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HomeMy WebLinkAbout016-1020-95-040~ o a~°i ° I ~' ~ °~ I h ~ O o a' ~ I ~ "' ~ ~ ~ Q! O I p 0 ~ ~ oa°c'~o I - r ~ U ~ •- - N a~ a~ a m I a _ _ coo~ v > I , ° a , ~ c ai ,d'~ a m c I C o ~ d c2o E~ ~ ~ o„ I O GL oa>'~o~Eai I ~ ~ C ~ N 7 7 ' L ~ G. C ' L o E ~ m ~= a o ° ~ o ~ y I '° ~ Z 3 ~ ° '"' v I c mc~m~da~ LL O C f0 U° yZ N 3 c :o =o ct c 3 o I , ~~ U ~ I M Q m~ S '° U I \ ~ Z ~ ~ N j ~ Q' ~ _ O "' ° ~ ~ I .~- Z o~ Z a m I I •y c ° O Z a a ~ F- .`- ~ aci ~ O E ~ •~ M a, ~ I o y ~ I c ~ I C O ~ ~ m ~ I i+ Z I O EI C ~ ~ ~ N 01 d M y ~ ` C d !~ w N J C ~'co ` a '~ I Q O zM> a (rn N fr/1 ~ . ~ > >. a~ w hh~~ ,3~~0 z `~J v Uaaa ~, a • :: I ~ V1 J U d N N } ~ v ~ ~ N O O ~ 0 N 1 Q ,,.. ' E ~~ r ~ q m ~ a I ~~ _~ d rn ¢zin °: ~o N .w ~ O\ V M N C ~ U ~ CO O ~ ( ~ O .w .~ v d °o I V O ~ iri ~ ~ c a~ E o f c v N c °~ ~ I p ~ 0 3 Ov yTiw °'v'o l FBI M C -~ Y O C C N L ~ ~ ~~ 2 a 0 Z C M g' fn O ~ I V r.+ a ~ ~ = E ~ °' ~ I r`1~i r + + w 'c c m A ciao oaici Wisconsin 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, 5.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Hall, Dennis Glenwood Townshi CST BM Elev: Insp. BM Elev: BM Description: ` ` / v e.. ~ c:. ~ j r 1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding J TANK SETBACK INFORMATION .~- ~ TANK TO P/L WELL BLDG. Gam, Vent to Air Intake ROAD Septic / ~.; 07- Dosing ~ , , .h: ©'~Q Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ` I~ / Model Number TDH Lift Friction Loss S~ ~.~~ ~• ZZ-.-. Forcemain Length S Dia. 5~ Z.o SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ Lengif-i DIMENSIONS ~ li1 INFORMATION Type Of System: ,~"(.Ol,~.~-L DISTRIBUTION SYSTEM Demand c~ t O.t"~ GPM ~ j~ . Dist. to Well ;v r,> y- ^. / No. Of Trenches , P/L BLDG WELL ~ Z p' ~~ ELEVATION DATA STATION BS HI FS ELEV. Benchmark 3. v3. Alt. BM Bldg. Sewer ~ ~^ ~~ ~ ~ D~ SUHt Inlet / , / SUHt Outlet .---- ~ Dt Inlet - ~----, Dt Bottom oI Header/Man. y.38 q~_2~. Dist. Pipe i E, V • 3 ~.3$ 9° ~ ~t4_2$ Bot. System n/ j ~ _ C~Co ~j•G~~ 8. cfo ~B. Cc f Final Grad ~- ~ ,~s~ ~ loo ~ S St Cover / ~ / Z ~/ PIT DIMENSIONS INo. Of Pits I Inside Dia_ (Liquid Depth LAKE/STREAM LEACHING Manufacturer: CHAMBER OR UNIT Model Number: Header/Manifold ~ ' Distribution x Hole ~ize x Hole Spacing Vent to Air Intake Length 3 Dia ~ Pipe(s) r ~~ Length ~~•~ Dia ~• ~ Spacing p 8 ) p a ~. G(~' ~~ SOIL COVER x Pressure Systems Oniv xx Mound Or At-Grade Svstems Oniv Depth Over ~ Depth Over , xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ Bed/Trench Edges ), ~ Topsoil ~ ~ Yes r~ No j J Yes ~ No ~` ` COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:1~/~/~c:~ _ Inspection #2:/~ / ~ 7 l~,,V~3f~ Location: 1633 St. Hwy 128 Glenwood City, WI 54013 (NE 1/4 SW 1/4 10 T30N R15W) NA Lot 3 0~-J Parcel No: 10.30.15. /~lW """ 1.) Alt BM Description = ~ CcSVI~ 2.) Bldg sewer length = ~$" t -amount of cover = ~3b'' ~~ F~uvu~a~'~ ~+~kd -~~ ,nas n~ d - ` h~ l~r~~S r~ ~,, v-kd/ Plan revision Required? ~ Yes [] No /~ A7 w ~` ~/"`/ ~ Use other side for additional information. I Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) county: St. Croix Sanitary Permit No: 430445 0 State Plan ID No: Parcel Ta No: OJ~v ~/oZv-`~5`'O ~O Section/Town/Range/Map No: 10.30.15 ~ Safety and Buildings Division County ~ ~ ST ~ O ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 , qG SCOOSIO Madison, WI 53707 - 7162 Sanitary Permit Ntunber (to be fdled in by Co J Department of Commerce (~8) 266-3151 ~6 7 7 Sanitary Permit Application State Plan I.D. Number ~ Z In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privac Law, C n Project Address (if different than mailing address) C iJ . I. Application Information -Please Print All Informa n ~~ 33 ~T ~~~ 1~ Property Owner's Na me ~ Parce # Lo # ~ B ~ / S ~'~ ST. CROIX COUNTY f C'' /C --1C "_' ~ 3C` " ")/ Property Owner' s M ailing Address OFFICE erty Location P r op ~I 1, / ~ `~ ~~ e't/~ / ~" ~f ~ / rvL 'k J ~ S4 Section City, State ~~~~ ~ ~ Zip Code Phone Nttmber , , ____~ circle ~,~ ~ ~ .~ ~%/~ T ~ ~ N R~E ~ II. Type of Building (check all that a ply) o ; ~1 or 2 Family Dwelling -Number of Bedrooms ~ Subdivi si on Name ~ CSM Number ^ Public/Commercial -Describe Use ~- / . ~ ~ / ?~ y f ~ 7~d J.J ~ ~, ^ State Owned -Describe Use 'S - _ / ^City ^ ]lage ~'ownship of / - 0 LY~MtO C~ CL~~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) `~' New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Ty of POWTS System: (Check all that ap ly) ^ 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 ^ Peat Filter ^ Aerobi c Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Applicatio Rate( s Dispersal Area aired (sf) Dispersal Area P oposed (sf) System Etevatio VI. Tank~Info apacity in Total Number M a cturer an uf Prefab Site Steel Fiber Plastic Gallons Gallons of Units ~ ~ ~ / J w Z? ~~ Concrete Constructed Glass New Existing ~± ~~C Tanks Tanks /'Y~ Septic or 1-~lai~ Dcl~ ~-- ~s cs~- Aerobic Treatment Unit ~~ C..~ ~ ~Z Dosing Chamber ~_ VII. Responsibility Statement- I, the"undersigned, assume responsibility for ' allation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature /MPRS Number Business Phone Number ~- ~ ~ .,~ ~ ~. ~ ~.- - 3~ S~av Plum is Addre ss (Street, ity, State, Cod VIII ount /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fe (includes Gro~~ ater Surcharge Fee) ,~ ~~ Date ssu ~ (~ I ing Agent i tore ps) ^ Owner Given Reason for Denial r'~~ IX. Conditions of Approval/Reasons for Disapproval 3 ~~LZ~j.t~G/ !?ti -cs ~~=~iC~~~ SYSTEM OWNER: 1 Septic tank, effluent filter and ~,~-yy,»,c ~3.~Z ~ q/2S/~33) d~4.~ r at' ~~~v U%k~i 7~ ~~~~~~' dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code) rdinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) ~ ~ '~ m ~_ ~ ~ ~ ~ n ~~ ~~ ~~ ` ~~ ~ e~ I ._~ o ~, °. 0 r P m L _9~ -_....~ ~~ ~. / ~ ~o c, a '~ ~i .~ ~ y o~ N ~ 4~ ~ fi n ~ ~ L ~ O `' ~ ~ 1~ ~ ~- N ~ ~ n cn ~ ~ ~ ~ w 0 ~ z w o~+ ~~ v 0 0 -~t :! I m A ~ ~ ~scons~n Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www.commeroe.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary September 25, 2003 CUST ID No.224617 LYLE J MYERS NORTHLAND PLUMBING INC E1556 STATE ROAD 64 BOYCEVILLE WI 54725 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/25/2005 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Dennis Hall State Hwy 128 Town of Glenwood St Croix County NE1/4, SW1/4, S10, T30N, R15W FOR: Object Type: POWT System Regulated Object ID No.: 922432 MOUND /DWELLING 450 GPD Transaction ID No. 921362 Site ID No. 665623 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 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. ~P. ~~/i~ A copy of the approved plans, specifications and this letter shall be on-site during construction and open to ,,,~, ~,,?, inspection by authorized representatives of the Department, which may include local inspectors. All permits ~ ~ •'~ ` required by the state or the local municipality shall be obtained prior to commencement of ~ " ~`~ GEP RT ; construction/installation/operation. D!V!s n 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 stars 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, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Robert Kanter POWTS Plan Reviewer ,Integrated Services WiSMART code: 7(133 (608)261-7735 ,Monday-friday 8:OOAM - 4:45PM rkanter@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Mound System Cover Page ~ ~ ~ 6 CD~lETE IE~E~ Project Name: Hall Mound Owner's Name Dennis Hall Owners Address 270 Magnolia Dr. Glenwood City, WI 54013 Legal Description Ne ~ %4, sw ~ %< Sec 10 T 30 N, R 15 w ~ Township Glenwood COUnty Saint Croix Subdivision N/A RECEIV ~` r"~ Lot# N/A ~ ~'~ ~ 5 ~ $AF Parcel ID# Pending ET~ ~, 8~~G5 , Table of Contents Pg• 1 Cover page ~ ° ~° ,-, . ~.~~. 2 Mound Sizing Calculations V° ., ~. p,. r p, 3 Pressure Distribution Layout and Dynamics ` ' ` ` ` ~.~' 4 Dose Tank ...> '' ~ ;`,,; ~" 5 Management and Contingency Plan `.- .~' 6 Plot Map - - ..~..,,' .,cE y, ~ ~su~ ~ ~~c ~ ~~ `; i~ t= i~J%E total # of pages: 6 Designer Name: Lyle J. Myers MP/License #: I.D.# 224617 Date: 9110103 Ph. #: 7156432520 Signature: Mound System Design Methods Used per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" Nersion 2.0)SBD-10691-P (N.01/01) per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" Nersion 2.0) SBD-10706•P (N 01/01) N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: • Mound System Mound Sizing Calculations Project Name: Halt Mound Site Conditions Project Type: 1 or 2 Family Dwelling Slope: 7 # of Bedrooms: 3 Depth to limiting factor: 24 in. Absorbtion rate of fill material: 1 gal/ft2/day Absorbtion rate of in-situ soil: 0.4 gal/ft2/day Effluent quality Eff#1 ~ Max BOD effluent value: 220 mg/I Max TSS effluent value: 150 mg/I Mound Plan mew /Qbserration Pipes .,~' Z-~~ ,~ Kam. ~,/~" .~ E?tE;tt~~ ~ A B k-K I Tilled AreatFill Material Design of Entire Fill Cell depth at upslope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H}: End slope width (K): Fill length (L): Upslope width (J): Downslope width (Toe) (I): Fill Width (W): L Mound Cross Section Final Grade Synthetic Fabric Distribution Cell System Elevation ~, ,4,d, __ _ ~ b Cover Ma#erial ~ ~~ Fill Material trnrert `~ ~~~~Slope bselvation Pipe ~---~ r G a ff ~`e° F y ~; Tilled Area Forcemain System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Pow z of s 12'0 Irk' 16.2 in. 10 in. 6 in. 12 in. 9.1 ft. 108.2 ft. 5.8 ft. 10.2 ft. 21.0 ft. Design of the Distribution Cell Basal Area System Design Flow: 450,0 gal/day Basa! area required: 1125 ft2 Distribution cell width (A): 5.00 ft Basal area available: 1368 ft2 Distribution cell length (B}: 90.0 ft '- Area of Distribution Cell: 450.0 ft2 Observation Pipes Contour Elevation of Mound: 98.00 ft Location from end of cell (Z): 15 ft System Elevation of Mound: 99.00 ft~ Final Grade of Mound: 100.83 ft Mound System ~9e s or s Pressure Distribution Calculations Project Name: Hall Mound Lateral Layout Lateral elevation: 99.5 ft Rows of Laterals: z ~ Manifold type: center • Orifice diameter: o.1z5 ~ In. # of Laterals: 4 Distal Pressure: 5 ft Lateral Length: 44,5 ft Lateral/Manifold Design Lateral diameter: 2 ~ In. Lateral spacing (S): 3 ft Lateral to cell edge: 1 ft Lateral discharge rate: 7.83 gpm System discharge rate: 31.31 gpm Manifold diameter: 2 ~ In. Manifold length: 3 ft Orifice Spacing/Distribution Orifice spacing (X): 28,86 Inches Orifices per lateral: 1 g Avg. ft2lOrifice: 5.92 ft2 Fort;,emain Friction Loss Forcemain length: 150 ft Forcemain diameter: 2 ~ In. Friction loss in forcemain: 3.146 ft Lateral Side View Lateral Length or plug Lateral Plan View -- Lateral Length -- Orifices on bottom of lakeral equally spaced Turn-up wlball valve or cleanout plug P'VC laterals and forcemain to comply w~h specifications per Comm $~.30(2)(e) Forcemain connection via tee of crass to manifold at any point Clean Out Detail Glean-out plug Grade r or ball valve Observation Pipes Sprinkler Box Long Sweep 90 or iwo 45's-` 6" Minimu~ cap Note: Cbset Collar may be used in place d 3!8" bar `~-3JBu Bar 2 Mound System Septic, Pump and Dose Tank Project: Halt Mound Tank Information Pump tank manufacturer. Wieser Concrete Pump tank size/model: wiooo/6so-MR Pump tank gal/inch: 17 Actual Pump Tank Volume: 646 gal Tank bottom elevation (inside): 86 ft Septic tank size/model: wsooo/6so-MR • Pump and Filter Pump Manufacturer: Little Giant ~ Pump Model: 9EH Effluent Filter: Zabel A100 Note: Access opening of sufficient size to be provided to allow removal of fitter. Opening to terminate at or above grade. Pump Tank Diagram Watertight Locking Cover 4 Inch With Warning Label Fini: Minimum ,T,..__ Aftemate~ Outlet I ~ L~ Location Eled. per Comm 16.28 and ~ NEC 300 ~ Weep Hale '~ or Anti- Siphon Device C D ~.s W E 5 ~ Pump must be capable of: and head pressure of: 31.3 GPM 22.5 Feet A Q W a.s 0 Page 4 of 6 Dosage Volume Forcemain drains back to tank? Qi Yes O No Lateral void volume: 31.0 gal Dosage to absorbtion Cell: 90.0 gal Forcemain volume: 26.1 gal Total dosage: 116.1 gal Total Dynamic Head Are laterals highest point? y if not, enter highest elevation: 0 ft System head (distal x 1.3) 6.50 ft Vertical Lift ("D" to lateral) 12.83 ft Friction loss in forcemain: 3.15 ft Pressure loss from filter: p Total dynamic head (TDH): 22.48 ft Dose Tank Levels In. Gal A Reserve 21.2 359.9 B Pump off to Alarm 2.0 34.0 C Total Dosage 6.8 116.1 D Effluent depth for pump 8.0 136.0 Total Capacity: 38.0 646.0 FLOV- LITERS/HOUR 9EH PUMP PERFORMANCE CURVE 115V 60HZ Mound System Management Plan pursuant to Comm 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routiney and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 113 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed ouUtested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Pertormance Monitoring; Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein {including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. ti 0 ` ~ 1f~ ~ r r°n ~ 3 ~ ~ a ` n v ,,~ ,t e -- ~. v~ ~ ~ 3 w W ~ ~ ~ ~ 7 ~ ~ ,~ 3 ~ ~ ~ y Z ~ ~3 w ~ t1. ~, u ~ '~ 1T~ 1i~. y _.. l~- M "~' ~ ~~ M ~ ~ Sao ~~ ~' sic ~ 1- ~~ .._ '~- ~ ~ ~ ~ a i ~ • ,~ -_ . a ~ po ~ __ ~ .. ° y __.. ~ ~ ~- ~ _ _. _. ,~ a y r y P .. ~ „ _ is 4 i ~ i f `t~ 1L I r ~~ i ~,~~ ~ ~ w 5.~p,~(G ~ ,~ ~c ~. w~scor,ain Department of commerce SOIL EVALUATION REPORT page ~ of~ Division of Satiety and Buildings m accoroance wnn wmm oa, ms. Ham. ~.ooe Plan must er not less than 8112 x 11 inches in size !tech com lete site lan on a County ~ A~O ~, Ci . ..: p p p p &iclude, but not limited to: vertical and horizontal reference sMy; direetiorr°~d percent slope, scale or dimensions, north arrou~arid Tpaadotr°arW dk9tanoelto nearest road. parcel I.D. d QO ©~~'"' ~~~~"' `d '~ Please print all information. Revi by Date Personal kMorm.tia, you proves m.y ~ „sae for y v!ao~ ~,e~r ~+«: ar. t s.oa (+) (mn- ~ ~ /4 /S 6 Property Owner ~ Prope Local /~/ Govt ~ 1/4 , j ~ 1/4 S ~Q T ,~d N R ~.~ iIR) W Property Owners Mailing Address ~ ~~ .~ .., . ~.... ~ Block # Subd. Name or CS ?~ v2 ~_ I ~ - - ~` ~ ~a ~ - ~ ~~ d UJtB S e Tp Code Phone Number ^ City ^ Vi{{ageTown Nearest Road (~( New Construction Use: QI Residential / Number of bedrooms ~ Code derived design flaw rate ~~~ GPD ^ Replacement ^ Public o), commercial - Desaibe: ___ _ ___. Parent material ~'.~ /iZ ~ / ~ ~ ~% ~~ Flood Plain elevation if applicable ~ /~ ft. General oommef~s and recorrurtendations: Boring # ~ Boring ~~~~ pit Ground srufaoe elev. _L_.-'~ ~ Depth to lind6ng factor Z ~ ~• Soil icabon Retie Morison Deptl~ Dominant Redox Description Texture Structure Consistence Boundary Roots G in. MunseN Qu. Sz Cont. Color Gr. Sz. Sh. •EA#1 •Etf#2 o ~ o `.- S L MS6~' ~~ ~ S ~ ~ / 2r ~i ~ L~ /g ~ -.~• ~ t 1 ~ / 1 BorinO ~ a ~~ Aa _ n .~ ~`"' I Ill Pit Ground surface elev. / it v,~ 8. Depth to luni6ng factor ~` ~_ ar. ~ x;ation Rate Horizon Depth Dominant Redox Description Texture Stnxxure Consistence Boundary Roots GP DIfF in. Mansell Qu. Sz. Cont. Color Sh. Gr. Sz. #1 'E1f •Eff#2 / t y~ (~` ~ ^ .~ • Effluent #1 = BOD_ > 30 < 220 moll. and TSS >30 < 1 50 moll 'Effluent #2 = BOD, < 30 rrglL and TSS < 30 mglL CST Name (Please Print) ~ Sig CST Number C~ Goa . ~ ~- ~ ~,~~~ ^ ~ ~ ~. ~ .~ A Date Evaluation Conducted Telephone Number ~12~ qtr /7c~ ~~~ - '~aod ~ r~ ~jiA ~- ~~ d3 7/.s-~~ ~.~d~ ~syoi;~ A /- .- ~~® rrMerty Owner tcN NG f~l /~'~/~~S ~arcal ID * ~~~ -~/ ~ ~~ gage Z _ a.~_ , a Pit Ground surface elev. ~~ ft. Depth to limiting factor ~~ in. ~~~ ° ~~ Sop Rate Horizon Depth Dominant Redox Description Texture Stnrchxe Consisterroe Boundary Roots GP DA'F in. Munsep Qu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 •Eff#2 ~~~- r 3 .~ ~ M R ~ s r A v V ~ ' d ~ ~j ` ~ M ~ a ~ -..-- ,~ r ~ Ong # ^ Bonng ^ Pit Ground surface elev. ft. Depth to IimiGng factor in. Sal ication Rate Horizon Depth Dominant Redox Description Texture Stnxxure Consistence Boundary Roots GP Dflf in. MurueU flu. Sz Cont Color Gr. Sz Sh. `Eff#1 •Etf#2 o~~~ ^ ~~ ^ Pit Ground srsfaoe elev. ft. Depth to tirrrtirrg factor h. Sop Rate Horizon Depth Dominant Redox Description. Texture Strrxxure Consistence Boundary Roots GP DIfF in. Munsep Qu. Sz Cont. Color Gr. Sz Sh. •Eif#1 'Eft#2 • Effluent fF1 =BODE > 30 _< 220 mglL and TSS >30 < 150 mglL ` Eftkier>t At2 = BODs < 30 mglL 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. sewswcR.6root ~ ~ - -- ~! - -~ ---- ` - -- _- 1 .--- -~ __ __ ___ A e ' f ~ ~ a d ~ - _. - ~ ~ I - --- -- I - I - ~- ---; ~ - ~ - -- - d. - ~ ~ __ _ ~ J -- - - - _ _ - ~ - ' - - - -- - - -- - - , - --, I -- -- --- -- - __- -- - - - --- ~ -- - - ~ -- _ -- - - --- -- -- - - ~ -_ _ -- _- - 1 --- ~, 7`. - I - ~ a - - -- - ~ - l j - -- - _ _- - -- - --- --- -- -- - - --- - - --- --- -- -_ ------~~ ~I - - _ - - = - - -._- - --- -- ~ - - -- -- - __ ____ --. -- i ! - ! 1 -- -- _ i ~- ~- i ~ -- --- -- -- - - - -- -- - -- t -- - - - - - ~ -- -- - - ~ ~ ~ ~ 7 ~ __ - - . ~ ~ ; -- ___ _ _ .- - ~ ; ~- -- _ - - I -- -, - --- ~- ~ -- --- - -- -- - - - ~ __ ~ J ' ~ %. o - -, ~ - -- - - - i I -- --- R' -- ~ -, --- --- a -- -- ~ - --- - - ---- - - --- - - -- __ _ - I _ ~ p - - - - ; ---~ -- - - - -- -~1 - -j I -- - - - -- -- - - _. - --- - - --. I -~ ---__ -- --' -- - -- j - - --- ' -- ~ --~ ____ --- ~ -~ - - f ~ - - - I y ~ ~ ~ - - - - - -- -- --~ _- - -- - - I - - - -- - ~ i ~ -. ~ I owner/Buycr ST CROIX COUN7C'~' SEPTIC TANK MAINTENANCI? AGREEMENT .AND OWNERS CERTir'ICATT0IJ FORM Mailing Address ~ ~~ ~' / /~G ~ d L•~ ~~iL G ~ 3 .~ ~ ~, Property Address ~ .~ ~ J -1:• (Verification required from fanning Department for now construction) Ci /State ~ ~--'`-~~`~ ~ ~ Parcel Identification Number c.J ~G _ ~~~3 ~~ .~ ~~v) ~ ~~~ T T('~AL DESCRIPTION ~ !~ _p O ' /~ Pro Location /~'C 1/a, ~ ~~ '/<, Sec. ~ T--~ N-R 1 ~ W, Town of ~-~ C ~-~tj ~~b p~h' Subdivision Lot # ~ . Cert~lfied Survey Map # ~ ~ ' J~~ e~ .Volume .,w..~.._+ Page # ~~ c' ~'' . ~ ~, Warranty Deed # , r, ~~ ~ -7 / .Volume _,.;,.2 ~ ? ~t Page # / ~ 5 Spec house ^ yes ~ no Lot Unes identifiable ~7' yes ®no gym ,~iNTENANCE I~mper use and maintenanceaf 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 disi~osal system. The property awaer agrees to submit to St. Croix Zoning Depaztrntnt a certification form, signed by the owner and by a masterplumber, journeymanplumbet, aestrictedplumber or a kconsedpumger varigyingthat (I) the on site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping {if necessary), the septic tank is less than 1/3 Rill of sludge. ~, 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 Ikpartment of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and. returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SI~C3NA`-'`-TUBE OF AP ICANT DATE BWNER RTIFICATION I (we) certif~+ that all statements on this form are tme to the best of my (our) knowledge. I (we) am (are) the owner(s) of the propcRy described above, by virtue of a warranty deed recorded is Register of Deeds Office. ~ bC. 10 /~ 1 ~~ SIGNATURE OF APPL ANT DATE . Any information that is mis-represented may result in the sanitary pcmzit being revoked by the Zoning Department. «~~*** **s*** ** Include with this application: a stamped warr+wty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM 2- 2000 Document Number _ WAI~xANTY DEED THIS DEED, made between Kenneth Maes and Mary Ann Maes, husband and wife, as Survivorship Marital Property, Grantor, and Dennis A. Hall and Jodi J. Hall, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Recording Area 74271 KATHLEEN H. MIALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 10/02!2003 03:50PM 1ARRANTY DEED EXEMPT ~ REC FEE: 13.08 TRANS FEE: 117.08 COPY FEE: CC FEE: PAGES: 2 Name and Return Address: Edina Realty Title, Inc. 400 S. 2"d St. -Suite 115 Exceptions to warranties: Hudson, W154016 Easements, restrictions and rights-of--way of record, if any. 412530 016-1021-30-000` ~4 CLr/I.e ,pw-c~Q Parcel Identification Number (PIN) This is not homestead property. Dated this 29th day of September, 2003. * Kenneth Maes AUTHENTICATION Signature(s) authenticated this 29th day ' """ Public # * State of Wiscor~s+rr TITLE: MEMBER STAT NSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Edina Realty Title -Doug Berg 400 South Second Street #115, Hudson, WI 54016 (Signatures may be authenticated or aclmowledged. Both are not necessary.) '`Names of persons signing in any capacity must be typed or printed below their signature ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this September 29, 2003 the above named Kenneth Maes and Mary Ann Maes, husband and wife, as Survivorship Marital Property to me latown to be the person(s) who executed the foregoing instalment and acknowle~yged the same. /~C ~~~L J *Diane M. Barron Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 11/19/2006 ) \~ WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 U 2y26P y96 EXHIBIT A Lot 3 of Certified Surve Ma filed Se tember 2, 2003 in~ Volume 17 of Certified Survey Map, Page 4600 as Document No. 738360, ocate m part of the NW '/, of the SW '/, and part of the NE '/, of the SW '/. an part o e , of the SW 'h of Section 10, T30N, R15W, Town of Glenwood, St. Croix County, Wisconsin. -~ 3g 3 6-~ Subject to an easement as shown on certified survey map filed September 2, 2003 in Volume 17, Page 4600, as Document No.~38360. CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1/4 OF THE SW1/4, PART OF THE NE1/4 OF THE SW7/4, PART OF THE SW1/4 OF THE NW1/4 AND PART OF THE SE1/4 OF THE NW1/4 OF SECTION 10, T30N, R15W, TOWN OF GLENWOOD, ST. CROIX COUNTY, WISCONSIN. o~ov N ~~" ~ ~ z ~ _ = z ~ ~ ~ z BEARINGS ARE REFERENCED TO THE ST. cn ~ ~ n ~ ~ ~ Z CROIX COUNTY COORDINATE SYSTEM ~: to z ~? m - ~ -~ o / `` S ~ A Z W - - O ~ ~ ~ • • - - ~ - g / ~" - . o ~ --~ ~° ~ ~ .~. Nf'. - .. ~. .~ ~~ ,--. ~ '•' t0 ' / p •- •- •~'- ~ o f ~ ~ • r '' --• ~ ~0 o . --. •~ o •..'. ~ -.- ~ ~/ /'' ' m cn O _ ~ . / ~ ~s~ o9ti~, Nr~°3~3g,F`\ ~ cn ~So ~ ,sr~r3g 26p.sa~Q ~, ~ ~ ~I m I~ ~Oi~~ ~ I ~ n I O> rn~~Sml~ N I r' I m I~~IpNp NI N ~ IN _ ~i 3 ~~ ~I ~ I I~ to I~ I Id 0 I~ I~ I I~ I¢ lO I~ I to Id b~ I i~ I^ In I~ I I 'O I~ I'll ..\ V ~89'bZ G ~` m W w iN gg ~6l'~G ,OS'90Z4 3.80~bEo00S ~ ~ z ~ n~~ C 0 0 0 Zp~ ~Z~ O Cmm ~zNo mvmc vii ~°C~ °~i°~ ppnO ~_m ~~ g N ~~m5 ~~~n0 O ~v~ic z O y ~m z~ z ~ ~ O o o ~ ~ .. ~cn T N ~mC Z ~~D ~~o -i o~`o - OON m m ~pz ~ O C r m~L~ p-I o '~ m v 0 m T O z z 50 Y' w ~ ~ m ~mc ~ ~~z rmi~ ~~, =W ~z~ ~~ v ~o~ ~ :i m~ z ~~~ O `: ~ ~ O ~ O m C Z o° ~ ..~ O n o ^i S00°34'10'E 261.63' MATCH LINE ~ ~ '~ SEE SHEET 2 P IQ ~ i~ I~ N i ^~ IOU iw i~ I~ ~I I~ ~ ,p l ~~ IQ I IP Id m ~~ N I~ I ~ I~ ~I 1° I ~ I~ I c CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1/4 OF THE SW7/4, PART OF THE NE7/4 OF THE 8W1/4, PART OF THE SW7/4 OF THE NW7/4 AND PART OF THE 8E1/4 OF THE NW1/4 OF 8ECTION 1 O, T30N, R1 dW, TOWN OF GLENWOOD, 8T. CRODC COUNTY, WISCON8IN. OWNER SURVEYOR KENNETH MASS EDWIN C FLANUM 1634 STATE FNVY'128' NORTHLAND SURVEYING, INC. 233.08 -HIGHWAY SETBACK UNE GIENWOOD CITY, WI 54013 856 A HWY "65' / P.O. BOX 14 No Nnprovernerrt Note ROBF_RTS, WI 54023 No Mryxarementa a stnrcttres are allowed between the right-of-v+ey Ikie and the hiptN+ay setback Nne. Improvert~errie and struchxes include, LxA are not Nmited to, alpna, perkkg areas, driveways, wells, septic systems, drekrepe faclNlies, brrtldkrga and retalninp walls, his expresey intended that this restrfctlon Is fa the beneNt of the public as provided in section 236.293, Wleconein Statutes. and shall be enforceable by the Department of Trarreportatlon a tts assigns. Carted the Wlaconsin Department of Transportation for more infametbn. The phone number may be obtained by carrtactlnp the County Highway Depsrtrnent. 233.05 -ACCESS RESTRICTION All iol8 and blocks are Hereby featriCted 80 that n0 ovrner, possessor, user, licensee, a other person may have any right of dkect vehicular Mgreas fran a sprees to any highway lying wtthM the right-ol-wey of S.T.H.128: N is e~ressy InterWed that tnls resMctlon conatiarte a restrictbn to the ttenefit of the pudic as provkfed M s.236.293, slate., and shah be enforceable try the department a tte assigns. Arty aa~sa shell be allowed only by special exceptbn. Arty access allowed by special exceptbn shell be axrNmred and premed aNy through the driveway pertnfttirp process and aN permits are revaxible. The departrnent of transpatatbn ftas prented a special exceptlon to Trans 233 fa the existing access, as shoMm on this map. Addilbnel land dMsia>s, change in use, a hdure Y proJecta may require a pubNc road intersection a rek~csaion of trre driveway to en atternathre pubic road at the discretion of the depeArnent 233.105 -NOISE NOTE: The bta of this land division may experience raise et levels mcceedinp levels in e. Trans 405.04, Table 1. These levels are based on federal starWerde. The department at tranepaetabn le not responside for abetlnp ralae from existing efate tnxrlc hipfrways a cannectinp hghways, in ttre absence of any increase by the depeAment to the twpl7ways through-lane capeoily. SURVEYOR'S CERTIFICATE I, Edwin C. Flamm, Registered Wisconsin land Surveyor, hereby certify that by the direction of Kenneth Maes, I have surveyed, mapped and described the parcel of land which Is represented by this Certified Survey Map; that the exterior boundary of the parcel of land surveyed and mapped is described as follows: A parcel of land located in part of the NW1/4 of the SW1/4, part of the NE1/4 of the SW1/4, part of the SW1/4 of the NWt/4 and part of the SE1/4 of the NWi/4 of Section 10, T30N, R15W, Town of Glenwood, St. Croix County, Wisconsin; described as follows: Commencing at the N1/4 Comer of said Section 10; thence S00°34'08"E, akXTg the north -south 1/4 line of said section, 2271.48 feet to the south line of Lot 2 of Certified Survey Map recorded in Volume 17, Page 4499 at the St. Croix County Register of Deeds Office, being the point of beginning; thence S89°59'46"W, along said south line, 912.28 feet to the west line of said Lot 2; thence N00°00'51 "W, along said west line, 490.57 feet to the south line of Lot 1 of Certified Survey Map recorded in Volume 12, Page 3502 at said office; thence S89°59'09'W, abng said south line, 540.36 feet; thence S75°47'40"W, along said south line, 291.84 feet to the east line of State Trunk Highway'128"; thence S07°29'21'E, abng said east line, 645.77 feet to the point of curvature of a 1854.86 foot radius curve, concave easterly, whose central angle measures 36°41'23', whose chord bears S25°50'02.5'E and measures 1167.58 feet; thence southerly, along the arc of said curve and eastery line, 1187.77 feet; thence S44°10'44"E, akxlg said east line, 136.60 feet to the northery line of Lot 1 of Certified Survey Map recorded in Volume 17, Page 4503 at above said office; thence N45°49'16'E, along said northerly line, 231.40 feet; thence N89°16'40'E, along said northerly line, 933.17 feet to the noRh -south 1/4 line; thence N00°34'08'W, along said north -south 1/4 line, 1197.41 feet to the point of beginning. Described parcel contains 53.12 acres (2,314,003 Sq. Ft.). Parcel is subject to all easements, restrictions and covenants of record. I, also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have iuly complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes, the t-and Subdivision Ordinance of the County of St. Croix and the Subdivi Qrdinance of the Town of Glenwood in surveying and mapping same. ;``o`~``ua`g GI NS/w~~,~i/yi ......... '-Y 4L ?~Ir. EDWIN C. .*' FLANUM 5-2487 AA ~~ ~ WIS~Lynl,.,'tr' g~~4 L~•" t~r~ D/aj ~o-'~osu!a~ ~ s, ~~~ q p, , g r r r r r I r r t r t, ,,, ~ r~ ~`~ . Each parcel shown on this map (plat) is subject to State and County laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the Town of Glenwood for advice. gHEET 3 OF 3 SHEETS Vo1.17 Page 4600 •„ 7 3 6 3 6 0 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1/4 OF THE BW1/4, PART OF THE NE1/4 OF THE SW1/4, PART OF THE SW1/4 OF THE NW1/4 AND PART OF THE SE1/4 OF THE NW1/4 OF SECTION 1 O, T30N, R16W, TOWN OF OLENWOOD, ST. CRODC COUNTY, W18CONSIN. CURVE DATA VOL 17 PAGE 4600 KATpLEER N. MiCSR""-' REGISTER OF DEEDS ST. CROIK (~. MI RECEIVED FOR ~tECORD 09/02/2003 10s~10AM CERTIFIED SURVEY I'[AP REC FEE: 13.80 COPY FEE: 1.00 PAGES: 3 NUMBER RADIUS CENTRAL ANGLE CHORD BEARING CHORD LENGTH ARC LENGTH TANGENT IN TANGENT OUT TOTAL 1854.86' 36'41'23' S25'S0'02.5'E 1167.58' 1187.77' S07'29'21'E S44'10'44'E 1 1854.86' OI'15'37' S08'07'09.5'E 40.80' 40.80' S07.29'21'E S08'44'S8'E 2 1854.86' 35'25'46' S26'27'51'E 1128.78' 1146.97' S08'44'S8'E S44'l0'44'E 8CALE IN FEET 1' = 200' O 200 400 _ ~ - S e v N~-• ---- - _ 3.~tr6Z°L08 - ~. ~ I ~ . -~ ~- "I~ +--1 JT' ,_ ._-- ~ " ~- ~- - I 8 3NA ~lH S " LL's ~od'tl"IOANI'03ti I m N O~ ~~ ~~ ~~ g~ Z N O ..........._ ~ 310N33S. ~ ... -... Z133HSNO 0~ ...... 3b SS3 ~, . .........1..... .1~ ~---- ~' jOLS'`Jd'~t~ I \ ` ~ •y~•g0t10"11i0 301M~9 1-- iP13W3Sd3 SS3 I ' I~ ce? ...... ........... a3y0{1i1S ~ .. - ~ ' ;-~ .1 Nl 0 ~ 3k1 I 19° Ig `` ~ \ ~ I \ ~~ ~ "C` ~ `r-- 1 I ~° I I i~ ` O 4 ~~ ~ ~ ~ Q~ j a ~r \ '` C O I c l I ~ ~ ~ ~ o , i ~ I I I I IGa ~i~° G' i I I~ i~ ~n~~ T2 0 n p I Zflj ~ I ° 1 I ~1 I ~~J ~ r O ~ ~ IQ5 t ~ d ~ .~.°~ I ~ I I~ O ~ ~ i I N ~ p ~ N m- ~~ ~~6 5 ~ ~~ r ~ I ~ 18 ~ m Zv~O ~y O ~ ~ ~~ I° mN a~ ~ ~ I ~~ ~I I ~ ~ I I 424.5T I 185.( ~ NOO°00'51 °VV 490.57' .. (N00°10'39'W) ' SEE SHEET 1 NIATCM LINE I~j ~ ~ ~ ; m r~~ S WW Z G~ >m ~~~ ~o ~~~ Q ~ aD- ~~ ~ Z Z~ ~' o ~ A _~ g (S00'4357'E) c S00°34'08'E 2981.45' S00°34'08'E 2271.48 N ~ SOllTFI 1/4 LINE BEARINGS ARE REFERENCED TO THE ST. Z I I ~ `~~ ° ~ OVED I Nnl ~~ ~ couNTY S e S Cann~ee d iQ °° c . ,nd Pa ~, 03 ~ SEP 0 2 20 I ~ min 30 Days of u nor reuxaed "" be shau > ' t I I [ry~ '~7 I i ~ ~ d e° aaoroval ma I --- ~.~ --- \ I -~ ~"~Z O ~~ I^ ~Ga 16;° O~ $ 3 rn I~ I~ ~ la 1 ^fnl bd~a~o ' ~ ~ 1 ° ~~ I~ ~ I 1 I~ I~ I ~ I ~ I 1 I la ~7 CROO(COUNTYCOORDINATESYSTEM 8HEET 1 OF 3 8HEETS E i ~~~ ~ ~N ;;~ A I w ~~ ~ ;~ ~ I ~ I f7~g ~ pp 2fiZm >~~ C m ~ '~ I _t~i ~ ~ T ~ fI T ~ 8~ i (j I ~ ~~~ Z ~ ~ I I I I ~ ' /5 Vo1.17 Page 4600