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HomeMy WebLinkAbout008-2000-90-105Wisennsin 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 Groskreutz, Brad Eau Galle, Town of CST BM Elev: Insp. BM Elev: BM Description: 00 ~ +~, l G SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 7 Dosing ~ r / CO Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 -~G ~ ~ ~ / / / ~ Dosing 7zG ~ cc~J l03' ~5 ' ~J ' r Aeration Holding County: St. CrOIX Sanitary Permit No: 463381 0 State Plan ID No: Parcel Tax No: . Section/Town/Range/Map No: 36.28.16. ELEVATION DATA STATION BS ~ HI FS ELEV. Benchmark 5,~~ ios_ /'~ Alt. BM Lv~ ' ~ 3 9~ ,~j j t 7 7 Bldg. Sewer SUHt Inlet ~y, b3 9~ ~~ St/Ht Outlet ~. Dt Inlet Dt Bottom ~7~4Z 8~6 Header/Man. ~ I u Z 7 /~ , z Dist. Pipe ~.• ~ 7 ~(~ ~ z Bot. System 5 ~ /~ ` ~~ / Final Grade ~,~ ~~Z7 St Cover ~ ~/L i 1 / 1 t ~ p 7,~ PUMP/SIPHON INFORMATION Manufacturer ~'~~ Demand GPM,3a •7 Model Number ~ /~~ TDH Lift Friction Loss System Head TDH Ft /Z.95 .3 Zo ~ 8 Forcemain Len th ~ Dia. / I Dist. to Well ~ z C[111 ARCCIRPTICIN SYCTFM BED/TRENCH Width r Length ~ No. Of ench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ !-~ / • ZS `J v~ e `~ ` \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR T e Of stem: YP Y ~ ~ ~~ ~~ / ^ I~ /~/ UNIT Model Number: - aJ 7 3~C I)ISTRIRLITI~N SYSTEM ~ , tJ / Header/Manifold , ~~ i/ / Distribution /3\v I rf ~f Pipe(s) 1. J ~ x Hole Size I '/ x Hole Spacing ~~ V~Jto Air Intak; Length Dia ~ ~ ~ Spacing~?_ Length, Dia ~~ Coll f _f]VFR ., o.e~~..~e c..~fe.,,~ nni.. .,.. nn.,~~nri nr et_[;raria Svctc±ms Only Depth Over / Bed/Trench Center Depth Over I Bed/Trench Edges O xx Depth of Topsoil 1 ~~ xx Seeded/Sodded No xx Mulched es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / (O / OS Inspect on #2: / /, Location: 2630 Boston Road Woodville, WI 54028 (NE 1/4 NE 1/4 36 T28N R16W) NA Lot 4 ~e5~- V`~P~el No: 36.28 16. 1.) Alt BM Description = ~~~ 7.~:'"'~ I^0~ ~ ~ ~a: ~• S e ~• c~`et'""`," wy~"1~ S~ J-t~, 2.) Bldg sewer length = ~ ' J ~ Cut~.{~ amount of cover = ~ . o ~ruadditional in Yes No /_i~~~s formation. _- - _--- ----- Date Insepctor's Si lure Cert. No. /) ` /~ Safety and Buildi ~ ~ ~ o~tY ` ~ 02 W. Was ngton~Cll® ST. CROIX ,~~~~~~~ \~ adi n, WI ~T+ 716 anitary Permit Number (to be filled in by Co.) \iv /~( 08) 266-3151 ~ 3 3 4~ Department of Commerce v 0 0 Sanitary Permit App • fate Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal inf ation prpl¢I1gC COUNTY TRANS. ID # 1121613 may be used for secondary purposes Privacy Law, sl .04(1ONING OFFICE ject Address (if different than mailing address) I. Application Information -Please Print All Information ~ Z(a 3Q gl7s'~j~ Q ~ _ Property Owner's Name ~ Pareel # .Lot # 'Bkack'# BRAD GROSKREUTZ 'r~ ' 008-2001-20-000 008-200-90-000 Property Owner's Mailing Address Property Location 1520 4TH AVENUE NE ,~ NE y, section 36 City, State Zip Code Phone Number g BALDWIN WI 5400 -7/ _ ~ ~~/o~a, 28 16(ciroleone) T N; R v` r S t II. Type of Building (check all that apply) ~ 3 ~ d 1 or 2 Family Dwelling -Number of Bedrooms ~ ~C~. Siibdivisierr3•ttrme CSM Number l4 ~ 9<{ _ x-85 Public/Commercial -Describe Use . Q ~~;a ~ ~ ^ State Owned -Describe Use QCity QVillage ~Cownahip of EAU GALLE III. Type of Permit: (Check only one box on line A. Complete line B if applicable t~v, ,' , A. © New System ^ Replacement System ^ Treatment/Holding Tank Replacem nt Only f- ^ Other Modification to rs mg System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Petmit Number and Date Issued Before Expiration Plumber Owner / I IV. T e of POW'TS S stem: Check all that a 1 X S • ZS' ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ~ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line (] Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Information: '" Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 1 450 450 100.64 VI. Tank Info Capacity in Total Number ~ Manufacture r Prefab Site Steel Fiber Plastic Gallons Gallons of Units /7~ ~~_ ~-~ ~ E'tt~'° 1 Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 1 WIESER CONCRETE X Aerobic Treatment Uni[ Dosing Chamber 600 600 1 WIESER CONCRETE X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation ol'the POWTS shown on the attached plans. Plumber's Name (Print) Plu 's Signature MP/MPRS Number Business Phone Number BENNIE HELGESON 220292 715/772-3278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. Coun /De artment Use Onl Approved ^ ed Sanitary Permit Fee (' Ludes Groundwater Date Issued Iss ing Signature (No Stamps) Surcharge Fee) ~~ '~- ~ ~ ^ Owner Given Re n for Denial IX. Conditions pprov k 3) Q~sw ~ a~ ~~ 12 ~~r SYSTEM OWNER: 1 Septic tank, effluent filter and Pte--' ~,~ _ S.~-u,~~ dispersal cell must all be serviced /maintained ~ as per management plan provided by plumber. S ~ I .~, ~ t 2. All setback requirements must be maintained as per applicable code/ordinances Attach complete plans (to the County only) for the system on paper not less than SllL x 11 inches in size r >I SBD-6398 (R. 01/03) ~ o~ !~ ~~~~p Ia-Yy~ ~.~c~~~ As Shoo=vt C~P~ e ~`~ ~~' commerce.wi.gov ^ ^ ~sconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. govlsb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 29, 2005 CUST ID No.220292 BENNIE W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/29/2007 SITE: Brad Groskreutz Boston Road Town of Eau Galle St Croix County NE1/4, NW1/4, S36, T28N, R16W FOR: ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers.'.. Transaction ID No. 1121613 Site ID No. 696198 Please refer to both identification numbers, above, in all comes ondence with the a enc . Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1010041 Maintenance required; 450 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual, SBD-10572-P (R.6/99); Pressure Component Manual, SBD-10573-P(R.6/99); 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: • This system is to be constructed and located in accordance with the enclosed approved plans and with publication SBD-10572-P(R.6/99) "Mound Component Manual for Private Onsite Wastewater Systems". • The pressure network is to be constructed in accordance with publications SBD-10573-P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". • 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. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. 4. . i~ %vyyM1..7 .ytF 4 ~:.~~r~~~$-4~~ ~ ~~ ~~ .,." ~ ~~~ .~ wo~r~eFA1T C)F CONi1:4EkG"t BENNIE W HELGESON Page 2 3/29/2005 Comm 83 22(7) - A copy of the approved Mans 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: The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval • 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence 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 code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 ~_ PROPERTY OWNER: INDEX SHEET BRAD GROSKREUTZ 1520 4TH AVENUE BALDWIN, WI 54002 PROJECT NAME: BRAD GROSKREUTZ PROJECT LOCATION: NE 1/4, NW 1/4, S 36, T 28 N, R 16 W MUNICIPALITY: TOWN OF EAU GALLE COUNTY: ST CROIX RECF/~~D S MAR24?0p5 AF~~~ gel CpjN~s 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 and Specifications Page 5: WLP 1000/600-MR ZABLE Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: March 23, 2005 4lV1S1C3N~f SAFETY ANl3 tsu~Lu~ GS SEE CORES ONDENCE 1~~ ~, ~ io~-~ C r r. ~ ,.. 1 ~' ~ cl C) ~.~c~~-~ ~ Sho«:v. 1„O I ~3.Ht°s lod,oo TaF ~f ~~„ pct ~~pes _ .~~ __ _ n- _~ rry~ SL6~_` ~ 2 7 3 ~, p~rox • ., ~~ -r-o Q ~~~".- ._ _ ___.----Sra.~ 1 . __ P-~p~F~: ~ ~~ }-~a Vn .- ~ + I y 3v ~ G ,--~- 5 j-~ ~ \ 9' y 3 ~`" '~ 83 ----- - --- 1 O U. '..%L.c1 ~, ~1 n t7.r Synthetic Covering ~, ,~STM C3.3 Medium Sand ~ ~} ~ E 3 Slope c: ~.a.0 f Z+- 2 ~i Aggregate _ Cross Section Of A Mound Signed: License Number: Date: Page ~i Df_~ Distribution Pipe G 0 C~`jZtil.~I' ~k~, 493 Force Main Plowed From Pump Loyer q g Ft. L3 ~~i "~'F t . K ~ Ft. ~ `7(~. ~SFt. J ~ Ft. ~ J~ F t . W Z6.9 Ft. D .~~ `Ft . E L~f Ft . F , 8~ Ft . G , S Ft . H j Ft. L ------ Observation Pipe ~K J -~ g,~_-_~__`__-_ 1 r-------------------~ -- - - --- - - - - -- - - ' A L------------- ~ ~ _ _.~ l-___~,_---------- ~ w 6 --- ~ C ~L.L 0 f 2„- 2 `~ pistribution Pipe A99re9ote ~ as~~ ~ (~ r ec~ -= 1 l Observation Pipe ~~L`x~- Plan View Of Mound ~~' '''~., ,~ ~r - - ~rrA d k r~.~.,~-f-z .. r C )ea~.o~-r ~<< r5 C ' ~ `IEtt~o~-~ J :~~ e I~~ rrp, Porlor.~--~ r_t ~. poioil End Vla.+ ' i {'or lorultU j Diseribucion I'1~>e_ L~ lle ____--- Signed: License Number: Dace: Holes Located on Bottom are Equally Spaced ~L.s P .S`y , . x _~y.. ~ ~, s ~. x ~ ~~ " Y .~-~~ {{ole Diameter ~ Inch Lateral " ~ Yncn (es) J ~ Inches Manifold -`"'~' rorce Main " __ ~__ Inches ~.,l.~L~E~~ Gl~e~. tit. i4 ~~lFS ~rr 1,~.-~'erc~-1 ~ ~5 i o ~~~1 (-~o I ~s - -- 75- ~~~, r.,-~ ~'' ', ~-- ~ J1"GL~ 9r'~ 5 ~ i~•e u~"~ Page `~ Of „~„ SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4 .P()C,-VENT PIPE 12" MIN. ABOVE GRADE E NEATHERPROOF JUNCTION BOX APPROVED > 25' FROM DOOR, WINDOW OR WITH CONDUIT V~R W%NPAD FRESH AIR I NTAKE LOCK ~froc~.~ ~IeU WARNING LABEL ~ : - ~ ,_-_ 4 " MIN . l q 7 .- ~. zy" s, a. 18" IN. '~ ~ IS rniN. INLET ,, ~ ~ . WAT ER TIGHT SEALS GAS- TIGHT ~ ~, ~/APPROYEO A SEAL ~ JOINTS KITH FIL7ER - ~ ~ A LM APPROVED PIPE APPROVED ZA $~~; _ B ' ON 3' ONTO PIPE 3' , to x~~ ~- ~ ~ SOLID SOtI ONTO SOLtO C i ' SOIL PUMP OFF ELEV . ~~ (~FT . -~-- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD . SPECIFIyC^ATjIONS ~ I~~S' __ I a llet t (T41 ~ EVE SEPTIC / DOSE 1 f0 `~ X S ~ ~$_~~ ~c~~, TANK MANUFACTURER: ~ ~ecr'/ TANK SIZES: SEPTIC ~- GAL. DOSE T~_ GALL . ALARM MANUFACTURER: ~~1 ~ L•I c~Tr~ •MODEL NUMBER: I-l~= SWITCH TYPE: ~ Y ~-~ PUMP MANUFACTURER: Z©~'<<~r' MODEL NUMBER: SWITCH TYPE : A~1~ ~~- ~7~ o c~ REQUIRED DISCHARGE RATE ~~~GPM DOSE VOLUME INCLUDING // I C3< ~, G~,a . C--~F LOWBAC K : (~ ~ • ~ S-GAL . CAPACITIES: A = / S INCHES = ,30~.~~GAL. B = 2 INCHES = , S~.? GAL. C = ~ INCHES = ©O.SC-~ GAL. D = ~~ INCHES = f ,7. ~_GAL. PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 1- ~~ FEET + MINIMUM NETWORK SUPPLY PRESSURE /„~ FEET + (~rj FEET FORCEMAIN X ~~_FT/100 FTOTALIDYNAMICAHEAD = ,fir ~ qcj FEET WIDTH DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LENGTH LIQUID 6EP'I`A-~~_ S S r' t `9~~ } ,pp ~ h ~ P i ~• j~o ~cL~, Tyr. St~c~ ~!C<c5F'-. S-r.~_ ~~~~ / S IGNED: LICENSE NUMBER: DATE: 1/88 ~.J-. Vnl O U Z W J ta. Q (/~ ~ o Q ~O Y ~ ~ a °° V m ~ ~ o oW a~ _ o ~ o~ W ~ ~ ~ iv cO m V1 a W/ ra^ = 0 ~ ~ ~ fn `VI ~ N= QOWJ^ W~Q O f7: ~.-~J~~ ~ U e W~LJ aOZ~ .. ~~yW 4r ~ ~3m~~~~~ma~ ~~c~ ~ w Q Z 33 J ' i C ~ ~ \' ._.1 , ' 1 I I , / ' ~ ~ ~ . . I i i ~-- re -I ~ u W_ ~ ~ O J ~ U N J ~ a `~ F~ o ~aW ~~, vv ~ ~Q zz ~ JS \~ q U J J N W FQ- W Ca,~ C~ ~ ~ovwi oo~ , ~ ^ O m W W n ~ I-~~ N~ r Q J Z ~ ~ Z F- N U ~~W Q N ~~~ Q ~ O U C~ o Z J O Q Z ~ J --~ f k J ,zb Z a ~ ~1 . J U ~F # ~ Na ~ ~ aNo p~o0 ~l~in ~c~a ~a~ 0 C I ~~~ QUW \NU Q C ~ ~ o F to G. ~' ](~ I=JU ~ ~ ~ N O ~~ ~ W W .p S W ~_ ~ N N 0 0 0 W 0 0 0 N r Z Q w =o „6~ „9S 12- x U_ 8- r 0 0 4- 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 Cx (L> G 1 G c~ ~~ HEAD CAPACITY CURVE MODEL 152/153 50 153 40 152 ~- 30 20 10 FLOW PER MINUTE CONSULT FACTORY FUR 5PEClAL APPLICATIONS • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level kxlg and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series 3 MODELS Control Selection ModN Volb•Ph Mods Am s Sim lex Du lex Nt ii 1 Non 8.5 1 2or3 aN152 115 1 Auto 8.5 Inducted 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 i Aub 4.3 Inducted 2 or 3 N153 115 1 Non 10.5 1 2 or 3 8N153 115 1 AtrOO 10.5 Inducted 2 or 3 E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Inducted 2 or 3 D CAUTION All insta-letion of controls, protection devices and wiring should be done by a qualified licensed electrician. All eteetrical and safety codes should he loliowed Including the most recent Nadonal Electric Coda (NEC) and the Occupational Salety and Health Act (OSHA). FoTnl. D~rranMlC HEAD/CAPACITY i'ER MINUTE FFFI DENT AND DEWATERING MODEL 152 153 Feet G Ivieters Gol. Liters Gal. Liters - 5 - t.5 69 261 77 291 1U 3.1 61 231 70 265 I t 5 4.6 53 201 61 231 20 6.1 44 167 52 197 25 7.6 34 129 42 159 30 9.1 23 87 33 125 _, -~ t ------- I 4U ~ . IU.7 +---- t 12.2 I -- - -- - -- 22., 11 85 42 ~_ -- Lock Volve: 38.0 Ft. (11.6m) 44.0 FL (13.4m) 3 27/ i t2 t/8 t r-, 5 1 /I SELECTION GUIDE S2 sz s~os~ 1. Single piggyback variable level float switch or double piggyback variable level 5oat switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a control activator, spedfy duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 4t, Louisville, KY 40256.0347 Manuracturerso/.. ~ y SH1P T0: 3649 Cane Run Road ~ ~1v ~~ ~ ® Louisville, KY 40211.1961 QvaurrPuuPe S,vcE /999 PUMP !O. (502) 7 ~~ 31.1(800) 928-PUMP httpJ/www.zoeliercom (502) 774.3624 © Copyright 2001 Zoeller Co. All rights reserved POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 8 J n ncn,e,n ATIAAIC ILE INFORMATION Owner BRAD GROSKREUTZ Permit # wu nwnww^CTeoe Number of Bedrooms 3 ^ NA Number of Public Facility Units ~ NA Estimated flow (average) 3UU al/day Design flow (peak), (Estimated x 1.5) 450 al/day Soil Application Rate O,5 al/day/ft2 Standard Influent/Effluent Quality Monthly average ' Fats, Oil & Grease (FOG) S30 mg/L Biochemical Oxygen Demand 16006) 5220 mg/L ~ NA Totai Suspended Solids ITS$) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSSI 530 mg/L C~NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ya in die. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank ettruent. v ~ v . - - Septic Tank Capacity lUOU al O NA Septic Tank Manufacturer~~I O NA Effluent Filter Manufacturer ZAf3EL O NA Effluent Filter ModelA-lU0 12" X 20" O NA Pump Tank Capacity 6UU al ^ NA Pump Tank Manufacturer WIESER CONCRETE O NA Pump Manufacturer ZOELLER PUr1P CO O NA Pump Model 152 ^ NA Pretreatment Unit ~ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cellls) ^ NA ^ In-Ground (gravity) ^ In-Ground Ipressuri~ed) ^ At-Grade ®Mound ^ Drip-Line ^ Other: Other: O NA Other. O NA Other. O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls) At least once every: 2 ^ month(s) (Maximum 3 years) ~ ear(s) ^ NA O NA Pump out contents of tankls) When combined sludge and scum equals one-third IY3) of tank volume ^ month(s) NA Inspect dispersal Cellls) At least once every: Z (Maximum 3 years) ~ earls) ^tmonthlsl O O NA Clean effluent filter At least once every: 13 ^ year(s) onth(s) ^ A Inspect pump, pump controls & alarm At least once every: 13 cm ^ year(s- onth(s) ^ O N A Flush laterals and pressure test At feast once every: 3 m ^cyear(s) ^ N onth(s) O A Other. At least once every: m ^ year(s) ^ N ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator.. Tank identify any cracks or leaks, inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, 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 1Y31 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) ., -OWNER: HPAD GROSKI<EUTG Page •$ cf- ~_ . .•.. STARt UP AND OPERATION. For new construction, prior to use of the POWYS check Ueatment tank(s) for the presence of painting products or Othef chemicals that may Impede the Vestment procoss and/or damage the dispersal cell(s). I(hlgh 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 cel(s} in one.large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent To avoid th(s 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 POW'f3 tiAatrttatner to assist in manually operating the pump cantrois 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 otharvvtse disturb or oorrtpac~, the area within 15 feet down slope of any mound or at-grade soq absorption area. Reduction or elimination of the following from the wastewater stream may improve the per(ormartce and prolong the ufe of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; deptai ~ meat disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasogne; grease; ~ . . scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brute. ABANDONKIUIENT ' When the POWTS falls and/or fs permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83:33, Wisconsin'Adminlstrative Code: Ail 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 Vold space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soU absorption system. The replacement area should be protected from disturbance and compactiott,and should Dot be infringed upon by required setbacks from exlstirig ar)d proposed structure, lot Imes 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 soli limitations. Barring advant~s In POWYS technology a holding tank may be installed as a last resort to replace the faAed POWYS. O The site has not been evaluated to Identify a suitable replacement area. Upon faqure of the POWYS s soq and site evaluation must be performed to locate a suitable replacement area. If no replacement area !s available e holding tank may be installed as a last resort to replace the failed POWYS. tg Mound and at-grade soil absorption systems may be reconsWcted 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/0R INSUFFICIENT OXYOt:N. RESUOLT.ERESC E OF AI PERSONOFROM THE lNTFERIORNOFTA TANK MAY B D F,F CULIT OR MPO S B MAY ADDITIONAL COMMENTS POWTS INSTALLER POVYfS MAINTAINER . Name HELGESON EXCAVATION INC Name I' ~ ' Phone 715/772-3278 •Phone 715/273-5811 . SEPTAGE SERVICINt3 OPERATOR PUMPER LOCAL REGULATORYAUTHORYFY Name JOHNSON SANITATION ~ Agency ST CilUIX COUNTY ZONING Phone 715/'173-5811 Phone 715/386-4f~80 This document.wa drsRed by the stRa of the Green Lake, Marquette and Waushara County Zonlny and Sanflatbn apent~e. Thle document meet one minimum requirement o/ ch. Comm 83.22(2)(b)(t)(d)d(~ and 83.54(1), (2) b (3), VJfsconsln Administrative Code. Otte of tNia doCUmertt titres nOt guarantee the perfonnancs or the POWTS. G1AW (?In1) r i ' APR I 12005 SF. ~,.. ,... ~?'. _ ,~ ., ~ 7 6 2 1 2 VOL 19 PAGE 4853 KATNT:EERf H. M~- REGISTER OF DEEDS ST. CRI]Ix CO. MI RECEIVBD FOR ~tHCORD 10/05/20@5 11:00AM CERTIFIED SURVEY MAP CERTIFIED SURVEY M~~:~~~2 LOCATED IN PART OF THE NORTHWEST 1/4 OF THE NORTHWEST 1/4 AND IN PART OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 36, TOWNSHIP 28 NORTH, RANGE 16 WEST, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN. OWNER: WEST LINE OF THE NORTHWEST i/4 PAUL & JANIS NELSON -- N 03'2057" W 2848.40"_ sc~~: t` - 300' r - - - a, 2626 BOSTON ROAD i •~ _ _ _ WOODVILLE, WI 54028 - - - - -"d':-r • L6 - ~" o ~s ,bo 300 -~- ,-- ,~ r tee, ~a' ~, LINE TABLE: NUMBER BEARING DISTANCE L1 N 89'50'07" W 105.38' L2 N 89'50'07" W 139.62' L3 N 89'50'07" W 55.30' L4 N 89'50'07" W 22.97' L5 S 89'46'51" E 33.02' L6 N 01'31'21" W 302.49' L7 N 03'17'21" W 358.55' L8 N 76'06'50" E 75.69' L9 N 89'48'10" W 375.10' L7 0 N 18'18'37" E 183.23' L11 N 18'18'37" E 42-73' L12 N 18'18'37" E 140.50' L13 N 26'09'20" E 44.68' L14 N 54'41'02" E 55.49' L15 N 89'48'10" W 297.75' L16 N 89'48'10" W 329.88' L17 N 89'48'10" W 112.89' L18 N 89'48'10" W 236.60' L19 N 56'19'12" E 219.85' L20 N 18'08'20" E 156.73' L21 N 65'49'23" W 184,05' L22 N 78'24'38" W 206.40' L23 N 89'46'51" W 174.72' L24 N 57'41'57" E 381.22' L25 N 74'18'51" W 359.19' L26 N 63'06'50" E 213.85' L27 N 13'04'44" E 252.74' L28 N 74'55'35" W 232.19' LEGEND: • SET 3/4" BY 18" IRON DRIVEWAY NOTE: ! PIN WT. 1.50 LBS./FT. JOINT DRIVE TO SERVE LOTS 3 & 4 _ COUNTY SECTION MONUMENT (FOUNp AS NOTED) - 100' BUILDING SETBACK LINE FROM ROW 75' BUILDING SETBACK LINE FROM'~W11~a~aas "--"--'- 66' JOINT DRIVEWAY EASEME p~,~ ~ ~''~~ wtti,~•........, -""-""'- DRAINAGE EASEMENT 8c ~'~~ 100 YR FLOODPLAIN S ~}`{ ROGER LYI ~- PROPOSED DRIVEWAY ~ ~ - MPHRE - - --- SOUTHERN ORDINARY HIGH ~ S-2186 WATER MARK (OHWM) ~'~r-.~~ LBO = LOWEST BUILDING OPENING 'ate. ~,e ~'••...... THIS INSTRUMENT DRAFTED HY KEVIN HUMPHREY ENGINEERING Vol 19 Pag 4853 5 vL as va +- ---- - - OF THE NORTHWEST 1/4 NW COR SEC 36 SET PK NAIL FROM TIES OF RECORD ~,M. TOP OF P.K. NAfL ELEVATION = 1080.63 z ~ C ~ m vi Q ri -` ~- - rn ~ ns z rn . N -~ NOTE: BEARINGS ARE REFERENCED TO THE WEST UNE OF THE NORTHWEST 1/4 OF SECTION 36, ASSUMED TO BEAR N03'ZO'57"W. 1/4 COR I FOUND 2" ~ IRON PIPE SHEET 1 OF 2 N eG • Vvlsconsin'Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of 3 In aCCOfOanCe wiui ~.omm oo, vvis. ream. wuC -- County Plan must 11 inches in size it t l 8 1/2 Att h l t l th . x comp e s an on paper no ess an ac e e p include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re ewed by Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Q Prope Owne I ~~9. ~~ ~e ~ S~ ~ ~,. .~..._,..~..,.....~.....~:.,:..n _.... Property Location / o Govt. Lot N.~ 1 /4 ~ ~1 /4 S3C~ T ~ o N R (6 E (or) Property Owner's Mailing Addres ~ a ..- .~ ,N ~-° ~ Lpt # Block # e or C~.SM# Subd. Na m (n ~ City State Zip Code ~ Phone; ~mb~r ,_ ~ .I~', ~] City ^ Village own Nearest Road I ~~ t ~~2 ~~ ~ ~ ~ iS) 9~--2 ~?/~.~ ~ ~ Cam- [ ~ e o ~~lew Construction Use: ®'~tesidential / N ,m~,~etfit~oiae~---~ Code derived design flow rate f GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~, 8 ~ SS ~ U 2.1- fl`I ~ Flood Plain elevation if applicable ~ General comments ~, ~ Ccr~S ~ o :~ ~'~ j and recommendations: ~ 5 ~ ~~ S~'^ cQ ctn ~~~ ~~ ~ ~.. C o •1 ~f'ou-Ir' 99 :3 S y s ~te~ ~,~ev_ = /fib , ~ y ~a u~~ c~ Boring # ~ Boring O a Pit Ground surface elev. 7• ~ ft. Depth to limiting factor ~ in. Soil A lication Rate l D i t C tion Descri R d Texture Structure Consistence Boundary Roots GP D/fg Horizon Depth in. nan or om o Munsell p e ox Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 h // t o ~ C; a ~~o ~ -- l / t >, , ~ , ~ ~ _ a Boring # ~ Boring ~it Ground surface elev. g7x 3 ft. Depth to limiting factor a~~ in. Soil A lication Rate i H th D i t Color D Redox Description Texture Structure Consistence Boundary Roots GPD/fg or zon ep in. nan om Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 a - ~U 10 3 - r„i 5~ t r i t 2b-- 1 o Yt2 ~' . s a ~ G 1. 3 -~ sb~ h1-F'( ~ 1 i ~ ~/ t o ~(~ ~-- C ~- p /~I ~-~ r O. v a 0 w~f 3 t s . ob , _ i~f 'Effluent #1 = BOD > 30 < ZZO mg/L ana 155 >3U < l5V mg/t_ unuent rrc - ovv _ vv nny~ a. ~+ ~.+~+ - .+~. ~„~~ CST Na (Please Print) ( ignature CST Number 2 ~. 2 ese, rr- a 0 Address ate Evaluation Conducted Telephone Number S ~~ Property Owner P(~ll.' ~e`SOf/L Parcel ID # Page ~ of Boring # U Boring ~t Ground surface elev. ,/oc~. r ft. Depth to limiting factor > 3 ~ in. Soil A lication Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 l - d y ~ ~t- C w W t l~ f ~~ ~~ - g _~ ~ i ti ~ 11 ~ ~ fo ~ ,~ [ ! v _3 0 - ~ ~ ,~ ivy o.~ o~ a ~ L . 5 Boring # U Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate H i th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz zon or p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 U Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil A lication Rate l i C tion x Descri R d Texture Structure Consistence Boundary Roots GP Dlfg Horizon Depth in. or Dom nant o Munsell p e o 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 =BODE < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sian.s)~~~ rtc o~;oo~ ~~ o~ ~~ a~ ~a5~ ~ o f 3 l'~t ~~~ ~~u ~ Q ~ SD6-- ~`,s,r j~jcv~vti~ Ne e~~~ ~~o~ya ~t-OA©Sec~Q, Hof W ~ ~~ Cv " _ ~f C3 ~~~ ~XC~1° ~s S ~oc.~:v` ~.A/I' S t nom. G ~ ., "~'~ Q o ~ `~; " 1~i1C ~? ape s ~, R`b~D~ ~. / Dgj ~ ~~~~ I ,~9 5~ ~- ~ ~~~ ~,~ -. /' ~~ ~'`~- 97.3 ~~ y9 ~ ,D Q3 ~ i00•/ Trail /~~--- 380± ~~ ~~ - ~ I I ~d5~0~'l ~~ a ~-GH C Pro~-e ~- ,~ L r ~ ~ ST CROIX COUNTY SEPTIC TANK MAIIV'1'ENANCE AGREEMENT AND OWNERSIiIP CBRTIFICATION FORM OwnerBuyer ~+ +.o. ~ ~r;l 1 S~ a0o5 - I SaC~ ply-~` ,J~ve~Ve ice.. a(c~ui~n~ (1J~ s`~f OO a • s 5~((0 Mailing Address ~i-e,. ,tsar;1 ~ S, at`~5- ~ IMF (~ ~~,~,,, ~~rPD-~- ~T~ c~[~~~ ~~ ~.>~r 54r~~ aCQ ~ O ~ . Property Address ~4 1> > ~- 2 ~ oc~ ~ i ~~ (Verification required from Planning Department for new construction) City/State ~rn ~ U , ~ `P C~~-- Pazcel Identification Number (7 ~~ ~ ~- ~ C~aZ~ ~o~ ~ acx~o --do- ~ LEGAL DESCRIPTION Property Location ~~ '/., •~„ %,, Sec. ~~ T~_N-R_~W, Town of Subdivision Z .Lot # ~_. Certified Survey Map # o~ ~ Volume Page # 5 Warranty Deed # I ~ ~ ~~ -I .Volume ~~ ~ Page # ~~. Spec house ^ yes no Lot lines identifiable ~. yes ^ no SYSTEM MAINTTNANCE Improper use and maintertanceof your acptic system could result in its premature fat~ure to beadle wastes. Proper maiatenaace consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put fate the system can affect the fuactioa of the septic tank as a treatment stage in the waste disposal system. The pmputy owner agt+xs to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastttplumber, journeyman Plumber, restricted plumber or a licensedpumpcr verifying flat (1) the on site wastewaterdisposal syslem 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. Ilwe, the undersigned have read the above requirements sad agree to maintain the private sewage disposal system with the standards set forth, herein, as set by ffie Deparment of Commerce and the Department of Natural Resources, State of Wiseonsia. Certification stating that your septic system bas bees maintained must be completed and returned to the St. Croix County Zoaiag Office within 30 ~r da/ys"of the three year expiration date. ~,,,,,/ nl ~ ~,od'~ ° V tt ! Ol /DOS. SIGNATURE OF APP 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 property described a ve, by irtue of a wamdstty deed recorded in Register of Deeds Office. SIGMA OF APPLIC DATE •'•••* Any information that is mis-represented may result in the sanitary pemut 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 r ~: ~.;. --. a- 212` Voi_ 19 neaQ4853 CERTIFIED SURVEY M.~a • 2 ' LOCATED IN PART QF THE NORTHWEST 1/4 OF THE NORTHWEST 1/4 AND IN PART OF THE NORTHEAST 1 4' OF THE NORTHWEST.1/4 ~ SECTION 36, TOWNSHIP 28 NORTH, RANGE iS WEST, TOWN OF EAU GALLS, •ST. CROIX - COUNTY. WISCONSIN. Oy1hiER: '~4~® WEST LINE OF THE NORTHWEST 1/4 PAUL & JAMS NELSON - N 0320'57" W 2848.40"_ ~ 2828 BOSTON ROAD ~ a. _ ___ _ --- ~' WOOD Wt 54028_ c 7s® -_-T ~ - L7 ~-91.29' L6 iii SE~i' PKR ~ 38 w 1/4 coR ~~ ~ _ FROM nES - LINE T sEC 3s 1 ~m aF RECORD NUMpER BEAR DISTANCE U N 89'59'0_ W 905.38' L2 N 89'5007" 13s:er L3 N 89'50'07" 55:30' L4 N -89 50'07 W .9T L5 5 89'48'51" E L6 N 01'31'21" W 30 l7 N 039721" W 358. ' L8 N?8'08'50" E 75.69' L9 N 89'48'14" W 375.iD' Lt0 N 1898'37" E 183.23' L11 N 189837" E 42.73' L12 N 1898'37" E 140.50' L13 N 28'09'20' E 44.88' L14 N 54141'02' E 55.49' L15 N 99%18'10° W' .287.75' l18 N 89'48'10" W 329.88' L17 N 89'48'10' W 112.89' L,18 N 89'48'10" W 236.60' L19 N 58'19'12" E 219.85' LZO N 18'08'20° E 156.73' L21 - N•85'49'23° W 184:05' L22 - N 78'2'4'38" W 206.40' L23 - N 89'46'51" W 174.72' L24 N 57•{1'g7" E 361.22' 1.25 N 7498'51" W 359.19' L26 N 63'06'50" E 2i 3.85' L27 N 13'04'44" E 252.74' i28 N 74'55'35" W .232.19' FOUND 3" 1 .M, TOP OF ALUM MON ~ ~ ~i~' P.K. NAIL i l ~~ 1 ~ '~.. - cz .. ELEVATION a 1080.63 11 o ~ I ~ ~ ~ r l i I 'J'~ LOT 1 ~ B ' ~~ W Q I I ~ a ' a I I c ? ~ P 'rA~9o ° ~ `T I I I I v, ~ ~ .~ . j I C I m ~ ~~' p~? 1~ o d'\ r ~ m I 1 I ~ ~, I • rn z a~ol ~ ~ HOUSE ~ m m II ~ 1 o ( I ~ I I~ ~ 1 1« I ..~88' 1 I I 1 I m I :I~ ,N LEGENI3: • SET 3/4" BY 18" IRON AY NOTE PIN W7. 1.50 LBS./FT. JOINT DRIVE TO 5ERVE LOTS 3 & 4 COUNTY SECTION M MENT (FOUND AS NOTED o. - 100' BUI G SETBACK UNE FROM ,ROW ~' 75' BU NC SETBACK UNE FROM rnery~" " 68' JOINT DRIVEWAY EA ~O~sG®~v~3` 4°! DRAINAGE EASEMENT do too YR FLOODPI.Aw '~} r ROGER LYNN `y~ PROPOSED DRIVEWAY PH --- SOUTHERN ORDINARY Hlgi 52188 WATER MARK (OHWM) _ _ _ LBO =LOWEST BUILDING OPENING ~/9 ..~..••'°'l~ ~ THIS INSTRUMENT DRAFTED BY KEViN SAMUEL ~'•~ •-~'' HUMPHREY ENgNEERING T/o1 19 Pag 4853 ry39 ~~ N ~i 2 ~ ~ ~' m m ~~F ~~ INC J v! ti LOT 3 LWE ,3 u '~. ,~`~I r SECTION 38, `_ ASSUMED 70 N03'20'57°W. IAT 4. ' - ~. ~. 66.09' -- S 02'3509" E 658.73' 1 .FOUND ~ ~~/ ~~~ OF THE NORTHWEST 1 /4 i IRON PEE SHEET 1 OF 2 11 2765P 536 STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Paul R. Nelson and Janis R. Nelson, husband and wife, Grantor, and Brad Groskretrtz and Tamara Groskreutz, 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: SEE ATTACHED EXHIBIT A 78574 ~~ KATHLEEN H. MALSH RfiGIS?fiR OF DEEDS ST. CROIX CO. ~ MI RfiCfiIVfiD FOR RECORD 83/17/2005 08:00At1 MARRANTY DfifiD EXEIQT tk REC FEE: 13.08 TRANS FEE: 218.70 COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2nd St. -Suite 115 Exceptions to warranties: Hudson, WI 5401G Easements, restrictions and rights-of-way of record, if any. 45G797 oos-ZOOl-2o-000..~~ -7440 - QO -Q~ Parcel Identificatitm Number (PIN) This is not homestead property. Dated this 15th day of March, 2005. '" Patil R. Nelson AUTHENTICATION '' Janis R. Nelson * ~ ~~ Signature(s) authenticated this 15th da os~t ot81'~Jil~Ut@n f1r Public • s TITLE: MEMBER STATE 8AR OF WISCONS (If not, authorized by § 706.OG, Wis. Stats.) TH1S INSTRUMENT WAS DRAFTEll BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 (Sigretures may be authenticated or acknowledged. Bah arc not necessary. ) •Names of persortc signing in any capacity mart lx typed or prinkd bebw their signptwe ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before the this March 15, 2005 the above named Paul R. Nelson and Janis R. Nelson, husband and wife to me known to be the person(s) who executed the foregoing ias t apd acknowled1g~~ th~e~ 111;N 1 1 *J ' VanHouten No Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 7/27/2008 ) WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2x00 2765P 537 EXHIBIT A Lots f Certified Survey Map filed January 18, 2005 in Vol. 19 of Certified Survey Maps, page 4913, as Document No. 785194, orated in part of the Northwest Quarter of the Northwest Qua anerrt din part of the Northeast Quarter of the Northwest Quarter of Section 36, Township 28 Noah, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin. CERTIFIED SURVEY MAP LOCATED IN PART OF THE NORTHWEST 1/4 OF THE NORTHWEST 1/4 AND IN PART OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 36, TOWNSHIP 28 NORTH, RANGE 16 WEST, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN. CURVE DATA TABLE: CURVE RADIUS ARC DELTA CHORD CHORD BEARING TAN. IN TAN. OUT Ct 750.10' 184.38' 14'05'00" 183.91' N 83'09'20" E S 89'48'10" E S 76'06'50" W C2 178.23' 121.82' 39'09'40" 119.46' S 70'13'17" E N 50'38'27" W S 89'48'06" E LOT AREA TABLE: INC. R-O-W EXC. R-O-W LOT SO. FT. ACRES SO. FT. ACRES LOT 1 656522 15.07 617936 14.18 LOT 2 403088 9.25 383094 8.79 LOT 3 292988 6.72 290327 6.66 LOT 4 388191 8.91 371255 8.52 SURVEYORS CERTIFICATE: I, ROGER L. HUMPHREY, REGISTERED WISCONSIN LAND SURVEYOR S-2188, DO HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS MAP IS A TRUE AND CORRECT REPRESENTATION OF PART OF THE NORTHWEST 1/4 OF THE NORTHWEST 1/4 AND PART OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 36, TOWNSHIP 28 NORTH, RANGE 16 WEST, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN AND MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF SAID SECTION 36, THENCE 589.46'51"E ALONG THE NORTH LINE OF THE NORTHWEST 1/4 2644.06 FEET, THENCE S02.55'09"E ALONG THE EAST LINE OF THE NORTHWEST 1/4 658.73 FEET, THENCE N89.50'07"W 2638.96 FEET, THENCE N03.20'S7"W ALONG THE WEST LINE OF THE NORTHWEST 1/4 661.53 FEET TO THE POINT OF BEGINNING. SAID PARCEL CONTAINS 1740789 SQUARE FEET OR 39.96 ACRES INCLUDING TOWN ROAD RIGHT OF WAY MORE OR LESS, AND IS SUBJECT TO ANY EASEMENTS OR RESTRICTIONS OF RECORD. THIS SURVEY CONDUCTED AT THE REQUEST OF THE OWNERS: PAUL & JANIS NELSON, 2626 BOSTON ROAD, WOODVILLE, WI 54028. I HEREBY CERTIFY THAT I HAVE FULLY COMPLIED WITH THE PROVISIONS OF SECTION 236.34 OF THE WISCONSIN REVISED STATUTES AND THE SUBDIVISION ORDINANCE OF ST. CROIX COUNTY ANO TOWN OF EAU GALLE IN SURVEYING AND MAPPING SAME. EACH PARCEL SHOWN REGULATIONS (I.E. WE DEVELOPING ANY PAF L. k+it?MPMREY, RLS DATE: ~/~3 ~_ IS MAP IS SUBJECT TO STATE, COUNTY AND TOWNSHIP LAWS, RULES, AND MINIMUM LOT SIZE, ACCESS TO PARCEL ETC.) BEFORE PURCHASING OR NTACT THE ST. CROIX COUNTY ZONING OFFICE AND THE TOWN OF EAU GALLE. Ao~ ~~ r E ~~.~ ~~~~~~ I -rB-oS 6~ ~~.,~~ G~~.-fit. SHEET 2 OF 2 Vol 19 Page 4913 rr - .V ~L~~ LINE 7851'3.4 YOL 19 PAGE 4913 KATHL~Ei~ H. ~"- REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 01/18/2005 11:15A![ ~1~3~° CERTIFIED SUR~2 3AP LOCATED IN PART OF THE NORTHWEST 1/4 OF THE NORTHWEST 1/4 AND IN PART OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 36, TOWNSHIP 28 NORTH, RANGE 16 WEST, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN. WEST LINE OF THE NORTHWEST 1/'I' - N 03'20'57" W 2646.40"= ~ - a,-w- SCALE: t' ~ 300' r - - - - - _ _ _ _ _ - '- - i ~ _ -"'= T- - • L6 r N W COR SEC 36 o ~s tso 30o T w L7 i' `--91.29' cn SET PK NAIL _ FROM TIES W 1/4 COR ~ ~ (v~- '- OF RECORD NUMBER BEARING DISTANCE L1 N 89'50'07" W 105.38' LZ N 89'50'07" W 139.62' L3 N 89'50'07" W 55.30' L4 N 89'50'07° W 22.97' L5 S 89'46'51" E 33.02' L6 N 01'31'21" W 302.49' L7 N 03'17'21" W 358.55' L8 N 76'06'50" E 75.69' L9 N 89'48'10" W 375.10' L10 N 18'18'37" E 183.23' L11 N 18'18'37" E 42.73' L12 N 18'18'37" E 140.50' L13 S 89'48'10" E 487.38' L14 S 00'11'50" W 66.00' L15 S 00'11'50" W 40.33' L16 N 00'11'50" E 40.30' L77 N 00'11'50" E 33.00' L7 B N 89'48'1 O" W 329.88' L19 N 89'48'10" W 454.24' l20 N 56'19'12" E 219.85' L21 N 18'08'20" E 156.73' L22 N 65'49'23" W 184.05' L23 N 78'24'38" W 206.40' L24 N 89'46'51" W 174.72' L25 N 57'41'57" E 381.22' L26 N 74'18'51" W 359.19' L27 N 63'06'50" E 213.85' L28 N 13'04'44" E 252 74' SEC 36 \\ 1 ~ ~`D FOUND 3" I ~ ~ B.M. TOP OF ALUM MON II I;,?o' :,-- _l P.K. NAIL ELEVATION = I l I , <~o X28 -''-••~ 1080.63 ~I I I ~_7 ~o e~\` ~JLI I I ~ ~' ' ~, ~ I i ~~S•~~ LOT 1 ~ NOTE: THIS CSM u CANCELS AND I 61 w'r ~9`Jc^ Z ~ ~ ~ SUPERCEDES ,,~3 I~ ~1p l ~'c~y~~, t CSM VOL. 19 O II m~ ~ ~ ~ PAGE 4853 x I ~1 ~2 '!' ! ~~, / I I s FL ,~ pA (: ~ o j~ ~ o ~° ~, ~~, z I ooh I ~ ~ ° `~\ °'S ~~` 1~ I I~I ~ I ~ °a'-~ `~ ~ Z ~ ~ I li I i ~ HOUSE ~ ~ m ~ ~ I z ~ ~ 09 a ~ O °- I I JOINT le0 ~9¢'s6 ~ m- - I ~I f LOT 2 'o~ `~'~` N Z I I ? ~ I I ' ~ METAL ~ ~ I NI BUILDING t,i I ~I I v Oo~i" I~ I , N 2 W ~ ~ ~ 6~2p. F N ~ I \ ~ ~ JOINT 3' ~ DRIVEWAY ~ EASEMENT L29 N 74'55'35" W 232.19' LEGEND: " NOTE: ' y LOT 3 BEARINGS ARE O SET 3/4" BY 18" IRON S~ REFERENCED TO PIN WT. 1.50 LBS./FT. ir~_ THE WEST LINE • FOUND 3/4" IRON PIN ~~'• NORTHWEST COUNTY SECTION MONUMENT ~ `O ~ E (FOUND AS NOTED) ~ j ~ ~~oj ~ S CTION 36. ASSUMED TO - 100' BUILDING SETBACK LINE FROM ROW ' 'ai`~_ $, BEAR N03'20'S7"W BUILDING SETBACK LINE FROM OHWM 75 . ---------- EASEMENT DyPjjLi g; LOT 4 PAUL do JANIS NE~_SON EASEMENT --------"'- DRAINAGE EASEMENT & 2626 BOSTON ROAD 100 YR FLOODPLAIN WOODVILLE, WI 54028 ~ 6.09' PROPOSED DRIVEWAY ~,~~ , _ _ - - - - --- SOUTHERN ORDINARY HIGH _ _ _ _ ARK OHWM -' 02'55'09" E 658.73' N 1/a COR ( ) WATER M S E NORTHWEST 1 /4 I FOUND 2" LBO = LOWEST BUILDING OPENING EAS T LINE OF TH i IRON PIPE THIS INSTRUMENT DRAFTED BY KEVIN SAMUEL SHEET 1 OF 2 HUMPHREY ENGINEERING Vol 19 Page 4913