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Home My WebLink About002-1034-95-200Wisconsin Department of Commerce Sfl{L EVALUAT ~t7h~f R~pC3RT P~~ page _,L__ of ~ Division of Safety erxi buildings in accordance with Ccmm f35, Wis. Adm C~~ is County S'T C,~ar k Attach comp{ate alts plan on paper nct less than B 112 x 11 inches fn size. Plan m .;;~t . include, but. nct ~mited to: wrticatii and horizontal reference paint (BM), direaiion a~ ~~+:i Parcel LD. perch slop!. scale or dtmernlons, north arrow, and location and distance to Waal u>a I oed. pate P41w-so pMnt ~p dnllwmaftfon. eview by -- s_., ~ Pereor»f IrAormrtlon you provitla msy be uee~f for gpq~ltl~car.p-+rp01NF>E , w 15.0• i"Il I ~r))~ P,ropartyQwnar . ° ~ Propertyi,aiQNlon ~' ~ ` c3ovt...nl .{/~ ~~/W,14 s /~ T ~ ~ N ~ l~ tto~w ,,, ~a y f>;r^fo c TES.. , ,, ., Property tZVr~rnal's Ma tg Address ., , " ~ Lot ;~ ~{3iock ~ Subd. Name ar CSMt~ v) $ R ~ ~ 3 ~ .~. Z . Po. sex ~i~ ..~.. ^ City ^ VlUege own Nearest Road _.~... _ uJo~c~ v~c,c-E w / i5 > G98-335 ,B~ /d~v~r, C.T~ E {$(~tew Conslruotbn Usr:~ RarkNnt(al I Number of bedrooms,,,,, 3„_ Gc;d~- JsrYwd d~ipn flow rate '~SU - OPis C1 Rep~osment ^ Pub~o ar rximmerclal - Dsaeribe: ~,,,._._......... Road ~lafn elevation it applk,abls ~~ Parent material __._ ~~~~.~. ~ ~ ~/ C3eneral oomn~er>ts and reoommsndatbns: t_,6ac>L .~.~'`x'.~ I a [~ Boring ~~ P ~' pit ground surface elev. ~i~~ R. . Depth tv ! mltirp faatcr ~~., ,.._ in. I•loriaon Depth porninrs~ Cobr Redooc peeorlption Yexture Strut~txe gh ~ ~i Cor>siNertoe Boundary Roots lft. Muneell QU. ~. CWit. Color p . ~ S ~3h-, ~ ~ o /a /a y,~3 yR¢/ s Scl 3s6 3s6K v r tf~r cS /~ o ~a_a d 3 __---- Borl~ ~o~. - PIt Onwnd surFsee Nev. ,~~~'~. Dsptl7 to limltlnp hctor ~ in. Fbrizon Depth pomin~t Color Redox paecriptian Texture ~~r~~ Coneistenca Boundary Root In. MtmeafE Qu. Sx. Cord. Color c r. B.z. Sh. / a-/o oy~~~ ~ 3s6k rrV~'r cS ,3rY, a2 p-/ 0 2 g S G T asb k rxV-~'r c S l~ 3 ~ ~ ~o ~/z ~` S d 0 72 S/ nt S ~~~ r11. ~ e .- .~ ~.~ ~. sy~4/.. ~,,/ ~0 ~ g spy n~ S .,c?s ~k. < c s -{ ~<~ • C-ii~ ~ : @QD a ~ < 220 mptL and T88 >34 < 1i30 mglir ~~~~ 8QQ - CST Dtams t?~,~ .. _ ~ ®1 / /„ , ~ ,. ~ addre.e .e~,~oad ~ tc.7 l~~3 T -~¢~-~.3~ U3 ~~f 3 ~~vt~ Avg, ~ ~ ~r r ~w+«wiw ~ z ~- .5 ~~ ~ '`~ ,~ /. a- - «~ + ~ ~~ ..~ , ~ .~. J. 2 ~- and TSS _< 30 y2~ ~S T~kphOrn Number fM1t+. n.~ww Two ~~~ ,. ~ ~ r_: A Pro~pe-rt~y Owner ~!~ y /QF-~t~T~- l 'S 1 ga~0 M ~ Ga/ ~/ ~~ paraellD~____..._... Pag® °~ °t /2 ~.^..~ ~-Pft Ground surtaoe euw,,1~v. ~ ' -- n. uopcn zG tiim~np ~ac~or,,,~,,:,,,,_,,,,, m' (ior'~son Depth Dominant Colo Redox D~aorip6on Tsxturor Structure Conslstaroa Boundary Roob Solt Aoetion Rate O3~DRt' in. MuneaM Qu. b`z. Cont. Color t~r..tt. Sh. "Etr1tH 'C-AIY2 l o -/ v /o yiZ3/3 s l ' 3.615 yh v 'r c- S 3 n.. . ,5 • ~ ~ ~~ /a'lie ~~ o? s6 k der e. S /-~' . ~ ~B / ~ Bortns ^ Pit Ground sorbs alav. ~ ~!. Depth to Ilmaltlp iaotor _____~,_,_ In. soil Ilostloh Rata Horizon Depth Dorttintnt Color Redox Deeori~ion Taptlure Stnxsture Conaiatenoe Boundary Roob P In. INhu»ol! Ctu. Sx. Cont. Cobr rr t;=. tih. `EfIB'f 'Et'IlK2 ^ Plt aro~d aurfsCe ~' --n• Depth to tlmhlnp factor _„_,,,,_ Ut. ttotl n Rate D ~ ° ~° - _ Horizon Depth Dominant Cotor Redox Deeoriptlor- Texture 5truotura Consfabnoa Boundary Roob tn. Mur>eatl Qu. sx. Cont. Color Car. ~. Bh. 'Et'~INN 'C-~Rlt2 .... .. . .~.... • Etlluent B9 ~ 9ClD„ > 30 ~ 22D m9ll. ark TSS >30 _< 160 mpN. ' EMuent ~t2 = BOC}f < 30 rnplL and TSS c 30 melt. The Department of Commerce is an t:~ual opportunity service pmvidar as~ci employer. If you need assistenoe to access setrvices or need materiel in as altern$te fc~rmmat. please contact the depattatent at 648-26G-3151 ar 'PTY 608.26-87??. BSD~i30 (A47/0~ C''7H ~ „ _.. ~- -~'. ~. ~' ~~ ~; '~ ~' ~~ ~'. ~- 9 ~~ s ~.4 i' n ~'r ,~ t ~~ ~j- ~~ r r~L. ~~ ~ - . ~~~~ ~~~ r~ ~ ~ ~- v ¢~ ~ ~ ~ ~, #= Q ~~,, 1 ~_ ~L ~ ~v ~.. V ~ `~ d r ~+S' ~ L~~ ~~"~ ~ ~ ~ 3 ~ ~ r~ , „ l3,. ~ ~ Z ~~ of ~ `~- c1 '~~~ ~.~ ., w.! ~ h ~ ~~ L~ ' ~~ ~~ `~~,,~.. ~~ ~~ •.... ~ ~ ~... 7v`9~tZl CERTIFIED SURVEY MAP Located in port of the Northeast Quarter of the Northwest Quarter of Suction 18, Township 29 North, Range 16 Weat, Town of Baldwin, St. Croix County. Wisconsin. Prepared for and at the request oF. Troy Affolter P.O. Box 219 Woodville, WI 54028 Owner. Dala Affoiter Droft~d by. Howard H. H~rrlld 111 tNARTHNEST CQk'NER SEQ 16-29- f6 (Ft?[/ND SURREY A/ARIC NA/LJ NAR77-I L/ _ ~ S8 S87 27'09 E S ..... ... ....~V~ ................ m Sf. CRrax ~~ tn~+e oNO m Z FNI~ le.ina e~ !'erka t:osM^ v i3-- ~~-~~' _ ~ ~~~17_?'~_~w.4Y "~" w ~ ~s87.2~'os"E ~o s2 .so• 87'27'09" E 297.83' _ _ o w N v' o cry O DR/1E o ~~ ~ o ~o ~~ ~~~ ~ ~ ~_ s ~~a~ 8~~~ 0 ~~ ~~~ ~ 3 a ^$ 0 O O >: ~~eE ~~ q Q s 3 m~ ~ aL s'' o ~~3~n mo ~o ~A a~3~ ogo~ o : ".. o~ ~n N p n rtq~ a~oa q ~ ~~ JOB ~ WI057SU748 Prepared by. //Jr~ SO/L BAR/NG LOCA770N ~e_ z4- ~a N 87'27'09" W 457.78' UNPLA TTED LAND' OF QWN~i4 Phone No. (715) 246-4319 NO~TH Fox No. (715) 246-3830 P.O. Box 325 Naw Richmond. WI 54017 Sheet 1 of 2 1~~~ • VOL 18 PAGE 4693 KATHLEEN H. t~ALSH REGISTER OF DEEDS :3T. CROIX CO. , 1fI RECEIVED FOR RECORG 01/28/2004 03:30PM CERTIFIED SURVEY KAP REC FEE: 13.00 COPY FEE: :3.00 PAGES: 2 Section Comer Monument of Record Set 1" x 18" Iron Pipe wei hang 1.13 pounds per linear foo~ Building Setback Lins (100' from Rlght of Way) UNPLA TTEQ LANDS NLW7fl 1/4 GIGYPNER (I E 7HE NAR7JYyE-,ST QUARTER .S£~ >'s-29-tB r[-FiDI/ND 57JRVFY A//IRK NA/LJ 7 27'09' E 297.83'648.86 crH E" --- :) AN 2 8 2004 ~ N This Agricultural Zoned parcel is crested pursuant to Section 17.14(lxb~, St. Croix County Zoning ordmance. The proposed house occupancy is required to comply with this section. ~O I If t1a (eOD~dp rnUtM 80 days of C s deM apps aheu be ~ apptoNM ,~ Ana vnN~ ,~ ~ DoT ~ IZ o TOTAL AREA: a I~ = 240.725 SQ. FT. I~ ~ 5.53 ACRES ICI y BREA EX. R.O.W.: ~ a' r. 230.896 SQ. FT. ~~ ~ ~ 5.30 ACRES ~ ~ ~Nlr j~ V~~°•N`~G1-~ Ip 2 Tv R. is (~ ~ OOD4E 5-2484 ~. CLEARS KE, r ~ y~~.., ••'OQ.~ I IZ I~ lol~ I i0~~ I~10 ~~I~ I~ I~ I (~ too o too GRAPHIC SCALE SCALE IN FEET 1 inch 100 feet BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE NW 7/4 OF SECTION 16. TOWNSHIP 29 N.. RANGE 18 W. WHICH IS ASSUMED TO BEAR S87'27'09"E. Vol 18 Page 4693 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTAyH TO PERMIT) Personal information you provide may be used for sewndary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Affolter, Tro Baldwin Townshi .ST BM Elev: Insp. BM Elev: BM Description: /'D G , v goo • o ~~G ~~- ~l IAIVR INrVKIVIAI IVN TYPE MANUFACTURER CAPACITY Septic t ~/' ~v t. /IJV Q (~" b~ Dosing 3 - UD Aeration ,1~ // Holding TANK SETBACK INFORMATION TANK TO /L WELL BLDG. Vent to Air Intake ROAD Septic ~ !~ ~ \ ~ i l 2 3 ~ Dosing ~ 35 Aeration Holding SOIL ABSORPTION SYSTEM tLtVAI IVIV UAIA county: St. Croix Sanitary Permit No: 453445 0 State Plan ID No: a - 03 ~~ -aod Parcel Tax No: c SectionlTown/Range/Map o: 16.29.16. STATION BS 2 HI M1-Z' FS ELEV. o a ~ b Benchm ~ / tv / ~ ~ Bldg. Sewer sc~/ o ioS ~..~ q~ . 7 St/Ht Inlet ~. 9~ -~ SUHt Outlet ~- Dt Inlet / Dt Bottom -~- /a. U3 g3 -~ 7 ead a .z ~ i -~ .35 02- 7 Dist. Pipe ~Q~o.li 'SAS' aZ.t'o Bot. System ~- t. f~U O ~ . f,~ Final Grade ~j` ,J'~ j®®~ y,7z /aa • ~ %~~~ ~~e s ~~ ~a/.7 y. ~ m // . ~ BED/TRENCH DIMENSIONS Width ~ f Length ~ ~ ~// No. Of Trenr~hes~ ~~ PIT DIME ISFONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHI C R Manufacturer. Type Of System: ~ ~A V UNIT o tuber: DISTRI¢LLTipN SYSTEM ~.F ~~ ~ p~ ~,//i,R/ Header/ anifold Z / ' Distribution // Pipe (s) ~7 / ( x Hole Size C/ ~~ r x Hole Sp~aci~nfg- ' / Vent to it I ~ ~~ Len th Dia g LL g Len th I Dia S acin P 9~ _L_.~ d ` l SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Only ~'KOr ke ` ~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil (~ Yes No CI Yes ~ J No COMMENTS: (Include code discr pg cies, persons present, etc.) Inspection #1:~/ °2 ~ / U ~~1~U~1/Yl• Location: 2335 Cty Rd E nknow (NE 1/4 NW 1/4 16 T29N R16W) NA Lot 1 7 1.) Alt BM Description = ~7 'C 6~'E r~ 2.) Bldg sewer length = ~•/{ ~ - amount of cover = ~ ~'~ ~~%p'~t~Q-2. Inspection #2: ~~/a~ Parcel No: 16.29.18. 3.) Contour = ~~ ~~ Plan revision Required? ~>:1 Yes /~ ~; ~ I Use other side for additional information. ~ l ~ , "'r I Q ~ ~ _ _ ~~ SBD-6710 (R.3/97) Date Insepctor's ature ~~~~ , ' -; Cert. No. , /, i PUMP/SIPHON INFORMATION- oo~-10,~~{ - ~i5-~ Safety and Buildings Division H •r/ Cnun ~L`` 1. 2 a ~ 201 W. Washington Ave., P.O. Box 7162 l" m '~ Madison,11V1 5370,7 - T 162 Sanitary Pertrrit Numbce (to be filbed in by CoJ ,~„~S~a~ (608) 266-3151 s 3 S~ De artment of Commert:e S e Plan t:D. Number Sanitary Permit Applicatilon ~~ ~~"~ 2 ~• Tee, ~~~ In accord with Comm 83.21, Wis. Adm. Cade, personal information you provide t Address (if different than mailing address) may be used for secondary purposes"Privacy-law, s15:04(1 xm) /~ /J t. Application Information -Please Print All Iafornnti n ~, 3 ~ 5~ ~ ~ , ` G r-,?" _- Pa # Lot # Block # Property Owner's Name ~ ~ ~ ~ , t Yic ~2~~ 6 ~`~~ ~' ~`'' , ,'`', ; ~ 1 Pro~n{y, O er,'/s~Mailing Address C~ Property anon ar Y ` v ., /J G ~ ~. ! l i (~ Lx'iti l~ r/ ~~, section ~ S~ - _ ... . Cljiry,,,t~State Zip Co/die ,. ° °~ . Ph^ont~Fmmber .. ,'.," WrjU ~r/ ~ /~{ ~ t ~~~a Z~' 6 ~ 1~- ~ ~~~"-~ TAN: R.1``r '~orWe) II. Tyke of Building (c6~nck all that apply) P,or S ~o~ ~~. ~ CSM Numtrec l or 2 Family Dwelling - Numbs' of Bedrooms S • V'. ~ . ~// 9 ; 35'Z ^ publicFCommereial- Dtscribe Use 'T ~O ~-t' ~nA ^Ciry_^Village ~`['ownshipof '+ ^ Strue Owned -Describe Use x ~ M Y t III. Type t-f r'mit: (Check oaly one-box on line A. Complete line B if applicable) A• ew System ^ Replacenratt System ^ TreatmenUHolding Tank Replacement Oniy ^ Other Modification to Existing System, List Previous Permit Number and Date Issued B. ^ Permit Rearewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration Plumber Owner IV. T e of POWTS S tem: Check all that a ~ ~ ^ ^ Nar-pressurized In-Ground ^ Mound > 24 in. of suitable soil ound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter Constructed Waland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating 5artd Filter ^ Recirtarlating Synthetic Media Filter ^ Leachin Chambrx ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis isaUTreatmeni Area Infotrmatioa; ~ ptta proposed (sf) S ~ d ~ d~ D~i~ (gpd) Design Soil ~ppd lion Rste(gpdst) Dispersat~ equired (st? spersat~ ~ S a Vi. Tank Info Capacity in Total Numbs Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing , Tanks Tanks Septic or Holding Tank QiG ~ t ~ ~ G ~ ~ Aerobic Treatmem Unit l>osiag Cltembd- / ~ ~ r VII. Res asibility Statetnettt- t, the ~r a~nme asibilitY for tasbdlatbn of the POWTS shown oa the attacYed Plumber's Name (P ''nt) Pium Sign~ttre .J~4P/MPRS Number Business Phone Number ~ ~G C' J ~14-yt ~~ 3 ~'l ~1 S ~ 2 l 3~ - ~ ~~ r'S `~ Plu bet's Address (Street, Ci ,Zip ) 1 ~o. ~G ~ a43 - ~v ~v . 1(c 41 t' s'z~c~~-~' VIII. Cozen /Dt: rtment Use Onl Approved ^ Disapproved Sanitary Permit Fee (inclydec Groundwater Date Issued 1 uin gent Signature o Stamps) Surcharge Fce) ~ ^ Owner Given Reason for Denial IX. Conditions of ApprovaURessoas for Disapproval SYSTEM OWNER: ` 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber 2. All setback requirements must be maintained as per applicable code/ordinances. Attach eaarpkh pLues (to the Camty wady) tar the system a pper rent leas 1Mn 81/2 x 11 iaetres sa ake SBD-6398 (R. 01!03) `.,_ - PLOT PLAN Scale 1"=~~~ ~ Page J of -7 a __ ~- .. - L1, ~ o_ o~ o,~.~: S:"~"~. , 3Cyktji A PV C Pl D~ i~~ ~ ~-~y ~..~ , ~~~ a ~ } c~ ~ ,. y, N o ~ !n ~~ fi~ 00 o~ eel ~- n .. ~~~ LI / ~O~ ~ 100 'li ~..y 3 ~~ ~~w~ ~~ E /,~, i .i k S v 6G~~L7 wl~.l, \.DC . ~~ ~p`oF-Z4 PVC ~cW1• ' ~ gnu # -L ~ ~'3 - so n'pT ca"~.p~e-T oR l~ ~S-fUtiZ.t3 'j~j1s ~~. - -o ~ \oti off. S.~' ~ ~~ v~~~~ ~~ g•Z o.°' • ~' ~~ ~~ ~~ NOTES • ~ - -- - 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4 "observation pipes with a roved ca s. Z 3. Septic tank to be ~000/~{,S~ gallon capacity. manufacturedrbyuired) . ~~~Z CC~.iC2~ (~wLP Lot)/ SO M~Z)wl~ ~0~00 ~tL E~~T~72 4 . Eench mark 5 S~~••- ~C13 ~ V ~ 5. Divert surface water around system to prevent ponding at the uphill side. ' ~ ,~ ~ ~ ~scons~n Department of Commerce RECEIVED NOV ~ 3 2003 ST. CROIX COUNTY .ZONING OFFICE October 28, 2003 OUST ID No.267341 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE PO BOX 74 RIVER FALLS WI 54022 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/28/2005 SITE: Troy Affolter County Road E Town of Baldwin St Croix County NE1/4, NW 1/4, 516, T29N, R16W Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce. state.wi. us/sb vvww.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary Identification Numbers Transaction ID No. 934872 Site ID No. 667343 Please refer to both identification numbers, above, in all correspondence with the agency. FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 927579 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 ~Ot1t~1 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: DEFARTMEN~ General Approval Requirements: ~ l' ' r SEE CORRI • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10572-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) 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. ARTHUR L WEGERER Owner Responsibilities: Page 2 10/28/03 Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, e ~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state. wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 ~,~~~ ~~U 2op3 TITLE SHEET Page ~ of ~ pC~ 15 ~,~~-} FOUND SYSTEM QQ~~ a~®~7-~ A FOR rCC"~ a V .~ BEDROOM RESIDENCE ~is plan has been prepared in accordance with the Mound Component Manual SBD-1057 P and the Pressure Distribution Manual SBD-10573-P CCZ, blg9.~ ,•' CR. blaq~ LOCATED IN THE N~ 1 /4 OF THE NW 1 /4 OF SECTION ~6 , T Z ~ N, R 1 ~ W, TOWid OF ~jP~`..~j,Jl ~ ~, S`T'. C\2.Q l X COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM rIAI~TAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW-CROSS SECTION - PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUI.IPING CHAP~IBER CROSS SECTION PAGE 7 of 7 PUMP PERFORI4ANCE CURVE PREPARED FOR R ~~ ~3p-X _ ~`q __ _ W sJ' OF COAM1yERC~ f ~~ ~NLDINGS PREPARED BY ~- =~'ONDENC WEGEE~ER SO S L . TEST S NG AND . • . DES 2 GN S~RV S CE P.O. Box 74 421 N.ilain.St. River Falls, ~dI 54022 Phone 715-425-0165 Fax 715-425-6864 ,. - JOB N0. ~ ~ ~.S --o 03 , Eby Mound System Management Plan Page ~Z. of 7 Pursuant to Comm 83.54, Wis. Adm. Code - Seotic Tank The septic tank shall be maintained by an individual.certifi r ed to service septic tanks under s. 281.48, Stats. 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 filter shall be assessed at least once every 3 years by inspection. The outlet filter 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 filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the 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, If the 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'~o 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, Safety and Buildings Division. Pum° Tank . The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be. inspected and serviced as necessary. Mound and Pressure Distribution S tem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound 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 mound 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 mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L GODS, 150 mg/L TSS, and 30 mg/L FOG. Influent flow 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 end 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 'rf 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. General - This system shall be operated in accordance with Cornet 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [S8D-10572-P (R. 6/99)] arid 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 Comm 83.33, 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 6y an effective locking device to prevent accidental or unauthorized entry into a tank or component, Contfnaencv Ptan 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 shall be immediately repaired or replaced with a component of the same or equal performance: If the mound 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 removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed toc The County Zoning -Office at ~ ~S - 3 ~_~ ~-~,(~ ~~ ST. ~° . The system. installer aG' ~ S ~ b9a -Z2~j - S ~ The tank manufacturer at _ '~ Q~j ='~;~ _g:~s ~L.~~ "`"` • The effluent filter manufacturer at ~'I:~tJ -Z-~.-57~Z Z~~~~ The pumP~_manufacturer at _ _. t~'SO -~Z~"- ~ ~~~' ~-CIVI_1~ S -_ RT.nm pT.ar1 '1 ~ ~L-f ~ ~ ~ Z 3~l `ice- ST. Scale 1"=~~' /~ Page 3 of ~ B _ ~- . - :fit, ~ o~S2: orv 5 ~``-~-C , Sty"Di A PV C PtP~ i~~ ~ . -, ~~... .. Gam. _L_1.~~ ~~ ~~~ ~ :.. ry .N ~ k .. -. N ~~~ V ~ k Sv 6G~~.~ wl~..l, ~. o ° ~-~-o wt E o -~ 2 ~i \oti ~ ~ o' ~ a ~ ~° ~. ~ ~.~ iJ `'' o ~ ~ ~ 4~ ~ ~~~ ~ ~ I 4iro ~~I ~-- n .. a`~ ~, ,~~ , goo -~, ...~ g.z a°` •~-- gw~ ~t-I ~ $~ ~' Z ~/~ , 3 0~ ~~~~~ ~ ~ ~ / ~ DoT ~-~, n~-e-1' oR ~ ~ s -tv r~t3 -~-t~. s -~tZ~ . NOTES : - -- 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4"observation pipes with approved caps. ( Z required). 3. Septic tank to be ~000/~~,SO gallon capac\\ity. manufactured by l~ L~~1Z GE~i C.\Z.~ r-ti1 l._P LO ~n / h S 0 wi 42.) wl ~ _ t 0bo Z-°~~2. Fi. t-`[~ ; 4 . $ench .mark ~= Ste`` _-°,~ ~ V ~ 5. Divert surface water around system to prevent ponding at the uphill side. . , Page ~ Or ~ Approved Synthetic Covering` AST~I C33 Medium. Sand stribution Pipe Topsoil - _ '^~° a :.----~ F Eiev. ~' C7 Z:.D -J i ,. 3 E '~ ~ ~ ~„ ,~ Slope - b• Distribution Cell of Force Moin Plowed i" to 2 Z" Aggregate From Pump Layer 0 ~.S:Ft. E 1.`7 y Ft. CROSS SECTION OF A MOUND SYSTE;i F 0. ~ Ft. G u ,S Ft. Linear Loading Rate= (, .0 GPD/LN FT Design Loading Rate=p.33GPD/SQ FT ~osi~t-i o n -o-r-- _y,.< _ Q• •• L A ~ Ft. ~;~ 1, 0 Ft. B ~S Ft. I ~ ~-. Ft. J `~ Ft . K \LFt. L q`l Ft. ;~ w z 6 Ft. ~} -Observation Pipe (-'--- 8---- ----- -.- ~ K.- -------~ '~ e ~~ss cs-~-•--------------------- -------------- I ---- ~ _ __:~ -i W ~_ T_~ -- _- ~- ---- _---- J Force f - ~ _. Distribution ~ ~ ~~ , „ Cell of ~ to 2~ ~ Pipe ~ _ aQ . pgregate , Observation• Pipe ~ • (anchor sec~zely) PLAN VIES OF A MOUND SYSTEIq Distribution Pipe Layout Place the holes at the botton of the distribution pipes . at~e~ual spacing. Behove alI burrs fron the pipe and holes. Extead the cad of etch Late.-aI up with the use or"Iong tt:r~ or 4f' ftr,:nP to a Foist witbia si.~ inches of the final Q*ade. Te.•minate the cads of the Late.-aIs with a valve,: threaded c: a or • threaded plug. Protizde ac:.~s from final grade far the vaIye; threaded c. a or tbre: ded pItts. - ~~~~cr L ~z~ss .s~~p~ Svc. F~a~ Svc - Laferl ~ ~ Manifold ,--. L;ferl P Lt'rt~ `J ~ c~,J _- P --~+ G- - ~ ~ ~~ hYS'J1F-J~: G- -- P 3~ Ft. ~ ~ Hole Diameter ~~~ Inch ~-~-~ S ~ Ft. ~ ~ Lateral ~ ) InchEes) X - ~nchps Manifold 1 ~~~Z.inches ~' ~ ~ Force Main " ~. Inches - ~; . # of hoses/pipe 1 q Invert Elevation of.Laterais 102:SFt. .. ~~.X: 0,41 = ~.~qx~ = 31,[6 G4~r-~ • Pace ~ of ~ - -o g= r'+ Frf 1V • - 1 ..~.~_.._. ~... ..... . _.. _ ~ - Combination Sept,3.c~-Tank and • PUMP CHAMBER CRO55 SECTiOtJ AAID__SPECIFICATIONS' PAGE ~ OF ~ •-,. ~- WEATHER PKOOF - •VEUT CAP ~U1JCT10-J 90X . ti C.Z. VENT PIPC ~ ,lPPROVE.D LOCKING ~ lO' FROM DOOR. MAIJHOLE COVER ivtlli :rIAl00W OR FRCSH ~ 7ti'P'R•tJIIJG L_ABEE.. ti+-~3G~1oU P-pEr ALR rIJTAKE ~ col,,cu~r - +~ /1}LcLr s ttT rnp ~ y s , .- _ _ ~. I G ~t'D E 4=. ` I i ~ `__ ~ 19•Mlq. ~~~ --- - .- ~ 11~ . 11JLET : ;~, PkOV10E ~ -~ __ •• ;~ ~~'" AIRTIGHT SEAL ~ I I .~ I I I 8 4t=>=~t APProved ~~ ~~~ "A I ICI APProved joint w/ Pr_t$Ol`~ i I I joint w/ p~C pipe I I~ ALARM PVC pipe a ~i i) I I - ~ ( ou - Q~ p c •I 1 tLCY. q 3,oofY __~ PUKP -~ ` OfF D • COIJCRETE . LSL.~ ~Z. O~C~ I BLOCK ti: - ~• RISER EXIT PERMiTfED OrJLy IF TA-JK M~uUFACTURCR 1•tA5 SUCH APPROVAL 3"A~PRo~t;p • ~SFDOtN4 SEPTIC f SPECIFICAT1Ut~IS . DOSE w, ~~ C-0IJC.~Z.~'lZi Tn-JK MA-1UFACTURCR: UElMBEA OF DOSES: ~'~ PER D,r~~ TA1JK SIZE:1!U~-'~ ~D00~6S~--'1.(ZGgLL01J5 DOSE VOLUME r ~ • ALARt'1 MANUFACTURCR; S-S• ~C'~.TI`LA S $T~-IS IAJCLUDIN6 OACKTLOW: 1-~ Z (,ALtONS MODEL 1.1UM6ER: ~~ ~ ~'~1 UPACITlES: A- l ~ lu[HCS OR .~ ~ CALLO>JS SWITCH TyPC:.~, I'`1 ~-~1~~(' 8 = //Z IIJCHES'OR ~ (i~,LL0A15 PUMP MAIJUFACTURCR: ~UV LQ S C= b IUCtiES OR ~~ Z' CALLOUS MODEL UUMBER: ~~~ S ,., 0= LZ IAICHES OR ZU~ CALLOUS SWITCH TYPE: _ ~~..°~~ WOTE: PUMP AUD ARM q~ R TO pC~lb MIIJIMUM DISCHARGE •RATE 3 ~- ~~ GPM pIN57AlLE0 OA1 SEPARATE CIRCUITS VERTICAL .DIFFERENCE DETWCEU PUMP OFF AtlO..DI5TR18UTI0U PIPE., _ I _~~ FEE7 + MI1.lIMUM 1UETWORK SUPPLY PRESSURE , ~ .. b ~S O FEET ~S-v }L I , 3' # ~ ~ FEET OF FORCE 1'1AlIJ X 2-°~F% fCFRIC71ou FAC70R_. ~' Z-SFEET TOTAL OyUAM1C. HEAD = ~~ -~5 •FEET As per ~Lanufacturer l`Z,p gal/in.. •Liquid depth 3~• ~ , ~. APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duly sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/a"maximum. • Capacities: up to 55 GPM. • 'total heads: up to 24 feet. • Discharge size:l'/i" NPT. ~ " • Mechanical seal: carbon- _ ro+ary/ceramic-stationary, BUNA-N elastomers_ • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel • Capable of running dry without damage to .components. Pump: EP05 • Solids handling capability: 3/0' maximum.:... • Capacities: up to 60 GPM. • Total heads: up to 31 feet • Discharge size:l'r~' NPT. • Mechanics! seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. Temperature: ~... - 104°F (40°C) continuous 140°F (60°C) intermittent 1_ . ~. ,- ~. ®1995 Goulds Pumps, Inc. Goulds ~E ~_°~ _~ Submersible Effluent Pump . i- L, EP04 EP05 • Fasteners: 300 series stainless steel • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz,1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset • Power cord: l0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERS FED' 10~ 91 s a ~ a W U 6 } 5 c ~ _4 0 3 2 1E o~ • Fully submerged in high ^ Motor Housing: Cast iron grade turbine oil for for efficient heat transfer, lubrication and efficient strength, and durability. heat transfer. ^ Motor Cover. Thermoplas- Availablefor automatic and tic cover with integral handle manual operation. Automatic 'and float switch attachment models include Mechanical Points. Float Switch assembled and ^ Power Cable: Severe duty preset at the factory. rated oil and water resistant. ^ Bearings: Upper and lower FEATURES heavy duty ball bearing ^ EP04 Impeller: Thermo- construction. plastic Semi-open design with pump out vanes for AGENCY LISTING - mechanical seal protection. ^ EP051mpeller: Thermo- plasticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. SA• Canadian StandardsAtisocia6on (CSA listed model numbers end in "F"or "AC°.) I I ., s' 30 ~ j I - --- 25 ~ ,_ _ ~ - 20 ~ ~- \-1 . 15 I _..:~ ~i.>~ ~5 10 ~~. , _ ,wi 5 - _ 0 _ 0 10 20 ~ 30 40 50 :• ;GPM Wisconsin Department o Com SOIL EVALUATION REPORT Page ~ of 3 ' Diyision of Safety and B Iding~`~CEIVED ~, in accordance ith Comm 85, Wis. Adm. Code __ • Cnunty ~--~ r+nacn complete site p n on ~~ not Ids 112 11 inches in size. Plan must ~ 1 • L.. tC-U ~ i inGude;.but not limite to: vertical and hbri efer ce point (BM), direction and percent slope, scale dime~ic~~orthOaUNTY nd I lion and distance to nearest road. CC xx Parcel LD. p p _) (p,, j _ SO -0pC'~ b1 ! S~Et7f0~ tlOn. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Reviewed by Date Property Owner ^^ ~~~ ~'( +~7 CFO LTA Property Location c3ovF-tots N ~ 1/4 'NW 1/4 S ~ ~ T Z9' N R ~ 6 E (o W Property Owner's Mailing Address P- a , 230X Z,~~ Lot # - Block # Subd. Name or CSM# CitY State Zip Code Phone Number vvnu~vt~L-c..t S~aZ$~ (zis) 64 _353 ^ City ^ Village 'Town 3~~~wtr~, Nearest Road e.o~,,,i~~ E-`~ ® New Construction Use: [7~ Residential / Number of bedrooms 3 Code derived design flow rate ^ Replacement ^ Public or commercial -Describe: Parent material ~~ ~~ ~ ~ l_,L Flood Plain elevation if applicable ~ Genera! comments and recommendations: 1`J10 Uh1~~ W ~ (~ X ~ c.~ ~ ~~ g~Z„~ $ V -R U1J C~ZL.. ~~`CU~2 ~Z.~V , l00 . S ' S GPD - Q _ ft. ^ Boring # ^ Boring I ~ pit Ground surface elev. ,~ Z - O {t, Depth to limiting factor Z- 3 i Solt ApplipGon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~Eff#1 'Eff#2 Z ~ -~ ~ lo~-c 2 ~ 1 - s i ~ ~ k s 1~ ew 1 v-f - s . ~ 3 Z3 37 ~S~22~J~ 1.S~2cz. S~v Slc~ ~~ ~,'Ft' - • D - ~ Boring # ^ Boring ® Pit Ground surface elev. ~ q ' ~ ft. Horizon Depth Dominant Color Redox Description Texture in. MunseN Qu. Sz. Cont. Color Depth to limiting factor 2-D in Swcture Consistence Boundary Gr. Sz. Sh. Soil Application Rate Roots GPD/ftz 'Eff#1 - 'Eff#2 ~.... 10 -z0 ~1v`~ i2 3 l b - S i 1 Z 1~k S h C+~.) ~ - S - ~ ~' ~ . cU~S Z .S`~2y1 Cj ZS ~-l~ S~~ S ~C) G~ ir/l`~ j _ ` ~ ' D 'Effluen t #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 5n mart • Fiflunnt in s ann a zn ..,,,n s.,.~ Tec . nn .....n CST Name (Please Pnnt) . , ~ .. - Si ature - - _ O , 3 _, l (-~ ,;: CST Number ,, .. /e 0 ..: . Arf;hur L: Wegerer ~ - 220254 Address W e g e r e r Soil Testing & Design S e r v i c e Date Evaluation Conducted Telephone Number 421 i1. P~iain St. River calls, t7I 54022 ~'-1Z-03 715-425-0165 ~P P f f 7 ! 1 Property Owner _r' r t~U L`jL~? ^ Boring # ^ Boring ParcellD# 002 _Lp3~.S0-0o0 ® pg Ground surface elev. ~ Q • ~ ft. Danth fn limitinn f~r•tnr ~ Q Page Z of 3 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Boil Application Rate GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z Q-\ 3 L cs-t. R 31b i 1 Z S~ S o i-v ~ , S ~~ 3 13-Lq ~•S`~Ry16 - Sic) ZynS1~h S C~ 1V ~ .£~ L~`-39 lu'Z2~13 cl `1-S~12S1~ ~.J Off. 1n'L i _ ,p . ~ ^ Boring # ^ Boring ^ Pit GfOUnd SUrfaCe elev. ft. Depth to limitinn facfnr :.. Horizon Deplh Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor __ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Appiigtion Rate GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODe < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at G08-266-3151 or TTY 608.264-8777. ,~ ,b .~ SBD-8330 (R.6/00) z ~,~- ~-. PLOT PLAid Scale 1' =y~' Page ~ of p~~~r^~-1..-- ~L ~(oo.p =~Un.~. S7"~~-C. ~ 3lVYDi A S~VC-~'P1D~_ Llt_. w ~a ~I V1 ~~ 00 ~Z k Sv6G~~l~~ w~.l, ~. ~~ ~ o ~ \ti o . ~^' fi, C% ~ ~~ ~ ~~~ ~~ ~~o ~~~ i ~. ,~ ~~- ~ SOT' ~-~ c~~-e-T~ ~R \oo. ti`° \ `~ ~~ ~ ~ s ~ ~ -rte. s -~~R. ` ~ ~.Z o°` •---- ~.,~ tt-) -tZ-D3 715-425-0165. 220254 ~ 3_) 64 CST Signature Date Telephone I~1o. CST AIo. Job PJO. ST CROIX COiJN1'X C7/S~ G ~ FS ~ ~ 3 ~-~ SEPTIC TANK NYAINrENe~tNCB AGREEMENT AND pWNEgSHIp t~RTIFICATION FORM Qvvcter/8uyer •,~~r Mailing Address _V~ property Address a~ ~~ ~g ~ `/.~P (Verification required from Planning Depatuncnt for new ~f° 2 ~ ' Parcel Identification Number O ~ 2 1 U3 ~' ~ City/State Q 1f ~-f~ ~ cTb ~ C L•EGAY. DESCRIPTION ~ / ,^,~' ~',f ~l of ,/~' / w i ~ Property Location („~~,._ y., I~ '!., Sec. ~ ~ , T ~ ~ N-g~W, Town f Lot # r Subdivision r~ (,ectiGt:d Survey Map # l s~~ ~G U ,Volume _~ Page # ~-• VVacran Deed # _ ~ `'r~r R ~ ~ - . Voltune ~ sue, Page # 3 3 ~,~.. ri Spoc hottse 1~] yes ^ rlo Lot lines identifiable D yes Q no cvSTEM 1VIAYNTENANC~ (utiproper use and maintenancx of your septic system coald result is its p~ failtue to handy~u ~ ~ ~ sy~0 consists of pumping out the septic tank every three yews or saoaet, if uceded by a licensed pumpe can affect the fim+etion of the septic tank as a treatment stage is the waste disposal systetn• t a catif•cation form. sigared by the owtret and by a The property owner agroes to submit to St Croix Zonung drat (1) the oo-site wastewaterdisposai system masterpltnaabec, jotmoeymanplumber, testrictedphmtbcr of a liceosedptttnpec tic tank is lcss than 113 full of sludge. is in proper opom~ condition and/or (2} sfter inspection and pumping (if necessary). the ~P ltvrc, th,e undacsigned have read the above rzquirements and agree b maintain the private sewage disposal system with the standards set foti6, haceiu. as set by the DeCp~ent of Catamerce and the Dep~ent of Natural Resoi:rees, State of W iscansie. (`,ertificatioa stem has been maintained must be completed and returned to the St. Croix Conbty Zoning Office atithin 30 stating that your teptiuC sY days o~e drr+ee year expiration date. l ~vf~ / "~ DATE SIONA OF APPLICANT' OWNER CERTIFICATIOI\ I (we} mortify that all ststements o~ this form are true to the best of my (our) ktrowledgc. I (v~'e) am (Are) the owner(s) the pro descn'bcd above, by virtue of a warranty wed tocorded to Register of Deeds Office- 7~~,0 DATE SIGNA O1; APPLICANT ~s«•.s R•+~•• Any ini'w•ma-tion that is mis-represented may result m the sazsrtary pertzut betag revoked by the Zantng Deparbneot. •• Include vrit6 tlrls Application; a stamped warranty deed from the Register of Deeds offfce a copy of the codified survey map if reference is made in the w~°tY deed U~ 2S22P 33? STATE BAR OF WISCONSIN FORM 3 - 2000 Document Number QUIT CLAIM DEED This Deed, made between Dale W. Affolter and Debr_a_M._A_ffolter_ husband and wife Grantor, and Troy W. Affolter and Danette A. Affofter husb__and and wife, _ __ holding as survivorship marital property Grantee. Grantor quit claims to Grantee the following described real estate in S_ t. Croix ___ _ _ County, State of Wisconsin (if more space is needed, please attach addendum): Part of the Northeast Quarter of the Northwest Quarter (NE I/4 of NW 1/4) of Section Sixteen (16), Township Twenty-nine (29) North, Range Sixteen (16) West, Recording Area Town of Baldwin, St. Croix County, Wisconsin, more particularly described as Name and Retui follows: 755983 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 03/08/2004 10:00Al1 QUIT CLAIlI DEED EXEPPT ~ 8 REC FEE : 11.00 TRAAS FEE: COPY FEE: CC FEE: PAGES: 1 Thomas A. McCormack Lot One of Certified Survey Map filed January 28, 2004, in Volume 18 of PO Box 2120 Certified Survey Maps, Page 4693, Document No. 752900, office of the Register of Baldwin WI 54002 Deeds for St. Croix County, Wisconsin. 002-1034-95 Parcel [dentification Number (PIN) This is not homestead property. (•i~ (is not) Together with all appurtenant rights, title and interests. Dated this ~~ ~ _ day of ~~~ _ _ , 2004 -_ - -- * AUTHENTICATION Signature(s) authenticated this day of _ __ . * le W. Affolter ~--i~Y~~ * Debra M. Affolter ACKNOWLEDGMENT STATE OF WISCONSIN ) nn -----------) ss. ~~ l%~.-1-~+(, County ) (y Perso ally came before me this ~ ~ day of l l , 2004 the~y~lnamed Dale W. Affolter and Debra M. Affolter ~ ,~ $N ;:, ;~4„ `: y . -_~ fib .. t.. 1" ~ ! ti. TITLE: MEMBER STATE BAR OF WISCONSIN t~ `'t ~ to me known to be the person(s) who executed : c (li'not, __ _ __ _ ___ ___.___________ __. ins ument and acknowled the same. ~ •~~ a y authorized by § 706.06. W is. Stats.) t 1 ~~ ~# ` THIS INSTRUMENT WAS DRAFTED BY * (hr~ ,~~ J~ ~ ~O~ -~; , a;~~ ~~ Tfiomas A. McCormack ___ __ _______ Nota~ry~"P"u~-bli~c,~State of WISCONSIN ~ ~`~' Baldwin, WI 54002 ____ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ! _ o~l~}"` - DOvr •) ' Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF W ISCONSIN QUIT CLAIM DEED FORM No. 3 - 2000 INFO-PRO (800)655-2021 www.infoproforms.com 1~ .• •, ~~ .-~-- 7S29~tZ] VOL 18 PAGE 4693_ KATNt~R H. MAL9t~ ~-~ REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD CERTIFIED SURVEY MAP ~ 01/28/2004 03:30PM Located in part of the Northeast Quarter of the Northwest Quarter of Section 16, CERTIFIED SURVEY MAP Township 29 North. Range 16 Weat. Town of Baldwin, St. Croix County, Wisconsin. REC FEE: 13.00 COPY FEE: 3.00 Prepared for and at the request of: l,E9Ed~ PAGES: 2 Troy Affolter P.O. Box 219 ~ Section Comer Monument Woodville, IM 54028 of Record Owner: Dals Affdtsr • Set 1" x 18" Iron Pipe weighting Drafted by: Howard H. Harild III 1.13 pounds per linear foof ARTt/Nf'ST CORNER • - •' • " • - Building Setback Line (100' from Right of Way) SEA 16-29-16 (FOUND SURVEY MARK NAIL) _UN_PLA TIED LANDS NAR7H 1/4 GY.WNER NORTH L/NE OF THE NORTHWEST QUARTER ~ (Fq(/ND SURVEY A/ARK NAIL) w ~ 587'27 g'E 2648.86 _ S 87'27'09" E 297.83' cTH E" S8T2To9' E ~ ~ COUNTY H/GHWA Y E 1324.43' - ~_ "' w ~ S87'27'09~,60' S41 87'27'09" E 297 83' - - ~ooo o~ e x o a r.~i. j~~0 N~'A° o •'' ~ 0 m-- mpp~ 0 a~ ~~a~ s °~ °oWo O~w~ ~~om ~• O A Q m ~. ~O d rt >: 7 a O ~'~ 3 to a7 n ~ o °od~4i ~-°- 3 n -« o ooQ~ 7 ,.t rt d0 W~ S.rtA 7 O ~ O d A n rt p IZ I~ I~ I~- I~ ~~ I~ Ib I~ ' o ~ w cn ~"_ DR/VF t cn o o W V .... ..... ... J s p~pfX COUP N gf m Z , I.d~.dww'~}~{Af1 A11!~ Q{if~f$ (`,(KT1111~~ W ~1I~~'"" ~• !''II W IAN 2 8 2004 ~ o s : ~! cp ~ wdh~n 3p days of ifs approval ighail be ~+ O qul~ and vdd ~ v TOTAL AREA: 240,725 SQ. FT. 5.53 ACRES REA A EX. R.O.W.: ~ ~ 230,896 SQ. FT. ~ ? 5.30 ACRES This Agricultural Zoned parcel is created pursuant to Section 17.14(ixb)., St. Croix County Zoning ordinance. The proposed house occupancy is required to comply with this section. rn '~ w 1e~a MMrrMM~. ~ ~ WYE 3.2484 ~a CLEAR LAKE, t SO/L BOR/NG LOCA T1GN "'°"' io- 24- D7 N JOB ~ WI057SU148 Prepared by. Consu/d'ng Gaup, lrx;. Phone No. (715) 246-4319 Fax No. (715) 248-3830 P.O. Box 325 New Richmond, WI 54017 Sheet 1 of 2 NO TH 87'27'09" W 457.78' UNPLA TTED LANDS OF OVYNER (~ I~ ~OI~ I 10~~ I~Ip I~I~ i~ I~ I (~ too o too 1 gtAPHIC SCALE SCALE IN FEET: finch = 100 feet BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE NW 1/4 OF SECTION 16, TOWNSHIP 29 N., RANGE 18 W. WHICH IS ASSUMED TO BEAR S8727'09"E. Vol 18 Page 4693