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Home My WebLink About022-1088-70-100 (2)Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM Count Y St. Croix INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 645495 Personal information you provide may be used for secondary purposes [Privacy Law. s 15 04 (1)(m)J State Plan ID No Permit Holder's Name Rollan &Deborah Fuller City Village Township Parcel Tax No TOWN OF KINNICKINNIC 022-1088-70-100 TANK INFORMATION TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss Syslem Head TDH Ft Forcemain Length Dia. Dist. to Well auto-NGOVRt•IIVIY OTO1tM ELEVATION DATA Sewer Inlet Outlet IDt Bottom BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Da Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer CHAMBER OR Type 01 System UNIT Model Number nieTMini rrr�u cw��r•.. Header/Mend dd Oistrib itcon x Hole Sae x Hole Spacing Vent to Air Intake Pipe(a) Length Dia Length pia Spacing onto rnven Depth Over Depot Over BedrTrench Center BedlTranch Edges n Depth of Topsoil xx Seeded.'Sodded _ xx Mulched Yes No J Yes No . WI■rITI11�I. I Q. (Include code discrepancies, persons present. etc.) Location: 149 HWY 65 1.) Alt BM Description = 2.) Bldg sewer length = • amount of cover = Inspection #1 Inspection 02. Plan revision Required? C Yes[-nJ No Use other side for additional information. SBD-6710 (R.3197) Date-- _ -�— --Insepctors Signature -- ---- - - Cen. No. --% 5Md -ZOZZ— 344 PYSP I w4L f�� inn — ttlq /,+•'^� t, Industry Services Division Canty D \`7 j 4922 Madison Yards Way St. Croix Madison, WI 53705 Sanitary Permit Number (to be filled in by Co.) DEC 2 9 2022 P.O. Box 7162 Madison, W15 707 62 I' `j' 5 N nn ' o n@Rn t Application State Transaction Number 102002422-C In accordance with . Code, submission of this form to the ov mmrntal unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to the DepaMnent of Safety and Professional Services. Personal information yoni provide may be used for secondary 149 H 65 purposes in accordance with the Privacy Law, s. 15.04(1 xm), Stats. L Appliestim Information - Please Print All Information Property Owner's Name Parcel a Rollan 8t Deborah Fuller 022-1088-70-100 Property Owner's Mailing Address Property Location P.O BOX 184 con. Lot "w ,, sw A. Section so City, State River Falls Wi. Zip Code Phone Number 715-338-8723 T 28 N R 18 E or W It. Type of Banding (ebeelt all that apply) Lot p Subdivision Name ZI or 2 Family Dwelling - Number of Bedrooms 3 1 D'ubli KinnimDe erciel - scribe Use Block p ity of fate Owned - Describe Use IV.30/ illage of CSM Num OC.: I It tin,9 6861 . Town of Kinni�nnic III. Type of PONM Permit (Cheek either "NW or "Replacement" mad other applicable on line A. Cheek one boll oa line B. Complete line C i applicable.) A ew System l L❑Jln-Grand rceplacemem System ication to Existing System (explain) Additional Pretreatment Unit (explain) �oidingTank R5/f ❑Mound Individual Site Design Other Type (explain) (canvemionenC. RernewdBefore ❑Revision Plumber Oransfer to New Owner nst Previous Permit Number and Date Issued F]tpira[ion 631250 2/19/2021 IV. DispernVrreattiateot Ara and Tank information: p = 2 (� Design Flow (gpd) Design Soil Application Rate(gpd/sn DsOWU Area Required (st) Di I Area Proposed (sf) System FJevation 450 .50 900 900 97.00 Capacity in Gallons Taal Gallons N of Units Manufacturer u c 8 Tark Information C Q �� - �0 /tom E u � New Tmka Eximd utg Tanks , Y o S U in G uJ LZ C7 iL septic ar Holding Task 1000 1000 1 Wieser Dan"Comber 750 750 1 Wieser V. Reaponsibilky Statement- 1. tbs tadodped, mma se mpoo for iaMs•atiam of tie POWTS sbown on *a ateaebed plum Plumber's Name (Prim) Plu i MP/MPRS Number Business Ph" Number 44 Keith Knudtson 6483 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th St. Roberts,Wi. 54023 V L C rtment Use Only Approved ❑ p ved// Permit Fee Date Issued (swing gent Signature o .�, for Denial s D— r�3o 2 Conditions of ppmv 3) �ecA? Q t r 1.p rµ A t' t j� -1,j _ r p / _6 mAe � SYSTEM OWNER: � 1 66� of � / � Septic tank, effluent filter and dispersal cell % LA ee Pee c+ must be serviced 1 maintained as per management plan provided by plumber. !V setback requirements must be maintained UjKt�zn — r^-rr^^^-'- ---attach-M eoi -�W piaas for the system and submit to the County only oa paper not summon a to % 11 ususs to me SBD-6398 (R. 03121) Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION L Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well ,UIL AtSbUKI• I IUN SYS I tM i BEDlTRENCH Width Length No. Of Trenches PR DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR UNIT Model Number: U1,1 KICU I IUN SYSTEM Header/Manifold Distribution x Hole Size ■Hole Spacing Vent to Air Intake Pipes) Langth Dia Length Dia Spacing .7UIL I.0 V CR flow .... V-..-A n. A6J--A- A..6. Depth Over Depth Over roc Depth of ■x Seeded/Sodded roc Mulched Bed/Trench Center Bed(Trench Edges Topsoil -, Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Location: 147 HWY 65 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Ito Yes e,. No Use other side for additional information. SOD-6710 (R.3/97) Dale Insepctor's Signature Inspection #2: Can. No. fir_-i�ranP ^tr'F,7-\ AyV -dodcj — y 14 / Safety and Buildings Division St.Croix Sanitary PermNumber (to be filled in by Co.) NOV 1 Z�2� ` 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707-7162 �._ St. Croix County ' V6 jol (o31z�o Sanitary Permit Applicati In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to he appropriate unit is required prior to obtaining a sanitary permit. Note: Application forms for state-o TS are submitted to the Deparunent of Safety and Professional Servies. Personal information you provide may be ndary StaeTrensadionNumber 102002422-C Pro) iliercnt then mailing address) 1491 purposes in accordance with the Privacy Law, s. 15. I m , Stats. liwy 65 1. Application Information - Please Print All Information Property Owner's Name 1 100 Rollan & Deborah Fuller 0nr6 ;;;62-1088-70-GOG- Property Owner's Mailing Address Property l2ration 44 r /p TO P.O. Box 184 t c. Gout I'm ) NW %4. SW %., Section City, State Zip Cade -Phone Number River Falls, W.15- 3 23 )30 T28 N R 18(cnclEorlXl 11. Type of Building (cheek all that apply) tut EI 1 or 2 Family Dwelling - Number ff Bedrooms 3 1 R �✓,�r _ Block ❑ Public/Commercial - Describe se ----�t-:_� ---- CSM ❑ State Owned - Describe Use --- . _ _ _ _ a Subdiv Name N City of Village of - - d Town of Kinnickinni A Number r O� 0❑ Vr 11 t M III. Type of Permit: (Check only one bon{ ou I' Complete tine B if applicable) A. New System ❑ Replacement System reatmentlliolding Tank R74cm Only Other Modification ' isting fWstem (explain) B. ❑Permit Renewal ❑Permit Revision ❑ Plumber emit T to N if Previous P umber and Date Before Expiration rILIL IV. Type of POW7 S S stetn/Com eot/Devlee: Check all that ble sod ❑ Non -Pressurized In-Gnx d ❑ Prcasurizcd In -Ground At-Cmdc nand > 24 in. of swtab W < 2X-4 ❑ Holding Tank ❑ Oder Disers pal Componrcnt (cxp in)_ _— -+ Preatreat explain)- _- V. DispeninVIrreatment Area Information: Design Flow (gpd) 450 Design Soil Application f) .50 Di Area Required (st Dispersal Area Propo 900 System I es•ation 97.60 VI. Tank Info Capacity in Gallons Total Gallons # of Units ufact POI -bk $ y o c w �u U $ 2 U 2. J, �5 '3 s New Tanks Existing T Septic or Bolding Task 1000 1000 1 Wieser x Doung chamber 750 750 1 Wieser x VIL Responsibility Statement- L the maderi , squiser respoosibihty astanstion of the POWT3 shown on the stacked plena Plumber's Name (Print 's Si MP/MPRS Number Business Phone Number Keith Knudtson 1 648443 651-470-1737 Plumber's Address (Street, City, State, Zip C 927 150th St. Roberts^ 54023 VIII. Countv/Depatritinewt Use Only Approved ❑ Di ved ❑ Owner rven Reason for ial $ �� e Issued l�ll�L Issu Agcpt Signs l IX. Conditions of4akEVAPROmourforntloppirtrilal -�` �. _ (� 94w ` C� n,d tie t SYSTEM OWNER: 1. Septic tank• effluent filter and � w V� dispersal cell must be servir4��i / m in in µ�5.� as per management plan provided by plumber. ` � '% o 5 oKS � ` na�ym��mya�intain r'��- ' �"rVfIIriQ1I"..Ci:-- �� ran d1e syNe� as r r �,c lu c . e gb�11 b�keC wly �kp(tter Jka i/I111 facYe�dt7 y/.� /Jt Z /} may; r 1 Pb� b"Vid� sU4� AkaZ� � r��CM 4-U SBD-6398(R.11/11) jrs 6 r5. Page 9 of 9 ToFNW J47RMy6f 3I0R to Imdde m"WSMd l�CO�*4 Sanitary Site Plan m For: Rollaa Faller Proposed Lot 1 of CSM Part of the NW114 - SWIM Secec.30 T28N-R28N-R18W Town of Kinnickinnic-SLCroi: County Mob Cea3aaC 5, Pwpaad 40&A 40PVC A* Sewn Aopaerd WIow Cmr=& WLPIWD-AR &P* 78at W&Aolj A*PUW Ftdtr 2Q02AoaPmal Aepwad t' Scic 4OPVCo►Asaw D-3034 PFC CmnvymwPIlw Acpawd WLP75040 Dan Hart Frupaed2'Sck IOPFCF.K 97.10' \ p,3 MOLY \ 521- PrgwsodlOjt :9OjLAKlim&A& mdDaPeadrAWW F:" Cam/erv/S vIon&n1 of97.00' Ops FtaldMw 17TmsadMev. --AJ-W NoneJla6MrbmWamdw hvfi mdbadzpwMg383.3I(B)M Elevation Data - Nail w/Pink RJp_Bsae of 5" DBH Fence Poet Proposed Septic Tank Grade = 99.30' * BRP—Sane ASSUMIRD ZL9V. — too.00' ECp pY October 13, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-10-13 Plan Review: PWTS-102002422-C KEITH E STONER 23220 Woodcreek Rd Siren WI 54872 SITE: _ 147 1lwy 65 River Falls WI 5402 Town of KINNICKINNIC St. Croix County Total Amount: $250.00 Description: 450 GPD (3 Bedrooms — ReplacemenU Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http:l/dsps.wi.gov/programs/industry-services www.vAsconsin.gov Tony Evers - Governor Darin Crim - Secretary APPROVED DEFT. of sM%j : AND PROFESSIONAL ;;IviZES 13114URM Or INDUSTRY SERVICES 0 Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-p (N.01/01, R 10/12) At -Grade Component Manual - Ver. 2.0, SBD-10854 (N.03/07, R. 1/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stets. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it roils into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS "Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock tiagments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger till area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall he 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. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state scats 101.12(2). nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, "�_e POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tim.vanderlcestil wisanuin.'ov Cell: 608-516-6134 RESIDENTIAL AT -GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project Rollan & Deborah Fuller At- Grade Mound System Owner Rollan & Deborah Fuller APPROVED DEPT. OF SAiETV AND PROFESSIONAL SERVICES DSSSON OF SIDUSTRY SERVICES Address P.O. Box 184 River Falls WI 54022 Property Address: 147 Hwy 65 :r� )/...-Jl- !""t SEE CORRESPONDENCE Phone: Legal Description Parcel in the NW1/4 of the SW1/4 Sec.30 T28N-R18W Township Kinnickinnic County St. Croix Subdivision Name CSM Pending Lot No. Parcel ID Number Part of 022-1088-70-000 Plan Transaction Number Designer Keith E. Stoner Signature Index sheet Calculations At -grade drawings Laterals and dose tank Specifications Management & contingency plan Pump curve & specifications Alternate Pump Float Setting Sanitary Site Plan License Number Phone Number Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Designer 1575-007 715-653-2324 rr1r — 5�$ Date 09/13/20 s•'�r• 't i'9141110tt�uant to: At -grade Component Manual Ver: 2.046r POWTS SBD-10854-P (N. 03Y9iJ, and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-107WP (N. 01/01)(_R /C112) Version 7 0 (03/12) Page 1 of 9 PRESSURIZED AT -GRADE DESIGN At -grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 300.0 Estimated wastewater flow (gpd) 450.0 Design wastewater flow (gpd) 4.00 % Site slope 97.00 Contour elev below lateral (ft) 83.00 Depth to limiting factor (in) 0.50 In -situ soil application rate (gpd/ft62) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 10.00 Linear loading rate gpd/ft 10.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 90.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) Not a final catcuiatron end Center or end lateral connection Number of laterals Orifice diameter (in) e.g. 0.25 d or t Estimated spacing ft pa 9 ( ) Forcemain diameter (in) Forcemain flow velocity (ft/sec) Forcemain length (ft) Pump tank elevation (ft) System head (ft) x 1.3 Vertical lift (ft) Friction loss (ft) In -line Filter Loss (ft) Total dynamic head (ft) 1 0.156 1.50 2.00 3.29 30.00 90.59 4.55 6.08 0.66 0.00 11.291 Designer must select one lateral diameter Lateral Diameter Selection Pipe diameter Design options Dmgn Chace 1 in 1.25 in 1.5 in 2 in X X 3 in X y or n y Does forcemain drain back? y or n y Are laterals at highest point? NA 49 Forcemain drainback (gal) 72.5 5x Lateral void volume (gal) 774 Minimum dose volume (gal) 322 System demand (gpm) Gallonslinch Calculator (optional) Total Tank Capacity (gal) Total Working Liquid Depth (in) Gain (enter result in cell G46) Treatment Tank Information 1000 I Septic tank capacity (gal) Wieser Concrete Manufacturer Effluent Filter Information Dose Tank Information Po Lok I Filter manufacturer 750.4 Dose tank capacity (gal) PL-525 IFilter model number [jig Dose tank volume (gal/in) Wieser Concrete Manufacturer Project: Rollan & Deborah Fuller At- Grade Mound System Transaction Number: Page 2 of 9 AT -GRADE PLAN VIEW r,r— T rD 1/6 a Observation pees (2 tYp�9 B 10.00 It 0.00 ft �� 1 /6 B 15.00 ft ....................... C 12.00 ft W C D 5.00 ft E 2.00 ft L 100.00 ft D B W 22.00 ft A x B 900.00 ft2 L Cap = cell A x B SlaeTypical obs. pipe. Total aggregateSrMled in the lower G, and O= Plowed area L x W anchored securely. 6• T Synthetic fabric cover Lateral invert elev. 97.50 ft Surface contour I 97.00 ft and system elevation AT -GRADE CROSS SECTION rr• aa� `�j��/_ = 12 in. topsoil and subsoil over aggregate and tapered to toes. = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project Rollan & Deborah Fuller At- Grade Mound System Transaction Number. Finished grade elevation �-- Observation pipe at aggregate toe Page 3 of 9 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - Center Connection 4 P Last hole dried oelt to erd cap lE X---1' I Latarats i for" main or PVC Sch 4e Halls a on the twnor" of th► Iareral w SPS TaW 3" ] #WWI fp� a Turn up udbalt wM or dMeautpiuS Lateral Specifications 0.156 Onfice diameter (in) X 1.49 Orifice spacing (ft) 60 Onfices/lateral 32 2 Lat. discharge rate (gpm) 32.2 Sys discharge rate (gpm) 11.29 TDH (ft) Final grade —\ Weather-proof junction box Center Lateral connection point 1 Number laterals P 88.66 Lateral length (ft) 2.00 Lateral diameter (in) 2.00 Forcemain diameter (in) 30.00 Forcemain Length (ft) Typical Pump Chamber Layout Tank component is property vented Electrical as per NEC 300 and SPS 316. 300 WAC C o A c 8 E C 0 0 Totals Inches Gallons 21.2 429A 2.0 40.6 3.8 77.4 10.0 2030 37.0 750.4 Tank full JA Alarm on Pump on B 91.42 ft C Pump off D disconnect Approved manhole cover with waming label and locking device 4" Alternate T s_ outlet location ]/\18" min Ir Approved_ outlet 1 joint Provide 114" weep hole or antmiphon device 4 90.59 ft Goulds Pump manufacturer ISJE Rhombus Alarm manufacturer EP04 Pump model number ITank Alert 1 Alarm model number Prol.ect: Rollan & Deborah Fuller At- Grade Mound System Transaction Number. Page 4 of 9 At -grade System Maintenance and Operation Specifications Service Providers Name I Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name ISt. Croix County Land Services Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 118 in Estimated Flow - Average 300 gpd Maximum BODE 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Sal Absorption Component Size 900.0 ft Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Septic and Pump Tank Effluent Filtei Pump and Controls Alarm Pressure System Mound Othei Service Frequency Inspect and/or service once every 3 years Inspect and clean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushed and pressure tested every 1.5 years Inspect for pondi and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the at -grade component manual. 2 Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6 Areas within 15 feet of the downs" toe will be protected from compaction. 7. All other construction details are as per the at -grade component manual SBD-10854-P (N. 03/07). Lateral Turn -au Detail Finished .............. . Grade 6-8" Diameter Lawn Sprinkler Valve Box Distribution 97.50 ft 0. Threaded Cleanout Plug or Ball Valve Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project. Rollan & Deborah Fuller At- Grade Mound System Transaction Number: Page 5 of 9 At -grade System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with iW component manuals ISBD-10854-P (N. 03107), SSWMP Pub. 9.6 (0181), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death Septic and pump tank abandonment shall be in accordance with SPS 393.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers. access risers and covers should be inspected for water tightness and soundness Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, detective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component Septic Tank The septic tank shall be maintained by an Individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113. Wis. Adm. Code. The operating condition of the septic: tank and nutlet fitter shall be assessed at least once every 3 years by inspection The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the fitter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 r3 the liquid vokxne of the tank Ifthe contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, It such products are used they shall be approved for septic lank use by the Department of Commerce. Pump Tank The pump (dosing) lank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. At -grade and Pressure Distribution System No trees or shrubs should be planted on the at -grade. Plantings maybe made around the al -grade's perimeter, and the at -grade shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the at -grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winder will promote frost penetration. Cold weather installations (October -February) dictate that the al - grade be heavily mulched as protection from freezing. Influent quality into the at -grade system may not exceed 220 mg/L BODS 150 mg/L TSS, and 30 nglL FOG for septic tank effluent or 30 mg/L BODS, 30 mglL TSS,10 mg/L FOG, and 104 cfu/100 mL lot highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the and of each lateral, and it is recornrmended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial lest when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requinrg additional, more frequent monitoring Contdnuency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective components) shag be immediately, repaired or replaced with a component of the same or equal performance. If the at -grade component fads to accept wastewater or begins to discharge wastewater to the ground surface, 9 will be repaired or replaced in ks' present location by increasing basal area if toe leakage occurs or by renovating the biologically dogged absorption and dispersal media, installing new piping, and replacing other components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider Project Rollan & Deborah Fuller At- Grad Transaction Number. Page 6 of 9 METERS FEET 10 9 30 8 25 7 f,J 6 20 5 O 15 4 3 10 2 5 1 0 L 0 ft"1eC9 i 5GPM F7 i I l i I — --- — EPOS i EP04 i 0 10 20 30 40 so GPM a a I 1 0 2 4 6 8 10 12 W1h CAPACITY MODEL INFORMATION Flea SI41 OrderMiiinwrn Nr Males Annpa Ciorc rhw Smiled card Di dm" mk&R n" m I .--" � �� Irr Style 1..y1h Connection an Level On Level Diamstar Sim 6"9 EP0411 4 115 12 20 1 No Swich 10, 1 %* Manual Manual 15' is 20/9.1 EP0411A 9 `l/ W e 10, 12' 6' 21 /9.5 EP0411 F Plu / No Switch 20' Manual Manual 20 / 9.1 EP0411 AC Piggyback / Wide -Angle 20' 12' 6' 21 / 9.S EP0412 230 6 10 No Switch 10, Manual Manual 20 / 9.1 EP0412F No Switch 20' Manual Manual 20 / 9.1 EP0511F .5 115 13 20 No Switch 20 Manual Manual 22110 EP0511AC Piggyback / Wide -Angle 20' 12' 6' 23 / 10.4 EP0512F 230 6.5 10 Plug / No Switch 21Y Manual Manual r22 / 10 PAGE 3 KEITH E. STONER LAND USE CONSULTANT, CERTIFIED SOIL TESTER AND DESIGNER OF SANITARY SYSTEMS 23220 Wood Creek Rd. Siren Wisconsin 54872 Phone (715) 653-2324 AdventurersQ..Centurvicl.net Oational Float Settings Dimension Inches Gallons A 20.50 415.74 B 2.00 40.56 C 4.50 91.26_ D 10.00 202.86 Total 37.00 750.36 37 inch liquid level 20.28 gals./inch Min. Dose = 72.25 gals. Max Dose = 90.00 gals. 91.26 gallons — 4.90 drain back = 86.36 gallons Outional Pump Na Note: Double float pump switch maybe required. Page 8 of 9 Page 9 of 9 7b PM 147 Hwy 65 310JLrRmd" r S,ab Caadlncdal &UftSaad P► vmW I'Sek 40PVC Moir, Sawn Aoparad A/raer Caalsaae IVLPIOM-Afit Sale Taut wVW Pdltdnt PZ425 PUw 2002dosPr�i Aopoaad 4' Sck IO PVC a►Amm D-3034PVC Cea Al W Sanitary Site Plan For: Rollan Fuller Proposed Lot 1 of CSM Part of the NWIM-SWIM Sec-M T28N-R18W Town of Kinnickinaie-SLCroix County Aopwad WLP750-M Dw flwt Anpaaal2'SA 4DPVCF-K 97.00'. Zbwd qfMWdCAdmmkJUOW PA + 97.-W \ �3 96.W 67- Acpaw110J!:90JLAI-( A4aadDtrpuaa,CaO%VWPlot CarmwA)mow Mvv. af97.00' ops mw sbr I ThaadFbr. S/ai imbwa0adwarritlamdacbparSPSM3.3/(a)(y Elevation Data - Nall wv/Piok Rbboa Base of 5" DBN Fence Post Proposed Septic Tank Grade = 99.30' * HRt—Sane ABWbMD LLV.- 100.00' Wwww Department d Safety and RDMssianai Services Oihsion d kaltrMry Sevices SOIL EVALUATION REPORT in accardenca SM SPS M5, Wis. Adrn. Cade Page 1 d 3 am starer CST Inchlde linabdb: MafrO�sl end fWftoontal ret wxm (n M), Plan must Percent WOO, $W err dfllelMICI novas Mrow, and locaWn�and( dtslanoe rooneareet ros0. P#M M prat err kilomraf/on. Paaonei �rlormslion Ya Pra(d• Ml' rwd for semndsry Papaws (PrNecY l.ew, t 15.04 Il) Ue1)- C SL CF0bt ParoM I.D. 022-IOW70-000 - Dafa ��H oww PAMM & Deborah Fuller FG5W Lacsdan GbM. Let NWIM, SWIM, NO. 79ft i118W Let • j-W M ft Subd Nfine or 1:.5hY - F'faparly OWmft I I Mg Addren - - PO Elm 164 CXY alai; 2fp Code Phone Nrrrrber F4verFa/s WI540221Kkwdddrnic - - — - ❑ cm/ [IVMW Totes, Neatest Hoed 1 147 Hwy 66 ® Now C Whuedon Use: ® ResidurllN / Nunber of bedrooms low 3 Code derived deeipn w rate 450 dPD ❑ fibMC err aoeenerdal -Describe: — Parent material San* OutwaSh ----- Flood ptmn eievelron a appfcabla NA N, General rwal rn n w d8"nem Propose a 10 x W AWJn& ffmW trel TO a pipe Mftff ayelem ebvafion = 97.W Pipe corilm staked arMIL and �. it ❑ � ® Pit Ground surface elev. 96.53 L Depth to bmiting factor >9 i --In. AppkMgn Rafe Hedzon Depo Don*m* Cdor Rados D6@0Vdm e Bdaldry fbft WOW in. Moises CkL S2- Con. Colorh. 1 2 0-9 10YR3/2 - so mvlrgs mfr 3Fm 0.6 08 9-16 MR413 - TSd2msbk !>s3Fm 0.4 Ob3 W32 10YR�/4 - Farr — ml gs - - 2Fm Ob LO 4 32.94 lantsm _ - 2f 0.7 1.6 — F2 Ieod„ar ❑Boft ®Pa Grand enlace ekay. 96.00 a. O"M b inMnp feast >94 f7 18d11ppgCrsri fish Nadzan Depth Do ins Color Redox Damm"err Torre Stnrrire _ BousdnY Rom Gpnw in. munew Ou. Sz- Carp. Cda Gf. Sz. Sh. '91e1 •�a2 1 010 10YR9/2 - Si 2trnbic mvfr 9s 3Fm 0.6 0.6 2 10-19 W"H/3 - sd 20nbk 2Ftnsbk 099 "Ar gs 31Lm 0.4 0.6 3 19-M 10MR4/4 - - sl !s nMF nd 96 95 2Fnt 2t 0.6 0.7 1.0 4 29-31 10"W3 16 5 3448 10M S/4 - s Os9 ni 95 if 0.7 1.6 6 7 49.60 i0MR5/4 IOYR5/4 Hof errs ss/fs pmy rN gs _-- if 0-5 LA 6116% _ -- g psy -- - 0.7 _ W nIWK- tinnara 82 - BOD sand TS 30 fng& S s.30 mgvt Name Cif (PYW Pthk) SIpnNMe: s 8T Nunibar K&M Sbrw CST 1►dmeee lfdaisfr224059 OWCrT �.,--- - 7129r- Carrdreffd f4Whw»limber rr22o woad t:r.dc rid 31r.n, vrl s+srl 715see-0900 SM43MM07113) jwmmw� (LunromaaQw,= l4e atr,j, 9S1 tue -ow ce s 9008 - wi3 . (jO Z// "TIuoslSWsmwn-PAO"sae,°ao9-WROW3. /S oh Zz/L)ts� �'®//4 TT `�° - - w 6� s CO 1T s6 --- alsatsv� - iiH-i/SHADT L&09 L Ny aso 6 A _ — i&+l/QwT om 3T s6 Ny SA a _ 9 911 cro w,a so w � -. - 9ro rro +wz so 4w a WVAAoi 05-ez f _ Ira 9ro of di_ �T £ Q 91-9 z 9v 9ro so 4AW 4qw2 7Aa-1 uu3. Is Z%f1lAOT - 8.0 T >�OdO - sxw� fgaw� '45 ZS •A Ala'J'!uDJ'sS'aD 'W uotaaedd►r u) 09 aapyg &M "09 Wisa u�al 4d o o 07 TO - - Mu 9'T ('0 JT c6 _ W 6sp 317D 15 IAOI 96 0 9 — - 97 L'0 ¢ so _ _ 6&+£/WAW 09.1E s PU Bep Sib 9ro chR so 4AW i�Di Aft i Is- - 9ro fro s0 yw vs --- *PW £/iilAOT OZ�i z 9ro w-K so JJKU d1aB. WAIL 844am MDOU Anp� 4S iS nJ °i MM 'woo � '� BoouMy y 9b S AM"WOMI A Oda, 'll -owl ao�rr0 mPa(� ploo ■�9ana yda0 uaQlb/t 06'96 +�eima pungip B4� ❑ � �IaQ _ �hOADI;NA+wq�i1100/�sa�q.r-Z/T41�-S/ 9'T L 0 _ _ W 8oD 0'T S 0 AT 56 - pu _ is hI59ADi 4 97 Co R 16 _ - 64+F"Wl it -is S ;u 6ip c�fi _ i/iilADi T� ; WT 9ro W�m 96 .yew iNilAOT sm £ ev 9ro ahl£ so JPAU _ ------- — �uoT a-uT z - �, „� _ -- vcawT or.o T +W�OdO >MqF! daipiaag coawl :S A � arpys J sS'� NNW"Y V Wd � KUV _ _ y fR< -gal ft" 4 4090 'e orYNl uolyoaa0 mlpy igloo 0 Mdao uaolioFl —OEL6 AGp Sgvj= punnp ed Q pa" f JQ z aged ----- - -- 0*- -YBDT'w * al p rd J* W=m v Uviii rwo Wrtb Pace 3 of 3 fbFM147Hoy 65 3I0)t, b Rawmm Awmawsmd s.aa AMPl.r,.r Soil Test Site Plan For: Rolla, Faller Proposed Lot of CSM Part of the NWIA-SWIM SeC30 T29N-RISW Town of Kirmickinnic-SLCroi: County Propomr "99i Rakwo Aare 3" Cawraatm Slink rm*LOVAOM /'30M 7�rwrgf� lEfwr rti + B #5 + 97.30' Prope"rne.biabta40IAM O 9,ar la ne 4% apm9l.wsae � IB as NbarArabdr.wagdod MrswAmdG trP@rVs.tal 4M" Bkvatioa Data B# I = 96.53' B#2 = 96.00' B#3 = 97.30' 8#4 = 95.40' B#5 = 99.90' Proposed Septic Tank Grade = 99.30' x B a1 7t�nerla7e. -�9t—� BM - Nail wdPiak Rbboa in Bau of 5" DBH Fence Pod * EMP—Same ASSUM`D ILlm — l oo.00' BwMw -PAr Z July 23rd, 2020 ad&g 8lataer CtiT# 2?MS! CERTIFIED SURVEY MAP U^FATED N PART OF THE Nwtp OF THE SW3/4 Of SECrM 30, r.M, nW, Town DF mmmcawwc. ST. aaz Comm. Wmamm W4 mime sErnaw30 1' /y Q. U SCALE.1" =100' 100 50 0 100 LEGEND 0 FOUM ALUMMM QDLWTY SEMON CORNER REOF UMW I O BET V laar arLONB Lu LLs. \\--, I X NO �. I � \ HOUSE I� v ACCEZ EASNOWNFOR \ \� REFERENCE I-5�B'S0'Li'E 1i2A9' �x � I Iz Im jzb— TTDw3o ORAFMBY: DOUG7A8" PROJECT.ffW* 1 DATE:SP" Ta ouDE DeAVETER BY MON WE, wetee w Poe WEAR FOOT NeOeR, M@IT - mUNTY maRDwATE PREPARED FOR ROLLAN i DEBORAH FULLER PC Boat 134 RNER FALLS, YN 54022 SURVEYOR: DOUR 2AHLEX S a N LAND S1ReNFYWG 2920 EROE ST. SURE M FRAWN, we S4MG B.oe P.rar tl�o.w a Br ra►1a ul�eetb � a.�nb.w iaeua rs.r....s nBraeoir M1e. riew.1.rr� A�tadle r� bPrcy(. �J Bra. prrAreby r relepYgeeiprcd orrurBt Deer Oar�gh #0NWCOwk ftradtO�Pt ad r Taw MAleNctlree AreWAa UNPLATTED LAND 1 \ rsrwE n.n �A �TE .► Byes 7-1 / Fo \ y LOT 1 \20 \ ' ) 2AW2ag DRAMMELD 1 fLOWFON 27L12,� tanner � � �� \ \ UNPLATTED LAND \ CMFFr / TTF7 0 m m m m m m ED ED o m o m i 1 � FII"i11 If I�Ii 11� �,_ lii�j1 ', ! Fl01, "'llil ililji'� ROLLFULLER BIE LUNDLUND�� 11 i�i ; Illi ! �' � 11 R i Jjwl - i t fig 3 a i ....''.......:.:.:: ".:........... e 3 i T _e ' �1+1',!g1'�' 1t'IlfI'' ROLLIE i DEBBIE FULLER LUNDLUND=IL i i IiIj1II�1'i!IliI;Illf1l"� s�$ r.....................,�r.,r.+t......,..........� � MGM N.M MGM M� 117 ww 1 6g y t ; r 4 i 3 T t................ j.....�. +; ► t: F. ........... S h fill Wa i►; It�� ,��,l�f�;`�i; ROLLIE t DEBBIE LUND= t t FULLER Jill .s �• lid �J,� R� i if ss o } 4 4 I I I 4 r ww , s�� £;t,illl ,fi, j,ROLLIE I�Ii.!��1``��!111 If t DEBBIE±di I [ LUNDBUILDS mll I, i;111111t II,� FULLER i r'C r r• n v � i 5b 1 IPII +. I w III _I Loll ��..� .ww �w awr �N.ew �Mm max• w.r n.wuw ale m �� x•w wwww w.w.ww `n M� NY mow, .wl/w �C SI wr ww..w ww� ww �. nwY se ,w ww .s r r cM m ss r^ it 0 m aw �•�_ ••__ www wnwww.i c wn .w.ww MTV ...w. 9 N■■■■■ ■ri13'i�i■■I�■�!■■■1■■■■■■■■■■■■■■■■ ON ■ NON ■■■■OM ION 3onN■■r,� is_1i�jGitl!■ ■■■■■■■■■■■i■■■ 11■■■■■rtmpr- �i■ u,nw hI X °?E' Immilopr ST. CROEK COUNTY SEPTIC TANK MAWTENANCE AGREEMENT AND OWNERSIIIP CERTIFICATION FORM Chvna/Buya Rollan 8t Deborah Fuller Mailing Address P.O. Box 184 River Falls Wi. 54022 Property Address Hwy. 65 1 ttol (Verification requied from Planning city/State River Falls, Wi. Parcel Identification hnnerrt fa =22-1�088-7�0-� f Ply Location NW ,,, SW r/, Sit 30 T 28 N R 18 W, Town of ICinniCklnnlC Subdivision Plat: • Lot # 1 Certified Survey Map # 1 11% volume -30 , page # 6 861 Warranty Dad # q(9173% (before 2007)volume page # ■,.._o Lot lines identifiebleerea0nro Improper use and maintenance of your septic system could result in its pr=NWM failure to handle wastes. Proper mehos eanc a assists of pumping out the septic toot every three years or sooner, if roeded, by a lioaracd pumper. Whet you put into the system an affect the function of the septic tank as a treotmmt she it the waste disposal syslan. Owner mainouwnce responsibilities we specified in §SPS. 393S2(1) and in Chapter 12 - SL Croix Courrty Sanitary Ordinance. IU property owner agrees to submit to St Croix County Planning k Zoning Department ■ ce ificsbon form, signed by the owner and by a manta plumber, journeyman plumber, restricted plumber or a licensed puanper verifying else (1) the mane waatwskr disposal system is in proper operuing condition and/or (2) after inspection and pumping (if nccouwy), We septic tank is has then V3 full of sludge. Uwe, the undersigned have read the above requuwrients and agree to maintain the private sewage disposal system with the standards sere forth, herein, as set by the Depwunent of Safety And Professional Services and the Department of Natural Resources, State of Vaconsim Certification spring that your septic system W been maintained must be completed and returned to the St Croix County Planing & Zoning Department within 30 days of the three year expiration date. Uwe arfify that all statements on this form are true to the best of mylour knowledge. I/we smiare the owner(s) of the property described above, by virtue of a warranty deed recorded in Regoar of Deeds Office. Number of bWroom 3 1`P�l� ( O s�.�. I�- It SIGNATURE OF APPLICANT(S) l/?3/�o.�D DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planting Q Zoning Department. ••• Include with this application a recorded warranty dad from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 84m) t I Parcel #: 022-1088-70-100 02/19/2021 09:35 AM PAGE 1 OF 1 Alt. Parcel #: 30.28.18.474B 022 - TOWN OF KINNICKINNIC Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 09/17/2020 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner ROLLAN F & DEBORAH J FULLER O - FULLER, ROLLAN F & DEBORAH J PO BOX 184 RIVER FALLS WI 54022 Property Address(es): ' = Primary • 149 HWY 65 Districts: SC = School SP = Special Type Dist # Description SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Notes: NEW FOR 2021: RETIRED 022-1088-70-000 W/RMNDR 022-1088-70-005 FOR CSM 30-6861 LOT 1 AS 022-1088-70-100 Legal Description: Acres: 2.002 SEC 30 T28N R18W PT NW SW CSM 30-6861 Parcel History: LOT 1 Date Doc # Vol/Page Type 09/17/2020 1111899 30/6861 CSM 08/31/2012 962738 WD 05/26/2011 936727 WD 08/14/1991 472503 912/64 LC Plat: ' = Primary Tract: (S-T-R 40% 160%GL) Block/Condo Bldg: • 6861-CSM 30-6861 022-020 30-28N-18W NW SW LOT 01 2021 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 12/1612020 Description Class Acres Land Improve Total State Reason Totals for 2021: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 519 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 AO 0.00 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW114 OF THE SWI14 OF SECTION 30, T2BN, R18W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN —_l_ as _ _ SCALE: 1" =100' 100 50 0 1D0 FOUND ALUMINUM COUNTY SECTION CORNER MONUMENT SET 1' OUTSIDE DIAMETER BY 18' LONG IRON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT \\ \\ V6 \ \ FOR WE \yyy'J 1111 1 `I S'IYQDRIVFR' DRAFTED BV OOUG71.1 f. TiON 3P_.'. COUNTY COORDINATE PREPARED FOR: ROUAN 6 DESORAH FULLER PO BOX 184 RIVER FALLS, WI U022 SURVEYOR: DOUG 2AHLER S & N LAND SURVEYING 2920 ENLOE ST. SUITE 101 HUDSON, WI W16 Eats pa,p/shoan, on ryas mp 1, s.b/Kt M S6h, "fly and rowmh/P swe, naau and tpugtlona /l. w, w'eW,Ms, mMhnum A. size. acce" to parcel, ".) Batson pmchsaby or devWopbay any part./ Confect Ma St C,otr Cauny Community DeeNopmM1 Dept and ryr Town o/Kim icklnnic for advice. The PoPWfY depicted on Mis map contains .rams Met an sub/Ktro Me$Mm nd0v@d@yZon/n9DstncY \\\\� addRionst nstncdonsa � ant apply. Contact Me Community P^a Depa,bnam tat gntlao lnromxdon. Illll l RIVEREDW i4 �" -i s I I IsFLEd .411-' LOT 1 s,��n�5 Z—W2 1Pf �dACRES l / ^ r ORATNFLEfQ.. _ LOC47WN PROJECT: A874-001 DATE: &W20, RevftW 91120 271.12' SHEET 1 OF 2 * Disturbance of 10,000 sq. ft. or greater between 12% and 19.9% requires a Land Use Permit. * Disturbance on anything greater than 20% slopes requires a Land Use Permit. Road and Driveway Disclosure Q✓ The proposed CSM does not involve the construction of any roads. Q✓ All driveways on the proposed CSM meet applicable separation distances. Water Resources Disclosure Q✓ The property either does not contain wetlands or development will not encroach upon identified wetlands. If wetlands are present on the property attach a map identifying their approximate boundaries. Q✓ The property does not contain flood hazard areas as identified by the Federal Emergency Management Agency (FEMA). l attest that the information contained in this application is true and correct to the best of my knowledge. Licensed Surveyor. Douglas J. Zahler (Name - please print) Surveyor Signature: 8/3/2020 / Page S of 5 C, d 1 ` sconsin Deerhnerti p' DiDM"ofNldut �j �fL PO � r i I ` #3549 Mb Qe� ^� Pape 1 of 3 1fv r 4)�02� i accordance with SPS 385, Wis. Adm. Code `sT-'�Uao _ � I � Keith Stoner CST U v County sit Attach a plan on paper less n B'h x 11 inches in size. Plan must �, CroiX include, not Nmited to; reference point (BM), direction and percent scaldbr (MR�0 row, and location and distance to nearest road. Parcel I.D. �0mm 022-ION-70.000Date se print all iMo►MBVon. Personal mformabon you provide may be used 1v semrda7 Purposes (Pmrecy Law. e. 15.04 (1) (m)). ( 3 Property Owner Property Location RoUan 8 Deborah Fuller GovL Lot NW1/4, SW1/4, S30, T28K R1BW Property Owners Melling Address Lot I Bodo • Subd. No or CSM# PO Box 184 city State 21p Code Plans Nunber ❑ city ❑ vow ®Town Nearest Road River Fats I WI 1 540221 Kinnickinnic 1 147 Hwy 65 ® New Construction Use: ® Residential / Number of bedroorns 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Descrbe: Parent material Sandy Outwaslt Flood plain elevation, if applicable _ _NA ft. General comments a 10 x W AWkade mound rfifu a ' elevation = 97. . Pipe oaMour started • s and rewmrrueruda0are: ; ~sf ar (l cJ C �1�0y� f7�>r� 7>rwl�AeA Ki ❑g4 Ground 96.53 ® Pit surface elev. R Depth to limiting tailor >94 in. Sol Application Rate Harfmun Depth Dominant Color Redox Description Twos Structure Consistenoe Boundary Roots (iPOIRe in. Munsell O u. Sz. Can. Color Gr. Sz. Sh. 'EOM -Esa 1 0-9 10YR3/2 - sit 2rnsbk nwrr 9S 3fin 0.6 0.8 2 9-16 10YR4/3 - 9d 2msbk rrtfr 9s 3f-m 0.4 0.6 3 16-32 10YR4/4 - 51 2f-msbk rrnfr 9s 2f-m 0.6 1.0 4 32-94 10YR5/4 - SIM 0S9 fill - 2f 0.7 1.6 2] earl s ❑ Borling Ground %.00 S ® Pit surface elev. R Depth to 6r96 Factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consislem Boundary Roots GPD" in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EMI 'Ees2 1 0-10 30YR3/2 - Sil 2fnsbk mvfr 9s 3f-m 0.6 0.8 2 10-19 10YR4/3 - Sd 2rrnsbk Ink 9s 3f-m 0.4 0.6 3 19-28 10YR4/4 - st 2f-msbk rrnrr 95 2Fm 0.6 1.0 4 28-34 10YR4/3 - Is 059 ml 9s 2f 0.7 L6 5 34 10YR5/4 - s 059 M ills if 0.7 1.6 6 4860 10YR5/4 °f srs 7.II4 Srs/fs OS9 rd gs if 0-5 LO 7 60-94 IOYR5/4 - s OS9 ad - - 0.7 1.6 ' Effluent #1 - BODs> 30 < 220 mg/L and TSS >30 <.150 mg/L • Ef*JM 82 - BODS S30 mg& and TSS S30 mgtL CST Name (Please Print) Signature: CST Number Keith Stoner 224059 Address Keen 91tnw CST Deb Evaluation CwKkcbd Telephone Number 23220 Wood Crook Rd Sken, WI 54872 7/2312020 715-566-0900 >MD4M9 PLW117) Owner Rohn Su Deborah Fu1er parcel ID 022-1088-70-000 Page 2 of 3_ 3] Boring ❑ Boring ® Pit Ground surface elev. 97.30 R. Depth to limiting tailor >g3 yr. Sol Application Rate Horizon Depth in. Dominant Color Munsell Redox Description ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consist Boundary Roots GPDW -EM1 •EfM2 1 0.10 30YR3/2 - so 2msbk n rr 9s X-M 0.6 0.8 2 10-29 IUM/3 - sd 2msbk mfr 95 3f-m 0.4 0.6 3 29-35 10YR4/4 - A 2f-msbk mvfr 9s 2f-m 0.6 1.0 4 5 35-51 10YR4/4 - - Ors sr fs/s 099 099 mI mI 9s gs 2f if 0.7 0.5 1.6 1.0 51-74 10YR4/3+5/4 6 74-83 30YRS/4 - oos 099 rd - - 0.7 1.6 - a5 - with 112 - 4- bards of dernae loamy vfs 10YR4/4 �19 s ❑ Boring ® Pn i]rnufR] surface elev. 95.40 ft. Depth to GrrriWlO hcWr >96 yn. Sol Syr Rate Horizon Depth in. Dominant Color Munsell Radom: Description Ou. Sz. Cont. Color TexkLm Structure Gr. Sz. Sh. C4neidemom Boundary Roala GPOW •Em 'ERR 1 2 0-10 10YR3/2 - sit sd 2msbk 2msbk nwfr mfr 9s 95 3f-m 3f-m 0.6 0.4 0.8 0.6 10-20 10YR4/3 - 3 20-26 IOYR4/4 - sl 2f-nisbk mnfr 9s 2f-m 0.6 1.0 4 26-34 10YR4/4 - grs 099 mI 95 2f 0.7 1.6 5 34-60 10YR4/3+5/4 - sr gr Cos Os9 tin 9s if 0.7 1.6 6 60-96 IOYR5/4 - sr fs 099 fW - - OS 1.0 #6 - with fregtlent 1 - 2- bards of so 10YR4/4 5 ❑ Bon g Boring a ®pit Ground surface elev. 98.90 ft. Depth to landing farlor 60 ✓ Horizon Deplh In. Dominant Color Munsell Redox Description ou. Sz. Corti. Color Tarire Structure Gr. Sz. Sh. Considence Boundary Rails GPD/W •ERif 'EM 1 0-8 1OYR3/2 - so 2msbk nMr 95 3f-m 0.6 0.8 2 8-16 10YR4/3 - sH 2msbk fftVfr 95 3f-m 0.6 0.8 3 16-29 10YR4/4 - sd 2msbk Mir 9s 2f-m 0.4 Ob 4 29-50 IOYRS/4 - Is 099 fN 9s 2f-m 0.7 1.6 5 50-53 IOYRS/4 - sr Us OS9 m1 95 if OS LO 6 53.60 IOYRS/4+4/4 - gr s Os9 rN 9s if 0.7 1.6 7 60S! 10YRS/4+4/4 c2d gr s 099 fd - - 0.7 1.6 • Effluent # t - BOO 5> 30 s 220 mgrL and TSS >30 t 150 mg(L 712V2,6 Effluent 02 . BODs s 30 nldL and TSS < 30 mg/L SHMO A'm(R.Q]/1)I Real skXW 6r Page Y of 3 To FN# 147 Hwy 65 310Jt. toReriderce Erdahv mw 2.002 Acre Parcel P/L Soil Test Site Plan For: Rollan Fuller Proposed Lot of CSM Part of the NW1/4 - SW1/4 Sec.30 T28N-R18W Town of Kinnickinnic-St.Croix County • .uposed iiYvE Bedroom Nome Slab comovedom 99.30' Sqpdc Tank Location 0 / >30% T6nad of Khwk& mdc River PIL + B 05 +\ 97.50' \ Proposed Dam TankLoeatlom O \ 97.00' \2.376 � 3 96 00 q Ili % V i WPM FWd Stae 1B �. Note: Afateaole well and wnaallne se0ackr per SPS 383.3I (8)(1) Elevation Data B#1=96.53' B#2 = 96.00' B#3 = 97.30' B#4 = 95.40' B#5 = 98.90' Proposed Septic Tank Grade = 99.30' 0 25 50 a'.yhk aws W"O 1 inch - 50 R AmadE/ev.--91.50' — Nail w/Pink Rbbon in Base of 5" DBH Fence Post * BRP—Same ASSUMED ELEV. — 100.00' 1 —Backhoe Pit � July 23rd, 2020 E. Stoner CST# 224059 CERTIFIED SURVEY MAP TOCATW M PART OF THE NFF1/4 OF THE SWl/4 OF SECnW 9%rAK MM, TOM OFID*MXMB,Sr. CUM OMM",Wnow IN Tv1/4C omen / mcmwso T SCAM r = lw 100 so D 100 LEGEND 0 FOLM ALLWINUM COUNTY SECTION COMM momu&uW SET 1. OUTSIDE ouwm ER BY may.-FmeP v � R �B FOM / X NO MOMMENT CDIRVTY COORDINATE \ \}'� mwmlit %1 PREPARED FOR: RDUAN a DEBORAH FUuea PO am 1" NM FAILS, un swn SURVEYOR: DOUR ZAIRER S i N LAND SURVEYING 19m EN OE ST. SM 101 RwSON, TM s o18 s.d,prretl M mvft wpigsuva+m sra CowWm dTowwMPr.S ia1wed n" , 1 044 - ,ti mh"= Intsb% wwftg tol'a,IBrbnpra '-of �'��W'i rrypralaw�Yre ewa cmk mab oo.wi v ow.kpmwDw Md Mw na Of/OwMd&VdCfar oA1ca EA+alFevr \ UNPLATTED LAND �. I sNowmwR �\ \�� — —"• � . \ ReE IEWC< \ ApPRauoINArE EASEWENT \ u'"' ATV9rFOGE I—SM34'Li'E ]B2,W' �m+E ` \ � • � 9&W Y 60 \. / \ �, Z � L JZc IS ItLOT 1 Io "' iOW� r�1► to p„POSED/� RA DNiBD i LOCATION L ar11ON3o DRAFTED BY: WW Z"%a pMM!C :1J9 "M DATE tvlrm UNPLATTED LAND iNFFT 1 r1F 7 040010MWk 84a' 6 rf 0461' ap's ;f4***wj 5r.Clft- couNnr No. 645495 OWNER PLUMBER TOWN /OR LOT S PERMIT EXPIRES SANITAY PERMIT I� 141 +twY 6 S fl�ENEWAQ PREVIOUlS NO.X; (,ZSO SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow Installation of the private sewage system described In the permit (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for ■ specified period (d) Changed regulations will not Impair the validity of a sanitary permit (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (1) The sanitary permit is transferable. History: 1977 c.168; 1979 c. 34,221; 1981 c. 314 Note: Ifyou wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER - DATE UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11120)