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STC - 104 CO e
AS BUILT SANITARY SYSTEM PORK ti n 15~~3
OWNER /Ye.r/a~ GJd d c~ 'vyd+~~ GE
1.9
ADDRESS ZA, d /a/ S
7
SUBDIVISION / CSM# LOT #
SECTION T N-R W, Town o
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
'`jr`fG II
G 4'O G
P
e~
sr
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:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: w e5.
Liquid Capacity: /dal
Setback from: Well ,S() House 30'
Other
Pump: Manufacturer_,:,!!-,.,, ,
Model# _.OF- Size
Float seperation
Gallons/cycle:-,/5-'e
Alarm Location
~ SOIL ABSORPTION SYSTEM
Width: /Length
Number of trenches 2.
Distance & Direction to nearest prop, line:
Setback from: well: /01 1 House-D&'~- 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: ~,qg
LICENSE NUMBER: ~Z
INSPECTOR:
3/93:jt
Wisconsin-Department of Industry, PRIVATE SEWAGE SYSTEM County:
LaL-Or and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GtNERAL INFORMATION VA 79
P bger s RY & ARDELLA E] City E] Village R Town of: State Plan No..
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
~;,r. rI1'~ Benchmark
Septic
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
ii tontake ROAD Dt Inlet
TANK TO P/ L WELL BLDG. A
Ar I
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
oss
Forcemain Length Dia. Dist. To wen
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I N
LEACHING
SETBACK Manufacturer:
SYSTEM TO P/ L BLDG WELL LAKE/STREAM
INFORMATION Type O ~n >7I a < /J ;f OR UNIT CHAMBER Model Number.
System: 'fr S
DISTRIBUTION SYSTEM
[Heagth der / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
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.) f-f ,
LOCATION: Baldwin.18.2 16W, S, NW, Hwy. 63
l
J
Zj,
Plan revision regd'yIe❑ Yes ❑ No r
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
bILHR SANITARY PERMIT APPLICATION
"ZI In accord with ILHR 83.05, Wis. Adm. Code COUNTY
~v si_ l@d x
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than a 33 4 r/ 9a
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
d ~ ll %A141 Y4, S T;2F 401% N, R E (or
PROPERTY OWNE S MAILING ADDRESS LOT # BLOCK #
47a Z 'Z
CITY, STATE LCODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
r
II. TYPE OF BUILDING: (Check one) 11 State Owned VILLLLAGE 1 NEAREST ROAD
~t dw *J &
❑ Public ig~ 1 or 2 Fam. Dwelling- # of bedrooms PARCEL X . UM ER(
III. BUILDING USE: (If building type is public, check all that apply) U "Y - 90
1 ❑ Apt/Condo
20 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 in line A. Check line B if applicable)
A) 1. El New 2. gReplacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 JO Mound 30 El Specify Type 41 El Holding Tank
12 1:1 Seepage Trench 22 In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Qtr d ELEVATION
y&-e ai 5l 9G Q r 3 Feet ?Ft S Feet
VII. TANK CAPACITY Site
in gallons Total of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank 2 SAC f^
Lift Pump Tank/Si hon Chamber lJ
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No mps) MP/ PRSW No.: Business Phone Number:
F'2- iS ?
Plum is Address (Street, City, State, Zip Code):-
/go ;7 4f G .S Q
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Da t Issuing Agent Signature (No Stamps)
pp Surcharge Fee) T
A roved ❑ Owner Given Initial /I
Adverse D termination O(
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: 41
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years. t
2. Your sanitary permit may be renewed before the expiration date, and at the 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 & 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 in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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 3% 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
i
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
-1~ = t
June 5, 1995 2226 Rose Street;
La Crosse WI 46M r
19
WEGERER SOIL TESTING 4~ `h -y
s h. r
421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S95-40517 FEE RECEIVED: 180.00
WOODS, HENRY & ARDELLA
S,NW,18,29,16W
TOWN OF BALDWIN 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,
h,
Dennis S renson
Plan Reviewer
Section of Private Sewage
(608) 785-9336
SBDA-7987 (R. 10194)
Page of 6
y
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE S95"40517
5 l tZ l?Cnox/ fit,
LOCATED IN THE X7`4 OF THE NW 1/4 OF SECTION l8 ,TN, RZ6 W,
TOWN OF $w1w , s1r. ClZULX 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
PAGE 6 of 6 PUMP PERFORMANCE CURVE Y 2 3 tss5
PREPARED FOR DIV.
-kE►-~ ~`f Nti~ ACED Z.tg wozD S
9 b `7 6 l G ttw PN 61
3 f L-. Ikli I w I sLlooz -
PREPARED- BY
WEGEF:?. E: F:;?-- S; C3 I L TEST I p4 C-3 AND.
IDES I C-sN SEF~V I CE r'd>
= AAl7iUR L ~
WEO;laER t
F.O. BOX 74 421 K. KAIK ST. i 4315f
eusa-•~TH_ S
RIVES FALLS. NI 54021
715-42.x-0165
SIGl;
a~o~no
Z~, l99 S
JOB NO _ q S _ 13 $
PLOT. PLAN Page 2- of
Scale 1"= 40'
S95
LoT L1N~
~uCL,L
k
3 BDRv-~
J t'Xl9 }1tiG h~
h 1 ~
0
O \ -L u ~l. i GPC2~'t G~'
t ZtLL'L
• 54 r Y I~t I
A'J 1 1 'S a f y ~Il\`0
:
5 1.
W ~ 1oa
0
25 ,
e•3 B.z
luT LI.n+E :
-'Z too runt eo*,~~e1-
1~- ' ~ o~ ~ \9lv R 3
~-~~s~aJG `~S ~ 'fit; w~'1nUl'~ ~~Z RY61ka,0ow~ Pkfic .~.o►~N.
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. required)
4. Septic tank to be Wso /650 gallon capacity manufactured by
5. Bench Mark tTt ~oCt rJ' c1►y \3n'~M oh w►L s tOlw G ~fi E
SOv T ~YtsT Cn RauCT`c or 'TIE 6 r"iZA GN
6. Divert surface water around mound to prevent ponding at the uphill side.
Page 3 Of
Approved Synthetic Covering S95-405 17
~STt~ C 33 Distribution Pipe
Medium Sand
H _ G
Topsoil F Elev. O
D
3 E
Trench Of 272% Force Main Plowed
3 % Slope
2 Layer
From Pump
Aggregate
p ~.O Ft.
Undisturbed
Soil E Ft.
Cross Section Of A Mound System Using F oFt.
2 Trenches For The Absorption Area G V -z Ft.
A __V_ Ft. H k_ S Ft.
B LI Ft.
C Ft.
I ~Z
Linear Loading Rate= q-)SGPD/LN FT Ft.
Design Loading Rate= o•3 GPD/SQ FT J 8 Ft.
K Ft.
L 67 Ft.
W L) 0 Ft.
L
J B K
Observation Permanent _
C pipes ~-Markers
(Anchor securely) Farce
- - - - - -
7 - - - - - - - - - Main
Distribution \ Trench Of 2 - 2'2
Pipe Aggregate
~._fi rns ~
1 ^a+~ r a~ ~ r ''S;~ r kR
. r!
1
Mound Using 2 Trenches For Absorption Area
y
Page Of
- -
Perforated Pipe Detall 17
0
End View
Perforated
Holes PVC Pipe Install permanent marker
End Cap zv-
at end of each lateral
Located On Bottom,
Are Equally Spaced
Q S
PVC Force Main
P
PVC
Manifold Pipe
Distri ution
plQe
Last Hole Should Be
Next To End Cap
End Cap
P 2.2.5 Ft.
Distribution Pipe Layout S (6 Ft.
,.4 X 3 Inches
_1~ ~ :,y 1 Inches
Hole Diameter Inch
r} 1'Z } C r
~r .r f
Lateral Inch(es
r~ r~ ?
v:
Manifold Z Inches
r,
: x Force Main Z Inches
of holes/pipe
F f~,I. Jy i t s
Invert Elevation of Laterals i-1•S0Ft.
-1.
q .1 y Gt?)'-t 'r rtL
3
u
Place 1st hole ~g from center of manifold with succeeding holes
at 36` intervals. Last hole to be next to the end cap.
Combination Septic;Tank and
PUMP CtIAMBE - CROSS-SEC-TIORI-. ARID SOECIFICATIOMS ~ PAGE S OF b
VEIJT CAP WEATHER PROOF
JUUCTION bolt
4'C.I. VENT PIPE APPROVED LOCKING
'-.1O' FROM DOOR, MANHOLE COVER wlv
,11tvDOW OR FRESH S 895-40517
AL INTAKE Gor~DUIT C f
/j i
tL LUG _ i y' MIU.
GRAA
I
IB' MIAI.
E 1=3
18~MIRI.
PROVIDE i
IAILE T AIRTIGHT SEAL I III ~
II I III
34FF~cS A I III APPROVED JOIIJ',
APPROVED JOINT I III W/C.I. PIPE~~
W/C.I. PIPFoltm construction I II ALARM
o" 1hall comply with I 11
d L H R 13.15 and 83.20 Is
` 4" I I o►J
r
C
2 of- 5 FT
t.C'1 __J
PUMP OFF
D COAICRETE
'1. r1 i ~z»P"
r BLOCK
13" APPR~
HAS SUCH APPROVAL.
, ; 86DD R EXIT PERMITTED OULU IF TAWK MAUUFACTURE:R
SPECIFICATIOR.IS
SEPTIC f 3.55
DOSE `M~~W.IJ ~CS7 NUMBER OF DOSES: PER D"
TAWK MANUFACTURER:
IOOl3 /650 GALLOWS DOSE VOLUME r
TAWK SIZC : IMCLUDIAIG BACKIFLOW: 5 3 GALLONS
At-ARM MANUFACTURER: S'S' ~'S `ZST~1'19
MODEL WUMBER'• 1p~ Mw CAPACITIES: A= i8 IMC14ES OR GALLOAIS SWITCH TyPC: WIN U J-f g = Z IMCHES'OR =.L G~ LLOLJS
q
PUMP MAWUFACTURElt: IWLHES OR N S3 GALLOUS
MODEL WUMBER: D- 9 INCHES OR \S1 GALLOUS
SWITCH TYPE: F'11 R MOTE: PUMP AWD ALARM ARE TO BE
GPM INSTALLED OW SEPARATE CIRCUITS
M1IJIMUM DISCHARGE RATE
VERTICAL DIFFEREWCE DETWEEkJ PUMP OFF AUD..DISTRIBUTIOW PIPE.. a,5 FEET
2.50 FLET
+ MIAIIMUM WETWORK SUPPI_y PRESSURE • . . . . . . . . . .
.F TOR.. "3S FEET
160 FEET OF FORCE MAIM X Z'~ FYorr.FKICTIOU FACTOR..
TOTAL 09MMIG HEAD FEET
DIAMETER 3 g
Pump chamber _
ILITERWAI_ DIMLW510W~i OF TAWK: LEIJ6TH ;WIDTH -;LIQUID DEPTH
BOTTOM AREA 231 - GAL/INCH
-)-O GAL/INCH
AS PER MANUFACTURER
3 7 8 6 1/4 -6F b -
W HEAD CAPACITY CURVE / -
to Ld
30-MODEL "98" 4 5/8 '
'
8 13 I
25 3 5/8
m
= 6-.?0- + +
0 O
15 ,S-63 4 3/16
o
4
0 10 37-Y
F
1 1/2-11 1/2 NPT
2
5
0 S95-40517
U.S. GALLONS 10 20 30 40 50 60 70 80
LITERS 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 45 170 _ 3 b/16
f `1
20 6.10 25 95 %
Lock VaWe 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 extemal 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 FMO477.
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 FM071Z for correct model of Electrical Alternator, "E-Pak".
N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify
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 Alex or duplex operation, 10-0002.
7. Two (2) hole "J-Pak", for watertight connection or splice.
CAUTION
For information on additional Zoeller products refer to catalog on Combination Starter, FMO514; All installation of controls, protection devices and wiring should be done by
a quali-
Piggyback Mercury Switches, FMO477; Electrical Alternator, FM0486; Mechanical Alternator, fied licensed electrician. All electrical and safety codes should be followed ioclud-
FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and
FM0732. Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
AWL TO. P.O. BOX 16347 Manufacturers o! .
LouilsWfie, KY 40258-0347
SHIP TO- 3280 ON Millers Lane a
Q OE~ E~ O. LotdsWft KY 40218 QU.IL/TYPUMPS SA'cE /9a~9
o (502) 778.2731 • 1(800) 928-PUMP
FAX (502) 774-3624
L) I L t'1 in accord with ILHR 83.05. Wis. Adm. Code
COUNTY
st-
c!'/ X
Attacs.oomplote site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but
p,il United to verticat and horizontal reference P?!oL4GMV ion and % of slope, scale or PARCELI.O. 8
;fimensioned, north arrow, and location and tr~4ib i le t r d.
APPLICANT INFORMATION-PLEA MNT ALL ll f17 N RtvIEwE08Y DATE
PROPEATYWYNEfT rQ~'v~r- - PROPERTYLOCATION
c O /I 2, ° ~ GOV. LOT S jj 114 S T 9 N.R /4 (a W
PROPERTY OWNER'S MAILM ADORES~ 1 r^r, LOT 8 13LOCK 1 SU80. NAME OR CSM I
Aw 3
CITY, STATE ZI MBER ❑CITY CIVILL_A/GE TOWN NEAREST ROAD / Z
~~I+J 1+'^' A. ..'S-~O Sy ~3 Q ~C3r LV / ~1.t3 • G~ ✓
(J New Construction Use Reside n e o 3
,QQ Replacement ( J Public or commer l e
Code derived dally flow 11:50 gpd Reeomrnerided design loading rate ' 2 bed, gpd4t2, _trench. gpd42
Absorption area required 3 '75 bed, ft2 37 j trench, ft2 Maximum design loadatg rate - S bed, gpM? trench. gpd/It2
Recommended infiltration surface elevation(s) It (as referred to site plan benchmark)
Additional design / site considerations
Parent material ~Illt ; "7e /I Flood plain elev?lion, it applicable N~q n
S = Suitable for system 00werrr"M MOUND iNGROIR(D RESSURE AT-GRADE SYSTEM N RLL HaOM TANK
U= Unsuitable V system ❑ S 0 U 5 S ❑ U ❑ S JU ❑ S w u ❑ S w u ❑ S Mu-
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/rt
Boring # Horizo in. Munsell CQu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence BmnJa y Roots Bed Tiend-
rm_ b :/3 /oy/e 3 Z.. .s; ` . msd g ~ r a.r,J C-P -
> Z i3-Z7 IVYk y y -Z 03
Ground 3 27 /D Y1e- _`1 0>72 S1 si rnlty^ G - 5
elev. ~ ti L} 5=38 /0 /bYR-13 S/ 2r7 silk rnt4:r Cw •5
Depth io 3 g -5 S yR do C Z~ /o Yg 7s SC ~ s~ /~I ~ • S
limiting
Worr
3
Remark's:
Boring #
WO MM J 'A5 J& No »C 2,s m ~r a w CM '5 1, G
11-25 7.5 R y G N,,i e 0? _rr^ a C_' •Z '3
a... S /
Ground c 2. C/ YR s i > s mirr' Q r to ' Z - 3
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 's
MAILING ADDRESS//
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
1 ~c:r e 1' i n n r~ l
PROPERTY LOCATION 5 ~I 1/4, Section 1 T_N-R_!4oW
TOWN OF 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 completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE:
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 i~
Location of ProPertY J1/ F 1/4, Section V~ _,T,~q_N-R_j_(p_W
Township Mailing address 9 0 D 3
Address of site 1-~WL4 1 117 , lAl I SUvO
.-Subdivision name Lot no.
Other homes on property? Yes--1Z-No
Previous owner of property ~tY1Q S + ~Iy---~?- ne
Total size of property
-*Total size of parcel
-Date parcel was created
Are all corners and lot lines identifiable? c/ Yes No
Is this property being developed for (spec house) ? Yes v,,- No
Volume and Page Number 5o~p as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. a 3 g g 5 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 Cou y Register of Deeds as Document No.
CS u of pplicant Co--App lcant
o l~-q~ q5
Date of Signature Date of Signature
a .1!
TWS SPACE RESERVI_aFOR RECORDING DATA
`DOCUMENT NO. WARRANTY DEED I f
' .1 STATE BAR OF WISCONSIN FORM 2-1982
523995 VOL IL 13b4~a~~506 =
' - v REGISTERS OFFICE
Thomas Stone and Dawn Stone, husband a _ nd <I ST. CROIX;CO., 1M
. 1
Read for Record
r. wife
K, 4
(DEC 2 199
d f A -
OdB and AI: e.. a 100 ~ II
~a coWnveys and warraeta to Henry L. WOldi M
oods,. • husband and. w.ife,..•ho . as................ Ni ~ i
i).~ V
suryiyorship. mar tal_..propertY..............
( P.egfster of fletde ~ ~
TURN O _
.
p
the following described real estate to _...._..._At.f...~JY.Q County,
t
=pt i State of Wisconsin:
Tax Parcel No:
Part of South Half (S~) of Fractional Northwest Quarter (NWT) of
Section Eighteen (18). Township Twenty-nine (29) North, Range
SixteeN (16) West described as follows: Commencing on the
f~ West lire of said South Half (Sh) of Fractional Northwest Quarter
II (NW'k) (being the centerline of a highway) 208.0 feet South of
the Northwest corner thereof; thence East 198.0 feet; thence
i South 266.0 feet; thence West 198.0 feet to the centerline of
the highway; thence North on said centerline 266.0 feet to the
li point of beginning, St. Croix County. Wisconsin.
Z
I ~
I This i 9 homestead property.
(is)
Exception to warranties: Easements and restrictions of record.
~j
4.
!j Dated this ---°2T.... day of November. - , 19. 9.
I
R (SEAL) I
-----(SEAL)
Thomas Stone
.
p (SEAL) Ii
(SEAL)
>r'` I -
Dawn Stone
- .
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) . STATE OF WISCONSIN j
Y ss.
- St CrO1X. County.
} I authenticated this day of------------------------- 119 Personally came before me this `~5day of
i November 1g-94.. the above named
Thomas Stone and Dawn Stone
w
TITLE: MEMBER STATE BAR OF WISCONSIN ~..1;;.,._..
(If not, _ i
w authorized by 4 706.06. Wis. State.) to rde ieriow b~the'parsons_.._..._... who executed the
for `In., urrier~t an Eck ow dge the same.
C'r
I =
=
I THIS INSTRUMENT WAS DRAFTED BY ~ 'j
Thomas A. McCormack X r c. `
` Baldwin, WI 54002 rp-_ . Ern Wis.
N~ Pu51fe . t..
j 5fy C t*
(Signatures may be authenticated or acknowledged. Both ommisaion is. permanent. (if not, state expI i
are not necessary.) date: T--___-.--, 19...--.
ii •fuii of DCrsODD eiEnintt in sny capncdy should tx typed or F ri nted helow the r eignuures.
- li Wisconsin Leaal Blank Co , Inc
WARRANTY DEED STATE BAR Oi WISCONSIN Milwaukee. 'N.consin
~r,~Y i FORM No. 2- 1a9?