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Parcel #: 231 - 1047 -70 -096 11/04/2005 10:59 AM
PAGE 1 OF 2
Alt. Parcel M 27.30.15.754T -10A 231 - CITY OF GLENWOOD CITY
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
ROBERT D & PHYLLIS J TR ATKINS O - ATKINS, ROBERT D & PHYLLIS J TR
2598 STAGECOACH TRL S
AFTON MN 55001
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 380 Plat: 4368 -CSM 16/4368
SEC 27 T30N R1 5W PT SE SE LOT 20.5 CSM Block/Condo Bldg: LOT 20.5
16/4368
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
27- 30N -15W SE SE
es: Parcel History:
Date Doc # Vol /Page Type
10/22/2003 744490 2441/296 WD
10/22/2003 744490 2441/296 WD
05108/2003 720584 2234/393 WD
02/28/2002 672326 1845/182 WD
more...
2005 SUMMARY Bill M Fair Market Value: Asses ed with:
0
Valuations: L st Chan d: 09/21/2005
Description Class Acres La Improve Total State Reason
RESIDENTIAL G1 3.380 27, 0 0 27,00 NO
Totals for 2005:
General Property 3.380 27,000 0 27,000
Woodland 0.000 0 0
Totals for 2004:
General Property 3.380 7,000 0 7,000
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
i
Parcel #: 231 - 1047 -70 -096 11/04/2005 10:59 AM
PAGE 2 OF 2
Parcel History: cont.
01/31/2001 637768 1581/452
SD
12/30/1998 594748 1391/317 WD
09/30/1998 588082 1361/323 WD
L
I
FORM NO, 98 A
\ 0/ .1. Off rsyt ��39374
P.- r- 1 ....!r VOL PAGE 4368
Stock No. 26273 ,�� em KATHLEEN H. WALSH
1 4111-468 REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
09 -05 -2002 12:15 P
CERTIFIED SURVEY MAP
CERTIFIED SURVEY MAP NO. 4368 COPYFFEE: 13'00
VOLUME 16 PAGE 4368 2
LOTS 20.3 AND 20.4, C.S.M. 4168, VOL. 15, PAGE 4168,
LOCATED IN THE SOUTHEAST 1/4 OF THE SOUTHEAST 1/4,
SECTION 27, TOWNSHIP 30 NORTH, RANGE 15 WEST,
CITY OF GLENWOOD CITY, ST. CROIX COUNTY, WISCONSIN
SCALE: 1"=200' DRAFTED BY : EAST 1/4
T CO
DONALD M. CLARK LEGEND ST. CROIX CO. MONU.T
0 100' 200' 400'
�S
NOTED) CORNER
OWNER • FND, 3/4 "X24 REBAR
SECLUDED LAND CO. LLC O SET, 3/4'X24' REBAR
1673 131/2 AVE. HWY 8 E. PABOX 99
BARRON. Wf 54812 WEIGHING 1.502 LOS. I
PER LINEAL FOOT.
Qv WELL HEAD
c
.o
u�
LOT 21.0
C.S.M. 3570
V__13 P. 3570 °^ "���d� /�� i•` �
o•
h
LOT 20.5
,1<b ti� 147,207 SO. FT. o
(3.38tACRES) o
W � � a • �
145 9 SO. FT.
S) LES
W OD
° 7 26'00 "E
S "E
Qo 6 O, 44 8.94' ° o
o Q o
1/1 _ O W
E 7 N Uii AI
<W< Wco ZI
m m LOT 18 �; '� `/� 2009 ;o ° J
g
C_S_M. 3051 a, LOT 20.6 0 Z
Fl l
o W I
ti� 234,570 SQ. FT. :--I
��.•••••••••. /y • V. 11 P. 3051 > (5.39tACRES) Z
••• • -- — - - - - -- %D �° JI
CA * ••''• *�: w 232,975 SQ. FT. oLl
DONALD M. - (5.35tACRES) LESS R \W �I
CLARK a
5-1580
MENOMOME --t;
••�'''• W1 r•��
...( LOT 19 S 83.30'02-
— E 387.38'
C.S.M. 3052 •�,
I
0
V. 11 P. 3052 N
SOUTHEAST CORNER
UNPLATTED LANDS SEC,27, T30N RI5W
CEDAR CORPORATION --- - - - - -- - - - -- ST. CROIX CO. MONO.
604 WILSON AVENUE
MENOMONIE, WI 54751
(715) 235 -9081 SHEET 1 OF 2
Vol. 16 Page 4368
« w Wisconsin Departm? oft'ommerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. CRC
Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)( m)j. 338834
Permit Holder's Name:
t. City El Village „� Town of: State Plan ID No.:
JEROME, ED GLENWOOD CIT
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
231 - 1047 - 70 --095
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet
ir
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. H Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
O Mod Number:
INFORMATION Type
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
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 E] Yes ❑ No [I Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: CITY OF GLENWOOD CITY 27.30.15 112 WINDMILL WAY
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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�:' ■�. Bure of Building Watr Division
SANITARY PERMIT APPLICATION y
Bureau of Building Water Systems
201 E_ Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. :57 /jam
• See reverse side for instructions for completing this application State Sanitary Permit Number
�53gg 34
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION I o?0
Property OvO�ner Name Propert Location
51,5 114 1/4, 5,27 T36 • N• E (0140
Property Ovvje3 ailing Address Lot Num eL.7 Block Number
� �—
Cit StateZip Code Ph n N u Per Subdivision me or CSM Number
(6� yv�v 3S' o
II. TYPE OF BUILDING: (check one) ❑ State Owned 0 !t / Nearest Road
Public 1 or 2 Family Dwelling- No. of bedrooms T4 OF (tZ- ` tt�G
III BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s)
.;2- /o 0 p s°
1 ❑ Apartment/ Condo Z'j1r /6 1 7 - /� �d 9 7
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. j ( New 2_ E] Replacement 3 E] Replacementof 4_ E] Reconnection of 5 ❑ Repair of an
_____System ________System`____________ Tank Only______________ Existing System _________Existing
system
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM:. (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 15(Mound 30 ❑ Specify Type 41 []Holding Tank
12 E] Seepage Trench 22[1 in-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev, 7. Final Grade
Required (sq. ft.) Proposed ( ft.) (Gals/day/ . ft.) (Min. /inch) Elevation
_ 6e Q j Feet Q S®Fet
VII. TANK in Capacity Total # of Prefab. Site Fiber Exper.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber e ek2 _ 7 / /, ❑ ❑ 1 ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumb is Na e: (Print) Plu b 's Si ature: (No Stam ) P PR W No.: Business Pho ne Number:
PIunj er / A dress (Street, City, S a )6,Zip Cod) if V
.�
IX. COUNTY / DEPARTMENT USE ONLY
E] Disapproved Sanitary Permit Fee (ncludesGroundwa[er atelssue IssungA entSigMnatuo Stamp s)
XA roved -6 Surcharge Fee) /1
pp ❑Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SHD -6396 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety 8 Buildings Division, Owner, Plumber
INSTRUCTIONS ,
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a 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.
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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. 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.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 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; pump or siphon
tanks; distribution boxes; soil absorption systems; replacements stem areas; and the location of the building served
Y 9 ,
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; and F) all sizing information.
---------------------------------------------------------------------------------------------- - - - - --
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
r
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3
Latxr Hurrlan Relations -
Divisi,% ' Safety & Buildings in accord with ILHR 133.05, 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 % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION PLEASE PRINT A elf A . R EWED BY DATE
PROPERTY OWNER: PRra RTY LOCATION
T SE 1/4 Str 1/4,S 1"1 T 3 O ,N,R N S E (o0w)
PROPERTY OWNEIT:S MAILING ADDRESS LOT,#' . BLOCK # SUBD. NAME OR CSM #
Lt�NGF 110.1 vu�. �3 , - -j 3s�o
CITY, STATE ZIP CODE PTVNE NUM ±n (RCITTY ILLAGE []rOWN NEAREST ROAD
�l :2S (� t (1,l'Z) q Q C t 1
QQ New Construction Use I>4 Residential / [ of bedroorl`f' AdditiQn to existing building
j) Replacement [) Public or comme
.. .
Code derived daily flow boy gpd R J ed design loading rate 1 b bed, gpd/ft - trench, gpd/ft
Absorption area required Soo bed, ft Soo tench, ft Maximum design baling rate • y bed, gpd /ft • S trench, gpd/tt
Recommended infiltration surface elevation(s) O 3 • S ft (as referred to site plan benchmark)
Additional design/ site considerations M Duh, M I "1 M Ur�1 Z.k(" or S FI L-(-
Parent material Flood plain elevation, if applicable Q i� ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑ S U ER S❑ U ❑ S g) U ❑ S ®U O S O U [I S 1�j U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench
�S 1 � S .b
Z Cl S`IR Sly — S1 CA S�lz >71�h �S - • �I S
Ground 1 `F 5 �k »M
elev. SZ 1� "-r� C� S16 41 / '( 1 cS\0'fL - myQt
I --)-s Li -
Depth to
limiting
factor 5
ZS
Remarks:
Boring #
o -� )\w-J 2 3 1 2 S i t Z `F m'Fh S
Z Z `1_t �.SyR �1 — s icl Z -�sb4t »1�- eS - •y •S
3 o1-1 S) yn cs
Ground
e 6 fl �1' S o`1 (z b ! — 1- S�2 - - �►�� tv4
Depth to 3 O-L i`1 S Z °1 u L im >vf: C_�vrS
limiting
factor
Remarks:
CST Name: — Please Print Arthur L. We gerer Phone. 715-425-0165
Address: Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022'
Signature: Q � Z Date: .Z 9 ( , B CST Number: 220
i><�
1
PROPERTYOWNER SOIL DESCRIPTION REPORT Page?- of 3
PARCEL I.D. # �C> I ►.i S
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxiary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
-
si1 Z`Fsb12 ��h eS � • s ��
Ground 3 S1 CA 0 --S 1 012 lvl'Fb- c-S • Z •3
elev.
1 •3 ft. Lf 1 2-, -Sz R31 y .SHR Sys C - dam-. lv�`� — Nh . Z
Depth to
limiting
factor N F-T
Zb
Remarks:
Boring #
C1 i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boling #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
.•
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
cnn.nggfHP nc In,\
PLOT PLAN Pa 3 of 3
SCALE 1 "= 1 -10 '
�1 t4-Z
'�T�o tom. �-. 101. g , •
kTt_ t�3 -5' 3s'
- - -- -T
Zs• I
_ I
I I b \gTvvz$ `1lNlS R'tL�A
—
B•3 I ( LT ' I
I
35-
Cti 9 °t
•
Bm*
`� `" =800 � y @Dl�►
00
d
ow�w„ s rrL' N
cam' x' f V'LL - M %VE t'rT l_evxST SO' �►z titi"J h'1 uvlvp
? �v -3ZZ
- 't�izt -' ( 715 ) 475 -0165 I4 00576
CST Signature Date Signed Telephone No. CST #
4lfisconsinDeparan Oflndusby, SOIL AND SITE EVALUATION REPORT Page \ of 3
Labor and Human RelaSons
DivWo"f SafQty 8 Buildhgs in accord with ILHR 133.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must include, but S'r^ C
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION RP EWE DATE
PROPERTY OWNER: F RTY LOCATION
AT SE 1/4 S1~ 1 /4,S z.") T 30 ,N,R 1 S E(ofD PERTY OWNER':S MAILING ADDRESS BLOCK # SUBD. NAME OR CSM #
6a�y L1�S1�G�R1� b�. Z CITY, STATE ZIP CODE PHONE NUMBER []VILLAGE TOWN NEAREST ROAD
S S Ll (, (611) q3S - L4 0 SO G L�.1wUt1v i`
pq New Construction Use [ >q Residential / Number of bedrooms `[ [ ] AddiliQn to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow boo gpd Recommended design loading rate 3 $ bed, gpd1ft - trench, gpd1fi
Absorption area required Soo bed, ft S DU trench, ft Maximum design loading rate • y bed, gpd /ft • S trench, gpd/0
Recommended infiltration surface elevations) 1 O 3 • S It (as referred to site plan benchmark)
Additional design / site considerations " OUILN_ - ) w /Y, ' 7L M I"l f Ural Z.q" (:)F R L-<
Parent material L- � t58 CsUt oU\'R _ I`Tb Flood plain elevation, if applicable K_� 1 � It
S = Suitable for system CONVENTIONAL MOUND IN4ROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑ S O U ER S ❑ U ❑ S ®U [IS ®U [I S 0 U ❑ S 1;� U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baidary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rrerich
o -1 tizmV - �I — S,.1 Z :s m�� 0 -S 1� -S .�
I .
Z q_zy �_S`-1R 31y - S� �I Z'�s m •f► :± s - . �� . 5
Ground 3 Z V- S ' 11Z icy - sr .5 1� y ,� `�. ,� S - , L _ 3
elev. - R s l 6 C 1 S -
y - 3 ff I i - I - S ti rL Si v 1 0 ►� �n _ ►ten:. Z
Depth to
li miting
factor
5
Remarks:
Boring #
0�1 lU�L2312 S C-S 1� •S •b
E l 1 1 -1 1 4. H R - ).S' V — Sic
Z'f sb rn'f1- c5 - •�( •5
3 1U -y0 S s� w)1 C-S
Ground
q 9 6 R
it V Lh_' ) 0`1 P_ — LS3
Depth to 3 � S Z 0 ) u t - L Im hJ t L�vlr
limiting
facto
Remarks:
TName: Please Print Arthur L. We gerer Phone. 715 -425 -0165
egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022'
Signature: �. Date: 1 Z _ Z CST Number:
I�� ttz 4a-3u v -�� 220254
PROPERTY OWNER M SOIL DESCRIPTION REPORT Page? of 3
PARCEL I.D. # 1 N 6
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch
Z S b ►�►i` �
3 � S l� •s .(,
Z. io 10 �t tZ 3 I b — `
s t 1 Z �-s blrt yvt fir• cS • S -L
Ground 3 zo Z-6 — I •S `-f R 3IV - s; z1 . 1 o-sbVZ_ m�,,• cg — • Z .3
elev.
� o`�•3 ft 16 - S2 '�•S4R3/ � 5' /8 C (3 v%n
Depth to
limiting
�
factor N I
I
i
Remarks:
Boring #
Ground
i
elev. ;
ft. '
i
Depth to
limiting
factor
I
Remarks:
Bdr7ng #
z
i
Ground
elev. '
ft.
i
Depth to i
limiting i
factor
Remarks:
Boring #
131
t
3.
i
Ground
elev.
ft.
Depth to
limiting
factor.
Remarks:
cnn nZgnrn n� - '—
PLOT PLAN Pa 3 of 3
SCALE 1 "=
hm
C kAt.. �L, 1 O . 5 ✓ •
OF g , 2 L Q°1
3 S
Is -
- bo NaT co►� -i p It -c..t 02
3 - �
B,3 a,
I
3S
) li�iv� -i E
� x
s
i
� - y "
WZLI_'� �F ti�T' �er�sT So' '�,� -c,►v► w� uv�
( 715 ) 42A 14 00576
CST Signature Date Signed Telephone No. CST #
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer t- Q
Mailing Address /o X,3 G 4ILo DA- /V
Property Address 2, 1 A5 f
(Verification required from Planning Department for new constructio
( City/State 4 00� Identification Number
LEGAL DESCRIPTION f //
Property Location %., S cE ' /,, Sec. , . , P ,? '7. T N -RLW,
Subdivision / 1 /A� -0,, e ' 4 Lot # -z4o• Z .
Certified Survey Map # S 3698 , Volume Page # 3
Warranty Deed # �S j e-17 ';t e Volume Page # 3 1
Spec house ❑ yes Kno Lot lines identifiable Ayes ❑ no
SYSTEM 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
masterplumber, journeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
day of the three y expiration date.
/ /
SI ATURE OF APPEIIIA DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
roperty cribed above, by virtue of a warranty deed recorded in Register of Deeds Office.
�\ 4jv� 9 / �'/
SIGNATURE OF APPL ANT 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
'17
t p4L13 15 491-1 -7 -1 a
Sl'.-V.E BAP OF �%:SCONSIN I ORINI 2 - 1982 KATHLEEN H. WALSH
5947,1d 'A'ARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
DOCUMENT NO RECEIVED FOR RECORD
Secluded Land Company, LLC; a Wisconsin Limited 12-36 9:30 AN
t — y - Com p a n) ,
--- --- WARRANTY DEED
EXEMPT 0
CERT COPY FrE:
COPY FEE:
K. Jerome,__
TRAN93 FEE. 195-00
kon\ watrant 10 _ Edward A. Jerome and Nancy 12.00
a marr couple (MN RECORDING FEE:
PAGES.. 2
I H , S L,^6� , A T A
NAME AND 'EloRN AD`R�SS
the t0flowing dc�krilvd rca estate in S t . C ro ix count J.V Smith
-)laic ol �Visccinsw� Secluded Land Company, TLC
P.O. Box 10
DeSoto, Wl 54624
See below *
F
CE !F
_ E T C
* part of: 231-1047-
* part of: 231-104
t ittached sheet for l lescription.
no t This non-marital propertv ior James W. Smith.
,Vs 1
4XI'iff[Orl 10 %&aFIJI1UCs sering the
Municipa and zoning ordinances, and recorded easement(s) I pubLic utilities
property, recorded building and use restrictions and covenants, general taxes levi-d in the
year of closing, and any liens and encumbrances created by the grantee.
Datcd ihv� 16th d �,t Qggembe r A D . 1 9 8-
SXclu ed Land CC) Kany,
-IA1
James W. Smith, Managing Member
ISEALC- - ------
ALI
�, i'll I"(0 James W. Sm-lith St of VVisconsin,
Joitin Ebben
1 -1 VE IP:R I F t� , %\ ['�� W"'It'
AIZ Or
"On t:C 1;
f k(-%Ii '41 .%As D4A]" D B
John P. Ebben, Attorney
j!, :Ioi
(B) GLWD 18, 20A,20B ct's
A\Pkk\l� 01 11)
LEGAL DESCilll'' '
Glenwood Meadows #18 #ZU.I
Lot 18 of Certified Survey Nlap No 3051 recorded all January 30, 1996, in Volume I I of
Certili.•d Survey Maps, Page 3051, Docwnent Number 539029, Said Certified Survey
Nlap being located in part ofthe Southwest 1/4 of* the Southeast 1/4, and pail of the
Southeast 1/4 ol'the Southeast 1/4, Section 27, Township 30 North, Range 15 West, City
4GIcimood City, St. Croix County, Wisconsin.
Along %%Uh,
Lot 20 1 :ind 2U 2 ofC'ertified Survey Klap No. 3570 recorded on Decen'ber 16, 1198, in
Volume I , ot'Cellified Surge} I laps, I'a-e 357U, I)OCUn Number 513888. Said
Certified Surve Map being; located in pall ofthe Northeast 1/4 ol'tlte Southeast 1/4, and
pall 01'111C Southeast 1 /4 ol'the Southeast I /4, Section 27, Township 30 North, Ram— 15
West, City ol'Glenwoud City, St. Croix County, Wisconsin.
Subject to and together with non- exclusive rights of ingress and egress over and across the
PRI`.'A H ROADS as more hilly depicted on the lollowing Certified Survey Maps.
( I) Certified Survey Flap No. 3047, Volume 11, {'age 3047
12) Certified Survey Flap No. 3048, Volume 1 1, Page 3048
(3)
Certified Survey Nlap . No. 3049, Volumc 11, Page 3049
14) Certified Survey Nlap No. 3050, Volume 11, Page 3050
(5) Certified Survey Map No. 3051, Volume It. Page 3051
(6) Certified Survey Nlap No. 3052, Volume 11, Page 3052
(7) Certified Survey Nlap No. 3570, Volume 13, rage 3570
fl is comveyance is made along with wid subject to the GLENWOOD MEADOWS Of-
' F CROIN COUNTY PROTECTIVE COVENANTS AND NIAIN INANC E
\SSO C IA PION DECLARATION as recorded on February 14. 1996, in Volume 1161,
Pa"cs 5:H-55-1, DOCUIUent No 530566.
Subject Io a 10 lix,l Mde utility casemcnl over and across the hcicin c,mveycd lot, said
e,iSem bein`, parallel with and abutting the PRIVATE " MD adjolmm, said lot
,:3) Ulcimood Meadm+ s M18. 020 I &, /120.2
12 51 Acres
FORM NO. 985-A \
4
Stock No. 26273
593888
I I
CERTIFIED SURVEY MAP NO. 3570
BEING LOT 2D - 2F TIFIED'' f RVEY MAP - 3052,
PART OF THE NORTHEAST 1/4 OF THE SOUTHEAST 1/4, AND
PART OF THE SOUTHEAST 1/4 OF THE SOUTHEAST 1/4,
SECTION 27, TOWNSHIP 30 NORTH, RANGE 15 WEST,
CITY OF GLENWOOD CITY, ST. CROIX COUNTY, WISCONSIN
EAST 14 CONER
SCALE:1 " -200' DRAFTED BY SEC27 /T30NR R15W Ch
DONALD M. CLARK LEGEND ST. CROIX CO. MONU.T
0' 100' 200' 400'
? OVERNMENT CORNER I
AS NOTED)
OWNER • FND. 3/4' REBAR
SECLUDED LAND CO. LLC • SET. 3/4'X24' REBAR
1673 13 1/2 AVE. P.O.BOX 99 WEIGHING 1.502 LBS.
BARRON, WI 54812 PER LINEAL FOOT.
LOT 1
UNPLATTED UNPLATTED
4—
. E _ 114-SE . L�. SEC. E7 . / � � J — \
C .S.M. 3 6
\ V.11 LANDS / N 6����2 l ir)
P_3047 LOT 21 ° ° �s \ \ tog
I LANDS
LOT 21.0
216,864 SQ. FT.
o o. R (4,98±ACRES)
g206,953 SQ. FT. 3' u6 A9 F LIE
® 2 (4,75±ACRES) LESS R\ _S.M. 3052 j 3 '
N / 3 165,564 SQ. FT.
evmmxli / % 11 P.3052 " - -°` 163, C3 5 2 t SQ.
`L
o / \ d~ <3.75±ACRES) LESS R \W o CD
Z D
LOT 17 p ,S 4 , 2 LOT 20.2
W s o £ LOT 20 N
� Ir C.S.M. 3051 46 3241
0 0 Cz
W^ W V.11 P.3051 / C S_M. 30__ OD z
BD
W w ___ LOT i 8 W_ LOT 20.1
J
t` V) w
°= 216,213 SQ. FT, Pi
Z W Z / C.S.M. 3051 <4.96±ACRES) ��
Er "' a —�— — -- 214,259 SQ. FT.
m F- m / N'o C4,92±ACRES) LESS R \W CD
V.11 P.3051 A It a
00 0 "wr /rr
S C .,� �� V.1 l P.3052 zI
O
* ' 1111 .•
DON ARK :* • LOT 19 N 8 ,
' T : ►aENOM80/ 02 W 387.38
NIE,
WI .,.,:; z C.S.M. 3052
• ' 1 I
uq�/��.•'�� V_11 P_3052 N
/�rrirrrrrlNrr� ._.
SOUTHEAST CORNER
1. "¢��� UNPLATTED LANDS SEC.27, T30N, MONO
ST. CROIX CO. �N
CEDAR CORPORATION
604 WILSON AVENUE Vol 13 Page 3570
MENOMONIE, WI 54751
(715) 235 -9081 PAGE_ / OF.2-
l _ _ i_
Safety and Buildings
2226 ROSE ST
LA CROSSE WI 54603 -1905
\ Visconsin Philip G. Thompson, Governor
lip Edw. Albert, Acting Secretary
Department of Commerce
January 05, 1999
CUST ID No.267341 ATTN: POWTS INSPECTOR
WEGERER SOIL TESTING & DESIGN ZONING OFFICE
421 N MAIN ST � ST CROIX COUNTY
PO BOX 74 h 4 .. 1101, CARMICHAEL RD
RIVER FALLS WI 54022 HUDNON WI 54016
RE: CONDITIONAL APPROVALr-
APPROVAL EXPIRES: 01/05/2001 Sr r Identification Numbers
'DUX Transaction ID No. 204591
201 VIN U Op Ft( � F / Site ID No. 1 6 5 667
SITE:; Please refer to both identification numbers,
Site ID: 165667 j�. j above, in all correspondence with the agency.
St Croix County, Glenwood City
SE1 /4, SETA, S27, T30N, R15W
Edward Jerome
FOR:
Description: Mound
Object Type: POWT System Regulated Object ID No.: 444428
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• 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.
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 /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 12/30/1998
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
( t ' ard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM
jswim @commerce.state.wi.us WiSMAR.T coop; 7633
r
Page of 6
MOUND SYSTEM
FOR
A - BEDROOM RESIDENCE
LOCATED IN THE 1/4 OF THE S 1/4 OF SECTION Z ,T 3r� N, R LS W,
i!] OF C�L�vwdo� C L` , ST . c�z c►uc COUNTY, WISCONSIN.
earn RECEIVED
. L.oT ZO - \ T1rW ZA .Z of CSwI Von... \3 , I'9 3 5
DEC 3 0 1998
INDEX SAFETY & BLDGS. DIV.
PAGE. 1 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW -CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
.PAGE 5 of 6 PUMPING CHAMBER '
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
ED
�DWf�F'. S �' �► COMMLRC
SPAEK BUILDI
�� 1 1V 1 ►�'1 IV S 5 36 1v vF s
G v�FtE
NOE�
PREPARED BY
Wr= (3EE EF2 E; C3 I[ !___ . TEST I NG
AND. ,egm4ttNlt+pw�►
DES I G nt s�tZv z c a► •� ~
°
�5
F.O. SOX 74 421 K. KAIK ST. .'�'.r'
RIVE.. FALLS. NI 54022 = WFGE EA
715'4i`r -01bJ ° =5 P •
• ELLSWUFTH,
W(S.
Z� e I G
uB
-
III` Rf3 --3 z Z
I; JOB NO
If
h
PLOT PLAN Page - Z- of
Scale 1"= I-)p'
. �Tbu2 N.L.. to �.5' •
t3 o'tTi or- %ft g. Z EL.°l°% 6
- \o3 -S' 3s' ____
I
� I
_ � ( I ( �� �►0'C" Cow'► Ph 02
Prvt 'A
g•3 Cr II O �-
II I
- AS \SS OF
2'�PUC F•M,
S
s
i - o
o
�-- a
4 ` =$a o ` 1 -4 g D i
ti
�i�L.l. � `3E �T L�sT 50' '�� -c►►'� ►^-t uv
?flf PS T ZS' S= 14M TlV%_ . __ -_
kjq S1+ 1)y ° b16 PUC 'pi PE
t'rt.L w� u N Es � -> s ' �►zor� �► o U rio . - - -- -- —
NOTES
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be\ ZOO1800 gallon capacity, manufactured by
5. Bench Marks , S Pn3uUh -
6. Divert surface water around system to prevent. ponding at the uphill side.
Page 3 Of 6
Approved Synthetic covering
`rYs�'w► c 33 Distribution Pipe
Medium Sand
_ H _ _ G
Topsoil �. -_ _ ___ F Elev. 1.03.5
E — D
3 of
it
b
— 7. % Slope
Bed Of Z- 2 2 ( Force Moin Plowed
Aggregate From Pump Layer
D Z. 0 Ft.
Cross Section Of A Mound System Using E Z -56 Ft.
B For The Absorption
F a. % Ft.
A Bed tion Area p
G t -y Ft.
A Ft. H ).5 Ft.
Linear Loadin g Rate= q -S GPD / LN FT B 6 3 Ft.
Design Loading Rate= 0.3$.GPD /SQ FT j 1 - 1 Ft.
J 10 Ft.
K Ft.
Alternate fusittun- �— L °I 1 Ft.
F- ewe - -Pqa it W
SS Ft.
L
Observation Pipe
8 � K
A
I• - - - -- ----- - - - - -- ------------------ - - --�� Force Main
�Pt)g t
Distribution Bed Of 2 "- 2-
Pipe Aggregate
Observation Pipe Permanent Markers
(Anchor securely)
4
Plan View Of Mound Using A Bed For The Absorption Area
• Pag y Of 6
Perforated Pipe Detail
<0
End View
) Perforated
End Cap. oboe 0 PVC Pipe Install permanent *marker
Sa o %c at end of each lateral
Holes Located On Bottom.
Are Equally Spored
I
Q S
PVC Force Main
P
PVC
Manifold Pipe
Distri ution
Pi e
Lost Hole Should Be
Next 7o End Cop 1
End Cap /
P 3U Ft.
Distribution Pipe Layout
S y Ft.
X Y 8 Inches
Y ' �' Inches
Hole Diameter Inch
Lateral Inch(es,
I
Manifold Z Inches
Force Main Z Inches
# of holes /pipe 8
Invert Elevation of Laterals -0 Ft.
j $xI•I .cl.3LY- uy G1pr -1
I
Place lst hole from center of manifold with succeeding holes
at 0 intervals. Last hole to be next to the end cap.
- Combination Sept4c; Tank and
PUMP . CHAMBER CROSS SECTIOM ARID SPECIFICATIONS ' PAGE. S .OF
~ WEATHER PKOOP'
- VEIJT CAP
JUIJCTIOL1 80K
If C. I. VENT PIPC APPROVED LOCKIN(a
lO' FROM ODOR. Ir HOLE COVER'.Jt ',i •.,i OR FRESH A, IAITAKE s cowD�
q i >✓
/ I t' N1IIJ.
I
y ° lusl��t�aa PIPS PROVIDE -- --
I
IAlLE T
7AIRTIGHT SEAL, I I
APPROVED JOIUT 3gppL�S A I I I i APPROVED JOIIJ
W C.I. EPCJ III W /C-I- PIPEI*Pjc
/ Tank construction I 11 ALARM
shall comply with
ILHRX (83.15 and 83.20 e ( I
I I Ow
C i
ELEY. FT PUMP -� - -�
- OFF
O COIJCRETE
lsZ.�l. I- OO BLOCK
3" APPRovI D
RISER EXIT PERM11TED OIJLy IF TAUK MANUFACTURER HAS SUCH APPROVAL- BEpDiNG�
SEPTIC W SPE C.If` ICATIOUS
DOSE 1DIL1f N �j ��- wumtSER OF DOSES: PER DAy
TAWK MAN UFACTURER:
TAWK SIZE: Z'VO / a90 GALLOWS, DOSE VOLUME I Z�q- S
ALARM MAIJuFACTUR -CR: S S'��G�ZO IWCLUDIWG 5ACKFLOW: GALLONS
MODEL WU MHEK- 10l \A CAPACITIES: A= INCHES OR GALLOU3
SWITCH TtlPC: B= IWCHES"OR L l� , 4LLDLJS
PUMP MANUFACTURER: Z O EX Cp C - 9 IUCHE5 OR 121 CALLOUS
MODEL tJUMBEK: 1 y D- 8 INCHES OR �b GALLONS
SWITCH TUPE: �Y MOTE: PUMP ARID AI X A1'tE TO 6L -O
MIMIMUM DISCKAR&E RATE GPM INSTALLED OM SEPARATE CIRCUITS
Z Z_
VEKTICAL DIFFEFEMCE DETWCEU PUMP Off A►JO_Dl5TR%bUT10►J PIP[. FELT
+ miwtmum MCTWORK SUPPLE PRESSURE .. - 2.5 V FEET
2 •� FT y.2S
�S S FEET O F FORCE MAIN X y �ofi.FRICTIO FACTOR - . FEET
.._ TOTAL D!J JAMIC HEAD = Z9 " FEET
DIAMETER
Pump chamber
NJTERLIAL DIMLWStOkl� OF TA LEM&TH ;WIDTH ;LIQUID DEPTH
BOTTOM AREA t 231 = - GAL /INCH
AS PER MANUFACTURER - Z l • u5 GAL /INCH
Hl�AQ.CAPACfTY CURVE TOTAL DYNAMICHFAOCAPACITY SingleSeal
PER MWUTE Weight 53 lbs.
W ' MODELS "140/4140" EFFWENT AND DEWATERING 3 )/B
4 s/e
Ff. Meters Gal. Ltrs.
14 45 5 1.52 91 344 o J 7/8
10 3.05 54 315 +
12
40 I S 4.57 76 tae
•
1 40,4 140 20 6.10 6e 257 1 1/2 - 11 112 NPT
35 25 7.62 59 .223
10 39 9.14 49 105
30 35 10.67 36 144
29.0
40 12.19 21 79
a
25 45 11.72 5 19
Lock Valve: 46' 12 5/e
6 8 20 3l.
U - T
4 5/16
0 15 -�
J 4 .. SK1524A
0
10
2 6• • �-
5 - 3 7/a 6 1/4
4 5/e
0
U.S. GALLONS t0 20 30 40 5o 60 70 81 90 100 t10 0 3 7/8
LITERS +i
80 160 240 320 400 +
0 FLOW PER MINUTE
010940 a
1 1/2 - 11 1/2 NPr
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and supplied 1613/32
with an alarm.
• Mechanical alternators, for duplex systems, are available with or without
alarms. - - T
i
• Control alarm systems are available for 1 phase pumps used in simplex 4 5/16
system. See FMO732. SK15248
• Variable level control switches are available for controlling single phase
systems.
• Double piggyback variable level float switches are available for variable SELECTION GUIDE
level long cycle controls. 1. Single piggyback variable level float switch or double piggyback variable level
• Sealed Qwik -Box available for outdoor installations. See FM 1420. float switch. Refer to FM0447.
• Over 130eF. (54 special quotation required. 2: Mechanical a8emator M -Pak 10-0072 or 10 -0075.
• Refer to FMO806 for 200 F. applications. 3. See FM0712 for correct model of Electrical Altemator E -Pak.
4. Variable level control switch 10 -0225 used as a control activator, specify duplex
(3) or (4) float system.
5. Four (4) (role J -Pak, junction box, for water tight connection or wired -in simplex
140 Series - 53 lbs. 4140 Series - 73 lbs. or 2 pump operation, 10 -0002.
1404140"' MODELS Control Selection
Model Model Vohs -Ph Mode Amps Simplex Duplex
N140 N4140 115 1 Non 15.0 1 or 1 &5 2 or 3 & 4 CAUTION
E140 E4140 230 1 Nan 7.5 7 or 1 &5 2 or 3 & 4 All installation of controls, protection devices and wiring should be done by
BN140 BN4140 115 1 Non 15.0 1 or 1 & 5 2 or 3 & 4 a qualified licensed electrician. All electrical and safety codes should be
BE140 BE4140 230 1 Nan 7.5 1 or 1 & 5 2 or 3 & 4 followed including the most recent National Electric Code (NEC) and the
Do" seal pumps pre avabble With oowlalrroisture sensors. Seal Fad kdmtor light avaiMle tn NEMAIorNEMA4x Occupational Safety and Health Act (OSHA).
control panels.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MA4 TO: P.O. BOX 16347
�. Louisv8l KY 347. Manufacturers
3 649 . .
�
SHIP TO: C ane C ane Ru Road
Louisville, KY 40211-1961 rLW.1rr A!/MP9 S NCE /9,7
® PUMP f0. (502) 778.2731.1(800) 928 -PUMP
FAX(502)774-3624