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HomeMy WebLinkAbout022-1065-10-400 -0 0 Q o W a N C • Cy, O ti C! C. O ti i a Q I I I I ~ I 0 0 Z o LL C O co N Q °c I 3 m Z N co E C CO 00 IN W a m - Z o o z ~r a - ~ o I N t! IZ- Z E a m ~ I C ~ I • AJ O I m O 2 z z O E z° N 00 _ m_ : N M N > O i _ t6 d 4 'N L Y O O O O G a Q - o E NN Z V> H H d (n ~ N ~i LL 0 0 O Z O CL r N p y n n N J U rn rn ~ z J U O C co E F :1 CO C) m n N CL V Q) ~ N `Ivi w N d d m O M 3 +m+ 'y^ O O N N C O "O E O CQ ~ i C N O O j N O M C m E CL 0 L W C N C E N V 4Oi p C M 3 n.l N C O O V'; N z W m r N M E Q) (03" ca o f • y' O N Y N O Z Z1=5 CO o ~ - I w E d w d a #t _a L: CL L , A U M U 0 o W=onsin Deparoment of Industry. SOIL AND SITE EVALUATION REPORT Page ! of Labor and Human Relations Orvision of Safety 3 Buildings in accord with ILHR 83.05. Wis. Adm. Code COUNTY 5-Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must include, but C~ 0 x • not limited to vertical and horizonW reference point (BN), direction and % of slope, scale or PARCEL nIID. # n ~mensioned. north arrow, and location and distance to nearest road. 0 2l G - /V-APPLICANT INFORMATION-PLEASE PRINT ALL INFORMAT ON DATE PROPERTY PROPERTYLOCATION 0.01 'It:' Av 1 D b ~`~T~Y 49946T- NFvaN)a 114,SZ3 T Z 8 KR 18 E (010 PROPERTY OWNER'S MAILING ADDRESS L # BLOCK # SUBD. NAME OR CSM # 505. ZL Sr. - 0- sr1 CITY, STATE DP CODE PHONE NUMBER [ICITY []VILLAGE (TOWN NEAREST ROAD PZ0__S CUM i-i [ S V O Z I t7IS) Z6Z- S OIZ 1~\jJt`11ck1 lJN lc /3y2. f f7eA Qq New Construction Use [k) Residential 1 Number of bedrooms q AdcfitiQn to exsting bmun9 Replacement [ ) Public or commercial describe Code derived daily flow b o O gpd Recomrnernded design loading rate o •'4bed, gpolft2 trench, gpdAft2 Absorption area required 5140 bed, 112 S r) o trench, ft2 . Maximum design baring rate o. S bed, gpdfft2 0.6 trench, gpd►ft2 .Recommended infiltration surface elevation(s) °t °t _-i S ft (as referred to site plan Wicmark) Additional design I site considerations t" 1WJ rvp W / 6 ` x 8 4 ' B -6 . 1 ` I Iv . 1 ` Lt F Sf rAl R L L- . Parent material Wh t C~>~f1Tt~ S (~l~sl,0~l` Rood plain elevation, d applicable N • A • ft S = Suitable for system COMlBfnoNAL MOUND 1,N GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK u= Unsuitable for system ❑ S W U IM SDu ❑ S ®U ❑ S IMu ❑ S IZU ❑ S Nu SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Bid, r, 11 M JOE Z y_z$ I o~t R vl3 ~s CS~k w, v'Fl- Cs ~-S ° b Ground 3 S~ LO `1R SyR Sl$ O h1 V~h elev. °1,q-aft. 3 w lz~ C e-h1 I S S . »v PL- Depth to limiting faclor 2W Remarks: Boring # tz 1 - lS ~`F5b1T -Mv Z- Z t4-3y 10yR 4//3 `~j 1 csbk wfv'~- ~s - 0•S 0.6 bold 3 3y S2 1oy2~lY c 7.SYR51 ~S O-., h+tU`~i- 1p ~ . Ground 9 Ie S ft 3 ~v h=L C Qh/'tk~4\11 IJ 1 AJ P h ~Deepl h to 'co AP 2 Ribi factor X 3y'` - ~ ~ etc Remarks: CST Now.-Please P(W Arthur L. We erer Phone. 715-425-0165 eg rer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 9S-31,13 - q Date: j t_ Z,7_qS CST Number: 0 5 7 6 i I ION REPORT Page of Wisconsin Department of Industry, SOIL AND SI'f E 1 Labor and Human Relations , Vrrvision of Safety & Buildings in accord With ILHR 8 .'65r~~v s~ M. Code COUNTY Attach complete site plan on paper not less than $ 1/2,,x 11 inches in size. Fran milWiriOude, but not limited to vertical and horizontal reference po nt-, jqM), direction and 0% of slope, or PARCEL I.D. # dimensioned, north arrow, and location and distatW* fp nearest road. APPLICANT INFORMATION-PLEASE PRI TIA°t_L INFORMATION, REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION AV t D ~lv~ S~~Y - N X1/4 NE 1/4,S 73 T Z 8 N,R ! 8 E (010 PROPERTY OWNER':S MAILING ADDRESS # BLOCK # SUBD. NAME OR CSM # so s L-t~ s7-. c S M - /l CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE [MOWN NEAREST ROAD PZ0:2_scvrrl w~ s uz i (GIs) a62- SOIZ ~c~>J~lClzi~li~LC t} wrx~D FoRR N New Construction Use [x] Residential / Number of bedrooms q [ ]Addition to existing building j ] Replacement [ J Public or commercial desaibe Code derived dally flow b O O gpd Recommended design loading rate o bed, gWl? trench, gpd/ft2 Absorption area required Son bed, ft2 5 0 0 trench, ft2 Maximum design loading rate o • S bed, gpd/ft2 0.6 trench, gpd/ft2 Recommended infiltration surface elevation(s) a at --I 5 ft (as referred to site plan benchmark) Additional design/ site considerations 'i"QsN31r"~ I`/(b r X 814 " B 4> M / N . I' OF F t L-. Parent material wV C. S NCI SlU► Q Rood Plain elevation, if applicable /y A ft N`r-tL~Tt~ S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FI HOLDING TANK U= Unsuitable for stem ❑ S W U OS ❑ U ❑ S ®U ❑ S O U ❑ S MULL ❑ S NU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rer& K. R, o_y LO~f2. 3lz - 1s l~-Sbk Y~, U`Fy, aS ?Mi_ < 2- Lot fZ v/3 _ ~4 CS~k ►r, V ft- CS ~-S 6 6 Ground 3 2g S~ LD`'lR -SyR S1r~' aYV\ M V-V♦r elev. °t9 3ft. 3 w k~ 0-~~iEkjTLzz S S e . tint PL. Depth to limiting lac Remarks: Boring # ' O _y 1 OL-t tZ 3/ -Z - 1 S 56 "M U'Fh z Z y-~y toy 2 4138 csbl~ v~~ ~S - o.s o. 6 3 3y SZ o y 2 t y c . S `l I2 5l S C> "'t V - - Ground elev. ft 3 >ti ~L L~h/`T ~ hJ ! P frC Depth to limiting 3y • Remarks: CST Name:-Please Print Arthur L. We erer Pr'one' 715-425-0165 egerer Soil esting & Design Service-P.O. Box 74 River Falls,WI 54022 Sgnature: Date: CST Number: 95-3V3 - ! L-Z~ 9S M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2dR PARCEL I.D. # 4 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 0-3 lpYtZ 311S \ -~sYlU t^ a S - o.~ 0-8 ~s 3-3 cg c o- 2 cz. Yl3 ~s 1 ~ ~r ~ v ~F S - a- s 6 Ground 3 31..3' l O lZ `~S C S ~I-t; }tiy V `Ff. CS - 0• S o. elev ~t~•1 ft. 3~-SS 10 `~i iZ ~1 ~•Sy s/e `~S o~►-, rn v'(i. - - i _ Depth to CLI) lti (2~ S - fz:~L-ftc-t limiting factor 3-1 y ! I Remarks: Boring # I i I i Ground elev. ft. Depth to limiting factor i Remarks: Boring # s3`~ vg;~ E `'~.~aawv i i Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: S93D-9330(R 05/99) PLOT PLAN Page 3 of 3 r SCALE 1"= LJO ' ~az.66' -77' taa~ 1~LSZ L u_ ~t. er S 0' g`►~ - k--t \OO.O' ot'j -7 '?HIGH, 3fv, bls ~6. d ` Boa M Zto t~ M G G / X48- C10'`J`t0_ d . C, a -I S - / 13o~ti`~► QOF @ tFo g , z ~rL_ o ,v oT Clr rA t p JOI'C.T" C:) R 94-"]S 98S s- ~~S'fu~. 13 'Rf !S N-2~q. C) 01 G ~14~. 30 r V) ui 0.wi Sl4 etw ooD 1=13 Z[ k~5 D 1Z . a 1z 1zo R-D 9S3g3-y (715 ) 425-01(,5 _ 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations • Division of Safety & Buildngs in accord wiWLNR 83.05. Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/9 x 11 inches in size. Plan mustj';Nlude, but 5-171 clZ-Q,~ x riot limited to vertical and horizontal reference point,~OW, direction and % of slope se"or PARCEL I.D_ # dimensioned, north arrow, and location and distan4a40nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION r REVIEWED BY DATE PROPERTY OWNER: 4Y VPER t ATION AU L 17 lU~ Stu N`T S N ~1/4 Nf? 1/4,S Z3 T Z 8 •N.q ! 8 E (010 PROPERTY OWNER`S MAILING ADDRESS # SUBO. NAME OR CSM If 50.5. LZt`~ 57'. ~ pR..oPOSNA CSI"-I CITY, $TATE ZIP CODE PHONE NU6Z ❑VILLAGE ErOWN NEAREST ROAD P ZQsem-r, L'i [ S fit) Z 1 (~lS) z_ ll.~IV1C1'~11JNLC (}~RWo~D FoRR pQ New Construction Use [k] Residential / Number of bedrooms q [ ] AddtiQn to existing building [ J Replacement [ ] Public or commercial describe Code derived daily flow b O gpd Recommended design loading rate o • q bed, gpdt9 trench, gpd/ft2 Absorption area required Son bed, ft2 S o o trench, ft2 Maximum design (oading rate b- S bed, gpd/ft2 0.6 trench, gpo1ft2 Recommended infiltration surface elevation(s) °I. ( _-I S ft (as referred to site plan benchmark) Additional design / site considerations w / 6 ` X 8 13 Q7 • M j Aj. 1 r 0 F SIN^A:~ R t t- . Parent material wk :eNN-t - QeMauTtg~, S P~M~S1y~1L Flood plain elevation, H applicable N • A • it S = Suitable for system 1777-717 MOUND WGROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem ❑ S IN U IRS ❑ U ❑ S ®U ❑ S ID U 0S [zU 0S tI U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Modes Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench 3-V 1 S 1 ~ S bk ltit U o. ~ o, a } 1 tio~N2 3/z iu'AC'.. 4 ` -s o 6 'F Z 4-z8 Loy rL V/3 k), vc~- as Ground 3 2g S(, LO R > / y R S 143 tnt V Mfr elev. °!9 3ft 3 w 1z~ e~ e- S S ~ti P~ Depth to limiting factor Remarks: Boring # 1 O -y 0`1 tZ 3/ 2 - 1 S 1 Sb k inn v'~h °c- S o •7 0. x Z Z L4-3V Io 4 2 ~l3 g 1 csb►~ wf~- ~S - o.s 0.6 3 3y sz ► oy 2 ~ l y c ~ . s y tz s~ 't s C) ►+t v `~i. - - Giound ~ e S 3 L 12 t C L 1 TLa~ hJ Q~ ! P fr C Depth to limiting faft v Remarks: CST Na1e:-4IeasePnnt Arthur L. We ever Phone: 715-425-0165 egerer Soil eating & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: Date: CST Number: 95-313- 1 L-Z7 9S M00576 PROPERTY OWNER ~~RS SOIL DESCRIPTION REPORT Page 2af~3 PARCEL I.D. tf Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Bed Trench El Ground 3 31.33 v r3 ~-i tZ 71 C. b10 ri, V 'fy. cS - 0• S o. elev q 1 tt. -)-Ss ~ o 4 (z -)1 ~.s y SJS ~s oN,, m v - - Depth to LA-) L+ S `SLe limiting factor 3-7 Remarks: Boring # .y i i Ground elev. i ft. Depth to limiting factor i Remarks: Boring # Ground elev. ft. 1. Depth to limiting i factor 1 i Remarks: Boring # i` Ground elev. ft. Depth to limiting factor Remarks: SRD•8330(R.05/99) PLOT PLAN Page 3 of 3 SCALE 1"= q0' 68z• 66' WW544 -~M aF Prr c_c S T' Z s F11-0 x r-mu ,D ate- QTL 100.00N 31Y b1A. ~Z pv C P 1 P N w /`TAI • oa / `6 . o ~ ZOO t -'A m t~ 98 - G ~ tZ 94-7S x-985 ~ X14/. 3 O ~ ~c W (z.3~ Mi S!Aq\uvavD N=f)Mtttl: r b, 1Z. or~~.: ~okD 9S 3q3-y Z2 2 (715 ) 425-0165 1400576 CST Signature z Date Signed Telephone No. CST # ~UN261996 1 NCE .N N. WAGS r s Z sr c~oXcDewi H JUL 1 7 1996 0.1 CERTIFIED SURVEY MAP LOCATED IN THE NE-NE OF SECTION 23, T28N, RIM TOWN OF KINNICKINNIC" ST.CROIX CO., WI. I PREPARED FOR: DAVE PETERS NE CORNER OF I ECTIN 23. .N.VtATTED..J.AND.S. (COUNTY MONUMENTI FOUND) NORTH LINE OF THE NE-NE _ S 89°26' 17E 678, 63' NOTE: BEARINGS ARE 329. 4/' 349. 22. REFERENCED TO THE EAST 316. 22' ; 33. 00' LINE OF THE NE 1/4. (RECORD BEARING). 333 HIGHWAY SETBACK I O LINE y H ~ °o LOT 4 ° LOT 'I $ ~I 5.00 ACRES 81q, 5.02 ACRES w UNPLATTED LANDS (218,798 SO. FT.) - (217'585 SO.. FT. OI '1 4.54 AC. EXC' R/Wrn co m (I 97, 657 S0. FT.) I co ~ L~~ w \22~ ~ co AREA OF DEDICATED ROAD 1.80 ACRES (18,274 SO.FT, S 69'47' 04°E 100' ) cn l 91.31' HIGHWAY SET ACK LINE vL1'~NiiG.'. 7. • • p I 0 318. 3' 33.20 rn ,erg C © O ~ x), PROYED 307 95' a 591 8 y W C. 40= ~ g CAT I,y 2 n io DEDI 83°3 ~~N 2 6' 344.58' 33. 2 I m N 69047'041 °W © © 0 307. 39' 31 I. 38 ST. CROIX"COUNTX m C cmpr eh ensi ve PtarvCu Zoning mW z g , o Parks Committee $ ~ LOT 3 o UNPLATTED LANDS w° 5.00 ACRES °w LOT ;2 w (217,751 SO. FT.) 5.00 ACRES I if ntif feG01'4w, v ( 2 17, 765 SO.:FT.) within 30 tta" of ny ao 4. 50 AC. EXC: RiW approvai~' Me : rn approval'stambo cn (196, 185 SO.:FT.) N m I -4A & v6ld ° p l O 00 Q • I yl SOUTH LINE OF THE NE-NE 33 33' _ 309. 50' 33. 00' 366. 10' 342. 5d. N 8904 f' 25" 708. 60' z C. S. M. VOL. 5 C, S, M, w o c E 1i4 CORNER OF SEC. 23 (P. K. O ~r J NAIL FOUND) ~ cn~~ ; I Y. go t' CQA3 a a Q o 0 1a Q_jW a w ' U 4 .~-1 PrJ JUN 2-7, =11 11 D F.. ~d 3AO ,~t~. 2 T goat =Ow ~ R W WW X U- u. W v ~WWO W N ►'+WH~ RO`;X COUNTY wt-rc U~ ►..U- ~pp ! S ysOR`SRECORD . Lou r-- -j CU I=" V I . W=C--= 1f9 SY W F- m O w t~ t- ~ a1 CERTIFIED SURVEY MAP LOCATED IN THE NE 114 OF THE NE 114 OF SECTION 23, T. 28N. , R. 18W., TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN UNPLATTED LANDS NORTHEAST CORNER . SECTION 23 - FOUND NORTH L 1 NE OF THE NE-NE ALUMINUM CAP MONUMENT ( TO CAL C. POSITION) S89026'1218 E 640.51 N89°26' 12"W 320.26' 320.25' 678.63' FND. PIPE IS N30" 43' 52' E 0.30' FROM CAL C. y POSITION. o CERTIFIED 2 p ^ o p of p ~ W 1 ~O ° I LOT 7 m LOT 6 w SURVEY :k 4.62 ACRES 4.48 ACRES v y 201,376 SQ. FT. 194,934 SO. FT. rn y (n I W Of I to w ro co PREPARED FOR : ro , o TONY JAMES ~•!tiF C ~0 g • 13i MAP 2 N69"47' W h.' 91.3 rn y 3 10. 27': 4 S86-08'04"W © I I Iv rn 1- O --w 1 as Z S69°47' 8 ' ~ ~i I 91.31' z l : Z / S I z I : f~- N Gyk'gY ' to ' Z .VOLUME 11, m~ . m `O w I o LOT 5 - \ i : r W 4.02 ACRES APPROVED a O 175, 244 SO. FT. rn O: \~j I ST. CROIX COUNTY Planning Zoning and Parks Committee OD JUN 2 7 Z001 z 01 PACE..3l..►.8• , _ . If not recorded within 30 days of i t approval date approval shall be null and void _ _ - - _ - - - - _ EAST QUARTER CORNER o--N89041 ' 25" W _ r SECTION 23 - FOUND SOIITN I INF OF THE NF-NF , P. K. NA I L STC - 104 A AS BUILT SANITARY SYSTEM REPORT p r OWNER QYa c e e ~c r/S s r ~RC~X~L " ADDRESS C' ~~N1N,,0 FEE SUBDIVISION / CSM# LOT I SECTION T N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM b O Q Z1 ~U 'av e~ 1 J 3 0 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. T BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: l~Q'y G ~4 Setback from: Well dc~- House Other Sec Sr 7`c ~~-o.~ Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line:- -'C1 Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt - 1 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ! Safety and Buildings Division (ATTACH TO PERMIT) Sanitary PermitNo.: GENERAL INFORMATION 289303 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: MERGENS, BRUCFi. K'' WNQICKINNIC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 022-1065-10-boo TANK INFORMATION ELEVATION DATA /y -/l ,105.6, TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. a, o Septic ;11 / Benchmark o/, /G1~ , (!90 1l Dosing 6 SCI e jo _ Aeration Bldg. Sewer ng St / Y Inlet TANK SETBACK INFORMATION St/~K Outlet TANK TO P/ L WELL BLDG. VVe Air Intake ROAD Dt Inlet j Septic NA Dt Bottom 0 Dosing NA k r / Man. ? 9 i Aeration NA Dist. Pipe Holding _ - Bot. System <1 ~j PUMP / Sd fNFORMATION Final Grade Manufacturer Demand ~ Model Number GPM ~ e C)_' TDH Lift friction System, TDH Ft Forcemain Length Dia..2 Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length, No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DI I N ManufaCtur SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM' INFORMATION TypeO CHAMBER ode Num er. System: OR UN DISTRIBUTION SYSTEM k*mWr / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.L {S kL_k tf a--0-d Z" I • ddTION7 KINNICKINNIC 23.28.18.353,NE,1 FRIAR TUCK LANE LOT 4 'I'a 65 4~' f tL :Yl(1...-✓Af'.-3 r- / i 17 Plan revision required? ❑ Yes ❑ No Use other side for additional information. FT1 H SBD-6710 (R 05191) Date Inspector's Signature Cert No. r i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: v' 'r'■r'~a SANITARY PERMIT APPLICATION safety andBuilding rS ssDivisi ytem Bureau of Building Wate 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County t than 8 112 x 11 inches in size.'; ~ • See reverse side for instructions for completing this application State Sanitary Permit Numb r C989 -505 The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]: State Plan I.D. Number 1' APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pro erty Owner Name Property Location G .c S 114,Va 114, S 23 T .Z , N, R Ig'E (or) W Property Owner's Mailing ddress Lot Number Block Number ///.I- G r e a Tz te City, State Zip Code Phone Number Subdivision Name or CSM Number sou. s~- Qk, 4 ,d sa~~ c > csyn a~ G j0'9, t7/0 II. TYPE F BUILDING: (check one) ❑ State Owned E] qty Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms _P 9 Town OF fi : c ~.rvv~` ~Y r w ck L&.Al 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment / Condo j a t '-l D 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. [g New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Exi sting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 KLMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 'YS?1 l a 'I" f , Y Feet /,/d. I Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank PS ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ,BO we$TcY,r✓ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATE-MENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): o~ s_ - fir' d &ds111.J 3- Ya/~ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing A e mr ps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit. Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed- pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of.holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater- The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. f SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce April 22, 1997 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S97-40255 FEE RECEIVED: 180.00 MERGENS, BRUCE NE,NE,23,28,18W L ST C ~ TOWN OF KINNICKINNIC COUNTY OF +iRRkeE- MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. i Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, d i ate 6e M wim crnk n Plan Reviewer `D_,~ Section of Private Sewage (608) 785-9348 I7,CROX ` COUNTY ZONING 0 PRCE ~ f L9/ CS SBD-7997 (R.11196) `i Page of 6 MOUND SYSTEM RECEIVED FOR APR 2 1 1997 A 7B BEDROOM RESIDENCE SAFETY & BLQGS. DIV. LOCATED IN THE NE 1/4 OF THE Ne 1/4 OF SECTION 13 , T Z$ N, R V% W, TOWN OF 'cc~N►J~Ck11`1i`1 lC , ST.(-'"LX COUNTY, WISCONSIN. INDEX PAGE 1 "of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 -PUMPING CHAMBER ' PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR W's -~W~UEZ PlJ1 P~t'r z PREPARED- BY WEGEERER SO X L TESTING ~N4M1 AND. gCONs Sys ~P~yE F.U. BUI 74 421 K. 11AIK ST. WEGERER s RIM F&B. MI 54022 D-815 P ELLSWORTH, P dltjo 715-425-0165 . al r~ t~ 6fy~ pp>4 y4. 1011, N 5ss JOB NO. cf _q S PLOT PLAN Page Z_ of 6 Scale 1"= 1 ip' of a $ 4"PUe_ 0. 13S' o- Z PkjC YIN, a CAS 2J'_ P a(b 5 O~ deA- n .39 ne ~Tv s tRwpnp ~O~ST IZp oR ~ ~ItA NOTES: -1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install.4" observation pipes with approved caps. ( z required) 4.-Septic tank to be ~0oujbsb gallon capacity manufactured by 5. Bench Mark 1--L. 79.& ' o" 3)v"pi R. pUc pipe w/ LPr'01 6. Divert surface water around system to, prevent .ponding at the uphill side. i Page 30f 6 Approved Synthetic Covering rygTN► C33 Distribution Pipe Medium Sand _ G Topsoil H _J G Elev. O~q,\4 - -J E D - 3 ~ b 1 % Slope Force Main Plowed - Trench of V'-2k" From Pump Layer Aggregate Undisturbed D 1. Ft. E eS Ft. Soil Cross Section Of A Mound System Using F O~B Ft. I Trench For The Absorption Area G N.a Ft. A S Ft. H I. S Ft. B S Ft. I t0 Ft. Linear Loading Rate= 6•° GPD/LN FT J Ft. Design Loading Rate= o.y GPD/SQ FT K V3 Ft. L RS Ft. ^l fir Position of Force Main------___._ W Z 3 Ft. L J -Fefse B K Maici- A 4- - _ - - W Distribution Trench Of 2 - 2 2 Pipe Aggregate ' Observation Permanent J Markers Pipes (anchor securely) . Mound Using I Trench For Absorption Area Page Of Perforoted Pipe Detail 00 End View Perforated End Cop. <so~`c PVC Pipe 1 Jo • goo as Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cop PVC Force Main 4 Distnoution Pipe Lost Hole Should Be Next To End Cap Distribution Pipe- Layout P 3 •1 S Ft. X 3 V Inches Y 3 Inches Hole Diameter Inch Lateral n 1<1Y Inch (es) Manifold Inches Force Main " Z Inches # of hol es/pi pe tZ Invert Elevation of Laterals `t9,01 Ft. Place 1st hole Igo from tee with succeeding holes at 3C'4 intervals.. Last hole to be next to the end cap. Combination Septa-c Tank and S OF 6 PLf-tAP CHAIABER CROSS SECTION AMD SPECIFICATIOUS PAGE WEATHER PROOF -VEUT CAP JUAICTIOU 60X . H'C.I. VEUT PIPC APPROVED LOCKIMG -':10' FROM DOOR. MANHOLE COVER wl~ wARNIEIG L14pEL. ',AMDOW OR FRESH ALP, IWTAKE cor~Du~T 40 m1m. vill, 1 ~ ~ 10' MIAI. Ib~/'liAl. ~ h PROVIDE I - LET AIRTIGHT SEAL I I ggprrL~S A I I APPROVED JOIWTS APPROVED JOIUT I III W/C.I. rIPE4wC W/C.I. PIPE OR Tank construction ( 11 ALMIA shall comply with I II ILHR 133.15 and 83.20 e I 1 I I ow C I ELEV. g$ 15 FT PUMP -4, OFF D COIJCKETE L 5b, v0 BLOCK 3" APPROVED RISER EXIT PERMITTED OLILy IF TANK MAIJUFACTURIFR HAS SUCH APPROVAL gEDpl SEPTIC SPECIFICATIOIJS E DOSE 3•yy TAWK MA►IUFACTURCR: ~1I~~ P T IJUMDER OF DOSES: PER D" TAWK SIZE. ` 1DC~u t! 6S0 GALLOWS DOSE VOLUME S.S ~1,@zYRp S~tS`T~7~S INCLUDING 6ACKfLOw: GALLCUs ALARM MANUFACTURER. MODEL MUMBER: CAPACITIES: A= WCHES OIL 7a~6 WALLOWS SWITCH TUPE: "i :Q cu R-,-( 5= Z. IUCHES'OR 3Y 4LLOU5 PUMP MANUFACTURER: Go~~pg C: 9 IIJLHES OR `s3 GALLOWS MODEL MUMDER: D--INCHES OR ~S 3 GALLOUS I'I~RCSJt~f MOTE: PUMP AWD ALARM AR TO DC 6 SWITCH TYPE: Z8 O$ MIAIIMUM DISCHARGE RATE INSTALLED OM SEPARATE CIRCUITS GPM \t.\5 VERTICAL DIFFEILENCE DETWEEU PUMP Off AUD DISTRIBUTIOIJ PIPE.. FEET 2. So FCET t KIIJIMUM iJETWORK SUPPLY PRESSURE . : • Zas FEET OF FORCE MAIIJ X x'61 F oFLFRICTIOU FACTOR. FEET TOTAL 0tJUXMIC HEAD = ~S ~Z FEET DIAMETER Pump chamber IIJTERLIA6. DIMLW6110w~ Of TAUK: LEU6TH ;WIDTH ~;LIQUIO DEPTH BOTTOM AREA - 231= GAL/INCH AS PER MANUFACTURER = C 1:D GAL/INCH • Goulds 1c 6 of Submersible Effluent Pump 3871 EP04 - EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the • stainless steel. grade turbine oil for for efficient heat transfer, Capable of running lubrication and efficient strength, and durability. following uses: dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Effluent systems components. tic cover with integral handle • • Farms Homes Motor: manual Available for operation. automatic and Automatic and float switch attachment • Heavy duty sump • EP04 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EP04 built in overload with m EP04 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi-open design AGENCY LISTING 1/a' maximum. • Power cord: 10 foot with pump out vanes for • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. CO. Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding m EP05 Impeller: Thermo- • Discharge size: 11/2' NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC".) rotary/ceramic-stationary, three prong grounding plug improved performance. BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 1040F (400C) continuous superior strength and 140°F (600C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. i o 1. _ An' • Capable of running dry without damage to s 30 5!, i components. - + - ' r = i.-- Pump: EP05 8 • Solids handling capability: o z 25 IK" maximum. W • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. i • Discharge size: 1'fz'NPT. z 5 ~s.s2 • Mechanical seal: carbon- 0 15 rotary/ceramic-stationary, 4 BUNA-N elastomers. o • Temperature: 3 10 104°F (400C) continuous' 140°F (600C) intermittent 2- 5 1 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 ne/h J' -L -L L CAPACITY ®1995 Goulds Pumps, Inc. Effective may, 1995 ' MR71 • CERTIFIED SURVEY MAP LOCATED IN THE NE-NE OF SECTION 23, T28N, R18W, TOWN OF KINNICKINNIC, ST.CROIX CO., WI. I •PREPARED FOR: DAVE PETERS NE CORNER OF n n ^I @91 NOON 23. (COUNTY MONUII?ENT ' NORTH LINE OF THE NE-NE S 0902611 'E 678.63' I - - - - 329. 40' 349. 22' 0' HQJE_ BEARINGS ARE 316, 22' 33.0 Q REFERENCED TO THE EAST LINE OF THE NE 1 /4. ' 33 3I' (RECORD BEARING). J Z o I )T--L- L $ OT 4 W 5.00 ACRES rn p 0 5.02 ACRES - o (217.505 SO. FT. Q, - O LATTED (216,TSa so. FT.) - cJ` • ~ '44.54 AC. EXC. R/Wr~l~ UNP , • ' o • h' (197,657 S0. FT. ) T U I O, N m G1 to © ~ o yl S 6,90 4T• 318. 13' 33.20 O ~iI rn 09'61 351.33 - vsi B +O 3T T• /2• 307. 95 o O" W 659.28' 66. 40' r O 9'yr. 0 g 83 37, 5 651-98 m ' 2 04•IY 10 S 83° 37' 5 ~ W 344. 58' 33. 20 I rn 307.39' •311.38' A o O (D ~buv A~ z o o n o l~~ I g LOT 3 Q LOT 2 w w 5.00 ACRES UNP.L ATTED L ANDS,_ (217,751 So. FT.) 5. oo ACRES ~I ~ v ( 217.765 SO. FT. ) rn au V R' 4. 50 AC. EXC. R/W U - (196,185 S0. FT.) N ill 33 33' SOUTH LINE OF THE ME ME 309. 50' 33. 00' - - 366. 10' 342. 50' N 89-41'25' 708. 60' Z 0 _ Wo C. S. M. VOL. 5 Cf.~•~.r.M~.. E 114 CORNER OF a,w, SEC. 23 • (P K. O V OI, O NAIL FOUND) u y PAGE 1408 PG. 1710 O SET I' X 24" IRON PIPE WEIGHING 1. 13 ~i`~r LBS PER LINEAR FOOT Y: ~ Y' ° 1' IRON PIPE FOUND. ~v l ✓ JAhIr7n 1VE!I: N S I UJ ~ SPRING VALLEY ! 200 0 200 400 600 i bV15. r" GRAPHIC SCALE - FEET "~'•.+f,~.-'SHEET I OF 3 95-136 THIS INSTRUMENT DRAFTED BY JIM 11'EBER JAMF_S Al. IVE ERP ' k8aa NELSEN-WEBER LAND SURVEYING DATED THIS--g^DAY OF OC _ 1995. S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property lpdt~c i -ezz- 1vol j~E,e6,E s Location of property_A~e_1/4 ,(/;1/4, Section 23 ,T2$~_N-R IT W Township Mailing address ///s 0,41f Al Af+a Address of site Z Subdivision name Lot no. Other homes on property? X_Yes No Previous owner of property IDAV' Ae~{iQS Total size of property Total size of parcel 5-02 Date parcel was created /O Are all corners and lot lines identifiable? X Yes No Is this property being developed f r (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. ;VZO 9 g , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signa re of Applicant Co-Applicant 6 - C--> - 9 7 Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER &(LC ,~Lkee,4- l MAILING ADDRESS S /~~f /~~i~i'Z SS/~ l~1 i✓~'~ PROPERTY ADDRESS /5~ Z F.e%e T c~ ~~r~~"s Esc S`~o~ z (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~C/~U,~/~' ~~~~5 G✓/~~ PROPERTY LOCATION 1/4, NE 1/4, Section 23 T Z0 N-R~W TOWN OF , ltlrle ST. CROIX COUNTY, WI SUBDIVISION 0,4y O l7`~/~S LOT NUMBER _Z71 CERTIFIED SURVEY MAP , VOLUME~ , PAGE ?l~, LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 3191 PACCt VOL 547098 STATE BAR OF WISCONSIN FORM 2.- 1982 Ii WARRANTY DEED DOCUMENT NO. RMSTER3 MICE ST. CROIX CTY, WI j P&d for Rext1 Ii Maiden, Inca a WisconsinCorwration, JUL' 2 2 1996 8:30 A•~J~ Me pens and Lee Ann i L).Ak conveys and warrants to Bruce W K o ~I `Me,tgens, husband and tTife, a e survi vorship Il Phoster of Deeds rearital property., ' I. THIS SPACE RESERVED FOR RECORDING DATA - ; NAME AND RETURN ADDRESS y, ;j the following described real estate in St. Croix Count .I State of Wisconsin: EQUITY TITLE SERVICES I~ 400 SOUTH SECOND STREET E HUDSON, d 6 Coto Y - i; 022-1065-10 i I; PARCEL IDENTIFICATION NUMBER I I Lot 4 of Certified Survey Map filed June 6, 1996, in Vol. 11, page 3118, as Docunent No. 545925 being a part of the North East of the North East Quarter ~I (NE1/4 of NEI/4) of Sectiom'ItFrenty-three (23), Township Wenty-eight (28) North, of Range Eighteen (18) West, in the County of St. Croix and State of Wisconsin. TRAIL'Sf R $ - II This is not homestead property. (is not) II Exception to warranties: Easements, restrictions and rights-of-way of record, if any. II jI II A.D., 19 % 1 Dated this day of i n I ~I f . (SEAL) I (SEAL) ay David G. Peters If ` • - (SEAL) it (SEAL) ACKNOWLEDGMENT AUTHENTICATION State of Wisconsin, I Signature(s) L S t. Croix County daY of , 19 ptrsdully came before me tis (lay of authenticated this , 19S(1_,. the above mined ~laide*1, Inc a WisCQnc;n Cr~rnnration___ by David G.' Peters j • TITLE: MEMBER STATE BAR OF WISCONSIN - I~ (If not, who executed the foregoing authorized by $706.06, Wis. StatsJ to me ltnowr. to be the person Diane M. 6arron t IgTuntent and acknowledge the same. ! Notary Public n e 1~' Tins w3TRUMENT WAS DRAFTED ft#_#a -6 AAI;--- .e;w , 411 ' R • ,