HomeMy WebLinkAbout022-1020-40-000St. Croix County Planning and Zoning
Monday, January 23, 2006 at 9:21:39 AM
Detail Sanitary Information
Page 1 of
Computer #:
022-1020-40-000
Sub/Plat: Sleepy Hollow
Section: 8
Parcel #:
08.28.18.116
Lot: 4
TNIRNG: T28N R18W
Municipality.
Kinnidcinnic, Town of
CSM: Vol. 08 Pg. 2332
114114: SE 114 NE 1/4
Owner:
Coccia, Judith 492 Sleepy Hollow Rd. Roberts, WI 54023
State Permit:
218899 Issued:
06/16/1994 POWTS Dispersal: Mound
Permit: New
County Permit:
0 Installed:
06/1611994 POWTS Detail: NA
Bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
Notes
Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed
Not determined Yes Heise, Carl data from notecard - see 2005 ooncept/preliminary $0.00
Jim Thompson Signed Off: No plat for a CSM to split this 20+ acre parcel
notecard filed w/permit in archives
Maintenance
Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification
6/16/2006
GEHRIG, Nancy 5
Judith Coccia
168 White Pine Road
Lino Lakes, MN SS014
SF.;, NEIi, Sec. 8,
T28N-R18W, Town of
Kinnickinnic, Lot 4
Address Site: 492 Sleepy Hollow Drive
Roberts, WI 54023
Permit NO. 218899 6/16/94 Carl P. Heise
New System - Mound
Parcel #: 022-1020-40-000 01/23/2006 08:46 AM
PAGE 1 OF 1
Alt. Parcel #: 8.28.18.116 022 - TOWN OF KINNICKINNIC
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address:
Owner(s): 0 = Current Owner, C = Current Co -Owner
LARRY G PECHACEK
O - PECHACEK, LARRY G
492 SLEEPY HOLLOW DR
ROBERTS WI54023
Districts: SC = School SP = Special
Property Address(es):
• = Primary
Type Dist # Description
' 492 SLEEPY HOLLOW DR
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres:
20.006
P at: N/A -NOT AVAILABLE
SEC 8 T28N R18W PT SE NE BEING LOT 4 C
lock/Condo Bldg:
8/2332 20.006AC
Tract(s): (Sec-Twn-Rng
401/4 1601/4)
08-28N-18W
Notes:
Parcel History:
Date Doc #
Vol/Page Type
12/09/2003 748606
2470/521 WD
07/23/1997
1071/122 WD
07/23/1997
822/246
07/23/1997
5071279
2005 SUMMARY Bill M Fair Market Value: Assessed with:
143162 426,700
Valuations: Last Changed: 08/1012005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 20.006 150.000 281,400 431,400 NO
(:
Totals for 2005:
General Property
20.006
150,000
281,400 431,400
Woodland
0.000
0
0
Totals for 2004:
General Property
20.006
80,000
209,100 289,100
Woodland
0.000
0
0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 205
Specials:
User Special Code
Category
Amount
Total Special Assessments Special Chargs asDelinquent Chargees
s
I
O �
p
STC - 104 � Iss
AS BUILT SANITARY SYSTEM REPO
OWNER tlJ_ GY�.�. + .5 ,1� COCCiA, 9
ADDRESS /6 8 Li e c',
1%^0
SUBDIVISION / CSM# 51 e Mo 1� w LOT # 9
SECTION T N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING tt THIN 100 FEET OF SYSTEM
0 L4
Ncuyt
a
0
a
C
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: G"T sl� I n. 1 6 -2,141,
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: LL) -r�
Liquid Capacity: loo 0
Setback from: Well House 13 Other
Pump: Manufacturer Fr Model# q 7 Size
Float seperation �, 5 Gallons/cycle: 136.y
Alarm Location
SOIL ABSORPTION SYSTEM m0
Width: r Length 4 % Number of trenches b�
Distance & Direction to nearest prop. line: 40 W
Setback from: well: / / 5 House y Other
Building Sewer T3, Sr
ELEVATIONS
ST Inlet 93 I ST outlet y2.84
PC inlet 4 .� . G 3 PC bottom q, I ? Pump Off qG. 13
Header/Manifold 102, Bottom of system 1011
Existing Grade 100.9 Final grade 104,'i-
DATE OF INSTALLATION:
PLUMBER ON JOB: u6
LICENSE NUMBER: Iv 0
INSPECTOR:
3/93:jt
Wisconsin Department of Industry,
Labor and Human Relations
Safety and Buildings Division
GENERAL INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
PermitHo er's Name:
GEHR G, NANCY/JUDITH COCCIA
❑ city ❑ Village Town o :
T BM Elev.:
Insp. BM Elev.:
BM Description:
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANKTO
P/L
WELL
BLDG.
Ventto
An Intake
ROAD
Septic
NA
Dosing
NA
Aeration
NA
Holding
PUMP / SIPHON INFORMATION
Manufacturer / Demand
Model Number GPM
TDH Lift I Loss mead
Friction 5 stem TDH Ft
Forcemain Length _�/J Dia. Dist To Well
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County:
ST. CROIX
Sanitary Permit No
911
State Plan o.:
Parcel Tax No.:
AGAnniRA
STATION
BS
HI
FS
ELEV.
Benchmark
Bldg. Sewer
St/Ht Inlet
St/Ht Outlet
Dt Inlet
Dt Bottom
Header / Man.
Dist. Pipe
Bot. System
Final Grade
BED/TRENCH
DIMENSIONS
Width
Length
I
No. Of Trenches
I
PIT
DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
SETBACK
SYSTEM TO
P/L
BLDG
WELL
LAKE/STREAM
LEACHING
Manuacturer:
INFORMATION
CHAMBER
Type
Model Number:
System:
OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold
Distribution Pipe(s)
x Hole Sae
x Hole Spacing
Vent To Air Intake
Length Dia
Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
xx Depth Of
xx Seeded /Sodded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
❑ Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Iinnickinnic.8.28.18W, SE, NE, Lot 4
1I,-76,1 r
Pla4v.ik ion required? ❑ Yes ❑ No
' Use other side for additional information.
5BD-6710(R 0"1) Date Inspector's Signature Cert No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
S94=40441
PAGE OF
PUMP CHAMBER CROSS SCCTIQN! Ak1D SPECIFICATIOMS
VCIJ'r CAP
!C.I. VENT PIPC
WCATHCK Pitoor APPROVCD LOCKING
- . 06W0" JUUCTIOJJ'BOX MAWHOLIC COVERROM 0009,
IrAlu
SOOW OR FRCSW A
IAU)JTAK9
ORADE
40 N)J.
COUDUIT.1-10"
. . . . . . . . . .
T ONSITE SEWAGE�&�WE--;
o
AIRTIAAT SC -AL
In
IA
(foi2J4
PPILOVED JOIN
I III w1c.x. PIPE
VIC'. 11�?Ipc sm mm%
I III APPROYLI) JOINTS
KTCIJDIU(o
Q zo - 3% -
A V'ao AL&RA LXTELIOIUG a,
"LIST ONTO .50LID 6,011.
IT OF IN' j >
!DEPA 1, ' `.NCI
-;C DIVISIO Oc: Ft
V BUiLU5JF5SA'.. ow
L c T
SEE 'CURhr'VCN0L"NU
PUMP
Orr
D
COLICKCYC BLOCK
ir
EXIT Pilt W,-0-OfJLV IF YAWK 1AAWLIFACTLIPMR HAS 31, APPAW9
SUCH APPROVAL
SEPTIC
ZAkji(ft-. t4AIJUrACTURM. ujorl<s
. TAWK WZ914 A goo —"GALLo . us IJUMBER Of Dosw---I�PER DA41.
005g,voLuAc
UFAtTLIUR: Ott( PY' INCLU.0111410.0 DACKPLOW: lb-. GALLONS
IPL V
t i
.41* Io1w. CAPACITIES: AS 22,5 WCHL3 OA CALLOUS
SWITCH -rupci ' m C ( Uc's, V t. : I,
?
wm 1 8 —
PUMP -MAJJUY'ACTURCKO. Or A c v ()it 06LLOIJ5
IIJCIIE$01112/GALLONS
I-AODCL WUADE&O.
Dw _INCHES OR
CIALLOMS
A.WITCH YVEC: c r
.1w MOTE* :PUMP AMD ALARM ARC TO BE
'*IWIKUM DISCHARGE' RAYC - PtA
INSTALLED ON SEPARAT9 cmcuiY6
VERTICAL DirrExE&ICC 5ETWECIJ PUMP OFF A1JO.Oi-5TPIb4TIOtj pipe.. FECY
I., .
NfAIMIKUM NCTWORK 6VPPL.y PRESSURE
0 4 0 62 5 FEET
i- " a. 7 2-L. rcET or ropcc mw x -LWY.00jr.FKICTI0W FACYOR.. I'- FEET
TOTAL, ot:IwAm
FEET
IkITERILIAL. DIME,W610m or TAWK: LENGTH
--;WIDTH,- jLIQUIO DEPTH
"LICEWSE k4UM13ER- R 33
m ? '5
t
eAa11TAnv nfGnMMM Anni lf%Arinu
�flIL�R ,... Ivve. vas a re.ales. rya a _4.. ......
In accord with ILHR 83.05, Wis. Adm. Code
�uY
C�c,� C
)y
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than
-
9
8% x 11 inches in size.
C! i
%
❑ Check Brevision toprevious application
-See reverse side for instructions for completing this application.
STATE PLAN I.D. NUMBER
I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER
PROPERTY LOCATION
1,) n • *7
ry j- '/•, S Q' T ;�' , IN, R or W
PROPERTV OWNER'SIMAILING
LOT #
BLOCK 0
1ZADDRESS
CITY, STATE
ZIPCODE
PHONE NUMBER
SUBDIVISION NAME OR CSM NUMBER
k S yvt W
55n I
If. No lok 446749( \)*I 8 d
L TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE NEAREST ROAD
❑ Public W 1 or 2 Fam. Dwelling-# of bedroomsTAX N
Ill. BUILDING USE: (If building type is public, check all that apply) �� 0 eao .- (4d
1 ❑ Apt/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 in line A. Check line B if applicable)
A) 1. IN New 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 # — Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution Pressurized Distribution Experimental Other
11 El Seepage Bed 21 Mound 30 El SpecifyType 41 El 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 ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
72.
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
1.50 7 ( 1 C 0 C_ Feet . 4 & � Feet
VII. TANK
INFORMATION
CAPACITY
in allons
Total
Gallons
pof
Tanks
Manufacturer's Name
Prefab.
ConcreteCon-
Site
Steel
Fiber-
glass
Plastic
Exper.
App.
New
iatln
Tanks
Tanks
structed
Septic Tank or kr-
Litt Pump Tank/64phawQhannber
Q D ^
X
Fj
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)
MP/MPR$W No.:
Business Phone Number:
Plumber's Address (Street City, State, Zip ):
to-1, ,t ;r 9e 7. 1-
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved
Sanitary Permit Fee (Includes Groundwater
surcharge Fee)
Date IssuedIsauin.
gn tam )
q
Approved
❑Owner Given Initial
Initi
�o
(!Q /
^�r
tin
Adverse Determination
T
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety d Buildings Division, Owner, Plumber
INSTRUCTIONS
.ate
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 (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 & 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 systems be_ingta[104 y
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type -of permit. Check only one 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.
Vill. 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 836 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 11� 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 (A.11188)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS
INPUISTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 5379079
HUMAIfRffLATIONS (H63.090) & Chapter 145.045)
SECTION:
TOWNSHIPIMOIDIl UEKIN::
OT NO.
BLK NO.:
SUBDIVISION NAME:
SE �/VE��
c
8 /728 N/1fQ L8XR(or)w
Kinnickirniic
4
at
ISleepy Hollow
COUNTY:
St. Croix
5jjjZ1M79UV1WS NAME:
Robert Richter
MAI LINQ ADDRESS:
700 2nd. St., Hudson, wi. 54016
.ne
JSE
[iEResiderlca
0.
3
rOMMERCIAL DESCRIPTION:
n/a
lFlew ❑Replace
U- S-ta unsuitable for sydem
V A I ca vwc n v n ..v.w mn..
ITESTS:
3-26-92 3-28-92
nAI Inu: Y also w..-wu
ONVEN N L:
❑ S �U
....p._m
MOUND:
�a ❑u
1
IN�'i
❑ S �U
- -FILL
❑ S ®U
OLDING TANK:
❑ s ®u
RECOMMENDEDSYSTEM:(optional)
mound
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09,M)Ibl, indicate: n/a Floodplain, indicate Floodplain elevation: n/a
____„ PROFILE DESCRIPTIONS DaQe 75 SaC2
BORING
NUMBER
B-1
ut.LLutsi
TOTAL
5.00
ELEVATION
99.45
R U
D ATER-INCH S
CHARACTER SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
.,83, 10yr4629 1., 1.25,10yr4/4, sil., .92, l0yr
s.cl., 2. ,7.5 4/4 mot. s.cl.
BSERV D
3,00
2.Og
B_2
4.67
99.45
2.58
2,00
•67,10yr3/2,1., 1.33,10yr , si ., . , yr
w/mot cl. particles and water
B- 3
4.67
101.45
none
2.17
.58,10yr3/2, 1., .92,10yr4/4 sil., .67, 7.5yr-
4 4 s.l. 2.50 7.5 4/4 mot. s.cl.
B-
B-
B-
�_ �I PERCOLATION TESTS
TEST
NUMBER
DEPTH I
190EMK I
WATER IN HOLE
AFTER SWELLING
TEST TIME
INTERVAL -MIN.
DROP IN WATER LEVEL -INCH -ES
RATE MINUTES
PER INCH
IF Z
PE 1003
P- 1
2.001
none
30
30
40
P:
40
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. Vv_
SY 102.00
■ l..
�111■■;�■
►�11■E,
Al
■■■■■■■■■
■
■912111"In
■
REM
■■■■EMPO■i■
■■■■■■M■■
■■■
■01
■�!:!!!■■■■■
■■■■■■
�i�■■■®
■■�i■■■■■■■■
I■
N'
N■■■■
I'�i�■■■
■■■■■■■■■■■■■
�1
■■■■■■.!�!�■■
■■■■■■
■■■■■■■■■MOM
(�
■■■■■■MEN
TN
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief,
nnmc .Y• n,.,.
Gary L. Steel 3-28-92
ADDRESS: CERTIFICATION MBER: PHONE UMBERIoptional):
1554 200th. ave., New Richmond, wi. 54017 2298 715- _6-6200
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
OILHR-SBD-6395 (R. 02/82) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
F
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4, Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and your certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures
st
— Stone (over 10")
cob
- Cobble (3 - 10")
gr
— Gravel (under 3")
`s
— Sand
cs
-- Coarse Sand
med s
— Medium Sand
fs
— Fine Sand
Is
— Loamy Sand
'sl
-- Sandy Loam
`1
— Loam
`sit
— Silt Loam
si
— Silt
'cl
Clay 403m
scl
— Sandy Clad Loam
sicl
—, Silty Clay Loam
sc
* .Sandy Clak
sic
— Silty"Clay.
'c
-- Clay
pt
— Peat
m
- Muck
' Six general soil textures
for liquid waste disposal
V '
5'
TO THE OWNER:
Other Symbols
BR —
Bedrock
SS —
Sandstone
LS —
Limestone
HGW —
High Groundwater
Perc —
Percolation Rate
W —
Well
Bldg —
Building
—
Greater Than
—
Less Than
Bn —
Brown
BI --
Black
Gy —
Gray
Y —
Yellow
R —
Red
mot —
Mottles
w/ —
with
fff --
few, fine, faint
cc —
common, coarse
mm —
Many, medium
d —
distinct
p —
prominent
HWL —
High water level,
surface water
BM —
Bench Mark
VRP
Vertical Reference Point
a
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to the appropriate local authority in order to
obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction.
1 . A
JUN- 9-94 THU 10:49
--------- --
DIESEL SUPPLY FAX NO. 715+386+
..PLOT PLAN
20 AC9F PAQGEL LoT� 3
ONS1TE SEWAGE SYSTEM cal-E 1 %ppgo
,„
894-404.�
,. o
ot= Sl.row llMarsh Hay, Or
1 ?a. APPTtpVED Synthetic Covering
AST► C- 33 •
Sand
Topsoil
3J►TE
•M
% Slope
Bed Of i"— 2'z
Aggregate
OF.
S94-40441
/Distribution Pipe
M[7
Force Main
From Pump
Cross Section Of A Mound System Using
4314S7, E SEWAGE_sA7F__ , For The Absorption Area
A _�_ Ft.
Cwd'it�,F:!sLY
gm Ift B Ft.
Ap. 9
1mpo NT Cc INDUSIM'. �J.$!�f T�;ri Y:'t:: .;.� J_� Ft.
DIV1S.^JN Oi �i ' /fit •t3Uiuli^N K Q •1. Ft.
SLE CORBI SAINGENCE' L Ft.
�L
I
Y��Ft.
2 �'('.. M tr' O- d
�— Observation Pipe---.,
�Disiribution LBed Of Z�— 2 y
-Pipe Aggregate
Observation Pipe Permanent Markers
Pion View Of Mound - Using A •Bed For The Absorption Area
G
Plowed
Layer
D l . t7 Fr-
F !_Fr
G f . 0 Pr.
H r, 5 . FI'.
`K
S q '
IVI
X
Y
- E
Hole Diameter
%4
Inch
to
Manifold
Inches
Force Main
"
2
Inches"
K"
Lateral
10.
"
_L
Inches)
.r
,."
Holes Per
teral
, • IrhZ
rl
• i
4
1
1 V
•
,
1
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40� 50 60I 70 8'0 190 100 I110
160 240 320 400
PER MINUTE
S94 w 4:9441
MOVE THE EARTH
CARL HEISE EXCAVATING `' =
1042 South Main
RIVER FALLS, WI 54022
CARL P. HEISE (715) 425-2175
Owner
MOUND SYSTEM
FOR
3 BEDROOM RESIDENCE
LOCATED IN THE Sr "I OF THE WE Y1 OF SECTION �_, Ta&N, R IOW,
TOWN OF yyyy,(k„NN b ,_57 Cro%k 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 LAY -OUT
PAGE
5
of
6
PUMPING CHAMBER
PAGE
6
of
6
PUMP PERFORMANCE CURVE
PREPARED FOR
NANCY GEHRIG / .TUDJTH COCCIA
168 WHITE PINE RD
L1N0 LAKES MN 55014
lZ ,P PREPARED BY
Carl P. Heise
CST 3314 MPRS 3378
1042 South Main Street
River Falls,WI 54022
RECEIVED
JUN 0 7 1994
err a &aft. Div
as
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
June 9, 1994
HEISE, CARL
1042 S MAIN
RIVER FALLS WI 54022
RE: PLAN S94-40441
GEHRIG, NANCY / COCCIA, JUDITH
SE,NE,8928918W
TOWN OF KINNICKINNIC
MOUND SYSTEM
2226 Rose Street
La Crosse WI 54603
FEE RECEIVED
1411161129 rill A&I 1<N;113 EI
The Department has reviewed the above -referenced submittal.
180.00
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 ■e at the number listed below. Please refer
to the plan number shown above.
Sincerely,
"ennisrenson
Plan Reviewer
Section of Private Sewage
(608) 785-9336
---i cc: ST CROIX
ae13-123MOMP
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER NANCY 61-4 #R1 r' C7 / JU01 rH CZ C C 6+
MAIIIIG ADDRESS
40
' G 1iiv lo, es, NN S SD/ f
PROPERTY ADDRESS
ItiZ
sL Eff y
I`it (_ t_D w PK.
(location of septic system) Please obtain from the Planning Dept.
CM/STATE fo9fler-5 W/ 5Y az 3
NE Y� i If Nf f 4mL
PROPERTY LOCATION S E 1/4, /vE 1/4, Section , T ,?f N-R 19 W
TOWN OF k l AI N I C K / NN / G ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER -4�`
CERTIFIEDSURVEY MAP Wo 7 t 7/ , VOLUME B ,PAGE ,70-2, LOT NUMBER _5
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 i/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: S/�9�YJ� S Z_o L! ,y
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, W1 54016
11/93
8 T C - 100
This application form is to be completed in full and signed by the
owrier(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 /Vxlycy 6ENR(6 eecel.¢
sE ,Vf o< WErpr dfNu
Location of property��l/4o6iT, Section �F_,T �B N-R lB W
Township K/Nil//C K//VN(G Mailing address /,�8 Wh/k- &,, Xfl
G•s�a Geles IhN SSotf4
Address of site_ ` fd SLEEPY #0t e-.0W ,COACXr-r W/ 5-
subdivision name SCpy yac(ow Lot no.
Other homes on property? Yes�No
Previous owner of property 40,04Cr R6C.17174:4
Total size of property /6a a«e5
Total size of parcel a0- P06 4c-ee5
Date parcel was created DeroBER / (fyo
Are all corners and lot lines identifiable? i( Yes No
Is this property being developed for (spec house)? X Yes No
Volume /07/ and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. y/V 6.57 , 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.
L'Y6s7
Sign' a of Applicant
-1/W 71 fy
Date of Signature
-Applican
s//-7
Date of Signature