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016-1037-20-050
Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATIQ?V ~ (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 Sandber ,Dan Glenwood, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic /~ , 3 . S 1~1-. " 1/ i (Z; /a66 Dosing ~~ Aeratioa ^-~ G G.~ -OD Holding -___ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 /06 / ~~.. 3l + 3 / Dosing ~ /~ ~ N~- + i 3~ --. Aeration Holding ~- PUMP/SIPHON INFORMATION ..~ ~/ Manufacturer Q ~ Demand ~ , GPM Model Number ~~ ~ ~ , lr ~~ '7 TDH Lift Friction Loss System Head TDH Ft S. 37 Z ~ 7$ Forcemain Le 1 Dia. +/ Dist. to well ~3 7 Z g- SOIL ~4BSORPTION SYSTEM ELEVATION DATA County: St. CrolX Sanitary Permit No: 487924 0 State Plan ID No: Parcel Tax No: Sectionlrown/Range/Map No: 17.30.15. STATION BS ~~$ HI /a/ •/ FS ELEV. Benchmark /Z•y~ I iz.4y~ r' c~ Alt. BM A )~ , r~ /V Bldg. Sewer / ~Q ~ ~ . ~ O I SUHt Inlet 17.32 / 5• ~lO St/Ht Outlet ~ Dt Inlet ~ ~~ Dt Bottom ZZ. a3 ~ / . f `J Header/Man. 3, (~~ ~6 9 ~ 5 2.. Dist. Pipe 3, ~ ~ ~ g ~ 5 Z Bot. System ,/r 3` 7 J ` ~ • $ Final Grade St Cover ~n _ `/ BED/TRENCH Width + Length No. Of Tren es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ 5 ~ 7 ~~~000CCC _~ `_ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. ~ INFORMATION CHAMBER OR T e Of S stem: Yp ,/~ Y 1 1 O.J ~r~- , /~ ~ 75a' ~~ ^ I~, / 1/ UNIT Model Number. ~ nl_CTRIRI ITInN RVSTFM HeaderlManifold Length 3 ' Z + /I l Dia ~ !f 2 Distribution ~2> Pipe(s) Length I ~f Dia ~ 2 Spacing , ~ ~ Z x Hole Size + I ~ x Hole Spacing / / • / Vent to Air Intake SOII COVFR ,, o.e~~~~.o s..~+em¢ n.,t~ YY Mnnnd nr At-Grade Systems Only Depth Over / Bedlrrench Center / / Depth Over Bed/Trench Edges \ xx Depth of Topsoil ~ ~- xx Seeded/Sodded :] No es xx Mulched Yes ` ; -~ No ~ ~ ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /~ /~/_~ Inspection #2: / /_ Location: 2859 160th Avenue Glenwood Ci , WI 54013 (NW 114 NE 1/4 17 T30N R15W) NA Lot 1 5D. IS U~ Parcel No: 17.30.15. n 1.) Alt BM Description = r 2.) Bldg sewer length = 3 f ~o~ 5.~-~ P~°"~` - amount of cover = i/ 7 ~Z Plan revision Required? ~~Ei Yes Vo ~ 1 ' I ~ d~j Use other side for additional information. _~_ `. ~_! J JI' Date SBD-6710 (R.3197) ~~ --~ - T_ (~_ 3--`~ 7 ~_ Cert. No. P Sakty and Buildings Division ?0 i '~V. Washington A,ve„ ,7.0. Box 71 Cvunry \JJl , ,. ~~~~~~~ • MadiSOn, VyI 53707 -- 7l6 - _ itafy Permit Number (tnTie fil ed in by Co.) ~ (608) 265-.1151 ~ a Department of Commerce • Sax~%tary Pe~-m>it ,A-,p~lication ~~ LD. Nutnblt ~ ~ 8a ~` ' In accoM with Comm 83,2t, Wis, Ad:n. Code. personal info -°--•'- Wray be used for secondary purvoses Privacy Law, s 5.04(1 ~` ~ ~~ - 'ecr res.Q (if dif Brent than maUing address) ~ I. Application xnfotrrtlation _ Please Print All Ini;orntatiort ~; ~' ~~~] / ~J ~i I - ~ m, Owncr•s N BJock A araet R Lot ' ~ ~ S7. LRGIX COUNTS ' PeRY Ovmer's Mailing Address ~ ,E uFc.y Lrn:atio ~ ~l. , Secsion• ~~ Gity, S Zip COd phnnr. Nnmhe:r , f UfCle T,~QN; R~o l ) ll that'a e TI T f Bui ( h k pp y ~ ~~~~ ~ /~%Kn'~ c . ,gp o int: ec a •G / auhdivision Name GSNI Number or 2 Family Awclline -Number oFBedrooma l~ 1 U ^ ~D ~Q ~~~ PublicJCommc~ial-Dcxribc se ~ ^ by [}v'lltage l~fuwnstdp of ~Q _ ^ Stile Owned - Aeseribe Use I;II. T ype of Pernnit: (Checlt ortly one bvx qn line A. 'Cmrnplete line 8 if appiicabie) A. ew S ^ Replacement System ^ TrestmcnVHolding lank Replacemrnt Only ©Othef ModiScation to 1?Yistin$ System ~. ^ Yennit Kenewal ^ Pennlt Revlsl°n ^ Cluutgc of ~ Pertuic Trm+atEr so r7cw I'~~ i'~vt°us Permit Number srtd pate Issued Before E:tpiratico Yiumbtr Omer IV.'I' o o1F$OWTS svsleen_ Check all t6:tt a ! .__ ^ Non -Plcssuvtn:d 1o-Ground C~ Mound ~ 24 in. ofsuitablc soil Mound < 2d•ia, of suitahle soi]_ ^ Ao-Grada' ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized ln-GrounQ ^ Holding Tank ^ Peat Filter ^ Ae:abic TreattneAt Unit ^ RECirtulating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ ]7ri Line ^ Gravel-less Pi ^ Other (e:c lain ~i r ` Y. bis ersaVTreat ment Area TnformQtion: Daatgn Fiow (apd} z>~ign S i1 Applies ' Rate(gprJ9fj niartlrAa1 Aten Raguired Ga Di9per~1 Area Propoa d (sf) System £Ievatian i o ~:~- ~ ~ y.~ s, , y .o pit y.~ ~ yam, ~ ~ VI.TankIt-to Cnpacityin Gallons Total [i'ullu°s Number uCirtuts Manufacturer. P ab' otoeo Site Coeetructad Stcct Fiber Glass Plastio Nt:w Exlstiag ' Tanlsa Tanrc t•[eaiettraak / !XV / ~.Je ~` AatCl7ie Tnatmeor UtSt • G., • Dasiog GSamEer S VII. )E2esponsibiltty Statement- £, fife undetsiRacd, assume tesponstbillty far iastallatian of the POW'x'8 shwa on the atmched lens. Pl bet's Name (i'rlat} Plumber's Sigeature MP/MPRS Number Husiaass PhoneNumber / J /~Q Lt'~~ ~,~~ Pl bds Adt~ (Street, City, State, Ztp C e) II oun / Approved A~ rtment Lisa Onl ^ DistyDroved SanimrY Permit Fee (includes G.rouad~ ref ~ su in8 AS Si s) ^ Ownet Given )Zcasvn for Denial TX. Conditions of Approval/~easons forbisapp~av:t1 d~ yam, TEM OWNER: S~-~G!/Ytlv~' 1 Sep tc auk effluent filter and q/~9/4 ~: , _ ,~ dispersal cell must all be serviced /maintained ® ~ ~-'~ ~~`,~ ,~ ~ S ry~~. as per management plan provided~by plumber 0 - . 2. A a < requirements must be maintained /~ +~ ~~ ~G ~ ~ aS per aotJlicable code/ordinanres . ' Attach complcle pWos (to me Cannty Doty) for the system tin paper aoe less than 8a/1 x 1.1 iechea En aiar- ~• S.~.D-6398 (R. 41!03) S ~ ~".~ i~L~~, ' /60 ~' ~ri2 _ 3~~ ~ 4l2 s ~ 1320' ne 106.5' 105.5' 1 104.5' ~3 450' Qr ~'~~ ~ ~ ~ ~'~ o ~ Ldw r 0 S'6 0 T ~ ~~ ~ ~~o~ ~,.~ ~ Z ®a T~ Ear r- /~rx. ~ ~ ~ ~ Z 2. 3-/.r'7/ 3v, ytiP~,~ ~v~~/ , -6 ~K~~ _~----, a pG ~-~ /000/,S'-~/U ~~ Gc7s~ ~G ~. S/~'f/vS' ' ~ T 3v ~v ~l s-~/ ~ ~~.,, i ~,h sue. ~e U ~ ii s r c ¢-.~ , ;Z - ~u~ ~y ~f C G. ~ G ~ h V'C Gt1!/O +~ - T!/ c/` , /' 4 f~ ' ~~~ '~ 107.5' ~*:'~ ~/ t ~_ ~ ~ _a ( ZS Is' . r ~---- go~ , ~~ ~~~ ,~ ........... . 55' ,_ ,~ B- 6% Slope (~~o~ ~ ~r : s~.~ ~ ~.~~5 150' Brushy/Grass .area, not farmed by tree TL, ~vv {.~ 7` 100' ~, B.M: 1320' ~" '~ Property Line r . ., coimmerce.wi.gov isconsin Departmerrt of Commerce Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608j 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary September 29, 2005 CUST ID No. 225150 MICHAEL E WILSON HILL TOP EXCAVATING 894 STATE RD 46 PO BOX 232 AMERY WI 54001 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No.1198060 Object Type. POWTS Component Manual Regulated Object ID No.: 1041132 Maintenance required; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1} p f The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Cod and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as def -"~-----.._.._ chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. SEE GO, SITE: Site ID No. 704900 Dan Sandberg Please refer to both identification numbers, 160TH Ave above, in all cones ondence with the a enc . Town of Glenwood St Croix County NW1/4, NE1/4, 517, T30N, R15W ~ FOR: Description: New mound, 3 bedroom residence CO CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/29/2007 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: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. ,I~ey Item(s) / • The manifold must be 1.5" maximum diameter to maintain a flow velocity of at least 2 feet per second. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the f lter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. / = r MICHAEL E WILSON Page 2 9/29/2005 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. • Insulate building sewer per COMM 82.30(11)(c). • Provide frost protection per COMM 83.43(8)(c). 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 sh vide a copy of this letter to the owner and any others who are responsible for the installation, operation ainte ce of the POWTS. Patricia L Shand POWTS Plan eviewer tegrated Services (715) 634-78 0, Fax: 15) 634-5150 , M-f 7:45 am - 4:30 pm pshandorf@c ce.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 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Sandberg Owner's Name: Dan Sandberg Owner's Address: 244 East 9th St. Apt.3 St. Paul, Mn. 55101 Legal Description: NW 1/4 - NE 1/4 -SEC 17 - T30N - R/5W Township: Glenwood County: St. Croix Subdivision Name: 20a. Lot Number: Block Number: NIA """""i'~ ~ T ~. Parcel LD. Number. t"""'all ~. ~ Plan Transaction No.: r Page 1 Index and title Ty AN M cE Page 2 Data entry ~~- S Page 3 Mound drawings Page 4 Lateral and dose tank "P DENCE Page 5 System maintenance specifications Page 6 Management and contingency plan ~ / ~ ~~ Page 7 Pump curve and specifications c Page 8 Site Plan Page 9 Lift Tank Cross Sec. Page 10 Filtration Spec. Designer: Michael E. Wilson License Number: 225150 Date: 09/13/06 Phone Number: 715-268-6626 Signature: ,/~~.~ ~ ~ ~~ Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 5D6-10691-P (N. 01/01}, and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 4.0 (R. 04/03) Page 1 of 10 ~IAound and Pressure Distribution Component Design Design Worksheet Site Inform ation (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd} 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 6.00 Site Slope (%) 107.00 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 70.00 Dispersal Cell Length Along Contour (ft} _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information 2 ' ~`~/ ~~ (c ore) a Center or End Manifold 3.22 Lateral Spacing (ft) 2 Number of Laterals 0.156 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 150.00 Forcemain Length (ft) 95.00 Pump Tank Elevation (ft) 4.55 System Head (ft) x 1.3 13.67 Vertical Lift (ft) ~I 2.04 Friction Loss (ft) ~ 3 r 20.26 Total Dynamic Head (ft) Lateral ~~~ Diameter Selection in. dia. o tions choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal colfform of <= 36 inches. 6.43 Cell Width (ft) Are the laterals the highest int in the distribution Y network? Enter Y or N If N above, enter the elevation ft of the highest point. 9.78 ftz/orifice Does the forcemain drain back? Y Enter Y or N 24.47 Forcemain Drainback (gal} 62.78 5x Void Volume (gal) 87.25 Minimum Dose Volume (gal) 24.77 System Demand (gpm)~ Manifold Diameter Selection in. dia. o tions choice 1.25 x 1.50 x 2.00 3.00 Gallons/lnch Calculator (optional) Treatment Tank Information 500.00 Total Tank Capacity (gal) 1000.00 Se tic Tank Capacity (gal) 36.50 Total Working Liquid Depth (in) Wieser Manufacturer 13.70 gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 500.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer 13.70 Dose Tank Volume (gaUin) A100 Filter Model Number Wieser Manufacturer Project: Sandberg Page 2 of 10 Mound Plan View 1_ L Mound Component Dimensions B :: 3 :.:.:.:• :.:................. ........................... .......................... ........................... .......................... ........................... .......................... ........................... .......................... ........................... .......................... ........................... A 6.43 ft E 22.63 in B 70.00 ft F 9.50 in D 18.00 in G 0.50 ft 450.10 (ftZ) Dispersal Cell Area 6.43 (gpd/ft) Linear Loading Rate H 1.00 ft z 11.62 ft J 7.10 ft K 10.45 ft L 90.91 ft W 25.15 ft 1263.84 (ftz) Basal Area Available 7.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Elevation ~I Dispersal Cell D 6.0 % Site Slope Shading Key a ~. . ~- [~ ~ Topsoil Cap 0 ~ 1.5 ft Subsoil Cap `6 16 ~~: ASTM C33 Sand 0 ~~ Titled Layer r~r~sr~r Aggregate ~ ~ ~ c 0.5 ft _•i___ Finished Grade 110.29 (ft) H 109.00 (ft) Lateral Invert :. 1 107.00 (ft) Contour Elevation '~~:~ ateral ....,.', j r :}eft; :• A ------~ Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (Ax6). -r -f _f -1 Project: Sandberg Page 3 of 10 End Connection Lateral Layout Diagram Laterals centered ower the A h B dimension • =Turn-u p wf bell valve or of een out plu e p, .I All laterals are identical iE x-~I Holes drilled on the bottom of the Latera! i equally spaced ~ Force main oanrwc[ion via tee or gross to manifold at ang point. Laterals h foroe main of PVC Sdr 40 [per Ct7MM Table 84.30-5j Number of Laterals 2 Orifice Diameter Lateral Diameter 1.50 in Orifice Spacing (X) Lateral Length (P) 68.42 ft Orifices per Lateral Lateral Spacing (S} 3.22 ft Orifice Density Lateral Flow Rate 12.39 gpm Manifold Length System Flow Rate 24.77 gpm Manifold Diameter Total Dynamic Head 20.28 ft Forcemain Velocity Dos® Tank Information Electrical as per NEC 300 and ---- Comm 16.28 WAC Disconnect Tank component is properly vented Wieser Ca aci 500.00 Volume 13.70 Manufacturer Gallons gal/inch -r A i3 C D Dimension Inches Gallons A 24.13 330.55 8 2.00 27.40 C 6.37 87.25 D 4.00 54.80 Total 36.50 500.00 in 9.781ft`/orifice 2. Locking cover with warning label and locking device and sealed watertight 4 in. min. -~_ E--- Alternate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P~um o_ff_elevation (ft) 95.33 Dom se tank elevation (ft) 95.00 Alarm Manuafacturer S.J. Eie. Alarm Model Number 101 H.W. Pump Manufacturer Sta-Rite -~ Pump Model Number EC2 Pump Must Deliver 24.77 gpm at 20.26 ft TDH Project: Sandberg Page 4 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Hill Top Excavati~~ Phone 715-268-6626 POWTS Regulator's Name St. Croix County Phone 715-386-4680 Svstem Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 118 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450.1 ftiz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cful100 mL Service Freauencv Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Should ins ct and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ect for ondin and see a e once eve 3 ears Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ..~~~~~........ ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Sandberg Page 5 of 10 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Qeneral This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases maybe present the! could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33. Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an affective locking device to prevent accidental or unauthorized entry into a tank or component. Septic T~ The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The contents of the septic tank shall be disposed of in acxordance with NFt 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed et least once every 3 years by inspection. The outlet filter shall tie leaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retaih solids in the tank that may slough off the fitter when removed from its endosure. If the fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tahk. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be pertomted to maintain less than maximum scum and sludge akxumulation in the tank. The addkion of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. ,P~mp Tank The pump (dosing} tank shah be inspected at least once every 3 years. Ail swttdres, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank tt shall be inspected and serviced as necessary. Mound and Pressusg Distribution Svstem No trees or shrubs should be planted on the mound. Plantings maybe made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) On the mound is not recommended since soil compak~ion may hinder aeretion of the infiltrative surface within the mound and snow k~wnpadion in the winter will promote frost penetration. Cold weather installations (October-February} dilate that the mound be heavily mulched as protection from freezing. Influent quality iMo the mound system may not exk:eed 220 mg/L GODS, 150 mg/! TSS, and 30 mg/L FOG for septic tank effluent or 30 mg11.130D5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent Row may not exkxied maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice dogging has occurred and if orfice leaning is required to maintain squat distribution within the dispersal Coil, Observation pipes within the dispersal coil shah be chedked for effluent pending. Pending levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contfnsrency Plan If the septic tank or any of its Components become defective the tank or component shall be repaired or replaced to keep the system in proper operating Condition. If the dosing tank, pump, pump controls, alamt or related wiring becomes defective the defective component(s) shelf be immediately repaired or replaced with a component of the same or aqua) performance. If the mound component fails to accept wastewater or begins to disdrarge wastewater to the ground surface, tt wifi be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biobgicaly dogged absorption and dispersal media, and related piping, and replaang said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Sandberg Page 6 of 10 s STA-RITE' ^ 4/10 HP ^ Class 30 cast iron construction ^ 1-1/2" (38mm) NPT discharge ^ Carbon/Ceramic mechanical seal ^ Piggy-back style float for automatic or manual operation ^ Oil-filled motor with automatic reset overload provides safe operation ^ 8all bearing construction for long life ^ Easily replaceable power cord with optional lengths available Applications: Effluent and Wastewater Removal, Sump Drainage, Water Transfer, Flood Control Capacities: To 62 GPM (235 LPM) Heads: To 32 FT (9J5 M) Cord. Liquid Temp: 130°F (55°C) Motor: 4/10 HP (1550 RPM); Shaded pole with thermal overload Electrical: 115V,12.5FLA,1 Ph, 80Hz Operation: Tethered models or Manual models Min. Basin Diameter. Simplex =18" (457mm) Duplex = 30' (162mm) Impeller. Thermoplastic, non•clog, vortex type Solids Handling: 1/2' 112.7mm) Power Cord: 10' (3 M- or 20' (6 M)16-3, SJTW-A/SJTW e rt - • EC240110T CAPACITY LITRES PER MINUTE EC2401fOM o so 100 15a 200 250 EC240120T ~a ~ , 10 so ~ ~ ~ ~ ~ o ~ z r,~ '~ ~ ,1 a o 10 -, _ _ ~ 0 0 20 40 60 80 CAP CITY GALLONS PER MINUTE r-U~ 2G T : S4 K .~~..~.~5 EFFLUENT PUMP; . . ^ 1/3 HP ^ Complete Class 30 cast iron construction ^ 1-1/2" ~38mm) NPT discharge ^ Carbon/Ceramic mechanical seal ^ Piggy-back style float for automatic or manual operation ^ Oii-filled motorwith automatic reset overload provides safe operation ^ Ball bearing construction for long life ^ Easily replaceable power cord with optional lengths available Applications: Effluent and Wastewater Removal, Sump Drainage, WaterTransfer, Flood Control Capacities: To 55 GPM (208 LPM) Heads: To 21 FT (8.4 M- Cord. Liquid Temp: 130°F (55°C) Motor. 1/3 HP (1550 RPM); Shaded pole with thermal overload Electrical: 115V,12.OFLA,1 Ph, 60Hr, 230V, 7.OFLA,1 Ph, 60Hz Operation: Tethered models or Manual models Min. Basin Diameter. Simplex =18" (457mm) ,Duplex = 30" (162mm) Impeller. Thermoplastic, non-clog, vortex type Solids Handling: 3/4' (19mm) Power Cord: 20' I6 M-16-3, SJTW-A/SJTW ee EC333120T CAPACITY LITRES PER MINUTE EC333120M EC3332~T 25 EC333210M 20 Z 15 x Q 10 0 -- 0 sa 100 150 ~, z ~~~ ` >, , ~`' yp ~, ° • t, a a z s 2 0 10 20 30 40 50 0 CAPACITY GALLONS PER MINUTE ~s . -7 v -~' !O rho r=' ~e - 3~a ~ was ~' 1320' Property Line 106.5' 105.5' 10' 104.5' B-3 45 0' obi ~~ Ea s T T LT2.~,vcy w c+ ~ Z, p d / v ~ - ~- ~ ' o ~ - • S T • OV - tI ~L~t4L ~I® -ZZ ~-~~ 3v,. y ti p~~ ~o~ ~/ ~ ~K~~ ~.~ s~~, z b-~f 0 ~_ /ooo/S-vv ~= eva- ~~ ~ S/i y/ds'~ {'L1d~x ~., Loy. 4 ? -~~ ~- Q~ ~ _--- Imo' ~~.. ~ ~~~ T 3v ~-v .P/ s--~ ~" sue. `~ ~ s r; c. ~.~ ,-,Z _ ~~-. ~y .~j.^C ~ ~ a c~r~ ~r(~.. c..~vc~~ - 'T~.~..~, f 4~P ~- Brushy/Grass 150' .area, not farmed by tree TL, ~~v -~.~- 7` 100' B . M. 1320' 4w` ~ Property Line 53~" 78" 42" z r m w -i s I I I ~ ~. ~ 3" I 5" ~ D (n I A n m ~ ~ m ~ _ I Z ~ ~ ? e m " ' m n ~ u ~ 45~" ~ ~ l I ~ II II ~ 40" D Z m ~ ~ N D .'D m D Z ~ ~ ~ D ~ n O C --~ ~ ~ D N O ~ p O C~ D ~ Z~ D O r Z Z ~ -mmi rWi ~ ~ pv Omi ~ ~ A Z O g~m~r2~(~WfN ~ C O N y O c~ mZ -AsZ mOmvZrrnpOOD- TZ N A ~ Z D -Dp mO nO =oO~G~==m~~Z /~ ~ n ~ m n m N (~ mC NC 'ir~ ~'aOr~Owcn 0 ~ , A O m n I~T1 In Z ~ rf~ DI~ ~R~i fr+l a'AWN~W VTV7/1 O C7 D Z m C G1 G7 m 07 !n O r:~ ~ n v ~~ z ° ~ D O ~ m ~ ~ zz o ~ o ~ °~ ~ a Z ~ ~ °- ~ ~ m ~ z m ~ m WLP1000/S00-FDL scAlE: ~ 4"=1' REV N0. DATE: 1 DRAWN 8Y: SWT ~ ° = WIESER C~IICAETE SEPTIC MANUAL z N5561 MIRANDA WAY, FOND DU LAC, WI 5937 GATE: JANUARY, 2001 ~ ~° REV. JANUARY 2004 800-641-5937 FlLE:WLP7000 500-FDL / ~ I \ ~ ~ _ ~ 00 O ''~ m ~ Nmr ._--, ~~ . ,, ~~ \~ %' i~ ~~ 1 i ,\` // p ~/'D,~f t~.T: SQw~ ~e.°^~ ~®. % 010 I Us~-~- ~- ~~ 4110E M USA F~Ittrsdon 1~'Ifsn • The original Zabel Filter for waste flows from 3,000gpd to 4,500gpd. • Disc dam design is proven to reduce TSS and BOD in residential and commercial waste flows. • All A100-12 filters come ready to accept the Zabel SmartFilter Alarm. • Easy to install either in the tank or outside the tank in a Zabel Basin Assembly. • Extension handle included with every filter. Commerc Filter Packag A~oo-~sx~ Certified ro ANSi/NSF Standard 4G ~. .~ .~,..r A~oo-AnA Reducers are included with all A100-12x30's they are optional on A100-12x16 Filters .. _~ t, ... Handle Parts Included A=1/2"Tee (SLIPxSLIPxSLIP B =112" FemaleAdapter (MIPTx SLIP ~" ,C C =1/2" edule 40 pipe ~~ WASTEWATER FILTERS & ACCESSORIES A100-12x16 12" x 16" Case and Cartridge A100-12x30 12" x 30" Case and Cartridge ' Ai01-12x16 12" x 16" Replacement Cartridge A101-12x30 12" x 30" Replacement Cartridge 169.95 133.00 108.00 102.00 98.00 208.95 174.00 158.00 152.00 148.00 97.95 81.00 54.00 137.95 115.00 104.00 A100-12x16-FP A100-12x16 and 26" Basin Assembly 293.95 191.00 ~- A100/300-RHEK-SF SmartFilter Retrofit Handle Extension Kit 7.45 4.75 4.50 4.40 4.30 A100/300-RHEK Retrofit Handle Extension Kit 7.45 4.75 4.50 4.40 .4.30 A100/300ADA Extension Apapter 29.95 ~ 19.00 18.00 17.00 16.00 FC100 Flow Control/Maintenance Plate 9.95 9.00 8.00 7.00 6.00 All Zabel Filters are SmartFilter ready. Add $75.00 to the ~~.aJ~~ cT. sG~-,.c~ L~~~~ 1-800-227-574 of anv filter or filter to add the SmartFilter Alarm. PS . /O a-~' ~ O A100-'2x30 Ai00-12x16 .~ Wisconsin depa ee ommefce Division of Safety'arY : di s F~~~~C71~~AL ATION REPORT Page ~ of ~, - ~ ~ aGrAr anF~ w(~n~ oaa , VVIS. Ham, IJWC ~1,~ ~ .: ~ County C .~ ~ 1 ~- an must Attach com lan on• r not le s than 8 1/2 x 11 inches in size lete site J . . p p include, but not limited to: ve ' a ho zonta~r~f~r~gg,~j(ji 19~Jylh dire on and percent slope, scale or dimen. 'o orth rrow, a(~tio~j~(~stance t nearest road. Parcel LD. Q - / ~ ~~~..0--~~ Pleas print a m ormation. R ewed Date ~ Personal iMormaGon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ C/S Property Owner ~ Property Location ~~ T 3 D N R l~ E W ~ N ~ t ( 1-1 /4 S 1 /4 Govt. Lot l.( Property Owners M~ Address t ~ Lot # Block # Subd. Name or~ 7 ~ Cily State Zip Code Phone Number = ~Sl ~ ~ ~ ^ C' ^ ~Ilage own Barest Road ~ l ~ l~ o ~ 3 ( s ~ zl~ ~ t- rv D New Construction U esidential /Number of bedroo Code derived design flow rate J GPD ^ Replacement / ^ Pub' r Comm Describe: ____-___ __ -_- Parent material ! Flood Plain elevation if applicable ~~ ~ ' ft. General corrxne / and rewnlmendations: f ~ '~ t ~v Su~ 61.-~" Ong # ~ Boring pit Ground surface elev. ~ r ~. Depth to limiting factor =~ in. Soil liption Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Efi#1 •Eff#2 U ~.~ Cil~i ~ml- /rl~ ~ /YITJ~ J Boring i ~~ # Pit Ground surface elev~// `-S, ~ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ~ z-<B mss' ~- / s' J ' • Effluent #1 = BOD > 30 < 220 mg~L and TSS >30 < 150 'Effluent ft2 = 80D < 30 mg/L and rss < 30 R1g/L CST Name (Please Print) S' CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~--~~.~~~- 715-246-4516 ~~ Property Owner Parcel ID # Page of ri Ong # ^ Boring ~,,~ L ~ (~ -Pit Ground surface elev. ~ J~~7-1(-. ft. Depth to limiting fador ~_ in. Soil lipdon 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 p' ~ 3lz .~-' ~ ~ ~' ~ `Z 9-~ $ U s 5l rr. r ~ ~ ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting fador in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fi= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ^ Bonng Boring # Ground surface elev. ft. Depth to limiting fador in. ^ Pit Soil ication Rate Horizon Depth Dominant Cdor Redox Description. Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eft#2 • Effluent #1 = BODE > 30 < 220 mglt and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mg/L 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. sen-saw (rt.sroo~ Soil Test Plot Plan Project Name F~ichartl Overmueller Shaun Bird Address 2885 160th Ave Glenwood City Wi 54013 CST 2~ Lot ------ Subdivision -------- Date 6ii 8ro5 N W 1/4 NE 1/4S 17 T 30 N/R15 W Township Glenwood Boring 0 Nell PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation 108.5' *HRPSame as Benchmark 160th Ave OG~~? SX 1320' PrnnF+rty ~° 106.5'- 105.5' 10' 104.5' 1 --. R _'~ 450' 40 Scale is 1" = 40' unless otherwise noted B-1 6% Slope 107.5' 150' Brushy/Grass area, not farmed by tree 100' B.M. ~~~, Z,Z 1320' Property Line ~o~ I r;~,Q. . ,~ ST. CROIX COUNTY PERMIT APPLICATION CHECKLIST The following list must be completed prior to the submittal of all sanitary permit applications. i~ A COMPLETED SANITARY PERMIT (COMPLETENESS IS ESSENTIAL!!!!) • MUST HAVE LICENSED PLUMBER'S SIGNATURE • ATTACH STATE APPROVED PLANS (IF DESIGNED A5 A MOUND SYSTEM, AT- GRADE SYSTEM, IN-GROUND PRESSURE SYSTEM, HOLDING TANKS AND EXPERIMENTAL SYSTEMS) ^ DETAILED PLOT PLAN • ABSORPTION SYSTEMS: BOTH PRIMARY AND REPLACEMENT SYSTEM LOCATIONS • NORTH ARROW AND LEGEND • LOCATE AND DESCRIBE THE BENCHMARKS • IDENTIFY ALL SETBACKS DISTANCES FROM THE SYSTEM TO LAKES, STREAMS, BUILDINGS, PROPERTY LINES/EASEMENTS, CRITICAL SLOPES, ETC... • LOCATE DWELLING/BUILDING THAT IS SERVING THE SEPTIC SYSTEM • IDENTIFY ANY SETBACKS ISSUES ON ADJOINING PROPERTY ^ MANAGEMENT/CONTINGENCY PLAN it ORIGINAL SOIL REPORT (PLEASE INCLUDE THE DATE THE SOIL REPORT WAS COMPLETED AND THE ORIGINAL SOIL TESTER'S NAME) it A COMPLETED MAINTENANCE AND OWNERSHIP AGREEMENT FORM (MUST BE SIGNED BY THE OWNERS, ORIGINAL SIGNATURES ONLY, FAXED COPIES CANNOT BE ACCEPTED) it COPY OF THE WARRANTY DEED (REGISTER OF DEEDS) it COPY OF THE CERTIFIED SURVEYOR MAP (CSM) OR COPY OF THE LOTFROMTHE RECORDED SUBDNISION PLAT (REGISTER OF DEEDS) it COMPLETE SET OF HOUSE PLANS (NOT REQUIRED FOR REPLACEMENT SITES) ^ APPLICABLE FEES Incomplete applications will be placed in a "hold" file until they are completed. The workload and number of permits we receive necessitate that we handle only complete applications and that we obtain cooperation from the plumbers regarding the submittal of COMPLETE permits! REMEMBER: WE REVIEW ALL SANITARY PERMITS ON MONDAYS. YOUR COOPERATION WILL IMPROVE THE SERVICE WE PROVIDE. ~~~~ ~~.1L ~' JLJLJ~q JLl \ ~ o QUALITY MANUFACTURED AND MODULAR HQMES one rr~l~~e l~#©rth of Amer"~+ ©n HWy 46 Sherry & Mike Wean Shelly i~e~ltn Pty Box ~~ ~4rnery, W1 ` ~4~~?'1 office: 7~ 5-Zi"i~~954~ Fax: 715-~~~-7057 6P1 48 SHOWER ie _ , ~ 11TIUTY g ~ i i DtNING c~rx[onu rH+u•oUr ~ ; ~ ~ AREA.. ~ 8u '~ O C~ ~ 1AASTER f v B@DROOM / No. t oor. B 13'6" v~armr KlTCJiEN C401CTK176t6(i,178 SQ. Ft.J 36EDROOtr! - 2BATtlS-CATHEDRA! THRU-0llT C401 wwvr.riverviewhomesinc.net Email: sherry55chevy@aol.com LIYlHG R0~1 iCd' BfdRf>dkl No.2 A BEDROUTA 9'iG No.3 ~ 10'-0" / ~ . ~ ~ ~ , ....~.r 76X16 _ :_ __ _ ~~~-'~v~ ` BRINGING AMf ~It~ C~OMf. ~RiNGiNG ~IMMf RICA fUN. r~^n wwwakyiinehomQS.com ti ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address ~~n ~ required from Planning for new construction.) City/State ~~Q~tiGc.r~~ ~~ Parcel Identification Numb l6- ~ ~z.,v~vov 1 D/6 -/u~7-,7'a-oc~v LEGAL DESCRIPTION ,OGI/10rri~' ~-yt,Q,GcJ Property Location ~'/4 , ~'/4 ,Sea ~, T,~_N R~W, T/own of ~Qp~ Subdivision ,Lot # Certified Survey Map # g" O 7 $/ b ,Volume .ZO ,Page # ~'d 7 ~ Warranty Deed # ~'0'.Z, y pp ,Volume '-'c4'S~ ,Page # y FS'~ Spec house 0 yes ^ no Lot lines identifiable ~ yes 0 no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can aI3'ect the function of the septic tank as a treatment stage in the waste disposal system. The properly owner agrees to submit to St. Croix County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 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 Co merce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been tained must be completed and returned to the St. Croix County Zoning Department within 30 days of the three year expi _ ,~ ,,~ ~.._ _ ~i - 3/.~~ SIGNAT OF AP ANT DATE OWNER CERTIFICATION I/we certify that ail statements on this fo a to the best of my/ r knowledge. I/we am/are the owner(s) of the property tribe e, by virtue of a warran ee reco ded i Regist of ee ffic ~/L/~ SIGNATURE OF A I NT DATE ****** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. Parcel #: 016-1037-20-000 osi2arzoos 02:08 PM PAGE 1 OF 1 Alt. Parcel #: 17.30.15.269 016 -TOWN OF GLENWOOD Current ! X'~ ' ~ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner * OBERMUELLER, RICHARD A & GRACE M RICHARD A & GRACE M OBERMUELLER 2885 160TH 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: 40.000 Plat: N/A-NOT AVAILABLE SEC 17 T30N R15W NW NE Block/Condo Bldg: Tract{s): (Sec-Twn-Rng 401/4 1601/4) 17-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 9M5 CI IMMARV Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations' Last Changed: 10/06/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 39.000 6,600 0 6,600 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 20l?5: General Property 40.000 6,700 0 6,700 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 6,700 0 6,700 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 #: 016-1037-10-000 06/28/2005 02:09 PM PAGE10F1 Alt. Parcel #: 17.30.15.268 016 -TOWN OF GLENWOOD Current j_X'', ' ~ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner OBERMUELLER, RICHARD A & GRACE M RICHARD A & GRACE M OBERMUELLER 2885 160TH AVE GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Property Address(es): • =Primary Type Dist # Description ` 2885 160TH AVE SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 17 T30N R15W NE NE BlocklCondo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4} 17-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 445/155 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/06/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 36.000 5,300 0 5,300 NO UNDEVELOPED G5 2.000 200 0 200 NO OTHER G7 2.000 9,000 142,000 151,000 NO Totals for 2005: General Property 40.000 14,500 142,000 156,500 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 14,500 142,000 156,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 116 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U. 2858P 995 STATE EAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Richazd A. Obermueller and Grace M. Obermueller, husband and wife, Grantor, and Steven R. Sandberg and Elaine C. Sandberg Family Trust, Grantee. Grantor, for a va ua a consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: The West One-Half of the Northeast Quarter (W '/s of NE '/+) of Section 17, Township 30 North, Range 15 West, St. Croix County, Wisconsin. Recording Area 8~240t7J KATHLEEN H. MALSN REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD 08/04/2005 02:15PK MARRANTY DEED EXEMPT ~ REC FEE : 11.00 TRAAS FEE: 750.00 COPY FEE: CC FEE: PAGES: 1 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. ante and Return Address: RETI!RN T0: LEGA1 SERVICES, INC. 3S TH ZND AVENUE, SUITE 150 so , 5 POL(S, AQN 5540I-2217 47 016-1037-20-000.... 016 -10 3 7 -3 0 -000 Dated this 7th day of July, 2005. /~' ° * Richard A. Obermtteller AUTHENTICATION Signature(s) authenticated this 7th day of July, 2005 COW GheC' PubC~c , * 4 TITLE: MEMBER STATE BA.RC1T,i~0I~(SIN~- (Ifnot, ~~~` authorized by § 706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY Parcel Identification Number (PIN) This is not homestead property. ..ietro Legal aervtces EDIRET 473667 A 481686 W'D 373731 * Grace M. Obermueller ACKNOWLEDGMENT STATE OF WISCONSIN ST. CROIX COUNTY. j ss. Personalty came before me this July 7, 2005 the above named Richard A. Obermueller and Grace M. Obermueller, husband and wife to me lrnown to be the person(s) who executey~t~te foregAing instrument and aclmowledged the same. *Cheri`Brown " Notary Public, State of Wisconsin Peterson, Fram & Bergman -Steven H. Bruns My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 3/11/2007 (Signatures may be authenticated or aclrnowledged. Both are not necessary.) •Names oCpersons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 FROM :JBSURVEYING FAX NO. :7152654203 Oct. 04 2005 12:40AM P1 t ~~ Stock No, 26273 ' AAC,E St377 XArR'g BBGZSTfiR ~ ~ n~vz..~~ CERTIFIEb SURVEY .MAP . NO. ~'~'~" K~~D ~:00PI! VOI•.UIVIE _zo_____, PAGE Sa7~ ~~~ 3~RV~ MAP p~~YSFfi)ti 3. @0 THE WEST HALF OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER SECTION 17, TOWNSHIP 30 NORTH, RANGE i5 WE5T, TOWN OF GLENWOOD, ST_CROIX COUNTY,WISCONSIN P7orth I/4- Northeast Corner Section 17-30-15 '•~•••••~•2665.40'~•-. ...... Section 27-30-15 .. Fd Survey Mark Nail "~•~• •~¢Q~h Ave .• Fd Survey Mark Nai! S89'37 27 t''~' 866.35 ~ t 999.0 5 ~ 589 3727"E~ ~ ~666,3T ~ - _ _ _ 2 £ v ` 33.01' existing. /' 33.01' Onv4WOy --~----~ building setback line ~ --''--- I ~ or ~ UNPI.ATTED . _I.ANDS . ~ 880,842 sq.ft. ~ 4 20.22 acres w ~ incl. r-o-w ~ >~ U ~D i ~ 858,852 5q: ft. ~ ~LANDS 19.72 acres °' ~ OWNER/PREPARED FOR: ~ nat incl. r-o-w Steven Sandberg ° `= Sandberg Family Trust 11802 Akron Ave. tGH, MN 550'77 DRAFTED BY: Joel A. Brandt J8 SURVEYtNG lCC 966 Rustic Rd 3 Gl enwood City, WI SW corner o f soil tests the NW/NE \ to l N89'4Q'S0'W 667.22' t ~ c.,i ~ ! c>a rva'j`1= UNPI.A'£TED South I/4 Y ~ > I.ANA3 Section I7-30-15 ~ computed per ties ~ Note: Each parcel on this map is subject to State and Lounty taws, rules and regulations li.e. wetlands, minimum lot size, access to parcel, etc.). Before purthasing or developing any parcel, contact the St. Croix County Zoning Office for advice. ~ LEGEND Q~...,..,,,Government Corner (as noted) . o.._.......Set 1" x18" Iron Pipe weighing 1.6$ lbs./lineal ft. Nortl, is referenced to the North line of the Northeast Ruarter of Section 17-30-15, assumed to bear 589°37'27"E (St. Croix County Grid System) SCALE: 1" = 250' 0" Z50' 500 VoT 20 Yage 5077 JOFt A, w !liVM~7 e-epos acfa~rooo c~rv, ~C ~ \~b ~~ ~t~ `~ k b~ ~~ P F Page 1 of 2