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HomeMy WebLinkAbout022-1095-40-002 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner �. Address 1998 fT 2 ��wc rr,., !/. //� �� , --,, S CR , OIX City /State Rife•- Fl/ /,r, Ly / - ¢ O a) L'' j COUNTY \' ZONINGOFFICE Legal Description: ``'._ ^ Lot Z Block Subdivision/CSM # �•/ /'J` 4� ri ' '/• Aff '/, LE Sec. 3 3 , T Z* -R le Town of PIN # 0 1.L /V 7 - fo_o o SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer CI• "d« w> 4c -AO Size SThae ° /� / Setback from: Hous Well oU' P/L Pump manufacturer Model p *4 Alarm location (HOLDING TANKS ONLY) ,!/!D Rip /r�,►�f� Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: aw lr Width 3 �'' Length 1 Number of Trenches Setback from: House * Well X& PAL - .?0A Vent to fresh air intake > /o v IC—A ELEVATIONS Description of benchmark' levation y o Description of alternate benchmark, roe., r.� 14•9d.e70-e; — c" 0,/ Elevation 104- 60 -4 - ro o..g .ha� �,.,y -- r4. / BN j.•- xe,rr« t��,� Building ewer P -# N Le' a /car %•t g 1 ST/F�f inlet ��' v 7 ST Outlet- L � �'oZ PC Inlet �� � � e , f a itt c � d PC Bottom Header/M> d - 1 07-d Top of ST/FQr Manhole Cover Distribution Lines (t) /o Z. .- 7 (}) / v 6 • Bottom of System (1) /y 3 • �.� Final Grade (l) /J k. Date of installation /O /AW Permit number 31 J ?L `State plan number Plumber's signature VL License number I ''rb 837 Date / /L55 T Y Inspector �° ('omplctc plot plan NOTICE Please provide the Wlowing: • 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 N Powe4 Or +s�i �ternd t e i, D of �• q�•r.Pr - .� 3 s B _ y �„ >4 ► c Z 1 r4 C1 � �/ l� � tl h.l k.J' bl � • 5. j 0 0d C / 7/ Z I 6i h•i Cdc� fwI-vh Y • I � ,S a ptC r'd v exc�p��ue nr,f bh t AAC cJ /h INDICATE NORTH ARROW �w�y Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 315875 Permit Holder's Name: ❑ Cit El Villa a own of: State Plan ID No.: EBBEN, DAVE & KELLY KiNNICKINNIC CST BM Elev - :- Insp. BM Elev.: BM DUcription: Parcel Tax No.: 1 1 loo 31 n L e- 022 - 1095 -40 -002 TANK INFORMATION ELE ATION DATA A9800263 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. S pt. � (Pr�n re t�O-D Be 7/ 09• ?1 Z Dosing A 1l,f� Aerati Bldg. Sewer w f Holding (:Sy*t� Inlet I DW40C> .q 3 TANK SETBACK INFORMATION }� C 4 Outlet )oy.z &,i% TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet — eptic -AtSb m �jp� �/►J NA Dt Bottom --- Dosing A Header / Man. Aerati0 N Dist. Pipe IOq.� 3•�9 Y °�.sz r s s 1 66. 1 Holding Bot. System 1 90 i 0q.9.1 PUMP/ SIPHON INFORMATION Final Grade �Oq -1 ( 2 r �od Manufacturer Demand Model Number M TDH L Friction System DH Ft 'I oss Forcemain Lg la. H en I Dist. To Well SOIL ABSORPTION SYSTEM BED RENO Width r ngth No. Of Tr ches PIT No. Of Pits Inside Dia. Liqui pth IM N Le �7 )00 DIMENSION SETBACK SYSTEM TO P/L I 'BLDG: WELL LAKE /STREAM LEACHI — INFORMATION Type CHA ER Mod umber: Syste 3 2 -rw0 k'LOtf —' OR UNI DISTRIBUTION SYSTEM Header / Manifold 1 � Distribution Pipe(s) � x Hole Size x Hole Spacing L Vent To Air Intake Length V Dia. Length � Dia. Spacing t w 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 33.28.18.513F,NE,NE 8 EMERSON VALLEY DRIVE 2 � D $�.� J '�'�'� `�D �•>a -mil 7 - f S cwt p - 7 0 - X60' �64;; 11 y Q ! . M 6 1 rp 1�j oltft 41 Kw, pw, t-`f" c4rt . - *[MK c4 1-4,VA wd 4 444 Plan revision required roNo� Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's ignature Cert. No ­3 �,i ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: . 3 i .. a, �e E e e E E e. E e a .. , e ... «e. w u .T ... ..., e m .. ......_ .. e.. .,.. a .. ..... .;: .. _, s.. i ......_ ....... .. Vi sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. I n 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 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanit P Number The information you provide may be used b other government agency programs f`� fO �� Y P Y Y 9 9 Y P 9 �F ❑ Check i [Privacy Law, s. 15.04 (1) (m)). revis n to previous application g� EmGr o V^ t to / 1n Q l.� � 1J�1 CiY � State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property ne� I t /a t /a, S Propert Location 0 0 CL t Kt 9- 6be h 33 T , N, R! (o W Property Owner's Mailing Address Lot Number 11 Block Number F `^' City, Stat Zip Code `hon umber Subdivision Name or SM IVlu�_r,o� �p`JM►t �C-+ it Z! �S� S C;. M 0 73 J I ll. TYPE OF B LDING: (check one) ❑ State Owned i f r Nearest Road ] ❑ ViNage _,1. n )G ld cd Public 1 or 2 Family Dwelling - No. of bedrooms Town OF _ Kip) f:+�d 111. BUILDING USE (If building type is check all that apply) Parcel Tax Number(s) q 1 E] Apartment/ Condo aiv- 28 . 1g . 513E . 0 � / � � 1 0 2 ❑Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3_ ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an System ________System_____________ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 []Mound 30 ❑ Specify Type 41 []Holding Tank 12 Trench 22 ❑ In- Ground Pressure 1 r 42 ❑ Pit Privy 1 ❑ Seepage Pit .3 — 'r 1 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 cio 6) 1 Required (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) loT - �S" Elevation y [ D � Q O ©r `—� 104 Feet 11 l07Feet Capacit VII. TANK in Ca gallo s Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing structed Tanks Tanks ep is Tan �- 5 Q �- W tYy /e ecisr ❑ ❑ ❑ ❑ ❑ lift Pump Tank /Siphon Chamberl 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI ber'sSignature: (No Stamps M /MPRSWNo.: Business Phone Number: mber's ddress (Street, City, Sate, Zip Code): G U Y� IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing g t Sig ature (No Stamps) J(Approved ❑ Owner Given Initial p pQ/ Surcharge Fee) !' Adverse Determination � Y r X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: I I . SBD fR 11/98) DISTRIBUTION: Original to County, One copy To: Safety 8 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. f r i n. Provide all information re quested for numbers 1 through s ystem h 7. o VI. Absorption syste q 9 P 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. x � I be.ci, Ice 9 " 4 L 3 /y" PV p;p 2� •V Ch a � 5��� T�v e Sills y CT O IC N C.LnG "^ of �► t 9 11 3 2 • Fr �� G � e d�r i veNGh t to 716 / -�,��► ►� 2 ( 06' 10r, y goy � 1 T , O p7, L °I �.zvo c v�emc1 3 T P 4 0 I ,S trees. ti r�urV� r e� 4�8,�„u� Dq `e K8 1 e ���Ph L - I i h r� ` �. 0 V A1ti 2 l 6 998 ti r 1 \ \ 5T c C N?Y ; c � OFFS / ZO N1NG \ C F� a e Q N m I 1 ocf CO a H 3 RI Q � 5 • � n s N 1 o I _ `D p CA) CL P L X m IC U O - r o I IT1f � �s rJ d� f r C/) C/) sq m o FT CD C O s X a � - C7 ? �" ( T - = F- D ? Q r !I 2 o. " cD C/) Q D(R a m C O < C CD n (o Z i _ 1 ID I cn 0 CL (� m .D d Q(D En CD r " :; a 3 j m 0 Q cr �'.M x co o w 3 w W 1 � c 3 C. i 0 S nci 0 o — Invert 11" 6 CD s m co s' �nn r1 AkTTkYn7 n'% What is the absorption area for a leaching chamber? Leaching chambers take the place of aggregate, Below is atable listing all leaching chambers distribution piping, and geotextile fabric or marsh currently approved for use in Wisconsin, their width hay in soil absorption systems. However, some and length, and absorption area credit based on leaching chamber designs are credited during plan system type. review with providing additional absorption area in If you have questions regarding product approval trench -type systems, when compared to a gravel ofleaching chambers, contact Mike Beckwith, S &B s Plumbing Product Reviewer, 608 - 266 -6742, or Leaching chambers are only approved through mbeckwith @commerce.state.wi.us. the product review process for use in conventional J soil absorption systems, in- ground pressure If you have questions or. aspecific leaching I distribution systems, and mound systems covered chamber, please contact the manufacturer. Their by Comm 83.13, 83.14, and 83.23. telephone numbers are included inthetable. Soil Absorption Area for Leaching Chambers Manufacturer Product Name Model Actual bottom Absorption area area per unit credit per unit Hancor Enviro Chamber Hi Capacity (H- 34" x 75" = 17.7 ft - Beds; Frank Daly 10 & H -20) 17.7 ft 31.25 ft - 419- 424 -8305 Trench, except mound systems; 19 ft Trench, mound systems Hancor Enviro Chamber Standard Unit 34" x 76" = 17.7 ft - Beds; Frank Daly (H -10 & H -20) 17.7 ft 24 ft - Trench, 419- 424 -8305 except mound systems; 19 ft – Trench, mound systems Infiltrator Equalizer 36 EQ36 22" 100" = 15.28 ft z - - Beds; Jeff Iverson Chamber 15.28 ft 20.5 ft - Trench 800- 221 -4436 including mound systems { nfiltrator High Capacity None 32.9" x 75" = 1�fftl�Bed Jeff Iverson Sidewinder 17.14 ft 3 800- 221 -4436 Chamber except mound systems; 19 ft – Trench, mound systems Infiltrator Standard and 12" height, H -10 34" x 75" = 17.7 ft – all Jeff Iverson Contour and H -20 17.7 ft system types 801 0- 221 -44 I— P.S.A. Inc Bio- Diffuser i 11" high 34" x 75" = 17.7 ft –all Terrance Gray 17.7 ft system types 207 - 729 -1628 o� liGh 1 tE. s c [ •a e "'/w/ /° �j 6) S o c �C fr P c WPCR JUNE 1998 T V� W3 t�- s I 1 " ' la3 — — - - - -- -- — —�tdl t�l w� Y47 Nc z 106 y \ a roS _ I �O 10 t lu 0 s � C 76 c a l d�. �� AVM `le NIV J-� 3 N Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of y Labor and Human Relations Divi..ion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY sT• c.Q.o t X Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R BY D TE E PROPERTY OWNER: PROPERTY LOCATION EU6L 1�ISi7 N GOvT. LOT KNZ-� 1/4 Nr_ 1/4,S T z .,N,R 19 E (oW PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # Vh0-eY _U1ZJve 1 — C_aV -1 votes , ly8S CITY, STATE _ ZIP CODE PHONE NUMBER []CITY ❑VILLAGE MOWN 3NEAREST ROAD 1� I \Z �—fic LS w l SYo u (��S) �IZS_ ss y b �+vt� 1 ��rcJ AJN 1 C me4Sw u><rw'-XI c�R. 6C] New Construction Use [,(j Residential / Number of bedrooms 3 [ ] Addittt n to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow LAS gpd Recommended design loading rate bed, gplW 2 _ trench, gpo1ft Absorption area required — bed, ft N\Z S trend,, ft Maximum design loading rate ` bed, gpd/ft 0 . V trench, gpd/lt Recommended infiltration surface elevation(s) SEE WM 7D txC- h*rLLW_MPj. Y ft (as referred to site plan benchmark) Additional design / site consideratioms SSE 3 'TI�C.ffn ENati I �Io' LuiC F y It S Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL I MOUND IN GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 0S ❑ u CffS ❑ U I W S ❑ U W S ❑ u ❑ S ® U ❑ S WU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisterm Bound3Y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tlench F t 16 - t (3- 1 4 Ground elev. V b6- jft Depth to limiting factor,� Remarks: Boring # 2 61T mu`fh aS d.S o.b z z g_)g Il�`t� 6 Ground 3 1 1 `1 iZ Y /y s l� Z `� k Yr! 1, cS n. S n• 1b D ft. Y/L SL Z`fS�h cS a. S S y b 72 l D '7 2 V/% — c w, Y." T i,- � Depth to limiting WIG S mn) C_OlJ '(' facto 7 Z Remarks: - , `� I T Name Print Phone: ' Arthur L. We erer 71 ti`25. -01f9 NN egerer Soil Testing & Design Service P.O. Box 74 River Fa -1 " , X 540 '�'� Signature: � Date: - � ` 0 ; GST NO M00576 PROPERTY OWNER 'E=:"1kTZS6K3 SOIL DESCRIPTION REPORT Page? - of •l PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2- 3 mv`f Z b -3Z lo`1 31C — S1 I Z `�Jbk tiv►�h cs O. o 6 32=12 LO`2R �/6 — S O yti v 3 0• Ground 3 a o +-�, w► ti y elev. kx ft. Depth to limiting factor Remarks: Boring # - :.:�' ko-jV 2- yr v'�r 05 o. s o. K S 1 Z c) Ground elev, s 6 -BLS 7•S `72 3/y — S 2`f S bFz m `f fr C S o• S o. 6 Nk ft. ' o,S Depth to limiting S Vk S G S ° L 1 m E: ►"1 e\Jr S factor ? - )C) , Remarks: Boring # o- S to-J R 7,L - Z - s t z�sbk m v S S € Z S -3 2 t� Z �0-1 — sl� ZSbk >+��� cs o. Sa � 3 3Z-S� �.o `�,tz31b -. s 1 1 csblt �, u��. e S o•�( o•S Ground \l ft. 14 SO - Lu`1 5( Depth to limiting 's factor ' 2 -- )3 � Remarks: Boring # 1 b 2 3 h c S ,-� D• M U`Fl- C o . S o• k4k` , G,J <: >.......:<,., 3 SS J3 7.SY23`Y S� �sbk 1n`Fh o.� o• S Ground elev. lo -S ft. Depth to limiting x factor Remarks: SBD- 8330(R.05/92) PROPERTY OWNER 1r"kz2Sw SOIL DESCRIPTION REPORT Page 3 of PARCEL I.D. # Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 0 -1 `1 Q 31 y — 1 S 9 tin► `! 0-S o .� o• g _ tp `t [2 Ground elev. Vb .0 ft. Depth to limiting factor r � Remarks: Boring # roww " ' I " 1 1 1 11 1 1 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: _ SBD- 8330(8.05/92) PLOT PLAN Page 4 of y SCALE 1 "= 30 ' Ws. 6'OK► of 4 V posr. �M - kTL... Lo n.�' oti, q "ttiGN 3 / "DIR. C F� c 6�ve P► P� w/ �-h7N 0 2 3S' 9 6 t3.7 LXL I \ J I t/1 l�r ► C� N l �1'Z/ 1F►'f� �Fk�s �_ LL LLL �N u S "CO t3� �T ll�h sT Z,5 P'w S `'1 S sr1 fj 2 So <c ' t-MTE 12 SOS A ZZ.S' of S' RT Is' cv Z. »r ol.s " I.JL►-lu04 (" 1rpfYRa' , 30" D�3A Pr `T* vasL.o L QUGL , wI'POA,. - rtkiE� S U L) - ?ML '1�) D��N sLi s`I"L� EEL- L�A' pUtzIuG 2-LVUSIIWc -T7okJ. (71 5 ) 425 -01 __ M00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page ` of y Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 1.luG e�jC C 1� Sd N GOVT. LOT f 1/4 NE 1/4,S 33 T - 2 - 8 .,N,R IS E (o�W PROPERTY OWNER':S MAILING ADDRESS LOT # PLOCK # I SUBD. NAME OR CSM # 67 tEFMkAl2S( c S 1� 1U8S CITY, STATE ZIP CODE PHONE NUMBER OCITY []VILLAGE {'$TOWN NEAREST ROAD R I�'2 wit LL Nl SYo Z-z- (�rS) yzs_ s5y 1, `� -r�v►j I��JAJ� 10, w UWU_eX-t D* . i kj New Construction Use Residential I Number of bedrooms 3 [ ] Addtt n to etassfmg buildittg (J Replacement (] Public or commercial describe Code derived daily flow _ y SO gpd Recomrnerided design loading rate bed, gpolft n' V trench, gpoltt Absorption area required - bed, ft \ \Z S trench, ft Maximum design bading rate - - bed, gpdtft 0 . V trench, gpdM Recommended infiltration surhace elevations) SF k%)% Tb fVRult OuPQ -Y ft (as referred to site plan benchmark) AddCand design / site oonsiderafions SSE 3 _'n2 c4te3 e c 1 t�o LA+U G Tc L{ 8DRM S t L Parent material Flood plain elevation, if applicable ►J A • ft S = Suitable for System coNVENTIoNAL MOUND IN4ROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable for system ®S ❑ U {f'S ❑ U I W S ❑ U [as O U 0S ®U ❑ S qu SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmiday Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tiench 'I e -6 %b-1 V_ z l Z Ground elev. "'q-j ft. Depth to limiting factor, Remarks: Boring # 0 -8 w- t2z.12 — S1� 2.`F s6lh Ynv�h aS o.S o.b L tu�v_ 3[ — S[ Z'f T 0.5 o- b 3 18-35 tD`Z fZ V/y S I � Z`fs � 1►1 `F►' CS o_ S o• Ground elev. 3S-vu - ).Sy/z VA cS a, g 'p. 1b • ft rn v , i. , b lZ l0 `12 — Depth to S y V� 1 Ow, on T I. y factor m8 S i�v0 CO)v T factor Remarks: CS T Name.--Please Print Arthur L. We erer P 715 -425 -0165 e erer Soil Testing B 7 R iver F l WI 54022 g e tang & Design Service -P.O. ox 4 s R e a l, Signature: Date: CST Number: 0 /3_1 1 4 1 Q M00576 I - PROPERTY OWNER 0K3 SOIL DESCRIPTION REPORT Page? PARCEL I.D. # Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench tioKR zlz _ s j z sbk m CIS 0. 6 Z 6 - 3Z L0—j2 3/C S 1) ZJek ti» �� C S o, S o• 6 Ground 3 37- =72 LoKR VA — ^ a D �-� , , wv h o 3 o`� elev. �k z' 1 3 ft Depth to limiting factor ' �Zk Remarks: Boring # • • 1 n _ S �o � -tCz Zlz — s t � Z `Fs bk vn v'� e S o. s o•� ` �Z 3/ r 5 -7-Z lD � — S , � Z `� s ek �''�'C 1- c zz -3L loytz 3/L S I l csdk h,v o•Ll Ground , elev. �� ft. S US_�o �0�.2 Y/l — `FS o� w,v��, o •Y o, Depth to limiting S ti S S L M't evr S factor ? 70 Remarks: Boring # m y S< Z S -3 Z tib`12 31 L -- S M 0-S rn -� C s o•�( o S Ground `r elev. 4 SD - loK� Y/b — TS Om' yn vfM o•\4 i� S `l S ft. Depth to limiting factor Remarks: Boring # �Sitiji9.`:•`.:v:{ 1 � -. b 6 V �, � J L -. \ S l� 1� � U l h C �, 0, [ t �� v S ' 6 vn U'F I- C S o . S 0A >.:: >.,:.::,,..::.;... 3 SS X 3 7 .S Y R 3! � — S 1 � cs b k tin `F h o. �(� o• S Ground elev. % 5 ft. Depth to limiting factor >73 Remarks: SBD- 8330(8.05/92) PROPERTY OWNER Q " l kz SOIL DESCRIPTION REPORT Page 3 of -PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxiay Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 9>^ �v, v e s 0, 0 8 qSgKS 'M v o.S 0.6 Ground elev. �O •O ft. Depth to limiting f }t7� Remarks: Boring # E3 Ground elev. ft. Depth to limiting factor Remarks: Boring # 4 <i Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. Depth ft. to limiting factor Remarks: SBD- 8330(R.05/92) PLOT PLAN Page 4 of y SCALE 1 30 gM _ ' o+.� lUP OF ( 4 ° otR, wao0 F�C� pos 9M - t'L.. 1,00.0' oti ° ► "LitGN 3 /y wT L11u � � �tucQ eve. ptP� w /c -h'Rf 1.03 t u \ I I LrLLLt., 1 / I X106 8.l e.z ` O sv �' \PLC C�Rl'L�r FU \Z. 1►J1Y11�L �! CA 8.3 GNU s� "co va:i Pt'T' � 9T Z5� 1PrzAm :3" SWK I--�lZZ - Tb \P5' - 1S' 'F-!t�JtM 6' PI'P4fizT 30 DqV Prr `DK 00SloltL: V hJt`JyM1 -tr}� sv tMUL% T) A'. IAJ% *rLL. 'TO DETeLhwe` S sh-wt (715 ) 425 -01 M 00576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SUPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer F), Mailing Address l Property Address r' (Yerifieatioa required from P • [uiaiag Department for acw coastcuctioa) _ 4 l cty� L �L Pancei Ideutificatioa Number - - L EGAL DE- SCluPITON Property Location %, %<, Sec. _�3, T -AN -R —aW, Tow. of Subdivision Lot # Ceri6fied SmTey Map Volume Page # 14 Warranty Deed Volume C Page It SpCQ boase x ycs ❑ no Lot Imes yes ❑. no IaC,opatsscuadaiacof y�tiaitr F &I L to I�andicwasLcs.Properaocaaacc Consists cf pmmping oat mhc scptio tank cvmy d= yc= oc sooner. if d a U=scd ' cam affect& xunctiom of tie P ' Y P .iaLo the rystcm r�C�a •sstYg�efatbevaaste�;ystcaz, .. - . lba PmPeLy owner agrocs to submto SL Ccdx Z DcpatUmrmt k =rffica6m fora, signed by the ownr..c and by a mA= Pbm"b=.jOumcym=p1wnbcr. rcsftidedpunt, Corrine=x dpaqxrvaifyhCdw( I)&Con�dtcivastmatcrdzgmdsystcm is improper opend iag eoadtioa sad(or (2) after kq)oction and pampiag (j Y). the septratank•is less than M - Am of dad. -- 8 wd bcsvc=ad fire above togainem=s tad tgme to ms>atzin do pdvatc sewage disposal sys� wiftr tip sods Set tom, bcrcklas set by the Deputment of gym= tad the Departmeat of 2latmml R,GS==, State of Wuooasio - • CcvZcattoa d ' gu g d=t Y=tVticqst=basbom=kftiwd=stbecompktcdzad t the SL4oix.County Zoning Officewithia 30 days- of the throe 'on dam, STt;bTA 90�FAP y 0 DAZE OWNER �TIPTCA.TXON I (ate) certify that all statamats on this form are true to the best of my (our) kmwicdge. I (we) am (arc) the owaa(s) of due Property dcsmlcd above, by of a warranty deod rcwrn ed in Regi W of Dcods Office. SIGNA /rill qs OF APPrICANT DATE Any information that is n is ma •�•••• od y rcwlt in flue sanitary Permit being revoked by the Zoning Degartunca «« Indude with tots aPplicatlon: a stampod wa r aty flood Snow the RictEsta of Doe& office R copy of the cueW turvcY chap if rcfcccaoc is made in the warranty decd y VOL .74 5 81 83L� STATE BAR OF WISCONSIN FORM 16 — 1982 C71L7 V TRUSTEE'S DEED DOCUMENT NO. REGISTER'S OFFICE ST. CROIX CQ., WI }' u aene Emerson npt'r1 ft r.imn, -i as Trustee of JU 2 5 1998 Eugene Emerson Revocable Trust ✓ 4:00 P for a valual,le consideration conveys without warranty to David G .. "_ Fb and Kell - Ebben, husband and wife a s _ survivorship marital property THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS Grantee, the following described real estate in St. Croix County, State of Wisconsin: P.O. BOX 1;ltf 219 N. MAN ST RWEA FAILS, WI 51022 Lot One (1) of Certified Survey Map in Volume Five (5) of Certified Survey Maps, _ 9� - 254 Page 1485, as Document Number 397585, filed in St. Croix County Register of Deeds 022 - 1095 -40 -002 office on November 5, 1984, being part of PARCEL IDENTIFICATION NUMBER Northeast Quarter of Northeast Quarter (NE4 of NE4) of Section Thirty Three (33), Township Twenty Eight (28) North, Range Eighteen (18) West, Town of Kinnickinnic, EXCEPT land in Volume 826, Page 38, as Document Number 442599. Subject to easements as shown on said Certified Survey Map. TRANSFER FE Dated this 25 day of �-- 19 98 E E EMERSO VOCABLE TRUST (SEAL) (SEAL) • _ Euq ne Emerson Trustee Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ State of Wisconsin, ss. P , C 12 CtZ County il � authenticated this day of , 19 Personally came before me this Z5 day of 19 9 , the above named Eugene Emerson 'TITLE: MEMBER STATE BAR OF. ISCONSIN JULIE E. JENSEN (If not, NobryPublic authorized by §706.06, Wis. tats.) State of Wisconsin to me known to be the person who executed the foregoing My Comm. Expires 5/13/01 en nd acknow get ame. THIS INSTRUMENT WAS DRAFTED BY 11A P, C. L. Gaylord, Attorney River Falls, WI 54022 Notary Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (I( not state expiration date: necessary.) /it )} Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., In 1 RLIS "I fl'S nl'I'n Form No. 16 - 1997 Milwaukoo. W CERTIFIED SURVEY MAP EUGENE EMERSON r Part of the Northeast 1/4 of the Northeast 1/4 of Section 33 , Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin ao • Indicates 1 iron pipe found . 1 M o Indicates 1 x 24" iron pipe weighing 1.13 lbs. /lin. ft. set Is O It 0 O 50' 100' 200' 300' V , t a ALL BEARINGS REF. TO THE NORTH LINE OF THE NE 1/4 W 9 "r• w W OF fEC.33,T28N,RISW, RECORDED AS NSB•19'34 "E A N O _ Or 0 J Imn wi \ > 0 - - .J to 3 > t 0 ' 1- M J i OJ O M I n W W t+' N I n m I - W I O V I u 0 N I N Q O a , In- b. Q V I V a. O 3 90.00' o° 0. m 6 02' 11 "W 303.84 n ^ f4 m 6 a1 00" W •5. „ a ° ..1 N 1 95 ` So. ' 3 I ITAZ1 iv Z �° . O I� -Ir W T W W I > ' N __ N W `• � _ "i 1 O m B B. °,`3 0 s 3� �, Wo IY r �00 N I V 'v J '.. 0 910-bC 16 S H ►- u z a rn 3•IL c W O O d W V L O m rn 01 tll d M. m d V 1„4 4 W N LL Y p > h O ,n � W a / \ \ S00.27'30 "W 40.6 O / \ O 95.00' n / \ Q \� N C S02.02'II E 5TO.00 \ „ ©O 3 n w a 0 y Iq I ° CURVE DATA - 1O a'CURVE CHOROBEARING CHORD ARC RADIUS TAN. BEARINGS CENTRAL ANGLE •._ -..A B 522. 46 44.00' '44:97 80.00' t 3 36•.: J'...•Ja "t9_ 2ND S0 8•..4l.' 91 "W . 31- '33'16 W - • , z m C - D S51• 1 I OS.SE 103,99'113.13 80.00' 1 STN8T• 57'49 "E 2NOS11 "E 81.02'11" 1 2 '" _ - �� " :• X 2 . 30 00 "+: 2S1'SO'UO" ly v -E +46'19'06 `N 13T.31' ..3 :.iz t: :0 .0 K 0 _j I P z W F' N N Z V 2 W N W Z W • . - Uj N111111 V I� J Q I F 1- o F- S z a ? i• IAURE 0 _ .2 - W 1 W ti � Q. NCE t • 0 ' z 4 W ► •� .� d m In 1' 120.0 O MU W a ►- > , 36 i ♦ ° u1 140 I m' o z u FA o O p 736 E 12e.6 1 }' • W 6 SOT �'•., .gCi. �, , 0 44 d ` ♦ v d W� e ,. /111111�11�, a Ir ti ° 531 N IO• S1'14 " E � by LAURENCE W. MURPHY 11 /• ti ,T �� 1 4J.4 42• H ��. b ,` 26�� 1s 10 erf'► ±� O A ti ti REGISTERED LAND SURVEYOR s� 14 =' 4� 0 s Zs" a 0 6 w ' a O y (DESCRIPTION ON REVERSE) N I /4 rn R SFf 1 r 7R N 0 IR W. I ('AUNTY SIIRVFYOR' S MO N I