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HomeMy WebLinkAbout008-1098-90-100'ac' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety a~~d 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)(mp. Permit Holder's Name: City Village X Township Madson, Jeff Eau Galle Townshi CST BM Elev: ~ Insp. B Elev: M BM DescriptionQ: / ~ /~ ' TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic w ~ ~ ~- ~ / ~O~J Dosing ~ `` Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ [ ~ t [ „~ } / ~ ISd i ~--_ Dosing t1 ~l t~ ~ ~ ~s•p Aeration Holding PUMP/SIf1HON INFORMATION ~~w~~^• (Manufacturer ~ - Demand S GPM Model Number ~Pp ~ ~~ 3~~`I •~`•` Lift •~~ Fricti~ S~ System :esad~ TDH , Forcemain Length 0 Dia. ~ ,tt Dist. to Well ` SOIL ABSORPTION SYSTEM 1 BED/TRENCH Width ~ Length t No. Of TreneFies ' DIMENSIONS ~ ~~ ~~ ~a,~~.~„ SETBACK SYSTEM TO P/L BLDG WELL INFORMATION Type Of System: 1 ~~ ~,~ DISTRIBUTION SYSTEM ELEVATION DATA County: $t. CirOiX Sanitary Permit No: 420405 0 tate Plan ID No: 233 ~T~t,.~. ~p;~k arcel Tax No: 008-1098-90-100 STATION BS HI FS ELEV. Benchmark ~. ~, r `f' a~ o ~ • ~ ! Alt. BM Bldg. Sewer 1 J SUHt Inlet p ~~ a p - ! 1 StlHt Outlet Dt Inlet _ Dt Bottom /2 ~ ~ '. O 3 ~ Header/Man. ~ (e~ ~ Y Dist. Pipe ~~ . 6 ~ ~ Bot. System S.3 ~- 3~ ~t , Fin Grade ~ ~." : ~~ ~e 12 + - eo St Cover ~~ ~ / PiT DIMENSIONS No. Of Pits Inside Dia. I hitaader/ anifo ' D !I Distribution t ~ tt f (~~ t Pipe(s) 5 ~ ~s ~ x Hole Size' tt /~j x Hole Spacing ~ i Vent to Air Intake . Length Dia Z i ~ Z Length~_ Dia Spacing '" Z 2.3 SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depih of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ J No i ~, Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Insp ction #1:~/' /d Inspection #2: / / ~l oc i I t c4~1 T4-~~' - Parcel No: 35.28.16.5306 L at on' 35 250th Street Woodville, WI 54028 (NW 1/4 SW 1/4 35 T28N R1611~j NA~ot 2 1.) Alt BM Description = ~ ~'^~"~~"~G. ~~X~" , 2.) Bldg sewer length = ~,. Zp0 K ~ „r -amount of cover = ~ ~'~~ (pL, ~ ~- ~~,~~ G/~ S.jJ~ +~ .N~~ y~.~ ~ a ~~~ - 3.) Contour = ~~ ~ p --- - ~-_ _ __ ----- ___ _ ___ _ r revision Required? ,, Yes No ~• '~ ~~' ~. i / ' Use other side for additional information. ,__.__ ~_ . _~ _, _ _ __ _ ____ __- L_ _(~"~~ SBD-6710 (R.3/97) ""'/a ~ ~ Insepctor's Signature Cert. No. C Parcel #: 008-1098-90-130 02/08/2008 04:54 PM PAGE 1 OF 1 Alt. Parcel #: 35.28.16.5308-20 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08129/2005 00 0 ," ~,n C Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - MADSON, JEFFREY FREY MADSON 33 50TH ST ~DWIN WI 54002 Districts: SC =School SP =Special Property Address(es): ~ =Primary Type Dist # Description ~ 35 250TH ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 10.000 Plat: 5057-CSM 20-5057 008-05 SEC 35 T28N R16W PT NW SW & PT NE SW FKA Block/Condo Bldg: LOT 0 1 CSM 13/3756 LOT 2 (19.720AC) FKA CSM 18-4743 LOT 4 (27.22 AC) BEING CSM Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 20-5057 LOT 1 (10 AC) 35-28N-16W Notes: Parcel History: Date Doc # VollPage Type 09/16/2005 806638 2890/110 QC 08/29/2005 804673 20/5057 CSM 05/12/2005 794786 2801/474 EZ-U 05/06/2004 761707 18/4743 CSM more... 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/06/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 27,000 182,700 209,700 NO PRODUCTIVE FORST LANDS G6 8.000 21,700 0 21,700 NO Totals for 2008: General Property Woodland Totals for 2007: General Property Woodland 10.000 48,700 0.000 0 10.000 48,700 0.000 0 182,700 231,400 0 182,700 231,400 0 Lottery Credit: Claim Count: 1 Certification Date: 0710712006 Batch #: 06-06 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 008-1098-90-125 oz/osi2oos 04:52 PM PAGE 1 OF 1 Alt. Parcel #: 35.28.16.530B-10 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/29/2005 00 5 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - MADSON, RETIRED RETIRED MADSON Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 27.220 Plat: 4743-CSM 18-4743 008-04 SEC 35 T28N R16W PT NW SW & PT NE SW FKA Block/Condo Bldg: LOT 04 CSM 13/3756 LOT 2 (19.720AC) NKA CSM 18-4743 LOT 4 (27.22 AC) CSM 20-5057 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TAKES ALL 35-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 05/12/2005 794786 2801/474 EZ-U 05/06/2004 761707 18/4743 CSM 05/06/2004 761706 2565/332 WD 08/22/2001 654432 1703/526 W D more... 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 02/20/2006 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 ~h l~ RECEIVED D m o ~a n ~ a T o ° ~ cm i ~ o~ ~yo n ~oz~ y -+m Z O c ` mL^ o = m ~ y Q ~ O ~~ ~gm 3m ~ O S ro ~~ ~ "' va ~ ~~ Z @ ~~ yob 3 ~ ~ m~„ ~ qq~ g m ~~' ' O~ D Fn D m ~+ w°C ~ ~zy w ~ Z .i.3aais H,to~z~ 0 0 m b~ BL'8t£L ,LL'99 AM9L,Sb,LON ~L'9 ,~ S.~ n~ ~ ~" ~Q -,rn ~ O a cn -D o ~ ~ m~ zD 1Q mm p ice' g i° IQ IBS i~ ~ ~ b~ i ~ C~O~ i~it~ n C m m 1~ 1° T I ~ 1~ ~ a ~ ~ I~ i° Z7=~ ~ ~~ '= p 0 70 ~ I~^ TII Ccm77 ~ 2 m C ~ _ ~ m - < m o~ ~ ~ ~ 1 V C 7 ~ ~~~o~ V NQ°~o ~Q O f=11~v~°jPlo V_ ''~AAfgmmao~l(~1~ YI ~ I1gS7~~ ~~1~ i OR7 ~ Q 1 ~-'IoU ~ y ~om~~c.~~nn~~c~ _ ~ m0 i O Z D ~ T !~ o 0 ~ ~ 1 1~ ~~+P l~ I~ r° i~ O l~ lQ I Q ~ e I p 0 1 ~ ~S ~ N O O ~ Id b ~f ~ f V ST. CROlX COUNTY SURVEYOR'S RECORD --- -~1~-177~-~~-----n--7 -~--~-f'{-~-7-/~- ~QUV V U Q~2~ V ULJLIV U IJ .60'659 M..9 L,Sbo l ON AB'bLZ ,£ t'8S9 ~L'8LE ~^? N4~9 t.Sba tON ~°0~ ~~ rim m N ~~ - N m Q _ .v8-s L t Bt~4673 VOL. 2O PAGE 5057 KATR~EEII H. M](L~--- -- REGISTER DF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 08/29/2005 09:50A![ CERTIFIED SURVEY KAP REC FEE: 13.00 COPY FEE- 3.00 PAGES: 2 .60"SS9 --~A1~---~ Sb ON M. ,L 9L Y ~..a b/tMS 3H1 n > r ~ 30 3N41 SS3M z ~ ~ Q ~ ~ z ~ _ mrn oNv N N r" Z C~ !`~ y~ ~ ~ m N N ~ ~ D ~~ ~ (i7 ~ D~pNZ ~ Q m ~ ~ ~ D ~~' z +m m ~ ~o vZZm I W j P l° ~~ ~1 ~ v~v° ~o~Q Z g Z ~. O1~ < m- ~+ Q_-~Q m e ~1~ c~S~Z ~~am ~ Z p „n cvZ-~ ~~~ ~ Z~ mr ~m p D ~ m~~ ~ a p c~ ~ v Z m ~ ~ ~ O p p ~C m ~ o~ ~ _ ~'' ~~~ f11 Z ~ ~~ v 'T' "' ~ ~ ~ N ~ Q C ~ ~ ~ v ~ ~ c=~ ~_ -. m ~ mZ ~N~ ~ ~ A T ~i ~ ,94Sb.tOS o --~ l~ y DTI , _l _ ~ ' , O - ~96'SS L ~ ,~ ~ ~ 3~~9L~Sb.LOS p rn ~ ~ ~ ~ m ~ Dr N m ~ Q ~ o p ~ ~ c n (/ ~ ~ Cn Q fJ (n ~ p y ~i m A ~ ~ j ~ Z ~ ~ ~ G' ° ^' ~ ~ p ~" ~~ cn ~ 1 ~ ; ~ ~ w3isxs aNnow ~ A m l V o ~~ 1 4 m ° z 1 '6 ~ o l O S~oN ~ P $ ~1 ~ ° ~3 Z , I o0 7n I a C-~ I ' J I 27U 1° ~_~ b/LMS 3H1 d0 b/LMN 3Hl ~O 3NI~ 1S`d3 a' I ~ b/LMS 3Hl ~O b/t3N 3H1 ~O 3NIl 1S3M V w D A m r ~ ~~ ~ ~ ~ ~ ~ ~~ ~~ O A ~~~° b/tMS 3Hl d0 b/t3N 3H1 d0 S3FiOV St 1S3M 3H1 ~O 3NIl 1St .8 L' 199 3„91~6Eo LOS W31SAS 31VNI<7Fl000 ALNf100 XION3 1S 3Hl Ol a3~N3ld3~3k! 3W S`JNItIV38 O_ m Y'n _~ ~-a-------- c'~-J~~ °~1a.1 abb ~ °`90G~1 X10 57~9~7Co7d c `-'+ o A z m VOL 20 PAGE 5057 v y C '0 D ^ • e ~ Cj A A 0 ~ 8 r ~m ~ ~ O C mZ Q ~ m~ ~ ~ z g ~ m ~ ~ 2 ~ ~~ g m ~ m a v ~~ g"~ ° ° ° ~ -i m o ° 2 x W i N oQ 1 ~ Safety and Buildings Division 201 W, Washington Ave., P.O. Box 7162 ~4' ST . CROIX onsin ~. ~ s3~~ -7162 i ~Add~ sc . ~ 3~ ~'~ S~' De artment of Commerce ~ ` ~ 4:;. . Permit Nt Sanitary Permit Applicatio ti h ~~ ou provide Ia accord with Comm 83.21, Wis. Adm. Code. personal information ^ k if Itevisioa ma be used for seco ses Privac Law a15. 1 m I. Application Information -Please Print All IIaformatlon ' ^; .~tata lea LD. Number SITE ID# ~7~' a TRAN ID 648714 Property owner': Name ~ Parcel umber JEFF r1ADSON .,..,... ~:. .w _. y _ 1098-90-100 ~ ~p B Property Owner's Mailing Address Property Loeanou . W341 OAK STREET NW u SW ii• S 35 T 28 N A 16W~ City. State Zip Code Phone Number 1•ot N 2 81~A ~r lV/ SPRING VALLEY, WI 54767 15/778-5731 CSMNtonber • Subdivision Name .~ ~ v. c3~P 3~ -. II. Type of Budldisg (check all that apply) / xs ~ s,,.~,.,,,,`. ^city . ^ 1 or 2 Family Dwelling -Number of Bedrooms 3 n_D~,.,ns • ^VUlage e ribe Use D ^ Public/Commerc [~o~~ EAU GALLE '~ ,,~ ^ State Owned ~~" - • ~ ~' ~ Nearest Road , III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B it applleable) A. For 1 ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to County use _ stem Tank Onl Existin S stem Permit Number Date Issued - 8. ^ Check it Sanitary Permit Previously Issued IV. Type of Permit: (Check all that apply)(ntunbering scheme is for internal use) ~ e:Q -I~ _ 44 ^ Non -Pressurized In-Ground 21® Mound 47 ^ Sand Filter SO ^ Constructed Wetland 22 ^ Pressurized In-0rouad 41 ^ Holding Taiilt 48 ^ Single Pass Sl ^ Drip Liter 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recircula ' 30 ^ Other V. Dis ersal/1~reatment Area Informat Design Flow (gpd) Dispersal Area ion: Dispersal Area Soil Applicadoa Percolation Rate System Blevatioa Final Grade Required Proposed Rate(Gals./Days/Sq.FtJ. (MiaJl acW 8levatwa 450 450 ~ 450 ~ 1 N/A 97.7 99.53 VI. Tank Info Capacity in .Total Number Manufacturer Prefab ~~~ Site Coasttucted Steel Fiber Glass PlastlC . Gallons Gallons of Tanks New F.xistinq , Tanks Tanks Septic or Hoidin; Tank 1000 Dosin; Chunber 750 VII. R onsibllit Statement- I, the undersigned, assume respoasibilIty for installation of the POWYS shows oa the attached Plumber's Name (Print) P is SIgaature MP/MPRS Number Business Phoas Number ' BENNIE HELGESON .~^^-~-•-2' 220292. < z 715/772-3278 Plumber's Address (Street, City, Stau. Zip Code) W1229 770TH AVENUE, SPRING VALLEY WI 54767 VIII. Coun /De artment Use Onl o d ved ^ Di Sanitary Peradt Fee (includes Groundwater Date Issued Issuing Agent_$ignadtre (No Sttaagp;) ~ ' ve ppr sappro Surcharge F '' ' .. ^ Owner Given Luna! Adverse . ~S ~.~-- Z ~ ~ Determinadoa ~ . C~ lions of ApprovaUReasons fotr Disapprov~a~ .. C nn ~ w ~-,- f 0~~ . ' r, -•r ~~ 05!01) ~::: ~+I~ p~ Oo t>>• ~tY may) for UN system o0 paper eat le:f than i]/1 s 11 loehes !b nine tis~ E C~, 33 t y . ~~ Y o, J ~ / _ ~` U ~~ ~ ~ _'- ~, ~2 ~- `o J X J S ~ o a - ~ /~ ~~ ~ ~ - ~ ,- ~ ~ °~ g ~~ °.1 _ ~ ~ _. Q, Q S ~.h.,,QGJ/ ~ .~° ~ - ~ _ _ _ `~ ` -~{..__ _ ~ ~ ~ ~~ . y ~~ s ',i' -.~,. ~ 4- ~- ~ 3~4 ~~1_~ t-~ ~ o"~ s. _ __ _ C f _____-.- , ~~~ c.-Y ~ I __.._. r- u v ~L ~/ c7 /`\\ S ~T~ ~~ ~ ~~-~ ~~ d ~~ nn~ 0 ~ 'V C1 --- .~ i /Y' ~ ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary August 09, 2002 CUST ID No.220292 BENNIE W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/09/2004 A7TN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Jeff Madson 250a' Street Town of Eau Galle St Croix County NW1/4, SW1/4, 535, T28N, R16W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 864110 Identification Numbers Transaction ID No. 774233 Site ID No. 648714 Please refer to both identification numbers,: above, in all comes ondence with the a enc . 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 Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • 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. Stats. • 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. Owner Responsibilities: • Comm 83.52(1)(a) -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. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted ~'!i i~ry~~s.ap~ropriate for the component(s) utilized in the POWTS. Coy~dlh 1 ovally ~~ ~' BENNIE W HELGESON Page 2 8/9/02 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, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim 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 r > INDEX SHEET -~ ''~'~ ~~ ~~ ~~ ~ l®n °°~ PROPERTY OWNER: JEFF MADSONlj~(~ W341 OAK STREET y ~j~ SPRING VALLEY, WI 54767 • PROJECT NAME: JEFF MADSON PROJECT LOCATION: NW 1/4, SW 1/4 , S 35, T 28 N, R 16 W MUNICIPALITY: TOWN OF EAU GALLE 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 WLP750-MR 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 Signed _ Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: July 24, 202 ~ ~ ~ DEPARTMENT OF COMMERCE QIVI$IDN L1F FETY AND SUILDI~IGS SEE CORRE ONDENCE O C4 ~' t . `.1 ~ ~ ~T ~ 3 v .~ ~ ~ ~ ~ ~~ ~ ~'~ ~~ 1~ ~ ~~ d o ~ ~ -- J S ~ ~ ,~ J r b , ~~~~ / -~ - -- ~ e4 ' ~ ~ ~, ~ ' ~ ~ ~ ~~~ ~ -~ . , C ~ ~ ~ ~-- __ ~~ ~ r N V ~S D V/ -ca__ r `1 ~ b I__ J `~°C C J ~" . y/ ,~ _~ ~ S wig 4 ~ ~ ~~ v ~ o ' g. .. __ _ ~ ~ ~~Y ~ I ____._ s~~ j-_ .. - __ _ ... _.r ~-_~~' ------- •._ a1 Y __ 3 ,~ i ~~ [.~~ ew; ~e FF m a~ol ~ d h Synthetic Covering ,~57"M C 3:3 Medium Sand Topsoil _ J ~ E 3 ~ % Slope C C ~.~.0 f 2~- 2 'z Aggregaf e Cross Section Of A Mound Signed: License Number: Date: Page ~ Of~ istribution Pipe ~~fev, 9 . 5 3 G F ~ o _ Force Moin Plowed From Pump Loyer q ~ Ft. g ~~ Ft. K ~,~ Ft . ~ 1~Ft. J ~_ Ft . T ~_ F t . W ~,/~ Ft. p ~ Ft. E/-3~Ft. F ~~ Ft. 6 , ~S" Ft . H ~ Ft. Observation Pipe ~ B , -~----- K r-_-_ ~ ._._ _,._-- ._ .~-_ _._. --_... --- - -- 1 K~ ~ a A ~ _ ~ ------------------------------------- I w ~ ~ ~-- - _ - ,=T__-_----- _------_ ~ Distribution I`LL Of Pipe Aggregate ( rC sc / ~•,s ~ / Observation Pipe .(~,sc-~ Plan View Of Mound Q.L~ia.~'. ~l ~ ~c~Son C )eo.~.o~ ~"<< r5 ~ I ' IenNO~7 Perforot~d Plp. oeioll End Vl~w P~~Iorol~C , ~. ~ 1 oF8 Holes Located on Bottom are Equally Spaced Force. ~~ •- ~-- ~~ - !o!- iUeX~ -~o ~ aP C lei P~D• Distribution Pipe Layou t Signed: License Number: Dace: P Z S~ ~~ . . R ~,_ 3s s x ...a~~" 1 << Y~~ '~ Inch Hole Diameter _~ Lateral " ~ Incn (es) Manifold ~_ Inches Force Main " ~ Inches l-IOIP~ ~r ~-Q..~1'Y2t./ r ~ T~uv ~~e~ is - 7~ C~t~n er ; . J e~-~- YY1 ao~ s c.M PLIt•iP CHP./^.B~R CfiU55 :EC"t~~:.; ANt, ~PCCIF1i:f.IlU~!•`: VC NT CAP WINDOW OR FRCSH AIR iiJTAKE WEATHERPROOF JUAICTION BOX 12"MIU. GRADE 18"hIIN. IAILET ----.- APPROVED JOINT A W~C.I. PIPE EXTENDING 3~ 01JT0 SOLID SOIL b ~ ~-- c LLEV J! ''_. Fr D ~. RISER /~ Gam-/. SEPTIC E I I I' I `_ _ V PROVIDE AIRTIGHT SEAL . .~. O ~ APfRO%ED LOC.~.::.7i• MAI~IHOL E COPE f'. 4" MI1J. I ~L, i I B" /yI1J. ICI ~/ III APPROVED JOINTS III W/C.I. PIPE I ~ I1 ALARM EXTEUDIIJG 3' :-i ONTO SOLID SOIL. I I ~ oN . 'I I I PUMP --~ OFF -.. C0IJCRETE BLOCK 3 '' e~E'~t-~ 5q ~a~. ~ EXIT PERM171"ED ONLY IF TANK MANUFACTUR>`RU S~Svolu~e PP~~Q' ^ ~S.Zr+ ~ l~r /S SPEGIFI•GATIOI~IS /3:3y x 55= 66.7 f~ 1 0! DOSE ~~QS~~ TANKS MANUFACTURER: TAlJK SIZE : 7rV ~• .~ ,GAL~LOAIS s J. C (~`' "==7 S ~f~'-+S ALARM MA-JUFACTURER: - ~~ MODEL 1JUM9ER: ~~~ ` l ~•oa SWITCH TyPf: . rCC~ /~, ~~ ` ~ PUMP MANUFACTURER: v ' ' ~~~/ MODEL NUMDER:~ a•'----`--- Q~ ~ F~ SWITCH TYPE: ~.{ ~ ob.J ~.-~'e~~"~"" E i~ 1~ G PM ~G,c~` T t u~ vO ~u.rvl, ~ ~ t0 , s~ ~p~.) . DOSE VOLUME ~~°~~7~ G0`' TO~U-~ Dos~uCl~~ 7_J__~a-~^_GAIIONS CAPACITIES: A = ~`~ INCHES OR~a GAllONS B a~_IWCHES OR d GALLONS C a~,~11JGKE5 OR ~°~~ ~d GALLONS p.~_INCHESOR y 3L GALLONS NOTE: PUMP A1J0 ALARM ARE TO bE INSTALLED OIJ SEPARATE CIRCUITS MINIMUM DISCHARGE RAT ~~--~•~ ~__i1.__ F E E• T VERTICAL DIFFERENCE DETWEEN PUMP OFF AND DISTRIBUTION PIPE•• ~'~ .FEET ~- MIIJIMUM NETWORK SUPPLY PRESSUR~E/. -O yo FEET OF FORCE MAIN X ~-F/IOOIt.FRICTIOAJ FACTOR.. ~' 3 FEET + /~7? TOTAL Dy1JAMIG HEAD = //'~3 FEET _ 37" • LIQUID DEPT H IIJTERNAL. DIME-JSIONi OF TANK: •i'I-E"•~C•~TH - ;WIGT!-1 ~~'~~c,c S~«~ ~` U. c+7~ ~yu~~it/ ~/c~a,fc ~~ COIJOUIT •' UATE: SIGIJEO: - - LICE.NSF -.lUMBER: 0 U J W ~a ~ ~w° J o FO Z 0 Y~ .~. O 0 ~ m ~kQ Z C9 ~ ~ a ~O ~ OJ Ww ~ a ~ J a O ~ w ^ N Z c c i O d N O F -w ~ON C .9 C j O O ' ~ Q ~ a m _o~~~J ~Q N ~ mw~ N o. O~ aJ ~ s o ~~//~~ [ YJ ` NOQW J w~U w a N . OQ W ~e JJn ~~ ~ Ma~~~ppZWtlj ?w Z =yN } . {- YTV ZU' N~..QH~ ~- ~ oow oow a Q'WW'a W m ° a Y ~~°m°o~iom~~ a p a~ ` ' Zoa z Z Q ~ z z ° ° ° a O - J = ~ „ti8 W r~i~ Z r,N N '1 ~3 ~J ~ LwJ ~ U~ ~ ~n ~~ ~ Z ~ ~ (Q ~ ~ ~ C9 Z N ~ M ~ p O ~~ ~ ~ n g o ~~~ F ~ ~ ~ ~~ 0 O Z ~ ~ W s -_ „ ~; ~ ~ ( 3 5 u n ~ 9'b ~ Q V . i ~ ~ ~- ~t~_...,.,~.-.F.1 H e W .t F O a~~ O „l9 - '~~ 't/~~,• ~~~r- ~_~Dl.(~ Son t. Pttmp Specifications 'h HP Up to 40 GPM ~ Discharge size 1'/•" NPT Solids:'/~" maximum Motor Single phase: 115V Materials of Construction Brass/thermoplastic Features and Benefits - , •Top suction eliminates impeller clogging. •Corrosion resistant ,r } construction. N • Float actuated switch. I mFtfPS fEFI _ .,__ __,,..- _ 25 .. .. ..__. __ ... ' ~ i MODEL DVP03 ' ~ w 5 _ ~ v 15 ~' ~ ~ ~ ,o o ~ 2 0 5 ~, 0, 0 .! . , i......_.. L_. .. .. _ ~ ... 0 5 10 15 20 25 30 J5 d0 U.S.OPM '' tO m~Atr ~ 2 CAPACITY 5 e ~lo r,~ ~ METEU S FEF T _ .. to ~ l i ~ MODEL: 3871 ' 25 ._.._~...._-. .. ~......_t ~. ~ ~ ~,~ .._ _.-.. .. _..... .. t_... I , 6 20 - "" ~ _ ,._ - i cA 5 ~ ~ i -..., a t5 ----, -- -- --i -. - .EPOS. ~ C ' j~ !. .~ i. C ~ 7 t0 -.._..(....._..~__ __ II ___ I ~ .._. ~ ~ .._-. .... ~ .. ._ ... :... . 1 i . _.....,......~..._ ... ... I ~ 1 t 5 . _. ,..._ ,_.~ ~ _.... i._ ......, .. 0 0 ~.. _ ~___ iu -_-~- ~ ---- : ~ _.__ u ~--- .,o ... w uta,wl Pump Specifications '/to and'/: HP Up to 60 GPM Maximum head to 32' Discharge size 1'/="NPT Solids:'/~" maximum Motor All motors feature ball bearing construction. Single phase:115V Materials of Construction Cast iron Thermoplastic Stainless steel CAS AGJ~~ 3 f. ~/ Features and Benefits • EP04 impeller- semi-open design with pump out vanes to protect mechanical seal. • EP05 impeller -enclosed design for improved performance. • Rugged glass-filled thermoplastic casing and base design provides superior strength and corrosion resistance. •Cast iron motor housing for efficient heat transfer, strength, and durability. •Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. ' ~ ~ ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 8 .. r_ nie/1D11AATICIN 'ILG u~. v........._ Owner JEFF MADSON Permit # ....~.....~ nwoAlUG'TPRS UC~Wn r~uv-........_. __ Number of Bedrooms 3 ^ NA Number of Commercial Units tJ NA Estimated flow (average) 300 aUda Design flow (peak), (Estimated x 1.5) 450 aVda Soil Application Rate 0.5 al/da /ftz Influent/Effluent Quality Monthly average` Fats, Oil 8~ Grease (FOG) S:iO mg/L Biochemical Oxygen Demand (RODS) 420 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality [~ NA Monthly average`* Biochemical Oxygen Demand (RODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y inch diameter evc~re=iu SPECIFICATIONS ....... - Septic Tank Capacity .1000 _. al ^ NA Septic Tank Manufacturer IESER CONCRETE O NA Effluent Filter Manufacturer ZABEE O NA Effluent Filter Model ~-100 12" x20" ^ NA Pump Tank Capacity 750 al ^ ~ Pump Tank Manufacturer WIESER CONCRETE ^ NA ,Pump Manufacturer GOULDS PUMPSINC 0 ~ Pump Model 3871 ^ NA Pretreatment Unit ~ ^ Sand/Czravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other. Manufacturer Dispersal Cell(s) ^ In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ^ Mound ^ Dri line ^ Other: • Values typical for domestic (non-cammerclaq wastewater and septic tank effluent. ' .*+ Values typical for pretreated wastewater. 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, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certifted POWTS Maintainer. A service 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 : JEFF r1ADSON Page 8 of 8 START lIP 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. 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 ce(lls) and may result in the backup or surface 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 performance and prolong the Gfe of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter 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 properly 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: ^ 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 suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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 reconstructed in place following removal of the biomat 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 OXYGEN. DO 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 MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name HELGESON EXCAVATION INC Phone 715/772-3278 rn ^11 AI~ITA1\ICQ CV YY 1 J IYIFi Name u• 1 ~II~.-• Phone 715 273-5811 SEPTAGE SERVICING OPERATOR (PUMPER) GULATORY AUTHORITY Name JOHNSON SANITATION Phone LOCAL RE Name ST. CROIX COUNTY ZO Phone This document was drafted in compliance with chapter Comm 83.2212)Ib)(t-(d)&lf) and 83.54(1), 12) & (3), Wisconsin Administrative Code. ~ ~ Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Sa#ety and Buildings Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code - Attach complete site plan on paper not less roar: u 1i2 x 11 inches in size. Plan must Couniy ,include, but not limited to: vertical ar,d noriz~nt~.i , eierence point (BM), direction and C percent slope, scale or dimensic,n:; north ,.9rrOz, csr..; ucation and distance to nearest road. parcel LD. q~ C?3, ~ ~~/ Page ~ of 3 V. APPLICANT INFORIVIATIt3~i -Please pri aj ~tYSrmation:` ';' n~ ,i Reviewed by Date f Personal information you provide may be used for seconds pt~ses ( 'vacw, s. t 5.04 (1) (. )). Rm ~ - ~ ~ ~ ~ 'j Property Owner // -fhur- ~ ' ~ ~' °' - ~ `•~ t ~,. r ~~ -- ~ Pr' Govt.. Location ,) ~1 /~~~ 1/4 ~(N 1/4,S ~ ~ T ,.1 ~ .N,R ~ ~p E (or W~ Property Owner's Mailing Address ~ -~ t • ~` , Lot # ~- .~ Block# Subd. Name or CSM# y•~ ~ c~b ~t S ~ r'+~`• ..~ ~f i-z~ ~Ot ~r,,. r Ci~ State Lip Code 'adri .Nu~1'~NCGf=FICE '' ` ~ ity `' ^ Village _ own Nearest Road // ~~,/. ~d 1 I' ' / h cam/ t e New Construction Use: esidentiai /Number of bedrooms 3 Addition to existing building ^ Replacement ~.,~~> ^ Public or commercial -Describe: Code derived daily flow -~,yl~ C~ 9Pd Recommended design loading rate ~ S bed, 9pd/ft2 ~ trench. 9pd/ft2 Absorption area required ~_bed, ft2 "'-- trench, ft2 rMaximum desi n loading rate ~_bed, gpd/ft2~_trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ 7 7 ~ oc~ ~pc~ g-2~ ft (as referred to site plan benchmarks) ~ u~ l~cd` Sk 7~ Additional design/site considerations I __ / Sce ~ ~ ~g ~~Pk- G~/,V~P +'~ o~ .~~ ~ 9 Parent material - S ~ .._6 `~W Flood plain elevation, if applicable N~ -ft S = Suitable for system Conventional ~M-o~und In-Ground rP-r-,es~su/re AT-Grade System in Fill Holding Tank U = Unsuitable for system ^ S [~' ~ ° ^ U ^ S t~'u ^ S ~- ^ S [~-tt~ ^ S gnu neennioT~nt~ QRD~IRT Boring # f Ground elev. ~(,:.2n. Depth to limiting factor ,min. Boring # °~ Ground elev. Depth to limiting factor ~__in. Remarks: CST Name (Please Print Si nature 1 elepnone rvo. i g - ..~-~ -cam ti vt , -P ~ l 9 c~ S O '---- L-/ ~~,.t~~ Address ~j f Date CST Number i H th D Dominant Color Mottles Structure d t R GPD/ft2 zon or ep in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence ary Boun s oo Bed ,Trench ~ ~- s v K ~ t~ ~r ~ I r , ,~ ' , to rr ,.d ~ S'y / ~ ~ ~l f ~ ~3 ~ _I c~ yR___b ~~ -~~ ~ ~ ~ c c-~ ) v~ ~ l1 i~ ~ ~ ~ , s ; Remarks: $_tr ~ D ..? ^ b r tv~ ry~S r ~( SOEL DESCRIPTION REPORT PROPERTY JWNER ~r_~~u~__( ~'ev~ ~1 PARCEL I.D.;* Boring # J Ground elev. ~ft. Depth to limiting factor ~_in. Boring # Ground elev. ft. Depth to limiting factor ~? in. Boring # -~ Ground elev. ft. Depth to limiting factor ~J_in. Boring # Ground elev. ft. Page ~ of l Horizon Depth Dominant Color Mottles T t Structure i tence C Bo nda ots R 2 in. Mansell I Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ons s u ry o Bed ,Trench ~ ~ -~. s ~ S bU r ~ ~ ~ . S' Remarks: ~` U 7 Fti '~1. ~ j ~ ~ ~ IJ ~ r&i.. --~ ~ _ 5 ~ ~ Y-a ~ r uJ I ~~ ~ 5 ~~ ~ r Wl S ~ V , 6" I ~ Remarks: Horizon Depth Dominant Color Mottles T t Structure nc C i t B unda ts R PD/ft2 in. Mansell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ons s e e ry o oo Bed ,Trench d-~ O a -- S ~~sd~ ~ i u~ 't '.~ - a o `i2 ~ , s- ~ ~ 5c ~ sb~ ,~ /~ ~ ~ - 1- , Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) ~ n n -~- 1 ~ ..C O 0 -~ ~~N c~ °.~ r 5 ~ ~ w s ~~ I~ i ,~ ~ i t ~~ 1 ---I- ~o W 0 a-, W 'b ~ ~ ~~ v ~., p. -fi ;o v ~ ~- ~ ~~ c' .-, T °"' ~~ ro m~--~~c -o ~--- U 'p.~ ~~ ~. _ - _ _ _ ~ u ~~ ~, _ - __ ~o~~ ~~ ~.~ o c~:, g I:r S `fi'b ~ ~ ~g c O G r a ~C G s ,6 5 ~ ~, ~ ~~~ ~-~~ ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer t,,,,1 ~ ~ r ea ~ C~ >~ ~ ~~ C ~~ 5`~' Mailing Address Property Address 1~ / A (Verification required from Planning Department for new City/State ~T s~~67 Parcel Identification Number ~~` - l a 9 ~ - 9~ " ~""~ • S 30 (3~ LEGAL DESCRIPTION Property Location ~ `/o, ~ '/<, Sec. ~~ , T~~N-R~W, Town of ~G-~c ~~ ll -e Subdivision Lot # Certified Survey Map # ~ ~~~ Z, Volume ~ ~ ~ ,Page # ~u' Warranty Deed # ~ ~~~ ~ ~ ,Volume _ 1'1a 3 .Page # ~~ Spec house O yes~no Lot lines identifiable (Z9 yes O no SYSTEM MAINTENANCE Improper use and maintenancevf 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 1I3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. G~ ~'Is/o~ SIG A OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p ope described bove, by 'rtue of a warranty deed recorded in Register of Deeds Office. Ql ~l o~ S G A 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 vot_ 1~[1cJPl-GE 526 STATE 8AR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED This Deed, made between Arthur P. Kempen and Brenda K. Kempen, husband and wife Grantor, and Dean C. Madson and Jeffrey Madsoa Granted. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Part of the Nortltwest Quarter of Southwest Quarter (NW I/4 of SW 1/4) of Section Thirty Five (35), Township Twenty-eight North (T28N), Range Sixteen West (R16W), more particularity described a f Certified Survey Map fiiee};i)etobrer 28, 1999, in Vo1u of Certi urvey`l~l°aps page 3756 as Document No. 612812, Office of the Register of Deeds, St. Croix oZ unty,~ ons .. Exceptions to warranties: all easements and restrictions of record. Dated this 1 3 day of 2001 65x4432 KATHLEEN H. WALSH kEGISTEk OF DEEDS ST. Ck0I7( CO., WI RECEIVED FOR RECORD 48-22-2001 9:34 AM WARRRNTY DEED EXEMPT N CERT COPY FEE: COPY FEE: TRANSFER FEE: ?.25.00 RECORDING FEE: 10.00 PAGE5: 1 Name and Retum Address Thomas A. McCormack 1020 ]0th Ave. Baldwin, W154002 vus-tustt-vu-too ` • - ~- Parcel Identification Number (PIN) This not homestead property. (is not) C~ ~P• ~~~ ^ Arthur P. Kempen. AIlTHENTICATlON Signature(s) authenticated this ~ day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack__ Baldwin, WI 54002 (Signatures may be authenticated or acknowledged. Both aze not necessary.) s'SPenda K. Ke~n.J - ACKNOWLEDGMENT STATE OF WISCONSIN ) St. Croix - -) ss. County. ) Personally came before me [his / ~~ day of C- , 2001 the above named Arthur .Kempen and Brenda K. Kempen to me known to be the person(s) wh_ Q instjrJ/}~mtent and acknowledge/~s ::~ ~; ~ Notary Public, State of Wisconsin My Commission is pcrmanen . not, state exDlrauon te: •Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DELD STATL eAR OF WISCONSIN FORM No. Z - 1996 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI x00.655.7011 ~~6.aV9- 0 ~}p.EFN H•WAL~• .~~, ~~ sy.c~ou~co» O ;N ::"'t PREPARED FOR: ART KEMPEN :ZV ~ r r ~, ; Z .y W m ....~ o> ~ ~m w p oo a ~ ~° WEST QUARTER CORNER UNPLATTED LANDS I ~ ~ -FOUND, SECTION 35 ................................» RAILROAD SPIKE NORTH LINE OF THE NW-SW (FITTING TIES )S 8T°48' 12"E 1300.40' I 33: 08' 1273.32' 33 33' y`~ z Iy ~~ ~~ f 15' N. AND 5' W. OF FENCE _ _N 87° 48' 12' W R SEPTIC a, ~ z~ o~ AI roI W~ ~~ co I ~.~- a v CER T I F 1 ED SURVEY MAP BEING TH TONIMWV ~ E~ GALE 8 T. CRO X C~NTY ~ W 1 SCOIVS 1 N ' 16W. , °_ ; x SYSTEM] a E11 LOT ~ o a, e•~ / Q ~ +~ ~ ~ 19. T3 ACRES ~ `•° ~' : a + HODS 859, 626 SQ. FT. ~ ~ ~'= '` ~ 19.23 ACRES EXC. a/W OUTBUILDINGS ~ 837, 876 SO. FT. I o0'~ ~"~ D ~- I DR 1 VE ~ ~, S 8 7° 44' 08' E 1305.34' `-- 33.08' I y I ~'^ :~ :„ .~ Os W ~ 7C as o ;o o, ~wv . I .r I ~m 33. 08' 3' N. AND 8' W. OF FENCE 39 ! 8.58' EAST QUARTER CORNE SECTION 35 -FOUND PK NA I L o ~2 e n ~ fpy,~ ~ ~ °~ '' ; m rn m . p w ~' ' r :a ~ o Z :~ W i ti1 i ~ 1271.20' NE-SW N 8T°40' 04'W 1304.28' SE-SW i ~ Z L- SOUTH LINE OF THE NW-SW ~ C. S. M. VOL. 13, ' PG. 3708 ~ I-- ............................................ ........ W .ra ~ APPRD OD ~ ST. CROIX COUNTY ^~ Planntnp Zoning and Parks Committee co - _. ~,~-- SOUTHWEST CORNER SECTION 35 -FOUND ALUMINIUM MONUMENT OCT 2 ~ 1999 It not ceded ~~i~lshal b© aPWp`~'1 date apP nuU and void LEGEND • ~ FOUND !' IRON PIPE;` O ~ SET I'X24' IRON PIPE WEIGHING 1. 13 LBS. it (NEAR FOOT 1272. T' W. OF F ~~ LoT 2 S~o~ 19. T2 ACRES 858, 859 S0. FT. 19.22 ACRES EXC. RiN/ 837, 111 S0. FT. M. WEBER i~0~1 i!'RNi01NLLEY. 1N BENT 1 oFSTHEFSW Ni4D SEGTHON~ST