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038-1013-50-000
/ 0 2 CD k \ . j2 ¥ o 3 0 2 C) 6� \_ � $ & / k§$ »- x \ k/c / k) k { CL a \ )0 0 % < 00 c j D R _ � § � 16 & z > { 2 n § 0 \ a ■ % § z :t / , � 2 , . 2 / D z E ) / < < O z z 0 z a 2 / \ L) 2 u ~ � � GE � ■ ( ca� � ® � . CO) EZ \ k $ 2 / E c 7 k K & E ® t - t , E a a a § 2 ) J � v % k k 2 > § § 2 6 § \ u,§ = E ) / \ 5 4 ƒ 7 co ■ d § 2 m cl 7 § \ 2 £ = E o m / . 2 @ S J \ § ) § ) b \ ) 7 / % k � � ; a o , � � . ) ) a E a @ 2 = § o o m . a c o z _ z ■ n m � J k £ =k a . - IL� , : CL )\ ) \ k , k»c . • Parcel #: 038-1013-50-000 09/01/2005 11:20 AM PAGE 1 OF 1 Alt. Parcel#: 3.31.18.35B 038-TOWN OF STAR PRAIRIE 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 BONITA M PITZEN O-PITZEN, BONITA M 2385 CARDINAL DR NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description *2385 CARDINAL DR SC 3962 NEW RICHMOND ' SP 1700 WITC SP 8055 CEDAR LAKE/N R Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 3 T31 N RI 8W PT GL 1 COM 681.9'S& Block/Condo Bldg: 1914.04' E OF NW COR SEC 3 TH S 86 DEG E 200'TO MEANDER LN,TH S 2 DEG W 125'TH Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) N 86 DEG W 260 FT TH N 28 DEG E 137.59' 03-31N-18W TO POB Notes: Parcel History: Date Doc# Vol/Page Type 02/01/2001 637802 1581/578 QC 02/01/2001 637801 1581/576 QC 07/23/1997 451/29 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 168,500 191,500 360,000 NO Totals for 2005: General Property 0.000 168,500 191,500 360,000 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 168,500 191,500 360,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 122 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 L pp- I ' PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm anufacturer: Alarm Switch Type: N er of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Z Area Built:23-6 Fill depth to top of pipe: 11rZ Number of feet from nearest property line: Front, e7\Side, O Rear,O Ft . Number of feet from well: 96 r Number of feet from building: -C;p (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area B It: Has eit r a drop box O or distribution box O been used on any of the above soil absorb ion sytems? (Check one). HOLDING 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, 0Ft. Number of feet from well: Number of feet from building: /rmManluufacturer:umber of feet from nearest road: Inspector: Dated: b Plumber on job: License Number: 3/84:mj J Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ��N\, TOWNSHIP SEC. T _,jLN-R W ADDRESS �� `� ST. CROIX COUNTY, WISCONSIN SUBDIVISION r LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3 �f �g P� fi INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used �` - 01 tl Elevation of vertical reference point: 632 Proposed slope at site: SEPTIC TANK: Manufacturer: I Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elev n: Tank Outlet Elevation: Number of fe from nearest Road: Front, Side Rear, O O feet From nearest property line Front 10 Side 10 Rear,O feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) EE REVERSE SIDE r t PUMP CHAMBER Manufacturer: Liquid Capacity: goo Pump Model: w LA) ump Siphon Manufacturer: � Pump Size Z Rvc Elevation of inlet: B��ottom of tank elevation: � . Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: _� -�- Alarm Switch Type: Number of feet from nearest property line: Front, O Side, Rear,Q Ft. � Number of feet from well: r Number of feet from building: �© (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, 0 Rear,0 Vt . 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). HOLDING 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, 0Ft. e Number of feet from well: � Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: �3 r 87 Plumber on job: License Number: s t- 3/84:mj Form - STC - 104 i AS BUILT SANITARY SYSTEM REPORT OWNER plSr�,r�, TOWNSHIP h— , f' SEC. _ T�� R N- I$' W ADDRESS ST. CROIX COUNTY, WISCONSIN s'6 c19 SUBDIVISION - LOT LOT SIZE rl f ti —r PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 2� a� 0 1 0 -11 5 e �a INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 1 O O Proposed slope at site: - 70 SEPTIC TANK: Manufacturer: U J �"-:;, Liquid Capacity: � . Number of rings used: b Tank manhole cover elevation: 83'x_ (off Tank Inlet Elevation: �( q p Tank Outlet Elevation: Number of feet from nearest Road: Front,6z Side, Rear, O feet From nearest property line Front,0 Side,0 Rear,O j feet t r Number of feet from: well ,S 2 building: (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 MAD160N,WI 53707 NEk , NW1,4,S3,T31N-R18W El CONVENTIONAL XX ALTERNATIVE State Plan I.D.Number: IIf assigned) Town of Star Prairie ❑Holding Tank ® In-Ground Pressure ❑Mound 7-OrA to(vG s Cedar Lake NAME. F PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Paul Pitzen 44 Morningside Drive, St. Paul, MN 5511 &j,)_ 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: Garoy L. Steel 3254 St. Croix 95986 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO DYES ONO BEDDING: VENT DIA.: VENT MATL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: IVENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ONO I I OYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO DYES ❑NO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑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 FORGE MAIN'' the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING. COVER JINSIDE DIA.. *PITS: LIQUID EOT H. TRENCHES MATERIAL: PIT DEPTH: 41f�NSC ° GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR NUMBER OF r!PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER. ELEV.INLET JELEV.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. 1:1 YES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS 1:1 YES ONO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED: MULCHED. CENTER: EDGES. ❑YES ❑NO ❑YES ❑NO IOYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: y WIDTH. LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: f;IrERNH e TRENCHES: lONS e!.MANIFOLD PUMP MANIFOLD DISTR,PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. � I ELEV.. ELEV. DIA_. ELEV. PIPES: HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED RaTO1 PLANS DYES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NtlIER OF ! PROPERTY WELL: BUILDING: FEET FRO LINE: ❑YES ONO ❑YES 1:1 NO INEARPS T Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE: Zoning Administrator DILHR SBD 6710 (R.01/82) 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 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 it 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 fdrrri. 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. 6" Complete plans and specifications not smaller than 8'/z 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 ater included the creation of surcharges (fees) for a number of regulated practices which WisCO EI 'a 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 absorpt n u system or the disposal site used by your holding tank pumper. 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) SANITARY PERMIT APPLICATION COON n L]'DILHR In accord with ILHR 83.05,Wis.Adm.Code l.. P STATF SANITAR PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STA((TTEE))PLAN I.D.NUMBER 8%x 11 inches in size. 87-02665-s —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES D NO PROPERTY OWNER PROPERTY LOCATION Paul Pitzen NP, '/a NW '/4, S T , N, R (or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 44 Morningside Dr. n/a n/a n/a CITY,STATE ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD,LAKE OR LANDMARK St. Paul, Mirm. 55119 612 735-3599 E3 VILLAGE: Star Prarie Cedar Lake TOWN II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 2 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b. 0 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. ©Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. 6� IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 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: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): n,, 27 '479 '179 96.25 Feet [3Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xis Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for insta ation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber' nature:(No a ) /MPRSW No.: Business Phone Number: Gary L. Steel 3254 715 246-6200 Lc Plumber's Address(Street,City,State,Zip C Name of Designer: 988 N. shore Dr. New Richmond, Wi. 54017 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Gary L. Steel 2298 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N. Shore Dr. New Richmond, Wi. 54107 715 246-6200 COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S 'tary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) roved ❑ Owner Given Initial 4u^ Sc arge Fee Adverse Determination � X. COMM TS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber ' In-Ground Pressure System for Paul Pitzen NE'-4 NW-4 S.3, T31N-R18W Town of Star Prarie, St. Croix Co. pages R-Plan approval application #2-application for alternative system O-St. Croix Co. on-site #4-St. Croix Co. verification #5-115 #6-plot plan-plan view #7-work sheet #8-system cross section #9-pipe lateral layout #10-dosing chamber X611-pump curve Gary L. Steel 988 N. Shore Dr. New Richmond, Wi. 54017 MPRSW 3254 April 25, 1987 v STATE of WISCONSIN UILMN DIL�R PRIVATE SEWAGE SYSTEMS DIVISION OF SAFETY&BUILDINGS BUREAU OF PLUMBING PLAN APPROVAL APPLICATION 2M E.Wesh"on Avenue.Rm 141 P.O.Box MI.Madison,WI $3707 MIS SoB.zss-3Bts .STRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration. Document Sales,202 South Thornton Ave.,P.O.Box 7840,Madison,Wisconsin 53707,Telephone(608)266-3358. 1. PROJECT INFORMATION(Type or print dearly) Revision To Plan NumDe87%j26- Name of Submitting Party(Plans returned to same) Project Name In- round pressure Street&No.or Aural Route Project Location-Street 8 No.or Legal Description 988 N. Shore Dr. 04 NW-14 S.3-T31N.-R18W City or Villag! State Zip City County New Richmond, Wi. 54017 village OF: Town Star Prarie St.Croix Telephone No.(Inctude area code) 715-246-6200 Designer Telephone No.(Include area code) Owners Name Telephone No.(Include area code) Paul Pitzen 612-735-3599 Street a No. Street a No. 44 Mornin side Dr. City or Village State Zip City or Village state Zip St. Paul Minn. 55119 2. APPLICATION FOR: New Mound System(3a) Groundwater Monitorinig(7) Conventional System-Public Building(1) Replacement Mound(4a) Holding Tank(2) Replacement Pressurized System(4b) System in Fill (1) Petition For Variance(6) New Pressurized System(3b) System in Flood Fringe(1) Other Alternatives(5) .. FEE COMPUTATIONS(Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750- 1,500 gallon septic tank - 50.00 4a, 50.00 3b. 1.501 - 2.500 gallon septic tank - 60.00 4b. 3c. 2,501- 5.000 gallon septic tank - 60.00 4c, 3d. 5,001 - 9,000 gallon septic tank -100.00 4d. 3e. 9,001. 15,000 gallon septic tank -150.00 4e. 3f. Over 15,000 gallon septic tank -250.00 4f. 3g. 500- 1,000 gallon dose chamber - 30.00 49. 30_nn 3h. 1,001- 2.000 gallon dose chamber - 50.00 4h. 31. 2,001- 4,000 gallon dose chamber - 70.00 41. 3j. 4,001 - 8,000 gallon dose chamber - 90.00 4j. 3k. 8,001 - 12,000 gallon dose chamber -110.00 4k. 31. Over 12,000 gallon dose chamber -150.00 41. 3m. 500- 5,000 gallon holding tank - 30.00 4m. 3n. 5,001 -10.000 gallon holding tank - 55.00 4n. , 80. Over 10,000 gallon holding tank -100.00 4o. 3p. Revisions - 20,00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other than a proposed subdivision) Subtotal 80.00 3r. Priority plan review:walk through 4r. Submittal of plans in person, .r by appointment,with double fee 3S. Petition for variance Setback - 25.00 4s. Site evaluation - 50.00 Total Fee Rn_nn NOTE:Fees pwswM to Wls.Adm.Code,Csepbr Imi.M San-ssut In 11111111411 mey be Zr to cownee emwaitr STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF -AN ALTERNATIVE SYSTEM Location: Township/Municipality: NE kINW 141S 3 T 31 N/R18 XXMW Star Prairie Street Address: Subdivision: County: 44 Morningside Dr. St. Paul, MN 55119 St. Croix Landowners Name: Mailing Address: Paul Pitzen 44 Morningside Dr. St. Paul, MN 55119 I (We) , the undersigned , hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. 8702665 I further understand that an alternative system is more complex in nature than v a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved , the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have-been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applican Dat STATE OF WISCONSIN Su scribed and sworn to before me SS. COUNTY OF s, - G�� l� T day of 1 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Exp'rr . (� ST. CROIX COUNTY {f WISCONSIN ZONING OFFICE yL5 796-2239(HAMMOND) 425-8363 (RIVER FALLS) •HAMMOND, WI 54015 April 21, 1987 8702660 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Paul Pitzen property located in the NE 1/4 of the NW 1/4 of Section 3, T31N-R18W, Town of Star Prairie, in St. C roix County, revealed that the only suitable area for a system is by using an in-ground pressure system. Should you have any questions, please feel free to contact this office. Sincerely, C;Fn G�Cl 0. t\I J),�11 /r c— Thomas C. Nelson Zoning Administrator TCN:rc 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 NE 1/4, NW 1/4, Sec. 3 T 31 N, R 18 yX"x W Town or Municipality Star Prairie Street Address 44 Morningside Dr. St. Paul, MN 55111 Lot No. Block Subdivision Landowner's Name: Paul Pitzen The application for this site is for: ❑ new construction use.' ® replacement system use. '.6 616 Maw If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ❑ to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numbers'issue-d to you.) Done 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. 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 conventionalxsoil absorption system. ❑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 lot meets the criteria for a conventional private sewage system, check here.E] I certify that the above information is true and accurate to the b t f my knowledge. ' —�------ �— Name Thomas C. Nelson S_ignatUre County Official)—" Title St. Croix County Zoning Administrarr„- Date April 21 , 1987 DILHR-SBD-6158 (R 12/82) (�Dl DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDI^!' S ' INDUSTRY, DIVISivr: LABOR RF LATIONS HUMAN RE PERCOLATION TESTS (115) MADISON, W1 53 ' (H63.09(1) & Chapter 145.045) LO ATION: SECTION: TOWNSHIP Y: LOT NO.:BLK.NO.: SUBDIVISION NAME: NE lY4NW�/4 3 /T31 N/Rl8 1R(or) Star Prarie n/a n/a n/a COUNTY: OWNER'S eRj' j ME: MAILING ADDRESS: St. Croix Paul Pitzen 1 44 Morningside Dr. St. Paul, Minn. 55119 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLAT ION TES11-: ©Residence 2 n/a ❑New Replace 4-9-87 4-10-87 RATING:S=Site suitable for system U_=Site unsuitable for system CONVENTIONAL: MOUND: IfV-GiiR--O��UNO-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optionaU S aU ❑S DU �I s ❑U ❑s f]U ❑S KJU in-ground pressure li Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: n/a Floodplain, indicate FI'oodplain elevation: n/a PROFILE DESCRIPTIONS page 3 AMD2 BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEP' NUMBER bEFTiOtI?C OBSERVED EST, IGHEST I TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK,) B 1 6.33 99.25 none >6.33 ' ' .25bl.1. 2.75bn.gr. 3.33, bn.s.l. z -- B- 2 6.08 99.27 none >6.08 .33bl.1. 2.33bn.gr. 3.42bn.s.1. B- 3 6.83 99.93 none ktx gi; .33bl.l. 2.08 bn.gr. 4.42bn.s.l. B- `> >6.83 correction made 5-11-87 by Gary L. Steel B- P PERCOLATION TESTS G TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINI 4a NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD P RI D P R PER INCH P. .1 1 118 27 P- 2 3.02 none 30 2 17/8 17/8 16 P- 3 3.68 norie 30 34 3 3 10 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 n 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 pe ,-ern* of land slope. SYSTEM ELEVATION 96.25 it 'P to I ��A ' 7 ! 5��� � ! �v , II h 41 ),,dn I, the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the proced\,As avid methq sp the Wiscon=r Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belie:; �% NAME (print)-: TESTS WERE COMPLETED ON: Gary L. Steel 4-10-87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optiocJ. 988 N. Shore Dr. New Richmond, Wi. 54017 2298 . 71,5-246-6200 U. CST SIGNA RE: w DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R,02/82) -OVER -- I I' ,,.. .' >, . r- � Y ' i� P.. A' �A>. f ..1 �. ...e -'YM r .. ' �'��. :_� I R 1 4 E _ -7 b Jtt A. 8702065 ,� Q,J� t mvc� o (� . . 1 11�P . 303 j U} �0 b i F o sz [ �. 100 `9 4 � plot plan-planview OPTIONAL WORKSHEET 1. MOUND SYSTEM 11. IN{,ROUND PRESSURE Rate SYSTEMC"U nusd- 1. Wasowatet Load.Total Daily Flow= t. 10. Force Mal 3,( �,� Use s. IIHR 83.15 (3) (c) Minimuu m OosMi • M Code and PROVIDE A DETAILED Diameter- Adm. -- LIST OF SIZING ON PLANS. 11. Total sum He Head: 2. Depth'to LImItMW Factor■ ft. System Head• .Z OeQ� ft. 3. LandsbM' !� WRlul Lift■ , �3 � 4. Distance front Ouse Chamber to TDH 0 Less• N Distribution System■ n• TOH• S. Elevation Difference lktweett 12. Pump Selection:l d 8 Pump and Oktribudom SyMem` ft. Pump will -fL O at Mast 0. Absorption Area SkknW at . .A 3 ft,dotal dynamic Mad. Area Required• h.•ft. Pump m!aV 6 tttamufarwht: Sed or Trench Letwth(R)• 13, Dose Volume: Bed or Trench-Width(A)• R 10 Timm VeM Voksmta o1 I l Trench Spackni(C)• Distribution Lines• 7. Mound Hal0tt Dally wastewaw volume+ Fill Depth(0)• 4 Dome in 24 hre.• {i Fill Depth Downdope.(E fL led.or Trench Depth(f ` ft. minima • Cap and Topsoil DeP (G)• ft. Minimum r. • Cap and Topsoil (H)• - ft. 14. Dose Chamber. VOIYrIne• --P. i. Mound t.er.6th: End Slope(K) f` IIh CONVENTIONAL PRIVATE SEWAGE SYSTEM f; . Total Mound L (L)• � 1. Wastewater Lead.Total Dow Flow >D • �--- !. Mound Width: / Use s. ILUR 83.15 (3) (c) Wis. Updope Fad"• Adm.Cede and PROVIDE DETAILED Upstope W th(I)• LIST OF SIZING ON PLANS. Dow Correction Factor• - ----- ; Down Width(1)• . ft. 2. Required Sepik Tank Capacity ty• -� ft. 3. percolation Rab` tm Total ound Width(W)■ 4. Absorption AmSkl1W 10. weal a: Refer to Table 2 in cis. 83 1 Itratiw Capacity of. � � and PROVIDE A DETAILED Oi atural Soil■ . SIZING ON PLANS. Area Requited■ - w•R' .0811811 Area Available• sq.tL Required Area• �- ";1t 11. f standard Tables from Chapter I� 83 Width•• R »e'Iused,, Indicate Table N Number > For the Distribution Network.Use Numbers S•141n Section 11. Trench H. IN-GROUND PRESSURE SYSTEM. g3 S. Distribution S 1. Depth w Llnitkni Factor• , ft. Lateral L ` h Numbs Laterals• 2. Lamdslo.pe*0 Z' x le mfm./Mn. Lett Spsdn><• `�'-'"� 3. percolation Rate• �5 ft. D u from Sidewaq to Pipe` �.7 k 4. Proposed System Elevation• stem Elevatlon•' ---�•+P S. Wastewaw Lead l Flow (c) , W- _ �. Uses. Adm,Code and PROVIDE A DETAILED IV. S EM-I ems from LIST OF SIZING ON•PLANS. 11 in All Items from Section 111 RequkW Septic Tank Capacity= Q 0 a �' V. SEPTIC TANK 0. Absorption Am Sb*W mkt.pn. I. capacity• t 00 S Peroolattom Raw• Ana Requked• Z 7 w.D, 2, Manufacturer. System L*Mth• ft. 3. Show Site Constructed Tank Detalls on Plan System Width• "1L fti. VI. DOSING TANK 7. Oistrom lon Pipe SIXIM: S b. 1. capacity- .5�=•a H ine ole S • 2. Hole SpaCimR__ ft. Manufacturer. 3. Pump MAnufacluf0 ^ Lateral Lenitth, ft. s LaterA SIM • Im. S. Pump IAij He Lateral SpacinM ��.. fl• S. Opetatinil Htad= I G: ;';F1ow Ra1or: UbAmice Rota xWawaN 4"Phv in. 7. Show Site Constructed Tank Detags en.Phm N. Ulsirlbutioe Pipe DkdwW RAW „ . Number of 1101"Per Plea 41. Vll. IIW.UING TANK-' 1 low Per Pipe• N"m• 9: ManffoW Sillow. 1' Capsdty• Type(center or end)- n� ?:� Manufaclu • ft. 3Sitow Silo constructed Tank Detalk om Plans ltn Klh Diameter --�+-- In. _SHOW ALL INFORMATION ON PLANS- _....- PAC,E C F I GROSS 'SECTIOW OF- Vk-D SbSTEM Z10NS RED' p NU M�H • SOIL DISTRIBUTIOAI PIPC fJ-P A 'ROVED SyA1THETIC COVER 2" OF AGGREGATE (4 I'ERIAL OR 9"OF STRAW MARS" HAy 2J V"OP y=-L AGGRE ELEV. bF�6 FEET----,.. DISTRIBUTION PIPE TO BC M' LEIk6T INCHES BELOW ORIGINAL GRADE ANO AT LEASTLO 1AICHES BUT MO MORE THAW 42. ILIC14ES BELOW FILIAL GRADE MAXIMUM DEPTH OF EXCAVATION FROM ORIGIWA.L GRADE WILL BE INCHES MINIMUM DEPTH OF EXCAVATION FROM ORIGILIAL GRADE WILL-SE 26, — INCHES CC4 \ L.IGEWSC WUMBER: MO U,54) t_r DATE: Page — Of – Perforated Pipe Detail � n Cad View Perforated / End Cap ,y� PVC Pipe 4,.oar e Holes Leceted On Bottom. �s Are Equally paced `d Z66 Left Hole SAould Be ' Neat To End Cop Distribution Pipe Layout P ,33- Ft. S X ,34 Inchec Y -36 Inches Signed: p[_ Hole Diameter Inch Lateral " /yZ Inches) License Number: 1ry44 n 6740 3Z S - Manifold Inches Date: 2 5 - Force Main " �– Inches # of holes/pipe ) 2– PLUMBIt40 7.5 �p Invert Elevation of Laterals �o r Ft. ATP ' � � N RE:LA�IONS �4{nF nf� Nilh �I f► TRY• ILVNGS • (`F � OF SAFk� A G �S u E C cc)�� Ilk PAGE: CF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS frVEUT CAP -T H*C.I. VENT PIPE 2S' FROM DOOR. —T WEATHER, PROOF APPROVED LOCKING JUAICTIOU BOX MANHOLE COVER WIIJDOW OR FR.CSH it'MIU. ( j Wlb AIR INTAKE. GRADE 'I'MIAJ. (� COUDUIT INLET VIDE �VM IRTIG'dSEAL I APPROVED JOINT A •�' c"JalooWN I I I APPROVED JOIA� W C.I. PIPE CXTENDIW6 3' p t1�11'AN I I ALARM EXTENDING 3' OUTO SOLID &OIL g0R I I ONTO SOLID it a . '� 14: 5jR►, �� Cgs S i ou . ELEV. FT. __J PUMP-� orr o CONCRETE BLOCK RISER EXIT PERMITTED OULU If TAWK MAIJUFACTUKER HAS SUCH APPROVAL SEPTIC 3PECIFI'CA f IOUS 870 /r (i 5 oosc• � (JU TAWKS MAIJUFACTURER: r18ER OF DOSES: PER DM TAWK SIZE: ��© GALLOIJS DOSE VOLUME ALARM NMWfACTURCR: r t INCLUDIIJG LACK/LOW: 9 7' C GAut om MODCL LIUM1I;ER: CAPACITIES: A= INCHES OR -33 GALLON. SWITCH TSPL: Q° "' '�^'`� 8= IMCMES OR GALLON PUMP MAUUFACTUKER: D t t �.Gx G= ' INCHES OR 98 CPALLOIJ MODEL IJOIASER'. ���' D= INCHES OR ' O 7' GALLON SWITCH T%IPC: COTE: PUMP AMD ALARM ARE TO BE MUNIMUM DISCHAR" KATE ldZ3 GPM INSTALLED OU SEPARATE CIRCUITS VERTICAL DIFFEREti10E OETWC[IJ PUMP OFF AWO OI3TRI6UTIOIJ PIPE..ZO'Q FEET Z Z. z 9 } MILIIMUM NETWORK SUPPLY PRESSURE . . . . . . . . 2.5 FEET ♦ l�D FEET OF FORCE MN X Z.2 %(oo nFRICTIOW FACTOR. _ FEET TOTAL MOJAMIC. HEAD FEET UJTEKLIAL. DIM IONS Or TA".: LELIGTH ;WIDTH - LIQUID DEPTH LICEMSE WUMGER: a ■■■■■■■■■■■■■■■■■■■■ ®■■■■■®ilINN ���\■■■■■■:�■■■ ■■■!■■■■1■ ■■■\■��\■■v■■■ VL MODEL 3885 - - .. ■\■■■■■■■■■■■■■■■■ H a r STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z a a H OWNER/BUYER 1 r ROUTE/BOX NUMBER l'I' �'Li �� r�C��� - Fire Number CITY/STATE,5�v - �l �Ii � ��j /7 ZIP PROPERTY LOCATION : Pe, 14, NGV 14, Section T 3 / N , R / 8 W, Town of r� M �rt�4.�'��_ , St . Croix County , Subdivision A)/ Lot number Z �. 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 , 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 . 0 F 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- ro ment of Natural Resources . Certification form most be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED alt _ DATE ll/f�z St . Croix County Zoning Office P . O . Box 98 Hammond, WI 54015 715-796-2231 or 715-425-8363 Sign , date and return to above address . 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. Owner of Property Location of Property ,� _ ktL) 14, Section , T_ .L f N-R W Township Mailing Address ! „ �s� _ _ Address of Site Subdivision Name Lot Number Previous Owner of Property , 1 car n1 v9,r� �� .t Total Size of Parcel Date Parcel was Created — Are all corners and lot lines identifiable? L-----Yes No Is this property being developed for resale (spec house) ? Yes v No Volume,37D and Page Number 41-15 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 1 (We) eenti6y that aU statement,6 on thi4 60nm ane true to the beat o6 my (oun) hnowtedge; that 1 (we) am (cute) the owneA(b) 06 the pnopeh ty dens cA i.bed in this in6oAmation 6o4m, by vi ttue o6 a wa Aanty deed neconded in the 066ice 06 the County RegiAten o6 Veeds ass Document No. off¢_ , and that I (We) pnedentty own a pnopoeed d-ete bon the 6ewage dispoe byb em• (on I (we) have obtained an eabement, to nun with the above d6o i.bed pnopeUcty, 6o,% the eondtnucti.on o6 6ai.d a ydtem, and the tame had been duty neconded in the 066ice o6 the County Reg.i.aten o6 Veedd, ad Voeument No. ) . SIGNATURE 011 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ddaumii:Alf N0. Y G' ��LG�n wANA �i.r IEl1 11TA fb;01V Wl"NNIN-MAM i TNIs SFA42 RUMV0 FIM 890001110 DATA n[ A 7 ---5th _'__ April THIS INDENTURE, Made this . ..... ._. .._....day of... ....... ...... A. D., 19..0 between.._-SherMan -K.••--Stromen---_and Isabelle --•, 9men•,,.:..husband --and wife ,.. ........ . ....... .. ..... .........I• .................................... ...-- --. --....... ... ... . .. .................. .-....-.part. ies.of the first part and .........Paul---M--Pitzen,- and-..Bonita...M.....-Pit-zen;. Husband-........... ...--and._.wife....as-_--3o-int....tenantz. •. ..............._... --- --- part.49A..of the second part, RETURN T4 W 1 t n.e a s e t h, That the said part.. 1eS.of the first part, for and in consideration o[tbs,um oc--Qne,.-•dollsr••,--�-$1•.•00 -.- and other valuable-••.cons ' - : ..._. ....-._... ... ... ,::..._.. ........toa� .in hand paid by the said partl.es._.of the second part,the receipt whereof is hereby confessed and"ai4nowledged,ha.Ve-..:given,granted,bargained,sold,runised,released,aliened,conveyed and confirmed,and by these presents dq...... [CtYPC, nt,bargain, sell,remise,release,alien,convey and confirm unto the said part.-1e. f the second pwtthein and assigns Jy • , thaofbrflptg described real estate situated in the County of.StIOlX -•,•-•-•---•and State of Wisconsin, to•wit; t Part of Government Lot "1t' of section 3-31-18, described are follows : Commencing at a point R` which is 68:1.91 feet South and 1914.04 feet East of the NW corner of said section 3 as the POINT OF BEGINNING for parcel to be de- scribed ; thence proceed S 86 degrees 16 min- ; k' utes East a distance of 200 feet to an iron, r n pipe set on a meander line on Cedar Lake thence proceed S 2 degrees 34 minutes along paid meanderine a distance of 125 feet to ` " an iron stake; thence proceed N 86 degrees 16 minutes W a distance of 260 feet town iron r; f stake ; thence proceed N 28 degrees 25 minutes E a distance of 137 .59 feet to the point of beginning. r, (IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) Tii 1 with all and singular the hereditaments and appttrtenances thereunto belonging or in any wise appertaining;and all the estate rigbt,title,interest,claim or demand whatsoever,o[the said part:le%f the first part,either in law or equity,either in possession or expectancy yaggil svthe a ve bi-gained-pr"vtires, and their hereditament.n:o, .,pFarteparLM. _ r TO 4"was To Hold the said premises as above described with the hereditat ents TiYitt appurtenati a6 � . k^� v part,and to..U.IelX-_heirs and assigns FOREVER. y„ j<. . And The saW_..5ale. an..K..:...St9te. .....,.and ..lsabe-j7�-e_..S.trS24i<£. ......... ` .............................................................................................. ....... .... ................._ _. .......---......_._-...-....... for.......thei r..........................._..........----_...........heirs, executors and administrators, do................covenant, grant, bargain, and agree to and , with the said part- efilof the second part,..thei.I;...............heirs and assigns, that at the time of the ensealing and delivery bf these presents . ._..-:-._...d.XS'..................well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple,and that the same are free and clear from all incumbrances whatever.................................................................................... ..................------•--_...----.........•-- ._-...--- .._......--.....__ . _-.._•_..-...-.-.._...-•-•-_-....................................................--__•,............................. and that the above bargained premises in the quiet and peaceable possession of the said part._IeSf the second part,t.bP-A&s and assigns, against all and every person or persons lawfully claiming the whole or any part thereof,•t-hey....--..will forever WARRANT AND DEFEND. In Witness Whereof, the said pariefil__.of the first part ha-Y_1=_-hereunto set..theiX.hand-S-.._._.and sea§-__..._.this......5th...- day of—April................... A. D., 19---69_... ED AN S ED N SENCE OF „ A/�1'�a�--�—_ (SEAL) P Sherman K. Stromen (SEAL) Ga L. Bakke Isabelle Stromen ..._.-....-• -- ...-•.............. r (SEAL) / Llewellyn R•.---Reinstra •-• (SEAL) .•..............•.................._.........._.......................... STATE OF WISCONSIN, ss. _._St-... O1X.. ... ....----County. Personally came before me, this...................�th ..day of..._.ApY_1:1_...•-•--_..••..............................._...-•....._........,A. D., 19.69 the above named..:Sherman K. Stromen and Isabelle Stromen....................•...........__.-.-..................,..•.__...•..__......_...- ----------..............................................................-.......................................... -..-.-.............................................................._....._......... .. tome known to be the person-R--....who executed the foregoing instrument and acknowledged a sa . /�j L.R. Reinstra NOtAit► ......._.........................._................................................ St . Croix This instrument drafted by %4,Avrti Public.............................................._--..........County,Wis. is permanent DGar....Dr •. 8r NOVPan................................ Nv Commission ( .--......... _.................................... (section 59.51(1)of the Wisconsin Statutes provides that all Instrumento to be recorded shall hate plainly printed or typewritten tbwom the noses u at the trantors,ustatoss,witnesses and notary)- I. Co.wllr .:.,' ST. CROIX COUNTY WISCONSIN y a, .... ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) - HAMMOND, WI 54015 April 21, 1987 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sire: An on site investigation for the Paul Pitzen property located in the NE 1/4 of the NW 1/4 of Section 3, T31N-R18W, Town of Star Prairie, in St. C roix County, revealed that the only suitable area for a system is by using an in-ground pressure system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator TCN:rc i I x _ 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 NE 1/4, NW 1/4, Sec. 3 T 31 N, R 18 Vx W Town or Municipality Star Prairie Street Address 44 Morningside Dr. St. Paul, MN 55119 Lot No. Block Subdivision Landowner's Name: Paul Pitzen 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: ❑ to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numFers ssuea—to ) ❑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. [-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: ©a failing conventionalsoil absorption system. ❑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 lot meets the criteria for a conventional private sewage system, check here. I certify that the above information is true and accurate to the b t f my knowledge. Name Thomas C. Nelson Sign-at6re County Official Title St. Croix County Zoning Administra+ Date April 21, 1987 DILHR-SBD-6158 (R 12/82) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING " P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township/Municipality: NE 3L NW k1s 3 IT 31 N/R18 XX W Star Prairie Street Address: Subdivision: County: 44 Morningside Dr. St. Paul, MN 55119 St. Croix Landowners Name: Mailing Address: Paul Pitzen 44 Morningside Dr. St. Paul, MN 55119 I (We) , the undersigned , hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted , I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this 6pplication subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19_ Notary Public, State of Wisconsin My Commission Expires: DILHR-SBD-6413 (N. 05/81)