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COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 80 0-962-5227 ST. CROIX ZONING REPORT NO.* 04682/01 PAGE 1 ST. CROIX COMITY REPORT DATE* 5/04/90 COURTHOUSE DATE RECEIVEDS 5/03/90 HUDSONt WI 54016 ATTNS THOMAS C. NELSON OWNER* Daniel Bauer LOCATION* 107 E. Quarry Rd., River Falls COLLECTOR! M. Jenkins SOURCE OF SAMPLES Bathroom Sink COLIFORM* 0 /100 ml INTERPRETATION* Bacteriologically SAFE NITRATE -NS 1 ppm Under 10 ppm is safe for human consumption. Coliform Bacteria /100 mL Nitrate - Nitrogen, mg /L 'I LAB TECHNICIANS Pam Cane WI Approved Lab No. 19 �. \NDEiENp v S C Means "LESS THAN" Detectable Level Approved by* ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 h - �` 1 Trr�, '_t i r' '� :, .... +, ..�f' �: {: ♦ . : F Y � l I n X COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386 -4680 t. Croix County Zoning Office offers the service of septic water inspections to Lending Institutions, Realty Firms, and vote individuals. located Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------- - - - - -- -FEE: $ 25.00 (For nitrates and coliform bacteria) FEE: $175.00 WATER TESTING -- (For VOC'S) --------- - - - - -- -FEE: $25.00 SEPTIC SYSTEM INSPECTION- (Determines if system is properly functioning at t me of inspection) t� �- M. Property owner's name 1 Property owner's address Legal Des ription5�_1 /4 of the 1/4 of Section ,��, T N-R 4 ��W Town of Jnn;^ L ;v►vn,C,.- _ Lo Numb Subdivision Name gia s+ Color of house Realty sign by house ? so, list firm: S 4. PLRASX INCLUDE, IF AT ALL POSSIBLE, A MAP, .e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual re uesting services: 1)4n+el Telephone Number Y' 4-:;(0-75 � REPORT TO BE SENT TO: .� Closing date Signature �n9 e ctr - kes � �re.s e " t z& j l ; V%✓La' � vi a"u-� • 9-z.S D4 � sl . e,.... _w'!. f:n -its+ m....,+:. .wy w(^+IYJ,C.,:.pA'�iv� +1 .. �_.�,�.!'!'!�!r- v� � ,•� �� o — e e rn.a f I o - KINNICKINNIC -- T. 28 N. R.18 W. 17 D G M sonv SEE PAGE 29 s AVE. 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N rrt • C U 80 Ca Wi / /lams 41 w C A � tt � ry l.fo all • Dorothy MThhnsen Pvu/ d 0 v r tor +, IXLVi Debrt2 < d /th ea y v f Orsa E ri , n n 41 Va .....3 Ti: • W • f • F \ • • rre • rBO • ................. ............. /4O a Ru e ................. ................. • � so ass nwt oo �W� Lrue; /or i'EkitttEiti JKZtf ..... �(enne Jh Lee Len/ [.Mr/ e °' ................. :::: �:::..... Al !/ r �T a //y tl` F° LLS a to E� ; ' f ,. . =o Poo � w 0 4 A/eGa. P/ERCE 11 COUNTr River Falls Grain Drying Banking Medical Clinic, Ltd. HOIKKA IMPLEMENT INC. BulknHandling River Falls, Wi sconsin HIGHWAY 63 NORTH Liquid Fertilizer 425 -6701 BALDWIN, WISCONSIN 54002 Custom Grinding - Mixing Ellsworth 684 -4727 DEISS & NUGENT Medical Clinic FEED CO. Ellsworth, Wisconsin •rte E H L ' • • Phone: 273 -5066 j 273 -5041 East Ellsworth, Wisconsin 54010 f ti u " "w"k a a i . e �S *k i I VI ,e 5 41; i r• II a� I ST. CROIX COUNTY M k y ' ;♦ WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 _ (715) 386 -4680 May 5, 1990 Daniel Bauer 107 E. Quarry Rd. River Falls, WI 54022 Dear Mr. Bauer: An inspection of the septic system of Daniel & Janet Bauer, located at the SW 1/4 of the SW 1/4 of Section 29, T28N -R18W, Town of Kinnickinnic was inspected on May 2, 1990. At the same time I also obtained a water sample for testing. The results of that testing will be sent to you as soon as we receive them back form the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. I noticed at the time of the inspection the septic tank cover was exposed. Replace dirt over the septic tank cover. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cj . ' o� 0 ■ v 0 tv 2 K \ ) § ° Ln J % n R £ 2 E_ � 2 § � � � ■ 7 � � 2/ƒ o ° I 3 2 8 g § a / Co CD g ] ® ƒ \ � / eR a; Ee 2 CD CD : w > 0-0. 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O N N co > 2 O W (D p A m W CD A 0 O O W 7 'C7 I M m a O O m m 7 0 S I m C N a 3y o.m m O O 7 n O x O CD N F• -w O CD O CL p 0 I o I o N m CD p ti, m m Oa O I A b9 0 (fl 0 69 ti q a CD O p I O Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 128855 53 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bauer, Dan Kinnickinnic Township 022 - 1085 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 29.28.18.458A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding SVHt Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System 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 BEDITRENCH 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 I x Hole Size I x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes j_ No [E Yes EF] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 947 Quarry Rd. River Falls, WI 54022 (NW 1/4 SW 1/4 29 T28N R18W) NA Lot Parcel No: 29.28.18.458A 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ? Yes +,J No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. 4� County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER VIP* [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road � Hudson, WI 54016 -7710 (715)386 -4680 Fax(715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary Permit # ❑ Che revious a lication 00 53 1. Application Information - Please Print all Information Location: Property Owner Name APR 0 2 2003 !N1 / 1 /4, Sec ZW T o lj N, R E (or)090 Property Owner's Mailing Add res Lot Number Block Number W_ ZONING OFFICE City, S7 Zip Code Phone Numer Subdivision Name or CSM Number II Type of Building: (check one) S amity ❑ Village wn of 1 or 2 Family Dwelling - No. of Bedrooms: F r ❑ Public/Commercial (describe use): 1 ❑ State -owned Nearaid Road '/ 9�,j II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) i /(� Parcel Tax Number(s) A) 1 1.0 Repair 12.)q Reconnection 3. 01SIon - plumbing 4. ❑ Rejuvenation d Ta Sanitation B] Permit Nine � Date Issugd ' State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) A Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals./day/sq. ft. / / Elevation o b 3 �o r W � I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks 1 Dp ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11. Responsibility Statement I, the undersigned, assume responsibility for repair / reconnenction /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or thg jrlstallation of non - plumbing sanitation system. Plu hers Name (pri t) PI =e { st p ): PBusiness Pine be �a�� 5�' umbers d r (�t e, City t e i Cod U� f �� / I l 1 Dc) III. County Use Only — W p Llt// isapproved Sanitary Permit - Fee Date Issued Issu' Agent Signature (No stamps) Approved er Giv nitial Adverse PC etCetermi on IX. Conditions of Approval/ sons for oval: 6A �lc� Cbcw i �YS� 5 c•�. � wa+� � tM , �. ej 4 AS BUILT SANITARY SYSTEM REPORT OWNER k.hn� e v ^ TOWNSHIP <. SECTION Zc� _ T zP1 N - R L W 45gA 022 — ) S - iv- 00 v ADDRES 49S �fs,jtz_ Lt - ST. CROIX COUNTY, WISCONSIN SUBDIVISION AI% P' LOT 0 LOT SIZE tii) Ic PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f p . _ N. � l INDICATE NORTH ARROW DENC1Qt\nX :C , 1avat.'ion and desoriptions Alternate benchmark :,BPrTC TNtX:ttunuPacturer: L { Cap. �3oo Rings used: G Manhole cover elov3 Final grade elev. Tana: inlet elev.: ` � Tank l ot.t'tlet� elev. Ito, of feet from nearest road:Fronr Side, Rear — Ft. �f 'r rrom nearest prop. line:Front Side — , Rear Ft. _��jp No. of feet Prom: Well ¢Q1 '7 , Building: VS' (include this information in the above plot plan) (2 reference dimensions to septio tank) SEE REVERSE SIDE b'd IOGi96ESiG janeg uea e0I =60 EO I ,add f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRP3BMPNT AND OWNDRSHIP CBRIMCATION FORM ( :Q; /Buycr ba � Alllp jl l R M>uuag aaar y d r i�? rd , goy � S 01 Property Address (Vcdficatioa ;rod � from P ' l'�L Dcputamwt for tecw coastruc(ioa) � rtm i't Pond Ideaffimtion Numbs -I Z- -L=- )D WMQN N�t_w, Town of 1 ,��- Subdivisioa Lot # - . Caffi d Sauvty M # volume Page # ws"Mty De # vole � s�� pne, # SPM Imaw 0 yes 0 no x . Lot Beres Ricnifiabk 0 ya 0. no mdrrso°u0ru'°°°°f c ty k oaddacsasbGQits j comsatafpao�gtmf. 'Iam�etol eWasEcs.P,oapamaioaeo:ooe caasffoctt� c�t5e 7 iaaocs°° ��aododb�►it woodpm�e� pat3abot5a9ydm • �. a�aeatmeot�iiaQCVbsOe�spo�,�7� .. i IngMWVaraa %$abR te Mcwkz6ft D meatier foaao�, sigaod byt3rcowaersadfiy: ' islapaoQacq�gcoad�ioa P�►aa-7c cfric( i�Qrcaa�iuoe :�stcRa�oacaCsi�assts�em (� a�crios�ocCaa�mdtpmm {sFaoo�;.Qrc��rc�dcis kss�a 1/3tunafi'i�e. ���� � . adta�xam�n�epanatie� ,�.�hwe�dmd�Dds ' �3" ��Oom�m�x�ocmdmoDapnta�t��gosri�ofw�s000si ,c� dayrcfdwtTww tid ° s°° �mastbecaagsldod�adretmmodtoQreSkQ �u�j►T�mcn�Ot oe�rit5ia30 SM tAIUM OP A�� ty� DATE y �/ ,l� ['Y's 1Mn1 I ( � 8wt alt oa this faamt ace bw to do bcxt of my (out bwwlodgG, I (m) nut (are) the owncx(s) of PvP� mod by vsttue of a waam* dwd awoosdod is �s of Doody Offioc. src�uur��ov �r ecc DATE AwWmstia " iso* 4% rescdodata y testis dreaaibtypermitbdagwvo1rod b y the Zaniqg Dqm mccct, s••� •• s. IactU& Mitt flits • a � Ump0d wamoLy flood from tkc R of Doody oW., a copy of the c atiW a riy mV if refamwc is taadc is the waawy daod ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is o certify that I have inspected the septic tank presently serving the Q 1 fazl e 1p residence cated at: / � %, L Sec. T N, R /F W, Town of /`pig i�C' //w A St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No_,� (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: - -. Construction: Prefab Conc ete Steel Other Manufacturer (if known) : e c C. Age of Tank (if known) : — V o S /� h (Signature)` p (Name) Please Print (Title) (License Number) �2- edl'o (Date Form to be complete ice ed pl umber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (exc t for inspection opening over outle fle). - 7 Name �' 4 S ignature g x'ej� MP /MPRS System Management Plan Pursuant to Comm 83.54, Wis.Adm. Code Sectic Tank ' • The septic tank.. _ . p shafiie maintained by an individual certified to service septic tanks under S. 281.48, Slats. The patents of the septic tank shag be dispo of in act irdance with NR 113. Wis. Adm. Code. The operating condition of the septic tank and • outset fitter $hag be assessed at least once every 3 years by inspection. The outlet finer s1,a be cleaned as necassarl to ensure proper operation. Tne filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough ON the fitter when removed from its enc!csure. If the filter is equipped with an al- „ , the fil ter shall be 'serviced if the alarm is activated continuously. intermittent filter alarms may indicate surge flows or an k npen& q con T septic lank shag have its contents removed when the volume of sludge and scan in the tank exceeds 1133 the Gwd� of - the tank. If the contents of the ta are not removed at the time of a triennial assessment, ma personnel shag advise the'owner of when the next service nerds to be performed to maintain less than maximum sm�un and e the tank. The addition of biological or chemical additives to enhance septic tank performarcP is Berme t mural. t3ur�ding's Qivision. n in However, if s products are used they shag be approved for septic tank use by the Department of Commerce; Safety and Puma Tank :The pump (dosing) tank shall be inspected at least once every 3 years. AD switches, alartrts, and puns shall be tesibd to !retlf Proper operation. If an effluent Titer Is installed within the tank ti shaD be inspected and serviced as necessary. At- made Component and Pressure Distribution S stem e.ades de around s tubs s ou e p sate or be ma allowed to grow on the component. Plantings may b 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 BODE, 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 presstue dlstdbution W-ftm is provided vfth a flushing point at the end of each lateral, and fi is MCOmmended that each Island be flushed of accumulated $olds at least once every 18 months. When a pressure test is pedmMed I should be compared to the k" test when the system was installed to determine I orifice dogging has occurred and I orifice cleaning is required to ntaishtain equal distrbulion within the dispersal cep. Observation pipes within the dispersal cell shall be* checked 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, mote frequent monitoring in accordance with•Comm 83.52 a m . General TRY ay§tem shall be operated in accordance with Comm '82 -84 Wis.Adm.Code and shall be maintained in accordance with it!s component manual SBD 10 570 - P•(E.6 /99)•and.local and state rules pertaining to system maintenance and aaintenance reporting., No pip enter a septic pump tonic since dangerous gases may be present that corks � death. Septic and nment shag be in n accordance w8h Comm 83.33 S. Wi POWTS componerrts. n. Adm. Code when the tam>ks are no longer used as 14 Septic or Pump tank manhole risers access risers and covers should be inspected for water tightness and soundness. Access oPe�gs used Jbr service and assessment shag be sealed unsound, defective, or subject to failure must be replaced. watertight upon the completion of servic •Arty o pening deemed be 38MM d by an egertive be koV device to prevent a or unauthorized 'WM a tank component. diameter shalt Smile aygm n tank any of as conhponeruts bepmne d�tac5ve the tank or comp onent sh k •In Proper operating condition. all be repaired or replad to keep the the'd0 q ti nk PAP. Pump controls, alarm or f telatad wbing becomes defective the defective component shall be P*W or replaced web a componerg of the same or equal pertonnanca. If the at -grade co'mponentfails to accept iF stewater *o all da disc rge va reveler �to the giovnd anrface, it may be necessary to install an aerobic pre - treatment unit or . .replace the component. Additional site and sail evaluations may need to be done. and addlaonal plans may"need to be prepared and apppoved by the Department of Co*merce,. Safety and Buildings Division. . �Questions.about the operation maintenance of this system should + be directs hoc �+ The County Office at `11S - Z7•1.- 6 - 7q7 pIQy —iM 3 �6�U� Fa The system installer at 1 Z,$ p ig h1 („ The tank manufacturer at VQIQBeg- The effluent filter' manufacturer at _ ktn - Z z1 _ S Z.M 0- .8*2z_LL9 Ll Go�t..Og 4 to C'�) March 31, 2003 TO: Tom Wang Wang Excavating River Falls, WI 54022 Phone: 425 -9958 Fax: 425 -5344 Cell: 715 -821 -0424 FROM: Dan Bauer 498 Stageline Road Hudson, WI 54016 Home Phone: 386 -1740 Cell: 612- 991 -6395 Tom: I'm sending a copy of the Deed for the farm from the Schultzes to us dated 11- 15 -88, and a copy of the original Sanitary Permit Application. The address of the farm is 947 Quarry Road, River falls, WI 54022. Our mailing address and phone number is shown above. Thanks for your help. L an ' Aa — UeT T ' d T OL 1996S T L ..lanes uea e60:60 co To -add Purr CiwsBER Manufacturer: Liquid Capacity: Pump Ho del.: Pump /Siphon Hanufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons /cycle: Alarm: Han.: Switch Type: Location Distance from nearest prop. line: Front, side, Rear Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: k� Seepage Pit: z Width: 1� Length 7 6 Number of Lines; Area Built 2'C � Exist. Grade Elev. 9R�1 proposed Final Grade Elev. Fill depth to top of pipe: Ho. feet From nearest prop. line:Front--X-1 Side, Rear Ft. Ho. feet from well: I ' * No. .feet from building HOLDING TA14K M anufacb;irer: capacity: Ito. of rings used: ' Elevation of bottom.tank: Elevation of inlet: No. feet from nearest prop. line:Front_,, Side_, Rear �Ft. _, U0. feet from: Well , building nearest road Alarm Manufacturer: INSPECTOR: I DATE: & PLUMBER ON 3OB : .0 0 h.•, P &V�03'n LICENSE NUMBER: / +'i{ "; S �`> l 6 /90 :cj S - d iOGiSBESTG janeg uea 0 01:60 60 1O idu d SANITARY PERMIT APPLICATION 93ILHR In accord with ILHR 83.05, Wis. Adm. Code C! STATE SANITAR PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8 % x 11 inches in size. c eck If revis to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1.: APPLICANT INFORMAT — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 99L, IVLOY.. S LA) t / , S Zq T. N. R E (o 'W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # _ 4 ` Q. �t CI STATE ZIP CODE PHONE NUMB�E SUBDIVISION NAME OR CSM NUMBER CITY NEARitT ROAD II. TYPE I1 OFBUILDING: (Check one) ❑State Owned VILLAGE_ ;Mh,Gkr„I,t,C_ q,rr rct t . l Public 1 or 2 Fam. Dwelling -# of bedrooms a PARCEI TAX NUMBER(S) � a � � � Ia —o . 111. BUILDING USE: (it building type is public, check all that apply) j�- 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 El Campground 7 (� Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 Service Station /Car Wash 5 El Hotel /Motel 9 ❑ Office /Factory 13 H Other: Specify IV. TYPE OF PERMIT: (Check t El one in line A. Check line a if applicable) ((--�� A) 1. N New 2. L Replacement 3. Replacement of 4. ❑ Reconnection of 5. LJ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously Issued. Permit # ._ Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 19 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) u ELEVATION ��� ��© ` � 99'8'�t- CAPACITY VII. TANK in gallons Total of Prefab. Site Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks I Tanks structed e ticTa r Holain Tank Y LIT Pump Tank/Sl ohon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for Installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) M P Sw N .: 6 ;sln Phone Number: Plum is Address (Str6oe City, State. Zip Code): IX. COUNTY /DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date I ssued Issuin gent Signature (No Stamps) FT Approved Owner Given Initial J(Y 8urcharpefee) X. CONDITIONS OF APPROVAL/REASOE S FOR DISAPPROVAL: wo -esse (formerly PIb -e7) (R. 11 /gg) DISTRIBUTION: Original to county, One Copy To: safety & Buildings Division, Owner, Plumber 9'd TOLT996STL ,aaneg ueQ eOT =60 ED TO jald A-q,0 c� t7 t� DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY a BUILDING `LABOR &HUMAN RELATIONS P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON WI 59707 `'late Plan 1,C), Number: IW%,SW ,-, Sec. 29,T28 -R18 ( "a « ^O °I 'own of Kinnickinrt' CONVENTIONAL El Holding Tank ❑ in- Ground Pressure ❑ Mound NAME O ERMIT HOLDER• AO RESS F PERMIT HOLDER: INSPECTION DATE: ll ' 8ENCH MARK (Permanent reference DESCRIBE IF DIFFER N FRO LAN: REF, PT. EL CST REF. PT. EL � W j � Name OR Plumber. MPIMPRSW ND.: f County. Sanitafy Permit Number. SEPTIC TANK /HOLDING TAN " 10'�k MANUFACTURER: LIOUIO CAPACITY: TA LEV.: TANK OUTLET .. WAq NING LABEL LOCKING COVE m p r PROVIDED: PROVIDEp: 66 9o. 16 7 5 YES ❑ NO C) YES N BEDDING T OIA.: v MAIL. HIGH WATER M NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T RESH ALARM: FEET FROM �,.r LINk: AlH INLET• ❑ YES NO I YES O NEAREST ��` 3 DOSING/CHAMBER; MANUFACTURER: BEDDING: LIOUIU CAPACITY PUMP MODEL: PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: NO E3 YES ❑ NO ❑ YES ❑ NO GALLONS YCLE: PUMP AND CONTROLS OPERATIONAL: NU F PROPERTY WELL: BUILDING: VENT TO FRESH (DIFF CE BETWEEN FEET FROM LINE: AIR INLET PUMP ON AND OFF ❑ YES L NO NEAREST -- - SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER: AlATEFIIAL ANU or excavation. (if soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: I ND Of I DISTR. PIPE SPACING: COVER INSIDE OIA.: J) PITS: LIOUID BED/TRENCH / 120 TRENCHES: MATERIAL: � A DEPTH DIMENSIONS GRAVEL DEPTI I rILL DEPTH DISTR. PIPE DISTR. IPE OISTFt. N S R. NUMBER OF PROPERTY WELL: BUILDING' VEN i0 FR H BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. ENO: r .. Q f y �c IPE : FEET FROM LIME: • AIR INLET' 7 ft 9 to NEA REST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW 0 YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COV ,R TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS: C1 YES I] NO ❑ YES ED NO DEPTH OVER TRENCHIBED OEPTH ENCHIBED DEPTHS OF TOPSOIIr. ED: SEEDED: MULGAI:D• CENTER: ED YES — ❑ YES ❑ NO [DYES ❑ NO PRESSURIZE ISTRIBUTION SYSTEM: i 8ED /TREN WIDTH: LENGTH: NO. OF ES: LATERAL SPACING: GRAVEL FPTH 8ELOW PIPE: FILL DEPTH ABOVE COVER: fJ 1 TRENCH QIMENS S MANIFOLD PUMP MANIFOLD I DISTR, PIPE MANIFOLD MATERIAL: NO. DISTR. I DISTR. PIPE DISTRIBUTION PIPE MATERIAL 8 MARKING: ELE ATION AND ELEV.: ELEV.: DIA.: 1 PIPES: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: Y_ COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO i INFORMATION APPHUVLU PLANS _ Q YES D NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE WELL: t3U1LDING FEET FROM Q ED YES C3 NO ❑ YES .0 NO NEAREST — 0 , ,"`'' -`-per G Sd-L1A �J °2I� • r °�`q �" "��`� /- �'' lfi rr vr.. I Sketch System on Blain in county file for audit. Reverse $IOB- SIGN UR E: TITLE: � - 5BD -6710 (R. 06/88) c L. - CI IOGT9BESTL. -janeg uea eII :Go EO TO udU RECEIVED and 2- family dwellings Ui (Wis. Stats. 101.63 (7) & 101.65 (3)) A PR p 7 2003 INSTRUCTIONS ON BACK OF SECOND PL. sr. CR Personal information you provide may be used for secondary purposes. [Privac w NN E :.. Last Name First Name Middle Initial Street Address City State Zip Code Telephone No. (Include area code) W/, 1 _ Building Address Subdivision Name Lot # Block # Legal Description Parcel No. _ A, J 1/4, caLZ 1/4, Section a9 T 2 N, R 18 E or W 01 1 „ V ® 1 Family R Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: F, Nat. Gas L.P. Oil Elect. Solid Solar Space Heating 21 ❑ ❑ ❑ ❑ ❑ Water Heating IR ❑ ❑ ❑ ❑ ❑ hu 01 ME ❑ Site Constructed ❑ Concrete ❑ Masonry Treated Wood $J Manufactured (to the WI UDC; not U.S. HUD code ❑ Other (specify): H : £,jxe�'Sk 1�. s . :ssf. . <'^.' ',:� q , �'..3 E"3�.. n�,.S y day:. ( :.' S,. o r Living area = Square Feet $ I vouch that all the above information is correct, and understand that the issuance of this permit is for administrative purposes only. I understand that onsite construction inspections will not be performed by the municipality, but that the Uniform Dwelling Code, Chapters Comm 20 -25, still applies to all new 1- and 2- family dwellings and must be complied with. I understand that the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. — �� C- 1l °L.l —OZ A licant's Siknature Date Signed MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PLY 2 TO THE STATE DIVISION OF SAFETY AND BUILDINGS �^ i 1 ❑ To ❑Village ❑City ❑County of: S .. NG�URSD .T : �N:, r:A �� F4 F �� o hn •I WattnnM< NiP UT 111 E i SBD -8254 (8.2/00) Distribution: []Ply I -Issuing Jurisdiction ❑Ply 2 -Municipality Forwards to State if New Dwelling DPly 3 - Applicant ISSUING JURISDICTION i AANtEL r3Au6R 947 QVRRr2y ROAD t R ECEIVEDr A PR 0 7 2003 ST. CROIX COUNTY , ZONING OFFICE w� x� 0 az b:''� m, r3 RN m 0 480' a` 0 APPRok s v A _ �^i A� 1 Stpre J 272' 122' o a I vewA y o v a PRoP�'nty L�NE,S w � O O. C3 0 1 - ID FRRM HovSF _w� 7wo AcRo'S O I k qLo It Ft q O r P p APR 0 vrve y 1 I MAWN 1 1 I 1 1 1 I 1 r - -- - ----- -� ' 1 1 c 1 --- 1 1 ( 1 Uvwd Room 1 1 1 1 � KITCNW mo woo" 1 1 1 ® i 0 �ATN roYWI AOM i OWROOM 4 .o' . as 6TOOp 5- J10id I a D an; c Cut ems' Rot � WT- I Computer #: 022 - 1085 -10 -000 Parcel #: 29.28.18.458A Municipality: Kinnickinnic Township Address: 947 Quarry Rd. River Falls, W 1 54022 0110312003 Bauer, Dan Jon Sonnentag I explained to Dan that he will need a licensed plumber to submit a reconnection permit. He is having Darrel's plumbing complete a report regarding the system, but he wasn't sure what �— creditential they held. They will also need to file a management/contingency plan. All of the information gathered from Mr. Bauer, the soil survey, and the existing soil report would support that the soils are suitable for the existing system design. Site Information St. Croix County Zoning Districts 0 *Boundary locations and N Annexed ■ Commercial GPS coordinates are ❑; Residential ■ Industrial approximate. Lice0ed ❑Ag- Residential Conservancy surveyor would nefpd to CAgriculture II Riverway be contracted to ddliniate ■Agriculture exact locations. j Miles 0 1 2 4 i 272 e _ f h 7 I' i� rr i i i 1 Feet 0 116 230 460 690 t. r — F tor.... _----- • ^-._.._ - --". - ---_" = __•._.._�.. -_ �-. rw.e wAC: aenaver, roa ases{aa1Me ear► — DOGt1M£NT NO. 'CATS WA OP- GON9iN POl{D[ I WARRANTY DEED 4 GGi19 V OL 8'3J PAS 543 �� REGIMR'S OFF! ,E ve This Deed . �r made betwes nJ.... hu ........• for Rec And..Kathryn I7 A. 5chuits.,.. .hua.hand...and..vif.a,........ MAR 141989 ............ .................. t Grantor. and... Dafl ie J AL. -. Bauer.. an l ane t.. -It._ Bauer, ... hue 1 :20 P•M and wifa,. as • surviver9hip miarit&1.- property,......... • ................... . .............. ........................ .... ............................... - - 1 Wicnesseth That the said Grantor, for a valuable wns:derat.on - -.... ........... ... ............. ......................._....... atl r conveys to Grantor the following described real eatate in .- .•1...CrrO y County. State of Wisconsin: I —s I ! See atta clied Tax Parcel Nos .... .................... .......•... �i �. �I i�,,,nOC......... homestead pr >perty. 4 EM This ....... tt (is) (is not) Together with all and singular the hereditament% and apyurtenanGes theeeunto ...... grog; And ....... Guat.a"— K. Schul. t ,a...and.- Ka.thr tsA...ance..exeg...........- I warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances e: pt easements and rights of way of record MI and will w•irrant and defend the same. Iwi �! y.fi'lt�cf ' ..................18.. Dated this daY o[ .......•� ...... ` � (SEAL) ..,/�• ..... .. .., l. ... ................. ....... ...................... li 3 .... .........................(SEAL) ..... .................. ,.Katht; n.. M .- .Schu,..tz.• . .......... ...... AUTHSI'{ TIC ATION ACKNOWLSD0MBNT STATE OF ;iVISCONSIN 1 Sig nature(a) ................... ..... ......... I ................ ...... u , I Pi er Ae ..............county. rt ;1 1 f --- ��.•...-.... f k; Persona)] cams before me this .__ day o I authent[cated this ......_.day of ...................... .... 19...... t�v:rlc the ebovo named ................ ............................... Gwl}. k�xs� _..gh�.l.� I ...... .. ... ............. .... . :....• ......................... . .......... `I TISLE: 7if£MBER STATE dAA OF WISCONSIN ......... .......... ..... ....•...••••.... ..................... ........ i Ill .....:.. ......._... {Ifnot, ............. ......_...... ....... ..... .... ..... Wis. State.) I� anthorited by 1 '108.08, W ma k nown w be the person ....s ...... who ezec»ted the •. + acknowledge the a♦fne.' for ing instrument and .f,;. l� 7M{a IHSTFVMEN7 WAS ORAF'r[O eY - ��(��- ••• %,(, %•.•..... •. � _ � I ••• / / /111 II C r At ..................... .. t „ Pie.rce..... w...County. is. R .: 1f iver f WI 54022 Notary Fubiic ........... . .. Q `I . .,: ....................... . . ... ................ 9 ' . ( .. •-� •- •••• •••• • •••••• >;dy Commisaton is Permanent. (If no state exPir� ion j" I� (Sianaturea may be authenticated or acknowledged. Soth dace: t!a ar iX••`�•• - I8. sr •'� ,I are not necessary.) • 1 -• I ♦ .y n.a,r... •N•mw .r eeraan< <lenln[ In anY e•p. <U.Y rh.,ulA Lm UP<'1 or Yrinud _, _•_" .. r ',� ...:::._._.__._ —._. __. bTAY YOR]I He. WI tre7 Stti Stock No. MG1 z'd tOGt986StG janeg uea e60 :60 60 t0 JdN OL 835 eca544 The SW} of Section 29; all that part of the N� of SEk of Section 30 lying North and West of the highway crossing said described 80 acres; a parcel of land located in the WJ of the NEk of Section 30 described as follows: Beginning at the Southwest corner of said NEk of Section 30- 28 -18; thence North alongg She West line of said NE} a distance of 1147.5 feet; thence N88 OWE a distance of 228.5 feet; thence N47 26'E a distance of 834.3 feet to an iron pipe $take on the South shore of the Kinnickinnic River; thence N63 WE on a meander line along said shore a distance of 56.5 feut to a pipe stake on said shore; thence due East a distance of 403.5 feet along South line of parcel previously conveyed by Ward to George C. Kind; thence South along the East line of the W� of NEk a distance of 1740 feet to the South line of said NEk; thence West along said South line of the NEk a distance of 1319 feet to point of beginning, including all land lying between the above mentioned meander line and the Kinnickinnic River (this last described parcel contains 43.8 acres more or less); all located in Township 28 North, Range 18 West; subject to all easements and rights -of -way of record. EXCEPT parcels previously conveyed described as follows: Beginning at a point on the North line of the NEC of the SA of Section 29, Township 28 North, Range 18 West, 284 feet east of the northwest corner of said quarter section, thence East 467 feet, thence South 467 feet, thence West 467 feet, thence North 467 feet, to the point of beginning. (Approximately five acres). That certain parcel of land located in the NWk of the SA of Section 29, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows: Beginning at the Wes corner of said Section 29, thence go S 00 00'00 "E, along the wesX line of said Section 29 a distance of 322.00 feet; thence N 89' 10'00" E 272.00 feet; thence N 00 00'00" E 322.00 fegt; to the north line of the SWt of said Section 29; theucr S 89'10'010" W along said north line of the SWL. a jIstarce of 272.00 feet to the Point of Beginning, the above described parcel subject to easements for road way purposes along the North 33.00 feet of the above described parcel and the westerly 33.00 feet now being used for Town Road, and subject to an easement for driveway purposes across the North 15 feet to the South 25 feet,of the West 165 feet of the above described parcel. Part of the Northeast of the Southwest k of Section 29, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, as set forth and described on the.Certified Survey Map which is on file in the St. Croix County Register of Deeds' Office in Volume 3, Pagge 696 of Certified Survey Maps, dated September 27, 1978 at 2 o'clock P.M. (This deed is given in fulfillment of a Land Contract dated April 7, 1973, recorded July 16, 1973, in Vol. 496 Records, Page 371, as Doc. No. 315525, Register of Deeds' office, St. Croix County, Wisconsin.) J E'd IOLI98E5iL uaneg uea e60 =60 EO IO udd FORM - STC - 104 AS DUILT SANITARY SYSTEM REPORT OWNER ")c;vk E4,,, Q,. p TTOWNSHIP 'k, CL , " 6 c SECTION ZCj T Z\> N -R /i'a W 45 S,A 02-7, ) - lo-06o ADDRES ST. CROIX COUNTY, WISCONSIN rt .;A R S� r SUDDIVISION AJ /P� LOT 0 LOT SIZE crc4� t PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM U T qq 4 INDICATE NORTH ARROW DENCJU111ZK: Elevation and description: -CE c7 s l or Alternate benchmark SEPTIC TANK:tdanufacturer: �/cr�., (cz« s �c: Liquid Cap. P(A Rings used: Q Manhole cover elev: grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front Side , Rear Ft. From nearest prop. line:Front Side Rear Ft. "`l No. of feet from: Well /i;0 7 - , Building: 4 )�S" (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER �{ /S Manufacturer: Liquid Capacity: Pump Model: _Pump/Siphon Manufact.: Pump Size Elevation of inlet: of tank elevation Pump on elev.: Pump off elev.: Gallons /cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front,_, Side,, Rear Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: k Seepage Pit: Width: !� Length 7 Number of Lines : I Area Built 3S'C •fit Exist. Grade Elev. W it Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front Side , Rear Ft. No. feet from well: /cX r No. feet from building 4 HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , nearest road Alarm Manufacturer: INSPECTOR: DATE: j &`? 71 PLUMBER ON JOB: LICENSE NUMBER: A'j{'�'S 3 Llz. 6 /90:cj ( z- g � aonc� 17� DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING ` LABOR & HUMAN RELATIONS DIVISION U P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON WI 53707 State Plan I.D. Number: NWT , SW, Sec . 29 , T2$ -R18 `CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Kinnickinn Y� LJ Holding Tank El in-Ground Pressure ❑ Mound 0 NAME O PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Dan Raiipr Line Rd. - Hudson. WT It BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FRO LAN: REF. T. EL .. CST REF'. PT. EL / Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: SEPTIC TANK /HOLDING TAN • ,Z61 ZS' a' MANUFACTURER: LIQUID CAPACITY: TA LEV.: TANK OUTLET .. WARNING LABEL LOCKING COVE PROVIDED: PROVIDED: 0AP 7 YES ❑ NO ❑ YES NO ' BEDDING: T DIA.: VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T RESH ALARM: FEET FROM �� LINE: / AIR INL T: ❑ YES NO ❑ YES MIO NEAREST —�' 3( t DOSIN CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: I PUMP MODEL: PUMP / SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS YCLE: PUMP AND CONTROLS OPERATIONAL: NU F PROPERTY WELL: BUILDING: VENT TO FRESH (DIFF CE BETWEEN FEET FROM LINE: AIR INLET . PUKIP ON AND OFF ) ❑ YES ❑ NO NEAREST —* SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: I LIQUID BED /TRENCH / TRENCHES: MATERIAL: I DEPTH; DIMENSIONS '� c) GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. IPE DISTR. PIPE TERIA : N S R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPS: ABOVE COVER: ELEV. INLET: ELEV. END: f a�`Ae ;,�'� -P IPES: FEET FROM LINE: t AIR INLET: / N 9 A ✓C NEAREST ---► 5- A MOUND SYSTEM: 01) 1 Mound site plowed perpen Icular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: RMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH /BED DEPTH ENCH /BED DEPTHS OF TOPSOIL: 7 !4 SEEDED: MULCHED: CENTER: ED EYES ❑ NO ❑YES E:1 NO PRESSURIZE ISTRIBUTION SYSTEM: BEDITREN WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENS S MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: I DISTR.PIPE NO. DISTR. DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV: DIA.: ELEV.: PIPES: DA.: ELE ATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO I 1 ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST 7 * etain in county file for audit. Sketch System on Reverse Side. SIGN URE: TITLE: SBD -6710 (R. 06/88) c DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couN STATE SANITARY PE RMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than � 8% x 11 inches in size. El crfec if revisibF M previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORM – PLEAS PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION IVIO %4 SU)Y4, S 2q T28, N, R 1 0 E (Olnw PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # q CI , STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 1 5 40tt- 7 /.S 2 661 t! 3 s 04 42e- 11. TYPE OF BUILDING (Check one) CITY NEAR T ROAD ❑ State Owned VILLAGEwhiGk /hh�� Krkrr d, ❑ Public 9 1 or 2 Fam. Dwelling -# of bedrooms Z AR EL TAX NUMBER(S _ la _o III. BUILDING USE: (If building type is public, check all that apply) AA 5 �- V 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. VV New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued Perm ## — Da Issu V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) y ELEVATION 300 1 IS 1, , 9 7 �'S S m 99' 8 "60st VII. TANK CAPACITY Site in gallons Total ## of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed tic IgCQr Holding Tank S Lift Pump TanWSi hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MAWt Business Phone Number: UR.,L z__ I Z_ Plum is Address (StrdW City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY L. ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e I ssued Issuin gent Signature (No Stamps) K Approved ❑ owner Given initial (� Surcharge Fee) / Adverse a rm n ti n � 6 ` -� U X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -87) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber i INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608- 266 -3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name.and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if requixed by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) k APPLICATION FOR SANITARY PERMIT 8TC -100 This application form is to be completed in full and signed by the ownetts) of the property being developed. Any Inadequacies will only result In delays of the ptalt issuance. •Should this development be intended tot resale by owner /conttactot,(spec house), then a second form should be tetatned and completed when the property la sold and submitted to this office with the appropriate deed recording. ---- ----------------- --•---- • Owner of property L22."„ =� .- ---- -. Location of property � 1/4 5� 1/4, Section ��� T Z� .1i•RY Township Mailing address e rcQ CA . Address of alto .�,_'r Faa& s ul", SAO 2 sdbdivlslon nam NIA • Lot number w �,�• Previous owner of property Total slse of parcel , 2 CA crp s D ate pa rc el was created Ate all corners and lot lines Identifiable? as J( 0 is this property being developed tot resale ('spec house)? as _Jl Volvsie P 35- and Page Number ;L_ as recorded with the Register of Deeds. • • • - -• • • • - - • • • ------------ • - - • - • - • • • --------------- -- - - - - - - - --- - ---- •-- -- -••-•• INCLUDE WITH THIS APPLICATION THE FOLLOWINCt A WARRANTY DRED which Includes a DOCUMENT NUMBER, VOLUME AND PAOt NUMBER, and the SRAL OF THE a6018TER OF DREDS. In addition, a cettifled survey, It available, would be helpful so as to avoid delays of the reviewing process. it the deed description references to a Ce=tltled survey Map, the Cettlfled survey Map *hall also be required. -------------------------------------- - ----------------- --• ----------------- •- PROPERTY OWNER CERTIFICATION IIVe) certify that all statements on this form are true to the best of my (out) knowledge; that I (we) am (ate) the ownerts) of the ptoperty described In this Information form, by virtue of a warranty deed taco ded in the Office of the County Register of Deeds as Document Ho. 4CS[6 ,[ / ; and that I (we) presently own the proposed alts for the sewage disposal system (or 1 (we) have obtained an easement, to tun with the above described property, tot the construction of sold system, and the same has been ul recorded in the Office of he County Register of Deeds, as Document No. ). signature of owner 819natuto of Co -owner (If Applicable$ ae of l gnstute Date of Signature l 2 � y \� :� � 2 � % . /��� \ ��� /�� \ \» ���¥y d�a� zz :�� . y . - ~� �~ � 2� < �/ /��� §x� r�, e 1 x eN STC - 105 CA SEPTIC TANK MAINTENANCE AGREEMENT � St. Croix County r OWNER /BUYE o Fire Number ROUTE /BOX NUMBER � ' '��q � � �"�Gc�i•2 �• i (te- � � CITY/ STATE )qu ( Se) c.A ; LA t`� 5 l �D ZIP ":5 �O ( jro rt PROPERTY LOCATION: *-'NO� _ k, LU) k, Section 09 T Z f3 N, R 1 W, Town of .�;iti��;� St. Croix County, Subdivision I� / Lot number A4 4 . Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Prover maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed's'e tic tank um er. What you put into the system can af"fectthe function o t e s eptic tank as a treat - ment stage in the waste disposal system. St. Croix County residents may be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all'new ' sys'tems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and .(2).after inspection and pumping (if nec- essary), the septic-tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H I /WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as .set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed b and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE - St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386 -4680 Sign, date and return to the above address. DFPAP.TM , OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS DU�TRY I DIVISION L ABOR AND PERCOLATION TESTS (115 MADISON WI 537 9 53707 HUMAN RELATIONS 1 L 83.09(1) &Chapter 145) LOCATION: SECTION: TOWNSHIP UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: Nth'/ su) !/4 2`� /TAN /R /bE (o I ; N:� � AY� #IA �- COUNTY: MAILING ADDRESS: brX ems' 'S�� C 1, ra, ujsac& t uk n'fU l G USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILED S RIPTIONS: ER COLATION TESTS: Residence Z New ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system �rZ ONVENTIONAL: MOUND: IN- GROUND- PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) 91SE1UI 93S ❑U I ❑ S ®U ❑ S XU If Percolation Tests are NOT required .6 DESIGN RATE: If any portion of the tested area is in the 1J under s. ILHR 83.09(5)(b), indicate: /A l Floodplain, indicate Floodp elevation: d 24 PROFILE DESCRIPTIONS���' S w�r�r BORINGI TOTAL DEPTH TO GRO DWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) " o ° BI sITs -1i B- / D 99 `�" In aloe. C/10 2 ' ,, B J �a µens B - Z �� �8`7`� y $Q z. CIS 1 `�'-s�` ID1�YP� stlZlfu L4 Z Lr— CAe. 14 1 Gg' lllr �Q iz "QI s1 Ts B- , sZ'r Z �'f pk rr;K SI�Z�:r �� - i t (z el SI B - 5' 9 $l�II �g 'A std 3Z oe B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 P R PER INCH P_ 3 q / P- 39 vs. o — 3 P- V, b 42— P- 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. SY EM ELEVATION 95 l it T 4 _._ _ r - ' I P I 3_ b it ir t t t ! (3 t 4 _.__. JA � t 3 I, the undersigned, hereby certify that the soil tests reported on I nis were made by me with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: t /-r TU ADDRE .- 2� CERTIFICATION NUMBER: IPHONE NUMBER (optio al): qG U CSTSAT E DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 10/83) — OVER — i INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bedrock cob — Cobble (3 - 10 ") SS — Standstone gr — Gravel (under 3 ") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well Is — Fine Sand Bldg — Building Is— Loamy Sand — Greater Than 'sl — Loamy Sand — Less Than '1 — Loam Bn — Brown 'sit — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water ' Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. i J Nay r r. LJ y, Sec. zq ��-2-$0 ( c & Lo 1 � /�� 1Cro Cf a F, ilPi3 'r s F f. m A 9 M z s -lb? OT s' W s I •- 8�£� �til. � �c S a �s au -Q %w-� e44 f�db� 142- w C.5 e IMP o �o o Parcel #: 022 - 1085 -10 -000 01/25/2006 08:49 AM PAGE 1 OF 1 Alt. Parcel #: 29.28.18.458A 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DANIEL R & JANET M BAUER 0 - BAUER, DANIEL R & JANET M 947 QUARRY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 947 QUARRY RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 38.000 Plat: N/A -NOT AVAILABLE SEC 29 T28N R18W 38A NW SW EXC N 322' OF Block/Condo Bldg: W 272' EZ -UT- 1476/282 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 835/543 07/23/1997 496/371 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 143899 Use Value Assessment Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 40,000 401,000 441,000 NO AGRICULTURAL G4 18.000 2,700 0 2,700 NO AGRICULTURAL FOREST G5M 18.000 45,000 0 45,000 NO Totals for 2005: General Property 38.000 87,700 401,000 488,700 Woodland 0.000 0 0 Totals for 2004: General Property 38.000 14,500 81,000 95,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 571 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 II I Parcel #: 022 - 1085 -30 -000 01/25/2006 08:49 AM PAGE 1 OF 1 Alt. Parcel M 29.28.18.459 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DANIEL R & JANET M BAUER O - BAUER, DANIEL R & JANET M 947 QUARRY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 35.570 Plat: N/A -NOT AVAILABLE SEC 29 T28N R18W SW SW EXC THAT PT TO Block/Condo Bldg: CSM 812276 EZ -UT- 1476/282 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 835/543 07/23/1997 496/371 2005 SUMMARY Bill M Fair Market Value: Assessed with: 143901 Use Value Assessment Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 9.000 1,300 0 1,300 NO AGRICULTURAL FOREST G5M 26.570 66,000 0 66,000 NO Totals for 2005: General Property 35.570 67,300 0 67,300 Woodland 0.000 0 0 Totals for 2004: General Property 35.570 59,300 0 59,300 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 Parcel #: 022 - 1085 -40 -000 01/25/2006 08:49 AM PAGE 1 OF 1 Alt. Parcel #: 29.28.18.460 022 - TOWN OF KINNICKINNIC Current X' ST, CROIX COUNTY, WISCONSIN Creation Date Historical Date ' Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DANIEL R & JANET M BAUER O - BAUER, DANIEL R & JANET M 947 QUARRY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 38.150 Plat: N/A -NOT AVAILABLE SEC 29 T29N R18W SE SW EXC THAT PT TO Block/Condo Bldg: CSM 8/2276 & EXC PT TO PARCEL DESC 1004/389 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1004/389 WD 07/23/1997 835/543 07/23/1997 496/371 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 143903 Use Value Assessment Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 12.550 1,700 0 1,700 NO AGRICULTURAL FOREST G5M 25.000 61,000 0 61,000 NO Totals for 2005: General Property 37.550 62,700 0 62,700 Woodland 0.000 0 0 Totals for 2004: General Property 37.550 62,700 0 62,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROI X COUNTY WISC0NSI N 796 -2239 z ,,•y� ,. Z 0 N I N G O F F I C E Post Offfice Box 227 Hammond, WI 54015 March 13, 1980 Mr. Leroy Jansky On -site Waste Specialist Division of Health 718 W. Clairemont Avenue Eau Claire, WI 54701 Dear Leroy: We are forwarding to your office the attached letter directed to Mr. Dan Bauer of Route 2, Box 228, River Falls, WI 54022. As the letter states we have revoked sanitary permit number 317 : and septic tank permit number 17525 as the use�of the structure is prohibitive. It is our knowledge that the system is really an initial or new system; as the building is a barn and the existing sewer was for a floor drain. Should you wish to comment on this matter, please feel free to do so. Sincerely, HAROLD C. BARBER Zoning Administrator yh Attachment CC: Madison Office -Board of Health • i I ST. CROI X COUNTY h WI SC0 NSI N ZONING OFFICE Post Office Box 227 .•/ Hammond, WI 54015 February 28, 1980 LOCATION: NW 4 of SW 3%. of Section 29, Mr. Dan Bauer T28N -R18W, Kinnickinnic Route 2, Box 228 River Falls, WI 54022 Dear Mr. Bauer: It has come to my attention that you are planning to remodel a barn into a two family dwelling. This newly intended use of the structure would create a two -fold violation of the ST. CROIX COUNTY ZONING ORDINANCE. The violations would be as follows: 1. Creation of another residence without an approved land division, Section 2.6 Al referenced to 2.4 A2. 2. Creation of a two family dwelling on property zoned agricultural - residential,.Section 2.6 F2. In order for you to change the use of the structure, you will have to do the following: 1. Contact a licensed surveyor and have a parcel surveyed off to create a lot for presentation as a minor subdivision. 2. Apply for a special exception use before the Board of Adjustment, Section 2.6 F2; or petition to rezone the property to residential, Section 2.3 Al. Due to the circumstances, I will have to cancel the sanitary permit, number 317, and inform the Township that the building permit is not valid. Should you wish to discuss this matter, please contact this office to set up an appointment. Cordially yours, ; HAROLD C. BARBER Zoning Administrdtor HCB - TN : j h CC: Ardis Swenson, Clerk District Attorney Ross Pierson Richard Hopkins I ST. CROi X COUNTY . , .�.... W1 SC O N S I N ZONING OFFICE 796 -2239 P' Post Office Box 227 Hammond, WI 54015 February 28, 1980 Mrs. Ardis Swenson Route 2 River Falls, WI 54022 Dear Mrs. Swenson: The intended change of use for the structure on the Dan Bauer property is not a permitted use in the ST. CROIX COUNTY ZONING ORDINANCE. Therefore, the.building permit number 535 should be canceled at this time until the problem is corrected. Enclosed is a copy of the letter sent to Dan Bauer informing him of the problem and possible solutions. Sincerely, LJ L. �/ � -_. , OLD �� BARBER l Zoning Administrator HCB : j h cc: Dan Bauer Ross Pierson District Attorney I TOWN OF KINNICKINNIC RIVER FALLS. WISCONSIN r . r !, o f f" r r n f i � I Set back: r -4,3T of read of 100 feet f"Pm z i REPORT OF INSPECTION_INDIVIDUAL SEWAGE SYSTEM • San.izany Pexm.i•t • State Septic NAME Township t. Cxo.ix County Lo cat.iom ,(/_ a)_Sa Secti,on� _ SEPTIC TANK Size ga.t.tons. Numbers of Compaxtments I Viatance Fnom: We,t.t 12$ oA gneatex s.tope j# Bu.i.td.ing it. Wet.tands it. Highwazex it. DISPOSAL SYSTEM 12% on xeatex .a.to a it. D.ia #ante Fxom: We�t.t ��. g p Bu.i.td.ing 6.t. W et.tands Ft. • H.ighwa#eA it. FIELD DIMENSIONS: Width oS txench it. Depth o6 %ock be.tow t.i.te .in. Length o6 each tine it. Depth o6 Aock oven .t.i..te .i n. NumbeA- o6 tin e.6 Depth o6 ti.te be.tow gxade in. To#att .tength o6 .t.ines 6x. S.tope ab .txench in pen 100 it. D.idtance between Zines Depth'ta bedxock S . Toxatt abs oxbt.ion axea 6t Depth to ghoundwaten �.t. 2 Ty o CaveA: Pa en ox Straw Requ.iAed axea it yp p PIT DIMENSIONS: Num os pit's GAave,t axound pits yes no OutA ide d.iameteA 6t. Depth be.tow .in.tet 2 Tota.t absoxbt.ion axea it a A AAea %equixed it2 ^' INSPECTED BY TITLE APPROVED , DATE 191_. REJECTED ,DATE 191_. • A ij EM 115 I WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES y 4 DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 •� MADISON, WISCONSIN 53701 (�d REPORT ON SOIL BORINGS AND PERCOLATION TESTS l LOCATION. /v!W /a, /r /a, S ction �, T TN, R LS E (or) W, Township or Municipality /4 kI 'Z ��� / 11 ry Lot No. Block No. Count //�� Subdivision Name Owner's Name: & e Mailing Address: ' -' TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS /f PERCOLATION TESTS f- G ` SOIL MAP SHEET 9/ SOIL TYPE ) 51 PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P 3 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) 73 y PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas. Indicate on the plan the location and square feet of suitable areas. In 'cate number of square feet of absorption area needed for building type and occupancy. � Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. t N Er L Rev J I, 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 Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) / ` el .4' 1 i / Certification No. y i > c L sh. �. h Address �� 7 Name of installer if known /J COPY A — LOCAL AUTHORITY CST Signature 1 State and Count State Permit # 1 `• � PLR catio mi pp n Per 't Application y County Permit # l for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: •� X Z 2 8 Pt L (�S U3 Ise. B. LOCATION: MW Y S I, /4, Section a?�, T,,? N, R S € (or) W Lot# City Subdivision Name, nearest / road, lake or land mark / lBlk# �s Village - IkLS I S Q`�t� S(Wv 7 �'t"I�f ��I� C + �J (r n r ` / L'I 5� Towns t wi✓1Q/'iwy C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms S No. of Person D• SEPTIC TANK CAPACITY ZODO Total gallons No. of tanks Z HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel L.--- Fiberglass Other (specify) New installation Replacement Ll Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate - :Z Total Absorb Area d sq. ft. New Replacement 4--- Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: `'�— Length 9'0 ' Width 12' Depth " Tile depth (top 3 " No. of Line Z- Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land 0-7 Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as Iisted on EH 115 if other than p owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Cer ified Soil Tester, NAME C.S.T. # /y I and other information obtained from (owner/builder). Plumber's Signature ? MP /MPRSW# 1,:P _ Phone # I - y 6 Plumber's Addr orY, il Cc,. / - PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well coca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. eAN . . ., e.. .m d , l, b . f ��. E ��vm m t 3 e � . 3 F j E e j 3 i J� ..e.. S J F . i a s a I 3 d E ; € - E } Do Not Write in Space Below OR COUNTY AND STATE DEPARTMENT USE 0 N by Date of Application ` Fees Paid: Stat Co nt �W Date l ez ? - 7 2 Permit Issued /Rejected (date) Azy z ^79 Issuing Agent Name �, L t1 Inspection Yes4No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4, plumber (canary copy) Revised Date 7/1/78 I