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022-1080-30-000
a o ~ a~i °o I a~i °o, I " 6 0 6-P lu j ts 4) w a d I I C N ~ I I a E I I I I c E I ~ I I o ~ ~ m r at con ^ X o a`~i o L I Z aNi I ~ Z~ y I ~ Z I U. C M w LL C 0 0) o 3 o b c 3 0 `a o c Q° u10i I E Q I ~ I 3 N co D N N 3 Z E E Z = o = °o z N € V N am O O O Z C c~ w w f! IZ_- r O` C O Q C O c E c v d 'C Q2 Ch 'C 0) _E M ~w N N C. WJ C ~ 'C N 7 N CL N VJ c c O O N •IV ( 0 c o O Z co z Z F- Z o Z IN Z ~l e N V 'OV eO}} N O CN d j c a d c co LO ! 2 m m a o vi .9 m o~ o 0o G C a a iC G o a ~O CD N E LL E .9 Z O LL Nr Nr Nr I N Nr Nr N a~ z~ ~3~3030 av z 1a3o3o 0 •N ~'-aaa ~IL IL CL y a > o LO U) w J V rn co } X 0) 0) (D a`0 LE co v o Y d y 0 °D a O 0 0 O E c co c a ml c CL CL to 0) o m im n 4) (o 0) a.2 Q Q Y to m O N C co N c O F- 0) ~0 E 0 ad O ? O 0) (L O M a C U 1~ -9 C N C U Y C N U O w co oop°D c cmm c 0 c a~ Q) 75 d W o 1~ Y C v-0 d v 6- Z N~ N N c rn .4+ c do 0) .yd+ v Z a~i N GO c m w O yy (0 (0 A U N O) O v) p f0 10 s O O N Y j J Lo 0 Z y 2 S 2 00) 2 N 0 Z N Z~ r2 fn L: IL dad' LL 'L CL r`iv r~+ E 'c c c r A c0a~ aic0 l0 ) 0 . Parcel 022-1080-30-000 01/29/2007 03:22 PM PAGE 10F1 Alt. Parcel 28.28.18.P438D 022 - TOWN OF KINNICKINNIC Current X' ST. CROIX COUNTY, WISCONSIN 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 - HALLING, BRIAN V & SUSAN A BRIAN V & SUSAN A HALLING 1116 PINE RIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1116 PINE RIDGE DR SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.040 Plat: N/A-NOT AVAILABLE SEC 28 T28N R18W 5.04A W1/2 NW1/4 LOT 5 Block/Condo Bldg: CSM 5/1488 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 887/623 07/23/1997 885/404 07/23/1997 702/47 2006 SUMMARY Bill Fair Market Value: Assessed with: 179395 277,300 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.040 80,000 176,000 256,000 NO Totals for 2006: General Property 5.040 80,000 176,000 256,000 Woodland 0.000 0 0 Totals for 2005: General Property 5.040 80,000 176,000 256,0000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 147 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 Form- STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP 1,.;,► .a 1v~`r<'.• SEC. 2-'E' T N-R ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION J~r_- pitklt: 5 LOT LOT SIZE' S PLAN VIEW Distances and dimensions to meet requirements of ILRR 83 1Q SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM w -PROP 3 77- '41`+ INDICATE NORTH ARROW N BENCHMARK: Describe, the vertical reference point used IL's ezwkx C a~~ PUMP CHAMBER, Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of'inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 1d"` Trench: Width: Length: Number of Lines: e Area Built: Fill depth to top o f pipe: i +n c' 8. Number of feet from nearest property line: Front, O Side, Rear, V- ht . Number of feet from well:, Number-'of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box a or distribution boxO been used on any of the above soil absorbtton sytems? (Check one).; HOLDING TANK Manufacturer: Capacity: ~I Number of rings used; Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, Q Rear, 0Ft. Number of feet from well: w Number of feet from building: DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION • P.O. BOX 7969 BUREAU OF PLUMBING MAbISON,`WI 53707 XXCONVENTIONAL DALTERNATIVE State Plan l.D.Number: Ilf assigned) E] Holding Tank El In-Ground Pressure ❑ Mound NAME OF PERMIT H DER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Gnegony N. Lawson 215 Roosevelt, R.iveA Fa,M , W1 •r q S5 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.: NW NW, Section 28, T2 8N-R 18W, Town o6 K.inw%ck i,nnic, Lot #5 Name of Plumber: MP/MPRSW No, County: Sanitary Permit Number: 2739 St. Cno.ix 58927 j2af,e Qidd i SEPTIC TANK/HOLDING TANK: MANUFACTUp ER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: XYES ONO OYES NO BEDDING: VENT DIA.: VENT MAT HIGH WATER NUMBER OF ROAD: JLRI OP EWELBUILDING: VE TO FRESH ALARMFEET FRONE: I AI INLET/ YES ONO C~ OYES ONO NEAREST cz? DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY JPUMP MODEL. JPUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO OYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) OYES ONO NEAREST- 01 SOIL ABSORPTION SYSTEM. Check thesoil moisture at the depth of plowing JLErIhTHr DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.. #PITS. LIQUID BED/TRENCH ✓ TRENCO~S ! MATERIAL: PIT DEPTH: DIMENSIONS/. GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL: - NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES; ABOVE COVER EL NLET ELEV. END. P FEET FROM AIR INLET: Q - NEAR EST-i► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS. OYES ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: I ODDED. SEEDED: MULCHED: CENTER. EDGES. OYES ONO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.: DIA.. ELEV. PIPES. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED OYES ONO 1 PLANS DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: LINE: FEET ❑ YES ❑ NO D YES D NO INEAREST- Sketch OM System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) UjIsconesn. APPLICATION FOR SANITARY PERMIT ILHR St • Croix COUNTY (PLB 67) OEPRRTTEnT OF UNIFORM SANITARY PERMIT # ~InOUSTRY, LRBOR 6 HUTgn gELriTlOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Gregory N. Larson 215 Roosevelt, River Falls, Wl 54022 PROPERTY LOCATION J. NW 1/4 NW 1/4, S 28 , T 28 N, R 18 )o 'W TOWN m O Kinn.ickinnic LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER The Pined TYPE OF BUILDING OR USE SERVED X] 1 or 2 Family Number of Bedrooms: 2 ❑ Public (Specify): THIS PERMIT IS FOR A: Cl New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. IN Seepage Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Wieser Concrete 1000 1 X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: Wieser Concre e IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Toi:al *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Class 1 410 420 Ci Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility fo ' tallation f the private sewage system shown on the attached plans. Name of Plumber (Print): igna re: MP/MPRSW No.: Phone Number: Paul R. Cudd MPRSW2739(715)425-2049 Plumber's Address: Name of Designer: Rt. 5, Box 364, River 'Falls, WI 54022 Art Wegerer (576) COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: l~ Fee: Date: p ❑ Disapproved Approved ❑ Owner Given Initial Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. Form - S 'r C 100 Owner of Property Location of Property $ gjjj, Section ?~3 ,TZ N R --law Township_ .f~►.I_WV.- .tiNsG Mailing Address Subdivision Name Lot Number__ FaVc--- P revioua Owner of Property Sa=ge ~~~r,~ Gpm%_ Total Size of Parcel 5.04 Date Parcel Was Created (k- Z_1'.- ~Q Are all corners identifiable? X Yes No Include with this application one of the following: .Certified Survey Map .Dead .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION i 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. 3923Sl ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the some has been dui recorded in the Office of the County Register of Deeds, as Document No. 3'mcb _jtU'j_'.&5 o 61aNATUR f NftR SIGN TORE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED r i + i F ca.~K fw...S A , r#P~'..~ " -vd~y`~,"e`^°.,y',wc`,•'~`~.u 's 8 .¢eL~^ Q44 n: - r CERTIFIED SURVEY MAP LOCATED IN THE NW1 /4 OF THE NW1 /4 AND THE SW1 /4 OF THE NW1 /4 OF SECTION 28, T28N, R18W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN NW CORNER • SECTION 28 o w T28N, R18W o~ N -4O 'o 'o in N I I LANDS I l ' S89o19 29"E 1321_80' I (611 I LOT I Q~ LOT I W L `s - M o t ` o ~ R Oq~ Ile ZI , I~ POINT OF N z~ Qlz~ I ~O BEGINNING I Q J I LL I LOT _2_ w N 88°47'20"E 570.07' 1 of z I v, J~~ ~o~ of UJi toQ LOT 5 W W I WI ~ 5.04 Acres ± r- O I-I ¢I~I~ I ( M 219,471 S. F. ± • E-I to o al m LOT _1_ z N L Y ~I 4 Z i I-j I ; IW- . I I Z / Q I =i 16 61I 1 / > S88047120"W 1 f I - ....a........./ 507.76' I I NORTH LINE OF ~uw YJ1 /4 CORNER LOT 3 - 0' SECTION 28 y~T28N, R18W LOT _3 CERTIFIED S_URVEY_ MAP r M RECORDED IN-VOL.-2, PAGE _34_5 o N LEGEND 0 1"x24" IRON PIPE, SET, WEIGHING 1.68#/LINEAL FOOT. z • 1" IRON PIPE, FOUND. 0 1 1/411 IRON PIPE, FOUND. w Co EXISTING FENCE.. z En H a ST C- 105 r' r a SEPTIC TANK MAINTENANCE AGREEMENT ►H+ 0 St. Croix County z - a a OWNER/BUYER L-Res~t _ LAP,- ~ ROUTE/BOX NUMBER Fire Number CITY/ STATE_ `RaXC s PROPERTY LOCATION: j~N -4, Section T Z N, R W, Town of 6,%mz.Km1.iu=c St. Croix County, Subdivision TN's- pmue-S Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the was-ate 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. / SIGNED DATE a. St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. ST. CROI X COUNTY -A x ~,W I S C O N S I N a 9f' f r'~t?n 2 r qtok i 1 v> Z O N I N G O F F I C E 796-2239 . R rt, WW Post 066iice Box 227 Hammond, WI 54015 0 W N E`R P U M P E R A G R E E M E N T PLEASE BE ADVISED.. That until you arse again noatijied, I wilt contact with PAUL fir- 06 -4 SR_ us , Wisconsin, (Pumpers), ban the punpas e o6 removing at ti'waste 6nom the sanitaxy system to be .located on the pnopenty and 6utune home site .located in St. Croix County, Wisconsin, Township o6 iCk#jEqE;j.-L-uMz+~ being in the % o6 the,g % o6 Sec. ~ T. 2-e, N.-R. j~ W. (0n mo-ce Gutty descnibed as 6ottows:) I ' Dated this day o6 DE1'EMpr-(L,. 19 . (OWNER) State o6 Wisconsin) ss County o6 St. C&oix) Pensonnattyappeaned be6ane me this day o6 19 the above named to me known -ta be the person who execute the onegoing indtnumenz and acknowledged the .same. otany u .cc, t. noix aunty, My Comm. (is penmant) (Exp.in.e.s) I, heneinbe6one %e6enned to as Pumpers, join in the above agreement to the extent that I have a contract with Owner as above stated. (PUMPER) d > O C in w f. ~u„► o c c~ c~ co 0 Z' v v opt E (r w 'O y N j ro~ m d c< 0-0 C O 4 N y 0 C M `O O 0 m E O Cl `O y C y=,,,.0 3.Er ~ o.o C73r oco? coo ;ov W at O `a= c mmcv>>_m = -0 E ~N f. Q _m2- 0 >°,y o °w J (D 0) 0 V) L. o - N y c J LC ~c~c4-0 0 )CL -j0 1e~ d 30,3`('=~ °~C ° ~ C C (rj ~ O TJ . CC ui Ot C C M N C-M3w 0 w P a -mw~E 3 a)Cr 02 o m N c m 0 CO) O N C a~ co LL p c(o c~ ar c rn~ 0 3~S 0 3 p 41 0 w w O O R O U V co - ~ V ' = Q c ' CO C Q aa0O~D ~ WC,: C L `0y C y C O O 4) L.. OC O ca co i r y « .C„ v o E y C c0 7 E O O a 0 'o O co 0~ w C C a~ (D 0 CV) cm co N d_p 0 O C 0) E O ' " C~ q, d a M +C. C N- 019 0 0 3 p m a$ 3 o c 1311 vcoa~i(D~a 0 oa a o z ~>,0 c`a CM cm c w o' m o~ 0) ~-comCL E .=0 « o c O i i N C -le Q) N N 3 `o rN. 0 EN a', m_ c~c Fr- ~ 3w m m Ul C ~ Q = ° o (n o 0 CO) 0 g'a 0 d d f f c d o o o LOP) (D M CD ID ID m m 3 m A 'A 3 3 O X 1(xr; [n z y z O N 2 Cn " 2 2 ti z O cn r! 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N d N 00 CL ON a 00 z N z o z -I z z co z O n D 3 n D a j S O N O N CD CD lr CCDD CD C CD N C c v CD c COD CD ~f W CD co a Cp a a a 3 3 z CD (d z CD (o -1 (n Z (D N N C =S N a O a A 5 7 C W T ao v C N 000 (D CD (D (D 00 a a N z 0 3 c z " 0 0 co N ; fll ~ A W Cy N CD w CD w 3 CL 'i =3 -n v > T su c Cam, Oz a C Z) 5 a ((DZ ? o w O CO CJ _ to V X 00 CWjC O N CCDD A CD a CD ' A V CO n Q N O 1O ~ V CD A O O N CD CD 0 ~p~p ti fA 0 69 0 yA CD CD p O L 5 r 6 7 61 DEBA,RT-MFNT OF REPORT ON S B ND SAFETY & BUILDINGS INDUSTRY, DIVISION LAMA AND PERCOLATI 1 ) g~ ~/MADISON WI 53707 'HUMAN RELATIONS (H63.090) apt LOCATION- SECTION: TOWNSHIP/ -Jr L :BLK.NO.: SUBDIVISION NAME: WW 141 N so/ 1/4400(/4' 28 /T2gN/R/J41(or)W f/i.>rivi 7"Al W/- cE,P~. Su,Pr,E inA,o COUNTY: OWNER'S id*ME: MAILING \ ST, C,Qo/x 5'7 E5jlEN CT . C 4 0 p 4o vE,e s i .s4 oZ Z USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRI PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: (Residence 3 A1/i4 PTION: (New ❑Replace I 8/2 7/4 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYST ~M~ (`pti~O I I ®S oU ®S ❑U IS ❑U ❑S ~U [IS ®U CoNVEtirz° If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: A1/~Q Floodplain, indicate Floodplain elevation: 411x ^4 FE 9/ /m Q PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES 'CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (S ABBRV. ON BACK.) .PZ, OA Bert B- 96 99.6 No A) 46 96 s¢ '4' .a. , 34, Qn B- 2 76 96.8 AM A/ ~ 1_7 9 6 4t o 92, B-3 r72 96 , s NO Av E > 972 ,3 6 Q~n B- `t 8 9 9 9 / /V o V0 > 89 33 ,~c" J B- J_ loo 98.6 Alo.v~ /oo s 6 a B- PERCOLATION TESTS GLASS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD PERIOD PER INCH P- / ¢8 Al o x ¢ / 3 -9/St. -7 Z P- 2 f' N 1 3 3% 3/ 3 P- ,.7 S" Al I S Z~ 2 2 z P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 41141 Co.e, /)/E' ee'e SYSTEM ELEVATION yam: g AL NATE zo r ,r .coy-s" G® &'V 'a J* f~iPE Fo G NO / oiPW L~ < g ~ ~ ~ i ~ i E f I ~ r ain Q ` Ga C' 7-1e V. o o.v IV41,r7 F ° jLOCATioti, 40!4Ai5/ O *E-`3t P.<'~.c.r/T o S-Co vEj 0/~P~~'Tia~vf - IN I 0 ~ ' _-.?A ? _ ' Ws 71/,4/ ~ EL G-'4 'V r. _ 13- p 3 t ' 47 '5'Z_ '5-41'4 *14AI 7- F ' gB.3 / D F-~ E- PF~tJ ems- p - • INSTRUCTIONS FOR COMPLETING FORM 115 - SRC - 6395 To be a compl- . a accurate soil test, your report must in(aude: 1 . cornpi€ I n. 2. The use, .:rly indicate-v ' th ; is a residence or commercial project; 3. MAXIJt.r.)N hedroomsor it use planned; 4. Is t`s it system; 5. Got , 'rig boxes. "SUITABLE FOR ING TAN, Y IF ALL OTHER S) ULED OU." ON SOIL CONDITI' 0. =ASE m ons she i -iting profile des ~,s and cornp -4 the plot plan; 7. i,`<E A LEC acc your test location ng to sc os preferred. A sh, -fesir e i:.rence point are cle; I are permanent; -yes a addresses, flood plain dt_ tion test exemp- flood I ~es not apps- Nr A. in the ,>ropriate box; .)Ur curt ;;}ur certifica; Cop, I distribu ALL SOIL `;TS MUST BE FILED WITH THE LO? "k'JTHORITY WITHIN 30, 'LETION. JATIONS I _RTIFIED SOIL TESTERS J Textures Caber 1 BR - B Cob - t 10"1 SS - gr er 3") LS L H G VV I Perc B r - Civ y rEt - d - p _ I- VY E - I'Vi V R P DEPART!<VIENT OF • REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS MDUSTRY; DIVISION P.O. BOX 7969 ]UNIA AND PERCOLATION TESTS (115) g¢ MADISON WI 3707 (UMAf~ RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION' TOWNSHIP/~ LOT NO.: BLK. NO.: SUBDIVISION NAME: A '/ate /4 z8 /TzgNCR/g,for)W ir1A1N1D/V1.VA'1- ,S" CE.eT. sae vE Inov COUNTY: OWNER'S ftl- MME: MA N ADDRESS T ST C,2p/x 403 N 4 STEYEN CT . C 40 D /✓6.o F.qG Ls 'W'/ .sf OZ z ISE DATES OBSERVATIONS MADE NO. BEDRMS : COMMER AL DESCRIPTION: PROFIL P ONS: PERCOLATION TESTS: ®Residence 3 N/A ®New ❑RePlace I 8/2 7/ g/2 r7 ZATING: S= Site suitable for system Um Site unsuitable for system TE :ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMM HT~~N Q (Ptio 6'Q [gS au NS ❑U NS ❑u IEIS ®U OS Nu z¢'xsoI If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the ~1 under s.H63.09(5)(b), indicate: A114 Floodplain indicate Floodplain elevation: ~//y PA $E PROFILE DESCRIPTIONS 30RING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED ES IGHEST TO BEDROCK IF OBSERVED (S )E ABBRV. ON BACK.) B- / 96 9I 6 No A E 96 s4 B-n -a- - 3 6, Qn B- 2 96 9 6.5 Ald Al 0 X 96 4'1' 13-3 72 96 . S NO N E 7'72 3 6 ~ !fin B- ¢ e 9 9 9. IVO N 6 7 89 ,3"3 ,~c' • B- S /Od 98, 4 /NONE 7/DD B- PERCOLATION TESTS GLAss / TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT 2 2 P R PER INCH P. 2 ~S . 'V 0 314,14 3 / 3 2 P- .f Al a S Z 2 2 Z P- P- P- _ LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- )ntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent f land slope. /Y!y CG,2. N T.JJ 9,t. i3 0R/GiN qt ZIP 7- .r' ;YSTEM ELEVATION 4 G~-E~PNAT6 c:rouNO FDU^'a -A A ,2 - A.1 VAg 0.4? V 171 so 'e ~'a } P/. COLA7%D.f/ F~ Go AT/O - - ~l ~ I ~ .liP fG I Q E A i Al 9a _ _ - 99.3 Owner's name San. Permit No. H63.05 PLOT PLAN r Show: Location of building served UA Dosing chamber Septic tank Vertical/horizontal reference point Building sewer✓ System elevation is F-L 94•$U Effluent system t Yi Well Replacement system area r,A Property lines w/in 50' of system 1vA Distribution boxes Scale or dimensioned ivy Pump and controls: Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal.-per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: \ ~ ~P. L 1 UC 'a, 3 ~I ~ KRP Y IBYI++Z. ~~~P• 0 o c~ 96.90' 2 s3 eZ TT'--Th ~ I - 1 w ~L` r. -r> -Q I - - uS - I 8 O ~F Ll _ PU C I '~O 1 ~F ~~~v LA I (h I I _ • I I I ~ ~ ve-r~T .o ! r 3~ gw~tr~ ~"gyp ~ By the granting or approving of the above plan, or upon the event of a subsequent permit being issued,St,Croix County and the St.CroixCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or to installation. r.? P. „t.,r~s sif n. ure Limn., No. _LG rJVJ~J ET -S fJA NC CROSS SECTIDKJ OF A BED 5~3STEM_ t 1=1 N I S tt e"U~ Ex I ST~>Ll G N¢~ Z" OF AGGREGATE SOiI~ FILL r DISTRIBU•TIOU PIPE APPROVED SYIJTHETlc COVER - - - IAL OR 9" OF STRAW MATER 0 R MARSN HA.~3 `drp~ fop OFGGREGATE ELEV. OF °-I`E BO FEET FR!'~Z~7 Pii ~x DISTRIBUTIOIJ PIPE TO bE AT LEAST T~F{A1.] ,-i2Ei1.7CHE5 ~ OW FIAIAL GRA E AUD AT LEAST 20 I1JCHES BUT LIO MOR ` S3 t►JCHES MAYIM-Jt% DLP! H OF EXCAVATIOLI FROM ORIGIQAL GRADE. WILL BE Sa INCHES !'tlNlrAUM DEPTH DF EXCAVATIOIJ FROM ORIGIUAL GRADE WILL 6E 5161JED. p s vv LIGEUSC UWABER: Y s- STC - 104 AS BUILT SANITARY SYSTEM REPORT 1 r~ ~ OWNER jJ ADDRESS I G n ~~r ! a -e ~Pxc •f 1 SUBDIVISION / CSMj LOT SECTION --R R _T at N-R f~ W, Town of - knt1 fie' kihh 1 r ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WIT IN 100 FEET OF SYSTEM I~ro~ 0. N f 3 &Jwvn hA y CQ 1`C' " 7l~ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. u BENCHMARK: 2V, ~00, Q Top n ji- s/yec~,d:, Cvv~.~ ak t ALTERNATE BM: SEPTIC TANK / PBNP C~i4~t / *'~LB c~iG~ii~I€AR~!'~'IO~T Manufacturer Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length /DD Number of trenches o~ Distance & Direction to nearest prop. line: C J"fj Aker k Setback from: well: House 2 © 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: --kll t Sf~yl LICENSE NUMBER: INSPECTOR: 3/93:jt Wiscobsin 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 299111 Permit Holders Name: ❑ City ❑ Village Town of: State Plan ID No.: HALLING, BRIAN & SUE KINNICKINNIC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: / 1 022-1080-30-000 TANK INFORMATION ELEVATION DATA A9700430 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic moo Benchmark i ' U ys' /00 Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic >as ~.JO / X07 NA Dt Bottom Dosing NA Header/ Man. /a-y Lr 9/ yq' Aeration NA Dist. Pipe I Bot. System 3,90 .41 Holding PUMP/ SIPHON INFORMATION Final Grade Manufacturer emand Model Number GPM TDH Lift I Lrict' n System TDH Ft Head Forcemain Leng Did. f Dist. To Well SOIL ABSOR ION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SYSTEM TO P / L BLDG WELL LAKE /STREAM SETBACK INFORMATION TypeO CHAMBER Model Num er: System: ~O Id o ,(f & 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 r Bed /Trench Edges aV -d 4l ~ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC 28.28.18.P438D,W1/2,NW1/4 1116 PINERIDGE DR Plan revision required? ❑ Yes E31N o Use other side for additional information. p 6 SBD-6710 (R 05/91) Date n ctor's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ; SANITARY PERMIT NUMBER: Division SANITARY PERMIT APPLICATION 201eE. Wand ash nilgton Ave. `isconsin In accord with ILHR 83.05, Was. Adm. Code P.O. Box 7969 Department of Commerce 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. St Croix • See reverse side for instructions for completing this application State Sanitary Permit Number ❑ Check if revn to previous application The information you provide may be used by other government agency programs ` nt I [Privacy Law, s. 15.04 (1) (m)]. SQ "C State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name SVrope cation Brian Sue Hallin NW 1/4 1/4, 5 28 T 28 , N, R 18 R MW Property Owner' Mailing Address Lot Number Block Number 1116 Drive in _C idge 5 City, State zip code Phone Number Subdivision Name or CSM Number River Fal s WI 54022 (715) 425-8951 CSM VOL 5 Page 1488 II. TYPE F BUILDING: (check one) ❑ State Owned 1110 Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms -3 NTown of Kinnickinnic Pinerid e Drive III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo A9. a g - 19. P1810 022-1080-30 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. M Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System ________System_____________TankOnly______________ Existing System Exis--ting--System ❑ 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 ® 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) 91.5' Elevation 450 750 750 .6 92.0' Feet Feet VII. TANK Capacity in 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 0rA-t0# BXK 1000 1000 1 ( ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT t, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu ber's Signature: (No Stamps) MP/RNo.: 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 ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate slue Issuing A nt S ature ( Stam S) oved ❑Owner Given Initial Surcharge Fee) 1X Appr 110116 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber 1 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 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 curie; 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. Plo t l~~ 5C e lc I " 'y4 8r~an + Sue Hall,N~ f .4-~ ~l / r aa~~ 3 3r L I j ,l'rDI1A~@ Well I ~I ~xistrh~ ~rai~ ~c;'~ ~ ~Y/s~'1n~ I~OdO~a.( $F~C►'~,"c 7n<•~IE' M T c~~ o f ,Tn see c~ tf • mm `owUe4s NhML PLAN \41 E V) w ~Es~, c~ u c~~ ~w~tixs c,TS . o~s~a~~no~ pox ~Z.s~ s' y"t-VC ' we y„c-,sr tR.0w so~~~wt~~~ pE PEF2~UCZATE~ PIPE VIZ S~tPE w/ 6 MiN, APpRUV GRP 2.5 , T s CR,O SS ~ EC T~ 0 t~l °cnP i~OU~ C~rP A'r L93,lSr ZZ." /~$oU E r- W-1 S}} eb GR•.A DE Sp 1 L F! Lou Gt2.~ ~E E~. aZ.O t o ~~ER3~lG Ot ``5 Gfl , Q, c. au t ~L• PER.~Ut~kT~~ P' PE Tn_ auTTOrt oF.TtzEUCH 6voF'/z"TO zl/z?AGZ-RE-GM BEww ~~sTRiBvnov FVP'E 1 tvD z "_oF AGGREG&le ABOvE P t • P um r signature ricense o. a e WisconsinD'epartmentof Industry, SOIL AND SITE EVALUATION REPORT pap X of 3 L•_bor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code r.. COUNTY ' s`["• C%R-Ott 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 (EIM), dir ° of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to a da. > C!~ Z Z -1080--- 30 REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT FORTIOA` PROPERTY OWNER: MENtu PRO~ERp LOCATION RuD SUE ` gw 1/4 ' 1/4,S Za T Z-b N,R 18 E(o 111 PROPERTY OWNER':S MAILING ADDRESS ? „ ` s T # LOCK # SUBD. NAME OR CSM # 111 JtbJ( -l .L p6 p R.• u~ a r: ®Ix - csr-1 VuL, 5 t ~sg CITY, STATE ZIP CODE NUMBER,UUi~TV ❑C ILLAGE ®fOWN NEAREST ROAD T.tuez SUS W[ S'i oz-z ( ~IAr~1=Fl t~~Q.~-r-I/ut~j 1C ~l►~~~tD6F DR j New Construction Use Residential / Number [ ] AdditiQn to existing building JA Replacement [ ] Public or commercial describe Code derived daily flow qSo gpd Recommended design loading rate • S bed, gpd$ • trench, gp(W Absorption area required 011) 0 bed, ft2 S O trench, ft2 Maximum design loading rate s bed, gpd/ft2 • b trench, gpd1ft2 Recommended infiltration surface elevation(s) SF-k--- Qf< 6~ 3 ft (as referred to site plan benchmark) Additional design / site considerations Z-~1,J C=t(*qS , 'e~1-j S'#100 @vpt~ - Z. P?I- 1 S ~-l rti • R~ ~j . Parent material S'PNaZ)-f OUTUjh314 Flood plain elevation, if applicable >J - f~j . ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ZS ❑ U ®S ❑ U 0S ❑ U .@S ❑ U ❑ S NU ❑ S NU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. BW mrich tii i:_.yxn `plt tL Z CZ lS O S9 1 0.,S _ --1 k~~~'~v~'<~'>~~ Z s -31 ~o ti ~Z 3 !3 _ 1~s ~ ~sb1z ~ v `Fig e~, - • s - b Ground 31=~~ tiO~IR `!16 s3 J - • 5 b elev. 94.0 ft. Depth to limiting factor 6. Remarks: Boring # _ Z 6 -\E u 1 boo R 3 13 - 1`~ \ Sb1z rn U ea~stat:: w 3 t4b--73 ]0`zR Sll~ ~t C> Ground elev. ft. Depth to limiting factor ? 73` Remarks: TName:-Please Print Arthur L. We erer Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: rz// ; 91 ` 317 Date. ) C` _ CST Number 0 0 5 7 6 PROPERTYOWNER (C~-l_L10C. SOIL DESCRIPTION REPORT Page Z of ' PARCEL I.D.# 0 bD- 30 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw& rw > b-6 wo-t~. Z(z. - 1g a s •1 Z -~L S 10`-[ 3 !3 S 1 e- S~k m y CJ S 6 Ground 3 L) S 1S ti0 cjR V IL - ~-s d S5 elev. _u 19l 6, Oft. Depth to limiting factor Remarks: Boring # i i Ground elev. ft. Depth to limiting = factor Remarks: Boring # E:1 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of SCALE 1"= L R) ' p c~-E ` u*j O tvtn o,.I met s i WE OF - l I q F3 -z: _ -.)v Olt pct '1v PiL~p~.! X00' L~ s"rN OF ~TIZ@~J e~~s,- Sc~Cl.s 'f' N 8 021 ~v G ~ , Z Ar ~ 1`~'1~~ `T1`i't S P<M E _ }.~t'~P1fiz T 1°1Za~~L~Zr{ Love l.S ~ So" "OLIV OF `f'tLf.~CHE~ 5 o s_~ e a~ h trL y e F1 2 R 3 ~1 OL 571 e i 1j16 k o~NP,~b -t' ~ j ~P aF ~Sp~t~1pU PIPE . h" N Q Ud O r 9--) ' (715 ) 425-0169 M00576 CST Signature Date Signed Telephone No. CST # 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 Brian & Sue Halling residence located at: 1/4,W 1/4, 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? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /p00 Construction: Prefab Concrete Steel Other Manufacurer (if known): Age Noo fTank (if known) : o Paul C.J. Steiner (Signatur ) (Name) Please Print Master Plumber 6780 (Title) (License Number) October 14, 1997 (Date) Form to be completed by licensed plumber (s.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 inspection opening over outlet baffle). i Name Signatur ga'.PRS6 ! C?0 5/88 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ,t OWNER/BUYER C LC ~N MAILING ADDRESS I 1 ?1 M C, 1 DF~ PROPERTY ADDRESS ~AM (location of septic system) Please obtain from the Planning Dept. CITY/STATE R NG-t L FN U S nl W NW / Z PROPERTY LOCATION 1/4, ✓`t W 1/4, Section e--O , T D N-R~W TOWN OF K h Lti ST. CROIX COUNTY, WI SUBDIVISION CS G- 1 4~9 LOT NUMBER t CERTIFIEDSURVEY MAP , VOLUME , PAGE LOT NUMBER C 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 canaffect 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 expiration d e. SIGNED: DATE: 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 T C - 100 This application form is to be completed in full an owner(s) of the property being developed. d signed b only result in delays of the Y Y the development be perm it issuance adequacies will house intended for resale b Should this then a second form should be r tainedr and completed (Spec the property is sold and submitted to this office with the appropriate deed recording, when Owner of property Location of property vv 1/4 N Township 6 j m N I C l~ N! GW 1~4 , Section N_RW Mailing address j 11 Q ~E u W- i 5 40-7- Address of site Subdivision name (25/v% Other homes on property? Lot no. Previous o Yes No weer of propertyC G Total size of property S04 e4c Total size of parcel Date parcel was created i I I Z ~9 Are all corners and lot lines identifiable? Is this propert Yes No y being developed for (spec house) ? Yes Volume and Page N o umber _ZJ as recorded with the Register of-Deeds------------------- INCLUDE WITH THIS APPLICATION THE FOLLOW A WARRANTY DEED which includes a DO ING: NUMBER AND THE SEAL OF THE CiJMENT NUMBER, VOLUME AND PAGE certified survey REGISTER OF DEEDS. 'rev if available In addition, a delays of the would be helpful so as to avoid references to iewing process. a Certified Survey If the deed description shall also be required. Y Map, the Certified Survey Map PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this best of my form (our) knowledge that I are true to the property described in this (We) am (are) the owner(s) of the information deed recorded in the ofce lof the Count Deeds by virtue of a as Document No. 4y, 6 6 y Register of own the proposed site f , and that I obtained an easement to the sewage disposal system ) presently run the above des gibed construction of said system (we) the office of and the same has be Property' for the the County Register of duly recorded in D s- as Doc" en No. gnature of licant pplicant to ? Date 0 Signature 1-7 If -7 397 708 CERTIFIED SURVEY MAP LOCATED IN THE NW1 /4 OF THE NW1 /4.AND THE SW1 /4 OF THE NW1 /4 OF SECTION 28, T28N, R18W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN NW CORNER SECTION 28 g ! 9~ _ Dili T28N, R18W n l o_ ~ O °LM FILED n N OV 121984 I I U N P L A T T E D' L A' ND S JAMS G' CONKELL ~ I I - Rop4brof Deeds I _ S 8 9019' 2 9" E 1321.80' 84 Gola coon , wbowsla 16 1 E ~ L.OT _3_ i I i ~QZ/ 10T _4_ I L I W) ~ pR VATF~ v~ T ZI IO zi POINT OF W zl QI zl~ I 4;P5 BEGINNING` I ¢1 i u. L.OI O I ~i w ~4p- h/ 88047'20"E 570.07' I w I Io LOT 5 w w l 5.04 Acres ± i~ H I I- l w I M 219,471 S. F. ± K, I- I QI I~ I ID Ln O Q I I In LOT _3._ ( z N n -j I lJ )w n- I I I F- °I ~I % S88047120"W 166 R 50,7.76' I I ` =89' / I r NORTH LINE OF I W1 /4 CORNER LOT 3 W 'co SECTION 28 T28N, R18W LOT-3-CERTIFIED SURVEY MAP y~ `"Q' 0 M RECORDED IN-VOL.-2, PAGE 345 LEGEND 0 1"x24" IRON PIPE, SET, WEIGHING •1.68#/LINEAL FOOT. z • 1" IRON PIPE, FOUND. 0 1 1/4" IRON PIPE, FOUND. w EXISTING FENCE.. ° f g d Qgt~T a2Bj S aumToA •asuadXO oiTgnd u aq pTnoM aa~~uaaag~ s;soo aouuua'.uiuw 'puoa OTTgnd u su /4itsdT3Tunuc u Aq .nano uaxul aq APAtpuoa aZLIATad age. pTnotE •saouxo AzaadoadSut:utoCpu age. dq uiua-oad paaugs aq TTugs °puoa paupimis u su ao4ua4sTurutpy ButuoZ age. Aq Zuaoaddu szT aa:lg:u 'Aumpuoa a:.uAiad atlz jo s:.soo aouuua;u vm Auy •ArApuoa aIvATad u ST dau sits. uo umogs A-empuoa aqL :ZLON Ai„ZZ, 9ToTSN Ai,,0h ZToTN ,ZV & 20,OS M„T£ & VTo9ZN & OL' L9 , 06' 69 , 00' 08 - V-S AI, LSAN Al sZZ 19I,TSN ,ZZ 16ToOS M„TVa 9Oo9ZN i ZS' ZV i T6' £ti i 00' OS - £-V Al„ZZ,6VoTZN At,LSAN „ZZ,ZSoOZ M„TTs£ZoTTN ,L£'96 106'96 100'99Z - T-Z SNIUvaq SNR M a'I9Nd 9NIUVUff I IDNa'I HIDNq'I HLONg'I 'ON ON J.NH9NVJ, QNZ -LNa9NV-L .LST TVUNaO CWHO CrdOHO Duv SflIM . .LOZ 3AUM allgv.L viva Mflo ,~~,1•~t~~,~~ 41or~+ ZZOVS utsuoosiM `sTTu3 aanig -Sim 4aaaIS .q;V 'N £Oti _ 's-neJaMd ppnO *1 TTUD `3 '9 Uana4S = NOS MS Ida(HAR gfIS QNV 21aNM0 'ts~wtrr 01 y4 utsuooSTM `sTTu3 aaAid Z09.149 u'Ta '9 £ZT 'oO 2uzaQ0UT2U9 u6p2O 01VT-V *ON or Z8ti -S uosums •Z satuu ' V86T TZ 4sn.?ny 9:1 LC[ •aouuUtpaO BUTUOZ AjunoO xioaO *IS aq4..To gV•S UOT400S puu sa;nzuaS ursUO:)ST t age. -70 ti£'•9£Z UOT309S Jo SUOTSTAoad aq4 gZTm paTTduuoo ATTnj aAVq I zugI pup :.oaaaoo aau dvtu puu- UOTzdiaosap GAoqu 943 zvg2 A;T41ao I • ssaT ao aaotu zaad aaunbS TLV`6TZ 2UTaq `ssaT ao a.aotu °saa0y.V0•S SUTVZuoo Taoard STt{,L • 2UTUUT2aq j:o 4UTod oil; off. , LO' 0LS S„OZ & LVo88N aouagZ ` , L£' 96 M„TT,£ZoTTN sauaq paogo asogM ATIOZ90M aAUOUOO anano snipua 00.99Z u 9 ..nrv nc - nc AYTnTr-1 Tn,.r a^►TrarrI 4 .izc*cn7 m. is - nKi anuaus ' .7S•7b M..Tt.Qn-Q79 iJt+lEN7 NA. 13TAT BAP ODD WISCONSIN lK3IiS! 1-- tiM twa vacs aeaam, m r+aa - - MOSMwO aMTa WARRAWN DEED D made between Ge r r i A . .La r s o n.: $T, CRfJi7C COL, nglvoman Reed for %C a to _ a DEC 0 5 M . and . . R...Y......Flaii i . I)g-. . An . se. . . . , Grantor, $:50 .S.us&n..A....Ha.ll.ing.........._.• 2? mar.it.al...prape.r.ty_........... a ai anti Grsntae, `rilitnesseth, That the said Grantor, for a valuable consideration...... - conveys to Grantee the following described real estate in $L CTQ,1X. - i '~"~TO a County, State of Wisconsin: ;mss ~ iSt Taz Parcel No:...___ I Lot Five M of Certified Survey Map, Volume S, Page 1488, II Document Number 397708, being part of the AMI/4 of the I NW114 and the SW1/4 of the NW1/4 of Section 28, Township 28 North, Range 18 West. i I~ Ij !I I I s I, This .....is x homestead property. j I II Together with all and sin lar the hereditaments and appurtenances thereunto belonging; II And......... Gerri_-A. ars.....on warrants that the title is good. indefeasible in fee simple and free and dear of encumbrances except municipal and zoning ordinances, easement for public utilities, ~j and building restrictions of record, I! and will warrant and defend the same. I, th ! Dated this ..............2 9. day of No tuber is9O-•• ....................................................................(SEAL) . __(SEAL) ~I I ~.e.r.r.i . . . AA...-..La s..n . - - .............o... I (SEAL) - (SEAL) AUTHENTICATION ACHNOWLSDGMUNT ~I I~ signature (a) • STATE OF WISCONSIN S t . Cro i x .....................................County I authenticated this ........day of 19...... Personally came before me this a:'th day of NO November 90 L ar-. ar . s o n 19_. the above named Ge r r A . ii6Eii STATE BAR OF WISCONSIN -