HomeMy WebLinkAbout022-1057-90-000
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER M 1 In ~ip~ q t7V
ADDRESS < b I W er l/ rpVt
iU'er Fq(l-s U,)I 3y62z
SUBDIVISION / CSM# To QP oz 2 -/o57-`,e) LOT #
S ECTION_,~&d T eZ Ir N-RW , Town of
~l ri n E ~f / h n c
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
EXis~ih~ /ooo~dl Sepr T r
dU~Se $Uflcd ..lcJ.eeks Au-p7dxk
ict Vao~2 We 11 3,60'x5' T re,'CA s
Nbrtk
INDICATE NORTH ARROW
S I~ 1 " c
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: p WA ,te AlL~/Kaka u .kdew fiza" ll/ beat i5k&,wr
ALTERNATE BM:
R / PUMP CHAMBER ice-. ON
Manufacturer: e Liquid Capacity: 0,06
Setback from: Well 60 House Other
Pump: Manufacturer Model# Size
-7
Float seperation Gallons/cycle:
Alarm Location
-:SOIL ABSORPTION SYSTEM
Width: Length (e(~ Number of trenches 3
Distance & Direction to nearest prop. line:
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet; ST outlet 1'sl, y4
PC inlet '7'/. 3,'2 PC bottom_ Pump Off
Header/Manifold 99, 33 Bottom of system 7-7,4)1
Existing Grade 99; 55_$ Final grade 79.
3
DATE OF INSTALLATION: 161
PLUMBER ON JOB: P
I CJ _S~P/n 1 ✓
LICENSE NUMBER:
INSPECTOR:
3/93:jt
nsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
d Human ReDivision s INSPECTION REPORT
and Buildings
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
Permit H dejj'ss Na ❑ City ❑ Village n of: State Plan ID No.:
CST BM lev.: I p. Elev.: BM De cription: Parcel Tax No.:
i ~GC i c. r» / t
A .4
TANK INFORMATION ELEVATION DATA icy 67 ,
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic LI) Benchmark
Dosing S ~~C gG
Aeration Bldg. Sewer
Holding St/ Inlet .Lj
TANK SETBACK INFORMATION St/ )O Outlet
TANKTO P/L WELL BLDG. Aierlntake ROAD Dt Inlet ~T-33
Septic ~.S:)' S$' NA Dt Bottom
Dosing NA FleaeltzrTMan.
i
Aeration NA Dist. Pipe G, ~Z
Hold Bot. System L' PUMP / I INFORMATION Final Grade
Manufacturer Demand
Model Number „5 GPM
TDH Lift Friction System TDH Ft
Head
Forcemain Length Dia. Dist. To Well
SOILABSORPTION SYSTEM
BED/TRENCH Width Length No. Of enches PIT No. Of Pits Inside Dia. Liquid Depth
DI N ~l DIMEN I __N
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHI Manu actur
SETBACK CHAMBER
INFORMATION Type Of rc' A Moe er.
74 OR
System: 61 y7
DISTRIBUTION SYSTEM
Header / Id Distribution Pipe(s) ~i x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length SZ Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sy s
Depth Over Depth Over xx Depth Of x ed / Sodde xx Mulched
Bed / Toooeh Center Bed / T~h Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS (In ude code discrepancies, person present, etc.)
C,7
ICZl~
Plan revision required? ❑ Yes Q_Nc - lell VN
Use other side for additional information. IM 0.7
SBD-6710(R 05/91) . i Date Inspector'sSignatur Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i
m
LO UMl;,,rX 8wtqXtpnic.20.2W0%1rETf WAGE M 'J% Drive
County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division ST, CROIX
GENERAL (ATTACH TO PERMIT) Sanitary Permit No-:
INFORMATION
199842
Permit Holder's Name: ❑ City ❑ Village k; Town of: State Plan ID No.:
WfORePy -Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9400049
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P/ L WELL BLDG. A
ir Ito ntake ROAD Dt Inlet
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction Syestem TDH Ft
Loss
Forcemain Length Dia. FFii Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size 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: Kinnickinnic.20.28.18W, NW, SE, Rivre Drive
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i
DILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
- St. Croix
STATE SANITARY PERMIT #
-Attach'complete plans (to the county copy only) for the system, on paper not less than / 9 lfs ~
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
Mil and NW % SE %a, S 20 T 28 , N, R 18 W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
1068 River Drive
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
1015 425-7136
NEAREST ROAD
II. TYPE OF BUILDING: (Check one) ❑ State Owned k nn River Drive
❑ Public ®1 or 2 Fam. Dwelling- # of bedrooms 3 - PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) 022-1057-90
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 12 ❑ Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 1130 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 220 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 1,125 1,125 .4 97.0 Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank
Lift Pum Tan 800 800 x
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Pre: o Stam s) MP/1fA0SNo.: Business Phone Number:
Paul C. J. Steiner C. 6780 715 425-5544
Plumber's Address (Street, City, State, Zip Co e): V .11
N8230 Highway 65• River Falls WI 54022
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater a Is ssue Issuing Rlperix 'gnature (No amps
Surcharge Fee)
XApproved ❑ Owner Given Initial
Adverse Determination
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:
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'f2 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
i
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)
PLOT PLAN Page 3 of 3
SCALE 1"= 3p'
~~CJ.3l. IDS o2Z,lOS'~-9o
- l0U . Q RT B OTTp~ OF w II
C~ l.~r-i 1ru uM T"
~~ou~ ~GRaV, pDO~J ~?J~M~ 11~
. S?~iVytC cl•13K~.+ouT ►wu . t'L t'~ . q y
u LXO.,Ys
Pit hA 9 Tit,. k
60~
el 1196 6' pop z
\ bt3.~ 60
k EL 9 9 6 Su 1`i'~Y3 \ ~ F'(~
3 . RT S' x U,4 LLWC
ti
rJ
J J
'o
N
7
rp
_ ~ Rlu~ blZl UE
%v93
PAGE OF
CrUSS Secrlun O1~ r'l iJeO JyJern
Fresh Air Inlets And Observation Pipe
~-Approvsd Vent Cop
Minimum 12' Above
Final Grade
20- 42" Above Pipe _ 4" Cast Iron
To Final Grade Vent Pipe
Marsh May Or Synthatk Covering -
i win 2" Aggregate
Over Pips
Olt trlbutlon -
0 0 0 0 Toe
0
! 6" Aggragato
o Perforated Pipe Bolor,
Beneath Pip s
Coupling Terminating At
Bottom Of System
Pr~pQse~ ~I~kl ``qr~.~1{
SOIL FILL
DISTRIBUTIOM PIPE
APPROVED S4MIETIC COVER
/ ° ' MATEP,11% OR 9" OF STRAW
2 OF AGGREGATE. OR MARSH HA'3
e ~0F12-Zt/Z AGGREGATE .08
ELEV. OF fE~T-.. b
DISTRIgUTIOM PIPE TO BE AT LEAST /R IUCHES BELOW ORIGIMAL GRADE
A►Jp AT LEASTZO I.MCHES BUT AIO MORE THAt.1 42 IAICNES BELOW FINAL GRADE
MAXIMUM DEPTH OF EXCAVATIOO FROM ORI&INAL 6KAVR WILL BE .3.02 M IF= 1116- =
MINIMUM Ciff" OF EXCAVATImN FROM 01K141WAL GRADE WILL BE C LS / I
SIGHED:
LICEUSE DUMBER: Lp ` R 'C)
DATE: T~~ zz
PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VENT CAP
4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING
JUNCTION BOX
? ?-5' FRCM DOOR, MANHOLE COVER.
WINDOW OR FRESH IZ M"'~
AIR INTAKE i
GRADE
I `1° MIN.
T 18" MIM.
CONDUIT kl~- - _
f~ll_.E l" PROVIDE I
AIRTIGHT SEAL I I i I
I I
APPR.OVEC JOINT A I III APPROVED .JOINTS
W/C.1, PIPE. I III W/C.I. PIPE
EXTENDIAII. 3' I II ALARM EXTENDImG 3'
ONTO $0LID SC;;. B I I ONTO SOLID SOIL
I I
I I ON
C I I
I
PUMP---
OFF
D
CONCRETE BLOCK
RISER EXIT PERMITTED 01JLd IF TANK MANUFACTURILR HAS SUCH APPROVAL
SPECIFICATIOMS
SEPTIC AMC) DOSE TANKS MANUFACTURER: Wa R, 3 NUMBER OF DOSES: PER DA-4
TANK ;,IZE : woo GALLONS DOSE VOLUME
ALARM MANUFACTURER: Almv_ INCLUDING BACKFLOW: GALLONS
MODEL IJUMBER: rJ j/ CAPACITIES: A= INCHES OR Y6 GALLON5
SWITCH TyPE: , / ,-f 8= 27- INCHES OR 3c/ _Y GA'_LONS
PUMP MANUFACTURER: /UL a ees c, imr-HES OR IS 7 GALLOWS
MODEL NUMBER: S SM YAA D- 1,2- OR a20Y GALLONS
SWITCH TyPE: - Flo'. r NOTE: PUMP AND ALARM ARE TO BE .
PUMP DISCHAR4E RATE ~D GPM IN5TALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE B Yucc ► PUMP OFF AND DISTRIBUTION PIPE„ FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . , , . . . , . 2•S FEET
+ FEET OF FORCE MAIN X F 00FT.FRICTION FACTOR.. FEET
= TOTAL DYNAMIC. HEAD = FEET
INTERNAL DIMEWSIOtJS OF TANK: LENGTH 7 7
;WIDTH ;LIQUID DEPTH
SIGNED: LICENSE IJUMBE
R: ~ DATE: -117-
STEINER PLUMS & ELEC INC 7154258$18 P.01
500/4
Features
pump impeller is recessed Powetful 4110 HP Motor is Rotary Shaft Seal has carbon Mercury Switch 20 CAMP rating,
"Tornado' type operates oil filled for od Insulation and and ceramic faces for positive 3" cylinder, wide angle 1200 oper-
completely out of volute passage lubrication obearings and seal. seal. Body is stationary, prevents ation, polypropylene material,
giving full opening for flow of Overload protection built-in, has string or trash from winding Minimum recommended Tether
liquids and solids. no starting switch or reiay on Seal, length Is 31/g" from cord clip to
Motor Housing is heavy cast mechanism, Switch Housing (SSM4A) Is switch case (Pump Down 7-e"),
Iran, epoxy coated. Stator is Thrust Washers and Sleeve completely sealed from Sump 'Pump Down' can be increased
preased In for perfect alignment, Bearings are oil lubricated for liquid, easily removed for by increasing the Tether length.
best heat transfer, smooth operation, long pump life, replacement If needed.
Dimensions
SSM4M SSM4A
1
292.1 mm 2021 .mm
I 9 h e,h„
241.3mm r 241.9mm~
Performance Curve
CAPACITY LITERS PER MINUTE
a = 0 20 40 80 80 100 120 140 160 184 200 220 24
a _ - - - 9
26 e
24 y
to 22..
20
14 4 . 4 u7
12 s
16 4--
2 T_s - - - -
0
0 5 10 15 20 25 36 40 45 50 95 50
CAPACITY LON$ PER MINUTE
Accessories Performance Table
Myers offers a wide selection of accessory items for use with
the SSM4 pumps: adjustable level controls, wet sump controls, feet 2 4 6 8 10 12 14 16 18 20 22
Warm controls, electrical control boxes and switches, heavy Total
duty check valves, polyethiene and fiberglass basins, eto, Head Meters .61 1.22 1.83 2.44 3.05 3.66 4.27 4,88 5.49 6.10 6.71
Gallons Per Hour 3,600 3,600 3,450 3,300 3,150 2,940 2,550 2,250 1,800 1,300 660
titers
Per Hour 13,625 13,625 13,058 12,490 11,923 10,916 9,652 8,516 C:l Performance Capabilities
Capacities to 60 GPM 227 LPM
Heads to 24 feet 7.32 meters
IDO
Pump Dowd Range * 7 to 14 inches 177.8 to 355.6 mm
Automatic controls Control boxes
Solid Fiandling,Ca ablig ltY '/4 inch die, solids 191 mm die. solids
_ li uids Handled Fresh, drainage effluent waste water
Intermittent Liquid Temp. 150°F 66°C
Motor Yo HP
Electrical 1151230 V., 12.0 Amps, 1 60 Hertz
rl1ll Discharge 11/2 inch 3811 mm
I 'Automatic Model, (manual pump Variable with switch).
444111 DIVISION Of
Check vaNas F. E. MYERS CO. McNEIL
400ORANOtiSTREE CORPORATION
ASHLAND, OHIO 448116-2285
449/289.1144 TtLEX 98.7443 A AI
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Lakor and Human Relations
Divisidn 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 S~• ,
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. C) Z-Z - 1 O S7 - I2 O
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
" 1Lb bi"PL GA'Q. D GOVT. LOT NW 1/4 S E 1/4,S213 T Z$ N,R S E(ore
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
l~6 lulu ~\Zlu~ - -
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE DOWN NEAREST ROAD
'R,tiQL52..lr'11"LLS W SYOZ-Z- ('71-4 y2S-713/;, ~c.ll.~0.~ C1rrLIJJV RIUM bvlue
[ ] New Construction Use [x] Residential / Number of bedrooms 3 [ ] AdditilZn to eiasting building
Replacement [ ] Public or commercial describe
Code derived daily flow L450 gpd Recommended design loading rate - bed, gpd/ft2 ! • -S trench, gpd/ft2
Absorption area required 1\Z. S bed, 111:2 9 o0 trench, ft2 Maximum design loading rate o - ~ bed, gpd/ft2 0 - S trench, gpd/ft2
Recommended infiltration surface elevation(s) 01-1-O C ML 'M%uc Qt ) ft (as referred to site plan benchmark)
Additional design / site considerations S Py01l~r OIU lz~ ks t--- Z o 1= 3 ,
Parent material SNkj"- ov'm^s N Flood plain elevation, if applicable N - IN - ft
S = Suitable for SyStem CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for system US ❑ U ®S ❑ U WS ❑ U WS ❑ U WS El U ❑ S U
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. -Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tfench
1 -Z ►o~lz 31Z - \s `eS~k wtv~h c S _ o. 0-8
'.:r~tcri.~#< Z Z ~ 1 O~ Q 3 ~ (c ~ `T5 ` C ~ ~h U 1-F- C S O. O. S
Ground 3 Y l~`2lZ 4/~ - >~6>^ O S yn - o.~ u 8
elev.
tiW.Z ft. p
r
Depth to o~ VC
limiting
factor
AUG 3
> 86
ST C atX
Cy INGOFFICE
Remarks:
Boring #
D -2S vk'~' -M 31Z )s 1 c-S Novz 1^n U`Fh 5 0 1 ` $
Z 2 ZS SO 1O`-11Z 316 - ~S to w mv`Fh CS - o-4
3 sa-8 to `ID- V/L - 5 $6l,. Q S 1b -yn ~ - ~ o= 1 o. ~
Ground
elev. 4 y_q~ lug lZ 516 - S Gv - - - - -
99'• 5 ft _
Depth to
factor
°l Za SY-'n L _ E'F'E L U t NT 1 Fl'I' R t IIj r, ~ oU ..f t'-1 12l N -
I- I Remarks:
CST Name:-Please Print Phone-
Arthur L. We erer 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: ~ Date: CST Number:
d. 9 3 -16Z 8-Z-6-93 M00576
3
PROPERTYOWNER oPPE6~z D SOIL DESCRIPTION REPORT Page 0!
PARCEL I.D. # a '2-Z- 1(3 .5-)- CIO
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
I~
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Bed FTw&
to `i tZ -3 z- - ~ S 1 ~ ~ bar w~ v Q h e S 0.7 0 8
--Z-1/
,.g.
L 04
C-s o.s o.6 j
Ground 10`12 vl~ - Ts c"-\ Wt U e-S 1 0' y 0-S
elev.
ft. 1 wYR u/6 - S G~ O 3g w, 1 - o• o,
qg.6 y u~-~
Depth to
limiting
factor r
> SS
Remarks:
Boring #
.•i..•lv \ l
'e-T ~~S t U~llu L B C.C u
Ground X- C' 0 LL w
elev. N- VY AMU L G O F S S S.
ft.
Depth to
limiting -T 1 S \
factor
Remarks:
Boring #
LN
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of 3
W►L~.o C.N 6A''RD SCALE 1"= 3W
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OOAT'L Z (715 ) 425-0165 _ M00576
CST Signature Date Signed Telephone No. CST #
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the t 1 b 019J(J~ciId residence located at:
1/4, S ~5 1/4, sec. 02~ , T ;;?ff N, R /g W, Town of
h n►c ULLlrG Upon inspection, I certify that I have found the
tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced
Did flow back occur from absorption system? Yes Noll (if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete X Steel Other
Manufacurer (if known):
Age Tank (if known):
ILI, J s f~~ h -e y'
(Signatur ) (Name) Please Print
( itle) (License Number)
2/Z 7/?3
. (Date)
Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR-83, Wis. Adm. Code (except for
inspection opening over outlet baffle /
Name Signatur l MP/~P~~
5/88
SEPTIC TANK MAINTENANCE AGREEMENT ~
St. Croix County
R
OWNER/BUYER r~raaarc3 rt tA.
0
:J
ROUTE/BOX NUMBER ' 1'068 ver Drive Fire Number - d
54022 06
CITY/ STATE River Falls; WI ZIP cr
0
PROPERTY LOCATION:-.M' ► SE Section 20 T 28 No R 18 W,
Town of xinnickinnic , St. Croix County,
Subdivision Lot number.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes.- Prover maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed*s'e'ptic tank pumper. What you put into
the system can a-ffect the .unct on of tine septic tank as a treat-
ment-stage in the waste disposal system.
St. Croix County residents-may _ be eligible to recieve a grant for
a maximum of 604 of the cost-of replacement of a failing system,
whic 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 'sys'tems 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 mater 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. y
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 •d
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date
SIGNED.
DATE 6P/
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
• APPLICATION FOR SANITARY PERMIT
9TC-100
This application form Is to be completed In full and signed by the ornst(s) of
the property being developed. Any Inadequacies will only result In delays of
the petrrlt Issuance. -Should this development be Intended for tesala by
owner/contcactoc,(spec house), then a second form should be retained and
completed when the property Is sold and submitted to this ollice with the
apptoptlate deed recording.
- ft__-ft
Ownerof property Milo oppegard
Location of property _NW 1/4 sE 1/i, Section 20 . T_2j.j1 1l 18 Y
Township KiYLnickinnic
Malling address 1068 River, Drive
River Falls, WI 54022
Address of site 1068 River Drive; River Falls, WI 54022
subdivision name
Lot nuabet
Previous owner of property
Total six* of parcel
Date patcel was created
Ate all cornets and lot lines Identifiable? an Is this property being developed tot resale (spec house)? as 0
YoluNw _'421 -And Page Numbet _Lk 5_Z recorded With the Reglstar of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWINCt
A WARRANTY DRID which Includes a DOCUMRNT NUMBER, VOLVXZ AND PAOt NUMaiA, and
the SEAL OF THi RBOISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. It
the deed description tolerances to a Ceitltled Survey Map, the Cattltled Survey
Map shall also be requited.
ft - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I(We) cattily that all statements on this form ate true to the best of my (out)
knowledge that I (we) am (ate) the owner(s) of the ptopetty described In
this Information form, by virtue of a wstranty deed recorded In the Ollie* of
the County Registat of Deeds as Document Ho. _ 309J;L&- ; and that I (we)
ptesently own the proposed alts for the sewage disposal system (of I (we) have
obtained an easement, to run with the above described propecly, tot the
constcuctlon of said system, and.the same has been duly tecotdad In the office
~hcounly eglater of due as Document No.
s gnstuts of t signature of Co-owner ill Applicable)
L~
Bate • / elute o Date of Signature
DOCUMENT NO. WARRANTY DEED
Boo 481 PA ',;E452 STATE OF WISCONSIN-FORM I
3 " 9 1 2 6 THIS SPACE RESERVED FOR RECORDING DATA
Januar
• THIS INDENTURE. Made this. 3.1..c..t....... day of .........................Y.............................. REGISTERS OFFICE
ST. CROIX CO., WIS.
A. D., 19..72....., between---.Lester R.-..Gibson.--and -Lenorg---C.,---.Gik.&On.,.......---G:Lb husband and wife; and-•-Jerry-A.... . .g.Qtl-;-ants _-June.-L.-..Gibson,-.
Reed for Record this_3~tl__
husband and wife, day -A.D. 19Y?
at__ _~~3.4__. A~, M •
---.-...--••---.-..........-...--......-...partLeS of the first part and
Milo M. Oppegard and Betty--Lou-•.Oppegard,---husband_and..wife.,
as point tenants - -
Re t o sane
_
part..ieS -of the second part, RETURN TO v
W I t n e s s e t h, That the said part--.;,QS.-of the first part, for and in consideration
of the sum of..-.. 0ne_ Dollar--and---S?ther-.Valuable--. Consideration
to...... them in hand paid by the said part-ies_of the second part, the receipt whereof is hereby
confessed and acknowledged, ha.. Ve_ given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and 4b,y, these presents
do.__.------ give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part-- PS-of the second part, thPiPirs and assigns
forever, thegollowing described real estate situated in the County of...... _-.-.--S.t-,--..C>rQ.i%.......... and State of Wisconsin, to-wit:
The East 277 feet as measured from the South boundary of the following described parcel,
of land containing approximately 2.94 acres more or less. A parcel of land located in
the NW-4 of the SE4 of Section 20, T 28 N, R 18 W, more particularly described as follows:
Commencing at the SE corner of the NWT of SE's of Section 20, T 28 N, R 18 W, in the
center of a town road, thence North 471 feet to a wood conservation post, thence West
adjacent to state property a distance of 194 feet to a second wood conservation post,
thence in a southwesterly direction, adjacent to State Conservation property, a distance
of 551 feet to a third wood conservation post located 647 feet west and 157 feet north
of the point of beginning, thence South 157 feet to the center of the town road, thence
East 647 feet to the point of beginning, all located in the Town of Kinnickinnic, St.
Croix County, Wisconsin, containing approximately 5 acres•more or less.
(This deed is given in full and final satisfaction of the Land Contract recorded May 20,
1970, in Vol. 461 of Deeds on pages 379-380, as document #300598.)
(IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE)
Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate
right, title, interest, claim or demand whatsoever, of the said parieS.... of the first part, either in law or equity, either in possession or expectancy
of, in and to the above bargained premises, and their hereditaments and appurtenances.
To Have and To hold the said premises as above described with the hereditaments and appurtenances, unto the said parties of the
second part, and totheir------ heirs and assigns FOREVER.
And the said _Lester_R,_..Gibson,..Lenore -C.--.G.ibson,_ Jerry-,.~- Gibson and--.June L. Gibson.
for.- .themselves-.. anfl_.their._------- heirs, executors and administrators, do -........covenant, rant, bargain, and agree to and
with the said part_.ieSof the second part ..their_._.------ heirs and assigns, that at the time of the ensealing and delivery of these presents
they.are.-.__.-.---well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate cif inheritance
in the law, in fee simple, and that the same are free and clear from all incumbrances whatever.
- -
and that the above bargained premises in the quiet and peaceable possession of the said part.. esof the second part, theUirs and assigns, i
i
against all and every person or persons lawfully claiming the whole or any part thereof,- -they ---will forever WARRANT AND DF FEND.
In Witness Whereof, the said part.-.iQSof the first part ha.Me...hereunto set-,their.-- hand..$ _ and seal S this
day of__..January._....... A. I)., 19_72._-
SIGNED AND SEALED IN PRESENCE OF (SEAL)
Lester R. Gibs
E F.AL)
C. M!,-Bye~'7 Lenore C ibson
E mn- - - .
(SEAL-)
Jerry A. Gibson
Sandr-a--.Price.
. ,'r 1. l (SEAL)
June L. Gibson
STATE OF WISCONSIN, 1
Pierce } ss.
- - - ..County.,
Personally came before me, this...... - ...-.......1311 t day oL.°---. January--_. . , A. D., 19. 72...
the above named R. Gibson, Lenore C. Gibson, .Jerry A. Gibson and June L. Gibson
-
to me known to be the person-s...... who executed thq forlegtting instru 'N4 acknowledged the same.
TPRn
•
This instrument drafted by e '
k4otary Public erce County Wis.
c
C. M. B e Attorne ~ J.~•' c•
y....~ ......y.-................................. My Commission) (Is)...-.permanent.
River Falls Wisconsin.
(Section 59.61 (1) of the Wisconsin Statutes provides that all Instruments to be recorded shall have plainly printed or typewritten thereon the name.
of the grantors, grantees, witnesses and notary).
WARRANTY DEED-STATE OF WISCONSIN, FORM NO. I W C..ILLIR CO.. OILWAU11
Wisoonsin Department of Health and Sooial Services
Plb. #67 10/69 Division of Health
L mow.
PERMIT APPLICATION
for
PRIVATE DOMESTIC SEWAGE SYSTEMS
~t1lel --3- a -7D
fir-- -
A. mliFR. OF PROPERTY ~~j/ ~ TYPE OR USE BLACK INK
Nrllma vVb Address (Street, CC y, Zip Code)
County
B. LOCATION OF PROPERTY WH ARE SYSTEM 14ILL BE CONSTMJCTEV, ALTERED OR EXTENDED
Cheok One: V) 3 70
CITY VILLAGE LEGAL DESCRIPTION: (/X
TOWNSHIP ff ; 'cl~ ~y s 77/ X
C. IS LOCAL PERMIT REQUIRED FOR THIS 40K? YES NO PER IT N TSBEP. G
D. SEPTIC TANK CAPACITY rf'`/ 1 Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS; Prefab Concrete y Poured in Place Steel Other
NLMER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: Ono or Two Family Residence Commeroial Industrial Other
(Specify)
Number of Persons to be Accommodated Number of Bedrooms
F. APPLIANCES, ETC= Food Waste Grinder YES 5f~ NO Automatic Clothes Washer YES NO
Dishwasher YES i - NO Automatio Potato Peeler YES T NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW J5 EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet 4'~ l' Trench Width - Depth Number of Lines
Seepage Bedt Length Width Depth Tile Size No. Lines
Seepage Pitt Inside diameter Liquid Depth
-P E R C 0 L A T I 0 N T E S T
Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches Ninutes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last ro .all
lst W-otted Overnioht in Minutes Last Period Last Perio Period ?ne Inch
Example
P- 0 36" To Soil 10" Cla 2612 25 f es or no 30 1 2 1 2 1/2 60
RECORD DATA FROM MINIMUM OF 3 TEST HOLES
Compute size of absorption area in acooret with H 62.20 Wis. Administrative Code.
S O I L B 0 R I N G S- Minimum 3611 Below Pro used Absorption System
'l
oring Total Depth Depth to Ground Water Depth to Bedrock j
umber Inohes Observed Estimated Observed Estimated Character of Soil with Thickness in Inches j
xample
- 0 72" 72" Blaok To Soil 121• Cla 18"• Sand 1811, Gravel 2410
l
7f
V /,J
71
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
COMPLETE OTHER SIDE
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me
or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3),
Wisconsin Administrative Code, and tha'; the data recorded and location of test holes are correct to
the best of my knowledge and belief.
NAME% f, i f~ TITLE (Type or Print)
REGISTRATIONNO. or MASTER PLU B ER LICENSE No. C I
ADDRESS
DATE SIGNATLJTG
MASTER PLU1t3e:R MAKING APP ATION
~ MP
Signature: License Number;
MP RSW 7 1~ `f
(To be Completed by Issuing Agent)
Date of Application Fee Paid $
Permit Issued (d te) e> Permit Number/
Agent (name)%~ For
Z' JL
Town, Village, City, County, etc.
(Specify)
Notes The application cannot be considered for filing until all of the above questions are answered
and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the
Permit (yellow copy) to the Division of Health. Checks and money orders should be made
payable to the Division of Health.
i
Do not write in space below - FOR DEPARTMENT USE ONLY
DATE RECEIVED:{ / ~I1{ ACCEPTED BY RETURNED
/ (Initials) (Date) See Corres.T
FEE RECEIVED l VALID. NO. r 7. PERd'IIT NO. F~
(yes or No)
REVIEWED BY APPROVED DATE
(Initials) (Yes or No)
E
COMMENTS: