Loading...
HomeMy WebLinkAbout022-1077-80-000 Wisconsin Deprartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506216 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: Penton, Bryan Kinnickinnic, Town of 022 - 1077 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: a$ , 9 ry \ Z c5 27.28.18.P430G TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , M CAPACITY STATION BS HI I FS ELEV. Septic / Benchmark ZOO Q poi� 4' 7Sd Alt. BIv}.. AerAm 1 (1 SZ Bldg. Sewer 54 Holding SVHtInlet • 57 q �S3 TANK SETBACK INFORMATION SVHt Outlet 9y, 3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic ( Dt Bottom � 1 Dosing " Header /Man. Aeration Dist. Pipe 1 rp • 19 $Q, 'S 1 1•z 77 Holding Bot. System 1 7 . 1 17. PUMP /SIPHON INFORMATION Final Grade IM • 3 ��•� Manufacturer ° nd St Coved -, CC- 5 g � ��• Model Nu r ��' � t 7' $ ��• TDH I ift Friction Loss Syste ad TDH Ft �- ` ,� •� �� AAL Forcemain Len th Dia. Dist. to Well 9 1 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Tre nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 71, R 1 �• e �} SETBACK SYSTEM TO ! `,' P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ..L.^ Type Of System: UNIT C a �( ! e— Model Number: D vbJet�t7�� /� � � N J: DISTRIBUTION SYSTEM I f +-I 9 f' (9 57 tf +J , Header /Manifold, it Distribution x Hole Size x Hole Sp sing Vent to Air take [j Pipe(s) ` Z rte. QEr Length 7— 1 Dia r Length D a Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over If Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 3 Bed/Trench Edges \ Topsoil \ SYes [:] No I S E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 146 Cty. Rd. JJ River Falls, WI 54022 (NW 1/4 SE 1/4 27 T28N R18W) NA Lot 1 / Parcel No: 27.28.18.P430G 1.) Alt BM Description = �� Vim-• G�,�at : ,n,S � — � Is 2.) Bldg sewer length p - amount of cover = jX� �"� 1' , E•e Q`Xe_.Ip Plan revision Required? El Yes No 0 _ J � 7 Use other side for additional information. - -___ , _ SBD -6710 (R.3/97) Date Insepc Cert. No. commerce.wi'.gov Safety and Buildings n County 201 W. Washington Av P. ox 7162 seo n Madison, WI 537 - Sanitary Permit Number (to be fille in by Co.) Department of Commrc ee Sanitary Permit Application State TransactnNumber In accordance with s_ Comm. 83.21(2). Wis. Adm. Code, submission of this form to the appropriate vem /v/ unit is required prior to obtaining a sanitary permit. Note: Appl' ion forms for state -owned WT are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal intomiatio you prey condary ' u oses in accordance with the Privac Law, s. 15.04(1)(m), St.". f� C 1. Application Information - Please Print All Information Propert Owner's Name Parcel # l� if P r n 1o, JUN 0 1 2007 -f97 7 - eM Property Owner Mailing Address Property Location 3e /r LL COUNTY — s Govt. Lot `_ City State ` F,2 p Code Phone um Y, Section 7 lU�� yo�� — ,., � . � L /� r- � - ,,,_y trcle o '` 11. Type of Building (check all that apply) Lot # T N; R E `i_J I or 2 Famdv Dwelling -- Number of Bedrooms Subdivision Name Block # ❑ Public /Commercial - Describe Use _ Citv or ❑ State Owned - Describe Use CSM 7;/ ❑ Village of � Tow n of iC /h/'I C [�1/I r Ill. Type of Permit: (Check only one box on line A. Complete line B if pplicable) ` . New System ❑ y I'�Replacement System ❑ Treatment/Ho ]ding Tank Replacement Only El Other Modification to Existing System (explain) B. El Permit Previous Permit Number and Date Issued Pelmit Renewal ❑Permit Revision ❑ Change of Plumber ❑Permit Transfer to New p � Before piration Owner 0� 7 / 7i IV. T , > pfof POW TS System/Component/Device: Check all that apply) + V - 4-Pressurized In- Ground wed -Ir round ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) _ El Pretreat nt Device (e lain) 41 op A V. Dis ersalfrreatment Area Information: /7 6 Design Flow (gpd) Design Soil Application Rate(gpdsO Dispersal Area Required (st) Dispersal Area Pr po�d,(st] System Elevation C� - . i 1 pp A x a 7 3 �$S Vt. Tank Info Capacity in Total # of Manufacturer d Gallons Gallons Units New Tanks Existing Tanks a ) o v as Septic or Holding Tank aarz _ x Dosing Chamber (Y+ G .19 / - V11. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. K ber's Name (Prin Plumber's Signature NIP /MPRS Number Business Phob 0 �>,V - � Plum is dress (St eet, City, t . Zip Cod y r - � V A 4);r ��� Vlll. Co !De artment Use Only Permit Fee Date Issued Issuing Agent QnaturO roved ❑ Disapproved S �� I ,, -/ 11 Owner Given Reason for Denial U/ t' J UC-93(%TLRQP � lj W9val/Reasons for Disapproval 1 Septic tank, effluent filter and �� � �� dispersal cell must all be serviced / maintained -71' 00 qqq as per management plan provided by plumber. lLV Q Qygl/ 2. All setback requirements must be maintained J G� as per 81PP 1t1ME fft . for the system and submi o 0 ounty only on a er not less than 8 1/2r I 1 inches in size 1 67 SBD -6398 (R. 01/07) Valid thn101 /09 2 �j Sin �U Z12 �f C_14 Safety and Buildings Division County Nv n sin 201 W. Washington Ave., P.O. Box 7162 Madis SCO on, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) o Commerce (608) 266 -3151 Dep f Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code,personttl information you provide may be used for secondary purposes Privagy Law, s15.040 Xm) Project Address (if different than iling address) I. Application Information - Please Print All'Itiformation Property Owner's Name Parcel # t # Block # Property Owner's Mailing Address ` rProperty lionCity, State Zip Code Phone Number '/,, Section (circle one) R E or W H. Type of Building (check all that t ply) Subdivision Name CSM Number El or 2 Family Dwelling - Number of Bed ms ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City_ ❑village ❑Township of III. Type of Permit: (Check only one box o line A. Complete line B if applicali A. ❑ New System ❑ Replacement Sys ❑ Treatment/Holding Tank R acement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ermit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber weer IV. Type of POWTS System: Check all that a pplyl ❑ Non - Pressurized In- Ground ❑ Mound >24 in. of suite . soil Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber rip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis rsal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Now Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement - the undersigned, assume responsibility for i e POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature M Busines Phone Numbe o s 76 Plumber's Address (Street C' , S e, Kip Code / } r /D� 11 S VIII. County/Department Use On Approved ❑ isapproved Sanitary Permit Fee (includes Ground wa Date Issued issuing Agent Signature (No Stamps) Surcharge Fee) Owner Given Reason for Denial IX. Condition of Approval/Reasons for Disapproval Attach complete plans (to the County only) for the system on paper not less than 81/2 x I I inches in size SBD -6398 (R. 01/03) 14 / E VRP 1> r, ,ea�6 �� s Y RJR ��Y�� �� ex:s7•�� A �hc7HCe—�L ��3- I _ IDa -O - � s td '�t1 t�L, �P �A �t'Cr1 IL 2. rr � a x 6 � 6 CA T 0 b r;p% k -J, `hn,`C �l \CIG l �r sc�.r fCS7 Y� Dcrf' Pot, 3 uT J w e l l a- n �VRP �0 b�. G�euse� 1�a5 �ee11 n Qull RLkA Ua �v� I, s M 91,0 4 ► 8 4.0 al x a 61 [:corJ EIVED f 2 5 2007 Wisconsin Department of Commer SOIL VALUA EPORT Page / of Division of Safety and Buildings O COUNTY ance with Comm 5, Wis. Adm. Code f Cou nty 5 Ck o "X Attach complete site plan on pap s than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. > percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 1 O o4-C - /b7 7- Si' U 0 Please print all information. eviewed Date I /�� Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Cdr ' - V Property Owner 1 Property Location 8 #- ' Y aN ( day Lee Bch fog Geo..ket /VkV 1/4 SL' 1/4 S a7 T 2Y N R/ f -5-We Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# i 4 >s C/Q J — V i P 3 City State Zip Code Phone Number ❑ City ❑ Village J& Town Nearest Road ve• i ►� /.�r S4 �.� ( 7ir 9 z -8 � k ,' h a ; K ;,6 ti. C R <T T ❑ New Construction Use Vf Residential/ Number of bedrooms 44 Code deriv d design flow rate - 41 I&M GPD Replacement ❑ Public or commercial - Describe: l Z Parent material G d/ 7`i// Flood Plain elevation if applicable *VA ft. General comments �` 6 e 4(�e - ;s "4 n o c..., . % It s � S t S rn. y. . M e -r * et.a 0(,r d 7 and recommendations: Y d .srF. !�r r, on ce ,'r fo '6 71 7 9" , ee 0/ Terr 5' 6e j T r�� per •ks'`a ��� s s>Ca4 ca er.J t�r+� 07 sevead/ rows at^ �ed pcl+• "�' cAd- 7400 -r 2 T' 2 oCe �`liol�' �, o �C'f de /v�✓ �,.aZdP. /e. d h .h j /thlt.ve "lea C>.75; I LY' �ea/rr.+. s t7i/� wrier /<f� v� r�,Le `err �tnjfs. Boring Boring # p > �� IL Pit Ground surface elev. a 9 ' ft. Depth on R a Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 I - Eff#2 1 0 - 1 3 7S / s l tr Pr .S , IC c> -4 6- l3 3 7-.,$- rA ez, s 1 4 , 0-16 40 3 3 - 30 7.Si X ,1 - 4 I ilt A, /` k st S l � OL 30 -8 - s`Y.e6A' IL 0_7 1. ,6 Boring # � Boring Pit Ground surface elev. rrZ� ft. Depth to limiting factor > o in. Soil Application Rate Horizon I Depth Dominant Colorl Redox Description Texture Structure Consistence Boundary Roots . GPD/ffr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 7 6 .s m >ss/ -- - - o.7 i cf r i a Effluent #1 = BOD > 30 < 220 mg/L RhR TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number O C 73 . Address Evaluation Conducted Telephone Number .+�S�i.S� �'?��� s r_ .� '1s� � a-. f�, �c�,�" .� --,�. a l j �.=� �� /a ��s' ° 273 •3 4 �' v Property Owner 8 ry �� C/ �d /�eh'te a. Parcel ID # ®Z,� � D 7 " e1 � Q Page of 3 ❑ Boring # ❑ Boring Pit Ground surface elev. O- 0 ft. Depth to limiting factor ° in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 !L 7 zs ❑ Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. off #1 F-1 ❑ ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil ADDlication Rate .Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IP in. Munsell Qu. Sz. Cont. Color Gr. Sz: Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/l_ and TSS >30 < 150 mg/L * Effluent #2 BOD < 30 mg/L and TSS <_ 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -5330 (R.07 100) ��t #c•� A, ro fcs f Pot well ' ce VRP Y Rl�� �oY ex:s7.A ��; .K fdc`h ,�. steno to aHr- _F /= °j- -szx , st w M1 D 14 e r Lam' l n 8 j 6 � CA T ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyerd� Mailing Address UT Property Address (Verification re uired from Planning & Zoning Department for new construction.) City/State kl b �r � / �l e Parcel Identification Number LEGAL DESCRIPTION / Z/ Property Location '/4 , S '/4 , Sec. (/ T P? N R RJQ, Town of �P Lot P. Subdivision , e Ma # F- / , Volume AV 0 l 1 , Page # Certified Survey r I Warranty Deed # , Volume ! , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on- wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 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 reference is made in the warranty deed. (REV. 08/05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify Aiat I have inspected the septic tank presently serving the -�' - h n �b y► residence located at: � 1 /4, Section - 2� 7 , Town N e Ran g _ZfW, Town of lj , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service l Q Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate v+ me or len of time: gallons minutes Capacity: / � O �". �z - &a7� Construction: Prefab Concrete Steel Other Manufacturer (if known): �tl,e2 Age of Tank (if known): (Licensed Plumber Signatur (Print Name) (Title) (License Number) MP/MPRS I (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer R 113 Wisconsin Administrative P (N Code ado�'`"VG. System Management Plan Pu�'suant to Comm 83.54, His.Adm. Code Sectic Tank The septic tank shalfbe maintained by an individual certified to service septic tanks under S. 281 .48, Stars. contents of the septic tank shalt be disposed of in ac�nc rdae with NR 113, Wis. Adm. Code. The operating carxfition of the septic Cutlet after• stoma be assessed at least once ever 3 ears b ins ecdon- Tne outlet fitter W& ensure Proper' operation. The Ater Y Y Y P iii be waned as necessary to and may slough off the filter why cartridge should not be removed unless pro 'visions are made to retain solids in the tank that the alarm is actuated removed from its en�c sure. If the fitter is equipped with an - - „ the fitter &W be serviced if lnterrr tent after alarms may indicate surge lbws or an impending contaurous aWM T '.. septic tank shag have its contents removed when the volume of sludge and scum in the tank exceeds 113 the Aq vckm of ft tank. If the contents of the tank are not removed at the time of a triennial assessment, m nce p shah advise Wd the' of when the next service needs to be performed to maintain less ttwn ma*= Stunt and s4dge onnel s a shal advise However such � n of biological or chemical adites to enhance septic tank pefkmr = is 9sher;ly not required. in � Olvisba are used they shag be approved for seplic tank use by the Deparanent of C" nterce. Safety and The Pump (dosing) tank shill be inspected at least once every 3 years. AU switches, alarms, and pumps shwa be test8d to 1 f e l proper ot>eraibn. If an eftiuent t6ter is inShW wg� the tank A shag be inspected and serviced as necessary. At- rade Component and Pressure Distribution System tc o.es.or s rn s s on e p sate a owe to grow on the component. Plantings may made co e around the perimeter and the component shall be seeded and mulched as necessary 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 BOD this far this installation. , 150 mg /L TSS and 30 m FOG. Influent flow may not exceed the maximum design flow specified in the permit 7be n SyStlin Is Provided wM a flushbg lateral be u l� COnVWW Of d $096 at least once l at the end of each lateral, and A is m that each b the litaist test when the was l de m nuns o P�+m test is p It should be mci mad to nraintaln equal man within the caL ° MW critics cleaning is Observation pipes be the dis P levels should uld bt persal cell shall be for effluent ponding. reported to the owner and any levels above 4 inches considered' as an impending hydraulic failure requiring additional, more frequent monitoring in accordance with 83.52 (2). ' General t o System shall be operated in accordance with Comm '82-84 Wis.Adm.Code and shall be . maintained in accordance with it.3 component manual SBD 10 570 - P'(R.6 /99) local and state rules pertsiairig to system maintenance and maintenance reporting._ No one should ever enter a septic or pump tank since FO -S = nee shag be b � wah torten . WbL AAdm. Code when the tanks lie no longer used as Sept or Pmv tank tear & and �. access risers and cav should be for water %l*Was and soundness. Access Wwom d for serv . d 0303 srt 1014 s hwa be sealed opeidi lasso ed be aeczued die to mod. t xposed a te 8.1dw in dta peter shad ._ ..� Poem accidental or umuftdnd entry 6tto a tank or contponerti. pt " Of 18 CoaWne become detective the tank or shall be repakhe ed or red to keep ' if the p V mss, alarm or tet�ed wimp die the defiac re corriportentt arras be - I or reps r� a of are same or equal pedOem�e- - -- • — -the at -grade component fails to accept siaste'viiter 3ris�to disc arse wastevatei - to the gionnd surface, it may be necessary to install sa aerobic pre - treatment unit or .replace the component. Additional site and. Soil' evaluations may need to be. done. and additional plans may to be prepared and approved by the Department of Commerce,* - Safety and Building;* Division. . Questio>as.about the aperatiou'or maintenance of this system Si iii directed to� - The County Zoning Office at : ; 6j r , . r-.. -- The system installer at ">ls_ Z$_ �3QS3; Wiwir 7 , T�v The tank manufacturer at �pp_ 1��R The effluent filter' manufacturer at $ - 221 _ S_14 Z. 7_"%M z'Y►e. °"o.,,,,, ' ` • - -6 3 O- 112A q �' Got►�.ps Y DOCUMENT N,_3 WARRANTY DEED F •,. t..._.,F... .: - STATE BAR OF WISCONSIN FORM1r 2-1982 Ronald V. Riisager and Donna L. Riisager, husband and wiFe.; . NOV 991 OV - i? A. vouvc -ya awl warrants tr, _ .DYyBn J....ri;U lC?t l.- ?JLJSJ_.I�Gy . f�t�4.. icit,wit,, :I '�R "17•- �.. -+.•+ a= 9 - ;.r husband. and wife, {; the iolluwinq described real estate in ...... _... ..`J �-.-CXR2? ..... ...... -- Coun[y, state of Wisconsin: I Tax Pareel No: ... .. . ............... .. t ; ii i�rr r n F rho P7W1 /4 n F SF.1 /4 of SE.c L ion 27. "lbwnshiD 28 North. Range 18 West, !� St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey I! �I Map filed April 16, 1982, in Vol. "4 ", page 1155, Doc. No. 377145. ' i1 �tII I : i •i� r .t : i t' 9r.:�i {� }� f' I home stead p iG... - -. pro - -- - -- - - �j ceittion to wnrrttnties: r�t�uclt Its , rc� tiiCi_LVSia ctitu ririita of - tvuy of ' if any. day ul ' _ca�.� Wit--- t -� �4 f . c Ronald V. Ri_is!�er _.. .. —(SEAL.) ISEAI,t 14 ... _ Dopri a L.. .Ri s -ager- ; it AUTHENTICATION ACKNOWLEDGMENT �! STATE OF WISCONSH ;! i St. Croix ss ' -------- --- ----- --------- ••- _- --•---- -- ----•---- !! -- ---- -- - - - -•-- •-- -Coun f _ �- II authenticated this ... .__.,day of .......... ........... .. ... IO____. Personally_cante Pefore me this .- ... /,.'. �. -_ -aiay or if 19-.9!4-- the above named t� ---- -- -- ....... _..- ..... .......... ... - --- Ronald, V.- Riisager and Donna L. Riisager, ` -- -- - _ usb?nd -_and- wife,.......- TITLE: EMBER STATE BAR OF WISCONSIN + authorized by § x06.06, `V'ir. Staty r + t x;_ 1�< ` - v, k _S t > iio -t r to be the P•`r , _ t t '�*L; 9'a a C \aataled the S se ��}� ittJ ti[j�Scotrt_ ine, c. tet�alcaP -c t ?tc _. t � . -. iNs - rRu NIENT WAS ORAFT[-O eY ,S ��`�• �yy Y �,y A � — . l riStina- .Oglanrl _. ..r \t.lorney -.a -t Lacy � nl- r cJY GOB r,..,t: ��•,. - not - .- -.t ?: .. �,. �, u. ,.0 rl atq: f'u�LL'� �Sr/ i • •' � jz 'LVARRANTv DEED -ITAT1' n. %n or ta- t—'r si\ ' 3'7'7145 `� � ? R 1382 CERTIFIED SURVEY MAP LAMOINE KREAR Part of the Northwest 1/4 of the Southeast 1/4 of Section 27, Township 28 North, Range 18 West, Town of KinnickInnic, St. Croix County, Wisconsin. • Indicates 1 iron pipe found NE COR. SEC. 27, T 28 N, o Indicates 1" x 24" iron pipe weighing 1 -13 lbe /lin ft. set RIBW, l COUNTY I C. S.M�� VOL. 4, PAGE 961,1 SURVEYOR'S MONUMENT) ' OOC. 365223, , t ST. CROIX COUNTY < <` t n, � RECORDS � W I UNPLATT €O LAN(LS y I ' S88• 100105 "E 600.87' W 09.2 Z 9.y 341.33 50.14 W s3, r o /.I Oe �y W p f °' APPROVED eg . ao j a ° a / a a J• N LOT 1 7 $O. FT. 3.433 ACRES ool tv1 ` o APR 1 51982 149, 34 f Z ~f 1 NET = 3. 146 ACRES a 3 _J o ST. CROIX COUNTY tvr r. a1 COMPQENENSIVE PARK l = r 17 AND 20NING S PIANO 1INp a. COMMITTEE S • , qb 8 4 • I O 1.,: D z • 06 g6 52.. to ti F- z a4B.79' N 88 • 10' 05 "W :598.93' f =� T UNPLATT ED LANDS 1 SE' COR SEC-27. T 2BN, R18 W,(COUNTY SURVEYOR'S ALL BEARINGS REF. TO THE EAST LINE OF M0NU(�(�EtN SEC . 27,T 2 8 N, R 1 B W, ASSUMED N 00. 00' 00 "E Q�`���``"`�CJ. G O /vS % _C JA L li;o tz- Wt�J % PIVFR `, ` ILLS, ' O SO 100 200 300' • Wisc.' %�. F' •.. :S`2 SCALE I =loo LA i DESCRIPTION: That certain parcel of land located in the Northwest 1/4 of the Southeast 1/4 of Section 27, Township 28 North, Range 18 West, Town of KinnickInnic, St. Croix County, Wisconsin, more fully described as follows; COMIVNCING at the Southeast corner of said Section 27, thence N 270 06' 55" W 2719.75' to the POINT OF BEGINNING of the parcel to be herein described; thence S 06° 09' 47" W 250.00' along the centerline of C.T.H. "JJ "; thence N 88° 10. 0 5" W 598.93 thence N 05° 43' 10" E 249.86 thence S 880 10' 05" E 600.87' to the POINT OF BEGINNING, containing 3.433 acres, more or less, being subject to easement over the Easterly 50' thereof for C.T.H. "JJ" purposes; and also being subje @t to easements of record. (For purposes of this description, all bearings are referenced to the East line of Section 27, Township 28 North, Range 18 West, assumed N 00° 00' 00" E) State of Wisconsin) County of Pierce) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Lamoine Krear, I have surveyed and divided the lands shown hereon in accord- ance with official records, Chapter 236 of Wisconsin Statutes and the Ordinances of St. Croix County; and that the above map and descript ;on are a true and correct represent- ation thereof. Dated: 23 March 1982 vol. 4 Page 115 James L. Murphy Certified Survey M Registered Land Surveyor St. Croix County, Wisconsin , o ?; c ol 0 . \ \ k % ;M k t M m / f 0 I y o °\ f 2§ 2 2 8 g Q - @ / \ ( $ \ \ j \ \ , m Ch . j k CD k+§ m j 3 2§ 3° ¥ E§ � , < \ o o ECD0) ° @ ® ± E e n § E a $ E _0 co 9 \ § = e 2 $ § § CD ® 2 \ E / OD n E < r ■ OD e m \ m & § n 2 \ _k j j § \ 0 / k °' _ ( ( -91 2 ; $ I g d b : _ ° 2 CD : \ CL : a f � as ° X06 { / /§- 1 10 C , M CD w / M. / / / ` = \ } \ ¥ z 9 o 2 # ■ \ 2 o \ » m § m 00 . Z , » ; % \ ® : ^ \ m77± ca ��// k = r2- c�o0 % �o�� a CD CD ® CL \ r � D ER S »g\ � §_a - §[ \ � \ \ m � �. 0 .9k CD § % @ i R \ � k Parcel #: 022 - 1077 -80 -000 02/03/2006 11:09 AM PAGE 1 OF 1 Alt. Parcel M 27.28.18.P430G 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 BRYAN J &KAY LEE PENTON O - PENTON, BRYAN J & KAY LEE 146 CTY RD JJ RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): f = Primary Type Dist # Description * 146 CTY RD JJ ; SC 4893 SCH D OF RIVER FALLS pAL SP 0100 CHIP VALLEY VOTECH \ p n U r� V aA l S� Legal Description: Acres: 3.430 Plat: N/A -NOT AVAILABLE SEC 27 T28N R18W PT OF NW SE 3.43A LOT 1 Block/Condo Bldg: OF CSM V 4/1155 650/346 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 27- 28N -18W Notes: Parcel History: Date Doc # Vol /Page /1 D 07/23/1997 1101/322 %S WD 07/23/1997 921/146. n 2005 SUMMARY Bill M Fair Market Value Assessed with: 143810 381,900 1 / 5 Valuations Last Changed: 08/11/2005 Description Class Acres Land Improve; Total State Reason RESIDENTIAL G1 3.430 50,000 336,100 6100 NO A Iq8 2 s Totals for 2005: General Property 3.430 50,000 336,100 386,100 Woodland 0.000 0 0 Totals for 2004: General Property 3.430 25,000 261,500 286,500 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 132 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r - AS BUILT SANITARY SYSTEM REPORT , OWNER c -�''.� . TOWNSHIP,! SI:C '12N - l��W d ADDRES ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 pW E VERYTHING WITHIN 100 FRET OF SY S'1'l M CAS � r } I diral e qotrh�Arrow I, BENCHMARK: (Permanent reference Point) Describe: C'dv er? ,SepfC �T Elevation of reference point: S1up� at sit 3 SEPTIC TANK: Manufacturer: _� S _ I. i q �_i i d Capac : fZ(1() Number of rings on cover �� � Tank manhole cover c• I ova t i on Tank Inlet Elevation: i ati Out Let. I.l eva t i or► . PUMP CHAMBER Manufacturer: Number of L;a l Lures Number of gal. pump set for a cycle___ gal lore: tot .l] cal)"Ic i, t y of distribution lines gallon: s Lze or pump heild , gallon per minute horsepower brarjd rranic (0 prrtnp and model number __ Type of warning ev ce _ - __— _______- _.. _ _ HOLDING TANK: Manufacturer _ __ — _ Number ot. gal Ions Elevation of manhole °r, over Type of warning devipe _ -- SEEPAGE PIT SIZE: Number of pie Feet di.am�t�r feet liquid depth seepage pit inYet pipe elevat bottom of seepage p elevation feet. -, SEEPAGE BED SIZE: number of lines rl width ,�' leogth7n t.11y depth jj' SEEPAGE TRENCH: width lent' L11 _�,� - -- -. -- PERCOLATION RA'Z'E ass - REA QUIREb�f © & - Wt - A AS BUILT INSPI;C'f0R DATED T PLUMBER ON JOTS ,� a o-►�. LICENSE NUMBER J'p 95 ,9:; DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LAF,OR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS + O DIVISION P.O. BOX 7969 '3 Iv BUREAU OF PLUMBING MADISON, WI 53707 (CONVENTIONAL F-1 ALTERNATIVE State Plan I.D. Number: (If assigned) ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound NAME O ERMIT HOLDER: ADDRESS OF PERMIT HOLD R: INSPECTION DATE. BENCH MARK ermanent reference poi) DES RISE IF DIFFE EN FROM PLAN: REF. PT. ELEV.: REF. PT. ELEV. ' -7 f' o Name Plumber: MP /MPRSW No. County: Sanitary Permit Number: SEPTIC TANK /HOLDING TANK: - 7-() 7 MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV. WARN NG LABEL I LOCKIN U P DED: PROVI 0 D YES ❑NO ❑ NO BEDDING: VENT CIA.: VENT MATL. HIGH WA ER { 'ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH (� I ALARM l LINE AIR INLET: YES ❑ NO 1, 6 ❑ E LJNO � 'J / 0 DOSING CHAMBER: MANUFACTURER B ING. b CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: j YE ❑YES ONO i OYES ❑NO GALLONS PER CY L PUMP AND CONTROLS OPERATIONAL. PERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BE W E LINE AIR INLET: PUMP ON AND OFF) ❑YES ❑NO � PRO SO IL ABSORPTION SYSTEM. C eck the soi I mo istureat the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) CONVENTIONAL SYSTEM: "' Ta T i WIDTH. LENGTH. NO. OF DISTR_ PIPE SPACING: COVER INSIDE DIA_ #PITS: LIQUID TRENCHES '7 . M ERIAL: §k� DEPTH'. Z RA DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. I R *: PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PES ABOVE COVER. ELEV. INLET ELEV, END: PIP `+ LINE: AIR INLET: 2q ? 2.1 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. El YES 0 N SOIL COVER ITEXTURE PERMANENT MARKERS: J OBSERV WELLS ❑YES 1:1 NO 1:1 YES ID NO DEPTH OVER TRENCH'BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED SEEDED: MULCHED. CENTER EDGES. ❑YES El NO 1:1 YES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: 4« TRENCHES: - YL * MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELEV- DIA. ELEV. PIPES. DIA.: *a. HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ❑YES ❑NO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING: LINE: ❑YES ❑NO ❑YES 1:1 NO b t r l� Sketch System on Retail n unty file for audit. Reverse Side. SIGNA TITLE: DILHR SBD 6710 (R. 01/82) APPLICATION DEPART&CNT OF SAFETY & BU ILDINGS ` ,INDU6TR , FO SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: / e Property Location: -Gity, Village o Towns p. County: '/4 E' /aS iT N/R Af E (or) ` / t o/ Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: NA L J (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance ❑ Other (specify) Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY 1 5 X X HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: ale, n9GR- EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental 9 Seepage Bed ❑ Seepage Pit p�10 ❑ Alternative (specify) ❑ Seepage Trench Water Supply: O T Owner's Name as Listed on Soil Test Report (If other than present owner): a Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for ins tion of the private sewage system shown on the attached plans. Name f Plumber: ignature. V MP /MPRSW No.: Phone Number. PI is Address: Name of esigner: / S ✓c- Ze, 7 4 7 L COUNTY /DEPARTMENT USE ONLY N ,a§6atur of Issuin Ag Fee: Date: APPROVED Sanitary Permit Number: Q � h for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR -SBD -6398 (N.03/81) bc j -ri ro aj p e to V-4 pz Ni N 0 oo; o c Cs Jk a E-1 P4 1 0 e) •� c H v rn a -r4 3 > m� (z to og pq a to DEPARTMENT OF REPORT ON SOIL BORINGS A !8 FETY &BUILDINGS 'FNDUSJ � --� DIVISION HUMAN P. O. B OX 7969 A D PERCOLATION TESTS ( 11 ' HUMAN RELATIONS 1 � l� � ISON, WI 53707 !O % 9,n �j �o LOCATION: SECTION: TOWNSHIP /MUNICI ALITY: OT N . LK NO. 'P V E: Y441&4 /T28N /R/,'E (o W °'tip '9 i COUNTY: OWNER'S BUYER'S N MAILING ADDRESS: USE DATES11A NO. BEDRMS.: COMMER :lAL DESCRIPTION: STS: .Residence /1 New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system � CONVENTIONAL: MOUND: IN- GR)UND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) OS ❑U .dS ❑U J'S [:)U ❑$ U EIS OU Cove4fa•�a��c� /2X70 If Percolation Tests are NOT required DESIGN RATE: S If any portion of the lot is in the under s.H63.09(5)(b), indicate: I F loodplain, ind icate Floodplain elevation: 619 e 5C - Ja /,t' S PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER IDEPTH IN. ELEVATION OBSERVED EST.Hl HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) G• / B- 1 e 7g " „ / s; ", �' n s/ 20'" ' s 2:� " m ds 2/ s• /S bra s/ s 22 !3n fi s B-3 79 ' `3 ���,� -79 B- 13- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERT D2 PERIOD PERINCH P- / it Q K P_ '' A q P_ I f /i / i P- i PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION __ __ ------------ _ _ C. , i �2 cu a e Apra . ... . ! I _ _¢ a... P ao a iE - . - �� a , . J__ .m.;_...� � � I � La ..�G f� A ! nom.. t,_ �... e�. .. ��_ � . _�.. �� _ ,,,,// �G I l i 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wiscbr(si n "� Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ✓e- o;?- V- - ? Z ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER o ptional): S I N TUBE; DIS' . TRBUTION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page - Property Owner, 4th page -Soil Tester. I HR -SBD -6395 (N. 03/81) r A- ! � t 1 1 t� Fit Ep 3'7` 1 r APR1 of De ad, CERTIFIED SURVEY MAP lV ioaa,l� LAMOINE KREAR Part of the Northwest 1/4 of the Southeast 1/4 of Section 27, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. • Indicates 1 iron pipe found NE CoR. SEC. 27, T 28 N, o Indicates 1" x 24" iron pipe weighing 1.13 lbs /lin ft. set RISW, ( COUNTY I C. S. M. VOL. 4, PAGE 961,1 SURVEYOR'S MONUMENT) DOC. 365223, ST, CROIX COUNTY ( n ' N I RECORDS; ' 1 W 1 ' UNF!LATTED LAIVQS rn 1 S88. 10'105 "E 20 W 209. 600.87' Z 9 3. 341.53 50.14 -' W io S3 , �� I W O 0 1 a� 's,, . 40 08 o I Na O 11 N APPROVED 66 O 0 ' I o 0 a �. e W N O APR 15 1982 149, 54 T So3FT. AC RES cl ' z U f- li��(J QI NET 3.146 ACR� 04 o SL CROIX COUNTY COMPREHENSIVE PARKS PLANNING; o 2Z � ZI M AND ZONING CO MMIT7EE � I � �• � � „ h M Z Z 86 0 06 , 45 4e�9s2,, (0 548.79' N See 10' 05 11W 50 I a� 598.93' UNPLATTED LANDS S E' COR S EC. 27; T 28 N, R 18 W, (COUNTY SURVEYOR'S ALL BEARINGS REF. TO THE EAST LINE OF M O N U /lry /���� SEC. 27, T28 N, RI8 W, ASSUMED N00 °0000 " E ���w / /'/ ,• JAM; ; L. MURPHY S:1042 V) RIVER , "ALLS, a' 0 50 100 200 300' 1�� �J; WISC. SCALE I " e 100' LAND • c i DESCRIPTION: il lul rlun111110 That certain parcel of land located in the Northwest 1/4 of the Southeast 1/4 of Section 27, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows; COMMICING at the Southeast corner of said Section 27, thence N 27 06' 55" W 2719.75' to the POINT OF BEGINNING of the parcel to be herein described; thence S 06° 09' 47" W 250.00' along the centerline of C.T.H. "JJ"; thence N 880 10' 05" W 598.93'; thence N 05° 43' 10" E 249 .86 1 ; thence S 880 10' 05 E 600.87' to the POINT OF BEGINNING, containing 3.433 acres, more or less, being subject to easement over the Easterly 50' thereof for C.T.H. "JJ" purposes; and also being subjedt to easements of record. (For purposes of this description, all bearings are referenced to the Past line of Section 27, Township 28 North, Range 18 West, assumed N 00° 00' 00" E) State of Wisconsin) County of Pierce) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Lamoine Krear, I have surveyed and divided the lands shown hereon in accord- ance with official records, Chapter 236 of Wisconsin Statutes and the Ordinances of St. Croix County; and that the above map and description are a true and correct represent- ation thereof. ��,,, Dated: 23 March 1982 `G�'" ✓4 X Vol. 4 Page ii5 James L. Murphy Certified Survey M ' Registered Land Surveyor St. Croix County, Wisconsin