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HomeMy WebLinkAbout022-1041-10-400 I ©Z ,7 -- 16 N — t b .. gg 1 S ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner r Property Addr City /State D Legal Description: L t Block ubdivision/CSM # D� t /4 t/4, Sec. f, T N -R/ W, Town of r PIN # SEPTIC TANK -- DOSE CHAMBER - HOLDING TANK INFORMATION Tank manufacturer W PS t l $ ize ST/PC /W et ck from: House Well P/L Pump manufacturer !�z Lj Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: r 1� l Type of system: C Width c Length ./ Number of Trenches / Setback from: House - 7/6a Well �lDy' p/L r Vent to fresh air intake ELEVATIONS Description of benchmark Z, 6 ,- h ,4 Elevation Description of alternate benchi&rk ���` �� Elevation 55 Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines O O ( ) Bottom of System () (} ( ) Final Grade ( ) ( ) ( ) Date of installation / /e4ermit number -'AoAgT State plan number 3 del = Plumber's signature License number �% l Date Inspector �1� r � Complete plot plan NOTICE: Please provide the following: • A lan view sketch showing everything within 100 feet of the s p g � g stem. Y • o horizontal ref ence points to center of septic tank manhole cover. • S ow alternate ben hmark, if applicable. qn 1 y u ),oad D �4'�h � 4 PLAN o D I Y9 0 INDICATE NORTH ARROW_ f ftmf 'V'� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count y St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3�ebr�#�vo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ Village (( Town of: State Plan ID No.: Miller, Mike Kmmckinnic Townsh CST BM Elev. Insp. BM Elev.: BM Description: Parcel Tax No.: MAO O I 1 as . Ta p,{ 46 I = ccr -gm *l 022 - 1041 -10 -400 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1— 0D� Be hmar o - , I Dosing Alt. BM Aeration Bldg. Sewer C ; Holding _ - - St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic �� r 1 3 D' -- NA Dt Bottom '�,0 `�3•$' / Dosing NA Header/ Man. G •cs 101- - 4 1 Aeration NA Dist. Pipe (; [� Holding Bot. System ] (' PUMP) SIPHON INFORMATION � Final Grade m I,� cover � Manufacturer S Demand St co � ° f 8 10 •q l 'Y odel Number �o `C Ti. o GPM 13 M*- o • &q. Op , o / TDH Lift Frictio S� ystem TDH .23 Ft }.1 L g 2.5 - lb H 2• t2 Forcemain Length 61 Dia. Z- Dist. To Well SOIL, B PTION SYSTEM K Width Length No. Of T ff e the PIT No. is Inside Dia. Liquid Depth IMEN I N 5� 1 5 1 I D IMENSION S SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING facturer: SETBACK AMBE INFORMATION Type O CH i / Model Number: System: �J2 { { �) OR.131Q1T DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) I x x Hole Size Hole !pacing Vent To Air Intake Length �E 2 Dia. Length 3 ia. I Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil El El ❑ Yes ❑ No COMMENTS: ( co di scr an cLe perso e t . nspec ion : o eo ns ec ion : o n Location: 392 C emetary Itoacl, v an W 1 ��a�T r I�4 NE 1/4 15 T28N R1 8W) - 15 28.18.225A40 -Lot 4 1.) Alt BM Description= I « �Z• ��+ l• 2.) Bldg sewer length= 3o - amount of cover =19 f- (co,-,- l�, n .1 k r , &'*N 3.) contour= 4+ j 017 • o' ` ail LQ- +0 i o�Ilo 00 — C�-I.S Plan revision required? ❑ Yes ($( No Use other side for additional information. _O -q SZ6� SBD -6710 (R.3/97) Date inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 'Tp 0 F i I � _ �� 3 �z.. r�y Safety and Buildings Division Vi sconsin SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7162 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code , Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) f f th m, on paper n 'less county C than 8 1/2 x 11 inches in size. J Cpl • See reverse side for instructions for completing thfn State Sanitary Permit Number — c Personal information you provide may be used for secondary pure ❑Check if reViision to previous application [Privacy Law, s. 15.04 (1) (m)]. J 1'� State Plan Review Transaction Number t. APPLI ATION INFOR ATtON PL ASE PR TION 1 l� = Property r e pee q y,L ion Za 1A 1/4,S T ,N, R! (o W Property Ov Ad er' Mailin d s Lot Number Block Numb_ Cit rate �^ Zip C n � Phone Number ivision m�e or C Nu r . WPE OF B DING: (check one) ❑ State Owned it g Ne est Road ,� Public 1 or 2 Famil Dwellin - No. of bedrooms o row of I �v 111 BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) /5, 29 /$, 22,5W-1-110 - 1 ❑ Apartment/ Condo C) 0�// /V (ob 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 box on line A. Check box on line B, if applicable) A) 1. kNew 2. ❑ Replacement 3. ❑ Replacement o Reconnection of 5. E] Repair of an ______System ________System_____________ Tank Only __ 1 _ Existing System ________ ExlstingSystem B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) R ECElVE Non - Pressurized Distribution Pressurized Distrib io i 0 Other 11 ❑ Seepage Bed 21 Mound �, JU O 10 p'S ci pe 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 n In -Groun Pre S xxxx J `i 42 ❑ Pit Privy 13 ❑ Seepage Pit / 43 ❑ Vault Privy 14 ❑ System -In -Fill f Ul) ,Q 6 VI. A Y EM INFORMATION: & �, 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading a e 5. Perc. Rate 6. System Elev. 7. Final Grade 1 Requir d (sq. ft.) Propo ed sq. ft.) (Gals/da /sq. ft.) (Min /i ch) Elevati n D 5 d! e Feet Feet VII TANK Capacit gal Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank Z (9b U $ S ® 11 ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber �j ❑ ❑ 10 ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. P m er's Name: (Prin P m 's Signature: t mps) MP/ SW N BuFvne u ber: n - T i �6' Plumber's Ad M 4101 tr t, ity, St e, ip Code 1 r IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved . ° S nitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Sign Lure (No Stamps) (L Approved []Owner Given Initial Surcharge Fee) " Adverse Determination 3 � 2 s X. CONDITIONS OF APPR VAL / REASONS FOR DISAPPROVAL: a ?,.C, CookS I SBD -6398 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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 issuing 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 properly maintained. The septic tank(s) must be 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 and Buildings Division, 608 - 266 -3151. To be complete and accurzLte 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. 11. Type of building being served. Check only one and complete # of bedrooms if 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, 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. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; 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) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings R 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us Department of Commerce '! 1 Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary r June 02, 2000 CUST ID No.267341 ` A7TN: POWTS INSPECTOR WEGERER SOIL TESTING & DESIGh ' ` , �. ZONING OFFICE 421 N MAIN ST t < ? ST C)IOIX COUNTY SPIA PO BOX 74 ' 11 Of CARMICHAEL RD RIVER FALLS WI 54022 \ ° ifbDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/02/2002 Ident ca�i n Numb rs Transaction ID No. 319861 Site ID No. 193339 SITE: Please refer to both, identification numbers, Site ID: 193339, Mike Miller Proposed Residence above, in all correspondence with the agency. St. Croix County, Town of Kinnickinnic NE1/4, NE1/4, S15, T28N, R18W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 666550 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • 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. Stats. CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otp ential for a law suit that may delay the effective date of the code so this status may or may not change. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. I WEGERER SOIL TESTING & DESIGN Page 2 612100 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 05130/2000 1 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us WiSMAR"T code: 7633 I Page 1 of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE NE 1/4 OF THE 1/4 OF SECTION S ,T Z-c' N, R 1 W, TOWN OF �ct►�)�1\C 1JU�e , S �- C ��t�1�C COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN �� PAGE 3 of 6 PLAN VIEW -CROSS SECTIOP"t �p,� � GE 4 of 6 DISTRIBUTION PIPE LAYOUT 0 ;�� ' 4,; -PAGE 5 of 6 PUMPING CHAMBER � PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR t Zoe s, s`� s T• - � ?;:�t.T.�• G( tior�t�l r 0� B GOM LDM pF.i:, StIF y v1s►n PREPARED BY SEA= WEGEE<EFZ SQ I L TEST = NG AND . � D►ES I GN Sl I CE OP�a�+� P.O. BOX 74 421 K. KAIK ST. . + A- RIYEP FALLS. YI 54022 ARTHUR l 715- 425 -01x5 w�c.E FLt.&WQRTH, w i JOB NO. Ob , �S0 . Page 3 Of Approved Synthetic Covering Distribution Pipe Medium Sand _ H_ � Topsoil I Elev. E lt�l•c� ._J t I� p - 3 „ b % Slope Force Main Plowed Trench of k "-2-2" From Pump Layer Aggregate Undisturbed D Ft. Soil E \-Z Ft. Cross Section Of A Mound System Using F `3.S Ft. I Trench For The Absorption Area G N•ic Ft. A S Ft. H I• S Ft. B Ft. I 1 Z Ft. Linear Loading Rate =6•o GPD /LN FT d a Ft. Design Loading Rate= O.3S GPD /SQ FT K 11 Ft. L °t1 Ft. *R,-r, -, e Position of Force Main -- W Z•S Ft. L s ' -Fosse B K Mvim A 4- - ----- -• ---- - -_ - - W~ Distribution Trench Of 2 Pipe Aggregate f - Observation Permanent-/ Pipes Markers {Anchor securely) Mound Using I Trench For Absorption Area Page Of Perforated Pipe Detail 0 End View End Cap y . ) Perforated t - Ja ��ado o �b PVC Pipe ' Install permanent-marker at end of each lateral Holes Located On Bottom, the Equolly Spored Q End Cap PVC Force Main Oistn0ulion Pipe Lost Hole Should Be Next To End Cop Distribution Pipe Layout P 3y_S Ft. X 3�Q Inches Y " Inches Hole Diameter ' Inch Lateral < <Z Inch (es) Force Main Z Inches # of holes /pipe \Z Invert Elevation of Laterals X0\.5 Ft. 4 Place 1st hole 1`d from tee with succeeding holes at 3b° intervals.. Last hole to be next to the end cap. Combination Septic- Tank and PUMP CHAMBER CROSS SECTION AND SPE ' PAGE S OF NCUT C WEATHER PROOF JUIJCTIOIJ BOX 4'C.Z. VENT Pin , APPROVED LOC.KIIJG �:. 10 ' FROM DOOR, MANHOLE COVER �vCiTi '- ilUDOW OR FRESH �RRPJ)1JG LAgE(r AI_RIA] C ojaDU 1 T GRA • � - - �f' 18 Mlu: y�ltilSrCtT1w•J p►x � ��, ►A1 LET 'J/A1rg16.ttr dA-P PROVIDE , Ir _j'" AiRT►Gt(T SEAL 8 RF�L�S t Approved II ', A I Approved joint w/ Tank construction I I( ( joint w/ PVC pipe shall comply with ALARM PVC pipe ILHP 1;3.15 and 33.20 B I 11 . I I c I 1 OM I t CLEY. FT PUMP -� ` OFF D COUCKETE �t..�U • ° t\ . OD � e�ocx 5` RISER, EXIT PERMI - TrED OULy IF TAIJ MA UUFACTUR ER HAS SUCH APPROVAL SDOINr. 1 3 " BFOOIN� SEPTIC f $1PEGIFICATI0KjS DOSE TANK 1"1AL) IFACTURER: / � 37 ISUMBER OF DOSES: M TANK SIZE : yoco ! oso --PER DAy GALLOQ5 DOSE VOLUME z ' ALARM MAMUFACTURER: S.J INCLUDIMG BACKFLOW: S� GAGLON,S MODEL WUMBER: CAPACITIES: A= 1 3 - � Z-� WCHCS OR o GALLOyS SWITCH TtJPE: 8 = Z ►UCHES'OR ,�_ G�LLOUS PUMP MAM UFACTURER: — G c)ut_ 3 C --- L___ IAICH£5 OR \ S MODEL NUMBER: q, - • -L-- -- �LLOUS D - - -L. -1NC HES OR ) S 1 GALLoms SWITCH TYPE: �'1� ° �Y UO7E: PUt1P A*Ip ALAR . 6 bE MIMIMUM DISCHARGE RATE Zg•Da GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE OETWEEAJ PUMP OFF AUO..DIS7RIBUTIOU pIPE.. �`1S FEET + tAI►JIMUM METWORK SUPPLY PRESSURE 2.5a FE.6T + lK FEET OF FORCE MAIN X ` F oFzFRICTIOU FACroR.. ``b FEET TOTAL OyNAMIC HEAD = 1 "$ FEET As per manufacturer 1`l•CO gal /in. Liquid depth 3i Goulds Submersible Effluent Pump 38 71 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor: manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, g Pump: EPO4 built in overload with construction. ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING 3 /4" maximum. • Power cord: 10 foot with pump out vanes for • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. 0 Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding • Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 ! f k • Capable of running 4 # dry without damage to s 30 .— GPM+ components. Pump: EPO5 $ i 'l - 25Fr� Solids handling capability: 0 25 3 /4" maximum. W z i • Capacities: up to 60 GPM. U s 20 • Total heads: up to 31 feet. i I j • Discharge size: 1 t /2" NPT. Z 5 • Mechanical seal: carbon- 0 15 i rotary/ceramic- stationary, a 4 BUNA -N elastomers. ►- • Temperature: 3 1O4 (40 continuous ' jzS,oO EPO4' 140 OF (60 intermittent. 2 ; - I i 5 � f I X 0 0 i I l 0 10 20 30 40 50 GPM 0 2 4 6 S 10 12 m3 /h CAPACITY m 1995 Goulds Pumps, Inc. Effective May. 1995 Wisconsin Department of Industry SOIL AND SITE EVALUATION 1 3 Labor and Human Relations Page of Division of Safety and Buildings r An accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less a 1/� x 11 i ches in size. Plan must County C Include, but not limited to: vertical and hors t'al'refer �t M), direction and percent slope, scale or dimensions, north gyp, and I at d istance to nearest road. Parcel I.D. # Y gQ i 0 2-2- l O I 1 0 APPLICANT h ' Ll INFORMATION - P e e pr�ht al�lr'1'fo��ffon. _ � Re awed by Date F�ersonal Inlo'nnation you provide maybe used f 8F ndary pur ST CROI �osyacy Law, s.` 1 (1) (m)). Property Owner ,O r , :y Property Location t�& � Z - �i� ` Govt. lot NI; 1/4 N 1/4,s � perty T Z� ,N,R ,� E (or) W -� . a Pro owner's Mailing Address „ n `. e� Lot # Block# Subd. Name or CSM# C o�,� = r /OT i5 o - r �' CISH City State Zip Code Phone Number N�e Road D r? t O E V- fk 05 10 (, S yo 1Z (7[ S ) q S " 3 o City Village Town C 6�/trr/toe Y F New Construction Use: esidential / Number of bedrooms 3 E Addition to existing building ❑ Replacement ySo - ❑ Public or commercial - Describe: Code derived daily flow (O gpd Recommended design loading rate ' T bed, gpd /ft • s trench, gpd /fiz Absorption area required T _ bed, ft Sdv trench, ft Maximum design loading rate ' S bed, gpd/t1 • G trench, gpd /1t Recommended infiltration surface elevation(s) S,"- • 3 ft (as referred to site plan benchmark) Additional design /site considerations use GD / �v /fl f j w 1 ZwP Sys r- Parent material SCS �q s! fd��tl,/ s>SVlil -�� Flood plain elevation, if applicable N ft A S = Suitable for system Convent Mou In- Ground Pre�s re AT- Grade .,� System In Holding �T_ -aankk U = Unsuitable for system [� S LJ U lJ s ❑ U El S L"J U El S L�'f U El S I!7 U El Holding U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Si ucture GPD 1ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench VX 3 ---- toorr z sh/e im,-W S 3 _ 2- 6.3 /o V 3 1 - 0411 IfSh,e /MI w / 7' • � ; . S Ground 3 y7 / .9Y/e yl3 yf J / L �S�J� /YHT /• C� r . S . c� el�ft. �'{i /DYR s%!o F I JkOTS S /fS�t� �»�!� L , • 3 Depth to — limiting factor In. Remarks: /�DiP / y .s�7`zGc �t<�r� - Boring # o. g /o Y/? 3/.L- L L JJe ,wt �/� S 3 t . S • C. i L g• 2/ /©W 3!'r 5'L- -z f S re 3 •3 /a YR 31 51 - /� �► vft? qw . �{ : • S Ground 3 'Q /6 y/Q 514 f d f NOE WS f /JYC Depth to limiting t� / N ping tJ factor 1 R / �✓ -S� T U�P/¢ T.L� '31t In. Remarks: CST Name (Please Print) Signature 7 <J p. 2Z& Telephone No. k o (3ER T V u R 1 cza- ('tJIJ�✓vt - I S• 3 ?( ' Address Date CST Number S O s Lti :1 y z Private Sewage Consultants 665 O'Neil Rd. Hudson, Wis. 54018 0R1� Aid IN At- t PROPERTY OWNER u EMl`��D�TZ- SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# 10 q (• 10 CPEA) `D Boring Horizon Depth Dominant Color Mottles Structure 2 9 nan Texture Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 / O-W 10V 3 1 L ZfsJ& 4* v�,P S 2 - /f z io YX 3 A,/ L 2,w Shy ,r,, Ground 3 lo MO S�L 2-, s 4 ANT/ • Q� .`S ' •� elev. �'9• eft. ,/ ?•s V f Depth to = G �Q /l `Fl •f ft0r 5 L �J /e M'1 j a� • L � ; . S limiting /C iting �Q ,�1 2 • S y '71 ��s / lm-5 a �(• s , factor Remarks: Boring # Ground elev. - - - Depth to - -- — — limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ftt' Ill. Munsell Qu. Sz. Cont'Color Texture Gr. Sz. Sh. Gonsislence Boundary Roots Bed , Trench Boring # Ground elev. ft. Depth to ; limiting factor in. Remarks: Boring 4. Ground " elev. ft. Depth to — -- limiting factor in. Remarks: SBDW -8330 (R. 08/95) I I Licht Associates rants Sewage consu / private tA, , d. V 655 p Nall R 4018 �� Hudson, W is. T Ar I o p � olr , Sc 'f/E 3 0 s3 � � S o 1- s o fe y ss 0 3t � 13� L .O y� sur�v �v o7e.'s i " :r 33 c SSv 6-6EsTe D N ov..0 E) 6 i 64' ys r Kiev, 100 • �o 4 SIA) 0 PA6- C 3 o 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Q ) Owner/Buyer M g ( Mailing Address D V S l Property Address lip PA e/� (Verification required from Planning Department for new construe City /State Cbty R V , Parcel Identification Number LEGAL DESCRIPTION / Property Location � /4, I V 1 /4, Sec. t �, T N -R _W, Town of 1? A rtY J Subdivision �U`� `� 6 , Lot #. Map # � Page # � Certtfiei Survey M r Volume � , Warranty Deed # /� , Volume IKIL , Page # 3C Spec house ❑ yes ❑ no Lot lines identifiable Chi yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Propermaintenance 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 foam, signed by the owner and by a masterphimber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system ce slu e. is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1!3 full of slu 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 our septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da f y ac iration date. tA /A&v SIGNATURE 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 ope des jed ove, by virtue of a warranty deed recorded in Register of Deeds Office. S GN 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 622946 KATHLEEN H. WALSH DocQMENT No. WARPJUM Dzm REGISTER OF DEEDS �J�OpACE ST. CRDIX CO., WI RECEIVED FOR RECORD Gerald A. Emholtz, Grantor, conveys and warrants to Michael W. Miller 05 - 15 -2000 8:30 AM and Nancy Y. Miller, husband and wife as survivorship marital property, Grantee, the following described real estate in St. Croix County, State YARRAMTY DEED of Wisconsin: EXEMPT N 17 _ CERT COPT FEE: <Lot Four (9 T f Certified Survey Map in Volume Twelve (12) of certified R1 FEE TRANSFER FEE: survey Maps, page 3459, as document number 579996, filed in St. Croix RECORDING FEE: 10.08 County Register of Deeds on June 1, 1998, being located in the$; 1 Northeast Quarter of the Northeast Quarter (NE 1/4 of NE 1/4) of Section Fifteen (15), Township Twenty Eight (28) North, Range Eighteen (18) West, Town of Kinnickinnic. Together with and subject to easements as shown on said Certified Survey Map. This deed is given in full satisfaction of the Land Contract between the parties recorded August 20, 1999 in volume 1450, Pages 249 -251 as Document Number 608923. P, w•. MILt- rR......... . NAME AND RETURN ADDRESS X7 50vit4 FIVI - H S7Ag gwil( FA -5, Nq rv�zz 022- 1041 -10 -000 Parcel Identification Number (PIN) This is not homestead property. Exception to warranties: All easements, restrictions and rights -of -way of record, if any. Dated this day of January, 2000. (SEAL) /1 -/ -. ^ ✓�j„ (SEAL) Gerald A. Emholtz L (SEAL) (SEAL) AVTHZ9TICATIC%? ACKNOWLE Signature(5) STATE OF WISCONSIN ) ss. r ' ' COUNTY ) authenticated this day of , 29� Personally came before me this L of -- day the above named Gerald Emholtz to me known to be the persons(s) wh ex uted the fore oing instrument and acknowi 6 TITLE: MEMBER STATE BAR OF WISCONSIN ( /�• • .a •• (If not, 4 '. authorized by 5706.06, Wis. StatS.) 0 THIS INSTY4DOM WAS DR%7= BY: Notary Public I I aunty. Wis. Joseph D, Boles My commission is permanent. expi do date: Rodli, Beaker, Boles 6 Krueger, S.C. � . � P.O. Box 138 — River Falls, WI 54022 - Ae F E vEY MAP D EMHOL TZ 1'ar t vi tite ivvrmeast V4 v the Northeast 114 of Section 15, 7'vwirship 28 North, Range 18 West, Town of Kinnsickinnic, St. Croix C'or►r►ty, Wi.scvrrsin. NE COp, SEC. 15, r20N, R /0W, i A' 1 COR. SEC. 15, r zB N, UNP LA r r ED LA 12 " IRON PIPE FOUND, R 18 W, / / "IRON P/ PE FOUND, 4 N 88 • 0 7'0 7 "E 2676, 94 N LINE NE 114 Lr- ' 538.03' 1 540.00 I 89' ' S7 /. OJ i J3.02' 3� /565. 33'1 Kl LO 2 L O T M 5.590 ACRES 4,105 ACRES N 243, 506 S0, Fr. N 178, 020 SO. Fr. 5.464 ACRES EXC. RDA DEASEME v rS 3. 869 ACRESLXC. ROAD FA£EMEIIrTFS� O M 238, o28 50. Fr. j "`" ; 168, 526 SO, Fr• Q -f r q Z Z 539.23' i�`� O M >I J I` N87.53' ?7 "E ?72.26' J N Q N 87.53' ?7 " 1112.59 W( N ?39.47 J ) 33 ' W N 540.09 1poo-A � �' ?72. ?0 IC AMOK • Y_ N 1, T __ � L O h �> : �1 Q Z \u N I al LO T 3 � 3'.7/3 ACRES Q N87.31'31 "E . I6 /, 728 .SO. F7. 5_`33 ACRES 1 q� `re EX ACRES C. ROAD ,OO. 70.J633.02' J Q, -. -A / ?3,B 06 SO. Fr. 0 " �NYS A M 5. 407 ACRES fXl. ROAD fASEMENTS�� ' b 235, 539 SO. Fr. 2 ' 214.0 ' 1J N 07 ?7 "E 0.00' .O ' ' © 100 SO? .53' ?7' „� • AO 0 101.02' _. ,. 5gl 400 N 89 "W 296. 1a, S 87.53'57 "W 460.30' UNP rrED L m Y 2 Dated: December 10, 1.997 a W . 2 . Owner's Address: I 1250 C.T.H. "J 4' " E //4 coR. SEC. I5, reem,R /8W River Falls, WI 54022 Y LEGEND: /COUNTY SURVEYOR'S MON, � r ,`, , ` ��� /111 Urrp� ..1 RO Previously recorded data. �� G 1P , •� 0 1" x 24" iron pipe weighing �.%% �� �"Z s��, �• .> 1.13 lbs. /lin. ft. set. �� e ,.r'•. �•„ 16 1" iron pipe found. LAUS • r E W I Y ' . ALL BEARINGS REF, r0 rme EAsrLlNE OF rNE I'tI j r Nf 1/4 OF SEC. IS, r28N., RIO W, A'SSUM£D .� 13 N 00. 07' 00 "E V �• AIVER,FALLS, x This instrument drafted by Laurence W. '�Fi9�'••... �•������," Murphy o$ SCALE I" : 200' ' O 50' too 200 aurence W. Murphy 300 4 00.....500 .... 6001, Registered Land Surveyor I CURVE DA rA CURVE CHORD BEAR /NG CHORDDisr. ARCO /Sr. RADIUS CENrRAL ANGIE ISr TAN. BANG 2N0 rAN.BEAR /N6 1 - 574. 46'58.5 "W 90.77' 91.57 200.019 26•/J' J7" E RI - a7 '46 38.e W l2e.88 507.33 57 W 56/•40'00 "W y lJO.O /' 283.97 26'/3'57' 1000 'W 3 -6 N74.46'SB.J'E 9893' 56/• 99.80' St7.33 S7 " . W 2/7.97' 26•/3'57" No7.55'57'E N6 /•40'qo "t 7 -0 H74.46'SB.S "E /20.73' 121.79 266.Od 26•/357 N6 /•40'00 "E _. 6 L 87-55'57' SHEET / OF 2' e � J ► ff r ti 1 s FILED 2 °� JUN 1 1998 5"7999+ ry KATHLEEN fDea ft H �..t \� Register of De^dS 3 &Cron Co., CERTIFIED SUR VEY MAP GERALD EA11HOLTZ Part of the Northeast l;'t of the Northeast 114 of'.S'ec'tion 1.3, %rnrnship 28 Noah, Range 18 West, Town of Kinnickinnic, St. Croix ('cnmty, Wisconsin. Ne CDR, SEC. 15, T28N, R 18W, N 114 COR. SEC. l5, T 28 N UNP LA T T ED LA 12 "IRON PIPE FOUND) R /B W, / / "IRON PIPE FOUND/ ter• ,y LINE NE //4 BB • 07'07 "E 2676. 94 ' 340.00' 571.05' I 33.02 1363.89' / / / /.0 I �I b I Q L0 i M Lo _ ,DD' � 5.590 ACRES �" 4.103 ACRES ' N 243, 506 SO. FT. N /7B, 820 so. FT. N 5. 464 ACRES EXC. ROAD EASEMENTS 3. 869 ACRES EXC. ROAD EASE1d1ENTf4 m (� O � 238, 028 S0. FT. 168, 526 SO. FT. ? 539.23' N 87. 5357 E 572.26' W ` 30' v J W N87-53'57"E' 87.53' 57 "E 11 /2.59' ? I Q ry 339.4 7' ' 33.0 N 540.09 O 572. 50' �u }� �'� /079.56' L o r 4 Z o M \ NJ 2 O N 3.7/3 ACRES •c f 87'3. N V N 161, 728 S0. FT. 1 Q f N 103.3 J I 3.533 ACRES m 3, 531 ACRES EXC. ROAD 00 70.56'3 24 /, 023 SO. FT. A 0 O EASEMENTS 61• 0 ' 1 50' # 5. 407 ACRES EXC. ROAD EASEMENTS O 133,806 SO. FT. N 5p. z35, S0. FT. ? N87 37 " 214..0 �- -^ 68.00'3• (� © 00 ,1W S87' , ® 6 101.0 *.. N 89 "W 296.18' S 87.53'57 "W 460.30' R I H' 89 • 38 W) I UNP TYED L „ 0 W e 2 a Dated: December 10, 1997 "Revised this 22nd day of May, 1998. 'Owner's Address: 1250 C.T.H. "Y' E1.'4 COR. SEC. /5, T2.8N,R18W River Falls, WI 54022 /COUNTY SURVEYOR'S MON1 LEGEND: R() Previously ecorded data. % % % G � y �` � \S S �i O 1" x 24" iron pipe weighing ,....... ...••�/� iv 1.13 lbs. /lin. ft. set. n 1 iron pipe found. '• LAUR C « rVj W HY a * L L BEAR /NGS REF. TO THE EAST LINE OF 7HE '- S 1 3 .O7' 00 "E � V N E 1 14 OF SEC. / 5, T 28 N, R 18 W, ASSUME D ' ••, RIVER FALLS N 00 This instrument drafted by Laurence W. i'-44 � Fjj LAO S ,,�% Murphy ,t ��!! lJ l , SCALE 1" 200' aurence W. Murphy 0 50' loo' 200' 300" 4 00' 300' 600' Registered Land Surveyor 610 IN millililli�iii CU RVE DA TA CURVE CHORD BEARING CHORD D15 T. ARC 01ST. RADIUS CENTR ANGLE /ST TAN. BEAR /NG 2ND TAN.8EAR/NG / -2 S74 "W 90.77' 9/.37' 200.00' 26• S87.53'57 "W 561 "W 3 - 574.4 58. /28.8 /30.0/' 283.97' 26.13'57" S61 *40'00" S87 "W 3 - 6 N74 "£ _ 9d. 9 99.80' 217.97' 2 6•/3'5 7" N87 "E N61 *40'00"E 7 - N74 "E /20.73' /2/.79' 266.00 26•/3'5%" N6 /•40'00 "E N87 "E SHEET / OF 2 VOL 12 PAGE 3459 �I O Iv I I„ G i co m o 2? 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