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Home My WebLink About022-1082-10-075 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division -t` INSPECTION REPORT Sanitary Permit No: 405150 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: m75- Mead, Gary & Suzie I Kinnickinnic Township 022 - 1082 -10 -0,49 CST BM Elev: Insp. BM Elev: BM Description: j loo I 0' K O k) 1 - .-F TANK INFORMATION E EVA ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic B m r Dosing It. /� .1 t o A 1" r Aeration Bldg. Sewer i7 Holding St/Ht Inlet /�� 7 - V3 St/Ht Outlet r � TANK SETBACK INFORMATION TANK TO P/L WEH BLDG. Vent t Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. h Aeration Dis P u 1 7 , S Holding Bot. em z 7- ' 9 a qG •� PUMP /SIPHON INFORMATION Final G ' h 6 Manufacturer Demand St over < ate Model Nu r TDH Lift Fri Loss System Head TDH Ft For Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width ) Length / 7 No. Of Trenches PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � S SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING anuf u erg ,. II! INFORMATION CHAMBER OR G� tr Type f System: /! / f / UNIT Model Number: DISTRIBUTION SYSTEM LJ S 114 Sas Header /Manifold Distribution x Hole Size x Hole Spacing Vent to it Intake ] t Pipes) �f � `� Length Dia Length `• Dia pacing J '—_ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Ali Be /T Depth Over xx Depth of xx Yes Seeded /Sodded xx Mulched Bed/Trench Center 21 rench Edges Topsoil 1 � � No Yes J �c/, No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:14/II/ 0 Inspection #2: Location: 1195 Rifle Range Road River Falls, WI 54022 (SE 1/4 E 1/4 28 T28N R18W) NA Lot 3 Parcel No: 28.28.18.448 1.) Alt BM Description = ► vO 141 ✓� /�'dv'� ' � pr'ai (�� Co / � " 2.) Bldg sewer length = (OQ / -k/, - amount of cover Use other side for additional information. - - -� -- '2 f y__ fo n a�ture ! Plan revision Required. � j Yes L_ No �� SBD -6710 (R.3/97) Date Insepctor' Cert. No. PLOT PLAN PROJECT Gary and Suzie Mead ADDRESS 969 Falcon Drive River Falls Wi 54022 SE 1/4 SE 1/4S 28 /T 28 N/ 1 W TOWN Kinnickinnic COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE6 /4102 BEDROOM 3 CONVENTIONAL )= IN -G11' R SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATION - @SM796.0 Alt. BM Top of Steel Fence Post with Orange Ribbon @ 100.0' / Rifle Range Road Alt B.M. 1 10' 40' 15 3 -3' X 63' Cells with >3' Spacing 50' B -1 Od 13% ( Vent ' s ) Slope Vents 10' Plans Designed Using B -2 Conventional Powts T Manual Version 2.0 30' 509 60' ►��! 'yc Pro 3 � Bedroom , O C ) . House yt a j L . Standard Infiltrator Leaching Chamber with 3 1. 1 ft2 of Area i Grade at System Elevation 3 4 Safety and Buildings Division County a. 201 W. Washington Ave., P.O. Box 7162 , 1 X lSConsin 07- 7162 Site '�r� Department of Commerce REC ! ? S�Rl J�11! Sanitary Permit Apgli do ��1� �- s�i ��'fc sanitary Permit Number In accord with Comm 83.21. Wise . Adm. Code, personal ' �°`' ` 002 ❑ Check if Revision TV 5-1-5D be used for Law s15. 1 m L Application Information - Please Print All Information ST. CROIX COUNTY State Plan A/ Z ONIN Property r s Nana Parcel Number 07 S C p2Z - 982 - Id -&M Property Owner' ailing Address Property Location J a. li 'A: S"_1 T� N, L City. State zip Code Phone Number Lot Number B14 ck� Subdivision Name CSM Number Y' 2 �arol9 II. Type of Bu1dmS (check all that apply) y 1 2 Family Dwelling - Number of Bedrooms ❑Vdiage ❑ Public/Commercial - Describe Use ' ❑ State Owned 3 / ,X I V Nearest Road 1II. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete tine B if ap le) A 2 ❑ Replacement System 3 ❑ Replacement of 6 11 Addition to For County use Tank Onl B. ❑ (heck if Sanitary Permit Previously Issued Permit Number Date lssued IV. of Permit: (Check all that apply)(nnmbering scheme is for internal trse) S W -TO Pteawrized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland �QL( St 22 ❑ Pressurized 1n- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Lin 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recucalating 30 ❑ Other V. Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gah.IDays/Sq.Ft.) N%Jlneh) Q Elevation VI. Tank Info Capacky in Total Number Manufacturer Prefab Site Steel Fiber Plastic New Gallo Gallons of Tanks �� — Concrete Constructed Glass Tanks Tanks Septic or Holding Tank _ D osing VII. Responsibility Statement- I, the responsibility for installation of the POWTS shown on the attached plans. Plumber's Nara (Print) Phmrber' ' we MP/MPRS Number Business Phone Number Plumber's Address (Street, City. State, zi e) vDL Me eat Use O nly Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued of signaaue Stamps) Fee) r ❑ Owner Given Lutial Adverse Determination p� ` IX. Conditions of Approval/Reasons for Disapproval dt.Os Q�i�y. > Sd SAf b -I 43 —1 Attach asmt>kte plan. tto rte camuk, tot,) tbr�� C ` -kt not Im than ' •�/�' r 7 � - hl� ' PLOT PLAPI PROJECT Gary and Suzie Mead ADDRE 69 Falcon Drive River Falls Wi 54022 SE 1/4 SE 1/4 28 /T 28 N/R TO Kinnickinnic COUNTY ST. CROIX MPRS Shaun Bird 226900 j " 18 DATE6 / 4102 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PIE E CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambe 30 IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATIO 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 98.0/96.0 Alt. BM Top of Steel Fence Post with Orange Ribbon @ 100.0' Rifle Range Road Alt .M. 10' 40' _---- 15 , 2 -3' X 94' Cells with >3' Spacing 50' -1 13% Slope ' Vents Plans Designed Using B- 1 pNB 3 Conventional Powts Manual Version 2.0 30' 50' T 30' Pro 3 Bedroom House a� jL Standard Infiltrator Leaching Chamber with 3 1. 1 ft2 of Area 34 Grade at System Elevation 611322 W'sconsin Department of Commerce SOIL EVALUATION REPORT Page f of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County <- Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must J X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. U� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. �Y' .n Please print all information. "view Date Personal Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 4 Govt. Lot 1/4 ��1/4 S 2' T Z-� N R /� E (o 6w Property er's Mailing Address IVED Block # Subd. Name or CSM# tCo ' Fone City State Zip er ❑ ity ❑Village own Nearest Road vex �J Z 0 2 2002 , 1` ew Construction Use. esidential / Nu ber 6Rb 6i OU Y ode derived design flow rate / C� GPD F Replacement ❑ Public or corn G Q Parent material Flood Plain elevation if applicable General comments s / r— t and recommendations: � S 'f�'� -- �- 'P I/L I . / �' V Boring # Boring ) r '�. pit Ground surface elev ' ft. Depth to limiting factor / l � 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 - -,, = zq Boring # ❑ Boring v A pit Ground �— surface ele . J " � 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 - 7F& * 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 Na a (Please Print) ature CST Number Address _ Date ! aluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner Parcel ID # 1) Z Z '1 Dg 1-' 10 Page of Boring # ❑ Boring j M Pit Ground surface elev. — ft. Depth to limiting factor'F�� in. Soil Application Kate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Co Color Gr. Sz. Sh. 'Eff#1 'Eff#2 �r 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 I F-1 Boring # ❑ El Pit Boring 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 t Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 100) Property Owner Parcel ID # Page of a Boring # Boring i Pit Ground surface elev. 2. _ ft. Depth to limiting factor in. Soil Application Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F] Boring # Boring ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft 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. sso-8330 (R.mroo) 5 Soil Test Plot Plan Project Name Gary and Suzie Mead Shaun Bird Address 7969 Falcon Drive River Falls Wi 54022 CSTM 6900 Lot Subdivision ------- Date 3/30/02 SE 1/4 SE 1/4S 28 T 28 N /R W Township Kinniddnnic F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post with Orange Ribbon System Elevation 9 8.7/96.0 *HRpSame as Benchmark Alt. BM Top of Steel Fence Post with Orange Ribbon @ 100.0' Rifle Range Road Ali *B.M. 10' 40' 50' Alt 13% Slope 0 99' 50' B -3 B -2 101' 0' Pro 3 Bedroom House a� a 0 ST. CROIX COUNTY r WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 • Fax (715) 386 -4686 EROSION CONTROL PLAN COMMENTS: For Lot 3, 1195 Rifle Range Rd., Kinnickinnic Two. Plan for owners Gary & Suzie Mead 1. The main source for construction site runoff will be the house foundation excavation and any soil stockpiled until final grading and stabilization is complete. Apply seed and mulch as soon as grading is done to minimize erosion. 2. Divert runoff away from adjacent road drainage by installing temporary earthen berms ALONG CONTOUR between construction activity and Rifle Range road right -of -way. Maintain existing vegetation between house/ septic system excavation and road drainage ditch, house being located 110' from road per ESC plan. 3. Construction equipment and vehicles must use only one stabilized driveway access that is designed for heavy equipment; this will avoid muddy, rutted conditions that allow contaminated runoff into the road ditch. 4. Stabilize new septic system with seed and mulch immediately after installation — do not wait for final stabilization of entire site to cover exposed soils on the system. 5. If builder /excavator grades the site to create temporary berms, as recommended to contain sediment and leaves adequate vegetative cover between work area and road ditch, installation of silt fence MAY not be necessary. Silt fence will be required if sediment cannot be contained on the property with diversions/berms. Septic system inspector will evaluate ESC plan effectiveness and make recommendations accordingly. Please feel free to contact me with questions or ask for assistance with erosion & sediment control installation. Pamela Quinn, Soil Erosion Inspector #665054 • ■ ■��!!� ■ ■ ■ ■II/I ■ ■mow ■ \i:�!l�.�1�1! ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ .. , ■ air /■�\ ■ ■I ■ l ■II ■■ ■■■iii ■ ■R.� ■ ■ ■ ■■■■■■■■■ ■i1 ■N' X111■■ iI� ■ ■I ■ ■�! ■1�� ■ ■ \'t� ■ ■ ■ ■ ■ ■:1 ■■■■ ■ ■!71:ir \ ■ ■ ■11 ■Ii ■!il!Ir1 ■E!11 ■■\1 r'ARGEIIII ■■■■ - - • • - ■■I ■ ■ ■ ■►.'/1 ■ ■� / ■11 ■ ■I�JJ ■ \r� I'll�■I ■ ■ \ \ ■'G'- / \ ■■■■ ■FAUor,,A ENE INN 11■ INN ■& Ai_ %Zl,% W lh■\■■■■■■M ■■!•�I/,1�1 ■ ■ ■I�i1111 ■C ■ ■i?^u:7i ■■:ill ■■ ■IJ ■■■■■■■ ■r�■■ri■■■�� ■■■■► ■■■■ ■ ■■■■■� ■!ate ■■■ ■■ Lai Q ca EROSION CONTROL PLAN CHECKLIST Ui M Check (✓) appropriate boxes below, and complete the site diagram with necessary information. H z Site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. Location of existing drainageways, streams, rivers, lakes, wetlands or wells. Location of storm sewer inlets. Location of existing and proposed buildings and paved areas. The disturbed area on the lot. Approximate gradient and direction of slopes before grading operations. Approximate gradient and direction of slopes after grading operations. Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices Location of temporary soil storage piles. Note: Soil storage piles should be placed behind a sediment fence, a 10 foot 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 less). ❑' Location of sediment controls (filter fabric fence, straw bale fence or 10- foot -wide vegetative strip) that will prevent eroded soil from leaving the site. Location of sediment barriers around on -site storm sewer inlets. i Location of diversions. Note: Although not specifically required by code, it is recommended that concen- trated flow (drainageways) be diverted (re- directed) around disturbed areas. Overland runoff (sheet flow)from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. ovation 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, and re- vegetation by sodding or seeding with use of erosion control mats. Location of practices that will control erosion on 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 rock 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 should not be installed in perennial streams (streams with year round flow). Location of other planned practices not already noted. V Q Indicate management strategy by checking (✓) the appropriate box. Q Management Strategies . z 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 1 and September 15), or by other cover, such as tarping or mulching. Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment). • Indicate re- vegetation method:ed C] Sod Other • Expected date of permanent re- vegetation: — — i s • Re- vegetation responsibility of: ❑ Builder ❑ Owner /Buyer • Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? ❑ Yes�No Use of downspout and /or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed I through plastic drainage pipe to stable areas such as established sod or pavement. rapping sediment during de- watering operations. Note: Sediment -laden discharge water from pumping operations should be ponded _ f 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 height o f the barrier. • Breaks and gaps in sediment fences and barriers will be repaired imme- diately. 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 off -site due to storm events will be cleaned up before the end 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 the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW— Extension publication Erosion Control for Home Builders. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through the State of Wisconsin Document Sales, (608) 266 -3558. Erosion Control for Home Builders (GWQ001) can be ordered through Extension Publications, (608) 262 -3346 of the Department of Commerce, (608) 267 -4405. EROSION CONTROL REGULATIONS Erosion control and stormwater regulations can be complex. Local, state and, in some cases, federal regulations may apply. Before construction make sure you have the appropriate permits. i LOCAL ORDINANCES - Check with your county, city, village, or town for any local erosion control ordinances including shoreland zoning require- ments. Except for new 1- St 2- family dwellings, local ordinances may be more strict than state regulations. They may also require erosion control on construction projects not affected by state or federal regulations. UNIFORM DWELLING COLE (DEPT OF COMMERCE) CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT: • Silt fences, straw bales, or other approved perimeter • Local building inspector measures along downslope sides and side slopes. . Department of Commerce, Safety and Buildings Division, • Access drive. P.O. Box 7969, Madison, Wis. 53707, (608) 266 -2128. • Straw bales, filter fabric fences or other barriers to protect on -site sewer inlets. • Additional controls if needed for steep slopes or other special conditions. STQRMWATER PERMIT (DEPT. OF NATURAL RESOURCES) CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT • Erosion control measures specified in the Wisconsin Department of Natural Resources, Storm Water Permits, Construction Site Best Management Practice Handbook. P.O. 7921, Madison, WI 53707 -7921, (608) 266 -7078. • Measures to control storm water after construction. This publication is available from county UW- Extension offices or from Extension Publications, 45 N. Charter St., Madison, WI 53715. (608) 262 -3346 or toll -free (877) 947 -7827. A publication of the University of Wisconsin— Extension in cooperation with the Wisconsin Department of Natural Resources. - t:2 01999 by the Board of Regents of the University of Wisconsin System. Send inquiries about copyright permission to: Director, Cooperative Extension Publications, 201 Hiram Smith Hall, 1545 Observatory Dr., Madison, WI 53706. University of Wisconsin- Extension is an EEO /Affirmative Action employer and provides equal opportunities in employment and programming, including Title IX and ADA requirements. GW0001A Standard Erosion Control Plan for 1 bt 2 Family Dwelling Construction Sites *V Printed on D N R WT- 458 -96 R- 02- 02- 2M -10 -S Editing and design by the Environmental Resources Center, unive sity of Wisconsio-Extension. to recycled paper ST CROIX COUNTY (" ` o-5 S� SEP . C TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer v !�� Mailing Address 9� -/ ��l t��R /"G �S �� SDa2 Property Address R o R I V E /) w °q (Verification required from Planning D rtment for new construction) City/State Parcel Identification Number a Z? 6) LEGAL DESCRIPTION 4 1) Al r ,j l a � a , Town Property Location /., S N- Wof Subdivision _ `� Lot # Certified Survey Map # ` '° Volume _ ` Page # Z 7 Warranty Deed # if Z Volume S ✓" Page # r Spec house ❑ yo Lot lines identifi es ❑ no S YSTEM 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 maskrplumber, journeyman plumber, restricted plumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal 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. 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 year expiration date. 1�=AJ M&JrJ ,va IGNA 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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * « «* A 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 ��,,yz� ��;7 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent fitter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. S. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 -246 -4516 �PLZ� -,7 - -3c,6 f 80 Y Shaun Bird #226904 �n11653"GEM t6474�b S KATHLEEN H. tJALSH REGISTER OF DEEDS TERMINATION OF DECEDENT'S ST. CROIX CO., WI PROPERTY INTEREST RECEIVED FOR RECORD DECEDENTS NAME 06-05 -2001 2:00 PM Arnold M. Yunker TERM OF DECEDENT PRO ADDRESS OF DECEDENT AT DATE OF DEATH CITY STATE Zil EXEMPT N CERT COPY FEE: 1175 Rifle Range Road River Falls, WI 54022 COPY FEE: DATE OF DEATH SOCIAL SECURITY NUMBER TRANSFER FEE: RECORDING FEE: 25.00 July 21, 2000_ 472 -20 -7390 PAGES: 2 PRESENTATION OF DEATH CERTIFICATE I certify that I have viewed / a ce ' copy of the decedent's death certificate. G' Tune a- MOT Recolding area RE131STER OF DEED'S SIGNATURE DATE Name and return address: Interest In property Is terminated under (please check appropriate statute): kose Marie Yunker 175 Rifle Range Road x s. 867.045 which pertains to property In which the decedent was a joint tenant.* had iver Falls, WI 54022 a vendof s or mortgagee's Interest, or had a We estate. '(You must provide a copy of the document establishing joint tenancy or life estate.) _ s. 867.046 which pertains to (d) property of a decedent specified in a mortal property 022 - 1081 -70 -000; 022 - 1082 -10 -000 agreement, and also to (2) survivorship marital property. (You must provide a copy of the - _ _ document establishing survivorship marital property.) PARCEL IDENTIFICATION NUMBER Presentation of recorded document establishing joint tenancy, life estate, survivorship marital property, vendor interest, or mortgagee Interest in real estate. This document number is 97n7RQ volume 190 page 196 of (check one) Records --A— Deeds_. This document number is volume page of (check one) Records— Deeds_. Description of the real estate. Include onN the extent o/ownershin for vendor ormonaecee s intemstl kz land at the Um of the decedmt1t deaM If Me extant o / land ls exactly the same as on the document, a copy of that document maybe attached to desc*e the rest estate. Aftach taxbtll(s) foryear immediately preceding death, ifapplicable. (See direclions.) The legal desci0flon ofthe property and Me persons recaNMg Me property am as foliows: (fmore space rs needed, atach pages.) See Attached. SWSE Section 28 T28n R18W SESE except CSM volume 8 page 2282 1 11463352 and except CSM Vol 9 page 2695 # 506505 S}NESE except N 200' of W 325V All in Section 28 T28n R18W Description of personal property (If any) being transferred. You may list savings accounts, checking accounts and securities on altached pages. Indleate persons) receAft property. DECLARATION: I (We) declare that this document is, to the best of my (our) knowledge and belief, true, correct and complete and is in conformity with the provisions and limitations of the Wisconsin Statutes. (d morn space Is needed, attach pages.) Name and address of Persona Receiving Pro Relationship to Decedent at nature Motorized)DaN Rose Marie Yunker 1175 Rifle Range Road ^ River Falls, WI 54022 .. Spouse 6/5/01 C." , . U_ � N l �� STATE OF WISCONSIN, County of St. Croix This document was drafted . qq 1 (print or type name below .._ ;54schbad and swom to before me on 6 / 5 / 01 by the above named person(s). Rose Marie Yunker UJ iJ'; sign tureofnotary orotherper Authorized to administer an oath YNDDA I NOTE: SEE DIRECTIONS. 1 jrWdi� it 8. 706.06, 708.07) Wisconsin Register of Deeds Kathleen H. Walsh Association Form HT -110 Print or type name: Website Version 1/2001 Title L � r Date commission expires: Y 190 105 r==,, 4E3 1 422 KATHLEEN H. WALSH Document Number QUIT CLAIM DEED ST. CROIX RECEIVED FOR RECORD Rose Marie Yunker, a single person, quit - claims to Susan A. Mead, the 06 -10 -2002 3:00 PH following described real estate in St. Croix County, State of Wisconsin: QUIT gAIN DEED 8 Lof Certified Survey Map recorded on May 28, 2002, in Volume 16, REC FEE: 11.00 4299, as Doc. No. 680157, Register of Deeds' office, St. Croix TRANS FEE: Wisconsin, being part of the SE' /. of the SE' /. of Section 28, CERT COPY FEE: Township 28 North, Range 18 West, Town of Kinnickinnic. PAGES: 1 Recording Area Name and Return Address Susan A. Mead 969 Falcon Drive River Falls, WI 54022 022 - 1082 - 10-000 (Parcel Identification Number) This is not homestead property. Dated this 10 day of June, 2002. �` (SEAL) (SEAL) "Rose Marie Yunker (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature of authenticated this day of STATE OF WISCONSIN .2002. PIERCE COUNTY Personally came before me this 10"' day of Ju66, 2002, the above named Rose Marie Yunker to known to..be the person who executed the foregoing' ent and TITLE: MEMBER STATE BAR OF WISCONSIN a ckgpwiedge the same. (If not, authorized by § 706.06, Wis. Stats.) "Karen . Engel, Notary Public, State Wi si THIS INSTRUMENT WAS DRAFTED BY My commission expires June 19, 201 O f :' C. L. Gaylord Z Attorney at Law P. 0. Box 46 C': . River Falls, WI 54022 *Names of persons signing in any capacity should be'typed or printed below their signatures. INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800 -e55 -2021 • 6601 57 VOL 16 PAGE 4299 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., W1 RECEIVED FOR RECORD 05 -28 -2002 3.00 PH REC FEE: 13.00 CP CERTIFIED SURVEY MAP PAGES: 2.80 Rose Yunker Part of the Southeast 1/4 of the Southeast 1/4 of Section 28, T 28 N, R 18 W, Town of Kinnickinnic, St. Croix County, Wisconsin APPROVED ST. CROIX COUNTY Planlhinp Zoning om Pp i s MAY 2 8 20OZ I ; I If not recorded within ail days of LEGEND g' I X OWNER'S tJKE approval shall be ." 1175 Rifle Ran pe llnd River Fads, WI.54022 O Indicates 1 "O.D. x 18 Iron Pipe Set aC1 (Min. Wt. • 1.13 Ibs.Ain. ft.) �i I yIt • Found 1" Iron Pipe S pAv Section Corner Monument 0 (as noted) -- x --- Indicates Fence N _ " , �! >70� �� (R -) Recorded As •�ba I ! , Indicates Soil Boring E �b , a W<; Q�01% - = %9-1 1�' ms s'•. 'P! Scale in Feet 1"= 100' 50 25 0 50 100 15 Bearings are referenced to the South J a� line of the SE 114 of Sedan 28, assumed bearing N 89 °03'31" W.9� 0�� b1��Qt�Y 2 B> d�5 .t'tiy'0j? SOUTH QUARTER CORNER Y�� SECTION 28, T 28 N, R 18 W SOUTHEASTCORNER -- — _— ____.._ _____ __ SECTION 28, T 28 N, R 18 W (2 IRON PIPE 35' WIDE POWER LINE EASEMENT (BERNTSEN ALUMINUM MONUMENT FOUND) 17778.828.82' ' AS PER VOLUME 196, PAGE 311' 0--- �I 603 231.87' ROUTH LINE SE 1/4 SECTION 28 t •••N89 W (R -S88 °19'34` W) 2035.16'• -• LQT__4, .CERTIf_IER SlIR1lEY. !!M!A ?I L0U, C9RT,1F= -,W- RVfY_MAP_ KQ4VXE 1.1, P_A -GE_3-01 I ��>c>VOAt1s'6 S' LAUR NCE MU qj <' DATED: 0 71 ` * ° APRIL 1, 2002 RIVER FALLS, WI. ° 41 This Instrument Drafted by Mark W. Peavey SHEET 1 OF 2 Vol.16 Page 4299 I June 2002 July 2002 June 19, 2002 S M T W T F S S M T W T F S Wednesday 2 3 4 5 6 7 8 7 8 9 10 11 12 13 9 10 1112 13 14 15 14 15 16 17 18 19 20 161718'19 20 2122 21 '22 23 24 25 26 27 23 24 25 "26 27 28 29 28 29 30 31 30 TaskPad 7 am ❑ 21 TaskPad - 2 ❑ I Friday, 4/19 2 ❑ IThursda 4/18]02 2 ❑ I Wednesday, 4/17/02 8 00 ❑ I Tuesday, 4/16/02 2 ❑ I Monday, 4/15/02 91 ❑ I Friday, 4/12 0 ❑ Thursday, 4/11 goo 0 ❑ Wednesday 4/10 I - __ ❑ Tuesday, 4/9 1 ❑ Monday, 4/8 10 00 D.Marek/B.Bird 405027 (Star rairie) 1 0 Zentis /Utgar 9 5 (Lolly Acres, lot 6) V 2 .pm Fassino /Ut r 4051 (Lot 15 Pheasant Run Hudson) 00 M kinni Mead/Shaun (kinrnc c) 1 Notes 2 Frederickson /B. Bird 405019 (Star Prairie) 3 00 Todd Marek/B.Bird Mound Plowing (Richmond Hills) 4 00 S oo 6 00 Pam Quinn 1 06/18/2002