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Home My WebLink About040-1159-90-000 ^ v C) 4 0 3 o o C) o ~ c o a ~ ~ rn r.. a) o O ~ I N N o6 E 00 CD 0 c w rn N O y a o E m 0 m > N p co o c y N > GY fl. O L n O U `O 'v7 O) a- E Z (D c C Q 0 D "6 d C Z O O O N 7 Z N 7 c 3: c O LL O CN Co c .L.. E ¢~~3E 0 Z w O w E z 0 v z d m 00 a m N I- U) C C7 O 2 d O N m Z c fA F- r O a5 c E ~ E N N 0 (6 N O N o C N CL 1 O U) -C m ® Z m z O N o N Z O LO (D 3 m E 5 -0 vi d a L a ;g y (n LL C 0 a S1 O ~ C E fn fn fn D *•i' 0 0 0 •*Awl a a a a ❑ N N U > (D 0) 0) Zrri c 10 C -0 } C) 00 00 M O O O N d .L.. N N (D Q m m ¢ ❑ 7 C O Y O T C _U -0 t= CC Oi m ❑ t O W O O o 0 o" O N O N E N C a 0 0 N N y. CD 3 ~ N E 'O O O O • yr,' O N LO > Co 0 ~i N T CW 7 0 ~ L F- N O N Z U1 4 `a w tC ~ a t a_ a > • R a d U N y C E cio "~1 A U a 2 0 N UO ~ s STC - 104 AS BUILT SANITARY SYSTEM REPORT ~Y CIO p OWNER Dick & Ruth Van Keuren VEV Ln ADDRESS 273 Plainview Drive 5T CFGIk River Falls, WI 54022 2o/v SCE G SUBDIVISION / CSM# LOT # SECTION 25 T 28 N-R 20 W, Town of Troy ST. CROIX COUNTY, WISCONSIN bLly0 ~S I -10 --6b Jl as ag ~a ~`~g PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM hook rx • 0o ej, $Cytlc~n C.v• 00 I I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Wk BENCHMARK: on Spike 1' above Ground in Power Pole ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W ; Liquid Capacity: 1000 Gallon Setback from: Welly 100' House > 100' Other Dog Taining Bldg 12' Pump: Manufacturer None Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: 19 Length 30 Number of trenches 1 Distance & Direction to nearest prop. line: 27' East of West Property Line Setback from: well:' 100' House 100' Other Dog Training Bldg 150' 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: August 19, 1997 PLUMBER ON JOB: Z~~j qj4fft~~ LICENSE NUMBER: # X80 INSPECTOR: Marv Jenkins 3/93:jt yV5isconsin Department of Commerce PRIVATE SEWAGE SYSTEM ountkg CROIX `fery and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita . Personal information you provice may be used for secondary purposes [Privacy L3Lw, S.15.04 (1)(m)]. Permit Holder's Name: village Town of: State Plan ID No.: VAN KEUREN, RUTH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel l0 00'J TANK INFORMATION ELEVATION DATA TYPE `M, A,NUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark i 0: Dosing ' Aeration Bldg. Sewer Holding St/ Ht Inlet o TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet - Ar I Septic / y r / NA Dt Bottom L) o Dosing NA Header / Man. Q, Aeration NA Dist. Pipe ;3 ~J Holding Bot. System - 9~ JC i a PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand _ , Model Number GPM A"ss Lriction System TDH Ft TDH Lift Head Forcemain ength Dia. Dist.Towell SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of TJ~nches PIT No. Of Pits Inside Liquid Depth DIMENSIONS ' / DIMNI N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION -Type Of CHAMBER model Number: System: -f1 a7 /LQ U 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 w Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 25.28.20.623B,SW,1M 273 PLAINVIEW DRIVE Q ,C y1,t//~,c rC~u ,,}E^! Plan revision required? ❑ Yes ❑ No 3 Use other side for additional information. SBD 6710 (R.3/97) Date I s ctor's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH T SANITARY PERMIT NUMBER: Safety and Buildings Division NVisconsin SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, Wis. 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 1/2 x 11 inches in size. St. Croix • See reverse side for instructions for completing this application State Sanitary Permit Number I ~'94~~V The information you provide may be used by other government agency programs ❑ Check if revlslon to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION -5 77 -6 1 6~0 Property Owner Name Property Location Ruth Van Keuren SW 1/4 NE 1/4, S 25 T 28 , N, R 20 IXNdW Property Owner's Mailing Address Lot Number Block Number 273 Plainview - City, State Zip Code Phone Number Subdivision Name or CSM Number River Falls WI 54022 ( ) II. TYPE BUILDING: (check one) ❑ State Owned Nearest Road /I Public 1 or 2 Family Dwelling - No. of bedrooms Town OF Trog /W/h 1/ jr ~III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo O L16 ^ J 117 - 10 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-E] Service Station Car Wash. 5 E] Hotel/Motel 9 E] Office/Factory 13421 Other: specify /'a 150 IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ZK New 2. ❑ 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 Al ❑ Holding Tank 12E] Seepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43E] 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 J' F eet /00, ;Feet l VII. TANK Ca a Ions Total # of Prefab. Site Fiber- Exper. INFORMATION in g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank ooefto /a0,0 We -re 19 ❑ 0 ❑ 1:1 ❑ Lifit Pum -4-- PA 10 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans- Plumber's Name: (Print) k7j Sign tur :(No Stamps) MROMPRSW No.: Business Phone Number: c~ Ste e 6 zn 7~,~y~ - P ber's Ac dress (Street, City, State, Zip Code): ` S uj-t '4-O& Z IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (includes Groundwater ate Issued Issuing Age Sig a No am surcharge Fee) Approved ❑ Owner Given initial Q~I Adverse Determination U(/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBp-6398(R f f/96) DISTRIBUTION: Original 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. i 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. Ill. 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. Vlll. 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 a -)d 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. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations June 2, 1997 201 East Washington Avenue P. O. Box 7959 Madison WI 53707 WEGERER SOIL TESTING 421 11 MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE:: PLAN S97-01690 FEE RECEIVED: 110.00 VAN KEUREN, RUTH / DICK NW, NE,25,28,2O TOWN OF TROY :COUNTY OF ST CRCI7 NON-PRESSURIZED IN-GROUND wY' TFA-1 The Department has reVj._swed the abc.,,,e-refex:eiic•x_d sus:,:iu,tt.al. rya i *i i a.pp_r_i,;a1 is herebj r_ r ariatehd for the= plan Submittal. All S 1. t'.1i4 , LAlit t. .>}e'. TIl Of the ~+-"stein is based t.' and i> " «:1 chaptex a.45, Wisconsin Statut<~.;, and chapter C'omitz 83' and 84, V;isc,~iisln .it nc i1.1.5t x: Y1\JE code and i s costart a ~~nt upon contr..;a x,=s37ce w:i t h ctI1y ! tip Iat1 -T;s tox.-7n on t ie p1a23 . syz;te ui::> .no- been zc-riewed for the erode requirements set forth in chaptez Comm 82 or in chapters ILHR 50-64, T4isconsin Administrative. Code. This play submittal approval will e.;pire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the ina.t.:,.al sanitary permit expires. The licensed plumber responsible for thine installation, s ;all keep one set of plans with' the De attmn~nt.' s stamp of At _ tt 'L V~7G'l i. cy -L3ic LV1t :a T.. "TI Q. iii Fi. ai lE.".i ~.-..;X 1. 7_1 1; 3t ~ li'_ c~ i. i. ._c. insAectcr when 1 nsp,-x_-t1on. cap, bC-- lllaCle -11 permits required by the City. Il.a~e, taoarlSh ..p c.r C'0113)t? 511;Fia i-.:- obtained prior to installation. Inq:uiziz . shoiuld he dixc.,::ted to at/~ z t. the Iltltti.i. ez listed below. pleL :i::#_; el ,c the plan ntLmbeL ~i:hoN-.,n abo-r« . sincerely, kt.A Q-- 4 D.UalAe st.el.QeL Wastewater Specialist sr Section of Private Sewage (608) 355-3159 3332R/ 1 ssn.rwr ~x. oiraii► ` CONVENTIONAL. SCIL ABSORPTION SYSTEM FOR. Page 1 of LOCATED IN THE M"*31/4 OF. THE "e 1/4 OF SECTION zS,TZB N, R ! W, TOWN OF ---,d l( , ST• C.tZA tX COUNTY, WISCONSIN _ RECEIVED MAy30;07 INDEX SRF & BLDGS• DN. Page 1 of 4 TITLE SHEET Page 2 of 4 PROJECT DATA Page 3 of 4 PLOT PLAN Pape 4 of 4 PLAN VIEW-CROSS SECTION sO~~9O PREPARED FOR Z~ 3 PLPct N V_~ EW p~ . - N~~ea e PREPARED BY jr ARTKA L L~IEGEF~ER SQ = L TEST I hIG ~ i AND DES I (3m SEF~ V I CE "'F*, kw%S I ~ ~0► F_U_ IM 74 421 K. KAiI( ST_ 1wN _ RIM Fx1S_ III 54021 S _ 28 -~7 715-425-4165 Jos NO. 9~-67 PROJECT DATA Page 2 of i This conventional bed will serve_a building used as a dog training facility. Dog owners will be instructed in training procedures. A maximum of 20 persons per day is anticipated with the owner as instructor. A bathroom will be provided. Anticipated wastewater outdoor sports facility- 5 gpd X 20 persons = 100 gpd Employee (owner)- 20 gpd X 1 = 20 gpd Total = 120 gpd 120 - .5 loading rate = 240 sq.ft. of absorption area req'd. A 12' by 30' bed will be.installed providing 360 sq.ft. allowing up to 180 gpd. t oo Septic Tank ►7 180 + 750 = 930 gal. minimum capacity required A 1000 gallon precast concrete septic tank by Wieser Concrete Products will be installed. 'w AGO i o 3 y' _ Page of. PLOT PLAN SCALE V'= L4;3 ' FUucp . ~,ioT ~~R.oPt IL~ LINE H °f,?. S E B. B.Z. ~ ~z - - X3.0' of y•pv C 9.5 I y''auc ?s°lo ~7~ c- Thy-- gnO o' ow ~ 'm - Vat- too. QY ``v spy ~ou~ P ~ Nt. .Ar jam` .J S97-01690, QQ- (t O GC7 cJ Oc`cQ~ ~~Gi~' - P~-~Miuv~~l vR~. ~c.Z M~ l + j DF'Li~tJO`''tL N~ c,Ro S S sez-~n Illy • ~s`nwc wo s / LoCiY Of ,3 Sls,..TMW ✓ / _X60' ti5old L~ ~o NUM .~-Q48 S o, CL 40 ~ G~~ S\'~ X . C ~-.~vsC' t~fRt:`k_Ski'~hMs.~~'BO~.-~_~L?4ulO~S._Zos/o PV.oP~R'ry Uk/~• 5~t w~Z1Y1~ '2A' OF Bpi , . . 30 3~4 Y QEt~.FoR A'T~ Qv C. ~ V r,.aT , O\ST'R19V 0 "P!P 6 12~ T1 i.1 E O CRC-) SEc-F1 C) /\J y I Nfo T Pipe w/ NPpR.ove''D CHP----- --AT L" ST :IV ABOVE7 ~7~13t~Ep -GRADE -r► FAN\slt~ + ~~1t.~_ ~(Z.f~Ax1FIVF'1 -zu" MlN1hv►~. SO L. J o V p 0 ~+j G a a O A~ PRUVEO S~1J'1HE77Z b ~ c~ O ~ cOv t,aaAL. UU D o C G u O oL o6 cam`( , r u JJ V u u C GV fr S ~f L y ~ I s P ER FoRq'~D.. W'~,' G /~AovE P1r S - \~'j`R;v4oV Pw.o 5 Wison n Department Industry, SOIL AND S IT-E-- AU ATI ON REPORT Page. N - of- Labbr Division of Safety & Buildings in a "with ILl I "t/ s. Adm. Code • ~ r COUNTY a1:j00 ►1N9z ST- C"UC Attach complete site plan on paper not less than x 1 i inga" ze. Pla include, but not limited to vertical and horizontal reference i M), direr % of sloes a or PARCEL I.D. # dimensioned, north arrow, and location and d nc to n fF6, a~$ r. r r rn O- ~ l C'4 - so ° i REVIEWED BY DATE APPLICANT INFORMATION-PLEASE P ALL INFORMATION PROPERTY OWNER: .;i P TY LOCATION Rv`S1} D Ck V f l~j . C Z iJ W 1/4W 1/4,S LS T Z$ N,R ZO E (or~ PROPERTY OWNER':S MAILING ADDRESS /1 " 6 T # BLOCK # SUBD. NAME OR CSM # 'Z~3 ~LI~11JV1 'M- CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD Rtv FYCuS,"J1 S ou (~ls)4ZS_~«lo T1Z~ ~?~P,►uvt ► bR• Q~ New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building t 1V 1 N G t=- el l~'`•( j ] Replacement 14 Public or commercial describe bob -M%! ~tT, LGN -Cede deavwd daily flow 1 S O gpd Recommended design loading rate • S bed, glxW ' b trench, gp(W Absorption area required 36o bed, ft2 3r33 trench, ft2 Maximum design loading rate • 5 bed, gpd/Q2 L trench, gpd/ft2 Recommended infiltration surge elevation(s) 6116-S It (as referred to site plan benchmark) Additional design/ site considerations RR, . Mr-l evD $i~Z . C- Sim N0 aru ?"e 3) Parent material s r° ' I ouTwR3 N Flood plain elevation, H applicable t-j- A- ft S =Suitable for system cOwamoNAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FU HOLDING TANK U = Unsuitable fors stem ®S ❑ U 9S ❑ U ER S ❑ U N IS ❑ U ®S ❑ U ❑ S NIU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistiertce Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 a -'1 lwiv- 1/1 - %l 1 z.'Fs'b 1k Wh' oa-S - , S 6 Z 7-t1 1V `!2 S t~ Z.'~gbk yvt`fj. CS 5 6 Ground 3 n -2'I R V/G )~-S N CSbk Yn U'Ft- C-S • S • L elev. - S • 6 trab3It 3)-S2 10 Litz .S/y ~S O 169 W1~ cS Depth to 5 SZ _7 O l U y 1Z V/y - S C~ s g >h I - s- 8 limiting factor Remarks: Boring # ) o_ 10 ~p ~Z 313 - s 1 ~ zi- b k wt fl- g. S _ . S Z Z 1b Z3 10 `ftZ-3~L ~ Sl] Z'FS~k cS - 'S 3 23 -qz ,-SvR Y/6 - 1'~s lcS\v>k w►v~1- c-S _ • . 6 Ground elev. I y 4z--)o toY e s/y _ ~S in S w► t S , S ' . L Depth to limiting factor o' Remarks: TName:-PIssePrint Arthur L. We erer Phone: 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signahue: , Date CST Number: °1~-67 S _Zk, -``l-1 M00576 PROPERTYOWNER ViqQ- \(~-Ey`Z-ESN SOIL DESCRIPTION REPORT Page Za f 3 PARCEL IM4 0140- 11S9 -SCE i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends o-\Z Iti-ty- stk Z`F31 Y►'t ft- 0.,S .S 3 ~.x Z rzz6 tiotilZ 316 - si 1 Z~ sbk yr,`Fti cs - . S ,6 Ground 3 -~l 1 l. S Y R O L - S I C s b1t N7 V'~1- Q% S elev. tos.o ft. 41-8 6 ► e `t rz sly `Fg v S g w1 S L Depth to limiting factor Remarks: Boring # 0- t? lD`-112. 3/.j - SL ~ Z~Sb Y►'1`rr- ~l. s ~ • S y Z \Z-2S lOY2 3/b 8t) Z`FS blt h~`Fb C-S - S •b 3 zs-3S ~.SyR y/ Ground ` - , T S 1 ~S ~k lrnV`F\. C S S' - elev. tF 3s =ei ) o Y S/y g O s 9 lnr► - - S L ~oy.oft. Depth to limiting fact~$" . Remarks: Boring # o-f3 l0`i lL 3 3 s t Z~PSbI~ w~`~~ a, g -S 5 Z 8-~ \o `t IZ SIG ~ s i 1 Z.`~Sdh rn`E~►. cS - . S 6 r Ground 3 3 S `1R y/6 1 \ ~~~~>t YY) U`~ - cS S elev. 31-S y 10`112 S1 - T S S) H'1, c g , S , 1oz.$ ft. Depth to S Sy-9 Z )O YR Y/y - g s9 W1 - -1 ` . limiting factor l L I Remarks: Boring # .13 Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of 3 r SCALE 1"= 4q, ' ~.ioT ~~RoP~R1'1 LINE- kaR-SE S.Z B.3 ~ d0 2S°fo a )J B►"1- v'L too. o, 0" La SP1k L %I %tou 6RAVNp Ih p~ ~~k1 OR, Z- 'Tb I/ DRiUt s a~~ / l ociYilu►J S h-.N 6~sTw c tz~- tub °ro NO CL 90 ~ G~ D S\~ x _.5ft±yi =-~C53"_N1Qti10~s~o pO.c~t~ ~`It,`ry l,l hl~ (715 ) 495-011515 M00576 CST Signature Date Sign Telephone No. CST # Wisconsin Deparhnent of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Hwnan Relations liyision 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 ST- C:2Q rot limited to vertical and horizontal reference point (B", direction and % of slope, scale or PARCEL ID. # dimensioned, north arrow, and location and distance to nearest road. O ItO - ~ l S 9 - so APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: - PROPERTY LOCATION ~R V`~NA UhK3 QNJ\ZE'N eeW tOT NW 1/4 Wt 1/4,S1S T 2-6 N,R ZO E(or)Q PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # Z~3 1~LFl'INut~ ~DSZ. - CITY, STATE ZIP CODE PHONE NUMBER OCITY []VILLAGE MOWN NEAREST ROAD Rtuvm Fm--s,kjl Sg0Zz- ()Is)4ZS%Iz x'20 ?~fllaJvt ► ~lZ• Qd New Construction Use [ I Residential / Number of bedrooms [ I Adr Qr to existing building j I Replacement Public or commercial describe bob '~(Z ~At N 1 w Gcl tl `f DCTa LAN 4ede derarad daily flow too gpd Recommended design loading rate • S bed, gpdfft2 trench, 9pdA12 Absorption area required 31bo bed, ft2 aM trench, 1`12 Maximum design loading rate 5 bed, gp ''6 trench, 9pd/ft2 Recommended infiltration surface elevation(s) `113- S It (as referred to site plan benchmark) Additional design/ site considerations V4, MM ekjb 1 X 30 . C S ZIE~ "t1`Irc 07,i Qlts G' B~ Parent material s Ark_"oy ouTwtfs 14 Flood plain elevation, if applicable >ti- A- ft S = Suitable for system cmVEI•fIlao MOUND IN-GROUND PRESSURE AT-GRADE SYSTEId IN Ril HOLDING TANK U= Unsuitable for system ®S ❑ U 0S ❑ U ® S ❑ U. I II S❑ U Ns ❑ U ❑ S MU 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. Bed rt & l 0-1 1oHR all aS - . S 6 Z -t~ lu ye - s i 1 Z'~s bk Wt` cs . S L Ground 3 t~-31 ~•S`7R V/6 l~s 1 CSb1 mu`fi- cS S • L elev. . S , ~oo•3ft 3)-S2 IC`i2 S/y ~g d a9 M11 cS Depth to 5 S`Z 7 0 l U y R y/y - S G s 9 h1 I limiting facto Boring # Remarks: p_!p lo•.t2 313 - S1 ~ Z'FSbk ht~• cL.g • S ' b Z Z 1b Z-3 10 `i tz 3A S11 Z `FS k wf cS • S 3 i3-u2 s yR S(!6 - l~s 1 csbk w►v'E1- C-S Ground _ • s 6 elev. y ~ci ~n ~o~re s/y ~s c~ s w►1 cg - , S . L too•b~ Depth tD inciting for Remarks: TNa+ne-Please Print Arthur L. We ever Phone: 715-425-0165 eg rer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Sinn um 01-)_( 7 Date: S -cl-7 CST N . c5 76 PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2--of 3 PARCEL I.D. # 0413- l l S9 - SO i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxxby Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench } O-\L lD`~~Z jL~ ~ Sly Z`~3b1~ yrr`Fb• a-S -•S .l„ Z hz Z6 h.~ `1 ~Z X16 - s i) Z~ Sbh ~'F~- c s - , g , 6 Ground -YI 1.SYR y/(~ - ~~g lcsbk YN7vf1- CS S elev. IOS.o ft. 4h$b 1b7R Sly ~S v 3aj Yh~ - • S L Depth to ` limiting factor ? 86 Remarks: Boring # o-t: i~ytiZ 31~ - st ~ Z~sb' Yn`Fi- a.s .S I • 6 y Z \Z-ZS toy 2 3/6 s i t -Z`~S cs • s Ground 3 Z.S-3S `)-S `yR y/` - TS 1 C-S Ult lrnV`F1• C S • S 1 - elev. cE 3S ) o Y rT~ S/v hoy.oft. `~-g Ogg lnn 1 _ •S ; ~ L Depth to € limiting f~t88,~ i E i Remarks: Boring # 0-8 l0`t lL 3 - s l Z.'Psb~ vrt`F~ a, s . S ' El Z 8--~ ~ o `t tZ ~1 G s i I 2,`~' Sbh tin`(~t. cS - . S~, 6 Ground 3 3 s yR y/6 ~s ~~1~1t vn Uir- ~S • s l ; elev. ft. 31--Sy l 0`112 S1 Yvt, cg • S ; , 102.8 Depth to S Sy-9 z )O YR Y/y - s 0 39 WI } - .1 j a limiting i f Ztpat e% i Remarks: Boring # i E Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) _ PLOT PLAN Page 3 of 3 SCALE 1"= yp ' ~ioT \~RoP ~ry LINE ^ \-ialtsE 1 S!'t~-1~R 8 .l B ,3 4' C 8.s I . 30 ~ s". I ( A``'te / / / zs ale 8P1- EL. loo.o' ow SP1k %1 g3sue 6R.ovn~ IN Pa.i Via, L.1,1. h1 Pk-M ruv mew uR_ jO b%UU@R ~uu~ F-o ~v 6~1T~ c C\ to 0 5 a.,~ / loCin\p~ S k.+l. N RIDE ~ . cL g0 T-rv SCTti 7` Gov a 16~`Z- Oslo PRoP~`It,'r( Uk)e 1 . 9~-67 'q s - (715 ) - x40576 CST Signature Date Signed Telephone No. CST# 1 K STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNI:[Z/I3UYER < < z ( ~~/l / MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE C14e~ex 115t AS /~fl / t ~ Y ~Z Z PROPERTY LOCATION S( 1/4, _AZE_ 1/4, Sections N-1Z W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION L OT NUMBER CERTIFIEDSUIZVEY MAP yv , VOLUME , PAGE , L.OT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 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 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 UWe, the undersigned have read the above requirements and agree to maintain the private scwagc 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 77 St. Croix County Zoning Office Gover nnient Center 1101 Carmichael Road I lmkon, WI 54016 t t /'1 ~ 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 _ Ju-- -4 e, /.x Urn/ Location of property _560 1/41/4 , Section oZ$- , T 2 k N-R a C) W Township Mailing address Address of site subdivision name Lot no. Other homes on property? -Yes_ __X No Previous owner of property 0/12' Si¢~fiyo mar/ Total size of property 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 k_No Volume ,9,71 and Page Number - 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. Signature of Applicant Co-Applicant Date of Signature Date of Signature DOCUMENT NO. I WARRANTY DEED THIS !PACE RCtCRYCO 'OR RCCORDINO DATA 4ZSi~3 STATE BAR OF WISCONSIN FORM 2-1988 i1 - - - L - --NCI [ / /PAGE 45 i ReGISTERS OFFICE - - ST. CROIX CO., WM John; J, Salmon, ask/a. John Salmon and 11 Rac'd, fvr Record Ihls ! Harriet J. Salmon, husban- an wi _e as joint I 1.L_ I°r of M~ a,.~..~._A. D. 19t 7 of 8:30 ` conveys and warrants to QiCIS........V.dl~...Ke.ux.0...nd................... ..Rut k....Van..Keuren-,...husband..and..wife-, i I _ . RRIVER FALLS STATE-BANK YTS' SECOND ST. the in - --RIVER FALLS, WI - follow ing dacti.escrib..-~ rea l s --•-tate ......$.r...Cl - Q - County, State of Wisconsin: r Tax Parcel No: A parcel of land located inthe Southwest Quarter (SW:) of the i Northeast Quarter (NEB) of Section Twenty-five (25), Township Twenty-eight (28) North, Range Twenty (20) West, Town of Troy, St. Croix County, Wisconsin, more fully described as the North 345 feet of the West 647.8 feet, except the West 16 1/2 feet thereof. I Said parcel containing five (5) acres. Together with the use of the present roadway from the above described real estate to the public highway until such time as a public road gives access to any part of the land herein above described. ~i AND, A parcel of land described as follows: The South 250 feet of the West 647.8 feet of the NW; of the NE; of Section 25, Township 28 North, Range 20 West, Town of Troy. This Deed is given in satisfaction of those two certain land contracts dated April 27, 1967 which was recorded April 27, 1967 in Volume 432, Pages 167 and 168, as Document Number 288051 and that land contract dated October 17, 1969 which was recorded November 28, 1969 in Volume i 457, Pages 328 and 329, as Document 298847, both recorded at the i. Register of Deeds office for St. Croix County, Wisconsin. s This is n .....t.......... homestead property. (is) (in not) li ' Exception to warranties: Subject to easements, reservations and restrictions of record 1, ~tv Dated this . 1~ Ct o day of . j..............................._... , 19....87 • I (SEAL) (SEAL) li • _ OH ;k.. ..SALMO i ....(SEAL) I; .(SEAL) • . HARRIET J. SALMON i~ ADTHBNTICATION ACSNOWLBDOMBNT Signature (s) STATE OF WISCONSIN ii ss. 1r1 authenticated this ...day o County. f.-- 19.----- day of y . Personally came before me this 19-------- the above named 777```-? T-............---..-...TTT • /je ti u STC ^ ! 4 TITLE: EMBER STATE BAR OF WIS ONS[N (If not . authorized by 4 706.06. Wis. Stats.) to me known to be the person who executed the 1 V 1 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER _ 1101 Carmich - Hudson, i _7 -V (71 -46680- SEPTIC INSPECTION / WATER TEST REQUES ORM `Pr Please specify desired test(s) & remit appr sr ` fate r Y with,.../ application. Outside water lines are often t duri winter months, making access to the home necessa Pleas J- arrangements with this office to insure that entry r~C L 0 Water (VOC's) $185.00 0 Septic $50.00 LT Water (Nitrate & Bacteria) 45.00 0 Nitrate & Bacteria 0 Water (Lead Concentration) 21.00 retest $15.00 Owner: 1~,c l/,a,,, E,, P iv Requested by: _,P/c /,f tl, A:21r~, Address: Ae Address: ZIP,SIVozz ZIP Telephone W_: (/s) yes- _~i yU Telephone PVot%*.rtY a4ftm . (Fix* r et - ' Locate: VAU-NW1. R.41-42"Y' TO Realty firm: Lock Box Combo: Closing Date, 1 TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON Water sample tap location: ac \ Is the dwelling currently occupied? 3 Yes No If vacant, date last occupied: Age of septic system: 71/4 Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? OY ~PN Slow drainage from house. OY ION Sewage Back-up into dwelling. OY -PN Sewage discharge to ground surface or road ditch. OY 41N_ Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: ee4 1~ /~~G... DATE: 3 1/94 ERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 1 N(J ~ / ~ l vJ~l~ TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? OYes ONO Soil series per SCS Soil Survey: sheet Type of soil absorption system: OBelow grd OAt-Grd Mound Approx. size 'X OGravity ODOSe OPressurized Ft•= OBed OTrench ODry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES OOther OUnknown Septic tank Setbacks: OHouse OWell OProp. line OOther Dose tank Setbacks: OHouse OWell.. OProp. line 00ther OLocking cover OWarning label OPump/Floats OAlarm OElec. wiring- Soil Absorption System Setbacks: OHouse OWell OProp. line 00ther OPonding: ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title ~"ST. CROIX COUNTY WISCONSIN ~ ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carm1ch,40l.R04 I= Hudson. (71 \ MG-4686' SEPTIC INSPECTION / WATER TEST REQUES ORM Please specify desired test(s) & remit a ~ PPr 13.tS~iatesr EAW~-Vitti application. Outside water lines are often tdQduripg , winter months, making access to the home necessa ,Pleas~g ' arrangements with this office to insure that entry t~l~ 1 0 Water (VOC's) $185.00 ❑ Septic $50.00 Q1' Water (Nitrate & Racteri?) 45.00 ❑ Nitrate & Bacteria 11 Water (Lead Concentration) 21.00 retest $15.00 Owner: Requested by: Address • plc /c ~~..~f,L ' Address : A. ZIPS-r ozz ZIP Telephone N°: /y Telephone ) _sA,_c Property address (Fire 10 & Street) Location: h , Sec., Tfg N, RAW, Town of r-,feo y Realty firm: Lock Box Combo: Closing Date: *PROVIDE A SKETCH OF HOUSE &ESEPTIC SYSTEM ON REVERSE OF THIS FORMS TO BEE Water sample tap location: Is the dwelling currently occupied? I& Yes 0 No e-, If vacant, date last occupied: Age of septic system: Septic tank last pumped by: Previous Owner's Name(s): Date: Have any of the following been observed? ❑Y ON Slow drainage from house. OY ON Sewage Back-up into dwelling. OY ❑N Sewage discharge to ground surface or road ditch. OY ON Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE : A0R__1_ 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 1N TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? OYes ONo Soil series per SCS Soil Survey: sheet Tyne of soil absorption system: OBelow grd OAt-Grd OMound Approx. size 'X OGravity ODose OPressurized Ft•2 OBed OTrench ODry Well OHolding Tank OOutfall pipe OBSERVED DEFICIENCIES 00ther OUnknown Septic tank Setbacks: OHouse OWell OProp. line OOther Dose tank Setbacks: OHouse OWell.. OProp. line 00ther Mocking cover OWarning.label PUMP/FloatsOAlarm OElec. wiring Soil Absorption System Setbacks: OHouse OWell OProp. line OOther OPonding: ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector _ Title ST. CROIX COUNTY WISCONSIN ZONING OFFICE - ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmich Hudrn, J7 (6 0 SEPTIC INSPECTION / WATER TEST REQUES ?r P lease specify desired test(s) & remit appr es" x4wit~i application. Outside water lines are often t d~nNi~duri winter months, making access to the home necessa Pleasg` arrangements with this office to insure that entry t~ , y' 0 Water (VOC's) $185.00 0 Septic $50.00 X Water (Nitrate & Bacteria) 45.00 ~ 0 Nitrate & Bacteria 11 Water (Lead Concentration) 21.00 retest $15.00 Owner: WoAgF.v Requested b Address- Y:clf //,~v • De Address • ZIP o z z ZIP Telephone W: (/s) yes- yU Telephone W: Property address (Fire W & Street) Location: Sec. °2s- , TA9' N, RAW, Town of -r-,e oy Realty firm: Lock Box Combo: Closing Date: TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM Water sample tap location: e-A zu. 0:2 4- Is the dwelling currently occupied? 19 Yes 0 No If vacant, date last occupied: Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? OY ON Slow drainage from house. OY ON Sewage Back-up into dwelling. OY ON Sewage discharge to ground surface or road ditch. OY ON Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: 3 f~ 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? OYes ONo Soil series per SCS Soil Survey: sheet Type of soil absorption system: OBelow grd ❑At-Grd OMound Approx. size 'X OGravity ❑Dose OPressurized Ft•2 OBed OTrench ODry Well OHolding Tank OOutfall pipe OBSERVED DEFICIENCIES OOther Otlnknown Septic tank Setbacks: OHouse OWell ❑Prop. line OOther Dose tank Setbacks: OHouse OWell, OProp. line OOther ❑Locking cover OWarning label OPump/Floats ❑Alarm OElec. wiring Soil Absorption System Setbacks: OHouse OWell OProp. line OOther OPonding: ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title - ST. CROIX COUNTY WISCONSIN ZONING OFFICE e" u a M u Run ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 . (715) 386-4680 April 17, 1998 Dick VanKeuren 273 Plainview Drive River Falls, WI 54022 RE: Water Test Results Dear Mr. VanKeuren: Enclosed are the original water test results from Commercial Testing Laboratory for a water sample that was taken at your property on April 6, 1998. If you have any questions regarding this, please call our office at (715) 386-4680. Sincerely, 4d 6&tg~ Rod Eslinger Assistant Zoning Administrator Enclosure sm COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800-962-5227 FAX - 715-962-4030 ST. CROIX COUNTY ZONING OFFICE REPORT NO.S 60689/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATES 4/14/98 1101 CARMLICHAEL ROAD DATE RECEIVED: 4/07/98 HUDSON, WI 54016 ATTN: JIM TH MPM OWNER: Dick Van Keuren LOCATION: 273 Plainview Dr.. River Falls COLLECTOR: Rod EsLinger DATE COL.LECTEDS 4-06-98 TIME COLLECTED: 1:30pm SOURCE OF SAMPLE: Outside tap DATE ANALYZED:4-07-98 TIME ANALYZED: 2:00pm COLIFORMI: M FCC: 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE-NS 5.3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 mt Nitrate-Nitrogen, mg/L% ? l LAB TECHNICIAN: Pam Gane Sr cn WI Approved Lab No. 19 r cUROiX~9~ \ ?0NjHG / F op -ice cF C Means "LESS THAN" Detectable Level Approved by: ST. CROIX COUNTY WISCONSIN ZONING OFFICE z "'aR x COUNTY GOVERNMENT CENTER ' 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION REQUEST FORM Please specify desired test(s) & remit appropriate fee with ,~4e A application. Outside water lines are often turned off during a winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $200.00 ❑ Septic $125.00 Water (Nitrate & Bacteria) $55.00 0 Nitrate & Bacteria J] Water (Lead Concentration) $21.00 ~retest $15,.000 Owner: _~Di K e ,s Y'~ AV== Requested by 0a-4 Address: 2- 7 3 62/3 u Z-F._ Address: a" ~4 ZIP S4o7L ZIP Telephone W: Q) 4,-:Fa 7 / 4 v Telephone W: ( ) Property address (Fire W & Street) : 2 7-3 P),pI i Location:;, Nlri Sec.T Z ~5-_N, R Zo W, Town of ~f a Realty firm: Lock Box Combo: Closing Date: 04o- 1►s1- q0 _00L a57 ag. a-a. (~a3 TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: ,A J, -7 l.v2 -4 s-_ 1, oC 9,, Is the dwelling currently occupied? 13Yes ❑ No If vacant, date last occupied: Age of septic system: Ww Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y ❑N Slow drainage from house. ❑Y ON Sewage Back-up into dwelling. ❑Y ❑N Sewage discharge to ground surface or road ditch. ❑Y ❑N Foul odors. Other comments relative to system operation: I certify that the above informs ' complete nd true to the best of my knowledge. OWNERS SIG ATU DATE:/0_ ~-I"J 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? OYes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: OBelow grd OAt-Grd OMound Approx. size 'X OGravity ODose OPressurized Ft.2 ❑Bed OTrench ❑Dry Well ❑Holding Tank OOutfall pipe OBSERVED DEFICIENCIES OOther OUnknown Septic tank Setbacks: OHouse Dwell OProp. line 00ther Dose tank Setbacks: OHouse Dwell OProp. line ❑Other OLocking cover Owarning label OPump/Floats ❑Alarm OElec. wiring Soil Absorption System Setbacks: OHouse Dwell ❑Prop. line 00ther ❑Ponding: ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector °r~csl(_~ Title C, ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r r p p ST. CROIX COUNTY GOVERNMENT CENTER r~..~ 1101 Carmichael Road Hudson, WI 54016-7710 - (715) 386-4680 September 30, 1999 Dick VanKeuren 273 Plainview Drive River Falls, WI 54022 RE: Water Test Results for Dick VanKeuren located at 273 Plainview Drive, Town of Troy, St. Croix County, Wisconsin Dear Mr. VanKeuren: Enclosed are the original water test results from Commercial Testing Laboratory for a water sample that was taken on 9/22/99 at the above referenced property. If you have any questions regarding this, please call our office at (715) 386-4680. Sincerely, 4"r -Pz~ Mary J. Jenkins Assistant Zoning Administrator Enclosure /sm COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800-962-5227 716io FAX - 715-962-4030 I I ST. CROIX COUNTY ZONING OFFICE REPORT NO.: 29303/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT UATEY 9/29/99 1101 CAR'MICHAEL ROAD DATE RECEIVED: 9/23/99 HUISON, WI 54016 ATTW jIM THOMPSON OWNER Dick Van Kearen LOCATION 273 Plainview Dr., River Falls COLLECTOR: M. Jenkins DATE COLLECTEDt 9-22-99 TIME COLLECTED: 3:45pm SOURCE OF SAMf'LEi Outside faucet DATE ANALYZED:9-23-99 TIME ANALYZED:1:00pm COLIFORM,MFCC: 0 /100 ml INTEWRETATION: Bacteriologically SAFE NITRATE-N: 4.8 ppm Above 10 ppm exceeds the recommended Public DrinkiN Water Standard. Nitrate-Nitrogen, mg/L Coliform Bacteria/100 ml LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 < mans "LESS THAN" Dececiable Level Approved by. r U.