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022-1095-10-020
RECEIVED 13 3 SEP - 12006 ST. CROIX COUNTY 8 �—_ 8 S 3 SURVEYOR'S RECORD VO FAGE5232 ST- r OF DEE ® �° +� a � j� v /ZO 0 °CO M RECE Z FOR mN��i ° �D m y O y ° rn � rn �^'� o n Z XLsJ �o t' s " `�'�� c �Fl v �z -'� ° v g � i� D�a ~r Fz o jm o 0 o v �' mo�� �� YfiFE �F ° c'x x �Ki z ° ax �� -E 0 a � ��Z m °�. - NiAA k r.� Om z m z a , w ° p z Qi o +fo y W a c�> o En :u QQ C1_1��A mrn C Z� N� �ISI rn cl� °D - O Z SaMdl a3LLtndNn 00 A O o° A t60£ 3OVcJ �5 AW S'D 01 3 N 3NI - 1 IS3M 6'499 M 01 A v °a ow m Z rn I w A � � O 0 N � ,O 00L u� I 1N3W3SV3 � a v^yl N ,L£00£6 B o, NOIIVAN3SNOO do - J X O CO N `' ,L£ - 88£ M 00 N r LTI Z A 2 O �1 00 i V :.te M „bO,OI AO N_ c -, co V_ 2 H Z c$ _L o co O $' N F� r D M 14 ( rn v L ' V� I W V -• p i f Ti I 1 `J O O Lp co O `.. v i u iv N Q 6, ca �J FFFFFFffffff �...� u� tyyw p N CA Cz ' \^\' 226.27' w _ 212.00' rn z S 02'37'28" W 616.43 —� _ EAST L INE OF L OT 6, C S_M VOLU 77. P 309 w EMERSON V - -w ALLEY D R IV E LOT 4 LOT 3 1 VOL. 5� C.S.M.' VOL. 9, PAGE 2610 PAGE 1276 I 66 " — I 1of2 Vol. 21 Page 5232 �- C9 Parcel #: 022 - 1095 -10 -010 03/03/2008 11:37 AM PAGE 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 DAWES PL UNIT D 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... 2008 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 2008: General Property 2.310 50,000 0 50,000 Woodland 0.000 0 0 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 C RD�x CO 0 1646A U EROSION & SEDIMENT CONTROL PLAN Site location: 70 Emerson Valley Drive, Lot 8 of CSM #828539, Town of Kinnickinnic Owner(s): Jay Uldrych Parcel ID #33.28.18.513A02 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 following activities will be required in order to maintain compliance with the plan: 715- 386 -4675 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. Surface drainage is to the west of proposed mound into a wooded ravine, which is an intermittent tributary to the Kinnickinnic River. 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. (A s specification sheet for temporary diversions is available from county). P 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.) 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. Straw Wattles should be installed prior to mound plowing. ST. CROIX COUNTYGOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD, HUDSON, W1 54016 715 386 - 4686 FAA a Page Two — ESC Plan Acknowledgement Form 5. 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 permanent 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. 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: PAMELA QUINN, CPESC & SOIL EROSION INSPECTOR #665054 .. Owner ac knowledvement of ESC Plan re uir x/2007 Pleaw sign _ xetum ca al ESC fortn.to Pla Laing t Zon�>� 4 cap "14 ., # snips agrc,erneht which it given to the plumber at'time of permit issuance.) Copies provided for excavation contractor, plumber, and town building inspector ST CROIX COUNTY GoVE-RN.MENT CENTER 1 101 CARMICHAEL Ro as HUDSON. VV 54016 715- 386 -4656 F-4,\ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division A INSPECTION REPORT sanitary Permit No 0 506392 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Uldr ch, Jay Kinnickinnic, Town of 022- 1095 -10 -020 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Q, ip /Qa o / S ;, !;6 - 33.28.18.513A02 TANK INFORMATION V ELE ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 7 /5 /D7. /a a• Septic Benchmark Dosing /r (%O Alt. BM Q Aeration Bldg. Sewer ( Holding SUHt Inlet P. TANK SETBACK INFORMATION SUHt Outlet /9q (o TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet S y1 Septic M Dt Boffi r 2• d D osing > 106 He ader /M an. 0 , I ' fqq2^ Z Aeration / Dist. . P ! Holding Bot. System Final Grade I PUMP /SIPHON INFORMA N e___� Manufacturer Demand 91-Bover 3. I 2 Model Number n� y 3t' �, �� � 7 � TDH L t ctiO earl t ' S J TDH � , 2U �T - /.!v ForcemaiF Length Dia a Dist. to Well 1#21,1-7e r � SOIL AB961WYON SYSTEM / D q J6 ` BED /TRENCH Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Insid T uid Depth DIMENSIONS �� 7 t / / SETBACK SYSTEM TO IWELL LAKE /STRE NG Manufacturer: INFORMATION f System r CHAMBER A r� 10 / UNIT Type Model DISTRj94RON SYSTEM l w © d- Head Manifold Distribution x Hole Size x Hole Spacing Vent to ylntak LengthDia Length 58' ' Dia /• Z$ ` Spacing 3 . - 7- 5 r 5 (D Z D Z SOIL COVER x Pressure Systems Only x Mound O At - Grade Systems Only Depth Over IDepth Over xx Depth of , Seeded /Sodded xx Mulched Bed/Trench Center BedrTrench Edges ( Topsoil ' AM 9 bEi Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:_ /_t3i —U Inspection #2: 2t Location: 70 Emerson Valley Driv River Fallllys�, W 5402 ( 114 NE 1/4 33 T28N�18W) NA Lot 8 G Parcel No: 33.28.18.513A02 1.) Alt BM Description = �1� hQ� (Jd r JC 2.) Bldg sewer length = -� - amount of cover = ( e.�ac-/Zsw Plan revision Required? ❑ Yes NNo Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors Signature Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 d Madison, WI 537 -7162 Sanitary Permit Number (to be filled in by Co.) t i u L c of Commerce 2 Sanitary Permit Applieatio State Transaction Number In accordance with s. Comm. 83.21(2). Wis. Adm. Code, submission of this form to the ap riate me � D unit is required prior to obtaining a sanitary permit. Note: Application forms for state -o PO Project Address (if different than [[Wiling address) submitted to the Department of Commerce. Personal information you provide may be sew p urposes in accordance with the Privacy Law, s. 15.04(1 )(m . Stats. L Application Information - Please Print All Information Propeny Owner's Nana Parcel # �� y� h v�d ►-� h wiv 0 17 2007 Gad logs - �o_ Property Owner's Mailing Address ropcny Location Q 15 kn eKoYi )^t`l/e ST. CROIX COUNTY - ovt. Lot r City, State Zip S - 40,2- (circle CCode Phone Number �UF' �, � y,, Section 37 R, t�'zl 1 is L., ( c U � iU one T .2� N; R !� E or I Tvpe of Building (check all that apply) Lot At on Na 1 or 2 Family Dwelling - Number of Bedrooms _ _ - / , I Subdivision / � I G.) 3 '"1 -ft . i- ❑ Public/Commercial - Describe Use ? S * 2x / Clh "Ot aM ❑ I/ (Gl w CSM Number 11 Village of ❑ State Owned - Dcscritx Use 2 Ill. Type of Permit: (Check onl one box on line A. Complete fine B if applicable) A ' ❑ New System Replacement System g p Y ❑ TreatmenUHoldin Tank Replacement Only her Moditicati to Existing System (explain) D. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑Permit Transfer to New 2 & - 3 ✓1 List Previous Permit Number and Date Issued Before Expiration Owner � /0 / IV. Type of POWTS S stetn/Com onent/Device: Check al! ihat a 1 4 7S ❑ Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil JR Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) 2 V. Dis ersalffreatment Area Information: Design Flow (gpd) Design it Application ate{g Dispersal Area Req (sl) Dispersal Area Proposed f) System Elevation / /( 112 5 S l 7 22 VI. Tank Info C acity in Total # of Manufacturer J M Gallons Gallons Units New Tanks Existing Tanks (� S / u c AN sue of o� ti C7 O. Septic or Holdiug Tank 1 000 ( 00 0 i W ezO Dosingt11amber 4 $foo l weeks ✓� V11. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu s Signatu MP /MPRS Number Business Phone Number Da ���Ci� N�bbe�� .422/07 71.5 Plumber's Address (Street, City, State, Zip Code) 1 V 7 qg 0tA st �Zt -r-alt wu td�� Vlll ounh /De artment Use Onl Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent 'gnat ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval 1 Lh t/uG� SYSTEM OWNER: .��� 1 Septic tank effluent filter and w / 4- " dispersal cell must all be serviced / maintained ) as per management plan provided by plumber. FPRI ac co o coy nances. s and suiintit to the Cotmty on!V oo paper not less than I/2 x 11 inches i si I All setbaek ' - as per applicable de /or' yry �, tv 0G6 � SBD -6398 R. 01/07) Valid thou 01 /09 ; � � UU - MTV i PLAN L CB S= I& - Sra1�1i6- 5� ,c r. Clem _ MPQE e MY a � lG3.Ci L.f= �D '�pRil�i(aS Id y4ci2�s. (p�a�oSEa �. zt AeME - �o C3 LO Z it 10 LJ well— cQ��,��, No��� P►�ia ���� w J 9 J ! � Pt L) T S+Yxw w'A,41e -S -- Fto siu ke Qr x S1lryl l ak . Y z'd Lz8fr9ztrSTL OcRiew E6a -0T Lo SO IBC 6 1/4 HEAD CAPACITY CURVE MODEL "98" 4 5/8 t 2J ao - _ -- J � � 3 5/8 d 4- k 4 3 /16 2 1 1/2 -11 1/2 NPT a U.S. (;ALL.tNFtS Ia 20 30 40 50 6a 70 80 RS LriE –� - -- Q n0 160 240 FLOW R WNW MOM 98 60 CYCLE Feet Canons meter Liters 5 72 L5 273 10 Sr it 231 is 415 4.6 170 12 20 25 O' l 45 `� ^- Uk19971 4 3/16 SKIM CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available with or without alarm switches. for variable level long cycle controls. SELECTION GUIDE Standard all models - Wei ht 39 lbs. - /2 H.N. t. Integral operated 2 pole mkt external control required. switch. no 2 Sigfe piggybm* variable level float swkh or doulble piMgyba& variable level, 98 series contra selection flood switch. Refer to F1640477. mow vote -Ph Mode sim Ou a. Mechanical 10 -0072 or1fi -0075. 1 Aldo 9.4 1 or i 8 7 — 4. See FM0712, for oorrect model of 17e bical A% nheior_ M96 115 M98 115 1 Nan 8.4 2 or 2 & 7 3 a d S 5 5. Control switch 104)225 used as a control activator, specify duplex (3) or (4) nowt syslenh. DOB 230 t Auto 4.7 1 or 1 .T, 7 -- 6. Four (4) hole J- Pak, )taxcion boar, for waWdIA eomhection or wiedoin E9$t Nan 4_T 2 or 2 8 6 3 ar 4 8 5 simplex or duplex operation, l0 0002. 7. Two (2) hole J- Pak, for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Piggyback Variable Level Switches, All installation of controls. protection devices and wiring should be done by a qualified FMO47/; Electrical Alternator, FM0486 ; Mechanical Aitemator,FM0495 ;Sump/Sewage Basins,FMO487; licensed eiectrician, All electrical and safety codes should be followed including the most Single Phase Simplex Pump Control, FM1596; Alarm Systems, FMO732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. K41LTQ PO: BOX 1634? kisv lo 6 1025 unPlo INam�urersof.. SHP To. 3649 Cane Roar Road rte! j tauirviie. KY 40211 -1961 AW17YPaWW sew AW tr( MAvrrw.zoenbneom �y�'`� �� t AXF (582)[17+3624 ST CRD�x cOUN 16 46A - EROSION & SEDIMENT CONTROL PLAN Site location: 70 Emerson Valley Drive, Lot 8 of CSM #828539, Town of Kinnickinnic Owner(s): Jay Uldrych Parcel ID #33.28.18.513A02 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 following activities will be required in order to maintain compliance with the plan: 715 386 - 4675 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. Surface drainage is to the west of proposed mound into a wooded ravine, which is an intermittent tributary to the Kinnickinnic River. 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. (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.) 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. Straw Wattles should be installed prior to mound plowing. ST CROIX COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD. HUDSON, W1 54016 715 386 - 4686 FAA Page Two — ESC Plan Acknowledgement Form 5. 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 permanent 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. 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: PAMELA QUINN, CPESC & SOIL EROSION INSPECTOR #665054, ` 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 I ST. CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD. HUDSON. Wr 54016 715- 386 -4686 Fax I • Safety and Buildings commerce ov 4003 N KINNEY COULEE RD g LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www.commerce.wi.gov/sb/ www.wisconsin.gov epar merce 2007 Jim Doyle, Governor jUL 1 0 Mary P. Burke, Secretary ST. CROIX COUNTY July 05, 07 CUST ID No. 224832 ATTN.• POWTS Inspector MARY JO HOLLISTER ZONING OFFICE HOLLISTERS SOIL TESTING ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 -4011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/05/2009 Identification Numbers Transaction ID No. 1404503 SITE• Site ID No. 726458 Jay & Jan Uldyrch Please refer to both identification numbers, Emerson Valley Drive above, in all correspondence with the agency. Town of Kinnickinnic St Croix County NE1 /4, NE1 /4, S33, T28N, R18W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1135810 Maintenance required; Replacement system; 450 GPD Flow rate; 14 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, Ct� I�I stats. A j The following conditions shall be met during construction or installation and prior to occupancy or use: D XWEI Reminders orr SEE CORF • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • This plan has an approved Petition for Variance (Transaction I.D. # 1404502) associated with the design. All of the condition for the construction of this system shall be upheld. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • 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. MARY JO HOLLISTER Page 2 7/5/2007 • 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 83.55 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 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. RECE /V ED 4 .CEO J MOUND AND PRESSURE DISTRIBUTION COMPONENT Residential Application INDEX AND TITLE PAGE GS Project Name: JAY 8 JAN ULDRYCH Owner's Name: Owner's Address: 70 Emerson Valley Drive River Falls, Wl 54022 Legal Description: NE1 /4 of the NE1 /4, S33, T28N, R18W Township: Kinnickinnic County: St. Croix Subdivision Name: NA Lot Number. NA Block Number. NA Parcel I.D. Number. 022 -1095 -10 - 000 ,'` � •a ��i Transaction No.: `gO�Si //V #"*,, Page 1 Index and title Y +� ••. ''•�� Page 2 Data entry IS 1 p • Page 3 Mound drawings tank Page � 4 Lateral and dose to Pie rfr��ilnl Page 5 System maintenance specifications L- • 1 F \ Page 6 Management and contingency plan t, OVD INS Q Page 7 Pump curve and specifications r O F ='A • CQMME to LSPOND C Designer: Mary Jo Hollister License Number: 1859 -007 Date: 05/15107 L AO , , Phone Number. (715) 426 -1775 Signature: Designed Pursuant to the Mound component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (0181) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Pa e 1 of $ Version 5.1 (R. 06106) 9 t Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Mote: Sand fill (D) cab eftm assume a 300.00 Estimated Wastewater Flow (gpd) Table 8344 - 3 hi- l soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of <= 36 inures. 450.00 Design Flow (gpd) 14.00 Site Slope ( %) 99.75 Contour Line Elevation (ft) 14.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/fl?) Distribution Cell Information 60.001 Dispersal Cell Length Along Contour (ft) = 7.50 Cell Width (ft) �-� 1�.00 Dispersal Cell Design Loading Rate (gpde) L!J Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution F Y Pressure Distrbution Information network? Enter Y or N (C or E) C Center or End Manifold 3.75 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 7.50 ft /orifice 2 Forcemain Diameter (in) 74. orcemain Length (ft) Does the forcemain drain back? Y 91.00 Pump Tank Elevation (ft) Enter Y or N L A1.65 ystem 7Head (ft) x 1.3 12.07 Forcemain Drainback (gal) (� ertical ) 37.33 5x Void Volume (gal) iction ft 49.40 Minimum Dose Volume (gal) ft) 32.311 System Demand (gpm) 16.78 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options c o' e 0.75 1.25 x x 1.00 x 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weeks I Manufacturer gaUn (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) S mt Filter Manufacturer 1 /.U2 I hose l ank Voiume (gal /in) I/►z I Ricer Model Number Weeks Manufacturer Project: JAY & JAN ULDRYCH Page 2 of 8 r i Mound Plan and Cross Section Views 1/10 B = :: : ::::::::::::: :: -- - - : ::. _ _ ...... ... :' :': 3 -K - : - : - :- ration Pipe ti;. ;:;•. A W — :I: B . ..... L Mound Component Dimensions A 7.50 ft E 34.60 in H 1.00 ft K 12.39 ft B 60.00 ft F 9.25 in z 21.49 ft L 84.78 ft D 22.00 in G 0.50 ft J 6.56 ft W 35.55 ft 450.00 (ft Dispersal Cell Area 1 1739.22 (f't Basal Area Available 7.50 (gpd/ft) Linear Loading Rate 1 6.00 (ft) 1 /10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.35 (ft) JJJ.J.J /JJ.JJ,r... G * H J / /H / / /J /// % /JJIJJII •. 1 - i/JJ/J/IJJII /IJIJJ /IIJI/ JJ / /IJJJIJ /IJI/II/ / //I :.. F p�persal c 102.08 (ft) Lateral 101.58 (ft)—♦ i — Invert 3 ::•. 1 Dispersal Cell Elevation E i3 3 __ _ A < 1 x rc i, Cr. C`. C�h!.• �l�t`.(• hh' �lct/ ��t 11. �1.. t�1�c' �c 'e���.ct2.<`ti.�1�•i.tl<�1.r` �11 tic r�l�l•f<.C`<�1�t�. 4 A. <A < .? 1�r14c`�lt� 4tAAU` 1. ti`✓ lt' tt11�1 !`A�`1�r <�J1 -?�c �A,l1e! - ✓.1.11..�JJ.r.z z>. J.1� /1� .t�l� -1 l.tlr�h� �.c�.el.c�.<`.e`.L'Jlcil 1. ✓ W.l. �, t.. i � A .. > .. , 99.75 (ft) Contour Elevation 14.0 % Site Slope Geotextile Fabric Cover Shading Key a $. T Dispersal Cell See lateral details on 1� ®Topsoil Cap 1.5 ft :::..:• .:.....:..:... Page 4 for number, size, © JJJ /JJJ•J Subsoil Cap 75 o 5 '' ;` "::::' :::::':? "`; : and spacing of laterals. © ASTM C33 Sand F Laterals are equally ® Tilled Layer = 0.5 ft °Typical Lateral :;:; °. spaced from the 0 distribution cell's Aggregate v o '' ?r;,';_ :: }:•' ?` centedine in the A ---`-* distribution cell (Ax6). Project: JAY & JAN ULDRYCH Page 3 of Sa f Center Connection Lateral Layout Diagram Force main connection via tee or cross to man CM at and Point Laterals are identical P �k 0= Turtr -up wrball valve or X— �'Esl2 sl2 +l Laterals ti force main of PVC Sch 40 cleanoutplug per COMM Table 94-30-5 Holes dried on the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.02 ft Lateral Length (P) 29.29 ft Orifices per Lateral 15 Lateral Spacing (S) 3.75 Orifice Density 7. rifice Lateral Flow Rate 8.08 gpm Manifold Length 3.rin System Flow Rate 32.31 gpm Manifold Diameter 1. Total Dynamic Head 16.78 ft Forcemain Velocity 3.30 ft/sec Dose Tank Information Locking cover with warning label and locking device and seated watertight Electrical as per NEC 300 and —► —{- Comm 16.28 WAC Disconnect Tank component is property vented = => IE Alternate outlet location Forcemain diameter Weeks Manufacturer 2 in. o Ca 800.00 Gallons rt �CSYM'r E , A 2 T Volume 17.02 gal/inch A PM C.onE Weep hole or anti - Dimension Inches Galkxts B siphon device A 30.10 512.32 C B 2.00 34.04 Pump off elevation (ft) C 2.90 49.40 92.00 D 12.00 204.24 D Total 47.001 800.00 � -- Dose tank elevation (ft) 3" Bedding under tank. 91.00 Alarm Manuafacturer Level Alarm 1 Alarm Model Number Pump Manufacturer ME 1 rvn �c. �� A- Pump Model Num r 40 Pump Must Deliver 32.31 gpm at 1 16.78 ft TDH Project: JAY & JAN ULDRYCH Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Darrell's Septic Service d Phone 715) 425 -1025 POWTS Regulator's Name ( St. Croix County Zoning Phone 715) 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 Igpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freguencv Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and dean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Ws. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished .00000 Grade r 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lot @ru! Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: JAY & JAN ULDRYCH Page 5 of S mouna ayswm mnagement roan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shag maintained in accordance with its' component manuals ISBD- 10691 -P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and WW tank abanddrimerit shall be in accordance with Comm 83.33, We. Adm. Code when the tanks are no longer used as POWfS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shag be sealed watertight upon the completion of service. Any opening deerned unsound, defective or subject to failure must be replaced. Exposed access openings greater than 8- inches in diarneter shag be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component_ Septic Tank The septic tank shag be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shag be assessed at least once every 3 years by inspection. The outlet filter shag be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shag be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shag have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tans If the contents of the tank are not removed at the time of a triennial assessrrerrt, maintenance personnel shag advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical al additives to enhance septic tank performance is generally not required. However, if such products are used they shag be approved for septic tank use by the Department of Commerce. Pump Tanc The pump ( dosing) tank shag be inspected at bast once every 3 years. All switches, alarms, and pumps shag be tested to verify proper operation. If an effluent fir is Installed within the tank it shag be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be plarded on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as roc cry to prevent erosion and to provide some protection from frost penetFation. Traffic (other than for vegetative monlenanoe) on the mound is not recommerded since soli compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the maid system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 du/io0 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure ifistributiori system is provided with a flushing point at the end of each lateral, and it is recorrunended that each lateral be flushed of accumulated solids at Mast once every 18 months. When a pressure test is performed lt should be compared to the initial test when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shag be decked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Confinaennw Plan If the septic tank or any of its components become defective the tank or component shag be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wing becomes defective the defective component(s) shag be immediately repaired or replaced with a component of the same or equal performance. If the mound component fags to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present kcation by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to brag the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagernent and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: lily DRS —7SAy t 3AN Page 6 of S ME40 4110 HP Effibent and Drain Water PUMPS • VANE IMPELLER DESIG • ) VIDES MAXIMUM DO SING N H - Enclosed design for t9gh efficiency pumping - ' • \• l I: 0rv. •' perkxmic can be restored If wear occurs by replacing vok9e seat ring • I SV _ • DURABLE • • WILL D ELIV ER MANY R YEARS OF SER VICE. Off M ad molor for • / t wat •,sw.•• • am prone to faft. f s wv k e i s ever rm m echanicof ;b•' sw9ch provides •1 •: • down k • •; • • C ti • f uluff � capocmftlo lMG'' ■ M "sock % 322J MOMME" so" 314 Im 19giffn 40 12 ft)kK 09GMC(d DOW 4110 hp. 160 WM 116vtZro 25 2, AcCepkible pH ft"p 5-9 t f � , WL SUMP f . , � ' nDr PLAN Uwe WfM LOS= TAA r�, - sri3ttiro- 5� e b - CC�18iSL�Ib'��15 %. 40 fs A r r 3 J - Pt L) -�;+Yxw e�o sru ke S1yn�'hr �radua� - - '` of z'd LZBfr9zfrSTL orRjeW e6Z =0T LO SO Inr Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary July 05, 2007 JjG-ROIX 0 2007 CUST ID No. 1004879 S COUNTY ATT Inspector ZONING OFFICE JAY D ULDRYCH ST CROIX COUNTY SPIA 70 EMERSON VALLEY DR 1101 CARMICHAEL RD RIVER FALLS WI 54022 -5704 HUDSON WI 54016 APPROVAL OF PETITION FOR VARIANCE Identification Numbers Transaction ID No. 1404502 SITE: Site ID No. 726458 Jay & Jan Uldyrch Please refer to both identification numbers, Emerson Valley Drive above, in all correspondence with the agency. Town of Kinnickinnic St Croix County NE1 /4, NE1 /4, S33, T28N, R18W FOR: Petition for Variance Comm 84.43 (8) (i) Wis. Adm. Code The submittal described above has been reviewed for equivalency to applicable Wisconsin Administrative Codes and compliance with Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in section 101.01(10), Wisconsin Statutes, is responsible for compliance with all conditions of this petition approval and other applicable code requirements. Plan submittal and approval to the department or its agent may be necessary prior to construction undertaken per this petition. The code section petitioned requires POWTS treatment, holding and dispersal components shall be located so as to provide the minimum horizontal setback distances as outlined in Table 83.43 -1. The variance requested is to construct a mound distribution system to within 2 feet of the lot line near one corner of the down slope edge. The intent of the code section petitioned is to provide the minimum horizontal setback distances as outlined in table 83.43 -I as extra safety factors for public health, waters of the state and structures during construction and in the event of component failure. The petitioner submitted the SB -9890 application form including 11 additional pages of supporting documents and/or plans. Reviewer's Comments: 1. The lot line has been surveyed by a registered surveyor and recorded with the register of deeds. 2. The proposal for safety of public health is to construct a soil berm at the lot line to prevent any future possible toe seepage from migrating to the neighboring property. Departmental Action: CONDITIONAL APPROVAL JAY D ULDRYCH Page 2 7/5/2007 Reviewer's Conditions of Approval: All of the petitioner's statements of fact or intent included on the variance application form, any other documents submitted to the Department, as well as any other conditions of approval listed below, shall be carried out. This variance is specific to the subject petition and cannot be used for any additional modifications. • The down slope toe is to be no closer than 2 feet from the lot line. • The berm is to be of sufficient size and dimension that it will contain a small amount of seepage. This decision will become final unless the department within 30 days from the date of this letter receives a written request for a hearing. A request for hearing should be sent to the address shown on this letterhead. A copy of this letter must be included with the request for a hearing. The request for hearing should state the reasons for objecting to the department's decision, because a request for hearing may be denied if it does not present a significant question in fact, law or policy. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 225.00 Fee Received $ 225.00 Balance Due $ 0.00 Ch arles 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. Mary Jo Hollister, Hollisters Soil Testing (Plans Mailed To) �! RECEIVED 4 207 �:� e mmerce.wi.gov APPLICATION FOR REVIEW PETITION FO ANCE SBD -989OX E I `1,I all pages - i sc o n s i n SBD 9890X (R 08/06) (CLeck our website at httpJlwww.commerce.st�e JJrV wi uz/SB%SB Department of Commerce DivFomms.html for the most current version of this form) Safety & Buildings Division This page may be utilized for fax appointments Bureau of Integrated Services Complete and indicate date plans will be in our office 1. Facility Informati F O frice: plete for con appointments*: Facility (Building) Name: on ID: I Sa Z Number and Street zip: Related Trans. ID: tt __� Commerce Site Number (if known): Reviewer: _�;VA IC �� R ir R Z Legal Description: Office: iL 4 Cr o S S t County of. tart Date *: _ City ()Village () Town of l must be received in the office of the appointment no 2 workino days before the confirmed appointment. NOTE: Personal information you provide may be used for seconds ur oses P rivacv Law s. 15.04 1 m , Stats. 2. Owner Information Customer # 3. Desi per Information Customer # Z Name Designer -ZA aAAJ LkL_f]� MAtZj zo Noua Sl'aK Company Name Design Firm %I OLL LST7-tz S A lros Number and Street Number and Street City, State Zip Code City, State, Zip Code F� \&x P ER r s VJ1 s Contact Person Contact Person 5 u ?� KN 3b Telephone Number Fax Number Telephone Number Fax Number Z7 1 42j -`dJ0t i 5 42k-1 C 5 4 zfo- B 4. Plan Review Status Plan previously review by (please enclose a copy of review letter) k' Plan submitted with petition _ State _ Municipality _ Approved _ Held ` Denied Plan will be submitted after petition determination Code Being Petitioned _ Requesting revision _ Other. _Commercial Building _ HVAC Plumbing Private Sewage System Commerce Transaction Number _ Swimming Pool T Electrical _ Flammable Liquids _ Amusement Rides _ Uniform Dwelling Code — Boilers T Elevators _Gas Systems Refri Rental W eat h eri zati on Pro Ot her: 5. State the code section bein peti Toned AND the specific condition or issue you are requesting be covered under this petition for variance. SID. s LIMI - r' MoNS— k t AAI * kD Ni FE-P-r ID 1 rty LttJr-- -to 2 FEET 6. Reason why compliance with the code cannot be attained without the variance. WE - 9P w✓tSi l Ct!,�.M� Le" C' °�D9 t_ U'12.1s10 A S T hk S t,S ` IAC o e; i " C ©t� 'r t C 4; 'hZ t2ir Lei lvi;�l •� t f t'?t,�3T 7. State your proposed means and rationale of providing equivalent degree of health, safety, or welfare as addressed by the code section petitioned. - Ttk\b Sie-va CAI�Li- A3()T Zr-- Ill H F- .A(_.-* -\ Or- s -&Ferry - T3 1"K ek-Y t5 ZQ A UP Jhk VW F—U—i )(;? CA 10 BE 'tai A ,A)EAR i,C.`C`LtfE� 8.. List attachments to be considered as part of the petitioner's statements (i.e., model code sections, test reports, research articles, expert opin previously approved variances, pictures, plans, sketches, etc.). fk VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED WITH AFFIXED SEAL AND ACCOMPANIED BY REVIEW FEE Note: Petitioner must be the owner of the building or system or credential applicant for a Comm 5 petition. Tenants, agents, designers, contractors, attorneys, etc., shall not sign petition unless Power of Attorney is submitted with the Petition for Variance Application. being duly swom, I state as petitioner that I have read the foregoinngg ppetition and 1 believe Pe ones a e or nn it is true and that I have significant ownership rights to the subje ct bu7di or proj ect Petitioners Signature Subscribed and sworn Notary Public My missi n expires to be re me is d e on t',om late other side for variance nests from Comm m or d Comm 61-65 MAKE CHECKS PAYABLE TO DEPT. OF COMMERCE TOTAL AMOUNT DUE $ 00 Attach check here, � 25�• �� RECEIVED Wisconsin Department of Con meroe SO L EVALUATION REPORT Page 1 of 3 Division of Safety and Building MAR y4 r►�d h m 85, Wis. Adm. Code County ST. CROIX Attach complete site plan of paperoot $ 1 in es in size. Plan must include, but not limited to: cal,Yitt i r poi (BM), direction and Pared I.D. 022 - 1095 - 10 - 000 percent slope, scab or di n tion and distance to nearest road. Please print all information, eviewed by Date 2 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 3 Property Owner Property Location JAY & JAN ULDRYCH Govt. Lot - - -- NE 1/4 NE 1/4 S 33 T 28 N R 18 E Property Owner's Mailing Address ;i1ty Block # Name CSM# 70 Emerson Valley Drive City State Zip Code Phone Number 13viltige To Nearest Road River Falls, WI 1 54022 715 425-8505 1 o Emerson Valley Drive Gkinnic New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD E] Replacement Public or commercial - Describe: Parent material shale bedrock Flood Plain elevation if applicable W-A ft. General comments Mound System -- 1.84 ft. sand fill -- 0.4 loadin a and recommendations: - ��f Boring # Boring �9� 5— F T ] Pit Ground surface elev. 94.00 ft. Depth to limiting factor 14 in. OQ 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 1 0 -8 10YR2 /1 - sil 3fgr mvfr as 3vf-co 0.6 0.8 2 8 -14 l0YR3 /2 — cl 2fabk &gr mfr as 2vf-co( vf -co 0.4 0.6 3 14 -20 10YR3 /3 t2d ioYR4 /6 c 0m mfi -- 2vf-co 0.0 0.0 2 Boring # Boring 99.10 18 F Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10YR2 /1 — sil 3fgr mvfr cs 3vf -co 0.6 0.8 2 9 -14 10YR3 /2 cl 3fgr mfr cs 2vf -c 0.4 0.6 3 14 -18 10YR3 /3 - cl 2fabk mfi cs 2vf-co 0.6 4 18 -22 10YR3 /3 cid 1oYR4/6 c 2fabk m f i -- 2vf-co 0.2 0.3 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and -TSS < 30 mg/L CST Name (Please Print) nature J CST Number Mary Jo Hollister J�l 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 04 - 14 - 05 & 02 - 21 - 06 (715) 426 - 1775 Property Owner ULDRYCH, Jay Parcel ID # 022 - 1095 -10 -000 Page 2 of 3 Boring ❑Boring # ❑ Pit Ground surface elev. 99.75 ft. Depth to limiting factor 22 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 1 0 -10 10YR2 /1 -- sil 3fgr mvfr as 3vf-co 0.6 0.8 2 10 -22 ]OYR3 12 __ cl 2fabk mfr as 2vf -co 0.4 0.6 3 22-25 10YR3 /3 cId 10YR4 /6 c 2fabk mfi -- 2vf -co 0.2 0.3 Boring # Boring a ppit Ground surface elev. ft. Depth to limiting factor 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 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ' Effluent #1 = BOD > 30 220 mg/L and TSS >30:5 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS 5 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- 8330rest (R.07 /00) s M..,Or MAN 3 . �.� �� • Mmm kin L MPOW1. 8CrWht Mr,-,ID )OL IA E NE g T,c = TAP OF e /T. t��8'1►l�L�IS . !o 4e eF$ CNWac,-.F-O Z. z1 AcKE.$) WELL k 'lOo FRO ES A o /Jor4A ° 1p lu OD � Z Ail H. w - w. - 41. H. M i �1 l Wisconsin Department of Commerce Of BALM &MEP0 T Page 1 of 3 Division of Safety and Buildings in accordance m 85, VYus. Adm. Code 4 po mY ST. CROIX Attach complete site plan on paper not less than 81/2 x 11 in A s in s ! n ry 7 t 2005 include, but not limited to: vertical and horizontal reference poin (BM), direction and Par I.D. 022 - 1095 - 10 - 000 percent slope, scale or dimensions, north arrow, and location a distkn bdl*4OVW['!' Please print all information. ZONING OFFICE Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location JAY & JAN ULDRYCH Govt. Lot - -- NE 1/4 NE 114 s 33 T 28 N R 18 E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSW 70 Emerson Valley Drive -- -- -- City State Zip Code Phone Number ity []Mllage ■ Town Nearest Road River Falls, WI 1 54022 ( 715 ) 425-8505 Emerson Valley Drive New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 4 50 GPD a Replacement Public or commercial - Describe: Parent material shale Flood Plain elevation if applicable NA ft. General comments and recommendations: Mound System -- 1.84 ft. sand fill -- 0. o i / �O F rtoa.4J (Test Not Complete -- Need finish contours /elevations) �` t — > a Boring # E) Boring Pit Ground surface elev. ft. Depth to limiting factor 14 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *002 1 0-8 10YR2 /1 sil 3fgr mvfr as 3vf-co 0.6 0.8 � ►r (p 2 8 -14 10YR3 /2 — cl 2fabk &gr mfr as 2vf-co 0.4 0.6 3 14 -20 10YR3 /3 t2d 10YR4 /6 c Om mfi -- 2vf-co 0.0 0.0 2 Boring # ❑ Boring 18 Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil App lication 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 1 0 -9 10YR2 /1 - sil 3fgr mvfr cs 3vf -co 0.6 0.8 2 9 -14 10YR3 /2 _ cl 3fgr mfr cs 2vf -co 0.4 0.6 3 14 -18 10YR3/3 cl 2fabk mfi cs 2vf -co 0.4 0.6 4 18-22 10YR3 /3 ctd 10YR416 c 2fabk mfi — 2vf-co 0.2 0.3 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Mary Jo Hollister 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 04-14-05 (715) 426 - 1775 Property Owner ULDRYCH, Jay Parcel ID# 022 - 1095 -10 -000 Page 2 of 3 F71 Boring # a Boring 22 pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 1 0 -10 10YR2 /1 -- sil 3fgr mvfr as 3vf-co 0.6 0.8 2 10 -22 10YR3 /2 -- cl 2fabk mfr as 2vf-co 0.4 0.6 3 22 -25 10YR3 /3 cId 10YR4 /6 c 2fabk mfi -- 2vf-co 0.2 0.3 r-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfF#1 *Eff#2 F-1 Boring # Boring Pit Ground surface elev. ff. Depth to limiting factor in. Soil lication 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 * Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD- 8330Test (8.07/00) 1 1 / t_ LOV "4 Aj, M- �w Man OF C T, U2p G0lMaS5ff AIL MVA MS �_ FWD $oRtN6s J8.+4cR� W Et_t_ 15 7' 10Q E FROM TE5 AV5 2z ofo osZ VhH, M Hollister's Soil Testing Mary Jo Hollister W9875 690t Avenue River Falls, WI 54022 (715) 426 -1775 (715) 426 -4827 Send to: St. Croix County Zoning From: Mary Jo Attention: Pam Quinn Date: 04 -25 -05 Office Location: Office Location: Fax Number: 715 -386 -4686 Phone Number: ❑ Urgent ❑ Reply ASAP ❑ Please comment ❑ Please Review ❑ For your Information Total pages, including cover: Comments: Pam; Here's the soil report for Jay Uldrych that we discussed last week. Please let me know if you want to make a soil on -site. I wanted to get this going then I'll complete elevations /contours. Thank you for your time and attention to this matter. Have a great day. Mary Jo ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer -TC4 Y d< 744 h v L d y F e k, Mailing Address 70 If vm,-,V +0 Vk //el Dk Property Address 70 &" -e i +' vej / l e Y (o �,'ve (Verification required from Planning & Zoning Department for new construction.) City /State Lv I SNO)a Parcel Identification Number 0-22 -1 0f5_ -1 0 - 030 LEGAL DESCRIPTION Property Location t 'i4 , t E `/a , Sec. 33_, T `Z N R I? W, Town of ► Ck�'Nh�'� Subdivision Plat: A" , Lot # . r CY e Certified Survey Map # rj �a � � 6 -�- � Volume ,Page # Warranty Deed # �5� � 3 (before 2007)Volume / 1,Y � , Page # - 7 Spec house yes i/(/) Lot lines identifiable �/ 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 ( I ) 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 13 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County 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 3 NATURE OF AP LI ANT(S) 6 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. (REN'. 08/05) Parcel #: 022 - 1095 -10 -020 11/12/2007 11:04 AM PAGE 1 OF 1 Alt. Parcel #: 33.28.18.513A -02 022 - 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 0 - ULDRYCH, JAY D & JEANETTE R JAY D & JEANETTE R ULDRYCH 70 EMERSON VALLEY DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 70 EMERSON VALLEY DR SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.550 Plat: 5232 -CSM 21 -5232 SEC 33 T28N R18W PT NE NE FKA LOT 6 CSM Block /Condo Bldg: LOT 08 11/3091 NKA CSM 21 -5232 LOT 8 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 33- 28N -18W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 06/30/2006 828539 CSM 07/23/1997 1184/277 TD 07/23/1997 1046/221 LC 07/23/1997 842/234 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 2.550 50,000 126,000 176,000 NO Totals for 2007: General Property 2.550 50,000 126,000 176,000 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 .DOCUMENT NO. STATE BAR OF WISCONSIN FORM 16 -1982 THIS SPACE RESERVED FOR RECORDING DATA ` TRUSTEE'S DEED fd cso r g- REGISTER'S OFFICE EugenQ__ Elux s- QD ............................................. . ...•-- •- ,•-- •- .........•- - -• - -- ST. CROIX CTY., WI Rec'd for Record ---- - - - - -- -------------------- ----- •------ •-- - - - - -- ....................................... as Trustee of JUN 1 3 1996 Euge.ue ... Em.er -s.ou .e.uoQ b ...................................... ................................................. ......................................................... at 1:00 P. M ...................... •--•-••--•-• ................•---•-••-••-----.........._.... ....._.._••- ••................. -K JW6 for a valuable consideration conveys without warranty to .............................. ReyisterofD"Ift __,Jay. -.D. Uldrych-- and, • Jeanetto „R Uldrych, „- ,,,,,_,,,,_ husband - and • _ wi e ,as _survivorshi p_,mar--tal ---- -- - -- - - -- r p. _.. y --- - -• - -• _ _ _•- RETURN TO .... .. .... .. ....................................................... ......................... ---------------------- -......... -.................................................................... Grantee, the following described real estate in ------- S t . ` C1 O1X .................... County, d State of Wisconsin: Part of the NE=B of the NEk and part of the Tax Parcel No: ............................. SEk of the NEk, all in Section 33, Township 28 North, Range 18 West, Town of Kinnickinnic, G. St. Croix County, Wisconsin, described as follows: Lot 6 of the Certified Survey Map filed April 30, 1996 in Volume 11 of Certified Survey Maps, Page 3091 as Document No. 542946. TRANSF§R $ nc RECEIVED 13 3 i SEP 1 206 8T. CROIX COUNTY S 3 9 SURVEYOR'S RECORD KATpAGE5232 REGIg H. ST TER OF DEE o�myo A _ �E,TVED FO R Eg� yc�ms� /T�00011 �q D NFNOv �C Or C O� Z7 m 1T 5Sn'� a�DJ 6� °� :2' $ o °> zv °R ' b ' �y FE p .��$. c,Q c�J � < "�L'+] (nom H +A A Z j Z �;a T mo o m ` >�� icAoy ciAr� ? x m rn ➢ O � A Z n 0 Z m Z t 0 0 p m O O d co (� T o ° _ Ir SONV - 1 a3.LLbndNn � a a t k N � n L60£ 30Vd 'LL 3NU10A 'W'S'O '9 101 30 3NI 1S3M O >" I m z w ,96'*99 M „ *O,O 1.00 N . ° ➢ o w ham, W ° z r4i � zl �•� CNr� �I OS,OL.00 N . 1N3W3SV3 �, N o y N y °. NOLLVA2735N00 CA ' O Z W L j I c ' `• ,L£'88£ M .60, 00 N JYYY I �0 V:� \ e .L£'9 t 00'OLl .J z A a , m O 4 �' ''- �•1 < 25 JO 7 L� �0 2 O Z V 'I M ^ O C m O Q M „40,0 L.00 N 00 0 C N O \ ID �' c) ' C O 4l ' 0 O N X n'I ' oi P j 1 f D v< U) I m 1 m qg N N (O mz T - _ _yam• iy — _ — _ _ _ _ , _ _ — O m 1 � 226.27' '�• �"'.' v� O s -14• 178.16' v ° -i z 212.00' o , U 02 O F I ” OT W 616.43 -� - _ EA57 l _l P L OT 6, C. S_M . VOf� UME 71P AG . _ EM 30 7 - w V DR LOT 4 ' ' LOT 3 TC S.M. VOL. 5 C. S. M. — — — — fis• VOL- VO _ L 9, PAGE 2610 PAGE 1276 Io12 Vol. 21 Page 5232 �� ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 3a y d- Jc N y L d Y r c A residence located at: NP 1 /4, I [' 1 /4, Section - 73 Town ;2 6 N, Range 19 W, Town Of St. Croix County Wisconsin. Upon inspection, I certify that I41ave found the tank(s), to the best of my knowledge; - will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service — 7 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capaq'ty: 10 D0 Construction: Prefab Concrete X_ Steel Other Manufacturer (if known): W c-2 KS' - Age of Tank (if known): l y t' elx &we el b4)?RCLL 14ub�ell (Licensed Plumber Signature) (Print Name) 0 L 41 1 W 5 0202 J W (Title) (License Number) MP/MPRS 11 -7 -07 (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER A ADDRESS p Office Box 563 RivAr Fall. WT 54022 SUBDIVISION / CSM# Vol 11 Page 3091 Doc # 542946 LOT 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 t h �V o S co ►.� i , f I f i l f ♦ BM t'i�vJrP.t INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank, manhole cover. l- � BENCHMARK Tope of EL Pi p�nPrt�� T i e Stake Fl_,�vati on I 00_V ALTERNATE BM: 1 SEPTIC TANK 'PUMP CHAMBER /'HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /you rd Setback from: Well House Other t Pump: Manufacturer A 11to r4 Model# F) /i? Size ! z Float seperation 7, Gallons/cycle: / Alarm Location :SOIL ABSORPTION SYSTEM Width: 7 Length 1 Number of trenches Distance & Direction to nearest prop. line {; 6 4 N y 4 Setback from: well: /00 House > /DO Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header /Manifold Bottom of system ; d - — �1a)od Existing Grade - f /, Da- Final grade DATE OF INSTALLATION: /,;2 PLUMBER ON JOB: - Si e) �. LICENSE NUMBER: D INSPECTOR: l nit," 42 S 3/93:jt iVi Department of Industry, PRIVATE SEWAGE SYSTEM County: Llor Nid Human Relations INSPECTION REPORT S< -tfety znd Buildings Division ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 262365 Permit Holder's Name: ❑ City (I Village JX Town of: State Plan ID No.: ULDRYCH JAY & JEANETTE KINNICKINNIC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: A9600174 /6 / r TANK INFORMATION ELEVATION DATAG'% TYPE MANUFACTURER CAPACITY STATION BS H1 FS ELEV. Septic Benchmark IZ0,2a �T1 /(A0- Og Dosing ty ?t) - M In447n, 1170 Aeration Bldg. Sewer , 113,2,9 Holding St /Ht Inlet / 1' TANK SETBACK INFORMATION St /Ht Outlet v 95 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake // O Septic NA Dt Bottom Dosing NA Header /Man. #� 0,26 Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION f Final Grade imj r Manufacturer Demand �2 (��190 Model Number GPM ' �) vu hrn t kvw nt�mA TDH Lift Friction I System TDH Ft H Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length p,/ f No. Of Trenches PIT No. Of Pits Inside Di . Liquid Depth BED / TRENCH Wk DIMENSION / T DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO Ae &,.) CHAMBER Model Number: System: m 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 ❑ Yes ❑ No OMMENTS: (Include code discr aneie�, persons present, etc.) LOCATION: KIANICKINAIC.33.28.18W, NE, NE, LOT 6, COUNTY RD M /4A S Cap I� nz� v�� rj /'' Plan revision r it Y re ed es No 4 ❑ ❑ Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Siqnature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Led w � L FA WWA �,� & 2-e S a4A-). VOL 1r-JUPACE /54 PERMANENT EASEMENT FOR SEPTIC SYSTEM Document Number: 562084 _._.._.. _.... REGIST(_RS OFFI ;i~ Retum Address: ST. CROIX CTY„ W) iasNbrltaE4w j /D, lcl dryclt. WO 8, 1997. P.0..8ox 6 R, O'er Fa!ls zV_T 11 :0o A. Parcel I.D. Number (PIN): ; Reglsterof Deeds T This permanent easement, dated this day of June, 1997, by and between Charles Ketchum andX4rw Ketchum, (hereinafter "Grantors "), and Jay D. Uldrych and Jeanette fl. Uldrych (hereinafter "Grantees "), ��2urvf WITNESSETH: WHEREAS, Grantors are the owners of the following described real property located in St. Croix County, Wisconsin: 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, 1993, in Volume 9 CSM, page 2675, as Document No. 504574; and WHEREAS, Grantees are the owners of the following described property located in St. Croix County, Wisconsin: Lot Six (6) of that certain Certified Survey Map recorded on April 30, 1996, in Volume 11 CSM, page 3091, as Document No. 542946, said property_ being located in the NE 1/4 of the NE 1/4 and the SE 1/4 of the . NE 1/4 in Section 33, Township 28 North, Range 18 West, Town of Kinnickinnic; and WHEREAS, Grantees have installed a mound septic system which services the home located on Lot Six, said mound septic system encroaching slightly on the property owned by Grantors; and WHEREAS, Grantors wish to forego any legal remedies and provide for said encroachment by the recording of this Permanent Easement Agreement. NOW, THEREFORE, in consideration 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 ive fro property line of Lot Five, said mound septic system lying approximately 25 to 30 feet westerly of point the same appears on that certain Certified Survey Map recorded in Volume 9, page 2675, as Document No. 504574. 3qo, 63, — 30 = 310. 03' ,C,! SL).-) 4'T S 2. This permanent and perpetual easement is expressly limited to the current location of the mound septic system, and in no event ext ending 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 be done entirely at the expense of Grantees, their heirs, successors and assigns, and it shall not be moved from its current location on the land of Grantors, nor in any event exte m ore than 25 feet to the north from the southerly property line of Lot 5, being at a point approximately 25 to 30 feet weste_Fy of VOL 1�OUPACE-/ n0l poin vA on the aforesaid Certified Survey Map. It is the intent of the parties that this easement apply to no other are of Grantors' land nor shall it ever be expanded beyond 25 feet in depth onto Grantors' property, at its current `iocdtion. IN. WITNESS WHEREOF, the parties have placed their hands and seals on the date first written above. GRAN ORS GRANTEES (seal) �^�a�, (seal) Char s Ket um Ja rych seal) (seal) Ketchum Jeanette R. Uldrych ACKNOWLEDGMENT STATE OF WISCONSIN ) )Ss. ST. CROIX COUNTY ► Personally came before me this day of 1997, the above named Charles. Ketchum and Ellia Ketchum, to me known to be the persons who executed the foregoing instrument and acknow.ledge.,the same. 1 s kin �l Notar Public N(01 County, Wisconsin: My Commission 3 ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. ST. CROIX COUNTY ) Personally came before me this — 'K day of June, 1997, the above named Jay D. Uldrych and Jeanette R. Uldrych, to me known to be the persons who executed the foregoing instrument and acknowledge the same. P,FG� _ z ar P ublic County, Wisconsin My Commission THIS INSTRUMENT DRAFTED BY: Steven B. Goff Bye, Goff & Rohde, Ltd. PO Box 167 River Falls, WI 54022 SBG \MISC \Steiner Easement.doc -2- rtment of Industry, man Relations PRIVATE SEWAGE SYSTEM count Buildings Division INSPECTION REPORT ST CROIX TV . ERAS. INFORMATION (ATTACH TO PERMIT) Sanita Permit No.: 262365 rmit Holder s Name: ❑ City ❑ Village [2 Town of: State Plan ID No.: ULDRYCH JAY & JEANETTE KINNICKINNIC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: A9690174,,/_,,3/96_ f TANK INFORMATION ELEVATION DATA G TYPE MANUFACTURER CAPACITY STATION BS HI C ! FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer 9,- ; �` I /3, 29 Holding St! Ht Inlet TANK SETBACK INFORMATION St/ Ht outlet v 95" TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom _ / ' - - l .l, S' Dosing NA Header / Man. Aeration NA Dist. Pipe v , Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand - - Model Number GPM TDH lift Lriction System TDH Ft H ead Forcemain Length Dia Dist. To Well SOIL ABSORPTION SYSTEM �'I,o�' 3 1 / a -, BED /TRENCH Width DIMENSIONS / LengthQ� No- Of Trenches PIT No. Of Pits Inside Di Liquid Depth DIMNf ONS SYSTEM TO P/ L BLDG WELL LAKE LEACHING Manufacturer: SETBACK � /STREAM j INFORMATION Type 0 .4e ,,� CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipes) 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 ❑ Yes ❑ No — —f COMMENTS: (Include code discr gancie�, persor)s present etc.) �j.+c2 c -�=:� i �" C� �i�J a-"" !� �.. LOCATION: �K NICKINNIC.33.28.18W, NE, NJ, LOT 6, COUNTY RD M in revision required? ❑ Yes ❑ Nb other side for additional information. -6710(R 05/91) Date Inspector's Signature Cert No i` SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY St Croix STATE SANITARY PERMIT# —Attach complete plans (to the county copy only) for the system, on paper not less than ❑`c�eG Mf F 8% x 11 inches in size Check re on p � s a nation -See reverse side for instructions for comp leting this app lication. STATE PLAN I.D. NUMBER P 9 PP 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S96 -40032 PROPERTY OWNER PROPERTY LOCATION Jay & Jeanette Uldrych ME_ % NE ' /a,S 33 T 28 ,N,R 1 W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBE R SUBDIVISION NAME OR CSM NUMBERS 3091 612 S 492-375E Emerson Valle 11. TYPE OF BUILDING (Check one) ❑ State Owned NEAREST ROAD County road M ❑ Public [i] 1 or 2 Fam. Dwelling -# of bedrooms . - PARCEL TAX NU ER (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)1.12 New 2. El Replacement 3. El 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 N 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 1.2 94.02 Feet .70 Feet VII. TANK CAPACITY Site in gal lons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks oncrete structed glass App. Tanks I Tanks Se tic Tank 1 Weeks Lift Pump Tank ' 866T 800 1 Weeks Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu Signatur (No Stamps) MP /14tl?$11V No.: Business Phone Number: Pau C.J. Steiner 6AQ 678D 71 )425-5544 Plumber's Address (Street, City, State, Zip Code): N8230 945th Street; River Falls, WI 54022 IX. CQUNTYIDEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e ssue Issuing ent Sign ure (N A roved Surcharge Fee) pp ❑ O dvers e Given ,&� Od /� � Adverse Determination O X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber III- INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. y. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. °F 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VIi. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE i 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. - The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) S T C - 100 This application form ,is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property Tay K .TPanette Uldrvch Location of property NE 1/4 NE 1/4, Section 33 ,T 28 N -R 18 W Township Kinnickinnic Mailing address 2q646 P. o, g ox, scz, RIVF -K :FALL -s, W1 57g 07-2--05(oS ��- Address of site. ° `ILA F...MERSo" V/aL g,j VSpIVCR_ Maus, V-41 sq oZz Subdivision name C-5AJ &W. I/ ,w. 3091 Lot no. � Other homes on property? Yes x No Previous owner of property Eugene & Muriel Emerson Total size of property 'I -bb ACR Total size of parcel 2G. AUK-Em Date parcel was created 03/19_(0 2E`V(Sr -D Oy 130�q(o Are all corners and lot lines identifiable? _ Yes No Is this property being develope or (spec house) ? Yes x No Volume 5` and Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. s 5!� 3 p-3 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. ignature of Appl.i nt C lican Date of Signature Date of Signature .. i MOUND SYSTEM FOR Jay Uldrych 21646 Bentley Circle Jordan MN 55352 RECEIV E� FEg 0 61996 INDEX ptV• SAFETY 8, BLDGS . As ge l of 7 . ..........................Index �tti o� ........ ...................Calculations �✓ a%�►�s�f . ...........................Plot Plan ag e o ... .............:..........Lateral Layout F r.Nof 7 . ..........................Cross Section o ff• ow` gyp, a ge 5 of 7 ...........................Plan View ge 6 of 7 ...........................Pump Chamber Page 7 of 7 ...........................Pump Curve. Located in the NE a of the 4, Sec. 3 _ 3 T 28 N, R 18 W, Town of Kinnickinnic St Croix Co., Wisconsin. Prepared by Paul C.J. Steiner Steiner Plumbing and Electric, Inc. E N8230 945th Street River Falls, Wisconsin 54022 Master Plumb er: 1z ` - #6780 Date: February 5, 19 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, =XHAkodkAx spacing between laterals. STEP 2: Table 5: 11/2 diameter laterals, 1/4 11 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. DOSE _ t5c /4 ii2..S t (77 F, Ni X 1��) = i'Z5. IZ (,AL M 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 X`distribution pipe volume. Table 10:1 1/2 diam. pipe= .064 gal /ft X .064 = 100 X 10=_ gal. 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 2.50 11.89 TDH page 2 of 7 Page 3 of 7 PLM Ply 5c ale G., I� I?ReN, 000, ( sap i . Iln�; A i • fir-- Do no`s pi i �,�,ax' 750 a 1 Pli,� 6' Ta „k ®'' b i t , ` S1 e )-46 �g !�h Sldpe Sort doles D a f oe s i V- 00.60` C" le v A � M oSQ�` T / `0yro►. 96' y , �.�n e s /a L� CS �t 7`'0 Pr i Val c DrIvc �� Page 4_ �l LATERAL LAYOUT Perforated Pipe Detail 7 Perforated End View Pipe p Holes located on bottom, End Cap ® are equally spaced. Variable -Y" Distance 4 PVC Force Main From Pump Distribution Pipe Last Hole Should be ne;:t to end cap. p 46' X 48" Y 4S'' Hole Diameter 1/4 Inch Lateral " 1 1/2 Inches) LAT. Iwv . Ei.EV, - 94,-S 22' Force Main 2 Inches Page J Of 7 CROSS SECTION Strow, Marsh Hoy. Or Synthetic Covering 1 1 i Distributio n P ipe 1 46 i M G -33 Medium Sand H G Topsoil - = =- - F System Elev. 94.0 3 ` ki C6huz �t3,oz % Slope I � y "_ 2 Force Main Plowed Bed Of 2 2 From Pump Layer Aggregate D 1' E Cross Section Of A Mound System Using F ,8 ' A Bed For The Absorption Area - 0 , G 1. A 4 Ft. H 1.5 PLAN VIEW B _ Ft. I 18 Ft. J 8 Ft. K 10 Ft.(il L 114 Ft. Force Main W _.3o - Ft. L -- Observation Pipe -� - ,___, - - -! - W _ - ►• Distribution Bed Of 2 Pie A regate p 99 Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area DUMP CIIANAER CROSS SECTION Atli) SPECIFICATIONS Vent Cap Weather Proof - Approved Locking Junction Box Manhole Cover 4" C.I. ----- 12" Min Vent Pipe , Final 4" Min Crade 18" Min Conduit 18" ?fin - �, - -- - - - - - -- Approved Inlet ' Joints u/ i ,�� C. I. P 1 p e ' Extending i Ap, roved I 3' Onto Joint W/ " Solid I C. I. Pipe �' A Ground I i ' Extending; 3' Onto ' "' Alarm Solid - Cruund I i On C Pump - Off — Po Concrete Block Cf� U S I TF I C A TI ONS TANK • PU1•I1' Hanufacturer: Weeks Manufacturer: Myers Tank Materiel:_ Q2nq'ete Model Number: MEfo Tank Size: 800 Gallons Switch' Typo Float Total Dynamic (lead: 11.89 Ft. CAPACITI FS Pump Ui:►chtlrg;e Ra L : 30 GPM 2.C.31;'" [ Total Daily Effluent: 450 Gallons A - 11 or x. 34 "�_5 Cal Ions Number of Uoueu : 4 Per Day B 2 or 34,2 Callons Dose Volume :' 112.52 Gallons C • '! or li-27 2 Ca llons 110 tes : 1 . See putip curve for U - 16 9 or 2 89.34 Callong additional performance Total Tank information. 'Capacity Required - 798.06 Cnllona 2. Pump and alarm are to be C _ 7 5"' Est i2'1�, "Lr COALS. inatrilled on ucparat-! circuit ALAIIH au per I LIIR 16.19 NAC . Hnnuf ncturP.r: LeV Ala= TIor1 c 1 Il►►mbc r : _ T) Ou i t cl► Type. - Float 6 ' =g 7 r M E40 Series MYON 4/10 MP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 N 30 H 25 8 Z 120 6 4 15 a O 4 O 10 ~ 5 2 0 0 0 10 20 ZO 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER jay & Jeanette uldrych RIY f o y 2 - o5Co3 E,R FALLS WI Sy 7� A T l /'�' l T v.�-. 11AA7 CC.Z7�- MAILING ADDRESS j PROPERTY ADDRESS qC) EMIR -sc)N VALLG-y DZiVE (location of septic system) Please obtain from the Planning Dept. CITY /STATE River Falls, W I 54022 PROPERTY LOCATION NE 1/4, NE 1/4, Section 33 , T 2 8 N -R 18 W TOWN OF , Kimickimic ST. CROIX COUNTY, WI SUBDIVISION W / LOT NUMBE ,3oq CERTIFIEDSURVEY MAP 55!794 VOLUME PAGE LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on - site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNit. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016 . s PILED 8 APR 3 0 1996 ► 2 KATHI.EEN►I,ry� L ReDlsterolDeedt St. Croix W. V4 542946 cm CERTIFIED SURVEY MAP LOCATED IN THE NEI /4 OF THE NE 1/4 AND IN THE SE 1/4 OF THE NE 1/4, ALL IN SECTION 33, T28N, RIM TOWN OF K I NN I CK I NN I C, ST. CRO I X CO., W1. PREPARED FOR: EUGENE EMERSON �IQTlr HIGHWAY SETBACK LINES ARE I00 FROM RIGHT -OF -WAY LINES. ,VOL ...9,,,,PAGE 2675 / REC. AS S "E r ' REF ERENCED BEARINGS ARE S 86' 14' 1 ' 708. 6 REFERENCED TO THE E -W QUARTER LINE. (RECORD Z t C. S. M. VOL. 5 ' BEARING) I I ....• •..- PAGE . 1276 o LOT 6 is 9.86 ACRES M I (429,447 S0. FT. •p tp � O N 77 25' 00' W o 69.88' APPROX. NORTH L INE ROVED S 87 l 9' 29' E THE SE 1.11 4 -N�. • {,^4' L 644. 77' M • ........... 'R 3 0 WEST L I NE OF THE SE 11'4-NE 114 OU TL OT 7 H 16 40 ACRES C(2QIX COUNTY CD ( � �; ' Plarsnlr :c Z I (71 50. FT.) h I :z 15 84 AC EXC. R1W 4 W : i<.bnin9 and -o g (690,073 SQ. FT.) c�• Parks Committee -� S 51033'01'W dad 0 0 137. 75' / I ai;itin 30 days of ".pproval date w NOTE: APPROVAL OF '• " "'•" .. : D t - ?•: +rovat shall be :Z —THIS OUTLOT DOES , :0 NOT CONSTITUTE APPROVAL OF A EMERSO „ N VALLEY ' V BUILDING SITE. . (I LH 83.03) I DR / VE w � C I OUTL OT I U� 2 W 114 CORNER OF SEC. cr cn OO 1 33, (COUNTY MONUMENT p OO E 114 CORNER OF SEC. FOUND). a 5 O�`L' 33. ( COUNTY MONUMENT 'o $ FOUND) ' � m C. 7% N. ' MI' N 89 ° 59' 09' E a I 40 03.59 ' U 41 9:06' _ W _ 7 N E -W QUARTER LINE - 04 p,�ttttNh� M 7 0 = SET I" X 24" IRON PIPE WEIGHING 1. 13L BS" PER LINEAR FOOT. 1 JAMES M. WEBER e I" IRON PIPE FOUND. S-1804 SPRING VALLEY WI8. 300 0 300 600 900 % O. GRAPH I C SCALE - FEET -""^` ^ JAMES M. WEBER S -1804 NELSEN-WE LA ND SURV SHEET I OF 2 T A REVISED TH THIS 20TH DAY OF AA R l L, 19966 96 -19 THIS INSTRUMENT DRAFTED BY JIM WEBER 3oT•'• ' Vol. 11 Page 3091 DESCRIPTION A parcel of land located in the NE' /4 of the NE' /4 and in the SE' /4 of the NE 1 /4, all in Section 33, T28N, R18W, Town of Kinnickinnic, St.Croix County, Wisconsin, more fully described as follows: 1 on Commencing at the E /4 corner of sand Section 33; Thence S89 58 58 V4 al the East - West Quarter Section Line a distance of 790.07' to the POINT OF BEGINNING: Thence continuing S89 ° 58 1 58 "W along said line 495.42'; Thence N00 °10'50 "W 1370.25'; Thence N77 °25'00 "W 33.83'; Thence N00 °10'04 "W 554.95' to the southwest corner of Lot 5 of the Certified Survey Map recorded in Volume 9 of Certified Survey Maps, Page 2675; Thence S86 ° 14'15 "E (recorded as S88 ° 02 1 53 "E) alongthe south line of said Certified Survey 708.68' to a point on the west line of Emerson Valley Drive; Thence S02 ° 37'28 "W along said line 1073.30'; Thence S51 0 33'01 "W along said line 137.75'; Thence S01 °14'21 "W along said line 728.25' to the point of beginning, Contains 26.26 acres (1,143,982 sq. ft.) subject to conveyances for C.T.H. "M" highway purposes over the southerly portion as shown. Also subject to any and all additional easements, right -of- ways or conveyances of record. SURVEYOR'S CERTIFICATE 1, .Tames M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin statutes and the provisions of the St.Croix County Subdivision Ordinance and under the direction of Eugene Emerson, I have surveyed, divided and mapped the above described parcel of land and that this map is a correct [pcaesu ion of the boundary thereof. ��`�' Dated this day of 1996 JAMES M ,$ WEBER S 1804 James M. Weber S -1804 SPRING VALLEY NELSEN -WEBER LAND SURVEYING < 1 Wis. /Q7 I �l e� 100, s S U `F�g en fteot NOTE: The parcels shown on this map are subject to State, County and local laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the ST.Croix County Zoning Office and the appropriate Town Board for advice. SHEET 2 OF 2 96 -19 This instrument drafted by Jim Weber Vol. 11 Page 3091 sinDepa�rtment SOIL AND SITE EVALUATION REPORT Page of .3 jr Labor. and Human Relations Division of Safety & Buildings in accord HR B3.05 Wis. Adm. Code COUNTY Attach complete site plan on paper not less tha 9( M inches ifi. an must include, but C I X not limited to vertical and horizontal reference nt (BM), direetiornd % of lope, scale or PARCEL I.D. # dimensioned, north arrow, and location and istance to,nearest road. 2 Z —1 09 5 — t APPLICANT INFO RMATION- PLEAS.E4PRINT A LL RhtttION� REVIEWED BY DATE PROPERTY OWNER: . ' PERTY LOCATION E u ene 1 j' ry e �) ir�e • T N E 1/4 NE 1/4,S33 T 2 ,N,R I � PgTW PROP RTY OWNER':S MAILING ADDRESS T # BLOCK # SUBD. NAME OR CSM # (0 Emcr r. 10M l e — C1 , STATE ZIP CODE P []CITY []VILLAGE OWN NEAREST ROAD V F- 01 11s a- S X22 (7 (o 't tj N Kin e T, fit M New Construction Use Y4 Residential / Number of bedrooms Addition to existing building Replacement O Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft trench, gpd/ft Absorption area required bed, ft trench, ft ' Maximum design loading rate bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevations) It (as referred to site plan benchmark) Additional design / site considerations Parent material Q� g c to 1- -E-i I, Flood plain elevation, it applicable NA It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT-GRADE 9 SYSTEM N FILL HOLDING TANK U= Unsuitable fors stem [] S ,f'U S O U O S ,� U [] S A5J U ❑ S U O S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell QU. Sz. Cont Color Gr. Sz. Sh. Bed jTmnch n love 2 t -fir S 2 (::i:4iYYii Y J la S —! , I rn -fir c. Z Ground 27 10 YK 2 12 , s 2rn 5bK pjr I elev. r R ,o2 ft. y 2 I 3/z ;i j 2 f"ftly S A C 2. .1 Depth to S -55 / (4 ra v R a/` # m s r I 2 rn s K rr ' _ e5 limiting c 2d factor (o S5 -0 i Y K y ti rn 3� Remarks: brt r'6% ( pgcais ID YK 3 S� Boring # I CS C2 r _ 3 — s' zb Grourxl elev. 1 3 s'r I m 5 b )<, s .3. It. S S y 2 1, 6 Y 51 2- K C S Depth to 1 limiting 2 10 s ID Y k SA f5 (7 S i factor Remarks: r s 3 m r� i I rood v. h 3 s CS me:— Please Pr' Phone: �71 L�� 1 �} S ry 1 �\ 5 er ) Addr t. 2� r \ CST Number: AA 0310 PROPERTY OWNER E- mt rso n SOIL DESCRIPTION REPORT - Rage PARCELI.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Twxh 3 I 0-10 to R 2 11 I oy CLS cs eZ- z 10 . 2 - 2 I C , '2-/ s i I ols s � Ground 2 2,32 1 0 YR 3 / 1 i i 2m sbK d,5 elev. ! y.53ft• q 3z -5'7 0 3/2 1 ti S Z s 'F� Depth to 5 0- 2 i P s7 -6 lug 3 De S 1 ern b) — limiting factor Remarks: or, <" o r r` ) (+ cook Boring # <<M »:.x .... O: uiiie i Ground elev. ft. Depth to limitng factor Remarks: Boring # tai•�a<x Ground elev. ft Depth to limiting factor Remarks: Boring # x'v t. }o-vti i I Ground 1- elev. r ► ft. Depth to limiting factor Remarks: M- 8330(R.M92) 1 t Isconsin Department of Industry bor and Iju man Relations SOIL AND SITE EVALUATION REPORT Page of La Divisio of Safety &Buildings in accord with ILHR 83.05, Wis. Ad --' ` COUNTY ✓'� y Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. PI s dude, bpt� ? 5 r l Y 01 x not limited to vertical and horizontal reference point (BM), direction and % of seal EL I.D. # dimensioned, north arrow, and location and distance to nearest road. f �; , `:' .'pZ2— 10 95- I� APPLICANT INFORMATION- PLEASE PRINT ALL INFORIIMATIO+ /. r rR WD DATE PROPERTY OWNER: _ PERTY ODCATION r 1(Y\arl� l me �stir� J /4 NE # 4•S T Z 8 ,N,R [g FIW w PROPERV OWNERS MAILING ADDRESS L BL C S BD,� NA F OR M # /off �. O 'r� Q � � � � • '�,.. � Cl , STATE ZIP CODE PHONE NUMBER OCI Ik GE'IfOWN NEAREST ROAD oxr Fa1 s W1 2J 6 2Z (715) 5 -554 - i ) - _. 6 Wj ew Construction Use [ ] Residential / Number of bedrooms (] Addition to existing building [ ] Replacement Public or commercial describe Code derived daily flow �50 gpd Recommended design loading rate 0 � S bed, gpd /ft O.tO trench, gpd/ft Absorption area required q60 bed, ft `7 trench, ft Maximum design loading rate bed, gpd /ft O.G trench, gpd/ft Recommended infiltration surface elevation(s) -b be e[ er m „nom! ft (as referred to site plan benchmark) Additional design / site considerations Parent materia 'i 6i 1 4 Flood plain elevation, if applicable Npt It S = Suitable for system CONVENTIONAL I MOUND IN- GROUND RESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S U S U ❑ S EU O S U El XU E] S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTmnch _«4 J Q-S C 2 d 5 :< 13 -2O 10 Y R Z S 11 2 ►^'�sb rq Ground .s 2D - 2''7 ID y 2 z s 1 1 2 m O, elev. 9g0 2 ft. Z 36 It 2 6I1 2r Sbl m v- s c2d Depth to S^ 3 _ 55 10 ' to y e Y. to k s z r Z wtsbK I M-(i N limiting c Zd fac i l SS 0 to le- ` 10 y co S Q rn) — — I NK I M I Remarks: dYlzaa [n YY t x-a, L i2oCke4 5 16 w 3 /4 Boring # NM:IMIXti1 -t >; 1 0-13 10 yj< 21 r 1 7 - ) G c 2 O.S; <; Z f -2p r z S�) 2m 45 Z o.S b•b X " 2 ::4` ir 3 Z5 Ground " 2 —' 5< < Z err sb 5 - F S `•. 0. elev. LI 12S -Np I p 31 -:t;) 51 2 -m , bK 0151, 05 0-S 0-d R3.4 ft. - 3 _51 p 4/Z ..� S, Zmsb dsh — >v� my, Depth to � I limiting (v S1_ 2 ION 5 10 y 1<�Z 5 b Os d /U1� fact, Remarks: rizav,s 3 y n2Qvt I ar'7-0tn b 5 t ion Ica a aids CS Name: —Ple a int Phone: 7 2(o e- qIS dress: 25 S . S ( 400 I SiI;; Date: CST N umber: - /J 3 149'5 N 03 70 7 1 PROPERTY OWNER €1' ty E(4 eh-e SOIL DESCRIPTION REPORT Page Z of PARCELI.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourniary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0 -lo l0 p- 2 11 2--� ds GS e2 o.s 0. z io - z Z )0 21 5`I I m b K CZ o .,5 o. Ground 3 ZZ 32 - 1 0 K 3 /1 2 0 , 3bK j 5k a 5 0 •S 0.� elev. I gy.53 h• y 32- 1 0 )(6 to '1 s 1 I - ryz by, dv 9 I p Depth to j S - 6 34 I \1 2 ry 51 � mS d 1 limiting fact�or� Remarks: i+ COct l`nzo arol S t Boring # Ground elev. ft. Depth to limiting factor LL ---------- Remarks: Boring # .. Ground elev. ft. Depth to limiting factor Remarks: Boring # M1 . Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) ' ' Page ;� of PLOT PLAN Presperty Owner g �� r(la�ri et{ Em�Grs Legend: 1 = yO Legal Description NE' /y 0 L N£ %u, BM = + o -F �" yeilo�,,►n�al N ej T pr �y See. 33, T Zg � �O" � � pWn c����nnlck`�hyi�C 4�u, ed SI4 WOOd' �] = soil boring w /backhoQ F� Qar�3c.. Agee DAY LjkrN E� 93oy� C3 p s o � CL gq.53' o r �m too, n V �Il(" Prope(4y a V 3 zinc 54ake 1� ' 5�1z Ioctx�'. on • -b pr. r OJ c dil v'e ^ Va�1vy Rot .T. H Se�c.33 Signed CST �/&Jjj M03707 Date uguS'1 3.4°1 lSlcll.. ' 2 S, 19 I Page ;S of '« PLOT PLAN Property Owner C � r av� ,i C tl Ems- % On Legend: / If = W I Legal Description NE %4 o--4Vv. NE %y, B M = + o-f /" ye►low,nxe - e. 33 ,Tz$N�1218�, T pVOPe � Se 0 � T o wn ���-K`�nnick'�nvi�� Si{� Wood c�� S�.Cr C•kr`�Y� W soil boring w /backhoe � Qctr�L r r] 62 61 EL 93 oy' Q �83 C3, Ea_ 9 o V pine. ��e 4op o� 5�ecp h�I s�}c Iocmv"0"X -1-b Pv ;,g0je OUI\)p k Sec.33 Signed CST l \ C� M03707 Date f'iowusi 3.1,19.-