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CD .9 O Fn O 0 I 0 0 CD (D a ° o °- ° o c S REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM S anti.1 a4 y P 2><mi t r State Septic t Township St. St. CAoix County Locatio /w ction Lot # Sub cv, sion Size gatto ns Numb vL o b eo mpatetmentt6 / Di btcom: Wett Building 1.20 btope Highwate& PUMPING CHAMBER Size gattons Pump Manubaetune'T Modet Number HOLDING TANK Size x,610,90 gattons Numbers ob Compartments / Pumpers J Atatem System Di.6tanee beam: Wett Buitding 120 s tape - j 4�,_ � Highwatvt ABSORPTION SITE Bed Trench Distance bn.om: Wett Building 320 6tope Highwaten ABSORPTION SITE DIMENSIONS Width ob tteeneh bt Requi4ed area 6t Length o6 each tine bt Depth ob tco below tite in Numbers ab ti-ne,6 Depth ob tcock oven tite in Tatat length ob tines bt Depth o6 tite below grade in Distance between tine,5 bt Slope ob tkeneh in. pelt 100 bt Totat ab /soAption area b,t Type ob Coven: Papek otc 6tkaw PIT "DIll�iL .SIGNS Numb etc o b pits Gkavet axound pits ye-s no Outside diametete bt Depth betow .Lnte,t bt Total ab.sotcption atcea bx Atcea tcequtitc.ed bt INSPECTED By TITLE APPROVED X e DATE � O" 198 REJECTED DATE 19 REASON FOR REJECTION r I REPORT ON INSPECTION OF SANITARY PERMIT # 13 - IN (1 ) Name and Address of Permit Holder Person /Persons at Site (2 )Date of Inspection me, re s icens o o ins tan Plumber Time of Inspection 3L TON CO7,STS OF: Septic Tank [:]Seepage Trench [:]Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed , Holding Tank []Fill System B Permanent reference oin escriT e: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is.the warning device installed? []YES ❑ NO Wired? []YES ❑ NO 8 HOLDING TANK: Manufacturer of gallons ; construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES []NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES []NO; Wired? []YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe - elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE R N H: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? []YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES Q NO DILHR -SBD -6095 N.05/80 Signature of Inspector State and County 67' `•State Permit Application County Permit# for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date A,jproval Received from State if Required State Plan I.D. A. OWNER OF PROPERTY Mailing Address: C,,4-L1 �ol�' CI mob, In B. LOCATION: M '/4 '/4, Section T N, R E (or) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY 2 6 0 cJ Total gallons No. of tanks r Prefab concrete Poured -in -Place _� Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length Width Depth Tile depth (top No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than p owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, NAME C.S.T. # and other information obtained from (owner /builder). Plumber's Signature MP /MPRSW# 7 3T Phone Zq3— 3 ,2 3 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. RE t : LD SECT 10,1 . F m m�� �. E E i r I » e W Wpm t � E J t t 1 { � F I i � E —.,e. 7 8 Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application 'J - � Fees Paid: Stat q'�j.L County S�� D = v�•5 - Permit Issued /Rejected (date) - L) Issuing Agent Name Inspection Yes _No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P 2. state (pink copy) 4, plumber (canary copy) EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOI L BORINGS AND PERCOLATION TESTS a LOCATION :YlL' ,L��1'/4, Section -a, T I, R jS (orj(W ownship or Lot No. � , Block No. County ubdivi ion Nam Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B- B- B- PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 1 t 'N Li I 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 the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my kno ledge and belief. n Name (prin e k xre fi7z Certification No: Address Name of installer if known CST Signature COPY A —LOCAL AUTHORITY r 60 PRO.aECT DETAIL DATA SHEET /J NAME OF BUSINESS LEGAL DESCRIPTIO`N` OWNER MAILING ADDRESS S, ZIP - ARCHITECT, ENGINEER,Q ADDRESS / MBER R DESIGNER ZIP TELEPHONE NUMBER 7. Check appropriate building usage(s) - and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building T� - New building Addition ( ) Apartments and co ndominiums - Number of bedrooms ( ) Assembly hall . Seating capacity ( ) Bar ,.. . . . Seating capacity I- of meals served ( ) Bowling alley . Number of lanes ( ) With bar ( ) Campground and camping resorts . , , Number of sewered sites Number of unsewered sites ( ) . __ Total, number, of sites Camps s . ( ) Day use only Number of persons ( ) C ( ) Day and night Number of persons atchbasin ( ) Number Church , • ..R ( ) No kitchen .Number of persons ( ) With kitchen Number of person ( ) Dance hall . . . . . . . . . . . . . Number of persons ( ) Dining hall . . , , . , . . . . , Number of meals se — daily ( ) Doq kennels , . . , . , . , . . . . Number of enclosures ( ) Drive -in restaurant , . . . . , . . Inside seating capacity Car- service -- Number of car spaces ( ) Dump station . . . . . . , , , . . , Number of dump stations Employees ( total of all shifts) . . Number of employees ( ) Hotel ( ) Motel ( j Cottages . . , . Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. • Number of doctors, nurses, medical staff Number of office personnel Number of patients ( ) Mobile home parks , . . . , . . . . Number of sites -� Nursing ( ) homes ( } Parks , Number of beds , . Number of persons _ ( ) Toilets ( ) Showers Restaurant Seating capacity er)QA7A �� �� (0A-*-;) Dishwasher a;lu/or disposal? ( ) Retail store . . . , . , . . . . . Total number service fcustomers ( ) Schools . , , . Number of classrooms Meals ( ) Showers ( ) Self service laundry . . . . . . , Total number of machines ( ) Service station . . . . . . . . Number of cars served daily ( ) Swimming pool bathhouse . . . . . , Number of persons ( ) OTHER (Specify) , . . . . . . COMPLETE OTHER SIDE 2. Indicate whether the following facilities are present. * too Floor drain yes no _� Number of drains Food waste grinder .yes no Dishwasher yes no Automatic clothes washer yes no Number of clothes washers - 3. Septic tank capacity Holding tank capacity Septic or holding tank manufacturer 4. SEEPAGE TRENCHES: total square feet width of trenches length of trenches _ T depth � number of trenches SEEPAGE BEDS: total square feet _ _ _ width length of bed depth _ - - - -- -_ _� SEEPAGE PITS: total square feet outside diameter depth below inlet_ total depth from top to bottom of pit Signature of person completing form: FOR DEPARTMENTAL USE ONLY Address -- —�- �-- -- — P - Telephone Number Date s This agreement, made and entered on this 11 t lday of MARCH 19 by and between the Township of SPRINGFIELD P ddress GLEN HILLS GOLF CLUB, IN C. GLENWOOD CITY, WISCONSIN V- S: I n application has been made for a sanitation system on the following described property: W. 1/2 OF S. W. 1/4 OF SECTION 11 V i I EREAS: Septic tank drainage does not meet the minimum standards of the ordinance of St. Croix County and state codes. Il a holding tank for tic tank purposes se owner agrees to insta P '4�,�F;REAS: The o� g g . purposes. NC.VT', TEEREFORE: For and in consideration of the issuance by the Town- ship of SPRINGFIELD of a permit for the above premises, the parties do hereby agree and bind themselves as follows: 1. Owner agrees that they will conform to all the rules and regulations pertaining to a holding. tank system. They agree that anytime said township deems it necessary to pump out said tank, the owners sha11 have same pumped out in 24 hours, or township have said work doneand charged to owners and place same on their tax bill as a special charge. 2. The Township reserves the right to assess a bond if they desire to cover any possible pumping charge in the sum of $ 60! IT IS UNDERSTOOD that this agreement shall be binding on the owners, their heirs and assigns. IN V►.ITNESS WEEREOF, the parties have hereunto set their hands and seals the day and year first above written. Township of SPRINGFIELD b Developer GPN H GOLV CLUB, INC. or owner � STATE OF V11SCONSIN) SS: _ COUNTY CF ST. CRS) - Subscribed and sworn to before me this day of � Q ��_ , 19 C. /l St. Croix ounty s -. CO- OPERATIVE EXTENSION PROGRAMS L� UNIVERSITY OF WISCONSIN- EXTENSION ST. CROIX COUNTY OFFICE - AGRICULTURAL CENTER BUILDING BALDWIN, WISCONSIN 54002 AREA CODE 716- 684 -3301 COMMUNITY PROGRAMS February 2, 1981 To: County Board Members Town, Village and City Clerks Mayors, Village Presidents, Town Chairmen Interested Citizens'- Re: Solid and Toxic Waste Disposal Conference You are invited to attend the St.,_Croix.County Solid and Toxic Waste Disposal Conference to be held on February 13, 1981 from 9:00 A.M. to 3:45 P.M. at the Coachman Supper Club, Baldwin. A copy of the program is included for your reference. I believe that you,will find it to be an informative and interesting conference that will include discussions of environmental concerns, recycling, an update on the pro- gress of the St. Croix County Solid Waste Management Plan, .and presentations by representatives of area industries on their experiences and plans regarding waste disposal. Registration is $5.95 per person which includes noon lunch - eon, coffee and rolls, tax, and tip. No preregistration is required. Please notify others on your committees, boards, etc. of this conference and mark your calendar today to attend. if you have any questions do not hesitate to contact me at my office in Baldwin, telephone 684 -3301. See you on the 13th:. Sincerely, r � 2esJanke" Extension Resource Agent St. Croix County sen "UW- Extension provides equal opportunities in employment and programming" University Extension - U. S. 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' � a n7"f° x."�" :k a* of r `,wp P 4 _. Y'y x V _ -{ 9 ���� 5„ I �T';_''..y i � v � ' + �.`�,Y" ��, x %#,b'1 y ,,.,tl 11 ,� 3 �at r,1y(..•_ ♦y�.# � 1, 1 � ¢ y'4 4 •Y' � � ,Gt?Ytr -.. ,i Q 4 - f1 °+ h S e r y kr y�.' sr: *e 'k . it r# } ?tea "Al .. ,� ,w �' >y rf " , m fi e a i 1 1 � ' ° (4�y,, a t � z a er `� x vl a �' xw X 11K S 5 f ,v' . y � m 11, c 'i" 4 .i .,F.y°A'$,y.` T _ 2 P f ±.q '„"p,�e+4 5 T dp - r i irf '!4'6 ,�$� is ,� T _ , f' - .f .„6 W ry 4 ' ",, � ^ " t t; k ,:� set t' e �f '� s " , r - ll � q „ , . f ;F tl Y� y ,p s a , �, is v `ta^ s.. i._ a r ' ° ,? n .. .rte C. . _ ,a. a... <,iP-��e,.4< �AtACRV.,?• Plb 1000 12/78 y MOO j Pofto of 1-b With, AND F (�C`�kflAS SY''9TE`SIAS , IIP"t'1" { 1• n ; e '. v i , MA 61.0- DATE: may 1.f , PROJECT: 4 9 li1ls Golf Club, :Inc, l lol Ong Tank 5W Sec. 11, T290 R 5W4, Town of Springfield, .AtI . Mr. Wayne Lorenz St:. Croix County R oute 1, Box 313 uoycevi l 3 e, WI 54725 PLAN ID: # iii - 014J5 DERTACH HERE -- L----------------------------------------- --- ----- -•_ - - - -� : 1 en; i $1 s jolt cl u Ins PROJECT NAME PLAN ID. -,# This is to acknowledge receipt of your plans andspecifications for the above - indicated proms: Preliminary- review•indicates the plan review -fee required is-$. • ❑ Plan accepted for review, Fee received is $ 0 Fee is being returned because of ❑ Overpayment ❑ Underpayment. 1 y Providing one of the two catagories above is checked, remit correct fee in one payment. l ❑ - No - , fee has been remitted. Plans submitted with no fees will be held in abeyance. ❑ Plans being returned. r. W Additional information required. SEE BELOW. I. Plan Submission rSLA dditional information shall be submitted in triplicate unless specifically noted. Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) WisconsirvAt#istiftis ice Co" ❑ Affidavit enclosed. `r 11. Alternate sewage Disposal Systems (Mound Systems) ` ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required 0 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound, ❑ Pipe lateral layout. ❑ Plan view of alternate. A, Ill. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test data. Q Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank tobldgs, lot' lines, vvelt terpoursi6,.etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. ❑ Construction detail and cross- section of soil absorption system. %Soil boring and percolation test on EH 115•completed by certifiedsoil tester (1 copy). ® Complete data relative to anticipated use of bldg. ' 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank. ❑ Holding tank agreement signed by owner andiocal unit of government (sample enclosed). Reason for installing holding tank soil test or statement from county (1 copy), V. ' Lift Pump ❑ Calculations for total lift pump discharge, heath and gallons pumped per cycle. ❑ Size, length & depth of force main. Q Detail & model of pump or automatic siphons ncluding size, pump curves, drawdown and average flow rate GPM. Cross section of lift pump tank showing pump (s) or siphon(s). f • V.l. Systems In Fill (Fill must be placed priortooplan submission) . El Total area filled (fill 20' beyond edge of trench before side slope begin). Depth and type of fill. Copy of orrsite report by county or district plumbing-supervisor. ! ❑ Length of time fillhas been in place. k � a r � r 4 k tO . t, : e � ST. CROIX COUNTY �� WISCONSIN PLANNING & ZONING DEPARTMENT St. Croix County Government Center 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax: (715) 386 -4686 April 27, 2005 Glen Hills Golf Club ATTN: Ken Obermueller RE: Holding tank at Glen Hills Golf Club Dear Mr. Obermueller, Thank you for your letter concerning the holding tank at the Glen Hills Golf Club. You stated that the holding tank is pumped at least monthly, and is pumped more often when needed. You also stated that the holding tank has been inspected and is in good condition. Great! We, the county, are also required to maintain records of servicing events for all septic systems. The owner of the any POWTS (Privately Owned Wastewater Treatment System) is required to report to the governmental unit every inspection, maintenance, or servicing event, as per Comm 83.55 and ss. 145.245 of the state Statutes. The state requires reporting of every event to be submitted by the owner or owner's agent within 30 days of each event. Since this is a holding tank, and requires more frequent pumping than a septic tank, we are allowing holding tank owners to submit a list of pumping/ servicing events every six months. At least once every six months we must receive a signed statement from a pumper /hauler with the date the holding tank was serviced, and a signature from a pumper /hauler or licensed plumber stating that the holding tank is in compliance with state codes. This should simplify the requirements for the owner and the county and still satisfy the requirements of the State codes and statutes. I have enclosed a copy of the reporting requirements listed in Comm 83.55 for your review Please feel free to contact me with any questions or concerns. Sincerely, Kevin Grabau Zoning Specialist Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: ro Safety and building Division INSPECTION REPORT sanitaryy rm No: • 0 GENERAL INFORMATION (ATTACH TO PERMIT) State an o: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: '1 L6" Ik l �'S S f -f„�j of P CST BM Elev: Ins p. BM Elev: BM Descri tion: Section/Town /Ran e /Ma No P 9 p TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Fc.�w Z1170W Dosing � � Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic — Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer D n St Cover GPM Model Number I TDH Lift Fricti System Head TDH Ft Forcemain L th Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSION SETBACK SYST I P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type O stem: UNIT Model Number: DISTR TION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes � No Yes I No n � -_l �-� COMMENTS (include code discrepencies, persons present, etc.) Inspection #1: 2 Q� _ Inspection #2: Location: 1690 89th Street Somerset, WI 54025 (NE 1/4 NE 1/4 12 T30N R19W) The Highlands Lot 14 Parcel No: 12.30.19.1356 1.) Alt BM Description 2.) Bldg sewer length = A) - amount of cover = ^04 Plan revision Required? ', Yes No Use other side for additional information. - Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) r County Sanitary Pennit Application ST. CROP( COUNTY WISCONSIN in accord with 15.04 St. Gobs county Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy Law. S. 15.04(1 xm)] 1101 Carmichael Road �► Hudson, WI 54016 -7710 (715)3864680 Fax 15 686 Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. County_S Permit # ❑ Check if revision to previous application 6�ri on Information - C PlesePrint all Information Location: Owner Name 1/4 AJ USIA. Sec ( I•KS D r T N. R Owner's Mailing Address �, Lot Number Block Number �O 6 A /� "& 5u—t M 13 Q Cily, State Zip Code Phone Numer E&l I to 02 1 4 1S7 6'>'• 2? q 6Lau W Lus �kC4 1 Type of Building: (c Neck one) �y ❑ Village own of O 1 or 2 Family Dwelling - No. of Bedrooms: J (describe use): �f l.�P� l T A J ELb ID State-owned Nearest Road ft. Type of PemIL ((fleck ordy one box on One A. Check box on Care B N applicable) I c- �� Parcel T Numbers) A) 1.[3 Repair 2. 13 .. Reconnection Non -lumbi [3 Rejuvenation �3 I Sanitation 2 c l B) Permit Number Date Issued ❑ State Sanitary Permit was previously Issued . Type of POW System: (Check all that apply) ❑ Non pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Welland ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip tine ❑ At-grade ❑ Aerobic Treatment unit ❑ Recirculating Other vwja v . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (GalsJdaylsq.ft.) (MinJinch) Elevation Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete strutted glass Tanks Tanks WD TT ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ 1. Responsibility Statement 1, the undersigned, assume responsibility for repair/ reconnencUWrejuvenationfinstallation of non- plumbing for the POWTS shown on the attached plans. A icense Is not required for teralift repair or the installation of non - plumbing sanitation system. Pltnrubers Name (print) Plumber's Signatu no tamps): MP/MPRS No. Business Phone Number J ' — Z2-'+ o Lgent:ni 396. 3/ -1 s Address (Street, City , State Zip Code) 11. County Use Onl Disapproved Sanitary Permit Fee Date Issued I r ssuing (No stamps) JX Approved e Glve al Adverse 1X. Conditions Appro t SYSTE NER: ? Q 1 Septic tank, effluent filter and / / dispersal cell must all be serviced / maintained P ft u�'" P Cep as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. afety an B .il A J;1 my --------- - - - - -- ` ✓ - /�� o Ave., P.O. Box 7 �SI� itar Permit filled in b Co.) Depart n ommerce Zy Number (to be S n to Plan I. umber sanitary Permit Applieat In accord with Comm 83.21, Wis. Adm, Code, personal informs may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I f 1. Application Information - Please Print All Information _00 Property Owner's Na me Parcel # Lot # Block #� -5 of ' U S�/z �� �A G - A) lie !/' h Property Owner's M ailing Address perry Location City, State Zip Code Phone Number `1 A ti.Secdon a �✓ � ��6� ��� N; R 1 (c E a II. Type of Building (check all that apply) l ❑ is' ame CSM Number 1 or 2 Family Dwelling - Nu er of Bedrooms _ 9 Pubiic /Commercial - Describe _ V f _i!r` ❑ State Owned - Describe Use / City _ illage654.Township of — I III. Type of Permit: (Check only one b n line A. Complete applicabl A. New System ❑ Replacement Syste ❑ Treatment/Holdi Tank Rep! men t 0 0th ificatio Existing System - 40 it Number and Date Issued vious P B. ❑ Permit Renewal ❑ Permit Revision \hange of L P ransf to Ne Before Expiration Owne __ ' J IV. Type of POWTS Syst (Check all that a l) _ iJ Non - Pressurized In- Ground ❑ Mound > 24 in_ of suitable soil ❑Mound < in. of ble sot At -Grade ❑ Single Pass and Filter El Constructed Wetland ❑ Pressurized In- Ground ��ttk ❑Peat F' r ❑Aerobic ❑ Recircutatin Sand Filter ❑ Recirculating Synthetic Media Filter I] Leaching Chamber ❑ Drip L Gravel -less Pipe Ot (ex plain) V. Dispersal/Treatment Area Information: - Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area R (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufactu �- - Prefab Site Steel Fiber Plastic Gallons Gallons of iJnits I Concrete Constructed Glass New Existing Tanks Tanks I Septic or Holding Tank �DdQ I Aerobic Treatment Unit Dosing Chamber _ VII. Responsibility Statement- I, the undersigned, assurne r onsibIlity for ' llati of the POWTS she n the attached plans. Plumber's Na me (Print) Plumber's Si gnature I P/ PRS Number Business Phone Number i ,'/l��r►� w itali'- '" I Plumber's Addre ss (Street, City, State, Zip Code) l� o .tJ VIII. Count /De artment Use Onl nitary Permit Fee 'eludes Groundwater Date Issued I sui Ag`t star (No Stamps) Approved ❑ Disap urcharge Fez) / ❑ 0 Reason for / - -- IX. Conditions o r Reasefts4"_P -n'Yal -- 3) - T . M - s SYSTEM OWNER: I 1 Septic tank, effluent filter and dispersal cell must all be servi d I maintained I as per management plan pro ed by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 8112 x It inches in size �. ` '� '� « � �'1 �� � . � A • �_ �� °� ,, ,s �► � � , ;;► � ��� *' . ,ri. _ �, � '�; �.� ,� �h i i t � a cq% g6 I o0 M � v s Cam' r J? e 4 S J 1 C i 05/03/2005 10,26 17157237111 1 PAGE 02 I , F / T c a c -pi, Cam)_!- WFIIRLY Bpi; VENTILATOR I J = REAR ELEVATION _.. __. _.... � I b VAULT X j -l(r �• RIGHTELEVATION SCALE; '. /4' 1`0' alb? ELEVATION S10JNAR1 FRONT ELEVATION MATERIALSPEC6iCAr,CHS: o N TREMCOIDYMONI C- BROW2E•LNdESTY+NEC'OLCgS ';._._.__ —.. ..,.. ._._. _........ eR- u ': � ES• �' PAINT .. TR SEAL ISEALETUIT CCI.ORS. \ _ ^ — M /f 44r• BA RNLRAAND- L'HTFRKAL WALLS( ..I r: .L....._.... G•S0TZCH0CDI -n?L CHIP - III =" t F.P ENAMEL GLOSSPRIMER �i R,V EN T CHAR 4A NO PEAK( - :MCTAL WF.Ia N.ATr.Q Bno� UiDCOLA7F. 31CWN - GXTERIOR DOOR (INTERIOR SHALL HAVE (2) COATS SEALERYSTAINI q 1 d CAMP URINAL • 9RAOI fY SI•IGP,T MPTAL I �' G'4CVSL- RDmltC+l HAN51COPPID ACCECLM,f, I i Y..V' X 6'-6' X S R /6' !NA rRAK 6 DOOR PUSH 26C / PULL R' 260 uj rRYMOLT OMI T ITRRCE 641'CS,DSLNIF, I_,; TMEANOS;T 'L a A 512')( 4 112' 26 HNjE9 a CHECK CHAINS .. I h In DO OR ROYaR01.4f TV -3 .._. -, 8' X 16" LBURFTTER CAST ALUMINUM VIN" .y°✓ SWj(T. ` ADA APPRGYEb HANO1CAF1ICN -- - - - - -- -� or NX -OSf.O AGGREGATE EM..RIV11 F LOO R PLAN NCSF:f(OCR PITCHIS FLOEIR DRAIN 4 M URINAL, I v SCALE,: 11 n t' -6• M-197TAA HUFFCUTT CONCRETE INC. Page 1 of 1 CLICK THE IMAGE TO PROCEED TO PAGE 3 PIT TOILET B UIL D INGS • The buildings are set up and finished on site. This includes installation of grab bars. paper holders, and stalls. The completed interior is painted with a slain_ • Bug screens are cast into the walls to provide air circulation in each room. Ventilators on the roof draw air from both pits. • Finished building blends into surroundings AVAILABLE IN: PT - I )o PT250 7 FIT .4i)O lu::r •..•,a' tkifh ivir'wl P1eA"! P 2T� l'TfiSi� �+ .eat , .Ih rjr If you're responsible for the matntenance of a Pit TodeVRestroom Buiidmg or a UtiiitylSto(age Structure, you know what a hassle it is to keep these buildings in proper working order, The day to day upkeep as well as the occasional repair of vandalism can be very frustrating. Precast Concrete is the answer to many of these problems. Precast Concrete products are manu- factured in a controlled environment to ensure quality and durability. Our concrete Is a high streVh mix design and reinforced with rebar to give you many years of service These buildings are handicap aocessi l ble and meet ONR spec6catons. ' With no wood floors or walls 10 decay over time, maintenance of the building Can be a drum. When cleaning is required. € the buildkng can be hosed down with water or disinfectant. The buildings are very resistant to vary tf dalism. 'The stouts are made of durable a plastic and will not dent- The door and frame are constructed of steel. � s 'Vltxlcl PT250 CLICK THE IMAGE TO PROCEED TO PAGE 3 http://www.huffcutt.com/brochure i)age2.htm1 5/11/2005 05103,05 TLTE 08:12 FAX 715 684 2666 ST CROIX CO- UWEX /LWCD a 001 1960 Eighth Avenue Sule 130 Baldwin, WI 54002 St. Croix County Phone: 715.6842874 Extension 4 Fwc:715-684 -2666 Department Fwc Tor Bit, Schumaker PlumbhV From Dave Lar Parks Operations Manager Faoc (71 v7 386-3121 trite, May 3, 2005 Phone (715) 3OW121 Palim One Re: Campground Tolle /Privy Ceti ❑ Urgent X For Review X Pig Corwnant X Please Reply/ E2 Please Recycle •Comments: Bull: We have you on the calendar for Tuesday May 10, 3005 for the insta5ation of the campground toilet. Couple of quick quesdons/observationa. • Do you plan on having Hvlfcutt invoice you or the County for the PT- 175 unit? F- lunar way works for ine. • Do you have the privy permit froal Zoning? As agreed„ I have the building permit from the Town of Springlirel1d. • Who wiM be doing the excavation & what time will he be =riving? We can haul away the stumps A other debris. Let no know a time so 1 can have a crew avallsble. • Killnner Bechic is in the process of installing now LIG electrical service in the campground. When the toilet is installed they will run power to the unit S install an exterior light fixture. We kook forward to seeing you an May 10. WHIRLY BIRD _ SKYLIGHT VENTILATOR ° .. ' I w z o o a u 7 m m $ r FRONT ELEVATION a SCALE 1!4 "= V 0' I I i _- VAULT - 1 n ' w . I � v r Y v m LL 9' 7' -10 4 I 8' -6^ n RIGHT ELEVATION SCALE: 114' - 1'-0' .. (LEFT ELEVATION SIMILAR) W I � REAR ELEVATION v m z� SCALE :1 /4' - 1` -0" p r' 4 7 4 4 C MATERIAL SPECIFICATIONS -- -- -- LL \\ CAULK; U TREMCO /DYMONIC- BRONZE& LIMESTONE COLORS tl m BUG SCREEN LL '.. PAINT: _. _ \ \ � `�^ T RI -SEAL (SEALER/STAIN) _ =- N n COLORS: 6 ' VENT 36 G-5036 RIVERSAND - (INTERIOR WALLS) BAR \ G:5012 CHOCOLATE CHIP - (ROOF) F +F ENAMEL GLOSS PRIMER I, SAND PEBBLE - (METAL WELD PLATES m CHOCOLATE BROWN - {EXTERIOR DOOR) - - -, 4,. ED IINTER{OR SHALL HF.VE (2) COAT S SE AL @2tST }dN; .� CAMP URINAL - BRADLEY SHEEN "METAL - - STOOL - ROMTECH HANDICAPPED ACCESSIBLE C, HARDWARE i 3' -0" X 6-8" X 5 314" HM FRAME &DOOR n PUSH 20D /PULL 8'261) DEADBOL I" 47/8' T STRIKE O (,.IT CLOSURE 41/2 ' X41 /2 °26 HINGES Lu u CHECKCHAINS \ \ -� o a. ROYCE F401 S TP -3 d -K "X16" LEDBETTERCAST ALUMINUMVENTS 16' CL EANOUT -ADA APPROVED HANDICAP SIGN SHEET: - I' -0' X 5' -0" (2) LAYERED BUG SCREEN EXPOSED AGGREGATE f XFFRIOR NOTE: FI OOP PITCHES TO 4'F LOOP DRAIN &TOURINAL FLOOR PLAN ._.. SCALE 1"4"- 1 0' _ PI'RRS O � �� Q Page 1 of 1 Gle Hills County Park Site Plan I r 1� •. • + M Y8 LL rrr • •• r . p rea _ Parkin .1 Office • Txatl Flaad t . •� -- - -- 1 l . • � a at Launch •+ d 1VoA und 'z t Scanii Overlook 1 or / T., i 1 h ! � p " " t s I �ndo a I 9tatio Sfa..�� eking t 1 — f — � � �� t�lb�►�1 Le �r a t1o3� l � �Cou°tFiFf K:` �, Legend MaagTia* p ot Y MiMgi Croxi Colttp Wu�q qt iS1441P00It To is -Caa ps llx t iL !' _ too hup: / /www.co. saint- croix.wi.us/ Departments/ CountyPark/ CountyParklmages /GlenHilIsSit... 5/20/2005 ST. CROIX COUNTY WISCONSIN PLANNING & ZONING DEPARTMENT N t N N N ■ rrrrr St. Croix County Government Center - 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 F x: (715) 386 -4686 April 27, 2005 Glen Hills Golf Club ATTN: Ken Obermueller RE: Holding tank at Glen Hills Golf Club Dear Mr. Obermueller, Thank you for your letter concerning the holding tank at the Glen Hills Golf Club. You stated that the holding tank is pumped at least monthly, and is pumped more often when needed. You also stated that the holding tank has been inspected and is in good condition. Great! We, the county, are also required to maintain records of servicing events for all septic systems. The owner of the any POWTS (Privately Owned Wastewater Treatment System) is required to report to the governmental unit every inspection, maintenance, or servicing event, as per Comm 83.55 and ss. 145.245 of the state Statutes. The state requires reporting of every event to be submitted by the owner or owner's agent within 30 days of each event. Since this is a holding tank, and requires more frequent pumping than a septic tank, we are allowing holding tank owners to submit a list of pumping/ servicing events every six months. At least once every six months we must receive a signed statement from a pumper /hauler with the date the holding tank was serviced, and a signature from a pumper /hauler or licensed plumber stating that the holding tank is in compliance with state codes. This should simplify the requirements for the owner and the county and still satisfy the requirements of the State codes and statutes. I have enclosed a copy of the reporting requirements listed in Comm 83.55 for your review. Please feel free to contact me with any questions or concerns. c ely, ev Grabau Zoning Specialist April 12, 2005 St. Croix County Zoning RE: Holding Tank at Glen Hills Golf Club Inc. In regards to the notice that was sent. The holding tank is pumped monthly or even more often during peak periods. It has also been inspected and is in good condition. Respectfully Submitted, Y - J ILI - 11 — � Kendall Obermueller President – Glen Hills Golf Club Inc. / Wisconsin Master Plumber # 224081 Id: 224081 KENDALL G OBE ER Certification; Li use, or Registration a Expires 0 Master Plumber icense 03131/06 Wisconsin Department of Commerce Signature:��,..,�,r,. c (A0 z- c C v, A — 1 0 n 3 r* 3 � n C q N N ( p a) 0) 3 (�D v O_ O (D 3 < < O m N w.( • co O O 7 (D O O O O 7 n N O co o m m m' i �_ m m 7. d y m cn p D N a 7 7 O' N a 3 7 Q a v ^ O C O D ru C) 0) - V Q 0) C ,p O V> C A C C O C =w O p 3 3 IA m cn v Cn z D cn v cn Z D 4 CD D CD n ? ca D N CL v 3 a ° a 3 ° ° ° (o CD 0 (o d W (D p z O m O z O 3 O L O C O C 0 CD O O O C O (�D (O/f O f�D N N N C 3 F- T CL z z 0 0 0 (D l l ! `i 1 5 fn cn ° cn cn i G) ry,� FD' � o Sr =r 3 CO) Co CD -0 m _C F n N N O N N _ N c N CD (D (D (D y !r N N 3 a a .• ` �I o, Z Z 2 O D D c ° O d O a (a m tZ CD x c c Z = Z CD N N O m .00► 0 0 A z O 9 m ,n R 0 0 w � co P CL z a `a ;o ° o z V A o f l') (D wpm a - 0 f E a o f N3 - w°�m a 'o vi °� Q , a> ()o y w�3 ar �i'm m ° ° � v m w�3 a �a'm m ° � (o o) �cd o (cmv go mrn °� oN (omvav o - m c`O, i o CCD m o'� w d �� m d Ulam (D ,2 1 0) o 0) '0 v c :3 - Cwv ° am xy m c_n� z x(c Cmm O cn ° UCD 7 • �m �D �— z a p 0) N a 5 0) O Q 0) N 7 'O Cn a 2 N O 0. Cn O • 7 0 C,) Cn W cD CD o 7 w<. C)ZR N 7 Ad v N o 7 Q. 0ZRLEr 7 .P 0) V N 3 y x ma o.mo ( m ma o 3 ( - x aoa o'�o m o 6& (( - n y 0 M -0 X <Z (7 CL ° O. O V N .N.. ;o -p X Z � a O a (D ' r o y� 3 = v :o-° y N d T O 7 3 �� o O y Nd C n O; Cn ID C N -w ? C n O Q O Cn m C ID N A ado m y C , o ( m n o° y a7� m 5 ,L c m i . CD� .o 'w - 1CD a ° �' v om c v - I@ o ° °' pm o ?a3 m ?� < CD ?a m �Q=< 3 c m O 8 C? m 7 Cif to m N m o, O CD O 25 F y A aZV d p O =v C m o �y Oo Q� N=n ay w m On va o o N p -i O --I O O O 00 o y o CL 3 3 00 o N o+ °mac o (°n - - A O O b CD m ao c�N 0 0 0 o o 0 j e C) CD (D o o CD ti as O O CL N y Parcel #: 034 - 1030 -70 -000 02/08/2005 08:18 AM PAGE 1OF1 Alt. Parcel #: 14.29.15.214 034 - TOWN OF SPRINGFIELD Current X, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' = Current Owner STATE OF WIS CONSERV STATE OF WIS CONSERV X MADISON WI 53707 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 14 T29N R1 NW NW 40A Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 14- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/26/1989 Description Class Acres Land Improve Total State Reason STATE X2 40.000 0 0 0 NO Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ; n ■ ■ A) � c @ E f � § ; ■ ° � C k . M § t / ' 0 7 \ ƒ & ® � # 7 , � CL � 0 3: k § [ ; ® E _ ƒ o o Q a 2) i ` G # ' Fj 8 2 G @ % ¥ ° ° k § \ % CL ® > t § co 3 C 22 O C D / -4 M / § k § o c & _ § / 0 0 0 CD ® § § § @� \ ■ ■ ■ § § b o § , 0 5 / ® ® 8 . .� �� . \ / - / g § § ƒ / R j- } p \ 3 _ . 7 \ k 2 _ ` � � - \ � z 9 . \ � § § # E z � m k z & . 0 k � ~� � ■ � . 0 0 K / $ $ � 2 . q . 7 \ 0 / . \ / \ \/ «\ o ` ( k Wisconsin Department of Com rce PRIVATE EWAGE SYSTEM county: St. Croix Safety and Building Division INSP TION REPORT Sanita Permit No: �— ATT CH TO PERMIT) GENERAL INFORMATI N State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. j ,- Permit Holder's Name: City Village X Township Parcel Tax No: Glen Hills Golf Club I Springfield Townshi 03411802 =45 -990 CST BM Elev: Insp. BM Elev: BM Description: [co t� c�mue� Q3 - l b 3170 00� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 3 Be chmark tR"..1•+�acb...r 3.13 Dosing Alt. BM trCcs_S� Aeration Bldg. Sewer 1 4� S, 9g L (l) j Holding _ W nlet 8•Lilco °I S f St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ptic T f ? Dt Bottom C >� X300 —' n Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer I s Demand St Cover GPM Model Number WIC. ,. Io3.91 3.93 Ctom, •o TDH Lift Friction System Head T Ft — 7 Forcemain L Dia. Dist. to Well RP Ie%k1 SOIL AB SO BEDITRENCH Width Length No. No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO G WELL LAKE /STREAM LEACHI INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRI T YSTEM Header /Manifold ' n x Hole Size Vent to Air Intake Pipes) Length Dia Length Spacing SOIL COVER x Pressur xx Mound Or At -Grade Systems Only Depth Over ver xx xx Seeded /Sodded xx Mulched Bed/Trench Cente Bed/rrrench Edges Topsoil ®Yes �] No [� Yes FIJI No COMMENTS: (Include code discrepencies, pprsons present, etc.) Inspection #1: �`� / 2 �' / � ' Insp Location: 3127 Campgrounds Lane Glenwood City, WI 54013 (NW 1/4 NW 1/414 T29N R15W) NA Lot Parcel No: 14.29.15. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover b I t �Z Q; ..�, �v.s..t - �+b+ , Try. over �fr,,,•Q� ��w c.o.�' Plan revision Required? `I Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. c a L 1 County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE 0 40 Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax (715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Panitary Perroit # ❑ Check if revision to previous applicatlion 00 `�_ _.. '� s .I 1. Application Information - Please Print all Information "" "' cation: Property Owner Name S� /S wy I ' 6 LfJ 1/4 _14, Sec CJ ° N R �' W Property Owner's Mailing Address Number Block Number O City, State Zip Code Phone Number bdivision Name or CSM Number 11 Type of Building: (check on amity ❑ Village PaTown of 1 or 2 Family Dwelling - No. of Bedrooms: /e ❑ Public/Commercial (describe use): ❑ State -owned Nearest Ro 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) Parce T N ber(s) - (P 1.0 Repair 2. Reconnection 3. ❑Non - plumbing . ❑Rejuvenation t 1 --� (� 2 Sanitation D 9 B) Permit Number Date Issued ❑ State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) • Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ($� Holding Tank ❑ Single Pass ❑ Drip Line • At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min.finch) Elevation I �- 1. Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks / Ar Z G Alct ❑ !� ❑ ❑ ❑ -4 ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement 1, the undersigned, assume responsibility for repair/ reconnenction /rejuvenationrnstallation of non - plumbing for the POWTS shown on the attached plans. A l icense is not requir for terralift repair or the installation of non - plumbing sanitation system. Plumber's Name (print) Plumber's Signature (n4 stamps)* MPGAMOPOPNo. Business Phone Number 61- L Plumber's Address (Street, City, tate, Zip Code) Gtr D 765 _ s-0 —'76 J(` , 02 oz t Vlll. County Use Only Disapproved Sanitary Permit Fee Date Issued Issui Agent Sig ture (No stamps) Approved Owner Given Initial Adverse Determination 2 Z IX. Conditions of Approval /Reasons for Disapproval: ->E gyas su 3- W - �CL4 J-0- INN ON ONE ■ ■■ ■ ■� ■It ■ ■ ■ ■■ ■ ■fi ■ ■ ■ ■■■ ■■ ■■ Flom ME 0 Moi 0 M No. 10-9- 0.0�.MM -M mono so ■■■ ■ ■ /.�■IN ■- 000■ mmm ■ ■ ■ ■ ■ ■ ■ ■� ■ ■�� ■■EM MOON ME r/. rte' ■ r Safety and Buildings 10541 N RANCH ROAD HAYWARD Wl 54843 Visconsin TDD #: (608) 264 -8777 erce.s www.w w ww.commerce.s tate. wi. us/sb isconin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary August 26, 2002 CUST ID No.222234 A77N: POWTS Inspector GALE W SMITH ZONING OFFICE TUTTLE CONSTRUCTION ST CROIX COUNTY SPIA 316 E WALNUT ST 1101 CARMICHAEL RD GLENWOOD CITY WI 54013 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 08/26/2004 . Transaction ID No. 777595 SITE• Site ID No. 649303 Glen Hills Golf Club Please refer to both identification numbers, 3127 Campground Ln above, in all correspondence with the agency. Town of Springfield, 54013 St Croix County NW1 /4, NW1 /4, S14, T29N, R15W FOR: Holding tank, 2544 GPD. See key item(s) below Object Type: POWT System Regulated Object ID No.: 866620 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. () The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions �'AR This system is to be constructed and located in accordance with the enclosed approved plans and with the I ± aN { "Holding Tank Component Manual, SBD- 10571 -P (R.6/99)" • In the event this holding tank malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described the Holding Tank Component Manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located or other appropriate permit issuin g agency a in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Y e9 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance an for this system must be given to the owner of the POWTS. P Y • Note: County regulations concerning the prohibition of holding tanks may vary. Check with the local permit issuing agency. • Note: The servicing of POWTS holding and treatment components, including septic tanks and holding tanks, is required to be performed by licensed pumpers under chs. NR 113 and NR 114. Key Items) • This approval is for the connection of a 3 bed room residence to an existing holding tank that currently serves a golf club /restaurant and bar. The existing holding tank must be inspected for structural soundness and size and must be brought into conformance with the requirements of COMM 83, Wis. Adm. Code. If it does not conform a state approved tank must be installed. GALE W SMITH Page 2 8/26/02 • All joints and connections shall be made in accordance with Comm 84.40. Review Notes • Manhole cover or service port to be no more than 25' from service road or drive per Holding Tank Manual, Table 1. Reminders • A meter shall be installed by a properly licensed plumber on the water system that adequately measures the amount of water used by the structure, excluding hose bibs and wall hydrants, which do not discharge into the sanitary system. • Materials shall conform to the requirements of COMM 84. • Abandon failing system per COMM 83.33. • Maintain well and waterline set backs per COMM 83.43(8)(i). • Provide frost protection per COMM 83.43(8)(c). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal lation/operation. In antin this approval the Division of Safety & Buildings reserves the right to require changes or additions should S�' g PP Y g g conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left address rovide a copy of this letter to the owner and any others who are responsible for the installation, opera ' n or mainte ance of the POWTS. Sincere Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 Patricia I: Sh f POWTS Plan Re vi er , Integr ed Services WiSMART Bode: 7633' (715) 634 -7810, F :(71 4-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 e - a j!►/9' tWy/�'DESIGN Resid d a/ Application INDEX AND TITLE SHEET Project 6�1- e N !-//Z L. S Gad l= cL Z/ ,G OZd /N� Owner ,'A / Address 3/ r2 / e A M R 9RD q /V d Z AZ Legal Description �� LtJ, �/_(� S /tz / Township ��� . �� L o / County 5 Y al?,o / X Subdivision Name Lot No. Parcel ID Number ). ®.W.T.S. Plan Transaction Number liditioliall . m Index and title sheet Page 1 MENT of c W - - BUILDINGS calculations Page 2 I Hv/d /�v8 f;ml< drawings Page 3 'V= -- Page"*" ) - SPOND yawing Qe- `77 Site plan Page 1 L� Soil 41iiist", (4, So t2e s7c- Designer Gxxl e S M /�`/� License Number �iZ -.3 Signature = �� r Phone No. Date Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. Stats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)[. i i O FY - O = 17S 9"4 Le AM - ■�11 ■■ ■ ■■ ■■■■■ NEON 1 Eli ■■ ■■ ®,� :�l1, .'1���■ ■ ■ ■■e■ IN ■I■■■■ ■ ■■ eelr� ■ ■. - d ■Cer "0■■ ■■ 1■S ■■■ 171 N� ■!.�■■ ■N ■■ tS /NN■■ IO► NINON ' ■■■■■■■■■■■■ `E ■N■■ 1/ NONE ME ■■■■■■■■ ■■e ■■ I MEN ■■■ 1� ■ ■!�! ■ ■ ■E ■_ ■■■■■■■■e■■ ■ ■r■ ■ ■■■■■■■ ■N 1 0111111111■■ �► r, .■ ,■ ■�� !�■ .tea oil � rams i ■ ■■■■■■ e0 ■■ �71 � - I!�._ ■■■■■■ 1 ■ ■■■■■■■ _. _�R :Nee ■■■Nee■ ■■� IMEMESSEEM i ■ ■ ■a■ ■peg EM ■ �������Naa� ■:�!�e�■r�■�■ ���r ■r■NNN■■e■■■■■■ E■■■r■I■■ .__�..�■ ■ N ONE ■■■ ■■■■NNM 03.. _ 111111 NI■■■ ■■ ■■■ ■■tiii■u■■■ IN 1 1111011 ■■ MEN ■ ■■e ■■ ■l��BR • EN ■ am ■■ v ■ r� ■■NN N■ ■ ■■■■■■ ■ ■N e ■ 1 ■ ■ ■ i r I ■EN.lE 0 No ■■ ■ ■ ■1 ■Ol■ NOON■■ NOON■ NOON■■ 11.�lR��!�J,P.�1� ■�! NOON■■ NOON ■NONE■ NL' ::BEN ■ , ■ ■ ■ ■ ■NE iNIMI M USE MIMI 1 ■ ■■ INNII NNE Fi- .E'!4PRZ �?,Im !■ 1 NNN 1■1■■■■N N ■ft N■■■■N�■■■ ■N 1■ NN■ : ::N■■!. 1�►1�- © iii - ��.!EE ■Il• no aE 0 ■■■ _ _ ■■■N-mmmmm MEN I N I/ ■ / ■s■i■i■M ■■ ■ ■ ■ ■ ■■ ■ ■ -' ■NN`� ■ ■ ■ ■■ ■ NNE ■ONE ■ IN a ■ Pv1h'is l)irV 1"lHt`IUHL C.- 1 •�.aa -a aa.%.. a .,.A.. /FIL,E [NFORMATiON SYSTEM SPECIFICATIONS Owner 6.1- Tank Capacity gal ❑ NA Permit # � Manufacturer ,+1 L O NA Effluent Filter Manufacturer ❑ NA DESIGN .PARAMETERS ❑ NA Number of Bedrooms O NA Effluent Filter Model NA Number of Commercial Units ❑ NA Pump Tank Capacity gal ❑ Esdmated flow (average) gal /day Pump Tank Manufacturer ? ❑ NA Design flow (peak), (Estimated x 175) gal/day Pump Manufacturer ❑ NA gaVday /ft Pump Model ❑ NA Soil Application Rate ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oil a Grease (FOG) _ <30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) <_220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids ( TSS) 51 SO mg/L Manufacturer Pretreated Effluent Quality ' ❑ NA Monthly average* * pispersal Cell(s) Biochemical Oxygen Demand (BODs) <_30 mg/L ❑ In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At -grade ❑ Mound Fecal Copform (geometric mean) :5104 cfu/ I OOMI 1 O Drip -line ❑ Other: Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and sepd tank effluent. * * Values typical for pretreated wastewater MAINTENANCE SCHEDULE Service Event Service Frequency S) (Maximum 3 yrs. ) Inspect condition of tank(s) At (east once every ❑months �'year( Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume inspect dispersal cell(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs. ) Clean effluent fliter At least once every ❑ months ❑ year(s) inspect pump, pump controls U -alarm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA Other. At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS a inspections of tanks and dispersal cells shall be made b OTS Maintainer; Septage Servicing Operator. Tank lnsped( Plumber; Master Plumber Restricted Sewer; POWTS p ken hardware, dentify any cracks or laks, measure must Include a visual inspection of the tank(s) to identify any b missing u � p ding of ffluent the grow d surface• The dlspersa' volume of combined sludge and scum and to check for any P o all be visually Inspected to check the effl uent levels in the observation pipes and tc condition and requires the immediate c cell(s) shall the ground surface. The ponding of effluent on the ground surface may indicate a fading notification of the local regulatory authority. Whe the combined accumulation of sludge and scum In any tank equals one -third (15) or accordance of ewith ch. volume, h Whe NR 113, W scol contents of the tank shalt be removed by a Septage Servicing Op erator and disposed of in Administrative Code. The servicing of effluent filters, mechanical or pr�u zed sPOWTS be performed by a certified POWTS Main�talner.ny °they maintenance or monitoring at intervals of 12 months A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START Up AND OPERATION presence For new construcdon, prior to use of the POWTS check treatment tanks) for h concencoradonsdare detected ha e �the cond that may impede the treatment process and /or damage the dispersal cell(s). _t rka ranwo rpmovad `=y i wnwe servidng operztor prior to use. ' Pagc _o( System start up shall not occur when soil conditJons are (roan at the InNVadve surface. During power outages pump tanks may fill above normal hlghwater levels When power Is restored the excess wastewater will be discharged to the dispersal cells) In one large dose, overloading the cellW and may result In the backup or wrfiee discharge of effluent. To avoid this situation have the contents of the pump tank rt+'noved by a Stptagt Servicing Operator.prior.to restoring power to the effluent pump or contact a Plumber or POWTS Malntainer to assist In manually operadng the pump controls to restore ncrrnal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not dcivt or park ovtr, or otherwise dbwrb or compact, the area within 15 feet down slope of any mound or at-grade soil absorPdon area. Reduction or elimination of the following from the wastewater n"arn nuy Improv the performance rnd prolong th We of the POWTS: antibiotics; baby wipes; clgaretQ butts; condoms; couoo sw2b - ,; degreasers; dental floss; diapers; disinfectants; (at; foundation drain isump pump) water; fruit and vegetable petlings; Casoane; grease; herbicides; meat scraps; medications; oil; painting Products oe5dcldes: sanitary naokins: tampons; and water sofuner brine. ARAN DON EM ENT When the POWTS fails and /or Is permanently taken out of service time foil n sups shall be taken to Insure that the system is properly and safely abandoned In compflance with ch. Comm 83.33, yrisconsJn Admintstrative Coda • All piping to tanks and plu shall bt disconnected and the abandoned pipe opsnings staled, • The cwenu of all tanks and piu shall be removed and properly disposed of by a Septage Servicing Operator. • Aher pumpinY, all tanks and pl shall be excavated and removed or their covers removed and the void space filled with soil, grave( or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures hwe t-'t or must be taken, w provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be uti lized fo( the location of a replacement soil absorption system. The replacemtnt area should be protecud from disturbance and compaction and should not be Infringed upon by reQuired setbacks from exlstlng and proposed swcwry, lot lints and wells. Fallure to protect the rtplacenment area will result In the need for a new soil and site evaluation w estabilsh a wltab(e replacement area. Replacement systems must comply with the rules In effect at that tirne. • A su ltable replacerrunc area is not available due to setback anClor soil I1mluWru. Barring advancts In POWTS technology a holding tank may be Installed as a last resort to replace the f. POWTS. O The site has not been evaluated to Identify a sultab(e replacement area. Upon failure of the POWTS a soil and site evaluation must be per'ontmed to (ovate a sulub(e mplacerne:nt area, if no replacement area Is available a holding tank may be Installed as a last resort w replace the failed POWTS. O Mound and at-grade soil absorption systsms may be reconseve.jed in place following removal of the biomat at the Inflivative wrface. Reconswalons of such systems must.cc:r.lpl; with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAtH LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TP,CATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM TKE 1rZTERIOR OF A TANK MAY BE DIFFICULT OR IMPr1CCIR1 T. ADDITIONAL COMMENTS POWTS INSTALLER - ,'rS MAINTAINER Name one SEPTAGE SERVICING OPERATOR (PUMPER) L REGULATORY AUTHORITY ,_ . Name �..- , �Iwcy .� f� Phont �_ ,ono Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of v� Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all /ntbi matlon. Reviewed by Date Personal inforinshon you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). 1 p L Property Owner Property Location (^ e /V �� p �' C� (� Govt. Lot ; /A/&/ 1/4N/ S T a N R � W W Property Owner's Mailing Address Lot # I Block # Sutxi. Name or M# R -0 A/ d — City C � State Zi Code Phone Number ❑ City ❑ Village (Town Nearest Road % o c i�i�6� S c� I GIetv cvo o N d N_ ❑ New Construction Use: ❑ Residential/ Number of bedrooms Code derived design flow rate GPD %Replacement Public or commercial - Describe: d14 Parent material A,/- tl Flood Plain elevation if applicabl I VA ft. General comments and riecarr mendetions: Boring # ❑ Boring F71 ® Pit Ground surface elev. ft. Depth to limiting factor v in. Sod Applicadoin Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G PDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o - 4 A 0 3 Si sd Al v� e A S A A 5" A0 .s � d 0 3 S Ml=L' , z F-1 Borin # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sotl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/l? In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efl#1 'Eff#2 Effluent #1 = BOD > 30 < 220 rig& and TSS >30 150 mgA. ` Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L CST Name (Please Print) , Signature CST Number Gff /.v S - M / 7`h Lv� 3 Address �1 / Date Evaluation Conducted Telephone N k , / > .6""�,D� �yo /3 Property Owner Parcel ID # Page of F-1 Borft # ° Boring ❑ Pit Ground surface elev. ft. Depth to Gmita,g factor in. Sol A Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 F-1 Boft # ° Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture St ucture Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # E] Boring 11 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD4330 QW00) "VIA -- - - - -- f -_ - -- - 0 eWl? Piew -ef Wwy r 0. , 6- -2 gy- I L 00 JA LA 01 X- ig(z fyz sic Ati I 1 - I - 1 r- I l ; : li I : i I � ST 'CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e ///Z Mailing Address �,� C Property Address (Verification required from Planning Department for new construction) � ,�yo l3 City/State �i v o eft Parcel Identification Number LEGAL DESCRI TI ON Property Location IV/t% V4, (, y/f/ %., Sec. , , T-2�YN -R 2;�- W, Town of 6V 2Nwp Qal Subdivision . , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume . Page # b /� Spec house ❑ yes P j no Lot lines identifiable ❑ yes 1V no SSYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a 'oume Lumber restricted lumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system mastorplumber,I ymanp � P 1 sludge. is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than /3 full of the p sewage disposal system with the standards set forth, a to maintain p . e undersigned have read the above requirements an agree llwe, th ersign Certification Commerce and the Department of Natural Resources, State of Wisconsin. herein, as set by the Department of Co P 30 rth, Office within stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days of the three ear,' lion date. A ATURE /ti' U 9 / 1 <1 - / OF APPLICANT DATE OWNER CERTIFICATION the owner(s) of I (we) certify that all statements on this form are true to the best of m y (our) knowled I ( we ) am (are) the property d ribed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE « « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed p „4, • HOLLY PA T W � N & �_ �� � OUNTRY HOUSING #2 "T a New Standard of Excellence" _. $ � y x C 6 8 ' -of r ;t L/R B . /R -3 14 , -8 , � . 1472 (935 S.F.) 114 6" WALLS & NORTHERN INSULATION 6 PANEL FRONT DOOR W/ STORM FIBERGLASS TUB IN HALL BATH SHINGLE ROOF & VINYL SIDING PILOTLESS GAS FURNACE Goa �� • THERMOPANE WINDOWS LIGHTED FAN INSTALLED ° EXTERIOR FAUCET PORCELAIN (NO PLASTIC) SINKS IN BATH KITCHEN COUNTER BACKSPLASH SHUT -OFFS TO ALL FIXTURES 2 EXTERIOR ELECTRIC OUTLETS DEAD BOLT LOC MAINLINE WATER SHUT -OFF & MUCH MUCH MORE! na i. � r 77 T +fitifi�� a Al 4285 So. Prajjfe 'Vle* Road Chippewa Falls. WI 54729.8617 • Phapl.(1115) 834.1279 ' !� ' " .e '� 4 �^ tq 3 i '1 ° '�' • .. _ • ,. , �. wvv to R nandcountrvhott�� m V DOCUMENT NO. - WARRANTY oEEB -Br CorimtNa VOL A f- � fr;E �a STATE OF WISCONSIN -F 2 Z TIRO SPACE R13MYE9 FOR iEWAapG DATA 2 841 1 3 8 THIS INDENTURE, Alade this .... 3rd .............. day of......._ ..... _ Na .y ......... � ;;i` :c:' i C' - t•'CS A. D., 19..66.., between..._ .._S.t ...... Cro ... Craunty-._. Soil.... 6...-alat.er. ....... _...... ST. CROIX CC.. v:... Conscr .Vat!on..D.i'atric.t...... _....._. _ .............................. __.. .............. ......_.. , Corporatuon Recd for Record this -- 3rd _ duly org:uuzed and existing under and by vutue of the fawn of the State of Wisconsin, located day of -- N !C ------ A.D.19 66 at.. ...... ..._.. Bal dw- i ._.._.. ... ..... ._. ....... ......... ..... ............. Wisconsin, party of the first part and 1 nC P M. Wisconsin....ConsLruatioli.. yepar. tmsnt..........__ ...... ........................__...._ , !/ _....... - ................_:............................ ........................ ..... .._. ................... ..........:......................... - _.. ............... Register o reds f ?rt.7tt........of the second part, RETURN TO W i : n e s a e it h, That the said party of the first part, for n a :., consideration ' of the sum at_._.... One .._ i„ r. i. .- ,...,..� Richard P. Rivard Glenwood City,, Wi��_ ---- -- - - ---- --- --- D.011ar..... -- ..... - - ... -- . - -- . to it paid by the said part ...;t.. -...of the second part, the receipt whereof is hereby confessed and acknowledged, has given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents does give. grant, bargain, sell, remise, release, alien, convey and confirm unto the said part-.y of the second part,..._.. - ..heirs and assigns forever, the following described real estate situated in the County of.... ..S.t .. .... CrAiiX ............ and State of Wisconsin, to-wit: 1. South lialf (S 1/2) of the i'.ortll IICSt Quarter (NW 1/4) and 41orth Half (14 1/2) of tiie South lest Quarter (SW 114) of Section 11. 2. South half (S 1/2) of the South WeSt Quarter (SW 1/4) of Section 11. 3. hest 3U acres of forth West Quarter (NW 1/4) of North West Quarter (IlW 1/4) of Section 14. 4. Soutlx half (S 1/2) of North West Quarter (NW 1/4), of Section 14. (IN AFE66SBA32Y, CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances, To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said part.}(_.. -..of the second part, and to....itSa.....heirs and assigns FOREVER. ' And the said .........._. S. t......4 rO. 1X.... 4. Q. Un: l:. y....S.Oij .._�ld.ld._.ljat, _- r.._C9nsery4tion District_ ........... ................. . ................. ......... .................................. .................................... ............ . ............................_.. Party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said part..3l.. -...of the second part ,.......... 1 t:3 ....................heirs and assigns, that at the time of the ensealing and delivery of these presents it is 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._y._...of the second part ...... ...... heirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT AND DEFEND. In Witness Whereof. the saidSt ......Crclix...CmUnty....SO- 1..1 ....Wate1'....cons.eir al"On...D.3 it lcl........... party of the first part, has caused these presents to he si 1,5 _ William_. Thompzon.,_.Chairman....._., i4 ✓fCZAA1 and countersigned by . .ItoT`man....L.-- .1'inderS011. - -_ ... ........ _._ ............ , its Scen•tu 1 .._,1 .._.....1 . Wisconsin, and its corporate seal to be heremrto affixed thi,__....3rd._.._ Ally ae....... .... ....................I —, A. D., 19.6b....... , !%GNE OND S sfi"LED I PRESENCE OF ST. CRUIX COUNTY SOIL AND WATLR COASERVATION DISTRICT oryorate Aun�e �. . R. i. cA' gr'd._E._...Rivard.._.......... , tJ> lliam..:dhom�.s.on,.Chairman COU nSIGNED: .Ronald ... F. or. gmlh .............................. -. ............ �e.rrr.ry _..... .Norman...E.. ...Anderson .................... STATE OF WISCONSIN, • ss. ........... ..._St_c... rQ.ix .......... .-. ........... County. Personally came before me, this.3rd._......day of....... . ...I'laty..._ ................. A. D., 19.f>6_, .. yJil2- }9�...:PYlQIIIj]S.4A._._,_- ......... ..................... ._. ... ...... ...._.. Chairman. and ....NO.r►tk171...E Andersen ........................ Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument, and tom own to be suclChairmanEtjiAt I/ and..- ... " .................... .... . ... _...Secretary of said Corporation, ancJ,ackngwledged that they executed he t r going instru t as suc officers as the deed of acid Corporation, by its authority. f \' U This instrument drafted by Notary Publfa�t.- ..CroiX— .____County,Wis. ...............Fi�ilaxd.. P.... )R Y.ax`. _.._ ........... _ . ; M Commixixiouf(kiV144(18) permanent - (stenos 59.51 (1) of the WUooada st■t m cronitles that all lattramenu to be recorded eba4 tuns plainly piloted at emwdm tt tbareoa lu t asset. « tw amtwo. Arsataea. and ttotars). WARRANTY DEED -STATE OF WISCONSIN. FDRM NO. 2 284198 5. Part of South Half (S 1/2) of North East Quarter CITE 1/4) de- cribed as follows: Commencing at the NW corner of-said South Half (S 1/2) of iJorth East Quarter (JjL 1/4), thence L 132U feet; thence S 970 feet; thence L 350 feet; thence S 35U feet; thence W 1670 filet; thence N to the point of begianing. 6. All of South East Quarter (SE 1/4) EXCEPT the S 33U feet of the L 66U feet thereof, Section 11; ' 7.' Also North Half (Id 1/2) of faorth East Quarter G4L 1/4) of Section 14, EXCEPT the S 754 feet of the N 820 feet of the Last 545 feet thereOf. 8. ilortii Last Quarter (NL 1/4) of Borth West Quarter (iJW 1/4) and East lU acres of i4orth West Quarter (Ijkq 1/4) of Borth .°lest (ii.J 1/4) all in Section 14. 9. Also that part of iiorth Last Quarter (i +L 1/4) of north Last Quarter (NL 1/4) of Section 15 lying Ely of the iiighway, ALL In Township 29 north, Range 15, West. LLJ N L +! W Cl- 0 C_ s c_.2 W 3 C . a VOL 4? PAUG1'/