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Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION ~ ~' (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Anderson, Jason Eau Galle Townshi CST BM Elev: Insp. BM Elev: BM Description: /~l ~[) f ~~ 'Z C-~'j~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~, ~ ~~-2~~ ~ Qn Dosing / (:ra,nn,~i~ ~ ~~(~ ,Aefel,or, ~e.~ ~ I ~ y Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ y I ~) ~ ~ ~, J 1 Dosing ' L + ~~ I Aeration Holding PUMP/SIPHON INFORMATION _ .,.~./~ Manufacturer Demand `" Uli'~ ~ GPM Model Number (,J~c~S Z)~3~ TDH Lit Friction Loss System Head TDH 9 t Forcemain Length ~ Dia. / Dist. to well /~ ~~ ~ !~- SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CrDIX Sanitary Permit No: 453270 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 11.28.16. STATION S ~ HI c FS ELEV. ~D / Benchmark Z . ~ /rr ~3 ~~ i ~ I Alt. BM . ~, - ~~~~U ,Z ~~ ~. ~K, `f ~ , b v z. ri Bidg. S wer I~,1 BSI . 3 St/Ht Inlet ~5 ~ ~ ~~ ~ SUHt Outlet ~ ~ Dt Inlet ~~~ ~- Dt Bottom ~ q. ~ ~ 7~ 3 Header/Man. s /a2•JZ Dist. Pipe l ~ ~ Jae . iZ Bot. System z.5 , b+,5 Final Grade ,~ '03.IZ St Co le~ Ga z~ ~s BEDfrRENCH DIMENSIONS Width ! Length ~ No, Of enche PIT DIMENSIONS No O, f Pits ~ Inside Dia. Liquid Depth ~ ~~ ~C c ~ SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type F ystem; ~ ~«~ t ~ ~L~ ~ ~ A UNIT Model Number: v DISTRIBUTION SYSTEM ~ ~~~ Header/Manifold ~~ r Distributio ~~ ~, Pi ~ x Hole Size /I x Hole Spacing ~/ Vent to Air Intake , / ~ --~ ~ h ' f pe(s) ~ ~ lD L ~ ~ ~ C y~~ ~ Lengt _ . S Dia ength Dia Spacing c) SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv v Depth Over 7 BedlTrench Center ~ ~~ I Depth Over BedlTrench Ed es g \ xx Depth of To soil p 1 ~~ xx Seeded/Sodded es ~ No xx Mulched es ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: I ~ / ~ / O `~ ~ Inspection #2: / /. Location: 2584 42nd Ave. Woodville, WI 54028 (NE 1/4 SE 1/4 11 T28N R16W) NA Lot 1 ~`~ \S ~~' ~ Parcel No: 11.28.16. 1.) Alt BM Description = 2.) Bidg sewer length = ~ C~ - amount of cover = ~ r' Plan revision Required? ~ Yes No j-j~, ~ f Use other side for additional information. '~_I_~ _L___`_ I_~`I-~_ SBD-6710 (R.3/97) Date ~P~S~-c~ J ~~ - ~ - l ~ ~ ~ 1- - - -- -- - - -- - - ----- ---~ ,~ _-~ Insep t rs Sig ture Cert. No. ` Safety and Buildings Division 0 County ~ ~ - ` - 2 1 as r - g ox 2 ~ ~ 2 v t /C ~ SC~~~~~ Madi , V 1 ~0 2 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 261-6546 ~ ~ ~ ~U Sanitary Permit A plied 0 2004 State Pla r n~I.D. Numbe Q / _ ~ ~ ~ In accord with Comm 83.21, Wis. Adm. Code, nal informatio ou jrrovide_. tP (J may be used for secondary purposes Pri y Laws; SIt5~87Yh~U ~~~ ~ ~' Project Address (if different han mailing address) ZONING OFF E ~ / / +~ ~ rt " ' I A lication Information Pl a P i t All I f ti ~ a5 ~~e 1 I . pp - se r n e n orma on rl~ Property Owner's Name Parcel # t # Block # v l~ s~ I 3 vb~~ ~- ~~ Properly Owner's Mailing Address ~ l' ©~ ~ l S~ Prope Location l u 1 S ~ % S ti ~ Y State C ity, Zip C ode P hone Numbe r ., , ec on / ~ ) tit,/ C/(~ ~V cr ! ~C.~ ~ ~ p~ / ~"i (/ 2 b p s ~ ~/ t~ r~ [ l5^' F!i {O ~~3 [ L, ~• .f. ~O N. R ~~(ci~eWe) r I I . Type of Building (check all that apply) o F 2 ~ ~ C , ubdivi s S ion Name CSM Number G t~'1 or 2 Family Dwelling - Number of Bedrooms J r / ~ "'~ ~ - ~ ~~ ~ ~ ~ ~~ ^ PublidCommemial-Descrtbe Use ` i ` ~+ V --7 ^ State Owned -Describe Use ~ tsT'~~'L !~ / Q. 5 ^ ity ^Village l~'Township of III. T ype of Pe mit: (Check only one box on line A. Complete line B if app cable) A' ew S rem ys .~- ^ 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 IV. T e of POWTS S stem: Che ail that a 1 ^ Non -Pressurized [n-Ground ound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized [n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line Gravel-less Pipe ^ Other (explain) V, Dis ersallTreatment Area Information: Design Flow (gpd) ~~~ Design Soi] Application Rate(gpds ~ ~~h~~ ~ • -iii Dispersal Area a wired (sf) V L ' Dispersal Area Pr posed (sf) ~l ' ' System Elevation ! ~ .~ {Y oa ~ s /3s ~ , IG YI. Tank Info Capacity in Total Number Manufacturer refab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Facisting Tanks Tanks Septic or Holding Tank a U ~V / to p ~ C `G n W J ,C Aerobic Treattrxnt Unit / r Dosing Chamber ~ S U l 1 VII. Responsibility Statement- I, the under ned, assu es onsibility for installation of the POVY'TS shown on the attached plans. Plumber's Name (Print) ~~ ~ Scan Plum 's Signatur /MPRS Number ~23~~'?s Business Phone Number '~ f ~ ~~"'~- S'~6 Plumber's Address (Street, City, State, Zip e) VIII. own /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) ~}l ~ ~--~1 O`C7 ` ' Date Issued ~ h Iss ' g Agen igna re ps) ^ Owner Given Reason for Denial '~ ~ V " ~ V IX. Conditions of ApprovaUReasons for Disapproval 3 (yc° ~S YSTEM OWNI=f~: G~~ ~(j~ -~~-- ~ryl. ~~ ~' 1 eptlc an t, a went filter and C~~ ~ , , ~p~~ ~A ~~ s~ dispersal cell must all ~ serviu~d (maintained ~~YL "- as per management plan provided by plumber. d 2. A!I setback requirements must be maintained as per applicable code/ordinance . . 3. / wttacn complete plans (to the County only) for the system on paper not less then 8l/2 : U inches in size .~ 1 ~/" Q~ ~` ~~ SBD-6398 (R. 08/02) PLOT pL~~i Scale 1 "=y O' Page J cj • ~Mt~-I = ~-.l~c~.p 'cam, 1 Z `~t-t_:~ 3/~,'' Di q,-------- y_ _ _ _ ~ ~.,wy~k~._=_k~ _:1dC=0'-ON iV~``j'Pri-~ 3!~" Dt~-_._.__~ ~ ~° 3~,'+~-- _~ ._- -- ___. a .% N~f~RCST LpT .U Jt1~ 1 S ?_ lOQ ~ _._ -_ •~,~ .v'~ ~ j~`, ~. J n SST::. ~~---,-~IUU 1vD _: ~- ---- ~~~ ,~ i ~,/ • ~i r~ ~S ~ / , `' , /// i c ~ ~---- Wit.. 14.5' ~, •~5 ,'/ OtZ D~SZv~t3 ~~ ~i ~~ S ~Cs'A o- a• $~ ~-l r~ ~ ~ a N X O N C~ ,, 3 ~~ --sue a ~ ~ ~i~ ~i~ Ali r~ ~ ~~ P - fi ~~ SUGGgSTLsp ~ a w~~ Lac . -- k ~ ~ ~Z~~ ~v~. NOTES: ~ - I. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( "~ required). 3. Septic tank to be ~Ovo/bS0 gallon ca\pacity manufactured by Wt~ CuoaC1Z~- w~.P ~ouo/6SD w1~Z1wI~1w1'~CN STFID~ ~1L'SL`1Z. 4. Bench marks : ~~ ~oyL ~. Divert surface water around system to prevent ponding at the uphill side. commerce.wi.gov i ^ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. c o m m e rce. st a te. wi . u s/s b www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary April O1, 2004 CUST 1D No.267341 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SP[A 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/01/2006 SITE: Jason Anderson 42ND Ave Town of Eau Galle St Croix County NE1/4, SE1/4, S11, T28N, R16W Identification Numbers Transaction ID No. 982696 Site ID No. 672214 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manua] Regulated Object ID No.: 948617 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.01/01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes C'~tt(,~1tt41 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. ~ pRTMENT OF The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: ON A SEE CORRESI • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01 /01). • The changes made to this plan on 4/01/04 by this reviewer were acknowledged and approved by the system designer. The TDH is 29.16 feet with the addition of 0.5 feet of head assigned to friction loss with use of the Simtech effluent filter. • 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 well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c ARTHUR L WEGERER Page 2 4/1/04 • 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. Stets. • 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. Stet • Comm 83.22(7) A copy of the approved clans 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/instal lation/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 stets 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, ~c ,J Charles L Bretz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@comm erce. s tate. 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 TITLE SHEET C61~~~ 1 S MAR 2 9 2004 FOR AFE~, p Dr A 3 BEDROOr1 RESIDENCE cx U`pGS pw. This plan has been prepared in accordance ~1ith the Mound Component P4anual SBD-10691-P and the Pressure Distribution_ P•Ianual.SBD-10706-P (N.OlJ01) (N.O1/O1) LOCATED IPt THE N~, 1 /4 OF THE S L 1 /4 OF SECTION ~ ~ , T z~ N, R ~ 6 W, TOWi1 OF L~U Gf~I,LL ST-c4ZU~X COUNTY, WISCOPdSIId. FOUND SYSTE'~ INDEX - PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEI I-Ia~;AGE_I3~JT PLAi•i PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW-CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUi4PI1`1G CHAiiBER CROSS SECTION PAGE 7 of 7 PUMP PERFORI•IAiVCE CURVE PREPARED FOR S~SVt~ i~ND~S~n, ____ ~1 U Z C ~ 1Z-C1,~ ST1Z~ T wooer v t~~L , ~~ S ~tt3 Z-~d PREPARED BY WEGERER SQ ~ L .TEST 2 !VG AND . =3ES 2 Get S~RV 3 CE P.0. Box 74 421 iJ.iSain St. River Falls, WI 54022 Phone 715-425-0165 Fax 715-425-6864 , ~~~r~, ~'' ~~~~? ::OMMERCE A-~~~CIN6 'ONDENC i,R?'v.~a ~, `NE,if::?EA ~ ~ C.41'i W ~ Eu::.,,c,A1,~ YVIS. a, F,J Py . ~ ~ .. ~~~ L 1 ~ i, ~ - ~',~ ~yi .~ ~ ~ : t'a 3_~e-uy JOB N0. ~y- ~.~ PLOT PLP~'V ' Scale 1 "=~ b' eMt~-I-I -~_:~.:.lun,o'c~, 1z`'~ri-u. 3I~j~" L t:A~ ---- __ .__ __. -. ~,r71~2=..~:::al.0r_ON: 1.V''`T'P~'tc- 3~8" Dt-~.----J tJ~€F}RCsT CpT _.utU~ 1} ?_~.QD ~ --__ ^~a . . _-- __ Page 3 of -7 o' ~° 3wlit-2 ~ ~?~ / c~ i ~~ ~S, ~~ ~ ~ i ~.. ~ p ~ S' '~, ,~v ~', O\? b \Slv 213 ~~ ~i 'R~ S r~s'A - ~, o- ~n~ ~) s N 0 N ~~ ti. 3 ~ ~l~ _ ~ ~/,~ ~ ' SvGGgsT~o ~ o w~~ Lo c . -- k ~ J+ ~~y h1 i C~~3~~ NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic. tank to be ~Oop/6S0 gallon capacity manufactured by ~ry1~~ (~C1Z~ ~w~-P 101X~/6Sa 1~'11Z)wf~)w11~1i STFTD~ ~1t~'z.. 4. $ench marks = Ste- ~pVL 5. Divert surface water around system to prevent ponding at the uphill side. Fcge ~ Or -1 r Approved Synthetic Covering AST~i C33 Medium. Sand -~ Topsoil '" _~~ E 3 - % Slope ~ - Distribution Cell of %" to 2z" Aggregate z istribution Fipe W ' \ ~~ '~ D /!' _ ~ - ~ ~ b r `Force Moin From Pump CROSS SECTION OF A MOUVD SYSTE:i A ~ Ft. Linear Loading Rate=b ~~ GPD/LN FT Design Loading Rate=p,33GpD/SQ FT Aar-~~n F.~ . L. G Elev. ~ 1~.~ •.s Flowed Layer ~ ~ •~ Ft. E 1~•y~ Ft. .F~-QiFt. G~.SFt. H l,y Ft. 8 -1 S Ft. T ~~- Ft. ~-Q ~ 6 Ft. ~ `~~ '~ K t O Ft. ~ 1~ t ct `~ Ft. W Zy Ft. ,} -Observation Pipe (-' -- - - - ------~ ~ g ~s c~-~-•--------------------- --------------- A ~---`~6 8 _ ~ _ _ --- W ~•-,~------~------ - ---=-- --------------------_-t Force N t ~`~ Distribution ~•- Cell of 2" to 2 Z~~ °~'~'u9 Pipe aggregate . Observation • Pipe (2-achvr sec~relyl PLAN VIE~T OF A MOIIND SYSTEt4 in ~~ Distribution Pipe Layout pz~a S c= ~] ..~- Place the holes at the bOttOII of the dzstribution pipes at~equal spacing. Remove all burrs from the pipe and 'Holes. Extend the end of each late-al up with the use of long tt.rn or 4~' ~t•.:n? to a ~,oint w-ithiu s;.~ incises of the final made. Te.-mittaate the ends of the Iate.-aIs with a valve,: threaded earl or . threaded p1uQ. Pro~zde aces from fnal made for the valve; threaded c :p or thresded pIuQ. Tit F_ 1 cr L LZ~S S s_ -~ .;1~ t~__ Ft1~, F`3 ;: t?VC Lateri - Martitotd Later( x ~ x ~ z xIZ x!1 ~ x ~ x ~ x ~ x Lateral Leneth -~ - _ _ ~ Later<i Lencch = ~ i tom- L t=-N V ~ ~.~.~J _ -- F ---~+ ~.- _ r,~a~~~~.:. ~- -- P 3_` Ft. S ~ Ft. x 3 S inches . , ~~ ~ ~~~ .,ca=rs sox -~ --~ Hole Diameter ~ ~ ~ Inch ~ -~~ Lateral ~ I InchEes) Manifold 1~ 1~ Inches Force Main " ~ Inches Hof holes/pipe :~: 13 ~ . Invert Elevation of.Latera1s1o2_o Ft. 13xO.yI=S.33x~= Z( ,3Z 6p~ • _ ~ ~ - Combination Septd.c~Tank and • PUMP CHAMBER CRO55 SECTI0~1 A~10 SPECIFICATIOIJS' PAGE .b OF \Ot t'~~>~1 nUU1~ w~.- -- ----_- - _ _ WEATHEP, Pit00f • ~.~1 i~~ s „~+ucTIDU eox '~-r't'e t'4 tic !'iZ ! t..,rP-'~. ~: ~ - APPROVED LOCKING l4A>IFI91E toVER wt~?i - wA~.t.tIUG LP.BEL. ---~- CCt~putT ~C Z tZEQ~D 12 N~ ' ~ ~'ltv Q\~ ~ ~ ''. 18• /+llp. ao - ~ ` I I 1 PROVIDE• I l~ ' --- - ~~ 1 -ArttTlGHT SEAL I • I~ v ~aPFt.L $ >3r-~-L.~ -. A -~` r_~~ ~~ ~ P P r o v e e - -~4- ~v~--:~?!!~±T' ~} - .> > I ALAti?! PVCnpipe - w/ t?V C-.~.~i~L~ f b ~ I~ ~ ~ ~ I ~ c~ `~~.°lZ I E1-EV , FT. - ~ ~ I I PUY.P -~ _~....~ +` ~ CF. C COUCRETE~ _ ~~CV, `L3 ~ .OO t ~ CLOLK--~ FISER EXIT P1=RMIiiED G+.?L_ !F TAUK MA1„L'FACTURsR HAS SL'GH APPnCVA;.~3"APP,•cr~ . yfiFaJl>r SEPTIC f SPFGIFICATIO1~15 cosy _ - TAt,!~CS MA-.IUFACTURC:R: w~k~. C~r.~C,jZti'Tt ~;t:MSEA OF DOSES: S`am' c P..R ~_ TAfJK SIZE: 1~ ~V ~ 6 S t~ C-ALLp1~;$ DCSE VOLUME • nLARM MA1,7UFACTL'f1)`A; S.~'~-l_I;TC~f1Z0 S''15~~} 9 IA:CLUDIAlC, 6AGxf>,OW: ~ 19 GALLOh;; MODEL -.:UMBER: `O~ Hl/~ ,CA?Ai.ITICS: A= ~~ i ~ c 30 b 1J_HE.00. GAILCt;, SWITCH TyPC: 1'S~ZCvR-Y B = Z I~;CxES GR ~~ G~.LLOUS F'LMP MAfJUFACTURCR: 6 ~V~-~S Cs .~ IUCHES OR `~ ~ GALLOI.'S MODEL UUMHER: ~ EoS ~} 0= , 1 INLHESOR ,~~ 6ALL0-JS SWITCH TYPE: 1"~~12CV~t'f 3i$ ~~c., ~l{~ uOTE: PU11P AUO ALAR ARC 70 6C MIUIMuM D15cxARGE RATE Z ~' 3 Z C Px INSTALLED OAI SEPARATE CIRCUITS ~' fPv .Z~.a~ VERTICAL DIFFER£1JCE ~ETWEEU PUMP OFF AUD_DISTR18UT10-J PIPE.. `FEET ~- MtrvirlUM tUETWORK SUPPLY PRESSURE . . , .. 6 •SO FCET ~S_p x ~, 3~ 'I' ~ ~ ~ FEET OF FORCC MAIA1 X 1' O~ F~c fzFFCICTIOU (ACTOR.. Z • ~S FEET TOTAL DyUAMiC HEAD =- ~.r-="~' ~'•FEET .? ~j /G - As per manufacturer 1`x,0 gal/in. Liquid depth 38 ~ --. ~'C' ~ -' j''1 ~ ' ~ i~'~.i'- i ~~ '; L i `.'1 ~'"i v Cam'- ~. ~ ~. U t= 1-f i c: ` / ~~ . ~ • Overload protection must be provided in starter unit. • Shaft: threaded, 400 series stainless steel. • Bearings: ball bearings upper and iower. • Power cord: 20 foot standard length (optional lengths available). Single phase: • %3 and''/z HP -1613 SJTO with 115 V or 230 V three prong plug. • 3/4-1'/z HP -14/3 STO with bare leads. Three phase: •'/z-1'/z HP -14/4 STO with bare leads. On CSA listed models - 20 foot length SJTW and STW are standard. 3885 APPLICATIONS t ~..~ Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: 3/" maximum. • Discharge size: 2"NPT. • Capacities: up to 128 GPM. • Total heads: up to 123 feet TDH. • Mechanical seal: silicon carbide-rotary seat/silicon carbide-stationary seat, 300 series stainless steel metal parts, 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 Single phase: •'/s HP,115 V, 200 V, 230 V, 60 Hz, 1750 RPM;''/z HP, 115 V, 60 Hz, 3500 RPM; %i HP -1'h HP, 230 V, 60 Hz, 3500 RPM. • Built-in overload with automatic reset. • Class B insulation. Three phase: %z HP ..'`1'/x HP 200/230/ 460 V, 60 Hi, 3500. RPM. • Cla§s Binsulation. ' ©1995 Goulds Pumps, Inc. FEATURES ^ Impeller: Cast iron, semi- open, non-clog with pump- out vanes for mechanical seal protection. Balanced for METERS FEET [- 90 ~ ; i~, ~~ ~ ~. u~~n~~~ib~ e ~~ y smooth operation. Silicon bronze impeller available as an option. ^ Casing: Cast iron volute type for maximum efficiency, 2" NPT discharge adaptable for slide rail systems. ^ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts. BUNA-N elastomers. ^ Shaft: Corrosion-resistant stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation. ^ Motor: Fully submerged in high-grade turbine oil for lubrication and efficient heat transfer. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage. ^ Bearings: Upper and lower heavy duty ball bearing construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. ^ 0-ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS SA Canadian Standards Association ~~ Underwriters Laboratories I--- -- ~ --- -- `--! -~--- f --;__ ~- SERIE5:3885 I 30' r ? ' t ~ ~ ;SIZE: %; SOLIDS ! WEt ~H $ J +__ __~ ,~ 5 GPM __ _ ~ 1_ RPM: VARIOUS 70 ~` _ ~ -- - ~ t I ~ 's ~ ~ ~ ~ i t WEtOH~! -~~. ~' ! i ( bFT t ~ t ~ w 60 U a 15 50 Z 0 40 10 30 20 5 io 0 o~ ,~ I~ I~ i -, t I. i ~ t t, r i i l l l l i l i l 0 - 10 20 30 40 50 : , 80 70 80 ° 90 100 " 110 120 130GPM i ~ t i 0 10 20 30 m3lh caPACm • E'fective May, 1995 V'/isG:nsin Ceparhnent cf Ccmmerce ~~IL C`/f~\L'U~;TION RcrORT Division of Safehy and i:uildings pe5e ~ of - ~~,..+° in accordance with Comm ;;c, `Plis. Adm. Code Attach complete site plan on paper rtot less than 8 7/2 x 71 inc;tes ira sze. Plan must Counhj S~- Cl ~ ~ X include, but not limited to: vertical and horizontal reference pcint (9M), cirec5cn and percent slope, scale or dimensions, north arrow, and locaticn and distance to nearest road. Parcel LD. T~.~~)ti~ Please print al! information. Reviewed by Date Personal information ycu provide may be used fcr sec.^,ndary pur~oses (Fnv~c/ La•N, s. 75.04 (1) (mj). Property Owner I ~~+~~ ~~~~Z--S~~ Proper~yLocaticn C1 W ~~~ ~' ' :`"" ~'~ C:1~„J Geu#,.Lot ~ E. J4 5~ 1!4 S 1 ~ T Z. C~ ~U R ~ ~ E (cr LV Property Owner's Mailing Address y ~~ Z. CLV~~ •, ~~ „ Lo; ~ I Blcck R I SubjName or CSDA ; C'"y State Zip Code Phone Number , ~~' ~ G L-S~`~1 -I II City ^ Village (~ Town Nearest Ro d `."~~ f.ut. -_ iw s ~. aZ~i c ~ c s) b 4" _Z6~ ~'(~v G >~~ - I y Z "~ -~v E . :~ - u.~. ~~=W ~~~ isuucuon Use: (~j Residential / Number of bedrooms~_ Ccde derived design flow rate ~ S Q GPD ^ Replacement ^ Pubiic or commercial -Describe: - Parent material C~~?,_..l }~ ~ l.. L Flcod Plain e!eva5cn if applicable ~ ~ ft General cpmments and recommendations: Y~'~pUz.1fl ~ l 6 r ~ ~ 5 ~ ~~ S~'1Z1 r ~ .. ~ ~'~ ~J~J ~' ~Z~ ~~~v ~~v ~^. 12" c~~ 5~,~ ~~~ ^ goring # ^ Boring (~ ~, ~ pit Grou nd surface elev. -1 J' • 7 ft, Depth to limiting lac:cr Z-~ in. Horizon Depth Dominant Color i Redcx Descripticn Texture Stn:c:uro Consistence Bcundar y _ Rcc}s Scil P.pCiication Ra:_ GP'?i8 I n. Munsell o -9 goy Z 3 l Z Qu. Sz. Cont. Cclcr ~ - ~ S t 1 ~ Gr. Sz. Sh ~ ~ bk ~ ~ i ~ c 't ~~ I , Z q Z~ )OAR-3t~o l _ I I S 1 1 s I Zwc s k( .v I .. m 1- y l I cw _ S ~ . ~ 3 Z6 3S S~RUI6 ~~ ~•S~tZS~d (sicl t~-sb'~~+ y I yy,•~r ew ~ _ i . S I - i . Z . . 3 35-~1 ~ S~t2 3!Y ~~ ~ L ~ c~~-, ~ y~~,. ~ 3 - ~ • ~ ~ ~ -_ . , ~ Z Bering # 1^~t Bering ( tL~ pit Ground surface elev. ~q - Z ft, u Depth to limiting ~~c:or ~ 1 in. Hcrizort Depth Dominant Color Redcx Descripticn Texture Structure Consistence Boundary Soil Application Rate Roots GPD/ft~ In• Munsell C!u. Sz. Cont. Color I • Gr. Sz. Sh. 'Eff:1 'Eff:2 I o -~ t~ ~3 ~ - S L ~ Z~-sit-~ ~ m`~- c.w - . s . v Z q-Z lo~~ 3l - si l ?~nS6k ~n`f~- cw . S 3 Z~~ Z `~.SyRy f 6 C\ ~, Z S~j~ S~ S1c~ \.c Sb w~`F~. ew . z : ~ z_~ ~S y 2.31y ~1~ 7.S y2 s1 ~ 1s CS k v,nv'~'1-• - . ~ .~. ~ ~ NS of sic 1 'Effluent #1 = BOD > 30 < 220 m _ n d s _ 9~ a TSS >30 < 150 mg/L CST Name (Please Print) "• Effluent #2 =GODS < 30 mg/L and TSS < 30 mglL - ~irth~ur ~L `''Wegere~r ~ ,, ~ 1-~~YL~hw1~ ~• Sign re OL} -:1 C f- ~ •CSTNumber 2 ..Address (J e g e r e r Soil T ~-21 ;;1 i•Iain St d esting & Design S e r v i c e Date Evaluation Conducted - ' 2 2 t~ 5 4 Telephone Number . . iver r alls, tiI S~:OZZ Z -11_p4 71S-42S-O1bS Wisconsin Department of Commerce SOIL CVALUATION REPORT Di~~ision of Safety and Buildings ' ` in accordance with Corr Attach complete site plan on paper not less than 8 1/2 x 11 inch in si .,. f ~`~t~K~S~GD o my include, but not limited to: vertical and horizontal reference point, 9M), direction and Pa cel I.D. percent slope, scale or dimensions, north arrow, and location an distaq~e tQ n r st ro(~d. MAK ~ ~ ~"04 R iew d b Please print all information, v Personal information you provide may be used for secondary purposes ( rivac~~.~u~~1~4~1:~ldf~Tl' Page ~ of 3 S~" ~ CiZ.u ~ yC Date ~'~ ~`~ ~~ ~ ~ GhJ Gent,-LO,t ~ E. i/d SE 1/4 S 1 ` T ~-a N R ~ ro E (or W~~ Property Owner's Mailing Address ~ Lot # 81ock # Subd. Name or CSM# i L ~i City State Zip Code Phone Number -^ City ^ Village ®Town Nearest Rod v f~L- w s~toZ~ cZls~ 64 _Zb~ ~ Gt~-tL~- y Z>,~ ~v~ . ~ New Construction Use: (~ Residential / Number of bedrooms ~_ Code derived design flow rate _ ~. ~ o GPD ^ Replacement ^ Public or commercial -Describe: Parent material C~L~21 ~'S"t-- X1-1.1 Flood Plain elevation if applicable ~ ~ ft, General comments and recommendations: `i`~pU1~1~ 1.,.} (~ ` y~ ~ s ' ~~ S X121 ~ ~ 'e`~» ~w1v w? ~2.'~ ~~ Sri ~~~ i ^ Boring # ^ Boring c~ C~ ®pit Ground surface elev. -t o •-7 ft. Depth to limiting factor Z~ in. ' Soil Application Rate ; Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bcundary Reots GPD/ftz in. Munsell Ctu. Sz. Cont. Color Gr. Sz. Sh. 'Eff~:' ( 'Eft Z ~-2b fO~tz31~ - ~t t ZwtS h ( in. ew _ ~ . ~ . ~ 3 2.6 3S S'~ ~ 4 ~ 6 ~F1'~ 7 .S ~( R. S l ~ s t c_ 1 l^- S'~ i-~ w~. C6J -- ! . Z ; _ ~ 3S -~ ~ S~ Iz. 3ty ., L c~ w. vrt`~-• _ 3 5 Boring # t^~~77 Boring tCt, pit Ground surface elev. ~q - ~ fit. Depth to limiting factor Z ~t 'sn. __ ~_. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •r~„ GPD/ftz I in. Munsell Qu. Sz. Cont. Color • Gr. Sz. Sh. 'Eff#1 'Eff#2 t o -~ ~cx ~3 ~ - s~ ~ -Z..`Fsb-z ~~~ c.w - . s .~ Z q -Z ~ o~ ~ 3l - s i 1 Z,r-a SIB k wt~ cw . S . 3 Z~~ z ~:s~arZ~16 c~~, ~ s~~ s~ sLc~ ti~ sb w~~f1. e~ _ . i. _ ~ 2_~1. ~s~~3ly ~l~ ~Sye slg ~s e.s vnv~-~- - • - •~. ~ cU ~1S of sic 1 ~muen~ r~, = rsvvs ~ su < uu mgrt_ ana t ss >~o _< i 5o mg/L ' Effluent #2 =GODS < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) Sign re CST Number Arthur L. 'iJe~erer ~. ~~-~~y - ~ 2217254 Address cl e g e r e r S o i l T e s t i n g ~ Design S e r v i c e Date Evaluation Conducted Telephone Number .1121 iJ. iiain St. diver calls, tdI 5422 Z -1-1_L>~ 715-425-O1b5 .~ Property Owner _ ~ ~~ SC)N Parcel ID # ~~wU t 1'LJ G Boring # ^ Boring ~,vy ® Pit Ground surface elev. l~ 3 - o ft, Depth to limiting factor Z " in ^~ Page Z of Horizon Depth in Dominant Color Mun il Redox Description Q Texture Structure Consistence Boundary Roots So11 Application Rate GPD/ftx . ~-~ se IoylL31Z u. Sz. Cont. Color - sc 1 Gr. Sz, Sh. z~sb-2 wt`s cw _ 'Eff#1 ,s •Eff#2 •~ Z g z6 ~p~23/b ~ s! 1 z-~sbk YYl`~- c. kJ 3 ~ 3 ~ S ya ~l6 ~ ~ ~ .S ~ e sta s icl 1 c-sb~ r~~F~- - . Z. - 3 Boring # ^ Boring ~ -- ~n Pit Ground surface elev. ft no.,eh e., ~;.,,;+:..,, ~.,,.~,.. Horizon Depth in Dominant Color M Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft2 . unsell Qu. Sz. Cont. Color ~ Gr. Sz. Sh. •Eff#1 'Eff#2 ^ Boring # ^ Boring Pit Ground surface elev. ~ ft. Depth to timitina factor in Horizon Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft= n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 'Effluent #1 =GODS > 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 ppportunity 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. Sa0.83J0 (R.N00) _. ~a3w!y~~~1. =~Z,10rQ(.t1'Cty: _\Z`'Tm4 3~~ D!H_ _~=Fs~ w / ~~ . ~" ~ ~2 Lv~"r_ _. _ _-__ i~ ~ ~J ~~ ~` .~ ~~ ~ ~~~ ,. %i ~ ~O ~~~• ~ v ~~ J}~ v~ ~~pq t,/~J ~~~ e ~ /~ ~Z ,/ j , / f> `,, "~ ~ `~' ,~ ~/ i~/~ g.2 30' • ~ , ''77-~ lam' ~ :st,L ~ 0 v~' C._ 'N ~ 3 C°~~~ ~ ~ti .. / I ~ -_ R >o i I 1 ~ ~•~ ~~ .~ ~ , ~ ~, ~, '~ `mac '~`k . ~ / "y~ /$, ~ ~\/ ~~ ~0 ~6T Cl~~t~T ~ rn q Uv2 ~ ~s1v~3 y ~~ .o ~ ~~ 2 ~•7S ~i 1`o v _ _ _ _ y Z ~'~ Prue, _ L~'~/?~. -~,L. lilO•~`tY~>. ??i~TPrCI.,_31~'!~1 f'~- IZL •Gr~t-tZ._ )~%LL~i~'T'F! , i rI ~~ i ~~~ r~o* C~1Q~T ~ b 1 Sl'131'-"3 '~ S f='tZl~ ~:~ / .,~~ ~.~ CST Signature 2-t~_pt 71S_l.~C_n1G[ oon~rr 0~ -1 ~ Job P10. Date Telephone ito: CST i~lo. Mound System Management Plan `] Pursuant to Comm 83.54, Wis. Adm. Code ]?age Z of Septic Tank , The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. Tire contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank; If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall: advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used trey shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pum- p Tank The pump (dosing) tank shall be inspected at !east once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution S stem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than forwegetative maintenance) on the mound is not recommended since sot! compactior, may hinder aeration of the infiltrative surface within the mound and snow compaction in the w!nter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched fcr frost protection. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mglL TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing paint at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal ce(I. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 W!s. Adm. Code, and shall maintained in accordance with its' component manuaJ{~6-}$ reporting. ~ ]arid local or state rules pertaining to system maintenance and maintenance ~8p-1Dbg1-P No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shat( be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be Inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present Location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. . Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at r1 1'~ . 3$6 - y 613© ~ C~1X . The system installer at The tank manufacturer at 8 00~- 3.ZS- 8~1S6 L~1`~CTR The effluent filter manufacturer at •~$g_~CTC7_32,q.~ S1N1~'C~-4 The pump manufacturer at `I~ ~U- ~'Z,(~_ ~~~ ~ 6~VL~ S ~~ ~i x.}1;33 E ~.tt -r~.t~.~t ~:.~.. ~ a ~'' {l`er?~t~iic~~ rc~gt#iseri ir~m Plara~%t#.p ~Cp~~'•w#Ii for ~~~~ SYCLiJFt `._~.....__~~_. - ...~_..____~~~. _-. -~ ~~G"`~` ~ yi°~'`~ ~~z~~~~~rtv ~~~ss wGG Gt v. ~ l C., ~ ` i'~c~~ ~~et~ti~cati~r~ ~1~~1~~~' ,~~~v`St.~te ,,_,..,- ------~-------~------ _._ _ ~.. U ~~~~~ 25-1 a~ ~ ~~ } x ~.tir~ SVLL'i.:1.114~ ID.:+19 ~~~~:.' _na::i,L3.^.:c^,I}`d. ' 1~'~.. 1?r^, r"t11C'z~P.~ ~ ~. ~~ t Cc ut1:a1;4 L `. .. . 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Ft'S~'c1CfCi~C3~t1tI9Cz°~~}~~ ~1CCffi5C~ 01323113 T'"`~C ~~3C#P c::2"t ~ .mot` L'L Sit. e3~~5~4..WflCCf{3#`..~~~C~Sit ~ ~ s, Lf3~ P...t _, `<`ii3;-_ L4 t`:S~ d.ill~~i ~t`~ ~~} ~-t; Sk ~'~'~ ~cz~I.zficr, }ac~n w~ x P - _ c;ia~ a~#~ L;.I<r~t~ia~ ;ii ~~ ~c~~ SOII ~t°~r t~.~ after isls~sC a:u utclgca e~ c=attra~ ccr~~` l .. s; Pte; u~ia UIG ~t+3~~I{~~ ~~~; pr~at~ « c ~ ~' e~s6 °? ° z~i~11?tY'3G°Ttt,S.«ZE(~ 3~.rc%'-' 4t: ,willi3~i XS ~ ~ ;;.~ - . IS . ~5.51?TS~fl 331~r. . ~-u.- s1,} ` .- :~r1.2T' ' - . - _ ~. ,_ _ .Z il°1f ~T-~`-.x}IT3I11G1`Ci: d£1L3 iFiv iJ'~p~'dl~~"a"13 i1G `;i3ttt4Ce~~ ~ s z4.~. ~,.~.' '`• „ziSl~'f. rvX~11GC tsr ~il?CI =,! ~li. `C.i SL'4 iX} CS'1P ~-'-t'1£t'L - .. ' r r ~~ ,; ~^L2~' ::~`~~ti~> .'-'.' "' =:%? D!3LEiT.3`#`Cd,T_LLLi~ ~tl, l.C3zIIpfCS~t~ IIiIt~ F'Cxty~.^~ ~tl I titer:~ r~L :a ti:"4.~ (""A;','":-~w X39',^ _~ ~ ~ ~I r ki t a i' Ft'.:St C o~'~ i ~~;'+.^.`) t;CliSly ~I.n.3 `d SG'3~1:IT3L'ffi~.", iJf? KISS l~ir_i_ ~LN ~'SIi. C' `k ; Z~CC.''_. ~ t _ ~ ~~ tSC:.tf r°Cnff'~"d 1St -?~.E~Itir~F t- 1 CSC },'.t4 `'~7C'.'#:, 'J'~` 4.Tt?i., si., .~3.^i3II ~~ fp _ ,. -, A ~. dr... .... - - ___ ~ ): ~ . ~. . t ~. r;, d7i:C4i c3 i;tt'. x;:la:~:. ~=~E73F~iu.,A~. x~« ~~^e°~ ~Z}qr I12#t3IT7::iI1~_I L1'.-C 75 LElIG-i~*z1t'G`5;:11s:-tSiT'~x1Y i-t:SU~i cZ1 LI1C Sr';£?I~~. ,F'~3 =' ri Ca:1Str S •~ ~ttciutle rt3tfl t~Iis apglscati~Iat: ~ st~rr~ped warz~I~~' ric~d fran> tii~ iZc xistu* : ~ ~c:ect. of'Ficc - F3. CGTS,~ {S~ SIC CCrt1~zC~ gtyyE'V ITiap I~ ZGi~Gi- C 15 Irt3 l^ Zil. E~?C 4S'BLS:tr T~,~ {'('-.~".i': __ U..2581P 556 I STATE BAR OF WISCONSIN FORM 2 - 2000 Document Number WARRANTY DEED This Deed, made between Walter R. Jacobson and Dorene I. Jacobson, husband and wife Grantor, and Jason R. Anderson and Amy L. Anderson, husband and wife Grantee Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Part of Northeast Quarter of Southeast Quarter (NE 1/4 of SE I/4) of Section Eleven (11), Township Twenty-eight (28) North, Range Sixteen (16) West, described as follows: Lot One (1) of Certified Survey Map filed May 25, 2004, in Volume 18 of Certified Survey Maps, at Page 4 7 5 3, .' as Document No. 763727, office of the Register of Deeds for St. Croix County, Wisconsin. 763944 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 05/26/Z004 02:50P1t MARRANTY DEED EXEMPT ~ REC FEE: 11.00 TRANS FEfi: 144.00 COPY FEE: CC FEE: PAGES: 1 Area Name and Return Address Thomas A. McCormack p0 Box 2120 Baldwin WI 54002 008-1031-90 Parcel Identification Number (PIN) This is not homestead property. bid (is not) Exceptions to warranties: Easements and restrictions of record. Dated this ~ ~~ day of Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, k ~' * Walter .Jacob (~ C'f- * Dorene I. Jacobson AUTHENTICATION authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack Baldwin, WI 54002 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ' y St. Croix County) ~E'~, ~; {1 Personally came before me this / ~~"`A~ ~~. ~ ; ~'1 200 ~, r•,, z-s--~ _ abov ``. r , Walte • .Jacobson and Dorene I. Jacobs~fn • t;~,~_ ~ •- • ~- ~ J t to me known to be the person(s) o ~•ec ~rthe for going ' instrument a cknowledge ~ e ,..1_,. ;~ 'I r A T ; ` Wt-1-~-V r1!~ G Notary Public, State of WISCONSIN \ `~:.:`.-' My Commission is permanent. (If not, state expiration date: ,) 2004 * Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN iNFO-PRO (800)855-2021 www.infoproforms.com FORM No. 2 - 2000 V~ ~~ 7 M h Q~ .T W W . W o. AAN aso I` ~O ',hJ ~ ~U W Jet,~F ~OCO;N a °a< ~ ~~ ~ a~ >~ a. L~.~N N.w D •" N v m ." W 4~ HWW ~~ ~~ to tdN F ~W ~~ woo°e ~i9 UtY,tJO. ~Q~ WWI WNO wa =w F- LL () w~za Q J ': NU'~2M z~ON ~ Ha w=w°o mFrnv~ PREPARED FOR: WALT & DORENE JACOBSON 442 CTH "B" WOODVILLE, WI. 54028 ~ SURVEYOR: THOMAS M. HEALY S 8 N LAND SURVEYING, INC. 2920 ENLOE STREET HUDSON, WI 54018 LEGEND FOUND 1" BERNTSEN SURVEY MARKER Q• FOUND 314" DIAMETER IRON RE-BAR Q SET i"OUTSIDE DIAMETER BY 24" LONG IRON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT • • . • • • • 100' ROADWAY SETBACK ® SOIL BORING f- PROPOSED DRIVE LOCATION Grl~ Ai ~p ~N a~ o 1 ~ I AI ~ N ~ o ~~~~ ~N ~1 i a' S z' )~ ~ 1~" I y~ J ~'" ~ ~ Q' WI ~~ ~)1 Y I V SuR d SCALE: 1"= 200' 13.9T~ 9` CERTIFIED SURVEY MAP LOCATED INPART OFTHE NE1i4 OFTHE SE1/4 OF SECTION 11, T28N, R16W, TOWN OF EAU GALLE, EAST 1!4 UNPLATTED LANDS• ST. CROIX~~i~~gNS~N. coR, sEC.11 N88°12'31 "W 694.53' sT, cROlx COUts'rY 394.29' 300.24' ~arnirq Zoe and Parks Canmiriee MAY 2 4 2044 r` If not recorded within 30 days of ~ I N LOT 1 approval rate approval shall be N . _ a LOT 2 ~ nu1l and vad ~~°YY I ~ LL I AREA: w 0~ '29", 0 `~ AREA: tV w N TOTAL: ~ a L1NpLATTED ~''' t92 ~ J I w 7.89 ACRES TOTAL: ____ ____________ ~ (343,680 54. FT.) 2 8.11 ACRES ~~'• ;,,1 LANDS *~ ^ ~~ 3z ~ .......................... ......... SETBACK a (353,305 SQ. FT.) m N '--------- r; M C EX. RIGHT-0F-WAY ~ ~ 2 v .- 7,78 ACRES EX. RIGHT-0F•WAY ~ r`'t M n 100' z (338,793 SQ. FT.) ® 7.98 ACRES ;,~ p ~' a I a w • ti (346,658 SQ. FT.) ~ Z fV o ~ m O }~{ O p p,~~y~,~n ® ® w 'H Z N Z ® F°~'1T N O I M ~ a o N c N Iz ~ ® °z N89°28'48"W 444.56' 100' N AREA: v . TOTAL: N89°22'33"W 50.00'} w rn 7.285 ACRES •, ml ~ {317,343 SQ. FT.) LOT 3 N rya ~~ U' ~ JOINT DRIVE EASEMENT o ° o EX, RIGHT-0F-WAY m;'-1D0' z "~ c°'i 5.578 ACRES ~• ~ ~ (242 961 SQ. FT.) N: N` c --S88°56'09"E 1172.4T-- SOUTH LINE OF THE of '57'12"E,-'~~ NE114 OF THE SEi14 - Z 95' 241.40' ,16.36' + 359.01' 20,65'-~~ _ _ 572.01' 5.00- 4~ ~ ~ ~8"F ~ B .._ ~ .~. -....-_. M _ 1325:D6'! _ ~VENIIE ___. !' 100' ~ ` IN A~ ~, I w Zi Ot.,, ~ i n ~~ M ~~ M~;~o a~ n o M1 E"~i I w A M ~ (~' V, i O ~~ ° ( I 0 ~I Z z 100' J ~I~?I Z I w JU I TRAVELED "- "' "- - '-`-"''-~-~- "' ~I I CENTERLINE ~ ~ `~~' UNPLATTED LANDS- ~ M 1~ 0 200 ~ DRAFTED 8Y: WES ANDERSON PROJECT# 6386.01 DATE: 316104 REVISED: 4123104 SE COR. ~ SEC.11 W a W `~ 2~ N ~ N ~+ LL 0 W IW vI '~,...•~ CERTIFIED SURVEY MAP LOCATED IN PART OF THE NE114 OF THE SE114 OF SECTION 11, T28N, R16W, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN. SURVEYOR'S CERTIFICATE I, Thomas M. Healy, Registered Wisconsin Land Surveyor, hereby certify: PREPARED FOR: WALT & DORENE JACOB50N 442 CTH "B" WOODVILLE, WI. 54028 SURVEYOR: THOMAS M. HEALY S & N LAND SURVEYING, INC. 2920 ENLOE STREET HUDSON, W154016 That I have surveyed, divided and mapped that part of the Northeast Quarter of the Southeast; Section 11, Township 28 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin, described as follows: Commencing at the east quarter comer of said Section 11; thence South 00 degrees 02 minutes 33 seconds East, assumed bearing, along the east line of said Northeast Quarter of the Southeast Quarter, a distance of 579.71 feet to the point of beginning; thence North 70 degrees 11 minutes 29 seconds West, a distance of 192.46 feet; thence South 00 degrees 31 minutes 12 seconds West, a distance of 397.15 feet; thence North 89 degrees 28 minutes 48 seconds West, a distance of 444.56 feet; thence North 00 degrees 04 minutes 21 seconds East, a distance of 612.90 feet; thence North 88 degrees 12 minutes 31 seconds West, a distance of 694.53 feet to the west line of said Northeast Quarter of the Southeast Quarter; thence South 00 degrees 04 minutes 21 seconds West, along said west line, a distance of 1004.26 feet to south line of said Northeast quarter of the Southeast Quarter; thence South 88 degrees 15 minutes 08 seconds East, along said south line, a distance of 1325.06 feet to said east line of the Southeast Quarter; thence North 00 degrees 02 minutes 33 seconds West, along said east line, a distance of 737.94 feet to the point of beginning. Containing 23.29 acres, more or less. Subject to roadway easements over, under and across that part taken by 42nd Avenue and County Trunk Highway B and all other easements and restrictions of record, if any. That 1 have made such survey by the direction of Walt Jacobson, owner of said land. That such is a correct representation of all of the exterior boundaries of the land surveyed and the subdivision thereof made. That (have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the subdivision regulations of the Town of Eau Galle and St. Croix County, in surveying, dividing and mapping the same. Thomas M. Healy, S-2546 Date: April 23, 2004 THOMAS M. HEALY 3-2546 HUDSON, Q Wl _.~~ ~ `~~~\ Each parcel shown on this map is subject to Skate, County and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the Town of Eau Galle for advice. DRAFTED BY: WES ANDERSON PROJECT# 6386-01 DATE:3/6104 REVISED: 4(23/04 SHEET 2 OF 2 SHEETS Vol 18 Page 4753