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Parcel #: 022-1023-40-000 07/06/2005 02:05 PM
PAGE 1 OF 1
Alt.Parcel#: 9.28.18.129D 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): *=Current Owner
*
WILLIAM C&BONNIE J WORTH WORTH,WILLIAM C&BONNIE J
480 SKYLINE DR
ROBERTS WI 54023
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description *480 SKYLINE DR
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.700 Plat: N/A-NOT AVAILABLE
SEC 9 T28N R18W THAT PT OF E 35 RDS 7 Block/Condo Bldg:
LINKS OF NE NE LYING SWLY OF HWY 65
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
09-28N-18W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 796/202
07/23/1997 719/331
07/23/1997 455/405
2005 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/21/2000
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.700 20,000 42,100 62,100 NO
Totals for 2005:
General Property 1.700 20,000 42,100 62,100
Woodland 0.000 0 0
Totals for 2004:
General Property 1.700 20,000 42,100 62,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 314
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
G 2z_-lo-z3, y6-az),
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707
SE,,NF%,S9,T28N-R18W CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
(lf asilaned)
Town ob K,(,VInic <nni.0 ❑Holding Tank ❑In-Ground Pressure DNlound S$b-01958
SI2 tine Road
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Dennis Snow Route 1 RobeAts wI 54023 �4 /3 .00
BENCH MARK(Pe(manent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV..
Name of Plumber MP/MPRSW No County: Sanitary Permit Number:
Thoma6 A. Ulan 3231 1St. cuix 112695
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED-
❑YES ❑NO ❑YES ONO
BEDDING. VENT DIA. VE AT HIG ATER NUMBER OF ROAD- PROPERTY WELL: BUILDING.�VEN7 TO FRESH
AL M' FEET FROM LINE AIR INLET
DYES NO C� YES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
�G as �� PROVIDED: PRQVI(ES
U) l� YES ❑NO YES ON IL--J°`4ES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL JBUILDING V
(DIFFERENCE BETWEEN FEET FROM LINE� * y S ZS AIR2LET
PUMP ON AND OFF) YES ONO NEAREST L
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH: LENGTH. NO.Of DISTR.PIPE SPACING COVER ,N',IDE CIA -PITS LIQUIU
BED/TRENCH TRENCHES. MATERIAL! PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FHESH
BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END: PIPES FEET FROM LI NE AIR INLET
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
YES ONO
SOIL COVER[TEXTURE �� PEHMANE NT MARKERS OBSERVATION WELLS
_1✓1& YES ❑NO W/YES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MIr.CENTER / EDGES. I�
`7 ' S 1:1 YES NO YES 0 N?YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO.OF LATERAL SPACING (TRAVEL DEPTH BELOW P PF FILL DEPTH ABOVE COVER
BED/TRENCH S G3 TREN ES: / r / /
DIMENSIONS � J � J
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTHIBUTION PIPE MATERIAL&MARKING
ELEVATION AND
ELEV.'. ELEV.. DIA a ELEV. PIPES DI A..
L/c7
DISTRIBUTION
HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIA VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS 1� 2G YES ONO OYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING
FEET F LIN%
YES ONO YES 1:1 NO INEAREUM
Lo(�
Sketch System on Re ail ty file for audit.
Reverse Side.
ISIGNATURE. TITLE
Zoning Admin.Z6tJratoh
DILHR SBD 6710(R.01/82)
SANITARY PERMIT APPLICATION Coy" v
=Z971 LHR In accord with ILHR 83.05,Wis.Adm.Code r n
�,,. aSTATE SANITARY PERMIT#
i� 6 q's
-Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches in size. 3 —61 55 I?
-See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES YNO
PROPERTY WNER c PROPERTY LOCATION p
if � T 2F '�4 &6'14, Sq T o��, N, R 0 E (OK9)
PROP�Pjy D INER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
C1TY,� TE� .. ZIP CODE PHONE NUMBER CITY NEAREST ROA LAKE OR LANDMARK
,{,{��``JJ ,,��✓✓�Cnn a ❑ VILLAGE: r
r t
111. TYPE OF BUILDING OR USE SERVED:
Bedrooms if 1 or 2 Family OR ❑ Public(Specify):
Number o f ed
Y
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. ❑ New b. SJ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2)
1. a. ❑Conventional b. ®Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy Moundf. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ❑ Seepage Bed b. seepage Trench c. ❑seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
�/*17 0620 Feet ®Private El Joint El Public
VI. TANK CAPACITY Site
in allons Total ##of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank DOU w
Lift Pump Tank/Siphon Chamber ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
P1 be 's Name(Print): Plu Signature:(No amps) MP/MPRSW No.: Business Phone Number:
W "4�-, � -79)5 (
Plumber's Address Street,City,Sta ,Zip Code)- Na esigner:
00
VIII. SOIL TEST INFORMATION
Certified oil Tester(CST)N me CST#
CST's ADD ES�eet,City tate,Zi Cod ) Phone Number:
� LI); &�
IX. COUNTY/DEPARTMEN USE ONLY
,�y� ❑ Disapproved tary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
CN Approved ❑ Owner Given Initial y, Surcharge Fee
Adverse Determination ''�°�-� � - _A �'
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
I
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION '
TO THE APPLICANT:
1. This 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. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description where the system is to be
installed;
II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system_information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. 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. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8'h 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; dosing or pumping chambers; 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.
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2 years of steady negotiation and public debate. The groundwater bill Ground stet=
included the creation of surcharges (fees) for a number of regulated practices which Wjsco itl`$ a
can effect groundwater. The surcharge took effect on July 'I, 1984. All of the water that buried re 8si re
is used in your building is returned to the groundwater through your soil absorption u
system or the disposal site used by your holding tank pumper.
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground-
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
` 0�~4� �� Wisconsin&� n []8D8rtmeOtDf Industry, Labor and Human Relations
PRIVATE SEWAGE PLAN APPROVAL SAFETY m BUILDINGS DIVISION
,
Office of Division Codes and Application
- 201 East Washington Avenue
P.O. Box 7960
Madison, Wisconsin 53707
THOMAS WANG Owner: DENNIS SNOW
1009 1/2 W. MAPLE ROUTE 1
RIVER FALLS, WI 54822 ROBERTS, WI 54023
RE: Plan Number: Date Approved : July 5, 1988
Gallons Per Day: 460 Date Received: June 7^ 1988
Project Name: SNOW, DENNIS — RESIDENCE Location: 8E,NE,9,28, 18W
Town of KINNICKINNIC County: ST CR0IX
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements . This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are
stamped 'conditionally approved' . This approval is contingent upon compliance with
any stipulations shown on the plans . All items that are noted must be corrected .
All permits required by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department' s approval stamp at the
construction site. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires .
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the following components only:
— REPLACEMENT PETITION
— REPLACEMENT MOUND
Inquiries concerning this approval may be made by calling (008) 266-2880. |
ince
PETER E. PHG��
Section of Private Sewage
Division of Safety and Buildings �
PPP013/0009n/ 2
cc: DENNIS SNOW
___Private Sewage Consultant ___County ___UW—SSWMP Plumbing Conuultant
Owner Plumber Environmental Health
`
N maoo* xm.`won
N
State of Wisconsin \ Department of Industry, Labor and Human Relations
SAFETY&BUILDINGS DIVISION
June 27, 1988 201 E.Washington Avenue
P.O.Box 7969
Madison,Wisconsin 53707
Dennis Snow
Route 2, Box 114 A
Roberts, WI 54023
Petition No. S88-01958-P
Dear Mr. Snow:
i
Re: Dennis Snow - Residence
Private Sewage System
SE,NE,9,38,18W
Town of Kinnickinnic, St. Croix County, WI
i
Section 145.24 (1 ) , Wisconsin Statutes, and s. ILHR 83.09 (2) (b) , Wisconsin
Administrative Code, allow the owner to petition the department for a variance
to the installation for a private sewage system to replace an existing private
sewage system at a site which is not in full compliance with the siting
standards in the administrative rule. The system design proposed should
protect the waters of the state from contamination. If this system becomes a
failing system or contaminates the waters of the state, this variance shall be
rescinded.
The petition for a variance requested to s. ILHR 83.23 (1 ) (d) of the Wis.
Adm. Code was considered on June 22, 1988. The petition has been
conditionally approved. The condition being that in the event of failure, the
mound system shall be replaced with a holding tank or other off-lot system.
The rule requires that a mound system have a minimum of 24 inches of suitable
natural soil .
The variance requested was to install a replacement mound system on a site
with 12 inches of suitable natural soil .
All of the data and statements submitted on behalf of the petitioner were
considered. This variance is specific to the subject petition and cannot be
used for any additional modifications.
erel ,
ichar eyer, rchitect
Director, Office of Division
Codes and Application
(608) 266-3080
RM:PEP:2464e
cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls
Thomas Nelson, Zoning Administrator - St. Croix County
Thomas A. Wang, Plumber
SBD-8928(R.10/87)
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Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
Medium Sand
Topsoil - ==___=___==
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Page _ Of—
C*S1TE SEWAGF,S
AP Tlo,
Perforated Pie Detail �AgpR AN Ali L1
0011S
OF ►
DIV SAFE ND U IN
0
End View SEE COB ESP ENCE
Perforated
End Cap) PVC Pipe
Holes Located On Bottom,
Are Equally Spaced
R
P
PVC Force Main
P PVC
Manifold Pipe --
[ _ S88 019 518
Distribution
Pipe
Last Hole Should Be\'
Neat To End Cap
End Cap Distribution Pipe Layout P 3 Ft.
s
R fS
X 3 u Inches
Y 3() Inches
Signed: - ��?
i� � � Hole Diameter Inch
—�=t-
Lateral I '/Z Inch(es)
License Number: ''�3 I Manifold D— Inches
jr n
Date: /1� 'c� Force Main Inches
# of holes/pipe \ 1
Invert Elevation of Laterals/0,2-5- Ft.
Y
PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VENT CAP
4"CAI. VENT PIPE WEATHER PROOF APPROVED LOCKING
JUNCTION BOX MANHOLE COVER
� 25` FROM DOOR, _T
WINDOW OR FRESH 12"MIU.
AIR INTAKE
GRADE I y"MIIJ.
• , r
18"MIU.
CONDUIT -- �� ----------
IB"MIN. -----
\ 111
��OVIDE I -----
WLET ��y_ AIRTIGHT SEAL
JOIN I APPROVED JOINTS
APPROVED J 0%4
I W/C.I. PIPE
W/C.I. PIPE �.S�Q I I I EXTENDING 3'
EXTENDING 3' ALARM ONTO SOLID SOIL
OWTO SOLID SOIL
C Sm
a F
o I
q � �
ELEV. 9 •! FT. O QP���E O�NGTUMP-� --�
� pON y OFF
D O¢R
CONCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPEC.IFI'CATl0MS
DOSE L Z
TANKS MANUFACTURE NU
R: MBER OF DOSES: `� PER DAy
TAWK SIZE: / SO GALLONS DOSE VOLUME. 00 .Z 1 IS'
ALARM MANUFACTURER: �� f) Itit INCLUDING BACKPLOW: 1591 GALLONS
MODEL NUMBER: IJ CAPACITIES: A=INCHES OR 113 91 GALLONS
SWITCH TYPE' �- B= 2 INCHES OR 3` L° GALLOUS
�J 7 s
E
PUMP MANUFACTURR: C=INCHES OR I'll' GALLONS
MODEL NUMBER: L D= 0 INCHES OR 1_-74 yu_ GALLONS
SWITCH TYPE' I-+ NOTE: PUMP AMD ALARM ARE TO BE
MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 7 FEET
1 ,
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . 2.5 FEET y L' S `t
+ S� FEET OF FORCE MAIN X F/ooFxFRICTIOM FACTOR.. FEET
TOTAL DYNAMIC HEAD =(o? FEET
INTERNAL 7AfiMS10 NS OF TANK: LENGTH �,� 1 " ;WIDTH " 1 ;LIQUID DEPTH �3
51GUED: � `�� LICEMSE NUMBER: � DATE:41
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Bulletin CL2.1A
July 8, 1983
• For Homes ���L�S
• Farms —
• Trailer"courts Model 388`'5
• Motels (Supersedes Model 3870)
0
• Schools •
ump Submersible
Effluent P
• Hospitals Effluent Pumps
• Industry
- -. - -------
• Effluent Systems Pump Specifications
anywhere effluent Solids Handling Capability to
or drainage must be Dibdiargu Sipe
2 rdll
disposed of quickly,
Sarni Gpen Impaaler
quietly and efficiently. , dt;:l j1t 11 ead,;d -halt I
uaaltb u:,u lliipellcr loukuut lu
back off. Fhuup out vanes on A 111-1,.:11.,1
fol Inuluctiuu of ntechallical seal
Casing
Volute type for maximum efhclenCy
Stainless Steel Fasteners
Heavy-Duty Solids Handling wiles 3ot1 stainless steel for corrosion
Dependable Capability to 3/4" �`` resistance.
Mechanical Seal
1 Ceramic vs.Cat bon sealing faces,stainless steel
r� spring and 131411a N elastomers
---- - Maximum Temperature
1h, 1/2 H.P. 60 Hz 16W F.
Capable of Running Dry
Single Phase 115, 230 Volt. .. ... without damage to components.
I
Motor Specifications
1 1 Motor Fully Submerged
/z, 3/4, 1, 1/z H.P.'60 Hz
in high grade turbine oil for permanent lubrica-
Single Phase 230 Volt. Three lion of bearings and mechanical seal and
Phase 208-230, 46Q Volt. efficient heat dissipation.Motor sealed hone
environment by rugged cast 11`011 enclosure.
Bearings
Heavy-duty all ball bearing construction
Stainless Steel Shaft
` J! Series 300 stainless steel for corrosion
resistance. Threaded shaft.
Single Phase Units
All single phase units have built-in thermal
90 overload pioleclti,n with aul,,makc io ut
80 Three Phase Units
Ovel lu,nl pn,tectuaa ua stark:`(41111 euo 10
460 volls I luaaiwd sfaaft ou r 11
1- 70 M Power Cord
W
yt ,t' Wak.1 .ln(1 011 retiit taia Epo.t,xal(m 1
W 60 a.. iai;ls ds it sei.ondiary muibil4ii.t/aii-i lit
0 U
Q damage to Quiet lackeUng
W 50 glaltd licit
U
' Singh Phase Units
Q 40 If f' cyulppeU .:ilL 1', .,I Ili �
Z f' iJ I U vv1u1 1 I1n,ug groun.fu�.J I,I,,,a - i l t 1 t'
0 30 1 5 r �' 11iodvin e�l1,i,'l,,:d .volt 1`.,' of I-t
coi d.
H �
0 20
y SPECIFICATIONS ARE SUBJECT TO CHANGE
10 WITHOUT NOTICE.
0 0 10 20 •30 ' 40 50 60 70 80 90 106 110 120 GOULDS PUMPS, INC.
GALLONS PER MINUTE SENECA FALLS!*W tuRn I W8
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWN UYER Pe4kils 5/2b&j
ROUTE/BOX NUMBER FIRE NO.
CITY/STATE_&Ley t U( _ ZIP )
PROPERTY LOCATION: 1/4 /4, Section , TIZ N, R__/�__W,
Town of t1'hA1'J;,dI710 , St. Croix County,
Subdivision �r , Lot No.
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
$3000 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 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. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance with the standards set forth,
herein, as set by the Wisconsin Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
SIGNED
DATE h/�T
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
RTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
USTR'Y, C DIVISION
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WBOX I 3707
(H63.09(1)&Chapter 145.045)
LOCATION: SE ION: TO N HI MUNI IPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
f '/ L/ ' T N/�p'E ( ,
COUNTY /BUYER'S NAME: MA pDRESS:
bb t r-t S
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI D RIP 1 NS: PERCqLA ION TESTS:
Residence 2 ❑New /Q Replace
RATING:S=Site suitable for system U=Site unsuitable for system
O[]STI®Y • MU S ❑U IN-GROUND-PRESSURE:E]S �� rYSTEIVI-Ix I V L H❑SGT � .RECQ�h� FAD SYSTEM:(optional)
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- ( 3aa 1do-0
B.
C/� G C-4 I 1j) 4 G�L 6 3 frit At r ��l lfq'i ts� qf 16 6
B-9 ,00 lo 0 ,d y
U J/j F(
B-3 3,D() T1,p e �6 Suf�a �l r s��ae7�ud P boa G C 4J
B_ tAa4 ra-PtAA5. ca
PERCOLATION ESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. RIOD 1 PERIOD 2 P PER INCH
P- / O 70
P. a 30 6
P G�
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.
SYSTEM ELEVATION
!v .t. -- c�
_
a
qj
i
-
I ,
i I i
I i I
i
s i
4-
tj
IS, i
r
,
1,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 Wisconsgi a
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. 777
NAME pri 0: TESTS WERE OM E D ON:
J
ADDR SS: I , CERTI I ATI NUMBER: JPHONE NU AB Io$ nal►:
CST SI E:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
L,,HR-SBD 6395(R.02/82) —OVER —
I ,
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, cc_ DIVISION
LAbOR HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: OWNS /MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
NEB/ UE �/ z� TZ`1N/R 16 E (o LO"))NJ
--
COUNTY: OWNER'S UYER'S NAME: MAILING ADDRESS:
S�V' NJ L by! S VQ!Z
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: e PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence � N A. ❑New Replace � i/_Zcj`
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTE(�M-IN-IN TANK: RECOMMENDEDSYSTEM:(optional)EJS � ZS �U EJ ZU DS ZU D<J []U
If Percolation Tests are NOT required DESIGN RATE:
4 If any portion of the tested area is in the
\*J\^\ A '
under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: N'
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-
B-
B-
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD3 PERIOD PER INCH
P-
P_ SEa aP 'Z
P-
P-
P-
/ P
LOT 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.
SYSTEM ELEVATION sEIG 7---Nd Is l o r= z
_ z
3
eta
e '
e -
i
-
�! P
3
E
3
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.
NAME(print): TESTS WERE COMPLETED ON:
�Z.`Clty 12 L. W,��� � s-s
ADDRESS: ft.-J,Y_ ZZ`s CERTIFICATION NUMBER: IPHONE NUMBER(optional):
ELLS o1Z wt SVOt S76 - tS-LlZS-o16 Y
CST SIG TUR
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. —_>ft 6L OF
DILHR-SBD-6395 (R. 10/83) —OVER —
'L
'
. `
INSTRUCTIONS FOR COMPLETING FORM 1l5 ' SBQ - 6395 .
To be compecc and accu��esuii test, vou/ ,apoo mu� ioduda�
1 Cnmn!w1: |m8a| dmoo/ipzion;
2, Tho uweudon muotdaar|y incliute whocher thi� ion residence 0, oomma,oiu} pm)ont;
3, &1A:|K81-11`01numbwrofbodmomooroommm,nim| usap|am`ed�
X \o/hiownemur ,op|aopmentSymaW
5, Oomcxe-zothowuiiobi|iryrohn8bux,:m A SITE /S SUITABLE FOR A8OL0NG TANK DNLY |FALL
OTHERGY8TEAS ARE RULED OUT BASED ON SOIL CONDITIONS,
8. PLEASE ugjthe mh�mviacions d`mwn ha,o for v,htm8 px,%doaoWon,and oomp<+onQ too plot plan;
7� K8AKE A LEO<8LE diagram acou�Me|y |ocohng Your tos |oca ionu. Drawing to sua|e is preferred. A
yomamoaohe�may be used ifdesied;
8, 11jakesursyou, bexchmurk and vp,doo| a|cvadonreform`re noin! a,muieor|yoxumn'mndare pyrmmnan��
9. Cnm,!ete a|| appruprima boxes moto Am,nama.oddmoxoo' f|nud plain duca' pw,on|wciontmstexomn'
c}nn. it appropriate;
1s Urhminfonnatinn (such anfoodp|ain'o|eu$iun)does not.apply' plamoNLA, intheappmpriazobox�
11. Si8n�ho to�'m ond Wse your ourmnc uddnss ard your uordMumion nunubpm�
12, K8ako (e�jib|w oopiem and diutribuns as ALL 80| . TESTSK4UST BE F!LEDsm|TH THE
LDCALAUTHOR|TY WITH/N38 DAYS DFC0MPLET|00.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
F�oi! 1;epanotesund Twmtume Other Symbols �
'
or — S�onm WvW lO'') BR — Mrnnk
oob — Cohb\o (3 18''> 0� — Sondmmno
or — Gravel (under 3^) LS — Limomono
Sand HGVV — Nigh Groundsoter
cs — CoamoMd Porc - Perno|ation Rnm
mod o — K8edhum Sand VV — VVa||
fo — Fino3und B|dn — BuJding
|u — Loamy Sand — Gn.a/orToo
7�ndy &oam { — LmuThan
Loan` 8n — 8xzmn
of — Si|t Loam B| — B|ack
A — S�1t GY _ G/ov
— OuyI oam Y — YoUmm
wcl
to — 910 C|wy Lou,-, mo, — �o�|es
on — samkv My m� — �id`
A — silty clay �h — fm�' fin*'faint
My uo — common' coame
or — M., mm — �any' maJmno
m — K4uuk d — diminnr
HVVL — Highmmt r |��L
° Sixgmne'o| ezi| texwus oudacovat r
for |iquidWmd,dmpnz | BK8 — O�nohW1erk
VRP — v�mico| Refomnoe Point
. '
- '
`
TO THE OWNER:
This soil test report is the fiat step in secw%y a sanitary pumit. The county or 1he Department may request
verification of this uoi| test in the fidW pri*/ no permk ieuanou. A complete at of plans for the cQue
sewage oyuem and a permit app|ioation mug be oubmiuod to tha mpprop/|otm |non\ auzhority in order to
Mat a permit Thesmnim,y permit mum bn Mired and posted prio,toMsa-tofany construminn� �
� ' `
I
State of Wisconsin \ Department of Industry, Labor and Human Relations
SAFETY&BUILDINGS DIVISION
June 27, 1986 201 E.Washington Avenue
P.O.Box 7969
Madison,Wisconsin 53707
Dennis Snow 00 i
Route 2, box 114 A
Roberts, WI b4UcJ 0
Dear ilr. Snow: �
Re: Dennis Snow - Residence
Private Sewage System
SE,NE,g,3l,18W
Town of Kinnickinnic, St- Croix County, ail
Section 14 .24 (1 ) , Wisconsin Statutes, and S. ILI-iR 63.65 ,,�) (b) , Wisconsin
Adrli ni strati ve Code, allow the owner to petition the deparM;ient for a variance
to the installation for a private sewage systei, "Co replace an existing private
sewage systerI at a site which is not in -full col ipl 1 anct with the siting
standards in the administrative rule. Tl;e system design proposed should
protect the waters of the state froll contardrlation. If this system becomes a
failing system or contaminates the waters of tree state, this variance shall be
rescinded.
The petition for a variance requested to s. ILrP, 6,i.e_3 tl (d) of the Wis.
Adn. Code was considered on June 2L, The petition has been
conditionally approved. The condition being that in the event of failure, the
Mound system shall be replaced veal th a l)ol di ng tang: or other, off-lot system.
The rule requires that a i,Aound systeisi have a r!i nimurii of 24 inches of suitable
natural soil .
The variance requested was to install a rep I acetaent mount; systeta on a site
with 12 inches of suitable natural soil .
All of the data and stater(zents su iI,ii teed on belial f of the petitioner were
considered. This variance is specific to the subject petition and cannot be
used for any additional modifications.
in erelyW�.r.
iCltect
Director, Office of Division
Codes arau Application
(608) 266-33080
RPla:PEP:2464e
cc: Leroy Jansky, Private Sewage Consultant - District b, Chippewa Falls
Thoriias ilel son, Zoning Administrator - St. Croix County
Thomas A. Hang, Pl u(lber
SBD-6928(R.10/87)
State of Wisconsin ` Department of IndLt9try, Labor and Human Relations
SAFETY&BUILDINGS DIVISION
L
^OL
P F t'j Nljn)i'(Pre
ij
i
i
i 1 ,
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I �
,
SBD-6423(8.10/87)
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 i'l1h lS 3y&'
Location of property 1/4 lVf 1/4, Section _, T N-RjW
k �
Township (U16`) iC i4 11
'0
address r 'n'pr l
Address of site
Subdivision name
Lot number
Previous owner of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? _ Yes No
Is this property being developed for resale (spec house)? Yes No
Volume ,_and Page Number 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, 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.
---------------------------------------------------------7---------------------
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. 5�V ; and that I (We)
presently own the proposed site for the sewage isposal 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 dul recorded in the Office
of the County Register of Deeds, as Document No. ) .
.� LAY
Signature of Owner Signature of Co-Owner (If Applicable)
Date f gnature Date of Signature