HomeMy WebLinkAbout022-1038-95-000 (2)Wiscpnsin Deparment of lndustry,
LaLf ard Huinan Relatiors
Division of Safety & Buildings
SOIL AND SITE EVALUATION REPORT
in accord with ILHR 83.05, Wis. Adm. Code
Page \of 3
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction andl" of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
SOIL DESCRIPTION REPORT
Boring #
Ground
elev.
/b2.5 1
Depth to
limiting
factor>)6"
Remarks
COUNTYsl-. g\?o t )<
PARCEL I.D. #ozz-,D38- q5
REVIEWED BY DATE
PROPERW OWNER:K\)\ZT \<RUtr-69\"C BuV,"-ft)
PROPERWLOCATION
GOW.LOT s '1. #t NW1/4,S lv T 'aB ,N,R ls E(o(@
PROPERW OWNER':S MAILING ADDRESS)?--) fi-tr)q:Sl DE btcl uts- I\.-\O\LTF{
LOT #z BLOCK #SUBD. NAME OR CSM #
c- sl1 \lSU \ P3 z=z
CITY. STATEfh-rssSAJ r kJ I
ZIP CODEsvb,6 PHONE NUMBER
(?,s) 38t-\r3a DctTY DVTLLAGE $OWN\<.IIJl-r\CYc-IAJUIC
NEAREST ROAD
c-. f. F\ . " S
D( New Consfiuction
[ | Replacement
Use X Residential/ Number of bedrooms Z [ ] Additiqn to existing building
t I Public or commercialdescri ha
Code dedved daily ffofl iDo Spd Recommended desbn bading rab - bed, gpIS- e:Lfemn, gpdm2
Abor ion area rEuir* - 5.6, p r so renA, # iihximum d€sign loading raE o. j bed, gpdrtP-g. Y-rencn, gpof
Recommended inft lfation surface elevation(s)S€E T5ft6E 3 (as refened to site plan bendmark)ft
Additional design / site considerations ,Rq(s4ylB-rs L-rF-EXre-.lkEs.*ENes \ou LDNGTX.T\'"rH Tsru11> eRthBlst -
Parent material S qD\hEhJT ou ER sFn^,u ( cp,^dlqr- Flood plain elevation, if applicable N,h. ft
S = Suitable for
U = Unsuitable
svstem
foi system
CONVENIIOT{ALtrS trU
MOUNDEs tru IN.GROUND PRESSUREurs Du
AT.GRADEBS DU
sYSTEM rN FILL I rtolows rnnxtrs tru I trs Eu
Horizon Depth
rn
Dominant Color
Munsell
MoUes
Qu. Sz. Cont Color
Texture Structure
Gr. Sz. Sh
Cons'stence Bqndry Roots G P D/ftz
Bed Trerdr
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e,L zz-28 IsY fz 3/g s f I z$ 5\k n{x c.S \uT o.5 o.b
5 28-3b 1 . SLt E. V/L Cr^,sc,l ze- s\h rn 9r cs O. \[o.s
Y 3[ -14 r.Syrr v/O ersl \ c_ sbh lr u{h o 1 :o v
c-0,u\v^,s \luel s oF y4tssf JE. Ytr *r- s. \
Boring #
Ground
elar.\sq.v ft.
Deph to
limiting
tactor>B.l"
Remarks
sqs'art g o_F trlT
rq YE E/51 I Znttbh u^, (r.q.S lu*6 S o t\o -\L
z \z-zo tqYP 3/v sil z{s\t r,rr fr.cs )u{o.s o L
3 ?D.3y )-svp v/Q Crrsfl zcs\h m{x c S s. s i o.6
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CST Name:-Please Print Phone:7t5-425-0165Arthur L. Wegerer
Address:UlJege rer Soil Testing & Design Service-P.0. Box 7 4 River Falls,WI 54022
GST Number:
M00576
sisnature: o"J* r.q3 -3\
Date:IaF(t ZZ, l9cl3
a
\ r,{
srrYqR
PROPEFTY OIYITEfr
PABCEL I.D.
Boring #
\eE\)
zz- I O38 -
SOIL DESCRIPTIOI{ FEPORT nage z {t 3
Ground
€lev.
\$:z-ft.
Deph to
limiti,lg
lachr
> go'
Remarks
Hodzon Depth
in.
Dominant Colot
Munssll
irou6
Ou. &. Cont Color
Toxturg Structuro
Gr. Sz. Sh
Corlsisbnce Roots GPD/IIZ
Bed lfierdr
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Z q-23 1.sVQ y,lL sil ?{sbrt n{r cs \u{o.S o.L
\z3-3y IO YE Y/L {t bSq x.rl cs o,s s.b
tl \-r s i.S YE y/lD S)\ os\h nr\J$!.45 o.3 o'y
S l s-go ISYE Y/6 *s os1 s-S o.t
s OF uu.SluE , Ftl TLE SI
€)Oc J's>)oF L)rnE ilo^)s
Boring #
M
ffiqffiM
Gmund
6lg\r.
sbl,t.
Dsph b
limiting
tacfi "> 6E'
Boring #
Remarl(s:
\
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z \\-z z \s9\z 3/y sil z+ s\h rn(t^cs )u*o.S o'L
3 2Z-"4 l\YE )/l s\
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o s DF \Dt\:V/6
6 SH L\he}\dE-
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o..l
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b I v II
SSh J
nu$r^o.S
Gt
Ground
olw.rD!!f n.
Deph h
limilingw.
Rgmarks:
Boring #
Ground
elo'/.
\s.s:9 tt.
\o -to )blrB 3 /t-"il a$*h *.{l c.s
z s hl fl cs
\ cs\\h, u{F
z \o-z)toYE S/
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sil
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o-3 s.V
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limiting
9ta'
Remarks:
sBo-8330(R.0582)
PLOT PLAN
SCALE t"= 3S I
\-ro\e:-\FNSE To BE AT LSfisT zS' ppapr yuslucHqs .
td ql-L v v .. ,( SS' tt ..
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Page 3 of 3
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Teleplorre No. CST #T gnature
,
Date Signed
-
\
W:aorlsin OeperrrEnt of lndusry,
I-abor ard Hurnan RelalirrE
Division of Selety & Buildngs
SOIL AND SITE EVALUATION BEPORT
in accord with ILHR 83.05, Ws- Adm. Code
Attach compl€te sits plan on paper not l€ss than I 1/2 x 11 inch€s in sizs. Plan nust includo, but
not limitsd to venical and horizontal rererence point (BM). direction ard % of dops. scale or
dimensioned, notth arow, and location ard dislarrce lo nearest road.
APPLICAT{T II{FORIIATION-PLEASE PRIl{T ALL INFORIIATION
SOIL DESCRIPTIO}I FEPOFT
Boring #
Page 1 ot 3
Gmund
dev.
,oz. s I
Deph b
[miling
feh(>*"
Remarks:
COUNTY s=r. c-\zo \ x
PARCEL I.D.#oz?-,O18- 95
REVIEUIED BY DATE
PROPERTY OIi{NER:
Yc\r\:L\- \<_RuE6c-R c su.rre-e)
PROPERTY LOCATION
cow. LoT s)lLrB N\rJ1/4,s )v T zs ,N,R )s E (o@
PROPEFI'Y OTIVNER :S i,lAlLlNG AODRESS)z-1 I{lq€\zSrD€ \truu- lJoI.TH LOT 'z_
BLOCK I SUBO. NAME OR CSM,c-s},l \)sL 1 P3 zsz
CITY. STATEbh)SS\N r kJ I
ZIP CODE
svo r6
PHONE NUMBER(),s) 38 t- \r3 a ECITY EVILLAGE ETOWN\--ll.)u \ ctLtAJu I c
NEAREST ROADc.T.t1 ."S
D( Nev, CorBhriion
[ ] Replacement
use f(l Reid€nlial/ itumber ol bedroo.ns z I I AddiliAo to exbting building
tl Public or commercial desqibe
Code dedved dait fril 3[)o Spd RecornrEnded desilF loeding rab - bed, gNfP-erV-renA, gpdfl2
Absophn aroa rEuired - bed, fl2 -l 50 rendr, ft2 i,hximum des(f loading raE o - 3 bed, Str/t8-g. y-rerch, Spdfp
Recom]IEnd€d infi ltralim surlace elevation(s)S€E TJA6E 3 I (as refered h siE dan bendlmark)
Additiond d€sign / sits orEiderali hrtL rS L -Tt.Flra tl$st -EfiCt{ \OO LDN 6 . tu\.$l F\JF]P cltfrY1 Bst.
Parent matedal S ES\ta|+JT ou E\t si"^ { €E r\i,lEr-Fl@d plain elet atirn, il applicable N.h. tt
U=
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Urlsuitsble ft,i svstsm
co,lvB{noN Ltrs tru MOIJNDES E]U
[i€m(,{D PRESSUFEEIS trU
AT.GRADEES DU
SYSIEI IN FILTES trU
HOf,DIt{G TAII(trS EU
Horizon Depth
in.
Dominant Color
Munsell
Moues
Qu. Sz. Cort Colo(
Texhrre Structure
Gr. Sz. Sh.Consisbnce Bqrday Roots GPOfitz
Bed Trsdl
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BodrE #
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RemaiG:
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v 3'-ay lo.1 tr Y/6 wrl o.S 5.LSsos5
EEU-[!IIEIItr
CST l,lem.=4..t. Prl[Phooe:7t5-425-Ot65Arthur L. Ueqerer
ffier"r Soil Testing & Design Service-P.0. irox 74 River Falls,WI 54022q*" Aql-. {!r,ca."*-q3 -3\
Dab:r:.rra,.. ZZ' lg'13
CST Nmhc
u00 5 76
PNOPEFTY OlYilER
PARCEL I.D.
Boring #
\<R-lJE r:V SOIL DESCFIPTION REPORT
ozL- IO38-
Ground
elev,\\!:Lt.
Deph to
limiting
lactor
> go"
REmarks:
Page --1-cll-'
Horizon Depth
in.
Dominant Color
Munsoll
Illottes
Qu. Sz. Cont. Color
Texturg Structure
Gr. Sz. Sh.Consistencs Bo.nday Roots GPD/'t2
Bed lTlgdr
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s-S oSs -80 rs YE y/6
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o OsU 5 F)E ES oF L)h€l Yt"J r-
Boring #
ffiffi
Ground
6lev.
\s&Jfl.
oeplh to
limiting
lactor>69
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Boring #
Gtound
elev.\ob.ytr.
oepth to
limiting
lactor
> 6q"
Boring #
Gtound
elw.
\slSilllt.
Deph to
limiting
'g'ta,
El^m. r1,..
o -lo \D9B 3 sl
[O Ytr ],/Si
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z $s\rt ". {u c,S \u{o. s o.t
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3 zr-68
C
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Dt\ (l4..Qr 'S or )\'1R s/B $s
Rsmarks:
sBD-8330(R.05r'92)
o-9 tsYt !/r si \r*:\tq rn{r q.- S \u{o.S
6.S
o.V
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z q-zl \\9E 3/s;\zS slt )n SL as \u$o.t
3 zt-L?),s'tP V./6 Gusl \ csbk Yn u$r^o.S
Gr Go^/S\u -lv TI
S ,ueJ
t PLOT PLAN Page
SCALE 1" = 3S I
LfoE:rFW Tb Bt .qT LSfiJT zS' Tpore TTt\-)\lCHgS .
I;JQLL Y e .. t1 SS' t( .( _
l.loTE fS trJ SIftLLqR
PL\<rg -IILp.r:Uq3 2V " DEEP BT Tr+€ D0 ruNs LoP€ q:b6\-
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CST #
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CST Signature Date 5igned ep one No.
sTc 10 4
AS BUILT SANTTARY SYSTEM REPORT
OWNER LIK
ADDRESS ef,fl -:r.w
suBDrvrsroN / csM#
/ -r-\SECTION ,tl T J j N-R ) W, Town of
R
LOT #
sT. cRorx couNTY, wrscoNsrN
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
PLAN VIEW
SHOW EVERYTHING WITHTN 1OO OF SYSTEM
I ll
CttPlo o"\YO,
3t'I
)0
1
I @
l\u
73',
>lv
INDICATE NORTH ARROW
Y Beorro u, r'.
Alo ^"
rt lc
lf
3o'
I
1., ))>l-r.i'ttjBE
AI.,TERNATE B!I:
SEPTIC T PUUP CEAUBER / EoLDING TANK INFoRI(ATION
Manufacturer:
setback fron:
Pump: l,lanu f acturer
Float sep eration
Alarm Location
weIIOUe K House
Liquid capacity:
lS other
(JC
Model#
-
Size-
L,J. .kr
Gallons/cycle:
Teo., "\'' '
5 t"'\. ? ,; , il,Bct
.. t.t-'r_:. Irojo,.) {._ , __7,_TT
. AOTI, ABAORPTION SYATEU
widrh:5 Length
Bu i Id ing SeI^Ier
PC inle
Nunber of trenches ?lo
Distance & Direction to nearest prop. line:5
O\f t. r'r -r
setback frorn: well: lorJ' House I t other
Y
ELEVATIOII8
sr rnret i05'3G sr outret lOt.OS co v(t:
t08.'7|
li.n,,
Pc bottom
rr- (ruI,Punp Off
Manifold /oifJ ftl.abotton of s ystem l0o.5()Header/
Existing erade 5F Itv Final grade 'loj 7a
DATE OF INSTALI,ATION:)b 't)
i(, II llr. .. _1__-\LJ-iz: t) L,t.') ,-r;l .\PLT'IIIBER ON JOB:
LICENSE NI'I,{BER:3Y r,r V
INSPECTOR:
3/93 2jt
v
(
L ooeflhT 6N+ a rIftI*I$I6J6 I
. Labor and Human Relations
' Safety jnd Burldrngs Drvrsron
IINIC L4 .z8pftRrft'ffrvvfld#v3Thco - RD.
INSPECTION REPORT
(ATTACH TO PERMTT)GENERAL INFORMATION
TANK INFORMATION
TANK SETBACK INFORMATION
PUMP / SIPHON INFORMATION
SOIL ABSORPTION SYSTEM
ELEVATION DATA A9300043 9 )/2s
Permit Holder's Name*Ru@ G B,kr E City fl Village p rown of
KTNNTCKTNNIC
'CSTBMEIeilI' '
/ /,'), C, ;
'frGETM Ele[:--
,,/ :- (
BM Description PG( p/"-
e6unq
ST. CROIX
Sanitary Permit No
1_93384
State Plan lD No
ParcelTax No.:
a22-1038-95-000
TYPE MAN U FACTU RE R CAPACITY
Septi c a,/wK C-*o. Hod.
Dosiagr--
Aeration
Holding
F5 ELEVSTATIO N BS HI
F,3Z /cb, ()Benchmark
//c, a@*4,8,n/
Bldg. Sewer
SCa /0s, y'6 'x t y( lnlet
/</as3,17St I ff. Outlet
t*
-f
Dt lnlet
(--Dt Bottom
\)c /O/, OP 'Headerl&Bil.-
7, 05 /o/,27 'Dist Pipe
,/fl,Q'Bot. System
(/
7,70
/o-\ 77Final Grade
,/d7.f '{,
I
TAN K TO PIL WE LL BLDG Vent to
Arr lntake ROAD
Septic >fi (?)>d ,.)44 NA
Dosing'--,----NA
Aeration NA
Holding
MUU[est-=r--Demand
GPMModel Number
TDH Li ft Friction S TDH Ft
Forcemain Length Dia Drst To Well
lnside Dra Liquid DepthWrdth5LengthNo. Of Trenches3BED / TRENCH
SYSTEM TO PIL BLDG WELL LAKE / STREAIVI LEACH IN G
CHAMBER
OR UNIT
SETBACK
INFORMATION b,
fc,rrC7System
ype >/a''fr
DISTRIBUTION SYSTEM
Header /rrraai{c*d_
Lensth JL Dra a_Distrrbutron Prpe(s)
C,-- /Length / "x Hole Srze
Dia A Spacr ng rl x Hole Spacing Vent To Arr lntake
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over
pd / Trench Center 6 /Depth Over
Vtd lTrench Edges
xx Depth Of
Topsoil
xx Seeded /Sodded
!Yes DNo
xx Mulched
!Yes ENo
COMMENTS: (lnclude code discrepancies, persons present, etc.)
LOCATION.: KINNICKINNIC L4.?8. 1B -215C, S l/2,NW,
.r/ !
(-l /' , '
'''
' - /' ! t
s /3 23
co. RD. J , LOT 2
fft
@ Qru"n"/, &.
@ulll,/*rlre
///atA )ztl ZX
,l-'" ./,14
'.rn d
4
Plan revision required? ! Yes El No
Use other side for additional information.
sBD 6710 (R 05/91) ,l - .,,/ , .' I-/': Y' / '
r
Date lnspector's Srgnatu Cert No
' /.68
-:-
7/)
,/,<.?
\
PIT
DIMENSIONS
No:Of Prts
\acturer: /
)3 ModelwUr"Uq___Z
4,
(lJ.
!LHFI SANITARY PERMIT APPLICATION
ln accord with ILHR 83.05, Wis. Adm. Code
-Attach complete plans (to the county copy only) for the system, on paper not less than
8%x 11 inches in size.
-.See reverse side for instructions for completing this application.
I. APPLICANT INFORiIATION - PLEASE PRINT ALL INFORIIATION.
couNKt. ceox
STATE PLAN I.D. NUMBER
PROPERTYOWNER':::=:(;,.1 Keu*qrG TT,?Tffi;:i l\ rrB,N,R tB E(or)6)
C
PROPERTY uot'#a BLocK# NA
CITY. STATEK*il'?ol\s ti'rsc.Y 0)aCODEzlP
5 f'oiiK"^SUBDIVISION NAME OR CSM NUMBEReveY'Y'le'|w5'-fr"'\7;1"=^'l ?" )Sa
r E Aoucondo
z Z Assemblv Hall
g E Campgrouno
+ lJ Church/School
s E Hotet/Motet
VILLAGE:INN ItNr(
6
7
8
I
trtrtrtr
NEAREST 5Y_
1o E Outdoor Recreation
11 E RestauranUBar/Din
al Facility
ing
lll. BUILDING USE: (lf building type is public, check allthat apply)
Service Station/Car Wash
Other: Specity
l!. TYPE OF BUILDING: (Check one)State Owned
Medical Facility/Nursing Home
Merchandise: Sales/Repairs
Mobile Home Park
Office/Factory
12
13
E proli" EL or 2Fam.Dwellingr-fl of bedrooms
lV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
B) E A Sanitary Permit was previously issued. Permit #
4.5
Date lssued
Repair of an
Existing System
Reconnection ol
Existing System
n) t-Eluew z.
System
Replacement 3.
System
Replacement of
Tank Only
Seepage Bed
Seepage Trench
Seepage Pit
System-ln-Fill
Other
41
42
43ntr
u
ET
V. TYPE OF SYSTEM: (Check only one)
Experimental
30 E Specity Type Holding Tank
Pit Privy
Vault Privy
Non-Pressurized Distribution Pressurized Distribution
21 E uound
22 Z ln-Ground
Pressure
11
12
13
14
2. ABSORP. AREA
REQUIRED (sq.ft.)
/s oo
4. LOADING RATE
(Gals/daylsq. ft.)
.oY
5. PERC. RATE
(Min./inch)<V lp'Hsgt* Irl ioo 5 0 reet i
,oY.73
7. FINAL GRADE
ELEVATION
,Ol5nFeetlso6
VI. ABSORPTION SYSTEM INFORMATION:
3. ABSOBP. AREA
PROPOSED (sq. ft.)
CAPAClTY
in oallons Prefab.Fiber-
glass Plastic Exper.
App.
VII. TANK
NFORMAT!ON New
Tanks
Existino
Tanks-
Tota!
Gallons
#ot
Tanks Manufacturer's Name
Site
Con-
structed
Steel
Seotic Tank or Holdino Tank la0s
Litt Pump Tank/Siohon Chamber
VIII. RESPONSIBILITY STATEIIENT
l, the undersigned, assume responsibility lor installation of the onsite sewage system shown on the attached plans.
MP/MPRSW No.
3V0y
Business Phone Number
( J,3 ) 3Bt- rA0,hn
Plumber's Name (Print):
5 "" Bou\,et
Pl umber's Siglrature: (No Stalnps)
C,^ Ua""^ft
-t A DJO N fL,,0)-I
NW/DEPARTMENT USE ONLY!x.
Approved
Disapproved
Owner Given lnitial
(lncludes Groundwater
Surcharge Fee)
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD€398 (formerly Plb€7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Salety & Buildings Division, Owner, Plumber
E
STATE SANITARY PERMIT #
z " l,k# #:.{,pp, icarion
1. GALLONS PER DAY
Goo
trutr
t-t ntt
.-)
I
1
2
3
4
6
INSTRUCTIONS
A sanitary.permit is valid ror two (2) years.
Your. sanitaiy permit rnay be renewed before the expiration date, and at the tirn,: ol rercwal ilir',/ new
criteria in the Wiscor,sin Administrative Code v,/ill tre appiicable.
All revisions to this perrnit must oe approv'-'i f.y the pe, mii rrsLrir,g a.,tlri:.:i,
Changes in (rwnership (1r plumber requires a Sanitary Pe.m;l I,,rrslr':,4r:.:,''.r.'i,, ;,)!'rn (Sr.i. ::.':lati, lc r)i:
submitted to the L:.,unty prio( to inslallatidh. :
Onsltg sev,'alse fiy."l,3Pis nrust bc properiy lritr':tat reo th{r : . pli'. la' l.) ar' .i }:.--, . r' '/ l i.,: : li: 'tt-':'t' '
pumper whpnever necessary, usually every 2 to 3 yeai:i.
lf you have'questions ccncerning your onsite sewaOe systeqr, cunta,:l yorrr l.rcei :cCe adrriirristrat,r cr ihe
State ol Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include
Property owner's name and mailing address. Provide the legal descriptiJn and parcel tar number(s) of
where the systgm is to be inslalled.
Type o, buildi,ng being served. Checli only one and compiete # ot bedroo,ns i' 'l or 2 Farnily Dweitin.J
Building use. l, building type is Public, check al! appropriate boxes that apply.
Type ol permit. Check only one in line A. Complete line B if permit is for tank rer)!acemenl, re,)onnectron, or
tepai .
Type ot system. Check appropriate box depending on svstern type
Absorptian system infcrrnaiicn Proyide all infor:r3t,on rerir-,e e?','i ,:'r f -l ,'
Tank infoflrati.,r. Fiii ir, :llE capaiity of eve;r r,Fw,1ra,'"r axli.ii;'' : ia i( ji r!;: ! j: ,-, i:.,-r ',.. -
tankS anC ,l.afru"iiLfitrer'S nar'.,t i.rdiL-ate pr..tt"l-._'r'Sito C(,,iS1rrir. .:i ,;t' -,,ii r-r<ri, r,l '-;.,i 1 ,, ti: :'
septic, puntolsiphn: and ira,loing lanks fcr iii':i !v.te|ir al'ock r:/--.J'i'1 :' -t'),.:)zi,,i ir l l; : | " : , 'jL r:- : " '
erperimenlal lr.oduct apprcval fr':m DlLrlll
f l espons itrtlity statement ,-slaiil!r9 plumhgi i:r ir):'ll in'r''f','r r'-.' t-") " i'iL,j ' e'rlh !ipro,-)rr.rr1"'',,r,r:e:i
MP, etc.), address and i)iro,re nur,ber. Plurnber must:igo iip;rlicairrn i . .n
County/Department Use Only.
County/Department Use Only.
.
t
IV
vll
vll
IX
X
Com;'ir.:e fl.1n:- an{l spe,:iliceili.ii:. 4ot smailer than Bi! ii iro!re; n:ir-; tr, ' .t --i,' j 1') lh. ::. r 'l
FiirrrS r.,.s' r.)ciu..jr,, jhi.tcr:.)'{i.iJ ,\) plOtlla't !,"' l. a,r'.j r'.! il .
hcr.,Jing ;.irk(s). 1ea:ri.' r:.k':i (," ,ither treat:]r'; : lr. k: lr,;lr.: i . ,.
srfearns ari.i ialr:S l,t,mr),.jr sir)lr,..i ':ankii Jistr,nlri:r,,' ir^r.-.i. s , -.,,\,
areas, anj lh.,i,){lai.-,..1 i)i ?lr(-. tir : ' rig Serf-(1 i}) ',-j i;rj;i .- : . ,iil
,i.","'
,|,
C) complete specilicrrtiorrs tor puft,ps and controls, dos'3 !L,!irir,.,i eieva1 J; iirlia-acr.irer: lr;airc:r 'csr;: irrrx,p
perforfirance curve;lpump model and pump manutacturer; D) cross ie(jl:on ot the sori zbsorpr,(,,'] svstcm ii
![f iequireO Sr$re county: E] soil test data on a 1.l5form; and F) all sizing infornration.
GROUNDWATER SUf,CHARGE
1983 Wisconsin Act 410 included the crealion oI srrrcharglrs (feesl for u
",,|.-,,;".,r
t''l
regulatcd practices whrch can effecl Eroundwater.
!
The rnonies aollected thror,gh these sr",rcharges.rrij Ltr:d i:I ttoir.lali,,--- ()ri, ,;j!..3,.'
water conlarnioalion invesligairons and eslablishnienl ()I sla',.'la:-di
r..nd
sBo-6398 (R.11/88)
s T c 100
Th i s appr ication f orm is to be .compreted in f urr and signed bythe cwner(s) of the property n:ing-d.r"Ioped.---eny inadequacieswi I I only result in &9riy" -6r the'p"irit i""uan;;. shourd thisdeveropment be intended for r?:u]" by gwn er/contractor, (sDechouse ) ' then a second f orm stourd be .dtaineo- ilJ compreted )enthe property is sold and submitted - L this office with theapprcpriate deed recording,
Owner of property
Location
Townshi p
Hailing
of propert
address
d ro(b
Address of site
Subdivision name
Other homes on prope
Previous owner of pr
Total size of parcel
Date parcel \ras crea
r Qr n e <r
-ra4 QL
Y&ilhJ r/ 4, section JI_, r AB x-n_lfi_w
A
1
l'C-
Are all corners and lot lines identifiable?
is this property being developed for
::,l"@'Land Page Number ,12 a aof Deeds.
)
Lot no. .?
ES No
a e,n s
et -se 10.()eA
ri 7 ("
-_Yes Nc
( spec houee ) ?._yes )1-*o
s recortled wit h the Register
rty ?
operty
fC
ted
re5
INCLUDE WITH THIS APPLICATION THE FOLLOhIING:A FIATUTANTY DBED which in"iua-"" a DoculrBNT N*HBER, vcLLrHE AI{D ,AGENUHBER & THE 'EAL oF TIIE REGr;TER';; DEED'. ' rn *rJditicn r Ecerti f ied survey, if avairaui!', .would be helpfur so as to avoiddetays of rhe-re"*.111"9;;;cess. If th;-Etea crescription:;:ii":i:: JJ *n;i;:i:t;a 5ii,"v Map, the -cl'tirled .s,,iv"y Hap
r(
th
De
ob
th
No
rgnature of I
PROPERTY OWNER CERTIFIEATION
the
fa
cftrv
we)
for
ury
apP can o-app can
4-tbq?Date of S gnature K :tate of Si gnature
ent
y that all statements on this form abest of n y(our ) knowled ge that I (we) am (are )the owr,er (s) ofrty described i n this inf ormation f orm, by virtwa r ra nty deed recorded n the office of ther County ReDocument No., and tha t I (we
po
own the propo sed site for sewage dis sal systeman easement ,to run t he above st:ribed propert Yttruction of desaid sys tem , and the same has beer ecord ed in the offi ce of County Regi s':$r ot' deeds aEr
o
,
CERTIETED SUM/EY MAP
}M[I{ER JOTCENSCN
Pa
We
rt of, the South 1/2 of the Northwest 1/4 of Soctlon 14, Townshlp 28 North, Range 18st, Town of Kinnlcklnnlc, St. Crolx County,
SHliiiSS-y
/\
I
I$
I
Note: Bearings based on the
Ea st/West L I 4 lile of Sec . 14
be:ng assumd due East.
sa
C,TH, "tr,.,q
N gg'Z2'5o"8 /33q. o0
66'
No Accttt m EasE14ENr
6G m 5'
^ry
\tt,ttI,
I-i
\t
€I
5ca/e.: /"= /oO'
o Indicates 1n x 30trir crn pipe stake
weighrng L.L3 #ltt.
(,J
(/
I
lo
\i
,$
k
tu
$i
,\
(-;
I
Jt -,[3
ra
-^}
uu
a\
\t
ccat,
66'A'o'eAY';
17'
\s\oh
,\
R
.q
\\
t-oo t77.63' ,$
Z'
\\a Jt8o8/o3 5.5W
CD\.F-npn
/-"1/
?.0,for.s
e 20'PowerLire fs-l \
\
N
\
.\
.q
\
z?3.35'
\
9..9r-o.tif
1',
.l
il
{.
t<,-f Q
(r.'t
N88-22'fo? 5os.oo'
55 t("o ot
I\' /-o{ 2
?.13 Acre s
6or,.fcc. /+ -26'/8,k
Descriptlon: That certain parcel of land loeated in the s 1i*, T 2E N, R 18 W, Town of Kinr:ick:-nnic, S'L. Crc;x Ccunty,
descrrbed as follovrs; commencing at the West Ll|+ corner of
N B8o 221 50, E along the centerl jne of c. T. H. ir.J n L)3g,oO
lz of the N!,I 1/4 of Sectton
rr-isconsh, n()r''e fuiiy
sald Section t4r -thenee go
feet; thence N 01e 5Bt O5r' W
J0.00 feet to the north right ofvay of c.T.H. rJr! and the Polnt of Beginning of theparcel to be herein described; thence contlnue N 01o 58r O5n W 216.8?-feeti thence
N 40u 50r 29tt E tL3.3L feet; thence N 01o 58r 05n i,, 35o.oo feet; thenco S Bgo o1t 55, Wt??.6) feet-i thence S 18o O7t 14r W 304.3a feet. to t[-e rneander ilno of the KinnlckjnnlcRiver; thence along said meander S O8o 13t Ozt, W 63.18 feot; thence along saire
S L3o 551.49't W 314.86 feet; thence departlng said neander N 88o 22r Jor-E along thenorth right of lray of C.T.g. xJx a distance of 30:,.oo feet to the Polnt of Begi:rnlng,
the abovo described parcel lrtcluding aII lands lying between said rneander 11n6 and thethread of the Kinnlckinnic Rlver, together wlth an easeme,nt 66.00 feet ln rridth adjaeent
on the East slde of the above descrlbed parcel and 11.00 feet fui rridth adjacent on theNorth side of the north r.o.w. of C.T.H. nJil for:: distanclast described easement, the above described parcel beingfor power tranemj-ssion lino and consenratlon €?sei.-rsrt.
Dated z L7 ApriJ" LgZ6VOL. _ PAGE St. Crolrt Count3', Wis.
Cc:;ific'l Su:-;eyll:rs (:.,,..- ?-f
^/
t
h
,6\
s.104
the
ord
L.
i-. -a
sub
*
a
SEPTIC TA}IK HAINTENANCE AGREEI{EN'I
St. Croix CountY
g/CMn
i&u ;1.UT FIRE No:
: r4*U L/4, sEc./{ r
(inn ic inllrc ST.
a LOT NO.
&8 *-a l8 w,-
cRorx couNTy U)I-.
+(run gr
owNER/BUYER
ADDRESS:
LOCATION:
TOWN OF:
.i.r(
expiration dace.
Improper use and maintenance of your septic system could result
in its premature failure to handle wastes. proper maintenance
consisti of pumping out the septic tank every three years or
sooner , j-f. needed, bY a licensed septic tank pumper' . . What you
Fua int.o the system cln affect the fu-nction of the septic tank as
a treatment stige in the waste disposal system;
st - crcix ccuntv residents may be erigible to receive a grant to
help with the cost of the t"piacement of a failing system, which
was' in "p"i"iion
-prior to .rury L I LgzB . st croix county accepted
this pro|r.* in Airgtrst of 1980, with the requirement that owrters
of aII new syst6ms agree to keep their system properly
maintained.
The property owner agrees to submit to the st. croix county
ioni"g ,i ".iti f ication f orm, signed .by the owner and by a master
plumber, journeyman plumber, rLstricted plunber or a Iicensed
pumper *r*iif yin{ that ( 1) thg on-site wastewater disposal. system
i. "
^i1 pr,rp"i oierating condition and ( ? ) -af ter. inspecti^on and
p;"ti;g ( if necessary ) , the s-eptic tank - is less than L/3 f uII of
=lrrdrgt? and, scuil " Cirtif ication f rom wil} be sent approxinrateJ"y
3 o diys pr.ior tc three year expiration '
I /we, the r:.nde,,:s ignei have read the above requirements and agtree
to marinta..j-; th.:: pfivaie sewage disposal system in accordance wittl
the stanrJar:-ds set. f.or:th, he-rein, as seC by the Wisconsin DNR'
Certificat.i.or, fcrm must be completed and returned to che St"
Cro j..,.: Ccunty ?Jo1i.nq Of f ic*:r wilnin 3 O days of the three year
{t}(r{)\'ecu,I
3
St. Croix CountY Zoni-ng Of f ice
9lr 4Lh St-..
Hucison. WI 540l-6
SUBDIVI S ION :
\
SIGNED:
DATE:
DOCUMENT NO STATE BAB OF WISCONSIN FORM 1_1982
WARRANTY DEED
..--, Grantee,
:THIs SPACE REIEiVID FOi R'COiDIIIIG OAIA
1e.93....
(sEAL)
497?Oz
and will warrant and defend the same
Dsted rhis .............20th.......... . .
v0[10 PTGE
This D eed. made between .. ! qna.l.d..-J-q-r. g ens -o..4...4B.d......s-andre..J-q-r.gens.o..B,...hssb..and...ald-.w.r-f .e-
Grartor,
ana.......Kurt..J.,...Krueger...and..Joann..!1..".Krueg.er.,............
hus.band...and..tdife.,-..as...s.urvivor-strip-..mari.tel--,-.....-.-.
Pro.Perly
WitnOSsgth, That the ssid crantor, for 8 yalusble consideration::-:,:
Twenly.--one...Thous.and...(.$21.,.000. ^0.0).-.Dollars.
conveys to Gr8ntae the follolr,ing d*cribed real estate in ...-S.t'.--.Croix.-.----.
County, Stste of Wisconsin:
(18) West, Town of Kinnickin
Certified Survey Tlr parcel No: -.-------........---Survey Maps ,
333341, filed in St. Croix County
June 3, 1976, being l-ocated in the
Quarrer (sL/2 of Nw1/4) of secrionty-eight (28) North, Range Eighteennic.
Together with 66 foot and 33 foot easements as shown on said CertifiedSurvey Map.
Lots one (1) and Two (2) of
Map in Volume I of Certified
page 252, as document numberRegister of Deed's office on
South Half of the Northwest
Fourteen (14), Township Twen
:?ANI'FEE
i_b3j9o
I IJE
ThiE ......-.iS...nQ f ...-.. home8tesd property,
)oFxxriroQ$xx
Together q'ith all and ringular the heteditamentr &nd appurtersnces thereunto belonging;
ena.....Dp.na.Id..Ja.rg.e.n.$.an..and..Sandr-a.-JorgenE.on.,...husb.and.-and..wj.f.e*..............
Narrant8 that the title is good, indefealible iD fee simple and free and clear of encumbrsnces except easements,reservations and restrictions of record;
. (sEAL)
(SEAL)
AUTEBNTICATION
Sigreture (E)
autherticated this .--..-.-dsy of-.--------.---.--.--,,---., 19-,.---
,Ap.ril..... ....
Donald J g son
$ en d.r-e.. J q.r-g e..4 s.sR...
. day of -----..
(SEAL)
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, -------....-.,-
authorized by $ ?06.06, Wi.. Stats.)
IHIS INSTFUMEN'T WAS ORAFTED BY
Charles E, White, AEEorne at Law
River Falls, !'II 54022
(Signatures may be authenticated or acknowledged. Bothaae not necessary.)
ACENOWI,EDCUENT
STATE OF WISCONSIN
P ierce !1.
County.
PeEsonslly csme bdore De this 20rh d8y ol......AB.r.i]..,-..... rs9-3.--. the above na,ured
...D,o-o.e-1-d.--J-.srgens9.-n.-.a:B-d-..S-a:r-d.ra.-.-...--...
...J..qrge.r.r.s.o..n.-..hu-sb..and...a,nd.-.w-i.f .e-,..........
--.--.--------------., 19-----.--.)
;:;;;;;;:;;;lt;;tt;;# *;
foregoing in8trument ""a ."r."qkldl" @- r1.f t1 i, t
WwNi i /; i_! j. .Y{a* t.v. f.,.w:.#*8....,:)....:i'.
Notary Public --- - 6 4 *..:..:,..:,,1.-.:::dOfitv. wic.My Commission is permanent. (If nafr^.'r,lh&r eipiiation
date:
.Nrme! ot pelsoo! lirninr iD .ny crplcity lhould be typ€tt or Dritrted b.low their lEnstuB
REGISTER'S OTHGE
sT. cRoD(co.,ul
Rsc'd for Recbrd
APR 2 01993
at
WARBANTY DEED ATATE BAB OF WISCONSINFOiIU N6. l-li)rr wi.conlin L.Eil Bl.ok Co. IDe
mo'
I
fYrqonsin Dep3rh'ent ol lndustry,
L;bor ard Human Relations
Division ol Safety & Buildings
SOIL AND SITE EVALUATION BEPORT
in accord with ILHR 83.05, Wis. Adm. Code
Page \ of 3
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
SOIL DESCRIPTION REPOBT
Boring #
Ground
elev.
/b?,.5 1.
Depth to
limiting
factor>)6"
Elorno rlrc'r rUlriq.i-4.
CO sT'. C-\zo Lx
PARCEL I.D. #oz?-.lD38- q5
REVIEWED BY DATE
PROPERW OWNER
Y<-\J\-Lf- \< tRr:E6e\?C Buv €rr)
PROPERTY LOCATION
cow. LoT s ) 1r #f Nt{,1/4,s }V T ?-B ,N,R )t E (orl{D
PROPERW OWNER'S MAILING ADDRESSf z-) [{.t $ q?s I D E bt'l ut=- l\\ot'TF{
LOT #
L
SUBD. NAME OR CSM #c_sl-l \rqu \)>3 z>z
CITY- STATEfh-rSS\N r ,..r t
ZIP CODE
SVU /6
PHONE NUMBER
(?, s) 38 l-\r3a DctrY nvtLLAGE EIrowN
\<-\r=lr-l \ Ctt-tAJ}*j I e
NEAREST ROADc-.f.H-"S
ffi New Constructron Use X] Residential/ Number of bedrooms t I AdditiE to existing building
Replacement I I Puuic oI comrnercial desqibe
Code de ved daily flow 3so gd Recomrnended design loading late - bed, gNrt8- ljg-rencn, gpdxt2
Absorpton area rquired --:- bed, fP -) 50 rendl, fl2 ira.ximum design loading rate o. 3 bed, gpOltf-g-1-reflch, gpott2
Recommended inf ltratofl surh(r elevation(s) SS.=EAqE : .__fl (as fele.reC tc site plan benchnaik)
Additional design / site considerations r\(Q(ohhq\JL L -TEe()eJ* eS ..eftc H \ o0 LrJN 6 r x.r\-fH Tsun \> ctH\,hBLsR. .
Z
parent material s €DrneuT ou sr sh ( €E '\z(jL Flood plan elevation, if applicable N.\. ft
for
nsuitable
eUIS=Sr
U=U
tabl svstem
foi system
coNvENT]oNAttrS trU
MOUNDEs tru
IN.GROUND PRESSURE
ETS trU
AT.GRADEES !U SYSTEM IN FILLES trU
HOLDING TANKtrS E(U
Horizon Depth
tn
Dominant Color
Munsell
Mofies
Qu. Sz. Cont C,olor
Texture Structure
Gr. Sz. Sh
Consistence Bqrday Roots G P D/ftz
Bed Trcnfi
\o-?-Z \\YB ?-[Z s)\Ztu s bh yur {x <.s \ v{o.S o.k
Z zz-28 rsY rz 3/g :I)z$ 5\k vr {x c.S \ u$o.s o. b
3 z8-3b -t.SLtE V/L Cr^se.l zc- s\h m Cr-ES O. \[o.s
Y 3lo -1L _l6t-3I 1 c- s\k }D U$-(J \o.{
CO^J\v^Js \=\uss S SF Mh SS'JE.-YN Sr q\
Boring #
Ground
elev
rs9.Vtr
Depth to
limiting
hctor)Bq"
Remarks:
€\s'
\
f art
o -\L
,E OF PIT
\6,48 --/Z sr I Zx' tbh v"\' tx q-S )u$o.s i o.L
z \220 I\YP 3/V SiI z{s\t vn fr^CS )u{o.s!o L
3 ?D.\Y ).s YE VlL 6r^sr'I 7cs\h rn *f,CS S.5 o.f
Y 1\ -tsv l. S Ytz v/9"6\-s t \ c-: lY<.n u uttr o -r l".V
I.\)C-s T
\ qz sr \E OF PIT t ;g'-l ta\S .SlU e put 5
5 rr*l€tS FGuus
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Wdffe."r Soil Testing & Design Service-P.0. Box 74 River Fa1ls,WI 54022
CST Number:
M00576
Srgnature:q] -3\
Date.
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SOIL DESCRIPTION REPORT 'age ,1-'e; 5
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Horizon Depth
in.
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