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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division < INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Waidelich, Adam C Ion, Town of CST BM E/le/v~ ~ Insp. BM Elev: BM Description: ~J ~~ / ! VIZ ~+ ~ TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~G ~ Aeration Holding TANK SETBACK INFORMATION TANK TO ~ PI W~ BLDG. Vent ro Air Intake ROAD Septic ~ ~~ Dosing > ! Aeration Holding PUMP/SIPHON INFORMATION ~ei"~~~'0~~^~' Manufacturer Demand GPM Model Number ~ ~ ~ .~-~ TDH Lift ~/ Fric~ n Loss System Head G TDH~ ~~ Ft Forcemain Length ~ Dia. ~ ~ Dist. to Well ~ g,.. SOIL ABSORPTION SYSTEM i ~~ v~ BEDITRENCH Width , Lengt ~ ~ No. Of Trenc es PIT E IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ SETBACK SYSTEM TO P/L BLDG WELL L KE/ST AM CHING Manufacturer: T CHAM ION INFORMA T Of S tem: yp ~ ~ Model Number: (IISTRIBU110N SYSTEM t~iS /IUe, .__ ~~i.C'lC~~-t~-,.._ ~~ Heade Manifo Distribution x Hole Size x Hole Spaci n g Vent to Air Inta Di th Di S aci L / ~ / a Length p ng eng a SOIL COVER r Prassura Svsfiams only / Yx Mnund dr At-Grade Systems Qnly Depth Over Depth Over of ~ ~~ xx Seeded/Sod Bed/Trench Center/ BedlTrench Edges Topsoil ~ / ~ Yes Q No ~ Yes ~ No v i COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspe ion #2: / /~ Location: 1998 220th St~Deer Park, WI 54u0Ll07n(SE 11/4~S/~E 1/4 20 T31N R16W) NA i_ot 1/~',~, ~+,,~. ~~ P_ar/~ce,,l,N,o: 20.31.16.309A10 1.) Alt BM Description = " ! j~ P~ ~ ~' I-wvr~ `~'~'S ~~ t~ Ov~ ~ ~1~~~ ~ ~~V '~ i~ ~,f~ 2.) Bldg sewer length = ~~ VVV ~ ~~ [emu -amount of cover = ~) ~~ ~~ c ~- a~ ~~ ~~ ~~~;~ --, -- ,- -~ ~ Plan revision Required? 0 Yes '' No I ~ - ', ~ i J Use other side for additional information. ~ _ L ___ _! _ _ _ _ ~ _ _ _ _ Date Insepctor's Sig ature Cert. No. SBD-6710 (R.3/97) ELEVATION DATA county: St. Croix Sanitary Permit No: 506304 0 State Plan ID No: Parcel Tax No: 006-1044-90-100 Section/Town/RangelMap No: 20.31.16.309A10 STATION BS HI FS ELEV. Benc ark 0. '7 ~~• ~oa•-d Alt. BM ~ / Bldg. Sewer ----- .6 s 9y os tl Inlet ..5~ t~ ~f 7 T ~n • ~ ~ij ! ~- St/Ht Outlet ,,, ~-. Dt Inlet ~/ D otto ~~•/b ~{~ d Header/Man. /r ~ Dist. Pipe ~,4 ~' ~~ ~~ Bot. System 9,~ 0 ,I~. ~ , 2. 7 ~p , ~ O Final Grade /1~1~ S / !~ ~' St Cover , C~7t 2~ ~ ~~ ~D ~' 'y Q7'v ~+ ~. g y6.3 xx ulched 5t. Cr~o>Tac County Planning and Zoning ,/ Tuesday, June 13, 2006 at 4:29: SZ PM ~,\ ; Detail Sanitary Information r ' ~ Page 1 oft Computer #: 006-1067-70-000 Sub%Ptat: _,,,NA Section: 30 j Parcel #: ~30.31.16.465C Lot: ~ TN/RNG: Tj3'(N R16W Municipality: Cylon, Town of CSM: \~ 114 1/4:/>'SE 1/4 SW 1/4 ' Owner Gleason Irvin 2032 Highway 64 New Richmond, WI 54017 / _ State Permit: 149058 Issued: 05/ POWTS Dispersal: Non-Pressuri Il~round Permit: Replacement ~•, County Permit: ,0 Installed• 07/23/1991 POWTS Detail: ,Bed -See jge Bedrooms: 3 WI Fund: yes POWTS Pretreatment: NA /~ Notes ~ lssuerllnsaector As Built Plumber ~ Other Requirements Additional Notes Monev Owed Not determined Yes Powers, Ca in 4 $0.00 "Jim Thompson Signed Off: Yes ~ ~ _ Maintenance ~ '~ ` Scheduled Pumo Date Pumped 1st Notification 2nd Notification 3rd Notification - 7/23/1994 04/20/2006 ~e,~tacem,cM ~ Safety and Buildings Division County ' ~ G m m ` 201 W. Washington Ave., P.O. Box 7162 ~~: / _ ,~~~~,~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 266-3151 5 ~ ~ Sanitary Permit Application State Plan I.D. Number _ ~~% ~ yoz4ss- In accord with Comm 83.21, Wis. Adm. Code, personal information you provide f'^ may be used for secondary purposes Privacy Law, s15.04(1 x Project Address (if di Brent tha n mailing address) I. Application Information -Please Print All I rmation ' / ~ ~ q ~ ~ Z ~ ~ ~' , Property Owner's Name Parcel # Lot # Block # Prop Owner's Mailing Address ~ Properly Location / - 3aq~-~b G `- ~i~~G ~~ - _ ( ~~ y. S~/, Section City, to Zip Code P o Y , , !fir'' /i ~ ° - tJ. ~~ - ~E o y~ T ~ N; R ~J II. Type of Building (check all that apply) , ,~ 1 or 2 Family Dwelling - Number of Bedrooms ' ~ lG,~ SAbdivisio[rNmne CSM Number ^ Public/Commercial -Describe Use /b ~ 7i Z 53 Z rn ^ State Owned -Describe Use ~ ~' 7~ , ' /o~ ~,, ^City illage ownship of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New S loin ys a lacement S loin ~ p ys ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renews) ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: Check all that a 1 ,J ^ 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 ^ Reciroulati Sand Filter ^ ~~ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Qther (explain) c, ~ ~ ~ ~z V. Dis etsal/I'reatmentAroa Inforfation: Design Flow (gpd) Design Soil Application Rate( ~ ~' Dispersal Area Required (s ~ Dispersal Area Proposed ( ~ yttem Elevation o, ~~ ~~t~ /s y ~ ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Tanks Existing Tanks ~ n'C ~ ~~l ~~ IOW ~ , t optic Holding Tank Aerobic Treatment Unit G L"i .Yl ~ G hamber VII. Responsibility Statement- t, the undersigned, assume responsibility for installation of the POWTS shown on the at)ached pions. Plumber' sine (Print) Plumber' ignature " MP/MPRS Number Business Phone Number ~, Plumber' Address (Street, City, State, ip Code VIII. Coun /De artmen se Oal Approved isap ~ Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Signature o S ps) wrier-Given Reasonfor Denial Surcharge Fee) // ~ l0 ~ ~ o~ g ~ 07 IX. Conditions of ApprovaUReasons for Disapproval n ~-o fib ~. 4.,. o 3, 61ci1 sys{-e~ , SYSTEM OWNER: V ... n I 1. Septic tank, effluent filter and Cif /~ ~ d~_Q . ` dispersal cell must all be services /maintained ~ ~ . ' as per management plan provided by plymber, \ 2. All setback requirements must be malntairted ~ \ ~ ,~ ~ ~ i /~_ Sd ~~ f-{ o,~--~ as per applipbkcods / oMirtats~es. JJJ .r 0.," ''~ e ~ `~' CAL . o o ,2 n[tacn complete pmns (to the County only) for the system on paper not less than all2 x 11 inches in sire SBD-6398 (R. 01/03) • PLOT PLAN PROJECT Adam Waidelich ADDRESS 1998 220th st. Deer Park Wi 54007 S E 1 /4 S E 1 /4S 20 /T 31 NIR 16 W TOWN Cylon COUNTY ST. CROIX SYSTEM ELEVATION 97.9' 4 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND X70C SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chaarbers Wane ® BENCHMARK V.R.P. Top of nail with orange ribbon ASSUME ELEVATION 100' Filter BEST GF10-8 BOREHOLE O WELL * H. R. P. Same as Benchmark 300' Property Line Scale = 1 /4" = 10' unless otherwise noted . ~ Property Line Old System is to and buried 4 Bedroom House _:~ ~~• Z~ ~ Well Huffcutt combo Tank is to be properly bedded and provided with lockdown covers with approved warning labels ~a 96.9' Shea ~ \~ 6% Slope Area 15' below system is to remain undisturbed B -1 ~ *. - ' Grading is to be done to divert run-off away from system ~~!._ B.M.* B- ~yo~~ ~~ ~~ M B-2 ~ 96.5' 197.5 95.5' 80' _ ~ '. PLOT PLAN PROJECT Adam Waidelich ADDRESS 1998 220th st. Deer Park Wi 54007 SE 1 /q SE 1/4S 20 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX SYSTEM ELEVATION 97.9' 4 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of nail with orange ribbon ASSUME ELEVATION 100' F'i1teT BEST GF10-8 commerce.wi.gov i ^ isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.com merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 15, 2007 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING INC 1008 192 ND AVE NEW RICHMOND WI ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/15/2009 SITE: Adam Waidelich 200TH Avenue Town of Cylon St Croix County SE1/4, SE1/4, S20, T31N, R16W Identification Numbers Transaction ID No. 1428555 Site ID No. 729068 Please refer to both identification numbers, above, in all corres ondence with the a .enc. . FOR: Description: Mound /Four Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1146997 Maintenance required; Replacement system; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes, The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. • 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 POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat Coed ~~~ p~![Md OF SEE COR SHAi1N R BIRD Page 2 8/15/2007 • Comm 83.22(7 A co~y of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~ ~ 1~~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wiscons in. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. Byron Bird Jr ,Byron Bird Jr. Plumbing, Inc (Plans Mailed To) RECEIVED /;U u 1 0 2C07 SAFETY & DUILDING~ Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 8/ 8/07 Owner: Adam Waidelich Cover Page Location:SE1/4 SE1/4 S20 T31 N,R16 W Lot 1 200th Ave Cylon System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01 /31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Co 9-11. Soil test Shaun Bird Signatu License number ;y plan ````~~~~-un n ~nn~~~,~. `,o~~~~`o~a ~ ~ii~;'',-,, yy~.~2 j y' ~ ';- o ~ w6,~ ~G Z , -~ ' o~ ~ 2 ;' ~.. 2 ~'~'''%,,~FSIGNER ~~~,~~~~``. ~~~u~inin-~~~~` 'fIOt1Q~ a~VED 'T OF COMME~e •FfEY DESPONDENCE y Noa Wovea F~.1.tez Fabric 4" g~~~,gr~ pipe Perforated ~pist:ibutia+e• Pipe Belaw Filter Fabric ! • ~ - . /,1~8~I G-33 Sand ~ `::~ Tag J i ~ ~~_ a s E rs~ j ~ Supt Beth Ot tfr- 2 %Z Farts ~Eain Pfaweti Fst~ Pump LcYer • Dra?n Rock ~ „ _ ~: Crass Section Ot A tr4aursd'S sttss•~ Us~ie~ ~ F..~'~ A Std Far 7tte Apsar tFo+s Area &.~^ ~ g. ~ft. • • _ ; ~t •• ~, ~ .r •• • s ~k ~,~ ~,~Clf. . ! ~-- . ~Qbservaliaes Pipe-~~ _ _..._t( '. o ~ ~ ; FBrC! {~aiR • ~ •. ° Distribtttiart Bid t3~ ~ " +~ ~_ ~ Drain Rock PFpe . . 4t33~sacvotion P;pe~'~r,~Cat~c.~ Ptreaofien~ W[arker • •~S~i' !l~`f~-/ ~' ~o~! ~~~~~pe or Rods __ :``~~`` -' :'' Pion Vit~r ~t.~Vt~uhti thing A Bcd .Far Thy 1t~tarptson A:ea ~r R~#Orattd ~iaa DetOti Lscatse Oo S~fiaa. ggpslifi SO~osa ~~ t1tfT f1at.L 1liaCY •rs, ~~mn Ft. ~• .-~,~ , ~ ~ .. _ _ r - ~- . . ~;gam: .. 3~o3e Dfaa~eter ~3~€ach • tatera~ •" ~:. . inch{es} . ~.~ License Niger: ~ manifold _Z fps . ffa~te: ~ Farce l~tfn . " Z ~~ Ittt~es ~ 1 r~~~wll ~rMl~n. ~~. . ~ of hQTe5/p~Ae,,,.~2 • ~ Invert ~ev~tfan trf latera~s~4/~t: . ~ . .~:~. ,~~ ;;'. ,. . ~,~ . . f. ~r ~~~ ~~p~i~ER t"'ti fl5S gE~~ ~~ SE~I~ 'Tim ~' 8 • • ~n ~~ ~B.pT ~~ ~.~~` ~;~.~~~E GCE i£~~~ti ~~~ ~ / ~ 1 14 ~, ,!~• • ~~^ t~ .... ~ ..: . si~~ ~ t~li7'~ ~6~ g • ~"" . G. D - ~...- 3~ A~ ~ S~ECIF'FCR'~'~t31~3 .. ~~~ ~~ „3~~Cf~fl~T ~ ~~ ~~ ..-i~~T~ ~ ~f PAL` 5 ~~ u~~ ~ , ss s ~ mss- s~.~- .:°:, . •~ s . . ~ •' ~~~ . .. • 3 ~ ~ ' ~~ ~ . sp~CZ~zcA~~s ~.~,. .. ~ .. ~~sE~ cos ~ :. i -~ ~~ a ~ ~. ~ ' /O ~~.~ = ~~ R~1~EI) Dt~ ~~ _ ~ "1 ~ ~~~~,sv~E ` ~~~~~ ~~ - ~~~ FAT F ~a~~ g;£~`.•~ ~ ~~~ Tom. L~4~~B ~~'~~' . . ~ ~/ ~~ • ~ ~ 'LICE#S~ ~~$~' ~ . if ~~ Sant By: HP Laserlet 3100; ~{ 7~ ~ .~~ ~~L ~ ~ MLli/'.'7'i/O G ~ C7'~/'A~ ~ 4y~..N v 9EH SERIES SUMP/EFFLUENT PUMP u~rt ~ ~ ~ ~ ~ ~a ~ ~ ~' a ~ r. ~, ~, ~ as ua og ei ~~:sss~:w ~rJi ~ t1S ~1 S7J! ~ 76 ~ ~ ~ S7.! ~ ~ aft sft5{sa9~ ~~ 9~ 81~ il,~ a~ 3M b3 'f000 7A Ss 95 9i! t1A ~ 7d 6~ 55 +t ffi !S$ ~$ Z7 Sq:ti&titl1 Sfi~4 ilAS~ ~ ~ ~g~fry~nemnwMiF °~ {~mnoeb~-~iYis ~t~ion Co.ced cyst Imn FlAV~ LtYERS/>~R MO~iHO _Ira~ettes Matn-iat is -•- A'BS Vobuu .. ' Powac Cord 3f1'W A _ . ~a ~ Mechas~uaal Shstl. Seat snd s ~ F~stexuars - -S°-`-°aZesc Soeet' . ..._.. ~ S~n~ z~ ____....~. Ups Stoes~t and Lowe Belt 8e~ite~ o ... pu~eP p£RfCE t~itVE ~I ~;1t ~~ ~• li5v SOMZ !A Ms l~fi~tlYliM1~~C~1.~?3137 lis~oNLl4L2Si1 ~~IO: iii _ - -- ~Fpne09a$S6-C7J~ POWTS QWHER'S o€8ed~4R¢ ~~~~dai Urns ~Up-,. & MA~lAGE1~~~ ~~ r~n~ ~ ~` ~ ~~ . Moc~Y 6" P" ~ ~ ~ ,o ~'~'a t T01st S~ t~ s io s'rtf` du!'~OQts'iJ Feat ~ ~~citameter r~~ ~~~ ~_~ E/+~TNT'E~~ ~ gerytce FteQ~7 s) i~~'~ ~ r sew Ersnt ~ ~e~c ~ ~ v ,~~ ~ . ~,~ ~ ~~ ~~ ~~~t=~ tnspax ' when cpctbraecr siudga and seam e4u ' s) t~muea 3 yr ~p ocrt eono~ ofi S) At Least Once ewsry ~ ..? t'3 rs~ s) ~ O°~s? at least onoe every ~ m ~ s) O rrp- Mean ~ Rt yeast oruoe every Q s) O Hw ~~* t?~P• r aor"srors ~ atsrm ~ ~ race every ~ ~d C3 ys~Ess t7 ~ Elnsfi timersb and p~'e tee tit sesxt once every u ~ t1 its) D Nq ~ ~ mom ,qx yeast ~ar:ca evet]- ee4ut~'tt'iuNCE tNSTRUC'RONS asp std ~, rrrade 5Y as isnd'rrtduat cettY~Or : Sopte~ pkrmbadr. Masoar' P ~ °~ tie sankte) m ~ ~ uP Ssr~lg Op~~ Tank m ~ e of oorr~bined ~ d~c tlf~ ~ mar surfaoa- T~ ~ a~f its 9~txi ~tt~ the Io ~'°`14r- in the absar+~ t ~d to rfiedca ~~,'~~s me trnmer~s nom' ~ ~ of tt+e ~t1c voush1°. tl~e gcourtd ~Y a tainS VVhett the o ~~ of shx~9a ~ sSept~e ~ ~~ ~ 6di °~ to ~ ~ ~' MR enffis ocer~ss of the t~ be te<r+~ ~ ~ - ant t~ and s~ 1134 Wtaoa~n AdR~ ~ oa' ~~wrtzed POYitTS cam a ppgNtB M ~ ssrvidng of flf.T2 moms or less shad[ be Aetf°Rned ~ sew e~~ ~a ~~ ad mrat r~ authority wfftrin ~~ of co~'rP ~~' s1'ARi` t1P ~ OP'FRATiON s . if ingh ~ oo rise ~fttte PDWTS ettt tan~s3 ~ ~~ ~ For ae~v aoreth~otr• t~ eaclfor the ~ Qet+e~ed traY+e thsthe oo~ts ~ 3 ~10~ ~'s seP~age sanrtct~ Vim'' sa rte` .+ ~ P~ i~ i ~.,,_....ot Sys~xn start ~ noc oocnrvv~ss ~ condilions are frnzer: acme int~r'ative scsr~e. Dur+ns t~ ~ ~(~ abcrre aonmaS tsigh~retier ie~+eis. Where ' is:estoc~ the wlot be ~ tt,e c~it(s; in one Lange dose. osrecSoadu~g ~ cei(s} and may nth at t orsnufarce ~' To sttvnid #ttEs s is$va the cors~6eriLs of the P~F tarfic rernov+ed tsy~ se ~ ~R poNrer ~ the ettiuecst PAP or $ P~nbeGaC PO'flVtS ~fi X67 Y t8 ~ iic3 t~ft3 tlorritai fev'sts ~itFrs trice puma ~. DO t10t {tI11Ig ~ Vt~OS O'f!!@F taltkS And d LAS- ~ 1~ tf ttYB Of ~ 0~'s aC C~ ~t'C0~1Q~C~, the tt~a wffi~tt t5 ~ dog slope of aaY rrtoiatd or at~tittie ~ abeorp~ott i~ . ~ arm of the ~ ~ me w~bmrr~er sir:~am may imps the perfont>~oe ~ pmta~g~ Bte the ot't[a: ~ ~~ ~' condoms; comas swabs; deS: ~ ~ K~ r~ti {ac~mp p~P~ wad; srt~c af-d vegetable p ~ meat soaps: rnedi~tocn~ ~ ~ ~' mss: tampons •~d try ~ the ~ :s pemszne+~~-Larsen out ol` service the rst st+epe shalt ha tafoer: m tts~ tt~ mQ ~ ,.~ ~, ~atar>ed ~ ~ wilts ~ Comm 83.33, Wfsoorssirs Astride code: p~ p~Frg m tacrics sed pits stsmdt be dssconrtecLed and ttse abandorsed pipe aped aaeted .. ~ ~t~ ~ a$ tanks once t~ ~ ~ r~rro~ca and prcpa:fjr disposed ~ ~ ~ Sew 3 Atbet psanpicrg, aQ tanks and pits shalt tae and nerrsos+Ed ~' t~ ~~ resroxectand 8'~ .roid > tiltexf wiitt soQ 8~ ~ solid cnatetiat . cffI~#iiAiGi:ZltC1f PLAi1t Lila foEtotivtng measurrrs have been. or rrsust tee lattoea. trr prsa+rida a Dods ~ me>~wrs races and cannott~e r t~ • t3 A his rr~tecerssent'asaCa has beets evatuatecf and may be crtfl'rred fot t~se of a ~f sod awn , Tt~e ~t ar+aa shoukf be protected from dssfurbanw~ grid eorespau~ars and shoasfd nat ~ ~ ttpon ~ ~~ lirorn eking ar~d P~p~ed ~ Fos Rrtss and wed Fa$cu+e to pc+vbect the r~sapiasosrrtent area wffi EiBStstt in tine need for a nevtr soft arsd sFE+e ~evaluatiCxs 'b~ estsbtSis a scr~bte ~ _ ~~ppment sysLerrss must campy t+rsttt the rules to eftiBC.`t a! ~ Srrse. D A suttsiasle t~gart ate t$ rfat avs$at~te'due Lo setbasdc andlor sos"E tiscrismtioitS. t advarsces &r P01AtTS• ~ at tatsic ~,sy ~ ~artea s3s a fast r+eeoR m r+~Place tine failed PDWT'S. ~'Rze she Liss clot bassi evrsii~Dsd ba tdertti~y a su?b~b3e r^ePlacernertt areal. Upon >a~ of 8fe POWFS a Si6e evsatuattiOtt rrftt9't b6 perforrESed m loeaije a' suitable replacecrserst area. if t:o ropta+oe!=+~ ~tank nzay be Tr~sd as a Last ~,®sart m reptaioe S:e farted POw~s raursvrai of me tseansat st' r/~ ~ a~rsd at-grade soa a6socpQore sYst~s +>~ be te~n~ucbsd 7n ~sce toltavdng # su:tisae~, 3iaasnsh'tiellons of sudz systems must eosr~giy vvtth See tales in dLed at itsattirta~ <cyfFAttNIAf[~S . SEPTi~ PUIiR'P Atitt3 OTHF3t TRFJ#3'iidt3~ TANKS 64AY CONTAIN LE'~FiAi. GA5SE5 ANt3t~R [t~I.SUFFttXEtltt' cXYttt:hE. i>0 AlOT @~FI~R A SEP7ICY t?ifNlt' OR Q?HER'i'KFATMEN7' TANK UNDt:R AAtY ClRCttAdSTAAtGES_ DEATH tttAY ttESttLT_ . RESt~JE •OF R PER90IS FROM THE tM'Z=RiOR Ot= A TANK MAY 8E DOLT OR i0~P05~BLE ADDRTONAt. GOMMFNTS PoYt~ ~~ POWTS M14tNTAi~iEK N~ttne ~./ ~ / Name i-/t3' r SF.PfAGE SINN tJPEEtATOR LOCAL FZFGULAT€?RYkU?NORl7Y ntarze 7v .>^.-- ~ /f'I Agerlg- ~~ ~',~~ ,~. ~ ~ n , «~ ~ t~md ~ ~~r. rks.a case: zrrrd waaadr:ra courr[y?~:rrra 0Q . ~ dnsrirrart+ra~ mc> regetaraerr~s oEctt Coa+en t~t6HtlCQ~1 and ~-~('s3. Q1 b Cj1. w~soorrsla ~aCrrsQcsTsZ~~ Code, tbb of ffsts doau~ d~ ~ • gv3rantee the ~ otltre POW'[$. C~(~t) ` VII(sconstn Dept3ubner~ of Conxnenoe ofs~r and Buadr~s SOlL EVALUATfON REPORT ~ ~ Attach sl<8 P~ ~ AePer rwt less"fan 81/2x'11 irmhes in sloe. Plsn must Goo/ , but not ~rnited to: v~ka1 and 1 nsfenence Point (~Aj, dir+~iion and ercent slo scal r db i th Parcel LD. _ ~ p pe. e o nerrs orrs, nor arrow, and location and distance bo nearost road. Cii d ~ - ~{~ P/ease prritt a1/ /n~ormat/on. Reviewed t>,r gate Persanet IMonnatlon YW P~~e ~Y be used for secondary p (F+iracy Law, s. t&04 (t) (m)). . Property ~ Ptopsrty location ~ ~ by ~ I f C~ ! / C• Govt. Lot 1/4 /4 S ~ T N R E Property owners /Wdr+ess ®~ ~ S~ t:af # ~ ~ Name or Csbd# . ~~- jp- ZP _ r a ` ~~'/ ' - ^ City ^ ~e own Nearest Rona ~ ~ ` ~ f r ~ z ~ 7 t~-e-- ' v ~ ~ ! 11 ^ New Cor~nu~iar tJSe:~Residential / Number of be~ooms ~ Code derived design flaw raise GPD Repiaoement ^ Pubbic or I - ~ent material ~ ~ G ~ ~, 9~ b Flood Plain ele~vafion it apple ft General corrMrients 9 t-f ~ ^ P Ground surface elev. /'~ ' R E~pth to fim~ing factor~~~Z~ in. T Shc Rabe Horimn ~ Dotnhlatrt Redcor Dssalpflon TexWre Struchn~e Consl$bnce Boundary Roots &r. Munsep Qu. Sz. Cord. Cobr Gr. Sz Sh. ~ +gRrt •E~ 3 G Pit Ground scafaoe elev. ~ ft. Depth to Nrniting factor in. ~.~1 e Soi Rob Horizon Deptlr Oomirrard Color Redox Description Texturo Stnxdure Corrsiabnoe Boundary boots C~ OVIP in. MunseN Qu. Sz. Cont. Color Gr. Sz. Sh. '1 `~1 - b G = ~ ~YW N A i a BVIJ_ .1 ~ L Z~ mQ'~ ~r~' ~1 19n ! 'r ~ ft1AA ~ ~I W\4 $7 z ~ l 4/{ wue/ ~~J `M!. ~. OR ~...~ - - ___~_ •___r- c ~ CST Number J r" /r ~! s- D,S s~ Dale Evakratlorr Corrducbd Telapftate Number -~" ~ ~~" z.~ ~~y ~ T ~s Yea/ ~"= 3/- o ~/~~6~7.t//~ nT~\ M1A TMIM\ i+Property Owner l/7~! h'1 l///l~1 r ~~2~ G!> Parse! ID # l ~ ~ A~..~J ~..J~~~ ~1~.. / ~ ~ 3 f1~~i4 L ii..~YL~. L.J~~ ~ ~ /~ L Page of i - (.J ~ij Vi WiN NW iY{.O YiGY.~i4 i/OIiHi W NIiiWlia iGYiLN - N4 _ v CWwNN Horizon Depth Dominant Redooc D1 ~ Taodwe StrUCdJte BOUridar~/ -Roots /~~ ~ VP ~~ LAlC ~. Murlseq Qu. Sz. CoM. Color Gr. Sz Sh. `Etfp1 'Efpf2 vZ ! ~ o---~_ G r ^ ^ ph Ground surfaoo elev. ft: Depth m dmitlng factor ~. ~ Sod Fta6e Horizon Depth Dotr~nant • Redox Deecdption Texturo Stnxturo Consistienoe Boundmy Roots GP DVd' in. Munse~ Qu. Sz. Cont. Color Gr. Sz Sh. ~9 ~ O 8orirg Ground surtace elev. ft. Depth to 6rn~Ig factor in. ~~ Pit ~ So1 Rate Horizon Depth Dominant Redwc Deecriptlat Texture Structure Consie6ence Boundary Roots ~. Munsed Qu. Sz. CoM. Cobr Gr. Sz. Sh. 'E~t "E~2 • @tiutent #1= BODE > 30: 220 n~ and TSS >30 _< 150 mgfL • IB~eM ~ ffi 8ODs ~ 90 rrtgll. and TSS < 30 mgll. The Department of Commerce is asi equal opportunity service provider and employer. If you neod assistance to saxes services or need material in an alternate format, please contact the department at 608-266-31 S 1 or TTY b08-264-8717. sat>s~w tR.aaoof s ' - ~ Soil Test Plot Plan Project Name Adam Waidelich Byro d Jr. r Address 1998 220th~st. Deerpark Wi. 54007 C #220527 Lot Subdivision Date 5/312007 CountyST. CRO1X SE 1/4SE 1/4S20 T 31 N/A16 W TownshipCylon [~ Boring ~ Well PL Property Line# Alt. BM ,BM or VRP Assume Eievatton 100 ft.Nail in white spruce orange ribbon System Elv H.R.P. Same as BM SCALE 1" = 40 ` Unless other wise Noted ~'~11~sconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT page of n~ awvwa~nc wrtn wnnn oa, vvta. nuu~. a~,wc County .ems G/'O/ Attach complete site plan on paper not less than 81/2 x 11 inches in size Plan must . include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel i.D. / ~p ! d ~ - JCJ` Please print all information. Reviewed by Date Personal information you provide may be ysed for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Own r ~ ~ 1 ~~ Property Location ~ I L l C~ G~ Govt. lot 1/4 %4 S ®T N R E (or Property Owner's Maili Address Lot # Block # Su .Name or CSM# C'State Zip Code Phone Numbe ^ ^ Village own Nearest Road! 2 ^ New Construction Use:~Residential 1 Number of bedrooms ~ Code derived design flow rate GPD ® Replaoerrrent ^ Public or comI -Des ` . Parent material ~ ~ G ~~/ ',7~: ~~~ Flood Plain elevation if applicable ft. General corrttrtents and recommendations: ~~~~~,n ~ RECEIVE D BUG 2 2 2007 a Boring # ^ P t ng Ground surface elev. ~~ ft. Depth to~imitingUfador in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIfP in. Munseil Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'EtT#1 •E{~ - 0< z ~/~ ~ -s~~ ~~ G `~` ~ n Boring # 8on~ ,/ L.~1 ~ Pit Ground surface elev. ~ ft. Depth to limking factor in. Soil lication Rate Horizon Deptti Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/1F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *E~ ~` ~~ ~~ f, r~ G .~ 02 a ~ n ~ tidy G b c ~ .~ `Effluent #1 = BOD > 30 < 22p mglL and TSS >30 _< 15 0 mglL ' Effluent #2 = BOD < 30 mglL and TSS < 30 mglL CST (Please Print) ~ Sign a CST Number i r0 /r ~ ~~' IJ.S ®Z Add Date Evaluation Conducted T ,~/ elephone Number Property Owner ~d ~ h'I ~/l/~ i c~,2/ G6, Parcel ID # _ Page of Boring # ~ Boring ^ pit Ground surface elev. _~~~ ft. Depth to limiting tactor in. Soil Iication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP DlfI: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 -~' /D ~- ~i ~' ~~r C ~ - ~ - a~ .~ Boring # ^ Boring ^ pg Ground surface elev. ft. Depth to limiting factor in. Sod lication Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efi#1 'Eff#2 ^ Boring Boring # ..Ground surface elev. ft. Depth to limiting factor in. ^ Prt Soil lication Rate Hortron Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DItf? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eti#1 'Ef(#2 ' Effluent #1 = BODS > 30 < 220 mgfl. and TSS >30 _< 150 mglL ' Effluent #2 =GODS < 30 mgJL 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~6330 (ROT100) Property Owner ~d u ~y/ l/(/Gr ~ c~.Q~ ~~ Parcel 10 # Page of ®Boring # ~ Boring ^ pit Ground surface elev. _~~~$. Depth to limiting factor in• gp fl Cx;ation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP DHF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eii#1 *Efy~ -~' /6 Sri- ~i ~' ~~r C ~ • ~ ~ `~ ^ Boring # ^ Boring ^ ptt Ground surface elev. ft. Depth to limiting factor in. Sod Gcation Rate Horizon Depth Dominant Cobr Redox Descrg3tion Texture Structure Consistence Boundary Roots GP D/ff in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. ~{~~ ~~ ^ Boring # ^ Boring (, p~} Ground surface elev. ft. Depth to limitina factor ;n Horizon Depth Dominant Color Redox Descripton Texture StruGure Consistence Boundary Roots Soft Eton Rate GPD/If in. Munsell Qu. Sz. Coat. Color Gr. Sz. Sh. 'Etf#1 "Eff#2 `Effluent #1 =GODS > 30 < 220 mg1L and TSS >30 < 150 mgJL ' Effluent #2 = BODS < 30 mgll and TSS < 30 mgll The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. 580.8330 (807/00) ZT]~p] T] T] ~(] (] $] (eGAV(%*T] T] a, ]urhE[ ] }] jYT]jhY;]](]EUE(],](];]c]pPUI~UaSJ e](](]Ee(](]~EYT]hYYYx4]%((]]]T]x ` Soil Test Plot Plan Project Name Adam Waidelich Byron Bird Jr. Address 1998 220th st. Deerpark Wi. 54007 CSTM #220527 Lot Subdivision Date 5/31/2007 CountyST. CROIX SE 1/4SE 1/4S20 T 31 N/R16 W TownshipCylon ~] Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft.Nai! in white spruce orange ribbon System Elv H.R.P. Same as BM SCALE 1" = 40 ` Unless other wise Noted D N c 0 r N N ro a o~ w N 0~ OWNER PETE DONAHUE 160410TH AVENUE AMERY, WI 54001 l~~l~(L ^ ~4~D ~W~D~ NOTE: THIS MAP IS BEING CREATED UNDER THE FARMLAND coNSOUOanoN PROVISIaN. THE HOUSE SHOWN HEREON WAS BUILT APPROXIMATELY 1920+•. CORNER, SECTION 20 (ALUMINUM CAP FOUND ) A N89°06'061"W 1648,06' (~ --V NYa CORNER, SECTION 29 (ALUMINUM CAP FOUND ) NOTE, A POSSIBLE VIOLATION DF THE ST caonc couNrr mr~NG ORDINANCE wIu BE CREATED IF THE EXITING STRUCTURE LOCATED WITHIN 100 OF iFE PROPERTY LINE EVER HOUSES LIVESTOCI(OR POULTRY. CERTIFIED SURVEY MAP LOCATED iNTHE SE%a OF THE SEYa OF SECTION 20AND THE NEY OF THE NEYe OF SECTION 29, T31N,R16W, TOWN OF CYLON, ST. CROIX COUNTY, WISCONSIN, ~~p~Q~~~ ~_~~~ BEARINGS REFERENCED TO THE SOUTH UNE OF THE SEYa OF SECnON 20, ASSUMED 589°05'09'E 485.15+ TO BEAR N89.O6'O6'W. ENCE LINES LET 1 N 245,170 SQUARE FEET N ' (5.83 ACRES) INCL RNV 243,810 SQUARE FEET { s.so ACRES) EXa Rna ~ SOUTH LINE OF THE SEY SHED OF SECTION 20~ ~ NORTH LINE OF THE NE Y OF SECTION 29 N 8 z a N PREPARED BY: GRANBERG SURVEYING, INC. i 1235 C.T.H. 'E' NEW RICHMOND, WI.54011 PHONE (715) 246.7529 JOB N0.06.057 - - C 100' 200' 300' SCALE IN FEET 1' =100' SHED N89°05'13'W 485.15 N89°06'06'W .,.19.8T~,., ~ 21.33' SEPTIC ° :N89°O6'O6'N VENT(?) :I......... E LOCAT (NOTSHOWN INDEiAL) WELL ti,~ ~i S 95 i ANEW RWHMONO ~ ~~ ~, l~titi err ~~ ° su~~~ U"' @~ ~ ai SE CORNER, SECTION 20 (1' STEEL SURVEY MARKER NAIL FOUND AT POSITION ) _ 200TH A VENUE N89°O6'O6"W 507.40' ~ - - - - NE CORNER, SECTION 29 N { 1' STEEL SURVEY MARKER NAIL FOUND AT POSITION ) ~C LEGEND ~ ~ - INDICATES SECTION CORNER MONUMENT ~ (AS NOTED) N 0 -INDICATES 1.25' X 24' IRON PIPE WEIGHINCw 1.68 LBS. l LINEAR FOOT SET. • INDICATES 5U SETBACK LINE FROM RIGHT-OF•WAY LINES. SHEET 10F 2 7, c s v N~•~+1R~1sC7 W .~• N r ~`f~N nNi ~~ I~~qq W NRJ ~'?J~„OnSC~ ~~! mm W w~: ~ ~OH~A ~ ~ w N c` N ~d Vu ,~ CERTIFIED SURVEY MAP LOCATED IN THE SE'/, OF THE SE'/, OF SECTION 20 AND THE NE %, OF THE NE'/4 OF SECTION 29, T31 N, R16W, TOWN OF CYLON, ST.CROIX COUNTY, WISCONSIN DESCRIPTION: A parcel of land located in the SE %, of the SE'/, of Section 20 and the NE'/, of the NE'/, of Section 29, T31 N, R16W, Town of Cylon, St Croix County, Wisconsin, further described as follows: Commencing at the SE Corner of Section 20 and the NE Corner of Section 29; thence N89° 06'06"W 507.40' along the Section line to the point of beginning; thence S00°21'S2"E 242.36'; thence N89°05'13"W 485.16'; thence N00°21'S1"W 505.47'; thence S89°05'09"E 485.16'; thence S00°21'52"E 263.11' to the point of beginning, containing 245,170 square feet (5.63 acres }more or less and being subject to any easements, restrictions or covenants of records. SURVEYOR'S CERTIFICATE: I, Joseph W. Granberg, Registered Wisconsin Land Surveys, hereby certify that by the direction of Pete Donahue, I have surveyed and mapped the above described land in accordance with official records, Chapter 236.34 of the wsconsin Statutes, the Town of Cylon Subdivision Ordinance and the St. Croix County Subdivision Ordinance that this map and description are a true and correct representation to scale thereof. This Instrument drafted by: Kristin J. Granberg Dated this 19'h Day of September, 2006 GENERAL NOTICE STATEMENT The lot shown hereon is subject to state, county and township laws, rule and regulations (i.e. wetland restrictions, access to parcel, minimum lot size, etc. }. Before purchasing or developing parcel contact the St Croix County Zoning Office and the appropriate town board for advice. COUNfl TREASURER'S CERTIFICATE I, ~/~nr~_ cSQ tt? .r' . being~he~aly-eleeted, qualified and acting treasurer of the county of St. Croix , do hereby certify that the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments as of,~~~p~ (date } 31 ~~bv~ affecting the lands included on the Certified Survey Map. %~-Dl -D (o Date APPROVED sr.caeonccarHr~r DEC 0 4 2006 If not recorded within 30 days of approval date approval shah be Holt and void ~~ /fit ,~~~~Treasurer .. PREPARED BY: GRANBERG SURVEYING INC. 1235 C.T.H."E" NEW RICHMOND, WI 54017 PHONE (715) 246-7529 JOB N0.06-057 ~~,~ N * ~ "~JOSEP GRAN q ~ ~ NEW R~ MON C Q O y° sva~~y ^ D SHEET 2 OF 2 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ,~/~~~.~ _~t~~ ~ ~/~ ~c Mailing Address ~~ ~~ ~~,~~' f~ j7,~ Property Address ~ ~' ~'"- U' "~ `' ~ ~~ ~ j ~ ~ ~~ ~ (Verification required from Planning & Zoning Department for new construction.) City/State ~.~ ~ ~- ,~~~ ~ ~ Parcel Identification Number ~ ~ ~ ~- / ~ ~f ~ -- ~~ lam. LEGAL DESCRIPTION Property Location ~'/4 , L~ '/4 , Sec., T ~N R ~~ W, Town of ~y/ <, Subdivision ,Lot # Certified Survey Map # ~,~~I~-~' ,Volume ,Page # "` ,~ Warranty Deed # :_~ ~5w~,~ ~ ,Volume ,Page # Spec house yes Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2} after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms _~ SIGNATURE OF APPLICANT(S) ~G7 DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number ~~ Document Name THIS DEED, made between Peter J. Donahue an_d_ Van_e_ssa M. Donahue, husband and wife ("Grantor," whether one or more), and Adam J. Waidelich, a single person, and Jessica L. Sorensen, a single person ("Grantee," whether one or more). Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Part of the Sautheast Quarter of the Southeast Quarter (SE 1:~ of SE I/4) of Section Twenty (20) and the Northeast Quarter of the Northeast Quarter (NE 1/4 of NE 1/4) of Section Twenty-nine (29), Township Thirty-one (31) North, Range Sixteen (16) West, Town of Cylon, St. Croix County, Wisconsin, more particularly described as follows: Lot One (I) of Certified Survey Map filed December 4, 2006, in Volume 22 of Certified Survey Maps, at Page 5326, as Document No. 839985, office of the Register of Deeds for St. Croix County, Wisconsin. i~ii~ ~i~ii i~~~i ii~ii ~iiii iiiii i~~~ i~~ii~ ~«~ iii ~ 8 5 7 GG5 3GG rr~~3~~}} 1 ~J~~JJJ KATH!_EEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08/14%2007 II:IOAM WARRANTY DEED E%EMPT t REC FEE: 11.00 TRANS FEE: 450.00 PAGES: 1 Recording Area ~/ Name an~tg(Lun~~d~BANK ~~ PO BOX188 OSCEOLA, W1 54020 006-1044-90-100 Parcel Identification Number (PIN) This is homestead property. (is) {isabot) Exceptions to warranties: Easements and restrictions of record. By accepting delivery of this deed, Adam J. Waidelich consents to the addition of Jessica L. Sorensen as a co-equal purchaser under that certain Residential Offer to Purchase between the parties dated May 8, 2007. Dated ~I43'~~'~ (SEAL) ~ (SEAL) * P e .Donate (SEAL (SEAL) Vanessa M. Donahue AG'THE"171CATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN _ ) ss. authenticated on ~D(~'' COUNTY ) Personally came before me on _ 2(~~j , * __ the above-named Peter J. Donahue an Vane ahue_ TITLE: MEMBER STATE BAR OF WISCONSIN ~~~ A. 8 ~~i (If not, to a known to be the person(s) who. teti' thb 4'p ~g authorized by Wis. Stat. § 706.06 } i ment and ac/~,nowledged the same. ~ Q' : • ~~Q T A,41,. ~, t/~ ~ = -~_ THIS INSTRUMENT DRAFTED BY: * -. .o - Thomas A. McCormack _ _ ___ Notary Pub tc, State of WISCONSIN , •~~;_ Baldwin WI 54002 ~ My commission (is permanent) (expires: ~ ~` ) (Signatures may Lx authenticated or acknowledged. Both are not necessary.) "~`3"'^' 3Stt~~ NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED STATE BAR OF WISCONSIN FORM NO.2-2003 'Type name below signatures. ®State Bar of Wisconsin 2003 INFO-PROTM Legal Fama • (n0o)655-2o¢I • xdoproforms.ean 1 of t Wisconsin`Departmentoflndustry, SOIL AND SITE EVALUATION REPORT %Labor and Human Relations 1'1 :..:..:......i C.~inh. E Q. dl.i:....~ n _ ~ _ Page 1 of 3 ' III QliliVlV WIUI ILI 11 \ VJ.VJ, .fIJ. /vii.. vvaav COUNTY but n must include i Pl 1 1 i h i h 8 V2 l St. .Croix , n s ze. a x- - -- es an ., Attach complete site plan on paper not ess t tlc PARCEL LD. # ~d ~((i not limited to vertical and horizontal referencQ point (BM), directs and % of slope, scale or ~ dimensioned, north arrow, and location a ; dist~race to neart3st; rot 006-1063-10 -- ~. -, "~ r APPLICANT INFORMATION-PLE ;PRINT~FNFORNhA,T N RE EW Y ATE ~ ~' 4 w PROPERTY OWNER: ~~ ~,; ! , Oy ~ LOTION ~ J ~ ~ ~ ~ - J r __ Peter Donahue - d r W ,N 1/4,S 29 GOVT. L ` PROPERTY OWNER':3 MAILING A DRE ,;~~ St ~OrX.. J;~~ LOT # BLOCK# SUBD. NAM CSM ?~ 3 ~h ` na na na o R CITY, STATE ZIP Dl% ~~, ^CITY ^VILLAGE ®1'OWN NEARE ROAD y„ , Deer Park, WI. 54007 =",i''^(.. ~5) 24 [ J New Construction Use [xj Residential / u r~orrrts 5 [ J Addition to existing building ~[ Repnent ( ] Public or commercial describe Code derived daily flow 750 gpd Recommended design loading rate • 2 bed, gpolft2 •3 trench, gpd/ft2 Absorption area required na bed, ft2 625 trench, ft2 Maximum design loading rate • 2 bed, gpd/ft2 •3 trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.67 ft (as referred to site plan benchmark) Additional design /site considerations system el . based on contour line of el . 96.25' Parent material glacial drift Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL ^S ~7U MOUND ~S ^U IN-GROUND PRESSURE ^S ®U AT-GRADE ^S ®U SYSTEM IN FILL ^S ®U HOLDING TANK ^S ~U U=Unsuitable fors stem SOIL DESCRIPTION REPORT Boring # .................. ................. .................. ................. .................. ................. 1 `' Ground elev. 96.95 ft. Depth to limiting factor 58" Boring # 2 » Ground elev. 96.95 ft. Depth to limiting factor 19" Depth Dominant Color Mottles T Structure istence n C Boundar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color exture Gr. Sz. Sh. o s y Bed Trer~ 1 0-10 10yr4/2 none 1 2msbk mfr cs if .5 .6 2 10-22 10yr4/4 none sicl 2msbk mfr gw if .4 .5 3 22-58 5yt~/4 none scl lcsbk mfi gw na .2 .3 4 58-82 5yr4/4 if 7.5yr5/6 scl lcsbk mfr na na .2 .3 Remarks: 1 -10 10yr4/2 none 1 2msbk mfr cs if .5 .6 2 10-19 10yr4/4 none sicl lcsbk mfr gw if .2 .3 3 19-29 10yr4/4 c2p 7.5yr5/6 sicl lcsbk mfr gw na .2 ~ .3 4 9-80 5yr4/4 c2p 7.5yr5/8 scl lesbk mfr na na .2 ~ .3 Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1SS4 200th. A .New Richmond WI 54017 Signature: ~ Date: 4-21-98 CST Number: m02298 aJ PROPERTY OWNER Peter Donahue PARCEL I.D.# 006-1063-10- Boring # :~:<.: ~: ,..3 ~: <~ ~k; •i Ground elev. 93.95 ft. Depth to limiting factor 48" SOIL DESCRIPTION REPORT ..Page 2~r .o{ 3 H i Depth Dominant Color Mottles Texture Structure Consistence Bax~dary Roots GPD/ft or zon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-11 10yr4/2 none 1 2msbk mfr cs if .5 .6 2 11-17 10yr4/4 none sil lcsbk mfr gw if .2 .3 3 17-24 10yr4/4 none sil 2msbk mfr. gw if .5 .6 4 24-48 5yr4/4 none scl lcsbk mfr gw na .2 .3 5 48-70 5yr4/4 c2p 7.5yr5/8 scl lcsbk mfr na na .2 .3 ..; STEEL'S SOIL SERVICE Gary L. Steel CSTM2298 Peter Donahue MPRSW-3254 NE4NE4 S29-T31N-R16W town of Cylon N 1"=40' BM.= nail in wooden corner post C el. 100' Alt. BM.= nail in wooden fence post C el. 98.35' .- ~~, .~ ~ _ .r.. ary L. Steel 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 4-21-98 . s ~xioa~- ids o~n O~~~L~t~~~1~1~6~sAlEilo~zd Xt~~$~~Q~6-~'~44-90-~ 00 9LOb5 /M 'NOSOny `ONOZ/ 73b'H.~IW~/l~~ !OL ! PAGE 1 OF 1 ~131N3.'> 1N3WN2/3i10~ .C.LNn07 X/ON's 1S <,<;:::.,..:......~>„94~ iae~cel #s,s.....2fl.3~.:~FxB(3gA»1~ ,::~,A~ ....,,.... :,,>.,>:.>:.::::::>.::; :>::::.. .:::..:::., , ::,,~,fi ~TE3W~i £3FA~ ~.ON Current X ST. CROIX COUNTY, WISCt~1SIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/04/2006 00 0 '"`~"' .. Tax Address: Owner(s): O =Current Owner, C =Current Co-Over ~: O -WAIDELICH, ADAM J ~~ >~ ADAM J WAIDELICH C - SORENSEN, JESSICA L ~~'" JESSICA L SORENSEN 1998 220TH ST ,~~ DEER PARK WI 54007 ;~' Districts: SC =School SP =Special Property Address(es): " =Primary >~ Type Dist # Description ' 1998 220TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC .: ~; Legal Description: Acres: 5.630 Plat: 5326-CSM 22-5326 006/06 SEC 20 T31N R16W PT SE SE BEING CSM Block/Condo Bldg: LOT 01 22-5326 ('06) LOT 1 (5.630AC) ~'~~ Tract(s): (Sec-Twn-Rng 401/4 1601/4) {,~ ~ di' 20-31 N-16W SE SE ~E Notes: 2008 SUMMARY Bill # Parcel History: Date Doc # Vol/Page 08/14/2007 857534 08/14/2007 857533 12/04/2006 839985 22/5326 06/23/1998 581659 1334/339 Fair Market Value: Assessed with: 0 WD CSM SiL /sag Valuations: Description Class Acres Land OTHER G7 5.630 22,000 Last Changed: Improve Total State 113,600 135,600 NO ~L9b-98£-9TL ~uru-rsld uousur~o~ul pus? 089b-98£-STL srurcupfr apo,7 Totals for 2008: General Property 5.630 22,000 Woodland 0.000 0 Totals for 2007: General Property 5.630 22,000 Woodland 0.000 0 113,600 135,600 0 113,600 135,600 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User~Special Code Delinquent Charges 0.00 29-~I-16 0 N ~'. 0 r N N ro w o~ w N OWNER PETE DONAHUE 1604 70TH AVENUE AMERY, WI 54001 1~~~~~~©~aD~ NOTE: THIS MAP IS BEING CREATED UNDER THE FARMLAND CONSOLIDATION PROVISION. THE HOUSE SHOWN HEREON WAS BUILT APPROXIMATELY 1920+•. l~~I~ll~1~~D ~p~l©~ CORNER, SECTION 20 (ALUMINUM CAP FOUND ) A N89°08'O6~W 1648.05 (~ v NY, CORNER, SECTION 29 (ALUMINUM CAP FOUND ) NOIE: A POSS~LE VKXATKNJ OF THE ST CROU(COUNTY ZOI~NG ORDINANCE WILL BE CREATED IF TFE EXITING STRUCTURE LOCATED WITHIN 100 OF TFE PROPERTY UNE EVER HOUSES LIVESTOCK OR POULTRY. CERTIFIED SURVEY MAP LOCATED INTHE SE%a OF THE SEYa OF SECTION 20AND THE NEY OF THE NEY OF SECTION 29, T31N,R16W, TOWN OF CYION, ST. CROIX COUNTY, WISCONSIN. N1a~l~fi1~PL~D ~~l®~ BEARINGS REFERENCED TO THE SOUTH UNE OF THE SEYi OF SECI ION Z0, AS~l1MEO S89°05'09'E 485.15 _ TO BEAR N89°OB'08'W. / ENCE LINES LOT N 245,110 SOU/ARE FEET - (5.63 ACRES) INCL RNY `~ 243,810 SQUARE FEET ( 5.60 ACRES) EXCL RNV SHED (}~ BARN '(' `' O ~ N89°06'O6'W ~~ '.•19.8T ~ ~~ ~ SOUTH LINE OF THE SE Y ~ SHED OF SECTION 20~SHED ~ ~ NORTH LINE OF THE NEY ~ OF SECTION 29 z °V • ~ 21.33' 8 SEPTIC ° ; N89°O6'O6'N N SHED VENT() ~ ~••••••••. PREPARED BY: L0~ GRANBERG SURVEI7NGlNC. I (Nor sHOwN 1235 C.T.H.'E' 1NDETAII I NEW RICHMOND, WL 54017 PHONE { 715) 246.7529 ~ N89°05'13'W 485.15 WELL 0 JOB N0.06-057 - -- -- - - 0' 100' 200' 300' ~~~Q~~~® ~©~ SCALE IN FEET 1' =100' N I~ S,~ ~ti i ~ ~ ~ ®) * _' G BE ~ it gl = i i NEW RiCHMONO ®~ ~, WI 0 m 0 a 00 r~~ m n rn C m v ~~ ~~ ! ti j' Q n 9~0~~0 'U~ ~y ~~,- /d ~~ ' ~-/Gr~ aI SE CORNER, SECTION 20 ' , ~g~• IQ { 1 STEEL SURVEY MARKER NAIL FOUND AT POSITION) 2~ ~ `'~" T 300TH AVENUE T ~ ~`° r N89°06'05'W 507.40' W - NE CORNER, SECTION 29 :' (1' STEEL SURVEY MARKER NAl1 FOUND AT POSI110N ) IfGEND ~~ ~ n Nny~~r ~ -INDICATES SECTION CORNER MONUMENY ~ AS NOTED w w g ~wt~N N W '' nn ~ ~ ^' ~a~o ( ) N„ " ` ~; 0 -INDICATES 1.25 X 24 IRON PIPE WEIGHINCw ~ ~~~. ~ 1.68 LBS. t LINEAR FOOT SET. • • • • • • • • - INDICATES 50' SETBACK LINE FROM RIGHT-0F-WAYIiNES. ~ ~~w,~ ~ SkEET 10F 2 s '~ ~e ~ ~~