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HomeMy WebLinkAbout022-1083-10-300I E� St. Croix County Planning and Zoning Wednesday, February 08, 2006 of 11:16:11 PM Detail Sanitary Information Page I of I Computer #: 022-1083-10-300 SublPlat: NA Section: 29 Parcel 0: 29.28.18.449C Lot: 3 TN/RNG: T28N R18W Municipality: Kinnickinnic, Town of CSM: Vol. 09 Pg. 2644 1141/4: NE 1/4 NE 114 Owner: Gilbertson, Lon 1085 Prairie Moon Drive River Falls, WI 54022 State Permit: 208977 Issued: 05/03/1994 POWTS Dispersal: Non -plumbing Sanitation Permit: New County Permit: 0 Installed: 05/03/1994 POWTS Detail: Bed- Seepage Bedrooms: 3 POWTS Pretreatment: NA Notes Issuerllnspector As Built Plumber Other Requirements Mary Jenkins Yes Steiner, Paul Jim Thompson Signed Off: No Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 5t312006 WI Fund: Additional Notes Money Owed check data from nolecard - Install date, etc. $0.00 GILBERTSON, Lon/Janna NE40 NE14, Sec. 29, 3S0 Nicole Lane, N2 T28N-R18W, Town of River Falls, WI 54022 Kinnickinnic, Lot 3 Address Site: 1085 Prairie Moon Drive River Falls, WI 54022 Permit No.: 208977 5/3/94 Paul C.J. Steiner New System - Bed Parcel M 022-1083-10-300 02/08/2006 12:22 PM PAGE 1 OF 1 Alt. Parcel #: 29.28.18.449C 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 BRIAN P & LORI K CROOKS O - CROOKS, BRIAN P & LORI K 1085 PRAIRIE MOON DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 1085 PRAIRIE MOON DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.300 Plat: N/A -NOT AVAILABLE SEC 29 T28N R18W PT NE NE & PT SE NE Block/Condo Bldg: BEING LOT 3 OF CSM 912644 3.3 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 05/16/2002 679180 1892/180 WD 07/23/1997 1192/592 WD 07/23/1997 1074/102 WD 07/23/1997 1029/35 LC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 143863 392,600 Valuations: Last Changed: 09/08/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.300 50,000 347.000 397,000 NO Totals for 2005: General Property 3.300 50,000 347.000 397,000 Woodland 0.000 0 0 Totals for 2004: General Property 3.300 25,000 285,000 310,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 305 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 St. Croix County Planning and Zoning Detail Sanitary Information Computer #: 022-1083-10-300 Sub/Plat: NA Section: 29 Parcel #: 29.28.18.449C Lot: 3 TNIRNG: T28N R18W Municipality: Kinnidkinnic, Town of CSM: Vol. 09 Pg. 2644 1/4114: NE 1/4 NE 114 Owner: Crooks, Brian 10 rairie Moon Drive River Falls, WI 54022 State P it: 208977 Iss 05/03/1994 POWTS Dispersal: Non -plumbing Sanitation Permit: New County ermit: 0 stalled: 07/13/1994 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Thursday, September 07. 2006 at 3:50.43 PM Page I of I Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed J v Mary Jenkins Yes Steiner, Paul check data from notecard - install date, etc. $0.00 Jim Thompson Signed Off No ///111 nI Maintenance 1T Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 2006 3/- - - - - - - - - - - - - - - - - - - - - - - - - - 7/1/13/19971997 9y STc - 104 AS BUILT SANITARY SYSTEM REPORT �11 ADDRESS SUBDIVISION / CSMII V 0 �Q J75y LOT $ _ SECTION T N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /00` 20oT. I k;#;erTa.k Mvr k Scale OINDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE B, SEPTIC TANK / Manufacturer: Je, c er Liquid Capacity: ) 20 Ci Setback from: Well A House o2 Other Model# Size SOIL ABSORPTION SYSTEM Width:15- Length JO O Number of trenches .3c Distance & Direction to nearest prop. line: 70 9j ,4"*- 9 Setback from: well: House Other 1. ELEVATIONS Building Sewer O. ST Inlet. qi, 7C) ST outlet 9g. 3-1 PC inlet PC bottom Pump Off Header/Manifold qk no Bottom of system 9 % 66 Existing Grade Final grade DATE OF INSTALLATION: /Z/Z3) 9-j/ PLUMBER QN-JOB: .,4 `. J 5/e/?2 LICENSE NUMBER: elp 7 g O INSPECTOR: 3/93:jt 29.2 PRIME SEVIIIGE SYSTEM Road Labor and Human Relations SaferINSPECTION REPORT �nd Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: City I] Village Q Town o ns M l BM Description: /GlJ - Cd / . 60 X C l TANK INFORMATION TANK SETBACK INFORMATION TANKTO P/L WELL BLDG, Ventto Air Intake ROAD Septic NA Dosing NA Aeration _ 5 H I ' PUMP / SIPHON INFORMATION Model Number Demand GPM I TDH I Lift I Friction I Syst - H -44 I Forcemain Le Dia. I Dist Towell SOIL ABSORPTION SYSTEM ELEVATION DATA A9400100 STATION BS HI FS ELEV. Benchmark Bldg. Sewer 6,66' add i7 ' St/IK Inlet St/fit Outlet �aitaTi Header /lYBm �p ' Dist. Pipe g Bot. System rade 0--S. r. BED/TRENCH DIMENSIONS width r Length / No Of Trenches PITS- — DIMENSIONS No Of Pits Inside Dial. Ui uid Depth SETBACK SYSTEM TO P/L BLDG I WELL LAKE/STREAM LEACHIN INFORMATION jHA#AfffR OR UNIT Type System: - 3% Model Number: DISTRIBUTION SYSTEM Header Distribution Pipl/ x Hole Size x Hole Spaung tr Inta e Length _�' Di a Iel QZ� Da —� 4' Spacing SOIL COVER It Pressure Systems Only xx Mound Or At -Grade Sys Depth Over® „ . c) Depth Over �n „ ,� xx Depth Of x eded /Sodded xx Mulched Bed / enter —0 Bed ledges ,]CJ —tpv Topsoil - ❑ Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.)xl O� ' /%(��jtf—� LOCCATION: Kinnickinnic.29.28.18W, Lot 3. Liberty Road lz al tdif'"rno (9c% t� 5vQDateiiiii C� 4l= " l ��Plan revision requiredi ❑Yes at-�Use other side for additional information.SBD-6710(R 05191) Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: rtii &AfulrAfev fefcfo1116,111lr Annl Id�Arinfu DILHR %P^I..I/ §a■ I VI■I.III / w ■ r■VA■■VIV COUNTYSt. u In accord with ILHR 83.05, Wis. Adm. Code Croix STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than pR �/f�I1 8%x 11 inches in size. ElCheeknOrwbfantoprevlousapplication —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PRC!�gRTY LOCATION Lon & Janna Gilbertson P t 1/4 NE %, S 29 T 28, N. R 18 PROPERTY OWNER'S MAILING ADDRESS LOTS! BLOCK M 350 Nicole Lane # 2 3 ----------- CITY, STATE WI ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 54022 Vol. 9 CSM Page 2644 Document Number 502047 II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD State Owned VILLAGE: Liberty Road ❑ ® 4 Public 1 or 2 Fam. Dwelling—�# of bedrooms III. BUILDING USE: (If building type is public, check all that apply) 002 1083 10300 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. © 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 93 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 16.SYSTEMELEV. T FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 600 1,500 1 , 500 .4 .4 96.8 Feet 99.8 Feet VII. TANK INFORMATION CAPACITY injallons Total Gallons ##of Tanks Manufacturer's Name Prefab. oncret Site Con- Steelglass Fiber- PlasticAppTanksstrutted Exper. Nein Se tic Tank 21 25 1 Weiser 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 r' Sig tun mps) MP/MPRSW Ne : Business Phone Number: Paul C.J. Steiner 6780 If715 425-5544 Plumber's Address (Street, City, State, Zip N8230 945th Street; River Fall, WI 4022 IX. CqAPUNTYlDEPARTMENT USE ONLY Disapproved San lary Permit Fee (Includes Groundwater Date ssue Iseuing A nt Slg No m Approved ❑ Owner Given Initial Surcharge Fee) Adverse DeterminationLE] X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at 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: I. 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'fi 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-63M 111 11/88) ',' PLOT PLAN qL wuconsinDupartmantoflndustty, SOIL AND SITE EVALUATION REPORT Page _-ol—.- Ujw and Human Relations Division of Safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 612�— not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. t dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Steven CUdd GOVT. LOT NE 114 NE 1/4,S29 T 28 N•R 18 240q PROPERTY OWNER':S MAILING ADDRESS LOi BLOCK SUB0. NAME OR CSM 1 1120 Pine Ridge Drive 3 -- ---------- CITY, STATE ZIP CODE PHONE NUMBER ZoiDowaek EJOWN NEAREST ROAD V�11� tjT Fan97 t715) 4?5_5544 Kinnickinnic I Liberty Road J New Construction Use Jx J Residential i Number of bedrooms 4 J J Addition to "Sling ouilaing J J Replacement ( J Public or commercial desclipe Code derived daily flow 600 gpd Recommended design ba 4 late 14 bed, gpdit2_. 5 uencn, gparn3 Absorption area n:quired 1,,Q0 bed, h2 1 , 2oQ Uench, lt2 Maximum design loading rate - 5 Wd, gpd1h2_..fL_—Dencn, gpmn- Recommended infiltration surlace elevation(s) it (as tefened to site plan bencturlark) Additional design I site considerations Syatcxn Fl twat i inn 965 An' -- Parent material Flood plain elevation, it applicable h S = Suitable lof system CONVENTIONAL 610 S IN GRouND PRESSURE AT -GRADE SYSTEM W Ftll nG�GC,� h . u- Unsuitable for system ®S O u ®S ❑ U IDS O u I as O u O S 67 u I ❑ S Q u cnu nFSCRIPTIf)N REPORT Boring 0 1 Ground elvv. 10015s L It. Depth to Gnuung I;,clar Boring N 2 Ground elev. 102 _ RO it. Depth to limiting factor Horizon Deptn in. Dominant Color Munsell Mottles Du. Sz. ConL Color Texture Structure Gr. Sz. Sn. Consistence Barry Roots GrLnr" Boa Iw _, 1 0-21 10YR 2/1 None sl 2 m sbk mfr qs 1f .5 _i.6 2 21-36 10 4 6 None is 1 m sbk mf' cis 1f _1i�6 3 6-116 10YR 7/6 None s 0 m s mfr -- -- .5 1.6 1.... Ciomar4e• 1 0-30 10YR 2/1 None sl 2 m sbk mfr gs 1f .5 .6 2 0-44 10YR 4/6 None is 1 m sbk mfi gs 1f .5 .6 3 4-110 10YR 7/6 None s 0 m Sa mfr -- -- .5 .6 — r— Remarks: Nand -Boas Print Pnorw: 11wt �r• 3074 PROPERTY OWNER Steven Cudd SOIL DESCRIPTION REPORT PARCEL I.D. i Page,, LI - R. Boring # 3 Ground eiev. 103.36 It. tkpdt to limiting lactor Boring # 4 Ground elev. 100.83 IL Depth to limiting lactor Boring # 5 Ground elev. 101.60 IL Depth to timiiing lactor Boring rt Ground elev. It. Depth to linupng lactor Horizon Depth in. Dominant Color Munsell Moores Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sr. Consistence BIDJUAry Roots Beo Li w. 1 0-17 10 r 2 1 �6_ 2 17-33 10YR 4 6 None is 1 m sbk mf _;...6. 3 33-11 10YR 7/6 None s 0 m sg mfr -- -- 1 .5 i .6 Remarks: 1 0-14 10 2 1 None sl 2 rn shk mfr a R 1 f -,S-,6 2 14-30 10YR 4 6 None is 1 m sbk mf 3 30-113 10YR 7/6 None s 0 m sbk mfr -- -- .._,(j _ �5 _. ,6 Remarks: 1 0-27 10YR 2/2 None sl 2 m sbk mfr gs 1f 2 27-43 10YR 4/6 None is 1 m sbk mfr gs 1f .5 .6 3 3-110 10YR 7/6 none s 0 m Sig mfi Remarks: Remarks: SOD 83301R OSrL2) OWNER/BUYER SEPTIC TANK MAINTENANCE AGREEIIENT c icyG zaw�%d — Sz 3 St. Croix County ' 1- ROUTE/BOX NUMBER fl1�`� Vdpof\C, � ►� Fire Number CITY/ STATE j2,-,�.��5 f (�/I ZIP PROPERTY LOCATION: A/614 N,SGOL k, Section ya T L`d N, R /F) W, Town of Kf NeJ(C K( NN tC� , St. Croix County, Subdivision `('SPl yuA?21r`44 , Lot number 3 �e r_e .3 C t 6� 'rl r c/ 120 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proner maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed 'septic tank pumper. What you put into the system can atfect the unct on of the septic tank as a treat- ment stage in the waste disposal system. St. Croix Count? residents may be eligible to recieve 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 County Zoning a certification form, signed by the owner and by a matey plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic.tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 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 Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. (� SIGNED�.� St. Croix County '• / i o / Hudson, WI 54016 386-4680 DATE 4115114- I Zoning Office L i e_# A-"L �D . Sign, date and return to the above address. n w r r w n r• 0 0 d w rt N `Jr, . CUt1C COUNTY (, N° 420309 STATE SANITARY PERMIT 11TRANAgAi4NEWAL PREVIOU OWNER M kTr- PLUMBER 4w&uAi gti" LIC.# Zzcoiw T Y F S C=,T=N, AND/5 OT � ��' P. 4329 THIS PERMIT EXPIRES BLOCK - SUBDIVISION NO. CHAPTER 146.135 (t) WISCONSIN STATUTES (a) The purpose of the nn" Punic is to akow NMabdon (b► Of th pp aeornee In the p.ma bra on the dale of KMN a bead on repuatbne in (c) The sankary pwwA Is va9d and may be nrrerred bra a , Iled pubd. (d) Charged ► gubO a will not hWIr the vakdky of a sankary psrmk. (s) RerrsI I of the Owbry Pumk will be band on repuadons in bra at the dme rerrwwI Is sought, and OW dwW NlPlatlom may impede rs wmL m The sankary Perm* Is trankraba. Hatory: 1977 C.168;1979 0. 34.M;1981 a 314 Note: N you with to naw 1M Pumk, or trans* ownushlp of the W* Plane intact the coardy ardhorky. AUTHORIZED ISSUING OFFICER - DATE I 2w2 UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R.8/00) APPLICATION• FOR SANITARY PERMIT STC-100 This application form Is to be completed in full and signed by the ownet(s) of the ptoperty being developed. Any Inadequacies will only result in delays of the permit issuance. -Should this davelopment be Intended tot tesale by ownet/contcectoce(spee house)* then a second Iota should be retained and completed when the property to said and submitted to this 011194 with the apptoptlato deed recording. owner of property LON ova JA-njNlk (-71c-8tR>"SoAJ NE Y4 of SC Y4 O r Location of prapetty ic /1 NC- 1/It Oactlon Z_ T.-R-V Township KI so tj lcic � N v icy Melling address 150 N ocvi-f I AiUC # Z - rRC.LS, tut 54ozZ Address of site Subdivision name -' kel IA �� S Lot number VV3 Previous owner of property STEVCti) Total else of parcel 3• -30 Date parcel was created Acs all cornets and lot lines Identifiable? an lie is this ptoperty being developed lot trials Copse house)? as `� we Tolsme /0 7 4 and Page Humber /d a- as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLowtNOi A WARRANTY DIED which Includes a DOCUMENT NUMBER, VOLtME AND PACE NUMBER, and the SEAL OF THE REOtSTER OF DEEDS. In addition, a certified survey, It avallablet would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Cestllled Survey Map, the Cattllled survey Map shall also be required. PROPERTY OWNER CERTIFICATION t(wel cettify that all statements on this form are true to the best of my (out) Rnowledgel that t (we) an tat*) the ownet(s) off the property described In this Intocmation totm, by virtue of ■ warranty d Sad corded In the Office of the County Register of Deeds as Document Ho. S'/.S•i/.'�ro• t and that I (we) ptesently own the proposed site lot the savage disposal system (at I two) have obtained an tenement, ,to tun with the above described property, tot the construction at sold system, and the same has by�n dulcotdod In the Office of t+s County R [star of Deeds# as Docusent ate! / Qy s ). OVIs/94 Date of • gnatuto Signsturs KI Co-Own#jj (tt Applicable$ 4// 5/ g-� Date of signature l April 29, 1994 Mr. Paul C.J. Steiner N8230 945th Street River Falls, Wisconsin 54022 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54018-7710 (715) 386-4680 RE: sanitary Permit Application for Lon and Janna Gilbertson Dear Mr. Steiner: Enclosed is your Sanitary Permit Application and attachments for the Lon and Janna Gilbertson residence. Please resubmit the Sanitary Permit Application to our office once the plat plan is done. Thank you. Ve si cerely, t es Thom n Assistant Zoning Administrator mz Enclosures ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715)386-4680 PERMIT APPLICATION CHECKLIST A. COMPLETED Sanitary Permit Application./D r 6-,�ZT— lef 7• B. COMPLETED STC 100 & 105, Property Deed, Original Soil Report, CSM or Subdivision plat & detailed plot plan which mu t nclude the follgwing: /?o'0(pt'06a.' 644-64i1&4e ❑ 1. Own r, buyer (if applicable) & legal description. 2. ❑ Project location: Provide a reference from the project site to the nearest road intersection or section corner. 3. 0 Lot or parcel size. 4. ❑ North arrow & Legend. 5. 0 Scale or give dimensions from two directions. 6. 0 Locate & describe both the Vertical reference point (VRP or BM) & Horizontal reference point (HRP): The HRP can be the same as the VRP/BM if so described. 7. ❑ House/building locations with reference to the HRP. 8. ❑ Building sewer, forcemain, well & water service location. 9. ❑ Septic tank/lift chamber, distribution box, & diversion valve locations. Existing tanks: Provide Certification for the Utilization of an Existing Septic Tank Statement. 10. ❑ Absorption system(s): Both primary and replacement systems drawn to scale. 11. ❑ Effluent systems: Distribution piping and vent detail. 12. ❑ Setback distances from the system to lakes, streams, building, property lines/easements, critical slopes, etc. 13. ❑ Adjoining property information: show setbacks or state that setbacks are greater than the minimums required. 14. ❑ Pump chamber cross section, including dose volume & TDH calculations, pump manufacturer, model # & pump curve. 15. ❑ Master plumber/designer signature, date and license number on each page of plans or coversheet. m m to Q Q 0 LL ` 7, RECEIPT DATE LPLW 1 V � RECEIVED FROM ADDRESS IMMAMMY �■■ •'. �■ = -mil' I _� � �.� WISC panmentofIndustry. SOIL AND SITE EVALUATION REPORT t t.e a uman Relations Page_ of—. _ - - � III pYYVIY AIMI IYI 11 I VV.V VI ..,J• ri V.. r. vv.v COUNTY Attach complete site plan on paper not less than 81Y2 x 11 inches in size. Plan must include, but PARCEL I.D. 0 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY Dart - APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION Steven Cudd GOVT. LOT NE 1/4 NE 1/4,S29 T 28 N.R 18 4:l04 •rI PROPERTY OWNER':S MAILING ADDRESS LOT rr BLOCK rr SU6D. NAME OR CSM s ffaa rl. 1120 Pine Ridge Drive 3 1 -- I ------------ CITY, STATE ZIP CODE PHONE NUMBER f0moomma EI CIWN NEAREST ROAD River Falls WI 54022 (715) 425-5544 Kinnickinnic Tibert Road [>d New Construction Use JK I Residential / Number of bedroxns 3 [ I Addition to existing building I I Replacement [ I Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate 14 bed, gpolh2.5 trench, gpd1h2 Absorption area required 1,125 bed, h2 900' _ trench, tt2 Maximum design loading rate _bed, gpolft2-,f_uench, gpNh2 Recommended infiltration surface elevation(s) h (as referred to site plan benchmark) Additional design / site considerations Syst-pm F1 Pvat inn 96 Rn I _- Parent material Flood plain elevation, it applicable h S a Suitable lof system CONVENTIONAL E) S ❑ U MOUND ®S ❑ U IN -GROUND PRESSURE as ❑ U AT -GRADE I as U SYSTEM IN f4l ❑ S EIU WLD"G TA:n ❑ S W U tl a Unsuitable fors stem Boring fY Ground elev. 100 ,51 ft, DuFth to limiting fxlor Boring /1 2 Ground elev. 1 OZ M ft. Depth to limiting factor SOIL 13ESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles Gu. Sz. Cont. Color Texture Structure Gr. SZ. Sh. Consistence Botrmy Roots GPD!II_' Bea iliC+a, 1 0-21 10YR 2/1 None sl 2 m sbk mfr Cls 1f .5 1.6 2 21-36 1 4 6 None is 1 m sbk mfi 1 1 .-6. 3 6-116 10YR 7/6 None s 0 m s mfr -- -- 1 .5 1.6 Rcmnr4c- ' 01 9M / a ® I • ®=® ' Nwi15 .6 Remarks: Name: -Please Pr; Prone: June 1, 1993 NwnLw 3074 PROPERTYOWNER Steven (L� Sui. uES1..,.. PARCEL I.D. r Page —w— 10 Boring # 3' Ground ON. 103.36 It. L;Lplh to Iimiung facto[ Boring p 4 Ground elev. 100.83 ft. Depth to Iinii1ing factor Boring q 5 Ground elev. 1 01,fa IL Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Cw. Sz. Cons Color Texture Structure Gr. Sz. Sh. Consstertce BarrdurY Roots Bed In,�1r 10 r 2 1 10YR 4/6 10YR 7/6 None None is s 1 m sbk. 0 m sg mfr—!-.6. mfr -- -- '6 .5 I .6 1 2 0-17 17-33 3 33-11 Boring p Ground elev. It. O.plh to Inuiung laclor nemdns. 1 0-14 10 2 1 2 14-30 10YR 4 6 None 3 30-11 10YR 7/6 None is s 1 m sbk mf 0 m sbk mfr JS-- 5--p -- -- 5 -_- nerndrrv. 1 0-27 10YR 2/2 — None sl 2 m sbk mfr gs if — .5 .-.6— 2 27-43 10YR 4/6 None is 1 m sbk mfr gs 1f .5_ .6 3 3-110 10YR 7/6 none s 0 m s mfi -- -- _5 .6- Remarks: sno e330(R 05192) PLOT PLAN •S Gn 1, )"- La f 4 1,