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`Parcel #: 038-1149-70-000 08/15/2005 11:26 AM
PAGE 1 OF 2
Alt.Parcel M 17.31.18.668 038-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
ERNEST D&PATRICIA A NELSON O-NELSON, ERNEST D&PATRICIA A
912 BRAVE DR
SOMERSET WI 54025
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description *912 BRAVE DR
SC 5432 SCH D OF SOMERSET
SP 8050 SQUAW LAKE RHAB&MANAGE
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 2617-WIGWAM SHORES
SEC 17 T31 N R1 8W LOT 9 BLK F PLAT OF Block/Condo Bldg: F LOT 09
WIGWAM SHORES ALSO PT LOT 10 BLK F DESC
AS COM NW COR LOT 10;TH N 41 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
57.41';TH S 48 DEG E TO MEANDER LN 17-31N-18W
SQUAW LK;TH SWLY ALG MEANDER LN TO ITS
INTERSECTION WITH SWLY LN SD LOT;TH
more
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1049/08 WD
07/23/1997 758/453
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 72,000 133,600 205,600 NO
Totals for 2005:
General Property 0.000 72,000 133,600 205,600
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 72,000 133,600 205,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 204
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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-14, NEk, S17,T31N-R18W ENCONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number:
Town ofStar Prairie ❑Holding Tank El In-Ground Pressure Mound 08.201
Lot 9 Block F Wigwam Shores
NAME OF PERMIT HOLDER I ADDRESS OF PERMIT HOLDER: INSPECTI N D T
Ernie Nelson 109N McKnight Road, Apt. 212 St. Paul Mn ./� g
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN'. REF.PT.ELEV.: CST REF.PT.ELEV.
Name of Plumber JMPIMPRSWI No.: County'. Sanitary Permit Number:
Calvin Powers Jr. 1563 St. Croix 102835
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
q PROVIDED: PROVIDED
/A 32 OYES ❑NO ❑YES ONO
BEDDING. VENT DIA.. VENT MAT L.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING. JVENTTOFRESH
JALARM FEET FROM LINE'. AIR INLET
DYES ONO DYES ONO gNEAREST
DOSING CHAMBER: �f� O ^ {�b S. /6 �*
MANUFACTURER BEDDING. ILIOUID CAPACITY PUMP MODEL. PUMP IPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES FIND ❑YES ON DYES ❑NO
GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL'. NUMBER OF IN WELL BUILDING VENT TO FHESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH IDI AME TEH 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:
BED/TRENCH WIDTH LENGTH NC OF C S PIPE SPACING MATERIAL: PIT INMUE DIA &PITS LDI OTIID
DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR P ' DPIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FHESH
BELOW PIPES. ABOVE COVER. ELEV.INLET ELEV.END'. PIPES LINE AIR INLET
FEET FROM
NEAREST--►
MOUND SYSTEM:
Mound site pl ed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furr thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑NO
SOIL COVER ITE XTURE PERMANENT MARKERS OBSERVATION WE LLS
EYES ❑NO EYES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER. EDGES.
_ YE S ENO D YES ❑NO E YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING (TRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO OI STH DISTR.PIPE DISTHIBUTION PIPE MATERIAL&MAHKIN(;
ELEVATION AND
ELEV.'. ELEV.. DIA. ELEV.. PIPES DIA
�p
DISTRIBUTION UU
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES El NO DYES ❑NO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS'. NUMBER OF PROPERTY JWIELL'. BUILDING
FEET FROM LINE
DYES ❑NO [:]YES ❑NO NEAREST
-
/ r/ i
rill = IUC� �f Z.f tr
y,zoly.,la, MwA, ,mot. - ll�s
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE
Zoning Administrator i
DILHR SBD 6710(R.01/82) t
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
pijmper wherfever necessary, usua[ty:7every 2'to 8years;
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;
Ili. 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 81/2 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; 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 �T
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 Groundwater,
—
included the creation of surcharges (fees) for a number of regulated practices which Wisco, ws
can effect groundwater. The surcharge took effect on July 1, 1983. All of the water that buried feasur
is used in your building is returned to the groundwater through Vour soil absorption o
system or the disposal site used by your holding tank pumper.
n
The monies collected through these surcharges are credited to the groundwater fund adminis-
terecl. by the Department of Natural Resources. These funds are used for monitoring ground- f
wate , grourdwater contamination inv estigations and establishment of standards. Groundwater,
it's worth protecting.
SRD-`-.3 i8(8.03!86)
i
DILHR SANITARY PERMIT APPLICATION COUNTY ���
Y: In accord with ILHR 83.05,Wis.Adm.Code
STATE SANITARY PERMIT#
16 or?
—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.
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES N NO
PROPERTY OWNER PROPERTY LOCATION
4 '/4, S %7 N, R IS E(or)g
PROPERTY OWNER'S MAILING AD RESS LOT NU BER BLOCK NUMBER SUB (VISION NAME
T
CITY,STATE ZIP 60DE PHONE NUMBER CITY NEAREST ROAD,46K -OR LANDMARK
VILLAGE
p. ,/ i
II. TYPE OF BUILDING OR USE SERVED: /W` ��0 �7 g— 7d-00
Number of Bedrooms if 1 or 2 Family OR Public(Specify):
Ill. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. � New b. ❑ 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. K Alternative c. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e..3 Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. N 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):
Feet N Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glace Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank
Lift Pump Tank/Siphon Chamber ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installationjot3he private sewage system shown on the attached plans.
ZZber' Name(Print): Plumber's Signa re:( Sta ps) MP/MPRSW No.: Business Phone Number:
1dj,4y pad_;z"es )XI-4 I-S-6- <
Plu er's Address(Stree,City,State,Zip Coltler Name of Design r:
VI(I. SOIL TEST INFORMATION
CertrtJ'{y''ed Oil Tester ST)Name CST##
CST s DRESS(Str et,City,S te,Zip Code) Phone Number:
3 0
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved N�bo,oa ermit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial Sur ar e F e /� f7 Adverse Determination � �
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
f
4
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY&BUILDINGS DIVISION
PRIVATE SEWAGE PLAN APPROVAL
Office of Division Codes and Application
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53/07
CALVIN POWERS, JR. Owner: ERNIE NELSON
ROUTE 3, BOX 249 109 NORTH MC KNIGHT ROAD, APT. 212
NEW RICHMOND WI 54017 ST. PAUL MN 55402
RE: Plan Number 87-08201-S Date Approved: November 21, 1987
Gallons Per Day: 450 Date Received: November 20, 1987
Project Name: NELSON, ERNIE - RESIDENCE Location: SW,NE, 17,31,18W
'Town of STAR PRAIRIE County: ST GROIX
Fees Received (Priority Review) 160.00
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements. This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans arre
stamped 'conditionally approved' . This approval is contingent upon compliance with
any stipulations shown on the plans. All items that are noted must be corrected .
All permits required by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department' s approval stamp at the
construction site. 'The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have riot been reviewed for the code requirowerlts
set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the following components only:
- NEW ("SOUND
Inquir' s concerning this approval may be made by calling (608) 266-2889.
Sine 1.,.. y.
P .TER E. PAGEL
Section of Pri ate S�:•u;agn
Division of Safety and Buildings
PPP013/0009n122
cc: ERNIE NELSON
Private Sewage Consultant ----County -------UW-SSWMP Plumbing Consultant
SBD-6423(8.10/87) —Owner ..........-Plumber �-Environmental Health
WORKSHEET - MOUND SYSTEM DESIGN
PRDBLEM:
Design a mound system for a
The site characteristics are: ,�5�- in.
pepth to groundwater or bedrock t
Landslope � min,/in.
percolation rate ft.
from dose chamber to distribution system
Distance fG.ton
ion difference between Dump and distribution sYs
Elevet gal .
step 1.
WASTEWATER LOAD /`? �y� X
Step 2• SIZE ''tHE ABSORPTION ARE
.. Sqy ft.
�. Area fr i red • 5 C'j �'; /,;1 r 3 y
ftP
B) Bed or trench length (g} ' ' ft.
y
L) Bed or` trinch width (A) '
p) Trench spacing (C) ' 8 . *...--- ft.
L .24 coal/ftz/day
x stewater loa
tree+ es
Step g• MOUho HEIGHT _� ft.
q) Fill depth (D) ft
i
B) Fill depth (E) D ♦ slope (A_
0 Bed or trench depth (F) "`
ft.
D) Gap and topsoil depth (G) ' I.-ILICEIVED
ft.
E) and topsoil depth [ (jV 2 C� 187
n�prR �p.+Yr
Z- 8708zo
,.t
Stop 4. MOUND LENGTH
A) End slope (K) (D + E 1 + F + H x 3 « f�„ �s' ft.
B) Total mound length (L) • B + 2(K) ft.
Step 5. MOUND WIDTH
Al) Upslope correction factor
A2) Upslope width (J) (D + F + G)(3)(factor) ft.
01) Downslope correction factor =
B2) Oownslope width (I) - (E + F + G)(3)(factor) , ft.
C1) Total mound width (W) for bed J + A + I ft.
C2) Total mound width (W) for trenches
+ g + (no. trenches -1)(c) + A + I ft.
Step 6. BASAL AREA
A) Infiltrative capacity of natural soil gal./ft2/0V
B) Basal area required • wastewater flow :
natural soil infiltrative capa ity sq. ft.
r
C1) Basal area available for bed for sloping sites r
B x (A + I) s1 sq. ft.
C2) Bas are avail le for trench for sloping sites ■
B W 7J + A ' sq. ft.
C3 Basal area available for trench or bed for level
s*e s B x W = sq. ft.
Da*�•_1L�- _1 L_.
Vby 4 (^r
lW ,
Step 7. DISTRI66TION SYSTEM
7A) • SIZE DISTRIBUTION SYSTEM
1) Hole size =
�� in.
2) Hole spacing
in.
3) Distribution pipe length
4) Distribution pipe diameter i _ ;n
5) Spacing between distribution pipes
6) Distance from sidovall to distribution pipe
7B) DISTRIBUTION PIPE DTSC'IARGE R1,TE
1) Number of holes per pipe
2) Flow
per pipe
GPM
7C) SIZE MANIFOLD
1) Manifold is � central/ -. end
2) Manifold length a -
'_ ft.
3) Number of distribution lines
4) Manifold diameter ,
7D) SIZE FORCE MAIN
1) Minimum dosing rate m --
„�� GPM
2) Force main diameter
5 in.
3) Friction loss
ft.
7E) TOTAL, DYNAMIC HEAD
1) Vertical lift =
2) Friction loss =
r ft.
3) System head 2.5 ft.
ft.
4) Total dynamic head =
C key
8708201
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7F) PUMP SELECTION
1) Pump selected will discharge , GPM at . 5 ft.
total dynamic head.
2) Pump model and manufacturer
7G) DOSE VOLUME
1) 10 times voij volume of distribution lines * gal./cycle
2) Daily wastewater,volume ; 4 doses/24 hrs. / ;� gal./cycle
J.�/� �' .�C/ a /Zc ,15
3) Minimum dose vo urh�e I<= gat./cycle
7H) DOSE CHAMBER
1) Minimum capacity required "cX�-- yam gal .
is, e•_,,'L�.1'. ��'
N!EC I1 E-9
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808201
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RECEIVED
.q r,�a'vlrtrGps�lp� E`ll'°�'°n G(1Mt�
„.x
8708901,
model 3870 Submersible ble Effluent Pumps
140
120
�s
,tom
3
r
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Mg°ywjjs
°t W
pNo�,�•N P �
40
WPM03,'h H.P.
1 r 20 P03,'/,H.P.
�ur� 1y
5 60 80
100 121
A:
0 G1 ►►s perMlnute
Capes
H.P. Ordo r NO. VoHs
Wpp311 E 115 94
Sb
KPN4031 I F t150
y, Wp0312E 230 10 47
WPM03 12E
wpH0511E 115
wpH0512E, 2311 s 4 &
WpH0534E`
'• —WPH0534E 90
�� �1g� wPH0712E 230 '•
�A " % WPH0732E 2W230 30 z.7: 7o
�^ F vhgF°n Q'i fi`F WPH0734E 4_80 10 11 g 34M
WPH10/2£ 230
g4�
I WPH103 " 30 3.2
ryypHi.0,34 480 10 13.3
WpH1512E 9.2�
1 WPH1532£ 30 4.g SIC
WPHt53£ ASO
230 10 13.3
a Wp~512E 9.2_
WPHH1532E 2OW230 30
r WPHH1534E
4E0 416
5 $ S CIFICAT IONS ARE SUBJECT TO CHAN E WIT,
Ir
Ir
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Lateral �n , Inc,It(4S `l�
License Humber: Mani fold " Inohes ;`
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Force Main In�°tos,
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Q-82
'j 0 V_ t?_.1987 T
PAGE OF ;
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VENT CAP
4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING
2S' FROM DOOR,
JUAICTIOk1 BOX MANHOLE COVER
. � 12"MIU.
WINDOW OR FRESH
AIR IMTAKE
GRADE
I MIN.
CONDWT ----
IB"h11A1. ---
G PROVIDE
KT $CAL
APPROVED JOINT A APPROVED JOINTS
W/C.I. PIPF. Y
� ��, �� .4 I I W/C.T. PIPE
EXTENDIM& 3' 4 Ill ALARM EXTEaV01A16 3'
ONTO $01.10 Sc;:. G I ONTO SOLID $OIL
kN
Ow
PUMP
--� OiF
COMCKETE BLOCK
RISER EXIT PEKMIT'ED OWLy IF TANK MAMUFACTURCR HAS SUCH APPROVAL
�SPE FICATIOUS 8708201
SEPTIC AND
DOSE TAMKS MAWUFACTURER: r "-)r. .(', S.. r:fll ZW1, , NUMBER OF DOSES: / PER DAJ
TAWK SIZE fir GALLONS DOSE VOLUME /
` ! / INCLUV!-!C ;,A BLOW: S.�•y GAIEOAtE
ALAR MANUFACTURER: ?-i .r��r; ¢�fw:. ' tt.P J. ,'
MODEL AIUMBER: _ !� �.1`.C' CAPACITIES: A= aa INCHES OR r1-12 GALLOUS
SWITCH TYPE: Yle GALLOWS
,\ J ���
PUMP MANUFACTURER: C= �� INCHES OR GALLOWS
M 0 D E L WUM5EIt' " D- INCHES OR 6n`,'- GALLONS
SWITCH TYPE: ' MOTE: PUMP AMD ALARM ARE TO BE
PUMP DISC.HARf.E RATE .. �_ GPM 1 1 IUII►`} INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENC[ B€9'WEEIU PUMP OFF AMD DISTRIBUTION PIPE.. 4-�2 FEET
+ MINIMUM NETWORK SUPPLY PR/E/S;�SURE . . . . . . . . , . . 2.5/ FEET � �
�d.(' FEET OF FORCE MAIN X LLF/ocFtFKICTIOU FACTOR.._Lr:L,_ FEET 0 �9 �
TOTAL Ot AWAMIC HEAD = // ^ FEET �Pa!►�A!al �,� °^,�!, N"
INTERNAL RIMEWSIO OF TA►JK: LEM&TH ;WIDTH ;LIQUID DEPTH
SIGNED: ` LICEIJSE NUMBER: DATE:
-117
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l9�ft7 STRY :REPORT 0 1 WRINGS AN1
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"t#f� N RELATIONS
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N 1 ND: f f OLDt K:R7? ENI�E 31T t
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t#f�etcolation Tests aft NOT re Uir DESI RATE
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9 If ari>�oorticm of th>I fes#kd area is n the` t
t.H63.G%5)1b),rJndicaze: ,`, Fioodpfain,indicate Flo ciPisin eI}tvatic3ia
PR"LE DESCAWTIONS ,
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TOTAL 04M Ei.f�VAT10N T � 4 A
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ttLOf FLAN: Show fgcations of percolation tests,.soil borings and tf�e i hinen�ns o suitabfe soil areas. ,indicate,so t.Qr dishes dap arq
on �and vertical elution reference points and*how their lo, 0011,tp�plot plari'�Show the surfaCe.Mrlevation$#all �fpn00e arad�di�a►
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a1 TEM EI ViA71ON .f Q
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i.the: ersigned,hesetay certify that'the.nail tact*rPr- ,ed en this 4m..ra �..p tix r..0 P X01*� ....-1 d.xw G�gs'Aw�.i+ � f'i t+t• �- . $ ;s
e n fi n of h - o rtc toA of knov3ied e a Lief. •a'.
Adrnhiittrative Code,and that the data recorded a d t e location t 8 tom arlt c (hl# my g
l� pflt !-
f N r
Aid ss: j . r 1; Tt KA ION Na n+BE , P
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tT18 tiIBUTItaN:Original and one copy to Local Akuthority,Property uer,and Soil Tester. ,y
Ok
ni3i`id�i-•`iBD=6395 iFi.Q2{82}. OVER
APPLICATION FOR SANITARY PERMIT r
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 Pro ert '�L, Section _ T N - R W
P Y - Lr`� -
6i?wnship
1
Mailin g Address r _
Subdivision Name / r,j,
Lot Number
Previous Owner of Property 4�1""';W 6
Total Size of Parcel i
Date Parcel was Created SIJS
Are all corners and lot lines identifiable? � Yes No
Is this property being developed for resale (spec house) ? Yes _ No
Volume 7r- and Page Number - 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) ceAti.6y that a t 6tatement6 on .thiA faun ane tAue to the best ob my (oun)
know2edg e; that I (we) am (ane) the owneA(.$) o6 the pnopWy d"cA i b ed in this
in6onmcLtc:an 6anm, by v.cictue a6 a wahhavrty deed neeonded in the 066
County Reg i den o6 deeds as Document No. ' ''' ' ; and hcit I (we)
pneaen Zy own the proposed .6 to bon the be a-ge pod sybtem (on I (we) have
obtained an easement, to nun wi th the above de6cx bed pnopen ty, bon the
conb,icucti,on o6 6a.id b yetem, and the same has been duly neeonded in the 066.iee
o6 the County RegiAten o6 'Deeds, as Document No. ) .
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER IF APPLICABLE)
DATE SIGNED DATE SIGNED
• DOCUMENT NO. �I STATE BAR OF WISCONSIN FORM 1-1988 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED ,
5758 BOOK 158PAGE
Ral h S Nuebel ST, CROIX CO-' Woo
This Deed, made between P '-------- ---- 0th
.9wrd this-3-=-
................ Redd.for b
----•-------------------------------------------------•---•----•----• Oct
p.D. t9
Grantor, dcry 4:00 F MA
and----- -----_---------------
Wye,_. S_.j 41 x�t_ .enants----------•---...---•----------------
.................................................................................................................
------
----- --------------------- - -
-----------• ------------ - -
--- ------------------------- -._, Grantee,
-
Witnesseth, That the said Grantor, for a valuable consideration....._
;Y ...._...................•............._......................................_........_._°----....-°-.......... R
ETURN TO
`d conveys to Grantee the following described real estate in St,__,CIOiX............... I Ernest D. Nelson
County, State of Wisconsin: 1 169 No. McKnight Ave. Apt. 21
Lot 9, Block F, Wigwam Shores, Star Prairie Township, -S1 ---Paul- _M^
according to the plat thereof on file at the Register
of Deeds Office for St. Croix County.
Tax Parcel No
Together with a non-exclusive easement over that part
of the private road shown as Brave Drive on the plat
of•Wigwam Shores. More fully described as followst
Beginning at the North-South town road, lying Easterly
Of said plat; thence Westerly along said Brave Drive,
thence Northerly along said Brave Drive, thence Easterly
-along said Brave Drive to a Northerly extension of the
East line of said Lot 9, Block F, the point of termination
of said easement.
i
N SE
yalt �I'i
-------iS-.not--------- homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And---------•-----------•--------•----------------•--••--------------•---•-------•--•---------------------•----------------•---••--------------•-------------
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
ii
and will warrant and defend the same.
Dated this ...22nd-.................................... day of -----QG:tQt?e;C-...............................................
.. 19$�.....
i
•------------------------------•-----------------••••-••-•--•---•--••(SEAL) .................. •. ---- (SEAL)
Ralph S. Nuebel
....................
•------•-•--•.....................................•••.....---•-.•••--(SEAL) ....................................--..............................(SEAL
)
AUTHENTICATION ACKNOWLEDGMENT
Signatures) _.------ STATE OF
------ ---------------------- -- -
so.
--------------------------------------------•---------•------------------------ -Wash in Opt on
---------------------County.
authenticated this --------day of--------------------------- 19...... Personally came before me this --..Und...day of
----------------------- 19__86._ the above named
----------------------•-----•-----------------------------------•-------------- Ralph.5._Nuebel
-•-----------------------
* ------------------ ------------------------- ---------------------------- -•-------------------------------------------------
TITLE: MEMBER STATE BAR OF WISCONSIN --.--_
(If not- ---------------------•--------•----------------•------------ ---------------°--------------- ------•-----------------------•--------------
authorized by § 706.06, Wis. Stats.)
to me known to be the person ............ who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
..
Aal�ah._ ...Nueb�1...................................................
55025 ._ ---
2134P Fondant Ave. Forest Lake, MN. Notary Public __ �'?
--- ---- !,Ys��:- -----County,
IVA
(Signatures may be authenticated or acknowledged. Both My Commissiiron!is permanent.SI f t ation
j are not necessary.)
date: .. /
BERNtEE M: KO&TUG
YrBBEiE�liNP4:bOTA-�,__.—�:-��
*Names of persons signing in any capacity should be typed or printed below their signatures.' WASHINGTON COU"iTY
.,.. STATE BAR OF WI9CON3IN t MY Comm.wip�res Nov. 1�. 199x1
WA._..ANTY DEED FORM No. 1-1982 .,�.,,,r.r►�w•a'1@41 .
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ST C - 105 r-
9
SEPTIC TANK MAINTENANCE AGREEMENT '
c
St . Croix County z
d
9
OWNER/BUYER / p7
ROUTE/BOX NUMBER V �r i/(1 ��i7� Yl� Fire Number
CITY/STATE ZIP
PROPERTY LOCATION : -jjj '-t, Section��, T _:�/ N ,
Town of—`- _ St . Croix County,
l L _.
Subdivision Lot number
���f-",h.�;�sl _��,���
I
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 pit 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 . Cr'bix 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 . c
I/WE, the undersigned , have read the above requirements and agree v
to maintain the private sewage disposal system in accordance with
the standards set forth , herein, as set by the Wisconsin Depart-
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 .
SIGNED
D A T
St . Croix County Zoning Office
P.O. Box 98 1
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign , date and return to above address .
•�, .,i�' w�:`""'�'? antK. C y zr{ • '�^s r.'Mp.�!:1 ' ° ����� �;'�•z�
) Rnt
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. .'— ---- .— ^� 2a•ta' � -'of rr. '.
� U•I MINI e.0• � � •U• O .
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'-- -----%_mow-,�."' tvh•�a,.r. � I
ST. CROIX COUNTY
sy � WISCONSIN
Aft�A
* s��3a ZONING OFFICE
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
November 18, 1987
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Ernie Nelson property located in the
SW 1/4 of the NE 1/4 of Section 17, T31N-R18W, Town of Star Prairie,
St. Croix County, revealed suitable soils at a depth of 2.2 feet, 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
TCN:rc