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HomeMy WebLinkAbout016-1060-20-150Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Surety and Euilding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH ) Personal information you provide may be used for secondary purposes [Privacy L )]. Permit Holder's Name: Ci °- X Township Doornick, Dou Glenwood Townshi CST BM Elev: Insp. BM Elev: BM Descriptio /do. c~ ''~ i ~ ~T TANK INFORMATION TYPE MANUFACTURER .:``CAPACITY Septic ((~~ ~~ C~`~v~ I~aO Dosing ~~*~G ~~~ Aeration -7 ~\ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~, C~ I / ~ ~.. Z.tl- ~ Z'-1- ~ Dosing ~ ~~ ~ A ' /l~ z~-t ~~ f -- Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand ~~p,~ GPM Model Number / ~.~ 37 TDH Li Frictio Loss System Head TDH ` t Forcemain Len h ~ Dia. Z j~ Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 453383 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 28.30.15. STATION i, ~B~ HI /0~~ FS ELEV. 9 4 . Z Benchmark lQ~ Alt. BM (~; p ~ 5: t~ /dd ~ ~ Bldg. Sewer 5 ~ /g ~~j , / Z SUHt Inlet ~,~ 9~1, ~ St/Ht Outlet ` ~ Dt Inlet Dt Bottom ~ , ' ~~ ~ G t Header/ManHeader/Man. .~ /~~ ' 7 Dist. Pipe y T ~•~9 d~~~ Bot. System 3 . ~E ~ Y I Z~ l ~a6 ,,.I Final Grade ~ 3 ~' z.. 3 ~ 76 Z St Cover ~ `/' two n.~. v t' Z ~, ~'~' BEDITRENCH DIMENSIONS Width ~ Length ~ No. Of Trenc~lgs f ~ PIT D~IIAENSIONS No. Of\ Inside Di\ Liq epth ~ L ~ \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. ~ INFORMATION CHAMBER OR ` Type Qf~ ~t~ ~ ~ CY 1 ~ ~ i ~ (/~ ~ UNIT Model Numf~ DISTRIBUTION SYSTEM •~r,,,,~ f/~,n~d~~( Header/Manifo~ t 1 Length Dia ~ Distribution \ ~) ~ Pipe(s) zi J ~ Length 5y ~ Dia ~' Spacing x Hole Size 1 f ~ j x Hole Spacing ~ Vent to Air Intake ~ p 5 SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over ~ Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center ~ Bed/Trench Edges \ Topsoil I (~ ~ Yes No "^,j Yes j J No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ] 3 / ~ Inspection #2: / / -~16„y~ ~fj{ Location: 2936 130th Ave Glenwood City, WI 54013 (SE 1/4 SW 1/4 28 T30N R15W) NA Lot4 `~i of Parcel No: 28.30.15. ~ ` ~ , 1 1 a v.`) 1.) Alt BM Description = h~,,,o~o~.., S. ~, (~lam~" 2.) Bldg sewer length = Z4 r S cX.3~ ~~~~- 5~: ~~,,.l.~..ct -amount of cover = ~ ~ Plan revision Required? ~ ; Yes ,-~ No ~ ~ ~ ~ /'_ ~~~ ~~j Use other side for additional information. ~ ~ ~ ! I [__ ~`~'_L ' !___~J_I SBD-6710 (R.3/97) Date Cert. No. Safety and l3uitdings Division 201 W. Washington Ave., P.O: Box 71yb2 ' I S~O/I ~I ~ Madison, WI 53707 - 71 bL (608) 266-3151 De artment of Commerce _ Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(lxm) L Application Llforma6on -Please Print All Information ~ ~ ~ {'~ ~~ ~~, ~ ~4~ ,~~~ --Q~ ~~"vN~~ Ur~IC County ] ~) ~` Sanitary Pesoit Number (to be 1 state s~~~=TANS./D~ ~ _ r 3o a~,q~.sz.:_ Parcel # # Block # '[~ N; /R E o ~ ~~ II. Type of Building (check all that.>trppiy) .thief t~ ~ .S CSMNumber t or Z Family Dwelling - Number of [os ' V, ~ . , f~~ ~ PublidCotnrrre[cial - Dcsarbe Use Q , K s~' S ~'D ~~ _ . Sa ~ u C+ry_ Ydlage Township o State Owned - Descn'be Use I:Q. Type of Permit: {Check ody one boz oa line A. Complete line B if applicable) A' ~ System Replacement System Treabment/Holdiag Tank Replacement Only Other Modification to Existing System B. / Permit Renewal Pcrrtut Revision Qiange of permit Transfer to New List Previous Permit Number and Date Isseed Befon: Expiration Plumber Owner ltv. a of POVPIi'S S (Check all that a i ' Non -Pressuzzed In-Ground Mound _> 24 in. of suitable soil ound < 24 in of suitable soil At-Grade Ingle Pass Sand Titer Constructed Wedand Pressurized in-Ground Hdding Tank ~rloer Aerobic Tr+eahneat Unit ~ la6ngSand Flier , Recirculating Sytit}retic Media Silber Leaching tatamber Dri Line Gravel-kss Pi Othet (explain) / ~ V. Di tsal/Preatment Area Information Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfl Disposal Area Pro (sf) System Elevation VL Tank Info Capacity in Total Number M~anufa~cturer Site Steel iFber Plastic - .Gallons- -- Gallons of Units t,.~ (~~.~~~~T'--- - - ( ~ Concrete Consauctod Glass New F.zisriog i ` ~~ Aerobic YII. Res oltsibility Statement- I, Ure and assume responsibility for iasfauation of the I'OR'T5 shown on the attached as. Plumber's Name (Print) Plumber's MPlMP~RSf Nuq~mb/e~r~ Busituss Phone Number~~~~ _~i ~. ~ , Plumber's Address (Sheet, City, State. tip - ~ ~ ~` t,n~ ~ z ~ _ Geastv/Detaartmeat Use On1Y _ _ - -- ..---..._ ..n. ~b..,.,~, Surcharge Fee) ~ ~ m ` IX. Conditions of Approval/Reasons for Disapproval v ' SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) [or the system on paper not less than EI/I x 11 inches is size PLOT FLAN '` Doua Doornick ADDRESS 2930 430th Ave Glenwood Citv Wi 54013 /4 SW 1/4S 28 /T 30 N/R 15 W TOWN Glenwood COUNTY ST.CROIX ~~''" RS Shaun Bird 226900 DATE6/24/04 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. TOp Of 1/2" pipe ASSUME ELEVATION 100' Filter ZabelA-100 ^ BOREHOLE O WELL * H. R. P. same as Benchmark scale SYSTEM ELEVATION 102.2' 1.5' sand lift Scale = 1 /4" = 10' 10 2' 400' 3.M. is of 1 /2" @ 99.2' Area 15' below system is to remain undisturbed 11 % Slope 9 8' 100' i 00.7' B- z Huffcutt Combo tank Property Line (not to scale) Tank is to be properly bedded and provided with lockdown covers with approved warning labels B _ 2 Grading is to be done to divert ~ run-off away from system Well is to meet a!I setbacks found in Comm. 83 Pro 3 Bedroom House ~,,p~l G commerce.wi.gov - isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce. state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary July 02, 2004 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/02/2006 Identification Numbers Transaction ID No. 1015913 SITE: Site ID No. 685802 Doug Doornick Please referto both identification numbers, 130TH Ave above, in all cones ondence with the a enc . Town of Glenwood St Croix County SEl/4, SW1/4, S28, T30N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 966665 Maintenance required; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter 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. ~•Otd~ 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: ~,.pEF i2TMEN C~ly-( N OF General Approval Requirements: SEE CORK • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SHAUN R BIRD Page 2 7/2/04 • Comm 83 22(7) A copy of the approved Mans specifications and this letter shall be on-site during construction and men to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and The approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. Sincerely, ~~~ ~ ~/~~Gy~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@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 t Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Cover Page Date: 06/24/04 Owner: Doug Doornick Location:SE1/4SW1/4 S28 T30 N,R15W 130th ave Glenwood 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 7-8. Maintance and Contigency plan 9-11. Soil Shaun Birc Signature License ni ~~~~ ~~~ '~~Q ~~~ 2 8 20~~ ~~ ~~~~s o~~ ~~'~„f y .P ,, -r ,~NU~MERG~ LNG 'ONUEN r PLOT PLAN itROJECT Doua Doornick ADDRESS 2930 130th Ave Glenwood Citv Wi 54013 $E 1/4 SW 1/4S 28 /T 30 N/R 15 W TOWN Glenwood COUNTY ST.CROIX 6/24/04 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK -MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top Of 1/2" pipe ASSUME ELEVATION 100' Fiilter ZabelA-100 ^ BOREHOLE O WELL *H,R,p, same as Benchmark 10 2' SYSTEM ELEVATION 102.2' 1.5' sand lift Line (not to scale Scale = 1 /4" = 10' Area 15' below system is to remain undisturbed B- 11 % Slope 9 8' 100' 100.7' 400' AIt.B.M. is top of 1 /2" pipe @ 99.2' B.M. ~B -1 Huffcutt Combo tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels B _ 2 Grading is to be done to divert run-off away from system Well is to meet all setbacks found in Comm. 83 260' Pro 3 Bedroom House Property Line (not to scale) - ~:, No 'Designer Date Cress Section Of A Mound'S stem Usin Aged Ppr The Absorpt-on Arto _„- q ~ Ft. g ~t Ft. I '~ Ft.~ - - ~ ~ ~ Ft. . L~~, Ft. Non-Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric - AS7M C-33 Sand --~ "Topsoil _ J ~ ~~ ~E pistriDulion Pipe H G _. -.~ J~ + '• Slope Bed O1 ~ 2 `~ Force Main {f~ ~2 From Pump Drain Rock ~ jr s ~k t ~ u,~o s" r Piowe d Lover ~ , ~~ 'Edw. F_ 2~ `~ ~ G ~ L'~ ~ r~~- L 4~Observotion Piet-~ __._ K ~. A ~I ~ Force Moin -° ~----- -------------- --------------------- ~ From Pump Distribution Bed Of %2~- 2'2 ~ Grain Rock Pipe I 4~Obt-ervotion Pipe =.;-~c~. Perrnonent Marker ~s~^'- %1~ ~ ~iv~-~ bv~°~~,~.s" ~ pe or Rods Pion View Of Mound Using A Btd for Tt~e Absorption Arlo PAGE_ OF l~~a LoLared On 8o~to!r+. EquaEty sDOCee ERST tio6L Ntr.kT re Connst}ion Ft. ~~. Signed: ~.icense Number: Bate: X ~ Inches Yoh Inches Hole Diameter ~~nch lateral ~" ~ ~ Inch{es) Manifold ~ Inches Force Main Z-Inches ~ of holes/pipe Invert riev~t7ot~ Qf ~ateral~„~'. 7 Ft... PertorataC ~iDe Oetoii crvTZC -E1''N~ ~ F~MP ~ ~.~----- .__..- AND SFEC~=TCATIONS $F.R C$QSS SECT`GN ABOV £ GRADE ~ -VENT pYP£ Z2,. KYN - ~, c} ~~u~aw Q~ - y .~~' FROH D4flR. n FRF,S~~ a~R ;NTtiiCE ,~~rP ••~`- ~ _ E t p (O '~r~'V ~_ I ti LET ... ~-'^'':'...-----"""'~ --~-- s,:I~T£R TI6 i~i'T 5 ~~ ~3LTE•~ ~ g "'~~-_ APPiROYED C P~ 3SQLI0 l~~7 FT- SOIL pt3MP QFF £LEv • ---- O y~EAtNfR~Rt)GF ~ I2NTC~3hDiT~T W _- s. ~ :, ~. 3 '. T GHT ~ `~ s~Ai- ' ~- , f ApgROV ED ~~pLE COy Eft W/ PADLOCK ~, wARKi~t~ u~~.. . ,~" HZ~1 le~M~~ ~~ JOIi~RS Y1T3~ L.t~ /1pPR01-fQ PIPE N ~y~SQIt SEDD~NG Vi~DEg 'PARK CO CisETE PAU 3 ~ APPROV Efl j %/ S SpECZf ZCATIONS ._ ~ ~ - ~.--: HOSES ?£R 'DAY - .r..~-•~"" . ~HSEg D Z NG ~~GAL S~K=ICiAM1FAC~RER: l3,~gi. I3p5£ ~t~d~;''jE FNLflygpCK: ~ J "~ ,...1 GAL- 't' /~r~ _~~~-- Z~GfiES ~~ sZ Z£5 ' SEPTIC / Gp-t.• • TA1~K,....~.--- DOSE i ~~ CAPACZTI~~ A :2 INCHES ~ ~~~. ALA ~~FwC~~~: 8 = ..---- ~ ~ 7 -~ GAL. --^-~~ MpnEL ~sEg~s ~ / / ,e . ~'~ INCHES ----~- StiiZ'PC8 TYPE' ~ ~=~'_' INCHES - /.~-%- ~L. ,~ ~ = Z L~ i5. Z3 yuc PE7KP MA~FAC?iiRF.~ = - Ko~EL ~ur~aER = - M SIRS ~ As DER ~;fig T'tPE= PUHP ~ ~ A~ f ~ FEET FPM gSPE . •3 FEE? Rgt~13IR£n DZ SC~RSaE RAT _.-?--' £)I STR I BV'f I ~ - FEET CE 3sE'!'SrtE£N put~4P flr F ANB FACTt~ ,,.'~~ FEET vERTIG ~ NE~O~ ~ppLY Xg~S53 ~.FJ l04 • ET . FRi~Y~~IC H~ ~..~.'r."~ + MINIrN gpRC~I~i ....--~ TOTAL ~ DIAMETER .~----- F£~T ~ TANK ~ ~y23Cs11'I ~ ~1:.~-~~; - NSiDI~~ 4~ ~~P LIQ~IO ~~_ I ~tT£RNAL D IMF . s r~K~D= _ ~ - if 88 1 °¢ W _- >_ 0 r 0 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE FFFI_UFNT AND DEwATERING 0 MODEL t52 153 Feet Meters Goi. Liters Gol. Liters 5 L5 69 261 77 291 10 3.1 61 23i 70 265 15 4.6 53 201 61 231 20 6.1 44 167 52 197 25 7.6 34 129 42 159 30 9.1 23 ~ 87 33 125 35 10.7 -- 22 85 40 12.2 -- -- 11 42 Lock Vaive~ 138.0 Ft. (11.6m) 44.0 Ft. (13.4m) ~~ ~ ~nJ ~ $~ 160 'L4U JL V FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. ~`' ' • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Dduble piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available foroutdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series 152!153 MODELS Control Selection Model Volts•Ph Mode Am s Sim Iex Du lex N152 715 1 Non 8.5 1 2or3 BN152 115 1 Auto 6.5 Included 2 or 3 E752 230 t Non 4.3 1 2or3 BE152 230 1 Auto 4.3 included 2 or 3 N153 715 1 Non 10.5 1 2 or 3 BN753 175 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5:3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 O CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (05HA). 3 27 s2 sz t t I 12 ,/a ~ 1 I 5 tff 1 ~- stczoes SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of ElecVical Alternator E-Pak. 3. Variable level control switch 10A225 used as a control activator, spedly duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. efiu~ ro: p.o. sox 16347 Louisville, KY 4 0256 034 7 Manuracturersof. . SNIP TD: 3649 Carre Run Road ~ o p ® Louisville, KY 4021!-1961 ,Q!/A[/TY PUMPS ,7/NCE ~c7~c7 tl ~a~ (502) 778-2731. 1(800) 928-PUMP hifp://www.zoeller.com P~MP ~O FAX(502J 774-3624 © Copyright 2000 Zoeller Co. All rights reserved. . NT PtJ~N t'age of - " ''' ' ' ~ ~ ~Ft'S MANUAL 8~,MANAGE~ IC F[CA 8 TION QOW'TS OV1lN ~ SY3TFM SP al ^ NA . - Septic Tank C~P~- -_ .Lr. ~.~ . rT} DNA , ~n ,,.~ 101 for domest~ (npfT4D~"'nnn~ ~~~ a„Q y ~ ~c st}Iueni _ Values tyP~1 for Pre~~'rastews~r os~ licenses or ~;nmfner, SePt~e INSTRUOTrONS It be made by an ind"tvlduat carrying one o~ pOfo rig MAIM'ENAN~~~ and dlsperaat cells sha pOVYTS tnspedo • or broken Inspe Plumber Restnceed ~ r on of the tgnK{s) to ident~fY ate' rn~ any back up Mest~er plumber. Master stu e oertllkxtiofts~. ns rnust tndude a visual lnspeosJ and scum and ~ec~c the effluent levels SeMdf~9 pperator. Tank inspectio ~asuro ~e Volume of combined d~3 of effluent on the ~~ gny p~Clcs or teaks. The disperses cell{s) shall be vtsua(IY ~sP ~ ~~i~ round surface• of effluent on ttte ground surface, utatory a"tliO~Y- •' of effluent on the 9 for any ponding lion of the local r+e9 PIPa and to check d•~n and requires ute immediate notif+~a or mdre of the tank volume, the m the obsef~ration indt+rate a fai~ng °~ uals one-third (ys) anc~ with ch. NR ground surface fnaY a and scum in any tank eq 5ed of in accord mutation of sludg a Septage Servicing Operator and dispo When the pombined ao k shall be removed by and anY entire contents of the tan retreat~R'ent components. sin gdministraWe Code• orients, P t 13.1N18o0n ~ mechanical or Pressurized POWTS comp rfprtned by a c+rrtified POWTS M~ntain The servicing of e{~uent ~• is of 12 months or Tess. shall ~ ~ of completion of any service Qvent rice or monltofiftg ai in~f+~ within 10 days other matntena ~ to the local regulatory authority A sew report sha8~be pf'o'~ iJ roduds or other resents of pain 'n9 P TtON treatment tank(s) ~ the P trationS are START tJP ANO OPERA ppWTS check. ersa< cell(s). If high concen For new oonstrudion. Prior ~ uJe of the s andior damage the disc rator prior to use_ ~~ tl~at ~, impede the treatment Pf'~ ~ ~, a septage servicing Pe dtte~~ ham ifie contents of the tank(s) ee ~u~t Flter Model Pump~Tank CapadtY punyp Tank Manufadur$r Pu P ~~ Prey t Unlt ~ ~nicat Aeratioft ^ Dfsinfec~on v,~r~• round (,gcavit)+) p ln-g ~ gtgrade a~ INFORMp' w.. ~Q$c Tani ,,,,a..-•_-- ~ W/1 Owner ~ „i Effluent Filter i-Aau~ ~ ~,~. ~ p NA Page of ~._ ~.-. , Ye Stlrface- tconditions are frozen at the infittrati ~ rest0~ ~ excess start uP shalt not occur w'nen ~ ve notmal highwater levsis• men P~ ~ g and may result in the System ~ abo ,none large dose, overioadin9 the ce ( ) ~ ~~es pump tams rriaY c'sa< oett(s~ ~ ntents of the pr~'tP tank removed by a ,;r, po+er ~ to the disPe is situation have the ce Plumt~er or ppYYTS Maintainer to Du 9 wasterva~'!'~ ~ ~~ a of ett1~!t TO ~~ ~ t4 the effluent pump or canted ~ p or S`'`rtace Operatior Pry' 60 ~~~ S~restore normal levels wttttin the F . P age Ser~Q tin the pualP Qptlt~ ~ pver, or otiaenlvise disturb or compaa, assist ~ manually oP~ g ~- cells. Do not drive or pa _ over tarns and dispel lion area- po not drive or park veh mound or at-grade sorl absorp trn rave the performance and prolong the Gfe the area within 15 feet down sbpe of from the wastewater stream may P de~7reas~~ dente( floss; diapers; Reduction or-et'unination of the following ~~~ butts; condoms; cotton swabs; asofit;ue; gr+ease;~ herbit~dea; meat antibiotics; baby ~~ umpl vtrater, fruit and vegetable peelings; !3 of the POV1(TS: fecl~i~n drain {sump P na k-ns; ~ampons;'and water SoftBner brine. dsinfedllutts: ~ ntin r+Qduc~s; pestxzdes; sanitary P ~ _ _ ~~1ons; off; ~ ' g P taken out of setvioe the following steps sttali ~ taken to insure that the ABAI+IDOt+I*MMENT anentlY Wisconsin gt(ministnative Code: fails and/or i~ perm t1aflCe with ch. Comm 83.33, ` p~nintl5 seated. ~ ~ pmPO~ Sand safey abandoned in comp ~ ndoned P Pe all .be disconned~ and the aba disposed of by a $eptage'Servicing Operator. - . A[[ ptpln9 ~ tanks and pits Sh . The contents of alt tantcs and pits shall be removed and pro kS a['td pits shalt be excavated ana removed or their covers renneved and the void space Attar p in al[ tan • filled with solig, Breve! or another inert solid material. to rovide a code CONTINGENCY PLArid cannot be repairsed ~e foltowtn9 measures have bean, or must ~ ~~~ P If the POVYTS ~ utilized for the location of a replacement soil compliant np~cernent ~~ has been eyatuated and may be coon and should not p A suitable ~Plaaement"area rotected from disturbs lot tines andw lis_ Failure to absorption sys~"• The rep~Cement area should be p sad strucri.r n required setbacks from -existing and propo be infringed upo went area v+riU result in the need for a new soil and site °evsl a ~~~ ~~ tablfsh a suifab e protect the rep-acern tams must comply with ~1e rules in effect advances in POWTS replacement area. Replacement sys le replacement area is not availabl as a fast resort o eplacethe failed PO'NTSng pOWTS a sod and O techr'ro1e9y a holding tan>c may be installed n faAure of the _ not been evaluated ~ tdentrfY a su'rtabie replacement area Upo iacement area is available a_ ' ~ The site has ~ locate a suitable replacement area. If no rep site evaluation must be perf~~ st ~~ ~ replace the failed POYYTS• following removal of the biomat at aldng tank may ~ installed as a is lion systems may be reconstructed i [ p[~ ~e rotes in effect at that time. Mound and at~rade sot! absorp dons of such systems must compY the infiltrative surface- Rgc~~ <cWARNING» ~,p•I'MENT TAINKS MAY CONTAIN LETHAL GASCIRCEIMSTANCES~ DEATH MAYG~ SEPTIC, PUMP AND OTHER DO NOT ENTER A SEPTIC, PUMP QR p-I'}iER TREATMENT TANK UNDER . RESCUE OF A PI:.RSOK FROM THE INTERIOR OP A TANK tvtAY BE DIF'FiCtJLT OR IMPOSSIBLE. RESULT , ADDfTtOtYAL COMMENTS _ ppWTS MAIMTAi ER POylft'S INSTALLER Name Q't~~-- ~ ~~' --- Name _ ~ rc..~.~ " n '~' - .~ .S/ Phone l/ ' Z ne ~ ' 'Z ~' Phv //'- l><THOR~ YA R TO _ zocai. Rr=GUt.r3- SEPTAGE SERYlCING OPERATOR PUMPER - Agency ~ i ~i~~'~'~ Name Phone T` ~'~ ~ `~' Phone ~/~"' 1'hls dodrment meets the stsR's o#'the Green take. AAarquette and Waushara County Zoning and Sanitat}on agendas. mart does not This aoarment was drert+ed try. t ~ and 83_Sd(i}. ('2) 8~ (3). W+~mnsin E-Gmtnisu'a~ ~- Use of this doer - GNtyV (?l0U me minimum ropuuemerKS of dt Comm r33.21(2)(6x }(d} (fl guarantee the performance of the pflVYTS. e ~3 ~T ~. 3 ~. F` ~ ....... ............... 1 ~~ Wisconsin Department of Commerc! SOIL EVALUATION REPORT Page / of Z/ Division of Safety and Buildings -'~ in accordance with Comm 8b, Wis. Adm. Code County ~-~ ~ Attach complete site plan on pa not lessthan 81/2 x 11 inches inisize. Plan must - indude, but not limited to: vertical nd hori;3orrtall reference point ;,BivH~, direction and parcel LD. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R ewes by Date y provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 0 Personal information ou \ 1 Properly Owner Property Loc~~a""tion ~_ ~ r~ ~ Govt. LotrJ,~ 1/4~ $~ N ~ E (or Property Owner's Mailing A ss Lot Block # Subd. Name M# ~~ . / 4`s City State Zip Code Phone Number ^ City ^ Village ~T wn Nearest Road New Construction Use,,~`~tesidential / Number of bedrooms ~ Code derived design flow rate 'S'J"~/ b V rJ GPD ^ Replacement ~ ~/~~^ Public or ce mgrdal -Describe: ________ _ ___ Parent material ~2~.C (6C! t b 2° o / ~~ ~ L~L.LMJt~ Flood Plain elevation if applicable ~~~ ft. General corrxner>is and recommendations: ~ ~ / ~ ~ . ~ '~ J ° s~~~~•. ,- a Boring # Boring 6~ J/~ _ _ ~-a U Pit Ground surface el ~ ~ ft. Depth to limiting factor _~~~. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 ~/~ f// { ` j ~ ~~ '~~~ ~ ,rte ~) i~l '~ M/ a /' 'Zo, ~-~ "~~ ~ arr. ,,'-') ~ ~ N l /¢ ~' r -_+ Boring # ^ Boring ~ ~ L f Pit Ground surface elev/! ~ft. Depth to limiting factor ~ 7 in. Soil 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 ~- 5 ,,, ~, • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mg/L and TS5 < 30 mg/L CST Name (Please Print) Sig r CST Number Bird Plumbing, Inc. Shaun Bird .';.. 226900 Address Date Evaluation Conduct Telephone Number 1008 192nd Ave, New Richmond, WI 54017 r~--f~' .-v ~ 715-246-4516 Property Owner Parcel ID # Page of Boring C ~` Boring # pit Ground surface elev. ~. ft. Depth to IimiGng factor c~~n. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 ~ - ~~ ~ ,, 3 ~-- m- ~ ~ r-- - ~-- ^ 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 GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 ~~ # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Cdw Redox Desrxiption- Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Coles Gr. Sz. Sh. `Eff#1 'Eff#2 'Effluent #1 = BODE > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 rrxyL 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. 580.8330 (8.6/00) ' Soil Test Plot Pl. Project Name Doug Doornick ` ' ° ' S Address 2930 130th Ave Glenwood City Wi 54013 Lot SE Subdivision _ 1/4 S W 1/4S 28 T 30 @'STM #226900 Date 4/10/04 N/R15 W Township Glenwood Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe = ~~~ System Elevation 102.2' *HRPSame as Benchmark Alternate Benchmark Top of 1/2" pipe @ 99.2' ~ I~ ST CROIX COUNTY ~rTANCE A~REENIENT~ ~EPTIC'TANK M~~ .. 7/ ~ - z ~'~ ~~ ~ ~ OwnerBuyer Address °2 Mailing - D~Eg,SHIP CERTIFICATION FORM i r .3 I~ ~, 293(A - -~. c~.~ Property Address ed ~~ Planning Dopartment for new consti (Yerificatioa requir parcel Identification Number City/State LEGAL DESCgIpTION ~~ ~~ , %w .~ ~/--~_ Property Locatio~`' rGt/ i Sec. N-R Subdivision ~b 6~ o ~ Certified Surve Ma # ~6~~°~- ~~ _~1~ Town of (a//I [~tJ Lot # __~.___- Volume .~ -- ,Page # `~ ~ Z(a.o Page # ~ZZ Volume Warranty Deed # es Spec house ^ Y~~° Lot lines tdengfiable ^ no remature failure to handle wastes. Proper maintenance SYSTEM MAINTEN~~ tic system could result is iu p what you put into the system Improper use and maintenance of your sep a licensed pumper. in out the septic tank every three years or sooner, if seeded by stem. t stage in the waste disposal sY consists of pump g as a treatmen can affect the function of the septic tank ed by the owaer and by a ' t to St. Croix Zoning Department a certification form, sign oral system owner agrees to submi er verifying tit (l) ~ °n-site wastewai~ ~ of sludge. The propen3' lumber, festrictedplumbor or alicensed pump the septic tank is less than masterplumber, jourucYn~P ctioa and pumping (~ necessary), is is proper operating condition and/or (2) after inspe sal system with the standards ements and agree to maintain the private sewage dispo ~~~igned have read the above req~ artment of Natural Resources, State of Zoniong Off cue ~~ 30 Uwe, the tof Commezce and the Dep set forth, here ~ set by the Depa~n tamed must be completed and returned to the St. Croix County en main stating that Your septic system has be /~ ys f year expiration date. 6 ~ • DATE / SiG OF APPLICANT OWNER CERTIFICATION ' knowled e I (we) certify that all statements on this f °~deed recorded m Register of Deeds Office. cm, d above, by virtue of a warzanty I (we) am (are) the owner(s) of i~ DATE IGNA OF APPLICANT De artrneat. t is mis-represented may result in the sanitary permit being revoked by the Zoning p *:*:«*. Any infom~a~cn tha ff ce *!4#*• warranty deed from the Resister of Deeds o ~ deed ** Include with this application: a stamped if reference is made in the warranty a copy of the certified survey map . U 2609E 422 ~( STATE BAR OF WISCONSIN FORM 3 - 1998 !? ~'• QUIT CLAIM DEED ! ~, ~, Document Number 1__ _ - .- „ -- - ~~ This Deed, made between N ~~ 1, I ,~F~'i E. a' ~L EA Jh/ r: >; . ~' I ~~ ~f1'p~Gy~t,t~ jl Grantor, ij l and ~Q17 L•~L~tS J • ''}' S H1; I.t,E~ -G Uvv~ I iC~ ~! ~~', ,~ Grantee. claims to Grantee the following described real estate !n County, State of Wisconsin: L S r~ (~~# 'y (p (p(p07 ~~~~~~ HATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEI4ED FOR RECORD 07/02!2004 02:50PM QUIT C.LAI?I DEED EXiJIpT # 8 REC FEE: I1. 00 TRAMS FEE: COPY FEE: CC FEE: PAGES: 1 iiecoairng Area - - - -- Name and Return Atldrass o .~9 ~ oo r.~. wk (~ ~ ~ 0 ~ ~~- L~ ~ ~ L1 o\V lob.v do o~ po.r cif- 4~L~ /o lea ga - i o0 Parce4 Identification Numbet (PIN) This ~S horriestead property. ~~ ~ L~ ~~~ (is) (is not) }.. ~. s E -/y - S ~~~~ Sec.. a g T~ N R. IS w ;~ Together with all appurtenant rights, title and Interests. I, j~ Dated this ~ °z' day of ~~ Ill ~ .,20U i' ';~ `~` ~ ~v_'G, Ll (SEAL) *~o~luS ~ ~L~. o~~o~ t2 +~'S.~1~ '; cr F ,vK • amt / (~ l/L/C~_.~ _. _ _ (SEAL) I' * J{1GIIC.~.1 K..Dclorn(ncL ~, AUTHENTICATION Signature(s) authenticated this day of (SEAL) (SEAL) State of Wisconsin, ss. ST CROIX 'County. Personally came before me this AND day of ^~ JUNE 2004 the above named ,,•4~~~.,.~ DOUGLAS J DOORNINK, SHELLEY K DOORNINK . • .TF.ANE E CANFIELD, WILLAIM E CANFIELD ~ TITLE: MEMBER STATE BAR OF WISCOp)SII;f,r"ti,.1,,. t ' f t r1 • to (If not, s ..~ •t, ; me known to be the person S who executed the foregoing authorized by §706.06, Wis. Stets.) ' ~ `: ~,,,, t~ 1 ~'' ' ~ ~ ips ment and acknowledge the sam~e,/J 1 ~ 7C THIS INSTRUMENT WAS DRAFTED BY •~ •s ~J '' • ~ z rte. t t •JS`~"-• = PAULETTE ORF Notary Public, State of Wisconsin ~~ v~-~Cc1~y ~~ My commission is permanent. (If not, state expiration date: (Signatures may b authenttcated or acknowledged. Both are not DECEMBER 31 2004 .) necessary.) .. _ .. . `Names of persons signing in any capacity must ix typed or prin[ed Ixlow their signature. QUIT CLAM DEED STATE BAR OF WISCONSIN FORM No. 3 - 1998 Wisconsin Lo9a1 Blank Co.. InC. Milwaukee. WIS. ACKNOWLEDGME'_VT ~~~ 76661'7 VOL 18 PAGE 4774 KATRLEEN H. REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR RECORD 06/22/2004 10:40A1[ CERTIFIED SURVEY KAP PAGES: 2 CERTIFIED SURVEY MAP "'max FEt: William and Jeane Canfield, Aaron and Spring Doornink Part of the Southeast %. of the Southwest ; of Section 28, Township 30 North, Range 1 S West, Town of Glemvood, St. Croix County, Wisconsin, being Lots 1 and 2 of that Certified Survey Map recorded in Volume 14, Page 3821 of St. Croix County Certified Survey Maps. N BEARINGS ARE REFERENCED TO THE SDUTH UNE ~ THE SOUTHWES71/4 OF SECTION Z8, T 30 N, R 15 W, ASSUMED AS S DO'00'GD' W. LEGEND NORTH 1/4 CORNER SECTKMI 28, T 30 N, R f5 W - N NA 55! 'J (FOUND COUNTYBERNTSE IU m 3 ~ INDICATES 1.0. D. x 18' IRON 92` 3 PIPE SET (MIN. WT. -1.13 LB.2.F.) 3 Y • INDICATES 1' IRON PIPE FOUND ~ p SOIL 80RINGS (PROPOSED SEPTIC SYSTEM) 0 SECTION CORNER MONUMENT (AS NOTED) w - x - INDICATES FENCEUNE SCALE NV FEET r ^ 250• NAN EROSION CONTROL PLAN WILL BE REQ(/IRED BY THE ST. CRODCq 2(~ COUNTY ZONING OFFICE PRIOR TO CONSTRUCTION ON LOT ~. ~ r 7 50 50 1 1 z z o l t1lyP_CAZT_F~ ~LANIl~ ~/ s1l~LP1A_ i7~!? ~• ~, l.!~l7Qf~ - - OWNERS ADDRES5 2938 130TH AVENUE GLENWOOD CITY, W/ 54013 2930 130TH AVENUE GLENWOOD CITY, W! 54013 SEE SURVEYORS NOTE ON SHEET 2 REGARDING POND BERM ELEVATION. NORTH UNE SE1N-SW7/~ -x 860.64' LOT3 CONTAINS 878,433 SQ. FT. OR 20.120 AC. (856,612 SQ. FT. OR 19.685 AG IXCLUDING TOWN ROAD RIGHT OF WAYJ x,41 ~' sEPnc AREA ~~ -~ e~ela ~x x~~ ^h~~~T~ - ~` 38.87 ~U~ REFER CORNER - B.M. E ATlON 1006.2' LOT 4 5•t 1,118 S . OR 13.295 AC. SQ. FTn. OR 13.193 AC. EXCLUDING VN p ROAD RIGHT OF WRY) QJ~ ~ ~' ~z NOTE- ~ Ives.` ~~ j ~ USE MIT IS RE UQ /RED 27't -~ "7~ ~ DWELLING _ . wP _ EAST LINE .S 9O°OO'OO" W FORTHEDISTURBANCEOF LTI WW Apr" ~ L0T2 264.01' NOT ~7IFIm ON~rrle R ~ ~ Y' ,~, ~~'~~I _ ~ rE ` 3 ~~~ CS81..~ ~' ~ ~ 3 L T 5 CONTA/NS ~ PERMIT !S APPLIED FOR ~ tl~~~• 083 SQ. FT. OR c ~, THROUGH THE ZONING w - ~.~ 160 AC. -= ZI OFFICE ANO IS RENEWED ~ ~ ~' ` ~ (7,140 SQ. FT. OR '• ~ ~ °' THROUGH A PUBLIC ~ ~ ~ ~ 100 AC. EXCLUDING ~ ~ ~~ HEARING PROCESS BY 7HE •~' ~ '1 ~' WN ROAD RIGHT ST. CRODCCOtINTYBOARD FWAYJ ~ ~ ~I OFADJUS72MENT. g I 29't•,. ~, Z ( ,`' SHED d • S $9'48'53" E ~i ~~ o ~G ~~~r- ~ ~ 247.OT g ~ 3 o~ ~~ ~~~ ~1~g~ F- ~Q1- W ~LOTS~b N 'L ~ ~ (~ y4~' `~ S/if:~D FouNa4nav ~~ 88 ~; v''i I SETBACK UNE - - - -- Z Sp/~Fp- NyyyEly (]_: '~ is ~. CENTERLINE _; 3't I ~ N 89'48'53" W 061.08' ~ t~ SEPTIC DRIVEWAY ___ -. a~ --z- 69.24' - _• 54.77 `'~ 247.07' ~ AREA SOUTHWEST CORNER `cam. GONg/ ~ SECTION 28, 730 N,R75W S~ .•••••. (FOUND COUNTY BERNTSEN ALUMINUM MONUMENT- • ' •l...AUREN c CAP GONE) / w. MURPHY - ~: /~ 13 i IZ4TED1 1V9jry ~ ~EIVVILLE,~ 0 MAY T, 2004 ~ w~' -~ t`.p o ...... •$J~ LA N~ THIS INSTRUMENT DRAFTED BY JERALD CARSON - s 9o~oaoo~ w z6so.,s' - 1_311T~'! AI (lEN_~l~ ' - souTrl vs co1wER S1[1(PJA_ TT.EL? ~~~tfFp sECnon28, T30N, R 16W (FWND CO2HVTY BERNTSEN ALUMINUM MONUMENT) I~INQ~ AP~ROVED/_AN1?~ sr. 1x couNTY Vol 18 Page 4774 JUN 2 2 2004 It rat rocwluao, w,u;m vv v., ys ,;r SHEET 1 OF 2 approval date ~pprov:sl enaU 5e nul.:rad void i CONTAINS ~ 97-S+sa ~~u(v •~ ~ ~ 9/ c~ C71 4 ~ J06o _ C• ~Zf1¢ ~ . f ~-~ ~ REGiSTEk OF DEEDS ~L ZC 5T. CROIX CO. ~ WI !! ~~~~~ 3 ~ ((I f ~~' ~ _ t ~ C.(2 r~ ~r O ~ Z- RECEIVED FOR REGARD 03-31-2000 3:~5 PM Ot MnP 3 1 2000 ~ ~? CERTIFIED SURVEY MAP KATNEEESdri.ti"ASH EXEMPT N CERT COPY FEE: SG Croix Co„Wf TRANSFER ~ FEE: 4~ ~.. ~~` CERTIFIED SURVEY MADIN6 FEE: 22.00 -~__ . Witham and Jenne Canfield Part of the Southeast 1/4 o the Southwest I/4 of Section 28, T. 30 N., R. IS W., Town o lemvood, t. Croix County, Wisconsir~ 1 BEAR/NGS ARE REFERENCED TO \ TNESOUTNL/NE OFTNESW//4, SEE SURVEYOR'S NOTE SHEET 2 t ascs oooc R8/Sw,ASSUMEO REGARDING POND BERM ELEV. ~ ~ a OWNER'S ADDRESS - o M 2938 /30th AVENUE NOR TN //4 CORNER` ~ ~ SEC. Y8, TSON, R/3W a GLENWOOD C/TY, W/ 540/3 IFND. BERNTSENNAIL/~ ? W o SCALE FEET /"=300' An erosion control plan will be required on ~''~ ¢ ~ U Lot 1, prior to construction. This plan is to i o g~i so 20o aoo ~ svo be submitte9 to t5e St. Croix County Zoning ~ o o ~%j Off ice~,,,~, „r-,- ,. ~ 4 -.il _ _ S B9 ° 14'30 "E /,T26. 47' ~y $ 2 ~ i I NOR TN L / SE //4 - SW //4 --lB.67'~ NW CDR. ~ N CDR. - r` ~j~ ~3. ~ SETBACK L/NE F ~ ~ 4 ~ or i , ~ :, ~= e v ON TA/NS /, //3 6 SO. FT. O 25. 567 AC. ~ M . a i2., APPROVED ro " 99, 205 SO. F OR 2 // ACR/GNT OF w ~ OA D h c ~ ~" ~ ~ o. sr. cROa coulvTM '• Pfar:rNrg Zoning and Parks Committee / ~+ y sEPr/c E S 90°00'00" B/4. 86' ~IW 3 ~~R ~ 2 z~00 h / 550. 264 ' c !r 44' 38' W c~ n, N If~ot.atrtcAnUaa witirir: 30 days of ~ . ~ L o 2 "~ t7 r wppKrvai date apAroval shall be V' ` O ~yl o ttWt acrid void ~ ~ CONTA I 435, 940 SO. N ~~ I w, n c~ 0 1 T. O 0.008 AC. ^ ~iJ tic ' C ~, j I O r ~~ J ~ 2/4 SO. FT. OR ~ r ~ l,~ Fes! O ~ 't 9. AC. EXC. ROAD '? p64' }` I `:1 ? 2 r v~ G OF iVAYI ~ 3 3, ~: i p~ l -~ rq '` O t ~ r = ~ ' ~ 1 ~~~ ~` ~ W 4 ~ ~ M l4-JI ~~ ~ l ~~I ~ 2 ~ ~ W N F,j iy i. ~-I 3' r MOB NOME 1'O BE yQ ~ '~ O ~:l ~ W ~ ~ 1 J kEMOVEO O cli •°o~ ` /00' 8UlLO/NG S£TB . . ~ L/NF ~ O ll h y ~:I 8 to - - NB9~4B'S W ry /06/.08' -- p,~ . ~ I i., y- -.~- 3//.06' 330.02' ~ M17. SEPT/C _~"t s90~oo•00 •' wia2~L~'' - '~ 5//.07' -550. 00' - _ -J~-____-r -~--'S °O 00"W--- /06/.07--~ 9 - _~_ 6 / ~ SOUTHWEST CORNER M "~ -- S '00" 8630, /6' -- ~ SOUT 4 CORNER h SEC. PB. T 30 N, R /5W SW CDR. SEC. ? O N, R /5 W "~ !BERN TSEN MONUMENT- SE//4-SW/ ~ _ Doh ASE !BERN rsE UA//NUM CAPPED ACUM/NUN CAP GONE) MONUMENT/ LEGEND - ---- ~ Z l '~ -- - ````~~~~SCO/~S ~~~~,i O S£T / "X 24"IRON P/PE M/N. WT. /./3 LB /L.F. J ~~ ~} .=' ~ ~1. ~~f. GOVERNMENT CORNER TEO ~ '~ LAUR CE:': S - +*+ g °c ~ ~ W • {dRPHY ~"~" FE/Irt:E L /NE ' 7, 3 ---DRIVEWAYS ~ y •: RIVER FALLS,•; ~ ~ Dated : Sept . 6, 1999 ~_/~ •• a ++ "Revised this 2Sth d.ay of Oct. 1 9.' ~ ~ •••• J ++ ~~~ii ~~ •~ A Al ~ S,',~~~ ` s~s~eaaN saaee~ TH/S /NSTRt/~tlENT DRAFTED BY JERALD L. CARSON SHEET / OF 2 Vol . 7 4 Page 382 I Yoe 1502P~~E 593 621263 ' KATHLEEN H. WALSH REGISTER OF DEEDS DoeumentNum r W RRANTY DEED ST. CROIX CO_ y WI RECEIt-ED FOR RECORD William E. Canfield and Jeane E. Canfield, husband and 04-~a-2ooo r:o:45 wife as survivorship marital property, conveys and warrants QTY PEED to Aaron J. Doornink and Spring M. Doornink, husband and EXEIIpT M wi holdin as survivorshi marital ro erty, the foilowin 9 P P P 9 CERT COPT FEE• coax FEE: 2.00 d cribed real estate in St. Croix County, State of REC~oaDINC = io:oo Wi onsin: aacES: ~ Recordin Area y Nama and Ret Address Thomas A. onnack ___ VVV 1020 'I O'" 54002 ld i B ~ w n, a 6-1060-20 arcel Identification Number) Part of the Southeast arter of the Southwest Quarter (SE '/. SW '/.) of Section Twenty- eight (28), Township Thi (30) North, Range Fifteen (15) We Town of Glenwood, St. Croix County, Wiscon rticularly described as the South 0 feet (S940') of the West 336 feet (W366') o of One f Certified Survey Maps filed rch 31, 2000, in Volume,~]~of Certified Survey Maps, at Pa ~,1, as Document No. 62 91. The retained portion of said Lot ne (1) is being added the parcel shown on the document recorded in Vol. 14 of Certifie Survey Maps, Pag 3821, as Document No. 620491, described as: Lot Two (2) of Certi d Survey Maps in olume 14, Page 3821, to create one parcel, and this transaction is there exempt from apter 18 of the St. Croix County Land Use Regulations pursuant to Section 05(A)(3). Exception to warranties: all easements restrictions of record. ~ ~~ ; ,~ This is homestead property. Da this !,~-~r~ day of ~~--' 2000. • iii , AUTHENTICATION KNOWLEDGMENT Signature(s) STATE OF WISCON ST. CROIX COUNTY ~~~.~.r~ Personally came before this f ~ _ day of 2000, the above named a known to be the person(s) authenticated this day of who executed the foregoing l trument and acknowledge the t~-F ~1% ~ y ;r signature ' ~~ signature =aye o-. Q type or print name type or print name 7 'C~ • '~z'.• • ~ : ?.. Y' 1 TITLE: MEMBER STATE BAR OF ISCONSIN Notary Public St. Croix County, Wiscons'~i;~; (If not, My commission is permanent. (If not, state-~ ate= authored by §706.06, is. Stats.) ~~ ~ 7 ~ ~-' ~ THIS INSTRUMENT AS DRAFTED BY 'Names of persons signing in any capacity should be typed or Thomas A. cCormack printed below their signatures. Baldwin, 154002 lb InfoRnation Profeeaionals Company Fontl du Lac, W~scons~n 1100-8`.~.`'20z~