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022-1089-60-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572823 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Larson, David O. & Geraldine I Kinnickinnic, Town of 022-1089-60-200 Ins CST BM Elev: .BM lev: BM Description: Section/Town/Range/Map No: II p �ry) I 30.28.18.P480A1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ��C 1160 Benchmark e J X /� Dosin ,��w ` 6�i�-,� �J �a. Alt.63� 60 Js.�.. Aeration /�cw -_j Bldg.Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMAT N TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet Septic Dt Bottom fix• .�' Dosing Header/Man. AefetioTh i Dist. Pipe 5 33 �6 --7 Li 3M 7/66 7166 y ioa 7 16-6 � Holding Bot. System 6.4 L /0 7. /• PUMP/SIPHON INFORMATION Final Grade q•75 116 - 19 Manufacturer Demand S over /2"3l GPM CL4 Go �. -m Zcl ,/ Model Number TDH Lift � Frictio�os System Healz TDH, LFt , Forcemain Length Dial I Dist.to Well F::� SOIL ABSORPTION SYSTEM f /6 7. 3 BEDITRENCH Width Length No. Trenc s PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 75 W 9e SETBACK SYSTEM TO P/L BLDG IWELL LAKE/STREAM LEACHING Manufacturer: ` INFORMATION CHAMBER OR Type�f,$ystem: 1"/6(.- �11 71� UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold #I Distribution � / x Hole Size / Ix Hole Spacing 1 ( Vent to Air Intake Length Dia Length✓"'�� Dia a Spacing 3. 17 1 $ JZ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only f `� jNo Depth Over Depth Over xx Depth of ^ xx Seeded/Sodded xx Mulched Bed/Trench Center ( Bed/Trench Edges Topsoil I l-- es � No .ZFf COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 933 Quarry Road River Falls,WI 54022(SE 1/4 SE 1/4 30 T28N R1 8W) NA Lolt•1 Parcel No: 30.28.18.P480A1 1.)Alt BM Description I 2.)Bldg sewer length= -amount of cover= l J S4�. z • P�a�teJa Plan revision Required? Yes - No Z S Use other side for additional information. Date Insepctors Si ature Cert.No. SBD-6710(R.3/97) LQQel '9WVper,UWjn9+ NIC 30.2WfAyl���1lAGE SYSTEM County: Saf�d Human igs Division INSPECTION REPORT (ATTACH TO PERMIT) anitar r . it om GENERAL INFORMATION Permit Holder's Name: city 0 Village Town of: State PI .. ev.: Insp.BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300283 TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. Septic / , ; Benchmark /00 , Dosing GI/ .ham-7} F l o.n: p o, Aeration Bldg.Sewer Holding St/ Inlet /,q �.$3 TANK SETBACK INFORMATION St/Outlet Grp /1. TANK TO P/L WELL BLDG. AirI Ventto o ROAD Dt Inl Air Intake ( - -f 1,-1L (I�i 3 Se tic /3 NA Dt Bottom _ %(/ L p >a5 a y ?�v , 7 3 rcW,65 y.�;y� Dosing �d5 138 zy' >zY' NA ker/Man. Aeration NA Dist.Pipe Holding Bot.System a,93 / 0 y� PUMP/SIPHON INFORMATION Final Grade Manufacturer a,�iC�a v Demmand ' ( te, 4'�i d(r, R oz Model Number 9,� //.y, ) IDJ GPM Z /3, , -7 z p�7 TDH Li Friction 5 ste TDH Ft � lelk Forcemain Length �I Dia. a" Dist.Toweny,�1 �2i �C �'(1L?' irk /1?'u--' �- SOILABSORPTION SYSTEM BED/TRENCH Width / Length,,/, No.Of Tenches PIT No.Of Pits Inside Dia. Liquid Depth 1 / / Manu acturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING INFORMATION TypeO CHAMBER o e Num er: System:j4j,Q /tab ` Soo" > 5 o_i" ! l/.t OR UNIT DISTRIBUTION SYSTEM Afttivr/Manifold Distri ution Pipe(s) I/ x Ho a Size x Hoe Spacing Vent To Air Intake Length (e Dia. Length _TL Dia. � q U Spacing t�g I��rl W �� SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ,I Depth Over xx Depth Of xx 4eede Sodded xx Mulched Bed/Trench Center l6 Bed/Trench Edges i Z�l i! Topsoil Yes ❑ No Yes ❑ No �o.`COMMENTS: (Include code discrepancies,persons present,etc.) LOCATION: KINNICKINNTC 3.0.28.18.P480A /f Plan revision required? ❑ Yes Q/No /�" Use other side for additional information. (�� (J c." (. tk- 6 SBD-6710(R 05/91) Date In a or'sSignature Cert.No. or pl4h Aw- lv ©wk 0/ -S,c,fr Re CooS7 D a y,'o( L c<j roh rV /'-'` CooOk C+r I - /06> 1? t co � 3 u x j V3 Q6) 'h n? ` �X i v SJ \ `� y V a. v J w Zf v i- r J � IT U o w a ,Z o d � 1 a l , y 1 6 � 'F- o y \ d47. S` S '' •Y ' r- ; iii Buildings Division r, � � 2E11 W.WaShiltfltOtt Ave.,P.O.BOX:71$2 �Sanitary Prrmmt Number(1r5 be fdleml.ia ht�C.�:.) i •. ` #��l Allay arjl•t.115 E D ;". ts±;L"'t.' �rsrmn;t A ± ,� it+at. � ate 1 W4 �� t t��y ) St Transaction Numk> ct :., �,...,.� ::AA,>At C3.7i7ASiLLi.iVxx _ - ` In accordance with$PS 3I13:rl( j,Wis.Adm.Code,submission of this form to t�MFWKe0Q ital unit O[ 1 is required prior to obtaining a sanitary permit. Note:Application forng for; � p� Project Address(i different than mailing address) ► the Department of Safety and Professional Servies. Personal information yo tri be usenor secondary purposes in accordance wit'n the Privacy Law,s.15.040)(m),Stats. I. All ligation Information—Please Print All Information J Property Owner's Name Parcel ii n Property Location Property�'s mail' Address ? rr k luov .aof 7 J City,State 1 Lip Code Pimmme Number �' y, - ; , Section 30 �' } rclE or� { } �� Gil , ��o�a t � °�� IL Type of Ruilding(check all that apply) ( Lot Subdivision Name I or Family Dwelling-Number of Bedrooms — ----- -- r Block IN t Public/Conunereial-Describe Use ❑City of i CSM Number village of InSt.t.cnwrna—Describe use i >5 �U VA Town III.Type of Permit: (Check only one box on line A. Co m late line B if applicable) i A. a New System a 0 Replacement System t7trtiea�Holding Tank Replacement Only )10ther Modification to Existing System eXplaiu) =Before al d Permit Revision �Change of Plumber �+Pcntmmi/ioni of:,o New / List Previ us Permit Number and Date Issued Owner / g q . - 9 t IV.Type of POWTS System/Component/Device. (Check all that a pply) I]Non-Pressurized th-Ground ©Pressurized In-Ground ❑At-Grade CI Mound>24 in-of suitable soil 0 Mound<24 in,of suitable soil ©Bolding Tank Q tither Dispersal Component(explain] ❑Pretreatment Device(explain) 7 V.Dis ersal/Treatment Area Information: ; Gi J ,1( Design Flow(gpd) Design Sod A pp I' lion Ratc(gpdst) Dispersal Area R7,rexl(sf) Dispersal Area P posed(M System Elevation f t I Vi.Tank Info Capacity in Total of Manufac/p y } Gallons Gallons Units /kk 5 _ u L New T�ptiS Existing Tanks v a g ti 4illh c` U in M vs u..L -- L i Chamdbiner g Tak Septum ho Dosing p mo ! j r VII.Responsibility Statement-1,the undersigned,assume responsibility for installation of the POWTS shown on the attacked plans. Plumber's Name(Print) Piu s Signature MP/MPRS Number Business Phone Number 9 Plumber's address(Street City,State, ip Code) a o �ve� J WA �aa =A � On1• ' Permit Feer Date l�sucd l�daingAgcn S ieason for Denial IX.Conditions of Approval/Reasons for Disapproval � / � - ! 4 Y1 G i tZG 7zt 1 C Govt SYSTEM OWNER: " 1 1.Septic tank,effluent filter and � � � �/1.1i�� S �f7i✓ dispersal cell must 0�ser�gd/rnai jatned �= ���L G iL1ti " z - "✓- ��`" ���-le as per management plan provided by plumber. i 7 as per applicable for die system and submit to the County Only on paper not feu than g i!Y x 11 inches in silt SBD-6398(R. t I/11) 1 I - ,' '•5��9�P�T �T�n RECEIVED OF 10541N RANCH ROAD oil HAYWARD WI 54843 3 2 q q Contact Through Relay ®C ! f 4 hftp://dsps.wi.gov/programs/industry-services ov www.wisconsin. St. GROIX COUNTY www.wisconsin.gov ssror��' :OMMUNITY DEVELOPMENT Scott Walker,Governor Dave Ross,Secretary October 09,2014 CUST ID No. 220673 ATTIC•POWTS Inspector CHARLES L WEBSTER ZONING OFFICE WEBSTER SOIL TESTING&DESIGN ST CROIX COUNTY SPIA N5815 770TH ST 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/09/2016 Identification Numbers Transaction ID No.2464800 SITE: Site ID No. 806808 David Larson Please refer to both identification numbers, 933 Quarry Rd above,in all correspondence with the agency. Town of Kinnickinnic St Croix County SE1/4, SE1/4,S30,T28N,R18W FOR: Description:Mound,4 bedroom residence Object Type:POWTS Component Manual Regulated Object ID No.: 1506560 Maintenance required; Replacement system; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter CONDII The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes APPS and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed DEPT OF ; and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. PROFESSIO' The owner,as defined in chapter 101.01(10),Wisconsin Statutes, is responsible for compliance with all code requirements. DIVISION OF IN[ No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06 stats. The following conditions shall be met during construction or installation and prior to occupancy or use: SEE CORP Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. • Following the removal of the old sand fill,and prior to the construction of the system,check the moisture content of the soil to a depth of 8 inches.If the site is too wet to prepare,do not proceed until it dries.It is the recommendation of the department that the tanks be pumped for a couple of weeks prior to the mound removal procedure. This will help insure that the soil will have a chance to dry and retain some structure during the stripping process.Remove as much material from the upslope side as feasible.Tracked equipment on the site is required. • The existing septic/holding tank(s)must be inspected for structural soundness,size and baffles and must be brought into conformance with the requirements of SPS 383,Wis.Adm.Code.If it does not conform a state approved tank must be installed. CHARLES L WEBSTER Page 2 10/9/2014 �. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis.Adm. Code. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Patricia L Shandorf E Payment Submittal. POWTS Plan Reviewer,Integrated Services (715)634-7810, Fax:(715)634-5150,M-F 8:00 a.m.-4:45 p.m. WiSMART code:7633' pat.shandorf@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1,2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed In a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. i Webster Soil Testing & Sewer System Design Charlie Webster, Owner N5815 770th Street Ellsworth, WI 54011 WI Licenses: MP220673, ST220673, D 2110 P Telephon+(715) 273-3430 POWTS Index Sheet Page 1 of 10 Mound System for a 4 Bedroom Residence Property Owner/Project: David Larson SE 1/4 of SE 1/4 S30 T28N R18W 933°Quarry Road Town of Kinnickinnic, St Croix County Parcel I. D. 022-1089-60-200 Page 1 of 10 Index Sheet Page 2 of 10 Situation Report & Construction Considerations Page 3 of 10 Plot Plan Page 4 of 10 System Ctoft Section Page 5 of 10 Distribution Wipe Layout Page 6 of 10 SepW Tank and Filter Layout Page of 10 Pumps Chamber Layout Page 8 of 10 Pump Performance Curve -10NALLY Page 9 & 10 of 10 Management Plan ZOVED 07 %9Y SAFETY D ``�1�� �iq1/',/i .`SAL FtVi )U RVI ES WD BSTER ? ELLSWOF" ESpONDENC r WIS. � � Nett. ``�,• ►� �/e� z Component Manual Used: Name: Mound Component Manual for POWTS Version:2.0 SBD-10691-P Dated: January 30, 2001 Name: Pressure Distribution Manual for POWTS Version: 2.0 SBD-10706-P Dated: January 20, 2001 REPLACEMENT MOUND PLAN FOR DAVID CARSON KINNICKINNIC TOWNSHIP/ST CROIX COUNTY SITUATION REPORT The existing mound sewer system was installed in September, 1994 and was designed for a four bedroom residence under the rules in force at that time.This was plan No.S93-03767. The mound has developed an impervious biomat at the interface between the rock bed and the sand lift.The mound is leaking out the side at that point.There is no evidence of seepage at the toe of the mound.The limiting factor on the soil report is 30 inches. The bench mark has been reestablished as shown on the Plot Plan.This was done using the elevation of the pump pad given on both the original inspection report and on the As-Built. This was checked by comparing to the elevations of the system in taken in the inspection pipes,which were within 0.02 ft of the bench mark established off of the pump pad. This plan incorporates changes in the code that have taken place since the original installation.The distribution cell size is larger,the amount of cover is less,the height of the sand lift is less.The limiting factor on the soil test is 30 inches.The original plan had a sand lift of 1.0 ft.This design incorporates a sand lift of 0.7 ft.(only 0.5 ft is required).The exterior dimensions and location of the mound remain the same on the replacement as was on the original plan(in other words,the "footprint"remains the same. The dimensions shown on the plan cross section view compared to the dimensions shown on this plan are as follows: W,L, F,&J remain the same.Dimension A was 8.0 ft.,and is now 9.5 ft.,Dimension B was 63 ft.,and is now 64 ft.,Dimension I was 18 ft.and is now 16.5 ft.,Dimension K was 12 ft.,and is now 11.5 ft.,Dimension D was 1.0 ft.,and is now 0.7 ft., Dimension E was 2.0 ft.,and is now 1.84 ft.,Dimension G was 1.0 ft.,and is now 0.5 ft.,Dimension H was 1.5 ft.,and is now 1.0 ft. OTHER CONSTRUCTION AND DESIGN CONSIDERATIONS A filter needs to be installed on this system.The plan calls for a 320 gallon septic tank with a Polylok filter to be installed. Remove excess/overgrown vegetation from mound,mow and remove clippings. Pump out any standing wastewater through observation pipes. Permit dispersal area to dry out. Remove and stockpile topsoil from mound system. Remove aggregate from absorption area and dispose of in approved manner.It cannot be reused. Remove distribution pipes and observation pipes.Dispose of properly. Remove clogged sand plus an additional 3 inches of clean sand and dispose of properly.This sand cannot be reused. Inspect remaining sand for particle size to see if it meets ASTM Specification C-33. Install replacement mound system using procedure outlined in the approved mound component manual. f'Jcr P/aa Ml0-I Sc CA,rr �e c®>ylstru�t�o�, fior I� p� aj 'jC� O ci y1 4 Lao-j o h 1� K�'nhicKi`yhlc tw.,oSsCroik C+y It Ol � 3 � Cx s 1 r) CU qo fi s er a (u a v J r v b` O fO IA t a 1. yam' a p 5 n �- V ` r `i 04 d k Q4 v � s y a o a- ,�. � ---' !gyp z -clb- z , Wage �d,, k.,'e Approved Synthetic Covering FIST N) G 33 Distribution Pipe F%He /9/�r��a7e H G Topsoil _ -=== F Elev: //0. _J E D 3 s P/o,voaJ�4yec- �% Slope Bed Of 2�- Force Main* �` lE Ya"trdrl Aggregate — '� From Pump (sta p•jd dttj;1 a y,�te F•��e D o. -7 Ft Cross Section Of A Mound System Using E ,,+ Ft. A Bed For The Absorption Area F C7. � Ft. 6, A jF H /- ( Ft. z. Linear Loading Rate=?-'3 PD/LN FT B r Design Loading Rate=&..3l�GPD/SQ FT - </�+®✓, Ved a 1,/ rt red, r J rt. K L t. P"0-0° CA Afttco. w 3 �2-,Ft. eS'nrk ' Observation Pipe AI�-------- - --- --- _ _ ___- _ -- - ��--`•j o ` 6rac,6-ta%istribution Bed Of 2 2 2 B Pipe Aggregate Observation Pipe -!K a. AO (Anchor securely) ]-°ern 7►, �o.�es to 17,o v e �'�.%+►.k,-.tr d A,e 4 ir►e�, e s d e P t ayi'a�e�' 4.,rti�. t !f -dp, 4 d P a r d';,,cA d o `e, Page Of Perforated Pipe Detoll 0 End View Perforated y' PVC Pipe r t f .Ioasao / Holes Located On Bottom, Seat d e�d� Are EQuouy SpoCed `14 Q > s IT s } PVC a 17 MonHold Pipe A G� I Distribution .F 1 D / Pipe -�- Seems _ P 3a.6-7, Distribution PiPe Layout r� s 3.17 Ft. a,� c J 7( 3_ ty �'i ni hes' ei� X � n 00►'CS--t'(R r e- T*efms Hole Diameter 4 Inch Lateral _— Inches ; ' p»Z Manifold aZ- Inches Force Main " 3— Inches # of holes/pi pe1,,�_ a/c e ess 6�X ( tti"C'd �,�k Invert Elevation of Laterals //0. Ft. L.�y, s Y ye,eJ 4s C, ell ds d of e Place 1st hole�tti,ia. from center of manifold with succeeding holes at intervals. Gash 4**0le 1---fie �( " ' ce vi 'd L a` SaP7 z Sip t 7"a, k D rn m � a AS n c 58_ REQD U) D I 12 4" -n D 50' v� 0 48 A X m UP 47" � 4" CAS - - 43" LL 14 C) m IFIF 77 II II m m 3" � v � u, x s�" i `r� I I I o m II II > n L - - UP 45" 4" CAS 1�` g 1 46" O rn c N --1 N V m �} S •r D e D ° V° w N z�°� > 0 �= z z o -i _n9 xz � D c i m m D X9 V) D Gz) n O�z D�zDmpZmD<O ODp iF c° vX - Z 0 'DO �n0 V)00 0 0�02=A - r-z cn_q oz o- � 0 N -+ m Z cn m a _ _u (A Z =Q N Zm >m 03 O =N = g „�C D v 0 In0--n I (n ``C D °z C" z `''-�"' rrn o o y' �7 r g 'T1 `{ y �m D z =rz �� n m g P'° H �� � 0 0D 0 N m .D tJ1 2 N D C7 0 A i- m 0 Z Z c m C 3 0 r r m m m v \O m W320-MR MIENERCIRCRETE REV. NO. 2 CALE: 1/4"=V-0"DRAWN BY: SME S1'-0" PRE-POUR: POST-POUR: -I SEPTIC MANUAL DATE: JANUARY 2012 DATE:. 3/65/12 \ z W3716 US HWY 10 MAIDEN ROCK, WI 54750 ° REVISED JAN. 2012 800-325-8456 FILE: W320-M( �2Yi Q� L 4 rS D t: PAGI, OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIMS VC WT CAP y y�Y . w ti C.I. ai-Sc�ead,QO h w�zarj.�t /q Ge WEATHERPROOF g P/d.rtrC 1k-4r0• e JUIJCTIOJJ 80X � C ,ft-FROM DOOR, IZYMIU. WINDOW OR FRESH I AIR IMTAKE 1 GRADE 1 I—ILM I Q4-- COQDUIT �-- WMILJ. PROVIDE IfI I►JLET AIRTIGHT SEAL 1 * A I i ALARM IN e *APPROVED 0w C. JOINTS, WITH j I ELEV. FT. APPROVED PIPE PUMP---- __� 3' ONTO OFF D SOLID SOIL COUCKETE BLOCK I RISER EXIT PEKMIITED OWLti IF TALIA MAIJUFACTURER HAS SUCH APPROVAL. SEPTIC E S PE C I F I'CAti OU-5 DOSE I'VCG�'s IJUMBER Of DOSES: PER DAB TANKS MALJUFACTURCR: PaXTAWK SIZE'• $p0 GALLOWS DOSE VOLUME ALARM MAIJUFAGTUiCCR: 7CC Pr/aIdYfh IMCLUDING 6ACK FLOW:___1_SL.L,—..GALLOWS -� MODEL IJUM6ER: A� � CAPAC)T1ES: A= `�' 3 WCHES OR GALLOU5 SWITCH TYPE' �CCMQii9,��Q B= -°-2 IMCHESOR GALLOWS PUMP h1AMUFACTURER: o C=— 6 WCHES OR 1 GALLOWS MODEL WUMBER: 7 D. / °Z 114CHES OR Z GALLOWS SWITCH TYPE: P c14-rof"o dt AJOTE: PUMP AND ALARM ARE TO DC MIIJtMUM DISCHARGE RATE °� GPM WTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEREIJCE DETWEEW PUMP OFF ARID OISTItIbUTiOIJ PIP .. 6.-(7 FEET X z �`-FEET i- M�I7l imUM NETWORK SUPPLY PRESSpSURT,E/ . . . . . + °� � FEET OF FORCE MAIM X ,pCJ foo►LFRICTIOtJ FACTOR. FEET TOTAL DyIJAMIC. HEAD = �•� FEET �� mac► - ,'r /�./� LIQUID DEPTH ►hC4C IIJTERUAL DIMEWSIOQrb OF TAIJK: SPA�-, 'e Ta•� � k a O C� a ��e�►-11 r7fe CL HEAD CAPACITY CURVE MODEL""" 1� a a 1 4 / ,fn s 10 y' 2 5 0 U.S. GMIM 10 30 40 SO aD 70 so UTERS 114 ISO 210 0 FLOWPO NNOVE � 1a�rA►o�tawMwatawwewaaiwie MtVltaalrAlOaaarlawere i CMPAXY He" Ylara�l PONT a1a1!00 eAls .lTflt 3 1.81 72 273 to 3A6 111 231 is 4.57 46 170 30 6.10 as 96 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Eadrical&%Wralors,for dupkot symm.we available and • Varklbls level 009 wfthes are evelable for controlling single supplied with an alarm. and#w"phase systems. • Mechanical allernafdflrs• for duplex syslaiM,OM avalahim wlh • Dmft powba*varioba*M Ilfael switches are available or wd XXA Warm wim tee. for varabh aMSI brig cycle conbvW. SELECTON GUIDE Standarrat al nnodaiis- Ibs.• 'Ili W.P. 1.kMeanal11"Op~2 Pole medunioal sw"..no aabrnal cor"tavumW. 2. --- wn*"Wool ao6t 9-Nd or double pigrAwick vwwwa bevel• s><s.fraa cwAr l6NOMn« sMteelloti tlwlar lelCl SM. Moth) I vatwft moo 3.MIaa1 " 'of MNw 10,0072 or 10,0075. M BB 115 1 MO 111.4 1 t i 7 4. aa6 iM0712,Ibr e, d iwwal of EWcftW AAWroMw E•Pak. NO 115 1 Net Lf aw296 3w445 & CIO"wftk 104M uead as a car"acdvakv,wPSCNY dupieY(3)or(4) 008 230 1 Ado 4.7 1 aX 1 a 7 Ilea>I I E9a 2J0 1 Non 1.7 2 ar 2 s e 3w4&6 & Few(4)��4%K#Axftn bt,br waiw"M aornedon or wired-m sbvOw er dllift oprallon,10.0002. 7. Tvw M Neb 44%K far waWW', W. or apaa. CAUTION For' fM It�adt AN trier b"of swo@k: dwhea awl W"ww"he llwne by a quamd vawalwsalWa,RW1177;sYwMuf.l NlareMa+Mw+arw cl IlfaM�M so.awar.roYrawi AsweMhai.w6sat egrawaaeMe.wbeftilowesimlerdla4awo st stoop aria, 64*(NEC)2841 tbi OeCOVAND f Uf"Nd H"10 AC1(OSHA). RESERVE POWERED DESIGN For u UWW Dollar M a rasa W SWWY lector is anQi WWW into#*design of evwy Zoeller pump, z MK ra PA/0)f 1dw ly,A Y �� t.�YdlMyPV 4aMialri 4rrwbiMw►a a.. � Or r&�Mrw.rw Lair lfrt`4Wk1 ! AWYAWW SW My' .� ¢v, W .L. R r X C-7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of �O FILE.INFORMATION SYSTEM SPECIFICATIONS r'k-st.hs aUt Owner r Septic Tank Capacity Tor.,/ /-6-d-© al ❑ NA Permit# Septic Tank Manufacturer w°x x 3 ;L' . ,s ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer f'o/ /o k ❑ NA Number of Bedrooms 4 ❑NA Effluent Filter Model ❑ NA Number of Commercial Units XNA Pump Tank Capacity or c)C7 al ❑ NA Estimated flow(average) +00 gaijiday Pump Tank Manufacturer We-q-A" ❑ NA Design flow(peak), (Estimated x 1.5 �o Q Pump Manufacturer �c//�� ❑ NA Soil Application Rate �"'"`"r raw �°;3 aU Pump Model �' ❑ NA influent/Effluent Quality Monthly average' Pretreatment Unit XNA Fats, Oil&Grease (FOG) 530 mg/L ❑ Sand/qravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg1L ❑ In-ground (gravity) [3 In-ground(pressurized) Total Suspended Solids (TSS) 530 mg/L ❑At-grade ;Mound Fecal Coliform(geometric mean) 510''cf'u/100ml ❑ Drip-line ❑ Other: Maximum Effluent Particle Ste Y,Inch diameter values typical for domestic(non-convnercial)wastewater and septic tardc effluent ** Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months years) (Maximum 3 yrs.) Pump out contents of tanks) When combined sludge and scum equals one-third(> )of tank volume Inspect dispersal cell(s) At least once every ❑ months ❑year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 3 ❑ months ,(year(s) Inspect pump, pump controls&alarm At least once every ❑ months n years) ❑ NA j. 'l n/ Flush laterals and pressure test At least once every ❑ months ❑year(s) ❑ NA ztr'&1eeda j Other At least once every ❑ months ❑year(s) ❑ NA Other. At least once every O'months ❑year(s) ❑ NA M.� 1'CC00"ta- c/-r a/cJ.�rrg� fTl�r- &ace_g Ve'/ 3ye.)l.s.evc l eco�rir•s d tl Pt. MAINTENANCE INSTRUCTIONS you. c/e ijn rtl k>— every A0// to - V&'-`' a�y P—L/•r+' du r��� }he wtr,ter_ Inspections of tanks and dispersal cells shall be made by an individual carrying one of 6e following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s)shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third%)or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113,Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatifinent components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Page System Mart up shall not occur when soil conditions are huM at the infiltrative surface. During power outages pump tanks may fill above 17101IMa1 highweter levels. When power is restored the excess wastewater will be discharged to the dispersal oe111(s)in one large dose,overloading the oeii(s)and may result in the backup or sumacs dhx*mrge of effluent. To avoid this art have the contents of the pump tank removed by a ert S e Servicing O r to to the effluent pump or contort a Plumber or POWTS Maintain o ePth9 9 p prix restoring power assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal calks. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction orrelimination of the folkrMng from the wasdewatw stream may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes;cigarette butts;condoms;cotton swabs;degreasers; dental floss; diapers; disinfectants;fat;foundation drain(sump pump)water;fruit and vegetable peelings;gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides: sanitary napkins; tampons; and water softener brine. ABANDONM EN T When the POWTS fails and/or is permanently taken out of service the b&wAig steps shall be taken to Insure that the system is property and safely abandoned in compliance with ch. Comm 83:33,Wisc onsImAdministrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall'be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been,or must be taken,to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement anew should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. • A suitable replacement area Is not available due to setback and/or soft limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. .,k X Mound and at-grade soil absorption systems may be reconstructed In place foilowing removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS J� �112 S N?s 2 % �a ti T!/! �7 f/b�7 POWTS INSTALLER POWTS MAINTAINER wyi Name Tp,,, G!i'�� ,�xc� d�7`i/r Name Phone /S"_ 2—L — 7 7S- -Phone SEPTAGE SERVICING OPERATOR PUMPER G4,Khow LOCAL REGULATORY AUTHORITY Name Agency S¢ Cvc,, Z 017",1 Phone Phone 1!_ — i his document was drafted say the staffs of the Green Lake,LUMueft and WausMra County Zorft and Sanitation agencies. This d ,ment meets :he minimum requirements of ch.Comm s322(2)(b)(1)(d)3(f)and 83.W),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW(2/01) L T,WViart T,qWNIC 30.2 AMWAGE SYSTEM County: Labo• ,9 Human Relations INSPECTION REPORT Saf�d Buildings Division (ATTACH TO PERMIT) Sanitarlf ttrFhitlW.—__ . GENERAL INFORMATMN Permit Holder's Name: City Vi lage Town o : State P ev.: Insp.BM Elev.: BM Description: Parce Tax No.: 1001 �- G„ N2:J, TANK INFORMATION ELEVATION DATA A9300283 p -f{ ,,, TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ,..r �^ Benchmark Dosing o U, Aeration Bldg.Sewer Holding St/ Inlet AyS x,83 TANK SETBACK INFORMATION St/Outlet l/ 65 X6,3 Vent to ROAD Dt Inl f -IL I�i 3 �' 08. l VP I TANK TO P/L WELL BLDG. Air intake O --j ' � `f NA Dt Bottom w , 7 3 :2E,6 �' Septic > ,5 i a !3 a,/ 7�v Dosing �d5/ X38 zy' >zY' NA Wee&er/Man. Ko Aeration NA Dist.Pipe Holding Bot.System PUMP/SIPHON INFORMATION Final Grade a r�Ji>..,a Z Manufacturer a,�j�� , Demand S' &k.(^o! Gk1,Q d Lq -0L Model Number 9,� ( //- & GPM bill 2 /3, 7 z o�7 TDH Li Friction S ste TDH Ft Loss Forcemain Length �l Dia. a" Dist.Towelly SOIL ABSORPTION SYSTEM ' rl �' BED/TRENCH Width Length z/� No.Of Tenches PIT No.Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS/ / LEACHING Manu acturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER INFORMATION Type Of Model Number: 5 System:1"�� 0:�" i41!,c OR UNIT DISTRIBUTION SYSTEM r/Mani o Distribution Pipe(s) x Hoe Size x Hoe Spacing Vent To Air Intake a 1 0 length Dia. Length � Dia. Spacingg �� 7 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth Of xx See de Sodded xx Mulched Bed/Trench Center l6`I Bed/Trench Edges I z l8 Topsoil Yes ❑ No Yes ❑ No u;COMMENTS: (Include code discrepancies,persons present,etc.) LOCATION: KINNICKINNIC 30.28.18 P480A A? i I Plan revision required? ❑ Yes [Y/No Use other side for additional information q � � �/�`.` .�� � t.v'Ca-% •'-•� SBD-6710(R 05/91) Date In a oessignature Cert.No. { ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i i y , I < w _ Y C� t t � I ' I • i I � t t � ! _I _ 1 , � I s 7 e i I i . ( ° ° E f � t yy , p ,� ....E _. ( I ....... ........ r _€... � � �_�..... C'_!`' ( �..._._.._.. _,.._— ......,.._�_ ..,...:.E,...,..,..:a..,..:..,_} .. I � ......k�...._ 3 _j.._... _j,.,...:�.,,....,...}.,,...._.�.- €._.__.f _....�—.—.,...E ....._.. �...f r f{ I 4 1 t -0 C, a 3 a, O d 0 0. c o + 00 `e o o N C E C .y-. Y N O N 0r I p 3 65 6S OO 67 N 't Y L - 6s _ - y V y E_ N _ O n O c w o~ o u ao N O x ~ t v v-0 C). m a~ w cF" N n a4)2 N U) ch o V y" U y ,G ' c o E O y y L 63 N >6) C C O 0 6) y 0 H III L O H 6) C> O E N C N C O N w Of to p 3 N.L.. V C -O w O 'O C y 0 y y p o..mo~~n00 .rCC~~EL Y U O 'R 6) L N o Q.oac0mrnut0iymoa~ o - w 3 (D N U M CO O O p J d y O O N N E N L.+ O N 0 C= U C E c Z U C L 'O o C O O L 6) L" N LL O O <O yCy y N O O .0.. 3~ O> L~ Eyy E O U w 2 N c L p O` N j ~I N N •W f6 O> o E r m y (D _H C W Q w 65 w CV 0 3 U~ (O 9 .L... Q N y I Z N ao W E Z a m M H w _ O co C ~ N O z a N d Z U C O N ~w E ~ 0 0 0 • N N w O ~V L N 5E O C O V m 2 Z Z O N O zzcs N a CL C,4 a M o ° v N N 2 N N L G d > _a z ° `000 a= •N LLa.aa CL N (mil 0 M ~f a) c) 1~ N N J V III W O } 0 ti~ N co Z' E O = 'O N 6s m) c d L O m Q > U) 63 O M 7 b M O C O N N N O O O N C p E O C~ C d 7 n ° v U > (D y C V LL N O ~s rn E c N N co _ O a) N 0 P- 1~1 N N C N d H C N w O Z' O) 12 • ~y O c) Y 11 J O Z N (n r \ (D V ~ m 6s a a ` a CL z r`1V E 2 c c °r r A u(L2 0 vjiv LQAe g;Q*iart, #Tgi NIC 30.2W fAp(~%0NAGE SYSTEM County: Laho~ ~ I Human Relations REPORT jafWnd Buildings Division INSPECTION (ATTACH TO PERMIT) Sanitar rmit GENERAL INFORMATION Permit Holder's Name: . ❑ City ❑ Village 9 Town of: State Plan o.: T B ev.: Insp. BM Elev.: BM Description: R Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300283 o v3-fit ,,:;R, TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ag loo. Dosing ~ r, r s J u~ v. i ell D, Aeration Bldg. Sewer Holding St//Hf Inlet yS 7 3 TANK SETBACK INFORMATION St/Outlet / 1. 5 g (o3 Vent ir Ito ROAD Dt Inlet TANK TO P / L WELL BLDG. A l Air ntake 5,3 /06. Septic -dpi /3,9' a y' y NA Dt Bottom , 75 lCY, cl Dosing fc 5 l3$ zV >2Y' NA Hemmer/Man. Aeration NA Dist. Pipe a 3p Z Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade ~j a~ yrSr,;:.? Z Sb Manufacturer Demand t C v'~ a (p q oL Model Number GPM 7 -7 1 p~~ 7 TDH Lift Friction( Syste TDH t Ft Loss mead Forcemain I Length a~l Dia. a" Dist. To Well, SOIL ABSORPTION SYSTEM BED/TRENCH Width Length,, No. Of Tr nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ( DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu acturer: SETBACK INFORMATION Type O CHAMBER Mode Number: System: to t~ ` ~o o " ? S u,J " ~:1 OR UNIT DISTRIBUTION SYSTEM A;ftlde r /Manifold Distribution Pipe(s) x Hole Size x` ~H~ole Spacing Vent To Air Intake Length 41 Dia. Length ~ Dia. 11(p Spacing t Ilq ~ l~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ((ti Depth Over xx Depth Of xx Seeded Sodded xx Mulched Bed /Trench Center !u Bed /Trench Edges 17 Topsoil Yes E] No Yes ❑ No .`COMMENTS: (Include code discrepancies, persons present, etc.) t; ~ • 4: d2f ' ~ -C...~, • . ~~-a~_ ~ v a .ate-.<____ LOCATION: KINNICKINNIC 3.0.28.18 .P480A ,r-, f . r lf~G.~ f I4< `rcl -`ii' .f i ~1 ~Et• /y lJy~r'. Plan revision required? ❑ Yes [D/No , Use other side for additional information. I: SBD-6710 (R 05/91) Date Ins6eQtor's Signature Cert. No. s ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , /v i 1 m.a . p _ . STC 104 • AS BUILT SANITARY SYSTEM REPORT G 1 , rt' ~ _~;;~~,Q 1~7f} UC G~1 S d ~lJ A s f33 ..a,._., SUBDIVISION / CSM# e5 LOT # SECTION. 30 T 2-P N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - '0Z ORIGINAL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r~ ~7' Ole /0 7-op or- " zp T,41 /f T c4.P,v BENCHMARK: C3~ fE'vc~ 4uZ S/~?J~Ti~ ✓ - ~D 0, O 13Nt 4t z 4oP, SE? 7- (c TA,.j K - 130ITO., SfOCCO ALTERNATE BM: .57// 21,4j (r T O ffljU S~ - Uif ti` -/00,0 SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION 1200 Y1- 5Q11-f 7. Manufacturer: ~JbZ,e S _d-vC e7e_t 69. Liquid Capacity: ?00 " - Pu yp C, s~/1flC T Setback from: Well 13~ House Other Pump: Manufacturer 101611E~ "mow Model# Size 1 P1 it Float seperation X7, Gallons/cycle: Alarm Location IN Si1o!5_ :SOIL ABSORPTION SYSTEM Width: Length (W Number of trenches Distance & Direction to nearest prop. line: /0 710 VES 7- Setback from: well:> Soo House SOV Other 2 ELEVATIONS - /`ti'K Building Sewer 9 35 ST Inlet. 3 ST outlet Y'~&-44 13 1`4 PC inlet /0,?. /0 PC bottom 1Oy G ? • Pump Off /0 S, '70 Header/Manifold Bottom of system //0• ✓5-d Existing Grade Final grade '7_19/d of ~OU~l~ _ /AZ -ed 2/,v0€~' MpvuD yr . D as~P 7. f l~'F'~ bF INS, PLUMBER ON JOB: ~O Q~~ u LI3 IBC (A LICENSE NUMBER: M PPS 33 O 7 INSPECTOR: Mgt f 1( JEAJ S 3/93:jt AS - f3 U i L- T- PL07- P,L A wEii /ES 21' //IST S p-EC 5 - y~t/PA~F %y c,¢ r ig/s eev 13M # 2 ' /p"✓i/, e &,tTF A eo TFO TtP Gd / A S'YA'1'At i c ly' ~ Foe S tP T:4 T44,17(- FA II /3o MoAl &v~E- o~ ?p 1 " o E v,¢ r~b~ ioo D ~vok, /.Zoo SEO Tic F. ¢a PUG i,~ ovT AU-N o 'Off 70 TD 7,t G Li)T" SyZ /E'~ St;f' ~f'i u lr S ov Pv-4r Zo UOL-T' ~i tfP 16 14 7cti •90 pUC /Nsuc~tED 7 o ~W M J `Q lLJ N 1L 0 5 ~oTIDM of P~G 30 Q % 2 Jr' °F sue. A4,41A) ~ T 2lai Foy2M ~xiST/a G- I ('IEV,A?ro.v uwEe 1o------ o r3EO ~a~so' --------------------1 3z 01LHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code 5T' c "?w x ' STALif ITAYMP # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ T 8% x 11 inches in size. v ious a pplication -See reverse side for instructions for completing this application. sTAT E PLAI. EJER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. ~ (3 " CC PROPERTY OWNER PROPERTY LOCATION lc7_ Sr %-4~5 %4, S YD T21?, N, R f~ E (ot~ PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 2--j-0 k, CI / , STS ZIP CODE PHONE NUMBER SU IV'! ION NAME OR CSM N MBER II. TYPE OF BUILDING: 4fteck one CITY NEAREST ROAD ❑ State Owned ❑ V LAGE : /C/;&/ " , N OF: ❑ Public 21110'0-r 2 Fam. Dwelling-# of bedrooms A AX NUM III. BUILDING USE: (If building type is public, check all that apply) 0 2 Z - ddr f~ 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 RMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pre=ound istribution Experimental Other 11 ❑ Seepage Bed 21 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROS D (sq. ft.) (Gals/day/sq. ft.) jMlin./inch) ELEVATION 600 3-6 o 5U /,2- "'q //®,f Feet //L Feet VII. TANK CAPACITY Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Hold in Tank 744V 7- 9: Lift Pump Tank/Si hon Chamber 0491 11W / •'V e4 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) P/MPRSW No.: Business Phon mber• leo T Zl~~~r'~G~% 4 , 3 307 ~~s 3 71 J Plumber's Address (Street, City, State, Zip Code : SS 0 / ,vQl c . /~Vvre L' 6015= Sy6i IX. LINTY/DEPARTMENT USE ONLY X❑ Disapproved itary Permit Fee (Includes Groundwater Date Issued Issuing g natur (No S ) Approved ED Owner Given Initial ~ Surcharge Fee) a .7 Adverse termination o~CJ 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 properlymaintained. The septic tank(s) must be pumped by a licensed pumper.whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that 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; close 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 modes collected through these surcharges are used for monitoring groundwater, ground water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ULBRICHT & ASSOCIATES CO. 655 O'Neil Road - Hudson, Wl 54016 _ Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX 693-7 Date f3 DILHR Plan I.D. # Owner ~,<jUE L~/PSo.v Phone y~ 9 y27 Address 22-0 A/. iP%UEP is /05 L(J/• S y0 2 z. Legal Description P,4R7- of /(v0 itc,P~`5 sE /y , st /y , Sic, ao, 71p AJ, ~id'cJ Town of k,.V.V;C,e,:v,~~ County ST IC,POIX C.S.T, 211FL Installer T ?.4L(3 t'Ck T Local Authority/ Supervision ~r C~PDi~C CDU.v1 y ZtVA-) I'Z6 PROJECT DESCRIPTION S~rF ~,p~v%b~s~y ED - yso ~.-e l~ . rr a u ~ t~ - ~v~uJ you s ~,Puc7-eo ~ ti~w ~-!D v.~vl~ S s TE'~-! . Fa/c' IU/hST•E Flow X0005 . -1;ods tk 13or 5Er9SO.V,411y r- uR4T&-D 4 r 3 0 /34' e74 Us E o~ /c'ps' TaP~'c l-i'vE" 13 AA.)Dl' A-)6-. eDCs 1, 10^,0,u 6- ~P•4T`~ - S 6Pp / -Fq . 2 Pg, l . PLOT PLAN VIEWS e P9.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS 9Vaa~ai ~gg3 Pg. 3 PIPE.LATERAL LAYOUT j ww~@~••'' CODES S Abp ®N Pg.4 DOSING CHAMBER CROSS SECTIOk FICAM Pg.5 PUMP PERFORMANCE SPECSZ. HUDSON - Wis. D ;4 n, SAFETY A BUILDINGS DMSION State of Wisconsin Department of Industry, Labor and Human Relations October 8, 1993 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 HOMESITE SEPTIC PLUMBING ROBERT ULBRICHT 655 O'NEIL ROAD HUDSON WI 54016 RE: PLAN 593-03767 FEE RECEIVED: 180.00 LARSON, DAVID SE,SE,30,28,18W TOWN OF KINNICKINNIC COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Si rely, mes Quinlan Ian Reviewer Section of Private Sewage (608) 266-3937 88D70071R.01/Otl ILL Or~~,~y ~ ~ o ~A .Py R~~ "t i rn GJ (03 r rn ~ ~ O 11.0 00 1, 0. 00, m W C rWi, O ` 0 0 CD rr ~i i/' \ Oho 0 w n O I a~ new wa P. 0, C 3 a N N o ~ H H rt L r O CD mmoGQ EQn o r) i' I►~ hi F-b '.Q R ummmM 10 CD 0 0) w o wa*W•m c~u m om~w~ - Q yab cn w a v N. pi.Ocup 53 :3- x w"ao ctiom w ~ r~••~~ n C-- ti P, COO m Icbm o - - M. m 1 sue`' \~l OF I,u.,OMMY. IAA t f \ DIVISION OF SAF-010--N-1 SEE CCj[qJESP0NbLN(~E ~1j. v c J N Tje .~Y y of a~ o AJ V e-R 7T 0/ /fTc j-EV4-Ti on.)S roP OF R o c K Page of S _ TO of Synthetic Covering Distribution Pipe Medium Sand s y sreM ! - G Elev~•n•N Topsoil J E o J•--~ Slope waa R s D % i Z Bed Of ? Force Main Plowed Aggregate Layer /O J, S 64a fo,Pm To6- Gr.ve- / d D ' Ft. 107,36 E Ft. Cross Section'Of A Mound System Using PO Ft. ~SUCrGFSTz~~~ A Bed For The Absorption Area F • G O Ft. fl p A g Ft. H Ft. I lw IY~r h Wp Ai i 1h B 6 3 Ft. K 12- Ft. L 97 Ft. J G Ft. f 4 Ft. Force Main W 32- Ft. L Observation Pipe i A ~ o ~O 1•-- ----------------------•I w ---j t"r: ~ M Distribution. Bed 0f i Pipe Aggregate Observo tion-P e ' PernWanent Markers y" Al, G/tZ W SVEE~ ,PooS OF FM At Plan View Of Mound Using kAredl~~' Wb,Atsorption Area 2~Qc~i,pED 13~5/I~L /M = A414 y A-Aey TE F1040 SDi i /A/ '~i /T/~rtT~ (JE ~a /f Ci J~ y r,4 13 le o l~ sQ. ~r ~~opos~0 ~AsA-4! Ce 3 xl //0 39 sQ F77 Page 3_ Of FoRoF~ ~ • Vold U o 1VA4 E wok rr ~F Z Rive- Y11KE /45T XQle- Perforated Pipe Detail itpiaAr lop mt'vnE r- VA U.4 ~'ow End View Perforated End Cap to~ PVC Pipe • '40, Holes Located On Bottom. Are Equally Spaced R P * PVC Force Main w .7 ~ Q PVC Manifold Pipe Alternate Position Of Distribution Force Main ' Pipe Lost Hole Should Be A//Dw Next To End Cap End Cop Distribution Pipe Layout P 30 Ft. / 5 ENS w.4//S R X yg Inches Y y~ Inches Hole Diameter Y/ Inch Lateral Inch(es) Manifold Inches ,6 Force Main .t Z Inches SuE GsAIFIF2:f b~NDLN E # of holes/pipe Invert Elevation of Laterals Ft. • R S TR%l3uT/oA l 15eAAe C ~e,17r 7'E/c' o-r; 5 2-7) • -ro74l T1574i6utio,) 7iSCAqRGE ,1rE- ltley~lvo~P ~EAp .r r" ",..!'Te'RM;i4'nwn. a.. z . . : omrv~. ,-r..G . 4 v-- .a,^.'9.1,11-.w•++'+.+.r•. .-r „a....a as . PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS )e4ic `f of 5_ VEAIT CAP 4'C.I. VENT PIPE APPROVED LOCKING WEATHER PROOF MAWHOLE COVER 25' FROM OoOR, JUWCTIOM BOX 1~ A ~ 12"MIU. w/ !v,>r(N l3E WINDOW OR FRESH I AIR IIJTAKE I ~R~D~ ~~EWtT~On! GRADE i y" MIN. I I B" MI IJ. //2' O CONDUIT-- ~Ev~n cti /a8 PROVIDE - IAILET AIRTIGHT SEAL 1 I I I~G F,, APPROVED JOIWTS P W/C.I. PIPE W/C.I.PIPE ~ AARM EXTEUOIWG 3' APPROVED JOIWf713"7 EXTENDIWG 3i ONTO SOLID SOIL O►JTO SOLID SOIyy'`~3 G I I ow C ~PI 1'lLlJj1 ELEV. FT. 1 DE 4Y ~r;Fl SI}';I;ItaGS J / rUMP OFF D / LOCK f RISER EXIT PERMITTED OWL4 IF TAWK MAWUFACTURCR HAS SUCH APPROVAL SEPTIC E SPEC.IFI'CATIOKJS DOSE PER OAy TANKS MAWUFACTURER: IJUMBERoOF DOSES: TAWK SIZE: Poo GALLOIJS DOSE VOLUME ALARM MAUUFACTURER: INCLUDIMG BACKFLOW: GALLOWS MODEL AIUMBER: CAPACITIES: A= 22 IWCHES OR 700 GALLOWS 2 3 SWITCH TYPE: HE~~~,` y /~~T B= IAICHES OR (O GALLOWS Zc = 8'S IWCHES OR GALLOWS PUMP MANUFACTURER: 2-10 MODEL AIUMBER: D= INCHES OR GALLOWS SWITCH TYPE: p1jffdgex-' 14eGy'vy f/o*T WOTE: PUMP AND ALARM ARE TO BE INSTALLED OM SEPARATE CIRCUITS MINIMUM DISCHARGE RATE yw GPM VERTICAL DIFFERENCE CETWEEW PUMP OFF AWD D15TRIBUTIOW PIPE.. FEET -rAA)k S1 EGS p + MIIJIMUM NETWORK SUPPLY PRESSURE . . . . . . 2.5 FEET EAO(. G~ P~I- Z5 FEET OF FORCE MAIN X ? GZ F too F•FRICTIOW FACTOR.. ' G S FEET ~~r f S /a' Z A 77 0 TOTAL DIJUAMIC. HEAD = FEET, ~ovuD Q/ yy,. INTERAIAL DIMEWSIONS OF TAWK: LEU(vTH / ;WIDTH ;LIQUID DEPTH r tv~ 7 r to ~ HEAD CAPACITY CURVE 3 7/4 6 l/4 MODEL "98" ;b 30 4 5/8 25 . A,.. I t g 3 5/8 = 6-2 m + O 15 4 3/16 4 f4 • f- ~ 10 i - 1 1/2-11 1/2 NPT d 0 U.S. GALLONS 10 20 30 40 SO 60 70 80 LITERS 80 160 240 0 FLOW PER M114UTE TOTAL DYNAMIC HEADIFLOW PER MINUTE 1 EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITS/MIN FEET METERS GALS LTRS 5 1.52 72 231 _I 10 3.05 81 231 15 4.57 45 170 ~e 20 6.10 25 95 - 3 5/16 y Lock Valve "3 - ' L f-,r CONSULT FACTORY FOR SPECIAL APPLICATIONS ' • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. j • Mechanical alternators, for duplex systems, are available with or o Double piggyback mercury float switches are available for ty+ without alarm switches. variable level long cycle controls. SELECTION G=E 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models -Weight 39 lbs. -s72 H.P. 2. Single piggyback mercury float switch oroubie piggyback mercury, float 96 Series Control Selection switch. Refer to FM0477. Model Volts-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. ` M98 115 1 Auto 9.0 , 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify D98 230 1 Auto 1 4.5 1 or 1 & 7 duplex (3) or (4) float system. 6. Four (4) hole •'J-Pak", junction box, for watertight connection or wired-in sim- plex or duplex operation, 10-"2. 7. Two (2) hole "J-Pak", for watertight connection or,splice. CAUTION ` For Information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All installation of controls, protection devices and wiring should be done by a quali- Piggyback Mercury Switches, FMO477: Electrical Alternator, FM0486; tv'~-chanical Alternator, bed licensed electrician. All electrical; and safety codes should be followed includ- FM6495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and ;simplex Control Box, ing the most recent National Electdc Cods (NEC) and the Occupational Safety and FMD732. Health Act (OSHA). i RESERVE POWEI ED DESIGN For unusual conditions a reserve safety factor is dfi-gineered into the design of every Zoeller pump. MAIL T0: P.U. BOX 16347 LouisvrAS•, KY 40256-0347 Manulacturers o/.. . 0 SNIP TO. 3280 O%r' Millers Lane N it o LOt.r, vmc' KY 40216 U.II/>•Y ~S PS /NCf Q Yff (502) 778-2731 0 FAX (502) 774-3624 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER7---~a►.~.4,bp ADDRESS ~ C)►Q lV . ,-e-aa o FIRE NUMBER CITY /STATE__~, V 64 'Ri4L1-C i ZIP_ S 40 `~.~1 PROPERTY r/LOCATION : ~ 1/4 , _S E 1/4, SECTION 3 0 , T~~N-R'_W TOWN 0F_ I[) NwJ~ I C. 1C I wa,s I C- , St. Croix County, SUBDIVISION , 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 a 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 Co. Zoning officer within 30 days of the three year expiration date. SIGNED. 6 DATE: 9 q /(?-a St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. ,Should this development be intended for resale by owner/contractor,(spec house), thenla second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. owner of property ap~v, d Location of, p/r/opertyS E 1/4 SE 1/4, Section --So T_21$_N-R_11__W Township ,r, A„j „ c Mailing address LIJINrCr2 Sr 11 1 V+ (L /C L Lu r p Address of site cal ,q RQu ~O4r7 : 1?1 U64 -A c c~ Subdivision name Lot no. Other homes on property? yes No Previous owner of property Total size of parcel RV T - 5-Date parcel-was created 'Are all corners and lot lines identifiable? ___t~~Yes o Is this property being developed for (spec house)? Yes No Volume- -and. Page Number 2600 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description .references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 411 L/ O ~Z , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. Signature of applicant Co-app 'cant Date of ignature ate of Signature A DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1988 THIS *PAC% RESERVEO Foe RECORDING DATA WA tOTY 412104 741 PASE~ _ J REGISTERS QFFICE ST. CROIX CO., WIS. } This Deed, made between . ~obn.rk~rk_~erri ci Rec•d. for kaoord MNs zest day of !y A.D. 19 86 Grantor, t 8:30 A M and----- David. .0 _ La r_ s on-. and. -Sara. - S_ _ - Larson-,.. husbaad -and 977 Ldfp-- as - survivorship . maritah - -pr_o Rex ty . . . . d o•d- 11 Grantee, Witnesseth That the said Grantorv for a valuable consideration-.Qne - 4 !I -Th ($1.00.) Do11ar nd__2t}aer_ aod__and__va].uabJ.Q __ranuidel'at?on_ ay." Il ST tAn ONAL BANK Reru R A} conveys to Grantee the following described real estate in .5tx--C ix 'i County, State of Wisconsin: EtyER'~~ Tax Parcel No: South Half (S of the Southeast Quarter (SE 1) except a parcel described ag: MMMENCING on N line thereof 1225.8 feet W of NE turner thereof, thence S ~4 37' E 94.5 feet to centerline of a Town road and place of beginning; thence S 14 37' E 272.3 feet; thence N 75 23' E 160 feet; thence N 14 37' W 272.3 feet, more or less, to the centerline of said town road, thence Wly on said centerline to place of beginning; Sec. 30; North Half (N2) of Northeast Quarter (NEr), Section 31; all in Township Twenty-eight (23) North, Range Eighteen (18) West. Contains approximately 159 acres. THIS DEED IS GIVEN IN SATISFACTION of a Land Contract between the parties hereto dated November 30, 1976 and recorded on November 30, 1976, in the Office of the Register of Deeds for St. Croix Count-, in Volume 546 at Page 101-103, as document no. 336885. SF R TRAN EE13 0i I This is............not homestead property. (id (is not) i Together with all and singular the hereditaments and appurtenances thereunto belonging; And rantOr herein - warrants that the title is good, indefeanibie in fee simple and free and clear of encumbrances except easements, restrictions, covenants, reservations of mineral rights, and highway rights-of-way, if any, of record. and will warrant and defend the same. Dated this ..-•--•---•20th--••-- day of 19..__...86 - -------(SEAL) ............(SEAL) 'r John Mark Perrin .............••--•----(SEAL) -------------•------.._...•-•-------.--••---•-••-.............(SEAL) a - ' i AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN SS. Pierce . authenticated County. authenticated this day of_.......................... 19 Personally came before me this ..--20th day of JbYi~: i?3Y`k' P2P`YM'YI 193A.. the above named • TITLE: MEMBER STATE BAR OF WISCONSIN not, authorized by § 706.06, Wis. Stats.) to me known to be the person w,bm•exetuted the foregoing instrument and ac6owledge,t sCtle. THIS INSTRUMENT WAS DRAFTED BY ! DA.VISOa - A. VUCK Ju e C. Moel ter - 111_ ~t._.1~lalnut,..~4iuer_ Eal~ s, _ sdl----54QR2_-__- St. Croi3c Notary Public 4_/ -~-County} Wis. (Signatures may be authenticated or acknowledged. Beth My Commission is permanent. (if not; sLatg 4_x tiration are not necessary.) date: April 15 90 ---•------------------------=~e_::...:,•19,---... 1 •Namea of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leval Blank Co. Inc. FORM No. 1-1982 Milwaukee. Wis. i DOCUMENT No. STATE BAR OF WISCONSIN FORM 3-1982 THIS S►AC[ 4949MV90 FOR ACCOROINO OATH I QUIT CLAIM DEED 443159 - .....REGISTER'S OFFICE - I~ eoOx 8 7 PA ST. CROIX CO., M y q Recd for Record { i Nov 161988 I » » at 8:30 A. M { I ..-...»~ara.•.:._Larson a quitclaims to » Register of Deeds 1 I...................................... the following described real estate In S1 .t Croix County. CIF F'0 CT N4TI(1NAil RANK State of Wisconsin: RETUR" i° BOX 1: RIVER FALLS, WISCONSIN 54022 ATTN: Jeanne ' Tax Parcel No: i THE SOUTH HALF (S 1/2) OF SOUTHEAST QUARTER (SE 1/4) OF SECTION I THIRTY (30), EXCEPT parcel described as: - Commencing on North line thereof 1225.V--feet West of Northeast corner thereof, thence South 14°37' East 94.5 feet to centerline of a Town road and place of beginning; thence South 14° 37' East 272.3 feet; thence North 75°23' East 160 feet: thence line of North 14 o We st 272.3 feet, thence Westerly less, to the place of said town own r - beginning. And, THEO NORTH HALF (N 1/2) OF NORTHEAST QUARTER (NE 1/4) OF SECTION I tI THIRTY ONE (31).; ALL IN TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST. I 1 AND ALSO, SEE ATTACHED. i I E}CEMPT This . homestead property. (is 1S ) (is not) Dated this 4th day of November..... , 19.... 11 QG,1,/v........(SEAL) (SEAL) ...Sara J Larson • I I (SEAL) (SEAL) • • AUTHENTICATION ACKNOWLIIDOMENT I; 3isaatnra(s) STATE OF WISCONSIN ss ..............Pierce...........County. authenticated this ........day of ..........................119 Personally came before me this ..14.~!?......day of ovember lg8S,,, the above named I Nara JLarson I • • TITLE: MEMBER STATE BAR OF WISCONSIN ~~,►i!t!",~I::::, t, . authono (I!rized by 708.08. Wis. Stats.) to me known to be the person who exbopted1he + foregoing instrument and acknowlelt e~hp,gaille.';•~ THIS INSTRUMENT WAS DRAFT , BACK LAW O~~~I- 5.C • ....._R..P.-0:I17X'48'r . .lie C. Moelter .•,.•~.;1.:~ i.. Notary Public .....~~~r.:..~rrO1X,.:: '•........Cocnty, is. ' -••--•natu• My Commission is permanent. llf dot, state expiration res 1 are not necessary.je authenticated or acknowledged. Both date: 19..QQ...) ~s~~.®®wsrl~ i' fh" Yt Part of the SWJ of the SE4 of Section 30, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows: Roa and Commencing at a point at tsaldnSection130, centOFerlBEGINNING-Ine of of thedparcel t the North/South I line of to be herein described; thence South on said a line 5281; thence East at right he centerline angles to said 4 line thence 650"; thence paracenterlinellel thenPOINTtOF BEGINNING, of Quarry Road, containing 10 acres, more or less, being subject to easement over the Northwesterly 33' thereof for town road purposes and also being subject to easements of record. 0 BOOK 827 PA'%-; t4~ vvisconsid Department of Industry, SOIL AND SITE EVALUATION REPORT Pa / of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: TjUE' Lfj/P,fON PROPERTY LOCATION GOVT. LOT 56- 1 /4 SE 1/4,S 30 T 2, ,N,R) E (o Wi PROPERTY OWNER':S MAILING ADDRESS 220 N. !u/:LJTER Pig T 4~ /6 O 4 c e-5 CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE 27OWN NEAREST ROAD fifth-_R > CWIS LV/,S. Sy0 2 Z (7rs) / 15- 9f/27 ~~N.viG /.fi~vrG 'P'm Pel I'~'!7 [7Q New Construction Use [X] Residential / Number of bedrooms 3 (J Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow yS~ gpd Recommended design loading rate - s bed, gpd/ft2 ' G trench, gpd/ft2 Absorption area required 3 7S bed, ft2 3)-5 trench, ft2 Maximum design loading rate -s bed 2 . G , gpd/ft trench, gpd/ft2 Recommended infiltration surface elevation(s) P°~ 3 It (as referred to site plan benchmark) Additional design / site CW1511AWS rations 5' 7'F Sv 1'1` 4-d /E fd R .14 Cd-v 6,Vf Parent material $C•$ 45 AKedX4 ti&er To Flood plain elevation, if applicable N~ It r> r?1__JeA oL 5714 S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system ❑ S ®U ® S ❑ U ❑ S ®U ❑ S .®U ❑ S 9 ❑ S RIU 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 Toth 4 /0Ytf 31S 2,f 56& ~ftol;e CS 37.7 •00 ,B, 9- zl /o Y,e 3/4 /s Z, f, s 6~ ~,e ~s 2-t .00 Ground /3z 2-1"36 /o pe y/7 115 0,f 9•~ ~,e ~s S ~ elev. It C S l o ye S/6 s yR S/'? S 0, -f fe nM~ S , S . Depth to ~ -S~ 7SyiC' 3/z~ DSEO s/ / f~ Sf,~ ,r„ f CS :5,,f 7Vo617 el limiting factor ri _3 Remarks: DDS 4o .v X1 A.' 0.0 0S fjacoSS s,Pe7V_,f//S Boring # 31/ 6-1& ~r~, vf.P L's -)--f 7 • . 2- 13 ,G , .o-2-0 lo R 113 2, sd.C 'S B, -32- 7S- be 3/y s/ , J-4 cS 21 Ground elev. C Z • (,D ~o y/'i ern X ft. Depth to (O 7,5 YR 3/L ~rr~NDS 3 _414 I ~off~s<D limiting A. factor 3 2 cr, g Remarks: ~G h ►fS Mr~AJ y" e'OAd7 vOVs ti i -I CST Name:-Please Print Phone: 7, 8 N Address: HOMESITE SEPTIC PLUMBING CO. Signature: ?66C4 .,',,n Date: bet: ((.t 4-- ROBERT Ut:BRIGHT NIS. MASTER PLUMBER LIC. NO. 3307 M-P.RS• ^fAIN, INSTALLER & DESIGNER LIC. NO. Soy/s iu ~'s OR 19 I T,&-,e 7- s' r2-- 14,VC` 4 2es E- to, pPjD/ ? /.3/1-vQi;v G-- o O ff-E..pe V T E K T L,t°~ , f>otu v 4J~i~0 ~n T % ' f/'0 f Z0OW S 7,-f 72 E IrOK /-0 6-)4 f PROPERTY OWNER O'( SOIL DESCRIPTION REPORT Page Zof PARCEL I.D. # 1401-1- -O Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Boring # Horizon in. Munsell au. Sz. Cont. Color Gr. Sz. Sh. Y Bed Trench 3 0- /o R 3/ /s 2,f Shk W P, e5 .2 f 7 Ground 13y 30 7• S' f'e w. ft C o Hoye / -Fs o.f m► ,e- - s . -5 y Depth to 3/ limiting factor /{tJ/r~/ZO•v ~G wIf .S 7"Uit' TEO a,,,oP- L~;r 1 F Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # L01111- Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground . elev. ft. Depth to limiting factor FT I t Remarks: Con "IM/O ^r/nn% I li f JAV1@190 E r ca~'mz to C~ Oi~oZ o rn rn Gl L~ ° a o x w N - m m ~ O O G m -4 ~ o IN 0 Fn- ;p Ell I~j N r nv ~o Q 2 d t 0 d a o ~03',~6~~aa a ~ v N W oho ST. CROIX COUNTY WISCONSIN ZONING OFFICE 0 M M M M M M p■ M~M11~1 ST. CROIX COUNTY GOVERNMENT CENTER ,F 1101 Carmichael Road Hudson, WI 54016-7710 K (715) 386-4680 October 5, 1994 Mr. Dave Larson 933 Quarry Road River Falls, Wisconsin 54022 RE: Septic Inspection for Dave Larson Dear Mr. Larson: An inspection of the septic system for Dave Larson was conducted on September 19, 1994. This property is located in the SE, of the SE of Section 30, T28N-R18W, 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. If you have any questions with regard to the above, please do not hesitate in contacting our office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator St. Croix County, Wisconsin mz E3 3795'-3 KATHLEEN H. WALSH 'STATE BAR OF WISCONSIN FORM 3 - 2000 REGISTER OF DEEDS ST. CROIK GO., MI Document Number QUIT CLAIM DEED RECEIVED FOR RECORD This Deed, made between David O. Larson Grantor, and David O. 11/02/2006 10: 30AM Larson and Geraldine R. Larson husband and wife as survivorship marital ro er Grantee. SUIT CLAIM DEED gM Grantor quit claims to Grantee the following described real estate in St. EXIT # Croix County, State of Wisconsin (if more space is needed, please attach REC FEE: 11.00 addendum): TRANS FEE : COPY FEE: CC FEE: Lot 2 of Certified Survey Map recorded on PAGES: 1 March 9, 2006 in Volume 20, Page 5172 as Document Number 820432 being located in the SE 1/4 of the SE 1/4 of Section 30, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. Recording Area Name and Return Address Joseph D. Boles Rode, Beskar, Boles & Krueger, S.C. P. O. Box 138 River Falls, WI 54022-0138 022-1089-60-000 Together with all appurtenant rights, title and interests. Parcel Identification Number (PIN) This is homestead property. Dated this n 1 day of February , 2006. (is) is no * *David O. Larson AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. PIERCE Countv ) authenticated this day of Personaliv came before me this _ day of Februarv 2006 the above named David O. Larson * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who e(ectitedthe;fOre authorized by 5706.06, Wis. Stats.) instrument and acknowledged the sr tti , `C•_ THIS INSTRUMENT WAS DRAFTED BY Joseph D. Boles - Attornev at Law River Falls. WI 54022 Notary Public, State of W'~Scnr,S~~ i►~, tT_ ~ 'date: My Commission is Dermanent. (If not, state' rk,*ii (Signatures may be authenticated or acknowledged. Both are not necessary.) :-&~Ltry-,.be r cl ' Names of persons signing in any capacity must be typed or printed below their signature. wFO-PRO (800)655-2021 www.infoproforms.com STATE BAR OF WISCONSIN QUIT CLAIM DEED FORM No. 3.2000 1of1 Y R Parcel 022-1089-60-200 04/17/2007 11:01 AM PAGE 1 OF 1 Alt. Parcel 30.28.18.480A-2 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 05116/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - LARSON, DAVID O & GERALDINE R DAVID O & GERALDINE R LARSON 933 QUARRY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 935 QUARRY RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 30.780 Plat: 5172-CSM 20-5172 SEC 30 T28N R18W PT SE SE CSM 20-5172 Block/Condo Bldg: LOT 02 LOT 2 (30.78 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-28N-18W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 11/02/2006 837959 QC 03/09/2006 820432 20/5172 CSM 02/14/2006 818546 WD 07/23/1997 827/419 more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/16/2006 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 o 3 o I M p yr d o ~ III ~ ~ I 0., o I M c o ti E c 2 2 y 0 3 m m op m o N o=_ aoa~ u a 'r y U- o L d o 0) 0 0) N O. f0 _Q N N C 7 N ~ H w V N V o O N N C OF-~ N O ~~.0-• 3 L N C N Cl. C N C o d d w O~ N CO m `w O'a L~' °-YL c 0 V ~ O N N c N O c0 O N J m C y O o3 `p m ld o CD d OL 3 N y o co O 0a E N:E oo c z 'v vii O O ct m LL C 7 U E Y 2 N C O.N. E yy N~ _ U O (D c 3 ~ 3 NNm0>o2=m NW O L Q t0 f0 d U N O 3 V~ 3 ~ I v ~ co w E U) = O v z m (~i Cl) oH u a 00 N E N O z a Gvi 2 ~ c I y F- e- N ~ N o E 0 m I ~ c N ~ O O O ~ 'D L ~ m N 1~ O Q z z p z z o N CN d 0 . 16 O 04 0 a- w w a N N 0 to a CL v z 5 •;333 'ate m CL CL (w~ a g M C N to U rn rn o Q o ~ v ^I Z ° o E m a N N .0. Q > cn m C7 M ~i o M N N ~ C. O H p N ~ o C E r 72 O Q c = a rn cocqq v ci > oho co c o y v w o Y c o L I~ co C i o W y ~ 01 o C', Y m rn o Z N in ~ ~ I I r~ v CC O € a 7 d r~~l ~tx+ E m .2 V C C Ci 0 2 0 r A a ncVt1l VtU 13 SEP i 2I06 820432 VOL 20 PAGE 5172 • KATHLEEA H. WALSH ST. CROIX COUNTY REGISTER OF DEEDS SURVEYOR'S RECORD S7. RCROIX ECEIVED FOR CO. MI 03/09/29% 03.45" 45 CERTIFIED SURVEY MAP CERTIFIED SURVEY HAP LOCATED IN THE SE 1/4 OF THE SE 1/4 OF SECTION 30. T28N. R18W. RE COPY C Fes: 3 TOWN OF KINNICKINNIC. ST. CROIX COUNTY. WISCONSIN. PAGES. 2 CURVE DATA TABLE (ALL LENGTHS ARE IN FEET) Curve Radius Central Chord Chord Arc Tangent Bearings Number/ Lot Length Angle Bearing Length Length Tangent In Tangent Out C1 1033.00 18'10'05" N66'15'51.5"E 326.18 327.56 N75'2V54"E N57.10'49"E 1 1033.00 10.39'01' N70'01'23.5E 191.74 192.02 N75'20'S4'E N64'41153"E NORTH N/F.4R 2 1033.00 0731'04' N60'56'21'E 135.44 135.54 N6441'53E N57'10'49'E SECTION 30 C2 1000.00 15'15'19" N6743'14.5'E 265.47 266.25 N75'20'54"E N60'05'35'E 1 1000.00 11'00'22" N69'SO'43'E 191.80 192.09 N75'20'S4'E N64'20'32E 2 1000.00 04`14'57" N62'13'03.5"E 74.14 74.16 N642W32E N80 05'35"E C3 967.00 11'50'37' N69'25'35.5"E 199.53 199.89 N7520'54"E N6330'17'E 4 SEE DETAIL DEED b®~. nDNPU~A T(ED LANDS sa ,rp~JO9 a RO - 1 \ s g2~~PC- T9~ NORTH SE 1/4 OF THE SE 1/4 $ t71 4 ' ___W- 348.47 91&77' 1-1/4' IRON PIPE 4 m J~~jO (a -,I/FBKw V.~Ot , - ' of ea ov -980.07'- ILWAN PVE _ • ; _ -HOUSE ~ ~ PREPARED FOR: • VO - 1100, DAVID AND GERALDINE SHED PG. 234 LARSON KLACAN PAULA P SQ STS S)S HOUSE EACH PARCEL I © 3- vas s s s~8' \ 760, /-BARN z C oZ SHOWN ON THIS p rJa ,~01< ' , s 4' CENTERLINE k L c> rrnn MAP IS I O FNi ~,ir ' SEPTi DRIVEWAY N - m p Q I STATE. COUNTY V= vi F 588'49'43"E Z P AND T MNSHIP N A \\\261.45' ~~ae1n 1?1",T 2 • rn rn 1 z LAWS. RULES AND m o v \ ~SCON$/iy `''4 ~i I a REGULATIONS O Cri N -N1 LOT i # oG v w< O v (I .E.. WETLANDS. I A * TY R. z _W I MINIMUM LOT d p 0~ i . DODGE L W g 1- A!2 , SIZE. ACCESS S-2484 I TO PARCEL. /91, CLEAR LAKE, r• _ c+± ETC. BEFORE N f54~I wi p PURCHASING OR v,~ 58849 I31r -1 DEVELOPING DEVELOPING N7 °''..,,h0 SUR`IE„0 CCOONT CT I 3 4 7 W 68p 92 SC&tl FEET 1- = 250' THE ST. CROIX N COUNTY OFFICE / r ON ING g m 250 O 250 THE TOWN OF KINNICKINNIC FOR ADVICE. rn OVERHEAD SOUTHEAST m ELECTRIC SEC. 30 1320.36' E - E -E-E -E -E E-E - E - E - E -E -E - E - E - E - E 13 SOUTH 1/4 SOUTH UNE OF N88'49 43 W 1320.36 aa* Rc,E SOUTH~ CORNER THE SE 1/4 UNPlLATTED LANDS OF BOUNDARY SEC. 30 ---N8849'43'W 2640.72'- LOT AREA TABLE _S88*4a'26"~ 1,3&g,541 ~ DESCRIPTION SQ. FT. ACRES ZC 281.26 7.21 61.30' Lot 1 Total 372.408 8.55 -348.47 = Lot 1 exc r/w 362.400 8.32 g OUTLOT 1 C3~/a' Lot 2 Total 1.340.842 30.78 IW m GZ LOT 2 Lot 2 exc r/w 1.337.370 30.70 , Outlot 1 Total 26.954 0.62 rrj ws 5~~•E G N r`~ N Outlot 1 exc r/w 15.886 0.36 4~ Zo -$4" LEGEND \ NT 96-p4 "E `gi N7`~~ 83 EXISTING FIELD" ; SFOUND ALUMINUM COUNTY ECTION CORNER MONUMENT .01 N / \ O 83 CD~ETAIL • FOUND 1-1/4' OUTSIDE DIAMETER IRON PIPE 1 j9 \ 115.82 LOT 1 SET 1' OUTSIDE DIAMETER BY 18" LONG IRON x175 ~-SEPTiMIDEACPRIRIVVAATE PIPE. WEIGHING 1.13 LBS. PER LINEAR FOOT THIS IN TRUMENt DR AFTED EASEMENT IWAM KANE R - RECORDED BEARING AND/OR DISTANCE BUILDING SETBACK JOB NO. 6563-01 DATE. 12/08/2005 . • . • • • . • • • • (50' FROM R-O-w) SHEET 1 OF 2 1 oft Vol 20 Page 5172 QQ