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HomeMy WebLinkAbout016-1008-80-000 ST. CROIX COUNTY ZONING DEPARTMEN AS BUILT SANITARY REPORT O wner ".... r , Address _ 1­7 N �ir 1 te) t City /State _G�l.c��1 t:0c)po G iTY � +` cp��� ,t " r, Legal Description: Lot -- Block Subdivision/CSM # 'V4 M& ' /4 _,5SL, Sec. 4 , T__'3QN -RAW, Town of GL O tJcoP PIN # Oi (a — 1 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer S KA LD Size ST/PC l ow/ bW Setback from: House _ Ab Well M P/L 3 Pump manufacturer GouL os Model Wag 5 t__. AiLarm location Tnl 1-1 wser (HOLDING TANKS ONLY) Setbacks: Service road Vent to s fre h air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: _BerD Width 1 Length 51 Number of Trenches —' Setback from: House Well 300 P/L _Lo Vent to fresh air intake - *3UD ELEVATIONS Description of benchmark p CAF `©V _%Vat&DA{ -f C, 0L-V el;x� Elevation 100�0 Description of alternate benchmark Elevation Building Sewer 91 'Z�� ST/HT Inlet o13 ST Outlet g3.02 PC Inlet ` 1 3 •b2 , PC Bottom &1-3i Header/Manifold 95. Top of ST/PC Manhole Cover % ,+ Distribution Lines ( ) ( 1 5- 9 Z ( ) ( ) Bottom of System O 9 4 '? O ( ) Final Grade Date of installation Permit nuoiber 3 1 5850 State plan number Plumber's signature License number 'ZZ_6544- Date /ZP `i & Inspector e j�pD Complete plot plan I I � NOTICE Please provide the following: A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PL VIEW Dy is 55 ` c• 130 _ -- _ t3 _ r Ivy •- z N INDICATE NORTH ARROW r ST. CROIX COUNTY f•� L__ WISCONSIN ZONING OFFICE r r r oil p M - - ST. CROIX COUNTY GOVERNMENT CENTER ' "'•� 1101 Carmichael Road Hudson, WI 54016 -7710 - - (715) 386 -4680 NOTICE OF VIOLATION June 24, 1998 NUMBER 98 -V -19 LOCATION: NE Y. NE Y. Sec. 4 T30N -R15W Tn. of Glenwood, St. Croix Co., WI PIN # 016 - 1008 -80 Neil McGee 1734 HWY 128 Glenwood City, WI 54013 RE: Failing septic system Dear Mr. McGee: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.01(2)(c) Wisconsin Administrative Code, and Article 15.03 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(c) Wisconsin Statutes (Category 1). This violation was first noted on June 1, 1998. The violation noted is discharging sewage into zones of bedrock. The soil and site evaluation report submitted by Gary Steel (CST #2298) dated June 1, 1998 revealed that the existing system is located in non - compliant soils. An on -site inspection on June 24, 1998 did not reveal any surface discharge. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of that date in accordance with Chapter 145.12(4) Wisconsin Statutes. REQUIRED ACTION: Within 90 days of this notice, contract with a licensed plumber who will design the septic system and obtain a sanitary permit through this office. The septic system must be installed within 90 days of this notice. Please contact me if you require clarification of this matter. ely, o Rod Eslinger Assistant Zoning Administrator Wisconsin Department of Commerce PRIVATE SEW Safety and Buildings Division AGE SYSTEM Coun 15T . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita3ylPg "00.: Personal information you provice may be used for secondary purposes [Privacy , s.15.04 1 m Y O( )L Permit Holder's Name: ❑ Cit --aa Vil ge ❑ Town of: State Plan ID No.: CGEE NEIL GLETWOO) CS M EIev.; Insp. BM Elev.: B�O Description: ParceIG9 a.1008- loo l ] 'I d TANK INFORMATION U ELEVATION DATA A9800240 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benc m r r i • `•10 G�V O�vL Aeration Bldg. Sewer C ,5$ 7 7 7,0Z Holding St / Ht Inlet 1 ©7 ` C73 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. A ir ir I to ntake ROAD Dt Inlet S ptic L' 6_ �� NA Dt Bottom n 0 NA Header / Man. Aeration NA Dist. Piper Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 4 9� Manufacturer �. � emand WtuI�#� r -7 "l, 1 , Model Number 3 3,0 GPM TDH Lift 7.(p� Friction, A Syetem TDH a t oss Forcemain Length b Dia. HH n Dist. To Well SOIL ABSORPTION SYSTEM Z G► EN RENN H Width 1 � r Length No. Of Trenches PIT No. Of Pits Inside Dia. liquid Depth N I N SETBACK SYSTEM TO P/ L BLDG WELL M Manufacturer: INFORMATION Type Of a,, CHAMBER Model N er: System 2� U I I- OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length r Dia. Spacing ,� ST1v� -4 tf, �Z1 7 2�-d =c SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over l r� Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched B ed/ Tr ench Center d(a Bed /Trench es o ❑Yes ❑ N o COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: G 4.30.15.69B,NE,SE 1734 HIGHWAY 128 ` VW A A+ � vi wlY ii '�� � (a (a`F V C �B Pl,IV sion required '# K ❑YesNo /_ Use other side for additional information. tP 7. SBD -6710 (R.3/97) Date ' Ins& r ert. No. b I Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Departfnent of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. 4 .5 - r CA0 I X. • See reverse side for instructions for completing this application State Sanitary P ermit Number The information you provide may be used by other government agency programs E] Check ' revisionto application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name � Propert Location N 0% i... M G GS6 NF, 1/4 1/4, S Q- T 30 , N, R 1 Wr) W Property Owner's Mailing Address 1"1 Wfw Mb Lot Number Block Number City, State lZip Code Phone Number Subdivision Name or CSM Number C��N I,,i;o0o _ I'T't d.,?I 540 1.5 11. TYPE OF BUILDING: (check one) ❑ State Owned 0 cit Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF G La -rcX1n t ( +% 1 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 01 L= 100 e) 9� 1 ❑ Apartment/ Condo 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 ❑ New 2. W Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System _, System Tank Only 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ 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 (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) I Elevation 4'So ( 94, 5 Feet Feet VII. TANK Capacit in gallo S Total # Of Prefab. Site Fiber- Plastic Exper- INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete strutted Steel glass App. Tanksl Tanks Septic Tank or Holding Tank 1000 1 000 `jl{�.t,J Com&oAnc 0 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber (Fib ❑ ❑ 1 ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume respo sibil#y for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plut bel Sign ure: (No t m ) MPRSW No.: usiness Phone Number: Roo iz ► � �.. 22�: s�4- - 115 - ) (o3 Plumber's Address (Street, City, State, Zip Code): (4-10, 1 AV 15 AMr,.0 ? US 5+8 1 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sani ary Permit Fee (includes Groundwater ate ssue Issuing Agen nature (No ps) roved [3 Owner Given Initial /� Surcharge Fee) pp Adverse Determination /e`er �� X. CONDITIONS OF PPRVA�/REASONS FOR DISAPPROVA 1 % v Ago Lek, '4�77 SBD-6398 (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Pl unber 1�3 PvRopoR Logy- P,-n w l&4 so4. swcA- T3o� -15ua Touj o a r Gtzrjwoop - CAP-011, Co . N % 3gm� Noy �6 5T1 ho -� Bm d '� (�'j �Yl � u �1G�, �Yl1aCZi�. ��..- 100 = Cam T O St'r---S t. C0v,:r e AT Dg-' Z WA, ( 5 -,i pc, 5pt� e,�fa�►c P�w.p c1�mgrZ. Skt>us l�ocx� �A� Gc:-r�c3�r.�A'C►v� Dom. vv-Alo f16 - vpu uk, Loop-. - tl« a4 •�" �. .. ti� 9� Page 2 Of J COMBINATION SEPTIC TANK /PUMP CHAMBER 4" CI Vent Pipe with (No Scale) Approved Cap, +25' Approved Locking Manhole Cover From Buildings With Warning Label Attached Weatherproof Approved _ Warning Label Junction Box Vent Cap 12 Minimum V4" Final Grade --� 6" Minimum inimum 6" Maximum i 4" C.I. Disconnect 18" Minimum Insp. Pipe-- - i 1/4" Weep I --tj Hole Baffles !J � * t � A i Alarm 64 B On , C *APPROVED Off r' JOINTS WITH APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL 3" of Beddinq Under Tank—/ Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day/ o Doses: <_ Volume of Backflow:....... +__Gallons Tank Manufacturer: 5 1-AU-) - PeJ AsT Total Dose Volume: ........ = J-a Ga ons Tank Size - Septic /Pump:_1C4::)_cd.t,n0 Gallons Alarm Manufacturer: Model Number: lo t Capacities: A (Z i nches or 340.E Gal 1 ons Switch Type: m _�2�e + B Z inches or 5 Gallons Pump Manufacturer:_ + C 1O3zinches or Ir7a Gallons Model Number: lodgk v 3 L + D_�,_inches or qq Gallons Minimum Discharge Rate: GPM Total..... = �q_ inches or < e 4Z Gallons Vertical Difference Between Pump Off and Distribution Pipe: Feet Minimum Required Supply Pressure :........... ............... -- Feet Feet of Force Main x je Friction Factor /100 Feet: + eet Z Inch Diameter Force Main Total Dynamic Head: ... = 11.2 Feet Irl ;, Internal Tank Dimensions: Length_; Width 5 Liquid Depth 39 Signature License Number 'ZZ 65W Date 1 1 �� Gould ' Submersible Effluent Pump 3885 CANADIAN STANDARD ASSOCIATION SlI APPLICATIONS • Three phase: ' /z HP – FEATURES Motor: Fully submerged in 1'/2 HP 200/230/460 V, high -grade turbine oil for Specifically designed for the 60 Hz, 3500 RPM. Class D Impeller: Cast iron, semi- lubrication and efficient heat following uses: open non -clog with pump - insulation, overload transfer. Homes protection must be out - vanes for mechanical seal • Farms protection. Balanced for Designed for Continuous • Trailer courts provided in starter unit. smooth operation. Silicon Operation: Pump ratings are • Motels ' Shaft: threaded, 400 series bronze impeller available as within the motor manufacturer's Schools stainless steel, an option. recommended working limits, S • Bearings: ball bearings can be operated continuously Industry Hospitals up per and lower. Casing: Cast iron volute Pp t ype for maximum efficiency. without damage. Power cord: 20 foot • , e • Effluent systems �� Bearings: Upper and y standard length (optional 2 NPT discharge adaptable lengths available). for slide rail systems. lower heavy duty ball bearing construction. SPECIFICATIONS Single phase:' /3 and' /2 HP Mechanical Seal: Silicon Pump: – 16/3 SJTO with three carbide vs. silicon carbide Power Cable: Severe duty • Sollds handling capabilities: prong plug. 3 /4 -1'/2 HP sealing faces. Stainless steel rated, oil and water resistant. 3 /4 ' maximum. –14/3 STO with bare leads. metal parts BUNA -N Epoxy ovid es secondary moisture seal on motor end • Discharge size: 2" NPT. Three phase:' /2 - 1'/2 HP elastomers. provides l • Capacities: up to 128 GPM. – 14/4 STO with bare Shaft: Corrosion - resistant barrier In case of outer jacket Total heads: up to 123 feet leads. On CSA listed stainless steel. Threaded damage and to prevent oil TDH. models – 20 foot length design. Locknut on three wicking. Mechanical seal: silicon SJTW and STW are phase models to guard 0 -ring: Assures positive carbide -rotary seat/silicon standard. against component damage sealing against contaminants carbide- stationary seat, 300 on accidental reverse rotation. and oil leakage. series stainless steel metal parts, BUNA -N elastomers. • Temperature: ME TERS FEET 104 °F (40 °C) continuous 9 140 1 F 60 0 C intermittent. SERIES: 3885 • Fasteners: 300 series 25 80 Ei RPM:3VARIOUSS stainless steel. - – — –,► 5GPnn • Capable of running dry 70 E1 5FT without damage to a 20 __. _ -- _ -. _._. _ .. -- -- __. components. 80 eel Motor: 15 50 • Single phase:' /3 HP,115 Z or 230 V 60 Hz, 1750 RPM; 40 V EM H '/2 HP, 115 V, 60 Hz, 3500 RPM; '/2 HP — 1'/2 HP, R 10 30 ' 230 V, 60 Hz, 3500 RPM. 20 E Built -in overload with 5 automatic reset. 1 Class B insulation. 0 00 10 20 30 40 60 60 70 80 90 100 110 120 130GPM L I 0 10 20 30 m CAPACITY ©1994 Goulds Pumps, Inc. Effective May, 1994 1 1 83885 Wiscobsia Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 016 - 1008 -80 Attach complete site plan on paper not le han 6 f /2`x 1,4 j r es in size. Plan must include, but not limited to vertical and horizontal re r6nce point (BM), dir44ti and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and local 6,40d dis nceNo nearest roa . R WDBY D4 TE APPLICANT INFORMATION- 'EASE PAW PAW—T,42 INFOWM TION � PROPERTY OWNER: - �% 1w 7 1, I PROPERTY LOCATION Neil McGee S' Rr GOVT. LOT NE 1i4 SE 1i4,S 4 T 30 N,R 15 for) W PROPERTY OWNER':S MAILING ADD r',, r C'; ! ! Y LOT # BLOCK # SUBD. NAME OR CSM # 1734 HY. #128 rONINGOFFIC na na na CITY, STATE ZI 0[lE PHONE []CITY ❑VILLAGE []TOWN NEAREST ROAD Glenwood City, WI. 54013 1(7-1 Glenwood HY. #128 [ ] New Construction Use [ ;4 Residential / Number of bedrooms 3 [ ] Addition to existing building jx] Replacement [ ] Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate • 7 bed, gpd /ft - 8 trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate .7 bed, gpd /ft — trench, gpd /ft Recommended infiltration surface elevation(s) 94.50 ft (as referred to site plan benchmark) Additional design / site considerations area of B -1 to be backf i l led to code 18 ' x37 ' bed Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND 7IUR OUN D PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem Q S [I U KI S ❑ U S El U cis ®U LA S ❑ U [Is ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .................. ................. .................. ................. .................. 1 0 -15 10yr2 /2 none 1 2msbk mfr gw 2f .5 .6 1 2 15 10yr4 /4 none sicl lcgr mfr gw if .2 .3 Ground 3 33-50 7.5yr4/4 none c b. sicL lcsbk mfr gw na .2 .3 elev. 9 9.5 ft. 4 50 -96 10yr5 /4 none ms Osg mvfr na na .7 .8 Depth to limiting factor +96 Remarks: Boring # 1 0 -17 10yr2 /2 none 1 2msbk mfr 9w 2f .5 .6 2 2 17 -4 10yr4 /4 none ob. si 1 lcsbk mfr gw if .2 .3 3 48 -84 7.5yr3/4 none ms Osg mvfr na na .7 .8 Ground elev. 98.5 ft. Depth to limiting factor +84" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. v . New Rich nd WI 54017 Signature: Date: 6 - - CST Number: m02298 PROPERTYOWNER Neil McGee SOIL DESCRIPTION REPORT Page 3 PARCEL I.D. # 016 - 1008 -80 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxtary Roots GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench g. ..,,.< 1 0 -18 10yr2 /2 none 1 2msbk mfr gw 2f .5 .6 k�v v..: I N 2 18 -40 10yr4 /4 none cob. sic lcsbk mfr gw if .2 .3 :. Ground 3 40 -86 10yr5 /4 none ms sog mvfr na na .7 .$ elev. 98. ft. Depth to limiting factor +86" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 4nn• Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Neil McGee New Richmond, WI 54017 MPRSW -3254 NE4SE4 S4- T30N - (715) 246 -6200 town of Glenwood N 1 =40' BM.= top of culvert C el. 100 Alt. BM.= nail in Elm tree C el. 97.90 �}csrs�ih y W 4 r3 r ti PJ ft r, v� Gary L. Steel 6 -1 -98 Wisconsin, Department of Industry SOIL AND SITE EVALUATION REP 0 R T Page 1 of 2 l abor and Human Relations Privision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 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. 016 - 1008 -80 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION J BY D TE g 6 ►8 PROPERTY OWNER: PROPERTY LOCATION Chmw Kno s Sv er Nei McC -e-6 Ow r GOVT. LOT NE 1/4 SE 1/4,S 4 T 30 .N,R 15 Ikor) W PROPERTY OWNER':S MAICING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1734 HY.. #128 n;4 na CITY, STATE ZIP CODE PHONE NUMBER [ ❑VILLAGE Z]fOWN NEAREST ROAD Glenwood, City, WI. 54013 (715)265 -4360 Glenwood I Hy./ #128 [ ] New Construction Use [ X] Residential/ Number of bedrooms 3 [ ] Addition to existing building (�] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate na bed, gpd /ft na trench, gpd /ft Absorption area required na bed, ft na trench, ft Maximum design loading rate np bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) na ft (as referred to site plan benchmark) Additional design / site considerations na Ex%s+ina ap+o.V ' — �Gar� Parent material sedimentary rock Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem EIS ®U C7 S M [IS ®U ❑ S ® U EIS ®U [N S ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon p Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -15 10yr2 /2 none 1 2msbk mfr gw 2f .5 .6 La 2 15-32 10yr4 /4 none sicl lcsbk mfr yw if .2 .3 Ground 3 33-BC 10yr5 /4 none 3cl/Ls over 50 rock na na np np elev. na ft. Depth to limiting factor 33" Remarks: 15 ar Pho ' o w C, on 5b QG Boring # 1. r Ground - , - c I VL elev. t ft. k r C ROIX ` 98 Depth to COUNTY limiting Z011 INGOFFicE factor , Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 246 - 6200 Address: 1554 200th. Ave. New Rich nd WI 54017 Signature: Date: 6_1_98 CST Number: m02298 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # '• Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # :•iii .vv; 4ii nh Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) f STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. GSTM2298 Neil McGee New Richmond, WI 54017 MPRSW -3254 NE4SE4 S4- T30N -R15w (715) 246 -6200 t town of Glenwood N 1 =40' BM.= top of culvert C el. 100' Alt. BSI.= nail in Elm tree C el. 97.90' LQ per Phone convcrs v- / /C'.'j oVI t'16198. Re d. U" Lip 41; q�3 i Gary t. Steel 6 -1 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer o e l ► " m e ( GSM Mailing Address i'l - -- - �4- 1.1 w, i I—e C L ertj wc = C r Y LE Property Address 5 P�rY►V , (Verification required from Planning Department for new construction) City/State GLg N iswnn Crr r LtS. Parcel Identification Number 0 to — t 00 8 -- LEGAL DESCRIPTION Property Location _ %., Lv, %, Sec. 4 T � N- RJ.-ZW, Town of GkL tj ooro l . Subdivision , Lot # _ Certified Survey Map # . Volume . Page # Warranty Deed # 6 4 06 2Z E�) , Volume 11 t j . Page # `�- Spec house 0 yes 4 no Lot lines identifiable 19 yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could tesdlt in its premaiture -More to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooti &, if heeded by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in die waste disposal system. The property owner agrees to submit to St. Croix Zoning be0arhnent a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a lieewMpttntper Verifying dAt (1) the on -site a rastewaterdisposal system is in proper operating condition and/or (2) after inspection and pmnping.(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 Commence and the Department of Natural Resources; State of Wisconsin. Cerfacation stating that your septic system has been maintained must be compleW and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. - ZJ ;Wc, a- (V /M6 SIGNATURE OF APPLICANT DATE OWNER. CEATMCATION 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 the prop described 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 tha sanitary pennit 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 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2 -1982 r1n5 SPACE RESERVEDr Of 4 RI cunnlNC uAIA �I WARR,l1UT*'DEED 540528 von- 1165 PAG: 4 56 REGISTER'S OFFICE - -- — ---- - - - - -- ST. CROIX CTY., WI i Rec'd for Record ro dZ&E5 .SEA!- _ MAR 6 1996 I conveys and warrants to �/� /L L. ' Qt OXL I - - -- -- -- - Register of DWft I RFTunN TO (ylc(�ee 1 -7.3q to �9 the following described real estate in — 'ST e'R1) / X -- County, G en W o c d State of Wisconsin: II Tax Parcel No: --- �_,�Q %�,�... 65 I /o -7a PhA NE 0 5- 5E i D 5r c1/e5crrbed as _; /,,, o Cor�rnE.vc�. , r, Tic E % corner o See T.orr �f -30 -/5 he rC �c�rTer know . �S Tl�e /GtcC_ �,s Z1 irril,rl 7�4 V9 _14:2_" k,) See! 71 - le i ce. 50 5 >-- a y S 5 T ro a n )ron j oi�r, T /i�.T�c 8 3 06' ttJ for ��S.o �ecT Tv a� /ro It ��, 7he"C' S53 5e-e -7 7 e Iro�r p e I ewc ,5 /}S v �or .36 . rce To a 1 /Pori /�pc c, j-7 7 z: Al eo �ai W/ 7 S 3 �e� T To 7`hc A/ A' o � T/l � S� o L % h c /Q �uJ T'o The GNhTe //'ne d f/i:y4w `'/028 �� T`Ieyle� e A7 The '7 9/• g$ . - re T i `0 7 /je �/ae e o II / F 1 This _ / -5 homestead proper ty. (Is) (is not) Exception to Warranties: 4th March 96 Gated this --day o - - - - -- - - ---- - - - - -, 19__ -- _(SEAL) ` r" o,,5 ` --_-___(SEAL) Louis J. Hooser, Jr. Beverly Hooser AUTHENTICATION ACKNOWLEDG'AENT Signatures) STATE OF WISCONSIN ss. 5t Croix county, authenticated this day of Personally came before me 1 4th day of -- ------March - - ----- - -__ -_ , 19 �� _ the above named Louis J. Hoos Jr. and Beverly Hooser TITLE: MEMBER STATE BAR OF WISCONSIN (If not. _ to me known to be the person._ 5..._.._ s- Wt�QiCu authorized by § 706.06, Wis. Slats.) foregpinginyrument and ac}rgowle¢gflFhe9aAle. i ' U ••• THIS INSTRUMENT WAS DRAFTED BY � �'�- -zz..� :• C.F _ - �- • c LaVon J. Cassell a Q,.t! ; ro ' . _ -,? g — .fdt, 914 y St . Croi1C: Notary Public _- p_'� _ C8 1�it.%? (Signatures may be authenticated or acknowled ed Both M y Commission Is permanent. (IF d' �O.1itt'(1r�lu;,r1 are not necessary.) �,5 A date: - -- -March 9, -- -_ ' �i� ) 'hlq nap <n'I j�l +iannti 5i(rnlnq m,�ny rat ar ,iy ;t ri i •I b•' !r{ •. 1 .., ,n ui L•rt hMU.v ihe• 5�)n.0 Unc S-' {17 Nlf np1 li WARRAN DEED STATE BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307-0200 Fmm - Nn 2 -- 1981