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HomeMy WebLinkAbout022-1083-30-130 0 o p `fl o ao o N 0. 0 oto. ~ I 0 m v - U s O N y N w 0 rn = Q O C U h w ~ j f0 'O O = y _U O N a N U O a3 o .2- 0 N O c z c y E m E LL c ooE 0 3 '0 ~y0 'o f0 m U Q a 3 p z y a0 W E Z 00 a 0 Z 0 a m 0) N N F- U) ''I c O C C9 co O Z d c N avi Z v c z fo F- r c ~ a Q) m CD M N N c O N O a) Z Z O N E Z _ d N N U) > N O N - a) A Q. 0. d G L Y c co O N a7 Q) f0 2 O o O a EI U c\ Q p N Z N !n V) fA `7u L (n z 40 LL 3 3 3 •r >aaa' co -j V a) o) o }V p Z o o o E o 0- o ao m 0i m ) 'D N a) p d 4 m 0 LO 3 w p ~ C I I O y N r~,~ O o N c Sri r.+ m 0 o E o c E `o c O CQ W F- f6 U N O w L 0 0 0 C CL 0 0 Yr N N C7 C', > c C E co o a0 00 Y V) - N o co 0) N O c 'O 6 N N E - U • L' O N Y Q N O N.. U) ~V O .ti #6 0. a a E c c A v a 2 0 N U I ~ DEP,*TE" T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDI~ TR DIVISION LAB R AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS (.41 boq MADISON, WI 53707 (H63.0911) & Chapter 145.045) LOCATION: SECTION: ITOWNSHIP/M IIICIPALITY: n T NO.: LK. NO.: SUB IVIS10 NAME: SW /4N / /T2P N/R/'E (or) W r COUNTY: OWNER'S BUYER'S AME: IMAILING ADDRESS: . ~ IUD I e USE DATES OBSERVATIONS MADE NO. BEDRMS,: COMMERCIAL DESCRIP~ON: PROFILE DESCRIPTIONS: PERCC) LATIN TESTS: ,Residence ? New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system V V It` 140h l~ CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (opio I) DS ❑U ❑U OS ❑U ❑S ❑U 11OS ImU If Percolation Tests are NOT required DESIGN RATE: I If an L y portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST- HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~.D~ 10a DD .40 a9•oo 4 f/3 . oo ~m f3a n j B- G.ao . 7 ? .oa 9• ~O ells _Y,sd bn Sa n B- 3 6.a~ . 50 0 a6 C9160 611S 11/1 00 160 s a d B- .d~ 45'.~o d ~~•DL 6 ?.oo ells . od t~h 5;qo B- .DD /6Y, 0 o B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERnIOD1 PERIOD2 PERIOD PER INCH P_ P- a l7 d J p 1 a i P- 3.6U iS a/ 5 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. SYSTEM ELEVATION I9~ o E , repW € € E 4 ~S' C3 nPr Z4 ra., 61 ~ ~o 0 oe eo~'~ S E 15'w. 7 , , , 30 ? P3. 3° , It- 3 , , w 3 ~ ! 1 i tL j i € 1 i a x SS w . 6' 1. • S E, P. 1, . ' 'il!he 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. NAME (print): TESTS WERE COMP ETE ON: n e A a 511191?!~ - ADDRESS: CERTIFICATIO NJ4LjMBotR: PHONE NUMBER (optional): 1, 0 CST SIGN E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. LHR-SBD-6395 (R. 02/82) - - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate sail test, your report must include: 1. Comp, legal description; 2. The ui~r tion must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement systerra; 5~ Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED DN 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. F';awing to scale is preferred. A t heet may be used if desired; 8. ° sure your benchmark and vertical elevation reference point are c' ! sown, and are permanent; 9. C all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tic if appropriate; 107 If information (such as flood plain, elevation) does not apply, place N.A. in tv s e box; 11. S _ 'ie form and place your current address and your certification number; 12. legible copies and distribute as required. ALL SOIL TESTS MUST BE iLED WITH THE LOC81- AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols St 10") BR - frock cols Co `'e 10") SS -stone gr - Gravel (under 3") LS - Limestone *s - Sand HGW High Groundwater cs - Coarse Sand Perc - Per( -)k tion Rate ` s - Medium Sand W - Vfel' - Fine Sand Bldg s - Loarny Sand > - an sl - Sandy Loar-n < L ~ l - Loam Bn vv~ ~ *sil - Silt Loarn BI Si - Silt Gy <y *cl - Clay Loam Y - Yellow .l - Sandy Cla I/ L R - F ;I ' ~'Ity Clay LuLmot I ttl~ ndy Clay w1 - y lay fff - fine, faint *c cc - common, coarse pt _ I mrn Many, i -;-'ium ss - [V3,;: ; d distinct p - pro ji HWL - Higho. Six ge, 11 soil textures star , fo >te disposal BM - Bench i~ VRP - Vertic. lit TO THE OWNER: T: ° port is the first ' curing a sanitary perrr,it. The county the C 'raay r :.rest S' lost in riai" to sermi~ 'aC'. A cor? ay a . s niit applic; .7 -asst be subrnittE.,; to the approl -:_I o h y permit .:ust he obtai led and p, ;red prior tc rt, of are r I E ur All 04/16/2007 05:16 PM Parcel 022-1083-30-130 PAGE 1 OF 1 Alt. Parcel 29.28.18.451 E 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): O = Current Owner, C = Current Co-Owner O - BYSTROM II, LOWEIN B LOWEIN B BYSTROM II C - BYSTROM STACY M BYSTROM STACY M 1057 E RIVER DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1057 E RIVER DR SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.273 Plat: N/A-NOT AVAILABLE SEC 29 T28N R18W 2.273AC LOT 4 OF CSM Block/Condo Bldg: 6/1519 Tract(s): ( 9 Sec-Twn-Rn 40 1 /4 160 1/4) 29-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 11/25/2003 747553 2463/110 WD 07/23/1997 1232/238 WD 07/23/1997 1098/267 WD 07/23/1997 793/134 more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.270 50,000 351,600 401,600 NO Totals for 2007: General Property 2.270 50,000 351,600 401,600 Woodland 0.000 0 0 Totals for 2006: General Property 2.270 50,000 351,600 401,6000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 118 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER aola AW ADDRESS l/~y3j U ,lek- ~ SUBDIVISION LOT # SECTION_T .2f N-RW, Town of 'c ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM lA a c2 \ o ,.~i e/,a 7' a r e << ~lJu9e S. ?`'G INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 r BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: lgo 0 ,r~vT,Jr : l d Setback from: Well House 90, Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: 6' Length Number of trenches Distance & Direction to nearest prop. line: .2 3 ' p 11(e.( Setback from: well: House ,2F' 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:f PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR:- rT~ 3 / 9 3 j t : Wiscorssin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: 'GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village (Town o : State Plan o.: ADAMS, WILLIAM CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /16j , 1Gd< GO Q ~s 76- '1 ~ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic leC a< a~ Benchmark - O. ' xa, Dosing Aeration Bldg. Sewer Hol St t Inlet 3 87 TANK SETBACK INFORMATION St/* Outlet s 97~ 3, S~ Vent TANKTO P/L WELL BLDG. Airl to ntake ROAD Dt Inlet Air l Septic L~/ NA Dt Bottom Dosin NA Headers Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacture mand Model Number GP TDH Lift Fri on System t 55 I-koss a' en f Forcem gth Dia. Dist. To Well SOIL ABSORPTION SYSTEM _7 BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 ~ DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O " rr~. CHAMBER Model Number: OR UNIT System: ? DISTRIBUTION SYSTEM Header / Manffatd- Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 1124 Dia. Length (0-5 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys Depth Over Depth Over xx Depth Of eded / Sodded xx Mulched Trench Center 'f wrench Edges Topsoil ❑ Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Kinn*ckinnic.24.28.18W, SW, NE, Lot 4, River Road J ~ , ~%,~~✓LCti,i"~=<,•~Y "1 n!/~'~ v-{!'..,~ v _MZ M Plan revision required? ❑ Yes Ly"No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Id, SANITARY PERMIT APPLICATION CO In accord with ILHR 83.05, Wis. Adm. Code STATE SANITAR PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ~I 99' 8% X 11 inches in size. Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLANI.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION !f' otf a-,& s GJ S T2 , N, R l E (orV9 PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ~ 3 L✓: G `e,'7~' c ~ ~l CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 01q, v arl/s w J!f,11019 11Z Gsis-~ ~D / Y3 Ua X CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE 41s'7` 4OWN OF: 00~ 10 ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms ~ PARCH L TAX NU BER(S) uf III. BUILDING USE: (If building type is public, check all that apply) O•~ X00 3 d- l~ Q 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 80 Mobile Home Park 120 Service Station/Car Wash 5 El Hotel/Motel 9 El Office/Factory 13 El Other: Specify IV. TY~~PEE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. Ld-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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 X1 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. STEM EL V. 7. FINAL DE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min.//inch) ~ *E VATIO 9 110d 1,4165- c 4i y 10" 117 V ,,O Feet 9FZ -,V Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed El LJ Septic Tank or Holdin Tank X % Lift Pump Tank/Si hon Chamber El I L1 F1 Ej VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. iness Phone Number: Plumber's Name (Print): Plumber's Signature: (No Stamps) /MPRSW No.: r(u.;S"7 l `ate Scl e-^okllwv ~ loa C3e~~ Plumber's Address (Street, City, State, Zip Code): /d 2 D .S c 6 l/ L1 IX. COUNTY/DEPARTMENT USE ONLY Appr Disapproved Sa itary Permit Fee (Includes Groundwater ate ssue Issuing Age big re (No m oved ❑ Owner Given Initial Surcharge Fee) Adverse Determination /~~Am X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber t. 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. f 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 system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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 8% 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-6396 (R.11/88) /f - C l r'~ ait i~'~t .G2. ~ Lv l ~ l~ S~ j r~/O`GI/ oLv O , ' .y~'C.ff(" • . O .r ~ <<~ o '~1 V y ~ ~6G' S ~ m a ~ ~ ~ ~ t~ 3 Sx ~ S ~ ti . la ~ 4 ~ ~ ~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT pap of / 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Corte COUNTY Attach complete site plan on paper not less than sin size. Plan must include, but sr. c,Poix not limited to vertical and horizontal referenc r 9'a of slope, scale or PARCEL I.D. # dmensioned, north arrow, and location a s to nears` itdfy APPLICANT INFO RMATION-PLE~irPRIN&lrjFp R N REVIEWED BY DATE PROPERTY OWNER: t ' PROPERTY LOCATION _ GOVT. LOT 5~ 1/4 V-- 1/4,S 29 T a N.R IF E (or) W PROPERTY OWNER':S MAILING ADDRESS r~ - LOT # BLOCK A SUBD. NAME OR CSM # / 13 7 e$,~1 ~/Oiy33 vo% Pf f S1 F CITY, STATE IP 6_00E H !R , ,4 QCITY ]VILLAGE WN NEAREST ROAD 'i'U€ f~6/S s~yoz (~/s) Ys°1 ,-i vviL ~iPil~~tTE [ New Construction use Residential / "W61 bedrooms Y [ ) Addition to existing building Replacement [ [ Public or commercial describe Code derived daily flow ~vo D gpd Recommended design•loading rate__,--*' bed, gpdAt2 • I- trench, gpd/ft2 Absorption area required ::n~bed, ft2 trench, ft2 Maximum design loading rate ~ bed, gpd/ft2 ~Irench, gpolft2 Recommended infiltration surface elevation(s) s- P & • 3 ft (as referred to site plan benchmark) Additional design / site Considerations L o w 6- Nk a 00to -f-E E k)4-! S o a S /o w/ D OVP U I[ ir5 Parent material 9/ f~Aiv i c d S - ourw1451, P/f,~vs Flood plain elevation, if applicable ~f/,* ft S = Suitable for system CONVENTIONAL MOUND ❑ U T IN91- GRQUNo PR ESSURE ATGRADE SYST MI FILL HOLDING TANK U = Unsuitable fors stem Ut ❑ U [y~'$$ BI ❑ U aT- O U O S 21` SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bed wch /0 Y [3 15 74 fW 2vVbf 1-7 Ground 3 30 /o Ye y/4 s/ 7~~ eV elev 75a yl4 O. -S $ Depth to _ limiting M- i Remarks: A/Ge 1s f~ul2S ZF .7s %2 -4 !.E' 414141.5 . Boring # / - n+1 S ' O- 7 ioYl' 313 15 2 Sbr v4e Z ,7 = eo L L - /O 3/ ~5 l ~ 9 /'iF S /7C Ground 7, ~S elev. y it. Depth to limiting n AL factor Remarks: CST Name: Please Print A 8~,PT A/,d p/GGiT Phone: 7/S - 3 P4 -P/Ps- Address: D %,W11 le!, • /fUl~SO.c.~ 4r;l Ss/cY~ C ,S"T~ 14/rL Signature: ~,~p~4 h4r-` Date: L~ CST Number: ~13v '1,- 4 . y ~ R PROPERTY OWNER SOIL DESCRIPTION REPORT Page zof 3 PARCEL I.D. # ~T CS/y Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistsence Bourd3y Roots GPD/ft In. Munsell Qu. Sz. Cart. Color Gr. Sz. Sh. g~ ntdi 3 o-1,2- /O ,e 313 S,C /)111/" S - z L ~1 3/z// Ground D -9G ~o yJ~ y s o, s ,2 S elev. - Depth to limiting Factor Remarks: Boring # 0 /d ble 3/3 , 3 - AO /e f~ •s. 0, .S' 9►0 ,Q 15" i .6 Ground el Depth to f limiting i facctor Remarks: Boring # o-ZZ /0 Yom' -F sbl, n» v~,~ S 2~.. 7 ' z -'13 /2 YX y - /S l f y/~ ~h► ✓~'r2 s , S = G Ground S yP y16 , S 62. S - S elev. ft Depth to limiting ~ factor Remarks: Boring # 13 Ground elev. 1 F Depth to limiting factor Remarks: con 00)on10 nc,n,)% u.LsT DoT L 61 LO N W ~ \ \m\ \Z \ o w ~ ~ w p R~ 07 Na. .n \ 00 \ \-A ClIZI m W o o ~ ~ a0 a ~ o ~ \NJ olzl~l m 0 0 - rn N y m r~ P v N I n n c~. li J a Rj C n ~ h o o~ L z G G. ~~t5 T 4o r- 08/17/12. 15:07 V715 386 4628 S.C. CO CRTHOl1SE APARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NDUST USTRY, DIVISION \ -ABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 iUMA UMAN RELATIONS MADISON, WI 53707 3707 (1-163.090) & Chapter 145.045) LOCATION: SECTION: / / TOWNSHIP/ M IItCIPALITV: OT NO.: B: SUBDI VISION NAME: Sc~ ~ AIN/R E (or) W ' " OUNTY• OWN-EA'S/8UY E ~rc! R'SgrE: JMAILING A D , -5 1. a r av I if lqll ISE DATES 013SERVATIONS MADE I B COMMERCIAL DES RI ON:-J 4PROFI TIONS: IPERCqLAT!DN TESTS: Residence ®New ❑Replace 7- 7 IATING: S= Site suitable for system U- Site unsuitable for system :ONVE TfDWAC: M-0-U- O: IN a ~U a I©~ 7EJSI G®~ •RECOMMEI~I~~YSTEM:(optional) DS DU ®S DU KS If Percolation Tests are NOT required )E SIGN RATE: If any portion of the tested area is in the ender s.H63.09(5)(bl, indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS IORING TOTAL D PT T ROUND ATER-INCHES CiIAMACTER OF SOIL WITH THINNESS, COLOR, TEXTURE, ANO DEPTH 4UMBER DEPTH IN. ELEVATION OBSERV O EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) B-1. La /oo? Do Q J,40 .9,66 b I/ s . 00 B~ Sq.,, B- 6--A . 114-.170 • ~v Blls ~.~d ~a B- 3 t /d,?, 5,0 D Qa . v o 6 s, o o ,B~ sa ~ c~ B- es'eo d o a o s. o Bh B- .00 /DYt 51~ oa o B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME OP IN WATER LEVEL-INCHES RATE MINUTES \IUMBER INCHES AFTERSWELLING INTERVAL-MIN, p , PER INCH P- I J. SG a~ )V a1 S~ P- . d P-. P- P- -OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ntal 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 land slope. ;YSTEM ELEVATION 99. ~4 A! 8 L-J . Kff, 71 T ~1Cls rner ! I le 1 ) r ~ ~ - --f- nit r I 0 0. , TN at r + -o- the undersigned, hereby certify that the soil tests reported on this form were made by mein accord with the procedures and methods specified in the Wisconsin Iministrative Code, and that the data recorded and the location of the tests are correct to the best. of my knowledge and belief. 4ME print : TESTS WERE COMP E -E ON: - 714,*43 +4 5~ r "4- CERTIFI AUM R: PHONE NUMBER (optional : APLE -lk CST SI N E: y_ 4 11- • . 1 2 FILED APR 22198, SAMII 401433 »d:` a a~ vfba"61 CERTIFIED. SURVEY MAP PART OF THE SW 1/4 NE 1/4, SEC. 299 T28N- R IBW KINNICKINNIC TOWNSHIP ST. CROIX CO. WI. OWNER' GARY 9 -SUSAN WANG RIVER FALLS, WI. 0 200' 400' BEARINGS ARE ASSUMED AND SCALE: 1 200' REFERENCED TO THE EAST 1/4 LINE, SECTION 29 EXISTING MONUMENT, Rec. EXISTING MONUMENT, Rec. NORTH 1/4 CORNER NORTHEAST CORNER SEC. 29 SEC. 29 w TN. RQ w - Z to 0 J 66' PRIVATE N O 0 ROADE9M'T. UNPLATTED LANDS M 0 srr r NI ' w + rv vv I o 3 Z. O.O • 33' 33' 00. 010 9 90° 00'00" W 2611.941 QI 33.00 a NORTH LINE SW NE 809.32' ' 1769.62' .(P. 1 0 J pnlvaTE 33 ROAD r' ' O 61 I_; W b !E SEE PAGE 3, SHEET 2 ICI w; a o o UN PLATTED LAN DS_ TioN E snc oESCRIP- w •tfl J QI &al ' Z •00 t W1 JI 1 33' q° S 90°00' 00" W 876.32' .10 z v- 3~. - 809.32 ; O Z) t 1o`OR ----T-- -PPIVATE ROAD U) 132.32' 215.00' 215.00' 247.00' 0) to w Z cv to 33' tD 0Q p J I t7 _ Cl, Q p - E9M'T. W -0 O ON o w 01 o N 3 r" °o o id c co co 2 3 4 AI, o z o I- cb, _ a o I o z pA P O ,OO aO• O. m op° ~ a cI J U N ID In 40 * w 00 11 165.32 215.00' 215.00' 2 4 7.00' - o0, d N N 90000'00"E 842.32' ^ 00. U) w N-- -i u• 1 UNPLATTED LANDS 00 1 > 0 )ltl~i EXISTING MONUMENT, Rec. :)i. ~v1111i LEGEND EAST 1/4 CORNER, SEC. 29 - 3/4" X 24" ROUND IRON BARS SET WT. 1.50 LB./ LIN. FT. APPROVED - - I" X 24" IRON PIPE SET WT. 1.68 LG./ LIN. FT. APR 22 1945 `leixs '0N&11*i;. AREA SCHEDULE St. CROIX CCU141Y era 1"Z LOT I 1.521 ACRE (86,293 S.F.) INC. R/W CpNtpRENFFISIVE ►AI!Y.S OtAIINIfI(1 MARTIN F. HALVORSEN = LOT 2 1.979 ACRE (86,215 S.t:) INC. R/W AND Cowl+o coN.►~ItTCt S•1302 LOT 3 1.979 ACRE (86, 215 S.F.) INC. R/W IJUDSON, f LOT 4 2.273 ACRE (99, 047 S. F) INC. R/W WIS. TOWNSHIP APPROVALS i fvo sup CHAIRMAN' site its CLERK /TREAS. OCT. 115, 1984 REV. NOV. 14, 1984 Vol. 6 Page 151.9 OVER REV. APRIL 20, 1995 page 1 . 1 .2 FILED APR 22190!, 401433 **%b wafts v CERTIFIED. SURVEY MAP PART OF THE SW 1/4 NE 1/49 SEC. 29, T28 N- R 18W KINNICKINNIC TOWNSHIP ST. CROIX CO. W1. OWNER: GARY R - SUSAN WANG RIVER FALLS, W1. O 200' 400' BEARINGS ARE ASSUMED AND SCALE: 1"= 200' REFERENCED TO THE EAST 1/4 LINE, SECTION 29 EXISTING MONUMENT, Rec. EXISTING MONUMENT, Rec. NORTH 1/4 CORNER NORT14EAST CORNER SEC. 29 SEC. 29 w TN. RQ w g . Z to O J 66' PRIVATE N ROAD ESM'T. UN PLATTED LANDS N o E .i'1v/ w • IIt IN vv 14G O I . O.O mJ [43 q0- to M33, S 90° 00'00" W 2611.94' <33.00NORTH LINE SW NE 809..32' 176962' J PRIVATEI ~O •cp o) ROAD 0 )f SEE PAGE 3, SHEET 2 1 ul W' rr)0 r UNPLATTED LANDS cuLOE SAC OESCRIP- w I_ 2r NO p TION. o Z 1-1 O<' 1 Z .Opp f Ap J Qj `xWi 33' 9° S 90°00' 00" W 875.32' e0 rygp - 88. O 32' 11 O ji ----t-PRIVATE ROAD. - F_ (D u) _ U o e nl in w 33.00' N 132.32' 215.00' 215.00' 247.00 to b r ap O o z I nj 1 • .p V • LT N I M Ito 00' 90 'a e ° _j 33' ~ o O'' o ESM-m'T. co O ON OW W O .0 3r~ro oo WI to I 2 3 4 °ow ZOO. j-I a• 65. ~8~ O r7 b1-- c o ~1 W ~N oQ Z Pa P~ o aov - o~ m~JI J C O .00 O, N o m v: O to z0- ZI 11 I fD 165.32 215.00' 215.00' 247.00' °oo~I - (v N 90° 00' 00" E 842.32' U) (L rn .j ~J6• I UNPLA T T ED LANDS 00 1 > ' EXISTING MONUMENT, Rec. VI LEGEND EAST 1/4 CORNER, SEC. 29 - 3/4" X 24" ROUND IRON OARS SETA p WT. 1.50L0./ LIN. FT. NPf ROVED O- - - I" X 24" IRON PIPE SET WT. 1.68 Lo./ uN. Fr. APR 22 1985 y\5GON& s, %v AREA SCHEDULE ST. CROIY. couN1Y s LOT I 1.521 ACRE (66,293 S.F.) INC. R/W CoM►RE11FPISIVE PAPS PLAIT+uIU MARTIN E. HALVORSEN = coN.rAI1tEt M S-1302 LOT 2 1.979 ACRE (86,215 3. F) INC. R/W ANO ZONING LOT 3 1.979 ACRE ( 86, 215 S.F.) INC. R/W HUDSON. f LOT4 2.273 ACRE (99,047S.F) INC. R/W rrr WIS. f~f~ e C TOWNSHIP APPROVALS Su CHAIRMAN' s is R~I 'r its . . 9- . ~acn CLERK /TREAS. OCT. 13, 1984 RF_V. NOV. 14, 1984 Vol. 6 Page 151.9 OVER REV. APRIL 20, 1995 page 1 '08/17/12. 15:07- $715 386 4628 S.C. CO CRTHO(1SE Q.002 ' APARTMENT OF SAFETY & BUILDINGS REPORT ON R NDUSTRY SOIL BORINGS AND DIVISION -ABOR AND . P.O. 7969 4UMAN RELATIONS 3707 PERCOLATION TESTS (115) MADISON ON , WI BOX 53707 •IUMA t (1-1163.090) & Chapter 145.0451 LOCATION::#e SECTIO ; TOWNSHIP/MV N1CIPALITY: OT NO.: BUC NO.: SUBDI VISION NAME: "OUNTY• , OWNEF BUY S MAILING ADDRESS~( ,a e S zjx . Yo IX Q0 If 1A 4 h ISE _ DATES OBSERVATIONS MADE r O E A DES RI ON: PROFILE TIONS: PERC9LAT!0N TESTS: Residence 3 NNew ❑Replace / IATING: S= Site suitable for system U- Site unsuitable for system WE 'ONVE IRI TTaA ~C[MOU 0: tNt a SaEM ©L01NG®NK: RECOMMEIy~~~ STEM:(optional) ~$❑U 1 ®S❑U x S S U l~l. If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ender s.H63.09(5)1bl, indicate: Floodplain, indicate Floodplain elevation: -`f PROFILE DESCRIPTIONS TORING TOTAL D PT GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH DUMBER DEPTH IN, ELEVATION OBSERVED EST. H TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) lc eo d ? ~.d 0 ~ oo b / l l S . 00 8 tj Sa of B- J _ 6P0__ /Oil 0 4.160 191 4611s S.s'd AV 3a 0 13-3 6.614 .50 d 1.60611S y,001 Sq_d _ B- 4SW d 0 a? .0 o efls p hi :3~ `9 B /D eer o6 d o B- sPERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP-IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p t D PER INCH p: 7 P. a , l7 d 24 94Z P- 3.60 _0 1-15 P-. P_ P_ i _OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ntal 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 land slope. ,YSTEM ELEVATION 99.0 Pi. sTak~e lorry j i T-; -----f- : - 1 =/0 1 .0 Sri ` 4; ; A• ; I _~c~o~eS I IT N i , 192 P -T-, By I ; I I i; I- ~ I I l i ~ I I ? I i ~ I ~ ' I l- LL L_Ltj 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 Iministrative Code, and that the data recorded and the location of the tests are correct to the best, of my knowledge and belief- 4ME (Print:/mfQ " ~ TESTS WERE COMP ETE ON:. - r CERTIFICATIO UM R. PtIONE NUMBERIoptional : All t 16jr irk S ;?P CST SIGN E: STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER `'a s 4.1-a if, -:q MAILING ADDRESS !1Y3 7 A/, .A d e... C %r e r PROPERTY ADDRESS /4-?g k i L/cM L Ac-3 (location of septic system) Please obtain from the Planning Dept. CITY/STATE 9.41 e e ls dr PROPERTY LOCATION S 4)_ 1/4, 1/4, Section ~2?T_,I_r_N-R / Jr W TOWN OF / L1 C lei C ST. CROIX COUNTY, WI SUBDIVISION - A LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 dat . SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 APPLICATION FOR SANITARY PERMIT • 8TC-100 This oppllcatlon form Is to be complntad In full and algned by the ovnst(s) of the property being developed. Any Inadoquacles will only result In delays of ►ht pztmlt Issuance. -Should this development be Intended for reealt by owner/contrsctot,(spec house), then a second foam should be retained and completed when the property is sold and submitted to this oftlce with the approptlate decd rtcording. Ovn:r of property `i/.'lf''as~d¢ s Location of property x_1/1 _114, Bectlon _r? T_gF' M-R lw T o vn s h l p elk iz Ka IIIng address /j.'/- eJ Ca'tg;rl~-C' 4-e Address of site ','det✓'-~~ aubdIvI■1on maw* C~.S'~ UD Lot number Previous owner of property Total ■1se of parcel ~..2 t Data parcel was created Are all corners and lot lines ldentiflable? Yes - No Is this property being developed for resale (spec house)? Yes ~•_1K0 volume -and Page Humber a■ recorded with the Register of Deeds. INCLUDE WITH TH19 APPLICATION TIIZ FOLLOYIHCI A vARtil.NTr D¢SD which Includes a DOCUMICHT 14"BIR, VOLUNS AND PA02 NUXBIR, and the 8tKL OT TIIE Rg0ISTHR Of DEEDS. In addition, a eartILIad survey, It available, would be helpful so as to avold delays of the reviewing process. It the deed description tolerances to a Ceitlfled Survey Hap, the Certified Survey Hap shall also be required. PROPERTY OVHER CERTIFICATION I(ve) cot LIfy that all statements on this form are true to the best of sky (our) Rnovltdgei 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 piglater of Deeds AN Document No. 1 and that I (ve) pttstntly own the proposed site for tha oewage disposal•aysten (at I (we) have obtalntd an easement, to run with the above daaecIbad property, tar khe consttuctlon of said system, and the same has been duly recorded In the Office of t Z county R later of Deeds, as Document No. algnature of owner Signature of Co-owner (it Applicable) Date at signature Data of Signature ~j N" A ~j. DOCUMENT NO. !i THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED STATE BAR OF WISCONSIN FORM 2-19821! V Lewis C. May P~~d';x Caro ~ wi fe _y and R..an. .ee..J... . May.,... H.....usb-a---nd-----andd ; as surv ll vorship marital property .~.r.__ . . - - - . OCT 6 1994 it - conveys and warrants to William- D,-- Adams--and .Wanda.-L.----• ~ 3:30 n P. M ; I , -Adams t_--Husband and -wife.-as survivorship marital pa y u~tce0ea property. . . . . . - - I RETURN TO ~O fn ~ co 4iCw IciCQ.~ 1 - 17 ct MkaI r the following described real estate in .-Str___Cr01X ...................County, S OZZ State of Wisconsin: Tax Pa.~cI III: Part of SW 1/4 of NE 1/4 of Section 29-28-18 described as follows: Lot 4 of Certified Survey Map filed April 22, 1984 in Vol. "61", page 1519. TOGETHER WITH roadway easement in SE 1/4 of NW 1/4 of Section 29-28-18 as described on Certified Survey Map in Vol. "1", page 162 and including all lands lying Ely of said roadway and Wly of E line of said SE 1/4 of NW 1/4. TOGETHER WITH private road easement and cul de sac as shown on Certified Survey Map recorded in Vol. "6" page 1519 as Document #401433. T11 This is not homestead property. xkk (is rot) Exception to warranties: easements, restrictions and rights-of-way of record if any. Dated this _ ---------30--------------- day of - September.--.. 1x.94 ---(SEAL) - (SEAL) Lewis C. Ma y v - ' (SEAL) .(SEAL) ' • _Ranee --JrQQQ-Ma y... AUTHENTICATION ACKNOWLEDGMENT Signature(s) !'r1_S_C:.!~-!..-•-___-•___--•__ STATE OF WISCONSIN as. Cwt .t., . - i t~ 9-~ir~ County. authenticated this $l0 day o P 19 4 Personally came before me this 3-----,---day of _-__._.__SepteIber---------- 1994--- the above named Lewis C. May M ay. -----------•-----------------------and Ranee J TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by j 706.06, Wis. Stats.) to me known to be the person s---------- who exc vted the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ~ Leo A. Beskar, Attorney RODLI, BESKA----------------------------------------------- BOLS, S.C 2~q '._N9rt. ( Main . ~~j- Notary Public ..County, Wis. Hy Commission is permanent. (If not, state expiration ($Tgfra t s tR lfeSafitheALicated 6f Z~KTt ]edged. Both, are not necessary.) date: Names of persons signing in any eapacity should be typed or printed below their signatures. WARRANTT DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. - FORM No. 2 - 1982 Milwaukee. Wisconsin . ~T• , 1 ST. CROIX COUNTY WISCONSIN L ZONING OFFICE """"b ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 March 7, 1995 Ms. Marlene Linn First Federal of River Falls P.O. Box 307 River Falls, Wisconsin 54022 RE: Septic Inspection for William Adam Residence Located at 167A River Road, River Falls, Wisconsin Dear Ms. Linn: An inspection of the septic system serving the William Adam residence located at 167A River Road, River Falls, Wisconsin was conducted on October 20, 1994. This property is located in the SW1/ of the NEl/ of Section 29, T28N-R18W, Lot 4, Town of Kinnickinnic, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. Enclosed is the As Built and Inspection Report for said system which you can give to the owner of the property at the time of closing. If you have any questions with regard to the above, please do not hesitate in contacting our office. Sincerely, Thomas C. Nelson Zoning Administrator St. Croix County, Wisconsin mz