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HomeMy WebLinkAbout022-1003-45-000 N OO 4. o h p ~v N G ~O ti C p O ro I ~ I o i I, I 'n I n I r ~ m O d Z C _ 3 O LL C O (I a I M v a3i I Z ~ I cn = °o I Z `m d C' ~ a m N F N O O z d co O aUi Z d U) c U) CD z ° M E o` N o c O Q 2 z z z N ° d N I N N d M a w a~ L a .3 ° o p N N i O O V o n a a1 N a ° F_ F_ ~o N ~I z > a cn O O O z o • rasa O 3 I' W LO to o w co fA ..i U Z rn rn w o M M 10 Ln o E N O co c m n N O r _ 0 o m <t } ca I C ° LO 4) c o0 0 w c o E ►,Ol ° pp ~ u o o Ow A co o LO n o m cn co u CL rn o a a c _ y~,, ~ N 'C 'D N 'l ap C N G O O O M O o a) rNi vx t r° o ~6 12 I..I N N C ! U N C O M 45 N E E Z U N O O Y ! N O z U3 L CQ O ar C O T E L: CL CL U 0) 0 L c L) a, 0 0, j STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ' ~ K 0 < m ADDRESS '`h I R'o~ 127 n P ►1J.G~ L~ SUBDIVISION / CSM# LOT # SECTION__2_T N-R W, Town of K ~~rG k G ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM q r ern c E L r Q6.Ih. i r' 33 O ~I C~z IGr o s INDICATE NORTH ARROt141 Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank- manhole cover. Y ' r l~ BENCHMARK ~ICtiS C (r i C) ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: , oc i Liquid Capacity: !:~OJ, ~ ; U Setback from: Well /q House Other Pump: Manufacturer ZyeIle/' Model # S-7 Size j r Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM f ~ Width: Length 5 Number of trenches I Distance & Direction to nearest prop. line: 33 //k,, 4 Setback from.: well:_/'~House Other ELEVATIONS Building Sewer / 2- ST Inlet: ST outlet i ~9 PC inlet PyC bottom- 0/', 5'~Z_ Pump Off ~0 Header/Manifold Bottom of system l U Existing Grade Final grade DATE OF INSTALLATION: IO/3~ys- PLUMBER ON JOB: S() e span q LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Apartment of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety-and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: PeJOCHIEdeerr'sNamee: ❑ City ❑ Village ❑ Town of: State Plan o.: , DIRK X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i ~ _C7t` . &60 Benchmark Dosing j a , /6, 13, Aer Bldg. Sewer Holding St/ Inlet TA SETBACK INFORMATION St 0A Outlet Verit irito ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Septic > SQ w' NA Dt Bottom Dosing NA 1Man. Aeration NA 61sute . y, Pipe A Holding Bot. System PUMP / NFORMATION Final Grade Manufacturer eoa-,'" Demand ic" n_f Y Model Number GPM TDH Lift Friction System,~~ TDH Ft oss Forcemain Length Dia. FFaii " Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of renches PIT No. Of Pits Insid Liqui epth DIMENSIONS S DIMNI N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC anu urer: SETBACK CH BER INFORMATION Type Of 12242 Moe Number: 3 System: l'►!otwn OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake / Length Dia. Length Dia. i ~ Spacing 3~0 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 No Bed /Trench Center Bed /Trench Edges Topsoil E] Yes C] No ❑ Yes F] COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Kinnickinnic.2 28 18W, SW, SW, t 1, County Road N j C'.,c`v!'C / i f j w4l Plan revision required? ❑ Yes ~ Use other side for additional information. l0 d p SBD-6710 (R 05191) Date Inspector's Sifgnatu Cert No. ADDITIONAL COMMENTS AND SKETCH r SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water system: 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O_ Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ( 0-0, • See reverse side for instructions for completing this application State Sanitary Permn Number The information you provide may be used by other government agency programs E] Check it rreevsiiontto previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location Dirk JochemS SW 1/4 s 1/4, S 2 T 28 , N, R18 F (or) W Property Owner's Mailing Address Lot Number Block Number 1805 127th. Lane 1 City, State Zip Code Phone Number Subdivision N gar CSM Number Coon Ra ids 55448 ( 612) 755-9701 454 (I~('. 1,6A91 . Z/ II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Town oFKinnickinnic Ct . Rd. N III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ova_ I d 43 x-45 p-Y-v 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 online B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System ------7---------------------------------------------------------------------------------------- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7- Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 450 375 375 .83 106.0 Feet 108 Feet VII. TANK Ca n gaact i llo s Total # of Prefab. Site Fiber- Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank x 1000 1 Midwestern 0 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber x 650 1 Midwestern El ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P/MPRSW No.: Business Phone Number: Joe Stang M MP6646 715-698-2266 Plumber's Address (Street, City, State, Zip Code): 506 Willow Drive Woodville, WI. 54028 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa ary Permit Fee (Includes Groundwater ate Issue Issuing A ntSi nature( Stamps) Approved F1 Owner Given initial 100, Surcharge Fee) ( Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-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. 1 All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6_ If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and,Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL 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 ling 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. Corplete }lams and specifications not smaller than 8 1/2 x 11 inches must be submitted t~ tf,.e county. The plans must include t ie following: A) plot plan, drawn to scale or with complete &mension>, location of lu!dinc tank(s), septic tank(y, or other treatment tanks, building sewers; wells; water mains/water service, strea-rrs and lakes; pump or siphon tanks; disc; ii-;ution boxes, soil absorption systems; replacement system areas; arc the location of the building served; 8) horizontal , nd vertical elevation reference points, Cj complete speci ficatiom for pur-)ps arld ~ ontrols; dose volume,, elevation differences; friction loss; pump performance curve; pump model and ;)ump rnanufac?.urer; D) cross section of the soil absorption systern if required by the county; Q soil test data on a 115 form, and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges( (lees) 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 Industr prAnd Human Relations May 18, 1995 26 Rose Street Crosse WI 54603 b WEGERER SOIL TESTING f~^ 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 ti RE: PLAN S95-40491 FEE RECEIVED: 360.00 JOCHEMS, DIRK SW,SW,2,28,18W TOWN OF KINNICKINNIC 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, Gerard M. Sw' Plan Reviewer Section of Private Sewage (608) 785-9348 8513R/ 1 SBDA-7887111. 10/841 t Page of 6 MOUND SYSTEM 4 _ 4 91 RED'.` IVED FOR S9 A 3 BEDROOM RESIDENCE MAYIb1995 SAFETY & BLDGS. DIV. LOCATED IN THE SW 1/4 OF THE SW 1/4 OF SECTION 2 ,T-Z-6 N, R la W, TOWN OF ~cl~i►U LC ttllUlU C SY• ~~U U( COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PA GE 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 21rc ~bc~F~►~tS E$o5 t.Z.1 `f}4 LM~~ N W e Doti 1~ 1~P1 uS, Y~ N SSLIV8 PREPARED BY 1~1EGE[~ER SQ I L .TESTING ~~~~~~~~~o~oQ~ AND. DES I CGM SEF~V I CE ° ` ARTH, F.O. B0I 74 421 K. KMK ST_ = o=~ ~R g RIVES FALLS. V1 54022 s rLLSV0arH 715-4-45-01651 SIGIA ~fiero~e~" 17,1995 JOB NO. OI. S 3 S PLOT PLAN _ Page Z of SCa1E 1°=.yd r ` S95-40491 kt' tit OR 3~VyD1R- PUC Ptpj~ tv~ cQ ~ 'LS \ v •Q \!L Do ~vuT Cr~ReT aR \ b\STvRg 'C4~LS R-S~1R B3 ~ Z. S'oF z P'V C t \ \ +aS N Wait ~ - J• ~ am. 10N ©F SA -O b rrQ^ O 2'`1 R~~ pN'~,c0 -Nb 'aF Rfr u L ST Se r-uwl ino~►.,p C~n~]T LET 2 S' om~ `Cl~crv4L . NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. .Install 4" observation pipes with approved caps. ( : required) 4. Septic tank to bey-mrA16S(j' gallon capacity manufactured by " t t~ ~-'1 N, Tt~\Z 1~1 P C- C^ .3r , t &j C 5. Bench Mark S kzl,3Gue 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of 6 895-49491 . Approved Synthetic Covering r~sTM c 33 Distribution Pipe Medium Sand H ~G Topsoil F Eled. l06• DO 3 E b I p % Slope (Force Main Plowed Trench of -2"-2-2" From Pump Layer Aggregate Undisturbed D \.a Ft. Soil E \..S Ft. Cross Section Of A Mound System Using F a~ B Ft. I Trench For The Absorption Area G Ft. A S Ft. H I- S Ft. B -TS Ft. I 1 S Ft. Linear Loading Rate= 6• o GPD/LN FT J '7 Ft. Design Loading Rate= 0.3 GPD/SQ FT K L ~ Ft. L `~1 Ft. A"**m-er*e Position of Force Main ~a W Z -1 Ft. L B K A- W M Distribution Trench Of Pipe Aggregate I Permanent 1 Pi es'an Markers P (anchor securely) _ 'Y~ R ArY V W R C 1 a." Mound Using I Trench For AbsorptioAre Vq,1A 1'`~ SpF i Pa ge Of _ 8 9 5100 40491 Perforated Pipe Detail 0> End View Perforated End Cap_ `y. PVC Pipe W ~o``o `bete as Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced 4 End Cap Q ~-2 PVC Force Main Distribution Pipe Lost Hole Should Be Next To End Cap Distribution Pipe Layout p 34-5 Ft. F`s X 316 Inches f Y 36 Inches Hole Diameter l/y Inch >~WVs Lateral Inch(es) ' tstaY, V''~© o Manifold Inches Force Main Z Inches # of holes/pipe ~z F.. Invert Elevation of Laterals IOd.S Ft. z8 .o8 Gp,m ti rt Place lst hole Zg from tee with succeeding holes at 3 6 intervals. Last hole to be next to the end cap. Combination Septic;Tank and PUMP CH MBFR CROSS S£CTIOM AMD. SPECIFICATIOWS PAGE -S OF I, • S95-40491 -VEkIT CAP WEATHER PROOF JUIJCTIOIJ 90X 4'C.I. VELIT PIPC APPROVED LOCKIRJG lO' FROM DOOR, MAWHOLE COVER k4011''1 WIUDOW OR FRESH wAt21.lIWG L.AgEC. --40 ~[j A~IWTAKE corapulr r r 18' M1AI. 18MIkl. \ PROVIDE I IkILE T ~ AIRTIGHT SEAL I I v APPROVED JOIIJT BAPP~~S A I I i WAPPROVED JOWT W/C.T. PIPE aR construction I I I /EI. PIPE~ fa.. I I ALARM shall comply with 11 f4R ('33.15 and 83.20 8 I e w~ I Ow .92 I FEY.99 F T PUMPS ~ t OFF ~Z r ~x~IIStRY' O CONCRETE bLOCK ~I.g• 00 13" APPRv RISER EXIT PERMITTED OIJLy IF TAWK MANUFACTURER HAS SUCH APPROVAL UDDIN4 SPECIFICATIC)US SEPTIC f DOSE kI ►`-tlDwtlZl~J 1~Cct; ~~fST 3. TAUK MANUFACTURER: UMBER OF DOSES: ~t2 PER DAy TAWK SIZE: IOOU ! 650 6ALL01JS DOSE VOLUME r Q • S •S~ MJ3 SL{S`1~"'tS INCLUDING BACKIFLOW: \A9 GALLONS ALARM MANUFACTURER: MODEL WUMBER` CAPACITIES: A= `9-:1 ILICHES OR 306 GALLONS SWITCH TYPE: WJLT12C(J1Z L( B= Z IWCHES'OR _L G~LLOL15 PUMP MANUFACTURER: 7A ~'L C = -7 ►UCHES OR -*'119 GALLONS MODEL MUMBER: S7 D- " INCHES OR 16-1 GALLOk15 ` W1~1L~1 Y SWITCH TYPE: MOTE: PUMP A1JD ALARM ARE TO BE6 Z" MIkJIMUM DISCHARGE RATEZb-. b GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFF_EREMCE DETWEEU PUMP OFF AAJD,.D15TRIBUTIOIJ PIPE.. 6- SS FEET + Mtk11MUM METWORK SUPPIy PRESSURE , . . . . . . . . . . 2.50 FEET + S FEET OF FORCE MIN X x`61 F 00FT.FKICTIOU FAC.TOR_. b'qO FEET TOTAL OUWAMIC HEAD - 9'V 8 FEET Pump chamber DIAMETER 38y IMTERLIAL DIMLW510WI OF TAWK: LENC,TH ;WIDTH ;LIQUID DEPTH BOTTOM AREA 231-- GAL/INCH AS PER MANUFACTURER GAL/INCH 4% 6% U) H HEAD CAPACITY CURVE 45/a W W "57" - "59" SERIES LL 5/e 25 _1'k - 11'12 NPT W *43/16 20I'S 35'-4®491 Q I i w U 15 a z 4 9' 5/16 J F 10 X1.4 Fj 33/32 2 Z$. 5 TOTAL DYNAMIC HEAD/ FLOW PER MINUTE EFFLUENT AND DEWATERING HEAD CAPACITY UNITS/MIN 0 FEET METERS GAL LTRS US 10 20 30 40 50 5 1.52 43 163 GALLONS 10 3.05 34 129 LITERS 0 80 160 15 4.57 19 72 FLOW PER MINUTE 19.25 5.87 0 0 CONSULT FACTORY FOR SPECIAL APPLICATIONS . Piggyback Mercury Float Switches *Available with special cord lengths of 15', available. 25', 35' and 50'. -Variable level long cycle systems *Alarm systems available. available. a Duplex systems available. Standard cord length - automatic 9 ft. SELECTION GUIDE Standard cord length - non-automatic 15 ft. 1. Integral float operated mechanical switch, no external control required. 2. Single piggyback wide angle mercury float switch or double piggyback mercury 57/59 SERIES Control Selection float switch. Refer to FM0477. Model Volts-Ph Mode Am Simplex Duplex 3. Mechanical alternator 10-0072 or 10-W75- - 4. See FMO712 for correct model of Electrical Alternator, "E-Pak". M57/59 115 1 AUtO 8.0 1 or l &7 N57/59 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 5. Sensor mercury float switch 10-0225 used as a control activator, with "E-Pak" 1 4.0 1 or 1 &7 - duplex (3) or (4) float system. E57/59 ~2301 Non 4.0 2or2&6 3or4&5 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in simplex or 2 pump operation, 111-0002. 7. Two (2) hole "J-Pak", for watertight connection or splice, 10-0003. 57 Series - Wt. 27 -.3 H.P. 59 Series - Wt. 29 -.3 H.P. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, All installation of controls, protection devices andwiring should bedone byaqualified FM0514; Piggyback Mercury Float Switches, FMO477; Exectrical Alternator, FM0486; Mechani- licensed electrician. All electrical and safety codes should be followed Including the cal Alternator. FMO495; Alarm Package, FM0513; Sump/Sewage Basins. FMO487; and Simplex most recent National Electric Code (NEC) and ft Occupational Safety and Health Act Control Box, FM0732. (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 16347 Louis ft KY 40256-0347 Manufacturers of SNIP TO. 3280 Old Millers Lane OELLE/~' O. Louisylpe, KY 40216 H (502) 778-2731 • f (800) 928-PUMP QUAL/TY PL~L/P9 15IME ~~3 FAX (502) 774-3624 abborandnHe=Reations "S~' SOIL AND SITE EVALUATION REPORT Page - of 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST CkO /X Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or y 23. 3 PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. pw 5^1'.T'e- APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION //~Rj~jC,~}r%O✓ REVIEWEDBY DATE Z~+ St H 'r j i#H O A PROPERTY eWNE-R: /3 "YE/2 PROPERTY LOCATION pl'e'< & - 7IT O C 9 -t M 5 GOVT. LOT Sub 1 /4 Sup 1/4,S Z T Z P AR 1.0 E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # e- Su~DiU. / ?0 S ( 2 7 +L, t;~ V -(A) Ptler of /3 4GLe S CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD Caa./ P4201p5 /IN, 55yY6' (6j2) 755-77o/ %'iAViViC ~7"Y 11411, IV ] New Construction Use Residential / Number of bedrooms i~ [ ] Addition to existing building J Replacement [ ] Public or commercial describe Code derived daily flow O gpd Recommended design loading rate • S bed, gpd/ft2 ' trench, gpd/ft2 Absorption area required 5'60 bed, ft2 500 trench, ft2 Maximum design loading rate S bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) Ste- r' -3 ft (as referred to site plan benchmark11 Additional design/ site con ' rations h o LJNP 7 -PC_ 5 y S r6 o - L a u G r,C AlAe 2 o'v Parent material s &e lfie/4A.IO 5 M ru s o.v Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ®U ®S ❑ U ❑ S ®U ❑ S ❑ U ❑ S ®U ❑ S Pill 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 Trench , 0-7 lom 312- - 51J 2 f, 6hk die s 2`°' . S . G 4z 9- /7 /d 313 51-11 2. f, 54& Ih" f R 'S .6 1, sb~ ~w► ~,e G'S z,~, S Ground 13t /D ye 41' 511 elev. ft. Depth to 31,-.70 /o Yjp y! 7 7• S R 51e 5// 9.e em Z limiting N factor „ Ifo Iz t' 2v,.r S X lqo S v , .i, • Soy/S fi~ SE.g dA.;A //y w r 34 CF-1 Remarks'~~ Zee ~z l7 5 / O YR S/2 S~ T Hof Ts u-v S f3oring# dt p 5 / YA3/Z Z.f~ 5ht S Z~ . S• /o V 313 S~~ z f, Slok .w., ,e S 2 . s G R~ 12-Ls /oYR SlfI shk f,e ~s lam„ , Z 3 ` Ground elev. o j, a Sft. f, s/~ f l tip , z s/e s,/ Depth to limiting N 7 SSi U factor w- 13Z 4,+ S /o yR Z. 5 4/_'GT Co.r. S o /0 D S Remarks: SO i/S S4 T V 0eA7T&_l1_> A r g.-G " . .70 'CST Name: Please Print Phone: 71s - 3,N -/PS' Address: 655 O'NEIL RD., HUDSON, WIS. 54016 Signature: Date: CST Number: IS, MASTER PLUMBER LIC. NO. 3307 M.P.R.S. y 2_3 - ~3 2 y~Z "NN,~tNSTALLER & DESIGNER LIC. N0.00663 i f I 1 7-oc kc-Af 5 ' PROPERTY OWNER SOIL DESCRIPTION REPORT Page 12. of 13 '0~e -1 PARCELLD.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxbry Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tend 2- ela- f}I b -(s ~O yie 3 2 st / S~b~C nM S s , ` k /42 6-12- /o ye 313 S.l Z.f S6K fR rq s 4" • S . Ground S/Kf/p S z Z . 3 ell ft. 13i T -Y3 /D o z S/./` 3, t." , b k -(R C S 1 A+1 -5- C Depth to 3-60 /D YR 416 s k f~ limiting /a ye j factor ~i Remarks: /t7t'~ SE so~v7//~/ 4) 7- ~¢T 33 " Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 1:xv, Ground elev. ft. Depth to limiting factor Remarks: Boring # owx* + t S• Ground elev. ft. Depth to limiting factor Remarks: COIL 01113^10 f%cfn,fi it I I j i r n o :r F~6r- N=yam ? Rl ~ m~occ~ W mm °Z 6 -4 O N r4~PQ-oX w~sT ~T ~rAut X ~x~'sr, f,?.w~•C C.iN~ cp h? m c w rn ( m 4 Q c U) J o ; V CIO ~ o O UN - ,c U) 0 3 ti c 1 x o z W I O H p o c n N O L ~ fi R ?-won J % f - i J / t'vil , 7 (.1 VL6 in Departr"nt of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 r and N~,manw!sations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but $T Cko /X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or y 2-313 PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O/v S/ T,67- APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE UL Rif S, h `►(oM So w.J z~ PROPERTY eUWNER: 13 vY&2 PROPERTY LOCATION pl,QK G 70C 9- 't S GOVT. LOT sw 1/4 sw 1/4,S Z T L P N,R 19 E (or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 8o 5 12 7 -~-f, " N ' (A) P+197- OF 13 41 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD Caa(/ ~C'~i°ips Axj, SS yyr (612) 755-9701 A~11*vvle,61-.,, ~I. L C- 7`y /fcuy IV [X ] New Construction Use [x] Residential /Number of bedrooms ( ] Addition to existing building I 1 Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate S bed, gpd/ft2 trench, gpd/ft2 Absorption area required 60 bed ft2 Soo trench, ft2 Maximum design loading rate S bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) 2 o w Additional design/ site con ' rations M nONV TYPE 5-Y,5 o L y La,u G tiA/F Parent material ZSAf S 12e 5, S 116 &j s oti Flood plain elevation, if applicable Nom- ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ®U EIS ❑ U ❑ S ®U [1 S I DU ❑ S ®U El S 0 U 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 Trench , 0-% 10 yR 3/Z .5, / 2. f, Shk =77 's . G 142- 5--/7 /oYie 3/3 S1/ Z.f, 56k fR s Z,ee , s • G Ground /)-2-,p /O ye 5~3 S// -2, ^,_j, S6t fR CS elev. _ /o y_ ft. /3 z ~ /0 YX '5/7/ 6~ C s s Depth to - 20 / U Yx y! 7 7"s y R s/ . Z limiting ~ N factor Jfo R f 2-v S% v ~ • .t-~e we,i r 3 .50'.1s SE j a,✓A Ily Remarks: 7.'//d -'*20--' lgz tiff s d Yk s/ z. S" ?_7_ ?-"'f 7- 5 0--t, Boring # 2, f :5 313 AA Fie s a S G Ground R' 12 - a5 YX S/~ -si ShK f ,C g S 1 .w, Z 3 elev. R 2$~3y /OYP, y S G j p/, o -5-ft. / C y7 /0yx 2 Depth to limiting /2 a .v L i:5 /iL"f 57- 1q SS/41,dF factor k zo-.► 13L X,+ s 7o yR 2- s '4 T 404s 0-11 D S Remarks: ,Soi/S Tf 7DRItTTV i r 6;-6 _ 7o CST Name: Please Print Phone: 311P Address: 655 O'NEIL RD., HUDSON, WIS. 54016 Signature: Date: CST Number: "CIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. _ ",NN. INSTALLER & DESIGNER LIC. NO. 00663 ~ 23 qvakk PROPERTY OWNER d SOIL DESCRIPTION REPORT ?a~e?'of PARCEL I.D. # A/I jeT 01C7 13 44te.5. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed uch b -Co Y~ 3 Z s~ / 2, Sh~C nM S , S , 3 4 z. 6-12- /O Y le 31-3 S.l 21. f S6et nM fie s Z , . S . CP Ground l3, 2-/y /D yie 5/y 5/1 /,f, s/& M'~f/l' s z z , 3 /o_,.el,' h -33 ioy.P yl .5i/, 3,mA bk -F2 cs I . S Depth to C 3-Ga /D Yk 41~ 7 s fit rn f Z limiting /a YR Syk ' fa~tor t Remarks: soi/S /17p> SE Al 41/1 lvf r- ~9 T 3,3 Boring # S Ground ` elev. ft. Depth to limiting j factor Remarks: Boring # v Ground elev. ft. Depth to limiting factor Remarks: Boring # y~Sli:~i:::4:•:4.i•.:~k Ground elev. ft. Depth to limiting factor Remarks: COM z R n N sn o J o r -,-a~rm m 0 W mai~ ~occ0 OM ~z G \ Az~ r. -p aR r % hPPeox wts r c.vr t X ~XI'Sr, f.Q.~n,c~G LiNA. CP m ~ ~ w N rn c U) J L o C/I, = V CIO ~ o b ~ G In Ri 0 3 Nw ~rn c ~ n 0 ~ L ~ ~o ~ G V1 W t 03 ~ rn ~ ~ l SQ c ym c 14 1 R ~ I STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNEWBUYER Dirk Jochems MAILING ADDRESS 1805 127th Lane Coon Radis, MN 55448 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE 1315- C- 7-14 ~rA] PROPERTY LOCATION SW 1/4, SW 1/4, Section 2 T 28 N-R 18 W TOWN OF Kinnickinnic ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAP 503144 , VOLUME 9 , PAGE 2659 , LOT NUMBER 1 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 tile ov.,ncr 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. 1-Akle, the undersigned have read the above requirements and agree to maintain the private se"age 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 Si Cro,., County Zoning Officer within 30 days of the three year expir o d~ SIGNED: Derr: St. Croix County Zoning Office Government Center 1101 Cannichael Road liudson. \Vl 54016 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 Dirk Jochems Location of property SW 1/4 SW 1/4, Section 2 T 28 N-R 18 W Township Kinnickinnic Mailing address 1805 127th. Lane Coon Rapids, MN 55448 Address of site N6- C04 f u Subdivision name Pending Lot no. Other homes on property? Yes x No Previous owner of property Leland R. Wolfgang Total size of property 13 Acers Total size of parcel 13 Acers Date parcel was created Are all corners and lot lines identifiable? x Yes No Is this property being developed for (spec house)? Yes x No volume 1029 and Page Number 219 A as recorded with the Register I 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. 504211 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 y ded in the office of the County Register of Deeds as Document No. 504211 cant r CO /I Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS. $FACE RESERVEO FOR RECORDING OATH WARRANTY DEED ii 504211 9PAGE 219 3 OF VOL 1.012 ST. mac m This Deed made between ........-Leland R Wolfgang.... j Reed kw0A.oj and. James $eanF_isk............ j . AUG 2 p 1993 j• . - ui ' 3 ~ Grantor, $ M I and ..Dirk. G.....Ioch.ems. and...Cor.n.eli.a..Jochems,....------- husband. and wif a as..survivors.hip..m.ar.ital...... property , Grantee, Witnesseth, That the said Grantor, for a valuable consideration..... !I - _ L~l~k ~o .~~ch~m5 It RETURN TO cunveys to Grantee the following described real estate in ....St.... Croix . County, State of Wisconsin: /lms• ~,tQ) 1-27,4ave- C00", 94""Jss' ~/{JST. Tax Parcel No: Lot 1, Volume 9 , page 2659. As Document No. 503144. Certified Survey Maps, being a part of the SW -4 of the SW4 of Section 2, Township 28 North, Range 18 West, Town of Kinnicki.nnic. Subject to easements and rights of way of record. j~ l I~ FIB homestead property. This - ~is) not nut) Together with all and singular the hereditaments and appurtenances thereunto belonging; AI,d.......... Lel.an.d...R.....Wolfg.ang...and... James. D. Fi.sk_._ , N%arrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and rights of way of record and will warrant and defend the same. Dated this 30th day of joly.. - .....(SEAL) G_ Leland R. Wo p.8 a~k% Leland W a . (SEAL) _ .jS~.LI aames Dean Fisk" i. ~ •~I4S„~,~~ j AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN as. St. Croix Y ...................•---------County. this ....3.0 JU ly 0..day of I; i authenticated this ...._..da of.'-..-_:--'......-.----'-: 19 Personally came before, 1nie 9.93 1... the above named , II . , ` ---•J.ams_._Dt?l?'!E.i.sk.............. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to me known to be the pe sun _5 who executed the foregoin ~Strument acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY / G.....L.-...Gaylord1 Attorney... ~'C. River Falls WI 54022 (`.J • 'J)ta•-y Public T.?.. --County, Wis. (Signature; may be authenticated or acknowledtred. Both P"'!• Commission is ermanent. (If not, state expiration are not necessary.) date: _..A144 3-~?-------- II 19.9•) ~I I 'Names of ycnona eijninQ in any capacity should be typed or printed below their signatures. I ~l~tG R111e► STA'rtORM No. I 1982 WISCONSIN ___J Stock No. 13001 t - UQL. /0' e, Pte' ~l 1 State of Missouri ) ss. County of Wright ) Personally came before me this 9th day of August, 1993, Leland R. Wolfgang, to me known to be the person who executed the foregoing instrument and acknowledged the same. 0 My Commission Expires: March 23, 1995 Colleen Stofer Notary Public a ~ t I • J A CERTIFIED S "JEY MAP JAMES DEAN FISK AND LEELAND WOL CMG' Part of the Southwest 114 of the Southwest 114 of Section 2, Township 28 North, Range 18 West, Town OF Kinnickinnic, St. Croix County, Wisconsin. Description: i That certain parcel of land located in the Southwest 114 of the Southwest 114 of Section 2, Township 28 North, Range 18 West, Town of Kinnickinnip, St. Croy County, Wisconsin, more Fully described as follows; Commencing at the Southwest corner of saidoSection 2, the POINT OF BEGINNING, of the parcel to be herein described; thence N 00 2615611W (assumed bearing on the West line of the Southwest 114 OF said Section 2) a distance of 1262.781; thence N 89031147"E 14.071; thence Southeasterly on a curve concave to the East, having a radius of 716.201, whose chord bears $ 2905$11311E a distance of 616.661, on the centerline of C.T.H. "N"; thence''dpnt1nyq,on said ° centerline S 5128'13"E 785.601; thence Southeasterly on a curve concave to the Northeast, having a radius of 818.511, whose chord bears S 55050113'1E:a;distance of 124.64', on said centerline; thence S 38°31'47"W 163.101; thence N 69a541?W'1W 269.921; thence S 88°43'15"W 100.001; thence S O1°16'45"E 100.001; thence S 88°43'15"W 539.22' on the South line of the Southwest 114 of said Section 2, to the POINT OF BEGINNING, containing 11.759 acres, being subject to easement over Northeasterly portions of said parcel for C.T.H. "N" R.O.W. purposes and also being subject to easements of record. Oated: June 8, 1993 This instrument drafted by Laurence W. Murphy Each parcel shown on this map is subject to State and County laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel contact the St. Croix County Zoning OFFice For advice. State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owners, James Dean Fisk and Leeland Wolfgang, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 o1=.the Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and correct representation thereof. N~NN~ uurN % \5G O l,S/N , % =rLAUR N M W 1Y13 r IV FALLS,..-'* L ISC. t. qF'• S% LAND Laurenftf 'Oil' rphy Vol. 9 Page 2659 Registered Land Surveyor Certified Survey Maps St. Croix County, Wisconsin SHEET 2 OF 2Y~ AUG 0 1993 P- r JAMES O'CONNELL 5 9 03244 2 aogkStol o, 09aes S4 Croix C4; Wl 0 W114 c 0 R. sec. r 2 B N, R/ B w, CERTIFIED SURVEY MAP / c ouN r v s uR vE r oR's NON.) JAMES OE AN FISK A NO t FF1 ANO WOL F-'C,~ING y "art of the Southwest 114 of the Southwest 114 of Section 2, Township 28 North, Ranr..e 18 West, Town of Kinnickinnicl a St. Croix County, Wisconsin. b U_NPLATTED LANDS N 89 • 3! ' 4711E 14.071 \ O Indicates 1" x 24" iron pipe weighing 1.13 lbs./lin. Ft. set. o \ ,`~I~IIIIIIfIfp~ ~ b 33 In -1A + % \ F~ q 6 50, LAUR NC . m W M p oc APPROVED RIVE 'FALLS, • J~ ; W WISC, \ . , q~-.,,. h 2131 L A N D 5~~••~ w Lauren 6481ASOA urphy 7T. CROIX COUNTY I FENCE Registered Land Surveyor o b %Inowsllotlsitra PlatttMy Q o G r~" Zonirlp f~tld ?I b \Z,o y o Parka Catrr~ittN J 3 ro O W Q: ku 3 i within 30 days of b b ~ W I " L 0 T.` s m appro~rel dote J ' % i11~~Vi ~A • / I1.739 ACRES \ \ QS Q to Q IIi111VOW Q o0 3. / 2 , 22 6 So. F r. \ • `v \ Owner's Address : JI .9. 909 ACRES EXC. ROAD y ~r Q. R.O. W . s\ ~m 1279 C.T.H. "N" Z 4 3 6 3 3 s o. F r. •a•,\~t` \ Roberts, WI 540?3 I "hone No.- ?17-T4?cr_?a41 ^Y rc ♦ ~ o~ {r\ y \ r Oated : June 8, 1993 ~0, y \ \ 6y' Q~ ~r \ W 4~ 2 "This instrument drafted by J ~(Y Laurence W. Murphy S88.43'15"w O• 3 /00. 00' SO/•/6'43"E/00.00' ~ds•Jy " `f 0 45 Q~ J39.2?' ? 9yF?Orrv' 01 /6.81, . SW cOR. SEC. 2, r28N,R/8W, Sao, 43'/1"W 2636.03' / ICOUNrY SURVEYOR'S MON.1 UNPL A TTED LANDS / SCALE 200' S LINE SW4 O 10' /019' 200' 300' 400' $00' 600' s114 COR. SEC. 2, r 20N, R/8 w, I COON rY SURVEYOR'S MON.) CURVE DA TA URVE CHORD BEAR/NO CHORD D/Sr. ARC RADIUS CENT. ANGLE /Sr TAN. BEAR. 2ND rAu. BEAR 521. 18'13"E 616.66' 637.10' 7!6.20' 3/•00'00" SOO•ZB'!3"E $S/•2B'/3"E 3-I 511.10'/3"E /24.64' 7?4.76' B/8.1/' 08.44'00" SS/•28,/3"E s6o•/2 1-6 NJ4.4a'0?"W 440. 45' 446.73' 766.?O' 33.24'22 N11•281/3"ly NIB•oJ'I/".W Val. 9 page 2659 Certified Survey Maps St. Croix County, Wisconsin. SHEET 1 IF 2