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022-1084-50-425
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and tx,ilding Division INSPECTION REPORT Sanitary Permit No: 563825 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N Pers onal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. C-111-A Permit Holder's Name: City Village X Township Parcel Tax No: Bowman, Chad T. Kinnickinnic, Town of 022-1084-50-425 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: ov Z goer "\A-f ',X, 29.28.18.456A50 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark i ~Ets_1 leoo 4, ,5'b Dy.so (OO,o Dosing Alt. BM r S •q` _ Jo! 30 f Aeration Bldg. Sewer X yo Holding t,. ( St/Ht Inlet /0"00`0,1 qrf / St/Ht Outlet Afr-N TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic SD r A/I t' S ~Y Dt Bottom Dosing u L( Header/Man. Culp-~ g0 Aeration Dist. Pipe r~ 94,~v / Holding Bot. System 3'~ (o~ Ig lat Final Grade e6 cam` PUMP/SIPHON INFORMATION -Z Manufacturer C%'J Dema St Cover GP Model Number 3 3~ •3~ 1 2D r TDH ILiftQ Friction e System Head TD ~ O Ft Al- -i 66-V C9 219' l Forcemain Length Dr Dia. Dist. to well s 1 Q \ ew oro.3 6 0 0~~ 3D SOIL ABSORPTION SYSTEM /S Ye f Szl " w'^~'" BED RENC Width Kef No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME t ery SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING may act INFORMATION CHAMBER OR ff Type Of System: UNIT Mod umbe -r >s Ply, DISTRIBUTION M Q.e ~L q, -k Headers ani old R,,N istribution x Hole Size Hole Spacing Vent t`o Air Intake ipe(s) ( Length Dia Vength Dia Spacing SOIL OVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of T-SeededISodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes 0 No ~ Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 60 / / Inspection #2: / Parcel No: 29.28.18.456A50 o ation~:e 1j0~3~1 ever a River Falls, WI 54022 ( 1/4 SW 1/4 29 T28N R18W) NA Lot 5 `(.)TI BM er drip o-r ~aat~~ ~~`~/S M -t'r~-~l ~^'f• 2.) Bldg sewer length = rr ~~~wtwdA p~ ct7o ~e_ $e we✓ " p dl - amount of cover = (p0 o.~G6V~ °IZf`o+. aiQQ IcS ' r / _I _ _ f_- ntSe.J r m th b`jr LL) Plan revision Required? Yes No Use other side for additional information. L n SBD-6710 (R.3/97) -1) 50.z( e s ignatuur/i / S t.NI~ ll~J''~Q/ I Y ~ _ ~ , T~_ z~3- 2 7 Jti rN t o 'A~ f ; t County, Ce Safety and Buildings Division ~ filled by Co.) 201 W. Washington Ave., P.O. Box 7162 sanitaryp it Nu O ~"T V 7162 iyP Madison, WI 53707 J~ ' `S P S State Transacts Number 3 CRp~X c 1 ri ermit Application governmental unit ail' g address) In accordance with SPS 3 1( , Wis. Adm. Code, submission of this form to the appropriate ermit Note: Application forms for state-owned PObe for secondary the Department of Safety project Address (if 41 prior to obtaining a sanitary you provide may f /0 3 / ~e2 ~Q is required and Professional Servies. Personal information f~2=gjaj 41 • oses in accordance with the Privac Law, s. 15.04(1 (m , Stats Parcel # ~ 1. A lication Information -Please Print All Information S~~ S 11 Pr erty Owner's Name Location nj Property e owner's Mailing Address Govt. Lot r1 Prop ~ C ` 1 O e Section d Phone Number cle on (y Zip Code E I City, State / T N' R L I l r Lot # Subdivision Name II. 'T'ype of Building (check all that apply) 5 C S~ 1 or 2 Family Dwelling -Number of Bedrooms Block # ❑ City of ❑ public/Commercial -Describe Use CSM Number D Village of K . 1 Ci ~C I h State Owned - Describe Use Town of r l System (explain) letr line B if ap ica e) D Other Modification to Existing e of Permit: (Check only one box on line A. Comp Replacement Only D Replacement System D Treatment/Holding Tank List Previous Permit Number and Date issued A. Typ ew System Change of Plumber D Permit Transfer to New _ f B. ❑ permit Renewal if 1// 11 20 0 ❑ permit Revision Owner Before Expiratio ❑ Mound 24 m. of sortable so e of POWTS em/Com onent/Device: Check all that a l4 . of le sots. ( p d s Sys IV. T ❑ At-Grade ❑ Pressurized In-Ground eatr e ex Non Pressurized In-Ground 04 ❑ Holding Tank D Other Dispersal Component (explain) ; System Elevation V. is ment Area Infolmat on Rate(gpdsf) Dispersal ea R quire sf) ersal Area Proposed (sf) f v Design w (gpd) Design Soil App VI G f Manufacturer V - Total # o ~ L a Tank Info Capacity in allons Units w c o o -,7, o, Gallons y J, New Tanks Existing Tanks p„ U Septic or Holding Tank 5~U 1 W Nation of the POWTS shown on the attached plans. Dosing Chamber VII. Responsibility Statement- I, the undersigned, assu RS Number Business Phone Number responsibili or Plumber' ignature Plumber's Name ~t G' 7 1 ~(I2 Y ~ ~ Ci fate, p Code) r's Address (Street, Zi bes og Ag t Sign e L. Coun [Department Use 1I Permit Fee 00 Date ued (~lJ ~t!~('/l~✓t'~~ / / Z l C~ ~+(q~ Approved ❑ Disapproved $ iV/ 20/3 ❑ Owner Given Reason for Denialp roval / `3 Im. Conditions of Approval/Reasons for Disa p -~-o Ala roh~'r` x~ Qg~ SYSTEM OWNER: CS~ _ L / r{ {ro iced - 81 1. Septic tank, effluent filter and d I maintained ~r G(/l ll! 16 dispersal cell must bg.' n Provided by plumber. as per management p be maintained bl unty only on paper not less than 8 In 11 inches m size All s mo ,►ans forhe system and submit to the ~on '0 + ^ ~ S71D~ tM'~~ as per applica ' L 1 J r~ _ a -3 C~ Lf V) SBD-6398 (K 11/11) 1~ ~ Sys' v CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE~ Project Name: COCA V"\ Owners Name: C ' kj W i'~^G Vti WI)OA 42-C, Owner's Address: Legal Description: W V y C1 T2. N) Township: j r, I'1 l~ C k J 'J) County.. C U I X Subdivision Name: Lot Number. Parcel ID Number. (j~ ? / Page 1 Index and 6tie Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information ✓ Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page S Warranty Deed Page 9 CSM or Plat Attachme it Test & House Plans o~ ~1 Designer/Plumber, d~ License Number. nm,~o olr3~/S~/ Date: --o? n/Z Phone Number --T Signature Designed pursuant to the In-Ground Soil Absorptio mponent Manual for POWT'S Version 20 SBD-10705-P (N.01/01). Page 1 L fir, -4oo O s ~J a c•'' O vl _ ' r MaWI LY Vm l=) 1` j j IQQ t•L L It-- c-w i7 V rroperry LOCaUW M !RA$LTT?_-T- :S. VCo U6, 1-(-uj Sig- s fr 114 mum 114 S 2 q T Z~ N R I$ E (orl W Property Owner's Mailing Address OS # -Block # Subd. Name or CSM# 109 D ? t2.Prt R1h, MOOtN DIZIU L4 - - CS M City State Zip Code . Phone Number : p cny 1] Vinage- ® Town Nearest Road Rtv 13Z Fcu- S kvt SqQ I-ZA ( -11%) LL Ls - 111% ISI")2 C12 t1U to t C Tz1 V l5Z. UR.1v it New Construction Use: ® Residential J Number of bedrooms y Code derives design flow rate 04 GPO 0 Replacement ❑ Pubk or commercial - Describe: Parent q jte w G Le re-L PrL O U TWAJV~,i_q k+ Flood Plain elevation If applicable N - fL General comments - and reconurrendations: ~ECf3M1~1~1J1~ 3 C tr"t-( S, ~ i 3'~c % r- I- S ` LrWG r.1 t` n* Q3 uN t T"S OF Boring # : Boring - ® Pit Ground surface elev. a R ft Depth to nmMV factor b in. Son Application Rate Horizon Depth Domiaant Color Redox Deso"on Texture Structure Consistence Boundary Roots GPDnF In. Munson Qu. Sz. Cont. Cotes Gr. Sz. Sh. -Etf#1 'EH#2 Vn v _ ~w l~ : 5 g Z 1~ 37 loyR~I3 ZS ZcSb~ YYIV~-- 7-- bn~~ KiZ -s1~ ~Za'-~:~~1R 5/8-• ~ - ~ s9 m ~ - f ti W1 1 _ V1 - 0 Boring Bor9rtg # L -7 ® pit Ground surface elev. tt Depth to limiting factor Rate Hortmn Depth Dominant Color Redox Description Texture Structure Consistence Boundary GPDflF In." Munson Qu. Sz. Conn Color Gr. Sz. Sh. Ett#•t - -011#2 o-L lo`~ iZ 31 z _ L Z,irt s ion Yn v . S . . 1$ 3o io~cz:.3t3 ` ~S `e.:sbk mV~ c=S - ~ :`-ti 't. Z • 3 3E,--) 3 to`Lii _ •~s' O S°~ vh eS '4 LI... 3-40 lon~ riSlfs- `~s O Sq • Eftent #1= BW5 > 3o < 220 mg& and TSS >30 150 mg& - Eflurent #2 - BODs < 30 mg& and TSS < 30 mg& CST Name (Please Prirrq tae CST Number Arthur 'L: Wegeier 220254 oaos Evaluation Conducted Telephone Address Wegerer Soil Testing & Design Service Number 421 N. Main St. :River Falls, WI 54022 1`1Q_J31 715-425-0165 - I Owner C~30I7~ -~-1r°J!~ l ICJ S VL Parch ID # Es1,Jb/ h) Co Page G of ❑ Boring Boring # Pit Ground surface elev. Cl Depth to ikt~iting factor 6 to in. Rate- 0- Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots GPM In. Munsell Ctu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 O-Ly zh,s61z m\j ck, t-e ly=yu tO`!rz 3 t~ is l0S)Or- m\)+1 C S " ..7 t. Z ~o-i iz -%I 'Fs U s V', ~S • S `9 6 O v ft sic -~-Z 7 s4t2 S /S `Fs C7 S. m ! . S ~9 Boring # ❑ Boring ❑ pit Ground surface elev. ft Depth to lirrdtfng factor In. Sol Application Rate on Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM2 . In. Munseb Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 . 1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. : Depth to Nrnidng factor in. - sou gate J ; :on Depth Dominant Color Redox Description Toxkn Structure Consistence Boundary Roots GPD/lh In. Munsell Ctu. Sz. Cont. Color - Gr. Sz. Sh. •Eff#1 •Eff#2 t • = >30<zw wd 5S:,-= <15Eimplt: *mwmm#2a80D6<3Dvv#LandTSS<3DmplL. Emuwt#t t Im Dgmtmu t of COOMMM is sar =Fd qVOdOUiIY I=vroe Pcovddu and cnvk a- If you creed assistom b auras Servim or seed snateM in an a 6 fomOk plot Catttsfat fire depadment 4608-266-3151 or TTY 508-264-8777. .uwts.rvro~ G X00 1 PLOT PLAN Page ~ of .3 Scale 1'=50' - 2 w ett ~>~l u ~ %M vi-I i $1-LS' -~9 -y g ~ So' ' S'r-► w . Su rTpcv3 ~ Fe VZ IG~ ~LT_.S'r Z°!o ' %LD 6 S eTBrfelz Llw ~ ~p ►p 10 Mo - . r v nor .1 Oat y R-r eF~.Tt~RUhl~ OF MIUM -T,)1Z.t_V La: J:x "In- ON- ZkDy- SOIL ABSORPTION SYSTEM DETAIL / LEACHING CHAMBER Page of Owner's Name: ~a d 1 ()kA) rY~a Y► Z No. of Cells LEACHING CHAMBER SPECIFICATIONS 3 Manufacturer Product Model EISA Per Chamber c`3 ft Cell Width ADS Inc. Bio-Diffuser Bio 3 24.2 Arc 36 25 ft Cell Length Bio-Diffuser 16" High Capacity 31.1 Bio-diffuser 11" Standard 31.1 %3 ft Cell Spacing Infiltrator Quids 4 Standard 19.1 Systems Quids 4 Std. End Caps 5.8 / Pair Z Chambers per Cell Quick 4 Plus Standard 20 V~~~~ Quids 4 Plus Low Profile 20 LA / y -1 1 Total No. of Chambersp ~ Quick 4 Plus Standard End caps .1 / PBiG { E rtct $ Quids 4 Plus Low Profile End caps 4.6 / Pair 9 03, (osg ft Total EISA Leaching Chamber Manufacturer: T h p F f (,,-i o r ~D Z ado Leaching Chamber Model: CP W C V- P( 4.5 qa. Z~ Distribution Box Make/Model: _ /V ' /Ue& dn& TYPICAL CROSS SECTION Finished Grade it Vent Pipe went Cap in ,a Soil Backfill v Infiltrative Surface in b Limiting Factor in C Plumber/Designer Signature: License AMP 0< y2 3 &1 12.5- Date. t) J~ ~ ~ ~ Z w O z a F- LU oaQ U O= wwF- wow ~~jLJ-i ng uj U J M a CD Li ac ° U o~= owOo Q J LL J Ch U `O" QOo ""F- N N = LL C7 ti LL 00 n, I 4- O J w ~ r _ Q m 0 Cep LL co N Z¢Z rnO CO M SE O J Lo L O O c:> o NCD d~Q D U J e- r r O Q a - C)i z LL LL LL 0 O U~_ U C/3 i~ J_ F- F- lL Z ~d O °woL°n J ~ ° LL U J W O Q ILL. m - V- d LL co o ii v of r` z O_ NF- U) w El LLJ a o cr- LL JAM L L . CO LL GO m LL rn O U r ~ it C d ~ q U o U co W uj a d z = d F- co U N U`- U `n JO O O v ¢ N ~ cn cn d o T O~ Z= ~m N ® ® co F_ N O N LLI LUz5 OT LL ~ LLI 0 CL ® X - JLLJ J v LL LL d' LLt~LL a_ ® GoO w ® LL) E CD v COO CD N N PAGE CF PUMP CHAMBER CR055 SECT101.1 AND SPECIFICATIOUS V E UT CAP Y~ C.I. VENT PIPE WEATHERPROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER ~ 25` FROM DOOR, WINDOW OR FRESH I2"MIN. AIR INTAKE GRADE YMtA1. CONDUIT--//-- I8^Mw, - - INLET PROVIDE { / AIRTIGHT SEAL A 1 1 ALARM ti c *APPROVED I oN ppqq JOINTS WITH ELEV. FT. APPROVED PIPE 3' ONTO PUMP ~ OFF D SOLID SOIL CONCRETE BLOCK RISER EXIT PERP11'IfED 0IJL4 IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE TANKS 1AAWUFACTURER:•.40 NUMBER OF DOSES: PER DAB TAIJK SIZE:_6LG GALLOIJS DOSE VOLUME ALARM MANUFACTURER: ~ cf~ ~Li Carr-t 45, IIUCLUDING 6ACKFLOW: GALLON MODEL MUMBER: 429-6 /94s11 CAPACITIES: A= LINCHES OR ~7d GALLOU; SWITCH TYPE: 11,91, If- B = L INCHES OR G GALLON I PUMP MANUFACTURER: O C= INCHES OR GALLON MODEL NUMBER. D- 2 INCRES OF. 6ALLOW j SWITCH TYPE: - L WOTE: PUMP ARID 'ALARM ARE TO BE MINIMUM DISCHARGE RATE 162" GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AUD DISTRIBUTION PIPE.. _ FEET + MIIMIKUM NETWORK SUPPLY PRESSURE . . . 2.5 FEET + T - FEET OF FORCE MAIN Y. Lo F/ppmFRICTIOU FACTOR.- J S FEET TOTAL DyWAMIC. HEAD = FEET IMTERNAL D1 EIJSIOMS UK: LEIJ6TH ;WIDTH -;LIQUID DEPTH SIGIJED: LICENSE NUMBER:~~~~~}Dl1TE: ITT GOULDS PUMPS Wastewater PERFORMANCE RATINGS COMPONENTS Total Head Gallons Per Item Description (ft. of water) Minute No, EP04 EP05 1 Impeller 5 53 - 2 Base 10 /6 10 46 62 3 Pump Casing 8 15 36 55 4 Mechanical Seal 20 21 46 5 Ball Bearings j 25 0 33 6 0-Rings y 6 30 - 11 7 Power Cord 5 8 Oil Filled Motor 4 Motor Housing/ 3 9 Stator Assembly 1 10 Motor Cover METERS FEET 10 9 30' -►~5 GPM 8 #-2.5 Fr 25 0 7 W = 6 20 z 5 z 0 15 Q 4 EP05 O 3 1 I EP04 2 5 _ 1 I 0 00 10 20 30 40 _50_ GPM 0 2 4 6 8 10 12 m3/h CAPACITY 3 Jul-05-2013 08:54 AM St. Croix County Plan/Zoning 715-386-4686 2/6 -9 POWTS OWMER'S MANUAL & MANAGEMENT PLAN peie FILE INFORMATION SYSTEM SPECIFICATIONS Tank C O Owner Oa,,,,~ rv°.ci an, Septic ~aci~ 60 a! (3 NA ermit 56 Septic Tank Manufacturer -%-J : a? S c r 13 NA P ~ DESIGN PARAMETERS Effluent Filter Manufacturer J & S " i" ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model C, F [t 13 NA Number of Public Facility Unite E NA Pump Tank Capacity s al 0 NA Estimated flow leverage) 013 gal/day Pump Tank Manufacturer W ~ eC P © NA Design flow (peak). (Estimated x 1,6) ( al/da Pump Manufacturer 0 I & ❑ NA Soll Application Rate al/du ins Pump Model' O 5 0 NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit A Fate, Oil & Grease (FOG) :00 mg/L ❑ SandlGravet Filter ❑ Pest Filter Biochemical Oxygen Demand (BOD41 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Watland Total Suspended Solids ITSS) 5160 mg/L ❑ Disinfection Q Other. Pretreated Effluent Quality Monthly average Dispersal Csllls) 0 NA Biochemical Oxygen Demand (800,11 830 mg/L O In-Ground (gravity) E In-Ground (pressurized) Total Suspended Solids (TSSi 530 mg/L ■ NA 13 At-Grade ❑ Mound Fecal Coliform (geometric mean) 810" ofu1100m1 Q Drip-Line ❑ Other: Maximum Effluent Particle Size K in dla, O NA Other: C1 NA other: ❑ NA Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent, other. iD NA MAINTENANCE SCHEDULE Service Event Service Frequency At least once every: month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) IS ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume © NA At )east once every: `monthle) (Maximum 3 years) [3 NA Inspect dispersal call(s) .l(s) year(s) monthis) ❑ NA Clean effluent filter At least once every: M ear(s): Inspect pump, pump controls & alarm At least once every: ❑ monthis! 13 NA , E yearls) Flush laterals and pressure teat At least once every: L3 monthis) ■ NA 13 year(e) other. At least ones every: Q month(s) p NA ®yearls) thou DNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shell be made by an individual carrying one of the following licensee or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintalner; Septage Servicing Operator. Tank Inspections must include a visual inspection of the tank(s) to Identify any mieaing or broken hardware, identify any cracks or teaks, measure the volume of combined sludge and scum and to check for any back up or pandin8 of effluent on the ground surface. The dispersal call(s) shall be visually Inspected to check the effluent levels In the observation pipes and to cheok for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the immediate notification of the local regulatory authority, :'d on the a °rnbined occumuletlon of sluudge and scum. in any tank eguele one-third (lt1l or more of the tank volume, the entire a®: contents of the tank shell be removed by a Septaga Servicing Operator and dispocad of in accede- v 'vim Wisconsin Administrative Cons. ,,a3 rirrtesreEss fr€,'r€fE3:s 116 ;4 , - L::0 reel iivr n to t64. wanjiflm. rif affl innt €§i; if:±i. c r@3..:vs: i5 units, enc any Servicing aL iiticiva[si tt, 36 4 6„rc z.st ar - _._.a__ ..ip ra_ ~a~~sa _a ax asap =?41 i%aiiir>i ?9ii aa_ii~ -3 i?iiii a #i~?9 7c.v: ate. - - . Iiwivi i~iiiii G S %R z LSD 6'39 Sd 2iF l'mF S3 _ G • >`i -TeA r~R idi 6•F °a. ES Y ter - E NLE Id I13 cY. e_ _ i£s Sd - 8 rPr4'+. I. iF 3/. ii a--.9 a ra g,r~.. On F. .aa ..o- :-n.~a.m+r mina svs mmmwm~r wasv -mves.srvm as m:ea-.sa+u L ~t_~_~_ FSi i Ii 4 ®1 Ib- 3` 07ii g4$aY® the fv-!M1i'a~' tlltlt rAA~Y 1111}704?E7 6lIQ U4®!!!18116 ~dlVVvw.i ..vl V. L.wa..ra~ ~:~e. .-r rl.._ -s+m namn-:+m ..vm of the tank(s) removed by a septsge servicing operator prior to use. System start up shall not occur when soll conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the exoses wastewater will be disoharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent. To avoid this situation have the oontente of the pump tank removed by a Septage Servicing operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to aeslat In manually operating the pump controls to restore normal levels within the pump tank. U4 rSUi 4r1Va or }79r1i vqi llldtlw ulia - r-,.. - my ...r r. ,.Y within 15 feet down slope of any mound or at-grade soil absorption ores. Reduotion or elimination of the following from the wastewater stream may improve the performanoe and prolong the life of the POWTS: antibiotics; baby wipes, cigarette butts; condoms; cotton swabs; dogr+easers; dental floss; diapers; disinfectants; fat; foundation draln (sump pump) water; fruit and vegetable peelings; gasclire; grease; herbicides: most scraps; medications; oil; painting products; pesticides, sanitary napkins; tampone; and water softener brine. ABANDONMENT When the POWTS falls a.ndrrr ig Permanently taken out of aervlce the following steps shall be taken to Insure that the system Is properly and safoiy abandoned in compiianad With % ioNtcr °.wilim cQiV.v .A+~iSL^v^nvrn 0,,lm3w;g isc4lVA C-d- e All piping to tanks and pits shell be diaconneoted and the abandoned pipe openings sesied. e The contents of ell tanks and pits shall be removed and properly disposed of by a Septage oervWing vrera`o`' s HIiM{ fJEJaS f{J)1 iy-pa ® aiiiM Ea.LP n..r.. r r..vv••.•-~ ....m.•..z ee.....e va.u .....r c. ev vr.a sr ~w sisal, grove! or anotnor Inert aund material: i.S liY i iNi~i•SM[sF ~S_t55S! L••g Eu.€caeaR€i• -sseag~~u€ +Y - it the IPO S falls sn = u 3soaa•-aL .Y .4.`e ?.es rb~ =g'E-`3a__`: _ - am: - - - - - a'R' ,ay a'1n. a~ Si ::{Ia ;mss ;r rr 'z~Y9..aLia)ri .<r ® :saaia v. L m t- i 5 a.e~re Ai r'e i$$$ Y3a e"a aaEfa$yl.Fa frinlec+omant ax ue a*< _ ,,,,Rfi ..w ih sate N en i g9 y n._.r~.-+..- 'r'i r.-.>wf -!.m4 c.~ s3: nE ?sE Y24 P erb0wmlR TPP!8;. 391¢T Hrb*;iz-te Afwd & sjm-nns;LI 11 an .7➢➢V'a.1V Im L 3aVe ;^rring Ispor: r.~i .r+ ii~$i.Giia. class i- eRi+-+is as:.ia a•.-.-~+=~-a a- ~ - - - ^t-.r- ,..~e i=..-~.aa c~„a;i~r, e.,.. r•aTa•isant 91I°as rp°,rEF,~r~a€EnRrf 31E`i$q ?ka??!? w...o. +e...a a..wab. a•wua+®:sir? >AV aar9~a Yi acnn a-ca-i;i ai a-;a+ai L•+, c as ea aaa ac=s ~aasx aicliairi :::.?.?.v 4~ ia•aa%»= ...4 •_r--__. _ e_. . .n _r... .-...._..i.-.... a ...a., a` cv r.i R.•uT u.?se ~.TFA- iWR~.n.. §?vTnPT]x My>reai nh+X ae+us[ Sf.°Z`.~{5 3EE iai4 €b8~t8 .'i:t de 1-1 °;he dta hF not b$o?'- ova;u-5i°ad °z°v i~5aai ay .i.i 9v:°E r c$~7 ~ r raja g a~a3r7 taii9lr~ ar. "laic wsF a.s ~ w`wi, h . raCa~wsa! ba ~a a aia 1<r# ??tia?^ i?^ 4rk . li 5#S7 . E&#wiEF=,€ae€t Sr$$ IS $s'~a. a a$ .a<...~s_ a . .....v ♦ r w...i aw+ vJ.lS~~ .i...R rei)SSR.ER ft RJRS _taala9 f-.9_ _o .urr..r.. ..varw 5..-- r _ •'r^ ra ...r AilTCIL#giLlYag 7iUf[O{iQ. f14aFL,f [i=lE §AViii[.eH vi +'iy:.... rrs.:...m •r,i -.,eoa - - ~.e ~ 8Y br6fi kYSAi Ai T $ mi . 6aaasa fls a<~ a:;°ra+.ca. p r= s~ S 'go; Ansrv n-lq M-94 9iFIY.. EF-Q A 11XVIMR. DO~'i~Yi~r PUMP Amu ~ 4 !'aC.r'S &!50.64 Rkal5~ ??4?l~i5 65a}}? waa.4a 6saEa a.i-a ,s- NOT - . . :r.°r e'l~82~ ~6s#93 ai5~r yzcaui i. ncL~a.arr =!.T90 S;PTif'. -2$lik e3$~S t€?'i~:m. T EA IIMEN TANK UNDER ANY e.. - .n> . .s T ,a U.'°`z`OMM Wr J!, TAKES` %4AY gS D'a=- at:'a= ➢Sti'~P tee .raw.~r.. Er+e ~ a~ r-teeax~~ eTI ~#AS°I'9#I'--§~, yyFy{ q~ AU S-?aF 9i 118 f'. ~NGS 6.i aiaB4riYar°3aaSi.aF . Pnnn~a "a/ Phone j ~ Si:p. OPERATOR (PUMPER) LOCAL REGULATORY KU i HORiT°i r~.E3l= SERVICING Name IVama 0/J//J Phone j Phone i iL~ 6 {JAI YYiOVViiai{I MuliE iiioLa'P.ti.v .rv.~..g.. This document waa drafted in compliance with chapter Comm ta.l~{Ljibjil ji0jrxi4P 9110 '3.ii4i i!, 1,21 05/27/08 TUE 09:32 FAX 715 388 4086 _ iM001 ST. CRM COUNTY SEPTIC TANK MADfILINAWM AGPJHDdLNT AND OWNERSW CBI MICATION FORM Owtter/$ttyec C.' hctd Me li s 6- Sown-rtn Mailing Address Property Address 1031 ~ er CY". w. ~p0 (Vaificadon required fimm Plaaairo A 2;oniag D For aoadnacdom) City/Staw Zw ec Fn *s , \A/ I Parcel identification NuDAw Z S Property I.ocetion V4, NVY, . Sec. T 29N R W. Tows of h n c e ,ran ; L J~r Subdivision Platt= Lot Certified Survey Map # Gam' Vohttnee page # S 7 Z W=T mty Deed # C(/ (before 2007)Vohmne , rage # Spec bye :1 yes _I no trot lines identifiable C yes 13 no M ANCfi AND OWNER G'1&RT ELO SYSU Improper ne, and mtmteaaum of your npic system could rank in its prime t'at7are to htmelle vrariea. prow t oe coasisls of pumpAtg Out die Septic belt evatygiree, yews or now, if neeeled, by a iiooawd gmapea: What you put into the syMm cae atgeot the fimaiOa ofoe aepdc t okas s tra'a, , - stage io &e waste diap nd a - Oaeaec dremoe nq, i we sawified in ICOeam. 8352(1) awd in Climptar 12 - St: Crok camw Sa nkuy Ovens= The property Owner Ogrm m md*lut to St Crone COuW PkAmag dl: Zenis* DgWumd a boa form, signed by the owner sad by a mama plumber. journcyam per. mvicled plumber or a licensed PUAW verifying that (1) the on-sites wwsWwzier disposal eseem is is proper operating eoo"ou aadtor (2) after mWac bm sad pooM (ifnecessary). die septic tarok is kss d or t!3 fidl of shtdge. Uwe, the undasw ed have and then above requiromain and agree to nwhilds dye Private sewage Aposai system with the wndards set fordp, hacK asses by toes Dedparome nt of Commerce and die Depubma t: of Ndmai Re90urr008. Stags of WisooaAL Certification stafiag dud yaw sepic syskam has boa meiaoained VOWIt becom piemd and wooed m ilia St. Cre t County Plseeang A t Ad" 30 digs ofthelm yearegkWondait. Uwe eatifp that all sommo an this form are true to the best of myfemr knowledge. Nwe amlam the owner(s) of tW [property desmbe d above, by virtue of a warranty deed recorded in Register of Deeds Office. N ms OF CX► Mg) DATE *"Any it fame Oa doL s iniffqxamod may min dtebuypea9limS mpftdtby*e P188a9& T.ooutg D w&MIL • Inducle with this applic mm a recorded warranty deed from the Register of Deeds Office and a copy of dye certified survey map if -3crapce Is Maw is the warranty deed. (REV. Us 35-27-68 11:49 TO: FROX:715 385 4686- Fat ! 111111 ill ll Ilill INII 11111 IIIII 11111111111111 IIII * 9 1 5 7 0 0 1 State Bar of Wisconsin Form 6-2003 9 1 5700 SPECIAL WARRANTY DEED BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROI X CO., WI RECEIVED FOR RECORD 05/07/2010 08:30AM THIS DEED, made betwleen First Bank of Baldwin SPECIAL WARRANTY DEED EXEMPT i ("Grantor," whether one or more), and REC FEE: 11.00 Chad T Bowman, a 'Married Person _ TRANS FEE: 102.00 ("Grantee," whether one or more). PAGES : 1 Grantor for a valuable co sideration, conveys to Grantee the following described real estate, together with the!rents, profits, fixtures and other appurtenant interests, in St. Croix Qounty, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Recording Area Name and Return Address 1 Partof the NE of NW 4/< and part of the SE of NW of Section 29, Township ~-anr 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin described as follows: Lo,5 of Certified Survey Map filed July 25, 2003 in Vol. 17, U ft-T Page 4572, Doc. No. 732)55. 022-1084-50425 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the tide to the Property is good, indefeasible, in fee simple and free and clear of encumbrances arising by, through, or under Grantor, except: ~N Dated May i 2010 First of (SEAL (SEAL) * * M. Mentink, Pr tdent (SEAL) (SEAL) * *Dale R. Jensen, S or Vice President AUTHENTICATION ACKNOWLEDGMENT Signature(s) LON STATE OF WISCONSIN ) authenticated on NOTARY PUBLIC ) ss. • S ATE OF WISCONSIN St. Croix COUNTY ) * Personally came before me on May 041 , 2010 , the above-named Jon M. Mentink, President and Dale R. TITLE: MEMBER STArI E BAR OF WISCONSIN Jensen, Senior Vice President of First Bank of Baldwin (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrumen d acknowledged th q e. THIS INSTRUMENT DRAFTED BY: * r+d Attorney Doug Berg I No Pub c, State of Wisconsin 1200 Hosford Street, Suitp 201, Hudson, WI 54016 My Commission (is permanent) (expires: 2- .4,31 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE. THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. SPECIAL WARRANTY DEED @ 2003 STATE BAR OF WISCONSIN FORM NO. 6-2003 * Type name below signatures. 1 of 1 -7 3`- 12} SS VOL 17 PAGE 4572 KATFTL-E W H. WAL-SR-_~ - REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 07/25/2003 10:15AN CERTIFIED SURVEY MAP REG FEE: CERTIFIED SURVEY MAP COPY FEE: - PAGES: 3 Randall P. Cudd and Robert J. Kolashinski Located in part of the Northeast': of-the Northwest'.'; and part of-the Southeast !4 of the Northwest ,1/, oJ'Section 29, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix Coun ;;~~ng Lot 4 of that Certified Survey Map recorded in Volume 15,W". Croix County Certified Survey Maps. Planning Zoning anf4 Perks committee N JUL 2 5 2003 LEGEND BEAR' a 1 ' x 18" IRON PIPE SET NORTH V4 CORNER TO THE WAP 30 days of (MIN. WT. - 1.13 LB./LNV. FT.) SECTION 29, T 28 N. R 18 W IIs~be FOUND I"IRON PIPE (FOUND BERNTSEN ALUMINUM MONUMENT) R 18 W, AS FOUND CONCRETE (P. K) NAIL N 88°1350' E 0 IN SfTUMINOUS PAVEMENT OWNER'S ADDRESS SECTION CORNER MONUMENT $ SCALE: 1=300' 0 (AS NOTED) 1080 PRAIRIE MOON DRIVE ~ w (R RECORDED AS $ RIVER FALLS, WI 54022 16o 160 2 0 3 0 SETBACKLINE t g NOTE- LOT 2 o SOIL BORINGS (PROPOSED I ~6, AN EROSION CONTROL SEPTIC SYSTEM) PLAN WLL BE REQUIRED CERTIFLED SURVEI'~ ; I o BY THE ST. CROLY COUNTY 4 Il ZONING OFFICE PRIOR A.jAP VOLUME_7, UNPLATTED !ANDS TO ANY CONSTRUCTION. 1 PAGE 1902 CENTERLINE RIVERDRNE (~Ngg-,ypt75-E) . 2 1 LOT4 R= N 89'30175" CERTIFIED_SURVEYMAP N 86°32,51- 33. -l.T-- ~ 592.00' 1 ~ 1 g 3 I SOUTH RAN LINE o S o c•a = VOLUME 9. PAGE 2543 RIVER DRIVE LOT 1 P1 LOT 2 LOT 3 _SOUTH LINE NE_1144VW114 g LOT _ - - `o NORTH UNE SE1/4 NW1/4 Z ~~Qp A; OERTIF_l~D SURV- 1Y _MAP { 296'00' 0 66' N 88°32'51" E 592.01' VARABLE WIDTH T_ 8°32'51 • E VQL UME 6, PAGE 1754 NOTE- S 87°39'4T E 295.81 33 LOT 5 CONTAINS 96,243 SQ. FT. A OR 2.209 AC. (87,154 SQ. FT. OR I " - 2.001 AC. EXCLUDING TOWN (R=N90.0000 E)~1OOQ' ~ ~ ROAD RIGHT OF WAY) N 88°03'54' E ! _ s, Fwi - g r-J R/W ONE EAST RIVER ORNE `l SEE DETAIL PAGE 2 37 l uN - 1- 1~ 2 I 3 ~FZJ EASEMENT PER DEED w Cal fO~J VOL. 582 P. 486 AND EASEMENT PER C/3, - 3 \!Q- G C.S.M. VOL, i. PAGE 162 - VOL. 714, P. 405 ! I Sl1t3 - C EY MAP A~1S[ M E6, P 53 a s $ si 8 0 OUTLOT 1 a; Z 1,076,565 SQ. FT OR 24.715 AC. 6oti CERTIFIED NSI w ~L~uR~,~,LyE . (1,074,384 SO. FT- OR 24.665AC. EXCLUDING TOWN ROAD RIGHT OF WAY) s~S 4 SURVEY MAP_ 7'1"3 p LDENVILLE,•~ IY h VOLUME_1, W'. Ac CERTIFIED 1) •~d 41 SURVEY MAP ~aq!2 E 162 Fo No VOLUME 1, .PAGE-204 D ED: sWCOR. 1 MARCH 31, 2003 (Rs N 90'OObO" E' S 89°48'45" LOT 4 E) - N SB° t_ 3_30' E 261i 3.3~ N 88°13'30" E 1295.3T SOUTH LINE LOT4 N 88°13'30' E 934.09 1-- EASEMENT PER EAST-WEST 1/4 SECTION LINE (R= S 90°00'00" W. C.S.M. VOL. 1. R 204 (R= N 90.WDO'E) 1" ' N 89°48'45" W) o (R= S 89-48'45'E "5204.31) EAST 1/4 CORNER 29, N 88°13'30" E ;"5204.OT - SECTION W SERNTSEN WEST 114 CORNER UNPLATTED LANDS $ w (O N R 19 SECTION 29, T28 N. R 18 W (FOUND _ 8 v ALUM/NUM M MOO MONUM MENT) ((FOUND ERNTSEN ALUMINUM h ~ a g SOUTH 114 CORNER N SECTION 29, T 28 N, R 18 W THIS INSTRUMENT DRAFTED SY JERALD L. CARSON (FOUND BERNTSN7 ALUMINUM MONUMENn SHEET 1 OF 3 VOL.17 PAGE 4572 0~ Cl) O 3 n d c' c ° ° fD Lo1 v :1 m c • ~n z Ta rn 2 o A N N O (!r' O d c f= 7 N N ~.y C a CL :3 CD 9 W N m 00 C) U3 X N W ' A (D F), Ln 0 CD a O d O > N 1 c O to z y L co D a ° o m c CL Q z C) O O v ca O c ca c O O O Cl) -0 w < cn z tn~r+ =r 3 cn N N D m D O O h ~p N i I 'J tai f~D f~ O A T 3 N .i A cn tD -4 3 N Z W O Q D o' EP a O ~ ° O 3 c m "NA• o vi hl ~o m x m C O c ~a N N O a m ° O J A 3 (D cb 1 -I N co D o A ? n Z N Q W p m N c0 ~ a I a _ z ~ j O w 3 (D N (D A I W ~-N0M Q ° o. 0 -n 0 v c my m z a 0 °x?m N ' I m fn N 0 N o its ~ m 1 ~ CL ~ O A N 6 ' Ili n fD CL CL ;3, N N N CD O fD N 0 O O CD " = fD O N w O ~ N pp W f0 N E9 O . ~p { O Q a i Parcel Y 022-1084-50-425 04/19/2005 12:21 PM PAGE 1 OF 1 Alt. Parcel M 29.28.18.456A-50 022 - 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): Current Owner CRAIG C PECHACEK " PECHACEK, CRAIG C 1157 RIVER DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1031 RIVER DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.209 Plat: 1753-CSM 17-4572 022-03 SEC 29 T28N R18W PT NE NW & PT SE NW FKA Block/Condo Bldg: LOT 05 LOT 4 CSM 15/4065 (2.209 AC) BEING CSM 17-4572 LOT 5 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 29-28N-18W NW Notes: Parcel History: Date Doc # Vol/Page Type 01/23/2004 752552 24971218 WD 07/25/2003 732055 17/4572 CSM 04/29/2003 719242 2222/531 WD 01/05/2001 636321 1572/511 moLC re... 2004 SUMMARY Bill Fair Market Value: Assessed with: 12786 Use Value Assessment Valuations: Last Changed: 07/01/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.209 400 0 400 NO Totals for 2004: General Property 2.209 400 0 400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i Wisc n 4 Department of Commerce PRIVATE SEWAGE SYSTEM County qt C'mix Safety and Building Division ' INSPECTION REPORT Sanita it 463410 GENERAL INFORMATION (ATTACH TO PERMIT) fate 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: Zi ne o Builders Kinnickinnic, Town of 022-1084-50-4 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 29.28.18 6A50 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS FS ELEV. Septic Benchmark Dosing Alt. BM Aeration g e er Holding t/Ht in t 100 00r_ St/Ht O let TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. en it Intake ROA Dt Inlet Septic Dt Botto Dosing H der! n. Aeration Dist. Pipe Holding Bot. yste?m! final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) LLength Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over _TT Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges psoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1031 River Drive River Falls, WI 54022 (SE 1/4 SW 1/4 29 T28N R18W) NA Lot 5 Parcel No: 29.28.18.456A50 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. Date Insepctor's Signature Cen No SBD-6710 (R.3/97) Safety and Buildings Di ~D Tnty 1*is 20 1 W. Washi Madison WI 5 Sa itary Permit Number (to be filled in by Co.) ~O~~I 4 7 W Department of Commerce (6 ) 266-3151 Sanitary Permit Ali gicat on APR Stat Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informat n you proV61A01X CC maybe used for secondary purposes Privacy Law, s15.0 1)(m)S Z~Ny~G pFFICE t Address (if different than ling address) 1. Application Information - Please Print All Information 1631 Q Jec 62 I Property Owner's Name Parcel # Lot Block # Z/~1olt (,n© Uu/L CWS - Zod - C- 6A,-5~~ Property Owner's Mailing Address Property Location N A) Awa 107-11',4 vc 5(417-6- /D S City, State Zip Code Phone Number Section ,PALO W / IV VV f c- 0 o 4r a +I pp ircle owe) T 0 N; R / Eo II. Type of Building (check all that apply) ` 3 b - 45 rr . P4 Subdi 1 Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms ^ 1 ❑ Public/Commercial - Describe Use / III ❑ State Owned - Describe Use ❑City_❑Village RTownship of /II NNlCKINN C III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) X Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter eaching Chamb ❑ [kip Line ❑ Gravel-less Pipe ❑ O er (explain) V. Dispersal/Treat -ent Area Information: Design_ Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (so Dispersal Area Proposed (SO W. Syst 1 ation ,s C) D.5 %v2a Cpl. q cj7, 7 a VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber IaStIC Gallons Gallons of Units Concrete Constructed lass New Existing Tanks Tanks Septic or Holding Tank 1J ©O /000 E ` k- S C. A Y Aerobic Treatment Unit G / - W IT/+ Z ~?de Dosing Chamber /V0 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe 's 'gnature MP/MPRS Number Business Phone Number J flylN CKmlrr o'29.376O 7/s--sVF 6' J Plumber's Address (Street, City, State, Zip de) /b /SDTH ~L~7 SO," k;eSEr W VIII. Coun /De artment Use Only Approved ❑ p Sanitary Permit Fee (includes Groundwater Date Issued Issuing t Signature o trips) isa a Surcharge Fee) q ❑ O iven Rea for Denial 3M 1 IX. Conditions of Approval/Reasons for approval ,ZKSTEM OWNER: dG '~^t~"' S a I 1 Septic tan ,effluent filter and V ~11~ GC2 - C,,P,e-- "Z dispersal cell must all be serviced / maintained P as perm prove e y plumber. oL .,jV., _ 2. All setback requlremen mus a m -1 taMU11- X f/ > I , Su as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches SBD-6398 (R. 01/03) _ _ _ APPkotc•__6g . PvC I,(T5Pccr,,,oJ e► A l ~ 1 _ 8t 3 8aoeoon QoPvS ~ JOGC_GA~ S • !house G!4eAGc- PkW 6W A ~J. PRoPcs r W al L 4 i 2 7-gEnjc N c ,67Z 45 V4 r-,,CA) • ~r►m l - 6c.=1oo,oD Ar cJ~ ie►'Jc~4e Ve,ve ~ Gila EL. 0,,;Z L) oIu r, eatlrUD ,4'7- LO i Cc' Q N G L C OPY P. L • t,+v Z16A) 6 c C,f t- CA? S 5-0 rs yod ~~rn~,csLT Gv i ye yqoo pv~ox. _ y puC- t,uspcrr~v~ + - ' - . _ . _ - _ - - ~-»r --ems-u - - - ' ■ 1 33 I A ape $,e - ~-~~QeoVn QA~O ! ow se - - - - 10005!1 _ 5... ove, ~(~oPoS t t~- _ - I i W x.61. _TR6m c N - - - $ ►'1 'I -61.=/O.4 oo 4-r C/ L e _pie uc Cl e),u._6 eou,u o srsR~~c~---~~ !4 T, LO i rv Q N 1E ■3 ' O ~Ak)1N 6 rp- • D_~2~w IV b B Ica -10T, 16140- 13 0 ~t1~~r`~c,►i~_. ~1^ ~5"`~00 _ J`~e~'r1~~_5_~T _GtJi _ ~ y4;1 ~ r Wis sin Department of Commerce SOIL EVALUATION REPORT i Division of safety and Buildings Page 1 of 3 i in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I. percent slope, scale or dimensions north arrow, . and location and distance to nearest road. z G Please print all information, by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner 5 [Z i L I- F_ CUO b Property Locatif SjZ /4 S Z T Z8 N R 1$ E (o W Property Owner's Mailing Address Z t# Block # Subd. Name or CSM# IO(bri ?%?_P,1121g 1")vUN ~tLIUC ~s y ~~~-t1PC~ 'O CS w1 City State Zip Code Phone Number - ❑ City ❑ Village ® Town Nearest Road F-NETL FA1_LS kJ( S4.oZ (ZIS) LL LS - IQ Le, >-_jfj lvtCIrtLIUIUIC RlVk Z, UIL-1Utr New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate boo GPD ❑ Replacement ❑ Public or commercial - Describe: Parent rljaterial g LPrC.L P~-L O U TxJflg S- 14 Flood Plain elevation if applicable fv • ~ • ft. General comments . and recommendations: ?,ECQ l" l KIEI 3 S ice t~ 3 rX 8 r- -L S " L00VG W t n- l 3 L rN 1 T--T of W ISM- C t`ry S t l N~ U lme*. e "*-J gLaV _T t7 C ez c _ wl ]Jbs pvr--t. " GC tat~' ZW _W_eQ. Boring # ❑ Boring _ @ pit Ground surface elev. 9 S • 9 ft. Depth to limiting factor b ()in. . . . Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 o~Ly- lo~ ~Z X12 , L_ Z sbk Yn v cl~, 1~ s Z )~-3~ 1O`~2 1. ZS 1cSb~ YyIV fi. C-S - -1 l-Z C) S9 wt 1. y q. o+~ a Boring # ❑ Boring IOTA\ ~ _ . ® Pit -Ground surface elev. (uu ft. Depth to limiting factor 3 t'ioil.ROplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs` GPD)W In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ►Efl#1 +Eff#2 " V$ 3o CD's,rz: 3L3 3 3°--) 3 LO`t2S O so) m I eg _ S -9' L/ 3 =R o rLp R l to .9 Effluent #1 = BOD > 30 < 220 m _ g/L and TSS >30 < 150 mg/L _ Effluent #2 - BOD s _ < 30 m9/L and TSS_ 30 m g/L CST Name (Please Print) Signature CST Number Arthur "L ~Wegerer ;p1= bS =.y 220254 Date Evaluation Conducted Telephone Number Add` s Wegerer Soil Testing & Design Service 421 N. L"Iain St. River Falls, WI 54022 1-10 01 715-425-0165 Property Owner 1V S k t Parcel ID # t~1.I~1 ill G Page Z of 3 F Boring # ❑ Boring Pit Ground surface elev. C1 9 - ft. Depth to limiting factor b to in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I O_LV )o,-ljz 31 z L Zn,s6iz m\j+ cam, t-F Z ,y=yu loy)-a 3 13 is 1csb►z mvA- ~S 3 toy2 s[6 ~s G s r~r l g . s -9 L b6 ~g oY2 5A I v- S4s C~ s. m 1 - • S .9 ❑ 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/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ❑ Boring # ❑ 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/ft2 In. Munsell Qu. Sz. Cont. Color . Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD6 > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD6 < 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 of 608-266-31 S 1 or TTY 608-264-8777. SBD-8330 (R6=) PLOT PLAN Page ~ of 3 • Scale 1'=50' %M IA-j S So g. 3 S r~ w Su t`Ppc3 LL F''6Ct--YI F-0 V Z .1.0~ L1JZ~l~-L 191vt) Z 0/0 -L3 LID SCTI--3iAtek Lime ~n lU ~ LUr 3 L' 100, 0' ~T ezUw~ OF 2) ut"2 17~'zr U ~s . 10 - 0 ~ 715-425-0165 220254 0,1-0 S CST Signature Date Telephone No. CST No'. Job NO. rtiL_ ?004,11 ?4PML ,Fr CU )D C 1 No 6415 P• 2 ~j00) WtsonnainDeParkrwritofcomr,wrcc SOIt, EVALUATION REPORT Page Dvlwion of Safety and &nldin9s - of to B=rdanct With Comm ft. Wis. Aft. Cc" A(Mch tamprato site plan on per ftW County ;B Per than 8 7r2 x 11 inches In size, Plan rnust L CE2p K indude, but not united to: vertical and horizontal reteranre point (i3M) , direction ono vt3rCent slope, t =lo or ttirrrensiorts, notliz arrow, ans ioeaatfon and distance to nearest road, parcel I.D. P~~.lp! iJG Please priltt all Inform a fie q. Reviewed by pate Fermin wom,abon YOU Mide may be used lor. secondary putpuse$ (Fri,ycy L,,, s. tss; (1) (m)1• I nY t7wnerg ~1'{nn'lA! L L lam- CUtb-Z) pm-t> Property Location !.1 ~~-0 t_!g ~1-( tA) S f G*ot-Le S tic Nvj 114 S 2 0 T Z8 N R It E { 1h PAD ' Owners Mailing /tddrt s Lot ft - f3f ck SUM. Name or t:3M# }D813 l~ IItlt;. )~t1.0~3 ~CctUE rah ~S '4 os'b CSM i CJt r State Cote Phcna NUtnW. LJ City ❑ `Alinge 0 Town Nearest Road ' Vk~1L f-nu.S kUl WO LZ1 01ST ~tZS icU.srlsiCV-r ilfJA 11 C RIUt?Ti: -0ItlU(4 New Use: ® Residenttai Number of nedrpoms Coda derived design Raw rate 00 Q ftlacement Q Pubic or Comnertial . Describe: GPO f'aret~ afdferiat _ ' r LP,+~ 1 O U ~h Jt Flood Plain 4" bon N applICable W • A . Ctir:rtatRgi corrarrefttg - tt. and ammetaatom i~.ECpMMVj-z> 3 C&`LLS.3 0,TV 6 30 x s z S' its >.jt n+ t3 t,,,r cTS os= SLDr gA.,QL -t,-1 F CE#f>t,.~~~T2s --t2 C -c o - Gc*i!:r_•s~ ~ ~ z ~ Dom, ~.:..!ccrvutad su,tacs elev. `38.9 s~S _ rL D"M to UM114np factor b kn. ~Pd+ Dominant Ccior Redouc Doswt on Texture Sob AvPCcadao Rste i P6 $tiUCltrte Con9ketertce SoundOry Roots GROW fr in. frtt lva Qtt. Sz. Cont Cotar Gr; St Sts -7 64T fiS9ii:,W I L 2:M:sbk h-t v~t.= cis 1~ : S ='S ,,f'' 2' t 4 j7 i o~ tz. ~ t3 , ~g ~ c._5, bh. Yn U~ C. - Z 1• '.L 3 a -60 wiR sJ 6n*~ 'S t3 9~ tai) C,~ - -q 10`2 SJ~; tsvri 51a... CO.) R, 91 wi Pit "mound surfaao ekev. C DU . -7 R Depn to iw tgtactar 2 ) f`. e Ramon j Oeptl► DPm(nOAt Color Redpti Oescaipd~t T~xhtre 21 ' ..tom t SbUCd+te Consistence E !F14 P kl: ' Ndtmssu QU. Sz ConL Color Gr. $l. sh. OEM - 3o-~s tD~czslso _ ~s . ©S~j "wt; l cs ~ : s -4• ~:-~a Lo•~f~sl~ ~•z~l ~.~~~.sr>,.. . d-~~ . ~ --..,s_ esq..:,, ` EAkkatt! 7'b1- Sobs > 30 -(P20 mg& aw Tss Sao 1w m- ' EMunnt 02 = 900 <30 nlglt and TSS < 30 M$PL CST fYamg (P~,•~g ~ lure -cozi ,Artriur Wegerex 22~254ber rKl Addm" Wagerer Soil. Testing & Design Service' a~~18 °h 'am aiKneNtanf~e r t ~n 421 N. Main St. '.River Falls- VT SLn?7 Q b~: 5b t,U 11YH K 1 vtttrhi~t_.~ T OOOG 7CJJ • • _ --y F111/23 715 v•23- ~20C4 12:34PM P NDY CAD G 21 No 6 15 V I /04 TOE ii: 49 FAA 715 sdo 20,E ` rc ` property Owner s %W L1j SFc 9orsty P 0ortrta El Pit Ground surface elev. • q 9•7 {t Depth is Iknitlnp tacWt' D In. SvW Mate . 4itxttott D~th Dotntnnr►t Color Radox D~tpilon Texture Strudwe c4nall9wnCe Dowaary Kac b GP en. Mure"K 41u. Sx, Cont color Gr. 5z. SA. 14 6 ,oyrz Sl6 hr's b s i't) ~-S . s .9 L_ 6 7 lavrc Slb -{z~ "x•544 S/Y, ` S C~ 5. m J f Borlnp ~ ED Boring 0 [3 pit around sur(ece elev. r< Depth to limiting factor 011 ttoa► Kato Q ieXltlre Struelm consistenaa Soundwryy ticats GPDRP tiorfnort pepth Dominertt CoW Redox DGMOOw► 'B1iYt1 •Ef #2 I In. Munaetl Cu. S~-_ Cont. Color Car. S'- St 1 Nmitlnp radar In cation ate - t'It Ground awfaae elec. R Depth to Sod R a°1" # Rots GPWRt Texwm Stmewe Co"aleteriee Boundary Doptb Oardnad color Rodox Deeai0m •E j1 '~Hft2 in. wnsell cau. Sz Cont Color . Gr. Sz. SOL I Z • F-Mu mt $1 = BWs > 30 < 2?fl mail- and TSS >301 150 rnpti ' Efttuent 2 = BODa < 30 mgrL a TSS { 30 m8►1 sertztx rovider and eMptoycr, If you Hood assistace m GOP= scr4ocs of T ho Depar:mat of Con=cccc is hn equal oppatu"L#y P t at 608-Z66-3151 of TTY b0&-X54-8Tf1. need MAteriai is 08 altt.Mte f0l~Str plCSSC copttat:t 4~io depattttiu LA61tlb(Rb991 y b7 ~ JO CL i9Yn [t t vu<+ n~~..+ uuu~~u..-. PM RAN CUD[1 t 21 • h1~,.0915 P. 3 0002 q4 =904 12:3 5' - PLOT PLAN Page 3 of 3 t Scala V5p' i 4 I Sl- LS` S Asa I 3.3 5itiw szr wa u~- Pr- Fn4z TL. br 3 i 1 i ~o r y -`_k--lua.n' st7- c~1-ftRLJfv~. At= P?►vt'TL 1~lZ~v~'. j i 715-4_25-0165 220254 O.l -q s - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer / C 8 L/ 1 4-w e12 S Mailing Address r H d U e Le 1r,F 10,5- 48)11- 447w i-ly aZ Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number - / DA SD - Y2 S LEGAL DESCRIPTION 1 /y A) W Iq A N P, T o Property Location S Sec. 29 TaLg N-R_LLW, Town of N Al < < K i IJ / C Lot # Subdivision Certified Survey Map # , Volume _/--_7- ..Page # SGS 7~_ . Warranty Deed # , Volume ? 79 :2 Page # / D Spec house -U yes ❑ no Lot lines identifiable Ryes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a cefificatioa form, signed by the owner and by a masterplumber, joumeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system ism 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. Certificati30on stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within days of the three year expiration date. 4- . SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 1 (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICAN-f DATE * * * Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U. 2 7 3 2 P 180 78s1 Yti. STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Craig C. Pechacek Grantor, and ZiEnego RECEIVED FOR RECORD Builders, Inc., a Wisconsin Corporation Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee 01 /18/2085 09:15A1f the following described real estate in St. Croix County, State of Wisconsin (if WARRANTY DEED more space is needed, please attach addendum): EXEMPT # Part of the NE 1/4 of NW 1/4 and Part of the SE 1/4 of NW 114 of Section REC FEE: 11.00 29, Township 28 North, Range IS West, Town of Kinnickinnic, St. Croix TRANS FEE: 197.10 County, Wisconsin described as follows: Lot 5 of Certified Survey Map COPY FEE: filed July 25, 2003 in Vol. 17, Page 4572, Doc. No. 732055. CC FEE: PAGES: i Recording Area Name and Re-~turn Address ff % 1~3AAW'n A 022-1084-50-425 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions and rights of way of record, if any. Dated this 14-0 day of January, 2005. * * Craia C. Pechacek * * -k J AUTHENTICATION ACKNOWLEDGIV)1IE11T Sienature(s) STATE OF WISCONSIN 4, s$ -}ass, al j 'yt CRu hl, County. = ):i . r ; authenticated this day of N~ . iC la,' Personally came before me this ' -day )~j16 January 200' al v `,tied Craig C. Pechacek "~t•ttn~~ * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by X706.06, Wis. Stats.) ins knowledt_ e. THIS INSTRUMENT WAS DRAFTED BY Joseph D. Boles - Attorney at Law * iZ{ 3 U Zt'ti 1S River Falls. W154022 Notary Public, State of LL' t s e4V*. _ My Commission is~1 at. expiration date: (Signatures may be authenticated cr acknowledged. Both are not necessary.) NoWy ` ) • Names of persons signing in any capacity must be typed or printed below their signature. INFO-PRO (800)635.2021 www.infoproforms.com STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 2000 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pace of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Z i n e o Builders Septic Tank Capacity 1000 al 13 NA Permit # Septic Tank Manufacturer • Week s- C. P. ❑ NA ' DESIGN PARAMETERS Effluent Filter Manufacturer Z a be l ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A-100 ❑.NA. Number of Public Facility Units IN NA Pump Tank Capacity al N NA Estimated flow (average) 300 alida Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) 490 gal/day' Pump Manufacturer ■ NA Soll Application Rate al/da /ft= Pump Model 01 NA Standard Influent/Effluent Quality Monthly average- Pretreatment Unit ■ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD.) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) 530 mg/L N In-Ground (gravity) 'bin-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ® NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: O NA Maximum Effluent Particle Size Y. in die. ` r r ❑ NA Other: Other: ❑ NA Other: .13 NA 'Values typical for domestic wastewater and septic tank effluent. Other: p NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 N ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA.~ Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA. 3 N year(s) Clean effluent filter At least once every: ❑ month(s) ❑;NA 1.1 111 ear(s) ❑ month(s) 0 N 7. Inspect pump, pump-controls & alarm At least once every: ❑ ear(s) '0 month(s) O NA Rush laterals and pressure test At least once every: ❑ ear(s) , Other' At least once every: Q earls (s) E3 NA; Other: ❑ Na` MAINTENANCE INSTRUCTIONS ru Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sower; POWTS Inspector; POWTS Maintainer; Septaga Servicing Operator. .;:Tank inspections must include a visual inspection of the tank(s) to Identify any missing or broken hardware, identify any cracks or: leak measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any,..pon.1- of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires tha immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the ;entice contents of the tank shall be removed by a Septage Servicing operator and disposed of in accordance with chapter. NR;:113: .,ram„ Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals-of S12 months, shall be performed by a certified POWTS Maintalner. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. i Pago of START UP AND OPERATION For new construction., prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prW" use. 4 System start up shall not occur wh6n soil conditions arrf ~rozen at the Infiltrative surface. During power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may'result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal calls. Do-not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the • diapers; disinfectants; fat; POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss, foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. ra • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another mart solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ■ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement. area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to'setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. O The site has not 'been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank'': may be Installed as a last resort to replace the failed POWTS. O Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name' o n Schttfi3.tt Name owners choice Phone • Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name h ce Name St. Croix Ct . Zonin Phone Phone 715 386-4680 This docunwnt was drafted In compliance with chapter Comm 83,22(2)(b)(1)(d)&lQ and 83.54(1), (2) & (3), Wisconsin Administrative Code. f w x 1Z 4 Stands d Eros1001, r . for 1 & 2 : F;6 1 Dwellin ..Construction Sites Y r. :nv ...x v, w.. , r. , n • J. 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Applicant: Z 1 Co ly C& D 6 f,,i-'1 t_ o c e S e ct--L/6 O Daytime telephone number Name /O 6 l O r to Age RA to w. ~j T YOD a Street address, city, zip code Landowner: S A M Name Daytime telephone number Street address, city, zip code Loquon. of a building si (complete as appropriate): , t r ~ ~y ~'t wua PaZ- quarter of Section Town off. N., Range E. VJ Lot Block Street address I Instructions: 1. Complete this plan by filling in requested information, marking appropriate boxes, and completing the site diagram. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW - Extension publication Erosion Control for Home Builders can be referred to for assistance in completing this plan. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608/266-3358. Erosion Control for Home Builders (GW0001) can be ordered through Cooperative Extension Publications, 608(262-3346. 4. Submit this plan at the time of building permit application. .;4w o r --"'c Yj - i g. +f"...ra ` t r tip, J3 ; a L M oai~and ~oomplete`the site diagramwith aecessaiy;,informatton.s !^x- ~t e~x ro riart~'i a*~ b~' 4r ad4 c.nys+~it71 t tr•,y~ ° rx~~1 a*~ ( r~~i~~~~~!`~"5"~?~xtn~~":7~~'~ +.Yx Y~~E~ i ~ + r•.,.. n'' 3 - - a r CP .ova site Characteristics North arrow., scale, and site boundary.. Indicate and name adjacent streets or roadways. 1 1 it/ !)4 'n114)11 or OXIN 118 41144111npr'wtlyn, tilihawn, 1Ivols, hikem, wC1111Udr 01 welly. ❑ Location, of storm sewer inlets. The gradient' and direction of slopes before grading operations: The gradient and direction of slopes after final grading operations. Location of existing and proposed buildings and.paved areas p Overland'runoff (sheet IIow) coming onto the site from adjacent areas. groslon Contra 11ractloes, 0~ ❑ Location of empoiarysoli storage piles. Note• _ Although not specifically required by Code, it is recommended that soil storage piles be placed behind a sediment fence or more than 25 feet from any downslope road or drdinagewi'W". 2 Location of gravet access drive(s). Note: _ Recommended gravel drive design is 2 to.3 inch aggregate stone laid .at least .7 feet.wide,and 6 inches thick BWves`should extend from the roadway 50 feet or to the house foundation (which ever is less). 1d/ ❑ Location of sediment fences (filter fabric fence, straw bale fence) or vegetative strips that will prevent eroded r soil from leaving the site. ❑ tJ Location. of sediment barriers around on-site storm sewer inlets. ❑ Li Location of diversions. Note: Although not specifically required by Code, it is recommended that concentrated flow (drainageways) be diverted (re-directed) around disturbed areas. overland around diff (s dt flow from adjacent, areas greater than 10,000 sq. ft. should also be diverted ❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences,' diversions, and re-vegetation by sodding or by seeding with use of erosion control mats. ❑ @~i Locatiorfof practices that will control erosion in areas of concentrated runoff flow. erosion through Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from 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. j ❑ Location of other planned practices not alreau; .toted. ' •r{ ` •(14 i • Yyj,}JW ~y ~C,"~ f • 4 T S t 1 rf ra > S+ ta,L' c~ tie"''iii - . dicate cnt` strategy by checldng .theappropriate bow • f Y- ~ c~ Management Strategies 13 Temporary stabilisation of disturbed aec:w. Note. Although taut speclfically required by (:tile, it is recununended tlun distillbed terms and sell plies Ity? inactive for extended Ferioda of time be stabilized by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching, 1~ Permanent stabilization of site by re-vegetation or other means as soon as passible. ❑ [5 Use of downspout and/or sump pump outlet extensions. Note Although not specifically required by Code, it is recommended that flow front downspouts and sump y,;ry by F.y, x pump outlets be'routed to stable areas.such as established sod or pavenfent ❑ t~~ra ppinsedunent durin dewatering operations. Note. Although not specifically required by Code, it is recommended that sediment-laden discharge waterfront pumping operations be"ponded behind a sediment barrier until most of the sediment settles out.. Proper disposal of building material waste so that pollutants and debris are not carried off-site. L~J "~1 a Maintenance of erosion control practices, j' • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves off-site due to construction activity will be cleaned up before the end of'the same`workday • `'AU sediment that moves off-site due to storm events will be cleaned up before the end of the next "workday. i • Gravel access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilfzed. t T::tnde Land:;::..:.;::. , n e~' Y fy r5 the consLruCLion site erosion control provisions' of the Wtscottsiti Uniform r CV.~lI#ng CAde, and that t accept xesponstbtltty;for carrying out the above erosion control plan as approved by <>'; thed#ttfvrrement authoritj+. •::'Stgn~~itret~fapphcant Date Y i A publication of the University of Wisconsin-Extension, Ron Stress, UWEX Water Quality Education Specialist (12192), , Thu publication may be freely duplicated Additional copies are available through the UWEX Environmental Resources Center, 216 Ag Hall, 1450 Linden Drive, Madison, Wl, 53706. 01081262-36.52. 't ~ w ~ I 1 i - 14 A EROSION CONTROL PLAN I I LEGEND I I I I I i f 4 iI { I - PROPERTY - - LINE - j I EXISTING - ' DRAINAGE y - -11JJ- , E, t - TEMPORARY TD DIVERSION - - !L ..L FINISHED , - - i DRAINAGE LIMITS OF r- - - GRADING i - - SILT FENCE v STRAW j - -njr- I- I~ I i I BALES GRAVEL - - - i VEGEWION ®SPECIFICATION 1 I i ' I ~ _I' I ll ` AREA - - - - I I TREE } ® PRESERVATION - - - - - -I, - STOCKPILED ~ SOIL SCAM 1'=.40' IGrueiG ~~llr✓'~ - AJ ~c In i - SDsT z s`Yd~ I ~c/lad m 4-1 9 FILED APR 1 9 2001 s Q KAMM4 H. WILLSH J SLI, z 64325 v N CERTIFIED S Randall P. Cudd and Robert J. Kolashinski Located in part of the Northeast % of the Northwest and part of the Southeast %4 of the Northwest %4 of Section 29, Township 28 North, Range 18 West, 7own of Kinnickinnic, St. Croix County, Wisconsin. N OWNER'S ADDRESS tPRaIR1E ? I MVER FALLS, M 54M &EARN=ARE/ LEGEND Tlo Tm msr_*wr 1At NORTH 1 w coRnrER } I 4 !l SW MN LM 2A ~29.T2BK; • gFSE~T>nllll p VX2PIRON PIPE SET RR isl 1 T 21 N~ R 1s Assullet n As (MIN WT. -1.13 LE AIN. FT.) BERNTWN 1D N 81`f3 70' E • FOUND 1' IRON PIPE +r + ~MEIM _ SCALE: 14300' Ib►MINt U6 P VEMENf 8ECTION CORNER MONUmeff 114 r 100 0 100 200 300 0 (A8 NOTED) SEC 7 X W, 1At , / _ Lm I o: ( LOT 2_ + IR RECORDED t ; CERTIFIED SURVE UNPLATTED LANDS , 8 I , - VARIABLE WIDTH ROADAREA Q:a ~I ~ ( ly ti{ qqZ;~ MAP VOLUME 7 (DEDICATED (R- EAST) RNER DRNEDW (79.8 gap. R a O.31I ae. . N 88'Og64 E • 8• PAGE 1902 5ZO7 s st• I----- (1t- N Br3005• NORTH R/WLMIE R R~ -N 88°32'51^ E tuR6r- .ec LOT 4 - _ _ , CERTIFIED SURVEY MAP 33. 296.ar r 298.BD•1fE.31' ; .~1F a - SCUTNRhYLM1E alb 22&W RVER ORNE yrb• g 2. -N 88.3P51• E Y 1123.91•- 9' g h` r VOLUME 9r PAGE 2543 100' (~NTY W tfu[DwG g B •I 1R WW ` ~ ~ - LWE :11 AMA N. LME SEiH-MYf/4 LOT 1 100' too• LOT 2 LOT 4 S. SURVEYMAP e N CERTIFIED 298.ar s 66' 298.w W 298.01 $ e S 89.32.51° w s 98.3751• w sez m g VQ_LS1ME PAQE 17,54 AREA LOTS I AND 2- 1o m 86.886 SQUARE FEET OR 2.224 AC. 104 (87128 SQUARE FEET OR 2000 ACRES (R= N 90'00 )0 E 33.009 PAVL y~ST STRIVER ORNE EKCLUDING TOM ROAD RIGHT OF WAIF N 88°93' F 1 a3.9r SEE DETAIL (PAGE 3 OF 4) ~ _-t ^~i -1 2. 3 AREA LOTS- VOL SBZ PP. 4WR~ & 64SEMEAfr PER 0; 97,007 SQUARE FEET OR 2.227AC. C.S.M. VOL 1, PAGE 162 VOL 714 P. 403 EXCY (%U1VG TOwN o~ ZOQ2 RIGHT owA N°R c sr ~RTIFIED -SURVEY _-MAP Y1VOI.uME PACE 1519 '-PJN~9 4 q•8 a,oaaon CERTIF ~ LM IED } W • ° • • QTR LOT 1,172BObSQ4 ME S Ss~~"" ~ 1 tn~ LAUREN~ ° S_ i1R1/EY MAP FEET OR 28.824 AC. - ~S,n * e P 713 (1,161,544 SQUARE o^~ + o FEET OR 26 6MACRES CERTIFIED VOLUME 1, 5 ~ r FAL s. oa EXCLUDNG TOYM a~ ROAD RIGHT of wad SURVEY MAP PAGE 162 b ~ • • ° • • °,,~'~P I Oja O Lw NO 8 -LURE 1, PAGE 2 ~~4p4a''O (is<N90'0000•E. 31aOaRNER - PLATTE! UNPLA__T_T_ED LANDS S BW48'45 E) . SEfIRNWifO SW CORNER C.S.M. , -N B6y3.•E f 2613 N 89.13- E 1295.3T % SOUTH L MIsFAE~ HJy~ !4 ~nC4~=i: a. ' WNTPER -N W13W E 934.W- EAST-YVES SEC71pNLMRE.' EASE T--WEST 1/4 SECTION LMIE C.S.M. VOL. 1, P. 204 (R.S90vow-10) ' (R- S 88.48'43•E V 5204.31) EAST 1M CORER SEC7K N88.133VE Gr 5204.07= T2$AI.N28, T26NRf6W ~crro 4 C29, T 26 OFNERrL R fe IN UNPLATTED LANDS b W ~ AL MMruM MOANAffifM (FOULENnBEROSENALUMNVU MM M 8 ~ it /I DATED: 1-18-20APPR( -i; REVISED.3P -~4-2r4CRUIX00Un)TY 'SECTif1gC R SECTM nnlna7n~'~n+~ r. •.-r..- 29NR18W MAR 21 2001 A'LUX.A0..ONUMENT) THS INSTRUAIENT DRAFTED BY JERALD L LARSON SHEET 1 OF 4 It not rocoraad mrni,i •sv approval date approval sham t* MOP and 1-41 Vol. 15 Page 4065 CER'T'IFIED SURVEY F PCOPY Pft: AGES. 3 ' - Randall P. Cuas an Robert J. Kolashinski Locoled in pert r f the Northeast S: of the North west r. and part o/' the Southeast y: of rite Nnrth,ve v 4; f .S'acrion .29, Tn%,nshtn.28 Nn.rih, RvFrge 18 1'Ves: Town ii Kitmickinnic. Sr. Croix Coun 'ng Lot 4 o/'that Certified Survey Afiap r•ec orded Ot Volume l5- 10 YCroix County certified Survey maps, Plannina ZOnlnq an„ Parka r~nmi!rge N JUL 2 5 2003 LEGEND WS 1"a 18'001YPIPESET TO TW R) clays of f • W.. • 9.1,7 LOAX PT) NORTH IN CORNPFI ashf.bp FOUND 1'IROAI PIPE SEGIIOM29 T2SA4 A 18 W T2lM,R1L! PO (F0VA0fiVWTS&ALLtM/NlMMOMtMENt) N2#:H, arism-L a UNDCONCItLTE IRK) NAIL INWVbWOUS PAVfMENr t3WNER'S ~IDDR888 SECTION CORNER MONUMENT SCALE... r"~soo (AS NOTED) 1080 PRAIRIE MOON DRIVE Mii~ (R- } RECORDED AS RIMER FALLS, W) 54022 160 6 160 260 i6O SETSACKLfif x 1VOTL- LQT ❑ SOIL BORINGS (PROPOSED f I SfFT1G SYSTEM ~ AN EROSION CONTROL CERTIFIED SUI VEY~ PLAN VALE BE RBOU)RED BY n-ff Sr CROW COUNTY UNPLA"EC~NAS !'f IOWGOFFICE PRIOR APV Q~l~i6.7, _ . I TO ANYCONSTRUC)7ON. i PAGE 1_902 &TM -xa9"1cv~- .4 QT- -me ff zw 3: sounrwwur~E g $ 3 ` s, vo -,-v 9,.PAGE .'~4~ ~tEr+oR~vr LOT 1 p; LOT2 L4T3~ - p-,~ -1- _ - m !WrHLA-9 NE1r4NWIN LOT, j --------------------,-`-•---C-y-----... r. - -NOR7HL F set/4•NW1r4 „---~-I C aP5178910.~!`~RV = .&-4P zas.ea' - VARMSLrWVW 4 88"32'51-E w N 88°37Si E 592 01 VUL(J E PAGE 77,5.4 9 87"39'sr $ M,841 LOT 5 CONTAINS 98,243 SQ PT. ~OR 2.208 AC. {dT, f 54 SO. FT. OR t ~ , _ _ -~Oa . ~Q,2-'' 2001 .AC.EXCLUDINGTOWN ~,N40'DO'CO"Ei1100'~ ' ROA R04T OF WA N WE!- ,'.OUIN R?W L1N6 CAST RIVER ORNE 1 E 2 $7,46' `1 SM DETAL PAG 3 J ~Ptilq £ASEMEIJr °LRR'Jl~LC 'si ._a f VOL. SO? P. 496 AND £ASEMEItR E4 v] W ~Q A C4 M. VOL. t. FAGS 162 VDL. >1f. P. a43 GIRT-f•(gQ 31jRY6:Y .MAP cat vi T- 1,078,W5 SO, FT OR 34.713AC. ;'a~AVf4~~QCr (1474.384 SQ. FT. OR 24.865AC. ~'t~ , EA'CLUDM I -OVA ROAD RIGHT OF WAY) gk lb~ g SURVEYM4Pw~:7,3 * Fj 47 • LDKNVlLLH, i tC CERTIFIED as SURVEY MAP PAGE 62 0 LA 140 st' VOLUME 7 PAGE 204 A ED: SWCbR. ~ ~ MARGfi 31, 2003 r; i:4'nNx F, Lora T30' E 281r 3. ' v 3- 3I -70 3 89°49'x5"ft N 88°i334Y E 934.00' __j _ ry~ S `408'13 3T E 1295.37 W4 t-"- soul tNf, or4 EASrylfs~srbTRNr,cdNE CASEMENT F5R the 9 90.00@0" W. CIS M. VOL. f, P. 204 Po NXV000.0 N 89°48'43' W) ll S I94145"E 5204.7!} EAST 1,14 CORNER - N 69' 13'Z E 5204.07- ZC TNCN a'w IV£S? IM 00PNER w (fbttlND aERNTSEPI SECWNv p,, T28N, R 10 W UNPLATTED LANDS ALUMtNtlMINOAUMENT} FOUND 8EW-Sil ALUMINUM % N4NUMENTI SOUTH 114 CARNEP SFCIMN 2a 728 A; F is W Aw'M` °MO "MEnr7 SHEET 10F 3 THIS INSTRUMENT aRi4Fi'EDBYJERAL~QL, LAR50N VOL. 17 PAGE 4572 2062 889 STL saapjing o9au3rz RLE:60 SO ZT udd i