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016-1024-40-000
D'~~~ Division PLAN APPROVAL Safety and Building Bureau of Plumbing P.O Box 7%9 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 71 OFFICE USE ONLY ~ - Plan Identification No S e~ C'e i Gallon& Per Day C yve PRIORITY PLAN REVWW ONLY Plan Review Petition For Mb4fC'-a'60n Project Name Project Location - Street No. or Legal Description t7 ~Ic County tl ❑ City ❑ Village Town of: t.~170 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. ❑ FOR. GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. l FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. IN Comments: By: James Sargent Bureau Director If Questions _[Tans Approved By: Date Approved: Contact ♦ \ ~ `.w ~ cc:w OWS ❑ DPS ❑ H&R & Rec. San. Section County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other S8 ID 6678 (9.08/83) (Plb.1 00a),(Wis Stats. S. 1:45.02) f$TAT~ Ak ,HR *Qrtd. Return Upper r "No Pdrtion,0f This Farm ~ilith~ ua sal E. was ` Any Return Correspondence P.O. BOX .R M 41 MAMON, W1 53T07 . 3'a.. 4 . Goo-am 5 DATE: 06/10/85 PROJECT: Lyons, Robert - Residence ti -4 3a(b) 6~ \7j`J SE, SE,11,30,15W Slith Plumbing & Heatin 9 l y 4' St.OCroixQ WI 1 Route 2 Glenwood City, WI 54013 PLAN ID. # 85-02987 DETACH HERE PROJECT NAivll= Lyons, Robert Residence 85-02987 PLAN ID. # This Is to acknowledge receipt of your plans and. specifications for the above-indicate prolm . Preliminary review indicates the required fee is $ Fee Received.is $ 80.00 Plan accepted for review. ❑ Underpayment - Please submit additional fee. Plans will be held fn abeyahce: JET Plans being returned. ❑ Overpayment-Refund forthcoming. . Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data o I15 completed Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) All information submitted shall be signed, dated: and sealed or El complete data relative to anfieipatu of building. stamped in accord with .Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 colxy)~ ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks . Private sewage system to ; buildings, lot lines, .well, water- ❑ Holding tank profile showing vent, .manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. -Show benchmark with permanent elevation. construction details if site Constructed. ❑ Holding tank agreement "ned by owner,and looal N. ~ Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed).., ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from , and notarized. (1 copy) county or soil boring and percolation test data on County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service r$ad (enclosed). ❑ Cross.section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s); data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 2W beyond edge Construction details aril cross section of soil at sorption of trench before side slope 4aegin.) system: ❑ Depth and type of filt. ❑ Copy of signed onsite report by county or district Staff. 1 r 1 I: y 1 Y ST. CROI X COUNTY WI S C 0 N S I N ZONING OFFICE _ 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 May 31, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box.7969 Madison, WI 53707 Dear Sir: An on site investigation for the Robert Lyons property located at the SE'k of the SEA of Section 11, T30N-R15W, Town of Glenwood, St. Croix County, revealed suitable soils at a depth of 2.75 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator mj WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location SE 1/49 SE 1/4, Sec. 11 9 T 30 N, R 15 X: W Town d9 VpWW Glenwood Street Address Lot No. , Block Subdivision Landowner's Name: Robert Lyons The application for this site is for: ® new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ssuea to you.) ]one of the applications needing a quota number. The quota number assigned to this application is 59 - 08 - 6 ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. F 1for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. (....for an application on file prior to February 1, 1980. (_]for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑ a failing conventional soil absorption system. U a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here.n I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson SiVic re County Official) Title Assistant Zoning Administrator Date May 31, 1985 DILHR-SBD-6158 (R 12/82) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING - P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Towns hip/1`~tsCJ@~~ SEA SEA S 11 T 30 N/R 15 XX)MW Glenwood St. Cuix Street Address: Subdivision: County: Landowners Name: Mailing Address: Robert Lyons R. R. 2, Glenwood City, WI 54013 I (Me), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above prem13e3.are not suited for a conventional private sewage system. If approval is granted. I agree to have the System installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for-the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the System is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX ,%afe*'an l Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284299 Permit Holder's Name: ❑ City ❑ Village - Town of: State Plan ID No.: LYONS, ROBERT P. GLENWOOD CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 016-1024-40-000 TANK INFORMATION ELEVATION DATA A9700069 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM INFORMATION TypeO CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole size-- x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: GLENWOOD 11.30.15.188B,SE,SE, 320TH STREET Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division =sari; SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O- Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. C ~ 4 / • See reverse side for instructions for completing this application State Sanitary Permit Number °2 FIIWI~l The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION F,56~7 Propert Owf er Name Property Location GOB I O _r 1/4 e 1/4,S T p ,N,R~ 41111111W) W Property Owner's Mai In Ad ress Lot Number Block Number `y 61 -..r. Zip Code Phone Number Subdivision Name or CSM Number Cit , State , ,or 9) e)y Grid©d /)"-V - c c~6 > py 151OG II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Nearest Road E) Village ❑ Public Cj~ 1 or 2 Family Dwelling - No. of bedrooms Town OF ~~e W j e Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) I 5,0 15. 1 ❑ Apartment/ Condo O 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Mote[ 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4._J9 . Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 X Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 00 2 Feet Feet a VII_ TANK Capacity FORMATION in gallons Total # of Prefab. Site Fiber- Exper. Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ~ ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber, ®o ra ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb is Signature: (N tamps) MP/IaPlo.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 1 o`z lilt Q 62ly/lio0 D / IX. COUNTY/ DEPA TMENT USE ONLY Signat r ❑ Disapproved Sar tary Permit Fee (IncludesGroundwater ate Istat ort Fee) roved s pp ❑ Owner Given Initial 41 ~Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to Counly. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS Y of 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit: issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement- Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; Q soil test data on a 115 form; and F) all sizing information. > GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i w `at MIESER 111INETE RT. 2 (Hwy. 10) MAIDEN ROCK, WI 54750 • 715-647-2311 • FAX 715-647-5181 s 5 Q;, PNM p tO S ep l-~ c r~ ti N _ z o s 1 • Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP Cy,-1,e v SEC. T N-R /,6'W ADDRESSf ST. CROIX COUNTY, WISCONSIN ~l G N u~god ~T SUBDIVISION LOT LOT SIZE PLAN VIEW n248 Distances and dimensions to meet requirements of IlHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N d v a~ x b fi~ G P ~doN~b~~ 3 dA W H° Me ~v - INDICATE WORTH ARROW DL+LtlWADV n___~~t_ _____~1 _ r . _ L i A PUMP CHAMBER Manufacturer: I-V S edU Liquid Capacity: '6 4 Pump Model: t7.5,8_ _ Pump/Siphon Manufacturer: AJy, Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Z;~5~ Alarm Manufacturer: -5'j &Alarm Switch Type: Ilk*" &8A7V Number of feet from nearest property line: Front,( X)Side, O Rear Ft-1/57 Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: g - Length:. Number of Lines:_ Area Built: Fill depth to top of pipe: /S11 Number of feet from nearest property line: Front, l('v-'l Side, O Rear, Pt . Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size. Number of pits: Diameter: Liquid depth. Bottom of seepage pit elevation: Area Built: Has either a drop box O or distri ion box O been used on any of he above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacit . Number of rings used: Elevation bottom of tank. Elevation of inlet: Number of feet from nearest pro rty line: Front, O Side, O Rea OFt. Number feet from well: Number f feet from building: DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &'HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION PA BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 El CONVENTIONAL EjALTERNATIVE State Plan I D. Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned) 9 fSo 2, ?7 NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE. Robert Lyons R. R. 2 Glenwood City, I 54013 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. SE-',, of the SEk of Section 11 T30N-R15W Town of Glenwood Name of Plumber: JMPIMPRSW No. jC,"rly Sanitary Permit Number. IGale W. Smith 5690 St- Croix 69639 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV_ TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER P OV DED: PROVIDED QJt'2t~~ YES LINO WYES LINO BEDDING: VENT DIA.: VENT MATT HIGH WATER NUMBER OF ROAD PROPERTY WELL. BUILDING: VENT TO FRESH ( ALARM FEET FROM r7 LIN I AIR INI„Er. DYES EVqo DYES LINO NEAREST DOSING CHAMBER: MANUFACTURER 71"YNGS LIQ UID CAPACITY PUMP MODEL PUMP:SIPHON MANUE ACIUREH WARNINLABEL LOCKING COVER PROVIDEDPROVIDEDENO 0aJ YES LINO YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATION/L. J NUMBER OF PHOPERT WELL BUILDING VENT TO FRESH (DIFFERENCE'BETWEEN FEET FROM LINE AIR) T f PUMP ON AND OFF) W 2 YES E N -0 ~y~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the epth of plowing j" j[j]AMF TEH IMATE HIAL AND MAHKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE E e~ <j , the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTH INO OF IDISTH PIPE SPACINI, COVFH iNSI DE UTA -PITS JLIQUID BED/TRENCH THE NCHFS MATERIAL PIT DEPTH. DIMENSIONS C,RAVEL DEPTH FILL DEPTH USTH PI PE UISTH PIPE DISTR PIIF MATERIAL NO DISTH NUMBER OF `PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER EIIEV.INLFt ELE V. END PIPES LINE , ET:~- l FEET FROM NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. YES NO SOIL COVER TEXTURE 11111111ANI NI MAHKF HS OBSERVATION WE LLS y _ DYES LINO _ZYES LINO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BE I) UE PTH OF TOPSOIL S<)DDF11 EE UEO MULCHED CENTER EDGES / r ' 5 DYES. QNO SNYES LINO YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING IGHAVILD11THBILOWPIP1 FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS } 1 ~f - 21 / /15 MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD. MATERIAL INO UISTH 1111STR. PIPE DISTRIBUTION PIPE M SERIAL & MARKING ELEV.. ELE CIA ELE-/ PIPES CIA ELEVATION AND JI F Y( 7 ) s%~ J DISTRIBUTION ! IIJJ INFORMATION HOLE SIZE HOLE SPACING GRILLED CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ~,?J r YES LINO DYES >~NO COMMENTS: PERMANENT MARKER&4 OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE` DYES LINO YES LINO NEAREST 7.2 z v L_ Sketch System on R unty file for audit. Reverse Side. SIG ,.,..-,r--" TITLE. ✓ DILHR SBD 6710 (R. 01/82) PLAN APPROVAL Safety and Btimbi gs Division ~ ~ ~ Bureau o...umbing L. _ P.0 Box 7%9 - a ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 OFFICE USE ONIY Plan Identification No. Gallons Per Day 3<D Z PRI l'Y "N REYlkWjD.__.. Plan ReWew ntor hatTl'-' Pe0110 Project Name Project Location - Street No. or Legal Description I s es SE I - 3() County ❑ City ❑ Village Town of: Cj Qv. vJoo sv` e 10DV 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. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. 3 a ~'j,) Comments: Bye James Sargent Bureau Director If Questions lans Approved By: Date Approved: Contact ♦ ( - cc: OWS ❑ DPS ❑ H&R & Rec. San. Section County ❑ Local PI ❑ Facilities Need Analysis Section ❑ L)W-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other Smith Plumbing & Heating PHONE (715) 265-4838 _ Y4 Y,;t S e- c- 730 Al Af _ GLENWOOD CITY, WISCONSIN 54013 Pei,k ~ . N' e /'a) P COR NUM" A t+ND INGS MCA c. L.C) T gPeu~~~~ WAKIMEM Or h.ou'TR F x BUILD '.s DIWj10t1 OF ONDENCE SEE CORRES P; 17~~ CY 1 ~ *4` Con, b rta-110'1(t o c o /d(.)© CIA SAP f tae, qaI i 4. ~ GhAr.,bt.r ~ 18,50219 87 .0x4'v iv gy RECEIVED JUN 10 1985 /V 10-4-z fo PLUMBING BUREAU I 1 L ♦ r ` Page - Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand G Topsoil F 1 E D " 3 ~ b . % Slope "PLUMBING 'd'ed Of Z*- 2 %2 Force Main Plowed ea"-tk z i# Aggregate From Pump Layer APPROVED DEPARTMENT OF INDUSTRY, LABOR W NUMIN LI~I~flgN%ection Of A Mound System Using E C DIVISION OF SAFETY AND BUILDINGS F 4 A Bed For The Absorption Area ,.,Y. G / D SEE CORRESPONDENCE t A_ F t . H ~r - Signed: a ~~.'Ft. License Number: I Ft. Date: J Z.2 Ft. Alternate Position 7 Ft. 8502987 Force Main W~Ft. Observation Pipe--N\ --------------------_:I r A Force Main W FA o - From Pump Distribution Bed Of z _ 2 %2N Pipe Aggregate REC VED Observation Pipe Permanent Markers JUG! 1985 PLUMBING BUREAU Plan View Of Mound Using A Bed For The Absorption Area Page , Of t Perforated Pipe Detall w End View )Per forated / End Cop) PVC Pipe Ja...Holes Located On Bottom, p Are Equally Spaced PVC Force Main \ i * From Pump PVC / Manifold Pipe Oistnbutio Alternate Position of n Pipe Force Main From Pump Lost Hole Should Be Next To End Cop / End Cap - Distribution Pipe Layout P ' • a R , S 950 2 9 8 7 x Y Signed: Jo Hole Diameter Inch II Lateral Inch(es) License Nu ber: c-ZZ l.~ Manifold s Inches Date: Force Main Inches PL~OM~BING RECEIVED A P OP"' R %C )p A/ EEO DEPARTMENT OF INDUSTRY, LA' OR W) HUMAN RELATIONS AN 10 1985 DIVISION OF SAFETY AND BUILDINGS PLUMBING BUREAU SEE CORRESPONDENCE ' OLUMBING F PUMP CHAMBER CK055 SECTION AND SPECIFI l ROVED OR AND HiiNiAti " -V DEPARTMENT,OF LAB AND BUILDINGS IZHl11 - _EIJT CAP 4"C.1. VENT PIPE WFA1 H1_K PROOF JUMCTIOIJ BOX MAMHOLE COVER 25' F R C M D(,CR. WIMDOW OR F RLSH 12"MIU. Alit IAITAKE GRADE - COJDUIT 4"'MIIJI . B" M I IJ. - LET PROVIDE I --1~ W AIRTIGHT SEAL I I I I APPKG'JEIJ JGINT A I III APPROVED -IC," W/ C. i. PIPE. I III W/C.T. PIPE. EICTENDIAIG 3' _ I II ALARM EXTEkIDIw(' OMT0 SOLID %1,,IL. I I I ONTO SOLID 5; B I t I I OIJ C I I - PUMP 7-- OFF 0298 . C.OAICRETE BLOCK- RECEIVED RISER EXIT PERMITTED GIJL'-1 IF 1AUK MAMUFACTURE-K HAS SUCH APPROVAL JUN 10 1985 ,SP E C. I F 1 GAT i ON S PLUMBING BUREAI PTIC ANC) )SE TANKS MAAIUFACTURE K: 1JUMBEk CIF" DOSES: PER DAy TAIUK .,IIE GALLUMS DOSE VOLUME: _t --CALLOW, ALARM MAMLIFACTUKGK: _-s~.'~l•_ cl~'~ rrtl--_.__--_ CAPACITIES: A=._3_J- ►JCHES OR,3LVk_.-_ GAL! (I:, MOULL 1JUMBEK: r 11~~ B 4X UJCALS OK Zl?_ LALL.01.I yy~ OS&GALLM 5WITCH TtiVE: OR Ip - - I'LIMI' MMIiIf At I LIKI, R: ~Y'CG • U= - IAICHES OR - .LCD- - - - - MvI-E L MIJMBE R'. _ MO TL: I'LIMI' AND ALARM ARE. TO BE WII(.H V- jI,c:Me t~c•..~ ~ le4 In15TALL.ED ON SEPARATE f_IRCUIIS ~~r_ ro PUMP U1'3LHAKL,L KA-1 L I'M3(.p ! PRAGzJN ~y VERTICAL. Di Ftcl<LA1CE bE_-I WLE.N F'UMI' f)IF An1U DISI-kIBUTIGIJ F'IV'E.. FE_E_-I. + MIU MOM. IJC-I WORK SUPPLY PKL`„ukE . . . . . . . . . L FEET t i'EE f CAF F0RCE MAIN k 2-10- I KIC1101,1 FACTI-W.. ±S FEE I- Afp TOTAL. UJIJAMIL HLAD = - FEE1 ` r t+1t hIS+.:~:. F !AUK: L.EOU4S W . ~ IJi~41Q ~C~{µ R fiG k4w,!! l + 4 Won HYDR-D-MRTIC SECTION 100 a DIMENSIONAL DRAWINGS PUMPS & PERFORMANCE DATA MODEL: 6SP33 SUBMERSIBLE SUMP PUMP -MAX. SOLIDS s/s" SPHERE -1750 RPM TOTAL Lit. No. 113.5 348,- HEAD N T 3/,o HP MOTOR 24 22 y 4 20 C~9OCgA 18 gCi- is 14 12 10 8 6 FULL LOAD 4 AMPS AT 115 V. 6.5 2 0 10 20 30 40 50 60 U.S. GALLONS PER MINUTE 319 MODEL: OSP33 8 5 0 2 9 8 14 4 0 if 7 0 43/8 O Q 51/4 91/4 O 4 0 11/4 STD. 2s1/lffCiEIVE.U PIPE THD. ® 43/8 utl 101985 PLUMPING' 13UPEAU NOTE: CASTING DIM. MAY VARY ± 1/8 ~~°^S'^ APPLICATION FOR SANITARY PERMIT COUNTY ~d ~rDILHR - DEF~RRTmEnTbF (PLB 67) UNIFORM SANITARY PERMIT # - InbuSTRV,LRB°R&HUMRn RELRT1bnS /?4 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS / n Cc>' PROPERTY LOCATION CITY: 5 11 E 1/4, S D, N, R/ 5 (or) W V OWN OF: G L7I ")a dI LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME T ROAD, LAKE OR LANDMARK STATE PLAN I.D.-NUMBER =C0 day 7 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy g 5 0 2 7 ❑ Alternate System ❑ Reconnection ❑ Petition for Modification THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. e Bed ❑ Seepage Trench ❑ Seepage Pit El Holding Ta ❑ System- n- ❑ In-Ground Pressure ❑ Vault Privy Ivy ❑ Existing, For Which A Prevlo rmit Is On File, Permit # issued ❑ An Existing System That Has Been Ins nd Is C s ar As Soil Conditions. Total Prefab. Site Steel Fiberglass Plastic Gallons Tanks Crete Constructed Septic Tank Capacity Lift Pump Ta on Chamber Holdi ank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Cr~.s+b+srclj~vvl ~j Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ITO .42,1' 1 'Ale -12 6 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatur PRSW No.: Phone Number: Plumber's Address: Name of Designer: RR G e I e v, u, cod lv ► ~'iJG r r--r COUNTY/DEPARTMENT USE ONLY Signature f Issuing Agent: M F d Date: El Disapproved ❑ Owner Given Initial 4,04', 1 4A &h ` Approved Adverse Determination Reason for Disapproval: RECEIVED juN-i 01985 Alternate course(s) of Action Available: PLUMBING BUREAU DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 1 ' r INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal s"tem. 31* 1360 TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. DEPARTM,JENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, ^ DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO. SUBDIVISION NAME: T30 N/R41 (or) WI COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: f 7o*3 r, !tee 11 61emwood C+ T • J-~[ &J, t Icto 1' USE DATES OBS ATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DE RIPTIONS: P R ATION TESTS: Residence 9 New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: MIS TEM-IN-FILLHOLDING TANK: RECOMMENDED SYST (optional) ®U ❑U ❑S ~UlS ❑Uau~'I If Percolation Tests are NOT required DESIGN RATE: If an portion of the tested area is in the under s.H63.09(5)(b), indicate: I I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- d~ 7 a o iI n CIA' O B-.3 4. q'i y Alone 01 715 ',d Lsd 1, 33 B- B- ~r W S B- @' r o C lfc T~ ~~i) S C ,e0 00 0'f er v e ~d PERCOLATION TESTS TEST DEPTH" WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH P AM U l /l P- i' P- 7 J V*( Q P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION Q3 Al: r l rrits. 9 l 3 t •r r, # I C'Irt_~, iri ~ 3 , ~ i -7 4-4 INSTRUCTIONS FOR COMPLETING; FORM 115 - SRD - 6395 To be a comniete and accurate soil test, your rel)ort must in' Jude; 1. Complete I- = I description, 2_ The,use must Clearly indicate 4,ole is iw 4sidence or cornmer6al Ku ject, 3. MAXIMUfi1 ..Atber of bedrooms or commer use planned; 4. Is this a ncement system; 5. Compl-t- ity rating boxes. A SIT; ''FABLE FOR A HOLDING TANK ONLY_.IF ALL OTHER w ARE RULED OUT BAST D' -JIL CONDITIONS; 6. PLEASE u 3reviations shown here for . sting profile descriptions and completing the plot plan; 7, 'AKE A LEGIBLE diagram ~urately IOCatir~g your test locations. Drawing to scale is preferred. A ate s"el rimy b'6 rise(:] if _ ` . e sure your h, hmark and rical elevation reference point are clearly shoi..-- -rmanent; 0. rlete all al late box( is to dates, names, addresses, flood-.plain data, , s t exemp- _ if approl: 1f3. .forma : ch as flood anj does not apply, place e box„ 1 " the fc • place your current ~d your certification nr. iegib. a and distribute ;,e L ALL SOIL TESTS ,T BE I t,VITH THE ',.L AUT1' :CITY WITHIN 30 D 1 ' COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols Stone (over 10") BR Bedrock Cobble (3 - 10") SS Sandstone Gravel (under 3") LS - Limestone Sand HGW - Nigh Ground water cs Coarse Sand Pefc Percolation Rate g_-r A rated s..._ ;url Sand W - W fs S ,td Bldg Boil( Is L .<.-ny Sand > "s) I dy Loam < - Bn siI - Loarn BI si Cry cl Learn Y 'vv sci - y Clay Loam R - sicl Clay Loam mot -1.. Sc - Clay _ w/ _ sic Clay fff fia nt l_ U j c cc rse l T\ pt mm d u r ui P - g3 4 HWL - Nigh water level, ' Six general soil textures surface vt rer foi liquid v iste disposal - BM -Beach IV VRP - Vertic , i ~.~E,;e Point v N r S s CD 30 00 v w cnwow (~nCDM z ; aE; oa`Da,c,of - n a o aoo w Oo_w o T 09 w %CDSl<~ r n O <D CD 0O o3a o-.~ow C w O I :E 0 CD to M O 3°c Oc3oao Zo v k o wwcn, \ c o~ o-oa w ai - coo v v o to - to cr c Dc 0 CD w 0 0 - w n o O m " C ? O M M O C w n w O •-►aQO to =wt v=r 00 n Z D N~N ~0~~~~ o Z or w w o ID (4m ~CDMCD D-1 D O a CD n N RI cr cn CD m ca ~ a o to N CL aco~of C 171 Iwo Nww--i m m5 ? 0 CD 3 c Zr o °Lm in C1 v cr w► w m O w O CDCD (D O a N 0 N ~ N,r 7 (~D "m n N W ~30- cQ0c~= ft1 ao ~.v aN 0 aocCD cr w~a3 r Q C N 1. may. to. 1 ' 1 (n O G) fO 7 0 ' C) N s a c::. c. 0 co CL --4 CD S CD o a =r m' o o a c 3 O O 3 .M v 3 F Cl- o O CMD 50. 0 n! 0 RX. ST. CROIX COUNTY CERTIFIED SURVEY MAP NUMBER , RECORDED IN VOLUME OF CERTIFIED SURVEY MAPS ON PAGE LOCATED IN THE SOUTHEAST 4 OF THE SOUTHEAST 1 OF SECTION 11, T-30-N R-15-W MAP BEARINGS ARE REFERENCED TO THE PREPARED FOR: Leo Lyons, R.R. 2, GLENWOOD CITY, WI. 54763 EAST LINE OF THE PREPARED BY: Lee Villeneuve S.E. ~ OF SECTION 11 T-30-N R.R. 6, Box 150 R-15-W. AsSMAEDSNdINN = i6R% , Menomonie, wi. 54751 50 O 25 5d L E G E N D EAST 4 CORNER OF SECTION 11, T-30-N P.O.B. = POINT OF BEGINNING R-15-W• 12" X 24" IRON PIPE SET Q = 11" X24" IRON PIPE SET, WEIGHING AT FOUND, BENT AXEL SHAFT 1.70 POUNDS PER LINEAL FOOT 3 v= c~ z U N P L A T T E D L A N D N 0 I 0 M . Lo 0 } 31 33' _ Z • L S-89027'//'~-E 259.93' 1074. 238.19 2 I ~ W N , ui LOT I 48,344.30 SQUARE FEET = 1.11 ACRES a W o U N P Z A T T E D INCLUDING STREET RIGHT OF WAY N W Z Z ~ J 43,570.40 SQUARE FEET = 1.00ACRES I- N EXCLUDING STREET RIGHT OF WAY (n L A N Dom'' lu o°fi r I W too W, ~ N 1- tio~, ~ i '~~q;~ti&ny •a 0 -o N lop EUV ' 00 /49.00 20.87' $u+~~ - WEST /69.87 ~ i TT NP~LATTED LAND 33I +aags T jo Z 95"ed ®,~~S1f~eRff~~ S • bt n$ O4►~ •uTsuoosTM 1.9+unoo xtoao 'q-S 'SIM r' ' 'iNOV49S .a ~86o# SM aenauaTTiA •d 897 hnf 3011M s~ 331 a ! • - v 9UMS agq. 2uTddeui pie 2urPTetp '2rzTS9nans UT aoueuTpaO uoTSTATp-qng RQunoo xToaO •qg aqj. 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SuoT'e 'glnoS 30 2uTa•eaq paumss•e uv uo aouaqq. , 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/contractgg,("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 Location of Property 14 S~ 14, Section, TN - R W Township Mailing Address 01 .01 A Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable?_ Yes No Is this property being developed for resale (spec house) ? Yes No Volume 71Y and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3, Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ce&t i6 y that aP.e .6tatement6 on tki a {ohm cute tAue to the best o j my (oun ) k.now2edge; that I (we) am (are) the owner. (b) o A the pnopeAty des ch ibed in .th,i6 info, mation ~oAm, by virtue oA a wa4Aanty deed necotded in the 046i.ce of the rn,,,nf„ 11oniAfoh n,! Do_o.( A as Document No. 1129 t~ ~ ; ; and that 1 (we) y STC - 105 r y ti SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County d a> OWNER/~~~~ ROUTE/B-@3t=**ffftR Fire Number CITY/STATE ZIP PROPERTY LOCATION: 5z--- k, s~5 k, Section, T _,,'?V N, R,/-~r-W, Town ofz St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new stems 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), 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. o E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- •u ment of Natural Resources. Certification form must be completed and returned to.the St. Croix County Zoning 0ffi,c within 30 days of the three year expiration date. SIGNED DATE 3/,FS7 St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA y STATE BAR, OF WISCONSIN FORM 2-1982 wry 718p.AGE417 MGIsrERs Of FiC ° ST. CreeAlx CO., W IS, ~r r x is 15th E r+~ ' . ,.Husband ,day ; August A•D. ) r85 .ce Lyons .Beat. . ri. Leo Ly..o.ns and ......and Wife Ut 2:00 P M James O'Connell conveys and warrants to R N 1 Kathleen H. Walsh Robert..P....LY.QI?S.~-.A-.S n le...Person deputy . i RETURN TO V -R T '.+I UYFTC7 P. 0. BOY 9 Glenwood City X41 54013 St. - ........:....:....................County, the following described real estate in Croix State of Wisconsin: Tax Parcel No: Part of the Southeast One Quarter (SEA) of the Southeast One Quarter (SE14) of Section Eleven (11), Township Thirty (30) North, Range Fifteen (15) West, Town of Glenwood, St. Croix County, Wisconsin, described as follows: Commencing at the East k corner of Section Eleven (11), Township Thirty'(30) North, Range Fifteen (15) West, Town of Glenwood, St. Croix County, Wisconsin; Thence on an assumed bearing.of South, along the East line of the Southeast One Quarter (SEk) of said Section Eleven (11), a distance of 1328.81 feet to the point of beginning of the parcel herein described; Thence continuing South, along said East line 223.99 feet; Thence West, 169.87 feet to an iron pipe; Thence North 210 41' 03" West, 243.71 feet to an iron pipe; Thence South 890 27' 11" East, 259.92 feet to the point of beginning. Subject to easements and rights of way of record. F This LS..J!Q!........ homestead property. Xk) (is not) Exception to warranties: . day of .....August.................................., 19.8.5... Hated this ....15th Elate of Wbe6nstn ounty of St. Croix ....-(SEAL) ..................................................(SEAL) I hereby•certifyI"-thys mstrvrrtertt is a kA t u,: and correct copy of ;he docurne:it on fife * L 0 LYONS ......j./....................... d n: gar by me. I, J (SEAL) ..................(SEAL) .(IJ... 85 . BEATRICE LYONS „ James O'Connell mes O' Connell AUTAE ION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. P6 !k County. 1 t