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042-1031-30-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 200 GENERAL INFORMATION (ATTACH TO PERMIT) 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: City Village X Township Parcel Tax No: Nelson, Glen D. I Warren Town of 042-1031-30-000 CST BM Elev: Insp.BM Elev: BM Description: �, Section/Town/Range/Map No: ��• w� 7. 12.29.18.177C TANK INFORMATION LEVAT ON DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark s Dosing ClIX,t c Alt. BM Aeration Bldg. Sewer 47— AD bl- Holding „ 6 $ St/Ht Inlet 17Z 79 TANK SETBACK INFORMATION /vCA J Ijbp JS,t2? St/Ht outlet �\ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Z7 Dt Bottom $g Z7 Dosing Header/Man. 97 39' Aeration Dist. Pipe g7- 34o Holding Bot. System Final Grade �Y PUMP/SIPHON INFORMATION Manufacturer ` Demand St Cove / 2si�t-r� GPM Model Number ,/ Tltol TDH Lift Friction Loss System Head TDH Ft OJ � Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits nside Dia. Liquid Depth DIMENSIONS i //& SETBACK SYSTEM T ' L BLDG WELL LAKE/STREAM LEACHING Manufacturer: / INFORMATION CHAMBER OR Type Of System: UNIT /Z-7 Model Number: dill DISTRIBUTION SYSTEM Q i—s-C 'L, Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Inta GO J Pipe(s) Length Dia I 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 7hed Bed/Trench Center Bed/Trench Edges Topsoil Yes No H Yes n No COMMENTS: (include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1479 110th Av ue Hammond,WI 54015(NW 1/4 NE 1/4 12 T29N R1 8W) NA Lot y1� n n Parcel No: 12.29.18.177/C rv---p GOJ2.`� / 1 11D.��•�/ d� i•ti p�e(�Ja.Q'1�o✓� 1.)Alt BM Description= 2.)Bldg sewer length= �Lf p, i -amount of cover= Plan revision Required? Yes \I(No Use other side for additional information. ___ SBD-6710(R.3/97) Date Insep ors Signs re Cert.No. PLOT PLAN Page 3 of 7 Scale 1"=�10 ' 7'� RvE, 15 0 'TIA- S-r. NOT TO ty-1°1 w)Trt Plug DSO' t l cl•'D � y U t�0 yog COwIP T' �� L o►Z p l3'iURC3 / w \lS OF 1*1 ` -- 3 $D rir� 'Alit x x w�-�- .o� Co.hv�vz kc Rs-c; �o or— eeu a eR El, q rr �{p ilk 1�1 b 44 S- v1 G-:71M,QI S-�O @f= --,BM Wt. _l00.0.'ONJ 3".l-{IG1i -- aMtf-z=Lam, g6_ws, . 4 -- ? - ---"------ - ---- - --- - NOTES : 1 . Elevations shown are existing ground elevations unless otherwise noted. 2 . Install 4" observation pipes with approved caps. ( 2 required) . 3 . Septic tank to be Npob 1 bSo gallon capacity manufactured by 4 . Bench marks = SFE- P3oU� Divert surface water around system to prevent ponding at the uphill side. VO County Sanitary Permit Application ST.CROIX COUNTY WISCONSIN In accord with 15.04 St.Croix County Sanitary Ordinance ZONING OFFICE personal information you provide may be used for secondary purposes ST.CROIX COUNTY GOVERNMENT CENTER 01 (Privacy Law.S.15.04(1)(m)] 1101 Carmichael Road ��, 2 Hudson,WI 54016-7710 7+' Q �J� ( (715)386-4680 Fax(715)386-4686 6* �' Attach complete plans he system on not less than 8-1/2 x 11 inches in size. unty Sa 'tary Permit# ❑ Check if revision to previous application M z 1. Applicat on Information-Please Print all Information Location: Property Owner Name Alf—At(A 1/4 1/4,Sec // I-G N 6 L 5 o Al T .21 N, R /$ E(or Property Owner's Mailing Address Lot Number / Block Number /q ? q tlo R ue, City,State Zip Code Phone Numer Subdivision Name o CSM Number t4RMA& 0 A SYd a/ s 3,y7 81r( usF ,2 P-577 II Type of Building: (check one) amity ❑Village 0Fawn of 1 or 2 Family Dwelling-No.of Bedrooms: ❑ Public/Commercial describe use): ❑ State-owned Nearest Road 11.Type of Permit: (Check only o e A. Check box on line B if applicable) Parcel Tax Number(s) /I r�7 C A) 1.0 Repair Reconnection 3.❑Non-plumbing .❑Rejuvenation ( l Sanitation o y a- 1431— 3a— 6 O O B) 3q' of y-j a Permit Number q Date Issued SL State Sanitary Permit was previously issued 3 t y 36 -zoo f IV.Type of POWT System: (Check all that apply) --- ❑ Non-pressurized In-ground Mou ❑ 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: UZZ 270 . S 5w 1.Design Flow(gpd) 2.Dispersal Area 3.Dispersal Area 4.Soil Applicati n Rate 5.Percolation Rate 6.System Elevation 7.Final Grade Required Proposed (Gals./day/7 /.0 ft.) (Min./inch) �� 70 Elevation LSv gac ysv / ,sv Sb O.S �7� ` I. Tank Information Capaicty in Gallons Total #of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks _ � d Uu DLYJ l:Pi�h.- aK ❑ ❑ ❑ ❑ v w o ❑ ❑ ❑ ❑ ❑ II.Responsibility Statement I,the undersigned,assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A icerise is not required for terralift repair or the installation of non-plumbing sanitation system. Plumber's Name(print) Plumber's Signature(no stamps): MP/MPRS No. Business Phone Number w,ft1'C04 A1Ec W VV41- I ;t Its -7q Plumber's Address(Street,City,State,Zip Code) 4b� 0 6 5' �26t�- c.31 S_y0 3 III.Coupfy Use Only Disapproved San'pry Permit tFFeeO"n ( Date Issued Issuing Ag t Signatur o stamps) Approved Owner Given Initial Adverse 22 ! �� Determination IX.Conditions of Approval/Reasons for Disapproval: SYSTEM OWNER: 1.Septic tank,effluent filter and dispersal cell must ba serviced/njainined as per management plan provided by plumber. /Ulcmjft�AU-), 2.All setback requirements must be maintained a as per applicable code/ordinances, Paxi-rr, �- 0Tu2..- 2!1 LA � I ----------- 0 0 -7 TR C4 45� PLOT PLAN Scale 1"_ 0 ' •Page 3 of 7 W I C7-2.S hl • � — ti Re-;zL--T or 1 5 0 `f* ST. -ts_ o„ D0 rJor ComnPre-r of r ZKPVC F•M• 6 / 2q,- / S' -off , vL 3 $]rR?-M x w�--�- CQ.hUWz�,1,• q,S_0 b �, Qo or- eCLL tip• y_ 1-t�/�7.:1•'rt-L_:�.�5�[>r:JG--�`fC1�ikS_:'J'p @i=-:'PAS b0�!_ ♦--F� Piz�D� t I- dv 3" �}lsl� , ��y C PlaF _ - NOTES : " 1 . Elevations shown are existing ground elevations unless otherwise noted. 2 . Install 4" observation pipes with approved caps. ( Z required) . 3 . Septic tank to be 1ppp Ibso gallon capacity manufactured by O-VZ-e- w/ A 8 0 0 Z. QL Fi L7-ez 4. Bench marks_ SZE- paa3 � � . Divert surface water around system to prevent ponding at the uphill side. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) % `l 7 9 /to A eL,e located at: u w 1/4, nv,6� '/4, Section /;Z , Town_;j _N, Range / 8 W, Town of 6'� St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: /o oo 4 5'o Construction: Prefab Concrete ✓` Steel Other Manufacturer (if known): Age of Tank (if known): ..o a / Permit number (if known) (Licensed Plumber Signature) (Print Name) II (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM (Her>uyer 99-x` Mailing Address I q -7 9 / 10 ' �rcr - 14 c Property Address (Verification required from Planning&Zoning Department for new construction.) City/State l� A� cwt d C 0 Parcel Identification Number ®`l•Z ' / 3/-3° - LEGAL DESCRIPTION Property Location At 4-3 1/4 , NE 1/4 , Sec. /a. ' TA? N R /$ W, Town of � Subdivision Plat: , Lot# r -7 -7 Page # Certified Survey Map # 3 7 ,Volume_ � Warranty Deed# PL j�l 2 o j (before 2007)Volume 0 , Page# Spec house 0 yes Rno Lot lines identifiable 2,5(es 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in§SPS. 383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to Sf Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal 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. I/we,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 Safety And Professional Services 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 Planning&Zoning Department within 30 days of the three year expiration date. 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 property_described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms vy SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) • apts TTTgdn agj 19 8urpuod Juanaad ol 'malsgs puno.zs 39491, aoBians WanrQ • S ��og� S ; �x�sm gOUaff • +j .Sq pasnlosjnusm -fgtOedso uOTTE$ S pp� a o • (p9JTnb9-i • sdso ano.iddB l q xus� Or�dag • £ • a�ou asiMZa Z p g�?� sadtd uot�Bn�asgo TTaIsur ' Z p glo ssaTun suorjanaTa punoj2 2UTISTxa ais uMOgs SUOTjBnaTg ' T Rq ti oz� N0, 0`00-1-`21 _I f CQ81 -1"lk(_.CV v.-A 2� N =10 Lipy�p�l �o oq -s b -LA ztv�ll�p �D N usl--A;: • I'LL , S . N C Wu 1a-VcJL,4n -ON QQ �a a(lb +ll=16Lbl �s 01 10 N •�LS -i�.l, 0 S ` .1 vZ � 1a�r_�_O 1._:�R_._-c"�X11-"1-^���d�c�i._ �nd 1�L 011 � L 30 ab,ea. aTPOS fjwq T .T.(171T L ® �Ip F 1 L C° aPR 1978 ,�E6 q' C:.NNcLI t J :v{ ( 5 51. Croix '0wty, 1.f!•M•.•111 \ CERTIFIED SURVEY MAP � �� LiARVEY HIELKEMA Part of the Northwest 1/4 of the Northeast 1/4 and part of the Northeast 1/4 of the Northeast 1/4 of Section 12, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin NF— COR. SF-C-. 12, l T29N , R18W N90000cIW 660.00' Q� (Qk IN ASQwArL_'f) F� N!90000'00"W 96- Op 945.62 0 006 000 O 0 \11 0 6 0'� 2 STORY FRAME. 0I 0 pWE .LIN6 d o� 1.0 `o-r W 3 0 BAR R ` u z Do W a A ES W c Of O LA O SHEDS 0 do Id 0 9 1 z zNQ 0 o. u! 4- 0 Q ,W 0 °: 1rJ 000 O mlrN � O (n 00 00, O �0 z 0 i X041 \� d2n< N 90'OO"00'1E 600.00' SCALE. 1"M 200' o Indicates 1" x 24" iron pipe weighing 1.13 lbs./ft. set. Description: That certain parcel of land located in the Northeast 1/4 of the Northeast 1/4 add the Northwest 1/4 of the Northeast 1/4 of Section 12, T 29 N, R 18 W, Town of Warren, St. Croix County, Wisconsin more fully described as follows; Commencing at the Northeast corner of said Section 12, thence go N 9CP 00' 0(rW X45.62 feet to the POINT OF BEGINNING of the parcel t? be herein described; thence �o N 90000'00"W 660.00 feet; thence go S 00 00 00 E 660.00 feet; thence go N 00900'00"E 66o.00 feet to the POINT OF BEGINNING of the above described parcel, containing 10.00 acres, more or less, being subject to easement over the Northerly 33 feet thereof for Town Road p,.irposes. State of Wisconsin) (For purposes of this description all bearings referenced St. Croix County) to the X line of the NE 1/4 of Section 12, T 29 N, R 18 ! assumed N 90000000"W) I. James L. Murphy, Registei Land Surveyor, do hereby certify that by direction of the Owner, Harvey Hiel kema, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 216 of Wisconsin Statutes and the Ordinances of St. Croix, and the above map and description are a true and correct representation thereof. Dated; 31 March 1978 % ��rllti;r:rn!n'r�uii Vol. _ Page. 07 r� V St. Croix County Records ?gistereed es L. Murphy Certified Survey Maps Land Surv#'' -' „_f St. Croix County, Wisconsin _ :.lii'r� r S 1042 APPROVED ..%r�'''• RIVER FAILS, :' ` Wisc. APPROVAL OF THlri MINOR SUBDIVISION ��,,,/FD••LA` D DOES N�:T M:r�,N ”'/,^,L FC; APR 12 1978 ����pgi unnn►�������r� JIL171i•1G .. CJrt sr-nic :.`i itEF�R i0 rl:,2.40, S1. C:\OIX Cvu. YY COMP,2EHENSIVE PARKS PLANNrla AND ZONING COMMITTEE Volume 2 Page 577 Note t,d= ` 5to?05 - LIMITED WARRANTY DEED THIS INDENTURE, made this 31 day of August 19 89 , between Facm Credit Bank of St. Paul REGISTER'S OFFICE a federally chartered co `�t• C�Q�x CO., W� P 0 BOX 199, ration, with a post office address of s River Falls, Wisconsin 54022 Recd for Record SEP 0 51989 party of the first part, and Glen D. Nelson, a single at 8:00 A.Ail person a �B +ofD"ds whose post office address is —Route #1, BOX 139, _Hammond, Wisco nsin 54015 party of the second part, (hereinafter referred to as party whether singular or plural), WITNESSETH, that the said party of the first part, for and in consideration of the sum of Forty Five Thousand (S_45,000_00 DOLLARS, ), to it paid by the said party of the second part, the receipt whereof is hereby acknowledged, does grant, bargain, sell, and convey unto the said party of the second part, his/her/their heirs, successors and assigns forever, the following described real estate, situated in the County of _ St. Croix Recurdin�Intilrmati°o and State of Wisconsin , to-wit: Lo of Certified Survey Map recorded in Vol. 2 of Certified Survey Maps, page 577 as Dtcument No 347856, being located in the NEQNEa and the NW;NE; of Sec. 12-7`29N-R18W. The above described premises contain 10 acres, more or less. This Limited Warranty Deed is in fulfillment of a Land Contract dated june 27, 1984 and recorded in St. c::'oix County on June 27, 1984, Vol. 691, page 274-275, Document #394402. T� •7t., !, 1 !, • . I j subject to all existing easements dnd right, of wily, dfso suhleet n, all raxc, r.n ,;nd preen,es litr the year Iv ,8.9 _ . and lolha%ing year,. also subject to all unpaid parts and installments of ,jxu.tl .,s,c,,n,rnts -,it aid prcnn,e, µhlih tiat,c lillen duc. or «ill fill due hereafter FXCLUDING therefrom and excepting and re,cr,inL n, ,,bid pion I the tlr ! part .a;l nnnrral .:rJ n,•.,!n n.a.!hh. uncrc,ts, c,uues anJ titles heretofore reserved or excepted of record by the Fcdcral Land H.,nk ,:t Small p:ml poor to Jiiman ". Ivx(l, tt .,ny. Arth tach easements for ingress, egress and use of surface as rosy he-!n,ulenml or neces,iry Ire lose „t ,uLh n�ht, the t"r;�olne cxclu,nm. csctpuon and reserx:nnn, shall include, but not he linuted tops Al oil. gas. h}dr,Karhons, cn;rl and ;,rher mineral, of µhet,oe,cr rimurc Isine In ur under the :those described land, -and all royal(} interest, a, at,nl and t,thcr inmer,rl, pr,,, lus,.d anal ,.ncd !hr r,(n,nt It n c,prr„I•, undenp,,,,l Ih.,t ,i,c said party of the tint part µr11 make no w;irr.rnty ,r to the extent :,I It, - 'Arwr,hip of n,m,r,,h• �,r its 1., .1, tine thcret„ TOGETHER µ0 all and singular plot hen:d!ranient, on,l appurtwa,,nie ;L.rcur!„ ' •m: wd .iii .,.!,I!:' right, title, Interest. claim or demand shats,naer. of the said parts :,t Il,e I,r,t pert, either ;n I&A .rr "41n, clip r ni ,a.„c,,: aI ,: csi•s..t.:, (if, to and to the above hargamed pr,nr.,e,, and lhrir hcrcthtan,cnt, and ,ippurrcn,,n,es TO HAVE AND 1`0 1 HULL? the ,,ml prenu,_, e, sane,,. ,L•,.,;rtes), A tN, 'hr 11,1, .;n:r 1 I. oil yq,,•1.1:,,;.;• unto the •It,l 1,111 :•I bile second part, and to his.hertheir heirs ,k1ck.C,,,r, .Ind r.•;en, I rIRFr.I R i AND THE SAID party of the tir,t part. 1r,r usclt .mil ;I, .0„r: ,r,. .L r, . ,_,:,chant. tan! her>,rn .0,l .t,_,:c a, .in:1 .,nh Not ,wl p.,rts ,,I the second pdr. his hcr'Ihetr heir, .ucie„on arvi ,assign,, ig.onsi .ill .Ind c,,:r1 penrm „r penrrn, I,,wils ,imming the µhole• .,r .m, p.irt thereof, by, thrnn,gh r,r under ,;wl ,,,n: of the !:r,t p.,rt. ,lonl rn.nc ::,her It Ail! li,rv-,er N \RR \N f ;nd 1111.1 LM) Wisconsin Department of Commerce Count j safety a •� PRIVATE SEWAGE SYSTEM St. Croix Building Division • . .¢ sanitary Permit No: . � . INSPECTION REPORT 399430 G'9NLVRAL I`VORMATION (ATTACH TO PERMIT) 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: City Village X Township Parcel Tax No: Nelson, Glen I Warren Township 042 - 1031 -30 -000 CST BM Elev: Insp. BM Elev: BM Description r TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark r Dosing / 5 e Alt. BM -7, S 9 l � Bldg. Sewer &si -07 Holding , - S Ht Inlet 12_ ??, t et TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Septic 7 U i ±' 7 / 4 3 g r � Dt Bottom / G• Y L Dosing 1 I r Header /Man. Aeration - -- -- - __ Dist. Pipe g. ; Holding Bot. System P. qZ G►L PUMP /SIPHON INFORMATION 4 , final Grade Manufacturer Demand St Cover GPM Model Number TD H Lift Friction Loss System Hepd T H Ft v 16 S Forcemain I Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trendies PPIDINUENSIONS No. Of Pits Inside Dia. IlLiquid Depth DIMENSIONS �' U i I V / SETBACK SYSTEM TO P/L JBLDG WEL LAKE /STREAM LEACHING acturer. INFORMATION CHAMBE Type Of System: 1 v > IT Model Number: T J DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size FHole 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 IDepth Over xx Depth of T7eeded/Sodded x x Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [M:] No [] Yes [N� No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / o Inspection #2: L 1 O / 5 Location: 1479 110th Avenue Hammond, WI 54015 (NW 1/4 NE 1/412 T29N R18 NA LPtifIr Parcel No: 12.29918.1770 1.) Alt BM Description = 6 &' i 1 2.) Bldg sewer length = S/91 - amount of cover = >S b J 3.) Contour = `d pS� v Plan revision Required? ❑Yes A, No _ Use other side for additional information. V d �J Date Sepctor's n re / �/� Cart. No. SBD -6710 (R.3197) � lt�"1 o7(a o f 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 1 i.4 n personal information you provide may be used for secondary purposes Madison. WI 53707 -730, DE�partmerit of Commerce (Submit completed form to county if r [Privacy Law, s. 15,A4YTj(mj` state owner Attach com fete plans (to the count) co only xthe S),stem. on' ii ( qr > l ss than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number C`h k if si o previous appf anon St a P 1. D. Number .319 I. Application Information - Please Print all Information "- = `; Location: Property Owner Na► i5 Property Location ff� �ljaw r L J T�. h 4, S , T N, R or Property Owner's Mailing Address Lot Number Block Number 7 0 City, State Zip Code a ubdivision N e or CSM Number J' 42 P g77 II *Pe of Building: (check one) 0 ❑ �!tY ge L S wt ;� �,� •7 W I or 2 Family Dwelling — No. of Bedrooms: ❑ Public /Commercial (describe use): own of ❑ State -owned K � III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road ! l �/ v� A) 1. ❑ New System 2. Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) 30 � Y o p a System Tank Only Existing S stem 0 4�— i O 3 �— B) Permit Number I Date Issue ❑ A Sanitary Permit was previously issued q IV. Type of POWT System: (Check all that apply) • Non - pressurized In- ground ®'Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized n- ground , ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At -grade C ` e•„ .+, -.J 9�•O) n ❑ Aerobic Treatment Unit O circulating ❑ Other: 5 K . 100 -0 ;Awl dg) ` - 1 W ZO•`f " • Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 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 f �OS q6 / & $ . S AU141 9 g,S VI Tank Capact y otal # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing C crete strutted Tanks Tanks Pw W-1 iff S ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement I, the un dersigned, assume res on ibility for installation of the POWTS s hown on the attached plans. Plumber's Name (print) _ Plum is Signature ( o sta ps): MP/MPRS No. Business Phone Number Plummbe Address ( treet, City, Sta Zip Code) j lt5 VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I 'ng Agent Signature (No stamps) 1�Approved ❑ Owner Given Initial Adverse Surchar ee) aD Determination db 225 OJ96W d S 200 IX. Conditions of Approval /Reasons for Disa pproyal: S�4sk�w. w+�s� �- a ,.vdGo.�� a'o �L` C"-L �a4r ao S tfL' Mt S (A.4—iW_ wr,a,0 0. PRA of cokla SBD -6398 (R. 07/00) ` rip f Pd n/ = PLOT PLAN Scale 1 "= 0' Page of 3 7 i �- -N Si T*_ sT• - Lg - tno` :•�: w� r oF:: r� ovr DSO' t — / e at V Dp VL10T' eOw1PAeT // �/ L O6Z \1l3TURt > ! Tim / N 1 N , // '* F. X . N 1" 1 it w Qo�o or- af-YLL - ,q 0�. e �� - PWGI� = -- V"V 'V* - PrLL ::'QX S'T)V G "?Cr SDO) -ED -r CODE- _.-C-10010 ON) _% 1i 164, I1y DIR -. PV(2 [pipe. -- - - -- ----- — - - - -- - - -- — ai2 NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be l int) lbso gallon capacity manufactured by W 1 Ls'EiV_ CW 0_ -e t,11 - 4. Bench marks sFE- Paaip, �. Divert surface water around system to prevent ponding at the uphill side. r { t Safety and Buildings {. 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www. com merce. state.wi . us/sb *isconsin www.wisconsin.gov r Department of Commerce \,���� ` _�I t Scott McCallum, Governor �~ t Brenda J. Blanchard, Secretary NL1 August 06, 2001 CUST ID No.691727 ST Ci301X 77. = ATTN: POWTS Inspector COUNTY ARTHUR L WEGERER * "�; -� °•,, ZONW4GOFFtCE ZONING OFFICE WEGERER SOIL TESTING & D CST S VIC -' ST CROIX COUNTY SPIA PO BOX 74 `- ' ( 1 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/06/2003 Identification Numbers Transaction ID No. 664519 SITE: Site ID No. 633844 GLEN NELSON Please refer to both identification numbers, 1 10TH AV L above, in all correspondence with the agency, TOWN OF WARREN ST CROIX COUNTY NW1 /4, NE1 /4, S12, T29N, R18W LOT: 1, SUBDIVISION: CSM 347856 VOL 2 PG 577 FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 805177 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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 Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • 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 the Mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • 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). In addition, 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. • 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 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. ARTHUR L WEGERER Page 2 8/6/01 • 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. Stars. 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 Sec. 145.20(2)(d), Wis. Stats. 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 ` construct ion/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. A Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 J BALANCE DUE $ 0.00 Charles L Bratz PO WTS Plan reviewer II- Integrated Services (608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM WiSMART code: 7633 cbratz @commerce.state.wi.us cc: GLEN NELSON TITLE SHEET Page 1 of MOUND SYSTEM A 3 BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD -1057 P and the Pressure Distribution Manual SBD - 10573 =P C 6 /q _, C P` 6 lqq LOCATED IN THE NLy 1 / 4 OF THE N E: 1/4 OF SECTION 1 Z , T Z 9 N, R ) S W, TOWN OF W p�Zly ST'_ CCcp LX COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE COnifidonally PREPARED FOR APPROVED - - - - -- W*MUEKT0FC0UMERcE ON OF &VW AND 1UNNCs W 1_ Sal: d IS WE CORRESPONDENC PREPARED BY WEGEl:;tEFZ SO I L . TEST I NCG AND . DES I c3r4 SEf?V S CE P.O. Box 74 421 N.Main St. � River Falls, WI 54022 Phone 715-425-0165 .• »•»• -. �► ,. .,, ,�, Fax 715 - 425 -6864 J :'' � AfiTl?UR .� 0.915 P ' fALJW(M?7H, i RECEIVED 1� .....•.� ?� Al 2 6 2001 'I 11 1 SAFEN & BLOGS DIV. JOB NO. Mound System Management Plan Page 2 of Pursuant to Comm 83.54, Wis. Adm. Cade Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. Theoperating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th utiet r s tiah be cleaners as nerasca p r o ensure ro er on. The filter cartridge should not be removed unless provisions are made to retain.solids in the tank that may sough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The - septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank If the contents of the tank are not removed at the time pf a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shalt be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution S tem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial testwhen the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Ge neral This system shalt be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBO- 10572 -P (R. 6199)] arid local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and Pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contlnoencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning-Office at 316_ 1680 The system installer at The tank manufacturer at 800 , 3Z NS 6 W t Ers e The effluent filter manufacturer at $-00 Zz.� S7�[2. zpt13�T�. The pump manufacturer at -- 6 30, -8 — L � sou L-b-S I _ Page L Or 7 Approved Synthetic Covering ASTM C33 Distribution Pipe Medium. Sand Topsoil '" o- - _ "'� _ �o F - 1 3 E „ D 1 l � b .S % Slope Distribution Cell of Force Main Flowed 2" to 2- " Aggregate From Pump Layer g �•� Ft. E 1. aA Ft. CROSS SECTION OF A MOUND SYSTEM F o.S Ft. G 0.5 Ft. A. u; 5 Ft. F 1.0 Ft. Linear Loading Rate= 1 4- 5 GPD /Iu FT B 100 Ft. Design Loading Rate= O_Z,�GPD /SQ FT tZ I Ft. J 8 Ft. K 11 Ft. Position L N2Z Ft. o Force Main 'W Z4.S Ft. L {{ I �} I. - Observation Pipe 8 ' K o----------------- - - - - -- --------- - - - - -- - - - - - -- Box A W `�_ -T - - - -_- ------ - - - - -- Distribution �--- Cell of . x to 2 z Pipe aggregate Observation Pipe (Anchbr securely) PLAN VIEW OF A MOUND SYSTEM Distribution Pipe Layout page S of Place the holes at the bottom of the distribution i p es at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of Iong turn or 45 fitting to a point within six inches of the fnaI grade. Terminate the ends of the laterals with a valve,:th=aded cap or • threaded plug. Provide access from final grade for the valve; threaded cap or threaded plus. T`tP1C1� L �,ZDSS _SailU1�7 - P NJ C PV C. Lateral Maniiald Lateral x x x x XQ x2 x x x x Lateral Length — lateral Length — Distribution Line I TffCC—sMS S4X S 1=02� r+t!w i P Ft. Hole Diameter I / �' inch, S Ft. Lateral Inches) X inches Manifold Z- Inches Force Main " Z Incdes I of hot es /pi pe — ZS Invert Elevation of- Laterals Tl -Z Ft. Combination Septr3.c:lank and PLIA CHAMBER CROSS SECTIOM AND SPECIFICATIOUS ' PAGE OF •VEUT CAP WEATHER PROOF JUIJCTIOIJ BOX . ti C.I. MIT PIPE s APPROVED LOCKIWG LO' FROM DOOR, acutr MAIJHOLE COVER A- tIv .kDow OR FRESH wAR tJISJG L l�gEL , �sP�1o>3 P tprr � co KJJFntZ:n61, TarrP A LP INTAKE , • R , N • FI iv tg1}p � w . -�• � D 0 � � i Y. xlu. G Zp � C IMLET PROVIDE I — •� AIRT1414T SEAL Approved 'ZRB�t Ft� i ( Approved joint w/ I aL�Ttx PDC PVC pipe a -� II p • P c 1 ou CLEY. ��' D D FT PUKP -1� OFF • r D C01JCRETE tTL. 'S`R. oo BLocx RISCR EXIT PERM11T'ED OIJLy IF TAIJ MAUUFACTURiFR HAS SUCH APPROVAL -1 3NAPPRovt t Uoo mr, SEPTIC E SPECIFICATIOA.IS DOSE TA si KJ MALIUFACTURER: `' WUMBEA OF DOSES: S ' T PER DAB TAMK 51Z : 11Z) 16 SO GALLOU DOSE VOLUME z ALARM MAUUFACTURCR: S• S4511 ✓I INCLUDILIG 6ACKFLDW: lZ� Z GALLOht: ^C)DI =L WUMBER: 1 0 L Nw CAPACITIES: A 1$ i1JCHE5 OR 3 3WITGH T O 6 V GALL01J S �PC: � M—���� � c / IfJCHES'Oit `� T G�ILLOUS i PUMP /"lA1JUFACTURCR: �UI�S C: b INCHES OR �' � Z GALLOLIS MODEL f\lUF1pER: 3 aZ�' LAOS INCHES OR 2"O� GALLOLIS 5W17CH TYPE: _ m L)P-C WOTE: PUl1P At�10 ALARi�'1 ARE T2 MIMIMUM DISCKARGE - RATE 1 ` - 0 GPM INSTALLED bM SEPARATE CIRCUITS VERTICAL DIFFEILEUCE DETWEEIJ PUMP OFF AUO_DISTRIBUTIow PIPE.. - FEET t M METWORK SUPPLY PRESSURE . b SO FEET �S •o x 1. �� + l� S FEET OF FORCE MAIM X 3 ' Y6 F FZ FRICTIOU FALrOR_. 3 • FEET TOTAL OtNAMIC HEAD = _7_6 0 FEET' As per Manufacturer L-..O gal /in. Liquid depth Goulds Submersible Effluent Pump �s 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submefged in high ■ Motor Housing: Cast iron Specifically designed for the, " stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- components. tic cover with integral handle • Homes Available for automatic and g • Farms Motor: and float switch attachment Single P, • EPO4 Sin e: 0.4 H manual operation. Automatic points. Heavy duty sump 115 or 230 V, 60 e: 0.4 H0 models include Mechanical • Water transfer Float Switch assembled and ■ Power Cable: Severe duty RPM, built in overload with • Dewatering automatic reset. preset at the factory. rated oil and water resistant. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, heavy du ball beadn 9 115 V, 60 Hz, 1550 RPM, FEATURES v Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING 3 /4" maximum. • Power cord: 10 foot with pump out vanes for Capacities: up to 55 GPM. standard length 16/3 SJTO mechanical seal p rotection. p Q , • Canadian Standards Association btal heads: up to 24 feet. with three prong grounding p i ■ EP05 Impeller: Thermo - Oischarge size: 1 NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. I BUNA -N elastomers. standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 OF 40 C continuous p 9 140 °F (60 °C) superior strength and intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running =tom dry without damage to s 30 - Y5 GPM components. Pump: EP05 $ • Solids handling ili 25 9 ca P b y: o 3 /4 " maximum. a ` I • Capacities: up to 60 GPM. _ • Total heads: up to 31 feet. 6 20 • Discharge size: 11i' NPT. z 5 i • Mechanical seal: carbon- c 15 rotary/ceramic - stationary, _j a 4 BUNA -N elastomers. a • Temperature: R a 10 104 °F (40 °C) continuous EPOa 140 °F (60 °C) intermittent. 2 1 5 r. 0- 0 pp f 0 10 20 30 40 50 GPM L J_ i 0 2 4 6 8 10 12 m3 /h CAPACrrY DoT / /b 44e s S�' q5 ,0 � S YS j. 61itU• wiX 11P 4 ox 1ao ' 7 Cl,FS r P pvc o f 3/y �' 38 f 5� t 44r u T O '�.�- � � �,,� �, � ► yf �3o try O i 3 l3, a s Q 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM O� wn�er/Buyer ��- ��-- Mailing Address j X7 1 t Property Address (Verification required from Planning Department for new construction) ty -��, c 4 :2 i 31 - 3©- a 00 Ci ty /Stat e /State /r2 G'/1/ P arcel Identification Number LEGAL DESCRIPTION property Location M c /., '/4, Sec. Z, T,2 N -R_L8_W, Town of 0�2. Subdivision ' f "Op I . Lot # Certified Survey Map # 3 q 7 6 , Volume , Page # 6' 7 7 Warranty Deed # Volume — 5 - 0 Page # Spec house ❑ yes �o Lot lines identifiable dyes ❑ no SYSTEM MAINTENANCE 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, journeymanplumber, 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 three year xpiration date. fi SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this force are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of :Ax;:7 of a warranty deed recorded in Register of Deeds Office. ( L / /� 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 i v S50WE 322 i nw iai F%s`i "IT 451205 LIMITED WARRANTY DEED THIS INDENTURE, made this 31 day of August l9 89 , between Faern Credit Bank of St. Paul REGISTER OFFICE a federally chartered corporation, with a post office address of ST. CROIX CO., WI P.O. Box 199, River Falls, Wisconsin 54022 Recd for Record SEP 0 51989 party of the first part, and Glen D. Nelson, a single of 8:00 A Dam All . - " R"bWofDee6 whose post office address is Route 111, BOX 139, Hammond, Wisconsin 54015 party of the second part, (hereinafter referred to as party whether singular or plural), WITNESSETH, that the said parry of the first part, for and in consideration of the sum of Fort Five Thousand DOLLARS, (S 45.000_0() ), to it paid by the said party of the second part, the receipt whereof is hereby acknowledged, does grant, bargain, sell, and cow ey unto the said party of the second part, his /her /their heirs, successors and assigns forever, the following described real estate, situated in the County of _ St. Croix Recordi Information and State of Wisconsin to-wit: Lo of Certified Survey Map recorded in Vol. 2 of Certified Survey Maps, pa Z as Dactunent No. 347856, being located in the NE;NE; and the NW;NE; of Sec. 12- T29N -R18W. The above described premises contain 10 acres, more or less. This Limited Warranty Deed is in fulfillment of a Land Contract dated june 27, 1984 and recorded in St. c�oix County on June 27, 1984, Vol. 691, page 274 -275, Document #394402. subject to all existing easements and rights of way, also suhlect to ell taxes un said premises for the year 19 8 . and following year also subject to all unpaid parts and installments of ,Ixual a ,scs,nx ^,ts on aid r ramie µhich ha%e tellen due. or will fill due hereafter FXCLhDiNG therefrom and excepting and reserving , o ,aid party - 1 the tint part ail mineral and r,r, dtr nzhis_ interest,. a %lates and odes heretofore reserved ,r excepted of reaud by The Fcderal Land Bank of Saint Riul Prior to I.inuars 22. 1`1,46, it any. 'Rath such easement+ for ingress, egress and use of surface as may he incidental or necessary to use nl ouch ruzhts The tort—otn-- CrCluvnn cxcepnon and reservation shall inc'ude, but not he linuted to. all oil. gas. hpdrrxarh ns, Coal and other minerals it ,khat,o e: cr nature Mine in or under the aho»e- described lands and Al royalty interests is to nil, ,!as and o,thcr rnmerals PF-IUw :d ,nd ,.r :ed ihcr.irtu It i, c Prr „ly under,tooiol that he said party of the first part ,kill stake no Aarrinty a to the extent of it, ,f , r is t.. ,t, rile thcrrb TOGETHER Aith all and singular the herrditanients and ipj,irt, i ia tic ,L.r;u i ai• _ i i in t .o i right, title, interest. Jaim or demand xhats( w]%eT. of the 1a1d parts tit the hf Part, either :n l.iA 'r cgwln _ ,'1?iler 7'1 of, in and to the above hargamcd pr,iw es, and their hereditament, and .q- }urtcnan,r TO HAVE AND TO HOLD the ,aid proms,--, is ano._ drur,rx',1. .,nh the iicr ,u.ono, ter aml the ..ud put} second part, and to his heirs, success irs and .r TURF% i R AND THE SAID party of the first part. tot itself and its wuc, d—', _ .cnant. ,narit har +,iii: al "I •rvrC n . k;ih thi a j.irri t the second part, his herRheir heir <. .Uiles,nrs art assigns, ai:.unst all .ind es, ry per,nn i�r per !a ,ktully .lainnng qw so wle r any par' thereof, by, through or under ,:,col p r of the ?•,r.t part, surd rnme other n Ail! torcver W \RR \', f iiid i I'lEND . '50 323 171/0 ral f�i� IN WITNESS WHEREOF, the said party of the first part, has caused these presents to be executed in its corporate name the day and year first above written. WITNESSESS. FA'_ %1M REDIT BANK OF ST. PAUL By: 11z I L6 4 4Z Reg. Vice Presiden Mimi of the Federal Land Bank Association of Northwest W isconsin Acting as Attorney -in -fact for Farm Credit Bank of St. Paul. OR: PRODUCTION CREDIT ASSOCIATION OF By: mama; iT.Wr WISCONSI � STATE OF — I ss. COUNTY OF ST. CROIX The foregoing instrument was acknowledged before me on AUgUSt 31 1989 b Jerry Lehnertz Regional Vice President of the Federal !And Bank Association ; dame r i Tile; Alf Northwest Wisconsin as Attorney -in - fact on behalf of F Cjtd' i d'SI. �F*. I J � Cr ; N1y commission expires 2/11/90 NOTARY PUBLIC, Mary LOU Lev -•. It rt . u _ Pierce Wisconsin Count" State STATE OF COUNTY OF The foregoing instrument was acknowledged before me on its4 B _ of the Production Credit Association of on behalf of said corporation. `1y commi „ion expires NOTARY PUBLIC Counts State Flux drtlted ht FCS – NW Wisconsin P.O. Box 199 River Falls, WI 54022 6� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accor, iicx ,wit oriurl 5 yVis. Adm. Code County n STc ar K Attach complete site plan on paper not less than $ %1%2 x 11 inches in size. Plan must Include, but not limited to: vertical and horizonW' paint (BM), direction and Parcel I.D. percent slope, scale or dimensions, north:arrow, and lot�itbn �r)d,distance to nearest road. ,3 Q • Cab C7 o .2.• /O /• Please print( all.40o►M�ltion. viewed by Date Personal Information you provide may be used for secondary pu oses (Pftfllt Law, s. 15.04 (1) (m)). Property Owner ,�; , - ��^°'� �•- Or CCK)WY Property Location 10,els'Q..) \\- r-NINGOFFiGE Govt. Lot /V 1/4 / S 11 ' T �"� N R /6 E or W Property Owner's Mailing Address n --� ; Lot # Block # Subd. Name or CSM# 1Y7 1Y 7f 11 0 H-"L 11 1111-4 1 CSA y7856 1/0 /. z P 1 s 7'2 City State Zip Code Phone Number 0 City ❑ Village R] Town Nearest Road w/ ( 7/5 ) iyCo • 3h to A ❑ New Construction Use: M Residential / Number of bedrooms Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material /D4•SS VV& � EN.$� / / �� Flood Plain elevation if applicable ft. General comments and recommendations: 1-0416^ N! *4p 1 S yS/EM lv Q J�PlpieO[?� F/-1 Boring # [] Boring • 2 d /G �f}SONAI .S4Tu/Qi4'T/On) ja 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 O• y to ofs .►+�fR cs �f .S 2- S' /3 is yR 311 SQ Z -FSh4 li" cs 3. 16P LD S/L #Sj � C — • z . 3 22 ' O 116 Y /P /M 3 MO CL / F Boring # rn❑ Boring f 5 -0 0 ' /� �,4so o.4 L S�4T �RATio,.� 91 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 I •Effff2 0-7 f° YR 2/ if s bjl� /Wic/e Cs z f -S , g 2.- 7• I L /o t R — S! z S b& , L- - I& iot�2 - Sr S G x A0�,' C . Z L /d G2,4 1�J0 -s ,S �- l7 -* 7 / r -7. O Z 5 31 10Y)e 4P/ m p - r s CC /fS n"XA N N s yR s/G 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 Please Print) Signature CST Number Ro1ER T' 74 L-B R i C I►7 z, ic 3 -) S Address Date Evaluation Conducted Telephone Number / —Goo -7 /S• 3810• 8/8 -5 Ulbrtcht &Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 ORIGINAL , Property Owner 6 ^ w /Vt/ 1031. 30 Parcel ID # � • � [] Boring Page of U1 Boring # � 5 Ss} ryRi4T /o,J Pit Ground surface elev. (P 0 A4So d,4 L 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 /D • lo �tL .2 S �E' c � 5 17a . S 3 ------, s�(. /f S be ,.M, j ' 7 !G i M Mar s YX y/4- Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A GPD /fton Rate z In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ 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 /fl' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 m _ 9/L 'Effluent #2 = BOD < 30 mg /L and TSS < 30 mg1L 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.6/00) i I - I � t i r i I l nPR 3 4 6 Ilc: •. •IA CERTIFIED SURVEY MAP � ,� - URVEY HIELKEMA �v Part of the Northwest 1/4 of the Northeast 1/4 and part of the Northeast 1/4 of the Northeast 1/4 of Section 12, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin NE C-OR. SEC-- 12, T29N, R18w N'Wo 00 w 6 60.0 0 0 / O •90e .0 ; , N90 945.62' 0 0 4 O 0 00 2 STORY FRAME 010 0 WO IDWELL.IN6 1—* \4 L o-r 1 %O o BAR 0 A RE5 wz°° 10 sH>~D s � 0 0 0 0 0 0 do Wd1z 0 9 O � e0 0 0 OG O 0 N 0 0 0 _ 0 1 40 z -J N 90'00'00 "E 600.00` SCA L.F- 1 "- 200' o Indicates 1" x 24" iron pipe weighing 1.13 lbs. /ft. set. Description: Th?t certain parcel of land located in the Northeast 1/4 of the Northeast 1/4 add the Northwest 1/4 of the Northeast 1/4 of Section 12, T 29 N, R 18 W, Town of Warren, St. Croix County, Wisconsin more fully described as follows; Commencing at the Northeast corner of said Section 12, thence go N 9d' 00' 00"W 945.62 feet to the POINT OF BEGINNING of the parcel to by herein described; thence go N 9CP 00' 00 "W 660.00 feet; thence go S 00 00 00 E 660.00 feet; thence go N 00 00' 00 "E 660.00 feet to the POINT OF BEGINNING of the above described parcel, containing 10.00 acres, more or less, being subject to easement over the Northerly 33 feet thereof for Town Road p�Jrposes. State of Wisconsin) (for purposes of this description all bearings referenced St. Croix County) to the X line of the NE 1/4 of Section 12, T 29 N, R 18 W assumed N 90 I. James L. Murphy, Register Land Surveyor, do hereby certify that by direction of the Owner, Harvey Hiel kema, I have surveyed and divided the lands shown hereon In accordance with official records, Chapter 216 of Wisconsin Statutes and the Ordinances of St. Croix, and the alcove map and description are a true and correct representation thereof. Dated; 31 -'°larch 1978 Vol. 2 Page. K77 \ a � St. Croix County Records James L. Murphy R jrn 1 Certified Surve s y Ma p gist Land Surv4y�;' N1, „y •�� St. Croix County, Wisconsin _ �``':' ` - S - 1 0 , 2 - RIVER FALLS, :' 4 APPROVED ' ij Wisc. APPROVAL OF THIS MINOR St1L'DfVISION iii /'/ AHO F� F ........... DOES NAT M:�,N APF,.0 V ,L FC APR L 2 1978 ��� ii L I ���;��� 3JlLI�laJ'� .. Ott SEPT'C REFER i0 Si. CXOIX C\'U. FY COMPAEHENSIVE PARKS PLANwING AND ZONING COMMITTEE Volume 2 Page 577 Y a 1 f e D 4 • rfis �� s_ �0�3 �., G � / I l r j a t ' cn Q y } P 0 O 0 ^ L • r V En 9L OO 0 �+ ul