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038-1077-70-300
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N G IW S I W C C2- � 0 0 0 '.. 0 0 N 3 1 OD CA S O gyp' Z N O "Omit O Wes^ O : ° fD N N N m 0 I N 0 0 C) r Uf 0 0 3 `� m o o to y .°. a C c 3 00 z a 000 CD o N Z 3 y N N A O C 3 N N N D ° O O o N 3• M O (n N N O O CD m lD A ul p�j N m A ( lV O w 3 I a w z " `v o O D D o D D o O m O 3 m ah• (D 3 t,.►1 ° m jo CD CD � I c w m o p v ii: z o I oo-o I ao� 'Igo A co co z CL 3 c CD N Z I N I CD I I � T a a ° 3 a a 0 w o: o : � w a3i -n I v c I a o a o a CD F N CD z 0 I w I O I I � I I z I y � O P, N I O V I I 0 0 ti CD CD 00 o I o o w f f o o CL o 0- ti • 'Wisccgsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count INSPECTION REPORT St, Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 370207 Permit Holder's Name: ❑ City []Village ❑ 7Jown of: State Plan ID No.: ilkerson Richard I Star Prairie Township CST BM Elev -:- Insp. BM Elev.: BM Description: Parcel Tax No.: 4', U I ( 0 G� / 11 ( 038- 1077 -70 -300 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic We k s l/0c.) Benchmark / Dosing L, boo Alt. BM A Bldg. Sewer Holding 41 ,, &/ Ht Inlet 2. TANK SETBACK INFORMATION 1 1q1 Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet` Air Intake Septic > Z,ud 3 NA Dt Bottom sr-21 - Dosing Z / NA Header / Man. A NA Dist. Pipe o ding �' Bot. System w PUMP / SIPHON INFORMATION 5 Final Grade ' i Manufacturer .1Demand St cover p Z c Model Number �; 'L GPM - FVv\ 9Y- TDH Lift' 3 , (� Friction � y System / TD H?- ', Ft H gad Forcemain Length ,Z -RC` Dia. 7 r Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z I DIME`k I N - M anufacturer: SYSTEM TO P/ L BLDG WELL LAKE/STREAM LE SETBACK CHAMBER System: INFORMATION Type O � (v „ a r r �� Mode{ Num OR NIT � � `j' 3.S .,� LI DISTRIBUTION SYSTEM Header /manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake rr Length Dia. 3 // Length Dia. / 2 Spacing 1S r SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) Inspection #l: < / Z 1v0 Inspection #2: Location: 2117 80th Street, Some set, W1 5 025 (S)AT 1/4 SW 1/4 18 T3 IN R1 8W) - 18.31.18.319B20 -Lot 2 1.) Alt BM Description= vr'rY 2. Bldg ewer length = 7��� g � - amount of cover = - 71f ' 3.) *._ y,o G,rfl Oj t/ < It 4e !1^27n,/ Plan revision required? ❑ Yes M No l Use other side for additional informlation. 1 6/ L �• -I bUA SBD -6710 (R.3/97) Date Inspector's Sign ure Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e z r E E : , I 3 , t s e ; 3 a r , i 2J 1 95 Safety and Buildings Division SANITARY PERM .LItAT 201 W. Washin Avenue Visconsin P O Box 7302 Department of Commerce In accord with corn 8 is. A ode �N Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for t tem, iter not less (Zounty than 8112 x 11 inches in size. • See reverse side for instructions for completing this a . 1 tiohE s, to sanitary Permit Number Personal information you provide may be used for secondary purposes _ " ; Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). 7t' State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL F `fit N /D & is Prope wrier Name PrPr ocation 4 j 1/4, S j g T , N, R E (org Property Owner's Mailing ess Lot Number Block Number it to Zip Code ( hone ;umber Subdivi N me or CSM Number ^S � ' ��� II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t� Nearest Road ❑ Vil age , Zj Public 1 or 2 Family Dwelling - No. of bedrooms Town OF Ill BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) s. :5 19 20 1 ❑ Apartment/ Condo — �>6 v 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 1V. TY OF P MIT: (Check only one box on line A. Check box on line B, if A) 1. 2. ❑ Replacement 3. ❑ Replacement of 4 Reconnection of 5_ ❑ Repair of an ------ em ........ System Tank Only Exi sting System _______ Existing System B) A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 &Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 [] Pit Privy 13 El Seepage Pit 1 43 ❑ Vault Privy 14 ❑ System -In -Fill - ��wQ,(,� , 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 Feet Feet Capacity VII. TANK in allo s Total # of r Prefab. Site g Fiber- Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank — 13 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber %G S' IR ❑ I ❑ I ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatlA of the o site sewage system shown on the attached plans. Plumber's me: ri Plumber's ' nat : ( MP /MPRSW No.: Business Phone Number: 1 P um er's Address (Street, City, St e, Zip Code): 5 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved SIit Surcharge Fee) ary Permit Fee (includes Groundwater ate ssue Issuing Agent Signature (No Stamps) W W( pproved ❑ Owner Given Initial oZ Adverse Determination X C�IONS O PPRNy� R �S ONS n • nv�4�6 " S o -6398 (R. 4/99) x' otsr TION i to a +y aid Info w r �mt�y ` 1 INSTRUCTIONS p 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administfative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Chances 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'whehever 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 and Buildings Division 608 -266 -3151. 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 instarled. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /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 1/2 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 nk r other treatment nk buildin sewers; wells; water mains/water service; streams and lakes um or siphon to s o of e tanks; , () 9 pump p 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 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 contamination investigations and establishment of standards. Safety and Buildings R 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 Vhsconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 22, 2000 CUST ID No.224263 AM. POWTS INSPECTOR ZONING OFFICE KIM A O'CONNELL ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/22/2002 IdentN rs Transaction ID N .3162 Site ID No. 191987 SITE• Please refer to both identification numbers, Site ID: 191987, RICHARD GILKERSON above, in all correspondence with the agency. ST CROIX County, Town of STAR PRAIRIE; 80TH ST, OSCEOLA 54020 SWIA, SWIA, S18, T3 IN, RI 8W FOR: MOUND, 450 GPD Object Type: POWT System Regulated Object ID No.: 663264 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 P. w• chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. C itll The following conditions shall be met during construction or installation and prior to occupancy or use:�,, 1. This plan action is subject to designer comments on the plan. E".�RTMEN; 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular of 5AFE to the direction of maximum slope. D - 3. Vehicular traffic is prohibited in the area 25' beyond the down slope edge of the mound. ��✓' 4. This mound is designed with a 17' lift per page 7 of 9. gEE GORRE 5. The existing dwelling is to be removed from the system prior to the proposed dwelling being connected. CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a potential for a law suit that may delay the effective date of the code so this status may or may not change. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. KIM A O'CONNELL Page 2 5/22/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 4 Sincerely, DATE RECEIVED 05/05/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 ,� . '' c-�- "e (�� - L SHANDORF , POWT PAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 cc: RICHARD GILKERSON MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET Project RICHARD GILKERSON Owner RICHARD GILKERSON Address 131 BELMONT ST OSCEOLA WI 54020 Legal Description SW- SW- SEC18- T31N -R18W Township STAR PRAIRIE County ST. CROIX Subdivision Name Lot No. #### -- �ccy Parcel ID Number Plan Transaction Number F COM ��,p1►It� Y Index and title sheet Page 1 Mound calculations Page 2 - SPOW Mound drawings Page :S Pres. dist. caics. and laterals Page / TDH and pump tank drawing Page 7 3 I lY PUMP CURVES Page 6 PLOT PLAN Page g - 7 -5 - 7 7 z'*--5 r Designer KIM ONNELL License Number 224263 Signs Phone No. 715- 755 -3145 tur- Date 4 -2200 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result In disciplinary action under s. 145.10, Ms. Slats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). SBD- 10462 -E (R.05QB) Page 1 of 9 f WORKSHEET - MOUND SYSTEM DESIGN PROBLEM S Design a mound system fora ,�,�oas°.s�,.s, 1���,� , ,,_,,..,_,,,,,.,,,.,.,.,,_ The site characteristics are: Depth to groundwater or bedrock•�°�G landslope % Percolation rate _,�,Q_ min. /in. Distance from dose chamber to distribution system .„��J, Elevation difference between Dump and distribution system fr�.ft.. Step 1. WASTEWATER LOAD = /�'Q� ' y �a�,�,_ � gal:/ Step 2. SIZE THE ABSORPTION AREA r A) Area required = •►S�S --' ��,�,/ a r sq. ft. B) Bed or trench length (B) _ � ft. - `, C) Bed or trench width (A) ft. ; '•D) Trench spicing (C) Wastewater load : .24 gal /ft /day S ft. 'tre es ot Step 3. MOUND HEIGHT A) Fill depth (D) _ f t... i 6) Fill depth (E) D + slope (Ajf"J ft. C) Bed or trench depth (F) _ ft. D) Cap and topsoil depth (G) _ ft. E) Cap topsoil depth (H) Step 4. MOUND LENGTH A) End slope (K) _' (D + E/ + F + H x 3 ,� ft. B) Total mound length (L) B + 2(K) Step 5. MOUND WIDTH s 9 o - 4 0 5 2 3 Al) Upslope correction factor = �. A2) Upslope width (J) (D + F + G)(3)(factor) _Z, 1 ft. / �1., ,g,3 f /�( 3 )�.86�� '3 B1) Downslope correction factor • 62) Downslope width (I) _ (E + F + G)(3)(fac ^ r) _ �ft. ; o ��b ed `3J/I /c�V C1) Total mound width (W J + A + I ,� ft C2) Total mound width (W) for trenches • �.�; J + + (no. trenches - 1)(c) +A, + I ft. �• Step 6. BASAL AREA A) Infiltrative capacity of natural soil = �9a1.Jft B) Basal area required = wastewater flow natural soil infiltrative• apa ity / - sq. ft. C1) Basal area available for bed for sloping sites = B x (A + I) • sq. ft. C2) Bas are avail le for trench for sloping sites = B WJ + A 1 ft. C3 al area available for trench or bed for level dAJ es = B x W 14Z sq. ft. LiconEe Vu: Date: r Step 7. DISTRIBUTION SYSTEM ��w � ,d ss5re.2 A _ 1A) SIZE DISTRIBUTION SYSTEM .1) Hole size = 6' 90 - 40523 2- in: 2) Hole spacing = .ink 3) Distribution pipe length - 4) Distribution pipe diameters_ in. 5) Spacing between distribution pipes` = 6) Distance from sidewall to distribution pipe = ,f�� in. - 7B) DISTRIBUTION PIPE DISCHARGE RATE 1) Number of holes per pipe = _, 2) Flow per pipe = �, GPM 7C) SIZE MANIFOLD 1) Manifold is central/ end 2) Manifold length = /��1_ ft: 3) Number of distribution lines = 4) Manifold diameter = in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate = GPM 2) Force main diameter =• _ in. 3) Friction loss /0, �eo?G ,�_ ft. ioo 90 7E) TOTA4 DYNAMIC HEAD 1) Vertical lift = t. 2) Friction loss = ft. 3) System head 2.5 ft. s 'ft.i 4 Total dynamic head Data Page_ Of 9 } traw, Marsh Hay, or Synthetic Covering Distribution Pipe Medium- Sand H G Topsoil E ' D 3 a - ,,; ' +$ " ' Trench of V -A Force Main Plowed Layer +% of Slope Aggregate Undisturbed S' (� Sail Cross Section Of A Mound System Using 9 0 .. 4 0 2 Trenches For The Absorption Area D Ft. " A 3 Ft. <' E ',� Ft.- B Ft. F Ft. C Ft. G /,47 Ft i K Ft. H Ft. L - -4 Ft. Signed :� F p;cSE \NAGE SYSTEM License #: ;'" onjitiona Date: 741 RELATIONS t GS Alternate Position of Force Main L A. V 1 Observation I Main W Pipes i Permanent d ----------------- ------ Markers Distribution \Trench of V -2Y' Pipe Aggregate I Mound Using , Trenches For Absorption Area r pelga 4:' 9 1WI41 s3 90. 40 Perforated Pipe Detail End V1001 ' C O Perforated \\ p. End Cop PVC Pipe 5 C/ PVC'Fo.ce Mohr ''s Q PVC MoNfold Pipe "•`. w yy Alternate Posillon Of OiNriD �tion ;. Pipe fares Mein ,.... r, Lost Hole Should 8e Neat To Edo Cop End Cop Distribution Pipe Layout P � Ft. X , Inches. t" Y 07 Inches;' Signed: Hole Diameter Inch'' Lateral " ) Li cense Number: Manifold " Inches- . Date: ,g' 1 ��� Force Mein " _ Inchg3 of holes /pi pe Invert Elevation of Laterals Ft. 1 / TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 17.00 ft 5.18 m Are laterals the highest point in the Friction loss 0.75 ft 0.23 m system? Yes "K' here. u Total dynamic head 20.25 ft 6.17 m If no what is the highest elevation Dose Volume downstream of pump? L_ Dose is > 10 times lateral volume Forcemain drain Lateral void volume 15.2 gal 57.5 L back to tank? f5e' one) Minimum dose 152.0 gal 575.4 L x Yes Drain back 85.2 gal 322.5 L No Dose volume 237.2 gal 897.9 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with weather proof warning label and locking device grade Ie,sls junction box �� —�—� disconnect grade levels altern ate 4" vent pipe electric as per NEC 300 and E.-- ouJet Comm 18.28 WAC \ location 18" (46 cm) min. T wall of pump approved chamber or a outlet joint combination tank A Provide 1/4" weep hole or anti - alarm on siphon device as necessary pump on B Grade levels pump 85.9 ft - pump tank manhole = 4" (10 cm) off el Ell 25.21 m minimum above finished grade D - vent =1 T (30.5 cm) minimum above finished grade 85.0 Ift Pump tank elevation 3 " (75 mm) of bedding under tank 25.9 m bottom of tank Tank manufacturer WEEKS CONCRETE PRODUCTS Pump tank capacity , " 19.4 gal/in Pump tank volume �' 800 gal Pump manufacturer IGOULDS Inches Gallons Pump model number IWE07H c A 19.0 368.8 '05 B 2 38.8 Alarm manufacturer 18.J. ELEC_TO SYSTEMS E C 12.2 237.2 Alarm model number JHW 101 p D 1 8 71 155.2 Project: RICHARD GILKERSON Transaction Number: Page7of urves Pump mm" RET S oll ds 10 -- Z� — OJ ! l - WE01H- - 10 w t WEWL lo 110 1:v �rM :+0 mllh CAPACITY r►; .rl!'7�• w� ';•rte ""� A: I "� ; "t.,. �._U PUMPS. I METERS F9( N'OpEL 33b5 SIZE ids _I V .- I ._. I _.� 7_ i 70 ~ I WEOOrin.. lS � 1 � 11- • - r i 0 0 00 _y0 W Jv w w 1') r:U GPM 0 10 70 30 0 10 J �0 in 1 /h C r t 4r.�H .M r ►..� • rwo Ovww Iwnp�, InO. C J„• u.r , T i I INDUS DIVISION TMENT OF - REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, CC .LABOR HU AN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 3707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP( TY: LOT NO.:BLK. NO.: SUBDIVISION NAME: SW 1 W 1 /4 18 /T31 H/R 18 ( W Star Prarie n/a n/a n/a COUNTY: OWNER'S BUYER'S NAME: MAIL NG ADDRESS: St. Croix Gayle Callahan 114071 N. 30th. St., Stillwater, Mn. 55082 USE DATES OBSERVATIONS MADE I NO. BEDRMS : COMMER IAL D SCRIPTION: PROFI E D S RI TIONS. P R OLA N TESTS: R esidence 3 n/a �ew ❑Replace , 4 -4 -90 4 -11 -90 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND PRESSURE: I SYSTEM-IN-1:1LLHOLDING TANK: RECOMMENDED SYSTEM: (optional) EIS 9U EM U ❑ S E U ❑ S EN I ❑ S DU I mound If Percolation Tests are NOT required DESIGN RATE: Q If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a Floodplain, indi Floo elevation: n/a decimal' PROFILE DESCRIPTIONS page 11 AmC2 BORINGI TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER IDEPrTFNM, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) I a 1 B- 1 5.09 101.76 none 2.59; .67bl.1. .92bn.sil. 1.00bn,s.l, 2 _50bn.mot.s.l. LL B- 2 4.50 101.76 none 2.50 a .83bl.1. .75bn.sil. .92bn.s.1. 2.06b n.mot.s.sil. B _ 3 4.83 99.86 none 2.25 6, 41 1.0Obl.l. 1.25bn.s.sil. 2.58bn.mo s. 1. B- B- B- decimal PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER I AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P none 7J8 1/2 1/2 P-2 2.00 none 30 1/2 3 P-3 2.00 none 30 P -_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 102.76 —�— T --- ' 0 >.� t 0© _ �._.._.. — e , E i i f .. � I _._ _ _ I � e_ E E r I�, __ __ ._ _� __ a .� . _ _ __ _ _ _ _ _ ..__. _ _ I , i E , �. r i _ t ; f I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 4 -11 -90 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 988 N. Shore dr., New Richmond, Wi. 54017 229 71 246 -6200 CST SIG URE: I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — 1 INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 To be a cornplete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clear ly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or cornmercial use planned; 4. Is this <a nevv or replacement system; S. Complete the suitability rating boxes, A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; fi. PLEASE use the abbreviations shown her e for writing profile descriptions and completing the plot plan; 1. MAKE A LEGIBLE diagiam accurately locating Your test locations. Drawing to scab: is preferred. A separate sheet may be used if desired; B. Make Sure your benchmark and vertical elevation reference point are clearly shoU�n, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test. exemp- tion, if appropriate; 10, If the information ( as floors plain, elevation) does not apply, place N.A. ill the appropriate box; 11, Skin the farm and place your current address and your certification nurnber; 12, Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIES SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10 ") BR - Bedrock cot) - Cobble ( - 10 ") SS - Sandstone gr -- Gravel )sander 3 ") LS Limestone 's - Sand HGVV - High Grouridevater cs - Coarw Sand Perc - Percolation Fixate; rat s M ,rliurn' Sand W - Wl it rs Firw Sand BI<1ri _.. C3t ilciiri t Is - Loamy Sailer - Greater Tllsa €i sl - Sanely Loam Less Than `! Loan Bn - Brovvn sil - Silt Learn BI Black si -- Sift Gy - Gray �cl - Clay Loam; Y - Yellovvv scl - Sandy Clay Loam R - Reel sicl Silty Clay Loam mot - Mottles sc - Sandy Clay irvi - with sic - Silty Clay ffi fevv, fine, Faint y , Cray CC, comrrson, coarse p; - Peat rnal Many, mediurn ,n -- Muck d - distinct P - prominent HWIL - High Water level, Six general sail textures surface v ✓ater tot liquid waste disposal BM - Bench Mark VRP Vertical Reference Point TO THE OWNER: ? h=s soil test l eplwl is n i First step ill secut inn a sanitary riermit, The county oi ti`ae Dep;irtn Tray request €l iC: of this soil teat ill =.rlP lk"Id iii iol to nern it ;S:itt<i +t ...?. A corn }filet €:. set of p)lani s for the', private. �:ecae Nit w'd a p-rrlii r._plic,atl,ra mu;t be suhruitted to the appiotaai.tir: local aiutlrority in order to ta?z� a l eranit. l Ile s a Pt t ry t n °nit. n a_s° be of 11i11 ed and hosted psi )} to I t<rt of arly CO1)�truction. I ST CROIX COUNTY SEPTIC "PANIC MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 'OwnerBuyer Mailing Address Property Address 2 Z / (Verification required from Planning Department for new construction) City /State �^S f `��= Parcel Identification Number 03 - /D' 10 LE GAL DESCRIPTION Property Location 5l 'A, 5 Lc' '/4, Sec. , T #N -R4W, Town of S2 v f'A�' Lcl. Subdivision ,L # Certified Survey Map # �' J , Volume i Page # Warranty Deed # _�, , Volume /`5`PJ , Page # Spec house ❑ yes no Lot lines identifiable X yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition arid/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has becrn nu,intaured nnist he completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. i SIGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are tnic to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF A PLICANT DATE * * * * ** Any information that is m i's -represent ed may result in the sanitary permit being revoked by the Zoning Department. * *• * *• ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM 2 — 1982 622325 WARRANTY DEED KATHLEEN H. WALSH WAR • 1 K/ REGISTER OF DEEDS DOCUMENT NO. VOL 150 44 8 ST. CROIX CO., WI -- - -- __- --- - - - - -- _...._ --- - - - -__ RECEIVED FOR RECORD RICHARD O. STOUT and JANET P. STOUT, 05-03-2000 1:00 PN husband and wife, WMTY DEED EXEMPT N CERT COPY FEE: COPY FEE: conveys and warrants to RICHARD L GILKERSON- and TRMSFER FEE: 108.00 MARY A GTLKERSON, hiighanli anA wi fa R FEE: 10.00 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, �A Ay �j ��ee.S 'd State of Wisconsin: I ' 31 ' &e1&7 014 Located in part of the SW 1/4 of the SW 1/4 WT 5�0.20 of Section 18, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin; being part of Lot 1 of CSM recorded in Vol. 13, -- page 3750, more fully described as Lot 2 of p3A 1077 - Certified Survey Map recorded April 28,2000, PARCEL IDENTIFICATION NUMBER in Vol. 14, page 3838, as Document No. 622067. Note: Existing septic system will be used by new construction of Lot 2. Existing home will have easement to use existing system until such time that said home is disconnected from said system. Easement is automatically extinguished at such time. This is not homestead ro tt . P Pe Y (is) (is not) Exceptiontowarranties: easements, restrictions, rights -of -way and covenants of record. i Dated this 1st day of May A (SEAL) Aw.1it. (SEAL) Richard O. Stout Janet P. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, 1 Ss. !&;x County authenticated this day of 19� Personally came before me this day of + the above named t O A j* 'o :glwgr • sravr' TITLE: MEMBER STATE BAR OF WISCONSIN (If not, NOTARY HQ8LIC authorized by §706.06, Wis. Stats.) to me known tc TrAT�iIQF— 11$6+QNW&d the foregoing instru nd ack>(EMOMykeBAST THIS INSTRUMENT WAS DRAFTED BY Janet P. STout 1353 Awatukee Tr. Hud Snn, WT S d (11 6 Nota Public, K County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commissio is eJmanent. (if not, state expire necessary) �l ) • Names of persons signing in any capacity should by typed or primed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN wworisn leper Blake Co., Inc. Form No. 2 — 1982 Mtwauote, we. 622067 owrvER IED SURVEY MAP RI NET P. SMUT LOCAT T OF JA THE SWI 4 OF THE SWI 4 OF SECTION ET / 1353 AWATUKEE TRAIL 18, T31N, R181P, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, 5401 s HUDSON WI IIISCONSIN, BEING PART O F LOT f OF CERTIFIED SURVEY MAP N W z RECORDED IN VOLUME 13, PAGE 3750. 2 - NOTE: EXISTING SEPTIC SYSTEM WLL BE USED BY NEW CONSTRUCTION O a ON LOT 2. EXISTING HOME WILL HAVE EASEMENT TO USE EXISTING W SYSTEM UNTIL SUCH TIME THAT SAID HOME IS DISCONNECTED FROM p U. N SAID SYSTEM. EASEMENT IS AUTOMATICALLY EXTINGUISHED AT SUCH TIME. V O C WI/4 CORNER Z g Z 3 SECTION 18 w fl ' UNPLATTED LANDS _OWNED -BY - OTHERS ----------------- W W ml N M NORTH LINE OF THE SW1 14 OF THE SW1 14 N W F O o l � S 89 0 33'59" E 640.63' p W Z I 607.63' yW2 33.00' ( I (� Z 0 j NOTE: AN EROSION CONTROL PLAN MUST BE SUBMITTED TO TH Z Z N ri ST. CROIX COUNTY ZONING OFFICE BEFORE A = y Q 9 5' 8 I LOi 1 SANITARY PERMIT IS ISSUED ap" 2.650 ACRES m I 33' 33' j 115,420 �O FT N AVICABZZ � 66' JOINTIDRIVE � NN SEPTIC H.>r! L =833.0 I (� AREA 0 � 0 a I co N 89 Wei .89' II W �'�� �D Qi I __- G�1 I (� I p � IT ------ 75' SETBA �- --- - -- �/ �,/�j 1 (D la I h Qi °O A i t � i t o �+ i LOT 2 W 11 " I I ~ �i ° FF j R I• L- m a cq Z I m I W �� 3 tiQ 2.099 ACRES 9515 3 'd' r.l I 91,420 SO FT N 0 Al OI �I r Q la F 1 (0 jV� Q/ p (� I I p io S� G� S Titi O srtio Z I O I Z I Z � N 89"33'59" W 431.69' _j co I v ! LOT 3 A l 0� z �� A I N t1d j 1.794 ACRES Q / / W I W I ,p $ 'C� 78,153 SO FT �/ A O , 0 J j I W N1 1 ZO N A, � V 2 0- J I +; W Z I ! SEPTIC �/ i W I ( AREA H.W.L -955.1 a N c Q V 3 1 33.00' 1 . �` /� X r. I 342.44' a CT C Svc wi 3 I N 89 0 33'59" W 375.44' O. Q 8 z a I U_N_P_ LATTED LANDS OWNED BY _PLATTED a p - ----------- - - - - -- - - °J "� N 0. Z3 o PROPOSED I I. LL Z SW CORNER SECTION 18 LEGEND _� BENCHMARK 970.0 ZJ SCALE IN FEET 1 = 100 ALUMINUM COUNTY SECTION n W " CORNER MONUMENT FOUND I - m.j U 1 00 0 1 200 2' IRON PIPE FOUND z N E w:L �_ X) <.X STORM WATER RETENTION AREA TO 1" IRON PIPE FOUND HIGH WATER LINE (H.W.L. = HIGH WATER LINE ELEVATION) 0 1" X 24' IRON PIPE SET WEIGHING 1.13 LBS. PER LINEAR FOOT NOTE A GRADING THAT WOULD ALTER THE CAPACITY_ _ _ 100' ROADWAY SETBACK LINE OF THE STORM WATER RETENTION AREA IS PROHIBITED 12' UTILITY EASEMENT NOTE B BUILDINGS ARE PROHIBITED WITHIN THE STORM WATER RETENTION AREA Vol. 14 Page 3838 DEPARTMENT OF INDUSTRY, f� SAFETY & BUILDING LABOR s HUMAN RELATIONS NSPECTION REPORT FOR �� �// �� DIVISION P.O. BOX 7969 OA47 SEWAGE SYSTEMS OFFICE OF DIVISION CODES a APPLICATION M DIS N, WI 707 Slate Plan I.D. Number: Sw�, w�, ec.18,T31 -R18 ❑ CONVENTO'ONAL ❑ ALTERATIVE (If assigned) Town of Star Prairi� ©/ $0th St Holding Tank �❑ Ground Pressure Mound NAM9 PERMITHOLDER: ADD 0 PERMIT L IN I �� Gayle Callahan o B ENCH MARK (Permanent reference point) DESCRIBE IF UIFFERENT DIFFERENT FROM LAN: - - ... FIFF. PT. '4 / �C..•�.I.. _., �. (fc� � / r 'S 3 �': °.�, 5'.20 Name of Plumber: MP /MP W No.: County: Sanitary Permit Number: Calvin Powers Jr SEPTIC TANK/ ' 0 ' o d MANUFACTURER: LIQUID CAPACITY: TANK INLET EL .. K OUT WARNING LABEL 1 LOCKINGCOVER PROVIDED: PROVIDED: G pa"t `-�nC, / L 9O.v� X9.103 YE NO YES NO BEDDING: VEIVPDIA.: VGMfi HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T FRESH C . Ur d L' ,O, ALARM: FEET FROM c� LINE: / AIR INLET: YES ONO - 'C'C' �" ❑Y S NO NEAREST --► ?-�� > DOSING CHAMBE : // s, rn •�' ''6�k I MANUFACTURER: I BEOD LIQUID CAPACITY, PUMP MODEL:-- MAN FACTURER: WARNING LABEL LOCKING COVER ES ❑ NO G /D � p J � oC(A �S PRQ YES ❑ NO DYES ❑ NO GALLONS PER C LE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPER WELL: BUILD G: VENT TO FRESH (DIFFERENCE BETWEEN 11 FEET FROM LINE: / AIR INLET: PUMP ON AND OFF 3;-Y ❑ NO NEAREST —* / ^ ? SOIL ABSORPTION SYSTE . Check the soil oisture at the depth of plowing FORCE LENGTH: DIAMETER: M r A�.rV Ip,L ND ARKING: or excavation. (It soil can be rolled into a wire• construction shall cease until `i°' I S the soil is dry enough to continue.) MAIN //, _ �S CONVENTIONAL SYSTEM: BED/TRE WIDTH: LENGTH: NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. TERIAL: NO. DISTR. NUMBER OF LL: IL N : V 0 E H BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: S: FEET FROM LINE: AIR INLET MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAWOF SYSTEM slope and furrows thrown unsllo mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTUR : PERMANENT MARKERS: OBSERVATION WELLS; VO f' YES ❑ NO YES F-1 NO Z DEPTH OVER TRENCH /BED DEPTH OVER TRENCHIOM HS OF OPSOIL: SODDED: SEEDED: MULCHED: CENTER: �� DEPT EDGES: �/ 6o C 1 YES 2'1Q0 ES ❑ NO L -?TS ❑ NO PRESSURIZED DISTRIBUTION SYSTE - / ° t i BED/TRENCH WIDTH: LENGTH: LAT RAL SPACING: GRAVEL DEPTH ELOW P FILL DEPTH ABOVE COVER: 3 / TRENCHES: // DIMENSIONS G 3 Z �S �. MANIFOLD PUMP p MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL 8 MARKING ELEVATION AND ELEV.; ELEV.: / DIA.:� // EL 3r d PIPES: DIA.: N C.. (c-k C1!5' Or DISTRIBUTION e 1 7 HOLE I : HOLE SPACING: pRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORR SPONDS TO INFORMATION y APPROVE PLANS / ?J Ci�t [:] NO / ��. "" . 7, ❑ YES S1gZS _.: PERMANENT MARKERS' OBSERVATION WELLS: r NUMBER OF PROPERTY WELL: 8 LDING:` COMMENTS /Z - FEET FROM LINE: YES ED NO YES ❑ NO NEAREST —► tW to & 0 5rs'c/-a�1 l �, y7 � �'� �,�- �o•- �'-��. cal t,�CS , / 2, G� �� 41.1 -cxj�, c �. t � a<..�..�// Ci Sketch System on aln in county file for audit. Reverse Side. SIGNA RE: TITLE: SBD -6710 (R. 06/88) --m *Omer-, X DEPARTMENT OF INDUSTRY SPECTION REPORT FOR ,�Qf�� SAFETY &BUILDING LABOR & HOMAN RELATIONS ���y �/ (V� DIVISION P.O. BOX 7969 O TE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION M DIS N, WI 3707 State Plan I.D. Number: Sw, S 4 ,T -R18 (It assigned) Town of Star Prair� ❑ CONVENTONAL El ALTERATIVE 80th St . Holding Tank - Ground Pressure 0 Mound 9 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTIO E: /o /sS� itti Gayle Callahan 1 0 BENCHMARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. CST REF. PT. 14 _ ( . %Q ' 5.20 r iz Name of Plumber: W No.: County: Sanitary Permit Number: F 1 , 563 Calvin Powers Jr. SEPTIC TANK/ ' 3— 61 d MANUFACTURER: LIQUID CAPACITY: TANK INLET EL .. K OUT WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: G / vim' S �►tC. / O w 9a•�.� 8'9.103 YES ❑ NO ❑ YES 91 NO BEDDING: VE FFDIA.: VENfiMATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: I VENT T6 FRESH 0 ALARM: FEET FROM / LINE: AIR INLET: YES ❑ NO ❑ YES NO NEAREST --► '� > OSING CHAMBE : //. 6 s, m •L" ��Blk = O I MANUFACTURER: BEDD LIQUID CAPACITY: 1 PUMPMODEL: PUMP19WOON MANUFACTURER: WARNING LABEL LOCKING COVER n C / PROVIDED: PROVIDED: ES ❑ NO �i /D ��S 0 �K�.�v YES ❑ NO JaYES ❑ NO GALLONS PER C LE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILD G: VENT TO FRESH DIFFERENCE BETWEEN « FEET FROM LINE: / AIR INLET: PUMP ON AND OFF ES ❑ NO NEAREST —� /� �� ' SOIL ABSORPTION SYSTEM. Check the soil oisture at the depth of plowing FORCE LENGTH: DIAMETER: M � ER ND ARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until rr p is 1S p MAIN the soil is dry enough to continue.) / Cy _ O CONVENTIONAL SYSTEM: BED /TRE WIDTH LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: 0 PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH F DISTR. PIPE DISTR. TERIAL: NO. DISTR-1 NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: S: FEET FROM LINE: AIR INLET 35. 35 MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRA SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW aZLY ❑ YES NO Z meets the criteria for medium sand. ELEVATIONS MEASURED. � d SOIL COVER I TEXTURE PERMANENT MARKERS: OBSERVATION WELLS; /Z „ t✓ YES ❑ NO YES ❑ NO DEPTH OVER TRENCHIBED DEPTH OVER TRENCHIOM DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: H EDGES: /j // ,L.... Sr 67 o ❑ YES Ld<o ES ❑ NO F!!! 4 S ❑ NO PRESSURIZED DISTRIBUTION SYSTE ! ° WIDTH: LENGTH: Ae. O LATERAL SPACING: GRAVEL DEPTH ELOW P FILL DEPTH ABOVE COVER: BED /TRENCH l / TRENCHES: DIMENSIONS •G. MANIFOLD PUMP Q MANIFOLD DISTR. PIPE 1 MATERIAL:1 NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV: DIA.: /j ELEV., ,�py '/ PIPES: DIA.: ELEVATION AND 4 1I , ��J�G6 �Ob�GC� y h C(S 8 f DISTRIBUTION ' / 40 '% HOLE SIZ : HOLE SPAC DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION (t // APPROVE PLANS yl 7 J C EO❑ NO - ?� 4 41 ❑ YES Ci+I a PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: COMMENTS: 1 - FEET FROM LINE: , / YES ❑ NO YES [::] NO NEAREST --* !Q 0 710 D r U d � , �; air wJ� / ' �=' ✓- 3. EO o� S�'c✓- z. $� ( /o1.s��, ,�' , "lG ��f 10 Ci Sketch System on ain in county file for audit. Reverse Side. SIGNA RE'. TITLE: SBD -6710 (R. 06/88) Z OILHR S ANITARY PERMIT APPLICATION COUN In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERM # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ J rbvil 8% x 11 inches in size. C �1 b0bp vwus application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICA T INFORMATI N - PLEASE PRINT ALL INFORMATION. PROP RTY O NER PROPERTY LOCATION %4, S T , N, R PR P OWNER' MAILING ADDRESS LOT # BLOCK # ,AV1 71 CITY, STAT "A ZIP CODE PHONE NUMBER SUBDIVISION NAME CSM NUMBER 11. TYPE OF BUILDING: (Check one) ❑ State Owned VIL : NEAREST ROAD ❑ Public [4 1 or 2 Fam. Dwelling -# of bedrooms J?_ PARCEL TAX NUMBER(S) � III. BUILDING USE: (If building type is public, check all that apply) CP 70-6700 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. JX New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 A Mound 30 El 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 Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber / VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's N me (Print . PI umb 's Signet e: ( S m ) MP /MPRSW No.: Business Phone Number: Plumbs 's Address treat, City, State, Zip Co ). IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuin Agent Sig;ur.e NoS Approved ❑ Surcharge Fee) Owner Given Initial l /( A e etermin 6 i n / rn X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398, (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5_ Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: 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. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. 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 816 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 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) ST. CROIX COUNTY WISCONSIN ZONING OFFICE 44` ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386 -4680 Sao A 05 0:. Sept. 24, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Gayle Callahan property located at the SW 1/4 of the SW 1/4 of Section 18, T31N -R18W, Town of Star Prairie, St. Croix County revealed suitable soils at a depth of 2.25' below which seasonable high ground water was noted. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj WORKSHEET - MOUND SYSTEM DESIGN /, PROBLEM: S 9 0 m 4 0 5 2 3 Design a mound system for a „�,�',,n, The site characteristics are: Depth to g roundwater or bedrock p 9 Landslope _ Percolation rate min. /in. Distance from dose chamber to distribution system .„� ft., Elevation difference between Dump and distribution system Step 1. WASTEWATER LOAD Step'2. SIZE THE ABSORPTION AREA A) Area required = S"0�,�� ; �� a = sq. ft. B) Brad or trench length (B) _ -ft. C) Bed or trench width (A) _ , ft. D) Trench spacing (C) _ 2 j r Wastewater load .24 gal/ft /day B L�c.L. ft. trenches j es c Step 3. MOUND HEIGHT A) Fill depth (D) _ ft. B) Fill depth (E) = D + slope (AJf�� 0.2.�„ ft. f C) Bed or trench depth (F) rt. D) Cap and topsoil depth (G) _ ft.,/ E) Cap topsoil depth (H) _., �ft. License Nu:_ �� Step 4. MOUND LENGTH A) End slope (K) s' D + E l + F + H x 3 = ,� ft. 7 . B) Total mound length (L) B + 2(K) _�ft. / Step 5. MOUND WIDTH S Al) Upslope correction factor = A2) Upslope width (J) (D + F + G)(3)(factor) _ X-3 ft. / �/., ,8,f4- 81) Downslope correction factor = B2) Downslope width (I) _ (E + F + G)(3)(factor) = L��.�.ft. Cl) VP Total mound width (W for bed J + A + I • Qi ft. C2) Total mound width (W) for trenches J + 2 + (no. trenches -1)(c) + A + I 3 ft. Step 6. BASAL AREA A) Infiltrative capacity of natural soil .gal. /ft /da; B) Basal area required = wastewater flow ' natural soil infiltrative• apa ity = l„�sq. ft. � Cl) Basal area available for bed for sloping sites = B x (A + I) _ sq. ft. C2) Bas are avail le for trench for sloping sites = B W /J + A 1 = 01 al area available for trench or bed for level i ; es = B x W 16 sq. ft. Sign: a License Data: rye. .. • f. !S/D�'/ X30 � .S� 611 4 i Step 7. DISTRIBUTION SYSTEM Slellw Ix- eA/s'srg.2 I 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size = 6 90 - 40523 . in: � 2) Hole spacing = �3 ink 3 Distribution i e length in'•p'Gf'" P P 9 j `� 4) Distribution pipe diameter =_ in. 5) Spacing between distribution pipes' _ 6) Distance from sidewall to distribution pipe in.Y 7B) DISTRIBUTION PIPE DISCHARGE RATE 1) Number of holes per pipe 2) Flow per pipe �,�„ GPM, " 7C) SIZE MANIFOLD 1) Manifold is �„ central / end 2) Manifold length = /� ft: 3) Number of distribution lines 4) Manifold diameter = _ in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate ,GPM 2) Force main diameter _ in. 3) Friction loss = /X/.2 �'� �oz �L ft. 9d 7E) TOTAL DYNAMIC HEAD 1) Vertical lift = - 420ft. 2) Friction loss = ,�� ft. s 3) System head 2.5 ft. a J4 Total dynamic head Sign: Licerge: Date: of /�o7IN 3a A V , _ 6 0-405 9 23 1F) PUMP SELECTION 1) Pump selected will discharge GPM at 1 ft. Y total dynamic � amic head. 2) Pump model and manufactu er �.��. 7G) DOSE VOLUME 1) 10 times void volume of distribution lines ,[� gal. /cycle 2) Da ly Zst volume - dos s/ 4 hrs. _ gal. /cycle .. %� -� � /�s .: /lam, 5' 3) Minimum dosr volume = '//.r gal. /cycle 7H) DOSE CHAMBER 1) Minimum capacity required = a1. P Y 4 9 s 7SBg¢� �'�- Sign: License ::u:���_ r Date: ' I - - - r- �► o � ti_.. I I 6nj io�t i_ � p��ZM��� fi r . (,��' � C — -- - ti ..e• r f..._ -+ I... - � -.._. .� ._._i_� e — I I , : . I k I I _ : : : { I ; : , I : I 1 . Z I -- -- - � ar 5 Ft t�tz I i Page�of�� • � i a traw, Marsh Hay, or Synthetic Covering Distribution Pipe Medium Sand H . G F Topsoil J 1 — - = =_ �( D E Trench of Y' -2V Force Main Plowed Layer t% of Slope Aggregate Undisturbed •• 3 Soil Cross Section Of A Mound System Using S (� 7 ® 4 v n 5 2 Trenches For The Absorption Area D Ft.' A 3 Ft, E Ft.- B Ft . - F ,'� Ft ., C�Ft. G Ft,- Ft. H Ft.' L L Ft. � Ft Signed: 3... ;SEWAGE SYSTEM License #: 0* diti oaa#7 Date: �, `� , r rz9 ' 4 ,r1 fir. -.4 ,gip % V 'Af" . �Y. r RELAT(GNS {u , LIiVJ ii �=v t GS Alternate Position of pLPA4�Yti 11''1 `Iq Force Main v J B — Iljf —K-- -► A L --- - ----- -- - -- - - - -J t C Force/ Obs ervation I Main W Pipes Permanent ------- _. _ —' —_ — _ Marker s Distribution \Trench of V -2Y" Pipe Aggregate Y I Mound Using jX Trenches For Absorption Area m W n N k o S w� 90-40523 � o N N N • N n fr 0 f1 M �a rt � m 1 m N � .7 N rr to a -- rr - - - r w fD M j, 0 r t ti \ � " �•1 - - all r I rt 5 7 v $� rt a a a i 7i Al 3o�� Pdga G'4, f 90 40 Perforated Pipe Wall nd View �5�s d ) Perforated p.G End Cap ,�� PVC Pipe ��,, Ge Lot' 'A e PVc`FaeR Moir ;�.. I da PVC :r Manifold Pips AINrn4la Position Of Oistrib Non 'Force Main Pipe Last stole Should Bo Nest To End Cop ti , End Cop Distribution Pipe Layout P Q_ . Ft. R S 19 . �7; r •% 1 X ,; Inches' Y s T7 Inches Signed: Hole Diameter 1 Inch'' Lateral " Inch(es) License Number: Manifold inches Date: �,cz�s1 —9 Force Main " _ Inchos r # of holes /pipe Invert Elevation.of Laterals 3.,Z PAGE � OF 2:2— PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS Al- ?d VCNT CAP �^��(�< 4"C. I. VENT PIPE WEATHER PROOF APPROVED LOCKING 25' FROM DOOR, JUNCTION BOX MANHOLE COVER WINDOW OR FRESH 1 V IU. . AIR INTAKE GRADE-- I I • I I B" MI IJ. CONDUIT �-- le "MIN, 4 X1 PROVIDE YS��M AIRTIGHT SEAL . APPROVED JOIN /C.I. PIPE T APPROVED JOIN rJ� I I EXTENDINf" 3',. N �� ? I I I W /C.I. PIPE ONTO §41_ sc'; y �J f. 5 3 I I ALARM E X TENDING 3' ONTO SOLID SOIL �4 A „� °4a .� ' , `�c u�.. �`., ••''� , to a I oN ;L _ _ j PUMP --� OFF CONCRETE BLOCK RISER EXIT PERMI7TED OWLJ IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC AND SPECIFICATIONS DOSE TANKS MANUFACTURER : er''_1'r_� / X'd. ►UMBER OF DOSES: TANK � PER pA� .,IZE : GALL OIJS DOSE VOLUME ALARM MAAIUFACTUR¢R: "' INCLUC...• ZACY,FLOW; '-S GALLONS MODEL ►DUMBER: // � CAPACITIES: A= 22-P INCHES OR 7 GALLOWS SWITCH TYPE: - _ �" �p 1 24 (Al_.% INCHES OR ..G_lc.� GALLONS PUMP MANUFACTURER-. C = &S OR sC�G ALLONS MODEL NUMBER: 100 V5 (7Aa<_••-- ,Q/ / �j D INCHES OR Z GALLONS SWITCH TYPE: - - - -� — MOTE: PUMP AND ALARM ARE TO BE PUMP DISCHAR`E RATE GP4 17' INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE Be PUMP OFF AND DISTRIBUTION PIPE.. 1- FEET + MI (� A l/ AUM NETWORK SUPPLY PRESSURE , . . , , 2 . 5 FEET + -A2— FEET OF FORCE MAIN X � IDO FT.FRICTION FACTOR. FEET TOTAL 0!:IWAMIC HEAD — FEET INTERNAL RIME►JSIGNC TANK: LENGTH ;WIDTH -- --- ;LIQUID DEPTH 1 SIGNED:' - NUJ LICEIJSE IV UMBER: /_f Z ? DATE n -117 - Gat! LD S IBLE �:.+.' • ) tn. a PUMPS � �' SEWAGE• °AND EFFLUENT �yor� =3o r ER0311 � �, ;f,r'��'_�. •,. •. .. LIs'r Disc. 1's Ox1PFp0311 142 FP0311 1/3 Fp 115 V Effluent Pure 1 1/2" solids 156.80 172.10 xq 4� it ;� a [► @ i+4s1 S r! "S l.l b mersible EL E U .. 4 �►y�, MOD EL .,:. Effluent'Pump 5 2 SIZE Ya" SOLIDS q h ^ y t MMRS FEET ` x a 25 11 `, �! 20 7r C. 4 4 q t�I -4 T: Y- 2 7 C• }, ,a� r � 5 � t 1 t 0 0 4 a 12 16 YO 24 2a J2 Ja �0. GPM 0 2.5 5.0 7.5 m'/M CAPACITY �l ,G :. A N Y' #, Performance 3885 Curve MCTVU IT" K 90 _ MODEL 3885 SIZE 3 /4" Solid s p WLOSIS O , 10 30 F �' W[0X 0 ° o ,o z0 » a ' a ao )o so 00 l oo llo lm �►�+ .. j � •,� �.__..._ to ao w+rm �}k �.... q 4 0 • CAPACITY . 1 " . LIST DISC. 3/4' solids' 491.55 329.3S 000ME03111. 142 wFA311L 1/3 HP 115 V La! H 3/4^ solids 491.55 329.35 x )sa,� ,; x frq p()( ptdE031]M 142 ' HE0311M 1/3 HP 115 V Mod H' r 3/4" eglids 704.25 471.85 1 nl r ? 1 QJ(1Eh%OSll}I 142 WEOSIIH 1/2 IT 115 V High H 3/4 solids A43.65 565.25' T. 07UPh'E0712tf 142 WT 071211 HP 230 V High Fli. r ill ' AND SPECIFICATICYIS. A* 5 4, q Y ° Lt�.. ' FV111WING PACE FCR PEPFCEN1AF3r -E PAGE 07u �'� �.'. D�•g . '10/88. DII 30 tip• : ' DEPAR'TI REPORT ON SOIL BORINGS AND SAFEYY &BUILDINGS INDUSTRY, DIVISION LA ROR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN-RELATIONS (H63.090) &Chapter 145.045) LOCATION: ECTION: TOWNSHIP/ fPkkfTY: LOT NO.: BLK. NO.: SUBDIVISION NAME: Sw '1,PW t/4 18 /T31 N/R 18E (or) W Star Prarie n/a I n/a n/a COUNTY: OWNER'S BUYER'S NAME: MA LIN ADDRESS: St. Croix Gayle Callahan 114071 N. 30th. St., Stillwater, Mn. 55082 US DATES OBSERVATIONS MADE r � NO. BEDRMS.: COMMERCIAL DESCRIPTIO (��� PROFILE E D R P ' ONS: A ON TESTS: 129iesidence 3 n/a M New ❑Replace 4 -4 -90 4 -11 -90 RATING: S= Site suitable for system U =_Site unsuitable for system CONVENTI NAL: MOUND: IN- GROUND- PRESSUR : S STEM -IN -FILL HOLDING TANK: RECOMMEND :lopti I �0 S U 9S ❑ U [- 9 U ❑ S ®U ❑ S� mound If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. indicate: n/a Ftoodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 11 AmC2 BORING TOTAL DE PTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTF}W ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) B- 1 5.09 101.76 none 2.59 .67bl.1. .92bn.sil. 1.00bn.s.1. 2.50bn.mot.s.1. B _ 2 4.50 101.76 none 2.50 .83bl.1. .75bn.sil. .92bn.s.l. 2.00bn.mot.s.Sil. B- 3 4.83 99.86 none 2.25 1.00bl.l. 1.25bn.s.sil. 2.58bn.mot. S -1. B- B- B- decimal' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RA1 E MINUTES NUMBER 1 AFTERSWELLING INTERVAL -MIN. PERT o f PERt o P R PER INCH P none 7/$ 1/2 1/2 P_ 2 2.00 none 30 1 2 P- 3 2.00 none P- P- P PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 102.76 _. �ro3 I f t +0 1� rY► )'(,<��a. YO i 1 ' I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 4 -11 -90 ADDRESS: . f CERTIFICATION NUMBER PHONE NUMBER(optional): 988 N. Shore dr., New Richmond, Wi. 54017 229 71 246 -6200 CST SIGI RE. DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR SBD -6395 (R. 02/82) — OVER — !" I r ST. CROIX COUNTY WISCONSIN tr ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 Sept. 24, 1990 Division of Safety and Building Bureau of Plumbing F.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Gayle Callahan property located at the SW 1/4 of the SW 1/4 of Section 18, T31N -R18W, Town of Star Prairie, St. Croix County revealed suitable soils at a depth of 2.25' below which seasonable high ground water was noted. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj . APPLICATION FOR SANITARY PERMIT STC -100 This application form is to be completed in full and signed by the Ownet(s) of the property being developed Any lnadoquacles Will only result In delays of the patmIt Issuance. -Should this development be Intended tot tesali by owner /contractor#(spec house) thou a second foam should be retained and completed when tths property to sold and submitted to this ottlee With the appropriate deed recording. - - - - - -- - - - - - - - - - - - - - -- - -- -- - - - - -- - - - - --- - - ---- -- -- -- -- - -- Ovner of property 09 0% 0 La a Location of property � w l/1 - +_1/4• Section Township s P—t , t •e Melling address 114 Address of alto - Subdivision name Lot number Previous owner of property Total size of parcel Date parcel was created IS Are all cornets and lot lines ldentltlablet [._ Yes JI 0 is this property being developed for resale (epee house)T___Yas Volume ,wand Page Number 49.1/ as recorded vlth the Reglstet of Deeds. -------------------------------------------------------------- �-�•���•�a��• INCLUDS WITH THIS APPLICATION THE FOLLOWINCt A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE RE018TER Of DEEDS. In addition, a certified survey, It available, would be helpful so as to avoid delays of the tevleving process. It the deed desctlptlon references to a Ceitltled survey Map, the Cettitled Survey Map shall also be required. --------------------------------------------------------- T --------------------- PROPERTY OWNER CERTIFICATION live) certify that all statements on this form are true to the best of my (out) knowledge= that I (we) am (ate) the ownet(s) of the property described In this Intotmatlon totm, by virtue of a warranty deed recorded In the Office of the County Reglstet of Deeds as Document No. �S •.� S�o2 s and that I (Vol ptesently own the proposed alto for the sewage disposal system (at I (ve) have obtained an easement, to tun with the above described property, tot the conettuction of sold system, and the same has been duly recorded In the Office of the Coy ty Register of Doe", as Document No. 1. Signature ag - 6 - wn0i signature of Co -Ownet (11 Applicable) .. IL /3 �90 Ga te of signature Date of Slgnatute DOCUMENT NO. WARRANTY DEED STATE BAR OF WISCONSIN FORM 2 —� X982 THIS SPACE RESERVED FOR RECORDING DATA -_ - - --- -- �� pACE Q REGISTER'S - - -_ - S OFFICE Gary A. Breault and Patricia- -J.. •Breault ST• CROIX Co., WI husband "_and - ".wife -" -r- ReC fo Retard ... .. - • - - - -- - ---------- • "-- ............... -- - -- ---- • - - - -- - .............................. ar APR2 51990 conveys and warrants to . Ga . ................. • M YJ.e...K..- ."Callahan. - .and... Rosemary.. 10 5 ' per-ty..W han,.. husband - and. "wif.e,.. "as.._marital..pro. - - perty.. .wig. _ Reohtirofp -------- -- - - - -- P ......... - - - - -- ... ......... . . . .. - the followin g described real estate in - - "- `� -��-` -- -�--- - State of Wisconsin: St • Cr.Qi:. {..... -- --�M il�5A,T— ------- .County, Tax Parcel No: The Southwest Quarter of the Southwest Section Eighteen (13), Township Thirt Quarter (SW of o t<a�) of Y Range Eighteen (18) West. one (31) North, of 14 dD This i homestead 110t " - -• -- homestead (is) (is not) Property. Exception to warranties: bated this .. ...... _23 ........................ -- day f - Y .......... 1s..90... . -------- (SEAL) .. -- - - � .....--- ••-- (SEAL) ----------- - - - - -- - -- - - - - -- • - -Gar.y A. Breault •-------- - - - - -- ------------ (SEAL) ...... _ (SEAL) , .Patricia J. Breault .. . ........ AUT HENTICATION Signatures) ACK NOWLEDGMENT STATE OF WISCONSIN authenticated this St. Croix ss. ........ day of - - - - -- - •- - - -... ••------- • - - -, 19._. - -- .- .._.._.County. Personally came before me this A ---- - - - - -- ---•----------•--- --•-•---------- ••--------- -------- • - - - - -- -- •--- Ga A rl -- • - •• ---• --daY of •- p -- ----------------- - - - - -- 19.90.. the above named y - A, ► r . Breault and Patricia J. MEMBER Breault "ITLE: STATE BAR OF WISCONSIN (If not, _ -••_ - authorized 7 .0 Wis. Stats.) b ..._._...-- -• - -•- .__ •--- •--------- •-- - - - -•- --------------- ••-- .._...._._..--- ..._.. - - - -.. Y � 066, - - -- - • e . - -- - -- -..•- to me known t he the pe . rson -_S" T4 1S INSTRUMENT WAS DRAFTED BY foregoi inst "lent 't d a c; � �� `/� o me the !instra Van D } ' I r� � f. _- •-• ---- ---� k & Needh_a__m 1 Sout -- h Knowles Avenue, - - -f -S•C. ---- - - -• -- Box 127 .J O �/ ? �. i w. Richmond .., WI 54- Q1.7--------------- ---------- gnatures ma . Nntary r Zl y be authenticated or acknowled * Public . - -" St --• ----- not necessary.) - -� C9iX i ed. Both D[c C.onunission is pe t118nt. I Wis. t, stat _ e �U - date . of persons signing in any capacitY should be t �� rf •,` $ Spe.l or printed helnn• lh•'ir signnturrr. ��I dfo `••••••�*_,��S � k- 4RANTY DEED ����� If vi s! Q P - STATE; DAR • OF 4 L ° [3COAl�Iy � �+ F'(1nM r.. .. IV NIOM Q j 1\ F- O cc w oQ m \ z o z w J a w F Q p a : r �� W F w pLL U, 7 IL r`• w z Z wQ w Z r < C- z O J LLo ?� ° a O ( J Q CO cc LL W CC 07J Cr. �7• N O W N LL J F� U z O d ° O LL f Q = O Q= z ° r z ¢z pa - a ~� U O W J N W (7 U Q WJ wz a. c HN ZX Wa W J J >Q Q QO to j W c wr ¢O U OrO �- U'V - t a dU t p7 au r fW a_. � N W (} U Ix F W z w Q co L6 0 a CJ U = w W a o LX w W w z F W T. F- Ci � Q CD Z F. C U LU w W Q t7 W. Yl U aC CL u Ci cD ( J U) w F - z oo X v X -� E- CG ►-i O (� O Lu din Q Ot Y o ,try R: LU Q t..l M O dIR ~ z a. Watt= z 0.r Lei a rL 43: w W w R J a¢ U p CL w w `�' o ¢ u x C7 p O try U ►- O W r ..� Q "' U U U i Q; a I-- W >- W a)-- s z 0 W F 2 C4 f Cl) W U =a .- U F- S H W¢ Q U CL Qi 3 (ry Q (] � M OD W LL f. Z W O Ch w CJ x m> 00 C[ F. Z F F- r r V F �' < -M00 p s IL U IL t*i co u Q CL m 2 Co r LU �- lA th f N SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County OWNER /BUYER o �j , Fire Number o ROUTE/BOX NUMBER y 6 0 w CITY /STATE ZIP ,$.S 0" M PROPERTY LOCATION:' Section JS' T._N, RJZ,W, Town of �r= �.sr,: - ._ , St. Croix County, Subdivision /11A Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed' 'se t'ic tank pumper. What you put into the system can a . ect the unct on o. tae s eptic tank as a treat- ment'stage in the waste disposal system. St. Croix Count residents-may b Te e �agement t of a failing system, g rant a maximum of 60% of the cost o f p which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new ' sys't'ems agree to keep their system properly maintained. The property owner agrees to.submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on - site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- essary), the septic.tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. y 0 I /WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with as-set by the Wisconsin Depart- the standards set forth, herein, ment of rnedrtoo theoStCeCroixeCountyaZoningo0fficetwithinm30edays and returne of the three year expiration date. SIGNED '�'' •--' DATE to /3 �F St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386 -4680 Sign, date and return to the above address.