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HomeMy WebLinkAbout022-1083-95-000 0 0 i o?? 3 0 r1 0 r1 d I `D `°— • CD A 40, \ 1 S n 3 M O N O C ',. 2 CNO N `C • S- < c a o Sr > N N- FM N d N O N N ? N C 7 6 = o 00 1 N N CL 7 O7 N � i ?. A W C" o" c A C n 7 O N to CL 0 3 Q. (a7 oo C 7 tJ 0 7 O (V N cn z D a co co ca D I � a o c c a c C !I N3 0 NN CD "Alm C t IV O `G � o n r to N o o a !, cn o 0 CD o S -n .. SS N CFO �, G Z ° N to to D I CD y m Q v v c tQ C d 3 7 N N �l N CD z �. w N O D D D O o" 0 a �. ° ° ry�� CD c vy c I w m z m -1 to Z :3 p Z m d 0 to N) N W m NCO CO I a m CD z 3 z E2 3 M w m 1 CD Q CD © �I X7 7 f C ° N - n �Z a M o I N I m i a � I � A I o N �I N O 0 D ' I m lV C A () v N I o I o �,� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399621 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 Township F Parcel Gehier, Kevin & Coni Kinnickinnic Townshi 4 022 - 1083 -95 -000 CST BM Elev: Insp. BM Elev: BM Descri tion: TANK IN ORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ben ark Z �1Cs5'., ,. 3.4 �� Alt. 1G1 Dosing � � t0 Bldg. Sewer olding St/Ht Inlet t.t St/Ht Outlet g •3q 9 •'$ t TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �? ) Septic 5 �S I' 4 Dt Bottom r(D 1 ti Header /Man. 6.33 Dosing > �u0r / � ( (J ') b D Dist. Pipe ry t Aeration 9 >S • 2`( Holding Bot. system �•�o q�• rf Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover � r [, rVl GPM Model Number Sw� 7 DH Li Friction Loss System Head TDH Ft .�� 0 102 1 3.ZS_ rcemain Le -. ngth Dia. « Dist. to Well " v t z SOIL ABSORPTION SYSTEM BED/TRENCH Width # Length No Of Tandw PIT DIMENSIONS No. Of Pits Depth DIMENSIONS 10 S Z ca SETBACK SYSTEM TO P/L BLDG IWELL LAKEISTREAM LEAN' EManuf INFORMATION CRAM OR Type � System: � —+1 � � ! ' � / NIT Number. DISTRIBUTION SYSTEM Header/Manifold Distribution i x Hole Size (I I x Hole Spacing Vent to Air Intake I 1/ Pipe(s) 1 f 3 1 N Length Dia Length u+c�• )Dia Spacing_ �6 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over Depth of xx Seeded/Sodded xx Mulched xx Bed/Trench Center Bedrrrench Edges Topsoil ❑ Yes no No ® Yes :4 ]No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:�� -2-/ 7/ 0 Inspection #2: / P ) t tO `'`� ) ' 1 Parcel No: 29.28.18.452E Location: 160 Liberty Road River Falls, WI 54022 (SE 1/4 NE 114 229 T228N R�18W) N Lot 2 K 1.) Alt BM Description = /�� " ► t"`^i°" Set l L 0 GCt7� Sl>e� 2.) Bldg sewer length - amount of cover = 7 Plan revision Required? ❑ Yes ia� No ! J - I F Use other side for additional informatio . ate Insepctors Signature Cert. No. SBD -6710 (R.3197) � G.S 6 r Safety and Buildings Division.- County /� �,, 201 W. Washington Ave., P.O. Box 7162 � . LJf ly, isconsl n Madison, WI 53707 - 7162 ` Site Address D Department of Commerce rLt�t,f� 0070 7 Z • Sanitary Permit N be r Sanitary Permit Application �R�� In accord with Comm 83.21, Wis. Adm. Code, personal information ovi `4 may be used for secondary purposes Privacy Law, s15. El check if Revision I. Application Information - Please Print All Information "° "�, i ti 4 State Plan I.D. be Property Owner's Name ^'�,� Parcel Number d g , b . / Y JZ ,n ; p 2z --108 b- q S- om Property Owner's Mailing Address NOV 2 0 7UU1 = ) P roperty Location r I too Rd -� :;mac 1 S4 i S 7_ 4 j T ZO O N, R W City, State Zip Code hory+ll f '' Lot Number Block Number lkv e pakk s-1 5 40Z.7- - �T� -_ `• Subdivision Name CSM Number /' II. Type of Building (check all that apply) X 1 or 2 Family Dwelling - Number of Bedrooms 3 1/ E9 V ❑ Public /Commercial - Describe Use p nn1G K nri Townshi ❑ State Owned , Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. For County use 1 ❑New 2 ;K Replacement System 3 ❑Replacement of 6 11 Addition to System Tank Only Existinja S stem B - ❑ Check if Sanitary Permit Previously Issued Permit Number 7misued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ❑ Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 At -Grade V_ 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation `7.70 900 900 .56 - 971 t 9Ct� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank / 1 000 / OD R W ei ser Se �( Dosing Chamber y 6 SI� I M x VII. Responsibility Statement- I, the undersigned, assume respo 'bility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) is Sig re / MP/IrfPR9idnttiber Business Phone Number �auc, C4. ate ntr at - as 715- Plumber's Address (Street, City, State, Zip Code) y 6-t• *_9 i vc r tl) s ►Gc��'SbZZ. VIII Count Department Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ❑ Owner Given Initial Adverse . Surcharge Fee) J�-S f p� � • (0 I r ` /� / .� l.J Determination 1X. Conditions of Approval/Reasons for Disapproval Q �� � tAtiJti't' lac wba�(p�,�.- �t�L� Gtrr,(,t2 1' �'( pv o Ind -fih, ✓' �I'�e ,�I (��a (/ 01 �G, t la"k c 01 m —+ Attach complete Olans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 05101) * �!� < .. j .. -' 1 '. a .. ,t < y t !' • � . i j y ` �'. v t 1p ,r �- . ,.1Y• ,� *.f '► �, • •. }. ♦ r t.► :. J3 � •� a ti � /� '�. l .? f"� �r ,� � . � (►* ,••.� Z y� y / PLOT PLAN / Scale 1" =k4o'* Page 3 of NO, o?2- 1D83- 9S "_6op i 3 a D rq - - � w►- g. z � , NN hit aM c %O�v�vC s sp Y � t m-w�Aj6 Y' \ \� 111 tXlST1rj G 1000 4G - M"Z- Pry �`. Ol in Mtij bum L V� IJOW L/�wtJ� 41 r _ LJ `1 �. 0 ` /,j O 8r�i its _�z,:>oo•q' ory .Ao1T�w1 0> 1 -J�v\30uv : - w L& > -- S - - - -- - .[�s :nom Cov1PUu' 1'J�1�fi1vUP-t Sat) =IOSZ ►Np -�S� 'Ei-S- �Vp_�.sST'�Lcl�ltE= �v�LZ- D►v : :'IZf�T.__� — - " NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 3. Septic tank to be pipes with approved caps. ( Y required). Z won gallon capacity manufactured by 1ST. 10 0o 6Pct... w wnG A50 W L bw kg�� 7 LIV- 4. Bench marks • FTaaUE� Tom_ �. Divert surface water around system to re p vent pondin-a at rha ,,,,1,; i 1 ; a_ Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188 -2439 TDD #: (608) 264 -8777 N *hsconsin www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albe i g ry November 01, 2001 R EC D '��� CUST 1D No.691727 ATTN.- POWTS Inspector ��� 4 �' ft::.M..... ).....• ARTHUR L WEGERER ZONING OFFICE Sir : WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA >' PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 11/01/2003 Transaction ID No. 685971 SITE: Site ID No. 638386 Kevin and Coni Gehler Please refer to both identification numbers, 160 Liberty Road above, in all correspondence with the agency.; Town of Kinnickinnic, 54022 St Croix County SE1 /4, NE1 /4, S29, T28N, R18W FOR: Description: At- Grade, 3 Bedroom Object Type: POWT System Regulated Object ID No.: 818968 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. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At- grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the at -grade manual, and section VI of the pressure distribution component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • 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. Conditionally A • Inspection of the private sewage system installation is required. Arran e e s a be made with the designated county official in accordance with the provisions of Sec. t 4 A�rN OF'Cf D(Vi..iON OF SAFtTY %J' i:E C;ORiNE` ARTHUR L WEGERER Page 2 11 /1 /01 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. 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. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 l - Julia a Lewis- Osborne POWTS Reviewer 2, Integrated Services WiSMART code; 7633 (262) 548 -8638, Fax: (262) 548 -8614 jlewis@commerce.state.wi.us TITLE SHEET Page 1 of AT -GRADE SYSTEM FOR A BEDROOM RESIDENCE This plan has been prepared in accordance with the At -Grade Component Manual SBD 10570 -P "and the Pressure Distribution Manual SBD- 10573 -P C 2, 6 /qq) LOCATED IN THE S� 1 /4 OF THE NF- 1/4 OF SECTION Z T N, R td, TOWN OF T 'j Ali COUNTY, WISCONSIN. INDEX PAGE l of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT=PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR _l bo _ tt 3�zT.-f PREPARED BY uIEGEI�ER SL? = L .TEST S MCC AND. DES X (3" SE= CE P.O. Box 74 421 N. N1a i n St. River Falls, WI 54022 �4- s . " Phone 715- 425 -0165 ;:.•��• -•.;, Fax 715- 425 -6864 • fi WEuEHE1 D 915 P E LLSWORTN Wis. t 1VE� • .T 4 .....• w , .44.E 10 • 01V. � SAf� & 9LDGS• _. At -grade System'Management Plan Pursuant to Comm 83.54, Wis.Adm. Code Page Z of • Secti_ c Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic t<nk and outlet filter shall be assessed at least once every 3 years by inspection. The outlet fiiter shall be deahed as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the'owner of when the next service needs to be performed to maintain less than maximum scum and sludge 2=mulation in the tank The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Suldingi; Division. Purno Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter 1s installed within the tank it shall be inspected and serviced as necessary. At -,rade Component and Pressure Distribution System No trees or shrubs should be planted or allowed to grow on the component. Plantings may be made around the perimeter and the component shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the component is not allowed. Cold weather install- ations require the component to be heavily mulched for frost protection. Influent quality into the at -grade system may not exceed 220mg /L BODS, 150 mg /L TSS and 30 mg /L FOG. Influent flow may not exceed the maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a fiushirg point at the end of each lateral, and it is recommended that each later! be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice c'ogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be for effluent ponding. Ponding levels should be reported to the owner and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring in accordance with 83.52 (2). General This system shall be operated in accordance with Comm 82 -84 Wis.Adm.Code and shall be maintained in accordance with it!s component manual SBD 10570-P- (R.6/99) and local and state rules pertaining to system maintenance and maintenance reporting.. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and Pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. _ Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. -Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continaen w Ptan I f the septic tank or any of its components became defective the tank or component shall be repaired or replaced to keep the ' system-in properoperting condition. - Ii " the " dosfig tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a proponent of the same or equal perormance. If the at - grade component fails to accept w as tevater b - to disc�aige wastewater to the ground surface, it may be necessar y to install an aerobic pre-treatment .replace the component. Additional siteand soil• evaluations maneedtobe done t and additional plans may need to be prepared and approved by the Department of Commerce, Safety and Buildings Division. . -.:.._.._. p Questions .about the o eration or maintenance of this s should be directed to The County Zoning Office at -11x.- 3$-6_ qb$O The system installer at )S- 2.S - SS4 S7t�'1h�E1? The tank manufacturer at app 3ZS - gLj,> klJ Les LZ 2 The effluent filter'manufacturer at - Zzl -. s7�Z af(UCL ThIL .zz UV - A , r , • 1 L! I °/ - Z-8.4 - l I q N7 Ll M S PLOT PLAN Scale 1 " = - Page 3 7 .. y,�' of PPYSz,�, _ _1 t7 _►vp, OZ-Z -_t083 _°IS - - 000 : : - , i S•3 .'h G ICOO Gtrt- 7I 1 � s, OI,L MT$ Vj"DU C C IJDkf L1�W�.1� 64 r r/ LOT LIAjE pr is too -4 ory _ �M - My"I- Cd w)N \")Okv - _1 _OK- >Ot &JT /�119t�1U SaD- lCOS1p =_P _N_p. -YS-, 4Q_Ii1N S_LgPE. : ti?Dtsv - -'�-S �vp_ �3��T'RL�`[�V� : :�cj�LZ�►v =���_� -__ Rt. �-LSTS , NOTES: I. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved P P oved ca s. i P required). 3. S e tic tank to be P P y y �' _ P _Z�on gallon capacity manufactured by � - r lo0y 6PR. w / �000 165' w ��3 Ca.�CRE 7 mew /�} —��oo zw� O L�- 4. Bench mark 8 •- 5. Divert surface water around system to prevent ponding at the uphill side. L >5' B > 5� a5 2 T A O _ _O W — --, 0 1 p 1.Pe S T 5 I/6 B 1/6 B A = 10 C 3 F Linear Loading Rate = l S-O GRD /LN FT Design Loading Rate= O•S GPD /SQ FT „ z , z +_ _ Distribution Observation Well . - Lateral ELv.Ot Fabric.,, .>>,- ---. -� Soil 12 , -�a;� �� Cover VI –5' A > - 2' C A =2' ?5 j Plan ViOd and Cross Section of a Wisconsin At -grade Unit with Two - - -- Aj✓wxpticn Areas With in a Single Unit cn a Si coi_ing Site Distribution Pipe Layout P2Qe S of - 7 Place the holes at the bottom of the distribution es i P P at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each late u with the Use of Iona tumor 45 fittina to a oint wi ' • inches of the final erade. Te.•minate the ends of the Iate. -aIs with a valve, e3 o= six • ed plua. Provide aces from final grade for the valve threaded cap or threaded plus. Lateral Manifold x x x x x2 Lateral Length p - c- - �P P L-4 Ft. Hole Diameter 3 1 Inch 5 1 S Ft . Lateral L < <Z InchEes) X Z Inches Manifold Z Inches Force Main " Z Inches of holes /pipe Z3 Invert Elevation of .Laterals -1 .7 Ft. 30.3 6 P*j Combination Sept�.c;Tank and PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE 6 of 7. WEATHER PROOr - •VE1JT CAP - JUIJCTIOU 8OX . '1 C.I. VCNT PIPC APPROVED LOCKIIJG 110 FROM DOOR, MANHOLE COVER lv11H - Ail uDow OR FRESH wARI.1IIJG t_P.gEC.. - spC'c110>J PIPE ALP, IIJTAKE S cor�Du�T ►� /PrtR'Cl sdT'rfip t , G Mpco E 18'h11u. ---- - - - - -- 18�1�IN. ---- - - - - -- UJLET i" PROVIDE I - •• T AiRTIGHT SEAL I Approved z�Is�L r-t, A Approved joint c .7/ Lbpo I II I ,joint w/ PVC pipe ALARM PVC pipe - s I 1 1 1 1 olJ C I I LLEY. (D '�' rj o FT I PUMP - ` OFF D COUCRETE 4. coo • 5LOCK R15CR EXIT PERMITTED OI.1Ly IF TAUK MkQUFACTURZR HAS SUCH APPROVAL- IT' WQatRp SEDOIN4 sEPTIC f SPECIFICATIOUS DOSE TAIJKS MAWLIFACTURC : - U1JC•2 ►DUMBER OF DOSES: q PER DA TAWK SIZE: Wo /6SO GALLOWS DOSE VOLUME t AL A R#% MAUUFACTURER: S S• �Lecrgz LfST H*a INCL UDIAIG BA CKrLOW: GAL.LO&I: MODEL WUMBER: LO L Kw CAPACITIES: A_ 1UrI4ES OR 3b J0 GALLOIJS SWITCH TYPE: — g = Z IWCHES'OR - GIhLL0Al5 PUMP MAIJUFACTURCR: � S C: INCHES OR � ( � Z GALLOUS MODEL NUMBER: — $R NI '� D- 1Z - Z1)� INCHES OR GALLOAIS SWITCH TyPE: — ��Z�a -� ►DOTE: PUMP AAIp ALARM RE TO D c 41° MIMIMUM DISCKARGE - RATE GPM INSTALLED )N SEPARATE CIRCUITS VERTICAL DIFFEILEAICE DETWLEU PUMP OFF A1,10..DI5TRIBUTIOIJ PIPE.. � FEET + MWIMUM • METWORK SUPPLY PRESSURE . FEET ( Sy, L- 3) - S 5 FEET OF FORCE MAIM X �_ F Y,0cFLFRICTIOIJ FACTOR.. FEET TOTAL OyNAMIL HEAD = lZ . b FEET As per manufacturer X gal /in. Liquid depth 3 �N , P�FC�tiZ1L1 �u4,yt or - 7 TOTAL HEAD I N FEET V6" 9«E> C � O CTI O cn O Cil O o 0 O 0 r N O CD C) ° D w n O N n H 0 -{ All n D 1 O 1 ° 1 r 0 o m 7 x � G cn - 0 M o � N H Z ° C IT! Z o N m m ° O W N O CO O W W O O O O — N W -P c l m m CID TOTAL H AD IN METERS Y^consin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 f Division of Safety and Buildings in accorda nee with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, ar d location and distance to nearest road. Z.Z- - 1O S3 - 0 1 3- 000 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z• ^ ( O Property Owner Property Location r� N �Q R 'vJ co" I GE maul bet S F- 114 NG1A S Z (T Z$ N R 1 E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# I b 0 L \- g�- Z - C- Vn L- S I P� tZ(° 3 City State Zip Code Phone Number (] City ❑ Village q Town Nearest Road F-WEZ FF\uS wl SLLoZZ k.10 jjC Lt3E -- LY-( 2p ❑ New Construction Use: Q Residential / Numbe of bedrooms 3 Code derived design flow rate GPD Q Replacement ❑ Public or commerci I - Describe: Parent material \,-I Flood Plain elev plicable ft, General comments r Y i �R and recommendations: k � S,4-STEM w l ?� � !c� !� 0 X '-A S' Ld-1JG i CONYM v2 �� s�t 3 uYt �t ��L s -. 1 N� . y C acrr7 -f P t � 1 17 -1 Boring # ❑ Boring -� f ; ®'Pit Ground surface elev. �� � 1 ft. Depth to limiting � 8 1 c!: Soil Application Rate Horizon Depth Dominant Color Redox Des ription Texture S ctu s enc ndary Roots GPD /ftz in. Munsell Qu. Sz. Cor t. Color '� 'Eff#1 'Eff#2 3 CO us Owi ❑ Boring # t❑ Boring Z tJ pit Ground surface elev. S $ ft. Depth to limiting factor SO in. Soil Application Rate Horizon Depth Dominant Color Redo; Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Co t. Color nn-- Gr. Sz. Sh. •Eff#1 'Eff#2 O —l0 1044Z3lZ X51 Z*�Sd MU`E - C-W Zvi -S q 3 _ SD= 2 2 1 v`I R VA ' t" ' L i 2 S le, vk • Effluent #1 = BOD > 30 < 220 mg/L and TPS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si a e CST Number Arthur L. Wegerer ( : ) I 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Main St. River Falls, WI 54022 -c) 715-425-0165 71,5- 425 -0165 Property Owner G E14 LLZ Parcel ID # z - U8 3 - Q f S - 00 0 Page 2 - of F:�] 3 Boring # ❑ Boring ® Pit Ground surface elev. 9 -7 . ? ft. Depth to limiting factor Z 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 1 o D`1R -3lZ -- 2wisb rn v�Ft- ew � v�F .s .q S9 h1 V`Q1r- CS • S .q 3 Q7? -S3 - 2 .SYfz31 k2.SL�, 5 1 ��„� ►n`Ft� cs - . 3 , 5 4 53= tZ toL-1R X16 � , asl o�-,. rn U`�►� - - 3 . S ❑ Boring # ❑ Boring ❑ Pit Ground surface efev. 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 ❑ 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 /ftz 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 -8330 (R.6100) PLOT PLAIT Page 3 of 3 Scale PP►' C Z L - D QQ, OZZ -1083 _9s _ 000 -- '' Gf'�i g.3 M \ g.Z 9� fl 46 t�lS'P1J G 1.000 GPrt- 'fm`Jk S s, ` �� OI�D Cif C1� "ZUM LD J , V - ; C mow LP�w►.1� � IV 4 9, - 7. � , 0 p � LoT LwjE - Ft - `YjCL BN1 �L =_ Lz. lUU.O' OiV __�U'1�JU�2 0� CowUZ� _S�en3.• -_— _tF Z - - -�Z, X00 q ory I�jC) lM M C)1= w)nJz0k.) wtLL LS ? S F�Wwj -- L}S pL1Z;_ Cc�VLpOu�'1 !�J A S8D - LOS�p - P - ,N p �S - ?Qbv:ti� SlsJpL UND1 S 26 HZZ '( .L . _LZ t?Q Z�_ ��1D "1 v1?L?D►v_ZZfL1 ._- PAC. 5 7--Ls 1 `ti + LO - LB - 01 715 - 425 -0165 220.254 O1 - 3 L CST Signature Date Telephone No. CST No. Job NO. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Kevin and C'on r' 60,,Ifr- Mailing Address 16 o G bPr-fy Vg,- f-?? 115; W::r �'o Z Z- Properly Address 1 6 0 Lbor� �r vfr Lf /6 (Verification required from Planning Department for new construction) City /State f� ver Fg l � lNZ Parcel Identification Number LEGAL DESCRIPTION 2� Krhni�krhniG Properly Location S& v4, AI C- V4, Sec. . T N -R W, Town of Subdivision . Lot # Certified Survey Map # 3f S r y Z , Volume f __ # 12 Warranty Deed # 4 2 3 5 -7 4 , Volume - 7 -7 3 , Page # 2 9 Spec house 0 yes 0 no Lot lines identifiable ® yes C9 no SYSTEM MARnTNAN Improper use and maint -nance 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- ! Department a certification form, signed by the owner and by a The property owner agrees to submit to St. Croix Zoning Departm masterplumber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on 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. t / /iglo SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statem ents on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property descr above, by virtue of a warranty deed recorded in Register of Deeds Office. // /19/ o/ SIGNATURE OF APPLICANT DATE « « « «* p ermit bei revoked b the Zoni De * * * * * * Any information that is mis- represented may result in the sanitary p g Y g artment. p « 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 I • "00CVME"T 1410. WARRANTY DUD T e p & " NRSC"CD p" MWOMI" DATA VrATZ a" OF WISCONSIN FO&M 2 — IM 423W4 MK_773_Aar.0%7_ WGISTERS OFFICE V. CROIX CO., WI& nd and wi fe ........ .. be ison A. Anfirs 4L for ReooM ft 31s . ....... ....... .,hp#?a Marc .............................. .................................... ................................. m jr h A.ID6192.7 . ............................................................. .................................................. 8: 30 A AL ............. ............................................................... ......... amveys warrants to and .................................... _U fishlex, ... husband..and ... vile.-.as ... survivora.hip ............... bdft al Su*N .=XitA1..Pr.Q a tY ......................................................................... .................. . ............................................................................................. ................................................................................................................ ....... — ................................................................. A30116VALLEY THE SERUM W_ ......... ................................................................. I ..................................... 9 Komi KStreet m Street ................ ............................................................................. ................. U= 4M following &Wf%W MAI aftt* in ............ St&...r. r.Q. i X .............. Buts of Wistoubla Tax Pared No: ....................... ° - - --- A parcel of land in the SEA( of the NE4 of Section 29-28-18 in the Town of Kinnickinnic described as follows: Lot 2 of that certain Certified Survey Map recorded on June 6, 1983 in Volume 5, page 1293, as Document Number 385142, together with an easement for ingress and egress over that portion of Lot 1 of said Certified Survey Mar) which is designated as a Driveway Easement, St. Croix County, Wisconsin. 0 This ............ . ........... homestead property. (is) (is not) Exception to warranties: easements, restrictions, and rights of way of record, if any. Dated ........... .................................... day of ........ ...March..._.. ........... ........................... _(SEAL) .. ....... ......... ...... (SEAL) ... .. ................ 2 �o rn • . $qt e Ph Aen!i .... R_1 .... Am .... i-n ............. ........ ------------------------------------------------------------------ (SEAL) ....... (SEAL) • .......... ....................................................... e_ -Lynntt,_-_.A...Anf_inson ................ ---------------------------•.--.------ --•-•--- •- _---- •--- - -. - -- AUTRUNTICATION )kACKNOWLZDGMBNT Sixnat"1 ------• ................... ................................. STATE OF G�SiN I St. ------ ------------------- - - -------- - -- - ------------------- autbastimted tbb — day o[ . ..... ............ pit ------ Personally came before me this _�_Idl"y of .- March ---- - ----------------------- 19-97... the above named ------------------------------------ — --- - ---- - -------- - ------------­----- ............ Anfinson and Lynnette A. Stephen • ------------------ - --------------- * ------ ---------- * ----- . ................. .... . .. ............... ................ ••- - - -••- --------- ..Anfinson ----------------- . ....................................... TITLE: MEMBER STATE BAR OF WISCONSIN ..............•............. --------- --------------------- -------------------------------------------------------------------------------- to me known to be the person --- $ ....... who execu the foregoing instrument and acknowledse the "me. I THIS INSTRUMENT WAS DRAFTED SY • -A . .... 0 ..... .y ------------------ ------------ A — ------- 219 North Main Street, Box ............ --Ai*e-r --- F*1-1-& --- W-1--_"OZ2 -------------- o blic ................. -----------------_----- (UNIAr. g jj-:� "bt I (Signatares may be authentiested or salknowled -1 InaLission in permanent. (If not, state expiration are not necessary.) -----_-------- 19..�g) i % •390MM of pus"M einiei in say es"Wift dwald be typed or prig p STATU BAR 07 VVON SM FORM Me. 2 —1i +982 Stock No. 130 r - - -- - - - �o :�. ,✓ u r= /{ sir ,v, c. Kiw r �„ � ( , � JAAr'S KED �% b. F 19 83 O' CONNELL mr of !9 a �c CERTIFIED SURVEY MAP 1Nt�wn.in f �, . LOCATED IN THE SE 1/4 OF THE NE 1/4 OF SECTION 29, T28N, �+ R 18 W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN NE CORNER UNPLATTED LANDS \ I N 88 528.49 I p a 13225' I m 1 495.64 a� 1 9 I D IC N I Z M D I 9 �a , . I Z Z I Z i ,c i Z 'r rn 2 , r 4 2.06 ACRES (89891 SOFT) V) o, � 1� I 1"'� O rn > 9 INCLUDING RIGHT-OF-WAY a I 1� I -I Im "n m I� Z 1.94ACRES (84342SO.FT.) C , 0 i m ,o m m I� O EXCLUDING RIGHT-OF-WAY ° O p' I� N 88 029'58 "E 527.67' I Z O z , 159.26' A 132A6 W ,V -i 335.95 0 DRIVEWAY I -4 �D �0 O W o o1 EASEMENT ro � I I I A D = — °mob -- °1 I I M r N = {� — 1 57.69— 3_2_34' I 1 I D ITI Ir I / N86006'15 "W 190.03' o �O I D IZ ° i I 1O M -1 'D ° I � I 1 ' IZ ,,, 2.06 ACRES (89750 SO.FT.) 1 � I o Z r I INCLUDING RIGHT-OF- WAY HOUSE W 1 0 1 O Z I� 1.93 ACRES (84268SQ.FT.) =1 �a3a ft1 I� b EXCLUDING RIGHT 9 ' O a I s3 ' s i z0 e p ., ry 494.79' sg132.06 I POINT OF S 88 "W 526.85' 1 i BEGINNING MONUMENTED WESTERLY I RIGHT-OF-WAY LINE 1 2 O UNPLATTED LANDS z N SCALE IN FEET I 100' LEGEND E I/4 CORNER AR ED 100' 200' ® SECTION CORNER MONUMENT SECTION 29, • 1" IRON PIPE FOUND T28N,R18W JUN 11 83 0 1" X 24" IRON PIPE WEIGHING 1.68 LBS. /LIN. FT. SET ST, CROK COU'tii' DESCRIPTION CoMPAEFtEW51Y'E PARKS PILI <7UN AND ZON(NG COMMITTEE A parcel of land located in the SE 1 /4 of the NE 1 /4 of Section 29, T28N, R 18W , Town of Kinnickinnic, St. Croix County, Wisconsin, described as follows: Commencing at the E1 /4 corner of said Section 29; thence NORTH (assumed bearing referenced to the East line of said NE1 /4, bearing assumed NORTH) 321.19' along said East line to the point of beginning; thence S88 "W 526.85 thence NO °16'48 "W 341. 11'; thence N88 "E 528.49' to said East line; thence SOUTH 1 . � 'n 4 12 acres 17964 s 339.97 along said line to the point of beginning, contain ( q ft.), subject to Liberty Road right -of -way over the Easterly portion thereof, and subject to any other easements or restrictions of record. I, James E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision Ordinance, and the Town of Kinnickinnic Subdivision Ordinance to the best of my professional knowledge, understanding and belief. Vol. 5 FRgc 1293 ,. _ AS BUILT SANITARY SYSTEM REPORT A OSIER TOWNSHIP ;, ' ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW D, stances and dimensions to meet requirements of H63 w YEi3_THING WITHIN 100 FEET OF SYSTEM r n 7` ;< � r a , ? Idia othArro SC L �.. ENCtARii i(Permanent reference Point) Describe: levat3t of' vertical reference poi x Slope at s ite SEPTiU T"K: Manufacturex Liquid Capacity /V a Number of rings on cover lank manho cover elevation: " Tank Inlet Elevation. Tank Outlet Elevation: PUMP CLAMBER Manufacturer.: J Number of gallons Number of gal . puump set ter a cycle gallons; total capaci y of distribution,li.nes gallon: size .of pump head; gallon per Minute horsepower rangy name of pump ; and';%odel number ; p40 f warning evice AftDING TANK: Manufacturer Number of gallons Elevation of manhole cover Ty e of warning device c ' SEEPAtE PIT SIZE: um ex o pits M meet diameter feet liquid depth seepage pit in et pipe- elevation_ bottom of seepage pi� t elevation feet . SEEPAGE BED SIZE: , number of lines width '7 ? _leagth.,Y�tile aepthZ,,� . SEEPAGE TRENCH: wiAth length PERCOLATION RATE a'+! REQUIREP A A 9 B INS, �-�-- DATED�`" "" � PLUMBER ON J � LICENSE NUMBER - '' .�; *"''' a DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR Si HUMAN RELATIONS / xr7969 PRIVATE SEWAGE SYSTEMS DIVISION -P.O. BO �G/ f BUREAU OF PLUMBING MADISON, WI 53707 fff 11dCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: - (If assigned) El Holding Tank El In-Ground Pressure El Mound NAME OF PERMIT HOLDER: 7DDRESS OF PERMIT HOLDER: INSPECTION DATE: Richard Sirek R Liberty Road, River Falls, W BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.: SE NE, Section 29, T28N —R18W, To of Kinnickinnic Name of Plum ber: MP /MPRSW No.: County: Sanitary Permit Number: Paul Cudd 2739 St. Croix 38455 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER (.1 9J PRO ED: PROVIDED 1 1 no o , 87 YES ONO ❑YE ONO BEDDING: - VENT CIA.: VENT MATL.. HIGH WATER I NUIV ROAD: PROPERT WBUILDING: I VEN TO RESH ALARM. LIN AIR FEET FROM 9 Cr O ❑ ❑ �yS YES NO OYES ON NEAREST DOSING CHAMBER: MANUFACTURER: 71 L IQUID CAPACITY. PUMP MODEL PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ES ONO DYES ❑NO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER O PROPERTY WELL: BUILDING: J VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEARE T SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORC the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. P PE PACING. COyyy{ J INSIDE DIA.. #PITS. LIQUID EC3 /Tf ENCk1 as TRENCHES M IAL ply DEPTH: iPME11itNS S GRAVEL DEPTH FILL DEPTH DISTR. PIP' DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NU•M O F PROPERTY WELL: BUILDING: VENT TO FRESH BELOW IFIE9 AB E VER ELEV. INLET. ELEV. ENDS PIPES: LINE AIR INLET: �Z q . X 7019 FEET FROM /`d Sv � � 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- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE JPLRMANENT MARKERS: OBSERVATION WELLS OYES ONO DYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED. MULCHED: CENTER. EDGES: DYES ONO DYES ❑NO [ ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH'. LENGTH: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER TRENCHES: : ° ° ° e �MNIClNS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. J NO.DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. + � ELEV.: ELEV: CIA.: ELEV.: PIPES: DIA.: T1 ON, HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED � PLANS. EYES 0 N ❑YES El NO COMMEN S:: PERMANENT MARKERS: OBSERVATION WELLS: N DER PROPERTY WELL: BUILDING: FEE FROM LINE: 2 0 DYES E - 1 NO DYES 1:1 NO NEAREST O S 2 3 G- 2,0 a Letch System on etain in ounty file for audit. �e Side. SSIIGNAT w /r TITLE: SBD6710 (R.OI/82) ,,,,.• -''' -C'L' r - - DEPARTMENT OF APPLICAPON sAFETY &BUILDINGS It4DUSTFN FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 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. A legible reproduction of the soil test report or the owner's copy must be included. Proper Owner: , Maili ddress: Proper y Location: City,Villa a or Township: County: 4 �5- '/ ' /aS �T N/R E (or) W ` Lot umber: Blk No:: ISubdivision Name: Nearest Road, Lake r Land State Plan I.D. Number: (lf assigned) TY OF BUILDING Number of ❑ Public ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family * State Approval Required. coy TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY ,0 �— HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Z- Seepage Bed ❑ Seepage Pit _. ��� / ❑ Alternative (specify) ❑ Seepage Trench Water Supply: a (O Owner' Name as Listed o Soil Tes Report (If other than present owner): (K Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the att ached plans. ame Plumber- Sig nat, e: /MPRSW No.: Phone Number: �/ fez YA6 �� T PI u be 's Address: Name of Designe . COUNTY /DEPARTMENT USE ONLY Signqturf of Issuing Agent: Fogip &A:) Date: Date: Sanitary Permit Number: 4 6� ,L f 3 DISAPPROVED Reason 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 DILHRSBD -6398 (R.07/81) ��,� Y� �. ��� l �d Form 5 .j 1u ,Location of Fxoperty S'C /�/ Section `.:" ,T iKaiXi�ag ,:Addreas X'3.i iIh� t. on ��a'' 5 t gg v➢ §? i,til�if - a r' *aiwio`uss' Owner of Property a {'.Q t f4# a `Sl.ite of Parcel :Date Parcel Was Created Axe . corners idea t fiable "? _„ f Yes No . y s r n► th this a] ication one of the followin j f . Ce rt.1fied Survey Map z x T +,D*ed ft ►d Contract, or •'+ether I:egal Document which describes the property k; P1OPEAfit tIAiNEf CA7`IFlCATlON a r' ! tWe statements on this form are true to the best of m (our) k,: tf# 1iiYsi am tare) the owner(s) of the property"described in this infornr3aorfnkyvirtue of a warrant dead rec rd in the Office of the C00 Deeds as Document No. and that I (we) pre#tetttl, own tt prnPoted tits for the sewage disposal system (or I (we) have obtalnacl =erl event, to run with the above described property, for the co 00n , of laid system, and,the same has been duly ecorded in the Office of the,i ty Ff4qkW of Deeds, >as Document No. 1 i�s„ . oYY " I MAMAII& OF CO-0WNE (IF APPLICABLE) 4 L�3 DATE s lQ E r ��_ . � � �_ ���� ��. <u � z��_yz� � t «'���� CERTIFIED SURVEY MAP LOCATED IN THE SE 1/4 OF THE NE 1/4 OF SECTION 29, T28 N, i R 18 W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN NE CORNER t � 1 N 88033,49,E 528.49` 1 I 1 y � o 495.64' npa9 132 i D I C _4 CD sm I to I rn n 1 2 a, 71 C 2 Z i I IW v I , ' rn c� I -II y i � I m m v :P I r .1 P I ° I;u I O i— ,' I O 2.06 ACRES (89891 SQ.FT.) y O i O , I 1 � i� ca INCLUDING RIGHT-OF-WAY o -I I� I — '1Y1 f+I '� °= 1.94 ACRES (84342SQ.FT.) W I I� t s 1C) I --� 0 EXCLUDING RIGHT-OF-WAY 0 1 NO ► m I 1 1 Z 1 m Z O 1� N N 88 °29 527.67' x ` 1 3-35.95, z i 159.26' a 1 32.4 p,'* A io N 1 DRIVEWAY O + W EASEMENT ro i0 1 0 LR a l N -4 1 4 1^ 157.69' o �32 1 � I A C I �r N86 00615 1 W 1 90.03' :1 �, � , ,z n ° ° i 1D I Imo` m .N I> Iz u 2.06 ACRES( 83750 SQ.FT.) 1 UJ '— 10 INCLUDING RIGHT-OF-WAY HOUSE W I •Op 1p 1 1 O Z 1N 1.93 ACRES (84268 SO.FT) t ry4 EXCLUDING RIGHT �o 494.79' SJ}I32.06' I POINT OF S 88 "W 526.85 I BEGINNING MONUMENTED WESTERLY ' i RIGHT-OF-WAY LINE 1 Z O UNPLATTED LANDS _ t I SCALE IN FEET 1 =l00 LEGEND ® E 1/4 CORNER 0 100 20d SECTION CORNER MONUMENT SECTION 29, O '1" IRON PIPE FOUND T28N,R18W O 1 X 29 " I RON PIPE. WEIGHIN G I.68 LBS. /LIN. FT. SET DESCRIPTION ;A parcel of land located in the SE1 /4 of the NE1 /4 of Section 29, T28N, R18W, Town of Kinnickinnic, St. Croix County, Wisconsin, described as follows: Commencing at the E1 /4 corner of said Section 29; thence NORTH (assumed ..bearing referenced to the ,East line of said NE1 /4, bearing assumed NORTH) 321.19' along said East line to the point of beginning; thence S88 "W 526.85 thence ` N0 "W 341.11'; thence N88 "E 528.49' to said East line; thence SOUTH 339. 97' along said line to the point of beginning, containing 4. 12 acres (179641 sq. ft.), subject to Liberty Road right -of -way over the Easterly portion thereof, and subject any other easements or restrictions of record. I, Tames •E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that I leave surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully ". complied with the pravisionc of Chapter 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision 0.7dinance, and the Town of Kinnickinnic Subdivision Ordinance to . the best of my professional knowledge, understanding and belief. OEPARTME NT OF REPORT ON SOIL, BORINGS A ND D SAFETY & BUILDINGS INDUSTRY„ J �i TE ,11 DIVISION HUMAN RELATIONS ������� (115 MADISON WI 53707 (1-163.090) & Chapter 145.045) LOCATION: SE TION: TOWNSHIP/ SUBDIVISION NAME: �N /Rf� ,W II\ ! ic-K1 'iIJi' _--- F .. 1r_ A COUNTY: OWNER'S S NAME: MAILING ADDRESS: ' 4 :�40n , ' r' ►UF�AS� 'S t ia. P- Z 1_.. t 'C c _ t` :.� c� i? ,�1: F,c.I....( , vi P. USE S 1T r� Ey 1_ 1.JT L �1� n �J MD �Y' �J� { J^ e` DATES OBSERVATIONS MADE Yn U NGC- tQj- -- f � 6 DRMS.: I COMNUER IAL DES R PTION: R FBI ( N E A / N TESTS Residence -- New ❑Replace I 4 `y'� / 3 ¢ RATING: S Site suitable for system U - Site u nsuita ble for system O"JVENTI NAL: MOUND: IN-GROUNDPRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM:( tiana o q S []U � 1 S []U [AS ❑U � S 1r10ej A- 1__ N s � ❑U ❑S I It Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: --- C- �- H. �� S + Floodplain, indicate Fioodplain elevation: r i.t;.. ifit'8:T . PROFILE DESCRIPTIONS • l4 ' BORING TOTAL DEPTH TO GR INCHES CHARACTER OF SOIL WITH IHICKNESS. COLOR, TEXTURE. AND DEPTH NUMBER OEpTH -. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) {� 1,10• aL ! . S: 2.35 b L '5 % I Lr5 w/ ? r L �MW4r CaR) 4.Ba'YFS w/ tiNFS voucers < %¢ € L L. ;3. LPS w/ DECOM,POSINr: Ltt.r1 .STcsrJS;s C7t;,• GR.• t3 L 10,�0 /00r0/ 1va1.1E �/' ,1 .'• jai Yf5 \,k/ -< Vz`0 SN•FS PoL tE TS a DECoMP05/NG L,MES 4.o0' W LI C5 NE (Si Co$ !� r 2,00' 5L L-F5) Z•5o' &,j LPS� 0.90' Is" 4' w/ OfcOMPIOSMAS B J. S� �9 O ] \� 0 l� c �' �, , ��, L /ME5Ton/E rn 1G ,r L /MES i or,/c- Es 430' Y.FS w/ < �v -,C-5 -,C-5 (� C.OAA O / E•1 L /MES !V �. el; . C)7,7?- 1 , 1,s5' SL LPs 1.90' g„r L- L o.4s' 8n/ 5 w ' /L" C- A4J'05#N6 g-+ 1 9-3 5 - ' /7,7Z jYONE. p t "F_ST E o& 6PP-) o,9S' Y•FS w/ %z" vif S" -FS Por_E - Ts - L/M S o c 6'2• o :5 w Z 1 -lMJ1_ - 5T_0N,5 S0' 3L LE5i y .4S' Sr/ L 5 1•SS' E6 •RS , DEGcMPOS n/C� LML STO ' � NE 3•'SO �.J s �// � 6 pp > IO, U Q , R. L/ ST GIMAL PERCOLATION TESTS `�`l� �`J"t- TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER +FJER4Z-S AFTERSWELLING INTERVAL -MIN. p R D t P RI D 2 PER INCH P- :5 I OP-l 10 1 /6 % V I t S t o P - ? j 4- , c' 4 l • l t " Q l 7 / v ! / /(e I 5 71 [i IL P- P- PLOT PLAN: 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 slope. SYSTEM. ELEVATION 10 � >�61 c -INJ c� - -- � -- -- ST � _ j .� _ 5 �' _'��__ �.._.,'4_ _.....` 0 -- P4 L FT tK - T , } fl i., i .. I t -; —--- i -3p- , ( -r - t - , -- t - -i- 1310 I , .. �._ _ 1 �, KI - - - y t° - ,,,�, �' 1. �S I KE IN 6 �NdM ;16 Et oo.+o da' i , 1 t � . - ..1 _. 1._..- _- - -' - -- •- _.._. 1.... r _....t.. _ - `-- --t-- -- 1 - � --�- - A S S 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Coda, 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: (ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optionall: IGNATURE � I D!STRI BUT ION . Or igingl 9nr nn <!opy To Local Auth , )city, Prope, t Owner and SOil Tester. �, RCN 1�• ��.� S � ���_ San. Permit No. �aner's name H63.05 PLOT PLAN Show: Location of building served NA Dosing chamber Q Septic tank Vertical reference point Building sewer Q Horizontal reference point Effluent system Well Peplacement system area Property lines w /in 50' of system Di stribution boxes F;�7 Scale = 1 " = 30 � , or dimensioned Pump and controls: _ -- -- — Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal. -per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: T--A--R ti- sl -, hk -L wv-�X-l.- i\T LE:'hS`T S0 No2` or - ZAi L �0 of 4 CI: k- �tJSTV�LI \OOO� A - -"pE F= �1J�SH GRtFDE G�L.vv��s� _ To p� Su2F�t4. 3�71C �NVC 3 0, a ` f �2A�Nh6t Av-EA cEr�t a� 6 6 13 b i $f1 - 2Q SPI }� 1V3 6" RIK�.Tba1ty / 1 3s'l IJF- I 1 1 EL too,oa e a s B2 V �IJ By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, s- -p-vjx County and the S7-.CR0IX County Zoning Administrator,. does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or after installation. J } Plumber's signature Sar. Pc N 0 C T7 , Z2 rved - , )O sina chamber of bi_ iding se- Vertical reference p Septic tank Building sewer Horizontal reference point E:tfii)ent system Well lines w/in 50 ' O f systeiT area A7 V -I S n Cycle C !-Lin - -"D S S T. D. H. V Pi P e F lace c 'neck, mark in appropriate i�c)Y, indicating i s shown on plot pl an h- 10w: w1EN-t_ A7 LetS7 S'b Nom 1 B-1 14 6 13.s PIPS upDr' the event, of a subsequent ON Of T-hE ar'�JVe F"ar'l or B\: the granting or appr a n �_ _� nty Zoning Administrator, does "L r S Count }' and the ()Ix Co,�b plan permit 'be ng i ssued, jja'oae for any defects in plans or specifications, ni t asF . k -,me or hold itself vers construction, or any damage that may result in or eXaT7dnation c L Sta 13 a Plumber's sionature PAC.[ LC- L -t�R1� T?- r= o CROSS SECTIDhl OF A BED SYSTEM - t �t IJ�SH - : -C > TeAID E 7,. h*LI ST. G PM(z S�[Zi -t� GE - PEA 1 N �'t SE — — - e ?-" OF "AGGREGATE e- SOIL F 1 LL --'� • y Z' _y' C DISTRIBUTIOU PIPE p�PPROVED Sy►1THETiC COVER MATERIAL OR 9" OF STRAW OR MARSH HA`3 N ( ° p ° �OF %2 - 2 1 2 AGGR €GATE ELEV. OF 94 10 FEE - - DISTRIBUTIOIJ PIPE TU 9C AT LEAST y9,3 .1IJCHES BELOW ORIGIUAL GRADE AID AT LEAST 20 110CHES BUT UO MORE THAU 42 IUCHES B =LOW FIAIAL GRADE _ 70.9 WC.HES MAXIMUt -- % DEPTH OF EXCAVATIOF.1 FROM ORIGIQAl GRADE �.JILI BE S 9.3 INCHES ` MINIMUM DEPTH OF EXCAVATIOU FROM OfCIGIUAL GRADE WILL BC S►G1 -1ED: � - LICEti1SC UUMBER• J 17