Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
016-1024-10-000
~ G~ z~, z ~ ~ .F ~ o ai c3 C ` a ~ ~ N ~ r ~ C C ~ O N fl- ~ O ~ N O ~ ` ~ ~ n ~ ~ a o to o O L A N (D to ~ ~ o W t.. O ~ Z ~ O y ~ N C ~_ ~ d Z y O ~ ~ N N w d C ° o' 3 3 m ~ O O ~ 3 N 7 d ~ Z 0 ~ m O o 3 ~' m ~l O W c (D n 3 z ~ ~ o iU ~ O I I T. ID < a ~ '- a a v z v o ~ ~ m y C O I 7 N v a N (Q m a N O W O N ~ ~ 0 o Q c~v,o '~,~ wc~ o ;, f c d o 3 ° m '' ~• cne v ~ ~ .o c .° m m ~ 3 3 .. gc 0 0 ~ I~ ~ ~ o N W ~ y = O ' ~ ~ O O ~ D. j A N~ p ~ O O f W ~ O O O N N d ~ S (D ' ~I O m 4 ~ ' a j O O cn N ', ~ ~ ~ O S 0 ~ r 0 ~ l A .fi . a 3 ~ .. ~ ~ ~ ~ ~ ~ ~ ~ 0 0 ~ C C G C C C G O ~ ~ o W Z < A t q N - ': ~ D ~ ~ ~ m ~ ~~ D1 y' ~ N A A I O i ~ O W ., W 'I o D D c a N A O 0 m V1 J "~ U) C p Z ~ v -~ A a .`p 2 0 fD • • I ~ 3 i .. O ~ ~ W m m w o ~ i '' Z C ~_ A ;ll 3 m ~ N ~ ~p A A p~ Q CD m ~_ c a d .~ O "S A7 0 Z A .~ a z 0 c N O O V A n b ~ Q ~ A w r ~p a 3 Parcel #: 016-1024-10-130 Category Alt. Parcel #: 11.30.15.1856-30 016 -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 -WAKELING, MICHAEL T JR MICHAEL T JR WAKELING C - OSHEIM CHRISTAL B OSHEIM CHRISTAL B 3152 160TH AVE GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description * 3152 160TH AVE SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 16.100 Plat: 4266-CSM 16/4266 016/02 SEC 11 T30N R15W PT SW SE BEING CSM Block/Condo Bldg: LOT 03 16/4266 LOT 3 16.100AC Tract(s): (Sec-Twn-Rng 40 1 /4 160 1 /4) 11-30N-15W SW SE Notes: Parcel History: Date Doc # Vol/Page Type 06/26/2002 682712 1917/017 WD 03/28/2002 674774 16/4266 CSM 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/26/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,000 132,600 144,600 NO AGRICULTURAL G4 10.100 1,600 0 1,600 NO AGRICULTURAL FOREST G5M 4.000 4,000 0 4,000 NO Totals for 2007: General Property 16.100 17,600 132,600 150,200 Woodland 0.000 0 0 Totals for 2006: General Property 16.100 17,600 132,600 150,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10110/2005 Batch #: 05-30 Specials: User Special Code 04/06/2007 08:14 AM PAGE 1 OF 1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department oflndustry, SAIL AND SITE EVALUATION REPORT labor a~Human Relations D'Nisior of Safety 8~ Bulld'Ings ,,.,.~ ...:ati n u o 0o ne per., n,a..,, n,,,a,. Page 1 of 3 ... _ ................_.....,.,..,.., ....,............,.,., COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must include but St . Croix . , not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # ~' dimensioned, north arrow, and location and distance to nearest road. a~~ l0 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 1~raig Konder GOVT. LOT S~^T 114 SF 1/4,s 11 30 ,N,R 15 E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # / BLOCK # / SUBD. NAME RCS # ~~ n ~ ~^ / 3152 160th. Ave. a n n a n a 1, ,''1 C{TY, STATE Z PHONE NUMBER Glenwood City, ?~I. ~4~3 ( n~a ^CITY ^VILLAGE MOWN Glenwood NEAREST ROAD 160th. Ave. [ ]New Construction Use [x~ Residential / Number of bedrooms 3 [ ]Addition to existing building ~ Replacement [ ] Public or commeraal describe Code derived daily flow 450 gpd Recommended design loading rate . 2 bed, gpd/ft2 •3 trench, gpd/ft2 Absorption area required2250 bed, ft21500 trench, ft2 Maximum design loading rate . 2 bed, gpd/ft2 •2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 101.8 mound, 97.80trenq~(as referred to site plan benchmark) Additional design /site considerations rar•prnmPnrl m~ttncl , i f mettnd not used system shoud be trench Parent material windblown Flood plain elevation, if applicable n/a ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem ~ S ^ U ~6 ^ U l~ ^ U ~ S ^ U ^ S ~U ^ S ~U SOIL DESCRIPTION REPORT Boring # 1 Ground elev. 100.8Q, Depth to limiting factor >72° Boring # ::.~.: 2 Ground elev. 100.8 Depth to limiting ~~~or Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo~xtda Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trerldl 1 0-10 10yr3/3 none L. 2 m sbk mvfr d/s 2/f .5 .6 2 10-18 10yr4/4 none sil. 2/f/sbk mfr g/w 1/f .4 .5 3 18-72 10yr5/4 none sil. 1/f/sbk mfr n/a n/a .2 .3 Remarks: 1 0-11 10yr3/3 none L. 2/m/sbk mvfr d/s 2/f .5 .6 2 11-22 10 r4/4 none sil. 2/f_/sbk mfr g/w 1/f .5 .6 3 22-72 l0yr 5/4 noen sil. 1/f/sbk mfr n/a n/a .2 .3 rr \, ~6' ~~' ~ ~3. ` , `~ ~t-_ .. ear ~ , _ ~ `S~ . r~ ~~ Y ~ . Y. Remarks: Name:-Please Print 4 200th~Av.e, New Richmond, L•?I. 54017 71~'.1ae~y^ ~~,. Date: 10-24-92 2 PROPERTY OWNER Kraig Konder SOIL DESCRIPTION REPORT PARCEL I.D. ~ Boring # 3 Ground elev. 99.95 ft. Depth to limiting factor >72 • Page ? of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-10 1 r3/3 none L. 2/m/sbk mvfr d/s 2/f .5 .6 2 0-26 10yr4/4 none sil. 2/f/sbk mfr g/w 1/f .4 .5 3 6-72 10yr5/4 none sil. 1/f/sbk mfr na/ n/a .2 .3 Remarks: Boring # :<::~:.. S:<:: >:><.:: Ground elev. ft. Depth to limiting factor Remarks: Boring # k~::)v~ .... Ground elev. ft. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Remarks: Remarks: SBD-8330(8.05/92) .. _. ,, STEEL'S SOIL SERVICE Gary L. Steel C.S.T. 2298 MPRSW-3254 I Z~ ~c~ ~-~~ ~ p lO~ (~ 1,m~rv~ K ~~~~L ~-- t~ 0 14-~v ~S Kraig Konder SW4SE4 S11-T30N-R15W Glenwood, township ,~ ~~ ~ r ~ '~° ~ ~~` ~ .., ~~~~~ ~~ ~~o ~ ~~. 988 N. Shore Drive New Richmond, WI 54017 (715) 246-6200 Zoo g~~ ~, . z ~~~ ~~ ~ ~~ ~~ ~ ~ I _..~-__ Wisconsin Department of Industry, ~ SOIL AND SITE EVALUATION REPORT '' Labor end Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and °I° of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION Page 1 of 3 PROPERTY OWNER: PROPERTY LOCATION Kral Konder GOVT. LOT SW 1/4 SE 1/4,S11 T30 ,N,R 15 ~ic(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 160th. Ave. n/a n/a n/a CITY, STATE ZIP CODE PHON NUMBER []CITY (]VILLAGE MOWN NEAREST ROAD Glenwood Cit Wi. 54013 ( n~a 160th. Ave. [ ]New Construction Use~x[ Residential / Number of bedrooms 3 [ [Addition to existing building ~ Replacement [ ] Public or commercial describe Code derived dairy flow 450 gpd Recommended design k>ading rate ~_bed, gpd/ft2s~Uench, gpd/ft2 Absorption area required 375 bed, ft2 trench, ft2 Maximum design loading rate ~_bed, gpolft2~_trench, gpd/ft2 Recommended infiltration surface elevation(s) 101. $0 ft (as referred to site plan t~enchmark) Additional design !site considerations Parent material n/a Flood plain elevation, if applicable n,/R ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem ^ S ~U ~ S ^ U ^ S ~U O S fit! ^ S ~U ^ S ~U SOIL DESCRIPTION REPORT Boring # 1 Ground elev. 1oo.sq. Depth to fimi6ng f33" Boring # 2 Ground elev: 1t3I2...8~• Depth to limiting factor ~1 ' Horizon Depth Dominant Color Mottles Texture Structure Cons;stence Botrtdary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ged rertd~ 1 0-10 10yr3/3 none L. 2/m/sbk/ mvfr D/s 2/f .5 .6 2 LO-3 10yr4/4 none sil. 2/f/sbk mfr g/w 1If .4 .5 3 33-66 10yr5/4 none sit. 1/f/m mfr n1a n/a .0 .0 Remarks: 1 0-11 10yr3/3 none L. ~/m/sbk/g mvfr D/s 2/f .5 .6 2 11-31 10yr4/4 none sil. ~/f/sbk mfr g/w 1/f ~4 ~~~ 3 31-65 10yr5/4 none sil. 1/f1m mfr n/a n/a .0 .0 Remarks: CST Name:-Please Print Phone: 715-246-6200 Address:l5 54 2 .Ave . , New ' chmond, Wi . 54017 Signature: ~ ._ Date: CST Number: 'f -.. y,,.5 10-24-92 229t3 PROP~RTYOtiVNER Kraig Konder SOIL DESCRIPTION REPORT PARCEL LD. at . Boring # 3~ >. .` Ground elev. 99.9511. Depth to limiting (actor ~~ Boring # ~;,~.~ Ground elev. ft. Depth to timiting factor Boring # ~4K Ground elev. ft. Depth to limiting factor Boring # . •:y; '~ `~'` ~:,, Ground elev. Depth to Hmiting factor Page ? of 3 H i Depth Dominant Color Mottles Texture Structure Consistence Barr Roots GPD/ft or zon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tn~ 1 0-10 1 3/3 L. 2/m/sbk mvfr D/s 2/f .5 .6 2 10-26 10yr4/4 none sil. ~/f/sbk mfr g!w 1/f .4 .5 3 26-72 10yr5/4 none sil. 1/f/m mfr n/a n/a .0 .0 i Remarks: Remarks: Remarks: ~~ Remarks: SBD-833U(R.05l92) ., Gary L. Steel C.S.T. 2298 MPRSW-3254 I~ ~rnl~a ~~t~~-~~ ~ p~ rv~ A- ~- ~ ~. , l 00 r w 1vn~K@-riP,63L `~- ~ 0 1q-~v ~S STEEL'S SOIL SERVICE Kraig Konder SWaSE4 Sll-T30N-R15W Glenwood, township ,~ ?~~'~ p .~~--- o I -~ ~~~ ~~! y(Sis~i r-y ~~~~ ~~i ~ I `~ 988 N. Shore Drive New Richmond, WI 54017 (715) 246-6200 2~~ ~(P~ ~ . Z ~~ ~ ~ ~ ~ ~~ ~ ~.~~ /~o ~ ~~. ~~,, O S O CCU%,, ., . r~iy .., .. ,T. Cr, , ~ Plannir~n Z^~ ". y t~~AR ~ S 2002. m ' ttnotFptflr~,:uy.,..•„~ I' ',,~.~,ibe n li! r,~ri ~;r~. m V G.1 rO i^ \ ~C X11 .P 1 ~~ 1 A , '~'~ I ~ n~nl'~ m I Q;' w A ~J-O9~ ~ _ i oo i~ ~~ GutJ m ~~L~~ `O ' r O l O l~ ~ 1 I I~ WO ' ~~ a~S. I ~ ~ ~ ~~ _ ~~ i~ Z ~ ~° ; ~ ~ ' I 0.8 231.11' ~' o°os'~2v 312.00' ~ A ( I ~~~ , ~ 41 ' c~N2 I I~ ~ ~ -~- / ~ 50'I45' z I 0 ~ _ $ v?+ ~6 m I f m m ~o 1 zz ~~ • o ®. A pJ (n ' f G ~ ~ X i ~ N ,~~ ~~ z 8 i Z ~ O~Ii aC~D _ p ~'l 04aC~G3~ ~' ~ r NORTH -SOUTH 114 UNE ~ ~ $ ~ m Q m 14.4 +/- d04 9 ~ ~~ c~o~o~o as do ~ ~o ~~ ~ ~ m l~l 800°30'2a"E 739.02' 38.92' 700.10' f ~y ~ l ~° ~a a01~! ~TO~oo N ~'~~' O jZm~~o~ C ~N~ i -'-`~ ~n SAO z ~~Z p~ ~ ~ ~ y~~ v~ ~ D m m _~ V ~ a, Wr~i ~ ~m OXZ .i Z ~ m W L ~ Z m 1 ~~ Z v V .+~ wD oW wm am °~ ~n ~o s~ r ~~ 0 ~~W S00°04'51'E 559.74' + Om T Z On ~m io ~/Q f ~ i O r I r~ r r~ ~ C ~~~,~ rn i ~p i"V ~~ iuuU N ~ N ~ o ; l~ z !© -• o W D -' cn ~ y r N r' ~ ~ ~ a~'~ w C7 ~ m ^~ C7 ~ ~ O ~Q ~O IP ,o `~~o ' 'P ~ ~I ~ I I~ to to . o~,~ to I ~~ld I° ,~ ~ ~° I I~ ,~ n ~ m O ~,r~74774 ~ 6 PAGE 4266 KATHLEEN H. MALSH REGISTER OF DfifiDS ST. GROIX CO., MI RECEIVED FOR RECORD 03-28-2002 9:30 AM CERTIFIED SURVEY MAP REC FEE: 13.00 COPY Ffifi : 3.00 r==O mmmn ~z m a ~NM o m~ ~ O p '~ -n m Om O'p'~i OQ~z Z ~ m rw w Y' gy ~ ; m=~ 0 ~ 7 o m0 OOy"~ ~ m .~ Z ~ n ;gym o ;o;c~ o- a ~ ~~~~~ ~~zm I Z fA O , ~~ I p = i 00 ml~ ~.r~ ~ o,~li ~T; I~ O O N Z-~ ~ I N ~~ ;~ ~m'~°'~ mm N O .r CC z`=~ c~ ~~ • z m ~ m~ O WEST LINE OF THE Z1 ~ NE1/4 OF THE SE1/4 / T~ U c N m ~ Z ~ p m 800°74'2TE // p X z 347.17' ~ , (7 ~ C7 p n ~m / ~ ~ w ~~/ ~4ij ,may .8~, ~ / , /sa~ /~'~ / ~ ; '^ r"+ ~- ~~ ~ ~, ~ N ~ ~/ ,„ / o v~ c'~ i ~s ~ //- o~ ~ .. ,cousin Department of Commerce PRIVATE SEWAGE SYSTEM oafety and Building Divdsioh • 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 Jensen, Chris Glenwood Townshi CST BM Elev: Insp. BM Elev: BM Descriation: TANKINFORMA TYPE MANUFACTURER CAPACITY Septic ~~ rev Dosing ration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~ ~ ~~ / ~ ! ~ Dosing j1 11 y d ~,., f ~ < 1 Aeration ing PUMP/SIPHON INFORMATION Manufacturer ~~- rylodel Number ~~ ~ l~l dl ~ TDH Lift Friction Loss Sy ~ X7,9 •~3 ,-. ~~ Forcemain Lengt~Q ~ Dia.a !~ SOIL ABSORPTION SYSTEM BED/TRENCH Width ( Length DIMENSIONS SETBACK SYSTEM TO INFORMATION Type Of System: DISTRIBUTION SYSTEM o~'gS ONC_nC Demand GPM 3~.3~ em Head / TD ~l•~}t Ft Dist Well ~ I r Ne. Of ~urcJaos P/L BLDG WELL f ^' 33 ?~~ ~ ice! ELEVATION DATA county: St. Croix Sanitary Permit No: 408236 0 tate Plan ID No: Parcel Tax No: 016-1024.10-000 STATION BS Hl FS ELEV. Benchmark ~~ Alt. BM Bldg. Sewer ~ / YY ~~ ~ ~ ~-3~ Ht Inlet /„~'4~ J~ I (~ SUHt Outlet Dt Inlet Dt ~ g(.sy~ D,S `F Header/Man. ~D$•30 ~. ~ fl~ ~ r • Dist. Pipe 1~s.3~ 3.'3 ~3~35' / /ol~aS Bot. System ~OS,'~ , D ! 0~. O F' ~ w ~ i. ~ ~ Y l2 .{- -- St Cover DT ~~ .~,.. ga . ~ ~ I.~v }~'~ 60 Depth LAKE/STREAM HeaderlManifold 1,( ~~ ~~ Distribution ! D Pipe(s)L~ ) ~ Z !~ ~ ~ x Hole Si ~~ ~! x Hole Spacing ( I Vent to Air Intake Length I ~ pia ~ ~ 1 pia Length Spacing ~ SOIL COVER x Pressure Systems Oniy xx Mound Or At-Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [~ Yes ~ No ~ Yes [] No ~.- o-er COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: i~i Ins io #2: b ~'/ 3' / 0 2. ~~,~~_~ Location: 3152 160th Ave Glenwood City, WI 54013 (SE 1~ SE 1_ 141a T3[Q'N~R~5Wu~C~,~ a ~~S-~ ~ cel No: 11.3~~ 1~50.187A /~ 1.) Alt BM Description = QTY, ~~fuw. } /~/g( .~ ,~ ,(/ / / / ~ ~ ~"'Q u "`~%r ~r'T 2.) Bldg sewer length = n ~I:t~~ ^ ~ Slt~g`it ~~y 50`^'~ h~ laf~,~ ST/~ ~~ {~S J'~~0~ a(r~ - amount of cover = (~ u "~~''"'~ ~"' °~~G~-; 3.) Contour = N. ~r y. S~ y, SQ ~- ~d Q -' (3 3 ~,- _ _t~,~~ ~- ~- Plan revision Required? Yes No ~ D I 0 Z. 03 I ` I' Use other side for additional information. ~ ~__ __ _ __ _ - ~ _ __ J SBD-6710 (R.3/97) ~~ to C~,. ` Insepctor's Signature Cert. No. ,~.~.' ~~ l ~,} ,~~ ""' ~ w' ~,*\ +~ ~` ~ d ~y A ~ ~ ~' V ~ ~~ ~' r a ~-- v ~ „1X -v 6 1 , ~" sw ~ ~ ~ i N . ~, ,,U, ~l. ~-=~.. .: f ~U ® a. ~. ~ ~~ ~C 'N .-• --~ 1 ~./~ a ~ V" `~~~ a ~P ~, '` ~* ~~ `~ s ~~ 0~ :~ `'~ ,~,, ~- <~ ~ ~ v ~a ~ U 3 3 --~ ~ ~ \\ ~~~ ~` ~ ,~ --- _E J ~~~ ~' 1~. b ~ 1 ~- 1 f1 ~.~ ~ ~~ ~~ ~ r • ~ ~_ ~ Gam,--,.~ Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St CfOIX ISCO~SI~ Madison, WI 53707-7162 ` ~ 5i r S ~ j 3 5~ ' 0 ~, 3152 ~ X /t Department of Commerce - r. /!a Sanitary Permit Application Sanitary Permit Number 2 (~ ~~ ~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide J r" ^ Check if Revision may be used for second pu oses Privacy Law, m I. Application Information -Please Print Ail Information I4., '~ ~ ~ . ~ ~ R ' ~° c ' °` t ~ State Plan LD. Number ° 763919 Property Owner's Name Pazcel Number Chris Jensen ~~~n5-~v~'~v?X ~ ~ ~~-l~. .~~~:~i_ 0 ~ Zp~~ 016-1024-10-000 ./ Property Owner's Mailing Address ~ ~7~. ~ ~~;x ~ Ul i y: Property Location 1620 Coun Road X z. ~; ~~, ry ~ SE%4; SE'/4; S11; T30N, R15W City, State Zip Code Phone Number Lot Number Block Numbey ~ ~ ~ Glenwood City WI 54013 715-265-7392 {b aThJ1~J , Subdivision Name CSM Number _/ IL Type of Building (check all that apply) ~ - ,/ , ~~ ~ ~~ n Q{.~.ta~ "•-_ " _ X 1 or 2 Family Dwelling -Number of Bedrooms 4 ~ ~ ~~~/ / f ( S ^ Village - ^ Public/Commercial -Describe Use ~Qwy/ j,(,t,(;~6/ G~~-4.t': C.PX.E' ~ X ~ X Town Glenwoo ^ State Owned ~~' ~ ~ ~~ ~~ CG~3'L ~lu~./ ~~(1. ~ `c °° ' Nearest Road d'~ A_ - ~ ~ [ 1 - 0. 5 ~ ' ` S Coun Road X ~ Q ~`f>~ ,. , ri-t, III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) `~~ I ^ New 2 XReplacement System 3 ^ Replacement of 6 ^ Addition to For County use S stem ~' Tank Only Existin System B• ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that a ng scheme is for internal use) ~~ 44 ^ Non -Pressurized In-Ground 1 X Moun 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersal/Treatment Area Information: Design Flow (gpd) . Dispersal Area f Dispersal Area Soil Application Percolation System Elevation Final Grade Required Proposed Rate(Gals./Day q.) Rate Elevation 600 600 ft2 600ft2 0 S(~t ~ ' .5 Uvrl'l''rr// (Min./Inch) N/A 101.2 1/ 102.99 VI. Tank Info Capacity in Total Number Manufactu er Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing ,,, Q ~ _ /~~ , L'am Tanks Tanks ~ ` Septic 1250 1250 1 Skaw Precast X Pump 754 754 1 Skaw Precast X VII. Responsibility Statement- I, the undersi ,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P is Signat MP/MPRS Number Business Phone Number Thomas D. Gustum 227618 715 658-1344 Plumber's Address (Street, Ciry, State, Zip Code) N13450 937th St New Auburn, WI 54757 VIII. oun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issui t Signature (No Stamps) ^ Owner Given Initial Adverse Surchar a Fee) 'j ~ ~ ~ J~ ~ ~ .._, ..•- cr v G~~~ Determination IX. Conditions of Approval/Reasons for DisaPeroval a ~4,~n,~zd ~~'e f ~ Pa nvvr dcca~ n.o,~,J ,~tv~^-~-- E( /~c-„vn,~/ SyS~ ~~ ~'~' ~-cth~12,~" co ~R---' I~ .S'-j-c~e- c ~~ k 3 . ~ 3 -1 se~j'bo~k.Q,~ hR g-t~1,t~4.Qe~ , r~~ t~c`sfr~ c:~ > 2 s ~ fir, .~.-~- ° ? So ° -~-rrl~ rn~,~' _ -}~ ~ r w,r~ a-~ 2 /~-ban c(,~. --~`F r Ski n ~ s ysi~w. >~'t" lam v~ • 8 3 ~ 3 3 /~~-Gtic~~-tiu-n,-f~ ~ -F •~ 11 t•Y, ~-+c~.~,+-k~ ~ A~:~2,~rw 3 ~-ll~ - ' ~ /~-~ , l~iri.- . a - ct!u-ems v Attach comp a IanF/(to thBlCo~ynty only) for the system on paper not less than ffY/2 11 i es in size -~i~--~t-~.~z/~,-~-r-a~~.c.`~- GE's'-~l.r~.' ~ ~4. ~~02- /r'~ ~~ _ f a~ Q ~°d _ SBD-6398 (R. OS/O1) r ~ ~scons~n Department of Commerce Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188-2439 TDD #: (608) 264-8777 www. commerce.state. wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary June 25, 2002 CUST ID No.227618 THOMAS GUSTUM GUSTUM SEPTIC SERVICE N13450 937TH ST NEW AUBURN WI 54757 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 ~~~~.~~ CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/25/2004 SITE: Chris Jensen 3152 County Road X Town of Glenwood, 54013 St Croix County Identification Numbers. Transaction ID No. 763919 Site ID No. 646909 Please refer to both identification numbers, above, in all correspondence with the agency. FOR: Description: Mound, 4 Bedroom Object Type: POWT System Regulated Object ID No.: 858501 The submittal described above has beenxeviewed 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. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10706-P (N.O1/O1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. '~! Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. 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. Inspection of the private sewage system installation is required. Arrangements for inspections b de e designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stag, OF ~ `~s~~~ Rr4< ~F ~ A copy of the approved plans, specifications and this letter shall be on-site during constr~c~cc'~,~~ and o~'h to inspection by authorized representatives of the Department, which may include local insp~To 11 permits required by the state or the local municipality shall be obtained prior to commencement of ~~" construction/installation/operation. THOMAS GUSTUM Page 2 6/25/02 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. Sincerel , Julia ALewis-Osborne POWTS Reviewer 2 ,Integrated Services (262) 548-8638, Fax: (262) 548-8614 j Lewis@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 b~l~-~~ Mound System Management Plan pursuant to comet 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 routinely 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 1/3 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 ~!R 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 out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Pertormance monitoring must he 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. Mound System Page 3 of 6 Pressure Distribution Calculations Project Name: Jensen 4 Bedroom Mound Lateral Layout Lateral/Manifold Design Lateral elevation: 101.7 ft Lateral diameter: ivZ ~ In. Rows of Laterals: 2 • Lateral spacing (S): ~ft Manifold type: end • Lateral to cell edge: 2 ft Orifice diameter: 0.125 • In. Lateral discharge rate: 15.65 gpm # of Laterals: 2 System discharge rate: 31.31 gpm Distal Pressure: 5 ft Manifold diameter: z . In. Lateral Length: 74 ft Manifold length: 4 ft Orifice Spacing/Distribution Forcemain Fricti on Lass Orifice spacing (~: 24.00 Inches Forcemain length: 250 ft; -~ Orifices per lateral: 38 Forcemain diameter: 2 ~ In. Avg. ftz/Orifice: Y 7:89 ft2 Friction loss in forcemain: 5.244 ft Lateral Side View Manifold Lateral Lateral Length Lateral Plan View Lakeral Lengkh ` I I Turn-up wfball valve or cleanout plug ~ Orifices an botkam of PM1IC lakerals and forcemain to comply wikh lateral equally spaced specifications per Camm $4.30[2J[eJ Forcemain connection via tee ar cross to maniFold at any point Clean Out Detail Clean-out plug Grade ~- or ball valve Observation Pipes Sprinkler Box Long Sweep 90 ortwo ~5's-~..~ 6" Minimu~ ~` dilater tight cap or plug .Slo# Note: Claset Collar may be used in place of 316" bar X318" Bar MOUnd .System Page4of 6 Septic, Pump and Dose Tank Project: Jensen 4 Bedroom Mound Tank Information Pump tank manufacturer: Pump tank size/model: Pump tank gal/inch: Tank bottom elevation (inside) Septic tank manufacturer: Septic tank size/model: Skaw Precast 754 16.05 71 fl Skaw Precast 1250 Pump and Filter Pump Manufacturer: Zoeller Pump Model: 161 Effluent Filter: Zabel A100 ~ Note: Access opening of sufficient size to be provided to allow removal of filter. Opening to terminate at or above grade. Pump Tank Diagram Watertight Locking Cover A inch _ ~V~lith Warning Label r . Alternate Outlet Location; r pr Anti- Siphon Device E1eCt.;per Coi `16.28 and: fVEC 3011 s Dosage Volume Does forcemain drain back to tank? L___._J Lateral void volume: 15.6 gal Dosage to absorbtion Cell: 78.2 gal Forcemain volume: 43.6 gal Total dosage: 121.8 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) 29.87 ft Friction loss in forcemain: 5.24 ft Pressure loss from filter: p Total dynamic head (TDH): 41.61 ft ~d Dose Tank Levels In. A Reserve 27.4 B Pump off to Alarm 2.0 C Total Dosage 7.6 D Effluent depth for pump 10.0 Total Capacity: 47.0 Pump Curve: 161 Pump must be capable of: and head pressure of: 31.3 GPM 41.7 Feet ~'^`` ~~~t o 1 •D' a~ ~ r` ~~ Gal 439.6 32.1 121.8 160.5 754.0 1s~ra1~ 1 3 ~ • 31 ~"" I • ~ , u ~ ~u 'L 3 i ' _ Z M p ( ~ i ~ _ o ` gg $~~t75 a~~ 'S $~U ~\ Y ~ W co pp~ ~ 8 Yp~ ~ ._ ~ ~ a E ~ ~-t7~t i y a ~ N J = a ~ ~ ~ V ~ ~ a ~ ~~ . ~ ~ O ~ ~D m a M 3 U = oo W 0 C ~ N OO ~ n U = ~ • . ~ w o g' F- _~ ~ .~ ~ r '''~ •.~ ~• x • N p Z ~ ~ o ~= a~ ~ a X v O v •• ~ ~ J 1- J 8 O tiJ 1~ ~ ~ W w U ~ ~ b+-~ ` n n U . O/ ~ .`Z:L f~ ~/1 ~.• V ~ ~ `_ ~ sz W to •• • ZV / .r ° Ln /~p.JN2AUQ •• ` ~14 y N E ~ Q- m t- ~o ~ . v er LL F-' • 2, d ~ •• ~ VI co • •~ ~ i Q C ••• ;~ - Q ~ U ~p m ~ ~ N x•- ~ ° i i ~~ ~ ~ ~ i i ~~ ~ ` ~ f~ m y ~__~ d ~ ~ auk ~ado~d ~~~ s Pg6of6 °° p ~ m Q Wisconsin Department of Division of Safety and Bui RECEIVED JUN 1 3 2002 ~~$. CROIXOC~ ICEY ZONING„ eem,,,.,,, L EVALUATION REPORT Cnmm R5 Wis Adm Code 1586 Page 1 of 3 Gustum Septic Service ~ County pl p paper not less than 8'/z x 11 inches in size. Plan must Attach com ete site Ianan o St. Croix include, but not limited lo: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and ~catbn and distance to nearest road. ~ ~ . . 016-1024-10-000 Please print all Information. ~~g 'L ,S .3 /~ D R ewe By ate Personal information You provide may be used for secondary purposes (Privacy Law, s. t5.04 (1) (m)). _ Q ~ ~ ~ S ~ . Property Owner Property Location Jensen, Chris Govt. Lot n/a SE 1/4 SE 1/4 g 11 T 30 N R IS W Property Owner's Mailing Address Lot # Block # Subd. Name or CSNf# 1620 County Road X pending n/a Pending City State Zip Code Phone Number ~ City ~ Village yJ Town Nearest Road Glenwood City WI 54013 715-265-7392 Glenwood 160Th Ave. _f New Construction Use: i/ Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD ~ Replacement J Public or commercial -Describe: Parent material loess Flood plain elevation, if appligble n/a General comments and recommendations: Part of 16.17 acres. Recommend mound system along 100.7' contour. BM #1=100.0 el. BM #2= 104.9' ite address rs 3152 160th Ave. Boring # J Boring 1/ Pit Ground Surface elev. 100.8 ft. pepth to limiting factor 30 in. Soi-,gpplication Rate Horizon Depth Dominant Color Redox Description Texture Strucure Consistence Boundary Roots P in. Munsell C!u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2mcr mvfr as 2f,1 m 0.5 0.8 2 10-16 10yr3l4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 16-30 10yr4/4 none sil 2msbk mfr cwr - 0.5 0.8 4 3 50 10yr4/6 -7pg~_ ~g /2 sil lmsbk mfr - - 0.2 0.3 Boring # ~ Boring 1/ Pit Ground Surface elev. 100.7 ft Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-9 10yr3/2 none sil 2mcr mvfr as 2f,1m 0.5 0.8 2 9-14 10yr3/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 14-19 10yr4l4 none sil 2msbk mfr cmr - 0.5 0.8 4 19-32 10yr4/6 none sil 2msbk mfr cw - 0.5 0.8 5 32 5 10yr4/6 Q-~PS~~~l2 sil 1msbk mfr - - 0.2 0.3 * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 <_ 150 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatu ~ CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Autwm, WI 54757 5/29102 715-658-1344 Property Owner Jensen, Chris Parcel ID # 016-102410-000 Page 2 of 3 Boring # ~ Boring 1./ Pit Ground Surface elev. 100.2 ft. Deptli to limiting factor 35 in. Soil Appligtion Rate Horizon Depfh Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots : in. MunseU 9u. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 •Eft#2 1 0-9 10yr3/2 none sit 2mcr mvfr as 2f,1 m 0.5 0.8 2 9-13 10yr5/3 none sit 2msbk mvfr cw 1f 0.5 0.8 3 13-20 10yr4/4 none sit 2msbk mfr cw - 0.5 0.8 4 20-35 10yr4/6 none sit 2msbk mfr cw - 0.5 0.8 5 3 10yr4/6 f2-3p IOyr7/2 7 g /g sit 1msbk mfr - - 0.2 0.3 ^ Boring # J Boring Pit Ground Surface elev. ff. Depth to limiting factor in. Soil Application bate Horizon Depth Dominant Color Redox Oesaiption Texture Structure Consistence Boundary Roots = in. Munsell Du. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # --~ Boring J 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. Munsell Uu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2 * Effluent #1 = BOD 5> 30 < 220 mglL and TSS >30 < 150 rng/L * Effluent #2 = BODS <30 mgll. and TSS <30 mgR 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. . - . ~ e 7I 7 ~ '!`~J` ` G ~~`. ~' ~~ ~, ~~ ~ .~ ~` .~ n `. ~ ~.` N8 ~~~ • m r • N ~ 8 ~ ~~` ~10 ~~~`~ ~~ mg 2U1~ I(~12d( t0 ~$ d Q ~ M ~~ ~ ~ ~ c a ~~~ ~ a~ ~4(~ € lpp~ Y~'~ L N ~ W " y~y V ~ ~ to ~ 8 N 3 U ~~ X 'S ~' W IM I~ I~ ~~ ~~ ~ 0 U m ~ Q U Q' 2 O rn m C Q <T w O 7 O CO ~ n. U _ _H W ~ Y a ~ ~ H ~ Q m ~ o W ~ ~ Z V ~ ~ F' d $ po O Z ~ ~ W J v~ w w u u u ^ r- N ~ ~ m m m ~ Y ~ C 1\I m ~ ~ 1 e- ~ g ~ co ~, ~ o ~ ~t~ ~; ; - 1 ~ 1 =m ~~ C v , , ~ '- ~ C~ Y 1 ~ ~ W m m ~ L__~ r ~• ~ ~ ~scons~n Department of Commerce ~~~~~~} Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188-2439 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary June 25, 2002 CUST ID No.227618 7.ONiNG OFFICE~,~ THOMAS GUSTUM GUSTUM SEPTIC SERVICE N13450 937TH ST NEW AUBURN WI 54757 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/25(2004 ATTN.• POWTS Inspector J ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Chris Jensen 3152 County Road X Town of Glenwood, 54013 St Croix County FOR: Description: Mound, 4 Bedroom Object Type: POWT m R lated Object ID No.: 858501 Identification Numbers Transaction ID No. 763919 Site ID No. 646909 Please refer to both identification ntttttbers, 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. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10706-P (N.O1/O1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. 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. 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. Stats. 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 construction/installation/operation. v THOMAS GUSTUM Page 2 6/25/02 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 may be 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. Sincerel Julia ALewis-Osborne POWTS Reviewer 2 ,Integrated Services (262)548-8638, Fax: (262)548-8614 j Lewis@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 OwnerBuyer ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ~J2i d T v ~°~~ ~ /~ P L ~ ~ /,~~ ~% ~ tiJ ~ /~ Mailing Address ~ d~ v ~~ v U-~,T~' ~~ ~ b Property Address (Verification required from Planning Department for new City/State (yL/>"~/w~~ `? C ~'~ ~" ~ parcel Identification Number ~~ ~ - /o ~- ~ - /~ - Duo i/ • 30 . i S i~ 7/-~ EGAL DESCRIPTION ~ G property Location S ~ %., 5 ~ 1/4, Sec. l~ . T ~ ~ N-R ~s_W, Town of ~ ~"~"'O'~ . Subdivision .Lot # Certified Survey Map # ,Volume Page # ~ rran Deed # Volume ~ ~ .Page # ~ ~ ~ .~ ` ~ 3/R ~ wa ty 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 fimctioa 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 mastorplumber, journeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on site wastewaterdisposal system is is 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 that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days~of~tjhe three year expiration date. C/ ~ ~ ~~ ~ ~~/~ ~~ SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. /~ ~~ 6 ~ ~~, o~ SIGNATURE OF APPLICANT DATE *s*«*« pny 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 in the warranty deed ° tlOGUMENT NO. ' 41.619 ~~n~ 90~PAGf 2 /i WARRANTY DEED TNIa S-ACL R[S[RVLD fOR RECOROINO DATA STATE BAR OF WISCONSIN FOirv[ 2-1968 ~ Kraig K. Kor~or and Maureen C. Konder, ...-tlasbarid and wife 'as survivorship marital - ----.. .... . e conveys and warrants to .......Ct~'i3tOpheT'. R,-. Jensen_ and___------------- -..........Lorie..T°nsen,- husband .and. wife .............. _..------------.......... the following described real estate in t. CroiX County, State of Wisco:isin: S1/2 of SE/14 of Section 11-30-15, except part Burke in Vol. "503", Page 542 and excep, t 1 of CSM 1T5Z~5, and erce t o ons in Volume "8 except Lot of CSM in Vol. "8", Page 21 TRANSFEp $1.~ o ~~ ~.~, ~. . ,. ~. . r. ~~ - i •, . ,; This -- ....is---------------- ~- -------- day Dr .-- -- (xtooer .- ......... _.... - - - .. _-......., s. 92_. (~.~ ,. - - - - -•-•------_ (SEAL1 /~ n C. Konder ' --------Kraig-K. Korxier-.,- .......---• ----- --•---.._....--•-•-•-------------•-------------...(SEAL) ~.IITHHNTICATION signstr (s Kraig K. Koryder and -- t1 ~~'. K03~eT' mfg October g2 authenticated this~!~:!.f.__day o' ..............•-----...---+ 19-----. s Kristirla TITLE: MEMBER STATE BAR OF WISCONSIN (Ii not. ---------•---•--------------..-----...........__..._.._._... s~horized by ~ ?06.08. Wis. Ststs.) THIS INSTRUMENT WAS DRATTED BY ------..._.._... Kristina.Oglarid . ...................•---------- -Attorney at Iaw - (Signatures :nay be suthenticatsd or acknowledged. Both are not necessary.) - -- ... ----- - -------- -- ---•-- - - ------ --•----- ---...(SEAL) ACHNOWLBDOI[BNT 3?ATS OF WISCONSIN ------__...-----•---------------cDnnty. i~ Personally came before me this ................dsy of ---_-----------------•------°------+ 19--•----- the above named d se known fa be *he person __...-...... who executed the feeegning instrument and acknowledge the same. ii~Lary Arblic ..._:------------------------------•-----.County, Wis. D[~- Commission is permanent. (If not, state expiration date: -------°-----•------•--...-•- -------------------------- 19--------•) ~Nams of pRLOm .tialnf is LvY apacilt slaald be greed or Drlated below t-+ie'-ssatures. WAiSANT! DESII SlA17 HAS OC/ Y~DON~I>mi WiacoR+ln Lagal Blank CO., inc. -.. - TORY Ne- i- 1laL MMwaukea. WlscoRSin Ii~Gi~~i~~'~ OF~1~ 3T. C'tip1~ CO., WI Rt~'~ fa Record NQYi a ~ ~ 10:00 AM a ~~ RETURN TO Taz Parcel No: ..................... .ism G. and Marv s•' in V_ ol.~b~ ~i n ~..,_., xn. .,...,a ~7 SEE PAGE 70 ~" ~~ ~~ ~, $ 1 ~ Hri nnnw~ n_ • • t 2 l anda t 2 I • l - F3 ed k Clue Pauhis 1 john arkelen 273.5 ~^ elvin ~''8 3 3 4 63.t ` 6 151 ' ° ` ~ . 15 ~ a mas Jackelen ~ Th _ R ~ ~ } ' s " Jeffrey & Laura ,s , 3 a tbnson 6 r oa«,n , s 6 Bush ~ s Mi ha el & .R ~ 12 Emma Nitchey o Dale & ~1ei15 135.5 too.R ~ Enid Bahnub ' ~.,,,,R rte"'"' L M~ c awrenm Lake ~ & Schug as Sarah Cassellius g z g • Herman Pitt t y Ioann R 7 lR y •i to 9 R 2 436 tR • R 2 to y u7 ~ w q R 'o - ' '~ s Berends 111 Joseph ~ 257.5 Io '~S . • 234 i1 ffi a ~ Jackelen X 207.9 116 • ., t • 217 Harold & ~ zt• 173.2 + WI d 146 Little 1~•2 ` C x"' ~ ENTRAL N pJtmeStack ~ David Y ~ ~ r r Kevin iteven Roxanne Crow Rodru & Y i Bushy 80 92 Lake larence & oM 3 roast l 3s E ~ p. 8 GabOWei ~ ~, ~ Gordon ° ° tnc a Pa Venter Marrietta 107.5 Richard • Marcella I ° ~~ kl ~ &Patricia ~~ ~~e Sweeney $eversori i 4q ~ 15 a m Cazol Adams ~ 11 g r e ' Prinsen Helgevold Helgevol Bacon • Tr ~ ~ 126.4 • 4 a. • ~ 152 ( 80 R er & ~ Wayne whiewam m • _ Gerald Mitch $ Wrtdaert JO a Helen Jerry Frank & Thomas & r earrte xeur Frank • 66.5 76.5 ~ Robert ; . $ • Stansbury dr Karen Donna ter & Ile Warner Lynette Schug „ ~ :. ~ $ orta,o &Melodee 151 g ~ ~',•. 160 stoner Waniei ~urlneY 160 ~ ~ Ronald & Dine Borate oN Ke""~ & 226 ~ Forrest A 3 76 i 160 2~ 65 p°p m sema~e 4 ~ u- 0 rue Mary Maes O Peter & She LBerg• a tbo L Anderson 203.3 Donald 40 .0 • e.cma,u )ames& _ ,y o 1 Stephen one.- Glad Borate 4 ,.k ~ m ys t • Wa e & ab • Yn Newcom xubert etal Borate DEnn ,o • ~ $ ~ ~ = ~ earl & force Torleta 6R q sa ~ Dada ~ The ° • .Wesley ar Pray ' 0 159 T[ust• d . _9 E effre & J Y ~r ~ ~ We'd ~ Yoder Nieman Huffman : ~.., Niclwls tz Asplun 160 Sheila Wagner cs<<x m • 77.2 .7 - 71.2 8 0 ,t s i. • s, aa. ' tern ~ • N'om ~i ' Blare lueePh ~ • urlene •'•c Paul & mo Delmar ~ ry [t Richard • gg ~ -' 3 ~ v ~+ Herbert & Gregory Rose Luks ia ~"~ r 39s • n s ~ u ~ ~ ~.. ~ °. - !„ Susan S . d. ~ """ Marlene Goassens ~ '~ ~ 159 & Grace Robert & Theresa ~ X ~ ~m ld ' °" 3B Ro bert WedeY seott r • s e ~~, IrE G w m ween Obermueller • Obermueller z$ bo aro lio Ifhodes ~ ~ Palewicz Tuttle aey ga„mu,n 6r L • ~ is t merald 233.7 of • • 39 w Barrio er 74 is 426 ~ 160 ~ James ]r & wacaa~ m A ~ ~ ~, 97.2 .,.am a n ~ Wayne Peterson 40 4 217 ,. Schoenwetter Elwood john Dona Weyer • Gibson 80 M 39S ~ t w w m > ~ ~ r$ ~' i. . ~a = _, o '0 ~ . b Q erald Land E Trust oe naa~ef tta ~ ~ 5 ~ g Davie & ~ 7q 1.92 ara Fred & Bar (J r•ae m Corporation T;<noth Maerson Y 20 eo 160 ~ t~ • w ~ ledr. crease ao , . ~ ¢ ,S 40 •„ ll,eresa 0 ~ Hoffman • l)rinkman + h O •~ 1 • • D Kraig & ~ ~~ ~ • Ellison & Susan Mdersan • °^x~ re e m • SH ssn • e°r Lavern & ~ ss~ Joseph de • Q Charlare Drexler ~ cug 1aS 4 69 an onna, Ella All Maureen a7 ~ 695 v ro - ~ Jolene ~~ ~ m E' ^ 1"O~' . g0 en, Dh°t~t Ardys Konder Clifford & Anderson • F 5 ; $ 8 142.5 ,~ t T~ ~ .• 167.6 `4~ ~ 212 John Mce 200 77 1'1'amer • , Jean y ~ 121 ~ a ~ a ~ Z 132.7 • Inc . 1 ~ • • ~ T$ & 6 D • 71 i a a+ 70.1 • 183 Wayne TT ~ cynd,ia 198.1 ~ x ~ Steven Thomas & b W . y ~ u i X se e& 1 ~ bert R Tuttle Midrael / er e • &I~Y Linda ~~ K ak N o , Y H ira~e o & Evelyn Granica lames Sr y " ~ Smith Risen; Willie 124 Nansmr • Karrva r 53 es • • nm F 37.5 R Schroeder R Forrest • 40 •OrtDn Plass 120 ~• q0• • . G s •f aloe • ~ • b ~ G n 7rR wro~^^c /`t ~u; p„r~r David Schroeder 155 atlc CO lf1 ~. l.b • ~ p N ~ M,~ Keith ~• ~ ^ ~ ri • • • ~ ~ Betty ~ a D M&P ~ T°BeAm v John & Rose Dnxln - bs.e p x ~ 7g Evel N Francis dr Charles ~ ~ ~ tsar Luann B d ~ Buchit ~ .R ~ Mm~son ~q ~ McCvtchin 17 • "~ r ~ 3 .a Ho martrt P ~ ,o $ Kadileen mueller b ~m tl, our a p o~~,manr< • ~ Omi1h 75.3 218.5 ,~ cl Y. u g ~ 80 '~ ~ ~ 140 f~Q 3 : ~ p er ~• a 7 `V zs a ~° ° " ~ ~ ° $ e~~ 'a" GLENWOOD `~ Fg "°"`` Blue Walz G1 c~t _ David 6 Z .tl ~ Melvin, Duane k orma Rose Mundt b w 16 C I T Y 119.3 ~ $ JS Eileen Schreiber ~ wil4am Walter r 120 ~ ~ A'^~^O^ m. ` i Cila~ of .J ~ ~ Y ~ 80 40 ~ 0 ` ~ 40 c;ob.a „ ~~ t ~ • co Glenwood City t 8 3 • ~ ~ ane& Bonn;~ "' °~ • Davidk » . G •u2 .' ~ Bur leigh r • lxs.z nq za BevCe • d • Q Paul & ~ Donald & ~ rthouse r 120 y y ~ Theresa Hoffman 61.9 u. s mrec • e.e ~ Randy & Ka on er 31.8 ,. „ Iulie Fri Debra ~ eburg • ~ m ~ ~ ~ ~ SCO & Kristi ~' bba Doris Dean LeMay & Wa er gn Andrew ~, o e a ~ T . rnhy Dean ~ ~ ~ ~ 65.5 Teigen Bonnie Gunderson TllDirlpSOri G Bruce N Konder ~'em ~ lberg 115 > ~ e,nhela ao • I j ~ ~ r ntary GLmn 39 Teigen • • ltd ~~ 72 ' w ~ ° 180 ,ew r N al ~ o Hagen l 114.7 x ,`" ~ ~ Robert & • _ Velma Crosb 5 ~o~' 78 r 1"amra y lames 281.5 • 190 Terry & N 80 ~ .R 5 Rehwaldt Iruu oa ork• ~ N ~ n e Breaz 4o Terranm dr thi C 19.7 _ ~ $ . & Kristi W 80 steven Ian cec.s Deanna McGee b o ~ as.R Ma , ~ z ~ • ~ yn a xusaek 12 "`~` Teigen Robert Crosb y ~ Mona Bsem m zt a e " ~ Daniel & • C c n° q .~ Katherine Tultk • $ FC 37.2 M~ neaa , I Tt nn ""r ar ~ 80 162.7 e l lames RkM r9 40 nxmyre Draxter 264 8 7 ~ rem •t. r ykasW tte uR 3300 3 • 2700 2 G • 800 DD 2 SEE PAVE 40 3 000 3100 ,~ ~ F a '~ ~ ~ ~ .;~t ~~f x (~U$TOM ~I1LT ~It3XJ1ES :~ ~ ~ ~ ` ~, `` ~ . ~ <~,~. ODELING ~ RE _ °~,, ,~ ~ M ~,.~ ~ ~. y~ ar ~` "APARTMENT BUILDING , i ' ,.~ ' f- ~ .~~W~ , ~~ ~ 265-4919 R ~ N ~ <~ ~ ~` ~ ~~159~' SANDY GC ~4t~