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016-1035-70-100
c7~n0 3~n d C w~ ~ 7 C ~ O ~ C'! ~ A "'r ~1 ~ ~ .~ ; ~, ~ I 3 3 ~ ~ ~ ~ ~ ~ 0 ~ ~ ~ ~ ~ ~ o r ~ O rn ~ ~ • ? ~~ 3 y ~ a i (~/ j W~ 1~1 ~ D i O ! N Q ~ O 7 p ¢ ro y o !! ` 1 O OT C W C N C D G ! A~ ~ ~ y ~ 7 p 0 ~ A °' °^ ~ v m U) Z D co a o e~ m co D y ~ a C _ o ~l ~ N :. o~~ o oo= y N N Q ° y w O 3 c ~ I n .o ~ 00 =~ o ~ ~ o ~~ ~ v c o d ! ' °~ ~ ~ ~!. ~ W ~o - ' °: ~ I I N fl. ~ I w Z ~ D o I ='+ ~ ~ ' ' ~ ~ o a ~ I m c I w io °- ~ Z ~ ~ y ~ ~ p Z ~ ~ A ~ w ~ I o i .~ Z ~ rn a ~ Z ~ ~ A ~ I c r: Z I y ~ ~ Z O ~ i ~ ao a y N Q Q C71 7 - O '~ ~. C y C1 C ~ Z o d ~ ~ N I . O ~ 'O i H Q p~ I A N ~ I I 3 ~ o I a m o cn ! a ~ b ~ I m ao :° I o O ! m v 0 c I 0 ~- ~ Parcel #: 016-1035-70-100 01/05/2005 08:13 AM PAGE 1 OF 1 Alt. Parcel #: 16.30.15.258A 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: JOHN C & ELIZA S CARSON 2913 160TH AVE GLENWOOD CITY WI 54013 Owner(s): ` =Current Owner * CARSON, JOHN C & ELIZA S Districts: SC =School SP =Special Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 W ITC Property Address(es): * =Primary 2913 160TH AVE Legal Description: Acres: SEC 16 T30 R15W PT NW NW BEING CSM 14/3983 LOT 1 20.080AC 20.080 Plat: 1170-GSM 14/3983 Block/Condo Bldg: LOT 1 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-30N-15W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 07/30/2001 652344 1689/234 W D 08/07/2000 627764 1532/572 LC 07/23/1997 902/512 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 13318 Use Value Assessment Valuations: Last Changed: 10/08/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.080 20,000 127,400 147,400 NO AGRICULTURAL G4 16.000 1,900 0 1,900 NO Totals for 2004: General Property 20.080 21,900 127,400 149,300 Woodland 0.000 0 0 Totals for 2003: General Property 20.080 21,900 127,400 149,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 559 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~ 4 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings m accoraance wnn ~,omm oo, vvis. r~wn. ~,uuC - -- - County C ' // /~ J Attach complete site plan on Plan must a er not less than 8 112 x 11 inches in size Ci ~ p p . include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. /'7 Q ~ ~ ~ ~ '~ ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q ~~ / 1 P/ease print all information. Revi ed ~ Date Personal information you provi may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). l ~ V Property Owner Property Location ,6e ~' Lp Govt. Lot l r ~ 1!4 /~L{/I/4 S,~j T„~p N R ~ ~11REr) W Property Owner's Mailing Address ~ ~ / G o Rd G- Lot # / Block # - Subd. Name or CSM# ~ ~3 ~' 3 City State Zip Code Phone Number ^ City ^ Vllage Town Barest Road ~~~hw ooh ~%t /v l~ ~ o/~ (7/ )07~' = ..S .~ G~eN ~ ©o a/.-,,-~`--- _-._~dc5~~./`-~/ A v e New Construction Use: ~ Residential / Number of bedrooms ~_ Code derived design floaiv rate , ~ GPD ~- ~• ; ^ Replacement Public or comm~eyr~cial -Describe: . ~ - ~i~ ~. G~H C / ft ~ ~ l b /~ ~ c P le ~ ` . / / Flood Plain elevation if app i arent material a General comments fi ~ ~t ,! ~` ,a and recommendations: f 't ?QiQQ I--.~ ' ~ ~ S t C RC!tX /'.' .. a _ _.~\~? Boring # ~ Boring J • ~~ ~ ~ r~ ~ / ~ 1 ~ ~ ft. Depth to limiting factor / [~ Pit Ground surface elev. _ Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 -3/ log a-5 R e 3 ~ ,~ a~ s~a r M r .i -- - ~ - 6 Req- is S { ~'1 f Borino # ~ Boring ~ n _ ~ ~ ~ L ~' ~ I~SI Pit Vrouno surface elev. ~ i tt. ueptn to umtung racior ~ ~ m. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 I o~-1v to R 3 ~ sl ~ ~,~s~ rc M~ e s ~~ ~.~ ~ ~' /- 36 /o ~ 5' ,S R e' C ~ A~r s6 /~/ - -- . ~ .S e T S - `Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ~, Signat ~ CST Number ~ L lv f~ ~ ~. 2 ~. Address Date Evaluation Conducted Telephone N tuber ~~ P./S/ ~yy o ~ G~ 1~7~,r~ ~ i~S a /3 ~ ~ 5-- a o 7/~ 02 d5 = ~~ 3~~8't~wy ~~~. Property Owner 6rt~'eJ~ ~ ~~e~/"l ~ e< L eR Parcel ID #Q~O '~ ~b_~ ~Q ~~~~ Page ~ _ of J Boring # U Boring ®Pit Ground surface elev. ~~~ft. Depth to limiting factor _1~_. in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. 5h. 'Eff#1 •Eff#2 2. - l o -~- S aM 6 F c Lu v ,~- 1 - o e s -- -- • 6 -~ ~ s -~ ^ Boring # ^ Boring _ ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Et~#1 'Eff#2 Boring Boring # ^ Pit Ground surface elev. _ _, ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl' in. Munsell Qu. Sz. Cont. Color Gr. 5z. Sh. `Eff#1 `Eff#2 ` Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 =GODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (2.6(00) .~_.~- 'j-~ _aJ.-. i _-- ~ ___.- - ~ --__ ~ _-.. -..-. r _- /~ ~. _._. ~ ' ~-'1 ~ _'-__- i -I _._-- O __ - - - -- - / ~ ~ I~ 11 ~ _ __ --_7 _.._ _ _ ~ _ . _ _-.__. _- . __-_._ ___ I _-._ ~. __-.. ._---_ ~_ .~ _-_. --_ -_~ _....._ _~ 1 -- _ .--_. ---_ w _ _ I i 4 ~ _._ -- i ~ -__ ___ ' -_._ -._ f ~ __.. I l ~ --_~ ~.-- r-- ~._ --~~. ___ _~. _ -. - .___ _._ _-_. ._~-..;-__.. i 1 -..~._ ___._.. ___.. -..~ _~, __.-. _ ~_ - ._. -._-._ - _- _ - ! ~ ______ _ I _.. - - _ 4 1 .--. . 6 ° -- ___ ___ _ _ __ - -- ~ - -~ -_ - ~ -- - -- - - _ ^i 4 ff --- --- ~ -- -- -- - _ _ _ _ _ __ _ ,, _ -- - } ~ -- I - .~. a ---- d --- 1 ---;-- _ - _ _ i __- - ---- - - - - - - _ - ~- --- -- - _ _ ~ i - ~ ---- -- ~ --_ -- ---- -- ~ -- _ - - - l --. _ _ ,--- ~ --- -- - - v t o - -- ___ ----_ -- ---~ --- ---- -- -_ __ -_ _ - ~ . ___ --1 ~ - --_ - _ __ _ ~ __ _ ___ e __ - e - - -- , _ __ - _- j -- ' -- - _ - ___ - . _ `~ l _ - - --- -- --- --- -- _ ~--~ - - ~ -- -- --- --- -- __ ___ - - o ~ ~ ~ ~ ~ _ _ _ _ -_ - --- ~_ ~ --- -- ~ ~ . _ __ -- i -- - - --- - -- - ,-- -- ~ _ I ,___ ~ ~ - - 8 ~ 1 - ~ -- ' ~ -- __ ~ __ ___ .~ a ~ # ~' o _ ~9 ~ -- -- -- - ~ - - -- -- -- ~ --- ---- ! -- _ - ~ --- -_ ---- - -- -- -- __~ 1 __- _ - ~ 1_ - - -- -- --- ~ --- --- ---- -- j--- 1 - -- ---- ~--- ~ - - - -- --- -- l - -- - --- - _ -- ---- - - / - ~ -- -~ -- -- , ~ ~ _ } ~ i ~ . _ _ _ __ ~ ~. C~ __._ L ~_ ___ 0 ~ ~ ~- ~ I ~ ~ i i ~ __ _ -- -__ ~ ~ - __ -- _ __ - ~~ - .V __ ~--_ t --- _ i - - -- -- - - - -- --- --- ---- _ -- -- D - A ~ -- _e -~ o - ~ I - - _ __ - - ---- - -- - ~ ' ' ~ I ~ ~ ~ -- ---- --- -- __ -- _ -- -- - -- ---- --- - - --- -- -- --- __ ~y~~" v% ~8/.0, ~ RONAtD i. JOHNSON ~ s-„ag AMERY. WIS. nL 2 ' ~ F{LED 6 OC1 2 6 2000 ~- KATHLEEN H. WALSN v Register 01 Deeds <~~~~pQ-`~~ 4~ SLCIOlxCO«Wl -~ RVEY Locate~in~the Northwest Quarter oft west Quarter and in the Southwest Quarter of the I Quarter all in Section 16, Township 30 North, Range 15 West, Town of Glenwood, St. Croix County, .:~ .:; Prepared for and at the request of: OWNERS: Robert L. and Theresa A. Obermueller 2711 C.T.H."G" Glenwood City, WI. 54017 Dratted by. Jason M. Gustotson 66'-~ NORTHWEST CORNER ~ _ SECT/AN 16-30-15 ~ (FOUND ALUM/NUM .~`, COUNTY M~VUMEN T) i 33`-~I / Ny ~ i ~ ~~'I vc°iv ~a =~1 ° am ~ ~ y . ,N U ~ ~ ~ I M ° j °co-. W -~ ~E `g N ~ ° i ~ I ~ am ' I E .° ; c ; ~ ~ v+~ !.. I I i so l ~.-°,a" WI y„a° ~,~ WI ~ ~ u~i ~I ~3~a ZI j v ~ ° I ~ M N I ai < i o vo ~~ ~i 3 I you of I ~ I i ~ ~ L o ytv O I }'etc al I~.i o~ I °r I ' c ~ v Z 1 O~ 01 °~'~ 0 0 33 -~•) u z °°~o NI o I `°I ~ ~ rn ~ °-' m !~ i w ~ I a~ 2 c ^N I I w ~ I m- ~ I ~ _ ~t ~U ( rn W 1-- ~ Q x N o °z -° ° v N0 1'Fl c}- I ~1 ~I r ~I ~ 1 tD I ~ I WEST QUARTER CORNER ~~ ~ SECTION 16-30-15 ~ ~ (FOUND ALUM/NUA,! COUNTY MONUMENT) ( tF • I i ~: I N: I ~. ~•~- I ~3' TOTAL AREA; \ ~ ~, 874,894 SQ.FT. !1~ ` 2 ?0.08 ACRES 44'''°' 1 ~ AREA EXCLUD/NG R-O-W.~ ~ ~ 810, 354 SQ.FT. 18.60 ACRES 1294.24' X6.07' ~~33.00' ..R-O-W ~ ry ~~' N 89'23'12" W '' ~~` 1329.1 T I, I a~~ ~~~~ J , ~,. V Q ~~22 I V ~~~,~ '33;00' I S 892T44' E 1327.24' 2 ~LOT2 ~ : 3 i ~ TOTAL AREA: I ~ : p r ~ B7,3,6,J6 SQ.FT. ~ m I ~ : I I 20.06 ACRES ~ ~ I m : ~ , ~ AREA EXCLUDING R-O-W° ~ B51, 868 SOFT. h 19.56 ACRES W I N SOUTH L/NE AF' 7HE NW J/4 AF THE NW 1/4 t . ~ 3~ 1292.31' ~r33.00' ~ 5 89'32'1 T ~ 1325.31' ~ o LOT 3 o r~ ~t ~: \ '~ TOTAt AREA: Z ~ _ ' 87?,378 SQ.FT. \ 20 03 ACRES ~ ~ I . AREA EXCLUD/NG R-O-W.` Z I I I 850, 610 Sp.FT. 19 5 3 ACRES ( ~ . _ - 1290.39' .. ~I M ~ I of W OI m ~ uv~f_O-_. o~ .~_zi N JI ~ I Q' a~ i r 00' S 89 36'51` E 1323.39' 33 y ; I 55~1LOT4 I ~ ~ ~ TOTAL AREA: o~i' 871,119 SQ.FT. 20 00 ACRES W j `~ i i I . AREA EXCLUDING R-O-W° -~ , ti ~ i I ' I 849,353 SQ.FT. ~ ~ L- 33' i/ 19.50 ACRES ~ ~~ I %~ 1288.46' ;- 33.00' N 89'41'26` W 1321.46' ~~` v ~`` EAST-WEST QUARTER UNE County Section Corner Monument "----- N 89'41'26" W 5277.74'------ of Record Set 1" x 24" Iron Pipe. weighing UNPLATTED LANDS_ EAST QUARTER CORNER a minimum of 1.13 pounds per SECAON 16-.30-15 linear foot. (FOUND 2" IRON P/PE) 100' Building Setback from Right-Of-Way Centerline _UNPLATTEO_LANDS- Wisconsin. ~ 6 0 T H A {/,E N U E_ -------- N 89'23'12" W 2658.34=------ 7F! L/NE OIF THE NW J/4 i+•~ ~. 5 89 23'12' E 1329.17' + - ~ 160TH AVENUE ~~ ~S 8923'12" E 1 fit... M ................. LOT 1 W3 o~ za J ~ ~Z3 W '~ O x 0.S o~z tr W :~ O f- f= W o: ~ ~N~ a a ~~~ 1~I _z ~ ''- U ~3~ 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, s.15.04 (1)(m)]. Permit Holder's Name: City Village x Township Larson, John Glenwood Townshi CST BM Elev: ' Insp. BM Elev: ' BM Description: ~~ `` l0 0 D ~e, ~ 5'r ~ ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ ~ ~~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L ~a v'TM WELL BL~n .~"t' Vent to it Intake ROAD Septic , ~l t v ~ ~ i ` ~ ~ ~ Dosing t , ~ rJ,,,~ GUU ~1 ~ oG ~ ~ ~ ~ t ~ Aeration Holding d PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number ~~ ,3~ TDH Lift , ~/ Frictio System Head TD ~~t Forcemain Length I Dia r~ Dist. to well ~ NoriN~'- w~~c. /3~ SOIL ABSO TION SYSTEM ~ ZS' county: St. Croix Sanitary Permit No: 405096 0 State Plan ID No: Parcel Tax No: 016-1035-70-100 ELEVATION DATA ~ _~I /n ~ .~ / oz~ STATION BS HI FS ELEV. Z. . 2 ~ Benchmark ~- ~.as ioy,z /0~ Alt. M .S~-.Cev /08- ~? Bld .Sewer slab // . 2 - ~ ra3 ~'" SUHt Inlet /~~ 2s 9. / od, / SUHt Outlet Dt Inlet X03,'7 g• D ottom H der/ a . v3.'7 ~ S /oZ- ? Dist. Pipe X03.7 . S" D 2 , Z Bot. S o , 7S 03'1 2 . / D/. Fina ra e / ~ ~,Q ~~s - ~a3f 3~ t Cover l~l -2~ 2« ~ /~~ r/~ l ~~~ ~3. Z • I i ~ 4~v~~-~ ,~ 3 - /D0, . ~'1 • SS I n. 03 .'1 BED/TRENCH DIMENSIONS Width ^ / ~ / Len / ~1 No. Of Tre ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth j ~ J SETBACK SYSTEM TO P/L BLDG WELL ~1 LAKE/STREAM AC ING Manufacturer: INFORMATION CHA ER OR Type f ystem: \~ ~ SD ~ Y T Model Number: DISTRIBUTION SYSTEM Header/Manifold ~ r)~ Length Dia Distribution Pipe(s) ~l , ~ 6/ /' v Length Dia Spacing x Hole Size ~ /~t~ x Hole Spacing J7 / L nt to Air SOIL' COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only th Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Be rench Center ~ I / Bed/Trench Edges Topsoil ~,~ Yes [~ No r ]Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspectio # ~ 7 130 / ~ ~ Inspection #2: ~ / 30/ OZ Location: 2913 160th Ave Glenwood City, WI 54013 (NW 1/4 NW 1/4 16 T N R151~~~oK 1 ~ Parcel No: 16.30.15.258A /t ~ ~ / ~! < L ~ p~~ ~, 1.) Alt BM Description = ST'~r + ~~ ~~'~"~-~~~ (.~~ke~ ~f b•f ~ ~ jC-SP~T~ GtT!EZ`Fi~CXd /' I ~~ 2.) Bldg sewer length = ~~ r ~~ k1'l.i ~-e~~-+'~-•~~ -amount of cover ~ ~ ,L~,~r'/ ~=~~~U !dW ~ s~~~ ~~ ~~~s~v`~.• 3. Contour = ~ ~ ~ ---- ------ __ ~ -d- ' _ _ -- ----- - ----- - --- Use otherlside for addi on L.L~s '~" No ~ 13U G yl I ~ - -~ ~~r,~--~/~~_~ q L~ ~~ ~l.F' l~ information. _ _ __ _ '- SBD-6710 (R.3/97) /`~ 'h ~^-"~ ~' Date Insepctor's Si ature J Cert. No. n~.~ S,~e~olc~,, ~ ~,?, Gl~~•G~v ~_,~u?c-fz~~• ~,~~ f r PL PLAN - PROJECT John Larson DRESS P.O. Box 71 Knaoo Wi 54749 NW i / 4 NW 1 / 4 S 16 /T 30 ! W TOWN Glenwood COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5/1/02 BEDROOM 3 CONVENTIONAL XXX IN-GROUN ESSURE CONVENTIONAL LIFT HOLDING TANK BENCHMARK V.R.P. Top Of 2 Pipe ASSUME ELEVATIO 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark MOUND SEPTIC TANK SIZE 1000 gallons ~ LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none // SYSTEM ELEVATION 101.4 Scale = 1/4" = 10' __. _ Tank is to be properly bedded and provided with lockdown covers ~` Well is to meet all setbacks found in Comm. 83 Grading is to be done to divert run- B - 2 off away from system with approved warning labels B.M. Alt. B.M. 660' Property Line Pro 3 Bedroom House ~~ __~ G ~~- N eeks ' B-1 7% Slope S "`'' ~ • r ~s ~ qor ST ~~~1L ~<< ~1 '' i c ~1~~ ~ ~0 0 a 0 DT ~c,~~otc,a,, ~ T ~_ 1 01' B-3 Area 15' Below System is to remain undisturbed 100 9 9' / H.R.P.1 500' 290th St. ~ ~ `+ M ti ~. fir. T WtATR{fK~R017r ~ ; +-ltROvta MOGitf11IG =is =AO~ OOCR. ~ ~ .af~-iC":pl„i sax .'M~N~10LC eevRR ,UtR 1Af •'AN f t ~ , QrlIAiSR ~ I i _~~i ~ ~ i 1 I '1" IM~Ai, ~0'p1iN. f GO#uDYIT/~ ~•••• i~M1Ai. ` ar rr~~ ~ s tAfllT _ rROv,~= ~ .... .... s A } ~~; ~ I t j O ~ ~ ~-i.I11tM . APPROVES PIPE t O SOLIA SCI. •.. Gfe GOf1iCRtTf iWCK Rr!!R tX;T sC1t1~1?t'ta d#.1Ly t- TAtWt ~pCTLRIR NAf ~SiCN Ai-tltpllt+„ u~~ ~CtRitLT~p~j • MAYitK~-tT1.IRiA: !At~-K ski; ___X4°' k11~iIR~fR ~ aDl=!2 *LR iAi bRLi•01~ii D4t~= VOLWNt ~ CY'ifA~iR:..li~.I~Zy scr<~c. ~~-Ci.+tl~sN4 *ACI~I-604-: ,~ ~/!Ti!! TO~ii s n ~ CIMACtTI~=t /~ ~~b c J RfC1iC/ OR -~~~~~ ML+•Oot! .~i1{~ h~M~iiltl-6'I`NMttit! __ _ s • ~M~~i OR iAt.4OYt ~ ~~ n,~.rriy„ "'~oes~. yvM~tR: '~ d _ `~` ~' ~u+#es~ Otl Mwye#~ iM~rTtM TM1t: ~ ~ iNC~+Ri ~ ~*~.Va. OAi,~OAtt rt#MlMYlh 01iCKA1~~ RA7'i ~~• ruM~ A1~10 .At.a=ltM~ AR! TQ K vc~ric,~~ stntRfi~t ~rr+ ~+NST+~+.+•to ou ~t!#uillT[ CiRl4;~~ •t1' WtRrrt Rw~r Ma OtsTRtiLir:~ pit.. ,~ Rt;Y ~~ * r~~iwMii~t 1wItTWf~RK iu#'~y Mtt tiiRt ..... , . . . +~,.G~r, rctt a~ soRec ry~u ~ ~/ ~~ 3, rtt~r ~ , ~/. ?,~'~u~,~ r~TOlfR~ltTt~aiJ riAtTDlt/~„~'~,! TOTS„ py111AM#C MEAD a .,,~.~„ 1~'=.!! ~"fFit-tllt DiM! f~ t F '1"r-A,tK: i. RN6Th ~~ `_~ /~ --...-.."~.,.:w~at>• : i.it~titi9 DCATf~4 ,~....~...... b~;8 C: ~ ~~~~ ~.1GC ~l: F +~iliM B~ l . r t . Safety and Buildings Division Camty ' ' 201 W. Washington Ave., P.O. Box 7162 ~ Madison, WI 53707 - 7162 ~ Site Address ~~~~~5~~ D artment of Commerce S Z~ 0 Z ~ ~~ 2 Sanitary Permit Application ~ , ,y pest Number ~oso9~ In accord with Comm 83.21, Wis. Adm. code, personal information you provide ^ Check if Revision ma be used for ses Privac Law, s15. 1 m tio f ll SrAte p~ I.D. ber ~ orma n In I. Application Information -Please Print A ~j 2 Dl ~~S • i d Parcel Number ~ (, , 3D . I S 2 /4 property Owner's Name (~b~ic o - o3s~~o -~~ .~ Property Owner's Mailin8 Address Properly Location ~ ~ ~ J y~ ~ ST. CROIX COUNTY E N, T , S U Zip Code Lot Number .Block Number City, State ,.~- ~<~~~ Subdivision Name CSM Number II. Bulltiing (check all that apply) ~j' °`~ (p/S `^"` ^City Family Dwelling -Number of Bedrooms-_~~ ~~'~ ^Village ^ public/Cotnt~ - scribe l . 20 o ~P Neare t ^ State owned O , ~ ~4~ u _ f , j `; ~ f ~j ~~~ ~' ~ O bl li e) ca III. Type of ermit: (Check only one box on line A (numbering scheme for internal use). Complete line B if app A For County use New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to ~ stem sam Tank Onl Exis Permit Number Date Issued i $. ^ Check if Sanitary Permit Previously Issued IV. Type of Permit: (Check all that apply (numbering scheme is for internal use) 44 ^ Non -Pressurised In-Ground 47 ^ Sam Filter 50 ^ Constructed Wetland ~ ^ pn~~ In-C',round 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatmem Unit 49 ^ Recitculating 30 ^ Other V, eatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade ad on Elev Required proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) (~`-' U / / ) - ~ VI. Tank Info Capacity in Total Number Manufacturer Fiber Plastic Prefab Site Steel Co~rete Constructed Glass Gallons Gallons of Tanks ~ New Existin8 Tasks Tanks Septic or Holding Tank - Dosing Chamber VII. Responsibility Statement- I, the undersign responsibility for installation of the POWTS shown on the attached plans. Business Phone N b N er um Pl 's Name (Print) Plumber' IvIP/MPRS P umber's ddress (Street, City, State, /l l J " /~C / l~ VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ^ Disapproved Surcharge Fee) ^ Owner Given Initial Adverse ~ „ / LJ l~~ Determination ons for Disapproval ~ (~~~ ~ s IX. Conditions of ApprovaURea 1 'l -- nn L ^~ ~ '' that CXSLHn ` ~e.c,~'t't ~`~~ . Attach e~pide P~ (to the County only) [or the system oa Papa not less than 81/2 x 11 inches m size ~ cRn~~4R (R ~_5/Oil I y ,.,nn Larson PLOT • w.,~~Jl..ww i /4 NW AD ESS P.O. Box 71 Knaoo Wi 54749 1/4S 16 /T 30 ~_ N/R H' TOWN Glenwood ~~ MPRS Shaun Bird 226900 couNTY ST. CROIX CONVENTIONAL )00( 5J1/02 IN-GROUND SSURE DATE BEDROOM 3 CONVENTIONAL LIFT MOUND SEPTIC TANK SIZE 1000 gallons HOLDING TANK HOLDING TANK SIZE ~~ TANK SIZE DOSE TANK SIZE -_ LOAD RATE 1.0 ABSORPTION AREA 450 BENCHMARK V. # of chambers none R.P. Top of 2 Pipe ~' ~ BOREHOLE O ASSUME ELEVATION 100' wELL 'H.R.P. Same as Benchmark Filter Zabel A_lOp SYSTEM ELEVATION 101.4 .Tank is to be properly bedded and provided with kickdown covers with approved warning labels Well is to meet all setbacks found in Comm. 83 Pro 3 Bedroom House Scale - 1 /4" . 1 Q' Grading is to be done to divert run- off away from huffcutt system ~ r combo tank 0 °' a B-1 M T 101' ~\ ~ "~1 0 10 0 ~ ~ 7 /o Slope B - 3 9 9' ~t~~t ---- ,~; B.M. ' ~. n Alt. , ~~~ B.M. ,:~,.. . Area 15' Below System is to remain 5 0 0' --_-' undisturbed 660' Property Line 290th St. N.R.P. . C ~~ ~_~ `~ ~ ~P,~~~ Safety and Buildings 10541 N RANCH ROAD M ~,~Q~~/` HAYWARD WI 54843 ' ` ~ {~ J jA~ <t TDD #: (608) 264-8777 ~scoj~-s~n / ` ~---~° www•commerce.state.wi.us/sb www.wisconsin.gov Department of Commerce ~l ~ Scott McCallum, Govemix Philip Edw. Albert, Secretary May 14, 2002 CUST ID No.226900 SHAUN R BIRD ' BIRD PLUMBING,INC 1008 192 ND AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/14/2004 SITE: John & Eliza Larson 160TH Ave Town of Glenwood 5t Croix County NW1/4, NW1/4, S16, T30N, R15W ATTN.' POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 FOR: Description: Mound 450 Gpd. Object Type: POWT System Regulated Object ID No.: 850343 Identification Numbers ` Transaction ID No. 732014 Site ID No. 644283 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. The following conditions shall be met during construction or installation and prior to occupancy or use: Correspondence Notes: . • This plan action is subject to designer notes /comments on the plan. • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" Version 2.0 SBD-10691-P (N.Ol/Ol) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" (Version Z.0) SBD-10706-P (N.Ol/Ol). 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. 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. S' ly, ~ Fee Required $ 115.00 ~.~,.~,p Fee Received $ 175.00 Thomas EDevereaux / Balance Due $ 0.00 Plumbing / POWTS Reviewer II ,Integrated Services (715)634-3026 , 7:45 am - 4:45 pm Mon. -Fri. tdevereaux@commercestate.wi.us WiSMART code: 7633, cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 5/1 /02 Owner: John Larson System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01 /31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-9. Mai 10-12 S~ Signatu License number 226900 5/1 /02 "';~ 4.~. ~~a~~rc~dly !> `` ~- care cE . Y AND ILDINGS ;~ 5, ..._~-_~r~~~PyDEN~ .~I^'' ~ ..~ ~'jJ -}~ 7J~ !G- G/ PLOT AN PROJECT John Larson AD Ess P.O. Box 71 Knaoo Wi 54749 NW 1!4 NW i/4S 16 /T 30 N/R W TOWN Glenwood COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5/1/02 BEDROOM 3 CONVENTIONAL XXX IN-GROUND SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top Of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 101.4 Scale = 1 /4" = 10' Tank is to be properly bedded and provided with lockdown covers with approved warning labels Well is to meet all setbacks found in Comm. 83 Pro 3 Bedroom House Grading is to be done to divert run- off away from system huffcutt combo tank B-2 ~^ `. B.M. Alt. B.M. . 660' Property Line H.R.P.1 B-1 " 1 01' _ ~_ 10 0~ 7% 9 9' Slope B - 3 _~-- Area 15' Below System is to remain undisturbed .. a~ ~. 0 a` 0 N f0 T 500' 290th St. . Date~~' Q 7i 4" Observation Pipe Perforated Below Filter Fabric AS'~i C-33 S o n d ~" Topsoil ~J ~ ~i $tppe _ Bed Ot j~ 2 Droin Rack L ~~ t /r s ~k r~ w~s ~F lowe d LnYer ~~E. I,d F IVJ/ G (T H J Non-Woven Fitter Fabric ,Distribution Pipe ~'.:ems t ~~ i= = ~ t Force M.oin From Pump Cress Section Of A k!ound -System Usin A Bed For TAe Absorption Area A ~ Ft. 6~ Ft. I l~ . 6 Ft.- J Ft. - ~ _ _ ~ - ,c. .6 Ft. L ~, oZFt. - ~t~~ Ft. ~~~ _ L 1 ~ 4 0bservotion Pipe-~ L --~ - K ~- A ~ - . . W ~ to ----- -------------- --------------------- 1 Force Moin f ...... --------- ------- From Pump 3 ~ . p Distribution Bed Of %Z~- 2 !2 Ptpe -Orrin Rotk I ~„ 4 Obcervation Pipe Permonent Morker Pipe or Rods -- ~_~ _ Plop View pt Mound Uclnp A Bed Far Ttae Absorption Areo ~. wr w- k4 t totated An bottom. s Equdny Spoeed FtttST t?tot.L 1lttttT ~ts Con+lsc~i~ tz r 2 ~ ups' ~ ~ _ - Qistribution Pipe lay Signed: License Number: ~ ~ 6C/" Date : ~ / `r" b L ovt ~ ~~ ~~ ~ °'~,---- I nche s Y~~ Inches 3 / Hole Diameter ~~.6lnch Lateral -" Z ______ Inch (es ~ ~nifoid ~ Inches Force Main " ~ Inches ~ of holes/FiReo~~'p invert Elevation of Later~als~1 Ft. Perforated P+Rt OetOit rage (fit _......_ SEPTIC TANK ~ PUMP C(iAMSER CROSS SECTION AND SPECIFICATIONS ++" CI VENT FIPE 1Z" MIN. ABOVE GRADE ~ MEATt~RPR~F > 25' FROM DOOR. WINDOW OR JttNCTiON BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W! PADLOCK 8 FINISHED''G~R~ADE~ n ~-~-----WARNI~iG LABEL l Fp~i,~-• ! ~---..".""~ _,b. LJ1+ _~-~-~,..~ 4" MIN . 18" ~lIN y- C•z. tie~itw:rio~t .r.a. ~ {'lfE. .r. ~'~ ; 18uM1N. INLET ~~ ' WATER TIGHT SEALS ~ ! GAS- ~~ TIGHT , OJ~1PPRdYED FILTER ---+- A SEAL f ~ JOtt4TS WITH APPROVED -~-'- ~ ~ ~ APPROVED PiPF PIPE 3' --BF-- ~ i QN 3' ~ ~p SID C ' ~ SOt.IO SOIL SOiI pUMp pFF ELEV . ~ T. --~-- OFF D 3" APPROVED BEDDING UNDER TANK /~ CO CRETE PAD SPECIFICATIONS ~ %~J~GI.1 ti0 SEPTIC f DQSE .~ TANK MANUFACTURER: ~- TANK S I DES : SEPTICI !9'C7 GAL DOSE 36 GAL. ALARH MAiB7FACIVREA: ~"+`~r MODEL NUMBER SWITCH TYPE: PUMP MANUFACTURER: ~"~" M~EL NUliBER SWITCH TYPE: ANHHER DOSES PER DAY: ~~ • DOSE VOLUME INCLUDING ~ ~~ ~~ F LOWSACK : ~,-L-` GAL . APACITIES: A = D`/' ~ INCi~tES = ~ ~~ ~1•• 8 = ~ 2 INCHES = ~ ~/..~GAL. C = ~'SINCHES =~,_ J GAL. D = ~ INCHES = GAL. REQUIRED DISCHARGE RATE ~ c~rr1 - ~[fMP E ALARM LJIRING AS PER ILHR 16.23 WAC ~ VERTICAL DIFFERENCE BETWEEN PUMP OFF AND pISTRIBUTION PIPE ~ FEET ~ ~-FEET + MINIMUM NETWORK SUPPLY PRESSURE + s'6 FEET FQRCEMAIN X ~~ 3 FT ~ } - - - FEET ~ J100 FT. FRICTION FACTOR . ------- - r TOTAL DYNAMIC HEAD ~ FEET ~' ~+ DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: ~_:~~~ ~YQU D SIGNED: }/g8 LICENSE NUMSrR: ~~C7~1/sDATE: ~ / ~~ ~~ Pum Characteristics /Motor llaitt sa>~aers~le Models SNEf44M1 SHFF40N12 Aatoamtic Models SHFf40A1 SHEF40A2 wet 4(10 fu0 Load s 12 6.5 Motor Shaded Pole (4 Pole? R.P.ItI. t sso Plwse 10 volt t 1 i 230 hertz 60 otare 120° F Max. Raid NFJY{A A ~alioe Uess A Size 1 1 J2° NPT Solids 3/4° w • 28 ~s. .Power tad 18/3, S11W, 20' std. (30' oPtiooal} I~imancint'ettil Detc~ AAaterials of Construction stainless steel ~ Dlelearic 08 Motor Cast koa ca • cast lron waft Steil SLaft Seal soil farts: (boo/ceroae~ S~18ody: AAOdized sled S~ Staiel~s Steel. 8elfows: ttnaa-N r ed Woeae S{ee,re Lower Clow BaA Bohan Plate P ester foaled Steel Fasteners Staadess Sinel ~ ~ PPrfnr'mance Data 1 40 5 E F40 30 20 to 0 10 20 30 GP 40 50 60 TO Total Head {feet] 1O 14 17 21 25 28 30 35 (m) 3.0 4.3 5.2 b.l 7.b 8.5 8.8 10.7 GPM (US GPM) 70 60 50 40 30 20 10 0 (liters/sec) 4.4 3.8 3.2 2.5 1.9 1. 3 .63 - O ~-~~s- 6-5~e• (,sezn L All dimensions is indtes. tNletiic for. (98.42) 5' (12~ imemnttonol use). aam• 2. Component ~ ~Y (9a42~ vary + 1/8 utcb. ~ 3. Nof for wttstrucfiott purpose (~sa'.~~ ,,°-,u^/2~P'f unless certified. 3V~J(TACH 4. Dimensions and v are approximate. 5. We reserve the nngghht to make- revtsons 10 oar product and tbea specifrcafrotts triiroul »otKe. „a~a• ,oaks' (2ses2? (258as) ~- r ~ 2' (5o.a) Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7.Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump with out float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715-246-4516 Pumper: Tom Mondor 715-246-5148 St.Croix County Zoning 715-386-4680 Shaun Bird #226900 5!1 /02 w ~ POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page_ ~ Owner P m ~`. ........~...rr,enc NWRSf~ reuw~.._......r.. 3 ~ DNA Number of Bedrooms Nturtt~ of Cornmerdal Units NA Estanatied lbw (average) CS -O flow (peadq, (Esbntated x 1.5) .~ (~ . Soil Ap~cabo++ Rate .. ~ d = ail tnfluentlk~Ek+ent Qus6ly h~ e~ Fats.. Oil 8 Grease (FOG) 530 trtg/L 8ia~chemical Oxygen Demand {BODE} 5220 mglL Total Suspended Solids (1'SS) st50 Pretteabed Effluent Quality Moctfjtly BiC Oxygen Demand {RODS) 530 mgtL Total Suspended Solids (TSS) 530 mglt_ Fecal Coflform (geometric mean) 5t0` cfultt>omt Maxanum F_tfluent Partide Size ys atilt didurtetet SYSTEM SPEGirtt~-++Un~ Septic Tank Capacity /'Oil O p ~- SepticTank Manufacturer ~ NA Effkrer+t Manu[achmer u.,~,L ~ 17 PIA Eft Filter Model / U - o NA Pump-Tank Capacity ~U o NA Pump Tank Maaufadurer o NA .Pump Martufa~iu'er NA Pump Model 0 ^ NA pt'etr+eaiUrt~tt Unit o Sand/Grgvel F~ter ~ o Peat p M Aeration D wetland p won Mangy ^ other: s o in-ground (gravity) o in-9round (pr+essurized) o At-grade mound p o Other; • Vaka~s typical for domestic {non-oomnert~9 was6ewat~ ~d septic tarot et8uent !~ VaNres ~ ~ ~ wastexrater. MAIAtTENANGE 5(.'+ii`vU+.c Service Event Service Frequency Inspect condition of tank(s) At 1e2i5t once m+~Y ^ months ar{s) ' (Maximum 3 yrs.} Pump out contents of tank{s) ad (Y,) of tank volume When combated Sludge and scum equals one-th Insper~ dispersed ~S) At least once every ,~ o months s) (Maximum 3 yrs.} Gear effltent (titer At i~t once every ~,S'''t7 months r(s) Inspect pump. Ptxrtp cx?ntr°>s 8 alarm At least once every ,3 o months~,year(s) O NA laberats and P~st1fe test At feast once every 3 O moo r(s) DNA oa+er. At least once every ^ months ^ year(s} 17 PIA o~ At fast once every ^ months o year(s) o NA tWAiNTENANCE tWSTRUCTtONS otte ~ ~ 9 I~ses ~ irons ~ tanks and dispersal cells shag be made by art attgvWtr d cartyatg POWTS Maattaater; Septage ohs: Master Plumber, Master Plumber Restrid`~ed Sewer: POWi'S lnspecbor: g Operator. Tank ~~ must atdttde a visaed atspediol+ of the tank{s} b identify any missalg ~ brrlcen identiy any cracks a teaks. measure the voltane of combated SN+dge and scum and m check for any bads up ~ pondtrtg of effluent on the ground surface. The disperser oetl(sj shah be vlsuafht ir+sPected th dtedc the effluent levels at the o~ pipes and to check for any ponding of effluent on tl}e ground sucface_ The ponding ~ ~tlurs+t on the gpp~ surface may indicate a failing cortdidon and regttk+es the arurteediatte r+otificatior+ of the bcal regulatory autl~tY- tAmenthe ootnbined accumulation of sludge and scum fi any tank equals one-thrcd (Y~ or moos ~ the tank volume. the entme contents of the tank shad be removed by a Septeige Servicing Operafior and disposed of in accordance with ch. NR t 73.1Afisr:or+sin Administrative Code. - tized POWTS componen pr+etreatiFrrtent components, and arty The servicng of effluent filters, mechanical or pressu ~' at intervals of'12 months or less shaft be perfonn~ by a certified POWTS Maintainer other maintenance or rrlonihorir>g to the bcal ne9utabory aY tiuitt+in 10 days of completion of any servroe event A servir~e (sport shag be pKOVided START UP ANU OPERATION other For new oonstrr+dion. pry to use of the POWTS cheat treatment tank(s) for the presence of painting prod++ds or e fire treatrr~rtt Process and/or damage the dispersal cell(s). If high eortoentrations are dtemk~ds that may impel a septage servicing operator prior to use. detected have the contents of ttte tanlc(s} removed bl- System start up shall not occur whert sod'oanditions are frozen at the infiltrative surface_ Page °~- ~~9 P~ !~P tantr5 ~y ~ above normal higMarater levels. When power is restoried the e~ooess Mrastewaber w~ be discharged to the dial oed(sj in one large dose. overtoad"ng ~ mss? and ~Y resvit in the or stl~faoe disdlarge of etl~ren#. To avoid tl~ station have the catbents of the prirrrp tank nemov~ed Mr a Septage Servidr~ Opefabor prbr.tr power b fhe e~re<rt pump or contact a Pitanber or POWTS Mainta~ef ~ assist ~ m~lrra~r operatkig tl~e pt>rt~ contrds bo restore nom~a! levels wdhin the pump tank !b trot drive ar park vettides over tatdcs and dispersal oeNs. Do not drive or park over. or ottlerwise disturb or compact, the arm withM 15 feet down skrpe ~ any mound or at~rade sod aibsorptiori area. Redtx~icxt or-e~ of the ~ frrom the wastewater stream may kriprove the pa~Orrnanoe and prolong the life of the POWTS: ~~6abywtpes; cigarette butts; condoms; cotton swabs: degfreasers; dental floss: drape disinfet~su~ tat; foruid~or! dtalrt (scurry txtmPj weber; tndt and vegetable peelings; gneas~ herbiddes; meat six rrredi~ons: old P P Pte: s- nags: tmr~oris; and water soitexter brine. ABANDONMMtN't - - When the POWTS tolls anchor is perrrranerray-taken out of service the fodowinq steps shad t~ talaen too insane. that the system is properly and safely abandorr8d &! oomp~rtce with ch_ Camm 83.33. Wisooresirt motive Code: Ad pipkrg Ca tanks and pis stia>f be disconnected and the abandoned pipe opeNrtgs seated. The contents of as tanks and phs shall be renaved and propery disposed of by a Septage Servic~rlg operator. Attu P~Pmg. aq tanks and pits sfra~ be erocavated and rerrtatred or them carers removed-and the void space hied with soli, gravel or artottrer inert solid material. CONTINGENCY PLAN if the POWfS tads and rarfrtot be repctred the n9 measures Have been. or must be taken, to provide a code compliant replacement system: D A suitable. repla~oerrierfCarea bass been evaluated and may lie uhTized for the location of a replacerYtertt sod absorption system- The nepia~cemertt area should he protected from disturbance and c~crrpadion and should not be inftirtged upon by regtrtaed setbacks from existing and proposed structure. lot lines and weds. Failure m protect the replacement area wiq result in the need far a new sort and site evaluation to establish a suitat>te replacement area. Reptaoement systems must comply with the rules in effect at that tone. ^ A suitable replacement area is not avadat~le due to setback and/or sod limitations. Barring advances in POWTS technology a holding tankmay be installed as a last resort to replace the faded POWTS. ~-1]-e sr~e tree not been evacuated m identify a suitable replacement area. Upon faitrxe of the POWTS a sod and srte evaluation must be p~forrned to locate a suitab~ replacement area. If no repiacernent area is avat'table a tank may be installed as a last resort b replace the faded POWTS. and at-grade soil absorption systems maybe neoonsbuded ~ place foilowirg nemaval of the biomat at the irttdb~titne surface. Reconstructions of such systems must comply with the rules in effect at that time. <NYARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAtW LETHAL GASSES ANOfOR p~SUFFICIENT OXYGEN. t~ NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNgEft ANY CBtCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE ttiliF..R10R OF A TANK MAYBE DIFFICULT OR fMPOSSIBLE. ADORIONAL COMMtc"NT'S PnwrS iNSTALI.ER Name ,~~ ,~,~ ; .- Phone ~ ),; ~ ~ - eGarer~ SFavtr•~ivr oPt~2ATOR fPUMPERI Name Phone ~ J - ~ °' ~~ P[NNTS tifaAWl'AINER Name iv 3l r Phone ~/ S -~ ~' r nrer D~1li ATARYAI/TMARITY - ~ -. ---- - - j~- Phone ~ ~ . 3 $ (~- 6~ Tees doaxnant eras dtalted by the staffs of>fie Gieen t,afoe, Mar~elte and Waushara Courtly Zonirg and SanRa6on agaides_ T1~ doaxnett metes tl~e rnirrirnwn reerrts of ch. Carrara $3.22t2i(bx1}(d~(f} and 83.5t(i), {~ d. (3), Wesaonstn AdnurdsVatlve Cade. Use of this douasre~ does not guarantee the Perfortnanoe of tl~e PpVYTS. GMW {7mr} r Y Wisgonsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT ~~ Page of ... ----.__..-- --.... __.......,_............... ---- Coun ~' ~ ry '- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ' 6 / include, but not limited to: vertigl and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ~ / ~~ /(,).35 '~(1 < /~(~ Please print all information. Revi wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). -f e~,~ M ~'t' Property Owner Property Location ) ~O ~ ~/L"~ ~ / ~..~ cv ~Qr~- p ~/ Govt. Lot ~1/4 /4 S T ~ N R ~ E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ^'~ / ~ City State Zip Code Phone Number ~ City ~ Village Town Nearest Road New Construction UseJ-'~ Residential I Number of bedrooms _ ~ _ Code derived design flow rate '~ ~ Replacement ~] P Iic or com r 'al -Describe: Parent material Q ~ / Flood Plain elevation if applicable and recommendations: ~ 5~~.. ~ ~~/~~~~ ~/~ I ~ ~ RECEIVED V MAY 0 3 2002 ~1 U GPD ft. goring Boring # ~ ~ ST. CF~OIX COUNTY ZONING 0 C Pit Ground surface elev. ~ ft. Depth to 1-1~--- or gyn. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-l L ~ 3lL ~i ~' ~ ay-~ ~ S- - ~' Z- s c ~s,~ ~ ,~ ~3 ~Z , s ~ °- S Lr/ - ~ , ~ ~~?- Vii/} y/ • O Boring # Boring (~ Q J} pit Ground surface elev. / / . ~ ft. Depth to limiting factor ~ in. „~~"""" Tom- Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in . Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •E ff#2 / Oy! Z / / l L. ~ l ~+ L~ ~ Yv`i ~ ~ x ~ V - . ~ ~-- m ~ ~~ ~~ S , f~- ~ ~/ ~ - O . O 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 1 mg/L " Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name Please Print) Signature CST Number ~ ,` 2Z ~ ~ Address Date Evaluation Conducted Telephone Number 5t3U-8330 (K07/UU) s Property Owner Parcel ID # Page of ^ Boring Boring # - ~, pit Ground surface elev. - ft. Depth to limiting factor ~ 3~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ 2- ~ 3 --~" G ~ - Jam" ~ • J / r ~ //< ~ ~V ^ Boring # ^ Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/Land TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.0~100) i Prd~ject Name John Larson Address P.O. Box 71 Knapp Wi 54749 Lot 1 Subdivision ------- N W 1 /4 N W 1 /4S 16 T 30 N/R15 W Boring Q Well PL Proper BM or VRP Assume Ele tion 100 f~ System Elevation 101.4 Alt. BM Base of 2" Pipe ~a 98.8' L_ ---~. -~~G'a~ = f~~ l 6 ~ Pro 3 Bedroom House B- B-2 r~ B.M. l Alt. B.M. Soil Test Plot Plan `A'I'M #226900 Date 5/1 /02 Township Glenwood County ST. CROIX Top of 2" Pipe *HRPSW corner of rroperty .~ L a~ a 0 L a 0 N M T ^ 101' 100 ~% 9 9' Slope ~~ 500' 660' Property Line H.R.P. 290th St. #A 28X52 S ~`'~,~ ~el ~ J Z'a/ THE LOG HOME -~ Star construction -Six panel rear door -I.ow-E glass window: -Vinyl siding -'fhermopane windov~ -25 year Owens Corn...a ~..~~.a..,~ -Porcelain bath sinks -Frost tree exterior faucet -~0 g:il. water heater w/ double element -Single-lever kitchen faucet -40 Ih. snow load roof -Hot surt'ace ignition gas furnace -Zx6 exterior wall studs -(2) Exterior receptacle -One-piece fiberglass tub (bath 2) Perimeter Span -Glamour tub & fiberglass shower (mstr bth) -4" backsplash in kitchen & bath -123 cu. ft. frost free refrigerator -30" gas range -Hardwood cabinet doors & stiles -Cathedral ceilings throughout -Perimeter heat w/toe kick register (kitchen) ADDITIONAL OPTIONS SHOWN IN H OME -Cedcir log siding w/ brown trim -Dishwasher -Sand border -Fireplace-with fieldstone -Patio door -Space saver microwave -angle bay window -200 amp service -Octagon wndw. in M. bath TOWN & COUNTRY HOUSING 715-834-1279 _ ~): 4285 S. PRAIRIE VIEW RD, CHIPPEWA FALLS, WI 54729 ~'.,j Ple~tsevisit us on the Internet at www.townandcountryhousing.com J .a y l 13 7g Sq.Ft. ST CROIX COUNTY SEPTIC TANK bti!~INTENANCE AGREEMENT AND _ OWNERSHIP CERTIFICATION FORM OwnerBuyer `~ 6~~~/~- ~~~~ ~ Mailing Address r ~/, ~S ~.lC /f/~ ®~ l!~! Property Address ~ ~ ~ ~ ~ ~ p J (Verification required from Planning Department for new CityfState Parcel Identification Number LEGAL DESCRIPTIIO,N ~/ ~ ,~ _/~ Location ~" %1" ~~"' 1/4 S~~ T~"N-R ~`~ W, Town of Property /,~ Subdivision f Lot # / Certified Survey Map # ~~7 Volume ~ .Page #~ a Deed #~-~~ ~ ~ Volume ` ~ Page # G_7`-~,T . Wawa ty _, Spec house ^ y~o Lot Lines identifiab~ l~ ^ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 cam affect the fimction of the septic tank as a treatment stage in the waste disposal system. 'I9ie property owner agrees to submit to St. GYoix Zoning Department a certification form, signed by the owner and by a mastuphimber, journeymanplumber, restricted plumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the aaptic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agrx to maintain the private sewage disp~al 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 da f three year a iration date. ~~~~ O 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 pilOperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. OF APPLICANT sr~~ DATE ««~««« «««««« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. «• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made is the warranty deed STATE BAR OF WISCONSIN FORM 2 - J998 WARRANTY DEED DoL~,„ant Number vo)..1689PACE 234 This Deed, made between Robert L. Obermueller and Theresa A. Obermuel er, us an an w>. e -- Tobin O-I:arson an iza ~~arson, fiusband and _ an _wi a as survivors >,p marita~operty -'- - ----,----_ ._ Grantee. Grantor, for a valuable consideration, conveys and warrants to Crantee the following described real estate in St • CrO1X County State of Wisconsin: Part of the Northwest Quarter (NWT) of the Northwest Quarter (NWT), Section Sixteen (16) Township Thirty (30) North, Range Fifteen (15j West. More particularly described as of One (1 Certified Survey Map, filed October , 000, in VQ1ume Fourteen (14), Maps, Page 3983, #~9~ Office of the Register of Deeds for St. Croix County, Wisconsin. 652344` M(RiHLEEN H. WRLSH kEGISTER OF DEEDS E;~, CkDIX CQ,, WI ~ R);Cf 1tlED FDR RECDRD 27-~30-tOs~i 8:~5 AM Lt/4rfa~~~y Q~e3 EXEMPT M CEkT CORY FEE: GOPY FEE: TkAHSFER FEE: 12b.00 kECOkDIHG FEE: J0.00 vacES: 1 Name and Return Address Oakey & Oakey Title PO Box 126 Osceola, WT 54020 ~~ ~.i t 'i ©1(0-!035`70 o~a~eeee- Parcel Identification Number (PIN) ThIs1S nOt homestead property. x(k) Qs not) p(b-Io3S _ ~-o-1~TO (ro.3~ . )S. 2S"FSi~ Exceptions to warranties: Subject to easements and rights-of-way of record, if any; municipal and county zoning ordinances. Dated this _ ~ ~ day of ~~ ` Y 2001 Signature(s) authenticated [his *_ day of , 1 t tt.r.: MbmlteK s~l A~[>r tiAR OF WISCONSIN (If not. authorized by §706.06, WIS. S[ats.) THIS INSTRUMENT WAS DRAFTED BY Francis X. Rivard Menomonie, WI 54751 (Signatures may be authenticated or acknowledged. Both are not necessary) AUTHENTICATION (SEAL) I~ ~o'K'rot ta~ (SEAL) • Robert L. Obermueller (SEAL) ~~l~Ll/J•Gt, ~ (J'~yy1,Cw~.~c_~___ (SEAL) . Theresa A. Obermueller ACKNOWLEDGMENT State of Wisconsin, Personally came before me this )~l'E'h-~ .day of . ~~_. the above named _ _ _ fU me known to be the person ~_ who executed the foregoing 1 ent and acknowledge the same. Notary Public. State of Wlsconsi`~ n - i -- My co mission is permanent. (If not, state expiration date: 11 .) JUANITAA MYER3 ' Names ur persons signing in any capacity muu ~ typed or printed below their signxwre. NOTARY PUBLIC STATE BAR OF WISCONSIN `STATE QP WI$C,~N ~ 1YARRANTY DEED i anlc Co., mc. FORM No. 2 - 1998 Milwaukee, wis. p 8/j~a.• ~} RONALD i. i~t • JOHNSON I s-„a~ li1 AMt= F?Y, WIS. n/ FILED CCT 2 6 2000 - KATHLEEN H.~WAISH ' 1 ~ ~~~`79 Locotec{ In the Northwest Quorter of t~ V E Y M A P Quorter all In Sectlqn 16, Township 30 North, RangeQl5rWestnTowntof Glenwood,tStuCro+z Caunty,NW1 cousin. Prepared for and at the request of: OWNERS: Robert L. and Theresa A. Obermudler UNPtATTED_I.ANDS 2711 C.T.H."G" - - - _ _ Glenwood Clty, WI. 54017 Orofted by. Jason M. Gustalson ~6O TN A VENUE 66'-~ t+-~~-- ""---- N 89'23'12" W 2658.34'------- 1 I NORTH LINE Of• 1HE NW 1/f 17 ' NORTNIVEST CORNER ~ ~ _ S 893'12" E 1328,17' -i P{, 160TH AVENUE ``~`~ _ ~_~ - ^ ~ SECTION 16-30-15 ~ -- - - - - - _ (FOUND ALUM/NUM ~~1 `~ -"~"'S 89'23'12` E 1296.07' `~,~ V - - 000NTY MONUMENT) / `~ / 33=-.•~ :. t... n ................ .... 33.00 t ~' N 89'23'12. W _~ ' ~ ~ ~ LOT 1 •R V O^ ~ • ...*.. ~ ~~` 1326.17' w N t ~ ~ ~ (~ ; TOTAL AREA: ~ 7. t ~t ~ u ~ of ~ ro ; 874, 894 SOFT. 3 m~ 1 I W p 4 ~ ~ ~ ~ (may ; 20.08 ACRES ~ ~ N j ~` •~ ° °' ~ AREA EXCLUDING R-O-W.` ~ito~O ~ ^ ~ 2 TN U > : c~m °~ ~ ~ 810,354 Sq.FT. I W U a o ° ~ ~ ~3~ 18.60 ACRES ~ ~ ~ 2 j u° I Z 7294.24' \ Q ~o j ~ V ~ E ~ o i y ~ '33;00' I S 89'27'44" E 1327.24' 3 ~ ~ 6~ Z N._ao o f °m ~ ~~ LOT 2 ~ ~ ~~~~ o ro ~ i I d. I ~ : ~ I TOTAL AREA: ~ 2 y ~- V °-: c a• I '° ~ ~ • O t 873, 636 S4 FT. W A a C m ~ ~, n.. I 111 i ,~ ~ ~ ~ ~ ; ~ n ?0.06 ACRES V ~ ~ wi `" a o •° tnl ~ I ~ ~ m • „~ AREA EXCLUDING R-O-{SR to z °' ~ ~ °zl I ~ ~ Iri 851,868 SOFT. ~ '~ 3I ° °? °' Q I Q I a ~ ,o0 19.56 ACRES ~ n ~ n:~~ a --~~ ~ I I w 4I o ,n `o ° pl I 3 ~ ( ~ SOUTH L/NE ~ 7NE NW 1/4 OF 1H£ NW 1/•/ '1t OI E o rn~ ~I y + io ~ 1292.31' m m rn~ •o c ai ~ i 'QO ~ r33;00' c 5 89'32'77" E 1325.31' N - pQ_ - Qi -- t P °~ ~a ~~ 0i $ 33'-~ : ~ LOT 3 o a ;~ a~ ~I z ~ '• oo \ rn ~I .°c ° ~ ~ ~ I ~ I ~ : Z TOTAL AREA.• I <~ y q o °, N i I rn' of ; I 872,.'!78 SOFT. 3~ I al m ?' m e i w m~ ~~: I ?0.03 ACRES 2 I j I z l ~ ~ 'c I w + ~ AREA EXCLUDING R-O-1f:° 4i 'o j ~i '~N i ~ ~ ' I 850,610 Sq.FT. ~ I °- 3 ~ r ~ I 19.53 ACRES ~ ~ mo~~ ~ I i ~ t ` v ~ ' 1290.39' ~ w 3 3 a.o ~ + 33;00' S 89'36'51" E 1323.39' ~ ~ in z`~y" No TH ~ LOT 4 ~ °~ 1 c~ zQ I ~ • TOTAL AREA: ~ .~ o- I ~ ~ j am: 871,119 Sq.FT, W I I r I, ~ ~; 20.00 ACRES ~ o'OO i i rn z > ~ ~ AREA EXCL UD/NG R-O- its r~ ~ I t ~ ° o ~ ~ j 849,353 SQ.FT. h ~ tl ~ w "~ o WEST QUARTER CORNER ~~ (~ / 19.50 ACRES W t r ~ = o S£C1)ON 16-30-15 `~ 33 ~ / r N o (FOUND ALUM/NUM ~ I %~ 1288.46' ! o z COUNTY MONUMENT) N 89'41'26' W 1321.46' ~ .'' S" 33.00' ~~ `~`` EA5T-K£ST QUARTER UNE v~ ~~' 3956.28,• j~ County Section Corner Monument -----' N 69'41'26" W 5277,74'------ --' of Record • Set 1" x 24" Iron Pipe weighing UNALATfED_LANDS o minimum of 1.13 pounds per - EAST QUARTER CORNER linear foot. SECTION 16-30-15 • • • • • • 100' Building Setback from Rl ht-Of-W (FOUND 2" IRON P/PE) 9 ~ Centerline oy R-o-w Right-Of-Way APPRp~~V JOB #`A00100 Pr d b prjyy~l~ 1x COUNTY A and P k epare y. er s Co„ Im;hee LAND SURVEIING / ~CT 2 s Z~QQ do CIViL ENGINEERING Phone No. (715) Z46-4319 109 East Third Street, P.O. Box 325 New Richmond, WI 54017 Ifnptr~parWUw11M„gp ~PA/0yRldatea - i Sheet 1 of 2 DWov~l~ llbe 8~~dtrold r~ o: w°°OU~ U m ~~o °w ~ U ~ ww~i ANN aoa h y (~~- z ~m~ Z 'zi 100 a 400 GRAPHIC SCALE SCALE IN FEET: 1 Inch =400 feet Vol. 74 Page 3983