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C ' n o o o m o 0 o ° C co N O • f�D 7 .. C A 7 N 7 3 l' f rn 0) A a ° m N z m a ao ° ►p+� c W W .P c d ai w to 3 1D i i '< ' 0D N n CL a N 000 c coT y M m ° Ao 0 W W T C A N `< J C ° a o m l 3 ' o I e O <o co <D m cn v y a 01 CD a M D a a) m co a c'o y �' a v CD v = ( v W _ C m c < N 3 O°^ p A y 3 cL .a O N — CL A A L CD ° O W W N A? a 0 Q lr C M lr O 0 S A OZ 0 ! _a r il O v CO w : CA CA o o N rn o m o_ m � CD V i l o o m m �� �� OD l H o n co H a _ I =L e� c rn o �+ W F A fD W CL CL CA z rn z `v 0 O D D o O D D o N M l�l l o' CL o a l�1 • ' CD N W N M EL C C z � Z c N 0. N O �_ rt w ! �' z 0 a j Z N o m� o0 o m aeo _' CL 9 C + A $' 0 z 3 3 co 4J dl z CD N I A W 7 W 7 � .Nm a ° m a N �� o a oo Cn 0 0 aO O m 3o C c m m m CL ao N m m _. rn 3 * Cr ° 3 o CD :3 m m o b � a °- a � � m 2.m o CD m ° o = ti CD 0) CD N S"a oa ° o o� an a O 3 ° m o 3 o o A m 'm v> O to O +. CD m I 0 ICL I o IM ti Laibor and'lHu man Relations i a Industry Labor SOIL AND SITE EVALUATION REPORT Page 1 of 3 'Hu Rel Division of safety & Buildings In accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION– PLEASE PRINT ALL INFORMATION REVIEWED BY PATE PROPERTY OWNER: PROPERTY LOCATION Harlan Brenden GOVT. LOT NTj 1/4 NE 1/4,S 8 T 28 ,N,R &or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 22986 Plateau Dr. 7 n a I Sle epy Hollow CITY, STATE ZIP CODE PHONE NUMBER [ E]VILLAGE EITOWN NEAREST ROAD Lakeville TV. 55044 ( A a I Kinnickinnic Coulee Tr. k* New Construction Use [xk Residential / Number of bedrooms 4 [ j Addition to existing building L I Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 2 bed, gpd /ft .3 trench, gpd /ft Absorption area required n/P bed, ft 500 trench, ft Maximum design loading rate .2 bed, gpd /ft .3 trench, gpd /ft Recommended infiltration surface elevation(s) 102.24 ft (as referred to site plan benchmark) Additional design / site considerations n/a Parent material groun moraine Flood plain elevation, if applicable n/a ft F u = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK = Unsuitable fors stem ❑ S tau as ❑ U I ❑ S iaU ❑ S faU ❑ S iiU ❑ S fR U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourriaty Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -10 10yr4 /3 none L. 2/m/gr mfr c/s 2/f .5 .6 1 2 10 -20 10yr4 /4 none sil. 1/m /sbk mfr g/w 1/f .2 .3 Ground 3 20 -32 7.5yr4/4 none SL. 2/m /sbk mfr g/w 1/f .5 .6 elev. 99 ft. 4 32 -49 7.5yr4/4 c2d 7.5yr5/6 SL. 2/m /sbk mfr g/w 1/f .5 .6 Depth to 5 9 -54 10yr4 /4 c2d. 7.5 r5/6 sil. M n/a na/ n/a n/ n/ limiting factor 3 " Remarks: Boring # 1 0 -13 10yr4 /3 none L. 2 /m /gr mfr c/s 2/f .5 .6 2 2 13 -24 10yr4/4 none sil. 1/f /sbk mfr g/w 1/f .2 .3 3 24 -29 7.5yr4/4 none SL. 2/m /sbk mfr /w 1/f .5 46 Ground elev. 4 29 -52 7.5yr4/4 c2d 7.5yr5/8 Sil. M n/a n/a n/a n/ / 99 ft. Depth to limiting factor 29 Remarks: CST Name: — Please Print Phone: Gary L. steel Address: 155400th. Ave New Richmon WI. 54017 Signature: Date: CST Number: �:�2 = 4 '�� 6 -11 -93 2298 PROPERTY OWNER Harlan Brenden SOIL DESCRIPTION REPORT Page ?.,of 3 PARCEL I.D. # , Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -12 1 r3 3 none L. Z m r mfr c s 2/f .5 .6 2 12. -26 10yr4 /4 none sicl 1 /-f /gr mfr g/w 1/f .2 .3 Ground 3 1 26-51 1 5/4 c2d 7.5 5/8 sil. M n/a n/a n/a n/ n/ elev. 101 ft. Depth to limiting factor 26 Remarks: Boring # r mfr c/s 2/f 1.5 .6 1 10-10 10yr4 /3 none L. 2 /m /g 4 2 10 -2.2 10yr4 /4 none sil. 1 /f /gr mfr /w 1/f .2 .3 3 22 -32 7.5 r4/4 none SL. 2/m /sb1c mvfr /w 1/f .5 .6 Ground elev. 4 32 -52 7.5yr4/4 c2d 7.5yr5/6 SL. 2/m /sbk mvfr na/ na/ .5 .6 101 ft. Depth to limiting factor 32" Remarks: Boring # Ground elev. ft. Depth to limiting factor T--F Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: S13D- 8330(R.05/92) v I STEEL'S SOIL SERVICE J -5-5 1, —2-0-0- - tai -. Ave. Gary L. Steel Harlan Brenden C.S.T. 2298 1 1 N[a,.,NE S8- T 28N -R18Ta New Richmond, WI 54017 MPRSW -3254 town of Kinnickinnic (715) 246 -6200 lot #7, Sleepy Hollow ��.. LOO DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: T !WNSHLUMUN I CIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: l Wv) 1f 1 /4 g / 1 a6N /R19A(or)w SL ► W COUNTY: MAILING ADDRESS: 5 YOi Ke�-I �(tihr.edy 315 rv, 4'`' 5T ucv i'aQ to S!o Z 2 USE 7j,5 - 42S - 4 G DATES OBSERVATIONS MADE NO. BEDRMS.: I COMMERCIAL DESCRIPTION: PROFILE IONS: PERCOLATION TESTS: Residence Ri New =Rplce RATING: S= Site suitable for system U= Site unsuitable for system CONVENT L: M N RE: S ONAOUD: IN-GROUND-PRESSURE: TAN RECOMMENDED SYSTEM: (optional) El S 0U � S 0 o S ,�U El OU o S �u K: mowyy If Percolation Tests are NOT required DESIGN RATE: 4 If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Fl indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B l 54 1 D2, 0 -lo" C3k S;/ 1 0 - G4 ,5 r t 18 -34" a.. ►T.tb 3 L a- SL "4TQ, 39 1`IOHE 31 SCLL wlmofflfS 0 - 8 ' ek5: f 8-�S" � G7. SL �S "�8 Q« S r � �J/c�G v a � {Q N Rk w B- 2 5 t o t ,39 N oU z g s 1. w /4 4o -s2 "Ll & ,J SL 0.9 - . 18 -1 C-761 SL 1 -2G" - and SL a6 -46 I.T'19 ,;- B- S S2 1 00, S9 14 o N- 2 w /v►will�a 41.-52 "4-tr6h SCI.L 4+ /rrrfll�l 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 PE PERIOD3 PER INCH P- ! 20 0 1 / / G P- Zo 0 IV >` so 1 3 4 40 P- 2,0 YU a iZ 30 T + I 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. SYSTEM ELEVATION 103.39 3 f _ i f ( Rea I t t _ » - ...__.... .a..._....... . r _ __.} 1 7 I (;71t I p ron le �ron 6rl r i yv�� L T L. eS ilM >loaed _ i ___ `+e undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedueesand methods sliecified in the Wisconsin 'ctrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and b'eliei,'. TESTS WERE COMPLETED ON: qc►�t G a3 -9 4 CERTIFICATION NUMBER: PHONE NUMBER (optional): 54 *3 3 M 71S 425 2115 CST SIGNATURE: .%al and one copy to Local Authority, Property Owner and Soil Tester. ,4.10/83) — OVER — r INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 8. 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 scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols at — Stone (over 10 ") BR — Bedrock cob — Cobble (3 - 10 ") SS — Standstone gr — Gravel (under S') LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well Is — Fine Sand Bldg — Building Is— Loamy Sand > — Greater Than 'sl — Loamy Sand 'C — Less Than '1 — Loam Bn — Brown 'sil — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 56 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Grant, Randy & Margaret Easton I Kinnickinnic Township 022 - 1020 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 08.28.18.114 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Ful Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ! / Inspection #2: Location: 474 Sleepy Hollow Rd River Falls, WI 54022 (NE 1/4 NW 1/4 8 T28N R1 8W) NA Lot 7 Parcel No: 08.28.18.114 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 3.) Contour = Plan revision Required? _'1 Yes 0 No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)) 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax (715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application S ao 1. Application Information - Please Print all Information Location: Property Owner Name 1/4 1/4, Sec o` � ,5' 0 T N, R E (or W Property Own es Mailing Address Lot Number Block Number q33 City, State Zip Code Phone Numer Subdivision Name or CSM Number 11 Type of Building: (check one) amity ❑ Village Mown of M 1 or 2 Family Dwelling - No. of Bedrooms: 3 ❑ Public/Commercial (describe use): ❑ State -owned Nearest Road 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) al–E 0 Parcel Tax Numbers A) 1 1.0 Repair 1 2. / n Reconnection 3. ❑Non-plumbing . []Rejuvenation Sanitation --QQ 8) Permit Number Date Issued ❑ State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non- pressurized In- ground K Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete strutted glass Tanks Tanks /a eo moo ❑ ❑ ❑ ❑ D - ❑ ❑ ❑ ❑ 11. Responsibility Statement 1, the undersigned, assume responsibility for repair / reconnenction /rejuvenationfinstallation of non - plumbing for the POWTS shown on the attached plans. A icense is not required for terralift repair or tbonstallation of non - plumbing sanitation system. P tubers Name (p ' ) P11inbos Signature (nos Tm: M PR Business Phone Number s- - Plumber's Add ess (Street, City, State, Zip Code) Ill. County Use Only Disapproved Sanitary Permit Fee Date Issued Is=Agent ature ( stamps) IR Approved Owner Given Initial Adverse Determination IX. Conditions of A a e ns for Disapproval: A+ T` 1 a. Ss+.K - , o P R.v�nw.� `� '�6•, Ywt t. J� Y A Gh/bu� vA � •�t 0* ' �- �+6`S \ low � �e I!-�er �bwA� c o•+� -1Qs6r c o,w• Gig st aG c.4 &x . 1 1 I I 131 R^F S "Of c No seA - T - L oT �xcc - Fos o � rs - p Rt Je 5EU)eA /-loo k u/ Fat _ _ Ge - G PRP C uS e �o RANay' �r'2r4N'T o� �A%Z E ^o.�/' 9/1Acuix 9 33 5 9 - �a c�orE�sEr - 'IYov: A 2.12 r s r c c � - SE cIZ # X02 (J�� � � Of 0,4/?/✓. GXISSeT�cS� - P ia 914^fo CIZA/Y / ,496,44e6F E 9Srv.V � 9/lgcuix 13Y J - - �nr SAC 4�44,c eY �iEw T2 __ __ _. __ __ ___ i_ _ _ __ _ _.__. __ __ __ __ _ __ __ _ __ ___ __ __ _ _ __ i,_ __ __ _ _ _. __ _ - __ _ _ _ __ __ -_ _ _ -- __ _ - I _ - _ - ___._ __ __ ___ _ __ __ -__ __ __ ____ __ __ __. ___ _ ___ __ __ __ _ __ __ -- __ __ __ __ __ 11- Ls ki tl-� d1-- a au Clai Office • 7133 /834 -5583 Minneapolis Office • 6121425 -2 060 WiscoMT Department of Industry PRIVATE SEWAGE SYSTEM county: La bor Human Relations INSPECTION REPORT ST. CROIX ''i+afety ind Buildings Division GENERAL 1 ORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Hol City ❑ Village �} Town o : State Plan No.: , I 3 KENNE K EITH in K VTMMTCKTNNTC CST BM Elev.: Insp. BM Elev.: BM D scription: Parcel Tax No. al /OIJ. a,s Are All, — AQAani4i TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 51 C Benchmark Dosing � aG 3 Ig. 1.36' d 3, // Aeration V Bldg. Sewer / ' Holdin St /Ot Inlet 93 6v TA K SETBACK INFORMATION St/ 4 Outlet 07 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >S0 NA Dt Bottom Dosing NA I er /man. Aeration NA Dist. Pipe ,? 3 0 Holding Bot. System PUMP / ORMATION Final Grade Manufacturer Demand v sT S,SS Model Number ti� GPM sq TDH Lift �2,4q ' Friction S ste Apr TDH Ft [ Forcemain I Length Dia. Dist. To Well I SOIL ABSORPTION SYSTEM BED/TRENCH Width Q i Length _ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth U L DIMeiiiON SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHI u acturer: INFORMATION Type C ER Mod Number: System: /llU �p ; ��¢. OR UNIT i DISTRIBUTION SYSTEM ,( /Manifold Distribution Pipes „ x Hole Size x Hoe Spacing Vent To Air Intake N '• '/ ry Length Dia. Length ;2E ' Dia. I Spacin y 7`d > SQ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed/ EF center Bed /TF41r&Edges Topsoil ❑ Yes ❑ No []Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC 8.28.18.114,NW,NE,LOT 7,SLEEPY HOLLOW '6 id / , j > ✓ Plan revision required. es ❑ No Use other side for additional information. SSBD -6710 (R 05191) / Date Inspe rr's Signat re Cert. No. /`./�. ���'"�ou/ - -rGl' �i� r? ����;i,• /,c, G�7'i_ `` ma ---5 -"-7�� �a0_�'i�c� Q�- Y,LC�I c �rr0 10 11 9 � AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS 3l 5 W ad �� 5 T � Aj SUBDIVISION / CSM# LOT # SECTION T _,? � N —R I $ W, Town of ST. CROIX\COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM B8 m 0 'e __..._ "._. D clf INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ki44 G a,4A(T e- /3 2 /1 T EA f M A/' - - Mailing Address 8 93 -7 ScE r To D,e EnEN IJI? - //1 f Z"/ s3 y Property Address ?-- '� W 4i A (Verification required from Planning Department for new construction) City/State l��r3�-n S �'lJ /`, Parcel Identification Number 0A LUQ o -elm LEGAL DESCRIPTION Property Location #5 ' /., '!,, Sec. . T a 8 N- R1j — W, Town of , AM(le)C. nriV i c , Subdivision . Lot # z-_ Certified Survey Map # `/�, 7y , Volume F . Page # z .3.3 Warranty Deed # 7/5 MA , Volume Z 18 9. Page # f� . Spec house ❑ yes W no Lot lines identifiable Ll yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. IGN TUBE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed �I J 2 18 9 P 2 8 9 7 1 t H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Kevin E. Klinkhammer and Kelley M. 03/31/2003 03:30PH Gustaveson, husband and wife WARRANTY DEED EXEMPT # Grantor, and Randall A. Grant and Margaret A. Easton, husband and REC FEE: 11.00 wife TRANS FEE: 1109.10 COPY FEE: 2.00 CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Return AdP'1 '= Lot 7 of Certified Survey Map filed March 22, 1991 in Vol, 8, Page 2335 as CO/ n 14 A•L T T 7Z� I Document No. 467474 and being a part of the NE '/4 of the NW ''A and a part y p --p S p 1,t1� a Vl of the NW '/. of the NE '/4 of Section 8, Township 28 North, Range 18 �-} t {�S8 Y�� W T, '5 01 to West, Town of Kinnickinnic, St. Croix County, Wisconsin, together with the right of ingress and egress over the road right of way shown as Outlot 1 of /p T Cretified Survey Map filed March 22, 1991 in Vol. 8, Page 2329, Document No. 467468. 022- 1020 -20 -000 Parcel Identification Number (PIN) This is homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. � I I ° I(, X132 Dated this ) � ' day of March 2003 1 °f q 2 t ss2y/ zero * * ukh er * * Kelley M. Gustaveson AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) —..._ ) ss. l � County ) authenticated this day of — Personally came before me this A - 41- day of o ne M. Barron March 1 2003 the above named * Not P ubl ic Kevin E. Klin khammer and Kelley M. Gusteveson, husband and State of Wisconsin wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) A on THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, stet expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) � - 1 ; d4'6(O ) • Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals c ompany, Fond du Lao, wi STATE BAR OF WISCONSIN 800-6552021 WARRANTY DEED FORM No. 2 -1999 �3 7 1 5670 U 2 19 2 P 3 3 9 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO., VI Document Number Document Title RECEIVED FOR RECORD St. Croix County 04/03/2003 08:50AK AFFIDAVIT Occupancy Affidavit EXEMPT # REC FEE: 13.00 TRANS FEE: ' P,W0A 4 Z- /Q 6 4}, T COPY FEE: CC FEE: Name — (Owner) Typed or printed PAGES 2 being duly sworn , states, under oath, that: 1. Hetshe is the owner /part owner of the folio win g,parcel of land located in St. Croix County, Wisconsin, recorded in Volume — 1 :8 Page 95f Document Number /S 32Z St. Croix County Register of Deeds Office: Recordina Area A parcel of land located in the '/. of the _'% of Section 49 Name and Return Address ;ZW T� N - R 1_ W, Town of K y 4Mi1GK PV lG , St. Croix q-7q St C^ t r County, Wisconsin, being duly descmbed as follows (include lot no. and SL�'Y �ttl,ct.J Dn subdivision/CSM or detailed leg description): w.� a3 C vi J� liT/� 1 le � Parcel Identification Number (PIN) ^ , As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a a bedroom home, or a design flow of 45Z� gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently _6L occupants living in this residence; - .6, occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to aecomodate any increased wastewater flows and /or contaminant loads. 1 also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this day of L- < v� * * cn r 4 AUTHENTICATION ft ( ' L•EDG 1111 0 � Signature(s) STATE OF WISCONS I N authenticated this day of St. Croix minty. ) " Personally before me this day of r A003 the above named L TITLE: MEMBER STATE BAR OF WISCONSIN (If rot, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) Instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Notary PuSlic, State of I isconsln (Signatures may be authenticated or acknowledged. Both are not My Commiqp is permanent. If not, state expiration date: necessary.) Date: T "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" Tbls Information must be completed by subrrWer acrd EW (lf required). Other info mabon such as ilia grans ft clauses, laagal descxiptw, eta may be placed on this first pope of ft docrmnent ornmy be placed on add0onaf papas of ft documer#. hML Use of this cover page adds one page to your documarN and 200 to Bre mcongm fee. N9sconsin Statutes, 69.617. . j r � y'.�Ua Y,1 � �r•�l T3 ' • FRS.:'^ .: �Ti- _ ;►:. -�. �� �1���u L JURE 1S w C8'�• snsyst T.a1CAa t1 iq TtiB �ffllfi t rR� n+is, /4 AND att+riJk c 2k� Ka;: �'� 0� dF,C SOV �. X38: , ISid tow O! ktira `iCXlF1�iC� 8:'• CaOIlr COWTV, 1�xECa�a�Ie� o�aet ststscer F:Z+won, Vyr4anfia S.rDsE Of von+ $t N q �Z «I Vs xi Sc COMM tAom ME Mon-We r t l at +a .WI5 :0.5�J2 3! hS fi,_AVTFO BY KTCIAM r 1`] late ©U q to STC - 104t3 AS BUILT SANITARY SYSTEM REPORT 9 OWNER k t n n ej -1 C � ADDRESS (2,, SUBDIVISION / CSM# LOT # SECTION T N -R l W, Town of le- ST. CROIX`�COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM O `8 . G INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. I BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Wye's _-• - Cow r { Liquid Capacity: /oo a Setback from: Well 76 House 17't, Other Pump: Manufacturer 2 or1l0% Model# Size Float seperation g� Gallons /cycle: 144,4 Alarm Location SOIL ABSORPTION SYSTEM n1 6,J Width: Q Length 4� Number of trenches bcl Distance & Direction to nearest prop. line: _� S Setback from: well: 010' House I 0 Other ELEVATIONS Building Sewer qq ,3� ST Inlet q ,G ST outlet Y3. �/ PC inlet Q 3, Z PC bottom af, 9 �_ Pump Off 9 G, $S Header /Manifold 161 9 Bottom of system /o3.2 Existing Grade j o Z, Z `� Final grade / 6S , S 9 DATE OF INSTALLATION: PLUMBER ON JOB: 0-w" I �-t ri LICENSE NUMBER I1Q QS 3 "S7 INSPECTOR: �- 3/93:jt I C 7/1 �. STC — 104 AS BUILT SANITARY SYSTEM REPORT R `�v I I OWNER _ k--e-17i v N ADDRESS SUBDIVISION / CSM# LOT # SEC TION T _2_� N -R 1 $ W Town of ST. CROIX`•COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Wt ac S8 0 � 0 v INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. i Wiscorwin Department of Industry PRIVATE SEWAGE SYSTEM County: "Labor and Human Relations ST. CROIX Safety and Buildings Division I NSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: of: I I 3 / KENNEDY, KEITH City ❑village Town State Plan I No.: KINNIrKTNUTC n22-1020-2n-0 CST BM Elev.: Insp. BM Elev.: BM D script on: Parcel Tax No. /Gd, GI 10d. Cl o TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 7 ( ,, l 6j,- 5C . C , Benchmark 47 1 Dosing 3 � 3 .36 d 3,//' Aeration Bldg. Sewer 31 � Holding St/ Ot Inlet t3 9.3 6. " TANK SETBACK INFORMATION St/ hOt Outlet 9 c,/4 TANK TO P/ L WELL BLDG. A Intake ROAD Dt Inlet z ' Septic >SD� NA Dt Bottom Z "elm, Dosing a ti30 NA r /Man. Aeration NA Dist. Pipe Holding Bot. System PUMP /SVW41WOR Final Grade Manufacturer Demand Model Number •_. GPM TDH Lift �� �{� / Friction System X 9 9 TDH Ft r Forcemain Length / Dia. Dist.ToWell^ -j Cr i )f y(�S SOIL ABSORPTION SYSTEM BED/TRENCH width i Length / / i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �7 DIM I N SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHI ufacturer: J INFORMATION Typeo //e� C ER Moe Number: System: OR UNIT ti DISTRIBUTION SYSTEM ,1$ /Manifold Distribution Pipes) �� , x Ho y f�4 le Size x Hole Spacing Vent To Air Intake l ry sd �4• Length /� Dia. Length �� Dia. Spacing 5 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /yegMtenter Bed /Tr�chEdges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC 8.28.18.114,NW,NE,LOT 7,SLEEPY HOLLOW (10,2 a�) l Yf��� �� 7'I •' a , FQG-, e L17 -. Plan revision requiredon Yes ❑ No Q Use other side for additional information. d3 9 SBD- 6710(R 05/91) Date Insp J ecto / r's Signa / tu � re / qq Cert.No- •I 'I ����C.. - V"'�J�ffr& s / r 1 ADDITIONAL COMMENTS AND SKETCH . SANITARY PERMIT NUMBER: 7 7 I SANITARY PERMIT APPLICATION Cotm f In accord with ILHR 83.05, Wis. Adm. Code STA TE S/�IITr P E RMIT #i -Attach complete plans (to the county copy only) for the system, on paper not less than pZ / t6 T( - 8% X 11 inches in size. Check if revision o prev us application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PR PERTY OWNER PROPERTY LOCATION a K. G n 0% 1'11 F Y. S T .7, N, R )j (or) W PROPERTY OWNER'S MAILING AD RESS LOT # BLOCK # 3 w _St, 7 u CI , STATE ZIP CODE PHONE N BER SUBDIVISION NAME R CSM NUMBER uer a IBS W i 2 1-5 4�s -16 : v 1 (.,) II. TYPE OF BUILDING: (Check one) ❑ State Owned VIL LAGE ; �i NEAR ST ROAD I ll ,>ux« s)C l 0 0 ❑ Public X 1 or 2 Fam. Dwelling -# of bedrooms P ARCH III. BUILDING USE: (If building type is public, check all that apply) O, — ) 0,>0 1 ❑ Apt/Condo ti 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. �j New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 k Mound 30 El Specify Type 41 [1 Holding Tank ❑ 12 Seepage Trench 22 In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2, ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION S0 3 9 S 374 Feet Feet VII. TANK CAPACITY Site INFORMATION in alions Total # of Manufacturer' Prefab. Fiber - Exper. New istin Gallons Tanks s Name C oncrete Con- Steel glass Plastic App Tanks I Tanks strutted Sep tic Tank or I G — f o'o Q Lift Pump Tank/649wweh=Zer F — O 1 � e e C ©� L El Ej I El _ F Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) F 339 / .. Business Phone Number: a,rl e1"e ® P/ )5 gas -alp Plumber's Address (Street, City, State, Zip Code): l 0 .1 0 2 S. iI o_�=, 3fi, 'cue Te"lls W Saldw IX. CO NTY /DEPARTMENT USE ONLY Disapproved Sani ry Permit Fee (includes Groundwater Date Issued Issuing Ag t Sign re No Sta s Ap arge Fee) proved ❑Owner Given Initial � � ��- Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary` permit is valid for two (2) years. 2. Yaur 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 ;,suing authority. 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. Onsite sewage systems must be properiy maintained. The -- -Pft tank(s) rn,U.�t Lie pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. It. Type of building being served. Check only one and complete ## of bedrooms it 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. V11. Tarik information. Fill in the capacity of evjr r iew and /or existing; Tank, list the total gaYons, number of tanks and ;r;anutacturer's name. Indicate prefab or site consbcieJ d and tank material. Complete for all septic, purnp /siphon and holding tanks for thr s system. Check experimental approval only if tanks received experimen'tai product approval from DiLHR. Vill. Responsirility statement. Installing plumber is to fil; in nan;e, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County /Department Use Only. Completo plans and specifications r!ot smaller than 8'/ x 11 inches vIr ;t bc:° submitted to the county. The plans must include the following: F plot plan, drawn to scare or with co ple''o dimensions, location of holding tank(s), septic tark(s) or other treatment tanks; ui'cflr sE :wes el?y; water rnainsi.water service; streams and takes, pump or siphon tanks, distriblatit�n bo-ti s; - )5; systems, reps icernerit system areas; and the location of 'he building served; 3) horizonl - -! J v+- �rbccil levation reference point.; C) complete specifications for pumps and controls; dose vcr io me; 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; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin, Act 410 included the creation of surcharges (fees) far a number of regulated practices which can effect groundwater. The monies cohec.ted through these surcharges are Used f:)r m1- ,.. „ - rdwa!er : ground- water contamination investigations and establishment of stanoRrd <: SBD -6398 (R.11/88) i MOVE THE' CARL HEISE EXCAVATING 1042 South Main RIVER FALLS, WI 54022 CARL P. HEISE (715) 425 -2175 Owner MOUND SYSTEM FOR 3 BEDROOM RESIDENCE LOCATED IN THE vV WT I OF THE yV5 Yq OF SECTION TAN, R b W, TOWN OF Sf. Cvo1k COUNTY,WISCONSIN. _INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAY -OUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ONSITE SEWAGE SYSTEM -- - R IV E R FALLS W i 3 Q2 *, t ,, I4 RELATIONS DErARTN,i N' ` _..�. fat ,,�;� • „ . �,. NDENCE �APR A D BY Carl P. Heise CST 3314 MPRS 3378 1042 South Main Street River Fal'ls,WI 54022 S-94 3 P lo-r ?L A yJ e Z G L 0 ,alt � rCS ao c W B E kS Cpiuc 9Ker( ' tooOG4L 5EVyic *p 0 d w EEKS Cokve P.c/ Est v� .Jcl► I M 9 4L G.w.p 4 vurTruS �QS'a`p ' A Tp.n t �a► 41 a 'Q P O4 EFr J ti SO a� p Q * ITE SEWAGE SYSTEM LATIONS OEPARI � TRY ' " "Jt} 3biLDl���GS q�V1�.;d t Q (A T off j ",ion DENCE 6 Survtye✓- JRP4 -aP Scat - 10 510 14 t) '894 306 l OF. 6 St-row l Morsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil """ _ K `"�.v.. _.. �a • 3 , ' V 5 % Slope , Bed Of ! *- Force Main Plowed z 2 z Aggregate From Pump Layer D _L_O -F-T F � � S � S � jWs Section Of A Mound System Using ' pirtSt<TES . A Bed For The Absorption Area - - - A Ft. H . . �V "9 Al pc 'IAS10NS B •y,7 Ft. ErTE; Fin` rJ l;��t�FT`��fii�G,b`tt6L01N+�S T 2 Ft. DEPAR�P� DIVt �I iA SA J Ft. C R Ft. r S '�oc�c L 8 Ft. L d rb s on Pipe •` 1 _.r ..._..�_:..r .,. _....... Y �... ..... ....._.. ....., TAI • . '. V tr Distribution Bed Of •Pi e �: - P Aggregate Observation Pipe Permanent Markers 30305. Plan View Of Mound- Using A -Bed For The Absorption Area r Forto Pipe DoIoII Page, 9 CA I ' (FrrlororcG � r ;�'•,, Y EnP Copy .'f, • PVC Pi pt DzR U $U7 H, r%iZ1V..GZ i O • �D.ti Lhle►' lotoett Gr18ol1om, a(r E ouatly Spaced ?' PVC Pbrcc'Nloin -` From Pump 1 -1 PVC �- r t i„onllriG Flpt &. P,pr ' host H019 Should 6c I • IQ End Cop ` iad Cnn hiclribulion Pin Loyoul r` 4 /1 • S / r X i4 b rr > X #4 Y ; a ' Hole Diameter %q Inch • Y Manifold . r Inches. Sz ' Force Main.'! 2 Inche x Later. i9 1 inch es) r, Boles -Per 'teral , + 2 12 0 a 1 r� V'JAGf` SYS >l I ",s I . w=a 0i SE it F,a�l �I��Ill4, yr r { ¢ r p N . RELATIONS r�� ' �t���rsY, t.,1130 �,ti'! ' J ..' ©EPEisPi r i i�9 1 Imi "AOR u' SA�EIY AivD a�3i GdIvUS SL-E w •sin ,.._ . �•i+2a • >., _..._. S ti .,l..,, .t,;... ......... ....., � ,. .,r;,n:.yrcrp +� y ti ^ y. S94 30605 d.4 r PAG E c l PUMP CHAMBER C ROSS $A AM SP ECIFICATIOMS ' ;; VEWT CAP y�.C: ;VENT PIPC WCATHEK .PKOoIr APPROVED LOCKING � FROM DOOR. ; JUIJCTIOW�BOX + l�lA►JHOLE coven WIrii WIypOW OR FRCSN IL MIU. W c� rv��y, .e�btSL AIKIIJTAK6 GRAOC " I 4 Mum, C01JDU1T _• �; r SE 11� ' �` UJLCT Ot� OVIDE I - -_ -- �. Ai ► t� SEAL - I I I SrJ li I I, L APPROVED JO.IUT . A APPROV mOl1J w /c.t. PIPE s CXTCtJDiu(# 3' EXTENOIIJG ALARM 3 OU O,ti0L10 t01I. c. t, � p I I ONTO SOLID GAIL Ow f � 0 ' V.'::L>ZOFY. �'`'�" OOF'tE`' PUMP --�; orF o C04CKrLTC Dior.► ``''�3„ APPRoYiw IV . RIsR.'EX PERMLTtE oZ yiv AU�KYMAuuFSC7UReR HAS SUCH APPROVAL, J gC00tht� scY ink -_i.. Via. ST ?O� doh f. SP�CI! I1.A710f�JS n� ���+►1►iJUFJ►CYURCR: WUMBER OF OoSES:..• PER pAy r „ 1'AIJK LIZ '•' ' ' SOO .GALLOWS OOSI` .VOLUME CA t'a, ,iMADJUFA 14 r - .GTUItE.P: �w V kk clr - II.iGt,uO1l.�G DA '�r40W: _ I� 4 : 4 � - . - .....� GA�LoNS - a L V Y .. • OOSrL iJUN$CR- CAPACITIESI A .-_..INCKESOR `� 0 .. �L GALLONS ZWITGH. TUP ;` 8 - .?. mclics OR P � MAIJUFAGTURCR: '� '�.b�llcv C � 0 4 —•r-- r. , �.UJCHES OR - ►A LL OIJS �M001:L �, r ^4s. Du 12 Et OR 2 .-!8.4 GALLOU6 ,SWITCH 7yC: - �° av .LLB fir '' u E' ;'PUMP AMD ALARM ARE TO OE ;'I" IWIMUM.OI iARGC, R A re- Z11 OA cPM . Y INSTALLED OW SEPARATE CIRCUIT$ rVCRTICAI. OIFPEREIJCC OETWCCIJ PUMP OFF A1J0,.0I5TRId4TI0Q PIPE.. r 0 FEC -I MIIJIKUM WCTWP K SURPLy PRESSURE E -- �;, . MET O F.F'ORCC MAI)J X u _ FACYOF- 2 mil _ ET (� TOTAL, 0y10,k iC' FEET 0 . I TERImAL. nIME1J5►ON� OP TAIJK: l.E►JbYH WIDTH w OCPYH -4 s W W,t W LL �t 115 34 110 4 Cd 32 105 - 30 100 — 95 28 90 26 85 ti , I 24 80 MODEL Q 75 MODEL 189 G w 22 165 = 70 U 20 � 65' a 18 60 J 16 50 MODEL 163 MODEL O 14 45 188 12 40_ 35 ,0 MODEL 30 13 , 139 MODEL 8 25 185 MODEL 15 _.M DEL 161 10 2 MODEL 5 53, 55, 57,59 0 GALLONS 10 20 0 40� 50 60 70 80 90 100 110 LITERS 0 80 160 240 320 400 FLOW PER MINUTE /.S, 6 a 894 30605 4liconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page I of LAbar'and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but SI C vo� not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Kepi k Keh " e )'X GOVT. LOT ' r1W 1/4 1/4,S T N,R E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 31 GL etpv h CITY, STATE ZIP CODE PHONE NUMBER ❑CITY (]VILLAGE [MOWN NEAREST ROAD Fwtl s .Sdo22- (715) 4 2 5 - q& 36 Kt yu w i' , .�2 c New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow + 50 gpd Recommended design loading rate 0, bed, gpd /ft ©. trench, gpd/ft Absorption area required 3 � s bed, ft 3 lIr trench, ft Maximum design loading rate 0, 4 bed, gpd /ft C,s trench, gpd/ft Recommended infiltration surface elevation(s) 1 0 , 3..34 ft (as referred to site plan benchmark) Additional design / site considerations mow J W 4? kjt/ w r�, vh;., a "nA oye f Sicj Parent material Flood plain elevation, if applicable IN N ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S 0 U J�Q S ❑ U ❑ S Ru cis ,®.0 [IS 3 U ❑ S Z U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench I p -rd io )(6C 4/2 S ;/ 2 stir` r C ;' { <4 2 t0 -t ► d YQ 9/4 vitT r C S ► J T (P Ground 3 . 19 - .34 1 C) Y 9 4` — S L 2 r M r C g S elev. 4 �t I ft. 4 4 -56 I V Y 2 /5 4 S ul: o Z, — Depth to limiting factor Remarks: Boring # :.< :: :: ] 0 1oYit I/, S4k MF r C S ZVT 5 C s t - 4 5 jo <: • >:,:::... 3 15•28 i G Ys -4/6 S " 2 fs6k to Ground elev. 4 28-40 1 o M 9 S ?, Y(. 4 S L Z ^1), vk-F C s - o 2. 3 fH Depth to limiting fa 28 , � F Remarks: CST N e: y P l lease Prin Ge• Phone: '2 1 Sr _ 4 26 7 Address: t�r� [ 0 4 R s, vk Signature:n I Date: CST Number: (jjtraj �[tfy 4 CS7►no3 / i PROPERTYOWNER 1<6T4 1Ke,.4 SOIL DESCRIPTION REPORT Page 2- ofd PARCEL I.D. # V Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Uj � 0 ' ) 0 A .4 '(1 — 5 i a� 3 j� vtit T r C 5 Z V I S 2 0 - 19 10 YK 'q — SL a f �b1. n.7 C5 1v F .5 Ground 3 t 2G l U i 2 9 G S L .7, �`5'' ►�` r c .s elev. f� �(2 Q Depth to 4G-5 l v Y .-S Y { ScL L limiting factor Remarks: Boring # :• :vi C4i: Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor FT Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) ,• Y TL. SYSTEM ELEVATION �.� I .. •�. l s5 - I A 4or,r I - _ r N i "tt . : h� i ' r : s�l� � � aoo fie• 8� 1 0, r r i ; I' 7 h r i 1 ,4A 19916, give 9 St O � D 4G7474 4 co, w/ CERTIFIED SURVEY MAP LOCATED IN THE NE1 /4 OF THE NW1 /4 AND THE NW1 /4 OF THE NE1 /4 OF SECTION 8, T28N, R18W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN OWNER AND SUBDIVIDER Robert Richter 1152 Riverside Dr. N. C 4 00 00 Hudson, Wisconsin 54016 o o� X66' OU U Z W H 00 C14 o C SC LOT 6_ 455.84' 613.181 �1 15� • 34' pp' E 3 - SCALE IN FEET 512 "o 0 0\ 1 0 0, 0' 200 400' �°. CSM LOT 2 V) — Lr) `\ \ w ` inn �\ w It Cl) O \ Z ° ^ \ \ W H � �\ c/1 W x o `� 0Paz H H W +1 +1 W U C' ° Z W P.+ W �, H SURVEYOR'S CERTIFICATE I, James T. Swanson, Registered land Surveyor, hereby certify that I have surveyed, divided and mapped this Certified Survey Map located in the NE1 /4 of the NW1 /4 and the NW1 /4 of the NE1 /4 of Section 8, T28N, R18W, Town of Kinnickinnic, St. Croix County, Wisconsin, described as follows: Beginning at the North 1/4 corner of said Section 8; thence N87 ° 10'43 "E (Assumed bearing referenced to the North line of the NE1 /4 which bears N87 ° 10'43 "E) 775.37' along the North line of said NE1 /4; thence S12 613.18'; thence S78 ° 00'W 223.01'; thence Southwesterly 465.04' along a 633.00' radius curve concave Southeasterly whose chord bears S56 ° 57'12 "W 454.66'; thence N54 0 05'36 "W 1423.56'; thence N88 ° 34'57 "E 850.62' along the North line of said NW1 /4 to the point of beginning. This parcel contains 20.011 Acres, more or less, being 871,672 Square Feet, more or less. S££Z aStd 8 'TOA M „+1Z,�75 M,00,8LS 119£,SO,Z' „ZT,Z9,99S ,99''79'7 , 100'££9 Z - T SONR Vaq a'IONrd ON dVHq H ZONQ I HZO I MONd'I *ON ZNQONVI QNZ '4 ZST gvalNaD Q2i0HO CrdOHO DNV SIIIUN UAxnO 3i1S 0� Im aim anti 9TOV- uzsuooszM - uospnH = Zert - 'N •zQ apTszanT-d ZSTT l' err zalgOT-d gzagog N.ljGIAIQfinS aNV 2ISNMO IV ZZOtIS uTSUODSTM `STTs3 zaAT-d JaazIS InuTsM 'M £TT •o,, 2uTzaauT2ug uapa0 ZZRT -06 'oN qof ZgVT- -S uosusMS •Z saws '066T `T zagogo0 :agsQ •aU's aqi 2uZddpm pus 2uipTAZp '$uT�anzns uT XjunoO xTOZO •iS pus dTgsuMOZ JTLtiIT?IJZLIIITx �o 's aqi uoTsTnTpgnS aqI Pup saingVIS uTSUOOSTM 9141 JO 9£Z z, To SUOISTAozd aqq glTM paTTdmoo ATTn3 ansq I Jsgq lapsui 3oazagl uOTSTATpgns aqq pus paXanzns pusT aqi jo saTzspunoq aOTzalxa aql TTs Io uoTisluasazdaz joazzoo s ST dsiu Bons lsgq 'pusT pTss 3o szauMO aql Jo uOTgoazTp aqj Xq dVW XanznS paTJTIzaO pus uoTSTATp pusT 'XaAans u,ons apsui aASq I :Jst1:j AjTlaaD I •pzooaz xo sauawasBa o1 aoaConc STC -105 SEPTIC TANK MAINTENANCE AGREEMENT � -# L I 5 �St. Croix County L OWNER/BUYER J l2 lC� n Ec� i ��ri M . 6 -,{'fin 5r MAILING ADDRESS 6S ffi'r jk, u - RQaro ' &j.' Q�g2:Q Loo YO PROPERTY ADDRESS q2q S e epa U kLIt QY f 1. e. T?D eo z_Lor (location of septic syste�) P ease obtain from the Planning Dept. t yO CITY /STATE R O 6 @rt u3T- S L /©Zns PROPERTY LOCATION Al E 1/4, NW 1/4, Section T �� N - R _ l� W TOWN OF 4� 1 n 11 Y) l Ci ST. CROIX COUNTY, WI SUBDIVISION S ��'�.(�C.Q ( L �p (JL9 LOT NUMBER .7 CERTIFIED SURVEY MAP 4 (P � q 7 VOLU PAGE ,�33 , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year a iration date. SIGNED: A� DATE: Z St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 s S T C - 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 Kam'AA A4. f Location of propertyAZL_1/4 AlkJ1 14, Section !�, T,�9N -R _W Township 1:� nir-onncc' Mailing address J V kjyyu 12n . SY1 , 1A) l 5Lf Address of site _ L f - 7 ( 1e-e Qu tjL - b r i ye, kx'fs l (A-) t �4n,) Subdivision name eep�I�l� Lot no. 7 Other homes on property? Yes _.. )�_ No Previous owner of property XA- �- Total size of property L Total size of parcel _ DI I Date parcel was created 3/ 1 act I Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes __X No Volume_ and Page Number a.-33S as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT'NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a CeL t.if i. Sur vey I -l a p, the C er t i fied Survey 21ap shall also be required. PROPERTY OWNER CERTIFICATION I (we) cer that all statements on this form are true to the be of my (our) nowledge that I we) am (are) the owner(s) of the property de ed in this info ation form, by virtue of a warranty deed recorded in the office of the County gister of Deeds as Document No. 5 /9&L/ 2 , and that I Ewejpresentl own the proposed site for the sewage disposal sys or I e obtained an easement, to run the above described property, for e construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Si nature of Applicant Co- Applicant / Z- 1 �- c lq Date of S Date of Si nature I � ' DOCOMENT )40. WARRANTY DEED li mts srA' E RESERVED FOR RErORDING DATA r I (STATE LIAR OF WISCONSIN FORM 2 -1982 ` 511-9(;47 VOL 21 l if it REGISTER'S OFFICE Robert K. Richter a/k /a Robert Richter ST. CROIX CO., W1 4 ,............ __... F ......................._ Re+c'dforRecord i I -- . JUL 2 9 1994 ..... - - -... convey and warrants to - Kelth S. Kennedy, a Slagle perSOn� 11 � and Keri M. Gronseth,, a..single.,person, ,�. ........ ... . ........... ........ ......... ....... ... .......... .. R@®SLBr of heed '.! i . ... .......... ............ — .......................... ...- ... ...... ..................... ....... .... ..... ... .. ..... ........................ ............................... ................ .... .. .... ... nr rul'N )p .. .... ...... ..... .............. --- . ........... - ..... ... .. ... ... ... ......._.... ............. 6 St- ._County, s; the following teal estate to ....._ ...... e... X•9 �X .. ........ .... --------- - - - --- --- - -- - -- - '4 State of Wisconsin: k„ Tax Parcel No: --------•-------•--------•-•-- Part of the NEl /4 of NWI /4 and part of the NW1 /4 of NEl /4 of Section 8, Township 28 North, Range 18 West, St. Croix County, Wisconsin, described as follows: Lot 7 of Certified Survey Map filed March 22, 1991, in Vol. "8 ", Page 2335, Doc, No. 467474. TOGETHER WITH AND SUBJECT TO the right of ingress and -_)?,ress over the road right of way as shown as Outlot "1" of Certified Survey Map filed March 22, 1991, in Vol. "8 ", Page 2329, Doc. No. 467468. w l F This s.�-__. ....... homestead property. .� X i a (is not) 40, l \ Exception to warranties: + �� � ~ 16 y � •` J 1 r r -:: t t t' i • j tI a this .- ...... .... day of ......... ..... .. _ -.. 19 94 �Q�. ` "S - ....... .. . .. .... ... . ...... ........ _...(tiEAI") .a' V + Robert K. Richter a/k/a Rb ti .._....I ................. �. R_oert __...... Richter t k (SEAL) ---- ....... . ... ..... .. I ........ .....- . -- - ---.(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s)--- . ---------------------------------- STATE OF WISCONSIN •-- ••-- -- -- --•- •••- - --• -- --- ss. i - - _-- - - --•, 19.... -. Yersonal!y cr.I Ix fare t^ thin. . _ - - ....day n+ _ -•----••-----•-- ---- ---- --- 19.94 --- the above named Robert - K._. Richter _1 /kja_ Robert----------- -- - -- Richter TITLE: MEMBER STATE BAR OF WISCONSIN { 'r (If not, -- .......... •............................. ....•- ----. - --- -- --- -- ... ... .... .... - - •.. ---.. authorized by § 70S.OS, Wis. StatsJ to ale known to be the person ._..... ---- who executed the P•, foregoing instrument and acknowledge the same. '}. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogiand .. - - - - -- ........... . • - - - - -- - ---- - -•• -- •------- - - - - -- Alice Joy Connors ...- Attorney at Law - -- -- - NotAry Public ---- -- -- - County, Wis. (Signatures may be authenticated or acknowledged. Both Day Commission is permanent.(If not, st 'e expiration are not necessary.) date: + N.Me'1 et Pennon. elgaing in any eepnalty $h—fd br. tylx"1 or Vrintrd hrLru lh lr a;Rn nlu rce. WARRANTY DF.F,il RTATR nAR OF WV7CON!;IN wice.....m I rq:,l rri -,M I•n. I-- FORM Nn. 2 -- 19x2 MAwatA -?. Wi;rnnau) '. 1. ,