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HomeMy WebLinkAbout022-1012-90-050 Wisconsin Depart:oent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety grid Building Division INSPECTION REPORT Sanitary Permit No: 506267 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Oevering Homes LLC, c/o Kenneth J. Oeverin Kinnickinnic, Town of 022 - 1012 -90 -050 CST BM Elev: Insp. BM Elev: BM Description: 2 Section/Town /Range /Map No: j O� k.J VIA. C- k 05.28.18.788 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. p Se tic Benchmark � �' �rt 4' r i Dosing Alt. M Bldg. Sewer S . 3 Holding St/Ht Inlet O I f7 - C � ! 7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/4 WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 33 1 j^ � �� Dt Bottom 12-7 9 Z Dosing M/ -- (10"i t I ----- Header /Man. 3 / &!C. AH Aeration 1O Dist. Pipe • � Holding Bot. System ro PUMP /SIPHON INFORMATION Final Grade 3 166 ` 4 Manufacturer „I e— �� ` DP and St C , k / J �. /6z. Model Number '{¢'( 4D T Lift Friction Loss, System Head TDH� Ft Forcemain Len a,, Dia. It Dist. to Well w ' �5 L ,V SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. f1 en es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS $ 5 77 E �\ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Typ /�uC�jf b �/� System: /5 AA — . — — .A / UNIT Model Number: �\ /�r�IllL. �'{/ DISTRIBUTION SYSTEM Header /Manifolc�r ! / Distribution Z. J t x Hole Size / x Hole Spacing ` Ve o Air Intake Pipe(s) 4j Z � � �D Z� Length `'f Dia J Length J Dia Spacing ~ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only U �. Depth Over / Depth Over xx Depth of xx Seeded /Sodd`ed' ' xx Mulched Bed/Trench Center J • � Bed/Trench Edges Topsoil ` /es No es ,, No i COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / � / 6( In ection #2: / / Location: 1058 Rudy Drive Riv r Falls, WI 54022 (NW 1/4 SE 1/4 5 T28N R18W) NA Lo arcel No: 05.28.18.788 �J� Lj 1.) Alt BM Description w�e�— �"���- �•�¢�l Sa 2.) Bldg sewer length C / - amount of cover gignatu Plan revision Required? 1 Yes No . Use other side for additional information. Date Insepct Cart . No SBD -6710 (R.3/97) comnwire.wl.gov Safety and Buildings Division County 201 W. Washington Ave., P O. Box 7162 s con sin Madison, WI 5370 2 Sanitary Per / mit , �Numbee / r (to be filled in by Co.) t d 1 ooperUnent of Commerce s Z l0 7 Sanitary Permit Application S- r.an.. aeon N f nbe� If In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropria men / v 0 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned P are Project Address_ if diffe}t mantle dd submitted to the Department of Commerce. Personal information you provide may be used for secon /Q GJ K J purpos in accordance with the Privacy Law, s. 15.04 1 m , Slats. I. Application Information - Please Print All Information Parcel # Property Owner's Name // a Prope Owner's Mailing Ad Property Location ,,,���yyy 6 f � Govt. Lo City, State Zip Code Phoy r '/. n Sectio T 7 .R E W l R. Type of Building (check all that apply) ^7 p k euA t# I b Subdivision Name 2 Family Dwelling -Number of Bedrooms' P Block ❑ Public /Commercial - Describe Use ❑ City of CS / M Number ❑ Village of D — ❑ State Owned - Describe Use z, ,9 7 �T,own of 'x A I i �►i2 f �' /► // / 1B. ype o Permit: (Check only one box on line A. Complete line B if applicable) ..System ❑ Replacement System El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ List Previous Permit Number and Date Issued ❑Permit Renewal ❑Permit Revision Chan a g of Plumber ❑Permit Transfer to New Before Expiration Owner / IV. Type of POWTS S stem/Com onent/Device: Check all that a iJ ❑ Non - Pressurized In -Ground ❑ Pressurized In- Ground ❑ At -Grade > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: S tern Elevation Dest Ylow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requi sf) Dispersal Area P sed ys !Z5 J 4 VI. Tank Info Capacity in Total # of Manufacturer Y Gallons Gallons Units RL. o yar� " yy New Tanks Existing Tanks Septic or Holding Tank t Dosing _ Chamber . Responsibility Statement- 1, the undersigned, assume r osibility for installation of the POWTS shown on the attached plans. Plumber's ame (Print) Plumber's Si MP /MPR r Business Phone N ber Plumber's Address (Street, City, State, Zi Code) VIII. Coun /De artment Use Onl Permit Fee Date Issu Issuing Agent i afore 4 IKp pro ved =Zen S Reaso eniai l a IX. ConditteA � �( ,easons for Disapproval 3 1 J ` O J , n J; �, A e_L_� 1. Sept tank, effluent finer and dispersal cell must all be services i mairitained as per management plan provided by plumber. / 2. AD saRiack requirements must be maintained 4 �(0t ovl. Go ��� P 1 1 4- ✓l- system and submit to the County only on paper not less than s 1/2 x inchh SBD -6398 (R. 01/07) Valid thru 01/09 LQ, r _;� ,. '�� i ��a;�si;,, �"�3Y�LY$ �e r PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS P.O. Box 176 New Richmond Wi 54017 NW 1/4 SE 1 /4S 5 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX SYSTEM ELEVATION 105.0' 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top Survey Iron ASSUME ELEVATION 100' j+')!1' ter BEST GF10 -8 ❑ BOREHOLE O WELL. H. R. P, MEe as Benchmark 98' Property Line .M\ 1 #1 Scale = 1/4" = 10' unless otherwise stated 2 acre parcel 104.0' 105' 103' Huffcutt Combo Tank 101' B.M. #2 Pro 3 Bedroom _. __.._ _ B _ House 457' property line Grading is to be done to divert run -off away from system Well is to meet all B _ 10% Slope setbacks found in _ Comm. 83 Not use or Area 15' below system is esigning to remain undisturbed Ledde is to joperiy anided with own with approve g labels Kreuzinger Rd B -4 w PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS P.O. Box 176 New Richmond Wi 54017 NW 1/4 S E 1/4S 5 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX SYSTEM ELEVATION_ 105.0' 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R-P. Top'of Survey Iron ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL, H.R.P. Same as Benchmark 98' ProQerty Line B.M. #1 Scale = 1/4" = 10' unless otherwise stated 2 acre parcel 104.0' 105' 103' Huffcutt Combo Tank 101' B.M. #2 Pro 3 Bedroom _ _ .._ _ B - 6 House 457' property line Grading is to be done to divert run -off away from system Well is to meet all setbacks found in B B-5 10% Slope Comm. 83 Not used for Area 15' below system is designing to remain undisturbed Tank is to be properly bedded and provided with lockdown covers with approved warning labels Kreuzinger ❑ Rd B -4 i Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i s co n s i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 18 2007 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/18/2009 Identification Numbers Transaction ID No. 1415609 SITE: Site ID No. 727710 Oevering Homes Please refer to both identification numbers, 526 Kreuzinger Road above, in all co oncience with the agency. Town of Kinnickinnic St Croix County - NW1 /4, SETA, S5, T28N; R18W - - Lot: 1, Subdivision: "A" FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1141262 Maintenance required; 600 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual -Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, COMM stats. APP The following conditions shall be met during construction or installation and prior to occupancy or use: MENT Reminders OF • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRE component manuals listed above. W � • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The minimum distal pressure at the end of the distribution lateral is to meet three feet. This amount of pressure will supply a discharge of 0.72 gallons per minute through the 3/16 inch orifice. • The well must be a minim of 25 feet from any POWTS tank, and a minim of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19 Wis. Stats. SHAUN R BIRD Page 2 7/18/2007 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A co-py of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 11, Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. I Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 7/ 2/07 Owner: Oevering Homes LLC Location:NW1 /4 SE1 /4 S5 T28 N,R18 W Lot 1 Kreuzinger RD Kinnickinnic System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section��� 6. Pump Curve ~ V 7 -8. Maintance and Contigency plan OFC E y 9 -11. Soil test �p Shaun Bird Signature I L License numb 26900 RECEIVED JUL - 5 2007 SAFETY & BUILDINGS NO Date Non Waxen Mter Fabric 4 Observatior pipe Perforated �Distribution Pipe Below Filter Fabric AM C 33t�ni , t� Topsoil t = = - == =c •II 1 � ' J j 7. Slope Bed at Forte Main Pio�wed ` �� z From Pvmp Layer • Drain �tcck ' ,=B s Grass S tion Cif A Mound 'S s;em F LJs - A Bed For The Abs" p tion Area S1C Ft_ [ v:S W �; ® 2• - - t. d obs ervoiion pip,- _j� - r.K _ r---- -- -------- -- �_r�-- -fir- -w��v� � 'o Forca Moir a +- _-------------- - - - - -- From PvmP ° D's i sitl� $eS of �z '2 Pik Drain Rock 40bservation Piet C� Ptrtattrrent 1�[atktr . %; Plan itw Q w flint #sin d Bed for The Absorption Arso AWL Fesforaded PiDe Deta eaa vs.r �' tiafss ;,asatse Qa 8atso+u. �j •� Are legm*'Y S009*e f- at �� Q d� Ir } r PvC f=ocs: Udift PVC P;pe t++oe r Owssr; P i pe t.aYoa Fi. X e v IIWh*s Y .. Inches' Role Otameter � �1� Inch Signed: Lateral " Z Inch(is) License Humor: Manifold des Date: Force Main.* ire$ :avert Elev ,4tian of Laterals,�r SEC 'TANK �'c1tl Cli gER C IMS CXTI A SpE lip PROVO y Dom, MG L&BEIL His- T CAS- � f a tc L OWN"- c C pipe cow Foam 8kr - €� SK $ ?�T tTnD� EVE PAID g pZFI' {� DAY= {;#B DOSS' f IC 4 - cam` #C �, 9 , ionewtz GO = 16_2 VAC �s �= — R S'LR£3? }� SoC�z $' Erx Puts ds F Arm - O ;ACTM ►�. T�F�F' ' £ Y PR S50RE - i4'Fi- �� £ = 1 st 0 FEET or ^t$$ i 1 HP' LasOrJet 3100; T 715 a tstsz! ; JOV 9C.H S ERIES ,SUMP /E:F`F L-UENT PUM ' o $per ° , a c am N ai iv 4 q 2� 911 zllbszS9a 2 L ML in 1066 hs 6+ is 41 Qa �0 act +yr8 t15 54 S Al 32 in w X11 stlb6zi9e SOU 0 aft 3fQ 230 3k fii 1006 36 64 55 n 32 lu w 77 $t1 z116ez69i w 115 39 13m 1000 7 0 $ zYtSiz Zoratamus�r�tamef— rtPaefi�tilb �wa�rD��rse eaea�tlo1����r�ttl�o9 »aibid�+OmACS' CAtli' — ruction toa�;d C� Trop FLOW- LITERS/HMA A+4atar HO 20 3 Tmpcl stetisE POT Carborms - _. Closed vow . 3tr to VOlttu ABS - m Power Cold Niftily' with carbon and Ntechanicst Shafg Scat gamic fiws _ — s - ... Stacri3tss S'teet' . ......_. �+ Pasteaexs - shaft B rainkss Sett z z s - - --- — upper Sieo t ate. L gm Bait Beatings 6 c 20 so . so FLOW cALL04/sMac �� fii "t ftMp WO PuW PERFORMANCE CURVE rAams IWO- Oldebolocky. 731 4'D Fam W6236 070 www utuec4=tYumP.comE Pam & MANAGEME _ UAL AGEMEN T PLAN POWTS oWr4eWS mAN SYS'tE.M SPE(;jFjCATI0.4* SeptiaTank vD� i3 l+iA �o -�orc ( raA Owner se0cTank lam � P�� tl =lam 13 NA Effluent FMK hu 7 G'�ir- 8. Q NA tamtw of Bed ,19.NA Pump - ThA ��` o 10 NA � Malt NA p�m Tsank . Nulty of Co�t>m� U P NA EgMaW 50W . PuMP ,s- 0 Q e ti, (P - t� x 1. Pump (Model �a 1. urss� Mae pro Peat Faber Sod 11pPO' aysca9e� F Qcrai' M cuz�iY L3 SartdlG: An 0 ttifetiand tsttlit� D M II ogler. " P.dr Oii & Grass S.M Mg/L 0 t3WMfecWn Demand ,,&,, � MorithiY $'gage [3ispetsai LAM I3 In -qNS� a� O D (BE3Ds) :530 mg/- Q � t8de ©Other - Total Suspended S� £� s' Facet 000=, if3` dull f?Omi wad mind � rnesn) vaivastoraoez�f�� Incchstlasneter ss M� � ParWe Sloe Aor "' "' SCE SCHEDULE sonic* FregUoncY urn 3 yrs.) � Event � � months s} £Maxfira At feast once evesv, (sue 40f tank v oats and inspect cpnd Son pf tank{s when combfned sludge and scum e9 year(s) 01WIMIXIMUrn 3 yrs PUMP out conosrzts of UU N(s) once every C3 rstostths At least rncnths s} Waped dlspenug ceiKs) At feast once every • s) p MA clew >� least onoe e+sY 3 n maw s) o MA inspect Ptunp. PMM alarm ante every i3 rnatsths and ten At least Q tenths t3 y�ls) 13 NA piusts taf� At least once every Q II yews) E3 NA At least once every onwc �e' one of the t ar MAINIMNAWE iNSTRUGTtDNS t rn2�de try an ind"tviduat carrYinB f ,a yy -g �; Sew insp®d� o#tanja and dISS M fit '' � R SeveEr% POVV S �rss � g of t s t? �der�Y any for any back UP c tiutst ittdude s visual tnsPec�on of lthe lac+l as cif and Set++ Mg t:t+er tote volume of combined sis�e to cwt to of luerd iraed�, � ; ar teaks. Sh d COWS) at=oll ' inspe me Pow of slit an to or ffi The 9n rsd - pondlkV effluent txt t!!e n ' of the k� in ft o� P and cttectc and regeytt�es the irnmediabe t2�k y,Qiume, gMVW ststfx* nw Nufkate a taking m in any tank eq�$ 0116third 0 1 . 00 wth Of- NR Who tile= r3 a# sittdge a S"'Ien3 p¢etaflDr and ds of in of the w* shall be Mmoved - nt ne , a nd MY 1�3 !� t ar prWscfrtzed f 1•S camPecteffo W by a�� P0wT5 Maw The � of e}�Mg fls. tt 12 mouths or fees shalt be . sett dent. c>tttexmatrlterea�� ar�� � ��ie last ����' authatiiy wiifrm 10 d� of �P�on of arty . A te�xxts�ibe � lCM Or aMer . START UP AW OPER 770N zrse of Etta POYYTS atl�ertt tank(S) itx (s P am C89 ff high ff For new o . Pb anator dsmdge the d esPOSW imoode 90 _ dt hay$ t c�rttents the ,,.d by 2 septage servFcirtc3 ° A� to i not r�oczrs 5 "j - scions are f wn at th infaratnre surfam std up stta� above nonna4 hQhwatier begets. is tesOxed the a Wes DwM P� P te� cea(s). in one tatge dose, ovetfo8d the �S3 WA Y in the Wasm"Wr yet be To w OW Cgs � have the c� ftnts cf the pciM fw* renzovect by a pciot� a to rite effluent pump cx canter a Ptsst:�s or PE�f+V'{S �� t fti m� � Me POW � to t�Df is t]OfiT3a[ fevpLs ilKitX?itT ff �!� �'- { ! dmAe G' pa t Ott mid 1 �. io not dfive of park MG Or i�� di�f b Or COtitPa tie am Wab 15 feet draws spa of M W mototd or at -grade soft absorgflon arts - the w•astetsraw strwIn may irnprow th performance Mild � to ffe �ed�on or-e srltrsadc>n oftF s - the buds; condoms; cOtton swabs deg : & 11W 10M . & OW of the � �l vet'; tut and vaegeW;fe pew � � m d� tat tncsida dhil {stoup P 3 scram r xMfiC2 arts d$ pi- pfo d u cw, pesfidldes� sardbiry napWris: tamPons:'and v" ower bm ABANDONOMENT 1W taken to 3n we that the y ,-,„ is fte t die actor is r JOfwrlero- with ah COmm 83.33. Wry A�itl nistrat�i M Codec � �,�,� s� � in cam • All p4** tea tang and pns shat! be drsoonnecaed and the abandoned Pipe ogentW • . Th 000 of sit tactics and pets shall be- removes and pmpertf d of by a SOPWQB SMICkV operafar. After PEmVW. air t wg= 2nd pg shag be excavated and removed or #Herr covers rewavedand the voW spate Sod with sort, gm el or anoMer inert suftd mataffaL If t BSfO PL mi Sty foff*wing measures have hertz, c c arrest be taiceri. to Wouk e a code If the POYYTS Ws mi d rra3ttat be compt� 0 A she rspiacetTtertYar+c'a has been evaluated and r»ay be uMized fDr the Iora€on Of a rat W3 awn systwTL The r at area should be protected ;Yom disturbances arbd � riot be &Mi Ved upon by nxusad _ frprn es _q and proposed stwciu prolea the rephicenumt. area wM result in the nedd for a new soil and sib= evalualinss to estabEsh a suitaabte rapfacernent S'e'a RepisCrrtent systems must Comply vArn the rules in effec# at S'ta% *ne. Q A SLAWe rPta�nent Vra2 is not avasZabte'due to setback and/or stir fsmitationrs Sang advances kn POWTS ftclmology a ho1cft tank nt be vmWed as a last resort to replace the €ate PO VVTS- The site eras riot been evaksaod to lderrErfy a suitable replacer nt area Upon tanum of the POWTS a soi{.and srte e+rafuation tiros# be pew an>a is avaiiabte a, - So locate a' suitable replacezTtesxt area €f r:a na,oar � t= drip tank nW be InsUded as a last resort to replace the failed POWrS � of rile biornai at - — &uxnvd and at -graft soff abs�OSt �s s b r rts mu t c arn Fr: place fire �sre surer, of suciv systems must tarrsf�FY vrith lire cities ut effect at � frn� SEPTIC, PtftttFP I1NE7 OTHER TfZEATMS4T TANKS WAY CONTAIN LETKAL GASSES , R f11FSi1FiFtGiIIS [ i" OXYtit3aL oo tEQT 0TERA 8' MMC, tst j%p OR OTRER TREATMEW TANK UNDER ANY CIRCUMSTAMCES- DEATH MAY RESMT- , RESCUE -OF A pERSCM r~ROW THE INT OF A TANK MAY BE DIFFICULT OR EP.OSSMLE- ' ADDIi7OMAL tO� POWTS INSTALLER PflWTS AINTABtF.R E Puttee 7 L �' -r P M 7 77 i OPERATOR FOCAL REGULATORY HO#�lTY Agency ' 54' C rt, A b' Phone 7f�r= ..3�?6" 6 rnis dos xnenix�s dratted barge starts offt GUM Lam- � W rs d W=mfw County ZDaV MW SX& 'Wa - ' ttx set of dr. Cac�ra si.?z�t3pX =X6tadff � � -�{i). C�1 & �J. Wisconsin AQ[rs CacFc iJse oaf tfrlo dccunxnt Qoes � gvasaatee tfit perfaamrcoe of the IBS. C4 6V MV 1) waamlin Dspaen+ent SOIL EVALUATION REPORT D&tdmcfsawand Bukkw in acooba= vast constt W vWs. Adm. Cade county St. t2srriht: Attach ow0ata sale Oman paper not b0 than 8112 x 11 irtchea in size. Pier must bwkAe but not linrI m tO: vertical end hat ooroal retsrsrtce pOlnt tom. dir x*m and Pavel ID. pwoert elope. scateore menei�ne. noMamm. andkagmwWdWw . tordwmat md- 2?r Please pfft SN NtliorntaftL Dom �«.�� al eev.. a�. .�+a.�ra+w�s�r�..�..+eat +a�+»i. '7 � Propervowner P` po yLocation gals ZBwislak- -Fried Lea>ettz Clout. Lot NW 114 SE 414 8 5 T 28 N R 18 ElKW Property OmWs MWft Addmm -, Lot # Blm* # Stdhrl. Wwm or CSANa City 51ase� Gods 1 Viaps � : , . 1- 587 -5378 �p N JQ r 3 to 4 Coded mmidesipn law rata 450 to 600 CsPD New COrtstnhciort l : Resider#el t AYmh6er of bedroorr�a Replace rott '0 PdAcormmmsrciat -Dawn m Parent metww Loess over glacial t$1 sad bedrock Flood Plain sleAbm if appticWft » w 1L rmrmw and reaotmrts<tdteiorx TES so& report is to provLde add dorsal infarmadon to a soils vaport dated 12 -06-02 ft Fred lAwmtz. As the site was diwattied due to road building acdv& — cs, additional bon have_bmn descrdte I for an area edisci a� die odgmg am. Pam Quin from &a St. Croix zoamg ofte has been molvediww1befic madition alaettvttms. mw site is sO suitable for a MOUND SYSTFM. # 13 L'9 Pit Cahrhdtsurfacaelev. 200.20 R Oeputm Sol Rate Hwitron Depth DombwgColor RsdoR Description Tatdua try Roots WON F� an. Hansel! Clu. sr. Cate. Color 'Em 'EW2 1 0-18 10y:w - si1 ktk mr ew 2f .6 .8 2 18-20 l0 - lmsbk mfr cvtr if 6 .8 3 2045 10yr414 sicl lmsbk mar car - .2 - 4 45 -72 7.SyrV4 N O ml - .7 1.6 D �8 # + ft GrOUrtd etxtare etev. 104.75 11. pepeh b ItttBirg fect0r in. 8011 Rats HwIman Depth DominartColor Redox Desor"m TORUS 3tluck" carlablenm 19aatdery ROOM CaPOW in. Mutest Clu. SL e4a cow Sr. ss. Sh. 'Eff#1 *EW 1 0 10yr312 - sit 2msbk mfr cw 2f .6 .8 2 8-25 - sil 1 - Mfr ew if A .6 3 25-35 10yW4 azo r" Sid lmsbk mfr cw _ Z .3 4 35-45 OFMOM • F_flluertt #t • 190D > 30= 710 nglL. and TSS >3D :150 m9 L ' t Maw t #2 = POD S 30 wet and TSS < 30 ma L CST Name (Passes Arm) swat" CST Number Thomas C Nelson 227387 Addms Date Evaksalon Conduced Telephone Number 1432 120d Street, New Richmond, Wl 2127105 715-246-2454 Anw M'A IAMWA anACA AAnu Ann OT1 w .7 TA• IA "INT Property Owner Cbris Zawislsk --Fred Letts Parcel 10 #c Pao 2 or 3 F 7 1 ��� !:1 Pit Ground surtsaselev. 10125 Ito t�mr in. W Reis Horimn Depth Dominant Rsdox pseviption Taxwo Shames Conswe cs 8=xJery Koala GPOW in. Munae! Qu. Sz. Cont. Color Gr- Sz. Sh. •EW1 •EEti2 1 0-27 10y" - siI 2n�sblc m5 ' 2f .6 .8 2 27 -36 1 4 - sil 2msbk mfr cw if .6 .8 3 36-43 I0yr414 c2d5yr% Sid Imsbk mfr ' - 3 4 43-50 _ BEDROCK !t 7� � # pit Gro uid sudwe el 107.50 E. Depth tolirrilft tsdor vin. Rate i{orbm Depth Dentwmnt cow l tedon D"Mipson Teat! M Structure Consigenos 8ov 4" Rools GPOW 1 � L in. munser Qu. ft Cont. Cow Gr. ft Sh. 'EM '6Gitl Ad 1 0-9 10yr3/2 _ ail cw 2f .6 8 0t� 0 2 9-17 ij 1 cw if .2 3 3 17 -25 1 6 m5 aw 0 A 4 25-40 BEDROCK fL en 1 1. �D Pit Groundaurtacs elev. tt. Dspth to IimEnp>iECtor in. Soi Appka&n Ra/e Horizon Depth Dominant Color Rsdox Description Teodtus 9irudure Consistnoe 00rdery Rom In. munsel Qu. Sz. Cana. Color Gr. Sz. Sh 'EtDit1 *Em • _ > < end TSS � < 150 ' Edlusrrl #2 = am,:S 30 n WL. and T8S 130 nV L Etikrent#'t BDO 30_22DngM1. _ �L The Department of Cot>urt=* is sa equal opportunity service Provider and employer. Ifytyn aced assistance To sours services or need material in an amr ate: format, plow cordact the department at (M-266 -3151 or M 608 - 2644777. ex wos3ror ptM� nnn I� nnn: nnn n♦ • urn.• rn • w nn • • w .nn .. w wiSlak Chris Za So" 1'. 40• mm v oflron We IW-W Lot 1 Bw Top of iron *9 68.80' B41aa B5 104.75' NW1/4, SE1/4 Section 5 ss 1a1.2s' 87107.50' Lot c;orn,6e BM1 i 186' 84' Dice to lot corner at 14' 457.02' 7Q' B6 Bb2 1 sbpe 2 B5 B7 I B4 X02 7Apfw N"a 106' 1� ' 1w I - - -- - -- - -. - -- - -• -- --- ..__ Wisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. en g percent scale or dimensions, north arrow, and location and distance to nearest road. ZZ-- Please print all information. evie Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). (a 6 Property Owner Property Location Chris Zawislak- -Fred Lenertz Govt. Lot NW 1/4 SE 1/4 S 5 T 28 N R 18 E W Property Owner's Mailing Address Lot # Block # Subd. Name or CSW City State Zip Code .- one Nu r ity [:]Village R Tow N t R �zW� 6 - 587 - 5378 J�+� uh K N Q New Construction User Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD © Replacement ® Public or commercial - Describe: Parent material Loess over glacial till and bedrock Flood Plain elevation if applicable NA ft. General comments This soils report is to provide additional information to a soils report dated 12 -06 -02 for Fred Lenertz. As the site and recommendations: was disturbed due to road building activities, additional borings have been described for an area adaL* t to the original one. Pam Quin from the St. Croix zoning o ice ' Gas been involved with these additional activities. The 31 — '' - " -7 site is still suitable for a MOUND SYSTEM. 1 Boring # ® Boring Q pit Ground surface elev. 100.20 ft. Depth to limiting factor >72 in. Soil A icatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -18 10yr3/2 sil 2msbk mr cw 2f .6 .8 2 18 -20 l 4/4 sicl lmsbk mfr cw if 6 .8 3 20 -45 10yr4/4 - sicl lmsbk mfr cw - .2 .3 4 45 -72 7.5yr4/4 1s Osg ml - - .7 1.6 I 5 ® Boring 104.75 25 rl Boring # 0 pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots !GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Et 'Eff#2 1 0 -8 10yr3 /2 sil 2msbk mfr cw 2f .6 .8 2 8 -25 sil lmpl mfr cW if .4 .6 3 25 -35 10yr4/4 c2d5yr5 /8 sicl lmsbk mfr cw _ .2 .3 4 3545 BEDROCK ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nam (Please Print) Signature CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, Wl 2/27105 715- 246 -2454 I Property Owner C hris Zawislak- - Fred Lenertz Parcel ID # P ending Page 2 of 3 Boring 1 Boring # Q Pit Ground surface elev. 101.25 # Depth to limiting factor 36 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0 -27 10yr3/2 - sil 2msbk mfr ew 2f .6 .8 2 27 -36 I 414 - sil 2msbk mfr cw if .6 .8 3 36 -43 10yr4/4 c2d5yr5 /8 sicl lmsbk mfr cw _ .2 .3 4 43 -50 _ BEDROCK [ ] Boring # Boring 107.50 ��'/ ' Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff A A #2 0l� 1 0 -9 10yr3 /2 - sil 2msbk mfr cw 2f .6 .8 2 9 -17 1 10vr4/6 sicl lmsbk mfr cw if .2 .3 3 17 -25 10 4/6 c2 5 r5/8 cl Om mfi cw - .0 • 4 25-40 BEDROCK F-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. *Eff#1 *Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 609- 266 -3151 or TTY 608- 264 -9777. SDD- 8330Test (R.07 /00) Chris Zawislak Scale V = 40' BM1 Top of iron pipe 1o0.00' Lot 1 BM2 Top of iron pipe 99.60' 1 0. 7 5 ' NW1/4, SE1/4 1 Section 5 B5 104.75 B7107.50' Lot corner BM1 186' 84' 14' Distance to lot corner at 457.02' culdesac 70' Bly2 B6 10 slope 26 ' B7 B5 m �--_ 8 7' B . 7' 4 ymwqu 1 �, 104' 102' 100' CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1 /4 OF THE SE1 /4 OF SECTION 5, T28N, R18W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN. PREPARED FOR: SURVEYOR: FREDERICK LENERTZ THOMAS M. HEALY 220 LIVESTOCK S do N LAND EXCHANGE BUILDING SURVEYING, INC. ST. PAUL, MN 2920 ENLOE STREET 55075 HUDSON, WI 54016 SURVEYOR'S CERTIFICATE I, Thomas M. Healy, Registered Wisconsin Land Surveyor, hereby certify. That I have surveyed, divided and mapped that part of the Northwest Quarter of the Southeast Quarter of Section 5, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, described as follows: Commencing at the east quarter corner of said Section 5; thence South 88 degrees 04 minutes 02 seconds West, assumed bearing, along the east —west quarter line of said Section 5. a distance of 1290.85 feet to the northeast corner of said Northwest Quarter of the Southeast Quarter of Section 5 and the point of beginning; thence continue South 88 degrees 04 minutes 02 seconds West, along said line, a distance of 1290.84 feet to the northwest corner of Southeast Quarter of said Section 5; thence South 00 degrees 09 minutes 03 seconds East, along the west line of said Southeast Quarter of Section 5, a distance of 226.26 feet; thence South 72 degrees 14 minutes 57 seconds East, a distance of 570.60 feet; thence southerly, a distance of 111.53 feet, along a non — tangential curve concave to the east having a central angle of 27 degrees 25 minutes 29 seconds, a radius of 233.00 feet, a chord bearing of South 14 degrees 29 minutes 31.5 seconds West and a chord length of 110.46 feet; thence South 89 degrees 13 minutes 13 seconds East, not tangent to said curve, a distance of 66.00 feet; thence northeasterly, a distance of 268.12 feet, along a non — tangential curve concave to the southeast having a central angle of 91 degrees 59 minutes 22 seconds, a radius of 167.00 feet, a chord bearing of North 46 degrees 46 minutes 28 seconds East and a chord length of 240.24 feet; thence South 87 degrees 13 minutes 51 seconds East, tangent to said curve, a distance of 531.48 feet to the east line of said Northwest Quarter of the Southeast Quarter of Section 5; thence North 00 degrees 15 minutes 11 seconds East, along said east line, a distance of 412.75 feet to the point of beginning. Containing 10.91 acres, more or less. Subject to all easements and restrictions of record, if any. That I have made such survey by the direction of Mr. Fred Lenertz, owner of said land. That such is a correct representation of all of the exterior boundaries of the land surveyed and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the subdivision regulations of the Town of Kinnickinnic and St. Croix County, in surveying, dividing and mapping the same. 10AF Thomas M. Healy, S -2546 THOMAS M. {'t Date: April 1, 2003 9���3 HEALY 3-2546 HUDSON, W DS O Q -�. SUB Each parcel shown on this map is subject to State. County and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the Town of Kinnickinnic for advice. An erosion control plan will be required by the St. Croix County Zoning Department prior to construction. THIS INSTRUMENT DRAFTED BY: WILLIAM KANE JOB NO. 6000 -18 DATE: 01/16/2003 REVISED: 04/01/2003i9/s/ SHEET 2 OF 3 SHEETS Vo1.17 Page 4617 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1 /4 OF THE SE1 /4 OF SECTION 5. T28N, R18W. TOWN OF KINNICKINNIC, ST. CROIX COUNTY. WISCONSIN. PREPARED FOR: SURVEYOR: FREDERICK LENERTZ THOMAS M. HEALY 220 LIVESTOCK S & N LAND EXCHANGE BUILDING SURVEYING. INC. ST. PAUL, MN 2920 ENLOE STREET 55075 HUDSON. WI 54016 OWNER'S CERTIFICATE OF DEDICATION As owner, I hereby certify that I caused the land described on this Certified Survey Map to be surveyed, divided mapped and dedicated as represented on this Certified Survey Map. I also certify that this Certified Survey Map is required by S236.10 or S236.12 to be submitted to the following for approval or objection: Town of Kinnickinnic, St Croix County Planning, Zoning & Parks Committee. Wit ss hand and seal of said owner this �^ day of n\siN�ou 20 �Z In a resen a of: Fr tck L z State of Wisconsin) County of St. Croix)SS Personally came before me this >aNh Ooy of� 20 - the above named Frederick Lenertz, to me known to be the pers n ho ex"Y1E!LH" "lVa% foregoing instrument qipd acknow dged the same. ` ��`` "��R Notary Pu 'lic ,Wisconsin. NOTARI- My Commission Expires _ • i •' uj; .. f'UBL1G r o TOWN BOARD RESOLUTION Resolved, that this Certified Survey Map in the Town of Kinnickinnic, Frederick Lenertz, owner, is hereby approved by the Town Board. Mary Murphy Date Town Chair I hereby certify that the foregoing is a copy of a resolution adopted by the Town Board of the Town of Kinnickinni C /ate /o Carole Hoopinan Date Town Clerk ON��� THOMAS q ' 03 HE Y 3- HU Q WI l �0 THIS INSTRUMENT DRAFTED BY: O S U w V WILLIAM KANE JOB NO. 6000 -18 DATE: 01/96/2003 REVISED: 04/01/2O03jg13/ SHEET 3 OF 3 SHEETS Vol.17 Page 4617 1 illlll 1!111 lilll 11111 11111 Illll Ills 111111 IIII 1111 * 8 5 5 4 8 1 2 State Bar of Wisconsin Form 1 -2003 85548 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DocumeniNumber Document Name ST. CROIX Co., WI RECEIVED FOR RECORD THIS DEED, made between Christopher R. Zawislak and Laura T. Pope, both 07/12/2007 04:15PM single persons, WARRANTY DEED EXEMPT I ( "Grantor," whether one or more), REC FEE: 13.00 and Oevering Homes, LLC TRANS FEE: 147.00 PAGES: 2 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Recording Area needed, please attach addendum): RETURN TO: See Exhibit "A" Wisconsin Assured Title, LLC 1810 Crest View Dr. #1 B Hudson, WI 54016 5,, oZg 022- 1012 -90 -050 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements and Restrictions of Record. Dated July 6, 2007 (SEAL (SEAL) hr' . r Zawislak * Laura T. Pope (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) C till STATE OF WISCONSIN ) NOTARY Pd!31=10 authenticated on ) ss. St. Croix COUNTY ) * Personally came before me on 3uiy 6, 2407 , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Christopher R. Zawislak and Laura T. Pope (If not, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instru�t and acknowl ged th am THIS INSTRUMENT DRAFTED BY: Michael H. Forecki, Attorney * Connie S. Smith Eau Claire, Wisconsin Notary Public, State of Wisconsin My Commission (is permanent) (expires 1/16/2011 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 *Type name below signatures. 1 of 2 LL9ti abed LL' ¢ M„ZO,1 HY38 Ol 03Wf1SSV N to .- N N U LO 'S NOLL03S d0 3NIl */L LS3M- o N 1° C6 ° t g w 3H1 Ol 030N3N3J3N 3NV SON18V39 lW W U) Z 6 U) 33wW W �� � M otn°OCOOOC } 7 w >? 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Prope1ry Locatlon Lot # Subdivision �— l ' Volume Page # Certified Survey Map # . Page Warranty Deed # s , Volume a no Lot lines identifiable (yes no hoes Spec �� SYSTEM Mp��'tT;NANCE AND OWNER CE12TICATION failure no handle wastes. Proper er use and maintenance of your septic system could result in its premature a licensed pumper. What you put into Tmprop tic tank every three years or sooner, main if needed. by maintenance maintenance consists of pumping out the rep disposal system. Owner the system can affect the function of the septic tank as a treatment stage in the C w lisp Ordinance - responslbilities are specified in §Comm• 8352(1) and in Chapter 12 - St. Croix County Sanitary & Zoning Department a certific�°aform, signed by the s to submit to St. Croix County Planning vc5,g that (1 }the on site T proper O agr ee lumber, restricted plumber or a licensed Pumper sepfic tank wastewater disposal system is in proper operating condition and/or (2) after inspect is owner and by a Hassler plumber, journeyman p on and pumping (if necessary), i less than 1/3 full of sludge. pr .sewage disposal system with the I/we, the undersigned have read the above requirements and agree to maintain the pri of Natural Reso urces. State of Wisconsin. standards set forth, herein, as set by the Department of Commerce and the Department Certification stating that your sep completed and returned to the St. Croix County Planning & tic system has been maintained must b Zo ning Department within 30 days of the three year expiration date. I1we certify that a ll statements on this form are true to the best of mylour knowledge. III andam the owners) of the prop described above, by virtue of a warranty deed recorded in Register of Deeds Office. DATE � SIGNATURE APPLICANTS) ult in the san itary is resented may resitary permit being revoked by the Planning & Zoning DeP�eui. * ** * #* Any information that misrep resented a recorded warranty deed from the Register of Deeds Office and a eOgy of the certified survey mag if Include with this appli reference is made in the warranty deed. (REV. 0810 File No.: 11912 EXHIBIT A Lot I of Certified Survey Maps in Vol. 17, Page 4617, Doc. No. 740871, located in part of the N W '/< of the SE '/. of Section 5, Township 28 North, [range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin Tax ID #: 022 - 1012 -90 -050 2of2 FROM :OBJERING HOMES LLC FAX N0. :7155311282 Dec. 14 2004 10:14PM P11 -- ---- - - - - -- - - -' � '� � • 171p1p s.r s.s V1 H N � msp 1 I • 1ppy,1 J 1 � A 1 1 M FROM.:OEVERING HAS LLC FAX M0. :7155311282 Dec. 14 2004 10:14PM P12 INA Cp N � r • w ` IZFN # 1 --- ------------ _ r 1