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HomeMy WebLinkAbout010-1050-60-200 of ° I M 0.' ~ I w ~ I o I N o I ~ I I r I I I N I ~ Z I C ~i c I p Q I I Cl) Z H E z € d I c:,HCWi~ am i 0 E z v w z I a°i Z ~ c ~ I ~ I c ~ t p I c Q z z O Z Cl) N V N 12 N CD ! > w m a~ o I G G a d, h„ Q o Ummvr> j o rwJ z > 0 3 3 ° 0 O O O Z V*4 c CL CL CL if _ (D rn rn } I d1 J V c rn rn ~l Q r°) L ao o w O ~ I m N c d N N I M ~ ~ Q ~ (n f6 O+ co 7 O O y N C 0 '0 C C~ E 00 LO O co m 2 N C D. C a QOj N i.r O lh f6 N E % _ r r O O 'p E tD C N p c d ~ r Q) 00 M~ M y Y .0. ~ C N O O d E _N O O t~ O E co U • O N W = N O Z N Z .E fn 0 ~ = I V~ y ~ .a ~ a I r~ ° c ad u a~IL u CL 0 U) L) r Parcel 010-1050-60-200 03/06/2006 03:38 PM PAGE 1 OF 1 Alt. Parcel 21.30.16.311 B 010 - TOWN OF EMERALD Current XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BANYAI, LOUIS K LOUIS K BANYAI 2330 140TH AVE GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 2330 140TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 2.613 Plat: N/A-NOT AVAILABLE SEC 21 T30N R16W PT SE SW BEING LOT 1 OF Block/Condo Bldg: LOT 01 CSM 9/2660 2.613 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-30N-16W Notes: Parcel History: Date Doc # Vol/Page Type 08/30/2005 804927 2877/479 QC 07/19/2005 800830 2846/524 SCAF 05/06/2005 794331 2798/254 WD 01/09/1996 538383 1157/164 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 80329 148,800 Valuations: Last Changed: 10/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.613 18,000 118,800 136,800 NO Totals for 2005: General Property 2.613 18,000 118,800 136,800 Woodland 0.000 0 0 I~ Totals for 2004: ' General Property 2.613 18,000 118,800 136,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 139 j Specials: User Special Code Category Amount ~ 010-GARBAGE SPECIAL ASSESSMENT 30.00 I Special Assessments Special Charges Delinquent Charges Total 30.00 0.00 0.00 1 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /7 R V e / f /l°. I h t +rt 4 ADDRESS C~ .S 4 r~ rr, i~ l~ ► l' C' r'~., SUBDIVISION / CSM# LOT # SECTION 2 I T 0 N-R /4 W, Town of L^ B ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM F ed O ~ S.r t s )L /V t~ 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: -Me 01 ~t e t r,~ Liquid Capacity: f 0 0 0 Setback from: Well---- House Other Pump: Manufacturer 2 t I /t rj ~f Model#r Size Float seperation 3 Gallons/cycle: Alarm Location -;SOIL ABSORPTION SYSTEM ow Width: ~ Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well:- House Other p ELEVATIONS Building Sewer ST Inlet, ~i ST outlet PC inlet PC bottom cr / PUMP Off ?X v Header/Manifold Bottom of system _/0 0,S-Z_ Existing Grade (a,7 - Z. Final grade /0 DATE OF INSTALLATIO : ✓ PLUMBER ON JOB: LICENSE NUMBER: 1j) INSPECTOR: 3/93:jt Wisconsin Department of 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 o : State Plan I No.: HIELKEMA, HARVEY i CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: / 1e ~Z, a Q's ,O TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sept icn e Benchmark Dosing AeratiorT- Bldg. Sewer 2,30' S / Holding St / Ht Inlet TA SETBACK INFORMATION St/ Ht .Oot+etr Vent TANKTO P/L WELL BLDG. A irito ntake ROAD Dt Inlet Septic > a' 3 S~ NA Dt Bottom ' Dosing ' NA Y./ Man. Aeration NA Dist. Pipe ,75 ' M / H Bot. System PUMP/ SBN INFORMATION Final Grade Manufacturer Demand 4': ^ Model Number ,e X GPM TDH Lift Friction System,./ TDH Ft oss Head Forcemain I I Length 5~ Dia. ;:pDist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width r , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~S DIME SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC M adurer: SETBACK INFORMATION Type O /)Q,,,,,J.. HAMS C / Mo a Number. System: >25; OR T DISTRIBUTION SYSTEM [Le,gt eader / Manifold Distribution Pipe) r x Hole Size x Hole Spacing Vent To Air Intake hDia. Length Dia. Spacing t .3 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over r Depth Over „ c - xx Depth Of f xx Seeded/ Sodded xx Mulched Bed / Tfer~hrCenter /O Bed / #enttrEdges Topsoil L^ [9 des- ❑ No B -Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Emerald.21.30.16W, SE, SW 'Lot 3, 140th Avenue C,(6.. 0 kO : X90; ~w ode n 7~ ~7 U_~n , V Plan revision required? ❑ Yes Q N"b 42 Use other side for additional information. /d / k5d SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. _ _ I 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r Safety and Buildings Division V~iLt1f~' 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 than 8 112 x 11 inches in size. sel- CC-0 I-J( 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 ❑ Check if rev, i~ oTf'co'previot7s applica►ion [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION S - ~6 Pro rty Owner Name Property Location ~/or) 1;1.r 1 i4 i4, S T % J N, R tt( W O A t~ 1 _ r !l Property Owner's ailing Address tt Lot Number Block Number City, State f1 / Zip Code Phone Number Subd ivision Name or CSM Number / A, It 12- II. TYPE F BUILDIN : (check one) ❑ State Owned C Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town of 1--11i 4., 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo G t /J 1 06C C? - O 2-0 Q 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ICI New 2. ❑ Replacement 3. Replacement of 4_ E] Reconnection of 5. E] 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 EA 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation `7 5 CJ J f.~ 3 2 5..- 2 1(~ C) , S Feet a Feet VII. TANK Capacity gallons Total # Of r Prefab. Site Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete st noted Steel glass App. Tanks Tanks Septic Tank or Holding Tank / 1 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber !✓f 5-L" I 1 1115;;11 I ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility f r installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber; Signature: (N S ps) /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, Stat ip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee (Includes Groundwater Date Issue Issuing A nt Si ure (No amps) pproved E] Owner Given Initial Surcharge Fee) I Adverse Determination T -/j X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-6398 (R. 015/94) DISTRIBUTION: Original to eounly, one copy To: Safety & Buildings Di-,ion, Owner, Plumber r 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, re(onnection, 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 "i-formation. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and rnan! jcturer's name, indicate prefab or si'_:, constructed and tank material. Comolete for all septic, pump/siphon and hold ,~g tanks for this systern. Check experimental approval only if tanks receiv,> ! experimental product approval from D 1 L!-j1 I Vltl ResDornsibility statement. Installing plumber is to fill in name, license number v, h appropriate prefix (e g. MP, etc.), _dl d-n;ar,:d phone number. PI um.her mustsign application form. !X. woU )ty i Irl" f:,aru7ient Use Only X. County i Department Use Only ,..3* rs : ' _ ',r aan R 1C2 x Cf _s r _$ie my T1-e plans must complete Jim; tank(s), septic pump or siphon hul C!~ngserved, r ~i . U : r r c-oss section s-, g irtfnrmation_ GROUNDWATER SURCHARGE i C) f r i hr,: 'rea!ion of surcharges (fee,,) 'of nlltT <!i (t t JV i = can I t ~ . _ i _ ,_jrcil'.rges are used for monitoring _jrc. ~i ' uY -nver,tigations es c,. ;;ar;U-~rd SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 16, 1995 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S95-40959 FEE RECEIVED: 180.00 HIELKEMA, HARVEY SE,SW,21,30,16W TOWN OF EMERALD 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. incerely, q 10 r ~ RECECVE0 ennis orenson Plan Reviewer Z Section of Private Sewage (608) 785-9336 i;T CRLNX LP u*NTY ?OlNki ge'nC~ 'V SHDA•7907 (K. 18M) i Page of 6 r.--"aVED MOUND SYSTEM AM 16 v - 7 1995 FOR 7 A a BEDROOM RESIDENCE ~,r r Y b 8M. DIV. LOCATED IN THE SE 1/4 OF THE S W 1/4 OF SECTION 1) , T 30 N, R 16 W, TOWN OF -'~_n m AL'L , SY.`.17~1X 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 PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR `~Ac-Q vim( ~l Z 1LENt A _ ~~L~w2~v, w~ s~1ooZ PREPARED BY ~o\ L~IECEI~ER SOIL TESTING w: .4 nEE3I GtV SEF2V I CE d S ARTHUR L. : ® W;:JG2F:Eq j A = 0-975 FIF.O. BOX 74 421 K. KAIK ST. FI=;RTH' wis. RIVES? FALLS. V1 54022 • ti • 4'z~ 'p e 715-4225-0165 Imo LAS I G l; s-3- as JOB NO. Ci S - Z 3 M PLOT PLAN Page of Scale 1 - q-p S95-40959 Y ,I . f2 ~ I J v~ N 10 Q \ \.51v~2 9 S b ir~fz@'A S f h \ N ' I I' \ is eta 0p ti 9. 1 CIO Cr ~f t 13S'oP ZM S Pic. F ~ . 1 - 1 1~ a LA' of y" PV C J ! it `A 3 B b TL M I I I 1 I, 1~T ~-~-S T Z.S' F20i"'1 'T'Pt►v1zS . ~ tSu r-t PI~w~1-N 1~'T' 'Td `Ttt E k~-:-X is'r?jv 6 ~L _ _ a 2.3O -T1* 5T. -_.Lq_Q ~ _1,~ U e. - - , _ ,NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. rJ2. Install permanent markers at end of each lateral. ( Z- required) T3. Install 4" observation pipes with approved caps. ( z required) Septic tank to be loon/6Sogallon capacity manufactured by ~ , r--1 ~ ~ w tss~-~yz..►y ~ R-~i- sT! r ~v e 5 . Bench Mark ~t~v, L11o.0 ON or- 1 s nova Fm lu G`nu>v 6. Divert surface water around mound to prevent p ponding at the uphill side.. Page 3-of Approved Synthetic Covering S95-40959 ~sTM c 3~ Distribution Pipe Medium Sand _ G _ H _L Topsoil F Elev. Lub. S D - 3 E .r b % Slope Force Main Plowed I Trench of k"-2k" From Pump Layer Aggregate D l.0 Ft. Undisturbed Soil E 1 •o Ft. Cross Section Of A Mound System Using F o.$ Ft. 1 Trench For The Absorption Area G Q Ft. A S Ft. H I. S Ft. B 7S Ft. I Viz) Ft. Linear Loading Rate= 6•0 GPD/LN FT J t0 Ft. Design Loading Rate= GPD/SQ FT o-~-~! 1~ o•y wi~~. K ~D Ft. L a1 S Ft. 41terHate Position of Fo W Z S Ft. Force B K Main FA W 2i~ Distribution Trench Of 2 2 Pipe Aggregate . Permanent J ` Observation Pipes Marke.cs , , i (Anchor securely) t "1 sa;;. Y rL i tom, ~c r t Mound Using I Trench For A~~'~b p tion,'l#rea Q Of 6 I Perforated Pipe Detail 895-40959 0 End View )Perforated End Cop) PVC Pipe Install permanent-marker at end Of each lateral I Holes Located On Bottom, lit Are EgaoNy Spaced Q End Cap n r , * PVC Force Main r *ti' ..c, * i ~ ~is w •'tb.r Dislrioution pipe Lost Hole Should Be Next To End Cap ..6 Distribution Pipe_ Layout p 3q:SFt. X b Inches Y 36 Inches Hole Diameter )/Y Inch Lateral )1!y Inch(es) Manifold, Inches Force Main " Z Inches # of holes/pipe 1 Z Invert Elevation of Laterals 113Z.-Oft. Place 1st hole fro tee with succeeding holes at ~D intervals. Last hole to be next to the end cap. _Combination Septic Tank -.arid_- ; Pi1MP CHAMBER CROSS -SEM- 0 IdO SPI CIFIfii4T101d3 ISAG D • VEIJT CAP WEATHER PROOF J3 AP JuucT~~yu 4' C.I. VENT PIPE APPROVED KIIC'4 O 9 5 :9 1Q' FROM DOOR, MMJHOLE COVER rNI'M .Jiwww OR FRESH wARN1►J6 t-t~9EL. ALK INTAKE S~ cc&31>0 T ` t ~ I 40 MIM. In_ aq.s 18"MIN. 18"MIAI. ~ \ 11~ PROVIDE ( AIRTIGHT SEAL J~E I III I III BIaFF~~S A I III APPROVED JOINT APPKOVED:JOIWT I W/C.I. PIPE4PL I W/C.I. PIPE-OR Tank construction I I II~`t shall comply with ILHR 1,3.15 and 83.20 e ~11 C f sI~ V C t h. W "tF+4 sa. a3 i r' CLEV. yFw F7. Puf'lP , ~r D CORET t v= k, % APPW RISER EXIT PERMITTED 0QLy IF TAIJK MANUFACT' HAS ''SULH APPROVAL 3 ODIN( 5PCCIFICAT10KIS SEPTIC E DOSIEK MAIJUFACTURCR: IltiWLS`TL N'> AIUMBER OF DOSES: 3.q S PER DA4 TAWK 51ZL : l0 y0 / S S O GALLOWS DOSE VOLUME t INCLUDIIJCa 6ACKrLOW: 13~ GALLONS ALARM MAWUFACTURE.R: MODEL KIUMBER: 1O~ NW CAPACITIES: A=!NICHES OR 3O6 GALLOys SWITCH TZJPC• ~ZGUIZ-~( B= Z IIICHES"OR "Y - G(LLOUS PUMP MANUFACTURER: cta C s S ILJCHES OR GALLOAJS MODEL NUMBER: D- 10 ~LOR 6 GALLONS SWITCH TYPE: L1lLAJP_Y MOTE: PUMP AMD ALARM ARE TO BE MIMIMUM DISCHARGE RATE ?-si•os GPM INSTALLED OW 5EPARATE CIRCUITS VERTICAL DIFFERENCE OETWELIJ PUMP OFF AIJ0.015TRIBUTIOU PIPE.. N~ FEET t MINIMUM NETWORK SUPPLY PRESSURE . . 2_52 FEET 135 FEET OF FORCE MAIN X FjpFCFKICTIOIJ FACTOR. 2' 11 FEET TOTAL 0y1JAMIC HEAP = »`g FEET DIAMETER Pump chamber INTERNAL DIMLWSIOWJ OF TANK: LEKIGTH ;WIDTH ;LIQUIE) OLPTH BOTTOM AREA 231= - GAL/INCH AS PER MANUFACTURER GAL/INCH HEAD CAPACITY-CURVE 3 7/8 6 1/ 4 tJ P jG E G u F MODEL "98" 30 4 5/8 8 f3 25 q 3 5/8 = 6 20 + + v » 64 O a 15 4 3/16 o 4 o ~ to 1 1/2-11 1/2 NPT 2 5 895-40959 0 U.S. GALLONS 10 20 30 40 50 60 70 80 UTERS B0 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 1 20 6.10 25 95 Lock Valve 23' z 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 m dels - 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 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 l &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, FM0514; All installation of controls, protection devices and wiring should be done by a quali- Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO486: Mechanical Alternator, fied licensed electrician. All electrical and safety codes should be followed includ- FM0495; 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. 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 Louisville, KY 402560347 Manufacturers of . Q SHIP TO- 3280 Old Millers Lane ' fiF T c euisville, KY 40216 tQUAL/Tr PUMPS S~YCL /9.~9 O _ (502) 778 2731 • 1(800) 928-PUMP FAX f502) 774-3624 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER r k. MAILING ADDRESS PROPERTY ADDRESS 3 3 U `7 G t 4 Z (location of septic system) Please obtain from the Planning Dept. CITY/STATE G2 v d PROPERTY LOCATION L- 1/4, 1/4, Section T S C N-R W TOWN OF L t , ST. CROIX COUNTY, WI SUBDIVISION c LOT NUMBER I 6~a CEIIT1F1EDSURVEY MAP , VOLUMi , 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 I/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. rust be completed and returned to the St. Croix ' C'ulifcalion stating that your septic has been maintained n Countyloning Officer within 30 days of the three year expiration date. SIGNED: G p DATE: Ic e> ( L S~ St. Croix County "Zoning Office Government Center 1101 Carmichael Itoad I Judson, WI 54016 11193 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_ 4 ri V A Location of property! c 1/4 1/4, Section I T SO N-R 1 lr W Township Mailingaddress 4'4/0 . e, f"u ('~"7' d' /Y j'_' . - " I . j ce" '2 - Address of site 3 30 / y6 rS ~4 Gle n G/vm C( Subdivision name Lo z- / C s f Poo t 1 LG o Lot no . Other homes on property? Yes No Previous owner of property Total size of property 2 . G /.3 Total size of parcel 13 Date parcel was created ~?3 Are all corners and lot lines identifiable? de-""Yes No Is this property being developed for (spec house) ? / Yes No Volume/6"'(1 and Page Number 1 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. , 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. Signa re of Applicant Co-Applicant k 3 U / r ~rx- Dat of Signature Date of Signature ~ a v ell- NN b c t ~ r M \ ^ 1 V \ 0i0 - ~0 5 / c p,UG 7993 )09 c-' t- d}~IJ~E5 ~'CONN2LL Part of the Southeast 114 of the Southwest 1/4 of Section. E1, Township 30 North, lunge 16 West, Town of Emerald, St. Croix County,.Wiscons:i>n. Owner's Address: 1560 110TH AVE. O Indicates 1" x 24" iron pipe-weighing 1:•13 lbs./lin. Ft. Hammond, WI 54015 set, 3 Phone No.--l-715-795-55S4- Indicates Fence. a UNPLATTED LANDS Q UNPLATTED LANDS o - r, wArERcouRse 4 h' 90 00 00 "E 392.97' u N90. 00.00"E 222.00' k /96, 1l' /96. 46' l W I . Du/LD/NG SETOACK DU/LO/NG ^E rOACKI Ct 'I-- --L /Nf L/Nf •I I r Q to I ~ v O I • I 4il ! o N This instrument dreFte J by o o w 10' ri Laurence W. Murphy I ~ 1 10' h Q Dated: June 18, 1993 "9cvised this =nd Day F August, 1993." I h ° I J LO T l LOT 2 W vh v ;LOT 3 o I ~ m N O 2.1952 ACRES o m 2.1.9-12 ACRES' Z.GIJ ACRES Z. 6/1 ACRES I M O v o 0 O All 1015 ACRES EXC. ROAD 2.506 ACRES EX C. ROAD p 2.10( ACRESEXCI N ` U) 00 2,1 I h 0 R. O. w. ROAD R.O. R.10. W. N W O O ~ h 109, 261 SO, Fr. /00, 945 SO.Fr. ! Z h (212, 6J5 SO, Fr. n b I QI h M m ti I O J I ~ V _ I 7 M h 1 J i O h M ! Q N v v i ~I W I O v I I H n it h Z o I Q J ~ I W I Q h ~ ~ 90.00'00"f G6.00' 11 /001 3j M /00' 0 ~ O V N O O c O V o, O O ,,o J N v o~ Qi ~ .N H 39.33'3/"E 600, 77' 190.40•' /9 G. J9' n ~ 66.06, v n 22(.92' m y / 96, 45' 196.46' 66.00, 10 222. 00' e - r/9676"0 'oo"Ir 2724.00' 140 TH AVE. - M~ S LINE SIV 114 ` S1/4 COR. SE C. 21, rJON, R16:e, sw cOR. SE C. 2/, rJoA, R161r, UNPLATTED LANDS (couNrr &j%At't Ite,%, AtoN,j ( .l IRON ),/PC 'FOUNOI 0 N`•' J Y 10 'n SCALE /"z /00' W ' LAUREN i O SO' (o0' /10' ZOO' J00' 7 y 0 7 _ m cr- W R p o a C' 4W1713 1 N - FALLS.. vol 9 Page ?_660 f Wisc. Q CcrtiFied Survey Maps ~ F~•• c a N•0 CO St. Croix County, Wisconsin. Laurence W. MurPh o Y gistered Land Surveyor o- W o O M S1-lei' 1 OF- 2 • , ~i THIS SPACE RESERVED FOR RCCORDING DATA ~I ["OCUMENT NO. 0 WARRANTY DEED i1 ~I 'STATE BAR OF WISCONSIN FORM 2-1982 497875 ~i 0100' PAGE 151 _iL- John Geurkink and Patricia A. Geurkink, F,EGISTER'S OBE ~a I~1 survivorship ji Ret`dforRec,VA husband~'•and• 41fe......As marital 5 4 ro e . rt APR 2 3 1993 ...P......Y Q• Z u ETarvey . Hielkzma and conveys and warrants t Szanna_• H...-Helkema,. husband;: and::wi fe, hol_ding•- as .survivorship marital property ---il _ RETURN TO Ii II j the following described real estate in St.....~);0. --•......County, State of Wisconsin: Tax Parcel No L II 1. Northwest Quarter of Southeast Quarter (PIW4 of SE's). I 2. Northeast Quarter of Southwest Quarter (NE4 of SWh)• ji 3. Southeast Quarter of Southwest Quarter (SE's of SW's) j EXCEPT the South?ast Quarter of said Southeast Quarter of Southwest Quarter (SE4 of SE4 of SWk)• it All in Section Twenty-one (21), Township Thirty North (T30N)r II i Range Sixteen West (R16W). i PRANSFEb i FEE is not homestead property. This i (is) Exception to warranties: Easements and restrictions of record. a i . 1x..93 Dated this --•-----•-2110....-•....................... day of . . . April --(SEAL) (SEAL) hn G ink. G( s$I Zft~^_.(SEAL) • -Patricia A...-Geurkink AUTHENTICATION ACKNOWLEDGMENT Kentucky Signature(s) STATE OF X3= U0. County. 19 ersona y came before me this day of i authenticated this day o1..__•_______________ 1993 the a.,DVe named Jahn -Geurkink and-------------------r i pa is A. Geurkink TITLE: MEMBER STATE BAR OF WISCONS114 f (If not, - i•. i r to me I~nywri• hr• the person . 3._.. who executed the snthorized by 708.08, Wis. Stats.) r v { r lOle~roingf instr nt and ac owledge the same. t J' THIS INSTRUMENT WAS DRAFTED BY i Thomas A. McCormack s ' K Baldwin, WT 54002 Notary Public W.. .County, (Signatures may Le authenticated or acknowledged. Both My Commission is germane t. (If not. state expiration : are not necessary.) date -Noma of Persons signing in any capacity should be tYDedd ol• printed below their aitnswres. W 1RRANT7 Wisconsin Legal Blank Co.. Inc. DEED STAT8 BAR OF WISCONSIN Milwaukee, Wisconsin FORM No. 3- 1182