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HomeMy WebLinkAbout016-1070-20-150Wisconsin 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)]. 'ermit Holder's Name: City Village X Township Lo he, Rob Glenwood Townshi ;ST BM Elev: Insp. BM Elev: BM Description: ~ i I l~llZ. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic , ` I ~ ~/v ~ /,~ V Dosing ~~ Aeration Holding TANK SETBACK INFORMATION fct.~°el TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~ In jf~ 2~ ~ ~~, ~ Dosing ~l~„ Aeration Holding PUMP/SIPHON INFORMATION /~ Manufacturer mand PM Model Number ~~} 31.3 TDH Lift ~ Friction Loss System Head ~ ' TDH Ft ,1 1 I,ss ,s ~.s-r Forcemain Lengtl~,Q / ~ Dia.2 ~~ Dist.~~e ll ' I) ~ f SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 453040 0 State Plan ID No: Parcel Tax No: 016-1070-20-150 Section/Town/Range/Map No: 33.30.15.491 B STATION BS HI FS ELEV. Benchmark 5.35 ~~ -.~3 /oo. Alt. BM Bldg. Sewer I8.v3 7 3~ SUHt Inlet 7 ~'77 SUHt Outlet Dt Inlet Dt Bottom >-,,, ZI y ~~, ~ 1 a er a • ~.m-vf~v'" ~.r' /~O ~ZO Dist. Pipe s,~~ /00.1 Bot. System t,uES l' `- • 3 Final Grade ~s-f~ .t /0/-19 t Cover G I ~ YY1 S'• ~7 rQ ~ J G~ P I 13. ~ `f2~lG~ r~,s~ r.ir~„..,~,~~ . Yy. s 3~z~~/ _o, -6 BEDITRENCH DIMENSIONS Width / ~ Length ~~ ~ No. Of Trenches 1 ~.Q ~! PIT DIMENSIONS No. Of Pits nside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING anu r: INFORMATION CHAMBER OR Type Of System: ~ ,t,~ ~ GOB ~ ~ ~ A% ~ UNIT Model er: DISTRIBUTION SYSTEM W~~t" ~~ilnN~ P~t•~ Header/Manifold r~ Distribution~/ ~ t !~ ~ P x Hole Size f ~~ / x Hole Spacing ~' Vent to Air Inta ~ 3 0~ h i ipe(s) J ( I ~ ? 2 S L t Di i 8 ~[I 7 07~~f Lengt D a eng ng h a pac SOIL COVER x Pressure SvstemsOnly xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of / xx Seeded/Sod d xx Mulched Bed/Trench Center Bed/Trench Edges ~ Topsoil es ..i . No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~~/~ ~.Lfhspection #2: ~Q / 30/~~ Location: 2959 130th Avenue Glenwood City, WI 54013 (NW 1/4 NE 1/4 33 T30N R15W) NA Lot 3 Parcel o: 33.30.15.4916 2 i 1.)AItBMDescription= ,/~4'Y1~ ~'l ~, j'3~ S"""v~ ~~~'• :~6~i 2.) Bldg sewer length = ~~ ~ _ ,,11 -amount of cover = g~ L~~~ ~~ ~ `" V ~~~ loin . a ~ Use othesiside foruadditional in Yes No ~ ~ ~ ~ t~ ~ ~7j~ ~LTjTi~"/h . ~ I ~"1/l ~ ~ ~X/,/ formati n. ~_ ! ~ ~ _ _ ~ ! ~ SBD-6710 (R.3/97) Date I epctor's Signature Cert. No. r Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 J J! 1C' r~cons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (~8) 266-3151 L~~ Sanitary Permit Application State Pla~n/ I.D. Num~jber In accord with Comm 83.21, Wis. Adm. Code, personal information you orovide `~ ~ ` "(.~ may be used for secondary purposes Privacy I. Application Information -Please Print All Informatio Property Owner's Na me 0r Property OwnerTs M ailing Address w's)~\"~C1 V IG® 5T. C"r~01X. COON (Y i ~ _ Pro'ect Address (if different than mailing address) C~ c.~o6 ~, (.C.J t Parcel !f Lo Block rY / Pr~opper~ty{ Location G Q - 1~~- ` mow' NLy S4, G`'~ ~k,Section ~~~ 7 / Ci ,State Zip Code Phone Number ~ t r(circle e) II. Type of Building (check l that apply) T ~ N; R ~ ~ E o~ y g _ - $abcl~Xi~pn N,errye~~~~/~„ GSM Number ~ 1 or 2 Famil Dwellin Number of Bedrooms // fl'M S ~t~a / '~"`C -7 //~~ ^ Public/Commercial -Describe Use (Q 7 / o! ^ State Owned -Describe Use ~~ ^Ciry ^Village ~ ownship of '" 17 III, Type of Permit: (Check only one box on line A. mplete line B if applicable) A' New S stem y ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration Plumber Owner S• 1V, Ty of POWTS System: (Check all that a I) , ~' ~{ ~ ^ Non -Pressurized In-Ground ~ Mound > 24 in. of sm a soil ound < 24 i ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Fjyt r aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Appli tion Rate(gpdsf) Dispersal Area Re fired (sf) Dispersal Area Pro sed (sf) System Elevation VI. Tank Info Capacity in Total Number ~ [Ma~nupfacturer P efab Site Steel Fiber Plastic Gallons Gallons of Units ~/~_~C~ l~Q ~ /„ Concrete Constructed Glass New Existing J,'.~c Tanks Tanks (~(i Septic or Holding Tank O i ,ter Dosing Chamber ~ _,_ VII. Responsibility Statement- I, the undersigned, asstmte responsibility for ' tallation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's ' gnature P PRS Number Business Phone Number -~ .. s zz~ /S G ~5'~0 PI ber's Addre ss (Stree ,City, Stat , tp C e) r VII Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groun water Date Issue suing ent Signatur Stamps) Surcharge Fee) ~ ~ ~D `. 3 2/ D w ^ Owner Given Reason for Denial (v IX, Conditions of Approval/Reasons for Disapproval ~ n G/~/~~~ ~• ' / ~' '~~r~,~~ ~- ~' SYSTEM 0 nrnlF~_ (,~-yL ~c~- G eptic tank, effluent filter andC~yyly~ ~ : ~ ~~Q~2~ Q~ - - dispersal cell must ail be serviced / maln'famed ~u`' ~~ as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. . d'3.563-/ Attach complete plans (to the County only) for lice system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) ~~~ ~C ~~ I 0 0 ~`~, ~d C ~ P \ $ ,,~ °o ~ ~ N ~ ~ °o ~ ~ o N ~ ~S1 ~ pct w ~ N od c~i ~ ~'S o ~ -~ ~ ~ - ~ °O . rn ;~ ~o ~ N ~ ~~o ~ ° m~ Z h i ~ ! n ~ ~ I a ~ ~.,. I~ m ~ ~= I 1 -p C I -~ \ ~ s ~~ \ ~. ~ ~ ~ • ~ ~°' \ _, V w O 0 .\ Q~ -~- ~ D~ ~ ~ c --~ ~ ~1 ~ ~ ~ ~ (~y ~ Z ~ ~ C p- (, L ~- ~ G1 ~ (h ~ ~ ~ ~- w w Z .~ ~~~ '~ ~~ ~ \ ~ Z \ \ COPY isconsin Department of Commerce Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyie, Governor Cory L. Nettles, Secretary March 08, 2004 CUST ID No,224647 LYLE J MYERS NORTHLAND PLUMBING INC E1556 STATE ROAD 64 BOYCEVILLE WI 54725 ATTN: POWTS Lnspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/08/2006 SITE: Rob Logghe 130TH Avenue Town of Glenwood, 54012 St Croix County NW1/4, NE1/4, 533, T30N, R15W Lot: 3, Identification Numbers Transaction ID No. 974940 Site ID No. 671283 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Mound, 3 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 944893 Maintenance required; 450 GPD Flow rate; 22 in Soil minimum de th to limiting factor from original grade; System(s): Mound Component Manual, SBD-10572-P (R.6/99) 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 enclosed approved plans and with publication SBD-10572-P(R.6/99) "Mound Component Manual for Private Onsite Wastewater Systems". The pressure network is to be constructed in accordance with publications SBD-10573-P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". In the event this soil absorption system or any of its component parts malfunctions so as to cr~yj a l~a'ltly~zard, the property owner must follow the contingency plan as described in the approved plans. Ir~ddit e ~iel~ust comply with the operation, maintenance and monitoring duties as described in sec 'on Vl~$+ 9 0 o>~ponent manual. A copy of this information must be given to the owner upon completion ofd e prol~0~~~ / Maintenance information must be given to the owner of the tank exnla~~~ that perio leani ~ of the filter is required. Access to the filter for cleaning must be provided per Comm 84 roduct a pr onditions. 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. LYLE J MYERS Page 2 3/8/04 Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits rec~uir~d-b~th~ e local municipality shall be obtained prior to commencement of /clonstruction/installation/op ation. Owner Responsibilities: • Comm 8 2 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. 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, Julia ALewis-Osborne POWTS Reviewer 2 ,Integrated Services (262)548-8638, Fax: (262)548-8614 j Lewis @ commerce. state. wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code:.-763'.3 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 . '- Mound System Cover Page ~ ~ a e 1 WIES~E~ ~oE~ Project Name: Logghe-Mound Owner's Name Rob Logghe Owners Address 403 Misty Lane Glenwood City, WI 54013 Legal Description Nw ~ '/+, NE ~ %. Sec 33 T 30 _ N, R 15 w Township Glenwood COUnty Shcnt Croix Subdivision N/A Lot# 3 ParcellD# Pending Table of Contents ~~ R~C~~VEQ 1 Cover page 2 Mound Sizing Calculations MAR - :~ 2003 3 Pressure Distribution Layout and Dynamics 4 Dose Tank SAFETY & GLDG3. DIV. 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: Lyle J. Myers MP/License #: I.D.# 224617 Date: 1 /19/04 Ph. #: 7156432520 ~~ ; ~~ s~ % •S Signature: ~ g ~~` ~ ~~ 0 Mound System Design Methods Used 9~0 2'~ per "Mound Component Manual For Private OnsRe Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01) ~A ~G~~?~,F~ per ° Pressure Distribution Component manual for Private Onsrte Wastewater Treatment Systems" (Version 2.0) SB0.10706•P (N 01~ mil, vvF2 Cs Spreadsheet provided bv: 3bAdvisement N12486 220th St. Bovceville. WI 54725 Ph: 715.643.6068 emai: 3ba~ .Dorn Mound System Slope: # of Bedrooms: Depth to limiting factor: Absorbtion rate of fill material: Absorbtion rate of in-situ soil: Effluent quality Max BOD effluent value: Max TSS effluent value: Mound Sizing Calculations Project Name: Logghe-Mound Site Conditions Project Type: 1 or 2 Family Dwelling Mound Plan View C)bservafion Pipes ~~'~ ~` ~~< ~ ~ ~~T ,_ ~ k-K I Tilted Area~JFill Material I~ L ` (_221 in. 1 gaUft2/day 0.5 gal/ftz/day Eff#~1 ~ 220 mg/I 150 mg/I Pepe 2 d 6 a.4.0 in. 18.4 in. 9.5 in. 6 in. 12 in. 9.5 ft. 94.0 ft. 6.3 ft. 10.4 ft. 22.7 ft. Design of the Distribution Ceii Basal Area System Design Flow: 450.0 gal/day Basal area required: 900 ft2 Distribution cell width (A): 6.00 ft Basal area available: 1230 ft~ Distribution cell length (B): 75.0 ft Area of Distribution Cell: 450.0 ft2 Observation Pipes Contour Elevation of Mound: 98.55 ft / Location from end of cell (Z}: 12.5 ft System Elevation of Mound: 99.72 ft Final Grade of Mound: 101.51 ft Mound Cross Section Final Grade- SyntheticFabric Distribution Cell System Elevation Cover Material Fill Material :...~.~ ~"'~,.,,~Qb~selvs~G n Pipe ~ .f 6d ~ ~ a e, frt~,+ert ~.-~---Slope Design of Entire Fill Cell depth at upslope edge (D): C 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): ~ p~.Qa ~,. F ti,.,„, Tilled Area ~``~Forcemain System Contour Notes: FiN material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Syntl~etic Fabric covering on cell per Comm 84.30(8)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Page 3 of 8 Pressure Distribution Calculations Project Name: Logghe-Mound Lateral Layout Lateral elevation: 100.2 ft Rows of Laterals: 2 ~ Manifold type: Center Orifice diameter: o.i25 ~ In. # of Laterals: 4 Distal Pressure: 5 ft Lateral Length: 37 ft Lateral/Manifold Design Lateral diameter. 1'~ ~ In. Lateral spacing (S): 3 ft Lateral to cell edge: 1.5 ft Lateral discharge rate: 7.83 gpm System discharge rate: 31.31 gpm Manifold diameter. 2 ~ In. Manifold length: 3 ft Orifice Spacing/Distribution Orifice spacing (X): 24.00 Inches Orifices per lateral: 19 Avg. ft2/Orifice: C 6) 5.92 ft2 Forcemain Friction Loss Forcemain length: 80 ft Forcemain diameter. 2 ~ In, Friction loss in forcemain: 1.678 ft Lateral Side View Lateral Plan View Lateral Length Orifices on bottom of lateral equally spaced ~a Turrrup w/ball valve or cleanout plug PM1IC laterals and forcemain to comply w~h specifications per Comm 84.30(2](e] Forcemain connection via tee o- cross to marrifold at any point Clean Out Detail Glenn-out plug Grnde ror ball valve Observation Pipes Sprinkler Box Long Sweep 90 orMro 45`s-~ 6" Minimum or plug ~I Note: Cbsel Cdrar may tm used in place of 318" liar ^--3/8° Bnr Mound System Septic, Pump and Dose Tank Project: Logghe-Mound Tank Information Pump tank manufacturer: Wieser Concrete Pump tank size/model: wi000/650-MR Pump tank gal/inch: 17 Actual Pump Tank Volume: 646 gal Tank bottom elevation (inside): ~ g6 ft Septic tank size/model: wiooo/c>so-MR • Pump and filter Pump Manufacturer. Little Giant Pump Model: 9EH Effluent Filter. Zabel A100 Note: Access opening of sufCrcient size to be provided to allow removal of frlter. Opening to terminate at or above grade. I . (~ ~b g Pump Tank Diagram Watertight Locking Cover 41nch With Worming Lnbel Minimum f ~n~~ r_.e, Altemate~' - I ~;( o~net t~ Location Elect. per Comm 16.28 and NEC 300 Weep Hole A or Anti- Siphon B Device D a~eaae Dosage Volume Folremain drains back to tank? ~ Yes Q No Lateral void volume: 15.6 gal Dosage to absorbtion Cell: 78.2 gal Forcemain volume: 13.9 gal Total dosage: 92.2 gal Total Dynamic Head Are laterals highest point? y if not, enter highest elevation: 0 ft System head (distal x 1.3) 6.50 ft Vertical Lift ("D" to lateral) 13.55 ft Friction loss in forcemain: 1.68 ft Pressure loss from filter: t_=Jft Total dynamic head (TDH): 21.73 ft Dose Tank Levels In. A Reserve 22.6 B Pump off to Alarm 2.0 C Total Dosage 5.4 D Effluent depth for pump Total Capacity: 10 ~s Pump must be capable of: and head pressure of: 31.3 GPM 21.8 Feet s ' q es Gal 383.8 34.0 92.2 136.0 38.0 646.0 FLpV- LITERS/F[Rat Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & Leaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 113 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1!3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 113 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities andlor possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cieanout points at each end of the component to remove scum that may Gog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc} become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's can-ent location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. ~ _~- \ ~ ~,~, \ ~ o M~ ~ v ~~ ~ i ~ ~o \ ~a ~ ~ ~ n a ~ ~ ~ ~ ~ ~ \ _ ~ \ ~ ~~~ a ~ r \ ~ ~~ ~ _ ~~~ ~ rn ~ '`~ ~~ ~ ~ ' P~ M I1L ~- W~ i ~~ ~ ~ i `,o ~ ~ a ~` ~ \~ ~cl~ J ~' 3 ~ , ~~ ~ ~ ~~ ~ a ~ ~ ~~~`~' f- ~ ~ ~- ~ MM r- M Z ~b ~' '~ 1 ~, ~ ~ ~ d 3 ~° 0 --~ `Z ~ ~ e ~=i ~' V ~ ~ 3e1~IV'~' . , ' WiscarLBin tSepartment of Commerce Dfvis;on of Safety and Buildings SOIL EVALUAT'tt~tl~~ REPORT P~D Page / of ~ m acrarosnce wan a.orr+m aa, vvw. aam. ~~ ie ~~ ~ ~f~ Attach oompdete site plan on a er not less than 8112 x 11 inches in size Plan must . i p p . include, but not limited to vertical and f~rizontal reference point (BM), dtrecdan and percent stops, sc~e or ddmeneions, north arrow, and locaifan and distance to nearest n~ad. Par©et i.D. D/ ~O - D 70 - 2d - ~ Rlease prlnt,aG~ lMrorneation. ~ ~ Date Peroonal tntormatlon you prpvide m~ M u~tar ~ f Pr~+l,!~yiav+,aR 15.04 (1) hn}). ~ ... ~ ^ j Propettyf3wntif fyLnc~tion , ~(/9r ®~ /~O~ (? ~E 13ovt. l.at IV~~ 1/4 N~1/4 3.33 T 3U N R ~t~er 1f~ Property Owner's Mailing Address - ~• -~ ~ -~a3 ~~s7 ,C-.a.~/~ Lot # .~ 3 81ock # ~ Subd. Name Or 3 z~f 7 ~ ~ ~s-~~ nY e .,. , . ^ City Vlllege own Nearest Road _ a . 5 j f~t~fGc~aCb rti~/ l3 Gu-`.~~va~j /,~a fh. ~Qir~ New Cons6'uction . i1se~Residentiat / Number of bedrooms ~ lode derived design flow rate '~ SU r GPD (~ Repfacemient ^ Public or oommeraal -Describe: .._._ Parent material ~~ CjR /L ~ L4:,~ Flood Piam t>fevatian if applicable ..._. ~ a rnd soot m~mertde~tions: /~f~?~. ~t~'~~i 9~ ~-~~ n ~ln~# o B~l~ ~l/_ ~ 1 _ ~~ t_._J J~ Pit ~arouna sunace elev. / .x • - . n, uepm ~ nrreurig rauar ~~- a~. Soi3 ic ation Rate Horizon Depth Dominant Ce Redox Oescdplion Texture _ 5vucture Consistence Boundary Roots fn. Munselt Qu. Sz Cont. Color Gr. Sz.. Sh. , . 'Efi#1 'Ef(+y2 ~ ~2-~ y-~ .~ 2~ ~{ V r s ~~ e 5 3 2~ - ~~s -~' .5 e~ ~ sc. SS rn-~' ~ s ~-- o, o , o ~ ~'¢ 5'G ~ S -- O. U o . v ~J_ `' Baring # rat~yy t3oring ,~ tad- Pit Ground surface elev. 94~ ~51i. Depth to limiting factor ~ in, soy n Rate horizon Depth Dominant Redoac Descxfd?~ Texture 3vuct~Ke Consistence Boundary Rooms GP D/ttz in. u nselt M qu. Sz CorM. Cofer x. t3h. Gr, a 'Ef(t!1 'Efflt2 ~~~ ~/ p p VIN // ~a yy /•~"•~ r ,~/ .r~ l.-~.J !! J r~1 • ~ r ~' ~3 ~ Y s s~ft 3 /~ a - 5YK¢ -~'l ~~ $`~RS ~ sc bK ,,y s ._ o .v o~ tJ ., ' F~fluent #1= BOD_ > 30 < 220 mall and TSS >30 < 1 50 moA. ~' Effluent #2 = BOD . _< 30 nglL and TSS <_ ~ mg1L Name ` ~ r-S . _ dZ~=~ 945 Address Dah- Evaluation Conducted Telephone Number 2 3 ~ o ~ l., G den ~ eel Gv S' "D 3 !e -/3F- ~ 5 ~~ `-~/!o v'~- . r~~ nF~ n~nn /1./N.Mn. . . Prr~pertY Dwnw'~°~ ~'"~' 6 ~C- .._._ F Paroet ID ~ ..-... Pam ~ of ~-- w . /~ /J l;sortnq ~ ~ Plt sound ~ueiace p1ev. s 1~ tt. Deplt~ I~ II~'!y hCtnf. Gam ... ~. ;;olf Ion Fiats Horis~ 2~ ~ Depth in, p~ ./ _~~ 225 goe+ina~rt t~ctooc Desortptlon tlriunall Qu. Ss. Cont. Color o yR 2 ~ lb~fK' ~,s .5y2`~ .5y~s~ Textw+e $ ~uot~m a ~ 8h. ' 3s6 k s ZsLk ....... s~ ~K ~-- ~~k CexWetertioe 6 n,t~~'r r i ~ ~i` o+~v eS S S S ~ 3r ~. ~ 'EfAM1 ~ ~' ~ ~ o:v ~ , o '~ `EiN~2 ` 8 .,~. o, " o. o ....... [""1 ^ Borano °`~' ° ~'' " aura ~,. _.,,, f4 Dept, tt, I ~rnitino factor ----- an• ^ Pit _ Hortmn Depth DominantCotor ~Wnoc,DdealpNon Taxty~n ~tnlci~e QgmisMnoa Bountldt'Y F In, Munpeti 4u. t3z. Cont. GolOr tai ~• ~~ soil 'EIIfM n '~2 ......., .,...,. . .,...... ....... ........ Ir1 i-'1 ~ro ~„~ ~~a ^ Plt t~ourxlaurtaoao~v. - Horizon Depth . 17om(nent Color Fiedooc Daalptbn In. Munwp Clu. Ss. Cont Color R oepu, ro ~u~unpra~ u~ ........ Twdure t3trvcx=ire to~tenoe Boundary Root ~ ~ ~ ...N.~ r..~iOY . "BtIM.4 0~ rM.n - .. ~ r....ra ...IIYM ' .#tS s. ~Do> 30 ; Z~A.fC1411- pn0 Tt3t3 X30 _< 160 ~ ' E1'Auertt•p2 4 t30Do <.30•mplL ar+.d Tt3t3 ~ 30 n~ '~ Gapurtn-aut of~Ceuunaroe i~ au oyuai opporttu~ity eervioe provider e,~d ctnpiayer. If you need tagaiet4aoa to sooeea go~^vieae. or need rna~iel is ea sltsrnmre lbsmet. pleoee ootttt~ct the dop~+trrtoiu et 648-26e-3131 or TTY 608-264-8777. s~ spa cg.o~roo~ i~~,,~ '~ --~ ~ ~ ~. ~ ~Q ~~ ~ ~\ ~ ~ n \ ~ ,,,~ \ ~ °.,`~ `~ ~~ ~ ~, ~~ a a M /t k ~~ ~ ~ ~ ~ \ ~ \ \ ~ ~ ~ ~ V1 o ~ ~ 0 c ~~i ~~ 7 !~- .; ~ -- ~ r ~ M 7 ~ m ~a ~ ~ ~" ~ ~ a `~ ~. 3 rd ~~~~~~ r ~~~~~ N ~~~~ M ST CROIX COUI~I'I'Y SEPTIC TANK MAIN'I'ENANt"E AGREEMENT AND OWNERSHIP CERT'IFICA'T'I~JN FORM OwnerBuyer ~ot3 ~-o~~~E Mailing Address `~'y3 ~ ts-r 7 L ~t ~ E ~ ~ C,6 ~ w U o ~ ei T y ~~ ~ S~f Q 13 Property Address ~~ {Verification required from Planning Department for new City/State G t,e~ta o ate CtZ `t l w ~ Parcel Identif cation Number - - LEGAL DESCRIPTION ~~ r~ Pro Location ' /V'~ %., Sec. 33 • T 3C~ N-Re ~ s W, Town of GLE~c.LW oo ~ . p~,,y ~>~ /<, Subdivision _ _ .Lot # ~ Certified Survey Map # 73 ~ Z ~,~ ,Volume _ Page # ~`„~y~ Warranty Deed # ~ `~ 3 ~ St'S~ .Volume ~ `~ `-~ Page # 4 Spec house D yes j~l no Lot ?fines ideati$able Byes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result ixi it:; premature failure to handle wastes, Proper maintenance consists of pumping out the septic tank every three years or sooner, if ncrded 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. The property owner agrees to submit to St. Croix 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. Vwe, the undersigned have read the above requirements and agree to tnaixitain the private sewage disposal system with the standards set Earth, herein, as set by the Departtent of Commerce and the Deparmient of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. i- a is i ~~ SIGNATURE F I,ICANT DATE OWNER CERTIFICATION I (we} certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descn above, by virtue of a warranty decd recorded in lteg.ister of Deeds Office. a,a7, o~ SIC}NA AP ICANf DATE «•«**« *•**** Any information that is mis-represented may result in the sanitisry permit being revoked by the Zoning Department. *• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty daed U 2434P 46~ S'I'ATh. HAK OF WISCONSIN FOKM 1 - 199R ' ~ WARRANTY DEED This Dee(l, made between Donald E. Frieburg and Julie A. Frieburg, husband and wife, Granror, and Robert A. Logghe and Lisa D. l,ogghe, husband and wife, as survivorship marital property,_~______._____-__-__-_ _-___ Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property"l: 743485 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 10/13/2003 11:30AM MARRAHTY DEED EXEMPT 11 REC FEE: 11.00 TRANS FEE: 45.00 COPY FEE: CC FEE: PAGES: 1 Name anJ Kelurn AJJress James H. Krave Attorney at Law P.U. Box 30a GlenwoodCily, WI i~Ul3.03U-i ol~-uno-zo-ooo - ~Yt'e- ~ W I'arccl Idemilication Number 11'IN) -this _i s_ ___ homestead property. (is) (is not) Part of the NW '/. of NE '/. of Section 33, Township 30 North, Range 15 West, St. Croix County, Wisconsin described as follows: Lot 3 of Certified Survey Map filed August 19, 2003 in Vol. 17, Page 4591, Doc. No. 736247. 'together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements and encumbrances of record Dated Ihis ~ day of October 2003 AUTHENTICATION Signawre(s) _ _. ~~~~~~.0~~_ + J E. Fhebu r f=< t ~/. Julie A. Frie/burg / ACKNOWLEDGMENT ti'I'ATI:UPWISCONSIN I ss. St. Croix County. ) _. _- _ YY~(unn{Ip Personally came hefore me this g Ja) of authenticated this Jay of _ _ _ . - _ - `~w s_H. -( ~~~h~~ October, 2003 the ahov~ name) .` ~~. • • • ~L~'i~~Donald E. Frieburg and Julie A. Frieburg .~ - `• 1'I'1'Lli: MIbMB1ER JI'A'tli BAR OI' WISC01gti~•. A * G 2 ~_ __ _" _ _ N (~Bea,\ y ne known to h • ~ pc 'o vho a •u 1 the lircegoing (If'not, 2- nstr cm :mJ a kno • th • . le. au11us INS~Kl~1MI N wAS nKnrrt:o n~~rF~OFlW~SG~o~~~ /~-- James H. Krave, Attorney at Law '" ~~~_~(_ ~1., _, _-.l~N_y ~_--~ _... - Glenw(wd City, WI 54013-0304 o Puhlic, titate of Wisconsin (Signatures may hz authenticated or acknowledged Both are not 'ommission is ~mane'nt.,(I f not^, start cxpirat m Jatc: ~~ ~~~~ 'Names u(Ix:rslnls signing in mry capacity shuulJ be lypeJ ur prinleJ Ixluw (heir signamros Nl"A'r!: W k Ur W 15(.'nN51N WAYNANTY UCl:U !'nNM Ns. 1 - 19Y{ INF(1RA1 A'111IN PAl)FF.SSIl1N AI.S ('(~MPANY FIINn nI11.A(', W I aaU-hSS-2U? 1 7 3 6 2 4 7 VOL 17 PAGE 4591 HATHLEEA H. M~A-'- REGISPER OF DEEDS ST. CROIR CO.L MI RECEIVED FOR lfECORD 08/19/2003 11t00AM ner PAGES: s CERTIFIED SURVEY MAP wri r-~` 3'~ LOCATED IN Tlf NWS/4 OF TFE NEi/4 OF SECTION 33. T30N, R15M1, TOWN OF GlE1~Nr000, ST. OTaOIX COI~fT'Y, WIS(~PSIN. APPROo ED BEARINGS REFERENCED TO THE NORTH LINE OF THE NES/4 OF SECTION 33, ASSUMED TO ~a"^~~9zonr°na.,ypa,~.0~~~~ BEAR N89°21'41'E. (PREVIOUSLY RECORDED M+~OWNER SUBDIVIDER _ AS N69°39'33"E ). AUG 1 9 ZOOS 1284 300TH S~TREEGE~T~ GLENWOOO CITY, WI. 54013 C ~ if not ro~rn9d ~Nln 3U Days ci SURVEYED FOR y,` ••••.. S/,i, a~OVal ~ p~p~ shall pa ROB LOGGHE _ Z., - DJDICATES SECTION CORNER `~ EW RwHMON ~ ~ J (ESTABLISHED FROM TIES OF RECORD ) -N- r ~ -INDICATES i" (OUTSIDE DIAMETER ) 9~jr~`'•••.....••••~ IRDN PIPE FOUND. O SURV~ INDICATES 1" X SB" (OUTSIDE DIAMETER ) IRON PIPE WEIGHING 1.13 LBS. /LINEAR FOOT SET. (R) -INDICATES PREVIOUSLY RECORDED INF~IATION NS/4 CORNER, UNPLATTED LANDS SECTION 33 ~-NORTH LINE OF THE NE1/4 NE CORNER, SECTION 33 258.71' N89°21'41"E --------------- _--_~- _-/-(R N89°39'33'E) --- in IJV/!7 Nes°zi'41"E 466.70' AVENUE m - ~ c~NTERLINE of roWN aoAO~- - i9oi22' cn N89° 21 '41 "E - ------------- - - - - - - - - - N89° 29'52'E 466.70' - ~°'i, n M ~ 0 ~ ~~ ~¢ U x~,~ ~JH CCC~.~~.. hJ-1= Q lL ~ N~'` Z - ,..Z g o ~oN ~ n ~c¢iz W ~~~ g. m >~~a ~ m a~rz~a ~I t~ a ~7a7c~Z~ 1.1HUH ~~~~ 100' BUILDING SETBACK LINE FROM RIGHT-OF-WAY m c LOT 3 217,800 SQUARE FEET ( 5.000 ACRES ) INCLUDING RIGHT-OF-WAY 199.548 SQUARE FEET ( A.581 ACRES ) EXCLUDING RIGHT-OF-WAY S89°21'41"W 466.70' UNPLATTED LANDS GRAPHIC SCALE i"=100' 0 100 200 300 THIS INSTRUMENT DRAFTED BY' JOSEPH W. GRANBERG agi~~ ~°\." LN o ~; }IWI ° tnv LL. ~ WJ v w~'i ~~Q z ~I~~a.l O• ~ ¢ ~~LLI~I ~~ Ui>' a~~ BY: 1?J9 c.T.r(. ~• NEW RIpaMOrD, WI.64017 PHOPE (71b) 246-7b~9 JOB N0.03091 1 OF