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042-1101-20-100
St. Croix County Planning and Zoning Mondir�y, Jan itary 09, 2006 at !-d:34:06 AM Detail Sanitary Information Pao,-e I of I Computer #: 042-1101-20-100 Sub/Plat: NA Section: 36 Parcel #: 36.29.18,560A Lot: 1 TN/RNG: T29N R18W Municipality: Warren, Town of CSM: Vol. 16 Pg. 4260 - --------------- - - - 1/4 1/4: NE 1/4 NW 1/4 -------------- - -- --------- -- . ........ ------- --- ---- - - ---------------- ---------- - ... . ... -- --------------- ----- --------- ........ - - - - -- - - ------------------ Owner: ---------- - ----------- --- Simon, Mark 1465 70th Avenue Roberts, WI 54023 State Permit: 193382 Issued: 04/14/1993 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 07/16/1993 POWTS Detail: Trench - Seepage Bedrooms: 4 WI Fund: POWTS Pretreatment: NA Notes Issuer/inspector As Built Plumber Other Requirements Additional Notes Money Owed Jim Thompson Yes Nechville, Walter parcel split in 2004 $0.00 Jim Thompson Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 7/16/1996 7/7/1999 04/01/2005 7/7/2002 9/14/2004 04/01/2005 9/14/2007 I V.e August 3, 1993 TO: To Whom It May Concern FROM: St. Croix County Zoning ST. CROIX COUNTY W(SCONS(N ZONING OFFICE ST. CROIX COUNTY COURTHoUS[ I 1 01 Carmichael Road ' Hudson, WI 540' (715) 386-4680 RE: Mark Simon septic installation: 1465 70th Ave., Roberts, WI 54 02 3 known as the NW4-, NE Sec. 36, T29N-R18W. Town of Warren, St. Croix Co., WI. St. Croix Co. Zoning Department personnel inspected the installation of the septic system which is to serve the dwelling located at the above described property. The inspection was conducted on July 16, 1993 and revealed that the newly constructed portion of the system was designed and installed in accordance with all local and state requirements. Enclosed is a copy of the inspection report for your use. Should you have any questions, please feel free to contact this office. 9 ncerely,, 'ncei James K. Thompson Assistant Zoning Administrator Js STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS ff "or 1 SUBDIVISION / CSM# LOT # SECTION36 T��N-R�_W, Town of ��o4►..- �c1-'�i - lCe 5151 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ibd� 0 P � N ICATE NORTH ARROW Provide setback and elevation inform i� reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: /v� � � el_ � � u /f1,� ..� = % co � ALTERNATE BM: $8 / // 4 3Y/ SEPTIC TANK / PUMP CHAMBER / BOLDING TANK INFORMATION Manufacturer: Ui aja,-eitl pmf3 Liquid Capacity: �Lp6 Setback from: Well % � f House I Other Pump: Manufacturer Model# Size Float separation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM l � Width: Length 7 S Number of trenches 2- -78 Distance &Direction to nearest prop. line: v Setback from: well: 0 House /70 Other ELEVATIONS Building Sewer ST Inlet ST outlet PC inlet PC bottom Pump Off Header/Mani fold Bottom of system Existing Grade Final grade 0 -0,( DATE of INSTALLATION: -r PLUMBER ON JOB: 01 LICENSE NUMBER: 3/93 : jt 4N23 -_ir E 0rT A irAwau 1. 18. 5AarEn"VA9esvTI'rfT-1 rm Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION �ATTACH TO PERMIT) Pe,,,.rn,1t Holder's Name: E] City E] Village 1-k Town of: .r rT i"r.1 M _`EN ST IMON M RA Z WARnr CST BM Elev.: Insp- BM Elev-: BM Description: C 16�Ylk 0 et TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic , �' s �L c9 C)d Dosing Aeration Holding TANK SETBACK INFORMATION TAN KTO P 1 L WELL BLDG- Vent to Air Intake ROAD Septic 14 N A Dosing NA Aeration NA Holding A_ PUMP/ SIPHON INFORMATION Manufacturer- Demand Model Number GPM TDH Lift Friction Systerri aH Ft I Los5 - i Head I - Forcemain Length Dia. Dist. To Well County: qT ("RCIT111,_ Sanitary Permit No.: 1-93'182 -- State Plan ID No.: Parcel Tax No.: 042-11011-20—ancl A930"00336 %�.� :� STATION BS HI FS ELEV. Benchmark LC 2 Bldg. Sewer St / l�f inlet St//Fff Outlet 6 7 Dt Inlet F Dt Bottom Header 7,6 �IX7 Dist. Pipe Bot. System L Final Grade 3,9 SOIL ABSORPTION SYSTEM I BED/TRENCH Width Length No. Of TrenchesPIT No. Of Pits inside Dia- Liquid Depth DIMENSIONS n DIMENSIONManufacturer:. SETBACK SYSTEM TO P L BLDG WELL LAKE STREAM LEACHING CHAMBER Model Number: INFORMATION Type 0f..., OR UNIT System.. DISTRIBUTION SYSTEM Header/ RJAM Distribution Pipe(s) x Hole Size x Hole Spacing vent To Air Intake Length /, DI.- Length 2c; Dia- Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over Pp xx Depth Of xx Seeded /Sodded xx Mulched Jia;Pffrench Center gecd /Trench Edges 30 �Z/Z Topsoil Yes ❑ No ❑Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) 'KT LOCATION. WARREN 36.29-18.557,NW,NEj, 70TH 1-51vne Ll Plan revision required? F1 Yes 0----N �o Use other side for additional informatl i SBD-6710(R 05/91) .gel �,,. 7-- can M00 SANITARY PERMIT APPLICATION - (�t DILHR In accord with IL'HR 83.05, Wis. Adm. Code —Aftach complete plans (to the county copy only) for the system, on paper not less than 8�A X 11 inches in size. —See reverse side for instructions for completing this application. I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER 0 PROPERTY LOCATION COUNTY =f!S2� 0, S=dz. 600V STATE SANITARY PERMIT # ChJck ne ps�i3typr io application STATE PLAN I.D. NUMBER tJ 1/4 IV L7 1/4, S 91 T91 2 N9 R PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 3 0 9 r A11q, CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER R :57q) 0 (715- ) 7qq 3q4 x 0 It 1111. TYPE OF BUILDING: (Check one) 171 CIAGE State Owned C3 0 TOWN OL, O Public ES 1 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(S) 0 Y9 — I 111111. BUILDING USE: (If building type is public, check all that apply) OiR 11' 1 El Apt/Condo 2 El Assembly Hail 6 1:1 Medical Facility/Nursing Home 3 El campground 70 Merchandise: Sales/Repairs 4 0 Church/School 8 1:1 Mobile Home Park 5 El Hotel/Motel 9 El Office/Factory IV. TYPE OF PERMIT: (Check only one in line A. Check line B if.applf6i'ble) A}. New 2. El Replacement 3. El Replacement of System System Tank Only 13) El A Sanitary Permit was previously issued. Permit# V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution 11 ❑Seepage Bed 12 seepage Trench 13 ❑Seepage Pit 14 ❑System -In -Fill Pressurized Distribution 21 El Mound 22 F] In -Ground Pressure 18 E (or NEAREST ROAD -7 0 -"\- )9 10 ❑Outdoor Recreational Facility 11 El Restaurant./Bar/Dining 12 ❑Service Station/Car Wash 13 ❑Other: Specify 4. ❑Reconnection of Existing System Date Issued Experimental 30 ❑Specify Type 5. 0 Repair of an Existing System Other 41 ❑Holding Tank 42 ❑Pit Privy 43 ❑Vault Privy V1. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE ft.) 5. PERC. RATE (Min./inch) 6. SYSTEM ELEV. loo. REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. 7 :�TO ?1?j0Feet V11. TANK INFORMATION CAPACITY in qallons New xisting Total Gallons of Tanks Manufacturer's Name Prefab. Concrete Site Con- structed Steel Fiber - glass Tanks I Tanks r 1^ 1 F 7 1 F-1 7. FINAL GRADE ELEVA jc;Z.$Feet Plastic Exper. I App. Septic Tank or Holding Tank ��9 OkULo '.gAW Lift Pump Tank/Sichon Chamber M VIII. RESPONSIBILITY 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) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): .00 V C7 L IX. COUNTY/DEPARTMENT USE ONLY S. it Issuing ntSign No Stan)Ks) Disapproved Z5 ary Permit Fee (includes Groundwater Date Issue Surcharge Fee) 7i Approved Owner Given initial Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. � 2,. -- Your 'sa.nitary permit may be renewed before the expiration date, and a! the time of renewal any new criteria in the Wisconsin Adr-ninistrative 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 Fora; (SBD 63991 to be submitted to the county prior to installation. 5. onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever .necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing. address; Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in fine A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use only. X. County/Department Use only. Complete plans and specifications not smaller than 8'/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 tanks), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. 5 8 D-6398 (R .11 /88) APPLICATION FOR SANITARY PERMIT 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 propertyMe:_�ZL Location of property ��' 1/4 1/4, Section , T N--R % W Township b) -�� Mailing address"'_ l4 Ci2 f-A� Address of site Subdivision name N Lot number A L. Previous owner of property►- Total size of parcel .70 Y Date parcel was created Are all corners and lot lines identifiable? Yes No .s this property being developed for resale (spec house)? Yes No Volume q0i and Page Number -.._�/7q 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 X(We) certify that all statements on this form are true to the best of (our) knowledge; that X (we) i (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. ���� f ; and that (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with 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. ). Y/ Y a Signature of Owner Sig" ture of Co -Owner (If Applicable) Y Date of Signature Date of Signature noc.umF- i� WARRANTY DEED ftflS SPACE RESERVED FOR RErC PDING DATA •y . STATE BAR OF WISCONSIN FORM 2 ,! -- 15821REGISTER'S " _ II 1I OFFICE . .. .. ._, -.__.. - -. ...., .__ _•__ .._ ,...._._ten. ....... .« «_ .--__• - - __ ' I ST. CROIX CO., W1 Darwes rarm , :Inc. , a sconsin - ! Re-c*d for Record --- - - •- ......... Corporation ---•---- .............................. _...--•-•-................ - --- ---- - . _...._.. .----.............. _-...._.. - .... N,1AY 0 3 109 1 ---- - ---------------------- --- -- - •----- --..... a 11 20 A t A. NI cori`ey's arld Nvttr•r'allts to -. Ma-rk__W •.._ S.1-mon.. urban .i x>d-.Wife Simon and Jodie M ._holding as :_. r � Register of Deeds survivorship- - marital ty ...--------------___--_-_. _. __.. _.._._-•- ------`-----..._...... ............ I{ I !'I i; rrr•l kJr'rt t C) First National Bank of Baldwin _ ----------------- ...... ...... e� PO Box 145 the following described real estate in____St----Oriix ---------------------- C;ollnty, Ba.ldwiri, WI 54002 :Mate of -% isconsin : Tax Parcel No: ------------------------_..._ Northeast Quarter of Northwest Quarter (NE4 of NW4) and Northwest Quarter and Northeast Quarter (NW4 of NE4) of Section Thirty-six (36), Township Twenty-nine (29) North, Range Eighteen (18) West, EXCEPT Lot One (1) of Certified Survey Map in Volume 11 511 , page 1386. Subject to the roadway easement described in said Certified Survey Map. FRA . VOSA0 FEE This --J. S___n0t homestead property. li3OX (is not) Exception to warranties: Easements and restrictions of record. Dated this -------- 3rd -day of May .-•- .. .. _., 19.-91 -------- --------- DOR S FARMS, INC. z Y ,- b �.- ------ (SEAL) r '`�. -.. _ _. (SEAL) David Cowles, President ---------- ----- *----------- - --- --------------------------- --- Doris. -Cowles-:. Secr.eta-ry AUTHENTICATION ACKNOWLEDGMENT Signature(s)------------------------------------------------------------ STATE OF WISCONSIN ss. ----------------County. authenticated this -------- day of..........................1 19...... Personally cane before me this ___3rd------- day of .................... �`�y----------------, 19__91._ the above naniccl -- - -- -- - --- -----------------------------------------• -- --- - - -- •--._..._...--- - ----t -• - ..... .. ��vid Cowles President and --- -- -- --- -- - -- - - --•---------- - - .-- - ---------------------------------------------------------.... Doris Cowles, Secre ar TITLE: MEMBER STATE BAR OF WISCONSIN (If not, rtff� _- ----- -- - - - authorized by § 706.06, Wis. Stats.) ,% ��,1. U • A �`��,,f,,. ! to be the p son _ wh ec inst umen+ a ,a c wl e th ame. THIS INSTRUMENT WAS DRAFTED BY ;O y�� f Thomas A. McCormack =- - ---- --- ---- -- -- --- --- - - ------ ------ ----------------------------------•----------------------------- - yl� * nil G -S hm - - eft Baldwin, WI 54002 ; �t - --------------------•--------------------------------t"j---- ��% 1(.� �'V pIIC .---� .__ l..Z'dlX---- ---------------Count% W15. {Signatures may be authenticated or acknowledgS�igAh0'�' `11ission is Permanent. (If not, state e':l�irZtion are not necessary.) �iro� �L° Of � . t�� srrts sty PuUic-State of VAxxn 1 } f `� - - - - - - 3�y 'Names of persons signing in any capacity ahoum lee type,] or jlrintol lwlow their signsrlr,r��. WARRANTY DEED STA'rr,, BAR OF WISCONSIN Ith'trl' ("" I .�� REAL ESTATE TRANSFER ' IRN -- CONFIDENTIAL Wisconsin Department of R veriu,.2 V. PHYSICAL DESCRIPI ice' AND PRIMARY USE 1. Name 'wf' ^ F ? r Z �; , _ ; 3 w" , 15. Kind of property 16. Primary use 2. Full Address - New addreTs�s if property transferred was residence D Land only a.❑ Residential � 10 Di Vi - Z Ci 7'. •. c� � ❑ Land and buildings ❑ Single family/condominium Other (explain) ❑ Multi -family - # units 3. Grantor is ❑ Individual ❑ Partnership -- Corporation ❑ Other 17. Estimated land area and type Lot ❑ Time share unit II. GRANTEE: a size x b. Total acres 7 8 b.❑ Commercial sine5s use c.❑ Manufacturing 4. Name 1,1a r k 11 --7 4 c. MFL / FG / WTL acres d. X I Agricultural 5. Full Address d. Ft_ of water frontage Adjoining land? ❑ Yes ❑ No -1 r ea ' a Tn - e.❑ Other ex lain '?o�its >r olT r, 0 ? 3 VI.TRANSFER 18. Type of transfer:,❑ Sale ❑Gift ❑Exchange ❑❑ Other (explain) 6. is grantor related to grantee? El Yes No -If yes ex ain how related 19, Ownership interest transferred: U Full ❑ Other (explain) 7. Name and address to which tax bills should be sent if different than grantee's address 20. Does the grantor retain any of the following Hghts? ❑ 1 Life estate ❑ Easement 21. ❑ Deed in satisfaction of original land contract? Dated? 22. Points (prepaid interest) paid by seller $ 23. Value of personal property transferred but excluded from (25) $ III. ENERGY 8. Is this property subject to the Rental Weatherization Standards, ILHR67? El ❑ III W-11, 24, Value of property exempt from local property tax included on (25) $ Yes Na Exclusion code `# - E explain VII. COMPUTATION OF FEE OR STATEMENT OF EXEMPTION IV. PROPERTY TRANSFERRED 9. ❑ City ❑ Village I Town '3-2 r i" 0_.:1 25. Total value of REAL ESTATE transferred $ 1. 0 0 . 0 0 County 26. Transfer fee due (line 25 times .003) $ . 1 0 5 . 3 0 10. Street addres 27. TRANSFER EXEMPTION NUMBER, sec. 77.25 or Orig. LC. ❑ 11. Tax parcel number 12. Lot no.(s) glk. no.(s) 28. Grantee's financing obtained from a ❑ Seller Plat name If box a or b is checked, b. ❑ Assumed existing financing 13. Section Township Range_ __ complete Part VIII - c. Financial institution / Other 3rd party Financing berms 14. Legal Description metes and bounds: d. ❑ No financing involved (attach 4 copies if necessary) . i 3 � •_- J VIII. FINANCING TERMS (FOR SELLER/ASSUMED FINANCED TRANSACTIONS ONLY) 29. Total down payment $ 30. Amount of mortr'agerland 31. Interest 22 P•ir.�pal and, interest contract at purchase rate (stated) paid per payment rl Frequency ?d. Length of 35. Data of any lump sure 36. Arou ,t of lumip, sur'� of pymts contract (balloon) payments a. $ % $-- b. $ % $ - -1- --1- C. $ % $- 37. If the dollar amount paid per payment (32) is scheduled to change (not as a result of a change in the interest rate), fill in the line letter from above Enter the date of change - - 1- - / - - and the amount it will change to $ IX. CERTIFICATION We declare under penalty of law, that this return has been examined by us and to the best of our knowledge and belief it is true, correct and complete. Grantor or agent f` pate Grantor's telephone number SIGN HERE ;, l a' + ``, Grantee or agent 9 - ,. ' •�1" .� ,- Date Grantee's telephone number Print name and address of grantor's agent _ Agents telephone number Document number Vol. Page Date recorded Date and kind of conveyance Conv. code `q LEAVE parcel number - 1 2 3 4 THIS AREA Assmt. year 19 Field Sales number BLANK County _ _ ❑ Use Parcel classification I Tax disc. RE5 COM MFG AGR SIW FOR T ' a Assmt. list. ❑ Reject 1 2 3 4 5 6 PE-500 (R. 5-89) PROPERTY OWNER'S COPY Signatures of County of S t • Croix ss. This instrument was acknowledged before me on May 3 1991 19 9 1 , by Mark W . Simon and Jodie M. Simon authenticated this day of , 19 as kmm Title: Member State Bar of Wisconsin or ��� .. vVyr`���♦of _ authorized under §706.06, Wis. Stats �� Q•��* �moo.� JAOTARY10 This instrument was drafted by 0 op : « N1 First National Bank of BaldAsn 1 FUSiLI 10 0 "Type, or print name signed above. #440P&, Of WISCP �111"546 (Name(s) of person(s)) 14 {Type of authority; e.g., officer trustee, et . if any} r . "' INam of party,pn be I of instrumen as exe ted D el G. S hmit iry Public St . Croix County, Wis. Commission ( Expires)(Is) NOMrY 1:1111l4- " of ftcoftn Y Expiinas Oct. 30, 190.,4 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ BUYER .ryrn -.QQ- ROUTE/BOX NUMBER S.9Q2 PI2.c1SQn"f L511 FIRE NO. CITY/STATE ;&3 z I P ��Da PROPERTY LOCATION: 1/4 1/4, Section T N, R _W, Town of JSt. Croix County, Subdivision Ai (41 , Lot No. 11J, i4J_ a 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 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 $3000 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. UWE, the undersigned, have read the above requirements and agree to maintain I the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE �,IT St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, W1 54016 (715) 386-4680 Sign, Date, and Return to above address Page � of Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Labor and Human Relations Division of Safety & Buildings 3 ` L _ q3 in accord with I LH R 83.05, Wis. Adm. Code 411 1'&-R 7�S ,r� �' � �'" � U-v : Tldv 5 sv,�,�, y � 3 � ° � 4/ '0'/�Aas T— COUNTY S 1� G.�P,p��� Attach complete site plan on paper not less than 8 1!2 x 11 inches in size. Plan must include, but 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. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: ,�j ��� PROPERTY LOCATION %1% �� GOVT. LOT W 3&T Z-% 1/4 114,S N R E or PROPERTY OWNER':S MAILING ADDRESS 3 0 P01r-1 t,5 .4 /V ?' LOT # C5,kf BLOCK # SUED. NAME OR CSM # 0,4X r eir- ;& 4C4X S CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE JZ]iOWN NEAREST ROAD F['�'JNewConstruction Use[X} Residential! Number of bedrooms ° [ Addition to existing buildincement ( D,p Ili '1 �" vP�-c-'Trr�s.�9; r Code derived daily flow Coo gpd Recommended design loading rate '� 7 bed ' trench d/ft2 9 g � 9P� . 9p Absorption area required bed, ft2 _ trench, ft2 Maximum design loading rate • � bed, gpd1ft2 trench, gpdtft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design 1 site considerations '�� /3E 4VV s'dK _`i`�`-A_f s'.�Ty S�a.;�� s Lo�-ss �N� -,pt..9;,v ,-�' Parent material Flood plain elevation, if applicable ft ley Our_W1+5?V_ S » Suitable for system U= Unsuitable fors stem CONVENTIONAL ® S El U MOUND El S❑ U IN -GROUND PRESSURE El S❑ U AT -GRADE 4 S ❑ u SYSTEM IN FILL ❑ S 91 U HOLDING TANK ❑ S ,RJU 1576_5 (W Kh©WS 1+3 VC G -- SOIL DESCRIPTION REPORT 7— Boring # I y v Ground elev. ft Depth to limiting factor > /4 Boring # Ground elev. ft. Depth to limiting factor .>/a 0 Horizon Depth in. Dominant Color Munsell Moues Qu. Sz. Cant Color Texture structure Gr. Sz. Sh. Consistence BoLry Roots GPDIft Bed ITmrxh /®YX z/2- S.//&4- z . 3 / � f ra ye s/ he, -7�s . s VAO Id Yj- AOD1 / Remarks: //OrPIAOA/ h,45 fZ6cr- ��%� ( a 129oSe /4::2 yl° 5-/do IS -� /0 YA 2.4(Z._ z.f, sbk IL4 . s. _ � Y"� L11 I /40/tm 5it /;41 12-2-1 0 Y/f Y13 4; 2-1- YX J51-Y 2 '11W _07: Y/f 54 P 116 " ",Z,t,� �G r Cd,v r't ,[!S +C'Q•u ; 'vU.¢ S0410V©S 40jel/'o�,.� I I I j Remarks: CST Name: —Please Print YOMESITE SEPTIC PLUMBING CO. Phone: 71S , 3 o?/ PS -- Address: ROBERT ULBRIGNT MASTER PLUMBER 61G. N19. 3a97 M,1346 Signature: zr4 / ',' `;��. IM ;TALLER & DESIGNER UC. NO. 00663 Date: .; — — CST Number: 2- COPY PROPERTY OWNER N""I�:5rAf40A) SOIL DESCRIPTION REPORT PARCEL I.D. # c`" r 6rC 7e I cer-s Page o! Boring # Z Ground ele% . ft. Depth to limiting factor Boring # Ground elev. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Y Boring # :} Y4 �Y •'s Ground elev. ft. Depth to limiting factorL3 P „ Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh.. Consistence Bwxby Roots - GP D/fi Bed Trench - ` -13 1,9 Y,,� / N'D 1 _1 P /a / 44A s'6 A46 f e . 4 . S 62 s/ f s��,,s — -s 133 �21 16) SleP /5- AmX -5 7 1 P yie I Remarks: y/*e f/.3 / z, , , .5h,e S ItIf -S 13 � 3 - 3 0 K le�K- �Z� 2. 0 - Y/V A" 4*7 Remarks: .z- / Z f, s h,< nAA f4 3 , G KS-10a IeLle �//s 51k 6,vi-7W 5 3 ic ,2 /3 Oty4 Yl�l -T-30i 1-32 oy�jleyx /0 W 31( Remarks: /d yR 2-12- s A/f 7r, 2, aYX � w•~ /+ r Y • \ i�I�� r / '9 l.2 e yX -51Y P 1#4, Remarks:D iP -Zoe " C '' Cd,v�-:� s - M,,v y' ' � 3 '" co,vi•vr1�f-� - eon 011FIAto ncrnnM eoovl�x 130jeE- # 14 ke r 00t ,.O� 40e 000f /100U e-0 i'/ l IA '4 l/.fl Nmkl Zee �� 70 tt,,. � PAS >- of 7�? /fames r E L�6-u 7VT`1 0&3_5 i3 3 1' fpo��0 :5+LLrL Poo SP1*6Y ' yo HOVAESITE SEPTIC PLUMBING CO. 655 Q'NEIL RD., HUD -SON, WIS. 54016 ROBERT ULBRIGHT W;6. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MrNk INSTALLER & DESIGNER LIC. NO.00663 0 6-r-6-ELT t D ST-EA-1 (T-PCAJC- 6-h /0 I , 7N� ✓��cs� T ,` r � r 1� 5 ' 75 ' f-4 e4 � 30 �A r 106 .SYSTEM135 r . yor ' I I PROJECT . . .... r u v� y> _ Z _�! o �I—lO WaterPro Supplies Corporation 15801 W. 78th Street Eden Prairie, MN 55344-1894 Telephone-- 612-937-9666 FATS: 800-752-8112 Fax, 612-937-8065 j a Cr) 4 Page Of Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Labor and Human Relations 2- Division of Safety& Buildings in accord with ILHR 83.05, Wis. Adm. Code 4O/A) r6k 7j'r5o r e5 4�v . , m o 4 J/ 7— COUNTY 5 r, Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited . to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D. # I dimensioned, north arrow, and location and distance to nearest road. L17 110 2-0 - 16L APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE I PROPERTY OWNER: AMR)( -5/;4,) PROPERTY LOCATION GOVT. 3 &T LOT 41W 1/4 1/4,s N,R E (or) W PROPERTY OWNERS MAILING ADDRESS 4 AJ 7- LOT # BLOCK# SUBD. NAME OR CSM # ey'=' X? CITY, STATE r ZIP CODE PHONE NUMBER 9 [:]CITY []VILLAGE [TOWN &V1f1fkC"V NEAREST ROAD 1 7 4 U-C, New Construction Use Residential Number of bedrooms Addition to existing buildin F]Replacement 1 P - - - - --------- Code derived daily flow &0 0 gpd Recommended design loading rate sbed, gpd/ft2 trench,gpd,,ft2 Absorption area required bed,ft2 trench, ft2 Maximum design loading rate -bed, gpd/ft2 trench, gpd/ft2 Recommended infiltrafion surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations Parent material Flood plain elevation, if applicable '4 ft S = Suitable for system U = Unsuitable for system CONVENTIONAL 0 S E] U MOUND 0S E1U IN -GROUND PRESSURE 2 S 0 U AT -GRADE JKS E1U SYSTEM IN FILL EIS ®U HOLDING TANK [Is ZU Boring # Ground elev. Depth to limiting factor Boring # gg 2- Ground elev. ft. Depth to limiting factor .>/o 0 C C, 7- SOIL DESCRIPTION REPORT �11107_ 6-a,#,/!)& ' Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots — G P 5/ft Bed Tminch y lo yx 2-12- /0 y 62 141,e Yk 519 c `rh,4 -5 1�66� 1"X,)P5 A� yle EXP /s, Remarks: llolfl7-ON 4 149 YA 21" 2— _fW Jr 7`- 1,5 8 2-2-1 /0 VIV 2-1— yle -,51-y ------- 57 / 171 Y/f for 2_0A.) Cow 710 Remarks: ;ST Name: —Please Print �-,Olk,,IESITE SEPTIC PLUMBING CO. Phone: �'/ r�7 �— E�i O'NFIH11 L RD- , D.SON, WIS. 54016 Address: ROBERT ULBRIG1HT Signature: N,'��I. IN*TALLER & DESIGNER L11C. NO. 00663 Date. CST Number: 45(� 4�96 14ct 04 _; - 2- - �3 2- 'Oro, ORIGINAL ^era � ��} i, ,�r v�� � .j Gl) lei PROPERTY OWNER SOIL DESCRIPTION REPORT PARCEL I.D.# I'Wl— 01'5 w I Page of Boring # Ground ele\f. It. Depth to limiting factor Boring # ..... .. ...... x Ground elev. ft. Depth to limiting factor Boring # Ground elev. It. Depth to limiting factor Boring # Ground elev. Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence floury Roots GPD/ft2 Bed Trends ........... t /kpl Ile 13 /0 y/f lo-f 2 A4-1 f /f shk -IR .5, 13 Remarks: 21, P-/3 loyee f-/3 2 A",,5he 0 -iW lt000-f 92 so- 54 rl 41VI 441 T Remarks: ----------- S/ 2-, f sh, ,wfle,5 3f —� .5, �,f 7c 3 T-30V011f .2 441, 5,o�t I-hA .2- !yo yg (0 9 24) �14 114 404 0-tajo / /w/ -ec�llfil 4� 7— Remarks: — , 0 0-7 Ij y� 2-12- 311 ;21 5A& Awl f, , s / . s . 7-12, 10YX 2,-f 6'hlo� 1.2 3 0 yX .51S Remarks: (f -61-0 I`41,411_57 4414A.) Z 7-0 S Aoa---f Z-- eon onon/0 ACIrin% ,8AAV,r OF /Oro< 4 114-(l dev -�-45 TE-v e- 7�1,,5 x344-)do op�s ev/j% 6,4 /'Ou 1A11 eq P.,Vo sus ; St. Croix County Planning and Zoning Mondir�y, Jan itary 09, 2006 at !-d:34:06 AM Detail Sanitary Information Pao,-e I of I Computer #: 042-1101-20-100 Sub/Plat: NA Section: 36 Parcel #: 36.29.18,560A Lot: 1 TN/RNG: T29N R18W Municipality: Warren, Town of CSM: Vol. 16 Pg. 4260 - --------------- - - - 1/4 1/4: NE 1/4 NW 1/4 -------------- - -- --------- -- . ........ ------- --- ---- - - ---------------- ---------- - ... . ... -- --------------- ----- --------- ........ - - - - -- - - ------------------ Owner: ---------- - ----------- --- Simon, Mark 1465 70th Avenue Roberts, WI 54023 State Permit: 193382 Issued: 04/14/1993 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 07/16/1993 POWTS Detail: Trench - Seepage Bedrooms: 4 WI Fund: POWTS Pretreatment: NA Notes Issuer/inspector As Built Plumber Other Requirements Additional Notes Money Owed Jim Thompson Yes Nechville, Walter parcel split in 2004 $0.00 Jim Thompson Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 7/16/1996 7/7/1999 04/01/2005 7/7/2002 9/14/2004 04/01/2005 9/14/2007 I V.e August 3, 1993 TO: To Whom It May Concern FROM: St. Croix County Zoning ST. CROIX COUNTY W(SCONS(N ZONING OFFICE ST. CROIX COUNTY COURTHoUS[ I 1 01 Carmichael Road ' Hudson, WI 540' (715) 386-4680 RE: Mark Simon septic installation: 1465 70th Ave., Roberts, WI 54 02 3 known as the NW4-, NE Sec. 36, T29N-R18W. Town of Warren, St. Croix Co., WI. St. Croix Co. Zoning Department personnel inspected the installation of the septic system which is to serve the dwelling located at the above described property. The inspection was conducted on July 16, 1993 and revealed that the newly constructed portion of the system was designed and installed in accordance with all local and state requirements. Enclosed is a copy of the inspection report for your use. Should you have any questions, please feel free to contact this office. 9 ncerely,, 'ncei James K. Thompson Assistant Zoning Administrator Js STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS ff "or 1 SUBDIVISION / CSM# LOT # SECTION36 T��N-R�_W, Town of ��o4►..- �c1-'�i - lCe 5151 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ibd� 0 P � N ICATE NORTH ARROW Provide setback and elevation inform i� reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: /v� � � el_ � � u /f1,� ..� = % co � ALTERNATE BM: $8 / // 4 3Y/ SEPTIC TANK / PUMP CHAMBER / BOLDING TANK INFORMATION Manufacturer: Ui aja,-eitl pmf3 Liquid Capacity: �Lp6 Setback from: Well % � f House I Other Pump: Manufacturer Model# Size Float separation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM l � Width: Length 7 S Number of trenches 2- -78 Distance &Direction to nearest prop. line: v Setback from: well: 0 House /70 Other ELEVATIONS Building Sewer ST Inlet ST outlet PC inlet PC bottom Pump Off Header/Mani fold Bottom of system Existing Grade Final grade 0 -0,( DATE of INSTALLATION: -r PLUMBER ON JOB: 01 LICENSE NUMBER: 3/93 : jt 4N23 -_ir E 0rT A irAwau 1. 18. 5AarEn"VA9esvTI'rfT-1 rm Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION �ATTACH TO PERMIT) Pe,,,.rn,1t Holder's Name: E] City E] Village 1-k Town of: .r rT i"r.1 M _`EN ST IMON M RA Z WARnr CST BM Elev.: Insp- BM Elev-: BM Description: C 16�Ylk 0 et TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic , �' s �L c9 C)d Dosing Aeration Holding TANK SETBACK INFORMATION TAN KTO P 1 L WELL BLDG- Vent to Air Intake ROAD Septic 14 N A Dosing NA Aeration NA Holding A_ PUMP/ SIPHON INFORMATION Manufacturer- Demand Model Number GPM TDH Lift Friction Systerri aH Ft I Los5 - i Head I - Forcemain Length Dia. Dist. To Well County: qT ("RCIT111,_ Sanitary Permit No.: 1-93'182 -- State Plan ID No.: Parcel Tax No.: 042-11011-20—ancl A930"00336 %�.� :� STATION BS HI FS ELEV. Benchmark LC 2 Bldg. Sewer St / l�f inlet St//Fff Outlet 6 7 Dt Inlet F Dt Bottom Header 7,6 �IX7 Dist. Pipe Bot. System L Final Grade 3,9 SOIL ABSORPTION SYSTEM I BED/TRENCH Width Length No. Of TrenchesPIT No. Of Pits inside Dia- Liquid Depth DIMENSIONS n DIMENSIONManufacturer:. SETBACK SYSTEM TO P L BLDG WELL LAKE STREAM LEACHING CHAMBER Model Number: INFORMATION Type 0f..., OR UNIT System.. DISTRIBUTION SYSTEM Header/ RJAM Distribution Pipe(s) x Hole Size x Hole Spacing vent To Air Intake Length /, DI.- Length 2c; Dia- Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over Pp xx Depth Of xx Seeded /Sodded xx Mulched Jia;Pffrench Center gecd /Trench Edges 30 �Z/Z Topsoil Yes ❑ No ❑Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) 'KT LOCATION. WARREN 36.29-18.557,NW,NEj, 70TH 1-51vne Ll Plan revision required? F1 Yes 0----N �o Use other side for additional informatl i SBD-6710(R 05/91) .gel �,,. 7-- can M00 SANITARY PERMIT APPLICATION - (�t DILHR In accord with IL'HR 83.05, Wis. Adm. Code —Aftach complete plans (to the county copy only) for the system, on paper not less than 8�A X 11 inches in size. —See reverse side for instructions for completing this application. I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER 0 PROPERTY LOCATION COUNTY =f!S2� 0, S=dz. 600V STATE SANITARY PERMIT # ChJck ne ps�i3typr io application STATE PLAN I.D. NUMBER tJ 1/4 IV L7 1/4, S 91 T91 2 N9 R PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 3 0 9 r A11q, CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER R :57q) 0 (715- ) 7qq 3q4 x 0 It 1111. TYPE OF BUILDING: (Check one) 171 CIAGE State Owned C3 0 TOWN OL, O Public ES 1 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(S) 0 Y9 — I 111111. BUILDING USE: (If building type is public, check all that apply) OiR 11' 1 El Apt/Condo 2 El Assembly Hail 6 1:1 Medical Facility/Nursing Home 3 El campground 70 Merchandise: Sales/Repairs 4 0 Church/School 8 1:1 Mobile Home Park 5 El Hotel/Motel 9 El Office/Factory IV. TYPE OF PERMIT: (Check only one in line A. Check line B if.applf6i'ble) A}. New 2. El Replacement 3. El Replacement of System System Tank Only 13) El A Sanitary Permit was previously issued. Permit# V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution 11 ❑Seepage Bed 12 seepage Trench 13 ❑Seepage Pit 14 ❑System -In -Fill Pressurized Distribution 21 El Mound 22 F] In -Ground Pressure 18 E (or NEAREST ROAD -7 0 -"\- )9 10 ❑Outdoor Recreational Facility 11 El Restaurant./Bar/Dining 12 ❑Service Station/Car Wash 13 ❑Other: Specify 4. ❑Reconnection of Existing System Date Issued Experimental 30 ❑Specify Type 5. 0 Repair of an Existing System Other 41 ❑Holding Tank 42 ❑Pit Privy 43 ❑Vault Privy V1. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE ft.) 5. PERC. RATE (Min./inch) 6. SYSTEM ELEV. loo. REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. 7 :�TO ?1?j0Feet V11. TANK INFORMATION CAPACITY in qallons New xisting Total Gallons of Tanks Manufacturer's Name Prefab. Concrete Site Con- structed Steel Fiber - glass Tanks I Tanks r 1^ 1 F 7 1 F-1 7. FINAL GRADE ELEVA jc;Z.$Feet Plastic Exper. I App. Septic Tank or Holding Tank ��9 OkULo '.gAW Lift Pump Tank/Sichon Chamber M VIII. RESPONSIBILITY 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) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): .00 V C7 L IX. COUNTY/DEPARTMENT USE ONLY S. it Issuing ntSign No Stan)Ks) Disapproved Z5 ary Permit Fee (includes Groundwater Date Issue Surcharge Fee) 7i Approved Owner Given initial Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. � 2,. -- Your 'sa.nitary permit may be renewed before the expiration date, and a! the time of renewal any new criteria in the Wisconsin Adr-ninistrative 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 Fora; (SBD 63991 to be submitted to the county prior to installation. 5. onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever .necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing. address; Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in fine A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use only. X. County/Department Use only. Complete plans and specifications not smaller than 8'/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 tanks), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. 5 8 D-6398 (R .11 /88) APPLICATION FOR SANITARY PERMIT 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 propertyMe:_�ZL Location of property ��' 1/4 1/4, Section , T N--R % W Township b) -�� Mailing address"'_ l4 Ci2 f-A� Address of site Subdivision name N Lot number A L. Previous owner of property►- Total size of parcel .70 Y Date parcel was created Are all corners and lot lines identifiable? Yes No .s this property being developed for resale (spec house)? Yes No Volume q0i and Page Number -.._�/7q 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 X(We) certify that all statements on this form are true to the best of (our) knowledge; that X (we) i (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. ���� f ; and that (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with 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. ). Y/ Y a Signature of Owner Sig" ture of Co -Owner (If Applicable) Y Date of Signature Date of Signature noc.umF- i� WARRANTY DEED ftflS SPACE RESERVED FOR RErC PDING DATA •y . STATE BAR OF WISCONSIN FORM 2 ,! -- 15821REGISTER'S " _ II 1I OFFICE . .. .. ._, -.__.. - -. ...., .__ _•__ .._ ,...._._ten. ....... .« «_ .--__• - - __ ' I ST. CROIX CO., W1 Darwes rarm , :Inc. , a sconsin - ! Re-c*d for Record --- - - •- ......... Corporation ---•---- .............................. _...--•-•-................ - --- ---- - . _...._.. .----.............. _-...._.. - .... N,1AY 0 3 109 1 ---- - ---------------------- --- -- - •----- --..... a 11 20 A t A. NI cori`ey's arld Nvttr•r'allts to -. Ma-rk__W •.._ S.1-mon.. urban .i x>d-.Wife Simon and Jodie M ._holding as :_. r � Register of Deeds survivorship- - marital ty ...--------------___--_-_. _. __.. _.._._-•- ------`-----..._...... ............ I{ I !'I i; rrr•l kJr'rt t C) First National Bank of Baldwin _ ----------------- ...... ...... e� PO Box 145 the following described real estate in____St----Oriix ---------------------- C;ollnty, Ba.ldwiri, WI 54002 :Mate of -% isconsin : Tax Parcel No: ------------------------_..._ Northeast Quarter of Northwest Quarter (NE4 of NW4) and Northwest Quarter and Northeast Quarter (NW4 of NE4) of Section Thirty-six (36), Township Twenty-nine (29) North, Range Eighteen (18) West, EXCEPT Lot One (1) of Certified Survey Map in Volume 11 511 , page 1386. Subject to the roadway easement described in said Certified Survey Map. FRA . VOSA0 FEE This --J. S___n0t homestead property. li3OX (is not) Exception to warranties: Easements and restrictions of record. Dated this -------- 3rd -day of May .-•- .. .. _., 19.-91 -------- --------- DOR S FARMS, INC. z Y ,- b �.- ------ (SEAL) r '`�. -.. _ _. (SEAL) David Cowles, President ---------- ----- *----------- - --- --------------------------- --- Doris. -Cowles-:. Secr.eta-ry AUTHENTICATION ACKNOWLEDGMENT Signature(s)------------------------------------------------------------ STATE OF WISCONSIN ss. ----------------County. authenticated this -------- day of..........................1 19...... Personally cane before me this ___3rd------- day of .................... �`�y----------------, 19__91._ the above naniccl -- - -- -- - --- -----------------------------------------• -- --- - - -- •--._..._...--- - ----t -• - ..... .. ��vid Cowles President and --- -- -- --- -- - -- - - --•---------- - - .-- - ---------------------------------------------------------.... Doris Cowles, Secre ar TITLE: MEMBER STATE BAR OF WISCONSIN (If not, rtff� _- ----- -- - - - authorized by § 706.06, Wis. Stats.) ,% ��,1. U • A �`��,,f,,. ! to be the p son _ wh ec inst umen+ a ,a c wl e th ame. THIS INSTRUMENT WAS DRAFTED BY ;O y�� f Thomas A. McCormack =- - ---- --- ---- -- -- --- --- - - ------ ------ ----------------------------------•----------------------------- - yl� * nil G -S hm - - eft Baldwin, WI 54002 ; �t - --------------------•--------------------------------t"j---- ��% 1(.� �'V pIIC .---� .__ l..Z'dlX---- ---------------Count% W15. {Signatures may be authenticated or acknowledgS�igAh0'�' `11ission is Permanent. (If not, state e':l�irZtion are not necessary.) �iro� �L° Of � . t�� srrts sty PuUic-State of VAxxn 1 } f `� - - - - - - 3�y 'Names of persons signing in any capacity ahoum lee type,] or jlrintol lwlow their signsrlr,r��. WARRANTY DEED STA'rr,, BAR OF WISCONSIN Ith'trl' ("" I .�� REAL ESTATE TRANSFER ' IRN -- CONFIDENTIAL Wisconsin Department of R veriu,.2 V. PHYSICAL DESCRIPI ice' AND PRIMARY USE 1. Name 'wf' ^ F ? r Z �; , _ ; 3 w" , 15. Kind of property 16. Primary use 2. Full Address - New addreTs�s if property transferred was residence D Land only a.❑ Residential � 10 Di Vi - Z Ci 7'. •. c� � ❑ Land and buildings ❑ Single family/condominium Other (explain) ❑ Multi -family - # units 3. Grantor is ❑ Individual ❑ Partnership -- Corporation ❑ Other 17. Estimated land area and type Lot ❑ Time share unit II. GRANTEE: a size x b. Total acres 7 8 b.❑ Commercial sine5s use c.❑ Manufacturing 4. Name 1,1a r k 11 --7 4 c. MFL / FG / WTL acres d. X I Agricultural 5. Full Address d. Ft_ of water frontage Adjoining land? ❑ Yes ❑ No -1 r ea ' a Tn - e.❑ Other ex lain '?o�its >r olT r, 0 ? 3 VI.TRANSFER 18. Type of transfer:,❑ Sale ❑Gift ❑Exchange ❑❑ Other (explain) 6. is grantor related to grantee? El Yes No -If yes ex ain how related 19, Ownership interest transferred: U Full ❑ Other (explain) 7. Name and address to which tax bills should be sent if different than grantee's address 20. Does the grantor retain any of the following Hghts? ❑ 1 Life estate ❑ Easement 21. ❑ Deed in satisfaction of original land contract? Dated? 22. Points (prepaid interest) paid by seller $ 23. Value of personal property transferred but excluded from (25) $ III. ENERGY 8. Is this property subject to the Rental Weatherization Standards, ILHR67? El ❑ III W-11, 24, Value of property exempt from local property tax included on (25) $ Yes Na Exclusion code `# - E explain VII. COMPUTATION OF FEE OR STATEMENT OF EXEMPTION IV. PROPERTY TRANSFERRED 9. ❑ City ❑ Village I Town '3-2 r i" 0_.:1 25. Total value of REAL ESTATE transferred $ 1. 0 0 . 0 0 County 26. Transfer fee due (line 25 times .003) $ . 1 0 5 . 3 0 10. Street addres 27. TRANSFER EXEMPTION NUMBER, sec. 77.25 or Orig. LC. ❑ 11. Tax parcel number 12. Lot no.(s) glk. no.(s) 28. Grantee's financing obtained from a ❑ Seller Plat name If box a or b is checked, b. ❑ Assumed existing financing 13. Section Township Range_ __ complete Part VIII - c. Financial institution / Other 3rd party Financing berms 14. Legal Description metes and bounds: d. ❑ No financing involved (attach 4 copies if necessary) . i 3 � •_- J VIII. FINANCING TERMS (FOR SELLER/ASSUMED FINANCED TRANSACTIONS ONLY) 29. Total down payment $ 30. Amount of mortr'agerland 31. Interest 22 P•ir.�pal and, interest contract at purchase rate (stated) paid per payment rl Frequency ?d. Length of 35. Data of any lump sure 36. Arou ,t of lumip, sur'� of pymts contract (balloon) payments a. $ % $-- b. $ % $ - -1- --1- C. $ % $- 37. If the dollar amount paid per payment (32) is scheduled to change (not as a result of a change in the interest rate), fill in the line letter from above Enter the date of change - - 1- - / - - and the amount it will change to $ IX. CERTIFICATION We declare under penalty of law, that this return has been examined by us and to the best of our knowledge and belief it is true, correct and complete. Grantor or agent f` pate Grantor's telephone number SIGN HERE ;, l a' + ``, Grantee or agent 9 - ,. ' •�1" .� ,- Date Grantee's telephone number Print name and address of grantor's agent _ Agents telephone number Document number Vol. Page Date recorded Date and kind of conveyance Conv. code `q LEAVE parcel number - 1 2 3 4 THIS AREA Assmt. year 19 Field Sales number BLANK County _ _ ❑ Use Parcel classification I Tax disc. RE5 COM MFG AGR SIW FOR T ' a Assmt. list. ❑ Reject 1 2 3 4 5 6 PE-500 (R. 5-89) PROPERTY OWNER'S COPY Signatures of County of S t • Croix ss. This instrument was acknowledged before me on May 3 1991 19 9 1 , by Mark W . Simon and Jodie M. Simon authenticated this day of , 19 as kmm Title: Member State Bar of Wisconsin or ��� .. vVyr`���♦of _ authorized under §706.06, Wis. Stats �� Q•��* �moo.� JAOTARY10 This instrument was drafted by 0 op : « N1 First National Bank of BaldAsn 1 FUSiLI 10 0 "Type, or print name signed above. #440P&, Of WISCP �111"546 (Name(s) of person(s)) 14 {Type of authority; e.g., officer trustee, et . if any} r . "' INam of party,pn be I of instrumen as exe ted D el G. S hmit iry Public St . Croix County, Wis. Commission ( Expires)(Is) NOMrY 1:1111l4- " of ftcoftn Y Expiinas Oct. 30, 190.,4 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ BUYER .ryrn -.QQ- ROUTE/BOX NUMBER S.9Q2 PI2.c1SQn"f L511 FIRE NO. CITY/STATE ;&3 z I P ��Da PROPERTY LOCATION: 1/4 1/4, Section T N, R _W, Town of JSt. Croix County, Subdivision Ai (41 , Lot No. 11J, i4J_ a 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 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 $3000 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. UWE, the undersigned, have read the above requirements and agree to maintain I the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE �,IT St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, W1 54016 (715) 386-4680 Sign, Date, and Return to above address Page � of Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Labor and Human Relations Division of Safety & Buildings 3 ` L _ q3 in accord with I LH R 83.05, Wis. Adm. Code 411 1'&-R 7�S ,r� �' � �'" � U-v : Tldv 5 sv,�,�, y � 3 � ° � 4/ '0'/�Aas T— COUNTY S 1� G.�P,p��� Attach complete site plan on paper not less than 8 1!2 x 11 inches in size. Plan must include, but 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. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: ,�j ��� PROPERTY LOCATION %1% �� GOVT. LOT W 3&T Z-% 1/4 114,S N R E or PROPERTY OWNER':S MAILING ADDRESS 3 0 P01r-1 t,5 .4 /V ?' LOT # C5,kf BLOCK # SUED. NAME OR CSM # 0,4X r eir- ;& 4C4X S CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE JZ]iOWN NEAREST ROAD F['�'JNewConstruction Use[X} Residential! Number of bedrooms ° [ Addition to existing buildincement ( D,p Ili '1 �" vP�-c-'Trr�s.�9; r Code derived daily flow Coo gpd Recommended design loading rate '� 7 bed ' trench d/ft2 9 g � 9P� . 9p Absorption area required bed, ft2 _ trench, ft2 Maximum design loading rate • � bed, gpd1ft2 trench, gpdtft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design 1 site considerations '�� /3E 4VV s'dK _`i`�`-A_f s'.�Ty S�a.;�� s Lo�-ss �N� -,pt..9;,v ,-�' Parent material Flood plain elevation, if applicable ft ley Our_W1+5?V_ S » Suitable for system U= Unsuitable fors stem CONVENTIONAL ® S El U MOUND El S❑ U IN -GROUND PRESSURE El S❑ U AT -GRADE 4 S ❑ u SYSTEM IN FILL ❑ S 91 U HOLDING TANK ❑ S ,RJU 1576_5 (W Kh©WS 1+3 VC G -- SOIL DESCRIPTION REPORT 7— Boring # I y v Ground elev. ft Depth to limiting factor > /4 Boring # Ground elev. ft. Depth to limiting factor .>/a 0 Horizon Depth in. Dominant Color Munsell Moues Qu. Sz. Cant Color Texture structure Gr. Sz. Sh. Consistence BoLry Roots GPDIft Bed ITmrxh /®YX z/2- S.//&4- z . 3 / � f ra ye s/ he, -7�s . s VAO Id Yj- AOD1 / Remarks: //OrPIAOA/ h,45 fZ6cr- ��%� ( a 129oSe /4::2 yl° 5-/do IS -� /0 YA 2.4(Z._ z.f, sbk IL4 . s. _ � Y"� L11 I /40/tm 5it /;41 12-2-1 0 Y/f Y13 4; 2-1- YX J51-Y 2 '11W _07: Y/f 54 P 116 " ",Z,t,� �G r Cd,v r't ,[!S +C'Q•u ; 'vU.¢ S0410V©S 40jel/'o�,.� I I I j Remarks: CST Name: —Please Print YOMESITE SEPTIC PLUMBING CO. Phone: 71S , 3 o?/ PS -- Address: ROBERT ULBRIGNT MASTER PLUMBER 61G. N19. 3a97 M,1346 Signature: zr4 / ',' `;��. IM ;TALLER & DESIGNER UC. NO. 00663 Date: .; — — CST Number: 2- COPY PROPERTY OWNER N""I�:5rAf40A) SOIL DESCRIPTION REPORT PARCEL I.D. # c`" r 6rC 7e I cer-s Page o! Boring # Z Ground ele% . ft. Depth to limiting factor Boring # Ground elev. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Y Boring # :} Y4 �Y •'s Ground elev. ft. Depth to limiting factorL3 P „ Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh.. Consistence Bwxby Roots - GP D/fi Bed Trench - ` -13 1,9 Y,,� / N'D 1 _1 P /a / 44A s'6 A46 f e . 4 . S 62 s/ f s��,,s — -s 133 �21 16) SleP /5- AmX -5 7 1 P yie I Remarks: y/*e f/.3 / z, , , .5h,e S ItIf -S 13 � 3 - 3 0 K le�K- �Z� 2. 0 - Y/V A" 4*7 Remarks: .z- / Z f, s h,< nAA f4 3 , G KS-10a IeLle �//s 51k 6,vi-7W 5 3 ic ,2 /3 Oty4 Yl�l -T-30i 1-32 oy�jleyx /0 W 31( Remarks: /d yR 2-12- s A/f 7r, 2, aYX � w•~ /+ r Y • \ i�I�� r / '9 l.2 e yX -51Y P 1#4, Remarks:D iP -Zoe " C '' Cd,v�-:� s - M,,v y' ' � 3 '" co,vi•vr1�f-� - eon 011FIAto ncrnnM eoovl�x 130jeE- # 14 ke r 00t ,.O� 40e 000f /100U e-0 i'/ l IA '4 l/.fl Nmkl Zee �� 70 tt,,. � PAS >- of 7�? /fames r E L�6-u 7VT`1 0&3_5 i3 3 1' fpo��0 :5+LLrL Poo SP1*6Y ' yo HOVAESITE SEPTIC PLUMBING CO. 655 Q'NEIL RD., HUD -SON, WIS. 54016 ROBERT ULBRIGHT W;6. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MrNk INSTALLER & DESIGNER LIC. NO.00663 0 6-r-6-ELT t D ST-EA-1 (T-PCAJC- 6-h /0 I , 7N� ✓��cs� T ,` r � r 1� 5 ' 75 ' f-4 e4 � 30 �A r 106 .SYSTEM135 r . yor ' I I PROJECT . . .... r u v� y> _ Z _�! o �I—lO WaterPro Supplies Corporation 15801 W. 78th Street Eden Prairie, MN 55344-1894 Telephone-- 612-937-9666 FATS: 800-752-8112 Fax, 612-937-8065 j a Cr) 4 Page Of Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Labor and Human Relations 2- Division of Safety& Buildings in accord with ILHR 83.05, Wis. Adm. Code 4O/A) r6k 7j'r5o r e5 4�v . , m o 4 J/ 7— COUNTY 5 r, Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited . to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D. # I dimensioned, north arrow, and location and distance to nearest road. L17 110 2-0 - 16L APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE I PROPERTY OWNER: AMR)( -5/;4,) PROPERTY LOCATION GOVT. 3 &T LOT 41W 1/4 1/4,s N,R E (or) W PROPERTY OWNERS MAILING ADDRESS 4 AJ 7- LOT # BLOCK# SUBD. NAME OR CSM # ey'=' X? CITY, STATE r ZIP CODE PHONE NUMBER 9 [:]CITY []VILLAGE [TOWN &V1f1fkC"V NEAREST ROAD 1 7 4 U-C, New Construction Use Residential Number of bedrooms Addition to existing buildin F]Replacement 1 P - - - - --------- Code derived daily flow &0 0 gpd Recommended design loading rate sbed, gpd/ft2 trench,gpd,,ft2 Absorption area required bed,ft2 trench, ft2 Maximum design loading rate -bed, gpd/ft2 trench, gpd/ft2 Recommended infiltrafion surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations Parent material Flood plain elevation, if applicable '4 ft S = Suitable for system U = Unsuitable for system CONVENTIONAL 0 S E] U MOUND 0S E1U IN -GROUND PRESSURE 2 S 0 U AT -GRADE JKS E1U SYSTEM IN FILL EIS ®U HOLDING TANK [Is ZU Boring # Ground elev. Depth to limiting factor Boring # gg 2- Ground elev. ft. Depth to limiting factor .>/o 0 C C, 7- SOIL DESCRIPTION REPORT �11107_ 6-a,#,/!)& ' Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots — G P 5/ft Bed Tminch y lo yx 2-12- /0 y 62 141,e Yk 519 c `rh,4 -5 1�66� 1"X,)P5 A� yle EXP /s, Remarks: llolfl7-ON 4 149 YA 21" 2— _fW Jr 7`- 1,5 8 2-2-1 /0 VIV 2-1— yle -,51-y ------- 57 / 171 Y/f for 2_0A.) Cow 710 Remarks: ;ST Name: —Please Print �-,Olk,,IESITE SEPTIC PLUMBING CO. Phone: �'/ r�7 �— E�i O'NFIH11 L RD- , D.SON, WIS. 54016 Address: ROBERT ULBRIG1HT Signature: N,'��I. IN*TALLER & DESIGNER L11C. NO. 00663 Date. CST Number: 45(� 4�96 14ct 04 _; - 2- - �3 2- 'Oro, ORIGINAL ^era � ��} i, ,�r v�� � .j Gl) lei PROPERTY OWNER SOIL DESCRIPTION REPORT PARCEL I.D.# I'Wl— 01'5 w I Page of Boring # Ground ele\f. It. Depth to limiting factor Boring # ..... .. ...... x Ground elev. ft. Depth to limiting factor Boring # Ground elev. It. Depth to limiting factor Boring # Ground elev. Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence floury Roots GPD/ft2 Bed Trends ........... t /kpl Ile 13 /0 y/f lo-f 2 A4-1 f /f shk -IR .5, 13 Remarks: 21, P-/3 loyee f-/3 2 A",,5he 0 -iW lt000-f 92 so- 54 rl 41VI 441 T Remarks: ----------- S/ 2-, f sh, ,wfle,5 3f —� .5, �,f 7c 3 T-30V011f .2 441, 5,o�t I-hA .2- !yo yg (0 9 24) �14 114 404 0-tajo / /w/ -ec�llfil 4� 7— Remarks: — , 0 0-7 Ij y� 2-12- 311 ;21 5A& Awl f, , s / . s . 7-12, 10YX 2,-f 6'hlo� 1.2 3 0 yX .51S Remarks: (f -61-0 I`41,411_57 4414A.) Z 7-0 S Aoa---f Z-- eon onon/0 ACIrin% ,8AAV,r OF /Oro< 4 114-(l dev -�-45 TE-v e- 7�1,,5 x344-)do op�s ev/j% 6,4 /'Ou 1A11 eq P.,Vo sus ; 70 �A,4�T of -7� f cccs 5 c At F /0 01 410 133 /oy.S� y /o3 zit rA-7-5 C3 /Qo,a x X,f 0011- y 5�+e EL Roo SP,aku � e STfM Ask -Tetf- [ �- it 08out jOeOUAJD. ! P� f � IIQ Npkl Zk'Aellmw4yel'02 ID? kE I GL HOM-ESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO.3307 M.P.R.S, VrNN. INSTALLER & DESIGNER LIC. NO.006W L 0&6f S--tD S k/STD (7- P CAJ c- 6-h 7-A',057Aol C It, c. t! �/ thCr� •' a ��� �� / C i� rt ! t ! � r S ' 7S ' e4 t 30 r Mow-)o f ,sySTEM pro' p�,3of3 � k 70 �A,4�T of -7� f cccs 5 c At F /0 01 410 133 /oy.S� y /o3 zit rA-7-5 C3 /Qo,a x X,f 0011- y 5�+e EL Roo SP,aku � e STfM Ask -Tetf- [ �- it 08out jOeOUAJD. ! P� f � IIQ Npkl Zk'Aellmw4yel'02 ID? kE I GL HOM-ESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO.3307 M.P.R.S, VrNN. INSTALLER & DESIGNER LIC. NO.006W L 0&6f S--tD S k/STD (7- P CAJ c- 6-h 7-A',057Aol C It, c. t! �/ thCr� •' a ��� �� / C i� rt ! t ! � r S ' 7S ' e4 t 30 r Mow-)o f ,sySTEM pro' p�,3of3 � k