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HomeMy WebLinkAbout028-1018-70-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER G. 4 x4p & L l ; ADDRESS q l SUBDIVISION / CSM4 LOT # SECTION ) 2 T 2 d N-R~W, Town of I' v 4-10!4 ST. CROIX COUNTY, WISCONSIN PLAN VIEW , SHOW EVERYTHING WITHIN 100 F T F SYSTEM x F ~ R 5 r a' ~~4 Y ~ \X t I E 4 TNf1T Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK. t e, /7 G C v H G L ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: I Q& G G S 'U Setback from: Well 1&-r- House r/U' Other Pump: Manufacturer Zc 2 Model# Size Float seperation Gallons/cycle: 3 Alarm Location „Se e 'o- SOIL ABSORPTION SYSTEM Width: ° Length 14 ? Number of trenches Distance & Direction to nearest prop. line: /G 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 Safety and Buildings Division ST CROTX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 262379 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: GUERKINK. LARRY RUSH RIVER CST BM Elev.: r Insp. BM Elev.:, B escription: Parcel Tax No.: CIS Cb A9600193 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic. J1,-d (ALL S y 1 dv Benchmark elp Dosing m~i~ AeratioyT- Bldg. Sewer mac) Holdi St/ Ht Iu@4- TANK SETBACK INFORMATION St/ Ht Outlet Vent ir Ito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Septic 1> NA Dt Bottom Dosing NA Wva#eP;6 Aerati NA Dist. Pipe 0 A~ 66 0 Holding Bot. System PUMP/ ORMATION Final Grade Manufacturer o ~ DeXndM rn ° Q ' ~735' /6&3,5 P Model Number 2d TDH Lift Lriction~ 17 r System„ TDH 6,p_4t Forcemain Length 135 Dia. a " Dist. To Well >SD SOIL.ABSORPTION SYSTEM BED/TRENCH width 1, Length < No. Of TJenches No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `'~7 / DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING anu er: SETBACK CHAMBER INFORMATION Type O - Mode Nu-5;;Z-- INFORMATION System: .G.W. tV OR UNIT' DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) n x Hole Size r x Hole Spacing Vent To Air Intake Length Ya Dia. D~ Length Dia. / Spacing q - 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.) 106 &7 r . .17W, SE, SE, HWY 63 LOCATION: RUSH RIVER.12.28 /raq,~ /1 '7 odlfl~ AtL Z: x Fe Plan revision required? es No Use other side for additional information. 5--- SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I', Safety and Buildings Division vp`ri; 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 leck it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propgrtyr~Owner Name i / Property Location L d Q_ (It S~' 1/4 s5 1/4, S 1 , T N, R E (or) W Property Ow er's Mail in Address Lot Number Block Number CitytateZip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned o city Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms O Town OF AiS r I(f v~/~ 4/1~ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment /Condo C l C' j ~G L 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 online A. Check box online B, if applicable) A) 1. New 2. g Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 218 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade C' Required(sq. ft.) Pro s (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Ll r 1ls l; L' Feet Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Exist in strutted Tanks Tanks Septic Tank or Holding Tank t c s tit ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber )f U t ' ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatio_ n of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb 's Signature-( "Stamps) MPRSW NO.: Business Phone Number: Plumber's Address Street, Ci State, Zip Code): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary44- PPerrmit Fee (Includes Groundwater ate ss Is=7, ST!~L_ A roved surcharge Fee) Q pp ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF AP PROVAL/ REASONS FOR DISAPPROVAL, SBD-6398 (R. 015/94) 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 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 (S6D-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; 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. z SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 27, 1996 2226 Rose Street La Crosse WI 54 WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S96-41027 REVISION TO PLAN S96-40563 FEE RECEIVED; 60.00 GEURKINK, LARRY SE,SE,12,28,17W TOWN OF RUSH RIVER 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 approved changes will become an addendum to the plans previously approved. All other portions of the installation shall conform to the original approval. 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. SUDA-7997 (K. 10/84) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations WEGERER SOIL TESTING Page 2 August 27, 1996 PLAN S96-41027 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, erard M. im Plan Reviewer Section of Private Sewage (608) 785-9348 SHDA-7907 (K. 10/84) S96--41 0 27 Page ~ of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE AUG i ; ~y~:• SAFETY o, u' L)GS. LOCATED IN THE SE 1/4 OF THE SfE' 1/4 OF SECTION "~Z-, T -2ZN, R V1 W, TOWN OF v S \-,Zl U kz_~ , ST. G~IX COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT -PAGE 5 of 6 PUMPING CHAMBER STEM ' PAGE 6 of 6 PUMP PERFORMANCE CURVE h ,r`►.OE PREPARED FOR ED y, . tgT,10xs FE UNIAl1 L +~:lz~ v ~ ~.Yt. i N k - ~ ~ V►~ ~ aUO~.a~~ns 13 P~~ D w~ vv1 5 (4 0 °iv, P04 .14'e SEE GO PREPARED BY ox WECEE~EF::;;-" SQ 2 . TEST S 1,,IC.3 ib 4 AND. *1 40~ DES 2 GiV S1EE~V = CE . ' *Je s i a F.R. BOX 74 421 U. BRIM ST. WA GE EH { f Gni5 P RIVER FAUS. VI 54022 a als"101T.. 715-4i -O1b5 ~t wrs. a s 1'~~iZ_c►u~_ 4 >UNIj Y__313. _ S q6 uOjb3 JOB NO. R -20 1 PLOT PLAN Page of 6 Scale . o.zS n1j `~v ' n 2 SMI - tfL, 100 . Q oN e.~41-F, S I.I'~ ~Lr•'SwL Z ~~D' S~ ZX A;~,j')w 6 Ttthh<s hyl i rvs 'qev- cattz Zo of y PvC ~ sT se~~lLC 5 - -P SOS ZKnvC t=.M . 4` rti -n V NNT 5: iZ5 a. Z ~ t t"i1~ 4~ ~ 1 3 ~ SSE Gd \ \ \ 1 \ eoT cam- a~ NZ t~~.o' NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( V required) 3. Install 4" observation pipes with approved caps. ( z required) 4. Septic tank to be %ooo16s0 gallon capacity manufactured by 5. Bench Mark S 0~- "C, ULr 6. Divert surface water around mound to prevent ponding at the uphill side. Page Of 6 Approved Synthetic Covering Frs-7" c.3; Distribution Pipe Medium Sand H _ Topsoil G F Elev ~l~ E D , 3 „ b a 0 `7 % Slope NY t Bed Of 2- 2 2 Force Main Plowed 04 Aggregate From Pump Layer. ® trs D \-0 Ft. ~ ~A~ metro Cross Section Of A Mound System Using E 1.S6 Ft. A Bed For The Absorption Area F 0,8 Ft. ONDivC~ G 1 •-0 Ft. ;vt A 8 Ft. H 1,S Ft. Linear Loading Rate= 9 • b GPD/LN FT B Ft. Design Loading Rate= D .~.GPD/SQ FT I \ Ft. J 1 Ft. K lI Ft. --For-ee r- W 3 Ft L bservation Pipe 8 K A - -----•1 Force Main W ° -~,Distribution Bed Of 2M- 2.2 Pipe Aggregate 1 Observation Pipe Permanent Markers (Anchor securely) `T" l>> s Lb~E s 1 . S~ P~ E Z. o F 6. Plan View Of Mound Using A Bed For The Absorption Area Page Of 6 Perforated Pipe Detoif 0 End View )Perforated End Cap. PVC Pipe Install permanent-marker l aaat end of each lateral Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main P PVC Manifold Pipe Distri ution Pipe Last Hole Should Be I Next To End Cap 1 End Cap /J P Z Z Ft. Distribution Pipe_ Layout S , Ft. SYSTEM X y8 Inches 6 t ion' a", V Y V6 Inches 3i 0 Hole Diameter ley Inch Lateral Inch(es) ODUSTRY, LABOR & HUMAN BELATIONt Manifold " Z Inches F AFETY BUiwiKii" e4A Force Main " Inches # of holes/pipe b . t :5t N Jt Invert Elevation of Laterals 10& S Ft. Place 1st hole -L(4 from center of manifold with succeeding holes at VS' intervals. Last hole to be next to the end cap. - Coinbna-tion Segt;ic; Tank and PUMP CHAMBER CROSS SECTION ARID SPECIFICATIOMS ' PAGE 5 ,OF -VET CAP WEATHER. PROOF JUMCTIOM BOX 'i•C.I. VELIT PIPE N APPROVED LOCKING 2!.10, FROM DOOR, MA►JHOLE COVER wrM .ilMDOW OR FRESH wA(zNlA1G L_P.gEC. AtR IIJTAKE cwaputr - r I 4, MIM. I9• MITI. ' . _ \ 111 PROVIDE I I/JLE T- AIRTIGHT SEAL I III sfi 3gFFL~S A I i I APPROVED JOIAITS r APPROVED JOI?JT $ ` i(o I III w/C.I. PIPE~C WIC..:. PIPE aR T uction _ I II `p l ~`YSi t h 11 ALARM end 83.20 a I 11 ~ydo► ~ I I oIJ C i I POt`i' PUMP____ OFF E D COUCRETE II. Q 5.00 9LOCK 3" APPRovED RISER EXIT PERMITTED OIJLU IF TAIJK MAIJUFACTURE:R HAS SUCH APPROVAL I S&ODIN64 5PEC,IFICATIOIJS SEPTIC f DOSE MANUFACTURER: WUMBER OF DOSES: 3'9 PER DAU TANK SIZE: 000 J 6SO GALLOWS DOSE VOLUME r S.S• T-f"1ZQ S~1S3ZS IIJCLUDIIJG 6ACKFL.OW: l3GALLONS ALARM MANUFACTURER: MODEL HUMBER: ti~L Nw CAPACITIES: A= 1$ 306 GALLOlys ILICHE5 OR swITCH TZ PC• e= Z IIJCHES°OR 3y G, LLOU5 PUMP MANUFACTURER: Z.Ot:_S~<J~ C= 8 IAIGHESOR 136 CALLOUS MODEL UUMBER: g D- 1O INCHES oR 1~0 GALLONS w'th:~.c~ x_y MOTE: PUMP AMD ALARM ARE TO; OC6 SWITCH TYPE: _ MIAIIMUM DISCKARGE RATE -Z.8`O?5 GPM IN5TALLED ON 5EPA4tATE CIRCUITS VEKTICAL DIFFEKE14CE DETWEEIJ PUMP OFF AWD_D15TRI5UTIOM PIPE.. , FEET MwimUM NETWORK SUPPLY PRESSURE . ; 2.50 FEET + FEET OF FORCE MAIN Y, fi'b' FYoft.FKICTIOU FACTOR__ _l-_S-,0 FEET TOTAL OtJUAMIC HEAD = S. FEET Pump chamber DIAMETER IIJTERAIAI_ DIMENSIOM~ OF TAUK: LEM&TH- = ;WIDTH --.;LIQUID DEPTH BOTTOM AREA - " 231= GAL/INCH AS PER MANUFACTURER = ~~:0... GAL/INCH - - - p p -G E OF HEAD CAPACITY CURVE 3 7/e 6 1/4 MODEL "98" 30 4 5/9 8 2 A I 1 3 5/8 6 20 m -l- U O 15 \S xl 4 3/16 4 J ~ 10 Z8 0~ 1 1/2-11 1/2 NPT 2 5 0 NOWN U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 1 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITS/MIN FEET METERS-. GALS LTRS 5 1.52 72 273 10 3.05 61 231 / 15 4.57 5 9170 5 3 5 - zo 6.10 2 25 95 - /16 Lock Val" 23' , CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. • Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without alarm switches. variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - 1/2 H.P. 2 Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model Volts-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. M98 115 1 Auto 9.0 1 or 1 & 7 - 4. See FMO712, for correct model of Electrical Alternator, "E-Pak". 5. Mercury sensor float switch 10-0225 used as a control activator, specify N96 115 1 Non 9-0 2 or 2 & 6 _3 or 4 & 5 duplex (3) or (4) float system. • D98 230 1 Auto 4.5 1 or 1 & 7 - 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim- E98 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 pleat or duplex operation, 10-0002. 7. Two (2) hole "J-Pak", for watertight connection or splice. CAUTION For infomlatioe on additional Zoeller products refer to catalog on Combination Starter, FMO514; All installation of controls, protection devices and wiring should be done by a quati- Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO486; Mechanical AlEemator, FMO495; Alarm Package, FMO513; Sump/Sewalge Basins, FMO487; and Simplex Control Box, fled licensed electrician. All electrical and safety codes should Occupational followed i ing the oast recent National Electric Code (NEC) and the Safely and FM0732 Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 16347 LouhARe, KY 402584:#7 Manufacturers of . OELIfi~ O. SHIP Is KY 40lets Lane `emwrr PUMPS a/rIYCE AF rr o (5021778 2731. 1(800) 928 PUMP FAX (502) 774-3624 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Divisioh of Safety & Builclings 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 S1-. l X 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 DATE PROPERTY OWNER: PROPERTY LOCATION L h~Q,~2-~-( 6 Z~l}J h 881fT-EGT S E~ 14' t/4,P-' 7 N. E (or (j) PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # NAME OR CSM ~I Z ~t1 1 6 - cv 0 ^ of CITY, STATE ZIP CODE PHONE NUMBER CITY []VILLAGE WN RO 80t-1t~wtN, Lv l s qoo Z (-)Is) L8 V_ 2-06 Z - ~ s N vs 3 [ J New Construction Use VA Residential / Number of bedrooms 3 [ t to exis~ Replacement [ J Public or commercial describe Code derived daily flow L~ 50 gpd Recommended design loading rate o • bed, g - trench, gpd/ft2. Absorption area required 3 -1 bed, ft2 31 S trench, ft2 Maxirrlum design loading rate o S bed, gpd/ft2 o b trench, gpd/ft2 Recommended infiltration surface elevation(s) O 1.0 It (as referred to site plan benchmark) Additional design/ site considerations w'1 UvKA~j w/ 8' x y`1 ' ~o 1.1,j . of S kND F/ LL-. Parent material 0 NSS 0U art, e TlLt~ Flood plain elevation, if applicable N A , It S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem ❑ S 9 U ®S ❑ LI [IS ®U 0S ®U ❑ S ®U ❑ S E ill SOIL DESCRIPTION REPORT t Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Boundary. Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tench 1K ' fi I 0-9 ~o-,cZ 3I~ _ sL1 Z~sbk es C) s o;b Z q-Z ~kz 't fZ '3 S 11 Z,'F8 b1t ~1^ c S Ground 3 2~ 3y LO`-1vZ_ Y/6 - C1 CSb1t, yv,~~ cS - o L o. elev. ~ o t. S It. 14 34 -4 0 1b N1 R. L/h. a s its c~ o -I Depth to limiting factor Remarks: Boring # ~ _ C S - o . S o• ~ o-Ly ti0`1.1Z 31 z St l Z,'F ask ~ Z ~y ZS tv~-t►-Z. 3/ t~ S 11 Z `E' s6k wL C S ~ o_ s o . ~ s sus c o Yv< _ Ground elev. ,.0 It. ij Depth to j limiting I factor f Remarks: CST Name:-Please Print Phone. Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: - t l Date: 6 CST Number: M00576 PROPERTYOWNER GQ-JCL1zI/ )x SOIL DESCRIPTION REPORT Page L of 3 PARCEL I.D. # ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BWXJary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench O_~3 1o`t2 3!3 S Z` ,3~ C.S o. S v.b r1j" Z ~3-21~ 1o~-t~Z 3/6 Si I Z' Zs z w►~'~ Ground 3 'L6-uo 1O`t2 Yf(, elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: cnn-aianlp nSiO9~ PLOT PLAN Page 3 of 3 SCALE 1"= 413 ' ~ usH ' 63° o - -L s n1 j `ro Jr J 2 Tftj 3 gr1 - tt. too .o or.~ et~3'SE ~-JTI b oo~S . ~J P hyll x sealic . x OD.k wQi.l. 0 ~m lp raw. o- Or) f- .weksr 2 v~ B:3 \ c1°lO G ~ LIA t3u~o►~ o~ 9~ C=L lol.(~' q6-uz CJ ~ 6- 1' 16 ( 715 ) 4 01 A5 1400576 CSTSignature Date Signed Telephone No. CST # v SANITARY PERMIT APPLICATION BureaSafetyu o oand f f Building lding Water Systems Water S n 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 maybe used by.other government agency programs ❑ Chet; rkt( e. i to 1 ii a licati6n [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location lar Geurkink SE 1/4 E 1/4,S 12 T 21N, R 1 E (or) W Pro y Owner's Mailing Address Lot Number Block Number Af24 Hwy 63 City, State Zip Code Phone Number Subdivision Name or CSM Number Baldwin WI. 54002 1(715) 684-2062 LI. TYPE F BUILDING: (check one) ❑ State Owned ity Nearest Road 0 Village Public 1 or 2 Family Dwelling - No. of bedrooms _ Town OF Rush River 63 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo d 2 l b 1~ 7 O~~ U 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. A/Vew 2. [g Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 [?3 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 1 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 450 376 376 1.19 101.0 Feet 102,6 Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank X 1000/6-0 1 Midwestern FLI ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ El. I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for install I f the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum is Signatur ps MP/MPRSW No.: Business Phone Number: " Mp6646 1-715-698-2266 Joe Stang 1 ~ Plumber's Address (Street, City, State, Zip Code): 506 Willow Dr. Woodville, 54028 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing ent Signature (N mps). A roved Surcharge Fee) pp ❑ Owner Given initial 4~v fir. 40 a~ 9 Adverse Determination 0 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SOD-6398 (R. 05194) 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, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences,- friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; 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 State of Wisconsin Department of Industry, Labor and Human Relations June 13, 1996 2226 Rose Street 'L 3 La Crosse WI 546 ~ ~Ep s 1 3 fS WEGERER SOIL TESTING 421 N MAIN STREET sr cF,x PO BOX 74 ` zpn;1N Qf~, V RIVER FALLS WI 54022 l 6 RE: PLAN S96-40563 FEE RECEIVED: 180.00 GEURKINK, LARRY SE,SE,12,28,17W TOWN OF RUSH RIVER 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. 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, .rard M. S m Plan Reviewer Section of Private Sewage (608) 785-9348 seDA-7r I6W 1 Page of 6 MOUND SYSTEM S960040563 FOR A 3 BEDROOM RESIDENCE LOCATED IN THE S C 1/4 OF THE S e 1/4 OF SECTION 1 Z , T Z8 N, R 0 W, TOWN OF 1~z v S H Z IuTR S`i'. GIZJLX COUNTY, WISCONSIN. INDEX PA GE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ~~~~Y GEV2~.~►.~h zy 3 RECEIVED kA sgooz JUN 10 1996 SAFETY & BLMS. DIV. PREPARED BY ~~®i4141MN~ IN, I,IEGEF;tER SQ I L TEST I [~s(3 copi AND. I G1f~t S)ERET I CE ; yr CJ` $ ARTHUR R 4 S WAG 2 W0-915 PR = P~6vA I~ P.O. BQl 74 421 K. 11AIK ST. _ cRTH, coil itiOn RIVER FANS. VI 54422 ~p ? tea" 715-425-010 Nrrrr~iM{•_•••• ` .t ,m ~SIG14S " volr pf 1?1©OST . 1,p8~S NU ~~.4.~~'aE:i:'i ~V of SAE N SEE GO JOB NO. b z PLOT PLAN 6 Pages Z of . Scale.. 1"= qO ' S96-40563 o.2S Mj 'tv J n V D 2 Q! 3 J a - tTi . LO . p on.) e RA'TE , 74 b oo~S . h-S ~l2 C0Z L- It z-o o r- y"Pv C V ST• x owtw~.>r ~ \3uo~ 2''Pvc ~ m lowfw. ~a7°- o e?.~r ',~®Z 1. 2 co B~3 l ~ 81 LL to V Fevees -CRAP UAJl'S CAni~~2 ~2 ~vO.CI' 130~~1'1 OK 6!~ NOTES : 10 l.ti' 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. ( Z required) 4. Septic tank to be `oooI&S0 gallon capacity manufactured by 5. Bench Mark S E"G- "C, Ucr 6. Divert surface water around mound to. prevent ponding at the uphill side. Page 3 Of Approved Synthetic Covering C- 33 Distribution Pipe Medium Sand H _ G Topsoil = F Elev. 3 ` b ~ % Slope Bed Of 1" 2 %2 (Force Main Plowed Aggregate From Pump Layer D ~•o Ft. Cross Section Of A Mound System Using E \,-)Z Ft. A Bed For The Absorption Area F O. `3 Ft. G k.O Ft. A S Ft. H l- S Ft. Linear Loading Rate= a- io GPD/LN FT B 4-7 Ft. Design Loading Rate= o.~.GPD/SQ FT j 16 Ft. J -7 Ft. K k~ Ft. i e1-LTern rreez b~ • ec Position L Ft. of Force Main-_ W `3~ Ft. L _ Observation Pipe nA I - Distribution \,"Bed Of iM- 2 z Pipe f Aggregate Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page Y Of Perforated Pipe Detail End View Perforated End Cap, PVC Pipe f . o~. arc Install permanent marker at end of each lateral Holes Located On Bottom. Are Equally Spaced Q S Q PVC Manifold Pipe PVC Force Main Distn ution R Pipe Last Hole Should Be I Next To End Cap End Cap P Z Z Ft. Distribution Pipe. Layout S Ft. X V8 Inches Y 146 Inches Hole Diameter t~V Inch Lateral I Inch(es) Manifold 2- Inches Force Main Inches #of holes/pipe b Invert Elevation of Laterals101•5 Ft. Place lst hole 2V from center of manifold with succeeding holes y at LQ intervals. Last hole to be next to the end cap. Combination Septic;Tank and - PUMP CHAMBER CROSS SECTIOM AMD SPECIFICATIOAIS PAGE S OF E' -VE►JT CAP WEATHER PROOF JUWCTIOtJ BOX 4' C.I. V£AIT PIPC N PPROVED LOCKIAIG 10' FROM ODOR. MAWHOLE COVEK rvIV -iimoow OR FRESH wARNIUG LABEL AIR IIJTAKE S CA • r Hr MIU. 1, K-RA f ~ ~ 18" MI1J. L-_ PROVIDE I IAILET AIRTIGHT SEAL I III ` ' i II V ids APPROVED JOINT A I I I ( APPROVED JOIIJTS I I I W/C.I. PIPE iKPvC- W/C.z. PlvEatt. Tank construction t III ALARM shall comply with _ I I ILHR (83.15 and 83.20 8 I 11 t ow C L'OFF CLEV. FT. PUMPO COUCRETE !z ~j's DLOCK 3" APPRovEC RISER EXIT PERMITTED OWLtJ IF TAWK MAIJUFACTURCR HAS SUCH APPROVAL ISEDDING SEPTIC f SPECIFICATIOAIS DOSE I,ll~l~ ' 1J Q~ ST TA W K MAIJUFACTURCR: WUMbER OF DOSES: 3'9 PER DAU TANK SIZE: ti0~0 6 SO GALLONS DOSE VOLUME I el ALARM MAUUFACTUILER: L_- ql-frX0 Zt 01 -S IIJCLUDING 6ACKfLOW: GALLONS MODEL NUM6ER' LtzL Hw CAPACITIES: A= I$ IMCHE509 10E' CsALLOIJS SWITCH TtfPC: Z"Y B= Z IIJCHES"OR 2% OfLLOUS PUMP MAIJUFAGTURCR: Z~:u_siFz C = S IUCHE5 OR 16 CALLOUS MODEL NUMBER: S7 D= V3 INCHES OR 111~) GALLONS Y'1~MC.v1?Y MOTE: PUMP AIJD ALARM R TO 5E SWITCH TYPE: _ MILIIMUM DISCHARGE RATE Zg'O6 GPM INSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AUO._D15TRIBUTIOIJ PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . : . . . . . . . 2 S~ FE.ET + `3O FEET OF FORCE MAIM X FYo►LFRICTio►J FACTOR. z,~9 FEET TOTAL DyWAMIC HEAD = l p.21, FEET Pump chamber DIAMETER 38 IIJTERWAL DIMLIJSIOWt OF TANK: LEW&TH ;WIDTH -;LIQUID DEPTH BOTTOM AREA - 231= GAL/INCH AS PER MANUFACTURER = \~=Q~ GAL/INCH or- 6 - ' • , 4'% 61/4 ✓ HEAD CAPACITY CURVE 45/6 W "57" - "59" SERIES w u 45/6 25- _1112-111h 0 NPT 43/16 6 20 l D a w x U ~ 15 a z G 4 915/16 J Q ~ 10 W, 2L O 33/, 2 ~•O 5 TOTAL DYNAMIC HEAD/ FLOW PER MINUTE EFFLUENT AND DEWATERING HEAD CAPACITY UNITS/MIN 0 FEET METERS GAL LTRS US 10 20 30 40 50 5 1.52 43 163 GALLONS 10 3.05 34 129 LITERS 0 80 160 15 4.57 19 72 FLOW PER MINUTE 19.25 5.87 0 0 CONSULT FACTORY FOR SPECIAL APPLICATIONS e Piggyback Mercury Float Switches *Available with special cord lengths of 15', available. 25', 35' and 50'. e Variable level long cycle systems *Alarm systems available. available. a Duplex systems available. Standard cord length - automatic 9 ft. SELECTION GUIDE Standard cord length - non-automatic 15 ft. 1. Integral float operated mechanical switch, no external control required. 2. Single piggyback wide angle mercury float switch or double piggyback mercury 57/59 SERIES Control Selection float switch. Refer to FM0477. Model Volts-Ph Mode Am SIM ex Duplex 3. Mechanical alternator 10-0072 or 10-0075. M57/59 115 1 Auto 8.0 1 or 1 &7 - 4. See FM0712 for correct model of Electrical Alternator, "E-Pak". N57/59 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 5. Sensor mercury float switch 10-0225 used as a control activator, with "E-Pak" D57/59 230 1 Auto 4. 1 or l &7 - duplex (3) or (4) float system. E57/59 230 1 Non 4.0 2or2&6 3or4&5 6. Four (4)hole"J-Pak", junction box, forwatertight connection orwired-in simplex or 2 pump operation, 10-0002. 7. Two (2) hole "J-Pak", for watertight connection or splice. 10-0003. 57 Series - Wt. 27 -.3 H.P. 59 Series - Wt. 29 -.3 H.P. CAUTION For iMormation on additional Zoeller products refer to catalog on Combination Starter, All Installationotcontrols,protectiondwleesandrddngshouldbedonebyaquaRfled FM0514; Piggyback Mercury Float Switches, FMO477; Exectrical Alternator, FM0486; Mechani- licensed electrician. All electrical and safety codes should be followed Including the cal Alternator, FMO495; Alarm Package, FMO513; Sump/Sewage Basins, FMO487: and Simplex most recent Nations! Electric Code (NEC) and the Oceupadonal Safety and Health AM Control Box, FM0732. (OSHA). RESERVE POWERED DESIGN r1 For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: A0, 80X 16347 Louis KY 40256-0347 Manufacturers of... TO. 3280 Od uisvft, KY 40216 Lane M p ZZ7Z_ZZFjff O. SHIP Ln (502) 778-2731.1(800) 928-PUMP QUAL/rY PUMPB iVer ENS FAX (502) 774-3624 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Larry Geurkink MAILING ADDRESS 424 Hwy 63 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE Baldwin, WI. 54002 PROPERTY LOCATION SE 1/4, SE 1/4, Section 12 T 28 N-R 17 W TOWN OF Rusu River ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , 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 o-npleted and turned to t t. Cro' County Zoning Officer within 30 days of the three year expir n date. SIGNED: DATE: C 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 Larry Geurkink Location of property SE 1/4 SE 1/4, Section 12 ,T 28 N-R 17 W Township Rush River Mailing address 424 Hwy 63 Baldwin, WI. 54002 Address of site subdivision name Lot no. Other homes on property? Yes x No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes X No Volume ,2 and Page Number 7 U 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 ON he office of the County Register of Deeds as Document No. G ti 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 u office of the Coun-ty Re ister of Deeds as Document No. Signa re of Applicant Co-Applicant 12D Date f Sig tur Date of Signature S44 / 012 State Bar of Wisconsin Irorm 2 1",152 WARRANTY DEFT) DOCUfAENT NO. 1182PAu- 1 O _ REGISTER'S OFFICE l - _ - - - - ST. CROIX CTYM WI Reed to Read ______Lqurrel W. Geurkink and JoAnne Geurkink,- N 3 1996. 11 hu'baLtdnd ifeTas joint 1ie_ndnLs-,__-- ~I - - at 2:30 P . M ' conveys a a .v tram to J. Dona June and Mary Az ek2_ -~Kzska... R JAk nhus~anc an wi e, RG*W d Drift - - THIS SPACE nESERVEO fort nECOAOINO DATA - - i, NAME AND nETUnN Aeoness a jlii - - - Equity Title Services I - 400 S. 2nd St. the following described real estate in St. Croix_ - HlldSOn. WI 54016 County, Slate of Wisconsin: 169707 028-1018-70-000 It - (Parcel Identification Number) , A parcel of Land located in the Southeast Quarter of Southeast Quarter (SE 1/4 of SE 1/4) of Section 12, Township 28 North, Range 17 west, described as follows: Beginning at the Northeast corner of the SE 1/4 of SE 1/4 of said Section 12, thence South on the East lice of said Section 12 a distance of 208.71 feet, thence West parallel to the North line of the SE 114 of SE 1/4 of ~I said Section 12, thence East 411.42 feet to the point of beginning, St. Croix County, Wisconsin. ''ter s ~l This 1S homestead property. ( (is) KKW !l 1 ( Exception to warranties. Easements, restrictions and rights-of-way of record, if any. .i t II 1st June , 19 96 , i II ~ Z.Laurr day ~t _ (SEAL) _(SEAL) 1 W. Geurkink JoAnne aurkink (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT a-TAI-E OF WISCONSIN Signature(s) SS. t St. Croix County. 1st da of authenticated this day of '19- Personally come before me this day June 19 96 the above named - La,~,:_rel_jj, Gpurki nk and TnAnna or____ ~r_1r~?ik husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN ' (If not. authorized by §706.06, Wis. Slats.) :tv me kn it to be the per S who executed the rorrgoi g instrument an / ckknn ledge the same. THIS INSTRUMENT WAS DRAFTED BY 7 swab ~ Attorney Kristina 0gland _ enda Poulin State of VAsemIn VV 2=1 ' Hudson. WI 54016 Notary Public St Unix County. Wis. a DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 2 WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA T. CRO EGISTERS T. CRO husband S F2 OFFICE Arthur Everson and Lois Everson, S BY THIS DEED, IX CO., WIS. and wife, as point tenants, and said Lois Everson in Reed for Record this__ ~ her individual right, day of__Sept.__--_A.D.197) Grantor conveys and warrants to Laurrel W. Geurkink and JoAnne 11_'.2_M. Geurkiink, husband and wife, as joint tenants, Resister of Deeds Grantee S for a valuable consideration RETURN TO the following described real estate in St. Croix County, Stateomisconsin: Harold D. Olson A parcel of land located in the Southeast Quarter of Southeast Quarter (SE-14 of SE-14) of Section Twelve (12), Town- s homestead ship Twenty-eight (28) North, of Range Seventeen (17) West, This i property. St. Croix County, Wisconsin, described as follows: Beginning at the Northeast cor- ner of the Southeast Quarter of the Southeast Quarter (SE-14 of SE-14) of said Section Twelve (12), thence South on the East line of said Section Twelve (12)a distance of 208.71 feet, thence West parallel to the North line of the Southeast Quarter of the Southeast Quarter (SEu of SE-14) of said Section Twelve (12) a distance of 417.42 fee thence North 208.71 feet to the North line of the Southeast Quarter of the Southeast Quarter (SEu of SEk) of said Section Twelve (12), thence East 417.42 feet to the Point of Beginning. Said grantor agrees to pay all.,real estate taxes for the year 1973 . TRANSFER FEE Exception to warranties: . Executed at Baldwin, Wisconsin this 5th day off September 1913 SIGNED AND SEALED IN PRESENCE OF /N'~~ ~~Z !•y i%!L! (SEAL) n Arthur Everson l~ It_x w la_.GJ~ (SEAL) )Harold D. Olson /L Lois Everson L J LI_eT l YY , ~Cl/lJ~~l l~ LL / i9~ (SEAL) Pearl Grotenhuis (SEAL) Signatures of authenticated this day of 19-• Title: Member State Bar of Wisconsin or Other Party Authorized under Sec. 706.06 viz. STATE OF WISCONSIN St. Croix sa. count(. 5th as September 19 73 I came before me. this Y of