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HomeMy WebLinkAbout022-1050-40-000 c CA 0 c co 0 3 °�' o C `r1 c eD ID o ID I - #; O m u O N W *! O ID 3 3 G f0 _ - aD go, • 'n m' 3 0 y N iv c Z CL oD ^ l K-) o m y y v y iw ° ` 1 co o c CD v = CD 0 O n v O Cl 3 $ ° ° D O w y y y j � O I c'o o W `� �' w a cn CD CL I N p v c°ii CL p cc v rn o ° o N� o CD m < CA m o o m m m d a w w y y 000 OD y ° c tv c Z O O O v' m !r o_ 000': '' • n o ° N n 3 N N N N c (a (� N d Q o c 3 0 CD v a Q N 3 °y' m " d ° C a 0 r. a I OZ y ZG) Z ZCDZ N D a) p D CL O E p y ti CD ((DD ti • CD m C cn w C `Y CD I C O W �f a CD CL CD R1 3 7 N C6 CD in - n O A Z ID v 8 j c° CL a C I o' a z � I I _ CL m 0 au aD Z $ rt o It z I y N y Z m C C4 w � 0 CL ° a a CD m a 0 0 0• I 3°.� c I � N a) CD o a o Z a W o CD I M o N C Or s v I j N CD I � �. t Q . p CD I A N ;Z1 ck c I _ N y o a CD O b CD oo O ° O o 0 `" V Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 429951 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: Williams, Dale I Kinnickinnic Township 022 - 1050 -40 -000 CST BM Elev: insp. BM Elev: BM Desc tion: / Section/Town /Range/Map No: 18.28.18. 2 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C c < � .Q � Benchmark 1 00.0 Dosing ✓ Z r, Alt. BM 0 Aeration ml v Bid . Sewer u" b4i'vv Holding St/ t Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vet to Air Intake ROAD Dt Inlet r Septic Dt Bottom 1_ 73 , . /( n f�l 1 VIIY� ff'` eader Aeration P p Ala Holding / ot. System 1 C� I . tg ( S , PUMP /SIPHON INFORMATION Fi i Grade Manufacturer emand t Co r GPM �� Q , 4 j b Model Number TDH Lift Friction Lo Head TDH Ft a Z Forcemain ngth Dia. Dist. to Well 2 , — 7 SOIL ABSORPTION SYSTEM BED/TRENCH Width L Length j l\lo,�f Trnche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / SETBACK SYSTEM TO P/L BLDG LL LAKE /STREAM LEACHING Manufacturer a. 4 0 INFORMATION Typgpf System: > (� CHAMBER-40R Model Number. W DISTRIBUTION SYSTEM Header /Manifol Distribution x Hole Size x Hole Spacing Vent to Air ISke 2� li Pipe(s pa a cin n 3 / �� Length Length Dia Dia Sg SOIL COVE --30 3 ` - / x Pressure Systems Only xx Mound Or At - Grade Systems Only rlY Depth Over Depth Over xx Depth of TSeeded/Sodded xx Iched Bedrrrench Center Bed /Trench Ed es To soil g p] Yes; No [j Yes �'s COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: j I J / Inspection #2: / / Location: 351 Cty SS River Falls, WI 54022 (SW 1/4 NE 1/4 18 T28N R188^W) NA Lott / Parcel No: 18.28.18. 1.) Alt BM Description = N ( K/1 100 ( PA14vl " E 2.) Bldg sewer length - amount of cover = E&i P lan revision Required? ;i Yes �__ No - � Use other side for additional information. _ Date I Sig Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County S� 201 W. Washington Ave., P.O. Box 7082 N V&c o �asin Madison, WI 53707 – 7082 Sanitary Permit Number,(to b filled is by Co.) De (608) 261 -6546 1�) �J � S S an i tary Permit Application 7 /4 to Plan I.D. N In accord with Comm 83.21, Wis. Adm. Code, personal info `' �� may be used for secondary purposes Privacy Lsw, s15 (1 x V ect Address (if ifferent then mailing address) 1. Application Information - Please Print All information MAC 022 � � =Na 0 � U N 1. P I # ��I.,,ot//# Block # NG OF i �� L) - L�d V Property Owner's Mailing Address Property Location i , Section City, State _ Zip Code Phone Number T 2 N; R/?E o IL Type of Building (check all that apply) ff f 91 or 2 Family Dwelling - Number of Bedrooms � �x (�/ �j� f� Subdivision Name CSM Number r-- ❑ Publidcommmial - Describe Use ❑ State Owned - Describe Use ❑C ty ❑Village NTownship of �� I / C 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) - A. ❑ New System N�iteplscerrrent System ❑ Treatment/Holding Tank Repla Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number sad Date Issued Before Expiration Plumber Owner IV. Type of POWTS System. Check all that a pply) .Non - Pressurized 1n -Ground ❑ Mound 2:24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized in-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter 9 Recirculating Synthetic Media Filter ping Chamber ❑ Drip Line Travel less Pipe ❑ Other (explain) /� A 6-2 - eZ F/ 64-4) upi I V. DispenaVrreatment Area Information: ) Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation VI. Tank Info Capacity in Total I Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units �/� Constructed Glass Q _ New Existing �Y �_ /W' 7, s Teaks Tanks Oak Sepdc f or Holdia Tank s �. /Gel' Aerobic Treatment Unk , 5 Dosing Chamber - VII. Responsibility Statement - 1, the andersig ed, assume responsibility for la the POWTS shown on the attached plans. 5+ 5 Plum ber's Name (Print) '40 Pl ignature PRS Num Business Phone Number Plumbers Address (stmt, City, S zip Code VIII. an /D artment Use Onl Approved ❑ Disapproved ) Permit Fee (includes Groundwater Date ! ued wing Ag Signs ps) urc h� ) v ❑ Owner Given Reason for Denial S Fce 2 S 6 IX. Conditions of Approval/Reasons for Disapproval „ p Lut 2 �X I Sh`n fJrS+� wci( he cvud,t� wk'�h'`} ��C9ry" U - / /�`� A1tach complete plans (t0 the C a a for the systepl as rep tkaa g t� is ¢ X ae� 3 SBD -6398 (R. 08/02) �' /C C / / (N / ✓ Y� .Ov T S--?- Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of 3 Division of Safety and Buildings in accordance with Co 8 5,_W Attach complrate site plan on paper not less than 8 1/2 x 11 inc K�� � County st include, but not limited to: vertical and horizontal referen point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and to tion and distance g ry�(t roa Please print all informat n. MAY u Lu Revi ed by Date �7 Personal information you provide may be used for secondary pu oses 'qv �6b4 1�(m)). lC� �/` �3 � Property Owner ZONINU on i� S w 1/4 N �'1 /4 S )8 T G v N R l E (or )& Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# S l eoUK -' [ y u- State Zip Code Phone Number ❑ City E] Village 'Town Nearest Road n-LS w� s Z (��) �1ZS - 13 y 1zl>vQ10- lclu )j!C ' SS" ❑ New Construction Use: Residential / Number of bedrooms Code derived design flow rate l`! GPD ® Replacement ❑ Public or commercial - Describe: Parent material Lp mac, �� u f bv� )-� Flood Plain elevation if applicable ft General comments I and recommendations: -)ttt� 4 + � �� mac ,- t' T"D t�1 0 J. �' N L s , a Boring # ❑ Boring ® Pit Ground surface elev. 98-O ft. Depth to limiting factor > 80 — in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I 'Eff#2 1 0 -1Z \ © l- � \Z. — SO Z'�ShVL m44 � Z v� • S `� 2 1Z 3$ !vy�Zalb sit Z vn s, bk Y'v) Cs - •S -B 3 SO � 1 �cs�kvr S 6b-go p sg m 1 – -Z t. Z F Boring # - ❑ Boring s ` r Pit Ground surface elev. �1 $ ' Q ft. Depth to limiting factor 7 2 P 9 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 i 0 -k3 - -%N M c+'3 2v'p .5 Z . 1 -4 t' 1 Sj 1 I ?- Ig Yq �j- CvJ _ .•S g Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mgPL -- CST Name (Please Print) SignaUjre CST Number Arthur L Wegerer :3_�7 220254 Address N e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Main St. River F311s, WI 54022 L1 715 -425 -0165 Property Owner w �-! A h S Parcel ID # 0 Z Z -( USC) - Y �)- O O O Page Z of .3 Boring it ❑ Boring ® pit Ground surface elev. 3 - ft. Depth to limiting factor } 8� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 I c- t0 3/ i k M -'� c s Zvi -S , 8 k �- C .1 3 Zy -41 - 7.s4e3/y - s 1 esb�c L 1 )Vj ^,r w IZ_LLr Cj�),JgVTta Boring # [] Boring ® pit Ground surface elev. 1- S ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth 1 Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 a_�3 1D4 Ci,� Z 13 ZZ l0`�2 3/` S ' Z`rs b ►� `�- Cw - s g -� zz -�3 7 3��F -- s I 1 � S bh � � �. cw -- , � • b L/ 16`12 VA Borin g Boring ❑ F-1 g El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 i E > < Effluent - > - nt #1 BOD 30 _ 220 mg /L and TSS 30 < _ 150 mg/L Effluent #2 - BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 - 264 -8777. seas»o tn.6/00l PLOT PLAN Paa 3 of e 3 Scale 1' =�0' 3 Z I -- � tU \ 8 . v J 98 ` L / a �oz 9 g �p LS B• 3 Lp' ✓ ' °Z d 3 715 -425 -0165 220254 -p CST Signature Date Telephone I-To. CST No. Job NO. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of s Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County C: ST'- ° ulI ' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. OZ Z - 1 OSO — 4 b -OOP Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 1 rL�, W LLL1F\ �-q Geyb S\,Q 1/4 N X1/4 S ) T Zg N R 1 $` E per (or W Proty Owner's Mailing Address Lot # I Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ['Town Nearest Rf Ztiu�yz \- S w� s�f0Z- (1lS) �1ZS -Z3-7 Y �'�- ��v�1Ck11j)v 1 Sg ❑ New Construction Use: Eg Residential / Number of bedrooms Code derived design flow rate Ll 5 GPD ® Replacement ❑ Public or commercial - Describe: Parent material L—. ) E3S /-R Flood Plain elevation if applicable ft General comments i and recommendations: in t S� . Z 2 5 0 LF� C ✓=�S pig LET 2 y " L t~ Pfd 0E-- LPLS Boring # ❑ Boring ® Pit Ground surface elev. 96-O ft. Depth to limiting factor g O in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o - \o`-� \Z 3/ — S) I Z+a m'�r �w Z Vi • S • 6 Z 14 -- S1 1 Z bk '� C S - • S - 8 3 $SO �.Sy23l� l s \CS dw 4 -7 Sy23lY _ `S�s� \C-Sb rnV l- CI) S 66 z9 o - 7 S11 ¢ 3ly< ! s o gg m 1 - •Z 1, Z -- - F Boring # -❑ Boring ® pit Ground surface elev. c 1 $ • O ft. Depth to limiting factor 7 O L 2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z.. 1 -4 t 0`�R316 Sj 1 Z Sbk vn ... CVj Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L ,- CST Name (Please Prins) Sigma re CST Number Arthur' 'L: 'Wegerer `220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 16- 421 N. Mai.n'St. River Falls, WI 54022 �) -� -0� 715 -425 -0165 Property Owner \'Aj M'� S Parcel ID # 0 Z Z — y ' 00 o Page Z of ^ a Boring # ❑ Boring ® Pit Ground surface elev. 10 - S - O ft. Depth to limiting factor 7 tgg in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 zv .S , 8 z, g -Zy• ioK 2.316 — s l ( Z'P� b k �-�. � w - . s , � 3 Zy -y( �,sye3ey� — s i 1 esbk, m y �- C•S - • y - b t,J - IZ I `f -1LA,'Tta3 Boring # ❑ Boring ® Pit Ground surface elev. y - S ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 a_\3 IDLI .3l2 Z 13 -ZZ 10`1fZ- 31L S Z S 3 ?-z -q3 7 sti2 3ty Vh v `fy. cw • y F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.6/00) PLOT PLAN Page j of Scale 1' = 4- 3Z U V \ v J ZD 98 � rf he S v� • loZ 9p g•� E►y JH y CeLLs PrT B• 3 3w1 Z Ll ACS P- 3 , t-I - - -- o 7Mp c ��c`T2iC_ -° - - -- a►^'► tf'_� -_ =: - -fit, __ 9.9.: 1'_�-_�s -1--------- L �• ° _d 3 715 - 425 -0165 220254 ^— a,ti+•.1 -a z CST Signature Date Telephone I•To. CST No. Job NO. ST. CROIX COUNTY = WISCONSIN ZONING OFFICE ° 7 ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road E OS N CONTROL PLAN —Replacement of Existing Septic *bt�Ml 54016 -7710 (715) 386 -4680 • Fax (715) 386 -4686 For 351 County T. H. SS (Kinnickinnic ) — owner(s) Dale Williams Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." The Owner is responsible for notifying all contractors performing construction on this site that an Erosion Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The main source for construction site runoff will be excavation for the septic system and any soil stockpiled until final grading and stabilization of the replacement system is complete. Excavation during installation causes temporary disturbance, but erosion can be limited by applying seed and mulch or erosion control matting as recommended in #5. Primary effort must be to contain contaminated runoff on the owner's property. 2. Route contaminated runoff into vegetated areas by creating temporary diversions graded ALONG CONTOUR between construction activity and any drainage ditches or waterways. Maintain existing vegetation between potential receiving waters and exposed soil from excavation. The proposed replacement conventional system will be approx. 30 ft. from C.T.H. SS ditch to the west of the proposed system, so effective containment is essential until site can be stabilized. 3. If builder /excavator grades the site to create temporary berms (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of silt fence MAY not be necessary. Silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with the berms and vegetative buffers. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must use only one driveway access off town road that is properly stabilized for heavy equipment; this helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. This includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. 5. Stabilize new topsoil cover on septic system with seed and mulch immediately after installation — do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather does not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and, if installed properly, will provide protection even if seed germination is delayed. A detail for Temporary Diversions is attached. Please feel free to contact me with questions or to request assistance with erosion & sediment contro lation. Pamela Quinn, Soil Erosion Inspector #6650 GC %riles, Owner acknowledgement of ESC Plan requirements: / /2003 y PLOT PLAL Paae of Scale 1' =70' �- * ,� CNyus �a,,tJ A (� �J 5 � \4 5 -11 lot U � N 98 6 tIV k jk,"* %4 0 iL:;- C -s A:� /\ G � oZ � � g•1 v" \ y C�11S 4 t/, fu Ft, Fz Flow G1,, l �$ _- _L:s ., 100 , O+J Top cp E7-gr izl C - Pik Ie 1j; diet, 5 L �• 3 715- 425 -0165 220254 �-� O3 �7 PLOT PLAN Paae j of � Scale 1' =ZO' � li LWOt IV v a z 1 98 t 0 �o 9p 4 B Y!A$4 :L'C. I Do, or J -M p cam' Et_�C`iiz �.f � -0 3 715- 425 -0165 2202 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AQREBMWT AND OWNIMSHIP CPRTIFICATION FORM Own uycr r-- Mailing Address Pro" Address <L U 0 S (Veaficatioa troqumd frost Phaaiog Dot for aew coastcuctioa) s �- Pazoci Idcatiftcatiou Numbs l��'� 10 �'D -�f,�''dm I DES C 1'lON pery Locatioa Pro i <. Ys, Soc. T �N�t l� W. Towa of It All y Sub&isioa tot # - . Cadffi samy Man # values volum Page # SPOrf h0=0 p )Q no Lot lives idafifisbia El yes p. Do � Inadkwr�. aa,Ct35e� ��'' aa c�oo�ylfiroadodb� ►otocnsodt?,ar�ntl . st �kas.. :strge�ntba:w�sted�o�t� . , , • agaaxb sabaat<tb St C � ootr ?aacr� Mfificltiftfban. bytbaowue =dby -a vo ssmp�ap�opc�oai (4 at=amd �( �6ieen�6ci�asoc�ecdi�wsalsystrxa p (¢=O*cgk .&- cisics dmW fiII"ate- �adtoeshore ��0i� '�'°�'��bY�afOomem�eeoeaadQ�e t0�m�at5epcira >l�ie=dod�ds �� � baeam �Ioodmmibc000q�T ,dodaadr�aoaoredb StQrc QvccCamilY7aaiaig4ffmc f �j DATE �%iTCAT� (w'e) descaMed that all t�ctaxoo�s oa this fom sac tare to ft best of mY (our) Imwwl asst (are) tha owaa(s) of aborc, by vime of wamaq deed tcooi&d is of Doody Dace SIGMTME OFAPPEVArir DATE ssss�t � � that is mis- tr;per�eagtodnky i,�t iu Qrc aoihry peaanit bciog mvo1� ssss.s ss by � lvtdnQc �ritbt this aE' a• a doWod was a* dood fives dre Re6der of Doody o of dre d'ioc a SPY oatrwd mvY MV if lc1a+ccac is tnadc is dre wacnaty deed System Management Plan / Pu�isuant to Comm 83.54, Nis.Adm. Code Sectic Tank 'The septic tank shaiTbe maintained by an indrriduai certified to service septic tanks under s. 281.48. State. The contents of the septic tank shall be disposed of in acwirdance wdh NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter siia!! be assessed at feast once even 3 years by inspection. The outlet filtzr sl.all be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its encw sure. If the filter is equipped with an al ,m , the fitter s.hh be serviced if the alarm is activated continuously. Inlen ddent filter alarms may indicate surge flows or an impeni tg continuous alarm. The septic tank shall have its contents removed when the volume of sludge and sr,u m in the tank exceeds 113 the liquid volume of the tank, if the contents of the tank are not removed at the time of a td@nntal assessment, ns rtee p sha0 ve the owner of when the next service needs to be performed to maintain less than maximum srrm and sludge accs ersonnel steal s a a dvi the tank. The addition of biological or chemical additives to enhance septic tank perfomr�rmce is generally not required lj4"VSG if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and t3wldings division. Pumo Tank "The Pump (fig) tank shall be inspected at least once every 3 years. Ali Vm1ches, atartr>s, and pumps shall be tested to ! * Proper operation. If an efltuent Star Is installed wart time tank A shall be inspected and savkxd as necessary- At- Component and Pressure Distribution S stem No.trees.or s ru s s oul be planted or allowed to grow on the component. Plantings may be made around the perimeter and the component shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the component is not allowed. Cold weather install- ations require the component to be heavily mulched for frost protection. Influent quality into the at -grade system may not exceed 220mg /L BODS, 150 mg /L TSS and 30 mg /L FOG. Influent flow may not exceed the mazimirm design flow specified is the permit for this installation. The pressure distribution system is provided with a Rushing point at the end of eaci laterd, and I Is re=zWnded that each iaterd be flushed of accumuleted solids at Wad once 18 months. When a p comtrared 10 the mat test when the system was installed to determine I orifice c!ag� test and Q�cs be is required to maintain equal disc udon uri m the dispersal cell. Observation pipes within the dispersal cell shall be for effluent ponding. Ponding levels should be reported to the owner and any levels above 4 inches considered' as an impending hydraulic failure requiring additional, more frequent monitoring in accordance with-Comm 83.52 (2). General 'FfiTs system shall be operated i accordance with Comm '82-84 Ris.Adm.Code and shall be maintained is accordance with it!s component manual SBD 10570 P (B.6 /99)'and.local and state rules pertaining to system maintenance and maintenance reporting.. No one should ever enter a septic or pump tank Since Pump tank abandonment shag be In accordance with dangerous Comm 83.33 quo may Cod Present e Septic and POWTS components• longer used as Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be seated watertight upon the completion of servi ce. -Any o pening deemed ° defective. or subje a to failure must be replaced. Exposed access openings greater avert s- inches in diameter shat be Secured by an effective locking device 10 prevent accidental or unauttatmd entry into a tank or a =VmenL If lute SO* tank or arty Of Its components becoome defective the Vistem-In Proper aP condition. tank or component shalt be repaired or Tepi d to keep the ' ii6 ' ^9 tank PAP, pump controls, alarm of related Wft becomes defective the defective component shall be' &ttrrtuxiia* feP*ad or replaced with a cymponent of the same or equal Qom. - If the at -grade compoaent; to accept �srastewati�r'a'r began - ta discharge va stewater to the ground $=face, it may be necessary to, install as aerobic pre - treatment unit or .replace the component. Additional site and soil evaluations may need to be done and additional plans may to be prepared and approved by the Department of Commerce,. Safety and Buildings Division. . Questions -about the operation or maintenance of this system should �be dire - tied to: - The County ` ; .Zoning Office at _��S - Z 6 PLC- 's f,6w; _?? - 6 - 99 go The sys tea installer at �5 _ t ZS - a q S$ WIC., The tank manufacturer at _ Fs 00 - 3ZS_$q's %_M The effluent filter' manufacturer at &ky0 - zz1 _ S Z 0_ u g Gout,. S I ' ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 0c, ( 'e residence located at: a/0' %, A %, Sec. �, T N, R / � W, Town of " "4 / St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced '1 1 o-, d 0 Did flow back occur from absorption system? Yes No k (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: 6601') Construction? Prefab Concrete ?c Steel Other Manufacturer (if known): Age of Tank (if known): zu (Signature) /f (Name) Please Print (Title) (License Number) J � (Dat Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Cod e) - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet b ffle) . Name /'Pta 7) Signature 0" MP /MPRS 'a I �( Iq .1J5PAGF 17 609965 DOCUMANT NO. QUIT CLAIM DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI -- RECEIVED FOR RECORD 09-07 -1999 2:00 PM Lavern A. Williams and Raymond A. Williams, as tenants in common an undivided one -half interest each, quit - claims to the Dale R. (WIT CLAIM DEED Williams and Marcia L. Williams Family Trust, Lavern A. Williams and EXEMPT R 16 Raymond A. Williams, Co- Trustees, having full power to sell and CERT COPY FEE encumber, the following described real estate in St. Croix county, COPY FEE: state of Wisconsin: TRANSFER FEE: RECORDING FEE: 14.00 See attached Exhibit "A" for real estate description. PAGES: 3 . . . . . . . . . . . . . . . . . . . . . . NAME AND RETURN ADDRESS Leo A. Beskar, Attorney RODLI, BESKAR, BOLES & KRUEGER, S.C. 219 North Main Street, P. O. Box 138 River Falls, WI 54022 1.8.28. 18.2:�5A; 1 &-24—.44,4 1 6 6B; 3 6 ..2-8-: �9- 3-2.5 Parcel identification Number PIN OQ.� -(OSo -UO -tlo0 .A 7(P- 3o 000 Oa? 9f 1hio is not homestead property. Dated this 1st day of July, 1999. (SEAL) /` ✓ 'f �- �- � (SEAL) X LaVern A. Williams 1 A (SEAL) I �"� �- Y ��+^ (SEAL) Raymond #A. Williams AUTHENTICATION ACKNOWLEDGMENT Signatures of Lavern A. Williams and STATE OF WISCONSIN 1 S6 a and A. Williams COUNTY ) aut e i ted th's lst d of July, 1 Personally came before me this day of 19_ t)e above named to me known to be the persons) who executed the foregoing instrument and acknowledge the same. Leo A. Beaker TITLEt MEMBER STATE BAR OF WISCONSIN (If not authorized by 5706.06, Wis. State.) THIS INSTRUMENT WAS DRAFTED BY, Notary Public County, Wis. Leo A. a skar, Attorney My commission is permanent. I not, expiration date: RODLI, BESKAR, BOLES & KRUEGER, S.C. 219 North Main Street, P. O. Box 138 ) River Falls, WI 54022 V 18 EXHIBIT "A" PART OF THE SOUTHWEST QUARTER OF THE NORTHEAST QUARTER (SW 114 OF NE 1/4) OF SECTION EIGHTEEN (18), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST LYING SOUTH AND EAST OF COUNTY TRUNK HIGHWAY "SS" EXCEPT Commencing at the South Quarter corner of said Section 18; thence North 180.9 feet; thence N3005'E 1898.1 feet; thence N25 0 ME 1234.0 feet to place of beginning; thence N250 O'E 184.3 feet; thence at right angles 564050'E 50.0 feet to Southeasterly line of County Trunk Highway "SS "; thence N25010'E on said right -of -way line 196.74 feet; thence Northeasterly on said Southeasterly right -of -way line on curve concave Southeasterly, chord bearing N59022'E 557.03 feet to East line of said Southwest Quarter of Northeast Quarter; thence S 1013'W on said East line 566.3 feet; thence S86030'W 675.86 feet to place of beginning. St. Croix County, Wisconsin. AND; PART OF THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER (NE 1/4 OF SE 1/4) OF SECTION THIRTY SIX (36), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE NINETEEN (19) WEST, IN CITY OF RIVER FALLS, DESCRIBED AS FOLLOWS: Commencing at NE corner of said NE 1/4 of SE 1/4; thence West on North line of said NE 1/4 of SE 1/4 723.5 feet to West right -of -way line of State Trunk Highway "35 "; thence South on said West line 448.0 feet; thence East on said right -of -way line 22.0 feet; thence South on said right -of -way line 103.5 feet; thence West 155.70 feet to point of beginning; thence South parallel to said right -of -way line 76.10 feet; thence West 94.50 feet to East line of a Town Road; thence N3023'E on said East line 76.20 feet; thence East 90.0 feet to point of beginning. Subject to an easement for travel over the North 15.0 feet of the above described parcel. Together with an easement for driveway purposes across the Northerly 10.0 feet of the parcel immediately adjacent to the above described parcel on the South. AND; A parcel of land located in the NE 1/4 of SE 1/4 of Section 36- 28 -19, described as follows: From the NE corner of said NE 1/4 of SE 1/4 go W a distance of 723.5 feet along the N line of said NE 1/4 of SE 1/4, thence S along the W right of way line of State Trunk Highway "35 ", a distance of 448.0 feet, thence E a distance of 22.0 feet, thence S along said right of way a distance of 103.5 feet, thence W a distance of 155.7 feet, thence South 76.10 feet parallel with said right of way to the point of beginning of the parcel to be described; thence continue South 75.90 feet parallel with said right of way, thence W 98.70 feet; thence NO3 023 76.10 feet; thence East 94.50 feet to the point of beginning, being subject to easement over the Northerly 10 feet thereof for purposes of ingress and egress. Subject to a 5 foot wide easement across the South side of the property as described above, for the purposes of erecting a privacy fence. AND; r W.1455PAGE 19 That part of the West One -Half (W %:) of the Southeast Quarter (SE 1/4) of Section 18, Township 28 North, Range 18 West lying East of County Highway SS, all located in St. Croix County, Wisconsin, consisting of approximately 71 acres, more or less. EXCEPT; The Southwest 1/4 of the Southeast 1/4, all lying East of County Trunk Highway SS, Section 18 -28- 18 as located in St. Croix County, Wisconsin. Parcel #: 022- 1050 -40 -000 03/27/2006 03:41 PM PAGE 1 OF 1 Alt. Parcel M 18.28.18.275A 022 - TOWN OF KINNICKINNIC Current l ixt 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 DALE R & MARCIA L TR WILLIAMS O - WILLIAMS, DALE R & MARCIA L TR 351 CTY RD SS RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 351 CTY RD SS SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 14.000 Plat: N/A -NOT AVAILABLE SEC 18 T28N R18W SW NE E OF ROAD EXC Block/Condo Bldg: P275C Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 09/07/1999 609965 1455/17 QC 09/07/1999 609963 1455/13 QC 2005 SUMMARY Bill M Fair Market Value: Assessed with: 143485 Use Value Assessment Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 80,000 194,000 274,000 NO AGRICULTURAL G4 4.000 600 0 600 NO AGRICULTURAL FOREST G5M 5.000 12,500 0 12,500 NO Totals for 2005: General Property 14.000 93,100 194,000 287,100 Woodland 0.000 0 0 Totals for 2004: General Property 14.000 53,100 141,100 194,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 218 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 JJ / •/ AS BUILT SANITARY SYSTEM REPORT 'WNER (�� W/ i , TOWNSHIP l� SEC. T N, R W ..0. ADDRESS ST. ,CROIXCOUNTY, WISCONSIN. UBDIVISION , LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM � fof e� 1PTIC TANK(S) IRM MFGR. L bey n CONCRETE CV STEEL NO. of rings on cover Depth DRY WELL aENCHES NO. of width length area 'D no. of lines width lengt are depth to top of pipe y " 1GREGATE j� ARK RATE AREA REQUIRED{/_ AREA'AS BUILT S :sciaimer: The inspection of this system by St. Croix County does not imply complete , with State Administrative Codes. There are other areas that it is not possible : inspect at this point of construction. St. Croix County assumes no liability for -*stem operation. However, if failure is noted the County will make every effort to 2termine cause of failure. :EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. INSPECTOR DATED p / - � •, 7� PLUMBER ON JOB LICENSE NUMBER t e z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM Y Sanitaxy Pexmit ZzZ State Septic _3Z 1 NAME , (,kl Towna h� p ✓ S Cxoi x County �. Location LkA o6 XJ� - 4 , Sec s an_I�f_N, R W . SEPTIC TANK SizeI e4umbet o6 Compaxtmenta Distance Pxom: Web �j 6t. 12� on gxea�ex b�ap�it BuiZding 6t. We.t.Canda it. Highwaten it. DISPOSAL SYSTEM ,, / Distance Fxam: WetZ A/I it. 12% an gxea.tex stopedb�. Building _ it. Wet.2and6 �— F t. Highwatex -- bt. FIELD DIMENSIONS: W.Ld #h o6 txench it. Depth o6 tcock be.2ow tite � in. Length o4 each Zine 5t. Depth aj nock ovetc tite i n. Numbex, o6 tines � Depth of t.i,.2e be.2ow gxadel!Lin. TotaZ .2engxh of tineb it. Stope of ttcench in pet% 100 it. Distance between .roes t. Depth to bedxock ��. Totat abd oxbtion anea t t Depth to gnaundwatex fit. Requixed axea it 2 PIT DIMENSIONS: i Numbers of pits GxaveZ axound pitzs yes no Outside diametex Depth below inlet it. 2 Total ab s oxbtio ax it z Axea xeq %ed it rn INSPECTED BY TITL Z APPROVED ,DATE 197 �. REJECTED ,DATE 197 4 1 �1t�7�✓ 7 . i J 6� EH 115 W ISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 - ^ REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: SW ' /4, 6r_-' /a, Section I , TZ- R g ez-09; W, Township oc;M ti. ei P&N y V_ I " ��- Lot No. Block No. County ✓Y ` , � Subdivision Name Owner's Name: V\t tt- I A hti S Mailing Address: ZaV '« Z. , Z tZe.. W % S TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 4 - ( PERCOLATION TESTS �" 7- 7 � SOIL MAP SHEET I — CO�" SOIL TYPE N G-s 6y! La °`T^ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P- 35o - r.s . g� s I Z8 Zq. Na 30 3 3'/8 ;0 10 P- Z 3!p Ts Ia "� s Zfe" Z� No 30 Z� /g Z' /% Z' /g LO I P- 3 31�, Ts 9 s z7 Z4 Nn 30 Z 7k, SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B _ l - 72- L3C>L 7 "72 " `T. s, - 1 S I too y 5 5'• $ - Z 7¢ Noljff 7 74- T. S • ti - g 34." sl wiil, vol• l:¢4G. lG" S 11 B- 3 _7Z ►Jove 7 - 7Z` T.S. �" ; s I /�7► °: j , s 1o s;/ 37" 13 - 4 ?Z IDoi.sa > '°7Z" °►. S 5 I So" /3" B - S 73 Qou19 7 - !3" --r.s, to" SI 3( s 7 -7" 7Z NoPt; - 7Z" to" t* fib s/ wiA Pol. AA6 io - 3 5 ZZ" PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale o nces. Give horizontal and vertical reference points. Indicate slope. C At,,L 1" = 100 4. 4 X94E 1-0 b, 1 Y .� F+ @7 l ad it, 1 L FIC NN t / N C. V S ► N � F' O Z B P z o s / b PC esT 6L. S ' �; Co D Z I V 50 Y L i N I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. p Name (print) JAMES L le. ow; Certification No. S S' S ZZ Address 1603 �74,Lt.S, �/l(�s. S4'z> Z z- Name of installer if known CST Signature COPY A —LOCAL AUTHORITY ____ 1 State and County State Permit LB 67 Permit Application Cou C ounty Perm for Private Domestic Sewage Systems Count y -, *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: j j tV N. %, Section , T 2 N, R 1!!!!F=) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family �/� Duplex No. of Bedrooms No. of Persons •5 D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES - 190 # of Bathrooms A, Automatic Washer - -- YES NO Other (specify) E. SEPTIC TANK CAPACITY /8B© Total gallons No. of tanks / *Holding tank capacity Total gallons No. of tanks New Installation A- Addition _ Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) Z& 2► - /a - 3) _Total Absorb Area sq. ft. New_ Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length 'S'S Width 19 h Dept Tile Depth � No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified oil Tester, NAME J. S6 C.S.T. # and other information obtained from o - 3 (owner). Plumber's Signature MP /� vq Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). icAAE F %�d,A • i ��•-z S E � , i F E l 3 3 t } /� 1 . t-' t. .. —.. i i F E E N � o eyr ►d ! I L 1718)15- tnxv Do Not Write in Space Below FOR DEPARTMENT USE ONLY O Date of Application - - Fees Paid: State /L � ,- Co n y �� Date - Permit Issued /Rejected (date) - ��d Issuing Agent Name Inspection Ye4te No Valid# Date Recd 1. county ( copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 I 'i ~ � i �)l_ •. \: 4 -�� '� � -fit �• /�� .�� e♦ .� a� \ '' t