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004-1042-50-100
St. Croix County Planning and Zoning Detail Sanitary Information Tr~esrlay, March 27, 2007 at 4:14:07 PM Page 7 of 1 Computer #: 004-1042-50-100 Sub/Plat: NA Section: 18 Parcel #: 18.28.15.288A10 Lot: 1 TN/RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 15 Pg. 4196 1/4 114: NW 1/4 SE 1!4 Owner: Larson, Jason 2774 County Rd N Wilson, WI 54027 State Permit: 405021 Issued: 04!18/2002 POWTS Dispersal: Mound Permit: New County Permit: 0 Installed: 08/08/2002 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Not determined NA Helgeson, Bennie Pam Quinn ~iurae~,1 t~fi~ Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 8/8/2005 04/20/2006 Additional Notes Monev Owed $0.00 Wisconsin Department of Commerce DiVa§icx~ of Safety and Buildings SOIL EVALUATION REPORT Page ~ of J in accoraance wren Comm uo, vvis. Ham. ~,oae Plan must iz 11 i h i 8112 e County ~ f' es- n s e. nc x ss than Attach. complete site plan on-paper not l indude, but not limited to: vertical and horizontal reference point (BM), diredion and- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. p~ I,p, [~ 1 ~"' // (~ ,- ~~ / ` ~"~ ~ ! d Please print all info at~~lq. l A!~ \ Reviewed by Date Personal inforrnafion you provide may be used for sec apr uses Privacyl`ar+i°s ;j~~4 (1) (m)). Pro rfy er '' -- // ` ,' ,.~,r',r[1~ t/ ~~~2 i ~ ~' i ~ r - ` ~ ~~ ~ ` pe Location c~ ~ GoJt,.~.Lof; ~/ i 1/4~c. 1/4 S J~ T ~ ~ N R °E (o W Property Owners fling ddress , _ ,. ~ t~ o #-~ Block # Subd. Name~ojr`CSM# City State Zip Code ~ .ne Numbe GC~NTY !City r Village ~ Town Near ^ New Construdion Use: ^ Residential / Numbe~o>;bedrooms Code deri d design flow rate ~' ~ GPD (~-Replacement [~ ubl' commerdal - Desi;ribe: - ~ - '~- Yarent rnater~al Flaod PI4in eleuatioc if ,-:pplicVbie. ft• General cemments $' ~ ..,ti and recommendations: ~~° 7 Boring # ~ Boring _ p~ ® Pit Ground surface elev. 9.Sr D ft. Depth to limiting fador _ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Strudure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 -loo 7, S ~' !0 ~/~~ S ~ /~ ~ - ~ ~ Z ~~ „____.. ^ Boring ewer i ~~ ~~ ~ oft Ground surface elev. _- "_ ~ ~° ° fit. Depth to limiting fador „} J in. Sell A lication Rate H i D th lor D i t C Redox Description Texture Strudure Consistence Boundary Roots GP D/ft'- zon or ° ep in. nan o om Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -Y' ~ J J~f~J CC ~ ~lrC ® l~'i /, a J~~ ,3 ~ S -~ c v ~~~ a~ Jd~ -q~ r:3 F~/a ~s"/ S ~'- ~ ~ ~ Z ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >3 < 150 mg/L ' tmuent ~~ = tsvu ~ s~ mgrs ana ~ ao = w ~nyr~ CST me (Please Pri/n~t) ignature CST Number (3, ~"P ~~J ~ ~ ~ Address Date Evaluation Conduded Telephone Number ~`~.~ /yo '` ~ ; ~9M.~o .~ S' you ~ ~ y- ~~~ ~ ~~ra6 - X63 7 PropertyOwner`6~"a'~~ ParcellD# Page of ® Boring # ^ Borin / y J Pit Ground surface elev. ft. Depth to limiting factor .3 ~ in Horizon Depth Dominant Color Redox Description i M Texture Structure Consistence Boundary Roots Soil ligtion Rate GPD/fP n. unsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 -37 7 ~,5~/ -- -sue ~ ~Ps~ z ~~k~~ CL f' t4C~ ~r s~L 1~F ~~ ~' acs ,~ , ~ l Boring # ^ Boring L_J ^ p;t Ground surtace elev. _ ft. nantr, f~ IimiKnn f~rfn. Horizon Depth Dominant Color Redox Description Texture Structure Consistence ~~~~ Boundary Roots Soil- lication Rate GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ^ Boring # ~ Boring n vir Ground surface elev. ft. Death to limiting factor ~n Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil liption Rate GPD/ff 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 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employee. 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. SBD-8130 (R.6Po0) CG~~C%c~~ ~ /O ! ~j/I ~2 SE" S l ~~~" rQis ~ ,7'~~'. ~'/~e x'7.3 ,~. ~,~. ida, r ~~~ ~ ~ - L~ ~ ~ ~~~' "' ®~ a ~.~~~ 2' 3 ~~ ~- 22/x/7 / s~ ~o.e ~~ __1 //2 r l 0 ~~~0~~,~~~- 6-60051 `~~ ® IF~EGISTER OF DEED5 `~ 5T. CROIX CO. WI ~J ~ >• ~~ RECEIVED FOR RECdRD °"~1~~~ 10-25-2401 8:00 AM ' CORY FEE: .~. RECORDING FEE: 11.00 RAGES: 1 CERTIFIED SURVEY MAP PART OF THE NWI/4 OF THE SEI/4. SECTION IS T28N. R15W. TOWN OF CADY. ST. CROIX COUNTY WISCONSIN UNPLATTED LANDS '~DRAWAGE WAY 1 LOT 369.77~'., / ~ v , ov ~/ \, 1 168.063 SF. 3.86 AC. Z ~, WITH R-O-W 0 o U' °~ ~ 1144.930 SF. O `~' 3.33 AC. ~ WITHOUT R-O-W N ' w ~ ~ of z rU ~\ ,V ~~_ ~~~ ~~. ~ i ;\~ •p ~ ~, ~ ~~~ 3 ~s Z N w ~~ ZZ a J J of Q w f- rn w ~ rn a J ~ al z -v o ~ rn t n '~ -' ~ BUILDING SETBACK LINE ~ o ......................1........................................... W N M ~ N N J °O ZI O O ~ - ` N ~i . .. . , S 89° 56' S3'W 328. 7 . . C/L CO. HWY " M v N M W r`r. ~ v - - - - ~ - -~ 5T. CR~~IX CC?Uhr~Y. ~in!1 r,fr,~ 701`. ..i.,.! p,.y,:, ~ ~., . ,ln~ • OCT 2 ~ ?_.00 ii t'1Qi iE`COIG C(i ui,ll c~~ tiQ ,la ~r'S Uf 8p~iiOV31 CL::(.., acii= . •.:I .;li ,:' f)c: SCALE.. ; t i'~;'';;1 100 ' 0 100 200 I ~ BEARINGS REFERENCED TO THE EAST LINE SEI/4 SEC. 18 (ASSUMED N00°32'S2'W) LEGEND ~ SET 3/4" X 24' IRON PIN WT. 1.50 LBS/FT. w Q~ ~ - J W U WW ~y co °~ U M - ~ zv .: ~. M U O- ~O N LL W N N SOUTH LINE NWI/4-S S 89°II'31'W ~ ~ S 89°II'31'W 321.42' •• - 1330.18' ~ N N w UNPLATTED LANDS ~ ~n w _oo ` - N Z F- _ I. LYLE L. ELLIOTT. REGISTERED LAND SURVEYOR S-1300 DO HEREBY CERTIFY '''r7 _, THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS MAP IS A TRUE AND CORRECT REPRESENTATION OF PART OF THE NWI/4 OF THE SEI/4. OF SECTION I8, o ~ U N T28N. R15W. TOWN OF CADY. ST. CROIX COUNTY. WISCONSIN AND DESCRIBED z a o AS FOLLOWS: COMMENCING AT THE SOUTHEAST CORNER SAID SECTION 18. THENCE ~`' ~ ~ N00°32'52"W ALONG THE EAST LINE OF SAID SOUTHEAST QUARTER 1318.69 FEET ~-~ THENCE S89°II'31'W 1330.18 FEET TO THE POINT OF BEGINNING: THENCE ~ Y ~ S89°II'31'W ALONG THE SOUTH LINE OF THE NWI/4 OF THE SEI/4 SAID SECTION ~ ~ 18 321.42 FEET: THENCE N06°07'23'W 479.22 FEET: THENCE N86°25'44"E ~- - 369.77 FEET TO THE EAST LINE OF SAID NWI/4 OF THE SEI/4: THENCE w w S00°23'56"E ALONG SAID EAST LINE OF THE NWI/4 OF THE SEI/4 495.00 FEET TO "'~' THE POINT OF BEGINNING. SAID PARCEL CONTAINS 3.86 ACRES MORE OR LESS INCLUDING THE TOWN ROAD RIGHT-OF-WAY. AND SAID PARCEL IS SUBJECT TO ANY EASEMENTS OR RESTRICTIONS OF RECORD. I HEREBY CERTIFY THAT I HAVE FULLY COMPLIED WITH THE PROVISIONS OF SECTION 236.34 OF THE WISCOSNIN REVISED STATUTES AND THE ORDINANCE OF ST. CROIX COUNTY IN SURVEYING AND MAPPING SAME. EACH PARCEL SHOWN ON THIS MAP IS SUBJECT TO STATE. COUNTY AND TOWNSHIP LAWS. RULES AND REGULATIONS (i.e. WETLANDS. MINIMUM LOT SIZE. ACCESS TO PARCEL ETC.) BEFORE PURCHASING OR DEVELOPING ANY PARCEL CONTACT THE ST. CROIX COUNTY ZONING OFFICE AND THE APPROPRIATE TOWN BOARD FOR ADVICE. PRIOR TO CONSTRUCTION AN EROSION CONTROL PLAN MUST BE SUBMITTED TO THE COUNTY PLANNING AND ZONING OFFICE ON EACH LOT THIS SURVEY WAS MADE AT THE REQUEST OF RON RIEK 2768 40th AVE. WOODVILLE. WI. 54028 PH. 1715-698-3010 L L LL I OTT. RLS 1300 = ; UYLE L. E1.~1O DAT SEPTEMBER 22. 2001 ~ ~ '•, HUDSON WI :~ TH I S I NSTRUMENT DRAFTED BY L . ELL I OTT ~ •. ,.•'•~ `~ •~. .. VOI. 15 Page 4196 i N ~~ ~1 N/isconsin Department of Commerce PRIVATE SEWAGE SYSTEM S2fety and Building Division INSPECTION REPORT GIriVERA~ INFORMATION (ATTACH TO PERMIT) 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 Larson, Jason Cad Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION EL AT N DATA TYPE MANUFACTURER CAPACITY Septic ~ / ~' I~~"~' ' ~f~ ~~ DosingDOS1ng ~YYt. ~a{a, boy Aeration 1~ Holding ~`"`" TANK SETBACK INFORMATION TANK TO P/L WELL T LDG. ~w CvY' Vent to Air In ke ROAD Septic 5y~ '// i .~ ^ r W >~ ~ Dosing O 4 ~ ~ Aeration Holding DIIMD/cIDN('1N INF(1RMAT1[1N Manufacturer UL.~S r, GPm^nand Model Number ~ V ~~ , I TDH ft Friction L s Syste He TDH Ft ,/ Forcemain Len / Dia. ~~ Dist. to Weu 2 N`oT !nl ~ SOIL ABSORPTION SYSTEM BED/TRENCH Width r Length ~ DIMENSIONS SETBACK SYSTEM TO INFORMATION _ _. _ . nICTDIRI ITIf1N cVRTFM -, .. ~j / yET county: - St. Croix Sanitary Permit No: 405021 0 State Plan ID No: Parcel Tax No: 004-1042-50-100 STATION BS HI FS ELEV. B ~c~ 'rk - J , O ~ Alt. BM~ -~ o N W S ~ ~- ~ Bldg. Se r ~03 - St/Ht Inlet St/Ht Outlet ~- Dt Inlgt __. / '_ Dt Bottom ~~.~ y~ ~~ der/M~~ ~~~.~ ~~ •~~ Dist. Pipe , ~o a~ y G" /6 •0 Bot. System ~~ ! 03 . 3 • ~ ~D . Final ade / ~, lse 10/• ~ '?i OR HeaderlManifold / ~ !/ Length ~ Dia Distribution ~ ~ / Pipe(s) ~/ ~ ! Length `~ Dia ~ t Spacing x Hole Size / x Hole Spacing r ~~, f V snu CnVFR v Drnc~nrn c•.c4nmc Anly YY Mnunrl 6r At-Grade SVStemS Only =c~aee~ ~"`- t to Air Intake b r Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil ~~; Yes ~ No ~J Yes {~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ~ / ~ ~ Inspection #2:~/ / U !~ ~~~ Parcel No: 18.28. 5.2 A10 Location: 2774 County Rd N Wilson, WI 54027 (NW 1/4 SE 1/4 18 T28N R15W) NA Lot 1 _T o ~ Nrt/~a Ir ~-~. wa.~r. ~:~ +r~f -' w~cl,~.~z'-~ 1.) Alt BM Description - ~p ~~ v'e-~~--~y~- ~~[I'•~~ i 2.) Bldg sewer length = -~vl w ~ - amount of cover = ,, ~ ~~~y., ~~~V ~~~~~~ ~~.p~,¢ ,~.~•~,t~y ~ .~~,~4/I, ` ~.2t bf 7 3.) Contour = ~~c,` /~,s ~~~ J r of ~ - ,~1- - -- - -~ -- _ - --- q ~~~~ Use otheris de for additional information. No L_ ~ I I' D " ;__ -~ ~~~~c----~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) nside Dia. _ Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST. CROIX ~SCD~S~~ Madison, WI 53707 - 7162 Site Address ~ ~ Ck~t~ fa Y~ De artment of Commerce ~• ZZ-d ~- QI1~'~ ~~~y ~ ~U ' Sanitary Permit Application spy PertnIt N ~~j ~ ~ in accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if RevisloII ~~ ma be used for second ses Privac Law, s15. 1 m I. Application Information -Please Print All Inform RANS ID # ~ 72132 Property owners Name ~/ED /p~ JASON CARSON 004 1042 50 ~v Property Owner's Mailing Address Property Location • 1250 NORTON ST #1 sr. CR 2 2~~2 ~ ~ NW ~ SE u. S 18 T 28 N g 15W' City. State Zip LNG !CE ptnber ~ ~ Lot Ntltmbat BI k Nambet ;~} ~'/Q 715/79,6- 831 Subdivision Name CSM HAMNIOND ~WI 54015 ~' is/P. ~!9` 660051 `~' ~` II. Type of Building (check all that aPP1Y) Q11-~w4~-'~ppd - ^Ciry ~ ! or 2 Family Dwelling -Number of Bedrooms 3 J ~~ ~2 .feu*2~t1.%. ~~'~ ^Village ^ Public/Commercial -Describe Use ~`~Y''"~~~'~ W~~"~~~ ~1'ownshi LADY ^ State Owned S. ~~'~i~.. '' = (o th ~5 ~ / ~i (I "--f"~~ ~~~ . (• g 3 Y['~c~N1c1 Sind Nearest Road T ~_ an GcvGfz~zti•~ ~ ,e,~e~-~ l ~ 1 ~ (o ~ C . T . H . N III. Type of Per t: (Check only one boz on line A (ntunbering scheme for internal use). Complete line B it appllesble) A. For County use . 1 ~ Ncw 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to S stem Tank Onl F.xistin S stem Permit Number Date ~~ B. ^ Check if Sanitary Permit Previously Issued . IV. Type oP Permit: (Check all that apply)(ntunbertng scheme is Por internal use) 4d ^ Non -Pressurized In-Ground 21® Mou 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ A[-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ~ Other V. Dis ersal/'IYeatment Area Information: ' Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System 8lavation Final Gtad~':'i"'.,:, Requued Proposed Rate(Galf./Days/Sq. (Mict./L~ch) Blavation / ~~ ~~y 450 450 450 1 s~i~ p,S N/A 103.43 105.23 VI. Tank Info Capacity in .Total Number Manufacturer Prefab Sits Steel Pibet pj~iC ~. ~ o <i Gallons Gallows of Tattles ~ J` 12~ ~, Concrete Constructed Glass New lsxistinY ~~ ~ ~/ Tanks Tanks segue cr xoldina Tank 1000 - 1000 1 HUFFCUTT CONCRETE X °oina ~""'~" 600 600 1 HUFFCUTT CONCRETE X VII. Res onsibilit Statement- I, the undersigned, assume responsibility for tastallation of the POWTS shown on the attached " Plumber's Name (Print) Plum is Signature MP/MPRS Number Btrsittess PJtom.Nutpber BENNIE HELGESON ~ 220292 715/772-3278`\, Plumber's Address (Street. City, State, Zip Codc) W1229 770TH AVENUE, SPRING VALLEY, I 54767 • nun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Data Issued Agent Si~Otre (NO _ `, - Surcharge. ee) _ U ~ ~ '~'~°~ `~ _= ^ Owner Given Initial Adverse . Detertninadon Condtdons oP Approval/Reasons for Disapproval J ~ttthJC~ ~~1~~- , .V17~~~;~ .,Z`"]rl~t",tii'LQ~_~~%L~t~cr~ C~I.tC ~~-'-'klffli-~~~5~~~ r _ .~ ~ ~r /' CSC-f'~i~~rv a~2{,_sf (w J'tv><t~Z~ l _sa ~ ~~~ ~•a-r">'"fru~nz~, ru,i ' ~_~,- ~~Ccc<'~ a~°.``,,~-t~LLff,,~" r~ lc-n~~ ..~ ~ , L / _ L JJ ^ / ~f ~l . ~~-I~~'~G~u f.~ J~~j -E'2-Z'.L,l,a., ~~5~~~~ 5 ~ ~eGs^, [~1'1 > J(~~/1 /ZG?t ~ ~tr7'7~C~ j1Yt~r~'(~~ ~YIPS,S•4~~ "3ZC,L.. ~C"!'nr~dLC~vuri ~.~~, ~{: ~ /~'N,ca--~.-~-~azv' ~'~i.~~'/~. }, y''~`n- f~ /h~r~ ~~ -b C~2~,~~ 1'Ylll~r~K ~ t-c.~v~ . , Attach eomPlae Plan, (to ~a county enl~) r~r the system on paper not !w tlaa avs: u tneha to stu . .. _. caT1.~49R fR. QS/01) .~. isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD !~: (608) 264-8777 www.commerce. state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary April O5, 2002 CUST ID No.220292 BENNIE W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/05/2004 A7TN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Jason Larson - CTH N St. Croix County, Town of Cady NW1/4, SE1/4, S18, T28N, R15W FOR: --- ~ - Description: w Three Bedr m Mound System Object Type: P m Regulated Object ID No.: 835273 Identification Numbers Transaction ID No. 721325 Site [D No. 642781 Please refer to both identification numbers, above, in all cones ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • 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). • 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. Stats. • 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(1)(a) -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. P.O.W.T.S. Conditionally BENNIE W HELGESON Page 2 4/5/02 Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@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 INDEX SHEET PROPERTY OWNER: JASON CARSON 1250 NORTON STREET #1 HAMMOND WI 54015 PROJECT NAME: JASON CARSON PROJECT LOCATION: NW 1/4, SE 1/4 , S 18, T 28 N, R 15 W MUNICIPALITY: TOWNSHIP OF CADY COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R /99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section & Specifications. Page 5: Tank approval -Wisconsin Department of Commerce Page 6: Huffcutt Concrete 870659 tank specifications Pg 1 Page 7 Huffcutt Concrete 870659 Tank Specification Pg. 2 Page 8: Pump Specifications Page 9: POWTS Owner's Manual & Management Plan - Pg. 1 Page 10: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Sign ~ Date: April 1, 2002 DEPARTMENT OF COMMERCE WYISION SAFETY AND BUI DOINGS SEE CORRESPONDENCE ter`-- 1 ~I~~ ~~r, ~ r'~~ 1 ~ io tiC.1~-,---~-^-~ n t~q 'i ~ ~ ' ~ ,~ y a J~ M's IOO, o~ `ro~0 0 ~ ~ cw.Clt~e..~ ~ _ Slab Kk/S¢,.~5 Gang ,~, ., / _ ' ~3 ~ dld~ &~~ i n ~ .~ i~~ ~e /~ r ~ ~ ~ ~ ~, ' I 8/ ~ I ~4 4 f c <.,~ /rC~'~/tea' ~' C~-~ ~ ,~ .Sef~~<< /v~~ futi/c .,., / a -~~ ~., ` _ _ y ---_ . -~S . _ 1__.._ v- ~; ---- .S ~ f ti \ ~ ~~•% . Sw -_-___. / rtJ~GSL CQ 3 B. ~ ~}~Vri ~ ~~~~ ~~ u~ ctdc~~-Ei~~ ~~~~ ~~~ ~~ Car4~ ~1~~ 77 c, r. tl N f1)I~ r ' ~jgSOlld L-.~(.~r"5v N Synthetic Covering ASTN2 L 3.3 Medium Sand -~ Topsoil (_ Distribution F/~O G F Page Z Ofio Pipe a3 ~/~,~ /0.3• X13 // p/o Slope• C er l.il.O f 2r- 2 %2 Aggregate Cross Section Of A Mound ~_ _ ~~- ~ / Signed: License Number: Date: Force Moin Plowed From Pump Loyer 22'~ ~ i U ,~, 3 ~~~/p ~ Ft . r~^~} t~ ~n~r,,~15 ~ .~ Ft. ~G 1j Ft. ~~'S~\ g ~ Ft._~s-~s :~, r..zs'o~~e.~.,~rs K ~ Ft. L ~ Ft. r--~- ~ '7,_ ~_____ Ft . T 17._._? _ Ft . W ~p~ Ft . Observation Pipe ~ K ir~== --- -----------------------------~ --- , K` ~B l __ ~ --______~ w _._ _ _--------- ~ „ CALL Of 2 - 2 / Distribution Pipe A99fe9ate __ ~ ^--~ I ,,_ p/ Observation Pipe j~7~U •~Shc ~r~`~ _.---- _ Plan View Of Mound ~i U?rl ~r`_ ~ IISDy. ~/`SQi.I C )ep.lno~" ~GC~S~ ~E~a,tia~) Perforoled Plp. Onloll ~~ ~ End VI.w ' P.rlorolaa / ( ~ ~ u S~r ( d Noles Located on Bottom are ,E~q1 wally Spaced ~rcf j~~~r ~~x7 '~'u /"(ctvl,iol~ C lei Ylp. Discribucion Pipe Layouc_ Signed: License Number: e: '~ ~,`~ ;~ ~~ ~ R ~~~~ . ~Vl S ~~ f r X ~~ -~- .. L ~~ '~ r ~_ 3 a o, i zs ~~ ~ Inch Hole Diameter ___~,_, .. ~~. L ;'Inca (es) ~~--Lateral Manifold " _~ Inches rorce hiafn " a Inches ,~, 93 i,~~ LSE: R`~ ~ 1~~. / D SyS -~- ~~ ~i~lP~f'~ ~J~tSonl (-G~.~'So1J Page ~ Of iu SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE E NEATHERPROOf JUNCTION BOX >_ 25' FROM DOOR, WINDOW OR WITH CONDUIT FRESH AIR INTAKE ^ ~ FINISHED GRADE ri~n. 6~ 18" IN . y„C.Z. Q~SERWTiorJ PIPE INLET WATER TIGHT SEALS I FILTER APPROVED Z~ $~~ ~ ~~ PIPE 3' (a"x/(o" ONTO SOL I O ------- SOIL ~ J p Mp EV . 7 FT Zy' r. ~• :• I , .. , C I ' GAS- ~ ~~ TIGHT• A SEAL ~ _.1.. ~ r, g i ~I ~- ~, D 3" APPROVED BEDDING UNDER TANK APPROVED MANHOLE COVER W / PADLOCK E WARNING LABEL 4" MIN. • u 18 MIN. VAPPROVED JOINTS KITH LM APPROVED PIPE N 3' ONTO SOLID SOIL OFF CONCRETE PAD SPECIFICATIONS ~i [~ ~ G. ~ (-« 1 c Ty i R~~ 1rs~~ SEPTIC / DOSE y~ ~~.s X S ~ ~ S~ ~~I. TANK MANUFACTURER: d 41 TANK SIZES ~ DOSEIC ~- GAL. DO $~. ~OGo-I E FLO BACKG ~3. 3 GAL~~.~ '- ~ ,',r S CAPACITIES: A = a O INCHES = GAL. ALARM MANUFACTURER: ,~'r ~c~re Sa.S r.. .. Zy•86 MODEL NUMBER: ~n, H4 u.~ g = 2 INCHES = ~~" G9.5$ SWITCH TYPE: M.rrr ., ~/04~ '8 C = ~ INCHES = ~Zpe~,fl2~ PUMP MANUFACTURER MODEL NUMBER : 7 j~ D = ~(l _ INCHES = ,GAL. SWITCH TYPE: l~ ~~ ~~ 1. 23 WAG REQUIRED DISCHARGE RATE LI-I1o ~ PUMP I; ALARM WIRING AS PER IL ~ ~ ~~ ~.9 F T VERTICAL DIFFERENCE BETW MP OFF AND DISTRIBUTION PIPE. • !~_ FEET + M M NETWORK SUPPLY PRESSURE _ FEET / } FEET FORCEMAIN X ~j$FT/100 FTOTALIDYNAMICAHEAD ~_. ~~,~_,EETf/ '~° WIDTH DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LIQUID 6 Spa 4 _• ~ ~~(f l¢ 93 ~j~~ ~ Se e ~~..~ S~ LICENSE NUMBER: DATE: SIGNED: .~ ~, 1/88 ~scons~n Department of Commerce SAFETY AND BUILDINGS DIVISION Plumbing Product Review P.O. Box 7162 Madison, Wisconsin 53707 Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 12, 2000 HUFFCUTT CO., INC. BILL OLSON 737 HERBERT ST CHIPPEWA FALLS WI 54729 Re: Description: SEWAGE TANKS, CONCRETE Manufacturer. HUFFCUTT CO., INC. Product Name: SEPTIC/SEPTIC, SEPTIC/PUMP, SEPTIC/SIPHON OR HOLDING Model Number(s): 1000/600 (44.0" L.L., 24.9/15.2 GAU ., 96" MAX. DEPTH OF BURY, 845 G.P.D. WHEN USED AS A SEPTIC/SEPTIC TANK OR 525 G.P.D. WHEN USED AS A SEPTIC/PUMP OR SEPTIC SIPHON TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTAIL WASTEWATER) Product Ftle No: 20000781 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with Chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of April 2004. This approval supercedes the approval issued on February 10, 1999, under product file number 19990044. This approval is contingent upon compliance with the following stipulation(s): • This product is approved to use the following: -Four, six or eight inch inlet and outlet openings. -Bottom and side pipe openings for siphon, pump and holding tanks. -Pipe materials constructed in conformance with Table 84.30-2 or 84.30-11, Wis. Admin. Code poured into tank cover or access cover. -12-inch access port for holding tanks. - Four inch discharge opening in riser. -Two inch schedule 40 PVC cast in riser for electrical wiring. -Metal lockdown cover. -Cast-A-Seal and PSX Gasket System by Press Seal Gasket Corp., Polyfok 11 High Pressure Pipe Seal by Polylok, and A-Lok X-Cel by A-Lok Products, Inc. - Department approved effluent filter installed in accordance with the product approval far the filter including a properly sized and located access opening for service and maintenance. • .This tank must be designed to withstand the pressures to which it will be subjected. •'' The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. SBD-10564-E (N.10/97) File Ref: 00078101 ~1~~P.X-' 5oµ ~nRSo~ ~~, o ~ Iv 7G" ~g•• ~ 39" ` 1 i m v 30" 12" 30.. BAFFLE co r r ~ r ~ N ~ UI f u s ~ v N r 57" I 72" I I I I 78•• ! I F, PROJECTr 870650 ~ 1000/600 GALLON TANK (V SEPTIC a PUt~ TANK z m C T Z n 0 v HUFFCUTT CONCRETE 737 HERBERT STREET CHIPPEHA FALLS. WI 54729 (715) 723-7aa6 r Fax 1775) %23-71]1 (800) 924-7516 ~ MEMBERS Ohs NATIONAL C MISCONSIN PRECAST CONCiiETE AS$pC1ATI01. THIS DRhvING SHALL NOT BE COPIEO OR SUBntTTEO TO OTHERS vI TltOUT o~ I 35•~ I 39.. ,~- 7 ~: ,~' ~~~~lewv; ~Tsv~ ~,a r~ svn~ ~~ z r- W~ 7.. r r*; -~ i ~; r n m m m ~y I~ ~.i 7` ly I ni ~ ~n -~^ . i '~c-- rv--~ O ~ •, t.. cn 1..~~ ~n ., N N ~ -+ m n Z J , ' ~ ~ 0 0 Q ~, > > ~ > > ~n n __1` M N rr m~ 1 ':~' ~ v .+.~ 1 ® ~ ~ ~g 6 IN °v \ 8 ~°~ G T n O / m .r a I-} U i~ Vl m m i n rn l~ O A m rfi O A O 2 0 m A O 'O -1 O Z N O 3 m H m A n O CZ7 A m m 0 m A .. ._, ~' p. ZZ 8 .oor G~W~ ~O= m lii ~Q r 0~~.... ~QQQQ~Q ~ ~ O :. ~.... O n ~ m ~~ w~ :. -~ M ';; . ~~ PROJECTS 870650 H U F F C U T T CONCRETE (715) 723-7x46 ~ Fax (715) '72 37111 NATIONAI. ~ MISCONSIN ' 1000/600 GALLON TANK (E300) 924-1516 PRECAST CONCRETB ASSOCIATIOr+ 737 HEREIERT STREET ~ ~ raw rr n,.resw ee mt mru„ a utn. ~y ~__ ~ O C -~ ~' rn 1 • ~~~v~-~ w:' ~ /~S ~~ of La r2.S o N Submersible ~ Effluent Pump METERS I 8 7 0 a w g U ~ 5 Q z ~" 4 J Ia- O 3 I- 2 1 0~ •- 0 4 6 CAPACITY P~, ~o~l~ MODEL: 3871 DS SIZE. 3/4 SOLI RPM:1550 H P: 0.4 12 GOULD~ ~ ~,~,,~N~ce Elfediw October, was vawTeo w us.~. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 9 °f 10 en a II~IFARM4TION ~~..r.. ----- Owner JASON CARSON Permit # ~" -j ,,Z, DESIGN PARAMETERS 3 ~ Number of Bedrooms ^ NA Number of Commercial Units C~ NA Estimated flow (average) 300 aVda Design flow (peak), (Estimated x 1.5) 450 aVda Soli Application Rate p 5 at/da /ftz Inftuent/EfftuentQuaiity Monthly average' Fats, Oil 8 Grease (FOG) 530 mg/L Biochemical Oxygen Demand (80Da) 420 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality . ~ ^ NA Monthly average" Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y inch diameter SYSTEM SPECIFICATIONS Septic Tank Capacity 1000 ai ^ NA Septic Tank Manufacturer UFFCUTT CONCRE~ ~ Effluent Filter Manufacturer BABEL O NA Effluent Filter Model ~1-100 12" x 16~ NA Pump Tank Capacity A 600 al ^ NA Pump Tank Manufacturer H FFC 0 C NA .Pump Manufacturer GOULDS PUMPS- INQ NA Pump Model 3871 ^ NA Pretreatment Unit ~ NA ^ Sand/Czravei Filter O Peat Fiiter O Mechanical Aeration ^ Wetland ^ Disinfection O Other. Manufacturer Dispersal Cell(s) ^ In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ~ Mound ^ Dri line ^ Other: • Values typical for domestic (nor-comr»erda4 wastewater and septk tank effluent •+ Values typical for pretreated wastewater. ~......- MAIiV 1 tIVHiVGC ~t.navv~~ Service Event Service Frequency Inspect condition of tank(s) At least once every 2 ^ months ~ year(s) (Maximum 3 yrs.) ump out contents of tank(s) ~ When combined sludge and scum equals one-third (3z) of tank volume teal cells months ®year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 1 ^ months ®year(s) Inspect~pump, pump controls 8 alarm At teas once every NA Flush laterals and pressure test At least once every 3 ^ months Q year(s) O NA owes At least once every ^ months ^ year(s) ^ NA other. At feast once every l7 months ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servtdng Operator. Tank inspections must include a visual inspection of the tank(s) 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 back up or ponding of effluent on the ground surface. The dispersal cell(s) shat( be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components; and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. STARTUP AND OPERATION. 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. OWNER : JASON CARSON Pafle 10 of 10 ` System start up shall not occur when soil conditions are frozen at the infiltrative surface. • . During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the ceU(s) and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. .~ Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss;'diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbiGdes; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with ch. Comm 83:33, Wisconsin Admintstratlve Code: • AA 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 another 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 tide compliant replacement system: ^ 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 ar)d 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. ^ 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. O 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 CONTAIN 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 POWTS INSTALLER POWTS MAINTAINER Name HELGESON EXCAVATION I ~ Name -~ Phone 715/772'x3278 •Phone 7 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY ' ' ' ~ • • Name JOHNSON SANITATION Agency ~ ~ • Phone 715/273-5811 Phone 715/386-4680 `~ This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agenetes. This document meets the minimum requirements of ch. Comm 83.22(2j(b)(1)(d)8(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. ~~ (~~) (continued) Manufacturer's Name E~JEFCtlTT CGl., INC. HUFFCUTT CO., INC. SEWAGE TANKS, CONCRETE IRON CITY ENTERPRISES, INC. IRON CITY ENTERPRISES, INC. IRON CITY ENTERPRISES, INC. IRON CITY ENTERPRISES, INC. JOHN A. RODER CORPORATION JOHN A. RODER CORPORATION PRODUCT APPROVALS OR ALTERNATE PRODUCT APPROVALS Approval GOOD Product Name Model Numberfsl ti lation THRU SEPTIC/SEPTIC, SEPTIC/PUMP, SEPTIC/SIPHON 1000/600 - 201, 251, 252, 06/05 OR HOLDING DEPTH OF .. 24.5/14.5)ti3 GAUIN.,;96" MAX. 1113, 1114 BURY, 845 G.P.D. WHEN USED AS A SEPTIC/SEPTIC TANK OR 525 G.P.D. WHEN USED AS A SEPTIC/PUMP OR SEPTIC/SIPHON TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER) SEPTIC/SEPTIC, SEPTIC/PUMP, SEPTIC/SIPHON 1250/750 201, 251, 252, 05/04 OR HOLDING (45" L.L., 28.0/17.0 GAUIN., 96" MAX. DEPTH OF 1113, 1114 BURY, 969 G.P.D. WHEN USED AS A SEPTIC/SEPTIC TANK OR 603 G.P.D. WHEN USED AS A SEPTIC/PUMP OR SEPTIC/SIPHON TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER) SEPTIC, HOLDING OR PUMP 1500 185, 251, 252, 02/02 (38.0" L.L., 38.8 GAUIN., 36" MAX. DEPTH OF BURY, 1114 706 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER) SEPTIC, HOLDING OR PUMP 2500 185, 251, 252, 09/02 (65.0" L.L., 39.0 GAUIN. 36" MAX. DEPTH OF BURY, 1114 1214 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER) SEPTIC,HOLDING OR PUMP 1000 185, 251, 252, 11/05 (36.0" L.L., 28.8 GAUIN., 48" MAX. DEPTH OF BURY, 1 i 14 497 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER) SEPTIC,HOLDING, GREASE INTERCEPTOR OR 2000 185, 251, 252, 11/05 PUMP (53.0" L.L., 39.0 GAUIN., 36" MAX. DEPTH OF BURY, 1114 994 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER) SEPTIC, HOLDING OR PUMP 750 194, 251, 252, 08/06 (41.0" L.L., 19.4 GAUIN., 66" MAX. DEPTH OF BURY, 1114 381 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER) SEPTIC, HOLDING, GREASE INTERCEPTOR OR 1000 194, 251, 252, 09/05 PUMP (52.5" L.L., 19.4 GAUIN., 66" MAX. DEPTH OF BURY, 1114 488 G.P.D. WHEN USED AS A SEPTIC TANK PAGE 74 ,a Wisconsin Department of Commerce S VALUATION REPORT Page ~ of 3 Division of Safety and Buildings in accordance with mm '~~'~~ county Sf ~ o i Attach complete site plan on paper not less than 81/2 x 11 nches in size. Plan must include, but not limited to: vertical and horizontal reference int (~ ~irey,~iop anA~a parcel I.D. percent slope, scaie or dimensions, north arrow, and locati n and dis ce tie- d. ~~,. .....-- -s ~F: .. cr ,.~_ Rriviewed by Date d Ym» 1 T ary pur Personal information you provide may be used for secon • Property Owner f ,~~So y~ 1...~iv-S n.1 Props Govt. Lot ~~ 1/45 f/4 S ~ g T ~g N R ~s -E-for) W Property Owner's Mailing Addres Sf ~ ~ Lot # Block # Subd. Name or CSM# o~ ~~~ /~Sd ~or City State Zip Code Phone Number ^ City ^ Village own Nearest Road r ~` U Q UII s' OS (7/S-) 796-Sd'31 (-~ Ca.aP C•Ty / . 0,,,,,,,rn ~~ New Construction Use: L~Residential / Number of bedrooms ~ Code derived design flow rate y.SO GPO ^ Replacement ^ Public or commercial -Describe: , I ~ Parent material % %~ Fiood Plain elevation if applicable /~ ~ General comments . ~Q pUer <onfo~v- /a/,G -for t~..~pe and recommendations: (,CSE ~~ S•3 Ste" -- E~y~ d~ C~~~ ~ysf~~..., ~I~J. ~O3• y3 ~' x ~S-' ~~ Il ~- U Boring Boring # Depth to limiting factor y in. ~~~ • ~ ft v l d f . . ace e e sur ~Plt Groun Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP `Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~- v y ~ ~- S~ I ~ {sb r C w av . 5- - -~ ~~ .~ / V1'LF r G fl le ~ a ~~ ~- t.. / S , -- ---, ad ~ ._ - y , 6 ~ S s ~m Boring # [~ Byan9 \ Pit Ground surface elev. y • d ft. Depth to limiting factor a ! in. ~l ~~ ~ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fC- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eft#2 v'1 ~''~ O ~ ~ ~ S a U ~ K b ~ h r U a u -F ~ 9 - ~° ,~- Effluent #1 = BOD > 30 < 22o mgrL and i ss >su < ~ au mgrs uuuarn fra - u.. ~ ...y, ~ .~...... ~ _ - CST Name Please Print) Sjgnature r> CST ~~ Address , / I / II ,, Dat valua Telephone Number I,l>/2 a 9 7 70 ~~ f~~ ~ .~jri7 U~ /lam (N~ .. a _ /,3- D ~ (7~$~ 77, '3a7~ ~~ Property Owner ~~Cx~~^ ~ ai'S~`` Parcel ID # .Page ~ of 3 3 Lf Boring Boring # ~/ 10~ . ~ ft. De th to limitin fador a in. L~ Pit Ground surface elev. P 9 -.--~-- Soil IicaBon Rate C l i tion Redox Descri Texture Structure Consistence Boundary Roots GP D/f~ Horizon Depth in. o or nant Dom Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. 1 'Eff#2 _~ o ~ ~; v-~ ~ ,. ~ I v ~ r S _3 ~ 6k - ,,~ - y ~ ~ U Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting fador ~n• Soil lication Rate cri tion D R d Texture Structure Consistence Boundary Roots GP D/ft° Horizon Depth in. Dominant Color Munsell p ox es e Qu. Sz. Cont. Color Gr: Sz: Sh. 'Eff#1 'Eff#2 Lf Boring Boring # Ground surface elev. ft. Depth to limiting fador in. ^ Pit Soil lication Rate i ti Texture Structure Consistence Boundary Roots GPD/fP Horizon Depth in. Dominant Color Munsell p on Redox Descr 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 = BODS _< 30 mgll. and TSS _< 30 mglL 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. SBD-8330 (R.6/00) ~~i ~e fr ~ C~So ~ ~-.a~F~ S o c1 ' ~e ~ e~ sow ~~~~ ~~ z ~~ ~xc~e~Af As ~~ W E~ ~. _-.--~ ~~ ~. e 3 ~ ~ 3 f / ~ ~{,, /!~!•~ ~ ~. / ~ 3 I( ~ ~ O ~d ~arh 1 ~ ~oc,t~n~1i e ~ I ~ ~^ .r a~~.~-.~~~.gnh I~ar_Sti,. l ~~ ,O ~~~ r ~~~~~ ~ 3% S~' L Iv -~ l .w . _._ ~,, . _ , _. - - .. _ _ fk J, ~q, ,/ ~ , ~ . ~ _ CH's +oo.m~ rtoP e~ <a,~~~ s f~6 , I ~ r I ...._ '"5 ~. I~~ p ~ Trof'f°`-cc~ ~.4 l ~ „~ ~~ ~" j y u' rk «~ ~ his ~S~o~..~ ~Ub will C,T. N it/ ~~ ~_~ ~~ - . ~, 4'~ i3•op~c•~~ •t ~~ / t /~i.'~~L ~ ~ ~r S a i ~ ~~701'G .~ l 1l~ -~ 7~ ~' I ~ ~ ~ Eke /oy ~s~ ~. v~ ~~-~'~ `~ " ~~ ~xv ~c~J2.v's~ez~,es~ =~~ ~~~~~ ~~ ~~~` ~, ~~a ~ ~ 8~ ~ ~M ~~'~ ~N ~/6e a Gam. '~, ~ ~ .Sep i. ~ /~~ ~i~.E APR-18-02 10:24 AM Us. 16'01 'l'Hl 07;;iFi 1'.~1 i 1 ~~ .f48 4888 s d a Site Charac~teir(stics i~ ~'~ ST CR1 CO 'L01 ] ~G EROSION CONTROL nIJ~N CHECKLIST Check (/) appropriate boxes Below, and connplste the site diagram with necessary Information. North arrow, scaler and site boundary, :rldicate arttl ridmp sdjacch; streets pr rAadwdys, location of existing dram8ge~vays, stre.s;l~s, rivers, lakes, wetlands ur we..s, Locat:loh of storm sr°wer inlets. !oration of exisi,inq and pro{aoseG buddirtgs and ;,;svad arQrs. The disturbed ar~,~ on the lot., Approximate yracilenl and direr!ion of sl~rss before grading open.:.t~rm;- `/ Approximate gradient and directfor of sl,~pes attw grading operations Overland runoff (sheet Clow; coming onto tlu site from adjacenr..rreas. Erosion Control Practices ~F ;^ ~!',:, a' : • location ai' temaorary soli storage piles. Note: Soil storanc! piles should be {;laced bet;lnd a sediment Frnce, :s 10 f~•;,t ~~ide v!getativE strip, or should to covered wrth a trri, ,~r more than 2S -re: ! •on~ any downsrope road or drainageway. Locatioh of aCCesS drive(s), Note: Access drive shoul~a have ~ to ~ inch aclgrrrga!a srgr,P 4tid al leader 7 fae~ ~N'dr and 6 Inches trick, L~;ives snoulA axteitd born the r~sdwaiy SCE tali .:.r to the !louse toundatlvn (~~Idchevor Is mass). Location Of SeGiment tontrals (filter fabric fence: Straw bale fencr_ ~~r 10-fuar•wlde vragetatlve strip) that will prevent eroded sail tram leaving the side. i~r. • ,~~3' Location of s~dlment barriers around on-:~it, storm sewer inlets ~ ~ Location of diversions. • Note: Alttrough riot specifically requircci oy code, It 15 recon7rnende:l that c~;nCpn• tratr;+d flow (draindge~Yclys) E>e d;vir•:rid /rL~.directe~'r around dig:uri:ad areas, C)varland runoff ;sheet `law~r'rom adjacent areas grracQr thrr, 1 p,000 sit, h, ~' should also bN divertsrd atourld distu~ued areas. s~ ~ location: of p~iJ~~ticHS that ~,tiil~ be applied to control erosion or• steep slopres (gr2arer than 129E grads). Noce: Su!h vrac`.icrs include nalntain:ng e,:isung ~sg~taflnn, plu:ernsnr of aadrtional ,~ sed;merr: fvrrces, dltiersiers, and re•vzget~i~ion ay sodding or seedirr,~ with use of erosion control mats. . ^ •~1 Location; of }~rrz-rC!ice!s that will contro( erosion ort areas of cuncr:rttratrad runoff How, Nola: IJriS~jtJlli:od dra!nage~veys, ditches, dl~rrsinns, ahd inlr!s shuu~cl be prettcta~t rrc~rn ~rresion tfr-augh use of such pruc[icts as i:+•cha"nel r3k+rit or straw brie bar-~rrs, erasion :ortro! rllats, staked said, and rock np-rap tNhrn used, a Sri;~~° in•rFanne+l barrier should !+ot reteivN drainabh from more them two pores ~: { u:tr::v~c~ aver, oc t)n4 acre of paved arras. In-chan~~el practice; sh~ulcF trot be in~.~c'4~a hr ~1@tNr1RIJ~ 5!rBBR-5 (streh~lts ~s~ith ysar rourtJ slow',. P. 03 '®GUr ~-~' Local~an of ~t~~~r !~lar+n•~d Fracdces not s!ready nnr.ed, APR-18-02 10:25 AM uq.~~e-u~ tnt ue:ut: r:~-~ X13 ~ei3 aaBt! s7 CR1 co 'LU~!~c M • I~y^ n ! ~ °n i• :• ~< 1' ~ Indicate mehagrmknt st7ategy by checking (/) the apprupNate bns. 4 H ~` ~~ :'~ z° I Management Strategies i",.yam, ~,f~/ ~'i~. O Temporary stabiiir.ation of disturbed areas. ;~' ~' Note: It is recommended that disturbed areas and sG!I plies !eft inactive for exts,nded :~. periods of time be stabilized by seeding ;txtween April 1 anti September 15), or ~'~ :° by otret tower, Such as tarpiny ur mulching. ,ff~ Permanent stabilization of site by re-vegetarian or other means as soon as ossible (lawn establishment), p '~' • Indicate re-vegetation method: ~eed r'7 Sod [~ Other _ • Expected dace of permanent re-vegetation: ~(~-~----~~~_ '=:ry,, , • Re-aegetation responsibility of; ~ guilder Q~Own r/9tr uyer "' • Is temporary seeding or mulching pl ed If site is not seeded bye Sept. 15 or sodded by Nov. 151 es !'7 No ~~ ~ Use of downspout dnd/or sump pump outlet extensions. ,:,~°~':, Note: K !s recommended that flow lrrm downspouts and sump ~ump outlets be routed ~~i~ through plastic drainage pipe to stable areas such as estab.bhed sod or pavement. ~;: ;~~~ ~ Trapping sediment during de-watering operations. ;,,'.`.. =~':" Nutc: Sediment-laden discharyr water from pumping operations should be ponded ,~;,:., behind a sediment harrier until mast of the sediment settles out. .~,. Propf:r disposal of building material waste se that pollutants artd debris are not carried ''" off-site by wind or water. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and b;,rrir~rs •~ before it reaches a depth that is equal to half 'h~= hei!3i;1 o f the barrier • Breaks art! gaps in scdirnent ftr-cex and barrlerc will be repaired imrtce- dlately, pecornposing straw bales will be reploc f;,i rty;pt:ol bale !Ifs! is .. three months), • Al! sediment that moves off-site due to constructipn ~cti~~ty hill by ' ~ cleaned up before the end of the some workday. . • All sediment that moves ofF-site due to storm w~r~!.~ wiif b~ c~e~tned up !. before tl~e end of the next workday, • Access drives wi-I be maintained throughout constru~•~;~;n • All installed erosion control practices will be macntainc•rt until the di~:ureed tireas they protect are stabilized. For more assistance on, pfsn pr~iparatioiL refer tc the WiscortsEn Uniform t)welliny Cade, the t)~;h -'rrsrc:rsin .'nnsrr~+tr'~ri ;'; Bert MonogCrrKnt llondha+k, rlitrl LI1N- iYtension publita:lan Erosion ConlrJf for Honn~ fl:lll',jFfS. Ttie Ih;;consin Uniform, DwPp;r~ C,,dt and -he LYiscw-s~r. CO-!sr-utt~on SItB Best Mona,,7rrne,rt honohruk art av~ifat~le thr~ut~h the State of W!scons~n Ducurn~nt 5'vs, (bpti) 266-3558. P. 04 ~lao4 Ero,;n.~n Cor7t-el fcr Home BuilJers rf;Y 'Q001) ran be ordered l'tlrou9l- Extension rubtfct,rnns, rnUt3; ~b~.:;3an ;,1 mp De;sa,tment ~f Commerce, (60!,~ :~.`-g40S. APR-18-02 10:23 AM P. 02 - ~ • •••~ ~ ••• ~ ~ .,uv •unu i1 ~N,1 L'U 'l,U\1 Ali I~f IiUY - • ~ . Standard . Eros ~ o h Co n tr or 1- of Picas f ~ Z-Fam-Jy pwelliing Construction Si According tp Chapters ILHR 20 & 27 of the Wisconsin Uniform Dwellin Co teS control inf~rmatlon needs to oe included on the plot plan which is submitted and approved prior to the issuance of building perrnils for 1- & z-family dwelling units irl these jurisdil:tions where the soil erosion control provisions of the Uniform Dwelling Code are enforced, This Standord Erosion Control Tian is provided to assist in meeting this requirement. Instruttlons: 1 • Corripltte khis plan by filling in requested Information, completing the site diagr~~m and marking ~pprepriate boxes on the inside of this torts. 2. In completing the site diagram, glue consideration t'o fwtentia{ erosron t{iat. may uccur before, during, dr-d after grading. Water runoff patterns can change significantly as a site :s reshaped, 3, Submit this plan at the ilrne o% building pCr117it application. PRUlECT LOCATION ~~ 1 BIJI~pER , ~~~ .- ~~~~~_ OWNER -7 ,P-eese .nCicato Wont _:.1ttj-c,41,~,,,sp~,,~. _.~ , br Complofing Irle ~r-orv WORKSHEEt COMPLETED RY ~~ ~ ~„ DATE SITS DIAGRAM - N - _ _ -1 '~ _ Scale: 1 inch = _,_ feet ' ' . i ~' I ITT' ~" ' ~ '? • t --{ - ~ -T+-•;~-~ 1,~~T~r ~~ I -'' ~ r '' I ~~ ~. ~ ... ~ i I '~ T~-_~ Iii ~ J -' i - fi I I ~ I l-. •__I...._. ~ . ~.~ •N 1 ~~ ~ . ~ I-. i--- -r .~ y ~. ~ I ~~~~i J~ ~.L..LL .i_ J_.. _L~.-_..~ ~.~ff G I-~I . ~ _~a~t EROSION CONTROL PLAN LEGEND _ _ PROp~R-r :INE EXISTING -^~~' DAAI!VAOE ---~ . u TeM-~a~a~ : 0. V I=_NSnJN FINISH;U -~ oAAIWa;;E ,__ LIMIT S OF riRAL)ING SILT r•--.--~- srF~AAVa 13aL _ Q GriAVE~ VEuETAT~lh +PGC-FICe,Tro~~ TREE ~Ri:sEFvAT10h 9TOCKPILfD 9011 r11 ~ sn i ..~ ... APR-18-02 10:23 AM FAX COVER SWEET HELGESON EXCAVATION INC W1229 770TH AVENUE SPRING VALLEY W/ 54767 715/172-3278 FAX.' 715/!72-3387 SEND TO Company name From ST CROIX COUN`h( 20NIN0 OFFICE BENNIE HELGESON AkenNon Q,le KEVIN ~~ 8lD2 OK-ce locetlon 01f7ea IoeeNon HUDSON WI fex numbsi ~ Phone numbsY 17151386-d6BE Urpenf ^ RapIrABAP ^ Plasaseommenl ^ Ph~aso-ev/ew ~ Poryour/nrto-msdon P.O1 1101 f?~0. Hudson. WI ~rlstses~eo als~aetuses•ax St. C roi x County i Of fice Zon ng To: ~~~d~`~ From: '~~~ Fax. ~ ~ ~~Z ~ ~ ~ ~ ~ Pages: `J _ Phoc~ ~l S- ~ ~-2 ~ Z ~-'~ Date- ~ (~ , ? C7'0 '7~-- Re: CC. ^ Utgeat ^ For Review ^ Please Comment ^ Please Reply ^ Please Recycle ~ Comcaettts: ,`"'~ X660051 N,ATHLEEN H. WALSH kEGISTEk OF DEEDS ST. CkOIX CO. WI RECEIVED FOR RECaRD 14-25-2001 8:04 AM COPY FEE: kECORDIMG FEE: 11.00 PAGES: 1 CERTIFIED SURVEY MAP PART OF THE NWI/4 OF THE SEI/4. SECTION 18 T28N. R15W. TOWN OF CADY. ST. CROIX COUNTY WISCONSIN C UNPLATTED LANDS GE WAY 7 1 L~ T 1 168.063 SF, '3.86 AC. z ~ WITH ~-O-W 0 o u' °~ ~ 144.930 SF. o "'. I 3.33 AC. . WITHOUT R-O-W N ' w ~) 0 z Q J DI W F- F- Q J ~I Z w N 3 z rn w ~' z Z _a J J t-- ° I I ~ ~' w I ~7 rn w ~" Q, a z ~ ~) ~ O ~ ui v w ~ BUILDING SETBACK LINE N ' 1 O O S 89°56'53"W 328.76' ° C/L CO. HWY "N° ~ M ~1 N ~ W ~ ~ ~ - - N SOUTH LINE NWI/4-S S 89°il'31"W 321.42' UNPLATTED LANDS M N O O N w Y GC Q OD ~ - J WW I-- N N ~ f~ M - U M w ~ N N S 89° 11'31"W '~ 1330.18' o~ 3 w ~ N N ao !^ w - N Z I. LYLE L. ELLIOTT. REGISTERED LAND SURVEYOR S-1300 DO HEREBY CERTIFY "~~"~ ~ THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THiS MAP IS A TRUE AND ° CORRECT REPRESENTATION OF PART OF THE NWI/4 OF THE SEi/4. OF SECTION 18. °o y T28N. R15W. TOWN OF CADY. ST. CROIX COUNTY. WISCONSIN AND DESCRIBED z w AS FOLLOWS: COMMENCING AT THE SOUTHEAST CORNER SAID SECTION 18. THENCE N00°32'52"W ALONG THE EAST LINE OF SAID SOUTHEAST QUARTER 1318.69 FEET THENCE S89°II'31'W 1330.18 FEET TO THE POINT OF BEGINNING: THENCE S89°II'31'W ALONG THE SOUTH LINE OF THE NWI/4 OF THE SEI/4 SAID SECTION ~~ 18 321.42 FEET: THENCE N06°07'23'W 479.22 FEET: THENCE N86°25'44"E 369.77 FEET TO THE EAST LINE OF SAID NWI/4 OF THE SEI/4: THENCE S00°23'56"E ALONG SAID EAST LINE OF THE NWI/4 OF THE SEI/4 495.00 FEET TO THE POINT OF BEGINNING. SAID PARCEL CONTAINS 3.86 ACRES MORE OR LESS INCLUDING THE TOWN ROAD RIGHT-OF-WAY. AND SAID PARCEL IS SUBJECT TO ANY EASEMENTS OR RESTRICTIONS OF RECORD. I HEREBY CERTIFY THAT I HAVE FULLY COMPLIED WITH THE PROVISIONS OF SECTION 236.34 OF THE WISCONNIN REVISED STATUTES AND THE ORDINANCE OF ST. CROIX COUNTY IN SURVEYING AND MAPPING SAME. EACH PARCEL SHOWN ON THIS MAP IS SUBJECT TO STATE. COUNTY AND TOWNSHIP LAWS. RULES AND REGULATIONS (i.e. WETLANDS. MINIMUM LOT SIZE. ACCESS TO PARCEL ETC.) CHASING OR DEVELOPING ANY PARCEL CONTACT THE ST. CR OUNTY ZON CE AND THE APPROPRIATE Tvi~'N BOARD FOR ADVICE . PRIOR TO CONSTRUCTION A EROSION CONTROL PLAN ST BE SUBMITTED TO THE COUNTY PLANNING AND ZONI THIS SURVEY WAS MADE AT THE REQUEST OF RON RIEK 2768 40t h AVE . WOODV I LLE . W f . 54028 PH . 17 15-698-3010 ``,,,~~~~~~~~~', ~,~~\SGONS/N L L LLIOTT. RLS 1300 E~~10T~,`~ IYLES:1300 ~^ DAT SEPTEMBER 22. 2001 ~ ~, HUDgpN.Wt TH 1 S I NSTRUMENT DRAFTED BY L . ELL I OTT ~; •, ,.•~~ .•~ ''. aid C,ur~ -`~ ~i. . . eye. Vol . ~ 5 Page 4196 APPR®l~E~ ST. CROIX COUNTY Planning Zoninn and Parks Cr '!t°•e OCT 2 5 200" {f not recordad within sU d.~, , of approval date approval sh.: i;a SCAtE•"Ft'V6~ 100' 0 100 200 BEARINGS REFERENCED TO THE EAST LINE SEI/4 SEC. 18 (ASSUMED N00°32'52"W) LEGEND • SET 3/4" X 24' IRON PIN WT. 1.50 LBS/FT. ~ ~ - O U O- LL w N W -~ t-- - O U U W o rr ~ wo U Y av f- - ww N (n ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ ~Sov~ ~-rson Mailing Address I o~~0 1~4r--~bn ~~ I`I~-~t~to rt~~ ~-c~l S ~o~s Property Address ~ ~ ~ C b , ~w~ ~~. #- (Verification required from Department for new construction) ~ ~~ City/State ~~ ~~/ Parcel Identification Number G?o`/ /ova 5~ GO U LEGAL DESCRIPTION Property Location I~ftL '/<, SE '/4, Sec. ~~, T~8 N-R ! ~ W, Town of Subdivision Lot # 1 Certified Survey Map # O Sl ,Volume I ,~ ,Page # "f ~-~ ~ Warranty Deed # ~ ~ rS' S S `f .Volume /~ ~ 7 ,Page # ~1 7 Spec house ^ yes ~ no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds 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 resumed to the St. Croix County Zoning Office within 30 days of a three year piration date. - ,ZD, © Z SIGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope desc ~ ed above, b v' a of a warranty deed recorded in Register of Deeds Office. 3 i2~~ 0 2 SIGNATLyIj OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED ThLs Deed, made between Ronald R. Riek and Brenda L. Riek husband and wife Grantor, and Jason D Larson single Grantor, for a valuable consideration, conveys to Grantee the following w described real estate in St . Croix County, State of Wisct (tlte "Property"): RETURN T0: !J Burnet Title 7350 France Ava 3. F[rst Floor Edina, MN SS43S ATTN: Post Closing Central 66 SSS 4 Y,ATHLEEN N. WALSH 'r:EG1S'IEk OF DEEDS ST. CFOTX CO., Wl ~EiEIVED FOR ftECOkD 01-17-2002 3:30 AM UAkkAN?Y DEe:D EXEMPT A CERT COPY FEE: CORY FEE: TkANSffk FEE: 107.70 kECORDING FEE: 11.00 PAGES: 1 ame and Relwn Addmss Ja n D. Larson 2774 C ty Road North Wilson, 54027 -~ 3.1~3q 0~" a~a`t3 004 1042 50 000 I Parcel Identification Number (PIN) This I.S I7r(o>t'nn ))homestead property. Lot 1 Certified Survey Map, r. edAGc o er 25, 2001 as Documen'ts)NbtSn6t60051, part of the west 1/4 of Southeast 1/4, Section 16, Township 28 Nort ange 18 West, Town of Cady, St. Croix County, Wisconsin. Records of St. Croix County, Minnesota. Abstract Property. Together will all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasable in simple fee and free and clear of encumbrances except Dated this .9~ day of ~r•rnhPr 2001 (SEAL) w~ /` Ronald R. Riek AUTHENTICATION Signature(s) ,ll,l~ F o wli ~nN N~Q~ARY PUB IC autl't,~' c~-~ft~f~-' Hrenda L. Riek (SEAL) ACKNOWLEDGEMENT State Of Wisconsin, j ss. St . Croix County. Personally came before me this 2 9th day of October 2001 ~ the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowle ge the same. THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 01-34639 ~ 1301 Coulee Roa Notary ic, State of Wisconsin Hudson, WI 54016 My fission is permanent. (I not, state expiration d~ante~: ( Signatures maybe authenticated or aclmowledged. Both are °~w--1-~) not necessary.) ~ mes f genons signins: in any caoacily must be LWed_ or_grinted below their siguatun ~ DIAIl; tlAl( ur FORM No. 1 - 199$ Milwaukee, Wn. WpRRA\"rY DEED v 1 ~ ~~~ MANOR ~u~n~yas~„oN„~APp~.~cAr~o11~ T. cRO~x couN~r~r ~ ~ / `f S .7.~ d ~.- The submittal deadline for certlHed sulYey maps !s the 4~^ Tuesday of the month two months prior to the month of prasentat/on for eppn~l by the P/enn/ng, Zoning b Perks Committee. - ~ ~~'- ,. Property owner~'l chi; I d + Qrer~da ~i P Agent (If not owner) '~ Mailing address ~~ (s8 : 4-Oi-` I-~v~> _ \. 1~ lSo~ Mailing address • ~ ~~~~~ C e" -_ .~ ` Daytime phone `1-~ - ic'R 8 -24~b Z Dayflme phone •~ ~ '' ~'7 ~-~ Surveyor ~-~T ~ t= l 1 ~ ~-~---~- Addt Phone -1. ~ ~ 3 ~ j ' ~ I 1 1 °~ FAX ~~ `>~ ~ ~: ~ . ~ ~„ Properly location Nti~% `~/4 S L 114 Section ,~T Z. rr', N-R ~ 5 W, Town of ~~C{i ~ --~~- ~~? No. of lots ~ Total acreage of bts > ~~ Size of original parcel ~ Z-G ct_c~ L'S Parcel Idendflcation no(s). honing district of parcel Y~4`rti ~ MAKE A SKETCH IN THE BOX SHOWING HOW THE NEW LOT(S) FIT WITHIN THE ORIGINAL PARCEL I • •39.8 Ri< Mary 80 0~ ~ ~ s leOn Roxanne L rector 6z Lamb lizabeth ROB Ronald • Lie N ~ & Brenda t e>s on 1 ~~ 119.1 99.1 J~ s • • ~ ~ N .- ~S ~r ~ ~ ~~ ~~s ~ ~~~ ' Y ti '7 ~ t ~ ~. 'ds °.~ y I g .~~, ~ `,~ r s' I ~~l- Soil types~~ r' ~.~ ~ 2 Fo t.: Z ' t'~ m ~- L. Limitations A'concepC certified survey map Is to be submitted for staff review. The appllcantiagentw1ll be~~rired revisions. Once the 'concepC corrections are made, an official minor subdivision application me~i be subn~t O~X COL; tTY Punning Zening a_nd Part : r; - .._ ,:, NOTE: ONLX COMPLETE 8UBMITTAL9 LIIQ,~,L BE ACCEPTED. SUSMITTAl.S MUST INCLUCE THE FOLtwOWING: ocr ~ s zooT ,One (1) copy of the preliminary ceRfied survey map .Applicable fees .f not r.~corded withi;i 30 das o~~^- o Township approval (a copy of the map slgrred by fhe Town Chairmen or a merrrb~r~i~1e~'owrp~at~,u t, "~5 t C~ 4 A copy of the soil test for all proposed tots not having a residence on the lot - eon ; ,-,~ ~~~o,f °t l zg (soil test location to be shown on Individual lots) O DOT cartiflcatlon lettef if the proposed lot(s) is on a state highway o Road plans (If new roads are proposed) v Check Ilst from County Surveyors Office A final map, reflecting all requested revisions, as well as town approval and soli test 1f required, must be submitted 10 days prior to presentaflon to the Planning, Zoning & Parks Committee for approval. These deadlines are Rrm. The committee may approve, approve conditionally, or reject the certified survey map. PLANNING. 20NING $ PARKS COMMITTEE ACTION Page number of the~St. Crolxv o~ ty Soil $urvey vn 2 ~o ay a i pate 'YJiNmYV~Na~11K$r...r~ Approves ~ Rejects Conditionally approves \7EE rAOE 4d) ~~ rerkd.e, Gkwia v • \aa z Nanene lord ~ Clifford 6r Alice ~ elm • ewruwR ~ ~ .. 4 a Ltlnd 1 Datd I 14 ~ • vemwr k Ben ~ Joel U ~ Daniel 6: Acme Mark O'Meara • G•rY • a a.,roe sue. Di Duriel Norma Lra W 74 Ovke Mueller Lee 6r Pauline 81 7 K: ~ ~ moo`.. NN .Harold Dan iel ~ B° R . Schutts 83.9 A r 40 • ~ at 120 Trust (7 m ~ ~ ert p11 z:~ 1~5 uberl : Hemum k Violet Madc k ]%S 140 tas • ~ ~ ~~e Ma`r • JoM & Evelyn ~ etal o•\u,k ~ 1~ 56 6 ~ lZ n"°d°'e Kuesel Fam Tr B•rb•'• Badrara • M'~ M lk a 44_t ~ 69.5 Wasesverd 82 q~ . nary • 114.7 oavu tlil Bruce ~ttwyn• ZRH Partrwrrhip seevm 1011s1eW F`rioexhk 73 7 . 31S 4 116.9 ue r Vedyn ~~ 80 811 _ yak _ Fq!! R,~e~. k Kat k 40.7 . 42a • J • 39b Slwpk 40 o . ~ ~ • ~ 91 Bursaw y 33 p ~ ~r • •KUd~kr wn~d r~ ~ Ebenezer gp$ 87S O ~Prua~e • s ~ Ne4i ~ 32 y.. i ~ Ri • • Oaks lne d Z9 • k I..m KeA• &tkr ~ c i • • Cio «. Clifford k Alice Lund 120 • • r seriar, P ' k sm\l,. ~ +o • George • & Doris R x C 73 Formost • r' ~ ~ ~ k wa a st zu u ~ BD ~ 2 Lora, & Terri B k ~ r ~ k ~.y~ lagehki '""° Ronald ~ 154'a e Peterson Stockman 4o d ~ ~ sawn ~.. er ness o eW >s g n ~ • • 80 • l:aes A,4 6r Brenda 120 80 160 ~ y e,em~,,,y. 76.2 107 a4n r \Geraldine 78 • \ ~ii • Arthur Riek w ~ +o ='= ~ 2 Krueger Joseph • e°I • o cy7, 1 Tra 133 PP Randy & Kelly Mazy ~ JOAnn .19 sc t. • Roger 6r Audrey 105 p Gruber • Johnson Ddt11t Brandt 80 Menter 60 Cddek x4 120 Ronald ~, K 10 379 - ~ Daniel ~ Kim 110 etal m Kapp w e m 40 • • Riek ahO ~ Aiarw 78.9 ~ ~ Ofstie Wisiam& Pegi stephm load k Ted o ay,q „ 40 $~ 393 laaa + Ficken sonvwr ~ = ktdira. v . M ao L •39.e Ri[luly k t Geoyge do Doris n P~ 2375 ~ {•s 79.1 1r~ ~ ~,e1°b ~~ ~ eon Victor & ~ ~ • ~ era Owen k °~"rw Koa.mrg ~ • 1 ~3 ~ ° K. „ i ~° Alkn & ~ • i • Lori ~~' ~ Ronald. ~ B Wend Carl&joan • • W~jem• h 114 6 Hi 6 . Rabwlk sewe n• \... o rlw~..W~• DO`Otlly Fio~o era • k Ker` 1 Riek . Luch[ 8o ArMerson . g t3~w Capparrel Sdwd aaaa.,te 73.4 ~ .Betty .sb, kRuM a.r~ Aaan ~ n7 •155.2 M Ew 119 1 I kK • ~ ~s y~ WMleekr 393 Oar )o kPaeiria •69.1 a Nielsen MIOer S71 40• • . 99.1 k :. . ~~ 138b z ruaw •~ 40 N m - • D~ • •u ~ Douglas F~amryi l mm ar Diann 1185 eo ~ z N at.ia ~~ e+eb•ly o~i • o ~ . i ~ • • • 43 ~ Faber Leasing rt ~ kr•wnon L k • . Madred Richard kDariww urs. ~ ~` But1E[ ~ ~ ~k 40• •g5g1 40.4 wa Hrittan 59.7 + ~~+ 3 Cewgek etal Pretlo 60 iss 80 Tab awrentt M~ Wreg•nd kMuion 1Wie 80 10 Sw.m AMY w w ~ Menem . rrr • Thmlaa 0' 3~4 • 7g ~ 10 •so e7` 7o zB Robert & Patriaa Walter . a .rr m ~ r'r ~"t • • B.wea aD b • 41.1 r 5°IQ ~ a 7f1 - o"" k ~ Pinkston P ~PPa & Sylvia . • afarv:r p dr 'e rims um 40 . & Bemis Gerald & Kathy k Arta f]wrlw • m Jensen , ~ ~ . . rr ,~., 74.8 Faber • G b Milkr saeaw.n ~~, 80 •40 Bowen _ W t . amen Zigrwgo DIS°rl 565 ~ zo 220 a ~ . a riel & Theresa 118 4 • k aarr Dean Ddmx k Marline gq T+m •°"-" 1 r 220.7 d ' 77.5 Romeo Timm ~, Holldorf ' 170 Leonard 36.9 . w Kwu tl • 1kR ' ll~ ~ r 70 78.4 eo • •~l+ OLson • y'~ SCDtt & g0 ~ r BIei1 k ~ r r Norm & Marleen Truesdes k e 7.'e • rkR u Wne Garb . k subara • 80 & Vickie Eugene dbe . A w Kristine ~ H tO1 ~ be~'d p Rita 1~ 80 L w ~ ~ 80 80 , Pe Judith Bonnie Glam & BO s.w~i n 7a7 B Kielmeyer ~ 80 $ Ham ton yk ~toPller~+ Brian 6r Gay wang .~~ Gregory ~ Iawra . vdra awer T'n'"` Scott D 0 w d • • 791 77.1 • a'~i1 ~ ~ a0 ~ Glam ~ ~' . i No ~ Hugh "~"":„ ~ • Tnnm • ~ O ~~CS Hampton ~ Harold ~ Ann 4o Jacobs Tivst 138 ~ .200.2 rr Allan & - eo ~ ~ 80 Gerald & vidrie Joyce N P e 119.8 rY ~ w . Tamers ~ o Gla°'Pe 75.4 Larson 208 . a~ 112 J gy 1,o xc xil James Robert l 4: Joy G Thomas . Molaadeauer Faber 90 ~•n k~ Nornuee k Dekaes AI.n t M p~ Thomas 'a. Stringer Holaud 77S f1 Tinrae voeo-a 40 Marwlt Berme 1 Rex & Hour Trust 9 ~ . -4 4o eo 80 ~ ~ & Judith ~nB E.3 • Riw• 12 ~'9 ' ~A v~ Genz 76S 80 ~fnn 35.6 ~2 pa1e Kaaxh 109.9 &c~i1e T1O1p1 6 R 1 7 d[ Llnde 40 PaW k e ~ 795 Rex Gordon <W . g JB.7 ~ WBman ~ ~•'i°w ' i 160 ° Ruben ~ Ka00een 40 • tl ~ ~8 40 Brahma 75.5 ~ Alan r A 101 ; ~ s ° T & r o ~ mricht 40 . ~ .tseS Inc 333 ; 3 ~ d n ~ 783 • ae • m yow• ne NN ktidnel . 160 • ~ ~ • oward 6.4 • a7 l ~ s . • • ~ ~ taanr v.9 • eani an m Kenneth Mdoao ~ T 74S lance erma e • • • c Orviue ~ • 7 ~ ~. Sal Faa~ k ~~ " m & Cazla ~ ~a ` ~ r ~ Mazy ~ r~ & Velta Richardson rreaby rrealoff J R 0 ~ vO~' ~~ `~eb1 .'ter 228.9 n~ Dennis & • ~ Greiber~ l~ ~' a..bw. 146 7a rs •~ n a 110.8 Tao 7a.6 F Catherine ~ Wtz 3 Weber Richert - `~ d • 29 ~ RW Robnik 76.8 weber 1283 ~ ~ r k Rib . . Dean . 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