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HomeMy WebLinkAbout022-1048-30-300 c y o 3 m c t7 L1 eD j � O C/) N N o W N• ID S < . 7 � N C11 �p d D C .fi N n+ N O y CO �! s C N y O - 3 PD co o C D 7 , N "! n v �p C, O °p o c w (� ! S7 A 0 N _r lei v 0 z D m a ! 'o a lam. m (D D a C o � N CL sod C) 0 p N N o o 0 o a (p O C g a �• CD Or a v co _0 <NZ d a 3 N N Q D (p 6 Tl c o s N m d A T) 7 W � CD N C? �+ y N N 3 W d O z ° c z z :3 — 0 o a� O o 0 °' CD M oC umi a I � m n c , C N CD w 3 a a 3 7 s Oz O 7 � A z m !A N .�.. C ':I s X Lr N CL A 7 o Q s CD 0 V CD G s z o c X z N _ CD A A W a C C) d G N O Q N CD z N O Q W i n 0. m N b I Qn A 0 N CD �p N O °o Q ti r S , ►�� Wisconsin pepartnnent of ivision C:omrnerce PRIVATE SEWAGE SYSTEM `SttyCroiX Sate�r and Bu�'Idings D INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) s aqmP,.ecmit No.: Personal information you pmvice may be used for secondary purposes [Privacy , s.15.04 (1xm)). Permit lip game: cc]] W &Rgfe� nshl State Plan ID No.: ff11�gV6 afl 111 .-- y CST BM Elev.. Insp. BM Elev.: BM Dewnptio -nom P � � �� -30 -300 a� ve • a g� I TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic w Z(eO Benchmark 16, S 60.d Dosing 3 4 I Z z© r Aeration Bldg. Sewer �•� 10.11) Hol ing St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet S (05- 1 1 DI. is 1 TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Air I Septic S / NA Dt Bottom Dosing NA Header /Man. Aeration NA Dist. Pipe /DS�, r.� Holding Bot. System u ' S S D3 .10' PUMP/ SIPHON INFORMATION Final Grade Manuf cturer Demand Model N M TDH Friction System TDH Forcemain Length ia. Fi Dist.Towe SOIL ABSORPTION SYSTEM �3 e �,Q� -�J.,. (� Width r Length , No O Trenches PIT No. Of Pits Inside Dia. IME Liquid Deptfi • LS 1ME 1 N NG Manu ter: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHI . ~ S•Ze1• ^ L. \/ CHAMBER Moe Number: INFORMATION Typeo System- l.M!', LS Z Z 7C OR UNIT ��i - C DISTRIBUTION SYS M lam. P To Air Intake x Hole Size x Hole Spacing Vent He , DistributionPipe(s) 1 Dia. ength ia. Spacin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over reed/ pth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Trench Edges To soil ❑ Yes O N ❑ Yes ❑ No Cl ton / COMMENTS: (Include code discrepancies, persons present, a c. Location: 1052 Townhall Road, River Falls, WI 54022 (SW 1/4 NE 1/4 17 T28N R18W) - 172818259D - Lot 2 1.) Alt BM Description ; � � _ � � ` • 2.) Bldg sewer length i t = /'f \_A) s� - amount of cover = IS ro c•� f � &:` 2H6 A..L 4' - /�e� Plan revision required? Y ❑ Use other side for addition for tion. d Oat ` / 1 s ctor i Sigrjature Cert No sBD -s�,a cR.a/s�, � ��" S�U►�l d Parcel #: 022 - 1048 -30 -300 09/27/2004 11:58 AM PAGE 1 OF 1 Alt. Parcel #: 022 - TOWN OF KINNICKINNIC Current D ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): " = Current Owner DANIEL G & CLAUDIA D DENISSEN `DENISSEN, DANIEL G &CLAUDIA D 1052 TOWN HALL DR RIVER FALLS WI 54022 - ' = Districts: SC School SP - Special Property Address(es): Primary Type Dist # Description ' TOWN HALL DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.090 Plat: 1024 -CSM 14/3830 SEC 17 T28N R18W SW NE FORMERLY LOT 1 Block/Condo Bldg: LOT 2 CSM 6/1722 NKA LOT 2 CSM 14/3830 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17- 28N -18W SW NE Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 302,700 Valuations: Last Changed: 06/10/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.090 24,000 233,100 257,100 NO Totals for 2004: General Property 3.090 24,000 233,100 257,100 Woodland 0.000 0 0 24 233100 257 All 3 090 ,000 , 100 Totals for 2003: General Property 3.090 24,000 233,100 257,100 Woodland 0.000 0 0 Total 3.090 24,000 233,100 257,100 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 � sanitary Permit Application safty i!k rwilding Di ii., In accord with Comm 83.21, Wis. Adm. Code 201 W. WashWtao Ave. See reverse side for insouedons for compioda8 dcis applicatioA PO Box 7302 Deaartme�cam Personal information you provide may be used for secondary ism Madisron, WI 53907.7302 (Privacy Law, S. 15.04(1)(m)] (Submit completed forgo 00 ONO* ifnot 0 (to the ssh" owned} or th stern, oa not cis as 8.1 I Maht, e .4 - d X Nu mber wk !. rovfr on Prev IOM 0 ao as arssaa. - eall t oil Information M FMMWD*W MW ft" WWI MW&4 sS S w Blad Now 1 U Sa l - Lt.) ��; r 1; , , �, C P n n ame or -� - RE on* ass ryes cw6 L : y' } Q ci ty 1 or 2 Family DwaUh* -N of HeQrooma rC a P nbil4XOauaemial (dendbe we),_ (' ���� Of 3`1 c� s >ve ROW 3 31c ax • KIL IV" of ly one box oa l ine A. ec A N OW t 3. $ Tank Only of o S. 6 a Addi to c wn O A n mit wasi proviou!k laetied I&IONVOI ' O"UM (Chack all that apply) 4-- [op Cl D an Mound a Sand Filter 8� ❑ Hold Tank © Conewoted Wetland 13 At -8nade O Acrob�ic Treatment Unit p s Red W G o ther: Line 8 C7 Other: V� MtM Ot A&M IlIfOrMOVIDA. f. Ussir ROW i 3 -LINPOrNAM 4. RZUkW 1 61 Sys4i r� 0 0 - ( 'D -� --? n — ft"md (aals./day/sq. ft.) (banJiaoh} m sv 1Mkv VM Tag kksg o o ?�tsux p / 0� 3 Infernadaa t3a Gallons Tanks Con Cto steel er o N OW 81"s Tsmk$ crate sft cted /2� D a a ty tatelsa"t billry iba ittMllation o f the POWTS ahawn an the attached lane. Pat= no 1 I t M!N qM i! L � � L_ J JIL tuaOID.wrem..t Meo , bl� kfto aved 0 Ownar C31ven >(nitial Adwerie $ a l'oej as o es uar su t �a6asalon ��5. �" Co t r toner err pproval• ( IL Q 3B 9 Q7jpp} ff vwa.o " `Q e .tlL i S i-�• 2ClY� '�t1 , PLOT PLAN PROJECT Dan Dennison 4DRESS 1054 Town Hall Drive River Falls Wi 54022 SW 1/4 NE 114S 17 /T 28 18 W TOWN Kinnickinic COUNTY ST. CROIX MPRS Shaun Bird 226900 D ATE 5/29/01 BEDROOM 4 CONVENTIONAL XXX IN -GRO P SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .9 ABSORPTION AREA 670 # of chambers 39 BENCHMARK V.R.P. Top of Survey Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark Plans Designed Using SYSTEM ELEVATION 103.9' Conventional Powts Manual Version 2.0 Alt. BM Top of Survey Lathe @ 103.5 415' Prope Line Vent Sidewinder High > 12" Capacity Leaching of Cover Chamber 0 g 16" 6 Lon Grade at System Elevation oo 3 x 3- 3' X 82' Cells 4% with >3' Spacing Slope Vents 5 25' B �- 75' $- Pro 4 5 , Bedroom 40' House % 15' 45' 50' B- 5' 10' % lope 75' Vents Alt. B.M. R. M. I to 404' Property Line PLOT PLAN PROJECT Dan Dennison DRESS 1054 Town Hall Drive River Falls Wi 54022 SW 1/4 NE 1/4S 17 /T 28 1 18 W TOWN Kinnickinic COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5 /29/01 BEDROOM 4 CONVENTIONAL XXX IN -GRO P SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .9 ABSORPTION AREA 670 # of chambers 39 IL BENCHMARK V.R.P. Top of Survey Pipe ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Plans Designed Using SYSTEM ELEVATION 103.9' Conventional Powts Manual Version 2.0 Alt. BM Top of Survey Lathe @ 103.5 415' Property Line Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber c Long 16" at Lon Grade at System Elevation M 34" x 3- 3' X 82' Cells t 4% with >3' Spacing Slope Vents 5 25 75' $ Pro 4 5 , Bedroom 40' House % 15' 45' 50' B- 5' L 10' % Vents Slope 75' Alt. B.M. B.M. 404' Property Line Wi3cynsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety Ind Buildings Page of Bur9du of Integrated Services in accordance w h Comm 83.09 Wis. Adm. Code , Z ���� j � Pianon � h complete si a puss th 8 1/2 x 11 14 es in size. Plan must /—,),T j County 54 include, but not limited to: vertical and horizo I reference point (BM), direction and F _' cent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # A OP PPLICANT INFORMATION - Please print all information. ewed by 1: 1 - 71 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4 A l f 1/4,s /7 TO? ,N,R E ( ) W Property Owner's Mailing Address j Lot # Block# Subd. Name or CSM# 5 h o� City State Zip Code Phone Number ty ❑ Village Town Nearest Road ❑ Ci & New Construction Use: ;Rtesidential / Number of bedrooms y R Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow i' gpd Recommended design loading rate �� bed, gpd r trench, gpd /ft Absorption area required 900 bed, ft 7<� /ft trench, ft Maximum design loading rate s bed, gpd /ft gp trench, d/ft Recommended infiltration surface elevation(s) �� ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable _/✓ S = Suitable for system Conventional Mound In- Ground Pressure AT Grade System in Fill Holding T k U = Unsuitable for system ❑ U S❑ U �-6. ❑ U 1 ) < s El U El U — 1 S U SOIL DESCRIPTION REPORT New —� 1 Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench � 1 z Z- Ground 6 Ya S `2� �—G� S - elev Depth to limiting p 3 •�' fact r 7 ' Remarks: Boring # O 31 .. f Ground 3G Depth to limiting factor 7jj�'e in. Remarks: CST Name (Please Print) g ature ° Telephone No. / Dale Address ST Number 1 SOIL DESCRIPTION REPORT PROPERTY OWNER �� ✓�� Page of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench ......... .............:. rr Ground Depth to limiting o , factor Remarks: Boring # Ground Depth to ��• Q ' limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground / gl— Depth to limiting factor ? n. Remarks: Boring # In! 111 Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) Soil Test Plot Plan Project Name Dan Dennissen Shaun Address 1054 Town Hall Drive River Falls Wi 54022 CSTM #226900 Lot 2 Subdivision - - - - - -- Date 12/16/99 SW 1/4 NE 1/4S 17 T 28 N/R 1 8 W Township Kinniddnnic E] Boring Q Well PL Property Line County ST. CROIX BM o r VRP Assume Elevation 100 ft. Top of Survey Pipe System Elevation 103.9 *H Same as Benchmark Alt. BM Top of Survey Lathe @ 103.5 415' Property Line a� t~ a I o i` 00 / M O c� 3 O H 4% Slope 25' 1�=5- 75' B-4 - Pro 3 Bedroom B_ 40 , 5' House 4% Slope 15' 45' B`, Rte S lope 75' t. B.M. Ld B.M. 404' Property Line Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20& 21 of the Wisconsin Uniform Dwelling Code, soil erosion control informa- tion needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: / ' 1. Complete this Ian b fillip in requested information completing the site diagram and marking ✓ appropriate � P P Y 9 q � P 9 9 9( ) PP riate boXs P on the inside of this form. l 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. / Site Diagram Scale: 1 inch feet EROSION CONTROL PLAN LEGEND I PROPERTY LINE EXIST DRAINAGE TD TEMPORARY DIVERSION I - FINISHED -' DRAINAGE LIMITS OF GRADING i = SILT � FENCE STRAW d �♦ BALES GRAVEL O VEGETATION SPECIFICATION I Fioa 3 r ss Fr- TREE PRESERVATION l STOCKPILED t:G SOIL p J Please indicate north by completing the arrow below. —N— x � I b oy �' L • , PROJECT LOCATION BUILDER ��� /2�� -�'�' OWNER WORKSHEET COMPLETED BY �st— �� DATE 1 i EROSION CONTROL PLAN CHECKLIST ` Q Check ( ✓) appropriate boxes below, and complete the site diagram with necessary information. Q Q Site Characteristics V North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. [ ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells. ❑ [J' Location of storm sewer inlets. L?" Location of existing and proposed buildings and paved areas. [1� The disturbed area on the lot. Approximate gradient and direction of slopes before grading operations. Ap ximate gradient and direction of slopes after final grading operations. ❑ 4r Overland runoff sheet flow coming onto the site from adjacent ) 9 areas. 1 Erosion Control Practices V ❑ Location of temporary soil storage piles. Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. V11, Location of access drive(s). Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). [11 Location of sediment controls (filter fabric fence, straw bale fence or 10 -foot wide vegetative strips) that will pre - ve t eroded soil from leaving the site. El Location of sediment barriers around on -site storm sewer inlets. ❑ �/Location of diversions. Note: Although not specifically required by code, it is recommended that concentrated flow (drainageways) be diverted (re- directed) around disturbed areas. Overland runoff (sheet flow) from adjacent areas greater than 10 000 sq. ft. should also be diverted around disturbed areas. ❑ Q Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re- vegetation by sodding or by seeding with use of erosion control mats. ❑ P� Location of practices that will control erosion in areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap. When used, a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In- channel practices should not be installed in perennial streams (streams with year -round flow.) V I E] Location of other planned practices not already noted. a Indicate management strategy by checking ( ✓) the appropriate box: Management Strategies ❑ Temporary stabilization of disturbed areas. Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching. Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment). Indicate re- vegetation method: Seed' Sod ❑ Other ❑ l Expected date of permanent re- vegetation: ,cZ J' 2 oa Re- vegetation responsibility of: Builder ❑ Owner /Buye� Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? Yest< No ❑ ❑ Use of downspout and /or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. ❑ Trapping sediment during dewatering operations. j Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until 'E most of the sediment settles out Proper disposal of building material waste so that pollutants and debris are not carried off -site by wind or water. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to j half the barrier's height. • Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday. • Access drives will be maintained throughout construction. I I • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. i For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW- Extension publication Erosion Control for f Home Builders. I The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available k through State of Wisconsin Document Sales, 608/266 -3558. I Erosion Control for Home Builders (GWO001) can be ordered through Extension Publications, 608/262 -3346 or the Department of Commerce, 608/267 -4405. i EROSION CONTROL REGULATIONS UNIFORM DWELLING CODE (DEPT. OF COMMERCE) PROJECTS AFFECTED • Straw bales, filter fabric fences or other barriers to • All new 1 and 2 family dwellings in Wisconsin started protect on -site sewer inlets on or after December 1, 1992. • Additional controls if needed for steep slopes or other • Additions to dwellings built after June 1, 1980. special conditions MAINTENANCE AND WASTE DISPOSAL APPLICATION PROCESS • Sediment controls must be maintained until the site is • Erosion control measures must be included on the plot stabilized by mulching and seeding, sodding or plan submitted with the building permit application to landscaping the local building inspector in communities where the . All building waste must be properly disposed to pre - dwelling code is enforced vent pollutants and debris from being carried off -site • Plot plan must show: — Location of the dwelling, other buildings, wells, sur- ENFORCEMENT face waters and disposal systems on the site with •Erosion control inspections will be made during other respect to property lines regular inspections (footing and foundation, rough con - struction, final, etc.) — Direction of all slopes on the site •Violations must be corrected within 72 hours — Location and type of erosion control measures • Stop work orders may be issued for noncompliance CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT • Silt fences, straw bales, or other approved perimeter • Local building inspector measures along downslope sides and side slopes • Department of Commerce, Safety and Buildings Divi- • Access drive sion, P.O. Box 7969, Madison, Wisconsin 53707, (608) 266 -2128. STORMWATER PERMIT (DNR) PROJECTS AFFECTED — Proposed erosion and storm water pollution control • Any grading or construction project that disturbs 5 practices during and after construction acres or more and is not covered by a building permit — Documentation that an erosion control and storm • Smaller sites that are part of a planned development water management plan which meets DNR standards involving 5 acres or more of land disturbance has been prepared (plan does not need to be submit- • Effective October 1, 1992 for any new or continuing ted with the application) project —Other information related to site location and per- • Exceptions: Indian tribal lands and work done by local mit holder government staff CONTROLS REQUIRED APPLICATION PROCESS • Erosion control measures specified in the Wisconsin • File a "notice of intent" application (Form #3400 -161) Construction Site Best Management Practice Handbook with the Department of Natural Resources (DNR) 14 • Measures to control storm water after construction days before construction begins FOR MORE INFORMATION, CONTACT • Application must include: • Department of Natural Resources, Storm Water Per- - Timetable for land disturbing activities and installa- mits, P. O. 7921, Madison, WI 53707 -7921, (608) tion of erosion control measures including project 266 -7078 start and completion dates LOCAL ORDINANCES Check with your county, and city, village or town for any local erosion control ordinances including shoreland zoning requirements. Except for new 1 & 2 family dwellings, local ordinances may be more strict than state regulations. They may also require erosion control on construction projects not affected by state or federal regulations. A publication of the University of Wisconsin— Extension in cooperation with the Wisconsin Department of Natural Resources and Department of Commerce, Ron Struss, Water Quality Educator, UWEX Western Area and Carolyn D. Johnson, Urban Water Quality Educator, UWEX Southeast Area. UW— Extension provides equal opportunities in employment and programming. This publication is available from county UWEX offices or from Extension Publications, 630 W. Mifflin St., Madison, WI 53706, (608) 262 -3346. Copyright 1997 by the Board of Regents of the University of Wisconsin System doing business as Cooperative Extension, University of Wisconsin— Extension. Send inquiries about copyright permission to Director, Cooperative Extension Publications, 201 Hiram Smith Hall, 1545 Observatory Drive, Madison, WI 53706. GWO001A Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites DNR: WT -458-96 R -02- 97- 2M -10—S R Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 Shaun Bird 26900 ST CROIX COUNTY SEPTIC TANK MAII TgNANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ` w �p I s c�.�.� -R Mailing Address I u S 7 0 4 , Property Address to S ck 7`o A.,� tcle t. (Verification required from Planning Department for new construction) �M , City /State Parcel Identification Number LEGA_,� � DESCRIPTION Property Locations � /,, &F— V4, See. , 7 � N-R l _W, Town of K n Subdivision Lot � z v Certified Survey Map # 7 , Volume , Page # ✓ 0 Warranty ed # / / .�� -� t3' �.�._ , V olum e rage # Spec house ❑ yes;�no Lot lines identifiabl994es ❑ no SYSTEM A AINTENA CE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the ou - site wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three y iratioa date. A& vcv^ S yl SI NATURE OF APPLICANT DATE QWNER CERTFFICATJON I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property n abM by virtue of a warranty deed recorded in Register of Deeds Office. *SINATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** *+ Include with 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 : _ QOCUbIa N0. STATS BAR 0! WIffiCON81N FOAM I -3!M ass sties sasayso ma asconowe *Airs WARRANTY DIM® All fi X1.3 Imetsms office ST. CROIX 00. WI& if This Deed, made between Glen.. Ma...W.i . 40... +c ► ' for iteoo:d fhb StD ............................. _]. . ........... ................... ..................................... ...............••.........._... o; a 19-96 t ... ....................... ........... ....... ............................... I ............ ...... , Grantor, A A6 and.... D.anisl._G..... Danis s. eQ.. AAd... ClaudiA ... t?.,_..P.eD- 144An.f. _huaband ... and..w.i t.eJ............ property............................... ..•.... ................................... ............... ................................... ............. ................................... , Grantes, Witnesseth That the said Grantor, for • valuable consideration...... ..... ......... ..................... .... ....... I ............. ..... ..••- •-- ............ - -- - RETURN To conveys to Grantee the following described real estate in - St_.... CraiX........... County, State of Wisconsin: Part of SWk of of Section 17 -28 -18 described as follows: t 1 f Certified Survey Map filed Taxp arcelxo :.. ............_.__.__.. October 8, 1986 in Vol. "6 ", page 1722. N$& FM This ...... i.A_AQ.t........ homestead property. (is) (is not) Together with all and singular the hereditament, and appurtenances thereunto belonging; And..... •. Glen_ M._- W - - - - -. •------- - - - - -- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and rights of way of record, if any, and will warrant and defend the same. Dated this ... -i•l --- 1 . 3 . - -- -- -- day of ... Octobe.r -- - - - - -- __ --- 19...86.. -- • .(SEAL) ----- ..(SEAL) ` .......... ....................... --------- ------- - - - - -- ` - --Gl%n Nit --- Wiese... -- ---- -- --•--- -- -- --• (SEAL) - L.ola_.i4.... Wi AUTHENTICATION ACHNOWLBDGMBNT Signature(a) ....•�'-'- ..m.:_ , ei e S^ ATE OF WISCONSIN ---•---•------•------- •- •------ •---------- - - - -•• - -- Pierce -------------- - -•... -- - -. - -- • -- County. authenticated this _ i i day of.CC � b<- _ , 19__ a b Personally came before me this . day of // .- ---- --•-••-•. ............... d "- - c-6_ .._Qc.tob.a _ ______ ________________ 19.-S-6. the above :tamed .. .................................. . ._... - - -• -- .- 1 and__ Lola.. Wiese • Ki !s �, n .. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, .--•---------•-•- • .... .......................... .... . . .. . .. ................. ............ authorized by § 706.06, Wis. State.) to me knc :wn to he the person ............ who executed the for. going instrument and acknowledge the same. THIS INSTRUMENT WAS DP•fTTED BY ........ ....... .............. .... ._......_._._....... C,t..lt,.._. Gay_ lord L Attorney --------- .. ... .......... . Rixe>:_..Fall_a, ... i ._ 54022 - -- ----------------- - -• -•- Notary Public - - -- -- Coui.t , Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) date: .- . -__ -._ 19.........) oNam.a of Persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN ,tcrilM,ca,na.,�® FORM No. I — Ion Stock No. 13001 r FILE,) "AP p25 kAHLEEN 2q T f i H. Z B t , .,�LSy .j I �e9 sterol p�ds rorz 00 f y � J ° 79' CEP T I F I ED SUP V E Y MAP Located in the SW 1 /4 of the NE 1 /4 of Section 17, T28N, R 18W , Town of Kinnickinnic, being Lot 1 of that Certified Survey Map recorded in Volume page 1722, St. Croix County, Wisconsin. Owner: Dan Denissen 1054 Town Hall Road N1/4 Corner River Fahls, Wi. 3 54022 Section 17-Z8-18. ro St.Croix Co. cap j, UNPLATTED LANDS ° found. (aluminum cap) _ ' N 89' 17' 39 "E 415.00' �l ! ° . � � o 0 o 133' 33 N I CL 1 � 10 0 °• ; 134776 Sq.ft. (3.09 ac.) including ROW. V �Z 134349 Sq.ft. (3.08 ac.) excluding ROW. M W 11 _ � i . "WPROVE z I W ' . LU ST. CROIX COUNTY F ? Q Q J� Planning ZonhgW Parks Co n e ° APR 2 5 2000 ID ^ • i O` W O If not recorded within 30 days of to O: �' ? O a � 404.60' approval date approval shall e null and void Co ffi 07 lg' S4 W Ais . Bfl' IA n I IS N _ v W ° 3 o , S8 0 12'54 "W �I ®7T� Z 11.20' L lI J M CURVE INFO. I RADIUS- 1833.61' m 'I p 190799 Sq.ft, (4.38 ac.) m — 12 0 55'43" . L i v including ROW. : .177124 Sq.ft. (4.07 ac.) W4 L 413.75' Z I p I I" excluding ROW. O .CHORD - S00 I Z I \ (n 412.87' I TANS. SO 7 i Z S05 0 50'03 "W h / W I 4 I , ID i 1 I T � I _j s LUi 2 Q.i o Q ZI 1 Q i W I Z Q 3 0 1 4 j 1 lU ? a O 4 II J W 2 4 I 2 R a 1 0 z 2 W Q � 384.04' tO 33' 33' 1 S 89' 17' 39 "W 415.00' I LU UNPLAT_T_E_D LANDS_ ° • S1/4 Corner I � Bearings referenced to the West line of the am Northeast quarter of Section 17, assumed Section 17- 28 -18, q St. Croix Co. cap a to be NO 1 18'l 3 E. found. Bearings referenced to the North -South 1/4 Section (aluminum cap) . line, assumed to be N01 This instrument rafted by'.1 Vol.14 ;'age 3830 4992653