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HomeMy WebLinkAbout018-1018-20-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM SdfEYy 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)]. 'ermit Holder's Name: City Village X Township Ulferts Famil Trust Hammond, Town of .ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION , TYPE MANUFACTURER • f''' 1 CAPACITY Septic yL.. ~ ~ ~- ~: ~~.~. ~ ic~oo Aeration Holding ,~ ry TANK SETBACK INFORMATION TANK TO P{L~~ L WE L BLDG. ~ Vent to Air Intake ROAD Septic ~ ' ~~" / ~ _ ~ S~ ~ `. Dosing ,~- -_ Aeration Holding ' ~~ PUMP/SIPHON INFORMATION Manufacturer Demand G M Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length "-' Dist. to Well Cnll ARC(1RPTIfIN CYCTFM county: St. Croix Sanitary Permit No: 506182 0 State Plan ID No: Parcel Tax No: 018-1018-20-000 Section/Town/Range/Map No: 09.29.17.803 ELEVATION DATA STAT{ON SS HI FS ELEV. Benchmark / ~ $~ taZ• ~ /r~.3 Alt. Bfh..._`~ Co ~ '' ~ ~ .~ ~ aJ . ~ 5 er Bldg. S e w Z ~ ~ !~O • ~ 5 St/Htlnlet 3.3 98.~s ; StlHtOutlet 7 7,G Q,~ ~ 3C ! Dtlnlet ~ \ Dt Bottom ~ Header/Man. ~• 5 ~ ~ ~ ~~ Dist. Pipe ~,,~ ~. s Bot. System 9 •~7 93 . b S 93. '~ 5 Final Grade ~ ~ Z. Q ~, S St Cove~•~~ t~ Q . 5 ~~j f ~ ~5 BEDITRENCH Widih Length 1 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid D tgp h DIMENSIONS 3 { Z ~ ~~ ~•G.,MQ.I..J ~-- `-- ~•,~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ~ Manufa~{,~er~ i CHAMBER OR ~ i a INFORMATION Type Of System ; ~ ~ w ~ w ~ ~ j ' ~ UNIT Model Nu~nt Jr rIICTDiRI ITIf1AI CVCTFM t L,t L '~ ~ --- ----- - - Header/Manifold Length ~ Dia ~~ Distribution Pipe(s) ~ Length v- Dia \ pacing \ x Hole Size x Hole Spacing ~ Vent to Air talye~ _~w` ~~^' C('111 C`f1VFR ., o.e~~...o c..~so..,~ nni.~ .nr Mnnnrl r7r Gt_(;rade Systems Only Depth Over ~ Bed/Trench Center ~{,r ~ ~ Depth Over ~ Bed/Trench Edges ~ xx Depth of Topsoil xx Seeded/Sodded Yes No xx Mulched Yes :, No .ti 1 • 1. l COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:J_i '_ Location: 1085 174th Street ammond, WI 54015 (NE 1/4 NW 1/4 9 T29N R17W) Pheasant Ridge Lot 28 Parcel No: 09.29.17.803 1.) Alt BM Description = ! ° ~..~., •~- ~G/GS o 2.) Bldg sewer length = ~ ~{ -amount of cover = ~ ~Z ~1 Plan revision Required? Yes o ~ ~ ~ ~~ ~j ~ ~ Use other side for additional Information. Date Cert. No. SBD-6710 (R.3/97) CommerCe.wi,goV Safety and Buildings Division County ~~ /) ~) 201 W. Washington Ave., P.O- Box 7162 ~ (~ 1 ', ~ ~ ~ ~ ~ ~ /~ Madison, WI 53707-7162 Sanitary Permit Ntunber (to be filled in by Co.) V t~epat'crnertt of Commer^oe~ 5 o c~ ~ 8 Z Sanitary Permit Applica II submission of this form to the appropriate governmental Code Wis Adm ce with s Comm 83 2!(2) ccorda In State TransactAiolnQN.umber e`' ` ` , . . . . , . a n unit is required prior to obtaining a sanitary permit. Note: Application forms for are . ~ect Address (if different than mailing address) dary submitted tb the Department of Commerce. Personal inforrna[ion you provt ma b u ses in accordance with the Privac Law, s. 1.04 1 {m ,Stars. . ''I „£~1"? jr~~ " /~~.~i~'/ ' c /// ~~' 444th on L A lication Information -Please Print All [nfor F Property Owner's Name U 8 "LiliJ 1 Parcel # -,rt1D - l -- Z MAY p O Property Owner's Mailing Address Property Location ~ ~ O ~ ST. CR01X CUUNTY , / Govt. Lot City, S to ', ~ Zip Code Ph ~ ~~ y,, Section ~ • ~- cle o o~ (check all that apply) ak e of Buildin II T Lot . g . yp Subdivisi n Name 2 Family Dwelling-Number of Bedroom --- _ Su~ew.ilr}-e ~ Bloc # -L°(c-,~~ ^ Public/Commercial -Describe Use ~~ - ~o C.~ ,~-~- ^ City of (3 ~~c ~ tea.- - . i ~- CSM Number ^ Village of ^ State Owned -Describe Use •~ Q ~ Z p ~ ~l L/ 23 +'Z3 r wn o~ III. Type of Permit: (Check only one box online A. Complete line B if applicable) '4' ew System ^ Replacement System g Tank Re lacentent Onl ^ TreatmenUHoldin p Y ^ Other Modification to Existing System (explain) B. ^ Permit Renewal ^ Pem~it Revision ^ Change of Plumber ^ Perrnit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner i~~' ~- , IV. T e of POWYS S stem/Com onent/Device: Check all that a 1 Non-Pressurize In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. ofsuitable soil ^ Mound < 24 in of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Drs ersal/Treatment Area Information: - Design Flow (gpd) / Design Soil Applicatiojr Rate(gpdsf) _ / Dis 1 Area Requir (std Dis rsal Area Proposed (sfj S sum ev on ~ ~~ / ~ VI. Tank [nfo Capacity in Total # of Manufacturer y ~ ° Gallons New Tanks Existing Tanks Gallons Units ~ ~ ~~~ ?? ~ c a U o .:: ;? ~n ~, rn a 'w C7 C. Septic or Holdiag Tank ~~ L3osing Chamber VII. Resppnsibility Statement- i, the undersigned, assume re o lity for installation of the POWYS shown on the attached plans. Pl r' ame (Print) Plumber's Si to P/MPRS Number M siness Phone Number u B /A 7 r` Plumber'syAd~dress (Street, City, State, Zi //de~~ ~ y~ /'~ 1 r~ . GL~ ~~ !~ Jl L/L VIII. Cou~tt /De artment Ilse Onl ~pproved ^ tsapprove Pe~(mi~t Fe~ey $ ~ Date Is~jd ~ ~ Issuing Signature rven Reason for enial ! /V / IX. Conditt~rr~f~~~easons for Disapproval l 3 J ~) J~~ ~ ff f S P e~J~ c ~~ ~ 1 ~~~ eptic tank, t luent itter and 1. (~ t dispersal ceA must all be services /maintained ~ f ~~~~~ ~ ~~ `'~[" Se ~ ~S tis per management plan provided by plumber. U 2. AN se'tbacK tequirements must be maintained Attach to cmnptete ptmts for the sastem ants submit to th¢ couary Doty on paper not less roan a vi x ~ ~ mcnes m sue SBD-6398 (R. 01/07) Valid thru 01/09 . , PLOT PLAN PROJECT Ulferts FamilvTrust ADDRESS 1011 170th St. Hammond Wi 54015 NE' 1/4 NW 1/4S 9 /T N/R 1 W TOWN Hammond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE519f07 BEDROOM 3 CONVENTIONAL XXX IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •5 ABSORPTION AREA 931 # of chambers 46 ,BENCHMARK V.R.P. Top of Wood Stake ASSUME ELEVATION 100' Filter BEST Filter ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 92.9193.3 4.5' below grade setbacks required by WDNR Alternate Benchmark Top of wood stake c 100.3' 97th Ave Scale is 1" = 40' unless otherwise noted Plans Designed Using Conventional Powts Manual Version 2.0 Property Line 30' 60' ST Pro 3 Bedroom House 2-3' X 94' Cells with >3' spacing 100' Property Line Quick4 Standard-W Leaching Chamber with 20.0 ft2 of Area 5.8ft^2/pair of end caps Grade at System Elevation Atl. 5% Slope 00' Property Line B.M. 100' >6" of Cover ,Vent 4' Long112" __~ PLOT PLAN PROJECT UlfertsFamilvTrust ADDRESS 1011 170th St. Hammond Wi 54015 NE' 1/4 NW 1/4S 9 /T N/R 1 W TOWN Hammond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATES/9/07 BEDROOM 3 CONVENTIONAL XXX IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •S ABSORPTION AREA 931 # of chambers 46 ,BENCHMARK V.R.P. Top of Wood Stake ASSUME ELEVATION 100' Fi1teT BEST Filter ^ BOREHOLE O WELL *H,R,p, Same as Benchmark Well is to meet all SYSTEM ELEVATION 92.9/93.3 4.5' below grade setbacks required by WDNR Alternate Benchmark Top of wood stake c 100.3' 97th Ave Scale is 1" = 40' unless otherwise noted Plans Designed Using Conventional Powts Manual Version 2.0 Property Line 60' ST 30' Pro 3 Bedroom House 2-3' X 94' Cells with >3' spacing 15' 'i5% Slope B-2 00' Property Line >6" of Cover Vent 4' Long112" B-1 Property Line Quick4 Standard-W Leaching Chamber with 20.0 ft2 of Area 5.8ft^2/pair of end caps LGrade at System Elevation 30' B.M. B-3 1 100' 100' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County `j ~ C ~ , Plan must Attach complete site plan on paper not less than 8 112 x 11 inches in size . indude, but not limited to: vertical and horizontal reference point (BMj, direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Revie d by Date q ~ / I ~~ personal iMorrnation you provide may be used for secondary purposes w, s l14 )). Property Owner cation i- ~ .~- ~'~' ~ y 1 /4 /i/(,J1 /4 S T N R r E (or W Property Owners Mailing Add11r~~ess ff 7 r Lot Block # ~ Subd. Name or CSM# , ~ ~/ Q r • Q I U O 2 ~ ~ I b M S ~ +L~ CAS Cily State Zip Code hone Number ^ ^ Villa a Town Neares Road ~ wm ~ 5 D1S ~'~ ~ ~ m / } c«tstruction Use. sidenbal / Number of bedrooms Code derived design flow rate yv~ GPD ^ Replacement ^ Pub lic/~r commerdal -Describe: ___ _____ __~_~__________ ___ ~ Parent material t3 t ,C.i~-cJ u~`~~ Flood Plain elevation if applicable ~ ~ ,~ ft. General oonxnertts and recorrtrnendatitxrs: if , ~ / G-cJ=3`-~ ~L~!?t~ El ti ~~ N ~ S , ~ ystem eva on System Type Boring //~ I ~~ # pit Ground surface elev. ft. Depth to limiting factor ~! v in. Soil ication Rate Horizon Depth Dominant Cdor Redox Destxipfion Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 ~ b"I z- 1U X31 L J S ~~ - ~ ~~ 1 3.3 r it ~~ # p spring ~ /l ,~ Pit Ground surface elev. ~f ft. Depth to limiting factor ~ in. Soil licetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0-1 i U i .~ P >- ~ ,~ 2 I -3v C~ S ---- / , `~ , 3 b-(lo b s to -~ O s ~? ~ ~/.f ~,~ - S p _~ Eftlttent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL ` Effluent #2 = BOD < 30 mgiL and T55 < 30 mgtL CST Alarr>Q (Please Printj Signs CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 S~ ?--~ ~ 715-246-4516 Property Owner _ n Boring # ^ Boring ~J L~P rcel ID # / ~ / 1 a ~~ Page of _ I / I JLTPit c~rouna surrace eiev.c_%T~ n. urpui w um~ung ~au~ ~ ~ - n ~. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture ` S e Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color ,.~ '~Sz. Sh. 'Eff#1 •Eff#2 l ~il I~ ~ i~ ~' ,~ ..-.. `" ~- ~ rn~ ~s- ,o 2 I- y t ~ 5 - ~ ~ m ~ /n W ~ ~~.-~ - /0 . S ~' S Nl l ~~ D 1 r( rr h Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 ~~ # O Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon 7epth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 ng/L and TSS >30 < 150 mglL 'Effluent #2 = 80D5 < 30 mgJL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6A0) Property Owner _ Parcel ID # Page Boring # {~~ Boring L YJ~PIt Ground surface elev.~~ ft. Depth to IimiGng fador ~_ in. Soil lication Rate Horizon Depth Dominant Color Redox Description 'texture' fr~ re ~ S Consistence Boundary Roots GP D/Ff in. Munsell Qu. Sz. Cont. Color ~ ~_ ^ ~° Gr. Sz. Sh. `Eff#1 `Eff#2 ~ Z ~- ~t ~ S "~ 1 ~~ ~-, c.J ~ ~~-~ l0 . ~ S Nl l ~~ D ~ ,t ,r h a ~~ # ^ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Descriptlon Texture Structure Consistence Boundary Roots GPD/if in. Munsell Qu. Sz. Cont.-Color Gr. Sz. Sh. `Eff#1 'Eff#2 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate horizon 'lepth Dominant Cdor Redox Desrription- Texture Structure Consistence. Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluerrt #1 =GODS > 30 < 720 mg/L and TSS >30 < 150 mglL ' Effluent #2 =GODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seo-esw trt.6roo> Soil Test Plot Plan Project Name Ulferts Family Trust Sh i Address 1011 170th St. ~ Hammond Wi 54015 STM #226900 Lot 28 Subdivision Pheasant Ridge Date 5/8!07 NE 1/4 N W 1/4S 9 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Wood Stake System Elevation 92.9/93.3 *HRpSame as Benchmark AIteIlla.te Be11C11111a.Tk Top of Wood Stake @ 100.3' 97th Ave a,..,w,in.nnna• 1 JtA LtYtL rJAlve'rl NW CORNER OF SECT 1 ON 9 - 1082.21 ' N li4 CORNER OF SECTIION 9 - 1069.63' ADDJTIONAI BENCHMARKS ON PROPERTY IRONS as sxowN. i ~i i'i y~ "' ' SW I i4 ~i m~ ~,;~; ~i i ,., ,. -~ r-----' _____ SE li4 t 1 100TH (NO SCALE) AVE. NORTH L 1 NE OF THE NW 1 i4 '~ i s PURL 1 C S01 ° 47' 24" W I N01 ° 47' 24" E 36. 63' '' 38. 71 ' S89 ° 41 ~ 59" E I QI I e 240. 19' T ~ , : ® ~ ro ;ro ra= ~~ r' ¢ 1 O i i `~~ LOT 1 ~ ¢ g ° ° ~~ 0 O' ~ `~cS~. ~ ~ 1.50 ACRES ....:.....~ ~`~. ~ ~ ~: iC o.. o. ~ /. r L OT ~•31• ~-• ~1 '~ • ©,!•' ~ ~ ~ 8p. ;' J. 51 ACRES 'o ' LOT 2 `~ 2. 10 ACRES ms's S ~ 65, 981 S0. FT. ~ ~; 91, 582 S0. FT. c~' / . ,' HWE /062' ' s~, ~ ~+' /~ ~ ~ : • LFE 1064' ' i i / Qo ~9, / fs , ~, , ; , ~~ soh, 0°2'~~0 ~ , - ®.-~ L 07 30 ~ J. 63 ACRES 6~ ~/ 9 . ~ ,' T 1, 184 S0. FT. 589 Q / 0 2~ / y HWE 1062' C~~ ~~, , Q~ ~i9. i 3 '~ ~gQ , ~a °~ LFE 1064' ; ' ~~,`' •~ ~ ~a V ~ ,' O / ,' / ~ ~~ ~ `~° ~ ~ ~ '~ ~ LOT 29 01 62 .. ~,' ,~~, ,o , , ~°, '~ 6. 6 /~ ~~'~ 1.57 ACRES ,' ~ \ • g.~ ~ ~'• ~~ 68, 524 S0. FT. ~ `9 h 6i ~ 6 ~ ~ /' HWE 1062' ' / , ~ ~ ,% 6' ~~%• Q~ 6 ~ '~S,O LFE 1064, ~; S, n i V o''' ,'°° o ~y~PG 2\ roP of - • 1R . ~ ~ ~o ~ '4~ S ~y '~ , ' Q. P / PE 1061.50' .~, ' ~ ~ °$• hoc ~ 6 ' 0 .~~ LOT 28 ~'2 ~', ti a~ ,2 , ,~ 1.54 ACRES ' 67, 027 SD. FT. ' J°" ysio %. LOT 27 1.53 ACRES 66, 861 S0. FT. %. ~ `~O~ i i °. ~s sS. ~Q~ py~ ~ ~ J~Qti °o h• titi ~t3ISTERS Q~F1 srctto~c Co, wr, • ft~Ra~r~i thi 1$ o'c'GC?~.' ~ v - -~'-~~ ~•-•~- - ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFCATION FORM OwnerBuyer Mailing Address Property Address City/State ~n~ ~~ ~~ ~ J~ / :?.~ ~` (Verification required from Planning & Zoning Department for new construction.) ~--'V ~ 1$ - / o l ~g~z n -vU"p Parcel Identification Number LEGAL DESCRIPTION g °~ tc~ r S / ,~'~~ N Rte' -~-W, Town of Property Location ~~ /a , /v /a , ec. , . ~ Subdivision Certified Survey Map # Warranty Deed # ~ ` ~ _Li7` Lot # ~~ __ ~- ,Volume / ^ ,Page # c S 1 ~ .Volume ~ ~ ~ • page ~ `'~ Spec ho yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature fayure to handPe wastes.~P aP ou t into maintenance consists of pumping out the septic tank every three years or sooner, if needed, b a licensed umper: Y Pu the system can affect the function of the septic tank as a trea p ent stage in the waste disposal sys~n~~~' m~~nance responsibilities are specified in §Comm. 83.52(1) and in Cha ter 12 - St_ Croix County Sanitary The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and Bumping (if necessary), the septic tank is less than 113 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify. that all statements on this form are true to the best of mylour knowledge. Uwe amlare the owne1(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT(S) DATE *** Any information that is misrepresented may result in the sanitary permrt being revoked by the Planning ~ Zoning Department-*'~* Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey trap if reference is made in the wancanty deed. (REV. 08/05) Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 ...-, C mg cy Plan Option #1 f system fails, determine cause of failure, use alternate area and install new system in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 ~~ 'DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1992 WARRANTY DEEDoo Theodore Ulferts ~--ioi ~ <~~ ~.~~~ conveys and warrants to sltr u t yaf ~ ~~t f~ ~~c~~('~it~ l the following described real estate in ~ C nix County, State o/ Wisconsin: THIS SPACE RESERVED FOR RECORDING DATA REGISTER'S O~FIC~ S"1: CROIX CO., W{ Reu'd for Record SEP 2 7 I~~o at 9 : oo a. M Regtstar of poeds „ ;; .~ I ~ C r~ 1 Tax Parcel N The Grantor's 1/2 interest in the following two parcels: 1) W~ of Section 9-29-17 EXCEPT commencing at SE corner of said Wt~ of Section 9; thence N on ~ section line 341.8 feet; thence N82° W 340.0 feet; thence 852°W 170.0 feet; thence 839°W 170.0 feet; then 856°W 263.7 feet to section line; thence E on section line 798.78 feet to Place of Beginning. 2) NW~ of NW~ of Section 13-29-16, eai;ee~~ ~''-' F""'-'"- - -' -B~~n~}ng a~ >khe !iW eers~er e€ --- ~ --~_ ~ ~L-- - - -~ =-i tyre 4it ~r:te of ser8 9eetie::T656 €ee~ ~e awe#~~y-->=~ertee-~--~ty -s~~a3g3~~ ~~ne Pif3~ r ~ r Is-fcee a 6€ eail~ ~~fi-evr::er; b~:e:Zee-i~ a:: eese~ !~ - - -- -- .a.rac, t < _ ~ _ ,..,. ~.. s ... ... Also S~ of SW~ of SW} of Section 12-29-16 ~Ay~v~ Please Re-record due to the exception for an old ~ ~ ~ railroad bed that was erroneously listed. S~-L-C---~"' i-1-+~s- This iS nOt homestead property. (is) (is not) Exception to Warranties. Dated this • Theodore Ulferts AUTHENTICATION Signature(s) rc~ day of SP,pte:IDl~eT" . 19_3 EAL) SEAL) Gam, ~ _ EAL) // ~ (SEAL) i authenticated this day of 19 TITLE: MEMBER STATE BAR OF WISCONSIN (1 /not, authorized by § 706.06, Wis. Stats.) THIS tNSTRUM ENT WAS DRAFTED 9Y ACKNOWLEDGMENT :~L~ nloif STATE OF~FFS6-• ss. _ ' GL//N.IJ~IdR~County. Personally came before me this ~ y ~ day of ~~ - L-~- 19_.~L t he above named to me known to be the person who executed the foregoing instrument and ackna~Ai~a~~1Rt~Sllheleeeoeoeeo• p ARY P LIC, STATE OF ILI.INC c~`~ C . ~ ~ i ~ ~~ ~ rnauurccrnu rvnr°rc 2!2419 Notary Public__ ~ ~ ~J1lCAfeeeo r~aAll~tVMit-.~i,li (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) r,, e a-a y .19~,~, date: ~J Names of persons 5ign,ng ~n any capaaty should be typeo or peered below their 9~9natures ~ $B2 NTF 0021 W ARRANTV DEED STATE BAR Oi WISCONSIN Nelco Tax Fortes. P.O. Box 70206, Green Bay, WI 54307-0208 Form Np 2 - 1982 Z • • i 7 VOL i~~~ PAGE ~f'j C.ol~ rtE~V-Q /? 59651 C~ KATHLEEN H. WALSH f2EGISTEk OF DEEDS ST. CROIX CO., WT RECEIVED FOR REC~RD- 01-26-1999 2:~0 PM w~ANTr DEED EXENPT / 3 CERT CQPY FEE: COPP FEE: 3.00 TRI~ISFER FEE: RECDRDIN6 FEE: 12.QO PAGES: 2 Recom~ag wren Nnvpj anti Address o-!B -la-14-~ --o~o- Parcel Idmtificatioa Number (PII~I) p!$-IOl$ -3D-~O D-B-Sorg-yo -ate Orb-loig --SO -ooo OI$-!OI$ -~ -moo 018 - ~olg -~o -cx~a OI$ ~lOr$-80-opo 01$ - l018 -90 - oo© orb-1ot9-oo ~ooo 0o a -io~~ -8o-©©a ooa - I ors-~d -o~ "THlS PACE IS PART OF THIS LEGAL DOCUMENT-DO NOT REMOVE" lhie iaforttutioa awst be completed by submiper: dae/onent title. name & renern address, and ~ (~ jrequtred). Oalaer igjormaoioic such as the granting dausv, legal dveripKon, etc. tray be placed on this fast page of the document or may be placed on additional paav srf the documrnt. ore: Use of thir cover page adds one page to your document surd ~.OO ro the recordmr fcero the retordmr fee. Wveotvfn Stativus, 59.SI7. A'RDA 2/96 FROC'1.:(lEt1ERIh~i HOGS I.LC FAX N0. :?155311282 Dec. 14 2004 10~ 14PM Pit _,: F i t i .~ o ~T i£SSZL : 'ON Xtld ~l't S3WOH ~h{I?J9f1~0: 1.102t.~ ~Zd WdbZ:@j b00z bt aQ .. ,. ,wsnn Department of commerce SOIL EVALUATION REPORT ~ Page ~ of 3 `Division of Safety ant(-~dufldin9s n. owan ua..w v.u. van.ru w, .. w . wu.... vwv _-_ County - Attach complete site plan on paper not less than 81R x 11 inches in size. Plan rrwst i indude, but not flmited to: vertical and horizontal reference point (BM); direcflon and parcel I.D. o p 0 ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~~o • / 0 9~0 ~ ~ 0 00 P/ease prin all i~~E® P i P l intortn ti f d (m)) 15 04 1 Re ~ ,q-i/~lby ~//~k'~~%H l~l~ ( i ~ Date / ~7 ~/7 ~J r or secon ary purposes ( vacy on you Provide maybe us ersona a . ( ) . . s. ~ iyf/j ( ! Property .. _ J ~ ~. T ZDOz Property lACa6on fVlr n i/4 S 1 4 /V T Z ~ R ~~ E Q Govt. Lot W ` / , N (or1 Property Owner's Mailing Address ST.CROIX000N7Y Lot# Block# Subd.-Name orCSM# - - i~ ZONING OFFICE c~ Z ~ v City State Zip Code Phone Number ^ City _ ^ village Town Nea Dad ~mrY~pr~ la.~l X013 (15)1 - 112(0 ~, ~ 1p~' Pyre New Construt~ion (fie: ~ Residential /Number of bedrooms ~ - ~ Code derived design flow rate ~o Q GPD ^ Replacement ^ Public or rArnrr>ercial - Descn'be: Parent material ~ ~ Flood Plain elevation if applicable ~ ~ ~ ~ ft. General comments j ~ ~!' ~ ~.G ~~'nti?.~~•v, LpT o~7- Q>ti and recommendations: r~ ^'S ~~ ~ ~ ~~ ©d ~-~Q~~ ~,~~,~Za~~ - ^ Boring LS / D'y~ OZd~~ / ~1..`". Boring # ~ • ~ ~ De pit Ground surface elev. pth to limiting factor ~ in. Soil Application Rate Horizon Depth . Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munseii Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 •E ff#2 ((~~ r p 2 l2 -3b to r y l ~" S~ c-1 ~. k m-~ir- c 5 - . 4 , ~ ~'- lc~ `~ --' m OS c~ -. . ~ ~.Z ~ w ~ 3 ZP ~ .S r ~-I c~ fYl O 1 _ - ~ ~ 1. Z ® Boring # r^r~~ Boring p~ ~ L7 pit Ground surface elev. C`i • ~ ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munseli Qu. Sz. Cont.'Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I 0-13 I 12- ~~ ~sbk r~C' ~ 1 . 5 - ~ 2 13- tO ~ ~ cI 2 l< r ~-~ -- - ~ 3 -4S lC~ ~ mS 0 ran I c .~. -7 1- ~ ~- ~ 3 `7 , tQ vY-~ S _ - ~ . ~ l . 2 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) re CST Number ___, _-- ~r - _ Address Date Evaluation Conducted Telephone Number ,. Property Owner ~ ~ Parcel ID # / ~ ~ ~ ~ Page ~ of V ~ Pit GrOUnd surface elev. ~ U• Lr~ 7i. ~pu~ w m~uu~~y ia~.ur ~ ~ ~ n~. Soil Appliption Rate Horizon De th Dominant Color Redox Description Texture Structrrre Consistence Boundary Roots GPD1ft2 p in. Munsefl Qu. Sz Cont. Color _ Gr. Sz Sh. 'Eff#1 'Eff#2 ~ ~~ Z --- S ~ I ~,s ~ c ~ (-~ . 5 . ~' 2 I~(~Z~ ~f ~ 5~ ~ ~ -, . ~f 3 ZS- r 5 --~ m5 b 1 c ~-- , ^7 I, Z Boring # ~ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in' Soil Appliption Rate Horizon Depth . Dominant Color Redox Description Texture SWclure Consistence Boundary Roots GPD/ft2 in. Munseil Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliption Rate Horizon De th Dominant Color Redox Des(xiption Texture Structure Consistence Boundary Roots GPD/ft2 p in. Munseil Qu. Sz. Cont Cola Gr. Sz Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODS < 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. SBD$330 (R07/00) • ~ t '~ PAGE~OF 3 1~T A 1~rF ~j o rt 1' e LOT# Z $ T EGAL DESCRIPTION N r ~ Al W to ,S `~ T ZQ N.R. 1 ~ E(or~ SCALE:I"= yd BM 1 ELEVATION /DO- d BM 1 DESCRIPTION -~p Q -~ ~ ~ Q vG ~ ~ ~~2 BM 2 ELEVATION ~ ~ $~ BM 2 DESCRIPTION ~i,o ~~ ~ ~~~~~ QED e SYSTEM ELEVATION 99, S D SYSTEM TYPE w ~ ' lrracQ~ CONTOUR ELEVATION ~~ O4 N I ~ -t r S~G~ q i ~I p-1 Gov ~~ ~~ Dg o% ,o ~9s SIGNATURE ~i~ ~ ~ ~ DATE _ ~ _ ~ ` ~'~ 1~~ o artrn~rt of commerce SOIL EVALUATION REPORT D'iv of Safety and Buildings ~ aooordanoe with Comm 85, was. Adm. Code County Crd, ~ Attach complete site plan on paper not less than 81R x 11 indres in size. Plan must include, but not tirnfeed to: verticat and IrarizonW reference point (BM); direr ion and paw I.D. peroent slope, sale or dimensions, north arrow, and location and distance to nearest road. ~~ ~ - ~~` . Please print all Information. ~ br Pasond tnicrmatioa you provide mar be used - t.aw. ~ 15.04 l~ i (m))• Property Owney., _ Property t.ocation ~ ~ of~ 2~- ~y Date/ Go~rt. Lot /~JE 1/4 N 1ti11/4 S q T Z~ N R / ? E (or~ Property owners Mailing Addn~ JUN 1 0 2002 Z~ Block # subd~ or cstiae Q~ City StartVe~ Zip Code P OUNTY ^ City _ ^ V~Ilage -Town Nearest Road ' C FF ~ ' ~Atew Constnrction Use: Residential / Number of bedrooms _ ~- ~ . Code demred design flow rate _ ~ 5 0 ~ GPD ^ Repbcement ^ Public or corrrrrrercial - Describe- Parent material ~j' ~ t c~ - Flood Plain elevatron if applicable - g, recornrrati~ans: Sy.~ i~Pir ~/t u., _ / ~~ ZO Sys~'--- s~ Gy,. - ,1~ ~.~4~4/ Can~~~ ~eU' 9~~D (/ k da~c ~- l~vr.r.~.l~xi` ~'~ ~ .- 5-~- free-t,a~ ab, Uh,2~ ~~~ k.~ .. ^ Boring .71. T . r., V •- --- - - -,,. v...i.._tii,c.c~. ~9 ~ 1~1 ~^NRi p Pit Ground surface elev. • 0 ~ it. ...Depth to limiting factor ~_ in. Soq Application Rate Fforizon Depth Dominant Color Redox Description Texture Stnx~ure Consistence Boundary Roots GPDHt= in. Munsefl flu. Sz Cont. Cobr Gr. Sz. Sh. 'Etf#'1 •E (f#2 I b'(~ ICS Z `~iI 2 ~ CS IVY -~ p .8 3 ~- ,r,-s ~ os ~ s -- • ~ ~ . 2 4 3~-5b "l .5 r ~ C2P`l. v,-,~ ~- - ~ 1. 2 ~ s~ ~ vn flu/ 2 a # ^ p. ~ Pit Ground surface elev. • a~ ft. Depth to limiting factor ~ in. _ Soli Appliption Rate Horizon Depth Dominant Color Redox Oescxiption Texture Structure Consistence Boundary Roots GPD/ttz in. Munseti flu. Sz. Cont. Color Gr. Sz Sh. •Effffl 'Eif#2 ~ z ~ ~ z - ~' ~ ~ ~ ~ -~- 5 .8 Z 12, 2 10 `i~~ 5- cI 2 r~r c - ~ 3 2- ~o c ~. y l~ . s ~ _ ~ . 5 .9 M A- S SO ~ ~ o~ .~ . S ds ~n sElZi - / ~ al `~ .. Emuent Ai'1 = BOD > 30 < ~0 and TSS >30 < 150 _s _ _ mg/L _ mglL ' Effluent #2 =GODS < 30 mg/L and TSS < 30 mglL ~? / Date Evaluation Conducted Telephone Num ~, ,•' • PAGE~OF NAME ~ d ~ T e- T.OT# Z $ T.EGAT. DESCRIPTION N r ~ Al +~ta ,S `~ T Z4 ,N,R_ I ~ F.(or~ CALE• I"- ~n I BM 1 ELEVATION /DO-d ~. BM 2 ELEVA ,' BM 2 ~ J ~- ~ SYSTEM ELEVATION ~9, S ~ SYSTEM TYPE ~~-Y'acQe CONTOUR ELEVATION g~ ~ O n I ~ _ -t SPG. ~ I ~`_ ~ ~y ~~. i ~ ~~ ~,~ ok ~~ ~ i ~ a~ ~, / ~,„ a~ ~'~° '' ~ ~~ ~~;~ ~ yo SIGNATURE // ~~ ~°~ g-Z ,o 3~~~03 ~ 95 .TE L~ _ 9- eL' ~ t. 4~ 1 ~ t