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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
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IN� ICATE NORTH ARROW
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Wiscorlsin Department of Commerce Y'
Safety Vnd Buildings Division PRIVATE SEWAGE SYS Count ST . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary ruµt.Ala .:
Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. �
P P . Ci H old COLLOVA BUILDERS � h R p ffa TAwn of: state Plan ID No.:
CST BM Elev. Insp. BM Elev.: BM Description: �i Parcel T d3 t5 1170 - 70 - 000
r� « /
.
TANK INFORMATION - ELEVATION DATA A9800270
TYPE MANUFACTURER PACITY STATION BS HI FS ELEV.
Septic �. Berk M r s, s ! o S /0
Doug IAv �o A 14. k>WV 8
Aeration Bldg. Sewer �, 2 1V
Holding "" St �
Inlet
Q 4 ? 1;
TANK SETBACK INFORMATION S't * Outlet
TANK TO P / L WELL BLDG. vent to ROAD Dt Inlet
Air Intake
016 NA Dt Bottom
D f f Z0 NA Header /Man.
Aeration NA Dist. Pipe
40 '60 1.1 co 41 11L SFs
Holding r Bot. System .� L
-7 -7
PUMP/ SIPHON INFORMATION Final Grade 2 ,-Z
Manufacturer
Model Number �� YSGPM
TDH Lift (P.,qey Friction S`7 Systems TDH70t Head
Forcemain Length � Dia a ' Dist. To Well
SOIL ASWAPTION SYSTEM'
BED / N Width r / Length � No. Of renches PIT No. Of Pits Inside Dia. Liquid Dept
IDIMEhStV DIMENSION :::::�
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Ma acturer: ���
INFORMATION Type O CHAMBER del Number:
System � jCT Z� 0(Q OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold i r Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length U L Dia. `-r Length 5 6 " Dia Spacing A A Sr kA 3 c
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STAR PRAIRIE 3.31.18 SW,SW 1303 STARDUSK DRIVE
0A L1, IS M_ I do-a,1 c6- %C, C� t • jc•,s k 6W
All ~ � P�
til
Plan rXision required? Fa,-Yes ❑ No
rmation. 9 /6EU
SBD -6710 (R.3/97) Date inspector's ignature Cert. No
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
201 W. Washington Avenue
Vi scons i n SANITARY PERMIT APPLICATION P O Box 7302
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 8 112 x 11 inches in size. 1l;
• See reverse side for instructions for completing this application State Sanitary yP Permit �Number
�
Personal information you provide may be used for secondary purposes check if revision o p' revious application
[Privacy Law, s. 15.04 (1) (m)].,
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N
Property Owner Name Property Location
cc . �,� v 5 �114 A, S 1,2 T ,5� , N, 11 /,P E (orY�
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPEOF BUILDING: (check one) ❑ State Owned ❑ it� age Nearest Road
Public 1 or 2 Famil Dwellin ❑ vi! - No. of bedrooms �� Town OF 7a �✓ >_ IIt ' G G
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/Condo �� • ��' g • ��� ✓ a L
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. pd New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
------ System ________ System _____________ Tank Only______________ Existing S Ex is---- ina 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 C �j - 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
Z Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
Feet Q d 7G Feet
Capacity
VII TANK in Ca allons Total # of r Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin strutted
Tanksl Tanks
Septic Tank or an / I VC G' Iry e5y`t° (ice ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank A ==L l 1 f , 6 1 0- 1 ❑ 1 ❑ I ❑ I ❑ I ❑
NSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number:
� / S
Plumber's Address (Street, City, State, Zip Code):
/ 7z, - ,C / ,z ip,.C� a
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent ign ur o tamps)
kApproved ❑ Owner Given Initial 00 Surcharge Fee)
,nn
Adverse Determination M
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: original to County, One copy To: Safety & Buildings Division, Owner, Plumber
- SANITARY PERMIT APPLICATION 20 ,E WashngtonA
In co c r d with 83 0 5 . P.O. Box 7969
Department of Commerce a t ILHR Wis. A d m. Code Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Check ihe6sion . pr'evi ous application —
[Privacy Law, s_ 15.04 (1) (m)].
State, Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N
Property Owner Name r S property Location
G ��, �4j 114, T� j , N, R/r or) W
Prol5erty Owner's Mailing Address Lot Number Block Number
2 7 5 e v !fie- l
City, State Zip Code Phone Number Subdivision Name or CSM Number
t` o ( ) Gou fr eol- u1.5r
II. TYPE OF BUILDING: (check one) ❑ State Owned ° �t Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms _ ° Tow OF Spa` .' r v at 1-d&s'
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo Q-3 1 !l 1
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
S ❑ 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. 1Z New 2. ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5, ❑ Repair of an
. ...... System ........ System ---- --------- Tank Only______________ Existing System ________ Existing System
B) ❑ A Sanitary Permit was previously issued. Permit 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
1214 Seepage Trench 22 ❑ In- Ground Pressure -- t 42 C] Pit Privy
13 ❑ Seepage Pit oZ J �-�! y.b� 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 1 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
4�5_d �' Q7 7G Feet Feet
Capacit
V {I. TANK in Ca gallo s Total # of r Prefab. Site Fiber- plastic Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App.
New Existin strutted
Tanks I Tanks
Septic Tank or Holding Tank I @a ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber I ❑ ❑ ❑ 1 ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signatu : (No Stamps) P/ PRSW No.: Business Phone Number:
-F
Plumber's Address (Street, City, State, Zip Code):
to s '
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater at ssue d suing A nt Si t re (No Stamps)
harge ee)
Surd F
Approved C] Owner Given Initial (TU (
` �(
Adverse Determination `�
A � t' +� �
D rminatl n
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 IRA 1/96) Dt5TMW' IO%: Original to County. One copy To: safety 6 Buildings Division, Owner, Plumber
I
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_ It 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:
Proper,, owner's narnre and mailing address. Provide the legal description: and oa: —cel tax. rumber(s) of where the
system is to be installed.
I1. 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 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, dtawn 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.
----------------------------7-----------------------------------------------------------------------
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.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS
'INDUSTRY; C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS n
'7u"L — ` S t, "
( (ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: T NSHIP `7 NICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
S1 /sue''/ /_3 /T31 N /Rf6 E (or) W - ,�o
NTY: (ACA LING ADDRESS:
C azV
USE DATES OBSERVATIONS MADE
r�BEDRMS.: COMMERCIAL DESCRIPTION PROFILE DESC PTIONS: PER OLATION TESTS:
Residence � . �� New ❑Replace Z Z pd q �/ �Q
RATING: S= Site suitable for system U= Site unsuitable for system / T•J to !
r ONV NTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
ES ❑U ZS ❑U ®S [:]U ❑S ZU I ❑S ZU
If Percolation Tests are NOT required DESIGN -7q'- If any portion of the tested area is in the
under s. ILHR 83.09(5) (b), indicate: / Floodplain, indicate Floodplain elevation: —
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE A BBRV. ON BACK.)
B- ! � �� �v �z„� -L. ? 8-] , 8 -Z7 Z7 -yo
B- Z 8 / - - 9 6//, 9 - ♦; ' BUJ. i9 o H,� �•�.s.'/ 3Q - VZ
B- 3 8l�
Z-" / /, /'Z - 4 ee-T, i 9- 3 " �. �•�.s; ,/ 3i - yi
' Z�P Q/f..5.
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERI002 PER1003 PER INCH
P f' SO C) ! Z� ! Z�
P_ Z SL
P- 3 34,
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 9 ?. 94 73
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1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (pr' 1: TESTS WERE COMPLETED ON:
, "'_7 L /99_3
ADDRE : CERTIFIC ION NUMBER: PHO E NUMBER(optional):
/G2 / S 2 6 n t " C? X c 2c) �5 f`!f',S..� 3 ��s 4 17Z -k"'
CST NATURE:
u�
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR -SBD -6395 (R. 10/83) — OVER —
i
INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use suction must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER
SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet
may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if
appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and yur certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL
AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
I
Soil Separates and Textures Other Symbols
st — Stone (over 10 ") BR — Bedrock
cob — Cobble (3 - 10 ") SS — Standstone
gr — Gravel (under 3 ") LS — Limestone
's — Sand HGW — High Groundwater
cs — Coarse Sand Perc — Precolation Rate
med s — Medium Sand W — Well
is — Fine Sand Bldg — Building
Is— Loamy Sand — Greater Than
'sl — Loamy Sand < — Less Than
'1 — Loam Bn — Brown
'sil — Silt Loam BI — Black
si — Slit Gy — Gray
cl — Clay Loam Y — Yellow
scl — Sandy Clay Loam R — Red
sicl — Silty Clay Loam mot — Mottles
sc — Sandy Clay w/ — with
sic — Silty Clay fif — few, fine, faint
'c — Clay cc — common, coarse
pt — Peat mm — Many, Medium
m — Muck d — distinct
p — prominent
HWL — High water level,
surface water
Six general soil textures BM — Bench Mark
for liquid waste disposal VRP — Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system
and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary
permit must be obtained and posted prior to the start of any construction.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer A l c�.-LoV4 50i10 c
I
Mailing Address /.25 KELLEY VE ,
/?10.7
Property Address x A+��v sk �2 /V �w A u O
(Verification required from Planning Department for new construction
,p PaA rc4,f�
City/State I�EW R('Cf(M(j Va W-r parcel Identification Number
LEGAL DESCRIPTION
.
Property Location _ E , V" 5 W 5 W y,, Sec. , T 3 1 N -R � Town of t 1' /� 2h(r l�
Subdivision 00 +� A F A 0 o W -5 Lot # /0
Certified Survey Map # , Volume , Page #
Warranty Deed # 6 �'�/ // Volume / 3 34 , Page # �5 D
Spec house )<yes ❑ no Lot lines identifiableX yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature - failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeymanplumber, restrictedplumber Ora licensedpumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septie.tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days o three year expiration date.
GNATURE 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 - scribed above, by virtue of a warranty deed recorded in Register of Deeds Office.
tG&KfURt 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
I
581'711 VOL 1334 mrf'50?
STATE BAR OF WISCONSIN FORM 2 — 1982
WARRANTY DEED �
DOCUMENT NO.
R ECI��
TER13S '0FFICE
Allen J. Wittstock, Jr. ST. GRQIX C4:. WI
Ris•'u rtt'r i"�+taar•r�
JUN 24 1998
conveys and warrants to P.C. Cnl 1 nva Rni 1 tjPrc, Tnr. 9:30
A
ii
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
the following described real estate in St.. Croix County, K IZIS'I'INA
State of Wisconsin. LIIZop Estteen &I.,�ti (?bi n
P.p, Box 359
I{udson, WI 54016
038- 1170 -70
PARCEL IDENTIFICATION NUMBER
Lot 10, Country Meadows First Addition in the Town of Star Prairie, St.
Croix County, Wisconsin.
TTiq SFER
This is not homestead property.
)0= (is not)
Exception to warranties: Easements, restrictions and rights of way of record, if any.
Dated this day of June A.D., 19 98
(SEAL) (SEAL)
* * Al n J. Wittsto , Jr.
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signatures) Allen, J. Wittstock, Jr. State of Wisconsin,
ss.
County
authenticated this lay of June 19 98 Personally came before me this day of
19 , the above named
* Kristina OcI and
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing
instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland
Hudson, WI 54016 Notary Public, County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date:
necessary) 19 )
Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY D[I:D
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
Form No. 2 —1982 Milwaukee. Wis.
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55.02' j �," 382.26 238.00'
1 NBB • 46 ' 55 "W 675.28 ' I 63,
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Submersible - '-
Effluent Pump �� x
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387 .1 EPO4
EP05
APPLICATIONS • Fasteners: 300 series • = in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. e ocI for for efficient heat transfer,
lowing =O n i lubrication and efficient strength, and durability. fol Effluent systems a to heat transfer. ■ Motor Cover. Thermoplas-
• Homes 1111101017 Available for automatic and tic cover with integral handle
• Farms manual operation. Automatic float switch athrrient
• heavy duty sump EPO4 Single phi 0.4 HP, models Include Mechanical points.
• Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, built in overload with rated oil and water resistant.
automatic reset. P at the factory.
• EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower
SPECIFICATIONS 115 V, in 60 le phase: FEATURES heavy duty ball bearing
construction.
Pump: EPO4 built in overload with ■ EPO4 Impeller. Thermo-
• Solids handling capability automatic reset. plastic Semi - open design
1 /4 0 maximum. • Power cad: 10 foot with pump out vanes for AGENCY LISTING
• Capacities: up to 55 GPM. standard WO, 16/3 SJTO mechanical seal protection. P. can" SWM* A
• Total heads: up to 24 feet. with three prong grounding m EP05 Impeller. Thermo-
isch
• Darge size:1 % NPT. plug. Optional 20 foot (CSA listed model numbers
•
Mechanical seal: carbon- length, 1613 SJTW with plastic enclosed design for end in "F" or "AC".)
rotary/ceramic- stationary, three prong grounding plug improved performance.
BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature: thermoplastic design provides
104•F (40°C) continuous superior strength and
140•F (60•C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10
• Capable of running s,
dry without damage to s 30
components. f
Pump: >P05 a
• Solids handling capability: o
V4 maximum. < '
• Capacities: up to 60 GPM. s f
• Total heads: up to 31 feet.. % i
-W P011
• Discharge size: I W NPT. z s
• Mechanical seal: carbon- 0 15
fG"1Ceramio-st11ionary, < 4
BUNA -N elastomers. o i
• Temperature: ~ 3 10 2_
104•F ( ) 40•C continuous �
140-F (Wq kdermittent. 2
5
1
•
OL OO 10 20 30 40 50 (SPY
pA
.._
- 0 2 4 6 8 12 KWh
CA AC"
MW. tti6 i
PA V
PUtfkP CHAME;ER CROSS SECTIOIJ AIJG SPECIF ICA'r10�.15
VC UT CAP
`I "C.I. VENT PIPE
WEATHERPROOF APPROVED LOCKMIG
- 25' FROM DOOR,
JIJMCTIOKI BOX MAMHOLE COVER
WINDOW OR FRESH I2 "MIU.
AIR IAITAKE
GRADE
COUDUIT
18 "MIN. - - - - -__ - --
\ �1
IMLET PROVIDE - -_ —_
AIRTIGHT SEAL
I � *
* A I�I
I
I I I I ALARM
B I I(
I I
*APPROVED i Ow
JOINTS WITH
ELEV. FT. APPROVED PIPE - -�
3' ONTO PUMP OFF
D SOLID SOIL
CONCRETE BLOCK
RISER EXIT PERMITTED OULU IF TAUK MANUFACTURER HAS SUCH APPROVAL
SEPTIC f SPECIFICATIOUS
DOSE
TANKS MANUFACTURER: W41_- Sr7�rp, (DUMBER OF DOSES: e/ PER DAB
TAKIK SIZE: `�� !� GALLOWS DOSE VOLUME /� L/
ALARM MAMUFACTURER: E' ��,, sv� IMCLUDING BACKFLOW: _ / � ` GALLON`
MODEL IJ UMBEK: _, L v CAPACITIES: A- _IMCHIS OR ?5G GALLON:
SWITCH TYPE: g = INCHES OR _ GALLOW
PUMP MANUFACTURER: (5't C =L_ R UCHES OR F--- CALLOW!
MODEL NUMBEK* lie D =- 12— IMCHES OR GALLON!
SWITCH TYPE: -_ L G NOTE: PUMP AND ALARM ARE TO DE
' MIAIIMUM DISCHARGE RATEtrPM INSTALLED OM SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF ANO DISTRIBUTION PIPE.._ FEET
+ MI JIMUM NETWORK SUPPLY PRESSURE . , , , , , , , , _ FEET
-f d FEFRICT101,1 FACTOR_
FEET OF FORCE MAIN X -sel _ F / 2 FEET
� l00
i --
_ TOTAL 09MAMIC. HEAD - �C�� ! FEET Fa
.7
IUTERWAL DIMEWSIONZ OF TAKIK: LENGTH ;WIDTH ;LIQUID DEPTH
51GUE D: r � � � - �_ LICEMSE KIUMBER: '� 74 DATE:
FAX
ST. CROIX COUNTY ZONING OFFICE
1101 Carmichael Road
Hudson, WI 54016
(715) 386 -4680
DATE:
TO: Fax Number:
Name:
FROM: Fax Number. 386 -4686
Name:
Number of Pages Including Cover Sheet
tee Kee a tee
IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE
CONTACT:
NAME: ) I
TELEPHONE NUMBER: 3 �0 - Kd
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
p p a n n Ilion ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016 -7710
(715) 386 -4680
March 4, 1999
P.C. Collova Builders
Attn: Lori
705 County Trunk E
Hudson, WI 54016
RE: Septic Inspection for P.C. Collova Builders located at 1303 Stardusk Drive,
Lot 10 of Country Meadows, Town of Star Prairie, St. Croix County, Wisconsin
Dear Lori:
A septic inspection of the above referenced property was conducted on February 2, 1999.
This property is located in the SE Y4 of the SW of Section 13, T31 N -R18W, Lot 10 of
Country Meadows, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the
inspection, this septic system was found to be code compliant for a three (3) bedroom
home.
If you have any questions regarding this, please contact our office at (715) 386 4680.
Sin ly,
,� rl--
Rod Eslinger
Assistant Zoning Administrator
/sm