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HomeMy WebLinkAbout042-1078-70-120Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(III Permit Holder's Name: Ryan & Michaela Hudson City Village Township TOWN OF WARREN CST BM Elev: Insp, BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DA AT County: St. Croix Sanitary Permit No: 617810 State Plan ID No: Parcel Tax No: 042-1 07&70-1 20 See on/Town/Range/Map No: 29.29.18.447A-15 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg, Sewer SUHt Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Type Of System: Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 L.❑ Yes 0 No 0 Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Location: No Address Available 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision Required? ❑Yes 0 No Use other side for additional information. Inspection #1: Inspection #2: Date Insepctor's Signature Cert. No. County D Safe ty and Buildings Division ; t 201 W'Washington Ave., P.O. Box 7162 Sanitary Permit Number o Madist'n, Wl 53707-7162 11 Co' 17 F- St. GrolX C�ermit Application ��`4 In ac rd�u�'j�Ipl�Pl� rs. Adm. Code, submission of this form to the appropn governruental unit is re rte o taming a sanitary permit Nom: Application forms for state owned POWTS are submitted to the Dcpartmetrt of Safety and Professional Servies. Personal information ou rovrde Y� may be used for secondary pirtposes in accordance with the Privacy Laws 15 04{1){m) Stars r I. Appbcatlonlnformahon—_I'IeasePrmtAllInfonnration' 1�— E rroperty t>wner's Mailin Address " ' City, State . Zip Code too He Type of Building (check all that apply) r 2 Family Dwelling —Number of Bedrooms ❑ Public/Commercial — Describe Use C� I ❑ State Owmed — Describe Use III. Tvue.ofPermit- (Clipek only o e box on line A. Complete line B if applicable) ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only System B• ❑Permit Renewal Before Expiration Phone CSM b filled in by Co.) rrect Address (if different dtan mailing address) 7�15 /67 d-C, 5 Parcel # o a - ►� � s -7o._ �a o Property Location o LO _ Go�vt t LS �_'�y1L'/,, ection trcle one T � N� R E Subdivision Name ❑ Cit3of Village of own 0 00! �� J ❑ Other Modificafion to Existing System (explain) ❑ Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Owner • � � �� ry n r � � sremn.om onenvl)evice: Check all that apply) Non -Pressurized in -Ground ❑Pressurized ln-Ground ❑ At-Graue ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable so ❑ Holding Tank ❑ er Dispersal Component (expl ') ❑ Pretreatment Device (explain] V. Dis ersaVrrea entArea Information: - - Design Flow (gpd) Design Soil Application Rat dsf) Dispersal AAze'a Required (sf) Dispersal Area Ppposed ( System Elevati A(z) ` e - ! 4 ; %r uC7• 0 VL Tank Info Capacity in Total # of ff i Gallons Manufacturer Gallons Units New Tanks Existing Tama � � m o U ='• Septic or Holding Tank \ • � „ / /1 t •I1Ll� 4 U on m CIO Dosing Chamber VII. Responsibility Staten nt- I, the undersigned, a responsibility for installation of the POVM shown on the attached plans tyni3ec Pl's Name '(Print) Pl i�tature MPRvIPRS Number I RncinP c lri and Date Issued Zip Code� Approved ❑ 'approve SPermi�jt Fee Date sued issuin ent Signattn-e ❑ rven Reason for Denial ✓ �� � � Z.� Z� X. Co P6Eif/,Reasons for Disapproval •.� //-- 1. Septic tank, effluent filter and 3 C&YL r I w70 L 4. dispersal cell must be_service- / maintained nn- . ' / 1 / as per management plan provided by plumber, 2. All setback requirements must be maintained as pera lic Attach to complete plans for the *stem and submit to the County onlp on paper not less than 8 12 x Il inches in siu SBA-6398 (R. 11/11) � a � 15 r� PROJECT Michaela Hudson SW 1/4 NE 1/4S 29 /T 29 System PLOT PLAN ADDRESS 202 West Elm St, Roberts Wi 54023 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 99.4/99.3 3' below grade 12/26/19 DATE CONVENTIONAL XXX CONVENTIONAL LIFT MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE HOLDING TANK SIZE LOAD RATE .7 BENCHMARK V.R.P. Top of survey iron ❑ BOREHOLE O WELL H,R,P same as benchmark 160' 644' Property Line 2-3' X 66' cells with >3' spacing 1%Slope 20' B-2 Vents as 914' Property Line 100' Vent >6" of Cover 4' Long 112" 3 10' BEDROOM 3 HOLDING TANK DOSE TANK SIZE ABSORPTION AREA 651 # of chambers 32 ASSUME ELEVATION 104.3' Filter Lifetime Filter B.M* To 107th St. 3-1 10' Pro 3 Bedroom House Quicic4 Standard Leaching Chamber with 20.0 ft2 of Area 5.6ftA2/pair of end caps at System Elevation All piping shall be ASTM SDR 30/34, within 9 c,�� 10' of tank, piping shall be ASTM F891 �✓ �' ' JOEESMEIL'i .•� Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 12/27/19 Owner:Michaela Hudson Location: SW 1/4 NE 1/4 S29 T29 N,R18W Lot 12 107th St. Warren Manuals Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanc�,d Contigency Plan 7. Filter Cros�/Siection Signatu'f V _ Licens number #226900 System PLOT PLAN PROJECT Michaela Hudson ADDRESS 202 West Elm St. Roberts Wi SW 1/4 NE 1/4S 29 /T 29 N/R 18 W TOWN Warren SYSTEM ELEVATION 99.4/99.3 3' below qrade 12/26/19 DATE CONVENTIONAL X%�< CONVENTIONAL LIFT MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE 54023 COUNTY ST. CROIX BEDROOM 3 HOLDING TANK DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambersIL 32 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 104.3' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark B.M* 160' L'J Vent , Scale = 1/4" = 10' To 107th St. -1 10' �6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area „ 5.6ft^2/pair of end caps at System Elevation 914' Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ftA2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 102.4' S314 t Grade Vent „ 3,�30/34 Septic Tank 5' S' Long 1 3 6 " Grade at System Elevation Grade at System Elevation Spacing_ 5' 2-3' X 66' Cells Same on other end Observation tube/Vent i b cnamgers per cell System elevations: A 99.4' B 99.3' At end of cell h1 POWTS ©WNE�'S MANUAL. &MANAGEMENT PLAN 1- Page � of �- DESIGN PARAMFTFRc Number of Bedrooms � C] NA i Number of Public Facility Units NA j Estima#ed flow (average) I `� al/da Design flow (peak), {Estimated x 1.5) � �� aUda ! Soil Application Rate Standard InfluenttEffluent Quality aUda Monthly average* fft2 Fats, Oil &Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE} 220 mg/L ❑ NA Total Suspended Solids (TSS) <_150 mglL !Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) <30 mg/L ❑ NA Fecal Coliform (geometric mean) s104 cfu/100m1 iMaximum Effluent Particle Size � in dia. ❑ NA Other: ❑ NA values typical for domestic wastewater and septic tank effluent IAINTENANCE SCHEDULE Service Event Ilnspect condition of tanks) At least once every: SYSTEM SPFc^If=ireYinuc ---- � Septic Tank Capaaty al ❑ NA Septic Tank Manufacturer ❑ NA r. Effluent Filter Manufacturer P ❑ NA v ,.� Effluent Filter Model !� ❑ NA Pump Tank Capaaty NA r al ,; Pump Tank Manufacturer Ni4 Rump Manufacturer NA I< Pump Model NA 1� Pretreatment Unit N ❑ SandlGravel Filter ❑Peat Filter ❑ Mechanical Aeration ❑ Wetland l l ❑ Disinfection O Other. ' Dispersal Cells) ❑ NA ❑ !n-Ground {gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑Mound ❑ Drip -Line ❑Other. Other. ❑ �' NA` Other: ;: 13 NA Ocher. ❑ NAj Service Frequency (Maximum 3 years) ❑ NA - — - - - ; (Pump out contents of tanks) When combined sludge and scum equals one-third (�} of tank volume ❑ Nq "% Ilns ect die ersal cells ❑ month(s) — i p p O At least once every: j-�year(s) (Maximum 3 years) ❑ NA � I�lean effluent filter At least once every: ❑ month(s) � year(s) ❑ NA ! nspecf pump, pump controls &alarm At least once every: ❑ month(s} . ❑year{s) ❑ NA I=lush laterals and pressure test At least once every: ❑ month(s) i ❑ year{s) NA , tither. , At least once every: ❑ month(s} NA. MAINTENANCE IN5TRUCTI®NS "' Ilnspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: ast��v iPlumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank inspections muss linclude a visual inspection of the tanks) to identify any missing or broken Hardware, identify any cracks or leaks, measure the volume of cembined sludge and scum and to check far any back up or ponding of effluent on the ground surface. The dispersal cells) shall ba visually inspected to check the effluent levels in the observation pipes and to check far any ponding of effluent on the ground surface. 'T'he ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local I'egutatory authority. I,rVhen the combined .accumulation of sludge and scum in any tank equals one-third ('/3) or more of the tank volume, the entire con#eats of j:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin l4dministrative Code. ICI other services, including but not limited to the servicing of e�`fluen# filters, mechanical or pressurized components, pretreatment units, land any serviang at intervals of <12 months, shall be performed h;� a certified POV�IT'S Maintainer. I'� service report shall be provided to the local regulatory autho��ty �vithir. 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals t may impede the treatment process and/or damage the dispersal ceil(s). If high concentrations are detected have the contents of tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of efflu To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal le within the pump tank. Do not drive or park yehicies over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area w 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may tmprova the performance and prolong the life of the POV antiblotics; baby wipes; dgarette butts, condoms; cotton swabs; degreasers; dental foss; diapers; disinfectants; fat; foundation c (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail; painting prod pesticides, sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall betaken to insure that the system is pro and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • AN to tanks and pits shall be disconnec#ed and the abandoned pipe openings seated. TO • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumpingall tanks and pits sha{i Ise excavated and removed or their covers removed and the void space fill , ed with 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 corm replacement system: OF suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption sy: T Isreplacement area should be protected from disturbance and compaction and should not be infringed upon by req setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ru effect at that time. ® A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS tec holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be it 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 surface. Reconstructions of such systems must comply with the rules in effect at that time. n in as «WARNMG» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDJOR INSUFFICIENT OXYGEN. DO jriOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O� A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ,s i, POV1►TS Phone I / ti r Name Phone 1 �7 / This docxrrrtentwas drafted in corr�liance with chapter SPS 383.22(2)(b)(1}(d)So(fl and 383..54(1}, (2) & (3), Wisconsin 4 s v Frontier Yahoo Mail - Re: Hudson Residence- Warren Township 12/27/19, 7:44 PM �..?; LAL SEPTIC TANK MAIN'I'LNANU14o AUKItl;lvt IN a AND OWNERSHIP CERTIl'ICATION FORM Mailing Address1zs/��cr, Property Address _ .. _ (��` ' / _ (Verificatiotr required from Pl trmiug & Zoning Depat MnT foi neW Ccrostruchoa) City/staloi ,Ylqr�,, wiacN,511J Parcel Identificat7onNwaber ' o I,>✓c; �.1v1 s P'rYorr �I Z -' W7 S SubtlYvisioai T.,ot# 12, . Certified Sul-vey NIap # I Onl3 _U Vt.iume a0 . zt —'� Warranty Deeded # _ - ' Volume Page It Spec house yes Curl I.ot lines idonti5abto no SYS'ITM N+LAINT'EPTANCI: ANI) OWNER CERTIITCATION Improper trse and mairriennuce of your septic system could result in its premahue failum: to handle wastes, Proper mainlenan<u consists of pumping out the septic tank every unoo years or suonCr, u' need, by a licensrd pumper. What you put inty the system can affect the function of the septic tank as a treatment stage in the wasio disposal system Owner maintenance ursponsibilities are specified in §Comet 83.52(1) and in Chapter 12 - 5t. Croix County Sanitary Ordinance, The property owner< agrees to submit to St. Croix County Planning &Zoning Department a certification form, signed by the owner and by a master pluutbor, jotrrneynwu plumhcr, restricted plumber or a lleeused pumper verifying that (!)ate on -site Wastewater disposal system is in proper operating Conriition and/or (2) after inspection and pumping (if necessary), the septic tank is less than I/3 full of sludge. Uwe, the undersigned lyave road the about ruluirtarents and agrta: to maintain We private sovvage disposal system with the standards set forth, herein, ns act by the Department of C;omrnerce and the Departtr�tnt of Natural Resources, Stnta of Wisconsin. Certiftcadon stating that your septic System has been maintained mast be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are fret to the heal of ntylour k nowledgt. T/Wt am/are the owner(s) of the property described above, by virhro of a wamtnty deed recorded m Register of peerly Office, Num�crgofbt_dr/o ms t� SIGNATURE OF AP ICANT(S) DATD «*''Any information that is misrepresented may result in the sanitary perrttit being ritvokad by the Plxnrtiug &Zoning DepAti7ncut, ««. I�lttdc with this application a recorded warranty deed from We Register oi' Deeds Ctffiec and a copy of the certified 5'trVey reap if rcfoMnca is made in the warranty deed. (RL'V. 08105) Get Outlook for Android From: sbird@frontiernet.net <sbird@frontiernet.neb Sent: Thursday, December 26, 2019 4:07:19 PM To: Michaela Hudson <mick_ostertag9hotmail.com> Subject: Re: Hudson Residence. Warren Township need that form back about:blank Page 2 of � I ,E EY LOCATED IN PART OF THE INTHE SW'/a OF THE NEB OF SECTION 29, T29N, R18W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN; BEING ALL OF LOT L OF THAT CERTIFIED SURVEX MAP FILED IN VOLUME 28, PAGE 6466 AS DOC. NO. 1062316 IN THE ST. CROIX COLINTX REGISTER OF DEEDS. N%a CORNER, SECTION 29 BEARINGS REFERENCED 70 THE ALUMINUM CAP NORTH -SOUTH Ya SECTION LINE OF FOUND) SECTION 29. LINE BEARS NOO'16'53"W, ST. CROIX COUNTY COORDINATE SYSTEM. 1089376 BETH PABST REGISTER OF DEEDS` ST. CROIX CO., WI RECEIVED FOR RECORD 09/27/2019 03:59 PM CERTIFIED SURVEY MAP VOLUME: 30 PAGE: 6703 REC FEE: 30.00 PAGES: 2 ® �� � � ltiu 1.3" IRON PIPE FOUND AT CORNER AND ANOTHER 1.3" IRON PIPE FOUND ��1p�°�-�_��'�- � S00°18'45"E �. S07°25'Zi"W 0.99' FROM �Q�D� i 20.26' � I � COMPUTED CORNER f �; S89°50'13"E 644.81' J —� �_' �' d�� �' � �,� 0' cn ��Q �; �; O �' w �! V' Op i �" Oo ; 'F�,� c�� u> �� � �' o Oo; G�� �/��/�� Gay �� 0� °o O NOTE: ELEVATION 78.28' , OF TOP OF 1" IRON NOTE: LOWEST BUILDING PIPE = 1010.70' 100.11' - =�_ OPENING ALLOWED ON LOT 12 IS 1012.5'. LOT 92 654,916 SQ. FT. (15.03 ACRES) NOTE: LOT 12 HA5 LIMITED ACCESS UNTILTHE ' DRIVEWAY IS CONSTRUCTED. CONSTRUCTION f/ 111 OF TH RIVEWAY WILL REQUIRE A LAND USE PERMI R SLOPE DISTURBANCE. N Z �' -_� ON rn z �� �y � * 6g9R4�* �O MEiN.RWNMOTdd � ��' p o � o o `'ti :.«....-'"� i� �� Qom° � '� S UFti`j� p�� 0� �o q z 16' M w �_ 0 0 CV � S89°05'0� �,.� 88.46' S01°04'11"E� �� f�-16' 109.07' S89°05'02"W 751.14' � ��� � �e�o�o j MOL��_90$ _f�Co_��7g6 � ram. � LEGEND o N ' ® SECTION GORNER (AS NOTED). z � ■ %" IRON REBAR FOUND. • 1" OUTSIDE DIAMETER IRON PIPE FOUND. ® 1.3" OUTSIDE DIAMETER IRON PIPE FOUND. S�/a CORNER, ■ 0.75" IRON REBAR FOUND SECTION 29 ® 0.75" X 18" IRON REBAR (2.25" IRON PIPE WEIGHING 1.502 LBS. LINEAR FOUND) FOOT SET. FIELD �/OL�°_�4g I�C�o �6��_ --- - - - -- - I, N87°53'59"E 658.56' I 626.08' _ 547.80' 32.48' _ _ _ 580.28' II, CENTERLINE OF 33' � � �R\ ,N ��� WIDE ACCESS EASEMENT -- -S7J)6_� 30' BUILDING SETBACK,_.,---�' - �— � LINE FROM EASEMENT CURVE 1 I NOTE: THE FIRST 330' OF THE EASEMENT'ti � WEST OF THE RIGHT-OF-WAY LINE IS A ti I SHARED ACCESS FOR LOTS 11 & 12. �p I LOT 9' �'I 708 038 SGl FT (16.25 ACRES) I INCLUDING RIGHT-OF-WAY o I col" 689,095 SQ. FT. (15.82 ACRES) �' � 1�1 °o EXCLUDING RIGHT-OF-WAY � �� ,� � � Q' 1.3" IRON PIPE FOUND S87°02'50"W 0.97' FROM I I I �� COMPUTED CORNER 23.81' o Y 0 N 448.52' I_ I �q S86°33'22'� 472.33' ' J 16—�16' I �� I� � �� ~n o �'; �; w ' �e�o�o I �5; Leo��� pc° ago �� ct g----------- �i O _ ' �— �, nn �. LJ°c�i°llVllo �LOL�o_�39_pCo _aC�_� � --- - L_.—_ N L� �l� � _ Go�Sof_M_ln VO(�o_ � o g _G?C °_ 6466 NOTE: THIS MAP CONTAINS AREAS THAT ARE SUBJECT TO THE SHORELAND OVERLAY ZONING DISTRICT; ADDITIONAL RESTRICTIONS APPLY. CONTACT THE COMMUNITY DEVELOPMENT DEPARTMENT FOR MORE INFORMATION. WORK COMPLETED APRIL 2, 2019. SECTION CORNERS HAVE BEEN FOUND AND VERIFIED WITH TES OF RECORD AND ST. CROIX COUNTY COORDINATES. SCALE IN FEET O' 1OD' 200' 1 " = 200' I.A1VD JOSEPH GRANBERG DALE STEWART SOI,LJTIOIVS 1428 134TH AVENUE 757 107TH STREET ERG&,.5'O/V_N6NTfiG NEW RICHMOND, WI 54017 ROBERTS, WI 54023 St. Croix County 1089376 Page 1 of 2 DRAFTED BY: JWG JOB NO. 100-577 SHEET DATE: 04/18/19 1 OF 2 Document Number State Bar of Wisconsin Form 2-2003 • •'• ! 1 Document Name THIS PEED, made between Trust Agreement of Dale R. Stewart, Dale R. Stewart, Trustee ("Grantor," whether one or more), and Rvan Hudson and Michaels Hudson husband and wife ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix Couttry, State of Wisconsin ("Property") (if moI•e space is needed, please attach addendum}; That part of the SW114 NE1/4 of Sec. 29-T29N-R18W,'1'otivn of Warren, St. Croix County, Wiscousitt, described as follows: Lot 12 of Certified Survey Map recorded iIt Vol. 30 of Certified Survey Maps, page 6703 as Doc. No. 1089376. Excep_lions to warranties: Easements, restrictions and rights -of --way of record, if any. Dated :1 November, 2019 * 1092218 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 11/12/2019 09:14 AM EXEMPT#: REC FEE 30.00 TRANS FEE 480.00 PAGES: 1 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address: Attorney Krishna Ogtand Estreen & Ogland 304 Locust Street Hudson, �VI 540I6 Part of 042-1078-70-075 Parcel Ideutification Number (PIN) This is not homestead property. by: (SEAL) � (SEAL) *Dale R. Stewart, Trustee {SEAL) (SEAT,) * � AUTHENTICATION Signahtre(s) Dale R. Stewart authenticated TITLE: MEM$ER STATE BAR OF WISCONSTf1 (If not, authorized by Wis. Stat. § 706.06) TffiS INSTRUMENT DRAFTED ]3Y: ACKNOWLEDGMENT STATE OF ) ) ss. COUNTY ) Personally came before me on , the above -named to me known to be the person{s) who executed the foregoing insttvment and acknowledged the same. * Notary Pui�lic, Stag of My Cotnrnission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) ' NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NQ. 2-2003 * Type name below signatures. 1NFt7-PROT"' Legal Farms 800-655-2D21 wwnv.lnfoproforms.com _____.___St. Croix County_1092218 Pale 1 of 1 _ r J135 :b010Va1N00lV83N30 NOSO aaquunZ croa,czii�:xva (1H V13VHOIW ONV NVA21 :80103NJIS30A11Y03dS. 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Code County St. Croix Attach complete site plan on p er not I ss than 8 1/2 x 11 inches in size. 'zontal Plan must �a''F � ' include, but not limited'tbW`�itil�l and�ho reference point (BM), direction and Parcel LD. �{'Z, "1 �— (� � percent slope, scale or dimens�o�is, hort arrow, and location and distance to nearest road. - b1 Please print all information. Revie d by Date / Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 9 29 18 ®r® Dale R. Stewart Govt. Lot SW 1/4 � 1/4 S T N R Property Owner's Mailing Address Lot # 12 Block # Subd. N me or CSM# ' / ��`T}�((J� �Sr 757107thSt City State Zip Code Phone Number City Village ■Town Nearest Road Roberts WI 54023 ( 7� 5 497 9996 Wa17en 107th St � New Construction Use Residential / Number of bedrooms 4 Code derived design flow rate GPD Replacement � Public or commercial -Describe: ZO Parent material sandstone Flood Plain elevation if applicable �— ft. General comments and recommendations: %� Boring # Boring , p;f Ground surface elev. ft. Depth to limiting factor 72 in. Soil Aoolication Rate Horizon Depth in. u Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fg *Eff#1 *Eff#2 1 2 0-8 8-30 10YR3/2 10YR4/3 SL SL 2 M SBK 2 M SBK MFR MVR C S C S 2 F 1 VF 0.6 p.6 1.0 1.0 3 30-72 10YR4/6 S 0 SG MVFR 0.7 1.6 � tl 1 � , 6� �� `" I Boring # ©Boring J �i ■� per Ground surface elev. / C�� ft. Depth to limiting factor 74 in. Snil Anolication Rate Horizon Depth in. Dominant Color Redox Description Munsell Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/f� *Eff#1 *Eff#2 1 0-12 10YR2/1 SL 2 M SBK MFR C S 2 M 0.6 1.0 2 12-28 10YR4/6 SL 2 M SBK MFR C S 1 F 0.6 1.0 3 28-74 7.SYR3/4 S 0 SG MVFR 0.7 1.6 Il �. 2 gr * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L CST Name (Please Print) Signature Dale R. Stewart enr iFL = [SVUS � JV niyr� anu i �� � .iv ni�y�- CST Number 220879 Address 757 107th St. Roberts, WI 54023 Evaluation Conducted 04/ 19/2019 Telephone Number 715 497-9996 SBD-8330 (R07/13) Stewart, Dale R. Property Owner __ Parcel ID # �. Boring # Boring, , , ,� ., � �� pit � Ground surface elev. � C3� ``� ft. Depth to limiting factor 75 � t 2 3 Page of In. c„a e....r...,�:,... �„s„ Horizon Depth' w Dominant Color Redotc Description Texture Structure Consistence Boundary Roots GPD/fg in: 'Munsell Qu. Sz. � Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-28 10YR2/1 SL 2 M SBK MFR C S 1 F 0.6 1.0 2 28=41 10YR4/3 SL 2 M SBK MFI C S 1 VF 0.6 1.0 3 41-75 10YR4/6 � S 0 SG MFR 0.7 1.6 a Boring# � Boring Pit Ground surface elev. ft. Depth to limiting factor in. Snil Annliratinn Rata Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary � Roots GPD/fg *Eff#1 *Eff#2 Boring ❑ Boring # Ground surface elev. Pit ft. Depth to limiting factor in. Soil Aoolication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz, Cont. Color Texture Structure 'Consistence Gr. Sz. Sh. Y Boundary Roots - -- - -------- - ---- GPD/f� *Eff#1 *Eff#2 * Effluent #1 =GODS > 30 < 220 mg/t. and TSS >30 < 150 mg/L ' A* Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/t_ SBD-8330 (R07/13) f L0% /2� rah-LI �.s7 i .s?'� c 0 - INDICATES SOIL TEST LOCATION CERTIFIED SURVEY MAP LOCATED IN PART OF THE IN TILE SWV4 OF THE NEV4 OF SECTION 2% T29N, R18W, TOWN OF WARREN; INCLUDING ALL OF LOT 1 OF THAT CERTIFIED SURVEY MAP FILED IN VOLUME 28, PAGE 6466 AS DOC. NO. 1062316 IN THE ST. CROIX COUNTY REGISTER OF DEEDS. NY4 CORNER, SECTION 29 BEARINGS REFERENCED TO THE ALUMINUM CAP NORTH -SOUTH Ya SECTION LINE OF FOUND) SECTION 29. LINE BEARS N00'16253"W, Q ST, CROIX COUNTY COORDINATE SYSTEMN, 1.3" IRON PIPE FOUND AT CORNER AND ANOTHER 1.3" IRON PIPE FOUND S07025'21 "W 0,99' FROM 0 �I COMPUTED CORNER z / S89050'13"E - — - �'C�D I S00018'45"E ,ANDS I 20.26' 6 al 4.81' 78,28' J 4 C LOT 12 654,916" SQ. FT. (15.03 ACRES) w Z z O U W O ° O ^Op 9 O O�°u Z 723.61' N89005'02"E 834.64' S%4 CORNER, SECTION 29 2.25" IRON PIPE FOUND) iL MAY 01 2019 I CSrr*ao)9 -Gay dDl>=o_26g FQ-a I Gr; I N87°53'59' E 658.56' i 547,80' 32A ' 580.28' I _ CENTERLINE OF 33' �s\bs WIDE ACCESS EASEMENT \`�g6.76L_T 3Of UILDING SETBACK ) LI FROM EASEMENT LOT 11 o MI 416,323 SQ. FT. (9,56 ACRES) (° I INCLUDING RIGHT-OF-WAY m 397,380 SQ. FT. (9,12 ACRES) EXCLUDING RIGHT-OF-WAY � i �ol� {�I a I P' 1.3' IRON PIPE FOUND I I P S87002'50'W 0.97' FROM I COMPUTED CORNER 23 81' I �I { a f44845Z 1.03' OUTLOT 1 S89°05'02"W 88.46' 291,715 SQ. FT. (6.70 ACRES) t- S01°04'11"E, 109.07' , S89°05'02"W 751.14' VQLo_109 P(Qn_27° LEGEND SECTION CORNER (AS NOTED). ■ 1/2' IRON REBAR FOUND. 1" OUTSIDE DIAMETER IRON PIPE FOUND. ® 1.3" OUTSIDE DIAMETER IRON PIPE FOUND. ■ 0.75" IRON REBAR FOUND 83 0,75" X 18" IRON REBAR WEIGHING 1,502 LBS, LINEAR S86°33'22"W 472.33' N LOOTS I � ON al Pon see @4 W LJ°�°ll�'1l1° dOO La 39 Lff 0 'I LOT_I'_ z� I FOOT SET. FIELD WORK COMPLETED APRIL 2, 2019. SECTION CORNERS HAVE BEEN FOUND AND VERIFIED WITH TIES OF RECORD AND ST. CROIX COUNTY COORDINATES. SCALE IN FEET tf �D SVRVCTVIS: rncr�+ra....+ -•-• / SOLiJTIONS JOSEPH GRANBERG DALE STEWART DRAFTED BY: JWG S 1428 134TH AVENUE 757 107TH STREET JOB N0. 100-577 SHEET cry- • NEW RICHMOND, WI 54017 ROBERTS, WI 54023 DATE: 04/18/19 1 OF 2