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HomeMy WebLinkAbout022-1065-50-002 n cn 0 ! ■-0 n c , . S E$ c M 2 e J} � , • , ID z 7 E E Q p- m § / i \ \ - �@ - CD } U) � f � $ = o E o 6 2 z > / CD s > A 7 \ ■ § \i ® C.) / k ;o 2 0 E g � 0 3 3 f T 010 \ < a z \ § ■ ■ @ E_ $ > § � M ° R Y) ° @ , £ F _ c G -4 rT � r \ = k x- Ea tmg a C L 0 ! CD 7/I ogc ) m �: z m . ■ d- i: z $ i m ¥ � E m M . m m w 9 E ■ z 3 k \ k } ® � � . � � k � 0 § z R $ . � � \ � . ¥ � � { ° k ; � � Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453268 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: Alba, Rick L. Kinnickinnic Township 022 - 1065 -50 -002 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: MAW Q 1y\ -::� -'� I 23.28.18.3560 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t Benchmark Z156 �. �1 ,85 A 16 Dosing Alt. BM Ca W c� j so 6 of G". t ' 1. 3 / Z Aeration J Bldg. Se4jer Holding St/Ht Inlet p c TANK SETBACK INFORMATION SVHt Outlet \ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 13Z k (09 1 Dt Bottom t 1Z .0 J . Dosing 13 � . +� � Header /Man. U i Aeration Dist. Pipe Holding Bot. System /0" PUMP /SIPHON INFORMATION Final Grade 4 4. Z /62 • 6 Manufacturer M ` GPM St Cover �, Z � � 0 � nV- 's71 ' �Q G � ll Model Number n TDH Lift Friction Loss System Head TDH Ft (o. 5 1, 71 12- 591 Forcemain Length / Dia. .1 I Dist.toWell A 1 Z F SOIL ABSORPTION SYSTEM j ,� S' 'j BED/TRENCH Width , Length No. f Tre has PIT DIMENSIONS No. f Pits Inside Dia. Liquid\ DIMENSIONS 12- f SETBACK SYSTEM TO P/L jBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of Syste : / J it v Ar UNIT Model Number: -�- P DISTRIBUTION SYSTEM Header /Manifold Distribution /� x Hole Size t x Hole Spacing Vent to Air Intake Pi p () Length , Dia Z Length I Dia Spacing Z 1 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 L Yes No 'Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Z / L3 / Inspection #2: / / lb, -- Location: 260 Sherwood Fo rrest Road River Falls, WI 54022 (SE 114 NE 1/4 23 T28N R NA Lot 6 �� P _rc No: 3.28.18.3 1.) Alt BM Description = 1- ck- 2.) Bldg sewer length - amount of cover WepctoSign Plan revision Required? L] Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Cert. No. ST. CROIX COUNTY =- -_ WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER L - 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 • Fax (715) 386 -4686 EROSION & SEDIMENT CONTROL PLAN Parcel #28.28.18. Site: 260 Sherwood Forest Rd, Lot 6 (Kinnickinnic) — owner(s) Rick Alba 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 & Sediment Control (ESC) Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization has been completed. Septic system installation adds to temporary disturbance, 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. Surface drainage is southerly from the system area, with >50 feet of buffer between Sherwood Forest Road and the proposed house and mound system construction. 2. Route contaminated runoff into vegetated buffer areas on owner's property by creating temporary diversions graded ALONG CONTOUR between excavation areas and any potential receiving waters (this includes road ditches). Do not allow diverted runoff to be directed onto neighboring properties. (See specification sheet for temporary diversions provided by Zoning Dept.) 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 temporary diversions and vegetative buffers. The POWTS inspector and building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must 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. Please feel free to contact me with questions regarding erosion & sediment contro sta io . Prepared by: Pamela Quinn, Soil Erosion Inspector #665054 Owner acknowledgement of ESC Plan requirements: /2004 PLOT PLAN /1/ Rick Alba ADDRESS 1870 Roselawn Ave Falcon Heiahts Mn 55113 NE 1/4s 23 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX APRS Shaun Bird 226900 DATE 5/14/04 BEDROOM 4 ' ONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK IOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 (OLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1210 # of chambers none I BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100 Filter Zabel A -100 BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 101.2' Pro 4 Bedroom House Sherwood Well is to meet all Forest setbacks found in Tank is to be properly Comm. 83 bedded and provided Huffcutt Combo Tank with iockdown covers Grading is to be done to with approved warning divert run -off away labels from system d� F B - N1 01.2' 100' a It -3 B.M. Area 15' below 8% Slope system is to 1 I � remain Iv undisturbed Alt. BM. is top of 112" pipe @ 99.5' cale 1/4" = 101 (;01P*4 660' Prope rt Line Safety and Buildi County N v iscon si 201 W. Was hingto 7162 n MW 6' L Sanitary Permit Number (to be filled in by C ent of C 608 266-3151 De artm ( ) Commerce S3 2( Sanitary Permit Application S to Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provi �/^ f 7 -F21M1 S , may be used for secondary purposes Privacy Law, A 5.04(lxm) n'U ,1 ♦ Project (if ff r �l t " r � I. Application Information - Please Print All Informado i , �: ? -W pQ 11 Property Owner's Name 1 wtbb l # �/ - ct�MY � s ��v l # Lot Block # � Property Owners MadingAddrecs ST. CROIXCOUNIy Pro Locate �r NING OFFICE City, State Zap Code Phone Number = -� Section jkj -� �-- II. Type of Building ( all that apply) -.d P,er V — # EV �r 2 Family Dwelling - Number of Bedrooms S CSM Number PubliclComrnetrial - Describe U J ' P �7/ # �/ 3 State Owned - Describe Use d K � City_ Village Township o N ( NN L IQ. Type of Permit: (Check only one box on line A. Complete line B if applicable) — p(p s Sp _ CpZ 3 5t,C A New System Replacement System Treadnent/Holdi Tank Replacement eplacenent 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: (Check all that apply) Non - Pressurized In- Ground Mound Z 24 in. of suitable soil Mound < 24 in. of suitable soil At-Grade Single Pass Sand Filter Constructed Wetland Pressurized In- Ground Holding Tank Peat Filter Aerobic Treatment Recurwlating Sand Filter Recirculating Synthetic Media Filter Leaching Chamber Drip Lane Gravel4ess Pipe Other (explain) V. DispersaVIreatment Area Information: Design Plow (gpd) Design Soil Ap pl ic a tio n 6 /, � A pL_ Rate(gpdsf) Dispersal Area Regnirod (sB Dispersal Area Proposed (sf) System Elevation � V S „�� /O/ z. VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks cs Sc or Holding Tank Aerobic Treatment Unit Dosing Clamber VII. Responsibility Statement- I, the uudetsigm a responsibility for Installation of!t2±0WTS shown on the attached plan& Plum7bees . ame (fit) Plumber' MP/MPRS , KpAff Business Phone Nu �I�y( ; Plumber's Address (Street, City, State, vlll. Co /De artment use Oal Approved Disapproved Sanitary Permit Fee (includes Groundwater S /,O Issued tong i Signet ne Stamps) Surcharge Fee) ��rnrn Owner Given Reason for Denial J✓v'�_ o IX. Conditions of ApprovaMeasons for Disapproval SYSTEM OWNER. 1 Septic tank, effluent filter and digpersal cell must all bg s�rvicad /_Maintained o as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less Mau Sla x 1l inches in size QDn rlZ04 fD flt //lZ\ ___ ST. CROIX COUNTY = ~~- WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 • Fax (715) 386 -4686 EROSION & SEDIMENT CONTROL PLAN Parcel #28.28.18. Site: 260 Sherwood Forest Rd, Lot 6 (Kinnickinnic) — owner(s) Rick Alba 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 & Sediment Control (ESC) Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization has been completed. Septic system installation adds to temporary disturbance, 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. Surface drainage is southerly from the system area, with >50 feet of buffer between Sherwood Forest Road and the proposed house and mound system construction. 2. Route contaminated runoff into vegetated buffer areas on owner's property by creating temporary diversions graded ALONG CONTOUR between excavation areas and any potential receiving waters (this includes road ditches). Do not allow diverted runoff to be directed onto neighboring properties. (See specification sheet for temporary diversions provided by Zoning Dept.) 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 temporary diversions and vegetative buffers. The POWTS inspector and building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must 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. Please feel free to contact me with questions regarding erosion & sediment contro sta io . Pre ared by: Pamela Quinn, Soil Erosion Inspector #665054 Owner acknowledgement of ESC Plan requirements: /_/2004 49 75 - 1 - - - -- J I A eel f 96s 0 3 965 O 1974 J m n • innicki is m I � Qa O 55' O 0 ` 0 14i o 3 946 4073 i O 92 r o V R 943 � � I � • 11 2 0 1060 � o Q \ i 4071 O Y 1 97 86 % /0 // '- II O /0 o -- l 5 - -- - ,� 49 70 000 '"N tl � h I D. I //00 • Q 11 6 _•__ , Y__. ) - - -• - -- - Lail - • - - -• - � -- - - - -- -•- / iii - -- - - -• -- - - - - //s ® -- - 35 I o `F' _ 44 °52'30" 32'30" 6,37 IRTE IOR- GEO -C^L SURVEY, RESTON, V RGIN S 39`90oIIIr C 92.°30' ROAD CLASSIFICATION A— 47/01/04 TIN 15:09 FAX 715 386 4686 51 CKA CU 'LUNINU .(J VV1 Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 208 21 of the Wisconsin Uniform Dwelling Code, soil erosion control informa- tion needs to be Included on the plot plan which is submitted and approved prior to the issuance of building permits for 1 8 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking (d') appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. Site Diagram Scale: 'I inch = feet EROSION CONTROL PLAN LEGEND PROPERTY UNE _ EXISTING DRAINAGE TD TEMPORARY DIVERSION FINISHED -� DRAINAGE A PA _ LIMITS OF aPLADING SILT FENCE STRAW BALES GRAVEL ( lr VEGETATION !v O SPECIFICATION &j TREE PRESERVATION STOCKPILED SOIL Please indicate north by completing the arrow below. —N— I PROJECT LOCATION S� j ✓/ `� �� - lC�� /�9 BUILDER OWNER Zk k24j2�� WORKSHEET COMPLETED B ��- ^-�^ -� 1�� DATE p ^ 36 s•d dos =ot vo To inc 07/01/04 THU 15:10 FAX 715 386 4686 51 UMA Vu curt' "v - EROSION CONTROL PLAN CHECKLIST Check (e) appropriate bones below, and complete the site diagram with necessary information. m oo Site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. O Location of existing drainageways, streams, rivers, lakes, wetlands or wells. ❑ Vocation of storm sewer inlets. 'ion of existing and proposed buildings and paved areas. T disturbed area on the lot. 1� proximate gradient and direction of slopes Before grading operations. Appr mate gradient and direction of slopes after final grading operations. CJ 4 Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices Location of temporary soil storage piles. Note: Soil sto rage piles should be placed behind a sediment fence, a 10 toot wide vegetative strip, or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. Location of access drive(s). Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is loss). f7 Location of sediment controls (filter fabric fence, straw bale fence or 10 -foot wide vegetative strips) that will pre- vent oiled soil from leaving the site. O Lo t sediment barriers around on -site storm sewer inlets. ❑ Location of diversions. Note: Although not specificaW required by code, it is recommended that concentrated flow (drainageways) be diverted (re- directed) around disturbed areas. Overland runoff (sheet flow) from adjacent areas greater than 000 sq. h_ should also be diverted around disturbed areas. ❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, nd re- vegetation by sodding or by seeding with use of erosion control mats. r b o e Location of practices that will control erosion in areas of concentrated runoff flow. Note: Unstabilized drainageways. ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and ruck rip -rap. When used, a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In - channel practices fiLould not be installed in perennial streams (streams with year -round flow.). ❑ Location of other planned practices not already noted. 9 -d dOS :c)l 1r0 to 1nr- 0T101/U4 Iliu 13:tu rye rlo aoo tivov t � stra checking (of) the appropriate box:` A �� Indicate man C L� � merit �9Y b Y e = a Management Strategies ❑ Temporary stabilization of disturbed areas. Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1st and September 151h), or by other cover, such as tarping or mulching. Permanent stabilization of site by re - vege ation or other means as soon as possible (lawn establishment). Indicate re- vegetation method: S Sod Li Other ❑ , f Expected date of permanent re- vegetation: V i Re- vegetation responsibility of: Builder LJ Owner /Bule s temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15 Y�No ❑ ❑ of downspout and /or sump pump outlet extensions. J � ��` Note: It is recommended that Now from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. ❑ ping sediment during dewatering operations. Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until most of the sediment settles out. Proper disposal of building material waste so that pollutants and debris are not carried off -site by wind or water. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. • Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves o(1 -site due to storm events will be cleaned up before the and of the next workday. • Access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. For more assistance on plan preparation, refer to Chapters ILHR 20 A 21 of the Wisconsin Uniform Dwelling Code. the ONR Wisconsin Construction Site Best Management Handbook, and UW— Extension publication Erasion Control for Home Builders. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 6081266 -3558. Erosion Control for Hpme Builders i GW0001) can be ordered through Cooperative Extension Publications, 608/262 -3346 or the Department of Commerce, Go8267 -4405 . c -d dos :oz j,o io inC 1000 I- # ,J O 4975 5 ! 100 01 _ - 0 O o al J 0 ° ( gas D 9 1974 a 0 u innicki is m � ,4a o 55' jp0 � o 0 • 946 O 14 o 3 q' i 4973 p 9 40 \... 0 l i0oo� 49 72 R 943 o III. II h 2 9 o� o �I Q /000 li' I o '1 0 ' I'v e . 0 Q 1080 o � 958 Cre o 4971 c o l 0 u o �..• „ o o 87 979 86 /0 // o � i .. - - - -- 126 O -- - -- .._ .970000 -N — — o i — — 1 127 " T / /00 3 ; 15 11 a __.l o - //1/ -� �^ 44 1 52'30" /1S 29 32'30" 1337 9) INTE IOR- GEOLOGICAL SURVEY, RESTON, V RGIN A -19" 539000 -E 9Z30' ROAD CLASSIFICATION a- Safety and Buildings 4003 N KINNEY COULEE RD commerce .Wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary May 24, 2004 CUST ID No.226900 AYTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/24/2006 Identification Numbers Transaction ID No. 1002666 SITE: Site ID No. 683840 Rick Alba Please refer to both identification numbers, Sherwood Forest above, in all correspondence with the agency. Town of Kinnickinnic, 54022 St Croix County SE 1/4, NE 1/4, S23, T2 8N, R18W FOR: Description: Four BEdroom At -Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 959140 Maintenance required; 600 GPD Flow rate; 39 in Soil minimum depth to limiting factor from original grade; System: At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component Manual, SBD - 10573 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Condit No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, APPR stats. The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMENTt )DI�1 OF General Approval Requirements: C � SEE CORRE; • This system is to be constructed and located in accordance with the enclosed approved plans, the "At -grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570- P (R.6/99), the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99) and the publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SHAUN R BIRD Page 2 5/24/04 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 11, Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce. state. wi. us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 1 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 05/14/04 Owner: Rick Alba Location:SE 1 /4NE1 /4 S23 T28 N,R18W Sherwood Forest Kinnickinnic System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01 /81) Page# 1. Cover Page 2. At -Grade Plot Plan °ally 3. At - Grade Cross Section , )8p 4. Pipe Cross Section /Pipe Layout r� MFRCs Z DINGS 5. Pump Chamber Cross Section ;PONDENC 4 �� 6. Pump Curve 7 -8. Maintance and C tigency plan 9 -11. Soil test Shaun Bird �� Signature License number 26900 RECEIVED MAY 18 2004 SAFETY & BLDGS DIV. 1 PLOT PLAN PROJECT Rick Alba ADDRESS 1870 Roselawn Ave Falcon Heiahts Mn 55113 SE 1/4 NE 1/4S 23 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/14/04 BEDROOM 4 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1210 # of chambers none IL BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter ZabelA -100 ❑ BOREHOLE O WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 101 Pro 4 Bedroom House Sherwood Well is to meet all Forest setbacks found in Comm. 83 Tank is to be properly bedded and provided Huffcutt Combo Tank with lockdown covers Grading is to be done to with approved warning divert run -off away labels from system 102' �6 ! B -1 El B- 101.2' 100' B -3 B.M. 8% Area 15' below Slope system is to remain undisturbed Alt. BM. is top of 1/2" pipe @ 99.5' Scale = 1/4" = 10' 660' Property Line L 2:5 g > 5' lie --PVC FO�LEMAtIJ 2:5 t ,� ~ 2 t �- _ TURN— LAPS" W k— otsro%t&UTIO#J LA7E_RAL —� EA STA$1Li2ED oOSEAVombN WELL 5` I/6 B 1 /6B 1/2 B A x_ F{ CELL o F /L - 2 /Z AC,GaEr.arE Mi -Z _Zz Ft. AQPRD SY )4TttEnt Fabric Distribution Lateral -STAB IL '1ILb Observat ion - -� t4 ,-- -Soil Cover W e l l 1 2•• 71, � ' _ . j t 6�� NWEb LAYEQ 2:5 A =2 > 5' Yo SLOPE. Plan View and Cross Section of Wisconsin At -grade Unit with a Single Absorption Area on,a Sloping Site S.tG nt4'TU RE : Ltc.tiNSr- # I Page Of C Distribution Pipe Detail For Two Lateral Network ACCES5 BOX tj TURN -UP (CLEM40U T) Holes Located On Bottom Are Equally Spaced. PVC Force Main i PVC Distribution Pipe Y p 't f P * Last Hole Should Be Next To TURN - UP P Ft. Hole Diameter - Inch X Inches Lateral Diameter Inches) Y`'-� Inches Force Main Diameter Z--_ Inches # Of Holes /Pipe —�� Invert Elevation Of Laterals �Ft. Signed: License Number: Date: i =C AND SPECIFICATION PUMP C.aMB£R CrROS 'Toy, S SECT` SEPTIC wf ArMER APFRt?V £D ABOVE .GRADE j- tjj4CTI0N BOX MNMOLE COYER Z• WEN W ITK CONDUIT W1 PADLOCK 6 i G� V ENT PIPE W INDOW 4R rROK AR�I71yNG V�T�{ �SEr FRESI* �� T ��� icMM Ar GRAfl E i� S i INLET D S EALS TIGHT j . S WITH WATER TIGHT 5 SEAL. i , ALtt �iPPo� fi f- 14 - __ 3 O N smic SOIL AIpE 3' Q -- C ONm SID Pjm OFF gLEV • t F ?- D SOIL BEDF�RG tINDER TANS ►�- iNC,RETE PAD 3 a APPROVE SPA ATE � - ..� Dp5£S PER DAY = 1+NMBEg S EPTIC ! DOS E �{3L3.1ME IKC�II�iG /� i� GAL - TANK MAWFAC GAL- gfl5£ FLdWBpCiC / . 7-�� JGAL- SEPTZC GAL - � -J TAIiiC SIZES fl = TZ'ES: A - �� "..' : GAL. DOSE CAPAC� 2 INC H£S J _ FACZ�3RERS 8 = INCHES `/ ,�, GAL, IJCH 'INCrf£S = ) --_ GA L . C D ^ Q C PUM � �� L-- I y81� 15.23 � etUNDER % �L AS PER MODEL TYPE = ' a� PUMP AS WI RING FEET SWITC � GPK pO � EET DISCfIARGE RAT DIgTRZSOT REQUIRED pUMP OFF A _ _ _ - • FEET - FR ;CTI03 FACTOR , r q FEE? VERTICAL flZFFER�C pp yEPRESSU - MINIMtt NETW STN x ^ ° FT! O D • F� DTAL S?YN `IC i'EAfl / FEET FO WIDTH; DI An E'T�R + ��P L£N6� oe TNT��AI' DiMENgIflI�S Q� DA LICENSE �Mg�R •. SIGNED'- _r.- -- :I88 . 70TAL DYNAViC HEAD /CAPACITY p_R MINUTE AD CAA PCITY CURVE HE EFFLUENT AND DEWATERiNG ^ • ►v10DEt_ 152/15 � MoD EL ��- 7- 1 - 15,311 -711 i I Feet l Meters Goi. Liters l Gol. Liters g 77 291 Sp 5 I 1.5 � 6S I 261 70 1 265 153 10 1 3.1 1 61 231 i 1 5 ; 4.6 1 53 201 61 231 12 4 152 I I 2r , 6.1 44 I 157 I 52 197 W I L � 7 6 �4 129 42 159 30 30 9.1 '� I 67 33 i 1 .5 i I Z 8 '.0.7 -- I 22 i B5 20 40 12.2 � -- 11 ; 42 ; o �fi.O Ft )� (i d ) L ock Volve7 I' . (11.6m 4�.Q t. 1 ..M � ( 674500 4 10 I p I 40 gp 100 20 60 GALLONS LITERS 160 240 320 - 3 2 _ 7/32 , 4 5/8� p BO - FLOW PER MINUTE 9 I 3 _7132 - i 1® CONSULT FACTORY FOR SPECIAL APPLICATIONS 27/32 • Timed dosing panels available. lied with 1 • Electrical alternators, for duplex systems, are available and supplied ,– an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Ctwik -Box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. I t 152N53 Series Control n I I ! t t 1 3 E 5 :/5 Model Vplta Ph Mode Am a Sim lex I Du lex 5 t 2 or 3 I sxzow N152 115 1 Non 8 ( 2 or 3 ---I— 8.5 lnoluded 1 l ON152 t23O 1 Auto 4.3 1 2o,3 E152 1 Non BE152 1 Auto 4.3 Included 2 or 3 10.5 t 2or3 SELECTION GUIDE N1 1 Non 10.5 Inclu 2 or 3 BN1 53 1 ded A uto 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float E153 1 Non .3 t Iww 5.'s Inaludetl _L0 3 switch. Reter to FM0477. o CAU71oN 2. See FM0712 for correct model of Electrical Altemator E -Pak. du lex 3 . Variable level control switch 10 -026 used as a control activator, specify p ( ) All Installation of controls, protection devices and wiring should be done by a qualified or (4) float system. recent National Electric Co NEC) end the ccupational safety fo and Health Act (05m). RESERVE POWERED DESIGN . urn zoeiier For unusual conditions a reserve safety factor is engineered into the design of every p ump. MI. TO: P.O. BOX 15347 Louisville, KY 40256 -0347 Manufacturarsof. . SHIP t0: 3649 Cane Run Road ( Louisville, KY 40211.1961 QudwrrPuMV SncE /939 / / � (501 F AX(502) 77403624 PUMP httleywww.zoeller.cam �/ C Copyright 2000 Zoeller Co. All rights reserved. - EMT PLAN Page of _ .'' S OwNER'S MANUAL & MANA gPECiFlCAT10NS POWT SYSTEM nNA Septic Tank t'.aPa FILE INFO Owns EtMAT1ON Septic Tank Manufacturer r � C�tl rer E ff lue nt M anufa Effl nt F Permits. O NA N PiPAMETO d NA Effluent Filter Model al 0 NA DESlO �� Capacity toorr� Pump-Tank . Number of Bed manufacturer Units ank NA M . ber of CommeI U d Pump T um aV N Estimated flow (average) aVd . Pump Manufac+r� i a (Es x 'I.5} .•.: � Pump Mode{ Design flow (peak)+ al/d son Application average Pretr Monthly ��ent Unit D Peat Filter O 5andlGravel Fatter n [3 Wetland ratio lnfluer�Elfluent Quality Sat) mglL p Med�anlcal Ae D Other. Fats'.011 8 Grease B °O G �fl mg/L ❑ Disinf�on Demand Dom r Biochemical Oxygen n SS s't50 m n- Manufacture Total Suspen Solids (T SS) D cetl(s) Pty Effluent Quality • ❑ NA Monthly average" I round (gravity) D mound in (pressurized) 530 mg/L race O Mound en Demand (8005) At'g 0 Other_ Biochemical OxY9 530 m91L 0 ri - ne Total Suspended Solids (TSS) s . l o4 � ooml no � %vastewamr end Fecal Coltfotm (g eometric mean) Values typical for domestic y, inchd iameter ��b�elfluent. „�stewa Maximum Effluent Particle Size Values types for pretreated MAINTENANCE SCHgDULE Service Frequency D months earls) (Maximum 3 yrs.) Semite Event At Least once every uais one -third (1S) of tank volume rnspectcondition of tanks) When combined sludge and scum e4 r(s) (Maximum 3 yrs -) Pump out contents of tanks) O month At least once every � m onth ear( Inspect dispersal col I (s ) At least once every year(s) t3 NA Clean effluent filter mon At (east once every Inspect pump. Pump controls & alarm At l once every O months Yes) DNA to test p months D year(s) D NA Flush laWaW and p rew At least once every s) ❑ NA 01w_ At least once every C3 months fl year( Color_ MAINTENANCE INSTRUCTIONS an individual csrr one of the following licenses or Of tanks and dispersal cells shalt be made b S tnsPector, POWTS Maintainer, or bro e Inspections Restricted Sewer; POVYf to identify any trussing or broken oertlfic'ns: Master Plumber. Master Plumber on of the tan for any back up r. Tank inspecdons must include afOvis a of com bined sludge and scull' and tO check t levels O ure - the ins to cffluen Ser�dn9 P meal suali P heck the e the le aks, visually ton hardware, identity any mocks °r lea Th dispersal cell(s) shalt be riding of Cory a ut hori ty - t en the ground surface riding of effluent on the ground surface• and to check for any PO T p° ulatory or ponding of effluen in the observation Pines wires the Immediate notification of the local reg t may indicate a failing condition and um eq uals one -third (yQ or more of the tank volum ch NR ground surface a and scum in any tank eq S eQ of In accordance with When the combined accumulation of sludg a Septa9e Servicing Operator and dispo entire contents of the tank shall be removed by retreat�mentponents, and anY 113, Wisconsin Administrative Code. onents. p . 'n of effluent fitters, mechanical or pressurized POVVrS by a certified POWTS Maintainer. comp The Mvid g at ;ntervals of 12 months or less shall be p2 of completion of any service event other mair>tenanoe orb m onito r ing to the Iocai regulatory authority witfiin 10 days A some report shalt Provi for �e Presence of painting products or other START UP AND OPERATION of the pOWTS check treatment tanks) if high concentrations are For new oonsavdion, P o' to use treatment process and/or damage the dispe� cells for prior to use. chemicals that may impel a the removed by a septage servicing ope detected have the contents of the tank(s) ! a Page of- �. conditions are frozen at the infiltrative surface- is restored the excess s hat[ not occur wtten soft h hwatet leve s. W,en ppwer and may result in the S start up g above normal 1S . ovettoading the cells) utages pump tanks oett(s) in bne large dose, tank removed by a buying Powe rn� dLanged to the t To avoid this situation have the C' con tact a the or pOWTS Maintainer to or orP sucfa�e O per a d r p n9 'power to the effluent pump wasw age Servicing bvgs t restore normal levels within the pump tank moist in man P .. cells. Do not drive or park over, or othemiSe disturb or compact, ually opemdng the p vehicles over tanks and dispel lion area - Do not drive or Pa mound or at - grade soil absorP f anY ter stream may imprpYe the performance and prolong the rde the area within 15 feet down slope o or el'unination of the f+olktwir►8 from the wastewa . ,cotton swab degreasem: dental floss: diapers Reduction tte butts: condomsPOI ntibiotics; baby wipes; dg� water f and veg etable peelings; gasoline of the PO ; grease; herbicides; meat �t; fat fowida5cri drain (surnF P est na kins; tampons:'and wa ter brine. dialfa scraps; moons; of painting products: tlpdes; sanitary P ABANDOM� �nny.taken out of service the following steps shat! tae taken to insure that the NM When the POWTS Halls and/or is perm laance with �- system Comm 83.33, y/rsconsin Administrative Code: is property send safeh abandoned in Comp r Wings seated- be disconnected and the abandoned pipe a Servici Operator. . All piping to tanks and pits om its shalt be removed and property disposed of by a Sep 9 g The contents of all tanks and P excavated 8nd removed or their covers removed and the void space Afbar pumping, all tanks and pits Shat[ be filled with so il , gravel or another inert solid material. CONTINGENCY PLAN following measures have been, or must be taken, to Provide a code If the POWTS faits and cannot be repaired the compliant replacement system ction A suitable r and should not epl�ment area been has evaluated and may be utilized for the location of a replacement sod !a absorption � • 6 re placement area should be protected from disturbance and comps tem. be infringed upon by required setbacks from existing and proposed structure' l lines and wells. Failure to re p lacement area vrrllt result in the need for a new soil and site evaluation to establish a suitable protect the rep ms must comply with the rules in effect at that time• replacement area. Replacement Syste suitable replacement area is not available due �s res to rep a ' tire failed POVtf rS- advances in POWT O ' be Installed technology a holding tank may d as failure of the POV1lTS a sod an e Site has not been evaluated to identify suitable replacement area. Upon locate a suitable replacement area. if no replacement site evaluation must be P�oa"� to area is available a holding tank may be inslalled as a last resort to replace the failed POV''TS- ound and at -grade soil absorption systems may be reconstructed in place foll rus rem at that time. at th infiltrative surface. ReoonstFUCd°ns of such systems must comply <<WARNING>> NTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. TANKS MAY CO ANY SEPTIC, PUMP AND OTHER TREATMENT CIRCUMSTANCES. DEATH MAY DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR [MPOSSISLE. ADDITIONAL COMMENTS POWTS MAINTAINER POWTS INSTALLER III Name a ck, i Name Q w �✓ Phone Phone 4 SEPTAGE SERVICING OPERATOR Pt! PER 1111 LOCAL REGULATORY AUTHORITY Name 7a% Phone Phone 6'� 21 '' and Sanitation agendas. This document meats the status of the (2) Lake, Marquette and Waushara County Zoning This dowment was drAW by t ,� s 3.5s(t }. (2) & (3). Wisconsin AdrttlnlstratiYa Code. Use Of 'W document does not th e minimum requirements of ch. Comm 83.22(ZXb)( Xd)8(4 GMW (mot) guarantee the perforrnance of the POVVTS. Ao 0 Wisconsin Department of Commerce - - OIL EVAL'UATION REPORT Pag of Division of Safety and Buildings g F Il accordance with Comm '85, Wis. Adm. Code i County v� - O r© I Attach complete site plan on pa r not les than 8 2g ,1 t inches in size. Plan must include, but not limited to: verUca and h §A(ital.Fetrehce point (BM), direction and Parcel I.D. percent slope, scale or dimensio s, north arrow, and location and ditjtance ton cad. Pleas prirtf aW'����r�l�(���,a... ,�. r Re 'ewed by a Personal information you pr ovide ma be u \ Y Pr ry Puryoaes (Privacy Law, 1i.�)� (613 /0 Property Owner Pro cation 2'L/c �C - a3 / a.� Govt. Lot 114 "114 S T N R E o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# d' .r C� 2 -5 i -- (�0 f 9 1 S� 1 4o O City 9' State Zip Cods F bone Number 0 City ❑ Village Nearest Road r New Construction Use• Residential / Number of bedrooms Code derived design flow rate GPD oReplacement Public or commercial - Describe: Parent material J �. �' Flood Plain elevation if applicable ft. General txanments and recommendations: 7 — V-I� Boring # A Boring Pit Ground surface elev.4 Depth to limiting factor in. Sal Application 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 'Eff#2 31z , /h -,;i(- Z i r 1��Y ' © Ong # Boring Pit Ground surface ele/ ft. Depth to limiting factor ��� in. Soil Application 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 `Eff#2 Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �' �� 715 - 246 -4516 Property Owner _ Parcel ID # Page of Boring �/`� ❑ Boring it Ground surface elev. ft. Depth to limiting factor in. Soil Application 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 C ✓ �- r /77 r 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/Ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 •Eff#2 F [] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application 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 - Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mgll- ' Effluent #2 = BOD < 30 mgA- and TSS < 30 mglL 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. SOD-9330 (R.6(00) Soil Test Plot Pla Project Name Rick Alba m Sha ird Address 1870 Roselawn Ave W. Falcon Heights Mn 55113 M 4226900 Lot ----- Subdivision - ------ Date /14/04 SE 1/4 NE 1/4S 23 T 28 N /R W Township FCinniddnnic Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. = Top of 1/2" pipe = 5►M4� System Elevation 101.2' *HRPSameas Benchmark Scale is 1" = 40' unless otherwise noted Sherwood Forest l 102' B-1 B -2 101.2' 100' B- 3 B.M. 8% Slope It. B is top of 1 pipe @ 99.5' Scale = 1/4" = 10' -6691 Property Line a 1y/- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND. OWNERSHIP CERTIFICATION FORM OwnerBuyer �, / Mailing Address 2-! ac.�� Property Address 0 (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location , ->-jt:-' r /st '15 r/,, Sec. , T � N -R/ Y—W, Town of Subdivision , Lot # �. Certified Survey Map # q/ 7/ 3 2 - , Volume . . Page # 1 - 0 Warranty Deed # 4 3 T/3 , Volume _ 25'7 9 , Page # 6- Spec house ❑ Y o Lot lines identifiabVeZes El no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewater disposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin - Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ,A 6g�L -- SI OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.*** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DEPARTMENT Q REPO RT ON IL WRINGS AND S A FETY & BUI LDING S N INDUSTRY, DIVISIO LABOR AND PERCOLAT l P.O. Box 7969 LABOR RELATIONS T (115) MADISON, volt 5 53707 (1"163.0969) & ChaPtifr 145.046) /MUNICIPALITY: O• I SLISDI V I � N�� S )1 r -1 / 4 ,�Y N j R re or iL►af ►C k /Ai 1 OUNTY: � Cu x T-r 3 � C#1 C Id -r � VF_ rR __ DATO OBURVATION& list Residence ._ f'�l Y �`.,{ ,�( C►Replaoa -fit - !SolL:. — 8rJC� .. iJ� f - C�cctioBfblM RATING: 0- Site suitable for system Lie Site unwttebls for William IN-PIL K: RlticOMlMfcNOED sYf#T'I M,(optionatl v U M S DU N �QU EIS U i�..1 S U1 if Percolation Tests era NOT required DES~ N ATE: if any portion of the tested tires is in tha _^ ~^ under s.1­163.09(5)(bl, indicate:: '"" 4 i Floodplain, indicate Floo t ion: in e lsva N• 14 <c : PROFILE DESCRIPTI BARING TOTAL P A I A A L ! lam, L" jt 1' X� UR� AND DEPTH NI.M4�ER ELL"- 1IATiC3N T aE R K IF OBSERVE E A BRV. ON SACK.) ®- J 12 S `s. l� N� .'j47� IZ $LSL. 3t 1,w- R1,I T g3cn. & Q C'� 9 � .q .7 �• i P " A �. Wa � air Q Ei. e• 3 { 7 9 a -C 4.66 '*A ts em I i a i Sy s _Q. / ems► �. AA A PERCOLATION TESTS . TEST DEPTH I WAT R IN MOLE TOT TM NUMIEIER 1 AFT A4ii 6LLIN INTERVAL-MIN. - __ . fi _ PFR INCkt w PLOT PLAN: Shoo+, iacations of percolation tests, sail borings and the dimensions of suitalbie s. Indjoirts txaf+t stances. Doseriba what .are the hori sontel and vertical elevation retevertm, paints and show their location an the plot plsa. ;Show t iq+[e � borin" and the direction and tvrceni of lend slope. I j SYSTEM ELEVATION A/A T it I!_._2579P 620 - 7 63 - 7 13 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 05/25/2004 08:00AM THIS DEED, made between Michael P. a Stromber g single le WARRANTY DEED Grantor, and Rick I. Alba and Marcie A. Chevalier, husband and wife, as EXEMPT # Survivorship Marital Property, Grantee. REC FEE: 13.00 Grantor, for a valuable consideration, cones and warrants to G rantee TRANS FEE: 315.00 tder y G the following described real estate in St. Croix County, State of Wisconsin: COPY FEE: CC FEE: PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Edy to Realty Ti ,Inc. Rj ek i - A lbei 400 S. ° — Suite 115 /'g'7'0 4 H sdw 1(e Exceptions to warranties: Hu , WI Easements, restrictions and rights -of -way of record, if any. 0584 Fa�[ttrri f}�i�t'1tS, /Il N SS //3 DU -d ?j 022 - 1065 -50 -002 Parcel Identification Number (PIN) This is not homestead property. Dated this 21st day of M y, 2 * chael tromberg * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) PIERCE COUNTY. ) ss. authenticated this 21st day o 004 41. , Tary Public Personally came before me this May 21, 2004 the above oi ` ' of W named Michael P. Stromberg, a single person to me known to * � !t TITLE: MEMBER STATE BAR OF WISCONSIN be the person(s) who executed the foregoing instrument and acknowl ged the same. (If not, authorized by § 706.06, Wis. Stats.) L AI, THIS INSTRUMENT WAS DRAFTED BY *Diane M. Barron Peterson, Fram & Ber otary Public, State of Wisconsin gman — Steven My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 5510 1 Bruns 11/19/2006 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 U 2579P 621 EXHIBIT A LOT SI ) OF CERTIFIED SURVEY MAP IN VOLUME SIX (6) OF CERTIFIED SURVEY MAPS, PAGE AS DOCUMENT NUMBER 417132; FILED IN ST. CROIX COUNTY RE ISTER OF DEEDS OFFICE ON SEPTEMBER 18, 1986, BEING LOCATED IN THE SOUTHEAST QUART R OF THE NORTHEAST QUARTER (SEIK OF NEX) OF SECTION TWENTY THREE (23), TOWNSHIP ENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC, FORM LY PART OF LOT 4 OF CERTIFIED SURVEY MAP IN VOLUME 6, PAGE 1635, AS DOCUMENT NUM ER 409847, FORMERLY PART OF LOT 2 OF CERTIFIED SURVEY MAP IN VOLUME 5, PAGE 1408, A DOCUMENT NUMBER 392275. i Subject to 140 Street right of way. St. Croix County, Wisconsin. I 4171.12 CERTIFIED SURVEY MAP Located in the SE1 /4 of the NE1 /4 of Section 23, T28N, R18W, Town of Kinnickinnic, St. Croix County, Wisconsin being also a part of that Certified Survey Map recorded in Volume 5, Page 1408 Surveyed for: Jeanette M. Leonard 386 W . Church NE CORNER River Fal1•s, WI 54022 SECTION 23 (a o �, $ _U I� 8 89'41'25 647.22' .16 6 PRED 614.22' 33' SEP 1P 7 % L NORTH LINE OF THE SEI /4 OF THE NE 1/4 I aGomm CA LOT 7 LEGEND 214747 SO. F7. (4.930 ACRES) ( <I (' INCLUDING RIGHT Of WAY III SECTION CORNER 20378 so.. fr. (4.679 eY2RES) FI 3 MONUMENT EXCLUDING RIGHT OF WAY w I It I" IRON PIPE FOUND N � O I ° X24 ° ROUND IRON S 89 0 41 0 25 0 E 647.28 ' 1 0 PIPE WEIGHING 614.28' 33 I I C 1.68 LBS / LIN. (W`I Q Z FT. SET LOT 6 NII W c W W 214297 SO. FT. ( 4.920 ACRES) 4 (0I W INCLUDING RIGHT OF WAY a 203395 SOFT. (4.670 ACRES) W � NI QI OQ r (q EXCLUDING RIGHT OF WAY N M a I M of C W I't I W 13 "_) 8 89' 49' 10' E 647.34' `_° . W r-I W Z >- v' I n a 614.34' M 33` m aI it O >�wl alp! c, o r.� (L U- � Jio a LOT 5 W I• 'i ��' O U) �I W I'o > I 429110 SO. FT. (9.851 ACRES) O z \ OIti10I OLI INCLUDING RIGHT OF WAY >I 4I 386982 SOFT. (8.884 A CRES) W W WI EXCLUDING RIGHT OF WAY i m3 "I W I W I) IA I . C (n I C; x�l LL I OI � I all w 6. 6' E 1/4 CORNER N 89 56 55" W SECTION 23 _ 614.46' r T28N. R18W �y 4 � 64525 25 TH O DRI VE _ LLO T' N8905 /6'55 " W_ (0 _ N_89 0 56 0 55 0 M 64 7. 47 ' _ _ t W 1/4 CORNER _UNPLATTED LANQ$- SECTION 23 SCAN FEET 1 200' A pF`� `, 0 100 200 /y �" O y ED 1 7 Volume 6 Page 1710: SEP 1986 I. C 'RO'X COUNTY CO b 7 P „ EHPNSIYE A PARKS PUNNING NU ZONING COMM►TTEE 485 -569