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018-1030-80-100
Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Gillis, James Hammond Townshi CST BM Elev: Insp. BM Elev: BM DeTscription: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic - 0-U O I Dosing /~ ~ ~ c.~fJ ~° ~ ~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL ~ BLDG. (f% /~ Vent to Air Intake ROAD Septic , ~~ I / r / ~ ''f Fri r Dosing .fy., 7 , ~ ~ ~ Aeration Holding ~~ PUMP/SIPHON INFORMATION Manufacturer C,~07~Q~S '~~ Demand GPM Model Number ~~ ~3, v TDH Lift / Fric'onOL s System He~~ TD Ft Forcemain Le th Dia. h Dist. to well Jll6~j /~ ,.~ G 1 SnIL_ ABSORPTION SYSTEM ELEVATION DATA County: $t. CI'OiX Sanitary Permit No: 399630 0 State Plan ID No: Parcel Tax No: 018-1030-80-100 STATION ~ BS .0 HI 03 FS ELEV. Ov Bench am rk ~/ a - ~ ~G- C ~6 r Alt. BM ~~. ~ 3.l0?/ q ~ /- 3 S'I O Bldg. Sewer ~_~ gso3 St1Ht Inlet l SUHt Outlet / Dt Inlet / Dt Bottom i3, ~ l I Header/Man. Dist. Pipe '~ ~. 'I z ~ e~ ~' S ~ S /3 q / 7• 1 B~ort_Syste~ C~6~ S aH 2 - ,~ ~ .,- Final G de ~Z ~0 ~ -~ St Cover 2 ~ .3 ~oo. Z ~'~ ' BEDITRENCH DIMENSIONS Width ~ Length / No. Of Tjegche~ / ~~,8 PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L s BLDG WELL LAK STREAM L CHI Manufacturer: INFORMATION CHA OR Type Of System: ' ~ / ~ j~ ~ ~ ~ T Model Number. DISTRIBUTION SYSTEM Header/Manifold ~ '/ Distribution I ~ //~ x Hole Size ~~ x Hole Spacing ~ ~ `/ Ven to it Int ce Dia 2 th Len Spacing ` Length Dia ` ~ ~ g SOIL COVER r Preaeure Svsteme Only xx Mound Or At-Grade Systems Only Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~L Bed/Trench Edges Topsoil ~ Yes [] No ~ Yes ®No COMMENTS: (Include code discrepencies, persons present, etc.) I tion #1:~~ /~/ d v Inspection #2:~/~/~_Z v ' ~Y,(`l~,"~-,~J Parcel No: 14.29.17.219810 Location: 913190th St Hammond, WI 54015 (SW 1/4 SW 1/414 T29N R17W) N Lot 2 1.) Alt BM Description = ~'P (~O~fgIY ~~~'° Cam- ~~~'~~'~ ~ t~ ~ 2.) Bldg sewer length = L.` ~,/ / ~Z~h. S8- 1 mss'; ~~" ~ ~' r ~ i~'a:Qt• ~h'y - amount of cover = 3 l~ ~~~ t~-~ = 3.32 (~~.~') Plan revision Required? ^ Yes ~ i Use other side for additional information. ~ ~ I~ ~~ ~~~'~ ~'~~vV}!L Date Insepctor's ignature Cert. No. SBD-6710 (R.3/97) ~ ~ County ' Safety and BuildingsaDivision ~ 201 W. Washington Ave., P:i1. Box 7162 iscons~n Madison, WI 53707 - 7162 Site Address De artment of Commerce ~ ~ 3~ ~~~ ~ mforcriation o Sanitary Permit Number Sanitary Permit Applicatiea - - 3 ~q ~ 3 In accord wilt Comm 83.21, Wis. Adm. Code, personp~ y uprovide '^ Check if Revision ma be used for sceo ses Privac Law, s15. 1 m Spue Plan LD. Number I. Application Information -Please Print All Informs"tion ' c~ ~-t.r property Owner's Name j•.':; r' 'S Parcel Number /G,, 2. . ~ 2 "~ .-- ~ ~ T 4iifJlX ~~~ Property Location ~0 Od ~ try Owner's Mailing Address 1 S ' ~ Opl1NTY StsJ 5i - !i : S N R ~7 ® F Zip Code`, Phone Nttmbei' ' ~ ~ Lot Number Block Number City, State ~~ . _ •, ~' Z ~`'~, ~~ of s ,( ~-~~ Subdivision Name CSM Number _._.._~..-y- v~ 7~ = - Bad ,~ ~.~' II. Type of Btriltiin (cheek all that apply) 3 tdl'Y013YY15 a~l-e S~t.ot.~ ~~ Oeity i or 2 Family Dwelling -Number of Bedrooms ~ / ^Village . /~ ownship `~ ^ Public/Commercial -Describe Use Nearest Road `~ ^ State Owned ~~ ,~~' FrN III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) For County ttse A' 1 ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to S stem Tank Onl Exis ' S stem Permit Number Date Issued B. ^ Check if Sanitary Permit Previously Issued IN. Type of Permit: (Check all that apply)(numbering scheme is for internal use) , , , ~ .. ° " 44 ^ Non -Pressurized In-Ground • 21^ Mour-d 47 ^ Sard Filter ' SU.~ Constructed Wetland 22 ^ Presattr}zed In-Ground 41 ^ Holding Tank 48 ^ Singlo Pass 51 ^ Drip Line t~ 46 ^ Aero ' sting 30 ^ Other 45 At-Grade V. D ersal/Treatment Area Infotmati percolation Rate stem Elevation Final Grade ~~ Flow ~) Dispersal Area Area Soil Applica ' Elevation Required Proposed s./Days/Sq.Ft.) (Min./Inch) G ~ i ~ Total Number Manufactttrer Prefab Site Steel Fiber Plastic VI. Tank Info ~ n' Concrete Constructed Glass Gallons Gallons of Tanks Ntw ExistinY ''-- II Tanks Tanks W '~(~~fJG~ ~ Septie ori~lelding•~dc ~.._ 0 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on thB~~chedhpolans~wnber Pltunber's Signatur ~ MPfMPRS Number Plumber's Name (Print) Fo Piumbin & Perk Testin ~ ~ ~/ ~d 7/j - ~ ~Go~ Phtpohee~~~CT1`~`'~~' state, zip code . ~' ~~~~ ~7~ _ I~1 , 7 ~•~e G S /- y®~ - ~~vG LtSL ~ 7~~ VIII. Count /De artment Use Onl ent Si Heart (No Stamps) Sanitary Permit Fee (includes Groundwater Date Issued tng 8 Approved ^ Disapproved Surcharge Fee) ) l Z ~ (.L+ ~` ^ Owner Given Initial Adverse d Z~ ~~ / ~ ~(Jl I Determirtadon 111 ~" vv o~~ FJC. Conditions of ApprovallReasons for Disapproval ~, . Qtc1 . ~~°4~P (~ t h ' i ~t. ~ t 5 Y`L4~61v'(,~,¢ p~.~, ~l w~t.sn.~N-~-G , d~~ ~ 4'ON! ~i `~~t,,t~"~ ~'~ ~~~ wrL~~2/ls~ / U - V~ ~ ~~5-- g' ` W 8r.""' S ~l t. Gro ~ w~, G ol,^, ~H.... 4i k.a,Q Q ~IC -~`-fs ~ ~ ~rt~ JWY~. eomplde plane (w tea county only) roc we s~atem oa pars' not less 81/2: tl laehes In SBD-6398 (R. OS/O1) ~I 2 0 r --- NOTES : - ~- 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be lp~p /600 gallon capacity manufactured by 1.`J l FS~. GUn1 C[Z-~~ kJ~ ~-1640 Z ~~L.. ~ ~-7Z3'R 4. $ench marker . Ste- A~3aUL 5. Divert surface water around t PLOT PLAN Scale 1 "_ ~0 ' LI - 0r-i ~ Z ~- - s~ 0 a' ab ? ~ a~ co~,~,vcc ~, b ~S G~7• ^ ,~ ~ a,d ~.c~s~ _ ~~,~~y - Z3~ r z1 --~y 1` 1 . 1 ,1 ~ Z -1.S' ~ •~ ~ °1 1 0 1 ¢ • 3~, 7'~ 2~~P~ F''y ~ 1 ~ ~ lkow-~ S,o~ I uar~~ I I Do ~ uT COt" )Afl~T I ~ 01Z ~1S~u3 ~ 1~i1~ ~sA I _ ,g, '`, Z1 ~ -- °t6 _9.7 Br'I-iE=1_J-=.E2- ~o.o~o~~-p1~-_:OF: t!.~~lk~R-01~ _--_- _::_.__-------- 1~ ~t=Z =-LZ--~9<_~!$ " -cam! - ~.~ .:OF: =S_~t~?=BC.Qc.Iz _ FD~T`T~ ~vG_--= Page 3 of 7 S ploy ' sys em to prevent ponding at the uphill side. "i 1 isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw: Albert, Acting Secretary October 31, 2001 CUST ID No.691727 ARTHUR L WEGERER WEGERER SO[L TESTING & DESIGN SERVICE PO BOX 74 RIVER FALLS WI 54022 ___~~ ;-r,.. CONDITIONAL APPROVAL •~~~' PLAN APPROVAL EXPIRES: 10/3I;,/1~0~ „~ 1 ~~'~{sV ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers u Transaction ID No. 684924 ~ .Site ID No. 638021 `~ Please refer to both identification numbers, .,,~ above, in all cones ondence with the a enc . Description: Three Bedroom At-Grade Sys '_._. Object Type: POWT System Regulated Object [D No.: 817842 SITE: ; ~ ~ ~C! j t James Gillis 190TH S ~ °~w' ! ~,~~..` ~~ t ~~~, ST C Town of Hammond S C i ~ ~X ~ ~~IN x County t ro OOFF~~ SW1l4, SW1/4, S14, T29 N, R17 S, .-'~. .. FOR: _,, ` , -,~. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At- grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 1OS70-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-1OS73-P (8.6/99). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the at- grade manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The well must be a minimum of 2S feet from any POWTS tank, and a minimum of SO feet from the absorption area. • Limited activities are allowed in the area 1 S feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, the owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. ARTHUR L WEGERER Page 2 10/31/01 • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • 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. 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/instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely,. ,~ ~ ~ /;' ~ ~~ ~~~~. ,,~ Charles L Sratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: James Gillis •., TITLE SHEET Page 1 of 7 AT-GRADE SYSTEP~1 FOR A 3 BEDROOM RESIDENCE This plan has been prepared in accordance Faith the At-Grade Component Manual SBD-10570-P 'and the Pressure Distribution Manual SBD-10573-P ~ 2. b/age C 2. 6/q~~ . LOCATED IN THE S W 1 /4 OF THE SLV 1 /4 OF SECTION ~ ~ , T Zq N, R !7 ~ [J, TOWiJ OF ~~-~ ~~yVD , S1'- e~ VC COUNTY, WISCOidSIN. _-- ~:o~ Z_ ~1==--~5~`,r-: -bot , ~~_~ bra=s'~_ ~03~~ INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEPi riANAGEMEN~= PLAid PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW-CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAi1BER CROSS SECTION PAGE 7 of 7 PUriP PERFORMANCE CURVE PREPARED FOR ~~ __ --- - 4 _ ~O `'v-oo~_y t LLB , rwl S.~Lo Z.a--_ - - l ''-., ~~ . ~~~~ PREPARED BY WEGEI~ER Sa 2 L .TEST 2 NG AND . 3~ES 2 G~i SERV 2 CE P.O. Box 74 421 Id.ilain St. River Falls, WI 54022 Phone 715-425-0165 Fax 715-425-6864 Conditforta~y APPROVEp ~~~`~,~ ~~o~/ ~` '°~ ~ ART: rJN ~ , VJL~sFHEA 1 n.eS 5 P . ~ ELL ;?`(ON7h, -~~~ ~o-~,.o~ JOB NO . ~ ~ -~--? ) At-grade Sys tem~tianagement Plan Pursuant to Comm 83.54, Wis.Adm. Code Page z .of 7 Sectic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. Tne contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. Tne outlet filter s..all be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to .retain solids in the ink that may slough off the filter when removed from its enc:csure. If the filter is equipped with an alarm, the fitter shall be serviced if the alarm is ac5vated continuously. Intermittent filter slams may indicete surge flows or an impending continuous alarm. Tne " septic tank shall have its contents removed when the volume of sludge and scum in the ink exceeds 1/3 the liquid volume of the tank If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the•owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generlly not required. However, if such produces are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buldings Division. Pum-._Tank _ _ The pump (dosing) tank shall be inspeCed ai least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary,. At- rode Component and Pressure Distribution S stem • No .trees .or shrubs shoul be planted or allowed to grow on the component. Plantings may be made around the perimeter and the component shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the component is not allowed. Cold weather install- ations require the component to be heavily mulched for frost protection. Influent quality into the at-grade system may not exceed 220mg/L BODS, 150 mg/L TSS and 30 mg/L FOG. Influent flow may not exceed the maximum design flow specified in the permit for this installation. The pressure distributfcn system is prcvided with a 9ushirc pcint at the end or eaci lateral, and it is recommenced the; coca later! be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distr-buUon within the dispersal ce!l. Observation pipes within the dispersal cell shall be'checked for effluent ponding. Ponding levels should be reported to the owner and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more freouent monitoring in accordance with~Comm 33.52 (2). General This system shall be operated in accordance with Comm '82-84 Wis.Adm.COde and shall be maintained in accordance with it!s component manual SBD 10570-P•(E,6/99)~and local and state rules pertaining to system maintenance and maintenance reporting., No one should ever enter a septic or pump tank since dangerous gases maybe present that could ceuse death. Septic and pump tank abandonment shelf be in accordance wtfh Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. . Septic or pump tank manhole risers, access risers and covers should be inspected for watertightness and soundness. Access openings used for service and assessment shat! be sealed rrtertight upon the rampletion of service. .Any opening deemed unsound, defective, ar subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component • CanSnaencv Pten If the septic tank or any of its gmponents become defective the tank ar component shall be repaired or replaced to keep the system in proper operating condition. _ - -- - ~ • If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be • immedately repaired or replaced with a component of the same or equal performance. If the at-grade component fails to accept easteaater~o~eg3ris~o iiischacge wastewater to the ground surface, it may be necessary to install an aerobic pre-treatment unit or .replace the component. Additional site and soil evaluations may need to be done and additional plans may'need to be prepared and approved by the Department of Commerce, Safety and Buildings Division. . Questions .about the•operatiori or maintenance of•this-system should•be directed to • •~• The County Zoning Office at ~ ~J~--3~'O--W.68o Sr'..e.(2.t).~X •. The system installer at ~~S ,~ 3S - ~q~ FOG~2`~-/ • The tank manufacturer at _ ADO - 3ZS-~'~S ~, Yy 1 ~5 t='cc The effluent filter' manufacturer at ~~- ZZ~ . S7 y.Z Z.P'(~`Tt rr;Q ~~~n - K 63o-.~ZA- yR~18 Gout_~S PLOT PLAN Scale 1 "_ ~0 ' Z.-.~~ V ~{ _~ 0 r a6 q,~ ~ - co~`tuv2 ~.°1 - T~IST_ P 1 P~ °!7 2 S ~'1 8M !f 2 SH~U _,_13~_'f4~Z-_LSL:_`34._<1.~,' ~--~.1? OF__S-~tEl~~crOC.lz_ F~7t~`n=-- _ ---- ..-- - ... NOTES: ~~ 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required).. 3. Septic tank to be l~Up / 6 0 O gallon capacity manufactured by w 1 ~~- CUh1 Ctz~ kJ/ ~- loo Z ~~L. ~ ~~ 4. bench marker . S ~3pUL _ ~' 3 $DQ'Y''~ `~ 1 °~0 1 r ~ Z~lpUC F'''~ 0111 1 ~1` R 311 ~1 i 7 ~~ i~ 1 I ~ Do ~ oT C,p~(~t?eT ~ ~~ ~~ n1S~u3 II Ttii-13 P~tL~ L~ _ ~s, a.1 2.1 , a6 49.7 1JLPc1ZU3T ~-oT LINE Bra ~{ ~ 0 4 ~ S. Divert surface water around system to prevent ponding at the uphill side. .. __ . _ - .. . L 5' W ~ 5' } 5, I B (~ Fo 1zCE MP~-t N _>5~ r2~ -- ---=S--L=--1 ---------.---~ ~tl~=1~Z11Z" 1~6GR1'G~~'t a~ ~ 1-- ~ ~ _ -- ~ -1 ~ p BsL~u t~ll+~l Lv ~tlg _ Z tZ~~ o . I/6 B A= ~_ Feet B= 11~p Feet L= 1l0 Feet W= ZI Feet Fabric Observafiion We I I ~,v c~tor~ 5~:~,Y _.. Page L~ of ~ I/6B Linear Loading Rate= y,. S GPD/LN FT Design Loading Rate= o. SGPD/SQ FT '',~~ ` ~` --- Distribution ~ Late n~~ L'ti-~T~l _ ~-~ ZS Ih V` U ~~ Soil Cover ~ ~~ ~ 2 ~~ . ~ ~, - ~-6-~ rte' ~-•-~ ~~~~ _ ` ~•• \~ ~ ~• \ \`• ~.ix, , ,_ ~=.._ I I J/o S L~pc ~5~ A ~2' i ~5~ Plan View and Cross Section of Wisconsin At-grade Unit with a Single Absorption Area on a Sloping Site Distribution Pipe Layout Pace ~ of ~ Place the holes at the botton of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of Long turn or 4~ ° fitting to a point within s1x inches of the final grade. Te.~ninate the ends of the Iate.•aIs with a valve,:threaded caD or threaded plug. Provide access from final ~~de for the vaIye; threaded eap or threaded plus. T ~t F 1 Ct~ L i;,ZilS S S ~.~ i 101y FVC Later!-~ r~ ~'T.-~~ ,--. Lat rl x I x!1 I zf1 x ~ L ~~ V ~ P -~ o- - l ~s ~.oX - - - - -~ r- F~~zec w,mN .' P _~1~` Ft. Hole Diameter 3~~ ~ Inch ~~~ Z Lateral ~ l 1 ~Z Inches) X ~ ~ ~nchPS _ __- Force Main " ~ Inches ~ of holes/pipe ZS Invert Elevation of.Laterals°I~.'2;SFt. ZSX0.66_ lb.sxz= 33.0 .G~~ ' .. _. ~' - Combination Sept,~.c~ Tank and . Pl.1~MP CHAMBER CROSS SECTIOtd ._ AIJD SPECIFICATIOlUS ~ PAGE ~ OF ~'. • -VEIJ7 CAP ~ . WEATHER PROOF ' JUfJCT101J e0X . '1 C.I. VEUT PIPC ~ APPROVED LOCKIIJG ~ lO' FROM DOOR. M~l1JHOLE COVER cu!'nl 1~.~3P~1otJ 1'tPE :ilUDOw oR FRESH ~ ~ wP+R~IIJG L"a6EL., - A~tUT/lKE coiaDu~T G~~~ I 18'^'1111. 18'/'111.1. ~\ ---------- ~ ` . ~ IAILET Approved joint w/ PVC pipe ` : ;, ' •~ •^~ 8>~TrFLE (-1-1800 - I ~ _ - ~l PROVIDE I AIRTIGHT SEAL I I1 I I _,,~ I ICI III I II ALN,RM a II II I I 1 ( ou C •I I I I PUMP -~ -'~ OFF D COUCRETE BLOCK V Approved joint w/ PVC pipe ~- RISER EXIT PERMIT(ED O-.ILy IF TAUK MA~71lFACTURCR HRS SUCH APPROVAL 3"AAPRoy!<D ~Br:OD t N4 SEPTIC f ~w~UOp/bop-MLZ~ SPECIFICATIOI~IS Doss ~•vt~~~. cc»J e TAUKS MAfJUFACTURCR: IJUMBEA OF DOSES:- -9 PER DAB TA1JK ~-ZE : 1 000 1600 GALLOAIS DOSE VOLUME r ~ ' ALAR11 MAUUFACTURCR: S •S • ~ SLLS`Tt~'js INCLUOIWG 6ACKfLOW: ~ ~4-6 GALLOhI: MODEL -•1UMSER: ~~ ~ ~~~ CAPACITIES: A. ~~ IAJCHCS OR 30~• 3 GALL0/1s SWITCH TyPf: - ~ 8 = _ Z IAJCHES'OR Z~• ~G~LLOA15 PUMP MAIJUFAGTUR{<R: GAUL-b S G s 8 t-JCHES OR ~~"~ GALLOIlS MDDEL -JUMBER: _ 3a-1 I ' ~ ~'DL{ ,., 0= ~'s IAlCHES OR 1~'~' 3GALL01J5 SWt7CH TYPE: - I'`~~''--C~~ UDTE: PUriP A1JD ALARM ARC TO b°E~ 8 MI1JlMUM DISCKARGE RATE 33-D ~pM INSTALLED OAI SEPARATE CIRCUITS VERTICAL DIFFEREIJCF DETWfEU PUMP OFF AUO..D15TR18UTIOIJ PIPE.-~•u~ FEET f KIL1lMUM NETWORK SUPPLY PRESSURE . , . ~ 3'ZS ~FCET ~ - Sx~• 3~ FEET OF FORCE MJ111J X Z.3Z F~oF~FRICTIOU FACTOR..O'3S FEET .~ , _ - ~ TOTAL DyFJAMit HEAD = l~'l?~ FEET LI As per manufacturer ~,1.$ Z gal/in. Liquid depth Sl ,--~ ~-- ~E ~ or 7 uouias Su~~ae~si~~~ ~~~~~~~# P~~ ~~ 3871 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ^ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ^ Motor Cover: Thermo las- P • Homes ~ • Farms - components. Motor: Available for automatic and tic cover with integral handle and float switch attachment • Heavy duty sump • EP04 Single phase: 0.4 HP, manual operation. Automatic models include Mechanical points. • Water transfer • Dewatering 115 or 230 V, 60 Hz, 1550 RPM, built in overload with Float Switch assembled and ^ Power Cable: Severe duty rated oil and water resistant automatic reset. preset at the factory. . SPECIFICATIONS •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, FEATURES ^ Bearings: Upper and lower heavy duty ball bearing ,Pump: EP04 built in overload with ^ EP04 Impeller: Thermo- construction. •Solids handling capability: " automatic reset. plastic Semi-open design 3/4 maximum. • Power cord: l0 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. ~ standard length,l6/3 SJTO mechanical seal rotection. P SA• Canadian Standards Association .i?tal heads: up to 24 feet. -~ ,~' - Discharge size: l'/z°NPT. with three prong grounding plug. Optional 20 foot ^EP05 Impeller: Thermo- (CSA listed model numbers -~ • Mechanical seal: carbon- length,l6/3 SJTW with plastic enclosed design for improved performance end in "F" or "AC".) rotary/ceramic-stationary, three prong grounding plug . BUNA-N elastomers. (standard on EP05). ^ Casing and Base: Rugged • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series Mi=_TeRS I=FFY ` stainless steel. i o • Capable of running dry without damage to s components. Pump: EP05 - e • Solids handling capability: c 3/"maximum: a W. ~ • Capacities: up to 60 GPM. ~ s • Total heads: up to 31 feet.. ~ • Discharge size:lYz' NPT. z 5 • Mechanical seal: carbon- c rotary/ceramic-stationary, ~ 4 BUNA-N elastomers. • Temperature: ~ ~ ° a ' 104°F (40°C) continuous . 140°F (60°C) intermittent. 2 --~ 1 / ~ ~'' ~) ` ~ 0 ~.,,, a _~ ,.. 3 z 2 1 1 thermoplastic design provides superior strength and, corrosion resistance. Y`1,P PF2~i121^~fl'~JC~ Gv'~.V ~~ ~~ 0 2 4 6 8 ; 10 12 m~/h CAPACITY Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of -3 rn accordance witn Comm ua, wis. Aam. t,ooe County -- n must Pl h i i 2 1 i a nc es n s ze. x 1 Attach complete site plan on paper not less than 811 but not limited to: vertical and horizontal reference point (BM), direction and include Parcel I. . , percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~. .... -- !moo Please prfnt all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). i~ ~ ~''r ~ ~ Property Owner Property Location ~Z~•.rf Govt. Lot S~ 1 /4 SG/ 1l4 S T N R E Pro rty Owner's Mailing Address Lot # Block # Subd. Name or M# ,S'- ~ O L State Zip Code Phone Number ^ City ^ Yllage Town Nearest oa~ ~6~AY~~ ~- ( '" ~s/~ s~' New Construction Use: f ~ Residential / Number of bedrooms Code derived design How rite -_ ~dID•- GPD ^ Replacement /^ Public or commercial -Describe: _-_-- ~ ----- --- - --- Parent material LLD ~ ~ZYT L yI~/Yi Flood PI in elevation if ap cable ft• General comments ~`. `/ //~~ .~..' ' t-? and recommendations: ~~ ~/i !°~~ SG~~f' --~ ,~ Q ~~ ~ ~ Z~~~ ~ ': S7 CfIOtX .~ / 9 p~'~,/ Bonng # Borin ~- ~~ ~ pit Ground surface elev. ~ ft. Depth to limiting factor i7:.."•~ ~ r°; ~_"` Hption Rate l C i D ti R d Texture Structure Consistence Boun~rq •}- GP D/ff Horizon Depth in. or Dominant o Munsell p on ox escr e Qu. Sz. Cont. Color "Gr. _ •Eff#1 •Eff#2 •5 -. 2 ----- L S 2 - ~ 3 ?~~-'~ ~~ C ~~~~ l r 7. . F~ s s8 ~ ~ - ~- Boring # ~ Boring ~ ~/p ~ pit Ground surface elev. 7 2 ft. Depth to limiting factor ~ in. Soil ication Rate th D minant Color D Redox Description Texture Structure Consistence Boundary Roots GP D/fP Horizon ep in. o Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Effft2 ~ - // -.3 Z G S ~ L /-2 . ~ - S 8 3 7- s- --- '"' • 3 -- L~ ~~' ~~ cv ~v • Effluent #1 = BOD > 30 <_ 220 mglL and TSS >30 < 1 50 mglL 'Effluent #2 = BOD < 30 mglL and TSS <_ 30 ntglL - Si na CST Number . Fogerty Plum )ing & Perk Testing ~ Z2// U Address 28288 McKenzie Rd. Date Evaluation Conducted Telephor~ Number cnnnnrt' wl ~aRn t ie - lJ~.- ~ / ~llS'. 7~,1 ` lo3S- 9~' - - - _ cE-~c ds~ - yon _~io6 Property Owner ~.t/N ~T~-l-.r-r Parcel ID # ~~~=1~~d "' D ` ©d Page ~ of!~ ,~• 3 Boring # U_ Boring [d pit Ground surface elev. _,~r]~ ft. Depth to limiting factor ~ in. Soil ication Rate h t C l r i D tion Redox Descri Texture Structure Consistence Boundary Roots GP D/fP Horizon Dept in. o o om nan Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •EfftF2 Z ~ ,_- L .8 S- _- --. • rX0T7'~I.~ ^ Boring ^ Boring # Pit Ground surface elev. ___^__ ft. Depth to limiting factor in• Soil ication 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 ^ Boring Boring # Ground surface elev. ____ ft. Depth to limiting factor in• Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots fE~GPD Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access servrces or need material in an alternate format, please contact the department at 608~66°31~1 or'fTY 608-264-8777. _ ~~ SBD-8330 (R.6l00) - I~ ~ u N ~. v \ ~ `~, v I ~ e ~ y N ~~ ~ ~ x t~-n -,r- a a- ~ '~ ~, ~ ~ ~ ~ © ,. ~ ~ ~~.~ ~~ ~ ~~ ~ ~ ~ ~ ~. . w ~ ~ ~, © ~,. ~~ ~ ~ boo -s~ ~ ~ o e v ~ ~ w ~\ M V O ~~ _~ y ~ ~~ ~ ~ o ~ t ~, 1 ~- ~~ -r ~ -i- ~ b t ~~` ~~ 1 ~ ~~ 1 ~ ~` ~ ~ i ~ _' ~ ~~ a J ~_ ~~ O r Wiscongsi Department of Industry, Labor ~ndH'~.~aan Relations Division of Safety and Buildings Attach complete site plan on paper not less th include, but not limited to: vertical anc~horizo _ percent slope, scale or dimensions, north arro APPLICANT INFORMAT Oas Personal information you provide may be used for sewn Property Owner ~, Property Owner's Mailing Address City State Zip Code lvoQ L lv % ~ 2 x 11 i~I~iW~~. PI ference point (BM), direct. d lo~{I_o~i'a~ip d)st~o -- --- EVALUATION Page ILHR 83.09, Wis. ~~ rL ~//. ~ County / r ~~ / road. parcel I.D. # "~ ~ Revie ed b7y Date (Privacy Law, (m)) ~, ~' [/~"' ~l l/~"'~ \ i s y3 ~~ ( ~, ~ Property Location Govt. Lot ~ 1/4 ~1/4,S ~ T~ ,N,R ~ ~t7r) W Lot # Block# Subd. Name or CSM# Phone Number Nearest Road ~ ~/..3'~•~.~'/~t~o70 ^ City hl~M9M e/V~d o~ I ~9~ ~' New Construction Use: ®Residential / Number of bedrooms J Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~~'' ~ gpd Recommended design loading rate bed, gpd/ft2~trench, gpd/ft2 Absorption area required ~D D bed, ft2~trench, ft~ Maximum design loading rate _~_bed, gpd/fi~~._trench, gpd/ft2 Recommended infiltration surface elevation(s) ~:1. ~ o ft (as referred to site plan benchmark) Additional design/site considerations r ~ ft Parent material G,~ Ar ~ ~ A ` ~/~ ~ Flood plain elevation, if applicable ,~ S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u = Unsuitable for system ~ s ^ u ~J s ^ u [~ s ^ u ®s ^ u ^ s ®u ^ s ,® u Boring # Ground elev. ~,QLft. Depth t0 limiting factor ~~_in. SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure i C t B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons s ence oun ary oo s Bed ,Trench o- O 3 ~ ~---~-- /~C Mme" .~ , lo~~ S ~ ~ t ~- S Ic 3 _ - Y~ ~-- - s ' ~ Remarks: Boring # Ground de1~,e, 9 N Depth to limiting l - /2 .? 2 S ~. ~ S6 ~ ~ 2 -~ ~ ~ !?- -----' ~ L- x s C"~ a- S F ~ .~ ~~ -- s L s6k F v - - '- ~" ' 6 factor 7~in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number PROPERTY OWNER ~/~ Me _S" ~/LL /.S SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # 3m s Ground elev. 9~. Depth to limiting factor ?~in. Boring # Ground elev. ~~tt. Depth to limiting factor ~~in. Boring # Ground elev. 1.~.~~ft. Depth to limiting factor ~~in. Boring # Ground elev. tt. Depth to limiting factor in. Page "~„ ~~ ' Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Remarks: / a 3 S/~ 2 6 /~l~' ~ ,S ~ ~ ,S' ; ~ 2 /f .. GAL .2 c M~.r G,S' ~ ~..5"' ~ ~--~ SL ,6 vFR ~- - ,s"' ~ ~ Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench o- i~ 3 - s' ~ ~ s'6k ~i ~ S ~, .s, ~ ~ Remarks: Remarks: SBDW-8330 (R. 08/95) T -{ _ _ __ __ __ ~ _ ~ _~ _ ~ ~ - ~- s _._ _ R _ ._- ~ ~ ,r ~ i _. _'__ __ __~ _..- I ~ __.-_- ~.. I __ __ _. ___..- ~ _- - ____J _.__..__ _._~_. _._J __. ~_ _ _ i ~~ ___.. __._ _~ _.. _ .._ _~ - ~_. _ _.__ _.___.4 __. _.~. ~.._.. _. __ _~. .. __ - __ __ _~.. ._- ~. .~ I I ~. .. _ -y - ___.__ _.__ __-- __ _ .-___. ..__ __ ~ ~ ~I ~ __ ~ ~ _. - ___ __1 i { __~1 __. .___ i __ ._ ~___ __ ___ ~ _, ___~ ___~ _ _ _ _ _ ~ - ____j r ~ - _ B ~ v ~ --_ -- - - - --- ~f ---- - -- -- - i ~ ~ 0 ~ ~- _ _ i _ _ .~. -- - --- J ~ -~ _ _~ ~ L - ---a ___ - ---- ~ _ -7 ~- -- _ -- --- -- --- ~ -- Q -_ __ i - I ' p __ __-_ ___ -_ __ ~ _ _- __ __ -- .- -- ~- _ - ___ _._ _ ____ .___I __-- I - ----- -- __ _ ~ - - -- - __ -- -- --1 ~ - ~ - -- C- -_ _- - - ~ -- _- -- _ _ _ 1 _ --- -- -- - ~ ~ "- _ N ~ d - - -- -- , -- - _- - ___ _ Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites Applicant: , , `.4 ~ t_ , ., ~ = r~ ~ ~ -~ l f ~- ~• `; Naive Daytime telephone number ~- Sweet address, city, zip code Landowner. ~ ';~',~`,:' Name Daytime telephone number Street address, city, zip code Location of the bnt~ding site (complete as appropriate): See/ quarter of Section ~ Town 19 N., Range ~_ ~. Gv Lot Z 131ock "" q i3 iao~~ S Street Instrudtons: 1. Complete this plan by filling in requested information, marking (.~ appropriate boxes, and completing the site diagram. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW -Extension publication Erosion Control for Home Builders can be referred to for assistance in completing this plan. The Wisconsin Uniform Dwelling Code and the Wrsconsiti Construction Site Best Managemem Handbook are available through State of Wisconsin Document Sales, 608J1G6-3358. Erosion Control jor Home Builders (GW0001) can be ordered through Cooperative Extension Publications, 6088.62.3346. 4. Submit this plan at the time of building permit application. Q~oc1c ~~ aPPropriate bows below, and complete the site diagram with necessary information: ~e ~~~ vie ~~ ono Location of existing drainageways, streams, rivers, lakes, wetlands or wells. Location of storm sewer inlets. The gradient and direction of slopes before grading operations. The gradient and direction of slopes after final grading operations. Location of eadsting and proposed buildings and paved areas. Overland runoff (sheet flow) coming onto the site from adjacent areas. l~ North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. ^( 0 t3 ~o f J1 or ~~7 Site Characteristics Erosion Control Practices Location of temporary soil storage piles. Note: Although not specifically required by Code, it is recommended that soil storage piles be placed behind a sediment fence or more than 25 feet from any downslope toad or drainageway. Location of gravel access drive(s). Note: Recommended gravel drive design is 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick Drives should extend from the roadway SO feet or to the house foundation (which ever is less). Location of sediment fences (filter fabric fence, straw bale fence) or vegetative strips that will prevent eroded sots from leaving the site. Location of sediment barriers around on-site storm sewer inlets. Location of diversions. Note: Although .not specifically required by Code, it is recommended that concentrated flow {drainageways} be diverted (redirected) around disturbed areas. Overland runoff'' (sheet flow} from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re-vegetation by sodding or by seeding with use of erosion control mats. Location of practices that will control erosion in areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in~hannel fabric or straw bale barriers, erosion control mats, staked sock and rock rip-rap. When used; a given in-channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In-channel practices should not be installed in perennial streams. Location of other planned practices not already noted. ~~~ ~ ~~ -Site Diagram- ~ c /~.~ Nntp • Anv hash man of ucPablp scale Can bC SUbStitut.~dfsr~t~ S S CBt. Site Diagram Legend _ _ _ -PROPERTY SILT LINE ~ ~~ FENCE _ EXISTING ' STRAW DRAINAGE ~"'"~~ BALES ---~ TD TEMPORARY ~ GRAVEL DIVERSION _~ FINISHED TREE DRAINAGE PRESERVATION LIMITS OF STOCKPtLEO _ _ _ GRADING TOPSOIL VEGETATION tO SPECIFICATION AREA ~~~ 'lt ~'~ Please indicate north direction by completing the arrow. I ~N- Scale: 1 inch = ~ feet i ~ - ... la~dicate management strategy by chocking (.~ the appropriate box; a~~ `~~~ 4/~0`' Managcment Stratep_ics ^ Temporary stabilization of disturbed areas. Note: Although not specifically required by Cody it is recommended tha[ disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1st and September 1Sth), or by other cover, such as tarping or mulching. Permanent stabilization of site by re-vegetation or other means as soon as passible. ~^ Use of downspout and/or sump pump outlet ezteosioas. Note: Although not specifically required by Code, & is recommended that~low from downspouts and sump pump outlets be routed to stable areas such as established sod or pavement ^ T~PP~ sediment during dewatering operations. Note: Although not specifically required by Cody it it recommended that sediment-laden discharge water from pumping operations be ponded behind a sediment barrier until most of the sediment settles out Pro dis of buddin material waste so that IIatants and debris are not carried otf~ite. P~ P~ g Po Maintenance of erosion control radices. P Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. . Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). All sediment that moves off-site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off-site due to storm events will be cleaned up before the end of the next workday. Gravel access drives will be maintained throughout construction. All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. A publication of the University of Wisconsin-Extetuion, Ron Struss, UWF.X Water Quality Education Specialist (12/92). ?his publication may be freely duplicated. Additional copies are available [hrough the UWF.X Environmental Resources Center, 216 Ag Nall, 1450 Linden Drive, Madison, Wl, S370f~ 6081262-3652 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerfBayer ~ ~xZ~S Mailing Address ~ ~v.C ~ //O ~ ~~ ~ /,d.~GGi= ' _ ~~ ~O.~ ~ /1 A Property Address (Verification required from Planning Department for aew City/State ~f1!?»~tte~'i~_ e%L' ~Ys/S Parcel Identification Number ~~~ - ~D?~ -moo -~©o' LEGAL DESCRIPTION Property Location ,~~ '/., ~c1L_ '/,, Sec. _~ Y . T N-RAW, Town of ~ 7 Subdivision ~- 'Lot # -2,--' Certified Survey Map # `- .Volume ,Page # Warranty Deed # S/~65~7 ,Volume ~ 93 ,Page # ~''3 Spec house ^ yes ~no Lot lines identifiable,~yes ^ no SYSTEM MAINTFNANCE Im,»roper 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 masterplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (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 the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three yeaz expiration date. G, SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this forth are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the,property described move, by virtue'of a warranty deed recorded in Register of Deeds Office. (,., ' 5 . ,~,; it ;f / f ~ / v X2%/1 t-~-?-~:°~ ~ ,~-~,~= ~.k~ ~ ~ -,,_ . ~ ~ .. ~,.~~: ~ SIGNATURE OF APPLICANT DATE ****** *"***1** 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 A ~'~ n• ~ r b;~t~~99 fORM N0. 985-A 411C.IVM Stock No. 26273 ,,,,~ ,,..,~ r a s FILEb EB 0 9 ~onf KATtt1EFN t1. wALSl1 /~ Certified Survey Map No. 4032 - ~ster ~$ ~ I `~~,,;~,,~; I: ; ~ ~;.,,. SCALE: 1" = 200' ~V\Je•.+° ti's*~' ° STEVEN J.° ° wAI;K . ~," 0' 200' 400' _`~: - - s-~F+o , J9~ WIS. ~`( ~- ' ` j'' LEGEND ;r `~~~~ 11.'ttllt ' $_.......Government Corner las noted) q ~Z2~Ix~ o._. Set 3/4" x 24" rebar weighing 1.502 lbs./lineal ft. (Steel ) W.1/4 car. 14-29-17 •._.......Found iron rod (3/4") ~` Fd. 2"LP./cap 3 .~ .....SePtlC Vent v ._.. 0 ^~ i ~ O.__.....Well I APPROVED o I ~ Unplatted Lands __ _________ ST.CROIX000NTY z i ~ Pianninn 7nn~nn and Parks Coramitt<e '33'I~3j 404.00' N89°51'12"E ~~ • t6 O 9 2001 i ~ 24.00' 3 ~ I ~ ~,~~ O ~ If not recorded within 30 days of approval date approval shat! be ~--,oa- ~ i ~ LOT 2 ~''~' e,~. Zta1 r' ~I~ null and void mi I 1~ 1 0,8 S.F./ 6 AC. ? E: Each parcel on 111 ' is sub~~'ecf to State and ,°,1 I s fi EX /W ,., County lass, rules, and regulations ti.e. wetlands, minimum ,ol ~; lot size, access fo parcel, ect.l Before purchasing or I r 141,914 S.F./3.26 '~~ - I ~+ developing any parcel, contact the St. Croix County Zoning N ,cmv Office for advise. j N I 1 c i ~ c Th/ instrument drafted by Steven J. Waak i l 589°51'12"W 4 ~~ ~ L' N 1 I I I 24.U0' I~r7' 390.00' N of 1 1 _ ~1 ~I 1 I 1 _ ~ CI C J I 1 I -1I r A~ di i ~ i c ° ° vi d.~3 /'V/ r`9 i 1 1 ~ 1 ; v o eJ/ cl 1 ~ 1 N ~ W CI +t-Lo ~ I I p 1 p G ~ I o J e I c I .n ~ ~` ~ 1 ~ d Z o i~ o ~a~ `w ~ 1 0 r ~ O wLa ~?~'° L0T3 ~ ~ ~'a° I o 284,725 S.F./6.54 AC. o r ~°, e EXCL. R/W _ ~ } N ~ ~ I ~ 255,271 S.F./5.86 AC. n z o .o ~ 6I ' l I n ~i i l1 ~ Volume 15 ,Page 4032 , CN rJ/ BEING lOT 10F CERTIFIED SURVEY MAP N0.1339, VOLUME 5, ON PAGE 1339, LOCATED IN THE SOUTHWEST 1/4 OF THE SOUTHWEST 1/4 OF SECTION 14, T.29 N., R.17 W., TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN. 1 ~ 1 0° 4 4 0 ' m 2236.00' ' $89'51'12°W "` N89°51'12"E -----~ ---------------------------- =--- S.V4cor. i i 5 W cor. 2640.00' 14-29-17 1 I 114-29-17 Fd. 2"I.P./cap Fd. P.K. over mon. Cedar Corporation Unplatted Lands 604 Wilson Avenue Menomonie, Wi. 54751 J/ Vol. 15 Vo1.4032 rpw~wlP (~~Il~S PREPARED FOR: Mr. Jim Gillis 2628 110th Avenue Woodville, Wi. 54026 Page ~ of ? 0 I M O f ti ' DOCUMENT NO. ~ ~ _ wA~~~Y ~~O "' -- ` _ r-ne s-~cs e[scarac roe eccowo~wa o•~~ ~~~c7~~ ,,STATE BAR OF WISCONSIN FORM 9-196><I ~ C7 ~~ B~clt 7~~ ~a.c ~~ !~ _ ., )tfGISTERS OffICE Robert Leo Stanke and Anita L. Stanke, .. -.ti~ustianct...ari°...w~i~e~...a§- ~joiiiE..£~eriarits ......................... conveys and srrsnts to .... J,i}_~,:12.9 .,.Q .-. _ G i 11 s ;,and _ I l.a.. C . -..-.-G-il s_ ...husband..and..w.if,a,....as...su.i^x~ivs7.rS}a~.9......... ,) ,mar ta1.._ ro ert • . 1~.....~ ..~ ... ............................................................ i :...::::::::::::..._....._..................................._............._....................... tM ollowing described real estate in ......... S t . _ Croix .....County, . .......................... Sts of Wisconsin: ST. CROIX ~ W{Se 18a'd for fLourd ~ 6ch ~ ~ oc~ t~_A.0.14 ~7 lo:oo A ~ Ta= Psrod No :.............................. Part of the Southwest Quarter of the Southwest Quarter (SW's of SW~{) of Section Fourteen (14), Township Twenty-nine North (T29N), Range Seventeen West (R17W), Town of Hammond, described as follows: Lot One (1) of Certified Survey Maps, filed September 12, 1983 in Vol. "5", pate 1339, as Document No. 387679, in the Office of the Register of Deeds for St. Croix County. ~_ O This ..----.$..I10t---•--- homestead property. Qb) (is not) Exception to warranties: Easements and restrictions of record. Dsted this ~ ...................... day of .-.. J ! ......................•--•---- .-.1.. ~"":.'a.--...~~Q---~!"~' ...................(SEAL) Robert Leo Stanke ----- -------------------------••----••-•---....-----•---•--.....---(SEAL) AIITSSN?(CATION signatare(a) authenticated this ..---...day of....° ..................... 19.._... TITLE: YE][BE8 STATE BAB OF WISCONSIN (If not. ---.._..--•-------------------------------------------•--... authorised by ; 706.08. Wis. 3tats.) THIf INiTRUMlNT WAa DRAFT[D eY Thomas A. McCormack ----•OC~.~ ................................................. IY.87.. .............. (SEAL) , Anita L. Stanke ..------•---- --------•---.......--•------•• ....................:: (SEAL) ., ,. ., Ai. J . ACHNOWLSDfi1[ ~ ~ 1 ~ o STATE OF WISCONSIN - ~ Y ~ ~ A Y f~ -sax "~•. !r fi --....._.~~_.._-7~i.I.~.ji..X.....---County. ~ , ' ~ ~ W Personally came before me thin .- -•;:....,,,(jay o~` ____ O C t - --------------- 19 ~ 7.. the Robert Leo Stanke and An to Stanke to me known to be the person s___.....__ who executed the foregoi true ern ">i~+~ scknowledye the same. Reuben Doorn nk --•-- -- Baldwin. WI 54002 ------------•---------- ----- ----- ------------------•--------....----- j i; •-----------------•-------.....-----•------.....-..............---°.......-•--- Notary Public .----St.---CTO~X-.....-......---taunt ,Wis. ~,~ ($ignatnres may be suthentieated or acknowledged. Both Wy Commission is permanent. (If not, state expiration ~~ ~e date: ----------•------•--. A~•g'---27•r----------------~ 1^-$~--•)