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HomeMy WebLinkAbout231-1034-40-100 isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St, Croix iafety and Building Divisirr INSPECTION REPORT Sanitary Permit No: 408202 O GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. - 73 � ` Q Permit Holder's Name: X City Village Township Parcel Tax No: Kraft, David City of Glenwood 231 - 1034 -40 -100 CST BM Elev: Insp. BM Elev: BM Description: 6M TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � � /6 Q Benchmark - 0 , Dosing r (5b Alt. BM S r Aeration ¢ 6d Bldg. Sewer ,+ l .. Holding St/Ht Inlet 6.3 13 St/Ht Outlet TANK SETBACK INFORMATION I Piz TANK TO P/L WE BLDG. Vent to it Intake ROAD Dt Inlet S s ,ae o{� wt.✓ L, W i 3 .,Y Septic 3 Dt Bottom�� � ao Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System / S-14 e_ it G • 93 f/ Final Grade / PUMP /SIPHON INFORMATION ot Manufacturer Al Demand St Cover ILI, 1 � GPM i, + d� Model Number I ri r I t - 31 TDH Lift M Friction Loss System Head TDH Ft . Forcemain Length Dist. t��� J SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIME SIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LCACHING Manufacturer: INFORMATION CHA OR Type Of System: / Model Number: d, >IW o/ >I �b DISTR ON SYSTEM C*4,*A,4 0 2 /'h / 'ty►� S x Hole i x Hole S Vent to Air Intake I He d r anifold Distribution o e S ze ae p 9 N Pipe(s) �• / ( �, 1 Length Dia 2 Length Dia ' � Spacing 3 J SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Gtr Depth Over Depth Over xx Depth of xx Seeded /Sodded T x Mulched Bd/Trenc e nter V ed/ - r.nch Edges Topsoil r � J Yes _ No ! - Yes �* No COMMENTS: (Includi code discrepencies, persons present, etc.) Inspectio #1: ! q / /�� Inspection #2:q/_0/ d Location: 901 First St Glenwood City, WI 54013 S 1/2 SE 1/4 22 T30N R15W NA Lo'f 2 �G �' -+d' ar� le N4: 22.30.15.663A7 1.) Alt BM Description 2.) Bldg sewer length = Su t�' l uf /ST 1, on �Zo>, Skrt� - amount of cover = a fpea tea! 3.) Contour 0 r Plan revision Required? Yes No Use other side for additional information. - -_ —/ -_ — _ _ __ -- __. -. _ - G,� Date Insepctor's Signat re Cert. No. SBD -6710 (R.3/97) Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 NViscons Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not _pZ state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than I Px 11 inches in size. County State Sanitary Permit Number ❑ Check if revision to previous applicatio State Plan I. D. Number 8202. 173 I. Application Information - Please Print all Information Location: 9 5 Property �Owner Name / Property Location (/�IAS451 /4, S. 4 T30,N, �or& Property Owner's Mailing Address Lot Number Block Number D e u- oZ City, State Zip Code Phone u Subdivision Nam or CSM Number �T. CROIX OUNTY � � � � — �tf P?� II. Type of Building: (check one) � 0V rty A 1 or 2 Family Dwelling - No. of Bedrooms: ❑ own � ❑ Town of e ❑Public /Commercial (describe use):_ ❑ State -Owned Neare�Road 6 _ ( Parcel ax mbe s)� �_ M I r v . tt r' d �� 1 III. Type of ermit: (Check only one box on line A. Check box on line B if applicable) 2. 30. 5. "3A-1C A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) -)E oi3 MW ❑ Non - pressurized In- ground Olound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation S �S yS7� z �/'�. �� VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed �^ Tanks Tanks c5 L 1 & r- r ❑ ❑ ❑ ❑ � 6V ❑ ❑ ❑ ❑ VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS show n the attached plans. Plum e flame (print) Plumber's Signature (no stamps): &P PRS No. Business Phone Number �/ 1p 3 o2S ac's Plumb 's Address (Street, Citj, State, Zip e) 1 ( sz 6 q L r S z I.X. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued i Issui Agent Signature (No stamps) [Approved ❑ Owner Given Initial Adverse Surch a Fee) Determination Is 325. 2B 2�Z X. Conditions of Approval /Reasons for Disapproval: Act SBD -6398 (R. 07/00) , PLUMBING, INC. FAX N0. : 715 -643 -2520 Jun. 05 2002 12:55PM P2 / 2- 4o C A-7-1 ��'f•' a fo edk 47 fit,, ( / �� �6� Wr ��3$ 1 ( ` v C. e n�i.+.�c)o (J C. C.I.Jr �C L. , , � eP GY Tc� q�z s� r 110 ° H 6 � SG.4 -LF `00 i4 -i�F.4 Cf too \ i � jl P p pp6s� _ 1 'f Les Z n I I Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188 -2439 TDD #: (608) 264 -8777 visconsi www.commerce.state.wi.us /sb www.wisconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary June 18, 2002 CUST ID No.224617 ATTN.• POWTS Inspector LYLE J MYERS ZONING OFFICE NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA E1556 ST RD 64 1101 CARMICHAEL RD BOYCEVILLE WI 54725 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/18/2004 Identification Numbers Transaction ID No. 732499 SITE: Site ID No. 644376 David Kraft Please refer to both identification numbers, County Highway G above, in all correspondence with the agency. Town of Glenwood, 54012 St Croix County NWIA, SETA, S22, T30N, R15W Lot: 17, FOR: Description: Mound, 3 Bedroom Object Type: POWT System Regulated Object ID No.: 850620 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. 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 the "Mound Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10706 -P (N.01 /O1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of theilter is required. Access to the filter for cleaning must be provided per Comm 84 product approval condit oRs. A Sanitary Permit must be obtained from the county where this project is located in cordaike �ntli tha -1) `1 requirements of Sec. 145.135 and 145.19, Wis. Stats. 4,G Inspection of the private sewage system installation is required. Arrangements for inspectl>il4i s 11 be rilade with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats !�6 LYLE J MYERS Page 2 6/18/02 A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. v left addressee shall provide a co of this letter to the owner and an others who are responsible for the res The above s e p copy y p installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Julia A Lewis- Osborne POWTS Reviewer 2, Integrated Services WiSMART; codq,: X633 (262) 548 -8638, Fax: (262) 548-8614 jlewis @commerce.state.wi.us cc: Leroy G Jansky, ,Wastewater Specialist, (715) 726 -2544 I FROM : NORTHLAND PLUMBING, INC. FAX NO. : 715 - 643 -2520 Jun. 05 2002 12:55PM P2 / d 474) C. ire g TOM ID 2Z , x .2 6 ,3 M (ee��4.so S a 5 Gil L \ \ `oa k• , • .4- �z.;E.4- ,� � � VQ� . I ' CL rno S a. ,A, T0 J o00 K rope r 40 ' ,(A B 7 Ac Ls'S Ir - Mound System Cov Page pg 1 of 6 MIESER COIICRETE Project Name: DAVID KRAFT MOUND Owner's Name DAVID KRAFT Owners Address P. 0. Box 470 Hanover, Wi. 53542 Legal Description Nw %. Se %4 Sec 22 T 30 N, R F - 15 - $ W !_ Township Glenwood County Saint Croix Subdivision Lot# 17 Parcel 1D# 231 - 1034 -40 -100 Table of Contents p9- 1 Cover page 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank 5 Management and Contingency Plan RECEIVED 6 Plot Map MAY - 6 2002 SAFETY & ROGS. DIV. total # of pages: 6 Designer Name: Lyle J. Myers MP /License #: MP 224617 Date: 4/18/02 Ph. #: 7156432520 Signature: Mound System Design Methods Used per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691 -P (N.01101) per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10706 -P (N 01101) Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715.6436066 email: 3bae3badvisement.com Mound System P 2 of 6 Mound Sizing Calculations Project Name: DAVID KRAFT MOUND Site Conditions Design of Entire Fill Project Type: �l or 2 Famiy Dwelling Cell depth at upslope edge (D): 11.0 in. % Slope: 5 % Cell depth at downslope edge (E): 13.7 in. # of Bedrooms: 3 Distribution cell depth (F): 9.5 in. Depth to limiting factor: 25 in. Cover thickness over edge (G): 6 in. Absorbtion rate of fill material: 1 gal /ft /day Cover thickness over center (H): 12 in. Absorbtion rate of in -situ soil: 0.2 gal/ft /day End slope width (K): 8.5 ft. Effluent quality Eff #1 • Fill length (L): 117.0 ft. Max BOD effluent value: 220 mg/I Upslope width (J): 5.8 ft. Max TSS effluent value: 150 mg /I Downslope width (Toe) (1): 18.0 ft. Fill Width (W): 28.3 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal/day Basal area required: 2250 ft Distribution cell width (A): 4.50 ft Basal area available: 2250 ft Distribution cell length (B): F 100.0 ft Area of Distribution Cell: 450.0 ft Observation Pipes Contour Elevation of Mound: 96.00 ft Location from end of cell (Z): 16.67 ft System Elevation of Mound: 96.92 ft Final Grade of Mound: 98.71 ft Mound Plan View Observation Pipes 4:1 W K- --:: , - Distribu#iot� Celt B ILK I Tilled ArealFill Material L ' Mound Cross Section Final Grade `'_ Observation Pipe Synthetic Fabric G Distribution Cell ■ System Elevation �, $� � I �b � Cover Material reit 3 Fill Material Invert Tilled Area Slope " *—Forcemain System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Page 3of s Pressure Distribution Calculations Project Name: DAVID KRAFT MOUND Lateral Layout Lateral /Manifold Design Lateral elevation: 97.4 ft Lateral diameter: 1 1 , w In, Rows of Laterals: 2 Lateral spacing (S): ft Manifold type: center Lateral to cell edge: 0.75 ft Orifice diameter: 0.125 In. Lateral discharge rate: 7.83 gpm # of Laterals: 4 System discharge rate: 31.31 gpm Distal Pressure: 5 ft Manifold diameter: 2 In. Lateral Length: 49.5 ft Manifold length: 3 ft Orifice Spacing /Distribution Forcemain Friction Loss Orifice spacing (X): 32.11 Inches Forcemain length: 75 f /3 S Orifices per lateral: 19 Forcemain diameter: z ` In. Avg. ft /Orifice: 5.92 ft Friction loss in forcemain: 1.573 ft Lateral Side View Manifold Lateral Lateral x x x x x x x x t x x x x 2 2 Lateral Length Lateral Length Lateral Plan View Lateral Length Turn -up wfball valve or cleanout plug 0 0 T S v a Orifices on of PVC laterals and forcemain to comply with lateral equalllly y spaced specifications per Comm 84.30(2)(e) Forcemain connection via tee or cross to manifold at any point Clean Out Detail Observation Pipes Glean -out plug Final Grade or ball valve Water tight cap or plug Lawn Sprinkler Box lot Note: Closet Collar G" Minimum may be used in Long Sweep 90 L akWe of M" bar Lateral or two 45's 3/8" Bar Mound System Pa a of e Septic, Pump and Dose Tank Project: DAVID KRAFT MOUND Tank Information Dosage Volume Pump tank manufacturer: Wieser Concrete Forcemain drains back to tank? *Yes O No Pump tank size /model: W1 -MR Lateral void volume: 20.9 gal Pump tank gal /inch: 17 Dosage to absorbtion Cell: 90.0 gal Actual Pump Tank Volume: 646 gal Forcemain volume: 13.1 gal Tank bottom elevation (inside): 871 ft Total dosage: 103.1 gal Septic tank size /model: I WIOW /650 -MR • Pump and Filter Total Dynamic Head Pump Manufacturer: Little Giant Are laterals highest point? y Pump Model: 9EH if not, enter highest elevation: 0 ft Effluent Filter: Zabel A100 System head (distal x 1.3) 6.50 ft Vertical Lift ( "D" to lateral) 2.421— Note: Access opening of sufficient size to be provided to allow removal of filter. Opening to terminate at or above grade. Friction loss In forcemaln: 1.57 ft Pressure loss from filter: �p ft Total dynamic head (TDH): 17.49 ft Pump Tank Diagram Dose Tank Levels Watertight Locking Cover In. Gal 4 Inch With Warning Label inished A ('Reserve 17.9 304.9 Minimum re Grade Pump off to Alarm 2.0 34.0 Alternate C Total Dosage 6.1 103.1 Outlet 14 Location Elect. per Comm D Effluent depth for pump 12.0 204.0 16.28 and Total Capacity: 38.0 646.0 NEC 300 Weep Hole A or Anti- Siphon 9 Device FLOV- LITERS /HOUR C 0 1000 2000 3000 D 30 10 W —7.522 20 W Z ca 5 i La Pump must be capable of: 31.3 GPM 10 and head pressure of: 17.5 Feet as 0 0 11 0 2O ao so so Little Giant FLOW- GALLONS /MINUTE 9EH PUMP PERFORMANCE CURVE 115V 60HZ III 1n Mound System Management Plan pursuant to comm 63.54 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 & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 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 1/3 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 and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog 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 current 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. ft sconsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of 3 Division of Safety and Buildings in accordanc I s 164W 8 3,09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches' Pla U" ounty include but not limited to: vertical and horizontal reference point directioftV percent slope, scale or dimensions, north arrow, and location a;ince to nearest rofttf' del I.D. # APPLICANT INFORMATION - Please print all inf n. sr CRa e e ed by Date Personal information you provide may be used for secondary purposes (P Property Owner Property r DA V F S 1/45 1 /4,S T3© ,N,R /�) W Property Owner's Mailing Address ock# Subd. Name or CSM# City State Zip Code Phone Number Nearest Road / �. ( / D )� �� 8 City �� Village ❑ © / �. New Construction Use: ZResidential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow �J�D gpd Recommended design loading rate bed, gpde — trench, gpd/ft Absorption area required bed, ft �.� trench, ft 2 Maximum design loading rate t . bed, gpd/f1 j_ trench, gpd /ft Recommended infiltration surface elevation(s) 7, aZ, ft (as referred to site plan benchmark) Additional design /site considerations / �f / Parent material �� G /A L �/ L G Flood plain elevation, if applicable `Y , 4 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S [A U Z S ❑ U ❑ S ®U I ❑ S ®U ❑ S Z U ❑ S Au SOIL DESCRIPTION REPORT T ( I moo ti Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 4T g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 13 a -h /0 �/a 5*//- �Z)1_5j 16IF9. d 15 .2 AT -T, :21- V0 -As /0 A4F)SF hit/ Ground 5" 8 6, d C 6 M V �� � Depth to limiting factor Remarks: #0 R" l`1 e Boring # _ ®- F /0 3 a •2 F My� C S ;2 : R •s Ground .elev. ft• , Depth to limiting fact r m. Remarks: df CST Name (Please Print) Signature Telephone No. Address Date CST Number 3�� I'�o C�etYt,v0 ql � � 0/3 4 a/ 9 2 PROPERTY OWNER /l A �� a /rg,# SOIL DESCRIPTION REPORT ' Page of PARCEL I.D.# Borin g # Horizon exture Consistence Boundary Roots on Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench S/L Ground 3 C -3 ft. Depth to limiting , factor �in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; L Ground elev. � ft. Depth to limiting factor ' Remarks: Boring # Ground elev. ft. ' I Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) 7 i d % — - - - Ca 91 i 0 I --� -1-- - - D - G -- - - -- -- - f -- U e- _ v L I I h I I , l _ : I J I I I - : I►I i I i i � I I �I � � I I I : I - I I I i I - -- - F -I -- 7 - - -- - -- _ I i - -- - - - - _ I I I I L I ST CROIX CCO1JIM • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer i r,) Mailing Address T . C- .Roue �7fi ^ ' i Z Property Address (V rification required fro Planning Department t r new construction) City/State n /,E parcel Identification Number. /– 11)3 – O /'D e ) � y LEGAL DESCRIPTION �r ( y /1 ,p Property Location � '/4, � 1 /4, Sec. �� . T�N••.R �W, �of V zc wa-10 1 , Y Subdivision _ Lot #. ' Certified Survey Map # � ���7 Z , Volume. C Z . Page # Warranty Deed # ' � Keg Iry v Volume ,� 33 Page # 34' / Spec house ❑ yes ❑ no Lot lines idcntifiable,iZT`yes ❑ no STEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the tic tank as a treatment stage in the waste disposal �P g a ispo system The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a maste,rpiumber, journeyman plumber, restrictedplumber or a licensedpamper verifying that (1) the on -site wastewaterdisposal 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. Uwe, the undersigned have read the above requirements and agree to mabitain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed aid wturned to the St. Croix County Zoning Office within 30 days o the three year expiration date. a I l SIGNATURE OF APPLICANT DA'Z'E 9332 ' R CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p foperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLI ANT DATE a * ** * * Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" •* Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed t,a1�A•C7`JO STATE BAR OF WISCONSIN IFOR 1 — 1982 �`•. , B TY D )F DOCUMENT NO. VOL �.'J' '' P AU r) Y + REC1�1'Irt�'$" �F'FIC This Deed, made between Bernhardt H. Jeske and ST. CROIX CO.. W! Diane R. .Teske, hq and and wife 5rantor, JUL 13 1 99$ and 3z .,rafC and Jo Kraft a survivor- 9:00 A ' s.li�arita nr operty l Re 'atoo�ls 't a Grantee, Witnesseth That the said Grantor, for a valuable oocuidera a)? i d i� t herein conveys to Grantee the following described real estate in S t . C j THIS SPACE RESERVED FOR REGUROiNG DATA County State of Wisc=in: NAME AND RETURN ACDRESS Part of the NW1 /4 of the SE1 /4 and the SW1 /4� of the SE1 /4 of Section 22, Township 30 North, ij v ;Y c r - , J i . ?� Range 15 West, Glenwood City, St. Croix !' T County, Wisconsin being part of Outlot 16 of ;4 ��Qx�i' j Ass 's Plat to Glenwood City, described a Lot 2 of the Certified Survey Map filed May 1998 in Vol. 12, page 3453 as Doc. � 3l- 103 -4 10 No. 5 7 9572 PARCEI. IDENTIFICATION NUMBER p ., li {. t TRiNSFER , Q FE This I , i s _ homestead property. + , r (is) at) it i I r { Together with all and singular the hereditaments and appunert�cs thereunto belonging; And the grantors warrants that the title is good, indefeasible in fee simple and free and x'car of encumbrances except s and will warrant and defend the same. if x ## e ! Dated this 23rd day of June — _,19_9$_ N.. (SEAL) (SEAL) V , if i A 4 �.' r f> (SEAL) z . a AUTHENTICATION ACKNOWLEDGMENT Signature(s) Bernhardt H. Jeske State of Wisconsin, ss. and Diane R. Jeske County. , authenticated this 2 — 3r daily of Jun Personally came befure me this day of 19 , the above named l > A James H. Kr ave { ". TITLc: MEMBER STATE BAR OF WISCONSIN (If not, i' ..� zI authorized by 9706.06, Wis. Slats.) to me known to be the person who executed the foregoing 11 instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED dY ' James H. Kr P.O. Box 304 h Glenwood City , WI 54013 Notary Public, County Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration _ate: necewary.) Names a persons signing In any capacity should by typed or primed below their signx s -- - -' - -' -i - -- i 11' 1 STATE BAR OF WISCONSIN W=Onsn Legal 8!ank CO.. Inc. I ` WARRANTY DEED Form Ma 1 - 1982 M wankel. we. Yk — _ - - -_. - _ _._ - — .....- -.. .r. aw.. . rrr _r se r Le. '.I .► ^1 _..qt.. .. . . . ;.4 ,j 1 1 ' � I k -�: FORM NO. 985-A 57 9572 �►icmwa. �'� . Stock No. 26273 FILED M AY 2 1 1998 t will III CERTIFIED SURVEY MAP NO. 3453 SL CO3W1 VOLUME 12 PAGE 3453 �co LOCATED IN THE NORTHWEST 1/4 OF THE SOUTHEAST 1/4 AND SOUTHWEST 1/4 OF THE SOUTHEAST 1/4 OF SECTION 22, TOWNSHIP 30 NORTH, RANGE 15 WEST, GLENWOOD CITY, ST. CROIX COUNTY, API. BEING PART OF OUTLOT 16 OF ASSESSOR'S PLAT TO GLENWOOD CITY. UNPLATTED 1 �. % UNPLATTED LAND - -- -- ! ------------------ � w w �M�• z3 Colk N ` :1 N n - N �•. 1, �V W N \ (n JAMES T. w 00 cr JAMES T. SWANSON, R.L.S. 1482 S WANSON * ``' ~ u') :\ \\ AS S --1452 0 r g \ 0 5f�o/98 L'IENOMONE, ~ z z Y is. W F Cn � I IX Z \ �\ ¢ m LL 0 �0 ` ao �..� OUTLOT 1 j Cr ui N 2 �. `� 1 Q N i NE NW SE m o a ` `` --------------------- - - - - -- --- - - - - -- A OWNERS — PART OF OUTLOT 16 ��x ;•� �`� BERNHARDT H. do DIANE JESKE '� .• `.� 901 1ST ST. GLENWOOD CITY, W. 54013 rn LEGEND o H LOT 2 0 a 404,280 S. F. C9.28*ACR.) \ \S NOTED) CORNER O p, Z `•S; • FOUND 3/4" RE —BAR O SET, 3/4 "X24" REBAR, `.° 3 z �'`• WEIGHING 1.502 LBS. I ►- = W °� PER LINEAL FOOT. i o = , J - 1� fp� � I O= ix V Q 417.42 \ i 0 FENCELINE z GARAGE ` �., i z�°� w r- 4 . 0 m i _ GARAGE F W 2 W crzcro z i O W 1/4— SE1 /4 0 1 °� HOUSE )�:3� �`�1 o lu a m - -- - -- ------- - - - - -- --- - - - - -� -- LOT 1 O w i O SW 1/4— SE1 /4 M �� 87,964 S. F. u F O a. m <2.02t SEPT] ACR.> NTCOS - _- - ER - BAST 1/4 CCfr i 0't i ' — C •�• SEC.22, 130N, R15W n z I , _ - -''- SCALE:1 =200 (BERNTSEN MON. FD. Iw I 400' i N a 100' 2 0 00' 8 LOT 2 C.S.M. 13 9 t , O N VOL. 5, PAGE 70 o N SOUTHEAST CORNER I SEC.22. 130N, R15W I z I P.K. NAIL FOUND L------- --- - - - --------------------- - -- - -- ----------------------------- CEDAR CORPORATION S 89 W 604 WILSON AVENUE 2638.96' MENOMONIE. W. 54751 715 - 235 -9081 PAGE 1 OF 2 Vol. 12 Page 3453