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Parcel #: 016-1020-50-000
08/08/2007 03:40 PM
PAGE 1 OF 1
__
Alt. Parcel #: 10.30.15.160A 016 -TOWN OF GLENWOOD
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner
O - KOSTKA, LANCE N & CYNTHIA M
LANCE N & CYNTHIA M KOSTKA
1664 00TH 3l n~
GLE CITY WI 54013
Districts: SC =School SP =Special Propert s(es): " =Primary
Type Dist # Description ~ 166 00TH ST /~
SC 2198 GLENWOOD CITY ~) v
SP 1700 WITC
Legal Description: Acres: 5.710 Plat: N/A-NOT AVAILABLE
SEC 10 T30N R15W 5.71A IN SE NE LOT 2 Block/Condo Bldg:
CSM VOL 2/385
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
10-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1025/02 WD
07/23/1997 844/323
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.710 23,000 130,400 153,400 NO
Totals for 2007:
General Property 5.710 23,000 130,400 153,400
Woodland 0.000 0 0
Totals for 2006:
General Property 5.710 23,000 130,400 153,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 521
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin ' partment of commerce PRIVATE SEWAGE SYSTEM
S<,fety am ilding Division
INSPECTION REPORT
GEN' :AL INFORMATION (ATTACH TO PERMIT)
Person: iformation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J.
'ermit Holder's Name: City Village X Township
Kostka, Lance Glenwood Townshi
;ST BM Elev: Insp. BM Elev: BM Description:
y~ L ~ ~Ir`i~
'ANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACIT
eptic ~~~~ Alo ~aaC7
Dosing ~~
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. vent to Air Intake ROAD
ep is ~.~ ~~ ~ ~ ZS~ ~ 'f"(Q'~
osing ~ ~~.Q ~~ 2~
"~~
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer D v 6 ~ Deman~
GPM
Model Number `~~ ~~
TDH Lifts Friction Loss System Head TDH ~w Ft
Z r~' .....--- ~ D •
Forcemain Length$~ Dia. Ly Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width ~ Length
DIMENSIONS 3~~ ~ ~
SETBACK SYSTEM TO F
INFORMATION _ _,,,
nISTRIRIITIAN SYSTEM
S
62.1- ~ `~Z) ~ ~ ~
county: St. Croix
Sanitary Permit No:
399548
State Plan ID No:
(Parcel Tax No:
Il 016-1020-50-000
STATION BS HI FS ELEV.
Benchmark
(~•~ ~+,~ ~~
Alt. BM
Bldg. Sewer
t8. o ~~ ! 3
to
St/Ht Inlet ~~ •5 ~ ~~
SUHt Outlet
Dt Inlet
Dt Bottom Z~ ~ p E.~.S.
Header/Man. 7 (
1~1
- L~ ,y
~ ~ pa„ ps
Dist. Pipe '6 erg
l o a• ~•'A +`3v
~e ~
tv o- t T
9.8 L
Bof. System ~j ~, ~.y
~.
Final Grade >•~
~sV.B ~ ~~. ~O~••v~f
St Cover / 6
• !fl•f3 ~.~
r
T-
Fa' ~ !
«•a. y~ t
9.a- 4 ~
Dia.
CHAMBER OR
UNIT
wiauwi~`:x!
fel Number.
1
19_ •19
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
,~,) d ~~
~
7 i
Pipe(s) .~ ~ ~ k
S
i
~' - -
Length
Dia pac
ng
Dia
Length
SOIL COVER Y Proccnro Svs4ams []nlv YY Mnund Or At-Grade Sv5tem5 Only LO... t_..- Z i• tlr" T
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bedlfrench Edges Topsoil ~ Yes ®No ~] Yes ~ No
'J
r~o,
DD.
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: l ~ /~pu~ /~~ Inspection #2: / /
Location: 1664 30th Street Glenwood City, WI 54013 (SE 1/4 NE 1/410 T30N R15W) NA Lot 2 ,L. Parcel No: 10.30.(1/n5.160A
1.) Alt BM Description = `o t f .GJ~~S~j 5y S k w In~.e~ Gj l ~iy~ ~v~p« N C~j K. C O^ ~-
2.) Bidg sewer length = 1~ ~1 iu~~~ ~~~
~ i
- amount of cover = 7Z ~~.~`~~ ~ ~ ~~ ~ ~ /_
~i ~i w, i w~~-ll4co~ d iY~ ~°~^T~~ IGI
~n re i~ sion Required? ~] Yes No ~ I ~,~
other si f r additional information: ~ ~ ~ i ~ v ~ ~
Use de o L
Date Insepctor's Si ure
SBD-6710 (R.3/97)
»l~a- z ~~ ~ 7~
Safety and Buildings Division
Washington Ave., ~P.O. fox 7162
201 W C~~' /~ ~ ~
l• ~'
.
~~ ~~~~~ ~ ~ ~ Madison. WI 53707 - 7162
~~~ Sitte A~ ~ ~ t 4 ~~
! ~ ~ -6
l3ep';~rtment of Commerce
Sanitary Permit Number
Sanitary Permit Application G
~
~ ~~
Ia accord with Comm 83.21, Wis. Adm. Code, pcrsoual information you provide ^ Check if Revision
(
tna be used for seco ses Privac Law, s15. 1 m
I. Application Information -Please Print All Information
State Plan I.D. Ntrmber~
Property Owner's Name Parcel Number ~ 0 . ~j~ ~ / S, I !a0 l~
C;hd l~v~tk~
~
~~
L v«'tG2G -s-~-.~oG
,
-
~~,
Prot perty Owner's Mailing Address
~V r ~ Ste'
~ ?
~ ( Property Location
~~ ~~ Sf:S l~ T~b~' N.R~~'E
J
l
,
City, State Zip Code Phone Number Lot Ny~nber Block Number
L
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~ si~q _~m~ CSM Number
~Subdivi
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3~s-
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P
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~~Q •~.~ ^Ciry
II. Type of Building (check all that apply) ~.,` ;,'
~r
~-1 r 2 Family Dwelling -Number of Bedrooms ~ - ~~ - ^Village
~
~
'Township 1'e- ~1-- t/ r o
^ publiclCottrmercial -Describe Use ~,, A ~ ~~
1( N 3t) ~oa,~ Sfr c
fi
^ state Owned ~\ ~'~ ~~ ~~
e.~''
~~
`
,
III. Type of permit: (Check only one box on line A (ntrmbering~sche terrtal use). `Complete line B if applicable)
A' 1 ^ New 2 ~ Replacement System 3 ^ Replacement ofy ,6 Q; Add+tion~\ r County use
~
.
S stem Tank Onl ~ .
Permit Number Date Issued
B. ^ Check if Sanitary Permit Previously Issued
IV. Type of Permit: (Check all that apply)(ntrmbering scheme is for internal use)
44 ~ Non -Pressurized In-Ground,/ 21^ Mound 47 C Sand Filter 50 ^ Constructed Wetland
~ ^ prod M~,roube 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line
~ ~ ~ ~ ~~
45 ^ At-Gn-de 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other X
V. D' rsali'IYeatment Area Informati
Design Flow (gpd) Dispersal Area on: I w~il(rwQar t+ -1 a
Dispersal Area Soil Application ~ br~--
Percolation is
System Elevation
Final Grade/[y2.~
i 02
l
i
Required ~ Proposed ~ ;~( Rate(Gals./Days/Sq. ~.) (Min./Inch) Q q ~ ct ., C(~ , 3
1 . j
evat
on
E
Id/. ~ /oi• r
'
4 ~ s -~
-
_ :,, ~
VI. Tank Info Ca i m
P~ ~' ~ Total Number Manufacturer Prefab
Concrete Site
Constructed Steel Fiber
Glass Plastic
Gallons Gallons of Tanks
New Existing
Tanks Tanks
Septic or Holding Tank _ / ~~, (J ~ t GSG
Dosing chamber L ~ i~ t ,
VII. Responsibility Statement- I, the unde ed, assume possibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plum s Signature ~hfPRviPRS Number Business Phone Number
'~~3~1~5~ ~~s-G~~l-s1~G
'
~~~ ~
s~-~. ~
Plumber's Address (Street, Ci ,State, Zi e)
VIII. Count /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agem Signature (No Stamps)
Approved ^ Disapproved Surcharge Fee) ~~
/ 6
6 !
q
' ~)
'
-
~
^ Owner Given Initial Adverse ~a.S
7
C-
Determination
lIX. Conditions of Approval/Reasons for Disapproval t:oe:~2 f,~~~
w
4
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~ • ! complete plant (to the County only) for the system oa paper aot leas than 81/2 x 11 inches Sn size
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' , ~~P1.1~MP CidAF"'18ER CitpSS SECTIQi~I AtJD SPEClFICATIDIJS ~ PAGE ~ +~F
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YERTI[gL ptFFr`R.ERiC6 bE'1•WC£LI PUMP pfF AIJD.. .. ~..'_ FEET
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TOTAL Uy1JAl`tIC ~~:wp 1 `.~ ~fE£T
- ~~
As per manufacturer ~`~-O gal/in. Liquid. 8epth 3$
r= r ---
Submersible
~~luent dump
~ ~ ~ ~~
QQ ~ EP04
~V~ EP45
xPrucanotils
~`~
Specifically designed for the
following uses:
• Effluent systems
• Homes
• Farms
• Heavy duty sump
• lAlater transfer
• Dewatering
SPECIFi1Cxi'It~ __---
Prnrtp: CF04
• Solids handling capability:
'/,'maximum.
• Gapacities: up to 55 GPM.
.~hdl heads: up to 24 feet.
1 ~ t)ischarga size: l'/z" NPT.
° l4techan'sCai seal: carESOn~
rotarylceramic-stationary,
BUNA-N elastomers.
* Temperature:
104°F (40°C) continuous
140°F (ti0°C) intermtttent
• Fasteners: 3~ series
stainless steel.
• Capable of running
dry without damage to
components..
Pump: EP05
• Solids handling capability:
~/"maximum.
• Capacities: up to 6Q 6Pfut.
• Total heads' up to 31 fast.
• Discharge size:l ~" NPT.
Mechanical seal carban-
fOllry/C6rarrltG-StatiOn~ry,
BUNG-N eiastomers.
• Temperature:
t04~F (4ttaC) continuous
140°F X60°C) intermittent
~ ~~• ~.
• Fasteners: 300 series
stainless steel.
• Capable of running
dry without dam2ga to
cvrnponsnts.
Motor:
• EP04 Sltigb phase: 0.4 HP,
t 15 or 230 V, 60 #iz,1550
RPM, built in Overload with
automatic reset.
• t:P05 Sin41e puss: 0.5 HP,
115 V: ti4 Hz,1550 RPM,
built in ovsrtaad with
automatic reset.
• Power card: l0 foot
standard tengih,16'3 SJTO
with three prong grounding
plug. Optionat 2d foot
isngth,16t3 SJTW with
three prong grounding plug
(standard on EP05).
IAEiER5 FEET
1u~
9 3C
s
o ~
a
~.
z
c~ 6 2r
5
~, ~;
~ ,4
la-
,o
a ,~
2
t
• Fully submerged in high
grade turbine oil for
lubricatton and efficient
heattransfer.
Asrdltabls for atdOrttBtk and
mararal oparadoe, Aatprnatic
models laclade Mecdaarcat
Float Switch assembled and
preset at the tactotY.
FEAT11RE8
^ EPf}4 impairer: Thermo-
plastic Semi-open design
with pump out vanes for
mechanical seal proter~ion.
^ EP05 Imparter: Thermo
plastic eHCtoaed design for
improved performance.
^ Cooing and Base: Rugged
thermoplastic design provides
superior strength and
corrosion resistance.
^ tYlat~ Nousrng: Cast iron
fnr efficient heat transfer,
strength, and durability.
^ Motor Cavsr:'f herr'noplas-
tic cover with integral 1~ndle
and boat switch attachment
poiMS-
~ Power Cable: Severe duty
ratetl oil and water resistant.
^ Bearrags: Upper and lower
heavy duty haft bearing
CQnS2CllCtiQn.
AQEMCY US><glt5
~~ Cuigdian 8lsnda+dt JbtodAttm~
(CSA l(st>3d model numbers
end in "F" or "AC".)
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~rAPAt~TY
w~sconsinDepartrnentoflndustry, $OIL AND SITE EVALUATION,R~R-QRT
tabor aril Human Relations
Divis~~a Of Barely 8 Buildrgs in ar•rnrri with II {-IR RQ n~ Wra ~rl.rv r`n~lo ~ •' ,
•
Page ~ of 3
- ~ -- --- ---- . ' COUNTY
Attach complets site plan on paper not less than 81/2 x 11 inches in size. Plan must include
but
,
not limited to vertical and horizontal reference point (BM), drection and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. ~ c7 l 6 _ 1 OZD - S Q•
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE~DBY DATE
l l -L-c~ i
PROPERTY OWNER: ~ PROPERTY LOCATION
L P'r~ CE f~+~j ~1,/v~~-f ~pST'1'c.fi~ 681FF.t6T S ~ 114 N>r 1L4,S ~~ T 3~ ,N.R 1 S E ( W
PROPERTY OWNER':S MAILING ADDRESS. LOT # BLOCK # SUED. NAME OR CSM #
lb b 3l 0 `T!} ST ~ _
Z. .,.~ ..__. _ ,, . C-3-'9 VOt_ Z. >>~-SE 38 5
CITY, STATE Z1P CODE PHONE NUMBEA ^CITY ^VILLAGE ®fOWN ' NEAREST ROAD
~t~il...joo~ C-ITi,-vt Sao ~3 (~tsJZ65_v6sy Gt_~l~oo~ 310 `rtt- ST.
[)New Construction .Use [,~ Residential / Numt~er of bedrooms 3 [)Addition to existing building
(~ Replacement [ ] Public or commeraal desaibe
Code derived daily flow ~1,S0 gpd Recommended design loading rate - bed, gpd/ft2 ' `/a trench, gpolft2
Absorption area required a,o h bed, ft2 ~S 4 trench, ft2 Ma~dmum design loading rate ~ 5 bed, gpd/ft2 ~ b trench, gpd/ft2
Recommended infiltration surface elevation(s) S ~ tJ~TE T~ ft (as referred to site plan benchmark)
Additional design /site considerations _ L>ll s~t_~~rt. c~1 AGE 3
Parent material Lo ~s py ~ z '1~ ~..~ ~ Flood plain elevation, if applicable N ~ ft
S =Suitable for system
U = Unsuitable for s stem CONVENTIONAL
ID'S ^ U MOUND
~ S ^ U IN-GROUND PRESSURE
®S ^ U AT-GRADE
,®S ^ U SYSTEM IN FlLL
^ S [~ U HOLDWG TANK
^ S ® U
SOIL DESCRIPTION REPORT
Boring #
~ ~<
Ground
elev.
~o~l-s tt
Depth to
limiting
factor
7 7 Z',
Boring #
Z
Ground
elev.
10Z • Zft.
Depth to
limiting
factor
~ ~yti
Horizon Depth
i Dominant Color Mottles Texture Structure Consistence Roots GPD/ft
n. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. g~ rerx~
o-~ id `1 R.31Z - sit Z'Fsb>z m`{~- c.s 1v~ ~S ,b
Z $ -Zy t o ~ tz- 3 [ t; s l l Z, `Fs b>t m'~1~ ew - • s . b
--3 2,4 S n ~ . S ~ rz ~ l y - s i J 2.rn s b>z >h~~- C~ . S • 6
V• so ~z 7.S `-tIZ qty - s1 o w, m~~ _ -~ .y
Remarks:
o-~; l0`~1Z ~Lz.. ~ si 1 z.'Fsbk m'Fh cS 1v~F •s .6
i. g ~. 1o~.R~tty _ sit Z~sb>z 1n'F1- c,,,~ _ .s .~
3 SS I o ~2 ~ X16 - si I 2+n sb~ wl~ft- ~S - . S J-6
~ sS--~~ ~ .522 .~1y _ g 1 ~h-l ~'F~. - , 3 ~ •y
Remarks:
ST Name:-Please Print Phone:
Arthur L. WeQerer 715-425-0165 '
~egerer Soil Testing & Design Service-P.O. Box 74 River.Falls,WI 54022' .
>ignature: ~ Date: ~ CST Number..
0 0-15 Z. $ • zo0o 220251
PROPERTY OWNER 1u~ST~LA SOIL DESCRIPTION REPORT
PARCELI.D.~ Old- lOZO - S~
Boring #
~.S\~\4.\th^ri~.
:`:~ ~ '\
2~ ..:.
,:~ .<::.
Ground
elev.
g~i. ~ tt.
Deplh to
limiting
(actor
Z"
Boring #
..y
. ~,:~ ~~
....
~:~:~< 2„
Ground
elev.
N ~ ft.
Depth to
limiting
factor
~L3''
Boring #
w ;::::;~:;...::.
} 3 r.::
~~
Ground
elev.
tt.
Depth to
limiting
(actor
3oring #
Aa~:~:•,
<f
>s
~;~ t
around
~lev,
tt.
)epth to
inviting
actor
Remarks:
,f ,
Page?- of ~
Horizon Depth
in Dominant Color
Munsell Mottles
Qu
S
C
l
t
C Texture Structure Consistence 8ouxtary~ Roots GPD/ft
. .
z.
on
.
o
or Gr. Sz. Sh. Bed Trerxh
1 0-~ l~K R ~!z - s' Z'Q-Sbh w~~ -- e_ s 1~~ , s .6
Z g -3d to ~ ti 3!6 S; ~ Z'P s l~k ~, ~ r e_r,~, - . S . 6
3 3u-sb L~~R 31~ Si5 ZwiS~,1c rri`Fi- Chi '- - S •~
y sb ~z ~-spa. 3Ly sa ow, ,~~,- - • ~ •y
. ,.
't
i
i
f
0_9 lo~,~~~Z - sil Z~sbh m'gh ~ !v-4'- ~S~ ~.6
Z ~-~o Lb`-tR'31l, - Sr 1 Z-nSb12 a~g~ ~~ - -S ~.~
3 30 -U3 l~`~1~ 31~ ~ - ~ si1 t~sbh : ~g ~ ~~ ~ _ .-Z. ~ ,.3 ',
y ~3-s~ `t •S'~tZ y!y ~ ~.S Utz s/g Si c.l l ~sbk ~ h _ _ z ~ 3
I
I
Remarks: `1'li'lS 'B~~2bn6 )S lV@'R'f~ `T9i'~ C'Sz-t...S'r'n~1G •~l~ti/ ~~;~
} .
t
1
~•
. {.
Remarks: '
,~ .
Remarks:
n no•in~t~ .,r ~,..,,
~ ,
PLOT PLAN
SCALE 1"= 30 '
Page 3 of 3
tics--z~~r t~ ~z.c~p~~z~r~ ~~,~~
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~~ ~~
a--i ~tZ
3 Bb1~'-1
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~t~sTfi~l.:_ S _Z1~-~etf2S , ~1~ 3' x 3-~: S ' LO-J G w/. b _ ~rv.~7=,s _=off
- ' -~~-[=~~t_~Prfie c't-y s t D~"w~wot~ ~~e-t~ ettfl w~e~s ~ u ~'-
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-- - -
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L 1~ ~L ~. Z,~ _ Q~- ~ O O
CST Signature Date Signed
~o_~S
--
- - zzoZ.S y
( 715 ) 42.5-n7 h5 _
Telephone No. CST #
~ ~~ l
e
~ ~
a
r
a ~
~-
N
~ oT 70
-
=~
S Eq ~ ~)
-cam ~Ps`J__~ l
x t-~-~s-c~N ~ s~~-~n~
r~ ~~
n.~ ~'
POWTS OWNER
.. •NFORMATION
~. Cwt. N
Permit #
...•r~i•~f nA D AlrfL'TCDC
27~-/J 7c
SYSTEM 5PE(;lF•lc.Al wn~
Septic Tank Capadty l O o O I ^ NA
Septic Tank Manufacwrer ln1 ~ ~ s e ,r- ^ NA
Effluent Filter Manufacwrer c4 ^ NA
Effluent Fiiter Model ~ (off ^ N'°'
Pump Tank Capacity (a Sv gal ^ NA
Pump Tank Manufacwrer ~~ ,~ s ~ r ^ NA
Pump Manufacturer {,-~ ~~ ~ ~ S ^ NA
Pump Model EPo ~ ^ NA
Pretreatment Unit
^ Sand/Gravel Filter
^ Mechanical Aeration
^ Disinfection
Manufacturer
^ Peat Filter
^ Wetland
^ Other: ^ NA
Dispersal Cell(s)
~ In-;round (gravity)
^ At-grade
^ Drip-line
^ in-ground (pressurized)
^ Mound
^ Other:
ffGJ~~iR «aav~a .r. r.~
Number of Bedrooms
^ ~•
Number of Commercial Units ^ NA
Estimated flow (average) gal/day
Design flow (peak), (Estimated x 1.5) ~ t f~ gal/day
Soil Apptiation state ~
.~ Grp ~' gal/day/ftZ
lnfluenUEffluent Quality Monthly average*
Fats, Oii » Grease (FOG) s30 mg/L
Biochemical Oxygen Demand (BODs) <_220 mg/L
Total Suspended Solids (TSS) s 150 mg/L
Prevented Effluent Quality ^ NA Monthly average*
Biochemical Oxygen Demand (BODs) <_30 mg/L
Total Suspended Solids (TSS) <_30 mglL
Fecal Conform (geometric mean) <_104 cfu/100m1
Maximum Effluent Particle Size % inch diameter
MAINTENANCE SCHEDULE
Service Event
Inspect condition of tank(s)
Pump out contents of tank(s)
Inspect dispersal cell(s)
Clean effluent filter
Inspect pump, pump controls 8t:alarm
Flush laterals and pressure test
* Values typical for domestic (non-commerdat) wastewater and septt~
tank effluent.
* * Values typical for prevented wastewater.
Service Eregccency
At least once every ^ months ~rear(s)3 (Maximum 3 yrs. )
When combined sludge and scum equals one-third (Ys) of tank volume
At least once every ^ months year(s) ?j(Maximam 3 yrs.)
At least once every ^ months (~--year(s)
^ months l~year(s) `^ NA
At least once every
At Least once every ^ months ear(s) ~ NA
At least once every ^ months ^ year(s) ^ NA
At least once every ^ months ^ year(s) ^ NA
MAINTENANCE INSTRUCTIONS
inspections of tanks and dispersal cells Shan be m~s b~ae~odi pOa~?S Maintaine~f Septage Servidng Operator~Tank inspectic
Plumber; Master Plumber Restricted Sewer; PO p ,
must include a visual irtspec[ion of the tank(s) to tdenti an nb k up o~ pond'ng of effluention the groundasurfaceedThe dispersal
volume of combined sludge and scum and to check fo y
cell(s) shall be visually inspected to check the effluent sound surface msay ndi ate aefaili gt~onditionoand regirdesnthe immedi ten
the ground surface. The ponding of effluent on the gr
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third ('h) or more of the tank volume, the Wiscor
contents of the tank shat{ be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113,
Adminisvative Code.
The servicing of effluent filters, mechanial or pressu o'd SOW ~ be performed by a certified POWTS Ma n~tainer.ny °ther
maintenance or monitoring at intervals of 12 months
A service report shall be provided to the Iota! regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other c em
that may impede the vestment process and/or damage the dispersal cell(s). if high concenvations are detected have the come
~r rho rar+4(s'4 ramovad by ~ sentaRe servicing operator prior co use.
pate ~ o(__
System start up shall not occur when loll conditions are frown at dte lnffltratlve surface.
During power outiEes pump tanks may fll! above normal hlgfiwater levels. tiYilea Power h restored the excess wastewater will be
discharged to the dlsperYal cell(s) In one large dose, overloadlreg the cell(s) and may result In the backup or surtace discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Sspa>te Servking Operator.prior to restorlnti
power to the effluent pump or contact a Pk,mber or P04YT5 Mattltalner to assist In manually operatlltg the pump controls co
restore normal levels wlthln the pump tank.
Do not drive or park vehicles over unks and dispersal cells. Do not delve or park over, or otherwise dlswre or compact, the area
wlthln 15 feet down slope of any mound or at-grade sot( absotptlon area.
Reduction or ellminatlon of the following from the wutewater stream n,ay kllprove the perfomtanCe and prolong the lik of the
POWTS: antlbiotla; baoy wipes; cigarette butts; condoms; coaon swaix; deCreasers; dental floss; diapers; dlslnfectants; fat:
foundation drain (sump pump) water; fTVlt and vegetable peetles¢s; gasotlne; Crease; herbiddes; meat seeps; medications; oil;
palnclnR croducts: aesticldes: sanitan naakins: tampons; and wAcer sofuner brine,
AgANDON6MENT
When the POWTS fails xndfar is permanently liken out of service the following sups stall be taken to insure that the system is
taroperly and safely abandoned In compliance with ch. Comm 83.33, Wlscorsrln Adminlstraclve Code:
• All plpln¢ to tanks and plu shall be disconnected and the abandoneQ pipe op~sntngs sealed.
• The contenu of ail tanks and pits shaft be removed and prc+perty disposed of by a Septage $ervking Operator.
P~fter purnpine, ail tanks and plu shall be excavated and removed or their covers removed an4 tfx void space tilled with
soil, gravel or another inert solid material.
C;~N7INGENCY PLAN
It trie POWTS fails and cannot be repatced the (ollowing measures have been, or muse be taken, W provl4e a code compliant
replacement system:
t7 A suitable replacement area has been evaluated and may be utll>zed for the locadon of a replacement soil absorpdon
system. The replacement area should be protkc'ted from dtswrbance and compaction and should not be InfNnged upon by
required sttbacks from extsting and proposed strt+cwr~, lot (tees and wells. Failure to protect the replacement area will
result fn the need for a r~ew soli and site evaluagon to esubllsh a sultabte replacement area. Replacement systems rnust
comply with the rules In effect at that dme.
O A suitable replacement area !s not available due to setback andlor son Umitataorts. earring advances in POWTS technology
a holdtrlg tank may tx Installed u a last resort w replan the faiieQ POW75.
The site has not been evaluated to identify a suitable repiacelnerit uea. Upon failure of the POV~TS a soil and site
valuation must be performe6 to locate a salable rcplace~leM 8rta. If no roplacsment area >s available a holding tank may
be Instilled as a last resort to replace the failed POWTS.
O Mound and at•grade so11 absorption systems may tx reconstructed In place following removal of the biomat at the
tnflltratlve surface. RecoruwcYloets of such rystems must.comply with the rules In effect at that dme.
K <WARNING> >
SEPTIC, PUMP AND OTKER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT
OXYGEN. p0 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES.
DEATH MAY RESULT, RESGUE Of A PERSON fROM TKE IN?ERIOR OF A TANK MAY 6E DIFFICULT OR
IMPl1CtIRl i.
ADO1T10NAL COMMENTS
POWTS INSTALLER
Name ~'vE `r' ~
Phone ~c5 -(
SEPTAGE SERVICING OPERATOR (PUMPER
Name
Phn~•
POWTS MAINTAINER
-Name
Phone
tACAI Rfr4~l[I.ATORY AUTHORITY
Aii'QMY t Dl bJNY I.SC. - t
b-
&T ~ROIX ~t3tT~TE4l'I'7r'~
S~'"Y I~ °TANK MAIAITBNAIriC~ .A~REEMEN'I
ANf~
a WNERSI-iiP CERTfIi ICATIOh~ FARM
Ciwr-arfBuyer ~ ~ n C °V !1 ~s 2 k /•~
h~laitit~~; Addrt;ss ~ ~ ~ `~ 31 y ~ `' S ~
~'roperty Address -S ~ ~"'~ ~-
{t,~erification repaired from Platmittg Department for ue~ constructionl
! c~ ~, ~ b! C~ lG - !G 2 0 - ~'~~ D~ u
~: itgilState ~ Yr C~ L U Y _ - i'ascel Idezitificatian I~tumber
I.~~AY.. Y3ESCkZIP1'IOF~
1 y ! 3 ~ N-R 1 S~~t TQwia e~f ~-/~ ~. ~,.- :~~ ~
~'roperty Location s G- `fa, ~ ~ %,, dec. ,
~ubdivisiort
Lot #
'°~ U ~ s~~ V
l
~ Page t# ~ ~`~
,
eed Survc~ NlEap ~
ume _
o
_.___..~
f
U !
~ S
V
l Page #f ~ L
,
~
q~p gy ~ S
a`T ~~$~.~r F~'Q'L'~ ~ 1 ~
_
utne
ca .
~ia~ house ~ yes ~ no
Lot lines identifiable (~ yes Cl nta~
SySTEI1'~.1VIAl1'~`I~EXoI Ali C
Improper use and maantcuance of yat~r septic system could resujt in its p~ e ~ z~atuse : aiiu~e io hantiic wastes. Proper maintea~ciee
corasistS of pumping out the septic tans; every three years or sooner, if aeesicdi3y a iicestseti p~~per. ZE hat you put into the systctn
qua aff'cct the fautction of the septic iso1: as a treatment stage in the v~taste dispasa} s~~stem.
The pzogerty aw'ner agrees to submit to St, Croix Zonutg Dapartnicut a cc~cation form, sued by the owner aid by a
mastorptuanber, j~cytnanplumber, restrictcdplumber or a licensed pumper verii;ring that {=3 fhe on-site vvastewaterdisposal system
is iu proper operating cox~dttton andlnr (?~ after tnsgcetton aid putatp:ng {if necesss-y?, the septic tank. iS less tit2.n 113 full of sludge.
flee attadersigzted have read ttte sbo~ c atcpairemauts snd agree to uzaintain ~c private sc~~age disposal system with the standards
~we° artzztcnt of CatDmcrce: and tito Department of hratural Resources, State of Wisconsin. Certification
set Eerily izercin, as set by iha Dep
Mating fleet your s::ptic s}~stcm, bas been maintained must be campicted and rettuned to tllc St. Croie County Zvniug Office within
ys of tl T Q;t.FifatiOD
`(~ f ° /
/~ `
5I ATIJKE {.1F APPLICANT
~'taYI~tER CLRTIFIC.~'~1[C)N
rtify that all staienaenty or. this for.. dew ~c ra a ttt Begirt •r cf Deeds {,}T~d~c. l {~a••:} ar? (are} the o~vneT(sl c
" c pro rtY dcsc dab ve, by virtue of a vJarranty ~/ , ~ i ~/
DATE I
SIf's 'T€IItE QF ApPLICAN'f
«««~«a
««~««« ~y iDfotmatian that is taus-rcpresenicd may Lesult isi tits saaitart' c~ernit being revctk4d by the ?.oning Department.
*'~ Incittde mFitla this application: ~ c p~f tlac cert~£ed survey map fezc esc~ Ezs mmde lac tEle •vsc:aniy d-ed
+.
it
.i
'DOCUMENT NO
. `'~ ' ifs' ".i "<" .~ ~ s s,!`.`'f~_
I '
II WARRANTY DEED 'I
~ STATE BAR OF WISCONSIN FOR1[ S-19e~~~
Yoe 102-.t.~n~
_-,
__ 5(33158
l~laxx.~a.-~ .airx~.~.inch.l9~shle~n,..~ouab~nd-and.~rife,......
and .Craig--Ashleacn. and-Mar~r . nat,tp~,.,,---~-~,dfe,.-
conveys and warrants to .-~iY713..N.--BOStka..iti]d.~Ilthid.M. ..............
Kostka, -.hvsband.and .wife-as.. survivcrship.marital_ pra- ---..
.Pert~r. ...............................•--.......-•-----........................----.......----•---......-..
the following described real estate in .................aS-~s.. ~'~?4 .............County,
State of Wisconsin:
Part of Southeast one quarter (SE 1/4) of Northeast
one quarter (NE 1/4) of Section 10-30-15, described
as Iot 2 of certified Survey Map filed JLII>,e 16, 1977,
in Volume "2", page 385.
Zhis deed is signed by the grantors in satisfaction
oaf the terms of the contract by and between the sane
parties as herein, said contract recorded with the
office of the Register of Deeds, St. Croix Qotanty,
Wisconsin, on 6-27-89, in 844-323, #449162.
TNI! lIAC[ R[![RV[D /OR R[CORDINO DATA I!
(I
REGISI~-ER`S OFFICE
ST. CR~IX CO., WI
Recd for Recoro
'AUG ~ 1993
~~ - -8:30Q- _ nn. M
~ dOMdi
R[TVRN
ATTORNEY
Taz Parcel No :..............................
~risF as o
,~
This -----~.--..-...°-_°---- homestead property.
(is) (is not)
Ezception to warranties:
Dated this ----------------••-•-•-•---..~..~-••-----... day of .------------------ ------..Jlrily......--------------------------. aa.~-3.-.
~„LI,IC._.j !-F~~C-C~a~~'~---- (SEAL)
IAiIlG~i1..~----•-------°--•-----------•--•--•--
AIIlHiiNTICATIOM
Sisnatare(s) Q~_~IODt7iR.~l.sf~._T.~I1i~._----.
Ashllesan and Craiq A81'11eBOCa & Mazy
- - ---/--~~-----]~~j`
anthantiealsd/l16e _1__l.dar ei_______~111v' -- _ ro 93
•~.~Cti~gea ...........................................
TITLE: Y BER STATE BAB OF WISCONSIN
agthorlsed b±; 90t.OQ, Wis. Stats.)
•G~TN/I±a INVfT~ItaU JMENT WAe DRAFTlD tY
JIRM~Ni._~iw__/V7fiRJww+ a-~ -~AJ/]/~,J/i.~
(Sl~natnres may be aathenticated or acknowledged. Both
are not neesasaty.)
-------..-.~~.-~ ... ..-.. .......(SEAL)
• ..sQ[3 . ...................•--------•--...
------•- ---- -~-•--• - - ---- -•-----(SEAL?
• Max'X..~.... -•-•----•-----' ...................
ACENOWLSD0i1[BN?
STATE OF WISCONSIN
s~
---------------°--•-------•-----.....Conaty.
Personally cants before its this ................day of
».--°----------°------------------•----~ I>i..------ the abon named
Eo me (mown to be the person ..------.._. who ezeeuted the
foregoins instrament and acknowledge the same.
e ...................................................................~'.-'--..
No4ry Pnblk ..........................................Conn Wis.
Yy Commission is permanent. (If not, state ezpirstioa
date :.............................................. .....•.... 1i1.........)
•
~ ..~~'
r • `
340858
CERTIFIED SURVE ~' MAP N0. Voltaic 2 PzEe 385
Located i n the SE 4 of the NE 4 and the NE; of the SE 4,
'o - 1 n od oun of
Sects n 10, ~30~J, R15W, Town of G e wo C ty
St ("rnix~, Stata of Wiscnnsin '
SCALE I" =200'
200 , 0 50 100 150200 300 400
.;c~%~uet~cd
:
P
,. UNPLATTED LANDS
.................. 66'
.
y`` ~
,
~~~,~`
c o n~
~
~
~ ....
53'
13
"
' ~ I
.•.."."'•••.
~< ~
r•
~
+ O
•• .
W 5
40
S 88° 32
'~' t
•~1. ~O
:'' JOHN F. r 9 F4 80.63'
'~
\ , .~ o.
,,ti"
o
oW
d : KLOVrdING s ~
U
~ •
a?oy ~' ~
~
~ ~
0 ~ ~ I W ;
Z •
.
u
ta~~ s•)n$5
,•
'
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a
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a~ L ME)J0T
rw ti
.
w1s
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3
p :
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e' !I ••• •
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4+
;~ EXISTING ~ #~"x'~x~y
n BUIl01NGS
~•
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i W=
~ y
. <
..•~~ .•/~/
6~ a.
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t~`0 ~~'` ~E Y'• `. ~ n
Q~'~
l a LOT 2 ~~ ` h IQ ~ a
z
e
..
C . d
~easoecce~
248 762. S0. FT.
~ ' 5.71 ACRES ~
o
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•
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8
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tP Q.
qM~ Xs 19 , ~
~
.
~~
- ~
-66~yc. .
00
"~-
>L i O 1 t/4" x 30" ROUND IRON ROD
J
77
J•
~ ~
O,C _
,
~ ~ ~
'- Z:
I F
17 lBS/l
WEIGHING 4
R~BI~~
ONKE(I ~~ .
_.
.
Wbeonrtin tY, F-. I ~
8 ~, 9 I-:
a r i ~ t
Z,
°
: 3 ~ LOT I ~ ~ I
~;
~ 1 Z. 0 418,094. 50. FT
~ ~ 9.60 ACRES '
N ~
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~.
`
rte. ~~
b r
h F
o
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.
~~ I I SECTIONIOERT30N,
~.
1 (•I ~
IBO°3310
I
~ R
15W
.,
~' ~'- R
I
L` `1 1
~-
~' ~~
~
~
~j. ~ ~I~ °'
IN °
ZI
~I ~I
O
(~' aaa
~~~~
°jry\ o(~ (UNDER CONSTRUCTION) goo I
°
°
z
j °p ~--EXISTING
'22.20 ~o BUILDING ,
S 2qo 432.87 00,
00°
~
92 jO.,E - o ~
-N 89 26' SO~~ E 465.87=33.00'
UNPLATTED LANDS ~~
I, John F. Klovning, registered land surveyor, hereby certify:
That I have surveyed, divided and mapped a part of the SE':; of the+fJE4, and the NE'4 of the
R15W, Town of Glenwood, County of
T30N
Section 10
SEa St. Croix, State of Wisconsin, more
,
,
,
particularly described a s follows:
Commencing at the E'4 Corner of Section 10, T3ON, R15W~, the point of beginning; thence North
880.80 feet along .the Ea st Line a'f%the NEa of Section 10;
Thence S 88° 32' 40" W 513.53 feet; '
Thence S 05° 56' 00" W 1124.60 feet;
Thence S 74° 42' 10" E 172.70 feet;
Thence N 89° 26' 50" E 465.87 feet: