HomeMy WebLinkAbout022-1038-50-100
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Io m 9dY y O ,V
ADDRESS /~O f O if®,T
/i. 'j, r- Y. 'rit //5' G,J,.
SUBDIVISION / CSM# LOT #
SECTIONT N-R /F W, Town of k.'p_4j,`C,
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
GG
F
INDICATE NOR H RROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
I
BENCHMARK : 1,5-
ALTERNATE BM: 7~o f~ 4G !+/~k ou~`du n►G~~f~'a.rJ
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer 5,914 1/ Mekev ^ Model# SA* % Size /J3
Float seperation -7 Gallons/cycle: 11 7
Alarm Location ~pwsL°
SOIL ABSORPTION SYSTEM
Width: Length Gam' Number of trenches j
Distance & Direction to nearest prop. line: ?O `
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:/?f%
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CRO
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 289313
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
4 MORROW, TOM KINNICK-INNTIt
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
022-1039-50-000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark C,/ '27
Dosing
'1.,<_ ~Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
i
Septic NA Dt Bottom
Dosing " NA HpFkar / Man.
Aerati NA Dist. Pipe
Holding Bot. System j, 30 2 5~s
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand 0.
Model Number GPM
TDH Lift Friction System TDH Ft
Loss I Head
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Di a. Liquid Depth
DIMENSIONS DIMENSIONS
%'LEACHING Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type O CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
o
LOC&TION: KINNICKINNIC 14.28.18.2~2B,SE,NE CTY RD JLOT 1
99
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Safety and Buildings Division
~•ia~ SANITARY PERMIT APPLICATION Bureau of Building water systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8112 x 11 inches in size. s'TC Xo i
• See reverse side for instructions for completing this application State Sanitary Permit Number
R?g313
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (11 State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
7A 01 &,7 V di.) _Jed; v 114,/4 114, S 141 T IF, N, R E (or) iAl
Property Owner's Mailing Address Lot Number Block Number
/Yo Jp co A?J IC ld .7
City, State Zip Code Phone Number Subdivision Name or CSM Number
B.v <ra fr wr ` D 22 (7/5 ) LAS in 6_67 f of 2 5" UAL ee 32 t
II. TYPE OF BUILDING: (check one) ❑ State Owned City Nearest Road
P E] Public 1 or 2 Family Dwelling - No. of bedrooms own of Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 F1 Apartment/ Condo O a _ l~'~ ~•-S
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1 ®New 2_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank OnlyExisting System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 K Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
5,6
Gt. ` D
Feet Q . S Feet
t/ 1 2
%_3~'~ l3~G f 3
i
VII. TANK Capacity
in Total # Of Prefab. Site Fiber- Exper.
INFORMATION gallons Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App
New Exist in strutted
Tanks Tanks
Septic Tank or Holding Tank l~44 ,`eE/aJ~S ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber pe, 6d S -tl ( S ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.-
Plumber's Name: (Print) Plumber's Signature: No Stamps) MP MPRSW NO.: Business Phone Number:
2 a"7 Q70 7e5-- 3P4' fe'a
Plumber's Address (Street, City, State, Zip Code): /
1 C ~l .$~D.v L~✓ r
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee)
%%7Y//7~((//ffw~77
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One ropy To: Safety & Buildings Divi ion, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815-
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling-
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7_
VII. Tank information- Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber isto fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes, pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
i
I
• I SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
March 11, 1997 2226 Rose Street
La Crosse WI 54603
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S97-40108 FEE RECEIVED: 180.00
MORROW, TOM
SE,NE,14,28,18W
TOWN OF KINNICKINNIC COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincerely,
6rard M. Swim
Plan Reviewer
Section of Private Sewage
(608) 785-9348
SBDA-7887 (K. 10!84)
C r ~ Page l of
S 40 6
1 8
MOUND SYSTEM RECEIVE L)
A 3 BEDROOM RESIDENCE MAR 1 U 1997
. SAFETY a gLD6S DIV.
LOCATED IN THE SE 1/4 OF THE NE 1/4 OF SECTION IV TZb N, R 18W,
TOWN OF ~IN1j l,C\tipj"IC , S'I^.CROIX COUNTY, WISCONSIN.
INDEZ
PAGE 1'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
. PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PA GE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
'ro wl Pr /vim SEiz. l F'1 olzz U w
T~ l U ~1Z ~flC~--L S, 1 S ~,L O Z Z
PREPARED BY
eeNtttt
WEGElREE~ SA'Q L TEST S NG CO
'y.
ESVjAGSS =GN sE~vzcE At
ARTHUR 4
P~`VAT ally P.O. BOX 74 421 N. KAIK ST. ~ x WEGERER
ditt®n RIVET? FALLS. KI 54022 ~ 'LL WOATH.
Coll
715-425-016 i r~ 1 W~ `
Vol D
BON: ~S I G'14
gOR ~ hOM Lpi~ ~~~~MONNt~'"
son. OF ~ aSSA'1+ p41D 01l~
0 ~zctia ~L~3t7
ESPONpEq~GE
SEE C
JOB NO. - 3 S
PLOT PLAN
Page Z of
Scale 1"= EcE/q
D
MAR 1 ® 1997
SAFt ~ Y ~ gLpGs pN
y~ o oD ~ ~p Z
oa rvur eW°►P1 r o Pte. - •H r"1 - -.~OO.O' R ~`~hGl4 , Sig` Dt R l2tE--wem
olt lt~A31vNzes w~Tl4 LA'iZ} .
~r
3 n~
O ~~s. S 30~~ o a \-\-Ov swt
ZS' of 4 Pv
W d1 _ a
J
~ B~2
o S
0
22
°
i
w F L"rsT Su' F%rj" ovx~~~
~ ~ rte- L l~sT Z, s' F►zci►~ ~►-.roc s .
2
0,1 r► t 1 * 1v
S Et1F__Rw o(Y0 FoR.esr kzA*).
2~ C ou ►j r,l • S'
NOTES:
•1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. (Y required)
3. Install •4" observation pipes with approved caps. ( Z required)
4. -Septic tank to be '1000 16aa gallon capacity manufactured by
w ~ , c.ON ea.E~ ~R~O~ DTs' ~iv~.PcT-16oc1~
5. Bench Mark S ~-(3 0 V E
6. Divert surface water around system to. prevent-.ponding at the uphill side.
RECEl ft of b
MAR 10 1997
Approved Synthetic Covering SAFE 'I Y & BLDGS. DIV.
F}s-r" c 33 Distribution Pipe
Medium Sand
Topsoil = F Elev. , p
3 E
D
b
% Slope
Bed Of 2~ 2 Force Main Plowed
Aggregate From Pump Layer
D ~•o Ft.
Cross Section Of A Mound System Using E 1.6L Ft.
F o-a Ft.
A Bed For The Absorption Area
G 1. 0 Ft.
A b Ft. H I- S Ft.
Linear Loading Rate=-1-1 GPD/LN FT B bl~ Ft.
Design Loading Rate= 0.3ZGPD/SQ FT I Ft.
J 6 Ft.
K 11_ Ft.
Ate Position L SS Ft.
of
Force Main W Z S Ft.
J L
Observation Pipe
r to,
A I -
W (o ---7--------------- ----------------------•I
Distribution Bed Of 2"- 2 2
Pipe Aggregate
1
Observation Pipe Permanent Markers
(Anchbr securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page L4 Of
RECEIVED
Perforated Pipe Oetoll MAR 10 1997
SAFLTY & BLDGS. DIV.
0
End View
)Perforated
End Cop. nee PVC Pipe .
Jo~`p an~c
as` Install permanent-marker
at end of each lateral
Holes Located On Bottom.
Are Equally Spaced
Q S
Q
PVC
Manifold Pipe
PVC Force Main
Distn ution
Pipe
Lost Hole Should Be I
Next To End Cap
End Cap
P 3 0 Ft.
Distribution Pipe Layout
S Y Ft.
X 149 Inches
Y " L8 Inches
Hole Diameter 1~L1 Inch
Lateral ) Inch(es)
Manifold Z Inches
Force Main " Z Inches
# of holes/pipe $
Invert Elevation of Lateralsl%31.5 Ft.
1,
Place lst hole Zqfrom center of manifold with succeeding holes
at Y*E~ intervals. Last hole to be next to the end cap. I
- Combination Septa c; Tank and
PUMP CHAMBER CROSS SECTION AKID SPECIFICATIOMS ' PAGE S OF~
WEATHER PROOF
-VE►JT CAP JuuCTIOIJ BOX ~q/Q , YY~O
4'C.I. VELIT PIPC APPROVED LOCKIIJGCCFTy
2.10' FROM DOOR. MANHOLE COVER yuI''I Bl `991
- Z wati,r.IIIJG LA>3Et_ ~t!'i
'.i11J0OW OR FRESH Cot.~DutT S O/
AL_IUTAKE
~ fj
~ I
4+ MI IJ`
~ ~ IeMIU.
11~
PROVIDE I
IAILE T AIRTIGHT SEAL
APPROVED JOIWT BRPF~~S A I I) ( APPROVED JOIAITS
I I ( W/C.I. PIPE,;XI'"r-
W/C.L PIPEaR Tank construction
shall comply with - I 1I ALARM
ILHR 133.15 and 33.20 ° I I
I I Oki
c I 1
a 3 s I
LLEY. FT. PUMP_ __j
OFF
O CONCRETE
L 013. QQ CLOCK
3" AVPRoVED
RISER EXIT PE:RMITfEO OIJLy IF TA1JK MALIUFAGTURER HAS SUCH APPROVAL gEDpIµS
a 5PCCIFICATI0k1S
SEPTIC
w~pCT- LkjUo
DOSE MANUFACTURER: ~'l)L COQ CC`CT NUMBER OF DOSES: 3• ~9 PER DAU
TANK SIZE: ~pOO ~ b00 GALLONS DOSE VOLUME
ALARM MAWUFACTURCR: YlS IMCLUDIMG 6ACKFLOW: GALLONS
MODEL NUMBER-. CAPACITIES: A= a IMCH15 OR GALLONS
SWITCH TJPC: ~~~~Y B = Z IUCHES`OR =_l G( LL0115
PUMP MAIJUFAGTURCR: 1`'►`L~~S C= IuLHES OR GALLONS
MODEL UUMBER: S~' y DINCHES OR 1S0 5 CALLOUS
I~1~~S2CUSZ~/ MOTE: PUMP AUD ALARM ARE TO 6E, 9
SWITCH TYPE:
MIKIIMUM DISCHARGE RATE 3, y GPM INSTALLED OU 5EPARATE CIRCUITS
VEKTICAL DIFFEKENCE DETWCEIJ PUMP OFF AUD..015TRIBUTION PIPE.. FEET
+ MIIJIMUM NETWORK SUPPLY PRESSURE . ; . . . . . . . 2-50 FEET
-F ZS FEET OF FORCE MAIN X Z'24 F j FRICTIOU FACTOR. O' 62 FEET
100 f C
TOTAL DyKIAMIC HEAD = "FEET
Pump chamber DIAMETER
`I -
INTERUAL DIMLWSIOLI~ OF TALA: LENGTH -,WIDTH -;LIQUID DEPTH
BOTTOM AREA 231= _ GAL/INCH
AS PER MANUFACTURER GAL/INCH
TOTAL HEAD IN FEET" 9L'~~ 6 or- 6
O cn o cn o cNn o RECEIVED
0 ° MAR 10 1997
SAFETY & BLDGS. Day
0 0
N CD
O O
n r
D
D w _
n O N D
H O
H
G) ° o -c
D
r- H
N
z c
U) o T
3 m
~o
M ° N
~ z
0
7 -1
H J m
Z o
c N
0
0
m
OD
0
w
N
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co
0
W
0 s
O
O
o
O - N C4 ~ UI m J m (0
TOTAL HEAD IN METERS
i
Wisconsin Department oflndusby, SOIL AND SITE EVALUATION REPORT Page I of 3
Labor and Human Relations
Division of Safety & Bindings in accord with IL.HR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but I.D. #
not limited to vertical and horizontal reference point (13 fi, direction and % of slope, scale or PARCEL I.D #
dmensioned, north arrow, and location and dstance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWEDBY DATE
PROPERTY OWNER: PROPERTY LOCATION
V O't'1 tl p1Z~p W , C OW. tOT- SF 1/4 NE 1/4,S IV T Z8 N,R 16 E (or Vj~l
PROPERTY OWNER'S MAILING ADDRESS y LOT # BLOCK # SUBD. NAME OR CSM #
1~1~8 C,c)v~ ' S t - p~?os~ esM _
CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE DOWN NEAREST ROAD
~IUM lS 1v~ SgOZZ (7IS) ttLS- 0661 ~v_1fut 3 tC~tllv111l l C-aj j" Sr
New Construction Use M Residential / Number of bedrooms 3 [ J Addikn to e)dsting building
j j Replacement [ j Public or commercial describe
Code derived daily flow Ll SO gpd Recommended design loading rate "S Z bed, gpo1ft2 - trench, gpo1ft2
Absorption area required 315 bed, ft2 315 trench, ft2 Ma)dmum design loading rate o- _S bed, gpcW o, 6 trench, gpd&l
Recommended infiltration surface elevation(s) 1 O ~ . (3, ft (as referred to site plan benchmark)
Additional design/ site considerations ~'1o~NO w/ 6 ')c 6 3 ' 8 Ir-0 . " 11V ,w, u" ) ' OF SPttiD Fr ,LL
Parent material S Z-tt M ey out rL C ~ T LL Flood plain elevation, if applicable N-~, • 4 - ft
S = Suitable for system (ONIIENTM& MOUND IN-GROUND PRESSURE IT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S 0 U ®S ❑ U ❑ S ®U ❑ S ®U ❑ S [21U ❑ S MU
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Texture Structure ConsistenceBoudary Roots GPD/ft
in. Munsell Qu. Sz. Cons Color Gr. Sz. Sh. Bed rerldl
0-lZ ~ll"I1Z 312 ZMSb1Z m' Qs 1 •5 ,6
Z 11-SY z s`12 icy - sl ~s~k ~nU'~. eg .S
Ground 3 sy- 601 1o-1 V_ ~s 3t3 sc~ es b12 ►n'~ -
elev.
1131.0 ft
Depth to
limiting
factor
L_j
Remarks:
Boring #
O- l 0 10~'11Z ~ l 2 S l z rn S D EC yn 4-1. ou s ` S • b
Z z to 1,oy tz.3lG - s~ 1 z'Fsb►~ rn`~- ~s • S • ~
Ground 3 ap.316 -)•S`tfL3ly - S ~Cg~1z v►~v`PI,. ChJ k4 •5
elev. 3SfL $-SS S`7R yl` LSktz3L3 Sc~ ~cSbk M C.r.%, -
~
lD
Depth to
limiting
9
38" ~ MA
Remarks: ' w
CST Name.--Haase Print Phone:
Arthur L. We erer 715-425-0165
eg rer Soil Testing & Design .Service-P.O. Box 74 River Falls,WI 54022
Signahxe 'IIU e ~l7- 3 S Date. , 5 CST Number: ;
M00576
PROPERTY OWNER 0TLVLQ w SOIL DESCRIPTION REPORT Page of
3
PARCEL I.D. #E
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxtary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3 a_ l 0 I w-1 a l t - S t Z ~ `Fh wS ' • 6
Z ~o -33 1O`~ r~- Z-l z s 1 ~ 2 •F s bh ►~-`FI- CS ~ • 5 • ~
Ground 3 33 -S Z ) 011 R- V/6 'F 1 a 3! 3 s 0-3 I 12 M'1 U C W -
elev. 4 sz_63 to-. R- v/G s c 1 1 b~ m _
Depth to S w tyv S i
limiting
factor
i
Remarks:
Boring #
_ i
Ground
elev.
ft.
Depth to ;
limiting 3.
factor
i
Remarks:
Boring #
i
1
i
13
i
i
Ground `
elev.
ft.
Depth to - I
limiting
factor f
Remarks:
Boring #
. I
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
• . ' PLOT PLAN Page 3 of 3
SCALE 1"= 4 '
MOOD J'p? Q3vj
'EL. vo 0.0, cam, q lc-h 6 4 , S~gr of R ize -fa i-a
X
tj 8.3 L1- . X01
s_
o
W d~_ a
2
J'
o LrLL03.S
O
N p~
,moo
~ Nom:---
B 6- ~T`Z T Z s S= tZUw1 1-1 pVrvt -
~ u 'ro T~'i• L~-8T 5 ~ -Y`-R0~ w10V1v'p , -
C>, 4 h4 i To
q q'7 S tit~wooo F-oR:~rr- R.i~ ,
r (715 ) 425 n7 6S )vI00576
CST Signature Date Sign Telephone No. CST #
FILED y
? 4PR 2 5 1997
a 10
~a$ 2~ scc►o GZ,ft
CERTIFIED SURVEY MAP
HAROLD AND JOANNE MORROW
Located in the SE1/4 of the NE1/4 of Section 14, T28N, R18W, Town of
Kinnickinnic, St. Croix County, Wisconsin.
OWNERS ADDRESS.' 50 GLENDALE DRIVE
RIVER FALLS, WI. 54022
NE COR., SEC. 14, 7-28N, R18W
/ COUNTY SURVEYOR'S MON. 1 W
LEGEND
SECTION CORNER MONUMENT
/AS NorED J UNPL A T_ T_ ED LANDS v o
O I"X 24" IRON PIPE WEIGHING m
1.68 LBS. I L / N. FT. SET. REEK b O
-'A-,r- FENCE ~ N
J~-
pA f?_K_ER s
jF~lrotir.
N81• 33' 55,E , 3~F
4.0
APPROVED 5 q z .
75' ORDINARY 6, W
W ~_HIGH WATER MARK i
? I SETBACK LINE .r W
Q APR 2.5 '97 Q i ~
W6 N
W(A -Ij 41
W IA CROIX COi.JNTY 3
;"p I
Q :if-mpre)0sns1v0 Ptanna QI
o v honing and QI M J
Committee
W W if riot recorded QI Q
LOT 1
2 wiihin 30 days of Jl o o W
506,965 SOUARE FEET o - ~I
W :approval date
Q O 41 = N / 11.638 ACRES)
W N ~I
approval shall be
p W o EXCLUDING RIGHT OF WAY h
kk ~
null and void ``Q ~
kw e ^j N ^ 524,612 SOUARE FEET - 0 QI
R W M q 112. 043 ACRES)
ki ^ JI
Z O Q1 INCLUDING RIGHT OF WAY ~I
i o J~ ~I
to tL. o
0 o h p
JI HIGHWAY R/GHT - OF-WAY S ETBACK LINE
.................I. O
S 00.26' 52"E
~p O
E - W 114 SEC. LINEN /OOS89133' O8"W 7.00' S 89,55,0811W
I1 2
~ 415.26 ' /96.03
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5254.03 N89.57: 05"W II--
C$ 1
WI/4 COR., SEC. 14 , T28N, R18W EI14 COR., SEC. 14,T28N,R18W
I
/ COUNTY SURVEYOR'S MON.) /COUNTY SURVEYOR'S MON. ! 1~1~1
UNPL AT TED_ LANDS
1144," _f URVE_ INFORMATION
04' 28, 97 MON 13:07 FAX 715 386 4636 ST CRT CO ZONING Z002
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house) , then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property
Location of property711Sl/41' C 1/4 , Section /f] ,T 2 N-R I ' W
Township V1;,r,;.( "_` Mail ing address / </O V C-4-t `
Viz., :s AL Pe
Address of site CA /3 ,e1 /r'>' (ls
Subdivision name Lot no.
Other homes on property? Yes — No
Previous owner of property
Total size of property / c.erA- ..�. � �� a �`...(
Total size of parcel
Date parcel was created . a T /997
Are all corners and lot lines identifiable? x Yes No
Is this property being developed fo�r/ (spec house) ? Yes ,X No
Volume ( and Page Number -3p1y T as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUM-4NT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. —, and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement , to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of Applicant Co-Applicant
Date of Signature Date of Signature
04%28/97 MON 19:07 FAa 715 986 4686 ST CR:I CO ZONING ~ 009
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 1-V , (til i.~!` ro
MAILING ADDRESS 1 O 5
PROPERTY ADDRESS k 11-el f=~ ~ls r'`
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE v+.r-
PROPERTY LOCATION 5t 1/4, IN t~ 1/4, Section T J~,W
TOWN OF 1 L- Vim` L ST. CROIX COUNTY, WI
SUBDIVISION 4141 is r LOT NUMBER
CERTIFIED SURVEY MAP $y VOLUME l , PAGE 3 V LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:- '1040K
DATE: y -a - 7
St. Croix County Zoning Office
Government Center
1101 Carmichael Road 11/93
Hudson, WI 54016
. t
STATE BAR OF WISCONSIN FO!!/ 3 - 1982
50rW43 ~
DOCUMENT NO.
REGISTERS OFFI;E
Harold D. Morrow a/k/a Harold Morrow and ST CROIXCTY.,YYI
w~a a fs,Iali
Joanne M. Morrow a/k/a Joanne Morrow, husband
and wife MAY 2 1991
quit-cWms to Thomas H. Morrow and Rebecca J. ,
Morrow. husband and wife as survivorship 9:30 A M
marital Droaerty 44 U.40'
HggWer of Do" ~
the following described real estate in St. Croix County,
State of Wisconsin:
THIS SPACE RESERVED FOR RECORD08 DATA
Part of the Southeast NAME AND RETURN ADDRESS
Quarter (SE-%) of the
Northeast Quarter (NE'i) of Section 14, TMo"^af ~I. ►N~e>*r•w
Township 28 North, Range 18 West, more Igo? C,61 IU r
particularly described as: o tit. r(oaa-
Lot One (1) of that Certified Survey Map
recorded in the Office of the St. Croix
County Register of Deeds, in Volutae 11 022-1038-50
of Certified Survey Maps, at page 3244, PARCEL IDENTIFICATION NUMBER
as Document No. 558425.
i~
i
I~
'i
This is not homestead property. ~I {
(is not)
I
Dated this tat day of May , 1997
l
(SEAL) ✓~t'7'l (SEAL)
• Harold D. Morrow
(SEAL)
ft 7 W4 V.4 V--
(SEAL)
• Joanne M. Morrow
THENTICATION ACKNOWLEDGMENT
Y
Signutue(s) old D. Morrow and State of Wisconsin,
cantle M. Morrow ss.
S / County
suthendate day . 1-Q97 Personally came before me this day of
May , 19-1-7 the above tamed
Edward F. Vlack Harold D. Morrow and
TITLE: MEMBER STATE BAR OF WISCONSIN Joanne M. Morrow
(if not,
authorized by 8706.06, Wis. Sus.) a me known to be the person a who executed the kxeg ttg
instrument and acknowledge the saute.