HomeMy WebLinkAbout032-2014-95-000 0 y 2 3 N O tv
� ' m
I � �
0 y O N O to 3 G CD CD
= N O C1 f^D C 1
C (D O
N N 0 -
00 N C N C=D j O Ill O
in O
C
o
a
D eo =.
a
in
cc 3 CL
N V O C
C N �1
i O �1
W co co N C lei
O O O
rn o
n' F CO) u1 (/) N D OI Q
o ° y (D
A
m
Q � I00 N
o c z 0
=ao
O F =o. N.
Z
CD
z m
o N A Z (D
w A � 0
0
z —I
(D �z
8� A�
o �
O
CD
Q m
o i
I w c
3
OZ CL
N O
I y
� O
O
I I �
A
fi
I I �
I � w
N
i O
A
O I Oo
CD w
f0
e 0 ~ b
CD
°o CL `�' a
` ST. CROIX COUNTY ZONING DEPART �' 10
AS BUILT SANITARY REPORT �' >>
F
Owner (` i ✓� F
Property Address S01 0o
City/State
zo
Legal Description:
Lot Block N A Subdivision/CSM #
� VJ t /4 W 1 /4, Sec. , T2D4 -R_ W, Town of SoM �o rs��" PIN o� • —
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer W's -p Size So Setback from: House Well P/L
Pump manufacturer Model 1j L
Alarm location
(Ho G TANKS NLY) '
Setbacks. e e road Vent to fresh air intake" Water Line
Meter locati
Alarm loc ion
v
SOI ABSORPTION SYSTEM:
Type of system: Width 7 • S Length -rd) Number of Trenches
Setback from: House 0 Well P/L / 0 Vent to fresh air intake Z6
ELEVATIONS
Description of benchmark To Elevation 0 0
Description of alternate benchmark Elevation
Building Sewer _ ST/HT Inlet ST Outlet PC Inlet 8 -$
PC Bottom g/` — Header/Manifold 94 Top of ST/PC Manhole Cover
Distribution Lines ( ) %, ( ) ( )
Bottom of System O 95, y ( ) ( )
Final Grade () ��'• �o () ( )
Date of installation /2V it number SS State plan number c� 3 a$'(o "7
Plumber's signature License number QQLQ S 3 Date 7
Inspector
Complete plot plan a
w `
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.
PLAN VIEW
`o �
INDICATE NORTH ARROW
D , ._
s FILED ,o
S EP 3 0 1998 ► NOV 1 71998
KATMLEEgKWAM ST,CROIXCOUNTY
RegisterolDeeft SLL Croix Col SURVEYOR'S RECORD
C,ERTI -FIFO SURVEY MAC'
Bonnie Lind
Part of the Northwest 1/4 of the Northwest 1/4 and of the Northeast 1/4
of the Northwest 1/4 of Section 4 30 N, R 19 W, Town of Somerset,
LEGEND St. Croix County, Wisconsin.
O INDICATES I "x 24 "IRON PIPE SET
(MIN. WT.- /:/JLBS. /LIN. FT.) O ADDRESS -
• INDICATES / "IRON PIPE FOUND 74.� LUNG ST. NO.
A /NDICATES5 /8 " /RONBAR FOUND HUDSON, WJ
4 • cDUNTYsuRVEYOR'SMONUMENT Note: These three parcels comply with the St. Croix County
(R= ) RECORDED AS net project area requirement.
�/ I12 ACRE MIN. CONTIGUOUS SL 00. 8ENCNMARK LOT 6
/,t TOP IRON P/PE 322,260 SO. FT. OR 7.398ACRES INC L. R/W
/.G• AREA W /LESS THAN 19%SLOPES EL.: I00.00(ASSUMED) �f 1372. 296,799 SQ FT. OR 6.791 ACRES JX CL. R/W
X SOIL BORING - - - -N 88 °2J'J4 "E 2103.20' - --- NORTH 114 COA NER
UNPL AT,T D WA ER � 4 85.9 SEC. 4, TJON, /9W
NORTHWEST CORNER •g. (77271.9 A NOS
08 SOUTHEAST CORNER
SECTION 4 TJON R /9 W �^ — _ 6• T311V R 9 W
, � + -� , IO SECTION J4, a
?
} UNPLATTED POND LANDS
SEC , -. , :.344 J
./.x; -
82847 l•'•' ' 'f ,� T/ - �._ � , _,.c.�.S6B°f `f3 "f
Q � I • • NO_RTtl L /NE NW f4 T /ON 4
DRY - 1478.37' - -- +.� ' +y
p QI S • r/ONCORNER/S2.B'± I �� �' o •ki 3 `�� SJB°/B47 "W
> ZI O)I S UTHOFSOUTHERLYR/W 1 �ti'1 h•yP�� ���i• �. i (R +S4/ J 9Y
NI `POND / d LOT 6 soO oh y p� �',,, Wiz,, i
p� Si ACKLINE �y g
\ SJB "W
BOTr.Et. -90.8 W 7 0 h� b y M1�, f �� 1 - ,,r, aiQ�08
(a1I 3 t s1 �Q SU !"•^'"
C7 (7/27/98! t s rp �, �,'— , ' RVEY
` •./ki'��� � �- / $'aµ/41.1 p4•� r y �7 rr
7 S rg SO. FT. OR 17.?9/ ACRES /NCL. R/W N /// F '!a `F 0 4 u 41. 4 .
ccI 74 i78S . so. FT, 0 ! I90 AC' E L. R/W ✓ / �3• 8 _� ( �sS 4 38�� w' . , : t, ,.,. ,.
^s �����/ / Z V SJB °4B 47 "W
_LOT
MAP
o
tul CI tul 33.00
WEST LINE �by6p� 6� ?s�.P•,;
k� �I N W //4 "q� ?ms ` s �� , ,y NW SEG4
�I , � r sECrioN 4 N' ° �1ry r .►3 � '� i /99 ;:, ,.•
���"` s
0
c�j a Z �3� J4s w Q 141 ti��F� 'p o,, *; I "t1
1 6 ap`t R, • r ..`A y i C,
aI p � h LOT 7 s,, � a , ,�� ">• ::; . pan
Q I t 8
498,986 SQ. FT. OR 11.455 ACRES INCL. R/W v ?!
C Q.FT. `�d•• `�"" I � \ :.r.. t : cay
485,20 OR !1: /39ACRE '=F 13
��q
Nore-
3 i � _ L.R / BOO
(bl '� � 0 N ` ASPERADJO NINS CSMa
WI al o +
)I o G! ry� LOT 2 SCALE /NFEET 1" 300'
yi ? °• �(.•'� o �;'� 50100 200 300 600
t C C_ • "�, . • • 0 y BEARINGS ARE REFERENCED TO THE IORrH
LINE OF THE NWI/ OF SEC7/ON 4, A SUMED
` i •j1' • /„ Mp,P BEARING N88°23 A
�I til �K LIN t a64 V ��
rZ 1 of oI '' •••'sETBAC � 46 � &
R•
e � if Dated: August 14, 1998
e � � R ��
� � ' IN. . �•g'g� ; E''� 1 �g0 "Revised this 28th day of 3ept.
Vj 1 Sg9° 35 i P pE �'� %% 11111111 1 . 4 1998.
N•
Cp - i i LA
U m W MUR H i o.
171
t WEST 114 CORNER i N RI FAL S
SEC TION4,T30N,R /9W 1 A J •
i (MON..IS 4' BELOW SURFACE, W
••••• , Q`
SET I "IRON PIPE AT SURFACE) , � ? 9 F0 L A NO
This Instrument Drafted by Mork W. Peavey �������� SHEET / OF 3 i,+
Vol. 13 Page 3525
U
ST. CRUIX CO NTY
S €.jRVYCR R "; tlrri
c� C E _K T I F I E D S U R V E Y M A P
� I
66.00'
POINT OF BEGINNING
S 55 "E 261.36' N 64 W, 1,495.09'
p 228 36' 3 3 FROM SF� CO OF
O NE4 NW 4 SEC 0 -30 -19
0 _
O
`Q ' O
N a N
"N
S
W LOT I O C S 55 14" E 380.88'
O 3 2 81.0 9' 0► 66.7' e�
� C r / N
r• 3 p
N
(x ��• of
�" \\
Z 228.36'
N 55 261.36 LOT 2 0Q °
66.00'
o by
O
to hOO• Q. �O / �ST.H. 35 a 6
c
TOW ROA r` a0 a O
��' •
Scales 1" = 100' �� Boa • �Q'
CO
Us
Q denotes 1" x 24" iron pipe set m
0
ti m�
0 33. Co
M S8 ,,1�111i1ffry���
z zs ��`yJ�G 4NS�
G. ROBERT 'N is
SHEFFERS
This instrument drafted by EAU CLAIRE j
G. Robert Sheffers W IS.
Certified Survey Map number S
OOaO• 0)
See reverse side for certification , �..
� Page 58
1
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y
Safety and Buildings Division Count
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No IX
Personal information you provice may be used for secondary purposes [Privacy La I s.15.04 (1)(m)j. 344550
PernktNft' Namg� El City, Villg Town of: State Plan ID No.:
CST BBIVI Elev.; ((:: Insp. BM Elev.: BM Description: DDMM ttC(�� Parcel Tax No.:
pp Qfl.o
032 - 2014 -95 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV_
Septic r ` S coo Benchmark — 362 4b• 3� t aD . O
Dosing x 1OZ- 91 0
Aeration Bldg. Sewer —a
Holding St/ Ht Inlet .a
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake !l .3 p S
Septic > ?_5'0 } 2 o � NA Dt Bottom
Dosing ;sZ o >60 L 3 r > 6:9 NA Header / Man.
Aeration NA Dist. Pipe G • 9y 9s,
Holding Bot. System
�6i
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer 61 RA& s Demand �.� , a #A I n. 13
Model Number 311, 1O GPM
TDH Lift ,b1 Lrictioo A t System 1 5 TDH�SSFt
oss mead Forcemain Length 1•{ 1a Dia. Dist. To Well >(,o
SOIL ABSORPTION SYSTEM
BED ) T PlCd Width Length r
I No. QQ f PIT No. Of Pits Inside Dia. Liquid Depth
EN I N oZ) DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION TyPe O n , r Model Number:
System: ed� l a >$`f -- OR UNIT
DISTRIBUTION SYSTEM
Header /M M n'fold a Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length T Dia. 3 Length 5_0 Dia. 2 Spacing _y_ & 1 3(- it
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded *"x Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes_ ❑ No ❑ Yes ❑ N �n o � ��--
COMMENTS: (Include code discrepancies, persons present, etc.) /'� = 6(�'l 3(a .{ " &d S
LOCATION: SOMERSET 4.30.19.523E,NW,NW 1786 50TH STREET f5t4k _3 3 (.Z 6- kbwt3M /
�-
®C�
Plan revision required? ❑ Yes fjM No QQ
Use other side for additional inform tion. t l c
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
6
z
e
t §
E �
..
e.
3
a
e
.......w _.. .... .......... ...... ., . .. y
� r
r
;- ....
e�
3 � �
§ j
i {
mY m
ae v .'�..... .. ee KM. _ : ..,... „a .... e. _.., e . .....,,.. .._. ... .. .. s e .
r
t
? j g
.
E
F �
i ti ...., ........., .. e . _.,.... _�... ...... ., q .... .. .. , �. ,,,,,
§ ? E e §
i
u
f
i
E E t
_.... _.
e
e e�
s tl § a
e.
3
i
a.me.
e..
e
§ §
�mm
4
e .... mm, ...-.. e�m e.e ..a ,. e s •`�- o e s ...ewe. ...�.�.,., xe. Ke .... § e .,. .... e m e �.e »m .. , .. .. ......gig..
a
e =
M.. 1
{ Safety and Buildings Division
-
NAsconsin SANITARY PERMIT APPLICATION 2 1 W Washington
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size. S 0 xv i
0 See reverse side for instructions for completing this application state sanitary F P it N_ _u
Personal information you provide may be used for secondary purposes ❑ Check it r vision to previous application
(Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION a3 a 9 (07
Propert wner Na a Property Location
.� 1 1 /a w 1 /a, S T , N, R E (00 i M
1 Nw
.g � '� 3c� l
Property wner's Mailing Lot Number_ Block Number ty
City, State Zip Code Phone Number Subdivision Name or CSM Number 't
lvx I sq 0CD5 I r7M)
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road
Public 1 or 2 Family Dwelling ❑ Vilrage
- No. of bedrooms 3 own o f so
111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 4,2 • I q - sa-3
1 ❑ Apartment/ Condo 0 - 'a0I _~
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. YReplacement 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 Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Mound 30 E] Specify Type 41 []Holding Tank
12 E] Seepage Trench 22 In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTI 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 9G• / Feet
VII. TANK ` Capacity
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanksl Tanks
Septic Tank He khm lanK 6 ro N Pk ❑ ❑ ❑ ❑ ❑
lift Pump ank I Z5' ` f s ❑ ❑ 1:1 ❑ ❑
ESPON SIB ILITY STATEMENT
I, the undersigned, assume responsibility for ins tion of the onsite sewage system shown on the attached plans.
Plu is Name: (Print) P! ber' No amps) MP /MPRSW No.: Business Phone Number:
U�CLILA W `Q-P� � !s s 3 S
Plumb 's Address (Street, City, Stag, Zip Code):
T *, V - 0, t 1
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuin a Si P ure (No Stamps) rrp7 4t A roved Surcharge Fee)
�pp ❑ Owner Given Initial �% �� '
Adverse Determination /tD
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
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
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.
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 isto 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 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
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.
r Safety and Buildings
2226 ROSE ST
IA CROSSE WI 54603 -1905
TDD #: (608) 264 -8777
,\Ifisconsi www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
July 02, 1999
CUST ID No.273085 A7TN.- Rod Eslinger
CALVIN POWERS ZONING OFFICE
POWERS EXCAVATING INC ST CROIX COUNTY SPIA
1969 185TH AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 07102/2001 Identification Numbers
Transaction ID No. 232867
Site ID No. 65330
SITE: Please refer to both' identification numbers,
Site ID: 65330 above, in all correspondence with the agency.
St Croix County, Town of Somerset
NW 1/4, NW 1/4, S4, T30N, R19W
Facility: Curtis Kisler Residence
FOR:
Description: Replacement Mound
Object Type: POWT System Regulated Object ID No.: 475630
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
i
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. Adm. Code.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats.
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.
l rcly, DATE RECEIVED 06/15/1999
FEE REQUIRED $ 180.00
is R. drens n FEE RECEIVED $ 180.00
Wastewater Specialist BALANCE DUE $ 0.00
(608) 785 -9336
dsorenson @commerce.state.wi.us
WiSMART. code: 7633
N v i APPLICATION FOR REVIEW POWTS
seonsr►n - Complete all pages -
Department of Commerce
Safety & Buildings Division This page may be utilized for fax appointment requests
Bureau of Integrated Services Complete and indicate date plans will be in our office
NOTE: Personal information you provide may be used for secondary Complete for confirmed appointments *:
p urposes [Priv acy.Law s. 15.04(1)(m)). Not available for POWTS at this,tine.
1. Private Sewage Submittal 2. Type of Submittal: 11
System Type New Transaction ID:
( )
( ) Groundwater Monitoring Previous Related Trans. ID:
( ) Site Evaluation ( Replacement
(N POWTS System ( ) Petition (attach form SBD -9890) Appointment Date *:
( ) At Grade ( ) Experimental Review
( ) Assigned Reviewer:
Holding Tank
( )Engineered System
( ) Nonpressureized In- Assigned Office:
Ground - conventional *Plans must be received in the office of the appointment no later than
( ) Pressurized In- 2 working days before the confirmed appointment.
Ground
Mound 3. Project Site Information - Fill in all known information.
(
(
Aerobic System Site Number
( ) Sand Filter Number & Street: ti S� � Oc�
( ) Constructed Wetland Legal Description: N W t q 5 4 X30 c
1 4 Vp
( ) Other: County ` ( ) City ( ) Village ( ) Town of Flo ry"k /`S •iT
Gallons per Day: yv Facility Name: (individual and /or usiness name of project)
Building Type (check one): r
(')C) Dwelling, 1 or 2 family r
( ) Public Building Facility Address: (project address) Zip Code
( ) State -owned Building I ���� V ,L
4. After plans are reviewed, please: (check all that apply)
Call when completed. Mail plans to custome<�, 3, 4
Requesting party will pick up Circle customer number from below.
Other:
5. Complete the following designer /owner /requesting information. Utilize the check boxes when designer, owner or requesting party is the
same to avoid repeating information.
Designer,lnforinatloo (Customet3a), ,,, „ ! .'Requesting;Party if different than designer(Customer 3) ^`
F sQ� �t�a� _ Customer Number First Name Last Name Customer Number
L V%� yo
C°o)any Name Company Name
V., till 0411
Address Address
- 1 L09 1 13
City (� State Zip +4 (9digits) City Sta ® Zip +4 (9digits)
s:q o f G
Phone Number (area code) Fax or Internet Phone Number (area code) x or Jlte
k5l -Iasi -P
Check others if applicable Check others if applicable We
( ) Owner ( ) Payer ) Requesting party ( ) Owner ( ) Payer
;Owner Infoririation stonier 2 ) A n :;.Other Please specify (Customer 4)
First Name Last Name Customer Number First Name Last Name Customer Number
Company Name Company Name
Address Address
City State Zip +4 (9digits) City State Zip +4 (9digits)
Phone Number (area code) Fax or Internet Phone Number (area code) Fax or Internet
Check others if applicable Check others if applicable
( ) Payer ( ) Payer ( ) Other
MAKE CHECKS PAYABLE TO DEPT OF COMMERCE TOTAL AMOUNT DUE
Attach check here
Rev ei w Code 7633
C
SBD -1077 (8.10/98) 47�__ 1 ;
PAGE I #OF�
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
LOCATED IN THE N wA AOF THE 1 /40F SECTION'_,T qW,
TOWN OF So me y-s- - fi , 5 ; COUNTY, WISCONSIN.
INDEX is y
PAGE IA OF 9 TITLE SHEET
PAGE 1 OF 9 WORK SHEET
PAGE 2 OF 9 WORK SHEET
PAGE 3 OF 9 WORK SHEET
PAGE 4 OF 9 WORK SHEET
PAGE 5 OF 9 PLOT PLAN
PAGE 6 OF 9 PLANVIEW CROSS SECTION
PAGE 7 OF 9 DISTRIBUTION PIPE LAYOUT
PAGE 8 OF 9 PUMP CHAMBER
PAGE 9 OF 9 PUMP PERFORMANCE CURVE
PREPARED FOR
t -7 gu SOS Sl1
soe "o -s.`r, � S y o 3,5
PREPARED BY
POWXRSEXC TING C.
1969 185th AVE
NEW RICHMOND, WISC. 54017
715- 246 -5135
PCV
tj w k(Y 30
F
WORKSHEET - MOUND SYSTEM DESIGN
PROBLEM:
Design a mound system fora 3 _
The site characteristics area
Depth to groundwater or bedrock in '
Landslope - %
Percolation rate .:. c-�.,_ min. /in.
Distance from dose chamber to distribution system ft.
Elevation difference between aump and distribution systern � ft•
cir��roo o.aI
Step 1. WASTEWATER LOAD - q5b
Step 2. SIZE "THE ABSORPTION AREA
A) Area required - 4/ 50 -3 sq. ft.
B) Bed or trench length (B) d .50 -50 f t.
C) Bed or tr 2nch width (A) n f _�• 5 ft.
D) Trench spicing (C) z
" Wastewa :er load . .'L4 caal /ft; ?_ /day B . ft.
tt re
Step 3. MOUND HEIGHT
A) F111 depth (D) - ___,�__ ft.
B) Fill depth (E) - D + slope (AY#0 __.- ft.
C) Bed or trench depth (F) - --=83 ft.
D) Cap and topsoil depth (G):- „ ft.
E) Cap and topsoil depth (H) f 5 ft'
199;?_ .
K sl e
1'
� WNw Yy {
c�.Ej M.•DJ' S SLR
Step 4. MOUND LENGTH
'A) End slope (K) _ ( D + E + F + H x 3 ft.
LC
B) Total mound length (L) B + 2(K) ft.
Step 5. MOUND WIDTH
Al) Upslope correction factor
A2) Upslope width (J) D + F + G)(3)(factor) a 91a ft.
1 t,83 +), 5) 3 A
B1) Downslope correction factor f_
B2) Downslope width (I) _ ; (E + F g3 � + G) 3)(factor) _ �_ 'S ft.
lS�,3X
Cl) Total mound width (W) for bed - i + A + I ft.
9,a 5 4
C2) Total mound width (W) for trenches :-
J + �+ (no. trenches -1)(c) + A + i r- ft.
Step 6, BASAL AREA
A) Infiltrative capacity of natural soil ■ u_ gal. /ft /4ay
r
B) Basal area required = wastewater flow 1 q
natural soil inti� � ative- capacity 06 sq. ft.
C1) Basal area available for bed for sloping sites =
B x (A + I) _ 5 sq. ft.
56) X(7,5 +1/,g� : C? 05
C2) Bas are avail le for trench for sloping sites =
B W -- �J + A = sq. ft.
C3) Basal area available for trench or bed for level
sites - B x W = sq. ft.
Li r, rir e „,z a 7
D a t a
I
I�
G��t's K :s( er Poe-
7 8'lo sc'n^
�o�o%s�
Step 7. DISTRIBUTION SYSTEM
1A) SIZE DISTRIBUTION SYSTEM
1) Hole size Y 4 1 in.
2) Hole spacing = 3
3) Distribution pipe length
4) Distribution pipe diameter a / % in.
5) Spacing between distribution pipes = ���•
6) Distance from sidewall to distribution pipe / in.
7B) DISTRIBUTION PIPE DISCHARGE RATE 60 ft.
1) Number of holes per pipe m _ _L7
7
2) Flow per pipe = XO GPM
7C) SIZE MANIFOLD
1) Manifold is central / �„ end
2) Manifold length = ft.
3) Number of distribution lines a
4) Manifold diameter = _ in.
7D) SIZE FORCE MAIN
1) Minimum dosing rate =
__Y0 GPM
2) Force main diameter = -.3 in.
..__`
3) Friction loss /0 - '� � ft.
7E) TOTAL DYNAMIC HEAD
1) Vertical lift = .� ft.
2) Friction loss z ft.
3) System head 2.5 ft..- ft.
4) Total dynamic head A /�q ft.
.dGe /"'-aa0S3.7
1 '7 g(o w:1-
Soav�..ars� �
7F) PUMP SELECTION
1) Pump selected will discharge GPM at ft.
total dynamic head.
2) Pump model and manufacturer
7G) DOSE VOLUME
I
1) 10 times void volume of distribution lines gal. /cycle
2) Daily wastewater volume 4 doses /24 hrs. r gal. /cycle
yso s
3) Minimum dose volume = � �s". gal. /cycle
3�y 3(1 3 3,11
7H) DOSE CHAMBER �y
1) Minimum capacity required a 25 0 gal. ? /annJ
i
Licuns:: .:u �?,z0. 53
Date:_
I
)V kJ - fi w T 3 0 -,f 9 LJ
17$'b sow
So m.a r ga� W fi S �� 2 5
1 a7> I e ol oA nd ag,S X 7
7,5 X JS E( STS. y
#0537 .
M � c
t
/Cvt)
4f N
3
3 t °"
SYSTE
allY
I it° "
►V't510N 0 SpEES`r
�OWN"
� SpoN pENCE
S
I /
Page of
Straw, Marsh Hay, Or
Synthetic Covtiring
Distribution Pipe3 /
di Sand
Topsoil = H�___,�._ 9 3�
3
_.., E SEWp`GE 9Y8'TE % Slope
. . ona * Bed Of �— 2 -2 Force Main Plowed
ndtt� Aggregate Layer
D f Ft .pP O Z
pF SAFETY Am IWLM E // 3 Ft.
WV Cross Section Of A Mound System Using
83
A Bed For The Absorption Area Ft.
G Ft. ,
SEE G06RR SP�NDENOE H /,5 Ft.
A 7, Ft.
B 30 Ft. "' n
License Number: # a , ;- )0 , 5 7 K /0 Ft. r ,
Date: J ut ne. 19 1 T � L 7 Ft.
Ft. 1
Al ternate Position J /gig F
t.
of
,. .. Force Main W aS.S Ft,
L_
Observation Pipe
K
A-------------- - - - - -- ---------------------
��_ Force Main R.
0
�,Distribution. Bed Of
Pipe,.
Aggregate "
Observation Pie
P Permanent Markers
{
1
t
Plan View - Of Mound Using A Bed For The Absorption Area
P490 .z 4 "...�
Perforated Pipe Detoll
End View'
Putorohd
End Cop PVC Pipe
e {o w • , .
Holes Locate4.'On Bottom,. �y
x'
Ar Equally Spaced
4 Jf ,
PVC Force Maim
PRIVATE SEWAGE SYSTEM
Conditionally PVC
Monlrold Pipe
FrR
'A OVED
DIVISION Of SAFETY AND BUILDINGS
SEE CORRESPONDENCi'. Distribution Pipe Layout
P ,. 5� Ft.
R ,
q t
S .-._._
X Inches,
Y a Inches
Hole Diameter ---.1- Inch
License Humber:. DO 7
Lateral ". / Inch(es)
Manifold " 3 Inches
Date: / 4 Force Mein " 3 Inchiis
# of holes /pipe
Invert Elevation of Lateralsc /5 Ft,
PAGE _.52._ OF
PUMP CH A MISER CROSS SEelTIA ANO SPECIFICATIOIJS'
Vf WT GA►
`i'C.Z. VENT PIP[ WEATHER PROOF APPROVED LOCKIAJG
? XS' FROM OOOR� JUUGTION IsOX MAUWLC COVER w /�,�lclr�n� ncr
• ) V
WINDOW OR FRESH IYMIu.
Alit INTAKE
GRADE
I '1' MIAI.
l __ •� ! 'MI
coAJDUI
IAJLE T • 'PROVIDE ( - -----
_T
AIRTIGHT SEAL
I I ( v
APPROVED JOIAIT A I I I APPROVED JOIN w /C.I. PIPE I III W /C.X. PIPE
EXTENDING 3' ( II AL ARM EXTEM011,16 3'
ONTO 60FlQBWV G eSYSTEM i i I ONTO SOLID TOIL
Con i '® ally � °"'
;. PUMP --
dvED
J .�
1 ,� OFF
DIVISION OF �'E III BU1LDfNGS •
COIJCRETC BLOCK
RISER EXIT PERMITTED OWLy IF TANK MANUFAG 3" APPROVED
TURCR HAS SUCH APPROVAL APPR
SEPTIC E SPECIFICATIOMS ...
OOSE
TAWAS IMAIJ UFACTURCR. a �� (=' "S. WUMBER OF DOSES' PER DAU
TANK 51ZE : GALLOWS DOSE VOLUME
ALARM MAWUFACTURCR' S�J C�.c��c .� INCLUDING BACKFLOW: �� GALLONS
MODEL MUMSCR: - - 101 8 CAPACITIES: A = //4 INCHES OR 3 01, GA LL0113
SWITCH TuPC: r -�� \0,� a= IiJCHES OR 3 " 7 GALLOWS - _ -
PUMP MAWUFACTURCR: CC(ibI A A C=_ OR 1 " LLO US
MODEL W UMBER: 3 3 11 L 43 D • IMCHES OR " GALLOWS
SWITCH TYPE: — 4 ��oc ; 2: MOTE: PUMP AWD ALARM ARE TO OE
MIUIMUM DISCHARGE RATC S O GPM INSTALLED OW SEPARATE CIRCUITS
(01� /
VERTICAL DIFFEREWCE OETWEEIJ PUMP OFF AND JOISTRIBUTIOW PIPE.. 9 FEET 17, 85 91 L l�n
♦ MIWIAUM NETWORK SUPPLY PRESSURE 2 . 5 FEET C! /
♦ — 1— FEET OF FORCE MAIN X � fYOi;FKICTIOU FACTOR.. �� FEET
f TOTAL DtlWAMIC• HEAD = i9 FEET
IMTERWAI. DIMEIJSIOWS Of TAWK: LENGTH ;WIDTH — ;LIQUID DEPTH
• k,��`.S K ���� P 0. a ovC(
1-1�V sa �, 5 y c�guulds
s "`�'��^ •`�`� Submersible
Effluent Pump
Enlu 11
3885
APPLICATIONS • Overload protection must smooth operation. Silicon can be operated continuously
Specifically designed for the • be provided in starter unit. bronze impeller available as without damage.
following uses: Shaft: threaded, 400 series an option. ■ Bearings: Upper and
• Homes stainless steel. ■ Casing: Cast iron volute lower heavy duty ball bearing
• Farms • Bearings: ball bearings type for maximum efficiency. construction.
upper and lower. 2" NPT discharge adaptable
• Trailer courts 9 ■Power Cable: Severe du ty
• Motels • Power cord: 20 foot for slide rail systems. rated, oil and water resistant.
• Schools standard length (optional m Mechanical Seal: SILICON Epoxy seal on motor end
lengths available).
• Hospitals CARBIDE VS. SILICON provides secondary moisture
Single phase:
• Industry •, , CARBIDE sealing faces. barrier in case of outer jacket
/3 and /2 HP -16/3 SJTO
• Effluent systems Stainless steel metal parts, damage and to prevent oil
with 115 V or 230 V three BUNA -N elastomers. wicking.
prong plug.
SPECIFICATIONS • 3 / -1 Y2 HP -14/3 STO with m Shaft: Corrosion - resistant ■ 0 -ring: Assures positive
Pump bare leads. stainless steel. Threaded sealing against contaminants
• Solids handling capabilities: Three phase: design. Locknut on three and oil leakage.
3 /4 " maximum. •'' -1'/2 HP -14/4 STO phase models to guard
• Discharge size: 2" NPT. with bare leads. On CSA against component damage AGENCY LISTINGS
• Capacities: up to 128 GPM. listed models - 20 foot on accidental reverse rotation.
• Total heads: up to 123 feet length SJTW and STW ■ Motor: Fully submerged in SP Canadian Standards Association
TDH. are standard. high -grade turbine oil for
• Mechanical seal: silicon lubrication and efficient heat ( Hi Underwriters Laboratories
carbide -rotary seat/silicon FEATURES transfer.
carbide - stationary seat, 300 ■ Designed for Continuous
series stainless steel metal •Impeller: Cast iron, semi- open, non -clog with pump -
Operation: Pump ratings are
parts, BUNA -N elastomers. out vanes for mechanical seal within the motor manufacturer's
• Temperature: recommended working limits, f
1041(40 °C) continuous protection. Balanced for
140 °F (60 °C) intermittent. M ETERS FEET
• Fasteners: 300 series 90 SERIES: 3885
stainless steel. i_ _....._ _. .. ... - - - .4_4 - _1 -- -... _
S" E: SOLIDS
• Capable of running dry 25 80 WEt N RPM: VARIOUS
without damage to ...... ............:.................. �......_........__...._.... - -a -- - _
—► � SFT - 5 GPM ...... __...... . .............................. ...._.......
_......
I
components. 7 0 y E , H i
20 ; - -- - - -j- - - - - -
_
r
Motor
w 60 -
Single phase: _ .weo
• %3 HP, 115 V, 200 V, 230 V, " 5 o I
60 Hz, 1750 RPM; 1 /2 HP, Z 15 !......... __...- __. __.__... _.
115 V, 60 Hz, 3500 RPM; 0 40 w E0 H
HP -1'/ HP, 230 V, a - �- - - - - - - -
60 Hz, 3500 RPM. ° 10 . 30 w I I
• Built - in overload with WFO3<
automatic reset. 5 20 i _ _ __ _
• Class B insulation. -- I
- 1'/2 H P 200/230/
Three phase: 10 � -+- -
'
- -
- - --
• 'I/ H P o o - - - -
460 V, 60 Hz, 3500 RPM. 0 1 10 20 30 40 60 60 70 80 90 100 110 120 130GPM
• Class B insulation, o iO 2 30 M
CAPACITY
(<) 1995 Goulds Pumps Effective May, 1995
83885
Wisconsin Oepartment of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
U 0*"rr. � � r. Govt. Lot Iv LU 1/4 N W 1 /4,S T 30,N,R E (orIS
Property Owner's Mailing Address Lot # Block# Subd. Name or CSKt#
City State Zip Code Phone Number City ❑ Village `` Nearest Road
❑ C yam ,, Town
❑ New Construction Use: Residential / Number of bedrooms Addition to existing building
(� Replacement ❑ Public or commercial - Describe:
( Code derived daily flow � gpd Recommended design loading rate 15 bed, gpd /fe Jb trench, gpd /ft
Absorption area required _ 3 7S bed, ft 3 75 _trench, ft Maximum design loading rate i S bed, gpd /ft2 __,_�_ trench, gpd /ft
Recommended infiltration surface elevation(s) _C.. 3�_ _ 0.141 �5 � 3 / ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material tj / H f Flood plain elevation, if applicable N ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding K
U = Unsuitable for system ❑ S 91 U KS El El Ea U EIS R U ❑ S EZ U ❑ S
SOIL DESCRIPTION REPORTP afb 4 r!'!G 2
Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
p �U 2 �b Yh'�✓ w � m � S .�
is .� s MU+►- h.
Ground q C a ►Y1 SS — q k�� elev.
Depth to
limiting
factor
"'> Y-5 in.
Remarks:
Boring #
/oLf R slk r �. 5
m � ✓ w S
o A S,
Ground
eft.
Depth to
limiting
I
actor
2-3-0— Remarks:
CST Name (Please Pr' Signature Telephone No.
I ` �A3� - 7 / r'o� YG S /3S
Address Date U CST Number
1 S v N v� wz oti -7- 9 aamc2
Cur OWNER u r`; s � � S (� SOIL DESCRIPTION REPORT
Page °? of 3
PARCEL I.D.# ` �s
Boring # Horizon Depth Dominant Color Mottles Texture Structure 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
/ o �1 s io
;L W 56 � r w
Y8 - /OVR
Ground 7
elevt�', S "'� S yy" , S
4 4
Depth to
limiting
factor
in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Structure GPD /ft2
in Texture Consistence Boundary oots
Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trench
Boring #
r
y:
Ground
elev.
ft.
Depth to
limiting
factor
' Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R. 07/96)
Gu
Nw�AJ 73��19�
So rr)erS W =
e- V 1"
s�aas
Ll Q a r-- • h
-X
q ai
c�
�9 I
�dam 37,
�5
N or �1�•
Y
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the ( uu4 K residence located at:
tV W 1/4, A (k) 1 /4, Sec . T T N, R "': Town of
e> ma er, - Upon inspection, I certify that I have found the
tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced
Did flow back occur from absorption system? Yes No )(-(if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacurer (if known):
Age of Tan (i known):
0 " � , CA V'. v� �8 W�CyS
(Signature) (Name) Please Print
(Title) (License Number)
Jam,Y.Q_
M9
(Date).
-- -
(Date)
Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR -83, Wis. Adm. Code (except for
inspection opening over outlet baffle) . ^�
Name �rill��. A O� eS S ignatur MP /MPRS ��5.3 77
5/88
N _'n Department of Commerce SOIL AND SITE EVALUATION
f Safety and Buildings Page of
Bureau of Integrated Services in accordance ILHR 83.09, Wis. Adm. Code
���
Attach complete site plan on paper not less than 8 112 x 1 6`6s size. Plan mu County
st r
include, but not limited to: vertical and horizontal referen ��4irtt (BM),fq eot�n and r0
percent slope, scale or dimensions, north arrow, and to t+pryand dist ri¢> rnaWst ro4 Parcel I.D. #
APPLICANT INFORMATION - Please prim11E information` Re iewed by Date
Personal information you provide may be used for secondary pikpoSQs (Privacy 1 dvj 0�`i(m)) ✓� / /�y
i
Property Owner ( `: GOP. Property 6q ation
C ll0' 1' �S��ul•P /` j' .., Gov t N w 1/4 ��1/4,S T ��,N,R t E (or W
Property Owner's Mailing Address ' t �• ( L Block# Subd. Name or CS
l�
City State Zip Code Phone Number
❑ City ❑Village Town Nearest Road
❑ New Construction Use: Residential / Number of bedrooms Addition to existing building
Replacement ❑ Public or commercial - Describe:
( Code derived daily flow � gpd Recommended design loading rate - bed, gpd /ft 14 trench, gpd /ft
Absorption area required - bed, ft - trench, ft2 Maximum design loading rate i S bed, gpd /ft2 jj� trench, gpd /ft
Recommended infiltration surface elevation(s) _ � q�i �� v a;( I /'15 � 3 / ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material Flood plain elevation, if applicable AJI ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S 93 U KS ❑ U ❑ S (Q U ❑ T I S W U ❑ S X U ❑ S ® U
SOIL DESCRIPTION REPORTR a6 4 rn C 2.
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
O 15 /0YP, 2 sb k rri WC ;Q r"
-�' I s Y1f1U�r 1 �►. S d
Ground .3 ss a m T S 6 M w k °°
lst�Z ,
Depth to
limiting
factor
Yin.
Remarks:
Boring #
Ground
t4ft.
Depth to
limiting
F
factor
in. Remarks:
CST Name (Please Pr' Signature Telephone No.
Orel 7iS�dY6
Address Date CST Number
_ CIC
1
C(er�5 �S� SOIL DESCRIPTION REPORT a rt PROPERTY OWNER Page
PARCEL I.D.#
Borin # Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
Ground .3 5Q M
n elev
Depth to
limiting
factor
in.
Remarks:
i3 Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring #
[3
Ground
elev.
ft
Depth to
limiting
factor
in. Remarks:
Boring #
13
Ground
elev.
ft. '
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
1� � 5 1`Qk-
�1
1 ?g Svm S NW •N �3c - 19
S cry7e r szt Qj r J erS_a�
5yaa-S
/QLr'p� 4
� 37�
M
y
� V
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
1
Owner/Buyer iJl. ��`� �, �, l •Q,�
Mailin Address L �
Property Address vv. SL
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number 3a - Q o I i j — 9
LEGAL DESCRIPTION
Property Location AAJ ' /4, 0 Q-) '' / a, Sec. _ T N -R W, Town of Sto nv' jFF .
Subdivision 0 , Lot # iV A .
Certified Survey Map # , Volume , Page #
Warranty Deed # 3 , Volume Page # _.
Spec house ❑ yes IX no Lot lines identifiable �a 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.
I
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 and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification .
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
da of the hree year a pira ion date.
lie
SIGNATURE OF APPLICANT DATE /
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the roperty escribed ab ve, virtue of a warranty deed recorded in Register of Deeds Office.
/ / C
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented 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
DO(','MENT NO. STATE BAR OF WISCONSIN -FORM Z
,�. r 4 . e NIA,R(t+W'fr OEIiO
`• VOL 5 ?? r 1 • i.Ji1 THIS SPACE RESERVED FOR RECORDING DATA
u -- r L
x his wi VEFD' - WESi�EY W 1 . I�ALLE and LINDA R HALLS, i f `l{� t.; �•,x °o•• \NIS.
nf1
s h w ` C icK
-- I
K� - - - - -_ - - -- - - - - -- -- __. _ -- - - -- - - -- - day c;f - August - - - -A. D. 1925
- Grantor conveys and warrants to __— CURTIS R ,_- EISLER._and . NANCY_ R,__
___X1SLER, husband __and wife,__as.__ joint-tenant s_
i Register of Deeds
Grantees_-
(c. a valuable consideration __on 00) - Dollar_ and. -other _._ __- RETURN TO
__good and - _value ble- -cons ideration
the following described real estate in _ ,St. Cr oi x __._.. County, State of Wisconsin:
Part of North half (N�) of NWT of Section 4, Township rax Key
Thirty (30) North, Range 19 West, described as followahis is __. _ _ homestead property.
Commencing at SE corner of NE4 of NA of said Section 4; thence N64 0 26'43 "W
1495.09 feet to the centerline of State Trunk Highway "35" and "64 "; thence
S63 "W on said centerline 68.1 feet; thence SWly on said centerline,
on curve line, concave NWly, long chord bearing S66 0 49'01 "W 646.38 feet, an
arc distance of 646.7 feet; thence N34 0 17'46 "E 479.4 feet; thence N55 0 42'14 "W
33.0 feet to Place of Beginning; thence N55 0 42'14 "W 228.36 feet; thence N34
17'46 "E 250.0 feet; thence S55 °42 "E 228.36 feet; thence S34 ° 17'46 "W 250.0
feet to Place of Beginning, being Lot 1 of Certified Survey Map filed May
3, 1973 on page 58.
Grantees agree to assume the mortgage to United States of America acting
through Farmers Home Administration dated and recorded June 28, 1973 in
Vol. "499 ", page 478. Doc. #316"39 in the Office of Register of Deeds for
St. Croix County, WI.
Exception to warranties: •. ���._M
Executed at
Hudson, Wisconsin 11th _ day of August 19 75
_ .. _._ this, .
SIGNFD AND SEALED IN PRESENCE. OF _ __— (SEAL)
Wesley W. Halle
(SEAL)
Linda R. Halle
` (SEAL)
1 `
(SEAL)
Signatures of
authenticated this day •.,f
'title: Member State 1':'! n`- Wisconsin or Other Party
Authorirrd under Se<•, 706 i;6 viz. .. _
k'
STATE OF WISCONSIN
St. Croix County.
11th da of August __ __ . to 75
., . Firsnnully Dame Fa•L••re mc, this -
the abo ,iam••d Wesley W. Halle and Linda R. Halle, his wife, -. -- - -
to me kv t•1 t•e thr prr;, 36 h,, rxr•, ule the Lrrryning instrument and acknoaI,dverl'hr yaq•e.
This twitrume wa; drafted b9 Y ' '•� �; C. A . Richards _
RICHARDS & WALL fJ � �,,tary F'ubh' State of MP79,9 wis
Attorneys at Law
The use of witnctises iR •,pti••nat, M permanent
Names of persons sii:ning in auy e aparit •r sh•.IUL.t 1, typed o printed below their. sivnat - ulec.
WARRAYTY DEFD TATS BAR OF - r. a YSIS FORM NO 7 19 1 6'
;.,.+ •e, a,� fi ?..,... a ra - T�. - � c•:�• a�r.,2>,1 •�, € ' M r ,' e +x ��,,. z s _ �..�:`
. 7 ; •.ri r i � - a xe #r.. :; r .,dr f .
1
I , 6UP PHY LAND SthiV i -XI NG MC88 -037
Scale 1" = 100'
Mortgage Plat drawing for the Bank of New Richmond 5 -21-$
(Curtis and Nancy Kisler)
s
♦ R
h ♦ ?
6 sEPr/C
♦M
LOTl. C. S. A/. VOL. /, SHED
M� PA O E 18 a /
DWELL /ND 0
h 0'
P WELL ti P
� 0
4
J . ♦ X/ \1 40
w 9
a
1
Description:
Part of N 1/2 of NW 1/4 of Section 4- 30 -19, described as follows: Commencing at the
SE corner of NE 1/4 of NW 1/4 of said Section 4• thence N 64 26'43 "W 1495.09' to the
centerline of S.T.H. "35" and "64 "; thence S 63 "W on said centerline 68.1'•
thence SWly on said centerline, on curve line concave NUly, Long chord bearing �
S 66 ° 49' 01 "W' 646,38', an arc distance of 6 +6.7'; thence N 34 ° 17'46"K 479.4'; thence
N 55 ° 42 '1.4 "W 33.0' to Place of beginning; thencee N 55 thence N 34 ° 17'46
250.0'; thence S 55 0 42 1 14 "E 228.36';thence S 34 0 17 , 46"W 250.0' to Place of Beginning,
being Lot 1 of Certified Survey Map filed May 3, 1973 on Page 58.
Note: This drawing is not intended to represent a survey. It is intended only to
be used for mortgage purposes.
I