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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Vr l
ADDRESS
SUBDIVISION / CSM#_~ LOT #
SECTION ✓ J T ,Q p
N-
R W
Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
;~)aoo ~a I se~~ c S
1,000 4I prAin P
a ,
o B.rv~ 1QQ.Q o~ %y'`Pv~
INDICATE NORTH ARROW
I
i
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: /L'Ur(j T61o
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
*4100S 0 J 4 ( Y` Manufacture : r ,r / fdC'C'Q S f Liquid Capacity:
P
Setback from: Well House Other
Pump: Manufacturer Model# 19,F33 Size
Float seperation Gallons/cycle: ~QJ Q
~r
Alarm Location L, 0" C~ r
SOIL ABSORPTION SYSTEM
Width: a Length 1616 Number of trenches '6 6/ k
Distance & Direction to nearest prop. line: N
Setback from: well :7 365)6 House -::>,XD Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wi4(0,43in Department 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.:
Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State PI o..
RICK, JERRY X
CST BM Elev.: Insp. BM Elev j BM Description: KINKIGKINNIG Parcel Tax No.:
6D A9500206
TANK INFORMATION ELEVATION DATA ~y S = g ES
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 2-627 e`~ Benchmark
Dosing lr 01W i
Aeration- Bldg. Sewer/,
Holding--~ St/ Inlet
TANK SETBACK INFORMATION St IX Outlet g°'~8o S(o
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake J ~4.5 S
Septic / NA Dt Bottom a-fl'
l % Dosing >IZ 3 ~ ~Q ( NA Deader / Man. 56
Aeration-- NA Dist. Pipe 0715'
Holding Bot. System
PUMP / SAWNMFORMATION (,,P,t Final Grade 17 n Manufacturer ,P✓ Demand - rf zY' ~3, J/ ss
r
Model Number M 33 GPM y ,LAS 1~5 37
TDH Lift Lriction Systems TDHaj.D Ft
COSS H
U Forcemain Length - .7 ` Dia.:' Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width f Length No. Of Tr niches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION DIMEN IONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING anu acturer.
SETBACK
INFORMATION Type O /7 e A__ CHAMBER Mo um er:
System: yY1o~31_ ~l' >5160 OR UNIT
DISTRIBUTION SYSTEM
Ham/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
r
i
Length 36 Dia. ~ Length 3( Dia. Spacing 30
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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: KTKNICKINNIC.23.28.I8W, NW, NW, CTY JJ
7,-)
0
- y
~ / J'~ le. Sty , Nj-~ ~CG~' ~ ~ ! ~ ,es',.~' ~ t%'L.~"rL.l~~~ ~ ~ ~ /LF~ ~ '.C!C✓ ~J
Plan revision required? ❑ Yes c❑-Pd~ /
Use other side for additional information.
SBD 6710 (R 05/91) Date Inspector's Signature Cert. No.
U -
1
ADDITIONAL COMMENTS AND SKETCH _
SANITARY PERMIT NUMBER:
O4 r k? ~,.tt-Pr t/ - ~iC r ,~d<'R~4 t2 f~yGJ Qe~ ir?~
I
I
;f, ~ Safety and Buildings Division
r~~■`r=r,. 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 pU t
than 8112 x 11 inches in size. /C.
• See reverse side for instructions for completing this application State Sanitary Permit Number
ado 7/-3
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 D 3
Property Owner Property Location
-Till t. 1i Pc, t- /q0/4 W 1/4,S a3 Tag , N, R/' E (o W
Property Owner's MaylingAddr s Lot Number Block Number
SS rr~~e x
Cit , State , Zip Code Phone Number Subdivision Name or CSM Number
( __4_'
l
II. TYPE UILD G: (check one) ❑ State Owned Cityyy ___JNearest Road T
❑ Public 1 or 2 Family Dwellin - No. of bedrooms rowa9 OF
A -A ~1 if ` r r, TT
Ill. 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)
A) 1. RNew 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ 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 (s a. ft.) (Gals/day/sq. ft_) (Min./inch)
®(J t , Elevation
6 , 5 Feet ~G Feet
VII. TANK Caaa
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Exist in strutted
Tanks Tanks
Septic Tank or Holding Tank p7(y('~ w PS 1'~~wg ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber bd l << ® ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum er's Name: (Print) Plu ignature: (No St m s) MRZMTRSW No.: BusinessgqPhone Numb r.
k® A % A In. X q ~ 3 0 7
Plumber's Address (Street, City State, ip ode):
7 c° Lj t~
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Is ing Agent Signature (No Stamps)
Owner Given Initial Surcharge Fee)
Approved ❑
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SB0-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divi icm, Owner, Plumber
INSTRUCTIONS _t
1 . A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
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-
11 . 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 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, rumbE'f oftanks and
fs) cturer's name, indicate prefab or site constructed and tank material- Corr plete far ~ar`l se;iic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experi ^lent:il c roduct approval from
CIt.HR
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropnal e refix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County / Department Use Only.
(.fl- +-rir>lete pl;rns and specifications not smaller than 8 1/2 x 11 inches must be submitted t ° e cc; my T1he plans must
,r_auz r Ville foilowincl: plot Egan, drawn to scale or vvith complete d;mensior;,. iocatic..r ioi.Aing tank(s), septic
s_;1~ 2aC 2nt t,:nk b..iiding sewers; wells; water mains/water ser.ice, sire r Y tr•:cs; pump or sip'tron
L JOi, sofl U__;orption systems; replacerrlent system !the building served;
B, Jr'c_ d caI e; vcon refere:lce f?olnts; C; cor-ipleLe s pe~i*I ICutli- for ~Jr-i .3n-t',U) d(-)Se V.7IUme;.
eievatiorv ffei~- (,i-, friction ics,~ , pump performance (:urve; pump rnodei a ;..;rip rr; I cr; D) cross section
of the soil absorption system if r qui red by the county, E) soil test data on a 1 1' -irrrl, lif ~J .,iz'ng 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 contam nation investigations
and establishment of standards
i
" I SAFETY & BUILDINGS DIVISION
in
S 45MM
Department of Ind Human Relations
June 13, 1995 47",, i% 26 Rose Street
cell; Crosse WI 54603
< l~^
1
LO 7:7.
co,
WEGERER SOIL TESTING ""•~f, r°~c;~ 1,`"
421 N MAIN STREET
PO BOX 74 •'fZ
RIVER FALLS WI 54022
RE: PLAN S95-40637 FEE RECEIVED: 360.00
RICK, JERRY
NW,NW,23,28,18W
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.
Sincere
t
Gerard M. Swi
Plan Reviewer
Section of Private Sewage
(608) 785-9348
1130R/ 1
SHDA-7897 (R. 18M)
t
Page 1 of 6
RECEIVED
MOUND SYSTEM
JUN 121995 • .FOR kS 9 6 40 , 3 7
A Ll BEDROOM RESIDENCE
SAFETY i KNS. DIV.
LOCATED IN THE NW 1/4 OF THE NW 1/4 OF SECTION Z3 ,T Z8 N, R 18 W,
TOWN OF 1~ 1 ty1V t C h l1UiJ 1 C , ST• e..12.oyx 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
lvv\2 ~Gtf'~0►J, MN ss t t Z
p=Al= BY
®srapjp.
WEGEF;Z ER SOIL TEST S NG.•«'~'w.^~ '
AND- ~s e* 7
DES S CE-4 S1ERW ICE ARTHUR
~
• MY~9£RcR 4 spa
Z 0.e55?
BLLEV/G~SR7N,
P.O. BiIX 74 421 N. 1SAIK Si.
RIV9. FALLS. V1 54022 ~ ey
715-4-45-0165
~SIGIO'
to
S , l `t 9 S
S - S 3
JOB NO.
1
C
G
SD
Aid-aPOg~p 1
~CtIV~Wtry ~
L
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O
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30 7
M
IN
0
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a
Pages 3_ Df, 6
7
Approved Synthetic Covering
Fnts7" c- 33 Distribution Pipe
Medium Sand
_ H _ G
Topsoil F Flev . ot-l.p I
E "
j.~
E '7
,
p R1
o~d b
Slope
IdVs~ . Bed Of ZN- 2 Force Main Plowed
i Aggregate From Pump Layer
u►BOR a° !_,TiaAS D ~.O Ft.
DEPT. OF IN RY,
D ! ! FEU NU :3i
# s Section Of A Mound System Using E 1 •`lo Ft.
F Ft.
E 4C0 POt:4ti; .4` A Bed For The Absorption Area
G ~.o Ft.
A Ft. H \.S Ft.
Linear Loading Rate= -I. l GPD/LN FT B 8 y Ft.
Design Loading Rate=o-1gGPD/SQ FT I NS Ft.
J 7 Ft.
K 11 Ft.
Alternate Posit*eft- L ZOb Ft.
W Z 8, Ft.
L
7- -11
t Observation Pipe
$ K
~
[JA
-t
----------------------~I Force Main
N N
Distribution Bed Of 2 - 2 2
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
/0
End View
Perforated
End Cop e~6~e PVC Pipe Install permanent marker
~a<~ s`ooc at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
PVC Force Main
Q
PVC
Manifold Pipe
Distri ution
Pipe
Lost Hole Should Be I
Next To End Cop
End Cop
P Ft.
Distribution Pipe. Layout
S 3 Ft.
k~1R S'~ST~M X -12 Inches
r~107 Y ~Z Inches
.Hole Diameter I Inch
1 rf7
} Lateral Inch(es
' t~ yM.~(s Manifold Z Inches
Force Main Z Inches
# of holes/pipe `7
Invert Elevation of Laterals 4-7-S Ft.
.I
Place lst hole 36 from center of manifold with succeeding holes
at -t intervals. Last hole to be next to the end cap.
` PUMP _ CHAMBER GROSS SECTION -ARID SPFLIFICATIOMS ' PAGE S OF 6
VEIJT CAP + I
'i"C.Z. VENT PIPE WEATHER PROOF
APPROVED LOCKING MANHOLE
JULICTIOIJ BOX COVER WITH WARNING LABEL
~ 1 0 'FROM DOOR, (.2•/n11L1.
wiMDOW OR FRESH I
AIR MTAKE I
GRADE I y" MIIJ.
18' MIIJ.
COWDUIT
11~
• PROVIDE I -
INLET AIRTIGHT SEAL I I
I I
T nAt ~c u~YaV shall comply I I I APPROVED .i01NTs
APPROVED JO1MT~ A
.1,, : ; ( I I
with ILA P, 83 ,11jand ILHR 83.20
I r,
C ,,~;dr.,. I ICI ALARM
F"< k i
i ow
C ,p, sx HI,P ',,kn 7ls
- - "7 4.1 Z BOR &
r AG+D ij, :a PUMP-~ --j
CLEW F? . of 19
iG"1 DF S OFF
y
Z ~ G" COLICRETE BLOCK
3" APPRwfr>
• RISER EXIT PERMITTED OWLI IF TAWK MAMUFACTURRR HAS SUCH APPROVAL• gEpplµ4
SPECIFICATICIMS
005E : W~~ C[)h1 C~s-n iJUMBER OF DOSES: 3' 6 9 PER DM
MAIJUFACTURCR
TANK
TAWK 51ZE: "30Q GALLOWS DOSE VOLUME r
S.S• t~~M 5'YST&I-S INCLUDING 6ACKILGW: 201.0 GALLONS
At-ARM MAyUFACTU.Rf~R:
MODEL WUMBCR: 1Z1 NW CAPACITIES: A=_14 IAICHE50R y,o1'9 GALLONS
5WITCII TYPE' 1R-11B = Z INCHES OR S7' 4LLOW5
PUMP MANUFACTURER: QV- S r.._7 INCHES OR WALLOWS
MODEL NUMBER: 33 Ds 1311Z-INCHES OR 3r. ID GALLONS
1 ~1` C.U1Z I-( MOTE: PUMP AMD ALAR~NE TO DE
SWITCH TYPE:
MINIMUM D15CHARGE RATE 3? , 6-GPM INSTALLED OM SEPARATE CIRCUITS
VERTICAL DIFFERENCE D£TWCEW PUMP OFF AUD_DISTRIBUTIOCI PIPE...\8 -3$ FEET
+ MimIMUM NETWORK SUPPLY PKE5SUFLE . . . . . . . 2•50 FEET
+ Z35 FEET OF FORCE MAIN X Z' F 00 FT.FRICTIOU FACTOR.. S. Z~3 FEET
TOTAL DYNAMIC HEAD = ZS'9 1 FEET
DIAMETER 1 `I
36 ~z
INTERNAL DIMLWSIOW~ OF TAWK: LEM&TH _ ;WIDTH _---LIQUID DEPTH
_ BOTTOM AREA - - 231= GAL/INCH
AS PER MANUFACTURER = Z& 1~.. GAL/INCH _
- 0 6
ME Series M"M
1/3 through 1-1/2 HP
Effluent Pumps
Performance Curve" - ` 7
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350 400 450
100
26
90
80 MFG 24 W
SO c
W'
70 H
LLJ
w M~/00 20
W Z
W 60
z o
AZ Q
16 Q 50 ~,S = Lij
W
T- Q
H 40 MFSQ 12 p
O ~
E-
30
is.q 1 13
20 33
2.-) 6 4
10
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 130
CAPACITY GALLONS PER MINUTE
F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805-1923
419/289-1144 FAX 419/289-6658 Telex 98-7443
K3327 7/91 Printed in U.S.A.
W...scpnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
Division of Safety & Buikfings in accord with ILHR 83.05. Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inc i ude, but s'r• 1 X
not limited to vertical and horizontal reference point (BM), di . o or PARCEL I.D. #
dimensioned, north arrow, and location and distance to ne ad. O Z-Z- 1Z)6 s- -70
APPLICANT INFORMATION-PLEASE PRINT AL ORMAQN REVIEWED BY DATE
PROPERTY OWNER: tp,, PR Ty L ON
I M%
SZ ~L I}j RAi31N R,IC 1/4 Nk11/4,S 13 T Z-8 N,R 1.8 E (or(@PROPERTY OWNERS MAILING ADDRESS ~
SUBD. NAME OR CSM #
Nce L 1 B
Y`1-1 S R%X-?~ tifV Pk \r f+t N E
E ®
fOWN NEAREST ROAD
CITY, STATE ZIP CODE PHONE NU EA` ❑CI Qm
10~ ~~~Gtt%U "IV SS1\2. (612) !kjlj lc C~•55•
K New Construction Use [)C] Residential / Number of bedrooms [ ] Addition to existing building
] Replacement [ ] Public or commercial describe
Code derived daily flow to0o gpd Recommended design loading rate "Zi bed, gpd/ft? trench, gpdtft2
Absorption area required Soo bed, ft2 Soo trench, 11:2 Maximum design loading rate Q, S berl, gpd/ft2 o. b trench, gpdtft2
Recommended infiltration surface elevation(s) S P NG E It (as referred to site plan bench r--k-
Parent Additional design /site considerations l' )U ~ w/ 6"f-8%4' BM . >~iti . I 'o F S R>"p R tro_. material Stz~ k M twT- o V m ~'ti LL Flood plain elevation, if
applicable N - A- _ It
S = Suitable for system CONVEMIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S ®U 19S ❑ U ❑ S ®U ❑ S 0 ❑ S [XU ❑ S RU
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 Tmnch
w o-tn lo`n \ 3f 3 - s l I Z g~k F4- 0-S 0-S o.b
Z ~o-~q ~ o~l rz !3 - s L 1 Z s ~k YK iF - cw - o S o.
Ground 3 ~9-3v ~•S`2tZ3ly s~ ZcSlt~k yhU~~. cS - b,q a-S
elev.
°~b_3ft 4 3y-6`{ ~,o~,cz s1 b f-ti
Depth to CU rv f~l#v S -).Is `t 2 Y! o" w L C sq d S .
limiting
faL`tot ~ 4
3
Remarks:
Boring #
~ O-9 LO `t2 3L3 - S 1, Z~sl~1z m'F►- ~S - o•So-~
Zcl~ -Z~ to ~f Q 3/ 6 S i t Z s a>t wt f~ w o. S r,.. i
V
3 Z~ 33 10 4 IZ V1 ~ S o. b
Ground f~
elev. 33=1 1o`'bR vk 12 SjS 'CS Oyy\ -,m U- Yv - - -
2~3n2 ft 1I
Depth to cAU S S 3l v trnh I
limiting
factor
33
Remarks:
CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022
S" nature: _ Date: CST Number:. -
]S3 MPft 6 T9,`~S :M0057:6
PROPERTY OWNER 1C~rC SOIL DESCRIPTION REPORT Page of
PARCEL I.D. # ZZ-- L O 6 S- 7
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed d Trench
o -Zo do `-t tZ z L L - S i l Zh1 s~ k M'~ o~ w - o• S o• 6
~r:;:>:>`<< Z Zu z.8 do ~ ~z 31 - S ~ ~ Z S b k ~ 'F>~. ~ w - o • S o • 6
Ground 3 Z$-48 Lo`ti2 3J~ ~-j ~tR S /8 S t t:~ vr~ 1~~} -
elev.
-'1') • -7 ft.
Depth to
limiting
factor
- Remarks:
Boring #
Sbh
''~,,,3.; Z `~--3D ~.O `1.2 316 - S Z.'E' S~I~t »'l Guv - 0 • S ` V• I,
-yo U ~l,' e - o o S
Ground S
elev. 4 -S Z 10`112- 3!y S k iz sJ0 c, cotes f~- cS - - ,
g3.~ ft.
5 Sz-.0 w-,rz 613 - LS%R
Depth to
limiting
factor
Ln b
Remarks:
Boring #
) o_°I 1otiR 31z s~1 ZmSbk o.S
CS o-s a 6
Ground
elev. L uZ-$ l0 `l R 3/fir S`iQ SIL' 0)1
0 - - -
g;1. Z ft.
Depth to
limiting
facto r
Remarks:
Boring #
~'~y•.:s:~x••,,•,.,:•:; felt, Z• y~OU S\. S Lt>N C~ S t)~
ow WLLL D w 1 51 lS 1'0 ~ ~
z` n<<?
Ground ~lZIOlZ 1~0 lnpUK),~ ~~S1GN
elev.
ft.
Depth to
"limiting
factor
Remarks:
PLOT PLAN Page 3 of 3
s--]0
N L,o t~11►v 5~~.~4
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N
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106 601, aF TL eL~
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relatwns
6wision of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST L `X
not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. v Z.Z-106 S- 70
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
~~.1R- ftxjlj RA131N R.ICICC GOVL-= NW 1/4 W 1/4,S 7?-3 T Z6 N,R L8 E (or1.!'J
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
\-1-1 S RR%X.Vll 1113" A 1- Nh 3 e - -
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®rOWN NEAREST ROAD
SS11Z (612) 633_60~~ `tC•IN~~CkI~►., is c`"~tt S5'~
N ~aNK% *m" 1~1)kj
pq, New Construction Use N Residential / Number of bedrooms [ ] AdditiQn to existing building
j) Replacement [ ] Public or commercial describe
Code derived daily flow boo gpd Recommended design loading rate o.34 bed, gpd/ft2 trench, gpcW
Absorption area required Soo bed, ft2 Soo trench, 112 Maximum design loading rate o - S bed, gpd1ft2 0. b trench, gpolft2
Recommended infiltration surface elevation(s) S PftG E 3 It (as referred to site plan benchmark)
-L~
Additional design / site considerations * 1 uu KJ-t, W j 6" -8 W ' lj~M - 1"t iti , l 'C F S NkiD Fi t_t.. ~S mom-.0.1
Parent material Sz1V n tI T o V L 7-%,LL Flood plain elevation, if applicable M - A- _ ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U =Unsuitable fors stem ❑ S O U IRS ❑ U ❑ S O U ❑ S OU ❑ S Eau ❑ S IRU
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color mottles Texture Structure ConsistenceBonclary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed re &
I o- lC) 10 `•t ~Z 3 L 3 s l l Z wL 3 ~bc w~ h C S
o . a.
&
- S
Z ~0-Lq ~O`1 R L1~3 S L] Z'F S~k yl f\-
Ground 3 19-3`/ 7•S`t231y s~ Zo-sbk~~~. cg - b.~( 0.5
elev.
A.b.IfL 3y-b`f vu`1C2 S16 As-1p- s/?. ~s -
Depth to CO hJ rN S 1• S `t R 11 OM L-3L t_ 0-&l k4ltM d S.
limiting
factor
Remarks:
Boring #
0_9 LO `1tL 313 - S 11 2.~s~~ mil- ~S - o•S°-~
Z OL 1.0 '-i Q 3/ 6 S l l Z S ~k ~ LN - o• S o
o~ mv'Ft- O-S - o S ` o b
3 2~33 l u `t 2 V~io - 1 ~S
Ground
elev. 33=1 ll~`'tR yI6 ~.S`iQ s~~ ~S Omu~N - - -
8l~nlfL
f
Depth to Cou S - S `t 3l 'non \Aj k t!w Tt-f~ s '
limiting
factor i
3-a
Remarks:
CST Name:-Please Print Phone:
Arthur L. We erer 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Sgnabi 7 Date CSTNumiserr
X15--IS3 = ' ~1P L-L6 T% TS
1 00 7.6
PROPERTY OWNER ~AclC. SOIL DESCRIPTION REPORT Page? of 3
PARCEL I.D. # ZZ_ to 6 S -
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
. "y
4~:.::t o -2o do ~l ~z l z s t 1 Zh1 s ~ IZ ~ ~ oQ.w - o • s o• 6
:E,:i Z ZV ZS V~ `Z 3 1 S I C S D~ V~l U. b
Ground 3 2$-4f$ Ltd' 1 R 31(~ ~-lj yR 5/8 S1 0 vr~ W -
elev.
-'1-) •'7 ft.
Depth to
limiting
factor
Z8"
Remarks:
'Boring #
10 `tom 31Z S 1 Z S b h v,,, `F h S o S o- L
3'<' Z ~z-3o ~.0~2 ~l~ - S l l Z~ sbh m~~ Lw _ o, s u- ~
3 3~-y,~ ~.S`ttzY/ - S~ 1~sUk ~~'~t^ eg _ o~y'o.S
Ground
elev, y~_S-L lz~ `1R- 3I y Fz-~S`1 2 shb C1
$,3•-7 ft.
5 Si-..60 w`tirz 613 - LSBR - - -
Depth to
limiting
`factor
"L Remarks:
Boring #
-,'~;+fi~.,«<: ) o-°~ 10~.~. 31z std Z~,sbk ~.f~ ~S - o.s o• ~
:f= Z Z
Z, u ti, ~Z 316 S i l Z S bh w► ~ c 5 0• S a 6
.Ground
elev. L( 'uZ-S l0 `t R 3/v -I V- $/S C)i
ft.
Depth to
limiting
factor
4
Remarks:
>;Boring #
, ;;A fvu Z M o u strlEs ' S wiv d S v
ow WL6L t W l c 51 is ro v$m
T
Ground ~ ~-f O1Z U 1+'l0uri/b 16/Q -
elev.
ft.
Depth to
'limiting
factor
Remarks:.
3 of 3
Page
PLOT PLAN
13 14
it,6S-
o e~
v> TLQ
5 IT IF
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
In.
OWNER/BUYER L° 16, C C
MAILING ADDRESS Q
n C-'
PROPERTY ADDRESS
(location of septic stem) Please obtain from the Planning Dept.
CITY/STATE ( / ✓l
PROPERTY LOCATION 1/4, N;k) 1/4, Section .0 T !2 J N-R ,,?y W
TOWN OF f G1 lCt~ t ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME PAGE - , LOT NUMBER r-
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 (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED: ,
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
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 Y'
Location of propert _l/4/V 1/4, Section 2,T c~2d N-RW
Township t~111 [ C Yl~ 1'I l ' Mailing address
Address of site 1 y I11
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property S 0,1/I
Total size of property
Total size of parcel
Date parcel was created - J g
Are all corners and lot lines lde tifiable? Yes No`
Is this property being developed for (spec house)? Yes r~No
Volume C' and Page Number c~ as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the o fice of the County Register of
Deeds as Document No. L~ and that I (we) presently
own the proposed site for t e 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 Vfice of the County Register of Deeds as Document No.
1
Signature of Applicant Co-Applicant
J1
-Y-/ ~ ' /J/~ Dat of ignature Date of Signature
JUL-19-1995 15:08 R I ()ER FALLS :STATE BANI<: P.03
, ~~•••r ~''';1 ~g SPACE RESERVED FnR n[CUFUINI: DATw
• ~ oocuMCrJr NO. WARRANTY DEED
STATE 13AR Q WISCONSIN F RM 2 1982
n~
v~LG.r"aSFC)~
b s
Thomas N. Christianson and Karen M. Christianson
ife.............................................................. Roed for kDoWd
husband and w -
J U L 7 1994
conveys and warrants to .Gerald R- Rick a>?d Rabin E. .)Zick, { rt 3~9y1
R+or tSaea+c
..husb~t}d:.and:..............................~..~
. ...........................i.._...................... RE . P.O. box 89
AiYER l~ALL~3, MIA i
the following described real estate in St.--.Cr-oix.............................. County, -
State of Wisconsin
Tax Parcel No
(See Attached Exhibit "A")
4 S.,
J"W
This 5••1?OC.............. homestead property.
)M (is not)
Exception to warranties: Easements, restrictions and rights-of-way of record,
if any,
Dated this . Sixth.................... day of Jt,ly....:........... 1994
(SEAL) (SEAL)
raren N - ChE-i-stdan.wn
(SEAL) r :41~,eGf~ Y . (SEAL)
' ...C 1.rigtian9o1...... .
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) STATE OF WISCONSIN
Pierce ss
.............•.......................Count
.
authenticated this ........day of 19...... Personally came before me this 6......... day of
%Isay............ 1991{.... the above named
Momas.id_.. Chris tianson..an-_KareuA.•........
• Chri
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, by § 706.06. Wis. Stats.) to me known to be the person who executed the
.0 . L .1 q foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED R `04~~: j~ L
{CO
.K~ristina Wand I Q, I A% 11
.
Attorney at Law
I` .kh.......... Notary Public.................. ierce... .County, Wis.
(Signatures may be authenticated or ackcnojede U. t~C ? My Commission is permanent. (If not, state expiration
are not necessary.) ' . Cdute: Augus.t.. ~5 19.96..)
•Naaoaa at ]»een/ alRainC in Any cAnaclty ahoultl bt Uo ~~GH,orjNM.kgU- o"Ir nianaturea. r
TOTAL P.03
EXHIBIT "A"
South 2070.0 feet of Wh of SWk of Section 14--28-18
EXCEPT 20 foot right of way, the centerline described as
follows: Commencing 1278.0 feet S89.574E of a point on
West line of said Section 14, 26x1.8 feet South of
Northwest corner of said Section 14; thence 510500E 118.1
feett thence S551161W 36.0 feet; thenco N85'521W 206.5
feet; thence S131081W 355.2 feet; thence S49'181W 666.5
feet to termination and EXCEPT Commencing on West line of
said W~ of SWN on centerline of Kinnickinnic Riven
thence South 9 rods; thence East 35 rods t thence North 28
rods; thence West to centerline of River; thence on
Centerline to Places of Beginning and
EXCEPT part West of above described right of way and
Northerly of Northerly line of second exception.
sZ~ of SEN of Section 1528--18.
Nh of Nwh of Section 23-28-•18.