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004-1048-20-200
5t. Croix County Planning and Zoning Tuesday, March 27, 2007 at 4:41:52 PM Detail Sanitary Information Page 1 of l Computer #: 004-1048-20-200 Sub/Plat: NA Section: 21 Parcel #: 21.28.15.323B20 Lot: 2 TN/RNG: T28N R15W Municipality: Cady, Town of GSM: Vol. 14 Pg. 4010 1!4 1l4: NE 1/4 NE 1/4 Owner: Christ the King Lutheran Church 2991 30th Avenue Wilson, WI 54 027 State Permit: 399460 Issued: 10/12/2001 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 12/20/2001 POWTS Detail: Infiltrator -High Capacity Bedrooms: 4 WI Fund: POWTS Pretreatment: NA Motes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Monev Owed Not determined >4/1/00 -Not Required Timm, Roger $0.00 Kevin Grabau Si=:z~~e<f '__~'~ Yes hlasntenarace Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 12/20/2004 7/29/2004 04/01/2005 7/29/2007 Parcel #: 004-1048-20-000 Category Alt. Parcel #: 21.28.15.323B 004 -TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - HORNE, RETIRED RETIRED HORNE Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 11.069 Plat: N/A-NOT AVAILABL E SEC 21 T28N R15W 11.69A IN NE NE N 358 Block/Condo Bldg: FT OF W 934 FT & N 449.07 FT OF E 388 FT OF NE NE 457/639 EXC PT TO STATE (0.16A) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 641/130 NKA CSM 14/4010 21-28N-15W NE NE Notes: Parcel History: Date Doc # Vol/Page Type 03/31 /1999 600380 1415/041 OC 07/23/1997 641 /130 07/23/1997 399/68 07/23/1997 376/363 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 12/28/2000 Description Class Acres Land Improve Total State Reason - Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code 03/27/2007 04:42 PM PAGE 1 OF 1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 rURIGINlAL Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 1224 Page 1 of 2 Certified Soil Testing ounty Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road . . . 004-1048-20-000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy l.aw, s. 15.04 (1) (m)). r wn (\ rope oca ion Timm, Roger a. 't 1/ Govt. Lot NE 1/4 NE 1/4 S 21 28 N R 15 W roperty wne s aim ress Lot # Block # Subd. Name or CSM 3128 20th Ave. City tate Ip ode Phone Number ~ Cit ~ Village ~ Town Nearest Road Wilson ~ WI 54027 715-772-3214 Cady 30Th Ave.1WSHW 128 New Construction se: r Residential / Number of bedrooms Code derived design flow rate Replacement ~ Public or commercial - Describe$xlsttng schooUPotential church Parent material till _ Flood plain elevation, if applicable General comments and recommendations: Preliminary Soils only adjacent to existing field to verify existing installation ---~, GPD NA a Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor ~ 107 in• Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 0-8 10YR 3/2 - sil 2 m gr mvfr cs 1f/m .5 .8 2 8-26 10YR 3/3,4/6 - sl/scl 1 m sbk mvfr cs 1 m .2 .3 3 26-47 10YR 4/6 - scl 0 m mvfr cs 1f 0 0 4 47-60 10YR 4/4 - Is 0 sg ml gs - .7 1.2 5 60-72 10YR 4/4 - s 0 sg ml cs - .7 1.2 6 72-90 10YR 5/4 - s 0 sg ml cs - .7 1.2 7 90-107 10YR 3/4 - Is 0 sg ml - - .7 1.2 ^ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft'__ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-26 above fill 2 45-65 5YR 3/3,4/6 - s 0 sg & 0 m ml & dsh no pI wa )us a ow sys em a eva Ion; Iron nc san s possibly an effect from old system effluent Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L ame ease not Igna u um er Henry F. Grote 222774 Address Certified Soil Testing Date Eva nation Con ucte Telephone Number ~. 4366 353rd Ave., Menomonie, WI 5 10/31/2000 715-233-0398 Iv _ N ~ t/`~ ~ ~- s ~~, f .~ c TES" ? p ~~ t t ~ ~ a~ l j ~ ~ (t•~~ 1 /. '!' -f' ~~ o ~ ^ ~~ p/ , ~ ~` ~~VJ r ~ ~~ I ~'' 0 ~~ r P r P z 6 .r- G ^`` f~ lJ~ ri r ~ -1-- .~- N r r ~' '~1 6 d ~ --~ ~ .~- ~~. qIq G_ l~ W ~, r r ! _~ c ;~ N •~ ~P ~ ~ ~ ~ e ~ 's 'c ~ ~ ~ ~ 3 f v" r- -~ oi~ `~ ~~t~~i~ `)N+P1C~t a:.ran:~~~, v,~n~~ iS U~ i; ,..~ • 1 _I yli..i.i~~,# .F .; v l} , ~ ~~~: j~ / \~ / P N N 0~ r G c A s P . f ~~ G L 1 r~ N ~ ; n ~ r l.~' ~ G' 1 ^~ 1 !~ a 0 ~J 0 ~J a f G -P G G ~ ~ ; G w Wisconsin Department of Industry, SOIL AND SITE EVALUATION / 3 Labor and Human Relations Page of _ Division of Safety and Buildings in accordance with s. ILHR 83.09, WIS. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ""`' /~ • C/P~ ~ X- include, but not limited to: vertical and horizontal reference point (BM .ytion and 7 percent slope, scale or dimensions, north arrow, and location istafice tp e~; t road. Parcel LD. # APPLICANT INFORMATION -Please print or ai~~1~`'i~• Reviewed by Date ~, r Personal information you provide may be used for secondary p rpp~~s (Privadyl~vr, s' tS`.04 (1) (m)). Property Owner ; _ r ,. ,., ~ ~ ~Rr~~rtY Loca)ion / p F~/tl~i~ ~~/piU~ ~:' Govt. Lott ~ 1 /4 /VG 1/4,S y~ T Z. d ,N,R ~ Cj E (or~ Property Owner's Mailing Address ~;~! . , Qt # 1 ;,,,, k# Subd. Name or CSM# R p p i2 oX , STfF(rLc"Li.vE' ~!~ • -~,~~~cs,~: p~N9i.UG- C /. o ~K.~.2 yz 9 ~ s~i s Ci~tyf Sta~t~e f Zip Code Phonee Number' ~s _.. "" ~,,, Nearest Road ~ S', NW 6/v~S~'tJ ~i/ ~ Sy0/ ( 3 0~0) ~ ~< 1 ^ Village © Town 3~°t'~+~~ ~ ~ Z G ~, New Construction Use: Residential / Number of bedrooms ~_ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~ ~ gpd O~ Recommended design loading rate _' bed, gpd/tt2 ~ trench, gpd/ft2 Absorption area required ,sue bed, tt2 ~ trench, ft 2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 's'ue" 3 tt (as referred to site plan benchmark) ,~ Additional design/site considerations ~ON~ N ~~ /~'jDV.(J~ s~$T' ~~ ~V~/p~~ • Parent material ~O~SS D(9~ Sfftlf~ ~/ ~lls Flood plain elevation, if applicable ~~~ ft S = Suitable for system Conventional ~Moun/d In-Ground Pressuy~ AT-Grade System i-n Fill/ Holding Tank u = Unsuitable for system ^ s ~ l~ ^ U ^ S f~G ^ S ^ S L~-~ ^ S ~ Boring # Ground ei v. ~q. ~ft. Depth to limiting factor 7 .~in. Boring # z~ gnu neer~nroTlnru RRDr1RT H i D th Dominant Color Mottles Structure d R t GPD/ft2 or zon ep in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boun ary s oo Bed ,Trench Remarks: t o • i3 ioy~ 3/3 S L 2 fsd,~ ~- v~,e c~v ~ f • S ; • ~ 1 s O - _ 7' Ground G elev. l~•~n. Depth to limiting factor •~~in. Remarks: SST Name (Please Print) Signature - Telephone No. '~pREIzT" 2t~BR~'cti7- ~7t5. 38~•d/8,S Address Date CST Number /Ll~G1 _ Z~• ?tea ~ 22ce 3 'l S Ulbricht 8 Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 ~ ~,~~fE"L p~~~ ~tDvvp ~S',~r~ ~- f~ - fv %D ~" ~ i3,Pt~~ ~ `~ ~~ PROPERTY OWNER PARCEL I.D.M Boring # 3 Ground elev. c~ a . ~ft. Depth to limiting factor ~~in. s S.s . Boring # Ground elev. S,~n. ~'; ~D~jt/,~-- SOIL DESCRIPTION REPORT oay• ~b~~. ~ • a~ Page~_~ ~ `'~ Horizon Depth Dominant Color Mottles Structure i t C d B R t 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons ence s oun ary oo s Bed ,Trench ~ o-~ io ye 3/3 sc ~fsb~ ~v~~ cs ~ f • s ~ • ~ SGi' ~ M G o.~ eye 3~ -- s~ -~ c - ~ ~~ . s ,~~ ~ ~ f a.,~ ; • S _ °~ . S D G~ ~ . ~ ; /O ' Remarks: ? /o ~ /f shy ~-~' c -- .`(; s c 2 ~- nofs L l fSh rrn v~Fr ivY~ ~il~ - --- . s~ie s7~ - Depth to limiting factor in. r- Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Remarks: ,~D%~ rQ~~"rl~- 0~ /3 ~ / ~(!OT svrT/~lE iQV,L„~. ~Z /~'jdvvfJ C l Mottles Structure R GPD/ft2 Horizon Depth in. or o Dominant Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary oots Bed ,Trench Remarks: Depth to limiting factor in. Remarks: I SBDW-8330 (R. 08/95) IMPORTANT NOTE TO OWNERS & INSTALLER: All the finer textured soils (loams,silts, etc.) can & will be easily smeared Or compacted even by a backhoe bucket during trench construction. When this occurs premature failure will result. As per ILHR 83.13 (4), the installer MUST be very careful to properly hand rake the sidewalls & bottoms to re-expose all of the soils natural structure. Minn. even recommends that scarifying devices be mounted on the sides of the bucket. Only in this way can treatment & absorption be most enhanced for normal longer system life. r C1, 3o t~ /f~~, G~~ u1 , ~y~ 2~ ~istes Itaats Utbticbt$e s4°~0nsu Pd~° BIIRd•~018 ~~on~Wis• S ~, Zyl~ 3 ~/ CS ~pD ~i ~~ 5 W E G~~a , ~ ~.5 ~ ~~ - ~~p~~ , ,~/~ Zoz 3!c I y/ _o i 1~ e ~1 ~,o ..- 3a` ----. ~3 Lo ~ 2 Sc~~ ' ~ ~~" 3 ~ . =~c~~oe p~ rs ` o~ ~~ ~ ~ ,/ Z ~o .. Movti~? s~~~~,~ ~~.ev, ~'' ~ ~~ w~ ~a~i s~~~ ~~~~ ~0~,3~ ~ l s 0 30 719' ~~~~ou, S~, X07` ~/%v~ -18y'N ~'~5 ~ Go ~ GiN~ ~~ yo LOI (~ QM ~ Z S£r q~ _--_ ~o~,~~'T~.c s~/s~ s oaf ~~ LvT `~ ~ 4'1 ~ti~ f~,~~ ~o,,~av~ ~/,v.Q ~'~, 3G ' _ ~--~ ~M~#~r ~. S ~ ~,, ~. = Boa. v . ----~ f~ L/NE' .? V ~~ OWNER CERTIFIED SURVEY MAP EINAR "oRNE LOCATED INPART OFTHE NE1/4 OF THE NEl/4 OF SECTION 21, 429 STAGELINE ROAD HUDSON, WI 54016 T28N, R15W, TOWN OF CADY, ST. CROIX COUNTY, WISCOSNIN. SEE DETAIL N89 53'2T1N 00 ~aC~D D17 00 4b[~G3~ o `~°• ° ---------- o~ 150.07' - o r °o m N W Q 0 n 0 z m O ~ N89°53'27"W 1323.22' w NORTH LINE OF THE NE114 N89°53'27"W 1173.15' o° Z NE CORNER w ~ °-' 4;64' SECTION 21 N1/4 CORNER - 30TH AVE. 726.x7 443.96' ° SECTION 21 ~ N89°53'27hN 1172 93' w ~ N89 55 4 W NOTE A I 1 I~ NOTE A 3/4" REBAR FOUND N00°23'29"W 5.97' FROM SET LOT CORNER DETAIL NO SCALE w io _ ~~ 0 c o~ ~ Z ro z w0 ~U~ pwn F. (A (V LL ~ ~~m Z~-Z W~~ w Wpm ~ O WLL~ 0 QW~ ~Z~ (}J~ Z=~ ~~Q fD~N SCALE IN FEET 1" = 200' 200 0 200 400 - r " 8 100.60' ° $ N I~ IG ID I~ ....... ~' .......... .......•A•.. ... I~~~ o ........................................ .N~ L0T11NC.RM' wm o I~I~ ° W o w LOT 2 INC. RM' ~' m c x ~~ ~ ~ Cn ° ro ~ ~ w 221,969 SO FT I I I I~ N ~ ~ 261,377 SO FT - N ~ ~ N ~ < Cna 5.096 ACRES ~ w = low qN o 6.000 ACRES ~° ZZ N ~~ I~~' LOT2 EXC. R/W - LOT 1 EXC. RNV ~ ~ EXISTIN ~ O ~ ~~ I~ 10° I~ m 237,322 SO FT ~ s s 207,313 SO FT DRIVE ~ ~ m I~ I~ 5.448 ACRES ~ 4.759 ACRES j D{ ~~ IO h I 729.72' 206.32' ~ ~ I~ h I~ S89°53'27"E 936.04' ~ I~ o ~• I~I~ I(+~i l~ i o rpv S89°53'27"E 337.87' ~ I pQG°~C~C~d Oa MOd° ~ ~ ~ ~, p~° ~ ~ ~ m o~ O~aC~D D`~7 04aL~°3~ m LEGEND ALUMINUM COUNTY SECTION CORNER MONUMENT FOUND •o- EXISTING POWER POLE ~ 1"IRON PIPE FOUND ® EXISTING SEPTIC VENTS O 1"X 24"IRON PIPE SET WEIGHING © EXISTING WELL 1.13 LBS. PER LINEAR FOOT ~ SOIL BORING m 3/4" REBAR FOUND EXISTING FENCELINE ~ 1-114" REBAR FOUND 100' ROADWAY SETBACK LINE _ __. ~; T~•V»~ Wisconsin'Department of Commerce PRIVATE SEWAGE SYSTEM s Safety an!-Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Parsonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 'ermit Holder's Name: City Village X Township Christ the Kin Lutheran Church Cad Townshi :ST BM Elev: ( Insp. BM Elev: ~ BM Description: T~4NK INFORMATION TYPE MANUFACTURER CAPACITY Septic /- Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD septic ~ ~ ~ ~ ~ 4~r 2 Dosing ~ ~'D ~ ~ ~f 3 ~ • .. 3 s Aeration Holding PUMPISIPHON INFORMATION S~ 5•'~ %~ tLtVA11VIV UAIA STATION BS • HI FS ELEV. Benchmar Z t ~ ~ ~l gs.ge o.Gor 9 Alt. BM n ~¢ q¢.~ Bldg. Sewer ,, _ ,,,,,, n ~ ~' `~'` SUHt Inlet 8 s '' ~•~Z ~ ~ St/Ht Outlet ~ r~ K D. ~ ~~ ~~ Dtlnlet Br~~ ~.ro~ g~,31r Dt Bottom ~ 2, o} 43.91 f Header/Man. Dist. Pipe ~• .L V• ~ (~~ ot. System $ ~ 3 . °~2 • C~.t p _~ final ra~1e , ,~„ ~ ~ • 0• ~-3r St CC r ' 3 `~~~ .3s) ` 92.63 Manufacturer Demand S GPM Model Number GI" ~ ` ` / Lift ~5 1 FrictionOLiss System ead DH ~ Ft , Forcemain Length / Dia. tr Dist. to well O .. ~ ~+r~u AOClIOOT~lIAI cv~~ a~nn i . ~ u. .. .e..~~s i.~ ~a...r BCD RENCH DIME SIONS idth 3 ~ Length ..,. r ~ No. Of Trenches ' C 3~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth .Zs Q J SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufa r: =~~ Est INFORMATION Of S t UNIT Type ys em: ti ~I • ~ t,~ • ~- Model Nttrpberi 111@T~IQI ITIlIAI CVCTGM Header/M ~n~tiol• II C Length a+ Dia Distribution Pipe Length Dia Spacing ole Size x Hole Spacing Vent to Air Intake •~. ~ r c r~u rr-iv~o __ n____.___ c•.-_a_.... r~.. ~.. .... ^~...~nr• r•r nr_u rang SVSiPmS Uf~1V Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil ®Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (Z/~/ Dl Location: 2991 30th Avenue Wilson, WI 54027 (NE 1/4 NE 1/4 21 T28N R15W) NA Lot 2 ~/ S~ Cole,/' (r~~s 1.) Alt BM Description ~~ b I ~^~O`~" 2.) Bldg sewer length = ~;~?~ ~ ~•SI - amount of cover = ~ . ae 48.98 r Inspection #2: ~ -" Parcel No: 21.28.15.323820 .fS' 8•s4 " ~~r Plan revision Re uired? Ye ~" Use other side for addition I Z- 20 ~ ~ _ ~_ Date Insepctor's Signature SBD-6710(R.3/97) / _~j ~ ~`,,, _O~~'-' Cert. No. Sanitary Permit Application Safety & Buildings Division ` In accord with Comm 83.21. V.'is. Adm. Code See reverse side for instructions fo lication co l ti this a 201 W. Washington Ave PO Boy 7302 ~ isCOnsin `Department or Commerce r mp e ng pp Personal information }•ou provide ma}• be used for secondan purposes 04(I)( -~. [Privacy Lavc 15 s Madison. WI 537t?i-730 (Submit completed form to county if r ,,, . . . `' `1""'-; state owne. Attach com lete tans (to the county co • only) for the s • a er rb't less than„8-I/2 x 1 I inches in size. Coun ~ ~ State SanitQry P mtit Number ^ Check v on to pr us a plicatiofr'l~ .State Plan I D. Number I. A lication Information -Please Print all Information ~ ocation: Property Owner Name _ ~ -~~ ~~ ~ ~ ~ 2~~ -P perty Location - ~ p,~ . c~'' u~ 15 S jd ~.~YC~t,rr I/4/~~I/4.SZ1 TZ ,N.R or) ' Property Owner's Mailing Address ~~, ~( ~ of Number Block Number I aka ~ ~~~- ,~ ~, ~"~ Z Cit)', State Zip Code Phone 1`+4urstbr , -- - Subdivision Name or CS~1 Number 11 Type of Building: (check one) ~ ~ ^ Gty vill ^ , 1 or 2 Family Dwelling - No. of Bedrooms: O ,,~/ , age R}TOWn of Public/Commercial (describe use): ^ State-owned III Type of Permit: (Ghee}: o.^.!y one bex on line A. Check box on line B if applicable) Nearest R d ,^^ I n A) I. New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Par~r;I,T,ax/Number_(~s) C C~.~ S stem Tank Only Existin S stem /UY~ ^ Z!) B) A Sanita Permit was reviousl ~ issued Permit Number '/ / 3 (~ 7 tp0 Date Issued ~Q- /Z ~ C~ IV. Type of POWT System: (Check all that apply) ^ Non-pressurized In-ground ^ Mound ~ Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holr+~- ~ le Pass ^ Drip Line ~.~'h-~~/ ^ At- rade ^ ~ g / ~ ~ culating ^ Other: ~ ~.~ C= , V Dis ersatlTreatment Area Information: ~/ " c~ --~ ~~ I D i Fl d 2 Di ~ ~ ~ . ow (gp es gn ) . spersalArea 3. Dispersal Area /~ ~ ( Rate b. System Elevatton 7. Final Grade Re i d P 1 ~ d ' qu re ropose {~.~ ~/ ~ . L Elevatton , - oU l06 . !oT ~ ~i 3~ ~' ~jv , t VI Tank Capacity in Total # of ~ . ,crab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks f~/oU -' e J ~+ ^ ^ ^ ^ h- ~~~ - 8G~ ^ ^ ^ ^ I Res onsibility Statement 1, the undersi red, assume res ensibilit f^r irst21!ation of the POWTS shown on the attached laps. Plumber's Namc (print) _ Plumber' Signature (no stamps): MP/MPRS No. Business Phone Number -x-.- ~ 2z~ z 7~~- 7~L- 3z~y Plumber' Address (Street, City, State, Zip Code) l 2 ~l~y l~v,, ~~ GU • _ ~~d Z T VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I su Agent Signatur o stamps) ~Q,Approved ^ Owner Given Initial Adverse Surcharge Fee ~"~~ `~ Z ~8 ~ Determination l ~ IX. Conditions of Approval /Reasons for Disapproval: ~r,Q.etlre.- ~ vtiu/ ~~ SBD-6398 (R. 07/00) ~- Z" VEA1T CAP 'i°C. Z. VENT PIPE APPROVED LOCKI~JG WEATHER PROOF JUAICTIOAI BOX MAWHOI.E COVER ~ 25' FROM DOOR. `2a w/ `"~aR~`N ~' WINDOW OR FRESH I L.AQ~s~- AIR IAITAKE I GRADE I 4~~ Q.~w . I cou~ulT `-- ~` ~~ X11, --- PROVIOe I ----- AIRTIGHT SEAL I (~ I V T I I • .~SZ.S~E*'A+-~. 2~5~~•y~ f~ Z~~ ( III APPROVED JOIAITS ' I III W/C.I. PIPE y I II ALARM EXTE1JOtUG 3' ~„ I (I ONTO SOLID SOIL ~- I I O IJ n. i 7, •I I 'Tom f ~v-Q a/, I PUMP-~ __~ a-\Q'"• i2" _e w. ' DLOCK E~_.lw~. gy Ob _ - . G~~d !~Ra~~i ~, ~ , ', ~, 5~ Lem ~ ~lurw- ~ ~ I ~ ~ i I ti»~~- i, I 'i ' .»-- «..---r- i ~ ' ~ ~~,q~~ ~, ~ ~ ~ `7S as . s1 ~~~ 1.,,,~„ ~~5/~ /~~ ~ /b o y ~ i i ,t' ~ fie,, E~~ ~ ~ 6 ~- 5. z ~~ ~~ ~~~~~+ • L~55 ` ~ j ~rl ~~-~~ ~~ 5 .~ 71 ~ ~ . ~, !, to ~ ~- ~a •. ~ o j i TIMM EXCAVATING Route 1 Box 192 WILSON, WISCONSIN 54027 (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN doe L/~y~s~ ~~c. R.,rYPFi L,.cl-t'S.+~/G~.r2c. C. ~KuC!'1 SHEET NO. ~ OF Z CALCULATED 6Y -'~ ~' DATE ~2 - ~ ~`~ CHECKED BY DATE ~rr_ ~oi SCALE ~'L ~ n•;~ PRODUCT 205-i~ Inc., Groton, Mass.01471. To Order PHONE TOLL FREE 1-~P225~G1B0 ~~ ~~~ aa7 Sanitary Permit Applicatio a Safety & Buildings Division W 201 W hi A ;~~ In accord with Comm 83.21. Wis. Adm. de lication See reverse side for instructions for com this a letin . ve. as ngton PO Box 7302 ~~t'i~ns~n Department or Commerce pp p g Personal information you provide may be used for secondan~ purposes Madison, WI 53707-730.^ (Submit completed form to cou:tty if r (privacy LaH•, s. 15.04(1)(m)] state owner Attach cam fete tans (to the counh~ co ~ only) for the svste r s than 8-U2 x 11 inches in size. County Stat Sanita emut Number O Check if is i n ~~ State Plan I. D. Number ~ ri~i o - ~ P~ 1. A lication Information -Please Print all Information Location: Property Owner Name roperty L oc a ion / ~/ 7 ~ ' ' J ~ n ,~ ~ / ~ ~ '' , 1. (~e~.7 K+2i/ L I /4 ~V~; t /4, S T ,N, R 1~ or Property Owner's Mailing Address of Number Block Number City, State Zip Code P n be ~ Subdivision Name or CSM Number 44 II l,(.~ t, ~Sc~ C~ / ~ a Z c 3 5 3 S ~ y~ /o! II Type of Building: (check one) ^ Ciq- O I or 2 Family Dwelling - No. of Bedrooms:~ >~ ~ ^ village _ ^ Public/Commercial (describe use): Town of ~~ ^ State-owned iII Type of Permit: (Check only one bex on line A. Check box on line B if applicable) Nearest Roa / ~O A) 1. ~ New Syste> 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onlv Existin S stem -- O ^ oZ $) Permit Number Date Issued ^ A Sanit Permit was reviousl issued , aZ (~ 3~ IV. Type of POWT System~ck all that apply) Non-pressurized In-ground ^ Mound ^ Sand Filter D Constructed Wetland ^ Pressurized In-ground O Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating O Other: V Dis ersaUTreatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Galslday/sq.~ft~ Ga r ( (Min./inch) - T 1 ~. ~ ?'Z 87 , $ Elevation (P ~P ~ , (0 7 L~ ~ g r jtt, ~' ~ ?' 3 7. g/. Z - ~iD. VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks r Z !~J C~' ^ O ^ O pr(oo ^ ^ ^ ^ o VII Responsibility Statement I the undersi .ed, assume res onsibilit fer installation of the POWTS shown on the attached laps. Plumber's Namc (print) Plum er's Signature (nos ps): MP/MPRS No. Business Phone Number ~~-N-~- ~ ~ of z ~ - ~ z - 3z~ Plum i s Address (Street, City, Sta ip Code) te Z ~ { ~ l~ , ~~ /' / ~~ VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued is g A ent Signature (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Fee) ~ Sens) O d d l ~ ~ ~~ Determination /rdc] IX. Conditions of Approval /Reasons for Disapproval: ~ ~ - a ~' a.~i~~t~. ; 1. Effluent filter to be installed and maintained per manufacturer's recommendations. c~. nii acwacn~ w ayow,u a„u ,w,uv,,,.,u, ~ ............ ........ ........ 3. This system was designed in accordance with the in-ground soil absorption component manual (version 2.0). 4. System shall be installed 36-inches below uniform contour line to ensure proper location within soil profile. 5. Filling and grading is prohibited in the designated drainage way or mapped wetland. a~ SBD-6398 (R. 07/00) ~, TIMM EXCAVATING Route 1 Box 192 WILSON, WISCONSIN 54027 (715j 772-3214 (715j 386-5443 MPRS #3224 WI MPCA #696 MN roe ~'tiv.s~ Tf/~ ~r•iti L,~.~~.-~.~ C'~{.~~i SHEET NO. ~ OF Q~ CAICULATEO BY ~ DATE 7 ~ 2?~ ~j CHECKED BY DATE /~~_`~ SCALE 5~.2 ~~ 8 .~ ._....i._./ . PRODUCT 20b1~/V~~ Inc., Grdon, Mless. 0171. To OrAx PHONE TOLL FREE 1-80P22SG180 ' '. TIMM EXCAVATING Route 1 Box 192 ' WILSON, WISCONSIN 54027 (715) 772-3214 (715) 386.5443 MPRS #3224 WI MPCA #696 MN JOB ~YI r/~T T~ "Y/t~i ( ~ ~K+rL.~1 C. ~"Gr4l.~G /'l SHEET NO. ~ OF CALCULATED BY ~ DATE ~ r 2 ~~ ~~ CHECKED BY DATE l ~/ ~ ~ ' SCALE .T v..~...~......... _... .: ,. y.r..~.... ~~~ 8 a'Z ~'C. e J PRODUCT 205-1~ Inc., Groton, Mass.01171. To OrOer PHONE TOLL FREE 1-BOP225~6380 ~..,.~.,.~.....~w.:~.....^.._ ,.. _ ,. . ,,~ ~ , . - ~ ~RIGBNlAL Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code c~_~ `G/ 1377 • Page 1 of 4 Certified Soil Testing -- ounty Attach complete site plan on paper not less than 8%: x 11 jpches insize. Plan must St. Croix include, but not limited to: vertical and horizontal reh point(BM), direction and ~ Parcel I D percent slope, scale or dimemsions, north arrow;• apdiocatbn and distance to crest road ~"~; '~ ` . . . CSM Pending Please print alllnformation..~ , ~, - ~` R wed Date Personal information you provide may be used fa secondary pury0ses (pyvpc~.aw, s. 18.04 {t f m)). l O /~ O / ropey wner r e oca ion Horne, Einar ';~" '°~-" ?~ ~~ Go'.~t NE 1/4 NE 1/4 S 21 28 NR 15 W roperty wner s ai mg dress }~_., ST CAOIX Lo Block # Subd. Name or CSM 429 Stageline Road ~. -,, ,, GOttNTY ~ CSM Pending From 004-1048-20-000 City State Zip de Rio Cit Village Town Nearest Road Hudson ~ WI 5401 ~ fi= c Cady 30Th Ave. ..., New Construction Use: Residential / Number o edrooms 4 Code derived design flow rate b00 _ GPD Replacement Public or commercial -Describe: Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: install 2 - 2.7' x 93.75' trenches @sys elev of 92.0 (91.6 to 93.6 OK) or 3 - 2.7' x 81.25' trenches @sys elev of 89.2, 88.8, 88.4 using stipulation 1099 chambers Boring # ~ Boring Pit Ground Surface elev. 97.2 ft . Depth to limiting factor ~ 114 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 ' 0-9 10YR 3/2 - sil 2 m gr ds cs 1f/m .5 .8 2 9-17 10YR 4/3 - sil 3 f sbk mvfr cs 1 m .5 .8 3 17-43 10YR 4/4 - sil 3 m sbk mvfr cs 1 m .5 .8 4 43-80 7.5YR 4/6 - s 0 sg ml cs - .7 1.2 5 ~ 80-114 10YR 4/6 - s 0 sg ml - - .7 1.2 common gy si coa s on pe s Boring # Boring Pit Ground Surface elev. 98.4 ft. Depth to limiting factor ' 125 in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-10 10YR 3/2 - sil 2 m gr ds cs 1f/m .5 .8 2 10-15 10YR 3/2 - sil 2 f sbk ds gs 1 m .5 ~ .8 3 ji 15-24 10YR 4/3 - sil 3 f sbk mvfr gs 1 m .5 .8 4 1 24-50 10YR 4/4 - sil 3 m sbk mvfr cs 1 m .5 .8 5 50-100 7.5YR 4/6 - s 0 sg ml gw - .7 1.2 6 I - t00-12 10YR 4/6 - s 0 sg ml - - .7 1.2 common gy si coa s on pe s - `Effluent #1 = BODE > 30 < 220 mg/Land TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L - ~- - ame ( ease not i n ure: um er Henry F. Grote ~ 222774 Address Certified Soil Testing Date Evaluation onducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 8/21/2001 715-233-0398 ~~ Property Owner Horne, Einar Parcel ID # CSM Pending Page 2 of 4 g k Boring Borin # Pit Ground Surface elev. 97.8 ft• Depth to limiting factor ~ 110 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-6 10YR 3/2 - sil 2 f sbk ds cs 1f/m .5 .8 2 ~ 6-31 7.5YR 4/4 - Is 0 sg ml cs 1 m .7 1.2 3 31-44 7.5YR 4/6 - s 0 sg ml cs 1f .7 1.2 4 ~ 44-80 10YR 4/4,4/6 - s 0 sg ml cs - .7 1.2 5 80-110 10YR 6/4 - s 0 sg ml - - .7 1.2 -1 to - as a er soi s t an -4 to - ; consi era a gr co st in onzon w occasiona s poc ets ^ Boring # Boring Pit Ground Surface elev. 90.4 ft• Depth to limiting factor ~ 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-12 10YR 3/2 - sl 2 m gr mvfr cs 1f/m .5 .9 2 12-41 10YR 4/3 _ Is 0 sg dl cs 1 m .7 1.2 3 1 41-53 10YR 4/4 - s 0 sg dl cs - .7 1.2 4 ! 53-96 10YR 4/6 - s 0 sg dl - - .7 1.2 -- - ~~ ~ i ^ Boring # Boring Pit Ground Surface elev. 89.8 ft. Depth to limiting factor 64 in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 ~ 0-3 10YR 3/2 - sl 2 m gr ds cs 1f/m .5 .9 2 !. 3-9 10YR 3/2 - sl 2 f sbk dsh cs ~ 1 m .5 .9 3 ! 9-18 10YR 4/3 - sl 2 m sbk dsh cs 1 m .5 .9 4 '~ 18-31 7.5YR 4/4 _ Is 0 sg dl cs 1f .7 1.2 5 ', 31-64 ~ -- 10YR 4/6 - s 0 sg dl cs - .7 1.2 6 64-ti9 10YR 4/6 f2p 7.5YR 5/8 s 0 sg ml as - .7 ~ 1.2 7 ~ 69-74 10YR 4/4 c2p 7.5YR 5/8,5/3 sl 0 m mfr - - .3 .5 '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 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-8310 (R 07/00) Certified Soil Testing r - ~ ~r ,Property Owner Horne, Einar Parcel ID # CSM Pending Page 3 of 4 Boring # Boring Pit Ground Surface elev. 91.2 ft. Depth to limiting factor 64 in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-9 10YR 3/2 - sl 2 f sbk ds cs 1f/m .5 .9 2 9-23 10YR 4/3 - sil 2 m sbk dsh gs 1f .5 .8 3 23-44 10YR 4/4 - sil 2 m sbk dsh cs 1 m .5 .8 4 44-68 10YR 4/4 - s 0 sg ml cs - .7 1.2 5 68-84 10YR 4/6 - s 0 sg ml cs - .7 1.2 6 84-87 10YR 4/4 c2p 7.5YR 5/8,5!3 sl 0 m mfr - - .3 .5 common gy si coats on pe s -4 Boring # "--=i Boring ~, Pit Ground Surface elev. ft. Depth to limiting factor in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I ^ Boring # ;Boring Pit Ground Surface elev. ft. Depth to limiting factor in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ------ i ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L s- 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.07/00) Certified sai resa~y i .1 q.N \~ .O h N Q~ ~ + ` O ~ ~ ~ A, u~ M za ~ '} z4.q}' LGL ~J t+. tti1~~4. ~ ~3~y LT.\a~t~ uw bla.~~/x aw` r q l Z.. ..a{ l ~ac.J~ l r • ~s.~t~..s^ ~ tiLl. ASK ~s.'i .~ 2 ~~ a.l i 0«1 at,Z ~~ ~ ~e. ar ~N. a ~ S S c. L ~o ~...~ xw a~ b~ ~ S ~^ 4 ~.~.~ .,~~,Ywn' v.. q -. L Z.. a-.,..LI S - 2.}~x kr.sY' s.~, 5 !; ~.. ~OM ~or.q .~ ~,. ~c.y, ~. ~ `6q. t SB~c.$ Y~ ($$.a.1 ~ $q•a gl.o1 ,~. l V~ 13-b '~5~s~, ~ Y4.¢~ qn `~~1e .~ ~-- ~-- (a r.z.) ' `(a 3.4~ all f5 W ~k. Z . b ...~-. . cc S" ~ Z v ~ ~ C... ~~ 9L•~ 1 { •' c9 ~- 2 , l-4 0. M a. ~yw(~ N ~ . K ~ - tl - 21t - ESL `,,, 3.~~~„~ wsww ~z~ R~ ~ . ~' `~ "`~ ttI w w o~. S ~; Q~.li... - 011 c~+~'vw ~1L 1~.ri qt.c ~.$4.L) ~ I' ~~~ C- I ~,~4•E1~ ~go.4S i'il•'S~ ~n.~~ ~ , ~ ga9b~43•z.~ ~~ c ~-c, n o•~'l.Jl Sk..n ~~ ~~ ~~~ X40 C~ws~ +- ~ n~* t n -3 3Z5'•4t' / ~'-1 /~ 1 g~.t ~.~~ 4 ~. ~ _~~ ~ pp ~ ih <oo.o) .. 44. L System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715-772-3214, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . [f the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. ~. Garbage disposals are not recommended; if you must have one, use it sparingly. 6 No paper products other than tissue should go into the system. 7 No chemicals should go into the system. 8 Avoid surge flows of water; try to spread laundry throughout the week. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. ?. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required ifthe combined scum and solids volume equals one third of the tank volume. 3 When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. ~. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7 ,Avoid compaction such as vehicle traffic within ] 5' down-slope of the adsorption system. 8 Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.4 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 7 Mailing Address c~ ~/ ~f ~ ~ f ~`' v ~r~ Property Address (Verification required from Planning Department for new City/State 'lti~ ~~~ ~2nn L~-~'~' Parcel Identification Number a~~~ !C3 ~f ~" ~ LEGAL DESCRIPTION Property Location ~~ 1/<, Subdivision Certified Survey Map # Lot # Z Volume _1~ .Page # ~O/~ Warranty Deed # Volume .Page # Spec house ^ yes ~, no ~ 1/., Sec. 2 I . T Z,~N-R /J~ W, Town of 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 masterplumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a three year ex tion date. ~ ~ ~?~, v 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 pr erty describe bove, by virtue of a warranty deed recorded in Register of Deeds Office. /~ ~ Q ~ SIN ~ O PLICANT 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 . ~ w~~ 171.8PA~_4~9 ~ ' STATE BAR OF WISCONSIN FORM 3 - 1992 656564 DOCU-MENT No. QUIT CLAIM DEED ~r ~ ;:, G:[5 TEF OF DEEDS RECE'iUED FOR RECOkD )-14-200; 9:30 An OuT C~AIn DEED E?:EnRT a CERT COPY FEE: :O~~i FEE: iRANSFEF' FEE: 45.00 EIVAR D. HORN E, Grantor, uit claims to CHRIST THE KING q ~:e~ORDlNS FcE: ':. DO LUTHERAN CHURCH OF WILSON, WISCONSIN, INC., a Wisconsin SAGES: corporation, Grantee, RETURN TOt Barry C. Lundeen, Attorney the following described real estate in St. Croix County, State of Wisconsin: Iio Second Ecreet Hudson wI Sa016 Parcel ID g00a-1098-20 Part of NE-1/4 of NE-1/4 of Section 21-28-15 described as follows: Lot 2 of'Certified Survey Map filed December l9, 2000 in Volume 14, Page 4010, Document Number 635535. 1 hls is not Homestead property. Dated this ._~ tiay of ~~~~~" ~~ 2001. `""-'i- SEAL) Einar D. borne AL''CHENTIC,~'TION Signamrc o(Einar D. Home authcnucated this day o(--\y--J-' ,~`' r~ C. TfTLE: MEMBER ATE DAR 0 WISCONSM I f not, _ awhori ud by q 706.Oti, Wis. Stars. ACKNOWLEDGMENT STATE OF WISCONSIN >ss ST. CROIX COUNTY Personally came before me this ~ day of SEt'rt ri 6tR, 2001, the above named Einar D. Home, to me known to be the person who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Barry C. Lundeen, Attorney n1 ;; UG t, PORTER, LUNDEEN & SEGI;IN, S.C. i la Second Str<et, P O. Box 469 htudson. Wisconsin S4Uti Notary Public, State of Wisconsin My Commission (cspircs) _ u I_ _ ~ p- U ~ _ i~ignatures may be auehenucatrd or acknowledged Bolh are not necessary) 80NITA A. KOPCHINSK! NOTARY PUBLIC ~uoo ut penwu nw my lr. u~y capciry sAUUW be ryye4 or pnn4J OtbW Wen uywmres STATr ^- 'rtSCONSIN Qli1T CLAIM DEED STATE BAR OF WISCONSIN FOR'yt No. 3 - 1982 ~~~ ~~ t ~` ~, 1~ f_I ~I ~. ~~~ r ~~~~ f ~ ~ ~~ `~~ ~'~ ~ _ d , ~ I ~ ! ' i OWNER ~ EINAR HORNE 429 STAGELINE AOAD HUDSON, WI 540 DETAIL NC SCALE ~~ ~~ on b O~ a o ~ Z a 64' N89°55'44"W 100.60' ACCESS RESTRICTION NOTE. CER~'1 FBI ECG SURVEY MAP LOCATED IN PART tJF THE NE1I4 OF THE NEll4 OF SECTION 21, T28N, R15W, TOWN OF CP.~)Y, ST. CROIX COUNTY, WISCOSNIN. NOTE A 314' REBAR FOUND N00°23'29'W 5 9T EROM SET LOT CORNER SCALE IN FEET 1" = 200' _~ ~ ~w~~~G^Q~~~~ ~G^1G1D`u 20~ 0 2ao aoo O~n1a~D D~' 04~L~G3~ SEf ~ D`~A~L o ~~ 0 ~3'2T'vV 1323.22' n w N1la CORNER - ~" SECTION 21 As owner I hereby restrict all lots antl blocky so that no owner, possessor, user, licensee, or other person may have any right of direct vehicular ingress item or egress to any highway lying within the rght of-way of STN ~ 8 oa t i expressly intended Thar t''w restr~cuon constitute a restriction for the benefit of the pubic as c•owded ~n s.236.293. Wisconsin Statutes and may be enforceaoie by the beoartmen. or its NO IMPROVEMENT NOTE Ne improvements or structures are allowed between the right-o(~way and the setback line. Improvements include but are not limited to signs, parking pots, paraliei anveways, wells, sepuc systems, cra~nage facilities. etc., it bung expressly intended th; ;this restriction mall constitute a restriction for the benefit of the public accortl~ng to section 236.293. Wisconsin Statutes and shall be enforceable by the Department of Transportation. Contact the Wisconsin Department of Transportation District Office for more intorrnation. The phone number may be ootained by contacting your County Highway Department. NOISE ABATEMENT NOTE The lots of this land division may experience noise al levels exceeding the levels in s Trans 405.04, Table i. These revels are based on federal standards Owners of These lots are responsible for abating norse sufficient to pro[ect mese loss I~ I~ ~ I~ I~ 'o ;~ ~~ ~ ° I~~ Ir ~ ~ 10 ID o ~ ' I a° I~ rrt ~ I~ i o Ic ~~ I;rf~ iU i~J i~ 1 NORTH LINE OF THE ~ IEila N89°53'27"W 1173.15' m Z ~ NE CORNER 444._,; m a ~, SECTION 21 3~TH AFL-. 728.9T w ~ 93' w NB9°53'27"YJ 1112 ~aa396 N89°55'4 'W NOTE A g . o 8 N ' , 10Q60' I I R ~ ~ n Imo,' I~ . ~ ° ........ . .......... ..... ......... . ... ~ '; .. -.~ !~~ I < D ~~ I ~ N . ~ rn L01 21NC. R/W ~ i ~ LOT ]INC. RNJ 969 SO ~x 22 o p ° m ~i ~~ 1 = rn a w 26'~"377 SO FT ~ m R S , I ; 5.096 ACRES ~ m ~ w p m , ~~ I I 0 6.YJOAC ~ E ~~ LOT 2 EXC R/W 3a~ ~ i ZZ' b LOT 1 FJ(C RIW ~ ~ ~ ~ N ~ D 7J n S mo, U ao I~ . ~ s SO Ff ? 7 ~ k FT ' ~ ~ 23 ,322 s l ,;~ j1< ~ I ~ 207,313 SO ~ ~ - ~ ~ I SA48 ACRES ~ j.. ~ 4.759 ACRES A m O ~ 3 , ' I~ I[~ '25.'2 ' ° " ' 206.32' ~ i 50' HIG"v~tv`~ ~ D '"' S89 27 E 936.04 53 SETBACK PER ~ ~ ~~'-~~ cn ~ TRANS 233 ~ ~ ? i ~ ~ I„SO~U I ~ I~ o ~ }~r--~~e S89°53'27"E~337.8T _ 1= ° ~. ~ a ~ °' °' OLD MO~ ~ ~ ~ ~ pQ' ~ ~~~ ~ o _ ~ ~ ~ - - ,1 00 G9a~D D~'I 00 4~~~~ im i~ I LEGEND ALUMINUM COUN i .SECTION CORNER MONUMENT FOUND ~ 1' IRON PIPE FOUND ~ 1' X 2a' IRON PIPE SET WEIGHING 1.13 LBS PER LINEAR FOOT 314` REBAR FOUND ~ 1-114" REBAR FOUND ~ EXISTING POWER POLE ~s EXISTING SEPTIC VENTS EXISTING WELL ~ SOIL BORING EXISTING FENCE'_INE 100' ROADWAY SETBACK LINE r I / z w0 ~~3 pw~ H N N LL ~ ~~m z~z wwQ eu~~ ~ww w F- m ¢ 0 ww~ ~~o Qww cn '_ ~ C7~~ Z - N QjQ THIS INSTRUMENT DRAFTED BY EDWIN FLANUM w 0 m (n N JGB N0 99-157 DATE a-t2-00 e~. GOULDS PUMPS Submersible Effluent Pump Q EP04 3 U ~ ~ EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: /a'"maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/z° NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTOW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~' Canadian Standards Assodation (CSA listed model numbers end in "F" or "C".) Goulds Pumps is ISO 9001 Registered. c a u s a c a c cc,Paclrr Goulds Pumps ©2000 Goulds Pumps Effective February, 2000 63871 ITT Industries 0 2 4 6 8 10 12 m~/h