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HomeMy WebLinkAbout004-1061-60-100/Visconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM . INSPECTION REPORT GENERAL INFORMATIOI~~ ~ (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 Voelker, Cherl Cad Townshi CST BM Elev: Insp. BM Elev: BM Description: l0~- a /Ol~~a TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / ~~0 Dosing ~d Aeration Holding TANK SETBACK INFORMATION TANK TO P/L+ WELL BLDG. Vent to Air Intake J ROAD Septic '? ~ I ` O.. f ~ Dosing ~ / ~ S,2 v Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number n ~ ` ~/ /~ TDH Lift I o. Z Friction L ~ System Hemet lo• S TDH Ft Forcemain Ler~tS ~ Dia. ~ /i Dist. to Weyl b~ i SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Be~hrt}a~c / Alt. BM STS Ccva /tea. S'i Bldg. Sewer d•7 1S•92 SUHt Inlet !~ ~~ SUHt Outlet / _. Dt Inlet ~- Dt Bottom ~G, q1. a~ Header/Man. .y~ o/. ~ Dist. Pipe ~ b~ S y r,t`S' /D/ L Bot. Systeryi (?.yl (p, 13 ~ ad Final Grade / .L ~ ~ /O ~ St Cover ,,. S Z S / p V '~d f ~(~. ~~ 7• ~ g9 2~ BED/TRENCH DIMENSIONS W idth ~ Length ~ No. Of Trenches ~ d PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~ 7 . ~ SETBACK SYSTEM TO P!L BLDG W L LAKE/STREAM AC Manufacturer: INFORMATION CHA R OR Type f System: ~~ y T ~ 55 a ~ UN Model Number: ` ~ UIJ I K113U I IVN SYS I tM "'' ' ' ° `" G.~rrw+ n' ~~~. ~J,(/~ti , ~,(~_pL! r•,~,o Gn Header/Manifol ~ ~• ~ Distribution pipe(s) ` ~ J ~' I' ~ ~ ~ x Hole Size I N / x Hole Spacing Z d, ~" 5 Vent to Air Int e ~ ~ ~ ~ Length Dia Length= Dia Spacing 0 SOIL COVER x Pressure Svstems Onlv Depth Over .r Depth Over p Bed/Trench Center ~~y.~~ ~ j-J " Bed/Trench Edges Topsoil [~ Yes No ~ ~._ Yes [ _;, No i COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / ~3 Lo a ' n: 3156 S Hw 29 Wilso , WI 54027 SE 1/4 SW 1/4 26 T28N R15W N Lot 1 ~ ,~,, ~~/ P rcel No: 26.2. 1.)~I B escrip ion =3~~~ > > ~~ ~ ~~~~ 2.) Bldg sewer length = 6~ 1 Y~'~ J ru~~ -amount of cover - ~ ~ 7 ~ ~~~~ .. . r~ -rI-- i Ir - _ - - - ` ~ ~- - - - Plan revision Re uired? Yes No Use other side for additional information. _._'" ;_~ __i ~ ~ i ~~- , ~, I~~ _ ~S SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. ~~ J~ 'LtJ, iQ$ xx Mound Or At-Grade Systems Only~C'~/.~ C-rL~o/La~S~o2t.,,, {c.Q~) xx De th of xx Seeded/Sodded xx Mulched County: St. CrOIX Sanitary Permit No: 430000 0 State Plan ID No: (~ Parcel Tax No: D (JO 004-1061-60 Section/Town/Range/Map No: 26.28.15. yl~/ nra ,rnS Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 ST CROIX ~scon~n ~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 ~~ ~~ Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide TRANS ID# 856909 may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information -Please Print All Inform ion RECEIVED # 31~ ~ ST' ~-w Y Z ~J Property Owner's Na me Parcel k Lot # Block A CHERYL A VOELKER MAY 1 9 2003 ~ /06~ -:oo oao -- Property Owner's M ailing Address Property Location ST. CROIX COUNTY 3154 HWY ~y ZONING OFFICE 26 SE •k SW y S i City, State Zip Code Phone Number ,, , ect on 4dILSON WI 54027 715/772-4514 (circle one) ~ 28 N 15 II. Type of Building (check all that apply) ~ ; R T E ot owti~ ~ ~ Sw Pi S l }i i ~ CSM N be ®1 or 2 Family Dwelling -Number of Bedrooms 3 e[~~ a~e tt x v s um r /~, ^. Public/Commercial -Describe Us ~ ~ ` ~ , ! ~ P `f T9-( 7 / ~O~ d ~ ^ State Owned -Describe Use ( ^City ^Village Township of C.AI~Y ~ ~~ _ - _ III. Type of Permit: (Check only one box on line A. Comp ete line B if applicable) A. New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 1V. Ty of POWTS System: (Check all that appl ) ^ Non -Pressurized In-Ground ®Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber Drip Line ^ Gravet-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Q,Q q.- pD Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis sal Area Required (sf) Dispersal Area Pr posed (sf) System Elevation 450 -~-5(~ ~~ 0 450 --1-- 5~ ~ 100.57 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 00 WIESER CONCRETE ~o X Aerobic Treatment Unit 600 600 WIESER CONCRETE X Dosing Chamber VII. Responsibility Statement- I, the'undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plu ber's Si gnatur MP/MPRS Number Business Phone Number BENNIE HELGESON 220292 715/772-3278 Plumber's Addre ss (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundy~ater Surchar e Fee) ~ Date Issued Is ui Agent Signatur ( Stamps) ^ Owner Given Reason for Denial g / ~ 3Z~ ( ~ _ lX. Conditions of Approval/R e aso ns fo Di r sa pproval ~ ., _ G I.~p ~ n , ~ ~ ~' ~~ q , r+(yacn complete plans ([o me county only) for the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) ' P(a-t ~I a~, ~a s~ .L ~ ~ 1~`P of I ~ pug P•~ e __ ~11 (bO.bC~ -~ (1 '' ~o ~ ~ y ! ~. ~ t°.,P'e ~~ ~~ Sr4' Ito ~~ ~, J ~ Ga ~i ' $ 7c ~ i si.~P{ , ~ ~~ ~ , a" P f ~o~ ~Y~ ~`, ., Puc. ~:; 's Q-i'~ P~ i o ~ ~ ,~ ,' 'a~ . -~= ,~ i~ ,, ~y t?^cpc~S~~~ I Uoo~~Oa Gz~l. Qr-e poSecQ Se ~ 4-. c ~,l~as ~ ~Q.•• (/.. ~., 313~~Q Horn 1 r ~~ ~y~ ~~ \\ \~ \\ by i spa I-~ ~ '~= y y' ~xc~e~-~- ~ ~1~Ow~ ~4h v, ss ~ ~sc~ns~n 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 Jim Doyle, Governor Cory L. Nettles, Secretary April 15, 2003 CUST ID No.220292 I RECEIVED ATTN: POWTS Inspector BENNIE W HELGESON MAY 1 9 2003 HELGESON EXCAVATING W 1229 770TH AVE ST. CROIX COUNTY SPRING VALLEY WI 54767 ZONING OFFICE CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/15/2005 ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Cheryl a Voelcker Hwy 29 Town of Cady St Croix County SE1/4, SW1/4, 526, T28N, R15W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 899318 Identification Numbers Transaction ID No. 856909 Site ID No. 657821 Please refer-to both identification numbers, above, in all correspondence with the agency. 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 Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans. • Per manual cited on the index page, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Can~`~~~o~~u~'~,~ ~~~ BENNIE W HELGESON Owner Responsibilities: Page 2 4/15/03 • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 maybe made to me at the telephone number listed below, or at the address on this letterhead. The 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 jswim@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: CHERYL A VOELKER 3154 HWY 29 WILSON, WI 54027 PROJECT NAME: CHERYL A VOELKER 'AFC ~~~ ~ ~ q Fey ~ ~~~ ."~ ~~ PROJECT LOCATION: SE 1/4, SW 1/4 , S 26, T 28 N, R 15 W MUNICIl'ALITY: TOWN 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 WLP1000/600-MR ZABLE Tank Specifications Page 6 Pump Specifications Page 7 POWTS Owner's Manual & Management Plan - Pg. 1 Page 8 POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Signed Date: Apri18, 2002 DEPARTMENT TY CN~'8U LDINGS DtV15i0N OF ~ SEE GORRESP ENCE ~c..~:ut tea- ' C h~. ry ~ ~4 ~/oe 1 k ~"- i.~ w~. C~1" i ~ C v~ v~ ~ -r ~ e l c r s c, •ti ~ o~ c7 ~ /~ /~ <5 ~ 4 ~ ~(~ J ~ 5i•..p -fi F'~ ~ o ~ ~ 1 9~ ~' r ~s Q-3 ~~ ti~~ ~ ~~~ ~ ~~~ puL f'•~ e ~ sa GL~~ - " g 70 ~~ „ P c, - ~ a 11 (a©. an ~ - ~ ~Y~ ~1 ~~ ~ ~ ~ .~ C ;~ 8r y > to Nay ~ `( L .~ '~, ~ ooo~~oo Ge;~l . P.-epos e~Q S"~ r ~. ~ ~,~7~s <- ~7"a ~ ~.. ~, 313 ~ I-~on1 ,! by ~~ ~x~~~-~- s ~how~ J f~Kt-~ r~. Synthetic Covering ,~srM c 3.3 Medium Sand •~ Topsoil _ J - ~ E 3 ~~ % Slope C E L.if.O f 2~- 2 %2 Aggregate Cross Section Of A Mound Signed: License Number: Date: r-- ` - Page ~ Of8 Distribution Pipe ~leJ. foa,3`1 G /~ - c°o~ o Force Main Plowed From Pump Layer p ~ Ft. E ~ ~ Ft. F . 8 Ft. G , S Ft. q ~i Ft. H _,~_ Ft. 6 `7S Ft. K D• / Ft . L ~~ Ft. ~ ~,y Ft. T !~, ~ Ft . w a~ Ft Observation Pipe ~ K J g _ -_ • __, _ ~__ 1 r ----------------------------- --- A ~ - ~ -------------------------------__ - J W 4~ g . --- _ - -l _ _ _ _ __.- --- --- _ _, _ _ _ ~- . N Distribution E~l_L Of 2 - Z'2 ' Pipe Aggregate I r 36 S' ~ ~ws ~ r' ~~CG`" Observation Pipe Plan View Of Mound P 3pF J ~ ~! End Vl~w P.rlorole0 , PVC Pipt . En~ /'/Gull 401 Holes Located on Bottom are Equally Spaced F~rC~ i r« `/"//'CC T~O IC !VEIL[ TO ~(I Y1~~0{6i ~+ ~E'a4.c..~~~5 -a pitlrlDulloa.•• vip. Distribution Pipe Layout P 7°^' ./~~ rr . . R ' S 3 ~. /r X ~~ y a3 ~ ~ Hole Diameter ~ Inch Signed: License Number: . Dare: Lateral " ~ ~ Manifold " a force Main " ~ ~,A)VE~~ ~~~e~. ~p~e5 ~~- evri I k ~c~o ~-o- e~~S _ Inches _ Inches /o/. 0 7 ~ ~ 3 ~" ~~ C )ea~.o~ 1" Perlorot.d Plp. O.roll A.C~rS~ ~-~.f'~Gc~ L ~i y©~ 1 lC.~r Page~Of F~ . ~ SEPTIC TANK ~ PUMP CHAMBER CROSS SECTION AND SPECIFICATION 4~~ DV(. VENT PIPE 12" MIN. ABOVE GRADE E > 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE FINISHED GRADE ~~ 6 µ,n. 18 " I N . y~~ ~,U~ a~SER~T'o~! PIPE INLET ~- WATER TIGHT SEALS FINER A APPROVED B PIPE 3' ~~..x~~„ ~_ ONTO SOLID C SOIL PUMP OFF ELEV . GL3•~FT. D NEATHERPROOf JUNCTION BOX WITH CONDUIT APPROVED MANHOLE COVER ' W/ PADLOCK ~ WARNING LABEL 4" MIN. 18~~ MlN• VAPPROVED JOINTS WITH ALM APPROVED RIPE ' oN 3' ONTO SOLID SOIL OFF zy" ;, s. a. i~ ~ ~. GAS- ~ ~, TIGHTS SEAL r ~-* ~ , I ' 3" PPA ROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICAT•IO+NS ~ .{- '~,t1C _ Y~ \L'. \ ~S«.~ S LL LL? l ~c~ SEPTIC / DOSE ) C '~ S ~~' 7 ~~`'• 3, 3_.y.- x---~ TANK MANUFACTURER: ~Pr u'~ TANK SIZES: SEPTIC fODo s ~{ ~FLO BACKG DO ( ~ GAL. DOSE o• GAL. ~- = Ig L 6~ GAL• INCHES = ~Qj CTURER PACITIES: A S ~~~- (ru~STt"..-~ , . ALARM MANUFA - MODEL NUMBER. , o ~ B 2 _ 3 INCHES 3,.S~GA4• , SWITCH TYPE: ~ ~a- ~ INCHES = ~• S~° GAL. _ C - o PUMP MANUFACTURER: MODEL NUMBER : ' ~` 'r D = ~(~ erc a ~~~ INCHES = X107 ~O .C'AL' SWITCH TYPE: u, ~ ALARM WIRING A S PER ILHR 16.23. WAC REQUIRED DISCHARGE RATE (o GPM PUMP E VERTICAL DIFFERENCE DISTRIBUTION PIPE• AND BETWEEN PUMP OFF O FEET • ~ FEET . • . + MINIMUM NETWORK SUPPLY PRESSURE FEET FORCEMAIN X a.a FT/100 FT. FRICTION FACTOR ~ DYNAMIC HEAD j~_ FEET •- FEET ~~~ + ~j TOTAL INTERNAL DIMENSIONS • WIDTH DIAMETER OF PUMP TANK: LIQUID 6T.`~A~~~ ~~~ ' LICENSE NUMBER: DATE' S IGNED: 1/~8 TOP VIEW SCALE: 1 /4° 1' w" ~TAITC OUTLET .n , tT M ~~nr ~ nrw JVAIt: 1~4 = 1 ~a~8 WLP1000/600-MR ZABLE TANK SPECIFICATIONS DIMENSIONS: WALL: 3' BOTTOM: 3' COVER: 5" MANHOLE: 24` I.D. HEIGHT: 56" O.D. LENGTH: 150" O.D. WIDTH: 84" O.D. BELOW INLET: 42' O.D. LIQUID LEVEL: 36" WEIGHT: 14.795 IBS. INLET ANO OUTLET: 4° BORE MATH STOP FOR QUIK-TITE, FERNCO GASKET, CAST-A-SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLES: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) 4" VENTS LIQUID CAPACITY: 27.88 GAL/IN (SEPTIC) 16.76 GAL/IN (PUMP) LOADING DESIGN: 7' 0" UNSATURATED SOIL JLET N d ~~~~~a r~o~r~o~~~ W3716 US HWY 10, MAIDEN ROCK, WI 54750 800-325-8456 MODEL WLP1000/600-MR ZABLE SEPTIC/SEPTIC, SEPTIC/PUMP OR SEPTIC/SIPHON JANUARY, 2000 FILE: WLP10oo 600-MR . ~• ~1 . HEAD CAPACITY CURVE MODEL 98 125 6 -{ 20 r-3 7 ~ - W s Y t5 4 ~ 10 0 ~ 2 5 J U.S. GALLONS t0 20 LITERS 0 BO 30 40 50 60 70 t60 240 rLOW PER MINUTE 80 ooeer+ 4 3/16 a 3/16 SK1/02 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available with or without alarm switches. for variable level long cycle controls. [~~.. J.-J ..rl ......Iwl~. _ Wninh4 4Q the . +/, H.P_ 98 Series Control Selection Modst Yolts-Pct Mode Am s Sim lax Du lax M98 115 1 Auto 9.4 1 - N98 115 1 Non 9.4 2 3 or 4& 5 098 230 1 Auto 4.7 1 E98 230 1 Non 4.7 2 3 or 4 8 5 SELECTION GUIDE 1. Integral float operated 2-pole mechanical switch, no external control required. 2. Single piggyback variable level float switch or doublepiggybedc variable level, float switch. Refer W FM0477. 3. Mechanical attemator 10-0072 or 10-0075. 4. See FM0712, for coned model of Electrical Alternator. 5. Control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. CAUTION For infortnatan on additional Zoeller products rater to catalog on Piggyback Variable Level Switches, All installation of controls, protection devices and wiring should be done by a qualified FM0477;EIectricalAltema~r, FM0486; MedtanicalAltemalor, FM0495; SumplSewage Basins, FM0487; licensed electrician. All electrical and safety codes should be followed including the most Sit>pe phase Simplex Pump Control, FM1598; Alarm Systems, FM0732, recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - MAIL T0: P.0. BOX 16347 Louisville, KY 40158-0347 Marwlaclruers ol. . ~~ ~ SHIP T0: 3649 Cane Run Road L!7 a Lobe. KY 40211.1961 Qu,~rrPu~ S~~ /9.99 f PUMP £O. (sot) n8.2731.1(800) 928-PUMP httpJ/tvww.zoellercom FAX (502) 774.3624 ® Copyright 2001 Zoeller Co. All rights reserved. ~~(~ U~ p - 6 1/4 --~-I a S/8 -~j - l .L -~/8 1 1/2-11 1/2 NPT POWTS OWNER'S MANUAL ~ MANAGEMENT PLAN Page 7 of 8 ~u t= tNF~RMATION Owner CHERYL.'_A VUELK Permit # nce1RN aeaAMETERS Number of Bedrooms 3 ~ ^ NA Number of Commercial Units ®NA Estimated flow (average) 300 aVda Design flow (peak), (Estimated x 1.5) 450 aVda Soil Application Rate 0.5 aUda /ftz Influent/EffluentQuaiity Monthly average' Fats, Oil 8 Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 420 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality ,~ ^ NA Monthly average" Biochemical Oxygen Demand (GODS) 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 al ^ NA Septic Tank Manufacturer IESER CONCRETE ^ NA Effluent Filter Manufacturer ZABLE ^ NA Effluent Filter Model A-l0U 12"x 20" ^ NA Pump Tank Capacity 600 al ^ NA Pump Tank Manufacturer WIESER CONCRETE ^ NA .Pump Manufacturer ZOELLER PUMP CO ^ NA Pump Model 98 ^ NA Pretreatment Unit ~ NA ^ Sand/C~ravel Filter ^ Peat Filter ^ Mechanical Aeration O Wetland ^ Disinfection ^ Other. Manufacturer Dispersal Cell(s) ^ In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ®Mound ^ Dri -line ^ Other: • Values typical for domestic (non-commerGan wastewater and septic tank effluent. •• Values typical for pretreated wastewater. •..~~~~ ~ ~~AI'! Ant ~C11111 G IYIHIIY 1 Cryhl~a+c ~7vnca+v~.~ Service Event Service Frequency Inspect condition of tank(s) At least once every 2 ^ months ~ year(s) (Maximum 3 yrs.) Pump out contents of tank(s) ~ When combined sludge and scum equals one-third (X) of tank volume Inspect dispersal cell(s) At least once every 2 ^ months ~ year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 1 ^ months . ~ year(s) Inspectpump, pump controls 8~ alarm At least once every 1 ^ months ~ year(s) ^ NA Flush laterals and pressure test ~ At least once every 3 ^ months Q year(s) ^ NA other At least once every ^ months ^ year(s) ^ NA other. At least once every ^ 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 Servidng 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) shall 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, pretreatrpment components, and any other maintenance or monitoring at Intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servige 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: Ch A. Voelker Pase 7 of~ _ 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 cell(s) and may result in the backup or surtace 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 pertormance and prolong the life of the POWTS: antibiotics; baby wipes; c(garette butts; condoms; cotton swabs; degreasers; dental floss;'tliapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbkides; 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 property and safely abandoned in compliance with ch. Comm 83:33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property 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 code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction, and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a §uitat?le replacement area. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances Gi 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 reconsWcted in place following removal of the btomat 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 OXYCsEN. 00 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 MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name HE . Phone 715/772-3278 POWTS MAINTAINER Name Phone 715 7 - SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY ' ' Name JOHNSON SANITATION Agency ST. CROIX COUNTY ZONING Phone 715/273-5811 Phone 715/386-4680 ~ This document was drafted by the staffs of the Grean Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), VYtsconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GC1~VIf tai) Wiswnsin Department of Corimerce SOIL EVALUATION REPORT Page ~ of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code qty ~1r0/ Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must include, but not limited to: veNcal and horizontal reference point (BM), direction and Paroel I.D. ~?'~'• ~: percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ""' Re wed by ~~ ~ ' y~.~ -L. Please print all lnformatfon. 3 ~ ~ y Z ~ - 1/-z ~ ~ 3 Personal information you provide may be used for secondary purposes (PrNacy Law, s. 5.04 (1) (m)). P rty location property Owner ~ ' ~ ~ R c 1V Ep r GCG / Go l.ot .~~ 1/451/4 Sip T ~ ~ N R t!cS E( ~N ae f ~ S a~ property Owner' Mailing Address ~ 9 5 200 Lot Block # SutxL Name a CSM# N N~ iu~- 3 ~ s= ~y ~w - State Tip Code hone umber ~ N ^ ^ village awn Nearest Road . -w - ": Ufa lsah D r. is ~~ ... QcA .w C ®'Few construction Use: L~ Residential / Nu o adrooms ~_ Code derived design flow rate y~~ ~ ^ Replacements ^ Public or commerdai - Describe: ~ Parent material _ :' l d c s S .___ Flood Plain elevation if applicable ~ ~ I ~ ~ ~ ~ r' I .. 3 3 ~ ,S ~~ o(, fc r<c~e r- ~ ' ~ ' ~ General comments and recommendations: ~S,E _ ~ ~ c,J c k 7 ,s ~ c r capper eaP3~ B~ C~c/~ D~. COK~{o~V- 99.e1y /" l O~.t t~~ ..S 5 t~C t.~ ~~e U . /PyO~ s7 . , ::~~t (~~ ~ Boring I 7 I Bones # r:"i/ r_.,,, ,,,~ ~, ~~ra~A Aia~ 1~~ ~.~ft. Depth to limiting factor ~ in. ~„t, en~,~,~, ~~ , ~ Horizon Depth in. u ru __-- Dominant Color Munsell ~ ~ D ~ -_ Redox Description Qu. Sz. Cont. Color 3d ~.s ya Y~ Texture Structure Gr. Sz. Sh. Consistence f Boundary ~~ v / / v ~ -- •Faf#1 S - ~ 'Eff#2 ~ .. .,.,~_.: r--i n Q,..~.. ~, Boring # of Pit Ground surface elev. ~.~ ft. Depth to limiting factor ~ ~~ Rete d Roots GP D/fE "~ Horizon Depth Dominant Color Redox Description Texture SWcture Consistence ary Boun 'Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ ' ''f ~ ~ b ~ o ~ ~ - !oy ~I tt ~ ~-~ 10 ~` sd a ` uK ro ~ wt S . l < 220 mglL and TSS >30 <_ 150 mglL 'Effluent #2 = BOD _< 30 mglL and TSS _< 30 mglL 'Effluent #1 = BOD > 30 _ CST (Please Print) Signatu GS~f Number . ~~ ~~~9~ ~ e esa Address /~ Date Evaluation Conducted Telephone N r ~~G- U Page ~ of -~ -7~~ `~ Parcel ID # 4t 1 ` _ , ~ --t''°'~"` Property Owner -` '~ " ~ ^ Boring ~.g - _ . __.. a Boring # [~-~ Ground surface elev. ~'7 6 ,~ft• Depth to limiting factWr ~n• Soil icatbn Rate ._ .._.. ~ " cture St Consistence Boundary Roots GP D/fP. Horizon Depth Dominant Color Redox Description Texture ru 'Eff#1 . ~.. 'Eff#2:. in. Munsell Qu. Sz. Cont. Color Gr: Sz. Sh. r -v S ~ ~ `~ . j ~ 51k ~- ~,,,, , z , 0 3 lo`I 7.sy2 oy ~ ,~,. ,~ ~ ~ Iy f 0 ^ Boring Boring # Soil ^ Pit Ground surface elev. ft. Depth to limiting factor in• Horizon Depth Dominant Color Redox Des(xiption Texture Structure Consistence Boundary Roots `Eff#1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. .r Boring ~, a goring # Ground surface elev. ft. Depth to ('uniting factor ^ Pit Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ° ., F .E~ soil k;ation Rate GPD/ff 'Eff#1 `Eff#2 Effluent #1 =BODE > 30 _< 220 mglL and TSS >30 _< 150 mglL 'Effluent #2 =BODE _< 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 oc need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6/00) ,~~~ 3 ~ ~ 3 ~ .ti ` ~ ~ y 1 1 ' ~ O ,~ ~ ~ ~ ~ 1 ' ~~~ ~ %' / / ~!~> y 3 76 ~ ~ / ~~ ~ ~' , " i .~ ~~ ~~ aye ~ ~?, 51,p~- ~ ~. ;B~ ~ ~ ~ ~~° Tod ~f ~~ RUC i~~io~ ( ~a~~J~`l~ © -~ v g~~!' i JV ": ~ lea 1-e I 4 C~ ~, L a _ S~ioww ~~~~ ~pra~s~~ 3 L~~Q ~ovn c~.E(c~. lc~3,2 ~-. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address ~ ~ ~~~ S+~ ~' Z ~ ~~\~-~-- (Verification're-quired from Planning Department for new construction) City/State `~/! 11 ~~ . I~CJ._ I~ _- P~'cel Identification Number ~(,~~ ~ ~ b ~ ~ - ~~ "b~~~ LEGAL DESCRIPTION Property Location ~~ '/,, ~ '/a, Sec. a1~ ,Taft N-R /S W, Town of Subdivision ,Lot # ~ l Certified Survey Map # '7 / ~ ~ a `/ ,Volume ~ 7 ,Page # ~~ ~ `~ Warranty Deed # "1 a u ~' ~ ~ ,Volume a a 3~ ,Page # 55 S Spec house O yes ®no Lot lines identifiable O yes O 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, restricted plumber or a licensed 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 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 day f the three yea i tion ate. !~ IGNA 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 th r erty scrib o b virtue of a warranty deed recorded in Register of Deeds Office. c ! ! GNAT 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 l 2236!' 555 • STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Stanley G. Voelker, a/k/a Stan Voelker and Carol A. Voelker, a/Wa Carol Voelker, husband and wife Grantor, and Cheryl A. Voelker, a single person Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, ff Wisconsin (if more space is needed, please attach addendum): of f Certified Survey Map recorded with the Office of the Register of Deeds for St. Croix County, Wisconsin on the 9th day of April, 2003 at 1:00 P.M. in Volume 17, Page 4494 as Document Number 716604. Exceptions to warranties: None. Dated this _ day of ~ p r ~ ~ , 2003 s s AUTHENTICATION Signatures ey oelker, a/k/a Stan Voelker and Carol A. Voelk of Voelker au o r ~, ~ , 2003 ~. II• x^=•• y. OF WISCONSIN aul.~teF _ ~ 06.Og,,Wis. Stats.) THIS GINS MEN'f WAS DRAFTED BY Jorv R Gavic Spring Valley, WI 54767 (Signatures may be authenticated or acknowledged. Both are not necessary.) Names of persons signing in any capacity must be typed or printed below thei 720856 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. ~ MI RECEIVED FOR RECORD 05/09!2003 09:30AT1 MARRANTY DEED EXEMIpT ~ 8 REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address Jorv R. Gavic Gavic Law Offices P.O. Box 400 Spring Valley, WI 54767 Parcel Identification Number (PIN) This homestead property. (is) (is not) Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. s Notary Public, State of My Commission is permanent. not, state exprratron ate:...-.. •) ~gturg, Information Professionals Company, Fond du Lac, VN 8001iSS2027 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -1999 * Carol A. Voelker, a/k/a Carol Voelker ACKNOWLEDGMENT STATE OF ) ss. County ) RPR-21-03 MON 17:07 LANDMARICL LAND SURVEYING 17157723441 P.01 at-+-° ~ 7 i. 6 C~ rzr 4 VOL 17 PAt;F. 4494 R£C6IV~9~FQii'kECC 04/05/003 B1>'8Q REC FfiEf 25.80 CER7lF1EO SURVEY MAPp°~ES=~~''~° L OCATfO t N THE 3f 1 s4 OF THE SW 1•+4 OF SECT f old P$, T28N. R t OW, TOWN Of CRDY, ST.CROIX COUNTY, WlStGNSfk. PREPARED FOR: APi~fi~~4 ~ STANLEY YORKER , ~.cr~a%cai„r*r .UMPtA,TT~Q ,J<,ANDS ~awnm,~,.,,.,,_..,..t..~..__ ... RPR 0 " 2003 N88.54' 20' E !S(QjE; BEAR rNGS ARE SOlJrN TS rji L tNER~CTH W g E 250.00' fsr,GROJx ca,Nrr ,rx,,~.~„~„r„~,,,,, ,,,.,,~spl CGORDJNaTE srsTEMt. approval sale aoprovai sneb Ge ~e-2Q-seer-2ooa C' ~ p~p O y ~ : ~b ~> ~ LOT ~ ~ .n :m O 3.00 ACRfS ~ ~~ :M ;p ~ l30, Tao SO. J; T. rn :ti ~r :fi ~ :ti :~ r •° w o :~ 8 ~ ,y _ w~ Auk JAMES M. 1NESER SB8° 4~'W `i ~ ~ I a~~ ce r y'UA (~ - w . n ~' g~$ JAIYES N. N S-l8O4 g ~~ bG ~ tANOMARK 3URYEYJNG O AT -~\ ~ S~ n ~ ~ Z D ED ~ • ~ ~ ~ p'~ Q'J94£ Ric +~t~4 ~3 -Z~^o~i 6 ~ ~ Nre 3~'-~ ' ~ ~ 9 w ~ I i 'Q r /~ INC,RE9S AND EGRESS EASEAENT 6 ~ ~ ln vaone arse PAO b78 ~ ea, eY~ h/ ryr~ q' ~ ~~ ~~" ~~ a r~~ tom'" o N d set•2T' Ja•J5 it ~ exJSrrN~ Via: oo~'f, saz°~r' qr•w ~ SW CORNER OF S£CTlON ~ ?6 1F¢fjND 1' DR f YE -~ `-' ~ IBP.68' NB ~ ' ~ ~ aa, oa' ~- . JRON RJFEJ. 7 2T I W WIDTH YARIES $, ~+ H - -- -- " 29" ~ - • S !~4 CORNER OF SEGTfOH~ - - - ~. ., ~ ^, _ ~ Pfi. MOUND ALUMIMUM MDNUAENr), O sr: T r' O. D. x r 8' 1 ROH P J pE +1~fcarNO r. rates J3ER LrNEAR FOOT. ACCESS RESTRICTED. SEE NOTE 0 ~._;~,,, Sh1EET ,s OF 3. NO DIRECT ACCE'S ---.~ ~~ CER T ! F 1 ED SURVEY MAP t.OCA7f0 tN THE SE !r4 OF THE SW I/4 OF SECTION P@, 7>?~~It~bV~/i OF GARY, ST.GROIX fQtJN~Y, wl3cgV5rN. sr.cROlxoour~n' • aP+~ o ~ zao~ If ndt recar°ea wiuun 3UBayaot gpPrm'a1 date aDD~'MI shat[ Ite DESC~tIPTIUN °,~~~ ~r,~ ~^,^ A parcel of land located in the SIv /. ofthe SW %, of Section 26, T28N, RISW, Tgwr1 of Cady, St.Craix County, Wiswnsin, more fiulIy described as fbilows: Commencing at the S % ~rrter of Seetian 26, T28N, Rl SW: Thence N89°54' 12"W along the south line of the SVv 1/., 555.41'; Thence 100°05'40"W 570.70' to the l'tSINT OF $lrGiNMNG: Thence coniinuir-g N00°05'40"W 523.00'; Thence N$4°4'20"E 250.00'; Thence S00°05'40"l/ 523.00 ; Thence S$g°54'20"W 250.Q0' to the point ofhegirmittg. Contains 3.00 acres (130,750 Sq,Ft.}. Together with a 66' wide ingress and egress casement recorded in Volume 2186, Page 578. SLJRVF.YGR,, ^~FRTIFICATE I, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wi scansin Statutes and the provisions of the St.Croix County Subdivision Ordinance and under the direction of Stanley Voelker, I have surveyed and mapped the hereon described parcel of land and that this map is a correct reprcaentation of the boundary thereof. Dated this ~3 \zT day of O.isg~ ,2002. James M. Weber S- l 804 JAME$ M. wi{tom i110f SHEET 2 OF 3 20(}2100A This insttument drafted by Jim Weber CERTlF !ED SURVEY MAP lOGATEO !N THE SE ti9 OF THE SW !~4 of s£CrIt7N 28, raeAP~~~~~- ~ CADY, ST.CRO/X COUNTY. tVISCONSrN. Ftannrn7~~~^^+'•eo+•~~r;~~,x~lune APR Q ~ 2003 U 2186P S?8 EASEIIEN'P D]® Document Number This Easement Deed, made between Stanley G. Voelker, a/k/a Stan Voelker, and Carol A. Voelker, a/k/a Carol Voelker. husband and wife Grantor, and Cheryl A. Voelker, a single person Grantee. Grantors hereby give, grant and convey to Grantee, and Grantee's heirs, successors and assigns, if any, a permanent 66 foot wide use and access easement for ingress and egress purposes located in the Southeast One Quarter of the Southwest One Quarter of Section 26, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin, more fully described as follows: Commencing at the Sl/4 corner of Section 26, T28N, R15W: Thence N89°54'12"W along the south line of the SWl/4 , 655.44; Thence N00°05'40"W 375.71' to the POINT OF BEGINNING: Thence continuing N00°05'40"W 194.98 ; Thence N89°54'20"E 66.00 ; Thence S00°05'40"E 143.00 ; Thence S76°32'39"E 243.00 ; Thence S15°20'S5"W 226.68; Thence S87°27'18"E 100.00; Thence S02°32'42"W 66.00' to a point on the North line of S.T.H. " 29' ; Thence N87°27'18"W along said right-of--way line 182.68 ; ,Thence N 15°20'55"E 241.14 ; Thence N76°32'39"W 226.97' to the point of beginning. Together with all appurtenant rights, title and interests. Dated this day of l ~ ~ f C ~ , 2003 • .AUTHENTICATION Si¢na s Stanley G. V el and Carol A. Voelker thenticated thi ~ day of~ i ~ ~ 2003 - •- .~ '' JO[:V ~Vi x - TIC:, E T 'I'E BAR OF W SCONSIN ,.. (•- o ' • •'•~-ith , ;706.06, W' . Stats.) iii,'' .y /~ • • rt 1,,a ''~,,,• THIS •1 UMENT AS DRAFTED BY Jorv It. ~ta~it"~ Spring Valley, WI 54767 (Signatures may be authenticated or acknowledged. Both are not necessary.) l~. ~ 1 5rb35 KATHLEEN H. HALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03/28/2003 i1:i5A1! EASEMENT EXEIPT ~ 8 REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Recording Area 1 Name and Return Address Jorv R. Gavic Gavic Law Offices P.O. Box 400 Spring Valley, WI 54767 004-1061-60-000 \ Parcel Identification Number (PIN) This is not homestead property. (~iac) (is not) ~~ * Stanley G. oelker,a/k/a Stan Voelker • Carol A. Voelker, a/k/a Carol Voelker ACKNOWLEDGMENT STATE OF ) ss. County. ) Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public, State of My Commission is permanent. not, state exprratlon ate: 'Names of persons signing in any capacity should be typed oc printed below their signatures INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800-655-2021 11 Out Ie;urCUU r.c~m •stl days o- epprortl Cola approval sn8n na fi~il{ Cn.l .....~f A~,c~s~ RFSTR/CT,'ON CLAUSE Ail tats and btpcks are hereby resMCt6d so that no owner, possessor, user, licensee, or other person may Have any right of direct vehlcutar ingress fmm ar egnsss to any highway tying within the right-of- way of S.T.N 28; it is expressly Intended that this restr9et/on constitute a restrietlon /or the benefit of the publlC as provided In 5.236.293, Stets., and shalt be enforr:eaDle by the department or its assigns. Any access shelf be allowed only by speC7e1 exception. Any access allowed by special exception shalt be confirmed and granted onry tfrrough the driveway permltting process and dJl permits ere rBYOCab16. " HIGHWAY SE7$ACK RESTRIGTfdN "No improvercents or structures era allowed between the right~f--way line and the hiyhwey setback line. Jmprovements and strtrctures include, but are not flmited ta, signs, parking areas, driveways, welts, septic systems, drainage facilities, buildings and refaining wefts. !t is expressly intended that this restriction is far the beraeflt of the pabllc as provided in section 238.253. Wisconsin Statutes, and shat! be enforceable by the Department of Tirrnsportatian or its assigns. Contact the Wr'aconsln pepertmsnt of Transportation for mare information. The phone number may be obtah'ied by contacting the County Nlghway department.' NQTE: "The Wisconsin Department of Transportation has granted a Spec/al Fxceptlon to trans 233 for the exlsting access, as shown on this map. Addttlonal land dtvlslons, change In land use, or future highway project(s) may require a public road intersection Gr relocation of the driveway to an alternative publk road et the dlseretron offhe department." JAMES M WEf3~R ~ b11304 SPRtWf3 VAU.SY, Wt Qi SHEET 3 OF 3 2002t00A This instrument drafted by Jlm Weber V01.17 PBge 449Q