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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ,Te
ADDRESS
SUBDIVISION / CSM# ~U ~GCV _ s° LOT #
SECTION 2Zr Ta,~- N-R /W' W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERRYTHING WITHIN 100 F F SYSTEM
X >
I~ I ~ J
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK' ®h't e -I
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: ~j,'~wes7"P~- Liquid Capacity:
; /2 c~ C
Setback from: Well !~i" House Other
Pump: Manufacturer -15- c - / /tModel# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROTN
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 284X62
L%Vlolcly~ e: [j!jj fL1L t e Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM DescriptlQ` -GALL Parcel Tax No.:
TANK INFORMATION LEVATION DATA A9600414
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /Dl
14A.gy~ /U n• Dosing v 0
Aeration Bldg. Sewer
Holding St/ Ht inlet ,
TANK SETBACK INFORMATION St/Ht Outlet / _C/
v~.
TANKTO P/L WELL BLDG. Aeintake ROAD Dt inlet `d.GaS
Septic y10 ` Q 7!2 7 X.5' NA Dt Bottom S,
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System 3 /OPo,(>V
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
qV
Model Number ( GPM
TDH Lifta1,Sk_ Lriction~ System, 5 TDH 41,L` Ft
Forcemain Length "
1,1 I Dia. C_ Dist. To Well >5~O/
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits In Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM CHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O model Number:
System: °~U r 15 1 N A OR UNIT
DISTRIBUTION SYSTEM
Hole Spacing Vent To Air Intake
Headea Manifold Distribution Pipe(s) a x Hole Size x '7
s
Length Dia Length Dia. Spacing o
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over r Depth Over 'b , xx Depth Of / -.f xx-Seeded / Soddett- xx Mulched
Bed /Trench Center Bed /Trench Edges I I Topsoil lP lg -'es ❑ No [JyYes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: EAU GALLE.27.28.16W, NE, NU, 250TH STREET
Plan revision required? ❑ Yes [(No / J ~T Us
e other side for additional information. t
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH +
SANITARY PERMIT NUMBER:
t1(.
Al
t
r as:° Safety and Buildings Division
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 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Check ii revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
114 1/4, SR 7 T a c
ea Ig- , N, R /j; E (or)
Property Owner's Mailing Address Lot Number Block Numb r /
GZ.2 j? d 'k
City, State Zip Code Phone Number Subdivision Name or CSM Numbe
LJ,' ( ~31
. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Neares oad
❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms,. EXTown OF
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
.5 0
1 ❑ Apartment / Condo
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. ❑ New 2. K Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
-----System System Tank OnlyExisting 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
11E] Seepage Bed 21 Mound 30E] Specify Type 41 ❑ Holding Tank
12E] Seepage Trench 22nIn-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14E] 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
~S~ Required d (s . ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 9 -7 S~? $7 7 r 3 Feet Feet
VII. TANK Capacity
in gallons Total # Of Prefab. Site Fiber- Plastic Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank 08 r / ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber EA, I ❑ ❑ ❑ ❑ ❑
Vill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's SiM No Sta m ) PRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
n ile
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved SSa tary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps)
Approved f-1 Owner Given Initial Surcharge Fee)
`
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) 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 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-lame, 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; 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.
? t
f SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
August 27, 1996 2226 Rose Street 9Q
La Crosse WI 54603
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74 tO Cf~c7x
RIVER FALLS WI 54022 COONrY
ZONINGOFFIGE: ~
RE: PLAN S96-41058 FEE RECEIVED: 360.0 j
LEAF, JEFF
NE,NE,27,28,16W
TOWN OF EAU GALLE 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 ILHR 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 ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
- The existing tank being converted to a septic tank must be inspected for
structural soundness, size and baffles, and must be brought into conformance
with the requirements of chapter ILHR 83, Wis. Adm. Code. If it does not
comply, a state approved septic tank shall be installed.
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.
Sincerely,
%
t/~ C
erard M. Swim
Plan Reviewer
Section of Private Sewage
(608) 785-9348
SHDA-7887(8. 10184)
ti
S96-41058 Pa 1 of 6
CEtVED
MOUND SYSTEM AUG 2 3 1996
FOR
3
A BEDROOM RESIDENCE SAFETY & BLDGS. DIV.
LOCATED IN THE 1/4 OF THE "a: 1/4 OF SECTION T'~,b N, R 16 W,
TOWN OF a-f yN C~P~t L~ S' r. "-',RUtX COUNTY, WISCONSIN.
INDEX
PAGE 1'of 6 TITLE SHEET
PAGE 2 of 6 PLAT 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 SN 'P' eM
s M io 1Y
Gtlt
PREPARED FOR,
~ ~ F F LlTq F
Hu
~1. Z 9 z S ~ s T. . u` AMD e.
g~E Go"
PREPARE BY
WEGEE:RER SO X L - TEST I t~IG ~9taw~~
AND . ♦o
DES I GiV S~~V CE
F.O. WX 74 421 L Ml ST. A
RIVET FNIS. V1 54022 f AMU R
"15 P
R I SwoAra,
W&
JOB NO. ~l6 - L~
} PLOT PLAN
Page Z of 6
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NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Y required)
3. Install 4" observation pipes with approved caps. / required)
4. Septic tank to be V000 gallon capacity manufactured by
M I b JESTEWN 1 T nee.. 1~- u~1P 1~c `51~ 8E M r bki~51Z'2rv -1 S
5, Bench Mark % 1--4~ oV t--
6. Divert surface water around mound to prevent ponding at the uphill side.
6
' Page _B Of
Approved Synthetic Covering
PtSTr~t C 3 3 Distribution Pipe
Medium Sand
H G
Topsoil F Elev'.l0l>,O
D
3 E
I Slope Trench Of 2~- 2 Force Main Plowed
Aggregate From Pump Layer
Undisturbed D Z O Ft.
Soil E•
Cross Section Of A Mound System Using, 5 ~ 5r'q'~ 8 lyt.
2 Trenches For The Absorption Area'' tit
h
A £ 01
Ft.
B LI-7 Ft.
1J►6
I Ft.2IX• Wo
Linear Loading Rate x(.79 GPD/LN FT iy~~1 -
Design Loading Rate= o-3 GPD/SQ FT J 9 Ft. '0~~
~
K Ft.
e osi ion o L q Ft. i
Hi L Ft.~Z
L
J K
Observation Permanent
C t-- - - - -
Pipes Markers
,~s p~-
1
(Anchor securely) Force OPP0S I~
- Ck~
L-- - - - - - - - - - Main
Distribution Trench Of 2 2 2
Pipe Aggregate
1
Mound Using 2 Trenches For Absorption Area
Page Of 6 1
Perforated Pipe Detail
0
End View ~
)Perforated
End Cap. o~\c `E PVC Pipe Install permanent marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
PVC Force Main
PVC So Manifold Pipe
AAQtA~
Dist ution
Pi a
I
Lost Hole Should Be
Next To End Cap
End Cop J
P Zl-ZS Ft.
Distribution Pipe Layout S I / Ft.
X 30 Inches
y 30 Inches
Hole Diameter Its Inch
Lateral " ~<<y Inch(es)
Manifold " Z- Inches
Force Main z- Inches
# of holes/pipe 9
A
Invert Elevation of Laterals 06S Ft.
o1X1.n= 1,3 •S4-z L1Z.~Z GPt"I
u
Place 1st hole from center of manifold with succeeding holes
at 30~'intervals. Last hole to be next to the end cap.
{
• PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS PAGE S OF
VEIJT CAP
'i" C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING MANHOLE
10' FROM DOOR, JUNCTION BOX COVER WITH WARNING LABEL
WINDOW OR FRESH f2 MIN. I
AIR WTAKE
GRADE
I `i" Mild.
COIJDUIT
18"1KIN.\
IIJLET PROVIDE I 1
• AIRTIGHT SEAL
+`fa 'ri''/ ~ I 1 ~ v
JOIWT f A Tank 1 t >5 h 1;1 comply I I ~ ~ APPROVED JOIIJTS
a r~ati' L APPROVED ILHR 83.20 I ICI
8 ~ ~ g'd'®~~~z~,..~ _ I i I ALARM
1 1
C
.
- - 8 350
ELEV. F7
PUMP + OFF
Z. S I) ' COLICKETE 6LOCK
.
RISER EXIT PERMiTfED OIJLy IF TANK MANUFAGTUR>FR HAS SUCH APPROVAL. 3" AQFRoYE
U00iNQ
SPECIFICATIOUS
DOSE • `M t~k1~S~1 l~R~1' 3.19
TAIJK MANUFACTURER. AlUMBER OF DOSES: PER DAB
TANK 51ZE : SO GALLONS DOSE VOLUME
ALARM PIANUFACTUlRER: RD S`i- S INCLUDING 5ACKfLOW: GALLONS
MOD£L NUMBER: 10~ HW CAPACITIES: A= l ~ INCHESOR 3`Z GALLONS
SWITCH TUPE: L~Z~RY B= 2- ILICHES OR 39 G(LLOIJS
PUMP MANUFACTURER: Z~ C= 1 IIJCHES OR I~OS- GALLOWS
MODEL NUMBER: 1 E'3 D+~ Z INCHES OOR GALLONS
SWITCH TYPE:
2C=L/R ~l MOTE: PUMP AND ALARM ARE To 5L~
INSTALLED 01J SEPARATE CIRCUITS
MIIJIMI3M DISCHARGE RATE '11-' • 1Z GPM
VERTICAL DIFFERENCE CETWEEU PUMP OFF A1JO.OISTRIBUTIOti1 PIPE.. Z. -,w3 FEET
+ MIAIIMUM NETWORK SUPPLY PRESSURE . 2.50 FEET
-1- `5 O FEET OF FORCE MAIM X 3'~~ F~oFLFRICTIOU FACTOR. S' FEET
TOTAL OyNAMIC. HEAD = 3~' 62 FEET
DIAMETER
IIJTERASAL DIIALWSIOW; OF TAWK: LENGTH ;WIDTH 1 *LIQUID DEPTH 3~ 1ZN
BOTTOM AREA - 231= GAL/INCH
AS PER MANUFACTURER = 1aS GAL/INCH
► - A 6 0~
TOTAL DYNAMIC HEAD/FtM PER MINUTE
a HEAD CAPACITY CURVE EFFLUENT AND DEWATERING
W ' ' ' 161,163 AND 165 SERIES SERIES 761 763 765
Fr. M Gal Ur Gal Ltr Gal Ur
5 1.52 106 401 61 231 61 23T-
28- 10 3.05 100 378 61 231 61 231
90 15 4.57 91 344 60 227 60 227
20 6.10 82 310 59 223 60 227
24 80 25 7.62 74 280 57 216 59 223
30 9.14 65 246 55' 206 58 220
0 70 165 40 12.19 46 174 46 172 55 206
= 20 163 50 1524 21 80 33 ,125 51 191 60 1829
60 70 21.34 30 114
a 16 80 24.38 14 53
50 90 27A3
100 30.48
N
12 40 LOCK VALVE 56' 66' 87'
0
b .167
30 1
8--
20
4 q z- Z 161 4 7/32 8 3/4
10
6 1/2
0 1
U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 i
LITERS 4 7/32
0 80 160 240 320 400
FLOW PER MINUTE _
6 11/32
I
Standard all models - Weight 77 his. - 20 ft. card -1h H.P. 1
161 MODELS Control Selection Listings
/Z" -11 1/2 NPT
Model Vohs-Ph Mode Amps Simplex Duplex CSA UL .1 1 1- 71 1/2 NPT (OR)
M161 115 1 Auto 15.5 1 or 1& 9 Y Y 1
3" - 8 NPT
N161 115 1 Non 15.5 2or2&8 3or5&6 Y Y
D161 230 1 Auto 7.0 1 or 1& 9 Y Y
E161 230 1 Non 7.0 2or2&8 3or5&6 Y Y
F161 230 3 Non 4.0 2&4 3&4or5&6 Y Y l
H161 200-208 1 Auto 8.2 1&9 Y N
1161 200-208 1 Non 8.2 2&8 3 or 5& 6 Y N
J161 200-208 3 Non 5.2 2&4 3& 4 or 5& 6 Y Y
G161 460 3 Non 2.0 2&4 3&4or5&6 Y Y 18 9/16 1
Standard all models - Weight 77 Ihs. - 20 fl. cord - Y2 N.P.
163 MODELS Control Selection Listings
Model Volts-Ph Made Amps Simplex Duplex CSA UL i 6
M163 115 1 Auto 14.0 1 or 1& 9 Y Y
N163 115 1 Non 14.0 2or2&8 3or5&6 Y Y
D163 230 1 Auto 7.0 1 or 1& 9 Y Y
E163 230 .1 Non 7.0 2or2&8 3or5&6 Y Y
F163 230 3 Non 4.0 2&4 3&4or5&6 Y Y
H163 200-208 1 Auto 8.2 1&9 Y N
1163 200-208 1 Non 8.2 2&8 3 or 5& 6 Y N SELECTION GUIDE
' J163 200-208 3 Non 5.2 2&4 3 & 4 or 5 & 6 Y Y 1. Integral float operated mechanical switch, no external control required.
G163 460 3 Non 2.0 2&4 3 &4 or 5 &6 Y Y 2• Single piggyback mercury floatswitch or double piggyback mercury, float switch.
Refer to FMO477.
Standard all models - Weight 77 Ills. - 20 h. cord -1 H.P. 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075.
165 MODELS Control Selection hisDO s 4. Combination starter. Refer to FMO514.
Model Valk-Ph Made Amps Simplex Duplex CSA UL 5. See FM0712, for correct model of Electrical Alternator, "E-Pak".
D165 230 1 Auto 9.8 1 or l & 9 Y Y 6. Mercury sensor float switch 10-0225 used as a control activator, with 'E-Pak"
atemator, 3 or 4 float system.
E165 230 1 Non 9.8 2 or 2 & 8 3 or 5 &6 Y Y 7. SIMPLEX CONTROL BOX 10-0050,11523OV,1 Ph. max.2HP use one(1) single
F165 230 3 Non 6.6 2&4 3 & 4 or 5 & 6 Y Y piggyback wide angle mercury float switch OR two (2) 10-0225 mercury sensor
H165 200-208 1 Auto 10.7 149 Y N floats for level control.
1165 200-208 1 Non 101 2&8 3 Or 5 &6 Y N B. Four(4) hole "J-Pak", function box, for watertightconneclion orwired-in simplex
J165 200-208 3 Non 7.0 2&4 3 &4 or 5 & 6 y y or duplex operation.
6165 460 3 Non 3.3 2&4 3 &4 or5 &6 Y Y 9. Two (2) hole "J-Pak", )unction box, for watertight connection or splice.
'
' BA165 575 3 Non 3.0 2&4 3 & 4 or 5 & 6 Y N 'No Molded Plug
CAUTION
For information on additional Zoeller products refer to catalog on Combination Starter,FM0514; All lnslatialiesolcoalrola,protection devkesandwidngthooldhedaro6yagaallHedlicensed
PipgybackMeimry9wkches,FNID477;EtKbialAaanator,FM0486;MxhanicalAnanator,FM0495; electrician. All electrical and safety codes should he followed indediag the most recent
Alarm Package, FMD513; Sump/Sewage Basins, FM0487; and Simplok Control Box. FMD732. National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Duman Relations -
Division of Safety & Buildings
in accord with ILHR 83.05, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2x 11 inches in size. Plan must include, btK S" e
r
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P "ID #
dimensioned, north arrow, and location and distance to nearest road
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION NEVI D Y dO CATE
rr
PROPERTY OWNER: PROPERTY LOCATI -%.jNT
•r
"I UT Sea- G994=. NN 1t!)0FFJU E (oWW
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # S
101 zS0 Sr. - s~
CITY, STATE ZIP CODE PHONE NUMBER []CITY ILLAGE [@TOWN EST ROAD
l~vOUDVILIE I.ul S4132S (71S) 695 -Z1~ tjh-L-i? Zp TM- uE.
P4 New Construction Use [Xj Residential / Number of bedrooms 3 [ J Addition to existing buikting
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow DSO gpd Recommended design loading rate bed, gpd/ft2 1 trench, gpd1 t2
Absorption area required - bed, ft2 - trench, ft2 Maximum design loading rate - bed, gpd/ft2 _ trench, gpd/ft2
Recommended infiltration surface elevation(s) y It (as referred to site plan benchmark)
Additional design / site considerations
Parent material S t t-~ S Q1--'akM tjT ou ~St C 1 171 L Flood plain elevation, if applicable - It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for stem ❑ S ®U ❑ S ®U ❑ S O U ❑ S ®U ❑ S ®U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouncl3y Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Sed Trerxh
.:'i'ivS{.ten
t'€ n 1 0 -`1 lp ` l 2 31Z S L ` Z 1-So h 'F- ct, - 0-S o" _L
r° Z -7-13 1.0 `-I IZ 313 - S i 1 2 `FS~l7 w~~t C~ - o_ S o,
Ground 3 t3-L`7 )o`~ R Yl3 _ SL sdk k, ~j C g - o-S o• 6
elev.
1pS.0 ft V) 3S 10`iR-Yl~ C 1•S`lVL 3! C~
Depth to
limiting
factor 11
Remarks:
Boring #
0,1 ti0`tR- 3[Z SL~ Z `FS btZ CL,S - G. S .
Z Z 1-ZO lb`t2 Yl3 - sil Z~SI~k i~~t cg - o-S 1 o. 6
} 3 20 2S 1o`t R Ylb e ~.S `t 2 3[ e I-SCI o wti' - `~i -
Ground
elev.
`14- ft
Depth to
limiting
factor
Z~y
Remarks:
CST Name.-Please Print Arthur L. We erer Phone: 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022
Signature: ~7'L 6-4 3 _ 1 Date:::,,, S / ~~CST Number:
M00576
PROPERTY OWNER S SOIL DESCRIPTION REPORT Page ?-of
PARCEL I.D.
GPD/ft
Depth Dominant Color Mottles Texture Structure Consistence coots
Boring # Horizon In: Munsell 11u. Sz. Cont Color Gr. Sz. Sh. Bed Tn~l
L3,... 0.1 ~~~R 3~2 - i 2,Fsblz ~'El•- ~S - o• S o.6
x~ ~ 2, _t l O rZ yL3 s t l 2 ~blz ►~'f c s 1 0- S o.
Ground 3 )~!-y0 10`i 2 V /L c )-S'2R 31 y S 0- o .rn `F~
elev.
01 ft.
Depth to
limiting
factor
Remarks:
Boring #
0 k -t. \2 3 1'Z - 51 ~ 2 S~Yt yq `F> O' S O • S 0.
E 2 -I - ~y ll~`4 (Z yl3 - s1• J Z ~sb~ C s v. s 0.6
3 t.y-3S !o~ fz y~6 c ~•S ~R 31 e 1 m ~f - ~ ; ,
Ground
elev.
bs'?-ft.
Depth to
limiting
factor
Remarks:
Boring #
►JU 5 l (i f~ L QL w v 5:)S M L)c -S
Zn
fx r, o F- 3- Mo U K)G w S 1=o v hZ~ P~ L (~5
rL
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
cn^ 0~1nin nr n,\
f
I
PROPERTY OWNER SOIL_DESCRIPTION REPORT Page Z of
PARCEL I.D. #
Depth ;QominantColor Mottles Structure GPD/ft
Boring # Horizon Texture Consistence -day hoots
In'. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
3 01-1 Voy,R. 31 z - si 2'Fs61~ 0.•S o. S a. 6
2 -t -t y t o tz yL3 SO t 2 gblz w►~E'~. c S o.,S o.
Ground 3 14-40 tio`t 2 Y/L --7•S LM 31V S 00 y,1 `h~,
el
~J~ft. -
Depth to
limiting
factor
1
i
Remarks:
Boring # _
1 0-~ ~o~~i`3t`z - sal 2`~sbk y' f- 0"S
2 ,_~y tu`21Z yl3 - s~ 1 Z~sb~ ~1, C
Ground - .3 ty-3S log 2 y~6 e ~•S `i2 3t e ~ v~ In ~j - ~
elev.
1bS.Zft.
Depth to
limiting
factor
i
Remarks:
Boring #
t~ S ;f'~p l u k,L AL w SLiE- V A-r 5~)S M.uc S '2.n '
OF- 3. Mo Ll w S Pb V /y L i~-z
Ground
elev.
it.
Depth to
limiting
factor
FT
Remarks:
Boring #
.13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
cnn no~~in nc,n~
PLOT PLAN Page 3 of 3
SCALE 1"= LlQ'
,0, -Z C) `T* PN t .
Z So T* sr.
• a~ - t~ too. 0' one • a4 9
j7rLt Gt{, Sly` DtA 9.3
PAC PtpF til~~'T~}
t*~.49
a .Z
Lo s ?
6-1
668.8x' ~-ws
fla
°16-R3- I
(715 ) 4L-016r, M00576
CST Signature Date Signed Telephone No. CST #
•Wisbonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3
Labo= and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
' COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but -3-r.
e
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
F-F L ~~'cF G8W-L8T-. NN 1/4 NE 1/4,S Z-) T ~a N,R 16 E (43
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
LL 'Z-9 _ Z, S ' TV ST , 1 - c S r-I
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [@rOWN NEAREST ROAD
UvOUDVILI.E but SLCOZB (CIS) 695--LL, EAU C-1 L0 T)f ()UF,
[ I New Construction Use [XJ Residential / Number of bedrooms 3 Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flowk-~SO gpd Recommended design loading rate bed, gpolft2 2.3 trench, gpd/ft2
Absorption area required 31S bed, ft2 -3 S trench, ft2 Maximum design loading rate a S bed, gpd/ft2 0- L trench, gpd/ft2
Recommended infiltration surface elevation(s) 1 6 ft (as referred to site plan benchmark)
Additional design I site considerations n 5Ut'-% w /2- 4 eS - t_-MH WY. 4-)' - M JAJ . I ' of SAD 9 t_(.,
Parent material S I L`M S t N*m,, ~5iT O LSL C k In LA- Flood plain elevation, if applicable I- At - It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑ S Il U ❑ S ®U ❑ S O U ❑ S [MU ❑ S ® U ❑ S MU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boutlary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Ued Trench
.jj~::ifwit•1010
"K 1 0 --l ~o `12 31 z - S L Z `FS~k S - o- S b~ ,l
1 '
0
t Z --7-f 3 10 `Z FL_ 31
3 - s i) 2 `FSbh w~ C~ - o_ s u, b
Ground 3 l3-t'l )O`~ RYl3 St) Z Sbk 1,,. C - o S b• 6
elev.
IDS.0 fL Y 0-3s IA12 fL V/.~ C 1.S `2 R C ►tit t - _
Depth to
limiting
factor
Remarks:
Boring # 0 1 tip`t~ 3lZ SL Z `F S b~
I Z Sb11 ►'Ft Cg - o _ S ` o. 6
Z ` Z 1 Z0 lb`1 lZ ~l3 - S1
'i25•kt
2v 3S to ez
3 `t R Y/6 1.s Y2 3 / 00 -ge( ate, m'F-m~f
Ground - ~ €
elev.
99- i, ft
Depth to
limiting 1
factor
Remarks:
CST Name:-Please Print Phone.
Arthur L. We erer 715-425-0165
M gerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date: CST Nurnber____
MOD576
•
PROPERTY OWNER SOIL DESCRIPTION REPORT Page _Z of 3
PARCEL I.D. #
Borin Depth Dominant Color Mottles Texture Structure Consistence ea.~y Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw&
0-1 `o-t R 3/2 - i 2~sdlz Y.,
~
Yq'Fk c s o. S 0.
Ground • 3 )y-y0 1O`t R V/ L C L-7.S kR 31V s aA 0), YVL f - -
elev.
Cft-j ft.
Depth to
limiting I
factor
• i
Remarks:
Boring # - '
1 0--1 ~~~\z 3 tz - 51 l -Z `Fsbk ►-t
z -~y )u~R yl3 - st' 1 Z ~'sd►~ c S - o. S 0.6
Z
3 I.y-3S EI 2 e ~R 31 e ~ caw,
Ground
elev.
)OS.Zft.
Depth to
limiting
factor
i
Remarks:
Boring # i
tJU S tf' w n `n v fK of w v S~,fs M. U a- -S 2.13 '
of 3 . N'L~ lrl F-bv / . L
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
cnr) nnnnrn n-n-
PLOT-PLAN Page 3 of 3
SCALE 1"= L10'
o Z S ►vt i lro
2 SO Rr- ST.
l
~f
' awl - tit ti0o.a' ON 6- aR9
tt«tf, Sty` 0) A a IA/ Pv e pcpF +~lc.q 7~ t~~ ~
*7
,>'n~c~;
cAr.>~pvv2 . 10U. 0
B o1~Uh'l of 'TRH ~CkttS 02 \e\Y 19 6
vi
Zoe' f g.
~oS? NQ/
~9
a-1
668.8b, ~'i-w s
'v~'ST t.tn.~ of !0 fie Cor
-9~o (715 ) 425-0169 140-0576
CST Signature - - Date Signed Telephone No. CST #
r ,
Wisoonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pago 1 of 3
-Labor and Human Relations -
. Division of Safety & Buildings in accord with ILHR 83.03, Wis. Adm. Code
COUNTY
L°
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but -3-r.
not fimited to vertical and horizontal reference point (13", direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
7Z1E-r-'F L..N`PrF GG\9-L$T-. 1,5E~-114 NE 1/4,S 2.-) T ~g NR 16 E (oCW
PROPERTY OWNER.S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
L1,7-1- _ Z S 0 . T* S- r. - _ C S r.t
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [gOWN NEAREST ROAD
livou~V lt_~F k) l W13 ZS (-)Is,) 693-2.LL 1 1R•v C~fvf L_s 2,p T?f uF,
[ ] New Construction Use [XJ Residential / Number of bedrooms [ ] AddibQn to e)dsfing building
I4 Replacement [ ] Public or commercial describe
Code derived daily flow qSO gpd Recommended design baling rate bed, gpdtft2 3 trench, gpd/tt2.
Absorption area required 3-1S bed, ft2 3~S trench, ft2 Ma*n mt design loading rate a bed, gpdKI2 O- L trench,
gp&V
Recommended infiltration surface elevation(s) 1 O 6 - p • " It (as referred to site plan benchmark)
Additional design / site considerations 11 Dur.~ WIZ '_M~ UV-S - ~.'MH WY- q-)' - Wt !nj . 2 , ol= s*"'t ft t.C_
Parent material S t L T11 S i1t~-vWT ou %&a- C ~ 1 t t-L Flood plain elevation, if applicable 1- - It
S = Suitable for System CONVENTIONAL MOUND IFGROt1ND PRESSURE AT-GRADE SYSTEM IN FILL HOLDM TANK
U=Unsuitable for system ❑S E) U ❑S ®H ❑S ®U ❑S ®U ❑S ®t1 ❑S MU
SOIL DESCRIPTION REPORT
Boring # Horizon ,Depth Dominant Color Mottles Texture Structure Consistence Bour>daly Roots GPDlftin. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Wed
tench
o -1 1 `12 312 - S L Z `F- "bh ou S - o_ S b. _L
Z -7-t3 10`2R_ 313 - St 1 Z ~-'SbFt C~ - a_S o,
Ground 3 13-1~ f"- V13 - sLj sbk h, c - 0-S o.6
elev.
10S.0 fL Oki
Depth to
limiting
factor Remarks:
Boring #
o; l ti0`t~ 3!Z St Z `FS blC cx,$
Z: 2 1 Zo lb`1 tZ Yl3 - si I Z S~,k~~ C.g - o.S o. 6
3 20 2S Io`t R V/6 e 1•S `i tL 3l
Ground
elev.
C14- tL
Depth to
limiting j
factor F
,
Remarks:
CST Name-Please Print Phone:
Arthur L. We erer` 715-425-0165
egerer Soil Testing & Design Sorvice-P.O. Box•74 River Falls,WI 54022
e _ CST Nt#ctber
Signatur _ -m! _ Date: 8 - N-9 IQ M00 57 6
f ~
I ,
PROPERTY OWNER S SOIL DESCRIPTION REPORT Page Z of
PARCEL I.D. tf
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tram
El 0 "l `i.lL 312 - i O, S d, b
Z 1_ L q L O `t R- Y!3 0 Z~ ~b1L ►~'f c s o- S o.
Ground • 3 N-y0 tio`t 2 Y!(e c' -).S Kfz 31Y S el o~ v+1 `l?~. _
elev.
~l ft.
Depth to
limiting
factor
Remarks:
Boring #
`Fsb>z '
El 2 -~y l~`-t!z y!3 - st1 Z 'sslr 1-n -4 C, S o. S 0.6
Ground 3 Ly-3S lU`ZP- y~6 C S `„J2 3l C v h1 j -
elev.
IOS.Zft.
Depth to
limiting
factor
14 ILI
I
E
Remarks:
Boring # i
tau 5 Pip D t u r, -i A-t- i S w v S ee, s Z,v
OF- 3• `Nbo t! w-S Rb v L 5
Ground
t
elev.
ft.
Depth to
limiting j
factor i
I
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
„ factor
Remarks: -
cnrn noonin nc,nn\
PLOT-PLAN Page 3 of 3
SCALE 1"=
a•ZS to i lro
Z so ~ sr.
I
a+vt - tf- too. 0` ON ® qq 9
q" t6t}, 3Jy` Djq A/
Pv e t tpF ~lu~{ ~t~}t, ~
cA~v~OV~,L f`l.. ZOII.O` ~ ~
eo~~ of 'TR~UC~s ~ ~ ~Y.a9 ~
` r l
4 \ '
ws?
a
a ?9
s-~
668.8b' L-LW S
- tp CoT
S~-L~-~!o (71.5 ) 425-M69 M00576
- CST #
CST Signature Date Signed Telephone No,
Wisconsin, Department of Industry, " SOIL AND SITE EVALUATION REPORT Page
of 3
Labor and Human Relations -
DiVision of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (Blu), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
" l L-T Sea- Gg&.kAT-, NN 1/4 Nt.; 1/4,S Z7 T ZS N,R 16 E (o
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
. )qa zso Sr. - \-Z~l T?-AV,03SD cst^~
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [@rOWN NEAREST ROAD
I~vnu~VLlrlty INI SvI3215 piss) 69-w-!L6 j Grou- Z-0 T?f 1iUel.
PQ New Construction Use [XI Residential / Number of bedrooms [ ] Addition to etassbq buildirtg
I I Replacement [ I Public or commercial describe
Code derived daily flow ASO gpd Recommended design loading rate bed, gpolft2 trench, gpol t2
Absorption area required bed, I12 - trench, ft2 Matamum design loading rate - bed, gpdm2 trench, gpo1ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan bendunaN
Additional design /,site considerations -
Parent materW S ► t'-'C4 S4MVM WT ov LSt C 1 In t.t.. Flood plain elevation, 9 applicable 1--• - It
S = Suitable for system cONVeflx NAM MOl1ND IN-GROUND PRESSURE AT-GRADE SYSTEM IN Fll HOLDING TANK
U = Unsuitable for stem ❑ S O U S ®U ❑ S ®U S ®U ❑ S ®U ❑ S M U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon Texture Cortsistence Bolndary Roots , Sed ten'tdi
in. Munsell QU. SZ. Cont. Color Gr. Sz. Sh.
~514a '
1 0--1 10 `12 31Z - SLR Z `FS~12 V', - LL S 0-:s t)-J-
-7 -4 3 10`1231
3 St 1 Z~S~41 ~ C~ - o.S
Gro und 3 13-L-7 )o`~RYl3 SL1 Z~Sek o•S b•.~
elev.
ft. tj Y-) 3S IO`2fL1t1b 1,S`iR 3! C~ ►Nt`~l
Depth to
limiting
factor
Remarks:
Boring #
0.1 ti0`t~ 31Z st 2 `FS ~p1Z I- a,S o. s .
CZ Z 1 Zo l~`tIZ Yl3 - stl Z S~k cg - o_S o. 6
Zo 3S Io eZ
Ground 3 `1 R Y/b 1•S `t 2 3L e,-3eI m'f(. -M~j - ~
elev.
`14 ft.
Depth to
limiting
factor
Z~y
Remarks:
CST Name:-PleasePrir►t Phone: Arthur L. We erer 715-425-0165
Ad:
egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022
Signature: - Date: CST Number.
MOO-5-76
- J
PROPERTY OWNER SOIL.DESCRIPTION IIEPO.RT Page Z of Z
PARCEL I.D.
Boring # Horizon Depth Dominant Color. Mottles Structure Consistence gam,. Roots GPD/ft
In. " Munsell Qu. Sz. Cont. Color Texture Gr.. Sz. Sh. Bed Trench
.3 0-1 ~.SJ~LIL 3t 2 i 2.~F561Z w1`~,. 0.,S o• s o, 6
Z 1-l q t o `1 R= Y[3 s i 1 sblz w►'f c s 1 0. s o. G
Ground 3 N-yo 1o`i lL Yl(, c 'L-)•S'4R 31V S 06 Chi-n wi
~~v
ft.
Depth to
limiting
factor
~j
Remarks:
Boring #
st 1 2 sb ~s - o.So.~
1wirL y[3 - st1 Z'~'sbk CS - o.S X0,6
Ground 3 ~y-3S 1TI 2 y~6 c -)•S `f tZ 3 t e 1 n h1 _ ,
elev. '
bS.Zft.
i
Depth to
limiting
s
factor
I
Remarks:
Boring #
E31 Nu S PLO D t k-L pt w QjLe- v S M. V e- S "2-0 '
ts- oF- 3• 'MO Lrl w S Pb~j /YT L
Ground
elev.
ft.
Depth to
limiting
factor i
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
inn nn,jnin nr,nn\
PLOT PLAN Page 3 of 3
SCALE 1"= HQ'
Zp `TW PN t .
o-Z.S mi Zro
J? -
r
( a1"I - tTL1oo•0' ON -'►0 IEL 449
tt. `t9 ~
8 .Z
~ Zop'f
B -y
~asz
a.,
668.80' ez.w s
L-t
OP to ^e. cor
°16-q3- J
1079
~ (71 ) 495-0169 M00576
CST Signature - - Date Signed Telephone No. CST #
•
STC - 105 G ^'�
SEPTIC TANK MAINTENANCE AGREEMENT PL.—)
St. Croix County
OWNER/BUYER J E err-EV A- '4- 30-n r k Lop,-F
MAILING ADDRESS I-7'aq- a?5`7 ' ST i J d v, /)e (A), L VrA1
PROPERTY ADDRESS 1/77
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE 1/00cc1✓/ /I-t k/
PROPERTY LOCATION >: 1/4, 1ki t 1/4, Section Ai , T a, k' N-R I(o W
TOWN OF f p}tv, (.2cL I t.e_, , ST. CROIX COUNTY, WI
SUBDIVISION , LOT NUMBER
CERTIFIED SURVEY MA `L I ,VOLUME I I ,PAGE 3111,LOT NUMBER I
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 e piration date.
SIGNED: lR--0-6.
DAIL: -vim 9-��
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
GU
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 ,k(cr�Y - q y L c)Ins IZ �
Location of property N 1/4 AC 1/4, Section aZ 7 ,T 07S N-R //, W
Township E/4 Cct 11L Mailing address h/? Q- al s7'
Address of site ai/77 2 7`1 `.Ja..d
Subdivision name CS r4 !/0-Q, / /t . 3 J 17 Lot no.
Other homes on property? Yes )s/ No
Previous owner of property M i Hari , ( 1/)mmc y 5e /1
Total size of property qG A_ ±
Total size of parcel \c ptL,
Date parcel was created
Are all corners and lot lines identifiable? K Yes No
Is this property being developed for (spec house) ? Yes x No
Volume (( and Page Number 3/1-7 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 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. 47'7 y ,7 , 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.
ales my.- Liikb
Si to e of A icant Co- pplicant
Date of Signature Date of SianatturP
AIL D
JUN ` 6 1996
KA7HL~Ch~ H. wALSH
Register of Deeds
54592. s~croiXco.,wi
0
1
CERTIFIED SURVEY MAP
MILTON AND NANCY SELL
Part of the Northeast 1/4 of the Northeast 1/4 of Section 27, Township 28 North, Range
16 West, Town of Eau Galle, St. Croix County, Wisconsin.
OInaicates 1" x 24" iron pipe weighing 1.13 lbs./lin.
N114 COR. SEC. 27, r 28 N , R16 W, ft. Set .
/COUNTY SURVEYOR'S 14ON.1 Indicates fence.
A/ N£ COR. SEC. 27, 7 2 8 N, R/ 6 W
U=Y~LATTED LANDS /COUNTY SURVEYOR'S MON./
_ S 87•/4'54'•£ 2680.02' _
670, O/ /340.0/' N LINE 7C 114
q t,
669.94 ' 670. 00'
W W
+ O N87•/4'54"W 636.
O a w /306.85' ~0
SHED rl
O ~ OR1VEWAY I 2
2 SHED J,y Z
LOT / a LOT2 o
O q q
~ W q W Jf _7~I \
/0. 192 ACRES SHED LJ +
b 443, 978 q = 10.215 ACRES I q :E 0
q
S0, F r. ` °j
W 444, 978 S0. Fr. O WELL HOIUSf
9,685 ACRES EXC. ROAD R, O. W, q
9.228 ACRES EX C. ROAD R.O.W. ~ ~ I m p
42/, 87/ S0, FT. r/C
% m 40 975 S0. FT. Selo; 2
o Owner's Address: I Q I
m 198 250TH St. WATFRCO RSE I O
Woodville, WI 54028 i 9
1 °o l l y
y
1 ~ ~ O o
I W •I
668. 80' 668,80' b O I^
/9' O a
" (33.04'
N B7. 07'/5 W 635.7o6-
1357.00, O
Z Dated: March 13, 1996 v
C ~
`"Revised this 20th day of June, 1996." I H w
ID %~\cjCi0 /VS/This instrument drafted by Laurence W. i o rol
ro l q
14 Murphy
Z
y I
h = LAUR C•
APPROVEL3 I I
q _
o m W SMPH Y • /
. •
tU ifs LOT 3 ,..~OD'~ N
a u ER F J~ 1* JUN 2 5'W 1 u u ~VII
I~ i WISC. % 20.001 ACRES ro ro O
''4~~ O ~a~~ 871, 244 so. Fr. f ul u I~
,II„/9.506 ACRES EX C. ROAD R. 0.W,CROIX COUNTY f
849, 701 So. Fr. Iy
~ (.o{T1QrSI1YrISiYi PIarxuf I I J
r2i, Zoning and 1
Laurence W. Murphy
R 0AO FMS A grnLr/ ,VN tE t 133 33'
N.11
Registered Land Surveyor
25' If not fecor4od 1 66 I
f
+ /302. 05 within 30 days of 1 33.04'
54 1449 STATE BAR OF WISCONSIN FORM 2 - 1982
WARRANTY DEED
DOCUMENT NO. VOL Q~ D14 9 2 _
,..cf
- Rr-_GIS i'R 3 OFHCE
Milton G. Sell and Nancy E. Sell, husband ST. CROIX CTY., Wl
and wife, holding as survivorship marital RsedbrReeaI
property JUL 2 9 1996
conveys and warrants to Jeffrey A. T,eaf and ,lane K. 01.55 P. M
T.Qaf, hLaband and wife, hot di ng as + . R+1+rr_R bihk
survivorship marital property Reet~Deeds
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS p O
the following described real estate in St. Croix County, Ile.
State of Wisconsin: 0
L/ 9 ~
-rmAt f FER
II $
j PARCEL IDENTIFICATION NUMBER
jl Part of the Northeast Quarter of the Northeast Quarter (NE4 of NEh)
k of Section Twenty-seven (27), Township Twenty-eight (28) North, j
Range Sixteen 16) West, Town of Eau Galle, more particularly
described a Lot of Certified Survey Maps filed June 26, 1996,
in Volume 11 o ertified Survey Maps, at Page 3117, as Document
No. 545921, office of the Register of Deeds for St. Croix County,
Wisconsin.
i,
I
j!
jl
This 1 S riO homestead property.
3{a1¢ (is not)
Exception to warranties: Easements and restrictions of record.
I I'
Dated this C~ L day of A.D., 19 96
(SEAL) -I f (SEAL)
Milton G. Sell
(SEAL) (SEAL)
* Nancy . Sell
li AUTHENTICATION ACKNOWLEDGMENT
~j Signature(s) State of Wisconsin,
ss.
St. Croix Count fill-