HomeMy WebLinkAbout022-1095-10-010 WiscCisin Department of Commerce
PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
515041 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be Osed for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: City Village X Township Parcel Tax No:
Saxton, Angela & Jason I Kinnickinnic, Town of 022 - 1095 -10 -040
CST BM Elev: Insp. BM Elev: BM Descripti Section/Town /Range/Map No:
/ i L I A) eLi Q M 6^1 6�— W4 33.28.18.513A01
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ` CAPACITY STATION BS HI FS ELEV.
Septic ! Benchmark // C /�
0A41 /000 7 / IT 25
Dosing -;,A . a 750 C�oroe P S�Q; �' 0 •`t / 3S, `� L l
A rt- Bldg. Sewer ` / 3O . 7
A th
Holding SUHt Inlet 7 J /
7, / 25. S
Q - b
TANK SETBACK INFORMATION St/Ht Outlet cJ `r I
TANK TO P WELL BLDG. Vent to Air Intake ROAD Dt Inlet /1.3 % �f y
Septic q . �( Dt Bottom '/ .a� 11-2.
Dosing _ Header /M n. �
Aeration Dist. Pip
9J.7
Holding Bot. System
9 „�/�
PUMP /SIPHON INFORMATION Final Grade 7
Manufacturer C Demand St Cie I ✓ ?Z
PM 3'
r J
Model Number �
E Z4 1a
f? ,? . 3.5 125 .2
TDH Lift ' Z� Friction Loss ,5! ystem Heck 3'L TDH �l� 6
Forcemain Len�th / I Dia. Z � Dist. to Well c`aJ /
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No O f Pits Inside Dia, Liquid Depth
DIMENSIONS ��
SETBACK SYSTEM TO r BL WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: /JA- UNIT
Model Number: �
DISTRIBUTION SYSTEM
Header /Manifold C x Hole Size x Hole Spacing Veit to Air Intake
Length Dia Spacing
.a
SOIL COVER x l4ressitra 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 ! (`4 Yes No N sJes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: ! /
Location: 72 Emerson Valley , Drive River Falls, WI 540 2 (NE 1/4 NE 114 33 T28N R18W) NA Lot 7 Parcel No: 33.28.18.513A01
1.) Alt BM Description = " ' b ��btwti by . 51 ti
2.) Bldg sewer length = �' e C5 P.,J I 000
- amount of cover = E L
Plan revision Required? El Yes X o / _ (� Ocj /
Use other side for additional information. i Q i j �
SBD -6710 (R.3/97) Date Insepctoe ignatur Cert. No.
F
P
. ID
commerce.wi.gov Safety and Buildings Division � County
201 W. Washington A 1I'��
s /'moon i n Madison, WI 5 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Co tnmeros :515 6 A 1
Sanitary Permit Application sta e Transaca ° Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the M'OK
unit is required prior to obtaining a sanitary permit. Note: Application forms r Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary UAL
p urposes in accordance with the Privacy Law, s. 15.04 I m , Slats. G AM �Q' �.7�✓" l�/Zj
L Application Information - Please Print All Information
Property Owner's Name Parcel #
�1 5 ^/ ry 6 z
Property Owner's Mailing Address Property Location
L4 �; G Govt. Lot (/ • ?
City, State Zip Code Phone Number A L y,y., Section �3
I r ` ` ® { . 7, T -� (•� ircle one)
V C� 7 t/V N; R E oe
II. Type of Building (check all that apply) p �G Lot #
l or 2 Family Dwelling - Number of Bedrooms _ �� ...- S.u�d_i.YlSiQn Name . _. - - -.._
Stlbnv►, _Bock # _
❑ Public/Commercial - Describe Use
G ❑ City of
❑ State Owned - Describe Use CSM Number a ❑ Village of
7--g 5234R-Town of t N A.#C e/ it/.t/ /G
III. Type of Permit: (Check only one box o ine A. Complete line B if applicable)
A' ❑ New System y ❑Replacement System Treatment /Holding Tank Replacement Only ❑Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
3 �
fV. Type of POWTS System/Component/Device: Check all that appl
❑ Non - Pressurized In -Ground ❑ Pressurized In- Ground ❑ At -Grade 9 Mound > 24 in. ofsuitable soil Q Mound < 24 in of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersaareattright Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispetsal Area Required (sf) Dispersal Area Proposed (sf) System on
Vl. Tank Info Capacity in Total # of ufacttuer
Gallons Gallons Units S z u o v
New Tanks Existing Tanks f� C U ��
A PP v� 'w c7 a.
Septic or Holding Tank / `., e,ar/i
Dosing Chamber / °(J'r / �� //�
7 So z
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation ofthe POWTS shown on the attached plans.
Plumber's Name (Print) Plumb is Signature MP /WARBNumber Business Phone Number
i� z Z6 l"z 2 3 -
P1u 's ddress (Street, City, State, Zip Code)
VIII oun /De artment Use Onl
Approved tsapprov Permit Fee Date Is wd Issuing ent Signs e
Given Reas or Denial O ' Ob /
IX. Condl%,t[ *8 %�ffeasons for Disapproval 3\
1. Septic tank, effluent filter and J
dispersal cell must all be services / maintained
as per management plan ust bdby plumber.
2 Eros, d i �"t a l p�4� 4 �; ►1.e�d�C
A� setback raquirettte�tts must be maintained
e e system and submit to th only o aper not less than 8 to x 11 Inches I size
��.
SBD -6398 (R. 01/07) Valid thru 01/09
1
I
26
i5�nb' 4 � � lbGJ 9ii49�i�� 16� i6
r
Jason and Angela Saxton
River Dawes
ver Fa3 se Place
Wl 54022 o' %Ne
NE 114, NE 1t4, S 33, T 28 N, R 18 W �
�1
Town of Kinnickinnic.
St. Croix county j I
BM ei. =100' Exsiting mound I
Scale 1" = 60'
W
O
1 �/
I %
NQW
Wieser 750 pump tank BM
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� Ia ,
I
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SEA
I Wieser 1000 tank
io rn
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c° — House z
a.
N I � t • ??
AA z•
\Y 11
_N orth .�
I
212' East lot line
Emerson Valley Drive Page 11 of 11
ECOPY
Jason and Angela Saxton
2469 Dawes Place i "ONO
i�
River Falls, WI 54022 / 1 1 " ' V e s
NE 1/4, NE 1/4, S 33, T 28 N, R 18 W
Town of Kinnickinnic
St. Croix county i 4 -1 .
BM el. =100' Exsiting mound
Scale 1" = 60' j
- -- so' o °---= o
i
0
i
i
new
Wieser 750 pump tank BM
i
1
' I
I I j
� a
t
,
I
,
l �
sF� coat
� I
f4C W
\-
4.Wieser 1000 tank,"
I a rn
c -- House o
i
1 I
v 14 1
4 M {
I _N orth
i
212' East lot l ine
Emerson Valley Drive Page 11 of 11
Safety and Buildings
itl ww 3824 N CREEKSIDE LA
commerce.wi.gov HOLMEN WI 54636
iscon TDD #: (608) 264 -8777
i n www.commerce.wi.gov /sb/
Department of Commerce
w.wisconsin.gov
Jim Doyle, Governor
Jack L. Fischer, A.I.A., Secretary
May 09, 2008
CUST ID No. 226497 ATTN.- POWTS Inspector
ROGER D NELSON ZONING OFFICE
NELSON PLUMBING ST CROIX COUNTY SPIA
122 E SUMMIT AVE 1101 CARMICHAEL RD
ELLSWORTH WI 54011 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/09/2010 Identification Numbers
Transaction ID No. 1531167
SITE: Site ID No. 736484
Jason & Angela Saxton Please i refer to both identification numbers,
Emerson Valley Dr I above, in all correspondence with the agency.
Town of Kinnickinnic
St Croix County
NEIA, NEIA, S33, T28N, R18W
FOR:
Description: Treatment & Dose Tank Replacement only for an Existing POWTS
Object Type: POWTS Component Manual Regulated Object ID No.: 1179294
Maintenance required; 450 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade
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 unlesslicensed 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:
• The existing POWTS tanks shall be properly abandoned per Comm 83.33, Wis. Adm. Code.
• 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.
• Inspection of the private sewage system installation is required. Arrangements for inspection shallbe made with
the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stats.
• Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent
filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval
conditions.
• 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:
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in the approval.
• 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)
P.O.W.T.S.
Conditionally
APPRO
ROGER D NELSON Page 2 5/9/2008
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the aunty for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
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
Balance Due $ 0.00
Gerard M Swan
POWTS Plan Reviewer, Integrated Services
(608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm. WiSMART code: 7633'
jerry.swirn@wisconsin.gov
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M.
ads
O
Plans for installing new tanks for an existing
3- bedroom mound system
Jason and Angela Saxton
2469 Dawes Place
River Falls, WI 54022
Index
Page I
Pages 2 -8 old state approved mound plans
Page 9 calculations work sheet
Page 10 pump tank cross section - mc-
Page 11 plot plan
Page 12 county inspection report
NEI /,NE %,533, T28N,R18 W
Town of Kinnickinnic
St. Croix County
Designer: Roger Nelson License # MP226497
Date: 411012008 Phone # 715- 273 -4444
Signature Date f S o
DtPARTMENT OF COMMtKLL
DIVISION F SAFETY AND BUILDINGS
SEE COR KSPONDENCE
i
MOUND SYSTEM
FOR '
Jay Uldrych
21646 Bentley circle
jordan. MN 55352
RECE�
FE806��
INDEX D1V.
SAFET 8, g`DGS
a1 ige 1 of 7 .. .........................Index
o f,�7 .. ..... ...................Calculations
o � 0"
4U�1► f . ...........................Plot Plan
e o ... . .......................Lateral Layout
9 Y
of 7 ................ ...........Cross Section
dam ,
e 5 of 7 ...........................Plan View
ge 6 of 7 ...........................Pump Chamber
Page 7 of 7 ................... .......Pump Curve.
Located in the NE 4 of the NE 4, Sec. 33 ,
T _ 28 N, R 18 W, Town of Kiruli ckinnic St Croix Co.,
Wisconsin.
Prepared by Paul C.J. Steiner
Steiner Plumbing and Electric, Inc.
N8230 945th Street
River Falls, Wisconsin 54022
Master Plumber: #6?80
Date: I 'ebrua'y 5, 1996
I
CALCULATIONS
STEP 1: Absorption area: 150 gpd /bedroom X 3 = 450 gpd.
Table 4: 450 1.2 = 375 square feet required.
Use ft X ft bed
Use 1 trenches, 4 ft wide X 94 ft long
2 laterals, each 46 ft long, X dc"
spacing between laterals.
STEP 2: Table 5: 11/2 diameter laterals, 1/4 " diameter holes at
48 " spacing between holes.
STEP 3: Table 6: 12 holes /lateral, 15 gpm discharge rate per
lateral. 15 gpm X Z = 30 gpm total discharge.
STEP 4: Table 7: diam. manifold, inlet at of
foot long manifold.
DQS� = '�'" /,�, = ii2dS � (77 r.� x (��`) -- �2h.12 C,�4�. � i�i.
STEP 5: Design dose volume is 112.50 gal /dose at a rate of 4 times
per day. Min. dose volume must be at least 10,`X` , qistribution
pipe volume.
Table 10:1' 1 2 diam. pipe= .064 gal /ft X .064 = 100 X 1 .
STEP 6: Table 13: Dosing rate = 30 gpm.
STEP 7: Table 9: Friction loss in 2 diam. force main, 77' long;
30 _gpm= 1_54 in 100 feet.
ELEVATION DIFFERENCE 8.2
FRICTION LOSS 1.19
HEAD 2, 50
i
11.$9 TDH
page 2 of — 7
I
Page 3 of 7
PLM PLM
Scale
�.b 5
— / r . �.
� �re� I,UF•e
`-
3 4K
!�' nis ►b Th;t Area
750 a� A 'IIR Tank
s
B ore Poles sli
8 3.8 1
c 7 1 1. D;k
1 0� -
66.60 v M
ile✓ y j.rn e s7�e�2 F6 o 1 j
t Pr i u o 7 c Dr 1 i!
Payer _ y
LATERAL LAYOUT
Perforated Pipe Detail
'7 0
Perforate End. View
PVC Pipe
Holes located on bottom,
End Cap are equally spaced.
Variable -Y" �\
Distance 4
PVC Force Main
From Pump
D istribution
Pipe
.st Hole Should be
Lext to end cap.
p 46'
X 48"
Y -2< 48`'
Hole Diameter 1/4 Inch
Lateral " 1 1/2 Inches)
LA ( MV. F = 94A5
Force Main 2 Inches
Page 5 Of 7
-CROSS SECTION
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
INST M
Medium Sand =—
M G
Topsoil = F System Elev. 94.0
3
to
tz. � % slope
Bed Of 2— 2 %2 (Force Main Plowed
Aggregate From Pump Layer
0 it
l E 1.4 ' � i `��)
Cross Section Of A Mound System Using F .4 1
.A Bed For The Absorption Area - G 1.0
A 4 Ft. H 1.5
PLAN VIEW a _ 94 Ft.
I ' 18 Ft.
8 Ft.
K 10 Ft. (if `)
L 114 Ft. o6'
Force Main —��. W 30_ Ft.
L
Observation Pipe -_�"
A L------------------- - - - - -- - -- - -- - - - -- - •�
\.Disiribution Bed Of
Pipe Aggregate
1
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
PUMP Cli Atilt ER CROSS SFCTIOil AIII) SPECIFICATIONS
vl:nC Cup T
We.athe-r Proof - Approved Locking
Junction Box Manhole Cover
4" G.I. 12" Min
Vent Pipe ;
Final 4" Min
Crncle� '
—f-- -- �-
18" Min
Conduit ......-----------
1
18" Min
Approved
Inlet Joints w/
I. Pipe
Extending
proved ' ';'
inc u/
3' Onto
I. Pipe I Solid
tending �; A Ground
Onto Arm
lid ► ';� _
ou nd ► R�
- -'
C
i
.Pump - O Off Pe P
Concrete Block p
OIFF LfC
S1
TANK . PUMP
nufacturer: Weeks Manufacturer: Myers
nk Material:_ D Model Number: ME40
nk Size: 800 Gallons Switch' Type Flom
Total Dynamic (lead 11_89 Ft.
CAPACITIES Pump Discharge Ra 30 GPM
2- c;38'y Total Daily Effluent: 450 Gallons
$a or 1 jf h 2,3 Canons Number of Doses: 4 per Day
2 " or 34.:2 Callons Dose Volume:' 112.52 Gallons
• _ or ti -2-y2 Gallons No tea : 1 . See pump curve for
16.92" or 2 89._3 4 Gallons additional performance
, tal Tank information.
pacity Required - 798.06 Callona 2. Pump and alarm are to be
r 7c O R 129,25 &AL-5 installed on ueparat ci
ALARM au per I LUR 1 G . 1 4 NAC .
in tif ncturer: Le A aXW
161el ►cumber -_
, I tch T y p e. y F loat
, . f -
AA
ME40 Series
4/10 MP Effluent
and Drain Water Pumps
Performance Curve
MOEXL ME40 EFFLUENT PUMP
CAPACITY LITERS PER MINUTE
0 SO 100 150 200 250 300 350
40
12
35
10 N
30
IL
H 25 8 E
Z
0 20
6
J
15 J
! — 4 O
10
5 2
O t I Ll I I I I O
0 10 20 00 40 50 60 70 80 90 100
CA ACITY GALLONS PER MINUTE
F. E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923
419/289 -1144 FAX 419/289 -M8 Telex 98 -7443
K3326 7/9t
Printed in U.S. A.
CALCULATIONS
STEP It Absorption area: 150 gpd /bedroom X 3 - 450 gpd.
Table 4: 450 t 1.2 = 375 square feet required.
Use — ft X ft bed
Use _1 V trenches, 4 ft wide X 94 ft long
2 each 46 ft long,
spacing between laterals.
STEP 2: Table 5: 11/2 diameter laterals, 1/4 " diameter holes at
48 " spacing between holes.
STEP 3: Table 6: 12 holes /lateral, 15 gpm discharge rate per
lateral. 15 gpm X 2 = 30 gpm total discharge.
STEP 4: Table 7: diam. manifold, inlet at of
foot long manifold.
Ba. t C77 F, X � Ito`f) = (25.12 FaAI: S IN.
STEP 5: Design dose volume is 112.50 gal /dose at a rate of '`'_4 times
per day. Min. dose volume must be at least 10` - distribution
pipe volume.
Table aCI: 1' 1 2 diam. pipe= .064 9 al /ft X .064 = 100 X� I = „gal .
STEP 6: Table 8: Dosing rate = 30 gpm.
STEP 7: Table 9: Friction loss in 2 diam. force main, 77' long;
--M— c-f pm in 100 feet.
ELEVATION DIFFERENCE 4* 2 ' BFI
FRICTION LOSS 1.19 6.50
i
HEAD �y(k x•
�.. TDH 6•�7 r
page
HUMP CV CHOS SECTION Atli) S1'I:CIFICATIONS
Vent Cup ue Approved Locking
.athrr Proof - Munliole Cover
Junction Box
T Min
Vent Pipe
Final 4" ltin
Grade '
18" Hin
-- fir--- -
Condui C
4,., " n ' -- -- '-----
Approved
V 4 /Y � D G �- / ` +' Joints v/
+ ; +�
+;, C.I. Pipe
roved �cPf� Ta.► ; Extending
+ +•
li t W/ I
3' Onto oil
A Solid
ending ) ',; Ground
Onto + "bAlarm
i d i ,' _
And '� 8
+ + On -
- -' +` C
Y u m 1) - -_._ - `j off Pte'
Concrete Block p
Si'i:CIF ICA1'I014S
TANK • PUMP
ufacturer: I cs per Manufacturer: 6_e4 o
k Material:_ (1QUCXOte Model Humbug A
k Size: 7,50 Callona Switch-Type - E1oAt
Total Dynamic Head: 6. t Ft.
CAPACITI rS Pump Uischurl -e Rate: ZOO. OS GPM
Total Daily Effluent: 450 Gallons
;Z./,y - i Gallons Number of Uoses : 4 Per D
" or s Callous hose Volume: 112_52 Gall
or Ca ll ons 140 tea : 1. See pump curve for
. a or t /L:� ��' Gallons additional performance
of Tank in or tan tion.
acity Kequired _ '7S" 2. Pump and alarm are to be
inut+illed on ucparat circuil
ALM(H au p 1 LIIK 16.19 NAC .
u(ncturer: A larm
tell T y p c Float
, .: I, II f4 of N
victor, : -: K+ partment of industry, PRIVATE SEWAGE SYSTEM Count
L-6hor." id Hurnen Relations
5 ; :fet; and Buildings Division I NSPECTION REPORT ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No -:
GENERAL INFORMATION 262365
Permit Hol der's Name: ❑ City [] Village (}X Town of: State Plan ID No_:
U JAY & JEANE:TTE KINNICKINNIC
CST SM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
A96.00174
TANK INFORMATION ELEVATION DATA"
ATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark r
Dosing r
Aeration Bldg. Sewer
/X3 2,9 `
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Ventto
TANK TO P/ L FWELL BLDG. Air Intake ROAD Dt Inlet (1, 7
Septic NA Dt Bottom
Dosing NA Header /Man-
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION , ` . ,7 Final Grade
Manufacturer Demand
Model Number GPM
TDH I Lift Friction system TDH Ft gad
Forcemain Length Dia. fi pint. To Weft
SOIL ABSORPTION SYSTEM 3
BED !TRENCH Width / 7 T Leegth� r No. Of Trenckes PIT No. Of Pits Inside Di . liquid Depth
I I DIMENS
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manuf acturer:
INFORMATION Type of 4j; CHAMBER model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) I x Hole Size I x Hoe Spacing ( Vent To Air Intake
Length Dia, I 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 ❑ No ❑ Yes ❑ No
\ COMMENTS: {Include code disc9e ancie�, . persogs present, etc.) rj�>;t t �= -ti �� ,ii'_rJ= ' `'
1. yam
LOCATION: KT1NICKIN'jIC.33.28.18W, NE, N , LOT 6, COUNTY RD M
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R 05191) Date 1nsoector's Sianature .Q _ _ /lr•.d aftrorr, Ki.
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
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o \o REV. JAN. 2008 800- 325 -8456 FILE:WLP750 -MR
P5/05/08 MON 12:42 FAX 715 386 4686 ST CRX CO ZONING R002
ATTACHMENT TO AMENDMENT
TO PERMANENT EASEMENT
FOR ( SEPTIC SYSTEM
THIS AGREEMENT made this l" day of May, 2008 between
Thomas M. Foley and Nancy M. Foley AND
Jason A. Saxton and Angela J. Saxton
Is an agreement to amend the original easement width as described in the document
AMENDMENT TO PERMANENT EASEMENT FOR SEPTIC SYSTEM
Along with Exhibit A and Exhibit B all recorded May 12 2006 as doc. number 825190 in
St. Croix County, Wisconsin
It i agreed betweea all aarties Ikat the width �dth of this this basement will be S aaded to 32 feet
Everything else remains unchanged.
Thomas M. Fole , �� Nanc M. Foley
The abo a A d Nancy M. Foley, were subscribed hereto before me this
May
Notary Public
State of Wis c.o.+
My Commission expires AP r, +
J - ason A. Saxton Angela J. SAW '
The above, Jason A. Saxton and Angela J. Saxton, were subscribed hereto before me this
-R- Day of
NOTARY otary Public
s .— State of 1✓ ra .. s
t PUBLIC My Commission expires Api, , /0 , z6,,
5
2ai3 dJ1"Gi�� �y/: w�ISifn �• �PS�On yTJ� �L/L7lf �LIi�Q�t' /S �Z1Y�
III
05/05/08 MON 12:42 FAX 715 386 4686 ST CRX CO ZONING 1A001
1 { { {i {i Ilili i { {ii lifli { {!i{ Ei {1{ till !I {I {I lfli if {i
Attachment to Amendment to * 6 7 4 0 2 6 3
Permanent Easement for Septic
Document Number System Document Tift KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
05/02/2008 01:40PM
EASEMENT
EXEMPT #
REC FEE: 15.00
PAGES: 3
Recording Area j C
Name and Relum Address / •7
Thomas & Nancy Foley
76 Emerson Valley Drive
fiver Falls, WI 54022
-I
Parcel Idettllicallon dumber (PIN)
This Inlomtatton must be completed by submittef; docu littl9 na e & return address. and FIN (I f required). Other Information such as
the granting clause, WOW description, eta, may be placed on this first page of the document or may be placed on addidwal pages of the
document. Mote: Use of this cover page adds one page to your document and $2.00 to the rmallne.fea Wisconsin Statutes, 59.43(2m).
WRDA HB Rev. 118/2004
1 of 3
Q5/05/08 MON 12:43 FAX 715 386 4686 ST CRX CO ZONING Q003
04/28/0b NON 14:34 FAX 715 386 4685 ST CRX CC ZDNIVG la ooe
r
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COMMENCING AT THE NORTHWEST CORNER OF LOT 6, CERTIFIED SURVEY
MASS, RECORDED IN VOLUME 11, PAGE 3091 IN SHE REGISTRAR OF DEEDS,
ST, CROIX COUNTY, WISCONSIN;
THENCE SOUTH 86'14'15 EAST, ASSUMED BEARING, ALONG THE NORTH
LINE OF SAID LOT 6, A DISTANCE OF 203.00 FEET TO THE POINT OF
BEGINNING OF THE LAND TO BE DESCRIBED;
THENCE NORTH 3'45'45" EAST, A DISTANCE OF 25.00 FEET;
THENCE SOUTH 86'1415 "EAS7, A DISTANCE OF 25.00 FEET;
THENCE SOUTH 3'4545 "EAST, A DISTANCE OF 25.00 FEET TO SAID
NORTH UNE;
THENCE NORTH 86'14'15" WEST, ALONG SAID NORTH LIME, A OISTANCE
OF 25.00 FEET TO THE POINT OF BEGINNING.
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GOU LDS PUMPS Submersible
Effluent Pump
PE
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SPECIFICATIONS MOTOR FEATURES
Pump — General: General: ■ Corrosion resistant
• Discharge: 1Yz" NPT • Single phase construction.
• Temperature: 104 (4000 • 60 Hertz ■ Cast iron body.
maximum, continuous when • 115 and 230 volts ■ Thermoplastic impeller and
fully submerged. • Built-in thermal overload pro- cover.
• Solids handling: 1 /2" tection with automatic reset ■ Upper sleeve and lower
maximum sphere. • Class B insulation. heavy duty ball bearing
• Automatic models include a • Oil -filled design. construction.
APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently
Specially designed for the • Manual models available. shaft. lubricated for extended
• Pumping range: see PE31 Motor:
following uses: service life.
• Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous
• operation.
Effluent/Dosing Systems PE31 Pump: • 115 volts
• All ratings are within Low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ e motor.
the
• Basement Draining Maximum head: 25' TDH PE41 Motor: working limits of the
9 ■Quick disconnect power
• Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM cord, 20' standard length,
Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts heavy duty 1613 SJTW with
• Maximum head: 29' TDH • PSC design 115 or 230 volt grounding
PE51 Pump: PE51 Motor: plug.
• Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty,
• Maximum head: 37' TDH • 115 and 230 volts portable and compact.
• PSC design ■ Mechanical seal is carbon,
METERS FEET ceramic, BUNA and stainless
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
Septic Tank Capacity 16:�o ga l ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
G✓r esc.1'
DESIGN PARAMETERS Effluent Filter Manufacturer 1 !ok ❑ NA
Number of Bedrooms 3 ❑ NA Effluent Filter Model 52 ❑ NA
Number of Public Facility Units PKNA Pump Tank Capacity 750 ga l ❑ NA
Estimated flow (average) 3 6 gal /day Pump Tank Manufacturer &) fier ❑ NA
Design flow (peak), (Estimated x 1.5) q!5 O gal /day Pump Manufacturer �a �rl �S ❑ NA
Soil Application Rate gal/day/ft' Pump Model ❑ NA
Standard Influent /Effluent Quality M average* Pretreatment Unit ANA
Fats, Oil & Grease (FOG) <_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD <_220 mg /L aNA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD <_30 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) <_30 mg /L <NA ❑ At -Grade Mound
Fecal Coliform (geometric mean) _ <10` cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size % in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 3 ❑ m !(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one - third ( %3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ; El months) (Maximum 3 years) ❑ NA
year(s)
pr--
Clean effluent filter At least once every: i Gr ❑ year(s) ❑ month(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
15 ;6�'year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
3 W years)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (% or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
I
Page Z- of Z
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
m be installed as a last resort to replace the failed POWTS.
Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< < WARNING > >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name � r I 150 Name
Phone / 7- 73 — Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone 7i5.(
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer JA S c5V + /aid G9 J A
Mailing Address _ j461 bAW ES �1� Ac z - FAI I c,
Property Address 7a
(Verification required from Planning & Zoning Department for new construction.)
City /State R,Q!9M_ 1 alts w I Parcel Identification Number
LEGAL DESCRIPTION
Property Location dE , 14 , 14C 1 /4 , Sec. 33 , T d_WR b_W, Town of
Subdivision CSK� , Lot #.
Certified Survey Map # , Volume , Page # 5 Z .3 Z
Warranty Deed # Z 7 7 , Volume , Page #
Spec house yes no Lot lines identifiable (a no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to 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 operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
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 am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
V-, 4 (1
SIGNATURE OF PLICANT(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.
(REV. 08105)
- � IIIIIIIIil1111111111111iiUllillllllllllllllllllll
* 8 5 2 7 rr�� 7 7.7 7 1
State Bar of Wisconsin Form 1 - 2003 852 r f 7
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number Document Name ST. CROIX CO., WI
RECEIVED FOR RECORD
06/13/2007 12:40PH
THIS DEED, made between WARRANTY DEED
Jay D Uldrych and Jeanette R. Uldrych, husband and wife EXEMPT I
( "Grantor," whether one or more), REC FEE: 11.00
an d TRANS FEE: 225.00
Angela J. Saxton and iason A. Saxton, wife and husband PAGES: 1
( "Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address
needed, please attach addendum):
Wisconsin Assured Title, LLC
Lot 7 of Certified Survey a recorded in Volume 21 on 1810 Crest View Drive, 41B
y p
page 5232 as Document No. 828539 being a part of Lot 6 of Hudson, WI 54016 S -aS
Certified Survey Map recorded in Volume 11 on page 3091 022 - 1095 -10 -000
and part of the Northeast Quarter of the Northeast Quarter Parcel Identification Number (P
(NE' /4 of NEt /4), Section 33, Township 28 North, Range 18 This IS NOT homestead property.
West. Town ofKinnickinnic. St. Croix County. Wisconsin. (is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
Roadways, Easements, Restrictions, and Rights of Way of Record
Dated _MU 3_0- 2007
(SEAL CJ� (SEAL)
* D. ch * Je tte R Uldrych
(SEAL) (SEAL)
AUTHENTI �Eq G A CKNOWLEDGMENT
Signature(s)
STATE OF WISCONSIN )
authenticated on * ) ss.
St. Croix COUNTY )
u' PUBLi
* 9 Personally came before me on May 30, 2007 ,
the above -named
TITLE: MEMBER STATE tl® Jay D. Uldrych and Jeanette R, Uldrych, husband and wife
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instr o edged � e.
THIS INSTRUMENT DRAFTED BY:
Richard K.Y. Lau - Redmon Law Chartered
* ! 15 4 W
2217 Vine St., Ste. 204 – Hudson, WI 54016 Notary Public, State of Wisconsin
My Commission (is permanent) (expires:
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
* Type name below signatures.
1 of 1
• C OUNTY
I
A-
PLANNIN & ZONING
EROSION & SEDIMENT CONTROL PLAN
Site location: 72 Emerson Valley Drive, lot 7, Town of Kinnickinnic
Owner(s): Jason and Angela Saxton
Parcel ID #33.28.18.513A -01
Code Administ
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 Inform ati 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:
sv
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 -
following activities will be required in order to maintain compliance with the plan:
1. Maintain existing vegetation wherever possible to minimize erosion and sediment
movement. The primary source for construction site runoff will be the house
foundation and driveway excavation, 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.
�J
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. (A specification sheet for temporary diversions is available from county).
4. It is likely that contaminated runoff will not be contained with temporary
diversions, so installation of approved sediment control products (straw wattles, silt
fence, etc.) as shown on engineer's site plan will be required. The POWTS inspector
and /or building inspector will evaluate ESC plan effectiveness and recommend
additional action required to comply with applicable regulations. Control measures
should be installed prior to mound plowing.
ST. CROIX COUNTY GOVERNMENT CENTER
110 1 CARMICHAEL ROAD, HUDSON, W1 54016 715386-4686 FAX
PZC SAINT- CROIX. W1. US W W W. C O. SAI NT-C R O IX. W I. U S
Page Two — ESC Plan Acknowledgement Form
5. bilize exposed soils (septic system included) with seed and mulch immediately after installation - DO
OT wait for final stabilization and/or landscaping of entire site to establish permanent cover on the site.
n late- season weather conditions will not permit seed germination, a heavy straw mulch cover will
pre erosion until vegetation can be established. Erosion control matting can be applied any time of year
and m' talled properly, will provide protection even if seed germination is delayed.
The owner rd during site construction will be responsible for compliance with state and county code
requirement pecified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions
regarding cro & sediment control product installation.
PLAN PREPAIiD BY: RYAN YARRINGTON, SOIL EROSION INSPECTOR #683475
Owner acka6ledgement of ESC Plan requirements: _/_/2009
(Please aig and return original ESC form to Planning & Zoning Dept. A copy is attached to the owner's permit and
mai ance agreement, which is given to the plumber at time of permit issuance.)
rovide copies for excavation contractor, plumber, and town building inspector as needed
F
a
ST CROIX COUNTY GOVERNMENT CENTER
1 101 CARMICHAEL ROAD, HUDSON, W1 54016 715- 386 -4686 FAX
PZG WWW.CO.SAINT- CROIX.WI.US
I ifflll Illll ifili illll ifllf llllf llil Till {! {III lilt
Attachment to Amendment to * 8 7 4 0 2 8 3
Permanent Easement for Septic 874026
Document Number System DocumentTltfe KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
05/02/2008 01:40PM
EASEMEtJT
EXEMPT II
REC FEE: 15.00
PAGES: 3
i
Recording Area
Name and Return Address !
homas & Nancy Foley
76 Emerson Valley Drive
iver Falls, WI 54022
-1 -20
Parcel identification t umber (PIN)
This information must be completed by submittern docu title name & return address and PIN (if required). Other information such as
the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the
document. Note: use of this cover page adds one page to your document and $2.00 to the recoWlno fee Wlsconsln Statutes, 59.43(2m).
WRDA HB Rev. 1/8/2004
1 of 3
ATTACHMENT TO AMENDMENT
TO PERMANENT EASEMENT
FOR SEPTIC SYSTEM
THIS AGREEMENT made this I' day of May, 2008 between
Thomas M. Foley and Nancy M. Foley AND
Jason A. Saxton and Angela J. Saxton
Is an agreement to amend the original easement width as described in the document
AMENDMENT TO PERMANENT EASEMENT FOR SEPTIC SYSTEM
Alona with Exhibit A and Exhibit B all recorded May 12 2006 as doc. number 825190 in
St. Croix County, Wisconsin
It is agreed between all varties that the width of this easement will be expanded to 32 feet
Everything else remains unchanged.
Thomas M. Fole Nanc M. Foley
The abo` d Nancy M. Foley, were subscribed hereto before me this
Ma�
Notary Public
State of W + r.o � S ."
OF My Commission expires
ason A. Saxton Angela J. Sakton
The above, Jason A. Saxton and Angela J. Saxton, were subscribed hereto before me this
a ^ d Day of
NOTARY O�
otary Public
-- ®— * Stated Vs co s
PUBLIC ��„ My Commission expires Apf "
OF SSG®
2 of 3 br r+�d L'�� cj�L SAn /;'1.
04;24/08 VON 14:?4 FAX 715 386 4686 ST CRX CO Z0'Q G 11006
F'
i
COMVENCING AT THE NORTHWEST `CORNER OF LOT 6, CERTIFIED SURVEY
MAP, RECORDED IN VnLUME 11, PAGE 3091 IN THE REGISTRAR OF DEEDS,
ST. CROIX COUNTY, WISCONSIN;
THENCE SOUTH 86'14'15 EAST, ASSUMED BEARING, ALONG THE NCRTH
LINE OF SAID LOT 6, A DISTANCE OF 203.00 FEET TO THE POINT OF
BEGINNING OF THE LAND TO BE DESCRIBED;
THENCE NORTH 3'45'45 EAST, A DISTANCE OF 25.00 17 EET;
THENCE SOUTH 86'14'15 "EAST, A DISTANCE OF 25.00 FEET;
THENCE SOUTH 3'45'45 "EAST, A DISTANCE OF 25.00 FEET TO SAIC
NORTH LINE;
THENCE NORTH 66'14'15" WEST, ALONG SAID NORTH LINE, A DISTANCE
OF 25.00 FEET TO THE POINT OF BEGINNING.
6016
3of3
RECEIVED 13
3
SEE 1 2
ST. CROIX COUNTY 40 8 5 3 9
SURVEYOR'S RECORD RATkA
S7 ,GISTER pF D ER'T'
REC
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EMERSON V ALLE Y DR -
— w
LOT 4 LOT 3 r S.M. VOL. S� ss' `
C.S.M. /VOL. 9, PAGE 2610 PAGE 1276 I
— — — —
I of 2 Vol. 21 Page 5232 Q
x ,
KATHLEEN H. NALSH
AMENDMENT TO PERMANENT REGISTER OF DEEDS
ST. CROIX CO., WI
Document Number EASEMENT FOR SEPTIC SYSTEM
Title of Doemment
RECEIVED FOR RECORD
05/12/2006 01:05PH
EASEMENT
Ex9p) #
REC FEE: 21.00
TRANS FEE:
COPY FEE:
CC FEE:
PAGES: 6
Recording Area
Name and Return Address
-1, ULD" CF+--
rj D vA Lk-e�1 D 2 kvc
?.iv �en. , U,, ►
I oR 5 - 1 o - aoa
Parcel Identification Number (PIN)
p
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INFO -PRO (800 )655 -2021 www.infoproforms.com
1 of 6
i
AMENDMENT TO
PERMANENT EASEMENT
j FOR SEPTIC SYSTEM
THIS AGREEMENT made this day of May, 2006 between Jay D. Uldrych and
Jeanette R. Uldrych, herein referred to as "Uldrych", and Thomas M. Foley and Nancy M. Foley,
dry rY Y Y , Y
herein referred to as "Foley ".
RECITALS
A. The undersigned parties are the current owners of property which is the subject of the
Permanent Easement for Septic System, a copy of which is attached hereto as Exhibit "A ".
B. The parties desire to amend this Agreement to reflect the correct description of the
Permanent Easement for Septic System which was in error on the original Agreement.
AGREEMENT
The parties agree as follows:
1. The Permanent Easement for Septic System which is attached hereto as Exhibit "A"
shall be amended to correct the description and the correct description shall govern the parties
and is attached hereto as Exhibit `B ".
2. Uldrych hereby relinquish their rights with respect to the area described in the original
Permanent Easement for Septic System which is an incorrect description.
3. All other provisions of the Permanent Easement for Septic System as shown in Exhibit
"A" shall remain in full force and effect and shall bind the parties hereto, their heirs, successors
I
2of6
and assigns.
Jay D. Uldrych eanette R. Uldrych
The above, Jay D. Uldrych and Jeantte R. Uldrych, were subscribed hereto before me
this day of May, 2006.
Y .4 SSA �
' Nublic
State of VJ} 5C0Y1SW
•�2 My Commission expires ! 0 a% 0 - 1
G .
WIS
11111k WON
Thomas M. Foley Nancy M. Foley
The above, Thomas M. Foley and Nancy M. Foley, were subscribed hereto before me
this day of May, 2006.
AA
N ary Public
tate of WISCCM-5116
My Commission expires 05 R1
This document drafted by
Joseph D. Boles
Rodli, Beskar, Boles & Krueger, S.C.
P. O. Box 138
River Falls, WI 54022 -0138
715 -425 -7281
3of5
f -
..� 41 � :.. j ' k fr" ,� •�L•Yi'af4 - 11 �. ,� • •BL +. • %. • a' y .�i. wi+• I:•� T IG '
V OL. ,2_50PaCE :: F - •. . .
PERMANENT EASEMENT One rr
FD t SEPTIC SYSTEM
Document Number:
56208 - ,
Retum Address: ST. CROIX CTY..'M
JQ A, urdryClt 00
P D. ,$ey 5G
R/ der W S Lv 5 y O�i a ... f} GJ.>•.i- i
Pamir! I.D. Nwabar IPNIi: HWrstarut�eu�t ^�` i
I' This permanent easement, dated this day of June. 1997, by and between Charles Ketchum
andXgw Ketchum, (hereinafter "Grantors "), and Jay D'. Uldrych. and Jeanette R. Uldrych (hereinafter. "Grantees% .
Elegwr WITNESSETH:
WHEREAS, Grantors are the- owners of. the following described real property located. in St. Croix
County, Wisconsin:
i
Lot Five (5) of that certain Certified Survey Map recorded in. the• office of
the • Register of Deeds for St. Croix County, Wisconsin, on August 27,
1903, in Volume 9 CSM, page 2675, as Document No. 504674;
and .
WHEREAS, Grantees are the owners of the following described propsrty located in St. Croix
County, Wisconsin:
Lot Six (61 of that certain Certified Survey -Map recorded on April 30,
1996, in Volume 11 CSM, page 3091, as Document No. 5 2946, said
property being located in the NE 114.of the NE 1.14 and.the S 114 of the
NE 1/4 in Section 33, Township 28 North, Rhnge 18 Wes , Town of
Kinnickinnic;
and -
WHEREAS, Grantees have installed a mound septic system -which services the home located on Lot
Six; said mound septic system encroachir.rg slightly on the property owned' by Grantors; and
WHEREAS. Grantors wish to forega any legal .remedies and provide for said encroachment by the
recording of this Permanent Easement Agreement.
NOW, THEREFORE; in consideratio •. of the mutual covenants contained herein; the - parties agree as
follows:
•1. Grantors, for themselves, their heirs, successors, _ and assigns, do hereby grant to
Grantees, their heirs, successors, and assigns, a permanent easement for a mound septic system extending no
further than 25 feet into Lot Five from the southerly property line of Lot Five, said mound septic system lying
approximately 25 to 30 feet westerly of point A as the same - appears on that certain ' Certified Survey Map
recorded in Volume 9. page 2675, as Document No, 504574.
2. This permanent and perpetual easement is expressly limited to the current. location of
the mound septic system..and in no event extending more than 25 feet northerly from the southerly property line
of said Lot Five. In the event the heirs, successors, or assigns of Grantees need. to, reconstruct; repair, or relocate
said mound septic system, it shall lie done entirely at..the expense Grantees, their heirs, successors and assigns,
and it shall not be' moved from its current location on the land of Grantors, nor Iry any event extend more than 25
feet to the north from the southerly property line of Lot 5,,.being:.at a point approximately 25 to 30 feet westerly of
A.-of- 6 :,.r +..s ., - �r- �ar.nr .rr •,•.x A rn�•u.c�ca�►xa a an4ca,aaRaaitr ::,te 2s::. xr + ta.
a ' 3w 4 +:�1x?" ..f f!. ?:. n". , =' .'IL• - SS"+: " i 3 j 4 ^� '.71:� . ,��:'..= i..
p.... .
10L 19- 50MU
point A on the aforesaid Certified Survey Map. It is the intent of the parties that this easement apply to no other
area of Grantors' land nor shall it ever be expanded beyond 25 feet in depth onto Grantors' property, at its current ..
location.
IN WITNESS WHEREOF, the parties have placed their hands and seals on the date first written
abo`•e.
GRAN ORS I; GRANTEES
(seal) (seal)
a s Ket um Ja rych
a-AjO r �
seat) _ ��'�1! _4 L (seal)
Ketchum J�J l drych
A CKNOWLEDGMENT
STATE OF WISCONSIN 1
ST. CROIX COUNTY )
I ' Personalty came before me this day of 3nR6, 1997, ther a *cave named Charles Ketchum and.
Z" Ketchum, to me known to be the persons who executed the foregoing ins ,risen and ackripledgathe same.
Nota Public
�(Ot County, Wisconsin's C,>
My Commission 3- •_ q� �;v ',
ACKNOWLEDGMENT "' ..
STATE OF WISCONSIN )'
ST. CROIX'COUNTY 1
Personalty came before me this day of June, 1997, the above named Jay 0. Uldrych• and
Jeanette R. Uldrych, to me known to' be the pert:xns who executed ttie foregoing instrument and ackndvAedge the
same. ,.,,,.,...,..,,.,.
A 1,11 /11 411
No ary P.ubGc �{�
a !My, County, Wisconsin O
My Commission ,� : ?.� - r l w '•'�
THIS INSTRUMENT DRAFTED BY:
Steven S. Goff
Bye, Goff & Rohde, Ltd.
PO Box 167
River Falls. WI 54022
58"ISMSWror Eawment.doc
i
''fflix VW- xilil -VI w -Mgt
Ex"arr s
COMMENCING AT THE NORTHWEST 'CORNER OF LOT 6, CERTIFIED SURVEY
MAP, RECORDED IN VOLUME 11, PAGE 3 IN THE REGISTRAR OF DEEDS,
ST, CROIX COUNTY, WISCONSIN;
THENCE SOUTH 86'14'15" EAST, ASSUMED BEARING, ALONG THE NORTH
LINE OF SAID LOT 6, A DISTANCE OF 203.00 FEET TO THE POINT OF
BEGINNING OF THE LAND TO BE DESCRIBED;
THENCE NORTH 3'45'45" EAST, A DISTANCE OF 25.00 FEET;
THENCE SOUTH 86'14'15 "EAST, A DISTANCE OF 25.00 FEET;
THENCE SOUTH 3'45'45 "EAST, A DISTANCE OF 25.00 FEET TO SAID
NORTH LINE;
THENCE NORTH 86'14'15" WEST, ALONG SAID NORTH LINE, A DISTANCE
OF 25.00 FEET TO THE POINT OF BEGINNING.
6of6
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042, 1Q9�" /0 /UV � /�F�- ►o �r�� C�ir �j�� 15.
�I e
t 5045"74
CERTIFIED SURVEY MAP
LOCATED IN THE NE 1/4 OFTHE NE 1/4 OF SECTION 33, T28N, R18W, TOWN OF
K INNICKI NNIC , ST. CROIX CO,, W1.
f
PREPARED FOR C� O
9� NOTE: BEARINGS ARE REFERENCED 70 EUGENE EMERSON
THE NORTH LINEOFTHENE 1 /4.v„ �
! RECORD BEARING). 71`JJ3
3 JAMES O'COAIh,, —,
Register o1 Deeds
St. Croix Co., Wl
<-v
NI /4 CORNER SEC. 33 UNPLATTED LANDS �N N NER SEC. 33.
( 2" IRON PIPE FOUND) ! COUNTY MONUMENT
NORTH LINE OF THE NE 1/4 FOUND).
N88 °19'34 "E N88 ° 19 X 34 "E 676.94 Q sea °19'3a "w /
— °` 640. 64'
1317,58' 231.15' G� � _—— _ -- - - -- OIOOlR= 640.93'1
1 EXISTING 16.5' WIDE ui
,,S EASEMENT.
v 1 / u)
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N Q • • Q
I � 5.07 ACRES N
I !220,765 SO. FT. >_ _ ° a
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APP
0 ! 244, 787 SO. FT.
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BUG 2 V931'"
y � 34Q. 03' h A I • _ p ;U2 / In
S1 CR�X vOW T Y 368. 65'
�rr1pl;.hMS1Y0P 31 U N 8 8 ° 023v53 "ly 708. 68 I
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Z o�9 and t� 2 S- 30' 1
Parh; C�iFttee
UNPLATTED LANDS X01
1( % »t jecorded I
,within 30 days 0 E M E R S O N I of v I
apxov zl data
j .mraval shah ba I 33' 33
void �,y1tE:�liollpR�N , I
O SET 1 "X 24" IRON PIPE WEIGHING���`,'�r
1.13 LBS. PER LINEAL FOOT, �/ If
w `
• c I" IRON PIPE FOUND. �w xf CSPRING M.` r.
• R
R c RECORDED AS .... ,. + 4
LLEY SCALE I" = 150 ' %,(- �O`�.
o' 75' 1 50' 300' A su J �,j
r 0 $910
SHEET I OF 3
JAMES M. WEBER S -1804
93 -83 TH IS INSTRUMENT DRAFTED BY J, W. DATED F.v(.'t.�493
9,eQ O z.S'`�3
Vol 9 Page 2675 cj
� CLIR.VI✓ L�1T.�1 TAB�.B
NO. RADIUS CENT. ANGLE ARC CHORD CH.BEARING
1 -2 80.00' 160 224.29' 157.72' S7 "W
Lot 4 80.00' 64 89.69' 85.07' S56 "W
Lot 5 80.00' 96 134.60' 119.28' S24 "E
Tangent bearings: At 1= S88 "W
At 2= 572 "E
CCURSE TABLE
A -B N7 "W 128.72' (R= N7 "W 128.68')
B -C N42 "W 193.69' (R= N42 "W 191.62')
C -D N10 "E 147.91' (R= N10 "E)
D -E N14 "W 101.95' (R= N14 "W)
E -F N14 "W 68.68' (R= N14 "W)
D -F N14 "W 170.63' (R= N14 "W 170.68')
F -G N11 "E 142.37' (R= N11 "E 142.34')
G -H N88 "E 445.79' (R= 445.53')
I -J S88 "W 432.95' (R =SS8 'W 432.64')
J -K 511 "W 125.42' (R= S11 "W)
K -L S14 "E 68..64' (R= S14 "E)
L -M 514 "E 101.84' (R= S14 "E)
K -M 514 "E 170.48' (R= S14 "E 170.53')
M -N S10 "W 143.40' (R= S10 "W
N -O S42 "E 190.56' (R= S42 "E 188.60')
O -P S7 "E 120.13' (R= S7 "E 120.04')
P -Q S88 "E 297.36'
S��i,,�
JAMES M. � Z
+ WEBER
S 1804
II SPRING VALLEY
WIS.
m
,i,wa�
Vol. 9 Page 2675
I
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93 -83 SHEET 2 OF 3
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Parcel #: 022- 1095 -10-010 11/12/2007 11:04 AM
1 OF 1
Alt. Parcel #: 33.28.18.513A -01 022 - TOWN OF KINNICKINNIC
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
08/04/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co - Owner
O - SAXTON, ANGELA J & JASON A
ANGELA J & JASON A SAXTON
2489 D AWE S PL UNIT D
FALL
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 72 EMERSON VALLEY DR �
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.310 Plat: 5232 -CSM 21 -5232
SEC 33 T28N R18W PT NE NE FKA LOT 6 CSM Block/Condo Bldg: LOT 07
11/3091 NKA CSM 21 -5232 LOT 7
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
33- 28N -18W NE NE
Notes: Parcel History:
Date Doc # Vol /Page Type
06/13/2007 852777 WD
06/30/2006 828539 CSM
06/13/1996 545303 1184/277 TD
11/04/1993 508369 1046/221 LC
more...
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/08/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.310 50,000 0 50,000 NO
Totals for 2007:
General Property 2.310 50,000 0 50,000
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
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
s f
ADDRESS _post Office Box 563
-River Falls, WI 54022
SUBDIVISION / CSM# Vol 11 Page 3091 Doc # 542946 L 6
SECTION 33 T 28 N -R 18 W, Town of kinnickinnic
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
�V r C.Q 1
r
k
f '
4"
R'
yt > L'[
i
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
I
' s
BENCHMARK Tope of 1" Iron Pi pp P o perty T i „P Stake Ele=.r+ i gip_ (t!_
ALTERNATE BM:
SEPTIC TANK / CHAMBER /HOLDING TANK INFORMATION
Manufacturer: uYf c' Liquid Capacity: X40
Setback from: Well House Other
t Pump: Manufacturer t l Model# FCC) Size
Float seperation `, n Gallons /cycle- /
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 1 Number of trenches 1
Distance & Direction to nearest prop. linei i
Setback from: well: 1"'0 0 House > Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header /Manifold Bottom of system d -
Existing Grade Oa- Final grade
DATE OF INSTALLATION: Iz
PLUMBER ON JOB: J + �
LICENSE NUMBER:
INSPECTOR: '
3/93:jt
wise .or>. : -Department of industry, PRIVATE SEWAGE SYSTEM County:
LS iety a d Human Relations I NSPECTION REPORT
Saletp and Buildings Division ST. C ROIX
'GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
262365
Permit Holder's Name: ❑ City ❑ Village [X Town of: State Plan ID No.:
ULDRYCH, JAY & JEANETTE KINNICKINNIC
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
A9F00174
TANK INFORMATION ELEVATION DATA("
ATA
TYPE MANUFACTURER CAPACITY STATION BS HI" FS ELEV.
Septic Q Benchmark r
Dosing �� , �✓t, �� 1174
Aeration Bldg. Sewer 113 2P
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Airl to ntake ROAD Dt Inlet !; i
Air I
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe 4 `)3, �y
Holding Bot. System
PUMP/ SIPHON INFORMATION �� v tYR I r Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction Systedm TDH Ft
He
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM 3
BED/TRENCH Width Length (� No. Of Trenches PIT No. Of Pits Inside Di . Liquid Depth
DIMENSIONS / DIMENSION
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type Of 4 eA ,J- CHAMBER Model Number:
System: & OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
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 ❑ No
rOMMENTS: (Include code discr g ancie ,persons present, etc ° IS",* u��.. C� . '_v �`
LOCATION: KINICKINNIC.33.28.18W, NE, N', LOT 6, COUNTY RD M
Plan revision required? ❑ Yes ❑ No ---�
Use other side for additional information. FF1 1-1
SBD -6710 (R 05191) Date Inspector's Siqnature Cert No
ADDITIONAL COMMENTS AND SKETCH
F
SANITARY PERMIT NUMBER:
U
C /r,
• �;M° SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
St Croix
STATE SANITAR #
—Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 2 ' bff
8'f x 11 inches in size. check re � on p � s a nation
— See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATIO S96 -40032
PROPERTY OWNER PROPERTY LOCATION
Jay & Janette Uldrych NE Y4 NE N4, S 3 3 T 2 , N, R 18 W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBFi SUBDIVISION NAME OR CSM NUMBER
2 612 4 95-375C Emerson Valle /!'� ' 3 091
11. TYPE OF BUILDING (Check one) 11 State Owned cow= : NEAREST ROAD
Kinnic kinnicl County road M
❑ Public ® 1 Or 2 Fam. Dwelling –# of bedrooms –3— PARCEL TAX NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply) 022 - 1095 -10
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. W 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. 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 ❑ 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) ELEVATION
450 375 375 1 1.2 94.02 Feet 9 .70 Feet
VII. TANK CAPACITY Site
in lions Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks I Tanks steucted
Sep tic Tank
Lift Pump Tank/ ' .. 800 1 800 1 Weeks 0 El
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): PlurpbeT) Signatur (No Stamps) MP /NtDB t11 No.: Business Phone Number:
Paul C.J. Steiner 6780 715 425 -5544
Plumber's Address (Street, City, State, Zip Code):
N8230 945th Street; River Falls, WI 54022
EAppmved NTY /DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing ent Sign ure (N a
& Surcharge Fee)
❑ Owner GDem0 d �� f7 c
Ad verse
D al nation �
X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL:
SBD- 6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
� INSTRUCTIONS
. ,
i P1 sanitary Permit iuma!id 'or 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 yv0beapplicable.
�
All revisions to this permit must be approved by the permit issuing authority,
4
Changes in ownership or plumber requires mSa�;itury PennitTranofer/Renewa| Form (SBD 0389 to be
oub�rnittedtothe county prior to installation.
5 ()naiteoemmgesystems must he properly maintained. The septic tmnk(n) muy1be pumped by licensed
pumpe[ whenever necessary, usually every 2 'to 3years.
�
ii ynu have questions concerning your onsite sewage system, contact your local code adminicrator or the
'
State of Wisconsin, Safety & Buildings Division, 008-266-3815.'
Tobe complete and accurate this sanitary permit application must include:
�
Property owner's name and mailing address. Provide the legal description and parcel taxnumbmr(o) of
vvha-ptteaymtem is to be installed.
U. Type ot building being nerved. Check only one and complete #ofbod,onms if 1 u/2 Family Dwelling.
U|. Building use. If building typo is Pub|io, check all appropriate boxes that apply.
|V. Type of permit. Check only one in line A Complete line B it permit is for tank replacement, renonnmction, or
repair.
V. Type of system. Check appropriate box depending on system type.
V\. 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 gul!ono, 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 D|LHR.
� V!|| Responsibility statement. Installing plumber iatofill in name license number with appropriate prefix (e.g.
MP, eto.). address and phone number. Plumber must sign application form.
� |X County/Department Use Only.
X. County/Department Use Only.
�
Complete plans and specifications not smaller than 8}6 « 11 inches must bm submitted to the county. The
�
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tunh(o), oeptictank(o) or other treatment tanks; building sewers; wm||u; water mainu/vvatereerviom;
streams and |ekeo� pump or siphon tanks; distribution boxes; soil absorption nya�mmno� 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 diffavoncen�fric1ion|ooa�pump
� . .
pm�onnancenurve�pumnpmode}andpumnpmanufmctunecD)nroamoectonofthemoi!aboorpbonoyatomif
required 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.
`
�
�
aen-6oyo(� 11ma
� -°
i
MOUND SYSTEM
FOR S S 6 J "'
Jay Uldrych
21646 Bentley Circle
Jordan, M 55352
RECE►V E�.
INDEX
F 0 61996
' 41V.
SA�E�Y & BLDGS-
s'�
s PGA �11 ge 1 o'
f 7 . ..........................Index
ati tti o %
C 7 ........ ...................Calculations
C ® a �f .. ....... .. .
Q ................Plot Plan
o .. .............:..........Lateral Layout
7.. ......... ................Cross Section
off' ms'
ge 5 of 7 ...........................Plan View
s�
ge 6 of 7 ...........................Pump Chamber
P age 7 of 7 . ..........................Pump Curve.
Located in the NE a of the =4 Sec. 33
, ,
T 28 N, R 18. Town of Kinnickinnic St Croix Co.,
Wisconsin.
Prepared by Paul C.J. Steiner
Steiner Plumbing and Electric, Inc.
N8230 945th Street
River Falls, Wisconsin 54022
Master Plumber: ( #6780
Date: February 5, 1 996
i
CALCULATIONS
STEP 1: Absorption area: 150 gpd /bedroom X 3 = 450 gpd.
Table 4: 450 1.2 = 375 square feet required.
Use ft X ft bed
Use 1 trenches, 4 ft wide X 94 ft long
2 laterals, each 46 ft long, �txx
spacing between laterals.
STEP 2: Table 5: 11/2 diameter laterals, 1/4 " diameter holes at
48 spacing between holes.
STEP 3: Table 6: 12 holes /lateral, 15 gpm discharge rate per
lateral. 15 gpm X 2 = 30 gpm total discharge.
STEP 4: Table 7: diam. manifold, inlet at H of
foot long manifold. v
DnSE = q�y� /,� = i1ZaS+ (77"F.M X 1�) i2�..12 C ►l, rat�N�
,._
STEP 5: Design dose volume is 112.50 gal /dose at a - rate of 4`- times
per day. Min. dose volume must be at least 1`0., k
pipe volume.
Table 10:11 2 diam. pipe .064 gal/ft X .064 = 100 X�1 - 6ga1.
i
STEP 6: Table 8: Dosing rate = 30 gpm.
STEP 7: Table 9: Friction loss in 2 diam. force main, 77' long;
30 gpm= 1.54 in 100 feet.
ELEVATION DIFFERENCE 8.2
FRICTION LOSS 1.19
HEAD 2 _ SO
11.89 TDH
I
page 2 of _7
Page 3 of 7
PLM PLM
S ID
P�- I,tlF;c
Noun
)Ooo Q.t ;a,Ql1C TQ k... 3;&R
Gone, �-------- _ - - - - -- - ____._.__
U vv \
O
A 1
Do of
' Sl e hq
l�lnsl
-� Bore 11oJe.9
/DO.Oo' Elev � A !�M
�op�
't Pr►uoI c D r+vc i'
Page 4—
LATERAL LAYOUT
Perforated Pipe Detail
i� 7 0
\ Perforatej End View
PVC Pipe
Holes located on bottom,
End Cap are equally spaced.
Variable -Y" /\
Distance 4
PVC Force Main
From Pump
Distribution
Pipe
Last Hole Should be
next to end cap.
p 46'
X 48"
Y 48`
Hole Diameter 1/4 Inch
Lateral 1 1/2 Inch(es)
LAT. (ay. F-LEY, = 94.52
Force ruin 2 Inches
Page 5 0f 7
-CROSS SECTION
t
Straw, Marsh Hay, Or
Synthetic Covering r� 9�
Distribution Pipe
.AS i iv` G - 33
Medium Sand
_ H G
Topsoil -_- F system Elev. 94.0
._J D
3
E
e•
%Slope
Bed Of 2�– 2 %Z ( Force Main Plowed
Aggregate
From Pump Layer
D 1+
E 1.4 '(i ,6 ��
Cross Section Of A Mound System Using F .8 '
.A Bed For The Absorption Area G 1.0
A 4 Ft. H 1.5
PLAN VIEW B 94 Ft.
I 18 Ft.
8 Ft.
K 10 Ft.
t
L 114 Ft (jt6'
Force Main W _ 3Q_ Ft.
L_
Observation Pipe --.,,,
j 13 K
W % \ --- ---..— - - - ---- --
�Distribution Bed Of,
Pipe Aggregate
Lu Observation Pipe Permanent Markers
Plan View 0 f Mound Using A Bed For The Absorption Area
PUMP CIIA tilt F.R CitOSS s Fun ON ANI) SPf:CIFICATIONS -
V l:I1C Cap
We.ather Proof - Approved Locking
T Junction BOX Manhole Cover
12" Hin
Vent Pipe
Final 4" Min
Crude
r — J — `
18" M i n
Conduit
18" Ifin -- - -- - - - - - --
1 Ei roved
PP
Inlet Joints W/
C.I. Ili PC
Extending
?approved 3' Onto
Joint W/ I 'ii Solid
C.I. Pipe I A
Ex t e n d i n g ' Ground
3' Onto Alarm
Solid --
Cround �� B -
� � On
C
Pump O Off
Concrete Block p
bFF �b i�jZ
S II ICATI ONS
TANK ruMl'
Hanufacturcr: Weeks Manufacturer: Myers
Tank Material:_ QpncretP )Model Number: ME40
Tank Size: 800_ _ Callona Switch' Type Float
Total Dynamic (lead 11.89 Ft.
CAPACITI Pump Diacharl;e Rate: 30 GPM
2.Ce36' Total Daily Eff luent: 450 Gallons
A .. n: ! or 1 16&341 J Cnllons Number of Uoues : 4 Per Day
y 2 " or 34.2 Gallons Dose Volume: 112.52 Gallons
or y,2 Callons Notes 1. See pump curve for
D - 16.92" or ~_ _ 289.34 Callona additional performance
Total Tank information.
Capacity Required - 798.06 Cnllonu 2. Pump and alarm are to be
L -z 7t !; " " OR 121.2 -5 GALS. inatalled on ueparat^ circuit
ALARM au lie r IUIR 16. 19 NAC .
Mnnuf ncturer: Lev 1a
11oftel f:umber: n
w! t c h f y p c. -- - - _ Float
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT P age of
Labor arxi 1{uman Relations g
`DivLsior<of Safety &Buildings in accord with ILHR 83.05, Wis. A .�
COU 5� ` Cr o 1 4
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. PI s ` elude, hilt i
not limited to vertical and horizontal reference point (BM), direction and % of seal r* A EL I.D. #
dimensioned, north arrow, and location and distance to nearest road. t"'Er
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATIOraEE RE a DBY DATE
�a
0 ,
PROPERTY OWNER: _ P PERTY �TIQN
t� fr �Jl IC t� 1 F_ M'e 't V\
V W4 P E ; 3/4 �'+ 3 T g_ ,N,R I8 J W
PROPER OWNER':S MAILING ADDRESS I L �BL S BD NA E OR C�SM #
(01 �Yr ex O h GI. (�� F.v i n
CITY, STATE ZIP CODE PHONE NUMBER ❑CI I" ar WN NEAREST ROAD
Xoxr Fc [ S USI: StJ67Z (7r5 a - 55 1 4 i h1C Inili:c -.- C rt H
Whew Construction Use[ ] Residential / Number of bedrooms F> [ ] Addition to existing building
( ] Replacement [ j Public or commercial describe
Code derived daily flow t450 gpd Recommended design loading rate 0.5 bed, gpd /ft Wo trench, gpd /ft
Absorption area required R 0 0 bed, ft 1 trench, ft Maximum design loading rate D.5 5 , gpd /ft 0.G trench, gpd/ft
Recommended infiltration surface elevation(s) -[o be d- e(ec ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material r_T I6 Flood plain elevation, if applicable NA It
S = Suitable for system CONVENTIONAL I MOUND IN- GROUN�RESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for stem ❑ S U S❑ U ❑ S U ❑ S U 13 S au 11 S QU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botrxlary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITmnch
' I 0 -13 l0 Y �1 C 2 0,5
1 3 - 20 10 y ItK -2- S1 � 2rr1� 5 C 0.6 0,
Ground 3 20 -2'1' ID Y 2 z- 5 1 2 m 5b m-fr 1 _ o, to
elev.
�j$02 Z� - 10 K ay a SI Z Yr�Sbl m�rr S -{ 0,5 b.
c 2�1
Depth to & - ' 16 2 Z 1b yk Y6 to V K z ► Z m�i CS
limiting
factor ,f ( 0
ss LO 10 P- 16 \ Zd ro s Q rrnl —
Remarks: Ytzon YYStX-ed-w 12oCke4 s 8� 16 yt< / sa4y s,I
Boring #
10ykZ/1 1 Zf- J
Z (3 -2p r Z — S1 Zm 45 S Z
Ground 3 -2s 2 —' S�� 2m �b S� 5 A S'• O.
elev. y _qp 10 NK 3+3 — 5r 2msb . S 5 { 0.5 O.
( 3.y ft. Lj
Depth to ' 3 -SI C) 4 Vic 4 A4 2 msb, K GI h — 1Jt~ N1C
� 1
limiting G 51- z 5 16 1l R 77 / 10 O s d /U V },
Remarks: mans 3 yL)a t1+ C OAS , B pr,MV, b s 10\1e-31Z ard:s
amf: —P 1 a nt 1 Phone: C'1(S a111 Add reis:
251, AA Ave, AVYAUV tZ 5 0
Sign Date: CST � N umber:
40A 3 149'5 Nld37o
PROPERTYOWNER EYY ff LUG f SOIL DESCRIPTION REPORT Page of „
PARCELI.D.t! OZz - fG c fS - '
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 (3-10 to 12 z/ i 2-� as cs C2 o.s o.�
... ;`: 2 - 2Z )0 2 1Z 5`I I '2 dsl� c2 .s o.
Ground ,3 ZZ -3Z o K 3 /1 I 2 b 51� o •s o.�
elev.
JV
%53 ft. q 32 -57 p l 10� I �y 51
i z msb J j h 5 1 h11�
C?
Depth to 5 S- d 31 1 5 - 11 2 m5hK d y h —
limiting
factor
i2 11
Remarks: r�z��n 3 1 ccxc 8 �nri zc�n and E S f
Boring #
r . . . . . . . . . .
.............
'...:w.'•s
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
r
Ground
elev.
i
ft.
Depth to
lid
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
Page ,� of
i`
PLOT PLAN
Property Owner C X14 lox�lell Emr - m r) Legend: 1 -
Legal Description NE /4 O--- Kr- NEyy, BM _ .{. p-F /" yetlow,►„e�al
properly 5
Ste. 33 ,T 2 $N�e1SV3 I Town 0� "fAVikC qt,&u.med 100
5 Crp,K C•u..Fy� WVSCOV�S�v�' SI'FL
= soil boring w /backhoe
£� QcLrijL �re�.
DAY
�n
2
C3
1
.b
EL q3 04 �
\3%
d L
� eL c1 ° LN
�1
tam
v 3 �olow P (O V e 1
C>
i
-a
-bp o�- 54cep h I I �-
si{c local o va -}O pel v of a olrl vf (1`r f�0�n va11c Rd
650 �
Y.
Sec. 33 Signed CST
/VM0370 7
Dat es{ a 1cl
I