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HomeMy WebLinkAbout022-1030-70-010 a O 3 d O CD C 3 3 ° n N H• w X CD N N O n C) ► 0, ° c 00 C) 0 fu o � ID a " 0 3 `D 90 o W o > > N N N j W 5 0 (V w v cn m d m CD IN a A C W z Q ' O ... Z! --� W O Z ° O N N (p O O cn co CD y c 3 of a o 0 0 a o � z (n v, co D 6 O T N (\ CD w u' w W N N O D D o Z m � C W i'I 7 � N m -i fn (n A Z CD N Z O N Z r W A m N co -, -' Z o z C » Z Go H Go z m w � I a CL o' c o a CD N fi O V ti O O Q. b b N ap O v ° * p 4 CD ✓isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Favision INSPECTION REPORT Sanitary Permit No: 514801 0 ATTACH TO PERMIT) GENERAL INFORMATION ( 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: Acker, Dave Kinnickinnic, Town of 022 - 1030 -70 -010 CST BM Elev: Insp. BM Elev: IBM Description: Section /Town /Range /Map No: A ✓Y\ 11.28.18.165B3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 1 CAPACITY STATION BS FS ELEV. (o , 07 / l�- $ /ate. $` Septic �,,�, 3 Benchmark C7. C Dosing Alt. B Bldg. Sewer r., I '3 Holding b St/Ht Inlet 6 b 7.55 TANK SETBACK INFORMATION St/Ht Outlet TANK TO S a P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet d Septic 3d / 3 / Dt Bottom 1 /61- -7 Dosing / �/ 3a / _ ____. Header /Man. " Z V. I 'a Aeration �- Dist. Pipe , Z Holding Bot. System Ilk Final Grade PUMP /SIPHON INFORMATION J Manufacturer O eFrand St Cover / �� • Z L j l�� a ��f- GPM /,, Z (e Model Number y� . 4 LO , q 4 34 , 10. /V f v J TDH L'ft Friction L Z System Head T H Ft -- - L f� Forcemain Length / Dia. 0 / Dist. to Well 3it> SOIL ABSORPTION SYSTEM BED /TRENCH Width J LNo. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 4C3, t _ / S ` -- SETBACK SYSTEM TO Ll, P/L BLDG JWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION P f CHAMBER OR Type Of S, stem: / A) /� AA- UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold i/ Distribution L x Hole Si 1 x Hole Spacin Ve to Air Intake Pipe(s) I / `tl Length � Length �� Dia Spacing // SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only M 117 De th Over IDepth Over xx Depth of (+� xx Seeded /Sodded x Mulched Bed /Trench Center Bed /Trench Edges ` Topsoil \ .L- No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 7 / 3 b / % Inspection #2: / / Location: 488 Cemetery Road River Falls, WWII 54022 (NE 1/4 NW 1/4 11 T28N R1 8W) NA Lot 5 G L ,� Parce No: 1`1.28.18.165133�1� -- 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = U - r- Alli 7 5 6 Plan revision Required? Yes No Use other side for additional information. ✓ vv CJ Date lnsepctor's ignatur Cert. No. SBD -6710 (R.3/97) cot1mmerce.Wf.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 i sco n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce :5 1.41 $O Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the app opri emmental I ' L1 O o � a� unit is required prior to obtaining a sanitary permit. Note: Application forms for stat wne POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be ed and q a (� /1 j <Ul p urposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. I. Application Information — Plea All Infor Property Owner's Name Parcel # o-oc Ackt-'' a ZZ - X0 30 - 76 - oia Property Owner's Mailing Address NUV 1 4 Property Location LA ' c g q L1 0� J+ • Govt. Lot City, State Zip ode ne her '� y, �� y, Section , `j 1 1 S Q I (circle one) II. Type of Building (check all that apply) Lot # U/ T N; R �j E or D CA or 2 Family Dwelling — Number of Bedrooms U V , Subdivision Name - 77— 1 Bloc ✓ ✓✓ C �rn v � P El — Describe Use city of El State Owned MCI OGGt R .� '% CSM Number El El Village of Describe Use 6t! i�l (taL ✓ ?Z_ Town of �l h n III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. 11 Permit Renewal ❑Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that app] ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) �Z V. Dispersal/Treatment Area Information: 0 Desi f low (gpd) Design Soil Applicatio ate(g dsf) Dispersal Area Required (sf) Dispersal Area Prop System Elevation L I .3 I.SV� /z5 15� III 45 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks c �'' o 0 dC C-t a U n A Septic or Holding Tank - Dosing Chamber / Oc D (p© I t VII. Responsibility State ment- I, the undersigned, assume responsibility for in olla 'on of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe 's Si ture MP/MPRS Number Business Phone Number °� aay 19 9 is -uls� Plumber's Address (Street, City, State, Zip Code) VIII. Count /De artment Use Onl Approved El ed Permit Fee Date ssued Issuin ent Signatu e o- iven Reaso r Denial � a $ (� , co ll 21,b'7 IX. Condi&lKp µlgf"easons for Disapproval \ 1. Septic tank, effluent filter and 3 J w r k o--,s r ~ dispersal cell must all be services / maintained _ (� _ C ' c_ as per management plan provided by plumber. F 2. All setback requirements must be maintained as per apple" code / al *wncK• Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 O 1 rr DO oo E Mf v s 3 £ 14 G6 .4 o l o �^ ^' s (1— o i d ro zz J M .� N o n J d J � r -A 4q -j c' > r t g o J O o O � 9 � _ N ti s � o P j � � d � 3 DO vi vo o ol n` J 09 s � ' - s � _ fy So s { d J J cl C) ` /'' o C7 4 `-� Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi,gov LA CROSSE WI 54601 -1831 : TDD #: (608) 264 -8777 i sc o n s i n www.commerce.wi.gov/sb/ artment of C www.wisconsin.gov Depommerce Jim Doyle, Governor Mary P. Burke, Secretary November 05, 2007 CUST ID No. 222774 A7TN.• POWTS Inspector HENRY F GROTE ZONING OFFICE CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA E4366 353RD AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/05/2009 Identification Numbers Transaction ID No. 1480622 SITE: Site ID No. 732185 Dave Acker Please refer to both identification numbers, 490 Cemetery Road above, in all correspondence with thew enc. Town of Kinnickinnic St Croix County N1 /2, NW1 /4, S11, T28N, RI 8W Lot: 1, Subdivision: CSM V 3 P 857 FOR: Description: Mound / Three Bedroom / Concave Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1160309 Maintenance required; 450 GPD Flow rate; 21 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (14.01/01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (14.01101); Bioftlter 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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • 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. � �"" i • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c;� r 4t7ti:cti i Q • A Sanitary Permit must be obtained from the county where this project is located in accordance with the t c OF E requirements of Sec. 145.135 and 145.19, Wis. Stats. 2 • 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 HENRY F GROTE Page 2 11/5/2007 • Comm 83.22(7) A copy of the ap rp oved 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/op eration. 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 C ✓ Balance Due $ 0.00 Charles L Bratz D POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charies.bratz@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Kent Hoke, H & H Plumbing LLC (Plans Mailed To) r t f ca 'A N j Dave Acker - Mound ' 06 Construction Materials and Techniques cc 11 materials must comply with Comm 84 and be installed in accordance with manufacturer's cMecifications. Construction methods must comply with the following Component Manuals: Pressure Distribution, SBD - 10706 -P (01 /01) Mound, SBD - 10691 -P (01 /01) Location: Lot 1, CSM p 857, v 3 Town: Kinnickinnic County: St. Croix Date: November 1, 2007 Owner: Dave Acker Address: N 8098 940 Ave. Colfax, WI 54730 ,,`e0 N Designer: Henry G �' O O g�N�E r. Signature: g License: WI D — 169 -007 # ; " G``` � Attachments: SBD -10577 - Plan Approval Application SBD -8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail�,�, 7: pump curve y 8: system management 'MD COMM CE page 1 of 8 LDING ;PONDEN t. Design Criteria Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 gal/bedroom/day x 1.5 gallons /day hydraulic load Design Calculations In situ designed loading rate o . S gallons /sq. ft. per day Depth to estimated high ground water in. Depth to bedrock '� in. Cross slope at system k ° ' O % v Force main length o ft. of z in. Q Manifold/header length ft. of t t in. o Z Drain -back �` Z gallons Lateral length @ S - 4 ft. of V 1 � in. Lateral elevation , �� S� ft. @ bottom of lateral Lateral hole size �b in. @ 3b. ° in. ft.) Spacing X ° holes /lateral holes total Lateral volume °' vg gallons Total lateral discharge rate �2, l0. gallons /minute @ 2 • ft. head Network pressure compensation losses �'��� ft. Elevation difference '4, ° s( f Friction loss ' g ft. @ 2 gallons /minute Total dynamic head k 0 4- ft. Pump /si.Aon z� gpm @ ft. of head Manufacturer L'� �e �'" �'-"�� Model # 6C L \ �A Dose volume gallons Lift/*on tank G­c� - ( D 0 1 3 Lo "0 b vb gallons Septic tank \ gallons Effluent filter Measurement pump on and off in. Height alarm from tank bottom in. Reserve capacity S gallons specs.acs.res Page Z of r 1 _ z �� 04 0 3 is 14,x, 1oq� W, Z 5 i's I CV ` �'✓� a k �IJG.�VG , 1. . � I 1�..10 16.6 l I I 1 11 l O• No-L. %A%44 :S 1,010 �ov�� �> 5A.3 e dC.a�las�o� r T �� ••gyp ',- �..�w,..\g U 40 - Z-1 „�YO,� }� hr/ V4,Vt �•1(iL O�► K:VR�GW� �ll 0 � IL t M. di,'. r. • � \', O\ �, O ..•. 1 . ` O.J.- �i �... � �.r. \p o 1 1 c ... � ; _ e..� �'.7 16 . O " A D•,,, � • � Q0, a 8'r , f X fi ort�� WEATNEFPRp�: LACKING cT QVICIC Diac,oVVtCT ---\ Grade, elev. 7/7�7��� IL 4 PVC sch ' X 40, 3' onto - solid ground • PVC 24" T. 1). �I ' tcn 4C ven: 4 /A" r ° wEz p f ww "NLO. 4" PVC WFLE j `scn 40, (}LI.. PI/'G 0 1 AL 3' cn�c wr E LT 10 044 —�— `" � T ON s o 2 d Ow *1 - ^CUnd P urlP ELF bLoCC 5EPTiC _ SPECIFICATIOIJS DOSE ,tA I TAUkS MA►JUFACTURCR: IJUMBER OF DoSCS: S �� _ per day TA►JK SIZC : V-b CALLOUS DOSC VOLUME ALARM r1A1.JU FACT LJRCR: S `� ` `K-� IIJCLUOIIJG 6ACKFI.OW: gy 7 l ea__c7s /'\ODCL UUTAbEK: \ ° I \'} CAPACITIES; A= '1Oio 'Z IUCHES CR ga'_cns SWITCH TYPE: �`"�` " \ b o Z 8 iuCHES ga''lcns PUMP /1AQUFACTURCR: %'\ LT S.O i^ C,'3_��i1s MODEL QUMDER; 0■ � INCHES OR Iso`�s� ga'_lcnS 5W17CH T»PE: V~QJv..{v .. IJOTE: PUMP AWD ALARM ARE To �E MIUI1'1UM DISCHARGE RATE �'" GpM INSTALLEO C)Q 5CPA0.ATE circuits 1 4E0.TICAL DIFFEKEUCC CETWEEU PUMP OFF AUO OISTRIDUTIOW PIPE.. FELT + ►JETWORK SUPPLY PREiLLIKE . . , , , . , , x _�S _ FCCTA-d. -s' + �0 FEET OF FOitCC MAIIJ X I'�� F /ioortFRICTIOU FACTOR. 0 4-g FEET 2} TOTAL DyJWAMIC. HEAD ° ' }Ic FEE T IUTER►JAC. DIME.U6101JC • 0( 7AUK: LE1.IC,TH `�� ;W;DTN � LIQUID OCPY _ 110 ZIL 6E - CIM SUMP /EFFLUENT PUMP 115V PLUG 8.72" 23 VV PLUG i �• 1• '•1/2" DISCHARGE • � I I I I I I I 1 9.88" 8.38" i I i 09.80" SCREEN TO PASS 1/2" SOLIDS Specifications MODEL ITEM SOLIDS RUNNING PERFORMANCE (GPM @ HEAD) SHUTOFF PWR CORD WEIGHT DIMENSIONS NO. NO. LISTING HP VOLTS (DIA.) AMPS/WATTS 5' 10' 15' (FT.) P.S.I. (FT.) (LBS) (H x L x W in.) 6E -CIM 506500 WA 1/3 127 1/2" 10/750 54 44 31 20 8.7 25 28 9.9 x 8.8 x 8.5 6E -CIM 506735 CSA 1/3 230* 1/2" 4.8/890 50 42 27 20 8.7 25+ 28 9.9 x 8.8 x 8.5 6E -CIM 506775 UUCSA 1/3 115 1/2" 10/750 50 42 27 20 8.7 25 28 9.9 x 8.8 x 6.5 6E -CIM 506711 UUCSA 1/3 115 1/2" 10/750 50 42 27 20 8.7 25 28 9.9 x 8.8 x 8.5 6E -CIM 506730 UUCSA 1/3 230* 1/2" 4.8/890 50 42 27 20 8.7 15 28 9.9 x 8.8 x 8.5 6E -CIM 506710 UUCSA 1/3 115 1/2" 10/750 50 42 27 20 8.7 10 27 9.9 x 8.8 x 8.5 6E- CIM -RFSN 506740 UUCSA 1/3 115 1/2" 10/750 50 42 27 20 8.7 10 27 9.9 x 8.8 x 3.5 *50/60 HZ. Performance Data Based on 60 Hz. CIM - Manual RFSN - Piggy Back Mechanical Float Switch + W /out Plug FLOW- LITERS /HOUR Construction 0 40 60 120 160 Cover Polycarbonate 25 Motor Housing Epoxy Coated Cast Iron 7.6 Impeller Material Nylon 20 Impeller Type Vortex s.25 Volute Epoxy Coated Cast Iron W 15 5 '2 Power Cord SJTW -A 4 Mechanical Shaft Seal Nitrile with carbon and 3.75 ceramic faces 10 Fasteners Stainless Steel 2.5 = Shaft Cold Polled Steel 5 Bearings Upper and loWer sintered 1.25 sleeve bearings 0 0 0 10 20 30 40 50 Little Giant Pump Co. FLOW- GALLONS /MINUTE PO Box 12010 ` Phone: 405.947.2511 PUMP PERFORMANCE CURVE Okla. City, OK 73157 Fax: 405.228.1550 115V 6OHz www.LittleGiantPump.com (� I Form No. 994465 - o /OC y System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, H & H Plumbin 715-962- 4155, or the St. Croix County Zoning Department, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site di system, "s s ystem , " is significantly dependent on the volume of water v, hich P g P Y P Y � g Y P flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet -rock and /or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water - saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. The upslope toe of the mound system must be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run -off; final settled slope should be 2 -3% over the system or 2 -3% diverting surface run -off around the ends of the system. Maintenance 1. The septic tank must be inspected eve three p p every years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allo%%s reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9, Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 11. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing. and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 RIGINAI: N *SC4nan SOIL EVALUATION REPORT #2507 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Certified Soil Testing, LLC Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County St. Croix l include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 022- 1030 -60 -000 Please print all information. Revie d By Date I . Personal information y u provi��9 n urposes (Privacy Law, s. 15.04 (1) (m)). 1 Property Owner Property Location r Acker, David Govt. Lot NE1 /4, N 1/4, 11, T28N, R1 8W Property Owners M fling Ad ress - Lot # Block # Subd. Name o CSM* N. 8098 940th St 1 CSM V 3, P 857 City L State ip Pone Number City ❑ Village ❑ Town Nearest Road Colfax WI 15- 962 -2363 Kinnickinnic 1 490 Cemetery Road ® New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material loess over sandstone Flood plain elevation, if applicable NA ft. General comments install 8'x 60' rock cell mound on 1 09.8 c ontour as upslope edge of rock w/ 1.25' sand fill for 3 br w/ 0.4 and recommendations: gpd /sq ft basal loading ❑Boring # ❑ Boring 1 -11 ® Pit Ground surface elev. 107.3 ft. Depth to limiting factor 51 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 'Eff #2 1 0 -9 7.5YR 2.5/1 - sl i f sbk mvfr Cs lm .4 .7 2 9 -30 7.5YR 3/2 - sl 1 m sbk mvfr Cw lm .4 .7 3 30 -38 10YR 4/3 - sl 1 m sbk mvfr gs im .4 .7 4 38 -51 10YR 4/4 - sl 1 m sbk mvfr Cs lm .4 .7 5 51 -58 10YR 4/4 f2d 10YR 6/2 sl 0 m mfr gs - .2 .6 6 58 -64 10YR 8/3 f2f 7.5YR 4/6 fs 0 sg dl - - .5 1.0 ❑ Boring # ❑ Boring ® Pit Ground surface elev. 107.6 ft. Depth to limiting factor 35 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0 - 7.5YR 2.5/1 - sl 2 m gr mvfr gs im .6 j 8 2 8 -28 7.5YR 3/2 - sl 1 m sbk mvfr gs 1m /C .4 .7 3 28 -35 10YR 4/3 - sl 0 m mvfr Cs lm .4 .7 4 35 -60 10YR 4/4 f2f 10YR 6/3 sil 0 m mfi - 1m 0 .2 Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >00 < 150 mg /L " Effluent 2 = Q0 S30 m /L and TSS s mg /L CST Name (Please Print) Sign to CST Number Henry F. Grote "' 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 11/13/2006 715- 233 -0398 SBD -8330 (R 07/00) "t - 1 F w Property Owner Acker, David Parcel ID# 022 - 1030- 66 =Ot0 Page _2 — of - 3' 3 ❑ Boring Boring # pit Ground surface elev. 109.9 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2 1 0 -6 7.5YR 2.5/1 - sl 2 m gr mvfr gs lm .6 .8 2 6 -21 7.5YR 3/2 - sl 1 m sbk mvfr cw lm .4 .7 3 21 -34 10YR 4/3 f3f 10YR 6/3 sil 1 m sbk mvfr cs lm .4 .6 4 34 -41 7.5YR 4/4 - Sid 0 m mvfr cs - 0 0 5 41+ SSBR H3 is near field capacity 4 [] Boring Boring # Pit Ground surface elev. 10 ft. Depth to limiting factor 61 in. [i -- -- Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2 1 0 -11 10YR 3/1 - sil 2 11 -20 7.5YR 3/4 - sil 3 20 -36 7.5YR 4/4 - sicl 4 36 -61 10YR 4/4 - sil 5 61+ SSBR pits constructed 11/13/06; hand borings on 10/31/07 after house staked & drive described near NE corner Boring 7 Boring # ❑ Pit Ground surface elev. 110.4 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots j _ GPD /ftz _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. St •Eff #1 Eff #2 1 0 -16 10YR 3/1 - sil 2 16 -20 7.5YR 3/4 - sil 3 20 -34 7.5YR 4/4 - sic:[ 4 34 -42 7.5YR 4/4 f7f 7.5YR 4/6 sil - -- -- - -- -- 10YR 6/3 �- -� - - -- 5 42 - 47 10YR 5/4 c2f 7.5YR 4/6 I's H1 gritty w/ s (almost sl); H5 is near field capacity & has inclusions sl ' 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 ser\ ices or need material in an altemate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.07 /00) Certified Soil Testing, LLC Property Ovyner Acker, David Parcel ID # 022- 1030- 6 0 Page _2_of_3 F 3 ❑ Boring Bring # Pit Ground surface elev. 109.9 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff #2 1 0 -6 7.5YR 2.5/1 - sl 2 m gr mvfr gs im 6 .8 2 6 -21 7.5YR 3/2 - sl 1 m sbk mvfr cw 1m 4 .7 3 21 - 34 10YR 4/3 f3f 10YR 6/3 sil 1 m sbk mvfr cs im .4 .6 4 34 -41 7.5YR 4/4 - Sid 0 m mvfr cs - 0 0 5 41+ SSBR i H3 is near field capacity F � ] [] Boring Boring # Pit Ground surface elev. 108.3 ft. Depth to limiting factor 6 1 in. ❑ -- Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff #t I •Eff#2 1 0 -11 10YR 3/1 - sil 2 11 -20 7.5YR 3/4 - sil 3 20 -36 7.5YR 4/4 - sicl 4 36 -61 10YR 4/4 - sil T 5 61+ SSBR pits constructed 11/13/06; hand borings on 10/31/07 after house staked & drive described near NE corner 5 [� Boring ]Boring # Pit Ground surface elev. 110.4 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD / ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 1 0 -16 10YR 3/1 - sil 2 16 -20 7.5YR 3/4 - sil 3 20 -34 7.5YR 4/4 - sicl i 4 34-42 7.5YR 4/4 f2f 7.5YR 4/6 sil 10YR 6/3 5 42 -47 10YR 5/4 c2f 7.5YR 4/6 fs H1 gritty w/ s (almost sl); H5 is near field capacity & has inclusions sl * 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 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8130 (R.07 /00) Certified Soil Testing, LLC r > L J � f O 9 Nl� o o\ o c oS." 0 _'l I rt i J 3 _ c s d � i JfQQ O � O C8 --� ci 11 t �, O i t fl o C w 1 �1 d O 1 3 S � rj `� ° n 03/06/2003 06:55 17158794481 DAVID ACKER PAGE 01 a VGL 22 PAGE 5363 KA.T13LRE-g 11 VALRU RZ01STER Ok. LENS ST. CROIX CO.. W,7 RECEIVED FOR RECORL 03/Q 2007 1 Ql r 05 '" CfiRTIFIRIi st)R 7Ey 11AP CLlpy - o PAGE$._ CE-" - .,,S►IJRVEY �VtA David acid Heather Acker Being Lots 1 and 2 of that Certified Survey Map recorded in Volume 3 of St. Croix County Certified Survey Maps, Page 857, ,located in the Northeast 1 /. of the Northwest 1/4 Of Section 11, 'Z' 28 N, R 18 W, Town of Kiuni.ckinnic, St. Croix County, Wisconsin r NORTHWESTCORNER iysv SKG770Nu TaBN,'RisW ° -: (Found BerrtbenAlurninratuMonumarlt) a. >•r. NORTH ppUARTRKC ANER P�1 �telv�rLZE,- a NOkMZJYENWj14 SEC. 11 S'emo�U 7'28N,.R18W w r. N89" z6 6-04'11 3 ((Founds "StaelsurvgvMnrker) ° °•. -,- 1328.0 oa"� 12 .08 s' DATED - 143 ~II 7 U F/E I COI' 200 1 Q E1'�7� �Qrj Ot- S8q "R 561{6) LQT 2 33 33' ' S ir GCE "bz618.2oT P t 480-57' L 4 - - - - - ---- - - -- - - E'.EB7lFjfo 9&VLY MAP a.1 OWNERS A nnrtF. ,S LOT $ YQ /LME 3 , pgC,€ 817 1 N8098 940th St. s.,4 O A R CRSS p� ® f � C01faz. PPY 34730 3 a , 13 9,9L'1 SQ. Fl: io R z "I� V 2.61oACR Fs,S OT j " �`�oo,'� OR �! o 113.6 SQ. FT. ' 6 �6 E ¢ D aa,,Q : � L OT I l2'aR¢I "Y1�r126 .60 6 s B' � � CE_R /Ff V- �( VFY M9/ Y�19, PAGE_49Q4. LOT , R 6 a L ao 1.931 ACRES s CH z.looaClZFS OOR L �' °.R �02'4' z. 56 S . FT 8 ,114 SQ. FT o u 9 4; 453 - a�+ POLY a x s vo•oobo" w 4 O� N' C��VE DATA I Curve t -2 LEGEND Radius m 2200.61' Arc Length 166 -t9' , . E Central le oa °aKSS^ p Indicates 1 "O.D. x i.8" Iron Pipe Set w<; Chord Beanng - S o8$ °go'23,g^ W (Min. Wt. - 1. a j %5./Hn. ft.) Chord Length - xo6a8' T ueni Searing =' 3 or27 W ang eer)ng = S 1 0 °13'20" w Found 1" Iron Pipe 5 Curve w! 2167.61' Section Corner Monument Scale in Feet . • 1`'. - 1 0' Arc Length - 100.74' 0 (as noted) Central Art&le s 62 °39'46" IMEN —1 Cbord Beanng ='S o8 °p'27" w ISO loo 50 0. 150 ChbM Length= loo 73 x Indicates Fence Tangerit Be6ring • S W3313j" w Bearings are .referenced to the North line TanX6nt Bearing . S 10 '13'20'W of thr xVW 1/I .of Section ax. assumed ) This InstrumentDraitc (R Recorded As bearing N 89 °84.09^ E d by Mack W. Peavey SHEET 1 OF 2 Vol. ZZ Page 5363 IF > ORIGINAL R #2507 S l` sl SOIL EVALUATION REP t Department of Commerce in accordance with Comm 85, Wis. Adm. Co Page 1 0 3 Division of Safety and Buildings Certified Soil Testing, LLC Attach complete site plan on paper not less than 8' /z County x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 022 -103 60 -0 Please print all information. Review By Date Personal information you provide may be Law, s. 15.04 (1) (m)). (Date Property Owner Property Location Acker, David Govt. Lot NE1 /4, NV/1 4, S11, T28 N. R 1 8W Property Owner's Mailing Address NOV 2 200 Lot # Block # Subd. Name or CSM4 N. 8098 940th St. 1 CSM V 3, P 857 City State Zip &d er ❑ City [] Village ® Town Nearest Road Colfax WI - - Kinnickinnic 1 490 Cemetery Road X New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial - Describe: Parent material loess over sandstone Flood plain elevation, if applicable NA ft. General comments install 6'x 76' rock cell mound on 108.0 contour as upslope edge of rock wl 1.25' sand fill for 3 br (3 br and recommendations: assumed, not staked) ^ , � Si'?yuz- l r7� /3 a Boring # Boring � 7 Z Pit Ground surface elev. 107.3 ft. Depth to limiting factor 51 in. Soil Application Rate Horizon Depth DominantCvtor RedoxDescription Texture Structure Gansistenc Boundary Roots GPD/ft in. Munsell Qu. St. Cont. Color Or, Sz. $h. •Eff#1 •Eff#2 1 0 -9 7.5YR 2.5/1 - sl 1 f sbk mvfr Cs 1m .4 .7 2 9 -30 7.5YR 3/2 - sl 1 m sbk mvfr Cw 1M .4 .7 3 30 -38 10YR 4/3 - sl 1 m sbk mvfr gs 1m .4 .7 i 4 38 -51 10YR 4/4 - sl 1 m sbk mvfr Cs im .4 .7 5 51 -58 10YR 4/4 f2d 10YR 6/2 sl 0 m mfr gs - .2 .6 6 58 -64 10YR 8/3 f2f 7.5YR 4/6 fs 0 sg dl - - .5 1.0 ❑ 2 Boring # Boring ❑ Pit Ground surface elev. 107.6 ft. Depth to limiting factor 35 in. ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0 -8 7.5YR 2.5/1 sl 2 m gr mvfr gs lm .6 .8 2 8 -28 7.5YR 3/2 - sl 1 m sbk mvfr gs 1m /C .4 .7 3 28 -35 10YR 4/3 - sl 0m mvfr Cs 1m ,4, .7 4 35 -60 10YR 4/4 f2f 10YR 6/3 sil 0 m mfi - 1m 0 .2 I Effluent #1 = BOD 30 < 220 mg /L and TS S 30 < 150 mg /L " Effluent #2 = BOP < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Sig at re: CST Number Henry F. Grote - 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 11/13/2006 715- 233 -0398 SBD -8330 (R.07100) I Property Owner Acker, David "a Parcel ID # 022 - 1030 -60 -000 Page 2 . of 3 T g Boring"' .Borin # Pit Ground surfacd"dlev. 109.9 ft. Depth to limiting factor 21 in. Soil Application Rat Horizon Depth' ' Dominant Color Redox:Descrlptlon Texture Structure ` Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Cofer Gr. Sz. Sh. •Eff #I •Efr#2 1 0 -6 7.5YR 2.5/1 - sl 2 m gr mvfr gs 1m .6 1 .8 2 6-21 7.5YR 3/2 - sl 1 m sbk mvfr cw lm .4 .7 3 21 -34 10YR 4/3 f3f 10YR 6/3 sil 1 m sbk mvfr cs lm .4 .6 4 34 -41 7.5YR 4/4 - Sid 0 m mvfr cs - 0 0 5 41+ SSBR H3 is near field capacity i i i i Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD s - < 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 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07/00) Certified Soil Testing, LLC Property Owner Acker, David' Y, ' Parcel ID # 022 - 1030 -60 -000 Page 2 _of _ 3 3 J Boring # Pit Ground surfaces �lev. 109.9 ft. Depth to limiting factor 21 in. Soil Application Rat Horizon Depth Dominant Color R "dii Dssciiption Teit_6re Structure Consistence Boundary Roots GPD /ft in. Murtsell Qu._sk Cori;. polar Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -6 7.5YR 2.5/1 - s) 2 m gr mvfr gs 1m .6 .8 2 6 -21 7.5YR 3/2 - sl 1 m sbk mvfr cw im .4 j .7 3 21 -34 10YR 4/3 f3f 10YR 6/3 sil 1 m sbk mvfr cs lm .4 .6 4 34 -41 7.5YR 4/4 - Sid 0 m mvfr cs - 0 0 5 41+ SSBR H3 is near field capacity I i 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 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R 07/00) CeRfied Soil Testing, LLC • a v 0 rn N 9 C34 I ` i rr�� oo 0 3 I � Mf a , t" �0 d +� • o N n d ^f 0 a oi { i J d S � �cA -Z:D ri d � x d f 03/06/2003 06:55 17158794481 DAVID ACKER PAGE 01 s IOJ- 22 PAGE 5363 XA.TJJLrR& }J, WALSU kZG".S7;ER L1F DEEMS ST. CRQZX CD_ . MI RJs'CS3 YED FOR RECon e3te5iys� 1 r e�arJ. REC FT1 SUR.yE.Y Y REC FEE 11A capy 00 s 13. A4l Davao and Heather Acker Being Lots 1 and 2 of that Certified Survey N,Iap recorded in Volutnte 3 of St. Croix County Certified Survey Maps, Page 857, .located in the Northeast 1 /. of the Northwest ✓4 of Section 11, T 28 N, R 18 W E x:ni. , TO °fnnickic, St, Croix County, Wisconsin NORTEWRSTCORNSR r wu c • � .. s�= GT7ONu, TaBN,'R iB W My (Found Berntsen,Aluminummonurnent) NoRTX OU R�z CQRNER PEl p�iv vrcx E a NORTHLiNENW114SEC 11 SBC770 .t1, r28N,Rt8W i1a789 °54 '03 "L 2656 .o ( Found t "Steel survey Marker) .. -..- 1328.0 2 ;a r fa 1328.02' a 'A y DATED - �'� CQR F /ED_ �Y� /aP VI March i, oo 3 g ( y? n ^ , ' PAGE IE7�9 pJ 2007 CR— S89 "E 561 -q6') ©` Y' 90"L "bzbl8.so3 MAP CER LOT 2 L/F1EQ SMAiTr - _ . . PB:U E_2�61 N ��'- OWNER °elDDRE4C CEBUFlf`D MY1F L MAP H1 � LOT ,5 YQU&M 3 , .PACE' 887 N8098 940th St. �) c $ 2'74 S hy 46 � / Colfar, R7 54730 S o OR LOT 1 � ov''` u� / b �� $�0a �13.6SQ•Pl °2 65 E c1ar. . ' `Y LOT r / W z C6Xc[. K/WI 1Q 6 rk orivwveyD : V 26 .60' sep'tcv " CER /FffO RffWcY M4 Y -J9, RACE_44 -4: ZI. l vet® o� LO 6 1.931 ACRES 2.lO0A OR 2 .cQt . b _ OR 4 SQ LOT '•, o p 91.456 SQ. PT. 8N LOT •, 453.69'1 � 47+- N89 g6.E6'W 48� $• l UNPI A.IUQ Oarve N' Q7BY.lE DATA l Radiu LEGEND Radius m 2zoo.61' . Arc Lea h A io6.t Central le 0 1 2 4553" p Indicates 1 "O.D. x 1 8" Iron Pipe Set t Chord Beania6 o S 08° 0'23.5" W Chord Length 106.18¢ (Min. Wt. - t.id Ibs./Hn. ft.) TAUS"t sestina = S 0 7° 2 727" W Tangent Bearing = S 10 1 13'20^ W • Found 1" Iron Pipe Cuxve 3 -a 5 Radius a 2x67.61' Section Corner Monument Scale in Feet Alec Length =100.74' 0 (as. noted) Central Angle s 6 °39'46" CbmdBeanng =308 °3'27 "W 150 too 5 Chbid Length = zoo 73 x Itndleates Tangent Bemring + S o7 W Bearings are referenced to the North line Tatutent Bea2iae r S 10 °1,3'20' W pf the NW 1/,t of $¢CtioA AA. assumed (R - ) Recorded As bearing N 89 °54'09" E This insfrumeat Arafted by Mark W. Peavey SkIEJET 1 OF 2 Vol. 22 Page: 5363 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer - -' �J J C'_" . 0 P G A r Mailing Address Property Address k( (z (Verification required trom Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION 4g z Q�� 0`01_7_�e_v� PL Property Location '/4 , ' /4 , Sec. T N R W Town of Subdivision Plat: , Lot # Certified Survey Map # b3 , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ' yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1!3 frill of sludge. I /we, 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 Planning & Zoning Department within 30 days of the three year expiration date. 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. Number of bedrooms 3 SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Parcel #: 022 - 1030 -70 -010 11/20/2007 04:22 PM PAGE 1 OF 1 Alt. Parcel #: 11.28.18.16563 022 - TOWN OF KINNICKINNIC Current 1X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type • 03/05/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DAVID & HEATHER ACKER O - ACKER, DAVID & HEATHER 486 OLD CEMETERY RD ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist# Description "488 CEMETERY RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.748 Plat: 5363 -CSM 22 -5363 022 -07 SEC 11 T28N R18W PT NE NW FKA LOT 1 CSM Block/Condo Bldg: LOT 05 IN VOL 3/857 BEING CSM 22 -5363 LOT 5 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 11- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 03/05/2007 845735 22/5363 CSM 11/27/2006 839543 WD • 07/23/1997 1013/142 WD 07/23/1997 874/548 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/14/2007 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ' Es3954 -� I KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM I - 2000 RECEIVED FOR RECORD DocumrntNumber WARRANTY DEED 11/27120% 04:40PH THIS DEED, made between Daniel E. Gedatus and Toni L. Gedatus. WARRANTY DEED EXEMPT # husband and wife, Grantors. and Dacid Acker . and Heather Acker. husband and wife as survivorship marital property, Grantees. TRANS FEE: 11.00 Grantor, for a valuable consideration, conveys to Grantee the following TRA FEE: 450.00 �� g CUPY FEE: described real estate in S!. Croix County, State of Wisconsin (the CC FEE: - Property"): PAGES: 1 Part of the NE' /s of the NW' /, of Section 11, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, described as follows: Lots 1 and 2 of Certified Survey Map recorded in Vol. 3 of C.S.M., pg. 857, as Doc. No. 359318. Recording Arra Name and Retwn Address: I.oberg Lase Office 3. 9 West Main Street Ellsworth, NNI ;41111 Together with all appurtenant rights, title and interests. 022 1030 - 70 - 000 & 022 1030 - 604)00 _ Parcel Identification Number (PIN) This is homestead property. Grantor warrants that the title to the Property is good indefeasible in fee simple and free and clear of encumbrances except casements, covenants. and conditions of record. Dated this 17 day of November, 2006. * Daniel E. Gedattis * Toni L. 'edattis * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) COUNTY OF PIERCE ) ss. authenticated this Personally came before me this 17' day of November, 2006 the above named Daniel E. Gedatus and Toni L. Gedat me known to person (s) persos) who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foreg ng i struntent an __no dg d the same. (If not, ljj/ authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY '�J di B Ch No - blic, State of Wisconsin Robert L. Loberg My commission is permanent. (If not. state expiration date: Loberg Law Office 09 -14 -2008 ) (Signatures may be authenticated or acknowledged. Butte are not necessary *Names of persons signing in any wpacitc mutt be typed or printed below their signature dpjb SST6232 tofu I ' bof a Hu� iations "5�' SOIL AND SITE EVALUATION REPORT Page / Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST, GieO{ J( Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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 ZF 10 410 5 ?e GOVT. LOT Nr 1/4 �G� ��7 114,S // T -10 ,N.R /P E (or) V1 PROPER 9 OWNER':S MAILING ADDRESS LOT ft BLOCK # SUBD. NAME OR CSM # ' i �I/Ew GSM TY, TATE ZIP CODE PHONE NUMBER []CITY QVILLAGE �I OWN NEAREST ROAD f o t7?TS Syo 7 C�� R New Construction Use Residential / Number of bedrooms 3 4 [ J Addition to existing building (J Replacement [ J Public or commercial describe Code derived daily flow 4O _ gpd Recommended design loading rate • S bed, gpdAt trench, gpd/ft Absorption area required _ trench, ft Maximum design loading rate • S bed, gpd/ft ' trench, gpolft Recommended infiltration surface elevation(s) - P 3 ft (as referred to site plan benchmark) Additional design / site considerations Y`O/Q Alea �P 7 - y ,4.=-- SySTE� - / Parent material Sc5 �� s�`/acvs its -f el •,,vP S /. Flood plain elevation, if applicable W i — ft S = Suitable for system CONVENTIONAL MOUND IN•GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem C1 J R U Eq S ❑ U Q S JZLU ❑ S J�U Q S M ❑ S LU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Psd ELY , h Ground P IDYie Y I ( 1s elev. fL C , 149 2- Depth to limiting factor „ Remarks: Boring # D s Zf Ground _?o se /0 y/ / G �' /2 5 ( �.�, s6i� �'r^ �i / y • s elev. ft. Depth to limiting factor „ Remarks: 7i�a�� Za-✓ C �i�S S�9r viPf T-,df, 7— /a w CST Name: — Please Print Phone: 7 ^_ L HOMESITE SEPTIC PLUMBING • / %5 300/ / Address: 653 O'NEIL RD., HUDSON, WIS. 54016 > . 12- �S�^M Z WZ RORFPtT 1 1 0 BRIGHT Signature: . MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Date: CST Number: M(NN. rNSTALLER A DESIONER LIC. NO. 00663 �ti 1 2 ��. 0 cS' c � � ORIGINAt� PROPERTY OWNER SOIL D E S C ' TI O N REPORT • Page of - PARCEL I.D. ft Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Y Roots G'p t in. Munsell Qu. Sz. Cont Color Gr. Sz, Sh. B� n� O-i jo 3/� /o�M z, f s6� ��,�f2 es- 3 • s . (�, y�e ib ._--- /o,�, Z, c', b ra �I2 if-5 zf Ground /32. 1 2-1 C, GS 7� S elev. s S.l /, �' Sh,� �► �, ' " .— ---- . y b S Depth to limiting factor ,_ Remarks: A: i N = = C " S,97 URIJ 7 - 6 - Z -D /1 7 7 Boring # 3 i Ground elev. Depth to ! limiting factor Remarks: Boring # y � Ground elev. ft. Depth to limiting i factor i Remarks: Boring # _ r Ground elev. It Depth to limiting factor Remarks: OWN 000nio ncinrn JA MIRIPO . u I 4 4-r NE G0 GD,p�vt7c' 0 33 C So' 3, • �g • 3 � W Gi :tJE' 6 r r `7 ELE UA p,JS 13 . z 10 2- 5-0 ' IN I`3.3 101,2-6 i S E" f S r o srsT.E.� /07 . ZS HOMESITE SEPTIC PLUW" Co. 653 OWL RD.; KM, wI$. 6016 ROBE'R'T UMIGHT WIG, MAM PLUMBER LIC. NO. 33(17 M.P.Ft& MfNN. INSTALLER 6 OESiONER LIC. NO.04663 C I ?!1'1':II 1 KI) � :Y MA 1' El-.DON BA D A-1 fart of thn. IJor °then 1t 1/ of the Northwent 11 of Sec t.ion 11 , b ,,„,. f , R4 a ._ '� Township 28 North, Range 18 West, Town of 1{innickinnic, 49 /V St. Croix County, Wisconsin. 1 nd I (.;)1, :1 1" i run 101v f611ti l j2 W o I rid icatc 1" r. 2 iron pipe -190 p4 5. wc?.i F',h.i rtl� 1 . 1 ,i lh:.�l't sot. �� sv 90 0 - 00 w' S/ Q . 20 ✓ ivE Cc> Q « , 00 J 0 ; two 9) 0 G C7T / : 2 13. 2 !St A(=. S By �S E- �O 3.// AC. i09.0O "� �� V0 .EXC. R. O. W. k \ N1 a� 0 2 D 33 0 a A � � A N N m� o �a��� 01 . � 000 j1 ~. r �Q 0 0 /Z-)9. /-7 , ' 1� NCO C> 00 "E = ZZ • SD e��� O LOT Z /. 2.4C AC. SGALE / "� /00 A 07 A C:. EXC. State of Wisconsin) St. Croix County) J, jamt� "I "." Nurphy, Iteg aterei L Surveyor, do hereby certify that by direction of the Owner Eldon Bader, I have surveyed and divided the lands shown hereon in . accordance with official records, Chapter 236 of Wisconsin Statutes and the ordin- ances of St. Croix County; and that the above map and description ary a true and a correct representation thereof. Dated: 7 Aum 1979 / `� `` ` S N •° JAMES L. Vol. 3 Page James L. Murphy = MURPHY Certified Survey Maps Registered Land Surveyor o S -1042 St. Croix County, Wisconsin` RIVER FALLS �4 WISC. - .5 1 4 1 it E LAND CS ' yy/ H//11111111111 1111U1 � 1 (Description on reverse) 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: % � < , Section // T Z8E (or6>ownship or Municipality '� N Lot No. , Block No. County G �O /.l S ubd ivision Nam g. 10 Owner's/Buyers Name: Mailing Address: /=' X69 AUG 8 TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 COMMERCIAL - ONIN EFFLUENT DISPOSAL SYSTEM: NEW y / REPLACEMENT ALTERNATE SYST THER DATES OBSERVATIONS MADE: SOIL BORINGS �— �— -7 PERCOLATION TESTS %! 1 SOIL MAP SHEET �6 NAME OF SOIL MAP UNIT N �� PERCOLATION TESTS TEST HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL BER INCHES THICKNESS IN INCHES 1STWETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P- / TS �`[. /6//T ZPAL V, LS 4Pa' S N o y O / L vim P- n P -2 ZU� TS �L /6f+'r" Q.cry r. 30 / ' sa P— P_ SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES f OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B / �+ /410�V 4V ri7 Jf 6 t:I6NT ,Q/Lm 6U Ve44 ,0 r-.f a 4" i l B S' '' ��i s L / /� N B- 6 1 ¢ '� �i¢ �' L 1, rw ziT 1-7-da N 4S 7U ELL 06✓ 1- � PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy G Sp fr• .Indicate scale or distances. Give horizontal and vertical reference pants. Indicate slope. E _�v Ilk ._./cts�d i. aQC L /_.2Q!c1a.,E�/f? , , ''VCW IP -!� 9 � � �N m. W q .�?v why /¢L L � E .. p 1,► e I + /� . W, a , T , i t 3 Eta '_ I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) LA y E NCB /VL L Ila /� •y/ Certification No. S Address A'o u �7 i ✓E/z__ j= 4.r' A// S V¢y Z Z Name of installer if known v ,�.v w —Local Authority HF� qinnat OWN- S T C cOU N TY PLANNING TOILING EROSION & SEDIMENT CONTROL PLAN Site location: 488 Cemetery Rd, Lot 5, Town of Kinnickinnic Owner(s): David Acker Parcel ID #11.28.18.165B3 Code Administration 715 - 386 -4680 Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." In Land Information addition, Wisconsin Uniform Dwelling Code Comm. 21.125 requires the building permit Planning applicant and /or landowner to follow erosion control procedures and maintain them until 715 -386 -4674 the site has been stabilized (Uniform Dwelling Code Comm 21 is available on -line at: www. commerce. state. wi .us /SB /SB- DivCodesListing.htmi) Real Property 715 - 386 -4677 The Owner of the above parcel is responsible for notification of all contractors performing construction activities on this site that an Erosion & Sediment Control Plan is in effect and the Recycling following activities will be required in order to maintain compliance with the plan: 715 - 386 - 4675 1. Maintain existing vegetation wherever possible to minimize erosion and sediment movement. The primary source for construction site runoff will be the house foundation excavation, driveway, well drilling, and soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #4 below. 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and /or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on Public roadways must be removed at the end of each workday. i. Do not allow contaminated runoff to be directed onto neighboring property or into surface water conveyances. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. (Refer to specification sheet for temporary diversions available from county). 4. Stabilize exposed soils (septic system included) with seed and mulch immediately after installation - do not wait for final stabilization and /or landscaping of entire site to establish permanent cover on the site. When late- season weather conditions will not permit seed germination, a heavy straw mulch cover will prevent erosion until vegetation can be established. Erosion control matting can be applied any time of year and, if installed properly, will provide protection even if seed germination is delayed. ST. CRO /X COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD, HUDSON, W1 54016 715 386 - 4686 FAA Page Two — ESC Plan Acknowledgement Form The owner of record during site construction will be responsible for compliance with state and county code requirements as specified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions regarding erosion & sediment control product installation. PLAN PREPARED BY: RYAN YARRINGTON, ZONING TECHNICIAN #683475 Owner acknowledgement of ESC Plan requirements: 2007 (Please sign and return original ESC form to Planning & Zoning Dept. A copy is attached to the owner's permit and maintenance agreement, which is given to the plumber at time of permit issuance.) Copies provided for excavation contractor, plumber, and town building inspector ST. CRO /X COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD, HUDSON, W1 54016 715- 386 -4686 FAA t