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HomeMy WebLinkAbout020-1353-56-000 ST, CROIX COUNTY ZONING DEPARTMENT 5 AS BUILT SANITARY REPORT Owner �1� Z_ =t47 Property Address /3 373 JCtz"� City /State gbS2k! . Ott o/6 e t Legal Description: Lot rv Block — Subdivision/CSM # CO tl �� ' Z of /4 /4 Sec. T -R Town SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC /.A!6<Ff�' Setback from: House .25 Well P/I- � Pump manufacturer "GIGI, Model EAQd .5 Alarm location RL466 2 — _- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM s Type of system: r Width �_ Length ,5­0 Number of T+eriehes 3 Setback from: House Well P/L 79 Vent to fresh air intake 1-- ELEVATIONS Description of benchmark - 7bA B f XIOUVI ,E40 -4M TJZC..E Elevation 100. d Description of alternate benchmark Elevation Building Sewer A07 , ST/HT Inlet 3 ST Outlet "S. ff PC Inlet PC Bottom Header/Manifold tWed Top of ST/PC Manhole Cover z Distribution Lines ( ) _Aj: P () ( ) Bottom of System () FoP. &S () ( ) Final Grade O O ( ) / State p lan number Date of installation /�- // /� Permit numb � S/�/G� /� p Plumber's signature License number /Ifo Date / / /f /ff Inspector /t /� Complete plot plan � I t Y 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. I o s ✓ 33 -� S- x / X A s /mv • � rtl L- Al 6fGT• �i��E,�t�� /� x fjb,/ 3 INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 344611 Permit Holder's Name: ❑ City ❑ Village k] Town of: State Plan ID No.: Town of Hudson ST M Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: / v od ; PI, ,. 020- 1353 -56 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ZV d Benchmark Dosing P06 Alt. BM /I ,Z : p 3 Aeration Bldg. Sewer �F �ro►r y�, Holdin S f Ht Inlet AF TANK SETBACK INFORMATION &) Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Q > . S s Septic NA Dt Bottom w 36 $ O Dosing 5 % t/ t,� NA Header / Ma cr Aeration Dist. Pipe L 1 gZ Holdin Bot. System , 65 PUMP/ SIPHON INFORMATION Final Grad , t3 q ( ,z Manufacturer &V *jks 133gland St cover Q3. c?Z Model Number foss 2' GPM I�VtO , 10 JCFD d� TDH Lift ` V Friction �(�k System .�. TD �` Ft Forcemain Length 5 5-1 1 Dia. 1 H Dist. To Well SOIL ABSORPTION SYSTEM BENCH Width r Len th I No O PIT No. Of Pits Inside Dia. Liquid Depth EN I N DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Typeo CHAMBER f I Model Number: System: 5 33 OR UNIT DISTRIBUTION SYSTEM Header / M nifoid Distribution Pip (s) « x Hole Size x Hole Spacing Vent To Air Intake I � Length Dia. u Length Dia. Spacing Z 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.) Inspection #1:('Z- / f fInspection #2: ft /�1 0 f�'`l'� Location: 635 Hillary Farm Road, Hudson, WI (SEl /4, NW1 /4, Sectio 36 T29N - RI - 36.29.19.2056 1, l 6 drscr� PTLW. ` bn. 0 or Pte S,' h«d 16 Jet Z_' ,� -�/ 'ee.�Q S; ►� -k`' Plan revisiotfecl red? ❑ Yes ❑ No Use other side for additional information. 7 4 14 '" SBD -6710 (R.3/97) D to „_ : s ector's Si / Ce / No . I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e " e 4 f a " " € } � E i 2 { x f ,, an m. w ay ., . , , .e..a. ,,.... .. � i. e E, i H j 1 a 3 4 1 y a. { F " r t x F i S I E a 5 I t i { m 9 e { s � S $ r 1 F £ { x 1 S r 4 { 9 { ' Safety and Buildings Division SANITARY PER p LIGATION 201 W. Washington Avenue Visconsin In accord wit 10-W, m ode P O Box 7302 Department of CommerceMadison, WI 53707 -7302 • Attach complete plans (to the county copy only a sys An pa �%n t less County than 8112 x 11 inches in size. n YC� i , c • See reverse side for instructions for completin s ❑ a*f qt n i r State Sanitary Permit Number 8 U6 i9 3e / / Personal information you provide may be us d ses Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)). F State Pl an I.D. Number 1. APPLICATION INFORMATION - PLEASE P LL Property Owner Name rty Location S u r 4 Number dzkj 1/4,5 T� ,N,R E(o Property Owner's Mailing Address of Block Number i37 5 - 6 ----- City State Zip Code Phone Number Subdivision Name or CfIVr%T Vmw . TYPE OF BUILDING: (check one) ❑ State Owned !t Nearest Road o Public 1 or 2 Family Dwelling - No. of bedrooms row o f III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/Condo — ,3 -- . ��� 0 6 — icya 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 Eg 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 g Seepage Bed 21 E] Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1; Seepage Trench 22 ❑ In- Ground Pressure / 42 ❑ Pit Privy 13 ❑ Seepage Pit /ei- - 7a 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPT 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 A40 I F r 7 Feet PKV r Feet Capacit VII. TANK in Ca gallo s Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic T Tank ,'� .� X119 E] 1:1 1:1 11 1:1 Lift Pump Tank /Siphon Chamber 1pod ❑ ❑ ❑ I ❑ ❑ ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation oVRe onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumbe 's Signature: (No S mps) PRSW No.: Business Phone Number: �� �^ 0 Plumber's Address (Street, City, State, Zip de): X . C UNT / DEPART USE O E] Disapproved Sa tary Permit Fee (Includes Groundwater ate ssue Issui Age Si nature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) C Adverse Determination � 'Z� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: l SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber , INSTRUCTIONS ' 7 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 Perfnit 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 use. If building type is public, check all appropriate boxes that apply. 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 isto 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 effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i 0 t 8� o y s 1 3? ' g ' % j/ C4VAS7'X IW'0 r o / A 42- 7° 0 • � F SU fR& Q�r DAVE FOORTY PL�tOM �j�" \� Lams" TesW & (�a r� #3233 #3M- RO$E S. 6 i i �- � � � � _ _ _ ___ _ i � � i � 1 ; ._.__._ _ �_._ .. __.. � --_- -f .. _ _ _.. r -} _ � � -. _ .. ._._ _. __ ! ' � I i - -._ l ' . _ _ —. -� _ _ -- - — J - - -- 1 '. � __._.. __. ', i r � i ;, i _� I � i I ' � i � � � � �' � f � ' i ' r � 1 - I , i _�. i 1.._ _.. � I �. _. .. ... -. ._�. _ � ._... � _. _.. .. .. . . _. _.. ... _ _.._ _ .__ _ _.... _..1_. -. � 1 ' i � '. i t i � � 1 �_ i _ i _� _ , - - _ _ _- - — .— _ _. t � , r - - .— i i . , I � i + � �� _ , :..::. � _.- { � f 4 - -- -- - , - -- I i I � , ` � � -- _ _ _� _ .._ � - -. _ _._ . - __ � -- __ - -- - - -r - r i j f — _.._ 1 __. _. _ _. . < _� _, _... � _ ._.. ..._.__ _- - -. ___ . � _. _. _ ._ r�. — -- i t '` � I � i -- ._. , - - _, -._ - - _ . _ _ _ - - -- __ - - _ _.. _ _ . _ �_ .._ , — - - -� r - - ; i � i _ - .._ _. __- -- •� - - - - -� -- ' i _, � � - � i i I � � � -_ ( I � j ` � . _ - _ _ _ . -- - - - -- - _�. l.__._; I 1 4_ _. I, � � _.. ' i - I. .. I ' i i _ _ _ � � I ._ .- . r � _ �� � � � � � _ ,_ � i � { i i � � ��.' � '� r _ ,tom -.. _ __ �. _._. _ •1� Vic: �.�* , � :. .. y {r Y I \�: �; ,_ __ ___. i � ti �. �� Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance s,. I, - PtPt Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 indhes in size. Plar,)Vust County include, but not limited to: vertical and horizontal reference point,(BM), ditVetion S C I percent slope, scale or dimensions, north arrow, and locatio'6 and distance toM ( road '� parcel I.D. # APPLICANT INFORMATION - Please print aM informatf9p � i Re - wed b Date Personal information you provide may be used for secondary purposes (Privacy Property Owner 1 oWrty41da' n jGkc, J ! Govt L4, � 114 TZq ,N,R I q E(or)(@ Property Owner's Mailing Address Block# Subd. Name or CSM# 13 5 w -I-v k e �f-r . C n City State Zip Code Phone Number ❑ City ❑ � Village [H' Town Nearest Roa W New Construction Use: EgResidential / Number of bedrooms 3 - y Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow G d gpd Recommended design loading rate e 7 bed, gpolff trench, gpd /ft Absorption area required _p G�SL _ bed, ft 7 S 0 trench, ft Maximum design loading rate P7 bed, gpd /ft gp trench, d /ft Recommended infiltration surface elevation(s) g ft (as referred to site plan benchmark) Additional design /site considerati ons 4Lt, Q_I -ear. 11.170 Parent material 64 —r— t'-t_ rill j - (nla .S Flood plain elevation, if applicable /tIlA 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 ® S ❑ U ❑ S ®U ❑ S ® u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench U' $ — 5 r l ,rtccb r e S �' 6 C Ground 3 / -n ,- 0 s • ? .O elev. p f 6•.rat- Depth to limiting /cc factor Z_in. Remarks: Boring # 0- tv r- 3/ — 5 r' 1 m mf r CS L 3 r '� 7 — S o�in« WY cr Ground � elev. fv•' y ft. , Depth to limiting factor m in. Remarks: CST Name (Please Print) S' nature Telephone No. a W v f- c ,e C 7 -,- 5/7- O LE - Address Date CST Number 5'ezl4 a S 3 O -TCJZJ SOIL DESCRIPTION REPORT PROPERTY OWNER Page e- of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 I o -i2 0 r 3/3 r 2 !G r _ S rna Ground v r [�/ 5 Yn C S 7 elev. Depth to limiting p factor l� in. Remarks: Boring # C5 Ground elev. q3L- Depth to q1 a limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # / -- S,' irta� m r C l •S�' Ground elev. ��• Depth to . Z 04 . Z limiting factor 10 7 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) oor 0+3 M -e d X -z N • tlau- too, V 9 / d a- � V 03 of Q,nL • r oz• by A� i I� J I _ `i PAG� CF PUMP CHAMBER CROS5 SEC IOI,J AMD SPECIFICcrI0K15 VEUT CAP `"C.I. VENT PIPE WEATHERPROOF APFROVED LOCKIAJG N Z5' FROM DOOR, .JUKJCTION BOX MANHOLE COVER .0 WINDOW OR FRESH 12 MIU. AIR INTAKE GRADE I AL I I 18 "MIKI. COK1pUiT �-- 18 "MIN. ---- -_ -_ -- 11� INLET PROVIDE - T AIRTIGHT SEAL i I * f A I II I I I I ALARM d I II I I o *APPROVED ` om . JOINTS WITH I ELEV_ FT. APPROVED PIPE - -� 3' ONTO PUMP --� OFF D SOLID SOIL i COKICRETE BLOCK RISER EXIT PERMITTED OKJLy IF TAKJK MAUUFACTURER HAS SUCH APPROVAL SEPTIC E SPEGIFI'CATIOUS DOSE TANKS MAWUFACTURER : 1G WMBER OF DOSES: PER DAy TA1.► SIZE: ®d GALLOKIS DOSE VOLUME . f.Z� ALARM MANUFACTURER: Al/C 'op i '!fO IMCLUDIMG 5ACKFLOW:-o? GALLONS MODEL IJUMBER: .tp l/!i CAPACITIES: A= IUCAES OR X631 GALLOWS SWITCH TYPE: _ae�/e B _ > - I OR � � GALLOOS PUMP MAMUFACTURFR: 6aULL ` C= �� +� IAICHES OR / • GALLOU5 MODEL KIUMBER: D= 7 IMCHES OR lZ GALLONS SWITCH TYPE: —.'a ci;R- V �, ,C NOTE: PUMP AND ALARM ARE TO BE MIMIMUM DISCHARGE RATE PM INSTALLED OKJ SEPARATE CIRCUITS VERTICAL DIFFEKEUCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. ' FEET + MIKJIMUM NETWORK SUPPLY PRESSURE - -�''r' < �� ��--yy FEET II I �- Lam- �� FEET OF FORCE FACTOR. M ,,/� ,) 'S MAIM X /ppF�FRICTlo1,! .J.>g2- FEET i TO AL D91JAMIC. HEAD FEET 3 IIJTERNAL DIME►,ISION>: OF TA1JK: LEN 4w. GTH ;WIDTH ;LIQUID DEPTH I � 51GUE0: LICENSE MUMSER: Zit OAT f:_ r'_T' JI MODEL 3871 • • • Su bmers i b l e • i W OLDS I u ump Specifications METERS FEET ti Up t0 40 yGF MODEL: 3871 Discharge size 1 y4" NPT 9 30 Solids (, maximum 8 Mot or MOt - • f . 7 25 Single phase:115V Materials of Construction1 = 6 20 Brassfthermop�stic , s ,5 Features and Benefits 4 EP OS *Top suction eliminates 3 10 impeller clogging. 2 EPOa • Corrosion resistant 5 construction. • Float actuated switch. - ° °° 10 20 30 40 50 US.6PM 1 .,. 0 2 4 6 8 10 12 METERS FEET caPacm MODEL DVP03 Pump Specifications Features and Benefits G 6 20 4 /1° and 1 /2 HP • EPO4 impeller- semi -open design Uj 5 Up to 60 GPM with pump out vanes to protect € 4 15 Maximum head to 32' mechanical seal. t 3 10 Discharge size 1 NPT • EP05 impeller - enclosed design Solids: 3 /4" maximum for improved performance. 5 Motor • Rugged glass - filled thermoplastic All motors feature ball casing and base design provides 0 °° 5 10 15 20 z5 30 35 40 u.S.GPM bearing construction. superior strength and corrosion Single phase:115V resistance. 2 caPacm e 6 10naror Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • GSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer �( iev >T&'W7 Mailing Address 113 - 1 7 •��Tak ,€' J7. ,t,!G,� ,y w _g-yae j_ Property Address A 3S 124 -e-AK y LYK (Verification required from Planning Department for new construction City /State G X rut.= S �/ Parcel Identification Number rg2n- >3s3 - Et a LEGAL DESCRIPTION Property Location ' /., ' /4, Sec. 4 T _ N -RZ5 W, Town of te1U1>,A0 Subdivision _�?'�D.r/G�iJ,� /2.L' ©� , Lot # Certified Survey Map # Volume — , Page # Warranty Deed # SbD _Z 1 37/ , Page # Spec house ❑ yes 14 no Lot lines identifiable CK yes ❑ no SYSTEM MAI 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da ys of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ib SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I o� 1:71 o�c� .;f �o WARR SEE Document Number: r 4 EG13TF+i j �f riCE i R Return Address: OCT 3 U 1998 Parcel I.D. Numbe. (PIN); 042. 1086.10; 042. 1086 -20; 042 - 1086 -40; 042.1085 50; 042 - 1085.60; 042 - 1085 -40; 042 - 1085 -20; 010- 1108.50; 020. 1108 -60; 020. 1108 -70; 020 - 1108 -80 Th* Deed, made between Frederick G. Lenertz Land and Cittle Company, L.L.C., a Wisconsin limited liability company, Grantor, and Richard 0. Stout ana .ianet P. Stout, husband and wife, as survivorship marital property, Grantee, Witnesseth, That the said Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Alisconsin: NE 114 OF SECTION 36, TOWNSHIP 29 NORTH, RANGE 19 WEST, ST. CROIX COUNTY, WISCONSIN THAT LIES SOUTHERLY OF INTERSTATE HIGHWAY 94. NW 1/4 OF SECTION 31, TOWNSHIP 29 NORTH, RANGE 1 8 WEST, ST. CROIX CC >UNTY, WISCONSIN LYING SOUTHERLY OF INTERSTATE HIGHWAY 94 cX .EPT CERTIFIED SURVEY MAT IN VOL. 1, PACE 221 AND EXCEPT PART IN I VOL. 634, PAGE 138 AND EXCEPT PART IN VOL. 913, PAGE 201. NE 114 OF SECTION 31, TOWNSHIP 29 NORTH, RANGE 18 WEST, ST. CROIX COUNTY, WISCONSIN LYING NORTHERLY OF 65TH AVENUE AND SOUTHERLY 0'= INTERSTATE HIGHWAY 94 EXCEPT PART IN VOL. 913, PAGE 201. This is not homestead property. Together with all and singular the hereditaments and appt,rtenances thereunto belonging: And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record and will warrant and defend the same. ' Dated this 30th day of October, 1998. FREDERICK G. LENERTZ LAND AND T RANSFER CATTLE COMPANY, L.L.C. - E� 3. Steven B. Goff, Power of AVorney Frederick G. Lenertz ACKNOWLEDGMENT STATE OF WISCONSIN i ST. CROIX COUNTY 1 Personally came before me this 30th day of October, 1998, the above named Steven B. Goff to me known to be the person who executed the foregoing instrument and acknowledge the same. 4. Pawel.l A. Skorude, Notary Public ; St. Croix C;! /vnty, Wisconsin: •l ;; . WV Commission expires: March THIS INSTRUMENT DRAFTED BY: Steven B. Goff ; f B;e, Goff & Rohde, Ltd. •'••.+t. ' P^ Box 157 River Fans, WI 54022 S8G±LENERTZ'('•_APP1D1 WD s 1 1 -- 1 1`Il ss , � O nL 11 1 1 I 'r. 1 1 1 ...........L /• 1 1 I I 1 I Y 1 N I I l l o ,j 1111 � S I I �1tr wo A � I Iy tT ! iS 1 1 j N ; op 1 lo+ 111 �i3/ i I � \ 1 1 4 ` I I A \ 1 I Im 1 \ \ I OD I�� 43 �. ` �4 � I i ��• _ i 112�'.��. •�O i i � T � Div i sion o Department of Commerce f SOIL AND SITE EVALUATION Division of Safety and Buildings � Page of 3 Bureau of Integrated Services in accordance with COMM Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must, ",,,, County include, but not limited to: vertical and horizontal reference point (BM), direction and 4- ar percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # -- APPLICANT INFORMATION - Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner PropertyUc atioIn (61412/' S Govt. Lot .S " # 4��1/4,S �6 T N,R E (or Property Owners Mailing Address tot.# 1 P96 #`` Subd. Name or CSM# City State Zip Code Phone Number ❑ City El Village Town Nearest Road W New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement 9 Public or commercial - Describe: Code derived daily flow �d� gpd Recommended design loading rate 1 ,Z — bed, gpd/ft . trench, gpd/ t Absorption area required _ bed, ft r rich, ft Maximum design loading rate _gy bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevations) A&zi ft (as referred to site plan benchmark) Additional design /site considerations Parent material L l W- 1 %­ ood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U unsuitable for system I Os ❑ u ❑ S CZ u V S EJ U ❑ S IZI U I ❑ S V1 U ❑ S V1 U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft -g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench Z V& -7G ~— sG S tir s .. Ground .3 `— ScT- NfL elev. ft. Depth to limiting , factor Remarks: Boring # .n c 1A c r ' 3 Ground elev. 9XI-ft . .z Depth to limiting /� fact r in. Remarks: Al CST Name (Please Print) Signature Telephone No. Address Date CST Number i PROPERTY OWNER �- Shy/ SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D.# Q.• �� S_�— J b Boren # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Ground — (v 3 his evs� 44 elev. �tZft. Depth to limiting factor Remarks: Boring # :s:':::3:::e2;w Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Boring # ; E3 Ground elev. ft. Depth to limiting factor ' Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R.9/98) L r I I �. fu 54 0 no a M i l �--, --