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HomeMy WebLinkAbout022-1061-95-000 k� (� (?—k V 62 101 R_ I County: Wisconsin Department of Commerc -` PRIVATES WAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 429993 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal irL'ormation 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: Hake, David Kinnickinnic Township 022 - 1061 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: - L Section/Town /Range /Map No: 10 (o /00.0 Ac-&' .vl 21.28.18.P333C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic G _ C s � r Benchmark f / IUD. b Dosing Alt. BM Aeration 11 Bldg. Sewer Holding St/Ht Inlet SVHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septi I Z I Dt Bottom ' Dosin Heade Man. yew- Z J 'a. to . L eration Dist. Pipe r dwdn 1 Holding Bot. System PUMP /SIPHON INFORMATION Final e S �, ��► •8z Manufacturer Demand Std r - ` l GPM tJ Model Number TDH Lift Friction Loss Syste d TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM /p-� /0 NO f BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Insid Dia. Liquid Depth DIMENSIONS 3 too , o j— / — d SETBACK SYSTEM TO �` P/L B DG WELL LAKE /STREAM LEACHING Manufact er/ 15 - 2-11 0710 INFORMATION CHAMBER OR �v� C Typgpf System- ti 4 / UNIT Model Number: n 0 Y DISTRIBUTION SYSTEM d4- ,6. �iy►�., * t to Air Intake Header /Manifold Distribution x le Size x Hole Spacing Ven Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over TBedp/ Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center rench Edges Topsoil - Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 2 t / OP inspection f2: Location: 1180 River Drive River Falls, WI 54022 (NE 1/4 SE 1/4 21 T28N R18W) NA Lot arce 21.28 1.) Alt BM Description = S y b4 2.) Bldg sewer length = 1 r amount 9f cover = g 3 � Its g Plan revision Req r ? 'Yes r i� No �.: � Use other side for ditional information. '5 Z 0� SBD -6710 (R.3/97) Date �Inr's Signatur Cert. No. o aa) ° M ~ 0 c eG m I =, w co S c C I @ m O N O N U p O "t D Z C C C @ V) (n 7 LL c Q N O O S] E a 7 U U N M a V a) m of N co U) O C O 0 � d a) 0 N W a m Z 4 x C o o-0 s N U \ O Z 7 ° c -0 U _ m v o N m O o a) Z c c N Z m c m CL N m C C = N O U p V) • N O. C O O C) w a q- Z z o m i _ 1 O C \ \ N N N 0 0 a s m J� Q O fn fn co 73 co i Z \]' •N @ 0 a a O IL n CL 2 1 1 - E Cl) J Cl) LL ! ° o o O N N Z O O N ` a) O O O i7 _ > 'd Q Z w m re O O C O N N C) U o 00 O �� + o M m 7 m O o y C O C o M ` a) C O N G of O rn o; W -o �: al 0.0 N N C m N O N O a) m U • �V' o c� Y = c o Z! Z Y to • •CC Q a) .V a) .CD C 1 Q 0 a. � i 0 cn U Safety and Buildings Division County A P.O. an 201 W. Washington Ave., Box 7082 5 -F' (-90 ` G Madis r►seonsin on, 53707 - 7082 Sanitary Permit Number (to be filled is by C Department of Commerce (608) 261546 - 1 1 2N 3 Sanitary Permit Application State Plan Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide ' ZA may be used for secondary purposes Privacy Law, s 15.04(1 Xm) Project Addr&s (if if different than mailing address) I. Application Information — Please Print All Inf rm dR E C E I / 1 a o o / " V e D2f Property Owner 'a me ) �j DAU t � /a � /l MAY 1 4 2003 � Parcel a v ,,o - ?S -Ap� Lot t n Block a r/ Cr a a Property Owner's Mailing Address Property Location ST. CROiX COUNTY • 133 ��' City, State G OFFICE %., %' Section l e �' , n Ztp one umberi� 2 n t v - e o- j J �� � � O J �� T d � N� R cE le o ) IL Type of Building (check all that apply) ` /� l or 2 Family Dwelling - Number of Bedrooms W�ZC, fiyty Subdivision Name CSM Number ❑ Pab&Xo.W - Describe use Ti to - ❑ State Owned - Describe Use ❑City ❑Village Wownship of r IIL Type of Permit: ( Cbeck o rte box on omplete line B if applicable) A ❑ New System AReplacenent System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New last Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a pply) 'RJV - Pressurized In - Ground _ ❑ Mound?: 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At Grade ❑ Single Pass Sand Filter ❑ Constructed Wetbnd ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gmv&less Pipe Xod. (ex lain ) P? 6 �/ V. Db reatmeat Area Information: E Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) I Dispersal Area (ad) System Ekvahon�j- jaw 3, VI. Tank Info ity in Total Num Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units A . .- ( (�?� Concrete Constructed Glass New F-isting Tanks asks Septic a Holding Talc Aerobic Tre smeat Usk Dosing Chamber VII. Responsibilit Statement - % the andenkWd assume responsibility for lastallatlanAtAbtfOWTS shown on the attached plans. Plum 's Name (Print) P s M Business Phone Nu �a s � umber's Address (Street, City, Stati,,Eip Code) MOd 9 111, lokey VAY DI -eycW VIII oun /D epartment Use Oal Approved ❑ Disapproved Sanitary Permit Fee includes Groundwater 5bl ing Ag t Si Stamps) ,R ❑ Owner Given Reason for Denial Surcharge Fee) � n `' IX. Conditions �A� vaUReasons for opr v� � Q 3' �� /t;a ©(, D � /l} Z �OLCI utirti� -1y1,u d�- l � " D�� ' �"� 10 UH+.c 'l 1 t' � `l P01,eI73 / �ih f� �' t Attach complete plans (to the County only) for the system on papa not less Than VA s it lathes to sin SBD -6398 (R. 08/02) 05,39/2003 13:32 17154256864 WEGERER SOIL TE=;TING ' PLOT PLA'a Pa;e of S gem Scale 1` =Y0 ' .Kk)n )m OF S L D t,v C ...- . - - - -- - LTA . ` S .. ,N $l„`Pt'�`�.' f ..__L�. { I 1�_6K �i , S q N e,0 Alter 1Ster 0/ 100 2:4 Tie P•eAse t5cis1l:n syp -C 'T p cwt ��a� G1raU Dt� n ad Ee Carr vfvp S> S J y d HOPP- k% )11 9,97 y69 4T �� 5f�3fa3 715 -425 -0165 2 202 5 4 03 -6 CST Signature Date Telephone IT6. CST No. Job 110. 05,x9/2003 13:32 17154256864 WEGERER SOIL TESTING PAGE 04 PLOT PLAN P ave - of Seale 1' =� ' i��11 -.• l'J.p`tY� �Tl)P a�2 ©n.) u`l'S M Or- s eir U ; GO U n Ifs �'X 100 �z V - Lq6 c f _ 16ki *4 w A its 1�LVIm X12 -1U(1Z _ R to e `z b fiz._i y p 5 >3 a3 (a 715- •425 -0165 2202 CST Signature Date Telephone Igo. CST No. Job 210, ST. CROIX COUNTY WISCONSIN ZONING OFFICE NNN1�11NN11■ •__ OH• ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 EROSION CONTROL PLAN (715) 386 -4680 • Fax (715) 386 -4686 For 1180 River Drive (Kinnickinnic) — owner(s) David Hake 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." Comm. 21.125 also requires the building permit applicant and/or landowner to follow erosion control procedures and maintain them until the site has been stabilized. 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 primary source for contaminated runoff on a replacement system will be excavation for the septic system during installation, but establishing cover on exposed soils will prevent erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement. 2. Route contaminated runoff into vegetated buffer areas by creating temporary diversions graded ALONG CONTOUR between excavation areas and any drainage ditches or waterways. A diversion may be used to contain runoff on owner's property and prevent off -site sediment deposition. 3. If builder /excavator grades the site to create temporary diversions (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 diversions and vegetative buffers. The POWTS inspector will evaluate ESC plan effectiveness and make recommendations to owner and building inspector for any action required to comply with applicable regulations. 4. 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 access the property during construction. This helps 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. 5. Stabilize new topsoil cover over 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 will 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. The owner of record during site construction will be responsible for compliance with the ESC Plan. A detail for temporary diversions is attached. Please feel free to contact me with questions or ask for assistance with erosion & sediment control installation. Prepared by: Pamela Quinn, Soil Erosion Inspector #665054 Owner acknowledgement of ESC Plan requirements: C^ ......... 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 'Division of Safety and Buildings f in accordance with Comm 85. Wis. Adm.,,,(rrade - �� ounty S C1ZQ yC Attach complete site plan on paper not less than 8 1/2 x 11 inc t W include, but not limited to: vertical and horizontal reference poi (BM), on , and P cel I.D. percent slope, scale or dimensions, north arrow, and location a rint all matron distance to nearest d3 0 Z,Z„ _ 0 6 j _ o� S ` d 0 Q Please information. `( w p o . �Q y Dat Personal information you provide may be used for secondary purposes (P acy Law, s. 1 Property Owner p-, �� n r m �� � 1+ Vz Gent -bet N' 1/4 S(- 114 S G� T Z.� N R � E (or) F Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 118 'ZtLU�'`1Z bJD-L �`� _ City State Zip Code Phone Number ❑City ❑Village 0 Town Nearest Road lz�u us w 1 S�l�zz (a cs ) �IZS _�3 1 - �j AU)vl �- zIkj R LUn. iz I U ❑ New Construction Use: Residential / Number of bedrooms Code deriv design flow rate S GPD ® Replacement ❑ Public or commercial - Describe: JA 0 Q Parent material S PS�)1 M k' . 1 6U` A S H Flood Plain elevation if applicable General comments and recommendations: JS �> CLr.r� t ; �U;:J ` t::f _ �!Z Ul l}ti r� S`1 S t Lv IT)a m l&j l m Vk l Z 2 S L 1 w Lz�— } T c) p i Z- 1=K u C l g 1;'2S t i p r� wt Ntivp i B�)I1v m ur 1 Boring # ❑ Boring Ground surface I 40 . ❑ pit a ev. � O 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 �1? - 1s 1e-Sbk rn uf7- c;�, - ,• My FTI Boring # ❑ Boring tt ® pit Ground surface eiev. P b 3 ft. Depth to limiting factor 2 Q S 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 o�Z3 �SK2 t _ L lcSb4z m NJ aw - , q 23 3 7 S (2 3 l 1 O- S b h C- -` 3 38 gS �s�fzyl6 1s lcsbl mU- - --7 i. Z ' 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) Si na re CST Number .Arthur L.. Wegerer o(_ 3- S 220254 Ad dress W e g e r e r Soi Testing & Design Service Date Evaluation conducted Telephone Number 421 N. 14ain St. River Falls, RI 54022 S -Z -0 3 715 - 425 - 0165 Property Owner P Y `� rcC . Parcel ID # � 2 � ' lU � � � - L S — UO Page Z of a Boring # ❑ Boring pit Ground surface elev. C � • Z ft. Depth to limiting factor �� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structuro Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z 1S -33 L y" v - 3 3 3-53 ICS�k w►V`f'�- (Z' • �� F-1 Boring # ❑Boring ❑ pit Ground surface eiev. 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 L - T Boring # ❑ Boring F ❑ 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 p►ovider 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. SBDD8330 (R.6/00) PLOT PLAN Page of R' b Scale 1' =yO ' Q�It�L- .et�s. On1 RvTom OF Stt)1�j(s,_- ____ - -- s kFL �N n- - Po gab Z � 90 I Z R I )72 b �Z-a v � S -Z- U 3 715- 425 -0165 220254 03 - 6 S CST Signature Date Telephone No. CST No. Job PTO. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Divisiou'of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code S l • C ZZC� x Attach complete.site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 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 LZ, — 1 r3 6 — O t S — 0 00 Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privac/ Law, s. 15.04 (1) (m)). Property Owner Property Location 1/45�� 114 S T Z� N R � E (or)-W --E Property Owner's Mailing Address Lo71Block # Subd. Name or CSM# lc u —LU City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road 1� IU CS �I S�1�Z2- c - 2 Is) 1 -12.S _z3 lzlAi >u �1 I kj1 jI C Rl c biztu ❑ New Construction Use: ® Residential / Number of bedrooms -3 Code derived design flow rate S GPD IS Replacement ❑ Public or commercial - Describe: Parent material _ '� ( 1►) 1 b CUv I L i N Flood Plain elevation if applicable N - ft. General comments and recommendations: Z Z S L 1 w Sum M or e:"L�S '(v 3 b- Afi LZ- �A) ti Boring # ❑ Boring '2 4 O ® pit Ground surface elev. - ft. Depth to limiting factor in. Soil Application Rate j 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 -t(4 - 2.s gcz - ) lz — >> 1�S��c m vf�- cam, - .-� \. Z I Z) -�L� •S� (Z�l — 1 s l e s b k m v cc,j - . - 7 �. - z- 1Z V/6 _ S USA ❑ Boring # ❑ Boring ® pit Ground surface elev. ft. Depth to limiting factor S 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 C) 2 3 �S� -ti23 c - L 10.Sb�z yn V�P1r• alti - Z 1 1r _ l�sbh mvf �W -- •� z•s�1Z V1 ' 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) Si gn ature CST Number Arthur 'L:'. WVegerer X3_6 S 220254 Address W e g e r e r Soil T e s t i n g & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, WI 54022 S -Z -p 3 715- 425 -0165 Property Owner 1�cC . Parcel ID # 2 Z ' �U b I - -` S Page of Boring # ❑ Boring °t 6 Z o 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 I •Eff#2 o- is -i's Ya_ 3 t Z - L >'n v`P► C Lv -- , y 3 33-53 s t2 ply s � wi V `Pv- Cw , 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 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. SB114330 (R.6/00) PLOT PLAN P a cr e of Scale 1' =t{0 Y Qwlti -Z —Ez cos. 4 o EVmm'l DF S�l�t��G._._ - - - -- - - - - - -- � 30 J PAZ gab 3 J �I i 10(x.' St. t � oT � D1ZS'- - _.o� - _std_ )72 b ELI d N 715- 425 -0165 22 CST Signature Date Telephone Igo. CST No. Job NO. f 05/19/2003 13:39 17154256864 WEGERER SOIL TESTING PAGE 01 WEGERER'SOIL TESTING and DESIGN SERVICE SOIL TESTING - SEWER SYSTEM DESIGN ATTN: -yam DATE CC: SUBJECT: THE FOLLOWING ITEMS ARE 0, OF DESCRIPTION C OPIES a 2 SENT TO YOU FOR THE FOLLOWING REASONS: ''FOR YOUR USE FOR REVIEW AND COMMENT INFORMATION DESIRED t—i tt�l t T w )) ` F WEGERER SOIL TESTING AND DESIGN SERVICE ^ P.O,BOX 74 421 N.MAIN ST. RIVER FALLS,WI 54022 PHONE 715 - 425 -0165 05/19/2003 13:39 17154256864 WEGERER SOIL TESTING PAGE 02 Wisconsin Department of Commerce SOIL EVALUATION REPORT Pape � of 3 Division of Safety and Buildings in accordance with Comm 8F Wis. Adm. Code � �.4 1 Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must County Y• IneJude, 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. 0 U Please print all information. Reviewed by Date Personal Intormrgon you provide moy be used for secondary purposes (Privacy Law. s. 1 5.04 (1) (m)). Property Owner Property Location DNU 1-D Pnh/fl O w - tN " �V e- fie! NiiE 1 /,& SC,` 1 S ?- I T Z-a N R E (or) Property Owners Mailing Address Lot # Bbcic # Subd- Name or CSM# 11 BO t-tiu . biZLJ(:� — ity State Zip Code Phone Number ❑ City ❑ Wisp ® Town Nearest Road IU E'CZ S tuI Sq(j zZ (z ISM L4ZS -zj 3 1 C1r1:•1,11 X TUUM bit u L` [] New Construction Use: EJ Residential / Number of bedrooms Code derived design flow rate , _ . 1 .1 S GPD IS Replacement ❑ Public or commercial - Describe: Parent material . 5 eZ�i1 h QQT OIL OVTW A S H Flood Plain elevation if applicable IV . A ft. Genera i i �� � )QV�11UJ0P - IA -GVWUM) !S `-t LvITtJ "WIMtJi� and recommendations: Z S L w Lam. - T of C- z - F -4- t) ct e �-QS S. � 'Go M o y FeL , L K 4 3 , x 6G , LAG . t v " or- ct�S 11i 3 �� - /}fi U 1V 4 3 . Q Boring # Boring 1 ® Pit Ground eurface elev, _ q D - O fL Depth m Ilmiting factor '2 CID in. Sell Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Ou. Sz. Cont. Color Or. Sz. Sh. 'Eff#1 - Ef#!2 I -N �.sK - 1S 1cSbk In V - C(A, - �. Z ❑ Boring tt ® Pit Ground surface elev. D• — S ft. Depth to limiting factor S In. Sail Appiicabort Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMN In. Munsell O4. SL Cont cow Gr. Sz. Sh. ' - Eff#2 o Z3 -I 3 Lj C - S vn V tr Ow – • Ll 39 Z3 3 7 S6fR 31Y 3 – T - 45 'I - r"Y 112V - is lcsb na 1 c // • Mot t #1 # SOD, > 30 1220 MIWL and TSS >30 t ISO (no& ' Effluent 82 s SOD, 1 30 mg1L and TSS < 30 mWL CST Name (Please Print) ro WNW mer b .Arthur L': f4geier al _ 3 —� S 220254 Add"I W e g e r e r Soil Testing & Design Service Date Eval uation t:arducted Talsphorrs Number 421 N. Ifain Se. River Falls, WZ 54022 S 715 - 425 - 0165 05/1912003 13:39 17154256864 WEGERER SOIL TESTING PAGE 03 ,s Property Owner �1 rC.� Parcel IDS 0 L Z " l� o ` C IS —()() Page Z of a Boring 0 ❑ Boring ® pit Ground surface elev. 0 1 6 • Z ft. Depth to limiting factor _l.b�f _. In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence SWAdery Roots GPDMI In. Munsell Qu. Sz, Cont. Color Or, Sz. Sh. /011114 Eff#2 1 0-1S - 1- s "M311 1asb� Mv'f'� CCU - �y z - s '-f L c vin v 'E- CW -- 3 3) �s� �1 �esb m v`Fw- c. � - �1 •� T9 -1. S P- V /6 3 F-1 Boring # [.7 Boring 1_ l Pit Ground surface elegy. fL Depth to limitlnp factor In. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EM -EM n Boring # ❑ Boring I ❑ pit Ground surface slew. fl. Depth to YmIWV faeW In. Soft A001 1callm Palo Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roole GPD1ft In, Munsell M. Ss_ Cont. Color Gr. Sz. Sh. - Efhr1 'Efflt t " pm- Effluent 01 a BOD, 2 30 c 220 mg/L and TSS >30 c 150 mWL ` Mont 02 = SOD, 30 mg/L and TSS c 30 mwL The Department of Cowimercc is an equal opportunity service provider and employer, if you need assistance to awss oarviees or need material in an alternate format, please contact the depattrnent at 608 - 266 - 3151 or TTY 608 264 - 8777. saau)o tte.sioo� 05/19/2003 13:39 17154256864 WEGERER SOIL TESTING PAGE 04 *� PLOT PLAT Page of Scale V =40 ' LOT L, v ka it Qr1t�L --Ln C1.8 V DrQ 8u1 DF sLDING. -. -- -- �_ TF; s LTA ` S... NE'rT L `1 V r- do g.3 bet J AK s�Q1n C bJ aM IoF'L . W.L NS > F MI DRsS 1 - 'j? , d 715- 425 -0165 220254 CST Signature Date Telephone No. CST No. Job 110. 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 U t residence 1 cated at: 1 /,, SL %, Sec. , T ag N, R /8' W , Town of /�/� lC hh e(' St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good ondi ion, and it appears to be functioning properly. Last time serviced L' - P " Did flow back occur from absorption system? Yes No�C (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: - Construction: Prefab Concrete Steel Other Manufacturer (if known) : 46ZJ;/ Age of Tank ( if known) : (Signature) (Name) Please Print P/T YY L WX (Title) (License Number) (Dat Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer MR. 113 Wisconsin Administrative Code) 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 (ex c t for inspection opening over outlet baffle). Name 6 �' Q Signature MP /MPRS ST CROIX COUNTY • SCPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIIIP CBRTIPICATION FORM Owner/Buyer Mailing Address 1 ! U p V -A I D P S d�� Property Address � jvL (Vetiftcatioa "imd f m Phnaiag Dot for acw conshuctioa) - lS city/state ��` �� Patcxl Ideutifieation Number � a � 7 dD0 IX DID Pmlxxiy Location ffv,. %<, Sec. T dP N-R g W,. Town of + Subdivision A Lot # lea Satvey Map # vote . Page # wsa=ty Deed it �6 �, (� ` volume Pei Spoq .hovse 0 Ya II° Lot H= Mmdfidk C] yes 0. no t:IN[Ati�'I�yi4�I(� . . sy:8aucoaldtt�tiaiaPreai�udi�i to c�aastleak per aax � mc�ane6oacftLe Cv'CLY&=YC=°C if bysHb=w&p=p= :Wbatympatided osystem txpdctas ssige In the �stcdot�bcau. . ,nistoc owacra,�oacst�o mb`°ctto Sk C��oCC?,aamgmc��� 6ytb�eoa�xaodby s is'apw�Capo�coo�onsm�dl «(� a&r,mdp�p�(¢.� �ccc�Gc•,� t�dnn lf3�II do1nv�ecadt6e •�3'�s7^�Lasboeam�be SaoeofWisooasin. t aftbe�rce date. aadre6mraodfoQieS' G�oocmtYZAaie�gIOWiioew iil5na30 h \ DATE O �xCAUONI Y (v'C) tlwt an sCttetoeats OR this faau ate bw to do best of my (oar) Imovdodgg. I (rm) am (are) tic own=(s) of by view of a dy � � �Y dood = dod is o f Doo �� ��!� 1� .,..,.. tom DA'C'E s��sws AM/ iafor natim dat is mils - p�l�ay •cv* LL the any pckRta ifd bGLlt 1Yi dmd by t he Zeni,,,,,1L....�meti s.. �s ��� this .." """ ...,!'....",.'•" 4 + a�pluxtion: a won" dood fiam the Ram of Doody *Mee a Dopy of the cWifiad wrfty wap if ram= is made is the warranty dcod ec, System: Management Plan Putsuant to Comm 83.54, tiis.Adm. Code 3 4ecti c Tank The septic ta nk shdCbe maintained by an individual certified to service septic tanks under S. 281.48, Stats. The contents of the SePtic tank she!l be disposed of in 8=*dance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter 36 90 be assessed at least once every 3 years by inspecClon. The outlet filter shall be deared as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to' etain solids in the tank that may slough off the MW when removed from its enc :csure. If the fitter is equipped with an an - „ ,the Cuter shall be serviced if the alarm is activated continuously. intermittent filter slam or s may indicate surge flows im septic tank shall have its contents removed when the volume of sludge Pig continuous alarm. Tae the tank. if the contents of the tank are not removed at the time of a ass lo lot � exceeds 1l3 the liquid vol ll d s ' theovmer of when the next ��� � Personae! Shall advise service needs to be perfomted to maintain less than max<mum sr.,um and sludge acoumulation in the tank. The addition of biological or chemical additives to enhance septic tank perlormance is generally not required. N.owever, if such products are used they shall be approved for septic tank use by the Oepaftent of Commence; Safety and Binding's Division. Purno Tank The Pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be test6d to V PrOPer operation. If an went Ru is installed within the tank k shad be inspected and serviced as necessary.. At- Lade Component and Pressure Distribution System Ho.trees.or s ru s sou 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 BODg, 150 mg /L TSS and 30 mg /L FOG. Influent flow may not exceed the maximum design flow specified in the permit for this installation. distributio The PrOsSUM lateral be ftthed of system is provided with a flushing point at the and of each hterd, and k Is nsdrtunended that each COmpared emulated $odds at West once every 18 monam When a pressure test is performed d should be required tolo �equal �n " stem w as within the disperse de termine g togging has oc�rned and gorifice cezning is Observation pipes within the dispersal cell shall be* checked 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 THr system shall be operated is accordance with Comm '8Z-84 Wis-Adm Code and shall be maintained in 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 dangerous gases may be present that could c:rise deafh. Septic and POW TS �t shall be in =Mlance wdh Comm 83.33, Wis. Adm. Code when fhe tanks ace no khrhger used as mponents. Septic or Pip tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access unsound, defectiM or s used for service and assessment shall be sealed watertight upon the gmplef3on of service. •Arty oiled Ing dee. be secu ed ' to Padure must be replaced. Exposed access openings greater than 8-ithches in diameter shall 99 DA emr � kh bkkhg device to prevent 2=Wsntal or unaut hod¢id entry into a tank or cimporhent. If Is SOM tank or any SYstenin °t as compo nwft become defective the tank or component shall be repaired or rep" to keep the 9 concfion. If the dosing ptrmp, PX cotek alarm or defective the defective cony onent shad be mWKI or replaced witis a c9mponerd of the same or equal PVbVW.= If th� a grade component fails to accepf"arastewater "oeias - to disc rage wastewater to the ground surface, it say 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 CoWrce,- Safrety and Buildings Division. . Questions .about the operation ar maintenance of this system should be directed toi - The County,.Zoning Office at Z - 6'7q 50,0 The system installer at - 1LS RRS$ kip The tank manufacturer at _ �Qt _3ZS_a1 s �, wt�s The effluent fl manufacturer at x'00 - zzl _ Slq z Zr"c' kr_.:„ rho- i'UV�%p Stock No. 13001 00CUMM NO. STATE BAR OF WISCONSIN –FORM 1 h WARRANTY DEED s VO� ^r I� Pa �0� 380650 Ii V Y THIS SPACE RESERVED FOR RECORDING DATA REGISTERS OFFICE TM DEED. made between Ralph R. Hake ST. CROIX CEO., W*L Recd. for Ro=d f1t4c 28tk Grantor day of D ct AD. 19 an d David fJ. Hake. a single man of 4 :25 P Grantee, De W pe Mitaeas*tIt, That the said Grantor, for a valuable consideration --- RsTURN to r conveys to Grantee the following de*gi real eta sn or a.....11 C , State of w iscoa a: Ili eer a ?n parL� an D or t kct of real estate located in the NEk of the ')Ek A S7 of Section 21,T28N,R18W.Town of Kinnickinnic, St. e2• ,,.�., ► ^ }�s ra Cray'.:: County, Wisconsin, said tract being the Westerly 2.0 acres of a larger tract recorded in Vol. Ta a No. 453, at page 273, in the Register of Deeds office of said oun y, parce to be herein conveyed more fully described as follows: Beginning at the inter - section of the West line of said NEk of the SE34 and the centerline of the Town Roads thence North along said West line a distance of 322.75'; hence S 87e 59' E along the North line of said larger tract a distance of 269.93'; thence on a new line through said larger tract South a distance of 322.75' j to said centerline of the Town Road;thence N 87 °59' W along said centerline a distance of 269.93' to the point of beginning, including that part of the , above described parcel lying adjacent to the centerline of the Town Road presently being used for highway purposes. I �a This is not homestead property. yr (is) (is not) Together with all and singulat the hereditaments and appurtenances thereunto belonc:u_.". And Ralph R. Hake ryN warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except !I easements and restrictions and rights -of -way of record i and will wirrrant and defend the same. 1 Dated this 28th day of October 19 82. s /Q (SEAL) ' (SEAL) 3 Ralph R. Hake � (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT signatures authenticated thi , t ay of STATE OF WISCONSIN ` 19— ` ss. _ Pierce County. Personally came before me, this _28th day of Oct _ v 198 . the above named TTME: MEMBER STATE BAR OF WISCONSIN Ralph R. Hake (it not, authorised by 17%.06, Wis. State.) _ This instrument was drafted by Zen A. Beskar, Attorney to m-: known to be the person _ who executed the fore - 123 ftZttt tfttLL St. Rivet Falls, Wis. 5402 , x , , going in ument and ac ow!e ed the same. ' ( signatures may be authenticated or acknow , qd, �o A t ' R� attl not necessary.) Notary Public _ County, Wis. 4� My Commission is permanent. (If not, state expiration _ � ° .._ � - ` :� � •.� � ,,: aNaaaa of peso=s afaaiaa N any capacity must G6 t"' 'ur.printed.below their signatures. �4 r WARRMTT 411110- •S'E'AT! SAN OW NtaCONSOr. WORM NO. 1 -1977 ' r o N 0 ? - 0 0 d �< 4t C �: CD GI CD (n (D Z in Z o N 0 3 oN • m o m o t"S ZY < C 'D T` ` W Q O (QD N COO (D n W O O W "" 1 N Q O Q 3 O' CD CL n W Ut O O O C O O s l W O_ -1 W O y N W : n 00 C N y O 7 O d m ;7 o N cn z D m a m m (o D N a m m < (D = o o O cn Q cD i Fw� N N CD (� O O O K W W z 0 0 0 0 n ° N N cnn cD n C7 N I o v v rV ' (D �_ CD 3 °—'• m m N 'z N z z o o CD a o I h• I :3 n m o m (n � Vq O (D D W (D Q Q D !_ _ Q 0 ::3 d _ C Z CD O O CD N it A .Z7 n n' n CL Q A Z O F m I G7 6 O j O cr x (D Z N o co C m 00 V 3 ° z 0 A (D O =• cn M 00 O- N I � A 7 ) I n m I m a m 3 co - Q m o — (D 7 0 A O O _' (D O O I m o f I N v O N 7 I n W Co CD ti I I v I o b I m Dro a Efa O o (D ° o C- Q.tV •��1 �6 Wisconsin Department of Commerc PRIVATE JWAGE SYSTEM St. Croix Count Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 429993 0 GENERAL INFORMATION 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: Hake, David I Kinnickinnic Township 022 - 1061 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: 21.28.18.P333C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t Dt Bottom Dosin Header /Man. . to - O yv+ Ltd �•to .L eration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 19 •82 Ar Manufacturer Demand St Cover GPM Model Number 1 • � 2• � # v� - v..�3r •� Id J TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM Fj BEDITRENCH Width Length No Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L B DG WELL LAKE /STREAM LEACHING Manufact INFORMATION CHAMBER OR Type Of System: I i UNIT Model Number: ( 3 - DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length D Spacin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ( Yes [ No ( Yes L' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / ?.( - / LOP Inspection #2: - - 7 6 -- Location: 1180 River Drive River Fails, WI 54022 (NE 1/4 SE 1/4 21 T28N R1 8W) NA Lot S Parcel No: 21.28.18.P333C 1.) Alt BM Description = Y 2.) Bldg sewer length = I 6 t - a mount f cover - 3) _ . z Use other l s de for r ditional Yes No T Information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. ` Safety and Buildings Division County IN IN 201 W. Washington Ave., P.O. Box 7082 5 ,��Ons1�� Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by C .) De artment Of Commerce (608) 261 546 3 Sanitary Permit Application State Plan Number In accord with Comm 83.21, Wis. Aden Code, personal information you provide ' may be used for secondary purposes Privacy Law, s 15.04(1)(m) Projw Addr (if different than mailing address) I. Application Information - Please Print All In f rmati�ECEIV Pa # L °` # Block iv / /a o / `� Vev- D2� f v Property Owner's N me r IC/� �' MAY 1 4 2003 d as v>bd1 - �S-�9 Property Owner's Mailing Address Property Location ST. CROIXCOUNTY G OFFICE yti Section City, State Zi p one umber ?t0 l a6`S A);t 1 �o�� a3�3 circle0 e) II. of Building T �� N; R�E Type g (check all that apply) /�-�� ,, t5 1 or 2 Family Dwelling - Number of Bedrooms -3 � 1� /S1 7 A ,�— JW6 t - //t Subdivision Name CSM Number ❑ Pubiicl Commnerciai - Describe Use 7 T ieeN ok(ES IK) / (0 ❑ State Owned - Describe Use ❑City ❑Village Wownship of ' 4" 1 1 - I , - - e F - [y III. Type of Permit: (Check o ne box on omplete line B if applicable) A - ❑ New System )iRept System ❑ TreatmwdFloiding 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 System: all that a pply) 'RZNon - Pressurized In- G round ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized !n -Ground ❑ HoWmg Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching chamber ❑ Drip Line ❑ Gravewm pipe 01ber (ex lain) h L / V. Dis reatment Area Information: E to Design Flow (gpd) Design Soil Application EBPds Dispersal Area Requited (sf) Dispersal Area used (sf) System Elevation I/ L taw 93� VI. Tank Info ty in Total N— Manufacturer Prefab Site Stool Fiber plastic Gallons Gallons of Units( (�Z Concrete Constructed Glass New Existing - ff �,\ Tanks Tanks IN W Septic err Holding Tads h Aerobic Trnuaeat Uma Dosing Chaunber VII. Responsibility Statement - I, the studersillpF4, assume responsibility for lustal4donAtAtQPOWTS shown on the attached plans. Plumber's Name (Print) Plum s M Business Phone Number C/ 9 yam 99s'oO Plumber's Address (Street, City, St Zip Code) bo g cg 9 �v f tp nv 11f Dl eydz VIII oun /D artment Use Onl Approved ❑Disapproved for Denial Surcharge Fee) Permit Fee (includes Groundwater Da a Issu ing t st Stamps) `' ❑ Owner Given Reason I7t;. Conditions Approval/Reasons for Disapproval 10 l f KA:t • QU��v �� I'�u%+u�zr". �� •G ��'��'r`' � ��'t�vy►�.. � 3.SZ `� �dtel?S v -� Attack complete plans (to the County only) for the system on paper not less than $112 x l l inches in size SBD -6398 (R. 08/02) 05, )9 2003 13: 1 154'2'56864 Wti-,EREt -' SOIL TE'_ PLQ1 PLA .1 P� °F — °t Scale 1' =�}� ' .�,,, eA t S v g�'Qkn 0.0 0 7UP OT: f tP- C-rxj1: t'l a - Iz- uc; �EZ . ci �5 - V ' olv E O` 113 M dl' S � 0 t t�J 6 - - -- - 1� qL IX L60 z b 8.3 g racer C� �h'Ci 1. In�i S q 3, t-La��Z l( huh Value r i lfcc(`Ao►ster to// )00 2:4e leer % - s'� tv►� - �-w A Gwe►.v � Di1J � h �� �� Ca � l�� _. X180 v U1ZIUc- d l�'inn ie�'inntC ' VIA ) p. .w.. d ,97Y6� 10 y �;� 5 _��� 715- 425 -0165 22 o� -b� CST Signature Date Telephone No. CST No. Job 210. n CO) O 3 v n o c d 0 _1 46 c Cn 3 7 Z O N N N fO!x'' • = m < y �p 77 O N N [ 1 N 7 j �p CD p} O CO ` 1 CL G 0 y W v N O -� O� D) 7 OD N a= Q � 7- 0 O O W �O O C m C W 6 !� 3 w vi o n ° O � G m co D N a s `�° ro W O 3 ° c c° < p 0 n m F No ; O : z o o m Z O w w w p a �• n 3 z z OO g O _ , Or o o vi y z D� c � v o CD O O �t 3 y a .3. z O C (n z N cc (n � a� o y N O CD 7 C O �+� N C w CD co d a 5�m Z vi > > �� N �_ N Q A Q O X N Z N o W M m w 3 a ` z 3 A T] cD p M CL D CL w m m � m a 3 CD 3 co C C' D X 7 �1 y y N C z a �fm o O 8 N CD O 0 N O cc 0 a I I j O CL 0 w OD ti CD I i � N p d O N CD d0 N � W V