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HomeMy WebLinkAbout022-1092-90-000 rosin D, pRImenSof Commerce PRIVATE SEWAGE SYSTEM County: St. Croix �tv and Building Division INSPECTION REPORT SahitaryPermitNo: 506242 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No Williams, Gerald Kinnickinnic, Town of 022 - 1092 -90 -000 CST BM Elev: Insp. BM Elev: BM Descrip ion: Section /Town /Range /Map No a 1 I 32.28.18.P504 TANK INFORMATION ELEVATION DATA c TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / , jl Benchmark iv a I, - uV I Dosing Aft. BM I --7 A Hold eration / �1 r BI21 <nI er ` 2 , in St/Ht J �y I g St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet S G� Septic V' � Dt Bottom__ A Dosin > 25D ,� /_O Header/ a / g 0 / h b 2.3 Aeration _ P O 3 Holding Bot. Syste Fi* al-Grade PUMP /SIPHON INFORM ATION QG c4d ` Manufacturer Demand St Cover �{ LrH kX:7 GPM -L lM Od Model Number 9 6-7-f /��� . , TDH t ift Friction Loss System Head TDH Z Ft l � �� 06. Force r�n in Length / Dia. p Dist. to Well �� i I i SOIL AB ORPTION SYSTEM vj-4 BEDITRENCH Width r Length No. Of Trenches PIT ME IONS No. Of Pits Inside Dia. IlLiquid Depth l DIMENSIONS SETBACK SYSTEM TO P/ t DG ELL LAK ST AM AC G Manufacturer: INFORMATION Cl R OR Type Of ystem: T Model Number DISTRI ION SYSTEM f s"a > Sa � �6u�S Header ,Van IDistributio x Hole Size x Hole Spacing Pnt to AiX In e Pipe(s) 11- ength _ Dia_ Length Dia Spacing t0 SOIL COVER x Pressure Systems Only xx d r At - Grade Systems Only S Depth Over Deptn Over xx Depth of ' Seeded /Sodded h ( ed Bed /Trench Center Bed,'Trench Fdges Topsoli es No� Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: a/ 01 Inspection #2:// V Location: 1056 County Road M Rive W4 Falls, WI 54022 (SE 1/4 NW 1/4 32 T28N RI 8W) 40 acres<�o't' ' " Par I No: 32.28.18.P504 1.) Alt BM Description T� 7'�r v -6 S� C7� r �IQi 2.) Bldg sewer length = G�li l JV p ih K� 0 - amount of cover Plan revision Required? Yes /N/o L Q � Use other side for additional Information. I Q � [_, Date nsepctor's Signatt ee Cert. No. SBD -6710 (R.3/97) J I J COmmerce.wi.gov Safety and Buildin ivision County 201 W. Washington A .O. x 7162 r� r f 1� 1 sco /�O Madison, WI 537 Sanitary Permit Number (to be filled in by Co.) in Department of Commerce 5 ZZI 7 - Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate gove ntal unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04(1 )(m , Stats. ✓rte - 1. Application Information - Please Print All Information Property Owner's Name Parcel # / ` , 11 IN 2 7 2007 0ZZ -- /09 Z - 9 - oa Property Owner's Mailing Address Property Location ST. CROIX COUNTY Govt. Lot City, State r Zip Code Phone Number y,�,� 1., Section �� �� (( T Z N; R r 11. Ty a of Building (check all that apply) pK Lot# Subdivision Name or 2 Family Dwelling - Number of Bedrooms t _ Ae ,. �— ^ (C �t : CrC o LrIL-C Block # -11.6 /'TG ❑ Public /Commercial - Describe Use p< '� ❑ City of CSM Number ❑ Village of — ❑ State Owned - Describe Use J / �— n of $ X57 III. Type o ermit: (Check only one box on line A. Complete line B if applicable) ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / I t IV. Type of POWTS S stem/Com onent/Device: Check all that a I ✓ ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade 1�rMound > 24 in. of suitable soil ❑ Mound < 24 in. of suitabl soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersalfrreatment Area Information: 1. Design Flow (gpd) esign Soil pplication Rate f) Dispersal rea Required (s Dispersal Area Propos st) Sy tem Elevati9p / V Tank nfo Capacity in Total # of Manufacturer . c Gallons Gallons Units � j ti New Tanks Existing Tanks ? o yr ri. 0 P. Septic or Holding Tank Dosing Chamber ^s VII. Responsibility Staternen 1, the undersigned, assume resp for installation of the POWTS shown on the attached plans. Plum sme (Print) c Plumber's Sign L� — Business Number '0 � /J 7 Plumber's Address ( treet, City, State, Zip Co e) VIII. County/Department Use Onl Approved 11 L�isapp Permit Fee Date d lssuin gent Sig re \ vim �p� • a° 6 7 ❑ O en Reason o nial IX. Conditions of Ap p ro _ va � l/ 3 \\ 6r" easons for Disapproval �� y �. r J� a � � ,,�� esrr b� ��✓�q SYSTEM AP R J 1. Septic tank, effluent filter and dispersal cefl must all be services / maintahrleti as per management plan provided by plumber. 2. All setback requirements must be maintained � �r i p� 4 tti T � t 1113 PO 8 ~ M ki " IM M e system and sub mr to the County only on paper 11�110 "t I than 8 l a l inches in size / �f eg SBD -6398 (R. 01/07) Valid thru 01/09 PLOT PLAN PROJECT Gerald Williams ADDRESS 1056 Ctv Rd M River Falls Wi 54022 SE 1/4 NW 1 /4S 32 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX SYSTEM ELEVATION 102.0' BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK XXX 1000 gallons LIFT TANK SIZE MOUND SEPTIC TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL * H. R. P. Scin e as Bench ark Scale = 1/4" = 10' 1320' Property Line' Pro q ? - 0; To Cty Rd M m ID Well is to meet tall setbacks found in J C Comm. 83 ;D ap ' 9 al 300' IoN S� a Grading is to be done to divert run -off away from Huffcutt Combo Tank system B -3 102' Tank is to be properly bedded and provided ��" 101' with lockdown covers with approv�/ 67, warning labels It. �� 100' O d, l� nra B - 2 B-1 �4 99 N 9% Slope Area 15' below system is Alt. B. M. to remain undisturbed 1320' Property Line PLOT PLAN PROJECT Gerald Williams ADDRESS 1056 Ctv Rd M River Falls Wi 54022 SE 1/4 NW 1 /4S 32 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX SYSTEM ELEVATION 102.0' 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none IL BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑BOREHOLE O WELL *H. R. P Same as Benchmark Scale = 1/4" = 10' 1320' Property Line Pro 3 To Cty Rd M Bedroom House Well is to meet all setbacks found in Comm. 83 r"� `T j 300' IL2 Grading is to be done to divert run -off away from Huffcutt Combo Tank system B -3 102' 101' Tank is to be properly bedded and provided with lockdown covers with approved M warning labels 1)B-2 ❑ d. B-1 99 9% Slope Area 15' below system is Alt. B.M. to remain undisturbed 1320' Property Line Safety and Buildings 4003 N KINNEY COULEE RD COltllllerC @.WLgOV LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www.commerce.wi.gov /sb/ isconsin www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary June 25, 2007 CUST ID No. 226900 A7TN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/25/2009 Identification Numbers Transaction ID No. 1405446 SITE: Site ID No. 726635 Gerald Williams Please refer to both identification numbers, County Road M above, Yn all corres ondence with the a enc . i! Town of Kinnickinnic St Croix County SETA, NW1 /4, S32, T28N, R18W FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1136489 Maintenance required; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10),. Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • The minimum distal pressure at the end of the distribution lateral is to meet three feet. This amount of pressure Cona will supply a discharge of 0.72 gallons per minute through the 3/16 inch orifice. APPF • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. 00VWME91 Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. SEE CORM • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. 1 SHAUN R BIRD Page 2 6/25/2007 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 8155 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 /� /� Fee Received $ 175.00 C / /�i� Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART;code;.7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday charles.bratz @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. i A Cover Page sqp °7 z00 1 �, Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 6/ 5/07 Owner: Gerald Williams Location:SE1 /4 NW1 /4 S32 T28 N,R18 W Cty Rd M Kinnickinnic System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -11. Soil test Shaun Bird fondly Signature -OVED // / I License numbe 6900 °F SPONDE E Mo Date Noa- -Woven Filter Fabric 4" 4bservatioa Pipe Perforated Aistr'sbutiOn Pipe Below Pil,ter Fabric . C--33 Sand G.' " TapsoSS ti -- = = = - -- - B 7. . Slope rtF �f f — 2 %Z �orct ttin �� Ployvett Frasn PusriR Layer Drain Rock .p Cross 5ection .01 A wound 'S -Stem Usiss i. I A Bed For The A,bsar tits Area �,� � A 15 Ft. Tct W. L d.`Qbservotiaft PiPO � oin IN From Purttp Distribu ion Bid (}f Pipe Di -airs Roc]K 4Observation Pipt .tocaRi Permanent Mar ker pi p e or- Rods p lan View Of.Mound Using A Bed f or The Ab Argo PAGE, i • j - PtttEOr � / . PVC P.ye / o SOON Lmast4 04 89111e S- `L Ae Ear SDCtt+s got PVC Force Maim >C t FLIST VdLr. �e+e� �a Cor+nse�a�n PVC �toni�o4t P:�t •. Pipe f LL t 2 -' Gt�$ ` . t"� rs l riti 0 e+ #�:�t L Oy03t p Ft. Xr Ihes " Inche Signed: 'Hol Dimete Ch L ateral - " - InchUs) License Numb � Manifold Inches = Force RgIh .' Z Inches # of toles/pipe Z lavert Elev4tion of LafteralsA 7.10 . I AND Sp If L ' ;Q3�i5 CROSS CHA SE GRAD J UNCTION BOX ER AS T PIPE 12 ��. lFarsa . ir�fu: - E � t• f j a • ,,,.���TT�� a Wilt '$'l6� . sue"' ' A6 £ � PIPE OM_ SUL PIK J CIO _ ..._ Orr E 2°-? - UNDER PAID g PER DAY svonC j RUSE 9 Tum SIZES.. $ Cpg S= C � at .� Smc FUW t/ s ` FEET T _.L On PIS �►� £ �� , REWIRED vases puts? OE _ - - - �FEtR rAcrOst DVTWV- el rAaT -pull? MT "`�� 1 71 bO2 dozy ; 11r�cy -a -ver e.;x�r.r, . uy►. s.3 v Sent 6 HP LoserJet 3100; �H S ERIES U P /E F-FLLJ�N T PUMP i ' o UL MLOL 11918 cc Um 9T BM1S 111e.1V mossS y Mt ex 9.n XIVA 991 "L 132 in 74 V a5 h SAD 11S 5 A 32 1$$ 7!C 71 8.11 s115/YQ81 BBi� amm MASt W4 28D am b5 1000 7Q 41 as 12$ 28 27 8.11 010%L99 13t! in 76 64 . 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Vg pn Demand SOWS Cr-CM— Sf 5C3 n- M ?=J. mond> sYersage present Quay . � m� �e �rav�y) PMb - ❑ At-S © - ed Ste } � �l ooml Q g f ash �r Sow TOW Fecal Y, indh6iamete v sr�►� mnk Maas( pride Stw . .� Wyrrd ftrpMw@A9d wra SCE SCHtWL Service Frs4uetszY Serv Even At feast once every Gi month Of Lank volume oafs Oct lnspe�t lion of tanks) When combined sludge and srsssn eR s) (M�udnsum 3 Yrsc -) Pump art contents of ranicts? p months - At least CnM every O month$ 5) snsped ca�ti{s) Al least once every II r ( s ) p NSA erlt111W yeatr(s} ESA tnspeet peunp, p� �srCts & alasrr► At least once every ❑ m Q orsshs At teas( Q r II yearfS) ❑ NA Flusats t and prOsswu t8a At least once every od+ec 13 n £1 year( N At feast once every ots�r arse. of sit � t or M�M �,aNS o� �( be, Ma de by an kidividual , swinge �� and H Sewer; Pow s tnsPe<�r lrs pivmbea; Msatoc Pturi ltd � of the tank(s) � idenarY any bock UP �. t de a vEsual pew and g ag Ts � m the volume of oomt5ined Of csAo am hardyaa^ identify znY - me di oBtKs) H be v or po AV 0� etEkaznt 9 pond'mg of amuwd on 'Else t�� of the local � In to oft Ptpes -end m on and regc��s the immedrafie nom tarok YpWM0, 9g MW g �, nd nor rods ®f+a a t a and scum to any tank equaags oaeoird ( „ ch. NR Wl�tt � of sludg a� Setvi operaW enft of the talc std be removed by ants. any 113 V0=201 Adm� �� Components. p �M t�e 1 conl'On Of �Itrent it�ers, rrle��taf or p�surt� � ate be {�?t by. �� �,nt w ff m d The send$ of .12 month of any serer at.mamD�nce or eorgoring at r, auifto* within 1t) d� of comp ert�e As MPcdshdte pit to the local t� fi a P�� Or OtW START AND OPERATION use of the poWrS dtw*.bV9Merlt tank {s} far #0 P asa For rseys±�• hY ardor damage the dsspe� t�11(s7- ff f 4h ctterrticab fetal ns�r fm,peee she rwrit g a SW39e I servfdng operate Prior t o use: deW Md taaM ttte corps of the is K5) removed s stna not a=ir when so7 �ditionS are fr=w at the iinfnmtive sur ce- tanks OW IM abMe normal #�glnwater tenets. Win a iesbot d Ste e During P cents} in one large dose, ovedOsdu�9 fine aed{S) and maY ram in lime srasommerwili be the d To avid flue sM.raimrt have the corrftrtt's of The pwM fasdC rarttosred by a bad craerface to the effluent purnp cr 8 Piu nbec POWM Mahler S pt3or�a t con bpft restore - p ower a5515t in tl� � #w � restore rlorrrnal iavels ern tine tnP - Do mt &WO or park vetW s ore. i� & CSk Do not dnve or park Ova or or compact, the ate 25 ford down slope of awry rno� or at-grade Sal absbiptbri aces - � na r of tine �5 frorin tm waste st eam may i mpam ft pe bffnarm and pin3otq file f e retbe butt; condoms, cotton swabs deg denhd 90W. &VSK of kt POV � 9I w310 wand vegetable pe�gK g g � meat d� tat fozaida� QtaYct {starlp } ,scraps me �* OgIrM products' es; -mulbry napkins tarnMm and wallet sa ftW Mm ABANX)NNUENT taFoen cut of service the tnua ring steps _ghao # s taken t o turn; that ttre Where the POWFS tails arndfor is perrna wnffy sysaem ft propedy=zd. Y abandoned in o=prsance with ch- Comm 83 -33, Wacosnsin Adridnistaf ve Code: • Rff piphng in Wig= end pile shalt be drsconrtiect�ed and the abandoned pipe openhngs seated. The «ontenrs of an ranks -w- id V ft shall be removed and properly dmposed of bar a SePt0Qe •S s pi5er pESnQhnQ. aII tanks 8nd pft sharr b ex= vztw ants removed or over covers re- w—dand tlse vwd spate Wed yet SOIL gmd 0r2rt05W bled sand r3naULmL COffWGENCY Pt.A11T tf� measures have been, or rr lust be Zak Rye a code if Me povaS tails and cannot be complraitrepwameft sntarm evaluate Q A suable �r h= beenn s! and may be u ized far the location of a �t sots absorp5on rystmm The rtepWoonvent area should be protected from disturbance assts Cort;pacdan and sbmW snot be k&kVed upon by fled set=cks from existing and proposed srruCtunk lest Fines and teens_ FBrlute loo pro the r+epi'a t area win r;wmlt in the need for a new soil and sitavvaduanian to a suitable went aroma. Replacement terns must comply math the rules In effect at that ticne- t i not avaffable•due to setback andlor soil trtn;ta t _ Sar*V advances fn P0WrS• D A suY�b e r+epla rrsent anea identify a suitable r t � a txdhrg tak,may be h:slaued as a last resort to replace the f Upo POWFS. Tloe eas riot beers, evsksatod replacement area Lrpon taSur�e of t POWTS 2t SO$ and Th s Site evaivatron must be p� to locate a suimbre repiace�rnent area. If no �t zrea is avaiiabre a tank matt be ks'taited as a Past resort to replace the failed POWTS_ l and at -grade sod ab 5 maY be reconstructed in place fclTov g removal of the beomat at mIt ratIve sc rbWa. R�ons of such systerns must comply with the rules in effect at !fiat dme . . <- _VVARNWG>> PT#G, P[TAdP AR+FD OTHER TRFATMElq TANKS MAY CONTAIN LETHAL GASSES rAdllI3lQR fNSUFFRCfETtTOXYGETI SF DO NOT ENTER A SMMC, PUMP OR OTHER TREATMENT TANK UNDER AMY ClRCBMSTANCES. DEATH MAY RESULT_ • RESCUE OF A PERSON FROM T*iE INTERIOR IOR OF A TANK MAY BE f] WSCULT OP- IMP.OS - MLE_ 'ADDITIONAL COMMENTS POWTS INSTALLER PQYYTS MAiNFAii�ER IF t Marne .x lssti/ J - ; �.f'r Phone SEPTAGE SIrRYIt NGOPFR4TOR LOCAL R.BGULATORYAUTHORI Y Narne Agency �/ 4e Pt3one �1 — rtus coaar�e�a as draw br roe stain: of Lrcr testae, bran =ft and W==trara Cotwo Z=LV acrd SaaiiaiSoe v==**nc= +ewAwaenm of aft. C== XrXdAM and 83_ ). 0 & J3). wsw=n A6m� Cade V%iW of V& doaanent*0ts (& gr>"Mat the perfoomam of ft PO TS. cscorssinpepartmentofCommerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ Attach complete site plan on paper not less than 812 x 11 inches In size. Plan must County , - include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. please print all information. Reviewed by Date Personal infonmabon you provide may be used for secondary Pubes (PAY Low. a. 15.04 (1) (m)). Property location " '*par ty f'�C -1 l Govt. Lot Sje 1 /4��14 S SN R E (or) Property owners Mails Address Lot # Block # Subd. Name or CSM# Code Phone Number ❑ City ❑ village 1-Town Nearest Road Construction . use eeideroal / Number of bedrooms 3 Code derived design flow rats GPD ❑ Replacement ❑ Public or commercial - Describe: — Parent material [�,e /�► Flood Plain elevation If applicable 's.-Jxy tt General oarriments and reowla ndations: System Type // /�� System Elevation / .2 / Boring # ❑Boring surface , � 2 Pit Ground elev. � ff. Depth to limiting factor � in. Sol Application Rase Horizon Depth porninant Color Redox Description Texture Structure Consistence Bourbdary Roofs GPDNF ln. Munsel Ou. Sz Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 d - C1 Mr3h- —' f c' .� , ' 70 f J �� j w 0 [ ❑7t / Boring /J J) / � ty > # Lt Pit Ground surface elev. � - Q ' ft Depth to limiting factor Ste, in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots WWI! in. Munsell clu. Sz. Cont Color Gr. Sz. Sh. 'E{f#1 '0#2 0`) 3 .r ----- c- .r W /• / �l • Effluent 91 = BOO > 30 220 mpt and TSS >30 150W Effluent #2 = BOO 30 mg& and TSS < 30 mglL CST Dime (Pia rA PmU CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5 17 �— �- "� 715- 246 -4516 Property Owner Parcel 1D # page of Boift # ❑ ,// /�� ! v 1 �. Pit Ground s eiev. v [ " it. Depth to G nbV sector � � in. Sol Rate Hottaon Depth Dominant Color Redox Description Texdue Stricture Consistence Boundary hoots in. Muntsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EM#2 J — -- Bortng # ❑ soft ❑ Pit Ground sumacs elev. ft. Depth to Writing sankeror in. Soil Rate Horizon Depth Do kwt Cokx Redox Desaiption TeWe Sh chn C mistenoe Boundary Roots GPD/ff' in. Mtn Ou. Sz Cont-Color Gr. Sz. Sh. `Elf#i 'Efflli2 ❑ Boring' # ❑ ftkv ❑ Pit s ew. - ft. Depth to &nbV Udw in. Sol Rate Horaon rmpth Ow*wt Redox Desaiptiat. Texture shuck" considence Bou nCiely Roots OPON in. Mu nsell OLL Sz. Cont Color Gr. Sz. Sh. "F�#1 `E1pK2 Effluent #1 SOD, 30,5= mgot and rss > 30 S 150 n V& ` Effluent 112 = BOD, _< 30 mg L and TS$134 nsglL The Department of Con=&= is an equal opportunity service provider and employer. If you need assistance to access services or peed material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608-2644777. IND 03 o OL6M) Soil Test Plot Plan Project Name Gerald Williams Shaun Address 1056 Cty Rd M River Falls Wi 54022 CS 26900 Lot ------ Subdivision - - ~ ---- Date /07 SE 1/4 N W 1 /4S 32 T 28 N /11 W Township 1Gnnft* [ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe System Elevation 102.0' - HRPSame as Benchmark Alternate Benchmark Top of 3i4' pipe @ 94.2' Scale = 1/4" - 10' 1320' Property Line -�— Scale is 1" = 40' To Cty Rd M unless otherwise noted 300' B -3 102' Fq 101' 100` 103 B-2 _...�- ._,__..__�� B -1 99' 9% Slope Alt. B.M. 1320' Property Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County �.-¢ �' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must T �° include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi by Date Personal information you provide may be used for seconds urposes (Privacy Lew, s. 15.04 (1) (m)). z Property er / E'v 15ope ovation e��{ � 66 // Govt. L S J 114N ,)14 gN R E (or) Property Owner's Mailing Address JUN 13 2 Q {ot # Block # Subd. Name or CSM# 0s' m — -- 5�v CRY to Zip Code P e N"b ffR01X COUN n C' El Village JESTown Nearest Road ew Construction Use esidential / Number of bedrooms 3 Code derived design flow rate GPD ❑ Replacement / ❑ Public or commercial - Describe: Parent material G� Flood Plain elevation if applicable General comments os i o L o o `r i cu v", Ko-lr6� S e and recommendations: R io System Type ` System Elevation /Q.2 l0 � Boring # ❑ Boring I 21 pit Ground surface elev. / ft. Depth to limiting factor 3 Q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 o -6 / Z -30 ' azkil< «t r,J i .�� -7 0 yyi ^ /'� o✓/ / Boring # ❑ Boring /� 91 Pit Ground surface elev. / ��f/ 'O ft. Depth to limiting factor r7' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 AL 2S- Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Narris (Please Print) lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54 r17 �' �_ � 7 715 - 246 -4516 Property Owner _ Parcel ID # Page of Boring # Boring ❑ F 3 - 1 ® pit Ground surface elev.' v (" ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Co nt. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - 7 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor )n F S — oilA pplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Effluent #1 = BOD > 30 1220 mglL and TSS >30:E 150 mg A- ' Effluent #2 = BOD < 30 mgA- and TSS 130 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SOD -9330 (8000) Property Owner _ Parcel ID # Page of Boring # ❑�11 Boring A ` ® 1� Pit Ground surface elev. " ft. Depth to limiting factor in. Soil lication t Ra e Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 a Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. C3 pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD :5 30 mg& and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD -8330 (RAM) Soil Test Plot Plan Project Name Gerald Williams Shaun i Address 1056 Cty Rd M River Falls Wi 54022 CS #126900 Lot -- ---- Subdivision --- ----- Date 6 107 SE 1/4 N W 1/4S 32 T 28 N /R W Township (innidcinnic r-l Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe System Elevation 102.0' *HRPSame as Benchmark Alternate Benchmark Top of 3/4" pipe @ 94.2' Scale = 1/4" = 10' 1320' Property Line Scale is 1" = 40' To Cty Rd M unless otherwise noted 300' B -3 102' 101' 100' p B -2 B -1 99' 9% Slope Alt. B.M. 1320' Property Line " U 274 6P 098 KATHLEEN If. WALSH STATE BAR OF WISCONSIN FORM 3 - 1999 REGISTER OF DEEDS Document Number QUIT CLAIM DEED ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Gerald A. Williams and Carol Williams, 02/08/2005 10 : 00AM husband and wife as tenants in common, each an undivided one half AUIT CLAIM DEED interest Grantor, i iiEtSF; a. and _Gerald A. Williams and Carol Williams, husband and wife as survivorship marital property Grantee. REC FEE: 13.00 Grantor quit claims to Grantee the following described real estate in COPYSFEE: St. Croix County, State of Wisconsin (if more space is needed, please attach CC FEE: addendum): PAGES: 2 See Attached Exhibit "A ". Recording Area Name and Return Address KAISTli`'A OGIAND ATTORNEY AT LAW P.O. BOX 359 HUDSON, WI 54016 022.1093 -95 -000 Together with all appurtenant rights, title and interests. Parcel Identification Number (PIN) This is homestead property. Dated this > fh day of March 1 2004 (is) (is not) - * * Geral A. Williams * * Carol Willia AUTHENTICATION ACKNOWLEDGMENT Signature(s) -- — — - - -- -- — — STATE OF �t>ISCCinS1 t, ) ) ss. ,C Y1�1 jC County ) authenticated this _ day of _ _ _ _ Personally came before me this /t; of p March 2004 the above -tamed `,`�����( G erald A. Williams and Carol W illiam s, husband and wife, as . * Q .• Q��i tenants in comm ea ch an u ndivided o n e half interest TITLE: MEMBER STATE BAR OF WIS60 �ji1"; (If not, _ _ ` . RH ONDa M• ;y"j me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) NS BE -instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTE� W`S(,;; /I? • n Gm, rn_ — — Attorney Kristin Ogland_ Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac. WI STATE BAR OF WISCONSIN 800- 655 -2021 QUIT CLAIM DEED FORM No. 3 -1999 U 2796P 099 Grantor! Gerald A. Williams and Carol Williams Grantee: Gerald A. Williams and carol Williams Additional parcel #'s: 022 -109 000, 022 - 1096 -20 -000, 022 - 1094 -50 -000 022 - 1096 -95 -000, 022 - 1092 -20 -000, 022 - 1092 -40 -100, 022 - 1097 -20 -000, 022 - 1092 -60 -000, -1092-90 - T ` f f , y '�`�:Jr.�9n4.re•:xG� a .. iit ; hest anS5i,. .,, !*Ck, lays .north- sits`: s out1 �tck . immedfatef�►_ d f: .. re f ce sr.tu;;tha �fQlIoving• dose lfo�• 1' d,. T�$: ;,Er' c;. :ca�emenafa a' :t .Sly corpq :a :th ~c her.Nltf?f�,� $'echo* . .3.'�'r �'T•o?+nsi:�.i :28'• •: Ran er' 18• ~ thenc'e: E�s� � t?ienc .x►'.. -: ' �C r thence.- Nasf:110''feet ;• . t�ien�eF''South: 3SQ•� ���`•` �r �e �i '1.i.. .'�1'Y:l.w •' ,. . iy ,M •A ,�.• Tlr~��: •�. 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S8'9�.SSk m oat, Ioiig;a�ia:.cantar�i�s• of '� T:�::,�t•.r ;��ir: thq�:. pot�it' b�: f be: �i�iirig,;�,on£�,ii'i�t�i�•;�S -: 29�•: ac�'es•� ` , ��sr.:•: ! a•".fr: .il: 6f' .e�r� `,• .•.y.'• 4' ��• •r �' ... . ::.f,Er; purpasfe: of .h description; aid,• be3nga: - arc:, ' zefesenced:'* oK .the�Kas.i+.•:�fiia�af:ths' of � RIBW;� =ssumed.:N00'-OQ�4$'!1�'. :,�r•:,.. •• •: EXCEPT parts sold by Grantees previous to the execution by Grantor Of this Deed in fulfillment of the underlying Iknd Contract. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND WENERSHIP CERTIFICATION FORM OwnerBuyer 4 Ace Mailing Address �-� ��� Property Address (Verification require from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 0� LEGAL DESCRIPTION Property Location .5� 1 /0 , '/4 ,'Sec. , T N P W, Town of Subdivision ^ Lot # Certified Survey Map # �— , Volume , Page # Warranty Deed # Volume 0- Page # Spec house yes ! Lot lines identifiable (ye� no SYSTEM MAINTENANCE AND 0 CERTIFICATION i Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septicitank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic lank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm 83.52(0 and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit t) St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operati{►g condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1 l/we, the undersigned have read the ab} ve requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Dep t of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we amlare the owner(s) of the property described above, by virtue of a warran�y deed recorded in Register of Deeds Office. Number of bedroo ig SIGNATUkf 6f APP LICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (RE 08/05) ArcIMS Viewer Page 1 of 1 loll! c � � `5 Y 3 I 4 w x http: //72.21. 230.178/ website /LRPortal /ARCIMS /MapFrame.asp ?PIN= 6/27/2007 • S T CRD cOU NTY )A4' PLANNING & ZONING EROSION & SEDIMENT CONTROL PLAN Site location: 1056 Cty Rd M, Town ofKinnickinnic Owner(s): Gerald Williams Parcel ID #32.28.18.P504 Code Administration 715- 386 -4680 Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." In Land Information addition, Wisconsin Uniform Dwelling Code Comm. 21.125 requires the building permit Planning applicant and /or landowner to follow erosion control procedures and maintain them until 715 386 - 4674 the site has been stabilized (Uniform Dwelling Code Comm 21 is available on -line at: www. commerce. state. wi .us /SB /SB- DivCodesListing.html) Real Property 715 - 386 -4677 The Owner of the above parcel is responsible for notification of all contractors performing construction activities on this site that an Erosion & Sediment Control Plan is in effect and the Recycling 715 - 386 - 4675 following activities will be required in order to maintain compliance with the plan: I . Maintain existing vegetation wherever possible to minimize erosion and sediment movement. The primary source for construction site runoff will be the house foundation excavation, driveway, well drilling, and soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #5 below. 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and /or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Do not allow contaminated runoff to be directed onto neighboring property or into surface water conveyances. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. (Refer to specification sheet for temporary diversions available from county). 4. Stabilize exposed soils (septic system included) with seed and mulch immediately after installation - do not wait for final stabilization and/or landscaping of entire site to establish pennanent cover on the site. When late- season weather conditions will not permit seed germination, a heavy straw mulch cover will prevent erosion until vegetation can be established. Erosion control matting can be applied any time of year and, if installed properly, will provide protection even if seed germination is delayed. ST. CROIX COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD. HUDSON. W1 54016 715 386 - 4686 FAX Page Two — ESC Plan Acknowledgement Form The owner of record during site construction will be responsible for compliance with state and county code requirements as specified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions regarding erosion & sediment control product installation. PLAN PREPARED BY: RYAN YARRINGTON, ZONING TECHNICIAN #683475 Owner acknowledgement of ESC Plan requirements: _/_/2007 (Please sign and return original ESC form to Planning & Zoning Dept. A copy is attached to the owner's permit and maintenance agreement, which is given to the plumber at time of permit issuance.) Copies provided for excavation contractor, plumber, and town building inspector ST CR01X COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, W1 54016 715-386 -4686 FAA