HomeMy WebLinkAbout016-1011-10-0001 3\r(sconsin Department of lndustry,
[;bor. and Human Relatiors
Division of Safety & Buildings
SOIL AND SITE EVALUATION REPORT
in accord with ILHR 83.05, Wis. Adm. Code
ofPage
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction andT" of slope, scale or
dimensioned, nortH arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
flt. Croix
PARCEL I.D. #
REVIEWED BY DATE
PROPERW OWNER:
Les Schouten
PROPERTY LOCATION
cOW. LOT SI{ 1/4 S[] 1/4,S 5 T 30 ,N,R 15 E (or)W
PROPERTY OWNER'.S MAILING ADDRESS
282.0 170th. Ave .
LOT #nla BLOCK #nla SUBD NAME OR CSM#nla
CITY STATE
Frnerald, WI.
ZIP CODE
540L2
PHONE NUMBER
TL5 I 265-4580 nclw EVILLAGE E[iOwtt
Glenwood
NEAREST ROAD170th. Ave.
[ ] New Construction
[x]<Replacement
Use [o[ Residential/ Number of bedrooms 2--I 1 Addition to existing building
tl Public or commercial describe
Code derived daily now 300 gtr Recommended design loading rate n/p bed, gpdft2--i-fench, gpd/ft2
Ahorption area requirs6 25o 6sd, 12-rsnch, ft2 [,hximum design loading rate n/p bed, gpd/ft2--!.1-rench, gpd,t2
Reco mmen ded infi ltrati on s urface elevation(s )
105. 85 ft (as refened to site plan benctmark)
Additional design / site considerations replacernent system less than 2'
Parent material glacial ti11 Flood plain elevation, if applicable nla ft
S = Suitable for svstem
U = Unsuitable fo? system
CONVENTIONAL
N S E}tJ
MOUNO
ELS t] U
IN-GROUND PRESSUREtrS EilJ
AT.GRADE
D S ETIJ
SYSTEM IN FILLtrS EKJ
HOLDING TANKtrS EU
SOIL DESCRIPTION REPORT
Boring #
Ground
elev.
101. 82 ft.
Depth to
limiting
factor
L4"
Remarks:
Horizon Depth
in.
Dominant Color
Munsell
MotUes
Qu. Sz. Cont Color
Texture Structure
Gr. Sz. Sh
Consistence BonCary Roots G P D/ftZ
Bed Trerrfi
1 0-B LOyr3 I 4 none L 2lnlshk mfr cls 2/t 5 6
?B-14 LOyr5 I 4 none si-1 .1/f/shk rnfr E/w Llf ,)/-3
3 L4-42 7 .5yr4l6 c1d 5yr4 I 6 sl.t/f/shk nfi nal nal 4 5
Boring #
Ground
elev.
101 . BZtt.
Depth to
limiting
lactor
16"
5 62lnlgrrnfrclszlt10-B LW3l4 none L
mfr 8lw rlf 652B-16 Lqrr5l4 none si-1.2lnlshk
8lw rlf Z :.3cZd 5yr4/6 scl Zlnlsbk mfr3L6-25 7 .5yr4l4
-,1D>Q./o/,nlp25-40 5yr4 I 4 cZd 5w416 c1 If4
sr-(
-q
\I
qffN'{
.qqt
--lurt
51
\
Name:-Please Print PL. Steel
r\rr? 54017t554h. Ave.Richmondress:
csrrq ff{$umuer7 -9-93 Date:Signature
Remarks:
ffi
\
/€
pRopEFry owNEB l-es Schouten soll DESCRIPTION FEPORT Page 2ol
-.
I
3
PARCEL I,D.I-
Boring #
Ground
elev,
104.02 [r.
Deph to
limit ng
lactor
L7"
Horizon Depth
tn
Dominant Color
Munsell
iroues
Ou. Sz. Cont Colo(
Texture Structure
Gr. Sz. Sh.
CorsisEnce Roots GPD/ftZ
Bed lTrcmh
1 0-9 1.}'yr3l4 none I,-2lmlsr mfr ?.1f 5 6
2
3
9-L7 tw5l4 none si1 2lnlsbk
1 f sbk
mfr Elw Uf 5 .6
17-33 7.5w414 c2.d 5yr4l6 sc1 mfr IJ rlt 2 .3
4 33-46 5vr3l4 c2d 5lurh l6 c1 l{n n n n
Remarks
Boring #
t{s*."."Et
Hfi ....*[
elev.
Ground
fL
Deph h
limiting
hcbr
Remarks
Boring #
ffi$s
Ground
elev.
fl.
Deph to
limifng
hcbr
Rsmarks
Boring #
elev
Ground
ft.
Deph h
limiling
factor
Remarks:
SBD{330{R.05,92}
TEETS SOIL SERVICE
Gary L. Steel
c.s.T. 2298
MPRSW€254
,p c\
/709fl,ta.
I-€s SchouEen$q $q s5-r3oN-R15r{
town of Glernsoodlootl-
Nsw Richmond, wl 54017
(/1s) 24e61X)
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361
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,fu
L. SLeel
7-9-93
Parcel #: 016-1011-10-000 04/092007 (N:05 PM
PAGE t OF I
Alt. Parcel #:
Current X
Creatlon Date
5.30.15.858
His6rical Date Map #
00
Sales Area Application #
0
016. TOWN OF GLENWOOD
ST. CROIX COUNTY, WISCONSIN
Permlt # Permlt Type
Tax Address:
LANCE W NASER
SC = School SP = Special
Description
GLENWOOO CITY
wtTc
Oyyn6l(s): O = Current Owner, C = Cunent Co-Owner
O - NASER, LANCE W
Property Address(es):
. 2820 170TH AVE
'= Primary
PIAI: N/A-NOTAVAILABLE
BlocUCondo Bldg:
Tract(s): (Sec-Twn-Rng 40 114 160',1141
05-30N-15W
2A20 170rH AVe
GLENWOOO CtTY Wt 54013
Districts:
Type Dist #
sc 2198sP 1700
Legal Description: Acres:
SEC 5 T3ON R15W 4.5ACRES IN SW SW COM SE
COR SW SW TH N 413'W 461'SLY 4,I8'TH E
ALG S LN 478' TO POB
Notes:
2OO7 SUMMARY Bi[ #:
4.500
Parcel Hlstory:
Dato Doc #
0610512002 680944
07i2311997
07/231',t997
07l23l't997
Vol/Pags
1905/104
11491627
1036/09
991t571
Type
WO
ac
WD
WD
Falr ilarket Value:
0
Asssssed wlth:
Valuations:
Description
RESIOENTIAL
Class
G1
Acres
4.500
Land
21,000
lmprovg
125,100
Last Changed:
Total State
140,100 No
10/06/2003
Roason
Totab for 2007:
Totals for 2006:
General Property
Woodland
4.500
0.000
General Property
Woodland
4.500
0.000
2'l,000
0
21,000
0
125,100 146,100
0
125,100 146,'100
0
Lottery Credit: ctatm count: 1 Certification Dato:Batch #: 112
Specials:
Us.r Spoclal Code Catsgory Amount
Total
Special Assessments
0.00
Special Charges Delinquqnt Charg0.00 0.
e3
00
STC 10 4
AS BUILT SANTTARY SYSTEM REPORT
OWNER /-t r- Sa ho ,,rJ @ rt
ADDRESS *€
suBDrvrsroN / cslr#NA
sECTrou-!, t -? t-r N -o15*,
--=rt
r.or # c
Town of
sT. cRorx cot NTY, wIScoNsrN
Provide setback and elevation information on reverse of this form'
Provide 2 dimensions to center of septic tank manhole cover'
PLAN VTEW
SHOI^I EVERYTH NG 100 ET OF SYSTEM
\\to'+
5u
en
U
g0
nh'
TNDTCATE NORTH ARROT^I
: ' 1,')T:r.'- ....i.!:
,
I
\LBENCHHARK:
ALTERNATE BM:
SEPTIC TANK / PUMP C}IAMBER / IIOLDING TANK INFORMATION
Manufacturer:.>Liguid capacity : ) ?nr-t Ve I,
Setback from: I-leIl lhJf House f -q ' other
I:=-
Pump: Manufacturer
Float seperation
Alarm Location
LICENSE NUMBER:
INSPECTOR:
Model # s,ilE ,tzt/ r6ir" /> l/./).
l{apt(GaIlons/ cyc)-e:
t-
width , 4 )'/
Building
PC inlet
I
Header/Mani fold
Existing Grade
DATE OF INSTALI,ATION:
PLUMBER ON JOB:
Sewer /L/ P 1z
I h2-L- PC bottom 6r/Pump Off
..SOIL ABSORPTTON SYETEU
Lenqth 1 =
' N,-r*ber of trenches /
-
Distance & Direction to nearest prop. line://7
Setback from: weIL l0O'f House / 4 /;
-
Other
ELE\rATIONS
ST Inlet:ST outlet 3 7/
17
OBottom of system
Final grade c
,
L
,)
3/93:1t
/,zry'
, LOGAff;[&U&nGI'SH$0OU/,5.30. 15. ffiVATE SEWAGE SySTEMLabor and Human Relations
safety andlurldrnss Drvrsron INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
t
TANK INFORMATION
TAN K SETBACK I NFORMATION
PU M P:lffifgtsl N FO R MATI O N
SOIL ABSORPTION SYSTEM
ELEVATION DATA A9300237 telo:
r^f Erlllrtfal\
El-elty If \/illase{ rown ofPermit Holder's Name,:
lnlrnrrfrrlillr ? EIQT Erv r^,
8M-Desan[tioE
aa5 /,)c,t ruCSTBM B5T: 'Tri3p. BNIElev.://), D
ou nty
r?n rnttar
tate
CAPACITYTYPEMAN U FACTU RE R
/t04(Septic 7
YfiqdlDosingI
Aeration \
Holding
STATION B5 HI FS
Benchmark ?sa
Bldg. Sewer
srtyl lnlet s I /0y',6'
*trt outlet 5,'70 la{, J8'
Dt lnlet t1ff /aa
Dt Bottom /
//?r,str'
FHcr / Man /(8,ttr
Dist. Pipe
7 /os,#
Bot. System
Final Grade
f
lYtrnlt l 2 II /a6.y'6
TAN K TO PIL WELL BLDG Vent to
Arr lntake ROAD
Septic > /6)\rA ?.3,4ausa-
Yo'qo-q<117?NA
Dosing 7'//D'> /0?
V />/a NA
Aeration NA
Holding
Manufacturer /)
C2 L {s Demand
GPMModel Number U)eo3// ryl
TDH Lifr Friction
Loss TDH Ft
Forcemain Length ,O'Dia. 2 Dist. ro wett).77)/
BED / TRENCH
DIMENSIONS
Wrdth
3
Lengt )a No. Of )'"
nches P!T
DIMENSIONS
No Of Pits lnside Dia Liquid Depth
SETBACK
INFORMATION
5Y5TEM TO PIL BLDG WE LL LAKE / STREAM LEACHTNG _cH^yB{
ofUrutrtype Ol,Q4,,.o.t ,
System: fn.n-d >/a )/ao'> /(b 44 ModefNumler
DISTR!BUTION SYSTEM
n pipe(s)
Lensth 14-"ia a I t"nnrn 4 spacrng -fuDra
x Hole Size4"7oiEJp-tc'n9
30"
Vent To Air lntake> /d)/
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over
B,ed4,Trench Center /8/Depth Over t, ^ //
#trrenchEdges p-/Y
xx Depth Of
Topsoil 6
xx Seeded /Sodded
EP*r- fl No
xx Mulched
ElJe&- E No
COMMENTS: (lnclude code discrepancies, persons present, etc.)
LOCATION: GLEM{OOD 5. 30.15.858
Plan revision required? [ Yes D^€
Use other side for additional information
sBD-6710 (R 05/91)
/>7 /
Date
q
lnspector's Srgnatur Cert No
ax a
/')ar*
>/d
ELEV.
I
,
)
3
L-v,t :I ?/3 ,n1r.43
t#:Elo
/
tr
--
trIILHFI SANITARY PERMIT APPLICATION
ln accord with ILHR 83.05, Wis. Adm. Code
-Attach complete plans (to the county copy only) for the system, on paper not less than
ElLx 11 inches in size.
-.See reverse side for instructions for completing this application.
I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
J;/. Enot{
:?ynffi.w :
",r
s a p p, i ca, .n
STATE PLAN I.D. NUMBERS 13 -{os ?7
5 T30,N,R /5 €or Wsd v,Y4, S
PROPERW LOCATIONPRoPERW o2 ER
c
BLOCK #//+LOT #PROPERTY OWNER'S MAILING ADD+IRESSfrl4zBZo I o
r5 z 5-
PHONE NUMBERZIP CODE
5+o t3 suBDrvyf NAME OR CSM NUMBER,+CITY, STATE et
VILLAGE a/aod
NEAll. TYPE OF BUILDING: (Check one)
E pruti. E[, or' 2Fam.Dwellingr-f, of bedroorc LState Owned
o/6'/c//^/o
1
2
3
4
5
ApUGondo
Assembly Hall
Campground
Church/School
Hotel/Motel
6
7
8
9
0
1
2
3E Ori." lFaclory
1
1
1
1
!!1. BUILDING USE: (lf building type is public, check 4lthat apply)
E otn"r: Specity
fl Service Station/Car Wash
Medical Faci I ity/Nursi ng Home
Merchandise: Sales/Repairs
Mobile Home Parktrtr
Outdoor Recreational Facil itY
RestauranUBar/Dining
lV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
Permit was previo
5.Elneptace
System
B)Date lssuedA San
Repair of an
Existing SystemTank Only
issued. Permit #
-
Reconnection of
Existing System
A) 1.E New 2
System
ment 3. E Replacement of 4. E
Pressurized Distri bution
21 EI uouno
22 a ln-Ground
Pressure
Other
41 fl Hotoln g Tank11 tr
13
14
42
43
12
Non-Pressu r!zed Distri bution Experimental
30 E Specify Type
V. TYPE OF SYSTEM: (Check only one)
Pit Privy
Vault Privy
Seepage Bed
Seepage Trench
Seepage Pit
System-ln-Fill
1. GALLONS PER DAY
3oo
5. PERC. RATE
(t*i*+iaen)-
..{-.€
6. SYSTEM ELEV.
/o5'85rrrt
2. ABSORP. AREA 3. ABSORP. AREA
REQUIRED (sq.ft.)PROPOSED (sq. ft.)
7. FINAL GRADE
LE E
o
VI. ABSORPTION SYSTEM INFORMATION:
zfz25o 1
4. LOADING RATE
(Gals/day/sq. ft.)
llons
CAP
ln Prefab Exper
App.
Fiber-
glass Plastic
Site
Con-
structed
Steel
New
Tanks
Total
Gallons
#or
Tanks Manufacturer's Name
VII. TANK
INFORMATION
/ ooo
Tan Chamber
the onsite sewage system shown on the attached plans.l, the undersigned, assume responsibility for installation
VIII. RESPONSIBILIW STATEMENT
/MPRSW NO.3zr+Business Phone Number:
z-U-4- 6zoo
Plumber's(Print):
L, S/e-e e
NamesPlu
,-45sm(Street,p
IZ-oO Ya1/ &-.
/DEPARTMENT USE ONLYtx.
lssuingSaneencludes(r
Fee)Surcharge
Approved
Disapproved
Owner Given lnitial
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-trlg8 (formerty ptb€7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
tr
a
lJ\rt tvt gtEpxisting
I Tanks ltRa./Seotic Tank or Holdino Tank .--f 8ao I
(No
'I
2
3
4
t
mtrtrrdrcIls
A sanitary permit is valid lor two (2) years.
Your sanitary permit may be renewed before lhe expiration date, and at the time of renewal dny new
criteria in the Wisconsin Administrative Code will be applicable.
All revisions to this permit must be approved by the permit issuing aulhority.
Changes in ownership or plumber requires a Sanitary Permit Transfer/Penewal Form (SBD 6399) to be
submitted to the county prior to installation.
Onsit6 sewage systems must be properly maintained. The septic tank(s) nrust be'pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
ll you have queslions concerning your onsite sewage syslem, contact your locaL code administrator or lhe
State ol Wisconsin, Safety & Buildings Division,608-266-3815.
To be complete and accurate lhis sanitary permit applicalion must include:
l. Property owner's name and mailing address. Provide lho legal description and parcel tax number(s) of
\,vhere the si,stem is lo be installed.
ll. Type o{ building being served. Check only one and complete # ol bedrooms if 1 or 2 Family Dwelling.lll. Building use. ll building type is Public, check all appropriate boxes that appty.
lV. Type of permit. Check only one in line A. Complete line B i, permit is lor tank replacement, reconnection, or
repair.
V. Type ol system. Check appropriate box depending on system type.
Vl. Absorption system inrormatlon. Provide all intormation requested in #1-7
Vll. Tank information. Fill in the capacity ol every new and/or existing tank, list llre totat gallons. number of
tanks and I anulacturer's name. lndicate prelab or site construcied and tank material. Complete for a//
septic. pump/siphon and holding lanks lor this system. Check experimental approva; only if tanks received
experimental product approval from DILHR.
Vlll. Responsibility statement. lnstalling plumber is to rill in name. license number with approp!.iate pretix (e.g.
MP, etc.), address and phone number. Plumber must sign application torm.
lX. County/O€partment Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% 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 ot
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; replacement syslem
areas, and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications lor pumps and controls; dose volume; elevalion ditferences: ,riction loss; pump
performance- curve; piJmp model and pump manufaclurer; D) cross section ol lhe soil absorption system if
required by lhe aounty; E) soil test data on a '115 form; and F) all sizing intormation
GROUNOWATER SUFCHANGE
1983 Wisconsin Act 410 included the crealion ol surcharges (fees) ,or a number of
regulated practices which can eflect groundwaler.
The monies collecled through ttlese su.rcharges are used for monitoring groundwater, ground-
water conlamination investigations and establishment of standards.
sBo{l}g8 (8.11/88)
STEEL'S SOIL SERVICE 1ssa h Arro
Gary L. Steel
c.s.T. 2298
MPRSW.3254
ffie
New Richmond, Wl 54017
(715) 246-6200
l'toturd System
for
Les Schouten
Swk Swl: S5-T30N-R15I,l
town of Glenwood
L.teel
s93r40899
SEEE/rFD
AUO2I
S4rerr;;r;:,
paSes
lll----- revier'r aPPlication
ll2----- soil- evaluation rePort
ll3----- plot Plan-Plan view
ll4----- work sheet
ll5----- system cross section
tl6----- pipe lateral laYout
#7--sing chamber
ll9----- pump curve
20-93
,1.-<-
Wisconsin Department of lndustrY,
Labor and Human Relations
PRIVATE SEWAGE SYSTEM
REVIEW APPLICATION
Safety and Buildings Division
Bureau of Building Water SYstems
Hayward Office
209 W lst Street
Rt 8, Box 8072
Hayward, Wl 54843
Phone (7 1 5) 634-4804
Fax (71 5) 634-5 1 50
La Crosse Off ice
2226 Rose Street
La Crosse, Wl 54603
Phone (608) 785-9334
Fax (608) 785-9330
Madison Office
201 E. Washington Ave
P.O. Box 7969
Madison, wl 53707
Phone (608) 267-5 1 1 9
Fax (508) 267-0592
Shawano Office
1053A E. Green Bay Street
P.O. Box 434
Shawano, Wl 54166
Phone (7 1 5) 524-3626
Fax (71 5) 524-3633
Waukesha OItice
401 Pilot Court, Suite C
Waukesha, Wl 53188
Phone (414) 548-8606
Fax (414) 548-8614
INSTRUCTIONS: To save time, schedule y our review with one of the off ices listed above prior to submittal. Fill in all applicable data and submit this
form together with fees and plans/inform ation. your submittal must be received at least one working day prior to the appointment at the off ice
where your review was scheduled. Please call any of the listed off ices if you need help filling out the form ,Hu'5''4u8"S :Ei'"ons
-submrt. PLEASE pRtNT VERY CLEARLY. A sample of a completed form is on the reverse side for your refe
Revrewer NameJerry Swim
1. APPOINTMENT INFORMATION - tt u have scheduled an a lclrntment. frll rn the information r uested below to save time
Apporntmbnt Da Il
t993
Plan ldentrf ication Number
s93-40899
2. PROJECT INFORMATION tI this revrew rs a revrsron or extenston to your exrstrng
lan identrficatron number, provide that number here
roject Name
Les Schouten
ect Locat
p
County
Sf. Croix
ovr. LoT SW 1/4 .S['l 1t4
3. APPLICATION FOR
System Type (check one)
n At-Grade
tr Holding Tank
Fk ruouna
t] Non-Pressurized ln-Grouhd (conventional)
n Pressurized ln-Ground
tr other
Building Type (check one):
D filr owetling, 1 or 2 Family
P n Public Building
s fl State-owned Building
Code Derived Daily Flow 300 9pd
fil Check lf Replacing Existing System
n Petition For Variance
tr GroundwaterMonitoring
n Site Evaluation in Lieu of
Groundwater Monitorinq
w
4. FEE COMPUTATIONS
System Type I (include new and existing tanks)
Up To 1,500 gallon septic tank
1 ,501 - 2,500 gallon septic tank . . .
2,501 - 5,000 gallon sePtic tank
5,001 - 9,000 gallon septic tank
9,001 -15,000 gallon septac tank
Over 15,000 gallon sePtic tank
UpTo 1,000gallon dose chamber
1,001 - 2,000 gallon dose chamber
2,001 - 4,000 gallon dose chamber
4,001 - 8,000 gallon dose chamber
8,001 -12,000 gallon dose chamber
Over 12,000 gallon dose chamber
Up To 5,000 gallon holding tank
5,001 -10,000 gallon holding tank
Over l0,000gallon holding tank
Experimental System (additional one time fee)
Revisions To Approved Plan 2 . . .
Petition For Variance: Setback
Site Evaluation
Plumbing
Revision
Groundwater Monitoring - Per Site
(other than a proposed subdivision)
s5 r30 Rt5N
A
H
M
N
P
o
11r0.00
$ r 20.00
$ 160.00
$ 200.00
$ 300.00
$ s00.00
$ 70.00
$ 80.00
$ 100.00
$ 120.00
1140.00
i 160.00
$ 60.00
i 100.00
11s0.00
i 300.00
i 6000
i 100 00
$ 225.00
$ 22s.00
s 75.00
I 60.00
FEE SUBMITTED
110.00
70 .00
Site Evaluation in Lieu of Groundwater Monitoring S 60.00
Subtotal:180.00
Priority Review: Enter same amount as Subtotal
MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: 180.00
I city I vitt"ee @cown of:
Glenwood
5. SUBMITT!NG PARTY !NFORMATION
Telephone No. (incl e area code & extension)
(7L5 ) 24606200
No. & Street Address Or P.O. Box
L55h 200th. Ave.
Contact Person
Gary L. Steel-
City, Town or Village, State, ZiP Code
New Rj-chmond ' IilI . 54017
I Aerobrc or prepackaged treatment system {ees are calculated based on equrvalent size septic tan
2 Revision fees are not applicable to temporary holding tanks or extensioni to exatting approvals
NOTE: Fees are pursuant to Wrs. Adm. Code, Chapter ILHR 2. and are subject to change annually
sBD 6748 (R 03A3)
Company Name
Steel's Soil Service
ks and dose chambers.
ovER ,-r>
Page 1 ot 3
Wisconsin Department of lndustrY,
Labor and Huinan Relations
Division ol Salety & Buildings
SOIL AND SITE EVALUATION REPORT
in accord with ILHR 83.05, Wis. Adm. Code
Atrach complete slte plan on pap€r not less than 8 112 x 11 inches in size. Plan must include, but
not limited t,o vertical and horizonlal relerence poinl (BM), direction andY" ol slope, ccale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION.PLEASE PRINT ALL INFORMATION S
NT
IE
PARCEL ,0. r
St. Crolx
PROPERTY LOCATION
GOW. LOT SIJ 1/4 SII 1/4,S 5 T 30 ,N,R L5 E (or)WPROPERW OWNER:
les Schouten
NEAREST BOAD170th. Ave.
N
BLOCK 'nla
ECITY LLAGE
G1
suBD. NAME OH CSM 'rrlaLOI #nlaPROPERIY OWNER,:S MAILING AODRESS
2B?.O 170th. Ave .
PHONE NUMBER
715 t 265-4580CITY. STATEI-fnerald, Wf .
ZIP CODE
540L2
[ | New Conslruction Use [of Residenlial/ Number ol bedrooms '2-'-
Recommended design loading rate n/P bed, gpd/ft2 .3 trench, gpdltl2
fi ilaximum design loading rate n/p bed , gpdn2-l--trench' gpd/ft2
repla cement system less than 2'
aldessibe
250 bed ft2
-_trendt,
Absorption area required
infiltration surlace elevation(s)
I I Addition lo existing building
ri11 plain elevation, if applicable
[xkReplacement I I Public 0t coffirlr€ICir
Code derived daily flow 300 gN
105. 85 ft (as reiened to site plan bendrmark)
n/a ft
Recommended
Additionaldesig
Parent material
n / site considerationsglacial
}-IOLONO TANKt] S E]U
SYSTEIT IN FILLDS EHJ
EzuAT.GRAD
DSIN.GROUND PRESSUREDS EKJ
CONVENTIONALNSzu MOTJNOES t]USuilortableS
UnsuitableU
SOIL DESCRIPTION REPORT
Boring #
Ground
elev.
101. 82 ft.
Depth lo
limiting
lactcr
14" -
Horizon Depth
ln.
Dominant Color
Munsell
MotUes
Ou. Sz. ConL Color
Texture Structure
Gr. Sz. Sh.
Consistence Bordary Roots G P D/IIZ
Bed Trsrfl
1 o-B LOyr3 I 4 none L Z/n/ shk mfr c/s 2/f 5 6
Z B-14 LOyr5 I 4 none si'f .L /f /shk mfr g/w rlt ,)
L 3
3 t4-42 7 .5yr4 /6 :Zd 5yr4l6 s1.tlf lshk nfi nal na/4 5
I
i
Remarks
Boring #
Ground
elev.
101 . 82 [.
Depth to
limiling
laclor
16,'
1 0-B LOyr3 / 4 none L 2/n/gr mfr cls 2/t 5 6
z B-16 l}yr5 / 4 none si-1.zlnlshk mfr 8lw t/f 5 6
3 L6-25 7 .5yr4 /4 c}d 5yr4/6 scl.2/n/shk mfr glw tlt 2 3
4 25-40 5yr4 I 4 cZd 5yrhl6 c1 lr nla nla nal n I p
:
I
,l
L
Remarks:
Phone:7t5-246-6200T Name:-Please Print
UateSignature
\cstrn
( ri)t
R i ehmonrl , !{r? 54917l.-t
x t
Steels: fi5h th. Ave
f+$$umuer./r1,,, / (7 -9-93
//iRTY owNER l,es Schouten
PARCEL I.D.I
Borlng #
SOIL DESCBIPTION REPORT Page 3of2
sggr40ggg
Ground
elev.
L04.OZ ft.
Depth to
!imiting
faclor
L7"
Horlzon Depth
ln.
Dominant Cqlor
Munsell
MotUes
Qu. Sz. Cont. Color
Texture Structure
Gr. Sz. Sh.Conslstence Bcurbry Roots GeonP
Bed Trerrjr
1
,)
L
o-9 LWr3l4 none Ir Zlmlsr mfr cls 2lf 5 6
9-L7 loyr5 I 4 none sl1.2lnlsbk mfr glw Llt 5 6
3 17 -33 7 .5yr4 /4 c?.d 5yr4 /6 sc1 1 /f/sbk mfr gl:ut tlt Z 3
4 33-46 5vr3 / 4 c2d 5vr4 / 6 cl lr nla nla nal nl nloDi
lN]1rr6$t$N.tS'r*i(
N$ Ei:t*Ril [iili
tt:!:\-\a:i::Nii::i:U
Boring #
Remarks:
Flemarks:
Ground
elev.
Ir.
Depth to
limiting
lactot
,I
I
I
Boring #
ta+]:.}!l:+f t.i:.il:.1
t..# *ii*.)! +i:t
elev
Ground
fr.
Depth to
limiting
lactor
Remarks:
Boring #
Ground
elev.
_ ft.
Depth to
limiting
faclor
Remarks:
sBD-8330(R.05A2)
S I3,,408 gg
STEEL'S SOIL SERVICE
Gary L. Steel
c.s.T. 2298
MPRSW.3254
er\
loot
lr.p [.es Schouten
st.lt swk'ss-T3oN-R15r,r
town of G-l.enwood
bt-g,='{ "') *'+" t'-r
tzJ l-f 1o'
T,Y>n
uusmgIEPEru[WU
New Richmond, Wl 54011
(715) 246-6200
1.
lo
rt r"r$e #*x;l
lp+
lb'
L?A'
$l
ti 4 gn
€.{\
,7
II
/(= *o t
fr,rt*74,v ? /";/ta L
fl,/. b,; Pdua€n4-
llo(t il sL,)0c)
3G'
l)^ z_
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\
$
bt'
thrv')
f oa \4-
Po\€:
ItSt
a?5.'i
/70 -Fpt'.4 ,
ft"/t
7-9-93
Steel
a
L
,N
\\o"t
w
/"=4a'
dot, /orr I /',4/rrL
0,1" At LL, loo'
by Towea gole
5) t vr ae*s Atl
P, butve,n',^4s I
+,." Aut 8l ,to- gz z e
,!'Vo
i''loi P\ nrr' firt,r VWu.t
/ 7ov pv€.uBos
'TAFEII
sEfI'
'S 6 loo'+.p" \
2 BF.
{2 08 gg
b <z_t
c
V'$"5
&
Itls a
D
R'
sEE
i\
qb{$3'oro
]r t,7g'
I 3o Q/c
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?, Qa
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4
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OPTTONAL WORKSHEET
I. TIOUNO SYSTEM
l. Wrtrrrtcr Lold, Totrl Drllv flor'
Uee Gr. ILHR 83.15 (3) (c)
t. Mound Lrn3ilt:
End SbP. (Xl'
fotrl Mound fon$h (Ll'
9. Mound Wldth:
UprbPr Cornctbn Frclot '
UprloPr Wldth (rl '
DounrloPc C.orlrctba F rctor'
Dorn*oPr tYldrh (ll' .
Totel Mound WUrh (Wl'
II. INGTOUND ?RESSURE SYSTEM
t. D.P0t ro Lhnltlnl Ftctor'
2. Lrndrlopr r
t. ?rrcolrtbn Rrll r
a. ?ropord Syrrm Ehvrtba r
t. tYrltrvtter Lord. Tolrl Drlly Flor:
ttCe i. ruin 83. 15 (3) (c) ,
Adm. C,odr rnd ?tOVlDE A DETAILE
LIST OF SIZING ON?LANS.
Rrqulnd $rPrlc Trnl Ce9rclrY r
6. AbPrPtbn Arrr Slrltu:
Arrr Rlqulnd r
SYrrm Lenjth r
SYrrrm wldth '7. Olrlrlburbn PlPr SklU:
Holo Slro I
Holo SPeclnl'
Lelorrl Lonlth '
l.etcrlt $lrc '
l.rlcrill SPrcltll
Itlrlertcc lrolrt Shh'lell'lo I'l;rc
l. Olrlrlhulktn PhG Dl*uhertc ll.tlc:
Numbor ol llohr ltr PIP '
I lov Pcr Plltc '9'. llmllold Slrlnt:
'JVpo (scnlcr or onrlf "
Lrnlth -
Olrlrtor
Adm. Codr rnd PIOVIOE A OETAIIED
tlST OF slZlNG ON ?LANS. , t 7
i'. il:ilrl'rrrn3Frctor' fu
a. Dlrtlrcr lrom Dor Chrmbrr to q f)
Dlrrrlbutbn SYrrm t --5J-:=-
t. Elcvrrba Dlfhnncr trtrm t /
?ump rnd Dlrulbnh 3Y.ut '6. Abprptbn Arrr tlrlaai /'t t'.'tt
Brd or Tnndr Loailh (!l' =i'*
Brd. or Trcnch Wtd0r (A) r 3' ;)
fntctr 3Prclnl (Cl'
-*,. tlound Hrhhr: / FJ
FlllDrPdr(Dlr *fil O.gtlr Dorndoge (El r -'u'{)t
Brd or Tnnch DrP$ (Ff r ' f'{-
Crp tnd ToProll OrPth (Gl '
Crp rnd TocPll Drclh (Hl' JJ-2-
INCROUilD ?RESSU TE SYSTEM€ONTINWd'
t0' Forcr Mrln: r,, lrrt. 3311,!.. on.Mlnlmum Oodltt lrt. I 6iL-r- 'n'Dhmrr'tt' "'ffiFri'nos gg'#li
Fdcrba Lor' : *
TDH. - 1c.79' @lt
r'' t'T::f5,fl;.,it rt v,,1 j 3,' ? 3 -"* J949-lu roul dYarrnlc h'd'
lt. Dor Voluml:
t0 Tlmo Vold Volurr of
Dhrlbullon Llno I
Drlty Wr*rullrr Voluml +
6 tfiott ln 2l hn '&BlcltloY'
Mlnlmum Dorr r
l{. Dor Chrmbrn
Volumr r
il.
-?ru-d.
z,?
gd.
ld.
aL
lnt
fLr
'L
'L
r.lL
'L
'L,L
'Ltt
'Ltr
fL
,L
,L
r. fL
'Ltt.
,L
'L
h.
ln.
'L
,)
III. COXVENTIONAL ?RIVATE SEU
l. Uutrrltrr Lord, Toul DrllV
Use 8. fLHR 83.15
Adm.Codr urd ?tOVlOE
....'l,uji;.
1.nl;'l*d
i-Yrttir'
Llsr oF SIZING Ot{
'LAX3'?. Roqulred ScPtlc TurI CDrclU'
t. Porcolrtlon Rtr'
a. AbPrPllon Anr Slrhl: -R;-f; to Tabre 2 ln ch
rrrd ?ROVIDE A DE
'IZtNG
ON ?LANS.
Rrqulnd Attl '
TAILEO o?
/dA*
,2-aaur.
AGE 3YgTEI
(3) (c), lfi!.
DETAILED
mlnJlt
ILIIR 83
J.-
----
-7
--a-
.t
Qcot,p Al.
fL
,L
3.lo!//a- tt
4t///-v,vT
-4-@5
-A99-tfLs.
o
/a cr
,3
-Z,,Le-//z*3',')-
)/' I
7..5-
-23-LT
Z1
jel.
t0. tur! Arcr:
lnflltrrtlvr CePrclrY of. 2
Nrru6t So1r '' i fdJrq.ltJdrY
Burl Anr Rrqulnd r (/ ":t1/''t n' tt.
Berd Ar:r Avrllrblr r t z -\ D r' tt'
I t. ll stend.rd Trbht from chrptrT ILHR 83
aielrugedr IndLcate Table ll
-
12. For tho Dlilrlbu3bn Nrlrorl, ur Numbrn 5.ll ln srctlon ll.
Lrn3th r
Wldth.OFl'a-
t. Dlrrlbutloa''SYil.m3
Lrrc( Lrlg6 r
SYSTEM.INf ILL
Flll ln All lrcrm from Srsth'n lll
ol LrSonlr I
Sprcln;'
Dlrtlrcr from Sldrdl lo ?l9r 'r
Syrrn Ehvrtbo r'
a
(
ro;r9'
Trnl Drullr oa ?hnr
v!t- *
I
tl.I
mlnJlo
,r.
3el.
,rl.
mla./ln.
t{. ft.
'Ltr.
in.
tr.
tr.
ln.
tr.
ln.
Y. SEPTIC TANK
l. CrPrclly I
2. Mrnufrcaurrn
,. Show Slr Con
VI. DOSING TANK
. Crorcltv'
'. Mrnulrclurcr:
?ump M.nul.clurG?3
Puntp flrxlcl:
gporerini Hord'
O.aflcr Brtc.'
7. 'Shor Sltc Conrtructod
vtt. llol.trlNGI'ANX-'
.t,
2.''. llrnul
CrprcllY.
aslutar:
truct.d Trnl Dlullr on ?lrn
cI
2
t
,l
5
Fn^: :jlt
ttl.
tPm.
llrm.
Ft
.i.:-lt.
-Z-
tn.
-SHOW ALL lNFORllATlOt'l Ot{ PTANS-
'@)orlltr s8c{?al (n.6trt2l
T.nt t}rtrllr or ?ln
3rl.
Tlrnch
,:
Slrow, Morsh HoY, Or sgg-
Synthetic Covering
Dislribution
9f"h Slope Trench Of L"- ZL,i Forc e Moin
Aggregote
Undisturbed
S oil
Cross Section Of A Mound S ystem U sing
/ Trenches For The AbsorPtion Areo
408 99
Pi pe
Pase 5 ot
Ft.
Ft.
Ft.
or&
ts
bLir-,ttl b
Medium Sond
Topsoil
G
Plowe d
Loyer
D
E
F
G
H
G Ft.
Ft.c7&
I
l'5
S I gned:
A .i. 5 Ft.
B nL tt.
c &-Ft-
K 12,78Ft.
L q7,56Ft.
J ?,bl Ft.
I /3,63 Ft.uffi6rt.
Li cens umber:YI 7t_-/
Date:8- z (.t. ?-2,
L
w
Mound Uslng / Trcnches For Absorplion Areo
T
J K
A
C
tI
t
PRI,VATE SEWAGE SYSTETT
*'ililll j
ry
DETT.
ot\llsl0
nally
/l lt
,TE
c
t-
o
Ead Vlor lo*' o' L t rt L.
Page (, 0f
Inch
Inch( es )
Inches
Inches
t
s93-10s99
prrtoro6d pipr 9r!!!!!
)Ptrloroltl
PVG PiCr
_/fal Gop
Lost Hol. Sltclrla !.
)lrrt To Ze{ q)
Dlrlr lbutim Pipr Loyoul
Slgned:
cense z fll I )t!.,$ (t)3z s4
Date:I -?0-q3
?
Hot. Locatrl Or lollon.
&. C$rly tlecrl
P _%_Ft.
s
X 30 Inches
Y 30 Inches
Hole Olrmeter
Lateral ir
ihnl fol d rr
Force ilaln rr
_L
PRIVATE SEWAGE. SYSTEM
ConditionallY
n
-I of hol cs/p lpe_4-
S C
I nvert El evatl on of Late ?ak t 0 G -Ft' '
LI
L
2_
APPBI}H
h/DE3'[..CIF IN OUSTRY, LABOR & H
DIVIS r0!l SAFETT AHt'
It,
SEE R S ENGE
-
NtJ/,\[' C}IA/AP,E R CROSs SECTlOIJ AND SPECIFICA'TIOIJS
.-- VE}JT CAP
\"/trATT{E R PROOF
JUUCTIOU BOX
GRADE
APPROVE D LOCKINIG
AANHOLE COVER'
tOl W fl1r'1 r$r, f*,rbt I
[tu.a.rgen or DosEs:?^
f,n r;t cF
-
Y" Alu.
ls'Alu.
s93-40sgg
,f"C,I. Vf t,ll Flpu
) z rr' f: R o,r'\ ooori,
u/ruD()v/ ()l( r'R r:5 t{
nli( lt\l'fnt(E
lB" /'\ lt\ I
,l\TLtr T
I2"HrU.
NPPROVID JOI
wl c.T. P,PE ^t' /
EXTENIDIUG 3.
oNTo s,ot lD solL
DOSE VOLUME
lucLUDrN6 6ACKTLO\^/:
APPROVED JOINTS
Vc.r. PtPE
EXTENOIUG 3'
oNro soLlD 80lL
PER DAs
rl
r.LEV. ?B.QJi,
X RtsER Extr pERntTrED ouLy tF TAUK AAuuFAcruRtrR HAs sucH APPRovAL
5EPTIC d
DOSE
TAI.IKS ANTTUFACTURER:
SPECIFI.CATIONS
c,{).
GALLON S
(
tJee(s
ALART\
^/tA\lIJFACTU
RE R:
AODE L UUI'\BER:a) ln
SWI'I'CH TSPE:
PUIt^P AAUUTACTURE R:2 a r l[/re
A1ODEL UUI4BER://lhS 3a
5WI-TC H TgPE:
r\I N I I{ U 11 D ISC HA R6E R^TE 3s,? 3 GPA
vrrRTrcAL DTFFERENcE 6ETwEEN puflp orF ANo orsrRrBurroN prpE.. 7,?x FEET 7"8
{- AI[JII'TUA( NETWORK SUPPL9 PRE6SURE ?,5 FE ET
-l- .]iii- Ft ET oF FoRcE rtAtu x ?rL-ilYoor:.,qtcrtou FAcroR. - , 7 a FEET
l%.91/55 _6ALLONS
cApA,rEs: A = /tqg Nc*rs on *t9{, ?Iit;i,
A'19" g= Z rNcHEsr^. 39, GALLous
c, A" . = \+r. rurHES s3 )tf5 L?ftout
o= lL tNcHEs oR Z 3b'GALLous
INOTE: PUAP AND ALARN ARE TO AE : ]
INSTALLEo ON SePnn,trg ctRCUtrj i
Qn \-IAUK SIZE.:
I tr\ g ''r o ur., s ''1
I
TOTAL OSUAI,TIC. HEAD
LEUGTH a(-' .
FEE T
4 q";LlQUlD DEP.r HloNg o lt;wrDTH
lilt),',,t.) J'.lttf
x
t.
r l,()w{rtt
OU
orF
AR HAL
g
* rsE Eru
PUI^P
--
CONCRETE ELOCK
vC
J
t)
ShFEfY
TTB'
-T PRrvArE
T 0s&
,TAY ltt1[0r
TI(;H T SEAL
ROVI D E
A
+
ll
rB$
sEwAGE sYsr*
I
It!TrRirAt. tlUlt
".^-/
,/
r tct ilqtr tJUr,lBER:
.4. ,,.r 1DATEig_)-!J
\,/
)-
l') ), u,n rt ,^'.,/
plgt
l.
'. lj I lt I
COUDUIT
riElAI$tl8
a
ilt,-
!
C tt'Ff,
HEAD/CAPACITY CURVE Sgg-40899id' r-tE lrrlrl u.ll- l!ht
r'-
r r0-JT
t2
JO
7C'
24
t0
r0-
GALLONS
LmFi-
JO
I
70 2t.3a
90r rro I JO t40 50r
EFFLUENT & DEWATERING
Warning: Model 185 should not be subjected to less
than 30 feet TDH.
Note: For Head Capacity on Model 112, industrial
column-explosion proof pump, see FM 219.
SEWAGE & DEWATERING
WARNING: Model 293 should not be subjected
to less than 15 feet TDH.
.0
o
a
GALLONS 10 20 30 a0 50 E0 00 100 fio 'r20 r30 1.0 r50 t60 170 tto t90 200 2r0 220 230
lrlIIll
t0
7t
70
c5
00
53
30
a3
a0
35
30
n
20
Ir
25
20
i5
t0
5
I
I
a
0
HEAD CAPACIIY CURVE
EFFLUENT MOOELS
\\\
\\\
rOO
95-
90-\\
\\\\\\
\\86i \
\\\\(65 \\\\\\\\
\\I\65 \\\\
a\\\\\
\\\
60
55
50
1
65-
\\\\\I a5 \\
\\\\
I \\\t89\
S S \$\\\l6r \\c \e7 \t88 \\\98 \\
5.7,59 tJi , rJ9
TOTAL OY}IAMIC HEAO/CAPACITY PER MIXUTE
EFFLUE}IT AXD DEWATERI}IO
SERIES
5$66
57{0 6'$t37-tr t6t (a r65 r85 r0a 't at ite
FT. tr.Gd. Lt.GA Lh GA Lh Gd. lrr CIC. ttl cld. Lll Od. Llr.Od. ttr.Cl{ Ltr.Od tr.od"
5 r.62 /(l lco s 2t?72 273 to4 tea tG ilot at 61 CT 2at g/,zo t65 837 t55 tt7
ro lG L t29 I 17.6r ?ct 79 u r@ 37!tr 2lt il6t szn t.O 6d,rtr ;n
15 a.a,ro ,'2 s6 rst tl6 tro c4 242 er il4 @ ztl a4l ta izx,t.2 6t7 t'as lre
20 aro t5 5'oa tI It t'ro g z:t e2t qzp II' TIE ItX' tlE
6
'.&2.
as 74 alo 67 2'rt ga gz&t2t tLa rct tfit
s a.t.65 24 55 20a 5a?2p $ tao 8r zto t2t aat t2f Ql
/.o t2l9 a6 tra 6 lfz 55 20C 73 At ya 16 $7 tla.(lt
50 r 42.2ts xr t25 6r 19|68 2re azp q, tat r@ trt
16 a7 4t ttr sa ltt '.220 ,t eo t6ra
! tta r0 ct a Itf Er tqt ,0 2(5
00 atSa ra 60 tat lr0 2a rQ t.&a
m 27.1t ata 2a t7 t{,
t@ IIaa rt ta at 7D
ilo ca@ ,t rs
Lock VJvr: !e.6' etrru'?,,26'56 6e'e7 7t't t6'er r r2'
TOTAL DYNAMIC HEAO/CAPACITY PER MINUTE
SETYAGE ANO OEWATERING
SERIES 252 2t3 294 2932ec2at2CE2a?2922U
Ff M'Grl Lttrr Grl. tlrt.Gal. Ltlt'G.l. LlaL Gal ttrr Gal LttL Grl ttra.Gal. ltnrrlGel. Lt !.Grl. Llrr"
5 r.6e.90 3at r28 tta 128 4Ea 128 4U 'r30 ag?180 cct v r40 !r$.r90 ,€225 $.
ro 3.6,ffi227'89 3l7 89 f,17 89 3it7 9s 3AO 158 5S 121 qa r6l 2o5.Ir!.i
r 5 a.t7 r85'rE22lt t3 .50 lte 30 rtr.50 lte 63 et,t35 ttl t06 rEl r30 agl 165 @5m c.ro roa o:a10 3E 10 3a 10 36 gg ra'106 ao'l 88 XB 1r9 t350 150 564
25 7.Qi2 153 mt,76 2ft'68 2tr',106 ll}t 136 515
30 lia 4t t7a 90 3.O.r2t tlst ,lao lfllir,.3 lGl
lt{) t2.r0 '.5t 5.tCl 30 rtr 9. rta rrs {iI
50 t52a ,U o.l fi7,n a9n
59 22c13.!960 rt2e
70 21.9 es'tj
Locl Vrlvc r8'21.5'26',35',12'.50'82',tt'21 3',21 s',
\.-l
293
\
\2A2
-t
292
-a
i
I
262 28{
I I
294 295
I
268268.267lrr
LITERS O t0m tto.* .?0
70 t0
5
LrF
E5
n.l-
,5-
70-
I
\
25$
60 te2,
\
i
I
SEPTIC TA}TK HAI}TTENA}ICE AGREE}TENESt. Croix County
''{NER/BUyER L t.s )
ADDRESS:-l 0--V No: 28Zo
LocATroN: Sui L/4, Stc) t/4, sEc.T3t]N -n I 5-_w ,_
TowN oF3 Gl Ant rcOC\
Lor No. .fu' n
rmproper use and maintenance of your septlc system could resurtin i.t= premature f ailure to handle vras€es. 'proper maintenanceconsist's of pumping out the septi" tinx every three years orsooner, if needed, by a 1icens.& s_eptJ.c tank p1.rrp"r. What youput into the system can affect the runctfor oi i,ft septlc tank asa treatment stage in the waste. aisposii-"y=temj
st' ' croix count'y residents nay be erigible to receive a grant tohelp with the cost of the r"piacement-of a falling systemr whichwas in operation prior to .Tuly L, 1978. st croix county acceptedthis program in August, of rs8o, wJ.th the requJ.rement that ovrners
ijr.lli""X:, svstems asree to xeel trreli- Jyste, p=operry
The property owner agrees to submit to the st. croix countyZoning a cert'ification- form, sign"a uV the owner and by a nasterplumber, j.o_urnerman
. pluryber, rLstricted plumber or a Iicensedpumper verifying that (1) the on-site wasiewatei di;posui-systemis in prgp-er operating condition and (?) after inspection andpumping ( i f necessary ) ; the septic tank ' is 1ess tnun L/3 fuII ofs rudge and scum. certification from wirl u"- """t approximatery3 o days prlor to three year expirili"".
ttre undersi gned have read the above requirements and a gre e
wi th
DNR.
st,.year
intain the p rivate sewage dis posal system. in accordancetandards se t forth herein,as set by the Wisconsin
loa
SUBDIVISION:
T/WEl
to ma
the sCertiCroix
e xpi r'
,fication form must be completed and returned to theCounty ZonIn 9 offl cer wlthln 30 day a of the threatLon date.
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SIGNED:
DATE:
St. Croix County Zoning Office911 4th st.
Hudson, WI 54016
x
q.l-q3
a
s T c - 100
1'lris applicatio n form is to be completed in ful Ithe oh'ltcr
w I
and si gned bytl only
(s ) of
Qrt
addres s zbz0 I lo*h
the p roperty be rng develo ed, Any lnad equac i e spresult in d elays of t he permit ssuance.ShouId thiscl e velopmelrt be int endecl for r esale b y owner contractorIrouse), Uren a seco nd forn shou lcl be r eta l necl and complete d when
aI
th e proper E y is s old and su bmitted to thls offlce wl th theappropriatedeecl re cording.
Owner of property
Locabion of property-1kl_L/4 Sr-) r/a,section .5 , T 3D N_nJ-awTownship
lla i l ing a o8 Gln Sclor 3
Address of site z f,? c>L ++e Lo r)(--{9n-o rSubdivision name A
other homes on property?es L/ ys
-iPrevious owner of property
Total size of parcel
f Do.,\.jA
5a6 !'t'c
-.->
Dat,e parcel was creat,ed tttl+
Are aII corners ancl 1ot 1ines identiflable?(-"- ygs _ Nore this prop€rty boing devetoped, for
:;r;I:#Ln"a pase. Numb€r 51t aa
( spec houee ) ?_yes Ut, tto
recorded. wLth the Reglst,er
-----_______---_________-----_-II{CLUDE I^IITII TIIIS APPLICATION TIIE FOLLOWI}TG:A l.,nltt(AlrrY I)liED *trictr i;;i";;; a DocuHEHT IyrJlgR, voLUHE AND pAcBllultul:lR & TII,, snar, otf TrE r.nCrir;ri;';; DBED,. ' rn additlon, o
cerLiriecl syr:vey, if oroiGbi;; l;;;; ;" h.qrprur so as to avoiclderavs or t.e 'ir"ip,-1in- -;;ocess. rf. tri;- o"gg _descrr.prron:,i:ii''Ii:: ;." ,i;iil:iii:E 5;;""v !!ap, -€rr" 't"rEirisd-rurviv
Hap
I ( r*'e
best
the
warr
Deed
tlte
reco
!{o.
(,
I a ture A PPI
^l 3
PROPEI(TY OWHtrR CE.RTIFICATIOH
the
atlvL
fa
oftlv
Lre )forury
-appl cant
Dat eof S g na ture
cant
Da eofs gnature
ent
I a
( spec
- -----------------------------------------------------
-----
v
y that aI I sta Lements on this form are truey(our ) Xnowle e that I we) arn ( are ) the owne
clg (rLy descril:ecl IN this irrfoffice of
ormat,io n fortheCounty
m, by vlrt
Reg i
y rleecl r e co rdeds Document llo., and th at, I (we)ov.'n th e pro posed s it e for e sew age dls posal 6ystemobbailred at.l easemen t I to run the above descri bed propertonstruct,i on o f said s ys tem,and the E ame h aE beeLhe of f ice of of de eds aaa
County ReglEter
DOCUMENT NO.WARRANTY DEED
STATE BAR OF WISCONSIN FOBU 2_1982
THIA APACE RESEHYEO FcrR RECORDING DATA
4s459G __r,rr|-gg}A(;r 571 BEGISTE FFICE
sT. cRox co., w
Rec'd for Record
FEB 2
B: 30
1993
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First NaEional Bank of Glenwood 204 E. Oak sr. ,P. 0. Box 338 Glenwood C rt wr 540 I 3-0338
conve1's and rvarrants to Lesle W. Schouten . 3 S].nSJ-..-.-----.--t1 1e erson
ParE of Ehe SouEhwesE Quarter (SW
SecEion Five (5), Township ThirEy
as follows:
at MA
o
ReSister
es -w-;sehmE en
FETuRN ,o 2820 I 70th Ave.
Glenwood CiEy, WI 5401
tu!
of Deeds \
[iro foliuwing described real estate in ...-.9.!-. Croix County,State of 'lYisconsin:
t/D of rhe souEhwesE q""tff#""$il"ir$of(30) NorEh, Range Fifreen (15) Wesr, described
Commencing aE the Southeast corner of said SW 1/4 of Ehe SW 1/4; thenceNorEh on Ehe EasE line of said Sw 1/4 of rhe SI^I 1/4, 413 feerl rhence, wesg461 feetl Ehence South 418 feetl thence East on the SouEh Line of saidsw l/4 of Ehe sw 1/4, 478 feer ro Ehe place of beginning.
-Srff
^Er",E
This IS
(is) (tixxrtX
Exception to warrantles:
homestead property.
Dated thie ........ 29Lh -. day of January
,..., 19-.....9.14t
+.crafrq..
tJ -,/^
n .,.---v .q -es-id-e.r.r-E
(SEAL) (SEAL)
;
tr David E.Steffen, VIce President
ACTNOWI,EDOMENT
STATE OF WISCONSIN
- - - - - 9 -t- -.-. - I I g ]- I. . - - . - . . - . - . . - . c o u n ry.
88.
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Peruonally c,ano before me thic .---..?9.Eh-.aay ot
-, lg--9--1-- the above named
-.. -...QLedy.e - - E-e s -E --and David Steffen
TITLE : MEMBER STATE BAn oF WTSCONSTN
(If not,
iuthorized- i;t-i' ib6;06;'w[:' iii;ili """
THIS INSTRUMENT WAg DRAFTED BY
G 1ad Best, Vice President
First National Bank of Glenwood
(Slr
Bre
g-natures rnay be authenHcated or acknowledged. Bothnot neeesgary.)
'lllncr ol Dcnonr rltnlng la rny eapaelty ahorrld bc typed or Drlntcd bctos thelr rtgnrturea.
to me known ---..- who executed the
the aame'.
------Coun ty, I[is.pirationnot, state ex
rs...9-J.-.1
-E113175ot ATATE DAN OP WISCONEINFORM No. t- l9E2
rl
and
l,
Stock No. | 3002
AUTEENTIOATION
Slenatu=e (cl
t
date
1,
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se 1US$