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N a c tD p N Z 3 O O Q N Z p, w3v a a (D < Cr rn fD t N O �z 3 j p !�a = q o CD o 4A co W CD a to h cu a� CD a r a �o CD wv,o 7�' N CD (D NWT C N a <_ O.Op O O A fD Cb CD 0 b @ N N O N O O CD O J CL Cp A N A O D .. 69 0 '69 O I i O O M � � a 0o CL o0 0. RECE Wisconsin Departme it of Commerce SOIL EVALUATION REPORT Page of Division of Safety anA I Buildings R A A R 1 9 Drdan with Comm 85, Ws. Adm. Code ,.� COUn s C ►' 0 Attach complete plan on paper not less than 81 x 11 inchesintize. Plan must include, but not I fed to Teft>ca4� dhd117tbntl;�1 refs nce point (BM), direction and Parcel D. percent slope, sea or dirrrd� ri iffi 4ifzm, and lion and distance to nearest road. Please print all Information. w M1 Date Personal Infonnadon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 716 property Owner Proparty Location D e n "t R at+.@ F c Govt. Lot 5 W 1/45E,114 S 3:5T N R E (or)® Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1 uk - 7 City State zip Code Phone Number ❑ City ❑ Village CR Town Nearest Rofd a �o fi vl 71a - 330 � rr h v e- r � New Construction Use: ® Residential / Number of bedrooms _ Code derived design flow rate A S O GPD ❑ Replacement Z3 Pub pr erdal - Describe: Paront material ,a � QC 1 0. d(Y Flood Plain elevation If applicable YV ft• General corwrrents a. 'A To 61,h C wr G� and reconrmendadons: `� h f`f �� Pn A w+n A w/t 2 S S Boring # Borin F7 I ❑ fl i ® Pit Ground surface elev. 10 2 ft. Depth to lim ling factor In. SoiI Application Rate Horizon Depth "Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 rn rn Zvi 0. 2Wi s- ? S ir 5 R 1A. rA s d o r ..� Boring #. ❑ Boring pit Ground surface elev. ft. Depth to limiting factor 2 In. Appl ication Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 )b Y k YWN r f 3 - 40 I. Y 2 Effluent #1 = BOO > 30 < 220 mg1L and TSS >30 150 mgA. ' Effluent #2 = BOD 1 30 mgA. and TSS 1 30 mg& CST N (Please Print) SI a CST Number P IS SS Address Date Evaluado Conducted Telephone Number 1 0 2 �� sT �e �1 l�v�3 h ►s 4 s I �S ' Pag Z of Property Owner � c n � S ► V G D ►J Parcel ID # 9 ng ❑ Pit Ground surface elev: ft. Depth to limiting•(actoG • • 2.4 in.._ ;... Soil Appl ication Rate _ ._. Redox Description Texture Structure Consistence Boundary Horizon :Depth .Dominant Color Roots. GPD/ff - In. Munselt - Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 ; 'Eff#2 1 o -ID S; C L/ Z 16.07 — ') — 0 `D 0 ` 12f v 4 y o F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor In. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EtT#2 ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor In. ❑ Pit soil "cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'EM Effluent #1 = SOD > 30 _< 220 mg/L and TSS >30 _5 150 mglL ' Effluent #2 = BOD, <_ 30 mg& and TSS 5 30 mg1L Tire 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. sso -Vw pr.doo) o 4 0 Ir 6 J 83 . gm * 2 Tof S p,'ke &t 9 9D <I S2 ro p s X ; k. t 09 r aT Ina Wisconsin Department of Commer PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 1 ' INSPECTION REPORT Sanitary Permit No: . - 453332 0 (ATTACH TO PERMIT) GENERAL INFORMATION (ATTACH Plan ID No: _ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. /99 3 = IS • D - N Permit Holder's Name: city Village e X Township Parcel Tax No: Nelson, Anton I Warren Township 042 - 1094 -50 -235 CST BM Elev: Insp. BM Elev: / BM Description: Section/Town/Range/Map No: °/• �l 99 �� ST w�Z 33.29.18.04 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �5�_ 12 Sn Benchmar 2 Q t 2L ( 8 i Dosing ' ` Alt. tM s Aeration Bldg. Sewer f • Holding St/Ht Inlet n9T' r 2.41 92.Iq TANK SETBACK INFORMATION St /Ht outlet ,!0 92.ao TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i &D I Dt Bottom _ / 6- 0 5 . S Dosing / Header /Man. J . • }Q r L l Aeration Dist. Pipe , Holding Bot. System 41 • / f PUMP /SIPHON INFORMATION final Grade _ Manufacturer Demand St CoverI ` Model Number D 2 1 3 y t.►�t' T TDH Lift Friction Loss System Head TDH Ft s} 49 orcemain Length/ Dia. Dist. to Well . 92 � •o OIL ABSORPTION SYSTEM / 0• Width Length r No.OtTrenches PIT DIM NSIONS No. Of Pits Inside is as th ENSIGNS SETBACK SYSTEM TO I P/L JBLDG IWELL LAKE /STREAM LEACH Manufacturer: INFORMATION CHAMB O Type Of System: i t IT Mode umber. 64 /! DISTRIBUTION SYSTEM Header /Manifold / Distribution ! �I x Hole Size x ole Spacing Vent to Air Intake O f I ! Pipe(s) p / Length Dia / Length f ea Dia ' Spacing 1 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Ove r Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes H No �FK1 Yes Ej No WAItBM TS 1 decode isc cies, persons present, etc.) Inspection 1 / Inspection #2: rr' �� * IVW 1 Ski 0 H S r n n (S S 1 4 SE 1/4 3 R18W NA Lot 4 � Parcel No: 3. 18.04 � b / 3 T2 N 9 ) escripti o 2.) Bldg sewer length - amount of cover 3.) Contour = f c o "."S ' r 44b _ - _ ki Plan re ision Required? [ Yes No Use other side for additional information. _ Ilk SBD -6710 (R.3197) Insepctor's Signature Cart. No. I J SF" 0 rs�A4fe2.SN/P 1-1 rzt Safety and Buildings cer Division State Plan I.D. Num l v ` 201 W. Washington Ave., P.O. Box 7162 ?Pe /� XA ,��O��I on, WI 53707 - 7162 M adison, Sanitary mber (to be filled in by Co.) (608)266 - 3151 3 2 Department of Commerce Sanitary Permit Application g9ll er � � Iit accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(I xm) Project Address (if different than mailing address) �_..., ._ _ . �33 .2 9, I S I 1. Application Information - Please Print All Information t _ - 1 S$ & 6 '4'-A , IC . P 7 V6 Property Owner's Name 1 , 1 Parcel # Pr o f t # Block # t 20 4 Lit tL i -50- Property Owner's Mailing Address Property Location t L _ %., 1> ' /., Section City, State Zip Code Phone Number IRo� t 5 l� rj 1 1p23 I Z'3'28' S �� 7 T N, R circle > II. Type of Building (check all that apply) E1� subt!NistorrTlexre CSM Number 'or 2 Family Dwelling - Number of Bedrooms / ❑ Publ ic/Commercial -Describe Use C v � t g 755 b3 23 ❑ State Owned - Describe Use ❑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 List Previous Permit Number and Date Issued B. ❑ Permit Renewal El Permit Revision ❑ Change of Permit Transfer to Ne Before Expiration Plumber O er IV. Type of POWTS System: Check all that appl ❑ 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 ❑ Recirculatin g Synthetic nthetic Media Filter El Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe 11 Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 0C ,. o Goo k o 96,/ in Total Manufacturer efab VI. Tank Info Capes ci ty Number Pr Site Steel Fiber Plastic Glass Gallons Gallons of Units Concrete Constructed New Existing Tanks Tanks Septic or Holding Tank �' ` Aerobic Treatment Unit 1 SO Dosing Chamber h �O 1 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PlumX ign ature MP /MPRS Number Business Phone Number M t Q37 220 cf ls' Y 308 Plumber's Address (Street, City, State, Zip Code) VIII. Count I /De artment Use Onl Approved El Disapproved Sanitary Permit Fee (in ludes Groundwater Date Issued Issu' g ent Signature No tamps) Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disapproval Septic OWNER: I � ,, � t I Se i I '1 tc tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained V"i or�t.RO/ a$ per applicable codelordinances. Attach complete plans (to the County only) for the System on paper not less than 81/2 x 11 inches in sire 1 SBD -6398 (R. 01/03) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division I. INSPECTION REPORT Sanitary Permit No: �► ' ' (ATTACH TO PERMIT) 453278 0 GENERAL fIFORMATION State Plan ID No: Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 Permit Holder's Name: City Village X Township Parcel Tax No: Nelson, Dennis & Faye Warren Township 042 - 1094 -50 -235 CST BM Elev: Insp. BM Elev: T Description: Section/Town /Range/Map No: 33.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION B§7 HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes E No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / 1 Location: Unknown (SW 1/4 SE 1/4 33 T29N RI 8W) NA Lot 4 Parcel No: 33.29.18. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 3.) Contour = Plan revision Required? (] Yes L No I Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. Safety and Buildings Division Couny �, , ` 201 W. Washington Ave., P.O. Box 7162 5'r C lr al X Madison, WI 53707 ­7162 Sanitary Permit Number (to be tilled in by Co.) iscvnsin ( ) J 608 266 -3 /�j Q Department of C ommerce ` 2 �° Permit Application ate Plan D . Number Sanitary pp 3 In accord with Comm 83.21, Wis. Adm. Cod e per ation ou provide ` ` , p _ __ p . ro ect Address if different than mailing � may be used for secondary purposes Priva y Law, I ( g address) Y 1. Application Information —Please Print All I n Property Owner's Name P cel k Lo # :Bl y ehnt �a e,f Co Proper Owner's Mailing Addres ; Prope Location P Y g �N NG 0E Vo gt) w 5' S4/ 1 /.. cS F e ow '' /4, Section City, State Zip Code Phone Number rm (7 V ) s S IQ l 1 1 T N; 4 11. Type of Building (che all that apply) w S i s. I irisierr�}tmrt�' ;&l or 2 Family Dwelling - Num r of drooms C�„,, ❑ Public /Commercial — Describe 11 State Owned — Describe Use /� ❑City illage �rownsh of W( 111. Type of Permit: (Check only one x on line A. Complete line B if applicable) q t : _Z3 A. ❑ Replacement stem g p )' New System ❑ Treatment/Holding Tank Re la et nl Ot r odi i o Existing System B List P o ermit Number and a Issued ❑ Permit Renewal ❑Permit Revision ❑ Change of ❑Pen Transfer t � Betixe. Expirat'i'on Plumber OVA IV. Type of POWTS S ystem: C heck all that a ❑ Non - Pressurized In- Ground 1Y Mound > 24 in. of sus le soil ❑ M d < 24 in. of sui e soil -Grade c Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holdi Tank eat Filter obic Tre m nit slating Sand Filter F1 Recirculating Synthetic Media Filter ❑ Leaching Chamber Drip ne ❑Gravel ipe ❑ her (exp ) V. Dis ersal /1'reatm put Area Information: Ak If Design Flow (gpd) Design Soil Application Rate(gpdst) Dis rsal Area ui d (st) ispersal Are o (st) System levati n Goo I OCy 6 9(, V1. Tank. Inks Capacity in Total Nut Manufacturer Pretab Site Steel Fiber Plastic Gallons Gallons of its Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic 1'reatment Unit / t Dosing Chautber X VI1. Responsibility Statement 1, the unde gned, assume responsibility for insta ion of the POWTS shown on the attached plans. Plumber's Name (Print) Plu er's Signature MP /M Number Business Phone Number �ruc 4 . �t65k� /h� 2 �0 7 7 �T9y YAP Plumber's Address (Street, City, State, Zip ode) VIII. County / De artment Use O Sanitary ermit Fee includes Groundwater Dale Issued ssuii Arent Signat (No Stamps) I Approved ❑ Disapproved ry I Surcharge f=ee) ❑ Owner Give eason f Denial 1 \. Conditions uf App rova easons for Disapproval SYSTEM OWN 1 Septic tank, ffluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable Code /ordinances Attach complete plans (to the County only) for the system on paper not less than 8IJ2 x 11 inches in size SBD -6398 (R. 01/03) I • Mti Apt L Noo ' jQ M i I I III 0 0 North Side Lot on fence Row 293,64 feet o • 4 9 end N 5 Shope th) Note 4 'offset In cent r z of Mound �h> circles shown In bed are ° from ° �, o Gdc% Iron fence EEE ontour B o in post at top of contour Scale in Feet o +' C5 0 2040 B3 w ' o 2 from o tour 1 top post 10�_ Weis r 750 ump Tank 1 25' from bed BENCH op post 29.4E Weiser from bed 2ND BENCH 1250 g septic i BI 92.6 B2 95.9 B3 93.9 Qo u s¢ Ar triangles are approx locations OP of previos test 1 „ = 50 feet Page 3 of 12 ► Safety and Buildings Division 4003 N. Kinney Coulee Rd cOmmerce .Wi.9ov LaCrosse WI 54601 -1831 www.commerce.state.wi.us /sb 4 t i lep artme nt sconsin of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary May 07, 2004 CUST ID No. 220499 A7TN: Inspector BRUCE ALLEN WEBSTER ZONING OFFICE WEBSTER PLUMBING & ELECTRIC ST CROIX COUNTY SPIA N3659 CTY RD C 1101 CARMIC1 AEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL cu m PLAN APPROVAL EXPIRES: 05/07/2006 yataa�i' Transaction ID No. 991993 SITE: Dennis & Faye Nelson Site ID No 682322 Town of Warren, St Croix County r �tes;�ber'� SW 1/4, SE 1/4, S33, T29N, R18W Lot: 4 1 FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 954544 Maintenance required Design Flow Rate: 600 gpd System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), and Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD- 10706 -P (N.01 /01). • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • This system is to be constructed and located in accordance with the approved plans, the "Mound Component Manual for Private Onsite Wastewater Systems Version 2" SBD- 1069 1 -P(N.0 1 /0 1). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to meat the telephone number listed below, or at the address i on this letterhead. I I I r - � •' t BRUCE ALLEN WEBSTER Page 2 517/04 The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 eroy G. J sky, Wastewater Specialist Integrated Services Bureau A W (715) 726 -2544 Voice (715) 726 -2549 Fax ljansky@commerce.state.wi.us cc: Leroy G. Jansky, Wastewater Specialist, (715) 726 -2544 s F Mound Puns -Por- [, ay N i'son 1-24 Cnty T N Z- Xo�oerts Vs 5 40'-- 7 9- X 3 0 7 o(- cat U ed in SW 33 IF 2 9 N R 8 W T(-Wn of W arre n S t Cf o) x C ount y 9 9 9 3 1 P ag e I Title Page Pace E? Plot Plan Page 3 Plot Plan Pa 4 Cross Soct!"or. P!a View Page 5 Dist Pipe Detai', r P a 6 i an l< 0 e t a!! �ondillonully Page 7 Pump C urve Im DI a 9 e ex e r e 8 S yn t ex ' I [. F U ,U L Page 9 Maintenecp P lan DEi'ARPAENT OF COMMERCE Page 10 Maintenence Man DIVI§iON OF SAFETY AND BUILDINGS Page 11 Pump Chamber /- Pa 12 Septic Tank !�SEE C- RE D B ruce 1, P r \A/R-kos D1195 N3G59 Cnl,,y Rb )\,-/ E s w o r- t h W s 5 4 01 1 RECEIVED APR 16 2004 �� SAFETY & BLOGS DIV, RECEIVED MAY 0 7 2004 SAFETY & BLDGS. DIV. 3 L� � CLJ c� 4- OU O 0 �,D CU C5 > a S j O - ! o J j - g y Y t;g ill algnu.ra7ap 51 aull aoua3 Pic }off Jo apps }saq - North Side Row Lot on e 293,64 feet CU 9 en d Qj S c o pe U Lot 4 s 0J -b Note 4'offset in cent r Of mound s o circles shown In bed are Iron fence o 0 1 from B2 a N v post at top z ontour °o ; of contour 0 LA Scale in Feet a d QJ B3 W U 0 20 40 ° C i I I 2 from co tour 0J 4- $' Weis r 750 ump Tank top post go 1 25 from bed BENCH o op post 99,4Q Weiser 1250 g septic from bed ;;R BENCH + o B1 92.6 B2 95.9 CI. B3 93.9 a Nreo o \.\O 0) -_ V) O U) triangles are approx locations of previos test ► 1 1" = 50 feet Page 3 of 12 I� gross section H Page 4 of 12 of Mound y° G Lateral discharge @ 96.6' A re ate F 95.1' 1 T I D rontou 3 E Mound S W Plowed Layer P Turnups at end FIVE % Slope "' °�r� cP of, laterals with threaded Fl plug Ptan View o-F Mound L J B 1 K A For_ Mair, o I o O a i ~� 1 W � 4 a Cl OJ A= 6 D= 1, 0 B =100 E- 1,3c� K =9 F 0.8 G= 0,5 J= 6 H= 1.0 I =11 W =23 Min supply Pressure 5,0 X 1,3 s,r. ,S plus 0,5 =7.0 Backflow 90 X 0,163 = 14.67 Max dose 600 / 5 + 14,67 = 134,67 Dennis Faye Nelson Page 5 of 18 0 ° N O a i G Q acoo� L �o ao rau�i af,� Al r �e ' X � Last Hole Near Turnup P = 4 9' S= 3' 5� 1/8" hoes X = 47 inches Hole Diameter 1/8" @ 0,41 g p r'1 per Lateral Diameter 1 1/4" h o e Mani -Pold Diameterlly ;K inch 2 1,32 m in dose Force Main 2 inch Holes per Lateral 13 r a - t e r e q Invert Ele Laterals 96.6' Void Volume of laterals 0,064 )K4x-49 = 12.544 Allowable workable dose range 63 to 120 gallons Dennis Faye Nelson Page 6 of 12 Approved Locking 750 g o d p u rn p tank manhole cover with warning label req min 4' above ground c P Q d L' N p u D1 4- G- f3 A B 750 gal pump tank /pump off elev 20,28 gal /inch ManSpec ° 83,0 D block Zvi- Go* 5a•eEcFILL AsPffL J4/j(IJKr-44P -T lR4R `5 sPFsil =( C- ,n 1 ..5 Manufacturer Wieser Doses /Day 5.19 Size 750 gallon Gallons /Dose 115.52 Alarm Manufacturer Level Arm Backflow Volume 16,3 Model # DLV Total Dose 131,82 Switch Type Steel Ball Pump Manufacturer Gould Model #38P-1 EP05 A= 20,5 = 415,74ga1 Min Discharge 21,32 gal /mn B= 2 // = 40,56ga1 C= 6,5 = 131.82 gal Backflow 0,163 )K100 =16,3 D= 8 " = 162,24 gal Verticle Lift 13,6 Tot 37" 750,36 gal Min Supply Pressure 5 )K1,3 +0,5 -7.0 Friction Loss 100 @1,02 1100 =1,02' Total Dynamic Head 21,62 Force Main Dia 2" Manufacture Tank Specks included in Plans Dennis Nelson r. A 7 ,2_ r GOULDS PUMPS Submersible Effluent Pump r 3871 EPO4 EP05 t APPLICATIONS • Fully submerged in high ■ EI Impeller. Thennuplas• M Bearings: Upper and lower grade turbine oil for tic endused design for heavy duty ball bearing. �• Speulically designed for the lubrication and efficient improved performance, construction, following uses: heat transfer, • Effluent systems ■Casing and Base: Rugged - r • Homes Available for automatic and thermoplastic design provides AGEIf CY LISTING •'Farms manual operation. Auto- superior strength and corrosion , Cwtiao $L&Wxds AswiaGvn • Heavy duty sump mauc models Include resistance. _ • water transfer Mechanical Float Switch ■ Motor (lousing: Cast iron (CSA listed model numbers end • Dewateting assembled and preset at file for efficient heat transfer, in "F" or 'C".) factory. strength, and durability, SPECIFICATIONS ■ motor Cover: Thermoplaslic OwkisNnpsnis09001 Regina ed. FEATURES cover with integral handle and • Solids handling capability: Boat switch attachment points. '/• maximum. to EPO4 Impeller: Themoplas- t Power Cable: Severe duty • Capacities: up to 60 GPM. lic Semi-open design with rated oil and water resistant. • Total heads: up to 31 fee(. pump out vanes for mechanical • Discharge size: 1' /i NPT. seal protection. • Mechanical seal: carbon• ro to ryk e r a m ic- stationary, BUNA•N elastomers. • Temperature: )04'F (40•() continuous METERS , FEET 1401 (60''0 interminent. 10 1 • Fasteners: 300 series �° -- ---' '— —'- stainless steel. _ I - • Capable of running P 9 - dry without damage to a "'- —' r I ' — L •_ z s rT components. 25 M otor, � .... _. �.... -_. . ;-- --°- - - - -...- --• -•• r • EPO4 Sin gle phase: 0.4 HP, Y 115 or 230 V. 60 Ht, 1550 RPM, built in overload with automatic reset 4 • EP05 Single phase: 0.5 HP, Z3 E o I IS V. 60 Hz, 1550 RPM, ' 3 to r built in overload with automaticresel 2 - - 'I - • Power cord: 10 loot 5 lo standard length, 16/3 S)FOW with three prong _ _ grounding plug. Optional 20 ° oo __ t0 z " ao 40 50 GPM loot length, 16/3 S)TW with thret prong grounding plug , m/h (standard on EPOS). z 4 a a tv Iz ` CAPACITY Goulds Pumps 01000 Gq�ldr►ympt �J`• � ITT Ondustries (flrtnc Fo O.—Y. 2000 , l e �oF i2 , II �1 11 11 1 i I 1 I 75 1 1 1 I I I 1 1 28 32.75 1 1 1 1 I 1 1 1 , ,I � � r 16. 3/5 1 1 1 I I 1 i 1 t 1 10 , 1 1 1 I I 1 1 1 1 I I 1 t GAG SIM /TECH FILTIR MU IIURIM BAY (WIN RU BUYI•IC 01Y, Y, 1.11 49112 I- UUU-999 -329U FAX 1- 231-502-7324 SIIVIEEII FINER ASS'Y MAIL PAIE 5005152 J IIUKRY I STF -100 GARY GEMY UMNER UXG 007 GS ve -cDm /Yvvyt d°oo k`1 I . on � r� s�► l (' c��� Y Management Phan Page 9 of 12 Owner Dennis Nelson Parcel # ---------- Permit # Tax ID # ---------- Parameters Your system has been designed for a 4 bedroom home, The estimated Bailey wastewater flow is 400 gallons, This system is designed to handle peak flows of 600 gat /day. The soil application rate of the Rock bed at the center of your mound has a soil application rate of 1,0 gal /day /sq ft. The effluent quality of your system is designed for a biological oxygen demand of 30 -220 mg /L of effluent The total suspended solids which your system is designed for is between 30 and 150 mg /L Your system has aA;;� f ilter in the pump chamber which will keep particles smatter than 1/8" in diameter from entering our mound, These parameters need to be followed to stop early matting in the mound, CONTINGENCY PLAN PART I Should the mound part of your system fail at the infiltration layer of sand and rock the rock and matted sand may be replaced to restore the system to its capabilities, MAINTAINENCE PLAN PART Your system has a saw r � filter in the y pump chamber which will, keep particles smatter than 1/8" in diameter from entering our mound. This filter needs to be cleaned and inspected every 13 months. The following steps need to be taken to clean your filter, 1) Shut off electric power to your system, This can be done by shutting off circuit breaker or unplugging the power cord to the pump. The cord is located in the electric box near the pump chamber, 2) Unlock and remove manhole cover (the cover with 4" pipe) from pump tank, 3) Remove 4" plug from symtex body by unscrewing in counter - clockwise direction, 4) Remove stainless steal fitter 5) Clean Fitter with garden hose pressure 6) Replace in order, canister, plug, cover, padtock and restore power. If you wish to have a person service your fitter call Johnson Sanitation (715)273 -5811 or your local Zoning office for a list of qualified individuals. Management Phan Page 10 of 12 CnNTINGENCY PLAN PART II Your system has an effluent pump that doses your system, These pumps can and do fail. There is an alarm system to alert you if your pump has failed, This alarm is located near your electricatat service panel and has a visual and sound alert devices, Should your alarm go of f the sound device may be shut of f by a switch on the alarm and turned back on after the problem is, If your pump should fail you have a 400 gallon backup capacity in your tank, If you use more than 400 gallons before your pump is replaced backup of effluent in your home is posiiole, Call a licensed plumber immediatly for pump replacement, MAITENENCE PLAN PART II Your system has a septic tank that will accumulate sludge /scum and need periodic inspection, Your tank needs to be inspected every three years. The tank will need to be pumped whenever 5CkAKANh- sludge occupies 1/3 of the tank. This can be accomplished by having the tank pumped upon inspection, The county zoning administration has a list of licensed pumpers in your area. This person should do a visual inspections of mound and controls and general inspection of tank, The property owner is responsible for the operations and maintenenceof the POWTS and submissions of required reports,The quantity and quality of the wastewater stream affect the performance and longevity of your POWTS, The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volumn. The brine or waste from water sof tenners and other water treatment devicesshould discharge to ground surface whenever possible, Thiss ystem is designed to handle domestic strength wastewater, food grease and oil discharging into this system should be kept to a minimum or avoided, Non biodegradable product such as tampons, cigareete butts dental floss, sanitary napkins should not be disposed of into the POWTS, Toilet paper is the only paper that should be disposed into any POWTS, Start Up Prior to use of POWTS check treatment tanks CIWTS INSTALLER Bruce Webster for presense of paint P phone 594 -3080 or chemicals that may Septic Pumper Johnson Sanitation Ellsworth damage dispercement cell POWTS Maintaner Johnson Sanitation Ellsworth If high concentrations Regulating Authority St Croix County Zoning Office 9 are detected have tank pumped prior to use, � 61" 40 O 84" Fn (n � 1 1 1 1 N D r i r Q 4 � ~ I rn i m 0� m 3° 4 rn . i Tyr II. AS rn N h D AJI- Z Z m Z -i S n O r ..1 � oz � rn N 42" -I r D M r - h C N -I > Z r D N Z O O rn c rn i M 7C p > a --a '' r0702�nm� T nj Z�A n�CZ7 9 ➢ D�-6 -- iaD <�rz zZ oF!� o E! rn D �� Lm xo�N =='o �n /1�1 cn c r= cn r1Z Zzz° ��° - r._m r VI m.. > S VI m rnZ rn rn"A , M y0 < -tzrn �' rn v�m> =N C z O W )> rn � 4A --I 0 --� O O 0 CA 4 mrn nv O NMD I4 ruNfTlOr O c �7 Z O O U3 [o r C7 �= D > -q �_ N c m a 0O C -> C 2 Z O A c� O Z r� C Z q 0 p rTl w z N m z A o T 0 0 0 Cp = f J�1 -i _ D N n O l JU r) Z 0 O 7c °o LA O O L1'�] -4 0 ° z ° 0 LA r- (�s� m O� O �r�i p M N O LA r C O rz co S D _ Z o S 4l F-� m Z J M r 9 72 86 0 50" r m I 1 1 1 \ 1 ! m N r 56 1 „ Q m m I ' I 4 " m i I O I 1 1 1 1 / 1 1 N m NI m Z _ T z i L � ,�, � C i C C Dr Z o G G r Z m D r 6 rrl m m C -+ C' C -1 _ Z v �Z �; DC� C' D a:, n �.�,�r - j mD Z nD Z �_ r O r. _ ca p � D rcn p u c, L•i .__� �r Z �n �2 V ➢�z �i z? �� �C = u l l m r v�C �mc �Zcc C) rm z ➢O .. �i.i� ` /gym w mm�O�? N D � �j G o (� b v m� CD K T cx z/ r<,o D ° z �c O l o z< c� O O C� yJO r � z 1 m Fl m �i m y m _ T �n Z p m m z 3 �= C) c m r z. Soil and Site Evaluation Page 1 of 4 �F: ti County St Croix i Parcell ID # Ll 9 O04 I. Pending Applicant Information y .?. CRCir� i�Ul ij%j7 i viewed b Da e 0 Property Owner - Locatl n Dennis and Faye Nelson Govt. Lot SW 1i4 SE 1/4 s 33 T 29 ,NR, 29 v Property e arners Mating ad*'ss Lot • Lock • Subd Name CSM 1224 Cnty TK N 4 City State Zip code Phone City ❑ Village [@Town Nearest Road Roberts Wisconsin 54023 715 749 -3307 Warren 60th Ave QNew Construction Use ® Residential /# of bedrooms 3 Code derived dally flow 450 sized 600 ❑ Replacement ❑ Public or comercial - Sized f or 4 Parent Material General Comments Horing Boring # NorthEast G�i ® pit Ground Surface Elevation 92.6 25 ,i f v' L � Depth to Limiting Factor SaH Applkatlon Raij Horizon Depth Munsell Redox Description Texture Structure cowstano� Boundary R GPD/ ft Inches Color d at done colar rte. Sa Sh Efrin EfF#2 1 0 -3 10 YR 3/4 --- - - - - -- sil 3 of abk m fr cs 1vf 0.5 3.8 2 3 -7 10 YR 3/4 --- - - - - -- sil 2 f ab in fr gs lvf 0.5 0.8 (� 3 7 -23 10 YR 4/4 --- - - - - -- slid 2 f a k m fri gs 1vf 0.5 0,8 to 4 2 -25 7.5 YR 4/4 --- - - - - -- scl 1 f ak ik d s 0`9.' b;8 3 Remarks! L Horizon 3 is close to clay loam on the texture triamole Boring Boring # SouthEast ® Pit Ground Surface Elevation 95.9 Depth to limiting Factor 25 Soli Application Rate Horizon Depth Munsell Redox Description Texture Structure GPII/ ft inches Color m ft oan omr fir. Sz SA ca"d 0nc' Boundary Roota Eff #1 Eff #2 1 0 -4 10 YR 3/4 --- - - - - -- sit 3 of abk m fr cs 1vf 10.5 318 2 4 -9 10 YR 3/4 --- - - - - -- sit 2 f nb in fr gs 1vf 0.5 0.8 3 9 -25 7.5 YR 4/4 --- - - - - -- scl 2 f abk d s gs lvf i Rerlarksi tbte CST Name ` Bruce Allen Webster 715 - 594 -3080 S ignature address date CSTM N3659 Cnty Rd C Ellsworth Wis 54011 220499 eSTM 5501902 owner Dennis Nelson Page property e 2 of 4 9 ❑ Boring # Boring ® Pit Ground Surface Elevatlon 93.9 Depth to limiting Factor 26 Soa AppUcatlon Rate Horizon Depth Munsell Redox Description Texture Structure cOnsistOnCe Boundary Rants GPD /s ft Inches Color ou t: Cant cater r., SM Sh Eff#1 Eff #2 1 0 -4 10 YR 3/4 --- - - - - -- sit 3 of abk M fr cs 1vf 0.5 318 2 4 -10 10 YR 3/4 --- - - - - -- sit 2 f abk M fr gs 1vf 0.5 318 1 (� 3 0 -26 7.5 YR 4/4 --- - - - - -- scl 2 f abk d s 19S 1vf 0.5, • 0's, • � y Remarks: ❑Boring F1 Boring # ❑ pit Ground Surface Elevation Depth to limiting Factor Soil Application Rate Horizon Depth Munsell Redox Description Texture Structure conalatance D,,,,,d, Roots GPD /s ft inches Color au tr cent rater �• SM Sk Eff #1 Eff #2 Remarks: ❑ Boring ❑ Boring # ❑ pit Ground Surface Elevation Depth to Uniting Factor Solt Application Rate Horizon Depth Munsell Redox Description Texture Structure GPD /s ft re inches Color a, t: rt rater �, Catvbtence Boundary Roots Eff#1 .Eff #2 Remarks: North Side Lot on f ence Row 293,64 f eet � 1 o f � 9 end Qj CU 0 Lot 4 d Note 4'offset in cent r of Mound ¢ o c1rcles shown � •� In bed are U 1 from ° �, o � Iron fence °z B2 N post at top 75 ontour o ; of contour o Scale in Feet a U) d -- BB3 W n, 0 2 0 40 2 from cortour Weis r 750 rip Tank U top post 100 V 1 25' from bed BENCH -v 2 to ost 99,48 Weiser 1250 g sep 25' from 2'ND BENCH P Bl 92.6 0 B2 95.9 -P B3 93,9 a pte° O 4- O ► ► _7_ `n 1 — S 0 -F e e -t triangles are approx locations -f-> of previos test Ln Page 3 of 4 Vest side of tot old • fence line Is decernnble • rrr * � • fit EN k r `• • e r A N R o t O Yr l� C I + It I i � C e • O c i ` R o f Way Q C Q� ro rD -PN. 01% O Qo �' ru �7 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owne,r/Buyer A e I S Mailing Address � B ft Alt A 1 2 Property Address ( 6 8 =`1 U �• (Verification required from Planning Department for new constructi C Cigatate bi, lf Parcel Identification Num er 0 4,2 — - S 77 t v LEGAL DESCRIPTION bj Properly Location C '/4, .5 t; '/4, Sec. - 33 T R.IIW, Town of -►�-� Subdivision , Lot # _. Certified Survey Map # - 7 6 Volume � Page # Warranty Deed # ��D �{� , Volume 25 Page # 5 S Spec house ❑ yes W no Lot lines identifiable A yes ❑ 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 mastor plumber, journeyman plumber, restricted plumber or a li cense d pum 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. 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 expiration date. I OF APPLIC DATE OWNER CERTIFICATION I (we) cer that all statements on this form are true to the best of my (our) I mowledge. I (we) am (are) the owner tify s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / d 74 4 IlAtl Atx-eP D ,�, A S, TURE OF PL C API DATE « « « « «s 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 Wisconsin Deparvnent of c ' V f3 V SOIL EVALUATION REPORT page o f Division of Safety and Suildi in accordance with Comm 85, Wis.-Mm. Code County Attach complete site plan on paper not less than 81/2 x 11 Inches Wsize. Plan must s C r D 1 include. but not limited to: vertical and horizontal reference point (6M), direction and Parcel D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Informat ion. Reviewed by Date Personal Infomadon you provide may be used for secondary purposes (Privacy law, s. 15.01(1) (m)). Pr operty Owner Property Location U e n 15 (Z a,r F G Govt Lot 5 �(� 1/4 S 33 T N R E {or)® Property Owner's Mailing Address Lot # • Block # [ �Name or CSW city J 2 Ste -7 Zip code Phone Number ❑ city ❑ village Town Nearest Redd Q o rtS v o L ?�� 7 • 33/ t J r r a v e New Construction Use: Residential / Number of bedrooms Code derived design flow rate 4 S 0 GPD ❑ Replacement L] Public pr Commercial - Describe: Paront material 0 1 a 1. Gl, d( ( n Y � Flood Plain elevation If applicable Y IJ n. 1�_ ` and recommendati `Tn f`f a �� M 0wh� ili2 Sah� SVS�CN� GI l0 c 109.1p F Boring # Boring r l ® Pit Ground surface elev. 0� r, 2 ft. Depth to limiting factor In. Applica Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eft#1 - Eff#2 D- q f '3 It i' Yr► Z y O S dil CA 2 5-51 9, s G M s d o [qq] � Boring 1 Pit Ground surface eiev..1 0 ft. Depth to limiting factor �_ In. SOLI R� Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf K Munsell Qu. Sz. Cont Color Gr. Sz. Sh. - Eff#1 - Eff#2 2 2, 4 -- 5 1 ,2 rw s t i3 2 .4 Y 4 f; _. - Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = SOD _< 30 mg/L and TSS 130 mg/L CST b (Please Print) SI a e CST Number r IS 0 SS Address Date Evaluatiod Conducted Telephone Nurnber 0 2 YA a S ? vC -k 1� t 141 3 11 5 4 2 s s • �I Property Owner p e- n n 5 G 1 S D Paroel ID # Page - Z- o( -4— Soring # . _.... .. -- ❑ Pit • Ground surface elev: 0 3, (O ft. Depth to Urnillnp- :11" .. 4 In.._ Rate Horizon Depth Dornlnant Color Redox Description Texture Structure ConsWAnce Boundary .. Roots GPDW in. Munsell - Qu. Sz. Cont Color Gr. Sz. Sh. 'Eftt 'ElW c 2 l o -a 5 0 3 al-9 o s o. 4 42.4 S o Boring Boring # Ground elev. ft. Depth to limiting factor h. C3 p surface Son Application Rate Horizon Depth Dominant Color Redox Description Texture Structure, Consistence Boundary Roots GPD/tf In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'E02 ❑ Boring # ° Boring ❑ Pit Ground surface elev. ft. Depth to "ft Fedor h• Sol Appl ication Rate Horizon ' Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G PDff In. Munsell Qu. Sz Cont Color Gr. Sz. Sh. 'Ef 1 • Effluent #1 : BOD, > 30 1220 rng1L and TSS >30 150 mg& ' Effluent #2 = BOD 1 30 rna& and TSS 130 rng& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. sao.u�o tR�) o` YV � PL 1�5 30-1 S t �n m 0 C a - 83 j +' 2 Top Sp, A \ y 105.5 ' 4 <1 s2 - QM ✓ r� 4' T O to © 7' ' ® g r ............... 0 Li:{.i:i.i ••i: 1I 1' •I:1: '1 :1:141 [� 14 1:14 : 1; 1:1:141 ;d.1;1 1: 1'1;1: •1:1:1• '_ [5� �� t'{ � 1 6 N.- 1 9 V— 1 :1:6:1 .1;1:1:1:1:141:I:I:I:I 0 S I:I:I:I:I:I:CI:I;I:C1;1 1:1: I:I:I:I:I:I:I: Y.CI;la :laa 1 19 r.j 4y,,� I:cccCl: o •1• 1:1:1:1: 1:1 1" 'l : Ct p(;� :cralaYia :r. l: � :1:1 • :I:Ia41:1: :I' 1 1•ra a:laaaaaa:l:l: i:l krr _ 0 V=cuvd ii��l :ia N •1:1:1:1. 1:1:1:1: :r.r.l:cr.ccr.la : r. b •1:1:1:1:1:1 Q :1:1:1:1:1:1:1:1:141:1 0 A •1 :ri :l :l :l :ia :i :fa -. •1:1:1:1: ... 1:1:1:1:1:1: 0 I:IU :I:1 1:1:1:141:1:1 '1;1:1: 1:1 '1:14141:1:1:1:1:1:1: '1:1:1: !:I 1:1:1:1:1: I :Ia :laaa :laa 1:1:1'1 '1:1:1:1:1:1:1: :1:1:1:1:1.•.1:1:1:1:1:1:14 I:I:I:I:I , - :I:1:1:1:1:1:1;1:1:1: ■ 1;1 ;1:141; I:I:I:I:CI: 1:1:1:1 ' 1 :141 :1 :1'1 :1 :1 :1'1 :1' C I •I;I :r.r.i :cc •1414 :1: i 1 •1:1.. •1 e ® ) o e�lu o j �1 r i _ 4 � J t 42 �'� I • _ -iii r � %T I - f .` � ' } I i t _'_' i � � i f - ...1 ...._, 4 t- _t�_5_- +- �.���� _._.__i � � i .�• _J ' - -y �T' t i �.:,.._. -'--� '._._; _...� I -- .- ____ -_. [ t f 1 119 1 _ V 2 5 8 1 1 1 7 '64264 � PP KATHLEEN H. WALSH REGISTER OF DEEDS ' STATE BAR OF WISCONSIN FORM 2- 2000 ST. CROIX CO.. MI RECEIVED FOR REGARD Document Number WARRANTY DEED 05/2812004 11:30AM THIS DEED, made between Dennis R. Nelson and Faye F. Nelson WARRANTY DEED a/k/a Faye Nelson, husband and wife, Grantor, and Anton D. EXOPT # 8 e Nelson, husband and wife; as Survivorship Marital Property, REC FEE: 13.00 rante TRANS FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: CC FEE: the following described real estate in St. Croix County, State of Wisconsin: PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Edina Realty Title, Inc. Exceptions to warranties: 400 S. 2 St. — Suite 115 Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 433961 Parcel Identification Number (PIN) This is not homestead property. Dated this I n d 14 p1 Dennis R. Nelson * Faye F el son atk/a Fa elson * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) COV1`�TY 4F 7-� authenticated this DiAVE (!1 GtC ) ss. Q Personally came before me this a day of P M. � onsin * Z the above named Dennis R. Nelson Ad Faye F. Nelson alk/a Faye Nelson, husband and TITLE: MEMBER STATE BAR OF WISCONSIN wife to me known to be the person(s) who executed the (If not, foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Dennis R. Nelson Notary Public, State of Wisconsin 1224 County Road N. Roberts. WI 54023 My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) -- *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 M V _2589 P 156 EXHIBIT A Parcel 1: Lot f Certified Survey Map filed May 26, 2004 in Volume 18 of Certified Survey Maps, Page 475 5, as Document Number 763923, _ being Lot 3 of that Certified Survey Map recorded in Volume 12, Page 3293 of St. Croix County Certifie urvey Maps, located in part of the Southwest'' /, of the Southeast '/,, and a part of the Southeast' /. of the Southeast' /, of Section 33, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, AND: Parcel 2: Together with a 66 foot private driveway easement for ingress and egress purposes as shown in Volume 18 of Certified Survey Maps, Page 4755, as Document Number 763923, being Lot 3 of that Certified Survey Map recorded in Volume 12. Page 3293 of St. Croix County Certified Survey Maps, located in part of the Southwest `/ of the Southeast' /., and a part of the Southeast'' /. of the Southeast 1 /4 of Section 33, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. �I • 3 i 76 3`23 VOL 1� PAGE 4755 KATHGEEH ST. CROIX Co. V11 CERTIFIED SURVEY MAP RECEIVED FOR10ECORD Dennis R. and F aye Nelson CERTIFIED SURVEY MAP Being Lot 3 of that Certified Survey Map recorded in Volume 12, Page REC FEE 13.00 3293 of St. Croix County Certified Survey Maps, located in part of the COPY FEE: 3.00 Southwest % of the Southeast %, and apart of the Southeast Y4 of the PAGE 2 Southeast % of Section 33, Township 29 North, Range 18 West, m Town of Warren, St. Croix County, Wisconsin. i o 1 I OWNERS ADDRESS ° 8 1224 COUNTY TRUNK HIGHWAY "N" -LQ' 1, - CEI?TJF_JEO S-UR- f EY MAP, y I ROBERTS, Wr 54023 VOLUME 4 PAGE 9.12 NORTH 114 CORNER SECTION 33, T 29 N, }�; g 2 (R = N 00 ° 21'10' W) R 18 W (FOUND COUNTY 1� 8'6� ( - N 00 °02'50" W 5220.90' - F0 � (NUM N 00 1059.28' x - N o0 °02 50" w 4161 408BY —X 17 .ar WEST UNE LOT 3 58478' � NORTH-SOUTH 114 100 cc X - 650.78'- •+ p 44 SECTION UNE co ;m r- 34 �� Q n �y y m SETBACK UNE y x O p v� R1 N °' N co 383.14' 408.50° 4t � C �2 ------ S00°03'21 "W -791.64 . ______o, 66' WIDE PRIVATE DRIVEWAY EASE FOR INGRESS AND EGRESS C - - — _.— _ - - - - -- ----- - - - - - -- 2c„ N00 °021 "E 791.64' X 0gY1 T y r � 'R7 ;0 O �� S -- - -- - -- ;oa"�'m 'N ,3 ' t SETBACK UNE 2 y 100' 373.70' ' '• j S 01 °05'20" W 49 71 OT EAST i D• O 0� o P LA NOS, b >c 'c 'c7 °'� a w u' .c ° ', f17 y y 0 �� c) i ,§ Tl C n ° 2- Or, o m� lz'J eu�, � ^ G TI O n O O oo v� A N i`� w �y rti �m c� co rn C9 '0 ;N xtt �n z o '' jA Z ° O � m � � V _ � $y -1 W `^� O o n m ° A v z�, Z o� O m tTl ;w I; T ° cn n m m� o o d t" o �� y� a -* UNPLATTED_LANDS 70 a � x ° N O ;Z • o r"i cr I 3 0 �� o> �O- D c b� m z o� o n N o `Q Cn ; 7 ch ti 6.6' �n � c 0 1 ; w �, n zn 21 ! I i< 1 111 :-4 m C i a 1 iI z 'APPROVED !� ;m ;0 ST. CROIX COUNTY ;M �� 'OD X09 Zoning and Parks Committee rn a 0 o y MAY 2 6 2004 o �y ;R, ; m S���K o recorded within 30 days of Z $i z o o C• �3 w $ approv approval shall be r, c o t �+ ----@+ '� null andwdd C') $ Z m _ rn ,�Sj UN4=,S /4 _ Q_ _ _ _ EAST LINE LOT 3 „ � /A _ STA T,E _ C08 LAURENCE °" �• 0 ' * : MURi * 7 /FIEp�� � •!_y_ %Gy � 8J66' R ss �,• h' UNF :- 13 e BELDENVILLE,e �0 VQC(1q j �8 A� " ; 1 gs ti'Fp .LAN •SJ�, D ATED: MARCH 8, 2004 QrIF � p � , ¢t i �' G A�? THIS INSTRUMENT DRAFTED BY JERALD L. LARSON .9 SHEET 1 OF ..Zr Vol 18 Pagc 4755 II I , .. s • � 1 l / I V t 1-D i O - I � .. •..,• � ��c7vAr >f 2� j I DOCUMENT NUMBER 6 � _7 O 3L KATHLEEN H. WALSH WAnRUrr Dsr.D R: G:(STER OF DEEDS T.. CROIX CO. , WI RECEIVED FOR RECORD Dan L. Nelson and Jacque L. Nelson, husband and wife, Grantor, conveys OS - 18 10:00 An warrants to Dennis R. and Waye Nelson, husband and wire as survivorship marital property, Grantee, the following described real WARRANTY DEED estate in St. Croix County, State of Wisconsin: EXEMPT # 13 CERT COPY FEE: All of the Southeast 1/4 of the Southeast 1/4 of Section 33, Township COPY FEE: 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, TRANSFER FEE: ly ing Wester of the R.O.W. of S.T.H. ••65^ as it RECORDING FEE: 11.00 y g y presently crosses said Southeast 1/4 of the Southeast 1/4, EXCEPTING THEREFROM, the PAGES: 1 Northerly 15 rods thereof, being subject to easements of record. NAME AND RETURN ADDRESS G Joseph D. Boles !/ P. O. Box 138 River Falls, WI 54022 -0138 Part of 042 - 1094 -60 -000 Parcel id N er This is not homestead property. Exception to warranties: '• All easements, restrictions and rights -of -way of record, if any. Dated this 16th day of January, 2002. (SEAL) (SEAL) Dan L. Nelson (SEAL) ^Q �� (SEAL) Ja L. son AVTAZNTICATXOH ACKNOWLZDGMNT Signature(s) STATE OF WISCONSIN ) ) as. Pierce COUNTY ) authenticated this day of 20 Personally came before me this 16t day of January, 2002 the above named Dan L. Nelson a Jacque . Weison (sienacuraf to me k n be the arsons ) who •tJ�e fore goi in trument a d ack ledg' 0 3 (Mama Printed er T—dl TITLE: MEMBER STATE BAR OF WISCONSIN M - si natur (If not Debra A. Cernohou a Y V r T authorizes by $706.06, Wis. state.) • M •�I THIS INSTRDlEENT WAS DRAWTED BY: Notary Public Pier .S e c a�tnty;e�tis. Joseph D. Boles My commission is permanent. (If �;.� pir ion date:) Rodli, Beskar, Boles & Krueger, S.C. P.O. Box 138 November 13, 2 •• River Falls, WI 54022 3 T I LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1094 -50 -235 Parcel Number 33.29.18.522B -35 OWNER NAME: First DENNIS R Last NELSO PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 1154 60TH AVE SECTION 33 TOWN 29N RANGE 18W %160 SE 1 /440 SW Line Description Line Description TOTAL ACREAGE 24.409 PLAT CSM 12/3293 LOT03 BILK 01 SEC 33 T29N R18W PT SW SE 15 02 BEING LOT 3 CSM 12/3293 16 03 (24.409AC) INC ALL SE SE LYI 17 04 NG WLY OF ROW OF HWY 65 EXC 18 05 THE NLY 15RDS 1 06 20 S vtJ 07 21 08 22 09 23 10 24 �g� 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, 177- Valuations, 178- History, F10 -Exit GENERAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR01 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1094 -50 -235 Parcel Number 33.29.18.522B -35 Claimed Date Re- certified / / Relate Number: OWNER NAME: First DENNIS R Last NELSON CO -OWNER Mailing Address 1224 CTY RD N City ROBERTS State W I Zip 54023 - Type Vol Page Doc # Rec.Date Type Vol Page Doc # Rec.Date HISTORY AFF 1818/ 205 668702 01/18/2002 WD 1818/ 204 668701 01/18/2002 PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name- Type SD Apartment Post Office 1154 60TH AVE School District: 2422 - ST CROIX CENTRAL Special District: (1) 1700 - (2) - (3) - W ITC Plat Code: Last Changed on: 10/28/2002 Book Number: 1 SECTION 33 TOWN 29N RANGE 18W '/160 SE 1 /440 SW Map Number: 00 - Sales Area: Parcel Control 0 TAXABLE Number of Units: ZONING: Permit Number: Type: Bank Numbers: F4 -Prev, F5 -Next, F6- Legal, F7- Value, F8- History, F10 -Exit, F12 -More [ 6 — cot,) W0.rretJ :."!. t1 Fl �997 � 56184' es CERTIFIED SURVEY MAP sl� DENNIS NELSON Part of the Southwest 1/4 of the Southeast 1/4 of Sectiona, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. • 1" iron pipe found. owner ' s Address: "Fence Ote4 -4 1224 C.T.H. "N" o 1" x 24" iron pipe weighing 1.13 lbs./lin; -�E4 Lq Roberts, WI 54023 ft. set. o UNP L AT T£_D LA � „ Dated: March 26, 1997 ^ ��, „ oo•o6'37 •w 381.71 ` ,� �� Revised this 21st - t. $ 'r day of May, 1997." N s E 1.1E SWI14 SE 114 Q O LAUR NC E ' 0 • W M H ac vs I h h S 73 �•'� W o VI N �? r land Surveyor FALLS,; Jk/ lu ` a W e wisc..Q LAND ��'' m BI e W. Murphy h ° o UN LA R Q o W Q S O /' 03' 20 •'W 43S.711 I h q 3 o q I 373.703 6. /• ? zt %!I t��' p O h 8 Q t O I t. 4 N N b b t'% w a O. `^ I ` ..) R h 373.70' • h 6.OI N Q b Q. N R ^ % NO /'0 ?'20 "E 4 9.7/' 3 (l 0 j q'^:h i ss•oto 4 I V O b h N i ALL BEAR /Nes REF. ro THE SOUTH LINE OP rHE SE 114 OF SEC. 33, ASSU.WEO N 90 • 00'00 - W V O a �44 O C This instrument drafted by Laurence W. Murphy O 8 416/.61' /019.19' f I W N 993.28. 166 0' V NIS 114 LINE NOO.02'10 "W 5210.90 R1N00121110 "Wl h O LO .1, C S: M. , V01- P A S E 912 z 4 q 4 Curve Data: Chord Bearing - S 10 "W, PREV/011SL Y RECOROEO OArA Chord Dist. - 239.31', Arc. Dist. - 239.41, Radius - 2362.01', Central Angle - 05 0 48 1 27 11 , 1 st Tan. Bear. w a S 12 ° 59'02 "W, 2nd Tan. Bear. - S 07 ° 10'35 "W o` SHEET 1 OF 2 h � � Volume 12 Page 3293 4 ( S VOL PAGE 4755 KAT RLU15TER OF DEEDS � r T ST. CROIX CO. MI CER RECEIVED EI� S FOR kECORD TI�'IEI� S 05/26/2004 10:25AK Dennis R. and Faye Nelson CERTIFIED SURVEY MAP Being Lot 3 of that Certified Survey Map recorded in Volume 12, Page REC FEE: 13.00 COPY FEE: 3.00 3293 of St. Croix County Certified Survey Maps, located in part of the PAGES 2 hwest % of the Southeast %4, and apart of the Southeast % of the Southeast %4 ofSection 33, Township 29 North, Range 18 West, _ wn of Warren, St. Croix County, Wisconsin. 1 - 23: OWNER'S ADDRESS LQ-T j, QE8TJFlE4 - S.0- fEY-1NAP, �4 1224 COUNTY TRUNK HIGHWAY "N" f 54023 V__Q�11_ME_4._PA_ 912 NORTH 114 CORNER y ROBERTS , SECTION 33, T29 N, 'a' X R 18 W (FOUND COUNTY z (R = N 00 "21'10' M BERNiSEN ALUMINUM r 11 :2 - N 00 °0750" W 5220.90' - rg MONUMENT) 3 N 00 0 02'50" W 1059.28' J-- + Nao°o75o•w a16t� , "r T WEST UNE LOT 3 584.78' �n �•W NORTH-SOUTH 114 100, -650.71 - t> Z to C1 In o x 4# S C zE UNEV to z n - .m I0 113r, �t- Dao •p.m aO '�l ' 1 113 C C y x A �~ O Z I y m _- SETBACK UNE _ _ _ Z v > 408.50' 4 + c o �'Q S 0 W 791.64' _ _ _ • - 66' WIDE PRIVATE DRIVEWAY EA SEME N T F INGRESS AND EGRESS C ' Ito, 10- (> -- --- - -- _ N00 °021 "E 791.64' — -- —� x * 0 O�tr R� k ?► C ma y 33 I SETBACKUN y y 66 01 I 100' 373.70' Q n m m s S 01 °05'2 " W 439.71' EAST uNE I D• O o m y LOT 3 �� C� Tn O m UNPIAT -TED; b w �Z n �' a 1 1 0 0 z "M i� ','�� ;C Zu J IA v � Z p A z v � rt`I tTj m iRl wo •'` $ c i `�'c' zo d vN ,D rn _ rc z O O a ru vt a i� "' z m w= - X 6.6' 'n $ o I t D �� z 2 iQ ;i, 'APPROVED ,rn i rn �- ST. CRolx COUNTY •O g z' .� u ;O Planr*v Zonino and Parks COMMW164 'M 20 MAY 2 6 04 z I ;C S ETBACAL ' rn rn z ;< I- rscordsd within 30 days of z I ° app approval shall be $ 'rX m null and-Vold :X(* �+ M TLJikS -SE114 _O - - -N -- - EAST UNE LOT 3 v *� n g �� CONS� ST f .• ° �. E) .� LAURENCE'• 40 � y �•�e1,6 10 " * ; �� P,l°n✓ : � - �oR__T /F/ EDP' 11 _R166 YMA/;NP491T��!�!l�Y,4,�Y • BELDENVILLE Q FO D ATED. 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