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HomeMy WebLinkAbout022-1030-75-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453206 0 GENERAL INFORMATION (ATTACH TO P,FRMIT) 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: Casey, Robert & Dena I Kinnickinnic Township 022- 1030 -75 -100 BM CST BM Elev: Insp. BM Elev: Description: Section/Town /Range /Map No: 16b G rA ( 11.28.18.165C40 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. o'. Septic Benchmark Dosing Alt. BM - kz, v /000 y k� • �� /05 - Aeration /� ` Bldg. S wer S.q c l l b , 4// Holding St/Ht Inlet -7 5 TANK SETBACK INFORMATION St/Ht Outlet �1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet - Z "3 Septic ! / / _ Dt Bottom 16,V g 5:119 ► q ` ` Dosing �^ �Z-7 i / ` Header /Man. CM 13Z Aeration {� Dist. Pipe ' 3. �g 4Z Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 7.. 9% • �� �,Z Manufacturer DP GM and t Cover �� �; ��g� 1K dZ Ok Model Number e 4 a ,n��o.� ,� S - l.s �i 7 TDH Li Friction Los System Head TDH t �* .6 1, ti G . k IS •I ► a� i Forcemain Lengt 1 D I Dist. to Well / J 1 ­ SOIL ABSORPTION SYSTEM BED/TRENCH Width 9 / Lengt No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth � DIMENSIONS I \1 '%1— \ SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type K) a t / / UNIT Model Number: I L - 7 P DISTRIBUTION SYSTEM Header /Manifold l i / Distribution - ] 111 x Hole Size x Hole Spacing Vent to Air Intake _ � ` i �1Z L "6� %1 /f I n Length Dia Length Dia _Spacing 1 1 9 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 y Z_ Bed/Trench Edges Topsoil ' P�— Xl_ ms F] No es i No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: I a / Z 6 4 Inspection #2: Location: 494 Cemetery Rd Unknown (NE 1/4 NW 1/4 11 T28N R18W) NA Lot 2 �+r0 7 P arcel No 11.28.18 5C40 1.) Alt BM Description = Cy 2.) Bldg sewer length= �b / tj vfay.; - amount of cover = q ti No 417n sepctor's — Plan revision Re uired Yes . Use other side for additional information. i � SBD - 6710 (R.3/97) Date natur Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 j j C o/�( ,\* seons�n 2 Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) 'Department of Commerce (608) 266 -3151 ' 53201'0 Z to Plan I.D. Number T?3350 Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide _ 1 ejWS. (b may be used for secondary purposes Privacy Law, -415.04 1 (m ) _ ll Address (if different than mailing address) I. Application Information - Please Print All Informatio t R E G y Prope�rt Owner's Na me �h�� � :j , _i� � - - - -_ Purccl N .o Iiluck N 2 � Property Owner's M ailing Address I rolerly Location 6 / 9 7 S /y ST ZONING OFFICi* - _.._..._ - - -A, A10 IA,Scctlon City. State "Zip Code Phone Number (circle c) II. Type of Building (check all that apply) 1 or 2 Family Dwelling - Number o Bedrooms Q�jt tl v CSM Nun er ll ❑ Public /Commercial - Describe Use _- r 9I Qr /• T(' / ❑ Ste te Owned - Describe Use -w X o _ Y vLO�+^0C CuJCX� I k-ity I.1Vlllage yfowlhsntp of k�d/le KJ / III. Type of Permit: (Check only one box on line A. Complete line B if applicable) O Z2- 1030 - t 5 -- / dc 1657c- q-0 A. New System / I S ys tem 'I'rcallnlcut /Ilnlding'I'unk Replacement Only I I Other Modification to i ?xisting m Syste I :I R e pl acement S -4tcllt m A. (� Permit Renewal I:) Permit Revision Change of I I Permit'l'raosfcr to New List Previous Permit Nunthor and Date Issued before rxpiration Plumber Owner N. T of P4WTS S stem: ( ❑ Non - Pressurized In- Ground Mound > 24 in. of suitable soil I_I Mound < 24 in. of suitable soil I.l At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland IJ Pressurized In- Ground I I Ifolding'rank 17 Peat filter I I Aerobic'I'reatment Unit 1 Recirculating Sand Filter g S ynth e tic _ ..0 -_. tiler Drip Line Gravel -less Pipe Other (explain) I f_1 I l Recirculatin Media Filter ❑ Leach C'han V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rale(glxisf) Dispersal Area Required Or) Dispersal Arca Proposed (sf) System Elevation Aso o. q J ® 756 9g•o VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of I!nits C r � ��yy11 Concrete Constructed Glass 1-t- New Existing 'aukx Yanks Sc Septic or I loll ...__.... .... _ __... .... p log 'Yank AVO/4600 f F 5 t 2- X. ACroh C'Ytcalment IIII l Duxhtg f'hanuhar - VII. Responsibility Statement I , the undersig assume resp onsihlllty for I nstallation of th e POWTS sh u n the ottt phuts. Plumber's Na me (Print) Plumber's Si gnature MP /MPRS Number Business Phone Number JU-1 Atrn 0, &p2cy _..._ C,J g . _._. _o 3 31 d �� �, a�� X 33 4 Plumber's Addre ss (Street, City, State, Zip Code) -~ - Wi2 -S /? Ce7S i4 PAS6 W . :5 Y,00 VIII. County/Depo Use Only Approved, ❑ Disapproved Sanitary Permit Ilse (includes Groundwater "- Date Issued Issui Ig Agent Signature (No Stamps) Surcharge 1'e�r� ❑ Owner ven Reason fo Deni cc) _ - _ .__ $ 3J�! _ �_ _ IX. Conditions pprnval SYSTEM OWNER: 3 No (t3 t e 6,v- 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained ` LAN as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less that 81/2 x 11 Inches in size — SAD -6398 (R, 01/03) PLOT PLPIJ Scale I" Page o f - - - - - -- - - -- e- - w:�� -- ? L J v tJ or Co M tP h e r p R2 1S VL'a TH'1S Mt`� 6 - 0 � U. r'fz Ft J Sv�� �S 1 P �Z11111JC17W �V t to I" t 5 r � J _ `, � \ 2 �, 1 s.R '' .5' 1°R� V� • V CON R� V 1Z �1.. a17.O' J EL q NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be t' pD 1600 gallon capacity manufactured by ('1tij L 10001 .. M Z - IQ 0 Zf(% 4. Bench mark 5. Divert surface water around system to prevent ponding at the uphill side.. .fix w .. Safety and Buildings s 4003 N KINNEY COULEE RD commerce.wi.gov f' May e� c LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i s co n s i n - www•commerce.state.wi.us /sb www.wisconsin.gov Department of Commerce tiG i�rr c T�� Jim Doyle, Governor Cory L. Nettles, Secretary April 28, 2004 CUST ID No.267341 ATTN: POWTS Inspector ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/28/2006 Identification Numbers Transaction ID No. 993350 SITE: Site ID No. 682460 Robert & Dena Casey Please refer to both identification numbers, Town of Kinnickinnic above, in all correspondence with the agency. St Croix County NE1 /4, NW1 /4, S11, T28N, R18W Lot: 2, FOR: Description: Five Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 954948 Maintenance required; 750 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD - 10573 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, (�Of?ldlff�l stats. , The following conditions shall be met during construction or installation and prior to occupancy or use: DE ARTMEN7 OF 1 General Approval Requirements: N 0 1 EY • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRE5P "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The 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 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system 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 r r ARTHUR L WEGERER Page 2 4/28/04 • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMARTcode: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 TI SHE 1 � q�O� o f MOUND SYSTEM � k&� A BEDROOM RESIDENCE 200'y FOR �j This plan has been prepared in accordance with the Mft Component Manual SBD - 1057 P and the Pressure Distribution Manual SBD - 10573 - P C 2 b_! cr . C ice. (� 199') LOCATED IN THE � -3 \Eil /4 OF THE NW 1/4 OF SECTION , T Z-b N, R ! Fj W, TOWZi OF Sr �Lo lk COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM IMA 1AGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT II I PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR N Z b 1 °l am S - nt S1- > _ PREPARED BY WECErt FEE R SO I L . TES J�,,;,� AND. OMMERCE DES I CBfd ANDEN C INGS 6 � P .0. Box 74 421 N.�lain St. River Falls, WI 54022 Phone 715 -425 -0165 too" Fax 715 - 425 -6864 �'��,�•;�p� � AW; k !w i VIC f.R 6lL3NJNTN ]H� r''S G �l -lQ-tl� JOB NO. Lk-S3 Mound System Management Plan page `z of Pursuant to Comm 83.54, Wis. Adm. Code . - Septic Tank - The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years b inspection. The outlet filter Y P shall be cleaned as n ec e ssary sure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids ensure the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge the u ge and scum in the tank exceeds 1/ t tank If the contents of 3 he liquid volume of he tank are not removed at the time of a triennial assessment maint personnel shall-advise the owner of when the next service needs to be performed to maintain I the tank. The addition of biological or chemical a less than maximum scum and sludge accumulation in ' However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution S tem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since. soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction iri the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and Pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be Immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning at �1 t S —3 � �, - �[ D50 The system installer at "� `S• Z Z - 33 ��'jOit�lZL''l The tank manufacturer at ` ®iJ0 - $ S(� �? tzs kn*z The effluent filter manufacturer at _ J0(3 _ z j,_- S7 Z Z(« L The -- -- _ pump manufacturer at 4 Ot_ZC Li��� __ - PLOT PLASJ Page — Scale 1 " =S0' w ` Zb > 5 UzUw1 J P J �g CO M`P'h� T DR- 6 N c O \ 1� 1� rl -� CoN t e- 47,0' J �3o�Tj C)F� CCL< NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required) . 3. Septic tank be 1 opb l600 ga capacit acit manufactud Wk�Zs�Z. C.OVC(Z. (' \ , \J p L' ID (yQ 1 W/ 6CO-M Z/ \ j IU 0 Zpr%T- RL r"x 1 VM� "M \ -- t �. ' �V 4. Bench mark Std OEOV� 5. Divert surface water around system to prevent ponding at the uphill side.. Pace 4 oi - 7 Aparove; Santhetic Coverinc - ASTH C33 Distribution Pipe Medium Sand - =�_ - =W H 1' 6 Topsail 3 E - � b Slope Distribution Cell of Force Main Flowed z" to 2 Aggregate From Pump Layer D 1.0 Ft'. E Ft. CROSS SECTION OF A MOUND SYSTEM F p_g Ft. G 0, Ft. A Ft. H 1 - Ft. Linear LoadLoading Rate = � •°t GPDjIuY FT B Ft. .. . Design Loading Rate =a .y GPD /SQ FT j i Ft. J b Ft. K \O Ft. �-tcra. Position L lOy Ft. 0' Force Main W 3 1 Ft. L ' I j I -Observation Pipe w -- t � -- - - _ - - -- - -- - - -- 7 ------------------- --�--0� Bile Distribution Cell of '�" to 2 2" Pipe aggregate Observation. Pipe (Anchbr securely) PLAN VIEW OF A MOUND SYSTEM Distribution Pipe Layout Pade 5 of o Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 45 fitting to a point within six inches of the final Bade. Terminate the ends of the laterals with a valve,:threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug, 7` P,1 CTS L . CZOS S pvc F vc S vc Lateral Manifold Lateral x x x x xQ xQ x x x x Lateral Length — Lateral Length — V Distribution Line - PLta-N V \Ew - -- • --0 S V 0-- P X11 Ft. Hole Diameter )�� Inch - S 3 Ft_ Lateral I Inches) X _ 4 Inches Manifold 1 I I•Z - Inches Force Main " - 2 Inches # of holes/ i 2 - Invert Elevation of. Lateral s g, S Ft. PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS PAGE OF YEIJT CAP `t "C.L VEIJT PIPC - W EATH ER PROOF JU APPROVED LOCKING MANHOLE 10' FROM DOOR, JU 80X COVER WITH WARNING LABEL WINDOW OR FRCSH IYM1U. AIR INTAKE I CIR �- R E i � I `I' MIAI. • f � 18' MUJ. COwDUIT 11� IMLET PROVIDE �7' AIRTIGHT SEAL I APPROVED JOI A I I ( APPROVED .JOINTS I I I � I I ALARM 0 - I II 1 I ow _ c _g i CLEV.�__ 3 FT - -� PUMP --- pFF 0 �Z- C) Z _ b O COWCKETE BLOCK RISER EXIT PERMITTED OIJLy IF TANK MAUUFACTURER HAS SUCH APPROVAL T* APPROVE Saw I NG SPECIFICATIOUS DOSE TA IJ KS MANU FACT URCR: ��C2 IJUMBER OF DOSES: ' �' PER pA,y TAAIK 51ZE : L boo GALLONS DOSE VOLUME s ALARH -- PIAUUFACTURGR: S•-J .�LL2`( SyST �lS IIJCLUDIAI6 OACKFLOW: b� ' GALLONS MODEL NUMBER: CAPACITIES: A= -- - _ 500. 9 - -- - -- (� INCHES OR GALLONS SWITCH TyPC: I n �-�CL-7 8- 7Z IIJCNESOR ��, G{�LLOf►IS PUMP MAMUFACTURER: \ 'I �'�S C = (' INCHES OR � GALLOWS MODEL NUMBER: D= 1 INCHES OR GALLOWS SWITCH TYPE: L`�YL LCJIZ MOTE: PUMP AIJD ALARM ARC TO bC \ 9 MI NIMUM DISCHARGE RATE 5 1 - b�? GPM INSTALLED ON 5EPARATE.CIRCUITS S _ �,'7 VERTICAL pIFFERE>,ICE CETWCCU PUMP OFF A {OiJ PIPE., FEET - MIIUIKUM ' NETWORK SUPPLY PRESSURE . .. • , - 6 ' 3C FEET 'f' _ �S FEET OF FORCE MAIN X S " Z F o fT.FRICTIOU FACTOR. �' $ FEET TOTAL OtIIJAMIC. HEAP _ FEET As - - -- - As per:manufac'turer �-� gal /in. Liquid depth 36 M E40 Series MYM 4/10 HP Effluent and Drain Water Pumps p Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 to W 30 W W W F_ Z 25 8 X Z W 20 6 O W J _ Fa- 15 J O Vz ,q7 4 H O 10 F 2 5 0 0 0 10 20 30 40 5J 60 70 80 90 100 CAPACITY GALLONS PER MINUTE 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. RECEIVED DivWw of Sa fety of cf�ne� SOIL EVALUATION REPOT l z in accordance vvlth cfmm 85, Wi s. Adm. cone DEC 2 6 2003 cotty Attach car�tete she tin on Paper not less than 8112 x 11 inches in size. plan must �N r -. include. but not to: vertical and horizontal reference point (BM direction and p percent slo pe. scale or �, north arrow. � iccatbn and distance to nearest road. Please print al/ Infcrmatlon. R by Date Menace's[ �+Y U " msy be used nor nw%j&7 purposes (r d"W LMW. s. 15.04 (1 an))• ! 3 sO r l AIV p N Property Location L �' �lfaPlsT %/livS'o�t/ co, NS ImAI S � E Mfg Address Lam# Block # suba Name or CSM# GS Zip Code Phone Number r- � 4 13,4: 71 She ❑ EMy 0 yu Town Neared Road �'� Sy (7IS) (• z5��- �:' �v ►c,I';�vvi �-- � Cervi. -l-g� - Qa. Naw� use: Kftsidentiat /Near rofbedroorns - Code derived design flow rate �D — CO oa GPD ©� ❑ Public or commerdal Describe. Parent /Idi (l% L IaRl d Flood Plain elevation if applicabl material General coarrnarft �� S 3 13�D/2 - - ft arxt recenurrenda8ons: Aft '" 7trgTtP Aea ; �NIIE�T D.(lr} /yOU�u,� ! S;YS7" a fy g # ❑ p . Co S 5 S l Pit Quunas +fn Soil Appkeftn Redo�c Pin TOM" Structure Boundary Roofs t GPM in. T QM Sz Cont Color Gr. Sz. Sh. /� t '@f#1 'Ei#2 1 0• i0 y 2f3 sh><' 3 P . s (,p ZQP-- 5 W-), s = . z . 3 /O ,r` �(' 1''�D tS G Ifl +4 Gt, 5 ..-- -- Z C Hof fI 5 / of f y- , Fq Pit Gr ormd surface elev. fL Depth to WnMV factor H 00 1 2= Sod Rate M CAL D � nent /� R .� edox Des crip tion Texture S Coruisteroe Bowery Raft Ra C- PD/tt IM SZ Cont co \A. SZ Sh. TON ( GIR1G 0 io yi2 L N-30 /D 5/Z- l S /� ec5 C,2,4 H 5 16Z , I D z sy�2 BM- > W< Z0 ►mss. and TSS >30 < 150 mg& • Effluent #2 = WD < 30 wq& and TSS _ 30 mglL AWM mom Address Date Evaluation Telephone Number ' A/6V . Q • - .2-o 0 3 7/5 . 77 ; • 30 Private Sewage Consultants 2812 1 Oth Ave. Spring Valley, WI 64767 a �,� � °t r �..� � � � tom► 08/11/00 FRI 13:12 FAX 715 386 4686 ST GRX CO LUN1NG ST CR OIX COtW1'X SEPTIC TANK MAUTrENMC13 AGREEMEM AND OWNERSHIP CERTIFICA'NON FORM owner/auy U Q V pV61 q75�� S4- Mailing Address property Address 1 ou for new construction) (Vetificationrequired from Planning Dep �ty/State kbL V- Parcel Identification Number (.'(, SC' 0 \ EGAL pESCR,IpTION �i n n i �' Il i �► rt � C property F � �t/l,U ' /.e, Sec. � r � T - R � � W. Town of Location — /A, I ,/s/t # Subdivision # ^ — 2 � G f ���,, Volume ` g-- - .Page # Certified Surrey Map Q Warranty Deed # . S Volume ��' Page # Spec house D Yes 0 no Lot lines identifiable yes ❑ no SYSTEM ENANCE em weld result is its premature failure to handle wastes. proper maintenance ImPr'oPu use and maintenance of your septic syst a licensed pumper. What you put into the vstem consists of pumping out the septic tank every Y or sooner, if neededbY can affect the function of the septic tank as a treatment stage is the waste disposal system sign b t t certifLCation form, sign Y the owner and by 'the property owner agrees to submit to St. Croix Zoning Deps�w a . that (1) the oa site wastewaterdisposal system uiasterplumber.]oyA Plumbes; restrictedplumber or a fieensedpumPa� the septic tank is less than 113 full of sludge. (if necessary). is in proper opl condition and/or (2) after inspection and putaping ( system with the standards t to ma in the private sewage d State l sK C,erdfication I/o�e, uadccsigned haved the of � e nerd the Depa�tmeat of xa, Resources, State of Wisconsin set forth, he is set by DeP feted and returned to the St. Cro County Zoning Office within 30 stating septic system has been maintained must be camp days expiration date. DATE GNA F APPLICANT 0 C nF iCATION Imowodge. I (we) am (arc) the oana(s) of I c ttify that all statements on this forza are true to the best of m y (our Deeds Office. the p ' scn bavc, by virtue of a warranty deed recorded in Reg DATE ONA APPLICANT eat " «rsr. ...•.. y infocntation that is mis Mpresented max result in the sanitary PwMi t being revoked by the Zoning Dcpa� . d warrtaty decd from tbo Register of Deeds office •• Include with th[s application: a stamper if t�cfcreaop trade is the waaanty decd a copy of the eertified savey map U 2499P 623 -7 t5 ii�- �D19 , KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 01/29/2004 09: 45AN WARRANTY DEED THIS DEED, made between Lee Christianson, a married person, EXEMPT # Grantor, and Robert J. Casey and Dena M. Casey, husband and wife, as Survivorship Marital Property, Grantee. REC FEE: 13.00 TRANS FEE: 180.00 Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: WESTCONSIN CREDIT UNION Exceptions to warranties: PO BOX 308 Easements, restrictions and rights -of -way of record, if any. i RIVER FALLS WI 54022 022- 1030 -75 -000 Parcel Identification Number (PIN) This is not homestead property. Dated this 26th day of January, 2004. * h6e istiau * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) �• PIERCE COUNTY. ) ss. authenticated this 26th day of January, 2 personally came before me this January 26, 2004 the * 0 above named Lee Christianson, a married person to me known G to be the person(s) who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF W NSIN ackno 1 ged th (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * Cheri Brown Notary Public, State of Wisconsin Edina Realty Title —Doug Berg My commission is permanent. (If not, state expiration date: 400 South Second Street #115, Hudson, WI 54016 3/11/2007 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 EXHIBIT A L CERTIFIED SURVEY MAP IN VOLUME EIGHTEEN (18 OF CERTIFIED SURVEY MAPS, EAGE 4679, AS DOCUMENT NUMBER 749954, FFLED IN ST. CROIX COUNTY REGISTER OF DEEDS OFFICE ON D CEMBER 23, 2003, REIN LOCATED IN THE NORTHEAST QUARTER OF THE NORTHWEST QUARTER (NE'/ OF NWYA) OF SECTION ELEVEN (11), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC. - Subject to C.T.H. "N" and Cemetery Road rights of way. • 7 VOL 18 PAGE L 4679 KATALEEA H. MfA 4 679 REGISTER OF DEEDS CERTIFIED SURVEY MAP ST CROIX CO. VI RECEIVED FOR WORD LOCATED IN PART OF THE NE1 /4 OF THE NW1 /4 12/23/2003 03:30PM CERTIFIED SURVEY MAP OF SECTION 11, T28N, R1 8W, TOWN OF REC FEE: 13. 3 00 KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN COPY FEE: 3.00 PAGES: 2 PREPARED FOR: LEGEND LEE CHRISTIANSON ALUMINUM COUNTY SECTION N 2037 BOTH AVENUE CORNER MONUMENT FOUND BALDWIN, WI 54002 1" STEEL SURVEY MARKER FOUND U DISTURBANCE OF SLOPES OF O % GREATER EXIT SURVEYOR w 8 H ON THE APPROVED C.S.M.. THIS PERMIT IS APPLIED F EDWIN C FLANUM • 1" O.D. IRON PIPE FOUND w THROUGH THE ZONING OFFICE AND IS REVIEWED � NORTHLAND SURVEYING, INC. w x THROUGH A PUBLIC HEARING PROCESS BY THE ST. 856 A HWY "65" Q 1"X 18" IRON PIPE SET WEIGHING w cc Q CROIX COUNTY BOARD OF ADJUSTMENT. 1.13 LBS. PER LINEAR FOOT 0 z ROBERTS, WI 54023 p OUTLOT 1 AREA . _ 100' ROADWAY SETBACK LINE 0 w po: ggz F- 0 0.68 ACRES INC. R/W —X —X EXISTING FENCELINE m 29,814 SQ. FT. z cr Z A SOIL TEST 0.65 ACRES EXC. R/W O O ����\o� , - ---- -- C� IV7Y TRUNK �� 2e,2s5 SO. Fr. , w 5 „ $8s 54'4rw HIGHWAY N se i s ao z N 1328.09' - _ S89°54'47'"W 6 806 69' 4• 250.28' -- - _ 304.35' NORTH LINE OF 9 :: o v° v - - _ THE N W1 /4 U- 3 34.02' N ^ m 0 � 249.5r 552.93' `A zo 2 u'S 1 6 G Cal I _ O1 ° S r LOT 2 �� N w i cO 4.0 ACRES d N � W 00 CO Z r /^ 0 — �1 Vi I-0— AS ACRES 10 � �� Ito o G' w 0 N LOT 1 _ s s F\ 1 A J O @ N dl $ / 2 '0 3.27 ACRES INC. R/W \` V1 Z Q / 'n p 142,364 SQ. FT. LO LO , ( ' 3.04 ACRES EXC. R/W l ( 33 f 0 132,211 SO. FT. ;� 1 \e2r�/� �I N APPROVED ST. CROIX COUNTY \ �] I :) Planning Zonino and Parks Committee ~ (� J , 2 3 2003 ° Z DEC � �• �� uj a u- If not recorded within 30 days of ►- o > approval date approval shall be w " I null end vnid Q C= I 47.57 233.16' •280.73' 0 247.50' 33.23' _ S89 °11'58 "'E 561.46' CURVE DATA TABLE d @La 011 p@. @ @T NUMBER RADIUS ICENTRAL ANGLE CHORD BEARING CHORD LENGTH ARC LENGTH TANGENT IN TANGENT OUT 1 2200.61' 04 N05'24'05'E 158,72' 158.75' N07 NO3'20'05'E 2 2167.61' 04'14'07' N05'27'08.5'E 160.19' 160.23' N07'34'12'E NO3'20'05'E 3 858.51' 01 N84'55'37'W 19.94' 19.94' I N85*35'32'W N84 SCALE IN FEET In = 100' THIS INSTRUMENT DRAFTED BY EDWIN FLANUM S HEET 1 OF 2 SHEETS 100 0 100 JOB NO. 03-76 DATE 10 -08 -03 Vol 18 Page 4679