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HomeMy WebLinkAbout036-1060-30-000 e � ° 00 O M y O C � L N v o E c N I' p m..@ `. LL O Ct M -0 YL C @ @ !0 O y'O N C_ N N Q N m } O j 7 U-) U Y .V r i 'oL2 CD y @_O Z X N N of I C _ N N O y 7 @ N O N C LL c � N a U c a O @ N d @ E Q � ��.r�F- 3 N I U it M 0 a' y W E U) O o Z £ LO N H z a m 0 O z v v v M CL N O CD N U)N c U L *i c O 76 O N Q U Z Z 0 N Z E N LO 4 �y 06 Q lC w N C v "' 3 G G a a C7 O a) E o 1---y H H 3 0 �w L333 z !v a •i C N Z o^o o^o � N U ' rn rn } Cl) LO m _ O r _ ° _ N � � N r N N ..33 M O l6 OO O N C CQ O Q c > ° E N co O o CO 3 @ U a o 0 C) oo O a� c c U a ° ° L F- w w N toil M N N O c — N N O C ° O ! m O rdE —C Z Z -:1 N N ~ `° M :° o ° o N E E s • �' co N U) Y OOi O FO- FO U) { CL at a a • c� o. d ,U m y c t`i�l E v c c Parcel #: 036-1060-30-000 02/22/2007 10:20 AM PAGE 1 OF 1 Alt. Parcel#: 25.31.17.386A 036-TOWN OF STANTON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner TERRI R KIEKHAFER O-KIEKHAFER, TERRI R 1929 197TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1929 197TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.810 Plat: N/A-NOT AVAILABLE SEC 25 T31N R17W 1.81A NW SE COM 290'W Block/Condo Bldg: OF SE COR NW SE,TH W 235', N 297', E 295', TH SWLY TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 25-31 N-1 7W Notes: Parcel History: Date Doc# Vol/Page Type 09/10/2004 773914 2653/017 QC 07/23/1997 725/279 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.810 18,000 102,700 120,700 NO Totals for 2007: General Property 1.810 18,000 102,700 120,700 Woodland 0.000 0 0 Totals for 2006: General Property 1.810 18,000 102,700 120,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 122 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 St. Croix County Map Output Page Page 1 of 1 St. Croix Count Ma in 4` �A N. t t 'R 1AiE Vl s S vi, CKON $E L%GV 1A A . LEGEND 0 Structures St.Croix County Planning Department — State Roads 1101 Carmichael Road Township Roads Hudson,WI 54016 County Roads Phone: (715)386-4674 Rivers and Streams Lakes DISCLAIMER:The information contained on this map is advisory.Map Villages accuracy is limited by the quality of the public records from which it was O Townships prepared.It is not intended as a substitute for an accurate field survey. Federal Land M State Land AERIAL PHOTOS:Aerial photography is date-sensitive.Features that exist am County Land presently in the County may not be present in the photos. ttv://stcrxdmz/servlet/com_esrl.esriman.Esriman?ServlceN m .=S C'roixOV&Clien Version=4.0 x/31/2004 PUMP CHAMBER ` Manufacturer:, Liquid Capacity: s34 Pump Model: 10 Eo '-3 LL k- Pump/Siphon Manufacturer: ��� ( Pump Size , . ' Elevation of inlet: �� ! Z Bottom of tank elevation: 9 Z Pump off switch elevation: _ Gallons per cycle: Alarm Manufacturer: L 4 Alarm Switch Type: Number of feet from nearest property line: Front, O Side, Rear, Ft.7Z Number of feet from well: Number of feet from building: Q" (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: C )Width: 1, Length: 75 Number of Lines: U Area Built: So Fill depth to top of pipe: Number of feet from nearest property line: Front; Side, 0 Rear,0 Vt . e Number of feet from well: i (� Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: ber of pits: Diameter: Liquid depth: ,. Bottom of seepage pit elevation: Area Bui`lt: i Has eithef a drop box O or distribution box O been used on any of the above soil abso tion sytems? (Check one) . LDING TANK Manufacturer: Capacity: Number of /ringsus Elevation of bottom of tank: Elevation Number of earest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: / Alarm Manufacturer: Inspector: Dated: (d Plumber on job, � � p "/;7 License Number: --It A� L� S, 3/84:mj w Form - S T C - 104 ` AS BUILT SANITARY SYSTEM REPORT OWNER @y y L_(4 ,C �j� h TOWNSHIP � jam_ SEC. -2 5 T N-R1 W ADDRESS ST. CROIX COUNTY, WISCONSIN 0 , , SUBDIVISION LOT ) LOT SIZE _, PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM *'y1 y` l�� goo f INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 44�-pA -dk45'� Elevation of vertical reference point: ] Proposed slope at site: '2_ SEPTIC TANK: Manufacturer: g��� Liquid Capacity: j nct6 c',49 ~ Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: ,Z Tank Outlet Elevation: 1z Number of ,feet from nearest Road: Front,ku Side,Q Rear, O j DOD feet From nearest property line Front,0 Side,0 Rear,O ac feet Number of feet from: well r0L1'-( , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS P.O,BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON,WI 53707 BUREAU OF PLUMBING NW-4; SEk,S25,T31N—R16W CONVENTIONAL ❑ALTERNATIVE IState Plan I.D.Number: Town of Stanton Willow River ❑ Ilf assigned) Holding Tank ❑ In-Ground Pressure ❑Mound t NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: David Kickhafer Route 3, New Richmond, WI 54017 c? _ 9-7 3 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: IcST REF.PT.ELEV.. Name of Plumber- ji�iP/MPRSW No.: Counry: Sanitary Permit Number: Gary L. Steel 3254 St. Croix 96000 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVER _ ED: PROVIDED: BEDDING: VENTD .: VE�_�MA TL.:J HIGH WATER y j ES ❑NO OYES ❑ ALARM. NUMBER QF ROAD: PROPERTY WELL: JBUILDING: VENT TO FRESH FEET FROM � LI" AIR INLETYES NO ❑YES NO NEAREST li v�J a DOSING CHAMBER: MANUFACTURER: BEDDING: LMODEL PUMP/SIP�4 N MANUFAC URER. WARNING LABEL LOCKING COVER / P�-O °ED: PR VIDED❑YES NrNO u I�JYES ❑NO ES ❑NO GALLONS PER CYCLE: ROLS OPERATIONAL. NUMBER OF PR OPERTV WELL. BUILDING. VENTTOFRESH (DIFFERENCE BETWEEN FEET FRaM u,l� / / AIR INLETPUMP ON AND OFF) ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moi of plowing FORGE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN . -j � the soil is dry enough to continue.) CONVENTIONAL SYSTEM: •WIDTH LENGTH- NO.OF DISTR.PIPE PACING. COVER INSIUE DIA_ #PITS. LIQUID TREN�ES. � � MATERIAL' PIT DEPTH GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR NU 13ER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES �^'�s' ABOVE VEH E .IJV ET V..�Ng.^ PIP ES^ FEET FROM LINE:/� ^/ AIR INLET / 7 �' NEAREST` (!/5 /T 2./5? 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. OYES NO SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS OYES ENO DYES IMULCHED❑ DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED SEEDED: . CENTER. JEDGES ❑YES ONO OYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: g��rr��..yy WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. g�ds+A� H `c TRENCHES: P MANIFOLD PUMP MANIFOLD DISTR.PIPE IMANIFOLDMATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARIQING: ELEV.. ELEV.. CIA_. ELEV.: PIPES: DIA.: .�,g�� O e*'HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED +71�+R4T� PLANS: ❑YES NO ❑YES NO COMMENTS: M1 PERMANENT MARKERS: OBSERVATION WELLS: NUMBER©F PROPERTY WELL: BUILDING: FEET)*R€MA LINE: ❑ ❑ YES NO ❑ ❑NO NEAf€EST O • 0 10 ,� p G 14,11 Z Sketch System on tain in cotmty file for audit. -7.010 Reverse Side. r SIGNA T DILHR SBD 6710 (R.01/82) oning Administrator 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; 1 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: Property owners name and mailing address. Provide the legal description where the system is to be installed; li. 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'/z 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 etas• included the creation of surcharges (fees) for a number of regulated practices which Wisco is e can effect groundwater. The surcharge took effect on July 1, 1984 All of the water that buried rea.sut•e is used in your building is returned to the groundwater through your soil absorption a system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by F 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) i SANITARY PERMIT APPLICATION COUNTY DILHR In accord with ILHR 83.05,Wis.Adm. Code STATE NITARYPERM�## VGA 0 o d -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 David Kickhafer NW % SE '/4, S 25 T 31, N, R 17 N(or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME R.R.##3 n/a n/a n/a CITY,STATE ZIP CODE PHONE NUMBER 7n CITY NEAREST ROAD,LAKE OR LANDMARK Nwew Richmond Wi. 54017 715 46-5643 VILLAGE:Stanton Willow Rover TOWN OF II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check##2,3 or 4,if applicable) 1. a. 1,IN.ew— aWacemeat..__.,.a..,l_1_Re�lacement of .d� estinn�f_ e.❑ Repair of an -� System System Septic Tan- n Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued *3:'�-,4f�E +sti+ SystQm,has heer„in pe d_Ind soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building Attach CommvrtEwflerslai ment to C opy. 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. ❑SeeDac3e 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): 94.90 Class 2 750 750 94.28 Feet 3P Private ❑Joint ❑ Public CAPACITY VI. TANK in allons Total ##of Prefab. Site Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New xistin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank x 1000 Weeks Concrete Lift Pump Tank/Siphon Chamber X 800 1 1 Weeks Concrete ❑ ❑ ❑ ❑ I ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for insta lation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber' ignature: s) /MPRSW No.: Business Phone Number: Gary L. Steel 3254 6-6200 Plumber's Address(Street,City,State,Zip Co ): Name of Designer: 988 N. shore Dr. , New Richmond, Wi. 54017 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## Gary L. Steel 2298 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N .Shore DR. New Richmond, Wi. 54017 715 46-6200 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) L3 Approved I❑ Owner Given Initial ! charge Fee Adverse Determination Inc), /_ w . V A-1 X. COMMENTS/REASONS FOR DISAPPROVAL: by /�sv ti SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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 David Kickhafer Location of Property NW it SE 14, Section 25 , T 31 N-R 17 W Township Stanton Mailing Address R.R.#3 New Richmond, Wi. 54017 Address of Site R.R.0, New Richmond, Wi. 54017 Subdivision Name n/a . Lot Number n/a Previous Owner of Property Marjorie R. Hilyar Total Size of Parcel n/a Date Parcel was Created 10-28-85 Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? Yes x No Volume 72_4 and Page Number 500 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 1 (we) ceAti.6y that att statement6 on this okm an.e true to the but o6 my (oun) hnow.etedge; that 1 (we) am (au) the owneA(bf o6 the ptopehty dedchi.bed in thiA .in6o4mati,on 6onm, by vi tue o6 a wahAanty deed neconded in the 066.ice o6 the County Regi,6ten o6 DeedA ad Document No. 406486 and that I (We) pliedentCy own the pnopobed date bon the 6ewage di,dpod dyb em (on I (we) have obtained an easement, to nun with the above dedcA bed pnopehty, 6oic the condtnuation o6 da•id d ye.tem, and the dame had been duty keemded in the 066.ice o6 the County Reg.i,dteh o6 Veeda, as Document No. ) . SIGNATURE OP OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) ( l� DATE SIGNED DATE SIGNED o DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2—19M !I Marjorie R. Hil ar. a k a Marjorie ...................................... - .... ..-•- -- -••---•••a Hil CY .single--.person............................................................................... ------------------------------------------------------------------------ --------------•--- ,Q .......... ..........................._....._ ...._............... ..._................ . r conveys and warrants to .A a_-v id.__J.._..Kickhafer-.and._Terri_ R.. /) ..Ki.ckhaf.er.,. husband..and_.wi.fe---as_-J-oiat--tenan.is..... RETURN TO I� ._... ... the following described real estate in St. CrOlX County, State of Wisconsin: Tax Parcel No: A parcel of land located in the Northwest Quarter of the Southeast Quarter (NW4 of SE4) of Section Twenty-five (25) , Township Thirty- one (31) North, of Range Seventeen (17) West, described as follows : ' Commencing at the Southeast corner of said Northwest Quarter of Southeast Quarter (NWT of SE4) ; thence West, on the South line thereof, 290 feet to the Point of Beginning; thence continuing West, on said South line, 235 feet; thence North 297 feet; thence East to the Westerly line of that certain parcel previously conveyed to Thomas R. -Breault and Phyllis J. Breault, by deed recorded October 25 , 1985 in Volume 724 , page 500 , Document No. 406486; thence Southwesterly, along said Westerly line, to the Point of Ili Beginning. �! i � � I This --------is................ homestead property. i (is) (is not) Exception to warranties: 'i 28thDated this --- day of .------•... .QptQber... .... ...............•--......-_.. 19.85..-. -------------•---- (SEAL) Ui 'U,�l � [L /�/"'� (SEAL) f J • _Mara-orze...R...-.Hlyar (SEAL) --- ---. .-....-.(SEAL) . -- AUTHENTICATION ACKNOWLEDGMENT Mar orie R. '11ii i ar STATE OF WISCONSIN Signature(s) ------------------------X---------• -------- as. ................ ............. .......•---........_............__...---- <• -•-----•--•--••------••--•••-•---County. a entjc• toy ......... 19..8.5 Personally came before me this ................day of " .` ._ --------- -------------- ------------•--• 19-------- the above named -- ---- - ---- - t..se._ - =s •--------- Scott Needham TIT E BER STATE BAR OF WISCONSIN (If not, ...................... •------•--•--- ----------------•----- ----------------------------- authorized by § 705.05. Wis. State.) to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED SY -------------------------------------•-•--•-----•---•-'----•--------•-----•--- Reintra, . ...Van Dyk & Needham, S.C. - - „ ---------------------- -------- ................ ----------------------------- New Richmond, WI 54017 --------------------------•---------------------------------------- Notary Public .-- --------------------------------------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary.) date. -------------------------------------------------------- 19......... •Napes of persons signing in any capacity should be typed or printed below their signatures. STATk,' BAR OF WISCONSIIH H.C.MillcrCar�alty� TORN! No. 2- 1982 Stock trio. 13002 'L H • a STC - 105 r v y SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a H OWNER/XK=X= David Kickhafer M ROUTE/BOX NUMBER R.R. /3 Fire Number CITY/STATE New Richmond Wi 54017 -ZIP 54n1 7 PROPERTY LOCATION : NW !4, SE 14, .Section 25 T 31 N , R 17 W, Town of Stanton , St . Croix County , Subdivision n/a Lot number n/z . Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into Ii the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system . I 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 . Ho 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- ►d ment 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 . SICNED _..� DATE St . Croix County Zoning Office P . O . Box 98- Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. INSTRUCTIONS IS FAR COMPLETING FORM 115 - SBD - 6399 To be a co mpiete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or cornrnerciai project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or, replacement systerrr; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL 01-IIER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 5. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating Your test locations. Drawing to scale is preferred. A separate sheet may be used if desire(]; S. Make SU!-=.your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropi ate; 10, If `rhe information (such as flood plain,elevation)does not apply, place N.A.in the appropriate box; 11. Sien the form and place your current.address and YOLIF certification number; 12. f'€erke legible copies and distribute 3S required. ALL SOIL TESTS MUST BE FILED WITH THE 1_C)C,AL AUTHORITY WITHIN 30 GAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st - Stone 'over 10""'t F3R Bedr�Yck cob -- C;obhle (3- 10") SS -- Sandstone r - Gravel (under ") LS -- Lin2estor're *s Sand HGW - Nigh Groutrdwatet CS - C(Jarsc� Sa!lli flerc -- P ,-r,latior= Rate nl e, s .. M(3(jiurn &irrc] °r s _ F're Sarni Bl€q Buildinq Is Loarrry Sand Greater Thai "sl Sandy Lrxatn <' Less 'Than Loarn tar, Btn,,°u„r S It 1,0ar3 lal Black si Silt C y <'s}% rC”! _ Clay loam y y _ `x'c�[rov,, c:l -- Sarrr:ly Clay Loarn R -- R,d sica Silly Clay Loans mot ._- i�Aottie,s . )r,dy Clay ,3 vv I sic - Silty Clay tff -... f--v1,,firer:,faint :)�. ..... p?'al d __ distinct {) HILL - High water level, _Six cieneral soil textures surface water fo! ligit id waste disposal BM - Berich Mark VRP - Vertical 'reference Point TO Ti IE OWNER: This s( test report is the first step in securing a sanitary perrnit.The county or the Department may request ve;rificazicm of this Soil test it) the field prier to permit issuance, A complete s€at: rrf plans for the private systenl and a petmii rmplicati mn must be submitted to the appropriate iocal autl otity in order to permit. ThEt sanitary tremlit musl he o It pined and pasted pi ior to the st,-jq of any construction, Q Z A DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS `INDUSTRY, DIVISION P.O. BOX LABOR AND PERCOLATION TESTS (115) 3707 ' HUMAN RELATIONS MADISON,WI 53707 (H63.090)& Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ C OT NO.:BLK.NO.: SUBDIVISION NAME: NW 114 SW4 25 /T 31 N/R 17f tor►W Stanton n/a n/a n/a COUNTY: OWNER' ME: MAILING ADDRESS: St. Croix David Kickhafer R.R.0, New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 n/a ❑New Replace I 5-13-87 n/a RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) al S ❑U O S ❑U O S ❑U I EIS ❑x U i EIS x❑U conventional 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: class 2. 1 Floodplain,indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS a e 21 AOBBRB BORING TOT DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. I HEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 1 6.67 97.20 none 5.92 .92bl.1. 1.17bn.sil. 3.25bn.c.s. .58bn.s.1..75-6t. .1. B- 2 6.58 97.22 none >6.58 .83bl.1. 1.08bn.sil. 3.00bn.c.s. .75bn.c.s.&gr. B- 3 6.74 97.73 none 5.83 •58bl.1. 1.33bn.sil. 2.00bn.c.s. 1.83bn.c.s.&gr. B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIUD 3 PER PER INCH P- P- see lesign rate P_ r P-- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. upper trench -94.90 SYSTEM ELEVATION lower trench 94.28 FI >< i _ 3 r- r^ r Gin-, _ w(� �. ._ _ l !- - lb tN_ �----Y—"-- i _ .�__ � ---- —. 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 ministrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. E(print): TESTS WERE COMPLETED ON: Gary L. Steel 5-13-87 DRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. shore Dr. New Richmond, Wi. 54017 22 1715-246-6200 CST SIG URE: 4� DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) OVER — Ah David Kickhafer 3W4 SE4 5.25-T31N-R17W Town of Stanton Loo ' J,-L 1'1'1 9- A l r. (4 .(, e-3, ►0 1��.,P \ Los- l ® 664- 1 0 X0"4 �LVtl"" eftr�s 0 b O V� to Z-7 Z - yy so yy.�ti Gary L. Steel 988 N. shore Dr. New Richmond, Wi. 54017 MPRSW 3254 PAGE GF PUMP CHAMBER CROSS SECT IOM AND SPECIFICATIMS VEUT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIMG JU1JCTIOtJ BOX MAMHOLE COVE Z5' FROM DOOR, �1w�°"'�"� V, G� WIIJDOW OR FRESH WMIU. i ,�'�d S�°� AIR IMTAKE (3 GRADE I I 'i"MIN. � 18"MIN. COWDUIT -- ---------- 18"MIAI. \\\\ \ PROVIDE I -- INLET AIRTIGHT SEAL I , ^ Y APPROVED JOIN A ( I)I �6�� APPROVED JOINTS W/C.=. PIPE �C.T. PIPE I III W EXTENDING. 3' I II ALARM EXTEkIDING 3' ONTO SOLID SOIL I 11 ONTO SOLID SOIL d I 1 I I ON C I I ELEV. 89.55 FT PUMP-� --� OFF D CONCRETE BLOCK RISER EXIT PERMITTED OIAJLH IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFItATIOUS DOSE TAIJKS MANUFACTURER: Weeks IJUMBER OF DOSES: 3 PER DAg TANK SIZE: 800 GALLONS DOSE VOLUME ALARM MANUFACTURER' Tank alert INCLUDING BACKFLOW: 27F GALLONS MODEL KIUMSEK: n/a CAPACITIES: A= IIJCHES OF, .57y GALLOWS SWITCH TYPE: mercury g=— _INCHES OR _-QL GALLONS PUMP MANUFACTURER: Gould C= INCHES OR �B( GALLONS MODEL NUMBER: We03L D-INCHES OR GALLONS SWITCH T`JPE: mercury MOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE 22 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 6.35 FEET + MINIMUM NETWORK SUPPLY PRESSURE/. . . . . . . . . . . � FEET + 175 FEET OF FORCE MAIN X •86 F tooFT.FRICTIOU FACTOR. 1.07 FEET TOTAL DSUAMIC. 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