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042-1052-60-200
Wisconsin Department of Commerce, PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 479241 0 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: Winston III, Willie I Warren, Town of 042 - 1052 -60 -200 CST BM Elev: r Insp. BM Elev, BM Description: r Section/Town /Range /Map No: Co. 0 (j0 , 0 = C - �>u I 19.29.18.2958 TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W Benchmark (� / Dosing - V s Alt. BM Aeration Bldg. Sewer /ZD gl Holding St/Ht Inlet 7 g2•5 St/Ht Outlet t TANK SETBACK INFORMATION �� `jZ• Zl TANK TO P/L WELL BLDG. Vent to Air Intake ROAD DR We t 5 Septic 30 0 + }5 t Zj l 20 / -f- 7 V 3 3 / Header /Man. Aeration Dist. Pipe ( 62 p �pf Holding Bot. System I p p 0o PUMP /SIPHON INFORMATION Final Grade r �► S �Sa �`f'10 Manufacturer De St Cover G PM Z �S f J 0 Model Numb TDH Lift ' tion Loss System Head TDH Ft Forc ain Length I Di . Dist. to W S IL AWRPTION SYSTE (, .4' 2 RENCH Width / Len No. Of Trenches PIT IMENSIONS No. Of Pits Inside Dia. Liquid Depth OMENSTONS 3 " 2- 1 SETBACK SYSTEM TO P/L WELL LAKE /STREAM LEACHING Manufactu r INFORMATION CHAMBER OR Type Of System: t UNIT Mod umbers �o +- 100 __ DISTRIBUTIONS STEM Header nif Ids � Distribution x Hole Size x Hole Spacing Vent to Air Intake Pip � /+ Length Di Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over j xx Depth of Teded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil '] Yes (] No Yes No i M TS clu code disc a encies, ersons resent, etc. Ins ection #1��� J Ins ection #2: i i AA OSAk P Pc. SZ S P ) P P O 904 87th Avenue Roberts, WI 54023 (SW 1/4 NW 1/4 19 T29N R1 8W) NA Lot 1 Parcel No: 19.29 .1 8.295B 1.) Alt BM Description = 4 N t �'�"K���� 2J Bldg sewer length I � / � - amount of cover = I gN �'� _ _ ( �� "`► _ 3•) J�S�V✓� w".�`�c� LQ�YW'YK�C, Ss i �' �iV ! SNS ""'^• . M�C�""""y Plan revision Required? ) Yes No2q, Use other side for additional information. —J L______ _.__ —-- - - - - -J — Date ,�..- Q� f Insepctor's Signature -" / S- 0 � ` Q� 3p �`� Safety and Buildings Division County W m 201 W. Washington Ave., P.O. Box 7162 Ma WI 53707 -7162 Sanitary Permit Number to be filled in by Co.) Donsirn �{� ) 266 -3 ,/ Department of Commerce .� �. `7 79Z Sanitary Permit Applie -*orgy Plan .D. Number, In accord with Comm 83.2 1, Wis. Adm. Code, personal informatio o p may be used for secondary purposes Privacy Law, s15,04(1)( ZF� N O Lec"t ress (if different than mailing address) I. Application Information - Please Print All Information S T. CROIX ZONI Property Owner's Name 4 Lot # Block # Property Owner's ailing Address Property Location 'l., .4L Section �9_ City, State Zip Code Phone Number (c ircle) II. Type of B R uilding check all that apply) N; o 5/1 or 2 Family Dwelling - Number of Bedrooms _ ok eus Subdivision Name CSM Num r ❑ Public /Commercial -Describe Use � _ G (� ❑ State Owned - Describe Use Z biod CgAC!S H.! 21 t-ZTj � �"�� �O ❑City Village Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. % New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. List Previous Permit Number and Date Issued ❑ Permit Renewal ❑Permit Revision ❑ Change'of [I Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS S stem: Check all that ap I Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leachin Cham 1 -less Pipe ❑ Other (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds ea Required (sf) Dispersal Area Proposed (sf) System Elevation . Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing � I � /l _ 160 �/ Tanks Tanks /O /�" Septic or Holding Tank / Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, atisujne responsibility for installation of the POWTS shown on the attached plans. Plumber's �e Plumbe ' Si MP/MPRS Number Business Phone Number umber's Address (Street, City State, Zip Cod A eT VIII Coun /De artment Use Onl pproved ❑ isapprov Sanitary Permit Fee (includes Groundwater Date Iss d Issuin gent Signatur (N s) Surcharge Fee) xxc El er Gi eas for Denial M �Q V J IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1. Septic lift, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2 AN fatback requirements must be maintained as per applicable code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 8112 z I I inches in size SBD -6398 (R. 01/03) o v& V)� -S�e /9 — tea? - X' uJ � g P 6, )5OX 1Y/ 131 I-, S,f,'3',e. mss- /FtA9 s-/ tJ,�s rot � O /iPo�oas�.o /S"S 30 � I 4ve \ yG 3 I A rC7.i�tIG/ �i fiC� ' �,eoT � "�� - rh �,b/�tS�K.�` �.�T!• � r ` car la/r lolo - REG. ED � 0 9 2005 Wisconsin Department of Co erce SUN S TION REPORT Page of Division of Safety and Building AUNTY th Cc 85, e ZONG�ING �' Attach complete site plan on n 8 1/2 x 11 inches in size. Plan County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. C percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 6 'qZ - r c/ Z D 'z(X Please print all information. Revi by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prope er Property Location / - r Govt. Loth k/ 1/4 114 S N R Er(or Prope Owner's Mailing Address Lot # I Block # Suhd . Name or CSM# r s City State Zip Code Phone Number City ❑ Village Town Nearest Road .� ( ) New Construction Use: Residential / Number of bedrooms _ Code derived design flow rate TS�� GPD ❑ Replacement / ❑ Public or commercial - Describe: Parent material 42 1 _sue Flood Plain elevation if applicable ft. General comments and recommendations: j q�7�ir - �. 8S ✓ Boring # Q Boring pit Ground surface elev. ft. Depth to limiting factor Zl� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efl#2 Z J4 41'T cL d� 4 q Boring # Q Boring f ® Pit Ground surface elev. �_ ft. Depth to limiting factor ? %/O in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Qont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 3 3 s 4 q a q * E nt #1 = BOD > 30 220 mg& and TSS >30 < 150 mgA_ * Effluent #2 = BOD < 30 mgA. and TSS < 30 mg/L CST Na ease 'rrt Signature CST Number Address Date Evaluation Conducted Telephone Number I i Properly Owner / ' c I L-1 / d 1 Parcel ID # Page � of F -31 Boring # ❑ Boring J pit Ground surface elev. ,Q-�Zp,S ft. Depth to limiting facto . e in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Z 42-9 �,' e -3 4 P a 4 F Boring # El 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 GPDfff 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ' Effluent #1 = BOD, > 30!E 220 mgfL and TSS >30 150 mgA- ` Effluent #2 = BOD c 30 mgA- and TSS < 30 mgfL 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, SB"MOLDWOD> ��✓n1F,� ®�s mil/✓ S`S� /� Wi�fik�✓ I /cam /00 I j sy� i Ale / -3 , MAY -27 -2005 06:35 AM WILLIE&EVA WINSTON 6516490858 P.03 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND / OWNERSHIP CERTIFICATION FORM Owner /Buyer ✓a, SGA 0 -- Mailing Address l- Property Address (Verification req from Planning Department for now construction) City/Stat / y tate Aiy�n /vim ^_ Parcel Identification Number LEGAL I)r,SCRiP_ IAN Property Location , ,5W yA, 'V 4 , %4, Sec, 9 , T .7 7N -R�_W, Town of Qoe1p Subdivision avd� , // �S , Lot # Certified Survey Map # , Volume A� , Page # . Warranty Deed # , Volume , Page # Spec house ❑ yes afio Lot lines identifiable Oyes 0 no I'ENAN•CE Improper use and rnainterlanca oryour septic system could result in its premature failure to handle wastes, Proper maintenance consists of purnptng out t1 septic talik every three years or sooner, if needed by it licensed pumper. What you put into the System can affect the function of the septic tank as a trcarmcnt stage in the waste disposal system, The ro c p p rty owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plutttbcr, juumeyrrtan plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) alter 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification s that your s'rptic e xpirat ion date. i has been day maintained 'lust be completed and returned to the St. Croix County Zoning Office within 30 days o uce yea expirat A��01-7 APPLIC A,NI DA W E 12 CERTIFICI All I (we) certify that alI statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro CrtY dcsct ib d above, by virtue of a warranty deed recorded in Register of Deeds Office, SIGNATURE OF APPLICANT 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 dead Page C_;;1 of 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 that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. S` stem 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 be discharged to the dispersal cell(s) in one large dose, overloading the cell(#) and may result in-the backup or surf&" discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior -to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually - operating the pump' controls to restore normal levels within the pump tank, Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, 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 life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental . floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herblcides; meaty scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the systern is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings a led. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage , Servioing Operator. • After pumping, all tanks and 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 fails and cannot be repaired the following measures have been, or must be taken,.,.to provide a code compliant replacement system: ,. t I A suitable replacement area has been evaluated and may be utilized for the locatlon 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, 13 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a 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 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. 0 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 of that time. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT, (RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER,,/; POWTS MAINTAINER . i Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATO Y AUTHORITY Name Name Phone Phone (his document was drafted in compliance with chapter Comm 93,22(2)Ib)(1)(d) &(f) and 93.64(1), (2) & (3), Wisconsin Administrative Code, POWTS OWNER'S MANUAL & MANAGEMENT PLAN_ , . Page _Z_of ;� FILE INFORMPTIJON SYSTEM SPECIFICATIONS 1 Tank Capacity ❑ Ni'�1 .Owner Septic a R Y al � Permit # Septic Tank Manufacturer . , z ❑ N� DESIGN PARAMETERS Effluent Filter Manufacturer ❑ Nf l i Number of Bedrooms O NA Effluent Filter Model _ D NA Number of Public Facility Units f�1 Pump Tank Capacity gal Estimated flow (average) al/da Pump Tank Manufacturer NA r Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer 1NA Soil Application Rate al /da /ff Pump Model ,ANA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit Ni-, Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ Ni, Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 m{f!L 00 NA O At -Grade ©Mound Fecal Coliform (geometric mean) S10' cfu /t00rnl ❑ Drip -Lino Q Other; Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other ❑ NA Other. ❑ NA Other: ❑ NA *values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: A earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume 13 NA At least once every: 11 months) (Maximum 3 years) O NA { Inspect dispersal cell(s) _0 year(s) I At least once every: ❑ month(s) , p N;, i Clean effluent filter years) �F, G Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ ear(s) O month(s) r , EY--Ni Flush laterals and pressure test At least once every: ❑ year(a) Other: At least once every: O month(s) DNA ❑ year(s) Other; ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. TanK inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires thv immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. ' All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintainer, A service report shall be provided to the local regulatory authority within 10 days of completion of any_ aervice event. OMW (4 /01. Parcel #: 042- 1052 -60 -200 06/09/2005 11:25 AM PAGE 1 OF 1 Alt. Parcel #: 19.29.18.295B 042 - TOWN OF WARREN Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * NIELSEN ENTERPRISES INC NIELSEN ENTERPRISES INC 1737 LAUREL AVE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 904 87TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 3.160 Plat: 1561 -CSM 16/4376 042/02 SEC 19 T29N R18W PT SW NW LOT 1 CSM Block/Condo Bldg: LOT 01 16/4376 EZ -RD- 1991/589 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 19- 29N -18W SW NW Notes: Parcel History: # Vol /Page Type ' r 93700 2007/486 WD '� 91255 16/4376 CSM 88137 1958/256 QC 66347 1 799/598 QC 2005 SUMMARY Bill M �` j - C � J Assessed with: Valuations Last Changed: 07/11/2003 Description Class 1111prove Total State Reason RESIDENTIAL G1 3.160 41,000 0 41,000 NO Totals for 2005: General Property 3.160 41,000 0 41,000 Woodland 0.000 0 0 Totals for 2004: General Property 3.160 41,000 0 41,000 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 MAY -27 -2005 06:38 AM WILLIE&EVA WINSTON 6516490858 P.07 `4 P VOI.A3E 4376 A ST. CAO OOUNTY ! KIITNLM H: YALSH m4nrinc.7Aldn find Pfiru Lmaitt It OF DEEDS SEP 17 z002 ST. - 001 % CO., wi `,/ N RECEIVED F01t RECORD If notrr�oolayRlrl d ���� V•�Y i M/`� 09 -20 -2002 Si�0O A oPPr�&I d� n RD IN PART OF THE SW7 /4 OF THE NW1 /4 CBRT1713D SURVEY IIAP OR GECTION 18. T29N, MOW, TOWN Or WARREM ' REC SERI 16.00 se ST. CROIX COUNM WISCONSIN. SPY F>aS: �' SU RVEYOR OWNER s m N LAND 9URYEYiNO IJVV CORNBR WppoHILL W = DOUOIAe J. IANLFA OQ SI =om 1 9 EiAU FIPAT NATIONAL BANK BWI.DING . aazo EN LOE STREET � t brTA M EET HUDSON, WI Sol$ x 3 3 per, MN bS1 PQP ® g JFI�E NvVTMi14 271.80' 1l;. 8' N �• co R g T !P i 04 m ® 12 o LOT 7 C a ADO p � ^^ i�'7 1 ,E09 SO FT 11 0 1 L ---------- p 6 I� 6 92nd AVENUE '►� e� . . .+ 766.4'7" 3.6 ? N88'29B "rr 30.94 N ---- ---- - - �- O . lo LOT 4 1 7.ao it ch O iii EACH PATiC>:1. SHOWN ON THIS r' MAP to WTH WRF31N AND ADJACENT'rO SPROIAL DEEP OASrrJG PIPE DEPTH ESTi 6 SKED HYYTHU 250.041 290:04' VASOONSIN DEPARTMENT OF NATUFIAL R"OUROES CDNM. 6II39 •2:5'43'W 51 O.OW GROUNDWATER IN THIS AREA 87 p HAS BEEN AFFECT» BY Ni- M19PL lJl. 4° II LEGEND VOLATiLB ORGANfO Q� ALMHUM OOtp�RY SECTION CORNER l`A MPOUNDS. OWNERS AND A MONUMiNTFOUND OCCUPANTS OF "01 PAROE. 1 6py OMDE DIAMETER IRON PIPE FOUND SHOULD OONTACT THE ONR FOR 1' OUTSIDE DLMAETM X 1W IRON PIPE SET jNSTSUOMONS R901ARDING VVeLL Vyy 0 RN9R 0. 1tiiFJGHgo 1.18 LBS. PER UN�I FOOT INSTAL AXNArrO SECTION 19 107 ROADWAYSET6k''KUNE MAIN'I'ENCE� AND WATER 5AMPLiNC3. +• 2 30 OUTSIDE D METER IRON PIPE FOUND SCALE IN FEET 1 is 150' x CENTER Or W RAd7EU8 0UL DE4P4 0000000000og PIOLMLYpSCORDEDMI KIENTS t 50 0 150 REV 300 ¢ PROPOSW MALE LOCATION U 2 8 1 0 P 1 2 6 - 7 9 61(2 3 6 STATE BAR OF WISCONSIN FORM 1 — 1998 KATHLEEN D EEDS WARRANTY DEED ST. CROI O X CO., WI RECEIVED FOR RECORD Document Number 05/2712005 09:45AlI This Deed, made between Nielsen Enterprises Inc., a Wisconsin Corporation Grantor, and Willie Winston 111 and Eva T. Scates- WARRANTY DEED Winston, husband and wife , Grantee. EXEMPT i Grantor, for a valuable consideration conveys to Grantee the following REC FEE: 11.00 described real estate in St. Croix County State of TRANS FEE: 293.70 Wisconsin (the "Property "): COPY FEE: CC FEE: PAGES: 1 Recordin2 Area Name and Return Address 94f r-cA - Jk T/ !lwv M N SS1S Parcel Identification Number (PIN) avD. ion c o aCC- This is not homestead property. (is) (is not) Lot 1, Certified Survey Map filed September 20, 2002 in Vol. 16, Page 4376, as Document No. 691255. Located in part of the SW % of the NW 1 14 of Section 19, T 29N, Range 18 West, Town of Warren, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except I Dated this. hh day of May 2005 (SEAL) (SEAL) Thomas K. Nielsen Nielsen Enterprises, Inc., a Wisconsin Corporation (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, NGTAR 121 I1 gJ IC } ss. authenticagcTtAi� E O Fd Idf C O N S I N St. Croix County N Personally came before me this t li day of May 2005 the above named Thomas K. Nielsen as President of Nielsen Enterprises. Inc. a Wisco 2 in Co oration to me known to be TITLE: MEMBER STATE BAR OF WISCONSIN the person who executed the foregoing instrument (If not, a d k wledge the sam authorized by §706.06, Wis. Slats) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet Pam Spencer Notary Public, State bf Wisconsin 1301 Coulee Road Hudson, WI 54016 My commission is pe an it (If not, state expiration date: ) � 5 -32999 $� $ ) (Signatures may be authenticated or acknowledged. Both are not necessary.) ' Names of persons siqninq in anv cavacitv must be tyDed or orinted below their si nature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. �riY -Lf -ZOOS 06;34 AM WILLIE &EVA WINSTON 6516490858 P.01 FAX COVER PAGE Date: 05/27/05 To: Belisle Excavating, Inc Fax: (715) 247 -3038 From: Willie and Eva Winston Phone: (651) 587 -6423 (cell) Re: Excavation Project Message: Hi Annie, Let me know if this information does not come through very well. Tell Tom I'm still waiting to hear from him! There are several questions about the estimate that I need to clarify. I should be available after 9:30. x-9 - 6 yaS v APPROVED 9 1 2 5 5 6T, CROIX COUNTY VOL 16 PAGE 4376 Plannlne Zo&n and Parks Committee KATHLEEN H. WALSH SEP ] 7 2OQz REGISTER OF DEEDS ST. CROIX CO., WI If not record RECEIVED FOR RECORD opproval dai l al b F, E D S U RV Ill" MAP 09 -20 -2002 11 :00 A nU Ud4A g rED IN PART OF THE SW7 /4 OF THE NW1 /4 CERTIFIED SURVEY MAP OF SECTION 19, T29N, RI 8W, TOWN OF WARREN, REC FEE: 15.00 ST. CROIX COUNTY, WISCONSIN. COPY FEE: 4.00 SURVEYOR PAGE S & N LAND SURVEYING NW CORNER OWNER DOUGLAS J. ZAHLER SECTION 19 WOODHILL LAND, LLC 2920 ENLOE STREET E1404 FIRST NATIONAL BANK BUILDING HUDSON, WI 54016 i C^ EE 332 MINNESOTA STRT W -► z o ST. PAUL, MN 55101 ' 4 M w W M�1pL�Q�V CAD �Q�JD� NORTH LINE OF THE -------------------------------------- N89 °1 1'55 "E 487.38 SW OF THE NW1 /4 271.80' 215.58' ' w O z •Nf Q1,1� N 1 � 1 [r� Ili N OwM 1 1 Z Q C/) 1� 1-' v m Q 152 O LL m (n ° ;`l V O _ O OD OD 0 Z Z 904/ 1 0 LOT 2 N 1� W w 03 I Ul a p 2.39 ACRES 1� w O j 104,200 SO FT O Q to �, LOT 1 m Z z= W 3.16 ACRES t71 v = " 137,608 SO F 0 l� o m 'm C .A 1M ---------- - - - -J• — ,I QQ 2 V ° O 4 11 � , NJ b °r , __ °22 •p0 c� °31 E 1-- - � • - - ST S813 °29'06'w - °28'56 "E 1 - - 1 c 0 -X . - •g7 - - - F 66.00 nd AVENUE ; -W X15 5 _ 5 E 23g• -+ 156.47' 0 N88 "E 30.14 - -- - Cl) :(9 - Q 19 y ----- - - - - -- N 0 1 to j -Um g W 1 �► ;� o o� LOT 3 w LOT 4 88 3.29 ACRES ; p °C�?J IO 1 OQ pp w O 143,174 SO FT m 1 0 0 1 -► 8 2.05 ACRES T 0 m (A W z� O lD 0 Z n O ;G N zr 7 l� EACH PARCEL SHOWN ON THIS N � rrp '� MAP IS BOTH WiT`HIN AND p ADJACENT TO SPECIAL DEEP CASING PIPE DEPTH REQUIREMENT AREAS ESTABLISHED BY THE 250.04' 260.04' WISCONSIN DEPARTMENT OF NATURAL RESOURCES (CONRI. W - O $89 °25'43 " W 51 O.OS' GROUNDWATER IN THIS AREA HAS BEEN AFFECTED BY N W M(G°?[�1 T�[D (�Ia1D LEGEND VOLATILE ORGANIC 'th COMPOUNDS. OWNERS AND A W ALUMINUM COUNTY SECTION CORNER OCCUPANTS OF EACH PARCEL MONUMENT FOUND SHOULD CONTACT THE DNR FOR 1 5/16" OUTSIDE DIAMETER IRON PIPE FOUND INSTRUCTIONS REGARDING WELL W111/4 CORNER Q 1" OUTSIDE DIAMETER X 18' IRON PIPE SET INSTALLATION AND SECTION 19 WEIGHING 1.13 Les. PER LINEAR FOOT MAINTENANCE, AND WATER - - - - - - - - - - 1 00' ROADWAY SETBACK LINE SAMPLING. ® 2 3/8" OUTSIDE DIAMETER IRON PIPE FOUND SCALE IN FEET 1 " = 150' X CENTER OF 80' RADIUS CUL -DE -SAC (xxxxxxxXxxX) PREVIOUSLY RECORDED MEASUREMENTS 150 0 150 300 + PROPOSED DRIVE LOCATION -- "- ' - - " -'- SHEET 1 OF 3 12'IJTILITYEASEMENT Vol.16 Page 4376 a a N tANU 5URVEYING OWNER DOUGLAS J. ZAHLER WOODHILL LAND, LLC 2920 HUD EN , W STREET E1404 FIRST NATIONAL BANK BUILDING HUDSON, WI 54016 332 MINNESOTA STREET ST. PAUL, MN 55101 CURVE DATA TABLE CURVE RADIUS CENTRAL CHORD CHORD ARC TANGENT TANGENT NUMBER LENGTH ANGLE BEARING LENGTH LENGTH BEARING IN BEARING OUT 1 167.00' 12 °00'10" S82 °29'01' W 34.92' 34.98' S76 °28'56 'w S88 "29'06"W 2 233.00' . 12 °00'10' N82 °29'01 "E 48.72' 48.81' N88 °29'06 "E N76 °28'56 "E SURVEYOR'S CERTIFICATE I, Douglas J. Zahler, registered Wisconsin Land Surveyor, hereby certify that by the direction of Woodhill Land, LLC, I have surveyed, divided and mapped a parcel of land located in part of the Southwest Quarter of the Northwest Quarter of Section 19, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin; described as follows: Commencing at the West Quarter corner of said Section 19; thence along the West line of the Northwest Quarter of said Section 19 N01 0 34'23 1 W a distance of 302.64 feet to the oint of beginning; thence continuing along the P g g W est line of Said Northwest Quarter N01 0 34 1 23 11 W a distance of 1018.79 feet to the north line of said Southwest Quarter of the Northwest Quarter; thence along said north line N89 °1 1'55 "E a distance of 487.38 feet; thence S00 0 48'05 "E a distance of 459.01 feet; thence S76 °28'56 1 W a distance of 105.13 feet; thence S1 3 a distance of 66.00 feet; thence N76 °28'56 "E a distance of 120.65 feet; thence S01 °34'23 "E a distance of 500.81 feet; thence S89 0 25'43 "W a distance of 510.08 feet to the point of beginning. Containing 11.477 acres or 499,952 square feet. Subject to all easements, restrictions and covenants of record. I also certify that this Certified Survey Map is a correctly dimensioned representation to scale of the boundaries surveyed and described; that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix and the Town of Warren in surveying and mapping same. OF W/S Dated this3.A&Lday of 2002 PAS coy c DOUGLAS J. Z 1 ZAHLER nr S -2145 7t Douglas J. Ie I- 145 i HUDSON, ,[ w1s. S & N Land Surveying, Inc. 2920 Enloe St. SURNJ Hudson, WI 54016 715- 386 -2007 Each Parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the Town of Warren for advice. SHEET 2 OF 3 THIS INSTRUMENT DRAFTED BY KEVIN REED JOB NO. 6161 -01 DATE: 4/4/02 Vol. 16 Page 4376 APPROVED Sr. Cf",olx COUNTY Planni— �n4 ?grkS Committee EP 17 ZOOz It not rec'ur . p appmval. a R I ED SURVEY (MAP n ' 66 ►p 1 ED IN PART OF THE SW1 /4 OF THE NW1 /4 OF SECTION 19, T29N, RI 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. SURVEYOR S & N LAND SURVEYING O WNER DOUGLAS J. ZAHLER WOODHILL LAND, LLC 2920 ENLOE STREET E1404 FIRST NATIONAL BANK BUILDING HUDSON, WI 54016 332 MINNESOTA STREET ST. PAUL, MN 55101 CURVE DATA TABLE CURVE RADIUS CENTRAL CHORD CHORD ARC TANGENT TANGENT NUMBER LENGTH ANGLE BEARING LENGTH LENGTH BEARING IN BEARING OUT 1 167.00' 12 °00'10 S82 °29'01' W 34.92' 34.98' S76 °28'Se W S88 °29'06"W 2 233.00' . 12 °00'10" N82 °29'01 "E 48.72' 48.81' N88 °29'06 "E N76 °28'56 "E SURVEYOR'S CERTIFICATE I, Douglas J. Zahler, registered Wisconsin Land Surveyor, hereby certify that by the direction of Woodhill Land, LLC, I have surveyed, divided and mapped a parcel of land located in part of the Southwest Quarter of the Northwest Quarter of Section 19, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin; described as follows: Commencing at the West Quarter corner of said Section 19; thence along the West line of the Northwest Quarter of said Section 19 N01 0 3423 "W a distance of 302.64 feet to the point of beginning; thence continuing along the West line of said Northwest Quarter N01 0 34'23 "W a distance of 1018.79 feet to the north line of said Southwest Quarter of the Northwest Quarter; thence along said north line N89 1'55"E a distance of 487.38 feet; thence SOO °48'05 "E a distance of 459.01 feet; thence S76 0 28'56 "W a distance of 105.13 feet; thence S1 3 a distance of 66.00 feet; thence N76 0 28'56 "E a distance of 120.65 feet; thence S01 0 34'23 "E a distance of 500.81 feet; thence S89 a distance of 510.08 feet to the point of beginning. Containing 11.477 acres or 499,952 square feet. Subject to all easements, restrictions and covenants of record. I also certify that this Certified Survey Map is a correctly dimensioned representation to scale of the boundaries surveyed and described; that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix and the Town of Warren in surveying and mapping same. OF W/S Dated this day of ,2002 P�� c�2 c DOUGLAS J. �2 A. ZAHLER �( S -2145 Douglas J. • file L 145 HUDSON, S & N Land Surveying, Inc. Wis. 2920 Enloe St. SUF'+1 Hudson, WI 54016 715- 386 -2007 Each Parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel contact the St. Croix County Zoning' Office and the Town of Warren for advice. SHEET 2 OF 3 THIS INSTRUMENT DRAFTED BY KEVIN REED JOB NO. 6161 DATE: 4/4/02 ", Vol. 16 Page 4376 APPROVED ST. CROIX COUNTY PlaMlno Icnini arr! " r4e SEP 17 If not recortlC , ,T�1 F 1 E D SURVEY MAP. aPProvai date P . aI � n ��� nlll� 'h-' -b 'fN PART OF THE SW1 /4 OF THE NW1 /4 OF SECTION 19, T29N, R1 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. SURVEYOR S & N LAND SURVEYING O WNER DOUGLAS J. ZAHLER WOODHILL LAND, LLC 2920 ENLOE STREET E1404 FIRST NATIONAL BANK BUILDING HUDSON, WI 54016 332 MINNESOTA STREET C ❑RP ❑RATE .OWNER'S CERTIFICATE OF DEDICATION ST. PAUL, MN 55101 WOODHILL LAND, LLC., A LIMITED LIABILITY COMPANY DULY ORGANIZED AND EXISTING UNDER AND BY VIRTUE OF THE LAWS OF THE STATE OF MINNESOTA, AS OWNER, DOES HEREBY CERTIFY THAT SAID COMPANY CAUSED THE LAND DESCRIBED ON THIS CERTIFIED SURVEY MAP TO BE SURVEYED, DIVIDED, MAPPED AND DEDICATED AS REPRESENTED ON THIS CERTIFIED SURVEY MAP. WOODHILL LAND, LLC., DOES FURTHER CERTIFY THAT THIS CERTIFIED SURVEY MAP IS REQUIRED BY S.236.10 OR S.236.12 TO BE SUBMITTED TO THE FOLLOWING FOR APPROVAL OR OBJECTION: TOWN OF WARREN, ST. CROIX COUNTY PLANNING, ZONING AND PARKS COMMITTEE. IN WITNESS WHEREOF, THE SAID WOODHILL LAND, LLC, HAS CAUSED THESE PRESENTS TO BE SIGNED BY AUSTIN J. BAILLON, RESIDENT AT c _ _ __ _ ____ _ __ __, THIS -a Q DAY OF- ,, �_ 2 a02. IN THE PRESENCE OF: WOODHILL LAND, LLC ----- - - - - -- ------------------- AUSTIN J. BA LON, PRESIDENT STATE OF WISCONSIN) )SS. ST, CROIX COUNTY) PERSONALLY CAME BEFORE ME THIS_a.,�'" DAY OF-__' 200a,, AUSTIN J. BAILLON, PRESIDENT OF THE ABOVE NAMED COMPANY', TO ME KNOWN TO BE THE PERSON WHO EXECUTED THE FOREGOING INSTRUMENT, AND TO ME KNOWN TO BE SUCH OFFICER OF SAID COMPANY, AND ACKNOWLEDGED THAT HE EXECUTED THE FOREGOING INSTRUMENT AS SUCH OFF IC�Rot'AS"mTNE DEED OF SAID COMPANY, BY ITS AUTH \\`\\. ,,.°�rJSIM -- _ � N ❑TAR Y P U 'I �f dlON MY COMMISSION EXPIRESn,-- off_ {f ... ` • D, '�>, TOWN BOARD RESOLUTION RESOLVED, THAT THIS CERTIFIED SURVEY MAP IN THE TOWN OF WARREN, WOODHILL LAND, LLC, OWNER, IS HEREBY APPROVED BY THE TOWN BOARD. RICHARD MEYER DATE CHAIRMAN I HEREBY CERTIFY THAT THE FOREGOING IS A COPY OF A RESOLUTION ADOPTED BY THE TOWN BOARD OF THE TOWN OF WARREN. - - - -- - - - - - - -- g A L NA RA DATE e SHEET 3 OF 3 CLERK Vol. 16 Page 4376 I W($ Department of Industry SOiL AND SiTE EVALUATION tabor Human Relations Page of - Division of safety and Buildings In accordanc It I 9, Wis. n ` Attach complete site plan on paper not less than 81/2 x 11 inches I ze. Plan unty Sr- G���• V Include, but not limited to: vertical and horizontal reference point ,M), direction �l percent slope, scale or dimensions, north arrow, and location a ance t roa - �' ��i± arest Pa c I LD..# APPOCANT INFORMATION - Plea -aeprfnt sUanfa 'o2 co�Rp� ad by Date Personal information you provide may bq used for secondary purposes (Priva ' s .4�' 6y Property Owner �i� AA.% 5 property N / L• N �I� 0 vi 1/4� 1114,S Property Owne s Mailing Address Lo Block# I Subd. Name or CSM# 3 32- Mi uveorf ST Is-7. N•!•T �e .P,4�w i v& CSAJ 37,E City State Zip Code Phone Number Nearest Road ST= pf�'uL 111 fIV. 5S /Ol ((s+Sl) 2.12 •SSS C1 cit ❑ village Town pvw �ew Construction Use: L'J Residential / Number of bedrooms 3 - Addition to existing building ❑ Replacement ❑ Public or commercial bescribe: AMP = A'07 Code derived daily flow gpd - Recommended design loading rate bed; gpd�F - trench, gpd/ft Absorption area required 1 V /gi bed, ft * f • ..t rench, (t 2 Maximum design loading rate iW bed, 9pd� s trench, gpd /ft Recommended infiltration surface elevation(s) Ste- 3 it (as referred t site plan benchmark) Additional design /site considerations ,4ON 6 t P v 9 !! � 4. Parent material 40 4SS Oyte ; /AWDl/ (J(>�"&*Sit„ Flood plain elevation, If applicable N rf it S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System In Fill Holding Tank 0 U = Unsuitable for system S El L7 U s ❑ U P� T E] U �❑ U El [Is Q^e SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mollies Structure GPD /ft 13 , In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bounda ry Roots Bed , Trench . - 2, •To /o YX 6 1-,f lmt ds c w Ground 02 ,..G .-�-� G S l �(-I 1 I s Depth to limiting �4 actor, in. Remarks: Boring # ioY4 3 140 0, 5Z A ds w z f . • s Z. •1 2 io Yr� S/L /f sdk �� cw /F ; •3 5 (3; . , /0 Y,4 y4 17e4e dsk e- _ . .s Ground 7• s /�'L • L s f ]� d� Q it e S ' • (� Depth to limiting or } 74?—In. Remarks: CST Name (Please Print) Signature Telephone No. 1� a T' uLQ 7!5' ! - Slo o S Address Date CST Number . l8 • `�`1' 2.24e 3 75 Ulbrtcht 3 Associate Pthrate Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 ORIGINAL ' 307 X 1 1 I Sj w / 271 CD n , J W Ln CD 00 LO Ln W 1 O 0 T I �I 3 Ln Oj CD C� r4�S9 ACRES o ........... z 0 ............. O l � Tks'r' � 1 .. °29`06 CD 230,20' N '88 > 29 / 06 // E 1 23-0,14 - • Q'ooi rns -�� d o o � ; dr�n �n 7p -- Q '8 ° i 217 o d off• : Mal i SOIL DESCRIPTION REPORT y 2 PROPENTY OWNER ✓II�. iL✓G+' ("ln a� 'age of . ^ti PARCEL I.D.ff L gorin g Horizon # Hori Depth ` Dorniitart,color Mottles Structure a Texture Bound Roots In. fJlunseli Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence ary Bed , Trench ey 4X t 04 149` f .Sic. If around YA Depth to ; limiting q factor T60n. .. . Remarks: Boring # r �/q nor : , ... sL •fps k wsk w Z-� z o YX S� /rrs � dsk cs -- • 4{ ' • s : • ,S Ground ele Depth to , limiting factor l Remarks: Horizon Depth Dominant Color Mottles Structure Texture Consistence Boundary Roots In. Munsell. Qu. Sz. Cont. Color. • Gr. Sz. Gh. Bed , Trench Y, Boring #. d • /� /d YiQ 3f L. / f fi,� S r L . Cv Y/1 Y4 file Ground Slay. ft. Depth to limiting f In' Remarks: Boring Ground Slay. Depth to , limiting factor in. Remarks; SBDW -8330 (R. 08/95) 10 •c r ST CROIX COUNTY t - SEPTIC TANK MAINTENANCE AGREEMENT AND / OWNERSHIP CERTIFICATION FORM OwnerBuyer i l( /%zS h iii sGdr k Mailing Address d,� /4///,3 t // Property Address (Verification required from Planning Department for new construction) City /State `i!/G`yP.n� � � Parcel Identification Number LE GAL DESCRIPTION Property Location SiK/ /,, /1/I'✓ i /4, Sec. 1 T_ -R_fW, Town of Subdivision —dA��. �/ ,��7 , Lot # Certified Survey Map # 0O 6 110 7 -5- 5- Volume Page # e ls 7 4P Warranty Deed # , Volume , Page # Spec house O yes E4,"n'o Lot lines identifiable [dyes 0 no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooncr, 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 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 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 three yea expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr�perty describ d above, by virtue of a warranty deed recorded in Register of Deeds Office. O,y SIGNATURE OF APPLICANT 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 -�.. � � �� .�Q 2 �� �� �r 2 �� y ��-`� 3 r �� �� x � X � Z Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor rtnd Human Relations Page / of Division of Safety and Buildings in accordan �\ ItVk. I FBI �9, Wis. V IZt i - C t ty , Plan un Attach complete site plan on paper not less than 8 1/2 x 11 inches I - size. Pla C dO�• �/ Include, but not limited to: vertical and horizontal reference point M), direction /"IFS percent slope, scale or dimensions, north arrow, and location and fttance 3q nearest ro a V Parc I I.D. # ' APPLICANT INFORMATION - Please print all info ? ion. CC) U P//k / � ed by )ate �c'/ Personal Information you provide may b@ used for secondary purpos , es (Privy raw, s ` ) ~' / J 2 6 y Property Owner 4VL ISIA1/ , Property ^/ vim^ N cov � Y �g1vt�L`o� 1/4� 1/4,S �� T Z9 01 Property Owner's Mailing Address Lo Block# I Subd. Name or CSM# ' 3 3 2- Ai ,Vi5Vr -4 ST /sr. A1*7- A / I &A14jN& CS- A l i�- 3 74 City State Zip Code Phone Number � Nearest Road 5'T= p411 L /N.V. SS' /O/ ((yS / • SSS ❑ city ❑ village Town p [19 ew Construction Use: L'J Residential / Number of bedrooms 3 ' Addition to existin building ❑ Replacement El Public or commercial Describe: �(// = 6 T &CD `, to • (da —T Code derived daily flow gpd o Recommended design loading rate bed, gpd/fF - s trench, gpd1fl Absorption area required bed, ft2 1),0 trench, ft 2 Maximum design loading rate �bed,gpdfft ' s trench, gpd /11 Recommended infiltration surface elevation(s) s .,s y 1 - q _3 ft (as referred to site plan benchmark) Additional design /site considerations 4ey it � /�E'y�- ct& V o w cs�s� Ld • — Parent material _LOESS 009!R S/},rl, j/ (UVr�J�J- i Flood plain elevation, it applicable N ft S = Suitable for system � Mound In- Ground Pressure AT- Grade System In Fill Holding Tank U = Unsuitable for system 0I S El IE S ❑ U 9 El 9- f ❑ U ❑ S I�1 El SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o•� Dye 14 ds' w Z r . 2. •fo /o Y� "61 L f l GfS' . ' • d' Ground 3 0•� 7SYR Y el v /D7• �tt Depth to limiting actor f in. ' Remarks: Boring # / p•�2- /O Y4 314" 5L. h dS w 2 7 . 1 4 ; • S Z. 2- •3 io Y/I Y1 — SQL 1fsd1- cP� cw /F - •3 . /oyie y� sL 1� �s e . s Ground 7.5 K / ' S 1 d'.%- a s elev. .174 Depth to limiting �f'� for in. Remarks: CST Name (Please Print) Signature Telephone No. Qoee r -71Y - 3q .6 Address Date CST Number . l8 4� zzc�375 t WtIcht 3 Associates Pftvate $swage Consultants 655 O'Neill Rd. Hudson, Wis. 54010 ORIGINAL I J SOIL DESCRIPTION REPORT PROPERTY OWNER Page Z of PARCEL LD.# 4 O r � t Boring # Horizon Depth Dominant Color Mottles Structure 2 In. Munsell ` Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 3 o• ioy.< 3/y — 5 ds w 2- - f • q :. s �' �o Q - S�� 1 ��. cw - • t ' • 3 Ground �p y — SL /�' dS c S _ .�! • S elev. ins 7• s Yfi /a /. Depth to limiting factor y Quin. ' Remarks: Boring # •l 9 ✓oY- 313 wsk w Z . q ' . s Y/6 Ground S Depth to limiting factor T in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ In. Munsell Qu. Sz. Cont. Color Gr. Sz. �Sh. Bed , Trench Boring # O• /Y /&YX 313 GS / f y S 4J L dv Ground , elev. Depth to limiting ; V f c�or in ' Remarks: Boring # Ground elev. ft. Depth to limiting factor In. Remarks: SBDW -8330 (R. 08/95) r I LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1052 -60 -200 Parcel Number 19.29.18.295B OWNER NAME: First Last NIELSEN ENTERPRISES INC PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 19 TOWN 29N RANGE 18W %160 NW 1 /440 SW M rip ion Line Description 3.160 PLAT CSM 1 376 042/02 LOT01 BLK N R18W PT SW NW 1 16/4376 16 /589 17 v 18 19 07 21 08 22 09 23 10 24 11 25 12 26 13 27 / 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit Ulbricht & Associates Pjh►ate Sewage Consultants 855 Mell Ad. ; Hudson, Wis. 54016 PE,v9:,vG- 30 �i► _ 16 w 1 SlrN 13_5 o T T 0 e ( �j1A : z- BUG p� i D3 • GG� �•�'o i SO, G or Li ,� 230 ' i00•0 �I�U . 27L80' .D � o 0 3 00 Ln Ln � o co Ln LOT I 3.159 ACRES ° o n � n m 137,606 SQ, FT, z ...................... .............. � z c/) T r 16 C 142-3 ° 2 9' 0 6 " E . . . . ....... 230,20' -- " D N88 °29'06 "E 1 � 230,14' U 2007P 986 STATE BAR OF WISCONSIN FORM 2-1999 6 9 3 - 7 Cb rd WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST, CROIX Co., WI This Deed, made between Woodhill Land, LLC, a Minnesota RECEIVED FOR RECORD limited Lability company 10 - 11 - 2002 8:95 AM WARKNTY DEED Grantor, and Nielsen Enterprises, Ilnc, A Wisconsin Co oration EXEMPT s REC FEE: 11.00 TRANS FEE: 1128.00 COPY FEE: Grantee. CERT COPY FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in SL Croix COUnty, State of Wisconsin: Part of the SWIA of the NW1 /4 of Sec.19.Township 29 N. Re c in a Ran I s eser Name and Retum Address Is 1,2,3,and 4 of Certified Survey Map filed September 20,2002 in Volunme 16,page 4376 as Document Number 691255, St. Croix County, Wisconsin. ottce:The interest conveyed hereby is subject to a Declaration Of��"�'�, _C(� Environmental Restrictions dated September 23, 2002, recorded in the St. Croix County Register of Deeds Office on September 26, 2002 as Document 042.1052.60 -OW No.691892 in Volume 1990, page 573. Parcel Identification Number (PIN) This not homestead property, Grantee or its successors and assigns shall forever rekase,covenant not to sue, and forever disc) (is not) successors, assigns,parent corporation pareent con � Grantor and its panties, Predecessors and affiliates and all their employees, ag managers, directors ,govenrors,members,sbareholders, any or all of them, from and for any and all existing or potential demands, causes of action equitable or legal claims, obligations ,damages,losses,penalties and liablitities of arty nature whatsoeverwhether asserted or unasserted known or unknown brought by Grantee or Grantee's successors or assigns that arise out of or are related to any contamination of the groundwater by volatile organic compounds and any other hazardous substances, as defined by applicable law,at,in under or emanating from or affecting the Real Estate,including without Limitation those claims arising from or connected to any investigation or cleanup work related to the prescence of any volatile organic compound and any other hazardous substances itkunder atecting or emanating from the Real Estate. This release is intended to be and shall constitute a covenant running with the title to the Real Estate and shall be binding upon all successor owners,lientons and occupants and persons or entities who have or may have any interest therein from and after the date hereof. Subject to easements, restrictions reservations,covenarrts and rights of way of record, if any. The warranties of this deed, either express or implied are limited by the grantor to the grantee, or anyone taking title from them in the chain of title, to the consideration expressed herein, that being the sum of S375,600.00. Exceptions to warranties. Dated this 2nd day of October 2002 Woodhill Land,LLC _ • by President V 1 • . Austin J. Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(&) SL Croix Cowuy. ) Personally came before me this 2nd day of authenticated this z day of October ' 2002 the above named Austin J. Billion TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing authorized by 6.06, Wis. Stara.) (If not instrument and acknowledge the same. § 70 THIS INSTRUMENT WAS DRAFTED BY ^`a PAUL A. 13AILLON Paul A. Baillon, Attorney at Law • Paul A. Bailloa!' 4 ' iy�;GMWME50rA Notary Public, State of W m ° 131 .2m6 (Signatures may be authenticated or acknowledged. Both are not My Commission is peralane ■ nece ssa r y.) January 31 2005 _ ) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE MAR OF WISCONSm FORM Na.2 . Ifaa INFORMATION PROFESSIONALS COWANY FOND DU LAC, WI SIXW5.2721 I U 1958P 256 STATE BAR OF WISCONSIN FORM 3 .1999 6 $ 8 1 M KATHLEEN H. WALSH QUIT CLAIM DEED REGISTER OF DEEDS Document Number ST. CROIX CO,, WI This Dud, made between Placid Land Company, LLC, a RECEIVED FOR RECORD Minnesota Limited Liability Compaq 08 -26 -2002 9100 All DUIT CLAIM DEED Grantor, and WoodhiN Land, LLC, a Minnesota Limited Liability EXDPT t Company TRANS 75.00 CERT COPY FEE: Grantee. PAGES- 1 Grantor, quit claims to Grantee the following described real estate in St Croix County, State of Wisconsin: Recordine Area Name and Return Address Woodhitl Land, LLC A parcel of land located in part of the Southwest Quarter of the Northwest 332 Minnesota Street Quarter and pa rt of the Southeast Quarter of the Northwest Suarter all in E 1404 Section 19, To p orth, Ranger$ WR'Cown of V�arren St Croix St. Paul Mn 55101 County, Wisconsin; described as follows: Beginning at the West Quarter corner of said Section 19; thence along the east -west quarter lime of said section 19 N89 25'43 "E a distance of 1645.04 feet; 042- 1052fi0-000, 042 - 1052 -70 000 thence NOI'34 23 "W a distance of 1328.03 feet to the north line of said Parcel Identification Num er Southeast Quarter of the Northwest Quarter, thence along last said line and the This is not homestead o e pr p rty. north line of said Southwest Quarter of the Northwest Quarter SO 11'55 "W a (is) (is not) distance of 1644.94 feet to the Northwest carrier of said Southwest Quarter of the Northwest Quarter, thence along the west line of said Southwest Quarter of the Northwest Quarter SOl"34'237E a distance of 1321.43 feet to the point of beginning. Containing 50.02 acres. Subject to an easment reserved by Grantor for access from 92nd Avenue to land lying to the East of the above described property. Said easement to include the right of ingress and egress and the right to construct and maintain a road which meets the specifications and standards for roads in St Croix County and the Town of Warren. Said Easement described as follows: A parcel of land located in part of the Southwest Quarter of the Northwest Quarter and part of the Southeast Quarter of the Northwest Quarter, all in Section 19, Township 29 North, Range 18 West, Town Of Warren, St. Croix County, Wisconsin; described further as follows: Com¢oncin$g at the West Quarter corner of said Section 19; thence along the West line of the Northwest Quarter of said section 19 NOC3473 "W a distance of of 302.64 feet; thence $89 "W a distance of 510.08 feet; thence NO (34'23 "W a distance of 334.49 feet to the point of beginning; thence N894259"E a distance of 1135.08 feet; thence NO 1 34'23 "W a distance of 400.10 feet; thence S89 4259 "W a distance of 1161.58 feet; thence S00 48'05 "E a distance of 173.03 feet; thence S7ti 28'56 "W a distance of 105.13 feet; thence S I 31'04 "E a distance of 66.00 feet; thence NV28'56"E a distance of 120.65 feet; thence SO f 34'23"E a distance of 166.32 feet to the point of beginning. subject to easements, restrictions,covenams and rights of way of record, if any Together with all appurtenant rights, title and interests. Dated this 25th day of July 2002 Placid Land Company, LLC • *by �', 4. President • a Austin L Baillon, President AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) SS. Ramsey County. ) Personally came before me this 25th day of authenticated this - day of July _ , 2002 the ve named Austin J. Baillon r TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowl ■ authorized by § 706.06, Wis. Stats.) l+.. P 2 PAUL A l3AlI LO14 THIS INSTRUMENT WAS DRAFTED BY t ATi♦y uFrA Paul A. Baillon, Attorney at Law ' Paul A. Baillon ■r colt■ISSON ExtiRES 141-0WS Notary Public, State of Wiscf a (Signatures may be authenticated or acknowledged Both are not My Commission is permanent. (If not, state expiration date: necessary.) January 31 2005 ) *Names of persons signing in any capacity should be typed or printed below Weir signatures QUIT CLAIM DEED STATE AAR OF WISCONSIN FORM Ns.3 . ISSS INFORMATION PROFESSIONALS COMPANY POND DU LAC, Wt 800.655 -4021 ` v 9 799oR 598 /S STATE BAR OF WISCONSIN FORM 3-199K 666347 QUIT CLAIM DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS 5T. CROTX CO., WT This Deed, made between Hum Lan Corpor ation, a Minnesota Corporation — -- RECEIVED FOR RECORD — --- -- - -- - - - - - -- — . - - -- 12 -25 -2001 10 :30 AM QUIT CLAIM DEED rantor, and!Pls�cid Land Company, LLC, a Minnesot Limited Liabilty EXEMPT N ISS Compan — — CERT COPY FEE: -- COPY FEE: TRANSFER FEE: — - RECORDING FEE: 15.00 Grantee. -- PAGES: 3 Grantor, quit claims to Grantee the following described real estate in SL Croix County, State of Wisconsin: Recording Area Name and Return Address Placid Land Company,LLC s 332 Minnesota Street See legal description dated 12/20/2001 and E 1404 attached hereto as "EXHIBIT A" St. Paul Mn 55101 see attached "F.XI IJBIT 13" Yarccl Idenlil ication !-0umbcr (PIN) This is not homestead property. (is) (is not) subject to casemcnis, restrictions, covenants and rights of way of record, if any Together with all appurtenant rights, title and interests. Dated this 20th _day of December _ 2001 Humbird Land Corporation ' _._.._ • by Pr esident_ ' Austin J. Baillon, Pr AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s)_ — ) sS. Ruoaey _ _ County. ) — -- Personally came before me this 20th day of authenticated this — day of - -, December _ — , 2001 _theabovenauned Austin J. Baillo 1711,E: [v(F, not MEM STATE BAR OF WISCONSIN to me known to be the pet'son(s) who executed the foregoing nuthoriz - ed by — j5) - 606, Wis. Stnts.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Paul A. Baillon, Attorney at Law ' Paul A. B aillon PAULA. BAILLON Notary Public, State of W isA- MY co wlss*N £MPIR£S 1.31 -2005 (Sigltatlues may be authenticated or acknowledged, Both are non My Cornmissiou is lxrinane Jl1V�bV It)uIOLW.t�FUvwwwv necessary.) January 31 21NI5 "Names ot'persons signing in any capacity should be typed or printed below theirsignstures QUIT CLAIM DEED aTATR BAR Or WISCONSIN FORM Na, 3. to" 1 - FORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 80"55 -1021 v 179 9 599 EXHIBIT A To QUIT CLAIM DEED From HUMBIRD LAND CORPORATION To PLACID LAND COMPANY, LLC DATED December 20, 2001 The South one -half of the Northwest quarter, (S 1/2 of the NW 1/4), and that part of the Northeast quarter (NE 1/4) which lies southerly of the southerly right of way line of the C hicago and North Western Transportation Company, in Section 19, Township 29 North, Range 18 West. Together with an easement for ingress and egress over the existing driveway, extending from U.S. Highway 12 southerly to the railroad crossing, over the land described in Vol. 798, Page 512, as Document Number 432858, and the land described in Vol. 868, Page 481, as Document Number 457840. All in the Town of Warren, St. Croix County, Wisconsin. � r VOL 1 199FACE 6 00 EXHIBIT B To QUIT CLAIM DEED From HUMBIRD LAND CORPORATION To PLACID LAND COMPANY, LLC DATED December 20, 2001 TAX PARCEL IDENTIFICATION NUMBERS 042 - 1051 -40 -000 042 - 1051 -50 -000 042 - 1052 -60 -000 042 - 1052 -70 -000 042- 1051 -10 -100