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N fD ~ N Q (D N ~(7N < (~-~ O ,,y ~ = y M ~ ~ ? d O .n.. o~ ~ ~ a ~.~ r ~i fD a 0 m 0 0 ~ O O L c 3~0~ d ~~ ~ W 3 m o ~ l1 ~ ~ ~ ~ ~ ' ~ ~ C ~ ~• ~ ~ ~ ~ ~ ~, .. ~ O ~ c ~ ~" w o g ci+ ~ o o ~ o ~ ~ Q < ~ ~ c I o ~ ~ Si ~ w a o ° ' ' t tom, C 4 0 J J ~ 0 o D i D ~ A OO ~ O O ~ W W ~ ~ ~ ~ ~ 3 ~ ~ !r 7 c C ~ ? ~ ~ G _CC o .~i y ~ G y W N O .. ~ N i D o v ~ ~ ~• y I C % trl . . -+ N J (~ v a 7 `b Z ~ ~ D A Q A I (Z j W ~ < ~ ~ p, , 3 ~ > 'L p c ~ w ~ ~ z ~ A i i A 7 a s I a A Q~ w O ~ b ~ ~ ~ ~ N w ~ I N 3Nisconsin [3epartment of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ,~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide. may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1• Permit Holder's Name: City Village X Township Anderson, David Glenwood Townshi CST BM Elev: Insp. BM Elev: BM Description: (: (~ , (.~ C (,~ . ~ T 0 ~ r~ I TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~: ~ Dosing ~ ~()~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic > I O ~ (~ ~ ~JO-F hot i h / ) 7 OC Dosing >i~o' ~ 75v N~?'t ~o~~~vv /oo' Aeration Holding PUMP/SIPHON INFORMATION O. ~ Manufacturer f~ ~i Demand J~ '°-~~,f[iZ GPM Model Number ~l~l i S ,~--~ ~~v TDH Lift / Friction Loss System Head TDH Ft Forcemain Length ; Dia. U Dist. to well ' ~ , 5U SOIL ABSORPTION SYSTEM county: _ St. Croix Sanitary Permit No: 430423 0 State Plan ID No: Parcel Tax No: 016-1015-30-000 Section/Town/Range/Map No: 07.30.15.119 ELEVATION DATA STATION BS HI FS ELEV. Benchmark t3 m S, ~ l~ S, ~ /~ • ~ Alt. BM ->,(r n 5e " c to /~ ~"!.~ ~' ~ ~ , / Bldg. Sewer ~ ~ S~ . 3,6 St/Ht Inlet ~(,Ib ,-] SbHt Outlet rl.3s 9 , -~ Dt Inlet ~ '~, ('p n, 1, a /_ Dt Bottom Pwa~ ~ (~ ~ S g~ ~ `~ Header/Man. ( ?, /~ ~( 8- (a ,3y Di~~Pi~g ~ ~.:3~ q7 S( Bot. System ~'7, j Y Final Gra St Cover ~ ~ ~ ~ ~ ~ l~e~.c~,t-t 3 ~,~~ q . z •r ~ BEDITRENCH Width Length No. Of Tranrh c Cr 1 [ 5 PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 ~ ~ 2 r -f .. SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ,:ji ~ l~c {'''~'~-J Type Of System: ~ ,,,,~}~- UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold 11~1 / ri Distribution Pipe(s) ~ (n r~ / x Hole Size x Hole Spacing Vent to Air Intake Length d~ Dia_ Length N ~ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over De th Over xx De th of xx Seeded/Sodded xx Mulched Bed/Trench C Bed renc dges Topsoil '~' 'No ~ . _ _ _ lv~ `oF ~~hS Spy COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/1~ / 03~iN-t'1i In Location: 2730 160th Avenue Glenwood City, WI 54013 (SW 1/4 SW 1147 T30N R15W) NA Lot Parcel No: 07.,3,0`15.119 1.) Alt BM Description = ~'t'"` ~~ / l~"~`~" n^"Jt'`{~ O-Lr-vl f~ ~ ~ ~,~ - W ~ {~~ 2.) Bldg sewer lengt = 5~ ~ ~~~ V~ 5'vl S~~ ~ S~ l1~ SQ,~.~ -amount of cover = 4~'t ~by~ ( '~h~-~ `~e~ L10 ~ 5~/cv+-~ (?~ G~ ~ ~ T-_-~. __-.i _- _____ -.__.___ r---_ I ~ ~ Plan revision Required? Yes ~ No ! ! ' ~ ~ ~ (,~ ~ ~ v ~I Use other side for additional information. IJ ~ ~! _,__L~_; ~~ ~_. ~_ _.,______ ___ J L~~~~~~ ~___.~' SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. (~-` Safety and Buildings Division /~ ~~~ 201 W. Washington Ave., P.O. Box 7082 C ~ D ~ ~ n Madison, wl 53707 - 7082 Suti Permit Number (to be filled in by Co.) ~seonsi (608) 261-6546 p De artment of Commerce State Plan LD. Number Sanitary Permit Application ou provide ersonal information d Wi Ad C i h 83 1 y o s. m. e, p In accord w t Comm .2 , may be used for aeconda>1' Purposes Pri Project Address (if different thaw mailing address) ~ i. Application Information -Please Print All Informat n 2~„3~ r~8 ~J~ ! t Property 'Name ~ Parcel # Lot # lileekM- ~--- ~•ZO o,GlL Property Owner's Mailing Address " BONING Or=FICE Property Location //'' \1 %;~W'~y $eCtl0i1 j City, State ., Zip Code Phone Number /- /~ ~J ~ CVC O , ) T~N; ~~ or W h l i i k ll h $ a t at app y) ng (c ec Type of Bu ld Subdivision Name CSM Number 2 Family Dwelling --Number of 13edrooms ~ S ~^ . ^ public/Commercial -Describe Use _ ,~,.,~ try []Viila~ownship o , ~ State Owned -Describe Use IIL Type f Permit: (Check only one box on IIne A. Complete line B if applicable) r ~ O ( - p - ~ '+' System ^ Replacement System ^ Treabrtmt/Holding Tank Replacement Only ^ Otha Modification to Existing System B. ^ Pecatit Renewal ^ Permit Revision ^ Change of ^ Pemtit Transfer to New Last Previous Permit Number and Date Issued 13efoce Expiration Plumber Owner IY.. of POWTS S s tem: Check aU that a 1 -pt~essurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized !n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Uait ^ Recirculating Sand F~er ^ i Recirculating S the6c Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain ~ J Y. Dis rsaUTreat nt Area Information: ~ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Proposed (sf) System Ele lion S S 5 S, S 3 ~, VI. Tank Info Capacity im Total Number Manufacturer Prefab Site Steel Plastic Gallons Gallons of Units Concrete Constructed lass New Facistirlg Tanks Tanks Septic w Holding Tank Aerobic Treatmed Unit Dosing Chamber VII. Responsibility Statement- I, the unden d, assume responsibility for installation of the POWTS shown on the attached plans. 's Name (Print) Plum i MP/MPRS N Business Phone Number P _ ~ . z fz tJ Plumber's Address Street, ty,_State, C ) I~ ~ VI oun /De artment Use Onl roved Sanitary Permit F (includes Groundwater Date Issued !ss in gent'ignatu tamps) d ^ Di A sapp pprove Surcharge Fee) n ~ ~_ O ~ O~ L ^ Owner Given Reason for Denial 1 I _ ~a~ ~ ~j„~;~J" IX. Conditions of ApprovaURessonsfnr Disapproval 31 ~ / w_ " brt/ J ~ a, ~ i y ~ I SYSTEM OWNER: S ~ ~~~ 1 S ti ep c tank, effluent filter and ~ ~~ ~ ~,~~~ dis ersal l! ~ p ce must all bebe std / maintainer as per management plan prpvided by plumper, ~'~'Z,N,~ ~ ~~ ~t>~er` 2 All setb t ~'," k . ac requirements must be maintained U as per applicable code/ordinances. ~~ ~~ S _. ~... ,. a1n .11 iwehes Ia ,1~ /1 n Arraea CampR[e P,aai \lV ,ac \.YY4ar ,r,.q~ ,.......J ~ _~ -~. _ T -~__ -w ~ ~. ~ - W . SBD-6398 (R. 08/02) C'~ ~~ i ~ e 1 ~ ~ 5 t~~1... PLOT PLAN PR CT Dave Anderson AD ESS 1571 Ctv Rd D Emerald Wi 54013 W /4 SW 1l4s 7 !T 30 N!R W TowN Glenwood couNTY ST.CROIX 9/14/03 BEDROOM 4 RS Shaun Bird 226900 DATE CONVENTIONAL IN-GROUND S5URE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE800 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1244 # of chambers 40 ,BENCHMARK V.R.P~Top Of 1/2" Plpe__~ ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark `,,~ Alt. BM A SYSTEM ELEVATION Top of 1/2" Pipe @ 99.8' Scale is 1" = 40' unless other ~~ 1~ noted ~-~ S~ S 1100' Plans Designed Using Conventional Powts Manual Version 2.0 Vent >6" of Cover 11" 6' Long B.M. , ~-.~~~: 95.5/95.4/95.3/95.2 ~ ' ~` __ 0 4 edroo 100'~jI ouse 300' 00' 10, ~+~ Vents ~, 4-3' 63' Cells ~ with > 'Spacing - p 10% ~ ~-3 Slope ~ 10% _ _ _ - lope ~' B-2 Vents / S1o ,~i( `~. ~ I 2 3 y \ti~ ~ °N~~ U W Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area at System Elevation COPY 1500' .ve PLOT PLAN PROJECT Dave Anderson AD Ess 1571 Ctv Rd D Emerald Wi 54013 SW 1 / 4 SW 1 / 4 s 7 /T 30 N/R w TowN Glenwood COUNTY ST. CROIX MPRS Shaun Bird 226940 J' DATES/14/03 BEDROOM 4 CONVENTIONAL IN-GROUND SSURE CONVENTIONAL LIFT )44( HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE800 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1244 # of chambers 40 ,BENCHMARK V.R.P. T°p Of 1/2" Pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *g,R,p, Same as Benchmark SYSTEM ELEVATION 95.5!95.4195.3!95.2 Alt. BM Top of 1/2" Pipe ~a 99.8' 04 Scale is 1" = 40' ~°° 100' ouse unless otherwise noted T 300' ~ 1100' ~ *B.M. B'1 10 ~ 40' ~,, 10' U Plans Designed Using Vents 5, 4.3° X 63' Cells Conventional Powts 70 with >3' Spacing Manual Version 2.0 10010 Slope 10% lope B-2 _.. Vents ,Vent >6„ Standard Biodiffuser of Cover 1-eaching Chamber with 31.1 ft2 of Area 11" 6' Long „ , „ Grade at System Elevation 1500' a~ U c W ve f . _ • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings m accuraance wnn ~.vrnm ate, vvw. r~urn. wua County ~ f Plan must Attach com lete site lan on er not less than 8 1/2 x 11 inches in size a p p . p p include, but not limited to: vertical and horizontal reference point (BM}, direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re 'ewes by Date Q~ ~ ` Personal iMortnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). O f . ~t~ P'te``'' RECEIVE Prop nv Location ~ (~ '~ ~ Govt. T N E (o W 1 /4 S of (,~ 1 /~ Property Owner's Mailing Address ('~ SEP 17 200 Lot # Block # -- Subd. Name or CSM# j ~ City State Code hone Number ^ ^ Village To Nearest Ro d ~ ~' ~ D/ ( ~ T. CROiX COUNE ~ ~ New Construction Use• Residential / Number of bedrooms Code derived design flow rate GPD ^ Replacement ^ Public or mm rclal -Describe: __ ____ __ ____~___.__ ___ Parent material d/LZ7~ ~--!~ Flood Plain elevation if applicable ~/ ri` ft. and ~recommenda~6'ons;3~-~/,~~ G~ l0~(J I ~~ J/'9si `/I ~s• ~~QS; Boring tf Bori ~ / 4,/~ b ~, ~ O Pit Ground surface elev~~ ft. pepth to limiting factor /~ in. Soil ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 v ~3 L ~---- ..~ ~ s Z . ~ L I ~----~ f'1'1 as ~~ ® ~ng # ^ Boring '' f2 '' .'~ 'Pit Ground surface elev~~j~. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dfff in. Munsell Qu. Sz. Corrt. Color Gr. Sz. Sh. `Eff#1 `EfF#2 ~- 6 --~ 3 --- ~ ~ Z • Effluent #1 = 80D > 30 < 220 mg/L and TSS >30 < 150 'Effluent f#'2 = BOD < 3u mg/L and T55 < 30 mg/L CST Alarrte (Please Print} lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address /1 Date Evaluation Conducted Telephone Number '-~3 1008 192nd Ave, New Richmond, WI 54017 (~i/~~~~ 715-246-4516 Property Owner Parcel ID # Page of Boring # Boring //~ J~~ it Ground surface elev.C~J.L~--ft. Depth to limiting factor ~ Z$ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 --11 ~3t v ---~,- ~ m C.r ..S" ~. _ ~ --, ~ ~ , S' , ~s. z~ Z a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor ~n• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 ~~ # a Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/fl= in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODE > 30 < 720 nxyL and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seaaa~o pe.~oo> .. ~ ~ ~ Soil Test Plot Plan .Project Name Dave Anderson Sha ird Address 1571 Cty Rd D Emerald Wi 54013 C M #226900 Lot °--- Subdivision ------- Date 9/14/03 S W 1 /4 S W 1 /4S 7 T 30 N/R15 W Township Glenwood Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 700 ft. Top of 1 /2" pipe System Elevation 95.5/95.4/95.3/95.2 *HRpSame as Benchmark Alt. BM Top of 1/2" Pipe @ 99.8' G ~'liMP CMAMbfcR CROas ~~~-ear Rt-~G StCC~~iCJ1Ttb.'.:9 C.:. rR ~! frMr ss =sere ooeR. ~~OOw 01t ~'R `'! ~ +~'~~. 7 i i c:~c~-~,. i~ . wtwrKtR~A,o~i~ ~" ..~iyC":Ota 10Y aRwmt ~ t - -E rROV~~= AtRTiiKt SCI-L ~, oix~ts~rT~ too ~~~~ S06I1~ SOii +~ttr~t -~.. GONCR~T~ •..,.. ,.,,.,.., w• ....... •-~+eorsa ~oc~t~t~ ~:Ma1~t~iOLL C`OY=R ~t"~. i~A1Ml. t t f! t f ~Ej ~i.ARM t ~ ~t ~E r wee R~flR tittT ~1RAt'A'q dul.lt ft T~-yK 1MCTYRI'R MA! iY6MM A~!-ItOYRi. AAYt,tl~A~TNRri~: i~~1_ ~cA ~ Ooats: S D lI11-IR ~s ; !R p-s b4Li.QN: DOii VOLWUi .~- ~+'1'aCN '!'i~Mti X17 CAlAC~~ A • ~ MIt11L~ Qlt ' ~ ~ hAyu/1~ClypilRt .`~"~ i • NHR~1ii Nt ~MOOt1. YvM1btR: ~' ~L~•........,.,..,.~. t • +~1t+iti ~ MI.~NN sw~KM '~`Mlii ~ !• MIGr+iiOR M1-I.Oyt ~+ss~r~~trt OHew- K+~'i r ~urt~ wwo J~s~tr, SRS ~ as MCR3'ttAL AFry; Qr-Pl ~iTA~~.tO Obt bLMf1AT[ Qi~liWTi ~ ttT+~~ 'w~ en rwo iK*r+r4wT:ou Mst,o~.Q..,.,.. RsDr ! o - ~ 8" * wµu'tW't ~1CTiet4RK iiilM~s IwRtisWtt + +~. e[sT OR eOAC! MAi#1 x / • • • • . • • ~ fttT 't `~ U X l.'3~i t.---- l-~ ~ = ~ , G ~ 's"+s*~-i, oec Mss ,.. Rye: ~/ 4'~'RItRt,. 01Mt~i~10AJt Qe A,IK: LbA16TA /~ .r.~.~;w~DtK.. ~ it~Q1~t~D OCATM~+~,.~,.~... S~,tE C: ~ J G~ ~j n.~~y TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING °a w z v a z 0 0 MODEL 15 2 153 Feet Meters Gal. Liters Gal. Liters 5 1.5 69 261 77 291 10 3.1 61 231 70 265 15 4.6 53 201 61 231 20 6.1 44 167 52 197 25 7.6 34 129 42 159 30 9.1 23 87 33 125 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 Lock Valve: 38.0 ft. (11.6m) 44.0 Ft. (13.4m) wasoa 0 3 27 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. ``' • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series 1521153 MODELS Control Selection Model Volts~Ph Mode Am s Sim lex Du lex N152 BN152 115 1 115 1 Non Auto 8.5 8.5 1 Included 2 or 3 2 or 3 E752 230 1 Non 4.3 1 2 or3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN753 115 1 Aulo 10.5 Included 2 or 3 E153 BE153 230 1 230 1 Non Auto 5.3 5.3 1 Included 2or3 2 or 3 O CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All elechical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupatlonal Safety and Health Ad (OSHA). 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. du ex 3 3. Variable level control switch 10-0225 used as a control activator, specify pl ( ) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. 80X 16347 ,,~.;. ,. Louisvile, KY 4025(1-0347 Manufacturersof.. Z ~ ~,~~~ ,~ SHIP 70: 3649 Cane Run Road ~ ' ® Louisville, KY 40211-1961 Q~UTy-PUMPS SNCE I~i~~ ,,, (502) 778.2731.1(800) 928-PUMP htiP://www.zoeller.com ' 'PL/MP !O. FAX (502) 774-3624 © Copyright 2000 Zoeller Co. All rights reserved. i2 S2 - __,, I ~ i 1z 1/e 5 1/ S SELECTION GUIDE UICRJ D 80 16D L4~J JLV Maintenance and Contingency Plan for a Septic System Maintenance Plan ed once ever 3 years. 1. Septic Tank is to be pump y e cleaned once a year. Please note: a larger filter is being installed in 2. Effluent filter ~s to b order to extend the maintenance interval of the filter: the inspections pipes at the ends of 3. Once every 3 years, cells are to be inspected via the cells. ner a rees to limit greases, garbage, and water conditioner discharge into the sys em. 4.Ow 9 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. . Discharge into system is not exceed those required as per Comm. 83 8 Contingency Plan ~ stem fails, determine cause of failure, use altern to area an install new system or 1. ifs .~ ~ ,` ~ f install system at a lower elevation. ~jw• . 2. ep ace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5146 Shaun Bird #226900 ' ~ ST CROIX COUNTY ' ~ SEPTIC -TANK MAINTENANCE AGIZEI;1GiENT ANA. OWNERSHIP CERTIFICATION FORM ~~ OwnerBuyer Mailing Address ~ ~ Property Address ~~ ~ ~~~ (Verification required from Planning Department for new r'ity/State Parcel Identification Number D (o -' a!S - 30 - . ~ ~ q~ ~.?A aua_ LEGAL DESCRIPTION ~) ~ ~ / Property Locations '/.,~~/'/4, Sec. T .~(/ N- ~ W, Town of Subdivision --_. Lot # Certified Survey Map # s .Volume ,Page # Warranty Deed # ~ ~~ g ,Volume Zia g .Page # 4~ Spec house ^ yes~ar'" Lot lines identifiabl es ^ 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 can 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 masterplumber, journeyman plumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and 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 forth, herein, as set by a Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic tem has been maintained must be completed and returned to the St. -Croix County Zoning Office within 30 da of a three r piration date. ~ NA APPLICANT DATE OWNER CERTFFICATION (we) certify that 11 statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pe described a c, by a of a warranty deed recorded in Register of Deeds Office. ~~ ** 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 IGNA O APPLIC DA E ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** 'J 206S1' N58 STATE BAR OF W ISCONSIN FORM 5 - 1998 ' ~ ~ PERSONAL REPRESENTATIVE'S Document Number DEED Ruth M. Asplund, as Personal Representative of the estate of Fritz N. Asplund, ("Decedent"), for a valuable consideration conveys, without warranty, to David L. Anderson, Grantee, the following described real estate in St. Croix County, State of Wisconsin (hereinafter called the "Property"): S I/2 ofSW 1/4 of Section 7-30-I5. 700698 KATHLI~EH H. MALSH REGISTER OF DEEDS ST. CROIK CO., MI RECEIVED FOR RECORD 12/04/2002 10:30A1! EXElPi ti REC FEE: 11.00 TRANS FEE: 394.20 COPY FEE: CERT COPY FEE: PAGES: 1 Name and Return Address Hendrik W. Van Dyk VAN DYK, O'BOYLE &SILER, S.C. Post OfOce Box 1 I8 New Richmond, WI 54017 The above-described premises are not [he homestead of Violet L. Asplund, who is the spouse o~the deceased holder or title. r '3 ~• 21O ~rDr ~ .~~9) ~ ~~ Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired~.r Dated this ~ day of /" ~~~"~"~~ 2002. *Ruth Nt. Asplund * Personal Represents ve Personal Representative * Personal Representative AU"1'HENTtCAT10N Signature(s) authenticated this day of , 2002. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. S[ats.) THIS INSTRUMENT WAS DRAFTED BY Hendrik W. Van Dyk VAN DYK, O'BOYLE &SILER, S.C. Post Oftice Box 118, New Richmond, WI 54017 (Signatures may be authenticated or acknowledged. Both are not necessary.) * Personal Representative ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County ) Personally came before me this ~_ day of _ 2002, the above named ~,~`t'tx Aw _, to me known to be the person ~ the foregoing instrument and acknowlet~s * ~~'0.G ~ Q Notary }~ soot ~ My Com gn' js ,pertnep _~{~f not, state expiration date: *Names of persons signing in any capacity should be typed or printed below their signatures PERSONAI. RFPRFSF.N'1'A'1'1 VE'S UF,ED STATE BAR OF WISCONSIN FORM No. S - I9YB INFORMATION PROFESSIONALS COMPANY FOND DU LAC. W I 500-655-2027 a ~ ~11~dp t,_w~ •.S O~I• - ~. ! ~~