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231-1047-70-080
n■o:■ - 0 n . @ § § K § 2 J T ■! $ I - � � ƒ ƒ / o ° � £i 0 2 § i § ¢ CD g ' ® g $ 2 ° § CL B k I k / / § f (A E� k o E f 2 z > C E C. CD ca \ CL \ o 0 �. 9 4M CL Q F3 Q / E S m 2 E c s t / V T� E "w. z 000 0. " 2 § % § { j Q / R . 3 1 ■ Co CC £_ § E ca 7 7�7 & i § ■ D§�J � ' w ° m » 2 z ° . \ > � & \ 0 \ / / ) - . ƒ w Cc @ / 2 } § ® _ w ■ cn � o � � � � � ■ § CD § { \ E 2 -1 rl) C � m 2 § % C/) k � q z 2 : a,m> I—D CL CL CD § a o X§ §{ G =z % § / _E i cn cn 0 RAE ' 7 4 , < a § §a k / % f i �g— CD 3 7 Ln / CL % CD 2 � o ■ 0 CD \ _0 �t-j I \ : � Parcel #: 231 - 1047 -70 -080 11/04/2005 11:16 AM PAGE 1 OF 1 Alt. Parcel #: 27.30.15.754Q -10 231 - CITY OF GLENWOOD CITY 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 ROBERT VEGA O - VEGA, ROBERT PO BOX 143 GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " GLEN MEADOWS LN SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 2.920 Plat: 3569 -CSM 13/3569 SEC 27 T30N R15W PT SE SE BEING LOT 17 Block/Condo Bldg: LOT 17.1 CSM 11/3051 5.52AC NKA LOT 17.1 OF CSM 13/3569 2.920AC Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 27- 30N -15W SE SE Notes: Parcel History: Date Doc # Vol /Page Type 02/07/2003 708724 2134/299 TI 09/16/1999 610440 1456/573 WD 09/30/1998 588082 1361/323 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/21/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.920 23,400 282,800 306,200 NO Totals for 2005: General Property 2.920 23,400 282,800 306,200 Woodland 0.000 0 0 Totals for 2004: General Property 2.920 5,800 194,400 200,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0 ? c 0 / , 2 E m § Q! / 0 E$ E t f o\§ Q BCD gy \) \ ¢ a) N) 0. , / - 0 \ \ \ _; e ® �k \ �§6 la a E E i E§ £ o k ) C , © CD $ § £ CL �i f' / \ � » » \ CD @ %EJ ( Z / § 0 § 0 c § ■ rr tr ( -0 -0 -0 E ■ lu Or o { 0000 0 \ \ 2 2 2 / / § § CO v —; 3 k \\ §5 j9 ƒ « \ k & { BE 2 7 § 0 CL � { ■ § � C 0 � a ; C 7 0 a 2 w E � / k \ ; 2 ¥ w T m § w CD CL k iz $ \ ) % ® CD mCL 0 0 § 8 \=rz % ¥Eƒ \E ƒ§ % }} 2 $ of ƒ �f / t 0 0 < § % \f tA cCL — — z Z Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must c�/ / lrC include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. cJ Cr percent slope, scale or dimensions, north arrow, and lo ti distance to nearest road. O r G �( C /' ReA 7 / 6 2 O wed b Dat Cam,. / Please print all information. li 1 S J Y Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). S b, Property Owner Property Location if © C Govt. Lot �. = /4 S T N R E (or Property Owner's Nailing Address Lot # I Block # Subd. Name or CSM# C Sta e Zip Code Phone Number ❑ City Village ❑ Town Nearest Road �`E 6 r A s c �� // -I, v Z ,{J -, _,. New Construction User` Residential/ Number of bedrooms _ , ' Code derived design flow rate �, jq 576 GPD ❑ Replacement ❑ Public or commerc' I - Describe: Parent material G2co Flood Plain elevation if applicable ft. General comments and recommendations: �!'�' ���� R1 Boring Boring # / Pit Ground surface elev.' J_ ft. Depth to limiting factor J in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 19 '-1 /6 z /?/o --. •� f` . 5 -S$ i Boring # Boring ® pit Ground surface elev. �_� ft. Depth to limiting factor _ in. — 7 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Ple a Print) / Signature CST Number Address loo D e Evaluation Conducted Telephone Number SBD -8330 (R07 /00) - I 2 1 � Property Owner Parcel ID # Page of Boring # 9 Boring 3 ❑ pit Ground surface elev. _ 71 1 - < � ft. Depth to limiting factor - 2 - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i I F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) s • - Soil Test Plot Plan Project Name Robert Verga B ro Bird Jr. . Y Address 2715 Meridian Dr. Robbinsdale Mn 55422 C #220527 Lot 17 Subdivision Glenwood Meadows Date 9/7/03 SE 1/4 SE 1/4S 27 T 30 N /R W Village Glenwood City Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Property Line Stake System Elevation 92.1' *HRPSame as Benchmark Alt. BM Top of Power Box @ 99.3' Scale = 1/4 = 10' 536' Property Line Area of >20% Slope B-3 3 (D 5% A CD Slo m U) 0 B -2 0 x j N 00 90' B -1 530' Property Line 91 92' M .M. 0 i c 2,0 / ' f � @ ■ � E z o # < g � � � k > # z ' / E § @ ° ƒ -4 § § r- ; § 2 « 2 § E E k 2 co } E E c $ § # C k f 3 C E _ � § \ 4 q§« Q CL 0 / / § c z 0 0 o Q f 2. \ 2 IA ( j § �. 7 f • £ _ CA CL f @ 0 .. X CL k ° m \ m q § 3 z � _ ■ ( _ E k z Ei 2 m G / U " I T q § -4 B rr m \ q z $ ® � ®M a QTR 0�z § 0 C m cn :r0 CL 78 0* CL ƒ AF § oE � C k o G § f ? t � Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building D�ision , INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430417 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: X City Village Township Parcel Tax No: Vega, Robert I City of Glenwood 231- 1047 -70 -082 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: fU 27.30.15.754Q20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 7c ` 1 G . f C 'ice_ . C G os Alt. BM I f - 42 L Z Aeration C/ Bldg. Sewer ?_ 01 1 7 3 Holding St/Ht Inlet SVHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. ent to Air Intake ROAD Dt Inlet Septic X1 co Dt Bottom Dosing \ �u Header /Man. 9 7 3 3 Aeration Dist. Pipe Holding R Bot. Sy 7,5 %3 9, , f PUMP /SIPHON INFORMATION Final ? Grade / ti 9LF - :g� Manufacturer Demand St Cover GPM Model Number /t) �y� C� n 4 TDH Lift Friction L2ss 3.3 System Head TDH _ Ft Forcemain L Dia. Dist. to Well %Q a ) ✓- SOIL ABSORPTION SYSTEM & - a ' 7 BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. O f Pits Inside Dia. Liquid Depth DIMENSIONS _ - ---- -- - SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: [� > �. T UNIT Ul �� • -3 1 M-' �__...... Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Ho e x Hole Spacing Vent to Air Intake Pipe(s Leng Dia Lengt Dia Spacing `i.`7 — SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil r- -- �] Yes [] No (, :; Yes _j No COMMENTS: (Include code discrepe Gies, persons present, etc.) Inspection #1: io / .27 / Z Inspection #2: /V / ZZ / 0 Location: CALL FOR ADDRESS Glenwood City, WI 54013 (SE 1/4 S 1/4 27 T30N R15W) NA Lot 17.2 Par I No: 2 7.3 15.754020 1.) Alt BM Description= 2.) Bldg sewer length - amount of cover = t : 5 •p` p� cd 1 °�� / o l `r+� �' /� \ ✓� S ,y f- `l °b Plan revision Required? Yes No �0 3 r b 4 ❑ 2 Use other side for additional information. - - -J'— -� SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. I S-4 � �� l q� � as i r,% Sanitary Permit Application Safety & Buildings Division ` o 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 lViscons Personal information ma ou p rovide be used for second p urpose s p Madison, WI 53707 -7302 Department of Commerce y p y (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. O County rG r State Sanitary Permit Number ❑ Check if revision to previous a lication State Plan I. D. Number �Z x o - 7 j O F 3 I. Application Information - Please Print all Information Location: vvr�-( or- touA1 G Property Owner Name Property Location !/l (gif/�e `� [/ t �IZI /4 '1/4, S I/'!N, R �E Property OVmees Mailing Address t Numb% Block Number � �� O� �1•� f1•�� City, State Zip Code one umber Subdivision Name or Number / o,Or n 5 ( ) II. Type of Building: (check one) ,/ -g ❑ City L 07� /7./ A? /7• Z A 1 or 2 Family Dwelling - No. of Bedrooms_ c Village • Public /Commer J own o cial describe use):_ Ct �J 1 b&" LOT J q �'� r • State -Owned � �✓� � �''�' 1 �• Z �0j//vD D/� Chu �'�X @ C �� Nearest Road. /J` f. d FYI (,}fyt/1i I , a4 'M h Parcel Tax Number fly _ t III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) CIO A) 1. XNew 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) `` ,� � pressurized In ground and / Zq S - 6 1 ❑ Sand Filter ❑ Constructed Wetland 'O Pressurized In- ground ol g a c ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ erobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Gals. /da q. ft. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required C1 � Proposed Rate t s J�� `' ( ) (Min. /inch) r� Elevation 4 ��' s� �ls t'<< , / os�V, tea. VII. Tank Capac' in Total # of M*iufacirurer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing t�a crete structed Tanks Tanks ❑ ❑ ❑ ❑ - x, �/ G G ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's a (print) / J Plumber's S' ure (no stamps • MP/MPRS No. Business Phone Number 7 Plum is dress (Street, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ; ssued suing nt Signature stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) (� + � S 1 4 Determination 3 5-D, , -� / 10 v - j X. Conditions of Approval /Reasons for Disapproval; ) /V/ SYSTEM OWNER � q� � 1 Septic tank, effluent filter and y3 -rL / f/Z / �3> fey dispersal cell must all be serviced / maintained �e�lvrtdi "T1'iZ 2 L(ft h Q1/'� a,1' N,E• ekLat as per management plan provided by plumber. i 2. All setback requirements must be maintained , 49 SBD -6398 (R. 07/00) Wisconsin Department of Colnmerce SOIL EVALUATION REPORT Pa / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ` Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and Ioga`on, and distance to nearest road. Date r LL �� � ,,,�. �.�-5 b -' �L' eviewed Y Crc / Please print all information . L% t Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot X1/4 ' 5 2 n /4 S 0 2 7T N R E (or Property Owner's ailing Address L Block # Subd. Name or CSM# le C( crc I / a /��Q c i City State Zip Code Phone Number C' Village ❑ Town Nearest Road 1 vz - TO 2 -3 Code derived design flow rate GPD New Construction User Resident' al /Number of bedrooms — ❑ Replacement ❑ Public or commerc' I - Describe: ` �J - - ' — - .� �/ �G �, / Flood Plain elevation if applicable 1 Parent material _ _ General comments Q/ f 0 .97 3 and recommendations: J,� ✓� / ✓ , Boring z 'n. � factor to limiting fa � oil A pplication Rate # � • .� . Depth 9 S PP Boring Ground surface elev. � — , ft z El Pit Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft 'Eff#1 `Eff#2 in. Munsell Qu. Sz. Cont. Color 7 _c -1 _3 G .2 # � Boring 0 ft. Depth to limiting factor T in. Soil Application Rate Boring , ,_ v ,_ , ele r surface z ® ❑ p Ground surfs � GPD /ft Structure Consistence Boundary Roots Texture Elf 2 'Eff#1 Dominant Color Redox Description Horizon Depth Gr. Sz. Sh. in. Munsell Qu. Sz. Cont. Color S T ' ffluent OD < 30 nig /L and TSS < 30 mg/L Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 15 nature CST Number g � 0 :5-- � "7 Name (Pie a Print) Number CST N ( / ...— Telephone Nu G r D e Evaluation Conducted Address ' �"'-t7 . SBD -8330 (RO7100) Property Owner Parcel ID # Page .Of 1 5 1 Boring Boring # ❑ Pit Ground surface elev. _ 7� ft. Depth to limiting factor_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 v ❑ Boring F—I Boring # ❑ pit Ground surface elev. ft. Depth to limiting factor In Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Boring # Boring ❑ — ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Application Rate Soil Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. Sao -8330 (R.07100) Soil Test Plot Plan Project Name Robert Verga yron it t Address 2715 Meridian Dr. Robbinsdale Mn 55422 Tm #2 527 Lot 17 Subdivision Glenwood Meadows Date 9/7/03 SE 1 SE 1/4S 27 T 30 N /13 W Village Glenwood City Boring Q Well PL Property Line County ST. CROIX IL BM or VRP Assume Elevation 100 ft. Top of Property Line Stake System Elevation 92.1' *HRPSame as Benchmark Alt. BM Top of Power Box @ 99.3 Scale = 1/4 = 10' V., - " Jau-t h 41- � 44 13 Alt � 536' Property Line h� Area of 0 >20% Slope B-3 5% > m SIOPE N 0 B -2 09 0 ca w j r_ a - ,-1 530' Property Line '� 9'{' 92' M g M. PLOT PLAN PROJECT Robert Veraa ADDRESS 2714 Meridian Dr. Robbinsdale Mn 55422 SE 1/4 SE 1 /4S 27 /T 30 N/R 15 W VillageGienwood City COUNTY ST. CROIX DATE 9/7/03 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFE HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of Property Line Post ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.1' Scale = 1/4' = 10' W, , � C-5 - s�/S- /'n i s c �'► Lo T 1-7. 2 -- 0 536' Property Line Area 15' below system is to remain undisturbed Pro 3 Bedrooff House Well is to meet all setbacks found in Comm. 83 Area of 0 >20% Slope B-3 Huffcutt 10 Combo Tank Tank is to be y - properly bedded and 5% provided with to lockdown covers ro with approved a warning labels B-2 .. 0 2 Grading is to be done to divert run -off away from system N 90' B -1 530' Property Line 91 1.1 92' ' Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 c0ns,n TDD r .stet 264 -8777 www. commerce. sta te.wi. us /sb Department of Commerce www•wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary September 29, 2003 CUST ID No.220527 ATTN: POWTS Inspector BYRON BIRD JR ZONING OFFICE BYRON BIRD JR. PLUMBING, INC ST CROIX COUNTY SPIA 896 68TH AVE 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 09/29/2005 ' Transaction ID No. 920832 SITE• Site ID No. 665493 Robert Verga Please refer to both identification numbers, State Hwy 128 above, in all correspondence with the agency. Town of Glenwood St Croix County SE1/4, SE1 /4, S27, T30N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWT System egu ated Object ID No.: 922015 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 COndih chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. RI The following conditions shall be met during construction or installation and prior to occupancy or use: ARTMENT 0 N OF General Approval Requirements: A - ' � SEE CORRES • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 /01). • A state approved effluent filter is required. Mai must be given to the owner of the tank exp arcing that periodic cleaning of the filter is require per Comm 84 product approval conditions. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • BYRON BIRD JR Page 2 9/29/03 • 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 See. 145.20(2)(d), Wis. Stat • Comm 83.22(7) 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services W SMART`code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i S Cover Page s�F Fpl o . FO Shaun Bird Bird Plumbing Inc. • 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 9/7/03 Owner:Robert Verga Location: SE1 /4 SE1 /4 S 27 T30 N,R 15W Glenwood City Lot 17 Glenwood Meadows System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page r P 2. Mound Plot Plan 3. Mound Cross Section C OW' RGE 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 'ONDENC 6. Pump Curve 7 -9. Maintance and Contigency plan 10 -12 Soil test Signature License number 220527 r PLOT PLAN PROJECT Robert Veraa ADDRESS 2714 Meridian Dr. Robbinsdale Mn 55422 SE , 1/4 SE 1 /4S 27 /T 30 N/R 15 W VillageGlenwood City COUNTY ST. CROIX DATE 9 /7/03 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of Property Line Post /V b ASSUME ELEVATION 100 Filter Zabel A -100 [:]BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.1' Scale = 1/4" = 10' - SySl�3'i ► S o n 1 - o T ! - 7• Z 0 536' Property Line Area 15' below system is to remain iz\ undisturbed Pro 3 Bedroo House V% Well is to meet all setbacks found in Comm. 83 Area of 0 >20% Slope �3 Huffcutt CD Combo Tank CD Tank is to be v properly bedded and 5% 0 M provided with . 2 o pe lockdown covers M with approved 0 warning labels B-2 ° 0 Grading is to be done to divert run -off away from system N co 90' B - 530' Property Line 91 92' 4 _T; - "C �,f - 3 i Designei No Date Non -Woven Filter Fabric 4" Observation Pipe Perforated ,,Distribulion Pipe Below Filter Fabric AsTN 0 -33 Sand � G ` }H " Topsoil C_ °- '• $1 °pe Bed Of fi 2 `2 Force },loin ��Ffowed From Pump Layer Drain Rock 'D ' E I, Cross Section of A Mound System Using F - -�� A Bed For The Absorption Area G -.�-- A �— Ft. h � g j Ft. I Ft. ?3���/ "7. J Ft. K s / Ft. L Ft. W , A r Ft. <_ 4' PiPe �\___1__ ..._ K I arce Ma in � A � � F �� _..�,------- - - - - -- -------------- - - - - -- - From Pump VY in _ _..... - t 3 Distribution Bed Of yi'_ Pipe Drain R OCK I 4Observation Pipe Permanent Marker %S�v'` �t�.��✓ �' �i�,^-� pi pe or Rods Plan View Of Mound Using A Bed For The Absorption Area PAGE, 4F Perforates3 Pipe Detail i End Vi_ ew �Perlorotea y ' PVC P.pe ,. tipl Located Ol t On Bottom. �/ -4 bNg`° Are Equally SOOCed A T } r t 9� B PVC Forte Main 1 , 7! i FtRST AOLC. NLK� r0 Ca+1ntC }nor PVC Monifoid Pipe Oistrioution Piae ex � Distr Pipe Layout P s Ft, '+ bra ,- Ft. X Inches Y Inches 1 � Signed: Hole Diameter �,� Inch Lateral Inch(es) License Number: Manifold °` '� Inches_ Date: Force Main Z Inches # of holes Invert Elevation of Laterals / Ft.. SEPTIC TANK E. FI;MP Cf,p,MB£R CROSS SECTION AND SP£CIi iCF+T it1NS Ci 'VENT PIP£ 12" MIN. ABOVE GRADE; WEATHERPftW sUucTIaN aax APPROVED > 2 5 t FROM DOOR, WIN')" OR WI TH TH CONDUIT MANHGL£ COVER FRESH AIR INTAKE W/ PADLOCK & WARNING iA$E =. giN;SH£D GRADE --- 4 11 MIN. n Is" ZN. y C ".�. * iL a 3 = INLET . s , CAS- a ,� f WATER TIGHT SEALS "'�- 'FIGHT t _ /RPPWVrLD A SEAL . JOINTS WITH SEE f E ONDE CE — -- ON ,Lm AP �r ONTO APPROVED _v_ : SOLID SOIL PIPE 3' C ' 4KT() SOLID /FT- OFF 50IL Pump )FF ELEV - D 3' APPROV B£iaDZ2iG LtNDtR TA P� _ C014CR£'iE PAD SP£CIFICATZON r � DOSES ?� DAY TANK MANUFACTUR SEPTIC / DOSE �, WKBE IrR= C DZ� / t3flSE �i fl�ME ZPi LU SEPTIC / GAL. FLOWBAC ?Aii3C SIZES; �- 6AL. l , �GAL- �,r CAPACITIES 2V GAL. ALA MANUFACT,3RER: 6' s 2 INCHES = ______ -- mot)EL NUMBER: Sw TYPE C = 5� INCFIES p43YtP MANyFACTUR£R = ; ..�' ZNC�iES MODEL NUM ✓ PER x LHR 15.23 WAC SWITCH Gg�i utiP £ AL.ARm TIRING AS REt?IFIRED DsSCFIARGE RATE /Z) FEEL p�PE - � FEET PUMP OFF AND DIS _ _ FE ET vER 'TICAL DIFFERENCE 5 _ - • FACTOR T ♦ . - FEE + A1IA1 �4ii "i t £,WORK SUPPLY PRESS F ' T /10 FT • FRi p��p��IC HEAD = r .�� FORCEMAIN X _��-- T{1';r'�i• FH oe "' DIAM£T£R SIO rMENNS O ID F pU Mp TANK: `s. 3`�� ' NT£RNAi .. t.IQ DATE LICENSy NUMBER' S`sGilED= _ TOTAL DYNAMIC NEAO /CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING a MODEL 15-2/153 MODEL 152 153 w t - 2 50 FFe Meters Gol. Liters Gol. Liters I 5 t .5 69 261 77 291 153 10 3.1 61 1 231 70 265 12- 4 0 201 15 4.6 53 201 61 231 °a 20 6 1 44 167 52 197 U' 42 159 -r 25 7.6 34 129 � 30 z 8 3p 9.i 23 87 33 125 0 35 10.7 -- -- 22 85 20 40 12.2 -- 11 42 0 4 Lock Volv 138.0 .rt- (11.6m) 44.0 rt. (13. ousoa t0 0 1 100 20 40 60 80 GALLONS 6 1/4 LITERS 0 80 160 240 320 - 3 27/32 4 5/a FLOW PER MINUTE i 3 27/52 y CONSULT FACTORY FOR SPECIAL APPLICATIONS 4 � 3 27/32 • Timed dosing panels available. • ailable and supplied with Electrical alternators, for duplex systems, are av an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable I i level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. i ° 1 q uotation 4 C. s as req uired. q q • Over 130 F. ( ) specia 1/8 150153 Series 152!153 ODELS Control Selection Model Volts•Ph Mode Am s Sim lex Duplex N152 115 1 Non 6.5 1 2 or 3 I sxzaea BN152 115 1 Auto 8.5 Included 2 or 3 1 I E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 RIn 2 or 3 or 3 N153 115 1 Non 10.5 SELECTION GUIDE BNt53 115 1 Auto 10.5 2 or 3 1. Single piggy back variable level float BN1 230 1 Non 5.3 2 or 3 back variable level float switch or double piggy BE153 230 1 Auto 5.3 2 or 3 switch. Refer to FM0477. o CAUTION 2. See FM0712 for correct model of Electrical Alternator a control a ac Pak. tivator, specify d 3 ) All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as licensed electrician. All electrical and safety codes should he followed including the most - or (4) float system. recent National Electric Code (NEC) and the occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL 70: P.O. BOX 16347 ManuFacturersof. . Louisville, KY 40256 -0347 ° SHIP 70: 3649 Cane Run Road E 7 Louisville, KY 40211 -1961 QUaurr PUMP9 S /NCE ��YY�� ( 502) 776 - 2731.1(800) 928 -PUMP ° PIMP ,CY FAX (502) 774 -3624 hitpJ /www•zoeller corn „ „ __6. -,nnn 7nollvr Co. All rights reserved. Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715- 246 -4516 Pumper: Tom Mondor 715 - 246 -5148 St.Croix County Zoning 715- 386 -4680 A isconsin , FAX COVER SHEET SAFETY AND BUILDINGS DIVISION Deaertment at ca.w. w e �' ') 4003 d LaCrosse, WI 546 ss Date: f STATE OF WISCONSIN To: O n DEPARTMENT OF COMMERCE '�' I t http: / /www.commerce.state.wi.us • CHARLIE BRATZ Attn• t PRIVATE SEWAGE PLAN REVIEWER Q 8 DIVISION OF SAFETY AND BUILDINGS Fax #• 7 1 6 - 3 ?(; — Y 6 BUREAU OF INTEGRATED SERVICES Phone TELEPHONE: (608) 789.7893 • 4003 N KINNEY COULEE ROAD FAX. (608) 765.9330 LACROSSE, WI 54601.1831 E -MAIL: cbratz@commerce.state.wi.us Re: Message: 7e e P 1�7 h e ��// if 1 9� d bve TV? e plo C C ec 1'' e Wce c 7 ti a ;fev I t7 kj 4 "Y Signed: ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT a � AND OWNERSH[P CERTIFICATION FORM Pro Address p FF STS 1- W I M V 6t.EIJ , 4 'ewo C r P�3' , 8 h (Veri cation required from Planning Department for new construction) �[ ka l � v 6s City/State ��� 4 e Parcel Identification Number 7 LEGAL DESCRIPTION 7 Property Location � ' /., A� V4, Secp2 � T � N -R W, Town of Subdivision C'L L" - J l7l gAba , Lot # Certified Survey Map # —'5 y,� / Volume f e _ , . Page # Warranty Deed # L0 1 e7 -// C/ C) , Volume /qJ �' , Page # Spec house eyes ❑ no Lot lines identifiable yes ❑ no SYSTEM CE Improper use and maintenance of 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 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 masterplumber, joumeyman plumber, restricted plumber or a licensed pumper 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 maintain 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 and returned to the St. Croix County Zoning Office within 30 days of the. y eW o te. SITURE OF APPLIC DATE OWNER CERTIFICATION I e) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the p d v virtue of a warranty deed recorded in Register of Deeds Office. SI NATURE OF APPLICAW /DATE ** * * ** 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 S MANUAL 8� 1 Z MANAGEME Page of PLAN ppy� OWNER' SYSTEM SPECIFICA FILE INFORMATION Septic Tank CaPacrtY /G'C �� al ❑ NA pwner �^ Septic Tank Manufacturer V; c�, ❑ NA Permit #. Effluent Filter Manufacturer ❑ NA ESIGN PARAMETERS Effluent Flier Model ❑ NA NA D 7 [] NA Number of Bedrooms Pump. Tank CaPactY C �' al ❑ Number Of Commercial Units aUda pump Tank Manufacturer 'i # c G+ Estimated flow (average) Manufacturer ❑ NA -7 r C3 NA j [7 aVd pump 1 Design flew (peak), (Estimated x 1.5) ... Pump Model R NA Sop Application gate pretreatment Unit Monthly average` b S Filter O Peat Fitter influent/Effluent Quality FOG) Si0 rn9/t- Wetland Fats,. Oil & Grease ( ❑ Mechanical Aeration ❑ Other. Oxygen Demand (BOD 5120 mg/L ❑ Disinfection Biochemical OxY9 -150 m /L Total Suspended Solids (T SS ) Manufacture r NA Monthly average" Dispersal Cetl(s) p In -ground (pressurized) pretreated Effluent Quality fit) p in -ground (gravity) Mound Bloch Oxygen Demand (BODs) mg/L [3 At-grade Suspended Solids (TSS) s30 m g [] pri ine ❑Other. Total metric mean) s10' cfu /100m1 Fecal COlifoml (g Y inch diameter • values typical for domestic (non- commerdai]) wastewater and Maximum Effluent Particle Size septic tank effluent •• values typical tar pretreated wastewater_ MAINTENANCE SCHEDULE Service Frequen. Service Event p months ar(s) (Maximum 3 yrs.) At least once every of tank volume inspect condition of tank(s) When combined sludge and scum equals one - thirds I ( Maximum 3 yrs.) Pump out contents of tank(s) AL least once every C] months year(s) Inspect dispersal cell(s) ❑ months 44 ear(s) At least once every Clean effluent filter p months ear(s) 0 NA controls &alarm At least once every Inspect pump, pump �' ❑ months year(s) ❑ NA At least once every C3 NA Flush Ldemis and pressure test. At least once every ❑ months ❑ year(s) Other ❑ months L year(s) ❑ NA Other At least once every n MAINTENANCE INSTRUCTIONS ster Plumber Restricted Sewer, POWTS catryi 9 nspe e of the following licenses or on ctor, POWTS Maintainer, Septage Inspections of tanks and dispers al cells shall be made by an individual ns must include a visual Inspection of the tank ctor s) to identify any missing or broken Ma c ertifications: Master Plumber; Servicing Operator. Tank inspe hardware, identify Y ted to check the effluent levels an uacks or leaks, measure a the dis i cetl( shall�be a Y inspec and to che ran back up of e {fluent on the or ponding of effluent on the ground surface- The of effluent on the ground surface- The ponding authority. in the observation pipes and to check for any po the immediate notification of the local regulatory ground surface may indicate a failing condition and requires eq uals one - third (Y) or more of the tank volume, the When the combined acc umulation of s ludg e and scum in any tank eq erator and disposed of i entire contents of the n accordance with ch- NR tank shall ll b r e m ove d move rl d by a Septage Servicing Op 113, Wisconsin Administrative co m p onents. pretreatfinent components, and any d by a certified POWTS Maintainer_ The servicing of effluent filters mecha ofV months or less shall be Pe of any service event. other maintenance or monitorin ulato authority within 10 days of co mpletion A service report shall be provided to the local re9 ry presence of painting products or other START UP AND OPERATION tank(s) f the pre pre For new construction, prior to use f th P 0KrS check o and tr eatmen t damage the dispers el s s If high concentrations are chemicals that may impede the tre atment to a servicing ope P rior to use. detected have the contents of the tank(s) removed by a sep g Page of shall not occur when soil conditions are frozen at the infiltrative surface - System start is restored the exces ghwater levels. When pow s During power outages pump tanks may fill above normal if wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the ceU(s) and may result in the bace 'tsc;harge of efflyent To avoid this situation have the contents of the pump tank removed by a backup or surfa d r surface p� tp power to the effluent pump or contact a Plumber or POWTS Maintainer to assist manually operating the c ontrols to restore normal levels within the pump tank disturb or compact Do not drive or park vehicles over tanks and dispersal cells. !Jo not drive or park over, or otherwise the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or-elimination of the following from the wastewater stream may improve the performance and prolong the fife - wipes• cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; of the POV1(i'S: antibiotics; disinfectant$; fat; foundation drain (sump pump) water; fruit and vegetable peelings; g asoline; grease;. herbicides; meat scraps; medications; oil; painting products$ Pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMMENT When the pOWTS fails and/or is permanentty.taken out of service the following steps shall Ile taken to Insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • AN piping to tanks and ; pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping all tanks a pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. advances in POWTS • A suitable replacement area is not available due to setback and/or soil limitations. Barring ad technology holding m be installed as a last resort to replace the failed POVVTS. a g tank The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. « WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GAS SES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTiC, PUMP OR OTHER TREATMENT R UF TANK N BE DIFFICULT OR I MPOSSIBLE. MAY RESULT.. RESCUE OF A PERSON FROM TH ADDITIONAL COMMENTS - POWTS INSTALLER POWTS MAINTAINER Name , -�vJ3` �, Name Phone � ") - G� �j Phone / .).- SEPTAGE SE OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Agency ���� I< Name Phone �J����` Phone ��„�—',�.'� staffs of the Green Lake, Marquette Waus This document meets This dowment was dialled try flue d oes te and hara County Zoning and Sanitation agendas. not the minimum requirements of dL Comm 83.22(2)(b)(1)(d) &(Q and 83.54(1), (2) & (3). Wiswnsin Administrable Code. Use of this document d G (210') guarantee the performance of the POWTS. STATE BAR OF WISCONSIN FORM 2 - 1998 61 X440 ITY P REGISTER OF DEEDS liih, , ;JDPAG. (� ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Rer 1 tided Lan Company, T.147 n 09-16 -1999 9:30 AM Wisconsin Ta i d I Com pe0.d Grantor. EXEMPT N CERT COPY FEE: and jRnhert Vega anti Lynda R Vpga, Husband and Wife COPY FEE: nr T - Tpnanrg TRANSFER FEE: 104.40 RECORDING FEE: 12.00 PAGES: Z Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in S Croix County, State of Wisconsin: I! f9c ordinq luea �i. Name and Return Address Secluded Land Company, LLC P.O. Box 10 :De Soto, WI 54624 See attached sheet for legal description. i 231- 1047 -70 -017 Parcel Identification Number (PIN) ii This is not homestead property. j! {1d_.( not) l �i This is non - marital property for James W. Smith. !I I i' ii Municipal and zoning ordinances, any recorded easement(s), recorded building and use restrictions and covenants, general taxes levied Exceptions to warranties: in the year of closing, and any liens and encumbrances created by the grantee. i Dated this 14th day of August 1999 Sec d d Land Company,. LL (SEAL) (SEAL) ji + James W. Smith, Sole Managing Mem Ij ii (SEAL) (SEAL) + + AUTHENTICATION ACKNOWLEDGMENT i' James W. Smith Signature(s) State of Wisconsin, lI ss. County. JJJ authenticated this 47 day of Personally came before me this day of the above named A hn P. Ebben a TITLE: MEMBER STATE BAR OF WISCONSIN — to (If not, me known to be the person __ who executed the foregoing ','i Instrument and acknowledge the same. authorized by §706.06, Wis. S[ats.) t 8 THIS INSTRUMENT WAS DRAFTED BY John P. Ebben, Attorney — — Notary Public, State of Wisconsin M Y commission is permanent. (if not, state expiration date (Signatures may be authenticated or acknowledged. Both are not ') necessary) (B) GM 17-1_ &, 17 7-2 L.K. _ ' N. of penom signing in any capacity must be typed or printed below their signature. �.^ STATE BAR OF WISCONSIN Wisconsin La9Inc. ai sunk Co.. In W SLc .Q6r] Mil — ukes. Wis. WARRANTY DEED FORM Na. 2 - 1998 Glenwood Meadows #17.1 �� �t)OP 5 14 L 7.1 of Ce rtified Survey Map No. 3569 recorded on December 16, 1998, in Volume 13 of Certified Survey Maps, Page 3569, Doenmeart um er . at erttfied Survey Map being located in part of the Southeast 114 of the Southeast 1/4, Section 27, Township 30 North, Range 15 West, City of Glenwood City, St. Croix County, Wisconsin. Subject to and together with non - exclusive rights of ingress and egress over and across the PRIVATE ROADS as more fully depicted on the following Certified Survey Maps: (1) Certified Survey Map No. 3047, Volume 11, Page 3047 (2) Certified Survey Map No. 3048, Volume 11, Page 3048 (3) Certified Survey Map No. 3049, Volume 11, Page 3049 (4) Certified Survey Map No. 3050, Volume 11, Page 3050 (5) Certified Survey Map No. 3051, Volume 11, Page 3051 (6) Certified Survey Map No. 3052, Volume 11, Page 3052 This conveyance is made along with and subject to the GLENWOOD MEADOWS OF ST. CROIX COUNTY PROTECTIVE COVENA14TS AND MAINTENANCE ASSOCIATION DECLARATION as recorded on February 14, 1996, in Volume 1161, Pages 544 -554, Document No. 539566. Subject to a 10 foot wide utility easement over and across the herein conveyed lot, said easement being parallel with and abutting the PRIVATE ROAD adjoining said lot. LEGAL DESCRIPTION Glenwood Meadows #17.2 Lot 17.2 of Certified Survey Map No. 3569 recorded on December 16, 1998, in Volume 13 of Certified Survey aps, age ocument Number Survey Map being located in part of the Southeast 1/4 of the Southeast 1/4, Section 27, Township 30 North, Range 15 West, City of Glenwood City, St. Croix County, Wisconsin. Subject to and together with non - exclusive rights cf ingress and egress over and across the PRIVATE ROADS as more fully depicted on the following Certified Survey Maps: (1) Certified Survey Map No. 3047, Volume 11. Page 3047 (2) Certified Survey Map No. 3048, Volume 11, Page 3048 (3) Certified Survey Map No. 3049, Volume 11, Page 3049 (4) Certified Survey Map No. 3050, Volume 11, Page 3050 (5) Certified Survey Map No. 3051, Vcdume 11, Page 3051 (6) Certified Survey Map No. 3052, Volume 11, Page 3052 This conveyance is made along with and subject to the GLENWOOD MEADOWS OF ST. CROIX COUNTY PROTECTIVE COVENANTS AND MAINTENANCE ASSOCIATION DECLARATION as recorded on February 14, 1996, in Volume 1161, Pages 544 -554, Document No. 539566. Subject to a 10 foot wide utility easement over and across the herein conveyed lot, said easement being parallel with and abutting the PRIVATE ROAD adjoining said lot. M r FORM NO. 985-A Stock No. 26273 S 59388'7 � F 6 �99� DE�> > H w� CERTIFIED SURVEY MAP NO. 3569 VOLUME 1 3 , PAGE 3569 ti V 3051 BEING LOT 17, CERTIFIED SURVEY MAP 3051, V. 11 P. , LOCATED IN THE SOUTHEAST 1/4 OF THE SOUTHEAST 1/4, SECTION 27, TOWNSHIP 30 NORTH, RANGE 15 WEST, CITY OF GLENWOOD CITY, ST. CROIX COUNTY, WISCONSIN SCALE: 1"=200' EAST 1/4 , R1 DRAFTED BY : sEC.2�, T30N5W DONALD M. CLARK LEGEND ST. CRDIX C MQNU. 0' 100' 200' VER OWNER: NMENT CORNER a F NoT • FND. 3/44' - REBAR N SECLUDED LAND CO. LLC • SET, 3/4'X24' REBAR 1673 13 1/2 AVE, P.O.BOX 99 WEIGHING 1.502 LB& El BARRON, WI 54812 PER LINEAL FOOT. I W� Z LOT 1 Z3 � UNPLATTED �a a3 raI WE ff se'vs -se v +, sec n W C.S.M_. 3 0 _ _ — I LANDS / 0 0 \ -- V W "\ \ \� P_30_4 7 / LOT 21 I W . o �� / C.S.M. 3052 \ \ Z �� p zw a w a LOT 14\ 'r — l P_ / m m O � N . C.S.M. 3050 \\ / r