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M O 5 4 N O O (D a Z Z 0) o rn v co CD •N o o '': m rn o z N H H in Q °= a m CL r A U a O U , e PUMP CHAMBER Manufacturer: Liquid Capacity: ao /S .' �. •~.. �3 N.^I Pum P Model: Manufacturer: U Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: ✓-G Ll✓V Number of feet from nearestl property line: Front, O Side, O Rear, 'Ft._.5"0 Number of feet from , well: Number of feet from building: (Include distances on plot plan), SOIL ABSORPTION SYSTEM Bed: S Trench: Width: % Len$th: 32 Number of Lines: 2 Area Built: /246' Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,O Ft . �/ Number of feet from well: Number.of feet from building: SS (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: / jpite e Liquid depth: Bottom of s e aa ion: A rea Built: Has either a drop box O or distrib ion �/xob n used�on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capaci Number of rings used: Elev ion of otto f tank: Elevation of inlet: Number of feet from nearest prope y ine: on , O Side, O Rear, OFt. Number of fee from e Number of feet from building: t. Number of feet from nearest mad: Alarm Manufacturer: / r7 Inspector: _ Dated: !� — / Plumber on job: A/Q, G^�i License Number: A o ::��Z 1' 3/84:mj Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER r'C/ /A SS TOWNSHIP , /7 Ilalley SEC. �� T LN-R 17 W l�t.f11 1`V`•�Ir` ADDRESS 7)7' ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT 1V,4 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i 3d /�ounQD , •�Di —" Q �00��� /tea _S�• s/Cry ��, �O _ A1p P vnar \j INDICATE NORTH ARROW q q BENCHILAIT tr: / Y / De cribe the vertical reference point used /o ai =_ -Elevation of vertical reference point: 106 -01 Proposed slope at site: arf SEPTIC TANK: Manufacturer: "-5- Liquid Capacity: 1 �45p0 eals �a-•s7'1-;79 /Cr k Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: — Tank Outlet Elevation: Number of feet from nearest , Road: Front,O Side Rear, 0 feet From nearest- property line Front,OSide,O Rear //D feet Number of feet from: well 7 , building: _%D (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 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 SW1,4,NE4, S3,T28N-R17W El CONVENTIONAL KIALTERNATIVE State PlanI.DNumber:I If Town of Pleasant Valley El Holding Tank ❑In-Ground Pressure ®Mound (D I-94 on CTY T NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Joseph Bacon (Arctic Glass) Route 1, SpringValley, WI 54767 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF,PT,ELEV.. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Dale E. Hudson 6629 St. Croix 92519 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER P O IDED: PROVIDED. lSL9(� YES ONO ❑YES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERT WELL: BUILDING:IVEN TO FRESH C� ALARM: FEET FROM LIME: AIR INLET 1:1 YES NO I ! ❑YES NO NEAREST �C) O DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER ` P OVIDED: PROVIDED: //Ww) Y ES NO O L GL YES ❑NO I %YES ONO GALLONS PER CYCL PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING.IVENTTOFPE§TT (DIFFERENCE BETWEEN p FEET FROM LINe �` 2- Aly INLET PUMP ON AND OFF) S 0 YES ❑NO NEAREST �� S 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 L./ the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH IND TRENCHES: DISTR.PIPE SPACING MATERIAL PIT INSIDE DIA SPITS LIQUID DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.IN ELEV.END: PIPES: FEET FROM LINE: AIR INLET. NEAREST------W: 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. %YES El NO SOIL CO ERITEXTURE PERMANENT MARKERS OBSERVATION WELLS YES ❑NO BYES FIND DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. S MULCHED CENTER: EDGES. ,�-cc---,,// ,,��55 J, ❑YES I NO ONO .b1YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW P11. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: / DIMENSIONS MANIFO D PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. 1110.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV. , EI- DIA. ELEV.: PIPES DIA.'. ELEVATION AND S� LZ 7 I�;SL DISTRIBUTION t� INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY CO PLANS VER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED — INFORMATION YES ❑NO >6YES El NO COMMENTS: PERMANENT MARKERS:I OBSERVATION WELLS NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE/� 2 '� C YES ❑NO YES ❑NO NEAREST L/[ J Sketch System on If n co—' y fT4s for audit. Reverse Side. 1 SIGNATURE x M TITL D I L H R S B D 6710(R.0 1/62) `` Zoning Administrator INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained.. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owners name and mailing address. Provide the legal description where the system is to be installed: 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete$#2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 131/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; 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; those 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 comrnoniy 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 agar included the creation of surcharges (tees) for a number of regulated practices which WisCO ir3' can effect groundwater. The surcharge took effect on July/ 1, 1984. All of the water that buried reasure J is used in your building is returned toy the groundwater through your soil absorption o , system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tereo by tree Department of Natural R+!source,. These funs are used for monitoring ground- T water, yr,ur;dwater contamination investigations and esiablishment of standards. Groundwater, i+'s worth protecting. 3G x.398 8.03/86) SANITARY PERMIT APPLICATION COUNTY T fILHR In accord with ILHR 83.05,Wis.Adm.Code Sf• STATFAANITARY PERMIT## —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. R&/o?7 6 '7 —See reverse side for instructions for completing this application. PETITION �( 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE El YES L�1 NO PROPERTY OWNER A PROPERTY LOCATION (14.--C- C, (SS) Ste'/a/(�� '/a, S __3' TAP, N, R If:(or PROPERTY O ER'S MAILING ADDRESS LOT NUMBER BLOCK NU BER SUBDIVISION NAME AIA CITY,STATE �� ZIP CODER PHONE NUMBER� r7/ CITY P� QS4 n NEAREST ROAD,LAKE OR LANDMARK S �i%7 UCI// ail//, S��lv /.:� .37'3/! f VILLAGE: l/Q lc° �` o-► ��1.TOWN OF7 II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ® Public(Specify): �,�� ouoL �f0 III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b.20 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.,X 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 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutte/s per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Z- �2� .� /0/,L0 Feet Dd Private ❑Joint ❑ Public CAPACITY VI. TANK Site in gallons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New xisting Gallons Tanks Concrete strutted glass App. Tanks Tanks eiSG' S Septic Tank or Holding Tank "` 560 So i ❑ El I El Lift Pump Tank/Siphon Chamber /G_� QOO / ❑ ❑ ❑ ❑ 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 Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: -Dale f- ::f, wz4� Z9 Plumber's Address(Street,City,State,Zip Code): ame of Designer: i ieel� VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## .�e2/e � rdr 3�/3 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY PoD:sanepr proved Sanitary Permit Fee Groundwater ate Is uing Agent Signature(No Stamps) Approved Given Initial S rcharge Fee 1 ] Adverse Determination • v0 v" "` X. COMM TS/REASONS FOR DI APP VAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 4 —7— td�• :5 R ( �_ 3 � �` � H 'b o Os .__. v to c b ti Lk .:�----- -- o C.ondiliona A P P ` �w N to EPARTtvIE -1 OF ���� 5� r �; l;" , 'i MAN RELATT'*S� "v ` UI J11�GS `� �`� IQ �[. Vii__ Rage Of .3 All Straws. Morsh Hoye Qr Synthetic` Covering Distribution Pipe Medium Sand . Topsoil c t � ;^ E , yo Slope ided Q ! "- 2 Force Main Plowed A,Q� y , te From Pump Layer D AO E /V Cross Section Qf A Mound System Using ----� A Bed For The Absorption Area" F 7S G -,-= Signed; A ` Ft. H _ License Number: Ft, Date: /O it jpn �- fit Alternate PQ . of s L 5�Z Ft. FQrce`Main W Ft; L T 3 Observation Pipe, K ► - — — — - -�►�— - — — _ _, - Cen��a Force Main W From Pu m p ..,. Oistributipn _^ ;, � Of pipe X- grte Qiservatl �, f ''� ` . l S, bE r � p Permo @TI rs e , .J l�1N s it ham': �. Plan View -Qf'Mound Using A ed For The Absorpti'or� Area s Page Z 0f3 I ! Perforated Pipe Detail Eng;,L,V.16W Enp 0oR Perforated y~ PVC Pipe i A,t t Q`k' Hole: l.pr<ated On 6otiom, Are e6glly sp9c4d% y !' PVC Force Main ,1 r PVC ' 4pnlfold Pipe s 0istripuIio "- ,,r '. Pipe L?Nt>�HIR':5haulq 8� pop Co 0 rTlCijS R a, , y t Nl+,ig f,Y signed A t� t�r ,:1s �.am ter Inch rtr�l� finch es • �-ic�n�® Numb�rt , �� l�Zq aI a+ foj` K Mani d " �- Inches Date C1in ��. .. Inches l ` # of hpiWpipe Invent Elevatiprl 4f 6to,ra1s/o/0 Ft. a.. 1.. PAGE —3 OF `3 PUMP CHAMBER CROSS SECTION AND SPECIFICATIOUS --VENT CAP `I"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING M E CO E R JUNCTION 80X AM HOLE V — 25 FROM DGOR, WINDOW OR FRESH 12"Mill. AIR INTAKE GRADE I 'i"MIN. CONDUIT -- _______ 18"MIN. �'��� ---------- INLET PROVIDE I ----- AIRTIGHT SEAL' I III II APPROVED JOINT A f I III APPROVED JGIIJ- W/C.Z. PIPE I I I I W/C.=. PIPE EXTENDING 3' _ '? �r 'e �,P•y lis I I I ( EXTEUDIAIG 3' aI ALARM ONTO SOLID SCAU B �' * t I I I ONTO SOLID SOI � a ` y Yt o I it i h" , , I oN u oI�i G;j f •:-, �,>.1•�' _ _ ! OFF s"�L' �• / CONCRETE BLOCK 4� E RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS SEPTIC AND DOSE TANKS MANUFACTURER: IJUMBER OF DOSES:— PER DA-4 TAMK GIZE : — lam/ GALLONS DOSE VOLUME:- 11"rf GALLL/ONS ALARM MANUFACTURER: -��11 CAPACITIES' A= INCHES OR 'TGALLOMS, MODEL AIUM6ER: B= _INCHES OR GAL L01J5 SWITCH TYPE: C4e 7— V ��,�-�� ' C= o' INCHES OR GL,L:f2 6ALLCIJS PUMP MANUFACTURER: D=—ZZ IMCHES OR -2 GALLOUS MODEL NUMBER:,�e�,6O.?G -5'fa Jr NOTE: PUMP AND ALARM ARE TO BE SWITCH TYPE: r I INSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RATE ' GPM VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE... FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . 2.5 FEET + _ 70 FEET OF FORCE MAIN X 'SO FT. 1010FT.FRICTIOU FACTOR.."20 FEET TOTAL DJNAMIC HEAD = 2i7 FEET INTERNAL DIMEIJSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH L7 SIGNED: LICEMSE NUMBE R DATE. I t�G J / Effluc-.- . Performance Curves Pumps METERS FEET 90 MODEL 3885 25 80 SIZE 3/4" Solids 0 WE15H w 70 Z 20— _WE10 H J 60 —WE 07H 15 50 40 WE05H NIL 10 30 WE03M IN 20 WE03L 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L L 1 1 0 10 20 30 m°/h CAPACITY �GOULDS PUMPS, INC. SBNECA FALLS WW YOM 13148 \�- METERS FEET 120 MODE 885 35 110 WE15HH SIZE 3 100 30 90 25.- 80 Q 70 U) 20 J H 60 0 50 WE05HH 15 40 10 30 20 5 10 �J 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 20 30 m'/h CAPACITY 01985 Goulds Pumps,Inc. Effective July,1985 a tX, V0 i C Fo LIN kA U) � � V ��, � t �• ..Gam` c � i Trito' � W mu " ru k zz Cal u -o ro CU J Q d cry y" C� . ST. CROIX COUNTY WISCONSIN �.A,JL f�U1M1'L S rv�-JV ZONING OFFICE - 796-2239 (HAMMOND) " '9 425-8363 (RIVER FALLS) HAMMOND, WI 54015 October 27, 1986 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir : An on site investigation for the Joe Bacon property, located at the SW1/4 of the NE1/4 of Section 33, T28N-R17W, Town of Pleasant Valley, revealed suitable soils at a depth of 30 inches, below which seasonable high groundwater was noted . This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office . Sincerely, r Thomas C. Nelson Assistant Zoning Administrator TCN/mj - WISCONSIN DEPARTMENT OF. INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of st. croix Location SW 1/4, NE 1/4, Sec. 33 T 28 N, R 17 X&XW* W Town X�IXi,'I��ICIG ��W Pleasant Valley Street Address Lot No. , Block Subdivision Landowner's Name: Joe Bacon The application for this site is for: ❑new construction use. ®replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: �.1to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ers—�s eTFo you.) [ one of the applications needing a quota number. The quota number assigned to this application is - - ❑for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. F.1 for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. [._. for an application on file prior to February 1, 1980. [_ for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: Fla failing conventional soil absorption system. U a holding tank that was installed and in use prior to February 1, 1980. ❑a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here. I certify that the above information is true and accurate to the best of my knowledge. +�..0�— Name Thomas C. Nelson Si re County Official Title Assistant Zoning Administratory Date October 27, 1986 DILHR-SBD-6158 (R 12/82) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor., ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - =- - - - - - - - - - - - - - - - - - - - � C / Owner of Property J�j Sc� �o Location of Property s it /V014, Section , T D N - R / 7 W TownshipGQ Mailing Address _ Af Subdivision Name Lot Number Previous Owner of Property C10,4,Pdl Ale L4�L,(,' Total Size of Parcel 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 2R� as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. • Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays . of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - -.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - -- - - PROPERTV OWNER CERTIFICATION I (we) eenti,6y that aft 6tateme.nta on #hi.6 6oh.m axe t,%ue to the best o6 my (oua) . knowledge; that 1 (cue) am (aice) the owneh.(d) 06 the pnopeAty dedehi,bed in xhib .in6oAmati,on 6onm, by vi tue o6 a wamanty deed xeconded in the 066ice o6 the County Reg.i..a.ten 06 Deeds as Document No. and that I (we) pneaently own the plcoposed 4 to 6orc the sewage posa�-sus#em (0rc I (we) have obtained an eadement, to Wn with the above de,6cAi.bed pnopeAty, bon the constucti,on o6 said dys.tem) and the dame had been duty neeoxded in the 066tee 06 the County Reg.iaten 066/Deeds, as Document No. ) , SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED . — DOCUMENT NO. I I STATE BAR OF WISCONSIN FORM 1-19821j THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED it 756 PACK 86 , t, t?SISi' RS OFFICE R01X 00.v WM This Deed, made between .._.._•_____________•__..................................._ ;1aa° . for Record ft 9th .•---•--•--•---•••---•--••••----•--•-. -••--- PECAN SHOPPE--OF_•_PASG.Q, N.C.� � d'w1 of Oct -A.D. 1986 ---•-------••----•------•--- •-•- Grantor, :•$ 8:30 A anci._____..sTOBP )1.0..__ Eacom,.____ara.d_Be.tsy-L•.-Bacon,..------............................ r husband._and_.wife,-.as_.mar-its].--joint-•tenants---- •----- M ,l„ of o.e+• -------••---...-----•-•..............•--•--•-•-----.--•-•-•---------•-•--•--•-•---•--••---•----•--, Grantee, Witnesseth, That the said Grantor, for a valuable consideration..____ Sixt -five Thousand rr C 0 Q 0.Q }� I 1-_ _- _ -- -- �; ......__...Y......................................(.$..... _..... a.S!Y.).__/-/.Q 11ar_S__._.______.___ i( RETURN TO conveys to Grantee the following described real estate in __St.-_•CrQ1X.......... ; '! County, State of Wisconsin: Part of Southwest Quarter of 'Northwest- Quarter (SWiNWI ) of Section Three (3) , -- -,— - ---------- — ; Township Twenty-eight (28) North, Range Seventeen ii (17) West, described as follows: Commencing ,at the Tax Parcel No: ............. ...................... W$ corner of said section 3; thence North on the West line of said,-'NW ;975. 00 feet; thence East 75. 00 feet to the point of beginning; thence S. 174° 48 ' E. 309 . 24 feet; thence S. 1 010 ' W. 386. 37 feet; thence N. 75° 27 ' W. '. ;on the Northerly right-of-way line of Interstate Highway "94" , 308. 40 feet; lithence N. 1' 10 ' E. on the Easterly right-of-way line of County Trunk j Highway "T" 390. 00 feet to the point of beginning; 'subject to the right of former owners William G. Loock and Esther Loock, ;;their heirs, devisees, grantees and assigns, to use that part of the above ':parcel described as: From the said point of beginning, thence South 74D ': 48 ' East 309. 24 feet; thence West to a point on the west boundary of the ;;parcel 75 feet south of the point of beginning; thence North along said ;.boundary to the point of beginning, for automobile and truck traffic, but !upon the conditions that said traffic not interfere with Grantee ' s use j <'of the parcel and that the above-named former owners, their heirs, devisees, grantees and assigns contribute one-half of the cast of main- i'tainin li g the pavement in the area subject to such use after such use ;;commences. This ...........110 ---•-•---- homestead property. _ y , __...- (is) (is not) S BiR Together with all and singular the hereditaments and appurtenances thereunto belonging; � � i; it And._..-•------_...• -• -•--••---••--•-----------------------•-••-••---...._...;i<_:: - ti warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except i' ,�9sAro and will warrant and defend the same. Dated this .............lst ......... .............. day of ..........OCtQh.er........................................., 1,9.:$• ro- ,�.' ,i PECAN S- 0PPE OF PASCO I C. '' b •- SEAL s•::(S ' i oward K. Mc n yre ✓'� a��,��.+++`'�� �' I -__- - ---_-- --• ' (SEAL) -- .. --....._.V--✓..-----•............. . ......(SEAL) l * Jewell._L_, Payne -------- = ••- I; - ile C. Tucker AUTHENTICATION ACKNOWLEDGMENT I; SM Signature(s) ----------------------------------•--•-•--- STATE OF1 OLINA j ss. ------------------------------------------•-•----------------------------------- 17t�,.C,1V V IEEE, ' ---• -•- .._.._ County. �; authenticated this ........day of___________________________ 19______ Personally came before me this .....l5.t,_.day of _____ _________________ 19__H__ the above named ------------------------ ------------------------ --IIo-wa d-K_.___Mc.1at�rr_e.,-_-Pres-ident--:---- I, j *-•••-----•----•------.._--•-------------••-•-•---•-••-----••--•••-------•--•-• ---andAgile- C . Tucker, Secretary, TITLE: MEMBER STATE BAR OF WISCONSIN authorized b ...... ................................................... .....y § 706.06, Wis. Stats.) to me known to be the persons----------- who executed the foregoing instrument and acknow ed a the same.. . I THIS INSTRUMENT WAS DRAFTED BY ewe :_ _ '•c ---Pecan--Shoppe--of--Rasc¢f• Inc. y Y --••-------------------•------•---------------------------------•--•------•-•--- Notary Public xO __� (Signatures may be authenticated or acknowledged. Both My Commission i �p,��,ei (i ' ry6 *U44 are not necessary.) �1re.. .---•---•..._ it *Names of persons signing in any capacity should be typed or printed below their signatures. ►L-_ - -__ _ __ J H.QMdlarCanparrylMl - STATE' BAR OF WISCONSIN P•••• •• wi pegpp h+mttttll FORM No. 1-1982 .Stock NO. 13001 • z y a STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z _ a OWNER/BUYER c� ROUTE/BOX NUMBER 7 . ( /(� / Fire Number .CITY/STATE ZIP 5 Y( y / 5 �C.J PROPERTY LOCATION: � '�, J� '�, Section , T 2 N , R W, Town of 1�j,�s`� /Pl � , St . Croix County, Subdivision Al Lot number 1114 Improper use and maintenance of Y septic P s our e t system could result in Y its premature failure to handle wastes . Proper maintenance con- sists of pumping out the i septic tank every three years or sooner , if needed by a licensed septic tank pu m pe r. W hat y o u 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 operatinn 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. o • E I/WE, the undersigned, have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- It ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within .,W days of the three year expiration date. SIGNED DATE St . Croix County Zoning Office P.O. Box 98� Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . N TIdfENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS IDUS NDUSTf�Y, DIVISION LABOR.AND PERCOLATION TESTS (115) MADISON W1 7969 HUMAN RELATIONS (H63.090)& Chapter 145.045) �/LOCAT!ON:j.j,�"E 1/4 SECTION: 3�/����/�/n�(o W TOW©��s`N�I�PALITY: rOT NO.:BLK.NO.: SUBDIVISION NAME: COUNTY: OWNER'S BUYER'S NAM/E: n r MAILINJGyADDs,R%E1SS: /,Y// 57, c©r) J /e W, 7 USE IJISEIRVATIONS MADE NO.BEDRiX: C20%5R L DESCRI e I PR ON PERCOLATION ESTS: mResidence N� JI LCD � / ❑New ,Replace /0— /0_ /O_ z 62 RATING:S=Site suitable for system U=Site unsuitable for system r ONVENTIIOyNAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) OSLn1U PAS ❑U ❑SPaU ❑SEJU ❑SG�U If Percolation Testsare NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH N$, ELEVATION OBSERVED EST. I H/E�ST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- �,O' r 9' ✓ 2, '' s/• ' '/� A / ri B-3 b,fs" 97,59 Al B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D P R PER INCH P_ ,o� 7 3 P. r P- 3 •O 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 41 . 1 I i I i f I j i _J Lj TN r I I _ i G — i I,the undersigned,hereby certify 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 COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): f, / _poy Iyl-,4 / J Z -?--113 CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02/82) —OVER— A DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTIlff, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 H6MAN RELATIONS MADISON,WI 53707 (H63.09(1)&Chapter 145.045) LOtATION:'xt��E1/ SECTION: 33/Tj9N/R/q,�(o W TOW���S��PALITY: LOT NO.:BLK NO.: SUBDIVISION NAME: COUNTY: OWNER'S BUYER'S NAME: MAIL19G ADDd,RRESSS: r/,�j/ �] 57", I` L'©/) e-,, le CSC//- ._7 . /C/ / USE DATES OIJISEIRVATIONS MADE NO.BEDRi% : C / R L DESCRIPTIff R NS: N TESTS: rl Re e N9 006,r/el ❑New Replace I �O_ —mil/ RATING:S=Site suitable for system U=Site unsuitable for system /f 6 CONVENTIONAL: MOUND: IN-GROUNDPRESSURE:S STEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) as_®u ®s ❑u as ®u osRu EIS MU I �Aezyal If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: 14114 I Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER IDEPTH F4. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- B- [B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D2 PERIOD PER INCH P •o� �. 7 -� // 3 P- �•D � �i • 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. , „ A, rw SYSTEM ELEVATION /o/•o' `'ff I i i i C - f— -- -j I,the undersigned,hereby certify 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 COMPLETED ON: I:> /0-//- ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): Z/1- , Z 2-1' 13 CST SIGNATURE: / DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER—