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014-1007-10-005
~ ~ ~ v, z ° a' ~' O. O 00 ~ O ~, N w ~ ~ ~ ~ A y0 ~ A `~. ~ ri, O 7 [r1 O 7 AA .+ O 7 ,~. 7 "" w ~ :A 5" MO' ~'N N z'rn N ~ n ~' 7 ~ p~ \ ~ Pi 000 ~ ~D v0 X00 C~ a. !~ ro N ~ O c ~o ~o o ~. ~c ~ N O ~'0 ~-+?.Oy .0. ~~m ~inm O O 0D~ O ~m M .. LT' ~ C w ~~Onw ~~w P' ~' w rn ~ ~yON A.p MVl m ^u ~ O~ N _ ~ ~• (p W y .O-. D\ ~ ~ p' O 6 D v, oo 'C Z p pp llTT11 A ~ O O. A 7 a ~„ N ~ .. n, o ~' ti ~ w rn ~~ o ~~~I~ ~ ~'~ °, Oy ~~~~ cc~sm o c, ~ a~ ~~ =°s" o d ~ o ~~ ~ m ~ o"" ~ H ~' % ~ q"'y '`~ n. 6 ~ cµ'o ~~ a~. ~• a v~8z~. .d ° ~ b y m pp `~ m ~ O z m ZJ A ~ ~ ~ O ~. 2 ~~ A (A m z p ~ Z m ~ z7 a ,a~ ~ °~°,y o ~~ Uo~ ~ ~ ~,'~ a0 0 `` G ~ ~ ~ 'L '00 ~ n ~ ~ ~ ~ O~ ~Tl n. a g o n ~, ~ a~ o~ m ~- N ~ ~ ~ ~ N (G ~ O ` N Cn ~ C • m N ? O W (D O `~ O ~ ~i 00 ~ oD .'~ cD '~ to O- ~' O ~ ~ m ~ ~ ~ rn O ~ ~ y0 O ~~ O ~ 7. ~ M "'~ ,r ~ ~ ~ .r'T n ~ 01 ,~~ d m ~ ~. ~. N ` w X `? P- N CP' n O z x~ w e H D. D• ti N o c ~ a. 7''ti ~ `° o. co t~ Q '~ a 0 w A. `!. Q. ~ ~ ~ y. 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J y~j ti F'y ~ ti G N 01 (D lO d _ 0 P. ~ O < ~'• b' N ~ Or ~. C N A fl` N 01 ~ !! ~' H 0'~'S' O ~ C" ~ '0 0 ~ 0 ~] o a d N ~ R. ~ G. '+ P~ a' tbo y m G b ~ ~ ~ ~ ~ O O .r ~ N (D W O ~! (D UO ~ C ~] M m~ N y y~ ~ N N N N C O m ~ ~ W N ~ D. ~.~ y~ ~ ~ ~y~ ~ ~ '~ _ ti O M x• ~ 0 0~ 0 . y N" N ~ m ~ ~~ ~ ~ M ^t N Z O 2 Z m O T z m A I I I L_ ----,~~- li y ~ Ol K ~ ~~ z~ y ao zz ~ `_° Cd ~D a ~ o O tc ro tr7 ~ o 7 ~ A OZ Cl C1 u W O O Parcel #: 014-1007-20-000 04/25/2008 03:03 PM PAGE 1 OF 1 Alt. Parcel #: 04.31.15.50 014 -TOWN OF FOREST Current X 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 - ROSEN, ASHLIE A ASHLIE A ROSEN 162 BARRON-DUNN AVE CLEAR LAKE WI 54005 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 2873 POLK/ST CROIX RD SC 1127 CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 26.980 Plat: N/A-NOT AVAILABL E SEC 4 T31 N R15W NW NE FRL EXC PT TO Block/Condo Bldg: W D-1504/211 ...~---- Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-31 N-15W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 09/28/2006 835570 WD 04/20/2000 621584 1504/211 WD 07/23/1997 943/481 07/23/1997 850/558 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/17/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 4.000 500 0 500 NO AGRICULTURAL FOREST G5M 22.980 25,300 0 25,300 NO Totals for 2008: General Property 26.980 25,800 0 25,800 Woodland 0.000 0 0 Totals for 2007: General Property 26.980 25,800 0 25,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 219 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 c 3 a~i on ~ ~ ~ ~ ~ ~ c ~. ~ # ''r ~p m f9 3 0 '°''O rt ~ CD W ,l.: ~ ~ ~ F-+ ~ ~ ' ~ N (:: ~ ':'. ~ ~ j, v 6 O ~ i ~ ~ O ~; ~ 7 Q, ~ ~ 0 i O ._.- --- J n Q ~ o a ~ v ~ ~ _~ v ~ ~ i n N z n ~ ~ ~ 3 ' ' ~ 'w , r .. ~ '. p \ .A __._~ f~D ',. ~ '.. Z ' ~', r-r rn r . .--i ~ ~ ~ ~ O X O ~ i 4/ ~ ~ I O N ~ n ~ ~ a n ~ o O ~ ~ ~ ~~ ~ ~ ~ ~ c z -I ~ o w T. ~ r+ ~ fD Z `- O ~ ~ ~, .. ~ ~ "~ T '~ lD ^ lp ^ Q ~ ~ Q l0 Parcel #: 014-10 -20-000 11/11/2004 08:53 AM PAGE 1 OF 1 Alt. Parcel #: 4.31.15.5 014 - TOWN OF FOREST Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * =Current Owner * ROSEN, LONI J &KRISTIE D LONI J & KRISTIE D ROSEN 2105 HWY 63 DEER PARK WI 54007-7719 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 2873 POLK/ST CROIX RD SC 1127 CLEAR LAKE Legal Description: Acres: 26.980 lat: N/A-NOT AVAILABLE SEC~~1 N R15W NW NE FRL EXC PT TO Block/Condo Bidg: W -15D 04/211 Tract(s): (Sec-Twn-Rng 401/4 1601/4) Gam' ~ 04-31 N-15W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 04/20/2000 621584 1504/211 W D 07/23/1997 943/481 07/23/1997 850/558 ~nnd ci innnnea?v Bill #: Fair Market Value: Assessed with: Valuations: Description Class AGRICULTURAL G4 PRODUCTIVE FORST LANC G6 Totals for 2004: General Property Woodland Totals for 2003: General Property Woodland Use Value Assessment _ Last Changed: 04/17/2003 Acres Land Improve Total State Reason 4.000 a 0 400 NO 22.980 10,400 0 10,400 NO 26.980 10,800 0 10,800 0.000 0 0 26.980 10,800 0 10,800 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 219 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 } Parcel #: 014-1007-10-000 11/11/2004 08:54 AM PAGE 1 OF 1 Alt. Parcel #: 4.31.15.49 014 - TOW N OF FOREST Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * =Current Owner * GRENDAHL, GARY M & LINDA L GARY M & LI RENDAHL 873 POLK/ST CROIX RD °°'~AKE W 154005 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description p ~ ~ 3 ~ ~ ~~" ~~~~~%~~'' ~ SC 1127 CLEAR LAKE o SP 1700 WITC Legal Description: Acres: 68.020 Plat: N/A-NOT AVAILABLE SEC 4 T31 N R15W NE NE FRL 48.60AC & PT Block/Condo Bldg: W NE F L COMM N R ; NE COR SD SEC 4; TH S 01' W 1544.02FT;TH N 89' W 1933.50 FT; Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TH N 01' E 1520.67FT TO N LN; TH N 89' E 04-31 N-15W NE NE 1934.OOFT TO POB Notes: Parcel History: Date Doc # Vol/Page Type 04/20/2000 621584 1504/211 W D 07/23/1997 943/481 07/23/1997 850/558 2004 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/17/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 7,500 99,800 107,300 NO AGRICULTURAL G4 56.200 5,600 0 5,600 NO UNDEVELOPED G5 2.000 200 0 200 NO PRODUCTIVE FORST LANC G6 7.820 3,500 0 3,500 NO Totals for 2004: General Property 68.020 16,800 99,800 116,600 Woodland 0.000 0 0 Totals for 2003: General Property 68.020 16,800 99,800 116,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code ~ Category Amount Special Assessments Total 0.00 Special Charges Delinquent Charges 0.00 0.00 ~ n ~. ~ ~ ~ n C ~ C '1 O ~ ~ n ~ ~ ~ ~ ~.. I ~ it <D r_. ~ A ~ I m ~ ~ ~ 1 ~ p. ` l 1 .: ~ ~ ~ _ ~ ~ Z ~ ~ ~ O A ~ ~ • ~ m. v ~^ ~ ~ ~ ~ ~ a h~l ~ ~~` a~ I ~~ v m uoi ~o r ~ _ ~ ~ ~o A ~ 111 ~ I c°-~ ? > o 17 m ~ n ~~ W o ~ O ~ ~ ~ o ~ ~ m ~ ~_~ ~, ~ , j I ~ Cy I v I v cn Z D m •`:- ~ m co O a ~ ( ' 3 W _ ~ 3 ~ 0 ° ~ , ~ N i ~ N ~ I N o c ~' -°• a N• ( -1 O ~ c c ~ ~ ~ coo 3 N y a i D i .. ~Q 'v vr - '~ I > > ~ I ~ _, ~ I o ~' m ('; ', I a ~ _ .. :~ I O C Z 1 I =} p ~ ~ D I o ~ t_ I I m I I c 1 W I Z ' ~ ° • ~ y p ~ z ~ .o„ ~ A ~ O 7 •• A I ~ ~ d Z A ~ I .. O N Z m ~ ~ _ .. I Z ` A . W {. oo~t~-1 D C ~ I >>om~a ~ fp '.'1 ~ ~ !~ O. C _ G _. I o ~ y o ~, Ol ~.Q 07• C ~ S v i (O - _ _. Z ~ d D I O Q y y O '< ? o 0 0 O n ? 7 N I o ~ Sao y v, - a ~ _ ~~N~~ 'I I mdo~m ii 'z'1 I ~ ~R°c ~ I ~ N ~~m~` ° I ~ no ~ ~ _ TT 3 ~ 1 Q N ~ N ~ Q ~ > > N I I I o li ~' m °p ~ //'''~~ p Y ~ ti 0 N L VGsconsin Department of Commerce PRIVATE SEWAGE SYSTEM safety and Buildings Division ~ INSPECTION REPORT ~iENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ Tglwn of: Grendahl, Gary Forest Township CST BMElev.:- Insp. BM Elev.: BM Description: TANK INFORMATION U V ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ ~N ~~ eo0 (off Dosing ~,j Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ? t~ r ~s r I (` '_"' NA Dosing ~~ ~` (cf-r NA Aeration NA Holding PUMP /HON INFORMATION ~' Manufacturer Gr~~S Demand Model Number Epps,(. 3~"~~GPM TDH Lift ~.,$3 Lriction2•~~ System2•s TDH IZ,SpFt Forcemain Length ~p' Dia. 2 • Dist. To Well) ~S r SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No.: 363929 S to Plan ID No.: arcel Tax No.: 014-1007-10-000 STATION BS HI FS ELEV. Benchmark d I.13 101•[3 ao.~' Alt. BM ----' Bldg. Sewer ~" S;Q' C=~~ fl}~ 6•~ , St/Ht Inlet 6,}~ 9`E•3~~ St/ Ht Outlet -, -- Dt Inlet -" ~- Dt Bottom p,~ 90.5 ' Header /Man. ~ ~ Z ~ tL •~ 2 2• r 98.90' 8.92 Dist. Pipe .~ r .~ 2 2•ro Z. ry •qc 98.92 Bot. System '~" r •t't 2 • 2 2.4Z i B.i'f' Final Grade ~ ~ yr St cover v- eftbvt Mme( ~-IZ- .Ob Iol.o(~ oD.p , 9E9 / RENCH Width r Length ~ No. Of PIT N .Of Pits Inside Dia. Li DIME g ~ DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEAC G M acturer: SETBACK INFORMATION Type O , r r CHA tuber: System: >IW "' I~ >5~ NIT DISTRIBUTION SYSTEM ~"'~_~""`'D~ ~1..,,,D.~ Header /Manifold rr b pi Z 0 Distribution Pipe(s) y) ~ „ f Z ~-- ~~•~ ~ /` x Hole Size r r' x Hole Spacing tr Vent To Air Intake • Length I Dia. •• • f Spacing Length Z Dia. 3G 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 Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) .~.~Cv*~"" ~ (`~~~~0`~ Inspection #1: oil©f/ ay Inspection #2: o}/ IZ / e0-1~- Location: 2873 Polk/ St. Croix Road, Clear Lake, WI 54005 (NW 1/4 NE 1/4 4 T31N R15W) - 04311549 1.) Alt BM Description = N/~} ~ , 2.) Bldg sewer length = , ~ ,~-~y~~~¢ c~Ti ~ -amount of cover = ' I c I, t; ~ ~S 4' 3 ~~ C.d) 3.) contour= 5.~8/S.`F~SZfo~b.~S'C~25~"'* Plan revision required? ^ Yes ~ No 02 22 or I Use other slrjg f r ~tion yltform tion. >~ INlfu~ w ~~ I f sa. ~ Z Z Z o SBD-6710 (R.3/97) eue! Y'et,f;~ (,~{r+eu~d~ `'~l"~ '~~ae7(~+6+1~(~~(lw~oe'tnspector Signature Cert. No. lisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety.and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ wn o Grendahl, Gary Forest Township CST BM Elev.; Insp. BM Elev.: BM Description: b0 ~ i Hwn nvr~rcros•~ i Ivry TYPE MANUFACTURER CAPACITY Septic ~ e~y. P,e,~`4 ~'~ 6sa Dosing ~~y„~~~ Holdi TANK SETBACK INFORMATI011j, • ~ _ ,~,.~„ ~~ TANK TO P/L r WELL, LAG. Aentto ROAD Septic ` ~~ NA Dosing ~ ~~ ~~ NA A Holdi PUMP /SIPHON INFORMATION Manufacturer ~ ~ Dem nd Model Number PO `r7~'~~PM I} ~ DH Lift ~ ~3 Lriction,~ ~ System ~ TDH ~Z.SflFt / Forcemain Length ~p~ Dia. '~ h Dist. To Well ELEVATION DATA Count ~t. Croix Sanita~p3e~rSjt No.: State .Plan IDLLN~o.: Parcel Tax No.: 014-1007-10-000 STATION BS HI FS ELEV. Benchmark 3 Alt. BM Bldg. Sewer So,," ~ ` 96.gg ` S / Ht Inlet ~.c..f ~ y, -~ z St/ Ht Outlet ~` ------ Dt Inlet ~-- ~~ Dt Bottom ~-,~ ~ p , 50 90-3~ Header /Man. '~-• r ~ L 2. tV Z • , ~ 9 •9D 9~ • q z' Dist. Pipe r~' +~ z- Z ~r y ~g .9Z~ Bot. System 4 !14 r• .~ i 2.9 Z- ~.4L 9 . 8•/ Final Grade ~ S__ ~~ St cover ~ i ec~~ ~1 ~•iz-z ~ ~, ot.ee ,~,_~- SOIL ABSORPTION SYSTEM ~j( BED THE Width Len f ,r nc es ` PIT No. Of Pits Inside Dia. Liquid Depth DIM N (_`( DIMEN SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LE G acturer: INFORMATION TypeO '(~ r ~ `-"-~ CHA Num er: System: Oft UNIT DISTRIBUTION SYSTEM ~ •` tob ~ "°~-~ ~ I sf ~''"'~ .. . Header /Id j Distribution Pipe(s) r i 4 / x Hole Size x Hole Spacing Vent To Air Intake Length Dia ngth ia. Spacng '~~` 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 d hC d I ^ ^ ^ ^ Be /Trent enter Be /Trench Edges Topsoi Yes No Yes No COMMENTS: (Include code discrepancies, persons present, etc.) ~ S ' Inspection #1: ~~ /~/o is Inspection #2: o~ /t2 /~ Location: 2873 Polk/ St. Croix Road, Clear Lake, WI 54005 (NW 1/4 NE 1/4 4 T31N R15W) - 04311549 1.) Alt BM Description = /V~14' .~ cf $. ~ `~ - 2 , z t 2.) Bldg sewer length = \ ~,e~-~ o=¢ t ~yPc~~ - ~ S•`I'3 -amount of over = 3.) contour = S• (~r ~ `~ S- L (; to . 65 , (5, Z - 9.~; q3~ Plan revision required? ^ Yes ~ No Us other ide f r a d'tional inf rmatio S~ ~~ ~ ~ ~ ~ ~ S~ Date Inspector's Signature Cert. No. SBbb-6710 (R.3 7) ~I Wisconsin Department of Commerce SANITARY PERMIT APPLICATION In accord with ILHR 83 i . d /J Safety and Buildings Division 201 E. Washington Ave. P.O. Box 7969 Madison, WI .53707-7969 • Attach complete plans (to the county copy only) fort m, o~pa r n th 8 1 11 i h in i County ~ r an R x nc es s ze. RE~ • See reverse side for instructions for completing this icatioi•1- ~ Q ~~ ~ mit Number State Sanitary7Per ~ ' The information you provide maybe used by other government age y grar~v~ ~ ~x ~ (Privacy Law 15 04 (1) (m)] s C g p Ch~'ck fievi on~[o previous application , . . . ~ ~- S S Nr State Plan I.D. Number I. APPLI TI N INF RMATION -PLEA E PRIN NF Propert caner Name ,, a,H ~,.~ G re s Prop ion va, 5 T , N, R ~E (or) W Property Owner' Maili g Address o ~y-b c)C Lot r Bloc Number ._,--- City, Stat Zip de Phone Number Subdivision Name or CSM Number II. PE B ILDING: (check one) ^ State Owned ~ rt~ Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms 3 V age own of U .. III. BUILDING USE: (It building type is public, check all that apply) Parcel T~~~~xx Number(s) olY- /40 , - lv - O°~ 1 ^ Apartment /Condo `~- 3l. !S: ~ 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 Nome Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Checl only one box on line A. Check box on line B, if applicable) A) 1. ^ New 2. eplacement 3. ^ Replacement of 4. ^ Reconnection of 5. ~ Repair of an ,______S~rstem -_ _____System __________ TankOnly______________ Existing System ___-____ ExistingSListem B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) , Non-Pressurized Distribution Pressuri d Distribution Experimental Other 1 t ^ Seepage Bed 21 Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground Pressure , ~ 42 ^ Pit Privy 13 ^ Seepage Pit Z r~c•~•. 5 43 ^ Vault Privy 14 ^ System-In-Fill G ~ ~~ d ~ VI. ABSORPTION SYSTEM I~I~MATION: 1. Gallons Per Day 2. Abso~~p~Area 3. Absorp. Area 4_ Load'ng Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required ft.) Proposed (sq. ftJ (Gals/day/sq. .) (Min./inch). /~~ Elevation 3 (Q , J Feet ~eet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer s Name Prefab. Site Fiber- Plastic Ex er_ p New Existin Gallons Tanks . concrete ~~n- steel glass App. Tanks Tanks strutted eptic Tan or~Foidtng'fiank ~p ~ ~ ~. ^ ^ ^ ^ ^ Li Pump Ta ~ ~ ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY S ATEMENT I, the undersigned, assume responsibility for installation of the nsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu r ignat a MPRSW No.: Business Phone Number: Plumb 's Address (Str ~ ,City, State, Zip Code): r~~ ,. 6 e 0 0 ~l . IX. COUNTY /DEPARTMENT USE ONLY ^ DlsapprOVed Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) A roved pp ^ Owner Given Initial Surcharge Fee) ~ / Adverse Determination 3ZS0C3 (~ 3o d ti.. X. CONDITIONS OF APPROVAL /REASONS FOR DISAP ROVAL: oara~P ~~ ;~.. ~~ L ~ / eK~ Sl-i ~ t y S 1~Cs-•. 7~ ~o~ q `/a~..at~O~'1 C ~O~ r G~GY~ . >;~o yw. Q~ ~G~- a ~ Ge Gtp ~'~e~ ~ t~ /~^- ~o be p ~o vt' aQ ~GrO ~ r ror ~ SY S 1~f•-w.. G e 1v~.~ ~e ~~ o r-~ . SBD-6396 (8.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber l INSTRUCTIONS - _ . w --.. r. J i ._t. 1n:~, 1. A sanitary permit is valid for two (2) yea,~S. •; -~ y ~ "K '-r- 2. Your sanitary permit may be renewedbg'fdre the'expir~{1~i3~ daft, arld at a time of renewal any new criteria in the Wisconsin Administrative Code will be a~pl~cai,~e. ; y~` ; 3. All revisions to this permit must be apprpf~ed by iFbag~{aerm~t-~ssuin~authority. 4. Changes in ownership or plumber requ~tre~ Sarita~y'Permit Tr~'3'fQr /Renewal Form (SBD-6399) to be submitted to the county prior to installation , ,•:- • _ '-~G'. ,C^~ '.., d. c' ` .' , ~ 5. Onsite sewage systems must be properly maititained~ 'fi1~s~tic 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, 608-266-3151. 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. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pumplsiphon 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 1/2 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; 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; 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 contamination investigations and establishment of standards. Owners name H63.05 PLOT PLAN Show: Location of building served Septic tank Building sewer Effluent system Q . Replacement system area ~/ Q Distribution boxes Eo~d 7 Pump and controls: ~rou~ds 3~7/ Mfr. & Model No. San, Permit No. Dosing chamber ~. Vertical horizontal referen ~ point System elevation is ~~ Well Q Property lines w/in 50' of system Scale = , or dimensioned Vertical Lift Size Force Main Friction Loss T, D. H. Vol. Dist. Pipe Gal. per Min.. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: ~d - ~, C~;,X you ~L;~ mod, ---- 3. ~~ 3 8 D ~,o~~„ " ~ ~fous~ s a _n ~, r'~~0 ~~~~ ~ ~~ ~e~+n~ ~ ~ ~ cll "~°" ~o i `tij h /~ ~Y E ~o i ~ ~ c~ ~P ~ h ~ ~' ~~ , Ul d'Q ~' ~~ ~~ ~ ~ ~ .~ ~ , By the granting or approving of the above plan, or upon the event of a subsequent permit being .issued, .Pierce County and the Pierce County Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or after installation, ~.=y~.~ ~ ~~3 0 ~ o P um r s signature icense o. ate r, Rev. 3/83 - ~ ~ iscons~n Department of Commerce June 10, 2000 CUST ID No.267341 r`i; WEGERER SOIL TESTING & 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/11 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary ~' C rq ~~.9 ~~. ~ ~~. j`,'' ~. y ,~1_f i , ~'`~ ~~. ,.. SITE: Site ID: 193956, Gary & Linda Grendahl St. Croix County, Town of Forest NWl/4, NE1/4, S4, T31N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 667964 POWTS INSPECTOR KG OFFICE :OIX COUNTY SPIA CARMICHAEL RD >ON WI 54016 Identification Numbers Transaction ID No. 322455 Site ID No. 193956 Please refer to bath identification numbers, above, in all' corres ondence with the en The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otp ential for a law suit that may delay the effective date of the code so this status may or may not change. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. WEGERER SOIL TESTING & DESIGN Page 2 6/10/00 Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, ~/~ 1/~~ 1. Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-785-9348, Mon. -Fri. 7:15 AM to 4:00 PM j swim@commerce.state.wi.us DATE RECEIVED 06/07/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 WiSMART code: 7633 k Page ` of 6 T'l~E, S bl- ~ ~ MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE PAGE 1 'of 6 PAGE 2 of 6 PAGE 3 of 6 PA GE 4 of 6 PA GE g of b PAGE 6 of 6 INDEX TITLE SHEET Q W ~'s~ PLOT PLAN p' ~tlOnully PLAN VIEW-CROSS SECTION ; C~11t~ ~~ DISTRIBUTION PIPE LAYOUT O~MERC~. PUMPING C EAMBE R ~~ ~ ~04 coM ~~o~~ PUMP PERFORMANCE CURVE ' oEpARjMSp j~'r/,'N~~, PREPARED FOR lsZ wt,~ s~tz Cc~~~zT'.-: IUD 81ZtGt{'jU 1V ~ w!/V SS l~Z, ~~~ '~~~F s,~,~ ~% . 9: ~ ~~ ~~~~ e~o~s o~~ FREP~ARED~ BY WEGEE~ER SOIL .TESTING AND . DESIGN SEi~V I CE F.O. BOI 74 421 N. iIAIM 5T. RIVQ? F+LLS. YI 54022 115-4~.r0165 JOB N0. Da`1S9 LOCATED IN THE Nw 1/4 OF THE N ~ 1/4 OF SECTION ~ , T 3) N , R lS W, TOWN OF ~'p~~rgr , g~-, C,}2.D lK COUNTY, WISCONSIN. t 6 -~-o~ ~r.nm ~r TrT Scale 1"= alp' CAU~Lj Ll'tJE t~UN. Page ~-of 6 O. 3 1tit i lv i I Z~! O `TN- ST . J ~9~=-- -~ .-_ ~, ~~ ~~ s~'nC7 c ~P~1 rn-~ l ~L ~ ~D'fr,~1 `/ x l' / H'OM L' --~' x 1 OoF~l4PUC, Ch-~IIv, 4Z4~0U~Q 1 a~ ~~ s, i &s , c~ ~tb 6 ~t 2 , . k ~L o~~ I ` '1~J g.1 ~ n ~1~_ ~ y5 /~ ~~ ~ S ~ B-3~ /„ } y ~ ~ s t~q6 /i ~ ~ ~~ 'LS \~~ wooer ~ ~, F~c~ -v ~5 ~ ' i ~u~~~ Q. q~ S ~ ~ r3, Z . ~ 8n1~ ~~~~~\ S. / ~ i ~ . 48; s ~ ~Z i L~-gS ~ truce 15-- - ~ e~z ~ ~ ~~ 1vOT C,cs-~-pPre_-~ $~"t ~'EI ---~-~-CC10.0 - Qp OGZ p t SZV(zB b+~1 1'TZ1-1 OF ~IUIiSE~: SbDroG-_-_ __-- -- ~~'t'LS W(1~ pwt~2 -~'L.: -AO . S ` 0+~ 1'oP or- kJ 00.D ~J e~ -_F~ c~-ST : _ -- NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( y required) 3. Install 4" observation pipes with approved caps. ( y required) 4. Septic tank to be~bW l~sn gallon capacity manufactured by Y"1~pI.JLSS~ ~1 i , 1tic, 5. Bench Marks = S~ p~oU~ 6. Divert surface water around mound to prevent ponding at the uphill side.., Page 3 Of Approved Synthetic Covering ~ST'r~ C 3 3 Medium Sand Topsoil - _l~ _ E .3 \ %- Slope Undisturbed Soil B ~~ Ft . C ~`~I Ft. Linear Loading Rate= ~ -~ GPD/LN FT I ~ 'f Ft . Design Loading Rate=p,ZaGPD/SQ FT~VtI/?> ,7 \\ Ft. o •3~ u~PL'~z. ZS'~CN ~ . 'L~ 1_.uwF(L `~5~./cN K 13 F t . L ~ 3 Ft . !~~ Position of Force Main ~` W y S Ft. L J ~ B K A ~_-----_- _-__ -----~ Observation Permanent _ C Pipes Markers J~ . _ _ (Anchor_securely) _ - I _ - _ _ _ / W ~ ~ t ,~ ,- I Distribution Trench Of 2 2 2 Pipe Aggregate Distribution Pi G ~. Elev. °l g . S Trench Of i ~- 2 i2 Force Main Aggregate From Pump Plowed Layer D Z .O Ft . E Z - Z Ft . Cross Section Of A Mound System Using F O.`a Ft. 2 Trenches For The Absorption Area G ~-D Ft. A .~ Ft. H l_S Ft. Mound Usinq 2 Trenches For Absorption Area Page ~~ Of 6 Perforated Pipe Oetoil End Co Lost Hole Next To Rotes Located On Bottom, Are Equally Spaced . P ZZ.S Ft. Distribution Pipe Layout S 1 ~ Ft . X 3 b Inches Y 3 ~ Inches Hole Diameter Icy Inch Lateral ~ Inch(es) - Manifold ~.- Inches Force Main Z Inches # of holes/pipe 8 Invert Elevation of Laterals °19.o Ft.. ~~ Place 1st hole l8 from center of manifold with succeeding holes b at ~36 intervals. Last hole to be next to the end cap. End View 'erforoted 'VC Pipe Install permanent marker 't -nd of each lateral J •t Combination Sep.t.i.c~ Tank and PUMP CHAMBER CRO55 SECTION AND SPECIFICATIONS ' PAGE S pF .b -VEIJT CAP WEATHER PROOF _ JUUCTIOIJ 80X '1'C.I. VEAIT PIPC , ,1PPROVED LOCKING ~ lO' FROM DOOR„ MANHOLE COVER ~vl~l +~~AIOOW OR FRESH ~ wAAtJ1~.16 LI~gEI. A~IIJTAKE --'i 5"Mrx. ~ ~~ jI I ,6'~MIIJ,1 ..~ /_ D - 18"/'11 N. I~.ILE T Approved joint w/• PVC pipe ~ cor~tw~r ~ ~ i I I I ~-- .~, ~,~: ~\~; ~r' xlu, J ~ j I B• h11 u. y°ws1`~nat~ Qty W / R'1tZR6t1'r t` R-p B RFFL~S Tank construction sha11 comply with ILHP I~3.15 and x3.20 -r AIRTIGHT SEAL, I I I . •~ I PUMP ~ --~ CLEY.~~'33 FT. C061CRETE BLOLK 'i~ ~~I ICI I~ I ~ ALARM II t OAJ 1 OFF Approved joint w/ PVC pipe RISER EXIT PERM1'TfED ONLY IF TAI.IK MAfJUFACTURER HAS SUGH APPROVAL 3~~APPR~FD ~BE04 t>vG SEPTIC f SPEGIFICATIOt~1S DOSE TA1JK MA~IUFACTURCR: ~''l~Dt~+'ST~.~J F~«P-gT 3.8 AJUMIiER OF DOSES: pER ~~ TAAIK :,fZC : ~~00 1 b50 GAL.LOIJS DOSC VOLUME r - ' ALARM MAUUFACTURCR: S`~• ~L~Z-SRO S~~'~S IAICLUp11JG 6ACKFLOW: 130 GALLON,, MODEL NUMBER: LO ~ ~w CAPACITIES: A. l8 IAICHES OR 34~ GALLOys SWITCH T~PC: ~ ~~~'(~ 8= Z IAlCHES°OR `3L G~.LLOUS PUMP MAAJUFACTURCR: ___ GOU L~ MODEL NUMBER: __ 3a~I pp~} C`--8 -tUCHES OR 13~i GALLOUS • D = ~ ~ INCHES OR_ 110 GALLOAIS SWITCH TYPE: ~~Z-~~ 1JOTE: PUMP A1Jp ALARM RE TO 6L 6 MIIJIMUM DISCIiARGE RATE ~~,~4 GpM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEU PUMP OFF AuO..DISTR18UTI0A1 ptPE.. ~' 61 FEET t MINIMUM NETWORK SUPPLY PRESSURE . ~ _2_ 50 FEET '~ 8S FEET OF FORCE rulN X ~--~~ F j FRICTIO~,I FACTOR, ~.3~ loo fr. FEET TOTAL Oy1.JAMIC HE:AO = `_?'S~ FEET As per manufacturer 11. ~ gal/in. Liquid depth 3a ~ ,~ . , Goulds ~ ~~~~~~~~ ~~i37~3 'r., v ~ ~ ~ T~ LJ EP04 _ __ _ 7 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/a" maximum. -- ~ .Capacities: up to 55 GPM. "j`~ Total heads: up to 24 feet. • Discharge size: l1/z"NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F.(60°C)intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3/4" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'r~"NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C)intermittent. ~- • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERS II FEET 10F 0 a i U a Z D J H O s, a s 5 4 3 2 1 0 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermo- plastic Semi-open design with pump out vanes for mechanical seal protection. ^ EP05 Impeller: Thermo- plastic enclosed design for improved pertormance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplas- ticcover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Canadian Standards Association (CSA listed model numbers end in "F" or "AC".) h 30 ~ I ~ ~; ;:l ~ ~ ---~SGPM~ i , , -' i ~-zs FT : ~. 25 i ~ •---- - i 20 ~ i I 15 i i .I, 10 ~ I~ 'l.4 EP04 5 I -- -- i 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m~/h CAPACITY ~ ©1995 Goulds Pumos. Inc. Wisconsin Department of Industry, SOIL AND SITE E V A L U A T10.N REPORT Page ` of 3 Labor and Human Relations D'rvjsian of 9afery 3 Buildngs in accord with ILHR 8,,~`~, ~S.'Adm. Code ~;?~`; ~ `""' COUNTY ~,,`- ~ ST. CR-~ tX Attach complete site plan on paper not less than 81/2 x 11 inches n . Pla~i vst'hj~ia~ie, but not limited to vertical and horizontal reference point (Bf~, drectio ~ % of sfb'Ite; scale or 'PARCEL LD. x dmensioned,-north arrow, and location and dstance to nearest r aif:i' ~, _~; •~~~ ' APPLICANT INFORMATION-PLEASE PRINT ALL INFO >~7,t710N~`'`fi., ~x ~~ D Y DAT .-• a S 1 ~~ ` PROPERTY OWNER: ~/~ P N G ADD Lir~A 61z~~t~{L c~' N W 1/4 W~ 1/4,S 4 T 3) ,N,R 1 5 E ('"~ J PROPERTY OWNEA':S MAILING ADDRESS • L ~ 1` ~BLOCK;L: SUED. NAME OR CSM ~ 18Z wtn~DSO~ ~ovu~--r _,_ = -~ CITY, STATE ZIP CODE PHONE NUMBER ~CfTY (]1/ILLAGE I~fOWN ' NEAREST ROAD Nt~1 BQ15tJ1UiU,-+-r N sstt2 (b lt) b33 =~19.z9 tZlssT c~x~t~'-~ U~JE' A~UE/ [ ]New Construction Use [X] Residential ! Number of bedrooms 3 [ J Addition to existing building pQ. Replacement (]Public or commerdal desaibe Code derived dally flow L1. SD gpd Recommended design loading rate -' bed, gpd/ft2 ~ 3 trench, gpd/ft2 Absorption area required '- ~ bed, ft2 3'zS french, it2 ~ fvla~dmum design loading rate ~ Z bed, gpd/ft2 • 3 trench, gpd/ft2 Recommended infiltration surface elevations °i S • S () ft (as referred to site plan benchmark) Additional design /site considerations !'"w~ u~ w/ 2T1~ ~~ - ~ y kV7 ~ l.a,iG I.~J /~/ti - ~ 4 of S~ Ficc '. Parent material Lo QT'S S Ou ~ 11 I_L ~ Flood plain elevation, if applicable N A ft S =Suitable for system CONVEtJTIOtVAL I MOUND W-GROUND PRESSURE AT-GRADE SYSTguI M FlLL yoLpQ~, Tq~ U = Unsuitable for stem D S lSU (a S ^ U ^ S ®U ( D S ®U ^ S ®U I D S D'U Boring # ~~ Ground elev. Rb_•~,ft Depth to limiting factor L7"• Boring # 2 Ground elev. qs-S n Depth to limiting factor 1.Z.`' . SOIL DESCRIPTIAAI RGRncT e th D i Horizon d p in. $ om nant Color Munsell ' Mottles ~ Du. Sz Cont Color Texture Structure I Gr. Sz. Sh. Consistence ' I Roots GPD/ft Bed rerctt 1 0- tio`~iZ~L Z - - si - Z`F-sbl-c rn~fi- ~S 1~• • 5 .~ ~ ~-~~' 10`1,2 s /3 - sit l~sbk >n.`Fy- cS - .z .3 ~ 3 1Z-32 ~S~R ~~~ •S'-1.fZ s~~ 7 L t~sbk ~f>^ - .- •~ ~ ,--~ Remarxs: ~ ~ ~ r -I ~-a~' l0`~(,23L2 .St1 Z'F'Sbjz 171` ~S `.~ •S,r b Z $-t2•' Lo~f.2 S13 ~ std Z~Sbk ~ `~1- a.S ~~ _. ~ S: 3 ~Z Z3 . to~2 3~6 ~ ,S ~~ s~8 S~1 ~ t~sbh m'fi~ - • Z' .~ r ----~ . nay ua~ etJ: - ~ r ~ ~ -t / . Name:-Please Pnnt Phone: • Arthur L. We~erer ~ 715-425-0165 ~ g~rer Soil esting & Design Service-P.O. Box 74 River.Falls,WI. 54022 ~' ature: ~' p ` `S Date: 6 .. CST Number:. . ~ '~~O 22254 PROPERTYOWNER_ G~-~1p~HL SOIL DESCRIPTION REPORT PARCEL I.D, A Boring # ~:%.~fi~N a: • <: ~. ~:<, >~ ~, •~t...~„ Ground elev. ~• 5 tl. Deplh to limiting factor ~~ Boring # Ground elev. f t: Depth to limning factor Boring # ~..., . ^^*~c~ax ~~~ k ts'F ,~: <',>,ur, Ground elev. It. Deplh to limiting factor 3oring # ^;,?~ .,..:: r:.``, around :lev. ft. )eplh to imiting actor Page z- of ~ ' Horizon Depth in. Dominant Color Munsell .Mottles Qu. Sz. Cont Color Texture Structure Gr S Sh Conslstenoe eot~y Roots GPD/ft . . z. . Bed Trench Z ~- ~Z ~ 1,O~-t li S L 3 -~ s i 1 ~`t2,sb 1c m`~1- oc. S - . S ' •.6 3 >2 Z~ • 1 v `-1,tZ S 13 -~ SyRS18 si I t c,S~1•c M ~t- - . Z .3 ~ ~ri Remarks: neiiidins ~rl no•~n~f+.:r ~..... rive i iar na. neii~ctr-c5: ~~ ~ i ' PLOT PLAN Page -~ of ~ SCALE 1"= L~~ ' ~ ~vu~'-1 L1 ~1E t~U~. ( 0.3 m~ ~ I i i cz~/ cv~ J ~' '~ s~nC DPtI'~.t_ yc ~ ~©'R~ n"h` x i / HOME --e --ax t - 3~1 *~ ~..ab 6 k ~o~° i { ~~ s. /n ~5 ! ~• ~ S ~~~ 5 ~ ~~~ tis i~\` Wbu 1~ ~ ` ~~ ~~ ~L'TiCET -~i ~5 L`pU~'oVR @-.965' ~ ~3. ~~ 8 n1~ CF TZ~,e}~\ S ~ ~ i F3 ~\ ~~2 '®".~' ~O SOT C,artip~~- -____ ~_ -~= ~ lU o : 6 ` .6-.1 S30TTU --I OF ~1lJSE"_ S ~ D%u~ OQ O l S~$ -- -- ~-1.`,LS ~'R~A ~2'~Z- -LrL. 1.00.5 ` M~ 'Nn OF k10QA ~t~l ~l' -GUST- n oo-lS`? C~,o~ ~. 6- _ _ __ _---- -- ~G~~'~~ y- 0 O z.zoZ S y ; . (715 ) 425-n1 ~5 CST Signature Date Signed Telep one No.ST ~- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT OwnerBuyer Mailing Addri Properly (Verification required from Planning Department for City/State Parcel Identification Number i~/~~1-'_l_~' 010 LEGAL DESCRIPTION . ~ /~ _I / property Location ~ -'/., ~ ~ '/., Sec. ~, T~N-R_,/~W, Town of '' z Subdivision .Lot # Certified Survey Map # ,Volume .Page # Warranty Deed # ~~ 7 ~ ~~ ,Volume Page # Spec house ^ yes IIQ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE 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 a licensed pumper. What you put into the system caa affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on site wastewaterdisposal system is is proper operating condition and/or (2) after inspection aad pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fo herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification ' g your septic system n maintained must be completed and returned to the St. Croix County Zoning Office within 30 of year exp' e. ~j~ //?-v..~~d ATURE OF APPLIC DATE O ~ CERTIFICATION I certify that a t ments on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the op s bed a v b / rtue of a warranty deed recorded in Register of Deeds Office. 7,~z~d~ SI ATURE OF APPLIC DATE ****** «***** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed AND OWNERSHIP CERTIFICATION FORM - ~o~ 1504P~~E 211 STATE BAR OF WISCONSIN FORN12-1999 Document Number WARRANTY DEED This Deed, made between Loni J. Rosen and Kristie D. Rosen Grantor, and Gary M. Grenda6l and Linda L. Grendshl, husband and wife Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed please attach addendum): G21584 KRTHLEEM H. WALSN REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04-20-2400 10;00 AM i#~ANTr DEEa EXERT # CERT COPY FEE: COPY FEE: TRANSFER FEE: 5#5.00 RECORDIH6 FEES 12.00 PAOES: 2 Recording Area See Attached Name and Rctum Address ~ws ~ - /t 41007-20 This is homestead property. (is) iIDiOQ Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~ 34'M day of April , 2000 s AUTHENTICATION Signature(s) Loni J. Rosen aad Kritrie D. Roaea, husband and wife + Loni J. oxen J ,(/ /^ r Krishe D. Rosen ACKNOWLEDGMENT STATE OF WISCONSIN SS. County ) authenticated this 7 day of April , 2000 personally came before me this day of , the above named • Kriarina Oglaod TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by $ 706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristiaa Oglamd Notary Public, State of Wisconsin Hudson, 1 My Commission is permanent. (If not, state expiration da (Signawres may be authenticated or acknowledged. Both arc not necessary.) ' Inmrmeaon Pmre.sionde Camwm. Fob du Lee. WI + Names of persons signing in any capacity must be typed or printed below ihe'v signature. eoaass2ozt STATE BAR OF WISCONStN WARRANTY DEED FORMNa.2-1999 Y ~0~.1504PA~E 212 EXHIBIT "A" A parcel of land located in the fractional NEl/4 of the NE1/4 and the fractional NW1/4 of the NE1/9 of Section 4-31-15, Town of Forest, St. Croix County, Wisconsin, further described as follows: Beginning at the NE corner of the said Section 4; thence 501°33'02"W 1544.02' along the East line of the NE1/9 of said Section 4; thence N69°59'15"W 1933.50' along the South line of the fractional N1/2 of the NE1/4 of said Section 4; thence NO1°38'10"E 1520.67' to the North line of the NE1/9 of said Section 4; thence N89°19'09"E 1934.00 to the point of beginning. St. Croix County, Wisconsin.