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HomeMy WebLinkAbout022-1060-50-100 0 fA Q! $ •L n C j_ O V� l 3 A 1 3 r. 0 S A,s 3 N W_ N eC 3 v_ 7 N N hr W O d� p 3 O O R O C D A 3 7c' p d pp � rn �• rn O• C W o . C) m o -4 o Q N Oro C O 43'0 W 3 3 cn cn O p d /5 u D G 3 A � Co A O G N N d CA W cr O Z ()1 O N O C O 0 N N G O O O C N a N CL "ft O O O n i < -'z aQ o D 0 Z 3 Z O w N m p D 3 - 0 (D O 3 N m y !�1 • ID C) O a C (yM� m = c ci m �1 m m 3 co4 0 � n � v0@ °c n co 3 A z o CD 9 a G7 o3 co cn O �p O ? m Z --I N 03 M N C G O � a � Q A z � 0 t °< m o m � I -o a ' a A p� CD a CD CL o y o � ^ w c I 3 ?� W 0 0 t , N � n 4 (D O o n 3 N b y N O O W �O I A 0 N O O CD < y^Q p o F b O N O e Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division � INSPECTION REPORT Sanitary Permit No: 487904 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)j. Permit Holder's Name: Village X Township Parcel Tax No: City Williams, Jon & Susan Kinnickinnic, Town of 022 - 1060 -50 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: a ' 5 4-a — z l'!'1 I 21.28.18.3278 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 �l l � � �' / 2 x-71 Benchmark Dosing h /a / / _ Alt. BM � � 1 � 0 3 . R Bldg. Sewer SUH Inlet Z t Ou tlet ' TANK SETBACK INFORMATION — 3$ TANK TO Py WELL BLDG. ent to it Intake ROAD Dt Inlet Septic > �i > 1+6 /fit � Dt Bottom ' V Header /Man. ., s'� - s 9 Aeration , Dist. Pipe Z q• b E �� Holding B stem l ot. S ID• 9S. Q1C Final Grade _� PUMP /SIPHON INFORMATION l!� Manufacturer Demand St Cover GPM -� Gdn Model Number TDH Lift Friction Los Sys te TDH Ft Forcemain Length Dia. I Dist. to Well SOIL ABSORPTION SYSTEM z BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f n y SETBACK SYSTEM TO Iv P/ BLDG WELL AK STREAM EACHI G Manufa urer. INFORMATION CHAMBER O Type System: U Model Number. ���w sb S �' � 7S DIS IBUTION SYSTEM JoH eader/yanifold IDistributi on x Hole Size x Hole Spacing ent to Air Intake /L/ Pipe(s) t (r �l / �I G�� 3 — __ ength Dia Lengt Dia 4 Spacing C� J C� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only (- Depth Over r / Depth Over xx Depth of xx Seeded / Sodded xx Mulc e Bed/Trench Center / — Bed/Trench Edges Topsoil L Yes No Lj Yes 1] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Z / �) Inspection #2: Location: 263 Liberty Road River Falls, WI 54022 (NW 1/4 SW 1/4 21 T28N R18W) NA Lot 1 Q Parcel No: 21.28.18.327B 1.) Alt BM Description = Sn Covi�� v SLR c S �- 2.) Bldg sewer length - amount of cover Plan revision Required? J Yes � No Use other side for additional information. (� G(L�1�1"' II Date Insepctors ignature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave. O. Box 7162 �o t \ Visconsirn Madison, WI 537 71 tary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3 4F7746 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, perso may be used for secondary purposes Privacy L w, sl RE MOVED Project Address (if different than mailing address) I. Application Information - Please Print All Information S E P 2 7 2 005 Z_(, - 1 �' J_ e L. �o ' perry Owner's Name Parcel k Lot N lock # l � t T. CROIX COUNTY a Property Owner's Ma iling Ad ress Property Location 6 ( e IV �• �(JLJ 1 A,1TJ0 1 A,Section p� / City, tate (� Zip Cod Phone Number p l v c �76 n )) jdO /a �� T 0 N; R l� E o ) •5Z -7 H. Type of Building (check all that apply) ;!�-i or 2 Family Dwelling - Number of Bedrooms ���- Subdivision Name Q SM Number ❑ Public /Commercial - Describe Use - C� ❑ State Owned - Describe Use ❑City_ ❑Village MT tlship o� 1 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New System " Placement System y p y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS S stem: (Check all that ap I ply) 1k Non - Pressurized In- Gro und ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wedand ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter I) , ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip 4ine ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: tl P C S =� r MaAhe es Design Flo ) Design Soil Appli_ canon Rate(gpdsf) Dispersal Area Required (s Dispersal A a Propos t) �evation �_� p lam 65 �l pi 9 . VI. Tank Info Capacity in Total Number Manufactur r Prefab Site Steel Fiber Plastic Gallons Gallons of Units q-146 46 P /ter I �oncrete Constructed Glass New Existing > Tanks Tanks Septic or Holding Tank i, l �► is Aerobic Treatment Unit 1� Y Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) Plu Signa cure MP /MPRS Number Business Phone Number Plumber's Address (Street , Ciry, S te, Zip Code) If A VIII. Count partment Use Onl Approved sappr Sanitary Permit Fee (includes Groundwater Dat Issu Issuing ent Si re o Stain ) Surcharge Fee) 6 rven Reaso enial IX. Conditions of Approval /Reasons for Disapproval \ t3 o4 5 j 6�,X 5 Ps�-k SYSTEM OWNER: I. `Septic: tw*. etlktettt filter artd dispersal cell must all be Services / rr okfined \ ' as,per mWqpmWt plan provided by pitxnber. J a����; �je� +�W�� Z AM sefback requirements must be maintained a C i cJ L acs per q*§* le code / ordirmrtcea. �Je� �.� u' � Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) Po Scale 1' K4jk) k:n eC oui 263 Lt8�2`n r a P �6 9 9 ab Iz-M � 4Zt u1 _ 1 4, y 'Di r�.'rz. g �ertl� j hod e z lob, , 5yJ Ste -- I t:: .` \r1 R O F � f 715- 425 -0165 220254 CST Signature Date Telephone No. CST Ado. Job P10: Scale 1' Leo �'' �iCli4lu K� *At e nji (C ' tov P h , Y at cwt NN �Ec t . 1 I ,. 'Vi-E ' .off z�RJ -i KIZ � 'dew I �aov a� SQP� ►C w ?�b�( s - � JDp x; lfet� �► tieS W lb Q ::0Q . 3U'T�Dr'1 -, OF..S 1 b)AlS__L \,r1 � 715- 425-0165 220254 CST Signature Date Telephone No. CST No. Job NO. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ` of DNision of Safety and Buildings 2$. 1. 3Z —T in accordance with Comm 85, Wis. Adm. Code 21 ' ._ County ��-� • C�Z.O �� 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. 1 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Z Z —) O �_ cj p .• Please print all information Revi wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). . ZS 2 Property Owner Property Location _ t Gpvl:-tot• �� 1/4 1/4 S T N R 1� E (01 W' Property Owner's Mailing Address Loot # Block # I Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ErTown Nearest Road TZI cLS w( Sgozz ( ) 1- �t� JJ 1 C- Lj�'JM C ❑ New Construction Use: Q Residential / Number of bedrooms Code derived design flow rate p —� �' UU G D [ZReplacement ❑ Public or commercial - Describe: Parent material L g 6 fl -( - O V Flood Plain elevation if applicable ft. General comments and recommendations: 3 ' x (o UU ) OF ))U Fj(_ 2 L " '\�1A 0 113N s' a u�wM 0>_- LZLLS Boring # ❑ Boring Cock .� tyl 7 2Cb -� ® pit Ground surface elev. 03. 0 ft. Depth to limiting factor 2' yb in. 1 Soil Application Rate +L 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 1 o -1S D') 'Z sl sbk Q Cw 1= .s Z 1C - �l ��� lZ 313 — s • ? Z`~�'S h � � �-- t� ti.J — , � � i� bo -10 l0`1�2 VA - S O S9 M I — •1 �, Z © Boring # Boring ® pit Ground surface elev. �� 0 fL Depth to limiting factor 1 �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. St •Eff#1 - Eff#2 Z lb -6o Io�� 33 c1'j _ ,S 9 0 S GG o • 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 Print) ignature CST Number Arthur L. Wegerer 0- - \ S �J' 220254 Address I7 e g e r e r Soil T e sting & Design Service Date Evaluation conducted Telephone Number 421 N. Hain St. River Falls, U1 54022 03 715 -425 -0165 r Property Owner t u— L f S Parcel ID # U ZZ ID "S u — Q Page of 3 a Boring # ❑ Boring Pit Ground surface elev. �� 0 ft. Depth to limiting factor 0 i3 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 1 0 -f 1 ujvL3 l Z S ) I Z`F3 cw l� .S -8 tb `Z 1 -3'7 - z .S `l 1S des yGZ m `PY c • - 3 37�1of3 toY2s�6 — S 0 S9 vn 1 — ,-7 1. 2 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. Si. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 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 r P 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. r SBD -8330 (R.6/00) Property Owner L L L f S Parcel ID # �D ° O S u — Page of F�S] Boring # ❑ Boring ��3- 0 D /- I � N-(1 �ic> 7 � O � ) [$ pit Ground surface elev. (. Dep h 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 1 0 -18 ul1z31Z s Z 1 Lal -) F -1 Boring # E] 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 ❑ 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Mat r F 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.6100) , Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page ' of in accordance with Comm 85, Wis. Adm. Code v Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S�7 • C Z 0 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. O Z b Q_ S – l�U 0 Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 75.04 (1) (m)). Property Owner Property location n SCO�� W 1 L.`.1 Gevt: -E0t- S1Q 1/4 N W 1/4 S Z T N R 1 F3 E (o W Property Owner's Mailing Address Lot # Block Subd. Name or CSM# Z 6 3 L.l ��lZ'C� Ilk) � -- — % — Cib State Zip Code Phone Number ❑ City ❑ Village ErTown Nearest Road RA L 2L EMS I wl S -oiz ❑ New Construction Use: [2 Residential / Number of bedrooms �4 Code derived design flow rate �7 pU GPD I� Replacement ❑ Public or commercial - Describe: Parent material Ly tF-%s g A yA� l Prl- C) Q r---j ft N Flood Plain elevation if applicable ft General comments and recommendations: (.° L�LS 1 k;�C!`? 3 '4 6 Z . S Wf v ( I, t// 1 UU l OF IJJ F1C 1 -c,6� � L-2 0 - Y+ i a o)''17)m C)p LLL( F T1 Boring # ❑ Boring ®pit Ground surface elev. [ 03 • 0 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 •Eff #2 I 0 -1S 1 0`1 iZ 31 Z s i l Z`�sb & S C+w �= .-S • 8 'S 6o -10 MIR VA - S O S9 © Boring # ❑ Boring 100.0 > t 08 ® 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. •Etf#1 • 'Effft2 3LZ sl z�'sb cw 1� •s .g io�rz =313 — S w zm 3b`2 -r CL" 3 6o -hS 1A�2 �l6 — S 0 S rr) 1 -- •-� .. : � .P ... ' .Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L • Effluent #2 = BOD 130 � and TSS _< 30 nVIL CST Name (Please Print) < ;t gnature CST Number Arthur L. �Wegerer �. � 1 220254 Address We Date Evaluation Conducted umber e r e r S O' v Telephone it Testin N g � & Design Service p 421 N. Bain St. River Falls, ICI 54022 715 -425 -0165 PLOT PLAN Page 3 of 3 Scale L.' ="�a y �3 1 Zr� tior - ra s � bv2rv��f i �VY-A- S S v ,o 715- 425 -0165 220254 D 3 - ISO CST Signature Date Telephone Igo. CST Igo. Job NO. 7 1 4 1 3 5 VOL 17 PAGE 4480 KATE H. WALSH REGISTER OF DEEDS ST. CROIR CO. MI CERTI FI EM S V RVEY MAP RECEIVED FOR 1 t 30A 03/21/2003 11:30AM LOCATED IN PART OF THE SW1 /4 OF THE NW1 /4 AND IN PART OF RECTFEEt SURVEY THE NW1 /4 OF THE SW1 /4 OF SECTION 21, T28N, R1 8W, TOWN O COPY FEE: 3.00 ICINNICICINNIC, ST. CRODC COUNTY, WISCONSIN. PAGES: 2 PREPARED FOR: SURVEYOR: ° LEIF AND REBECCA ERICKSON THOMAS M. HEALY —NW CORNER OF SECTION 21, T28N, R18W 263 SOUTH LIBERTY ROAD S & N LAND SURVEYING, INC. RIVER FALLS, WI 54022 2920 ENLOE STREET D.O.T. NUMBER 66 -65- 3640 -2003 HUDSON. WI 54016 u+ M.1M � N I M95 ( all PRA r�r mm o z - - — 889 596.09' — — — - I _ z C 1 ` I P310P_ COMBINED CONVEYANCE RESTRICTION ` LOT 1 AND OUTLOT 1 ARE CONSOLIDATED FOR ALL PURPOSES. INCLUDING THOSE w a CD OF ASSESMENT, TAXATION, DEVISE, DESCENT, AND CONVEYANCE: w ` QI BENCHMARK: ALUMINUM DISC ON BRIDGE OVER I Z jr 2 ri x - d100' KINNICKINNIC RIVER I ® ELEVATION-920.3N ? O w ccr c OHWL ELEVATION -916.& I su SILO CORN CRIBS mi 0 00 [� TING DRIVEWAY M _ ^.. Arf ixEq� - S � LOT � kRy HIGH.a y� AREA TO TH LINE INC R/VV Q 1 6.171 ACRES (268,788 SO. FT.) O _CONCRETE .....- .. AREA TO THE MEANDER LINE EXC R/W o[l m V ,"'� @F UDGE r ..i-" 5.849 ACRES (254,780 SO. FT.) ORDINARY HIGH_ — _ . • TOTAL AREA WATER LINE \ I QO 7.0m ACRES C'S I ^ NB3°43'1 i "E 289.13' z - h 1A It z N 33' 1 3 , I ji. ?7. \ 7 ��7 � ' z ° . 'LOT <., L f AREA TO THE M ER LINE INC R/W ` 1.995 ACRES (86,886 SO. FT.) I AREA TO THE MEANDER LINE EXC RtW \ 2 Z"-' ? I I I N88 °58 9 "E 39.11' 1.829 ACRES (79,692 SO. FT.) TOTALAREA \ „ /FOUND REFERENCE 3.0x ACRES MON. 1.7 FEET NORTH w� � / TI IgLCgp OF r iOF THE EAST WEST 1/4 LINE EAST -WEST 1 / 4 THE RIVE - .S00°5362"E 47.81' -WEST LINE O� THE SW 1/4 FENCE ON LINE - 1 379-4630-E 1 / ! -,33.01' - -'' - - - - -- 582.05' -- - - - ='� / N _7 615.06' LQO 4 9 (DIP 6 c� o la O — F-- j 678' ' - t - I ao j NW CORNER OF M OO d 9 9 6 X39 A � CSM VOL.11 PAGE 3132 _ LEGEND \ cc w � ¢ FOUND ALUMINUM ST. CROIX COUNTY SECTION 9, CORNER MONUMENT c� / �� g � �� 0 SET 1" OUTSIDE DIAMETER BY 18" LONG IRON PIPE. N WEIGHING 1.13 LBS. PER LINEAR FOOT 3 z 0 FOUND 1" IRON PIPE ( SW CORNER 1 FOUND 1 1/4 IRON PIPE N OF SECTION . • •• . • • • ROADWAY SETBACK LINE (AS SHOWN) 21, T28N, R18W DSON, � ® EXISTING WELL VVI �Q ® EXISTING BUILDINGS Q 7 --fit- EXISTING FENCE SHEET 1 OF 2 SHEETS Vol. 17 Page 4480 St- Croix County Map Output Page Page 1 of 1 St. Croix County Mappin za �fij� Is�" $� fd Y SW 114-NW 114 SE 114.14411 • SE 114 -NE 114 P� CSM 18• R M n n a Mii i n i o--^pp CSM 17.4480 r LORI R ` a � NE 114 -9N NE 114 -SE 114 LORI NW 14-SW 114 L073 LOR2 7, t RII�tr'i1cIPa1 6oaridabs St Croix County Planning Department Oub dlv&Flo 1101 Carmichael Road C= cerrye a Carver MAPS Hudson, WI 54016 Q Pa Qls Phone: (715) 386 -4674 Pond PAMFo d Drai rirage DISCLAIMER : The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was Dan prepared. It is not intended as a substitute for an accurate field survey. Peg rerdal CM eam r,*rm Ilenl :rear.. AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist presently in the County may not be present in the photos. http://69.58.147.26/ servlet /com.esri.esrimap. Esrimap? ServiceName= StCroixOV &ClientVersi... 1/25/2005 ua• vawa�a vv vi• a a SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer .t Q - t?� L' D 1 `! `C( 0 Mailing Address p o 4 1"'IL 'ej Property Address am e- 1 (Verification required from Planning & Zoning Department for new construction.) City /State l'l�r G�CG Y S�✓t , Parcel Identification Number - 100 LEGAL DESCRIPTION (� Property Location � IJ ' /4 , #10 , Sec. f , T p 0 N R l / P W, Town of Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # �` (d (� , Volume L 1 �� P, Page # 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. um r of be ms ��� SIGNATURE 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) Puesuant to Comm 83.54, tiis.Adm. Code Seodc Tank The septic tank SW be maintained by septic tank shall be ah °� ceedfied to service septic tanks under S. 281.48, State. The contents of the disposed of in ac;ardance w 113, WW Adm. Code. The operating conean of the septic tank and . outlet BRec shall be assessed at least once ever 3 ensure proper operation. The Mier cor5id a g J Y ears by inspe on. The outlet fine: s�,a;l be Ceaneci as necess.r/ to may slough off the Mw when should not be removed unless provisions are made to retain solids in the tank that . the alarm is actdvated continuo ved from its ers�csure. !f the fitter is equipped wets an �. the Star be serviced if sep� tonic shag have as q . Intermittent lifter alarms may inmate stage flows or an hVendlo ous g ca*W aWM The '- the tank. If the nten� removed when the volume of fudge and scum In the tactic exceeds 113 be Uyvid veiume of antents of the tank are not removed at the time of a hdennial assessment, to pal shall advise 0* ae r of w here the next service needs lo be lamed b mairdain dm =in= sc and stn ge won in 1 dut raral Wives to enhance W* tank petbMWIM is genergy not mquhd. Bum Oivisioa they shall be approved for septic tat>!c use by the OeparttneM of Cararterce, Sde1Y and ucrso T ank The Pump ( dosing) tank shall be inspected at least once every 3 years. AU switC' alarms, and pumps shaft be tes*d to !�Y POW fin. p an effluent Mw Is installed wk the fan(c it shop be ictspec:ed at4 serviced as terry. At - g rade Cam onent and Pressure Distribution System 0 -trees .ors s s ou e p sate 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 mainteuance)•ou the component is not allowed. Cold weather install- atioas require the component to be heavily mulched for frost protection. Influent quality into the at -grade system may not exceed 220mg /L BODj, 150 mg /L TSS and mg /L FOG. Influ fo r this ins ant flow may not exceed the ma:imism design flow specified in the permit fo tallation. The Preswim dstribuiian sY- Is provided wft a lateral be Shed of tad so at le ast once 1 at the end of each Pateral, and it is r � that eaCs b the of when a m system W83 W d months. Whets a dogging test is perb=d it should be regttbW b maw �ibufloct Within deterrrurre tl otiflce has and P orifice cleaning is 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 may tem shall be operated im accordance with Cam '82 -84 Qis.Ada.Code and shall be maintained in accordance with it!s component manual SBD 10570- P'(8.6 /99)'and.local and state rules pertaining to system maintenance and maintenance reporting., or pump tank since dangerous No 0 = dKXW ww enter PA M abandoMMd *4 be h gases may that c�dd death. Sepik and FOW M Comp Comm 83.98 Wls. Adm. Code when the tanks ace no bW used as qW*W used S for manFwk . mess risers and covers should be don water tightness std sotrrdness. Axes mo e d. ddSCU , s b std be sealed wad# opoo � 0f . Anyoaf9 deemed 3QMW by an e ve Wring device lo NM or� entry ko a tank 84rdw in d=GW Ad Q�°w'Vft�bink or a of Its Camp onents - •"" �becottse delve the ' t ._ 8,co on. w* or � shy be repaked or ral" to keep the doe Pump mnbcle. alarm or cued widip becomes dt eda the dive l lwwm arraptaced � a c mp nmttaf the ram or agtd perk». 0D�° sheD be the at -grade compoaeat fails to accept iiistewitei'osls'ie 3aa'o' disc rge wastevatei - to the t�ound surface, it may be necessary to install as aerobic pre - treatment unit or 'replace the compoaeat• Additional site and soil* evaluations may need to be done. and additional plsas mar need to be prepared and approved by the Department of Co prerce,• . Safety and buildings Division. . Questions .ibont the operation or maintenance of this system should be dire cte<i to: - �• The CountYAoniag Office at __.`LlS 6 The system.installer at 11.5_ The tank mgaufac rarer a t - 3 2 5_ $ ! • __ _ �s00 gU �, The effluent filter' manufacturer at Y U 2197 P 48`1 716293 STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Leif O. Erickson and Rebecca L. Erickson, 04/08/2003 08 t 25AN husband and wife Grantor, and Jon Scott Williams and Susan Elaine WARRANTY DEED Williams. husband and wife , Grantee. EXEIPT • Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of REC FEE: 11.00 TRANS FEE: 1349.70 Wisconsin (the "Property "): COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Ret Address Jon Scott ms Susan E. i : Mortgage Dept. 263 Li B of River F aft River t Box 166 River Falls, WI 54022 022 - 1060 -50 -000 and 022 1060 95 - C�b� Parcel Identification Number (PIN) This is homestead property. (is) (is not) Lot 1 and Outlot 1 of CSM filed in Volume 17, page 4480, Document No. 714135 being located In part of the SW '/4 of the NW '% and to part of the NW % of the SW '/, of Section 21, T 28 N, R 18 W, Town of Kinnickinnic, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 4th day of Aaril 2003 (SEAL) (SEAL) elf ickson Rebecca L. Erickson (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, WENDY SWAT71NA } as. t s NOT � Y f PUBLIC St. Croix County authenticated EO o TT Personally came before me this 4th day of April 2003 the above named Leif O. Erickson anel, Rebecca L. Erickson to me known to be the perso o executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN i tru nt and ac l ge the same. (If not, authorized by §706.06, Wis. Slats) ` J THIS INSTRUMENT WAS DRAFTED BY Notary Public, Tate of Wisconsin Coldwell Banker Burnet 1301 Coulee Road My commission i pe anent. (If not, state expiration date: Hudson, W 1 54016 2 -50597 l q� 15104 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) Names of rsons 2!2 ning in any CaDaCIN must be typed or printed below their slonature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. PLOT PLAN Pane 3 of 3 Scale 1' =a ' �l Rb zm AMT or - ro 1 ' won? 7 S G� ova s � B:1 ti 6 R . �s 715- 425 -0165 220254 03 — ISO CST Signature Date Telephone No. CST No. Job NO. Parcel #: 022 -1 060 -50 -100 01/25/2005 12:03 PM PAGE 1 OF 1 Alt. Parcel #: 21.28.18.327B 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): * = Current Owner JON S & SUSAN E WILLIAMS ` WILLIAMS, JON S & SUSAN E 263 LIBERTY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 263 LIBERTY RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 10.000 Plat: 1662 -CSM 17 -4480 022 -03 SEC 21 T28N R18W PT SW NW & PT NW SW CSM Block/Condo Bldg: LOT 01 OL 17 -4480 LOT 1 & OL 1 (10 AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21- 28N -18W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 04/08/2003 716293 2197/484 WD 03/21/2003 714135 17/4480 CSM 1018/522 WD 808/327 more 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 12499 427,500 Valuations: Last Changed: 07/01/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.000 100,000 222,000 322,000 NO Totals for 2004: General Property 10.000 100,000 222,000 322,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 136 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00