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HomeMy WebLinkAbout022-1080-80-100 Ind 0 o O d m 1 ''I 3 ' 3 H, CD 3 m (1 0 ~ O O N 0 C I~ W °N eC ~1 • -P~ ryll a i m ea ~ Q 00 cn CO o ° o m 7 W 10 N A O "A O 3 a : O o o v N ° O N O vv'3 ~ D o (D G M N G -0 3 ~ A N N (D L O N O OOVO OOD O N C l~tiy a N N I M z o O o m I o n T < N z $ Ito N' D v v ° o m m * l 0) 0 d :r (Q N N N O = 7 N A z N Z -A O O D m \y 0 !~i g' m ? • C (D r - CD (D -0 N c (0) CD W N (D 7 CD --i CA A C 0 CL p O 3 II O I (n -'I N W OD C (CD , z '0 3 zl N Z CD a O N a 3 cD a O fD 7 -1 (D 7 v c O_ Co o Z a j n O 7 0' N y M CD = O ~ O 3 A ~ LU ~ m m 'Ili Q o C I 3 s ' i I ~ o N O O I V A M (OD ti A. li N o0 I O O O N a O ti N, Section 28 02/20/2007 11:49 AM W Q PAGE 1 OF 1 CUD1}, STEVEN .G• T28N-R18W 022 -TOWN OF KINNICKINNIC of Kinnickinnic ST. CROIX COUNTY, WISCONSIN High Ridge Road Town 615 WI 54022 Permit # Permit Type River Falls, 54022 Road, River Falls q O = Current Owner, C = Current Co-Owner of Site.,16ute 2 Liberty Thomas H. Cody .N G & GAIL L Address / 2-12-87 San Permit #88474 Conventional., New es): Primary DR Legal Description: Acres: 5.880 Plat: N/A-NOT AVAILABLE SEC 28 T28N R18W SW NW 5.88 AC THAT PART Block/Condo Bldg: OF LOT 3 CSM 2/345 NOW KNOW AS LOT 2 CSM 6/1746 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.880 90,000 326,000 416,000 NO Totals for 2007: General Property 5.880 90,000 326,000 416,000 Woodland 0.000 0 0 Totals for 2006: General Property 5.880 90,000 326,000 416,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 555 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0OV191986 419476 54 r away, q~ 99 &vw ftmwoefto* LOCATED IN THE SW C1/4 OF ERTIFNW 1/4 IED SURSECTION 28, VEY MAP KINNICKINNIC, ST.CROIX COUNTY, WISCONSIN. OWNED BY: STEVEN G. AND GAIL L.CUDD v 403 N. 4TH STREET. *4S O SHEET 2 0 rCRII rION AND G'URVi~ DATA** RIVER FALLS, WI 54022. ,,,~OF 2 FOR 01~ APPIROVED N NOV 14 1986 m UNPLATTED LANDS, ST. CROIX COU;•ITY WEST LINE OF THE NWI/4 COMPriEHENS)VE PARKS PLANhANO - _ - - ' ---~r ~ AND i t~.-LGJ,(r17d UEI N057 00 W w N0057'00"W 561.31' (R a 562.09') ui SO 57 00 E 1428.73 i3lb 655.29 W `41 BRTY ROAQ~ 0 57T-'T562.00' w w w , w o m O O ~ o 7 O c OD _ ,°w I +11 RI N G- \ ' Z O Z 0 ZG 1A dD Om Nn p ao .•a. y~z o WO m Azz ~mA ym - v o~Eo a e ° N I%/ Cn Z--„ 2• ~I i N~ A M •C' ZC n y m O c) • (1 A 4b N V 1 y 1 1 z21 •i~: N •~UW ""_'y' W OO jz 1 w m A Q - 01 f .C C y t z _i cn r D v ).Ox : to r 0 0 _ o O c o rn GD v uD f 1.~ O O m I C. ; y m V b V roots f 3 -i mn m cm E) zm f~ : U3 r IN z r ;m yl-1 : f N Oro •U7 W N ! N z D v mm z (;0- (;0z " 6' 0 o "Z :b w Mk. :17 NI. 08'14W 514.14' 2 N 2z 00 to m ou ~A O ro m :f- 1 I V '.-m N N .T N N A mm :N Oao 0 On N ~O m .d - o m aD m D I J to m 0 A to D m p° m 1 + - In O a : O (n 74 N) 00 -4 rEAST LINE SWI14-NWI/4 IQ\ ~~`pAlippp~f S I° 0 7 4 5' E 5 8 9. 2 1 to _ O r3 m0 N 0~ UNPLATTED LAND.S• m2 1i s' o e SET I "X 24"IRON PIPE WEIGHING 1.13 z mm JAMES LBS. PER LINEAL FOOT, 1 mm s I I~1 D w x 1> WEBER , S' 1804 1 • z I" IRON PIPE FOUND. om v SPRING VALLEY I " . . z WIS 1 ~ R ='1•tECORDED AS 20 loo ryp,,® SCALE 1 200' % SU R ;o o 100 200 400' SHEET I OF 2 JAMES M. WEBER S- 1804 WEGER ER, WEBER AND ASSOC. DATED sopT• 1+ THIS INSTRUMENT DRAFTED BY RawsEO oLt.~o, +y 0~, Volume,' 6 P,I o 174' 6 l PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: , Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Z Width: Length: Number of Lines: l 4"4krea Built: 504 L-, Fill depth to top of pipe: 22:" Number of feet from nearest property line: Front, O Side, O Rear,O Pt.sk~'&" Number of feet from well: 74 E-51. Number of feet from building: 40S (Include distances on plot plan). SEEPAGE PIT t Size: E L;,.ou,..1 Number of pits: 1 Diameter: Liquid depth: M~-S" Bottom of seepage pit elevation:. Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: i Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feetfrom building: from nearest road: Number of feet Alarm Manufacturer: I ctor: Dated: '7 - 2 Plumber on Job: License Number : 3/84:mj i Form - S T C 104 AS BUILT SANITARY SYSTEM REPORT OWNER Q,t,4,p TOWNSHIP K'zw~a~cets*i*oxc SEC. , T 7:_N-R 1 W ` ADDRESS ho, SOLO OWY f°y. ST. CROIX COUNTY, WISCONSIN f rAU,3 1 ac.. $4p2 2. SUBDIVISION P,,~S LOT Z LOT SIZE PLAN VIEW Distances a0d dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ o ~ wA V U) 6 INDICATE NORTH ARROW i BENCHMARK: Describe the vertical reference point used SpiyE- I~ AlLwe C~aa,.aa T, Zoe' } 4 j Elevation of vertical reference point: MC,, Proposed slope at site: lo 1 SEPTIC TANK: Manufacturer: WzeLiquid Capacity: IZSO G-,q~to~a Number of rings used: Tank manhole cover elevation: q9.Z~ Tank Inlet Elevation: 47.~ Tank Outlet Elevation: q ?.5b Number of feet from nearest Road: Front,O Side,Q Rear, © 10D~ feet From nearest property line Front,O Side,O Rear, O~ feet ` s Number of feet from: well 46 building: 4 t (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE .DEPAKWENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 NW,NW,28,28,18W 91 CONVENTIONAL ❑ALTERNATIVE Estate Pion I.D. Number: (If assigned) Town of Kinnickinnic ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound The Pines, Lot #2 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Steven G. Cudd 615 High Ridge Road, River Falls, WI 54022 T. ELE: . P BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: 7v~ Name of Plumber: MPIMPRSW No.: County: Sanitary Permit Number: Thomas H. Cody 6593 St. Croix 88474 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WA ER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH JALARM: LINE: AIR INLET. FEET FROM ❑YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: 1puMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH LINE. AIR INLET. (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES ❑NO NEAREST 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 INSIDE DIA. #PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER ELEV. INLET. ELEV. END. PIPES. FEET FROM LINE: 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 ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH 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 DISTRIBUTION PIPE MATERIAL & MARKING MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. :D1 STR. =DIA E LE V.ELEV.: DIA.ELE V.PIPEELEVATION A ND DISTRIBUTION HOLE SIZE HOLE SPACING' DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF L O ERTY WELL: BUILDING. INE: FEET FROM ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) Zoning Administrator Thomas C. Nelson 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: 1. Property owners name and mailing address. Provide the legal description where the system is to be installed; 11. 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; Ili. Purpose of application: Check only one in ##1. Complete 42 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'/ 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 rater inciuded the creation of surcharges (tees) for a number of regulated practices which Wiscorisin's a can effect groundwater. The surcharge took effect on July 1. 1984. All of the water that r ea5ure ! is used in your building is returned t " the groundwater through your soil absorption buried t system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credi"ed to the groundwater fund adminis- a tered by the -Department of Natural Ri-sources. These funds are used for monitoring ground- t watt}r grourdwater contamination investigations and estE.blishment of standards Groundwat-, "'s protecting. SANITARY PERMIT APPLICATION COUNTY LHR In accord with ILHR 83.05, Wis. Adm. Code T eR61 x L STATE SANITARY PERMIT # 8' y 7 -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. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ® NO PROPERTY OWNER PROPERTY LOCATION W'/4~(JrtJ 1/4, S clq Ta N, R l~ E (or& PROPERTY OWNER'S MAILING ADDRES LOT NUMBER BLOCK NUMBER SUBDI ISION NAME Y, STATE ZIP CODE PHONE NUMBER NEAREST ROAD, LAKE OR LANDMARK ( f t~ S_4~~~ VILLAGE : a ► . y~~ -~t. l W .,L II. TYPE OF BUILDING OR USE SERVED: p Number of Bedrooms if1 br 2 Family 4 OR ❑ Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. 4 New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E1 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 e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSO PTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): r~ AIA- OL)o q3o / Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank ` S e ❑ El L 11 Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumb r Signature: (No Stamps) PRSW No.: Business Phone Number: "T . Cd~~, Wn 106 7'iR' -3 3~-y Plumber's Address (Street, City, State, Zip Code): N me of Desi ner: ~R, VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # h1 CST's ADDRESS (Street, City, Sta , Zigg Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY fpt ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) ICI Approved ❑ Owner Given Initial urcharge Fee P- Adverse Determination klo\6-oo ~V6 a &Wrr 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 • A n 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 ~t U C a t~ Location of Property Section' , T N-R Township iwai c. K m.Y11S_ y j, Mailing Address 1 i r4 L~UQ a E. t ( s + Address of Site r_5 Subdivision Name T Lot Number, Previous Owner of property Total Size of Parcel 3 :j c~.s,~rt< Date Parcel was Created" P -f- I jf I i f!y Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume 6 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION I (We) cen ti.6 y that att 6tatement/5 on th i s 6ohm ane th.ue to the best o6 my ( oun) k.nowtedge; that I (we) am (ane) the ownen(,s) ob the ptcopenty descAi.bed in this inboxmafii.on bonm, by viktue ob a waA&anty deed neconded in the 064ice o4 the County Reg.usteh. o6 Deeddas Document No. a 2c, rc ; and that I (We) pnuentty own the ptopobed Aite Got the sewage dizpoz system (on I (we) have obtained an eabement, to nun with the above duct bed pnopenty, Got the conbthucti.on o6 said .6y,stem, and the .6ame hays been duty neconded in the 046ice o4 the County Registeh o6 Deeds, as Document No. ~y act ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 12:52 1 - F'7 DATE SIGNED DATE SIGNED y 41.0 r 1 ; ;la ~ e! eds. s al~l.u~9" E 13~I.lf3'3 books tj~ Ile a W%,l- r~ OF.44 { E ~ M lr#i ~S, ~ tones and ~dt H STC - 105 r r v ~a SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z y OWNER/BUYER ROUTE/BOX NUMBER_____ __a Tire Number;- • CITY/STATE- v~~- ~(is Ev` IP J y1 ,Z~,---- PROPERTY LOCATION: l~IW Nor 14, Section~~T , TJ~( N, RJ~f W, I Ii Town of St. Croix County, ~C.~LLZi1~ G Subdivision Lot number. 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 Rummer. What you put 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. H I/WE, the undersigned, have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- w ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zon'ing Office within 30 days of the three year expiration date. SIGNED DATE- _-L-~-t -_7 - St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-223C► or 715-425-8363 Sign, date and return to above address. RINGS AND SAFETY & B p VISION ON SOIL BO (1 l P.O. BOX 7969 DEPARTMENT OF REPORT T 0 ION TESTS (115) MADISON, WI 53707 INDUSTRY, PERCOLAT LABOR AND (H63.09(1) & Chapter 145.045) HUMAN RELATIONS 11 LOT NO.:BLK• NO.: SUBDIVISION NAME: TOWNSHIP/ UNICIPALITY: Z G . S _ p7 ~,P~opo S Q~ 1 SEECCTTIION' L! ~Z~N/R t8E (o ~,tN~ LCD rt]/J lC * sr. LOCAT cJ~'NW 1/4 /4 MAILING ADDRESS: S~vZ-Z OWNER'S UYER•SNAME: ~`v,y-LIrS COUNTY: .uU~ DATES OBSERVATIONS MD R LA ION TESTS: S~•~`~L~ Sv PROFILE DES R P IRS:' A. ? 3 USE COMMER IAL DESCRIPTION: )New ❑Replace _ NO. BEDRMS.: N•~ gR esidence tional) =Site unsuitable for system C,HES _ 7L- I up l v jC. L: E111-S:y- HOLDING TP`RE~~DED SYSTEM: op CONVENTI NAMOUND~+ J~ S E1U 1`'{~/.JIU RATING: S= Site suitable for system UIN G RIOUND-PRESSUR kMJ S J L=~ If any portion of the tested area is in the A 2 lain elevation: DESIGN RATE: Floodplain GLt~S S , indicate Floodp If Percolation Tests are NOT required PROFILE DESCRIPTIONS TEXTURE, AND DEPT under s.H63.09(5) (b), indicate: 1 EPTH TO GROUNDWATER-Ifs CHARACTER OF SOIL WITH THICKNESS, COLOR, TO BEDROCK IF OBSERVED (SEE ABBRV.ON BAClTB-_ BORING TOTAL ELEVATION OBSERVED E HIGHEST O 3~~ 3- 5 NUMBER DEPTH ! Jt K - ~t j Z.2 I ~ g,F,• X00.3'. _~~tvE - _ o.~ - l.Z_'.c3>zsl;.Z•-S ~ \s i Z aL.a r tl 2.~{ TbZ.6r tr Z- r. -aK 1 S 3 6` e '7~ ~t ' 3' 3 11' tt 0.1 y ,-q r ~•3 _nn q t ~ ~ Z. I' 3ti T S z. L4 r 1 S ~ Z D`~Bt^ 1 r ~ 8n 1 s T3 l.,rs . B- 5 6• ~ -z•3'~ O• B Ts - 2. oy~n`t~3~to 9r~ Is•o.t`~1~~'~S ~•3''Sr~n 'zai~1 IN S'~. E B- 95•y c ~ 6 ~ 6•Ir .$'8 1 h B- g r PERCOLATION TESTS RAPER INCHES B DROP IN WATER LEVEL-INCHES P R TEST TIME P F0 D WATER IN HOLE L-MIN. PE TEST DEPTH RIOD 1 NG NUMBER INCHES AFTER SWELLI INTERVA NL P- tl WIJ LL- ~jGE P- P- P P- P_ P- P P_ rcerr I borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the o P P-- percolation the surface elevation at all borings and 1tt`he di lec ndlpe _ S q1 ~1. Y tests, soil lot plan- Show P' PLOT PLAN: Show location CE s f p QLPc~~" ITT zontal and vertical elevation reference Poin`~,~1l'~their location on the p PLO' q3 ql•"~ , - qti • Q' zonta of land slope. s _-r d' 3 ° of Iar ELEVATION -r 1 t SYSTEM SY' i S 1 I I aS k - h - .E1- VC- t- ' ~ iltJ Z ' E 1 t 1 20 i -4- IRS" ~F - t - 1 EE i i I l I ! i_ I uue tt ' o-~t 1 _ I I TI ~ I' 35 ~ B'r1~) j ~ ~Oll fiSD-~ 1 ~ I I WUOh Lt?~TtI _ _ -y Wi_ _ - J- Nor ~sE W JTS7edu specified in the Wisc r 1 S C~I.E L • (~C7' e by me in accord with the pros ad belied knowledge thods 1, the undersigned, hereby certify that the soil tests reported on this form were Code, and that the data recorded and the location of the tests are correct to the best of TESTS WERE COMPLETED ON: I, the ur Adminisdersie Vb Adminisl NAME (print CERTIFICATION NUMBER: P `S Ey ZS- o~ 6 I NAME (1 ts. l Kv~Ow 2Z(o ~j~ ADDRESS: ~L p CST SIGNAT RE: ADDRE; DISTRIBUTION: Original and one copy to Local Authority, Property owner and Soil Tester. - -OVER - DISTRIBI DILHR-SBD-6395 (R. 02/82) DILHR•SL_*.. ocr~zl - OVER - _ San. Permit No. Owner's name • H63.05 PLOT PLAN Show: Location of building served NA Dosing chamber Septic tank Vertical/horizontal reference point Building sewer System elevation is ('L> RS-0' Effluent system UT Well sr Q ITE Replacement system area Q Property lines w/in 50' of system Distribution boxes Scale or dimensioned UA Pump and controls: - Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: LOT LIIJt? 1~--i-.99.1 coa splice 135 ~N 3`' PiuE By 5 5 ,J 20 Q ~6~/ f r~ O y. \ cj x)33 y' CI VEUTS . O~ C>Xj S P I k E 10(3 llyid~_~'~o 6P,uE ~i61 1 w~ESE~ a\s-Rt\avTCiv aox Be LI6 ZO S60 GRL• L4.3-1E9oF1Z aoQC, nZ, wtt~ y''so~~p~ure~ L goo 30. o~ \2S0 6e11. W ~CSim CouC. S ~Q ~k ~vC Pax y'p„ wo eF Pvc J l~0°SE No\Z = Wtll,~0 Q~ FAT LAST So' FTwr-~ O~INF►~.p ~ U2`-r W~L.L E~Np Fly' ~`tiST By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, St.CroixCounty and theSt.CToi.xCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or after i stallation. C-Tian r s signa ure 1cenSe o. a e j?n~' 3/ San. Permit No. owner's name • H63.05 PLOT PLAN Show: j !i' f Location of building served NA Dosing chamber Septic tank Vertical/horizontal reference point ( System elevation is t'1.j 93.0' LL~_11 Building sewer Q Effluent system Well S~ Qce- S7 r Replacement system area Q✓ Property lines w/in 50' of system Q Distribution boxes Scale , or dimensioned F AI Pump and controls: Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal-per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan,below: LOT LIlJ~ s' s vo Q !1 r, ~ ~ !r' \5 ~ b. oil t ~l 1 I r~~ ' ° y` PvC f~ERFoR.RTEO a1SlR»u'[,OrJ P~Pe " ~ ! r ,l r; ~ wiprlZleeacll f , r X35 .r %P) *I - EL 1W.O c3#J SPIkE P„~E 11-Z 6" Uj L U6I I' i l w~ESER Q\4'nLlevt~nv wax ? aY~ yy Soo 4aRL, wt ES eIR enc. -tSa-r w~. u y''sr~~~aa,vt~.~ ao. \,So snu w~ES~x two. sl411e ,k 5~1C PI Pe ~'Ayc NoeF " 4 PvC J t~°SE` Uo Wt~l t,l~ Z3~ RT LChS7 So' F~~ ~INF~? OC2~f Wtci L ~lwD PI'T Z S ` PR~v-~ 5~4~ C TP'~N k . I By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, St.CroixCounty and theSt:Croi.xCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or after installation. P tun r s signature e- 7N o. a e P o v . 3, - I ' N l~ Yi E q"V~1JT PIPE W/PP7.~~U~ CAP \Zl~ J~Bf~UE FIN 1 SN ED GRFD Sb1L ~1~-L.:_: APFR.OVE~ S~1J'TT}ET7G C1JV~~1J6 dR S" OF U1.1CAht~AGl"t'~ S~~zAt+v 41, pvc Y~~p2~ P1PE m cd yh-~ Et.£-V. ~LEl1. q 3 • o bU of 1/z4-M z//a, Ac~a EGhTE ~ I~FOR~T~~ PIPE BE~SJW 41 ?E Z~~ OF Bo'T'TC~Y1 C aF T~ElJCl•1 AGC&M-ELMS R-aNVE PIPE p1S'T1ZIsonD13 PI'P E Tn GE Ar L EpjST- ~Z 11JCt}ES BEtow oTZ.1G ,3&L GRADE PcT LAST ZO li.~ClFES B"`[ 1JO Y1~RC `n+ffQ 14 1f•~CItES BE.ow i=1NRL 62/~D~ . <~AX11-)U1F1 DE zMA of EXCAN)X-ni~J ~RO►-i o1Z►61FJhl C~T?ftDE 1111 t_L T3~=- Z6 INCHES. 1.11 Q IMOM U~EPTH OF EXCAVP.MW3 F~?AYI o12.\GIOJt~L GRAbSi KILL 8E Z~- 1"CF4CS S \ G 1J ~-_-S:) 8`1 ~,1G~SE ►~o~ : f w C CO) Q 3 d G V 7 ID N n ID 'O T O ?k .C. `r (D m 3 ~ y ` 1 I ~ O 0 Z 0 N z o 00 c N .C :T CL 3 O O C O A 00 n :3 ~a n C CD ZI -9' Q j O M D :3 ~Q CD i7 n o o O 3 a 1 0 ° o p N N ~ 7 ~ w Us { D a o CD cn CD CL c W c 3 co 0 i O N C ~y Z N (O OD 0 O CD O C o rL c~ t O -I -I -I pTj 0 N D n 0 Ul co - -'o Z C, O G y o S M N ~~1 O ' lr 3 m H N N 3 L1 rp A :3 T (D Q 3 N : O) Z O 0 Z Z D fD O w O o F5' ? N• c C (C m D m S. m a z n n A O R O (n N W C 0 W CL z 0 Z1 O y 00 z j ~ f ~ A i 0 o CL > CL n '0 o a m N -n CD 7 Z C. 7 n O 0 (n .O ' CD o o`3 ~ N II o 6 a I p c, I o 'Y 3 ti I a I h, o° v A 0 N rn O O o O y~ 0 CD 5 O CL 1. Ta be ~ Horn JNS~~~CT/ Cam plete X115 fi 2 rhP plHte /e, a/ and ac(, pR C~ 4 qk/ Section ~escr,ptio~ura 0 so// tes p~FT//v 5 /s this UM nu rust c/e. t Your C'{ ' ~on1pl~te tW of ep/rof hetfr101nt/rcatH report~~stM 11$, 6. P Tf~`Fq S he stota acejt'Fnt r~~s or Whether tr Chide; Se0 ' 6 - M SSE u yST F1~Sdt v rats. sYsten, , Comm this - - - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD 6395 coinplev curate s it report mast inclu(:fe: ''~1S' F" r~r ~C3E1"ar71ercia K TALK ONLY IF ALL. de".-: ip, _ 1 c moletinq the plot plan; locations. c scale: is preferred. A 3r,r• i -VI, T . . S/ SG sic x C of t7 enera _ rsr~ ft-llcl faint c. )n, coarse tnln - r:''Aium it d _ d; nct m p prorninenl 9- ,VL _ High water level, surface water r . )Y:S ;M -Bench Mark for i ,l,osal VRP Vertical Reference Point TO TH , s a ri: is the f.," : st(~p in secur, j >.Irlitary permit. The county or the Department may request Thic , permit issuance. A complete set of plans for the private s ra riate local authority in order to k submitted to the app p a I• 4 obtained and posted prior to the start of any construction. Va. Po SON Wl PN~ M NPMg Q~S~ ~pR X1151 Sig°,J\~ ~ _ G4~° Sp~~' ~~S~S g~~.N°•G pR g► G\,aPteC 2 h-~' U ~ ~'r SMP~E P \ P - R~Q Gp~g~11 \C\PP\\"\~~`G , X03 s VS SvP\ ~\ONS r~ ` ` IN Sy\\P I uN G~POpP~SS. C - ~P gF of O ~ q~~ Ito . \00 \ONS QEko O~eP\aoe ~ S s~s\EM~ OED NO P-~ \N NFt~\. ~\ON•. -~~I NPM~•. ~Ne~ SNOEO S ~ L NuMP S U~EF{ G~ GR\O ' R~COMM GCE P. O ER'S pES \ p.N~' a 1" P redarea \s ~`oo: PNO OE \ L V~~IA IA S_~ MM - O\ O\\`\C'~V 2 ~1 Co IJ ' OS e\eja VRE N~~n ORS sV~eO ON the tes o C. CEXC GO U tap\ef°rg gVS~ v o(i~ooo`c~teF\o06\,) CO\O C\~l S / Cl Ste' L4 ,te ~0so+ anY P\a`n \nd KNESS' ON gP ~1~2 ugE \f~ S °vNOV F~oodP ~N\C gg~J , S \ 5 ~s\ONS O\\\gO IsEE P , 0 3 S;, Z. 5 dence {ot sY®R` \N_'G \Q S'& R °F ogSgFi~ . ~h ~S- 3- r ~n 5)"j USE a su`tab\ vNO.' IV F" 4b. S~Si ROC O ~Re= RPT\NGN~\pNP\ M0 V OEc~G t~s QR0F~\,~\•~~~OGNPA C°NJr, C3 OV rea~\ced ~~~.\t s\ o.S~ n 1 L L o L o RATING:, ® ° N P~ \G -,2 a \ t `g \estsateNdreate ROV O gS H ~j' r r Q CONVENT, \{PettO\at`G°3og\51Vol .t^ (OG rr S \ \j -7 ®S L N O Pig ~REO (~.`'f~ o-S s 3 3\.~-cam` 2-yr3 s ~cr- UodeC s p C\ON ~t~~,, GG"l M z0-T, I .(n rr l5 r D F--Pder rcolation I COCP\ E~ %r -Z.~ Z ~.O ^ r s.H6 3.09(, NRgEPO~ 7 Z-l Y\1 Fes"" c $ +~r BORING TOTAL 6" Z Z i `~S S ` "L NUMBER DEPTH M, -7 - O al r ~-Iclcp Ts' C 4 - r , 13- L4 CVt. G R B- 6-l F\cOVP'C\O~OP\N`N PE {0o 2 ~E PE O 8 (o q5 a ME PE \OO t ~ V a ~ B- 8' ~ ~ ~ t p .\ES ~ PLM,N .DQ\n~ ice NO LNG \N~ ER t! 5ea\e o< boo aog< B 6' OEpC~S P ~ERS~g 5 Z \e so+\ ate fare e~eJa ati`o a\a\\ B- I \~jU ~~Fz \NCN hs`ors o\ the ~d the d\ `~he Prot PST W. { 1 L, b°t%Ogs\ocat~ Cy ' 0'\\ TEST DEPTH N WATER IN HOL teats s '010 UMBER INCHES AFTER SWELLIN P \On sho'N ^rr \ O - at d P- co an P'- s o{ Pate Pornt\>~~~'1 i p- Aocatror to{eteoc 3 Cz) P- P a . ;i LPN Sh°a~ {ejat`On P Q~o"( P \\C\ goopN a P- Zoo{ \aod s\oPe' - P- JS~C O l PLOT PLAN: Show locations of percolation tests, o zontal and vertical elevation reference of land slope. points and SYSTEM ELEVATION ~'~012 s _oI 1 7 - i I I ~Z 5 `a 4 e t I • 3 f I ( Vl ; ~L~ests rP' the SODA t and . - eJ~ dot otded S tir{V a tec t ce to d hetebV h tthe ~ ~ ~ ? o~det4t9o~ode~aod r t T W E - , ME tP f undersigned, hereby certify thet the soil tests reported on this form were mao PO to ninistrative Code, and that the OR ss` data recorded and the y VIE (print): location of the tests are correc Fe _J a\ 3\16 one coP lecified in the Wisconsin 069 .\0 )RESS: ` w O\SCR\BU1Q6 * k1 k-o21g21 , ON: ~1.. WO Z ~ ~ 2 2. \-{a.sg " t b ~ t3 _ g (o Q I~[~~ O -ASTION NUMBER: PHONE NUMBER (Optional): CST SIGNATU lS- ~ZS - OL y RIBUTION: Original and one co Py to Local Authority, Property Owner and Soil Tester. R-SBD-6395 (R. 02/82) ~~G EE- Z p~ - OVER - nNNOV1911988bb am$ 419476 ftMw ol We* 4 Cook Q", CERTIFIED SURVEY MAP e a LOCATED IN THE SW 1/4 OF THE NW 1/4 OF SECTION 28, T28N, R18W, TOWNSHIP OF KINNICKINNIC, ST.CROIX COUNTY, WISCONSIN. OWNED 8Y: STEVEN G. AND GAIL L.CUDD l v 403 N. 4TH STREET. id,Fr:';' SHEET „ RIVER FALLS, WI 54022. aELP EFT 2 OF 2 FOR .DLc ~CRIITION AND CU111,J~~'~ DATA-, APPROVED NOV 14 1986 rr' UNPLATTED LANDS 51. CkUIX COU'tIY WEST LINE OF THE NW 1/4 CAMP-EHENSWE PARKS PLAWANG •Af~P ;.~~+I•t~.-L0,~.1LL1LiE~_ _ NO 57 00 W w NO°57'00"W 561.31 ' (R _ 562.09') SO°57'00 E 1428.73 ' 655.29 w i418RTY ROAD €w _ S 0° 5 0 0 E 5 6 2 .~OO"y t w w IA o o OD m m ::E cm. z<••~p Z OZ0 Coo h yAZ OD A z b1 to 20 m `I o 40 0*0 .4 ~nm A ym A M ( ZC[mi zO W m - 01 N Cy .t z , O tnr(nn V DOx_: W m' 1 ` 'n m O m o Nz a' i v cn ~o;D m 3 y n cp tc to O z m V) rC-m ................r^....: L.. o^I / 2 i z mI0 r) ch z y m f~ N m t m _ i N2D N ~ 0 0 `t to w .W_.._. . 51 4.14 g x : ^p to N 1• 0 8' 1 4 'ii ' z N a r, M 0 OD . pm r1 ~p. . OD ,r' 'V AN m V "AN N m;u 0 00 .0 o m a m t m m° ar) - 'SI N 0 -1 tO O xi fi co i . A c) M C) OD ,.EAST LINE SWI14-NWI14~ S 1° 07'4 5' E 5 8 9. 2 1 _ RO P rv r 3 m 0 UNPLATTED LANDS ►z°z z OA O SET I "X 24"IRON PIPE WEIGHING 1.13 z mrn w JAMES LBS. PER LINEAL FOOT, t mm m ft WEBER S 8D4 w si a I"IRON PIPE FOUND. O xotn t °e SPRING VALLEY I ° ° WIS. ! it R ORECORDED AS 2O Act ~p z ' ~5~~ ,~'►•°•.r°,r°j°~.t'~' ~/~p® SC ALE 1 2 00 ~ fsUfk,o' Ioo' 200400' ffwt Jd__~r...•.~~s~ SHEET I OF 2 JAMESM.WESERS-1804 WEGERER, WEBERANDASSOC. DATED sepT• 1~~\~0~. THIS INSTRUMENT DRAFTED BY J~ ~Vo4,.~ Volume G P c' 174'6