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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 Moe, Dale Glenwood, Town of CST BM Elev; Insp. BM Elev: BM Descri tion: j~~ ,.~ as b TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~~ Aeration ~3 Holding ~ (- ~ ` TANK SETBACK INFORMATION ~~ f~~`t'0~-~ TANK TO P~ WELL BLDG. Ve~ Air Intake ROAD Septic ~ ~ .~ f { J ~ ~ ~ , f / Dosing Aeration Holdin g PUMPISIPHON INFORMATION Manufacturer ~~ N,r ' Demand GPM Model Number ~~-~ 2S TDH Lift ~ :~ Friction Lo~ ~ ~ t~ SQL System Head 3. 'z s- TDH Ft Forc~ ~in f,(.J ~ Length Dia. ~ y Dist. to ; I~S~l V SOfL ABSORPTION SYSTEM ELEVATION DATA ~~~ -~; ~d/ County: $t. CrOIX Sanita ernit No: 487906 0 State Plan ID No: Parcel Tax No: 016-1036-10-100 Section/Town/Range/Map No: 16.30.15.261 B STATION S HI FS ELEV. Benchmark '~ 0 S~ ~~~ Alt. BM _ ._--'' ~.T V Bldg. Sewer ------ s~ . s' / 11 ~ as St/ Inlet j. ~ /pU. S t Outlet ''-____- Dt Inlet ,~--- ~-~' Dt Bottom zy ~~. ~ Head an. ~ ~ /~ Z p Bo, t. System ~ /~v ,~~~ 3~ ~[~J Z~~ Final Grade ~ , ~ ~~ / A ,?~ /~ / ~ t~ St Cover '3 ~fr, ~~ r,rt+w I' Z ~~ D.2 . .~i7U u~ i BED/TRENCH Width Length No. Of Trenches PIT DIMENSI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~j~ ~ // ~ /~ SETBACK TO SYSTE M P/L BLDG WELL LAKE/STREAM LEACHING anufacturer. INFORMATION CHAMB Ty~~yst~m: ~ ' ~I i /~/ ~ (~~ / IT Model Number. DISTRtB11TJON SYSTEM YD.n .n //e. /1 // . f~_ ~ 2i t~ Header anifold n ' Distribution ,.-~ Pipe(s) ~ ~ / ~ x Hole Size x Hole Spacing S Vey n~t to~A,ir~Intake ~ 2/ th Dia Len th Dia= Spacing Len 8 .e4,il~e~f g g SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only `"''~ ""~ `'~ "~"~ Depth Over I _ ~, , (~a Depth Over xx Depth of xx Seeded/Sodded c 8edlTrench Center ' "f'r 0 ~''" _ BedlTrench Edges Topsoil ~T.,~ /rte. /!r„Q/ ~ z~ Yes ~'*~ No "^:'~1~~~1~f' COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~1~1~ Inspection #2: ~ ~ /__~~~~ '~. Location: 1545 290th Street Glenwood~Ci~ty/~WI 54013 (NW 1/4 SW 1/4 16 T30N R1S~W)Q~NA Lot 1 `~ "~ ~ arcel No:y1,6.30./15.2~6~18 ~ 1.}Alt BM Description = ~.3 YW-x-C- ,~v-`~`~ ~ ~ ~ (1I2 LL~ ~~ 1~_~Ls'~ rU„(~w w~{~1/'~ 2.} Bldg sewer length = r ~~ ~ ~I ~ ~(IGt'7~ ~~ 1'~-f ~7~-.- ~'"'' ~ { -amount of cover = ~~ ~U ~ ~f$~dj~(p~_ ~ ~~ ~'V~f -'1u6~ l~ ~ r - - ~-- -- --, , --------T I ------- -- i - -- 1,~I ~ Plan revision Required? ~ _; Yes ~ ~ No ~ J ~~ ~ ` se other side for additional information. L_!____L_ ~ D~ i _~ ~ ~ __~ _ ~ Date Insepctor's ture Gert. No. ~-6710 (R.3197) Safety and Buildings Division County 201 W. Washington P.O. Box 7162 St. Croix iseonsin Madison, WI 07 162,.. Sanitary Permit Number (to be filled in by Co.) Department of Commerce `~ 8~ 0 Sanitary Permit App ~ieati®n state Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, persona informi~yotrprpvide + 1190804 . "TQ.fQtiTS • /~~~ may be used for secondary purposes Privacy w, s 15. )(m Project Address (if different than mailing address) I. Application Information -Please Print All Information %'~~ `-;~'Jti;;~~_l_y 290f' St. # ~S~S Property Owner's Name Parcel #.~ Lot # ~ ~B~1esk~. Dale Moe 06- oho-/o-loa .2Cpl$ Property Owner's Mailing Address Property Location 123 Burr St. NW ''/4 SW '/< Section 16 City, State Zip Code Phone Number , , T 30 N; R 15 W Roberts, WI 54023 715-749 II. Type of Building (check all that apply) , ~ _ X 1 or 2 Family Dwelling -Number of Bedrooms 3 ~ tom" ~ ~~~~ I t ~ lvtslo ame # M Number S tt ^ Public/Commercial -Describe Use ~ ^ State Owned -Describe Use ~ 3 - yk[~uti~s ^City_^Village X Township of Glenwood III. Type of Permit: (Check only one box on line A. Complete line 13 if applicable) `~~ X New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner / U tl IV. T e of POWTS S stem: (Check all that a 1 2.O ^ Non -Pressurized In-Ground ~ _ i to e'~jl Mound < 24 in. of suitable soil At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) f V. Dis ersal/Treatment Area Information: =. 00 , ~ O Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 0.6 ~' ~ O s - n J\ 450 450 102.1 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Stw..~CG STF --110 Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank X 1000 1 Skaw Pre-cast X Aerobic Treatment Unit Dosing Chamber X 642 1 Skaw Pre-cast X VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the PON'TS shown on the attached plans. Plumber's Name (Print) Plumb 's Si r MP/MPRS Number Business Phone Number Tom Gustum ~ .~C2~ '~i~ 227618 715-658-1344 Plumber's Address (Street, City, State, Zip Code) N13450 937°i Street, New Auburn, WI 54757 VIII. Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ^ O n for Denial Surcharge Fee) ~j~"~ `j , Z IX. Conditions of p ~~I{Re~~al 3 Ji y~4~V'~(t ~ "/`guy SYSTEM OWNER: „, , ;~ ~ Sc~ ` ~ !~ 1. 1 Septic tank effluent filter and '~`~"`""' 'f'D `~-" , r J ~ " dispersal cell must all be serviced /maintained ~~ ~ ~ ~ 4 B .^- S; -~ vei ~~ttf~Cib''~ . as per management plan provided by plumber. o~ S~S $ ~~ ~ wm~ Sti ~~ , 2. All setback requirements must be maintained I nn ~ ~ _ r 0. as per applicable code/ordinances. ~a( ~ ~° Attach complete plans (to the (:ounty only) for the system on pa er not less th n 81/2 x 11 inches in size SBD-6398 (R. 01/03) ~ v 3 f ~ ~ ~ Q ~ ~ ~ O d' ~ ~ s ~ 1 I ~ 1 1 1 ~ ~ ~ ~ 1 !" ~ ~ ~ ~ m~'~ '~ 1 m 1 / ~ r GI. m i i ~ ~ ~~~ .6 ~ 0 c~ ~i _ . - d ~ ~ ~ ~ I ~y^~ C ~ , ~ C m ~ Q 7 ~~ i C ~ m ~ ~ 'p- ~ ~ ~ ~~ ~p ~ sO} ~ ~ E M ~ m~ , '~ ~~ fA O ~ Q fA ~'~ ~ ~ ~ ~ ~ ~ - ~ \' ~' ~s` V t L Oft ~ ~ ~ O ~ U ~ ~ Q Q ~ ~ ~ Y (V ~ ~ ~ e a o acnx ~. ~ °° ° '~d-Q.~'~ ~~ a ~ x -- ~ n`a- c .~ Q w 0 'C Q t `~ ~ t m N ~~N~ a ~~~~~ ~~~~58: ,S m ~ ~ ~ ~ ~ E ~~~°Cr-z ° a " N j U ~a ~~ ~M a ~ d. ~ `~ 2 (6 ~` ~ ~ B 0 3 a> o ~ _ O ~ ~ ~ L § ~ -~ II m ~`? ~ `~ ~ o o> ~ $ o LLI cp W a~ ~~ J Q ~ m V ~ ~~ ~~ 11 m m •~~ ~ U f~ Q commerce.wi.gov isconsin~ Department of Commerce Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608j 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 31, 2005 CUST ID No. 679647 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: 08/31/2007 SITE: Moe 290TH St Town of Glenwood St Croix County SE1/4, SW1/4, 520, T34N, R11W Identification Numbers Transaction ID No. 1190804 Site ID No. 703942 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Mound System for Dale Moe Object Type: POWTS Component Manual, Regulated Object ID No.: 1037434 Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1) 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P (N.O1/Ol). • The pressure network is to be constructed in accordance with publications SBD-10706- P (NO1/Ol) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (Ol/81)". 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. GUSTUM SEPTIC SERVICE Page 2 8/31/2005 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions. should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~~~ Keith A Wilkinson POWTS Plan Reviewer ,Integrated Services (715) 524-3630, Fax: (715) 524-3633 , M-f 7:45 am - 4:30 pm kwilkinson@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 r .. Mound System pg 1 of 6 Cover Page Project Name: Owner's Name Owners Address Moe 450 GPD Mound Dale Moe 123 Burr Street AUG26 SAFETY ~ BLD Roberts, WI 54023 715-749-3523 -- Legal Description ~ '/a, SW ~ '/4 Sec 16 T 30 N, R 15 j W NW'~ ' '~~ Township Glenwood County ~ Saint Croix ~~ _ _ _ PO WTS Subdivision Lot# Parcel ID# ... Coricli~ionr~lly .P P 0~ D DEPARTMENT OF COMMERCE DI`JIStON OF SAFET AND BUILDINGS Table of Contents 5EE CORRESPONDENCE p9~ 1 Cover page +- ~>, 2 Mound Sizing Calculations ~ D. ~~ ~, ;,~ ~, 3 Pressure Distribution Layout and Dynamics QUSTt1Aq a'~' 4 Dose Tank /Pump Curve 120'1 s 5 Management and Contingency Plan ~e.,_ ~,,: ' 6 Plot Map total # of pages: 6 Designer Name: License #: Date: Ph. #: Signature: Tom Gustum D1201 8/22/2005 715-658-1344 Mound System Design Methods Used per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0)SBD-10691-P (N,01I01) per "Pressure Distribution Component manual for Private Onsite Wastewater Treatment Svstems" (Version 2.0) SBD-10708-P (N 01/01) 'IV. I Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: 3ba@3badvisement.com Mound System Mound Sizing Calculations Project Name: Moe 450 GPD Mound Site Conditions Project Type: ~1 or 2 Family Dwelling ~~ Slope: 6 # of Bedrooms: 3 Depth to limiting factor: 12 in. Absorbtion rate of fill material: 1 gal/ft2/day Absorbtion rate of in-situ soil: 0.6 gal/ftz/day Effluent quality j Eff#i Max BOD effluent value: 220 mg/I Max TSS effluent value: 150 mg/I Design of Entire Fill Cell depth at upslope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H): End slope width (K): Fill length (L): Upslope width (J): Downslope width (Toe) (I): Fill Width (W): Page 2 of 6 24.0 in. 28.4 in. 9.5 in. 6 in. 12 in. 12.0 ft. 99.0 ft. 8.4 ft. 13.4 ft. 27.8 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal/day Basal area required: 750 ft2 Distribution cell width (A): 6.00 ft Basal area available: 1455 ft2 Distribution cell length (B): 75.0 ft Area of Distribution Cell: 450.0 ft2 Observation Pipes Contour Elevation of Mound: 100.10 ft Location from end of cell (Z): 12.5 ft System Elevation of Mound: 102.10 ft Final Grade of Mound: 103.89 ft Mound Plan View /Observation Pipes\ ~Z VV K ;~~ Distribution Celt ti, A f Tilled Area/Fill Material Mound Cross Section Final Crade Synthetic Fabric--- DistrifJUtian Dell ~ '~ ~, System Elevcition-~=. Cover Material Fill Material ;-t- b Lateral In~~ert -~ ~ u .:...~-~ Slope Farcemt3iin System Contcaur Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Page 3 of 6 Pressure Distribution Calculations Project Name: Moe 450 GPD Mound Lateral Layout Lateral elevation: 102.6 ft ---- Rows of Laterals: ' 2 ii • Manifold type: end U ~__ - - --- Orifice diameter: o.iss ~ In. -- - # of Laterals: 2 Distal Pressure: 2.5 ft Lateral Length: ,Z ~ft Orifice Spacing/Distributi~y g Orifice spacing (X): Inches Orifices per lateral: 1 g Avg. ftZ/Orifice: y'I~ft~ i 2..Ov Lateral/Manifold Design Lateral diameter: ivz ~ In. Lateral spacing (S): 3 ft Lateral to cell edge: 1.5 ft Lateral discharge rate: 12.52 gpm System discharge rate: 25.04 gpm Manifold diameter: ~ z _ j • In. Manifold length: 3 ft Forcemain Friction Loss Forcemain length: 47 ft Forcemain diameter: ~ z I ~ In. Friction loss in forcemain: 0.652 ft Lateral Side View Lateral Length Turi}uo wlbal I value or cleanouf Orifices ~ bosom of PVC laferals andforcemaintocanplyw~h anal equally spaced spec~ic~ions perComm 84.30(2) Forcemain ~nnec~ion via fee oraoss to manifoldaf any p~r~ Lateral Plan View ~1 ar~ifc~ld Lateral x x x x x Lateral Length Clean Out Detail Glean-aut plug Grade ~ or ball val~re Observation Pipes Sprinkler Bax Long Sweep 90 ar iwa 45's-~ 6" fviinimu~ Nate r ti g ht cap ar plug Nate: Claret Gallar may 6e used in place of 3l8" bar `--318" Bar I' Mound System Septic, Pump and Dose Tank Project: Moe 450 GPD 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 642 16.47 92 Skaw Precast 1000 Pump and Filter Pump Manufacturer: Little Giant Pump Model: 9EH Effluent Filter: simtec STF 110 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 flinch ~WthV~amingLabel Finish. fulnimum _ Grade Alternate J outlet ~ Location Elect. per Canm 16.28 and 'remain NEC 300 Nkep t orMti- Siphon Device B c D Total Dynamic Head Are laterals highest point? if not, enter highest elevation: 0 ft System head (distal x 1.3} 3.25 ft Vertical Lift ("D" to lateral) t ~ 9.60 ft ~'~ -I Friction loss in forcemain: 0.65 ft Pressure loss from filter: ~ft Total dynamic head (TDH): 13.50 ft Dose Tank Levels In. Gal A Reserve 1~,g ,~8~'~ 325.0 B Pump off to Alarm 2.0 32.9 C Total Dosage 5.2 86.4 D Effluent depth for pump 12.0 197.6 Total Capacity: 39.0 642.0 Pump Curve: 9EH FLAW- L[TERS/HOUR Page 4 of 6 Dosage Volume Does forcemain drain back to tank? Lateral void volume: ~?~2~a1 ft Dosage to absorbtion Cell: 78.2 gal Forcemain volume: '7, ~o ~o ~ -8~tgal Total dosage: 86.4 gal to Pump must be capable of: and head pressure of: 25.0 GPM 13.6 Feet F- W W I a Vi 7.S W r W f s a z.s 80 0 20 40 60 Little Giant FLOW- GALLONS/MINUTE 9EN PUMP PERFORMANCE CURVE 115V 60HZ ~" ~~ ' Wisconsin Department of Commerce SOIL EVALUATION REPO Division Of Safetyarrd BUllditrgs in arrnrrranra with (: mTi m'~~wi~rdl~~ri~'"r _ ( 2076 Page t of 3 Gustum Septic Service a»•~- _ Co my Attach complete site plan on paper not less than 8'r4 x 11 inches in i l d b t t li it d t ti l d h i t l f i t B e. Plan must di ti d .Croix nc u e, u no m e o: ver ca an or zon a re erence po n ( _ rec o4 an percent slope, scale or dmemsions, north arrow, and location and d tance to nearest road.` Pa el LD. Please print all information. ~ f'ersonaf irdorrnation de m be used for second Y'~ P~ eY gY twos { i Y i ~ r; U U N Lew. ~' ~;t.4,d jj e ed ~ D Property Owner Property Location Moe, Dale Govt. Lot n/a NW 1/4 SW 1/4 S t6 T 30 N R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 123 Burr Street n/a n/a N/A City State Zip Code Phone Number ;City ;Village / Town Nearest Road Roberts ~ WI 54023 715-749-3523 Glenwood 290Th Street 1/~ New Construction Use: /i Residential /Number of bedrooms 3 Code derived design flow rate _ j Replacement ;Public or commercial -Describe: Parent material glacial til Flood plain elevation, if applicable General comments and recommendations: Part of 20 acres. Recommend mound syste along 100.1'dour. ``~fis v ~Ier~ 450 GPD n/a Boring # Boring Pit Ground Surface elev. 98.4 ~ ~ t;S u o..~~ . c,~ Depth td I Riifi ~ng factor ~ -~' in• Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DJft2 *Eff#1 *Eff#2 1 0-9 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 9-14 10yr5l4 none sil 2msbk mvfr cw 1f 0.6 0.8 3 14-17 10yr4/4 none sil 2msbk mfr cw 1f 0.6 0.8 4 17-21 10y4/6 none stony sil 2msbk mfr cw - 0.6 0.8 5 ~,35 7.Syr4/6 o27d~r~ rg ,2 gr. scl 2msbk mfi - - 0.4 0.6 Boring # _ 'Boring Pit Ground Surface elev. 102.1 ft. Depth to limiting factor 16 ~. in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/(t2 *Eff#1 *Eff#2 1 0-9 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 9-16 10yr5/4 none sil 2msbk mvfr cw 1f 0.6 0.8 3 116-25 10yr5/6 o2~d`r~,g ,2 sil 2msbk mfr cw 1f 0.6 0.8 4 25-35 7.5yr4/6 c2 7 ~ ~ r~ g 2 gr. scl 2msbk mfi cw - 0.4 0.6 * Fffli ~cnt ~!1 c Rr)r) > 'fin < ~n mnlr anri TCC ~Rn c 1 S!r mrtl- * Fffli ianf ~t'J . Rrlrl c ~n mn/I arui TSC < ~n mn/1 CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Aubum, WI 54757 8/3/2005 715-658-1344 ~', ! ," party O~ Mce, Dale Parcel ID # Page 2 of, 3 ~~ # ~ ` :, - Pit "'"~~' Ground Surface elev. 100.1 ft. Depth to limning factor 12 ,in. Sal Application Rate Horizon Depth nt~Golor"" Domin Redox Description Texture Structure Consistence Boundary Roots 2 ~ *Eff#1 *Eff#2 1 0-7 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 . < 7-10 10yr3/4 none sil 2msbk mvfr cw 1f 0.6 0.8 3 10-12 10yr4/6 none stony sil 2msbk mfr cw 1f 0.6 0.8 4 12-18 7.5y4/6 `'2 j d ~ ~` g 2 gr. sil 2msbk mfr cw - 0.6 0.8 5 18-30 7.5yr4/6 r.2 jp` ~~g ~ gr. scl 2msbk mfi - - 0.4 0.6 ~~ # Boring Pn Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 ^ ~~ # Boring Pn Ground Surface elev. ft. Depth to limiting factor in. Soil application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mgiL * Effluent #2 = GODSa 30 mg/L and TSS < 30 mgll The Department of Cotnmen:e is an equal opportunih- sen•ice provider and emplo~-er. ll you need assistance to access sen~ices ar nswrl motP.;al in on akvrnotn fnrmo4 nlnoen `.n»tant ths. iranorfmont of ~llrt_7~~_21 G7 nr TTV (.(1R_7(•A_R777 r -_ r~ D W n O • ins ~+aosa ~~~ ~ ao u ~ ~ o v ~ u u- D m m ~ r ~ ~ ~ o ~ D <~ rog~' m o `° a " m `°- ° ~ ~ .. ~, ~ - o n ~ ~ . ~ o o ~, o `° ~° m ~ ~ v ~ 'U ~ N ~ O ~ ~ ~ ~ o w~ ~v ~ N Q ~ ~ o ~ ° ' ~ ~ n _ v ~ ~~ ~ N NN m = . ~ r o ~ orog O ~ ' i g D S Z~ ~vw~ ~ O~ ~~ ~i . 7....m LA a O v ~ L ~ ~ i m w ~ e ~~ w~~ a ~o 0 o N ~p W 1 m n W ~ ~ O p~ W -i ~ ~ N ~ ~ g s a c,~ ~ W ~ O c 5 o -, y ~ ~ v 09/22/2005 15:39 715-726-2549 S&B CHIPPEWA FALLS X9/22/05 THC~ 08: a0 FAX ?16 9b6 atiats~ ~~4~? `~a~~ .~ /v^\ e ~ . ~J..i! of ,1 ,il r~ ~ l~Ol ~Yl r~ PAGE 01 •w~.x.rracwrtnwv+MMYiiNnha ~±•.••wrr~a;mwM~:rv~r..:.~`n :• ~Ax R-.EMO Codc Admtnis 715-3116-abeo Ld>.d xk~ P1a3ntag g6-aG77 Post-Ir Fax Note 7871 Date ,L ~- 7b C V ~ 6 From ` S came. 2~ N t a Co. M+"- ~ Phone N Phone r Fax N Fetc e FAx ~UtHBE1~: 715-386-4686 PHONE hrUME~R: 3~i - ~~ NUMBER GF PAC~~S, INGL.~IDING CQYER SMEET: 7 r~~: t~ y t~v ~+- t-~ `r ~ ~~ 4 gE ~+2 ~t~s ~ o c--e. X33 `~ 4~ S ~~ p~s'~C,Z;AINT{ROIX. W I,U:i x7 A .~r~s -~ titi A' .~~•arga!'ClY4R'M`uR'CCIJIIMyIw-N ~prlww.«arinµtuv.~n.r.ui Vi111rtNM~.:.....:•R+ast.~i^•rRl"+rwMY~WO.r-..w-rw.a..vwwl...~~ S'r.CRO~.r GOIINTT GOYtfVNAfQVT G6NTEP ~ ~ S3FJf+~h'E1C t iuc 1 10 ~ C~Nr+rcrvie~ ~QoDI N/pBpN, W~ 5•?t7 - 6 WWr!1~Sic~:.~~I~~r~Rt71% yn,! i4 FAX MEIV[o DATE: ~~ • 22 , zw S- Code Administrative FAX NUMBER: ~~S' ~ ~~ ~ 25'~~ 715-386-4680 Landlnformati F, FROM: ~~t!//V Planning ~, -~ F'~ NUMBER: 715-386-4686 715-386- 4 PHONE NUMBER: 3F1. - ~~ Rea roperty -386-4677 r / R ling NUMBER OF PAGES, INCLUDING COVER SHEET: 7 71 6-4675 "'`._ ,. RE: ~ y `` ~ `` ~ ~ -- - - _ -!- -_--~--~ 5 K' ST. CROIX COUNTY GOVERNMENT CENTER 1 1 O 1 CARMICHAEL ROAD, HUDSON, W/ 54016 71 X386,4686 FAX PZ@CO.SAI NT-C ROIX. W I_US W W W. CO.: SAI NT-CROIX. W!. US i Wisconsin Department of Commerce ~ SOIL EVALUATION REPO -"~'~^- Division of Safely and Buildings in acxordance with C mm 8l~6n{~:~5'd~"~ 2076 Page 1 of 3 Gustum Septic Service • w~-~ ~ ° _ C my Attach complete site plan on paper not less than lii4 x 11 inches in .Plan must CfO1X include but not limited to: vertical and horizontal reference oi t (B ti d d . , p n rec qq~~,a,n -;, ;; ~; percent slope, scale or dmemsions, north avow, and location and di fence tn`l~arest road:' Pa el LD. P/®ase print alt infiormation. Personalinfametion dem be usediorsecond • i(j iiCi;c~UiVTY ~r ,+} c~FFICE Re ewedBy Date Property Ovvner Property Location Moe, Dale Govt. Lot n/a NW 1/4 SW 1/4 S 1G T ;U N R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 123 Burr Street n/a n/a N/A City State Zip Code Phone Number City ,Village /~ Town Nearest Road Roberts WI 54023 715-749-3523 Glenwood 290Th Street /i New Construction Use: / Residential /Number of bedrooms ~ Code dernred design flow rate 1 Replacement ~ Public orcommercial -Describe: Parent material glacial til Flood plain elevation, if applicable General comments and recommendations: Part of 20 acres. Recommend mound system along 100.1' contour. 45i.1 GPD n/a ^ Boring # Borng /; Pft Ground Surface elev. 98.4 ft. Depth to timrlt'ng factor -?~-~' in. Shc Application Rate Horizon Depth Dominant Color Redox Descr~tion Texture Structure Consistence Boundary Roots /ft2 *Eff#1 *Eff#2 1 0-9 10yr3/2 none sit 2msbk mvfr as 2f, i m 0.6 0.8 2 9-14 10yr5/4 none sil 2msbk mvfr cw 1f 0.6 0.8 3 14-17 10yr4/4 none sil 2msbk mfr cvv 1f 0.6 0.8 4 17-21 10y4/6 none stony sil 2msbk mfr cw - 0.6 0.8 5 2i1-,35 7.5yr4/6 c2 ~ d T~~ ~g '2 gr. scl 2msbk mfi - - 0.4 0.6 Boring # - ` Boring . /~ Pit Ground Surface elev. 102.1 ft. pepth to limiting factor min. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP /ft2 *Eff#1 *Eff#2 1 0-9 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 9-16 10yr5/4 none sil 2msbk mvfr cw 1f 0.6 0.8 3 16-25 10 x516 y c2-3d t(n-r72 7.~~r~ 8 sil 2msbk mfr cw 1f 0.6 0.8 4 25-35 7.5yr4/6 02 j d ~ g 2 gr. scl 2msbk mfi cw - 0.4 0.6 * Effluent #1 = BOD ~ 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) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450937th St., New Auburn, WI 54757 8/3/2005 715-658-1344 party O~~ Mce, Dale Parcel ID # Page 2 of 3 a Boring # -' BGnr~g ,w.*..~~ i; - . /~ Pit ~~ """'`~~ Ground Surface elev. 100.1 ft. Depth to limiting factor 12 ,.in. Sal Application Rate T Horizon De ttr Domn nt~'+olor`"' Redox Description Texture Structure Consistence Boundary Roots p ~ *Eff#1 `Eff#2 1 0-7 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 7-10 10yr3/4 none sil 2msbk mvfr cw 1f 0.6 0.8 3 10-12 10yr4/6 none stony sil 2msbk mfr cw 1f 0.6 0.8 4 12-18 7.5y4/6 c2-3d I(hr72 ~ ~~.p 3 gr. sil 2msbk mfr cw - 0.6 0.8 5 18-30 7.5yr4/6 c2-,p 1(h-r7 ~ 7.~~r~ 8 r. scl g 2msbk mfi - - 0.4 0.6 ^ Boring # _ . Bonng 'Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Efi#1 *Eff#2 ^ Boring # `Boring ' Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 `Eff#2 * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mglL * Effluent #2 = BODS <30 mg/Land TSS <30 mg/L The Department of Conuneree is an equal opportunih~ ser~•ice proeider and euiplo~-er. If ~-ou need assistance to access srrt•ices or ...~.rr ...otP.;91 :,, s., oltwy,otP f ..,,ot nrP9oP r....,tq..t the ,iP,.Yrt.,,Pnt of Ft1R_7~F_21 G1 ..r TTV ~r1R_7Fn_R'77'7 ~~~ ~~~~ ~ ~o v ~ u u~ r m a G ~ ~. m ~ ~ ~ ~~i.~ 1" o `~ Z ° x m~4~ s ~~o~ -~ ~~~ u ~ o rt ~o ~~~ ,~ ~ o cn ~ 8 ~ a > > W C7 of cap -T N ~ ~ W 'U '~ ~~ ~ m ~° ~ a W `~ ~ 0 ~ ~ ~~ ~ W ~ ,\ ~ ` A ~ ~~ ~ '\ W ~ N N ~ ~ ,i ~ , W ` i ' ~ ~ '~ i ~ ~ t ~ l I '~I i ~ I ~ ~ ~ °~°9 i 03 N a:Z"~~o^~~ W - cn ' m ' I ' ~ I ~iow I I ~ ~ yS 3 ~ ~ ALA ~ 7' ~- l g S ~ ~ ~ ~ I I ~ r i ~ I I I _4.~ W ~ ~ T V ~ ~ ~ N 1 ~ f0 J ~ m d ~ ~ ~ ~ -~ W ~ N .J~ ~ C7 S O ~ W ' c'~ 2 x O ~ O C -, D °0 1 ~ O Q 0 D~ r • ~ ~, WiscPrisin Department of Commerce SOIL EVALUATION REPORT Page ~ of [)ivision of Safety and Buildings -' in accordance with Comm 85, Wis. Adm. Code County ~ ~ j06 Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and p~ I,p, / O~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~ ~~ ~ ,3~i ,v~® Please print all information. ew ~ Date Personal information you provide may be used fog,r~se~co~ndary purposes (Privacy Law, s. 15.04 (1) (m)). i ~,~ ~ h/ Q Property Owner (^~ V' ~" ` ~ Z W ~ Property Location ~ ~Q ~ Govt. Lot ~,/ f/4~~f1/4 S /~j T ~D N R /~"' fir) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ,City State Zip Code Phone Number ^ Gity ^ Villag 'Town Nearest Road La 6oaCdr "~ dv r D/ (7/ ) ~' D G~ E o d /7~`~ S o2 p 7`h S j~' New Construction Use: (~ Residential ! Number of bedrooms ~_ Cq~e rl-r-i~ ~1es` i~(n ;Aq r to ~ ~ GPD ^ Replacement ^ Public or commercial -Describe: r ' . ~ ``~ ~ ~ _~ ~} -------__----- ft. Parent material ~~i4 Q % A` L ~/.G .L FJoo3'f?t8in+ele cab ~~ ti _ General comments ` ~ s `" ~~~t! 5 . `-T~/j/ /i~ ~ :' and recommendations: ~/L'~L~~ ~ ~~s~yv~-~ ; ~,`~~ ~2-~/~"e ems, _.,,.,,. _ ~ , ,. Boring j\ -? _., ...., ~,.-~,ct ,< ~ ~.~~I) ~~ C.S/~1 /'~// S)S Boring # d~~' /p ~ pit Ground surface elev. ~ ft. Dept~t.tgtirpiti7,x,~ in. - ~ Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure` ence Boundary Roots GP D/ft? in. Munsell Qu. Sz. Cont. Color Sh. Gr. Sz. 'Eff#1 'Eff#2 ` / S ~ S' Bering # ~ Boring Pit Ground surface elev. ~~ ft. Depth to limiting factor ~_ in. Soil licetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDifP in. MunseN Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 v~ © .~ s°r L. a ~ ~ s , ~ z- .- ~~ ~ , _._-- sic ~~ ,~ ~ ~ s. ~, , P ,3 as :~~' ~' _ , -~~! L ~~ iM b ~..~ -- d ~ ~ • Eftfuent #1 = BOD > 30 < 220 ntg/L and TSS >30 < 150 mg/L ' tmuent iF1 = rsw < :w mg/L and t ay < su mcyL CST Name (Please Print) ,, Signa ~ CST Number M/ !~ - vZoZ~~ Address Date Evaluation Conducted Telephone ber „Slf D/J' <~ Property Owner ~~ /~ /'/ ~ ~ Parcel ID # (~/~"'" / ~ .~y ~~ IQ ~'C~O o Page ~ of ~_ <~ Bonng # ^ Boring 9 .Z Pit Ground surface elev. ---~~=f- ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff` in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 y fd a ~ ~ - s ~ ~sd ~- ~= N s ,~..~ , d 2 .. r~ c~6f s t!' wf ,. s' ^ Boring # ° Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ~~ # ^ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/ftT in. Munsell Qu. Sz. Cont, Color Gr. Sz. Sh. •Eff#1 •Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 =GODS < 30 mglL and TSS < 30 mgfL 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 (86/00) a ~~~~ Property Owner ;1 ~~7 /y /'"/ d °V Parcel ID # ~~D r ~~.~d " ~~ ''O~' o Page ~ of _~ ® ~°""~ # ^ Boring 9 z~ Pit Ground surface elev. ---~~=1~ ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP DIft` in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 4 /a o 3 -- s ~s6 ~ ,G ~ s ~...~ ,~ d 2 r~ c' ~6 ~ .s v F .. s ^ Ong # ^ eonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil liption Rate Horizon Depth Dominant Coi Redox Description Texlure Structure Consistence Boundary Roots GP DHf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ~~ # ^ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GP D/f1? in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 `Eff#2 'Effluent #1 =BODE > 30 < 220 mglL and TSS >30 _< 150 mglL `Effluent #2 =BODE < 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. seo-e~o~e.~root _ ~ ~ _~ ~ --- -_ r_ _ i/L/J ... ~_. _ ~ ~ J ~ ~ - _ - ~.. ~_. _~~._ _[l-_ __.. //t _ __._ _.._.. __ ._-___. __.-. __.. I -_ __ _ _..__.~. __-_ • ~ ' ~~ i ~ ~ _ -_ ___ _. ___ ~. -._. -_ __-_ _.. .._- _ ~- _-~ - .-. _. ,.- _- _.___ _.. 1 ~l . - _~ _ I I ~ I ~ -... .~_ ____ ---_ _~-_ ___._._. ~_.__ .~_ ~ __-_ ___ ___ _ _ __ ____.. ` _ _ _- __, . _ - _.___ -. _ -._ __ _-_.. _.__.. ~_ I _- i . ___ ___. _ -_. t ~ - 1 ___ __-_ -- I L ~ ~ ~ - - -- -, - ---- - - -- _ _ - _ ~~ ~ I -- - - ti - -_ -_~1 -- V -- _- I ~ - - - -- ~ --~ -- r - - _ -- --- -_ _ ~ - ~` --- ---, ---- -- ---- ~ ~ ~ _ ~ r- - - -- -- -- _ __ __ _ __ _ _ -- __ , -- ---- - -- - .. _ __ _ __ ' -- -_ _~- I -- ---- j 0 - -- - -- - I-- ' --~ -- ~ - - - --- - - - - ~ ~ ' - ~- - - -- 1 - ---- - - - __ - - - --- - -- _ - }-- I -- - - - - ~ i - -- - - _ ,. ' - - , ~~ -- ~ --- 1- i - -- L- - - - ~ - -- a _ __ --- -- - -_ - _ ~~ I _ __ ~_ , - - -- -- ~ ___ ~ - -- --- - -- - - ~ - - ~ ~ - - ~ 1 ~ - r- -- - -- -- ~ --- I I ~ - -- -- -- - __ - - Q __ --- _ - -- -- - ~ _-- -- - - I-- -- ~_ i - ~ 1~ ~ -- ,~ - } - ____ - - - -- - -- -- - _ -- -- __ -- ~ 1---- - ,--- -- i ~ -- -~ e ~ - ~ e 3 -- - ~ - -~- r I '~ RONALD F. '>~ O ~ ~ ~ ~ .,,V ~,.,,~ ~'~' 6~~i~L~r~B JOHNSON = s-tloa AWISY~ : N~V ~ ~ ~ ,.~~ i ~ ~. r. ~~ <,9 ,y0 ,~ _.._.... ~,:: $2475 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED F~ RECORD '~ ~~ SuR`I~ ~~ ? ~;,~..~~ 10- 6-000 3:00 PM ~''••+~«-w' C E R ...- I-.~~ ~' . E D._ S U R V E Y M ACE4tTIFIED SURVEY IIAP Located in part of $he Northwest quarter of the Southwest quarter of Section 16, TownshiTl~t~: Range 15 West, Town of Glenwood, St. Croix County, Wisconsin. ~~''~i Prepared for and at the request of: EAST QUARTER CORNER ohnER. Moe SECAON 16-30-15 2904 150th Avenue ~ ;\ ~ (FOUND 2 /RON P/PE) Glenwood City, WI. 54013 ~ ~~ a Grafted by. Jason M. Guatofaon~ ~ ~ a ''~ S 00'01'22" W 648.79' COPY FEE: 3.00 TRANSFER FEE: _UNPLATTED_LANDS_~~~Ff EE: 22.00 I ~ EAST UNf OF 1HE NW 1/4 OF 1NE SW 1/4 yN I I v v m °' I I _ ~ o I .~n+o 5 I ~ m ~ o ~ I ~ . U o O ~ ~ ~ v h I .~ E ~i ~ N I .° E -~.. o '~ j N'E °am W I .°.E~.c I i ~rdoo ~ o ~l N N ?, ~ rn Zj h r i ~ _~ a a , ao ~ tat ~ ; ~ a o to oaid~ ~1 I N O ~ O 0 ~1 I 4.1 d' H~ C ._,+ ' ~ i i m to ai .o .s o I I C a,'c o I o m ~ v I ~ .o a I y~~~ I m o °' ~ W I _ y ~m,C ~ ~ ~ ~ I ~ ~N ~wj a o ~ C W ~~~Z I a i ~a~~ 1 ~ 1 H U ~~Q~ j p 0 c ao ~Z O~ ~ z~- °c~ p ~VOj ~~~v ; ~ ~ I ~I APPRC3'~ED ' ~ ST. CROIX COUNTY 2 Planning Zoning and Parks Committee QCT 2 ~ Z~OOQ y If not records in 30 days of approval date arovaf shall be null and void _ I W Q :ss 1 ~ ~I I I WI o I ~ ~ ~ ~ ~1 tnl 2 ~ ,~ zl ~p ~ a sl- ~ ~~~~?~y~ N 3 DI N ~' ~OQ"'~Q.7 `~ m ~ I J ~~~Q~~ •5 l m ~I "1 - to I V ', ~._.. _..__.... -- ____. __.._..._.------ A. ___.. - -- -_.I_.. E~---. _...._._....~_ P ._.__~ 1 T ~ 1 I~ I ~~ I 1 w3 ~~ u_ o ~., w z ~~ ~Z3 ~o~ W M Sao o~z $~< w m ~~O ~00 ~ F W W N O Q ~ to ~ ~ Z_ ~\~_ m tan 3= c~ ` I ~ ~ 9 3 ~ 12 ~ ~ ~~j ~ ~~ . orn p ~1`Q; ~ ~ Ct) aa ~~ ~~ 6 ~0 ~. ....:. ............................................. ~ V 2 z o° RIGHT-OF-WAY ° ~ ~~` M N 00'07'10" W 656.47~~ '`~ 1 / ~ NEST L/NE t71F' 7NE SW 1 •f "~ ~- ~ +"~ ~~~ ~~~ ~ _ .~_ ~ N p0'07'10" W 656.67' _ _ ^ _ _ ~'~EET~ ~ ~ ~ - - _ _ _ ~~ ~-'-' ----- N 00'07'10" W 2627.56=----- ___~-~ ~~~ 29 0 TH S TREE T County Section Comer Monument ------------------"'-~ of Record UNPLATTED LANDS • Set 1" x 24" Iron Pipe weighing a minimum of 1.13 pounds Ner linear foot. ~ • • • • 100' Building Setback from Right-Of-Way t Parcel #: 016-1036-10-1 OO 01/05/2005 08:15 AM PAGE 1 OF 1 Alt. Parcel #: 16.30.15.2616 ~ 016 - TOWN OF GLENWOOD Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner * MOE, DALE E DALE E MOE 123 BURR ROBERTS WI 54023 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description 45 290TH ST SC 2198 GLENWOOD CITY SP 1700 WITC Legal Desce~ption~ --AcFes~, 790 Plat: 1169-CSM 14/3982 S 16 T30N R15W PT NW SW BEING CSM BlocklCondo Bidg: LOT 1 14 3982 LOT 1 19.790AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-30N-15W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 01 /22/2001 637138 1577/329 W D 01 /22/2001 637137 1577/328 W D 02/18/1998 573227 1297/232 LC 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 13324 Use Value Assessment Valuations: Last Changed: 10/06/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 14.790 2,400 0 2,400 NO PRODUCTIVE FORST LANC G6 5.000 10,000 0 10,000 NO Totals for 2004: General Property 19.790 12,400 0 12,400 Woodland 0.000 0 0 Totals for 2003: General Property 19.790 12,400 0 12,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 - Parcel #: 016-1036-10-050 01/05!2005 08:11 AM PAGE 1 OF 1 Alt. Parcel #: 16.30.15.261A 016 -TOWN OF GLENWOOD Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " =Current Owner * MOE, JOHN R JOHN R MOE 2904 150TH AVE GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Property Address{es): ' =Primary Type Dist # Description SC 2198 GLENWOOD CITY ~~ SP 1700 WITC ~ ~ ~~ . ~ ~~ ( f L e~~~~escriptionc' ~ Acres: 0.000 lat: N/A-NOT AVAILABLE , E5 C 16 T30N R15W NW SW FKA 16- - BlocklCondo Bldg: (26: ) EX 14/3982 Tract(s): (Sec-Twn-Rng 401(4 1601!4) -r---`f~_~ ,. 16-30N-15W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 02/18/1998 573227 1297/232 LC 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/13/2000 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~'rD r/~'ll ~~ Q ~~ ~OJ JOHNSON s-„ as AMERY. wts.,~~ r,~a~°° ~ i:_ ~ -l~ ~ FILED O C T 2 6 2000 ~- ~->Nt.~w it.watsH SQL Cro eCo ,~' 2 Q ~~~pb~ ,~ ~ I AN ~ ~~~ E R l~y~r~-~~'~ SURVEY S Ro~'S R E D Locate~in the Northwest Quarter oft west Quarter and in the Southwest Quarter of the Northwes Quarter all in Section 16, Township 30 North, Range 15 West, Town of Glenwood, St. Croix County, Wisconsin. .. ...! ~..f . L. t ~ Prepared for and at the request of: OWNERS: Robert L. and Theresa A. Obermueller 2711 C.T.H."G" Glenwood City, WI. 54017 Drafted by. Jason M. Gustafson NORTHWIt'ST CORNER sECnoN 1s-.3o-1s (FOUND ALUM/NUM COUNTY MONUMENT) U N 'p U y oa~u .Y ,N v 5 C M .,~, p V-°coio ai is ,~ ~ ~ o to ~ am °Ec3 +'v; o 0 u .o ~ o c u ~ +-, a o ~ °' o 'c m ; '~i a °'. ~ a o" ~ o ~, o ~c~u w ~ c •~ ~~o~ crn~o ~ ~ u c ~ o.~ to~0 N y w O~ n- -ayi ~ m c .-: °o ~~ m- - ~ ~~ uV N ~ 3 n, x °z F°- ° v ~t I ~ I NI ~ I 41 ~ 1 Ji ~ of y ~ 1 g~ Z ~ o_~ I~ I ~~ O OI I N! NO TH 66'--~ I 33'--~ ~~~ 2 2 : I I I I I I I I iA c0 M so N 3 in 0 O 0 0 eF I co ai so 33'-~ i~ ~' of w ~ I N I o ~ rn N z 1 I 1 i 1 I I I t ~~ I ~ ~ ~ ~~ WEST QUARTER CORNER ~~ SECAON 16-30-15 (FOUND ALUM/NUM COUNTY MONUMENT) _UNPLATTED_LANDS 160 TH A VENUE -------- N 89'23'12" W 2658.34'------- - rNOR1N UNE OlF' THE NW 1/4 i~ -- - -~. .{f- ~ S 8923'12' E 1329.17' i ~ ~ 160TH AVENUE `~` T. ~. -- _ _ - - - - - `~ ~S 8923'12" E i 96.07' ~ .~ ~, , ~ , , , ~ 33.00 i . ` ~• ................................ ' ~ O T > ~R-o-w r'. . I ( ~ : TOTAL AREA: \ ~ " ^ i~ ~~ I ~ ; 874, 894 SOFT. n ( ~ ; 20.08 ACRES d" ~ ~ c`t~l AREA EXCLUD/NG R-O-W.` ~~tD I ; 810,354 SQ.FT. I 18.60 ACRES 1 ~3. 1294.24' N 89'23'12' W "' ~~\ 1329.1 T 11 11~ I I i . '33;00' I S 89'27'44" E 1327.24' 2 I I I i ~LO T 2 ' 3 I ~ TOTAL AREA: I ( ~ : o i ~ 87,3, 636 SQ.FT. ~ m I~: I I 20.06 ACRES Z ri 'n I m : ~ ~ AREA EXCLUD/NG R-O- i4h ~ ~ ~' M 851, 868 SO. FT. c~.~ ~ ~ I ~ 19.56 ACRES W N I N SOUTH L/NE ~' THE NW 1/4 OVA 7H£ NW 1/4 ~ W = 3 1292.31' o0 m O x33.00' c S 89'32'17" ~ 1325.31' ~ P 0 ~' 8 SLOT 3 ~ I - ~ v, I ~ : Z '~ TOTAt AREA: ~ io ~ ' ~ 872,378 SQ.FT. 3 ao I ~ : ~ \ ' 20.03 ACRES = ~ I I AREA EXCLUD/NG R-O-N!' ~ iD j I ~ 19.5,3 ACRES T I I 1290.39' ~ ' 33;00' S 89'36'51" E 1323.39' y (~S ~ L O T 4 ~~ I ~ ~ ~ TOTAL AREA: i omi 871,119 SQ.FT. ~, i ~ I 20.00 ACRES j `a$ l ~ AREA EXCLUD/NG R-O- N~ ~ ^ I l I : ~ 849,353 SQ.FT. e~ i i ~- 33' i 19.50 ACRES ~" ~ ~ i ~ i i~ _ ~~' 1288.46' ~' • N _8_9 41'26-"--W- ~-1 • ~- 33.00 a32_L•46 `. .' II Fes; `~`` /~~EAST--WF'ST QUARTER UNE ~~ 3956.28 County Section Corner Monu ent --- N 89'41'26" W 5277 4'--- -- --' of Record ~ ~~ •3g~~~ 0 • Set 1" x 24" Iron Pipe weigh UNPL LANDS_ EA UARTER CORNER a minimum of 1.13 pounds per CTION 16-30-15 ' iineor foot. (FOUND 2" /RON PIPE) • • • 100' Building Setback from Right-Of-Way Centerline ~h ~u~2~ j~ Q ~~J~ ~~~~ _~~~ ~I I OI OI NI I - Z I .- J ~I ~I ~I I I 'I w3 u~ ow za ~~ ~Z3 io 0 w``~o ~=°O o~z W~~ U -m <O 0 ~~ Fw o: ~ W W ~ a 'r' ~~ ~~~ z ~\~ ~3~ m ~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address ~ ~ .~ ~U f" f ~J ~ ~o~ ~' fS ~/ ~ ~ C ~ -~ `~D~ Property Address ~ ~~ 2 d Th ~l~n w a ~ ~ ~. , V (Verification required from Planning & Zoning Department for new construction.) City/State C Jan quo ad (j; isG . Parcel Identification Number ~ J~ln ~,~ ~~ C~ ' ~ DO , • ~'r8~ LEGAL DESCRIPTION q~ \1 r ~ ~ ~ IJ / Property Location ~ 1/4 , ~t~'/4 ,Sec. ~~, T ,~U N R GSJ W, T/own of ~~ o a Subdivision Lot # Certified Survey Map # ~ ~a ~7~1 ,Volume ~~ ,Page # ~ ~.. Warranty Deed # !p ~ 7~ ~ 0 ,Volume `'J ,Page # Spec house yes ~ 'no .__ rl Lot lines identifiable` ~es no ...r'' SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms °~G) ~ ~ ~~~~i SIGNATURE OF APPLICANT(S) /~/~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ~~ ~~ ~ ~', i f ~ r +~ °~ '~'~~ h ' ~ ~~ ~~ :.j Z p i 4 d.. ~:~'GI'~. AG ..~_:: a~C~ ~~ i s -~ ~ z ~ . ~U~-- SHPT'- 'Z9, ~-m S' oa.-~tr COQ .~-.. '~ c~o-.,~ ~. ~-~o ~ ~ w~- Qu~~~l c :~ • • Parcel #: 016-1035-95-050 01/05/2005 08:43 AM PAGE 1 OF 1 Alt. Parcel #: 16.30.15.260A 016 - TOWN OF GLENWOOD Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner * MOE, JOHN R JOHN R MOE 2904 150TH AVE GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: _ Acres: 60.210 lat: N/A-NOT AVAILABLE SEC 16 T30N R1 E SW FKA ~1 ~- 95 2 BlocklCondo Bldg: (260) & INC NW W EXC CSM 14/398 \ '"~ Tract(s): (Sec-Twn-Rng 401/4 1601/4) - ~ 16-30N-15W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 02/18/1998 573227 1297/232 LC 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 13323 Use Value Assessment Valuations: Description Class AGRICULTURAL G4 UNDEVELOPED G5 Totals for 2004: General Property Woodland Totals for 2003: General Property Woodland Last Changed: 10/06/2003 Acres Land Improve Total State Reason 59.210 8,200 0 8,200 NO 1.000 100 0 100 NO 60.210 8,300 0 8,300 0.000 0 0 60.210 8,300 0 8,300 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 voi_ ~S~~PACE329 John R. Moe conveys and warrants to Dale E. Moe the following described real estate in St. Croix County, State of Wisconsin: C~3~138 Y,ATHLEEN H. WALSH REGISTEr1 OF DEEDS ST, CRQIX CO., WI RECEIVED FOR RECORD 01-2~-2001 9:30 AM YARRANTY DEED EXEMPT # CERT COPY FEE: COPY FEE: TRANSFER FEE: 90.00 RECORDING FEE: 10.00 PAGES: 1 ling Area and Return Thomas A. McCormack 1020 10"' Avenue P.O. Box 2120 Baldwin, WI 54002 016-1036-10-000 (Parcel Identification Number) Part of the Northwest Qu Southwest Quarter (NW '/4 of SW '/4), more particularly described as follows: L ne Certified Survey Map filed October 26, 2000, in Volume 14 of Certified Survey Maps, at pave 3982, as Document No. 632478, Office of the Register of weeds, St. Croix County, Wisconsin. Exception to warranties: all easements and restrictions of record. C-- This is not homestead property. Dated this ~ day of ~Cc~,~~, , 200 - AUTHENTICATION Signature(s) authenticated this day of signature type or pant name x ~ ~_~_ _ "J R. Moe ACKNOWLEDGMENT STATE OF WISCONSIN ST: CROIX COUNTY P rsonally came : before me'.:. this ~ day of ~QK. ~r,7 , 200 the above named John R. Moe to me known to be the person(s) who executed a fgg g instrument a cknowledge the s ~~~ ~ `1'a; ~ ~ , ~ ~~ x .~~~... •~• ... /r' --,- _- --.y. type or print name Z-JV~~,d ~ ~ ~ 5L-i N 1 ~ 1.•. sy* ~~ •~• \ y ~r N~ ~^ B - 2 ~a' SOH.*:SnN r ~••.iR'+~ !8 Bi~4~'$ a-, ..-~ ~ KATHLEEN H. iJALSN Aiv~4--~-, REGISTER OF DEEDS WI5. _ ~ + ST. CROIX CO., WI ~,r ~ O~,r ~~ NO ~~ RECEIVED FOR RECORD ~~ SURJ ~ ''••~•+++~"' C E R T I F I E D SURVEY M Al0- -~oo0 3:00 ~, e TIFIED st~uEY i11RP Located in part of the Northwest Quarter of the Southwest Quorter of Section Range 15 West, Town of Glenwood St. Croix Count Wis o i 16, Townshi~XTl~rth" t:t GuvT FEE , y, c ns n. . COPY FEEL 3.00 Prepared for and at the request of: TRAMSFER FEE: pyyli~. EAST QUARTER CORNER UNPLA7TED LANDS $ SEE: 12.00 John R. Moe ~ SECTION 16-30-15 - -P~~ - 2 2904 150th Avenue ~ Glenwood City, WI. 54013 , ~ Orofted by.Joson M. Gustafson Il + ~~~ N ~ ~ :! i (FOUND 2" /RON P/PE) 00"01'22" w 646.79' I ~ EAST UNE OF THE NW i/f O1F 7NE SW 1/4 ~ 7 t ' APPROVED ST. CROIX COUNTY Planning 2txtinp and Parks CommiNae ~ OCT 2 6 200Q _ ~ N 1 i ~ c o ~ p 1 ~' It not teoorded within 30 days of ~ N s ~ ~ approval date approval shall b0 ., ? ~ ? .~ $ a I I i ~ ~ null and void I 1 p .~. c U ° ~ ~ sF ~ n 1 1 1 1 ~ ~ ~ N I I I ~ 1 1 1 p~ p o ~ ~ ~ ! C dm W 1 V I '~ E c 3 C.7 yj O O I 01 io N ~ ~ V m a o c v ~y ate. 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Z roc a n i ~ ~ N p0.07'10" W 856.67' _ _ ~T~EET~ ~ ~ ~' ------N 00'07'10' W 2627.56=---- ---" 29 0TH S TREE T County Section Comer Monument ----'---------------- of Record _UNPLATTEO_~ANDS_ • Set 1" x 24" Iron Pipe weighing a minimum o/ 1.13 pounds per linear toot. • • • • 100' Building Setback from Right-Of-Way ~, Centerline JOt3 ~ A00101 p Prepared by. , A & E ~ ~j~~D LAND SURVEYING Ac CIVIL ENGINEERIN pCr 2 Phone No. (715) 246-4319 108 East TFlird Street, P.O. box 325 ... kAT1yt 6 ~~~Q ~ New Richmond, WI 54017 4~ ~/~~H. yy~ Sheet 1 of 2 ~. sxp~~ r ~' f W. ~ ~ ` ~`~. .T,. L~~ O Z zoo o zao GRAPHIC SCALE SCALE IN FEET: 1 Jnch 200 feet Vol . 7 ~ Page 3982