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010-1016-90-100
\ e 2 o o 0 & 4 ; . \ < / \ ; a 0 ƒ \ � } ƒ \ � . $ 7 Co co . \ U. \ = 2 \ \ a) f , 2 n a \ \ E J � \ \ \ \ z ¥ \ \ k k k D z § 7 \ � � \ D § \ < < \ 0 . c ) / 7 2 ■ $ CL M 00 Je /) / z $ \ \ k / \ § E » » 3 ® ] . 0 0 0 a a a a « 0 K � ■ u 2 \ \ 2 :q n � o � \ \ < § § \ » E / / g } J 2 % C) 2 o f a a% 2 k z e A � G ■ 2 - \ \ / \ \ ` \ C> \ \ \ \ n$ -Si 2 G§ 2 a / \ j ) \ E j ) \ ] 3 } \ ©% / - G R w> o m o \# z} k\ 2 \ � J } k { C 2 E�0 0 %f t ( - 10 5 Q \ IL \ 0 k \ � {¥ Parcel #: 010- 1016 -90 -150 04/02/2007 11:18 AM PAGE 1 OF 1 Alt. Parcel #: 07.30.16.99C -15 010 - TOWN OF EMERALD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/18/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner ANNE CAROL ANNE MARENTIC CO - G OBKE I AMES JAMES ANDREW GLOBKE 2102 160TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 2100 160TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 4.801 Plat: 4773 -CSM 18 -4773 010 SEC 7 T30N R16W 5.387A PT S112 SW FRL Block/Condo Bldg: LOT 5 BEING LOT 2 OF CSM 9/2498 NKA CSM 18 -4773 LOT 5 ( 4.801 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 07- 30N -16W Notes: Parcel History: Date Doc # Vol /Page Type 07/05/2006 828865 WD 06/18/2004 766213 18/4773 CSM 07/23/1997 1118/432 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/29/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 25,000 0 25,000 NO Totals for 2007: General Property 0.000 25,000 0 25,000 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 25,000 0 25,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DUA-RTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR A ND PERCOLATION PERCOLATION TESTS (11 P.O. BOX 7969 HUMAN SON, WI 53707 MADI (H63.09(1) &Chapter 145.045) LOCATION: SECTION: TOWNSHIP / ¢i�LITY: LOT N .: K. N B IV SION NAME: SW ��S I/ 7 /T 30 11/11 1 6 * (or) W F leralc n/a COUNTY: OWNER'S /8VWWS NAME: MAILING ADDRESS: St. Croix R. Doornink & H. Hielkema 841 220th. St., Baldwin, Wi. 54002 USE DATES OBSERVATIONS MADE NO. BEDRMS.: I COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 n/a New ❑Replace 5 -9 -92 5- 11 -92 RATING: S= Site suitable for system U= Site unsuitable for system 1� CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDIN A : RECOMMENDED SYSTEM:(opti a ❑ ) S ©U CAS ❑U ❑ S ®U I OSPA ❑ S `®U mound If Percolation Tests are NOT required DESIGN RATE: 4 If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n Floodplain, indicate Floodplain elevation: n/a decimal PROFILE DESCRIPTIONS paae 30 An.C2 BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER ELEVATION OBSERVE EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 4.84 101.18 none 2.84 .92, 10yr4 /3, 1., .75, 10yr4 /4, sil., 1.17, - 7.5yr4/4, s.l., 2.00, 7.5yr4/4, not. s.l. & sil. B_ 2 4.34 101.18 none ._�- 2,34 .67, 10yr4 /3, 1., .67, 10yr4.4, s.sil., 1.00, - 7.5 4 4 s.1. 2.00 7.5 4/4 not s.il.. B- 3 4.00 103.23 none 2.50 .83, 10yr4/3, 1., .67, 10yr4 /4, sil., 1.00,- 7.5 4/4 s.l., 1.50, 7.5yr, mot.s.l. & 5yr4/4- mot. sil. B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD PERIOD3 PERIOD PER INCH P _ 1 24 none 30 1_ 21 P _ 2 214 none 30 1. 1,. 1 -r P _ none 3 1 P -_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 104.00 - [ € y I � 77 99 p t E ' r 3 t f E _ ___w_L ` t u 4 CCC c E W ` a TM__ __. 1, the undersigned, hereby certify that the soil test r p ed on this form we by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded a 41a ocatio%of thefts are c rr� to the best of my knowledge and belief. , NAME (print): —.1 T ` u' ' C y TESTS WERE COMPLETED ON: Gary L. steel C u c �� 5 -11 - ADDRESS: { CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. acve.,New Ric hmo � ��i�;�401 `�� 2298 715 CST SI U _0001Z N�� �+ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — ~. � i � � � INSTRUCTIONS FOR COMPLETING FORM 115-SBD'6395 � To bna complete and accurate soil test, your report most include: 1. Complete legal description; Z The use section must clearly indicate who/her this is a residence or commercial project; 1 MAXIMUM number of bedrooms orcommemim! use planned; 4� Is this u new or replacement system; 5, Complete the suitability rating boxes. AS|TE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED UN SOIL CONDITIONS; G, PLEASE use the abbreviations dhuxvn here for writing profile desc and completing the plot plan; 7, MAKE A LEGIBLE diagram oocumtn|v locating your test locations. Drawing to om|o is preferred. A separate sheet may be used ifdesimd; 8, Make sure your benchmark and vertical elevation /cb,vnre point are clearly shown, undarm permanent; & Complete all appropriate boxes as to dates, names, addresses, Uood plain data, percolation test exemp- tion, ifappnopriace� 10. If the informa (such as flood plain, elevation) doex riot apply, place N,A°in the appropriate box; 11. 88n the form and piaoc your cuneot address and your certification number; 12� Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE / LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols ot — Stone (over 10") BR — Bedrock nob — Cobble (3'l0'') SS — Sandstone g, — Gravel (under 3") LS — Limestone ° — Sand HGVV — High Gwumwate, cs — Coarse Sand Prrc — Percolation Rate meds — Medium Sand VV — Well I — Fine Sand Bldg — Building Is — Loamy Sand > — Greater Than °s| — Sandy Loom < — Less Than °! — Loam Bn — Brmwn ° — Slit Loom 8| — Black oi — Sill Gy — Gray ~d — Clay Loam, Y YnUmm sd — Sandy Clay Loam R — Rod sid —Silty Clay Loam nmt — Mmtle oc — Sandy Clay mY — with sic — Silty Clay Mf — few, finu faint ° Clay cc — mmmon P1 — Peat mm — Mmny m — Muck d — distinct p — prominent HWL — High mmtor/eve| ° Six general soil textures uurfaro water for liquid waste disposal ' BM — Bench Mark ` VRP — Vertical Rofnmnoo Point � TO THE OWNER: This soil test repor is the first stop in securing a sanitary permit. The county or the Department may request verification of this »oil test in the field prior to pe,mit issuance. A complete pet of plans for the private sewage system and a permit application must be o"bmitted to the appropriate |orol authority in order to obtain n permit. The sanitary permit must be obtained and posted prior to the start of ony oonS,uuion. ^ � | . REPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS i DIVISION INDU5TRY, P.O. BOX 7969 LABOR AND PERCOLATION. TESTS (115 MADISON, WI 53707 HUMAN RELATIONS (H63.09(1) &Chapter 145.045) LOCATION: SECTION: TOWNSHIP /NLITY: ILOT NO.:BLK. NO.: SUBDIVISION NAME: SW 1 /sw 7 /T 30 N /R l6)& .,) W Iinerald n/a n/a COUNTY: OWNER'S $ AME: MAILING ADDRESS: St. Croix R. Doornink & H. Hielkema 841 220th. St., Baldwin, Idi. 54002 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL S RIP 10 IPROFILE DESCRIPTIONS: S F L :F Residence 3 n/a ONew Ekleplace l I 5 -9 -92 5 - 11 - 9? ? RATING: S- Site sui table for system U- Site unsuitable for system ONVENTI NAL: MOUND: IN- GROUND , ESS : S - N -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) r O S � US D DS 2U O S OV I O S ®U I mound If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09W(b), indicate: n/a Floodplain, indicat Floo elevation: n/a decimal' PROFILE DESCRIPTIONS page 30 FnB BORING TOTAL P H R ND AT R -INCHE CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHXK ELEVATION OBSERV TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) sl ., ,— B-1 4.75 100.25 none 2.75 7.5yr4/4, s.1 � � .,2.00,7.5yr4/4, mot. s.sil. 2 4.00 100.25 none 2.50 75 , 10yr4 /3, 1., .75,7.5yr4 , s.sil., 1.00- B- 7.5 r4/4, s.l., 1.50,7.5yr4/4, mot. s.l. 102.6 none 3.34 .92, 10yr4/3, 1., .42, 10yr4/4, sil., 2.00,- 6- 3 4.84 4 4 s.l. 1.5 4 4 mot. s.sil. , B- LB- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER -IN RA TER INCH ES NU INCHES AFTER SWELLING INTERVAL -MIN. ''t none 30 1 P_ 1 i I P_ 2 24 none 30 1 t 1 P_ 3 2 none 30 P- P. P _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Shpw the surface elevation at all borings and the direction and percent of land slope. I 1 UR $ SYSTEM ELEVATION lol'oo I I I i t. r alb � i I, I I 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 5- 11-92 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., New nichmond, I•di. 54017 2298 715- 6 -6200 CST SIGNA DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. I rll I Ili SBD-63f)5 (R, 02/82) — OVER — q,;0•/.�: ST. CROIX COUNTY ZONING DEPARTMEN3 AS BUILT SANITARY REPORT ` Owner Address o ?/ a =` City /Stat Legal Description: Lot Block Subdivision/CSM # Sec. 2, T30 N -R W, Town of PIN* � /!� 1 ` •.do SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC / /Gw Setback from: House 7S Well Pump manufacturer 4,&:26JI1�Aeoe Model /YO 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: Width � Length ----�— Number of Trenches Setback from: House 2,2 Well �> S O P/L > Vent to fresh air intake :;> 2 S� ELEVATIONS Description of benchmark _ `Tg o� , 1 ray <°S % S Elevation 106 Description of alternate benchmark Elevation 2;> 7�;P Building Sewer 22.—/L— &/HT Inlet ��, �� ST Outlet PC Inlet PC Bottom �_ Header/Manifold /03 -.3 4 Top of ST/PC Manhole Cover Distribution Lines O / 0 , D( ( ) ( ) Bottom of System ( ) /0.3- ( ) ( ) Final Grade ( ) ( ) ( ) Date of installation 6 / / Permit number 32 �/� �� State plan number Plumber's signature License number Z2 IV7/ Date Inspector complete plot plan •+ NOTICE: Please provide the following: A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW n i INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division I$T . CROI X INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar7 _"rr/i6N3P.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)). Pgr�rli�JjAI lNa CST ,,T M EE [�� [] Town of: State Plan ID No.: BM Insp. BM Elev.: BM Description: Parcel 610 :1016-90— 0 i A9900024 , /6, TANK INFORMATION ELEVATION DATA ? 30 �l0 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e tic t ��✓ /000 Bench $ /DY• Dt� Dosin ��k n 7,a l� 13 S1 1-l i ck '; Z.�i� /00•/ 7.77 Aeration Bldg. Sewer pa 1 ) .al Holding .___.,._--- -°--.. t Inlet TANK SETBACK INFORMATION C011k Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake eptic ( �lpV' �? NA Dt Bottom /Do,/ I S•5�{ $" �o/ a t lop' `� NA Header / Man. ivg2b, Y . 7,;1L Aeration NA Dist. Pipe /og.Zb 14 1.0'S Holding Bot. System /cog a8 3. , ; 1 3 to 3.�� PUMP/ SIPHON INFORMATION Final Grade Manufacturer Cc�e `1 w� Demand 1 4 H. ✓jA /o$, /o. S/ Model Number :)7• TDH Lift g 9S Friction System ?.s TDH2ZA) Ft L H tb•t Force / ! Dia. a Dist. To Well v.W SOIL ABSORPTION SYSTEM vr? / TRENCH Width / Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid De th _QfME NSIONS Q t) i DIMENSION SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEACHING nu acturer: INFORMATION TypeO , CHAMB Mo a 7N - _ 5 er: Syste Q 30 6 116 OR UNI DISTRIBUTION SYSTEM R Header / Man ifold i Distribution Pipe(s) // x Hole Size x Hole Spacing Vent To Air Intake Length Dia._ Length �jlJ• ?S Dia. 2L Spacing cD� t1`1K S I' 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 E] Yes ❑ No ❑ Yes No COMMENTS: (Include code discrepancies, persons present, etc.) q- 7d LOCATION: EMERALD 7.30.16,SW,SW 2102 160TH AVE*UE — LOT 2 �T . r f. Yvk --t 1 t o 10 0 � crfn [fJQ `fj C 3 il� �o6 9 31( ' � 4 7 ��/ y �o �bwnSla�- �• Vps ti - s � VcK{' bZ {1n-4a1 IG�� �'.� a �o�K — Srtvc aa�lys;5 9'j w►P C, Plan revision required? ❑ Yes ❑ No / Use other side for additional information. SBD -6710 (R.3197) 61I r G/ 4#71 Date Inspector's Signature Cert No. a ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r o ,, • ViSANITARY PERMIT APPLICATION 201 Saf W and ah ington Ave ulen scons�n In accord with ILHR 83.05, Wis. Adm. Code P Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. ST • See reverse side for instructions for completing this application State sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application 3 A4 ll03 [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATI N Propert Owng Name Property Location OV1 /4 Sw 1/4, S '� T 3D , N, R/( E (or)� Propert' wner's riling Address Lot Number Block Number V A T/0 City to 1 Zip Code Phone Number Subdivision Name or CSM Number / D /s") 3rA — 11. TYPE F B ILDI G: (check one) ❑ State Owned o it Nea est Road Public 1 or 2 Family Dwelling - No. of bedrooms ° Tov of /x r4 / c ��_ 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 6 1 _. 3o 99 C• _ 10 1 ❑ Apartment/ Condo - 0 - 9W - X 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 g New 2 ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an ------ System ________ System_____________ Tank Only______________ Existing 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 ❑ System -In -Fill VI. ABSOR PTION 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/d y /sq. ft.) (Min. /inch) Elevation L o o O S00 7 � Feet Feet Capacity VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glaze Plastic App New Existing structed Tanks Tanks M olding Tank /.ZSG Z5 � ❑ El 13 1:1 11 Chamber 7S4 7 B ❑ ❑ ❑ 1 ❑ 1 ❑ 1 ❑ VIIL RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewa tem shown on the attached plans. Plumber's Name: (Print) PI is Signature• Stamps) M PR Business Phone Number: 2 /S/7/ P er's Address (Stfft, City, State, Zi ode): _ 3[ Z- 5YU S/ ;-ev kv l 5 / IX. COUNTY/ DEPARTMENT USE ONLY , g [:]Disapproved Sa nitary Permit Fee ('ndude, Groundwater ate ssue Issuing Agent Signature (No Stamps) - 9 waa�� Approved E] Owner Given Initial `GPt Surcharge Fee) — f) I Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: W. SBD- 6398 (R.11197) 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 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 se. If building type is public, check all appropriate boxes that apply. 9 9 YP P PP . Y IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. 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 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), 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. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can i effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. - Safety and Buildings • 15837 USH HAYWARD WI 54843 -8107 07 Nvisconsin Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary Department of Commerce January 28, 1999 CUST ID No.221471 ATTIC• POWTS INSPECTOR ZONING OFFICE DENNIS J GILLE ST CROIX COUNTY 372 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 01/28/2001 Identification Numbers Transaction ED No. 208575 Site ID No. 166568 SITE: Please refer to both identification numbers, Site ID: 166568 above, in all correspondence with the agency. ST CROIX County, Town of EMERALD SW1 /4, SW1 /4, S7, T30N, R16W JEFF CLEMENTS RESIDENCE SEPTIC SYSTEM FOR: Description: MOUND SYSTEM, 600 GPD Object Type: POWT System Regulated Object ID No.: 448324 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. The following conditions shall be met during construction or installation and prior to occupancy or use: 0 1. This plan action is subject to designer comments on the plan. 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular G�.r' to the direction of maximum slope.1 3. The area 25' below the downslope edge of the mound must remain undisturbed. A P 4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a) DEPARTME? 5. Clarification on page 5: It is proposed to install a Huffcutt 1250/750 combination tank. DIYJSRIN Of SA 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 S F E CCU RF 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 01/26/1999 FEE REQUIRED $ 180.00 —'�� ~� /�� ` "����– �- /- ` ' FEE RECEIVED $ 180.00 PATRICIA L SHANDORF , POW PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WSMART code: 7633 MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET Project JEFF CLEMENTS Owner JEFF CLEMENTS Address P.O. BOX 1310 HUDSON, WI 54016 Legal Description SW SW S7 T 30 NR 16 W Township EMERALD County ST. CROIX Subdivision Name Lot No. !At T c Parcel ID Number .i���ally "' Plan Transaction Number 4u VE D T OF C RCE (=E I)ILD1N index and title sheet Page 1 v Mound calculations Page 2 .ESPONDENCE Mound drawings Page 3 Pres. dist. calcs. and laterals Page 4 G} TDH and pump tank drawing Page J Designer DENNIS GILLE License Number 221471 Signature Phone No. 715 - 268 -6637 Date 1/22/99 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 (R.05198) Pagel of MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. I -poun ds Metric Residential or commercial? R (r or c) (y or n) �� Replacement system? Creviced bedrock site? n (y or n) Slope 5 % Wastewater flow rate 600 gpd 2271 Lpd Depth to limiting factor 28 in 71.1 cm In situ soil infiltration rate 0.6 gpd/ft 24.4 Lpd /m Contour line elevation 102.0 ft 31.09 m Use standard fill depths? x OR Design depth? in cm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. Center or end manifold (c or e) Hole diameter 0.25 in 0.125, 0.156, 0188 0.219, . - Lateral spacing 6.00 ft Use 0 lateral spacing for trenches. 025 0.281 or 0.313 Inch only. Estimated hole space 4.00 ft Not a final calculation. Number of laterals B Pump tank elevation 85 ft Outside bottom of tank. Forcemain length 90.0 ft Forcemain diameter 2.0 in 1 - 2. 3 or 4 inch only. 2.067 in Actual I.D. HOLE DIAMETER CONVERSIONS 1/8 = 0.125 114 = 0.250 SYSTEM SOLUTIONS Inch-pounds Metric 5/32=0.156 9/32=0.281 Estimated daily flow 600 gpd 1 2271 Lpd 3116 = 0.188 5/16 = 0.313 7/32 = 0.219 Absorption cell Design load rate & area 1.2 gpdW 500.0 ft 46.45 m Linear loading rate (LLR) 12.00 gpd/ft 148.8 Lpd /m Design width (A) 10.00 ft 3.05 m Cell length (B) 50.0 ft 15.24 m Depth of cell (F) 10.0 in 25.4 cm Sand filter Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 18.0 in 45.7 cm Basal area required (gpd /infiltration rate) 1000.0 ft 92.90 m Supporting components 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 (K) 10.75 ft 3.28 m Up slope toe length (J) 7.40 ft 2.26 m Down slope toe length (1) 11.80 ft 3.60 m Total mound length (L) 71.50 ft 21.79 m Total mound width (W) 29.20 ft 8.90 m Project JEFF CLEMENTS Transaction Number: Page 2 of f MOUND PLAN VIEW observation pip" (typical) J 29.2 ft - A = 0. A 1 00 ft 3.05 m 8.91m . - B - 50.0 ft 15.24 m W B J= 7.40 ft 2.28 m I K 1= 11.80 ft 3.80 m K = 10.75 ft 3.28 m L L 71.50 ft 21.79 m typ. obs. pipe (anchored securely) I = down slope dimension = absorption cell (AxB) J = up slope dimension = plowed area (Lxw) I , , K = end slope dimension s• (152 mm) T MOUND CROSS SECTION il cap bso D = 12.0 in 30.5 cm su lateral topsoil G H E = 18.0 in 45.7 cm invert 103.50 ft F = 10.0 in 25.4 cm 31.55 m - -- -- ------ -F G = 12.0 in 30.5 cm 4- ASTM c33 H = 18.0 in 45.7 cm D Sand Fill E sYs 103.00 ft elev. 1 31.39 m 102.00 ft contour 31.09 m elev. 5 % 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: Project: JEFF CLEMENTS Transaction Number: Page 3 of PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch -pounds Metric Width (A) 1 10 Ift 1 3.05 Im Length (B) 50.0 ft 15.24 m Lateral specifications Number laterals 2 Holesflateral 12 holes Lateral length (P) 46.75 ft 14.25 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 13.98 gpm 0.88 Us Sys. dis. rate 27.96 gpm 1.76 Us Hole spacing (X) 51 in 129.5 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) _ Place X in red 'V one choice 1 1/4 in (32 mm) x box of chosen from the options 1 112 in (40 mm) x diameter. provided. 2 in (50 mm) X X 3 in (75 mm) X Manifold diameter Pipe diameter Design options Design choice Designer must i in (25 mm) W' one choice 1 114 in (32 mm) x Place X in red from the options 1 1/2 in (40 mm) x box of chosen provided. 2 in (50 mm) x X diameter 3 in (75 mm) x 4 in (1 00 mm) x Distribution system contains: 2 Lateral(s) LATERAL DIAGRAM - END CONNECTION Place correct lateral di a ram b clicking in one of the drawings at right and dragg the diagram into this area. atera 5 oentere .Stet % , e mens on Last !role drilled next to end cap en cap C. + P --_ —, All laterals are identical I<- X —�) Holes drilled on the bottom of the lateral squalbl spaced Force main eonneotion uia too or gross to manifold at any point. Laterals & Force main of PVC Sch 44 s • = permanent end marker (per C:CMwTM Table 84.30 -5) Inch -pound Metric Lateral length (P) 46.75 ft 14.25 m Lateral spacing (S) 6.00 ft 1.83 m Hole spacing (3) 51 in 129.5 cm Manifold length 6.00 ft 1.83 m Hole diameter 0.250 in 6.4 mm Lateral diameter 2.00 in 50 mm Forcemain diameter 2.00 in 50 mm Project: JEFF CLEMENTS Transaction Number: Page 4 of TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 17.70 ft 5.39 m Are laterals the highest point in the Friction loss 1.23 ft 0.37 m system? rtes x" here. Total dynamic head 21.43 6.53 If no what is the highest elevation Dose Volume downstream of pump Dose is > 10 t imes lateral volume Forcemain drain Lateral void volume 16.3 gal 61.7 L back to tank? ('Y' one) Minimum dose 163.0 gal 617.0 L x Yes Drain back 15.7 gal 59.4 L No Dose volume 178.7 al 676.5 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 7F weather proof warning label and locking device grade levels junction box " —"� disconnect grade levels y alternate 4" vent pipe electric as per NEC 300 and s outlet Comm 16.28 WAC Wation 18" (46 cm) min. wall of pump A:�- approved chamber or s outlet joint combination tank A Provide 1/4" weep hole or anti - alarm on siphon device as necessary pump on B C tirade levels pump 85.8 ft - pump tank manhole = 4" (10 c m) off elev. 26.2 m minimum above finished grade D - vent =12" (30.5 cm) minimum above finished grade 8570 ft Pump tank elevation 3 " (75 mm) of bedding under tank 25.9 Im bottom of tank Tank manufacturer HUFFCUTT Pump tank capacity 12 gaUn Pump tank volume 750 gal Pump manufacturer IZOELLER I Inches Gallons Pump model number 140 c A 39.6 475.3 'Z B 2 24.0 Alarm manufacturer LEVEL AL M _ 0 C 14.9 178.7 Alarm model number DV o L D 6 72.0 Project: JEFF CLEMENTS Transaction Number: Page 5 of lye c .72Iv> f SWSW 577"30 A4/4 SIDE— C/e /03.0 r Aw l I N The area 25ft, below the downslope edge of the Soil Absorption System must remain undisturbed, - 2f I Q -- > ,al> ' I 3em ' 7! /fro oM-c, HEAD CAPACITY CURVE TpTAI DYNAMIC HEAD /CAPACITY �l _ MODELS "14014140^ AND V EWATERING Ft. Meters G 01 Ltrs 10 y 3.05 64 lie - 15 — 4.57 76 26A1 140,4140 i0 _ 610 __ . °6 _ _ T7 35 25 1 7.62 59 111- to -... 50 _ 4 49 169 i r•. }s 10.67 }e _ 144 , 40 12.19 21 79 25 4s 13.77 loco yp1r0 46 ... - J = 6 4 1 1/16 15 — . 4 O t0 — 2 a . U.S. GALLONS 10 20 30 40 SO 60 70 eo 90 f00 . 1 1 0 LITERS eo 160 240 320 400 0 FLOW PER MINUTE 010940 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Mechanical alternators, for duplex systems, are available with or without , alarms • Control alarm systems are available for 1 phase pumps used in simplex 1 sx16249 system, See FM0732. • Variable level control switches are available for controlling single phase systems, * Double piggyback variable level float switches are available for variable SELECTION GUIDE level "cycle controls. 1. Single piggyback variable level float switch or doable piggyback variable level • Sealed Rwik•Box available for outdoor installations. See FM 1420. float switch. Refer to FM0477. • Over 130 °F. (54 °C.) special quotation required. 2 Mechanical alternator M•Pak 10.0072 or 10.0075, • Reter to FM0806 for 200 F. applications. 3. See FMO712 for correct model of Electrical Alternator E - Pak. 4. Variable level control switch 10.0225 used ass control activator, specify duplex (3) or (4) float system 5. Four (4) hole J•Pak. junction box, for watertight connection or wired -in simplex 140 Series • 53 lbs. 4140 Series - 73 lbs. or 2 pump operation, 10 -0002. 1041411"" MO L$ Co ntrol 801010" Mi odN 1 MOdei Vel1•Ph MofIAAMPS SIm&1a aup>•x N140 N4140 115 1 Non I 15.0 1 or 1 8 b 1 or 3 8 a CAUTION 140 x140 1 Non 7.5 - 1 or 1 B 5 - - 2 or 3 6 4 ( All installation of controls, protection devices and wiring should be done by B 1 11'5, 1 Non _ ... 15.0 79L_$ 6 z or 3 y I a qualified licensed electrician. All electrical and safety codes should be BE140 BE4140 230 1 1110"_ 7.5 _1 or 1 aL 5 ••_, -._ 2 or,3 a 4 followed including the most rele National Electric Code (NEC) and the ^• Double sal pump, are,vell" we optional moisture serlsots. sell Fait inditaw Nom avaleble in NEMA 1 nr NEMA 4x Occupational Safety and Health Act (OSHA). Comm! panels. RESERVE POWERED DESIGN For unusual cond itions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: R0. BOX 16347 Lowst7iaae, KY 40256 -0347 Ma711daeturersoi, . SNIP T0: 3649 Cone Run Rced Louisville. KY 40211.1961 Qqw rr ANOW 9nnr ARF PUMP !Q ( 50 2) 778.2731.1(800) 928-PUMP —____ FAX-(502)774.3624 ;s G C`.. DA 1 Ot C i a 1TION MADE Joe _ _ _ ..'_ ,: {:',. --.... _.. .�__.. r[ ,_ , .. ..1 iUr75 {I'ENI:OL,1 ll) r�o ... — •, 5 !41 I I c o ` RATING: S. Site suit for sy U= Site o nsuitabie for Wt¢m �_— - - -- �ODIV yTIt�NA MO I'rivp(jWb- AMU : S } 6M•IN•FILLHOL —OT TAiJK; Het, Or+ 1ME�'JUE1]'S'(STEM:tol >lion: +11 0 cY U L� S ❑� I ❑ S L� 0 S EU S ' I not.:nrl Ir PCrL'UI'JliOn Tests ar¢ NOT : ec;cnn�r. RUT iQr1 R i E: If and portion i lhC :Ca r, tl f+n'7 �und¢rs,HG2.09( 5;{W,;ndicat¢: n /? F loodp+a+n, ind Flnodula�n �': n/a PROFILE DESCRIPTIONS Tiaoe 1,01 decinal' -_ jgpi�INGI TOTAL 1 %NOWATBFt -INCH HARAC7ER O SOIL '•vITH THICY(JrinV CDL T XTUfiE, ANO DEPTH 4 ELEVr T10N � Et3E7y cp ES . HI H T TO 3EOROCK IF OPSERVEO (EC' Atl t lZV, O N IiACK.I S INUP.:OER OED• •f t— .92, 10yr4 /3, 1. , .15 lnyr4 /4, si. 1.17, - 2. 34 7.5 r4/4, s.l. , ?.00, .. ) yr�+ /4, rtoL. 5.1. & si.l. P, 1 4.5 101.1 :ton`= .67, 10yr4 /3, 1., 67, l0yr4- S.Sil., 1.00, 5 2 4.34 1 101.13 - .•_ � 2.3 7 4 4 _s.1• 0 0, - 5vr4/4, not s.il.. �-- — °3 1. . .67, l;)yr4 /4 1.00,- , sil., 6 3 14.00 103.23 none I 2.50 ( 7.5yr4/4 s.1 1.50, Syr, rtot.s.l. 5yr4 / Mot. Sil. B . B- L 8• ` PERCOLATION TESTS pq IN WAl'ER LEVEL•INCHES RATE MINUTES DEPTH , WATER IN HOLE TEST TIME „ , PSR tNCH P 1 t. Nt1MC33ER INCHES AFTER SWELLING IN7fl�VAL•MI N. i P. 1 24 none - -' -- P• 2 7 gone _c P ; none P• ' P• ons of suitable soil areas. at scale LC: - -- t ho rl PLOT PLAN: Show locations of percolation tests, soil borings and the dimensi surface elevation on at all borings c¢s. gs and the e di d i what are rection and p p ercce - zontal and vertical elevation reference points and show their location on the plot plan, Show the orinnt of land slope. SYSTEM ELEVATION 1 - l .ice i•- I - � � I I I 10 jl J'1�w2 i • "�.f / tl l � �} ✓. � ' - -r /7_ ..I r , -- i t.!� `, I . I � I I, the undersign¢d• her¢bl` certify :!'at :h¢ soil casts re oca� ion ohtha are correct ) orr et o best of my knovvwdl v'an and r l m¢thudi sponfied in the Wisconsin belicr Administrative Code, and that the data recorUed and , T'c5T5':'4Ef'E COi PLETED ON! nN,:ML• Iprntl: - - .+. s:_ei rIFI 1- �— - -_— S:LRi:,- ; GiJNU� 10 E1 r't Ri� 5'v uo6;,ona! >� 715; r 2 46 - 62 �DUKESS o _ , i 229E i 1 Cary t 1 ` 1554 BOO L 3C•: L'. -- - .. ^ „0.. ., ,.i• — c:iT ,;i� ;f.4.i ila r��— .�' ;! -i I r - - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, c DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.090) &Chapter 145.045) LOCATION: SECTION: TOWNSHIP / LOT NO.:BLK. NO.: SUBDIVISION NAME: S11 1 / 4 S1 7 /j30 N /R (or)W F�*tera1 n/a I n/a n/a COUNTY: OWNER'S ID'S NAME: MAILING ADDRESS: St. Croix R. Doornink & 3I. Hielkema 841 220th. St., Baldwin, Wi. 54002 USE DATES OBSERVATIONS MADE F NO. BEDRMS.: COMMERCIAL DESCRIPTION: {-�� PROFILE DESCR PTIONS: RCO AT ON TESTS: Residence 3 n/a Xx NeW ❑Replace 5_9_92 RATIN S= Site suitable for system Y Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND- PRESSURE: SYSTEM -IN -FILL HOLDING RECOMMENDED SYSTEM: (optional) 0 s au 1 14s ❑u ❑ s HU�EI s Eu ❑ s EU mound If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a Floodplain, in dicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 30 AmC2 BORING TOTAL DEPTH TO GROU NDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHN� ELEVATION OBSERVE E S . HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 4.84 101.18 none 2.84 92, 10yr4/3, 1., .75, 10yr4 /4, sil., 1.17,- 7.5yr4/4, s.l., 2.00, 7.5yr4/4, not. S.I. & sil. B_ 2 4.34 101.18 none. 2.34 .67, 10yr4/3, 1., .67, 10yr4.4, s.sil., 1.00,- 7.5 r4 4 s.l. 2.00 7.5 r4/4 not s-il.. 3 4.00 103.28 none 2.50 .83, 10yr4/3, 1., .67, 10yr4 /4, sil., 1.00,- 6- 7.5 r4/4 s.l., 1.50, 7.5yr, mot.s.l. & 5yr4/4- mot. sil. B- B- B- }�, VJ- co So 5 /2 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD PERIOD 3 PER INCH P- P- P- P- P- P-_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 104.00 k E t I ( z i 0m KI t I ; A F N I IL I I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in th Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. steel ADDRESS: CERTIFICATION NUMBER: PV 1554 200th. acve.,TTew Richmond, Wi. 54017 2298 CSTSI N U i DISTRIBUTION: Original and one copy to Loc Property Owner and Soil Tester. ST CROIk COUNTX SEPTIC 'ANK ;MAINTENANCE AGREEMENT AND OWb ERSHIP CERTIFICATION FORM owtter/Buyer Mailing Address 7 5% Property Address v �0 2— (Verification required frou i Planning Department for new construction)„ City /State _ Parcel Identification Wtunber / v � bi� L EGAL DESCRIE110N Prapexty Location S<✓ / <, S�! %, Sit;. Town of Subdivision _ -- - -- Lot # j Certified Survey Map # Volume I Page # Warranty Deed # �, f2- FO Z -3 Volume 1 11 r Page # Spec house ❑ yes no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your sel pc system could result in its premature failure to handle wastes. Proper M;Liatenan ce consists of pumping out the s tbr septic tank every i a years or sooner, if tredddd by a licensed pumper. What you put into the system can affect the function of the septic tank as a trot �neut stage in the waste disposal system, i The property owner agrees to submit to .St. Oroix Zoning Departmmeut a cerdfloation form, signed by the comer and by a rnuterplumber, journeyman plumber, restrictedpis tmber or a licemedpunrper verifying that (1) the ott -site wastewaterdisposal system is in proper operatuug condition and/or (2) after in: �ection and purnping (if necessary), the septic tank is less than 1/3 full of alud.ga. I/we, the utldersigned have read the above requirri bents and agmo to maintain the private sewage disposal systems with the standards set forth, hert:4 as set by the Departmettt of CoT.' tierce grad the Departmont of Natural Resouwa, Statd of Wisoonsltl. Cevt fiwion stating that your septic system urea been maintainer { must be completed Arid mtorned to the St. Cf&k County Zoning Office Within 30 days of the three year xpiration date. 4Z31 sI of APPLICANT DAVE OW CERDEFI T� ION I (aye) certify that all statements on this f irmrr are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warm ity deed recorded is Register of Deeds Office. SOFAV OF APPLICANT laA'r>? A ja y information that it; mis represented rr ay result in the sanitary permit being revoked by the Zoning Department. * * * * *• *' Include with this applicati a stamped warn ltity deed from the Register of ]deeds off. a copy of the a rtified survey rnap if reference is made in the warranty deed DOCUMENT NO. WARRANTY DEED TW O aFACC REeER"Ea FOR R[coa0049 DATA STATE BAR Ok' (,ONSIN FORM t -162 t s28o�.3 ViL s o�cE WI P-Wd fw �, Reub� -n D y_N. Hi oornink and Harveelkema AKA ................. .........................I..... ..... g 1995 Harve Y...-.... .. Hielkema " " " "'" "' " " "' APR ................. .... ..._........... ................ ............... ............................... .............................................----....... .............................................. _........ 8.00 A.M .. ..... . ... ....... - . ... ....................... .... ......... b• r �l. r,,L�.�, eonvsys an warrants to ..... 4tf _.4S.t._ - C�,4!1►Pl1 ::... !:�5�--- Shecry- -_Ar _._....... , . as • ,joint . tenants with .. the r -At OX d ....I .................. . .......................... survivorship ........ ... ..... . ........................ ......................... . . . . .. .. .. ...... .. ............................................................ ........ i......................_.. - ............... ................................................................................. ................. RaTURM To .................... .................................. ....................... ................. .......... ............................................... St. C ...•••--.... ro ..•• -_..... x the following described real estate in ....................... .................... ....Coeaty. State of Wiaconsla: Tax: Pared No: ....................... . ..... Part of S1/2 of the SW Frac. 1/4 of Section 7, Township 30 North, Range 16 West, St. Croix County, Wisconsin described as follows: Lots 2 and 3 of Certified Survey Map filed July 1, 1992 in Vol. "9 ", j Page 2498, Doc. No. 485374 rim Ape— I s� k This AA S.. n Q t ............ homestead property. XW O K A09) Exception to warranties: Dated this .......................I ......... day of ........ � -- -..........- ................. ......., ......---•---• ...... ............................... ..............•...(SEAL) ...... ... .— ..............(SEAL) Reuben Doorink `---- ...•--- .......-- •- ••-- - -•• -• • • _. - . W ....- - - - - -. -- --- -. ....(SEAL) ------- W6,0111"? !11ir .............(SEAL) Harvey- -N•' -. Hie_lke ........ AUTHNN , &ICATION ACHNOWLNDGMBNT Signatures) ......... . .. ..... _.._.. ......... STATE OF WISCONSIN ss. ------------------------------------------------------------ ------------------- St. Croix County. -----•----------------------------•-- authenticated this ........ day of_ ................ ......... It ..... Personally came before me this — .... h. u:. o f --- - April._......__. 19.95_ the abort: n rued ..._.......• ..............•.........._...._____ _.- ._..._...._.__...._...__.... ReuTen Doornink and Harve N • -- --.... .•........- •-- ••------ ••- -• - - -• -- •- •y ............. Hielkema TITLE: MEMBER STATE BAR OF WISCONSIN - -- -- --------------°-......------•-----••---------••----•-•--•---- (If 3tsts.) not, ....................................... authorized by to me kvimm to be the person >i 708.06. Wis. - °"�- -- • foregoing instrument and wand' t THIS INSTRUMENT WAS DRAFTED BY .. -. Reuben Doornink ' vs• ............... .................................. rr •[ C _.G ..�... .. ._. Baldwin WI 54002 "- - " -� -- • f� - - r" ...... t-• °............•••• .............. • °-• °-....._.._.. Notary Public -- - - - - -- ••;`.- Wis. m (Signatures may be authenticated or adrnowledged. Both pe My Commission is rmanent. �(a$4 ` iratioR are not necessary.) date: ............••---..O - ---- ..._ -. --- ". ... 19 /C7...J •Naaua of peraom E1Eaing in any capacity eboald be typed or printed below their ebraabuas. -- ( WABRADTI'Y DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. S[ .` FOR No. !— is= Milwaukee, Wisconsin . •T &PSM ENGR 235 -BW -38 612 575 3065 01/25 '99 14:09 N0.024 02/03 ---- H�V�HIELKEM ANO FeuaQq 000M3': W Part of the 5outh 1/? of the Southwest Fractional 1/4 o,F Section 7, Township 30- North, Rang* 19 West, Town of Emer-ald, St —croix county, Wisconsin. �'• WiI4 CO N, 91�C. r, r3oN, R IF w. 1 P.K. NAIL P�7VNpJ `• a 0Indicates 1 X X 4' 1 iron pipe weighing ''•,:� ' � h b' 1.13 lbs. /lin. Ft. set. qt 3 a — = G -�f� L ANaS ►,I�pRQVE w s Hs • 40• x ?+ E J OOl. i 0• 1 ti _• •. Hs, JUL Q� 1! 921 3 � � t st Ho • , . h 3y' � S 00 •J Ado. 9>t' � � • • fI� N 89,• c o+ _ ( _ (Zorn ;►rahapstva'p�annFbi Zoning and. y ( (• L Q T i 2 L O T L 07" ,a —r yr fks COmrl�:teo - b a Q � a .• W fA F REd 6�OiY ACR£ 0� �O trocordad lta ti q Ys., BH! O, xr, ti 19 J, r'.r 1 S Irr, q �fy Cd sv, er. I mina 30'd 15 of a 4.IB Ae er . w w {,, A CR£S P ACR 4S 6X C, ROAD . Il � : 4 , (xc: )toit b a Exe. R04D w 4 X , o_�r• 14 4 ,�,va�xhalfLio'' /64, 0I1 So, Fr. 1, w b Q 33 c3' 4. i ; O ..b 1 . � b y � � M.6 V VD& A S � f NWq TtAC� {J N � .�.__ 1 ti I ° _ ' ww rER �ovR e e t a .I h ! eJ• d 7 f• gyp r S 1-Jove SI/ fRAC'. 1."./ ate_ ^ ao • t 310. OD• M ld'00 Oti '�gt.6p• SO 4 !? "W aw CPA. SEC. r. rJON, R!d w, 1I.A. NAIL Rd VN01 I U N A Q 2 L,gN�S +• l ,"-t c oA. sec P. rso A,,Rlaw, 1/ERNrrEN MoN. FOVNpJ W ~ SOALC I "'r r00' p O ' o. IS0't4p' Soo' 4047• Soo* coo- Owner! s Address. o • �Y a C 0 t v ' s i ho n _ t _7 ,+ � •� LAURE k w ° - W 14 fr h t Q � a o oatdC : ma 2 , 199 l� r -. RtVE L 8, ; 4 + Raviied: June :-: 1992 J . 3 M H a a t Lnur•enee W. Murphy Registered Land Surveyor- Vol. 9 Page 2498 EartiPied Survey Maps St.__CrZiX—cownty, Wisconsil. This instrumant-- rdmaFted by Laurence W. Murphy i