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- ~e~L~t't'nK~ 5Y51'Y~14 REPORT
i.)DRESS
SUBDIVISION / CSMj
LOT ~ -2
SFr?rn
S
~tO1'
r_~-~LINTY
•.I SCO NSItt
SHOW E'/ERYTHING WITHIN :LOO FFF.T flt` cvemEnr
7"
5
•'~~r gtiP
w
j
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V~y
Provide setback and elevation i-nform11-.i.on on rev,,.z
:arm.
Provide 2 dimensions to center- c:f
i
BENCHMARK: N4,~~ Gh ! S" U n k
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: S~c~ h Liquiei Capacity: D U
Setback from: Well _ 2 5-0 House S Other
Pump: Manufacturer _Z-ff-,'• Modell (d size
Float seperction__D
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Uenctth- Number of trer~ches
Di stance & Direction to nearest prop. line: Setback from: well.- HousB )30 Other
ELEVATIONS
Building Sewer 741,12 ST Inlet: S"L ST outlet
PC PC bottom ~G : ~ Pump 0 f f
flaader/Metni Bottom or system
Existing Grade___ _ Final grade
DATE 01' INSTALLATION
11111IMBEG ON JOB:
LICENSE NUMBER:
INSPECTOR:
,w
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety an"uildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 2AA
Pe [nigjIdgS; 'M JAMES ❑ City ❑ Village X Town of: State Plan o.:
CST BM Elev.: Insp. BM Elev.: BM Description: /~i Parcel Tax No.:
TAN INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic' Benchmark / O'P
Dosin ~m 12~i SzI 2. 97 60/
Aera u n Bldg. Sewer
Holding _ St/ Ht Inlet S-
TAN SETBACK INFORMATION St/ Ht Outlet y~
TAN TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic >j1~d - NA Dt Bottom
n, 3 / NA Head an. Aeration NA Dist. Pipe 3.05 9
Holdi g Bot. System 3 7~' ✓0 '
PUM /INFORMATION 7 1/09 Final Grade
Manufacturer r~-y errand { ^
~,791
Model Numberl 45; GP fa c>~~ f' ~.~{Z~ i
TDH Lift Loss Head stem T H Ft
Force ain Length ti 16D ( Dia.,-; ' Dist. To Well
tSOIL ABSORPTION SYSTEM
3",o BED TRENCH Width / Length No. Of Trenches PIT - No. Of Pits Inside Dia. Depth
DIMENSIONS 7S DIMENSIONS
M ac urer:
U SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING
AX61 ti SETS CK Model Number:
-7 1,
INFO MATION Type O OR UN1T
System:
~tp JI ' DIST 1BLITION SYSTEM
Heade / Manifold Distribution Pipe s) x Hole Size x Hole Spacing Vent To Air Intake
Length, Dia. Length 'M Dia. 14 Spacing ✓ `j~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth ver Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
No
Bed /T ench Center Bed /Trench Edges Topsoil ❑ Yes E] No F] Yes E]
COMMENTS: (Include code discrepancies, persons present, etc.)
A 2
LOCATION: Eau Ga11e.4.2$.16W, , NE, 60th Av nue
Plan evision required? ❑ Yes ET"No
Use other side for additional information. l.~
SBD-6 10(R 05/91) Date Inspector's Signature Cert No
^~"u ~ Safety and Buildings Division
01 HR SANITARY PERMIT APPLICATION Bureau of Building Water System!
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 s~ e/`8
thanlI8 112 x 11 inches in size-
• See rleverse side for instructions for completing this application State Sanitary Permit Number
.2 V97-10
The inform tion you provide may be used by other government agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property O ner Name Property Location
Jame Widiker NW 114 NE 1/4, S 4 T 28 r N, R 16 RE (or) W
Property O ner's Mailing Address Lot Number Block Number
1560 Frankin Street
City, State Zip Code Phone Number Subdivision Name or CSM Number
1(-71 ) _
II. TYPE BUILDING: (check one) ❑ State Owned ❑ City Nearest Road
3 ❑ VIl age
P blic 1 or 2 Family Dwelling - No. of bedrooms Town OF
III. BUI DING USE: (If building type is public, check all thatapply) Parcel Tax Number(s)
1 E] A' artment / Condo d 0, 0
2 ❑ A sembly 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 ❑ H tel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TY E OF PERMIT: (Check only one box online A. Check box online B, if applicable)
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5 Repair of an
--System System Tank OnlyExisting System _ ❑_ExisstingSystem
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYP OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ S epage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13E] S epage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallon Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft_) (Min./inch) Elevation
450 375 375 .83 97.7 Feet Feet
VII. TANK Ca
in gacit
gallons Total # of Prefab. Site Fiber- Exper.
IN ORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel lass Plastic ANew Existing strutted 9 PP
Tanks Tanks
Septic Tank' or Holding Tank x 1000/65) = ,Midwestern ® ❑ ❑ ❑ ❑ ❑
Lift Pump T' nk /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, theundersigned, assume responsibili for inst ti n of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plu er's Sign e• No Stamps) MP/MPRSW No.: Business Phone Number:
Joe Stang MP 6646 1-715-698-2266
Plumber's ddress (Street, City, State, Zip Code)
506 illow DRive W ville WI. 54028
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sa tary Permit Fee (includes Groundwater Date Issued k Issuing A ent 771:S)0~
Approved F1 ry Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 5/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Dive ion, 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 systern, 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:
I_ 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 v,,i appro -jlate- prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County I Department Use Only
C ~t . -;:v2, ifications not smaik-r than 8 1/.2 x 1 1 inches must be ; tt~d t., -,e my The plans must
i;J: o lot +-~an, draw; kale or with complete ai'i r_ S tl Jiri _I tank(s), septic
i~tiX~>~, sC _:.O ;'~IUr~S~St..zi" f plLl C~ Sy I: tti' (7ullc'ingserved,
, ~r' , ~Is, ;.Jose volume;
I- :I„' PC-I C-os' se,_`! on
quli ~d hy e _Gu s,- .est uU_a , .1+i >IZil g irliOrmatlO
- - - - - - - - - - - - -
GROUNDWATER SURCHARGE
1 yc~ `dliscor t 410 Mcluded the creation of surcharges (fees) for riujmbe v ed p! cct.tes which can
effect groi_indviai_er_
11iemunk-s(c)iectedthrough these surcharges areUsed formor~itc,,r,,c;r: i<<v.w :.o!-i-in-in-tiorinvestigations
and establishment of standards
I SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
August 28, 1995 2226 Rose Street
La Crosse WI 54603
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S95-40960 FEE RECEIVED: 180.00
WIDIKER, JAMES
NW,NE,4,28,16W
TOWN OF EAU GALLE COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not'been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
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, 9 J)
Ge a. i
an evie AU G 3 1 1995
Section of Private Sewage ST
(608) 785-9348 zta'
2203R/ 1
SBDA-7997(x.10/94)
Page of 6
REGEIVED
AUG Z 3 1995 MOUND SYSTEM 895-40960
FOR
SAFETY i OM. W. A 3 BEDROOM RESIDENCE
LOCATED IN THE NvJ 1/4 OF THE NE 1/4 OF SECTION T Z8 N, R 1 W,
TOWN OFk:-T~ ~F~l LN , !s7T lQ \w l K COUNTY, WISCONSIN.
INDEX
PAGE 1 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PA GE 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
1 S b ~2~ckylz l Sr.
\3 Pc`O kJ1N L.,j J SLl bbZ
PREPARED BY
~ g ~ Y, ~ Exi,~•`"si ~~rr
I~Et3EFtER SC I L VEST ? iti4~ ' `rt
AND Q : aFTYR .
4'd4GF.nER ~ S I
DES I Chi SERV = CE ca i o-s,sP
O S.LSV;Gk7H.
• wry.
~ •t
P.U. 801 74 421 N. MIN ST. ~
RIVER. FALLS. VI 54022 jjt; Z
715-425-01L5 v I G
PNG. ZZ, tg9s
JOB NO. 9S-Z-33
PLOT PLAN Page -Z-of 6
Scale 1 y p `
6O ` It nv
A 's^
tv~~T L l ju ~ o H ~ 0~ ~-tZ-
p _O
0
NI
f►t3r\No(-)k 'TM t-- VX
S~f i iC 5>15i 11.5 ~ F:
~i~ser
EL. lno.a` a►~ sPi► bq'aF- 4yhuC
3' PrOovt Gttuv~+q tt\3 S.
~-hST S~O~ OF LS"D!h
(4 -i 1 O S ' d l= Z V F. Yom! ,
9~ a. 1
\ ps, ti,
~ ~ s~v ~z g Tti ~ s h-it~~► ~ \ ~ . z \ ~ 3~3
EL 6
V3,
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( 2 required)
4. Septic tank to be ►oo0/bS0 gallon capacity manufactured by
N '1 1,J t` S L R ~U ~2~ ~A S 1', 11~ c
5. Bench Mark S E L~ OU(,
6. Divert surface water around mound to prevent ponding at the uphill side.
p 1tGk Got=
6
` HEAD CAPACITY CURVE 3 7/8 6 1/4
MODEL "98"
30 4 5/8
8 6
25
3 5/8
6 20 + f
Sb O
15 4 3/16
o
_J 4-
Z8, $
i<_
Or 10-
1 1/2-11 1/2 NPPT
2 5 S 95-40960
0
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 5/16
20 6.10 25 95 - ~
Lock Valve 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 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 FM0712. 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
D98 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system.
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 plex 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 qualm
Piggyback Mercury Switches, FMO477; Electrical Alternator, FM0486; Mechanical Alternator, fied licensed electrician. All electrical and safety codes should be followed includ-
FMO495; Alarm Package, FMO513; Sump/Sewage Basins, FMO487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and
FM0732. Heahh 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
Louisville, KY 40256-0347 Manufacturers of .
SHIP TO: 3280 Old Millers Lane
Louisville, KY 40216 `Q!/AL/7Y PUMPS SINIcr AF
(502) 778-2731 0 1(800) 928-PUMP
FAX602) 774-3624
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page X of 3
Labor and Human Relations
Qivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
• COUNTY
W S-r: c-wax
Attach complete site plan on paper not less than 8 x 11 e i Plan must include, but
not limited to vertical and horizontal reference n slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and dicta o nearest road.
APPLICANT INFO RMATION-PLEASE:1P T OPJHTIO REVIEWED BY DATE
PROPERTY OWNER: f~G rq ERTY LOCATION Z , 1
6
-tOT
5Pt'+'lVZS 1.v b1tt fVW 1/4 W 1/4,S y T $ N,R E («)(6
PROPERTY OWNER':S MAILING ADDRESS # BLOCK # SUED. NAME OR CSM # -
w - -
VN
5 60 T--[Z.Rf'JttL
CITY, STATE ZIP CODE E NUMBEJPr CITY []VILLAGE [90WN NEAREST ROAD
1Z Pt l-bILIX u, w t s o o z. v vft t_t . 6 o rrt Rue~ -
[ ] New Construction Use Residential / Number of ooms 3 [ ] Addition to existing building
Q<] Replacement Public or commercial desaibe
Code derived dafly flow q S O gpd Recommended design loading rate - bed, gpd/ft2 0.3 trench, gpdr'ft2
Absorption area required ' ~ S bed, ft2 3-1 S trench, ft2 Mabmum design loading rate 0 - -S bed, gpd P 0.6 trench, gpolft2
Recommended infiltration surface elevation(s) OL -l • ft (as referred to site plan benchmark)
Additional design/ site considerations ~ JM't1't D W 6U _b k)/ S' x 1 S' jPJaUC-U - NI, >v , 1' aF Sk*.Yp 1=t Lt- .
Parent material L,oi~P-SS v v\) tm 5 l -r u- Flood plain elevation, if applicable N. A. it
S = Suitable for system CONVENMI AL MOUND "ROUND PRESSURE AT-GRADE S111TI11 IV FILL HOLDING TANK
U = Unsuitable for stem ❑ S (DU EIS ❑ U ❑ S O U ❑ S ®U ❑ S C$U ❑ S [RU
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ftin. Munsell Gu. Sz. Cont Color Gr. Sz. Sh. Bed ienc
1
] 1-8 lo`{tL ZI Z - Sl Zwt 3V w~ CS - o, S o.6
Z 849 to`ttz s/6 - sit 2~sb Ft- cS 0.5 0.6
Ground 3 fa-3D 5''t z y /y - s e s bk vr► ~`FI~ CS - o.11 0.5
elev.
't O ft 30. S`1Q ! cZ S`iRVl6 _
Depth to
limiting
factor
30"
Remarks:
Boring #
zt-Z Zwtsb►~ CS - o.S 0.6
z Z a-l.9 10~~ 316 SII Z s~k W, ~k CS
3 A --0 S `t R- y! - s` \ ~ s biz wtv c S o y o.5
Ground
elev. .511 2 yfy s/ s1 O►,~ 1M`~~. - -
Depth to
limiting
factor
Remarks:
CST Name---Maass Print Phone:
Arthur L. We erer 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date: CST Number:
°t 5- 3Z 3- ~3-01 M00576
PROPERTYOWNER w~Ol~c SOIL DESCRIPTION REPORT Page Z of 3
PARCEL I.D. '
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3 I o-~.U ~oti~Z zlZ s~ ZVy~ 3\b F7
cS o. s o.6
z to-zS ~~~e 3!6 - st Z sb~r~w -
5 till ~!y - S I 1 e 3bk \OA ~s o.y n•5
Ground 3 is-as
elev. C Z - S 'tit Y!J.
OIL,(. ft. 3$_$D 5 `t 2 5l! { t rz~ It- S! g 0 yv~ - i
Depth to
limiting
factor i
3S'
Remarks:
Boring #
v t
Ground
elev.
ft.
Depth to `
limiting
factor j
E
c
i
Remarks:
Boring #
''~:s~~a~ke3
Ground
:
elev. '
i
ft.
Depth to
limiting i
factor
i
Remarks:
Boring #
i
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
Page 3 of 3
- PLOT PLAN _
SCALE 1"= W3 '
r`1c.C~Y IRS S!{-Ow~v
60 T if nue.
WkfU- LS IID~ CJtlrup LpO~ #
NoR.`R1 of Nouse'•
A ~
3 aeaw-t
sp I"
3' P~OeVt GU\)P-% tN
L-%Yr s l OF L S"DIR •
~k gym. C
~Gx
~a ~2 s
Do oz QT fe"pkaT cup. pS.
\S11►lZ@ TTF\S RR1 \B.2
el 41 \ 6
~s I
\ ~ B• 3
\ vj~
\ i
C Z
3-v3- CIS 9S -3
(715 ) 425-a1 fi M00576
CST Signature Date Signed Telephone No. CST #
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER James Widiker
MAILING ADDRESS 1560 Franklin St.
PROPERTY ADDRESS 1- G G r 4
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE Baldwin, WI. 54002
PROPERTY LOCATION NW 1/4, NE 1/4, Section 4 T 28 N-R 16 W
TOWN OF Eau Galle ST. CROIK 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. r Ao~
SIGNED: v
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
'z 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 James Widiker
Location of property NW 1/4 NE 1/4, Section 4 T 28 N-R 16 W
Township Eau Galle Mailing address 1560 Franklin St.
Baldwin, WI. 54002
Address of site 236 '7 ` 6 4 ~L-i
Subdivision name Lot no.
Other homes on property? Yes x No
Previous owner of property Cr Z4- n p e- A i d
Total size of property 90 acre
Total size of parcel U
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/.//` and Page Number 402- 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.
I
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. rl G r 2.( , 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 offi e of the County Register of Deeds as Document No.
5~2 4 ~Z
4ig~natu~reo~fAppMica~nt Co-Applicant
Date of Signature Date of Signature
t ~ K .
A
DOCUMENT NO. ST.\TF. li 11t OF WISCONSIN FORM .5-1982' *HIS SeA.E RESERVED FOR REC~40IN: DA*w
P':RSONAL REPRESENTATIVE'S uEED
f y
526821 VOL 1114PA,F41 - REGISTERS OFFICE
SL CROD(CJ.. M
at' Gerald Hegland, a/k/a Gerald C. Hegland Rea'afor Record
z, MAR 17 1995
as Personal Representative of the estate of
Glenn R. Hegland
9.45 A.
_ _ ("Decedent"),
Regbter of Deeds
II for a valuable consideration conveys, without warranty, to ___-JAMes...R.e--------
?1d1keX---?lAd...SNKrQ_ll':R-._.[~]la_ ke)C_R._husband__and-_.----
e i; wife.,__ho7,d_ing__assury1:V1KP ip__marital__________________
....property . , Grantee, RETURN TD
the following described real estate in S,t_---Cr_oix_______ ______County,
~I State of Wisconsin (hereinafter called the "Property'
I Tax Parcel No:
I
~xY North Half of Northeast Quarter (N'h of NEh) and Northeast
' Quarter of Northeast Quarter *(NE' NE}NWO-_: of Section Four (4),
r}. Township Twenty-Eight North (T28N), Range Sixteen West (R16W)
*OF NORTHWEST QUARTER
i
it S F~
I `r
j Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which
the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the
•r II Personal Representati a has since acquired. A~
Dated this day of /y~~- 19---95.
I
ESTATE OF GLENN R. HEGLAND r-
l
j~ -(.SEAL) by
. SEAL)
a Gerald.Hegland, a/k/a Gerald C.
- - -
Personal Representative Personal Representative Aegland
I I _
i
AUTHENTICATION ACKNOWLEDGMENT
i
!j Signature(s) _ STATE OF WISCONSIN
ss.
St. Croix
x : ---...•----......County. / .
*r I authenticated this da of. 19....._ Pprsgnally epme before me this !f~_.day of
i i ~l•(ft ~C fT
19..45__ the above named
Gera.ld.._Hagland,.___&/k.la---
I
f ; ---Gerald ..C-•---kieBland--•---------------_-.---------------
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, '
authorized by § 706.06, Wis. Stats.)
to be the person who executed the
and now ge the same.
it THIS INSTRUMENT WAS DRAFTED BY -
Thomas A. McCormack -
f
Baldwin WI 54002 - -
r k six
- - - County. Wis.
(Signatures may be authenticated or acknowledged. Both 'Pb i is permanent. (If not, state expiration
R
are not necessary.) P..... StatedWieoOrtrir~
ExpTrM IrTerdl
4 it -Names of persons signing in any capacity should be typed or printed below their signatures.
I'~•F STATE BAR OF WISCONSIN WI eonsm Lertal Blank Ca. Inc.
w PERSONAL REPRESP.NTAME'S DEED FORK Ne. S 1982 ]l lwaul.ee, Wis
1 rs+ gyp' f 1} a ,r y a" t` .r• sr,y,~i °kI ~y+ r 7 ~'"i r" :,y Y: #f A{e $ - , > ;14 i z~ ;