HomeMy WebLinkAbout024-1015-90-100
STC - 10 4
AS BUILT SANITARY SYSTEM REPOR
OWNER G i
STJCRpIX
f
ADDRESS__ ~orviN~o~FicE
0 j . Nt
SUBDIVISION--/ CSt4 LOT
SECTION
T- N-R= Town o fie y
ST..CROIX COUNTY-, WISCONSIN
PLAN VIEW.
SHOW EVERYTHING W H 100 FEET OF _SYSTEM
to
jal~
Apt.
•
N1
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK • byLC~ ~D f ~o~i
BM
ALTERNATE y~L~n fD~. t :.1
51 ,111:.
SEPTIC TANK./ PUMP CHAMBER p G µ
. ~ ANK:IE.ORMATION
Manufacturer: QC~s
Liquid ,~Capacit~, /Da
- ;
Setback-#rom
oel 1 vrr
House
Othe
Pump:- urbr- --fie Model: 9/
Float s
eperation Gallons A. ~7
cycle . -77
3s t?
Alarm Location
SOIL ABSORPTION SYSTEM
Width: - /
- Length Number.of trenches
Distance & Direction to nearest prop. line:
;r
Setback .from: well: House
_ 4 $ Other ' - .
ELEVATIONS
Building Sewer ST Inlet: /GY> aU ST outlet: S' 8 3
PC inlet PC bottom Q , -of Pump Off
% o ~'ccd4r
Header/Manifold loo, (,3 Bottom of system /ao, oc)
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR: ~d
3/93:jt
Wir:onsin Department of Commerce PRIVATE SEWAGE SYSTEM
SafevIand l3uildings Division CountY
INSPECTION REPORT S~ Cvoi
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: L ❑ City ❑ Village ~ Town of: State Plan ID No.:
G, G SG ~ l3 C'I L Gti
CST BM Elev.: f Insp. BM Elev.: + BM Description`: Parcel Tax No.:
00
TANK INFORMATION ELEVATION DATA p
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
epti Bench r %2 /D6%L /GO
72
Aeration Bldg. Sewer
Holding 6 Inlet
TANK SETBACK INFORMATION (t Outlet C11•
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet 7
Air Intake
e t -V t NA Dt Bottom 476 .fig f
&ZL NA Header / Man.
Aeration NA Dist. Pipe l~0• (0 3
Holdin Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer 67gvGl Demand o
Model Number 7jO GPM
TDH lift3 Friction 17 System TDH7,(ta~ Ft
Forcemain Length Dia. Fi J ` Dist. To Well
SOIL ABSORPTION SYSTEM
BED Width I Length ' ` t No. Of Trenches PIT No. Of Pits Inside Dia. Liquid D th
DIMENSIONS K DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM HING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Mod ber:
System: &0 teV 1 S
DISTRIBUTION SYSTEM
Header / M fold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
t+ t~ a g rI
Length t
Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over L 4 Depth Over xx Depth Of f xx Seeded/ Sodded xx Mulched
Bed /Trench Center 1 O Bed /Trench Edges Topsoil ~Z Yes ❑ No es ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) 172.S' Gf7
Am. am - r3 a .,r- 5 zf; "wale f /
z-) T-0Kk- eve-Le. iA-S46l4 a S Gl.alcli ~2s `{~~~93 h~✓c✓ v~c~`~s
P ~
Plan revision requlrld? ❑ Yes o S
Use other side for additional infor atl n.
SBD-6710 (R.3/97) Date I ctor' i ature
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
f
I
SANITARY PERMIT APPLICATION 201eE. Wand ashington AD vision
*&cvnsin P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size. ST cjQo /n
• See reverse side for instructions for completing this application State Sanitary Permit Number
Zg~tgS~
The information you provide may be used by other government a ncy programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. S State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION s4' 023
Property Owner Name Property Location
1,f1/4 n/~j 1/4, S T , N, R J 7 \(or)(~U)
Property wn r Mailin Address Lot Number Block Number
171 '7 a~ L
City, State , f Zi Code Phone Numpy~r Subdivision Name or CSM Number
/ICJ p ( ) I (J/'t
II. TYPE BUILDING: (check one) ❑ State Owned City earest Road
Public 1 or 2 Family Dwelling - No. of bedrooms T Villa oa e
Town OF c."/ ~ G' 011!?</ ~
D
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 9. a9 ! 7! p/_~7
1 ❑ Apartment/ Condo oC.V
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. 5j New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
------System ___System_____________TankOnly Existing System -
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 L] 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 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
vo 5ad /v u- /6 Feet %l?Z - (-Feet
VII. TANK Capacity Total # of Prefab. Site -
App
INFORMATION in g Gallons Tanks Manufacturerrs Name Concrete co"- steel Fiberglass- Plastic Exper
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank 601o Oco ~-i 14,7 (3
❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber !ice 61 " 10 1 ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' Name: (Print) Plumbe ' Signature: (No mps) rIXL~SW.~ Business Phone Number:
t S - 7 7Z.
Plumber's c dress Stree
t, City, State, Zi Code): nn 4_4
11101
7!2 f~I KJ lc~ 3 b z-
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved anitary Permit Fee (includes Groundwater ate Issued Issuing Agent//[[rrignature (No Stamps)
~O Surcharge Pee) ! ~f}
(Approved ❑ Owner Given Initial a ~ .
Adverse Determination fro
X. CONDITIONS OF APPROVAL / REASONS OR DISAPPROVAL:
SBD-6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, owner, Plumber -
INSTRUCTIONS '
1- A sanitary permit is valid for two (2) years.
2_ Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in-ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to 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, 668-266-3151.
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.
111. 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 81/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
SAFETY & BUILDINGS DIVISION
N 201 E. Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
Department of Commerce Tommy G. Thompson, Governor
William J. McCoshen, Secretary
August 27, 1997
ULBRICHT & ASSOCIATES
ROBERT ULBRICHT
655 O'NEILL ROAD
HUDSON WI 54016
RE: PLAN S97-02349 FEE RECEIVED: 180.00
SCHULTE, WAYNE
NW, NW, 9, 28,17W
TOWN OF PLEASANT VALLEY COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Si erely,
James Quinlan
Plan Reviewer
Section of Private Sewage
(608) 266-3937
5757R/ 1
SBD-5524 (R.07/96)
8 9 7 - 0 2 3 4 9
UIBRICHT & ASSOCIATES CO.
655 O'Neil Road - Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
PROJECT INDEX 2 5
DILHR Plan I.D. # S97-02349 Date Aug. 29, 1997
Owner Wayne Schulte Phone 715-796-5523
Address 471 165th. St. Hammond, Wis. 54015 Part of Tax Parcel (40 acres)
-
024-1015-90.
Legal Description Proposed 2 acre CSM Lot 1. NW, NW, S9, T28N, R17W.
Town of Pleasant Valley County St. Croix
C.S.T. Robert Ulbricht CSTM2482 Installer
Local Authority/ Supervision
St. Croix County Zoning Dept.
PROJECT DESCRIPTION
New construction, for a proposed 2-3 bedroom sized home.
Estimated daily wasteflow - 300 to :450 gals.
Soils are slowly permiable (.3 GPD/Ft 2) and seasonally
saturated at 32 inches. A long narrow trench-type mound system
using 12" sand fill is proposed.
It is strongly recommended that the installer provide a
Zabel fliter in the septic tank to ensure the highest degree of
pretreatment of the effluent to prolong the life of the trench
system and mound.
4 AL
``~"~~IIg11110/Ipfbgj4ry
P 'FA* M E 11"
to A KIJ
DEPARTMENT OF COMMERCE C01VS4~~
/DkISION OF SAFETY AND "ILDINGS
ROBERT VL y
ULBRICHT t
SEE CORRESPONDENCE D1160
P tHUDSON, WI z
Pg . l PLOT PLAN VIEWS
Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS
Pg.3 PIPE LATERAL LAYOUT
Pg.4 DOSING CHAMBER CROSS SECTION
Pg.5 PUMP PERFORMANCE SPECS
CTy,~.
0 0
_Aj
Lo T` oo~w-tom
7, Y, t
o p o5~~
° 1be area cS it. below the ~on~iope edge of the
s`~ ' ~ ~~v y° Soil Ipso 0o ~
t4 01 nadis rbed,
iT6
kilo ~y
f33
Agsociales p 1
Ulb~icht$eWa9e~0~sultante
prlvateNeil Rd fJ~` I I
j4uds son,"S 540" I /
Hu ~~p rr~ T• ~ I
I I
~ovG,ef~ ~ 8~0 ,
1
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U.u/ i~aiE'iy
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-rota of
w ~c p~~ ~ ~ f 9. ~a
ivooD -F~ce poS1'-~
I10 UtPJ- o F (~Z I7ITEPA (S ~0 d.000
• TOP 'O l v I,NT.EPA~5
Td ~ Of R vc k
sysrEII-A
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6IFUATI °,V
JI
Page 2. 0f s
Straw, Marsh Nay, Or
Synthetic Covering
/Distribution Pipe
Medium Sand -
H -~G
Topsoil
3 3 i E 1-D
sa v~ i FDR M
8 % Slope Trench Of 2t'- 21 Force Main Plowed
Layer
Aggregate
Undisturbed D 1-0 Ft.
Soil E 1-3 Ft.
Cross Section Of A Mound System Using F -92- Ft.
Trenches For The Absorption Area G /•O Ft.
A Ft. H Ft.
B Ft.
K Ft.
L Ft.
J 7 Ft.
Alternate Position of Force Main I I Co Ft.
W z7 Ft.
L
J i
B s~+- K
W Observation
S Pipes
Distribution Trwnrh Of
- 7
J p t
or
~P/,q« /4s r
Perforated Pipe Detail
up, l*6 r Foe V/11416
VAC u'i r f'o,v 0
End Vie-
PVC End Cop) PVC Pipe
1.
o.
Holes Located On Bollom,
Are Equally Spaced
P
~1 PVC Force Main
P
Distribution
Pipe
Lost Hole Should Be
Next To End Cop
End Cop Dislribulion Pipe Layout P
Ft.
'I
X Inches
d~ b • ~ O~"'S Y ~ Inches
N-f 7- lv Hole Diameter Inch
Lateral Inch(es)
Manifold Inches
Force Main Z Inches
# of, holes/pipe ! Z- O
Invert Elevation of Laterals Ft.
• -D15TRi6V r-10+u 3)t5cH^ Q&E- RATE FOR E-AC R `
Lf1T E R A L 1" A r- O T i S 2-7
Q
~MiAI _
PUMP CHAMBER CROSS SECTION ' i lD SPECIFICATION' PiJE of S
-VEMT CAP
4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIM&
JUNCTION BOX MAMHOLE COVER
25' FROM DOOR, 41~1/(A11N~f IA13EI
WINDOW OR FRESH 12"MID.
AIR INTAKE
1/1 D it GRADE I 4" MIN.
I
IB" MIN.
COIJDUIT--
r
~ X11
Cl'~, p PROVIDE
IIJLET AIRTIGHT SEAL I III
E I I I APPROVED JOINTS
y,o
APPROVED JOINT A IN ~rIK ,A I III W/C.I. PIPE
w/C.T. PIPE ~V I I I I ALARM EXTENDING 3'
EXTENDING 3' D~ ONTO SOLID SOIL
OIJTO SOLID SOIL B A/ ' \ I II
ON
1q1° C
ELEV, FT. PUMP OFF V'SE 3
i ' ~10,PE' eF
t ~p
'IA~K Wp) 6 I BLOCK
cc /c v!I ( i o d
RIStR EXIT PERMITTED OUL.9 IF YANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E 5PEGIIFI'CAGT, IOus
-3
DOSE GvEEII'S YJ~CJG1.~iT C v WMBER OF DOSES: PER DAH
TAIJKS MANUFACTURER: o
C'S C7 LI GALLOMS DOSE VOLUME ~i ( 5
TA►JK SIZE : n
LE1J~[, f~~,M INCLUDIAIG BACKFLOW: - GALLONS
ALARM MANUFACTURER:
MODEL NUMBER* CAPACITIES: A = I q . 0 INCHES OR 3 GALLONS
SWITCH TYPE: 1 ~E-RCy R_J f` o),vr B = ~Z~INCHES OR GALLONS
PUMP MANUFACTURER: C = INCHES OR I S~ GALLOAIS
MODEL DUMBER: /Z D =(INCHES OR 3 03 GALLONS
SWITCH T9PE:Pt95y(3Adc Mrz R` Fl OAT NOTE: PUMP AUD ALARM ARE TO BE
INSTALLED ON SEPARATE CIRCUITS
MINIMUM DISCHARGE RATE 3~ GPM S l S
VERTICAL DIFFERENCE BETWEEN PUMP OFF AUD DISTRIBUTION PIPE.. 51 FEET A!-
2.5 FEET EAG(A,
+ MIUIMUM NETWORK SUPPLY PRES LIKE r
+ ~ FEET OF FORCE MAIN X ,"W FYoFtFRICTIOU FACYOR.. SZ FEET ~'Urf S 2~• ISM
TOTAL DYNAMIC. HEAD = 72 FEET
R 0VAIP 3~
INTERNAL DIMENSIONS OF TAIJK: LENGTH ;WIDTH ;LIQUID DE-
11 7
Coulds
:submersible
Effluent Pump
- EP04
3871 EP05
f APPLICATIONS ` • Fasteners!66 fie. • Fully submerged in high ■ Motor Housing iron R-
Specificail designed for the stainlesssteei ~ grade turpin a oil for for efficient heat: ,
Specifically • Ca ble 4 .i6 lubrication a id efficient strength, and tld
following uses: dry With OittCla heat trans fer■ Motor Cover Alas'"• Effluent systems
compon M~ tic cover with i In e
• Homes available fornutomati 'and -
Mntor' and float switch a ent
• Farms anual operalw,N womatic points. ~
Heavy-duty.sump EP ~ i i odeis 1W4fda`M nkat
~,Water'fransfer ~ 1 n ' r1w Switch a sseii bled and ■ Power Cable `duty
• Dewat&Md i sutama 'reset MOO +ctoryrated oil and Wa{ tai 4
zr ■ Bearings: Up ewer
EPp'a~ _
r 1 TURES.'Y duty ball bT
SPECIFICATIONS h
;
construction w77
Pump, EPttaA bump ' Impel er:,Thelmo
g UN, A.
Solids fid
d1ing.capability a s j t Semj-oaet► ~eSign AGENCY LISTiNtt,
a/4■ maximum: •7 Potiier° svithrpump~ut va6 0S49 F •Capacfties p t55GPM. stanch riiechanical'sei pro CaNd~an SW'ftrd i( dc iadl0k,
Total-h` c!6Opoto 2 `f t, wittfth' i s r r
~'005 Impel er Thermo- CSA listed model rthr~bers
• Disch"a'r a sfiet~lW NPT.- P1000 c plc encioa<+d dei
~rmangn for
Mechani seal: caibdn= leng h,+1 pe~rf rce end in "F" or "AC"
rotary/ceramic-stationary, three
p plu and BUNA-N elastomers. (standard rrEP05): t ■;Casing:and base: Rugged Y
Temperature: thermoplastic" Design provides
1040F (400C) continuous superior strength and ° . ;
140°F (60°C) intermittent corrosion resistance.
• Fasteners: 300 series MMRSI~ FM
stainless steel. "~jo
• Capable of running
dry without damage to s 30
components. - -~r
Pump: EP05 e,.'.,
Solids handling capability: 2a ~f
3/"maximum.
• Capacities: up to 60 GPM. 20
• Total heads: up to 31 feet.' s
• Discharge'size:1IN NPT. s -
• Mechanical seal: carbon- y a "
rotary/ceramic-stationary, a 4
BUNA-N elastomers.'
• Temperature: 3 10 h~
1040F (400C) continuous
140°F (60°0) intermittent. ,2
xF~ Q
7F
0 1' 2Q < 30 ' 40 CiPM~' 4
8: 10z ~anl
Fit cApc
1995
~ ,qulde Pumps Inc. ~.uF`~i r• u
71'2 -S
HOLDING TANK SERVICING CONTRACT
.oniracl Date
1-98 This contract is made between the
folding Tank Owner(s) Name(s) and I Pumper's Name
~~1..~ L/
Ne acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1. The owner agrees to file a copy ofthis contract with the local governmental unit hereinafter called the "municipality", which has
signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and
t
with the County of S ` Gr t~
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 all-weather 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 municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis.
Adm. Code, 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 volumes 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 the municipality
and the County named above within ten (10) business days from the date of change to this service contract.
Owner(s) Name(s) ((Print) I Owner's Signature(s) Al 0~
y
I , ,~2~'~ ~ Subscribed and sworn to before me on this date:
I ~ qA.~t IIIII/7~~~i
aL
Pumper's Name (Print) I Pumper's Signature ♦ . • to V_ ubl c
My commission expires. : Z s
Pumper's Registration Numbe
177 9
SBD-7574 (N. 11/85) This instrument was drafted by the State of Wisconsin Department '''''~~~'~~~~,I~ i~♦♦♦♦♦`
of Industry, Labor and Human Relations, Bureau of Plumbing.
Document xutriber/Plan I.D. No. HOLDING TANK AGREEMENT
This agreement is made between the government
unit and holding tank owners .
Name and Return Address
Parcel identifier number (PIN) Agreement Date
Governmental Unit Holding Tank Owner(s)
We acknowledge that application is being made for the installation of (a) holding tank(s) on the
following property: (Provide legal land description. Use reverse side if additional space is needed)
or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage.
Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm.
Code, or Ch. 145, Stats.
As an inducement to the 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. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the
holding tank properly serviced in response to orders issued by the governmental unit to prevent or abate a human health hazard as described in a.
254.59, Stats., the governmental unit 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.
66.60, Stats.
2. The owner agrees, pursuant to a. ILHR 83.18 (10), Wis. Adm. Code, to have a water meter installed in a new building or new structure. The water
meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation complying with State regulations
and manufacturers specifications. The owner agrees to be finally responsible for the purchase, installation, maintenance, and repair of the water
meter, and agrees to allow the governmental unit to enter the above described property on a regular basis to read and/or inspect the water meter.
3. Owner agrees to pay all charges and cost incurred by the governmental unit for inspection, pumping, hauling, 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
4or the abatement of a human health hazard, and the tax Shall be collected as provided by law.
4. The owner, except as provided by s. 146.20 (3) (d), Stats., 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 or the owner's registration 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 contract.
5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the governmental unit and the county
on a semiannual basis a report in accordance with a. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of
registration under s. 146.20 (3) (d), Stats., the owner shall submit the report to the governmental unit and the county. The governmental unit or
county may enter upon the property to investigate the condition of the holding tank when pumping reports and meter r` may indicate that the
holding tank is not being properly maintained. VA 10 6. This agreement will remain in effect only until the governmental unit responsible for the regulation of privy
Tivl; V(9
ha~+~pPiifies that the
property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 8~ e. •In edition, this
agreement may be canceled by executing and recording said certification with refetMeAto this agreement ~n such manner whicli.v l}~ermit the
existence of the certification to be determined by reference to the property. = e
7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The ow&-r dl}a13ts e. • mnent to the
01
register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit f ey f th ment to be
determined by reference to the property where the holding tank is installed. ~~~,If • • N~'
31 bed and swom to a on this date:
11 lease Print Subscri
Owner(s) Name(s) - Please Print Governmental Unit Offci
F r IQ4~
Notarized Owner(s) Signature(s) dove mental Unit Official Tide - Please Print Notary Public
C A h N s.0A/ C4 _ ` t
4 Govern tat Official Si ure My cornfission a pires
Drafted by Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (lxm)l.
SAFETY & BUILDINGS DIVISION
201 E. Washington Avenue
P.O. Box 7969
*Ionsin scMadison, Wisconsin 53707
Department of Commerce Tommy G. Thompson, Governor
William J. McCoshen, Secretary
August 27, 1997
ULBRICHT & ASSOCIATES
ROBERT ULBRICHT
655 O'NEILL ROAD
HUDSON WI 54016
RE: PLAN S97-02349 FEE RECEIVED: 180.00
SCHULTE, WAYNE
NW, NW, 9, 28,17W
TOWN OF PLEASANT VALLEY COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
i
i
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Si rely,
'James Quinlan
Plan Reviewer
Section of Private Sewage
(608) 266-3937
5757R/ 1
SBD-5524 (R.07/96)
Wisconsin Department of Industry, SOIL AND SITE EVALUATION :3
-Labor and Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must County
Include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # t72 y p
APPLICANT INFORMATION - Please print all Information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
4 v/AViva se4AZ -Ie_ Govt. Lot 41kl 114 NA11/4,s 9 T1,9 N,R 117 E (or)o
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
41-71 /6 S tsp. 57T- - / &H p&r,Vn1,-'6--
Cl State Zip Code Phone Number
Nearest Road
0IVP $~(d IS ( 713y ) 7f6 • sSSa3 El city 11 Village Town 0. /fw I:z
E New Construction Use: Ml esidential / Number of bedrooms 3 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow y40 gpd 2 Recommended design loading rate bed, gpdffl2 • trench, gpd/fi2
Absorption area required ~~bed, tt2 37 trench, tt2 Maximum design loading rate ~ bed, gpd/ft2 _*3 trench, gpd/ft2
Recommended Infiltration surface elevation(s) S-u 3 ft (as referred to site plan benchmark)
Additional design/site considers ons .S/TLS 5-0;7W416- ®,vL`( Fv.,e /!O TJ.trQ 7W a- 5y5-7T
Parent material 5C5 77 50W6- - f SEWi fiexAi 5 °U&, Flood plain elevation, if applicable it
11 -it . I
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grandee, System in Fill Holding Tank
U = Unsuitable for system ❑ S EKG LO s ❑ U C1 S 2.0su El S D-u/ ❑ S 0--6- ❑ S
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
o-/,0 /b y z/z L /~SAe m-l s / . y s
Z L-25, 1,00e 31-L - S/G MfAe Cs ~ . i ' . 3
Ground 3 /o - > U a S S
elev.
41 2-
5• Y
Depth to .'4_40 41
limiting
fa or
In.
SS Remarks:
Boring # /3 /o
31 Z S/L h~S nyr S . z • 3
L Z 13 0 3Z .3 /f •S,,& C' S /7r- ' • 3
3 -y o 3/~ S~ I ash ~ cw • ; • 5-
Ground • G / O 2 G L M~► f/e • Z '
elev. 5 y D y!
Depth to
limiting
factor
3 2- In. Remarks:
CST Name (Please Print) Signature Telephone No.
Address Ulbricht & Associates Date CST Number
Private Sewage Consultants 2 y jr 9- eYr1402, /pZ.
Yw l7 SOIL DESCRIPTION REPORT j
PROPERTY OWNER ~e(1141~'►v`~~ - Page of '
PARCEL LD.ff GO CSA4 3-11~
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GVDjft2
f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
3 / -iL /a 2 Z S/L 17 .fdt' ~Je V /f . Z • 3
L • s o 3 S/G 6
Ground 1 1/. 3 41 16 lh? Sit -74'jA4 IWt`t~J • C~ ~ • ~ . ~r
elev.
y'9. ,ten /a 7. s • 2 ~ - 3
Depth to
limiting
factor
,
d In.
SSf Remarks:
Boring #
Ground
elev.
n.
Depth to
limiting
factor
In.
Remarks:
Horizon Depth Dominant Color Mottles Structure
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh: Consistence Boundary Roots
Bed Trench
Boring # . ;
Ground
elev.
n.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
In. Remarks:
SBDW-8330 (R. 08/95)
C T y,GC~.
O
Lo r
117,
gild /
ultanta
ulb~lcht & Ass eccons
PrivatepSewa9
g55 ~Nell Rd• 16 I
540 $ / J
Hudson,Nils.
~
I
0 Fa
-79
Tod o t= 31y'l
w"C PIP
wooD ff,"a p0 Sr-
CERTIFIED SURVEY MAP
LOCATED IN THE NW 1 /4 OF THE NW 1 /4 OF SECTION 9, T28N, RIM TOWN OF\BqEt RIPER,
ST. CRO I X COUNTY, WISCONSIN.
PREPARED FOR WAYNE SCHUL TE
NOTE; BEARINGS ARE
REFERENCED TO THE
NORTH LINE OF THE NW
114. (RECORD
BEARING).
C. S. M.: VOL. 1 1, PAGE 3090
NORTH L INE OF THE NW 114
~~.Tr.H....ozo
NL99_°00N 90000'00"E 204. 51 ' N 90000' 00* W
D_O .E _
777.38' 1645.32'
N-20° Q.QL 00:f-
INW CORNER OF SECTION S T 204.51' g
9. (COUNTY MONUMENT N 114 CORNER OF SECTION
FOUND). ~ a 9. (COUNTY MONUMENT
g FOUND).
BUILDING SETBACK
S L I NE a
:C tp cp ~C
:z :z
n LOT I 3 a
2.00 ACRES
•m 10 g (87,117 SO. FT.) g :m
N 1.80 ACRES EXC. R1W N
:r M M (78,528 SO. FT.)
:z :z
:N Z y :N
N 90°00' 00°W 204.51'
.W4l 19.1? OHN,
" s
0 - SET I" X 24- IRON PIPE ~~y` JAmrs IN, ~r~'~
Wisgon'sin Department of Industry, SOIL AND SITE EVALUATION
Labor anct Human Relations Page of .
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
Include, but not limited to: vertical and horizontal reference point (BM), direction and 7
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # d 1 /d/,J = y O
o u7`61- /1f
APPLICANT INFORMATION - Please print all Information. Reviewed by Date
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). '
Property Owner / 1 Property Location
~/q rN~ S~LTJ~F_ Govt. Lot 41kl 114/VU1114,S / T Z S N,R 11 E (or)
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# O T - OF
Y-71 /6 S
f f, s-r PeA,1,P1,4J-~1-o AA-e s
clState Zip Code Phone Number Neare oad
ftAMMoNl~ 111. S yoi's ( 713-) M ' sS23 ❑ City❑ Village Town ~L~ • ~r7 ii
Lr New Construction Use: 21iesidential / Number of bedrooms 3 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 3 trench, gpd1ft2
Absorption area required bed, ft2 37~tranch ft2 Maximum design loading rate a bed, gpd1ft2 ' 3 trench, gpd/tt2
Recommended Infiltration surface elevation(s) s-U _3 ft (as referred to site plan benchmark)
Additional design/site considers Ions Sur X45 o OZ y fa,p 1!O ZP-VP T}/ O 5YS-7-.
Parent material 565 /7 50806- _ Si'/]~ SEl7i~sL+'~u~,f outer
Flood plain elevation, if applicable tt
S = Suitable for system Conventional ET- Mound In-Ground Pressure AT-Grad--e, / System in Fill Holding Tank
U = Unsuitable for system ❑ S ~ 5 ❑ U ❑ S [R' El S Liu El s 0-9/ El S Liu
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
In. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench
/e y z/,- L /lUe .wi . y : S
Ground 3 Y/f Y1 L( 174M 7r_X U It S
elev.
Ey
Depth to
limiting
fsc or
in. ,
V5_5 Remarks:
Boring #
1 /3 /0 3 Z S/L h~s~i n~ f /f . z ' • 3
Z 13 0 1/ 3 S'/L 3
3 _Y /0 yX 3/(- 5Z l cf`! /w i' Cw y ; - 5-
Ground Ille f j_Y 7o2 G L 4 w-GX - 2-
elev. s Vie ty !
Sy /aft. ~
Depth to
limiting
factor
3 2- n. Remarks:
CST Name (Please Print) Signature Telephone No.
Address Ulbricht & Associates Date
CST Number
Private Sewage Consultants - y eSrlefO2.VF2
638 O'Neil Rd.
PROPERTY OWNER'4j('h!K- 3'~q Ile SOIL DESCRIPTION REPORT Pag& • Za 3
PARCEL I.13.9 6~ I CS~y
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Gep/ft2
In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench /a z S/L /f'sd,~ nr►-FiC' 4J . L • 3
Z 0 3 ,M i S U . Z • 3
Ground ;5(341 S li aTSh,~ n n~f • CGcJ • ✓ 1 . ~r
elev.
~ 9. ~ff• EZ, a 7. S VA /hi . Z 3
Depth to L 4-4 ' N
limiting
factor
Sin.
SSS Remarks:
Boring #
Ground
elev.
ff.
Depth to
limiting
factor
In.
Remarks:
Horizon Depth Dominant Color Mottles Structure D/
Texture Consistence Boundary Roots
In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh: Bed , Trench
Boring 4.
;
Ground
elev.
ff.
Depth to
limiting
factor
i" Remarks:
Boring #
' I
Ground
elev.
ff.
Depth to
limiting
factor
In, Remarks:
SBDW-6330 (R. 09195)
k CTY, 7
a o
13,E
AJ
40
4CI
SG•4GE; ~ y~
qx&
~Ibricht & pss ecconsultante
vate PriOsewa9
655 .NeiW sd. 54016
.udson,
0 Fa
194 yl" Z S-e
Top of 314 Gi~v~ 1~1'
,
10 oos -F#-AAO po 5r
,TP
CERTIFIED SURVEY MAP ~L S'
LOCATED IN THE NW 1/4 OF THE NW 1/4 OF SECTION 9, T28N, RIM TOWN 0 USH R_VL6R,
ST. CR01 X COUNTY, WISCONSIN.
PREPARED FORR: WAYNE SCHUL TE
@ NOTE: BEARINGS ARE
REFERENCED TO THE
NORTH LINE OF THE NW
1--,4. (RECORD
BEARING).
C. S. M.:. VOL. 1,1. • PAGE 3090
4
NORTH L I NE. OF THE NW 114
°
N 90 0 90- 0.0'E N 90000' 00° E 204. 51 ' ---.N 90000'00'W
----b-- - --mob
777.38' A 1645.32'
ro
ALSO° QQ O0:f-
INW CORNER OF SECTION g T 204.51' g
9. (COUNTY MONUMENT N Ii4 CORNER OF SECTION
FOUND). v 9. (COUNTY MONUMENT
FOUND).
p BUILDING SETBACK p
i. iNE
~C tp tp ~C
:z N :z
'a LOT I :n
2.00 ACRES 3
m g (87, 117 SO. FT.) g ° m
%
N 1.80 ACRES EXC. RIW N
X- M M (78,528 SO. FT.) M r
:z :z
:0 g $ :0
An 2 y Mo
N 90000' 00' W 204.51 '
- SET I' X 24' IRON PIPE ~7 JALtFS iu
564509
CERTIFIED SURVEY MAP
LOCATED IN THE NW 1/4 OF THE NW 1/4 OF SECTION 9, T28N, R17W, TOWN OF PLEASANT VALLEY,
ST.CROIX COUNTY, WISCONSIN.
PREPARED- FOR WAYNE SCHULTE
NOTE: BEARINGS ARE
REFERENCED TO THE
NORTH 'L I NE OF THE NW
1,14. (RECORD
BEARING).
C. S. M.: VOL. 1 1, PAGE 3090
NORTH L I NE OF THE NW 114
_ N 90° oo' 00" E ° N 90° 00' 00" E 204.51 ' _ N 90000'00'W
777.38' A 1645.32'
NW CORNER OF SECTION g I 204.51' o
9. (COUNTY MONUMENT N I CORNER OF SECTION
FOUND). 9. (COUNTY MONUMENT
o FOUND).
0
p BUILDING SETBACK
O o0
LINE 1
:C td cti :C
:Z N N :Z
- LOT ( 3 £ FILED
2.00 ACRES b = AUG 2 8 1997 ►
m `D o (87, 117 SO. FT.) o m ZLEEN H. WALSH
cV opt
APPROVED N 1.80 ACRES EXC. RiW CD
n o (78,528 S0. FT.) M o :D SL CMIX cv g g :v
AUG 2 8 '97 z y :N ti
37. C#ijki it%i19d't1l
Cs , Pret*nv~;F, Punning
ZanOg and
Paft CtXrffyw ss
Ifror Q
vwkhiM 30 days of
aWoval date
-^Wcval slhall be N 90° 00' 00" W 204. 5 P
zrrd void
,~1NPLQ►TT~D • LANDS `
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER k
MAILING ADDRESS
PROPERTY ADDRESS / 7 Z5 L K ~o~ Z
(location of sep c system)) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION *Ai 1/4, AIA-j 1/4, Section T 29 N-R W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME/Z,,PAGE 33&, LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 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 systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater 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.
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 stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE: / - 977
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
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,
5
r
Location of property fy /4 1/4, Section ,T_Z,?N-R_~7_W
Township P Mailing address
Address of site 7_Z$ cj 2
Subdivision name d5'/''J 41, It /Z q3Lot no. /
Other homes on property? Yes
_No
Previous owner of property Seh.' 1, f-e
Total size of property
Total size of parcel _ 41elt 5'
Date parcel was created ' - q
Are all corners and lot lines identifiable? _>--QYes No
Is this property being developed for (spec house)? Yes No
Volume 71 and Page Number :3V-3 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (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. 1716 b / 13 , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
ignature f Applicant Co-Applicant
Date of Signature Date of Signature
ii
THIS SPACE RESENVEO FOR RECONOINO DATA
I
j DOCUMENT NO. (STATE BAR OF WISCONSIN FORM 3-1985
QUIT CLAIM DEED
3
40:153 15►A,E34
- - - REGISTERS OPME
Jean M. Schulte ST. CROIX CO., WIS.
Rec'd for Record this --1st
...................Schulte Bros. . -a. co- artnersh day of July A.D. 14_85
quit-claims to t . P---
9 M.
consisting of Donald H * Schulte and Wayne A. 10t3O
Schulte - . Cr
oix
. County,
the following described real estate in St
State of Wisconsin RETURN TO
NE1/4 of Section 8 and the W1/2 of the NW1/4
of Section 9, all in T28N, R17W.
Zy - io ~t - tom'
Tax Parcel No: i57-
This deed is executed for the purpose of terminating Jean M. Schulte's
interest in this property, and divesting the Grantor herein of all
right, title, and interest to said property, pursuant to the stipulation
entered into on May 29, 1985 by the parties and as per the Judgment of
the Court as found in the Findings of Fact, Conclusions of Law and
Judgment, Case No. 84 FA 168, signed by the Honorable Phillip P. Todryk,
St. Croix County Circuit Court - Branch II.
FE
~~Tt
This is homestead property.
(is) (is not)
- day of June 19..85-.
Dated this
(SEAL) __(SEAL)
JEAN M. SCHULTE
(SEAL) _ _ ..._(SEAL)
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN
Signature(s) - - - - - - -
ss.
- L E•t a County.
da of
authenticated this _ . _ _ day of - 19..-.-. Personally came before me this Y
_
t - C !.l. E...------••------+ 19-s1 5--- the above named
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not........ . -..._...-,..:...r_
' ;vApp
to me known t4 who executed the
authorized by 5 706,.06, Wis. Stats.)
foregoing in nt' urid aC. e3Jledgj the same.
~ r'. IJJlJJ ~ ff ~