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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page L of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST CO/' K
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 9WNER: 1,3 v PROPERTY LOCATION
T'OM 3 6-,41' L .vp e.✓ GOVT. LOT /VE 114 /VW1/4,S ~~_T 2-e N,R /e E (o Wi
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUB
AJP7_ tor
D. NAME OR CSM # d
CITY, STATE ZIP CODE PHONE NUMBER OCITY VILLAGE WN NEAREST ROAD
U So,-) Cv/S" . Sy61& (its) 3 14? G -27DS '&61itivrG-- emu" ~p~~.✓
[ ew Construction Use [ Residential / Number of bedrooms y [ ] Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow & G y gpd Recommended design loading rate - bed, gpd$ , E trench, gpd/ft2
Absorption area required S~ bed, ft2 S6z) trench, ft2 Maximum design loading rate 7 bed, gpd#t 2 trench, gpolh
2
Recommended infiltration surface elevation(s) S-ec. 'P q . 3 ft (as referred to site plan benchmark)
Additional design/ site considerations s/TE u rT ,B/ - o.v ~o~p ~fOV-vp 7 O~ S STc~'A! S
Parent material SC 92- 1,136 r1,P0 S Flood plain elevation, if applicable ft
E N .aJ
S =Suitable for system CONVENTIONS MOUN F I IN-GROUND _PRI,SSURE AT S DE / S❑YSS IN FlLL HO SING~
U = Unsuitable fors stem 11 S EN I Dos- p U O S Lr]~' [g'U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft
g in. Munsell Qu. Sz. Cont Color Consistence Baxtdary Roots
Gr. Sz. Sh. Bed Trench
/o yle `//3 /S / ,?vf~P 5 /,w. -
Ground V,49 /m a 7i ?
elev.
ff, g~ ft. g'o ~o 7/3 P s ~f. s s d s ti ti N
Depth to ~~HE~r GG~ SES
limiting
factor , iP i Zd-v G/~ S e G
57P-0,4.) 6- t c WiA t; E 7' j~ ~9 G~.o s ' 6v !/S
13, R ' Remarks:
Boring #
/0 Y,4e Yl 2- A5- fe 2- -F. -7
2
2 y ~'90 y/ 3
Ground /O S S /cwt ~jyt vf~P L'$
/p6.12, ft. I~- ,D /o //t' 713 7 s 513 U/. s , O,
Depth to
limiting
factor t
4'S - Remarks: /74b.e i 2o.v .~ri s GuE ,~L 5M1.4, L
B ' ko' CST Name:-Please Print -PO B&-,e T 77 Phone: 71.4
Address:
Signature: Date: CST Number:
r wiNT 'TP *t57" eeAJPIT/oNS
svvv y yo °f, z~ ~ Ieo s7-
s
A;
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PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3
PARCEL I.D. /
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDJft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tn
y ° ~/Q /o y~e y /4v fiP S - ~7
Ground 3 D
elev.
ft. s /D 7/ S s b f s. 0
-7 v
Depth to
limiting
factgi C ~q ti 7 GG~ S
L -
ss
13-k - Remarks:
Boring #
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Ground
elev.
ft.
Depth to
limiting
factor
F7
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev. T
ft.
Depth to
limiting
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Remarks:
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STC - 104 ~~;~71X
AS BUILT SANITARY SYSTEM REPORT
OWNER h ler
sQ/1
ADDRESS 8~ Sc DPI
t~ c~.s~h ~f 1
SUBDIVISION / CSM# LOT #
SECTION-?T- a,3 N-R-16 W, Town of
1~i,ti't 1G11 f .L
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
se a It
635 ,'Upl flee /00,
Spike 1211' '4bore
0 /re-e
5 „T n
/Y
/V of f- BM on S-tt, {,proved
Plan i,S nor ►n t4a r1~kr 3 ORM
Placle) /Is - 8uitfi ~s j/or~e
R+ r INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
A
A
BENCHMARK: S/RikO D1/a T >0,s ~yPV
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Wt li t r Liquid Capacity: D D Od
Setback from: Well /V f,l /%House No /h Other
Pump: Manufacturer J Mode l# ~u L40 Size
Float seperation /l Gallons/cycle: 130
Alarm Location IL~QdC'/yLEw~
-;SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line: 71J
/Vol ,n. Alot 1 n
Setback from: well: House Other
ELEVATIONS
Building SewerA 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 : 1Od tt l x l ice-SO& Aer h Q,•~
LICENSE NUMBER: M
INSPECTOR: J / h
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
LOboranci'F~umanRelations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Pe;rp tl-iaJ §61Vame- El City E] Village f1 Town of: State PI o.: TOM A1V 11 +K , R
CST BM EElev/.:Insp. BM)Ele'v.,:) BM Descriptioon: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA -s
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Q~ r ~ f, GNU Benchmark Zj 6
Dosing ~a>~= `rG' ~
r~l
Aerate Bldg. Sewer
Hol St/ lelnlet /
f,
G/ j lr f
TANK SETBACK INFORMATION St/ FWOutlet
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet - -
Air I
Septic > !570, NA Dt Bottom
Dosing > 50 NA Header /Man. zo SC 7
Aeration NA Dist. Pipe
11.7) 5:zo' 94 s
Holdi Bot. System , . cX
PUMP / INFORMATION $ G~ Final Grade <i
Manufacturer Demtnd
Model Number rj yyf y 41 G
TDH Lift,,,g~ Friction 1-5 Systemi. T D H
(pJft
oss Forcemain Length Dia. Ha" Dist. To Well 3
iSOIL ABSORPTION SYSTEM
r` BED/TRENCH width r Length 7 No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIM I N
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACH IN Manufa r:
SETBACK
INFORMATION Type O ~ CHAMBER odel Number:
System: h^c ~f~j d' OR UNIT
DISTRIBUTION SYSTEM
Her /Manifold r Distribution Pipe(s) x Hole Size X Hole Spacing Vent To Air Intake
Length Dia- o? , Length Rs Dia. Spacing XX /I I rQ
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: Kinnickinnic.25.28.18W, NE, NW, Lot 2, Evergreen Drive
CGS 6 k-- C 1 c= l~ / //Cf /6L~-' j~
Plan revision required? ❑ Yes 2_14
Use other side for additional information. e
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No
SANITARY PERMIT APPLICATION
' In accord with ILHR 83.05, Wis. Adm. Code COUNTY
St Croix
STATE SANITARY PE~R/MIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than c L4913 1
8% x 11 inches in size. ❑ Check if revision t6 previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 95-41033
PROPERTY OWNER PROPERTY LOCATION
Tom Anderson NE t/4 NW '/4, S 25 T 28 , N, R 18 )eRWW
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
985 Scott Road _ 2
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
Hudson WI 154016 715)386-2705 Y91.. 10 page 2881
II. TYPE OF BUILDING: (Check one) El State Owned NEAREST ROAD
Evergreen Drive
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms 4PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) 022-1070-20-100
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranUBar/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 in line A. Check line Bit applicable)
A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit 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 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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 .5 98.0' Feet Feet
VII. TANK CAPACITY Site
in gallons Total # of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or 1 Wieser Concrete
Lift Pump Tanta 600 1 Wieser Concrete
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plu Signature: (No S amps) MP.ZVR IN No.: Business Phone Number:
C 6780 715 425-5544
Plumber's Address (Street, City, State, Zip Code):
N8230 945th Street; River Falls, 54022
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agen ture (No Stamps)
,may(
Jd[J Approved El Owner Given Initial Surcharge Fee)
~
Adverse Determination 8'0
0
f
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety s 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 the 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 (S8D 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 & 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.
Ill. Building use. If building type is Public check all appropriate boxes that
aPPIY.
IV. Type of permit. Check only one in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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 Wi 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
• I SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
August 24, 1995 2226 Rose Street
jj La Crosse WI 54603
~ nn
WEGERER SOIL TESTING -4 421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S95-41033 FEE RECEIVED: 180.00
ANDERSON, TOM
NE,NW,25,28,18W
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.
I
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,
ennis Sorenson
Wastewater Specialist
Section of Private Sewage
(608) 785-9336
SHDA-7997 (R. 10194)
Page of b
MOUND SYSTEM
U~ 6 19 A 3 BEDROOMRRESIDENCE S95-4103,9
5 DIV.
LOCATED IN THE NL:l 1/4 OF THE Nui 1/4 OF SECTION Z,S,TZ8 N, RIB W,
TOWN OF ktkQ►V \CtzL~J IV 1 C , ST• C-\2AlIC COUNTY, WISCONSIN.
INDEX
PAGE l '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
PA GE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
NZ~) ~z-12.SON
°t S S S C~TT R,u A D
1v , w) s 01~
PREPARED BY
WEIS EF:;t E: I=;-- SQ I L. TEST S NG
AND
D 1=-:!E3 I G P4 S IE= F:z w I C E as ARTHUq .
2 a F
Q~ • g15VI YiOFiTM,
F.O. BOX 74 421 K. KAIK ST. wrs.
s e
RIVET? FALLS. MI 54022
SIG14
N~sea
Rvca, 11, l9 9S
JOB NO. q S - Z Y
- PLOT PLAN _
Page Z of
Scale 1„=
S95-41033
ao v~►or c.~n-~pq-eT- oil
_LLgS$ -LSD
1` 32'
i
32 ~ '
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6
a~4~•°~ 3~l°
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Z BM - V-L, t~o.o' oN sp1h.6 Zy1' C
r~uvL - vR.uvw.,p try.,
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or- 4 ~PV c
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NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. (Y required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be Mo /600 gallon capacity manufactured by
5. Bench Mark S 10fe0U1r' lit-PrN
6. Divert surface water around mound to prevent ponding at the uphill side.
S95-w41033
Approved Synthetic covering
Frs-7m c 33 Distribution Pipe
Medium Sand
Topsoil = F Elev q$ , 0
E D
3 `
b
Slope
Bed Of iM 2 %2 Force Main Plowed
Aggregate From Pump Layer
E< D 1, 0 Ft.
E N. Z Ft.
Cr Section Of A Mound System Using
A Bed For The Absorption Area F o.8 Ft.
G Ft.
A S Ft. H 1. 5 Ft.
Linear Loading Rate=Q-S-I GPD/LN FT l3 - -~J-j- Ft.
Design Loading Rate= D,y GPD/SQ FT I Ft.
J g Ft.
K ~O Ft.
A;4@-r~ Position L 6-7 Ft.
of -
Force Main W 3 Z Ft .
L
Observation lipe $ K
A I
------------I C'--- KA
Distribution --~Bed Of 2"- 2
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Of io
Page
Perforated Pipe Detail S95-41033
I
0
End View
)Perforated
End Cop) boo PVC Pipe
i . ~o~~o `once
o,S Install permanent marker
at ei.d of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
i
Q
PVC
Monifold Pipe
PVC Forte Main
Distri ution
Pipe
Lost Hole Should Be I
Next To End Cop
End Cop
P Z Z Ft.
Distribution Pipe Layout
S Ft.
X Y3 Inches
Y Inches
Hole Diameter 1~y Inch
Lateral ) Inch(es)
S
Manifold Z Inches
Force Main Z Inches
# of holes/pipe
rte.: .
Invert Elevation of LateralsgB.S Ft.
Place lst hole 2(4 from center of manifold with succeeding holes
at (4 8" intervals _ Last hole to be next to the end cap.
Combination. Sepi<lq Tank and - -
PLUMP CHAMBER CROSS SECTI(Q WD_-5PE~IFICATIOMS' PAGE S OF
VET CAP WEATHER. PROOF
JUUCTION Box
ti°C.I. VENT PIPC APPROVED LOCKING
'-•lO' FROM ODOR, M&WHOLE COVER wll'K
wARNt►JG Lt4eEl.
•dItJDOW OR FRESH 2
couputT
AL►t INTAKE 895-41033
t
I
LL g S - I ~r' MIM.
1 115' Alm.
16MIN. Z., \
' 11~
PROVIDE I -
IAJLE T 71
AIRTIGHT SEAL I I i I
A APPROVED
APPROVED JOIfJT 84FFL~S I III JOW
C.I. PI PE W/C.I. PIPE~f
W
Tarik,~ cong,tr,uction ALARM
•s.kh-all.cmpl..y with, I 11
4f.
ILHR 0 .15• and `33:20 a I I
. _ - I i oIJ
C
PUMP OFF
D COIJCRETE
O BLOCK
3" APPF
RISER EXIT PERMITTED OIJLy IF TAIJK MANUFACTURER HAS SUCH APPROVAL. gCpDlti•
SEPTIC E 5PEGIFICATIOA.IS
D 0
5E MAIJUFACTURE R: WLOM llfYJ C,VQTM IJUMbER OF DOSES: 3 ' PER DAy
TAMKj
TAWK siZC: t~Cw ! 600 GALLOWS DOSE VOLUME
S~Snsy i IAICLUDING OACKFLOW: 0 GALLON'
SAS.
ALARM MAUUFACTUR6~R:
MODEL WUMBER: 1 ~t ~W CAPACITIES: A= Z INCHES OR 301' 3 GALLOiv~
SWITCH TZJPC: cili Y 5= IWCHES'OR Z3'~G(LLOU~
PUMP MANUFACTURER* `-tEzs C: 1 I IWLHES OR ~3u'2 GALLOU'_
MODEL MUMBER: SR y D= Z INCHES OR_1q"?3 GALLOIJ! 0 1. '1
SWITCH TYPE: MOTE: PUMP AND ALARTI~AR UTO E
MIMIMUM DISCHARGE RATE ZS' O$ GPM IN5TALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AlJD..D15TRtbUTiow PIPE_ q' S O FEET
-F MINIMUM m[TWORK SUPPLY PRESSURE 2.50 FEET
I 65 FEET OF FORCE MAIN X 1, F j0FT.FKICTIOIV FAtTOR_. S FEET
10
. = TOTAL DYNAMIC HEAD = 13-0 S FEET
Pump chamber DIAMETER -
r- ` 11
iIJTERNAL DIMLWSIOIJ~ OF TAWK: LE►.IGTH ;WIDTH LIQUID DEPTH l
BOTTOM AREA - 231= - GAL/INCH
AS PER MANUFACTURER = l~-$Z GAL/INCH
WtsconsmDepartmentoflndust , - OIL AND-SITE,EVALU`ATtON'REPORT _Laborand_Human -Relations
• UlvySiun-3f safety &13criidirigs _ _ -
in accord withlLHR 83.05, VVis.7dm. Code
' _ COUNTY
" S't"• G~.O LX
s Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BMand % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distanc MF
.00 q.
APPLICANT INFORMATION-PLEASE P NREVIEWED BY DATE
PROPERTY OWNER: .9G PERTY LOCATION
TO)I-A NKj Z) k~!1Z S 0 CrC('`' 1WF 1/4 NW 1/4,S ZS T 18 N,R 1$ E(ore)
PROPERTY OWNER':S MAILING ADDRESS BLOCK# SUBD. NAME OR CSM #
4 S S S Carl- Ric) j
CITY, STATE ZIP CO PHONE NUMBER ❑VILLAGE (MOWN NEAREST ROAD
`t'NnSO)v WI S~-l.ul6 lS)3t?6 uv►..~~C\Z-Ln~t~.►lC ~~.Gft~1N Dlz.
[DQ New Construction Use (,4 Residential rspf [ ] Addif Qn to existing building
j ] Replacement Public or commercl
Code derived daily flow VSO gpd Recommended design loading rate cN. y bed, gpd/ft2 - trench, gpd/ft2
Absorption area required 3' 1 S bed, ft2 31 S trench, ft2 Maximum design loading rate Z. S bed, gpd/ft2 0. ( trench, gpd/ft2
Recommended infiltration surface elevation(s) g8.0 ft (as referred to site plan benchmark)
Additional design/ site considerations `~'\ovn~p w/8 "Y l17, tm _ f~11►y , )rot= SArvn f ;u_ t Z 1e
Parent material : S ftKjz SZ'o~'j N Flood plain elevation, if applicable N3- ft
S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑ S 14U ® S ❑ U DS U ❑ S ®U E] S U ❑ S ®U -
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BouxJ3y Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench
• `f. Q 31 1 1 s ~ w~ ~ w. v'F-~- s 3 of o , 5 t,. ~
S/ S l~ S 91 V 'l~ ~l . S Q . V
f 1 ~•s ~~~s/
Ground 3 ~LZ S` tz 4/~fo dtU`-t 6!) Sl r1 1 4S
elev.
°)8.3ft. ~l$-S9 1~`1\Z ~,~J f]~S-1v-S Ynv`~1r- _ - -
Depth to LS V-)VL)F - oKJ s S
limiting
factor
L 1'
Remarks:
Boring #
1..Z Z S 3L% 1 `'t2 s1y - S O s vnUi- C_S o. S o.
.Ground..... 3 3 ~-~1$ L U `t t2 $ ll . S y \2 SI ~ ~S O~ >1n v~j,, - _ ~
elev. L
d ft. lZ \ s 1'-S f ~ L l~ l~ht t'V - S r~ 1 I
Depth to
limiting
factor
Remarks:
CST Name: Please Print Phone:
9r*>1ur T; . t,?eoerer 715-425-0165
ess:
erer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
eg
Signature: S_ Date: ` G LO t l9 C, 5 CST Number: Z 0 0 5 7 6
PROPERTY OWNER ~~~~ZSON SOIL DESCRIPTION REPORT Page Z of
#
PARCEL IA
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft,'
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T
0_ b ti ~u► \Z 31Z OL-S 3 u
3 `n
Z (,-3S 1.x`1\2 S1 1 't-S O S YnU'F1- CS - 6.5 o•b
Ground 3 3S_SO l0"lR 8 c-~:P S1S Caw. M V _
elev. t.C~ - S
9 S, ft. 3 lZ 1 S S 1-c. ~ ~
Depth to r
limiting
factor
c
i
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SRn_a3sMR nr;M:'l
PLOT PLAT Page 3 of 3
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CST Signature Date Signed Telephone No. CST #
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2 KATHCffN4 199,5
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CERTIFIED SURVEY MAP
LOCATED IN THE NE 1/4 OF THE NW 1/4 OF SECTION 25, T28N, R18W, TOWN OF KINNICKINNIC,
ST. CROIX CO.,WISCONSIN.
PREPARED FOR : RANDY CUDD
NOTE: BEARINGS ARE REFERENCED TO THE
NORTH LINE OF THE NW 1/4.( ASSUMED).
NI/4 CORNER OF SEC.
NW CORNER OF SEC. 25.
UNPLATTER LANDS 589.57'24"W
NORTH LINE OF THE NW 1/4 24.75
N89•57'24E N 89057'24~ E 1 2 9 7. 34
1322.09' 827.00 470.34
S44°57'19"E
34.95
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O.
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M m
m N
M LOT I - LOT 2
2 5.08 ACRES , 14.99 ACRES
W O 11,092,624 SO.FT.1 (653,094 SO.FT.) 3
m 24.89 AC. EXC. ROAD R.O.W. W M 14.96 AC. EXC. ROAD R.O.W.
N ( 1,084,329 SO.FT.) `N, 1651, 750 SO.FT.1 Ol
00 -
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_ N89.15'42 W 831.00 ' e31.0 0' 495.08
N89 15'42"W 495.11
_ M M
M VERGREEN R I V 1_326.06 M
U N PL ATTED LANDS tjt;C1~:lS&~~~~
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0
'4r JAMES
Z ` Jr, a WEBER
' ® v COUNTY SURVEY MONUMENT FOUND. FEB ~ S-1804
SPRING VALLEY •
O =SET 1"X 24" IRON PIPE WEIGHING s w'( WI$• fly
1.13 LBS. PER LINEAR FOOT. TV f
pp3it ;i~. ~ts e ~p A0
SCALE I 200' t'ca~~.~tatl~t ~~PdI . U
,.~E?• ~1).<',~ JAMES M. WEBER S`-1804
NELSEN - WEBER SURVEYING
r` it1 ".P10 days of DATED
S H E E T 1 0 F .24-,.-ro al da: o -z - -z 3 N
94-167 THIS INSTRUMENT DRAFTED BYJIMWERE;Ry,-)roVaiSit;.r5li_`^
Vol 10 Page 2881.
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Thomas & Gail Andersen
MAILING ADDRESS 91I85 Scott Road
PROPERTY ADDRESS W Evergreen Drive; River Falls, WI 54022
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE River Falls, WI 54022
PROPERTY LOCATION NE 1/4, NW 1/4, Section 25 , T 28 N-R 18 W
TOWN OF Kinnickinnic ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER 2
CERTIFIED SURVEY MAP 526214 , VOLUME 10 , PAGE 2881 , LOT NUMBER 2
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: e z'
DATE: A h~
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
STC-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 Thomas & Gail Andersen
Location of property NE 1/4 NW 1/4, Section 25 T 28 N-R 18 W
Township Kinnickinnic Mailing address 985 Scott Road; Hudson, WI 54016
Address of site IL 16e) Evergreen Drive; River Falls, WI 54022
Subdivision name Lot no. 2
Other homes on property? Yes No
Previous owner of property Randall & Yvonne Cudd
Total size of property / qq
Total size of parcel
Date parcel was created a~a y 9~
Are all corners and lot lines identifiable? , Yes No
Is this property being developed for (spec house)? Yes No
volume 11141 and Page Number a5-e. as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. S Z 6-7 4~ and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of Applicant Co-Applicant
Date of Sig ature Date of Signature
DZCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECOROING DATA i
WARRANTY DEED r9;_ 14 A3 I
5746 vol ~~1~56 REGISTER'S
Randall P. Cudd and Yvonne R. Cudd, husband ST. CROIX cl. '
an wife as-survivorship marital property Rec'dlcrR_: ;
i
MAR 15 1995
conveys andwarr tale i_ omas n ersen an al A. at 10:00 A.M.
Andersen, husband an wife as: survivorship
C
marital property
j Regi;tar ~f ~ ,
t
3 RETURN TO
1 A,
i the following described real estate in S Cr01 X County, 1 ,y
State of Wisconsin: 022-1070-20 I 31
Tax Parcel No:
Part of NEJNW4 Sec. 25-T28N-R18W described as follows:
Lot 2 of Certified Survey Map recorded in Vol. 10 of Certified Survey Maps, page 2881
as Doc. No. 526214. `
40 "1
I ''all
.I
t
No firearms shall-be discharged on this property without prior consent of property
owner(s),of the balance'of the NE'1/4 NW 1/4 Sec. 25-T28N-R18W. This con-•anant
shall also be in effect for adjoining lot #1 of same certified survey map.
i
;i
is not
This homestead property.
03) (is not)
Exception to Warrantles:
! 7th j .
Dated this day of , 19 95
(SEAL) (SEAL)
Randall P. Cudd
(SEAL)
i (SEAL)
Yvonne R. Cudd
.
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
as.
l~ ~ C f01 7~ County.
{ authenticated this day of , 19 Person fy came before met is_L--oay of
19 the above named
i All P. C,
1
TITLE: MEMBER STATE BAR OF WISCONSIN
(11 not, to me known to be the person
authorized by § 706.06, Wis. Slats.) foregoing instrument and acknowTHIS INSTRUMENT WAS DRAFTED BY
Randall P_ Cudd- No Pblic (Signatures may be authenticated or acknowledged. Both ion is permanenare not necessary.) date:
'Names of persons signing in any capacily should be typed at printed below their signatures. NTF 22110
WARRANTY DEED STATE BAR OF WISCONSIN Neico Forms. P.O. Box 1075. Green Bay. WI 54305-1075
Form No. 2 - 19e2