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022-1098-80-400
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579044 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)[. ZS'75'3l Permit Holder's Name: City Village X Township Parcel Tax No: Bilicke, Trevor & Michelle Kinnickinnic, Town of 022-1098-80-400 CST BM Elev: Insp. BM Elev: B11 Description: Section/Town/Range/Map No: ~0•~~ E bF onJG dW4AJ YY &-VZ W 34.28.18.532A40 TANK INFORMATION ELEVATION DATA CVR TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /Pao Dosing Alma S Alt. BM S F-/ac9 D Aeration Bldg. Sewer - Holding St/Ht Inlet v6 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom l~!•zZ q!. 3~ Dosing Header/Man. 3. ZS wZ. 30 Aeration Dist. Pipe Holding Bot. System /J PUMP/SIPHON INFORMATION Final Grade 71 « D3 7S Manufacturer / &A VJ Demand St 8e+er rr QQ v1 L GPM w/v n y 0~ /~a.70 Model Number rp 9 l 7C/ TDH Lift Friction Loss System Head r TDH Ft to.f7 1~03 ;.z.5-fo.s / .7 Forcemain Length I Dia. , Dist. to Well ZD z' rSD SOIL ABSORPTION SYSTEM RENCH BEDIT D IMENSIONS Width J ength No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR 6"?'r-wk) Type Of System: y~~► k01 } 75' UNIT Model Number: 03 DISTRIBUTION SYSTEM p1u~0~_ Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 'C+G~'3'F3 Pipe(s) N ti 7 Length Dia L Length_5:0- Dia , Spacing_ ? 3/!9 %~t lY0 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 D Bedfrrench Edges > Topsoil l c ~ Yes g No Fia Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:$1/ Inspection #2: Location: 1298 County Road M River Falls, WI 54022 (SE 1/4 NE 1/4 34 T28N R1 8W) NA Lot 4 Parcel No: 34.28.18.532A40 ,r 1.) Alt BM Description oFF 06,> !.4~LAUSr: ~'cdA~ ~¢ll pLIt'~ = ~ ~ S 2.) Bldg sewer length = COV,'lJ '6T_ vaR I Fy If A" OA11P MYtS Cj&!fA/, ,y~,w~sD wh AlG ~Mp~D Ekc~'/ - amount of cover - EKI'Ieq' R.I S~~ ~ DosE ''R~~• • -_i Plan revision Required? ❑ Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctors Signature Cert. No. EC VEU County l c r Safety and Buildings Division 3 s - ~1I I 201 W. W shi On P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) M 'so k 07-7162 ST CROIX COUNTY S 7 S ,OMMUNTI anltary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit C9 Jl is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mai 'ng address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary !z IF r, pA/V urposes in accordance with the Privacy Law s. 15.04 1 m Slats. L Application Information - Please Print All Inf ation 2 6 « 0- O Property Oxvner's Name t Parcel # Zr& "I/ c ~ 2 ~Zl D Property Owner's Mailing Address Property Location 1 Z°►~ `~l~ Govt. Lot City, Stat % lv~ e Zip Code Phone Number / F Section Lot # T ~o N; R / D E on,,-) lei q ircle oII. Type of Building (check all that apply) r~i ,DN or 2 Family Dwelling - Number of Bedrooms Subdivision Name ~ > G # ^C-, El Public/Commercial - Describe Use ' Block ❑ City of ❑ State Owned - Describe Use ! CSM Number 7(4 095 Z ❑ Village of , 9 ~ QJa 60 - y, ❑ Town of III. Type of Permit: (C eck only one box on line A. Complete line B if applicable) A. ❑ New System X Replacement System ❑ Treatment/Hof ding Tank Replacement Only r NI U odif t n to xis ng ste (explain) 8• El Permit Renewal ❑ Permit Revision ❑ Change of Plumber List revious Permit Numbe and Date Issued ❑ Permit Transfer to New f / Before Expiration Owner 2(t /Z(,I 9(t 1 IV. Type of POWTS S stem/Corn onent/Deviee: Check all that apply) A , ❑ Non-Pressurized In-Ground- ❑ Pressurized In-Ground ❑ At-Grade 15rmound 2:24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ er Dispersal Component (explain) ❑ Pretreatment Device (explain) i 4V V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(b ; Q Dispersal Area Requir (sf) Dispersal Area Pro sed (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks c v 0.U ~ ~ rn wt7 a Septic or Holding Tank ~OD f tpS Dosing Chamber J VII. Responsibility Statement- I, the undersigned, a sume responsibility for installation of the POWTS show ttached plans. PIumbe s Name (Print) Plu s Signature MPftAPM N Business Phone Number Plumber's Address (Street, Ci , State, ip Code) VIII. County epartment Use Only pproved ❑ approv $ Permit Fee Date Issued Issuing t Signature (ozs.aa O 'ven Reason for nial Ao I16 IX. Condt Wftea er for Disapproval 1 Y' nk, efflu'eht er and ! Ir oy~ dispersal cell must all be servtces / maintained f / eft,per management plan provided by plumber. ` I AX1 o46 ( e l e d -ct 1t 1~11) seta ei requir rnents WOW tie rnaintairi6d per4ocabla code I oftnerim. Attach to complete plans for the system and submit to the County o n r nai less th 8 /2 x II inches i e SBD-6398 (R. 11/11) plot pl 4G, t 61- M044A d ~ coo foe 3 ®4 r ~ Ti, t a 9 ~ 1~ lam( _ Pgvce-l.~.b.3 -aS./8.s-~~t- / 4 1 pe~ Q. S, alc wa J Y L ~ J EXlst'•/f Soo Q 6,h ~ f F i Iddd p'cc.. /n2 coiorro~. l idJt~1/ cl S7-F160 F r (F /'C 4/E l~k _ f df CXCG ti bh..+ (Jjj p D ~ - Ta T 1p G C~•,C lGfG¢S/4..D T"'6 +7 r 6/ IS- -,,z c L- ~b.PI.S" ~ , Tom, o sc~ori'c 7a+,~ eG~f= `T. J© dV 16-7> X 7(f n i, e r fi ~r S a Scc. -4c l C1 / q t S c +c t n/ Cctifi O Lr Qs '2e'C j1 ~ i ~ C e ~ - ~T,p~Y~RTE~ o R~'►~~\/E® DIVISION OF INDUSTRY SERVICES T V ~I o% \ 10541 N RANCH ROAD D HAYWARD WI 54843 Contact Through Relay 9 S http://dsps.wi.gov/programs/industry-services ° ST. CROIX COUNTY www.wisconsin.gov °ssioN~15w ^,OMMUNITY DEVELOPMENT Scott Walker, Governor Dave Ross, Secretary July 20, 2015 CUST ID No. 220673 ATTN.• POWTS Inspector CHARLES L WEBSTER ZONING OFFICE WEBSTER SOIL TESTING & DESIGN SERVICES ST CROIX COUNTY SPIA N5815 770TH ST 1101 CARMIC14AEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/20/2017 Identification Numbers Transaction ID No. 2575311 SITE: Site ID No. 814842 Trevor Billicke Please refer to both identification numbers, 1298 Cr M above, in all correspondence with the agency. Town of Kinnickinnic St Croix County SE1/4, NE1/4, S34, T28N, R18W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1545922 Maintenance required; Replacement system; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. CHARLES L WEBSTER Page 2 7/20/2015 r Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Carl J Lippert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSMART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm CHARLES L WEBSTER Page 2 7/20/2015 Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Carl J Lippert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSMART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Webster Soil Testing & Sewer System Design Charlie Webster, Owner N5815 770th Street Ellsworth, WI 54011 WI Licenses: MP220673, ST220673, D 2110 P Telephoni(715) 273-3430 POWTS Index Sheet Page 1 of 10 Mound System for a 3 Bedroom Residence Property Owner/Project:7bTrevor Billicke SE 1/4 of NE 1/4 S34 T28 NR18 W 1298CRM Town of KINNICKINIC/ST CROIX CTY Parcel I. D. 34.28.18.532D Page 1 of 10 Index Sheet Page 2 of 10 Situation Report & Construction Considerations Page 3 of 10 Plot Plan Page 4 of 10 Mound Cross Section Page 4 of 10 Distribution Pipe Layout Page 5 of 10 EZ Flow Media Layout Page 7 of 10 Pump Chamber Layout Page 8 of 10 Pump Performance Curve Page 9&10 of 10 Management Plaln CONDITtO"> .LY APPRO` ED OAt \SC S'/ DEPT OF SA,F E°I Y AN D PROFESSIONAL SRY SE►`a" BS~R ° c. DIVISION OF IN ELLSWORTH WIS. ;&IFS PONDENCE !U,,= ~GN SEE F s Component Manual Used: Name: Mound Component Manual for POWTS Version:2.0 SBD-10691-P Dated: January 30, 2001 Name: Pressure Distribution Manual for POWTS Version: 2.0 SBD-10706-P Dated: January 20, 2001 REPLACEMENT MOUND FOR TREVER & MICHELLE BILLICKE KTNNICKNINNIC TWN-ST CROIX COUNTY SITUATION REPORT The original mound at this location was installed in 1996 in accordance with a state approved plan and the plumbing code that was in effect at that time. The dispersal cell in this mound is clogged where the rock bed interfaces with the sand lift. The original plan number is S96-40601. The original bench mark is no longer present. The inspection pipes have been partially filled so they could not be used to re- establish the bench mark. The bench mark was re-established based on the elevation of the top of the distribution laterals in the existing system. The original system had 12 inches of sand lift under the dispersal cell. Based on the soil test, current code requires a sand lift of 8 inches. This mound redo plan is based on a sand lift of 9 inches. The original dispersal cell was 8 by 47 ft. in size. To meet the current code, this has been increased to 9 by 50 ft. For construction, I recommend that the dispersal cell be extended 1 ft. further north and 2 ft. further south that the existing system. One ft. will need to be extended to the south for the replacement mound as well. The pump should be replaced and a Simtech STF 100 filter should be installed on the pump discharge. Other changes from the original plan mound cross section are as follows: The "D" dimension changes from 12 inches to 9 inches. The "I" dimension changes from 16 ft. to 15 ft. The "K" dimension changes from 10 ft to 9 ft. The "L" dimension changes from 67 ft. to 68 ft. Other dimensions remain the same as original. OTHER CONSTRUCTION DESIGNS AND CONSIDERATIONS Remove excess/overgrown vegetation from mound, mow and remove clippings. Pump out any standing wastewater through observation pipes. Permit dispersal area to dry out. Remove and stockpile topsoil from mound system. Remove aggregate from absorption area and dispose of in approved manner. It cannot be reused. Remove distribution pipes and observation pipes. Dispose of property. Remove clogged sand plus an additional 3 inches of clean sand and dispose of properly. This sand cannot be reused. Inspect remaining sand for particle size to see if it meets ASTM Specification C-33. Install replacement mound system using procedure outlined in the approved mound component manual. I plot Pl (q-h td;- Mau* tY ~C4 Poe 3 0 tc ~o l w vv e// \L~ ~s ~:~a ,r yc~ Q Pohci7 n ~m y Pr t¢ tG ~t+ a/ ,i} L h~ Solt wa/,` \O(j }C / Xr st+ l d oar/600 a .c-t,`0 I-a.q ~C j ~ror•• 'W~}.`cy'~h L~c~,~4-c. 7~c. i'~ ~p ~~i e,k ~s f,i~~ I / j9rt ~w..t} Cf /;e eoG+fro/.1 t s~.cf~ sh~fecli fTf-160 G r 5cc a~ 1e l ; k4 f C~ F, CX c t p It r o s/~ o o te+ca~ t 7-. a T CG a C ~ C.-? 'C S ~Q.O ! jr Y'y'6 +r T GS-/L~1 - 9, p Cc C-45 f Tod a piw--Jo cAa.~.6e coves` ~I= Qkq.l~ G I o e v `M V E d~ C,X OAP 44 r- e YO ?PC, 1%4 edge c1c off e-psu CetiQ 3 v.*c 1C> C),f C) Gs as ~irflh~t c e /l , Mound Plan View ~j B ono J K A W :.r. - B L Mound Component Dimensions A ft E !1, in(.1- H f O ft K ft B ft F in z ft L ft D in( 4W- a. ,1 ft J ft W 3 ft (ftz) Dispersal Cell Area (fe) Basal Area AW$j d (gpd/ft) Linear Loading Rate 2,CO Mound Cross Section View EZflow Dispersal Area Finished Grade (ft) ----0 H w!/iii~ii rinnrlr G I X/lflHNlfff fr/~flrr/fN (ft) I F 's F CsN (ft) Lateral q ~r Invert Elevation= Dispersal Cell ..D •3 Elevation=7?- 4 78S (ft) Contour Elevation % Site Slope Typical Dispersal Cell Shading Key See Pa" g © = Topsoil Cap ~ I 2 /fffti/ Subsoil Cap Approved Geotextile Fabric Cover ASTM C33 Sand 2.0 ft • 4 ~ Tilled Layer 5 F 5 EZflow Media 5 4- 0.5 ft * 0 - A See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Protect. P 4 Page Gf Perforated Pipe 00011 n End Vier )Perforoled I PVC Pipe Hotel located On Bottom, sec de~a.I Are Equally Spaced- S t'sTa"''~c~ """3 t I Distrtbution Pi4e dcfid~ rE(~ P Ft. Distribution Pi X pinches Hole Diameter f c'> Inch •~,®h."`"~1e f> Lateral Inch(es) r, Manifold Inches o Force Main " Inches # of holes/pipe B ~ of c e ess 6.X ~'k ►<<ded'oAaj Invert Elevation of Laterals t. .75 1%,41 e h,1 Place 1st hole -Deha4c-.r Fjq., eaJ,~~j;~,;6wta►co~1 with succeeding holes at 10t'h.intervals _ Eiw* Distribution Cali Media Layout CON Wkkh (it) ,5 SWwraN to L.aral (ft) 9 ft Wide L~pnd C"Ponent SRI JA Bundle - 5 ft or 10 ft lengths SR1-12A or EZ 1201A in 5 ft or 10 ft WVths SR3-12H or EZ 1201P or SR3-12H in 5 ft or 10 ft lengths O 4" Perforated Distribution Pipe With Pressure Laterm inside Tumup Enclosure - - - - - Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. lfsbribudon CON Plan View Layout - Typical Cell WWU -A (ft) CON Levh - B (ft) Fong Main prCC M <i h iw, Project: P of r - / Ile- /-f c(l e P q- ~t )AY e-S r re C, r4 /"04 -,0 C4 ee,,, ~d - /f, ~..~'c~Gf~ ~.'t~`71~ ~'t s~d►,s~,gl~F t Q a#a ~ tcf W 'APP reV turf' c a C 410 4 /v + jay ~rii+sr Tec 4 P 3~ (weddr«~t ode, ra.~K Noce: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day/Doses: 6&.-~Gallons Volume of Back fI ow:+9j~.O!6,,O -6.S-Gallons "ank Manufacturer: ({flfS"rr ~ncF~~ Total Dose Volume: =~J- GalIonsuk- Tank Size-Septic/Pump: to 0o ,6 o e; a ons Alarm Manufacturer: 7 ,C t,;odel Number: 7-, Ic 11- C h e Capacities: A 33 inches or36 Gallons Switch Type:_ + B inches or oZ. Gallons Pump Manufacturer: + C;nches or allons Model Number:. f3 / O + D inches orb all ons Minimum Discharge Rate: Total.....= inches or Co Gallons 'iertical Difference Between Pump Off and Distribution Pipe: Z23-Feet E/ Xiiiwum Required Supply Pressure: .a:s` Cl30-7.>.........+. X137Feet `A "eet of Force Main x /_.3,LFriction Factor/100 Feet: s3Feet !f1 Inch Diameter Force Main Total Dynamic head:...= /3_OFeet n4ernal Tank Dimensions: Length/ S17;,~; Width; +zfi Dfyrtt~ L , .q e4 , t( P c-r t4 +►1 Qc~f CA J. `e.- * ~ t! eit r.++r ~ •i G i D~ D I R J ,U Q S~~ ~o t Emil] . 3871 EP04 EP05 APPLICATIM Fasteners: 300 serer Fully submerged in high ■ Motor Housing: Cast iron Specificaly designed for the stainless steel. grade turmb oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. f Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas- components. tic cover with integral handle • Homes motor., Avail" and float switch attachment • farms • Heavy duty sump • EP04 Single use. Q4 ' mom MGM* M 1 points. 115 or 230 V, 60:Hz,1S5050 • Water transfer 1 aW ■ Power Ca: Severe duty • RPM, bulk in overload with rated oil and water resistant. Dewatering automatic reset. = ' • EP05 Single phase: 0.5 HP, ■ ~ ~ Upper and dower SPECIFMATiIQ11S 115 V, 60 Hz, 1550 RPM, heavy duty ball bearing construction. Pump: EP04 built in overload with ■ EM kqM. Thermo- • Solids handling capability: automatic reset. plastic Swni-operr design '/a' maximum: • Power cord: 10 foot with pump out wanes for Y • Capacities: up to 55 GPM. standard length, IN SJTD mechanical SOW protection. Caralrr~n „ • Total heads: up to 24 feet with three prong grounding f EP05 ImpeNw. Thermo- • Discharge size: 11/2' NPT. plug. Optional 20 foot , plastic design for (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with improved performance. end in "I" or "AC".) rotary/ceramic-stationary, three prong grounding plug BUNA-N elastomers. (standard on EP05). ■ Cog sail fie: Rugged • Temperature: design provides 104°F (40°C) continuous superior strength and 140°F (W) intermittent, corrosion resistance. • Fasteners: 300 series METM FM } stainless steel. 10 I • Capable of running , dry without damage to s 30, components. I Pump: EP06 8 25 • Solids handling capability: 0 7- VV maximum. • Capacities: up to 60 GPM. s 20 { Total heads: up to 31 feet. ! Discharge size: l r~ NPT. z 5 I • Mechanical seal: carbon- 0 15 rotary/ceramic-statonary, a 4 BUNA-N elastomers. c • Temperature: 3 40 104°F (400C) continuous I 140OF (WC) intermittent. 2 i I0 10 20 30 40 5o GPM 0 2 4 s s 10 12 ma1N C PAWY a 1855 Goulds Pumps, Inc. ESeadw May. 1995 83871 of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ FILE INFORMATION SYSTEM SPECIFICATIONS owner Septic Tank Ca testy ? gal ❑ NA - Permit # Septic Tank Manufacturer C e-l, es;' a ❑ NA DESIGN PARAMETERS Effluent Fib Manufacturer S:irrTec A- ❑ NA Number of Bedrooms ❑ NA Effluent F'dter Model S T F /00 ❑ NA Number of Commercial Units O NA Pump Tank Capacity co ® al o NA Estimated flow (average) D C7 g@;(dW Pump Tank Manufacturer ❑ NA Design fbw (peak), (Estimated x 1.5) g0ffla Pump Manufacturer ~ a w ~ 9l ❑ NA Son Application Rate ` - 0 6 = 0 3 Pump Model 3~~ ❑ NA Influent/Effluent Quality Monthly aveuaW Pretreatment Unit NA Fats, On & Grease (FOG) 530 mg/L ❑ SwOQravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODg) :gW mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 MgIL ❑ Disinfectiot ❑ Other: Manufiur+e r Pretueated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODs) s30 mg/L ❑ In-ground (gravity) ❑ in-ground (pressurized) Total Suspended Solids (TSS) s30 mg/L 0 At-grade >Wound Fecal Conform. ( eonmWic mean) s1 W cfu/100m1 ❑ ❑ Other: Maximum Effluent Particle Size K inch diameter • vmm vpkw for dwnewc (non-c~4 wasteeratar and septic tonic mull. vskras "W rW pr end wart widr. MAINTENANCE SCHEDULE Service Event Serve Frequency Inspect condition of tank(s) At least once every ❑ months ❑ Year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (V of tank volume inspect diSpersal ceps) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Clean effluent filter - - At least once every 3 ❑ months xyear(s) co ~"A`n -re 00 KM Inspect pump, pump controls & alarm At least once every Q months. ❑ year(s) ❑ NA Flush laterals and pressure test At least once every 0 months ❑ year(s) ❑ NA 0#w. At least once every ❑ months ❑ year(s) ❑ NA ~y At least once every 0 'months ❑ year(s) ❑ NA dr A 'C'40- 1c.a -7 tJ 17' ns 4~ ~ G N e. C e JS A /'a C le 1h 4r MAINTENANCE INSTRUCTIONS 0"*" ,,,hle a. .r a'A tee, q-r 06 e e /00A, yyear. b ~t o« rf c c:L/,G Inspections of tanks and disposal calla shop be made by an Individual carrying one of the fb lvw~ licenses or certifications: Master Plumber, Master Plumber Raicithbsd Sw*w-, POWTS Inspector; POWTS Makfthf , Septage Servicing Operator Tank Inspections must Ipplude a visual inspection of the tank(s) to Identify any missing or broken hardware, identify any cracks or leaks, measure the vol une of combined s je and scum and to check far any back up or ponding of effluent on the ground sur boe. The dispersal oaks) shall be visually inspected to check the effluent levels in the observation pipes and to check for arty poncnrhg of effluent on the ground surf ce. The ponding of effluent on the ground surface may indiade a bW ft condition and requires the Imrnediab neon of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one-third (V or more of the tank volume, the entire contents of the tank shalt be removed by a Septage Servicing Operator and disposed of In accordance with ch. NR 113, Wisconsin Administrative Code. The swvir*g of effluent filters, mechanical or pressurized POWTS components, pretrea"nt components, and any other maintenance or monitoring at intervals of 12 months or lass shah be perfumed by a certified POWTS Maintainer. A service report shall be provided to the local mgufatoy authat fr wbhin 10 deya of caompledon of any servioe event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process andfor damage the dispersal cell(s), if high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. 0 ,'A' .7 Page System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal calks) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent To avoid this slttration have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction oreliminatfon of the following from the washy ater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings, gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. i ABANDONMENT When the POWTS faits and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned In compliance with ch. Comm 83:33, Wisoonsin`Administrative Code: All piping t0 tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall, be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from wdsting and proposed structure, Ict Unes and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation to establish a suitable replacement any. Replacement systems must comply with the rum in effect at that time. ❑ A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suite replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS P'OWTS INSTALLER POWTS MAINTAINER _ C.C a /fin Name 44,, ccn Name Phone Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name p':t. yr r- jS --fie c Agency Sr ~~-~•`)r Cf oa„iy Phone 7/S - 4.!S-- f S`" Phone ~l S - G e D 'his document was dratted by the surfs of the Green Lake, Marquette and Waushars County Zoning and Sankstion agencies. This document meets .he minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2/01) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT .'AND OWNERSHIP CERTII:ICATION FORM Owner/Buyer / V t r Mailing Address Property Address lsxeh (Verification required from Planning & Zoning Department for now construction.) city/State EOV EA ZAJI, Parcel Identification Number LEGAL PIN99MION f '/4, fq , Sec. _BL, T N R+ Town of ®7/, j~t/l f7 ! e Property Location Subdivision , Lot 4 Certified Survey Map # Volume 19 , Page # 4-, Warranty Deed # , Volume , Page # Spec house yes Lot lines identifiable (n-v Ito sT x CE AM QMM o 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 a licensed pumper. W Aunt you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, ;journeyman plumber, restricted phtn *er or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 frill of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, heroin, as set by the Department taf`C6minar'and the Department ofNaiural'Resotirces, State ofwiscomin. Certification stating that your septic system has been maintained must be completed and retuned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/me the owner(s) of the property descnlW above, by virtue of a 7"ty teed recorded m Register of Deeds Office. N of bedrooms SIGNATURE OF APPLICANT(SYk* DATE ***Any motion that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 0865) EXHIBIT "A" LOT FOUR (4) OF CERTIFIED SURVEY MAP IN VOLUME EIGHTEEN (18) OF CERTIFIED SURVEY MAPS, PAGE 4736, AS DOCUMENT NUMBER 760952, FILED IN ST. CROIX COUNTY REGISTER OF DEEDS OFFICE ON APRIL 28, 2004, BEING LOCATED IN THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER (SE 1/4 OF NE 1/4) OF SECTION THIRTY FOUR (34), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC. Subject to Covenants as stated in Warranty Deed as document number 803204. Subject to C.T.H. "M" right of way. Subject to the following Covenants: No animals at large. No abandoned vehicles, etc. No exotic animals, those normally found in the wild, will be raised or housed on the property. Owners of Lots 1, 3, and 4 must agree to the following conditions: A. The owner of Lot 1 must be willing to dedicate the East 66 feet of Lot 1 for a public road in the event the owner or grantor of Lot 1 or 4 wanted to construct a town road on that strip. B. The owners of Lots 1, 3, and 4 must be agreeable that in the event a public road would be constructed on the 66' strip, it may be necessary to work outside of that 66 foot possible town road right of way for finish grading. The builder of that road would be allowed to work up to what is shown as a setback line and be required to restore those disturbed areas to a reasonable condition. 2 of 2 I 3 0 -0 6.3, m a ~ I 0 o Q o I M a 1-- 8 i 0 o ` ~ I 02 a ~ `m I v 0 o. N +L~ ai c 3 I O --o C z 7 (6 y~2 LL O..'N(n ~ ~ arnV I oa~3 E Q 0. v I ° co v ~ H ZE Z O z (L m C-4 W U) 0 O z i d z c z N F r (D N M N ~ o O z z U z N _ M N N d t4 E a E 0 g I N O d rn co 0 cc U) U) U) Z ~ > d •N ate.aa N IL U) mo m J U rn rn } N 0 N 0 a) U o o E 0' N N Q } (n (6 O y C O r.+ O N H d O V C N y a N C9 Lo ~ C C W o 0) U co N ' « O C'+ O N cD d O _ 04 Go 0 O c Y U N O Z c TG (n ~ N d m I a 3 sa 2- 1 L: CL o m 3 E 0= -1 A c~ a o cn c~ t AP POV X17 7 E, 4CD 9 S 2 Plir+*V =4~M ~gpn sod Pxftssrlxs Cn 's VOL18 PAGE' 4736 APR 2 7 2005 Cc 2004 KATRUM H. ALSH APR 2 g REGISTER OF DEEDS ST. CROI K CO. WI Si CP€',XC~UNTY RECEIVED FOR kECORD W~~wWnin 30 04/28!2004 12:00P!! ,qy CERTIFIED SURVEY MAP ~ REC FEE: 13.00 PY FEE: S: 2 3.00 CERTIFIED SURVEY MAP PAGE Roger and Toni Christiansen Located in the Southeast % of the Northeast Y4 of Section 34, T 28 N, R 18 W, Town of Kinnickinnic, St. Croix County, Wisconsin. OWNERS'ADDRESS LEGEND 1298 COUNTY TRUNK HIGHWAY M" N x 16"IRON 3 RIVER FALLS, W! 54022 PIPE SET (MIN. WT. - 1.13 LBIL.F.) m • INDICATES t' IRON PIPE FOUND a a BEARINGS ARE REFERENCED Q SOIL BORINGS (PROPOSED SEPTIC SYSTEM) O TO T THE EAST-WEST 114 SECTION ~ SECTION CORNER MONUMENT (AS NOTED) UNE OF SECTION 34, T 28 N, R 18 W, INDICATES FENCELINE - ASSUMED ASS 89.2491' W. ■ PROPOSED DRIVEWAY LOCATION' (R=) RECORDED AS SCALE IN FEET 1"w300' NOT- AN EROSION CONTROL PLAN WILL. 100 100 260 3 BE REQUIRED BY THE ST. CROIX w COUNTY ZONING OFFICE PRIOR TO U NPL AT D I CONSTRUCTION ON THIS LOT. h o LAN_4_S ' N 89° 16'52" E 1318.41' 1~R171 UNE SE1/4 NE V4 Cc - x x x- - 868.35' - . --rx W - - - - 9.+ 450.06' fie, 151 \ UNPiA TTED x LOT 4 LOT 1 CONTAINS 1,003,029 SQ. FT. OR 23.026 AC. 00 LANDS CONTAINS 353,877 (976,339 SQ. FT. OR 22.414 AC. EXCLUDING \ SQ. FT. OR 8.124 AC. P ROAD RIGHT OF WAY) (351,558 SQ. FT. P /ac OR 8.071 AC. EXC. ~r ~i~a WELL P \ RIGHT OF WAY) y a POLE Z OWELUNG SHED 7[ sEpwc 1LQ-r I AREA N 89'20'42' E 497.97 LU y ;n 137.01' 360.96' Q N LOT__ $ LOT 2 h~ry~ © g $URVEYMAP X A LOT € Jot, DRIVEW pA3}i42 EASEMENT w ~ (SEE W DETAIL) 51 $ ° 0 CENTERLINE $ S89° W 8755..1 ~u 25 g9.OT ~7S y" _ NORTH RiW UNE C.T H. 'M' 187.00' S89° 3. 200. 7' - QS, 405.84' - - 88'24'31' W 400_ s s 14_ c I 48.60' -$M9Z43.L" VY13~38'. e - S 89'24'31' W 5277.44' - K ST 114 CORNER 00-UNTY TRUNK_ HIGHWAY_ 'M_"_ L<L~IPl c4IT_E~? SECTION 34, T28N, R 18W (FOUND COUNT'BERNTSEN ,J 7TC Awl ALUMINUM MONUMENT) ( ~ NEL-A- - EP 1 Lc7iJP_5 (1N-PLATTFQ LANDS DETAIL L4lVOS I , • ° " NOTE - LOT 2 LOT 3 L.4u w N~E LOT2 CONTAINS 2OA427 SQ. FT. 66.00' OR 4.716 AC. (188,587 SQ. FT. S 89°3 '29" I'=100' enu► IV OR 4.329 AC. OCCLUDING 3Q33.00' 33.00 -17-13 ROAD RIGHT OF WAY) L~ENVILLE, v I<`~'. v p LOT 3 CONTAINS 187,261 SQ. FT. NORTH RAN WE Ao C.T.H. 'M' I~ a S J~ OR 4.299 AC. (180,174 SQ. FT 170.55' S I 8 167.00' ° ° • F` 33.00' 33.00 z R v OR 4.136 AC. OCCLUDING p--~ 2 ~-~~p Fo • Np s ROAD RIGHT OF WAY) S 89°3 '29" W DATED: 66.00' FEBRUARY26, 2 THIS INSTRUMENT DRAFTED BY JERALD L. LARSON SHEET 1 OF 2 Vol 18 Page 4736 - Wisconsin Department of Industry, - SOIL AND SIT E -E t . N- REPORT Page of - - 3 borarxl Human Relations sionotSafety &Buildings in aCCOrd wit r VVt ode COUNTY Attach complete site plan on paper not less than 81/2 x•1 es in size. t?la'iust incl t not limited to vertical and horizontal reference point (BM) on of slop, a I e PARCEL.I,D. # dimensioned, north arrow, and location and distance to road. d dPI@ vas REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT AL i OEM PROPERTY OWNER: Z;ERTY N fojlw'~- . Vff 1/4 NE 1/4,S 3~ T Z$ N,R 1S E (oQW IRZ Ci~2 N9V~ '-To V.3 1 C~1ST"l PROPERTY OWNERS MAILING ADDRESS 0 K # SUED. NAME OR CSM # NS3 1-'>W) z SA CITY, STATE ZIP CODE PHONE NUMBER 4C-ITY OVILLAGE ®fOWN NC o Z,\.Ut k)I s~Eoz.Z n> s) zs_ s s°r3 ~~tlufV~ ~v New Construction Use [pd Residential / Number of bedrooms 3 [ j Addi3iQn to existing building j ] Replacement [ J Public or commercial describe Code derived dairy flow 'A SO gpd Recommended design loading rate o • bed, gpd/ft2 - trench, gpd/ft2 Absorption area required 31 S bed, ft2 3~ S trench, ft2 Maximum design loading rate O.5 bed, gpd/ft2 0.6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 9c9 • S It (as referred to site plan benchmark) Additional design/ site considerations "Ivup w / 8' K U1' t3 tD . "v". 1'or- S" Fit-t-, Parent material S Pr>up' i o v ~ wn-S N Flood plain elevation, if applicable N-~ A, It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S ®U ER S o u Qs ®U 0 S ®U ❑ S W U ❑ S MU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmidary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed retch o~ S v. $ lo~-I 3!Z - s Z S~ YK`~'H cLr - o.S b =y Z 8 Z-3 1 b Iz 3 t - s Z w► Sb1z M'~' h C$ o. S o. 6 Ground 3 Z3_~3 -)-S K R VA - S o SCS yn ~ CS elev. 00A It. Y 33 -6z S 11 R VA. -A tz .51t S o s~ M - - - Depth to N w hz L e-~FM 8"JD 4 limiting factor ate' Remarks: Boring # nam o-►~ to`~►Z 31Z - si 1 Z`FSbk Cw _ o. S o.~ Z Z lOZ tiek~ 31y - st` ZwtSbk 1v~'F~. cS o.S o.~ 3 z~ 33 to~ttz 31L - s ~ sbk w, eS - o.y o•S Ground C~ 33- ~~`1 RS//bS`!12 SIB ~S o Yvlv~1-' - - - Depth to limiting factor Remarks: T Name:-Please Print Phone: _Arthur L. [deRerer- 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Z2~ Date: CST Number: g S -Z3 3~u6. Z L L99S M00576 t f PROPERTY W*ER O WN'i`(_S`1 I h1 J S eQ SOIL DESCRIPTION. REPORT Page -of 3 a PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bouncy Roots GPD/ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends tr 0-13 1 I`1R 31 Z s 1} Z Sb>rc w► `F~- e g o• S o- r<>}r>:: Z ~3 1 s `1 R 3 Jt~ ~S O S ~j 1^n CS Ground 3 11- 3 S n- S `t R Y/6 m 0-S elev _ ~,.~ft. 3s_so S1c~ sit S~Is o'S Q, Depth to C yv S %'11 ~~M Ft "J FL 1. C°.. L limiting " factor Remarks: Boring# S ~-~~bk wL`FI G~ - o.S o. ~ o -13 IO~R. 3 LZ - l '51 L vt_ -1 !cm rL L L ~RsIE; ~t I - 3 -~t t Ground elev. 3 0_t,-N. S Z~ V., p N-1-3 O F S S J L° CI"1. ft. Depth to limiting factor L.~ 4 Remarks: Boring # ivKviyC:::iGround elev. ft. Depth to limiting factor Remarks: Boring # i Ground elev. ft. Depth to limiting factor ! Remarks: - SBD.8330(R.05/92) V PLOT PLAN Page 3 of 3 SCALE 1"= 30 ' NI ~o't-sow of 8~ l'1. 44.5 trL q -7 q 3v+ g.l l't al'16 13-~ 3 'Zolo rv~ COhp{tC1' •-z.isH -CI •IAl1.p'av tl 1 STUR$ 1 6,^ ~Z``I~IGN, 3~V`DI►~_ ~v e, pt pE w/th't'N ~.y \ \ trL q-14 N l~T~T u s~7o ~k~- f YT L s7 ZS~ F-twM nbuti!b.__ ~l Q i _ - c`n-F ri r S -Z3 ~ L`Lc~ S (715 4L-0169 1400576 CST Signature Date Signed Telephone No. CST # WisconsinDepartrnentofIndustry, SOIL AND SITE EVALUATION REPORT Page_~-of- -3 Labor and Human Relations Division-of safety & Buildiings - - - - in accord with ILHR 83.05, Ws Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S'T"- G(2 p Ix 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 to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: a~~l~z s ` S PROPERTY LOCATION R,b C, v(}JD "Y'ri N 1 CS~t 1 rti ~1V S IE- 114 NE 114,S 34 T Zg N,R 1S E (oew PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # _ \ S 3 D~1Z-d S >q 1~-~'PCD CITY, STATE ZIP CODE PHONE NUMBER gCITY ❑VILLAGE MOWN NEAREST ROAD Z v 2 F-Aus w( sgoZz bis Nz.s- s sq3 r 1►v,v~c ~U rv e c`~-} r~ y New Construction Use [M Residential / Number of bedrooms 3 (j AdditiQn to existing building j ] Replacement Public or commercial describe Code derived daily flow u- SO gpd Recommended design loading rate o • bed, gpd/ft2 - trench, gpd/ft2 Absorption area required 3~ S bed, ft2 3-1 S trench, ft2 Maximum design loading rate o 5 bed, gpd/ft2 G. 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 019 • S ft (as referred to site plan benchmark) Additional design / site considerations "%4\3up w f S' x 11 t" ot= S 1bvD Ft LL_ , Parent material S 111o1_( o V _N_L R S N Flood plain elevation, if applicable N3• At. ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable fors stem ❑ S ®U M S ❑ U 0S ®U ❑ S ® U ❑ S [B 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 rends 3) Z S Z S b YA h CL. 5 - 0.5 Z $ 23 1 b ~-t tZ 3 ! S 1 Zw► sb)rz 'M c S o• S a - 6 Ground 3 Z37-S `12 y/b - S o S~ m \ S _ o.- a' s elev. 0L2•~ft. Y 33-bZ 7-S `1R 1116 ~l s1g S O Saj M~ - - - Depth to r) w ~L ~t 8fs"aD 3 limiting factor Remarks: Boring # ) Gw o • S o• 6 k` Z Z lOZ ~o`t1Z 31y - Sly 2rnsbh 1vl c o•S o.~ 3 23 33 1o11 tZ 3Jto - s I 1 Vn sbk wt~. eS - o•4 0-S Ground elev. 9a-I ft -S)o l~`-tFL Y SyR SIB lat A - - Depth to limiting factor ~y Remarks: T Name:-Please Print Phone: Arthur _L__Idegerer715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Q Date: CST Number: a( q S -Z,3 F~U6. Z Ms M00576 PROPERTY OWNER CAtY 1 SMhQ Se,J SOIL DESCRIPTION REPUf3T Page _of 43 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trey \3-Z4 1 S`912 31~ is O CS o •7 0 8 zl-3S -~•3 `2R.l6 S v gy m eS o~ Ground 3 elev ft. 3S_So -7.S~t2slc~ z.s~-t2 slf~ 5~1s w,1 _ Depth to OMWIJ yv S S >N Ft U C~ l_ limiting factor 3 S Remarks: Boring # Z G _ p, S o. r-n-"~~>~~ Z Ground 3 tt l ~t R E3 S s elev. 3 cC)X) 5 z5P Ta O F S S L° c21 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD•8330(R.05/92) 3 3 Page of PLOT PLAN SCALE 1"= 30 ' NI CpN~UV~ 98'5/ '8o'Y-rati~ of B~~ EL q4. s ZL q -7 3~r g.1 ~ 'ZS CL a~ s B' 3 •Zoj o 1 , ~o K,) ur CO}-1PY'-,vr ~Z"!}IGN, alt(°p1H oR f S}UR$ Svc pipF w/ CIS ~L~. g.y c t 4-) 4 1V 1~~T ?A t A/ - - cam} q5-Z3 k{ tint cTN " T-Yu C~. Zl, l'l't.S (715 ) 42-5-(11 h5 _ 1400576 CST Signature Date Signed Telephone No. CST # Parcel 022-1098-80-000 10/14/2005 09:32 AM PAGE 1 OF 1 Alt. Parcel M 34.28.18.532 022 - TOWN OF KINNICKINNIC Current X, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/28/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CHRISTIANSEN, RETIRED RETIRED CHRISTIANSEN Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1298 CTY RD M SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 34 T28N R1 8W SE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1139/136 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/25/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 022-1098-80-400 10/14/2005 09:33 AM PAGE 1 OF 1 Alt. Parcel 34.28.18.532D 022 - TOWN OF KINNICKINNIC Current [X1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/28/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CHRISTIANSEN, ROGER D & TONI M ROGER D & TONI M CHRISTIANSEN 1298 CTY RD M RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1298 CTY RD M SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 23.026 Plat: 4736-CSM 18-4736 022-04 SEC 34 T28N R1 8W SE NE CSM 18-4736 LOT 4 Block/Condo Bldg: LOT 4 (23.026 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-28N-18W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 04/28/2004 760952 18/4726 CSM 07/23/1997 1139/136 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 80,000 341,000 421,000 NO AGRICULTURAL G4 18.026 3,000 0 3,000 NO Totals for 2005: General Property 23.026 83,000 341,000 424,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 O'Z-Z • 1048-- fir,-6oc~ ~~,ZB< <8, Sat STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER foq'C~- J/v ADDRESS 361 !f L1 3q . SUBDIVISION/ CSM# LOT # SECTION ( T N-R~ W, Town of tIC/' o 1 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM it ' 3) .r ► i~ )u)-') 'Tor INDICATE NORTH ARROW s i1 'U' Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ram ~y PUS ALTERNATE BM: !C TANK / PUMP C R / HOLDING TANK INFORMATION Manufacturer: kt froe6S f Liquid Capacity:%CSOU ~5 Setback from: Well House S' d Other Pump: Manufacturer (~Q~( Model# Size Float seperation~ Gallons/cycle: } Alarm Location SOIL ABSORPTION SYSTEM i Width: Length_ Number of trenches :Distance & Direction to nearest prop. line: Y~C? r Setback from: well: S House 9s 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 INSTALLATI PLUMBER ON JOB: LICENSE NUMBER : S INSPECTOR: 3/93:jt Wisconsin DepartmentQf Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. C)tolX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268664 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: CHRISTIANSEN, ROGER KINNICKINNIC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: © lJ ~S~C h lti7 TANK INFORMATION ELEVATION DATA A9600369 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic M Benchmark ~da< j a SS /00.0 4 Dosing 6~ GAZ --1a to T V Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vntto TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet `SC Septic 710' -50 a S~ NA Dt Bottom Dosing , '_1V , ,Z S 7 NA Header / Man. , 3 5- ' j a a b 2.~ Aeration NA Dist. Pipe 4/ 160.1V Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift X101 FrictionSystem se) TDH l~ Ft oss Read Forcemain Length J0 Dia. 7 Dist. To Well -5-0' SOIL ABSORPTION SYSTEM. BED/TRENCH Width el Length,, No_ Of Trenches PIT No. Of Pits Inside Dia. uid Depth DIMENSIONS DIMENSIONS LEACHING Manufa rer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O CHAMBER o el Number: System: 60 'J75 -15- 411A OR UNIT DISTRIBUTION SYSTEM ttee4w / Manifold Distribution Pipe(s) q x Hole Size x Hole Spacing Vent To Air Intake Length Dia a` Length !-2,4 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / 1,1 FIB3ed pth Over xx Depth Of } xx Seeded / Sedd2fi- xx Mulched Bed /Trench Center r /Trench Edges Topsoil -~Xes [3 No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) %a~O I-r if CIA/( LOCATION: KINNICKINNIC.34.28.18, SE,NE, CTY M } l A 0~-t N Plan revision required? ❑ Yes ❑ No Use other side for additional information. ! b 3 O~,f F % i c'% (1 SBD-6710 (R 05/91) Date In4'p or's Signature Cert. No. s Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O- Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County ` than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Numb r t , The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s- 15.04 (1) (m)]. State Plan I-D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prope Owner Name ` Property Location 1 , N, R /S E (o W o lev- S'~` an g e Z,14 ,~„4, 5 1 11 Property O ner's ailin A ress Lot Number Block Number tY6 %1 C Sta Zi ^ PF_One Number Subdivision Name or CSM Number i,v te F4 S e to 0 0 it y Nearest a II. TYPE F BUILDING: (check one) ❑ State Owned ~ village ~fib ( ' Public 1 or 2 Family Dwelling - No. of bedrooms Town OFe(XA? )C f N r 1-~ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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) New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an A) 1 ❑ System System Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 W Seepage Bed 2 t*QMound 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 D Required ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./i ch) Elevation 66 6 Feet ~O~ (s Feet VII. TANK Capacity site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper INFORMATION New Existin Gallons Tanks ' f Concrete strutted glass APP. Tanks Tanks Septic Tank or Holding Tank El ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 11-1 1 El ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewa tem shown on the attached plans. Plu er's Name: Xt) Plu76 Signature: (No S a ps) M PRSW No. Business Phone y~ e T jq 41 n 31 a7 Plumber' s Ad r (S eet, Ci to Z:i o Zia Z l (/a /to 6 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Induces Groundwater Date Issue Issuing A nt Sig ture (No am surcharge Fee) ved [:]Owner Determmi; alnation _$/~f,~j ,,Q(VV A4_P"P*'ro Ad verse Dete X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHO-6398 (R. 05/94) 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. Onste sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber 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 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan; drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells, water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I f SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations June 17, 1996 2226 Rose Street. 33 4 La. Crosse WI 5 RE~v~D r~ WEGERER SOIL TESTING cv i U N 2 1 1996 cR 421 N MAIN STREET PO BOX 74 ST CRQIX ~ RIVER FALLS WI 54022 COUNTY ZONINGOFf'fGe RE: PLAN 596-40601 FEE RECEIVED: CHRISTIANSEN, ROGER SE,NE,34,28,18W TOWN OF KINNIKINNIC COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, { erard M. m Plan Reviewer Section of Private Sewage (608) 785-9348 SBDA-7997 (x.10/94) Page of 6 MOUND : .FOR STEM S96-40601 A 3 BEDROOM RESIDENCE LOCATED IN THE SlEz 1/4 OF THE NE 1/4 OF SECTION T 25 N, R IS W, TOWN OF !~t►,trJ1CkJJ.Ily 1C S7. CC~a1X COUNTY, WISCONSIN. INDEX PAGE 1'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ~oG~z ~ ToN~ CL`h'usri~str~ L U LIZ L~ $ 1~J S 0 2'Z ✓ull SAF " ~ Ery8 e~~s• DIV. PREPARED BY WECEE:ZER SO 2 L TEST I NG ♦o®~44a4~P+11 AND. (3M c-3E= GE SYSTEM ~ s F.O. B0I 74 421 K. KAIK ST. ' RRTHJR L. i il6'C~"„ J ~ WF.CacRER t ~ plat ion ally RIYEP FALLS. VI 54022 $ _ bier'uinf~`it 715-4i`i-OIbS wrs. ' • SID ® 66 y RtMNt °4® RolES I G♦♦ %Aso B` H ;U40~ in ; set 9se ~tiQ lZ-1 l 9 OFLB P NpEWCE JOB NO. 6 - 2 PLOT PLAN Page 7-of 6 Scale 1"= 3 3' S96-40601 x ~oer~~N r 0 i C' Z . s zx; Q 9 ZV c~ZyP H. ~ L.l~ G{~lO1J S~It-ETCH J ~ , o x \ N In B•3 1 Zoo i s \ 11 6 J 47 ~ 11 3r'{ - ' r a_~{ a►t ~ NTH G ~ 3z, a-z . ` oo NoT C~*1PR~T ~ Co,.~~vvr` ~.'t , °16 • S " Tt~-1S 1YR L~ R _ NOTES : 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( L required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be 1000 /Loo gallon capacity manufactured by 1ti ~ ~ ~ CotJ CR-~ ~RU nv cTS 5.- Bench Mark it_yLiEJ 100 n' a,,) SOP of 12 `XAI CH , 31y" bit). PLC PIPE ~ St?"E "c3we R L a . 6. Divert surface water around mound to prevent ponding at the uphill side. page 3 Df 6 Approved Synthetic Covering Distribution Pipe C3-ST~"l C- 3 3 Medium Sand H G Topsoil F Elev `3 cl S 3 E D _ ~ b Z % Slope Bed Of i~- 2 %2 (Force Main Plowed Aggregate From Pump Layer D Z.D Ft. E \ . lSo Ft. Cross Section Of A Mound System Using F o.8 Ft. A Bed For The Absorption Area G l . b Ft. A Ft. H 1.5 Ft. Linear Loading Rate= q•57GPD/LN FT B t4 7 Ft. Design Loading Rate= 0.4 GPD/SQ FT j ~p Ft. J Ft. K -~1 Ft. L -8-7 Ft. Fnrr° Ma in W 3 Z Ft. L Observation Pipe 8 K F----------- A I - _ - ~ - ----------------------•I Force Main in ox", Distribution Bed Of 2N- 2 2,D°S Pipe Aggregate l Observation Pipe Permanent Markers (Anchor securely) Plan View of Mound Using A Bed For The Absorption Area Page L Of Perforated Pipe Detail 0 End View Perforated End Cop.) A° PVC Pipe Install permanent -marker f - ~ ads at end of each lateral Holes Located On Bottom, Are Equally Spaced Q ~ PVC Force Main P PVC Manifold Pipe Distri ution Pipe Last Hole Should Be I Next To End Cop End Cap P Z Z Ft. Distribution Pipe Layout S _V Ft. X Il8 Inches Y X18 Inches Hole Diameter j1 Y Inch Lateral Inches Manifold Z- Inches Force Main 2 Inches # of holes/pipe Invert Elevation of Laterals Qu.oo' Ft. bx\.\~~ x_02 xy; -zp G Place lst hole from center of manifold with succeeding holes at L48" intervals. Last hole to be next to the end cap. Combination Septic~Tank and PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE S OF -VET CAP I WEATHER PROOF JUMCTIOIJ BOIL 4"C_I. VENT PIPC APPROVED LOCKING 10' FROM DOOR, MAIJHOLE COVER rv1'M WINDOW OR FRESH wAR1J11.!` Ll48~L. A R INTAKE cwapu~r t r tj `L-1 1• I (GWi I IB'MIAI. PROVIDE I IAILET -T AIRTIGHT SEAL I I I v ~aF«~s I i ~ I APPROVED JOIUT I I I APPROVED JOIIJTS WIC W/C.~. PIPE DR Tank construction I III ' r~P6~~~ _ I I I ALARM shall comply with ILHR ('33.15 and 83.20 e j it I I OW C I Bq_ LLEY. FT PUMP-., OFF D COAICRET - r BLOCK RISER EXIT PERMITTED OiJL.J IF TAWK MANUFACTURER HAS SUCH APPROVAL -IEDPRoY6i. 86p~i►~ SEPTIC E SPCCIFICATIOAJS DOSE WZ ~R Colo IJUMBER OF DOSES: 3' 6s PLFL DAy TA1JK MAIJUFACTUILCR: TANK SIZE: »bD ~bOb GALLOWS DOSE VOLUME 5-S. ~L,~c~Q S` ST~'1 S INCLUDING BACKFLOW: N--so' O GALLONS ALARM MAIJUFACTURCR: MODEL WUMBER: l0) 11AJ CAPACITIES: A= Z b IMCHES OR 3Ol ' GALLOyg SWITCH TYPE: N-)Zzcu" 8= Z IMCHES'OK 23' 10 G( LLOW5 PUMP MANUFACTURER: C= IUCHE5 OR `tll-2 GALLOWS MODEL WUMBEM S~w'1 y D- INCHES OR lq" GALLOWS SWITCH TYPE: w~QZZ.U1~1_ MOTE: PUMP AMD ALARM ARE TO BC MINIMUM DlSCKARGE RATE Z$-08 G PM INSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFERENCE OETWEEW PUMP OFF AUD..0I5TRIBUTION PIPE.. Too FEET f MI►JIMUM NETWORK SUPPLY PRESSURE . , , , , . . ,,2.S2 FCET + _ O FEET OF FORCE MIN X ~'bI FYo fLFRICTIOU FACTOR. 0- W FEET TOTAL Dt1 JAMIC. HEAD - FEET Pump chamber DIAMETER S)~` IIJTERNAL. DIMEIJSIOLlf OF TAWK: LENGTH ;WIDTH -_..;LIQUID DEPTH BOTTOM AREA - 231 GAL/INCH AS PER MANUFACTURER = 1J.82~ GAL/INCH TOTAL HEAD IN FEET t,6" WS)i ~ - - N N W _ O Ul O Ul O Ul O p O O p N O m O D D w _ C7 ° N H p D ~ D C7 H O rn D p ~ r H r ul m z O N O ~ m .O O N H ~ Z O H v m Z o C N 0 m GO O w N O (D O E O O w p O - N W ~ Ul G) J m (D TOTAL HEAD IN METERS 1 y STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER R oqe~ D. dnd Toni 1•/l . ~`'1Y'iS~lahSQYl MAILING ADDRESS 15 3 Pov) a ey-o 5 0. R4. R i vd~r- Fa 1(s) \nl i , PROPERTY ADDRESS 12) $ C o \(\'t y T K . ' ^ TE A ST (location of septic system) Please obtain from the Planning Dept. CITY/STATE R i V e V_ Val ` 5 To vy M_ 1, p PROPERTY LOCATION S E 1/4, N E 1/4, Section _3 41-T Z. $ N-R 16 W TOWN OF K ► nY1 I C K 1 v ) i c, ST. CROIK COUNTY, WI SUBDIVISION /A , LOT NUMBER CERTIFIEDSURVEY MAP VOLUME N R, PAGE A , LOT NUMBER N/ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (l) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: e $ , ~~I 9~p 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 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 Roger 'D. q-icA Tom M. C~~i_S'~ia+-~seh Location of property ,SF 1/4 IVE. 1/4, Section 3LF ,T 2$ N-R/1?> W Township Ki yiy1+G Ki "n i c-- Mailing address 153 1bncAeY'o5ai Rd, RIVe_r r-6105,, Vii. S OZZ--S(~ZCo Address of site 12-98 8 C 0 t& V\tg rK. M 0.s Subdivision name NLA Lot no. 14 A Other homes on property? Yes No Previous owner of property C a Y V and vn Total size of property 46 QC►-G Total size of parcel 0 a CKC5 Date parcel was created S Are all corners and lot lines identifiable? < Yes No Is this property being developed for (spec house)? Yes 2!~ No Volume N/A and Page Number as recorded with the Register of Deeds. i 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. I PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 33 S 5 2_ , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. YLA ~kt; 4e_` Sign ture of Applicant Co-Appl cant /L4 A; Dat of Sianature Harp )f ~in~at~irp ~ . r r DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA tom( STATE BAR OF WISCONSIN FORM 2-1982' S33v~ i~, n 1.439 Pacr- I" REGISTER'S OFFICE i ST. CROIX CO., WI Recd for Record Gary,.A,__ Grimm. and Judith _S,___Grimm, Husband-and_Wif ez_.. ....as. Joint-Tenants - S EP 8 19 at 9:30 A. N conveys and warrants to ..Rager-Il.._.Ghr.isti.ansen.-and..Tnni-M....._ tC~ +s..r..~• istar of Deeds ._Christiansen,-.Hushand-and -holding _.as...Survivarship- Reg Marit.al_-Progen------------------------------------------ io RETURN TO fp v17-+~~•' C-e O the following described real estate in ..._.....,~t.t..QKQ;Ui .......................County, State of Wisconsin: Tax Parcel No: The Southeast Quarter of Northeast Quarter (SEJ of NEJ) of Section Thirty-Four (34), Township Twenty-eight (28) i North, Range Eighteen (18) West. fRANSFE FED This .._..ls------------------- homestead property. (is) (is not) Exception to warranties: Easements, restrictions, and rights-of-way of record, if any i' September. 19_.95... Dated this day of 5th (SEAL) (SEAL) . . . * Gary A. Grimm -------------------------------(SEAL)~~G` (SEAL) 45 * ---.)ud_tb_.- +~d111ii-t1Nti////~ AUTHENTICATION ACSNOWLEDGMEN ~a ~••.•••••~•o.• a, STA Signature (s) TE OF WISCONSIN l - a d v FIERCE County. ~i authenticated this : day of- ~ T 1T i.-~- Personally came before me this r~ / , Se tembe r _LLL -------•---P-- 19_.95-_ the ~tan'rc d A___( - Gary A. Grimm and Judith S:•-G - n.