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DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX t7969 BUREAU OF PLUMBING
M+4DISONI,,W 153707
NW'-4, NW-4, S5,T30N-R17W CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
(
Town of Erin Prairie El Holding Tank El In-Ground Pressure ❑ Mound
160th Street
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Richard Tibbett Route 3, Box 310, New Richmond, WI 5401
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV..
Name of Plumber: IMP/MPRSW No.. County Sanitary Permit Number:
Calvin Powers Jr. 1563 St. Croix 99081
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES DYES ONO
BEDDING: VENT DIA.: VENT MATLHIGH WATER NUMBER OF ROAD: ROPERTY WLDING: VENT TO FRESH
ALARM: FEET FROM LINE. AIR INLET:
DYES ONO DYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: ILIQUIDCAPACITY. PUMP MODEL. JPUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES ONO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. BUILDING .IVENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) DYES NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILE%(,T11 DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH. LENGTH. INOEOF DISTRPIPE SPACINGCOVER INSIDE IA#PITSLIQUID
BED/TRENCH THNCHES MATERIAL: PIT DEPTH.
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES. ABOVE COVER. ELEV. INLET. ELEV. END. PIPES. FEET FROM LINE: AIR INLET:
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
DYES ONO DYES NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED. MULCHED:
CENTER. EDGES.
DYES NO DYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER:
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.. DIA.. ELEV.. PIPES: DT:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO OYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
DYES ONO DYES ONO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE:
Zoning Administrator
DILHR SBD 6710 IR.01/821
SANITARY PERMIT APPLICATION COUNTY
T DILHR In accord with ILHR 83.05, Wis. Adm. Code '57 G~~< X
STATE SANITARY PERMIT #
9001
-Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER
8'/z x 11 inches in size.
-See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES Ev'I NO
PROP ~Ty OWNER PROPERTY LOCATION
'/4 '/a, S T N, R / E (or)
1.017 - PRO TY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK N MBER SUBD ISON NAME
CITY, STATE ZIP CODE PHONE NUMBER CI NEAREST RO AKE OR LAN BARK
VILLAGE : yam'
r
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public (Specify):
III. PURPOSE OF APPLICATION: (Check only one in #1. Check 2,3 or 4, if applicable)
1. a. X New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E] Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2)
1. a. ® Conventional b. ❑ Alternative C. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ® seepage Bed b. ❑ seepage Trench c. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (S ap Feet): PROPOSED (Squarq Feet):
f , Feet ® Private ❑ Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks / structed
Septic Tank or Holdin Tank ! ❑
Lift Pump Tank/Si hon Chamber ❑ ❑
VII. RESPONSIBILITY STATEMENT
private sewage system shown on the attached plans.
I, the undersigned, assume responsibility for installation QUbe
Plu er's ame (Prjr): Plum is Signa re: (N Sta s) MP/MPRSW No.: Business Phone Number:
Plumb 's Addre/s7s``('Sttreet, ity, State, 'p Code): Name of Designer:
V Ill. SOIL TEST INFORMATION
Certifield Soi Tester (CST ame CST #
CS r s DRESS, (Street, ity, State, Zi Code) Phone Number:
7
IX. OUNTY/DEPARTMENT USE ONLY
❑ Disapproved anitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps)
Approved F-1 Owner Given Initial /mar urcharge Fee
Adverse Determination
X. 7MMENTSIREASONS FOR DISAPPROVAL: _
SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
TO THE APPLICANT:
1. This sanitary permit is valid for two (2) years;
2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 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 where the system is to be
installed;
Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8'/z x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement
system areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form.
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This, change in statutes was the
result of over 2 ears of steady negotiation and public debate. The groundwater bill
y Y Groured~. afar -
included the creation of surcharges (fees) for a number of regulated practices which Wisco'in's
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that
buries; j, Easure
is used in your building is returned to the groundwater through your soil absorpticn
system or the disposal site used by your holding tank purnper. -
The monies collected through these surcharges are credited to the groundwater fJ id adminis-
tered by the Department of Natural Resource%, These funds are used for rnonitorr-g ground- t r~
wa ee , groundwater c,ontaminatie°i investigations and estriblisf-iment of standards,around,,,vat- 7-7,_ ._....._..._1
it's worth protecting.
APPLICATION FOR SANITARY PERMIT
STC - 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 Richard. G. & Joanna R. Tibbetts
Location of Property i-! 1% rk, Section 5 , T__~Q N-Rjj_ W
Township Eni n Prai ri e
.
Nailing Address R 3 Box 310 New Richmond Wis. 54017
Address of Site Sane
Subdivision Name Prairie Vi-em Amps
.Lot Number
Previous Owner of Property Richard Marilyn Dauck
Total Size of Parcel 2 L0 Acres, Tne /14
Date Parcel was Created a119~ 1282
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for resale (spec house) ? X- Yes No
Volume 75.51 and Page Number 18$ as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
Warranty Deed wh ch includes a Document number, volume and page number, and the
Seal o ster 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (toe( centi.6y that a.Qt b.tatement6 on this Sonm cute tAue to the bmt o6 my (our)
hnowtedge; that I (we) am (cute) the ownerbs) o6 the pnopehty densc i.bed in .th.ia
.in ovn
a,ti.on onm b v
6 .chtue o6 a w
6 by 6 «lvcanty deed recorded in the O6.ice o the
Countyy RepA ten o6 Veed~s as Voeumewt No. A 16750 ; and that 1 (We ) p4ea en tty
own .the p1toposed site bon the sewage d"po3 ey~stem (oiL I (we) have obtained an
easement, to nun with the above deA cA ibed pnopeAty, bon the eoutAuc ti.on 06 said
e ys.tem, and the dame has been duty n, Bonded in the 066ice 06 the County Regis teA o6
Veeda, ab Poeument No. ,
SIGNATURE Op OWNER GNATURE OF CO-OWNER (IF APPLICABLE)
7Z
DATE SIGNED DATE SIGNED
Y.
V
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BATH ;i
DINE
MASTER BEDRM. O Ff~MILY ROOM KIT.
design 12'x 11'-10" 17 0' x II'-10" 9'x11'-10
ES-103 oe'7
N.
ENERGY SAVING HOME _ _
C. dn. 1P.T.,A W D GARAGE
N
C. 19'-8"x 23'-4"
STORAGE HTR.CLO.
Living Area C. PLAN - 2 PLAN-2
1364 Sq. Ft. BEDROOM BEDROOM LIVING ROOM
10'- I"x 10'-2" 10'-6"x IV-6" C. 2 3'-6" x 11'- 6"
- - - - - - - - - - - - - -
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w/ s't/o) 7 UAI(01 WI sH E D G4rm.Se.
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I
CERTIFIED SURVEY MAP
Located in part of the A of the NWa of Section 5, T30N, R17W, Town of
Erin Prairie, St. Croix County, Wisconsin; being part of Lot 1 of
Certified Survey Map, Volume 2, Page 480 of the St. Croix County
Register of Deeds.
Unplatted lands owned by others
NW Corner of North line of the NW4 of Section 5 N89°29113"E, 2631.36'
Section 5
o m
N8 029113"E 503.92' N CN ' d
o c rt r
C . T . H . "K" ° 212 .44' N4 Corner of
S890 26'07"W 475.65' Section 5 y
I N R/W Line No ° fD
ao o- o m
.OIN ;0.4 N y
o w W 7 rt m
N LOT 1
I O X:
IN I N
N A1- n
t° N
S8902610711W 502.53'
W rt
IF'' 475.65' ti °
Iarn 26.88' ,n O
10 " rt.
IH
Iix Existing House
cn
°
I SCALE IN FEET +
rt
6 i I 1:3 0 100 200 400
Existing Barn
00 ~ LEGEND
O
do coo C 10 I CL
LOT 2 i N County Section Monument
v z
w C:, w io • 1" iron pipe found
IM I ~o = I to 1 a O 1"x24" iron pipe set, weighing 1.68 Lbs.
E .r w
per linear foot
io
rt N N 12-
Ln
I I
N J i co
y I ; y OWNER
C) I W Richard Tibbett
N
,2 I - Route 3, Box 310
o I New Richmond, WI 54017
S8705113411W 498.82'
Ln 475.96'
22.861 LOT AREAS
2 Itq N N Lot No. Including R/W Excluding R/W
IN I~ o LOT 3 0 1 140,787 SQ. FT. 106,120 SQ. FT.
Its
(IH I' - 3.23 Acres 2.44 Acres
S8705113411W 497.77'
475.96' 2 400,151 SQ. FT. 380,112 SQ. FT.
21.81' 9.19 Acres 8.73 Acres
s
I I~ 3 104,588 SQ. FT. 99,899 SQ. FT.
N - LOT 4 2.40 Acres 2.29 Acres
to 0 0
4 124,719 SQ. FT. 119,403 SQ. FT.
I I
~0.56' 2.86 Acres 2.74 Acres
~
I ~:LS87 51' 34"W 496.52 01
N el
W r
ALLEN C.
Lot 2 of C.S.M. Vol'. 2, Pg. 480 1
o -
f'>
S-1407 'e
cn
HUDSC£ r
y
1f',ii.~i.
<
W4 Corner of ~~j~`R ' UR{u°
Section 5
This instrument was drafted by Fran Bleskacek Job No. 77-76-187
SURVEYOR'S CERTIFICATE
I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, do hereby
certify that by the direction of Richard Tibbett, I surveyed,
described and mapped the land parcel which is represented by this
Certified Survey Map; that the exterior boundary of the land parcel
surveyed and mapped is described as follows:
A parcel of land located in part of the W 1/2 of the NW 1/4 of Section
5, T30N, R17W, Town of Erin Prairie, St. Croix County, Wisconsin,
being part of Lot 1 of Certified Survey Map, Volume 2, Page 480 of the
St. Croix County Register of Deeds; further described as follows:
Commencing at the NW Corner of said Section 5, also being the point of
beginning of this description; thence N890-291-13"E along the North
line of the NW 1/4 of said Section, 503.92 feet; thence due South,
1533.27 feet; thence S870-511-34"W to the West line of said NW 1/4,
496.52 feet; thence NOOo-17'-10"W along said West line, 1547.32 feet to
the point of beginning of this description.
Above described parcel is subject to right-of-way for C.T.H. "K"
and a Town Road as shown on this map and all other easements of
record.
That this Certified Survey Map is a correct representation of the
exterior boundary surveyed and described; that I have fully complied
with the current provisions of Chapter 236.34 of the Wisconsin
Revised Statues and the Land Subdivision Ordinance of the County
of St. Croix is Surveying and mapping same.
4r t_I_eN c.Y,
4r rVYiV, '
'
~n
l psi xc..,~ C. "aa-~ 7
r Allen C. Nyhagen date
s' L
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ST C- 105 r
a
y
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
d
a
H
OWN ER / B.iLYE6. Fiioard G. & Joanne R T~ bhett
ROUTE/BOX NUMBER R 3 Box 310 Fire Number
C I T Y / S T A T E New R i c h m o n d . 1is. Z I P 54017
_k, Section- 5
PROPERTY LOCATION: TY , T ~0 N, R ~ W
Town of in 1~.aj„rie , St. Croix County,
je VSew Acres , Lot number 3
Subdivision
.rl Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into II
the system can affect the function of the septic tank as a treat-
ment 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 systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. Ho
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart- b
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED_ DATE
St. Croix County Zoning Office
P.O. Box 98-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY,, DIVISION
LABOR BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MU IPArL ITY: LOT NO.: BLK. Np.: SUB I VISION NA E:
/T3 N/R (or ,3 x
COUNTY: O N _'S/BU'
E 'S NA E: Al I ADDRESS:
1 !
USE DATES OBSERVATIONS MADE
DESCRIPTIONS: PERCOLATION TESTS:
NO. BEDRMS.: COMM R L DESCRIP =27
Residence TION:
®New ❑Replace
f')
l5
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUNDPRESSURE:S ST M-I -FILL HOLD GTANK: EC MENDED SYSTEM: (optional)
~Q s au ®s au ®s ❑u ❑ s ZIu 0S ou -
If Percolation Tests are NOT require DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: - Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH M. ELEVATION OBSERVED EST. HIGHEST TO B DROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- r ~-s l
a Zn
B^ 4
p PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER IfeHCS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 ___P r:_9 PER INCH
P S
i
P
P- le _,2 t
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 9
i ,
.
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X I0400! J'4~1
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1, the undersigned, hereby certify that the soil tests reported on this form were made b me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME-I(pri TESTS WERE COMPLETED ON:
AUDR S : CERTIFICATION N BER: ONE NUMB Rloptional):
CS SI N UR 17:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
I DILHR-SBD-6395 (R. 02/82) - OVER
IL
YIA)
/ isc;lo-I
~ nOf 1Y04S,~ '
PAGE OF
CrvSS Szc~ton b~ ~ct~ SyS~en-~
Fresh Air Inlets And Observation Pipe
Approved Vent Cap
Minimum 12" Above
Final Grade
20- 42" Above Pipe _ 4" Cast Iron
To Final Grade Vent Pipe
Marsh Hoy Or Synlhellc Covering
min 2" Aggregate
i Over Plpe
i Olurlbullon
Pipe -co 0 0 0 0 - Tee
B Aggregate
Beneath Perforated Pipe Below
Pip* _
o Coupling Terminating At
Bottom Of System
P(~p~OSei~ T~tnc_L C,('c.clt ~ /
~.leJ•.~ tun
SOIL FILL
DISTKIBUYIOf.I PIPE
APPROVED S4WPETIC COVER
° MATF-ROW OR 9' OF ST. RAW
2"OFAGGREGATE OR MARSH HAy -cD
to OFAGGREGATE X.,
tLEV.OF; FEET,
4
DIS-rRIBUTIOM PIPE TO BE AT LEAST iIJC.HES BELOW ORIGIIJAL GRADE
AMU AT LEAST20 ItJCHES BUT 1.10 MORE THAI) 42 IAICHES BELOW FILIAL GRADE
MAXIMUM DEPTH OF EXCAVATtawi FROM oW wu 6RAoF- WILL BE INCHES
IA1141MUM OEpT't4 OF FACAVATIOW FROM. 01KI16NAL GRAPE WILL BE v-~ INCHES
SIGHED: J(~
LICEUSE DUMBER: ,-,~&13
DAT E . l
110
500/4
Features .
Pomp Impeller is recessed Powerful 4/10 HP Motor is Rotary Shaft Seal has carbon Mercury Switch 20 AMP rating,
"Tornado" type - operates oil filled for ggood Insulation and and ceramic faces for positive 3" cylinder, wide angle 1200 oper-
completely out of volute passage lubrication of bearings and seal. seal. Body is stationary, prevents ation, polypropylene material.
giving full opening for flow of Overload protection built-in, has string or trash from winding Minimum recommended Tether
liquids and solids. no starting switch or relay on seal. length is 31/2" from cord clip to
Motor Housing is heavy cast mechanism. Switch Housing (SSM4A) is switch case (Pump Down 7-8").
iron, epoxy coated. Stator is Thrust Washers and Sleeve completely sealed from sump 'Pump Down' can be increased
pressed in for perfect alignment, Bearings are oil lubricated for liquid, easily removed for by increasing the Tether length.
best heat transfer. smooth operation, long pump life. replacement if needed.
Dimensions
aT tirY,yr
k IVA ? Y1K'`.t
1mm 1 ;
F 24t$mn4'14i±
Performance Curve
0 '',2QtXl. ' e0 t'.lOQ '120 140 t90 .`1e0
1 L^
v,
\ ;2s
22
20 I Y` - - HERO CApgC'TY
Cj tB
- -
's
x}. B
2
z' 0 3 `10 'iS 20 25 30
CAPACITY GALLONS 1'!R {
Accessories
y Performance Table
Myers offtsrti a wide selection of accessory Items for uae with ~f
,#he SSM4 p+,imps tlidjustaWe leVei controls, wet sump contr f Feet 2 4 6 8 10 12 14 16 18 20 22
;letsh conttots 91ai trlcalt trdand switches heady y Total
chgclsa4vtL poly glass basins at
4` Head Meters .61 1.22 1.83 2.44 3.05 3.66 4.21 4.88 5.49 6.10 6.11
:]Is, r7n, 1 Gallons Per Hour 3,600 3,600 3,450 3,300 3,150 2,900 2,550 2,250 1,800 1,300 660
Liters Per Hour 13,625 13,625 13,058 12,490 11,923 10,916 9,652 8,516 6,813 4,921 2,498
i
Performance Capabilities
0 o
® a;.
o
❑ ❑ Capacities to 60 GPM 227 LPM
Heads to 24 feet 3
Pup Down Range * 7 to 14 inches 1778 to 355.6 mm
Solid Handling Capability 3/4 inch dia. solids 19.1 mm dia. solids
liquids Handled Fresh, drainage effluent waste water
F '
aM a Intermittent Liquid Temp. 150°F 66°C
Motor Viill HP ~
1 j
Electrical 115/230 V., 12.0 A/6.0 A, 1 , 60 Hertz
r r Dischar a lyi inch 38.1 mm
Automatic Model, (manual pump variable with switch).
DIVISION OF
~1A
LL N f : Che*kio*v~ T F. E. MYERS CO. McNEIL
1 i 400 ORANGE STREET CORPORATION
va,r ~ t p 419/289-1 44 TELEX098-7443 0
I -
R
STC - 104 -
AS BUILT SANITARY SYSTEM REPORT
-_.OWNER o !Lr"~ F71 pi'j
ADDRESS
/ V L t .1 ~ I t.,l C M-►~ d ~'[~17 . (-S V / `7
L ~ LOT $ 3
SUBDIVISION / CSM# Vo 15~ 4:_ ~
I~
SE ION ~a T -R1~W , -Town of ~j2 I Aj Pry-, g
ST_'
CROIX COUNTY, WISCONSIN I'
I 7s• PLAN VIEW
SH¢W EVERY RING WITHIN 100 FEET OF SYSTEM
P
0
INDICATE FORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
- r
Y
BENCHMARK: lap 4 S IZ~~
ALTERNATE BM: L-
f
SEPTIC THAN / UMP CHAMBER~ / HOLDING TANK INFORMATION
Manufacturer: (,Iiquid;Capacity:~d~.) SZ
Setback from: Well House Other
Pump: Manufacturer Model# 13 1 Size d 7~ r
Float seperation - Ga Tons/cycle:
Alarm Loca~ion f I
SOIL AiSORPTION 'SYSTEM,
Width: - Length Number of trenches"
d
Distance & irection to neares prop. line:
r
Setback from: well: //0 Hou a / Other A
ELEVATIONS {
Building Sewer ST Inlet. ST 'outlet PC inlet PC bottom $1-,'Z Pump Off
Header/Manifold 3.TZ_ Bottom of system Q
Existing Grade 10 9 1ial grade C1 q _
DATE OF INSTALLATION: A7/ Y~
PLUMBER ON JOB:_
LICENSE NUMBER: INSPECTOR: Z?l fir, je S
3/93:jt _
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan o.:
FRIDAY, FORD
CST BM Elev.: T Insp. BM Elev.: BM Description: r rcel Tax No.
0 /D0' 1 (to Cs r
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /6_~7u loo,
Dosing et.! /00,
Aeration Bldg. Sewer
Holding St/Ht Inlet `Z 73
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet
Air I
Septic NA Dt Bottom
Dosing NA Header/Man. 6,7
9~ /~Lf
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer a14_t~ Demand
Model Number 131 GPM
riction System TDH Ft
TDH Lift F
Loss mead
Forcemain Length Dia. alt Dist. To Well 2
SOIL ABSORPTION SYSTEM
BED/TRENCH Width I Length. No. Of nches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
LEACHING Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM
INFORMATION Type of , , CHAMBER Moe Number:
System: 4AL 1/30, 00 .v 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 ~t { Depth Over i _ xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center. Bed / Trench Edges f~ Topsoil El Yes E] No El Yes El
No
COMMENTS: (Include code discrepancies, persons present, etc.) j 1 ; > <<
7' ;
LOCATION: ERIN PRAIRIE 5.30.17.66D,NW,NW,LOT 3,160TH STREET 2 9
i4
Plan revision required? ❑ Yes No
L - e other side for additional information. 41
6710 (R 05/91) Date Inspector's Signature Cert No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
HR SANITARY PERMIT APPLICATION 9.
In accord with ILHR 83.05, Wis. Adm. Code co
=aah i
STATE SVITARY_PE~IMI
-Attach complete plans (to the county copy only) for the system, on paper not less than °°~77''1177I1 11//OO__ tti1177__
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER P~R~ P TY C ION
A '/a /a, S t' T-30, N, R j E (o W.
PROPERTY OWNER'S MAILING FD R f LOT # BLOCK #
-
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISIO NAME OR CSM NUMB
d
II. TYPE OF BUILDING: (Check one ❑ State Owned 7-3 CITY NEAREST ROAD
❑ YILLAGE
- TAX
❑ Public
P9j or 2 Fam. Dwelling-# of bedrooms PARCEL NUMB
III. BUILDING USE: (If building type is public, check all that apply) VF 36 /
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. New 2.E] Replacement 3.E] Replacement of 4.E] Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 220 In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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.) PR POS (sq. ft.) (Gals/da /sq. ft.) (Min./inch) LEVATION
~ c SZ e, / t5---Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper..
INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank I
Lift Pump Tank/Si hon Chamber /Zt= I ! E Z El E] 1:1 1 El
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plu er's N e (Print): Plumber' Signat e: (No Stamps) P PRSW No.: Business Phone Number:
i
Plum s Address (Street, City, S ip Cod
47
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sa ry Permit Fee (Includes Groundwater a e ssue ssuing A ent Sign o m
j~ Surcharge Fee)
pproved ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings 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 the 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 & 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 in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; (Jose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D}cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
- -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
6 Fitt '/Y rJCC~ ~j/ -c' S~ T3 c? /(~-TL /'Jug
F-rt irJ ~rl,~ .2t
11l ~-zt 1~~ c r o.c ~ oI ~j► S S u,6 ► s..v
D v it c.ir l~ C-rt~ /~t' /~Fs
1
Kle
/N'
140,6A-L- ~emB~
0230' ' _ .
t ~~3 P~ SCI
('j-0 rIA
C 'fit ?'~z t,Ja-s 14 ~ E r--
_
_ ~
-
F
v
N,. ,
F--
i~
fff 2
I
J
Page Of
SEPTIC TANK PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS j
4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF
25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE -WITH CONDUIT MANHOLE COVER
W/. -PADLOCK, &
FINISHED GRADE WARNING LABEL
4" CI RISER x_41+ MIN.
lg" N. s.. MAX
INLET
i
GAS
WATER TIGHT SEALS TIGHTS
~
A ;SEAL PPROVED
JOINTS WITH
ALM APPROVED PIPE
APPROVED B i ON VONTO
A
PIPE 3' ONTO SOLID SOLID SOIL
C
OFF RISER EXIT %
SOIL . PUMP OFF LEV . FT • i
~ PERMITTED ONLY
I D
IF TANK
MANUFACTURER
HAS APPROVAL
3" APPROVED BEDDING ONDER TAkK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE I_
TANK MANUFACTURER: r - NUMBER DQSES PER DAY:
TANK SIZES: SEPTIC GAL. DOSE VOLUIME INCLUDING
GAL.
GAL. ! FLOWBACK :
DOSE.
ALARM CAPACITIES: A = INCHES =GAL.
MANUFACTURER: ;S ~ GZZC~ i Z~vS ~
MODEL NUMBER:
SWITCH TYPE: B = 2 INCHES _-GAL.
PUMP MANUFACTURER: C = 6-Zy INCHES = y=GAL.
c'
MODEL NUMBER : D = _ INCHES'
SWITCH TYPE:a
REQUIRED DISCHARGE RATE GPM PUMP ALARM WIRING AS PER ILHR 16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 7- FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . 2.5 FEET
+ s7-o FEET FORCEMAIN X FT/100 FT. FRICTION FACTOR FEET
TOTAL DYNAMIC HEAD - FEET
INTERNAL DIMENSIONS OF PUMP TANK: LINUID ;PTH WI `DTH J DIAMETER
L Q
)/7
SIGNED: -9 LIC£r''E NUMBER: / jDATE:
i ~aR
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human 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 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference poi re ' and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and di t 012-1014-030110
APPLICANT INFORMATION-PLEAS ALI ,,NF0R N REVIEWED BY DATE
PROPERTY OWNER: 4 PROPERTY LOCATION
Richard T i GOVT. LOT NW 1/4 NW 1i4,S 5 T 3 0 ,N,R 17 YmTor) W
PROPERTY OWNER':SMAIi_INGADDRESS t%OT# BLOCK# ISUBD.NAMEORCSM# vol. 7pagel874
113 Alden Pond L 3 na Prarie View Acres
CITY, STATE ZIP C , ' PHONE , ' MO R _ F []CITY []VILLAGE [KOWN NEAREST ROAD
Ea en, Mn. 55121 Erin Prairie 160t St.
[x) New Construction Use (x) Residential / Ember of s 3 O Addition to existing building
j ] Replacement Public or commercial describe
Code derived daily flow 4 5 0 gpd Recommended design loading rate • 7 bed, gpd/ft2 • 8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 88 trench, gpd/ft2
Rl ecnm tended infiltration surface elevation(s) 96.15 alt=97.16 It (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwa sh Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem VX ❑ U Is ❑ U,S [3 U X3 S El U El S ®U ❑ S Q 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 Ttend
::{:SJk'Ci+RSiiy
1 0-1 10 r3 3 none 1 2msbk mfr w 2f .5 .6
<::4 1 >
<4\
2 12-2 7.5yr4/4 none sl 2msbk mfr gw if .5 .6
Ground 3 27-8 7.5yr4/6 none cos osg ml na na .7 .8
elev.
99.15ft.
Depth to
limiting
factor
+82"
Remarks:
Boring #
M 1 0-10 10 r3/3 none 1 2msbk mfr w 2f .5 .6
2
2 10-20 10 r4/4 none sil 2m r mfr w if .5 .6
3 0-25 7.5Yr4/4 none is osg mvfr gw na .7 .8
Ground
elev. 4 5-90 7.5 r4 6 none cos os ml na na .7 .8
99.2811.
Depth to
limiting
+90r
Remarks:
CST Name _Please Print Phone:
Address: 1554 200t Ave. New Richmond, Wi. 54017
Signature: Date: CST Number:
8-2-94 2298
PROPERTYOWNER Rir-ha rtj T; bbe$;6 SOIL DESCRIPTION REPORT Page 2 of
PARCELI.D.# 012-1014-30110
Boring # Horizon) Depth I Dominant Color I Mottles I Texture I Structure Consistence IBourxiary I Roots Be tl DTft2
in. Munsell Ou. Sz. Cont.Color Gr. Sz. Sh.
1 0-12 10 r3 3 none 2msbk mfr 1 w 2f .5 .6
3
- xv 2 12-2 10yr4/4 one sil lfgr mfr gw if .2 .3
Ground 3 25-8 7.5 r4/6 one cos os ml na na .7 .8
elev.
99.43it.
Depth to
limiting
factor
+86"
Remarks:
Boring #
1 0-12 10 r3/3 none 1 2msbk mfr w 2f .5 .6
4
2 12-2 10yr4/4 none sil 2msbk mfr w if .5 .6
" 3 21-3 7.5yr4/4 none is osg mfr gw na
.7 .8
Ground
elev. 4 36-8 7 , 5yr4/6 none cos osg ml na na .7 .8
99.33t.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0-12 10yr3/3 none 1 2msbk mfr w 2f .5 .6
5 2 12-2 10yr4/4 none sl 2msbk mfr gw if .5 .6
3 20-5 7.5yr4/6 none cos os ml na na .7 .8
Ground
elev. 4 59-8 7,5 r4/4 none sil if r mfr A na -2 -3,
99 .08ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
Ground
elev. 1
ft.
Depth to
limiting
factor
i
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Richard Tibbett 1554 200th Ave.
CSTM2298 NW4NW4 S5-T30N-R17W New Richmond, WI 54017
MPRSW 3254 lot #3-Prarie view Acres (715) 246-6200
town of Erin Prarie
N
11°=40 °
BM=top of 111 steel pipe by NW lot corner at el. 100°
Alt. BM= top of anchor of side lot steel post
11
7-o,j, 16
1 5
16 -
~
~ BUJ ~ D &0
7
I ;CEi.'Z
Gary L. Steel
8-2-94
n25 42
9494 CERTIFIED SURVEY MAP
Located in part of the W~ of the NWQ of section 5, T30N, R17W, Town of
Erin Prairie, St. Croix County, Wisconsin; being part of Lot 1 of
Certified Survey Map, Volume 2, Page 480 of the St. Croix County
Register of Deeds.
Unplatted lands owned by others
NW Corner of North line of the NWj of Section 5 N89°2913"E, 2631. 36
Section 5
N8 1_3 _"E 503.92' N °
N 9 a
o c r+• -3
C.T_.H_. "K" 212 .44' NJ Corner of S r~
-1 S89°26'07"W 475.65' IL, Section 5 0 a
N R/W Line vrn c' o A
00 1 o r
s
olw LOT 1 CFW APPROVED z
co IN I N lD Z N
n q N rh. 0
I S89°26'07"W 502.53' AUG 12 1967 (A2 o
W rr
(IF-+ 475.65' v> o
m cc
Irn 26.88
10 sr. C~Oia: Y rr s
ly OOMPREHENSIV'~ PARKS PU.`WI`1 ,
Ilx Existing House AND ZONING COMMITTEE
I I~ SCALE IN FEET
rr g "M I
0 100 200 400
661
~ = o t a
in
~"r o I Z I Existing Barn rt
~n o to ~a LEGEND
o O
co
C i d
`D I C. ! N ,3 County Section Monument
Q LOT 2 Cn x ; N
;o I N o w o 1" iron pipe found
iz 0 O
to ; c 0 1"x24" iron pipe set, weighing 1.68 Lbs.
Cr per linear foot
i1C 0 ( ( r W i~c
' :1 ~ ' I O
cr F ' N rt
Ln Lo -j
cn I
I N NOTE: The NW corner of Section 5 as shown on this
map is not in the same position as shown on
o (w ( I Certified Survey Map volume 2, page 480. Corner
was measured north and east of original position.
o I
S8705113411W 498.82
Ln 475.96' LOT AREAS
I 22.86'
OD IUl r~-2 ~ Lot No. Including R/W Excluding R/W
ii LOT 3 1 140,787 SQ. FT. 106,120 SQ. FT.
Icy - 3.23 Acres 2.44 Acres
S8 7°51'34"W 497.77' 2 400,151 SQ. FT. 380,112 SQ. FT.
I
21.81' 475.96' 9.19 Acres 8.73 Acres
I N 3 104,588 SQ. FT. 99,899 SQ. FT.
LOT 4 2.40 Acres 2.29 Acres
I Io 0 0
_ 4 124,719 SQ. FT. 119,403 SQ. FT.
I 2.86 Acres 2.74 Acres
/20.56' 47
fi~a'!@"M"f rs
I S87 51' 34"W 496.52' Co
Lot 2 of C.S.M. Vol. P 480 Al-1-N C'"i ~Yy
~ a
S-1407
w
OWNER F11 UDSC;t r
Richard Tibbett'
Rt. 3 Box 310`" v ~U
orner of New Richmond, Wi .
ion 5 54017
was drafted by Fran Bleskacek Job No. 77-76-187
Vol. 7 Pg. 1874
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Fo_ rc P'rz i d al
MAILING ADDRESS 6? 7 9, r 1• ~ New W
PROPERTY ADDRESS l/~~
(location of septic system) Please obtain from the Planning` Dept.
CITY/STATES
PROPERTY LOCATION 1/4, 1/4, Section T_=3(9 N-R_LZ_W
TOWN OF ~ /N ' 41ae- ST. CROIX COUNTY, WI
SUBDIVISION FiZ 14-1 6Ji 4`w 4e, 2c=~ LOT NUMBER 3
CERTIFIED SURVEY MAP , VOLUME 7, 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 expi tion date.
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
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 Fo k4 F i da Acko^,r
Location of property 1/4 1/4, Section ,T-36N-R_L7 _W
Township CX1`j 70le14112A Mailingaddress
Address of site d f) t4S C, rtyc ),o
subdivision name Lot no. d7//
Other homes on property? Yes No
Previous owner of property ie 1-6-1ye-0 IT ,566'7-T
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes 4,-No
Volume and Page Numbers recorded with the Register
of Deeds:-"' J~
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. Ck) , 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.
Signatur of Applicar~j Co-Applicant
9/~~
Date of Signatur Date of Signature
DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-1982
:00 3 ur). e4` ~a,z g REGISTER'S Ot=rIVE
ST. CROIX CO., WI
Richard G. Tibbett and Joanne R. Tibbett, Recd for Record
- - -
_...husband. a1nd.wi -e1----- _ AUG If 1994
8:00 A
at q d' 'eti•~e.,QQ„
Shar
conveys and warrants to ---------•------o--n---L---.---R----aygo----r--a------nd--F--------ord--G---.-------------
-----------Fr d?y---- r Register of Deeds
RETURN TO
P O ffHWEST SAVINGS IBMA
532 KNOWLES
the following described real estate in S-t..Cr-Oi C______________________County, 7
State of Wisconsin:
Tax Parcel No:
Part of the W1/2 of the NW1/4 of Section 5, T30N, R17W, Town of Erin
Prairie, St. Croix County, Wisconsin, described as follows: Lot 3 of
Certified Survey Map filed August 25, 1987, in Vol. 7, Page 1874.
17
This iS not - homestead property.
} (is not)
Exception to warranties: Easements, restrictions and rights-of-way of record,
if any.
Dated this day of -August--- - 1 19_.94...
G2GC~ .
SEAL ...(SEAL)
* Richard G. Tibbett
(SEAL)
---(SEAL) -
* Joanne R. Tibbett
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Richard-- G-.-- --Tibbe---t-t STATE OF WISCONSIN
Joanne R. Tibbett ss.
County.
authenticate is .._ay of___ August 19___94 Personally came before me this ................day of
19.---•--- the above named
-
Kristi- a_ Ogland--------------------------------------
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
---•------.KriSt111B Q+
*
Attorney at Law County, Wis.
Notary Public
signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
not necessary.)
date: 19-------••)
persons signing in any capacity should be typed or printed below their signatures.
TY DEED STATF f3AR OF WISCONSTN Wisconsin Legal Blank Co.. Inc.