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(gA-/l) /,1 n/ J~ S/ Z3 tY 'cr SUBDIVISION / CSM S C'2 0 ~~c S f ~¢-~2~ S LOT SECTION~T N-R W, Town of ClqtO "t D X \~IST. CROIX COUNTY, WISCONSIN q0~ PLAN VIEW 0 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 7- 0 f /%N v ~ N ~oe INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: 400 sr- GJ ( <0eA Fo unld Ovv- 7 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: ~z 4-a gll0 Setback from: Well House 2/0 Other Pump: Manufacturer /Ul S Model# /nC ~O Size Float seperation Gallons/cycle: Alarm Location ~fk5(t cewf- ,:SOIL ABSORPTION SYSTEM Width: -S LengthS Number of trenches -Z Distance & Direction to nearest prop, line: Setback from: well: s o House 7,5Q Other ELEVATIONS / Building Sewer 7i,3 ST Inlet. 6 ST outlet Ks` PC inlet T 6 PKMP ?AD PC bottom v Pump Off Header/Manifold Z 5-7, Z6 Bottom of systems Existing Grade 1031 Final grade DATE OF INSTALLATION: 3 PLUMBER ON JOB: LICENSE NUMBER: P 61 7-g INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SE` 4AGE SYSTEM County: LaborandHumanRelations INSPECTION REPORT ST. CROIX safety and 3uildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town of: State Plan o.: BATES. STEPHEN & KATHERINE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: a ~ 4 TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing AZ 59 Aeration Bldg. Sewer Holding St/Ht Inlet p' ? TANK SETBACK INFORMATION St/ Ht Outlet Vent TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet Ar • 90 y. 9 ` Septic > 3 , NA Dt Bottom 5 S,. Dosing NA Header/ Man. g6 < 71, ` Aeration NA Dist. Pipe c' Holding Bot. System 0, PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand`' f,0,1.4 Z> Model Number GPM I Loss Friction System TDH 5,I~' Ft TDH Lift Forcemain I Length ~U/ Dia. I-I Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK INFORMATION TypeO CHAMBER Model Number: System: /a 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 : HU DSON . 28 . 29. 29W . SW. NW. JOSEPH CIRCLE a_x Zn revision required? ❑ Yes [If No Use other side for additional information. 19411 0"(e44 96~1k.,,aw ~a SBD-6710 (R 05/91) Date I e is nature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems In accord with ILHR 83.05, Wis. Adm. Code 201 E. Washington Ave. 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 12 x 11 inches in size. (f /,C G / • 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 (Privacy Law, s. 15.04 (1) (m)]. ❑ Check if revision to previous application State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location +Alf 611-vt BA-Fe-"s s (,a/4 /V {V 1/4, S -2- P T Z , N, R E (or)& Propert Owner's Mai Iin ddress Lot Number Block Number Znl2r/ City, State Zip Code Phone Number Subdivision Name or Gi kamber z-3 Cp`o /x- Fs II. TYPE F BUILDING: (check one) ❑ State Owned E] ity Nearest Road Public 1 or 2 Family Dwellin - No. of bedrooms E3 Menage own OF k III. BUILDING USE: (If building type is public, check all that apply) Parcel. Tax Number(s) 1 ❑ Apartment/Condo ©ZO •-/,3/s - 2 Q 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. ❑ Replacement 3_ ❑ Replacement of 4 E] Reconnection of System System Tank Only Existing System 5_ ❑_Exi stin9 gSystem 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 12gSeepage 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 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/da/sq. ft.) (Min-/inch) q~,OS Elev (U 7s6 7S~ ~ Feet /O/To Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Ex per. New Existin Gallons Tanks Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 2 dt) /?-&o G.j -E~c s, ICI ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber fev dv , ` ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum er's Name: (Print) Plumber's ignature: (N ps) MP/~ R0%hNo.: Business Phone Number: ©6 ~ C.S0 6 Z Plumber's Address (Street, City, State, Zip Code): ~-SWd7Z ~ ~ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Agent Sig ature (N a s) pproved ❑OwnerGivenInitial Surcnargelee) 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 , 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 Wisconsir-PAdministrative 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. - L 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. Vl. 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 constructea and tank material. Complete for all septic, purnp/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. PL 4/J LL G~ M l0'° -36-7 a anti a~ a 214 F ' L yet w Q PAGE OF _ Cro S S Sec I u n o eo Sy.s ern Fresh Air Inlets And Observation Pipe 1 -Approved Vent Cap MWmwn 12' Above Final Grade 20 - 42' Above Pipe _ 4' Cast Iron To Final Grade Vent Pipe Marsh May Or Synthetic Covering Yin. 2' Aggregote - Over Pipe . Olstributlon - Tee Pips o 0 0 BeMatb Pip. ( 13 Aggregate a Perforeled Pipe Below Coupling Terminating At - Sollom Of System ProPoSeD ~Inal. grr.Cl< SOIL.. FILL DISTRIBUTIOU PIPE APPROVED $JQfjHETIC COVER MA7ERIA~- OR 9" OF STRAW r OF AGGjAlFIFM OR tAARSN HA`~ a OF Yp ELAT E ALE I aF T_ U DIST1115UTIOU PIPE TO BE AT LEAST INCHES BELOW ORIGIAIAL GRADE AWU AT LEAST20 INCHES BUT 1.10 MORE THAM 42 IUCNES BELOW FMAL GRADE MAXIMUM Milli OF F-XCAVATIOO FROM ORIGWg4 6KADF- WILL BE INCHES Pummum M" OF EXCAVATION FROM 0oKI4IbAL (jRAD€ WILL BE -INCHES SIG"ED: 9 LIGEWSE DUMBER: a DATE: ~i/~ PAGV cr PUMP CHAMBER CROSS SEC IOIJ AMD SPECIFICATIMS VEUT CAP 4"C 2.I5. V FERONTM PIPE DOOR, WEATHERPROOF APPROVED LOCKIAIG JUMCTIOM BOX MAMHOLE COVER R, WINDOW OR FRESH 12"MIU. AIR INTAKE I GRADE i I 4" MIM. I IB"M1u. COMDUIT 18"MIAs. ll~ IAILET PROVIDE I AIRTIGHT SEAL I ~ I I I I ALARM B II. I I *APPROVED I OAI JOINTS WITH I ELEV. FT. APPROVED PIPE 3' ONTO PUMP ` OFF D SOLID SOIL COAICRETE BLOCK RISER EXIT PERMITTED OWLy IF TAWK MAMUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOAIS DOSE TAWKS MAIJUFACTURER: r`t-t~i~-1622-5 I.IUMBER OF DOSES: PEP, DAS TAWK SIZE ~vV GALLOUS DOSE VOLUME J ALARM MAAIUFACTURER: IKICLUDIMG BACKFLOW: GALLOWS MODEL UUMBEK: CAPACITIES: A= IMCAES OR (Lo GALLOWS SWITCH TYPE: B= Z IMCHES OR ~60 GALLOWS PUMP MAMUFACTURER: C= - IMCHES OR C~ GALLOWS MODEL IJUMBER: Ss 3~ 73 D- INCHES OR /60 GALLOWS SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO BE MIMIMUM DISCHARGE RATE GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFEKEAICE BETWEEU PUMP OFF ARID DISTRIBUTIOAI PIPE.. aQ FEET + MIAIIMUM METWORK SUPPLY PRESSURT~,E/. , , , , . , , 2.5 FEET + [W FEET OF FORCE MAIM X F/oc pzFRICT10M FACTOR. FEET TOTAL DSMA.MIC HEAD = FEET i IMTERIWAL DIMEIJSIOAIt OF TAUK: LEAIGTN ;WIDTH ;LIQUID DEPTH SIGIJED: LICENSE IJUMBER✓~ 01-7y ~ / ~ ~ r,~.,~ rnr~r.r•~V lik.$IC1N1~ 3iT.~i , W ~ "P !s 427-00 ~ i ' -307-00. F o©LIn 80 a0a z r 0 w u M co 5 , l d q S $ ~r, 3 6 1 co Y ' OD LI) a n1 co wool CAT E t.) TO do r , JOSEPH W ,~,r.rr.•rrr EhlGlNFxau~~. 1 1 r /eo }o!•nwoo/C1AV~4n Goa l Gy G/1rgi+~ Vie, mm ` I ' t S25 SSM33 1/4 HP Submersible Sump Pump 1/311P Submersible Sump & Effluent Pump VERSATILITY FOR MANY LIGHT DUTY JOBS. DESIGNED FOR LIGHT APPLICAITONS. ■ Designed for drain waier removal, or permanent ■ Removal of drainage water and light septic lank effluent. lications bris. 0 Au ■ UL (except proximity switch°motdel) and CSA listed, ■ UL,tCSAtand SSPMA listed ration models available. SSPMA approved. ?CURABLE MOTOR FOR YEARS OF SERVICE. HEPVY DUTY RELIABII.TI'Y, a Oil-filled motor for ■ Oil-filled motor for maximum heat dissipation, continuous bearing lubricationmaximum heat clissipafion continuous bearing lubrication. ■ Recessed vortex impeller for free flow of li ■ Recessed vortex impeller for free flow of liquids, solids. quids, solids. ■ Thermal overload protection with auto reset. ■ Thermal overload protection with auto reset. LWNTENANCE-FREE OPERATION ■ Wide-angle mercury switch, or proximityswitch for small 10" dia. sumps. PRODUCT CAPABILITIES PRODUCT CAPABU ITIES CapaC76es to 28 gpm (IOS rpm) Heads to 23 K. (7 m) Capacities to 31 gpm (117 lpm) Pu(mp Down Range Heads to 23 ft. (7 m) F1So it h O -on) _ ~nP awn Range' 7-101n. (178-254 mm) 7 in. 178 mm) (Switch Off-On) Proximity Switch 4 in. (101 mm) Solids Handling 1/4" dia. (6.4 mm) Solids Handling I/4" dia. (6.4 mm) Liquids Handling drainage etlluent liquids Handling drain water Intermittent Liq.'It:mP. to 150°F (66°C) Inermittent Liq. Temp. to 140°F (600C) fdotor Motor 1/3 HP shaded pole 1/4 HP shaded pole. 3000 rpm Electrical 115V, 7.5A 19). 60 Hz. Electrical 115V, 9A I , 60 Hz. pH Range 6-9 pH Range 6-9 Dixharge. NPF 1-1/2 in. (38.1 mm) Discharge. NPT 1-1/2 in. (38.1 mrn Min. SumF Dia 12 in. (304.8 mm) . Min. Sump Dia. Housing h Float Switch ]8 in. 457 mm envy cast iron PrO~ty Switch 10 in. 254 mm~ Power Cord 10 it.. 16/3, SFFO/Sl rOW-A; Housing cast iron Mecho-I Seal type 6. carbon & ceramic Volute Case thermoplastic Automatic model oNy Power Cord 10 ft.. 16/3, S.UO/SFFOW-A; 20 ft.. 16/3. SJOW/S IOW-A Mechanical Seal type 6. carbon & ceramic PERFORMANCE CURVE PERFORMANCE CURVE CAPACITY - LITERS PER MINUTE '5 30 45 60 76 go 105 CAPACITY -LITERS PER MINUTE 240 20 40 60 so - 100 120 z. 22 7 22 SS 20 VM n 6 N 20 MP W I 8 M 18 LL 15 5 ru 16 LL 3 14 14 5 a 12 = IQ Q W 17 i 6 O i j /2 4 a 10 S x 0 6 z o ° 8---- 3 a F o 4 2 o s 10 ~s za zs ao 1 4 CAPACITY -GALLONS PER MINUTE 20 5 10 15 20 25 30 35 CAPACITY -GALLONS PER MINUTE 7 , Isc,msin Department of Industry, L.aborand Human Relations SOIL AND SITE EVALUATION REPORT 3 Division of Safety & Buildings ' in accord with ILHR 83.05, Wis. Adm. Code r✓ .01 CO 1Y=` Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but { St Croix'~J jrq not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P L LD. i i t dimensioned, north arrow, and location and distance to nearest road e in APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R D BY . DAT PROPERTY OWNER: PROPERTY LOCATION John Rauchnot GOVT. LOT ` 3....., ~a SW 1/4 NW 1/4,S 28`T 2 ,N. kw) W PROPERTY OWNER':S MA!I_ING ADDRESS LOT # BLOCK # SUED- NAME OR CSM # 527 Co. Rd. #W 12 na St. Croix Estates CITY STATE ZIP CODE PHONE NUMBER ❑CITY (~VILLAGE MOWN NEAREST ROAD Hudson, WI. 54016 (715) 386-3052 HuTson CrosIpy Dr. [ )i New Construction Use [xJ Residential /Number of bedrooms 3 [ ) Addition to existing building j ) Replacement [ I Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, 2 .8 2 gpd/ft trench, gpdm Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 - 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) trenches 98.05 & 96.4 ft (as referred to site plan benchmark) Additional design / site considerations alt site= trenches @ 95.9' & 93.4' Parent material outwash Flood plain elevation, if applicable na It S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system ®S ❑ U ❑ S ®U EIS ❑ U 2! ❑ U I ❑ S (RU ❑ S I U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft in. Munsell Ou. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trerxil 1... 1 0-9 10yr2/2 none 1 2msbk mfr gw 2f .5 .6 2 9-27 10yr4/4 none sl 2msbk mfr gw if .5 .6 Ground 3 27-87 7.5yr4/6 none co s Osg ml na na .7 .8 elev. 101.3 ft. Depth to limiting factor +87" Remarks: Boring # 1 0-6 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 `Y 2 6-31 7.5yr4/4 none scl 2msbk mfr gw if .4 .5 3 31-84 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 96.4 n, Depth to limiting factor +84 Remarks: CST Name _Please Print Gary L. Steel Phone: 715-246-6200 Address: 1 4 200th. Ave , New Richmond, WI. 54017 Signature: Date: CST Number: 11-4-95 cstm 02298 Page ? of 3 , PROPERTY OWNER John Rauchnot SOIL DESCRIPTION REPORT , PARCEL I.D. # pending I Depth Dominant Color i Mottles Texture Structure Consistence lBou dary Roots GPD/ft Bed iTrerdi Boring # Horizon in Munsell Qu. Sz. Cont. Color I I Gr. Sz. Sh. I 1 0-6 10yr3/3 none l 3 2 6-10 10yr4/4 none sl 2msbk mfr gw 3.f .5 .6 3 10-82 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 99.4 ft. Depth to limiting factor +82" Remarks: Boring # 1 0-16 10yr3/3 none sl 2mgr mvfr gw If .5 ;:.6 2 16-84 7.5yr4/6 none co s Osg Ground elev. 96.6 ft. Depth to limiting factor +84" Remarks: Boring # 1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 ~.6 5 2 10-27 10yr4/4 none scl 2msbk mfr 9w If .4 .5 na .7 .8 3 27-88 7.5yr4/6 none S Osg ml na Ground elev. 101.6 ft. Depth to limiting factor +88. Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel John Rauchnot 1554 200th Ave. CSTM2298 WIWI S28-T29N-R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 lot #12-St. Croix Estates 1"=40' 'Po BM.= top of 11'steel pipe C el. 100' A Alt. BM.= nail in Juniper tree C el. 103.7' 77 J~ i.71 Ao 50, Gary L. Steel 11-4-95 05-09-1996 07:24AM Richard ConstructionsInc. 715 425 1089 P.02 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERIBUY ER C',ty~)*U t' Jean U''TATIwg. t • ~ rtic MAIIJNG ADDRESS \AZ\ jotaaQ au W\JE hJ;j , um Ss )13 PROP=ERTY ADDRESS C kc&"u C.\ cl-L. AumoN 1 W X (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~-y dcr,~, 11,r PROPERTY LOCATION _ZM 1/4, )IV _ 1/4, Section Qg • T-_N-RW TOWN OF )a ST. CROIX COUNTY, WI SUBDIVLSION SS Ucsw 'L S'wis.& LOT NUMBER CERTIFIED SURVEY MAP VOLUME ]JS~, PAGE LOT NUMBM 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 took pumper. What you put into the system can affect the function of the septic tank as a treatment a 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 'tb"is program in August of 1980, with the requirement that owners of all new systems ag m 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 mad 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 y expiration date. SIGNED: DATE: A- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 05-09-1996 07:24AM Richard ConstructionoInc. 715 425 1089 P.01 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 X-Imts Location of property SW -1/41/4, Section _;gL_, T_q _N-R__a_W Township 12s,* oT_ IM A Mailing address LAS l omi~Sowtr U\\ a A 'C K Z Address of site .!)t, 1c&4.P1', ukla 1NyD&'~'M . )NI Subdivision name & C_Wnw Y_-MlE5 Lot no. _ Other homes on property? -Yes--A-No Previous owner of property I N&JL" o tt-4 "wMmT QoW.1,h%y Total size of property 10tl S© f"TTotal size of parcel Cli 1971 SQ '--71, - Date parcel was created A aghjn Zn A06 Are all corners and lot lines identifiable? __~_Yes No Is this property being developed for (spec house) ? Yes x No Volume 1L,G and Page Number as recorded with the Register of Deeds. INCLUDE WITB•TBIB APPLICATION TS8 FOLLOWINA~. A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PA __4E 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. C2,r-,j , 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. Z~n~11 Signature of Applicant Co-Applicant - 9- 9G Date of Signature Date of Signature Q002 .Q5/09/96 08:37 '8715 386 9281 1st FED-LaLeHU VOL. 1101iPAG: 4h C •bocLau E'NT NO, STATE BAR O. ISCONSIN FORM 2-1982 TMS SPAC' 'RESERVED FOR RECORDING DATA WARRANTY DEED R doCland Development Co " 11 JAN 3 1996 Katherine 10:15 A. f;7 ' conveys and warrants to XXMM ku&dud-and wife .L 1 ~ v.of' VF 760cls RLPMAN TO, the following described teal estate in St Croix County, State of Wisconsin rAx PwrtwcEl-Na 0ZI'^ 121 C - Z~ _ Lot 12, St Croix Estates in the Town of Hudson, St. Croix County. Wisconsin- AR This is not homestead property. (is) (S-) Exceptions to Warranties: Dated this - 1 X day of Zh&MUb= 19 9s (SEAL) SEAL.) ~ (SEAL) (SEAL) • i AUTHIMITICATION ACKNO%VLEDGMENT Signatures authenticated this day of STATE OF M NNESOTA 19 D9kat County Personally carne before me, this 18 _day of --°-ber 1996 the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not authorized by 706.06, Wis. S=c.) This instrument was drafted by who executed the to the known to be the person BridSeland Development Company foregoing instrument and acknowledged the same. (Signatures may be authenticated or aelmowledged. ir~~~t9 T Rancr Both are not necessary.) Notary Public nAti^rs = county, 1VfN My commission expires January 1. 2000. 0 DARLA.. AAM OEM" =4 DDANMOWNTY OR iCwnlsslon E*m im. 91.2000 *Names of persons signing in any capacity should be typed or printed below their sis atiu=. 3132 NrF 0021 WARRANTY DEED STATE BAR OF WISCONSIN, FOR M NO. 2-1982 ME40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 to W 30 4- 8 E rZ+ 25 z 0 l~ 20 6 15 a F-- 4 0 I- 10 2 5 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F. E. Myers, A Pentair Company -1101 Myers Parkway, Ashland, Ohio 44805-1923 419/289-1144 FAX 419/289-6658 Telex 98-7443 K3326 7/91 Printed in U,S.A. i