HomeMy WebLinkAbout022-1057-80-000
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ;l'L'e
ADDRESS a'Y~S' 5/ • 5~/~
SUBDIVISION / CSM# LOT
SECTION T -9 N-R AL W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
s
f,
i'J' I f
s
Z - 7.Sc, yam/ s~ C•~
NI
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:P.f~r Liquid Capacity:
Setback from: Well House 26' Other
Pump: Manufacturer Model# E'po f// Size
Float seperation Gallons/cycle:
Alarm Location J~Se kv,
SOIL ABSORPTION SYSTEM
Width: lJ/ Length 7Z2 Number of trenches Z
Distance & Direction to nearest prop. line:
Setback from: well: House Other
'77
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:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Visconsin SANITARY PERMIT APPLICATION 201eE. W shingtonAve ision
P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)).
State Plan LD. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Property Owner Name ~ Property Location
1C' ~~.Gc t~6F' 1i4 re 1/4, S _2 T ZE1 , N, R (or
Property Owner's ceding Address Lot Number Block Number
IttA Zip Code Phone Number Subdivision Name or CSM Number
AI zu jr, o Z. -3 ("t/" ; `3-,f aloes
11. TYPE F BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road
❑ Village ,e /
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF ~iA/~ rfrt,IC,
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo p2~ - 10 7 6~)O
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, ;y 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
110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 RI Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14E] 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
CJXM 756 Feet 'eO0 Feet
VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank or Holding Tank 14!tpo e-,6 o, C , ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 1 -711,31 1 75,0, 0 ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumb is Name: (Print) Plumber's Signature: (No S mps) /MPRSW No Business Phone Number:
Z M 71t!~ ` 7 7r_ ` sy Z f
Plumb 's Ac dress (S reet, City, State, Zip Cori)'. P
rl lGt S Gc~ `s e~ 7"7
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater. Date Issued Issuing Agent Signature (No Stamps)
❑Approved ❑OwnerGivenInitial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266=3151.
To be complete and accurate this sanitary permit application must include:
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 is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
- - - - - - - - - - - - - - - -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
PAGE 5 OF-a-
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VEIJT CAP
4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING
JUUCTION BOX MANHOLE COVER
25' FRCM DOOR,
WINDOW OR FRESH 12 M''~' I
AIR INTAKE
GRADE
I y" MIIJ.
IB"MIIJ.
CONDUIT
4F
f~ll_.F_l PROVIDE I I
AIRTIGHT SEAL I III
( I
APPROVEC JOINT A I III APPROVED JOWTS
W/ C.Z. PIPF.. I III W/C.T. PIPE
EXTENDIMC+ 3' I II ALARM EXTEMDING 3'
01JT0 SOLID Sr t.. B I I ONTO SOLID SOIL
I ow
C
I
PUMP----
~1 y OFF
A % CONCRETE BLOCK
RISER EXIT PERMITTED UIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL
SPECIFICATIOUS
SEPTIC AND
DOSE TANKS MANUFACTURER: NUMBER OF DOSES: PER DA-4
TANK ;,IZE : -<~v GALLONS DOSE VOLUME
ALARM MANUFACTURER: 5. 1)7- INCLUDING 15ACKFL.OW: 7 3'y7 GALLONS
MODEL NUMBER: r~lievf CAPACITIES: A= INCHE5 OR GALLONS
SWITCH TYPE: 8 = Z" INCHES OR y~ GA'_LONS
PUMP MANUFACTURER: ac,,_/4 C = 9 IAICHES ORGA_LOUS
MODEL NUMBER: ~~L) f~~~ D= ~O IKICHES OR GALLONS
SWITCH TYPE: ~ MOTE: PUMP AND ALARM ARE TO BE
PUMP DISCHAR4E RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFEKEAICE Bt -wEEAI PUMP OFF AND DISTRIBUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . FEET
+ '24) FEET OF FORCE MAIN X F 00FTFRICTION FACTOR.. 4/7 FEET
= TOTAL DyAJAMIC. HEAD = ;7, /7- FEET
INTERNAL DIMEWSIONS OF TANK: LENGTH 7P Q ~ ~
;WIDTH ;LIQUID DEPTH
SIGNED:-. LICENSE ?DUMBER: DATE:
-11~-
a.
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations
Safety and @uildings Division INSPECTION REPORT ST. CROIX
(ATTACH TO PERMIT) 5anitaryPerm itNo.:
GENERAL INFORMATION 284277
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.:
ROSEWALD, JEFFREY AND KAREN KINNICKINNIC
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
6J, c~) ' 1 4 b 022-1057-80-000
TANK INFORMATION ELEVATION DATA A9700047
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 5 C_ / - Qqalenchmark S'V2_
Dosing
Aeratio Bldg. Sewer
-Hv Ing St/iiilliA Inlet
TANK SETBACK INFORMATION St/V1 Outlet 9`/• 3
tTANK TO P/ L WELL BLDG. Ai Inake ROAD Dt Inlet
Septic NA Dt Bottom
Dosing NA Header- n _001%z 72oh ,
Aeration NA Dist. Pipe q7, 6 7'
Holding Bot. System g~Z 9a G. Sf
PUMP / SINFORMATION Final Grade
Manufacturer / Demand app y 9 '
Model Number GPM ~ n_-
TDH Lift Friction System TDH Ft
Head
Forcemain Length HDi Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width 6 Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 5 7S a DI EN I
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA anuacturer:
SETBACK ER Mo e
INFORMATION Type O CHA
System: rPn>k> t1A OR UNIT
DISTRIBUTION SYSTEM
(>Y Header Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Ord 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.)
LOCATION: KINNICKINNIC 20.28.18.318A,NW,SE
Da 1~ (V
l%
Plan revision required? M-1-es ❑ 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
~•~i~rar,. SANITARY PERMIT APPLICATION Bureau of Building Water System!
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
0 Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. Or6u~
• See reverse side for instructions for completing this application State Sanitary Permit Number
49-?4
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Pr perty Location 14 i4 1i4, S Z D T N, R ~(or~
Property Owner's Mailing Address Lot Number Block Num er
t0:6 d*ev 14--it 101i
City, tate Zip Code Phone Number Subdivision Name or CSM Number
v 2 ( 71 )'/t 3 01 3
&I LAO &4 lAk 1
11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road
❑ Village /
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF I A
h- G • #iw
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 2;2,_ J057 by
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_____________TankOnly______-------- Existing System Exl-----System
-
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 W1 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
D'U -750 -75o , ~L 5 Feet Feet
VII. TANK Ca
n gaacct
i llon Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App-
New Existin structed
Tanks Tanks
Septic Tank or Holding Tank X ,r~ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
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 ignature: (No St ps) r MP~~No.: Business Phone Number:
7732!
i7 -7.6, '
Plumber's ddress (St
3j ge u, reet, City, State, Zip Code): /
7 Uc-~
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Late Issue JIssuing Agent Signature (No Stamps)
N Approved ❑ Owner Given Initial ~cU( Surcharge Fee)
Adverse Determination -C9/
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety 8 Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit. Transfer /Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
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 3 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 is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
JOB a FIQ iC~ p~G✓Y. ~f
TIMM EXCAVATING SHEET NO. OF 2
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY---J~ J1 DATE 3' ~l ~7
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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PRODUCT 2051 ~ns.,Groton,Mess,01471. To Order PHONE TOLL FREE I-800-2256380
JOB J£ Coe 6,/,
TIMM EXCAVATING SHEET NO. Z" OF
• Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY )ew.e_ DATE 3 f7
(715) 772-3214 (715) 386.5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE I-8DD-225-8380
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page 1 of 3
DOhion of Safety and Buildings
f S. ILHR 83.09, Wis. Adm. Code
ItMA
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Jeff & Karen Rodewald Govt. Lot NW 1/4 SE 1/4,S 20 T 28 N,R 18 VXO) W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
488 Valley View Road
City State Zip Code Phone Number Nearest Road
Roberts, WI 54023 ~ 715 ) 425-9399 ❑ City ❑ Village ® Town
Kinnickinnic WSHW 65
New Construction Use: Residential / Number of bedrooms 3 Addition to existing building
Replacement ❑ Public or commercial - Describe:
Code derived daily flow 45n gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2
Absorption area required 643 bed, ft2 562.5 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 '8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 96.5 ft (as referred to site plan benchmark)
Additional design/site considerations install 2 - 5' x 75' trenches
Parent material sandy/loamy outwash Flood plain elevation, if applicable NA ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
u= unsuitable for system [9 s ❑ U Q s❑ u ®s ❑ u M s ❑ u ❑ s ] u ❑ s n u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
1 0-9 10YR 2/2 - sl 2 m cr mvfr cs f/m .5 ,.6
2 9-24 10YR 2/2 - sl 1 m sbk mvfr cs
Ground 4 32-50 7.5YR 4/4 - sl 1 m sbk mvfr cs 1m .4 .5
elev. 5 50-64 7.5YR 4/6 - is 1 m s my r cs m
100.1ft.
6 64-92 10YR 4/6 - mcos 0 sg m cs
Depth to 7 92-96 10YR 4/6 - mcos sg m -
limiting 1.0ar fiold-Sattt- i nQ JAI/ qiHP1A1A1 1 q-PP 0 96 1
factor
96 in.
Remarks:
Boring #
1 0-4 10YR 2/2 - sl 2 m cr mvfr cs 1f/m .5 .6
3 2 4-20 10YR 2/2 - sl 1 m sbk mvfr cs 1m .4 ,.5
3 20-29 10YR 3/3 - sl 2 m sbk mfr cs 1m .4 5
4 29-54 7.5YR 4/4 - sl 1 m sbk mvfr cs 1m .4 .5
Ground
elev. 5 54-61 7.5YR 4/6 - is 1 m sbk mvfr cs 1m .7 -.8
100.9 ft,
6 61-10 10YR 4/6 - mcos 0 sg ml - - .7 ;.8
Depth to w/ some os
limiting
factor
5 log in. Remarks:
CST Name (Please Print) Signatur Telephone No.
Henry F. Grote l 715-665-2681
Address PO Box 57, Knapp, WI 54749-0057 111/Date 18/96 3065umber
.
Jeff/Karen Rodewald SOIL DESCRIPTION REPORT
PROPERTY OWNER Page Z_ of 3
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Geptft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
1 0-8 10YR 2/2 - sl 2 m cr mvfr cs 1f/m .5 .6
2 8-2 10YR 2/2 - sl 1 m sbk mvfr cs lm .4 .5
Ground 3 20-29 10YR 3/3 - sl 2 m sbk mfr cs 1m .5 .6
elev.
101.6ft 4 29-46 7.5YR 4/4 - sl 1 m sbk mvfr gs 1m .4 .5
[]1671-113 1 7.5YR 4/6 - is 1 m sbk mvfr cs 1m .7 .8
Depth to
limiting 10YR 4/6 - mcos 0 sg ml - - .7 : ,8
factor
'>113 in.
Remarks:
Boring #
1 0-6 7.5YR 3/2 - is 1 m cr mvfr cs 1f/m .7 ; .8
2 6-22 7.5YR 3/2 - is 1 m abk mvfr cs 1m .7 .8
3 22-3 10YR 5/4 - sl 1 m sbk mvfr cs if .4 .5
Ground 4 37-3 7.5YR 4/4 - sl 1 m sbk mvfr cs 1m .4 .5
elev. 5 39-7 10YR 4/4 - mcos 0 sg ml cs -
100 7 8
.Oft.
6 78-9 10YR 4/4 - mcos 0 sg ml - - .7 ,8
Depth to
limiting w/ sidewall eep @ 78
'
factor
78 in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # 1 0-6 7.5YR 3/2 - is 1 m cr mvfr cs 1 f/m .7 .8
6 2 6-20 7.5YR 3/2 - is 1 m abk mvfr cs 1m .7 .8
3 20-3 10YR 3/3 - sl 1 m sbk mvfr cs 1m .4 .5
Ground 4 30-5 7.5YR 4/4 - sl 1 m sbk mvfr cs 1m .4 .5
elev. 5 58-6 10YR 4/4 - mcos 0 sg ml cs 1m .7 .8
101..6_ft.
6 67-110 10YR 4/6 - mcos 0 sg ml - - .7 .8
Depth to
limiting w/ some co
factor
7jjn_in. Remarks:
Boring #
1 0-5 7.5YR 3/2 - is 1 f cr mvfr cs 1f/m .7 .8
5-20 7.5YR 3/2 - is 1 m abk mvfr cw 1f/m .7 .8
1 -
4 28-4 10YR 4/6 - s 0 sg ml cs if .7 .8
near fie capaci y 39-42
Ground
elev. - 2 7.5YR 5/3 scl 1 c abk mfr - - .2 ,3
Depth to
limiting
factor
42 in. Remarks: outside of conventional system area
SBDW-8330 (R. 08/95)
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09,!17/97 MON 10:50 FAX 7159867289 P&D Contractors 1@003
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 " e
Location of property_&:L_7./4 SC- 1/4, Section C% .T ? N-R r~ w
Township Mailing address yFg
Address of site o~ S 5'71kfie-
Subdivision name Lot no.
other homes an property? Yes ~No
Previous owner of property ):e^
Total size of property, IJL•^.es _
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? __Y_Yes No
is this property being developed for (spec house) ? Yes _.X_`No
Volume 122q and Page Number as recorded with the Register
of Deeds.
- -
INCLUDE WITR THIS APPLICATION THE FOLLOWING:
A WARRhUTY DEED which includes a DOCUMENT NUMMR, 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 dead description
references to a Certified survey Map, the Certified Survey Map
shall also be required.
i
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. ~F 2,2 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.
s'4 ur art Applicant 'Co-Applicant
C
STATE BAR OF WISCONSIN FORM 16 - 1982
• ^ 555929 TRUSTEE'S .SEED
DOCUMENT NO. VOL 2-2- PAPE'
Jerry A. Gibson; J
__Le as Trustee of FEB 2 4 19
nore C. Gibson Family Trust 11:30 A.*
y J.
for a valuable consideration conveys without warranty to Jeffre
j Rodewald and Karen L. Rodewa.la, husband and
wie, as survivorship marital property,
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
Grantee, ~ L/ YC K G
the following described real estate in St. Croix County, Y~ -.1
State of Wisconsin:U
CLL "r
022-1057-80
PARCEL IDENTIFICATION NUMBER
~i
NW1/4 of SE1/4 of Section 20-28-18 EXCEPT Commencing at the SE
corner of the NW1/4 of SE1/4 of Section 20-28--18, in the center
of a town road, thence North 471 feet to a wood conservation
post, thence West adjacent to state property a distance of 194
feet to a second wood conservation post, thence in a
j Southwesterly direction, adjacent to State Conservation property,
a distance of 551 feet to a third wood conservation post located
647 feet West and 157 feet North of the point of beginning,
thence South 157 feet to the center of the town road, thence East i
647 feet to the point of beginning.
T RAV,T `
Dated this day of February 19 97
(SEAL) - (SEAL)
Jerr A. Gibson
C Trustee Trustee
I
i
AUTHENTICATION ACKNOWLEDGMENT
Signature{s) State of Wisconsin,
I1
03/17/97 MON 10:49 FAX 7153867283 P&D Contractors 2002
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St Croix County
OWNER/BU1'ER e ~•Q i ~u e L:~~ ew~~
MAILING ADDRESS 411e% PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
tv"- f- Z(s C?-
CM/STATE v
_
PROPERTY LOCA'T'ION IV W / 114, S ~ 114, Section T N-R 1Y W
t /G ' r1 c
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIEDSURVEYMAP VOL'UMEPAGE ,LOT NUMBER
Improper use and maintenance of your septic system could result in its premature fitilure 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 ccrdfscation form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewatar 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.
SIGNCD: T.i~ u , v .
DATE: ? - -
St. Croix County Zoning Office
Government Ccntcr
1101 Carmichael /toad 11/93
Hudson, WI 54016