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CERTIFIED SURVEY MAP Z `
ADOLPH ZILLMER
Part of the Southwest 1/4 of the Northwest 1/4 of Section 5, Township 28 North, Range 16
West, Town of Eau Galle, St. Croix County, Wisconsin.
o Indicates 1" x 24" iron pipe weighing 1 .13 lbs/ft. set.
Fak:3.o,----- �� ��° 1` 000
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DESCRIPTION:
That certain parcel of land located in the Southwest 1/4 of the Northwest 1/4 of Section 5,
Township 28 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin, more
fully described as follows;
Commencing at the West 1/4 corner of said Section 5, thence N 00° 00' 00" E (assumed bear-
ing) along the West line of the Northwest 1/4 of said Section 5, 10.00' to the POINT OF
BEGINNING of the parcel to be herein described; thence continue N 00° 00' 00" E 271 .68'
along said line; thence S 87° 51 ' 28" E 567.50' ; thence S 04° 01 ' 20" W 279.77' to the
centerline of a Town Road; thence along said centerline go N 87° 00' 30" W 547.90' to the
POINT OF BEGINI�TING, containing 3.53 acres, more or less, being subject to eas i��►►►�iRU�mi,
the 'v.'esterly and the Southerly 33' thereof for Town Road purposes. ��O` scONS/���//,'/
J' JAMIE$ L.
�!�;ro� x►c,�: !s _ ; MURPHY -
S 1 0 4 2
State of Wisconsin) � ;�; �� 1 ��S Cpl. RIVE FALLS, r O ~
County of Pierce) '' .
I, James L. Murphy, Registered Land Survenyb I CaGiChS9by certify that by dir nL�I�DtYi�,a
Owner, Adolph Zillmer, I have surveyed and divided the lands shown hereon in dkAP1L�`�� `
with official records, Chapter 236 of Wisconsin Statutes and the Ordinances of St. Croix
County; and that the above map and description are a trues and correct representation there)
Dated: '15 August 1980 y
Vol. 4 Page 988
j f s L. Murphy
Certified Survey Maps egisd Land Surveyor
St. Croix Courty, Wisconsin
s
Parcel #: 008-1013-95-000 01/31/2006 05:00 PM
PAGE 1 OF 1
Alt. Parcel#: 5.28.16.71 B 008-TOWN OF EAU GALLE
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
JAMES R ANDERSON O-ANDERSON,JAMES R
2206 55TH AVE
BALDWIN WI 54002
Districts: SC=School SP= *=Special Property Address(es): Primary
Type Dist# Description *2206 55TH AVE
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 3.530 Plat: N/A-NOT AVAILABLE
SEC 5 T28N R16W 3.53AC LOT 1 CSM VOL Block/Condo Bldg:
4/988
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
05-28N-16W
Notes: Parcel History:
Date Doc# Vol/Page Type
08/29/2005 804822 2876/596 QC
07/28/1999 607615 WD
07/23/1997 770/209 `C
2005 SUMMARY Bill M Fair Market Value: Assessed with:
138270 312,700
Valuations: Last Changed: 10/09/2000
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.530 25,600 194,400 220,000 NO
Totals for 2005:
General Property 3.530 25,600 194,400 220,000
Woodland 0.000 0 0
Totals for 2004:
General Property 3.530 25,600 194,400 220,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch M 513
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 138.00
Special Assessments Special Charges Delinquent Charges
Total 138.00 0.00 0.00
r
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ���Z-tlGtc �f L � G TOWNSHIP SEC. �� T,;a N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
c`>r' 1bfzl It")t _r)/5
I �
SUBDIVISION �✓ ,r� ' LOT LOT SIZE 44
PLAN VIEW
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
BPI
Y
t
i 1
ST
CSC I Jul `
f
c� (f
_ 6 ,
.,
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point usedLGJ>/�+/✓C
Elevation of vertical reference point: ' ' �• Proposed slope at site: "/y
SEPTIC TANK: Manufacturer: NAJ,% n /� 57- Liquid Capacity• /,!!:!P
Number of rings used: _ Tank manhole cover elevation: f�
Tank Inlet Elevation:
C _^ Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side,O Rear, ® r.y� feet
From nearest- property line Front 0 Side 10 Rear,0 feet
Number of feet from: well , building: /%/r
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
1
PUMP CHAMBER
Manufacturer: T Liquid Capacity: � ✓) i G
Pump Model: /' `?7 Pump/Siphon Manufacturer: �C7 G/ c y1 Pump Size ,
Elevation of inlet: ,l '�� Bottom of tank elevation: ---
Pump off switch elevation: J Gallons per cycle: 1 (541,
Alarm Manufacturer: - -2 �yp
Number of feet from nearest property line: Front, O Side, O Rear,
Number of feet from well:
Number of feet from building: �!a
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: X Trench:
Width: LenEh: Number of Lines: j Area Built: S
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Srid�, ( Rear,O Pt ..�
Xy n t,
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one) .
HOLD G TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
- Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector: d SS�2
Dated: Plumber on job:
License Number: /
3/84:mj
r -
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707
SW'-4 NWT S5 T28N—R16W X1 CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
f f (II assigned)
Town of Eau Galle ❑Holding Tank ❑In-Ground Pressure ®Mound 87-07969
233 Street
NAME OF PERMIT HOLDER'. JADDRESS OF PERMIT HOLDER: INSPECTIO11 D T
Bruce Berg Route 1 Baldwin, WI 54002
BENCH MARK(Permanent reference pointl DESCRIBE IF DIFFERENT FROM PLAN'. REF.PT.ELEV.: CST REF.PT.ELEV..
Name of Plumber IMPIMPRSW No.: County: Sanitary Permit Number:
[Lyle J. Myers 6219 St. Croix 102837
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED.
DYES ❑NO DYES ONO
BEDDING. VENT DIA I VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BOIL DING.JVENTTOFRESH
ALARM FEET FROM LINE AIR INLET
❑YES ONO ❑YES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED'. PR OVI DED.
❑YES ON ❑YES ❑NO IF_]YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING JVENTTO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) E:1 YES 1:1 NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (if soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH'. LENGTH N O OF DISTR.PIPE SPACING COVER JINSIDE CIA nPITS LIOUIU
BED/TRENCH TRENCHES MATERIAL: PIT DEPT t
DIMENSIONS
GRAVEL DEPTH FILL DEPTH IDISTRPIPF DISTR.PIPE DISTR,PIPE MATERIAL. NO DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV.INLET ELEV.END: PIPES FEET FROM LINE AIR INLET
NEAREST—
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
F-1 YES El NO
SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS
E]YES 1:1 N 0 OYES 1:1 NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCHIBED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
OYES 0 N OYES F-1 NO OYES 1:1 NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE M NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATLHIAL&MARKING ELEV.' ELEV.. DIA.. ELE V. PIPES DIAELEVATION ANO DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY VR MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES El No DYES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS'. NUMBER OF PROPERTY WELL'. BUILDING.
FEET FROM LINE
1:1 YES ❑NO ❑YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE 1
DILHR SBD 6710(R.01/82) Zoning Administrator
(Z) DIII_R SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05,Wis.Adm.Code ��(' u
�.�°�.....,.....,a� STATE SANITARY PER MIT#
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches in size. 87—L
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 0 NO
PROPE Y OWNER PROPERTY LOC TION
7 e�rc: '/4/t,� '/4, S _57—T1 9, N, R 16 E (o W
-PROPERTY OWNER'S MAILING ADDRESS LOT NU BER BLO K UMBER SUBDIVISION AME
0A � /4 xo
CITY,STATE Z O IP CODE PHONE NUMBER C TY NEARES OAD,LAKE OR LANDMARK
0112,Q Q,�64 R S /� v. ❑ VILLAGE: C-4v i5 177
II. TYPE OF BUILDING OR USE SERVED: 00?`101g-4?�5--mod
Number of Bedrooms if 1 or 2 Family 'g���� 5 OR ❑ Public(Specify):
111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. ❑ New b. 2f Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System Is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2)
1. a. ❑Conventional b.;0 Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.0 Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. X Seepage Bed b. ❑Seepage Trench c. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): I PROPOSED(Square Feet):
SO4—
V Feet ❑
Private Joint ❑ Public
„ S' � r
VI. TANK CAPACITY Site
in aa ons Total ##of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks QU�r structed
Septic Tank or Holding Tank O d C'
jJ
Lift Pump Tank/Siphon Chamber, /16 (,AST' PS ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's Signat e:(No S amps) MP/MPRSW No.: Business Phone Number:
A �? LAS l'�i Q �S'r
Plu tier's Address(Street,City,State,Zip Cod Name of Design
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST## _
CST's A D ESS(Street,City,State,Zip Code) Phone Number:
S Sr Z —Z Z
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial rchharrgge'Fee V
Adverse Determination 90.00 °°��• ��+a
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION `
TO THE APPLICANT:
1. This sanitary permit is valid for two (2) years;
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable;
3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation;
5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every 2 to3:years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description where the system is to be
installed;
II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. .
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use count or res on given when application b a a cation is disapproved.
Y Y 9 PP PP
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement
system areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form.
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2 years of steady negotiation and public debate. The groundwater bill Ground 8t$r
included the creation of surcharges (fees) for a number of regulated practices which Wisco ih' '
°
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure
is used in your building is returned to the groundwater through your soil absorption o
system or the disposal site-used by your holding tank pumper.
c' o
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
i
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signdd by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
Owner of Property 04- ,( 1::72r
Location of Property Sit 14 &IL 1%, Section �� , T Z N-R W
Township - _ r� •j��-L el
Nailing Address
a C, lt / 1
Address of Site Ad le
Subdivision pane
. Lot Number
Number
• previous Amer of Property 2, tik e y
Total Size of Parcel !'%f�5
Date Parcel was Created
Are all corners and lot lines identifiable? / Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number `�S15J
as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
i (100 CeAtt6y that a,tt statements on tl"A 60AM cute true to the best o6 my (oun)
hncwtedge; that i (we) am (ahe) .tlle oeune k) o6 the pnopenty dezcAi.bed in thiA
.inAolmation 6o4m, by viAtue o6 a waAAanty deed neeonded in the 066.ice 06 the
Caitn,tyy Reg us ten o6 Veeds ass Voeument No, Z 2 gZ - and that i (we) pneaentty
own tl,e p�.opoaed bite 6oh .the -sewage di�spob .6ys (oft I (we) have obtained an
eoulemewt, to Au" with the above dvAmtbed phopeAty, 6o& the eonAtAucti.on o6 eaid
ayatem, and the same ha.a been duty kecotded to the 066tce o6 the County Reg,isteA o6
Veede,'' ae Doemen.t No. C�z 9 Z'1 1 .
SIGNATURE OI? OWNER SIGNATURE OF CO-OWNER (IF AP CABLE)
/2 � 47 _
DATE SIGNED DATE SIGNED _
-
opctNT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-1982
_
422827 _v00K 770 wl�[209
RECa15TEE7S OFFICE
ST. CROIX CO., WIS,
- -------- ----------------------- ------------- ........ Reed. for Record this 2nd
...................................... -------------•- -------•---------------------- -•------•--------------• ii day of March A.D. 19 87
--Adolph---Z i-llmex,--.a---idower-------------------------------------------------- 11 t 8:30 A
-- -- -- - ---- ------ ----- -- ------•------------------- .....------. 64
conveys and warrants to __.and--Ce j
{ _.. n _- ife, •as... nint__ ean-ts-,..-_........Berg-,-husband $ N.
------------------------------------------------------------------ -------------------------------
�� ---- ---------------------------•----------------- ------- -------------- ------ ------ -----------------
--------------------------------------- --
-------------------------------------------------------------------------------------------------------.. RETURN TO
i!
i, - - – —
-
jthe following described real estate in .............St.:__•QrQiX-------------County,
State of Wisconsin:
Tax Parcel No- ------------------------------
I� Part of SWa of NW-1-4 of Section 5-28-16 , described
I as follows : Lot number one in Vol. "4" , page 988 ,
no. 366520 of Certified Survey Map filed September
23 , 1980 in the office of Register of Deeds for
I St. Croix County.
Deed is given by grantor in satisfaction of terms
of contract executed by and between the same parties
as herein and recorded with Register of Deeds , St. Ii
Croix County, Wisconsin, on 4-3-81 in 627 , page 263 ,
#370108.
-b
p0
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it!
!
it
j
11 This ____________________________ homestead property. I�
(is) (is not)
11 Exception to warranties:
r
Dated this --------- Y ------.Februar - 19.. 7...
\ (SEAL) ------------ ------ (SEAL) II
I
* --•------•-•-•----------••--- - -
------(SEAL)
----...-•------•----•----.... (SEAL) - - - I
----- " ---------- - - - �.
�i
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) ._.Q_f__AdQ_1.p�?.._7.i1ne_r__________ STATE OF WISCONSIN
as.
-------------------- ----------------------------------------------------------
.Z
--------------- --- County
authenticate t is --------day of FEWISCONSIN ry---_, 19--- � Personally came before me this ................day of
------------------- 19-------- the above named------------- --•----------------
-•-----------------•--•-.... ------------- ----------------•-------
Joh _ _G._ Nestin�e---- --------------•--- - - - - - ..............................
TITLE: EMBER STATE BAR
---------- --- ---- --- --- --- -
(If not- -----------------------------------------•------------------ ........... --------------------------------------------------- ----------------
authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the
foregoing instrument and acknowledge the same. I
THIS INSTRUMENT WAS DRAFTED BY
John G. Nestingen, Atty' E
Baldwin Wisconsin 54002 Notary Public _-_._._.-_..__._ _County, Wis.
- ----------------------- -------- --------------
(Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration
are not necessary.) date: -------------------------------------------------------- 19------ ) it
*Names of persona signing in any capacity should be typed or printed below their signatures. Ij
i
STATE BAR OF WISCONSIN
H.GMlllerCompalq� FORM No. 2- 1982 Stock No. 13002
H
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STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT
0
St . Croix County z
t7 I
a
OWNER/BUYER
ROUTE/BOX NUMBER '� Fire Number
CITY/STATE <-ff/�4z ED r1i N / ZIP
PROPERTY LOCATION :- J -S' T�N �_
� Section R W,
Town of r L St . Croix County ,
Subdivision 4JA Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner , I
if needed , by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St . Croix. County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
journeyman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping ( if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration . H
0
I/WE, the undersigned , have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth , herein , as set by the Wisconsin Depart- •c
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Office within 30 days
of the three year expiration date . 7
SIGNED
DATE
St . Croix County Zoning Office
P. O . Box 98
Hammond , WI 54015
715-796-2239 or 715-425-8363
Sign , date and return to above address .
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDI
INDUSTRY, DIVIS
LABOR AND PERCOLATION TESTS (115) MADISON WI 53
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TO SHIP/MUNICI A TY: LOT NO.:B SUBDIVI 10 AME:
L 14 tc / JN/R/1E (or
UNTY- OW R'S BUYER'S NA MAILIN D R S:— / R mu-t��
s
USE fl, DATES OBSERVATIONS MADE
P-Residence BEDRMS.: COMMERCIAL-Q CRIPTION: PROFIL DESC 1PTIONS: PER ATIO TESTS:
LJResidence � A /�I ❑New Replace I /''1 /1D �,'l//_ / '1�I
RATING:S=Site suitable for system U=Site unsuitable for system UC oCfJ �C. L O�c
CON�VENTIONprL: MOU 9S 11U❑� IN-GROUND-PRESSJdRE: SYSTEM-I�LHO�LDING TA I :RECOMMENDED SYSTEM:(o tional)
:
If Percolation Tests are NOT required DESIGN RATE If any portion of the tested area is in the
under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: 'y(
'PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED SEE ABBRV.ON BACK.)
10K nsn psi/� / Gy�n. sil,
B / .3� l9 e s,c.l wl a �8 — w - o
o' ns,l f3 ns�l qGy �3 s ,l �9" pn scl
0 Q / 9 w `n I y 113 w/'C 'Of 03,'—;3c�
I0 K On silo Jr' $n� , d /S`GY8/15/G/
�3 0 w —s36- t4jd!c c m o it Q o '-30
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. IOD 1 PEBIOD 2 P PER INCH
P_ 62 0 !Co /Co ICe
P- 3 0
P /!u O
P-
P
P_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION I b 15
E
3
,
ta
- - —
I
E ,
E
E Q
,
a�
CAS_,
N
I
E
3
sF
8
fi
1
to ..y
17777"
_ mm.
I,the undersigned, MWC—rk;y`that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME(print): TESTS WERE COMPL ED ON:
C. r 102 /,v(,
ADDRESS: , CERJIFICATION NUMBER: PHONE NUMBER(optional):
\J5• &o 16—la--g—ag
CST SI URE:
t
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) —OVER —
i
CiS
69 �
INSTRUCTIONS FOR COMPLETING FORM 115 - SB - 6595
To he a complete and accurate soil test:,your report must>? clude.
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project,
3- MAX IMUM number of bedrooms or corr)mercial use planned;
4, Is this a new or replacement system;
S. Complete the suitai)lity rating boxers. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abb€eviations shown here for writing profile descriptions and completing the plot plan,
7. MAKE A LEGIBLE diagram accurately locating your test: locations. Drawing to scale is preferred. A
separate sheet rnay be used if de.sireCI;
8, Make sure your benchmark and vertical elevation reference;point are clearly shown,and are permanent;
9 Complete all appropriate boxes cis to dates, names,addresses,flood plain data,percolation test exemp-
tion, it appropriate;
10. if the inforination (such as flood plain,elevation)does not apply, place N.A.in the appropriate box;
11, Sign the form and Place your current address and your certification number;
12_ Make legible copies and distribute as required, ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
St - Slone (over 10") BIB Bedrock
cob Cobble (3- 10") SS Sandstone
gr - Caravel (under 3") LS Limestone
*s Sand HGW High Groundwater
cs Coarse Sand Perc - Percolation Rate
coed s Medium Sand W - Well
Is Fine Sand Bldg - Building
is Loarny Sand > - Greater,Than
Sandy Loam < - Less Than
�l Loam Bn Brown
s. - Silt. Loam BI - Black
si -- Silt Gy - Gray
Clay Loam Y scl - Sandy Clay Loam R �� R6vv
rdo
sic[ - Silty Clay Loam niot Moltless
sc Sandy Clay vx,; wi i h
sic, - Silty Clay ffi' - few, fine,faint
*c Clay cc - cv€rarnorr,coarse
pr Peat min - Many, €r-sediriln
in - Muck 1 - distinct
p ___ prom ne rat
I+VYL - Sigh water level,
Srx general ;curl textures surface water
for hqui£ waste disposal BM Bench Mark
VRP Vertical Reference Point
TO THE OWNER:
�p This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to the appropriate local authority in order to
�� obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction.
State Of Wisconsin Department of Industry, Labor and Human Relations'
5 SAFETY&BUILDINGS DIVISION
r �
> i- 987
Ofrjr f
c
BD-6423 (N.04/81)
ST. CROIX COUNTY
WISCONSIN
tv-
ZONING OFFICE
796-2239 (HAMMOND)
425-8363(RIVER FALLS)
HAMMOND, WI 54015
October 21, 1987
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Bruce Berg property, located in the SWk
of the NW14 of Section 5, T28N-R16W, Town of Eau Galle, St. Croix County,
revealed suitable soils at a depth of 14 inches, below which seasonable high
ground water was noted.
This site should be suitable for a mound system.
Should you have any questions, please feel free to contact this office.
Sincerely,
Thomas C. Nelson
Zoning Administrator
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8707969
P{cQiSlAj
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r Page — Of —
Straw, Marsh Hay, Or
Synthetic Coverinp�
Distribution Pipe
Medium Sand
G
Topsoil F
_J E D
' 3
P P�J P� fit• I
co � :? (Force Main Plowed
gate
From Pump Layer
A
t r� 0 on Of 'A Mound System Using
aE �� �0 F Bed For The Absorption Area F
5
•♦ G� A Qa Ft. H 1
Signe B y 1 Ft.
License Number: Q I Ft.
Oa to: _ J �.L Ft.
-$T
7 1
l o� — K Ft.
Alternate Position 7�,'7y' : L Ft. 870 E 9' 9 Q
of
Force Main W 3 Ft.
L
FA Observation Pipe
---------------- ---- -------_---------_----- -
I-------- ------------- ----------------------•i
---- --------------- ---------------- Force Main
--rl
W — ------- ------- From Pump
r
�DOf istribulion
LBerd Zr— 2 %2
Pipe gate Observation Pipe t Markers
Plan View Of Mound Using A Bed For The Absorption Area
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ILq-
Page _ Of_
. V ATE SEW AGE SYSTEM
pR1
c�
d T�oNs
Perforated Pipe Delall p a N
W
I aaN� av�s
End vi.. , C�aRESP
ONCE
)Per I of a I ad SEE
End Cep PVC Pipe
r
°r,oo�e •
c
Holes Locoled On Bolcom,
s Are Equally Spaced
PVC Force Main
From Pump
.7
/Q PVC 7 9 (i o
Manifold Pope
OulnDulron Allernole Poelllon Of
Pope �� Force Main From Pump
Loaf Hole Should Be
Neel To End Cop ■
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End top pitlribulion Pipe Layout P
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Signed: Hole Diameter tidy Inch
Lateral Inches)
License Number: Manifold Z Inches
Date: _ /Q�z - ��� Force Main " 3 Inches
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' PAGE OF
PUMP CHAMBER CROSS SE6TIOM MID SPECIFICATIONS
VCIJT CAP
C.Z. VENT PIPE WEATHER. PROOF APPROVED LOCKING
JUNCTION BOX MANHOLE COVER
25' FROM DOOR. IJ:�MIU.
i►JOOW OR FRESH I
IR INTAKE I
GRADE I 4*AIM.
�. 10'MIU.
• GOAJDUIT �"— ___—_—__—
\ 11,
PGE SY PROVIDE I I
. INLET P�E S AI RTI6HT SEAL
P •tSe I
kPPROVEO JOIN III APPROVED JOINTS
(�
'4/C.z T. PIPE ti✓° NS 1 111 W/C.=. PIPE
:KTENDING 3' ® E�'Sw I II ALARM CXTEWDIUG 3'
INTO SOLID SOIL D I I I ONTO SOLID SOIL
IL
A I I ON
.L Ek �F T. WjMEN DIN�S ENC+E -_J
OR PUMP-•� � Orr
707
D � SEE, G
CONCRETE BLOCK
1110101144%3 IWC14
RISER EXIT PCRMIlTrD OWLJ IF TANK MANUFACTURER HAS SUCH APPROVAL ptRcvtfl
SEPTIC Ii SPEC.IFICATIOUS
DOSE rJ fr l\ r
TANK MAI.IUFACTURER: r �I k, ,1Pi_I ITT( 41 NUMBER OF DOSES: 3-PER DAy
TANK SIZE: �- gC ) GA ONS DOSE VOLUME 1gS74I50,
ALARM MANUFACTURER' INCLUDING DACKFLOW: I L '��GALLONS
MODEL MUMBCR: CAPACITIES: A= ! ' INCHES OR 'S13111 GALLONS
SWITCH TUPL: ` B- Z INCWES OR l i J 4ALLOMS
PUMP MANUFACTURER' 7 n ,tA f v en 11 ILICHES OR —I Lill iALLOLIS
1 ) -
MODEL NUMBER: D I INCHES OK GALLONS
SWITCH TYPE: '+ MOTE: PUMP AMD ALARM ARE TO OL
MINIMUM DISCHARGE RATE GPM /INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE..L_. FEET ' "�� q q
•I- MINIMUM NETWORK SUPPLY PRESSURT�E/. . . . . . . . . . 2.5 FEET I
45♦ FEET OF FORCE MAIN X '� F/oo nFRICTIOU FACTOR.. 1�� FEET
TOTAL DYNAMIC. HEAD = Ib. FEET
ILITERIJAL DIMLWSIONS OF TANK: LEAIGTH ';WIDTH ;LIQUID DEPTH X13
SIGHED* 2 LICENSE MUMBER:�/" C�J� DATE:1/
i
Y CURVE
and
D EWAT E R I N G
r
TOTAL DYNAMIC MEAD/CAPACITY PER MINUTE
EFFLUENT AND DEWATERINO
53-55
yam,
SERIES 57-59 97 137-139 161 163 165 165 166 169
FT. M Gal. Urs. Gal. Urs. Gal. Urs. Gal. Lira. Gal Ltrs. Gala Ltrs. Gal. Ltrs. Gala Lira. Gal, Urs.
34 (110 --� -- --- _ 5 1.52 43 163 57 216 104 394 108 401 61. 231 '61 231 BS 322
10 3.05 34 129 ,51 193 79 300 100 37861. 231 _T1_ 85 322
i -„•15, 4.57 19' 72 43 163 64; 242 -`91.' 344 '60,r 227 60! 227 ` .652 322
32 -1105 _____ __-.-_ _ 20 6 10 27 104 36 136 82 310 59 223 60; 227 63 322
25 1.62 8 30 74 280 57 216 59 223 ?k •85'' 322
30 9.14 65 246 55 : 206 Se 220 90. 340 65` 322
30 1-100- -- 40 12.19 46' 174 46 172 '65' 206 75: 283 lj 337 83 314
50 15.24 21 80 33 125 ST' 191 58 219 73' 276 77 292
95 60 18.29 15 57 143i 161 36 136 57'• 216 ,67 253
70 21.34 30 114 10 38 37: 140 .'-Q" 216
28 +-- 80 2438 14. 53 ! 13'. 49 -4,4 178
90 - 90 27.43 '.36"! 138
100 3048 21, 80
26 -i 65 Lock Valve 19' 24.5' 26' S8' 66* 8T 73' 85' 110'
24 +So ----
75 189
22 - 1
V6Z 7 20 18 55 0v 16 50 163 �� 188 N _14 45
12 40_
35
10 MODEL
130 - 2,
8 1 5 �
25
6 20.
11
15 in d�?/b
4
10
2 5 51, 55,
0
GALLONS 10 20 30 401 50 60 70 80 90 100 110
LITERS 0 80 160 240 320
. 400