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004-1003-70-100
al County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN 0! p,In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT ~~~~pppp~f~Y I information you provide may be used for secondaF Ipurposes ST. CROIX COUNTY GOVERNMENT CENTER sw [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016-7710 0 C j (715)386-4680 Fax (715)386-4686 Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previei(s i b`at Ij r- L Application Information - Please Print all Information Location: \ Property Owner Name l 1 _ Svc( 1/4 tV~1/4, sec 2- & J G r~ V1 Clk- L e m c ✓t LA_ Pe- 2 N, R 15 E (or W Property Owner's Mailing Address Lot Number Block Number f ~ e C. - - . - - - - - - - 5 (o 9 - 3 c City, State Zip Code Phone Numer Subdivision Name or CSM Number W ; 1 sail , W ( 5402-7 -115 •1'72 -42CC:-') 5c hu-t}, C.S M II Type of Building: (check one) / t t Cxity ❑ Village Town of (i Kt d~ ~~fi~L- ❑ 1 or 2 Family Dwelling - No. of Bedrooms: Ca ❑ Public/Commercial (describe use): C3e~r-1-5 dy ❑ State-owned &ra Nearest Road ii. Type of Permit: (Check only one box on line A. Check box on line B If applicable) Parcel Tax Number(s) A) 1.0 Repair 2. 1~, Reconnection . ❑ Non-plumbing 4. ❑ Rejuvenation a _ I _ O y1 Sanitation B) Permit Number Date Issued State Sanitary Permit was previously issued C50 l0 I L13 0 4/ 2 0 I Z dU -7 IV. Type of PO System: (Check all that app ❑ Non-pressurized In-ground 2~ Mound Z 24 in. suitable soil ❑ Mound 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Fitter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other At-grade ❑ Aerobic Treatment Unit ❑ Recirculating Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals./day/sq.ft.) (Min./inch) (0 , S Elevation Zv OO 2'50-7 a 357 2 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Rber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks I'll I IK ldvo t e ba r I$ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement 1, the undersigned, assume responsibility for repair/reconnenation/rejuvenationfinstallation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Plumber's Name (print) Plum s Si nature (n ps): MP/MPRS No. Business Phone Number e,.s SO W 7/s s / Plumber's Addre (Street, City, State, Zip Code) w Iii. County Use Only fCOme,~Give oved Sanitary Permit Fee Date Issued Issuing Ag ignature o s ps) Approved erse 60 n IX. Conditions of A,4roval/Reasons for Disapproval: O c1 ~ ~ d ~fG 5YSTEM OWNER: 3 1. Septic tank, effluent filter and /n~ dispersal cell must all be services ! maintained d~ r as per management plan provided by plumber. 9.:. Alt setback, requirements must be maintained 3'e r 1 , 1 e as per aplicable code / wtManres, c/G C T O,Nt W 1 Oct 22 13 09:47a Anthony Flom 715-665-2639 p.1 Standard Erosion Control Plan for I- & 2-FaMily DWelling Construction Sites According to Chapters Comm 20 & 21 of the Wisconsin Uniform Dwelling Code, soil erosion control information needs to be included on the plot plan which is submitted and approved prior to the issuance of Jiuildmg permits for 1- & 2-family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking appropriate boxes on the ;inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. PROJECT LOCATION /r► f BU IEDER%rf~, Please indicate north OWNER completing the arrow. of WORKSHEET COMPLETED BY ! ir,r•~;~ DATE %;V- j': z- N SITE DIAGRAM a ~ Scale: 1 = iG feet EROSION CONTROL PLAN ti LEGEND - - PROPERTY LINE i ~ EXISTING DRAINAGE iy TD TEMPORARY I c:tit ' DIVERSION FINISHED '-r DRAINAGE LIMITS OF C+- GRADING h ■ ■ _ SILT I FENCE STRAW BALES GRAVEL 0 VEGETATION N SPECIFICATION u t TREE PRESERVATION I STOCKPILED SOIL d G. 4 - 0 . IMAID Ummav-U-Lis Is tom ~<awwuw~~m ,..,Mwac. ~i Y IAWhwH a1e0 :dey aam 3 a7''am MUOPN acee•swl9ty SWOMd El-~ •IgNNi eauaPlnt! x1n4*5 aulMod'8 es'! ~'lflWt Y~C~ 3JVd 1Ntl1bOdWi cit."vi lwd SUS(I"UngdWVNO 9 N ?4 U) ~ FNS 4L Y1 t W fA QW ~Ck. d' r.. ro )C z~ 0 v0 ~L .4,i ,ta ,tA C a CD 0 II a y 9 ~ O $ g i -s i L, v, o) rid ~S1 v I r X341 fodm t ~ 1 r• ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer onvva'~f& l/~ r wV 15' Mailing Address '5 t19 ' S; \N w b4021 Property Address bU01 ~30 `S_t " ~ I V " D4D2 1 (Verification required from Planning & Zoning Department for new construction.) City/State Al Son , W I Parcel Identification Number U~4 - I W 3 -_70 ` C)03 LEGAL DESCRIPTION Property Location SW 1/4 , NW 1/4 , Sec. 2 , T _a_N R .19W, Town of 00.dV Subdivision Plat: SChU+~s as m , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 1~15-1 D % (before 2007)Volume , Page # Spec house r1yes o Lot lines identifiable byes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a yarranty deed recorded in Register of Deeds Office. N r of be r in 4 `-1 f L~ll~i13 SIGNATURE OF APP T(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) 111111 iil~' IIII! 11111 Illii IIII 111111 Iili IIlI 853946 KATHLEEN H. WALSH REGISTER OF DEEDS ST. WI RECEIVEDIFORORECORD " ► O • X 06/21/2007 08:OOAM + CERTIFIED SURVEY MAP m VOL: 22 PAGE: 5414 o~ ;E -n m m co, 9 r REC FEE: 13.00 i n -'C ~r- ~Q S; 7O ~x o mo A- r'. m COPY FEE: 3.00 =70=POcZ ;0= D o oZ oc PAGES: 2 ivy ~~i N_ ~~17 ,{'Z► z D m2 Z ! 0 m 20, Qo pp ~:•yZ f~c1 'n < 9 - 'O Z o Z o m 8~ o y C ~ a Z O D \ ~m Ov_ BEARINGS ARE REFERENCED TO THE ST. 4 Z CROIX COUNTY COORDINATE SYSTEM X -0 MU~1pdQ441D L~G1G`r_]©~3 m m a m CZ C) 31 OTH STREET Z O g m - N Z N j~ -n s27' cQ 800°24'08"W 330.04' soo°24'oa'w m 0 V- soo°24-o8- w WEST LINE OF THE NW1/4 33.00' 1323.31' N N - N S00°2408W 330.04 ^ ^ m ..............I. c O m C" ~Nm y V lc i N W Z N I~Ip Z m O Z I CO) &D N ccn C cl) CD 1 1AD p Z ~ Z I~ C ► = O -1 m 1 m Ilo z 0 C" ► O 0) 8 m- -4 In 'n CR1l O~ DZ A T 4 Q' Z ` I ► T. I 0 O D a C:) 0 =c; Z n-1 IwZ O m 310 X 1171 F z m m 0z m o I°~C ~o=z J ~ A 0 N z: N00°24'08"E 330.04' I S _ °Q J g M GJP[~C1441 D I~G1 I n 1 of 2 I Vol. 22 Page 5414 1111111111111 ~ 11111111 11f11111 8 1$ 9 5 7 8 Document Number Document Title TX :4157308 987771 St. Croix County BET H P BST Occupancy Affidavit for a single P'®VVTS REGISTER OF DEEDS ST. CROIX CO., wI servicing Two Dwellings via PIMS RECEIVED FOR RECORD w?dl 1,~ 10/18/2013 2:58 PM Name - (Owner) Typed or printEXEMPT REC FEE: 30.00 being duly sworn , states, under oath, that: PAGES' 1 1. He/she is the owner/co-owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume A_ Page NA Document Number85980 St. Croix County Register of Deeds Office: . Recording Area t Name and A parcel of land located in the SW t/< of the N W /4 of Section Return Address 2 , f ZV, T28 N - R 19 W, Town of E c. , St. Croix Count `r"E S~ 9 3 o t>n s 9 C Wisconsin, being duly described as follows (include lot number and 021" ~ ws S y 27 subdivision/CSM or detailed legal description): &tr2~ L--c~+ 4 C~fiF.`~d -_9A.-i/e.+1 / o-10 Parcel Identification Number (PIN) oay- )003-, 70-400 VDlume, a1 Pe!6e. S~/~{ loo As owner of the above described property, I acknowledge that this dwelling will be connected to a single Private On-site Wastewater Treatment System (POWTS) located on an adjacent parcel via Private Interceptor Main Sewer (PIMS) in compliance with Comm 82.30(12). The POWTS servicing two dwellings is sized for 4 bedroom(s) with a design wastewater flow of b[Yl gallons/day. (DWF calculation based'on 150 gpd /bedroom @ 2 persons/bedroom). A maximum of _EL occupants are permitted. There are currently a total of,Yoccupants in these two residences, therefore the POWTS can be considered code- compliant at this time. However, I understand that if the number of occupants exceeds the maximum for POWTS design, the system will be undersized to accommodate any increased wastewater flows and/or contaminant loads and may be subject to premature failure. I also acknowledge that I will disclose this information to any parties interested in purchasing this property in the future. Dated this if?fA day of a_-4- ;7,o /3 71a- al few~4~v~,e * * AUTHENTICATIONC~ ACKNOWLEDGMENT Sign e(s) STATE OF WISCONSIN ) Er6ix County. ) authenticated this day of Personally came before me this day of (~Ct~(ac h o'u~ l the above named TITLE: MEMBER STATE BAR OF, WISCONSIN to me known (If not, to be the person(s) who executed the foregoing instrument and acknowledge the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. My Commission is permanent. If not, state expiration Both are not necessary.) date: Date: `M' BO~ r' "THIS PACE IS PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE" This iii/b,w.,fi n nu+st he completed h>• suhnviuer: tincun+ent title. rn (Ile d return address and QL (if'reyuired). Other information s.. e Z clauses. legal description. etc. mar be placed on this first page of the document or may be placed on additional pages ofthe documenr. N°/d't/4.FH K{"N co, er 'I otpQge adds one page to your document and $2.00 to the recording feg P/rsconsin Stahttes, 59.5/ 7. t WAK.KAN Y I) EU uj+juv`t KATHLEEN H. WALSH Document Number Document Name REGISTER OF DEEDS ST. CROIX CO,, W1 CDR RECORD THIS DEED, made between Lee G. Schutts and Pauline Schutts, husband and 09/04/20 ; 1 i :45AM wife WARRANTY DEED EXEMPT A REC FEE: 11.00 °Crrant.or," whether one or more), and Onnalee Schutts-Wayne, a married woman TRANS FEE: 67.50 PAGES: I ("Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real Recording Area estate, true her with the rents, profits, fixtures and other appurtenant interests, in Name and Return Address St. Croix County. State of Wisconsin ("Property") (if more space is Leo A. Beskar needed, please attach addendum): Rodli Beska.r_Roles Krveger & Pletcher, SC Lot 4 of Certified Survey Map recorded inahe St. Croix County Register of Deeds 219 N: Main Street, PO Box 138 Office on June 21, 2007 in Certified Survey Maps, Volume 22, page 5414, as River Falls WI 54022 Document Number 853946, as located in part of the Southwest Quarter of the Northwest Quarter (SW'1 of iNW`V4) and part of the fractional Northwest Quarter of the Northwest Quarter of Section Two (2), Township Twenty-Eight (28) North, 004-1004-30-000 - Range Fifteen (15) West, Town of Cady, St. Croix County Wisconsin. Parcel Identification Number (PIN) This is not homestead property. ON) (is not) Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except: easement, restrictions or rights of way of record. Dated_ tts *auline ,(SEAL') (SEAT.,) i -le ~:Z (SEAL) hutts AUT )sNTIC TIO ACKNOWLEDGMENT Signature(s) STATE 011 } 5S. au w !rated on COUNTY) Personally came before me on the above-named - TITLE: MEMBER STATE BAR OF WISCONSIN (if not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUIvIENT DRAFTED BY; Leo A. Beskar Notary Public, State of (~tsc~) (~f4sittessoa Rodh Beskar Boles Krueger & Pletcher, SC My commission W ~u={xf~~ ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDE. I WARRANTY DEED STATE BAR OF WISCONSIN BORWi 0 i-2043 "Type name t Blow signatures. 0 State Bar of VYsconsin 2003 INFO-PRO- Legal Forms • (800)655-2021 • infoproforms com rC o o O o~ Ntp en tl c y O E !E en w 3cccoa~iE N L U y O O,0Z c c .0 N U) C O O U m c a) o-0 y L ~ _ O M Y _ H C.j~j 0 C 7 N c 0' p7Na C N 'O y y f0 C C U c 'd T y L U 7 O y l4 ~p y (D ` O yO d C- c C 7 fn >1 S N.C. N C-C aTcmE U U ld N E C 5 'O m m O 'p U) 2 'C 7 C fO c C ~~p~3a°-0 -2 "7 0 .~axi~ - 0 CD 0) 'O O N t7 0 _C y C 0 a O y C Z y N c V C~'OY O~i y O- N 0 C (nn w U. o c R 0) v a` V :1 O O N E j C C L Q LO.. LO., 7 m° w O v 3 U Z E ~ Z = O a0~ am N H U) m I O Z N v '9 y I d Z~ y c N H r - N N c _ co Y y ~ N p 0 ZZ N ~ j n y I ~ jl N LO Y w 0 d - N l y d N c'ooa a~ zv>°; °P PP a~ 3 3 3 • ~aaa a c r a°i y U) J C.1 Oo Oo C p N N O 0 co mftk- M N O Z 0 (D 0 0 p d LO cU i CO ~ c C O y ~ CA N Q A U) id a N N rj o o ~l o °t. - c o O E o C7 0 V M c c v O N 3 J y c m N H to ` N 7 c O co 7 11 y01 C N C c 'O N dTl • N O O U U) U) O Z y of d U) O E v EL €a m 'c c a c _1 A c~a~ ',0UU))U Parcel 004-1003-70-100 01/23/2008 08:52 AM PAGE 10F1 Alt. Parcel 02.28.15.23A 004 - TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/21/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - SCHUTTS-WAYNE, ONNALEE ONNALEE SCHUTTS-WAYNE 569 310TH ST WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 569 310TH ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: 5414-CSM 22-5414 004-07 SEC 2 T28N R1 5W PT SW NW & NW NW BEING Block/Condo Bldg: LOT 04 LOT 4 CSM 22-5414 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-28N-15W SW NW 02-28N-15W NW NW Notes: Parcel History: Date Do Vol/Page Type 09/04/2007 85980 06/21/2007 6 22/5414 CSM 04/27/2007 849339 QCD 05/19/2003 721924 2245/226 EZ-U more... 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/12/2007 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 RECEIVED I lfilll lily` Illll I111111111111111111111111 I2 IN fl ~ SEP 1 42001 853946 KATHLEEN H. WALSH REGISTER OF DEEDS 2 ST. ~ppp~ GpU ST. CROIX CO., WI C/) o RECEIVED FOR RECORD % Y R'S RECORD 0 X 06/21/2007 08:OOAM ~~+a1• 14 - CERTIFIED SURVEY MAP o z p?`: , w o ➢ VOL: 22 PAGE: 5414 n v ~Of rn rro T - o a m o r' REC FEE: 13.00 mo = _ = O = p o? rm x ° c-' Pi o m m COPY FEE: 3.00 Z m PAGES: 2 P° G} z 'y n i OR o m '0 -10:1 Z %0 m Z m O n n m m V ~J ~ m Z Z~ m m m m ° v O 07 ° m S C 00 Z p w CAP r 010 BEARINGS ARE REFERENCED TO THE ST. m a CRO X COUNTY COORDINA m Z TE SYSTEM m - Mf - - dG1~ - - r--- - D GrJD- - Z m:* z a `0 ° 31 OTH STREET 2 ~a m o v m z \ -n ~ N A 99327 800°24'08"W 330.04' a, S00.24'08-W O S00°24'08"W w 1323.31' _X n m WEST LINE OF THE N 4 33.00' 23 S00°24'08'W 330.04 + m _ IT o Rf .a m ZZ0 v n ~ n>, ~ m y Z C C) Z ~ Z L \ Z iqi~ t+n an A N CO) m ► of ~ Its it o ~Mp Z~~r CA) m I ncn j g m 0110 Z' m V v~$A >1° 6's oN b, 0 I~ O S N 8- ►m $ m o Q 1 1L 0) o ~n D A m I z 0- rn 0) 0 -1 1~ ° I o0 0 m o z ~ V1 a A N lj~ p ZOo Z0 >111 M O m 5~ cr: m m N ~ A m co X n 17f C m ~7vZmN Z N O rn OppO imoc°iZC 04 Ao ' 11 NOO°24'08"E 330.04' I o 0 Q 1 r1 c:1 I ° CUJGJG~L~CQ u-11 LSD ~ll. D~ i 1 of 2 1 Z I ~ Vol. 22 Page 5414 Parcel 004-1003-70-100 01/23/2008 08:52 AM PAGE 1 OF 1 Alt. Parcel 02.28.15.23A 004 - TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/21/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - SCHUTTS-WAYNE, ONNALEE ONNALEE SCHUTTS-WAYNE 569 310TH ST WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 569 310TH ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: 5414-CSM 22-5414 004-07 SEC 2 T28N R1 5W PT SW NW & NW NW BEING Block/Condo Bldg: LOT 04 LOT 4 CSM 22-5414 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-28N-15W SW NW 02-28N-15W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 09/04/2007 859804 WD 06/21/2007 853946 22/5414 CSM 04/27/2007 849339 QCD 05/19/2003 721924 2245/226 EZ-U more... 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/12/2007 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 RECEIVED I lillll Ilf~' 11111 Illll IIIiI 2 IIII IIII III! f III 2 SEP 14 20 853946 KATHLEEN H. WALSH REGISTER OF DEEDS X ST. Cgpq~ ppU ST. CROIX CO., WI zo Z YOR'S REC-CM D RECEIVED FOR RECORD a i~ X 0612112007 08:OOAM N ~ : ~•a ~4 CERTIFIED SURVEY MAP o z ~~.N o o n VOL : 22 PAGE : Y T m co, 5414 o cod rn q, j _ a a M REC FEE: 13.00 n o *.Tai ~^h' Z - = O = ao ° X ° o m O COPY FEE: 3.00 ac m PAGES: 2 Zm m mm ~Z o C) a o p m v X ^cn Z Z Tm m g v co Oo z O Z Ov BEARINGS ARE REFERENCED TO THE ST. = Z CROIX COUNTY COORDINATE SYSTEM m m C nn C) g ° 31 OTH STREET o~ ° O m -4 N Z 2 Z M m N a T w a 993.2T 8OO°24'08"W 330.04' a, soo°2a'p8yy 01 S00°24'08"W w _ WEST LINE OF THE N 4 33.00' 1323.31' M m ` N S00°24'OS'W 330,04 T O m C IT cOpb m Z Z O v au am y Z m O _ m z- N Z N iqi~ in ~ C W ► ~I ~o i~i~ Z~v 0-0 1~ zl Az Iajl~ A 1 I Z O m cDi v D 1" l~ O 0) [S Q O g `t6m 8m ►2 Of $ m O O C m oZ A z ~ ~ I D ~ ~ ~ I G o C1 o o Dm q m rC Z: a pW n~ \I Z 0 -1 C" 0 °o 0 n m k A c 1 m a v z m N z N o ~ ~ Opp o z amiC 04 * a ZO T ' N00°24'08"E 330.04' o O Q ° mDl.C%VIT D 1 dLQG:]DD 1 of 2 I z 1 Vol. 22 Page 5414 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506143 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Schutts, Lee & Pauline Cady, Town of 004-1003-70-1100 CST BM Elev: Insp. BM Elev: Description: Section/Town/Range/Map No U /60 BM U c~ "t rlt.-t,,,¢l 02.28.15.23 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 12 C -b Benchmark 7 V /07 l0~'-O Dosing Alt. BM / G V. ©S Aeration Bldcr 30 w Ps 2. S 6u -WW Holding St/Ht Inlet .1. SUHt Outlet TANK SETBACK INFORMATION TANK TO IL WELL BLDG. Vent to Air Intake ROAD Dt Inlet 1 T All 131Z Al 17--Septic ~O Dt Bottom 6' ! J 6 Dosing + / He er/Ma Aeration Dist. Pipe -r®p d /O 2. 2 Bot. System Holding Ak I 1 00 Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover r~ GPM .7 7/- Model Number -39 j 7. Y yC12 . C7 TDH Lift D' Friction,~qjis System Head. T~ Ft c ° °l// ii . 9utT Forcemain Len th I Dia. + Dist to well 2 illa -0 SOIL ABSORPTION SYSTEM - f BED/TRENCH Width J Length No. Of Trenches PIT DIME S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM L CH Manuf urer: INFORMATION CHA R OR T Of System: `211__ 3O1 ~D / 7S- r Model urnb N SYSTEM °SSK,tiK[~ DISTRI ~v d'y►'~~ ~l`-• H ad anifold n/ ID istributionA~, Ix Hole Size Ix Hole Spacing Ven to r )Make Pipe(s) + _ ?/"i rr S ~0 / 4 .2 -tvv)w 64 Leng Dia Length lio ! Dia Spacing 311L SOIL COVER x Pressure Systems Only xx Mound O t-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded r M I Bed/Trench Center Bed/Trench Edges Topsoil' / Yes a Yes -6.. COMMENT99S, (inc~.l,u~Ae code discrepencies, persons present, etc.) Inspection #1: le Inspection #2:~ 17 Location: Unknown (SW 1/4 NW 1/4 2 T28 R1 W) 40 acres Lot 4 ~Q ~S~ Parcel No: 02.28.15.23 1.) Alt BM Description or LAA, -r,4- a-4- ~2lhiecaz4, 2.) Bldg sewer length = ~Q ~Q G1J/ p2 (~Q~i►L ~(/Y>~~1~~~ir~+(C /'1 yb,wa"~'(/~ - amount of cover I Plan revision Required? Yes !f'No Use other side for additional information. I Date Insepctor's ignature Cert. No. j ;BD-6710 (R.3/97) S;atety and Buildings Division County ~-'-l 201 W. Washington Ave., P.O. Box 7162 ~T yz, K f ! ®°consi~ I ivladison, WI 53707-771 62 Sanitary Permit Number (to be filled in by Co. j Department of Commerce $O~p ! y 3 Sanitar e 1 cation Sta e,P an I Y.n u7///8s In accord with Comm 83. m. Cade, personal i d'otrrlaijo yqu fog de2007 I' W1 JD SS 3 ,nay be used for secondary putposy s 15.(((i Project Address (if different zi iartf~ng a~dre~~1 11. Application Information - Please Print All Informati 1/ ST. CROI ~ Prape Owner's Name c ikl-9 ne Sc hl4 "arc el # 1-7 2, .7 L O.4- 140-7b-aaa Property Owner's Mailing Address Property Location 553 31b~'~ S~ ' z3 i City, , State Li Colt. Phone Tun16e Sectioll ISM 1 f (circle }}s~ae) U. Type of Building (check all that apply) T o~ N; Rotadl) 64--or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ~ lnnJSe. Public/Commercial - Describe use 3 A~e~ wy`_ S~~K ~Y 5 C s/r &Ji ❑ State Owned - Describe Use J~_- City ❑Village 9'ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) r A. l1ew System ❑ Replacement. System ❑ Treatment/Holding Tank Replacement Only 13 Other Modification to Existing System 11, ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit `Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner / I _M Type of POWTS System: Check all that apply) p~ - i ❑ :Nan Pressurized In-Ground ❑ Mound > 24 it.. of suitable soil P~Acxrnd 124 in.. of :suitable soil ❑ At-Grade ❑ Single Pass Sand Filter 0 ~ `orsuucted Wetland ❑ Pressurized hr-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ I Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) ~ V. Dispersal/Treatment Area Information: - a { { Design Flow (gpd) Design ~Sf it AppI' on Rate(gpdsf) Dispersal Area Required Dispersal Area Proposed f) ystem Elevation 1 42 1- ~ 1 0 6 d 3 a- 15°b 3- 6 35 e S✓ I V1. Tank Info Cap city in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons ofilnit Concrete Constructed Glass, New Existing Tanks Tani peptic or Holding Tank Ik/ 1 Aerobic Treatment Unit Dosing Chamber Rao VII. Responsibility Statement- I, the undersigned, assu responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' gnatu Number T Business Phone Number lumber's Address - treet, City, State, Li o To 2,2 S 7/15 CW 35- 3 9_~ VIII. County/De artment Use 1 Approved ❑ isapproved Sanitary Permit Fee (includes Groundwater Dat Issu Issuin gent Signa re t o Sta ) I Surcharge Fec) N~ ❑ O ivel Reason • Denial Z~ O7 IX, Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1. Septic tank, effluentfdter and f Y dispersal cell must pll be Services / maintained 2C~n~ , as per management plan provided by plumber. 2. All setback requiirsomts must be maintained as per applic" code I ordinances. ~T Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD-6398 (R. 01/03) i .w ,13 c/' 'C1 Q - d' .s . J s s ~ 2d _ U" 'All 0 y~ ` r O O ~ ~ N o ~ t 0 S r- d i 7 a' Do! NI, \ O s v 4 w-, to LA __o c2i I s p t 6 9 ' 3 Q J 3 9 II - J x c o S s D ~ o ~ 0 Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wl.gov LACROSSE WI 54601-1831 TDD (608) 264-8777 / i scons i n www.commerce.wi.gov/sb/ www.wiscoisconsinsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary April 16, 2007 CUST ID No. 222774 ATTN: POWTS Inspector HENRY F GROTE ZONING OFFICE CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA E4366 353RD AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/16/2009 Identification Numbers Transaction ID No. 1385738 SITE: Site ED No. 724188 Onnalee Schutts & Earl Wayne Please refer to both identification numbers, 310TH Street above, in allcorrespondence with the agency. Town of Cady St Croix County SW1/4, NW1/4, S2, T28N, R15W Lot: 4, Subdivision: Schutts CSM FOR: Description: Mound / Four Bedroom / Concave Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1126423 Maintenance required; 600 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD-10691-P (N.01101), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. 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 • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • 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. Cond11Ct11 • 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 APP DEPARTMENT 01 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the OF requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE CORK S • Inspection of the POWTS 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 HENRY F GROTE Page 2 4/16/2007 • 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 Owner Responsibilities: • 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, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 11, Integrated Services WiSMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. ti Onnalee Schutts & Earl Wayne - Mound R ECEI~ED Construction Materials and Techniques qPR 1 All materials must comply with Comm 84 and be installed in accordance witPY~~~~,, ure ~s?401 specifications. Construction methods must comply with the following Componen1ntt~~/ CHINOS Pressure Distribution, SBD-10706-P (01/01) Mound, SBD-10691-P (01 /01) Location: Lot 4, Schutts CSM SW '/a, NW i/4, Sec. 2, T 28 N, R 15 W Town: Cady County: St. Croix Date: April 17, 2007 Owner: Onnalee Schutts & Earl Wayne Address: N. 2658 460th St. ~ t I I II~~~ Menomonie, WI 54751 G~ Designer: Henry Grote EN OBE • GO OMON\~ • Signature: N License: WI D - 16 -007 1,i' ••••pEg;G~%'0` Attachments: SBD-10577 - Plan Approval Application SBD-8330 Page l: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management f.,. page 1 of 8 COMMERCE NGS 'ONDE,NCE i. Design Criteria 4 ~s Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L f Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL f Fats, oils, grease < 30 mg/L L Bedrooms x 100 gal/bedroom/day x 1.5 gallons/day hydraulic load Design Calculations In situ designed loading rate o zb gallons/sq. ft. per day Depth to estimated high ground water in. Depth to bedrock > S in. Cross slope at system '+'0 % X Z~o+ , ~3 Z Force main length U 10 ft. of 2- in _'Z_ ifol Bader length r/2ft. of ~Y Z in. c~'z3 Z r,G~t.a Drain-back %14q gallons Lateral length 6' @ 6, O,O ft. of in. Lateral elevation ~ 0 2 , o ft. @ bottom of lateral Lateral hole size 3~~b in. @ in. ( 4'g ft.) Spacing i € ` 3 holes/lateral S Z holes total Lateral volume gallons 4 Total lateral discharge rate 3 4 3 Z gallons/minute @ 2, ft. head Network pressure compensation losses ft. Elevation difference °'O ft. Friction loss g 3 ° ,S Z- ft. @ 3S gallons/minute Total dynamic head E Pump/si'p)ion g gpm @ ft. of head Manufacturer ~peA(a.-, Model # Dose volume gallons Lift/si~hon tank o~ t Zs~ - ro C-D 7T%---' gallons Septic tank t Z~~ gallons Effluent filter Measurement pump on and off in. Height alarm from tank bottom in. Reserve capacity ~b gallons specs.calcsses Page Z- of l' 4L 4L 1 0%0 o-7 - , 46 z 1 ~ 1r ot,~ hh /t ( n o ~ tl'tZf e~b0 "oVt cwa.r 33 co eM M~a tx 1 ~ e.v t` 1 vim, s`Of 1o.i3,g, \ ' ) i i c o O .i oa - ~ = r o c>j 0 p c a Y O. P r C)6 O 11J ~ ~ r s - p f ,p P fo~ b o p r r/ ir 0 CIS LIP" ~ ~ f 0: ~ ~ ► 1 N P~ 41 r fO S • 6 09 O ED P o 00 i • Z F oar WEATHERPROOF LOCKINGwCOVER JUNCTION 6cac Gv~In'M µ .c ABEC . Qv~CK D~~CON~~CT--1 t Cs- Oe PIV~ 3' 01!'1U No1SSUR8~D • ~a, Soil. 24" %.D. I 4 EIJT truwua~ • Nb~ /4" T I~~ A ~o d wot 4„ nv~ 6MKET -ZWr,5 iAL&W4" gL1FFLE Au. C.0" E C.T 1 O A 4 ` l'Q ~N ^ -6t + G RouKo a z . o ow 4; Pt*(P CONuE-rF . C Lw. ec°C•C ~lt,o lt■.~z / SCPTIC E SPEC.IFI'GATIOtJS DOSE TAWKS MANUFACTURER: QUMBER OF DOSES: PER TAWK SIZE: GALLOWS DOSE VOLUME ALARM MJWUFACTIJRCR' S-r F1aa.LVo INCLUDING DACKFLOW: GA~~ONS MODEL WLIAb'Elt: CAPACITIES: A= ~O' IWCNCS OR GALLOQ s SWITCH TYPE: B r IAICHES OR GALL OV s PUMP MAWUFACTURER: ~OQ ~l C ■ ~'O IUCMES OR Q(o'~Z C,AL~0Q5 MODEL WUMDER; t ~~b D ■ INCHES OR ;,AL;.0~j 5 SWITCH TYPE: r• WOTE: PUMP AWD ALARM ARE TO DE MIWIMUm DISCHAR" RATC GPM INSTALLED OW SEPARATE CIRCUIr,S VCRTICAL DIFFEKEIJCE OETWEEW PUMP OFF AIJO 013TRIDUTIOW PIPE.. ~~,fo FEET L + MiuIMUM WETWORK SUPPLY PKi&SURE . . , , , . , z'S FCET + ° FEET OF FORCC MAIW X Z. S f 0.'s Z- R loo rMICTIOU FACTOR. BEET . TOTAL DtIWAMIC HEAD FEET IIJTEFWAL. DIMEW510Wi 01 TAWK: LEW&TH \.t% 'L I _..__;WIDTFI ; LIQUID DEPTH 9, IL PUMP. PERFORMANCE CURVE MODEL 151/152/153 TOTAL DYNAMIC HEAD/FLOW 50 PER MINUTE 14 45 1s3 EFFLUENT AND DEWATERING _ 12- 40 ,t• ^ti Q MODEL 151 152 153 35 j 10 152 Feet Meters Gel. Liters Gal. Liters Gal. Liters 3 a' 30 5 1.5 50 189 69 261 77 291 9 151 10 3.0 45 170 61 231 70 265 25 15 4.6 3e 144 R3) 20 6.1 29 110 6 20 25 7.6 .16 61 is 30 9.1 - 4 -35 10.7 4012.2 2 Shut-off Head: 301t. 9.1m 5 01450&6 0 10 20 30 40 50 80 70 80 90 1 GALLONS LITERS 0 40 80 120 180 240 2 FLOW PER MINUTE 014308A Model 151 Models 152 / 153 CONSULT FACTORY FOR j•~- 6 7/32 i SPECIAL APPLICATIONS ` F.- 6 3 7/8 a 5/8 3 27/32- a 5/8 8-.-i • Timed dosing panels available. I I I • Electrical alternators, for duplex systems, are available and I 3 7/8 supplied with an alarm, _ • Variable level control switches are available for controlling ® 3 7/8 single phase systems. • Double piggyback variable level float switches are available - L for variable level long and short cycle controls. I • Sealed Qwik-Box available for outdoor installations. See FM 1420. i • Over 130°F, (54°C.) special quotation required. ' I I ~l Il 11/16 12 1/8 1511152h53 Series ' 151/1521153 MODELS Control Selection i ~ Model ' Volts-Ph Mode Amps Sim Duplex a 3j8 = N151 115 Non 6.0 1 2or3 t i BN 151 115 1 Auto 6.0 Included 20r3 L Et 51 230 1 Non 3.2 1 2or3 BE1 11 230 1 Auto 3.2 Included 2or3 tst SK2064 N152 115 1 Non 8.5 1 2or3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN 153 115 1 Auto 10.5 Included 2 or 3 E153 230 t Non 5.3 1 2or3 SELECTION GUIDE BE153 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FMO477. O CAUTION 2. See FMO712 for correct model of Electrical Alternator E•Pak. Nil hlsiallation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify dupiez 13) liconsed electrician. All electrical and safety codes should be followed including the most ri;rant National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN for unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Louisville, KY 402564N7 Manufacturers of. . a SHIP TO. 3649 Cane Run Road ® r, o Louisville, KY 40211.1961 j7 http✓/wwwzoelleccom PUMP ~O ( 2)778-2731.I(800)928•PUMP ?rPUMP9SNCE ~93~Y FAX (502) 774.3624 0 Copyright 2003 Zoeller Co. All rights reserved.s Qr e System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber or the St. Croix County Zoning Department, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. The upslope toe of the mound system must be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 11. Warning: Do not enter septic,, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing. and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 f ` ORIGINAL s SOIL EVALUATION REPO #2532 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Certified Soil Testing, LLC Attach complete site plan on not less than 8'/Y x 11 inches in size. Plan must County P paper St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. pending Please print all information. Revi ed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). W /Z167 Property Owner Property Location 61-b Schutts & Wayne, Onnalee & Ea Mo ovt. Lot SW1 , NW1/4, S2, T28N, R15W Property Owner's Mailing Address of # Block # Subd. Name or CSM# N. 2658 460th St. Schutts CSM City State City Vi llage ® Town Nearest Road Menomonie WI 1 Cady 310Th St. New Construction Use: ooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: Parent material loess over till Flood plain elevation, if applicable NA ft. General comments install 5'x 124' rock cell mound on 100.0 as upslope edge of rock w/ 15 sand fill @ 0.4 gpd/sq ft basal and recommendations: loading Boring 1 Boring # ~ X1 Pit Ground surface elev. 101.6 ft. Depth to limiting factor 27 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 •Eff#2 1 0-10 7.5YR 3/3 - sl 1 f sbk mvfr cs lm .4 .7 2 10-14 10YR 4/6 - sl 1 m sbk mvfr gs lm .4 .7 3 14-21 7.5YR 4/4 - sl 1 m sbk mvfr cs lm .4 .7 4 21-27 10YR 5/3 - sl 2 m sbk mvfr CS lm .6 1.0 5 27-51 10YR 6/4 c2d 7.5YR 4/6 Ifs 0 sg ml - - .5 1.0 Boring Boring # Z Pit Ground surface elev. 98.9 ft. Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eft#2 1 0-10 7.5YR 3/2 - sl 2 f sbk mvfr cs 1m .6 1.0 2 10-23 10YR 3/4 - sl 1 m sbk mvfr cs if .4 .7 3 23-50 10YR 6/4 c2d 7.5YR 4/6 fs 0 s ml - - 5 1.0 10YR 6/2 g i i ' Effluent #1 = BOD5> 30 < 220 mg/L and TSS >3 < 150 mg/L ` E #2 = BODS < 30 m /L and TSS < 30 mg/L CST Name (Please Print) Signatu CST Number Henry F. Grote 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 4/4/2007 715-233-0398 $BD-8330 (R 07~00) Property Owner Schutts & Wayne, Onnalee & Earl Parcel ID # lending Page 2 of 3 3 Boring X Boring # X Pit h -Ground surface elev. 100.0 ft. Depth to limiting factor 20 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 1 0-11 7.5YR 3/3 - sl 2 f sbk mvfr cs lm .6 1.0 2 11-20 10YR 3/4 - sl 2 m sbk mvfr cw lm .6 1.0 f3d 7.5YR 4/6,5/8 3 20-48 lOYR 6/4 10YR 6/2 Ifs 0 sg ml - - .5 1.0 i H 3 haas some inclusions sl and a little fs F4] Boring Boring # X Pit Ground surface elev. 98.8 ft. Depth to limiting factor 18 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#l i 'Eff#2 1 0-10 7.5YR 3/3 - sl 2 f sbk mvfr cs lm 6 1.0 2 10-18 10YR 3/4 - sl 1 m sbk mvfr cs lm 4 .7 c2d 7.5YR 4/6 3 18-46 10YR 5/4,4/4 lOYR 6/2 Ifs 0 sg ml - - 5 t 1.0 some sl inclusions in H 3 ' Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 < 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 608-266-3151 or TTY 608-264-8777. SBU-8330 (R 07/00) Certified Soil Testing, LLC Property Owner Schutts & Wayne,'Onnalee & Earl Parcel ID#_pending Page 2 of 3 3 L Boring' ❑ Boring # Pit - ` -Ground surface elev. 100.0 ft. Depth to limiting factor 20 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#1 I -Eff#2 1 0-11 7.5YR 3/3 - sl 2 f sbk mvfr cs 1m .6 1.0 2 11-20 10YR 3/4 - sl 2 m sbk mvfr cw lm .6 1..0 3 20-48 10YR 6/4 fad 7.5YR 4/6,5/8 Ifs 0 s9 ml - - 10YR 6/2 .5 1.0 H 3 haas some inclusions sl and a little fs Boring # Boring 4 X Pit Ground surface elev. 98.8 ft. Depth to limiting factor 18 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 -Eff#2 1 0-10 7.5YR 3/3 - sl 2 f sbk mvfr cs 1M .6 1.0 2 10-18 10YR 3/4 - sl 1 m sbk mvfr cs lm .4 .7 c2d 7.5YR 4/6 3 18-46 10YR 5/4,4/4 10YR 6 2 Ifs 0 Sig ml - - 5 1.0 - - j some sl inclusions in H 3 ' Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L he 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 608-266-3151 or TTY 608-264-8777. SHU-33 ;0 I R 97100) Certified Soil Testing. yUp. o s a o y C ,1 0 ~ ~J o J ~ ~✓11 C3 J a 50 I~jl a a 5, 3 r 0 9 s r N f 'nJ d _d S rt S D ~ o J J O vY~/ CERTIFIED SURVEY MAP LOCATED IN MART OF THE SW1/4 OF THE NW1/4 AND PART OF THE FRACTIONAL NW1/4 OF THE NW1/4 OF SECTION 2, T28N, RI 5W, TOWN OF CADY, ST. CRODC NW CORNER COUNTY, WISCONSIN. OWNER SURVEYOR SECTION 2 ~ ~ LEE AND PAULINE SCHUTTS EDWIN C FLANUM 553 310TH STREET NORTHLAND SURVEYING, INC. I I ~OO 4 c~3 C~i~lu OGII WILSON, WI 54027 P.O. BOX 14 ROBERTS, WI 54023 fin ~'lOda 9C~s PC~o 4199 I - - - - - - - - 6 I SOUTH LINE OF THE N1/2 OF THE NW1/4 I - - S89°30'46'W 660.00 - - ~ -627.W- LEGEND 9 I SOUTH LINE OF THE FRACTIONALNW1/4 OF THE NW1/4~ ALUMINUM COUNTY SECTION L CORNER MONUMENT FOUND i ~i I I Q I X SECTION CORNER COMPUTED FROM TIES I W I 0 I OF RECORD (SEE COUNTY SURVEYOR) ~I g E PROPOSED M I.O.D. IRON PIPE FOL WD i ~I I I ~flIVE 0° I LOT 4 314' x 18' IRON REBAR SET WEIGHING I I co O 5. ACRES INC. RlW m 1.50 LBS. PER LINEAR FOOT OI it Z I ° 217.800 SO. FT. 0 50' ROADWAY SETBACK LINE ~J I I N t 4.75 ACRES EXC. R/W oN °a I I I 206.909 SO. FT. 0 f31 N z 1 33' 33' Lu 627.00' 33.00 275.46 51. ' w N89'3046'E 660.00' Z' W 3 N I MG~]pL~LQ44(® dQG9D~7 ~sv wD ~g a; ~O U Z a SCALE IN FEET V = 100' 6 ¢ W1/4 CORNER THIS INSTRUMENT DRAFTED BY KEVIN REED co u SECTION 2 JOB NO. 07-21 DATE 02-20-07 SHEET 1 OF 2 SHEETS 100 0 100 r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L-e e-, cIA- Po-y-U n-e, S(,h S Mailing Address 3 'A 0 7-7 454~ q 4 S'J~-` Property Address /Q (Verification requ ed from Planning & Zoning Department for new construction.) City/State V"~~~Jh C Parcel Identification Number Od - 76 -faA-t-I _7 LEGAL DESCRIPTION Property Location V~ 1/4 , W W%4 Sec. , T &N R 5 W, Town of Subdivision , Lot # 1.1 n Certified Survey Map # ,Q, &&A' U , Volume , Page # , Warranty Deed # Volume 1-Is-z- , Page # g Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. umbe of bedrooms 3 SIGNATURE F APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL MANAGEMENT PLAN 'VILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity pU gal ❑ NA kf Permit # Septic Tank Manufacturer / esz-,-- ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 100gpd/bedroom ❑ NA Effluent Filter Model _ 1047 ❑ NA Number of Commercial Units NA Pump Tank Capacity od gal p NA Estimated flow (average)* gal/day Pump Tank Manufacturer -e, ~ ❑ NA e _5 Design flow (peak), estimated x 1.5* .90 gal/day Pump Manufacturer 7, ❑ NA Soil Application Rate ~ ~ gal/day Pump Model ❑ NA Pretreatment Unit InfluentlEffluent Quality {NACI) Monthly Average** ❑ Sand/Gravel Filter ❑ NA Fats. Oil & Grease (FOG ❑ Peat Filter Biochemical Oxygen Demand (BODs) 30 mg/L [3 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5 220 mg/L ❑ Disinfection ❑ Other: S 250 mg/L Manufacturer: Model: Pretreated Effluent Quality D Monthly Average*** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) ❑ In-ground (gravity) ❑ In-ground (pressurized) ~ Total Suspended Solids (TSS) < 30 mg/L p At-grade ~A+Iound Fecal Colifonn (geometric means 30 mg/L ❑ Drip-line C1 Other: 510+cf'u/l00m1 © Leaching Chamber Manufacturer Maximum Effluent Particle Size 1/8 inch diameter Model Approval Stipulation * Wastewater Flow Verification on and calculations: Soil Application Rate_ _ gpd/ftz Area Req. t (Other than bedroom based) Absarption Area Credit per unit f 2 Minimum Number of Chambers r-1 Aggregate Design Flow/Loading Rate= -in in Values typical for domestic (non-commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMMM and be installed per manufacturers specifications ***Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At-grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manuar' Converse, LC. and E.J. Tyler. Publication 15.22 0 "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 El "Design of Conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/I-80-012 October 1980 C3 SBD -10570-P (8.6/99) "At-Grade Component Manual Using Pressure Distribution" o SBD -10567P (8.6/99) "In Ground Absorption Component Manual" ❑ SBD -10705-P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 EJ SBD -10628-P (N.6199) "Recirculating Sand Filter System Component Manual" o SBD -10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD -10572-P (1.6/99) "Mound Component Manual" 004BD - 10691-P (N.01/01) "Mound Component Manual" Version 2.0 M SBD - 10595-P (R.6/99) "Single Pass Sand Filter Component Manual" SBD - 10657-P (8.6/99) "Drip-line Effluent Disposal Component Manual" ❑ SBD -10573 P (R 6/99) "Pressure Distribution Component Manual" SBD - 10706-P (N.01/01) "Pressure Distribution Component Manual" Version 2.0 1"7 Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units Cl MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (1/3) of tank volume Inspect dispersal cell(s) At least once every ❑ months ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ear(s) Inspect pump, pump controls & alarm At least once every 21 ❑ months j63 year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months or(s) ❑ NA Valves At least once every ❑ months © year(s) CM NA Other: At least once every ❑ months year(s) NA Page of START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. Cl '`Valves Valves shall be operated in the following manner: iYAlarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POW17S Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NRi 13, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. &a'Pstmp Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. Q Ire Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of ound, At-Grade, In-Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. :REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: D A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. Cl The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> ' SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS A POWTS INSTALLE POWTS MAIWAWER ,4/ j rNa-m-e-'P~, . Name hone a 3$ _ Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency e: G Phone Phone _ e6 K:\WPDATA1EWOWTS OWNER'S MANUAL.doe Page of . ~ S f rr CIoSPt ~ut~ fPr P,~ ray 1+'1 coor B P p r°v ri • Q`'`~`Dad~ C~t I w D s rooh 7,4 - 0o v~~ J~b ~lyb Private On-Site Wastewater Treatment System (POWTS) Index & Title Sheet Owner: Sc G~'~s r LA e. 7 Project Name and System Type: Location: Street Address ~C zirv ~c2 Legal Desctition 5`f a Township/Count Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Management Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan P)410: Certified Survey 1qp Page 11: Copy of House Plans Attachments: T S Q ~~4c~~ Plumber/Designer: Mike Rogers Signed: Credential Number: 225094 Date: CDT, DZ_ t DOCUMENT NO, WARRANTY NEED STATE OF WISCONSIN-FORM 9 309362, T= STACK 2MV® MR RZC=WG DATA T105 DEN'!"M.Made by Grace Peterson, n woman her t7}~ T e_n'-: ~7~ ;CIS I`. ST. CKdi)t';( CC.)_ wjV` . ReC'd for Rl:c&d t`,:< grantor of St. CrOiX County, Wisconsin, ereb Counveys and warrants day of___Tiarch_<3.72 to Lee Gordon Schutts andau~line c11 tts, at_Z~"R = 3.0hus band and w a as ~t tv~ joint tenants, of o+~ grantee s of St. Croix NETDRN TO County, Wisconsin, for the sum of Twenty-Eight Thousand ($_2$,000.00 1 Dollars the following tract of land in St. CroiX County, State of Wisconsin; Northwest Quarter and Northwest Quarter of Southwest Quarter (NW4 and NA of SW-14) of Section Two (2), Township Twenty-eight (28) North, Range Fifteen (15) West. The said real estate is subject to all existing easements. This deed is given in fulfillment of that Land Contract between the said Vendor and said Purchaser, dated April.7, 1970. FED; E 1~IVEi IN WITNESS WHEREOF, the said grantor ha S hereunto set her hand _ and seal _ this Is t . day of _ 00 t obe r , A. D., 19 71 SIGNED AND SEALED IN PRESENCE OF (SEAL) - ap P rson (SEAL) Harold D 01"n Z L' (SEAL) r re e (SEAL) STATE OF WISCONSIN, l St. Croix }sa. County. JJJ Personally came before me, this lat. day of 00-tO12er-.__ , A. D., 1971-. the above named - Grace Peterson, a woman tNlwu!rr, to me known to be the person _.who executed the ( g~p~{frlt~ent and acknowledged the same. E' o %cNorw Harold D. Olson se This instrument drafted by Notary public St. Croix County, Wis. Harold D. Olson.~~'~'.,~bFl MyCommirsion,(I) Permanent Bald~►in Wis, onsn 54002 (Section 59.51 (1) of the Wisconsin Statutes provider that enp to riled shall have plainly printed or typewritten thereon the names of the grantors, grantees, witnesses and not"7 p WARRANTY DEED-STATE OF WISCONSIN, FORM NY~ •n ~w~ X. C. MILLER CO.. Ylle~tlR[6 Parcel 004-1003-70-000 04i20i2007 09:42 AM PAGE 1 OF 1 Alt. Parcel 2.28.15.23 004 - TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - SCHUTTS, LEE G & PAULINE LEE G & PAULINE SCHUTTS 553 310TH ST WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 2 T28N R15W 40A SW NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 05/19/2003 721924 2245/226 EZ-U 07/23/1997 428/314 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/06/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 39.000 4,300 0 4,300 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2007: General Property 40.000 4,400 0 4,400 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 4,300 0 4,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch M PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00