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Home My WebLink About022-1052-10-000 c o v' O g m -0 0 o d m f 0 3 CD m • ) CD v m ~ 0 3 \ 1 3 _ O w N `C • n 3 o n=i uN O o to C: 0-4 N M_ O (D S n CO r~ 0- lD Z it CD co ? a y CA W :0 Z 7' N CD CCD n O co Q O O O O D N C co O 3 O N O O C~{' La %'C rn N o C Q ` N ~ CD O G ~O v m OU ~ n a (7 N O c c CD A QM N O oo ~ n - CT z CD Co n - cn ~y cf) 4i (n GTJ ° co co N N c z H J Z v CD !r • o Z O O O m e a o O T < Z rye - k{1 ° o N N to o D ~t A~ n~ fli CD S v v v t- o a' m I m N, o rn ° o m °7 D w o n d ey y N 3 J V IV ~N (b a' Z CQ p 0 ZD W OZ O 4~1 Go 0 CL OZ, CD Z CD ~ rn CD c T1 cc C CD CD oo ~ I a o CD G7 Z 7 p Z CD v, C v n A F S 0 1 oo Cl) W T C CD CD z A 00 co M N z I w (D ~ I C a w a ~ 0 3 v c o_ z a 0 CD ~ fn 0 y D~Q fi ti ti ' N O O CT A O= A O W O A O O ti CD :E o CD o CL Parcel 022-1052-10-000 08/15/2006 10:10 AM PAGE 1 OF 1 Alt. Parcel 18.28.18.287A 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - KIRCHNER, NORMAN J & JUDITH NORMAN J & JUDITH KIRCHNER 307 CTY RD SS RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 307 CTY RD SS SC 4893 RIVER FALLS S? 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.669 Plat: N/A-NOT AVAILABLE S=C 18 T28N R1 8W PT SW SE BEING LOT 1 OF Block/Condo Bldg: CSM 10/2877 2.669 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/12/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.669 60,000 201,500 261,500 NO Totals for 2006: General Property 2.669 60,000 201,500 261,500 Woodland 0.000 0 0 Totals for 2005: General Property 2.669 60,000 201,500 261,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 124 Specials: U,3er Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 1 AS BUILT SANITARY SYSTEM REPORT OWN 1~:13 TOWN SIll1' SEC. T- N-It W ADDKESS - S`1'. CROIX COUNTY, WISCONSIN. SUHDIVIS10N LOT LOT SIZE PLAN VIEW Distances and dimvusions to muuL requirements of H63 SHOW EVERYTHING WITHIN 100 FKET OF SYSTEM r I { i it die at N r h rrc w LL. BENCHMARK: (Permanent refereuQu Point) Uescr>_be: Elevation of vertical reference point-i~ Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings on cover Tank manholo cover elevation: 'l'ank Inlet Elevation: Tank Outlet Elevation: 1 /1 , PUMP CHAMBER Manufacturer: Y _ Number of gallons Number of gal. pump set for a cycle___ gallons; Total capacity of distrlbutLun lines gallon: size of pump- head; gallon per minute horsepower - _-;brand name of pump and model cumber - ' 't'ype of warning device HOLDING TANK: Manufacturer Number of gallons- Elevation of manhole cover > 't'ype of warning device SEEPAGE PIT SIZE; Number of pits - feet diameter feet liquid depth _ seepage pit inlet pipe-elevation feet. button of seepage pit elevation SEEPAGE BED SIZE: number of lines width length____tile deptl SEEP E-TRENCH : width RE Leugth-i PERCOLATION RA'Z'E AREA C1UI1ZEll AREA AS BUILT INSPECTOR DATED PLUMBER ON JOB C E N S E N' ; : " i: - DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O, BOX )kq BUREAU OF PLUMBING W,DISON, WI 53707 MCONVENTIONAL ❑ALTERNATIVE S',,, Plan LD. Numbec (lt assigned) ❑ Holding Tank ❑ In-Ground Pressure E Mound NAME OF PERMIT HOLDER. T DDRESS OF PERMIT HOLDER: INSPECTION DATE. Noteman K,vAchnetc 327 N. 3tcd S Rivelc EaPP~, (VI 54022 BENCH MARK IPermaneof reference pomfl DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PL ELEV. SW SE, Section 18, T28N-R18W, Town ob Kinn~ cFiinnic Neme of Plum be, JMPIMPRSVI No. Sanoar mbe,: Eugene GtLove 5569 Tk~ ix ~4 SEPTIC TANK/HOLDING TANK: MANUFACTURER. r LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WAIG LABEL LOCK NG C EVER I r PED'. PR O DEC) I Iq ~3 I , 1 YES NO ES ENO BEDDING. VENT DIA.: VENT MATL HIGH WATER NUMBER OF ROAD'. PROPERT WELL: BUILDING. VENT TO FRESH ALARM IFEET FROM 1 AIR IN= FT - EYES NO EYES NO NEAREST' DOSING C AMBER: r MANUFACTURER rj I NGLIQUID CAPACITY PUMP MODEL PUMN M NUFACTURER WARNING LABEL LOCKING COVER PROVIDEDPROVIDEDYES NO EYES ENO DYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATI NUMBER OF PROPERTY WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) EYES LINO NEAREST 110 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LEN(;TH 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: BED/TRENCH WIDTH LENGTH No !OF ew DISTR PIPE SPACING COV DIA tt PITS LIQUID DIMENSIONS THE JES M FRIA ]:~~JSIDI ' DEPTH GRAVEL DEPTH FILL DEPTH UISTH. PIPE DISTR. PIPE DISTR PIPE MATERIAL. NO. DI R. NUMBER OF PR OPERTV WELL. BUILDING. VENT TO FRESH BELOW PIF FS~ A8011 COVER E, V T EI/$.VyE~ IPIPES FEET FROM . LINE: AIR INLET'. f ~s p NEAREST-► << L3 ' MOUND SYSTEM: 94 Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- YES E NO meets the criteria for medium sand. TIONS MEASURED. E SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS EYES ENO EYES ENO DEPTH OVER THENCH.'BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES EYES ENO EYES ENO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELF V.'. ELEV.. DIA. ELEV. PIPES DIA.-. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS EYES NO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: G C' FEET FROM LI"E. r1J L, EYES ENO DYES ENO NEAREST r I F )x,00 Sketch System on e for audit. Reverse Side. SIGNATU TITLE. DILHR SBD 6710 (R. 01/82) DEPAIsTMENT OF REPORT ON SOIL BORINGS AN ETY.& UILDINGS INDUSTRY; r j,DIVISION LABOR AND PERCOLATION TESTS (115) MAR S Fj P•6-}BOX 7969 HUMAN RELATIONS ISO1V `WI 53707 (H63.09(1) & Chapter 145.045) •y, I4HjN~ LOCATION: SECTION: TOWNSHIP/M1lN-tQPALITY: LOT NO.:BLK. SUBDI ON NAM 1/ y , /TN/R~ E(or)W COUNTY: tMf4k=R=S/BUYER'S NAME: MAILING ADDRESS. -i USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: !Residence `l [SlNex/v ❑Replace _ i RATING: S= Site suitable for system U= Site unsuitable for system CONVECNTION'AfL: MOUND: T N-GROUNCD PRESISIURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) 5 V ~ V EIS E V ElV [~S EU EIS '96L.u'~l v 7`•) =tJ L- r s ..'._`.1 ~1 r..~~ If Percolation Tests are NOT required DESIGN RATE: 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 ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B I ytf \V may` ~'`JETCr Dl I.U'pr 1.~' 7~' B j "6WP"s v,~~r $ E5 LS1 1Z Nr l.$r -i, LS/' (J! Z! c' e E ~_F,`' ~laoT;~/.3'L71 n ~s wf J,}.b [TIJh v 1:s' B C?• ) -,a - _ j lS~ 1n t 6 L ~SwH~T~ )-3' V._tiC STS Ijh ~•8' 1n 51 LT F~" n B- j V.~, Jn.~ lwlV~ } ' - i r j'r a'i; sf LT . B - L-2 -7 ~ \•J ~.1~_.. .~11.3•Cj'hJ`IIjO.L~'11JY 5~~1.Z~}7 rcl: • ' ~ PERCOLATION TESTS ^Li rrtQ~U ,ti TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IIVE++ES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH J P 1 z w -3 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. I N t; t: Z% _ `l,~ SYSTEM ELEVATIONS o 89. s~ • i r i ~ ~ { 7 t ) t z nVI.J~ ~`~~L'I~C~lJ i ww 11 L17 t S ps i tiZ~lO~ft"CL~b 650' fw1 x:300 t. 6 ~ V) x l ( p'7BM BitRP , 1 MS5 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: , DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - 1 i3 Tj~t t s: 4 € a:°: ¢i" s[kiq(f CAi +.3 lJ~ K.,_ A IL F- c.,EC~a L " ..t.Eijj .v F7, 4 ie,1?" { te8 pig ?H +..«tF L~ ~ 3 3 ~t2 kr, i=t 4i _ € f1=+ ~ su ~ t'~, til .l l i4sza, ow ion, e, ,:,r, :=1 tel.. { j a= =a'. ik, a pt fil IB, L'S I€ ,€e i i 10 mow. ,r N _t t fit} t€',, CT zu w's`°ns'n APPLICATION FOR SANITARY PERMIT Kc)~j V L H COUNTY ocr~RR TTnc V,~nT of (PLB 67) 'nousTRRr3°RGHUMRnRELRT1°n5 UNIFORM SANITARY PERMIT # 171 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION 1 7 3,1 3)elp:3 _ ~ ~ f'f'i-Y l1/4 ,x'1/4, S f , T;Z N, R r 9 E (or W TOWN LOT NUMBER BLOCK NUMBER SUBDIVISION NAME N REST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED kJ 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): /y,4 T THIS PERMIT IS FOR A: K New System ❑ Tank Replacement ❑ Repair El Replacement Soil Absorption System - ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. EEI Seepage Bed [Seepage Trench ❑ Seepage Pit ❑ Holdiny Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total # of Prefab. Site Steel Fiberglass Plastic /p~ Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: [?"Private ❑ Joint ❑ Public FNam e undersigned, hereby assume responsibility for installation of the private sew ge system shown on the attached plans. e ofPllu mjb}er (Printl: Signatur: MP/~FR&SiN No.: phone Number: ber's Address: Name of Designer. S v` I U Jv ,L vax_ .C T. C r Z- COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given initial Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber Form - S '1' C 1 00 Owner of P r o p e r t y Location of Prope rty-;3•LLi `-4- Section T o w n s h i p~1-111y~~/t'1.s%/l1. + Mailing Address 41. Subdivision Name_ Lot Number ~~e Previous Owner of Property- ~c Total Size of Parcel i Date Parcel was Created Are all corners identifiable? Yes No Include wit II this II pion one of CII [oIIuWjII .Certified Survey Mai, --~-Deed .Land CUri t raC t , .Other Legal DoCLA:- Ii. I) i-i1u 1) rul,~rty 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. 3 Y/ C2 6 - and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No- ~'✓i9 ) 51 NATURE OF OW EH SI - TUNE OF CO-OWNER (IF APPLICABLI ) J i DATE SIG ED DATE SIGN I.) - ' Parcel 022-1052-10-100 08/15/2006 10:13 AM PAGE 1 OF 1 Alt. Parcel 18.28.18.2878 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner NORMAN J & JUDITH KIRCHNER O - KIRCHNER, NORMAN J & JUDITH 307 CTY RD SS RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 37.331 Plat: N/A-NOT AVAILABLE SEC 18 T28N R18W SW SE EXC PT TO CSM Block/Condo Bldg: 10/2877 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 25.000 3,700 0 3,700 NO AGRICULTURAL FOREST G5M 12.331 30,800 0 30,800 NO Totals for 2006: General Property 37.331 34,500 0 34,500 Woodland 0.000 0 0 Totals for 2005: General Property 37.331 34,500 0 34,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00