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HomeMy WebLinkAbout004-1043-95-000Wisconsin 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)]. Permit Holder's Name: City Village x Township Kielme er, Scott Cad Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic C,1 EcSC~l2_ ado lbw Dosing ~ ~f ~p ~t Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ t o0 r ~ ~ f Dosing « ~~ I1 ....,, ~$'~ Aeration Holding Pl~MP/SIPHON INFORMATION MBt~yufacturer ...}.- Demand • L ~ ~ CQ..ti, \ GPM Moc~l Number ~~ ~~ 3~~ ~ H Lift ~ Friction Loss System Head ~ TDH Ft ,~,0 . ~ 9' ~ . S.2q Forcemain Lengt"~O t Dia.Z Ir Dist. to well M tiVIL Af35VKl' I IUN SYS I tM ELEVATION DATA county: St. Croix Sanitary Permit No: 408250 0 State Plan ID Norte ~~ .~ v /bows . 1 P. Parcel Tax No: 004-1043-95-000 STATION BS HI FS ELEV. Benchmark S los,~a ~.o' Alt. BM Bldg. Sewer /. ~Z ~d~~~ ~ SUHt Inlet D . ~ R6.92 t I St/Ht Outlet Dt Inlet Dt Bottom I Z Z 3 4 3.25 Header/Man. t-(. ~3 ~ ~ cz , b Dist. Pipe , ~3 t I~ •6S Bot. System 5.~ S, rj'- ~eo.o; Q.42' Final Grade Sejf~i !`S' St Cover SS `~•q3~ rn'~~ S s s •a3' B Width Length No. Of T PIT DIMENSIONS No. Of Pits Inside Dia. iqw epth IMENSIONS /_ r '~. 5' ~ I` ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEAC G Man INFORMATION CHAMBER Type Of System: ~ ~' a tuber: ~ ~~ ,~ ~ DISTRIBUTION SYSTEM ~- ~ Header/Manifold U ' Distribution `~ Pipe(s) 1 I D x Hole Size1 ~~ x Hole Spacing Y Vent to Air Intake ~ 2' th 3 ~ Di L Z. S 7 ' L th ~ Di i `(~ ~ ~ • eng a eng pac ng a SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Tre ~' Edges >; Topsoil ®Yes '1 No [] Yes [~ No Cam, NQ EN-jS: _(Incxlude co ~llscrepencP, persons present, etc.) Inspection #~ p~-~~~ - Inspection #2: Location: 2745 27th A Woodville, WI 5.02 (SE 1/4 NW 1/419 T28N R15W) NA Lot k Parcel o: 19.28.15.298 /~ •~~, d~ l-t t Ss-i ~ to~rV tn~ 1.) Alt BM Description = r~v..~ ilM~~ Lb~t.r~. S, ~~ /" 2.) Bldg sewer length = ~. ~ ~ ~ ~ t ~ q ~~L~C 10~ ~• - amount of over = ~ ~ ~ , ti)• ~ ~ _ ~_3 $-`( /v~ \~ S 1 J 3. Contour = q ~ //K _ ! f ___ - _ - _ ~ _ - ____ _ ,N,,,,.,,,.,~ ~ sit -HY ~~~~ -~• 0.~~ .~..~,t~.., c~.~.,-_I_ Nc,. ~:~~~a~-_, ,-- /~ - i ~ ~ ,. 1 ~, an revision Required? Yes No I ~ ~ I J \ Use other side for additional information. ~_!-~_2b ~ ,~2'^ .,_. _._ •Q,~,~/~_ p g ___ -._-J 'D-6710 (R.3/97) (O at `~~ s Inse ctor's Si nature Cert. No. \ Vj ~kk-- ~~5 Z~- f A,r ~ _ Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. ' `~ See reverse side for instructions for completing this application PO Box 7302 sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] ~ ~ (Submit completed form to county if not ? 3a o i- ,~,S,S33 state owned.) Attach complete pl s (o the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. Coun ~" ~ State S Permit Number ^ Check if revision to previous application ZS p State Plan I. D. Number ~ x-63 Z ~~`rowts . I!D I. Application Information -Please Print all Information Location: Property Owner Name Property Locati n ~~ / Z ~ ~ ~, ~1/4~t(,~/4, S T~N, R~~r) W Property Owner's Mailing Ad ss Lot Number Block Number ~~~~ ~ ~ City, State Zip Code Phone Number Subdrv ion Name or CSM Number L 1 ~~ ~ ( ) II. Type of Building: (check one) V ED ^ Ciry !~ 1 or 2 Family Dwelling - No. of Bedrooms ECEI ~~ $ 1 ^ P bli /C i d ib l ^ Village ''Town of u c ommerc escr a ( e use):_ J 1 5 2002 ~ ~ D ~ ^ State-Owned ,~UL ~}~p TY IX Nearest Road ~ ~ Z ~ O~F ST. CRO u CE ~/ a I ,~~D ZONING r ~I ~ ~ Ip tt ~, Parcel Numbe s z 11 S r ~~ I. Type of Permit: (Check only one box on line A. Check box on line B if applicable) ~ Z Q A) 1. New 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System B) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) top ^ Non-pressurized In-ground Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit D Recirculating ^ Other: . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft. (Min./inch) Elevation ~~ ` /~ ~~~ 0 VII. ank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- lactic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ~G ~ 0 n5c; ~ ^ ^ ^ ^ ^ ^ ^ ^ ' VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS show n the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): P PRS No. Business Phone Number T '(? ail t / / ~ ~ .ji S~ Pl bet's Address (Street, ity, State, Zip e) ~ /~.~~ s ~ ~ d ~y IX. County/Department Use Only O Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui g Agent Signatu (No stamps) Approved ^ Owner Given Initial Adverse Su arge Fee) dp Determination .~- ~ 2GDZ X. Con~~dit~~ippons on~f""Approval/Reasons for Disapproval: , ~ /~ ~ ~2. ntire,~l~-~4l~bJ o~ ~ rZo QrQSL Gt~e~4o /p~c~t~o~t f~ . SRyfpo~crC_ ~ ~ ~ GQR(9~.1 N~ltl.l. I \ ~(~'u ~ ~ t - S cu~c.~~"~S . SBD-6398 (R. 07/00) L:I.n U~K' ..~c~o JIc,Gr~ c~ ~ ~ Y©.z~; Q '7 -~'" a' ~rJc~ ~~-~ ~~ ~~ ~~ ~ 7 ~~ ,~~ ~ P ~ `-': C //Y~ /lJ cu fib; S / ~(~ 7".,t ~t iu iZ i.~~ ceJ Tc~.VSi~.P_ ~140`~ 1~ 3 ~ ,Yz~ .~~., c.c~~?- ,~ s~Cgg, o ~~ ~~ ~~ f ~. \.i l ~'lvu,~~ ~ ~ ~ ~s , --~ .v~r /'~> ~~~~Cu D ~' w~z~ ~~ ~~ ~~ may... c~- '~ , y~L ~d ~~~ # -~~- °° P`- s"~ .fit- ~ ~10 « ~ 3~~ ~+ ~.~ ~~`~ ~4 \ ? `,~+ <Z ~', 3 d ~. ~~. ~. ~, `r~•~ ~~•~ A f /v isc~-nsin Department of Commerce Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188-2439 TDD ti: (608) 264-8777 www. comme rce. state.wi. uslsb www.wisconsin.gov Scott McCallum, Governor Philip Edw. A{bert, Secretary June 24, 2002 CUST ID No.224617 LYLE J MYERS NORTHLAND PLUMBING INC E1556 ST RD 64 BOYCEVILLE WI 54725 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/24/2004 ATT7V.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON ~WI 54016 SITE: Scott Kiehneyer 27TH Ave Town of Cady St Croix County FOR: Object Type: POWT System Regulated Object ID No.: 858225 Description: 450 gpd design wastewater flow mound system. Identification Numbers Transaction ID No. 763552 Site ID No. 646829 Please refer to both identification numbers, above, in all correspondence with the agency. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Waste Treatment Systems" SBD- 10691-P (N O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10706-P (N O1/O1). • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. r • Maintenance information must be given to the owner of the tank explaining that is ~ f the filter is required. Access to the filter for cleaning must be provided per Comm 84 pr~Iluc~ ip+!Qi~i~s. ~ '``~dI~A.On. .~SY~ • A Sanitary Permit must be obtained from the county where this project i catec~'$p~~e with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SF~ s.~'~"' • Inspection of the private sewage system installation is required. Arrangements ' pection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2 d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. ;~, ;, LYLE J MYERS Page 2 6/24/02 t In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state slats 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sinc ely, Fee Required $ 175.00 Fee Received $ 175.00 ~~,/Y~ Balance Due_ $ 0.00 r Thomas J Perkins POWTS Plan Reviewer ,Integrated Services (262)521-5064 , 7:30-4:00 tperkins@commerce.state.wi.us cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 Lyle J Myers ,Northland Plumbing Inc Scott Kielmeyer .. Mound System Cover Page as, ~ s ~~ ~l1ETE ~~ Project Name: SCOTT KIELMEYER MOUND Owner's Name Scott Kielmeyer Owners Address 200 Oak St. Woodville, Wi. 54028 Legal Description SE ~ '/., Nw ~ %< Sec 19 T 28 N, R 15 w ~ Township CADY County Saint Crobc ~ Subdivision Proposed CSM Lot# ~//A ParcellD# Pending Table of Contents P9~ 1 Cover page 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: Lyle J. Myers ~, I`s MP/License #: I.D.# 224617 ~j ~j~ Date: 5/30/02 ,~ Ph. #: 7156432520 q~a~T~ Signature: : ~ ~~,Qo~~ i ^~O ycs Mound System Design Methods Used F~. per "Mound Corponent Manual Fw Private Onsite Wastewater Treatment Systems" Version 2.0) SBD-10691-P (N.01101) C~ per "Pressure Distribution Component manual iw Private Onsite Wastewater Treatment Systems" Version 2.0) SBD-10706-P (N 01l'01) ~ Spreadsheet provided by: 3bAdvisement N12486 220th St, Boycevilfe, WI 54725 Ph:715-643-6068 email: 3ba~3bedvisement.com I Mound System . Mound Sizing Calculations Project Name: SCOTT KIELMEYER MOUND Site Conditions Project Type: 1 or 2 Family Dwelling ~ Slope: 9 °~ # of Bedrooms: 3 Depth to limiting factor: 17 in. Absorbtion rate of fill material: 1 gal/ft2/day Absorbtion rate of in-situ soil: 0.4 gal/ft2/day Effluent quality Eff#1 ~ Max BOD effluent value: 220 mg/I Max TSS effluent value: 150 mg/I Design of the Di; System Design Flow: Distribution cell width (A): Distribution cell length (B): Area of Distribution Cell: Contour Elevation of Mound: System Elevation of Mound: Final Grade of Mound: Design of Entire Fill Cell depth at upslope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H}; End slope width (K): Fill length (L): Upslope width (J): Downslope width (Toe) (I): Filt Width (W}: Page 2 of 6 19.0 in. 25.5 in. 9.5 in. 6 in. 12 in. 11.0 ft. 97.0 ft. 6.8 ft. 14.1 ft. 26.9 ft. ~tribution Cell Basal Area 450.0 gal/day Basal area required: 1125 ft2 6.00 ft Basal area available: 1508 ft2 75.0 ft 450.0 ftz Observation Pipes 97.00 ft Location from end of cell (Z}: 12.5 ft 98.58 ft 100.38 ft Mound Plan View ~ Observation Pipes ~ ~ z-=-l~ K~ o Dtstr7butian Cell B ILK t I Tilled ArealFill Material L Mound Cross Section Final Grade Synthetic Fabric ~ Distribution Cell System Elevation ~n ~ ~~~ n ~_ Cover Material I ~raetsr~ E Invert Fill Material ~..-~-Slaps Observation Ripe G ,~ '~$ ~° F ,~ 1 D 3 Tilled Area Forcemain System Contour Notes: FiN material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Management Plan pursuant m comm 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If su additives are used, make sure they are ap rove De artment of Commerce, Safet and Buildin s Div.. Effluent filters are to be remove a as necessary, with provisions to kee m passing the sep is during remova o more an 1/3 of the usable tan volume may be occupied by s u ge scum. 3 year inspection: ank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehiGes, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation ar at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the Dogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. . ~ sc_vc~17~~ %~J42=Y11."'~,C'..~ ~ rf?- ~`~ ~•'Y']yr_.?S clSc~o J~e.tr, L,J ~ ~,Y©x6 .F.~c~y~..~ -v; c,~,c= (.¢~- .5 ~ 7~~.>" .--~.~.- L~ r7 ~ ,_ ~` /'~r~rJ c~~-.~~~ ro ~~~~~ 'T"G~c~t.~ ~5 i~~ P ~- ~ iQ' i7 e~I 1~ .~ ~ r,`i [.t:~!r' ~~ ~ ~~ ~`~ ~\ ~~u~~ ~ , ~~ ~ ~S. ~L ~J ~~ 30 r _ rV1 ~ r ~.~ ~.~~ .~,~ ~ c-~ c~ ~~~,-'~ ~jlfy'~-~,v 3-~ ~Yl ~ ~~ ~~i ~d ~~~ ~~ r, `''`t Z ~rI ~ d ~. ~• `~ t ti ~`~• rt` r~~~ ~;v t~ f ,~ _ _ __ _ 'BQ s ~s-ol Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 ,. Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Pian must vV~ ~~ 5~". ~~lX I include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ~~~1N G Please print all information. Personal information you provide may be used for. secondary purposes (Privacy Law, s. 15.04 (1) (m)). a iewed by Date 2 1 Property Owner S ~~T ~ ~-~-~`~ ~ (~1Z Property Owners Mailing Address Zvp Oak ST. Property Location Gev~-Eet- SE 1/4 N W 1/4 S 1 ~ T Z. ~ N R 1 5 E (or~W Lot # Block # Subd. Name or CSM# \ - P~ppS~ eSr1 City State Zip Code Phone Number ^ City ^ Village ®Town _ Nearest Road (New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow ~2 GPD ^ Replacement ^ Public or t:ommercial -Describe: '~~` ~ Parent material _ G L.'P~LL Y~-L ~" 11.,L Flood Plain elevation if ap ft, General comments ,°z° ,,~~, ~, - and recommendations: ' `;' , µ'lUUh~ I.v ~~,~~_ . 6 ~Z S ~ts`r-z~t3v`nUk- c~Z~ _~ ~ ~ ~~1~1. ~`~ 1t1JJ lwt,U N'1 l ~ `` o r S'Pa~ Ft u ~'" t ~~ ~ . Boring # ^ Boring ~,. ~ ,~., ' I ^ Pit Ground surface elev. ~ ~`• 8 ft. Depth to limiting factor 1 'yid: J i ,~; `,, ~ '~ ,.~-'Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munseli ~ Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ -7 l ~'-~ 2 31 z. - g ~ ~ Z~'s blz y-~-`~1~ ~S 1 ~ , S , g Z ~_ca ~ ~ ~ rz X16 - S i ~ Z~'S bk fn-Ft.- c.S ~ v-~ • S . 8 3 lg Z9 ~.s~Rs~lr, eta~.s~cr~sls si~1 l~sbk m~>^ _ .z. • 3 Z Boring # ^ Boring - a ®Pit Ground surface elev. ~ ~' ~ ft. De th to limitin factor Z in p g ~ ~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 a -g 10`t 2 3l Z - ~ s i I Z~'s 61t; h'L`Fh ~S 1~ . 5 . ~ Z. 8-'Z~f L~`%23~(, _ S j) ~-`~sbk Wl`Ff^ CS` 1 V'~ • S • ~'i 3 Z~-Z8 lpH2S1 ~~~, ~.S~(YZSl~, si C p m~~ - •o •O r cmuesni ~ r = nvus ~ au ~ ~u mgn_ ana 1 ss >30 _< 150 mg/L • Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L - CST Name (Please-Print) ,, Signature CST Number ~ . Arthur L . Wegerer ~. Q I - ! 00 220254 Address 4d e g e r e r S o i l Testing & Design S e r v i c e Date Evaluation conducted Telephone Number 421 I1. P~iain St. River Falls, F7I 54022 S_\~_Q) 715-425-0165 ~Z Property Owner ~`-` ~~. ~ C~ Parcel ID # pO~1~lh.l !-' o".s Z ,.~ 3 ^ Boring # ^ Boring - ®Pit Ground surface elev. ~?g. 3 ft, Depth to limiting factor ~1~ in. Soil Appiication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 o_~ 1oH.~31 - St 1 Z`Fsbk vn~r ~S 1~ •S .43 Z ~ - l'1 ~ s ~ r~ ~tf6 -- sic 1 Z'P sbk 1~21~i- c s l v ~. • ~ _ {, 3 1.-t=Zg ~_SYRy1 elc~~S`i2S/$ Slcl ~-eSbk 1~2`FI- - -Z- _3 y ~ Boring # ^^ Boring I 1 Pif Ground surtaCe elev. ft. nranfn rn ilm:rinn f~r,n~ t.. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. `' 'Eff#1 'Eff#2 ' Eftiuent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 =BODE < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (86/00) a PLOT PLAP1 Scale 1'=~C~ ' .' 7M - :LSL:~:L~p~p~._oiv~-Z~"1~t~,3C~-_._ 1q_PV:C-~1P~__~i^~~~. T~' 1~2~~~~+Di. _._N _. h of ,~ a--_7 _.____.__~ __-__._t _-. _. __.--.-_ ~}6tiSE_~:_~~.__~r_T-L~T_--.5-~ _~Z-e~~2__r?(Lv-v_1~~-- ~y _. .. _____ _----- - r- -w~L k .__._ k .. S _ .._ K ~ ~. _ _. a ___ ---- _.. 3~ tt- 99 ®$,z !` \ v`a ~ Ao~,o 9y ~~ ~~. ~3 q..o "~',~ o ~ ~t.~ NZ.~-~3g.sg ~, S-1~,-0~ 715-425-0165 220254 Page 3 of 3 ~/z C'1-b~ NtJ " 2 O1- 110 ~\ ~~ ~. >- ,. ~~ ~1S1v2D `v' ~+-~ s ~,~ 9y CST Signature Date Telephone Ito. CST I~1o. Job rdo. ~~~~r ~~~ ,~ ,~ c ~~ OwnerBuyer Mailing Address Property Address a ST CROIX COUN'I["iI' SEPTIC TANK MAINTENANCI3 AGREEMENT AND OWNERSHIP CERTIFICATI-d]1 FpRM (Verification required from Planning Department for neR' 5 Yd Parcel Identification dumber ,S~ -- ~' ©~.~.=, S~ ~~ `~ City/State ~ [~ , ~ gam, / ~~ Z g g~ LEGAL DESCRIPTION r ~ r i ~ W, Town of ~ ~ ~ Property Location s ~ /., ~~ /~, Sec. 1 ~1 . T~~ N-R_~r I.ot # Subdivision Certffied Survey Map # ~~~ .Volume ._... ..Page # Warranty Deed # ~.~ ~~ `~ ~ .Volume ,1.~~~ Page # G~ Spec house ~ yes ~ no Lot lines identifiable yes O no S,YSTE MAINTENANCE Improper use and maintenance of your septic system could result in its premature failtue to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if aerded by a licensed pumper. What You put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Depat~tme tit a certification form, signed by the owner and by a taas#orplumber, journeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping {if necessary), We septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintains the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification has been maintained must be completed and reiurned to the St. Croix County Zoning Office within 3Q stating that your septic system days of the three year expiration date. •~ % ~i :~ .~..~ ,~~ .~~_ 1!-t DATE SI+C3NAT(JRE OF APPLI~ C OWNER CERTIFICATION I (we) certify that alt statements on this form are true to the best o1' my (our) knowledge. I (we) am (are} the owners} of the property descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~;~-l~ ~ ~~s;-.~,-~~~--.- DATE SIGNATURE OF APPLICANT Any infornsation that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ****** ** Include with this application: s stamped Warranty deed from tin Register of Deeds efRce a copy of the certified survey map if reference is made in the warranty deed 05i10~02 10:37 n~~ofi'tbvc is: ib p~aeto~nbd ~ ~ ivy ~.1 ~, ;, r •~, . ~ Yl • Q ~ ~ ~u ~~`~ ~O ~ M u O ~~ JCc~ c ~~ ~.~ e,~ ~ N0. 120 P002~002 ~~~~~ HDLLY PARK 'PA6E 0?%92 0 D I eTG~~V~ w$~ I ,9-.St-----~ . X ~ Cp h 0. I- N ~~ ~~ ~ ~ ~~ ~ g~ ~ f~~ 200'd 1y69~90 Z0/G0/50 ~ ~ _~~` ~ _ ~ ~ .r. i 0 x ~.. ~.~ ~~ a~ ~,~ ~- ~I ~" ~/~ ~ ~~, e I I ;~ ~ ~ ~ .s~-1 ~-,,• w ~ _~~ f°~i ~ ,~ ~ $ _, -w N l rF ~ -`~I + e 6 ~ O . ~ r 3 ~ _~ X V ~o v ~~ ~ ~ a• r v ~ _ ~ n ~.J ~ 2 O z ~~ ~ n J d R DOCUMENT NO ~~~:14g3FA~r 463 WARRANTY DEED 019149 ~i:-r;r~7ER pF !!EEpS ~•Frrr4Fl! FUR kE('.URD i7i-03-'OOfi q:3A AM Kristine Kielmever, a/kfa Kristine M Kielmever a single person conveys and warrants to Scott Kielmever. a/k/a Scott T Kielmever a sinole person following described real estate in St. Croix County, State of Wisconsin: 4RRRANTY DEED ~xF~PT # Dr. ~FRT COPY FEE: ~UPY FEE: TkANSFEk FEE: RECORDING FEE: 14.00 'NGES: 3 RETURN TO: NNER LA N •~ T r. E M ON/E, W/ ~ Par umber (P/NJ art of.• 048004-1044-1D-0oo_• nna- 1tjOtj: 008-1071-8x000• and 008- 1071-10-000: 008-1071-2x000• and OOB- >o7>-6aooo SEE A TTACHED LEGAL DESCR/PTION This Deed is given pursuant to the terms of the d/vorce judgment entered /n Cese No. 98 FA >70, St. Croix County, Wisconsin. This is homestead property. (IsJ Exception to warranties: highways, easements and restNetions ofrecord. Dated this _~~ __ day of ~ppg_ * (SEAL) _1~j ~ (SEAL) * Kristine M. Kie/never (SEAL) AUTHENTICAT/ON Signature(s) Krist/ne M. Kie/meyer 2~ authenticated this ~'~ day of _r_ _ , f9J9' `- c-'T~ * Brent D. Skinner T/TLE.• MEMBER STA TE BAR OF W/SCONS/N (/f not, authorized by §706.06, W/s. Stats TH/S /NSTRUMENT DRAFTED BY (sEACJ * ACKNOWLEDGMENT STATE OF W/SCONS/N )ss. County. Persona//y came before me this day of , >999, the above named to me known to be the person who executed the instrument and acknow/edge the same. Brent D. Skinner Notary Pub/ic County, Wisconsin. 406 Techno/oqy Or: E. Menomonie. W/ 54751 My commission is permanent (/fnot, state expiration date: . >9 , (Signatures maybe authenticated or acknow/edged. Both are not necessary. J ~~ 1 *Names of persons signing /n any capacity shoo/d be typed or printed be%w their signatures. 40?..~ 493 PeG: 464 A PART OF THE SElitt OF THE SWli4, ANG THE NEli4 OF THE 5W1i4, ANG THE SEli4 OF THE NW1ia, SECTION 19, T28N, RISW, TOWiJ OF CAG'i, ST. CROIX COUtJT'f, WISCONSIN, AND GESCRI6ED AS FOLLOWS; BEGItJNING AT THE SOUTH QUARTER CORNER SAID SECTION 19 , THEtJCE 590°00'00"W ALONG THE SOUTH LINE SECTION 19 1180.50 FEET TO AN IRON PIN: THEtJCE NOG°38'09"E 1720,17 FEET TO AN IRON PIN; THEtJCE N01°48'25"E 1203.83 FEET TO AN IRON PIN; THErJCE tJ89°09'Oc"E 758.75 FEET TO AN IROtJ PZN; TFiciJCE NOv°03'33"W 981,15 FEET TO THE NORTH LINE SE1/4-PiWli4 SAIG SECTION 19; THENCE Nog°G8'13"E ALONG SAID NORTH LItJE SEIi4-NWli4 40O.0G FEET 70 THE iJGRTH-SOUTH QUARTER LINE; THErJCE S0O°03'33"E ALONG SAID QUARTER LINE 3921.7v FEET TO THE POItJT OF BEGINtJING, SAID PARCEL CONTAINS 80.70 ACRES h10RE OR LE 75, AtJD SU6JECT TO AtJY EASEttENTS OR RESTRICTIONS OF RECGRO, Parcel ll's - Part of 004-1044-LO-000 004-1044-60-000 008-1071-80-000 008-1071-10-000 008-1071-20-000 008-1071-60-000 -AND- ATTACHED LEGAL DESCRIPTION .~ . '°~ "_ '. . ~~~ .1493P~~:465 A parcel of land~locatec an. the ti£k of the Nb1, thr tiwt o! the tikk, the SWk of the NEk, I:nd ~ha: Skh of the IJEk u! Sactaun 25, '1'2dN, R16W, TOwn:.ot Y.~u Galle, 3t. Croix County, SfiiCOnsin, des- cribed as fclloMS: cwomencing :.t thr East 1/4 corner of said Sectioa 153 theDCe N0l04'19"E (assumed Crating referenced to the monumented,Ease~Zine.ot said NEy, be~rinq assuswd NO.04':9'F.l 577.51 feet along iid East line tv ~ 3/4" x t4` steal Lar and thQ poinc of beginAingi 'thence continuing ~t0°04'19•£ 20bt.36 feet to a 1• inside dieP!elkr'steel.pipe at the NE corner of aaad Section 23i thence N88.O1'S/"W 1677.63 feet along the North lino o[ said NGk co a 3/4' x 24" steel bar; thenca 50.0<'19'f. {,.•aral:al with said East line] 2074.33 feet to a 3/4" x 21" stc.~l bas; :twnce 587.45' 28"E 1677.92 feet to the point oa beyin:,ing. containing 86.00 acres, more or less. INCLUDING a non-exclusive 66' wide a:ascma;nt for an;ress and egress along a farm field road as located in the f:,llowany descrtbed par- cels: A parcel of land located in the tiEk of tha• SWk o: Section 25, To:rn- ship 28.~orth,•'Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin described as follows: Co."~mencing at the Ek corner of said Section X51:.thence N8y•IS'28"W (assumed bearing referenced tv the East line of.ths NEk of said Sectavn 25, bearing assured NO• 04'15"E) 264Q.Z< test.along the East-West 1/4.Sectaon lane. of said Section 25 to a 3/4" x 24" steel bar at the Center of said Section 25 and the point.pt.beginningi .thence continuing N67.45'28"M 165.16 feet along said,East-West line to a 3/1" x.24• steel bar; thercc SO°14'33"E 13I6.46,fGet to a 3/4" x 24° steel bar on tho South line of said NEk of;,the SWki thence S87°56'4o'E 1G5.13 feet along said south line,•a4:a`3/4..x 24 steel bar at the Se corner of sand NEk of the SW~~:•'thence::p0`14'33"W 1315.92 fa:et along the East Iine of said NEk. •of ~ ttie.; SWk• tp;,the point of beq.inning, containing 4.986 acres, ,r4ZwF~'o;",~.Rsi.,~ A parcel of ~land;`}ocp~gd•~,in the:.SEk of the NWk of Section 25, ^ewn- ship 28 North,Y•ltaigekl6' West,,. Tgwn of. Eau Galle, St. Croix County, Wisconsin,.~desci:$bed~ ps.`fgllows: Commencing at the Ek ~urna:r of said Section ;2S•:aahejiCe`N87!{5'28°W (assumed t•carang referenced to the monumented`Eastsine at; ~t.h~ \1:!. of said 5eotion 25, lwar::~q assumed NO°04! I9•'Ej;~.26,40, 2q feet alone: the Fast-iiaat 1!4 Sectior. line to a, 3/4" x,-24".;.•s~,gpl rod at thv Center of sa.d Section 25 and the point of:,beg,;~,nnil.,Rgi` thence .lV87"45' 2d"tv 91.75 tCa`t .along said East-Hest:line=t _,a:.3/~" %: 24' Steel rod; thence N46ai4'33"E 126.4n feet to a;3/~" ;x24.", sf~el rgi1. vn the North-South 1,'4 Se~cicn lire; Lhence SO'14'~~3•E',9I.Ol:tea:t aloi,g ::aid t:orth-SOUCti li:,.• ca; tyc point of beginnirig;~'containing 0.10 acres; morn or ;esF. A parcel of land ".located ',ip the SE-. of tho NEk ;and the $hy of t :a: NEk of Section .25,•.:~ow:tship 28 North, Range 16.West, Towq of kau Calle, St. Cro~fx"'Cotiifty, Wisconsin, described as follows: begin- ning ac the E~:cortaer;•o-f said Section 25; thence N87.45'28"w (assumed bea~Cing`;~YefeZenced to the monumuntad East line of the VEk of said SeCtton;2S,.bearinq assumed 'i0.04'19"£1 2640.24 feci along the East-West'•1%/,'Section line to a 3/4" x 24" steel taxi st the center of said Suction 25i thence NJ°14'33"W 577.64. feet along the yorth-South l/4'$ection ling to a 3/4" x 24• steel rod; thence S 87.45'28"E 264,3.'42 feet to a 3/4" x 2~" steel room on the Ensc line of said Section 25; thence SO°04'19"N 577.51 feet alon.i said East line-•to` a l-3/8" Steel red and the point of ba:.tarntr.u. Containing 35.00 acres, more or less. SUBJECT TO a icon-exclusive 66' wide ucrmanent access eascraa+nt across the E.300'-fast of the SEk of the Nkk of S_ctiun 25, whic:~ will be later• described- and conveyed by sun•eya:d drscraut:or. at such tame aS`'a road is built through the propert~•. SUBJECT TO town road easement fo- Cardinal Lane in th.• Sr1y of Section 25, Township 28 North, Ran•)u 16 heat, Ta Nn cif E.:u a;.:l le, St. Croix County, Wisconsin.