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HomeMy WebLinkAbout022-1045-10-000 a o Q> oo N 03 GS i c o a) M 0. ~ I °o c N N O ti N ~=L N I E rn -o n. C t N ~ w m C Z C N 3 m E N U. c0 O w. C Q> o E Q -oo m U ~ M CL v ) y w o Z O LU a co z c o I o z y `z v II E o N zz E CD ai Cl) _0 0) 3 N O m Q) Q) Q)` U o c O © o m Q z F z \ Z l v n ~ ro c '0 E c N 7 m C N (U °d N w = rll C N d N O O O ~r11 a) C, in in d 11 > N O LO U) U) Q) E F- F- F- 3 N N N m E - > 3: C1. Z O d. 4 Z O O m CL a. IL Z; LL Ni ~5 o 0 ~i o o N 0') o y J U rn z 'D Cl) "%INA m o o Q) o 0 0 E N O C''> m a M E N _ E a d Q O c w La' C O O 3 2 N C OO Q F- OOi C C E C14 CD O O N U M N y y U d p C, \ L LD !Z C N a f^ ro N N_ v p c c E E E M M 'O't LL aO V .,d o - 'O n Cl) I.I N F- F- N N C'! c 00 yr Y C N cg ai E E • ?a N CO o U Y Cl z U7 4-i E t4 E N dt o m a " a • C~ G W .V d7 r C: E i C 7 -1 A vat Oinv DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NE 4 i NE 4 f Sec. 16 ;'T28-R1AdingTank CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Kinnickini~ H ❑ In-Ground Pressure ❑ Mound IN*MfE E I HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Fred Kurtz Rt.2,399MOnument Rd., River Falls, WI /O BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: ST REF.. PT. ELE O 8/ C!/'o / ame of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Henry Nechville 3258 St. 128764 SEPTIC TANK/ 3• hale Cotu z D r .09~ MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVE PROVIDED: PROVIDED: ~/e cpY1G . /0ji'~ C , 9 / YES ❑ NO ❑YES N0' q;2 BEDDING: VEfdTDIA.: MW MATL.: HIGH WATER NUMBER OF ROAD: PROPER ELL: BUILDING; VENT -Pb FRESH C,,O, ALARM: FEET FROM LINE: ,r r AIR INLET: ❑ YES NO ❑ YES NO NEAREST - DOSING CHAMBER: MA PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO ENT GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER O PROPERTY WELL: BUILDING: AIR N OFRESH (DIFFERENCE BETWEEN FEET FROM I LE PUMP ON AND OFF ❑ YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire onstruction shall cease until MAIN the soil is dry enough to continue CONVENTIONAL SYSTE. /2. , QS' BED/TRENCH WIDTH: r LENG7R OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID / TREN HES: IAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DIST . PIPE D T~1 PIP-E MATERIAL: TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH PE LINE: p' AIR INLET: P BELOW PIS: ABOVE COVER: E LET: E D: Sc.,F,.✓ I I 5~ f _P FEET FROM ili+f~+-+~ 0~7 NEAREST O (•V, ZJ MOUND SYSTEM: ii.S9 //23 /SZ Mound site plowed per Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENT FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST --1111'. oy-'S P2-4-1 A g.99 tub ?9.96 b X8.53 ~ in in county file for audit. eta Sketch System on Reverse Side. SIGNAT E: TITLE: SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION ~7W. U dILHR In accord with ILHR 83.05, Wis. Adm. Code es .~nw„~w,ar STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 42 P / l a 4 8% X 11 inches in size. Check if revision to prjvious 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 F-% %,S T ?,NR /I E(or -1. ot 7 Z , PROPERTY O ER'SSMAILING ADDRESS LOT # BLOCK # CI STATE r ZIP CODE PHONE NUMBER SUBDIVISION NAME OR MBER Z /s ;tS =.59 CITY NEAREST RO D II. TYPE OF BUILD7%10r, heck one) ❑ State Owned ❑ LLAGE ❑ Public 2 Fam. Dwelling-#~ of bedroom9~ PARCEL TAX MB R() oaa ~ III. BUILDING USE: (If building type is public, check all that apply) / 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check on one in line A. Check line B if applicable) A) 1.0 New 2. Replacement 3. ❑ Replacement of 4.0 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 ❑ bg'!eepage 00age Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Trench 22 El 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. (Gals/day/sq. ft.) (Min./inch) Flat 92,S40 ErLEVATIONI ~✓~°0 , . 'l 15 soo 1.2. 1.er r 8y'e et X acFeet VII. TANK CAPA ITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret strutted Con- Steel glass Plastic App Tanks Tanks Septic Tank or Holdin Tank 900 _7 di'LIL I ME Lift Pump Tank/Si hon Chamber L_j Li VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Rk: Phone Number: Plumber's Name (Print): Plumber' Signature: (No Stam ) MP PRSW Busines Plumber's Address (Street, ity, State, Zip Code): IX. C LINTY/DEPART T USE ONLY Disapproved Sanitary Permit Fee (includes Groundwat7ate ssue suing A ent Signature (No S ps) Fee) X pproved El owner Given Initial p O 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 f 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. t 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; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on.a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 1 APPLICATION FOR SANITARY PERMIT STC-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), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property la A • k T 2- Location of property 1/9 1/9, Section -yL~ TN-R1 Township KI A( A/ 1 C k IN I( I ~ - Nailing address 2. 374/ Alcooym c--A,, T RD- Address of site P) A Subdivision name /U Lot number Previous owner of property IYcttu~ / d Total size of parcel/ Date parcel was created 9 5 Are all corners and lot lines identifiable? s No Is this property being developed for resale (spec house)? Yes N0 `Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THIS FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of th County Register of Deeds, as Document No. ✓t.~ Q , Signature of owner Signature of C -0 er (If App cable) -.-L - I, Z -Fo Date of Signature Date of Signature , r ~IIIS elaet imp! ~ ~ , - 86' fl~Ti Nr1 -II shuaba~...~4As . :t. cr imsei iw ft 0W ..._....raac~,ci..A ~tui tri.....iiioid..S►hi~X--xuxi............ ofa ~Itb~o~:..#s~..xi~sa_._aA ..a~uxxi.~taxs~~..~arital..Rxsamer~ty aea - - ............w e.N oesosr see . rd..w eorYSeawaOnt'. ' «.auad._atlaer..~aadsiad...rilush1P-r_ona-ide ,r UTA_ „,,,,,ya w fless~tsa iM siwdas A -P red eaIMs b SL-....%.roix...... ors°11►, StsAs e! •iws~sia: _ _ -fi Tax Pared Na: That certain parcel of land located in the Northeast 1/4 of the Nortb- east 1/4 of Section ib, Township 28 North, fullyRange de18 Westq To scribed aswfollows~~ kinnic, St. Croix County, Wisconsin, Commencing at the North 1/4 corner of said Section 16, thence go 1190°00'00 E 1319.6 feet along the North line of the Northeast 1/4 of Section 16 to the Northwest corner of said 1/4 of the NorTO east 1/4 of Section 16, being the POINT OF BEGINNING BE HEREIN CONVEYED; thence continue N90°00'00"E 463.67 feet; thence£ SO0°46'40"W 222.55 feet; thence S84°46'40"W 466.18 feet; thence , 1100°46'40"E 264.98 ,et to the POINT OF BEGINNING, EXCEPTING the R, Northerly 182 feet of the Westerly 350 feet thereof, containing 1.13 acres more or less. Subject to easement over the westerly 33 feet thereof for Town Road purposes. The above described parcel abuts that Volume 316 , on page 456 of the records of the parcel described in Register of Deeds, St. Croix County, Wisconsin, and is to be attached i! t ereto. (Parcel described in Volume 316 on page 456 of Records is described as: "The west 350 feet of the North 182 feet of the North- 1 east 1/4 of the Northeast 1/4 of Section 16, Township 28 North, RanC roix) bomestead popedty. 18 West Town of Kinnickinnic, St. This is (i.) Co., I • and i s t e "e cept ion" in the . - . - • • Te0*w W" all ow sinsaiar tbs WWOO s Ad.. ranx goocere.in J ~sarraaRs d" Via VMS in d• ind,24caeibie is he e els ~M and fret and dear of eoeusbrancM =Get easements, restrictions, reservations or covenants, if any of record, and highway rights-of-way, aod wiri warssat ad ddead the masse. {t day of ...Apr.it r . i Dow tie (ssAL) 2 (8E1L) ward E. Madsen ! h4 sSAL) ; ` l _ AOTURNTICATION ACKNOWLSnOURUT N Howard E. Madsen and STATS Or WISCONSIN Garda Madsen... (i OL of April 11 .•.R? Pen osdiy came bdore ew this d1e d it ~/Sfder . i F-hn 10........ tie AM sommi _W. Davison - - - TI'!'Li: l[!!LElS STATE BAIt or WISCONSIN (Iastboact . rised by 1 706.06, Wis. Stats.) ksow.......................................... to b~ t Die wb etNrN@d 00 f forecoins isstsement ad aeksa.b s do ama+ THIS INEMUM[NT WAS DRAFTED BY John W. Davisoni-----DA-- --V--IS-------•ON-•---g..-•..--.- .--VLACK 111 WWalnut River Falls WI 54022i,Totary Pnblic ][y Cemmissba is pairs,asest. (1t ast, stela ==be be antbentiested or aetsoubipi. Both date - t ! ~ • t~ ~ *Memo d ,e•rer wars is w c.P.rNe iwU M VeW 4r v 1ol•w *Wr d =twr4& sue: ~ tw Warman" now H x H . a 5TC- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT Ho St. Croix County z d OWNER/BUYER M rr~~ ~ ROUTS/BOX NUMBER ~-c9 39f A4V&'dA4rk"7_ 29 Fire Number c~ .CITY/STATE @VC~ A L LS / W / ZIP 5-17o PROPERTY LOCATION: Ix. /yL ;b, Section, T-:kF N, R 8 W Town of //y/U/w~ /,NeV/4 St. Croix County, Subdivision Lot number_Al-. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master 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. E I/WE, the undersigned, have read the above requirements and agree z„ to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offkre within 30 days of the three year expiration date. SIGNED DATE 1S ~ -2- / 4710 St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. LABOR A PERCOLATION TESTS (115) DIVISION "HUMAN, RELATIONS , P.O. BOX 7869 (H63.090) & Chapter 145.045) MADISON, WI 637Q7 LO ATION: ION: TOWNSHIP/IIYWN+uAl, y: OT NO.: BLK. NCI: SUBDIVISION NAME: NE M__ - ~ t o /Ta N/R& E (or W e11V v1'C~/NA1 'G P>jR of ~t,~_ Pia y- COUNTY: WN R'S f3t• UWS NAME: MAILING ADDRESS: 571 to NRS Fi2FV kuut'z 24 i Ro x 27G RIII FAIIs w'1- SVOZ USE - $ ~ NO. 8EDRMS: COMMERCIAL DATES OBSERVATIONS MADE DESCRIPTION: STS PROFILE DESCRIPTIONS: IPERCOLA Residence N a : ❑New Reace Z - S+j6 IS- 13 p, RATING: S= Site suitable for system U= Site unsuitable for system Sc S ~3 NE Ste. f Imo- 5' NE Q ONVEN ZONAL: MOUND: tIV-GROUWWESSURE:SYSTEM-IN-FILLH OLDING TANK: RECOMMENDED SYSTEM:16ptional) ❑S DU DS DU CIS EU ❑S ©U CIS R]U Mov~o- eR c0,VVC_,1r10,v,F1 TR£uc ~s ;N• GR ~v-vv w tjo .yv,u;~aP,,J(r If Percolation Tests are NOT required Dunder s. H63.09(5)(b), indicate: 1- If any portion of the tested area is in the floodplain, indicate Floodplain elevation: rl,~. s OLSCRIPTIONS 14! ~EGi.rt'FL •F-I- BORING TOTAL P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED ES . HIGHES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- / ('•0 0 Z JA, 7S 6 7 'x.13- - V T-op S-oi I ti,X _ of 13,3 51 ~ I r s 1. 0 - f sl w ~Ik, f B- f N -To Q- 6t Mofs 3.0 f; .,wt W• RN • S. B-Z ~.0 `x-3.02 ~f .2.5 S~ Dt' v. s I. i Ba 2.33 NN. OF y . -fow I D15r,,cT oIk,6y MofS hr - 0.2S-B- 3.3 3 f,;u.e T.~ w k rl t 'BA 4j of o S Am v B- t.i"0 ~~o• OL 6.0 ol2/ 5ve a.-Is l Cwi~~M4•G7I" B~rssy OR Gy. o¢,r r 2.;3__ t v 6-R - Iw ~cciHtl F I-• PERCOLATION TESTS C44y-104-1 ~>r 4.O' TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES NUMBER INCHES) AFTER SWELLING INTERVAL-MIN. p R p RATE MINU ES P. / S 2 yt~r-- PER INCH 2- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope, p Fok ?/'E•vc kl5 N~64, ~-RE~c-4 ~ye. so SYSTEM ELEVATION /ow TREND $7, 5O This test sit' - - ' PE, APPROVED for a conven i,-inai sc=a3tio system. ccfS p . -1- - ~eQ explanation. o -~--3~ I 70 0 .6 v, * h - s E111 7.7 y I, r 33 G % ~ ' I j~ I I ~ _ 6 'X 5a' .a rA,rti,u r3 33 N''Vf` T kew&'.' ~ I~iiNr U $ S0, t J ~1GK//oE 'D08t: f .5CA LE I F o x= Pe RC Srr~s s uER r• PC-F. PT_. - 3000-A E P&L "F AW-r, l 4.) U-I -A s i D • ~ C_ 4-7-cl&V-f Teo,) = /00. O ' I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. S NAME (print): TESTS )HERE COMPLETED N: 7 I 11 ESITE SEPTIC PLUMBING CO. -i ?8 ADDRESS: CERTIFICATION NUMBER: PHONE NUM ER(o tional): 2 /r. ROBERT ULBRIGHT LC 13 00 6 106 MINN. INSTALLER & DESIGNER LIC NO. 00663 CST SIG : Dlsl'Hwu rION: Oi iyinol untl unC 1.ojJV to Locai Amlim rty, I'ioIav; 1 ✓ Ovvjwr :iod Soil Te,ivs. ALHH-SCU-6.19b (H. 02182) 1 OVEH Ilk- 'jt k of Wisconsin ` Department of Industry, Labor and Human Relations r' SAFETY & BUILDINGS DIVISION April 10, 1990 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 Robert Ulbricht Homesite Septic Plumbing 655 O'Neil Road Hudson, WI 54016 Plan Identification No. S90-00524-M Dear Mr. Ulbricht: Re: Fred Kurtz - Residence Groundwater Monitoring NE,NE,16,28,18W Town of Kinnickinnic, St. Croix County, WI Groundwater monitoring data submitted in accord with section ILHR 83.09 (7) (a), Wisconsin Administrative Code, has been reviewed. A roval is hereby granted to allow the installation of a CC onventional system This approval is for the depth to groundwater only and does not include review of the design and size of the systems. All other criteria in chapter ILHR 83, Wis. Adm. Code, must be met prior to issuance of the sanitary permits by the local authority. No installation can begin before issuance of those permits. This letter in no way relinquishes the use of soil mottling to determine the depth to high groundwater on any other parcels or any other portions of the parcels than those described herein. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval shall remain valid unless the sites are altered in such a way that the depth to groundwater would change, or unless water is ever present within the critical depth for system operation for at least seven consecutive days. SOD-6926 kR. 10187) ~ate of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY 8 BUILDINGS DIVISION Robert Ul brl cht 201 E. Washington Avenue Page 2 P.O. Box 7969 April 10, 1990 Madison, Wisconsin 53707 In the event that this approval creates liquid waste problems at ground level or if any other operational or maintenance problems occur, the provisions necessary to resolve these problems shall be commenced upon receipt of approval by this department. Sincer , Peter E. Pagel, Plan Examiner Onsite Sewage Section Office of Division Codes and Application (608) 266-2889 PEP:0116e cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Fred Kurtz 580•6928(R 10/87) ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURtHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 March 26, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear.Sir : This county was aware of and was involved with the monitering of the Fred Kurtz property. The property is located at the NE4 of the NE4 of Section 16, T28N- -R18W, Town of Kinnickinnic, St. Croix County. Should you have any questions regarding this matter, please contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj University of Wisconsin RIVER FALLS River Falls, Wl 54022 Graduate Studies, Continuing Education and Extension 715/425-3844/3256 March 20, 1990 Bob Oulbricht 655 O'Neil Road Hudson, WI 54016 Dear Mr'. Oulbricht: The precipatation data for Fred Kurtz's land in River Falls, Wisconsin is: 1988 September 6.34 October 0.81 November 1.65 December 0.39 1989 January 0.47 February 0.57 March 0.46 April 2.22 May 4.71 Sin ely, Dr, ger A. Swanson Dean, Graduate Studies c I Department of Industry, GROUNDWATER Safety & Buildings Division Labor and Human Relations MONITORING P.O. Box 7969 REPORT Madison, Wisconsin 53707 Note: show--depths in inches. Lot No. Block No. Location: r, DEPTH F OM SURFACE TO WATER NONE ` AX kNE 14S/(Q /T 19 N/Rid E(or)W OBSERVATION WELL WELL WELL WELL Township ty: DATE / # 2- I~l-3 # _K~'NN~cKiNN~c MARtti 15 ' o v 4 Count Owner s Name• 95 sT . c~'RoI K FR>:D kv RT2 4~5"sf`15 2 2 Mailing Address: O U 'er. z Sox y7G ~iX 2 -FA11S WIS .S401 2 - ~9 Wd _3 WELL l y 3 .NUMBER: - /O - Q9 p D WELL 9, 7S / ' U 0 0 DE_PTH:_ PROPOSED INDIVIDUAL L1 _ (j C> C7 SUBDIVISION © LOT ~ f! ;Rainfall Data Obta'ned From: 2 7 - ualy. O)F- ems- s . - '1 , u Ek. FA l 30 „ 8' G o v MONTHLY DATA /glfp / i Q a 1 88 Sept,, Oct I Nov It I Dec o I Jan 1 Feb " Total (8.5") Y 0. '0 _Y 0 Z> !March April Ma w otal (Need 7,6") T 'I N 2,3" _ /-cal D I lei ;0 5 7-6 Provide daily rainfall data on a separate sheet for March, April and May.,, Z D G D D 6 write total rainfall for March, April and may in the above boxes. Q p p ARTIFICIAL DRAINAGE Check the site for artificial drainage. If the site is affected by such drainage, submit complete details for the drainage system. Indic iate wh 3 will be responsible for maintenance of the drainage system. CHECK ONE: No artificial drainage 0 Information regarding artificial drainage affecting this site. affecting this site is attached. Attach a SBD-6395(115) or SBD-6309 (if a proposed subdivision), for soil information and estimated depth to high groundwater using mottling. Submi E "':"o 2 copies of the Groundwater Monitoring Report to the Bureau of Plumbing, P.O. Box 7969, Madison, wi 53707 and submit 1 copy to the local authority. INDIVIDUAL LOT PLAN-Provide a diagram showing accurate locations and surface elevations of all monitoring wells. SUBDIVISION-Attach a scaled map showing well locations and relative elevations (1 in. = 100 feet referred). N s ' 6 5 0' Ell D., JH N, WIS 5 4016 N~fl IS. ST R P UM C. N . ININAL R & NE LIC NO.i0066 i j i I, the undersigned, hereby certify that the data recorded and location of tests reported on this form are correct to the best of my knowledge and belief. ate: CST signature, SBD-6412 (8.12/87) 2z) Z tl~ 1 ~J y.I J l )p r m v► ~i rrn p • C3 b ~o ~ c n 0 0 O I Vi O p p q\ L Z ~ VIN c N i i _ v^ CIA, ZT: N o, m v ~ ( N ,1 UQ T c z g Se TO r h O M'z 05 Z 1 CD _ a -7F u ..yr c a j W \ 1 L HOMESITE SEWER & SEPTIC CO. Route 3, O'Neil Road • Hudson, Wisconsin 54016 • (715) 386-8185 SMALL COMMUNITY TREATMENT SYSTEMS • ON SITE COMMERCIAL TREATMENT SYSTEMS ON SITE RESIDENTIAL SYSTEMS SITE TESTING & EVALUATION - PLANNING & DESIGN - TE INSTALLATION COMPLETE MAINTENANCE S Its,- i /O3o J-0, :Nuts s~ • ti~~ j,q.0VD 4is Syo~ r 47T/U : Atelek A~ 14SS7- •,vivl ~7.y . . W Cv iJ-K ~ I aoelZ 4Z k4S -74 40' OW-sl~(e s " ).,.i i y /,V S?c ~4 A ,f . w,t f, -710 Ac~ C'a S J NOMESITE SEPTIC ►1IS161Nf1 M At. fp IT, 30'NEII RR N; M& *16 R88ERT ANN WIS. MASTER PLUMBER UC. N0.3301 M.P.R.& SERVING MINNESOTA & WISCONSIN NN.uV tttEq dE EatIG t E 0tlip Certified, Minnesota P.C.A. Certified & Licensed Wisconsin D.N.R. and D.I.L.H.R. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTPY, DIVISION ~,LlkBOR PERCOLATION TESTS 115 P.O. BOX 7969 (H63.090) & Chapter 145.045) MADISON, WI 537Q7 ' LOCATION: SECTION: TOWNSHIP/ MtiW+GQA,LLT Y: OT NO.:BLK. NO.: SUBDIVISION NAME: IVE ~/4 1/4 /TAN/R18 E (or k11VV1'Ce14,A11'C- Nie of / rj LI-c_ P/o ~ COUNTY: OWN R'S BU4 "i•R'S NAME: MAILING ADDRESS: fAR• HAS F12ED l~vkfZ P4.2 Ro x 27G QIUER falls' W P,S• Se102 USE 2S - S q.S DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I PRO I I NS: A ESTS: ®Residence ? ❑New ZReplace L En~ Z L 1S e' AAS RATING: S= Site suitable for system U= Site unsuitable for system SC s 3 NESt~, 1 rte- 5 1 GO f7 Ea'~ ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING Tjb K: RECOMMENDED SYSTEM:(optional) ❑S ©U ©S ❑U ❑S ®U I ❑S ©U ❑S Mo vNO- eiF cvvv~.vr~e.v.c/ TR><4!G Ef ini- GR ey.vV w 0~~ old v iforp/~J~ If Percolation Tests are NOT required DESIGN RATE: , under s.H63.0915) Ib), indicate: t^~A S S r [Floodplairn,' poton Of the tested area is in the indicat e Floodplain elevation: PROFILE DESCRIPTIONS Irv BORING TOTAL P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-/ ~•Dr 1T•~Z` ~o ~f 7$- • .67 fJN- s 7-oPso;l, /l7G - U-yy- s, 2r~ , Mrx - of B,a. 5 ~ l5 1.0 ' f "X"c 730 . S1 w Ilk F li tr B- t-~lwt- oA- y Mo I 3.0 - f;vim Lf•Qj • S. B-1 c~.0 I.3.02r y.Z$ r 'S~ N. 3 Ba 22,331 rriY. of 13,., . S~ u+i fOw I 17i'STi-JcT 0k-6y. A•lo•fS ht- 3 2 S' . 3 j ' -C~ tJ.t T.4 N ~ w /i E 'Brl ~I D6 0 .SA~v D B- r MD Sl 343 W• TAN -('r "RN.t. B-/ 6'O' 0Z •O r ~.(.o S' ~'f~Q°• •Sr ~'G7~ ~'v SV S~ ~•Sr Gy. r•'V-~ T 33- tt.XP ole. $I (uu1 HAay I Or,~T. -'6y."j'vfi U1917~td (yR . IN 'DcclMk( 'F'I-• PERCOLATION TESTS «1"4^r ~tT 4•d ' TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHE AFTERSWELLING INTERVAL-MIN. p RI p t p RI D2 PER INCH P- 2 D I Z 2- P- 12 P 2- S~- /O i /G / G 7 P- P- SG o ~4 /G i P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. FoR Tee v cAe s H l 6-k -1-R F,)at S' 0 - SYSTEM ELEVATION /ow TRE4 col - So T Thfs test R - . ! L:4 ZR& syS$et71 Cesp ~ I 3S I 76 7 <h _ - 3 E11 i /6 6 rX 5or Mr'viHt1M J33 Hirrti TQtNGt!i'~ kuN~. t1~ 51 x So Irp i So_ ldT Lr'ns~-', p x. Pe: PC- S ►re s . I VeA r• 12C-F. Pr = FovoK 6 P&C !i- 't-r- 5 -F ALU-ter /,v V,, S i O 1,J rn O r _ rEVknoa = ~ao• o _-~_t I, the undersigned, hereby certify that the soil tests reported on thls form were a ith the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests a e e f y owledge and belief, j NAME (print : TE ERE COMPLETED N: F(OMESITE SEPTIC PLUMBING CO. 3 ~8 7 ADDRESS: ER TION NUMBER: PHONE NUM R optional): WIS. MA ROBERT ULBRIGNT p~ SEC rte- 3P6 ' MINN. INSTALLER & DESIGNER LIC. NO. CST tQ ATUR ~ Wes"' • DISTRIBUTION: Original and one copy to Local Authority, Propel ty Owner an r} t DILHR-SOD-6395 (R. 02/82) OVER - I • DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION ' LABOR AND PERCOLATION TESTS (115) P.O. BOX 7968 HUMAN RELATIONS MADISON, WI 63717 ' (H63.0911) & Chapter 145.045) # LOCATION: SECTION: TOWNSHIP/MIiPFF6lil,gi,LTY: LOT NO.: BLK NO,: SUBDIVISION NAME: NE 16, /TaN/R)8 E for W kl v vlIC*'1Nti1.C- P~aR et / A f'/I.4-- P/o 7" COUNTY: OWN R'S f3611CiER'S NAME: MAILIN ADDRESS: S-/•CiPoifAR. HISS FRELP f-'vR-f7 R4 2 Ro x 276 Qluc'R f~Its ~'S Sy02 USE 2S - S f 4-3 DATES OBSERVATIONS MADE NO.BEDRMS,: COMMER IALDESCRIPTION: P MResidence ❑New DESCRIPTIONS: E TS: 3 Replace IS ipt,0 RATING: S= Site suitable for system U= Site unsuitable for system SC s 9 Nf~SC& NE Q rONVENTIONVL:M1 OUND : I-UNPSTEINFIOLDING TANRECOMMENDED ptional) ❑S Z©S ❑U_ ❑S 0U ❑S ©U ❑S 0U MovND-'Ol e, 0,.vvE•vr"'Oti4/ 7T-Rf4/6 Es /N- 6-1Pe(y.vy w APPRO ,yvV j~ /,U4, If Percolation Tests are NOT required DESIGN RATE: under s.H63.09(511b1, indicate: C/i4S S s If any portion of the tested area is in the Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ht1 'Ec%-o"tL ,Ff BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HI HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK,) 41 7S ' G7' ~~A-, s roPso;l//L' O-yy. s~ -2-16 B-~ Q .(fir 1~ oZ! ~D of 1351 ' B- 14 f~1;,u t- o R - 6r Ho'f.S , 3.0 L1. Qj . S . 2.33~NV.0 f Z13-.2 D' . sl Wt'A -F9w I 'Dt'STi%jcr off.-by M0s hr f.Zs' 3. 3 3 ' -c-Le T.4 a 'B~► ~ Deo SA~+ D B- .3 92 ULo > ~.0 ` .6 7' 'K a S x.33 0 51) 3 i-1 A N IG N A Sq,u e-y (•O Y&.oL 6.0 ' 3.G 5" O~Q,. S, 1•67 ' BA.)-$Y ICI I's, 6y. 2 vR (Wt4,, M4,0y 1 Orsr• oR-Gy.yo¢r v~v/rd G-R l ZCGIMRI -P4-• PERCOLATION TESTS ~~~!%'~Of''t /fi'' G•d' TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHE AFTERSWELLING INTERVAL-MIN. p RI p t P RI D P- / J 2 he- PER INCH /O I '%a Z L P- P. z .S1.. /O P- rG /G P P,SG /0 - PLOT T PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. >coR 7iPE.u c At s 14,'6- ~ TRE-4-Z, 88. so' . SYSTEM ELEVATION - This test rite C a PP' R E s' loo" 6-0 iv- ff for a convey na'a ~ ,llc system. See explam,ation. corSped c, 3S 1 _ i i *h - - 75 70 O EC~Well 6 '7p TN 11411 rReAl 5'x so" 3 ~ 33 Nifl. TQr~Gi1' j r - r - r - - i SO LOT J 0 _ JRAcKNo6 BORES 5G.4 Lt ~ "-sT` tj = pe lac S Ore's _ _ 7-T . vER r, REF. PT - 43oi7o"y E vbfz °F Acv-- O4.)L-t si0.JG 4-7- ` 5. t oQ~P"y► 1" r ~ ClEv.l- oo,~ = loo- o I, the undersigned, hereby certify that the soil tests reported on this form were m rt(e - St with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are c r t nowledge and belief, NAME (print):. I T „MERE COMPLETED N: 7 :.'VESITE SEPTIC PLUMBING CO. ' Nr~.';C AODR ESS: Sob OrNtIL G ROBERTULBRIGIiT 'j-1 RTl TION NUMBER: PHONE NUM ER(optiona1): Et3P6 MINN. INSTALLER & DESIGNER LIC. NO. ST O0 111iTM CST I N TUR s r 1 DISI-RIBUTION: Oti9mal and ona (iol)Y to Lo.;al Autluo„ty, l',ol)ci;y Owrn:r :in,01 / Iief, DILHR-SCD-6395 (R. 02/82) OVER 4! HOMESITE SEWER & SEPTIC CO. Route 3, O'Neil Road • Hudson, Wisconsin 54016 • (715) 386-8185 SMALL COMMUNITY TREATMENT SYSTEMS • ON SITE COMMERCIAL TREATMENT SYSTEMS ON SITE RESIDENTIAL SYSTEMS SITE TESTING & EVALUATION - PLANNING & DESIGN - COMPLETE INSTALLATION COMPLETE MAINTENANCE SERVICE y- It co s, /3 141t,41",Iewp 91- t~~ O e,C ti 9 2- 2 4- D AAA ~ i/v y ~S Q sti es If d11t 74, /P14v lei/ • /y !~MIESITE SEPTIC PLUMBING CO- 655 O'NEIL RD., HUDSON, WIS. 6401 c ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. -AX INSTALLER & DI ~ t1C: N0.00883 cc : f~1' /lv,~fZ Parcel 022-1045-10-000 02/08/2007 10:38 AM PAGE IOF 1 Alt. Parcel 16.28.18.P241A 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - KURTZ, FREDERICK A & SHIRLEY TR FREDERICK A & SHIRLEY TR KURTZ 698 CTY RD MM RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 399 MONUMENT RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.590 Plat: N/A-NOT AVAILABLE SEC 16 T28N R18W NE NE COM N 1/4 COR SEC Block/Condo Bldg: 16, N 90 DEG E 1319.65' TO POB, N 90 DEG E 463.67', S 222.55', S 84 DEG W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 466.18', N 264.98'- POB 16-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 06/07/1999 604475 1432/186 QC 06/07/1999 604474 1432/185 QC 07/23/1997 777/570 07/23/1997 316/456 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.590 50,000 111,500 161,500 NO Totals for 2007: General Property 2.590 50,000 111,500 161,500 Woodland 0.000 0 0 Totals for 2006: General Property 2.590 50,000 111,500 161,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 135 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00