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HomeMy WebLinkAbout022-1061-30-000 'D C) " oo C> a> a) 4 o 3 0 c v O 69 O N c a p o a 0. I c Ct L _ C w ~ N I C I o `o O) O N v ' N 0 N 0 N C L O m w U N Z U) a 0 . o n a O N o z ~ o Z ~ 3 c0 co U. c m E C: U. X O O o C- (D 3 `r E a N N co C a Z N ai I'I o 00 0 Z 6 d d N 0 _ 00 a m a co N F- C O O Z V C w avi Z o c c z O N M N p N a O N N C_ N O 0 0 _O a y_ a c O I'. O a0i Q O CO a N Z U) Z o Z F- Z o z d a N 4) £ N O W N W lC 7 0 ~ d (0 }y N G1 - 0 7 OC. (O y ` `y O `l 06 O N CL N N N w d C O TO 0) Ln G O a G G C. o N ~~V dl Q CL U) Z, " Z° O O O X 0 0 0 • o. a o. N o. o. o. LL 76 a a~ U- > 0 0 1- o N V1 V rn 0) Z ~D ~2 (D a _ m :7- p ~ o ~ E m m N C~ a) L N N L.3"t C7) (D ~ N O p N Q Z U) 0 J y Q U1 ~N 10 Ci C N N N p U) N O O i N C i N y E y o CO O W O •D C O o E O 4 M M N U) a) =1 o CY) U C 0 0 C T 0 E Y C p O L C' C 7 €n c9 N N C C CO 0 r- s Z; co 2 cli Lo 2, 7 O "O N w? = L3 r- ~ N y co o . a m m O >0 0)j O w O c6 U • ►~1 O N Y I'i > "t O n 2 Z > N O N Z Cn r~' it w E d ~ a V v~ weal n. 0) CL IL r a tt`F~Ali E '3 3 w ; 'o i a 2 II 0 (1) 00 O y v "~1 A c0 Parcel 022-1061-30-000 07/11/2007 04:24 PM PAGE 1 OF 1 Alt. Parcel 21.28.18.P331 B 022 - TOWN OF KINNICKINNIC ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - PECHACEK, CRAIG C CRAIG C PECHACEK 205 LIBERTY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 205 LIBERTY RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.750 rBlock/Condo : N/A-NOT AVAILABLE SEC 21 T28N R18W 1.75A IN SW SW S 216.5' Bldg: OF W 351.8' OF SW SW 460/457 ct(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 01/04/2007 841867 WD 08/11/2006 831939 SD 12/08/1997 569586 1281/365 WD 07/23/1997 460/457 more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.750 40,000 148,000 188,000 NO Totals for 2007: General Property 1.750 40,000 148,000 188,0000 Woodland 0.000 0 Totals for 2006: General Property 1.750 40,000 148,000 188,0000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 562 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Health and Social Serviccs Plb. X57 10/69 Division of Health ' PERMIT APPLICATION for PRIVATE Du.;Es,rIC SEWAGE SYSTDIS 4A 51AJIS a) IX FCC TZ~7 ---I A. OWNER OF PROPEiTIY TYPE OR USE BLACK INK Name Address (Street, Cit / Zip Code) !1j f 1a/L.~/ County B. LOCATION OF PrnPERTY WFi+RE SY;TEJ'I WILL BE CONSTRUCTED, ALTER5D IR,EkDED Check One: CITY VILLAGE LEGAL DESCRIPTION;/ TOWNSHIP 7 14 C. IS LOCAL PErMIT REQUIRED FOR THIS h,URK? YES NO PERMIT Nl.T`'`iEP. D. SEPTIC TANS{ CAPACITY Gallons NEW INSTALLATION L REPLACEI ENT ADDITION MATERIALS: Prefab Concrete X Poured in Place Steel other NLMER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commercial Industrial Other ~pecify) Number of Persons to be Accommodated Number of Bedrooms F. A?,LIANCES, ETCs Food Waste Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. EFFLUF1NT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEI;ENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Beds Length Width Depth Tile Size No. Lines Seepage Pitt Inside diameter Liquid Depth 1-5 P E R C O L A T I O N T E S T Test Depth } Character of Soil Hours Water Test rime Drop in Water Level Inches 'Minutes Number Inchas Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall 1st Wetted Dverniaht in Minutes Last Period) Last Period Period OnA Inch Exa^1ple P- 0 36" To Soil 1011. Clay 25 es or no 30 1/2 1/2 112 60 H _ J L / h 7 1 RECORD DATA FROM MINIMUM OF 3 TEST HOLES i ompute size of absorption area in accord with H 62.20 Wis. Adninistre.+.ive Code. S 0 I L B O R I N G S- Minimum 36" Below Pro osed Absorotion System oring Total Depth Depth to Ground Water Depth to bedrock Lumber Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches i xample - 0 72" 72" Black To Soil 121• Cla 18"• Sand le"• Gravel 2411 RECORD DATA FROM MINIMUM. OF 3 BORE HOLES COMPLETE OTHER SIDE J w ~ dF 1 I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under by supervision in aooord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative Code, and that the data recorded and location of test toles are correct to the best of my knowledge and belief. NAME 14 7 1 % ~ TITLE (Type or Print) REGISTRATION NO. o.r MASTER PLUrB ER LICENSE No. ADDRESS' DATE ' SIGNATUREL: (.LL rJf'~ I I MASTER Pj I,JIQER I'iAnING APPLICATION Signature.( L License Number; MP RSW I (To ,be Com-feted by Issuing Agent) p Date of Application 70 Fee Paid $ Permit Issued (da'-e) Permit Number i Agent (name'/'_; For: Town, Village, Cit , County, etc. (Specify) Notes The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. / Do not write in space below - FOR DEPARTI1ENT USE ONLY DATE RECEIVED ACCEPTED BY G RETURNED (Initials) (Date) See Corrrjes. FEE RECEIVED C/ . VALID. NO. PERKIT NO. ~ v (Yes o_ No) REVIEWED BY APPROVED DATE (Initials) (Yes or No) COMMENTS : y~z ~r~r~1y alp r AS BUILT SANITARY SYSTEM REPORT T OWNER Q F0 ADDRESS ~f r'q )ra S wL a SUBDIVISION / CSMJ LOT SECTION I T Q Y N-R IS W, Town of. /ZIA /G kl"n n ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C5 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ff 1 ~ IIENCHMARK: /60i / T6,® _3 / N I k wood f 0 s/ ALTERNATE BM: W-44SIPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length 7jr Number of trenches Distance & Direction to nearest prop. line: ~ Setback from: well: 16o House_ O O r 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: PLUMBER ON JOB: i/ l cvQ CA 5 1,, , el, LICENSE NUMBER: INSPECTOR: 3/93:jt P 1~ ~ Man ar r ' n Weis 3Br ~W~l( )9"C S~ tic. Tar If d, x~ x fih~ H "Spwc r 6~H Fence 6-oi l.►r~ e. Tm ck Ov.C 91 ► t3hl rkV. )60,o Top 3 ► Nf~~ W~e~~ Fence ( 06r & MO Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299113 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: WEISS, MARILYN KINNICKINNIC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: QOM d-~ C rZ P~ k 022-1061-30-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark .lo Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet Air Septic 75pr 3- -15-' >>S~ NA Dt Bottom NA Header/Man. Dosing za- Aeration NA Dist. Pipe cf y Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lricti n System TDH Ft Head Forcemain Lengt12/ Dia. Dist. To Well L L SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7L_ DIMEN I N LEACHING SETBACK -Manufacturer: SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION TypeO CHAMBER Moe Number: OR UNIT System: -16, 12o r 6 Jj/ 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 a " Bed /Trench Edges /~-'2 2 Topsoil ❑ Yes ❑ No ❑ Yes El No (DL j COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC 21.28.18,SW,SW 205 LIBERTY ROAD~~- 6t- pk) Plan revision required? ❑ Yes ff~'No j Use other side for additional information. ° L to SBD-6710 (R 05/91) Date Ins a 's Signature Cert. No. r ADDITIONAL COMMENTS AND SKETCH y SANITARY PERMIT NUMBER: I SANITARY PERMIT APPLICATION 201BE.Wand ahnllgtonAve sion Visconsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707-7969 • Attach complefe plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. St Croix • 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 ❑ Checki revision"to previous application [Privacy Law, s. 15.04 (1) (m)]. [ a jqz State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location ;.k I Marilyn Weiss 1/4 NW 1/4, S T 28 , N, R 18 )!W Property Owner's Mailing Address L umber Block Number 205 Liberty d City, State Zip Code Phone Number Subdivision Name or CSM Number River Falls WI 54022 415 ) 425-9814 II. TYPE BUILDING: (check one) ❑ State Owned Nearest Road Public 1 or 2 Family Dwelling - No_ of bedrooms 3 pg NA Town OF Kinnickinn' Liberty 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo a/'a g` /g. p33/ 49 l06 3O 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 Q Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 Q 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. [g] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ________System_____________TankOnly Existing 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 ❑ Mound 30 ❑ Specify Type 41 Q 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) 93.5' Elevation 450 750 750 .6 92.5' Feet Feet Capacity TANK Ca in allons Total # of r Prefab. Site Fiber- Exper. g Manufacturers Name Con- Steel Plastic INFORMATION Gallons Tanks concrete glass App. New Existing strutted Tanks Tanks Septic Tank 1QM0(CbXT Xx 1000 1000 1 0 ❑ ❑ ❑ ❑ El Lift Pump Tank /Siphon Chamber ❑ El ❑ El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu is Signature:. (No Stamps) r P~! No.: Business Phone Number: Paul C.J. Steiner 6780 (715 425-5544 Plumber's A( dress (Street, City, State, Zip Code): N8230 945th Street; River Falls WI 54022 IX. COUNTY / DEPARTMENT USE ONLY Q Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A ent Si nature( St ps) A roved Surcharge Fee) pp ❑ Owner Given Initial Adverse Determination CJ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R 11/96) DISTRIBUTION: "inal to County, One copy To: Safety & 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, 608-266-3151. 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 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 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. Plot Man I'A8rifyn Weiss .3 Br ~J)Jt t 83 ,a o~H Fence J-01 1.►~' e E Tfevrck Ovs T 931 t3h1 f kv. 160,0 rap 7,0 h'►q~~L~tN L~.~E1S f owue~'s r.~+~c O~ S'RZaQ:u'T10N • la4X ~2.5~ ~,thDC _ y PVC. y~~CP~ST_1RUN 6'tg11J. sot 1owt~r_~ P1PE p~~URAiEU PIPE VEUT P1PE w/ AP~PRUV ~ G4P 5, z.s. I ' - -2 S ~ CROSS S EcT O ~Q f 14"e-Z. VENT A r~- ~nP>zov~ C~\P tt-T c&~sT ~Z" RBoUE r:k-~1SH eb GR-ADE Spli_ FTLL- ~X.l~~ G n D I JJ APP RUV ED 5`7tif7f ET7 C cc ° PER F~itT~ p 1 PE TO aoTMJl 0f=-T9EKCJ4 3~1IJ1,v ~~STRlBvl~ov PIPE litiD Z"OFRC~i2E6R7~ Ti"Sc~VE -PIPE P u,mr s signature icense o. a e Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pa l of 3 Labor and Human Relations - Division of Safety & Buildings in accord with ILHR 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 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance =e;0 2.'Z - 1Q 6 ) - 3~ APPLICANT INFORMATION-PLEASE P ~'q j~p REVIEWED BY DATE PROPERTY OWNER: ,p PERTY LOCATION \'SR L l:~ 1 SS `1 1/4 Mk)1/4,S Z8 T 2 $ N,R 18 E (orw PROPERTY OWNER':S MAILING ADDRESS, t it QT BLOCK# SUBD. NAME OR CSM # Z 0 S LtSMN Rul Z CITY STATE _ ZIP COD PHONE NtIMB /Ty [I VILLAGE MOWN NEAREST ROAD zi us 2i. t $ LJ 1 5 rj 71 S) ~ U r ) t'j I'j 10-\tl &)ru ~ C L 18 QR-`C~l D [ ] New Construction Use [X] Residential 'N M r Addition to existing building Replacement [ ] Public or commer Code derived daily flow ~lSo gpd Recommended design loading rate - S bed, gpd/ft2 • trench, gpd/ft2 Absorption area required q~O bed, 11:2 -1 S0 trench, ft2 Maximum design loading rate • S bed, gpd/ft2 • t- trench, gpdt t2 Recommended infiltration surface elevation(s) 9 • S ft (as referred to site plan benchmark) Additional design / site considerations Z`C1 C H'~ , t1} S 'Y- -1 5 ' L_av G . Parent material S t ~l U v~ WttSM Rood plain elevation, if applicable P ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S [I U EIS E 1U ®S U .91S O U ❑ S Lau ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. g~ Trt>r ) p 14` l~ 2. 1 S ©S~ mU- e S - t . 8 ROME Z b-~ I t.o~.~z 31 1`~s cSb~ Vh U ~1• S . b Ground 3 _ LO`1Q s) elev. 93•Sft. Depth to limiting gr$ fact Remarks: Boring # ~N1KEY< 1 o-1O \b`lR z1Z 1 9t^ '~4 aS - L] S Z 2 10 Z(, Lb~231 S Ground 3 ~6`6B l 0 7 R s 1 o s 3 1vt _ • S - b elev. qS.O ft. Depth to limiting factor Remarks: CST Name--Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Sgnature: Date: CST Number: M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page ~-of PARCEL I.D. # O`Z. *Z~ - 1 O 6 ~ - a o • . Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bid Trench o-b 1o 7- z [ Z L Z 3'k 44' a wv< Z S, -'0 S `i 2 3 ! S l Z sb~C Vn C S - S - Ground 3 z° -7Z t t~ ~ 2 sl C g b S9 y,,~ - • S elev. 00•Sft. Depth to limiting factor ?`!Z. Remarks: Boring # p_ 6 1 p Z f 1 S d S9 M j +h C S Film". 6 t~ 1 3 18.68 1b -t P- S / c, - ~S s wit I - S ' • b Ground elev. otS.Dft. i Depth to limiting factor Remarks: Boring # r Ground elev. ft. Depth to limiting factor Remarks: Boring # i Ground elev. ft. Depth to limiting factor Remarks: RRn-A83o(R 0IM") PLOT PLAN Page 3 of SCALE 1"= 0 J I Q Seals c ,J wood pEavCl l~, FeUQ~- !>oSr, n @Z $ @t 91S x\021W~TtL S' 90 s.3 MIA'. 0 s 1 41. qj S lur uN p q~-318 715 ) 425-0169 M00576 CST Signature Date Signed Telephone No. CST # - i ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the Marilyn Weiss residence located at NW 1/4, NW 4, Sec. 28 T 28 N, R 18 W, Town of Kinnickinnic Upon Inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Ye$ No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: 1060 6 Construction: Prefab Concrete.- X Steel Other Manufacurer (if known): Age o Tank (if known): Pa it C. J. Steiner (Signature (Name) Please Print Master Plumber 6780 (Title) (License Number) October 14, 1997 (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer _(NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspec 'on opening over outlet baffle). Name Signature Pau ~ C 1 Sfe;ueo MP/ ( 786 5/88 1~~e3f ,C.i he .SGC. Z► I p, Fe 3 /lS.B 3 3 I ' I 1 ~ I ~ ' /.yam ~`rsf ~9 i' N { 3I 1 3 .'sec Z I I I i oal of 1.75 the southwest corner of A per pares located in of Seatio ~ Southwest Quarter of Croix sCounty~$ Wisoonsino furthern ~the I 21t T 28 Ile R 1s W O Ste deoribed as follows; beginning at the southwest corner of said sftotion 21• thenoe north along the Nast line of said thence east parallel 1 Seotion 21 a 11 stenee of 216,5 feet south line of said Seotion 21adistnece distance with et the th*nae loath f~rallel with sold west f of 2 645 feet, the noe west along the south line of sbiginning, Seotion 21 a distanoe of 331• feet to the point ♦hfs wont 33 feet of such peroel being unod for public roads • STC - 105 SEPTIC "TANK MAINTENANCE AGIZEEMI,'N'I' St. Croix ty OWNER/1.311YER MAILING ADDRESS 17 PROPERTY ADDRESS _ (location of septic system) Please tain from the Planning Dept. CITY/STATE, PROPER'rY LOCA'T'ION -54t) 1/4, ~ 14~) 1/4, Section c ~ T_'; l N-1Z ~W TOWN OF ST. CROIX COUNTY, WI SUBDIVISIO LOT NUMBER CF.IZTIFIEI)SURVEY MAP ~-~4-VOLUME /t, PAGE 7~ , LO 1' NUMIIiat 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 I, 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 properly 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 (I) (lie 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 1/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 ye expiration date - SIGNED: j DATE: St. Croix County Zoning 0111ce Government Center 1101 Carmichael Road Hudson, \VI 54016 I Ir'13 X37 vik4c,- Gfi, 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 devblopment 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. /6_11_/ 94 eiSS Location of property~l/4,3 60 1/4, Section T cN-R_1W Township Mailing address _ 2,, 7 u` c Address of site G b '0l' Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property 45~~ Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes I/ No Volume g4f7j and Page Number _pj7'~" as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT 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. Signatuife of A plicant Co-Applicant /0 !e~z Date of Signature Date of Signature . DOCUMENT NO. STATZ BAR OF WISCONSIN FORK 3--1 TMu s•.cs -V= row 09C•ND-N SAVA • QtXT CLAIM DEED 534428 " W PAGE 187 - RFGI5IWS OFRM St CRW co, m Duane E. ifeiss Rwed Im R S EP 2 2 1995 git mms•to »Maril~rn,J.. -ileise at 9:30 A. M ftoleW d D"M . L2 as leBswdag d"albed real "tau in St. Croix . - - th MU 8 M State at Ni~eenah: pr4 VA MW SOUTH 216.5 FEET OF WEST 351.8 FEET OF SOUTHWEST QUARTER OF SOUTHWEST QUARTER (SWI/4 OF SWI/4) OF SECTION TWENTY ONE (21), TOWNSHIP TWENTY EIGHT (28) Tae: Pawl Nos NORTH, RANGE EIGHTEEN (18) WEST. St. Croix County, Wisconsin. This deed is given pursuant to the terms and provisions of the parties' divorce decree dated September 16, .992. ~:At:•iw+s"•a+ Dated tUb .......ltA.......».._........ day of .._e~`•!:...T........................ Il.9. .................(2ZAL) II • • Duane E. Weiss »......(S>r/►L) (8ZAL) • • . AQTZNNTICATION &.O=NOWLSDOItsNT N} STATS O! VISCONWN awt waid"ted tlds ........dq d , is •f A• • come beta zee ~._/.Y .Aar of Duane It. Weiss It tfe a>terw eaeied . TMR:XZUBRR STATZ HAIL OF W(8C0 :w~cbe:a.ex f'roe:a~ wk gip... a b. w yersow wb s mtd the hofteocet awl acknowledge tM saaaa. TN#e iasTSUwaNT WAS on~rrso er # -s- & 1 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ~'"N Nov. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 November 5, 1997 ~ ll To Whom It May Concern: On November 4, 1997, a new septic system was installed as a replacement for the existing system on the Marilyn Weiss property located at 205 Liberty Road, River Falls, Wisconsin. The legal description of the property is part of the SW1% of the SW% of Section 21, T28N-R18W, Town of Kinnickinnic, St. Croix County, Wisconsin. The system was inspected by this office, and found to be code complying for a three bedroom home. Should you have any questions, please contact me at the above number. Sincerely, Mary J. Jenkins Assistant Zoning Administrator POWTS Inspector No. 224834