905
,sconsin Tommy G. Thompson, Governor
Departmen o Co William J. McCoshen, Secretary
June 04, 1998
CUST ID No.267341 ATTN: PO US INSPECTOR
WEGERER SOIL TESTING & DESIGN
421 N MAIN ST
PO BOX 74
RIVER FALLS WI 54022
RE: CONDITIONAL APPROVAL Transaction ID No.,W74
APPROVAL EXPIRES: 06/04/2000
SITE:
Site ID: 9848
St. Croix County, Town of Kinnickinnic
NEIA, SE1/4 & SE1 /4, NE1 /4, S27, T28N, R18W i
GARY SPEER
FOR:
Description: AT -GRADE
Object Type: POWT System Regulated Object ID No.: 24952 ,
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:
• 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 by discharge of partially treated or untreated liquid wastes to ground surface or into surface waters or
groundwaters 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 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. Adm. Code.
• 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(d), Wis. Slats.
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 /instal lation/operation.
WEGERER SOIL T ?STING & DESIGN Page 2 6/4/98
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.
Sincerely, -.
DATE RECEIVED 06/02/1998
FEE REQUIRED $ 180.00
GERARD M SWIM, POWTS PLAN REVIEWER FEE RECEIVED $ 180.00
Integrated Services BALANCE DUE $ 0.00
(608)785-9348, MON - FRI, 7:15 AM - 4:00 PM
JSWIM @COMMERCE.STATE. WI.US
Page 1 of 6
AT -GRADE SYSTEM
FOR
A q BEDROOM RESIDENCE
'N E— s Z AtivD
LOCATED IN THE S�_r 1/4 OF THE ue 1/4 OF SECTION z ,T N, R It W,
TOWN OF ST'• HOLY COUNTY, WISCONSIN.
INDEZ , �
PAGE 1 'of 6 TITLE SHEET
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
PA GE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
G -`.t 1wvo B �TTy SP
1004 Q v'p,�R-Y R o �fl
`2.1UOZ Fl tk.S, W 1
RECEIVED
JUN _ 2 1998
FIM `A= BY SAFETY & BLDGS. DIV.
WEGEERER SC3 I L TEST i I
AND . �0�NeeeNt
I3ES IC G1\1 ST_=Rw i CE ®�
P.O. BOX 74 421 K. KAIK ST_ o� .�►�5••'..»..••S /�
P.Q.W.T.S. RIVE_ MIS. MI 54422 � ARTHUa =
Conditionally 7l5- 445 a9 -0165 i WE1 p '
!
K�SWOHrN,
A PPROVEDc wrs
DEPARTMENT Of COMMERCE '••••••••''
VISION 4 ETY N B NGS "� -4 'S I G l; A
�BKlilMN��
SEE CORRESPO NCE
JOB NO.
PLOT PLAN
Page ZL of
Scale
P
•
>+ z 10 o►J Sptk@
%V, ' � , -rsove 4,;W*z
OL
1
���[[[/// ptuuk\� 1�Q:.l�w�{ 4� ®*-►mot -+�. �oo.a o.t s4tke
ms�ewl- 30" �o�F Ci wavr.rfl
I ' ��Y
�Ll�lp 9 p. t( B.S
\VQ
LZ
_ - 22' = I CA1�7SOVR
EL. V ta;Z tim Yt
—
j S
tU o � y�Pvc B.\
- 7
WK
• � 1L � g 3 8.2.
2 a-
W�ZL ZO LA R'f LeA ST' To FR4A1 S`ts Pt►v�
r U`tN� ZS' Flro 1 Tfyvk.
NOTES
-1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( 3 required)
4. Septic tank to be vzuo J 8oio gallon capacity manufactured by
5. Bench Marks S ZLT f wj tz I
E!
6. Divert surface water around system to prevent.ponding at the uphill side.
Page 3 of 6
i
L
> 5' B > 5'
> 5 - 2'
-F1 --------------1------------
W A
I L -0 -0- -0
>5
1/6B 1/6B
1/2 B
A d Feet
B= Feet
Linear Loading Rate= �� GPD /LN FT
L= 1l0 Feet Design Loading Rate= o,6GPD /SQ FT
W= Feet
Fabric Distribution • Laterial
Observation U, , �� -Soil Cover
W e l l 12
Plan View and Ccvss Section of Wisconsin At -grade Unit with a
Single Absorption Area on a Sloping Site
Page H Of —�
Perforated Pipe Detail
0
' End View
) Perforated
End Cop ob\cy` PVC Pipe
•
Install permanent
at end of each lateral
Holes Locored Oo Bottom,
Are EQuoNy Spaced
Q End Cop
* PVC Force Main
Distnoution
Pipe
Lost Hole Should Be
Next To End Cop
Distribution Pipe Layou P Ft.
X 1 1 O Inches
Y I Inches
Hole Diameter J/y Inch
Lateral ) / IV Inches)
Manifold Inches
Force Main Inches
# of holes /pipe
Invert Elevation of Laterals to 2.5 Ft.
Place 1st hole tee with succeeding holes at 3� intervals.
Last hole to be next to the end cap.
Combination Sept;c-...Tank and
" PUMP CHAMBER CROSS SE_CTIOIJ, AID SPECIFiCAT10I�IS ' PAGE S OF 6
- VEIJT CAP �f WCATHEK PROOF
juUCTIOU box .
'i'C.I. VENT PIPC APPROVED LOCKIMG
lO' FROM DOOR, MANHOLE COVER wIV
AL IMTAKE t .ilU00W OR FRESH wP+ttt�ltJG LIBEL..
cowuu>tT
/
y PII�t PROVIDE I — - --
• IIJLE T - — '[ - AIRTIGHT SEAL
3ta> =FEES I APPROVED JOIA,T:
APPROVED JOINT A
W /C.I. PIPF�t
W /C.I.PIP6OR Tank construction
shall comply with ") II ALARM
ILHR 1;3.15 and 33.20 a I
C
�u. e� I
LLLv. FT. PUMP OFF
—� - -�
0 COUCRCTE
Z,
q BLOCK
3" AAPR
RISER EXIT PERMITTED OtJLy IF TAIJK MAUUFACTURCK HAS SUCH APPROVAL BE40tNG
SEPTIC f
SPECIFICATIOhJS
DOS
UK MAIJUFACTURI~R: ` �JG�t'�`tJ P AZ- IJUMbF -R OF DOSES:
TAIJK SIZE : " GALLOIJ DOSE VOLUME r t/
ALARM MAUUFACTURCR: � ` � rJ�`r
INCLUDIUG B ACKFLOW: �o�' 7 GALLOWS
MODEL WUMBER: `�l »'y CAPACITIES: A= Zp IMCHESOK GALLOtJS
SWITCH T�IPC: " B= z IUCHES OK L4 1 * ` G�LLOAIS
PUMP MAIJUFACTURCK: yOV `DS C- IIJEHES OR 1 b 8 ' GALLOUS
MODEL DUMBER: '671 e,;P'QI-f D =INCHES OR 16 GALLOWS
`row _ -iol 4.q
SWITCH TYPE: 1��: c�.Y W TE: PUMP A ALARM ARE TO BE
MIIJIMUM DISCHARGE RA TE � GpM INSTALLED OU SEPARATE CIRCUITS
vERTiCAL DIFFERENCE DCTWLCIJ PUMP OFF AUD.DISTRIBUTIOU PIPE.. -1 FEET
t MIiJIMUM WCTWORK SUPPLY PRESSURE .. . . . .. .. 2.5� FEET
ZO FEET OF FORCE MAlN K Z ' ,
F Y FEET
F/1GTOR.. -SS FEET
TOTAL OtJUXMIC HEAD = � $`3 FEET
DIAMETER
N
Pump chamber r
IUTERWAL. DIMEIJSIOLI� OF TAUK: LEIJCGTH ;WIDTH ;LIQUID DEPTH
BOTTOM AREA `— 231= GAL /INCH
AS PER MANUFACTURER -- Z -DS GAL /INCH
-
. Goulds nfvc,E 6 0>= 6
Submersible
Effluent Pump
lJ
EPO4
-- EP05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas-
• Homes components. Available for automatic and tic cover with integral handle
Motor: and float switch attachment
•Farms manual operation. Automatic
• Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points.
g
115 or 230 V, 60 Hz, preset at the factory. 1550 ■ Power Cable: Severe duty
• Water transfer RPM, built in overload with Float Switch assembled and
• Dewaterin rated oil and water resistant.
automatic reset. ■ Bearings: Upper and lower
SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing
115 V, 60 Hz, 1550 RPM, construction.
Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo-
* Solids handling capability: automatic reset. plastic Semi -open design
'A maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING
r - • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Q Canadian Standards Association
• Total heads: up to 24 feet. with three prong grounding
■ EP05 Impeller: Thermo-
• Discharge size: 1 /z" NPT. plug. Optional 20 foot (CSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".)
rotary/ceramic- stationary, three prong grounding plug improved performance.
BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature: thermoplastic design provides
104 °F (40 °C) continuous superior strength and
140 °F (60 °C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET,
stainless steel. to
• Capable of running - -- - -- - - -- - - -
dry without damage to s 30; -= — .�f sGPM -
components.
Pump: EP05 8
• Solids handling capability: 0 7 25
3 IV maximum. w - -- —; -- - - -' -- - - - -1 — - - - • Capacities: up to 60 GPM. X s 20
• Total heads: up to 31 feet.
• Discharge size:1 V NPT. z 5 - - - ---- - - - - -- - -- - - - __ - _ - - • Mechanical seal: carbon- }
is
rotary/ceramic - stationary, a 4 1 I
— i — — -- -- -- - EP05
BUNA -N elastomers. o _ - --- - - - - �o �S
• Temperature: 3 10
104 °F 40 °C continuous I _
( ) ;
140 °F (60 °C) intermittent. 2 - - -- -_. - -- - -� - - _ ___ �•� EPO4 -- _ -_ -- 1 - - - --
j
5
i 0 00 10 20 30 40 50 GPM
0 2 4 6 8 10 12 m
CAPACrrY
®1995 Goulds Pumps, Inc. Effective May, 1995
RQR
Wisconsin Department of industry SOIL AND SITE EVALUATION R E P O R T
Labor'and Human Relations Page 1 Of 3
Division of Safety & Builclings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. I h) C.
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R ED BY D TE
3
PROPERTY OWNER: PROPERTY LOCATION tip
wv` - LAS = ( Sm l y Rub S eT S 1/4 ►Jir 1/4,S - n T Z8 ,N,R L a E (or�
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
Lo64 QUwM2zy 3 — V. , �14ar�Sqj, cs
CITY, STATE _ ZIP CODE PHONE NUMBER (]CITY []VILLAGE WrOWN NEAREST ROAD
C�LU t - tr1lS V•v► S \1 oZ DDS) qzS. ZBS11 I �,\1�QJ (z lf)M .0 I CTv} " SS'
[y4 New Construction Use [X] Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 00 gpd pv � � Recommended design loading rate bed, gpd/111 gpd, L
Absorption area required — bed, ft2 \o,a #eael# ft Maximum design loading rate - bed, gpd /ft2 b treflch, gpd/ft
Recommended infiltration surface elevations) • t. \p Z . S ' it (as referred to site plan benchmark)
Additional design / site considerations _ NZICZr%vn 1 F 1 rT- C_7tty gtr S`tST -j - ZZ ` x 1 1O' LAN G - Qz�-In\aa.L02. o
Parent material Flood plain elevation, if applicable t,3, N, ft
S = Suitable for system CONVENTIONAL MOUND tWGROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem 0 S (RU ®S ❑ U ❑ S fB U ®S ❑ U O S ❑ U ❑ S W11
SOIL DESCRIPTION .REPORT _ G`e
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou Clary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
o - 3LZ
9 - LS 10 ��Z 316
Z _ — `�s 1 abk �, s cS -
Ground 3 L S -14 LO `'l R Sl 1 b s r► C
elev.
V ol. - I ft. `f yo -6L 10 `t 6 13
Depth to
limiting
factor
Remarks:
Boring #
'A 'L
Z .a Z B I 1 `12 3I _ `tS 1 gab YW -
-F
Yitpi ?ikkiiiti
3
[ ZI 40 L O`IfL A 'M c.tv _ •6
Ground
elev.
L - ft U -6 S ) b - fiz 613 - S Ik S )I& '
Depth to w z - l w " Ks_�/
limiting �` w -I it s 1 t Yn VT'C_Z1
factor
Oy
Remarks:
CST Name.—Please Print Arthur L. We erer Phone. 715 -425 -0165
egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022
Signature: l Date: CST Number.
M00576
i
PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of
PARCEL I.D. # n1 C
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
. Fla
�: 1 6 ti� � � t Z — 1 �s � �- able � v `Fr °�- s - • �
3`
Cable' y
Ground V) `1 iZ yf�
elev. 1
ml,9 ft. S S v3 `I1z._6 13 - •S ` V- S 1 S3 S o-n
Depth to
limiting
fa
W i
I
Remarks:
Boring #
0 1 0`12 312. _
�o � tZ31L
...,.w. S::s
Ground '
slay. _
�J -60 l b`1 fL 6 �� -�, 2 S 1$ `�S n w. Vh \A�
V M-i ft.
Depth to `
limiting GTE �� W0 �- S 3"
factor
Remarks:
Boring #
��. ti 1 0 -� tib X1 _ >�` 1 � bn � v'� �.S -- •�
3 S - \{o tO , i IZ y /6 o S9
Ground
1 1 ft. '4 q 0` -S9 10 `1 R 613 c - I -S � R S /$ �S � �'►� Y61 V`� — • � i
Depth to
limiting
factor
\4 W
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
PLOT PLAN Pa a of 3
SCALE 1 "= L( ) '
3r"1 ►� z _- x.100. \'� SpFlc@
r zz." t�'8pv1 �iRa�+w
v
R- �l�►�/(f�{ 4 mw1�1 - �o0.p oN S4t1ce
° 1 S0� � 'T'0 CgUt�M 1 3'S 4 CF- `�o7'ZU sCtcc�� �►•� W� �
�►oo� p.y s.5
1
�Va `
�• � _ = l cA,J�ovR
22'
i PIPE _
j d
woOd�b
B. \
p g
(r 9 L- 1c�3
!{ 10 lm--; tCT LJE� Zs' C-"Ij Ri -GR^ble
W N- L
q� -1,33
Z,7- 9 f l (715 ) 425 -0165
- 1400576
CST Signature Date Signed Telephone No. CST #
"sconsin% arT oflndusby, SOIL AND SITE EVALUATION REPORT Page Of 3
• Labor and Fluman Relations
Uwis:gn of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code
c COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. 0
dimensioned, north arrow, and location and distance to nearest road. PfOl) U a
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION Nlt-SQr PKID
( S my S GAVT-±0T SE 1/4 ►,NQ 1/4,S 27 T Z8 ,N,R E
PROPERTY OWNER' - .S MAILING ADDRESS LOT # [ KE - KK x SUBD. NAME OR CSM #
lop4 QUft'IZ-zy _kZWb 3 Cs
CITY, STATE _ ZIP CODE PHONE NUMBER QCITY OVILLAGE MrOWN NEAREST ROAD
C VW, !K V PCLLS G01 S \[r,ZZ 0'S) qZS - ZaSa k\ 1.11,1tC \z►,FJ7.1tC C.Tb} " SS A
[yg New Construction Use N Residential / Number of bedrooms (] Additign to existing building
(] Replacement [ ] Public or commercial describe
Code derived daily flow DO gpd p _ � � Recommended design loading rate bed, gpd/ft �° treasb, gpt�
Absorption area required - bed, ft2 \,3,a,3 #erg ft Maximum design loading rate - bed, gpd /ft �° trenctr, gpd/ft
Recommended infiltration surface elevations) oAST • pt� k!1 'o Z . S ' ft (as referred to site plan benchmark)
Additional design / site considerations S`tS�T '_j - ZZ , x L l0 ' 1;11116- CZQ v'ZLa.102 0
Parent material S Py' S - MtJE Flood plain elevation, if applicable IJ . N • ft
S = Suitable for system CONVENTIONAL MOUND W- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TA
U= Unsuitable for s stem ❑ S (au 0 S ❑ U ❑ S O U ®S ❑ U NK
Q S ❑ U O S [W U
SOIL DESCRIPTION REPORT`- GR1YO�
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Boundary Roots
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
I I o 312 l l �- Qbh wl U-'y a, - -
S
9 -kS 10 `1Cz 31� - �S l�ab� y„v' 1 CS - •�
Ground 3 \S - qo LO ` fL V% 1,3
elev. L
(3 vrrv
Depth to
limiting
factor
Remarks:
Boring #
ti w.Z,:-v Z g Z.I l0 `t Iz 31 &00 Yl
- 1 -
3 Zl -\Io tb4fz A - � o s� 'M 1 C_ 1, — •� -
Ground
elev. 1b `1IZ 6 13 - 2 S J FS O
X -8 ft -
Depth to VJ"h_L(t
limiting \ mo I it s J I W1
factor
Oy
Remarks:
FCI Name.- -Please Print Phone:
Arthur L. We erer 715- 425 -0165
e erer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 -
Si nature: JJ Date: CST Number:
98-133 M00576
PROPERTY OWNER 5 '�'�'E�' SOIL DESCRIPTION REPORT Page? of ;, 3
PARCEL I.D. ff PFhJ01 N C
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence 8axxiary Roots
3 1 6 1� R J 1 — 1 `�s e a b12 U'�h a- s - • �.
Ground `1 R_ VA. —
I o1.9 ft. IZ613 - I •S HR. S ! $ S o" Yv1 U'f 1-.
Depth to
limiting '
factor
i
Remarks: '
Boring #
n l� w IZ31
Ground
eleV. 1, RS1$ n��. YnUj
► 0�•9 ft, s _
Depth to
limiting G T� `Rz'� per
factor
3 +
Remarks:
Boring #
1 o -b tib 3tZ � 1� to -�-b� � v� a�S _ •�
5
3 s_.{o 1b ti tZ y16 — `Fs � rti 1 (2") ( .-
Ground o S
elev.
tt. '4 y ty - o `i R 613 a� s y D- S )8
Depth to
limiting jLpU N� Jlw "
facto S
4
Remarks:
Boring #
Ground I
elev,
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
PLOT PLAN pa a of 3
SCALE 1"= 40 '
3wt W Z k . \' Splice
ZZ" t's�IUF <i\28ta�
,� � q "s�� �o Co rr rcy ` SS "C►�o1 Zo sct�c� Lm
B•Y
i
X 2i' S _ cA�.7�ovR
�pZ.O
4 wo
j
B.\
t
`�ivv �F tai LAST z F�T -6"DF -
� 3
C l iL - L�
( 715 ) 42 -016 14 00576
CST Signature Date Signed Telephone No. CST #
ov
i
L
.......... ...
------------ vtc
t
l
Wiscor)in Department of Commerce SOIL AND SITE EVALUATION r
Division of Safety and Buildings Page __ of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
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
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
I
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 Property Location New
Govt. Lot Sf 114 C 1 /4,SP'7 T 2 �,N,R Jy E (or) W
Property Owner's Mailing Add ss j I Lot # Block# Subd. Name or CSM#
00 cs ni'\
ity Stat , Zip Code Phone Number ❑ Ci Nearest Road
� � yaS �S < ❑Village Town � � T � ,
J
New Construction Use: 21 Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow eoev gpd Recommended design loading rate bed, gpd/ft trench, gpd/ft
Absorption area required bed, ft trench, ft 2 Maximum design loading rate bed, gpdfft trench, gpd/ft
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design /site co sid ti ns
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 [Is {E] U 0 S ❑ U ❑ S ❑ U I ❑ S ❑ U I ❑ S ❑ U ❑ S ❑ U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
IdYR Vs 1 �abr
Ca 101E
Ground 3 W t o yK 4 1& v S
elev.
ft. 4 4 k i -So lD y y c i f -7.5 s/
Depth to
limiting
factor
Remarks:
Rnrinn !t
st&z4k�ct - ��,,. ® 37 r he h'&e�
I o Y 7 , )
It �� K '�
2 C10 YQ 1 �
db IS, w 6"
� � � � c�•�rav`c --
f
NJ SAFETY AND BUILDINGS DIVISION
• 201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
N I Visconsin
Department of Commerce Tommy G. Thompson, Governor
William J. McCoshen, Secretary
At -Grade System
Onsite 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?
/0 j
County Offi ial Signature Date
Property Location jca -Ks%A-�
M ey beAo�
Landowners Name
i3
J mss: 7 S eel
7
0
�,/w R T k l �
4.,J
SBD- 10513(N.11/96)
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 6A le.
Mailing Address 0 d 16# �d lL� 9-A3-115
Property Address ! / � 1 1 T 1 J J
(Verification required from Planning Department for new constructi
City /Stat c `' S Parcel Identification Number 6 D-. 76 9 - .60 Z)
LEGAL DESCRIPTION
Property Location ! '/4, ' /4, See. cJ j , T c9O N -R Town of A 4 s
Subdivision , Lot #
/) nn l�
7 o� e
� Certified Survey Map # � � `� , Volume rag #
Warrant Deed # Volume Page #
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no
SYSTEM AtAAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
da s o the three a ex iration date.
y Y P
Y" /
/�� �
SIGNA OF A LIC DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pro rty describe bove, by virtue of a warranty deed recorded in Register of Deeds Office.
7
� IGNA
OF AWLICANt DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
DOCUMENT NO. WARRANTY DEED
585580 VOL 1 '350 Dau 4-
Merle C. Nielsen and Maxine P. Nielsen, husband and wife, Grantor,
conveys and warrants to Gary Speer and Betty L. Speer, husband and wife E �
as survivorship marital property, Grantee, the following described real
estate in St. Croix County, State of Wisconsin: 5T. C R OIX CO., W1
P. +c'd for ':,cord
F
LOT THREE (3) OF CERTIFIED SURVEY MAP IN VOLUME TWELVE (12) OF AUG 2 11998
CERTIFIED SURVEY MAPS, PAGE 3496, AS DOCUMENT NUMBER 584400, FILED IN
/O•ls CROIX COUNTY REGISTER OF DEEDS OFFICE ON AUGUST 5, 1998, BEING PART \�
OF THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER (NE 1/4 OF SE 1/4) x! ` M
AND THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER (SE 1/4 OF NE 1/4)
OF SECTION TWENTY SEVEN (27), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE Register of Deeds
EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC.
TOGETHER WITH private road easement as shown in Volume 1345, page 514,
as document number 584375.
. . . . . . . . . . . . . . . . . . . . . .
TRA N FER NAME AND RETURN ADDRESS
$ A 3 � Rodli, Beskar, Boles & Krueger, S.C.
FEE 219 North Main
PO BOX 138
River Falls, WI 54022
Part of 022- 1075 -60 -000 and 022 - 1076 -90 -000
This is not homestead property. Parcel Identification Number (PIN)
Exception to warranties:
All easements, restrictions and rights -of -way of record, if any.
Dated this 21st day of August, 1998.
(SEAL) � � � � (SEAL)
�rC
(SEAL) (SEAL)
4Max'a P. ielsen
AUTHENTICATION ACKNOWLEDGMENT
Signatures of Merle C. Nielsen and Maxine P. STATE OF WISCONSIN )
) ss.
Nielsen COUNTY )
authenticated this 21st day of August, 1998. Personally came before me this day of
19 the above named
(f to me known to be the person(s) who executed the
foregoing instrument and acknowledge the same.
* se h Boles
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY: Notary Public County, Wis.
My commission is permanent. (If not, expiration date:
Joseph D. Boles
Rodli, Beskar, Boles & Krueger, S.C. )
P.O. Box 138
River Falls, WI 54022
s �
FILED g
AUG 0 5 1998 ►
9 KATHLEEN H. WALSH 1O
Register of Deeds
St. Croix Co., WI
54,'00 ti
� l
CERTIFIED SURVEY MAP
MERLE NIELSON
Part of the Northeast 1/4 of the Southeast 1/4 and the Southeast 1/4 of the Northeast 1/4 of Section 27,
Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin.
W 114 COR, SEC. 27, r26 N, R /6 W,
(2" IRON PIPE FOUND)
a � �
'LAUR N
W M PHY 401'r ro o CD �.. N96• /6'4s "w 90.49'
1 13 9.34
IVER FALLS, n�
L A N
a jo�IIl1��� s
'v x
G
Laurence W. Murphy
Registered Land Surveyor p Q)
N
w�
� Q r
Legend
q o
® Indicates 1" iron pipe found. u I�
O Indicates l" x 24" iron pipe
weighing 1.13 lbs. /lin. ft. set.%
Indicates fence. C
This instrument drafted by �I.� W a
Laurence W. Murphy u lQ) a
"Revised this 18th day of Dec. a
Dated: November 11, 1997 1997.' �(0) I w
N
Owner's Address k I ALL 8EAR /NOS REF. rO THE EAST LINE OF
1295 Evergreen Drive rT1 I I brNE NE 114 OF SEC. 27, r29N, R /9 w,
River Falls, WI 54022 I >1 >1 ASSUMED N 01' 29'01 "E
66' y
O 3 37.22
2 0 g 376.9?'
N
N 0 5'45 105 "E'
2 783 -43 , 2 O
IZ ��
'b n
Z
q A o a O a N to
14 2 r b N 4 b 4 Z
fl l a e "' a v o
'o it m a F
Ip a z l a
1 i,r,itl' V O
?; rµ r Ir "Vf41rr V
m y
n9..rj ytyr 2204.35' N A
• 2263.20'
415.21' 378.52 `
S OI '24 ' 55 "W e619.56' S OI • 29'01 '•W 2641. 72'
E LINE SE 114
U NPL A T T E LINE NE 114
r „F LANDS
SHEET 1 OF 2
-
Vol. 12 Page 3496
l
CERTIFIED SURVEY MAP
MERLE NIELSON
part of the Northeast 1/4 of the Southeast 114 and the Southeast 1/4 oix the Wisc 1/ n ot Section 27,
Township 28 North, Range 18 West, Town of Kinnickmmc, St. Y
CURVE DA TA
2N0 TAN. BEAR.
URVf
6/. 5B' 273./?' /2'55.08 77 "W
HO RD BEAR /NG C
CHORD D/ST. ARC D /ST. RAD /US CENT. ANGLE N89•l6'45 "W S77.4 TAN. BEA
- /-2 S 84'/5' 4 / "W 61. 45'
3 -4
S 84 • /5' 4/ "W 52.42' 52.34' 233.00' 12 •35'08" S 77. 48'07 "W N89 •/6'4 W
I.
Description: of the
That certain parcel e
l of land located in the Northeast 1/4 of the So utheast tonlofKinnickiSo roix County,
I l
8W
Northeast 1/4 of Section 27, Township 28 North, Rang
at the East 1/4 corner of said Section 27, the
Wisconsin, more fully described as follows; Comm
thence S 01'24'55 "W 415.21' on the East line
POINT OF BEGINNING, of the parcel to be herein described; thence N 05 ° 45'05 "E 783.43'; thence S
of the Southeast 1/4 of said Section 27; thence
N87 cri
89 "E 471.17'; thence S 01 ° 29'01 "W (assumed bearing on the East line o f
9.046 achesa being subj to
Secti 27 a distance of 378.52', to the POINT OF BEGINNING,
con
an d cl rI_gasements of record.
Note: Each parcel shown on this map is subject to State,
County and Township laws, rules and regulations
i.e. wetlands, minimum lot size, access to parcel, etc.). Before Bpourrca for ado vice,
any parcel contact
the St. Croix County Zoning Office and the app ropriate Town
State of Wisconsin)
County of Pierce)
h Registered Land Surveyor, do hereby certify that by direction of the Owner, Merle
I, Laurence W. Murphy, $
Nielson; T have surveyed and divided the lands shown hereon in accordance with official records, Chapter
236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description
are a true and correct representation thereof.
`'`` ��t� a uur••
instrument drafted by Laurence W. Murphy ,,.`��yJ�SG 1V S�
This � � : ••• �
LAUR AI 9G
Dated: November 11, 1997 _ _ M RFH
1997." m
18th day of Dec.
"Revised this 13
Y •
IVE FALLS,,:
9 ' .• Wisc.
LAND
s it
L ence W. Murphy
Registered Land Surveyor
SHEET 2 OF 2
Vol. 12 Page 3496