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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
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'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
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ell-
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0i0 - ~0 5 / c p,UG 7993
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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
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to
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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
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All 1015 ACRES EXC. ROAD
2.506 ACRES EX C. ROAD p 2.10( ACRESEXCI N ` U) 00 2,1
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R. O. w. ROAD R.O. R.10. W. N W
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h 109, 261 SO, Fr. /00, 945 SO.Fr. ! Z h (212, 6J5 SO, Fr.
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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`•'
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10
'n SCALE /"z /00'
W ' LAUREN
i O SO' (o0' /10' ZOO' J00' 7 y
0 7 _ m cr-
W R p
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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