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STC - 104
AS BUILT SANITARY SYSTEM REPO
OWNER/r~r' i2 I lr
ADDRESS
SUBDIVISION / CSM#__ LOT
SECTION 1'9 T N-R W, Town of- E l- 6, Cr, 1
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
J7 ac
w JVIC~ h
INDICATE NORTH ARROSNl
Provide setback and elevation information on reverse of this form. i
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK •
ALTERNATE BM' /I / vim Pg~
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: _14e Liquid Capacity:
Setback from: Well House C90 r Other
Pump: Manufacturer
Model# Size
Float seperation Gallons/cycle: ~7 2 Y3
Alarm Location_ e~ M
s
SOIL ABSORPTION SYSTEM
Width: Length. Number of trenches
Distance & Direction to nearest prop. line: l'-socA
Setback from: well: 3Ci House 4~=) i Other
~•)-I• 100(0 0 ELEVATIONS
7-of oT _rospe4torl D r ILXC~ O,\ s_P4-'C ~Gc+~
Building Sewer ST Inlet. ! 3 ST outlet y
i
PC inlet PC bottom / 6 7 Pump Off • y„~
Header/Manifold /C)C) ° Bottom of system
Existing Grade Final --grade 10~
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR: '4
3/93:jt
l
k
iiWi3corlsin Ddpartment Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P 1
TRUE, NORMAN & REBECCA X
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
loo ~ ADO ~~vr~ ~
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 103'(4,
o .
Dosing /6~,bb ~O6
Aeration Bldg. Sewer 1Q,8qr g(~,~5
Holding St/ Ht Inlet , )7
TANK SETBACK INFORMATION St/ Ht Outlet
vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet ' 3 I
7137
Septic ?5[~' ,l'ab' do, raS' NA Dt Bottom !a•6 2'
Dosing ~~p' idol a3 ~a ' NA Header/Man. 3,/7 /00,
Aeration NA Dist. Pipe 3 (4 ' /oo
Holding Bot. System Apo,
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Vfl 2"a Demand
Model Number / GPM
TDH Lift fjf? Lriction 0 System TDH)~ 1Ft
oss mead
Forcemain Length/0.71 Dia. Dist.Towell>(bo°
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS F a,S' DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING M acturer: .1 11
SETBACK CHAMBE
INFORMATION Type O / Mo a Num er:
System: 41L6 j, 7j~' ORU
DISTRIBUTION SYSTEM
er / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length ~013 ~Dia. //V 7 Spacing] / ~4 5
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 ~b Bed /Trench Edges Topsoil - a`~'es ❑ No E3-~es ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: EAU GALLE.18.28, 16W, SW, W, 30TH AVENUE 3
J
Plan revision required? ❑ ~ s ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date n e is Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
L.
SANITARY PERMIT APPLICATION Bureau and uil ing Water reau o off Buildin 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
than 81/2 x 11 inches in size. ST CROIX
• See reverse side for instructions for completing this application State Sanitary P'errmmiit Number
The information you provide may be used by other government agency programs E] Check vision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION S95-40434
Property Owner Name Property Location
NORMAN & REBECCA TRUE SW 1 /4 SW 1/4, S 18 T 28 , N, R 16 V X(ll W
Property Owner's Mailing Address Lot Number Block Number
2118 30TH AVENUE N/A N/A
City, State Zi Code Phone Number Subdivision Name or CSM Number
BALDWIN WI 4002 (715) 684-3269 N/A
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road
Village EAU GALLE 30TH AVENUE
❑ Public 1 or 2 Family Dwelling - No. of bedrooms 4 _ Town OF
111. BUILDING USE: (If building type is public, check a I that apply) Parcel Tax Number(s)
008-1054-50
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel / Mote[ 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2. a] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank OnlyExisting System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 [D Mound 30 ❑ Specify Type 410 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
600 Re uir d (sq. ft.) Propos d (sq. ft.) (Gal /day/sq. ft-) (Min./inch) Elevation
5 O .38 1 Feat 4-5 Feet
VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Plastic E Axper.
INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete Con- Steel g pP
strutted
Tanks Tanks
Septic Tank or Holding Tank 1200 1200 1 WIESER CONCRETE ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 7,50 750 1 WIESER CONCRETE ® ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name. (Print) Plumber's Signature: (No Sta ps) RSW No.: Business Phone Number:
BENNIE HELGESON MP/MP RS 3215 715/772-3278
Plumber's Address (Street, City, State, Zip Code):
W1229 770TH AVENUE, SPRING VALLEY WI 54767
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sa itary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signatu ps)
Approved ❑ Surcharge Fee)
Owner Given initial aq 0z/
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SHD-6398 (R. 05/94) DISTRIBUTION: Original to county, one copy To: Safety & Buildings Divi 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 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 informatior 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 s!te constructed and tank material. Complete for all septic, lump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental oroduct approval from
D!LHR.
VIII, Responsibility statement. Installing plumber is to fill in name, license number with approori-3te Drefi : (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX County/ Department Use Only.
X County/ Department Use Only.
lCatt<)nS nGf_ Sma 1 1/1 X 1 Inch s mt.._t 5,-, s;j1, .l t'--',] tO the x-51, nty. The plans must
,u;,~, 3
,;i ,":j ii'; ii r rirav~,f C? ~cai%e or V'/Itn U)mF, ciEi ,'EIf-sl(~("... ICS _.it1C; .)f n*', ,ding tarlk(S), septic
dump or siphon
i ilk
w,-. , ~rr r..:, e r,
D o o tip iii: !ding served;
i o;1. dose volume-
err' - rrrl'• crosssection
~i. 7y OU Stijl LeStci,., "(:l, g ~nf~_)rmattOn.
GROUNDWATER SURCHARGE
1983 Art, 410 in(uded the :reaticm, o' surcharges (lees) for a number of re~_,lated pra~tice~, whi.:h can
effect aru,,,!-id
1 he monies through these urcharges are ~Jsed for monitoring groundwater cont„m ~ ir,tion investigations
and es )of of standards-
S95-40484
17Are - I `l -9
t." qo
9 ac-t---5 - r FD
lv.1 1995
SAFETY &
~ ~s BOGS. OIV.
~Ug({►'~. ppD 6
p~• OF 0~
t0u ~V1S10~
~ n~ d- lev, ENGE
I o0.3 8 ~
S~ Ih'~I f
i " Ai3ANACr,i -ENE f:X1ii iN4 S~(''fll
As rer-
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off/ rt ° °.F c.~~1c r~~- S-FY ~ ~ ovt (1
2
S95-40434 PageOf
Straw, Marsh Hay, Or
Synthetic Covering
.AS OA L-33 Distribution Pipe
Medium Sand
yip o
H = G
Topsoil G
3 E ` y D
I!
2 % Slope
Bed Of -2-0-2 %2 Force Main Plowed
Aggregate From Pump Layer
D ( Ft.
E Ft.
Cross Section Of A Mound System Using
F Ft.
A Bed For The Absorption Area
G j Ft.
A Ft. H ~.S Ft.
Signed: Z4,_... B ba.S Ft.
License Number: jj/,(~,~ K / Ft.
Dater L Ft.
j Ft.
Alternate Position T Ft.
of
Force Main W -~,7. 7 Ft.
L
Observation Pipe--,,,"
g K
01
Force Main
icy
D istribu ' io
d Of 2 - 2 2
P pe
oregate
Observati P~' e ~e~a b H ~*ItNnanent Markers
OF lt~9~s~R't . P!1
O
GaR
Plan View Of Mou Using A Bed For The Absorption Area
895-40434
Perforated Pipe Defoll
~0
End View
-End Cop Perloroled '
PVC Pipe
Ob~c •
~oo`•`c~c ~ Permanent End Markers
s Holes Located on Bottom
are Equally Spaced
PVC Force-Main
From Pump `
P PVC
~No
Cp / Monllold Pipe
40r A/C.
Oistribullon..•
Pipe
Losl Hole Should Be
Nexl To End40 p
a~~ S Distribution Pipe Layout
P 3 3
v
v~
VVI d~v
~oP x ~
Y
igned: - Hole Diameter Inch
License Number: w~oP/L Lateral " Inch (es)
Date: /7 Manifold " o~ Inches
Force Main " Inches
Ho 1 Per- ~~rr¢
F L vin n v. 1 it W -
SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
S 95 -404 34
4" CI VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF
::t251 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVE.
FINISHED GRADE W/ PADLOC< c
4" CI RISER ~-WARNING LAZE
_~A L_-_ 4 " MIN.
18" IN. y 6••
INLET4 ~V
GAS-
Y ~o T(LS IA T I G HT F\/A
PPROVED
SEAL OINTS bJ
ITH
APPROVOB ALM PPONTOD PIPE
PIPE 3 0 ON
ONTO SOLI C OLID SOIL
SOIL PUM OFF ELEV . FF RISER EXI
D ERMITTED ON
IF TANK
MANUFACTURER
HAS APPROVAL
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
r '
SEPTIC / DOSE
TANK MANUFACTURER : NUMBER DOSES PER DAY :
TANK SIZES: SEPTIC GAL. DOSE VOLUME INCLUDING
DOSE GAL. f .23,7 FLOWBACK: 17 3. 78' GAL.
ALARM MANUFACTURER:( SYS,,PACITIES: A = S INCHES = ~5~ 3,•~S c_
MODEL NUMBER: 1I 14 SWITCH TYPE: B = 2 INCHES = 3GAL
T
= INCHES = 1.~
PUMP MANUFACTURER: C
MODEL NUMBER:
T-Z' Z-617 Ctr~~,~ D = INCHES = / GA!
SWITCH TYPE:
REQUIRED DISCHARGE RATE 31-71P GPM PUMP & ALARM WIRING AS PER ILHR 16.23 W.
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 9~0 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . 2.5 FEET
+ /qs_ FEET FORCEMAIN X L%y_FT/100 FT. FRICTION FACTOR FE=T
TOTAL DYNAMIC HEAD = f9-F E 7- T
INTERNAL DIMENSIONS OF PUMP TANK: LENG'T'H ; WIDTH DIAMETER
sc < Ta'`I_ spec _ S LIQUID nT=
SIGNED: LICENSE NUMBER: DA'T'E:
1/88
S95-40424
"art ~ N~"i n I
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b
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c. Y~~. j"` 6 X11 ~.'l . «~7y 'r H } i ~ ~ r .
C
4'~ay~*~l~`~'
H ~ ikS~_'~ f'~t .YxY tidy t";!'~<V~ ~ j~'~i~i~k~<~ Y x~ 3,~
rt ~~+~~~aR ~j~ ~ ~ v u •,~`x..c,~ ~ k~~5gx ~~T ~ :i'
ANK 'SPECIFICATION
S $
t t
CAPACITY: 12001750' 'szg INLET AND OUTLET.
` f s
{ CONCRETE STREN QQQ' 4" BORE'WITH;STOP,FOR TYSEAL OR
REINFORCEMENT: FERNCO !GASKET f .'x ~`k
,COVER #44REBA ~ T}'INLET AND OUTLET BAFFLES:
'r i ;;ntTANK: 6x6/10 GA`: t; P.V.C. 'MEETS WI. D.I:L.H.R. AND
DIMENSIONS MN. M.P C A SPECIFICATIONS
1 WALL 21/ ,°LEN LIQUID CAPACITY
BOTTOM: 3" WIDTHS 25.40 GAL/INCH (SEPTIC)
COVER 5" ~BELQIN: INLET 53"s 'r 16.13 GAL/INCH (PUMP)
HEIGHT 66 MAN E- 24 1 D fic; WEIGHT: 14, 795 POUNDS
MODEL WCT-1950
1200/750 Combination Tank MIESER 00HURETE
Rt. 2 (Hy 10) Maiden Rock, WI 54750-(715)647.2311
~g MODEL43SOLIDS
Submersible SIZE. 3/
Effluent Pump RPM:
METERS FEET ' 4 0 4 3 4
- i
$ 25 _ ---j-__
7
o ~
a g 20
U
1
N 5 ~I
Z 15
0 4 j', I - - I
J
3 10
2
.5
1
0 00 10 20 30 40 50 GPM
0 2 4 6 8 10 12 m3/h
CAPACITY
MGOULDS PUMPS. INC.
S&L FALLS ►EW Yq~dC r3148
Effective October, 1988
0 1988 Goulds Pumps, Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A
~bo-0ninDepatmentofIn use' SOIL AND SITE EVALUATION REPORT Page 1 of 3 Hum Relations
`division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8,lfc 14 ' c e size. Plan must include, but St. Croix
not limited to vertical and horizontal reference i of slo~' scale or PARCEL I.D. #
dimensioned, north arrow, and location and 5tista?wd"to nearest roam 008-1054-50
APPLICANT INFO RMATION-PLEASIs ~*N' T ALL IN AT REVIEWED BY DATE
OPERTY LOCATION
PROPERTY OWNER:
LEM
Norman or Rebecca True VT. LOT SW 1/4 SW 1/4,S 18 T 28 N,R 16 *(or) W
BLOCK # SUED. NAME OR CSM #
PROPERTY OWNERS MAKING ADDRESS ) T#
1844 Park St. na na 79 acres
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [:]VILLAGE MOWN NEAREST ROAD
White Bear Lake, MN. 55110 (61,426-{J Eau Galle 30th. Ave.
[ ] New Construction Use (x] Residential /Number of bedrooms 3 [ ] Addition to existing building
[ Replacement [ ] Public or commercial describe
Code derived daily flow 450 aDd Recommended design loading rate • 5 bed, gpd/ft2 .6 trench, gpdtft2
Absorption area required 375 bed, n2 375 trench, n2 Maximum design loading rate • 5 bed, gpdm2 .6 trench, gpdtft2
Recommended infiltration surface elevation(s) 101.38 It (as referred to site plan benchmark)
Additional design / site considerations contour line at el. 100.38
Parent material glacial drift over sandstone uplands Flood plain elevation, if applicable na it
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE 7 SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem 1 ❑ S :01.1 ®S ❑ U ❑ S [3U ❑ S ®U ❑ S ®U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence El nfty Roots GPD/ft
in. Munsell Ou. Sz. Con. Color Gr. Sz. Sh. Bed Trerxil
1 1 0-9 10 r4 2 none 1 2ms bk mfr crw if .5 .6
2 9-18 10yr4/3 none sil 2msbk mfr gw if .5 .6
Ground 3 18-32 10yr4/4 none sil lmsbk mfr 5w na 2 ;3
elev.
100.53ft. 4 32-50 10yr7/3 none sandstone residuum na na np np
Depth to
limiting
fry
Remarks:
Boring #
1 0-12 10yr4/2 none 1 2msbk mfr 9w if .5 `•..6
2~~ 2 12-22 10yr4/3 none:,; sil 2msbk mfr gw if .5 .6
3 22-35 7.5Yr5/6 none
sl lmsbk mfr gw na .4 .5
Ground
elev. 4 35-50 10yr7/3 none sandstone residuum na na up 'np
100.53n,
Depth to
limiting
factor
35"
Remarks:
CST Name:-Please Print Gary L. Steel Phone' 715-246-6200
Address: 1554 2 ,90th. Ave., New ichmond, WI. 54017
Signature: Date: CST Number:
1-24-95 cstm 02298
PROPERTY OWNER Norman True SOIL DESCRIPTION REPORT Paget 3~
PARCELI.04 008-1054-50
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary I Roots GPD/ft
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench
3 1 0-11 10yr4/2 none 1 2msbk mfr 9w if .5 ; .6
2 11-2 10yr4/3 none sil 2msbk mfr gw if .5 .6
Ground 3 22-32 10yr4/4 none scl lmsbk mfr gw na .2 .3
elev.
99.38 ft. 4 32-6 10yr7/3 none sandstone residuum na na np np
Depth to
limiting
factor
32"
Remarks:
Boring #
5n.
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
AJ
Ground
elev.
ft.
Depth to
iiTAi g
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor FT
Remarks:
SBD-8330(R.05/92)
A f ~ f
STEEL'S SOIL SERVICE
Gary L. Steel Norman True 1554 200th Ave.
CSTM2298 Sw4 Sw4 S18-T28N-R16w New Richmond, WI 54017
MPRSW 3254 town of Eau Galle (715) 246-6200
79 acres
N
1"=40'
EM.= top7of cement step to porch C el. 100'
12
I
3M
Gary L. Steel
1-24-95
uov, •e Y nn cn I U. 2J
~ 9 CZcres
OK40LJLb- Elev,
¢ iC70,38 -
- OUL4 i X
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER NORMAN OR REBECCA TRUE
MAILING ADDRESS 2118 50TH AVENUE, BALDWIN WI 54002
PROPERTY ADDRESS 2118 30TH AVENUE, BALDWIN WI 54002
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE BALDWIN WI 54002
PROPERTY LOCATION SW 1/4, SW 1/4, Section 18 T 28 N-R 16 W
TOWN OF EAU GALLE ST. CROIX COUNTY, WI
SUBDIVISION N/A LOT NUMBER N/A
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
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
~J
S T C - loo
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 NORMAN OR REBECCA TRUE
Location of property SW 1/4 SW 1/4, Section 18 , T 28 N-R 16 W
Township EAU GALLE Mailing address 2118 30TH AVENUE
BALDWIN WI 54002
Address of site SAME
Subdivision name N/A Lot no. N/A
Other homes on property? Yes V/ No
Previous owner of property G e_ d _ &,s, k_seth
Total size of property 2 a eres
Total size of parcel 7 ~e rrs
Date parcel was created
Are all corners and lot lines identifiable? ✓ Yes No
Is this property being developed for (spec house)? Yes No
Volume jh1 and Page Number 1,5_0 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. „l 79 , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
_S",z 6 C P9
ignature of A'pp ilit cant -Co-Applicant
9s Z9 q
Date of Signature Date of , ian t-iira
526699 State Bar of Wisconsin Form 2 - 1982
`~J WARRANTY DEED
DOCUMENT NO.
Vol ~ REGISTERS QFFic
ST CROIX C0., W1
Recd for Record
Celia A. Berkseth, a single person, MAR 13 1996
- at 11:30 A.i:i
t
conveys and warrants to Norman G. True and Rebecca I. Tj 11P, Register of D
husband and wife, w
_ THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
the following described real estate in St. Croix
County, State of Wisconsin:
(Parcel Identification Number)
S1/2 of SW1/4 and SW1/4 of SE1/4 of Section 18-28-16 EXCEPT the East 2 rods
thereof.
i
fRAN Sf
/
UZI
This is homestead property.
(is) MW
Exception to warranties: Easements, restrictions and rights-of-way of record,
if any.
Dated this X 3rd day of March 19--95.
(SEAL) d_/~-2~- (SEAL)
* * Celia A. Berkseth
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) S1'A'I'E OF WISCONSIN
ss.
St. Croix
County.
authenticated this day of Personally came before me this _r day of
19-95_ the above named
- Celia A. Berkseth, a -single--gersQn-r----
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stats.) to me known to be the person who executed the
Diane M. BatrQl6ing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY Notary Public
Kristina Ogland State of WISOOTI -
Attorney at Law L
Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date:
necessary.)
'Nano} of peiwnc signing in any capacity should he typed or printed below their signahan s.
WARItAN 1' DEED STAVE IIAP OF WISCONSIN Wisconsut Logal Blan% Co . Inc
i
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