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HomeMy WebLinkAbout022-1048-10-120 o m R. o c 0 U rt (n O z z `� a 0 r- W U1 7 N rY Un (S+ fD W O V •• o� W P 00 L1 '.v W O � r O� fD V I N N OD P �-3 z C P. N m � z w F-M Q.7) t •`' o n o H rt r o Oj n 1C ' ny0 0 CO) 0 3 -0n tv ° f ° 5i c ° M T n ' T �' c � eo m d eD X Q G O --1 y O O N n y O O N 7 v N • ? 3 C N O 7 3 3 c e� o N cn °' a@ z z CD ° p O N m OX co N c_ CD (D j A G 3 C C: j > OD 00 0 N N Co Gt N N N O CD W 7 N - 0 I O N 4 O O - 0 n 7 7 CD d O - 0 n 7 O =r v d O loo m c o c m o v -�� o 3 O1 3 N W I 3 3 N 0 0 C Co c m I cn c D a o u? v D ° a ° CD to o N a m N C c� -0 o W = r o m r N 3 O c- ' rn rn r 3 0° cn c°\n m CD O O F� N N N O C7t lri rn o co aoD a o c ° o ° o GOi m y 00 00 0 m 0) 3 c M T CD O O O o z C C < A 0 f� '0 '•i i y d I O o 0 m cn y ch v, y co y $o o CD po l o v° oo 0000 G N 3 N N 3 N N !D W CL OD O z z O z z 0 my o a o v a !r o m CD o ° < °- �. M m m I ay CD j 3 c m a c w m w a 3 n a -• 3 o o m N (D y ° m m o 1: z d <. pt N J - rt N A z O 0 O I O y .. Wo W� m NJ ! N m ID 7 a N co 0 X c o 0 o z 3 j m co ° 3 N y ^D NI 01 A W A y i �yooaa I OW 5. CD m 300 a T.q @�cD mod f�D y 0• CD d fA O _ O. N 7 •« O - O fD I � I I �y ° 3 v c I o r m o S ao. m c� -0 o o a no ov p•=o° o a x c p 0 n N N ! C7 N N 'O a 7' N N �_ cn O CD .. N m N O y .�• O I < O fND N O O. 7 - N 0 N C O fD CD --c o m It C O D c m-0 c aao a m nv. <.gD•3 N . 0 C 7 SO.D C .�D. co C 7 ^� I N M V7 7 fD -• O - C CL .. • o N m CD O 3 0 0 O - NO O O as N a yo 0 Fi'o na a9 O 3 iv o= U'�vo > >O o �• S O o > a Qa 00 m o f a q 0 0 CD m ob 0 m 0 Fn O O o0 I I ° o o- I ° o o• � "---3 R -� - - "" " "��" "" `" 8u�uaz pun 8uruuvld Nuno,� na {J 7,Q r Wiscons Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix County: Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488175 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: George, Philip Kinnickinnic, Town of 022 - 1048 -10 -120 CST BM Elev: Insp. BM Elev: BM cription: Sectionfrown/Range /Map No: � - '"b' — /C • d �- 17.28.18.257A20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Gc! Septic Benchmark 2 qq. g Dosing � f �D Alt. BM Aeration / Bldg. Sewer Holding Ht Inlet V G a — St/Ht Outlet / TANK SETBACK INFORMATION TANK TO P W� BL P G. t to Air Intake ' ROAD Dt Inlet Septic � Z6 12/ 3O / t Botto /^ V 3 , 19 rW b4 Do Header /Man. / sing -3 (c (�6 f' Aeration Dist. Pipe / Holding Bot. System Final Grad T PUMP /SIPHON INFORMATION Manufacturer Demand t Cover /� GPM Model Number P Z �� TDH Lift Friction Loss SH Ft 3 Forcemain Length Dia. Dist. to Well •,� Nit SOIL ABSORPTION SYSTEM S-�_ .� BED/TRENCH Width Length No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P /Le JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION Type Of System: CHAMBER OR >s- ) UNIT Model Number: DISTRIPYRON SYSTEM r`S Header/ anifold IDistribution 1 x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia j 11-ength Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 9 p Fs Yes M No ®Yes N No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 14 Inspection #2: / / t , j Location: 391 North Liberty Road River Falls, WI 54022 (NE 1/4 NE 1/4 17 28N R18W). NNA,( Lot t33 Parcel No: 17.28.18.257A20 1.) Alt BM Description 2.) Bldg sewer length /� ��„ '/ ` J ,(c ty / � / - amount of cover = ( 4Gt L Qkla 3.) Contour = —A� Plan revision Required? 0 Yes [fl No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. t flu ' �v', 17� Safety and Buildings Division County S 201 W. Washington Ave., P.O. Box 7162 r VIr'sconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (fig) 266 -3151 Sanitary Permit Appli State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide A may be used for secondary purposes Privacy Lavel roject Address tif different than mailing address) 1. Application Information — Please Print All Information S�Y 02 — —1Q' Propey�Owner's Name 5 Q arcel # t #_ B ;k# '("J i I I S Property Owner' Mailing Address roperty Location / 4 • � r 'et y �,, Section Ci Statep,� Zip Code Phone (l>(.1' �GLC lJ f . T na N' J4 E II. Type of Building (check all that apply) ( N 11 or 2 Family Dwelling - Number of Bedrooms � � � Subdivision Name / CSM Nu ber El Public/Commercial - Describe Use �� �, ❑State Owned - Describe Use ❑City _❑Village'Township of I11. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New System ❑ Replacement System 0 Treatment/Holdin k Rt1acement ❑ Other Modification to Existing System B. El Permit Renewal ❑ Permit Revision ❑ Change of El PermList Previous Pennit Number and Date Issued Before Expiration Plumber Owner 2 IV. T of POWTS System: Check all that a 1 ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suita oil ❑ Mound < 24.1. of suitabl At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaVrreatment Area Information: Design Flow (gpd) Design Soil Application Rate( sf) Dispersal AFea Requir (s� Dispersal Area Pr posed (sf) System Elevation VI. Tank Info Capacity in Total Number Manulli Orefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing e Tanks Tanks (! v A" Septic or Holding Tank k �d Aerobic Treatment Unit i Dosing Chamber ? Q D (� ! LO ir VII. Responsibility Statement- 1, the unde ed, assume responsibility for in n of the POWTS shown on the attached plans Plum is Name (Print) PI s Signature P tuber Busi ess Phone Nu b� IIMAA_� � ,ql _ a Plumber's - A ZslStrqt, City,t U� l�u �� , t/ /s a// S'�� VIII. Cpfinty /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date ssued Is rng Age Sign re ps) proved isapproved Surcharge Fee) jrj Uv S� � Q ` ❑ Owner Given Reason for DenialCJ�� onditions of Approval/Reasons for Disapproval add a / itii t9u y STEM OWNER: 1 Septic tank, effluent filter and tN dispersal cell must all be serviced / maintained /✓( — G �ir/ as per management plan provided by plumber. /�, _ . 1G4.�ti 2. I setback requirements must be main acne as per applicable code /ordinances. S To QGt�ll✓ '�n' "U Attach complete plans (to the County o y) for tip syatempn paper noNesa ti n 81/2 :11 inc i size a l SBD -6398 (R. 01/03) 4 51` ( 0� ��' '� J ocool 0 0 0 0 d r1 P.P. i7 T CD rf C2 3 3 - 0 - 0 CD cp z o co -4 0 0 =r ' — — co 0 K) (D 'D (D a) Cc 3 3 M (D 00 CL C, cn -4 0 -4 Z z CD ' ;r C CD CD t" CD . 1 Of 5 CO CD UT m m (A 9 0 0 C) -0 0 :3 :3 CD d = = CD C (D -4 tn 0 0 3 0 0 C.) 0 co co H fn (n c C z Z 0 /) F� o > (n V :3 CL Al (5 In CL 77 =r CD CD CL 0 0 - CD (D C: C 0 Cn CD O CL 0 CD CD 0 OD co 0 o rn 0) C r OD OD CD 0. m CL ;o CL 0 0 0 CD 0 0 o o Z -n n 0 CO) CO) Ch CA (A > OI Q a F CD 3 3 5 . a' M cr C) (D M co C, fO U, C) , 7 7 CD z D z z > z > > o > 0 O 6 0 0 c CL CL 0 CD CD CD 3 c w 3 z 0 (D CD 0 CD 0 =r m Z Z4 (n CD CD (D M 00 Z 0 0 o z m CD CD 600- > co CL'a 0 > 3 1 0) CL 0 CD , ao U,, 0. CD co a CD CD C) CD - 0 C —0, - m n 3 =r,. o z 0 0 (D 0 -0 a :3 0 0 6 3 0 3 0 . 0 5 6 cn 0 C C A D CF a 77 0 0 < 0 CD CC 3 Er 0 7 CL 0 w 0 c OD w 5 3 o m 0 CL 0 x. = Cl) @ CD CD 5' fD -0 CD =r c -I CL c - t CL cD 3 - =t , 0 Cb M 0. 0 F 0 0 UT .3 o COL 0 - a Ri C) c a) 5 M O 3 0 < Qb Ri 3 Co co CD rn 00 0 0 k-j =3 =3 CD d o tA CD 00 < < 0 o 0 0 CD ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer , ` r Mailing Address '� �'U �Oev Property Address (Verification required from Planning & Zoning Department for new construction.) City /State �� �9l / /, ` ym Parcel Identification Number 0 13 LEGAL DESCRIPTION Property Location N ti '/ , 0 1 /4, Sec. , T N RZ Town of Ajjlc 1114 /0 Subdivision , Lot # 3 Certified Survey Map # , Volume a ,Page # U, Warranty Deed # ,Volume ! , Pag # !�F7 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 full 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. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ;of e rooms f ��/j� f i 2Q d - w 4{ GNA 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) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page f of 2 FILE INFORMAT12V SYSTEM SPECIFICATIONS Owner Septic Tank Capacity �� al ❑ NA Permit # (� �/ 0 0 J Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity -7Z-8W gal ❑ NA Estimated flow (average) O D gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) S7) gal /day Pump Manufacturer ❑ NA Soil Application Rate nZ A al /day /ftz Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) :!= mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD :530 mg /L ❑ in-Ground (gravity) Q ln- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ NA ❑ At -Grade Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: -Z - - - - - ❑t s ( imum 3 years) 11 NA year Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: mon s (Maximum 3 years) ❑ NA ❑ year(s) Clean effluent filter At least once every: _ 3 ❑ m nth(s) 1-1 NA �ar(s) Ins Inspect um ❑ nth(s) p pump, pump controls & alarm At least once every: Z!?j [I NA _ _ i �rear(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: 6 ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of an sludge and scum in tank equals one -third (Yl 3 or more of the tank volume, the entire Y q contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page y of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua ' a o Ong ank b e ai a RD{- f1�31T;1L� �� A16 Catj5 7z(I� D" Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS e P OWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Name s—(`, C11 Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &M and 83.54(1), (2) & (3), Wisconsin Administrative Code. • DOCUMENT NO WARRANTY DEED TN'S SPA E Rr,,ER - r . /c)N Rc.'-r)Rn N❑ CArA STATE BAR OF WISCONSIN FORM 2 -1492 467874 Vo 807 r4 i?44 REGI TTER'$ OFFICE Ve mix cA-1 w1 Eldon L. Wagner and Arlene L. Wagner, husband and wife d for 1aefd _... ...... APR 031991 a .......... coovevA and warrants to .Philip B . George and Judith - L. George, husband and wife as survivgr6hip Ipar +.Ca.l..propg ;.ty De4 _... _ RETUFN 'THE FIRST NATIONAL BANK B);( 166 the following described real estate in St. Croix __Co, t RIVER FALLS, WISCONSIN 54022 .......... - - .............ny, 1 State ui Wisconsin: Tax Parcel No: .............................. LOT THREE (3) OF CERTIFIED SURVEY MAP IN VOLUME 8 OF CERTIFIED SURVEY MAPS, PAGE 2138, FILED IN ST. CROIX (AUNTY REGISTER OF DEEDS OFFICE ON AUGUST 17, 1989, BEING LOCATED IN THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER (NE 1/4 OF NE 1/4) OF SECTION SEVENTEEN (17), TOWNSHIP TWENTY -EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC. Subject to any and all easements, right -of -ways or conveyances of record. n .. ;',F,? This . ... , is not homestead property. (TA (is not) Exception to warranties: easements, restrictions and rights of way of record, if any. Dated this 29th day of March 19 91 . (SEAL) (-cGr-r— wt/ iSEAL1 Eldon L. Wagner (SEAL) (SEALI Arlene L. Wagner AUTHENTICATION ACKNOWLEDGMENT Signature (s) ... ......... ...................... ... STATE OF WISCONSIN 83. ................................................. ........................... .... 111 --------------- - - --- -- - - -- -- -County. authenticated this .- ...... day of ........................... 19.._... Personally came before me this ......?9Ch.day of _ -•-- - _Ma_rch . .............. ........ 19- -9.1.. the above named - - -- --- - - - --- - - -- -- •..... - -- - ---- _.._.... .... ........ --- ... a --- ----- -- - - -- - -- -• - - -- - Eldon . Eldon L. -- Wagner...... ---- - •-_... ............ .- TITLE: MEMBER STATE BAR OF WISCONSIN Arlene L. _Wagner ..... - ..... ._........ ...... (If not . . ..... ............. authorized by 1 708.08, Wis. StatsJ to we known to be the person' s�.:.,,110 executed the foregoing instrument apd acknow THIS INSTRUMENT WAS r'RAFTED BY i A ' Joseph L. Boles -- Attorney at Law `s •-•---•---....... ..................... ................_........• - -• -- _ ..... ra River Falls, WI 54022 (715) 425 -7281 � . ... ..........I- --•-- -- - -•--- ............... . - --........ • Nota ^y Public ............. ..... ounty, Wis. (Signatures may be authenticated or acknowledged. Both My Cnmtnission is pernlantpt.(If n t, state, exi)iration are not necessary.) Z date: aBt;_me, of persona ,i[ning ii any capacity should be typwi e.r printed h,Io :hrir signac:re . WAARANTT DEED STATE BAR OF WISCONSIN A'in nn,in L gsl Ill- -, 4'.. inr FORM No 2— 19Y2 %V w Parcel #: 022 - 1048 -10 -120 05/15/2006 03:06 PM PAGE 1 OF 1 Alt. Parcel #: 17.28.18.257A20 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner PHILIP B & JUDITH L GEORGE O - GEORGE, PHILIP B & JUDITH L 391 N LIBERTY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 391 N LIBERTY RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 13.590 Plat: N/A -NOT AVAILABLE SEC 17 T28N R18W PT NE NE LOT 3 CSM Block/Condo Bldg: 8/2138 (MUTUAL EASEM'T & MAINTEN- ANCE AGREEM'T 888/280) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 17- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 897/244 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/12/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 13.590 120,000 351,000 471,000 NO Totals for 2006: General Property 13.590 120,000 351,000 471,000 Woodland 0.000 0 0 Totals for 2005: General Property 13.590 120,000 351,000 471,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 303 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 TOTAL DYNAMIC HEAD • • • • • o D O m O=W- O n v o °'v�"c° N N W l O m 4m o Ln o o in o m ° v m H l0 N m ..9 ? f I I w vi'orDN o 1' e eD eD t i ma am a m D, v f1 ! xx x.2 v ? -v o30°.gxa�x3� c c 3 c c 3 c c 3 3 0 - .q+ c S & c -.� G1 o ( 330 330 330 0 3n 3c D 9 _ 3 m� n rD o SS'rD 2 t an a� nn m n (D U3 c -_ N eD �' ? . L-Q p D oj O T D I o0 0�' wW S Ll a ° o v P `° rJ m m m 0 3 �` un v : sn,Ww sxOn�w (7) CA O nv,o n v+o y w a, Z' -n S. ' CD S'rD -i o{ f - CL c�s� ° ° x� tea- c;TF =ta y O H D, V O A a, V O d K o o n rD W O 0 O (D rD - 'A c O O C O 3 O t� N _c. S N $ 30 3o a c c s�•°: rr ID 3 �� ,n�� a ?3m T s 3, a CD v r•t G1 a ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ �+ _ Q m v, 'r^.. m � I'1 Z 0- n • 0 D O -v v, c n 0- c n -� n n Q n, ID rp O O m N O c p Q , O N "O p n d D rD Z `° 0 n � 3 u'� o _ rD `e ?.0. � °,� <'D LZ g N < 2 fD �. N Q'O C D ` N 7r = - * - O J � (� N O. (1 N n ^. rD 5 In C O -a La's O• Q = rD -. C a v O O 2 O • m m c 0 c c v 0 0 3 m o rD �� 0 0 0 C 3_ m n OD r �1 Z rD Zm a. -.'c �O1> > N iD n � a ? o °0« g ,c 3•�c v D o 00 m /tea '� v rD la rD a- p S 3 S 0 rD "O 0 a _a O 3 a Lo O m m n 0 to •" a a w w_ n A p� W rs T 3 m 3 :R 3 c m o o O N Z a 0 0 o T � �a a A o t a w O Z H 0 3 c m �• c p m h � Z _�Z Z z Qo - rp v, rp Vf N v, -• O, w Ol v o =0 m 02 N d + a A F MOUND SYSTEM FOR Eldnn Wagner 16775 Co. 34 Nnrwnnd, MN 9916R INDEX Page 1 of 7... .................Index Page 2 of 7 ... ...................Calculations Page 3 of 7 ......................Plot Plan Page 4 of 7 ......................Lateral Layout Page 5 of 7 ......................Cross Section Page 5 of 7........... .........Plan View Page 6 of 7 ......................Pump Chamber Page of 7 ......................Pump Curve Located in the NE a of the NE 4, Section 17 , T 28 N, R 18 W, Token of Kinnickinnic County, Wisconsin. Prepared by Paul C.J. Steiner Steiner Plumbing & Electric,Inc Route 1 Bay City, Wisconsin 54723 Master Plumber J � #6780 Date: RECEIVED JUN 71988 S8 8 - 01945 OFFICE OF DIVISION COIFS Atin P.rPuCATION CALCULATIONS STEP 1: Absorption area: 150 gpd /bedroom X 4 = _rnn gpd., Table 4: 600 + 1.2 = 500 square feet required. Use 64 ft X 8.8 ft bed Us - ------ tteneh -es ,- f t -wide --X ------ - ft- 3.-on 4 laterals, each 30 ft long, 1 1 manifold, 5_ spacing between laterals. ` STEP 2: Table 5: lk " diameter laterals, a diameter holes at X CW , spacing between holes. STEP 3: Table 6: 6 holes /lateral, 7 gpm discharge rate per lateral. 7 gpm X 4 = 28 gpm total discharge. STEP 4: Table 7: 1; diam. manifold, inlet at center of 5.25 foot long manifold. STEP 5: Design dose volume is 127.2 gal /dose at a rate of 3 times per day. Min. dose volume must be at least 10 X distribution pipe volume. Table 10: 1 1 '2 diam. pipe= • 092 gal /ft X 120 _1 X 10= ga] STEP 6: Table 8: Dosing rate = 28 gpm. STEP 7: Table 9: Friction loss in 31, diam. force main, 80' long; 40 g p m = •23 in 100 feet. E S 'qSSSM ELEVATION DIFFERENCE 6.25 NS` � S �jdPG FRIICTION LOSS .18 . d D 2.50 pN 8.93 TDH o �N�E RECEIVED � $ g _ 01945 � JUN 7198 $ OFFICE OF DIVISION page 4 COPtS AtIn r.coZiCAT(nN of 7 FLO A OD uo� 3 2oJo 1 PGA SYS 60 HoLZ 2 n e \ \ u GS �► spa PAR� DE t,� O � D �Nt✓E � \ r✓, t � G �RF�E 3o2e ? S To E k 1 Za0 &AL. '5LPTIC- TA01<- � ry ti . M 100 �pasEO 1 ;7 o RECEIVED ABM ^ 100' r P of (rQV-A4rG STE>rL �"FNC.F' MOST r JUN 71988 - OFFICE OF DIV Q r IrAT10M S 88 g 019 45 COPS A�ln r.ce ..y`. ..V•.... ^!.`1 !)•,.. /.^ ,"'!M+ .I4.: ... .. .!t ... .. . •. Fie �. al .. .• rr.. /R't.h ,!'Ir*Y� .!!"rTga.. ?Yfi.'4'Efil". ..a_:.. de.• ....__ ~ �._....�+� • t�•nrl,..�a. .. .•• _ .. .. ..�.� ..w...+ti.- w....r r .M....+. . ..a .... ... •- r .4•... .Ir Mv...i�•.••r . ftLl 'r. Perforated Pipe Detoll End View End Cop ) Perforated d1e y. I Pipe '6 �e Hobs Located On Bottom. S Me Equally spaced Q PVC Force Main * From Pump Q PVC Marigold Pipe ; Distribution Pipe Last Hole Should Be Next To End Cop i Distribution Pipe Layout P A R S X EM 3'( Y 1t� S aGE $ Hole Diameter inch DNS Lateral Inches li Manifold " , Mz Inches Otis N u Force Main ,�, Inches T DEPAR� � 1S�i0 �E S N SEE CGRRE RECEIVED JUN 71488 COOFF F a D / GA �N S S S - 019 4 5 Page _ Of — Synthetic Covering1 1 Distribution Pipe Medium Sand _ _ H G Topsoil = __ _ F 3 E �; D ✓ r % Slope Bed Of 2 2 %2 Force Main Plowed Aggregate From Pump Layer D� � Cross Section Of A Mound System Using E 8 � grS A Bed For The Absorption Area F • , ' o� s� n �� A S7 Ft. H I"s B 6 Y Ft. HV GS I 1 Ft. J /() ' Ft RECEIVED JUN 71988 QP� L l , Ft. 1 O OFFICE OF DIVISION 3 rce Main W / n rd Ft. CWR aNn Rrn,IrArroN SE L Observation Pipe -� �•--------------- - - - - -- ------------------ - - - - ♦ A 11 I�___ ________ _______________________ -- Distribution Bed Of Pipe Aggregate Observation Pipe Permanent Markers S88 01945 Plan View Of Mound Using A Bed For The Absorption Area PUMP CIIAMIIER CROSS SECTION AND SPECIFICATIONS Vent Cap Weather Proof Approved Locking Junction Box Manhole Cover 4" C.I. ---+ 12" Min Vent Pipe Final ' 4" Min Grade ' i 18" Min Condui t' F 18" Min -- `` -------- - - - - -- Inlet �� i Approved AGE SYS'tE �� Joints w/ .� SEVd 1 �;� C.I. Pipe O Ng1 Approved � 1 ,,, Extending Joint w/ �j I � Solid C.I. Pipe Groui LIONS I �'' Extendi �E� I �" n g A � Ma �� I 3 Onto � • Lp,BOA 1.01 � ��; aY. , Al Solid arm OF 0 A I ,d Ground EQAF 0 S 0� - i �b B O n • N pEN ; ' ' C SEE Pump 4 Off Concrete Block D w RECEIVED g $ O L9 45 JUN 7 198 8SPECTFICATIO NS OFFICE OF DIVISION TANK COM Arin MOLICATION PUMP , Manufacturer_: We-Aer T Manufacturer: M Vers Tank Material: C Model Number: SSA (e Tank Size: /Q pc Gallons Switch Total Dynamic Head: Ap 1 FT CAPACITIES Pump Discharge Rate: GPM Total Daily Effluent: 6 66 Gallons A c>2740 or Gallons Number of • Doses : Per Day B or y3, A Gallons Dose Volume:` ��n Gallons C �� `� • /5 „ or aQ� Gallons Notes: 1. See pump curve for .D , or /n��s' Gallons additional performance Total nk information. Capacity Required 2y9, Gallons 2. Pump and alarm are to be Installed on separate circuits ALARM as per ILH 16.19 WAC . Hanuf ncturer: Le yo' A) ,i r SIGNED: Model Number: ) LICENSE NIIHIIFit: Switch Type. P 1Aep - - DATE SANITARY PERMIT APPLICATION COUNTY HR a � In accord with ILHR 83.05, WIS. Adm. Code STATE SANITARY PERMIT # — Attach comp lete plans to the count co A I. D. � p p ( y copy only) for the system, on paper not. less than ST PLAN L NUMBER 8 x 11 inches in size. .. —See reverse. side for instructions for completing this application. PETITION I. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES NO PROPERTY OWNER PROPERTY LOCATION 1/ '1 / T ,N,R Or it PROPERTY OWNER'S MAILING AD04ESS LOT NUMBER BLOC NUMBER SUBDIVIS ON NAME CIT ,STATE ZIP CODE PHONE NUMBER NEAREST ROAD, LAKE OR LANDMARK Q_V4.LAQC_: f f IL TYPE OF BUILDING OR USE SERVED: ~ Number of Bedrooms if 1 or 2 Family - OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check ## 2,3 or 4, if applicable) 1. a. XJ New b. ❑ Replacement c. ❑Replacement of d. El Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit.was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑. The System is shared by more than one owner /building. Attach Common Ownership Agreement to County. Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b, ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. F'; Mound f. ❑ IGP n -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seep Bed b. ❑ Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet Ja Private ❑ Joint ❑Public CAPACITY VI. TANK Site - in gallons Total ## of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks I � Septic Tank or Holding Tank = t Z L— Lift Pump Tank/Siphon Chamber ... ►' ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I the undersigned, assume responsibility form do 9 stalla n of the private sewage-system es plans. stem -shown on the attached p 9 Y P Plumber's Name (Print): Plumbers Signature: (No Stamps) MP Business Phone Number: ,., P m6&'s A dressjStreet, Drty, tate, Zip Codej Name of Designer: , VIII. SOIL TEST Certified Soil Tester (CST) Name CST ## '. CST's A'Bb ESS Beet, City, State Zip Code) Phone Number: - IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) �` Surcharge Fee Approved ❑ Owner Given Initial ✓� j Adverse Determination ! X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To:13u,reau of Plumbing, Owner, Plumber DEPARTMENT OF REPORT ON SVIL BORI AN D SAFETY &BUILDINGS DIVISION INDUSTRY, PERCOLATION T (115 I P.O. BOX 7969 LABOR AN# MADISON, WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: TOWNSHIP LOTNO.:BLK.NO.: SUBDIVISION NAME: E '/4 �/ /TV N /R/ i l 11 1 , / ' COUNTY: ER'S NAME: MA ADDRESS: (doh w 3 X No USE DATES OBSERVATIONS MADE ��VV�� NO. DR : CO R T O - tortesidence [ New ❑Replace I I S, a► �' /., /p / c r QO RATING: S- Site suitable for system U- Site unsuitable for system ,S S " 93 S a CONVENTT NAL: MOUND: iN -&OUN E U : S ST -FILL HOLDING TANK: RECOMMENDED SYSTE .(optional) C7S [ZU ®S CU OS ®U CIS Z]U ❑S ZU If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: I Floodplain, indicate Floodp el PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED ES T. HIU TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) h / �//� 7 r B - '^ 8 / 6 ' 02 �/ �/ r ' I/ r / a e , B- 3 95. y • ., a G ,8 / , 4 B / e 3fohr B- 8 to i . • // . Q / 4 s t ' / hal S fOh C PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR WATER V� . "INCH S RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN, R PER INCH P- I a 30 ; / 7 P- P. a Vn 7 P- P. j a ie. P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 96. t5�0� S88 019 4 5 83 fe n',ce 0 I 1 I , f Bore Hole's-. -... I i TN C o I i , I _.... _ _. i .�� I � s ��l �•I i i i ,. i i � A4 /00 1 I 1 i i I P o R I f7O 1, thw7mmdersigned ere y certify that the soil tests reported on this form were made by me in accord with the proc u and m ods specified in the Wis nsin Adrtrirrfsttatt ode, and that the data recorded and the location of the tests are correct to the best of my knowled and belief. j 0! TESTS ERE C7 'r TED ON: p l aw t C J S ,h' .eA R ED IVES ADD CERTIF TI NUMBE : PHONE NUMB nal): ELI tl 7 .• J - VN 3032 ICE OF Dw pt10N CST NATURE- { cS 1!1 t.c ur DISTRIBUTION. Original and one copy to Local Authority, Property Owner and Soil Tester, DILHR.SBD -6395 (R. 10/83) — OVER — i o ca —0 n o � 2 0' ] $ r T , 2 \ f e ¥ z– z o B , n, o a e o: > 7 E g E = c :, \_ @ = C z – m , . w ©�; £ E e ® m 1 B. \ o � C 0 k a m § E � ° ' , § $ m $ ° § ° ° ( _' o E E t o % o o E . � . g■ e� ■ 2 @ m :3 $ E E: E o o E � \ \ FL f co co ;o § r; c � co_¢� §..� � � ( T m m E: . * ƒ § § § �i / > � �/ k rr 7 7 2 E >�7 � & W � _ � & z z I / g > > \ / { . « = m . � CD ° � } c 0 j k cn § { i ƒ k § 00 \ e E § / z m [ B / r « / z » – % ® fa CL ] OD (D § -n / J 0 % n [ / � 2 E g . i f . / CD { } . I . \ ON E \ 0 o < \ o � % . Parcel #: 022 - 1048 -10 -120 04/07/2006 10:03 AM } PAGE 1 OF 1 Alt. Parcel #: 17.28.18.257A20 022 - TOWN OF KINNICKINNIC Current *1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - GEORGE, PHILIP B & JUDITH L PHILIP B 8, JUDITH L GEORGE 391 N LIBERTY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 391 N LIBERTY RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 13.590 Plat: N/A -NOT AVAILABLE SEC 17 T28N R18W PT NE NE LOT 3 CSM Block/Condo Bldg: 8/2138 (MUTUAL EASEM'T & MAINTEN- ANCE AGREEM'T 888/280) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 17- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 897/244 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/12/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 13.590 120,000 351,000 471,000 NO Totals for 2006: General Property 13.590 120,000 351,000 471,000 Woodland 0.000 0 0 Totals for 2005: General Property 13.590 120,000 351,000 471,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 303 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 T) & .4 450658 CERTIFIED SURVEY MAP -LOCATED IN THE NEI/4. OF THE NEI/4 OF SECTION 17, T281\1, RI8W TOWN OF Kf'NNICKI•'NIC CROIX CO., WISCONSIN. OWNER: ELDON WAGNER N 1/4 CORNER SEC. RT. Z BOX 272 8 ( 17. RIVER FALLS,Wl 54022 wN WEST LINE NE -NE M to EXISTING 66' ROAD UNP'LATTED L AN DS 0) CASEMENT . . . I . . . N _Q Oi se 2' E.., 6.6 61-.6 15. 0 I'_ .2�, 4 73.91- f S b < M?l :n fn 0 M ow 2 6 6 -6 9� M r > *A M @ z 4A * m 0) P r w z m mz 0 V) 0 0 0 zo t (n :e OD - m > m 00 h. W N 0 -1 • r 0 M " z !6 z m m #A 0 > M p M ITI L4 X CO in am rn M :, :0 M rj am 204. 10" 33.31". MZ o C 0 0 ('s ;r S0-00'44"f 31 7". 4 6' m' to a 0 > m VI 0 M r r p - n 0 r K m in m > r (D ai co z I' ' -4 RU7 AUG 171989&- T E JAMES o,cnNNFLL Register of Deeds 3 St. Croix Co., wl 151/4 CORNER SECTION 17 ( C OU NTY MONUMENT FOUND). • NE C O RNER ton ly tN 4.2. (COUNTY moaumeNr FOUND). Sto 25 4 2 W 6 3 5. 17 IV EAST LINE OF THE NE 1/4 Go UNPLATTED -LANDS . . . . . . . JAMES M. WESER 01AES M 8 M_ WE ER I" IRON PIPE FOUND. S 1804 SPRING VALLEY SET 1" X 24" IRON PIPE WEIGHING Wis o Wis. 1.13 LBS. PER LINE--AL- FOOT- * - e / 9 . kC C) SCALE 1"-- 200' AUG I 11P. U ft ;Otto u 1,,)(l.wwuru:N9VE PAIM J;LAIW 0 too' 200' 400' A1 PONWQ CrW%4M� - I—• JAMES M. WEBER 1804 SHEET I OF 2 DATED 89 -59 VOLUME 8 PAGE 2138 THIS INSTRUMENT DRAFTED 8YA'al+%k7)lAtaM � g6T "DVd L 9W(l'1 ����NO►adOR e s o lar 'MIIZ+IISZOIO$ jeaq o; pownsse LI - UOT430S 30 1 3N a44 4o autj ;sea ay; o; paoua,iajaj aje s6utjeag z m 4_ ° o — -- --- -- -- o 4_ spay ;o bq pauno spuej pa;;81 un u t O ru `� LI uoj}aaS 4 13N 0 44 jo ouil ;sea 0 .� o ti , LT 'S£9 M „Zfii, SZ TOS a �” O W N I , H N co z W4 H o z a �� M H In c oo I Ln 1 •-1 d I 01 it 'H TI � 1 N O N 1 v - lL • I N O w i ,Ln U U i i z 1— o a -4 1 a En -4 CLI Q 4-1 A i 1O 4_ O co 00 = 1 w � •o I - m >I W � � - At aJ ar I mot' .. - i z a, W W 41 1 N -' � N I ',� w >> z+ O �o I O O d l O t Ir N U c 00 0 4 C/) .0 = 1 z' z 00 ++ a' x 1 G1 •.i d I W 44 O b- O 34 • , LL- r4 ° C'- Z •J _ W cn cn v Q ) m s co 0 m •r1 C +r 4. � w d 44 O r m a, m . c v ar a• c 4-I f� •r-I c LL. + a) o a, c R, .0 a t n W A x c � c c ,ta {3N ay; �o {3N a43 �o autj ;saM 1N3W3SV3 OtlON 199 Y W N ,TO'ST9 TI 44 x� H ;� „TO , ZZoTON b N O W o a a . X _ Y 4-) a v .. -, W rt ---------------------- --- ---- -- m 0 0 • O spay ;o ,tq pauno spuej pa ; ;ejdug b y �ap�?;' +6' y}i��9 L IM 4, 00 Cr t o O to t :) � •� f 17 3NNOJ,O S3WVf �y�� C} Qm . a Nnt��;, — .�� a y ,•a' 41 ., sais£� III � � . • , . �� ' ��.�/ �'�/�