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HomeMy WebLinkAbout004-1060-40-000Wist:onsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township L ons, Robert P. Cad Townshi CST BM Elev: Insp. BM Elev: BM Description: ~ ~ ~ v~ M l G ~ ' i ` TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic r IZ, ~ S ~T~ /[.C.~CJ Dosing t ~ ~ e,,SRIL~ vw 6 Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~~ /9~~ X77' I ~, --~ Dosing c36~ ISLE I`7 ~ 1~7 ~ .~ Aeration Holding PUMP/SIPHON INFORMATION /,, Manufacturer - ~ ~` " Demand ;~` ~ GPM dd Model Number ~ ZS• 1 TDH Li~ $ FrictionaLos$3 System Hea + TD~ l ~ ~t 3•L z.d5 l0, Forcemain Len th / Dia. +i Dist. to Well a Z I ~~ SOIL ABSORPTION SYSTEM ~ County: St. CroiX Sanitary Permit No: - a -~.',.'~-- 0 State Plan ID No: Parcel Tax No: 004-1060-40-000 Section/Town/RangelMap No: 26.28.15.406 ELEVATION DATA) STATION BS HI FS ELEV. Benchmark Alt. B a~ ~i z• Z-- /05- Bldg. Se er 1,~. 58 /l . ~ I SUHt Inlet SUHt Outlet \ \~ Dt Inlet ~ • Dt Bottom Header/Man. 5.~5 /az.3s Dist. Pipe 5•b5 ~ ~ ~ • 3 S Bot. System S•~ /fir, ~ Final Grade y[ •~ /03.3 5 St Cover ~ ~ Iej I~ ~ `f, c7 (D ~`7, 7 Cov,.~-nom ~- 7, ~ ~ ~ BED/TRENCH Width / Length ~ No. Of Tr ches PIT DIMENSIONS o. Of Pits Inside Dia. ~ Liquid Depth DIMENSIONS `~ J ~ ~ \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ INFORMATION CHAMBER OR ~ Type ystem: J J g Z ~ / ~ ~C ~ r J ~ UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold ~J J Distribution ~{ ~ ~ ~ Pipe(s) S ~ IJ x Hole Size ~ +~ x Hole Spacing / Ve to Air Intake Z L th Di Z. 10+ 1 L h ~ / ~ eng a engt Dia Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Bed/Trench Center + S Depth Over Bed/Trench Edge xx Depth of Topsoil 1 ~ xx Seeded/Sodded xx Mulched ce r ~ ~ s , Yes ~ No i,. s i ' No ~ I.7~ ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~ / d .J Inspection #2: / / Location: 166 320th Streel;Spring Valley, WI 54767 (SE 1/4 NE 1/4 26 T28N R15W) 40 acre of M~ ~ Parcel No• 6.28.1(5-.406 1.) Alt BM Description = '~~ CaJ'~- ~~1,~ ~ ~D~~ G~~ ~~ ~Itsw ~Utn~-~ 2.) Bldg sewer length = !~~ + ~ ~- - amount of cover = L ~~ Z ~/~,^,p~j ~ rt,^, ~ t s PI~~ a ` ~ 2~J~ G"''~ CrJ ~ v~ r--~-~~ --~ -- - - - - - -~ ~- --~-- -~ Plan revision Re uired . Yes No ~1 ~ ~ /n Use other side for additional information. I~~~ `_~_- J ~ I __ _ I v J Date Insepctor's re Cert. No. SBD-6710 (R.3/97) ~-:~ c ~. ~~~ `iV`-tei 1 ~-, ~ ~` ~~Z.q~,~ /~~ ~ s ~ ~~~y/'.~ ~~ OS.~~ ~^ ~~•~~ C v-A ~l'~ I 'e ~31r1 _ C~ a ~, C I (~ ~. .• a 8~ 1~.. ST~gi~Q~l~tt1.p~ ~3 b ~.G(~.1.48~ ,G l~lo,-,~,, ~ ~.~„~, ~~~, d tiyp.S lV'!}LL. Simi.@~ b11~ K 6~ ~ a r 8 /~ ~~~~~~ ~s~a~ ~~~~~~ oom"1r~~ ~~' mm~~~~ ~~~~~~ ~mm~m~ • ,~ ' o 1 :. -., , , 3 ~..,, g:1-c i ~, 3 to ~ i ~~ ~..j~~~_ ~...._ .~r_.... ~~ 7~._.4Z,y 0 w. I~ C ( ' , 1/F~ J C0.\Q~ ~„ _' Y i 1 1 ~' l . _ _ . ' , It . ""'F--.. . ..~_._. O L~ ¢u ~ 1 l .. ,_ . . ... .. p ... _~_ ~ ~ u-utip ~ ~~ Go~op ~w '~ , .. `lam .~ _ , ~... . .. .~,, _ ~a ~~ o Wt t .}per O t..~v. i~Ow. ~. ~'~ L V`to i 1 ~ l~" S-o~t~; ~ ~ ~ ,~,(( ~~~K s~~gi+~('.ts~.o~ ~~ ~~ ~ aa~-~"ea. ,~ v ¢.1bw~` O,~w . • b ~c~e f J~w~a~~a,~ ~' i_ ~ :/ ~~ z .~ .. _ ~ ~~ I 1 s.. `1'3,.5?~ ~ ~ , Cwg4-) A bl ;' , \,~%_.~ t ~~o I ~ ~~ ~ ~1 ~tl,C C..a~~ (~~.o) Z "¢~~w C~ oz.~~ ml ``C ~+ S v}, w 1f R ~i o 'x'11 ~, ~ c.~ni,^ i' .. w ~ i ~„~l(~~ r! /i~~ ``~ ~, w~ v iw.~ V ~•(a O ice. 1Ob~VQMT~n FO(' ~d `~ 0..` OK ti L 1.V ~ Q : b!{ @ 3- bv~ p ~a .5,~C8 ~-~ s~ ~_~ $ tiff»>_ s ~~~~`~ ~s~~~,~ ~~~'~r~ o~,T -- ~~~~Nmr m ~,~, ~ommm~: ~~~ m~~.~ ~~~~~€ ~~~~~. Safety and Buildings Division County S ~ ~ V'C) ~ ~ 201 W. Washington Ave., P.O. Box 7162 X I ~~O~~, ~ Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) J i Department of Commerce (608)266-3151 Sanitary Permit Application st EIVED S~' SSA hi accord with Comm 83.21, Wis. Adm. Code, personal information you provide R (o C may be used for secondary purposes Privacy Law, sl ~ 6~1~)(m) / Project Address (if differ nt than mailing address) ~ I. Application Information -Please Print All Information. ~`~ •~ N 1 5 2005 ~ ~ 32 0 Prope Own is Na; e ~ ST /~ ~ ~ lAt ONING OFFICE O \ D ~ Property Owner's Mailin Address /' L ~ SS e I ~ ~ Property_)„Q~ation~~ / ~ b - e G i1 c~ l- Jp(V ~ % ./V~''/< Section a e~ V City, State Zip Code Phone Number , , W ~ 's~ h `,() ~ 1 ~j ~J' V rv - ~ 90q a ~ --fcircle e) T ~ N; R ~ E or~V II. Type of Building (check all that apply) `'~ Q/}~ ~ ~ ~~2 Subdivision Name CSM Number ,~ 6 ~1 or 2 Family Dwelling -Number of Bedrooms J ~ ^ PubliclCommercial - Describe Us ^ State Owned -Describe Use ~ ~ ~ ~ ^City_^Village Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ~ New System p y ^ Re lacement S stem ^ Treatment/Holdin Tank Re lacement Onl g p Y ^ Other Modification to Existin S stem g Y B• ^ .Permit Renewal ^ Permit Revision hange of ^ Permit Transfer to New List Previous Permit Number and Date Issued $efore Expiration Plumber Owner L.~/_ ~ '1 ~ ~ _ l~ ~ G,~ iS [l 6 ~O OTC _/ (J 7 IV. T e of POWTS S stem: Check all that a 1 ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank n n°°' °=" ~ aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic "' ~ ;Pipe ^ Other (explain) V. Dis ersal/Treatm ~ Design Flow (gpd) ~ D' per rea Proposed (st) System Elevation ' ~/ so j~ 1 y~~ i~o lol, 7 ~ Vl. Tank Info Prefab Site Steel Fiber Plastic Concrete Constructed Glass ~` / ~ r 7 Septic or Holding Tank ( 0 Aerobic Treatment Unit I _ 7 Dosing Chamber VII. Responsibility Sta f the POWT5 shown on the attached plans. Plum is Name (Print) ~ umber ~j '3, U Business Phone Number -~ ~ ~CC,~~- ~anc~ ~ - s = ~7~ ~a~ ~ C~ ~ r , 5 ~~ Plumber's Address (Street, ~ ,~/ ~ y X33 ( tvl '~ ~! 7 3 to VIII oun /De artmei Approved ^ Disapp: ...er Date Issued Issuing Age Signature t ps) . .......,,o~~c reeJ ~ O ~. ~ 'T ~ ^ Owner lirven Reason for Denial IX. Conditions of Approval/Reasons for Disapproval -s _ ,` Attach complete plans (to the 'ounty o~) for the syst on paper t less tnangu~~x i~r i-c~neQs m size ~~i`{'~~ SBD-6398 (R. 01/03) `ate Tl~ Ll. ST. CiQp~ C couNnr NO. 479256 STATE SANITARY PERMIT C.~ra~ ~~~.g~e. a~r~y ^T~ NEWAL PREVIOUS NO. y 32/2 l4 32o sT . OWNER PLUMBERCH~2/S .~4UEI2, LIC.# 22oG y TOWN OF SEC Zvi ,T~_ R !S E AND/OR LOT BLOC ,~~ ' ,r~ SUBDIVISION THIS PERMIT EXPIRES CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on fhe date of approval. (c) The sanitary permit is valid and may be renewed for a :pacified period. (d) Changed regulations will not impair the validity of a sanitary penniL (e) Renewal of the sanitary permit will be based on regulations in force at the tlme renewal is sought, and that changed regulations may impede renewal. (Q The sanitary permit is trensferabb. History: 1977 c.168;1979 c. 34,221;1981 c. 314 Note: ff you wish to renew the permh, or transfer ownerehip of the permit, please contact the county authority. AUTHORIZED ISSUING OFFICER -DATE ~ UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING .CONSTRUCTION SBD-06499 (R.8/00) /C~l ' Y Safe and it t isi~tl 0 7 201 W County ST C~lZ o/ k i ` ~'~~ M t Permit Number (to be filled in by Co ) Sanitar ,~~O~~I~ De artment of Commerce a (608) 266-3151 - y 3 ~ ~~ Sanitary Permit A pl>Iti~~ 2004 Stare Plan I.D. Numbcr $80858 7~g~s, In accord with Comm 83.21, Wis. Adm. Code, nycZu rsonal tpfo Provide I ' ~~ l ~ 7~ "'N I `~ address) than mailin f di(f may be used for secondary purpose Pri )( acy L2 j ZONING OFFICE g erem Project Address (i I ,~- ~' I. Application Information - e 'nt ll Information I S 1 ~ j /~~ 32v Property Owner's Na me ~ Parcel p Lot q Block p ~aa ~-ya~rs s~rCL~ .8~rr',~~ p~ - l ~(vo - ~~- j Property Owner's M ailing Address Property Location ) t ~U 7 0 j ~CP 22- 320 f~ s'f'. ~CSvY- (P ISIo ~" ~ ~ ~/~,~ S ,~ ,Sato a~ City. State Zip Code Phorx Number , G~E~ Gry `~ ~ ~~! 6 / ~ _ t ` (circle one) T a-S N; R1~~r~ /J~~~ G~ ~ ~ (check all that apply) e of Btvldin II T / g . yp 2 ,.._ v ~1 or 2 Family Dwelling -Number of Bedrooms / Subdivision Name CSM Number ~n f'f ^ Public/Commercial -Describe Use ~ i i ~y, ,,,~ ,,, ,/ .-7 ~^ State Owned -Describe Use ~ -rD n/rr~t ~,,[ ~ ~x ~ / ~'I ~'( ~~, ~ /~ • City_^village ~S'.Township of (.:A/> III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ~ Ne~ ~~_~~' i ^ Replacement System ^ TrcaanendHolding Tank Replacement my ^ Other Modific ion to Existing Syste B. ^ Permit Renewal ~ ^ Permit Revision Change of ^ Permit Tr fer to New N r ed Before Expiration i i Plum Owner lV. T of POWTS S stem: ((;heck all,that a t) ~ ^ Non -Pressurized [n-Ground ^ Mound > 24 in. of suitable soil ~Mo d < i lilable~soil ^ At-Grade 'til Single Pass Sand Filter .Constructed ~'/etland ' Pressurized In-Ground a Holding Tank eat Filter erobic Treaunent Unit ~ Recirculating S rid Ftl er / g ^ Other (explain) /I i ^ Reurculaun Synthetic Media Filter ^ Leaching Chamber ^ Dr' Lino ^ Gravel-less Pi `~~~~/~ ~~ 7 V. Dis ersal/Treatment Area Information: ' Design Flow (gpd) Design Soil Application te(gpds Dis al Area Requir (sf) Dispersal Area Pr ed (sf) ~ System Elevation /~ 2 , 2 ', 5d ~~~-.32 /.o ~'i( Aso vo;~ ~s o ~,' e~ VI. Tank Info Capacity in Total Num r ~ anufacturer Prefab i Site Steel Fiber ~ Plastic ~ i Galloru ~ Galloru of a ~ Concrete Coruwcted I ~ Glass ~ ~ New Existing j Tanks Tanks ~ ---__--- - -- Septic or Holding Tuck ~~~ _ _. /~ ~~ I I _ 'i ~ ' --; Aerobic Treatment Unii ~~__w..---- .,, U~/C p~~L ~ ' Dosing Chamber ____. /~ C• /~ VII. Responsibility Statement- 1, the undersigned, assume respoa5ibility for ' allation of the POWTS shown on the attached plans. Plumber's Na me ;'Pant) Plumbe ' Si tore PRS Number I Business Phone Number Plu / tier's Addre s~s (Sv /, ;City, State!. 'Zip /C//t e ~ J1 p 7 I i ~~ VIII. ount /De artment Use Onl Approved '~ Disapproved Sanitary Permi[ Fee (includ s Groundwater Dat Issued ~ suing Ag t Signatur (~ o Stamps) ' Surcharge Fee) ~ ~siJ1 ~ ~~ / D i ^ Owner Given Reason for Denial ,~-~(~ L~~~,~~ A,~ ,, ' IX. Conditions of ApprovaUReasoru for Disapproval ~ /) G~ ~k S~T/"~-c-- /~~` `r.'_ G~t~ I STEM OJpLdER_ `/~~~y`~ v ~~ ! Septic tank, effluent filter and ~' /~~ .S/~~~30 ~ ~~ dispersal cell must all be serviced /maintained /~ O ~Gr as per management plan provided by plumber. Lir ~Q C.1~~~ 9E~f'ylo~ se ac requlremen s mus a al Ine 0'~ ~~ ~ ~ as per applicable code/ordinances. jl Attach complete plans (to the o~for s7stem oo pape~ of less an 81/2 z 11~~~ ~ SBD-6398 (R. 01/03) .. ~ ~ ~~cons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.stata.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary July 15, 2003 OUST ID No.222774 HENRY F GROTE CERTIFIED SOIL TESTING E4366 353RD AVE MENOMONIE WI 54751 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/15/2005 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Bob Lyons 320TH St Town of Cady St Croix County SE1/4, NE1/4, S26, T28N, R15W FOR: Description: Three Bedroom ISD Mound System Object Type: POWT System Regulated Object ID No.: 912082 Identific be Transaction ID N 886858 Site ID No. 662011 Please refer to both identification numbers, above, in all correspondence with the agency. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes ('~I?f,~IflC and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in, chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: dEF TMENT OF OF EY General Approval Requirements: SEE CORRESf This system is to be constructed and located in accordance with the enclosed approved Individual Site Design plans, parts of the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • Maintenance of the vegetative cover on steep slope sites poses a hazard to the maintainer. The methods of maintenance for this site are listed in the owner's manual found on page 8 of this plan. These methods are to be reviewed with the owner. - • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. HENRY F GROTE Page 2 7/15/03 • 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. Stat • Comm 83.22(7) 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the. county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi.us Fee Required $ 300.00 Fee Received $ 300.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 . , s 7 Bob Lyons Mound Transaction # . RE~E~~Efl ~UL ' 2 ?003 SqF~, & B LDGS pIV. Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manual: Pressure Distribution, SBD-10706-P (01 /01) Mound by Individual Site Design Location: SE 1/4, NE 1/4, Sec. 26, T 28 N, R 15 W Town: Cady County: St. Croix Date: July 25, 2003 Owner: Bob Lyons' Address: 1622 320th St. Glenwood City, WI 54013 Designer: Henry Grote Signature: License # WI D - 1699-007 Attachments: 6748-Plan Approval Application SBD-8330 page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management g~l~~ ,E~ COM,ylERCE ~d ~NGS ~N~~NCE page 1 of 8 • Design Criteria `~'~S lZesidential Wastewater Contaminant Load: 30 mg/I., < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg1L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 gal/bedroom/day x 1.5 ~ gallons/day hydraulic load Design Calculations In situ designed loading rate o .3 Z gallons/sq. ft. per day Depth to estimated high ground water ~~ ~ ~ in. Depth to bedrock ~ ~ in. Cross slope at system x~'~'" % '^-~~ ~ `^`"~'` 9"~ Force main length '~•`~ ft. of Z in. Manifold/header length `~" ft. of •7- in. Drain-back 3 •e" i allons Lateral length ~. @ S4• `' Lateral elevation ~ °:. Z Lateral hole size ~+r. in. @ 31~•c~ ~~~ holes/lateral ~ $ Lateral volume ~ "g ~ b Total lateral discharge rate 2,s'~ o ~ Network pressure compensation losses ~ • ~~ Elevation difference ~ ° • Z- Friction loss ~• Z-g Total dynamic head ~ 3 ~~ ~ Pump/siphon 21a gpm @ L ~' - Manufacturer !'~' ~ ~ •~.~ ~ Dose volume ~;•~ Lift/sil?hon tank w ~ ~~ ~ ~ - ~~ ~-ow.G~ ,, Septic tank Effluent filter ~ ~-~ ~ -~ ~ Measurement pump on and off ~~ o Height alarm from tank bottom ~b•a Reserve capacity ~3~'~' specs.calcs.res g ft. of ~`~ z in. ft. @ bottom of lateral in. ( 3. o ft.) Spacing holes total gallons gallons/minute @ ~' "~ ft. head ft. ft. ft. @ ~5~ gallons/ 'nute ~ ~ ft. .Li -rru- G,~~7 ft. of head ~ ~ ~ Model # ~ W''' gallons V `'° gallons ~ ~-o gallons in. m. gallons Page ~ of .~ ~,., ~o ~ I ~ ~3 rt (~ ~. 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A ~~ ~ ~ / 4 SST ~M'J _~~ ~A~'FLE, ..L AE I j 3' o~'c -W E LT I O NS ~ ``^/ ~ K ~ .aQ, ~ - ~ Q'~ ~ ON I j V -,,; .. ~.. C c 1 11~ ~~, ~~- 5 0" 3 (~" I ~ 2 . p CXF PurlP ~I p • ~ q„ Go~E-r~ SCPrIc t _ SPEGIFI~GATIO-JS DOSC `mac , ~~~ Tnu..S MNUUFAGTURCR: (JUMBCR OF OOSCS: S'b PEh C~~ TA-JK SIZ C ; 1 Wc~ ~ ~'"° GALL01J5 OOSC VOLUMC ~ ~.~ S J ~7~.t,~vs IAJCLUOIIJG OALKfI.OW~ ;,~_.;,ti; A~ARh1 I'1MlUFACTUf1,CR; MOOCL 1JUVvbCR: `°, 1~' ``~ CAPACITIES Ac~~O IUCHCS OK 33'2' :,%~__~.: ~..~. wlb z ~ssZ . SWITCH TyP[; ~~ Bc IIJCNES OW ;.~_.~•_: PUMP /1A-JUFALTURC~ "~~0""~ ""'~^'~'~- C ^ S'~,,,IUCHES 0H ~;'g ;,..__~..: MODE L 1JUMDCR: S ~ ~~ ;~ 9 IS~'$~ . D^ INCHES GR ~~.--'-- SWITCN TtipC, ~Q'~'~"`~'Y " {JOT E' PUMP A1J0 ALARM ARC TO BC M1IJIMUf'~ pISCMARCrr< RATC..~, ~'~ G-M INSTALLCO ON SEP~RATC CIKC.. -:. VERTICAL DIFFCRCIJCC ~CTWCCIJ PUMP OF/ A1J0 OI~TRIDUTIOIJ PIPC..,~`~' FEET _ , 2S + MIuIMUM -JETWORK SUPPLY PRCiiURTTE/. Z'~ FCET r.o~~~ '~ + ~o FCET OF FORCC MAIiJ X ~'~9 F/Ipp~tFRICTIO-J FACTOR. O~g FEET ~ ~'~ .~~,~,~ - TOTAL Dy-JAMIG HEAP = 13'}; FEET ,~ ~, IIJTER-JAl_ DIMC-J6101JC '0/ TA-JK: LEI.I(s7H I~~ ;WIDTH ~-g , LIQUIC) pE=PT N 3 _1 SAFETY WARNING -Risk of electric shock. This pump is supplied with agrounding conductorand/orgrounding type attachment plug. To reduce the risk of electric shock, be certain that it is connected to a properly grounded grounding type receptacle. Your 115V effluent pump is equipped with a 3-prong electrical plug. The third prong is to ground the pump to prevent possible electrical shock hazard. Do not remove the third prong from the plug. A separate branch circuit is recommended. Do not use an extension cord. When a pump is in a basin, etc. do not touch motor, pipes or water until unit is unplugged or shut off. If your installation haswaterormoisturepresent, do nottouchwet area until all power has been turned off. If shut-off box is not accessible, call the electric company to shut off service to the house, or call your local fire department for instructions. Failure to followthiswarningcan resultinfatal electrical shock. The flexible PVC jacketed cord assembly mounted to the pump must not be modified in any way, with the exception of shortening the cord to fit into a control panel. Any splice between the pump and the control panel must be made within a junction box and mounted outside ofthe basin, and comply with the National Electrical Code. Do not use the power cord for lifting the pump. The pump motor is equipped with an automatic resetting thermal projector and may restart unexpectedly. Projector tipping is an indication of motor overloading as a result of operating the pump at low heads (low discharge restriction), excessively high or low voltage, inadequate wiring, incorrect motor connections, or a defective motor or pump. w w A a w 6( FLOW- GALLONS/MINUTE SAFETY GUIDELINES 1. Read all instructions and safety guidelines thoroughly. Failure to follow the guidelines and the instructions could result in serious bodily injury and/or property damage. 2. DO NOT USE TO PUMP FLAMMABLE OR EXPLOSIVE FLUIDS SUCH AS GASOLINE, FUEL OIL, KEROSENE, ETC. DO NOT USE IN EXPLOSIVE ATMOSPHERES OR HAZARDOUS LOCATIONS AS CLASSIFIED BY NEC, ANSI/NFPA70. FAILURE TO FOLLOW THIS WARNING CAN RESULT IN PERSONAL INJURY AND/OR PROPERTY DAMAGE. 3. During normal operation the pump is immersed in water. Also, during rain storms, water may be present in the surrounding area of the pump. Caution must be used to prevent bodily injury when working near the pump: a. The plug must be removed from the receptacle prior to touching, servicing or repairing the pump. b. To minimize possible fatal electrical shock hazard, extreme care should be used" when changing fuses. Do not stand in water while changing fuses or insert your finger into the fuse socket. 4. Do not run the pump in a dry basin. If the pump is run in a dry basin, the surface temperature of the pump will rise to a high level. This high level could cause skin burns if the pump is touched and will cause serious damage to your pump. 5. Do not oil the motor. The pump housing is sealed. A high grade dielectric oil devoid of water has been put into the motor housing at the factory. Use of other oil could cause serious electric shock and/or permanent damage to the pump. ~s.o 6. This pump's motor housing is filled with a dielectric lubricant at the factory for optimum motor heat transfer and lifetime lubrication of the ,2.5 ~ ~ bearings. Use of any other lubricant could cause ~ damage and void the warranty. This lubricant is to. o w non-toxic; however, if it escapes the motor housing, it should be removed from the surface ~, s ~ quickly by placing newspapers or other absorbent A Q material on the water surface to soak it up, so 5. 0 W = aquatic life is undisturbed. z. s 7. In any installation where property damage and/or personal injury might result from an inoperative or leaking pump due to power outages, discharge o line blockage, or any other reason, a backup system(s) and/or alarm should be used. PUMP PERP^RMANCE CURVE 115V 60HZ V ~TR.~ i.~~ i !'~'1 or~L q~'rf FL^W- LITERS/MINUTE Little~~T Pump Company • SAFETY • INSTALLATION • OPERATION • REPAIR LITTLE GIAN1~. SUBMERSIBLE EFFLUENT PUMP OWNERS MAN UAL FOR 9EH -CAUTION - READ SAFETY GUIDELINES AND- INSTRUCTIONS CAREFULLY World's Largest Manufacturer of Centrifugal Pumps +'~ •~ ~~" . ~• • Pumas Chara4rterisHcs r /Hour uen Sr~+srslll. Aefeemtit Nlodah SNEi30Ai Hort+pewor .SO F.kl Loud Ands i.0 Nlola Sladod hb {4 1 1t.tJA. I SSC E'i+a~e 6 1 Yek 11S Hort: 40 lomgentwo 1~0`F A MENU D.siSaA A Irnadrio. aos A o~hr She {-I/2• Iln {~rl~ So>kls Hadlinq 3/4' {igoW Wdt Woig~~ ~0 6s. hover Cord 16/x, SJ'1W, 24' std. p®rfern,ence Date x b -~ p ~~~lo I o` o Weh~ u.o ~, -r- urnhred t 1 i ~ iot~l Ro11~ foot ! t 12 1~ ZO 9d d~N fii.s.f 44 2i 2! 2Z 12 4 Dirn4*nsi4oanal Data ~o[ ~,, .,v , ., 1{, `. / 1 t' 7K (JO t) 1i1;~ =i-~ ~ b.. I s'•sn 3'•y~ ~t~e~ ~ (tf) -u-rarr t . AE dYrwder t" z (o.vaau 4n•dor I~ rey : 111 nd t. Iw Ar tM.avnwn ~ ~ ~.,~.+ 4 DYMUen ell ttsaM n 4M~~ S. OIJOfI Iml a{unoYr tp~dlmwn.tllaut Mtlt I~,`~j° HYDRQMATic~ ~~ . r 840 Brner Rwd AsNand, Oho 44105 1~I: 419dB9•J041 hx; 419-ill •1017 Wpb Sife: wrr,aeldrPuntp.rom SOIES CI'FKIS IN 4ll NIAJOA CRIES ANC t0UN7AIES u~m u: WoY•8350 1200 SM ~ 1999 MydrornGic' Purnp~, AsNorni, Cho. ~! Rgl - Yau Avthonzrd Wcd Disrciburor - of `~MI ^--••• ~ i ~ i i . _ .. .. _._. r...-T.. I I. ~ , ...I ~~ 1 .. .__ ..... .. _.. I ~ IQ I ~ ~ .._ a ,.. Materials of Cansfruttian ;. . T ~. *;,~. ` System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with tote adsorption system or any other system components, the installing plumber or the St. Croix County Zoning Office, 715- 386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 1 1. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance l . The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. l 1. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. 12. Note: Downslope toe of mound is relatively steep; mowing with riding lawnmower could be dangerous. Location is such that mowing of vegetative cover should not be necessary; if desired, it should be done using a weed whip, avoiding riding equipment. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.4 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 r_ .~ . r~RIGIN~4~~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accnrdanra with Cnmm Rr, Wic Aram CnAa 1793 P~ ~ Page 1 of 3 Certified Soil Testing County Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must l d b t li i t it d t ti l i f d h t l i BM i t i d St. Croix nc u m u e, no e o: ver ca an re or zon a erence po n ), d ( rect on an percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. ~~~~-lobo --~ ~ ~d ~ Please print all information. _ _ R sewed B ~ Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). ~ ~ ~ /) 1 v Property Owner Property Location Lyon, Bob Govt. Lot SE 1/4 NE 1/4 S 2ti T 28 N R 15 W Property Owner's Mailing Addre$ Lot # Block # Subd. Name or CSM# 1622 320th St. ~ Q~l1-- City State Zip Code Phone Number j City Town Nearest Road Glenwood City ~ WI 54013 715-265-4909 Cady 320Th St. / New Construction Use: / Residential /Number of bedrooms 3 Coded ' ed design flow rate Replacement Public or commercial -Describe: Parent material loess over till Flood plain elevation, if applicable General comments and recommendations: install 8' x 57' rock cell mound on 100.0 contour as upslope edge of rock w/ 1.7' sand fill 450 GPD NA Boring # i Boring / Pit Ground Surface elev. 99.3 ft. Depth to limiting factor 16 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G PD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 __ *Eff#2 1 0-8 7.5YR 2.5/1 - sil 2 f sbk mvfr cs 1f/m .5 ' .8 2 ~ 8-14 10YR 5/3 - sil 2 f sbk mvfr gs 1m .5 ~~ $ 3 14-16 10YR 5/3 - sl 1 m sbk mvfr cs 1f .4 ' .6 `~" -22 10YR 5/3 f1d 7.5YR 4/6 sl 1 m sbk mvfr cs 1f .4 6 5 22-32 7.5YR 4/4 c1p 7.5YR 5/8,5/3 sl 0 m mfr - - .3 ~ 5 --- I --- Boring # -~ Boring /; Pit Ground Surface elev. 101.2 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 ~, 0-8 7.5YR 2.5/1 - sil 2 f sbk mvfr cs 1f/m .5 8 2 ~ 8-26 10YR 4/4 - sl 2 f-m sbk mvfr cs 1 m .5 .9 3 26-48 10YR 4/4 f2f 7.5YR 4/6 sl 1 m sbk mvfr - 1f .4 ~I 6 -i- ----- ~ ---~ ---- -- - i I i --- tmuent ~i = f3w5> 30 < Z2D mgyt_ and TSS > 0 < 150 mg/L " Effl n #2 = BODS < 30 mg/L and TSS < 30 mgL CST Name {Please Print) Signa r CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 6/29/2003 715-233-0398 ~c . Property Owner LyOr1, Bo•b Parcel ID # .~. • • Page 2 of 3 ,4 $ Boring # -= boring` /J Pit-_ v . , ~ ' Ground Surface elev. 97.8 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Mansell (Ai. Sz. Conf. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 7.5YR 2.511 _ sil 2 f sbk mvfr cs 1f/m .5 .8 2 9-21 10YR 5/4 _ sl 1 m sbk mvfr cs 1 m .4 .6 3 21-36 10YR 5/4 f2d 7.SYR 4/6 l OYR 6/2 ' sl 1 m sbk mvfr - 1 m .4 .6 redoximorphic features become cap below 30" ^ Boring # -. ~ Boring i Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i I I -- I ^ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8130 ({1.07100) Certified Soil Testing Z C0.\Q„~ ~„ ~ TV1 o ~ z~ ` 4-~ 4~ , ~.~ u ~1 zZ.t~-~4 j __.r...._'-..._ _._..'.~. i `„2~w ~~ L ~- 1 S' -~ cam»... n S ~ - h4L_- Zb ~28-1s w 3 Zo~w S~ ~l ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT .AND OWNERSHIP CERTIFICATION FORM OwnerBuyer t~o~ ~K e~S Mailing Address ~ ~t ~ 2- ,3 ~, o y ti, s ']". G ~ ~ w e~ ~ r y, w I .5'~a /3 Property Address I ~P~Q ~ ~~ 5'T' (Verification required from Planning Department for new construction) City/State 5~~~~/G-VF~CG~: ~ Parcel Identification Number r`X)~-/~ ~~' ~ _60~ LEGAL DESCRIPTION ~° `~°~°~ Property Location S~ ~/,, ~& '/., Sec. 2!p , T ~ N-R !S W, Town of C'.RD`! Subdivision ,Lot # ,~_~ Certified Survey Map # Volume ,Page # Warranty Deed # ~ ~ ~ ~~ 3 ,Volume ~ ~ Page # ©~ ~~ Spec house ^ yes ~ no Lot lines identifiable~.yes ^ 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 master plumber, journeyman plumber, 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. Uwe, 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 yo septic s em has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o ~ e ar ~ date. IGNATURE OF PLIC' DATE I ( cert' a t e on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope des b a v , by i of a warranty deed recorded in Register of Deeds Office. x ATURE OF APP ICA 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 is the warranty deed FROM : NORTHLAND PLUMBING, INC. FAX N0. 715-643-2520 Nov. 18 2004 09:45AM P2 sT c~orx cc~rJrrr~r SEPTIC TANK MAIN'TENArJc~B AGREEMENT AND OWNERSHIP CI?RTIFIGA'l'ION FORM OwnerBuyer s, ~- / - Maiting Address _ _( to 2 _` 3 2 0 7 ~ s ~~_ ~ t~ A.J ~ aa~ Ct T y, w / 54\61,3 Properly Address ~ ~ K~ 3~ dam' ~T~ ~ 0.3 -~u,~ ,CU/Ll~ 1~,`~ ~ `r ~," --~ (Verification required from Planning Department for new City/State ~1 tZllC~~ V f~" L.~-~`/ . (~,~ PareeI Identification Number 0 U~' /~(DO-'' D 1~,~,, LEGAL DESCR.XPTIC)N' ~ ~~~ /,Q~~~QG~ n Pro a Location S ~ '/s, ~ ~ '/~, Sec. ~ ~- , T ~$ N-12 1 ~ W, Town of LfC'.Itb`I U ~CX~' P m' -- -- Subdivision _. .Lot # ~. Cetfiftcd Survey Map # , Voluxs7e _ __ ~1___ Page # . Warranty Deed # 7~ ~ ~~~ . Volume`,'~°~"~O 7 .Page # ~~~ Spec house ^ yes ~ no Lot lines ids;tttifiable~yes ^ no SYSTFIV~ 1KAINTENAI~CE Improper use and maintcnanccof your septic system mould result in its psztaature failure to handle wastes. Proper taaintenance consists of pusnpsng out the sepric tank every thrtc ytars or sooner, if needed by a lieoased puaspcr. What you put into tlse system can affect the function of the septic tank as a treatment stage in the waske disposal system. The pmpcrty owner agrees to submit to St. Croix Zoning Department a eertificadoA forte, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pturspe r verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if ssceessary), the septic tanK is less than I/3 fall of sludge. Uwe, the undersigned have read the above ret;ui.remeats and agree to maiutaia the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Departi~aesn~ of Nattual Resources, State of Wisconsin. Certification statia~yoty septic s~cp~~1 been maintained must be tomplctcd sad returned to the St. C,4+oix County Zoning Office within 30 days o iC mar a Ao date. OF ~~ DATE 1 ( ce a t e on this forth are kue to the beast of my (our) knowledge. I (we) am (arc) the owner(s) of the prop de a , by of a warranty deed recorded in legistet of Deeds Offset. `~ ~ pc I / l~ a AT'>;JRE OF APP ICIti DATE '•••'• Any information thst is mss-representedmay result in the ssaittry isersrsitbeing rcvolced by the Zoning Departzne:~t. "`*`**"` " Include with thi; appticatiou_ a stamped warraary deed =rOtu l]ae YtGgis:ter of 17eeds office ~a cLopy of the cereifted s/~urvey/ asap if sti[csence is made ' the warranty deed ~'~ Parcel #: 0~4-~ ~s~-4~-~~0 11/19/2004 07:46 AM PAGE 1 OF 1 Alt. Parcel #: 26.28.15.406 004 -TOWN OF CADY Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * =Current Owner ROBERT P LYONS ,D ~ _ /_ ~~ BUTTKE ~SHEBLY L P ~ BUTTKE SHELLY L 7J 77~ ~~" GLENWOOD CITY WI 54013 ~Gl~~ ~~ Eby ~A~~i2~~ Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description 0•-3 rw~ ~ Wt~t l~bV~'f^ °•~ ~~(,llY 2 ~ (~ SC 5586 SPRING VALLEY / • SP 0100 CHIP VALLEY VOTECH S~-~ °~ Zo ~e.. , Leal Description: Acre 40.000 Plat: N/A-NOT AVAILABLE SEC 26 T28N R15W 40A SE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 06/05/2003 724513 2264/087 W D ~nnd cl IM11AeQV Bill #: Fair Market Value: Assessed with: 2,200 Valuations: Description Class PRODUCTIVE FORST LANC G6 Totals for 2004: General Property Woodland Totals for 2003: General Property Woodland Last Changed: 05/25/2004 Acres Land Improve Total State Reason 40.000 28,000 0 28,000 NO 40.000 28,000 0 28,000 0.000 0 0 40.000 1,300 0 1,300 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 016-1024-40-000 11/19/2004 07:45 AM '! Alt. Parcel #: 11.30.15.1886 016 - TOWN OF GLENWOOD Current ~X ST. CRO COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Perm T pe # of Unit 00 0 C Tax Address: Owner(s): ' =Current Owner * LYONS, ROBERT P ROBERT P LYONS BUTTKE SHELLY L BUTTKE SHELLY L 1622 320TH ST GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Pope y Address(es): * =Primary Type Dist # Description 1622 320TH ST SC 2198 GLENWOOD CITY SP 1700 WITC egal Description: Acres: 1.110 Plat: N/A-NOT AVAILABL E SEC 11 T30N R15W SE SE LOT 1 OF C.S.M. 6/1565 BlocklCondo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 01/06/1998 570828 1286/375 WD 01 /06/1998 570827 1286/372 TI 07/23/1997 718/417 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 94,700 Valuations: Last Changed: 06/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.100 7,500 168,200 175,700 NO Totals for 2004: General Property 1.100 7,500 168,200 175,700 Woodland 0.000 0 0 Totals for 2003: Generai Property 1.100 7,500 89,700 97,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 116 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 , 'J 226yP 08? 7z~s~~ ~,* ` I STATE BAR OF WISCONSIN FORM 2.2006 Document Number WARRANTY DEED This Deed, made between Francis A. Schultz, a single person Grantor, and Robert P. Lyons, a single person, and Shelly L. Bnttke, a __ single person, as joint tenants and not as tenants-as-common - Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) The Southeast Quarter of the Northeast Quarter (SE 1/4 of NE 1/4) of Section Twenty-six (26), Township Twenty-eight (28) North, of Range Fifteen (15) West. KATHLEEN H. YALSH REGISTER OF DEEDS ST. GRQIX Ct]. , NI RECEIVED FOR RECORD 06/05/2003 09:30A1f YARRAHTY DEED EXElip7 # REC FEE: 11.00 TRANS FEE: 360.00 COPY FEES CC FEE: FAGES: 1 Area Name and Return Address Thomas A. McCormack PO Box 2120 Baldwin, WI 54002 0041060-40 Parcel Identification Number (PIN) This is not ~ homestead property. f~ (is not) Exceptions to warranties: Easements and restrictions of record. Dated this day of 2003 * AUTHENTICATION Signature(s) authenticated ties .r__.._ .___ _ day of ^~_, , ____ * .~a~~~ ~a *Francis A. Schultz * ACKNOWLEDGMENT STATE OF WLSCOl~1SIN I ss. St. Croi: County ) r Dually came before me this 2~ day of 2003 the above named Francis A. ultz l"--ti TITLE: MEMBER STATE BAR OF WISCONSIN ~ -- ----- ---------- --z'---- '-- --- ----- (Ifnot, ~thO~me known to be pens who rated fore ' authorized by § 706.06, Wis. Stats.) owled the e. ~,~/~ THIS INSTRUMENT WAS DRAFTED BY * ~~ ~ ~ G. ~i" _ Thomas A. McCormack N Public, State of WISC Baldwin, WI 54002 y Commis 'on is an f to expiration date: (Signatures may be authenticated or aclmowtedged Both are not necessary. ~~~ •) * Names of persons signing in any capacity must be typed or printed below their signature. WARR.4N.I1, PEED STATE BAR OF WISCONSIN INFO-PRO FORM No. 2 - 2006 (800}655-2021 www.iNoproforms.com