HomeMy WebLinkAbout010-1082-20-000 ST. CROIX COUNTY ZONING DEPARTMENT
1< y
AS BUILT SANITARY REPORT
Owner r 1 e °..
Property Address 2 t/ G-
City/State
Legal Description:
Lot Block Subdivision/CSM #
NI t/a tL� ' /a, Sec., T,N -RAW, Town of PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer M, c/.«r e-S4 Size ST/PC )GaU/ wetback from: House - Z2 Well PAL
Pump manufacturer :2r-//e Model l 3
Alarm location a L%G r. C-T t? a !4
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location r'
Alarm location
SOIL ABSORPTION SYSTEM
Type of system 111,6 G h e/ Width �� Length _ �( ? Number of Trenches
Setback from: House k5� Well PAL Vent to fresh air intake
ELEVATIONS
Description of benchmark L?4cr & l c e-C 04 0 Elevation 9 S ; / ?
Description of alternate benchmark 6 ?At Elevation qy
Building Sewer ST/HT Inlet ? 3 ST Outlet 1 PC Inlet
PC Bottom Header/Manifold U Top of ST/PC Manhole Cover 9 6 e f ?
Distribution Lines
Bottom of System O 1 �► O ( )
Final Grade
C JrPrty
Date of installation 0 /J(
/ Permit number' State plan number 2 3 6 2 - At
Plumber's signature c, 'Y License number Date
Inspector ��P. vim_
Complete plot plan �+
i
1 i
NOTICE Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
P LAN VIEW
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d
A� 3
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INDICATE NORTH ARROW
1
« Wisconsin Department ofCommerce PRIVATE SEWAGE SYSTEM County:
Safety aid Buildings Division
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)). 344668
Permit Holder's Name: ❑ City ❑ Village ❑ xTown of: State Plan ID No.:
Tyler, Mark & Jac-Lynn Town of Emerald ) 34e 2
CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.:
8D CsT Z 'W J 1 010 - 1082 -20 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV.
Septic W Q 'aV 6 Benchmark -'2. g4.70
Dosing \W Ce o `" Alt. BM 6 QS'•!}
Aeration Bldg. Sewer
Holding St /Ht Inlet q'( ---3'
TANK SETBACK INFORMATION
TANK TO P/ L WELL BLDG. Air I ntake ROAD D
Air
Septic >/50 ,$" NA Dt Bottom
Dosing f50 r " $ NA Header /Man.
Aeration NA Dist. Pipe 03.IKE
Holding Bot. System SD d S. 2�
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer G Q Demand St cover AA
. 9 b• °��
Model Number � 3 - I PM
TDH Li Friction „ I Syestem TDHa(•a Ft
oss
Forcemain Length 5 Dia. H 2 « Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width , !� r Len th t No. f renches PIT No. Of Pits Inside Dia. Depth /
DIMENSIONS T .Z DIM N I N
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Ma ufac er:
_ .
INFORMATION TypeO CHAMBER
,fir S-S r - - -� OR UNIT de Nu
System:
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipes x H le Size x Hole Spacing Vent To Air Intake
t u t u r t
Length Dia. Length 21�a Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ' 9
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil I ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: lo/ 1STg9 Inspection #2:
L 2467 QOt Woodville, r WI_ - ( ' NW1 /4, NE1 /4, Section 34 T30N -R16W) - 34.30.16.498
�i�.dCC,
��a5. DI.If3'
O ` ” e ta
Plan revision required? ❑ Yes No r
Use other side for additional information. 03 I t - Z- 1 0 I I l u
X SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH j t
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
,- SANITARY PERMIT 201 W. Washington Avenue
1scons - / 'r P O Box 7302
In accord with ILHR 83. Code Madison, WI 53707 -7302
Department of Commerce �`.
• 'Attach complete plans (to the county copy only) for the' , on less ., qunty
than 8 112 x 11 Inches In slip. ' yt D �>�. 6
• See reverse side for instructions for completing this ap I' ionA State Sanitary Permit Number
ST (;Row f
Personal information you provide may be used Sgcondary grpo COUNTY heck if revision o pre ou app ica wn
[Privacy La s. 15.04 (1) (m)]. (/
Z0 0 1 ate Plan I. D. Nu 6 r
. APPLICATION INFORMATION -PLEASE PRINT ALL F MATZO
Property Owner Name 1 e on
rl)a it 9 0.0 - L n l Y fi7 1 /a, S 3 q T 3 d r N, R 1 Lo E (or)�/
Property Owner's Mailing l�ddress Lot Number Block Number
aq Z 00
Cit , St to Zi Code Phone Number Subdivision Name or CSM Number
L u1 (UZ yo a$ (7)5 )&99 -�39q
II. TY PE B ILDING: (check one) ❑ State Owned ❑ ity Nearest RO�I
Public 1 or 2 Family Dwelling - No. of bedrooms _� Town OF m P- roLI d 130
III. BUILDING USE (If building type is public, check all that apply Parcel Tax Number(s) v i o — / ov 2 - 2 G G
1 ❑ Apartment/ Condo o., P"^�C� • -S /�' ' �� `
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 box on line A. Check box on line B, if applicable)
A) 1 _ New 2 rg Replacement 3_ E] Replacementof 4. [] Reconnection of 5. E] Repair of an
System System Tank Only Existing 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 ❑ Seepage Pit 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) a-� Elevation
3 O v ' 7 / 103 a Feet 11)5 _q Feet
VII. TANK Capacit gallon Total # Of Prefab. Site Fiber- Plastic Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App.
New Existin strutted
Tanks Tanks
an 'or PletdlMTrafrk / /DI'SC� �" u)e_ er] ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank ipkQaFlaftf6er 50 c1 4 f yl{ 4211 ❑ I ❑ 1 ❑ ❑ ❑
V II. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibili for instal lion of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plu I Ignatur mps) MP /MPRSW No.: Business Phone Number:
.��e 5 ��. s ��.� �3�l7_5
Plumber's Address( tree , City, State, Zip Co e):
IX. COUNTY/ DEPARTMENT USE ON
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued IswV tsnature (No Stamps)
Approved E] Owner Given Initial Surcharge Fee)
?� ZeOV
Adverse Determination ✓ J A>
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
s
r
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 Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownershipor 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 and Buildings Division, 608 -266 -3151.
To be complete and accurate this sanitary permit application must include:
o
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 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.
Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 81/2 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
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 contamination investigations
and establishment of standards.
Safety and Buildings
2226 ROSE ST
r • ,� LACROSSE WI 54603 -1905
TDD #: (608) 264 -8777
\, visconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
Jul 191
July 9 9 9
CUST ID No.267341 ATTN.• POWTS INSPECTOR
WEGERER SOIL TESTING & DESIGN ZONING OFFICE
421 N MAIN ST ST CROIX COUNTY SPIA
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 07/19/2001 Identifi n hers
;�` Transaction o. 236204
n
" , ,S ite ID No 176805
SITE: lease refer to, both identification numbers, ,
Site ID: 176805 ;r-n above, n all correspondence with the;agency
St Croix County, Town of Emerald
NW1 /4, NE1 /4, S34, T30N, R16W 199g
Facility: Mark & Jac -lynn Tyler Reside
FOR: '01V � Ct
Description: Three Bedroom Mound System`,/
Object Type: POWT System Regulated O ctr4� P;�
41U
! E
r
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• inspection shall be made with
Inspection of the private sewage system installation is required. Arrangements specho
P P g Y q
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The existing privy must be properly abandoned.
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.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, t DATE RECEIVED 07/10/1999
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
eerard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)785-9348, Mon - Fri, 7:15 AM - 4:00 PSI
e4de
jswim @commerce.state.wi.us Wl #A �
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labpj and Human Relations
Division of Safety 8 Buikfings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST• e �4 to
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road- o 0 104 2 - Z O
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
}'1'r't2.1rz_ Lr 0Z GauueT 1vX3 1/4 Utv 1 /4,S 3y T 3 0 ,N,R [6 E(or
PROPERTY OWNER':S MAILING ADDRESS• LOT # I BLOCK # SUBD. NAME OR CSM #
q D t w p� Nvry I _ ReN w a Lb C S
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE 9QTOWN NEAREST ROAD
Woo1JVLl,L� w St�IJZ$ ( - )13) Qpr . X30 Z.
[ ] New Construction Use [.X] Residential / Number of bedrooms S [ ] AdditiQn to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow 1 4SCJ gpd Recommended design loading rate bed, gpd /ft u trench, gpd /ft
Absorption area required 31 bed, ft - -'Z5 trench, ft Maximum design loading rate Z bed, gpd /ft ' 3 trench, gpd/ft
Recommended infiltration surface elevation(s) ^ '% O 3- Z ft (as referred to site plan benchmark)
Additional design/ site considerations MovwZ> tzmN \.-)' of Sri3 ib F%Lj_
Parent material L n M 8 ovr12 G\J eL kL Tt t L Flood plain elevation, if applicable N H ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S O U ®S ❑ U ❑ S [RU [IS O U ❑ S ®'U [Is O U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxby Roots GPD /ft
in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed Tre &
1
s 1
V — 5 t 1 l`FS�k 1��1.- � 1v� • Z - 3
Ground V/ y fl l -S`�tz S�$ t- ��''1 Yrl �, 3 •�
elev.
1 01. - 1 ft.
tic
Depth to
limiting O
factor
` C 6
Remarks: O w
Boring #
o -LO LO'-ltZ 3 L3 — S ti Z`�9ti `M`�- a IT • S 6
ov'
Ground
elev.
g°i•g ft
Depth to
limiting
fact
a
Remarks:
TName: Please Print Arthur L. We erer Phone: 715- 425 -0165
Address: Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022
Sgnature: i
9Ol- \V �J- Date CST Number: 6
220254
PROPERTY OWNER 1 l rz '
SOIL DESCRIPTION REPORT Page L of 3
PARCEL I.D. # _ C� 1 tJ - 10 a - - Zo
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft
in. Munsell Consistence Roots
Qu. Sz. Cont. Color Gr. Sz. Sh. Y Bed ITrench
Z 1 D -1l 10 `12 w - s l 1 'P s �i l- w� 'f�- a s Z • 3
Ground 3 n 6 s yR -5`1 P-1 S /s 0►�, \01 �y -
elev. • y
l -Z tt.
Depth to
limiting
factor !
Remarks:
Boring #
CCCC "'M1
I
i Ground
elev.
ft.
Depth to
limiting
factor ,
Remarks:
Boring #
Ground
elev.
ft. sa i
Depth to I
limiting j
factor
t 7 l,
Remarks:
Boring #
(
Ground s
elev.
ft.
Depth to
limiting
factor
Remarks:
Inn 0o11nin nr •n��
PLOT PLAN Page of 3
SCALE 1 "= u4 '
• _ _� X30 `1"�} (PV ,
o.3S 1nj �
Z SO T* ST.
ukit
i
3S�
Foam D nor TO Scl�Le
Ln.. L00, p' oN 6 k �116N, 3 hl * D) A C�1C �t>>� k►! L 1 -.
Ert. gat.
kT LET So' W (,v►vp ►��D �1 � cl
, L , Q , ' ZS
A
� � I
�, ` y i arhiFl
�� Nor eo�wrcc.T
mis � ► /,
14 il
_ zzoZS`f
( 715 ) 425
CST Signature Date Signed Telephone No. CST #
i
•'; Page of 6
MOUND SYSTEM
FOR
A BEDROOM RESIDENCE
1
3
LOCATED IN THE NW 1/4 OF THE Nti. 1/4 OF SECTION �' ,T X30 N , R b W ,
TOWN OF t_N -tom. �,9 , �• ��Uc COUNTY, WISCONS
IN.
R
INDEX
PAGE 1 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW -CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER '
PAGE 6 of 6 PUMP PERFORMANCE CURVE
p • ,�aaiy
PREPARED FOR c(littU , )
1'1 5 PtiC_�LLtvtJ `1 ,,{fin , COMME
Z p►�G�
b 6 cUU 2 v H DtF ,pRStJ�E F y D
y �f D b D
��ESpO EN
PREPARED BY
�0ONtN
W a (3 a FZ EF2 S(7 I !._ TEST S NC .
AND.
DES I[ (3M SlER�! S CE ARTHUR a
D-915 r
ELLSWORTH,
F.O. BOX 74 421 K. KAIK ST. ��5�[� W
RIVER. FALLS. KI 54022 �;••
715 - 42`.x-0165 ® ® ®� S i G I y �
RECEIVED
iI]1- 0 0 1999
"WETY & BL"I` DIV.
JOB NO.
PLOT PLAN
Page Z of 6
Scale 1 "= 4l) '
` _ _� x.30 "� �y � • _
o .
'IS rn i lZi
2 SO T1i ST.
1�
�1.1112A�JCC-„
6 1 Wq b A 1�1C '01Pk� wl LA7T1
AT LA-Mr S PUt*l ,w,. FiT (�l
DI
I
� o
g Z of
e,
I �
[I TI
`A 0A\
0
�v �. r -�W� -� cobL cow��c�Aur Fore �`zpi1C `t�L/ P�"►a 'rA�C_
NOTES
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( V required)
3. Install 4" observation pipes with approved caps. ( y required)
4. Septic tank to be\ MO16S0 gallon capacity manufactured by
5. Bench Marks ± 5e_E "0yp
6. Divert surface water around mound to prevent ponding at the uphill side.
Page 30f b
Approved Synthetic Covering
TSTM C 13 Distribution Pipe
Medium Sand
H _ G
Topsoil F Elev. 103.2
3
( %- Slope Trench Of 1 1", 2 12 Force Main Plowed
Layer
Pump Y
Aggregate From Pu p
Undisturbed D \. - 7 Ft.
Soil E Z. 'I Ft.
Cross Section Of A Mound System Using F o-$ Ft.
2 Trenches For The Absorption Area G 1..0 Ft.
A 9_ Ft. H \.5 Ft.
B l4 Ft.
C Ho Ft.
Linear Loading Rate =yl GPD /LN FT I Ft.
Design Loading Rate= p-25GPD /SQ FT ,7 q Ft.
K 1y Ft.
Tn L - 1 S Ft.
W 111 ` Ft.
L
J
K
b 3O C Observation Perm
600 /SQ.FI- Pipes Markers
(Anchor securely)
— — — — — — — Force
-------------- - - - - -- - - - - - --
�-- — — — — — — — — A Main
W _ ,.
Distribution Trench Of 2 2 2
Pipe Aggregate
c'4D S 0 FT,
1
Mound Using 2 Trenches For Absorption Area
Page Of b
1 '
Perforated Pipe Detail
End View
Perforated
End Gop) PVC Pipe Install permanent marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
F S
PVC Force Main
P
PVC
Manifold Pipe
Distri ution
Pipe
Last Hole Should Be I
Next To End Cop
End Cap
P z Z Ft.
Distribution Pipe_ Layout S } Ft.
X 1 413 Inches
Y ' Inches
Hole Diameter 1 1 Inch
Lateral ) Inch(e
Manifold- Z Inches
Force Main Z Inches
# of holes /pipe
Invert Elevation of Laterals ko3. Ft.
Place 1st hole Z`l tr from center of manifold with succeeding holes
at qb' intervals. Last hole to be next to the end cap.
Combination Septc;Tank and I
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS' PAGE S OF p
VENT CAP WEATHER PROOF
JUIJCTIOU BOX
4'C.I. VENT PIPC APPROVED LOCKING
� 10' FROM DOOR, MAWHOLE COVER PQIV
', IUDOW OR FRESH wA(ZN11J6 I..ABEL.
A�IIJTAKE coL-3purr
fj
18' MIfJ.
y�INS�e;�t1oN PIPC PROVIDE I
IlJLET AIRTIGHT SEAL
APPROVED
APPROVED JOIAJT A I JOWT3
W /C.I. PIPEaR Tank COnStTllCtiOn I I I W /GI. PIPE , * 1 c
I I I I ALARM
shall comply with
ILH1 ('33.15 and 33.20 B I 11
C
I I ow
68.6 Z
LLCV. FT. PUMP �
� OFF
D COUCKETE
BLOCK
3" APPFc�:
RISER EXIT PERMITTED OULU IF TAWK MAUUFACTURER HAS SUCH APPROVAL Br<DOING
SEPTIC E SPEGIFICATIOUS
DOSE
TAWK5 M AUUFACTURER: � / ��`� 1 C 1 `� `-� IJUMISER OF DOSES: 3 PI P. D"
TAWK SIZE : 1001 L S () GALLOIJS DOSE VOLUME r
g S'- SLS S IMCLUDIUG BACKFLOW: 1 5 3 GAL LONS
ALARM MA►JUFACTURCR: \
�=��ZO TAM
MODEL ►DUMBER: L t �4LAJ CAPACITIES: A= IUCHES OR 3136 GALLOIJS
SWITCH T-1PE: �� B = q Z I)JCHES`OR 3 � G(�LLOAi$
PUMP MAUUFACTURER: C = IUCHES 15 � GALLOUS
MODEL NUMBER: 1� Dw 9 1KLCHES OR `53 GALLOUS
SWITCH TYPE:
MOTE: PUMP A1J0 ALARM ARE TO 5E ,
Z� , • pb INSTALLED OW 5EPARATE CIRCUITS
MIIJIMUM DISCHARGE RATE GPM
vERTICAL DIFFERENCE DETWEEII PUMP OFF AUD.DI5TRIBUTIOU PIPE.. \S"b% FEET
+ MIIJIMUM NETWORK SUPPLY PRESSURE . . , . . . , . . . 2 -50 FEET
+ A5 5 FEET OF FORCE MAIN X 1 ' b � F 0o► r.FRICTIOU FALTOR_. 1-SO FEET
TOTAL "OyWAMIC HEAD = Z �' Og FEET
Pump chamber DIAMETER _ 3 �,.
IMTEKLIAL. DIMLWSIOWJ OF TAWK: LEKIGTH ;WIDTH — ;LIQUID DEPTH g
BOTTOM AREA — - 231= — GAL /INCH
AS PER MANUFACTURER — �`1.O GAL /INCH
- 4 13/16 7 7/16
W w HEAD CAPACITY CURVE MODELS 137/139 1-6 1/e
4 MODELS 137/139 Ft. Meters Gal. Ltrs.
e 5 1.52 93 352 o o 4 13/16
zs 10 3.05 79 299 _ _}
' ` < _ 15 4.57 64 242
/ 6 20 2p,Oi- 20 6.10 36 136
0 1 1/2" - 11 1/2 NPT
>
15- 25 1 7.62 8 1 30
�t, o
4tj Q 4 137,139 30 9.14
10 Lock Valve: 26 ft.
5
3
0
1
U.S. OF 1 _LONS 10 20 30 40 50 60 70 BO 90 100 110
LITERS 60 160 240 320 400 1 4
0 FLOW PER MINUTE SK373
009921
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Three phase pumps are avatlable in 200/208V, 230V or 460V, • Variable level control switches are available for controlling single and three
• Electrical alternators, for duplex systems, are available and supplied with phase systems.
an alarm. - ble piggyback i Dou p ggy ck vac able level float switches are available for variable
• Mechanical alternators, for duplex systems, are available with or without level long cycle controls.
alarm switches. • Over 130T. (54 °C.) special quotation required.
• Combination starters are available for 3 phase pumps. • Refer to FMO806 for 200° F. applications.
• Control alarm systems are available for 1 phase pumps.
137 Series - 47 lbs. 139 Series - 51 lbs. SELECTION GUIDE
sin Ie Seal Control Selection Listing 1. Integral float operated 2 pole mechanical switch, no external control required.
Model Volts -Ph I Mode Amps Simplex Duplex CSA UL
M137/139 115 1 Auto 10.7 1 or 1 & 8 _ - y y 2. Single piggyback variable level float switch or double piggyback variable level
N137/139 115 1 Non 10.7 2 or 2 & 7 3 or 5 & 6 Y Y float switch. Refer to FM0447.
BN137 115 1 Auto 10.7 Y Y 3. Mechanical alternator M -Pak 10 -0072 or 10 -0075. Refer to FM0495
D137/139 230 1 Auto 5.8 1 or 1 & 8 - Y Y 4. Combination Starter. Refer to FM0514.
E137/139 230 1 Non 5.8 2 or 2& 7 3 or 5& 6 Y Y
H137/139 200.208 1 Auto 6.2 1 & 8 Y N 5. See FM0712 for correct model of Electrical Alternator E -Pak.
1137/139 200.208 1 Non 6.2 2&7 3 or 5 & 6 Y N 6. Variable level control switch 10.0225 used as a control activator, specify duplex
J137/139 200 -208 3 Non 2.6 2 & 4 3 &4 or 5 &6 Y Y (3) or (4) float system.
F137/139 230 3 1 Non 2.6 2&4 3 &4 or 5 &6 Y Y
G137 460 3 Non 1.4 2 &4 3 &4 or 5&6 N N 7. Four (4) hole J junction box, for watertight connection forhardwired simplex
G139 460 3 Non 1.4 2&4 1 3 &4 or 5 &6 N N operation, 10 - 0002.
No molded plug **Single piggyback switch included. 8. Two (2) hole J -Pak, for Watertight hardwired Pconnection or splice, 10 -0003.
Pumps must be operated in upright position.
CAUTION
Three phase units require a control switch to operate an external magnetic or combination starter. All installation of controls, protection devices and wiring should be done by
a qualified licensed electrician. All electrical and safety codes should be
For information on additional Zoeller products refer to catalog on Combination starter, FM0514; followed including the most recent National Electric Code (NEC) and the
Piggyback Variable Level Float Switches, FMO477: Electrical Altemator ,FM0486; Mechanical Altema• Occup ational Safe and Health Act
tor, FM0495; Alarm Package, FM0732; and Sump/Sewage Basins, FM0487. P Safety ( OSHA ).
)•
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL T0: P.O. BOX 16347
Z QEI Manufacturers of.
SHIP TO. 3649 Cane Run Road ,
s Louisville, KY 40211 -1961
Z QVa[/Tr PUMPS S NCE I��� r
PUMP l0. (502) 778.2731.1(800) 928 -PUMP `
FAX(502) 774 -3624 ,
PP
ST CROIX C.OUNTV
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer S . WfiaA(. -
Mailing Address 0., 1�
Property Address �y (off �O'�.►`.
(Verification required from Planning Department for new construction)
City /State 1� )LLC— Parcel Identification Number _Q1O_. -1 -OSZ - 7,0
_LEGAL DESCRIPTION
Property Location 1VW %,, 1V i✓ ' /., Sec. ! `{ L
T N -R llo W, Town
Subdivision Lot #
Certified Survey Map # ,Volume ` C< `L _ ,Page # t_4
Warranty Deed # , Volume , Page #
Spec house O yes �1no Lot lines identifiable 0 yes ❑ no
SY 5 M A M NAN
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
coasista 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 syst
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
muterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full o 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 Zoning Office within 30
da e e ' tion date.
SIGNATURE OF AI ICANT g /-2O /Ct9
DATE
OMMR
IFICATI
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owncr(s) of
th a above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE WAPPLICANT
DATE
« « « « «« Any information that is mis- represented may result in the sanitary pemut 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
STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St Croix County
OWNER/BUYER S MAQ k , 3A(_- L d 0 -
P
MAILING ADDRESS 2-4lob Gam RD DP
PROPERTY ADDRESS 2m,:n I O Rv&,
(location of septic system) Please obtain from the Planning Dept.
CITY /STATE tlolr&
PROPERTY LOCATION Mw 1/4, 1/4, Section T 3 O N -R t b W
TOWN OF � �-� ST. CROIX COUNTY, WI
SUBDIVISION — LOT NUMBER
CERTIFIED SURVEY MAP — , 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 DNR.
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 ear expiration date.
SIGNED: C.
DATE: ✓� a 3 / 99
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
2!1/99 THU 09:33 FAX 715 386 4687 REG>�,STER OF DEEDS z001
/ .V E;4999 STATE BAR OF WISCONSIN FORM 11 -1982 I {
LAND a CO d N oRACr
i S I,T0 3 U FI�, A tiH0 tN OTHrit l.O�cONO` `I
DOCUMENT NO. - _ lTOgt U5Et7F0�RALt T N pN57 — _-_� -j; 7E;P OFFICE
ST. CROIX . adeh ,— -- �� ticcrd
Contract, by and between ,� lrvt:lYn p ,
S 1997
whether one or mots) and M+� l�r aA �72tC—L AM
i� H. T he husband and- �rif_. 'E
— �� ----- x® Cmods
(-Pur haser' , whether one or more), If
1 ----� n the rutript and full pet{ormance Ii
Ij Vendor sells and agres to convey to Purchaser, uPo P rof►ts, f
of this Contract by purchaser, the following. property, together with the tents. p
T i : futures and other appurtenant — Cou nty, (all called the `�Pe �o ty� ScaiC otv+ftst `I THIS SRACE RESELt+/ED FOR RECCROtNIi DATA
!1 St . Croix -- •� ---� z�¢
i INANE ANA RETt.'RN AOORESS
li {IThomas A. M CCarmaCk
Baldwin, WI 54002
I� i
u •i
I, �1
I I
NUMBr:R l
f PARCEL 10ENTIFlGATtON
Il uarter and the West Half -four
t ;
West Half of the Northeast Q (WI of NL�)
of the southeast Quarter (W� of SEh) all in S ec tion Thirty it
' h. Range Sixteen
(34 (1{} West.
P
), Township
Thirty (30) North. N S
R '4
is i s not homestead properry.
Th
xt¢ WDOtJ a lace de nated by vendor
Purchaser awes to purchase the Property and to pay w Vendor at '-- -��
the sum of Sig 3 s _3_5 ---- -- m the follt�wing manner: (a) 3. — together with interest from date
4t 444 . �, :
i ar. the execution of this Contract; and (b) the balance a[ S_ 5�V4n percent oar annum until paid in full, as follows'
r.
hereof on ili<brlance outstanding from time to time at the rate of October 1 . 1 and on the
monthly payments of $1,425.00 commencing ments shall decrease;,
p r i nc ipal balance shall not
same date of each month thereafter. Said monthly pay
warranty Deed in
to $500.00 at such time as the then remaining Pipe a
exceed $64,000.00, at which time Vendor shall J is contract
partial satisfaction of th
as to the test Half of the Southeastr
Quarter (A of SE a) -
Provided, however, the entire outstandi:tgbalancr shill be td in
[ail on ar before tnfeK— �a
x nereof . 1 2 �6 r annum on the entire amt a in default (which shell
Following any default to pa)tnent, interest shl ac crue lerahon or m the entire principal balancY).
include, without limitation, delinquent interest and, upon
rchaser, unless excused by Vendor, agrm to pay monthly to Vendor amounts sutYb 1C �cndor} Vendor algtet ant cs an -t al enLs t these l
�► Po Y P Ym ; I
!lw ssmcnts, fire and required insurance premiums wheat due. To the tartcnt received
obligations when due. Such amounts .ecetved by the Vendor for payment of taxes, muss
and insucxncc will be deposited into art escrow
fund yr tnistce account, but shall not bear interest unless otherwise required by law. f
Pay ments shall be applie first to interest on 19 the unpaid balance at the rate specified and then to principal. Any amount may be prepaid !,
J a u r 9 L
t��
witl+out premium or fee upon principal at any time aRer
In the event of any prepayment, this
contract shall not be treated as in default with respect to payment so long .L. the unpaid bai.•tntti rf
ztte is shall he
principal, ,rid interest (anti in such case accruing interest fL Jm month to month shall be tnawd its unparu ided that rnpn It1Y'apay1e amount t tat
said indebtedness Hrould have been had the monthly payments been made as first specified deirt above; f'
continued
m the event of credit of any proceeds of insurance or condemnation, the Conud premises txtng thereafter excluded bereft ,m.
Purchaser states that nrchSber ii satisfied With the titL ,_i shown by the titld cvidenct submitted to Purchaser for examin+tion exo pt:
a Pt,rchas,:r agret . to ,may the cast ul future title eti•idenre tf title etidence is in the Iona of ar afistrtCt, .t shall lit retained by Vend.�r taut
5 the full ourchase price is Paid. date p
rurchwier shall be enttdeti to take possession � the Pniperty on —. - - :— —"
cm-.0w Oft! " , nc LVON
.. •, 5IA IF BAR O 111
I AND CON[R�GT - individual and Carp.xau
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: ST. CR I)
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338993
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
TYLER, S. MARK & JAC —LYNN EMERALD
CST BM Elev. Insp. BM Elev.: BM Description: Parcel Tax No.:
010 - 1082 -20 -000
TANK INFORMATION ELEVATION DATA A9900223
TYPE MANUFACTURER CAPA ITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St /Ht Inlet
TANK SETBACK INFORMATION V St/ Ht Outlet
j TANKTO P/L WELL BLDG. Air Intake O D Dt Inlet
Septic NA Dt Bottom
Dosing N Header / Man.
Aeration N Dist. Pipe
Holding Bot. System
PUMP / SIPHON INFORMATI N Final Grade
Manufacturer D
Model Number GPM
TDH I Lift Friction S s em TDH Ft
L oss d
Forcemain Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIM N I N
SYSTEM TO P / L BLDG WELL LAKE/STREAM
LEACHING
SETBACK Manu acturer:
INFORMATION Type O CHAMBER Moe Number:
System:
OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil []Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Intl de code discrepancies, persons present, etc.)
LOCATION: EME D 34.30.16.498,NW,NE 2467 130TH AVENUE
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
Date Inspector's Signature Cert. No.
SBD -6710 R.3/97
�[Id Buildings Division
resin SANITARY PERMIT APPLICATION i` ; WOlshingtonAvenue
In accord with ILHR 83.05, Wis. Adm. Code ISO 90M 1302
nt of Commerce Mad i90A, WI 53707 - 7302
"Attach complete plans (to the county copy only) for the system, on paper not less county . C-ro r yG
than 8 v2 x 11 inches in size. .
• See reverse side for instructions for completing this application State Sanitary Permit Number
3 3a�5 3
Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Pr perty Owner Name Property Location
}� d' ff(� - L r\ �. �� AW /4 N 19, 1/4, S T 30 , N, R 11,p E (ore
Progert Owner's Mailin dress Lot Number Block Number
at f Do .
t ity, state „ Zi Code Phone Number Subdivision Name or CSM Number
oadur lt� (k)T. I104a (•70 ) 09' 3q 4
II. TYPE F B ILDING: (check one) ❑ State Owned i� C] it Nearest ad n,w-
Public 1 or 2 Family Dwelling - No. of bedrooms W Tow of R F M er� �
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ?,�-. ?, p, I ` �}-9
1❑ Apartment/ Condo d
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 Q Service Station / Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. tg New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5 ❑ Repair of an
- _____System ________ System _____________ Tank Only______________ Existing System Existing Systen
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 ®1lllound 30 ❑ Specify Type 41 []Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 []Seepage Pit 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. 17 . Final Grad
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
Feet Fee
VII. TANK.. Capacity
INFORMATION in gallons Total # Of Site Fiber- Name Prefab. Plastic Ap p
ft
Gallons Tanks Manufacturer a Concrete con- steel glass Ap
New Exist strutted l I
Tank Tanks
epticTank oat+k 1 G m r w�S�� !k ❑ ❑ ❑ ❑ C
Lift Pump Tank �nber I!, S (J t t E ❑ ❑ ❑ ❑ E
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum is Signatur : No Stamps) MP /MPRSW No.: Business Phone Number:
S-k� -, . (At a a 3 4 �s"" ��s - 19g -�a� �
Plumber's Address (Stree , Cit , State, Zip Code):
w; 1 t L.l� d W oat ;
IX. COUNTY / DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (includes Groundwater ate issued Issuing A Signature (No Stamps)
A Q pproved ❑Owner Given Initial 1� 5OW Surcharge Fee) n{ 1 �I �'
Adverse Determination � ��
X. C NDITIONS OF APPROVAL/ RE S NS FOR DISAPPROVAL: A y 7
a`/t.? 13c �v-� no luw�b� �Inw41 Irx �� �6W� � ---1he S�✓v�'}urC
t P
1f a ar -fico� , I-+1 -f IC ro 0- Rep lacei, ' A'�`'f ►► �
p pp"', STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ° S ,Mph Jam - LyN H 'f ice.
MAILING ADDRESS '` 24bb Ox% � RD DD
PROPERTY ADDRESS 22`x"1 0 ?14 A
(location of septic system) Please obtain from the Planning Dept.
CITY /STATE _ WCL(`J UU U-**m }p-
PROPERTY LOCATION ML.,� 1/4, 1/4, Section Iq T 3 O N -R Z b W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION -- LOT NUMBER
CERTIFIED SURVEY MAP , 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 DNR.
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 ear expiration date.
SIGNED: (`
15aTE: 3199
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
`Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division
INSPECTION REPORT
,GENE INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: ST CR IX
Personal information you provice may be used for secondary purposes (Privacy Law, s. 15.04 (1)(m)]. 338993
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
TYLER, S. MARK & JAC —LYNN EMERALD
CST BM Elev.: Insp. BM Elev.: BM Description: r, Parcel Tax No.:
/f1b lab 7 VC 010- 1082 -20 -000
TANK INFORMATION ELEVATION DATA A9900223
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �� ,, Bench ar
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet // . (a
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P / L WELL BLDG. Air I to ntake ROAD Dt Inlet
Air
Septic NA Dt Bottom /,t« �?. $7
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand S. 7•D f( 9G • 2?
Model Number GPM
TDH Lift friction System TDH Ft
Forcemain Length Dia. H Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIME N SIONS I I ION DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges I Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.)
LOCATJON: EMERALD 34.3 16.498, W,NE 2467 1307��H V UE,&j
l: 0 %K4j'�r DY► / 9°I =- Yiv no f %h S �ulC�,c iKs�e C 7b
ef&� 4 ( h5'2
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
1
ADDITIONAL COMMENTS AND SKETCH
.a r
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
NV PERMIT APPLICATION 201 W. Washington Avenue
n In accord with ILHR 83.05, Wis. AcI . Code P O Box 7302
Department of Commerce fi
P Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on pIaper not less County��rr
than 8 1/2 x 11 inches in size. .T�- Y'Ot 1t
• See reverse side for instructions for completing this application State sanitary Permit Number
Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
Pr pertyOwner Nam i Property Location
K J - L , n 44. E W/4 NE 1/4,5 34 T 30 , N, R l(p E (ore
Prope Owner's Mai Iin M dress . Lot Number Block Number
ity Z a Zi Code Phone Number Subdivision Name or CSM Number
vi 1)e 1. 9loa (715) GqQr- � W
II. TYPE OF BUILDING: (check one) ❑ State Owned � City C��t Nearest R ad /1
Public 1 or 2 Family Dwelling - No. of bedrooms row OF F rod of J3d 1
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) S+
I Apartment/ Condo L 0 ` I lc> 8 2 ^ ' R o o
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 box on line A. Check box on line B, if applicable)
A) 1, tg New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
- _____System ______ _____________Tank Only______________ Existing System --
B) 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 EVound 30 ❑ Specify Type 41 [:]Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43;KVault 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
Capacit
VIL INFORMATION in gallons L # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
New Existin s Tanks Concrete strutted glass App.
Tank Tanks
eptic Tank or�ACFdmg�ank )'►'t , w�sa c.A K ❑ ❑ ❑ ❑ ❑
Lift Pump Tank fiber ( t ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum r'sSignatur No Stamps) MP /MPRSWNo.: Business Phone Number:
kk�4, aa7s' 171:5- 0?-CM"
Plumber's Address (Stree , Cit , State, Zip Code):
W; 1 0 LAD w Ooh t I lv UZI 5 L4 0 a I
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Issuing A nn��n�-aaa-�r�•rtrtrt� 77 � Signature (No Stamps)
Approved E] Owner Given initial surcharge Fee) b � ,- 11
Adverse Determination � � � n�C �r /�_` L 11 /l.'
X. C NDITIONS OF APPROVAL / RE S NS FOR DISAPPROVAL: A - y
0 yt�7 i -`-Hne S�✓v�'�ur�
r� w�.��k tovl��r+co�f t��+1 - f- 1�,¢,� raV`c�5 a. R lec►�- r►'�GVv1�
eP
OQ it'
SBD- 6398 (R.11197) a ° ' ' a °Y ' in
INSTRUCTIONS
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 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 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 installed.
11. 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.
V1. 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 81/2 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
tank(s) or other treatment tanks; building sewers; wells; water mainstwater 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 contamination investigations
and establishment of standards.
O L�11v�2 S YU'f -f E;
S _
v�T/WaW 11JS'T U- V NU." PRAnI-
) J.i StcT ply -uGF
1
i
DAR
fi
i
J
P
iN�CT
T��� r- 1t1tJVFhcTU� ; r- t�ow�s rJ PX �'
1000 6S0
Ttc►v� -� S � _ GfCt.
.Owner's name San. Permit No.
y H63.05 PLOT PLAN
Show
ED Location of building served Dosing chamber
�✓ Sept e izank- VprULT \- Q Vertical/horizontal reference point
VKISID�Z %ITM f OF
Building sewer � System elevation is Ty ez.._ IBS.00
NA Effluent system N q Well
EI Replacement system area Property lines w /in 50 of system
F3q Distribution boxes Scale = 'N or , or dimensioned
Nq Pump and controls:
Mfr. & Model No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal..per Min. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan
+ o - 3 S ►tit i "M -- -
\'30 `� Pt'U�.• z So `TZt ST• t
so' i-
I '�•�R.w �'iC'I
. � Loc�oty
I
J
-
g tt
PvC P1P` w/ "!" e"1tE1
�•- .1�0.0 e►J 6�tt�N,3t�' +�iA, Zs '
L0�� p��y
J
By the. granting or approving of the above plan, or upon the event of a subsequent
permit being issued, St.CroixCounty and theSt.CroixCounty Zoning Administrator, does
not`assume or hold itself liable for any defects in plans or specifications, plan
omission, examination oversight, construction, or any damage that may result in or
after installation.
P lumber's signa ure License No. Date
` Document Number Voi tQ 503 603659
KATHLEEN H. WALSH
�i?I�h; `Tnl`ATiotJ �kk- ,¢+E�v; REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
05-24 -1999 2:05 PM
AGREEMENT
EXEMPT I
CERT COPY FEE:
COPY FEE:
TRANSFER FEE:
RECORDING FEE: 12.00
PAGES: 2
Recording Area
Name and Reduce Address
SRAM A, -L'(04 14 '7416L
Zc}bb CcxNmt bn
wk �lozb
Olb - lo�Z- Zs�
Pamel Identification N®ber (PER)
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT -DO NOT REMOVE"
TWO infornution must be completed by abmittec. doctanent tide, name do return address, and ELY (lf requdred). Odwr /gfornwaon mch
- the granting clatter, legal dercrlpdon, etc. may be placed on dds first page of the document or may be placed on additional pages of die
docwnend. N ow Use of this cover page odds one page to your document and $2.00 to the recording tee. Wisconsin Statute, S9.51 Z • WRDA 2196
STC - 106
voi..1428PAGE 504
PRIVY INSTALLATION AGRF.EMFNT
St. Croix County, Wisconsin
PRIVY INSTALLATION AGREEMENT -COPY TO REATTACHED TO THE SANITARY PERMIT APPLICATION.
PropertyOwner(s): Reserved For Recording Data
- 040L t 3Ac- LYNnf _F(UZ
Mailing Address: i
Zq-bb C xs; Y �o0�fl DLL W OCNI w)
Location:
NW }, N�. }, S 3y T30 N R L6 E o W
E*ty- cliltage, Township Of:
Parcel Tax Number:
OHO ID�Z -Zp
Legal Description:
AiW 1 14 - h ZIA g� 3 y -� -►6
1. No plumbing will be installed in the privy.
2. No plumbing will be installed in the premises served by the privy unless a code compliant soil absorption system or
holding tank exists, or a valid sanitary permit to install such a system has been issued.
3. A privy vault/ pit shall maintain minimum setbacks as specified in Table 1.
Table 1 Well Building Lake /Stream Additional County Setbacks
Open Pit 50 Ft 25 Ft Min. 75 Ft
Sealed Vault 25 Ft 25 Ft Min. 75 Ft
4. Privies for public buildings shall comply with ILHR 52.63, Wis Adm. Code.
5. Privies used for one- and two - family purposes shall be constructed in such a manner so as to exclude flies, rats and
other vermin. Doors should be self - closing and vault ventilators should terminate at least one foot above the roof -
6. A privy vault shall be constructed of watertight plastic, fiberglass, coated steel or monolithic concrete. Materials shall
comply the intent with ILHR 83.20, Wis. Adm. Code. Counties may, by ordinance, establish minimum sealed vault sizes
and type or construction within the guidelines of ILHR 83.20, Wis. Adm. Code.
7. The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR
113, Wis. Adm. Code
8. This agreement shall be binding on the owner, their heirs and assignees. This document shall be recorded by the
register of deeds in a manner which allows its existence to be determined by reference to the property where the
privy is installed.
Pnnte wrier s Names:
_ -� moat. I�tS�- Subscribed and sworn to before me on this date:
'�'t( - U
�r
Owner s
No far Pubhc
My commission expires on: ja LI)�
NOTE: This document was drafted by the State Department of Industry. Labor and Human Relations,
Bureau of Building Water Systems.
Wisconsin Department of Industry 1 SOIL AND SITE EVALUATION REPORT Page 1 of 3
Lat or and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but Ste. C RO �X
' PARCEL I.D. #
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
l
dimensioned, north arrow, and location and distance to nearest road.
'APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION RE DBY DATE
PROPERTY OWNER: PROPERTY LOCATION
N1 WS« W �b -S7)CZ - l:�i v T�1 G01r:F -� NW 1/4 Ntr 1/4,S 3y T 3 ra ,N,R fl i E (or
PROPERTY OWNER'S MAILING ADDRESS • LOT # I BLOCK # SUBD. NAME OR CSM If
q bt w PV . MU_T -1 CS
CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE [MOWN NEAREST ROAD
wm'1 \jLw� 5tg02,b on 6g8 -Z39y
[DQ New Construction Use [X] Residential / Number of bedrooms 3 [) AdditiQn to existing building
] Replacement [) Public or commercial describe
Code derived dairy flow 4S0 gpd Recommended design loading rate bed, gpd/ft - trench, gpd/ft
Absorption area required — bed, ft trench, ft MaAmum design loading rate bed, gpolft2 - trench, gpolft
Recommended infiltration surface elevation(s) It (as referred to site plan benchmark)
Additional design/ site cwnsiderations CBMN1 eyyp '4?ry LT CSR t UY W'/ Sir M byr'p
Parent material \_ Ova G Vk - 'yL1_L_ Flood On elevation, if applicable N A ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S OU I ❑ S ®.0 I ❑ S IRU EIS Z U ❑ S ®'U [I S O U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxivy Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITirench
0 - t &_j T 3 - s l I Z� 9� m �t- a. S 1 • S
Z q -18 tlY-m V/y
Ground ltZ S1s L- ��' ►YI 3 .�
elev.
1 01.7 ft
Depth to
limiting
factor
Remarks:
Boring #
s t Z `�9 h w�`�i a. -s 'I s 6
Z
T3 -1 3 i
- 3 L
Ground
elev.
ft :��
Depth to *` >
limi
Remarks:
T Name: — Please Print Phone: OU , - C,[:
Arthur L. We erer 715 - 425-
Add ress:
egerer Soil Testing & Design Service - P.O. Box 74 River Falls,W 3�
Signature: Date
`�1 -`� 0 2 5 4
PROPERTY OWNER T`11�Z SOIL DESCRIPTION REPORT Page • ?- + of_ 3 _
PARCEL I.D. # c� l p _ l0 8Z _ ?k) f
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
;� >.: {:,;� >a Bed Trench }.�
0 -10 lD`LR 3 [ si l Z 91' m��-
lZ Y! - s,
Ground 3 n 3 6 -S `!R yjy S /$ L lvi `F!• • y
elev.
l -Z ft.
Depth to
limiting
factor
Remarks:
Boring #
i
Ground
elev.
ft.
Depth to I
limiting E
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to `
limiting i
factor
Remarks:
Boring #
,{
Ground ;
elev.
ft.
Depth to
limiting
factor
Remarks:
^nrl
PLOT P LAN Page 3 of 3
SCALE 1 "= 1 40 '
_St
o _3S Mnj lb
Z SO T1t- ST.
1�
Nor 'iv solmtr
81'1 L X00,tJ' oN cgtm(s>.i,3hj rJw xs me w! LtTP 7) -.
v SF Z0 _ W _ P T L&v3T ZS' P;rmM
Rrw;x� DoT Lvuw Z 'in 'IwiE� Oer \ 5 .' r-i MT w - MU\j ,'
Co (ZI kN . VDl. S
a•Z 90�'`o►ti OF ID 3. Z
glgq 6 T1t�1 �'L ,
_
9•3 e1.►CA?
� 7S
�o Nor eo►����T
c�2 of St��a
mis ft"-
/� 'Siti 4 - Z S a
3 -2`j (77 5 ) 42A-0165
CST Signature Date Signed Telephone No. zz CST Z # 5y
V - Wr-w— GOW-- 114 Ulv 1/4,S 3y T 314 .N.R 16 E(or
PROPERTY OWNERS MAILING ADDRESS • LOT # BLOCK # I SUBD. NAME OR CSM #
14 W pvL-M T A - �RB>> vat CS
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD
wai\2�\ wl w S (ZS) 648-Z3qy t)'1 �,
04 New Construction Use Pq Residential ! Number of bedrooms 3 [ J AdditiQn to existing building
[ j Replacement [ ] Public or commercial describe
Code derived daily flow 4SC3 gpd Recommended design loading rate bed, gpdtfl2 _ trench, gpd19
Absorption area required - bed, ft — trench ft Maxunum design loading rate — bed, gpd/ft trench, gpo19
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/ site considerations M Cry'�:) Vf N \ T p fu Uy w� Z N� L1� �,TT 1+�1 Dy►� �p
Parent material x,0@5 3 ova Gv'ceLkL Flood plain elevation, if applicable N A ft
S = Suitable for system CONVENTIONAL MOUND WGIWID PRESSURE AT -GRADE SYSTEM IN FU HWM TANK
U= Unsuitable for sy stem O S XU El CCU ❑ S QU ❑ S O U ❑ S Eau [is a U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>ary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. - B Tench
L
Da
.Z .3 '
Ground 3 1$ -3 S `4 P- y/ i t 's 4m h. L ovn 3
elev.
1 01.1 ft
Depth to
limiting
fac M
Remarks:
Boring #
13 Z
3 l 6 z� - • S'1 R V/ Y 1 • S `1 tL SI Y L o 'yh- 1-
Ground
�$ ft la l
w.
Depth to
limiting
_.; APR
sj o
Remarks: .-
T Name:- Please Print Arthur L. W e e r e r Phone: 715-425 y % t
eg�rer Soil Testing & Desi n Service -P.O. Box 74 Riv er Falls,W 2
Sgnatww Date: CST N
C� V iA 9' ! -Z.S 3 - Z l -`1 220254
r
1. Y
PROPERTY OWNER T
LEA- SOIL DESCRIPTION REPORT P age I- o f 3
PARCEL W. # c� - ZZ
Boring Horizon Depth Dominant Color Mottles Structure 9 Texture dary Consistence Boun Roots
GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh
z 3 0_ 10 I D `11Z 3 L 3 S l 1 z 4 m�Fh a. S S
� c4- S
Ground 3 11 6 -S `JR y/v 4 2 S I>;
elev.
1 -Z ft.
Depth to
limiting
fa \1 ��
E
E
E
Remarks:
Boring #
i
Ground
E
elev.
ft.
E
Depth to -
limiting
factor
i
Remarks:
Boring #
E
Ground
elev.
ft. E
Depth to
limiting
factor
' Remarks:
Boring #
E
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
onn noon n nc n�
PLOT PLAN Page 3 of 3
v
SCALE 1 "= X10 '
op
_ _5� x,30 `�i} � • —
o_3S Mnj lb
Z SO Ali- ST.
Tv' v�%� _t o l_w$Z �M . 'WeF \-V�INZT S .' _ T -ate w�uv►��
�-LOt, 6 °to
a - �
Qt N _ VDl. S
�L9g� VIZN rl OF TS2L�1C� ETS NL ID 3. Z
Br'1� a B•3 e1 1CA z
r 7ZS
eon`- ►���t�
caz ZN STu2-I"
- MIS
� 3 -Z 9q -ZS 8
( 715 ) 42,5 -()16s
CST Signature Date Signed Telephone No. '7- CST #
H
k `
STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER .. S �N1AQ yt� - l.�iN (11 1 4
MAILING ADDRESS 24bb t RD DD
PROPERTY ADDRESS" Nioi I b 6l! pwe
(location of septic system) Please obtain from the Planning Dept.
CITY /STATE ` W�'`(7_ LIJE, Gr. '�_:O"Z'
PROPERTY LOCATION lIaW 1/4, 1/4, Section T 3 N -R Z b W
TOWN OF ST. CROIX COUNTY, W1
SUBDIVISION ___ LOT NUMBER
CERTIFIED SURVEY MAP , 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 DNR.
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 ear expira ion date.
SIGNED:
;say° 15ATE: / /,23 Zqq
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
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 f j. 49CIPIAc-L` NN W Tlug,
Location of property NW 1/4 N E 1/4, Section 34 , T IZ� N -R W
Township Mailing address ?_4 Qwx ". 0 - 0 DD
Vff" Wi Lks-
Address of site X6°1 1 DoT=` N
Subdivision name — Lot no. —
Other homes on property? Yes L.- No
Previous owner of property eNe' 4v-1 R'P>�,
Total size of property yp ro-
Total size of parcel C\53 r�e_
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? ✓ Yes No
Volume \z.6 Z and Page Number L161 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. S64 q. % 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.
Signature of pplicant -Appli nt
Date of Signature Date of Signature
05/2A/99 THU 09:33 FAX 715 386 4687 REGISTER OF DEEDS �70U1
a• �[�
STATE BAR tor- WISCONSIN FORM 11 -1482.
i LAND CONTRACY
irtduat and �osperate
tmd i{
1I 1 325oZ9.luiSFtoMRA Q N ACT ��+7NiCONO� II
ppCUnnErI7 n,o. EF- GI.STER 'S OFFICE
Evf:l n Rade WI
4 — -� _._ i $ - - — _ ..... - 0� R ccr d � ContraCt, by and betwexn �—� — � e �� r 8 1997 Marlr mV er an Jar�nn
0:00 AM whether one or chore) and and Sri f e •4�` H . T 1�husban — �-- ", -- r of om� %
Il (- Purchaser', whether Grit or more), 1j
full the P rOOT t and Performance ji
jj Vendor sells and agrees to convey to Purchaser. upon rpftt3,
j; of this contract by Purchaser, the following ptoperry'. together with the rents, p 1
__
1
ii fixtures and other appurtenant interests (all called the "Property op y, State f WL'"nsifi: !f THIS saaCe RE59 soA Rt coROiN� Onsw
Croix Ii __..
!i if HpME ANQ RETtiRN A
li k Thomas A. MCCormack
ii
i1
�� Saldwi�r, WI 54002
li it
,i
is ..
t
i P11RCF.l.1DENTlFlCATIQN NUMBER i
II and the West Half
West Half of the NdrtYteast Qu h)wallf in Section Thirty -four }
of the southeast Quarter (T+T ofSF West. 11
!
(34) , Tawn -ship Thirty (30) North, Range Sixteen (16
Ns
:i i ss not homestead propeRY
This -
aura a lace d e sign t by 1,e ndor
Purchaser agrees to purchase the Property and to pay W Vendor at —�— 41 '9 �•. �-- "
18 5 000 in the fuilawing manner: (a} S - - together with interest from date
the sum of S —r ^—'-- _. -
i at the execution o this t: and (b) the balance of 5 1
of Contract �I�^
S�V C'Y1 4 7 % p erce nt pee annum antil paid in full, as follows:
hereof on the balance outstanding from time to time at the rare of f�CtOIJeX 1, 1997 and 0 the
mcinthly payments of $1,425.00 commencing meats shall decrease
Principal balance shall not
same date
Said monthly Pal
Cif each month th remaining P ereafter. Warrant Dees in to $500.00 at such time as the then
exceed $60,f)f)fS.00 at which time Vendor shall give a y
partial. satisfa of this contract as to the test Half of the 5outheas
Quarter (W of sEa ?-
t a r . gala ate
Provided, however, the tn[£rC outstanding b,
shi11 be paid in full on or before tIlrcX— E:Y '�• `� =
jj _� r g n,ereof . 1 2 q, r annum on the entire a mt a in default (which shell
Following any default in payment, interest shall accrue at the tale of -- — !x
ion or maturity, the entire: principal balance).
include, without limitation, delinquent interest and, upon aceeierat
Vendor, a to a monthly to Vendor amounts sumcient to pr reasonably anticipated annual taxes, special
F P y hl , ,O a l 1 eats to these
Purchaser, unless excused by I
t req uired insurance P remiums when due. '10 the extent received by tendon, vendor a6r Ppy P'Yr
into a.,se9sntcnts, tire and req P , endor for pay meats and insurance will be deposited i act escrow '
obligations when due. such amounts , eccived by the Vendor of taxes, assess
fund or Emstce account, but shall not bear interest unless otherwise required by law, i
Payrnertts shalt be applied first to interest on the unpaid balance at the rite speolied and then to pnncipul. Any amount m +y be prepaid
y 7ariva - -,19 9
ailbouL premium or fee upon panel al at an time after
2vtt
1 treated as in shall be tutated as unps d principal) rc F l) lo lesahhan thc�muunt that
n the event of any prepayment, this contract shall not be
principal, and interest (and in such ease accreting interest ft�m mGrth to to rw ided that montflly payments ihall he
said indebteidncss would have been had the monthly payments been made as first s p e cified aixive; p
continued in the event of credit M any proceeds of insurance or eondemnaei0n, the COndetrred premises being thereafter excluded bereft +m.
Pur�;hasrr states that t i3 ;atis£itd with the ittt- as shown try the title rvidenct submitted to Furchaser for examination erccpt:
A
ptrrch:LSer ab etc to ,J:ry the cost of future tiA� e.'idcnce (f title c%idence is in the fontt of an tihstt:tcr, a shall be minined by Vendor utit i
the full nurch:tse Price tspm date qt C1oSit1t��4 ._=
f rutzhomr shall lx ene:de"i to rake p tisessi on of thr Pr Pe Y cn — — — "— --
1 • IN +'l�l,{ 1711!
Inc
W�xa+e eKy
• .. StnTF BAR OF »15Cc)tiStN ,
ie waxw..'.Vn
l A \[1 Cps IR�L ;T - indi.•idu.,l And Carp•�rare
Form Na.
,
1 [
05/20/99 THU 09:34 FAX 715 986 4687 REGISTER OF DEEDS Z 002
3.997 real estate taxes have been proracets �e� �=��, �_.�, a'� _ .___ .
to pay all real estate t zes wh du � a � �tandtodelivertoVcq or ,
purchaser promises Eo pay when due all to <es And assess —13 cd on the propettrf a interest nls
an dema receipts showing such payment• uisured a loss or datriage ocr�siorted by Ctre, exren covera .
Purchaser shall keep the impTOVe�ars on the o Proty in ser A � '�
acrd such other hazards as Vendor may tpqui!e, utitltput crrinsuta[tee, througl+. insurers approved by vendor, in the sum — .
v.��___.- --.� - •
but vuidar shaft not regrtire ctmrage in an amount morn than the balanaa owed under this Contract. Purcluuttr steal! pay the itsstttarse peemitun
wlrea due. The pollc %s shall contain the standard clause in favor of the Vetiidot� pd. Vendor otherwise agrees in wetting -s
trrigirn! of all policies covering the property shall be depasiu3 with &'r =rA Ce roceeds tz applied to restoration or repair f perry
afro vendor. Utiles". Purchaser an Vendor ath -rwise agree in writing. ' p
damaged, provided dw Vendor dcem the restoration or repair to be economically feasible. o oly P Y in A tenantable
purchaser covenants not to co mm it waste fro a ll ow v wt c m It rt o be the l en comm
of this CantrrAc , prop erty , d al with all ll laws, ordinances and
condition and repair, to keep the percept Y
=galations affecting tha Property liens or encumbrances ,,, c hase nice with interest and other MOMS tx tally paid and ail conditions ix fully per fm t d
Vendor agrees that in case the p P
xE the rimes a m !n the Marine. the specified,Vertdor will on demand, execrate and deliver to = act or dr(ault of Purrhtm, an d C=pc United the ptnperty, free and dear
of all liens and encumbrances,_ o ept y brances created by
tetras and conditions of purchaser. purC a ees to
erica Mic ors is Mere ass - -
in default of whiep► Purchaser a�rx�ees to
vith tbe r�i>~ of the CRP pr oc�ra> � vendo
aeldtlif a nd hold harmless Vendor fraat an loss ntsuc3
with arty equ t}
t[ of any rirrri ar interest uririch [or
prat agrees drat titers is of the "sweets and Ca) in the event of a default in the paymei p P which
x Peri of . Q.� days fo9aw�g the specifinl due date at (b) in the event o[ a default in perfora+arue i t mailed by certified tnaii) then the entire
o�nues fat a period of fi days following wri tten notice thereof by v (delivered personally
oat5randingbalatice under this contract shall become immedEately and remedies Csub°ee[ full, a tarrrirsrions pro ded by law) in a dition� �
1 he4xby waives). and Vendor shall also have the faIIoa�sig rlgpts
r ri rs, rifle and i law) in ills Etoperty And
pa ided by law or in egoiEr. (i) vendor may, at his option, terminate of redtm nuaUo be conditione upon Purrhasert full payment of the entire tion
inounts due nmover tee Property back through strict foreclosure
om.%anding balance, with interest ther on &amastrrshal� r E d t[uted xs liquidated damages for failure to d fulFill this Can tact an d ass srerental for be event ail atturrrrits
previous paid by
on
Ptaperty if Purchaser ails to redtth)i the a t a rate a oe the date of default and other mounts d e hereunder, in hick men Vendor
the cum outstanding balance,
the property shrill be auctioned at judicial sale and Fute�+ase 1 � l for �j trio d remo °e as a cloud on tle n a quie
pt rd price or any poroon thereof: or 04) Vendor may the
title action if rite equitable interest of i CS �'ro during the pendency of Any ac +order () , (ii) or ( abwef No wi r' and
Property
re
have a =Civet appointed to collect any p
at:y oral tour U t t s er all costs an i expanses including c^e o n a orneye fees o[Yend tneurred to enonx any remedy hereunder (whether
ud d or note �[o the exten not prohibited by law and expenses at title evidence shall be added to principal and paid by purchaser, as lncuned,
erred shall be included in any judgment. Consents to
Upon the commencement or dating the pendency of any action of foreelasu�re da[ t fi Caf t Proper ud ring the pendency of ch acu�on
a receives of the Propeny, including homestead interest. sh bailed the rents, issues, p � ri ghts under
convey
and such rents, issues and profits when sir cflLec an le b h table erest n the Propeny (by assir [ of a ny o f Purt tease
Purchaser shall not tratufer. sell or con y eq written
J& Contra t or by option, l ong - mrm least Or
is first paid in (all of r tlie iriteztst y co vtyed is a pp edge orassignm�tn of pu interest under Contract r;+lely
payable and
as security for an indebtedness of purettaser, In. the event m nay such tr due sate or and payab fi a without Vendor!; option vnthout .notice. the enure
o aw= ding balance payable under this c=ontract shall become rtgV outstanding due s
Vendot shall make all payments when due under any mortga8e outstrig against the Property on th payment of the amount C
t thettdue under any
Mortgage granEed by Purchaser) or under any note secured there provided purchaser makes timely
Contract. purchaser may make such payments directly io the Mortgpgee if Vendor fails to do so and a ll payments so made by Purchaser shall be
considered payments made on this Contract.
Vendor may waive any default without waiving other subsequent or prior default of Purchase succ esso rs of Vendor
All terms of th is Contract shall be binding upon and y tai'rA v consider� joins herein to release botnestead�rig�its to efts
and purchaser. (it not an owner of the property the
subject property and agrees to join in the execution of the deed to be made in fulfillment hereof.)
gated this 2 ^ day of Sep temb9r , 199
(SEAL) __ (SEAL) . Mar1t T
re
($EAW (SFAU
Tyle
At: iHENTICAT[ON ACKNOWLEDGMENT
State of Wisconsin,
s�
Sigaaturc(ti) _ - -
_ _ _ St. Cr oix
—
Personally before me this _ d3Y Of
authenticated this day of — - 19 - y 1) 97 dr.A� named
E Ve. yn RademaxgX F•,e�C,
— -
Tyle an Ja`.
TMI: MEMBER STATE BAR OF WISCONSIN
(if not, to me known to be the petsaa �e trd ft are�ing
authorized by !706 C6. WES. Stal5.3 insrn�mant nowledge the e. f •
THIS INSTRUMENT WAS DRAFTED By — —
omas A�MCCorm ? (� +� , C7?aG�"
h2 irk — — i cots.
W1 54002 Notary Public
t,� . —_—
Baldwin - -- comm is permanent, (lf not, state eKpi;aciou date:
(Sigrutures may be authenticated or
acknowledged. Both are not MY
nec-&ssary )
r / - 1'z�aK o{ pctyina stgit t1 any u Apocuy $bould be t)� or pnnt<d helm.: their xtgt,wiures. -
i /[� tA�D CONTRACT - tndi•iduar and Cvrpuratt - Stab bar a wibcoasin, Forth yc• 1I i 1982
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Est cr °;x co��t w:�.
EMERALD WOLLACK POLLED
FARMERS The Research Leader HEREFORD FARM
EXCHANGE Dairyland Seed Company Ed & Donna Wollock and Family
Roger Smith - Manager Route 1
DEALERS IN: for all your seeds, call Glenwood City, Wisconsin
Grain - Flour - Feed BRIAN HURTGEN (715) 684 -3738
Seeds - Hay & Fertilizer "s Glenwood City 65 -4966
Grinding & Mixing y. Registered Polled Herefor
B s Headquarters For Breeding Stock For So
Climatized Feeds
Emerald Section 3
St. Croix County 2005 Property
Report Pant Report
Generated: 4/28/2006 10:37:52 AM Data Updated: 4/28/2006 4:15:00 AM
PARCEL COMPUTER NUMBER: 010 - 1082 -20 -100
PARCEL MAP NUMBER: 34.30.16.4988
2002 1 2003 1 2004 1 2005 1 2006 < -- Click on the year to select the annual record. (* & dark red = delinquent)
Property Description Billing Information
Municipality: 010 - TOWN OF EMERALD Name / Attn.: JOSHUA G & VANESSA M MELSTROM
Document Number: 634386 Address: 2467 130TH AVE
Volume & Page: V1563, P88
Public Land Survey: SECTION 34 T30N R16W City, State, Zip: GLENWOOD CITY, WI 54013
Quarter: NE Country: USA
QQ / Tract: NW Ownership
Plat: CSM 14/3972 Primary Owner: JOSHUA G & VANESSA M MELSTROM
Description: SEC 34 T30N R16W PT NW NE BEING Address: 2467 130TH AVE
CSM 14/3972 LOT 1 4.00AC
City, State, Zip: GLENWOOD CITY WI 54013
Total Acres: 4.00 ACRES
Site Address: 2467 130TH AVE Country: USA
Secondary Owner:
Assessed Value Other
Valuation Date 10/19/2004 Fair Market Value: 139,200
Assessment Type Acres Land Improved Total Assessment Ratio: 0.9193
Value Value Value Net Assess. Val. Rate: 0.019110522
GI - RESIDENTIAL 4.00 25,000 103,000 128,000 School District: 2198 - GLENWOOD CITY
Totals - -> 4.00 25,000 103,000 128,000
Tax Installment Dates Tax Detail
Period Date Due Amount Category Tax Paid Balance
1 1/31/2006 1,167.42 Amounts Due
2 7/31/2006 1,223.07 Real Estate Tax Due 2,446.14
Total Taxes - -> 2,390.49
Lottery Credit ( -) 85.65
Tax Payment History
Net Property Tax 2,360.49 2,360.49 0.00
Date Paid Receipt Number Amount Special Assessments 30.00 30.00 0.00
12/31/2005 195 2,390.49 Special Charges 0.00 0.00 0.00
Paid By: National City ck# 2302031 Delinquent Charges 0.00 0.00 0.00
Total Payments - -> 2,390.49 Private Forest Crop 0.00 0.00 0.00
Woodland Tax Law 0.00 0.00 0.00
Specials Managed Forest Lands 0.00 0.00 0.00
Category Amount Penalties 0.00 0.00
GARBAGE 30.00 Interest 0.00 0.00
Totals - -> 2,390.49 2,390.49 0.00