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HomeMy WebLinkAbout016-1037-60-000 n N O -0 n d ~1 o c m o '0 3 a y ~1. (D v .a ax c v m m 3 _ m 0 0 O N w o ° A Cil w n- v° `C ~1 • 01 3 3 c m co CD j W OM ryl a z a in ° a o° o = O W 7 r 1, o cn O N c Al N N N CD O. IV \ 1 a O v \J 0) M o CAD C~ Q o oNO o A~ O O O r A 7 N N 0 ° O CO r~ CO O W C CD Cn CD a rn CD 0 N a 3 w 0 o 5 O_ V w O N A C O . O A A fn O C lei z O O O ° !r~ z ~r o n ~ tv c z ry~ UO r'3 III 3 cn In cn a D A m ? o a_ * o r ti a m CD W CD ID ~ cn rt1 m y - N o d 3 y w Q (D - N olo 0 z z O Nt~ D D o N ♦ d a Er_ a !r Oa ( O O "VA• C Cl) CD _Z CD_ , Z O A o m w ~ _ o ID z ' Z F* z . ° 3 A CD ? W tU i i CD O O d CCDD 63 2- N _n p O CL Z3 T 3 St N C = N a o Z3 m p N a° o < y N r. ' A O 7 lzt CD N A ~ O S CD A Q Z o = C n a CD n N O p ~ CT A C=D A O DQ A ~ Efl 0 N ° b °o CL Parcel 016-1037-60-000 01/06/2006 04:55 PM PAGE 1 OF 1 Alt. Parcel 17.30.15.272B 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): O = Current Owner, C = Current Co-Owner O - DRALLMEIER, ROBERT G & NANCY S ROBERT G & NANCY S DRALLMEIER 2835 160TH AVE GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2835 160TH AVE SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 17 T30N R15W 1A IN NE NW LOT 1 CSM Block/Condo Bldg: VOL 3/631 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 791/224 07/23/1997 581/451 2005 SUMMARY Bill Fair Market Value: Assessed with: 89317 82,900 Valuations: Last Changed: 10/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 7,500 62,400 69,900 NO Totals for 2005: General Property 1.000 7,500 62,400 69,900 Woodland 0.000 0 0 Totals for 2004: General Property 1.000 7,500 62,400 69,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 - Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT 21 OWNER (eTOWNSHIP D qC Ec, N-R W ADDRESSf ST. CROIX COUNTY, WISC N w~~o/ C/I`f Lam/ ~Le 61 SUBDIVISION LOT LOT SI7.E PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM O L G C~ HIla ~oGp Gf~L i 1j~~YC H /aa' 57 p~M n C /f, /Al h01 R i Ma ~ Nd INDICA E NORTH ARROW BENCHMARK: Describe the vertical reference point used t/10M p ,S/Q/j(Vy pIV S'W C oR Al el~ o ff= /-/G s e- - Elevation of vertical reference point: ~Q~ Proposed slope at site:^ SEPTIC TANK: Manufacturer: LvQ IT Liquid Capacity: a a0 Cr G Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, W Side t Rear, 0 ,?;2-5-feet From nearest property line Front,0 Side,0 Rear, 0 7Z feet Number of feet from: well, building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) PUMP CHAMBER Manufacturer: _~'ja-& ffs' Liquid Capacity: ~'D O G I Z Pump Model: 0,5,07? Pump/Siphon Manufacturer: //)/%64j ,41'`/e, Pump Size -~/a AlA Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: /.;2 Alarm Manufacturer: S1 S:Z e(7 pgy Alarm Switch Type: L/rl/fir` f xzoRN Number of feet from nearest property line: Front, Side, © Rear, Ft.7-f- 0 ~ q Number of feet from well: --y 7 Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: x Trench: r Width: Leng'th: Number of Lines: Area Built: 3 7~ Fill depth to top of pipe: Number of feet from nearest property line: Front, o Side, O Rear, Ft Number of feet from well: /2 Number of feet from building: -$-%2 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: /0~ 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL VALTERNATIVE state Plan LD. Number -71 ❑ Holding Tank ❑ In-Ground Pressure nlass9ne~l Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: =T=TEP'y IJZ~zZe V BENCH ARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PL ELE V. CST REF. PL ELEV Name of Plumber. MP/MPRSW N Iull unto'' I Sanitary Permit Number. 9,0 95© SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV WARNING LABEL LOCKING COVER PROVIDED'. PROVIDE I % - ~G=~ YES ❑ BEDDING. VENT DIA.: VENT MATL . HIGH WATER ALARM. NUMBER OF ' ROAD: PROPERTY WELL. [:]No BUILDING: VENT TO FRESH FEET FROM uNE AIR INy~__ ❑YES NO ❑Y NO NEAREST 7 / I DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MA 01 NUFAC UREN. T WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES NO ' ct S? j I,~ .~(3~f I~ GALLONS PER CYCLE: PUMP ANDCONTR LsoPERArIONAL L YES ❑NO XYES ❑NO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH l AIR "f LET FEET FROM LINE PUMP ON AND OFF) YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing NGTH DIAMETER MATERIAL AND MARKING IL E or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING COVER TRENCHES INSIDE DIA =PITS LIQUID DIMENSIONS MATERIAL' PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL NO. DISTR NUMBER OF PROPE BFLOW PIPES ABOVE COVER ELEV. INLE I ELEV. END. RTY WELL. BUILDING. VENT TO FRESH PIPES FEET FROM ' uNE AIR INLET. NEAREST-ir MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. YES ❑ NO SOIL COVER TEXTURE PERMANENT MARK ERS. OBSERVATION WELLS DEPTH OVER TRENCH C] YES ❑ NO OYES ❑NO 'BED DEPTH OVER TRENCHBED DEPTH OF :TOPSOIL CENTER EDCES SODDED SEEDED MULCHED ❑YES C NO OYES ❑NO YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER i TRENCHES- , DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV CIA ELEV.' PIPES DIA: f [DISTRIBUI ION 21 J INFORMATION POLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ❑NO YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL BOIL NG. NUMBER OF LINE: YES 1:1 NO FEET FROM ES 1"n ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) WISCOnsin APPLICATION FOR SANITARY PERMIT D I L H R f ' V COUNTY E OEPRRTmEnTOF (PLB 67) UNIFORM SANITARY PERMIT # InDUSTRY,LROOR 6HUMRn RELRTIOn5 g-ro -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION 6i1'T: 1/4 L rr- /4, S 17 , T:?~ N, R P;_10 (or) W TOWN OF: LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms. h-3 ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound ❑ In-Ground Pressure Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber i J Manufacturer: t i . ~ PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Private Z1 Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number: Plumber's Addr : Same A of Designer: rw h t 1. L C y -5 M l" COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: Disapproved ~3 / ❑ Owner Given Initial 7 o - Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc,), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. 1 Smith Plumbing & Heating PRONE (715) 265-4838 17 73ox/ /f 15-41 GLENWOOD CITY, WISCONSIN 54013 ,L,.C U n a r d f r if rl , /tom ~v o PLUA P o~if%~n~z ~lr~ P DEPM 1009@2 1STRY, LAM q ANP-Hrik!AM ill ~f DIVISlgi OF,$AFiy'fY,Ai.NQ/BkJlLpLNGS r ®rc 13 Per • ~9S es~ p r S. ~4 N oaf Gam. I . i A~ k 7.50 G , tau-~,~ ~hww►~r' 4.N~L.,. 48 1 C3 ~ Shed P3 P-1 Jp " Page 0f PLU?,,gI3ING Ifon ifinna Straw, Marsh Hay, Or ?t. J Synthetic Covering AP&q ~ CPAR'r,'ic,v' sf!~f P,iNMIP®fv'r1N REL,AIG1,J~ Medium Sand Topsoil DENCI_ E " 3 ' % b Slope . Bed Of Z~- 2 %2 Force Main Plowed Aggregate From Pump Layer % ~ C. N 2 '1994 D X13 E Cross Section of A Mound System Using cv-~-- F 75 ~ A Bed For The Absorption Area / G -lv A_ Ft. H Ski Signed: BFt. License Number: Ft. Date: d -5 t3Ft. r, 'Ft. K/ Alternate Position L'Z 'Ft. cc~~ of 40 19 Force Main W: c` YFt. Observation Pipe--,," Force Main W From Pump F-- - ~Distribuiion Bed Of 2 2 2 Pipe Aggregate I Observation Pipe Permanent Markers 4 i l Plan View Of Mound Using A Bed For The Absorption Area ' Pate Uf J P- Perforated Pipe Detail cy a~,tr End View Perforated i % End Cap J PVC Pipe ore' oe \ Holes Located On Bottom, f J~~~oc S \ Are Equally Spaced \ \ / PVC Force Main • From Pump PVC j Manifold Pipe ' Alternate Position Of Disir bullon Force Main From Pump Pipe ~ / Loci Hole Should Be / Next To End Cap End Cap Distribution Pipe Layout P X7,3 R S 5, 5 X JI/ Signed: Hole Diameter Inch Lateral Inch(es) License Number: Manifold ~ Inches Date: Force Main Inches ~t ark 2 i PAGE - C~ F - PUMP CHAMBLR CKOSi SECTION AN][) SPECIFICAT IONS VLIJT (-AP 'I"c'1. VLNT PIPE WI AI 141 K PKOOF - _-APPROVED LU( MAKIHOLE COVER 4 QPaM 'IUKJCT-IGKJ BOX ~ 12" M I U - C - f~ J1n l ,1K1r~ NItiUC)~! OK CRLSH f,IK{ INTAKE I I / f Li~c1 f / `W✓ C0IJDUIT WLF: T PROVIDE I j` AIRTIGHT SEAL I III I I I APPKOVEI) JGINT A I III APPROVED G' W1C.i. PIPE I III W/C.I. PIFE E><'T ENUING 3' I I I ALARM EXTEAlDIA1G OAJTG SUL-ID ;~.It. B I II ONTO SOLID S ~ Z I I oKi c ` I PUMP OFF D COUCRETE BLOCK { KISER EXIT PEKMITEEU GIJL`J IF TAKJK MAUUFACTURE-K HAS SUCH APPROVAL g 40 g 5 6PEGIFICATIDUS ZPTIC AND )SE TAKJK`- MAKIUFACTuRF- K: ~e DOSES: --.Y_--_-PF-K DAy 1AMK .,IZFL At_AK_M MAAJUf=ACTLIKEK: CAPACITIES: A= a!'_S-II.ICHES OR ~70 GAEt,> MOULL ►JUtAbEK: 6=--02- IMCHES OK jGALLOU ',WITLH IJPE: ~a~WCHESOR1-43,11 GALL CA. I'IIMI MnnllilA~ I LIRI, R: ^.t~la►~Lf~-_----- - - D = { IJ C t E S C :,R ~ vA L ,cam M I l l KJUMkSIK: __._----~:s r~ HOI L: PUMP AK1D ALARM AR6 TC, BF H I :J PL - IA-ISTALLED OM SEPARATE f.IRCUliS PuMI U15L A HAKC,L 11, A'! E _.-GPM 0-KT ICAL. DIFF EKEKILE 8E-I WLF" PtIMP Of F AKJD fJl;~l R1t3Ul IGIJ PIPL.. + MI"IMUM. M1:1 WOKK SUPPLY PKL'I- tl~KE , , . . . . . . . . . 2.5 FEET Z 4 46-45', i EE I C.) F FORt.E MAIKI k FKICIIOAI FACTOR-:!?. YY-3_ FEE I M 1 U I AL. fJ`JA1AM 1i,- HE_AU --~y F ILLI - If 32. :~.oAeMtw~.lata:J~,c rlyax~.s Or 7400 Lt7A &T1r_ 7e i4;,'Wrti 7 t-i41ulp psPT1'~ Wisconsin Department of industry, PL13-1 INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing Name o remises a e an i.D. No. County Sanitary ~ Permit as er umber i rm ame , ;T Address Journeyman Plumber Address Owner ress ' JQA ~ ~..~a'~'~ ~.E.m....~...'~.~t,."✓ 9.-{/..~rt,,~,~c..~.~..,. f ~~r, ^~,1~ rt ` ~J~'~«;. ~ J" f F r~6 R ' t 1 75 ~`Y~ a` ti . t" . - tat ~ ..~,....~...a..m ..e_m. A~Z 4f el .!'~~~~.,.:y~:~., 'e-~' ...,'L.4::_...t?..~a.'~.y,•.~.../~t 5.rt .,~~~`f.~:?_.'T.,.,„t.'r..~•.,-! ~ 1~~'~.......,,.''i~~~..:Cv..~......_....',....'A~ t- „t , 4...,._._..~.~~xS....:~" el. °'1 ~ .M1, ~{.t.'7.I../~' ' ~ /9y. • SY~ f ..t...~`':~'3,.....~ }mWgrr.. ~ "d. `aft `I ~ - i9._.(~ 7 ~..a' f gym.>_. Discussed with ature ( )See Attached. DILHR-SBD-6192 (R.10/82) Signature of is " n- as e, e Inspector Local Inspector Plumber or Responsi bl e TArty '-•-Owfier . x.~ f9 Pnd Social Se^,°.r tv ~ l ?r: rtp.td'of am F u I A!" drti:; d Soc+a' ,ec uri,,. Number r of (srar te,~ r a Scho 'rg40-t ct r 5y1 Vc3llac3Ze Road ~eU:1aT 1 H . Parent grid Helen A. Parent .9!arttor related to grantee? (Blood or Marriage) Yes No- Glenwood City, Wi. 54013 'dress to which t--.bills should be sent Glerwaod City, Wisconsin 54013 PART I - PROPERTY TRANSFERRED ,Linty of: Check proper box and enter name of munici alit P Y Street address of property transferred St. C*mix ❑ City ❑ Village OF:__QeD Town 4gal Description (Fill in legal description in space below or attach 2 copies of full legal description from instrument of conveyance) Lot No. _ Block No.------- Plat Name-----__._ or metes andtounds description: part of the NE of the MI of Sec. 17, TS 30 N R. 15 TU Town of GlernJOOC1, St. Croix County, Wi.., under certified survey No. 631 Lean R. Herrick, Land Surveyor, and filed with the Register of Deeds for St. Croix County, ;di., in Vol. 3 of certified survey maps, page 631, doc. No. 350032. Also the Grantor 9MtS to 1he Grantees, their heirs and assigns, a 66 foot easement as set forth in the above certified survey upon which there now exists a driveway for purposes of ingress and egress of foot and v€d-Licular travel. Said driveway to be maintained b the said grantor, however, retains for himself, his heirs and assigns, use man` for purposes of access to adjoining property, the rift to use said dri PART 11 -PHYSICAL DESCRIPTION AND INTENDED USE 1. Kind of Property 2. Principal Intended Use • a. Land only !and Area and Type a. ❑ Residential a. Lot Size - Estimated ❑ ❑ New Construction b. ❑ Commercial X ❑ Building Previously Used a ❑ Industrial b. Total Acres - Estimated b. Residential Units, if any d. ❑ Agricultural i. _ Tillable Acres ❑ One Family e. ❑ Recreational 2• W.T.L. Acres ❑ 2 thru 7 Units f. ❑ Other (Explain) _ 3• _ F.C. Acres ❑ 8 or more Units c. Fzet of Water Frontage _a Cstimated ❑ PART III -TRANSFER • ,Sale ❑ Gift 3. ❑ Exchange 4. ❑ Deed in satisfaction of L.C. dated- 5. Other Explain 44 Here PART IV - COMPUTATION OF FEE - Total value of real estate transferred (purchase price, etc.) . . . . . . . 2850.00 Ownership interest transferred , i7G Full ❑ Other (Explain)- $ Fee 2.05. 4. In your opinion, was this sale or transfer made at fair market value? $ ❑ Yes ❑ No ❑ No Opinion . (If no or no opinion, Explain (We) declare under Here) penalty of law, that this return (including any accompanying schedule) has been examined by me (us) and to the best of my (our) knowledge and belief it is true, correct and complete. Sign Signature of Grantee or Agent Date Here August 23, 1978 Document No. Vol. (Reel) Page (Image) Date Recorded Date and Kind of Conveyance LEAVE I THIS Parcel Num r DOW I AREA 19 County Co District Ccue 14 A B C L - BLANK D E F 1 1 Office 2 Field ~3 Use 4 Reject Ratio Consideration T T 4E-500 (R. 1-76) R NAd N Tom, iv k iJ -4: Te 1- jv /7 s N z Iv1 v u lYor A APPLiCATLON FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is old-and-submitted-to this-office with-the-appropriate deed recording. (timer of Property e© N.4wao✓ ~J/~R~IVJ Location of Property I yS Nom, Section T 7jr N _ R W Township pty .0 a/ Mailing Address 2 Subdivision Name ^ Lot Number Previous Owner of Property X At w I..f s'C f1 o em 4,, c ry`e,4 Total Size of Parcel I-,4dA! Date Parcel was Created 2-7.-~~ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes Volume _'.5709/ and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (ale) eeAti6y that aU statements on .thin 6mm aAe -tAue to the best o6 my (outs) knowledge; that I (we) am (aa.e) the ownetc (s) o6 the pteope.,Lty decAibed in -th.i..s insoAmation 6onm, by v-iA-tue o6 a wwucan,ty deed tcecoAded in the O County Regi,6teh o4 Deeds as Document No. r- r~r ~gcce e the peesentty own the puposed site ~oA the sewage ; and that I (we) obtained an easement, to ,Lun with the above descAibed p opseAty, (6oA thee) have eons.tAuct on o6 said system, and the same has been duty tteeoteded in the 066tice o6 the County Regi6teA o6 Deeds, as Document No. &:-l00s-8 ) 'IGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) SIGNED DATE SIGNED ''AR OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NUUS1'"liR Y , DIVISION UMA AND PERCOLATION TESTS (115) P.O. BOX 7961 I IUMAN RELATIONS MADISON, WI 53107 (H63.090) & Chapter 145.045) Ii nCATIN-/ S~CYTZSfTC_U_V9A%WAUE. p TOWNSHIP%_easaa~a ~ LOT NO.:BLK. NO.: SUBDIVISION NAME: ~1~1C 1/ /N/Ra Ulf 1000NTY: - O N R - T 1 COUNTY: I Cro MAILIN ADDR S: USE 1, r DATES OBSERVATIONS MADE IST- S: STS ce ON: 7-67K7~ ~i HATING: S- Site suitable for system U- Site unsuitable for system NVF I`.UEl S TI~V . Mp Q~ EIS ®L • EI-I FILL OLDINGTANK: RECOMMENDED SYST W(optional) _ (Ll4~J (IAA ~JJ UMCMS--U lil Percolation Tests are NOT required DESIGN RATE: under c.H63.0915)Ibl, indicate: I( A LFiocidplain, any portion of the tested area is in the indicate Floodplain elevation: PROFILE DESCRIPTIONS HORING TOTAL R ATER-INCHES CHA AC ER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH DEPTH IN NUMBER , ELEVATION H TO E CK IF OBSERVED (SEE ABBRV. ON BACK.) B j 3.6~ 8.S o ,33 1 70 Aicl B d .4 a.~ s Sir 976 - Z 6- 13, I j. ti. B- t PERCOLAI`ION ~7ESTS NUMBER INCHES AFTERSWELLIN INTER VA MIN. WA V I HES RATE MINUTES P_ r 3V PER fNCH P- ;gyp f7/ .2- P_ P_ l P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION X04,. S~ T f 1 _ if n T L 1H 7, •5 o p i 714 _ i • , r I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods s Administrative Coda, aind th"~taslsoxasor/iad and t pacified in the Wisconsin h4Mi0atlon of the tuts are correct to the best of my knowledge and belief. N AME print i p W TESTS WERE COMPILE I ED ON AD CERTIFICATION N MBE PHONE NUMB ER(optional):I J (--t (,~'f s CJ~ 3 7 4? X4 --If Ire S SIGNATURE: . /611 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Sol) Tester. DILHA-SOD-6396 (R. 02/82) - OVER - t,.,.::§sJp,M° K+r r~ vvev+w't:...q,ea wW.u igWa0a2 .mil N lmn e SANITARY PERMIT WPM& County I;MEI~.YiY1'I'lE/',7 Cray ~ GROUNDWATER SURCHARGE" Sanitary Permit No. On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. ^_7 Ground at$r w Sign ture of Issuin Agent Groundwater Fee: Date: Wisco4aln's 117 - buljed treataouf )IL9fR 513U-7289 (N. 05/84) i e H C/1 y S T C - 105 r y H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County d y OWNER/BUYER i t~YtGk."~ ROUTE/BOX NUMBER C-3 Fire Number CITY/STATE ~LL!I LiP -Yc /3 PROPERTY LOCATI.)N: Section 'I 3C' N, St. Croix County, Town o f Subdivision Lot number I Improper use and maintenance of your septic system could result in Proper maintenance con- its premature failure to handle wastes. ProE silts of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. o I/WE, the undersigned, have read the above requirements and agree vii to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- •u ment of Natural Resources. Certification form must be completed and returned to.the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DA'Z'E St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. ST. CROI X COUNTY WI SC O N S I N ZONING OFFICE _ 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 June 25, 1984 Division o4 Sa6e-ty and Bui tding BuAeau o4 Ptu.mbing P. 0. Box 7969 Madison, WI 53707 Dean. Si&: An on site investigation 4o4 .theLeonan.d Patcen.tpnopehty toectted in the NE-34 o4 the NW4 o4 Sectionl7, T30N-R15W, Town o4 Gtenwood, St. Cnoix County, teveated su.itabee eoitz at a depth o4 1.17 Keet,beeow which sea- sonabte high gAound wa.teA was noted. This site ahoutd be suitable 4on a mound ays.tem. Shoutd you have any questions, p.Pease fleet 6nee to contact .this o6Kiee. Sincen.e P omas C. Nelson Ass.c.s.tant Zoning Administ&aton. TCN: mj 'r, STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM I.ocation: Township NE NW ~ S 17 T 30 N/R 15 K OW W Gtenwood St. Cno,,x street Address: Subdivision: County: Landowners Name: Mailing Address: Leonaltd Pcvicent R. R. 2, Gtenwood City, W1 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises.are not auited for a conventional private sewage system. If approval is granted. I a ree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the oonditions and obligations set out in this application. Srignature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. C&Oix Location NE 1/4, NW 1/4, Sec. 17 T 30 N, R 15 XCO W Town )0xXlMAAj0l Xx G.Eevuvood Street Address Lot No. Block Subdivision Landowner.'s Name: LeonoAd Panen-t The application for this site is for: ❑ new construction use. lilreplacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ]to have one of the first five approvals guaranteed for this year. This is number - - of those applications. quota num ers issue you.) (Use one of the first five one of the applications needing a quota number. The quota number assigned to this application is L]for one additional homesite on a farm to he occupied by a parent, child grandchild, sibling, niece, nephew, or first cousin. ]for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. I ._Ifor an application on file prior to February 1, 1980. I....Ifor a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: Q a failing conventional soil absorption system. Lla holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and-.the lot meets the criteria for a conventional private sewage system, clack here. I certify that the above information is true and accurate to the best of y knowledge. Name Thomas C. Ne U on Sign - County icial Title Aab.ia. an.t Zoni.nq AdminiztAaton Date June 25, 1984 DILHR-SBD-6158 (R 12182) SBD 6678 (9/81) (Plb 100a) Detach And Return Upper STATE OF WISCONSIN DILHR DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 178 Any Return Correspondence P.O. BOX 7969 MADISON, WI 53707 DATE:, ° 608-266-3815 Gr C „ PROJECT: 30, Glenwood PLAN ID. # DETACH HERE - PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ Fee Received is $ ❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming. ❑ Plan accepted for review. ❑ Plans being returned. ❑ No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW. held in abeyance. 1. Plan Submission ❑ Complete data relative to anticipated use of bldg. ❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2) (a) Wisconsin Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and II. Pressurize Distribution Systems (Mound or In Ground Pressure) manufacturer if precast. Complete construction details if site constructed. ❑ Application for use of an alternative system signed by owner and notarized. (1 copy) E] Holding tank agreement signed by owner and local unit of government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement for pressurize distribution. ❑ Soil boring & percolation test data. from county (1 copy). ❑ Plot plan showing location of holding tank with lateral dist- ❑ Cross section of system. ❑ Pipe lateral layout. ances to any building, wells, water service ❑ Plan view of system. ❑ Plot plan. y 9, piping, water course, lot lines, swimming pools, all weather service road, ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. 111. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons tion system extending 25' on all sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system - provide soil data. ❑ Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. ❑ Plot plan showing lot size and all lateral distances from El Cross section of lift pump tank showing pump(s) or sewage disposal system to buildings, lot lines, well, water siphon(s). course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin)- ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff. ' State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION '9 JUL 301984 C+G r. 3tax 7 ZONING r OFFICE l urt$r Pa lAnt - Resij~?nc- 1 010A (I Ly on, St. Cro x Li,i 9'i>i.T a - t . t^al t.a0d, anti: - e si te, -E,25,3 ,16w A Of 4-wei CJ.llW, S&4 U7•G~'1 -+..14if `i.~y r._. coiuplete~ e j.re1 urinary revicw of We pli;:s 1~'?, if tCs~ 7~3dsa iti€o Tor ^idriame ieq i~:-sts for trt,, a.',u e-zic;iit{c€ed i°€:'"sitaeoc -s a. C,.j' ctxT';it~ttta te.~t1t''LfiYig <'`aa4:c# is 4 t i io s'3 cause of trw ?xtrc-tiely Iia:iteb ~;ulta'--l Ii y Of Lr t round system that tits t proposed sh(,kt1d be as lro'tq atw site cwiditions ;All ill y. If lies - -eo in the tow)-tic eucJ,: 17e sAt :D goe to i DILHR-SBD-6423 (N. 04/81)