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HomeMy WebLinkAbout030-1070-95-000 v o 3 0 o O 69 M ,C,^ N 0. c p~ O O n O C ~ a U V _ m E O O 'O w O. ) C% c .'L'•' CY) 0) 3 x o a~ Qo Or c O -o -J M c 3 N c Z v a) Co c LL c N _ U O m a) c 6 c L C-0 N 3 00 E Q O mom a) U _m CO a a N W E Z O of £ O L Z N y N H Z i a m i c O O Z d c ce w _ N F- m N z c E O i M N N 5) m (L) •~~w _ 0 O N Q w z co z Q N z N o C E E N z N O L O Y a d _ L _ 06 (0 N C RL Q) C: 0 d it N C O O O G a a c N N N N U o E g N~ 'ED ~•i 3 0 0 0 d 0 z° rv m a a a y a z n ~ p N c LO LO } ~1 N J U J 0') OR C N O N CL E O O O O LL ) N 0. q•ri Q CD v O N m M O p C O w a y o E 0 00 (D y N C N Y Y c N CL E v rte" r--)- y O u~ C -Oi ~ c Lo_ Lo_ O O y N 7 Z' U O O C:, ce) CD • M (o U 't m m cLi O N U) W N O Z (n O ~ I E a L: a. -6 2 L 1 0 a 2 ~I, O N 0 1 ' STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS f' Il SUBDIVISION / CSM# _ LOT # o/5?J SECTION _T~N-R_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VI SHOW EVERYTHING WITHIN 00 F T OF SYSTEM ~J i i r r 1r ~ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 4 r BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION > Manufacturer: Liquid Capacity: Setback from: Well ~n House Other Pump: Manufacturer Model# _?W;7 Size Float seperation Gallons/cycle: Alarm Location ~IJ SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: ~ , Setback from: well: fHouse Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet .,n 7g PC bottom ~Q7 Pump Off Header/Manifold Bottom of system C ; 7 Existing Grade Final grade DATE OF INSTALLATION: - PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR:- 3/93 : jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor an iumzlnRelations ST. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City Village Town of: State Plan D o.: ECKSTROM, ROGER E. R CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /GUi ZEV 14 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic a a o Benchmark ~a D OD Dosing u, Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet I y Verit TANK TO P/ L WELL BLDG. Air Ito ROAD Dt Inlet Air ntake 11171, 9p, 79 Septic > ~0 ; ~/O l / l , $ , NA Dt Bottom t s 3 / 1-), c~ Dosing 'SO , fl s NA Header / Man. 7,3 S / q S, .a Aeration NA Dist. Pipe 7, y7' 95',o3 ' Holding Bot. System S. y 3' 9y.o 7 PUMP/ SIPHON INFORMATION Final Grade Manufacturer bO,cQ Demand"' n Model Number ~/Z h GPM r~l TDH Lift Lriction System TDH Ft oss Fi , Forcemain Length 1-d0! Dia. Dist. To well > jp SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION / DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER Moe Number: System: L Q6 ' /00 --4--o' OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center ` I Bed /Trench Edges Topsoil E] Yes J1 0 ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.26.30.19W, NW, NE, Frog Pond Lane u Plan revision required? ❑ Yes ❑ No , Use other side for additional information. r/ , t,tYv SBD-6710(R 05/91) Date In e ' Signature Cert No. ADDITIONAL COMMENTS AND SKETCH - a. SANITARY PERMIT NUMBER: ° Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 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. ~ • See reverse side for instructions for completing this application State SaWary~ rmitNum er 15 The information 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 Prope Owner Name Property Location 2542_0_1~ (IA) 1/4 1/4, S T , N, R Y(or~ Property Owner's ailin Address Lot Number Block Number City State Zip Code Phone Number Subdivision Name or CSM Number r ( / I. TYPE F BUILDING: (check one) ❑ State Owned E] City Nearest Road 5 village El Public 1 or 2 Family Dwelling - No. of bedrooms / Town OF z~a AL- III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ^~Q~P 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. ❑ New 2. H Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing 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 jN Seepage Bed 21 ❑ 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.) (MinA ch) Elevation Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel lass Plastic App New Existing strutted g Tanks Tanks Septic Tank or Holding Tank J0160 1 112 1Z ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber An J9 I ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility fo installation of the onsite sewage system shown on the attached plans. Plumb 's Name: (Prirkt) Plum is ig tur (~V amps MP/MPRSW No.: Business Phone Number: Plumber's Address (Stree City S at ip Code): r IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge f ee) [ 7-S Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 015/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings Division, 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: 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. 111. 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 systern ir`farmation, Provide all information requested for number, throuc I. it 'ank. information. Fill In the capacity of every new/or existing tank, list the tc ;ailo^s -iurnN.~ of tanks and t r i6! z,,Ae p efab or site construe:ted and tank mater r . ;Y-t f , i'! >eptic, pump/siphon and i, "Iding tanks for thi s systern. Check experimental approval only if tanks retie v e periwenwl r,roduct approval from D LHR Vlll- Responsibilii.y statement. Installing plumber is to fill in -iame, license number vv ,.n appno tri,:1'.e refin (e.g. MP, etc.), address and phone number. Plumber must sign application form. iX. C :.,nty Department Use Only. X Cc.unty i Department Use Only. Ci ll~ut ~ nOi Sma it:r t -)n X 11 !Ilcket` 16 t _ - C -;nty The plans must plot an tfrovvn t! ,cafe Ot vil h CCrlipe'. ~~5 i p,nt .an,,(sf, septic b: Of 53php'1 Ion S~S =rn,;, re!)Iacelnti? t served, '"1 _ -j: i _ lY✓' "'1 .'.1 (-)sc se(tion 4 _ -ii'a information GROUNDWATER SL!RC1H.A0GF c,z ` 91 Vy'hi,:h; can "ges e si ; 11 _,i rove<tigations X06 7 ssua .G9nJ,E' .s'~ ~IpS~j~ ,A~'i4t~iS~~ ~d~o~T~(~i9i~ r~l~e~f• ,LL/cX~4 ~6✓S~ -z, -/oo -~s 0 ~y 0 33' a w' i X, PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEIJT CAP 'i*.Q, VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAWHOLE COVER 25' FRAM DOOR, rF7 I WIQDOW OR FRESH I2~MIU. AIR INTAKE GRADE I 4")M (N. I IB'/'MIIJ. COQDUIT INLET PROVIDE I AIRTIGHT SEAL I I I I V • I I I _T. APPROVED JOINT A I I APPROVED JMWTS W/t , PIPE I III W/6 PIPE EXTENDIN¢ 3' I I) ALARM EXTEWDIAIG 3' OWTO SOLID SOIL B I i I ONTO SOLID SOIL . I I oN I OFF • PUMP -g D ' CONCRETE BLOCll RISER EXIT PERMITTED OIJLy IF YANK MAWLIVACTURER HAS SUCH APPROVAL SPECIFI.CATIOUS LPT1C AND USE TANKS MAWUF'ACTURER: IJUMBER OF DOSES:'- PER DAB TAIJK t,IZE : GALLONS DOSE VOLUME: GALLONS ALARM MANUFACTURER: - ~ CAPACITIES: A:{~R INCHES OR ~ GALLOQS MODEL NUMBER: 6=IWCNES OR ~',g_ GALLOW5 SWITCH TYPE: C-~ _INCHES OK ,sue GALLOU5 PUMP MANUFACTURER: D- MCNES OR 7/1 GALLOQ5 MCMEL UUMBER. l NOTE. PUMP AND ALARM ARE TO BE / bW11CH T INSTALLED OW SEPARATE CIRCUITS `JPE: PUMP 015(.HXRGE. KA•rE GPM VERTICAL. DIhYERENCE DETWEEW PUMP OFF AND DISTRIBUTION PIPE., Z- FEET + MINIMUM NETWORK SUPPLY PRESSURE Z3- FEET + 'M FEET OF FORCE MAIN FJpo FLFRICTIOU FACTOR.. FEET TOTAL DYNAMIC. HEAD = /Z FEET INTERNAL. DIME SIONS O TA1JK: LEKIGTH ;WIDTH -;LIQUID DEPTH SIGIJED; LICEUSE DUMBER' > DATE: P'erfoirnance Submersible Curves Sewage Pumps METERS FEET MODEL 3887 16 50 SIZE 2" SOLIDS 14 oeti~ 40 12 w 10 >tisro z 30 8 wSf1~eF ' O i y~~eF 6 20 W 538 ` 4 10 0 20 40 60 80 100 120 140 160 180 GPM L i I I 0 10 20 30 40 m3/hr CAPACITY ~GOULDS PUMPS, INC. SENECA FALLS. NEW YORK 13148 ~i 1991 Goulds Pumps, Inc - Effective December. 1991 Ps. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN U.S.A. (3RRR7 i • sewage v,mv 3887 ETL LISTED E~I SUBMERSIBLE V PUMP CLASS I AND II DIV. 2 AND G1086131480 CLASS III DIV. 1 AND 2 ETL TESTING LABORATORIES. INC. - A.ND NEW vORK 30a5 APPLICATIONS Motor: FEATURES • Single Phase:'/3-'/2 HP, 115V or • Homes 230V, 60 Hz, 1750 RPM; 3/4-1 HP Impeller: Cast iron - semi-open, • Farms 230V, 60 Hz, 1750 RPM; 1 HP, non-clog with pump-out vanes for • Trailer Courts 230V, 60 Hz, 3500 RPM. Built-in mechanical seal protection. Balanced • Motels overload with automatic reset. for smooth operation. • Schools • Three Phase:'/2-1 HP, 208/230- Casing: Cast iron volute type for • Sewage Systems 460V, 60 Hz, 1750 RPM; 1 HP maximum efficiency. Adaptable for • Hospitals 208/230-460V, 60 Hz, 3500 RPM. slide rail systems. • Industry Overload protection must be Mechanical Seal: Ceramic vs. • Dewatering provided in starter unit. carbon sealing faces, stainless steel Anywhere waste or drainage must • Shaft: Threaded 400 series stainless metal parts, BUNA-N elastomers. be disposed of quickly, quietly and steel. Shaft: Corrosion resistant stainless efficiently. • Bearings: Ball bearings - upper steel. Threaded design. Locknut on and lower. three phase models to guard against • Power Cord: 15' standard (optional component damage on accidental SPECIFICATIONS lengths available). reverse rotation. Single Phase:'/-'/2 HP, 16/3 Motor: Fully submerged in high Pump: SJTO with three prong plug; 3/4 and grade turbine oil for lubrication and • Solids Handling Capabilities: 1 HP, 14/3 STO with bare leads. efficient heat transfer. 2" Maximum. Three Phase: '/2-1 HP 14/4 STO Designed for continuous operation. • Capacities: up to 180 GPM. with bare leads. All ratings are within the working • Total Heads: up to 49 ft. TDH. On CSA listed models: 20' length limits of the motor. • Discharge Size: Flanged - BF or SJTW or STW are standard. Bearings: Upper and lower heavy BHF units have 2" NPT threaded duty ball bearings construction. companion flange as standard. Power Cable: Severe duty rated, Optional 3" NPT threaded companion oil and water resistant. Epoxy seal on flange available and must be ordered motor-end provides secondary separately. (Order No. Al -3). moisture barrier in case of outer jacket • Mechanical Seal: Carbon rotary/ damage and to prevent oil wicking. ceramic stationary, 300 series O-Ring: Assures positive sealing stainless steel metal parts, against contaminants and oil leakage. BUNA-N elastomers. • Temperature: 160°F (71 °C) maximum. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. 1991 Goulds Pumps, Inc. Effective December, 1991 RZRR7 `.1 , 6 7 2, 3 ,y BF and BHF w.t Models 3887 4 8 9 FEATURES PERFORMANCE RATINGS 1 All Iron Construction 5 Epoxy Sealed Cable 8 Ejector Vanes In Gallons Per Minute 2 All Ball Bearing 6 High Grade Turbine Oil 9 Multi-Vane Non-Clog WS0511 BF Heavy Duty Design 7 Electrocoat Paint Cast Iron Impeller WS0512BF WS0712BF WS1012BF WS1012BHF 3 Stainless Steel Shaft Outside and Inside WS0311 BF WS05328F WS0732BF WS1032BF WS1032BHF 4 Mechanical Seal Order No. ► WS0312BF WS0534BF WS0734BF WS1034BF WS1034BHF HP ► /J /2 s/4 1 1 MODELS RPM ► 1750 3500 5 108 150 170 Order No. HP Volts Phase Max. Amps. RPM Solids wt. 10 76 124 150 168 170 WS0311BF 115 9.8 15 30 90 122 150 150 WS0312BF % 230 1 4,9 63 = 3 20 50 90 120 128 25 14 46 76 107 WS0511BF 115 13.0 "S 30 12 36 86 WS0512BF 230 1 6.5 'L 35 8 64 WS0532BF 208/230 3.3 65 40 43 WS0534BF 460 3 1.65 1750 45 24 WS0712BF 230 1 9.4 2' WS0732BF 3/4 2081230 3.6 WS07346F 460 3 1.8 WS1012BF 230 1 12.3 DIMENSIONS (in inches) WS1032BF 208230 5.8 85 WS1034BF 460 3 2.9 WS1012BHF 1 230 1 12.5- WS1032BHF 208230 7.0 3500 WS1034BHF 460 3 3.5 ~121/2' 5~ 3/4- SIMPLEX & DUPLEX SYSTEMS Rotation Simplex Ejector Systems: are used Ea'' n A' where drain facilities are below existing sewer lines. Also can be used for septic 81/4" il, tank applications where effluent must be pumped away from tank for disposal! '/4 73 63~ Kick-Back s Duplex Ejector Systems: offer the A' - All models are 173/4" except 3/4 HP 10 and 1 HP 1 o = 203/4° necessary safety required by institutions Dimensions are approximate. Do not use for construction purposes. which cannot afford an interruption in their sewage disposal systems. Available Certifications: / SP Canadian standards Association. Testing Laboratories k.`f~ SENECA FALLS. NEW YORK 13148 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN U.S.A. Wisconsin Department-of Industry, SOIL AND SITE E V A L U AT I O Page _L of Labor and Hbinan Relations 'Division of Safety & Buildings in accord with ILHR 83.05, Wis Code, lJ ~~~.tc11►C COU Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan include, but notlimited to vertical and horizontal reference point (BM), direction and % of sl aleR L 2 4 I CELT .7- dimensioned, north arrow, and location and distance to nearest road. ST APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE DATE PROP TY OWNER: PROP ION GOVT. LO TWk 1/ T ,N,R F, PR PERTY OWN R':S M ILING ADDRESS BLOCK ]NAME OR CSM # 04 Rev)4 //0 1 Z, STAT ZIP CODE PHONE NUMB R ❑CITY VILLA E OWN NEAREST ROAD [ ] New Construction Use Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flower gpd Recommended design loading rate ~ 7 ed, gpd/ft2 , ' trench, gpd/ft2 Absorption area required bed, ft2, trench, ft2 Maximum design loading rate ___7 bed, gpd1ft2__,S trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material plain elevation, if applicable r ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem fO S ❑ U OS ❑ U [4S ❑ U ®S ❑ U ❑ S a[ U ❑ S W U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tre & I f ' Ground 3 _ A/Z /,"a- t210 7._9 elev. 2,Zx/ft. _ Depth to limiting factor Remarks: Boring # - 5- ; Ground / elev. ~7 .9 &'o ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: / Address: Signature: Date: CST Number: PROPERTYOwNER G'~.~ mss , SOIL DESCRIPTION REPORT Page,,~of PARCEL I.D. # M-0 - Zo yL~2fS Depth Dominant Color Monies Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. nt Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trerxh ~x~..:.::•..: . kvv{ Ground 3 elev. ft. - - Depth to limiting fact y Remarks: Boring # In- Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # S.CGround elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) f H~ ~/U~.hCy✓p S~D~ 7 X vLo~'`iw~ o.~ S. ,f~ r~~~E ' - ~ n s~~ ~S3S ,t/ . G - 9r9~ ds c Y~ ~y ' .~/Ra / ~ ~if' ~ \ E¢ ~ I f \i ~~i t / ~'~s ar o~y, ~ ~~d~ ~S3 ~ ekls~N 1~ ~iPSS ` / } 7 sC~j~.~ C'8 ~~d x STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~o 2c ~S f2 a rn MAILING ADDRESS - 8Y f L4J wS~ 5>! ~Rft x'JN 'f'S'10z_ PROPERTY ADDRESS 13 8 6 PC, J 1.411- Z A WIX A&a (location of septic system) Please obtain from the Planning Dept. CITY/STATE A`C~/ m e•v d W,' fYO/-7 PROPERTY LOCATION N 1/ Nif 1/4, Section -Z & , T -3 0 N-R__Zf W TOWN OF _ /U' u1 k,'G A[m &e t W ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: lJ~ a e DATE: 9 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 -~m. ~E 2 S 71l 'I.-n Location of property _ZC~1/ 1/4, Section J , T 3v N-R W Township .5/4D 560 ~ Mailing address A-120 f L 19M,6 Alea) ~ `c /f M s~c✓d © 17 ~ s 4 - Address of site 1386 F201 (~eN Lg,r,iE Subdivision name Lot no. Other homes on property? Yes No Previous owner of property ( LF A'g'fon Total size of property 66 X IS-0 --t 4-. d /3ek s Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X_Yes No Is this property being developed for (spec house)? Yes KNo Volume and Page Number _5-/R _ 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 (eA-r) knowledge that I (we) am (tee) the owner(r.) 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. 3oA1 8 2 `0'3/9589 , and that I (w•e) presently own the proposed site for the sewage disposal system or I (w&.) 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. _3I9SSg Signat re o Applicant Co-Applicant -2Z ~y9y to of Signature Date of Signature a, 7,1V L~.VE R /40TH AVE. 2538 253P 253D ..53E \ b 3G \ 253A GOVERIVME~NT LOT 4 \ r~r r 'a j i iD^T*'rtCl'253G qy a ~:253S ~w - pt *41 C 253. 2531 \ 253L ' / K£LLY_s / 2531 SWAMP ~ ~ - ~ d~. f 253N 253M / I A tract of real estate: located in / I Quarter (NEk) of Section Twee the Northeast - ~I- Township thirty (30) North y"six (26) West, described as follows r Range Nineteen (19) Tex Key a Pipe stake located BEGINNING at an iron Thlslsnon pipe said Se 101.1 feet south and• .12 homestead prop thence N 500 00' , thence S'~100 00 75 '9 feet west of the northeast t W a distan ce of. W a distance of 120.0 ; .0 feet;'thence due North 312'13 feet; thence N 41 3o t feet distance of 9the a distance of 100.0 feet; thence due East ae of p 9oint0on the 9north 12A f shore to fnce. S 40 r rr f said shore S o r Wad Kellyostladistance of 130.35 feet to a distance of 274 12 istance of .1 swamp; thence on a meander line along W ,0 08, dicta 31.6 feet; thence S 260 25t.8afeet; thence S 7.7 feet; W leaving said shore N 720'001W a' Vi the above described a distance of 10.di stance of 90.7 feet; thence all lands 1 parcel containing 5.0 9.5 feet to point of beginning lying between the 7 acres, more or less and including "Kelly's Swam " above mentioned meander line and the waters of extending from Also including an easement To¢ether ith a 1 and sLhilarathed ee ddams~ a ib ed a tens for travel, 33 feet parcel ance to the Town Road in width2 thereunto belonQin Q or in an as now op e n and any wise appertaining; traveled ~(~GO, :~✓.'~Y ~~e~ 7,f/ 1 x01 Aly,6( L,n vE SR 140TH AVE. 253B 253P 253D 53E \ F 253A GOV6RIV/I%I&V7- LOT 4 N:,< t ~ 1 a S' r•i , r 4~~i ~•";~v 4i N.~ • A f• . ` 253G at + " , f 253S Ail, C 253 T 2531 253L / KE~.LY_S 253J SWAMP 253N 253M I A tract of real estate:located in the N Quarter (NEk) of Section Twent ortheast Township thirty Y-six (26.), West (30)•North, Range Nineteen described as follows: BEGINNING at (1 r TaX Key a pipe stake located an iron This is non corner of said Section 6f'eet south and. .12 homestead property. thence N 50o OOt ; thence S 40° 60 5'9 feet west of the northeast of ,0 W a distance of'. W a distance of 120.0 feet; 312-13 -thne 90 feet;' thence due North a d distance of ;-the 3 30 W a distance is.tanceeet;-thence N 43 0 r point on the northfshoret Ofnce.S 40 121 E eet; thence due East a aid shore e 74o t "Kelly swamp; distance Of 130.35 feet to a distance of 2 12 W a distance Of l p; thence on a meander line along sleavin 31.6 feet; thence S 260 79.8 feet; thence S.780 081 W g said shore N 720 00tW ~5 W a distance of a Vi the above described a distance of 10.9 ..5 90.7 feet; thence all lands -yin parcel containing 5,0 acres, les feet to point of beginning "Kelly's Swamp" Also includin g between the above mentioned meanderOlinerandsthend wat including exendin g an easement ers of To¢ether and, &;thfA514O d the tabo ee~d Tsn q iband ed ~r tearcnantel to th for t Traown vel Road 33 feet i oe es thereunto belonQinQ or in any wise nOW open en an appertaining; traveled it t1~ II WARRANTY DEED If f % a BOOK 465 PAun E15,2 I STATE OF WISCONSIN-FORM 9 30199 THIS SPACE RESERVED FOR RECORDING DATA THIS INDENTURE, Made by.......Dorothy J : Xobbe.... .nd...-• REGISTERS OFFICE Albart...L.._.-Y.Qbbie,...husband-and.:wi.fe., ST. cROlx co., wls. -'MiTin-; grantorS_... of........................................... Ramsey ......................County, Wftem3fi% Recd for Record this__4th-_ hereby conveys and warrants to...JRQF?QJ? . E-A_•,,Fcl~Strom~ a________________ af Se~temberq 1970 single man, day at__ llil~ _ A M. aWe v of Ds Ram - seY .................Count WITeRfirns orr the sum of Re _ One.-Dolla RETURN TO lOd 4tbe. '._yajjUab.j.Q considerations-•---•-----•------•-----------•--•-• - - the following tract of land in......... b...... Cr_oj-x .......................................County, Wisconsin : i Part of North One-half (M 2) of Northeast -Ome Quarter (NE14) l (Lot 4) of Section 26-30-19; described as follows: Commencing at the northeastcorner of Northeast One Quarter (NE2) of Section 26-30-19; thence west 1948 feet; thence south 269.5 feet; thence south 430301 east 484 feet; thence south 5000' east I! 198 feet to point of beginning; thence south 50001 east 66 feet; thence south 4000, west 155 feet more or less to the shore of Bass Lake; thence northwesterly along the shore of Bass Lake 66 feet more or less to a point which is 155 feet more or less south 4000, west of the place of beginning; thence north 40001 east to the point of beginning. Together with the right of ingress and egress across first parties land to the public highway as now laid out along II the north line of said Government Lot 4. I This deed is executed pursuant to an original unrecorded land contract dated November 30, 1960. 'I 302.82 ii hr-GISTS RS OFFICE ST. CROIX CO., WIS. FEF~ Recd for Record this_22nd_ Q i. day of Septembe3Z _A.D.19?2 EYEt 111 at__ - M. I Reg st i I II I III I' I~ Iitness Whereof e 4s*dgrantors.. have.-. hereunto set..... the.~..r............. hands... and seal...... this Ts ' ..2 da of.._ ,6 - y A. D., 1?DorothO ED AND SBALED IN PRESENCE OF " __..__._._..(SEAL) 6I(3N . Y bbie ~i"" - ~ ..................................•--G T~illiam J. R dosevich Albert L. obbie I G (sEnL) Geraldine M. Nord (SEAL) State of Wisconsin, - ~y - St. Cro1X-__ County. } Personally came before me, this ......day of ..'~~~.f A. D. 19.70_ , the above named -..__DSJ~.O_txly,~.17 x~d...Alk-ezt..14........-. -1-?.1?.:LGIF _k?u na---------------- and.... `e.r---...---•-•-•------._....-•---•---•----•-------•---------•- to me known to be the person ._S. o,ekec~ked~the.'l'oggoing instrtiment a d ack 1 same. THIS INSTRUMENT WAS DRAFTED c No'1'A1tf y Public . ....................................h...._•------...---County, Wis. i _William JRados e s J` ommission (expires) is (Section 39.31 (1) of the Wisconsin S (O,bL~_gpled shall have plainly printed or typewritten thereon ta T ddd~~~ the names of the grantors grantees, witnease f1"I nu r 7 y requires that the name of the person who, or govern- mental agency which, drafted such instrument, slue printed, typewritten, stamped or written thereon in a legible manner.) WARRANTY DEED STATE OF WISCONSIN Wisconsin Legal Blank Company FORM No. 9 Milwaukee, Wis. ( Job 28826 II rt ~ ; n a O z (n 0 ~p --^i $ rn to g i I i V 'i i~ i II I it I i' jl i i i j I i j I I i I j 05, - d DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 1 WARRANTY DEED i 3 Y 9 588 Boo K 505 PA' E 518 THIS SPACE RESERVED FOR RECORDING DATA THIS DEED, made between James C. Simon and Edna Simon REGISTERS OFFICE a/k/a Edna M. Simon, husband and wife, BT. CROix CO., WIS. Reed for Record this_ 28th- Grantor and Roger E. Eckstrom a single man day of__VLovtmber_A.D.19_73 at_.UA6 At., M. Grantee, /)'I. / W i t n e s s e t h, That the said Grantor for a valuable consideration ~wt~----- One Dollar ($1.00). and other valuable consideratio ~teg or of Dee4- convey s to Grantee the following described real estate in St.. Croix county, RETURN TO State of Wisconsin: A tract of real estate: located in the Northeast Quarter (NE14) of Section Twenty-six (26), Township thirty (30) North, Range Nineteen (19) Thhis iKey # s non Tisison West, described as follows: BEGINNING at an iron homestead property. pipe stake located 701.1 feet south and.1275.9 feet west of the northeast corner of said Section 26; thence S 400 00' W a distance of 120.0 feet; thence N 500 001. W a distance of 312.13 feet; thence N 430 30' W a distance { of 90.0 feet;:thence due North a distance of 100.0 feet; thence due East a distance of 912.8 feet;:.thence.'S 40 12' E a distance of 130.35 feet to a point on the north shore of "Kelly's" swamp; thence on a meander line along said shore S 740 12' W a distance of.179.8 feet; thence S 780 08' W a distance of 231.6 feet; thence S 260 25' W a distance of 90.7 feet; thence leaving said shore N 720 001W a distance of 109.5 feet to,point of beginning the above described parcel containing 5.07 acres, more or less and including all lands lying between the above mentioned meander line and the waters of "Kelly's Swamp" Also including an easement for travel, 33 feet in width extendin from the above described parcel to the Town Road as now open and I; Together ith all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining;, traveled And James C. Simon and Edna Simon warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except TRANSFER to and will warrant and defend the same. FE Executed at Hudson, Wisconsin this 2nd day of November '19-13. SIGNED AND SEALED IN PRESENCE OF (SEAL) James C. Simon _ jC_. (SEAL) Edna Simon (SEAL) (SEAL) Signatures of James C. Simon and Edna Simon, husband and wife, authenticated this 2nd day of November 1973 WILLI J. RADOSEVICH Title: Member State War of Wisconsin NX0tbpX_TXi= Authorized under Sec. 706.06 viz. a STATE OF WISCONSIN 1 J} County. as. Personally came before me, this day of 19 , the above named to me known to be the person- who executed the foregoing instrument and acknowledged the same. This instrument was drafted by WILLIAM J. RADOSEVICH Notary Public County, Wis. Hudson, Wisconsin The use of witnesses is optional. My Commission (Expires) (Is) Names of persons signing in any capacity should be typed or printed below their signatures. H.GMiI~Nrcanpany~ WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 1 - 1971 N NO ;v a a , T C7 rn mm ria ►v x I