Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
004-1019-40-000
St. Croix County Zoning Wednesday, September 29, 2004 at 7:58: 07 AM Detail Sanitary Information Page 1 of 2 Computer 004-1020-40-000 Sub/Plat: NA Section: 9 Parcel 09.28.15.141A Lot: TN/RNG: T28N R15W Municipality: Cady Township CSM: 1/41/4: NE 1/4 SE 1/4 Owner: Stockman, Rex D. 454 Hwy. 128 south Wilson, WI 54027 State Permit: 463029 Issued: 09/13/2004 POWTS Dispersal: Holding Tank Permit: Replacement County Permit: 0 Installed: 09/14/2004 POWTS Detail: NA Bedrooms: 40 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Mark Iverson (contr NA Koehler, Paul $0.00 Signed Off: Yes Pam Quinn NA Koehler, Paul Farm Supply is on both Ne/SE and SE/NE 1/4 of $0.00 Signed Off: No Section 9 9/13/04 Holding tank servicing contract and HT Agreement copies of recorded and notarized forms received + $325 fee Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/14/2007 Notes inspector As Built Plumber Other Requirements Additional Notes Money Owed Mark Iverson (contr NA Koehler, Paul $0.00 Signed Off: Yes Pam Quinn NA Koehler, Paul Farm Supply is on both Ne/SE and SE/NE 1/4 of $0.00 Signed Off: No Section 9 9/13/04 Holding tank servicing contract and HT Agreement copies of recorded and notarized forms received + $325 fee Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/14/2007 - - - - - - - - - - - - - - - - - - - - - - St. Croix County Zoning Wednesday, September 29, 2004 at 7:58:08 AM Detail Sanitary Information Page 2 oft Computer 0041020-40-000 Sub/Plat: NA Section: 9 Parcel 09.28.15.141A Lot: TN/RNG: T28N R15W Municipality: Cady Township CSM: 1/41/4: NE 1/4 SE 1/4 Owner: Stockman, Rex D. 454 Hwy. 128 south Wilson, WI 54027 State Permit: 463029 Issued: 09/13/2004 POWTS Dispersal: Holding Tank Permit: Replacement County Permit: 0 Installed: 09/14/2004 POWTS Detail: NA Bedrooms: 40 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Mark Iverson (contr NA Koehler, Paul $0.00 Signed Off: Yes Pam Quinn NA Koehler, Paul Farm Supply is on both Ne/SE and SE/NE 1/4 of $0.00 Signed Off: No Section 9 9/13/04 Holding tank servicing contract and HT Agreement copies of recorded and notarized forms received + $325 fee Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/14/2007 Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Mark Iverson (contr NA Koehler, Paul $0.00 Signed Off: Yes Pam Quinn NA Koehler, Paul Farm Supply is on both Ne/SE and SE/NE 1/4 of $0.00 Signed Off: No Section 9 9/13/04 Holding tank servicing contract and HT Agreement copies of recorded and notarized forms received + $325 fee Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/14/2007 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Wisconsin Denartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix S f6 and 643ing Division INSPECTION REPORT Sanitary Permit No: 463029 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Stockman, Rex D. Cad Township 004-1020-40-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: to 0. coo 09.28.15.141A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 l ; ` -7 .7C) Bench Jv U Dosing Alt. BM Aeration Bldg. Sewer 5 -1.8 19_03 0- 14 5.7- 7.4, 0.1 Holding St/Ht Inlet b . 7 3`fi St/Ht Outlet „T K SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic y t oo > g► to va Dt Bottom Dosing ~o R Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Li Friction System Head TDH Ft For main Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING anufacturer: INFORMATION CHAMBE R Type Of System: U N I Model Numlgi DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake r-~ Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 4 / tt / 041 Inspection #2: / ! Location: 454 Hwy. 128 south Wilson, WI 54027 (NE 1/4 SE 1/4 9 T28N R15W) NA Lot Parcel No: 09.28.15.141A 1.) Alt BM Description = p 2.) Bldg sewer length = 1 5 ' So,,AG, 1't N a- amount of cover = t 8 b•~-tsl.~-1 i Plan revision Required ]Yes No Z- /r -l~- - - - Use other side for additional information. SBD-6710 (R.3/97) Date Insepctors Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 iseonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co ) Department of Commerce (608) 266-3151 -3 ® State I.D. Number Sanitary Permit pp ,RE In accord with Comm 83.21, Wis. Adm. Codersona i tV i may be used for secondary purposes P avacy Law, s15.040 xm) Project Ad ress (if different than mailing address) l~cU-~ l z~ 1. Application Information - Please Print All Infor ation r > t -,-y ILL I Property er's Name ~.y~~y . L - " arcel # Lot # 1 caf r ~I L: Z0~ ING UF. ICF 2-6 tQir, Property Location Property Owner's Mailing Address J)4 L4 , ' 2 Z1(- City, State f Zip Code Phone Numb~er L ~1 :0 W 7~/`T b&n 1 ~ T c irc 3 II. Type of Building (check all that apply) Subdivision Name CSM Number ❑ 1 or 2 Family Dwelling - Number of Bedrooms Uu , i blic/Commercial - Describe Use _Gai rn Svc y ❑ State Owned - Describe Use ❑City_❑Village*ownship of III. Type of Permit: (Check on y one box on line A. Complete line B if applicable) A. 1) New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. 11 Permit Renewal 11 Permit Revision El Change of El Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) 11 Non -Pressurized In-Ground 11 Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil El At-Grade El Single Pass Sand Filter El Constructed Wetland El Pressurized In-Ground . Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter El Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe El Other (explain) V. Dis ersal/Treatment Area Information: n Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System FEle stic VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Fiber Pla Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plu is Na~e (Pr 'n Plumber' a MP/MP S Number Business Phone Number ~~1 l C~ - ] Q FA Plumber's Address (Street, City, State, Zip Code Ad nue- a~ r , r Z3 3 VIII. 'ount y/De artment Use Only pproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I uing Age t Signatur tamps) Surcharge Fee) al b I 0(r ❑ Owner Given Reason for Denial J IX. Conditions of Approval/Reasons for isapprova ' 4cg ~ J Teo a NT" G am` I 6e 74 nunn,~ _Wze A ch complete plans o the County only) f the sys on paper not less than 812 x441 inches in SBD-6398 (R. 01/03) ~K C -M recu(o4- 6r- I ~co,rd 6~ !i cc¢P ~ 2 6 5 3 P 6 2 3 -7 -7 `'1Z) ;L~- -7 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIR CO.. WI RECEIVED FOR RECORD 09/13/2004 08t15AN Document Number Document Title HOLDING TANK AGREEMENT St. Croix County auawt ; Holding Tank Agreement REC FEE: 11.00 TRANS FEE: COPY FEE: fate Plan Transaction N mbar - PC AGES- 1 .D . Sic Name - (Owner) Typed or printed being duly swom , states, under oath, that: 1. He/she is the owner/part owner of the followin parcel of land located in St. Croix County, Wisconsin, recorded in Volume Page Z'11-5 Document Number 3 S 575St. Croix County Register of Deeds Office: Recordin Area A parcel of land local to the Name and Return dress '/4 of the JOV. of Section ,fin t .StIPP / 57a c fc~ i4~ T N - R 1, W, Town of C A- D)4 . St. Croix "Y HSy ~~v County, Wisconsin, being dull described as foll ws (include lot no. and ! Z s subdivision/CSM or detailed legal description): gee- ~1 JZ1E h `sd w SAO Z~ L15-V A1Wt/ 2 S -7- -7 / RiC/2~a'/ y41A UD y ~~ZO ' d,de-0 •/S~//~' Agreement Date: P(sp~r 11 1/r~~eFnUAcation Number (PIN) We acknowledge that application Is being made for the installation of (a) holding tank(s) on the above sketibod/property or t-tat continued use of :he existing premises requires that s holding tank be !nstatled on the property for the purpose of proper containment of sewage. Aiso, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. Scats. As an inducement to the county to Issue a sanitary permit for the above-described property, we agree to do the following: 1 . Owner agrees to conform to all applicable requirements of Ch. Comm 63, Wis. Adm. Code rotating to holding tanks. If the owner fails to have the holding tank property serviced In response to orders Issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described In s. 254.59. State.. the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, State. 2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3)(9), Wis. Adm. Code,, to have a water mater Installed in the structure. The water meter shall be installed by a plumber authorized by the Department of Commerce to riako a . uch'Instaliations, with said Installation complying with State regulations and manufacturers specifications. The owner agress to:be financially responsible for the purchase. Installation, maintenance, and raoair of the water meter, and agrees to allow the govemmentAi unit or the Department of Commerce to enter, the above-described property on a regular basis to read and/or inspect the water meter. 3. Owner agrees to pay ail charges and costs Incurred by the governmental unit or county for Inspection, pumping, hauUng, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be' paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provktad by law. 4. The owner, agrees to contract with a person who is licensed under Ch. NR 113, WIS. Adm. Code. to have the holding tank serviced and to file a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contracL 5. The owner agrees to contract with a person licensed under Ch. NR 113, Whs. Adm. Code, who shall submit to the county on a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to Investigate the condition of the holding tank when pumping reports and meter readings may Indicate that the holding tank Is not being properly maintained. 8. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property Is served by either a municipal sewer or a private onslte wastewater treatment system that complies with Ch. Comm 83. Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement In such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shalt be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank Is installed. , j.o . Owner(s) Name(s) -Please Print Subscribed and sworn to before ma on,,ihtle I.V NotariXOvm s Signatu re(s) Notary Public y ! 2617 Q ~ J •'v G emmental Un Official Npme. Title - Please Print My Commission Expires t1♦ Governmental U it Official Slgnatu Drafted by: ,i °Z (,lvrvr= Personal Into atlen you provide may be used for secondary purposes (Privacy Law s. 15.04(1)(m)) "THIS PAGE 13 PART OF THIS LEGAL DOCUMENT-- DO NOT REMOVE" This lnformaUon must be completed by submitter document tale. name & retum address, andW (Nrepulred). Other information such as the granting clauses, leaga/ desodpilon, etc. may be placed on this first page of the document or may be placed on addttlonal papas of the document. ode" Use of this cover page adds one page to your document and 00 12 the Mgt tn, Mscons/n Statutes, 59.517. C HOLDING TANK SITE PLAN Project: Stockman N Legal Description: SE,NE,9,28N/R15W Subdivision Name: N.A. Scale: 1: 50 Parcel ID: 004-1019-40-000 Lot N).: N.A. No Lomrn F 3 ck ~ *a bl err,5 ~ c~ -\x2 .f sir o 16 ~o Ma W, JJ G ~ tic L4J 0 ~ Js s Tran% ion 1. D.: Page 3 of 7 ra L ~tLC C~ ShEd Safety and Buildings t~' J commerce.wi. OV 4003 N KINNEY COULEE RD g LACROSSE WI 54601-1831 TDD (608) 264-8777 sco n s i n www.commerce.state.wi.us/sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary August 11, 2004 CUST ID No.225410 ATTN.- POWTS Inspector PAUL R KOEHLER ZONING OFFICE KOEHLER SEPTIC & PLUMBING ST CROIX COUNTY SPIA E5678 704TH AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/11/2006 Identification Numbers Transaction ID No. 1037253 SITE: Site ID No. 687694 Stockman Farm Supply Please refer to both identification numbers, 454 Hwy 128 above, in all correspondence with the agency. Town of Cady St Croix County SE1/4, NE1/4, S9, T28N, RI 5W FOR: Description: Commercial Replacment Holding Tank Object Type: POWTS Component Manual Regulated Object ID No.: 974125 Maintenance required; Replacement system; 819 GPD estimated; System: Holding Tank Component Manual, SBD-10571-P (R.6/99) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD-10571-P (R.6/99 . , ~s w- • A Sanitary Permit must be obtained from the county where this project is located in accordance with the "Ie-4e4- requirements of Sec. 145.135 and 145.19, Wis. Stats. • 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(2)(d), Wis. Stats. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • Comm 83 22(7) - A cony 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. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. Fond tionalll, s L PAUL R KOEHLER Page 2 8/11/04 • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this holding tank or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 60.00 Fee Received $ 60.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)-789-7892, Mon. - Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 J S , CONCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project Stockman Owner Stockman Farm Supply Address 454 Highway 128 Wilson, WI 54027 Legal Description SE,NE,9,28N/R15W Township Cady County St. Croix Subdivision Name N.A. Lot No. N.A. Parcel ID Number 004-1019-40-000 Plan Transaction ID Number Index and title sheet Page 1 RECEIVED Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 AUG 0 5 2004 Sizing formula Page 5 -§anti - pumping S maintenance agreement Page 6 SAFETY & BLDGS DIV. Tank specifications Page 7 Attachments: soil test to state's plan Designer loretta / Paul KqehJor Signature Phone No. 715/235-5790 License Number MP 225410 Date 07/26/04 Designed pursuant to: Holding Tank Component Manual For POWTS SBD-10571-P (R.6W) Version 2.0 (0301) b y Pagel of 7 9- t- DH)ARTMENT OF COMMERCE DIVISioN i3F FETY AND BUILDINGS SLE CORRLSP NDENCE HOLDING TANK SPECIFICATIONS Number of bedrooms 1228.2 Non-residential estimated flow (gpd) 6141.0 Minimum holding tank volume required (gal) 7700.0 Proposed holding tank capacity (gal) Weiser Concrete Tank Manufacturer W7700 Tank model number S. J. Electro Alarm manufacturer S.-J1 Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank Ibs Weight of tank and cover 63.0 Liquid depth below inlet invert (in) Safety factor 8.0 Maximum depth of soil cover (ft) Ibs Weight of anchor required 77.0 Height (in) Outside in Soil cover req. for anchor or 238.0 Length (in) Dimensions yd' Concrete counter weight 142.0 Width (in) Only HOLDING TANK CROSS SECTION manhole cover with locking device and finished vet cap junction warning label grade box 4" min. 12" min. 24 in. Manhole and vent locations conduit may be reversed. vent pipe 18" min. ewer building service in. inlet blind plug alarm on Note: All tank joints, and to seal joints between tank outlet openings and piping are Electrical as per 51.0 in. sealed watertight. All NEC 300 pipe and vent materials and Comm 16 comply with Comm 84. 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Stockman Transaction Number: Page 2 of 7 HOLDING TANK SITE PLAN Project: Stockman N Legal Description: SE,NE,9,28N/R15W Subdivision Name: N.A. Scale: 1: 50 / Parcel ID: 004-1019-40-000 Lot N N.A. ~h PJ ~le,trjj~ QQ ,f i I~ i qS1 Id e 3 ) A 3~3Y ° 'W-6 i 60 'J J _ Il 17 V-1) t ` S4. .~C.-•,M [~h,.. D1 fie. ~ T... Transaction I.D.: 1 ray Page 3 of 7 i She-d ~ Stockman's Farm Supply - Sizing Retail Space: 37' x 174' - 6438 square feet 78' x 154' = 12012 " 50' x 60' = 3000 " W x 31' = 434 " 37'x 116' 4292 " Total retail = 26,176 square feet Retail sizing = (0.7 x 26,176)/30 = 610.8 gallons/day Employees: 16 FTE x 13 = 208 gallons/day No floor drains Estimated Daily Load = 610.84 208 818.8 gallons/day Design load = 818.8 x 1.5 = 1228.2 gallons/day Minimum holding tank sizing = 5 x 1228.2 = 6141 gallons Page5of 7 77j" 69' ( 142j" rn IF z II II . ~ II jl ~ II II II II , D cn I D In m m ~I II . 591" I I N I CA m m . II II : ao1-~ 11 ~ ( II C c II II . s„ I I . 9" ~ ~ ` II II z a i. : II D~~ II. N I m 1 \ G c M aN a Am o ~ N d 664' cl o , -I 3 a Z Z m 7C -4 6 Qr+ z z d -4 M~ z t:' C c m m m ° c: z Doz C -I - crw<rmx-w£y Z c c- w n Ll C~Ic° o<a .a m++~Im-iym mz<O rIO m o z m amD 3, z m~e ou xdg=-"ix°m°-v0 7C X _ Q a Z C-) m r-i7K M ~Nc C3 0 -H c° ~ ~mkD C T m N \ 0 n 2 -I W-4 I -I N m z W V • 0 C m ? DO -1zr Dr W<rNWVN ; V -N1 m0 m el rr C nm N mm~ m~ CD CDOD~..O, W v a~0 3 Z '9 Z D o ~-0 N Nmy r 0%W oD •tlmmO C-) D r N C LCl FO mt7Tml td brCW a O Cd "l Vi o m m O v m 3 c Drz O ~ ° N 70 D z .TJ d .:1 ;l C m m o r o m m m 1-1 F" 0 A m r r~ C-) N X y N rri r z Z m n so 0 Z m z F' m \ O T W7700 WIENER c08CIETE DSCALE: RAWN BY SWT' REV NO. DATE: z SEPTIC MANUAL MAIDEN ROCK, WI/PORTAGE, WI/ FOND W LAC, WI DATE: JANUARY, 2003 o REV. JAN. 2004 600-325-6456 FILE: W7700 '`a3ej ~ ~o~rv~ar~ ~4~e ! 6t HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10571-P 6/11/1999), and the St. Croix County Sanitary Ordinance. 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 1540.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer Koehler Septic & Plumbing Phone: 715/235-5790 b. Service Provider Koehler Septic & Plumbing Phone: 715/235-5790 c. Co. Zoning or Health Dept. St. Croix Zoning Phone: 715/386-4680 11. water meter to be instal Iac Project: Stockman Transaction Number: Page 4 of 7 HOLDING TANK SERVICING CONTRACT Contract Date'/ 9 //o Z This contract is made between the Holding ank Owner(s) Name(s) and Pump is Name dc 6~M-l We acknowledge the installation of (a) holdi g tank(s) on the following property: (Provide legal descriptions:) HWIZ /21 39F' I7-1 lGc~? [ti. SE ~4 a~ A J % Sec- q T -Z rAJ , 21S1~ 6 - Ul9- v-oDd i3Z 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm 83.52(1)(c)1. Wis. Adm. Code and the approved Holding Tank Component Manual. This agreement will also be filed with the St. Croix County Zoning Department. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit that has signed the pumping agreement and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volume in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: FW S~T"~~'/h~ro TodaVs Date Pumper's Name (Print) P mper's Sig tur Not ry Public Signature Wm 1*Y1n%a)097- i Z A Pumpe Registration Number Commission E piration 7 7Y ` "ORIGINAL, 2059 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach con lete site Ian on a er not less than 8% x 11 inches in size. Plan mus - County p P P P V` St. Croix include, but not limited to: vertical and ho percent slope, scale or dimensions, north arrow, ti i to a s~ pp Parcel I.D. (9 0 -9&0 Please print al/ information. h" viewed Dat Personal information you provide may be use for seco "rpcp.gp iv qqr , s. 15. 4 1 -7 Property Owner LLUUI~J Pr party Location Stockman Farm Supply S ? , Ci Olx COUI I F G . Lot SE 1/4 NE 1/4 S 9 T 28 N R 15 W Property Owner's Mailing Address # Block # Subd. Name or CSM# 454 HW 128 City State Zip Code Phone Number s City Village Town Nearest Road Wilson WI 54027 715-772-3128 Cady WSHW 128 New Construction Use: Residential / Number of bedrooms Code derived design flow rate 6141 GPD V Replacement Public or commercial - Describe: retail farm supply Parent material loess Flood plain elevation, if applicable NA General comments and recommendations: shallow soils over seasonal saturation; extensive blacktop & gravel dri~es , orage, parking; surface drainage waterruns all indicate holding tank - i ; a Boring # e Boring j Pit Ground Surface elev. -99 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-18 10YR 3/2 - Is/gr mixed fill 0 0 2 18-30 7.5YR 3/2 cl d 7.5YR 5/8 sil lacks A+4"; presumptive limit is 0" ❑ Boring # k' Boring Pit Ground Surface elev. - 90 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0-10 7.5YR 3/2 - sil 0 0 2 10-30 7.5YR 3/2 c1d 7.5YR 5/8 sil redox features rapidly grade to c2d; lacks A+4"; presumptive limit is 0" Effluent #1 = BOD5> 30 < 220 mg/L and TSS >3 < 50 mg/L ' Effluent # - D L and TSS < 30 mgL CST Name (Please Print) Signat re: CST Number Henry F. Grote ~-e 222774 Address Certified Soil Testing Date valuation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 5/13/2004 715-233-0398 Property Owner Stockmans Farm Supply Parcel ID # Page 2 of 4 3~ F Boring # pl,' Boring J Pit Ground Surface elev. -110 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 7.5YR 3/2 - sil 0 0 2 12-20 10YR 4/4 c3p 7.5YR 5/8,5/3 sil lacks A+4'; presumptive limit is 0" ❑ Boring # _J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS <30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Certified Soil Testing \,JV C-~ N Sm' i O ZS S~ I i lt~ FT1 ~ Cam' ~vn~ ~Cla. R cJ ~.r~rcc j r~ Cr? d(,lv•.vC CS, tt 'A ij I (y YF P'4~~. . 4 0~ l^J S O 40%, -~)L ,T; e4r Stockman's Farm Supply - Sizing Retail Space: 37' x 174' = 6438 square feet 78' x 154' = 12012 " 50' x 60' = 3000 " 14'x 31' = 434 " 37' x 116' = 4292 " Total retail = 26,176 square feet Retail sizing = (0.7 x 26,176)/30 = 610.8 gallons/day Employees: 16 FTE x 13 = 208 gallons/day No floor drains Estimated Daily Load = 610.8+208 = 818.8 gallons/day Design load = 818.8 x 1.5 = 1228.2 gallons/day Minimum holding tank sizing = 5 x 1228.2 = 6141 gallons Page 4 of 4 r; it ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer atciff" [am Mailing Address Property Address q5q 1 a 8 (Verification required from Planning Department for new construction.) City/State 4r) Parcel Identification Number LEGAL DESCRIPTION Property Location h f, '/a , SecQ_, T N R 5 W, Town of NAO Subdivision , Lot # Certified Survey Map # , Volume , Page # , Volume Page # 26 Warranty Deed # Spec house yes (n,o~ Lot lines identifiable 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. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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 Department wi 30 days of the three year expiration date. y--~ iA-i rtr' SS1614AAME (W A PLICANT 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 property d 'bed above, by vi o 'a warranty deed recorded in Register of Deeds Office 916NATUR"P APPLICANT DATE Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. Safety and Buildings Division County hington Ave., P.O. Box 7162 ' Madison, Wl 33707 - 7162 Sanitary permit Number (to be filled in by Co) NVE.A.Consin A 201 W. Was Department of Commerce 266-3151 Sanitary Permit Application State Plan I.D. Number In accord with Comm 13.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, aI5.040)(m) Project Address (if different than mailing address) 1. Application Information - Please Print All Information OU -/0 ZG-_~fQ-Cfr-D Property er's Name f Parcel N Lot N Block N Ntdmn afm &40,01Q Property Owner's Mailing ress Pro on W City, State Zip Code Phone Number Section T ZDL& N. R-eE 1e W ) II. Type of Building (check all that apply) ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number "blic/Cominat l - Describe Use rY) 5Lk- 0 State Owned - Describe Use ❑City_❑7Yillagc*ownship of 016 1 111. Type of Permit: (Check on one box on line A. Complete line B if applicable) A. ❑ New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Betbre Expirstskin Plumber Owner IV. Type of POWCS System: Check all that apply) ❑ Non -Pressurized In-Grand ❑ Mound ? 24 in. of suitable soil ❑ Mound <24 in. of suitablesoil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground 9 Holding Tank ❑ Pat Fitter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Lachi Chunber ❑ Dri Line ❑ Gravel-less Pi ❑ Other( (explain) V. Dic rsaL/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdat) Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation VI. Tank Into Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tmks Sepic ar Holding Tank WaVy Aerobic Treatment Unit Dosing Clamber VII. Responsibility Statement- 1, the undersigned, aassune responsibility for installation of the POWTS shown on the attached plans PI 's Naq~ (P 'n Plumber' MP/MP Number Business Phone Number f. ;p q5q/o ~P,, 0-e -10 -5 Plumber's Address (Street, City. State, Pp lvnut- ./of-oun a Vlll. County/Department Use Only _ _ _ ❑ Approved ❑ Disapproved Permit Fa (includes Groundwat Date shed Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of ApprovaUR ons for Disappro Ansielt a plat (ter the County aaly) for the N paper net lots ihar W x 11 Imbefit sine SBD-6398 (R. 01/03) l Ro~ec-(~ .sd-oekman l-~ e ~O ~ ~ 5 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF CADY COMPUTER NUMBER 004-1020-40-000 Parcel Number 9.28.15.141A OWNER NAME: First REX D Last STOCKMAN PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 454 HWY 128 SECTION 9 TOWN 28N RANGE 15W 1/4160 '/440 Line Description Line Description TOTAL ACREAGE 37.710 PLAT LOT BLK 01 SEC 9 T28N R15W 40A NE SE 15 02 EXC PART TO STATE AS IN 16 03 638/441 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit GENERAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR01 REAL ESTATE TOWN OF CADY COMPUTER NUMBER 004 - 1020-40-000 Parcel Number 9.28.15.141A Claimed Date Re-certified 04/17/2001 Relate Number: OWNER NAME: First REX D Last STOCKMAN CO-OWNER Mailing Address 454 HWY 128 City WILSON State WI Zip 54027 - Type Vol Page Doc # Rec.Date Type Vol Page Doc # Rec.Date HISTORY 638/441 07/23/1997 WD 588/ 295 354578 01/15/1979 PROPERTY ADDRESS: Hse # 1/2 PD --Street Name- Type SD Apartment Post Office 454 HWY 128 School District: 231 - BALDWIN-WOODVILLE AREA Special District: (1) 1700 - (2) - (3) - W ITC Plat Code: Last Changed on: 03/07/1994 Book Number: 1 SECTION 9 TOWN 28N RANGE 15W %160 '/440 Map Number: 00 - Sales Area: Parcel Control 0 TAXABLE Number of Units: ZONING: Permit Number: Type: Bank Numbers : F4-Prev, F5-Next, F6-Legal, F7-Value, F8-History, F10-Exit, F12-More LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF CADY COMPUTER NUMBER 004-1019-40-000 Parcel Number 9.28.15.132A OWNER NAME: First REX D Last STOCKMAN PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 454 HWY 128 SECTION 9 TOWN 28N RANGE 15W 1/4160 '/440 Line Description Line Description TOTAL ACREAGE 38.210 PLAT LOT BLK 01 SEC 9 T28N R15W 38.21A SE NE 15 02 16 03 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, 174-Prev. Parcel, 175-Next Parcel, F7-Valuations, F8-History, F10-Exit STATE BAR OF WISCONSIN-FORM 1 DOCUMENT NO. ` wAnANTY DEED 588 PACEZ-9S THIS SPACE RESERVED FOR RECORDING DATA 3545'x,$ REGISTERS OFFICE eor M Henriri nkson THIS DEED, made between ST. CROIX CO-, WIS. 15 Rec'd. for Record, this Grantor day of J_,,_anA.D. 1919 and Eat- 13 : 30 A r M. Grantee, R p ee W i t n e s s e t h, That the said Grantor for a valuable consideration Tweet fi vP Thnt:sanr3 anr] nn/Inn nn11.ar,9,_ S± _ C n X County, it URN TO conveys to Grantee the following described real estate in State of Wisconsin: ROBERT R. GAVIC LAW OF I S rin Valle WI 5476 North One-half of Southeast Quarter ('N;~ of SE'4Tax Key M of Section 9, Town 28 North, Range 15 West, This is nn homestead property. and Southwest Quart er_.._of-Sow_t Quarter ( SW14 of SE'k.) of Section 9, Town 28 North, MNSFER Range 15 West. ~00- FU This Deed is given in consumation of that certain Land.Contract between the parties dated May 31, 1972 and recorded June 8, 1972 in Book 487, page 187, Document No. 310648, Register of Deeds Office for St. Croix County Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining: . t, And Hendrinksnn warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the some. Executed at RaI (9wi n, [nIi snnn i n -this ~tr day of ' Ig79 A-f Aj ~1111' (SEAL) SIGNED AND SEALED IN PRESENCE OF Cora M. Hendrickson (SEAL) (SEAL) (SEAL) Signatures of Cora M. Hendrickson authenticated this 5th day of Hammarback i Title:. Member State Bar of Wisconsin or Other Party Authorised under Sec. 706.06 viz. STATE OF WISCONSIN as. County. day of 19-, Personally came before me, this the above named to me known to be the person- who executed the foregoing instrument and acknowledged the same. This instrument was drafted by ROBERT R. GAVIC Notary Public County, Wis. Attorney at Law My Commission (Expires) (Is) The use of witnesses is optional. . Names of persons signing in any capacity should be typed or printed below their signatures. KG~wuroMe.n~ WAanANTY DEED-STATE DAN Or WISCONSIN, RORM NO. 1 - 1971. A I life y ~ ~ ~ ~ r ~ (1 7- i O /\O L r cs' c o q O\ LOCATION: CADY 9.28.15.131,S1/2,NE, HWY.128 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 149336 Permit Holder's Name: ❑ City ❑ VlllageX3 Town o : State Plan ID No.: STOCKMAN, REX D CADY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: - _ ~~►n Q S cs~ r~(e, 004101930000 TANK INFORMATION ELEVATION DATA A92 183 Z av TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ i r4 Z_w i'C as art Septic Benchmark r 41/ Z, 3S_ Z Z 163 2/ Dosing n, 6,AC 3 ,~✓ux-rn f~c~25 O u0 m ion Bldg. Sewer n av~ /o5!.E L ~ Holding St/I Inlet _ 1 • E. 5- TANK SETBACK INFORMATION St/ Ig6utlet Vent TANK TO P/ L WELL BLDG- Air Ito ntake ROAD Dt Inlet S Air m`" >5 NA Dt Bottom f/Q,g , Septic . _15040- >50, /O Dosing > 6W' > Z CD NA Heade - / Man. 1a3„3 Ion Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION t% Final Grade 4 Manufacturer, Aemand 40r/1"4 Z Q 7, k ~ I ~~3 GPM ~ Ir ke /7,35 Model Number TDH LiftN, Lriction,, System~~ TDH ~,Ft oF.°~ i1d~s 1 Forcemain Length&Z Dia. 02 " Dist. To Well SOIL ABSORPTION SYSTEM,, BED/TRENCH Width i Length r No. Of Trenches p its Inside Dia. Liquid Depth DIMENSIONS lC 1MEN I N LEACHING `Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type O 0_" CHAMBER Mo e System: OR UNIT DISTRIBUTION SYSTEM Header / Man fold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake \i2a0 ' I-ength Dia- Length 150 Dia. I ~`I Spacing 14 57 , SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over t xx Depth Of xx Seeded/ SoddM xx Mulched Bed /+rz=PCenter p Bed / TfeweirEdges 17 Topsoil (p P-rrs- ❑ No @-"T- ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) _ / l l CC%, % Z ;o,zg' -6.73 / 60 ~/6D,c)> s /@ R 'T~ ~'(7, /D 2 Civ/ e - 3, P^~ = 99 9S ~ ion required? ❑ Yes Q side for additional information. o7~e l3 A(/~"- Date Inspector's Signature Cert. No. 05/91) ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ew~l 040 G~~ - SANITARY PERMIT APPLICATION 0- LHR In accord with ILHR 83.05, Wis. Adm. Code C" S Ciro. ` STATE SANITARY PERMIT # -Attacf+ complete plans (to the county copy only) for the system, on paper not less than ❑ / j~ 8% x 11 inches in size. C eck if revision to prey us application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 59.2 - Qa PROPER OWNER PROPERTY LOCATION S' %4,S T28,N,R F o W PROPER OWNER'S MAILING ADD711 LOT # BLOCK # ► S cohS/I CITY, STATE ZIP CODE INIONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11 1 &A - VlArst;, D II. TYPE O BUILDING Check one CITY : NEAREST ROAD ( ) State Owned L~ ❑ VILLAGE 1 k4w o4.6 ❑ Public1 or 2 Fam. Dwelling-# of bedroom9,,1 PA TAXNUMBER(S)l R( 111. BUILDING USE: (If building type is public, check all that apply) n 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 100 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 ly one in line A. Check line B if applicable) A) 1.E1 New 2)&eplacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System - System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressu ized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE TO REQUIRED (s . ft.) PROPOSED (sq. ft.) (Gals/day//sq. ft.) (Min./inch) ~f ELEVATION 17 © M ~d-- 0 / Feet Feet VII. TANK CAPACITY Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber rdkge&oct7_ F] F-1 F-1 F-1 F-1 Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum is Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: h s r P 3 S' P u tier's Addr ss (Street, City, State, Zip Code): I V w i IX. COU TY/DEPART ENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) r-of Approved El Owner Given Initial Surcharge Fee) ( Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time cf 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 1=arm (SBD 6399) to be submitted to the county`prior to installatiorl; j 5. Onsite'sewage systems must be properlytnaintained. 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 cede administrator oT 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 pa,cel tax number(s) of where the system is to be installed. it. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank nformation, 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 Pf 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'h 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; wader mainsiwater 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-d 115 form; and F) all sizing information. . - - - - - - - - - - - - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground,-. water contamination investigations and establishment of standards: SBD-6398 (R.11/88) SAFETY & BUILDINGS DIVISION I State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 WEGERER SOIL TESTING & DESIGN Owner: REX STOCKMAN PO BOX 74 BOX 40 RIVER FALLS WI 54022 WILSON WI 54027 RE: Plan Nutber: S92-40008 Date Approved: January 22, 1992 Gallons Per Day: 750 Date Received: January 14, 1992 Project Name: STOCKMAN, REX Location: S,NE,9,28,15W RESIDENCE Town of CADY County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT PETITION - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 785 1 Z ~O `b a~ 9 SBD 6423 i H. 011911 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations WEGERER SOIL TESTING & DESIGN Page 2 Sincerely, GERARD M. IM Section of Private Sewage Division of Safety and Buildings PPP039/0009n/27 cc: REX STOCKMAN X Private Sewage Consultant 911D 64231K.01/811 SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations January 17, 1992 REX STOCKMAN P 0 BOX 40 WILSON WI 54027 Petition No S92-40008-P Dear Mr, Stockman: Re: Rex Stockman - Residence Private Sewage System S,NE,9,28,15W Town of Cady, St Croix County, WI Your petition for a variance to sections ILHR 83.13 (1) and (2) and 83.23 (1)(d), Wisconsin Administrative Code, has been reviewed. The petition has been approved: The rules being petitioned require that seepage trench excavations shall be 1 to 5 feet in width, seepage bed excavations shall be more than 5 feet wide and have more than one distribution pipe, and there shall be at least 24 inches of unsaturated natural soil over high groundwater as indicated by soil mottling or direct observation of water in accord with s ILHR 83.09 (4)(d) and (e). The variances requested were to allow the installation of a replacement mound system with a 6-foot wide trench on a site with 16 inches of suitable natural soil. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Si cerely, i Weey , e D irector, Office of Di ion Codes and Applicati (608) 266-3080 RM:GS:1216WPP1 cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Art Wegerer SBD 6928 iR. 91191) Page 1 of 6 MOUND SYSTEM FOR A S BEDROOM RESIDENCE sE _.~y LOCATED IN THE sw 1/4 OF THE UL 1/4 OF SECTION 9 T Z8 N, R \S W, TOWN OF c-f" ,;b -l . ST. C_W31 X COUNTY, WISCONSIN. INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ''~zEY' STocvr- '13uY_ y VOiLSbtJ, i 11 5{oZ7 PREPARED BY 4sc ®.rvs/,y 'y. W EGEF;t ER SQ I I TEST I MCG AND ® ti ARTHUR L. DES I cam SEF;tV I CE ® WEGEREA Q-9f5 P d suswoRTH. 1 WiS F.O. BOX 74 421 N. RAIN ST. s RIVER FALLS. WI 54022 • . . 715-4125-0165 i G N o JOB NO. l- l 9 6 Page 3 'Of 6 ,Approved Synthetic covering - Distribution Pipe Medium Sand - Topsoil H G - -J F Elev. \I-L-10 3 D b. S-3 % Slope Bed Of 12.-'2 (Force Main Plowed Aggregate From Pump Layer Undisturbed D ~-1 Ft. Soil E ?--0 Ft. Cross Section Of A Mound System Using F c-% Ft. 1 Trench For The Absorption Area G '\•o Ft. A E, Ft. H I- S Ft. B 105 Ft. I 30 Ft. Linear Loading Rate=--7.1 GPD/LN FT J 9 Ft. Design Loading Rate= o-Z GPD/SQ FT K \2.SFt. L N3o Ft. Alternate Position of Force Main W L4 S Ft. L d Force - _B-~ K Mai- W w Distribution Trench Of 2 2 2Y I Pipe :kgg~fTE SEW E SYSTE Observation P one t D pipe ~torra 1~f4 (1lnchbr ssecurely) O &0% V n V V Et) DEPARTMENT OF INDUSTRY, LABOR AND H WAN RELATIONS z'OVISION D DI Mound Using I Trench For Absorptiorn rea C) Page Y Of 6 Perforoted Pipe Detoll End View Perforoted End Cop. PVC Pipe l _ ms`s .40 Install permanent-marker at end of each lateral Holes Located On Bottom. Are Equally Spored Q End Cap SEWAGE SYSTEM ~ - G~51T tjoaaI4 PVC Force Main Coadi ROV TtONS IFTWN V6jF Distnoution AP MN RE1 A ~R ANA • pipe DEPARTMENT `V1514N RY. LINGS Lost Hole Should Be of Next To End Cop ENCE SEE CORD Distribution Pipe_ Layout P S O Ft. X S7 Inches Y 57 Inches Hole Diameter W Inch Lateral OV Inch(es) Manifold " KJ,- . Inches Force Main " Z Inches of holes/pipe 11 Invert Elevation of Laterals 1Z3.20 Ft. t Place lst hole Z8)/2from tee with succeeding holes at S-7llintervals.. Last hole to be next to the end cap. PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE 5 OF 6 VEIJT CAP 4"C. T.. VENT PIPE • WEATHER PROOF APPROVED LOCKING MANHOLE 25'FROM ODOR, JWICTION DOX COVER WITH WARNING LABEL WINDOW OR FRESH it"MW. I AIR INTAKE GRADE l O 1 `I" MIN ~ COWDUIT 18"lrllAl. ``A~ .l wLET ONSITE SEWAG*$%X%TEM AiRT T SEAL I I I I i v Conbionatty APPROVED JOINT A APPROVED JOINTS r W-m ov Rug I I i ALARM A R E I DEPARTMEN OF INDUSTRY, LABOR HUMAN RELATION IN DIVISION SA B WING ~ i ON LLLV. gl'33FT. SEE CO E ENCE PUMPS OFF D ~L 83 COLICRETE BLOCK 3" APPROVED RISER EXIT PERMITTED OIJLy IF TANK MAWIJFAGTURER HAS SUCH APPROVAL. BE001NQ SPECIFICATIOMS 005E r.~~~,~I~-T~szIJ t~sr Z-30 TANK MAAIUFACTURCR. . P NUMBER OF DOSES: PER OAS C3 BDRY?) TANK 51ZE: 1L15~ GALLOWS DOSE VOLUME 3.83 C 5 lab") s -S . L.L'ect m SYSTCI"IS INCLUDIMCP 5ACKFLOW: 303.9 OALLONs ALARM MMJUFACTURGR: MODEL MUMBER: \O \ Hw CAPACITIES: A= INCHES OR 6710 CALLOUS SWITCH TUPCS `N1 mcNi\ttf 8= Z INCHES OR y6'8 .f4LLOW5 PUMP MALIUFACTURCR: Z,OELLem CAM%Z1µlY C= 13 INCHES OR 303'9 GALLOWS MODEL NUMDER. 163 D. IS 1NICHES OR qQ ' 8 GALLOWS SWITCH TYPE: Y'1 e~Lc-Qw{' MOTE: PUMP AND ALARM ARE TO OE MINIMUM DISCHARGE RATE III/ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF AWD.DISTRIDUTIOW PIPE.. 31-_8_7 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . 2.50 FLET ♦ 640 FEET OF FORCE MAIN X F,oo fLFRICTIOLI FACTOR. -21 FEET TOTAL DtIWAMIC HEAD = yZ'~ -FEET DIAMETER t3y " u. INTERNAL DIMLWSION~ OF TANK: LENGTH _ ;WIDTH ;LIQUID DEPTH 6Z BOTTOM AREA - 231= GAL/INCH 'Z3:3 GAL/INCH P P~GL 6OF9 { HEAD/CAPACITY CURVE 161,163 AND 165 SERIES TOTAL DYNAMIC HEAD/FLOW PER MINUTE W W EFFLUENT AND DEWATERING ~W 23so SERIES 161 163 165 FT. M. Gal. Ltrs. Gal. Ltrs. Gal. Ltrs. 24 do 5 1.52 106 401 61 231 61 231 MO EL 10 3.05 100 378 61 231 61 231 70 15 4.57 91 344 60 227 60 227 W 20 163 20 6.10 82 310 59 223 60 227 = 60 25 7.62 74 280 57 216 59 223 16 so z 30 9.14 65 246 55 206 58 220 40 12.19 46 174 46 172 55 206 z 12 a W o 9 50 15.24 21 80 33 125 51 191 a OD L 60 18.29 15 57 43 161 ~ 30 70 21.34 30 114 6 25aV 80 24.38 14 53 20 90 27.43 4 to 100 30.46 Lock Valve: 56' 66' 87' o c1 k M 7+S GALLONS 10 30 40 50 60 70 80 90 100 110 i ~4,-~: LITERS 0 80 160 240 320 400 FLOW PER MINUTE , 4'6 Standard all models - Weight 77 lbs. - 20 ft. cord -1h H.P. - o '%_11% PT - ,.,11%N,nNPT (oft) 161 MODELS Control Selection c Model Volts-Ph Mode Amps Sim lex Du lex 6'. M161 115 1 Auto 14.0 1 or 1& 9 - I i N161 115 1 Non 14.0 2or2&8 3or5&6 D161 230 1 Auto 7.0 1 or 1 & 9 - E161 230 1 Non 7.0 2or2&8 3or5&6 T- F161 230 3 Non 3.0 2&4 3&4or5&6 'H161 200-208 1 Auto 8.2 1 & 9 - f '1161 200-208 1 Non 8.2 2&8 3 or 5& 6 l { 'J161 200-208 3 Non 2.2 2&4 3 & 4 or 5 & 6 'G161 460 3 Non 1.5 2&4 3&4or5&6 Standard all models - Weight 77 lbs. - 20 ft. cord - 1/2 H.P. 163 MODELS Control Selection ? Model Volts-Ph Mode Amps Simplex Duplex 6 M163 115 1 to 14.0 1 or 1 & 9 - N163 115 1 Non 14.0 2or2&8 3or5&6 D163 230 1 Auto 7.0 1 or 1 & 9 - E163 230 1 Non 7.0 2or2&8 3or5&6 F163 230 3 Non 3.0 2&4 3 & 4 or 5 & 6 SELECTION GUIDE 'H163 200-208 1 Auto 8.2 1&9 - 1. Integral float operated mechanical switch, no external control required. `1163 200-208 1 Non 8.2 2&8 3 or 5 & 6 2. Single piggyback mercury float switch or double piggyback mercury float 'J163 200-208 3 Non 2.2 2&4 3 & 4 or 5 & 6 switch. Refer to FM0477. 'G163 460 3 Non 1.5 2&4 3 & 4 or 5 & 6 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075. Standard all models -Weight 82 lbs. - 20 ft cord - 1 H.P. 4. Combination starter. Refer to FM0514. 5. See FM0712; for correct model of Electrical Alternator, "E-Pak". 165 MODELS Control Selection 6. Mercury sensor float switch 10-0225 used as a control activator, with "E-Pak" Model Volts-Ph Mode Am Simplex Duplex alternator, 3 or 4 float system. D165 230 1 Auto 9.0 1 or l &9 - 7. SIMPLEX CONTROL BOX 10-0050, 115/230V, 1 Ph. max. 2HP use one (1) E165 230 1 Non 9.0 2 or 2 & 8 3 or 5 & 6 single piggyback wide angle mercury float switch OR two (2) 10-0225 mercury F165 230 3 Non 6.6 2&4 3 & 4 or 5 & 6 sensor floats for level control. 8. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in 'H165 200-208 1 Auto 10.7 1 or 1 & 9 - simplex or duplex operation. '1165 200-208 1 Non 10.7 2&8 3 or 5 & 6 9. Two (2) hole "J-Pak", junction box, for watertight connection or splice. -J165 200-208 3 Non 7.0 2 & 4 3&4o r 5 & 6 *No Molded Plug -G165 460 3 Non 3.3 2&4 3&4or5&6 For information on additional Zoeller products refer to catalog on Combination Starter, CAUTION FM0514; Piggyback Mercury Switches, FM0477; Electrical Alternator, FM0486; Mechanical AM won of earrkok proMebn dsNoas and wl" ahouW be door by a licensed quMaad Alternator, FM0495; Alarm Package, FMO513; Sump/Sewage Basins, FM0487; and Simplex aMctrl Al elaclrkd and =I* coded should be lorowd kK krding the mod recent Nadonal Control Box. FMO732 ELeble Code (NEC) and In Ocagaronal Safety and Hadlh Ad (OSHA} RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 3280 Old MlNOM Lane Manufacturers of . 0 P.O. Box 16347 ® ZAIZZ6F O. (Louisville, QUAL/TY PUMPB FINCE Iyyy N SAFETY & BUILDINGS DIVISION State of,Wisconsin Department of Industry, Labor and Human Relations , is•:"1 ( 3!~~ " 1 . l'~t 1. {~.F~i E,•`.r .f ~1 `jtl to } ~i if 1'?'.. RE ; Plant Number: S92-_0008 t$ ? `.1 !1 ~ e ,`f •,.t. a .}'r f t r 7s,i..Y _ i ~ e~. . 2 t ~ F 7 t..~~. ~ ~ 4 ( ~11 • D o . PI 3ror ,f'. . ,st 1• f?_ ~ ~i( ' ''?li r t 1 ~ ;1 1 . t .t ,I+. r'r''i ➢ S _ ~1'+S ! Y .z . . 1 . i ~ F:'. ~ t: z t 7 i , 4 f;>' L, < ~•P- s oYt r.g.{ u ;,'f;;. ! i• , ~ .1. ..9 . ..i t qZ '1. s.'114 t' `±.`t,k t.`. lire ,r2=, t.+ ,6 rtr't'.r ! ,Ft ? {e r 1,£ Tfl 4 , "1,'.._t t r~._ t rtt,~ t• y !P; r l ! of 1 ""TI 9 >p SUD~64231H.Ul/91) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry; Labor and Human Relations t~ 8110 &183(8. 01191) I I AR, I~JL SAFETY & BUILDIN 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations January 17, 1992 REX STOCKMAN P 0 BOX 40 WILSON WI 54027 Petition No. S92-40008-P Dear Mr. Stockman: Re: Rex Stockman - Residence Private Sewage System S,NE,9,28,15W Town of Cady, St, Croix County, WI Your petition for a variance to sections ILHR 83.13 (1) and (2) and 83.23 (1)(d), Wisconsin Administrative Code, has been reviewed. The petition has been approved. The rules being petitioned require that seepage trench excavations shall be 1 rj to 5 feet in width, seepage bed excavations shall be more than 5 feet wide and have more than one distribution pipe, and there shall be at least 24 inches of unsaturated natural soil over high groundwater as indicated by soil mottling or direct observation of water in accord with s. ILNR 83,09 (4)(d) and (e). The variances requested were to allow the installation of a replacement mound system with a 6-foot wide trench on a site with 16 inches of suitable natural soil. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Sincerely, i and ey r, -re ect Director, Office of Di i ion Codes and Applicati n (608) 266-3080 RM:GS:1216WPP1 cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Art Wegerer SBD 6928 iR. 01/911 t • S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property C mcf W Location of pro erty _ 1/4 ~1/4, section* T_!LR H- .Township CA Flailing address U Address of 'site V7/~7 Subdivision name r Lot no. hI~ other homes on property?'- yes No Previous owner of property At'vi, )fihe A) 1 I .I -I- I Total size of parcel 6 (bate parcel was created v N Are all corners and lot lines identifiable? Yes No Is this property being developpe~dj for (spec house)? Yes/X_No volume,/ 5--and Paige number v 0 as recorded. with the Register of Deeds. 114CLUDE WITH THIS APPLICATION THE FOLLOWING: A WARILMI'TY DEED which includes a DOCUMENT NUIU3ER VOLUME AND PACH NUMBER It THE SELL of THE ILEGISTLlt OF DEEDS. I In addition, a certified survey, if available, ;would be helpful so as to avoid delays of the reviewing process. If the deed description referencea to a certified survey Map, the certified survey Hap shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of ny (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the county Register of Deeds as Document No.'- , and that I (we) own the proposed site for tl a sewage disposal system orreI e(we) obtained an easement, to run the above described property, for the construction of said system, and the same has been dul recorded the or y Tice of County Register of deeds No. as Document Signature of'appl cant Co-appl cant 2- Date of S gnature Date of Signature ~ ~ 1M1~ ~ t R y , t .,w 323539 ao~i tar r re f~ t: $ TIIdCII P~ made thL S day Of A. V.. 1P4 t' between Martin Dahl and Althea Dahl, husband and wife, R ~ 3e,i~A~ tik Brat pat. and Rex Stockman and Wilma Stockman, husband and wile as ;*olA teliepts paf iesof the mono part Mtnt0ut4: That the said parties of the first part, for and as commideratfon of the saw of "Thirty-six Thousand Five Hundred and no/10b ($36,5o0.oo)•' f to them in hand paid by the said part ie s of the second part, the receipt whereof is hereby confessed and acknowledged, hire given, granted, bargained, sold, remised, relessed, aliened, conveyed j and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part ies of the second part, themselves and their heirs and assigns forever, the following described real estate, situated in the county of St. Croix. and State of Wisconsin, to-wit: The Northeast Quarter N_"~4) of Section Nine (9), Town it Twenty-eight (28), Range Fifteen (15), subject to all easements, right of ways and privileges of record. i This deed is executed by the grantors herein in full satisfaction of the terms of a land contract recorded on October 27, 1971, in 477, page 622, #307522, with the office of Register of Deeds, St. Croix County, Wisc. I, _i • FFU 0i EXEMPT ! ZogPiJPL with all and singular the hereditaments and appurtenances thereunto belonging or is anywise appertaining; and all the estate, right, title, interest, claim, or demand whatsoever, of the said part ies t of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained j premises and their hereditaments and appurtenances. Zo I?flbt anb to Kolb, the said premises as above described with the hereditaments and appurtenances, unto the said parties of the second part, and totheir heirs and assigns FOREVER. Anb the 08fb Martin Dahl and Althea Dahl forthemselves and their heirs, executors and administrators, do convenant, grant, bargain and agree to and with the said parties of the second part, their heirs and assigns, that at the time of the ensealing and delivery of these presents they are well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and i that the same are free and clear from all incumbrances whatever, • i ~ and that the above bargained premises in the quiet and peaceable possession of the said part ies of the I i 'i II - second part, their heirs and assigns, against all and every person or persons, lawfully claiming the whole or any part thereof, they will forever WARRANT and DEFEND. In MUMOO MIOMb the said part ies of the first part ha hereunto set their bands and seals this l a day of August , A. D., 19 74. i ned and Sealed is Presence of ---,n a "---(Seal) Alt e D a- ""~'----Seal) h a ahl John G. Nestingen' - ..__(Seal) Mary Anderson V)tdtt of ail OCOnOtn, ST. CROIX ss. County. Personally came before me, this a day of August xb" ?ly~,_ the above named Martin Dahl and Althea Dahl • to me known to be the persons who executed the foregoing ins ument and acknowledo•• w ►d?; C=- John G. NestWW1•e •~V_ Notary,Public, Pierce County, Wisconsin My commissions permanentxl*Axig Drafted by John G. Nestin~eni Baldwin, Wisconsin X4002 toen~ttean t~Ims 14=911re " Nut dl hastremtets to be eeeoeded shall have plainly Printed or t7yewritga thereoa the nem~ of an Sma. J l j 'll C _ O as CO as I (I A I,i e► ~ ~ i~ t. N! I IN 64 i vy ,t:"' ,ps17i;kF ra 14Y . 3 b. L(ti% "r., Ale jP 9 12 rAl Je. 2 kA/ y l d 9- 3 S4'1 T,2 g,v g-W v a NC SP r ~ c r .0 _j rJ r Q 2 r o °o o ~I y o- 0 4 0 ~ ~ ~ 10 LrnI, 0 X C CL N a 064 . ~ 2 Y oo Y O -T C M !n 4U (n QN ap (A t" -le A d A J r ul-C ~,N ~(~°oz o -VO . ~d CL Y V1 (A •A _ N LL 'o :3 v 01 ci > m° a 0 3 a Fr J 2 ~ ' N 2 3 _m ,n `f f~ l CL r N = o O ° J, C~ ea n O ~7 + t i ~ O "I o '0 a O U) L9 a o Q td a~i GI c D. c ro o 3 A ; D w Q ' a LU N 4+ 1 o °C v S = nJ - c OC a D ,o m 4r N c S W S a fn tj. 01 A E z O I' a O in c E E" 0 0 E r o, Q a, 7 V " 1 V w vTi vTi S ~ I W 2 T F) N vi VI /J J O (3` o N l7 (n O R ~ N~ r J ~ ~ N a o a I n j 1 1 .2 art o o - 1- ` rP a> ax, N r > 32 do - u u ~ 0 v O ~ ~ 02 2 0 d o r w 3 3 41 V1 O r'j n (A O n tp op 41 c N c1 Ul ! o k V Ni yt in 09 41 Z O M) 2 O ~ ~ Jl <G 3 O N v r/1 ? rr1 J rd T S CM (D -0 D C- 0 41 4v Go (A a- to -C oo LA l~ N Y Q f r~ I' r 41 = E d n 0 f i 0o tl~ COC / R N c o z d Q o c )4 y 7~ N O N y/,~1 c_ N~ Y N C JL :3 0 1 r n Rao (1) u , O ~I IT ~u 0 0 2 43, 3 7~3 (31 J co r` to J N ` ca x0 0 / N ur N C C N O o >.'o v`O- p .o c r 0 d no N W M N = / v a~Y 7z° E 41 CL A U' Cl ar o n V O O N N a o .2 O 9 a. V) to ^ c N (A 6, N VI LL J N x m 0 O VVV 1 3 a [j R J o co to M 41 CL 0 c Jl O CC N N 4v1 `'o aa, D Q y c CO. C `o 6 ° a m c r3 W 3 .0 a, a~i cc 0 A 04 q o d~ c 1 s y m a p N - E 3 1 4- s y y, - v, O N 0 r3 0 -C CL :3 Ln N R Q T In N N n u l J O 0` vii l7 / r O ~ o o O M a s J VI Q 04 O C - ° - >1 ID 0 ~r a~ a) cP O ~ O I- CL. Z o c, 'o r' To 0 N o r-j ;A ( 3 u l c, c v ul o c M z +-0 6A f5 a q 3 ~&A ,,w N~ LA :i fl) x F r 0 a a N o N v 4-J c N r W (n o r r r } a t C k Y 0 O `O I I Q r C 1 - o r o- rJ m ~ CC 1" r O C r CL C N r W Q 1 1 1 1 41 0 C O C O r rn v E a) O z o Z c~ d / N c f ` c CD GJ O 2 E W E O O 0,4 3a a ?~o~o~ o~ _ / rl M T Q 0 41 C , j N N N 4 f v o o ^ col 0 c7 Z V .0 al i~ J l7 o C M to r oa% D~ 111 ~ J mn C a 0 0 N N d ~ :4N ~ ~c ID_ C N /OOCC~ O r p ~ C 1 NdG O q J > V VI W dd d ui Q Y = O a q U' C1 C f ar w o O %A a- i C p vH C P N in ~ LL ~ c a a N er cr !i m 0 3~ a V ca ap 3 m N v. A r 0 O 171 go M GO Q p O C: N rcl ~ w a O d l o A D c Q) w oc 04 ~ A d~ c ~ S Z T (o 04 ~ ~N_ 03 -J yam' (l rn 00 Jn7 I F- D I a' E w E6 w~ V ~ V CL N ca p a~ y N ~ w cn z Q ~ ~ 7 to (li (~s J 0 61 a` i; O V1 / O1 04 0 0 ` v ° :3 - - 3 oo 0 ~ L U) Z 02 03 VI o rj V) v ++1 o cc 7jj ~ O N Y N Q a o V x Jl 3 f a 5. 2 0 ,J a 'ID ° T o v p N 1 y N Y U) N N c: r N oY E~ r r w N o a o t! x I r QE N ° a r? E o D2 E aW OC 0 w 1 aL c c O z a c~ c c ur 2 d '~4I m 'Z IJ- ° I- a W~ N l' /V `y N i+ ~O 4-) O' O cc Q o ~1J E M: SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER `p 5( S10 a ADDRESS: X ~I_ L _._•,___FIRE NO: LOCATION: 1/4, F 1/4, SEC.--f _1T_;_Q' N-R_zzLW" TOWN OF: ST.•CROIX COUNTY SUBDIVISION: T N0. Improper use and maintenance of your in its premature failure to handle wasseptic ste result tes. ercould maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What 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 to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August.of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix Count 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 from will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system-in accordance with the standards set forth, *herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning office 911 4th St. Hudson, WI 54016 C o h a0 v °0. 0 0 0 Z ~ ~ Ln 3 J ~x~ ~ J N tea`, ~ ~ cc n) Y 4- m NdG ° t~ Q r A t0 C 1 q .0 7 0 v m O CL a`r O o Q Y z Coln C d v N O O V1 a u C r0 9.~ d ) LL 0 :3 v 6~ d r > v ~ e m m ) v° 3 a a Vf N O a a~ D. (a C LU p q) 1 0 °C 'D C Z) 4 S to 00 E o 1= o p` E~ Q u p N m 0 T r• ni '/I n :3 ce 4- J O O O a~ 0~ v+ l7 I r r Q o 4' _j >1 x fl t/i l~1 1/~ ~ a > O cn LLI °2~ Z O d v1 c 7 c~ I I I a in Q~j ~a 3 ~N N N En x In a r .0e 0 2 to - c w fi N 61 -P a 2 (A 0 V) )7- CL Ew (D r c v x Y °i h" o 41 cr 0 :2 ri M ` QE N Y Q f 1 ~ 0 c WS E~ O7~ 1'l n~ pC Q oa'C a~i O z Q J d' c c - ` z of a O O N C 4-3 . 3~ w j~v~ 0 ~ o~ _ Q o c A o ~o N N 4 f% N 0 0 oa 0 Z 10 C M 3 :30%§ IM J 1 x c °M .gym N ~ 7i ~ y V1f1~ O ~-C Q r r p !O c 0 7 ® m " Io - O n G 3 d N O a~ Y 7 A ~ z d q U' CL a N a (P .2 Q V 07 w -00 dl (A kA LL c a a d v (J O 0 3 m o L ? Fj 1 41 4v Y O yf N o 'O o A Q c d C ar am c o S Nc uwp di ~'D O, t; I\ c Z 04 O N_ E 3 1 O ° V - c /J^/I ~ . r J , I~ ~I N N r D V W V1 N ~ yyy t y 1 P L ♦n N 0 V h z cr- o- 01 o m 0 ° a oa o a O J >1 o~ p 0 2 a) 4. 41 O ~4 L O ~ 41 .C U] O N 1 Wb to C c 41 0 i+ N Q all 3 N V7 V Io r 3~ a 2 ~ ~ a :3 4. C: a, C N N V c (13 C: C r T :0 E r _ a D D N - Y E~ W in rC: x Y Q Q 0= oil 0 2- E(/~ d?, nIU c~rc 1 - Of W c cv q N " 2 0 ao ` 0 a J YI d f U - G I Z c c C: 0 C: 00 E~E vvi M O j -A M •O 3J a 0 ov► _ a o c O o o Q 0 1 CD oa 0 0 0 rn r- --j 0 Z C M y a co r- ots x c ° N w = 1t " LO el-) °O ct ? ii~ i %A L.t J e..a co g e rA r v+ci~ a ° in j `fit 2 C,4 a n Y d ~1 6 8 to c 4-0 c a A V• 2C c- w 0 o 0 V n y m o ar m a1- N - 1" LL ^ J ^ 0 :3 v u a W 4-P > ¢ d h~ r? ° _ m J 0 m 3 u 'J J cc ap 3: Z 41 CL 0 N o A O ° -13 d C ro o~ ar to `o 10 Q w 3 L9 OG 1 a I „ _ a 1s, `sue U^' C'~' a yj 0 (a -1 0 ,j z W -j t2 C E- c 0!"L. 10 L) Erw V w z CL . s 4 x r 0 TO 'N d N D a v V) ` 1 o f~ _j 0 O N c, s J J ~ a a o a? p (n J >1 .2 0 o (A a) 41 > to 0 VI U) :z IM. 2 Z o o c cp L m o V `/l 60 Q no 3 aV? V v 410 `j o p N V Al 4 m :3 -1 c r (d 2 J c d N~, ~ 'J s ° r r 00 Z 41 E'2 -E c 41 W Go o a E~ x Y N Ln .n O-E r ° a E 1 ~n D~ ,,11 41 o vi 4, - 41 E N C-0 O z o I c to a) I J c M ° c_ E 01 ; 41 .6 J 3 J a 1~ J 0 Q 0 ~Sh • a l ~ ~ a- 8Z\ KLS `I ri k vi 4 a~ ;1, 4J r-I ai 07 tp-. 07 1 o ~T~ CQ F- ~U) b \44 0) ro 04 19 1 LL ti• z X00 x 4J 41 IQ 4J -b r.1 :j 0 ro 9 0 ~4 04 :J 04 •r♦ 4J U (0 4-) J N ' RS r-i b v 2?0-va5 QUO -H ~4 m 04 (1) 04 fd ol 93 4I M 04 (d :1 O U 0 b Ic: b U)N 3~ - 0 Pry ~ tr+ ~ u - ~ 4j M -H fo Q) M 41 04 0 to En -H 0 7 H P a O ~4 ~y (Tj 00~A ID 3 2 N rd O -P r 44 N O= r. J, 4 P a 0 04 d' ~ ~1 rt3 t1~ 4-) i U 3 M fa co -4QU (1) r ° u1 a) En N ~ N HwHH~n m a -10 J J2 ' 2 0 F A Q y 2 ~ !i ~(Y u- ?l- co fi u O 1 j 1 P, 0.. W . y ^ 1 P V) 0 o oel. Z. q • S o za c a o j o ? a~ d ~ Q ol I !L r 7 ~ ~ i ( ~ ~ ~ to ul (J ~ a Ql}rs 'C''~ `L 1, dG '~1 ~U >7 Ll r ~ N W 7 2 N a A d ~C~O r Q~ 7 ~ c9 Q i ~ $ -3 o our ou fv' rr { i O o- a 1w ►1, a \ F ° 4 2 -jj, a a . ~o 5 N o u ° ,0 ar ~ v ~N ~ O a . _ I IL q r ~ rn ~ I ~ i xa o; - rl to D Gl Q~ \ ~ P I ~t I o rr r I LIJ o to i I ?l y ri tI _o J F rj ~ as ~ ty' y 0 Q 0i u 0 S t, 00 ~ . \ ,L ~ \ T 4 O