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HomeMy WebLinkAbout018-1022-40-550vVisconsin 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 Anderson, Matt Hammond Townshi CST BM Elev: Insp. BM Efev: BM De cription: l QU ~ / ~ e~' 6G - TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic - ~~ U ~ ~ Dosing /~ ~ 0 C Aeration ~ N- Holding TANK SETBACK INFORMATION TANK TO P/L Sa WELL ~~l BLDG. %o~ ~r /~ Vent to Air Intake s ROAD Septic ~ ~ J ~~S/ 2 ~ / J ~,~ yr+ Dosing , 2 Aeration Holding PUMP/SIPHON INFORMATION Model Number ~~D ~ I' ~ v 1 ~-~ TDH Lit ~ -t+ Frictii n Los System Heard' T ~ ~ 0 Ft `~ , Forcemain Length A I Dia.2~ Dist. to Well ~ ~ 5 ABSORPTION SYSTEM BEDI RENCH Width ~ ~ Length / DI NSIONS //- SETBACK SYSTEM TO INFORMATION _ _. _ DISTRIBUTION SYSTEM '/LS B/LD~G WELL ~! ~~~ 7 ~ ~~~ ELEVATION DATA County: $t. CrOIX Sanitary Permit No: 408228 0 State Plan ID No: Parcel Tax No: 018-1022-40-200 7l~~ STN ~ ~ FS 9~ ~~, 7 Benchmark o w~odS f .~ I ~• a Alt. ` ~ _ 05 Bld . Se r 9~ v .3 8 7• ~ SUHt Inlet q7 ~ fl~ 9 St/Ht Outlet f- Dt Inlet Dt Bott ~,, ad 9~ y ~ ~ 3. o Header/Mann,. r~ ~.~{ ~02•~ , r 7 ~ Z ~O Dis ipe / o o ~ ~ jt~2. /OZ• I A ~ l - 2 Bot. Syste~ 3 h~ f 2•~f . ~'t 9~• ~'2 Final G de ~( 2- ~esy / 0~ std 97• y ~~( ~ ~ (o / ~ ~~,~~-~nn `~'V'L~, C ~ l~'~ R~ -tee DIMENSIONS ~~ Inside Dia. Liquid Depth G Manufacturer: OR . Model Number: o~ G~{Y.io'~ Header/Manifold "'_' Distribution '" / x Hole Si ze x Hole Spa ci ng Vent to Air Intake ! ~ tf ~ pipe(s) ~ ~ ~ ~C M ~ / J / ~ p ` '7 / ~ ~Y/ i• Dia Length Length Dia Spacing ~-- D SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Systems Onlv ! S'~ r...' c.~iiu-•~~-I D h Over ~~y(~ `~ ' Depth Over rr xx Depth of xx Seeded/Sodded xx Mulched ed ench Center' 1 Bed/Trench Edges b Topsoil ~ Yes [ 1 No [Yes ~~ No ~L COMMENTS: (Include code discrepencies, persons present, etc.) Inspecti ~ #1:~/~/ ~ Inspection #2:~/~/~~y~,_ Location: 1913 110th Avenue Hammond, WI 54015 (NW 1/4 NW 1/4 11 T29N R17W) NA Lo ~~~ /~(,~~,Parcel No: 11.29.17.1668 ~[~ 1 J Alt BM Description = ~'~~' ~~~~^' ~ G~ ~/ 2.) Bldg sewer length = 22/ - amount of cover = 7 j ~' / 3.) Contour = ~ • $ 7 /~j'7- ~b --T----,I ___- - - -- - r ~ -----~ Plan revision Required? f~ Yes ~ No ~ ~ ~ ~ ~j /~ Use other side for additional information. ~~~ ~-l ~ "-__~ ~ _ ___--- _-__-- - ^`'.---_-~ ~ -- _.~ SBD-6710 (R.3/97) Date Insepctor's gnature Cert. No. 3z5 Safety and Buildings Divisioa Co"~' - ~ r C ' ( ' 201 W. Washington Ave., P.O. Box 7162 V d 1 ,~~O~S,~ Madison, WI 53707 - 7162 rte Address P De artment of Commerce -~- -02_ 3.S.S~d Je [ Q ~ Sanitary Permit Application Sat"ffi''~ p~{j`~? Z~' In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check ff Revision ma be used for ses Priva Law, s15. 1 m I. Application Information -Please Print All Information ~ Stau Plan I.D. Number S 1 S~ttzO # 6 N 5 y l~ ~ ' property Owner's Name f ~a`~- ~} n ~ eV~ 0 ~'1 Parcel Number 0 l - -oZZ - o - 7.ae . Ibbg property Owner's Mailing Address ~~ O ~J ~ ~~~ ~t~ .. y~ J y) ~d Property Location ,,~ / ~ J' l VV 5f / V W !f ; S ~ T N, R ! City, State p Code~~~ ~ ~ Phone Num Lot Number ~ `s Block N C ~ r~ 8! 2~~2 Subdivision Name CSM Number II. Type of Building (check all that apply) ^Ciry ~ a ~ "^' ~ 1 or 2 Family Dwelling -Number of Bedrooms - ^Village ^ public/Commerc' - scrip ~ wnship ~l B1 I'ti D ^ State Owned r tt " r tt ~ Nearest Road l~2 !90 vel I [G~~ D = K~ I ,o z s ~i t III, 'I~pe of 't: (Check only one box on ' e A (numbering scheme for internal use). Complete line B if applicable) A 1 ew 2 ^ Replacement Sysum 3 ^ Replacement of 6 ^ Addition to For County use stem Tank Onl Eris ~ stem B. ^ Check if Sanitary Permit previously Issued Permit Number Date Issued 1V. 1~pe of Permit: (Check all that apply)(ntimbering scheme is for interns! use) •«^, STF ~ t~ 1x- 44 ^ Non -Ptessttrized In-Ground ?ound 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ pressurized In-C,round 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Cr:ade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. D' rsal/Treatment Area Informati Design Flow (gpd) Dispersal Area on: Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required proposed Rate(Gals./Days/Sq.Ft.) (Min.lInch) Elevation _ ~5 ~ ~S~ ~ Y~~ ~ ~ f ~ 1Vd~ q$.S7 ~q` ~7 ~. Tapk Info Capacity in .Total Number Manufacturer Prefab Concrete Site Constntcted Steel Fiber Glass Plastic Gallons Gallons of Tanks i New Existing Septic or Holding Tank ~( _ ~ ~p ~ •M n rn ,O 1. I~ /9 Nr ~C ----_ --- - r o v - - VII. Responsibility Statement- I, the undetalgued, assume respoastbility for installation of the PO shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/IvIP1tS Number Business Phone Number a~~~~ le h ~s~ ~ M~g3T ~~ y~~ ~~~ 8a1 7 ~g~ Plumber's Address (street, city. state, zip Code) N 36~' oao~ G ,~ / i 5 D v VIII. Cotmt /De artment se Ottl ~/ roved ^ Disapproved A Sanitary Permit Fee ('utcludes Groundwater Date Issued Issu' Agent Signature (No Stamps) PP tR ^ Owner Given Initial Adverse Surchar Fee) 2 r-- ~ ZS J ~ ~ ~ Determination , IX. Conditions on APProval/Reaso for DisapRroval `~ / ~ _ ~~~` + ' ~n. a~~t, /17:R~ /~ D~ ~et~ f w~-~o2 ttnA.~ \ ~ ( /~ • .~Ij-/~ ~j ~/~ /~ tS ~_ -- ~ i -'~I ~~ V ~.! is ,....,,r ~ rtun R] n : 11 inches in sixe ....~..........r..-- r-~- • -- "- + --per --- -- -+------ SBD-6398 (R. OS/Ol) ,, ~O (O S~ v ~ <-+ 0 ~ ~ n 3 O Q~ c+ ro O < ~ m~ a n a -~ -~ -~- X ~o ~~ ~ ~ n _~ ~~ ~: ~~ ~- tti ~ 3 i N lD >~ ~,- a • ~ ~ ~ ~scons~n Department of Commerce June 07, 2002 OUST ID No.220499 BRUCE ALLEN WEBSTER N3659 CTY RD C ELLSWORTH WI 54011 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/07/2004 SITE: Matt Anderson 110TH Ave Town of Hammond St Croix County NW1/4, NW1/4, S11, T29N, R17W FOR: FtE ICE VED JUN 0 7 2002 ST. CROIX COUNTY ZONING ATTN: POWTS Inspector Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 754341 Site ID No. 645419 Please refer to both identification numbers, above, in all correspondence with the agency. Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 853922 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 and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • 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. Note: The plumber has been to the site and verified the accuracy of the contours reported by the soil tester since there is a discrepancy between the two plot plans. He has revised his plot plan accordingly to reflect accurate contours. Owner Responsibilities: - .. t BRUCE ALLEN WEBSTER Page 2 6/7(02 • 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). Owner Responsibilities Continued: • 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 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, 7:15 am - 4:00 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 ~~ ~~ _ ~~ Y ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commenx.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary 3une 07, 2002 CUST ID No.220499 BRUCE ALLEN WEBSTER N3659 CTY RD C ELLSWORTH WI 54011 CONDITIONAL- APPROVAL PLAN APPROVAL EXPIRES: 06/07/2004 ~~th ATfN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SP[A 1101 CARM[GHAEL RD HUDSON WI 54016 SITE: Matt Anderson 110TH Ave Town of Hammond St Croix County NWl/4, NWI/4, S11, T29N, R(7W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 853922 Identification Numbers Transaction ID No. 754341 Site [D No. 645419 Please refer to both identification nttmbers, above, in all cotres 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 and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.OI/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1lO1). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.(35 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. Note: The plumber has been to the site and verified the accuracy of the contours reported by the soil tester since there is a discrepancy between the two plot plans. He has revised his plot plan accordingly to reflect accurate contours. 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). P.O. W.T.S Conditionally BRUCE ALLEN WEBSTER Owner Responsibilities Continued: Page 2 6!7/02 • Comm83.52(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 at intervats 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, 7:15 am - 4:00 pm jswim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 W iSMART code: 7633 cc: Leroy G lansky ,Wastewater Specialist, (715) 726-2544 n -off =~cc~~r*~d£~~r~bd~ ~ -p -0 -0 ~ ~ -0 -0 ~ ~ ~ io ~~ n u u t~ a ~~ n n n n n (D (O (O CO (O (O (O (D ~ o •+ b o- o ru ~ m ~n ~n ~ m N N N N r0 r0 N fo ,5 ~ P CJ1 OD N ~ fJl ~ O~ ~, ri 3 ~ J ~ LIl ~ N N '-' ~ ~ ~ < ~ in Q f-+ V J V~ lJ d 1l V F,--~ ~rm ~ ~ ~ Q ~ ~ ~ ~ • ~ c~ T7 ~ ~ ~ ~ ~ r0 Q 3 C~ C7 ~ ~ ~ ~ X ~ S rp ~ P < 3 O o Q N~ n~ a z v ~ ~ ~ -p II II 3 In ~ 0 0 ~ U1 rp o ~ ~r ~ n Q Q ~+ O 5 0 ~ ~ ~ °t r _ s ~' o ~ '-' ~«" ~ ru~v, rvrro rx o .+Q to n ~ Qc ~Q~ o ~ N ~o 0 0~_ ~- ~~.? `o~c .p Q -s Q u z o z~ ~ o~ ~Q 0 o v ,. ~ o c°ri -o Qw «c~n N Y,~~O~~_QA`°v3`0 Q3 ~ ~'~ ofs o h o rv o 0 o fl ~ n~ -n.-~~ i N ~z~ Q o ~o~ Q m ~ m~ ~ ~ -~s N ~'~ Q-QO r rv r°~ o QQ ~ ~ ~ n ~0 ~ ~ N ?S r1- 3 3 0 d N < UI ~- `~- 3~ N Q UI p Q N v~~ rp ~ O~ n 0 `+ -5 ~p N~ N F S N ~}~ O A n n 3 n-~ ~ Qp ~-P O~ ~ O ~ n ~ ~ ~ ~ ~ 3 ~ s s~ 3co o ~~ z S f ~ ~. Q ru "-o ~± 3 ~ ° v ,+co .+ p z s o ~" ~ '~ P to ~ v <+ o ~ n_ mo cow ~ ~ _~ ~"~`< Q n .n+ `F n co ~ ~~?QQ `0~nv~i ~~ ~~~ a `~°ro can ~~o ~ o Q ° ;~ QQ ~v ~- a -n v ~n Nm o ~ w "5 ~ O 0~ ~ fi o ~+ v N o rp ~ F 'p' N_ ~+ Ul N 3 ~ ~ ~' ~ ~ ~ f ~ __ _ CJI (U UI + _ ~ O N ~ v ~ w ~i W o S iOo~mQ ~±-u~i_ Q ~ ~ ~s o s ~~ n~,3°3 0 ~ '.o ~ l1~ o ~ wiz-+~ - n ~ a ~, N -,~ ~. - ~ -~ ~- ~ _ _ = m ~~ Q~ ~~ ~1'' °:° xx ~; '"' ~ Q3 ~ Q ~' td r- ~~ ~ ~ ~ ~ S a``~q~uununur ~ ~ ~a``~~ ,`~e~, a _~ ~ ~~ ~ ~ ~~ DEPARTMENT Of COMMERCE ~ "~' ~ '~ ~ ~ ~ ~ DIVISION ANQ BUILDING ' ~~ •~'"•••»»•"""'••~~; ~t ~'r r r n u m n n u i~ `~ ~~````\ .. ~~ SEE CORRE NDENCE n N Q 0 (/l = Z c-I- P 3 n 3 ~ O \ O__ ~ ~ X Q- O n-i~ O ~ ~ Z ~ ~ ~ ~ s~ ~- ~ n fU Z fC3 m m Q .. y t.n .. CJ~ I ru fU W ~ 3 fU O J ~ r, Q ~-- O '~ h Q S~ D ~ < ~ ~ O tz~ ~ Q Q Z ~__ o ~ Q ~~ ~- D n ~ Q cn ~ -A ~ to o O fU ~ - f I I ~~~~ o ~ ;-~- I ~'~ ~ .M r ~ !t3 r t •r ~~h ~ 11 ~v ~3 * ~ s ~* 3 0 ~~~ 9 ~ ~ t~~ ~~~ N tO ~ ~ ~ t• t7 ~ t ~ R ~ ~ ~ ~ ~~ ~~ __ w ~ __ - _. _ r 1 ', bz0y~ ~ n a I ~v North : ~ ~ :~ '~ ~ is .~ :n ~ x ~..~~ l I I m~ r~n ' V V f n ~~~ ~- ~ rD ~ n O r ~+- r~ G~ r~ ,--, 0 F--~ O O ~D (O Q ~l ~ c+ O ~ ~ n ~o Q~ ~o <~ ro~ a d rv ~- ~o _^ v i Page Gr Of Distribution Pipe Detail For A Four Lateral Network Alternate Position Of Force Hain PVC Distribution Pipe ~ / S ,:. ~~ ~~ \ ~~ .. .~ PVC Hanifold Pipe End Cap ~., PVC Force Mai ~t(1i'/t~1 ~ql~ L ~~~/ Holes Equally Spaced q~l On Bottom ~ ~ is * Last Hole Should Be Next To End Cap P S Ft. ~s s 3 Fc. X ~ ~ Inches //,,~~~~ ~ Y ~~ Inches Signed: _ ' Cc.4tiC,v/ Hole Diameter ~ Inch License Number: _~ ~ ~ ~ t lateral Diameter ~ Inch(es) i Date: ~rcy S ~CyQ ~. ~ Manifold Diameter Inches Force Main Diameter 2 Inches X Holes Per Pipe (,3 Invert Elevation Of Laterals ~iU7 Ft. • Page ~ Cf V _~ 6" Topsoil ....,/..\ ~\ IG ~~ ~ lE Synthetic Covering Medium Sond 1 _ Distribution Pipe i u °/. Slope Bed Of 2~- 2 ~? Force Main Plowed Aggregate Layer (6" Delow Pipe) p I~ rc.~ ~ Ft . Cross Section Of A Mound System Using E 1' ~ ~ Ft. A Bed For The Absorption Area F 0 ~ Ft. G ~ Ft. A ~ Ft. H ~- ~ Ft. Signed: ~~,~,~ . B ~ Ft. License Number: _`~~ ~ K ,~ Ft. Date: ~ ~ ~ J Ft . a~ e ,, Alternate Position I Ft. ,, ~Ud~ of Force Main W ~ Ft. L J ~ Observation Pipe - ~----- g K ~r -- -- - - ---- -------- -- 0 ~ --- ----------- ----------------------•I Force Main w j---- ~Oistribution Bed Of %~~- 2 %N 2 2 Pipe A99regate ~I Observation Pipe, Permanent Markers Plan View Of Mound Using A Bed For, The .Absorption Areo !~~ ~ - i'aue Ut ~' ~ SEPTIC 'TANK :~ _PUh1r _C!-iA1`IBER CROSS SECTION AND SPECIFICATIONS ~ T _~ ,, ~` r ~ ~' ~ S o ~ 4" CI VENT PIPE 12" MIPl. ABOVE GRADE ~ WEATHERPROOF ? 25' FROM DOOR, WIPlDOW OK JUP•1CTION BOX APPROVED FRESH AIR INTAKE - , ~ WITH CONDUIT MANHOLE CO '' ~.t~ J J~ ~'1 „~ ~ W ! PAD LOC K FINISHED GRADE ~- o~ ~~~°~' WARNING LA 4" GPI ISER ' i ..___-.- 4 " MIN . 18" IN. 6" MAX. fcoi ;. _ ~ INLET ~ ` ~~ ~+ WATER TIGHT SEA1~S GAS- , ' TIGHT ~ ~, APPROVED 5 ~ ~ ~ ~ ~ ~ SEAL ~ JOINTS WITH APPROVED `( ~ ALM APPROVED PIi '~ PIPE 3' -BF- ~ ON 3' ONTO OilTO SOl I 1' ! ~, ~ SOLID SO I L SOIL ~ ~ PUMP UFF ELEV . FI'. -- - OFF "'` RISER E; D PERMITTED ,,. ~ I F 1'A iJ K PIAiJUFAC'I'UR; HAS APPROVE 3" APPROVED BEDDING UNllE:R T1~Nf< CONCRETE PAD SPECIFICATIONS ____ SEPTIC / DOSE ~, TANK MANUFACTURER : ~/~~~5~/ IJL1P113ER DOSES PER DAY : ~ ~ ___ TANK SIZES: SEPTIC `d~G GAL. DOSE VOLUME INCLUDING I DOSE Sb GAL. pi+.~ ,2f , 2 ~ FLOWBACK: ~ ` ~ GAL. (~ $ ~ 3 ~, ALARM MANUFACTURER: LC~'~~ ~Ir~ CAPACT'TIES: A = ~' ~ INCHES = 3 ~ ~ G1 MODEL NUMBER : DL V y SWITCH TYPE: Srrx1 /3q iI B = 2 INCHES = 3 / G! PUMP MANUFACTURER : C`o~(J C = 1 INCHES = I ~ G1 MODEL NUMBER : Pp~ SWITCH TYPE: ST~t I ~ry D = ~ INCHES = ~~Gf REQUIRED DISCHARGE RATE (• JZ GPM PUMP 1; ALARM WIRING AS PER I LHR 16.23 ~ ~~ f 8.0'7 VERTICAL DIFFERENCE BETWEEN PUMP OF A1`1D pISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE .~~~ ~~ ~ t ©~ ~ fir": ~t° 'Z'eQ ?~ FEET + °oLGO FEET FORCEMAIN X ~Ro~- FT/100 FT. FRICTION FACTOR ~• $+~.~ FEET TOTAL DYNAMIC HEAD = ~~FEET 2.~.9~ ~ INTERPJAL DIMENSIONS OF PUMP TANK: LENGTH ~ ~ ~ ; WIDTH; DIAMETER LIQUID ~T _~~- IGNED: ~~Gri, ~~l-~~Y~ "~ LICENSE NUMBER : ~'~"~ ~ ` llATE : ~~~ J ~~02 1/88 ~~~~7 GOUI.DS PUMPS Submersible Effluent Pump ~~ V ~ ~ EP05 APPLICATIONS Spedfically designed far the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water Vansfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/. maximum. • Capadties: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/,' NPT. • Mechanical seal: carbon- rotary/ceramic•stationary, BUNA-N elastomers. • Temperature: 10a°F (40°C) continuous 1g0°F (60`'Q intemlinent. . • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor • EPOq Single phase: 0.4 HP, 1 t 5 or 230 V, 60 Hz, t 550 RPM, bush in overload wills automatic reset • EP05 Single phase: 0.5 HP, 11 S V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: t 0 foot standard length, 16/3 S1TOW with three prong grounding plug. Optional 20 toot length, 1613 S)TW wi[h Three prong grounding plug (standard on EP05). O 2000 Goulds Pumps Elfp~trvc Fc Dryey, 2000 83871 • Fully submerged in high grade turbine oii for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto• matic models Include Mechanica( Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. METERS FEET lo~ 9 3C 8 2: x v 6 r 5 o t; ~ 4 0 ~ ~ 3~ 11 z 7 0 ^ Bearings: Upper and lower heavy duty ball bearing conSlNCtion. AGENCY LISTING ~' Canadian SOndards Atsrxialion (CSA listed model numbers end in "F" or `C`.) Goulds f'trrrps k ISO 9001 Regiscared. (%5-e. ~y'a~ --- ._._ ._ i ....__ ~.-._.. I ' ' 1 __ - - - -_ ~.~ ~5~~ . , ,.. f -.. f ..--___. '-~_ I _.___....I..... _....__ .--._. ....-__ i -- ---• - - -...EP0 9 -._ r - -- ---,-~. -- ---- - - ~~ -- i -EP04 _.. --- .. ..... ,_ __ -_._._ L.._- ---._I .... ._ -... _ __ r... ....-_ ..._.i-..-- -- u 10 20 30 40 50 GDM 0 2 4 6 8 10 12 m°/h v-vautY r' ~~ f ~~ ^ EP05 Impeller. Thermoplas- tic enclosed design for improved performance. ^ Casing and Basv: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficent heat transfer, strength, and durability. ~ Motor Cover: Thermoplastic cover with integral handle and Ooat switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. a~ 3~~~^ Goulds Pumps ITT Industries J Flt _E INFORMATION Owner Nv ~ u h ~,, Permit # DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Commercial Units ^ NA Estimated flow (average) ., Q a aVda Design flow (peak), (Estimated x 1.5) ~ aVda Soli Application Rate (~ , aUda /ftz Influent/Effluent Quality Monthly average` Fats, Oi(& Grease (FOG) s30 mg/L Biochemical Oxygen Demand (GODS) 420 mg/L Total Suspended Solids (TSS) 6150 m /L Pretreated Effluent Quality ~ ^ NA Monthly average" Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS} <30 mg/L Fecal Colifotm (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y inch diameter PQWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~of n SYSTEM 5r'e~trt~A r tuns Septic Tank Capacity J r7 al ^ Nq, Septic Tank Manufacturer ~/,r<t St/ ^ NA Effluent Fitter Manufacturer ~'~S'IM/rTEC ^ NA Effluent Filter Model #~ STF-100 ^ NA Pump Tank Capacity (~; 'd al ^ NA Pump Tank Manufacturer I,,t/h3-w ^ NA Pump Manufacturer. ~d~~ ^ NA Pump Model ~ ~'~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection Manufacturer ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cell(s) ^ In-ground (gravity) ^ At-grade ^ Dri -line ^ In-ground (pressurized) 'Mound ^ Other: • Values typical for domestic (non-oommerdal) wastewater and septic tank effluent. •* Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ^ months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scrim equals one-third (Y,) of tank volume Inspect dispersal till(s) M At least once every months ear(s) (Maximum 3 yrs.j Clean effluent filter ; ~.., e C ~ At least once every months ^ year(s) Inspect pump, pump controls 8~ alarm At (east once every ^ months year(s) ^ NA Flush laterals and pressure test At least once every ^ months ~ year(s} ^ NA Other. At least once every ^ months ^ year(s) ~ NA other At least once every ^ months ^ year(s) ^ 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 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 surtace. The ponding of effluent on the ground surtace 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, pretreatgment components, and any other maintenance or monitoring at intervals of 12 months or less 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. 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. Sysfem 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 cells} in one large dose, overloading the cell(s) 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. Oo 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 life of the POWTS: antibiotics; baby wipes; ctgatette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump.pump} water, fruit aid vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkiris; tampons; and water softener brine. ABANDONMNIENT 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 ch. 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 aid 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.TREATMENTTRNK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDfTIONAL COMMENTS POWTS INSTALLER _ POWTS MAINTAINER Name Q rv~ ~ W~l,~ ~ Name Phone - 4vC ~ ~ r'~ 1.~ 6Sx~ ~ V Phone ~ - ~ y 3 p~/~ SEPTAGE SERVICING OPERATOR PUMPER ~ ~ 10CAL REGULATORY AUTHORITY Name p ~,, v,~ -ya ' ~ ,Agency vim, Phone C Zo a r Phone I ~~ ~© This document was drafted by the staffs of the Green Lake,~Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(t)(d)8(f) and 83.54(1), (2) $ (3), Wisconsin Adminrstrative Code. Use of this document does not guarantee the performance of the POWTS. Pag~ of GMW (2101) ,A i~ ~i N --- y ~ --- ,~ ~, ,~ ~~ ~~ - 1,812 .7 X2,75 ~ ~ 28 21 ~, ~~ 16, 375 ~~ ~~ ,, ~ FLOW ~ i i i i i i i ~ i i i ~~ GAG SIM/TECH FICTE~ 06598 HDRTDN BAY NDRTH RO BDYNE CITY, MI 49712 1-888-999-329D FAX 1-231-582-7324 SIM/TECH FILTER ASS' Y DETAIL PATENT 5885452 J HDWERY STF-100 1/27/00 GARY KDTESKEY DWNER DWG-D02 ;~ .t ~~ ~L I Sim Tcrh SI-F- I U0 etiluent filter The SimTcch i~ilter can be used in hoth residential and rom-'~:~-~ -»ercial applirttio~~s. Economical . Low maintEnancE Eas installation y f ExtEnds IifE of drainf, d improvES EffluEnt quality The Sim "Tech filter. »~ith it's uniy--c ~lr~i~~n and muuntin~ location. ;-Ilu~~. the filt~n-~~~ screen to be scrubbed while in ~~pcration. pl"oV~I1t111i nlaXImU111 nlalnl~nan~c In1Cr~ais v~'Ith Uml1alchl'd pel'iol"11T,1n~'i ~:Ipahlhtles. Tl~c filter screen is a tvpc ~-~- S ~ ~~ith .0(,? diameter holes. It is ~ inch~> in diameter and I H inches lone ~~ ith ;- (,~).~' squ.-re inch open area. This I;u~~~r -t I"~~ open area allo~~~s the 1~iltrr to pas< ~.~.~ s~allons per minute at 1 psi. tV~ith i~atures like these c~~en a partiall~~ clo~~,~cd scree-~ ~~~ill keep the system ~rc(I protected and ~~~orkin~ properly. This performance product assures ~}uality diluent with lower TSS le~el:_ keepirn~ your pressurized system i~un~li~~nin~~ at 100" ~~ elt~icicncy. I~n~incers and desizners nog+ ha~c the opportunity to otti:r a simple safczuard to meet performance standards nor and in the future. r -v: Total head loss 500? ft. or .? 1 psi ~ Cutaway view showing Fk»~~ rate w/cleap screen,: 1?0.672 (PD(u 1 psi filter casing and screen Flow rate ~~, ~)5°~„ plu~~ed screen: 1`]4.y12 ~~PD(a 1.8 ps- illustrated with optional r I, Protected under l S patent #5.885,452 ~ STF-105 Wire cage r •- 5 4~' 41" C 84" a , , I i i ~i ~ ~ `. ~ , ~ ~ ) i , . ~ i ii ~ i A , ~ ~ . i ~ ~ ~ ~ i ~ I Z ~ ~ ~ ~ ~ t i. 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Wiser sin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 „~ ~ision of Safety and Buildings m accoiaance wan ~.omm ao, vvis. rjam. ~.oae ~ - County ' lete site lan on er not less than 8 1/2 x 11 inches in size Plan must Attach com a ~~~ p p p p . include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale ordimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I Property Owner Property Location N Govt. Lot ,U~ 1/4~(/(,~ f 1/4 S (( T 2~' N R j E (or~ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# -, City State Zip Code Phone Number ~il~e ®Town Nearest Road ^ City `, ` ' ' w`r~ OZ (7S`)Co Z~Z 1 ~" [~ New Construction Use: ®Residential I Number of bedrooms 3 -y Code derived', design f(qw r to ~.5~ - ~i ~ O GPD ^ Replacement 99 ^ Public or commercial -Describe: ,~ Parent material *i ~ ~ ~ Flood Pfaih elevation if applioa~6lel ~V /~' ft. General comments 5'~/S{~E.-~ .G/-e v, 9~:.s o ~' °`"~ ~" and recommendations: el-e..~. ~~ ~~'';~ .,,~ ' ' Cort~au r 9 ~.5~ ..., Boring # ~ Boring ~ 25 ® Pit Ground surface elev. ~~ 7 ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft'- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 t -8 --' Si) m~r eS Z $-1 ~} 3 ~i ( ~r GS - 3 1- 5 Sl- 2 r~r c 5 . 5 . ~/ I ~~ fL}I ~J i ~ ~ 1 •~ . ~ 7 ' . ! ~ ^ Boring # ~ .Boring Pit Ground surface elev. Tli•~ ft. Depth to limiting factor zlo in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 ~ o -I I I D x313 Si ( 2rr,abk ~r ~ S 1 ~-~ ~ g '~ ((~ 2t'o f U ~I(c -- ~ 2 m5lok ~' ~ s ~' '~ Z / to ~ - `,ll SL ZmSbk ~ - - . 5 ____-_ * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number A-EPa v-~ Sc ~ww~cc_~-~ _ _, ~~--- zs33oc~ Address / Date Evaluation Conducted Telephone Number ~ // ~~ ~/7~ S~`' -SoinP r~e-~ w/. S ~D~ S~ ~ -/~ - ~ l -~ ~.S = 2 y ~ - 04 ~ Property Owner rt~f'f~ n ~ Parcel ID # Page ~ of ,,, ~~ Boring # ^ Boring ~~ ®Pit Ground surface elev. 9Sl Zo ft. Depth to limiting factor _T_ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o-io ~0 r3~ --- i f Zrr,ab m~'r cS Ivy' • 5 2 1 -2~! 13 - s a l 2 bk r ~5 - 3 2- 3 FI F ~.5 r S L 2msbk - - 5 ^ 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/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal 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 07/00) PAGE 3 OFD ~;A_ME~(lalcn Q~n~.rbov~ LOT# LEGAT DESCRIPTION kw ~41~,S l( T Z`( N.R. /~ E(or)d~ SCALE: 1"= ~O ~ BM I ELEVATION /Q~j • U BM 1 DESCRIPTION.(nQo -~ ~a.~ I~bo~~~-- ~~~ y~~ l1 BM 2 ELEVATION Ir/. / U ~ BM 2 DESCRIPTION -fvP a-.~ ~G~ H-~~rf- 1. Z r-1~~~ SYSTEM ELEVATION ~ f. Sb ALTERNATE ELEVATION ti/f~- CONTOITR ELEVATION ~j~..~o //D ~ 3s~' x ~ _~_ - -~- ` I ~• 0 '~ -r~ SIGNATURE .O.,.S ___G~~ ~~ ~-.--~ DATE ~- /~ ~ "~ . ~-3 ~- i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREBMENT AND OWNERSI~P CERTIFICATION FORM OwnerBuyer ~.~/,~~G.~l~~l-~J ~ ffn11J ~ULS [ L ~ - rrN.e~ E ~ c1~ Mailing Address t ~ ~ f4 7~ ~ .mil 2 Property Address l ~' l 3 //Q~4. (Verification required from Planning Department for new City/State ~~iIr~1d ~~-- Parcel Identification Number _O I R -, fo ZZ - ~~~ Z~ ~• f b6~~ LEGAL DESCRI~P/T(~ION ~~ Property Location/ V Vy '/4, ~U %., Sec. ~ T~N-R1~W, Town of ~~1 ~~'I d %I ~- ,Lot # °Z Subdivision Certified Survey Map # la s ~ ~ ~ cl ,Volume / S ,Page # / Warranty Deed # ~ ~~, Volume ,Page # Spec house ^ yes' no Lot lines identifiable ~' yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every throe 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 mastorplumber, 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 1/3 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 a three year expiration date. _ s F' -~/ IGNA OF APPLICANT O OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. the property descn abo , by virtue of a warranty deed recorded in Register of Deeds Office. SIGMA OF APPLICANT I (we) am (are) the owner(s) of f~7 /D// 02 DATE «***s* «**«** Any information that is aus-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 w w 0 `~ Ln N b i ~--{ I i --~ ~ o t f ~ ~ ~j ii~ 1 4~ ~ I rc o0 ~~ ~ i! w ; ~ cry ~ ~I ;~ V ~v ~~ {{~ .,.~ ,J v '?.~ c Q G ~ N I O t v ~ E ~ ~ I~ o .. . N ~ ~ t~ T^~ t M a N O o N U 1 8 6 1 P y 3 0 674656 STATE BAR OF WISCONSIN FORM 3 - 1999 KATHLEEH H. YALSH REGISTER OF DEEDS QUIT CLAIM DEED ST. CROIX CO. , YI Document Ivumoer RECEIVED FOR RECORD This Deed, made between Nolan Anderson, a/k/a Nolan E. 03-27-2002 9:30 AM Anderson and Ruth Anderson, a/k/a Ruth Ann Anderson, husband and wife _ QUIT CLAIM GEED ---' -".. E%El4PT i 8 Grantor, and Matthew J. Anderson and Tobie J. Anderson, husband _ REC FEE: 11.00 and wife -- - TRANS FEE: -- -..._ -" _ !- - - COPY FEE: PAGES: 1 Grantee. Grantor quit claims to Grantee the following described real estate in St. Croix _ County, State of Wisconsin (if more space is needed, please attach addendum): Part of the Northwest Quarter of the Northwest Quarter (NW 1/4 of N W I/4) of Section Eleven (11), l'ownship Twenty-nine (29) North, Range Seventeen (17) West, Town of }lammond, St. Croix County, Wisconsin, more particularly described as: t.ot't'wo' of Certified Survey Map dated February 8, 2001, and recorded October in Volume I S of Certified Survey Maps, at ~Pa a 4~193, as Document No. 659889, office of the Register of Deeds for St. Croix Cou- nty, W iseonst~n.''~" Recording Area Name and Return Address Thomas A. McCormack PO Box 2120 Baldwin, WI54002 O1S-1022-40 ____"... Parcel Identification Number (PIN) Tfiis is not _ homestead property. -- px) (is not) -- Together with all appurtenant rights, title and interests. Dated this ~~ day of t .2002 -- £ - ---- ~ "-"-- - + Nolan E. Anderson „_-. -._-.... --..- ---- - + Ruth Ann Anderson . __. _ -_.._._- .-_--- .-- AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ~ ~ ) Signalure(sl --- --.-. ----------. --- )ss. _.._-__- - --.-.~- ---- St. Croix Coumy ) authenticated this -day of -- -~ ~- - p~came before me this .~~" day of 2002 the above named - -- Nolan E. Anderson and Ruth Ann Anderson `_ ____ ____ ---- "f[TLE: MEMBER STATE BAR OF WISCONS}N tom nown to (If not, _ _ _- in nt a~,,~ authorized by § 706.06, Wis. StatsJL-S~rs~. TNl6 INSTRUMENT WAS DRAFTED BY + - .t"X ~~ Thomas A. McCormack Notary Pubtic, State of Wisconsin Baldwin, W[ X4002--. ___._ My Commission is permanent. (Signatures may` be authenticated or acknowledged. Both are not necessary) __.._ ' NamCS orpersons signing in any capacity must be typed or printed below their signature. STATE BAR OF W tSCONSIN QUIT CLAIM DEED FORM No.3- 1999 ,~~~~ ~ ~ :~ r, .' Z -.. -•) MfOfm+li0n ProfeasgrlBU Cornpeny, Fontl eu L+c, w1 000"655-2021 ' rJ ~I~I/ . r.~ 65 9 8 89 Y.ATHLEEN H. WALSH kEGISTEk OF DEEDS ST. CROIX CO. WI RECEIVED FOR RECaRD 10-23-2001 11:10 AM COPY FEE: 3.00 RECORDING FEE: 13.00 CERTIFIED SUR vEY MAP Located in the NW'/a of the NW'/a of Section 11, T29N, R17W, Town of Hammond, St. Croix County, Wisconsin. OWNED BY: NEL4& NORMAANDERSONLE C/O NOLAN & RUTH ANDERSON 1927110TM AVENUE BALDWIN, WI. 54002 I I ~I~ NW CORNER, SECTION 11 (1"STEEL SURVEY NAIL FOUND ) UNPLATTED ~1~= Ic I i W li Q < JJJ 3 JII. Z~I LOT 4 OF CERTIFIED SURVEY MAP I~~ ~IZI VOLUME 13, PAGE 353_3. Io, yl a ~' LANDS ~ 110 H AVENUE NORTH LINE OF THE NW1/4 I~ I i t - - - S 89° 3Y' 37" E - 1,304.31'- ----~--~ - 473.14'- CENTERLINE - 440.78'-~- ~ _ S 89° 40' 00_E_ _1,043.1_8' _ .. 441.05' "v 441.05' ~t LOT1 ~ ~ LOT2 «~ 129,092 SQ. FT. (2,964 AC.) ~ `arc ~ 119,980 SQ. FT. (2.754 AC.) INCL•UDING•RIGHT-OF-WAY--Nh o---INCLUDINGRIGHT-OF-WAY--~ 98,084 SQ. FT. (2.252 AC.) N ~ ~ 98,084 SQ. FT. (2.252 AC. ) EXCLUDING RIGHT-OF-WAY o EXCLUDING RIGHT-OF-WAY '~ O 864.62' Z 1.27' ,,~,„ •aa2.31' NIO MI~ NI I ti vi N O ~ J o~ vv vv ~ 100' BUIL ING SETBACK LINE I~ i 1,45 ..~ v N IN I~ 1 ~ 1, ' w ~ EX ~ (~ ~ BEARINGS REFERENCED TO i ~ ~ ~ ~ I THE NORTH LIl~iE OF THE ° r° ~ NWl/4,PREVIOUSLY ' ~ z ° ,~ ; RECORDED AS AND ASSUMED TO BEAR z i S89°32'3T'E. w~ _~ i I F- ~ ~I O i w~ z, .J I W I ~.-~~ N i '~ i Scale 1" = 200' ,r-27.1a' ~ C- ..1,299.se' S00°01'37"E W1/4 CORNER, SECTION 11 ( 1" STEEL SURVEY NAIL FOUND ) - _ ~.._ .- .-. I I - n s - 's~ ~ a_N 87° 54' 28"- I~ 2~,3T- v> 3 ~ ~ ~, -s. <O N - ~> ,," BENCHMARK = I"IRON PIPS SET AT NORTHEAST CORNER OF LOT 2, ELEVATION = 100.00 WETLAND BOUNDARIE3 (O.H.W.M.) AS IDENTIFIED BY THE ST. CROIX COUNTY ZONiNO OFFICE ON 04/27/01. 75' SETBACK FROM NAVIGABLE PONDI WETLAND LOT3 2,680 SD. FT. (33.349 AC. ) CLUDING RIGHT-OF-WAY , 404,767 SQ. FT. (32.249 AC.) CLUDING RIGHT-OF-WAY !•' .. A~~~ED ;. ST. CROIX COUNTY Planning Zoning and Parks CorAmtttee OCT 2 3 ZQ(11 If not recorded within 30 days of approval date approval shall be null And void ; g w S H u_ O' u x ~- O w z J v7 z.-.o gw~ J ~ ~ u 2 g5; s ~ o ~v / SOUTH LINE OF THE NW1/4 OF THE NW1/4 1,288.71': ,~ N 89° 32' 27" W 1,313.85' UNPLATTED LANDS ~ BENCHMARK - 30d NAIL 3ET LN EASTERLY C3ATE POST, ELEV. =100.00' . SCALE IN FEET I ~~ = 200 0~ 100 200 400 SC N ~ ~ ........ S` 'L ~, ~ .J -SE tt W. ' GF Far, .':