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AS BUILT SANITARY SYSTEM REPORT
OWNER 2L t A' t~ J, t' 13 C'- 4,A SHIP~.~ o c SEClye jjoN.-R 4W
ADDRLSS _a r; a ✓H ST. CROIX COUNTY, WISCONSIN. 'ro
-
tioG cF,~F
0
SUB1) tV LS t 0 N LOT LOT SIZE
PAr~~FC 8u' ~
PLAN VIEW
vl~,
Distances and dimensions to meet requirements of 1163
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -
I T
h
G,
I di at h' rr w
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point:---' Slope at site
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings on cover Tank manhole cover elevation:
'lank Inlet Elevation: Tank Outlet-Elevation:
PUMP CHAMBER
Manufacturer: -Number of gallons Sq,G)G'
Number of gal. pump set for a cycle 1/,5 gallons; Total capacity of
distribution lines-A,5,4- gallon: size of pump/-Jl!ej/r~~J/c4~3y ead;
gallon per minute horsepower ;brand name of pump
and model number -C NLarl.: S ~l6'L
1`Z
'Type of warning devi e t_ (a L~/a_~1_ ~ fC Z e-
HOLDING TANK: Manufacturer- _ Number of gallons
Elevation of manhole cover _
Type of warning device_
SEEPAGE PIT SIZE; Number of pits feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines width length tile depth
SEEPAGE TRENCH: width _ _ _ length_
PERCOLATION RATE AREA REQUIRED AREA AS BUILT
INSPECTOR
PLUMBER ON JOB.Cl~csn -
D ATE LICENSE NUMBER- /
DiEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS a DIVISION
P.O. BrJX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
❑CONVENTIONAL ❑ALTERNATIVE state Plan LD. Number
(It assigned)
r~
❑ Holding Tank In-Ground Pressure El Mound
NAME OF PERMIT HOLDER t ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
!'`rat°~ _t.... _ A~. V✓I IL tJ
i J1 Iv L BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
h
Name of Plumber. MP/MPRSW No County- Sanitary Permit Number
1
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITV~ TANK INLET ELEV.: TANK OUTLET ELEV. WRAOVRNI IDN EGD LABEL LOCKING CO ER
P. PROVIDED:
[:]YES NO ❑
BEDDING: VENT DIA.. V ATL. J HIGH W ER NUMBER OF ROAD. PROPERTY WELL. BUILDI ITENT TO FRESI
ALARM FEET FROM f'71 LINE AIR INLET' `
❑YES ❑NO ❑YES ❑NO NEAREST A", f lQ
DOSING CHAMBER:
MApIUFACTURFR BEDDING. LIQUID CAPACITY PUMP ()DEL PUMPi SIPH N MAINUF ACTIIR EH £ WARNING LABEL LOCKING COVER
.
!j~ ( A PROVIDED - PROVIDED
DYES NO 7~ YES ❑NC YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPERT WELL BwLONG AENrTOFRESH
LIN AIR INLET'.
(DIFFERENCE BETWEEN FEET FROM
PUMP ON AND OFF) ❑YES NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plow g ll )IA%` I PH MATERIAL A D MARKING
FORCE L
or excavation. (If soil can be rolled into a wire, 7.111 struction shall cease until MAIN j 7
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH LE H JNO'. OF DISTR. PIPE SPACING COVER INSIUE DIA. SPITS. LIQUID
BEd/TRENCH T ~EN MATERIAL PIT DEPTH
DIMENSIONS
1 1 F [L[ DEPTH TH. P 'E DISTR PIPE DISTR. PIPE MATERIAL. NO. DISTH NUMBER OF PH OPERTV WELL. BUILDING. VENT TO FRESH
BF LOW PIPES ABOVE COVER F FV IN ELEV END'. PIPES. FEET FROM I LINE AIR INLET.
NEAREST -=1
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the xture of t fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound s ems to ake ai I ON REVERSE SIDE. SHOW ELEVA-
meets t iteria f IF me nd. TIONS MEASURED.
❑YES ❑NO
SOIL COVER. TEXTUHF PERMANENT MARKERS. OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
SEEDED MULCHED.
UFPTH OVER TRENCH BFD DEPTH OVER TRENCH BED DEP H OFT PS SO D ED
CFNTER EDGES
[:]YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
v"['TH LENGTH NRAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
L AT E
BED/TRENCH jj TRENCHES
DIMENSIONS ~f t. J L~
MANIFOLD PUMP MANIFOLD- DISTR PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
EI.FV.. ELEV DIA. ELEV. PIPES DIA
DISTRSTRIBUT.~~
ELEVATION TION r AND 5~8e37 5 9,5, / ~I] ,INFORMATION` 1101 1-, SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS
TO APPROVED
7L1 / / PLANS ~C
r ES ❑NO ✓ DYES 1A.G 18 NO r'
1 PERMANENT MARKERS OBSERVATION WELLS : NUMBER OF uN PROPERTY WELL: BUILDING
TT
COMME NTS: E:
FEET FROM t Scb
AYES 1:1 NO 1 YES ❑ NO ~:]NEAREST--10I '
IA l~
L L e c~ u c c~ , stn e
If 3
Sketch System on Retai in county file for audit.
Reverse Side.
SIGNATURE. A ' TITLE
D I L H R S B D 6710 (R. 01/82)
APPLICATION SAFETY & BUILDINGS 10 INDUSTNTRY~, NT OF FOR SANITARY DIVISION
• NDUS
LAEsOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Pro rty Owner: Mailing Address
_XL Property Location: City, Village or Township: Contyt
-1/ /~lw~/aS / T /T~,.NCR ' E (or) / c 0 r~ - .~O / ~C
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
(If assigned)
TYPE OF BUILDING
Number of
Bedrooms:
El Public* ❑ Variance* El Other (specify)
or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY GZZ
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER Ov -Zr
MANUFACTURER:;' ~✓nI
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): mew ❑ Replacement ❑ /Experimental ❑ Seepage Best Seepage Pit
fflAlternative (specify) 4ee4l .cam ~ . ,rSS / ❑ Seepage Trench
Water Su ply: Owner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Namof Plumber: ) ture: - MP/MPRSW No.: Phone Number:
Plumber's Address: a of Designer-
COUNTY/ DEPARTMENT USE ONLY
Sign ture of Issuing Agent Fee: Date: APPROVED Sanitary Permit Number:
El DISAPPROVED 1
Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (R.07/81)
tit 1 0~ s
l~e.~no,rn` ~be.rr1vt~~e2
b3
1
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i
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r
9G Q i0A blue Markt.r rZnl ltb ~o ba rr, ~
l t~ Kn
CF
•
S
PLUMMING
r,'~>> 3 bt4 roo rn
~f h o~sc,
".7 pt ct- NG2 fnv~
DEn;i r ~OLN
gall
Ilk
4 4 1 f ~ ell
Aso
gel
P K ft%
l to I I UI c i 1 P
C~,~~,bcr r-
c
r Page Z Of
Y'
7)rYll ...r )~~•1
Perforated Pipe Detall
T
0
• End View
)Perforated
End Cap' ore PVC Pipe
d,Yo ~c
~e Holes Located On bortom,
R~
PVC Force Main
• w
From Pump
# PVC
Manifold Pipe
Distribution Alternate Position Of
Pipe i / Force Main From Pump
Lost Hole Should Be
Nest To End Cop
End cap
Distribution Pipe a_oyout p 3 U
R yr
S _3- Lz
X :3
Y I x
Signed: Hole Diameter -11 Inch
License Number: Lateral Inch(es)
Manifold J Inches
Date:
l Force Main Inches
I'AGE of
C:KOL)i A L I IUti! OF A bLD 3dSTLM
s
I'I SOIL FILL c=" iA- Ah-~K[-(,ATF-
0151 KIEi U I~IUAJ PIF'!- ~
AF'PK(jVLU ',JIJIHETIL (-OVEK
MAI LKIAL OR 4" OF S-T KAW
OR. MAK`. H HA'd
UF%P AGKEvATLL
ELEV. OFI210 IFEET,
D'ISTKIbuTFOFJ PIPE TU B£ AT LEA5T,` - IFJCHLJ bLLC)W URI(~IKJAL_ GKADE
A"D AT L.E7kST?D WCHE,S BUT 1.10 MORE THAF.I '2 INCHES OELOW FINIAL GRADE
MAXIMUM DEPI Fi OF E.XCAVATIOIJ FROM OKIGIIJAL GKADE WILL ESL q r~ IIJCHES
MINIMUM DEPTH OF EXCAVAI IOIJ FROM UKIGIkAAL. GKADE WILL BE 3o INCHES
5 IL7AWED:
LICELISE ►~IUMdER: JI I
PAGE" 41- OF
+ PUMP CHAMBER CROSS SECTIOkJ AND SPECIFICAT10"5`
ac,f(1Gfcl! Obcr~~e~Icr
- VCUT CAP
4"C.I. VEKiT PIPE WEATNFR PKOOF APPROVED LOCKING
_ MANHOLE COVER
JU►JCT101J BOX
25' FRCM DOOR, 12"MIU.
WINDOW OR F-RLSH I I
AIR Ik1TAKE I
GRADC i 4 MIkJ
18" M I IJ.
COIJDUIT -
18"MItJ.
I - -
PROVIDE
IkJLE. T AIRTIGHT SEAL_ I III ~
- I III
III
APPKUVE U JUIk1T A I I I W APPROVED PE 101 1
PIP[ I EXTENDIAIC, 3'
E>:TENUIk1G 3' I II ALARM
_ I II Ok1T0 SOLID SOII
OWTO SOLID B
- ( I oN
c
PUMP
~ 5 E' 10
D
COkJCRETE BLOCK
I / b
FUSER EXIT PERMI-TTED 6KJL IF TAUK MAIJUFACTURER HAS SUCH APPROVAL rJIo~IY1~
5PECIFICAT IOM S
F- ! TANK MAkAUFACTURER 4 y U M ~Irf_cr-% MUMBER OF DOSES: A-- ~ PER DA!
1AL1K ILE GALL0►JS DOSE VOLUME: Q-LL h-=~ C;ALLOAIS
I~r~- CAPACITIES: A=__ 1!r~__I►JCHES OR 477 CALLOW
ALARM MAAIUFACTUREk:
5-3 LOM5
MULE L iJUMBER: 1-o.Lrl ~+Y A%a6st, B=. IAICNES OR C,
bWITC TYPE: V~14Wi., C= IIJCHES OR L01J5
H f r
F'CIMI' MW11FACIilk6R. ~-IMr-HESOR 31 CALLOUS
MOI'LL NUMBER'. OTE: PUMP AND ALARM ARE TO BE
R7 I KISTALLED Okl SEPARATE CIRCUIT I S
'oWeICH TYPE: ,1
PUMP DISCHARGE. RATE GPM ~J37 L x W% NF
VERTICAL DIFhEFEAILE BETWELM PUMP OFF Ak1D DISTRIBUTIOIJ PIPE._ _3~__ FEEI 23
MIKJIMUM NETWORK SUPPLY PRESSURE . . . . . . . 2.5 FEET
FE E T OF FORCE MAIN X F Yo FT.FRICT10ki FACTOR.. FEET
3 _ EE T fry
TOTAL Dy1JAMIC. HEAD = F
OAITERNAL DIMENSIOKIS OF 1-AAJK: LEkJGT H ;WIDTH --(00 ;LIQUID OEPT H
SIGK)E-D:_/-A)~~ C,~a I ICEIJSE k uM,BER:1-ile DATE:/o^/pea "
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1111-NI•W31S,lS 'Al al-11V130 V 301AOad Pur oP07'1UPV
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u! - ad!d 01 IlvmaPIS wait a')ur1sl0 tt pI - u0ltrna13 wotsAS pmodo,d
111 = AutardS 1r1a1pl UI/'ufw = 31ra uolteloalod £
- slvlalel 1o loqumN = adolspuel 'Z
tf - 1419UO ~rlalrl io1:e3 1lultlwll 01 41do0 l
watsAS uoltnglnsl(] 5 W31S 1S 3mriss3Md 0Nnow9-NI '11
t; Aul:lpdS g3uo1;-
say uaal_ to lagwnN ll uollaaS ul bl•S 5jogwnN asn'tl.romloN uoflmQIJISl(l 341 .104 'Z1,
'14 41P1m 'ON olgrl olr!)lput'pasn o1r £9 H
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SNVId NO ONIZIS 1; bS = pannbaa easy Irsrg
40 1S11 0311V130 V 301AONd pup Arp/•1;'bs/'IeA z I!oS Iun1eN
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IrA = Alraedel duel a!ldas pa1!nbaa Z l; _ (1) 41p!M adolsumo0
SNVId NO 7NIZIS 30 I.SII = 1oUr j uop3allo:) adotsumo(]
0311V1-30 301AONd pup aPn7'wpV 1; _ (I) 41P!M adolsdn •
'S!M S 1 Co H uoir- aSn = lolat j uollaallol adotsdn •
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ll = (M) adolS Pu3
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.lvA ! I moll>farq 71 = (3) 4000 411,10il 1o po8
IeA = '514 bZ ul Soso(] t, (3) adotsum00 41do(] Illj
r } b + ownlOA lotrmolsvM AlleO 11 ° (0) 41da(] 1113
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6/17/80
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING, PLATTING & FIRE PROTECTION
POST OFFICE BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Sewage System
In the County of St. Croix
Location NE 1/4 NW 1/4 S 14 T 30 N, R 15 (or) W
Town or Municipality Glenwood Street Address Glenwood, W1 54013
Lot No. Block Subdivision
Landowner's Name: Bernard Obermueller
The application for this site is to serve a:
❑ new construction use.
❑ replacement system use.
If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be
included as:
❑ part of the 3°x/5% limitation. This is number of the applications
made through this office.
❑ one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
❑ 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.
❑ a lot that meets the site criteria for a conventional private sewage system.
In-Ground-Pressure
If this a REPLACEMENT SYSTEM USE, the "ttK4 is replacing:
❑ a failing conventional soil absorption system.
❑ a 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.
I certify that the above information is true and accurate to the best of my knowledge.
Name Thomas C. Nelson
Title Assistant Zoning Administrator October 18, 1982
e Date +I
DILHR-SBD- 6158 (8.7/80)
p}I~~
V
o I N ° .72
i
'J3ri l2~JL i
C t
39-78
State of Wisconsin ` Department of Industry, Labor and Human Relations
Please Reply to:
SAFETY & BUILDINGS DIVISION
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
Plan Identification Number
Re:
PRIVATE SEWAGE SYSTEM ONLY-
The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private
sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by
and received for
approval on
The soil and site evaluation was conducted by
The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of
The proposed system is for a
Wastes from the building will discharge to a -gallon capacity septic tank which will discharge to a -gallon capacity
feet will
pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of
discharge through a -inch diameter pipe to the soil absorption system.
It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of
approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation
of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this
approval and shall follow the directions or orders issued by the appropriate local or state authorities.
In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with
the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional
engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at
the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall
become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the
Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight,
construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions
arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the
permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void
this acceptance.
cc: OWS By:
County
Other ~ e!iYyll..~/ -e~
Enclosures
mes Sargent, B erector
DI LHR-SBD-61 59 (R. 7/81)
i
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
Location: Township/Municipality:
V 4 A14114 S k T 3~ N/R 1,5 E(or W E'- 4 / G lam' !
Street Address: Subdivision: ' County:
A3 A-,A 41, e-
Landowners Name: Mailing Addres
9
I (We), the undersigned, hereby make application for an alterna em on
the above-described premises. I recognize that the above premises are not
suited for a conventional private sewage system. If approval is granted, I
agree 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 conditions and obligations set out in this application.
Signature of Applicant D to
STATE OF WISCONSIN Subscribed and swgrn to before me
- SS. COUNTY OF 4 This day o r~/~~ 19
Nota y Public, State of Wisconsin
MARLIN W. SEVERSON
Notary Public - State of Wisconsin
My Commission Expires: My Cvmiaissiuuii ExYires 1.1ay 12.1985
DILHR-SBD-6413 (N. 05/81)
Wisconsin Department of Industry,
PLB-1 INSPECTION REPORT Labor & Human Relations
Safety & Buildings Division
Bureau of Plumbing, Platting & Fire Protection
Name o remises Date an No.
Street City County Sanitary Permit
Master Plumber irm Name dress
Journeyman Plumber Address
Owner Address
-
-
iscusse with bignaturF
( )See Attached.
DILHR-SBD-6192(N.09/80) Signature o is Plumbing up. On-Site Waste Specialist
White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner
ST. CR0I X COUNTY
WI SC O N S I N
ZONING OFFICE
4 r t 1
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
August 30, 1983
MA. Os can M.itand
R. R. 6
Menomonie, WI 54751
Dean MA. Mieand,
On Januaay 27, 1983 this o A6~'.ee Aeques,ted the AS BUILT on
the BeAnaAd ObenmuetteA in gAound pAessuAe system to eompterte
ouA 4ites. As o6 this wA.iting, it has not been Aeee.ived.
P.Lease send dame to this o66ice as soon as possibte.
We ane also unabte to p4ocess MA. ObeAmuetteA's WI Fund
apptieation as we do not have youA bid sheet. Ptease.send
that to ouA o64iee as soon as poss.ibte also.
Thank you in advance boa youA eoopeAa-t-ion.
S,inceAeky,
Many J. Jenk'Z
SeeAe-taAy to HaAotd BanbeeA
Enc.
!I
I
. I
T,
ST. CROI X COUNTY
t Y
WI S C 0 N S I N
!i 1 ~ f
ZONING OFFICE 796-2239
AWN K KIN
, HAMMOND, WI 54015
January 27, 1983
We have been holding the Sanitary Inspection
Sheet for the following system(s):
Bernard Ober.nnieller
Please turn the As-Built into this olfice as
soon as possible, so that we niay comp.l_ete our
tile.
It you have any questions, please feel Lree to
contact this office.
Yours truly
L'howas C. Neison
A:»1tait t !c)it iit g Ad Ili lui.c-i L rator
L
1
a
30662 7 0C 8
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, G DIVISION
LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON, WI 7969
HUMAN RELATIONS
LO ATION: SECTION: - TOWNSt IPM NICIPALITY: OT NO :BL . N SUBDIVISION AME:
UNTY: 1NNE-R'S BUYI- R'5 NAME MAILIN I D ESS
Q2 J_S!~
USE _ DATES OBSERVATIONS MADE
jNO.d~DRMS.: COMM€Flr:(AC~ES~`RI T~10N l
PR: CO ESTS:
t~Hesidence L New L1;Replace -
RATING: S= Site suitable for system U= Site unsuitable for system
C ENTIONAL MOUND: IN-GROUNDI'RESSUR : S STEM-IN-FILL HOLDING TANK: R COMMEN D SYSTEM :1 do 1
Smu I&S❑U RS❑U DS~u ❑s~u .
If Percolation Tests are NOT required DESIGN RATE: If any portion of the lot is in the
under s.H63.0915►(b), indicate:
y~ Floodplain, indicate Floodplain elevation: ~f
A PROFILE DESCRIPTIONS
BORING TOTAL. P HT GR UUNDWATER INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
r
B-
~c.
Bin I el, a
BQ 7() 5~g ? o s c,
B3 l 7 42.6 12 S i
r
13-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RI D PER INCH
P.
P-
P _
PLAN VIEW: 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 slop.
SYSTEM ELEV TION ia" la",
' I 1
,
Ile-
,
i _
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in tt~e Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
I~ NAME (p t y TESTS E E COM ETED ON:
1 C, k a I 'Q_ 'Pl-
ADDR , CE TIFICATION NUMBER: PHONE NUMBER optionall:
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Parcel 016-1030-50-100 12/22/2005 08:19 AM
PAGE 1 OF 1
Alt. Parcel 14.30.15.225A-10 016 - 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
DARREN & JOANN SMITH O - SMITH, DARREN & JOANN
1594 CTY RD X
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1594 CTY RD X
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 4.000 Plat: 4110-CSM 15/4110 016/01
SEC 14 T30N R15W PT NE NW BEING CSM Block/Condo Bldg: LOT 1
15/4110 LOT 1 4.OOAC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-30N-15W NE NW
Notes: Parcel History:
Date Doc # Vol/Page Type
08/28/2001 655015 1708/97 EZ-U
07/18/2001 651489 1682/566 AFF
07/10/2001 650754 1677/525 WD
10/25/1999 612604 1465/378 QC
2005 SUMMARY Bill Fair Market Value: Assessed with:
89255 170,600
Valuations: Last Changed: 10/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.000 17,500 126,300 143,800 NO
Totals for 2005:
General Property 4.000 17,500 126,300 143,800
Woodland 0.000 0 0
Totals for 2004:
General Property 4.000 17,500 126,300 143,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 547
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
FILED
JUN 1 5 2001 lo,
~EP 2 7 2001
~o
KN
S
CR
S
six catr~,~,~
` N
C ER T I E I ED S C.UR V E Y MA
Located in the Northeast quarter of the Northwest quarter of Section 14,
Township 30 North, Range 15 West, Town of Glenwood, St. Croix County.
I
_UNPL_ATTED LANDS
COUNTY HIGHWAY X"
LO NOO°0320"W
/-K S00°0.320 kQ __`S__Q0 _03 20 " E 90 . 86 4336.27'
535.25 Q 0 220.06' 117 170.80' M
t6 _ _ -NORTH-SOUTH I14 SE TION LINE
N1/4 Corner } S 0 \ 03' 20"E 38 30' S1/4 Corner
Sec. 14-30-15. I Sec. 14-30-15.
(survey nail found).. PK nail found.
w ~
J
IY ~ O
Z
SETBAC T A i
BARN
01 m O Owner
z tD C1
QI W o Q/ Lucille Obermueller
J
W /1594 Cty Rd "X"
o° Glenwood City, W i .
rho
c*t i h
~
co
LO ^
m
N ~i Zsr, car torret,~-;on Z Q,
Lot Areas
/ 174,240 sq.ft.(4.00ac)
including right-of-way.
0 161,500 sq.ft.(3.7lac)
STREAM excluding right -of -way.
Net project area -
2 1.08 acres.
227. 59..'''
N 00'03'20"W
0
UNPLATTED LANDS
- - - -
- - - APPROVED
ST. CROIX COUNTY
Planning Zonina and P-k< r-"t-
Legend JUN 15 2001
4J)- St. Croix County section corner monument.
(as noted). If not recorded within 30 nays a
• I "X24" Iron pipe weighing 1.68 pounds approval ndate ulil anrpvoid snap be
per lin. foot set.
Setback line (100' from highway, 75' from 4111111111111111,
water).
- - - - -Floodplain;e (elevation - 1060.2', BM elevation - arm
house finished floor - 1056.0'.) ,
Bearings referenced to the North-
Note on back regarding floodplain. South quarter section line, assumed
S00°03'20"E.
This instrument drafted by_&4992662
Vol.15 Page 4110
L~ ~ r~ a <1^<1 e f fIr e l l s t<
J R a2
acre
o l
S tie,.o
3~ectiro~r~-,
h cur}L
C
M-p- 1~~~
Parcel 016-1030-50-050 12/22/2005 08:19 AM
PAGE 1 OF 1
Alt. Parcel 14.30.15.225A 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 - JOHNSTON, JAMES H & LUCINDA S
JAMES H & LUCINDA S JOHNSTON C - MILLS JUDITH A
MILLS JUDITH A
1444 320TH ST
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2198 GLENWOOD CITY
SP 1700 WITC
I
Legal Description: Acres: 36.000 Plat: N/A-NOT AVAILABLE
SEC 14 T30N R1 5W NE NW FKA 016-1030-50 Block/Condo Bldg:
(225) & EXC CSM 15/4110 ~I
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-30N-15W NE NW
I
Notes: Parcel History:
Date Doc # Vol/Page Type
08/28/2001 655014 1708/96 EZ-U
07/10/2001 650753 1677/524 WD
10/25/1999 612604 1465/378 QC
2005 SUMMARY Bill Fair Market Value: Assessed with:
89254 Use Value Assessment
Valuations: Last Changed: 10/06/2003
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 36.000 3,500 0 3,500 NO
Totals for 2005:
General Property 36.000 3,500 0 3,500
Woodland 0.000 0 0
Totals for 2004:
General Property 36.000 3,500 0 3,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
I
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00