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042-1016-95-010 (2)
of Wisconsin Deeding Di ision Commerce PRIVATE SEWAGE SYSTEM Safety and Budding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPnvacy Law, s 15.04 (1)(m)) Permit Holder Name. C,ry village Township Clint & Melodie Leigh CST BM Fla,TOWN OF WARREN t TANK INFORMATInN TYPE MANUFACTURER CAPACITY plic FSe ' a Dosing Aeration Holding TANK SETBACK INFrTDaaATrnu 1 PUMP/SIPHON INFORMATION to SOIL 5 County St. Croix Sanitary Permit No 641915 State Plan ID No Parcel Tax No 042-1016-95-010 Section/TownlRange/Map No 07.29.18.101 C-10 TION DATA a - ..n . _ _ _ i s •, -- Bot System 01 --/� BEDfTRENCH DIMENSIONS Width Length 1 No 01 �° S PIT DIMENSIONS No Or Pns Inarde D�a Ligwd Depth OI SETBACK INFORMATION SYSTEM TO P!L B WELL LAKE/STREAM LEACHING Manufacturer T Of Yale CHAMBER OR I ` UNIT Model Number DISTRIBUTI N S ST M Header/Manifold Distnbubon Pipe(s) 1 I 1 r x Hole Size x Hole Spacing Vent to Air Intake Length Die Lenpth�- L5 Dra I ! i Spacing_Itl l\ ! i ; t Snll (`nVFD — — -- — a Pressure Systems Only xx Mound Or At -Grade Systems Only )epth Owr ��� Depth Over xx Depth of xx Seeded/Sodde 3ed/Tre Center i" F BedRrench Edges To sod ched P Yes Np _ Yes No 'nMaAFIJTC• — - -- t,•,uuwc ulbutapencies, persons present. e1c.) Inspection Ni: ///-P vV /0_,, q-7/ Inspection a2: Location: 930 107TH AVE / 1.) Alt BM Description �Covow, �' N�)Co/ LA V'`' �C k t Igo wCl1 �Q i S /od vl 2.) Bldg sewer length = - a•" ��T7o�en Oi (N 10 1V-7ij�IiN(j�S -amount of corer = ( �J � Z* l�Xcto � � ���s��Nyyla.. jj-��,i o� bG-tweeK fia1n�.. ir Plan revision Requiled9 ❑Yes No Use other side for a itional information.�SOD-6710 (R.3197) Date Irure - - -- - - Ce v `,lMryEr, Industn Seri ices IN%ision d822 Madison Yards R'ayMadison. County Sannan ermn Number Ito be tilled in lily CnP.O. WI 53705 Box 7162 j1VA $ 202 Madison. WI 53707-7162d4ef` i-L pplieation n State Transaction Number Pw rs ` 0 3,�2 OD 3"7 %--C In accordance with SPS o(this form to pre tog emn urn is required prior to obtaiit Note Application forms hx stat ed to Project Address Iif ditlerent than mailing address) the Department of Sat'ety and Professional Services Personal mtornation you prod e - us o dar J n O I (� purposes in accordance with the Privacy Law, s 15.040 Nm). Suits 5 1. Application Information — Please Print All It-nformation Property Oh ner's Name Parcel a F • o -i �L- ^iolb Property Owner's Mailing Address WProperty Location 920 /D- Gott. Lot Section T N R E or H' it .State r� W� Z£tp Ride ✓ ��/�� Phone Number ���•.-1-'. �' / J1�- 11. T of Baiiding (cheek all that apply) or 2 Family Dwelling- Number of edrooms Lot a Subdivision Name Q.Cj P24,_- aublic/Commercial - Describe U Block b State Owned - Describe Use ___ Village of C S%I Number wit n1 y Lis'. i+ FA III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i avolipb ew SystemReplacement to Exisunp System )explain) DAJdnwnal Pretreatmem llnn (explain) olding Tank ❑uIn-GroundMound *[:Y)thicaunn Individual Sit(conventional [%V Renewal Before ❑RevisionPlumber [Transfer to Ness Owner List Previous Permit Number and Date Issued Expiration . opt Lion Design Snd Apphcauon Rate(gpd.'st)J-7,Dispersal Area Required VC ispersal Are TO sed-LJASystem Elevation esign Flow fg Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer u � V CA al G' i New Tanks Exiaing Tanks Septic or Holding Tank ' w ' Dosing Chamber O V. Responsibility Statement- 1, t e traderdened, assame responsibility for inetallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe ' Signature MP,MPRS Number BR9l Oct 719- Plumber' Adress(Streel, �Sz) VI. CountyrADelliartment Use Only Approved ❑ Di rov Permit Fee /� � S F� ✓ Date Issued 3 z ?Ali -" Isswn Agent Signature ❑ Owner Given Reason for Denial Conditions pprov D OAA, LTA YSTEM O 3 � Septic tank, effluent fin44��^^ filter and ,ems �;4— r (wry, � . � dispersal cell must bbegrvioed / maintained �c� S management provided by plumber. 11 as per plan All setback requirements must be maintained as per applicable code/ordinances. AIMC• so compm.e pit... .o..... ....................... ... .... . SBD-6398 (R. 03l21) Project Name: Owner's Name: Owner's Address: Legal Description: Township .v—,(�g4o& COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Al / i1%iW �� � 07,22NA� County: M C &-,6 x- �Q Subdivision Name: G.S �t 1 1-S f�— Lot Number: 9 Parcel ID Number: dx% Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 Page g Page 9 St Croix Cty Septic Tank Maintenance Form Warranty Deed CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: 9E W Y—Y e Number: Date: Q, f•• , ;t1 Phone Number Signature i RO �2-Z-7gI 4A K¢"33;L� p Page 1 �rPSSw4- � ��- �—Gsrt,�� � `` , �s. 2, d 3ARrr I • DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304.5211 Contact Through Relay httpUdspsv..gov/programs/industry-services www wisconsin.gov IONAv Tony Evers - Governor Dawn Crim - Secretary March 4, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-03-04 Plan Review: PWTS-032200329-C JAMES K THOMPSON 340 Paulsen Lake Ln Osceola WI 54020 SITE: Leigh At -Grade 930 107th Ave. Town of Warren St. Croix County NW, NW, Sec.7, T29N, R18W Total Amount: $250.00 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF I STRY SERVICES SEE CORRESPOND CE FOR: Description: Four Bedroom At -Grade system 1 Sloped Site Pressure Distribution Component Manual — Ver. 2.0. SBD-10706-P (N.01/01, R 10/12) At -Grade Component Manual - Ver. 2.0, SBD-10854 (N.03/07, R. 1/12), 600 gpd, 36 inches to limiting factor from original grade, Maintenance required, effluent filter, New construction The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • 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. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, a is r-e- d POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: Katie. Petzel(a)wisconsin gov Cell: 608-574-1189 RESIDENTIAL AT -GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project Leigh 4 Bedroom Residential At -Grade Owner Merodie & Clint Leigh Address 931 107th Ave., Roberts, WI 54023 Pcl. Address: 930 107th Ave., Roberts, WI 54023 Legal Description NW1/4 NW1/4, Sec. 07, 29N., R.18W. Township Warren County St. Croix Subdivision Name CSM #1131579 Lot No. 1 Parcel ID Number 042-1016-95-010 Plan Transaction Number C0n1Index sheet `g�ONs j�i, Pagel Calculations Page 2 At -grade drawings JWa K = Laterals and dose tank Page 3 9 Conditionall APPROVV ED E 2399N 0-7_ Specifications Page 4 Page 5 DEPT. OF SAFETY AND PROFESSIONAL SERVICES W ` BOLA Management & contingency plan Page 6 DIVISION OF I STRY SERVICES WIS. y Pump curve & specifications Page 7 Site plan �ENa'NE���`�� Attached soil evaluation report Page 8 Page 9 SEE CORRESPOND CE Designer t mes f<. Thom son License Number 2390-7 Signature Phone Number (715) 248-7767 Date 02/24/22 Designed pursuant to: At -grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 03/07, R. 01/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101, R. 10/12) Version 7.0 (11112) Pagel of 9 PRESSURIZED AT -GRADE DESIGN At -grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c)40.60 Residential or commercial? Estimated wastewater flow (gpd) Design wastewater flow (gpd) % Site slope Contour elev. below lateral (ft) Depth to limiting factor (in) In -situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2)E10, Influent wastewater quality Linear loading rate gpd/ft Effective absorption width (ft) Max. effective width permitted (ft) Aggregate length (ft) Pressure Distribution Data Entry (c or e) c Center or end lateral connection 2 Number of laterals 0.156 Orifice di Not a final ameter (in) e.g. 0.25 calculation 1.50 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in) • nn 3.62 Forcemain flow velocity (ft/sec) . �v 40.00 Forcemain length (ft) el'o93.75 Pump tank elevation (ft) 4.55 System head (ft) x 1.3 6.40 Vertical lift (ft) 1.05 Friction loss (ft) 0.00 In -line Filter Loss (ft) 12.00 Total dynamic head (ft) Designer must select one lateral diameter y or n Does forcemain drain back? y or n Are laterals at highest point? NA 6.5 Forcemain drainback (gal) 45.0 5x Lateral void volume (gal) 51.5 Minimum dose volume (gal) 35.4 System demand (gpm) Effluent Filter Information Pol Lok Filter manufacturer PL-525 Filter model number Project: Leigh 4 Bedroom Residential At -Grade Transaction Number. Gallons/Inch Calculator (optional) 750.4 Total Tank Capacity (gal) 37 Total Working Liquid Depth (in) 20.3 Gatlin (enter result in cell G46) Treatment Tank Information i 250 Septic tank capacity (gal) Wieser ConcreW___1 Manufacturer Dose Tank Information 750.0 Dose tank capacity (gal) 20,28 1 Dose tank volume (gal/in) Wieser Concrete IManufacturer Page 2 of 9 N ze &- � � A.-&0 � AM loco O S 11-1 S C S O0 C6 Ttf7 fV ONO Q m m U O W J m Se x Q r 0 m m CL ci H q F ]l 1 J 2 a 0 65 0 N Q U PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - Center Connection Last hole drl W reR to end cap Holes dried on the bottom of the WKaL "UAI sP+oed I.atnals h fmo main of PVC Soh 40 pw VS Table 384M4 • =Turn-upudballwtworolesnoutpiug Lateral Specifications 0.156 Orifice diameter (in) X 1.50 Orifice spacing (ft) 33 Orifices/lateral 17.7 Lat. discharge rate (gpm) 35.4 Sys. discharge rate (gpm) 12 TDH (ft) Final grade Weather-proof junction box Center Lateral connection point 2 Number laterals P 48.75 Lateral le_ npth (ft) 1.50 Lateral diameter (in) 0 Forcemain diameter (in) 40.00 Forcemain Length (ft) Typical Pump Chamber Layout Tank component is property vented Electrical as per NEC 300 and SPS 316.300 WAC C o p E d E C S Totals Inches Gallons 20.32" 41 . 2.0 40.6 2.6 644 12.0 24" 36.9 750.0 Tank full JA 411.6Aamn on 52.7 Pump on 243.4 94.75 TC Pump off D Zoeller Pump manufacturer BN 161 Pump model number disconnect Approved manhole cover with warning label and locking device 4" Alternate j f` outlet location /18" min. ]I� -Approved_ outlet joint Provide 1/4" weep hole or antisiphon device. 93.75 ft SJE Rhombus Alarm manufacturer SJE11011421 Alarm model number Project: Leigh 4 Bedroom Residential At -Grade Transaction Number: Page 4 of 9 M-grade System Maintenance and Ocerafion Specifications Service Provider's Name]HenryNechville Phone 715 220 6054 POWTS Regulator's Name St. Croix Co. Zonin D- 't. Phone 715 386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1000.0 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Septic and Pump TanN Effluent Filter Pump and Controls Alarm Pressure System Mound Other Service Frequency Inspect and/or service once every 3 years Inspect and clean at least once every 3 years Test once �every 3 years Should test month Laterals should be flushed and Pressure tested eve 1.5 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the at -grade component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(1), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at -grade component manual SBD-10854-P IN. 03/07). Lateral Tum-up Detail Finished Grade 6-8" Diameter Lawn Sprinkler Valve Box Distribution 101.15 ft -> Project: Leigh 4 Bedroom Residential At -Grade Transaction Number. ......... 0 .... . Threaded Clearwut Plug or Bel VaW Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Page 5 of 9 At -grade System Management Plan Pursuant to SPS 383,54, Wis. Adm. Code This system shall be operated in accordance with SPS 382-38General 44 WIS. Adm. Code, and shall maintained in accordance with its' 00 onent manuals [SBD-10854-P (N. 03107. R. 01112), SSWMP Pub. 9.6 (01/81). and Pressure Distribution Component Manual Ver. 2.0 SBD 0706 (N. 01/01, R. 10/12)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383,33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under a. 281.48, State. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter Is equipped with an alarm, the filter shall be serviced Ifthe alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum In the tank exceeds 1/3 the liquid volume of the tank. Ifthe contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation In the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify operation. If an effluent filter is installed within the tank itshall be inspected and serviced a3 necessary. proper At -grade and Pressure Distribution System No trees or shrubs should be planted on the at -grade Plantings may be made around the at -grade's perimeter, and the at -grade shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the at -grade is not recommended since soil compaction may hinder aeration of the Infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather Installations (October -February) dictate that the at - grade be heavily mulched as protection from freezing. Influent quality into the at -grade system may not exceed 220 mg/L BOD5 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg& BOD5 30 mg/L TSS, 10 mg/L FOG, and 101 cfu/100 mL for highly treated effluent. Influent flaw may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the and of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and If orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Cgntingencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the at -grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by Increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Leigh 4 Bedroom Residential At4 Transaction Number. Page 6 of 9 PUMP PERFORMANCE CURVE MODEL 151/152H53 I ,mom 35 VV Pm M;�:.nct.n dlttJw�,K.lP6'd, CONSULT fACTORY.FOR C SPECIAL APPLICATIONS 37M Tuned dosing pales waddle. • Electrical altema6 M far duplex sysiemq wend" and supplied with an storm • Variable loud eanI switches ere available for controlling single photo* sydmn. • Do ble pWybwkYaI " Is1Nlbet switches are evadable for van" Iwo bw end what cycle contrds. • 80" Qwk-80 wobble for outdoor installations. See FM1420. • Over 1306F. (540C.) Wtodd quawion reglired. 15111521153 Series /W1myw slauats CatA7M @dodos stet 115 1 Mon to 1 2 a 3 91*161 115 1 Auk a toldrdr4 2a3 H51 2ro 1 Nan 3.2 1 2a3 BE15t 230 1 Aub &2 hrMrrrd 2aa N752 113 1 Nw 6.5 1 2a3 E 52 116 1 Aub 6.5 b*lbd 2a3 1 Not 43 1 a BEt 1 Aub 2a N153 in2a3 9153 15 t I Aub war h,4aara zas E157 23a 1 INan 6.7 1 2aa BE1531 30 i 1Aub Ss h�7d.4 2aa Al Intlsta5911 of contralti, lYoeatloe (1tvtoaa and willing thould be done by a quellled Meaneed NtoMdan. AN olsebleal and adely oodaa inwAd be followedInduddng the moat Want National Elwblo Coda (NEC) end the 0ooupaloned Solely and Health Ad (OSHA). TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING ©©0©DODO tv0toen■elam©0 000e�ae�e�oo' ew�oo©DDODI ome��©�70i.cil te�00oc>■otlto■e�a o�ssov■ao or:�as�ssoo �osasam© Model 151 Models 152 / 153 32= SELECTION GUIDE 1. Single 1369Ybeck variable level float wAch or dmble piggyback variable level load switcK Refer to FMO477. 2 See FM0712 for c ed nwdel of EleciridAlfanefor E4ak 3. Venable level eonbd aA4ch I0-11M used as a w*ol sc5vetor, opwdy duplex (3) or (4) float system, RESERVE POWERED DESIGN For unusual conditions a reserve adoly %cior is engineered inb the design of every Zoeller pump. lMr1� AY Iet564a17 a1r1a wets Qsla Ain Rid 4laawctoeaa a/.. LOIwtaYi AY 4@H•1tod1 Mpylwrcmr=coo PUMP !O_ ►n►2nr•fpro/ale-rnAw '/ Srcf /9.99" 1ezM n4 24 O Copyright 2004 Zoeller Co. All rigtws neservtad. P5. 7a�'q �TP�'��-3ryNt Ex%tf. g.xOk aIa • L.c,.� ed /o�dp, SiSst� r � IJterOdi [G'la.t Le,� Led o / CSM :!%.3�sTy /1rTvyj;wN, sec; o7 0 sE. cioxG., uii jar./, +r odQ-io.0 �9S-D/O be.'� s.ls7acnss �---�0+'fS'f/NG�tClon /O1�-G-S��t6Ck.I" fieX7 G�. s'i(iw�ttn It l� 1%1t X fez - Cowie, i y /t�(ZSO- �,q4 6 MI Sr a riewaE . rf3TM'OryPs3�-9��4.:1.. in�0u� eF law.. d F m:: w Avg 14N Aw mmm on-M am Property Owner Pared ID 0 ®.wt Ground 9LF1aCee1eAZ_)eO Z fL Depth to tYnwnp fads Paps of r,�. ►1�! � aww= � ©rifjiLJN MEA��A9�1� 1TRs�M=wjjW%1F.WA • Effluent pt - eoq > 30122D m94. and TW >30 � 150 mplt • Efl o t 92 - BOO. 130 nVL and TSS = 30 ffgk The Department orCommerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 of TTY 608-264-8777. sanaua(.sm) Soil Test Project Name Harold Bend Address 931 107th Ave Roberts Wi 54023 Shaun Bird U CSTM #226900 Lot 1 Subdivision ----- Date 1/21/21 N W 1/4 N W 1/4S 7 T 29 N/R18 W Township Warren Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD *HRaSame as Benchmark i DIVISION OF INDUSTRY SERVICES Plumbing Product Review P.O. Box 7302 Madison, Wisconsin 53701-2658 TTY: Contact Through Relay Governor Scott Walker Laura Gutierrez, Secretary May 4, 2018 WIESER CONCRETE PRODUCTS, INC. MARK WIESER 2815 RILEY ROAD MAY LV PORTAGE WI 53901 ..... Re: Description: SEWAGE TANKS, CONCRETE ............ Manufacturer. WIESER CONCRETE PRODUCTS, INC. Product Name: (trans id 3090427) SEPTIC, HOLDING, PUMP OR SIPHON Model Number(s): WLP 750-MR (37 L.L., 20.28 GAIJIN., 96" MAX. DEPTH OF BURY, 364 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER) Product File No: 20180110 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of May 2023. This approval supersedes the approval issued on August 12, 2013 under product file number 2013D228. This approval is contingent upon compliance with the following stipulation(s): • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the departments stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • When this product receives wastewater from dwellings and is used as a septic tank, it will produce an effluent quality with a maximum monthly average value for BOD5 greater than 30 mg/L but less than or equal to 220 mg/L, TSS greater than 30 mg/L but less than or equal to 150 mg/L and F.O.G. less than or equal to 30 mg/L. • These tanks shall be fitted with locking manhole covers in accordance with s. SPS 384.25 (7) (h) Wis. Adm. Code. The manhole cover must be secured to the riser using screws which are not standard or Philips head to be considered an effective locking device. • These tanks shall bear warning labels, that are visible after installation, that conform to s. SPS 384.25 (8). • The tank is not recommended to be installed where saturated soil or seasonal high ground water tables are indicated between the bottom of the tank and the ground surface. • BEDDING: 3-inches of compacted bedding shall be provided. The bedding material shall be dry, sandy loam material, or coarser s �Y2 diameter in the largest dimension. • BACKFILLING: must be compacted at s 6-inch intervals. Backfill material shall be free -flowing soil or gravel s 4 inches in diameter in the largest dimension. SBD-10564-E (N.10/97) File Rer: 18011002.DOC Wieser Concrete Products Inc. May 4, 2018 Page 2 of 2 Product File No.: 20180110 This product is approved to use the following: - Side opening for when product is used as a holding tank. - Department approved effluent filter designed to be installed in a four inch diameter tee with extension and installed in accordance with the product approval for the fitter including a properly sized and located access opening for service and maintenance. - Four inch discharge opening in riser. - Bottom and side pipe openings for siphon, pump and holding tanks. - Six inch inlet and outlet openings- - Two inch schedule 40 PVC cast in riser for electrical wiring. - Press Seal "Cast -A -Seal' and PSX Gasket System by Press Seal Gasket Corp., Polylok II High Pressure Pipe Seal by Polylok, and A-Lok X-Cel by A-Lok Products, Inc.. - Dual inlets at end of tank with one access opening above both inlets. - Dual inlets at end of tank with one access opening above each inlet. - Manhole riser and cover having a rectangular, round, or square shape with a minimum 24" inside dimension. - A slide -in dividing wall (Super Screen) in the septic tank or in the first septic compartment of a two compartment tank. The dividing wall has an B" diameter hole that has its center located 12" above the bottom and is centered in the width of the dividing wall. The top of the dividing wall extends at least 4" above the liquid level and terminates at least 2" below the bottom of the tank cover. The location of the dividing wall in a single compartment tank Is between 1/2 to 3/4 of the Inside length of the tank when measured from the tank inlet. The location of the dividing wall is between 1/4 to 1 /2 of the inside length of the first compartment of a two - compartment tank in relationship to the length of the compartment when measured from the tank inlet. The department is in no way endorsing this product or any advertising and is not responsible for any situation which may result from its use. Sincerel len W. Schlueter ` Plumbing Product Reviewer Department of Safety and Professional Services Division of Industry Services Bureau of Technical Services (608) 267-1401 Phone (608) 267-9723 Fax glen.schlueter@wi.gov E-mail a K •' / 4 n n M� SIDE M WLP750-MR TANK SPECIFICATIONS DIMENSIONS- WALL- 2 1 /Y BOTTOM: 3" COVER: 4" MANHOLE 24" LID. PRECAST CONCRETE RISER HEIGHT: FLAT COVER 54" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D. LIQUID LEVEL: 37" 4" CAST -A -SEAL WEIGHT: 6,150 LBS. INLET AND OUTLET. 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN. SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS OUTLET HOLE PLUGGED LOADING DESIGN: e' 0" UNSATURATED SOIL TANK CAN BE USED AS - SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER TANK: MIX DESIGN #10 (STRUCTU FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE OUTLET APPROM ...:..:: VWCF SAFETY&'Q PUMP PAD _~ PRIM MSM)NAL sERvt� TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS NEEDED BY: • APPROVAL I MR,; !;i�PROVAL DATE, II o 0 �00 w ro o < ME U p d �F1 ARTy�.. 4 APPLICATION FOR REVIi°VN Private Onsite -complete all pages- Wastewater Treatment ;d NOTE: Personal information you provide maybe used for secondary purposes OArsw µ [Privacy Laws. 15.04(1)(m), Stats.] Systems Division of Industry Services ❑ Plans to be E-filed. Provide SharePoint User name below: For plan status, check our website at htto://dsns wi aov veral coauMlesand ties theirldesignation delegated eck ourcertain website authority ttm Io� review plans in lieu of Division of Industry services. For a current list of those 1. Project IrNormatlon -Fill In all known information. Project/Site Name: Leigh 4 bedroom residential At -Grade Location, Number 13 Street of project (if unknown, indicated nearest road) 9 107'" Ave anhorta Las Legal Description: Lot 01, CSM 9113579 Vol 31 Po 6966 NWIMINW11 Sec. 07. T 29N R 1tWYV County Tn. of Warren, St Croix Co., wl. 2. After plans are reviewed, please; (check all that apply) ❑ Call customer 1, 2 (circle number)* ❑ Requesting party will pick up ® Mail plans to customer 1, 2 (circle number)* 'Refers to customer number from below. Confirmation of alrsignmem to a reviewer. Transaction ID: Previous Related Trans. ID: Estimated Completion Date: Assigned Reviewer: Assigned Office: Mall to your office of choice below: Hayward, LaCrosse, Waukesha NOTE: We reserve the right to redistribute plans to another office if needed to reasonably balance tumaround times. Check htto://dsoe.w I.gov for office availability and next available review date 3. Complete the following deslgner/ownedrequesting Information. L1611ae the check poxes when designer, owner or requesting party is the same to avoid repeating Information. Designer Infomlatlon (Customer 1) DSPS First Name Last Name James Customer Number Thompson Company Name P380-7 A.C.E. Soo 8 Site Evakretiona LLC Address 340 Paulsen Lake Lane Citsy OOceola Zip+4 (9 digits) wl Phone Number E-mail address 20 Cell Cell phone hone (area code) F715) 248-7767 acesoilMrontie met. net Check If appllcabie ❑ Owner at a DSPS office. Submittals received may be Submittal checklists can be found in each aool Hayward DSPS 10541N Ranch Rd Hayward WI54843 715-634-4870 Fax: 715-634-5150 Email: DsosSbPlanSchedule(rbwi qov Other Please Specify Below (Customer 2) DSPS First Name Last Name Customer Number Address City State Z" (9 digka) Phone Number E-mail address Cell phone (area code) Check if applicable or specify relationship t-sCheduling is not available. Plans will be assigned to a reviewer after receir offices other than the receiving office depending on reviewer availability. ment manual appearing on the POWTS Publications page, 0MP9NENT MANUAL. You may email technical code LaCrosse Area DSPS 3824 N Creekside Holman WI54636 (NOTE CHANGE) 608-785-9334 Fax: 608-785-9330 Email: Qso DPlan$cheduIe@wi qov Waukesha DSPS 141 NW Barstow St 4" Floor Waukesha WI53188-3789 262-548-8600 Fax: 262-648-8614 Email: OsosSbP1an6cheduk0wl goy Make Checks Payable to: Dhrialon of Industry Services OR ❑ Check box to invoice designer and sign below TOTAL AMOUNT DUE $250.00 Designer signature - Review Code 7633 . ,r 'Vur r kR lu/10) 5. POWfS SUBMITTAL (check all that apply —incomplete fortes may result In processing delays) ® NEW [:]REPLACEMENT SYSTEM TYPE(S) e■ ❑ Aerobic Treatmerrt Unit(s) ❑ Chlorinator ❑ ❑ Tank Replacement Only Commercial System ❑ W Disinfection Unit ❑Add Effluent Filter NOTE: Submit separate sheets for each system Ifsubmitting multiple systems on the same sits Revision to previously approved plan Miscellaneous Review 0.9. replacement of a septic tank, addition of an effluent filter or pretreatment device to an existing system, etc.) ❑ Component Manual ® At -Grade Component Manual - Ver. 2.0, SBD-10854 (N.03/07, R. 1112) ❑ In -ground Component Manual - Ver. 2.0, SBD-10705-P (N.01/01, R 1 all 2) ❑Mound Component Manual — Ver- 2.0, SM10691-P(N.01/01, R 10/12) ® Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10112) ❑ Other - Please specify ❑ Sol Based Individual Site Design' ❑ At Grade ❑ Non -Pressurized In -ground ❑ Pressurized In -ground ❑ Mound ❑ Drip -line ❑ Constructed Wetlands Documentation must be provided to support treatment and dispersal Claims. In a separate statement, provide rationale for the project and attach supporting documents (code sections test reports, technical papers, research articles, etc.) State -wined facilities: ❑ Holding Tank Component Manual, Ver. 2.0, SBD-10855-P (N.03/07, R1/12)• Non-stats owned Commercial and Residential Holding tanks that completely utilize this manual and have an estimated daily flow of less then 3000 gallons per day must be submitted to the appropriate governmental unit for review Instead of the Department. [see SPS 383.32(3)(a)] ❑ Holding Tank Individual Site Design', (i.e. site constructed, <5 day holding capacity, Co. mingled wastewater, etc.) Please specify: _ Documentation must be provided to support the rationale for the project In a separate statement, please include all code sections, test reports, technical papers, research articles, etc.) Design Wastewater Flow in Gallons Per day 600 GPD $eaoo $801hr All treatment components are previously approved under s. SPS 384.10 (2) or (3): Design wastewater flow of the proposed system: 1,000 gpd or less 1,D01 —2.000 gpd Enter Fee $ 250.00 I 260'� $ 325.00 One or more treatment components are not previousy approved under s. SPS 384.10 (2) or (3): (Individual site design/deviation frorn component Design manuals and use of components without product Wastewater Flow in approval): Gallons Per day Design wastewater flow of the proposed system: GPD 1,000 gpd or less $450.00 1,001 — 2,000 gpd $800.00 2.001 — 5,000 gpd $750.00 greater than 5,000 gpd $900.00 Plus $0.08 for each gallon over 5000 gpd Design Holding tanks previously approved under s. SPS Wastewater Flow In' 10 (2)(3). Design wastewater flow of the Gallons Per day I proposed ' 15,000 gpd or less $ 90.00 GPD 5,001— 10„000 gpd $150.00 greater than 10,1300 gpd $225.00 Design Holding tanks including site constructed tanks NOT Wastewater Flow in Prevlousy approved under s. SPS 384.10 (2) or (3). Gallons Per day Design wastewater flow of the proposed system: 5,000 gpd or less $180.00 5,001 — 10,000 gpd S300.00 GPD greater than 10,000 gpd $450.00 ❑ Sol Saturation Determination Report (using observation pipes) ❑ Interpretive Determination ❑ Experimental System (One time addRional fee). Submit fee for individual system as per appropriate above system type) Experiment Number _ Prior approval from a section chief is required fora priority review. If approval is granted, the priority will be reviewed within 5 days of receipt priority review fee is double the normal review fee. SPS-10577 (R 10/15) Priority Review (enter same amount as normal review fee listed above) Enter Total (rounded to the nearest dollar) $240.00 $400.00 $ $ 250.00 Parcel #: 042-1016-95-010 03/2212022 04:20 PM PAGE 1 OF 1 Alt. Parcel M 07.29.18.101C-10 042 - TOWN OF WARREN Current IX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 06/03/2021 00 0 Tax Address: MERODIE ELIZABETH LEIGH CLINTON LEWIS LEIGH 1367 SAND HILL RD AFTON MN 55001 Districts: SC = School SP = Special Type Dist # Description SC 2422 SCH D ST CROIX CENTRAL SP 1700 NORTHWOOD TECH Legal Description: Acres: 5.187 SEC 7 T29N R18W PTS NE NW & NW NW CSM 31-6966 LOT 1 Plat: • = Primary 6966-CSM 31-6966 042-021 Owner(s): O = Current Owner, C = Current Co -Owner O - LEIGH, MERODIE ELIZABETH C - LEIGH, CLINTON LEWIS Property Address(es): ' = Primary ' 930107TH AVE Notes: FOR 2022; KEEPING 042-1016-95-000 & 042-1017-20-000 CURRENT AS RMDRS FROM CSM 31-6966 LOT 1 AS O42-1016-95-010 Parcel History: Date Doc # Vol/Page 08/02/2021 1135912 06/03/2021 1131579 31 /6966 05/13/2021 1129958 08/11 /2011 940011 Tract: (S-T-R 40'% 160'/. GL) Block/Condo Bldg: 07-29N-18W NW LOT 01 Type QCD CSM AGREE WD MM.. 2022 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/28/2021 Description Class Acres Land Improve Total State Reason Totals for 2022: General Pro pe woodla d 0.000 0 ° 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Chargas Total 0.00 0 0 ST. CR NTY SANITARY SYSTEM File #: Only 41111�"J�r'r" OWNERSHIP/ADDRESS FORM Created Oce 120 1 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Propg y Files &&anorl weblink. OWNER/BUYER INFORMATION Owner/Buyer o f iAIT -! A Zs /-fflj; W f ,W i e Mailing Address City/State/Zip Phone Number (required) -rpm— 711r— Ra'l4e Email Address (wms ri vAt ..+ , C Lr a%, ^ t. _ ,A i _ J. Parcel Identification Number a y2 - 1,0 /� r_�lQ (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location /a � y4 ,Sec. --7, T A�-N R-&W, Town of —Iva #-%r;Gl✓ Subdivision Plat: Lot #I Certified Survey Map # �1,j/$ 7 9 Volume 3! Page #-_&.946. Warranty Deed # l 3S Z (before 2006)Volume . Page e # Number of bedrooms Spec house 0 yes 0<0Lot lines identifiables O no New Prop rty ddress Staff Initials) OFFICE USE o: *Ave. (Verification of new address required from 3 az 2-2- (Date) (Zn ne,,- GCS for new construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey mop if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center cdd@sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www.sccwi.aov r CST -anal - ODS Safety � � m JAN 2 6 2021 SOIL EVALUATION dingsREPORT Page a DMSM of °130 107+''P in accordance with Carom 85, Wis. Adm. Code r—/FtN '4ltach comb site Plan an Paper not IM #** 8 112x 11 in me. Plan must ncklde, but no 6rtked to: vet FOniontal reference Pont (BM), direction and Percent ebpa, scab or dimensions, north arrow, and location and distance to nearest road. Please print all Information. PwsonN Nlrpnyrion YOU Prdnos m" be U"d for ..rgnEa7 Purposes (Pnvacy La-, .. 75.o4 (1) (m)). party Owner Property Locetik Govt. Lot L, tf OtxtsYs Maiirg Address Lot # Block Yo,2 Cokrnly Parcel I.D. 04Z.-101(o-95- 010 Re by if 1/4,A/i, /4 S 2 T?2-q N R Skbd. Nana a CSMk 31- (PC) (06 1 1 ,11 1 Village slown Nearest Road r(070,_ E 2) )aJ4B1M ccosauction Usefil Residential / Number of bedrooms D R eplademeritpub/ Code derived design lbw rate G GPD Parent material 1 ra k✓N <�� rl� OrIM+C F r elevation it applicable /y/ GOO co m+enta f "" — / Z. tail i, fie. ,nil n.mn.rwd.nont. System Type_ f/� "l �(t l 7 ED System Elevation 1 Boring # ❑ Boring El Pit Ground surface etevF/ O0 . I ft. Depth to inuring Boring # ICI• Piet g Ground surfaoa eb� Id— ft DeoCt to timltne trans -- MOM - ---- --- - ^v6 sru ,a> eJv7lpu nwL CST Name (Please Print) neh Bird Plumbing, Inc. Shaun Bird Address 1432 120th St, New Richmond, WI W17 r Effluent 02 - OZ/', 30 ffV& and TSS c 30 rtgrL CST Number 226900 Telephone Number 715-246-4516 Pn7perty Owner _ Parcel ID Or Page of Boring L J Boring Pit Cm� sufooe elev �G" r R Depth to WnffinD %clOr 1 on. SolRate Horimn&10),W), Redox Description Qu. Sz Cont. Color Texture Struchse Gr. Sz Sh- C wiatence Borxxfe y Roots GPDIR 'Effill 6 'Eff#2 lD MM MM- MM MM- Effkw t #1 ■ BODS > 30 1220 nVL and TSS >30 1150 ffQlL ' Eftwill 02 • BOD, 130 n & and TSS < 30 ng4 The Department of Commerce is so equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TIY 608-264-8777. Property Owner Panxl ID # # ❑ Bo*v pt Ground rr1K8 Slav1W" R. Depth ID Urrtan0 facto► 7 U in. -4 r1 JVJAW � L�I g # U Sornp 1 1 ose Ground swiace Plev. 0 Li I 8 O1trg ri e«ir>g Grorrd arrfa Plav a rL.,r....�_ .�.� low LN Elfluert #1 - BOD. > 30 < 220 ffv& and TSS >30 < 150 ffv& • Ef&mt #2 : BODE < 3D nig& and TSS < 30 mpll. The Department of Commerce is an equal oPpmrmtmity service provider aid employer. If you teed assistance to access services or need material in an ahernate format, please contact the department at 6W266.3151 or TTY 6o8-2648777. S804 o c"w> Soil Test Plo Project Name Harold Bend Address 931 107th Ave Roberts Wi 54023 Lot 1 Subdivision ------ NW 1/4 NW 1/4S 7 T 29 N/R18 W ❑ Boring O Well PL Property Line ` BM or VRP Assume Elevation 100 ft. Shaun Bird y CSTM #226900 Date 1 /21 /21 Township Warren County ST. CROIX Top of survey iron HIM 1011 f it l e�I}o CODI" !OI! A MAY 1lYNDlMC! F _ ! M6AODIS t CLINf L';UHSk TOWN O/ WARREN, WIOCONOW urn ODRlrt row ♦war •ui EIG � D � �� MBAODI6 t CLINT L610ii } TOWN cOP WARREN, YMlGOWIN Z FA NT■ CONCEPT DIE & A u r LEIG MBRODIB ! CLINT LBIOH TOWN Or WARREN, WISCONNN Z CODIE A A Nb RtLEIG El ti 1MTOWN OF It CLINT LEIN _ TOWN O� WARREN. WIlGONSIN m un corcv+ row NOW wu.IG ` r ,;.To t CLINT LEIGS ?OWN OP WARREN, WISCONDIN Z OKOUNTY � I�*O. 641915 STATE SANIry RY PERMIT 1. 9ki ?30 adlows*ve PLUMBER TOWN PREVIO BLOCK SUBDIVISION NO4, EX) CHAPTER 145.135 (2) ONSIN STATUTES (a) The purpose of the sanitary permit Is to allow installation of the private sewage system described in the permit (b) The approval of the sanitary permit is based on regulations In force on the date of approval. (c) The sanitary permit is valid and maybe renewed form specified period (d) Changed regulations will not impair the validity of a sanitary permit (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may Impede reoewaL (1) The sanitary permit is transferable History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permlt, or transfer ownership of the permit, please contact the county authority. OFFICER - DATE RENEWED BEFORE POST IN PLAIN VIEW WZ T DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI 1/20) State Bar of Wisconsin Form 3-2093 QUIT CLAIM DEED `- Document Number II Document Name THIS DEED, made between Harold P. Band and Barbara R. Bend, as Trustees of Harold P. and Barbara R. Bend Living Trust cWa June 21, 2011 ("Grantor," whether one or more), ("Grantee," whether one or more). Grantor quit claims to Grantee the following dmcribed real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please aCach addendum): �f Certified Survey Map in Vol. 31 Page 964. Doctmtent No. 11315W recorded in the office of the Rag i of Doeda for St. Croix Cory i81a0i8 gw,iu 1135912 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 08/02/2021 08:50 AM EXEMPT#:9 REC FEE 30.00 PAGES: 1 Recording Arta Name and Return Address Rodmon raw Chewed 401 Second Street, Suite 200 Hudson, wI .W16 Ann: Richard I= 042-1017-20-M Oy2—lD/G- �6--000 Pared IdaMem an Ntwber(PIN) This is bomestead property. (m) (L me, Dated July 2021 g Trust (SEAL) *ffifiarold P. Bend *Barbara R. Bend, Trustee AMBER FOSLIEN (SEAL) s o R—PeSUEN Mom of WiseeMOR O t7 eroix OMFY PHbllrr— � y EKpkw 0311t5 W KNO GM� W Wisconsin Signature(s) ST 70FCONSIN ) 99. , authenticated On COUNTY ) ,� is Personally came }befix me on _ _-.. rheahnvr rwmrrl if/_-_-/_0 oL TITLE: MEMBER STATE BAR OF WISCONSIN X0-e&d= (if not. to me known to be a) who executed the foregoing authorised by WiL Stat. § 706.06) d game. THIS INSTRUMENT DRAFTED BY: Redmon Law Chartered (Richard Lau) ' P6F 401 Second Street, Suite 200, Hudson, WI 54016 Notary Public, State of Wisconsin My Commission (is It) (expo: (81patisms rosy be authenticated or acknowkdged. Both are not ameasary.) NOTE: THIS ES A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY Y IDENTUMM. QUIT CLAIM DEED O 20e3 STATE BAR OF WMCONSIN FORM NO, 3•2g03 • Type m below signatures I Cr& QQMIJL.12 P- agg 1 oft ---- --- --- -- --- -- - — s 0 0 W3Um> Np Qt W .W MW,4 io° IN0OC�>"teoN inCILU0pp00If eMN V4nz,x.,i NNf W W W l/ �m0UNML>LWe. W > W h NNW°u PREPARED FOR: HAROLD BEND 931207TH AVENUE ROBERTS, WI S40Z3 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NORTHWEST QUARTER OF THE NORTHWEST QUARTER AND PART OF THE NORTHEAST QUARTER OF THE NORTHWEST QUARTER OF SECTION 7,TOWNSHIP 29 NORTH, RANGE 18 WEST, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. UNPLATTED 'S6'12'W LANDS ----5862697.83'-- ' (NW48'40-E) 1 _ - N88'56'12"E 531. �— I.. MI 1111.76' 3 °jgg r 1 r4 00 40 �Zq99 LU 2 2�3 Q a Z SURVEYOR: TYR.DODGE AUTH CONSULTING ASSOCIATES 2920 ENLOE ST. STE.101 HUDSON, WIS4016 NORTHUNE Each Parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot sue, access to parcel, etc.) Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the Town of Warren for advice. WETLANDS i . LOT 1 225,952 SQ. FT. 5.187ACRES 91 P$o1" 4 CURVE DATA TABLE NUMBER RADIUS LENGTH CENTRAL ANGLE CHORD BEARING CHORD LENGTH ARC I LENGTH TANGENT IN TANGENT OUT a 80.00' 10'29'21" S4'33'28.5"W 14.63' 14.65' 1 sT48'09'W I Soni'121 The map contains areas that are subOd to the Shomland Overlay Zoning Diatr a additional re*iclions apply. Contact the Community Development Department for further information -" SCALE: 1 INCH =150 FEET ISO 75 0 ISO 30S4.12' a o ZWt $ LEGEND i n a FOUND cOUNTYSECTIONCORNER MONUMENT 12 4v sN ? F ■ FOUND 5/81NCH IRON BAR W 0 C wl� � i °s 2 W • FOUND 1-1/4 INCH OUTSIDE DIAMETER IRON PIPE to CL U O FOUND 1-1/2 INCH OUTSIDE DIAMETER IRON PIPE ro r >' O SET 1 INCH OUTSIDE DIAMETER BY 18 INCH LONG NI IRON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT 3T� w go tn. �I I ) RECORDED DEED INFORMATION g � V J OI Ilk WETLANDS a FIELDWORK COMPLETED: DECEMBER 2, 2020 y`O 3 ; LOT 1LC.S.M. ETE �_ APPROXCENIER \Z VOLUME 21, PAGE 5253 LI \ DRIVEWAY G ~ (RELO(ATED ro1078 C) -FOUND REDA'RPE . AVENUE N ta m vi i N6/'Of'41'E L7T 1tli FROMSETIRON \ /AAAB'S9'lSE/ N89' 18' 48T 52888---------------- \ EXISTING 66' WIDE ACCESS EASEMENT ` C1 Io I I °vl rd W DOCUMENT NUMBER 940071 1 1V 64.87' NTERUNE N89'1648T 528.65 i 5I.4 SB9IB'4Bw�\ VdSWDRrVEWAY 1388-59'151q = S00 41'IIT 1 `-66' WIDEACCUS EWMENT TO BE 1 / RECORDED ON SEPARATE DOCUMENT II LOT 1 1 UNPLATTED LANDS I VOLUME 1368 C.S.M.1� 1 PAGE 140 I VOLUME 6, 11m inZjt/ 3122/21 THIS INSTRUMENT WAS DRAFTED aYXV 108 NO.8015-001 DATE: IANUARY 29,2021 REVISED: 4UIRCH 22,2021 PAGE 1658 IZ 1 Ic 1 Im 9 9 I x 3 „W W z �14 Wy�°a Ix�040 0 1 W Y f Wy m=s W _� NORTH 1 N 7 u N LL O LU 1 W tAtA N `o 2 U N C CERTIFIED SURVEY MAP LOCATED IN PART OF THE NORTHWEST QUARTER OF THE NORTHWEST QUARTER AND PART OF THE NORTHEAST QUARTER OF THE NORTHWEST QUARTER OF SECTION 7,TOWNSHIP 29 NORTH, RANGE 18 WEST, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. PREPARED FOR: SURVEYOR: HAROLD BEND TY R. DODGE 931 207TH AVENUE AUTH CONSULTING ROBERTS, WI 54023 ASSOCIATES 2920 ENLOE ST. STE. 101 HUDSON, WI 54016 SURVEYOR'S CERTIFICATE 1, Ty R. Dodge, Wisconsin Professional Land Surveyor, hereby certify that by the direction of Harold Bend, I have surveyed and mapped part of the Northweet Quarter of the Northwest Quarter and part of the Northeast Quarter of the Northwest Quarter of Section 7, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin; described as follows: Commencing at the North Quarter comer of said Section 7; thence, along the north line of the Northwest Quarter of said Section 7. S 88' 56 12" W a distance of 1054.12 feat to the northwest corner of Lot 1 of Certified Survey Map, Volume 21. Page 5253, Document Number 831700. and the Point of Beginning; Thence, along the west line of sold Lot 1, S 00' 17' 3X' W for a distance of 631.69 feet to the northwest comer of the existing 66 foot wide access easement recorded in Document Number 940011; Thence S 89' 18' 48" W for a distance of 66.00 feet; Thence N 45' 04' 12" W 653.36 feet; Thence N 00' 01' 5T' W a distance of 161.18 feet to the north line of said Northwest Quarter; Thence, along last said north line. N 88' 56 12" E 531.95 feet to the Point of Beginning. Containing 5.187 acres of land. Subject to all easements, restrictions and covenants of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundaries surveyed and described, that field surveying has been completed as of the date shown hereon, and that 1 have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the Subdivision regulations of St. Croix County and the Town of Warren. 1/29/21 Date COUNTY TREASURER'S CERTIFICATE State of Wisconsin) County of St. Croix)SS Approve.' JUN 0 3 2021 St. ✓qx Coun♦) / �1►` V� 1F TVIL Doom saw4 CLEp ��1•Latt� I, Denise Anderson, being the duly appointed, qualified and acting treasurer of St. Croix County, do hereby certify that the records in my office show no unredeemed tax sales and no unpaid taxes or special as ess rents as Of D 2AW-43ffecting the land included on this Certified Survey Map. 20 2f�Z / Wise A.431ers �� TUfte C untylYeasurer TNIS INSTRUMENT WAS DRAFTED BYAV JOB NO. 8025. 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