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022-1095-10-030
sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561039 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: Burke, Brian & Sarah Kinnickinnic, Town of 022-1095-10-030 CST BM Elev: Insp. BM El : BM Description: Section/Town/Range/Map No: /9 (3/11 ( CST 33.28.18.513A03 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r CAPACITY STATION BS HI FS ELEV. Septic 911 Benchmark z Q iad 0A kA, - Tr/~ > / • d q Dosing Cad M~IE~$ D ~5a Alt. Br~Q'..l~t.~ (,~J 3 • ! 7 Bldg. f /Sewer Ar~ 5. 95• Z Awatiom 47"1 L Holding St/Ht Inlet 10.2 90.7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. V~t to Air Intake ROAD Dt Inlet v Septic 57 kA Ia 8 Dt Bottom $ / Dosing 1 1:315' , Header/Man. 3 y~be 57 Aeration Dist. Pipe 3.ce 162.1 3.3 9$.5 Holding Bot. System a 97 Final Grade e PUMP/SIPHON INFORMATION Manufacturer ^a w~ ~ GPtNand St Coved 9.7. ~7 a~ Model Number v (Y 140 oti ~ s 161 -6 5.7 74•3 TDH Lift Friction Loss System Head TDH Ft 11,5 3 Zc•5 Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM S. BED/TRENCH Width ! Length No. Of T the PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 75 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of S tem: CHAMBER OR J5 UNIT Model Number: di w DISTRIBUTION SYSTEM , A- Header/Mahifold Distribution / .I x Hole Size Ix Hole Spacing Ve I Air - ke Z" Pipe(s) 72 Z 2 V3 Z t Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center n Bed/Trench Edges \ Topsoil 1 P- Yes N1 o Yes J No G COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / ('7/ Inspection #2: Location: 68 Emerson Valley Drive River Falls, WI 54022 (NE 1/4 NE 1/4 33 T28N R18W) NA,Egt 9 Parcel UN: 33.2f18.513A03 1.) Alt BM Description 2.) Bldg sewer length yv.a{L 5 - amount of cover = vv C, V7 A 36' 3 ~ 7 //,L o (e 6 Plan revision Required? Fal Yes No Use other side for additional information. Date Insepctor's S nature Cert. No. SBD-6710 (R.3/97) PLOT PLAN PROJECT Brian Burke ADDRESS 68 Emerson Vallev Road River Falls Wi 54022 NE 1/4 NE 1/4s 33 /T 28 N/R 18 W TOWN 3/19/13 COUNTY ST.CROIX4 SYSTEM ELEVATION 97.5' 1.5' sand lift BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK XXX SEPTIC TANK SIZE 1255 gallons DOSE TANK SIZE 765 MOUND HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of iron pipe at 8" above grade ASSUME ELEVATION 100' ❑ BOREHOLE O WELL * H. R. P. same as benchmark Property} Line (not to scale) 10 acre parcel Scale = 1/4" = 10' Onsrte was done by county on 6/24/04, all soils were verified, and system may be moved closer to B-3(#2) if needed but will not be further north of B-3(#2). System elevation will be adjusted accordingly. Grading is to be done to divert run-off away from system Pro 4 A rea 15' be I ow syste m is Tank is to be properly bedded Bedroom to remain undisturbed and provided with lockdown ho use covers with approved warning 9% Slope labels B-3 (*2) 33, g5 ❑ 9' Property XS Lines scaled ~~•x' 9 4' 95' ❑ 96' H uffc utt Co m bo B- 3 B-2 tank to Emerson VaI Iey Road 98' B-1 i ne Property B.Mno o sca e B.M. P z co►r[rrrerce.wr1.9aw Safety and Buildings Division Count 201 Washington Ave., I.O. Box 7162 Ds+consirl Madist,n, WJ 5-3,1,7.- - ✓ :'jP3.21 f C - - - S`em nary .1+, rrlril a: t, O t din by 7u.) - r ermit Application - - Slate •f ransuclton NLarlber lri act oMallae wit (2 s Adm. Code, submission of this form to the appropriate govenim~ntat®~ __v S unit is required p ob sanitary permit. Note: Application forms for state-owned POWYS are Projec ess (if diftent'tilan mailing a ddress - ) submitted to the nt of Comrnerc.e. Personal iufbnnation you provide may be u y~ purposes iu accordance with the Privacy Lul•i, s. 15. 04(1)(1111, Stars, y used for FY. Application Information - Please Print All Information - Property Owner's Name 3 - ) C _ ~''U/x Parcel ll - . Property Owner's Malting Address „ r•-. V u t~' LiQ r t ' Properly Location ` f~ ~n • ~.Ity. Sttte Cudc Govt. Lot p P ne Number -3 :1 section ~r t •1e one) . Type of Building (check all that apply) Lot - 1' N; R or 2 Family Dwelling - Number of Bed oum Subdivision Nan Bloc-k. A Public/Conunercia! - Describe Use U city of - CSM idurnber l • L..1 State Owned Describe Use SZ3 IJ 'Village (Of' - 'rowel 2g i53q - III. Type -.(Check only one IbU% on l[Ite A. Complete line ifapplil able) - A.. ew System ❑ Replaeetnt'llt System ❑ Treatment/Holding "yank Replacement Only ❑ Other Modification to existing system (explain) ❑ Permit RCAGwat ❑ Permit Revision ❑ Change of Ptulnber I-1 Permit Trausti r to New List Previous Permit 1Jlunber alai hale [ssued Before Expiration Owner Type of NOWTS 5ystemlCornpon,erttJDevice: (Check all that apply}__ L Nun-Pressurized In-Ground ❑ Pressul ized in-Ground ❑ At-Glade LI Mound 24 in. of' suitable s ' old < 24 in. ot'suitable soil D f lowing Tardy ❑ Otter Dispersal Component (expl in) [J Preti tinenl Device (exp au _ j V. Dis ersaUT'reatment Area Informaytion: - Desi Flow Design Soil Applicai.ion (hpd) (gpdsi) Dispersal Area Regm ed (st) I Dispersal Area Proposed (st) S stern Elevation / L I'an nfo a,~alaiY m Total k of Manufacturer C ialtons _ Galion Units , , / n,,''L R New Tanks Existiag faaks v"/"~/L 't'r ~~V es. U vi ~ rn it. Ch Rseptic or Holding Tank - - - - Dosirtg Chanlbar 6.~~ / - - - - V11. Responsibility Statement- T, the undersigned, assume ausibility for installation of the PO'WTS shown on the attached plans- - Nbumber'Sint) - Plumber' tore MP/MP1tS NunbeBusiness Phone Number J/ ~ 9 Plumber's Address (Street, city, state, zip ( ode) VI.I 'punt apartment Use O[[ 1 Approved El Disapproved Permit Fee pv Date Issued uing Age t Signature _ r iiiven Reason for Denial Z 5 ' y/Z Zd ~3 _ _ - _ - ~tanetent 1 Rsons sbr IlisappruvaSeptic filter and 4a aubJ0- VtQ2d ' /lrt dispersal cell must s-erviced / maintained ~J wA d- °l , as per management t plan an provided by plum ber/~ C4 0 0 2. All setback requirements must be maintained ` ~~l~j lS - C / I S fi," 4& W. - _-~~L 1 es i- D ;;q per Attach to complete plans for the cyst od submit to the County y y an paper not Jess tl a tl z7 In it ! Y inches n sire SIiD-6398 (R. 02/09) ~ -VAR A, DIVISION OF INDUSTRY SERVICES 141 NW BARSTOW ST FL 4TH o~ a WAUKESHA WI 53188-3789 3 Contact Through Relay www.dsps.wi.gov/sb/ www.wisconsin.gov essicar~[+v Scott Walker, Governor Dave Ross, Secretary March 26, 2013 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/26/2015 Identification Numbers Transaction ID No. 2224548 SITE: Site ID No. 789169 Brian Burke Please refer to both identification numbers, 68 Emerson Valley Rd above, in all correspondence with the Town of Kinnickinnic agency. St Croix County NE1/4, NEI/4, S33, T28N, R18W Lot: 9, FOR: Description: Mound, 4 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1419111 Maintenance required; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. 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: This system is to be constructed and located in accordance with the enclosed approved plans and with"thv"lend Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691- 1) an e: " "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Syste ION SBD-10706-P (N.01/01). in' The building sewer and distribution network piping shall be of material listed in Table 384.30-3 d 84.30-5, Wis. Adm. Code. 2 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 comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 3/26/2013 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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/installation/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. e:~O~ When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Payment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia.lewis@wisconsin. gov 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. MIAI' S AbusnONI Cover Page °10Z yew 03AI3038 Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/ 19/13 Owner: Brian Burke Location: NE1 /4 N E 1 /4 S33 T28 N,R18 W68 Emerson Valley Road Kinnickinic System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-15. Soil test 16. Filter Specificati n and cross section Shaun Bird Signature License nu r 226900 RE IV,E MAR 2 2013 INDUSTRY SERVICES PLOT PLAN PROJECT Brian Burke ADDRESS 68 Emerson Vallev Road River Falls Wi 54022 NE 1/4 NE 1/4S 33 /T 28 N/R 18 W TOWN 3/19/13 COUNTY ST.CROIX4 SYSTEM ELEVATION 97.5' 1.5' sand lift BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK XXX SEPTIC TANK SIZE 1255 gallons DOSE TANK SIZE 765 MOUND HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of iron pipe at 8" above grade ASSUME ELEVATION 1001 ❑ BOREHOLE O WELL *H.R.P. same as benchmark Property/ Line (not to scale) 10 acre parcel Scale= 1/4" = 10' Onsite was done by county on 6/24/04, all soils were verified, and system may be moved closer to B-3(#2) if needed but will not be further north of B-3(#2). System elevation will be adjusted accordingly. Grading is to be done to divert run-off away/ from system Pro 4 Area 15' below system is Bedroom to remain undisturbed Tank is to be properly bedded house and provided with lockdown covers with approved warning 9% Slope labels 33,5 93, 14 Property/ Lines scaled 9 4' ❑ 95, 96' B- ❑ Huffcutt Combo B-2 tank to Emerson Valley Road 9 B' B-1 Property Line no to scale) B.M. P z Mound System Cross Section and Plan View - w.. ..`w..~. .r+ r.- w Y. .rj.... w ;wv nn y.i+ ~.e.:+! er M.• +n.. y+ rw! "7 1, Dimension Feet r J B 7 'r D _ r r r !ti•! .,r. •IJ r t 7~ ' r• yy •ti y 5 h 5 y5 A } } 4 r ~rr r W 40 0 J r 1 c> H r 1' 1 1' r I J 1 r 6 .I 1 1 K 3 1 ~ L is ~ W ~ K 7 B -1 Z I - lope % L 'I Z--Topsoil = ASTM C-33 Clean aggregate = 4 in. sch. 40 pvc 1 Cap Material sand fill r } '/z to 2 '/z in. dia. Q observation pipe u r 125-' Geotextile G I-I Fabric # T s'~ F } } } Ft D E Plowed Surface _ • . _?C' Ft Contour Slope Direction GENERAL INSTALLArCION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 'A inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page '7 of Pressure Lateral Layout Two Laterals End Manitalc~ Threaded [T Cleanout IL 7 Lateral Turn-tip Plug Manifold M r Long; Force Main Sweep 5 90 Bend Distribution Network S ecifications Pressure System Constr ction V`Q Lateral Diameter _ '2 In. N &A+ Manifold Diameter In. Laterals are constructed o hedule 441 PVC Orifice Diameter ~r3Z_ln. pp Orifices are driller pal tcti at to X Orifice Spacing) c7 In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded M Manifold Lend Ft, cleanotit plug and are enclosed in a 6-•8 inch Force Main Diameter. _ In. diameter lawn sprinkler valve 'box accessible r'orce Main Length__. _ Ft. from finished grade. • • • Grade • • • • 6-8 Inch Lawn Sprinkler Valve Box Page - of - 03l05 lgj Septic-Dose ank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Mane uer Model Number i PUM13 'l`ank Model Number 5 L Manufacturer Total Tar lCapaQit + Alarm Alarm model Number Max. Berry Depth t Switch ']['ype f~l' r Ilyn is Head (TDH) - Feet Filter Manufaot~ Total L.f Filter Model Nuna~er Elevation Tread Distnil Pmssuts ~ Network Loss r 75d arfor~ R squired Force Main Loss = MinimumPump ~ GP ( Ft T OH Total ' outlet Manhole ° 4'1 Above Grade With Manhole Min. 4" Above Grade Locking M itc.a. Inlet Manhole Securely Mounted With Docking Device b" Below Grade Sealed Watertight Westher`prr►of lunotion BOX wo amm Wei saw Woo "0 4%W WNW it Firiaisheci Graae~ vent Min, IT, Disconnect Above, Grade Means with 'V'ent Cap r~yi Y Y Y I Y Y Y Y r ririYIYVYV°iY irirrriyfsi°ipiyiyi/iVV YVY r Y r Y riiii•i; i°I,r iY1Y1Yr°iX.- outlet °firY /YI Yi i YiYi fYY V y Y Y . Y Y Y Y Y Y Y Y Y Y,Y IYVI Y,Y r r Filter .r;r riY We Wet Sair' "y'y ~Ql~~y~iyY ; i:% A f i Y{Y, .pry 14°1 switch S i and Reserve V iYiY 'il; weep Tank V'ok me ~ opt Hole 1 Volume Galt r . 'G1IuMiOu 1n011es YY r`iY :;i; (reserve) A: off Elevation C% i Ft~ BOUDIn (dose) J D : Elevation ;6, 44 7 (dead) ~ 1 a✓ ;Y Y,y,YiY,Y,,,y,Y{Y,YVYrY,Y Y; -2- "Total y.. s 111 •a•Y 1 i i i i i r s i i i i>i . { `{yi,t 1 f% Ii rirayVYaYIY'I,V r'y~YaYVY{Y"Yfy > Y Y I Y Y{PtY1Y ilYYrr~Y;Yirir.ri i°1 9°1°1 iY Y Y/ Y Y Y Y Y Y Y Y Y 1 v Y r i Y Y rYYY I y Y Y/ Y Y Y~ Y Y Y Y Y Y t Y Y l Y Y ••1•a The SOP&*50 tatlk is bedded and. baps. filled in accorda~tce with the GENEYtAT+ INSTALLATION: nm d tb of hUiY as, npdolfied. by tote manufacturer ma~+ not manuf~'s pmduet.approv'al spedfiioattons. Ma am °P ado have an effaoti~re locking device (padlock) be exceeded without pWiOr. Oppt.Q. 1Vtanhole cavern exposed to lP' with wafisrtigl►t installed fittings, and . Pipit►g at the inlet and outlet is of approved Mrcee rima~itt is aled'c►~ tonne d to frtith h. 40 pV'C to bridge the tank ent 9etdir►S or sage . laid. on stably soil tO 'P" "the ford . 16.29. excavation and the .slee' ve. is sealed ~1Outi • EleQuical-Ovice corrtpljes xivitlr+ I 300 and Comm Page . a 02/05 U Wastow*ef- SEW-40 series 4/10 hp Submersible Effluent Pump, 3/4" Solids ConstructJon Flow - Liters/Minute 0 so 100 ISO 200 250 300 Cover L~paxy-mated cast iron 35 11 hMotar, M n ERox Roated:p st~~ , qw 30 1a 9 Impeller Material Thermoplastic Elastomer 25 a inipallpr Tye _ iNort-clo0' { 7 20 6 volute Epoxy-coated cast iron 15 5 -Pak ar (;grd _ JTW . 4 d 70 Mechanical Shaft Nitrile with carbon and 3 ~ Seal ceramic feces $ 2 `'~a~tlers,. ~ _ Sta~~li3(3~s~t~91%'{ 1 0 0 Shaft Stool 0 20 60 80 - ~ Flow - Gallons/Minute qs UlapOr slntareo; Jeevs a PMT lovyer tai be~rak~~ e.ur--- - •F i 4.15" - r,t4• OW ` 1 T LEM SEN-40-AF SEN-40 Specifications SEN 46 504211 " 10iii 1 1/' FNPT Qf920 SD 76 60 A5 88' 32 14 20 26.5 1750 ~a4 > 1«112,", pNP ~/920'x $O Ob, @a -'u t3 .f K14 3Qa~h . ~ $ K 1 SEN 40 AF 669213'A'4/101 1 15 1-1/2" , FNPT 9/920 80 70 60 45 25 ` 32 14 20 275 7750 Franklin Electric 400 East Spring Street, Bluffton, IN 46714 Tel: 260.824.2900 • Fax: 260.824.2909 Form: 990199 7-11 wvvw.franklin-electric.com POWTS OWNER'S MANUAL & MANAGEMENT' PLAN Page-1 of-~_ BILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity j al E] NA Permit # Septic Tank Manufactul er O NA DESIGN PARAMETERS Effluent Filter Manufacturer ~ © NA Number of Bedrooms ❑ NA Effluent Filter Model - ❑ NA Number of Public Facility Units -4MA Pump Tank Capacity al O NA Estimated flow (average) T-~ 6-1111 gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.6) ® gal/day Pump Manufacturer ❑ NA Soil Application Rate al/da Iftz Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ~I§iNA Fats, Oil & Grease (FOG) 530 mg/L D Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) x220 mg/L D NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids_(TSS) 5150 mg/L 0 Disinfection D Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg1L ❑ In-Ground (gravity) 0 In-Ground (pressurized) Total Suspended Solids (TSS) s30 mg/L "NA ❑ At-Grade "KMound Fecal Coliform (geometric rnean) 5104 cfu1100m1 ❑ Drip-Line D Other: YMaximum Effluent Particle Size 1f, in dia. ❑ NA Other: - NA Iti _ i3ther: - - ~Z4~lA Other: NA "Values typical for domestic wastewater and septic tank affluent. Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency " Inspect condition of tank(s) At least once every: 11 month(s) t A ear(s ! (Maximum 3 Years) ❑ NA Plump out contents of tank(s) When combined sludge and scum equals one-third ('X) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: --Y-~ D Oypar( months"s) (Maximum 3 years) DNA / month( s) Glean effluent filter At least once every. O NA -inspect pump, pump controls & alarm At least once every: 0 months) © NA monthisj- -Flush laterals and pressure test At least once every: O NA Other: At least once every: © months) ❑ NA D year(s) D NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the 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. ]'he 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 chapter NR 113. Wisconsin Administrative Code, All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, 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. Page I of START UP AND OPERATION For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of painting products or tither 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to 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 cells. 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 or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diepors; 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. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with chapter Corrim 83,33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealwl. r The contents of all tanks and pits shall be removed and properly disposed of by a Septago 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 area should be protected from disturbance and compaction and sho ild 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 soil 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. ound and at-grade soil absorption systems may be reconstructed in place following 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 ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DI!ATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER ~ POWTS MAINTAINER Name ~r:t.Li 4✓ T' ' Nac' Phone LLme on e SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY A THORITY _ Name Name Phone Phone rhis document was drafted In compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.64(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MA'Nr'ENANCE AGREEMENT AND I BRISHIP CERTIFICATION FORM Owner/Buyer j Mailing Address Property Address -(Verification required fro rn plan Ding & Zo Department ar new c°onstrnction.) City/Strtte,~ l I~'rL `lS Parcel Identification Number Property LoratioI, %4 , ` ,Sec. .r, R/_ W, Towel o:/ 1 Subdivision Certf led Survey map # 7~7y_ Volume page # VVarran tyDeed # _y Volume Page # Spec house yes Lot lines identifiabl yes no SYS.~, T JAAIN~EN4 SCE AN O W R ~ERTr CATloly Tmproper use and rnairatetrance of your septic system could result in its prerr tune failure to handle maintenance consists of pumpirg out the septic tank every three years or sooner, wastes. proper if needed, by a li sensed pumper. What the system can affect the fnetitm of the septic tank as a treatment stage in the waste disposal system. Owner maintenance o13 put into responsibilities are specified in gCornm. 83.52(l) and in Chapter 12 -St. Croix County Sanitary Ordinance. The pruperty owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper , that i wastewater disposal system is in proper operating condition and/or (2) after inspection and roping (if necess ary)(1) , the the s septoneptic tank is i less than 1/3 full of sludge. Y/we, dw undersigned luive read the above requirements and agree to maintain the private ;iewage disposal system with the standards set forth, hareiri, as set by the Departmnt of Commerce and the Department of Natural R-esotu-ces, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned tt, the St. Croix County Planning Zoning Department within 30 days of the three year expiration date. nnrtng ~ I/we certify that all statements on this form are true to the best ofmy/ow knowledge. l/we am/are the owner(s) ofthe property described above, by virtue ofa warranty deed recorded in Registrar of Deeds Office. Number of bedraomS i SIG A~ URE OF .gPPLTCANI'(S) DATF, - 0"Any information that is misrepresented nay result in the sanitary permit being revoked by the Plthnrung & Zoning Department. Il'nclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if' jreference is made in the warranty deed. -J aEv. 08105) FILTER .,,,err C I > s'r"cb+ x Urp pt the tYlrayr class !aorta the MVJ ttot ti:ha alll6t pipe #o otetcnro it tut witarod urrdau the M=*" nNttatlgy. if Ives, tank thruuyh the autiat far aolo,itlnt "am (0 oftilar 10100 rrv!Pests IN Chn 1414 tgrtin#1"t t to.. pipe. ltlua) aYddi1 'lullaipips ~P a Vvhihs the r is stool eery flttt3d f1#1 the outlast pure, rraYrlrsura tho lnttytli at ~Itr-incl► plpa rrauJad to br~rrad tftn flttar fu Ehs # and WWII iI' uL'iiPElrrg #hn atlttartal supplaMarNtat 6'taiuWort. Yi rldm +auppart rrtilkirud. fu 4ot utilind, arotmed to stall tour. 5'rWO x For installattagrsi utilising the saptiarlal Nupglr,4'rni►tal sido suppwt_ solvarrat Wald the alt•dhch pilba ay&q. thrz liltey to". Xf,ride support hidoidrl it, trot utpheod. laroutrid to step four solve"t Ovoid the liftel awhile Oft the otrlist pilae. xrlswt tftel Ifitel. cartrtdgs into the case, prarislit l down uhto the filter' lraeks into the boa.mrs to tite cash. "f ~;•.t $;i•yu It a As O *C41 is utlti:lx"d. irrsort Into t1 eltickwise 90" "1° Iil►nr anti sock by turn6ag , n 'te a... Makitts"ance 1. The affluent filter aderautd be dealred ovary three the aepftlc L'nhi( 15 ssrvieerd. 2. upah th6 outlet mccess dpohirtty to Inspact tear tpllk mild ('liter s. pump the aiaptic tank rxtrrlplaitely, milki N o lever root the battarta of Mm Utede and pgt Jugit the sp 1 rt ~i4ve rtthe utlists a. Oloat then c Ntlaht level has b uixtV Imored hi e. di`t'itlnltt. N outlet pipe, fir dis Ltge tof the the y PUB YJp bh the filter hnndll tet to to dislodge the nJy case ebrtridgal iratta the . . 5, silde the cartrldya up mad ni u; of the 4:wtau hw taleltpitty, y G, it is vps swlteh tvtumatid tv are alllrtrr is prosent, tine switc1% sitreuld he removed by taraNroip creel,+L'ardockwisq goo Mid deaued " Wild, water Unly. 7. Whbe holding the crarriridge nn Its sidw parge gist surfrce hodov down) ovdr the acceeraa upersijig, 0"$@ ON the cj1lfirldUg tilitit w6kcrt' only, rraokbig cure all asiltago. Notalftvi la d0salt bWCk Hltu titre tank, d a. jr vrts swltcit fa utilized, roplwix, by 111surti hpl 'seta filter arrrd turrtirrg cirlydcuvtsa IIr1°. ~ , g. b srrt the filter cartridge back Into the ft", ►lrt "Ink down ut►tii tires rafter Itecks Iatto the laalttoun tae' thv cams , d' ' + 1O.Ftowlata and mature the iaf caul ltpstrNlg Yep the With. ~~n w• ,Yr.. Yr tY' •:1t I" + Jaj. .'4~ ~ 4/I .'irta•64Yar ' I I i ''1 1',t a fi It' f.tti :•VAa1M1lA }1„ 'J6 'NI•I, r+~'t+t►'rl~.~efatrurnrusif~.c~sann 8E~'a'~'~~l~l!t"t'M~1~S ~IS►~~~~iif~~~ • l { f SOIL EVALUATION REPORT Page of 3- 1 Wisconsin Department of Commerce t Division or safety and Buildings c ti in accordance with Comm 85, Wis. Adm. Code County CjT. L ' Att ach complete site plan on paper not less than 8 1!2 x 11 Inches n size.?Yb9t j include, but not limited to: vertical and horizontal reference point (8 dirk d . Parcel 1.0. rDIN~~ S s percent slope, scale or dimensions, north arrow, and location and stance to nearest road. Date 1 Please prlnt all Informatlon. (1) (m)) Personal informs6on you provide may be used for secondary purposes (Pct ecy Law, s 15,04 Property Owner 1Propwiytoc4lon • S/3A L V GPI . 1[91 1/4 S 3TJ T Z$ N R W 3~ D 1clr Subd. Name or CSM( z 1 Property Owner's Mailing Address #057N v - ° A.. t -70 EIVIEIZSb v P t -P-) bR • - - City State Zip Code Phone Number ity ❑ Village B(Town Nearest oad M AtlJe7 v f R~~ F A t.S SLW2 LS ) 42 5 50! K-t,kw 1 N t C e 0 GPD Use: Residential / Number of bedrooms Code derived design flow rate - New Construction 45- ❑ Replacement❑ Public or commercial - Des be: !t ` Parent material ROE i odr ~In elev n it liceor V j~ ~jy ~ 5 General commentsa-S V and recommendations: MOtki,1o SVS-Xr-M 0.5 LDAVIA)& ATE- I •~l SAfJQ FILL r AA ILA/ Boring C1rY~` it af,• n,% J -rh Ell Boring # •c~r~ t" Depth to limiting factor in. a tall pit Ground surface elev. n Soil A iication Rate GPD/ft? r Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ,Eff#1 'Eff#2 k In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. rt. _L d s 3V~-CO 0.5 O•~S z 0 Z3 to 2 SI I _ ab As D-6 Z l~- 01 S 0.9 { t z _ 0.5 0.% ' Y' y p Z'27 W 5 :5;11 cis ab ((r_ I' f t: Boring . Depth to I•rmlUng factor ,_Z- _ In. Pit S.1.11cation Rata R : Boring # Ground surtece elev. ft 1 ~ GPD",° t Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E 1 'Eff#2 0_ Munsell Qu. Sz. Cont. Color Z. e° v tn. CC p 4 Y. 7+ r 51~ _ d a,J Oag Y I -r )0 j - 24Z _ cis oa5 N2 f 1~-►v120 14 ~1 s ZV~-CQ .2- 4 a3 2-, 10 z o ~y/z t - a cis 0.3 R 3~z _ sty _ ~t s as z o 3 d .,E1 _ r Z- v,3 ° _ o ti K-*7- a o N Le, ` t 1 b rf ' _ Effluent #1 =BOO > 30 < 220 mgrL and TS5 >30 < 150 mg/L 'Effluent = BOD 30 mgll and TSS < 30 rrrg/L Signature / CST Number (Please Print) NAIAP0 QO HDLl_S n 119 3Z Date Evaluation Conducted Telephone Number Address W9g75 1004KAVE, RIVE FALLS WI 5'4012 0q-0 Z-0: L-7ls L416-\-17.5 i` I r i 1 3 Page of Property Owner parcel ID N f a Boring Boring # p {A1 pit Ground surface elev. _1 t h. Depth to limiting factor in. III Icalion Rate ' Horizon Depth Dominant Color Redox Description _ Texture Structure Consistence Boundary Roots GPD/tP In. Munsell Qu. Sz. Cont. Color Or, Sz.'S 'EtF#t 'Ef(#2 I ON K. 4Z nldhL ~I Z 4-18 0y~~2 f9►) aNC d 0. 2 .4 ~ s 2 0.5 a 8 3 1K-ZZ vRx/~ jam,! 4 ZZ-z.8 3 t 1 b d s l -r~ t_ o ~ W OYQ-5/z v t - abK dsh -1Yl . Z D"3 .j j Boring # Boring pit Ground surface elev. ft Depth to limiting factor in. Soil lication Rate * I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 J N Boring ❑ Boring # o pit Ground surface elev. Depth to limiting factor In. ~p gpplication Rafe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff l in. Munsell Qu. Sz. Cont, Color Gr. SZ. Sh. 'Efi'#1 'Eff#2 w d } jy T~r 1 A ' Effluent #1 = BOD" > 30: 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 ° BOO, < 30 mglL and TSS < 30 mg/L R The Department of C:ominerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608-266-31 SL or TTY 608 264.8777. r ' f SOD4)30(R,640t I 1" ~ a ~ ~ ~ I ~ I A IIA\\ I+ ~V O~ ~YJ 11 V 1 PAG~_OF~ ~J OMR: u.LD H A ! E y0' 3 EL WA TED I QM-7041-W OF /1' Al IPIF- -marg, mu 3 !J 5uuZFAC& - vC ~3oa + coAeUA;D-lOZ-Z7'0 UYl ¢ i NO COMM 83 K 7(j a 4OA&tJ Su 3yc 2 • ~I'~l ~"G ~d Yf'CcG~cT~-~ W&5 4 cd Uh less 00 25 7V h IIOG~ 4 ' '7 LIO w M ` 99.00 wR ABM 5~ Sok lti o uN . k~ ?r~ 1 IC;fN. nn hit t~ 4 T 0. b6 ~ °ve r 1~cGe. , S1IZ4 Oh Yip 2 •S l On-1t of ~i~e~ aSSvv~ l ad 3qe ff~ ~F~~ sa-rur~, 10-2,S- r ~ 13, ~Sji o~ 6Y~~ Z (U,l~ ~cti ~s • l war- pipe X2`7 I z3' ~r pi e e.) j raA •'1 -fv 100 r SOIL EVALUATION REPORT Page _1•_ of 3 wsoonsin Department of Commerce _ _ - Division of Safety and Buildings in accordance with Comm 85, 1i fr d Count GIeD\ Attach complete site plan on paper not less than 8 1!2 x 11 Inch j in size. Plen must Q include, but not limited to: vertical and horizontal reference point ~BM), dirQdion end ; ~ P81-11 L0• aicy percent slope, scale or dimensions, north arrow, and location and distan6'1o hea?fisiroi,~`!, _ pate $ Revs ad b I a please print all lnlormatlon. y l~ h o1` Parsonat intonnation you provide may be used for 6econdary purpocec I tvacy Law„s 19 09,O) 0)11 Property Owner N E 114 NE 114 S 7 7-K N R S LD Lo Block # Subd. Name or CS J { ' h Property owner's Mailing Address ~-p 1 -70 E: /d\EK SW LLE~, 7?R, r Town Nearest Road Phone Number O ity ❑ Village lv Cm, State Zip Code F oaz t76 )yz5-9SZ1 CK IC GPO Code derived design flow rate-- New Construction User Residential I Number of bedrooms Replacement ublic or con er at - Describe: } it. Mialn, ~atervatlon a rppiicai, d r-- Parent material 's fir/ A i} General comments ISjEA 04 L4>~1DW6 RA V11 L) I and recommendations: • ( 2,O1 Sfl~D F ~t..~. 1 ~ Boring V~~L Boring # Pit Ground surface elev. _ q V 3 h• Depth to limiting (actor }_9 in mil A tication Rate ~ ~ Roots GPD Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ,Eft#1 •Eff#2 oat. Color 0'5 D. in: Munse4! Qu. Sz. G Gf. as cb I Q.ta ~241 Z to-jq 0`fLZ41 3~2 tat l Z -m X d s Qt u~- 0, 5 O• fa 3 -19 0 d sh Q i u~-►~ ~>s,z 0.3 1-2-Z z ( 10 ~~I i~ -rn~1o1C p S zZ-Za vK 3lz t ov t SI ` _ G T% I T ❑ Boring # Boring q LS 1 Z- rfaceetev, k. Depth to limiting factor._~~ in Soil Iir al(on Rate Pit GrouncFU Roots GPDIff Horizon Depth Dominant Color Redox Description Texture Snciure Consistence Boundary •Eff#1 'EN#2 Gr. Sz. Sh. ' in. Munsell au. Sz. Cont. Color ds of .5 Q•g ' t 0 lt~i b}'1 d a,s o,8 Ai, -ti ~ z i y _ d a .S o~ N 5-29 31z 4 ' _ - e4i +t, < and TSS c 30 mglL • Effluent #2 =BOP _ ~ mglL r~ Effluent #1 = BOD > 30 220 aqL and TSS >30 < 150 mglL CST Numt~er i 1 I . d /J~ $ zJZ CST Name (Please Print) Signature +a~ N}A X30 FID S-C~- Data Evaluatlon Conduct ed Telephone Number Address N 2 to -1-175 WgB75 6913~hAVP- RIVE 'FALLS WT 5402Z b - R a i zl Property Owner Parcel 10 # 1 ~~IJDU~1(o Y^ Page Z of J Boring Boring Q # Pit Ground surface etev. ft. Depth to limiting factor Son Application Rate Horizon Depth Dominant Color Redox Description Texture Structura Consistence Boundary Roots GPO1ff in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#i 'EH#2 M A h ' 1 h &$I 'i Z S,~ C~7 0.5 .K -I 123/z 0.5 04 K;p y - z fou'i t xcqj at 1 1 Omar ds 0.7- 0,3 m-A b S► sb ds~► v~ m 0 z 0.3 5 20-Z Ng* ❑ Boring Boring # ❑ Flt Ground surface elev, Depth to limiting factor In. Soil Appiicavon Rate ~~tt Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fY in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Efi#2 i R ih ❑ Boring Boring # ❑ Pit Ground surface elev. h. Depth to limiting factor in. t Still A Iication Rate ' i Horizon Depth Dominant Color Redox Description Texture Structure Consistence BoundaryRoots GPDlft • in. Munself Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I 4, I ?Ih wt~. Effluent #1 = BOD, > 30 < 220 mgrt. and TSS >30 < 150 mp/L ' Effluent 02 = BOO{ < 30 mg& and TSS < 30 mglL The Department of C:ommcrce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. i s90-q70 (R NW) I ~ 1 l I ~I \1 V ~ i PAGE_O~ 3 s, a 0: u cat F / I7yjtj PjPI; 6rj" S FACF- h---- iMe0 IM0 1 i v ` -50L "INC W/ OAGKNOE NO COMM 83 %fOALK i't20MM5 44- 1 Su rvtie ten kod wo-d/,, n i r 0 o-J. EEC- BM 44. llooloo ( (.Saul N PtZOr~a`m~l ~~Ne 1 i q X ~ . 1 ti tST. CROIX COUNTY WISCONSIN rf"" "too' ZONING DEPARTMENT f - ST. CROIX COUNTY GOVERNMENT CENTER { { N { N N N ■ 1101 Carmichael Road Hudson, WI 54016-7710 Phone: (715) 386-4680 Fax (715) 386-4686 rs~ . Memo to F'11e From: Pam Quinn, Zoning Specialist ( II I C~ Date: 6/28/2004 Re: Soil on-site (NE % NE % Section 33, Town of Kinnickinnic - Jay Uldrych) On June24, 2004 a soil on-site determination was completed at the request of CST Mary Jo Hollister to verify that A+4" conditions (minimum state requirement for a mound Private On-site Wastewater Treatment System (POWTS) can be met. Staff (Pam Quinn) concurs with the finding of >A+4" conditions; mottling and redoximorphic features were not observed within 4 inches of the thick (>20") silt loam A horizon. Hand borings were dug in the vicinity of B1 & B3 on the southerly tested area to verify reported conditions. An additional hand boring was dug below the B3/B2 contour, where soil conditions appeared to be consistent. Mary Jo will need to make some corrections to the original reports, but the soil descriptions are acceptable. Two tested areas have been provided on this property, with the intent to split the acreage into 3 lots. The following comments must be addressed prior to applying for a Certified Survey Map approval: 1. Although soils have been located on the property that meet the minimum requirements for a mound system, the two tested areas are in extremely close proximity to one another, which make it nearly impossible to install one without affecting the other (damage by compaction from heavy equipment, etc.) Both sites have limitations on the mound dimensions (6' x 75') and design wastewater flows (450 GPD) due to property lines and steep (>20%) slopes of the adjacent ravine. 2. Both tested areas are so close to property lines that heavy equipment and materials needed for mound construction would not be able to access the sites unless permission is granted by neighboring land owner. 3. A ravine with >20% slopes separate the potential mound sites from the remainder of the acreage, which creates a problem for installation of forcemain pipes and pump chambers. Excavation on the slopes within the ravine may require a special exception permit. No tank installation is allowed below an identified Ordinary High Water Mark (OHWM). I 4. A qualified master plumber should be consulted to determine the feasibility of pumping wastewater to the tested areas, especially the idea of trying to re-route wastewater from the existing house. The estimated costs and logistical problems should be considered prior to developing a concept for lot splits. 5. The property owner should contact the Dept. of Natural Resources to determine if the ravine and its intermittent flow meet the definition of a "navigable waterway" and to delineate the OHWM. A Certified Survey Map must be approved before any sanitary permits can be issued by the zoning department. 13 3 8,8539 VA AGE5232 STGISxI'TgR OF DEE CE YED FOR O IFE R i 54 ' ~ r m g czi o ~ ei b ~ 7AC 8 L9E FE r~ ZZC4mQiq !l €n r2ZZ~<~~ i to o > s m ma $Z 1.1 O c p rS1 rp T. 2 c i 0 ~ r C) (~i > V n Z mom ; > i :2 Z < = O 'y R,>QQ r ~ vi rn m r $ ~coN m ; Io ~~t'p~ V! ...Q ~ r4S.C40~ Zra~~ =off < ^f K Q~ O a y1' I NZ A $ ~ f*I~NH! f m ~ n m D n0c, TI z rpiozm °Z DTI C A '1 l cmD~ °m O n m ° = ° Z " SaNVI 0311`c -IdNn m w v 0= N a C) I (Ji m z O °;s L60£ 30Vd 'LL 3Mn10A 'A'S'O '9 101 d0 3NI1 1S3M o ° I rn °z a ,96-*99 M .*0,0W0 N \ mzml w~ N N LN3N3SV3 rn < y I N ,LC£'0 '00C £ L L o NOUVA243SN00 m a v cri C,01 ODOO l O N B .L£'8ZZ i .OOL t _ b ml <o I n O oN `I _1 r O J r N I O - ` Z P = a 25 Jm~n V r ..:1 v ~ 2~ N ~ 0 2 Z ° M .40.0E AO NJ N m C C I 00 O 00 0 w o, CO ()1 ) I z u N c~ cc~ co O I~ ~ C N Ln CD W3 o U N C I O cn CO 1-3 CD rn C-) i<c~ i D ~ y V< m ICS v O O IN (n l O m V O co O cO ~ N N O Q ml°J --3 cn I D r•/1 ~i H......~ n N `..J.%- j rani G7 w $p Q.0 N I Z rl ~L I m oC;1 vl N ~ F{ i 7 ul ~ N 1UI " I 0~ W m - _ _ _ - - - - T n cn O 226.27' •06.14• 178.16 v 212.00' ° rn w S 02'37'28" W 616.43 EAST LINE OF L07 65C. S_M. VOLUME 1 . 7 PAGE 3091_ _ - EMERSON_VALLEY DRIVE_ LOT 4 - LOT 3 - C S.M. VOL. 5~ - I 66' C.S.M. VOL. 9, PAGE 2610 /PAGE 1276 1 of 2 Vol. 21 Page 5232 ► 8 0 0 1 5 9 3 State Bar of Wisconsin Form 2-2003 Tx :4001356 WARRANTY DEED 918658 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between WESTconsin Credit Union RECEIVED FOR RECORD 07/06/2010 3:58 PM EXEMPT ("Grantor," whether one or more), and Brian Burke and Sarah Burke, REC FEE: 30.00 husband and wife, as survivorship marital property TRANS FEE: 149.70 ("Grantee," whether one or more). PAGES:1 Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ("Property") (if more N RV; rum Address space is needed, please attach addendum): * S f 4 & 6G rVt.~, LOT NINE (9) OF CERTIFIED SURVEY MAP IN VOLUME TWENTY ONE (21) OF l bo b Y OO f Qvai' Dr. CERTIFIED SURVEY MAPS, PAGE 5232, AS DOCUMENT NUMBER 828539, FILED Hvv~/ ~s IIU' 5W-7, IN ST. CROIX COUNTY REGISTER OF DEEDS OFFICE ON JUNE 30, 2006, BEING LOCATED IN THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER (NE'/. OF NE%) IN SECTION THIRTY THREE (33), TOWNSHIP TWENTY EIGHT (28) 022-1095-10-030 NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC, FORMERLY Parcel Identification Number (PIN) BEING LOT 6 OF CERTIFIED SURVEY MAP IN VOLUME 11, PAGE 3091, AS This is not homestead property. DOCUMENT NUMBER 542946. Subject to easement as stated in Shared) (is not) Driveway Easement and Maintenance Agreement as document number 893741. Exceptions to warranties: easements, restrictions, and rights of way of record, if any. Dated June 24, 2010 WESTc in Credit Union (SEAL) a~~•• * * Gre ory L. n President (SEAL) SEAL)•': GG • *Sc AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) } ss. authenticated on Dunn COUNTY) Personally carne before me on June 24, 0-1y' * the above-named Gregory L. Lentz, Presiderd. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, Ito 6ie known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) in n an dg a same. THIS INSTRUMENT DRAFTED BY: * Deb K Gotlibson Maxfield E. Neuhaus -Attorney at Law Notary Public, State of Wisconsin ) River Falls, WI 54022-0138 My commission #s1xvn mwt) (expires: 1/26/2014 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED: WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. 2-2003 *Type name below signatures. INFO-PR0-www:infoprofom,sxom 1 of 1 oz/1a/zo AM 3 09:32 Parcel 022-1095-10-030 P PAGE E 1 1 OF 1 Alt. Parcel M 33.28.18.513A-03 022 - TOWN OF KINNICKINNIC ST. CROIX COUNTY, WISCONSIN Current OX Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 08/04/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - BURKE, BRIAN & SARAH BRIAN & SARAH BURKE 629 CEMETERY RD APT 2 RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 68 EMERSON VALLEY DR SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: 5232-CSM 21-5232 022-2006 SEC 33 T28N R1 8W PT NE NE FKA LOT 6 CSM Block/Condo Bldg: LOT 09 11/3091 NKA CSM 21-5232 LOT 9 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-28N-18W NE NE Notes: Parcel History: Date Doc # Vol/Page Type 07/06/2010 918658 WD 07/06/2010 918657 AFF 04/21/2009 893741 EZ-DRIVE 03/26/2009 891749 QC more... 2012 SUMMARY Bill M Fair Market Value: Assessed with: 198612 71,000 Valuations: Last Changed: 09/07/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 80,000 0 80,000 NO Totals for 2012: General Property 5.000 80,000 0 80,000 Woodland 0.000 0 0 Totals for 2011: General Property 5.000 80,000 0 80,000 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