Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
022-1061-70-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 1. INSPECTION REPORT Sanitary Permit No: 538715 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: Novak, Chadd & Tania I Kinnickinnic, Town of 022 - 1061 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range/Map No: GST 21.28.18.P333B1 TANK INFORMATION I / ELEVATION DATA TYPE MANUFACTURER / CAPACITY STATION BS HI FS ELEV. Septic , q•5 Benchmark 3 3'X 1 0 3.3 /to Der it g S2 Alt. BM 40 � Goy 2.9 ioo. 5�� Aeration Bldg. Sewer 7• g J Holding St/Ht Inlet _ g, l R5. St/Ht Outlet TANK SETBACK INFORMATION \ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet t `` We s el - ' Septic 66 A4 (10 1 — Dt Bottom / 9` 7 Dosing O / / _ Header /Man. ,7 9 (ci. 6o? Aeration Dist. Pipe Holding Bot. System 7, 1o9 Final Grade PUMP /SIPHON INFORMATION - Z , , Manufacturer Demand St Co er GPM �� CpJ Z,• /Go Model Number TDH Lift Friction Loss System Head H Ft Forcemain Length i Dia. , i Dist. to WeI 35 z N SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tre nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth _ DIMENSIONS 2 a 3 —/ SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: Z INFORMATION CHAMBER OR Type Of System, UNIT // l N t7� 5 4 a � UNIT Model Number: Co ✓� tJP� v DISTRIBUTION SYSTEM e5f- Header/Manifold 7 r Distribution x Hole Size x Hole Spacing Ve" Air Intake � 3 t� Pipe(s) I ✓ Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only a Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges \ Topsoil es 0 No Yes No .v \ COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1186 River Rd wer Falls, WI 54022 (NE 1/4 SE 114 21 T28N R1 8W) NA L t 1 Parcel No: 21.28.18.P333B1 1.) Alt BM Description = �`�� Go�� C�, k - 2.) Bldg sewer length = �� - amount of cover = t ^ r Plan revision Required? Yes F01 No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. r commerce .Wl.gov Safety and Buildings Division Count 1 201 W. Washington Ave., P.O. Box 7162 G t a( S V O n S I n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 111111 L7 C� 715 Sanitary Permit Application to Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropna menta /V unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned PO Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be u ed for secondary u oses in accordance with the Privacy Law, s. 15.04 1 m , Slats. r 1 I. Application Information - Please Pri ll Infor 1A Property Owner's Name Parcel # C, htij N / 00gP _ _ 0 _ 0 0 0 OZtZ Property Owner's Mailing ,At�ddress OC� � Property Location '333 iS 1 F 1 ® f3t/ UW' Govt. Lot rr. City, State Zip e � iG , s �- 1 J, N1NG d /� /., —_� /., Section t d elf Q l S ��(�„ 7 7/ circle on II. Type of Building (check all that apply) 0 � a0 Lot T �� N; R � E o� C�11 or 2 Family Dwelling — Number of Bedrooms Subdivision Name k0i I q ,1 Block # ' S I'N ❑ Public /Commercial - Describe Use t/► ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of p 4 � ,J 4 7f �TOWn of O fS 3 �` �,.�• S S�-�- EZ Rio �5.�3 " °` �J lA/YY1 t wo III. Type of Permit: (Check finly one box on line A. Complete line B if applicable) A* New System ,� y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that appl A Non- Pressurized In- Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatinent Area Information: Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Requi (sf) Dispersal Area P- 76d (st) System Elevation S VI. ank Info Capacity in Total # of Manufacturer Gallons Gallons Units c d New Tanks Existing Tanks l 7 w c CL. v in H h 'w C7 a Septic or Holding Tank 1 O D O Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsib'lity for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu er's Signature MP /MPRS Number Business Phone Number 6 ! to c9o�d t� 4951 Plumber's Address (Street, City, Stag �ip Cod ) 0 0 �-e- z VIII. Count /De artment Use Onl Approved ❑ Disa Permit Fee Date I ued Issuin nt Signatu Owne en Reason fo nial 7s ,o fo IX. C!onditi9qqpWMpMkjtpasons for Disapproval I . Septic tank, effluent filter and dispersal cell must all be services / main taine as per management plan provided by plumber. 2:_ 499 aback requitements must be maintained Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 Inches in size SBD -6398 (R. 02/09) Valid thru 02/11 Vi rer- 5e�� f ` 40 A � \everl f T• ee �► LT pr t a LOJ" S e 7 re r - _ 6 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: C � (� 0 032 4 k Owner's Name: Owner's Address: Legal Description: � _o� 6 Township: County: 5 �. ( 'v Q t 4 Subdivision Name: Lot Number: Parcel ID Number: Q 22 —1 61 _ 26 _ ® 06 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross - Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenanc Form Page 8 Warranty Deed Page 9 CSM or Plat At chments: Soil Test & House Plans Designer /Plumber: , License Number: ��G Ss� 9 U Date: Phone Number Signature Designed pursuant to the In- Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (N.01/01). Page 1 SGa4� 4 0 1:2 Ov A . ��� PorjrloK p o a�uc L r QrGQo,c� t�rt�� flLT RY L a, n eT -r-rS i tmr-� wil Flo w.$ 0 �pq� � �L.100•A8 v� o a � e� ire �.. ,e `rte wf pinit EZ ►��' IYC►+clt Fc.gS.S x,417 o N ll) O C, C7 d C) �O M M co LO CO co CD O Cl LL7 Z Z N W Lu LLI W_ Z C n J W Z C= � 0- xo m °v O a_ uj CD co J Z W CO r N C� m LO Z ® O o O �u c� =O L Z N F— J � Q ,'" I ♦ �1I1111111111IDllllllll99l1 '11!11I111IIII1 ! I I ll i l li ll i lllllllllllli I IIIIII,,;" - I I muuurual, uarn,, nuu „uw�noouunn��lououuu,!u,a�l� I IIII 1111111 .II �, ;I �II'1 III II '� — II �� ” 'ill II IIII II' ,I I Ii IIi � II � /! lillllllll611111d166111�61JdIIIddVIddIVVVIIVII�VIIIIIIIIIIVV11611611111111111VIVVIIVIIId1611111iIIIIIIIIIVIdIIIIIIIVIdd1llllihl111 ,l , 01 10' lilll! IIIIIIIIIIII1111111111119III1111IIIIIIIIIIIIIIIPIIIIIIIIIII�1111111111111111111111 '19111OIIPII 111111 'IIIIIIIIIIIIIIIIIII'IIDI II I! VIII!I' Ill' 19' I' I' PI' I' IIIIIIiII' I' IIIIIIIIIIIIIIIIIII 'I'I'I'I'I!I! III'I' Ill'I'IIII11111�������PI'I' Ill'I'I'I' Ill' I' I! 19' ��� !IIIII'I'I'111 III'I'ili'l 1'1'1'1 I I I I'I' Ill' I 'I'1199 1 1 1'1'1'1 l l' %i I� �IIIIIIIIII�IIIIIIIIIII�II�II illl�lll�ll��ll�ll{ Illl�llllllllll�lllllll�lllll�l�lll �IIIIIIIIIII! Ill�illl�ll�il��llllllllllllll��l�llllllllil�llli�lllllll�l�lllil�lllllll�Illllll���l�� �lllllll�l�l�ld� — ��I IO' IIIIIIIIIPI' 111111111111RIIIIIIIIIIIIIIII' I111IIIIII1111IIIII© IIIIIIIIIIIIIIIIIIIII111IIJ II' III0111IIIIIIIIl9 'IIIIIIII'lIIIIII'II�'Ii �"' 19411991' 14 199' I! I !1 I I IIII!IIIII'l lll'IIRIIIIIIIIIIPI I'IIIIIIIIIIII I'lll'I'lll'I I!I!IIIIIIIIIIIIIIIII'I'I' 19111 19 !I!11 lllli!I'llllllkl!I!III 1 lI �l'y_ — IIII117ddtl19IId�IlUlIIIIIII !IdIIIP i66111 � � I � �I � I � I i — Ill ' 4161 IIIIIIdIIllllil161LIIlIIllllillllllllllf6lllllldlh IIIIIIiIIIIIIIIIIIIl1661161i1iV66h166661illlll Iv' ���I IIII�QIIIIi [llllllul'lu s � -- !!\ /11��1 �IlJll III�I� III�616 1!IIIIII�II 61 �illli I I II IIIIII II I �I l l III I'I I I I I �` ,IIII�IIII IIII IIII 1111, ,I II 1 I � I; � I 1 III I � IIII I I� 1 111 I'_ II��I IIIIiIIII111'y" I I I I I �j II I II � I' � I � I I '� III II I l i II I 11) I 1 III I �Il�% ° III_ l9llllwl66ii6lil�i� iilll I lq' ►► 111 I I' I �I ai �I i�•�111'�I I lil. I I i!1111 ���� // // ' ��i /� v wo vvvvvvvvvvvvv�avyvyy��►vv»vvv ' frG, l,� f'G ,rl,,,' 111 n l j; � � � / i , / • . llllllllllllllll �lll�illlllllll�lll � � �': � _ ,,,� l lllllllllllllillllllllllll < ,, i i, /, � � �, ' ��� /�l �� � � ' /' %�i ll � j j % /,� / /� // �� 1, � • — If U NMI/' /1 / I r ) ll r U ( l � Aw�`�AOAV \VVVAAVVVO�w������o. ll�lllllllllill�lllllllllllllllllllllllllll� � ,';��r -I - r � � I I 'I'���� �IhI 'IVII'I II.II I ! �I'���� X11► ,�I - I ��i IIlii, „i�l il�l II � IIII �' 11111 !Il�il�ililll!!IIIIIIIIIIi Il�lll��l�llii�lil��ll�lllll�l�ll��luiiiii�� «��III �I �I�'ll illiliumuruiumniiuunarrnmurimoouairrruu i /IIIIIIV611VIIIVVIII IIV6VI III'I�IIIIIII!IIIII�IIIIIIIII Illlllllllil IIIIIIIII I Idllllllll IIIIIIIIIIIIIIIIIII I! I! IIIIIIII' IPII6lllllllllhlll�llllll�lllll '16111II16111�h66VIIIddJ lllldillllllldd1116hId11166V6i� �! i �I II'I'I!I!IIIII!III'I'I I III'I�I!III I'II'I'lll'I'I'I I'PI I I'll'I'lll!IIIII!I'lllll IIIII'IIllil'I'I'I'lll''I�I III lil'I'I I'lll�l lll9�llllll 'll1 I I'IIII'I�IIIIIII III!III'lll'I'I'I I'I'I'I'I Iilll'I'I�IIIIIII � / III�III�IIJ' I'' IhIdIJIIIIIIdllllllllll�lllI I I ' , , I ' II Ii � I Q VIII I I I Idd 1166h1 II I6VIIIIII III�IIIIII IIIJIId 111611JJ�6611111I I IddJ l I IddJdJ VIII I IJdIIIhh111611I IJ I IIIIIIIIIddII IdJ IIIJIIJ I6i� E] : �I IIIIII'lll!lilll'I'I'l l IIIII'hl'I I'I'I!I!I!I�lil l'I'I'I'I'I'I'I'I!I! III' I! I'IIIIIIIIPI!I!I!Illllilli!I!I' 111 'I'IIIIIII'PIIIIIIIIIII!III IIIIIIIIIII�( IIIIII !IIPI!RIIIIIIIII'I'l'PI' f IIIIIII!II III'' I' I' II' I' I' I' I'I'NI!I'lil'1`I'Ifl'I'I'i �, 1�,61dIh1166V61,UIIVI_ IIIIIIIIIII_,; IIIII6101III' �IIId�b6ld�liIIIIIIIIfiIiIII�iilll�l lull liliw °"I''' lll' 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner G�.a. 0Ja Septic Tank Capacity �Q ga l ❑ NA Permit # Septic Tank Manufacturer �rG ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 16 jr _ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model S ❑ NA Number of Public Facility Units `ANA Pump Tank Capacity ga l )IWA Estimated flow (average) gal /day Pump Tank Manufacturer N Design flow (peak), (Estimated x 1.5) �j gal /day Pump Manufacturer NPIA Soil Application Rate , gal /day /ftz Pump Model A Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 3 jA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter. ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD,) :_30 mg /L �n-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in di ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA years) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ onth(s) (Maximum 3 years) ❑ NA year(sll Clean effluent filter At least once every: ❑ onth(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or.more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but, not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be'provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page ° of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up'shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name s ` Name Phone 5 149Z-5:92 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY E me Name G I one Phone 7/ _ This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the, treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up'shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology holding tank may be installed gy g y sta ed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name a. ' Name Phone 5 - - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name G ' Phone Phone 745 ., This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Oct -19 -2010 01:59 PM St. Crcix County Plan /Zon ng 715 - 386 -4686 111 ST. CROIX COUNTY SEPTIC TANK MAINTIrNANCC AGR1 AND OWNERSHIP CERTIFICATION FORM 01v11e1. /Buyer __C.hadd M, lUb Mailing Address _ O aq ? ( I , I (VL ,T Li b.1 d, Property Address // 8'(o j Z 2 f4 /!S Cv r S L l Ud (Verification m1tilred from Planning & Zoning Department for new construction,) City /State ytr wrlS. Parcel Identification Number Od,) - / 6/ - — 06V LEGAL DESOMPTION Property Location JVL-_ '/q . _ '/q .Sec. I , T �$ N R l J W, Town of / i j * j 191 Subdivision Plat: , Lot # �. Certified Survey Map # 3 S a l� , Volume y , Page # 9 '9 Warranty Deed # (before 2007)Volunne i , Page # Spec house yes no Lot lines idenliliabia yes : no SYSTEM MAINTENANCE AND OWNER CERT EZCATI N Improper use and maintenance of your septic system could result in ite premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by it licensed pumper. What you put into the system can affect the fttnction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities arc specified in §Conant. 83.52(l) 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, sinned by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on -site wastewater disposal system is in proper operating condition and /ar (2) after inspection and pumping (if necessary). the septic lank iv less than P3 flit) orsludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, us set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certifioation 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 al statements on this form are true to the best of my /our knowledge. I /we artnfare the owner(s) of the property described above, virtue of a warranty deed recorded in Register of Deeds Ofce. Nu 0 ' edvoom /0 SIGNATURE OF APPLICANTS) 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 referetnce is made in the warranty deed. (REV. 08/05) 8008183 State Bar of Wisconsin Form I -2003 i TX :4006335 WARRANTY DEED 923382 2 Dcwument Number j Document Name BETH PABST REGISTER OF [SEEDS ST. CROrX Co., YVI RECEIVED FOR RECORD THIS DEED, made between Randy R. Rudesill, David P. Rudesill and 09/27 3:20 PM Mark _W. - - -- - - - - - -- ------ -_ -_ -- -- - � EXEMPT #: N/A - - - -- ---------------- REC FEE: 30.0 ( "Grantor - ," whether one or more), and Chadd -- E. No - a nd -- Tania - - - - - fiA. Novak - , - ht: and j, TRANS FEE. 90.00 and wife as survivorship marital p rope rt�i _— _ —___ -- -- - i �! PAGES: 3 ( "Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real ( Recording Area estate, together with the rents, profits, fixtures and other appurtenant interesrs in r 3 Name and Return Address St. Cr Count n " State of Wisconsin (" Prope r t y " ) if more , .,c- is Y. ( Pe _ ) ( 1 I � Leo A. Beskar needed. please attach a idendui I j Rodli. Reskar. Krtier 8 Pletchor S.L. Lot one ill of CertiTr d 5.; cry icial. ❑t JOiunln "roof i4i of Clmbud Sufvey iNidps. Page a39, as I i L "I J tva'n to iL1:,;1; i • fiJ EGZ Document number 366213, filed in St. Croix County Register of Deeds office on July 18, 1980, beu,g (� Ri Falls, WI 54012 located In the Northeast Quarter of the Southeast Quarter (NE 114 of SE 114) of Section Twenty One - ---- -- - - -- - (21), Township Twenty Eight (28) North, Range Eighteen (18) West, Town of Kirnickinnic. 022,1061 -70 -000 Subjeci to River [rive right of way. --- _ -. _ -- Parcel Identification Number (PIN) The grantors have the option to reacquire this property for a period of six (6) months from the date of 'fhis is not homestead property. closing as per the terms outlined in the original purchase agreement between the parties, dated (is) (is not) August 19, 2010. i,rantcr warfanrs that the title to the Property ►s good, indefeasible, in fee simple and free %nu cleei of encumbrances eft e ;N" resemeMb. ratio itAiosss and rights -of -way of record; :f arty - Dated - - -- - - - -- (SEAL) - - -- (SEAL; * - - -- - -- - -- -- -- - *Ran R. desill - :__ _— - - -- (SEAL) (SEAT.) s * AUTHENTICATION ACKNOWLEDGMENT Signature(s) - STATE OF authenticated an _ - _— —_ COUNTY ) _ Personally came before me on the above - named Ran R. R_ ud esilt TITLE: MEMBER STKFE BAR OF WISCONSIN (If not, _ —__ -- - ---- - - - - -- to jen n to be tc p sons) who executed authorized by Wis. Stat. ' 706.Oo) inst aekn dg d the same. '.•` THIS ; ^:STRUMENT DRAFTED BI': * L - -- LeU A , ,.l t:�l(sf.0 - - -- - - - - - -- - -- -- -- - --_--- - - - - -- rata. Publ.c.:)ldic of - - - • f - l - -_ 1 - = �D Rod eske Kru`r gef & Pletcher. S.C. .,__ ; _ -_ _ My cominiss!oo ( -ppen l.anentl (expire::: f (Signatures may may be authenticated or acknowledged bwa : r%• not uurwsary) ,Q NOTE: THIS IS A STANDARD FORM ANY MODIFICATION TO THIS F( M `.t1GLr D BE CLEAki 1' el)F.N `tlwt • ' da WARRANTY DEED (x32003 STATE '6A(t OF WI.SC ON O N tic3W3 "Type name below signMaires. l�!FO•PRO" Le> 1 Forms • (80.;655-20[ s i-f ^ {`.'cY_.':ixom Warranty Deed PIN: 022-1061-70-000 Date: (Jr� David P. Rudesill STATE 4-6� ) ss. COUNTY ) Persona ly came before me this �S day of 2010, the above named David P. Rudesill to me known to be the person(s) who executed the instrument and acknowledge the same. My commission expires: la - 69 , 201A i . + f =r Warranty Deed PIN: 022-1061-70-000 Date: zo f ZI - yv- ark W. Rudesi 1 STATE OF )g j 8(b05W * ) ) ) ss. lkay, COUNTY ) Personally came before me this day of - � b-rksr - 2010, the above named Mark W. Rudesill to me known to'ue the pqn {s) who executed the instrument and nol he same. t . w; r . E11eX�a�1 My commission expires: n W; 289•"75'" /„��° 1 e Indicates 1 iron pipe found. �,�,/ 1 o Indicates 1" x 24" iron pipe weigh - ing 1.13 lbs /ft. set. Y' !' 0 DESCRIPTION; That certain parcel of land located in v N the Northeast 1/4 of the Southeast 1/4 I I�!nn' 1 � A of Section 21, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described IV Hk I as follows; e l U Commencing at the East 1/4 corner of said 8 `( Section 21, thence S 00° 00' 00" E (assumed bearing) along the East line of the Southeast 1/4 of said Section 21, I 981.45' to the POINT OF BEGINNING of the parcel to be herein described; thence continue on said line S 00 00' 00" E 322-75'; thence N 880 30' 35" W 105+.84' ; 0 thence N 00° 31' 35" W 322 .75'; thence 0 I s 88° 30' 35" E 10 57.80' to the POINT OF BEGINNING, containing 7.83 acres \ more or less, being subject to easement over'the Southerly and Easterly 33' there of I of for Town Road purposes. (I' 0 U U 0 f rte �•-.�,�� �`.-q s' r � /v,� p.c u � C I U ,A I'f State of Wisconsin) J County of Pierce) S CD O° '_z=yT %E ZE . 7•S I, .lames L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the I Owner, Wayne Rudesill, I have surveyed and O divided the lands shown hereon in accordance with official records, Chapter 236 of Wisconsin Statutes and the Ordinances of St. Croix County; and that the above map and description are a O V true and correct representation thereof. � o N \13 James L. Murphy ��`✓ •.� Re§issttered Land Surve ,��QMtS L. e. APPROVED _ 1 MURPHY S 1042 �n f z8J '7'S' I JUL 16 X980 RIVER FALLS, ' i CC 0 -=3 ' �S W �3zz. � • N1ISC. /V D �a<o i t/T Vol. _ Page 959 Sr- CROIX COUNTY fSQ� • 0:4-i "'"Vi PARKS PLAn:,. - oii� Wig �• Certified Survey Maps �ru;� ,,� AN7 tommo COMMITyEs St. Cr oix County, Wisconsin Wisconsin Department of Commerce SOIL EVALUATION REPORTS J NLJIF� ]Rge -l—of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ Attach complete site plan on paper not less than 812 x 11 Inches in Wze. Plan must S r include, but not United 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. — 00 O Please print all Information Ravi ad by Date Pon mmal IMonnedon you provide may be u ey La s. 15.04 (1) (m)). P M PrcpeRylocation Govt. Lot iV lE 1/4 S.5 114 T,? 8 N R 1 E (orG Property Owner's Mailing Address Lot # Block # Subd Name or CSM# Q X 1 RO)X COUNTY I 3 a V 9� RoddJ City _ { f State Zip Cod PL�plpq(gi r� G ❑ City ❑ Village (4 Town Nearest l �wlir d 2 , 7 �v & New Construction Use: ❑ Residential /Number of bedrooms Code derived design now rate f OD GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 0 l., '7. i o. s Flood Plain elevation if applicable 119 tt General comments and recommendations: P r I l C 1 Lam{ —GD — 7�✓YP. /� Boring # ❑ Boring J O ® pit Ground surface elev. S ft. Depth to limiting factor In. Soil iicadon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0✓ 3 1 o z 2 -44 1 vVie 4 / ! h - AS It IQ S 10 1 44 -�D i 5 S. 4 ,/040 41< Z G •- .S o . If ®Boring # ° Boring ,r � pit Ground surface elev. 0 ©. � ft. Depth to limiting factor 7 10 0 in. Soli Apolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I - Eff#2 2 , s 48-4 — m i GS ur' 0 • E. #1 = BOD > 30 220 mg/L and TSS >30 < 150 m • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L. CST rn ' lease M t) I CST Number OSS Address h Date Evaluad Conducted Telephone Number o ra' -� -l6 s/ 44,5? Qs9' Property owner Neva k _ Parcel to # Page . -of ❑ Bo nrtg Baring # ;g� / S In �M pit Ground surface elev. - h. Depth to IhdUng factor � _ SW Appilcation PAM ! Horizon CepM Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots OPCMf In. Munsell Qu. Sz. Cons Color Gr. Sz. Sh. 'E11A11 p -► o )s m 1 Di, �m 40 0 4 — s l aI S t p O C r 4� �a Ks -- 3 ' il< m r CS Iv Ds 0, 4 .4 s *d1 I ❑ Boring 0 C] Boring ' Cl Pit Ground surface alay. _ fl. Depth to limiting factor In. Solt Application Rate Homan Cepth Dominant Coi Redox Description Texture Structure Consistence Boundary Roots GPD/if in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - EK#2 i 1 i � ' i ! Being it F ❑1 Pit Boring lJ Ground surface elev. -- -• _ —_ -- ft. Depth to limiting factor ln. on Rite Horizon Depth Dominant 6k4 Redox Description Texture Structure Consistence Boundary Roots GPOIN In. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. - Effiii 'Eff#2 a- ' Effluent iii : SOD, > 30:E 220 mglL and TSS >30:5 150 mg1L ' Effluent #2 = 800,:S 30 mgfL and TSS 130 mgli. The Departmant 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. SRC-4330t"001 OM Ptvpsrty owner Ol s yak Parcel ID 1 0 6 1^ 70 -00 Page — 2-oaf 5 Boring . a; Borkq # C3 y Pit Ground Surface elev. _ n. Depth to l"ng factor In Soil Apol iCatlon Rate I Horizon Cepth Daminent Color Redox Description Texture Struck" Consistence Boundary Roots OPCIff In. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. -E"I OEM m 4 1 G 0 4 -il in J 14- 5 lJl M C S I VT 0 R� s vn 0 . Sodng �d 1 i 1 f.J Plt Ground surface ofay. _ ft. Depth to limiting factor_ _ in. Sop Rate Horizon Cepth Dominant Co! Redox Descrption Texture Structure Consistence Boundary Roots GPDHf in. arise 4 M ii u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i I I i f t � ❑ Scdng Al ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in, Sod Rate Horizon Depth Dominant Colod Redox Description Texture Stricture Consistence Boundary Roots GP60 In. Munson Ou. Sz. Cant Color Gr. Sz. Sh. 'EW 'E1f#2 { Effluent #1 = SOD, > 30 <_ 220 nxYL and TSS >30:5 150 mgfL ' Effluent #2 = SOD, 1 30 mg1L and TSS 130 mg(L The Dep artment of Commerce is an equal opportunity service provider and employer. if you need as si s tance to access services or P 9 PP Y need material in an alternate format, please contact the department at 608.266 -3151 or TTY 608 -264 -8777. SHC•�]]0 (R.bo9I G�ai�►k NcutK Sc� e 1 Parc�l'�o�a -►a6�- �o -odo PL 07 PLN P3o� 5 fj ke wx r�bboN �l: �0►.8 �� 82 E i, l oo, 5 � %� �` f4 0 4 , 5 Ael F1,1 00, 5 ,QU3 w Trtt I I I) sl ST CROIX COUNTY JLA "Am PLAN NING & ZONING EROSION & SEDIMENT CONTROL PLAN Site location: 1186 River Rd, lot], Town of Kinnickinnic Owner(s): Chadd & Tania Novak Parcel ID #21.28.18.P333B1 Code Administ 715- 386 -4680 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." In Land Informatio addition, Wisconsin Uniform Dwelling Code Comm. 21.125 requires the building permit Planning applicant and /or landowner to follow erosion control procedures and maintain them until 715 - 386 -4674 the site has been stabilized (Uniform Dwelling Code Comm 21 is available on -line at: www. commerce. state. wi .us /SB /SB- DivCodesListing.html) Real Property 715 - 386 -4677 The Owner of the above parcel is responsible for notification of all contractors performing construction activities on this site that an Erosion & Sediment Control Plan is in effect and the Recycling following activities will be required in order to maintain compliance with the plan: 715 -386- 1. Maintain existing vegetation wherever possible to minimize erosion and sediment movement. The primary source for construction site runoff will be the house foundation and driveway excavation, well drilling, and soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #5 below. 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and /or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Do not allow contaminated runoff to be directed onto neighboring property or into surface water conveyances. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. (A specification sheet for temporary diversions is available from county). 4. It is likely that contaminated runoff will not be contained with temporary diversions, so installation of approved sediment control products (straw wattles, silt fence, etc.) as shown on engineer's site plan will be required. The POWTS inspector and /or building inspector will evaluate ESC plan effectiveness and recommend additional action required to comply with applicable regulations. Control measures should be installed prior to mound plowing. ST. CRO1X COUNTY GOVERNMENT CENTER 110 1 CARMICHAEL ROAD, HUDSON, W1 54016 715.3864686 FAx PZ0CO3SA /NT -CR01X W1. US WWW.CO.SAINT-CROIX.WI.US Page Two – ESC Plan Acknowledgement Form 5. bilize exposed soils (septic system included) with seed and mulch immediately after installation - DO OT wait for final stabilization and/or landscaping of entire site to establish permanent cover on the site. late- season weather conditions will not permit seed germination, a heavy straw mulch cover will pre erosion until vegetation can be established. Erosion control matting can be applied any time of year and talled properly, will provide protection even if seed germination is delayed. The owner rd during site construction will be responsible for compliance with state and county code requirement pecified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions I regarding ero & sediment control product installation. PLAN PREPA BY: RYAN YARRINGTON, SOIL EROSION INSPECTOR #683475 Owner ack °wiled ement of ESC Plan requirements: — (Please and return original ESC form to Planning & Zoning Dept. A copy is attached to the owner's permit and Mai ance agreement, which is given to the plumber at time of permit issuance.) ovide copies for excavation contractor, plumber, and town building inspector as needed Sr . CROIX COUNTY GOVERNMENT CENTER 1 101 CARM/CHAEL ROAD, HUDSON W/ 54016 715386 -4686 FAX PZ@CO.SA /NT- CRO /X. W/. US W W W. CO. SAI NT-C R OIX W I. U S o cn 0 !ad o C = �f � v1 M .. n y ic m t O ° L N= p {, y n o A O 0 co b to y�0'lo v D - a it CO 3 ° °o ° O <,� L O N N C pi ° N O O N ICI N M C ! CD 0 I = O 1 a v CL OOOm "Ode m CD r* c 3 ? n Oro O O CD 0 .. e Z 0 Q DM Z 0 c O o (DC (D y y �• CD (D o A CD °r a n °- DD CD H �'' li 3 0 3 T = VD y N T O it A Z_ ID 3 a A Z o c m ' Z w ao CY� CD ° Z CD a C d� :3 to p c Z w � D m a a yc° m - CD T CL 5 C G'S °-' S - y�'m o a Fr a y a N - ASD �O ° O 0 CD CD Q. �.. o 3 CD ti °—' c o v a CD o c I 'b m 1 p 0 [n O ti w ° o CD ti Parcel #: 022- 1061 - 70-000 01/04/2007 12:53 PM PAGE 1 OF 1 Alt: Parcel #: 21.28.18.P333131 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner RANDY R & DAVID & MARK RUDESILL O - RUDESILL, RANDY R & DAVID & MARK 1844 WISCONSIN RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH // Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE SEC 21 T28N R18W 2A IN NE SE LOT 1 OF Block/Condo Bldg: CSM VOL 4/959 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 06/05/2003 724493 2264/21 QC 2006 SUMMARY Bill M Fair Market Value: Assessed with: 179180 54,200 Valuations: st Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 50,000 0 50,000 NO Totals for 2006: General Property 2.000 50,000 0 50,000 Woodland 0.000 0 0 Totals for 2005: General Property 2.000 50,000 0 50,000 Woodland 0.000 0 0 Lottery Credit: Claim Count 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 E M 11 5 Rev. 9/78 S '� E CATION TEST WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 I v Vo (�lJ LOCATION: .' 5 C % <, Section ZI ,T �BN,R 151*#W, Township ap MwAffiaipgi4y. lIr—.1 NN le— IL,IIJIJI C Lot No. , Block No. C 1 S 1 M I County ST` Cleo ( X � Owner's %$arName: �� htYWC6 h" o075 -S I vL .L_ N ame Mailing Address: TC- Z— �tJ�K �Z l 'J tlL i W TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS — 7 — 1 1— 19 PERCOLATION TESTS N Tits �,►,� - SANg � pl L SOIL MAP SHEET 0 3 NAME OF SOIL MAP UNIT 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 AFTEF INTERVAL MIN /IN BER • 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- IN lO G Z <>r A"T' 6. P- - TS Z . D t 1 t.1 t o v ✓L 3 m i " 10 IM - N 1 1.1 L, 9- e_ 2 0 L-- Ki - T o A;>, P- L A S C �j o , fL %'V L_ V rJ ITS P - Ak L'V_ O E- T G . P_ --, SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- z N0NC' -7 2 B I- o o ti►L 7 7 - „ B- Z DNL 7 ']Z, B- 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 or distances. Give horizontal and vertical reference points. Indicate slope. ' . W - r op op 0'1 NIL Lac �1.AL_� 1 Z('tdl A13 ., 7 . 2e ffC S k s y 4 � t t 3 _ ► � L 3_0 _ a Itkh1��1 hilt, r A H/ I, the undersigend, 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. Name (print) L.Q C- 'e ' '� C� �r' Y Certification No. �S' — �¢¢S Address .Name of installer if known � Copy A —Local Authority CST re I C , E M 115 R.11. 9178 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION �E /< G %a, Section ;;:F ,T_42 ,R� (or) W, Township or- Mijn+eipafitp �������� Lot No. E , Block No. -" ' County u (vision ame Owner's %Buyers Name: C i �� �" f/L Mailing Add ress - E i4 ✓.4 / 4- - 13 TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS - 7'— // PERCOLATION TEST _7, r SOIL MAP SHEET NAME OF SOIL MAP UNIT LQA AA/ Fr. 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 BOLE AFTEF INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P— G>L T % ow /� UGT� G 4 P— P— P_ SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 13- 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 or distances. Give horizontal and vertical reference points. Indicate slope. -... to a vw N Fi i I , �- € . d i ,.. N € a dd_ $ .._ �__ � __� w_ -_. � __ - �a _ . _ � �. � .,� *� T% � .. N. i a 1 ' . s f 7 E t I I b Q/c� 6v' •r' I, the undersigend, 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. Name (print) G lU�`"� Certification No. Address -ei L�a� _ �7 .`°i yE /� �.�GL r �i /_� ���Z Z .Name of installer if known 2f Copy A —Local Authority CST, Qq FILED (� • JUL - 1 919 8() w t MAIS of CONNELL R"w.r of Reeds t' FA C Comfy, 9 CERTIFIED SURVEY MAP TO/y� .EaO••4 G7 WAYNE RUDESILL Part of the Northeast 1/4 of the South- east 1/4 of Section 21, Township 28 North, Range 18 West, Town of Kinnic- III Soo 00 "<>c:> kinnic, St. Croix County, Wisconsin. � m �� 2 a✓:3.75'' /, • Indicates 1" iron pipe found. {� `� Q �✓h� o Indicates 1" x 24" iron pipe weigh- ing 1.13 lbs /ft. set. V1 N N °�O DESCRIPTION• {� r o 0 o� . A � I � That certain parcel of land located in u NN the Northeast 1/4 of the Southeast 1/4 of Section 21, Township 28 North, Range op 18 West, Town of Kinnickinnic, St. Croix � l ry �' I1 t o0 N n� I V V County, Wisconsin, more fully described O �' �� I as follows; {` I Y Commencing at the East 1/4 corner of said 8 u � Section 21, thence S 00 00' 00" E V/ --�sOO°�� "�5 �2Z'75" I Q (assumed bearing) along the East line p, of the Southeast 1/4 of said Section 21, � = L l C 981.45' to the POINT OF BEGINNING of O I the parcel to be herein described; thence continue on said line S 00 00' 00" E 322-75'; thence N 88° 30' 35" W 1054.84 thence N 00° 31' 35" W 322 .75'; thence 0 ° N , S 88 30' 35" E 1057.80' to the POINT OF BEGINNING, containing 7.83 acres, \ I more or less, being subject to easement r over'the Southerly and Easterly 33 there- of for Town Road purposes. y O O P 0 -�'- N o mho I (D o ° I �( I State of Wisconsin) County of Pierce) S 00 �i "_=6 zsr -E 3 I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the \, Owner, Wayne Rudesill, I have surveyed and I divided the lands shown hereon in accordance with official records, Chapter 236 of Wisconsin Statutes and the Ordinances of St. Croix County. I III I W O and that the above map and description are a O i true and correct representation thereof. `` ` ���itl�ii 111t1tNIiII11 f�Y! }yY James L. Murphy ` V; ✓ ••? fill N o Red tered Land Surve ma x• JA MS L. y N r4PPROVED �' MURPHY 1042 \; JUL V C i RIVER FALLS, Z8� `75' ,t I I��V �J►� WISC. �l IV � Vol. _ Page 9S9 LAND Co �',�° "'Pi;" NSIYZ PARKS PLAN:,ri6 Certified Survey Maps AND Z ONING CQMMIIT[G ��,,,,,,���` St. Croix County, Wisconsin 4W