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HomeMy WebLinkAbout008-1025-30-000 - k ' ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Property dress City /State >� n �L.� �. S�l oo.a :s ��' CO �RO� _ 9 Legal Description: ZOAQ o cE Lot lock Subdivision/CSM # �' /a 1 ' /a, Sec. , TaN -R�W, Town of PIN # SEPTIC TANK — DOSE CHAMBER -- HOLDING TANK INFORMATION: i Tank manufacturer SizePC ji O_ Setback from: House,`C- Well P/L Pump manufacturer Model 36 71 Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Al Width �5' Length Number of Trenches Setback from: House_ Well P/L Vent to fresh air intake /lJ'' ELEVATIONS Description of benchmark e� ('cr_e_ /�, j &��� Elevation '0529, v Description of alternate benchmark - � Co Pl-- Elevation Building Sewer ST/HT Inlet ST Outlet f2 PC Inlet 2 8 PC Bottom 3 Header/Manifold Top of -OWPC Manhole Cover !® � Distribution Lines ( ) •���� () ( ) Bottom of System Final Grade () () ( ) 7 6 Date of installation / J � / Permit number 3' -� State plan number Plumber's signature License number Date i. Inspector Complete plot plan � IX I N TIC P1easi gW%rj4gjh * ;P}1 f. ing: • A 1 view sketch showing everything within 100 'the system. ( Tw� horizontal reference points to center of septic tank manhole c r. • SHo�b alternate benchmark, if e cable. - Owner'. enn;s c, - Sor) PLAN VIEW X57 2 33 c� 5f Li S S/doz Locaf,o . SEy�rIcJ %q Sce. 9, - 772B It., R. /!o u1 7m, of Ca Ca &E, 5t . L' ro,' (V, r a 10 ,233 mod r�` Se���iC b)-, / C 3 �JQLJ^pU,�J[ L2.� SL'/��i'L'lc 100 MZetc rer'MCntS aF /CS %cic/7CC f Comm. e3.1S(y)1.b. f _ 4 J "l�j BQn 1 r�� T aP D�' en-E.e Sfab a4. �arac�c c�/: A ssu►+�•td e 1,0 = i Qa• cm: 17� 5!\ed • X13' i'nq ,o,gv. /:ne � OJP o'of'.2 "Sc1.. 0/0 Pale. + r t"" INDICATE NORTH r OW i Pr e d s �� e�platt►,1ant . 8-1 S .z I' m 0 w Yld 5 Y 6 Gh1 � ��o�ibi'Elc� .(�i5r�icr.banCe. .Qr^Cci �+ i 7 o 0 s 3 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety apd Buildings Division INSPECTION REPORT ST CROIX ',SENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)], 353102 Permit Holder's Name: ❑ City ❑ Village M Town of: State Plan ID No.: PETERSON, Dennis EAU GALLE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: d0 Ov 008 - 1025 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �N Q�j� Benchmark t 3 Z 0 i Ud Dosing " /j ? J. 10 /() -r ration Bldg. Sewer ? Flo g St /Ht Inlet _� ? TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet �p pp ir l �"•bv Septic '> 5" r 71 /0 r NA Dt Bottom 11,3 9 .3 0 Dosing > }0 - 4 , 0 NA Header / Man. • 3 '� g p , 32 AeWjon Dist. Pipe 6 O0 . L$ RaM_ ing Bot. System (p.0� `f q. 6 Z PUMP/ SIPHON INFORMATION Final Grade (� Manufacturer Demand �L $, •0 Model Number (( T fO GPM TDH Lift +�� q Friction. Sy a TDH g-3 Ft Loss Forcemain Length 50 Dia. Fa t ` Dist. To Well SOI ABSORPTION SYSTEM A , Wfl TRENCH Width - r Len th / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN I N b 5 DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LE anu acturer: SETBACK INFORMATION Type O r ► � HAMBER Moe System: �� 7 /f(� OR UNIT DISTRIBUTION SYSTEM Header/ anifold y Distribution Pipe (s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length s ]v Dia. L Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) EAU GALLE 9.28.16.128B 457 23 d Street ae PA_ �oMnnT� �2te.r<e+i�, 1416/ w115 � P ccr� . r� w � c � .� �' — s �Aaision ? ❑ Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No. , ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: 4­­ .... ... .. a 7 4 i F F � oea F t } L E # g � € m s € c g a i t S E i gm, v ... _..., �. ...M� ....... _.� p ...�. _ ...,. ... _ ... .. .... .... .., a .... e f a F t ,, --- d a a r < F a a a g a _ F f F e e f P T F .�. _..am.. a t } e 3 , ......._ ;..m. .......,,,,.e ... a....N...._ ._ z _... d -.. ,.,.w... e., m .., ,....., e e.. .._ .... � .....q, �. w�..,..m..m� a 1 Vi Safety and Buildings Division S�conSin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 - 7302 • tAttach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ST CROIX • See reverse side for instructions for completing this application State Sanitary Permit Number 3S o Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application (Privacy Law s. 15.04 (1) (m)). qS T pZ3 - S_ r q_ <l State Plan I.D. Number Site ID 1 31 I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Trans. ID @jjjZI(/ 233459 Property Owner Name Property Location DENNIS PETERSON SE 1/4 NW 1/4, S 9 T 28 , N, R 16 1 10*1 W Property Owner's Mailing Address Lot Number Block Number 457 233RD STREET N/A I N/A City, State Zip Code Phone Number Subdivision Name or CSM Number BALDWIN WI 54002 (715)684 -3645 N/A PE rt ILDING: {check one) State Owned � � N r st a e Road Public 1 o r 2 Family Dwelling - No. of bedrooms —1 Town OF EAU GALLE 233 STREET III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 008- 1025 -30 -000 � 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2 ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ........ System __________ ___ Tank Only Existing xsting System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 C] System-In-Fill - „� 4 �} , `7 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 450 375 375 1.2 N/A 100.70 Feet /d.7,7 Feet Capacit VII. TANK in Ca allo g Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name concrete con Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank ai•� nk 1000 1000 1 ❑ ❑ ❑ ❑ ❑ ❑ 1 urrpTa r 750 1 1 750 1 1 MIDWESTERN PRECAS [ ❑ ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb 's Signature: (No to s) MP /MPRSW No.: Business Phone Number: BENNIE HELGESON 20292 715/772 -3278 Plumber's Address (Street, City, State, Zip Col e . W1229 770TH AVENUE, SPRING VALLEY WI 54767 !X. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate l ssued Issui gent Signature (No Stamps) E�Approved E] Owner Given Initial � � Surcharge Fee) LI? Adverse Determination /dl� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1 _ A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property -owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the 9 9 p P system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV T f rmit. Check nl one on line A. Complete line B if permit is for tank replacement, reconnection or repair. • ype o pe C c o y p p p p V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX_ County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with dimensions, location of hold i ng septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information- -------------------------------------- 7 ------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 TDD #: (608) 264 -8777 �sconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 09, 1999 CUST ID No.268093 ATTN.• POWTS INSPECTOR ZONING OFFICE HELGESON EXCAVATION INC ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 09/07/2001 Identification Numbers Transaction ID No. 233459 SITE: Site ID No. 175431 Site ID: 175431 1 Please refer to both identification numbers, St. Croix County, Town of Eau Galle above, in all correspondence with flee ageity: SE1/4, NW1 /4, S9, T28N, R16W Facility: Dennis Peterson Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 476774 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of ch. Comm 83, Wis. Adm. Code. If it does not conform a state approved tank must be installed. 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 06/21/1999 C� FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Oerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us WiSMART code: 76 ,3 4 I � ■ MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET Project Dennis Peterson 3 bedroom residential mound Owner Dennis Peterson C� .� •T'�' C.'o n gift ll y Address 457 233rd Str e et if ED Baldwin, WI 54002 nF V RC M COR K D pUILUIN Legal Description SW1 /4NW1/4, Sec. 9, T.28N., RAW ON�ENCE Dlv Township Eau Galle County St. Croix Subdivision Name Lot No. Parcel ID Number 008 -1025- 30-000 RECEIVED Plan Transaction Number JUN 17 1999 Index and title sheet Pagel SAFETY & BLDGS DIV. Mound calculations Page 2 Mound drawings Page 3 Pres. disc. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 Pump performance curve Page 6 Site plan Page 7 Attached soil evaluation report Page 8 Designer Bennie Helgeson License Number 220292 Signature Phone No. 71- 772 -3278 Date 6/01/99 Notice Tampering with this file by unauthorized persons Is prohibited. Deliberate modification will result In disciplinary action under s. 145.10, Wis. Stats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). SBD- 10462 -E (8.05/98) Page 1 of 8 3 I MOUND SYSTEM DESIGN I Complete red boxes as necessary. 1000 gpd maximum design flow. Inch- pounds Metric Residential or commercial? r (r or c) (y or n) y Replacement system? Creviced bedrock site? n (y or n) Slope 6 % Il Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 27 in 68.6 cm In situ soil infiltration rate 0.6 gPd/W 24.4 Lpd /m` S`' Contour line elevation 99.7 ft 30.39 m Use standard fill depths? x epth? in cm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design rill depth. Center or end manifold c (c or e) Hole diameter 0.25 in 0.125, 0.156, 0.188, 0.219, 0.25, 0.281, or 0.313 inch oniv. Lateral spacing 0.00 ft Use 0 lateral spacing for trenches. Estimated hole space 2.50 ft Not a final calculation. Number of laterals 2 Pump tank elevation 94 ft Outside bottom of tank. Forcemain length 30.0 ft Forcemain diameter 2.0 in 1.5, 2, 3 or 4 inch only. 2.067 in Actual I.D. HOLE DIAMETER CONVERSIONS 1/8 = 0.125 1/4 = 0.250 SYSTEM SOLUTIONS Inch-pounds Metric 5132 = 0.156 9/32 = 0.281 Estimated daily ow 450 gpd 1703 Lpd 3116=0.188 &16=0.313 y 7132 = 0.219 Absorption cell Design load rate & area 1.2 gpd/fe 375.0 W 34.84 m` Linear loading rate (LLR) 6.00 gpd /ft 74.4 Lpd/m Design width (A) 5.00 ft 1.52 m Cell length (B) 75.0 ft 22.86 m Depth of cell (F) 9.5 in 24.1 cm Sand filter RECEIVED Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 15.6 in 39.6 cm Basal area required (gpdrinfiltration rate) 750.0 ft 69.68 m SUN 1 7 099 Supportin components SAFETY & BLDGS DIV. Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (l) 10.33 ft 3.15 m Up slope toe length (J) 7.10 ft 2.16 m Down slope toe length (1) 11.30 ft 3.44 m Total mound length (L) 95.66 It 29.16 m Total mound width (W) 23.40 ft 7.13 m Project: Dennis Peterson 3 bedroom residential mound Transaction Number: Page 2 of 8 I MOUND PLAN VIEW observation pipes (typical) F 23.4 ft . . .::.....' A A= 5.00 ft 1.52m 7.13 m ; : ; • .....:.:.. B = 75.0 ft 22.86 m W B J= -- T1 - 0 ft 2.16m K 1= 11.30 ft 3.44 m K= 10.33 ft 3.15m _ 95.66 ft 29.16 m typ. obs. pipe (anchored securely) I = down slope dimension' = absorption cell (AxB) J = up slope dimension = plowed area (Lx)N) K = end slope dimension 6" (152 mm) T MOUND CROSS SECTION D = 12.0 in 30.5 cm lateral topsoil G H subsoil cap E = 15.6 in 39.6 cm invert 101.20 ft - -- - -- - - -- - ....... F - 9.5 in cm elev. 30.85 m :: :: F J G= 12.0 in 30.5 cm T ASTM c 33 H = 18.0 in 45.7 cm D and Fill E Sys. 100.70 ft elev. 30.69 m 99.70 ft contour 30.39 m elev. 6 o ---> Ck. *- S.W A*4-- slope D = upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media will consist F = absorption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered across AxB media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: - - J�IV � � •l�a�i9 SAFETY _ o oU) lr_c n �V, Project: Dennis Peterson 3 bedroom residential mound Transaction Number: Page 3 of 8 ' M PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch-pounds Metric Width (A) 1 5 Ift 1 1.52 Im Length (B) 75.0 ft 22.86 Im Lateral specifications Number laterals 2 Holes/lateral 14 holes Lateral length (P) 36.00 ft 10.97 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 16.31 gpm 1.03 Us Sys. dis. rate 32.62 gpm 2.06 Us Hole spacing (X) 32 l in 81.3 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) Place X in red X' one choice 1 114 in (32 mm) x box of chosen from the options 1 1/2 in (40 mm) X X diameter. provided. 2 in (50 mm) X 3 in (75 mm) X Manifold diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) X' one choice 1 1/4 in (32 mm) None required. from the options 1 1/2 in (40 mm) No choice necessary. provided. 2 in (50 mm) 3 in (75 mm) 4 in (100 mm) Distribution system contains: 2 Lateral(s) LATERAL DIAGRAM - CENTER CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. P end cap I (-X--4J<-x127 ` x12 ` Laterals & force main of PVC Sch 44 Last hole drBled next to end cap (per CON" Table 84.30 -5) Holes drilled on the bottom of the lateral, s = permanent end marker equally spaced Inch-pounds Metric Lateral length (P) 36.00 ft 10.97 m Lateral spacing (S) 0.00 ft 0.00 m Hole spacing (X) 32 in 81.3 cm Manifold length 0 ft 0.00 m Hole diameter 0.250 in 6.4 mm Lateral diameter 1.50 lin 40 mm Forcemain diameter 2.00 in 50 mm Project. Dennis Peterson 3 bedroom residential mound Transaction Number: Page 4 of 8 I TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 5.90 ft 1.80 m Are laterals the highest point in the Friction loss 0.54 ft 0.16 m system? Yes ~x" here. Total dynamic head 8.94 ft 2.72 m If no, what is the highest elevation Dose Volume downstream of pump? Dose is > 10 times lateral volume Forcemain drain Lateral void volume 7.6 gal 28.8 L back to tank? (x" " one) Minimum dose 112.5 gal .425.9 L x Yes Drain back 5.2 gal 19.7 L No Dose volume 117.7 gal 445.5 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with weather proof warning label and locking device grade levels junction b grade levels ' disconnect afternate 4" vent pipe electric as per NEC 300 and E — outlet Comm 16.28 WAC \� location 19'(46 cm) min. wail of pump k— approved chamber or a outlet joint combination tank A Provide 114" weep We or anti - alarm on siphon device as necessary pump on B T Grade levels PUMP 95.3 ft C W - pump tank manhole = 4"(10 cm) Off elev. 29.0 m minimum above finished grade D - vent = 12" (30.5 cm) minimum above finished grade 94.0 ft Pump tank elevation 3 " (75 mm) of bedding under tank 28.7 m bottom of tank Tank manufacturer n5O.751gal tern Precast 750 gal. Pump tank capacity 19.5 galfin Pump tank volume Pump manufacturer JiSoulds Inches Gallons Pump model number 3 f 71, EPO411F o A 18.5 360.1 B 2 39.0 Alarm manufacturer IS.J. Electro systems C 6.0 117.7 Alarm model number 1101 HW C) D 1 12 1 234.0 Project: Dennis Peterson 3 bedroom residential mound Transaction Number: Page 5 of 8 H MODEL: 3871 Submers SIZE: 3/4" SO LIDS Pump Cff- 0 Effluent METERS FEET 8 25 7 — Uj 6 20 2 5 z 15 z } 4 — 0 — J o 3 a a� 2 5 0 0 10 20 30 40 50 GPM C.�ti'1 c�rre�0 0 2 4 6 8 10 12 m /h CAPACITY [QGOULDS PUMPS, INC. SBZE{A ! -AU5 WVV YM 8148 Effective October, 1988 ®1988 Goulds Pumps, Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A. So; I ©bscrda-Eian I�; t ,ztd.Sl4 i Scale: / E O wn -e oe.nn;s (7eAexsoo -/S7 2 33 = ` 5f - BaCc�cJ %n, c�.)l. S ydow Locaf;on SEY�nrJ�g -kc. 9 T. ?8lr R, lf 7N, 0 /' 6 " CafGe, st .233 �d :St C�.�S�Inq - --� �XrS� n� I,U f gat Je��... nX. / b O I t J ,j Le ka n7C 3 ed r oa. � IZo �e �A Zoo M 2 c�S re fCi re rnsrr fS e F /e5idcr/cc I Comm. i benc.l. rIC Top Of Cohen Ee ff 57 ni -�J 3035/ S(a6 a { °�`5 `or Assaw�td & u e,16 No I �o y(i.S��nR Sysferl 5 e —� �Pwm�o�a,wbu: cloo �.r-- P,, ed 8 _ r ■ � c'e�plo�c.tw ntowrid S Y tf cw\ 7 oc i Wisconsin SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8 x 11 inches in size. Plan must County include, but not limited to. vertical and horizontal reference point (BM), direction and St. Croix_ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. -- -- _- - Parcel I.D.# 008 - 1025 -30 -000 APPLICANT INFORMATION - Please print all infortnation" - -- -- - - - -- — - - -� - -- Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Reviewed By Date Property Owner Property Location Dennis Peterson Govt. Lot SE 1/4 NW 1/4 S 9 T 28 N,R 16 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 457 233 Street NA NA NA - - -- - - - -- --- - - - - -- - City State Zip Code PhoneNumber [] City 0 Village (Town Nearest Road Baldwin Wl 54002 715- 684 -3645 Eau Galle 233 Street Ll New Construction L-1 Residential 1 Number of bedrooms 3 L]Addition to existing building Use: 1 Public or commercial describe T _ ;�� Replacement [ � Code Derived daily flow 450 gpd Recommended design loading rate 5 bed, gpd /ft .6 trench, gpd /ft Basal area required 900 bed, ft trench, ft' Maximum design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Recommended infiltration surface elevation(s) 99.70' at 12" above 98.70 contour. ft (as referred to site plan benchmark) Additional design I site considerations Mound site located on propoerty currently owned by Maloy Monicken and is being purchased by Peterson. Parent material Glacial till. Flood plai n elevation, if applicable NA ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system [] S C� U C S❑ U U S H U 11 S � U O S N U O S N U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots -- _ -GPD /ft2 Boring# Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -9 10yr3/3 None st 2fcr mvfr as 2f &m 0 ! 0.6 2 9 -12 10yr4/3 None sl 2f &msbk mvfr cs 2f,lm 0.5 0.6 Ground 3 12 - 10yr4/4 None SO 2m mfr cw 2f,l 0.4 0.5 elev -- — - — -- -- — — _97.92'ft 4 17 -30 7.5 None sl lcsb mfr cw If &m 0.5 0.6 Depth to 5 30 -68 7.5yr4/6 f2d 5yr5/8 sl 0 m mfr - - 0.5 0.6 limiting factor -- — _ -_ 30" Remarks: 2 1 0 -8 10yr3/3 None sl 215cr mvfr as 2f &m 0.5 0.6 2 8 -12 1Oyr4 /3 None sl 2msbk mvfr cs 2f,lm 0 0.6 Ground 3 12 -2 7 7. 5yr4/4 No ne sl 2msbk mfr cw 2f,lm 0.4 0.5 elev —� -- — - 97.97' ft 4 27 -36 ` 7.5yr4/4 f 5yr4/6 sl 1 csbk mfr cw 1 f &m 0.5 0.6 Depth to 5 36 -65 7.5yr4/6 m2d 5yr5/8 sl 0 m mfr - - 0.5 0.6 limiting factor 27" Remarks: - -- -- -- -- -— — CST Name (Please Print) Signature: Telephone No. James K. Thompson S 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, Wl 54020 5/26/99 3602 1040 i -- 1 SOIL DESCRIPTION REPORT toa0 Page 2 of _ - 3— .pROPERTY OWNER: Dennis Pete A.C.F. s o il &Site Evaluations " PARCEL IMA 08-1025-30- - -- GPD /ft2 th Dominant Color Mottles Structure nsistence Boundary Roots — - — - - - - -- De li Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Bed Trench 3 1 0 -8 10yr3 /3 None sl 2fcr mvfr as Mtn 0.5 0.6 - 2 8-11 10yr4 /3 None sl 2msbk mvfr cs 2f,im 0.5 0.6 Ground elev 3 11 -19 10yr4 /4 None scl 2msbk mfr cw 2fim 04 j 0.5 99.88' ft 4 19 -31 7.5yr4/4 None sl lcsbk mfr cw I f &m 0.5 0.6 Depth to 5 31 -69 7.5yr4/6 f2d 5yr5/8 sl 0 m mfr - - 0.5 0.6 limiting _ _ - -- - -..- -- - - - - - -- -_ - - -- - factor -- - - - - - -- - - - - - — -- -- - — - — - -- - -- Remarks: - - l 0 -8 10yr3 /3 None sl 2fcr mvfr as Mtn 0.5 0.6 2 8 -14 10yr4 /3 None sl 2f &msbk mvfr cs 2f lm 0.5 0.6 Ground elev 3 14 -22 10yr4 /4 None sl 2msbk mfr cw 2f lm 05 0. - 98.70'ft 4 22 -34 7.5yr4/4 None gr sl 1csbk mfr cw if &m 0.5 0.6 Depth to 5 34 -62 7.5y r4/6 f2 5yr5 sl 0 m mfr - - 0.5 0.6 limiting - - -- -- - -- - - -- - - -- -- - -- - - -- — - - -- factor - Remarks: Ground elev Depth to limiting -- - factor Remarks: _ -- Ground elev - - -- - -- - -- -- ----- --- - - - - -- --------------- ------- - - Depth to limiting - factor Remarks: . 3 W3 ` So; � 06.Scrda �� � 22.358' t.Jt « ScaLe� / O one►'. loenn ;s )IAC'Kscn , 1 0 57 .233 `-` 5f &(elv�in, Lot. SYDD.z Loca,E;on SEyyrI cJ�q Sce, 9, T. ?8A . R. llo cd, T , o f Ea 6'alle, 5t , e rb,X (' ., col. ,233 �d _ EXiS{i n So.*c' -1404 w4ceCs n a;- e.nsnts or �ancl. rl�� Top 0�' (!Doerr -E4 5fa6 a{ 8 -rug � `ar ,�ssanttd elelk- AO. UD. Shed ' S ySfern�� X X ■ $,3 ■ BA �e�plac.ewicnt e -f ■ ■ r+luwrld Sy�LM 8-z 4r2a I /�4 e4e Ill q /1 i4v% . - Wisconsin Department of Com V NIKE 6 5►T Ri�r+ Page 1 of 3 DivqJon at Safety and Buildings n.)1 067 M5 CCArd with Comm 83.05, Wis. Adm. Co P�tRL�t. p„yl �} '-' C.E. Soil &Site Evaluations Attach cwnplete site plan on paper not less than 8'/: x 11 inches in size. Plan must Ed; -include, but not limited to: vertical and horizontal reference pant (BM), direction and St. Croix percent slope, scale or dimensions, north arrow distance to nearest road. 008- 1025 -30 -000 APPLICANT INFORMATION - P n? a ion. Date Personal information you provide may be us dary (Pn s. 15.04 (1) (m)). G /- Property Owner ! Property Location Dennis Peterson — Govt. Lot SE 1/4 NW 1/4 S 9 T 28 N,R 16 W Property Owner's Mailing Address -�1 V 1199 i Lot # Block # Subd. Name or CSM# 4 233 Street "i ST Cpo)( r NA NA NA City Sta mber ,' ° City [� m lle 233 Street Villagge Town Nearest Road Baldwin WI �`��kOQ �3 5� ❑New Construction Use: h I �ftlh rooms 3 [ to existing building Z Replacement L] Public or rcial describe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/ft .6 trench, gpdff Basal area required 900 bed, ft trench, T Maximum design loading rate .5 bed, gpdr .6 trench, gpd/ft Recommended infiltration surface elevation(s) 99.70' at 12" above 98.70 contour. ft (as referred to site plan benchmark) Additional design / site considerations Mound site located on propoerty currently owned by Maloy Monicken and is being purchased by Peterson. Parent material Glacial till. Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT Grade System in Fill Holding Tank U= Unsuitable for system ❑ S ®U M S❑ U ❑ S U I ❑ S® U ❑ S MU ❑ S U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDIft Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ! Trench 1 1 0 -9 10yr3/3 None sl 2fcr mvfr as 2f &m 0.5 i 0.6 2 9 -12 10yr4/3 None sl 2f &msbk mv cs 2f,lm 0.5 0.6 Ground 3 12 -17 10yr4/4 None scl 2msbk mfr cw 2Qm 0.4 0.5 elev 97.92'ft 4 17 -30 7.5yr4/4 None A lcsbk mfr cw if &m - k.5 Depth to 5 30 -68 7.5yr4/6 f2d 5yr5/8 sl 0 m j mfr - - 0.5 0.6 limiting factor _ 30" Remarks: 2 1 0 -8 10yr3 /3 None sl 2fcr mvfr as 2f &m 0.5 0.6 2 8 -12 10yr4/3 None sl 2msbk mvfr cs 2f,lm 0.5 0.6 Ground 3 12 -27 7.5yr4/4 None sl 2msbk mfr cw 2f,lm 0.4 I 0.5 elev 97.97' ft 4 27 -36 7.5yr4/4 f2f 5yr4/6 sl lcsbk mfr cw i f &m ,Y 11:6 Depth to 5 36 -65 7.5yr4/6 m2d 5yr5/8 A 0 m mfr - - 0.5 0.6 limiting factor - 27" Remarks: 6 ti; c r n v V CST Name (Please Print) Signature: Telephone No. James K. Thompson Q ✓h �- 715-248-7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, Wl 54020 5/26/99 3602 1040 XOr YOWNM- Dm isftk son SOIL DESCRIPTION REPORT toad pge 2 of 3 PARCEL lDJ 008 -1025- 30-000 A.C.E. Soil &Site Evaluations Depth Dominant Color Mottles Structure GPDfft Horizon Depth Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. nsistence Boundary Roots Bed Trench 3 1 0 -8 10yr3 /3 None sl 2fcr mvfr as 2f &m 0.5 0.6 2 8 -11 10yr4 /3 None sl 2msbk mvfr cs 2f,lm 0.5 0.6 Ground elev 3 11 -19 1Oyr4 /4 None scl 2msbk mfr cw 2f,lm 0.4 0.5 99.88'ft 4 19 -31 7.5yr4/4 None sl lcsbk mfr cw if &In Ate" Depth to 5 31 -69 7.5yr4/6 f2d Syr5 /8 sl 0 m mfr - - 0.5 0.6 limiting factor 31" Remarks: 4 1 0 -8 10yr3 /3 None sl 2fcr mvfr as 2f &m 0.5 0.6 2 8 -14 1Oyr4 /3 None sl 2f &msbk mvfr cs 2Qrn 0.5 0.6 Ground elev 3 14 -22 10yr4 /4 None sl 2msbk mfr cw 2f,lm 0.5 0.5 98.70'ft 4 22 -34 7 .5yr4/4 None gr sl icsbk mfr cw if &m .9:5 Depth to 5 34 -62 7.5yr4/6 f2d 5yr5/8 sl 0 m mfr - - 0.5 0.6 limiting factor 34" Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: _ i �. 3 or3 r .27.3.58 Scale: � ^3d 0wner: FPlAcesoo ,/57 2 33 121 51 - B a(,c�cJin, Locaf;on . P. /Co (,d-, 7`i+. of Ea a co CCe, .233 EXiS{in Stptr,". Nae ZOO MItS �`e�ttirCrnsnts of BQrtC� � roP 0�' ConertE¢ 51ab aA� °rt 5c cx)r. ,+g efe0-= /cb.cro. 1 Shed o Sy � h .s zo8 B -3' � •'13 -'I �-- No�as �d �e lac t„, -nt B -I � nit ou rtd S y 6t (-M 1 I v J \ I 1 i I SE 1/4 --NW 114 128A z 23se , j Q47A 7 G o A ll eC2 9� N 2se o Al -7 KO t' ° g'� . � b G �'� L� v 5 & �b 0 I b C 6 G 30 � 9 NELSON' SUPER VRLU TEL :715 -654 -4224 Sep 10 0 19 15:23 No.004 P.0 j ST CROIX COUNT - SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CER11FICATION FORM Owner /Buyer ^ e>7 n t E> Mailing Address Property Address (Verilrwation required from Planning Department for now construction) Parcel Identification Number d ' 0100 Property Location L 'Ii, 1� ' /o, Sec. 3. _. '_ N -R 1 _ _ W, Town of 64A ball Subdivision A , Lot # Certified Survey Nlap # Volume , Page # � Warranty Deed # ^ � (. Page .1 y Z Volume t. n �, (, /(-) l ` R O Spec house O yes bd no Lot lines identifiable M yes ❑ no SYSTEM MAMTENLANC improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper mainteaance 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 treauneut stage in the waste disposal system. The property owner agreos to submit to St. Croix zoning Department a certiftoatio>: forest, signed by the owner and by a master plwnber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdiaposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic taAk is less than 1/3 frill of sludge Uwe, tine undersigned have read the above requireu%ett sod agree to maintain the private towage disposal system with the st udsrds Sr forth, heroin, as act by the Department of Commerce and the Department of Natural.Resotuaas, State of Wisaaneia. Certification Croix County Zoning O stating that your $optic system has been maintained must be comploted and returned to the St. office within 30 days of the three year expiration date. l - f ire 4 DATE GNATLJRE ONY ER CMU FICATIQrI i (we) certify that all statements on this form are true to tho best of my (our) knowledge. I (we) am (are) the owncr(4) of tiic property described above, by virtue of a warranty deed recorded in Register of beads Office. S' 1�g 1 DATE It4NATURE OF APP1:1 T *** * ** Any information that is mis- reprevented may result in the sanitary permit being revoked by the Zoning Department, it ** include with 0 application: a stamped warranty deed from th Register of Dca ds office tt Copy of the certified survey map if reference is made in the warranty dood i DOCOMENT NO. STATE BAR OF WISCONSIN-FORM I WAMANTY MCI 344772 .9-77 THIS SPACE RESERVED FOR RECORDING DAM ±� TMS DEED, made between - TERS OFFICE REG!.'j and .ftterson, Jr ST. CPO' C O . Peterson, husband and wife WI& Rec'd. f Ri,-"rd INS 16th Grantor day of__ILQv A. D. 19 -17 A M. �+ Grantee, Wi.nes8eth, That the said Grantor for a valuable consideration - qnc- dollars - ($1.00) and other qood and valuable consideratiokl conveys to Grantee the following described real estate in St. Croi x --COUntY. RETURN TO su_!e of Wisconsin: Part of SE 1/4 of NW 1/4 of Section 9-28-16 described as follows: Commencing 208.8 feet N Tax Key of SW corner of said SE 1/4 of NW 1/4; thence This is – _ homestead property. E parallel witn E–W 1/4 line of said Section 9, 208.0"thence N parallel with W line of said SE 1/4 of M1 1/4 200.0 feet; thence Mily 223.58 feet to point on said W line 282.0 feet N of point of beginning; thence S on said W line 282.0 feet to point of beginning. SEER FEE i. Together with all and singular the hereditaments and appurtenances thereunto belonging at in any wise appertaininc. An d n G. antors warreats that the title is good, indefeasible in fee simple and free and cleat of encumbrances except and will warrant and defend the some. Woodville, Wisconsin Executed at this_ !— dot of, November 77 SIGNED AND SEALED IN PRESENCE OF (SEAL) G� Carl A. Pet rson, Jr. —(SEAL) Leone K. Peterson (SEAL) Signqture. o Jr. and LeongK,,/ Peterson ,,hxjsband and wife � ,w � W authenticated thi: S 1`er (0 LAI Robert G. Walter Y Title: Member State Bar of Wisconsin or Other Party Authorized under Sec. 706.06 viz. STATE OF WISCONSIN —County. Personally came before me, this day of 19 the above named to me known to be the person— who executed the foregoing instrument and acknowledged the same. �} This instrument was drafted by PI)BERT G. WALTER Notary Public__ County. Ili.. d The use of witnesses is optional, My Commission (E^pir-s) ijsl Names of persons signing in any capacity should be typed or printed below their signal n o. WARRAN1Y DEED-STATE BAR OF OiSCONSIN FORK NO. I - 1971 h t c 1455PAGE 423 610116 Document Number Doe umcal lade KATHLEEN H. WALSH ttirr�� \ REGISTER OF DEEDS I�a ST. CROIX CO., WI Moog& RECEIVED FOR RECORD 09 -09 -1999 11:15 AM ZONING AFFIDAVIT EXEMPT N St. Croix County Zoning office CERT COPY FEE: COPY FEE: St.Croix County Government Center TRANSFER FEE: 1101 Carmichael Road RECORDING FEE: 12.00 Hudson, Wisconsin PAGES: 2 54016-7710 Rocotding Mu (715)386 -4680 Name and Return Address 1� �cK n is i AiQKv Fe — Ps50 1 AFFIDAVIT State of Wisconsin ) Part of 008 - 1025 -20 -000 ) s s. Added/M into 008 - 1025 -30 -000 County of St. Croix ) Pared Identification Number (PER) Dennis L. Peterson and Diane B. Peterson, his wife being duly sworn, states, under oath that: (name) 1. lie /she is the owner /part owner of the following parcel of land located in St. Croix County, Wiscon recorded in Volume 564 , Page 577 , Document No. 54572 St. Croix County Register of.Deed's Office: A parcel of land located Part of SE'/, NW' /o Sec. 9- T28N -R16W, described as follows: Beginning 208.8 feet N. of SW corner of said SE' /a NW'/ , thence E. parallel with E -W '/o line of said Sec. 9, 208.0 feet; thence N. parallel with W. line of said SE 1 /4 NW'/ 200.0 feet; thence NW'ly 223.58 feet to point on said W. line 282.0 feet N. of point of beginning; thence S. on said W. line 282.0 feet to the point of beginning. 2. The above parcel has had added to it the following described parcel recorded in Volume IySS Page . , Document No. lef0�i� St. Croix County Register of Deed's Office, resulting in a single parcel: A parcel of land located St. Croix County, Wisconsin, described as follows: Part of SE' /< NW'/ Sec. 9- T28N -R16W, described as follows: Commencing 208.8 feet N. of SW corner of said SE'/ NW' /a; thence E parallel with E -W '/a line of said Sec. 9, 93.0 feet to the Point of Beginning, thence continuing E. parallel with said E -W '/a Line, 115.0 feet; thence S parallel with the W line of said SE'/ of NW' /, 60.0 feet; thence W. parallel with said E -W Quarter Line of said Section 9, 115.0 feet; thence N parallel with said W line of said SE'/ of NW' /, 60.0 feet to said Point of Beginning. [bin ialotvutioa two be eoaVlcted by abauttee docsrmcnr ade. name A return oddrerr and ELM ( f regrdnd). Odhcr Information "C' a, d o jrmuin j clawes. loaf ducd0pdvn, etc, "be placed on dd, firs page of the docronnt c or taay be plated on addidonaf perdu Ql die doc -neat M We of A& corer pare add, one pare to your aacwnem and 17.00 to (he reconflae fee. Wireonsin Scaane,, S9.517. WROA 2196 A - J 1455 PAGE 424 von.. J 3. The addition is a transfer exempt from Chapter 18 of the St. Croix County Land Use Regulations pursuant to Section 18.05 (A) (3) . 4. The purpose of this affidavit is to notify the public of the addition and the resulting parcel. Dennis L. Peterson Diane B. Peterson Subscribed and sworn to before me this day of .19 17 VAuJAM I GILBERT Wo ry Public, $tote of WisCM* � lli ter' �� t My c�m� � Notary Public, State of Wisconsin My commission eN�i� t5 Pir'YL�? This instrument was drafted by W illiam J. Gilbert, 206 2nd St., Hudson WI 54016 10.1455pm '420 6101 15 DOCUMENT NUMBER QUIT CLAIM DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09 -09 -1999 11:15 AM Maloy L. Monicken, Jr. and Nola J. Monicken QUIT CLAIM DEED husband and wife, and each in their own right and capacity EXEMPT A CERT COPY FEE: COPY FEE: ("Grantor", whether one or more), TRANSFER FEE: 3.00 quit claims to PAGES: FEE: 3 .00 Dennis L. Peterson and Diane B. Peterson, husband and wife, and each in their own right and capacity, ( "Grantee ", whether one or more), RETURN TO in consideration of $1.00 and other valuable consideration, S 1-eet the following described real estate located in St. Croix 9.U..i. !vr .5540 County, Wisconsin: Tax Parcel No: Part of 008 - 1025 -20 -000 Added /Merged into 008 - 1025 -30 -000 Parcel Conveyed Herein Part of SE' /a NW' /a Sec. 9- T28N -R16W, described as follows: Commencing 208.8 feet N. of SW corner of said SE' /a NW' /a; thence E parallel with E -W '/a line of said Sec. 9, 93.0 feet to the Point of Beginning; thence continuing E. parallel with said E - '/a Line, 115.0 feet; thence S parallel with the W line of said SE' /a of NW' /a , 60.0 feet; thence W. parallel with said E -W Quarter Line of said Section 9, 115.0 feet; thence N parallel with said W line of said SE' /a of NW' /a, 60.0 feet to said Point of Beginning. Together with and subject to any easements, rights -of -way, covenants, reservations and restrictions of record, if any, but this shall not extend the term or expiration of any encumbrance on the above described property beyond that stated in documents of record or otherwise provided by law, unless expressly stated herein. DESCRIPTION CONTINUED ON BACK This is homestead property. Dated this 6 day of 5!4felw kc✓' 1999. a (SEAL) �� o-,� c ��� c�(SEAL) Maloy L. Monicken, Jr. U Nola J. Moni en AUTHENTICATION ACKNOWLEDGMENT Signature(s) of Maloy L. Monicken, Jr. and STATE OF WISCONSIN ) Nola J. Monicken, husband and wife, ) ss. COUNTY OF ST. CROIX ) authenticated f bG►^ 1999. Personally came before me this day of , 1999, the above named Maloy L. Monicken, Jr. and Nola Monicken, husband and wife, * o! /(I Cl m ✓ (S114 cr to me known to be the person(s) who executed the TITLE: MEMBER, STATE BAR OF WISCONSIN foregoing instrument and acknowledged the same. (If not, t authorized by Sec. 706.06, Wis. Stats.) Drafted By: William J. Gilbert, Attorney at Law Notary Public, St. Croix County, Wisconsin. 206 Second Street, Hudson, WI 54016 My Commission Expires: 19_ w.,1455PAGI r-, LEGAL D19SCRIPTION CONTINUED FROM FRONT: This is a conveyance between owners of adjoining lands. The above described parcel conveyed herein shall be deemed joined with and into the adjoining parcel presently owned by grantees, described as follows: Adjoining, Parcel to Which Conveyed Parcel is Added_ : Part of SE' /a NW' /a Sec. 9- T28N -R16W, described as follows: Beginning 208.8 feet N. of SW corner of said SE 1 /a NW /a , the el with E -W 1/ line of said Sec. 9, 208.0 feet; ce E. p arallel s P 1 1 a NW /a 200.0 feet; thence NW y 223.58 feet to thence N. parallel with W. line of said SE / point on said W. line 282.0 feet N. of point of beginning; thence S. on said W. line 282.0 feet to the point of beginning. Said parcels shall not be conveyed or encumbered separately except in compliance with applicable county and town subdivision and zoning ordinances. Said two parcels are hereby joined together and shall hereafter be deemed one undivided lot or tract of real estate, which may hereafter be described as follows: Combined Lot or Tract (Both Parcels Merged Together) Part of SE /a NW' /a Sec. 9- T28N -R16W, described as follows: Beginning 208.8 feet N. of SW corner of said SE /a NW /a; thence E. parallel with E -W 1 /a line of said Sec. 9, 93.0 feet; thence S. parallel with W. line of said SE /a NW 1 /a, 60.0 feet; thence E. parallel with said E -W 1 /a Line of said Sec. 9, 115.0 feet; thence N parallel with said W. line of said SE 1 /4 of NW 1 /a, 260.0 feet; thence NW'ly 223.58 feet to point on said W. line 282.0 feet N. of point of beginning; thence S. on said W. line 282.0 feet to the point of beginning. By executing this deed below, grantees acknowledge that they understand that the parcel conveyed herein is added and merged into grantees' adjoining parcel, becoming one undivided lot or tract of real estate as described immediately above, and that said parcels shall not be conveyed or encumbered separately except in compliance with applicable county and town subdivision and zoning ordinances. (SEAL) Q.1� �DS EAL) ennis L. Peterson Diane B. Peterson AUTHENTICATION ACKNOWLEDGMENT Signature(s) of Dennis L. Peterson and STATE OF WISCONSIN ) Diane B. Peterson, husband and wife, ) ss. COUNTY OF ST. CROIX ) authenticated 1999. Personally came before me this day of 1999, the above named Dennis L. Peterson and Diane B. Peterson, husband and wife, 07 ������''� to me known to be the person(s) who executed the TITLE: MEMBER, STATE BAR OF WISCONSIN foregoing instrument and acknowledged the same. (If not, authorized by Sec. 706.06, Wis. Stats.) Notary Public, St. Croix County, Wisconsin. My Commission Expires: , 19_ VOi..1455PAGE 422 Affidavit, Part 2 The parcel shown on this document is being added to the parcel shown on the document recorded in Vol. 5 ( e y , Page 5 Document No. ' described as a parcel of land located Se e to create one parcel, and this transaction is thereby exempt from Chapter 18 of the St. Croix County Land Use Regulations pursuant to Section 18.05 (A) (3) . 1 1101 Carmichael Road Hudson, WI 54016 Phone: (715) 386 -4680 Croix County Fax: (715) 386 -4686 Zoning Department Fax To: Jana From: Shawna Moe Fax: 386 -1548 Date: September 29, 1999 Phone: Pages: 2 Re: Septic Inspection Report - D. Peterson CC: ❑ Urgent x For Review O Please Comment ❑ Please Reply ❑ Please Recycle •Comments: r F , ST. CROIX COUNTY WISCONSIN ZONING OFFICE p I p o l l Y ST. CROIX COUNTY GOVERNMENT CENTER ��" _ " "M ■, 1101 Carmichael Road - Hudson, WI 54016 -7710 - (715) 386 -4680 September 29 1999 Norwest Bank Attn: Jana Hudson, WI 54016 RE: Septic Inspection for Dennis L. Peterson located at 457 233r Street, Town of Eau Galle, St. Croix County, Wisconsin Dear Jana: A septic inspection of the above referenced p roper t y was conducted on September 24, p p p p Y 1999. This property is located in Section 9, T28N R 16W Town of Eau Galle , St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, bwl; Kevin Grabau Zoning Technician /sm l i