HomeMy WebLinkAbout042-1085-60-250 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
574311 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
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 Parcel Tax No:
Langer, Nancy Warren, Town of
CST BM Elev: Insp.B" Elev: BM Description: Section/Town/Range/Map No:
w (6 M GS 31.29.18.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ,%w S5 CAPACITY STATION BS HI FS ELEV.
Septic ! i��_ ` Z.� /z 50 Benchmark Y Z 5 /_��Z /do
(�/ tJCJ Alt. M Q�I
Aeration Bldg.Sewer
.ZR /9. 9
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/lt_ WELL BLDG. Vent to Fyr Intake ROAD Dt Inlet `\
Septic N,/L ZB 7 3 I / r� Dt Bottom 1'
Dosing 5 Header/Man.
Act
Aeration Dist. Pipe /o' , 'H ,b
Holding Bot.System /p5 t73. If
PUMP/SIPHON INFORMATION Final Grade q7 5$
Manufacturer Demand i m�and St Cover�1 2.Z4 lvZ
Model Number
TDH Lift Friction Loss Sys ad Ft
Forcemain Length Dia. Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth A_'C'L4.� I DIMENSIONS 3 GJ1\ L �Ile_
SETBACK SYSTEM TO (CJ P/L BLDG WELL LAKE/STREAM LEACHING Manufacturers
INFORMATION CHAMBER OR J.^A �I C,
Type Of System: /I 1Q 7L A l UNIT Model umber•
DISTRIBUTION SYSTEM Z k Z Z f/ S
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to it I ke
Pipe(s) �! `_
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes ! No Yes No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 988 65th Ave Roberts,WI 54023(SE 1/4 NE 1/4 31 T29N R18W) NA Lot 2 Parcel No: 3 29.18.
1.)Alt BM Description= • ' '' - C'aJ G"`' �a t� O
2.)Bldg sewer length= 3 1
-amount of cover= L 1t
Plan revision Required? �j Yes No
Use other side for additional information.
SBD-6710(R.3/97) _
7 5
Date 1 Insepctor's Si ature Cert.No.
-4-_Q�'�'.r�.�c� ---
:
County
Safety and Buildings Division
p AKA 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be tilled in by Co.)
t Madis�p,
R. t -7,q3//
w
Mar State Transaction Number
Sanitary Permit Application � .
In accordance with SPS 383.21(2),wis.Adm.Code,submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)
e artment of Safety and Professional Servies. Personal information you provide may be used for secondary C /J *v e-
the D � gQ'Q J mil•►
Department s. 15. i m,Stats. /U U �U
u ses in accordance with the Privacy La
I. A lication Information-Please Pri I Information Parcel# /
Property er's Name
_ e
Property Location
Property er' ailing Address
Govt.Lot
Zip Code Phone Number �'/--�%+, Section
City,State (circle one
j- T�L N; R.Y_E or
g pp y? Lot#
II.Type of Buitdin (check alt that a 1 Subdivision Name
1 or 2 Family Dwelling-Number of Bedrooms
Block#
0 Public/Commercial-Describe Use ❑City of
�Cj-ale ee v� CSMNumber 1775 0 Village of
❑State Owned-Describe Use d Town of � --
2 ;s�- GLIIS t,✓
22-1,22— 6",Jll rS ✓ol' P �oOZ�
III.Type of Permit: (Chec only one box on fine A. Complete tine B if applicable
A New System 0 Replacement System 0 Treatment(Holding Tank Replacement Only ❑Other Modification to Existing System(explain)
B. 0 Permit Renewal 0 Permit Revision 0 Change of Plumber 0 Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Owner �J �Ya'
IV.T e of POWTS S stem/Com onent/Device: Check all that a 1 I�
Non-Pressurized in-Ground 0 Pressurized In-Ground 0 At-Grade ❑Mound>24 in_of suitable soil 0 Mound<24 in.of suitable soil
ding Tank� tsPersal Component(explain)
0 Pretreatment Device(explain)
0 Hol
V.Dis ersal/Treat ent Area Information: Dispersal Area pro sed System Elevation
Design Flow(gpd) Design Soil Application Rate(g t) Dispersal.Area Required(st) pe po
7 9
VL Tank Info Capacity in Total #of Manufacturer r
Gallons
Gallons Units W N
New Tanks Existing Tanks
Septic or Holding Tank — x
Dosing Chamber
VII.Res slbility Statement-I,the undersigned,assume respo ility for installation of the POWTS shown on the attached plans.
Plum r' ame i Plumber's igna MP/MPRS Number Business Phone Number
f
plumber's ddress Street,City,Stpe,Zip Code
VI oun /De artment Use Only
Permit Fee Date ued Issuin ent Signatu
pproved Disappro
0 Owner Giv on for Den J 7
IX.Condi$ Reasons for Disapproval
'Septic tank,efflulant filter and
dispersal cell must all be senrlces I rrtairiW=d
as per management plan provided by plutrlb#►.
2. All SOW*reOFernenta rtttxst ba>f"ltibd
88 COft/Ofd .
Attach to complete plans for the system aad submit to the county only on paper not less than 8 tI2:11 inches in size
CONVENTIONAL COMPONENT DESIGN
Residential application
INDEX AND TITLE PAGE
Project
Name:
e:
<: Owner's
::: - :>::>::><::::;::»:>::>;:::::>::>:::<:>:::>> :::>:::<=>:<:::::_ Name:
` _
a
Owner's
e
rs
................
.: ....................
Address:
sirs>>``<'><<»``�>�><<�>`>` >>�� >
Legal Description: A(Z/ ��J
Subdivision: Lot#
Town:
County:
Parcel ID#
Designer/Plumber: _Z1 License#��
Signature: Date:
Comments
I
I
i
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0
1 �
_ 98
IV
f
Soil Absoratlon Svstwn Cross Swoon
Final Grade
4 Schedule 40
F-� 4 l�I S o PVC Vent Pipe
A)r Wfth Vent Cap
n Leaching
Chamber
_ System Elevation
3 ft — ft
Soil Absorption SVStBM Plan View
9� ft
1 LeacWing Trench 7
Vent Or Observation Pipe Oh mhars
I
I
If Ufa.
Trench 2 !-leader
Leaching Chamber SROCIfications
Manufacturer And Model _ll,x- - � 1pv
EISA Rating 2(�21 sq ft per chamber Soil Application Rate �7 gpd/.-q ft
''---gpd Design Flow= , 7 Soil Application Rate _ EISA= embers
r+,
2 rows of chambers each.
Page_ of
INSTALLATION INSTRUCTIONS
11 =dPdA*b- PL-5251PL-525 FILTER
INSTALLATION INSTRUCTIONS
: wm openng
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_..S 'C. t•.'°^,'�`y Y Sy,^la,, $'ice' �.aw°7 �
T - t' '.t' V 'tu Y•s. t
Step 1: Step 2: Step 3:
(A)Locate the outlet of the septic tank. (A)Before instaliation,place the (A)Glue the filter housing on the
(B)Remove tank cover and pump tank fiiter housing on to the outlet pipe. outlet pipe.
tf necessary, (B)Make sure that the housing (B)insert the filter cartridge in the
is positioned so the filter can be housing,making sure the filter
removed from the tank for cartridge is properly aligned and
maintenance and service. completely inserted in the housing.
MAINTENANCE iNSTRUCiIONS
'��j�...i }`.q R` ., �y�� �t��`.`"YC.' `�`is��•� z ri •ia +f M'{�;
a. F 4'.�.rte'a_ •y r�- 7
s q °1
tt.=t Q4 s<aL•`.S .. �1i• -.r. � 1iTSf"`+,.Fa
.
TY � � �'�1+.�"j:y{:'7�y., � i"S�'3 1'6451+•2. .1 ���
Step 1: Step 2: Step 3:
Locate the outlet of the septic tank. (A) Remove tank cover and pump (A)Insert the filter cartridge back
i m if necessary. into the the housing making sure
D
WHEN• NOT USE FILTER P " the fitter is ar hed IS • ! (B)Pull the flter out of the housing. Properly ig
(C)Hose off the t�over the septic tank-
US] and completely inserted.
' B Replace septic tank cover
LR G_'Q $ Make sure all solids iWI back into the ( ) eP P
NHl1 Cl_ itt1(G FIl1 ER . . septic tar
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page':i--of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity al ❑ NA
Psrmit # Jt' Septic Tank Manufacturer, ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units NA Pump Tank Capacity gal 0 NA
Estimated flow (average) gal/day Pump Tank Manufacturer )3 NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA
Soil Application Rate gal/day/ft' Pump Model a NA
Standard Influent/Effluent Quality Monthly average`' Pretreatment Unit 19 NA
Fats, Oil & Grease (FOG) :_30 mg/L ❑ Sand/Gravel Filtbr ❑ Peat Filter
Biochemical Oxygen Demand (BODY) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :_150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) _:30 mg/L 14 In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) :_30 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) :_104 cfu/100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Ya in dia. ❑ NA Other: ❑ NA
Other: _ ❑ NA Other: ❑ NA
i
*Values typical for domestic wastewater and septic tank effluent.
Other: ❑ NA
/nAINTENANCE SCHEDULE
Service Frequency
Service Event
❑ month(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: ®' ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) 9 year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA 0 year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) J19 NA year(s)
❑ month(s) ® NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: At least once every: ❑ month(s)❑ year(s) NA
Other: ❑ 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 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 (Y3) 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)
Page (� of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface. I
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the 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. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrap's; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the PO TS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
repla;rA nt system:
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 i,j
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wit,
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTA LE POWTS MAINTAINER
Name J Name
Phone / Phone
Z& 297
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name tttfLJ
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1), (2)&(3),Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TAI\rK h2AD\rMNTANCE AGREEMENT
AND
OW-N-ERSHIP CERTIFICATION FORM
OvmerlBuyer
Mai.Iing Address C
em,
Pro Address g� `�
P (Verification required trom Planning&Zoning Department for new Construction.)
City/State
Parcel Identification Number
LEO-- DESCRIPTION
Pro erry Location 1/4: t� 14 , Sec. _: TcLN R_2 __W,Town of
P
,Lot# Z
Subdivision Plat:
Certified Survey Map # i , Volume ,Page# f%40
Warranty Deed# !cl �jl (before 2007)Volume ,Page#
Spec house 0 yes�.no Lot lines identifiable Jg yes 0 no
SYSTEM MAIllTTENANCE A-h'D OWNER CERTIFICATION
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 three years or sooner,if needed,by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in§SPS.353.52(1)and in Chapter 12-St Croix County Sanitary Ordinance.
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
sal stem is in proper o condition and/or(2)after inspection and pumping(if necessary),the septic tank is
wastewater disposal system Pr P Peratmg
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 Safety And Professional Services and the Department afNatwal Resources,
State of Wisconsin. Certificarion 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 �7deed are true to the best of my/our knowledge. Uwe am/are the owner(s)of the
property descnbed above,by virtue of a recorded in Register of Deeds Office.
Number of bedrooms
I _ F APPLICANTS) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zonina Department-
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
a V.04112) 7
997756
BETH PABST
REGISTER OF DEEDS
CERTIFIED SURVEY MAP RE ST.CROIX CO WI
CEIVED FOR R RECORD
LOCATED IN PART OF THE NE7 14 OF THE NE1 14,IN PART OF NW7/4 06/26/2014 11:28 AM
OF THE NE1/4,IN PART OF THE SW1 14 OF THE NE1/4 AND IN PART EXEMPT#:
OF THE SE1/4 OF THE NE1/4 OF SECTION 31,T29N,R16W,TOWN REC FEE:30.00
OF WARREN,ST.CROIX COUNTY,WISCONSIN;BEING OUTLOT 1
OF CERTIFIED SURVEY MAP RECORDED IN VOL.24,PG.8666, COPY FEE: 3.00
DOC.NO.907042. PAGES: 2
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KbOv 0 x z O D m` S r"-' p - p� r BEARINGS ARE REFERENCED TO THE
Q T ?D Z r 8 x 0 z ^m EAST UNF OF THE NEI/4 OF SECTION 31,
N O �m M 5- ma 2 Q BEARING SOO-W501W(ST.CROIX COUNTY
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NO2'3726"E 1388.62'
33.03' 1051.56'
EAST LINE OF THE W112 OF THE NE7/4 1335.48' 283.92'
nOn WEST UNE OF THE E1/2 OF THE NE1/4
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THIS INSTRUMENT DRAFTED BY EDWIN FLANUM z z
JOB NO.14.47 DATE 5/23/14 SHEET 1 OF 2 SHEETS '
St.Croix County 997756 Page 1 of 2 Vol 26 Page 6028
L �
CERTIFIED SURVEY MAP
LOCATED IN PART OF THE NE1/4 OF THE NE1/4,IN PART OF NW1/4 OF THE NE1/4.IN PART
OF THE SW1/4 OF THE NE1/4 AND IN PART OF THE SE1/4 OF THE NE1/4 OF SECTION 31,
T29N,RI 11111W.TOWN OF WARREN.ST.CROIX COUNTY,WISCONSIN.
OWNERS SURVEYOR
GLENRIDGE PROPERTIES EDWIN C FLANUM
1353 AWATUKEE TRAIL NORTHLAND SURVEYING,INC.
HUDSON.WI 54016 P.O.BOX 152
AMERY,WI 54001
CURVE DATA TABLE
CENTRAL CHORD CHORD ARC
LC2 RADIUS ANGLE BEARING LENGTH LENGTH TANGENT IN TANGENT OUT
600.00 07.50'36' S75'34'03'W 82.07 82.14 S79'29'21'W S71'38'45'W
720.00 22'29'52' S78.52'22'W 280.90 282.72 S67'37'26'W N89'52'42'W
633.00 07'22'12' S75'48'15'W 81.37 81.42 S79'29'21'W S72'07'09'W
687.00 23'25'53' S78'17'08.5'W 279.00 280.95 S66'34'12'W N89'59'55'W
SURVEYOR'S CERTIFICATE
1,Edwin C.Flanum,Registered Wisconsin Land Surveyor,hereby certify that by the direction of Richard Stout 1 have surveyed,mapped and
described the parcel of land which is represented by this Certified Survey Map;that the exterior boundary of the parcel of land surveyed and
mapped is described as follows:
A parcel of land located in part of the NEIIA of the NE1 14,in part of the NW1/4 of the NE1 14,in part of the SW1/4 of the NE11/4 and in part of the
SE1/4 of the NE1/4 of Section 31,T29N,RI 8W,Town of Warren,St.Croix County,Wisconsin;described as follows:
Commencing at the NE Corner of said Section 31;thence S00`W50"W,along the east line of the NEt/4 of said section,1295.60 feet to the point
of beginning;thence continuing S00°09,WV.along said east line,804.98 feet to the centers ne of 651h Avenue;theme S79°2921'W,along said
centerline,627.36 feet to the point of curvature of a 600.00 foot radius curve,concave:southerly,whose central angle measures 07°51736',whhose
chord bears 575'3403"W and measures 82.07 feet;thence southwesterly along said centerline and the arc of said curve,82.14 feel to the east
line of Lot 1 of Certified Survey Map recorded in Volume 24,Page 5666,Document Number 907042;thence N09'2024V,along said east line,
407.58 feet to the north line of said Lot 1;thence S68"06'12'W,along said north line,412.32 feet to the west line of said Lot 1;thence
S01°29'37 E,along said west line,499.42 feet to the point of curvature of a 720.00 foot radius curve,concave northwesterly,whose central angle
measures 22°29'52'.whose chord bears S78'5272"W and measures 280.90 feel;thence southwesterly along said centerine and the arc of said
curve,282.72 feet to the west line of Outlot 1 of said Certified Survey Map;thence NO2'3726°E,along said west line,1368.52 feet to the south
line of U.S.Interstate*W;thence N8r40'23E,along said south line,1268.83 feet;thence S00°09'5M 172.65 feet to the south line of the NI/2
of said NE1/4;thence S89'18'14'E,along said south fine,80.00 feet to the point of beginning.Described parcel contains 31.43 acres(1,368,912
Sq.Ft.).
Parcel.s subject to town roads(100th Street and 65th Avenue)right-of-way and all other easements,restrictions,and covenants of record.
I,also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described;that I have fully
complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes,the Land Subdivision Ordinance of the County of St.Croix,and
the Subdivision Ordinance of the Town of Warren,in surveying and mapping same.
APPROVED �,�•��ONSi''
9
JUN 2.6 2014
ST.CKUtX GUuN I Y
PLANNING 8 ZONING OFFICE IF Z
�qty
COUNTY TREASURER'S CERTIFICATE
STATE OF WISCONSIN)SS
COUNTY OF ST.CROIX)
1,Laurie Noble,being the duly elected,qualified and acting Treasurer of St.Croix County,do hereby certify that
the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments as of
C(e 5..�(Lpy-�affecting the land included in this Certified Survey Map.
1 Llw� tN► 0-ooe 7,5 Zot�
Laurie Noble, l�iSC A-down Date
County Treasurer
rz6t ap'N
Each parcel shown on this map(plat)is subject to State,County and Township laws,rules and regulations(i.e.,wetlands,minimum lot size,
access to parcel,etc.).Before purchasing or developing any parcel contact the St.Croix County Zoning Office and the Town of Warren.
SHEET 2 OF 2 SHEETS
St Croix County 997756 Page 2 of 2 Vol 26 Page 6028
!
8 Tx44198057 2
State Bar of Wisconsin Form 1-2003 998341
WARRANTY DEED BETH PABST
REGISTER OF DEEDS
Document Number Document Name ST. CROIX CO., WI
07/08/2014 4:10 PM
THIS DEED,made between GLENRIDGE PROPERTIES,LLC,a Wisconsin EXEMPT#: N/A
Limited Liability Company, REC FEE: 30.00
("Grantor,"whether one or more), TRANS FEE: 105.00
and NANCY A.LANGER a married woman PAGES: 1
("Grantee,"whether one or more).
Grantor,for a valuable consideration,conveys to Grantee the following described real
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St.Croix County, State of Wisconsin("Property")(if more space is Recording Area
needed,please attach addendum): Name and Return Address
Located in art of the NE 1/4 of the NE 1/4,in art of NW 1/4 of the NE 1/4 in art c/o Dick Properties,LLC
p p � P c/o Dick 5[out
of the SW 1/4 of the NE 1/4 and in part of the SE 1/4 of the NE 1/4 of Section 31, 1353 Awatukee Trail
T29N,R18W,Town of Warren,St.Croix County,Wisconsin;being OUTLOT 1 of Hudson,wl 54016
Certified Survey Map recorded in Vol.24,page 5666,as Document No.907042;
more fully described as: /
LOT 2 of Certified Survey Map recorded in the Office of the St.Croix County ✓ 042-1085-60-050
Register of Deeds on 06/26/14,to Vol.26,Page 6028,as Document No.997756. Parcel ldcntitication Number(PIN)
This is not homestead property.
(is)(is not)
Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except:
easements,restrictions and rights-of-way of record.
Dated July 1,2014 1
GLENRIDG PROPERcTIES,LLC-VENDOR
(SEAL)
*Richard 0.Stout,Member
00• (SEAL) (SEAL)
* anet P.Stout,Member
AUTHENTICATION ACKNOWLEDGMENT ••�•�,.......ti��•
Signature(s) STATE OF WISCONSIN )
ss. ;'NOTARY:
authenticated on St.Croix COUNTY
PUBLIC.
Personally came before me on July 1,2014 ••'V�'' '�
the above-named Richard 0.Stout and Janet P.Stout
TITLE:MEMBER STATE BAR OF WISCONSIN
(If not to me known to be the person(s) who executed the foregoing
authorized by Wis.Stat. §706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
Janet P.Stout
1353 Awatukee Trail,Hudson,WI 54016 Notary Public,State of Wisconsin
My Commission(is permanent)(expires: �g z.b
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO.1-2003
•T naLne bel�w�sBn tur sPa
St.G oix C oun �d ge 1 of 1
,t
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Property Owner /,&c Parcel ID# Page , of
L-71 Boring# BoringL
M Pit Ground surface elev. ft. Depth to limiting factor ?,d425--,in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * ff#2
3 a
-3 d
:J Q
F-1 Boring# 1:1 El❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft Z
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 ff#2
Boring
Boring# Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Si.Sh. ff#1 ff#2
*Effluent#1=BOD ,>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD s<30 mg/L and TSS <30 mg/L
The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay.
SBD-8330(RI1/11)
�P A I
Wis. � kssional services SOIL� EPORT Page of
Divisidh of Safety ldingt� �t
�P\ Go\3 0.116 in accordance with SIPS 385,Wis. Adm. Code County
Attach com I��tt ?eto:�6n paper not less than 8 1/2 x 11 inches in size.Plan must
include,t t ' vertical and horizontal reference point(BM),direction and Parcel I.D.mensions,north arrow,and location and distance to nearest road. �2—l0J
;G Re ' ed byN^ D
Please print all information.
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)).
Prope Owner Property Location
Govt.Lot 1/4 1/4 3 1,121? N R E(or&C
Property ner's Mailing Address / Lot# Block# Subd.Name r SNW
City State Zip Code Phone Number ❑City ❑Village OTown Nearest Road/
ILI( ( ) }�
New Construction Use:Mf Residential/Number of bedrooms Code derived design flow rate — GPD
❑Replacement ❑ Public or commercial-Describe:
Parent material l 1�45 _ Flood Plain elevation if applicable ft.
General comments �� � Sys1,F�a �,� 93 J ,� ,
and recommendations: �
at1f 10 1—
csrvt Z�/ S6L�
Boring#
F/-1
Boring El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Co t.Color Gr.Sz.Sh. 01 * ff#2
0
R G
3 S in
9 q
Boring# Boring �}
® Pit Ground surface elev. / ft. Depth to limiting factor in.
=oil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 * ff#2
-�`✓ 6
ta Ld — q U
1
I
*Effl ent =BOD >30<220 mg/L and TSS>30_150 mg/L nt#2=BOD <30 mg/L and TSS <30 mg/L
CST Name(P a Print) Signature CST Number
Address ate Evaluation Conducted Telephone Number
SBD-8330(Rl l/11)
Wis., �CFSafe ty d11�� ssional Services SOIL t VAI UATlnnl REPORT �CO p ge�_of
Divisi of Safe ildingg, P
\3 pµE� in accordance with SPS 385,Wis. Adm. Code
\` GG �O County
Attach compl �Sn paper not less than 8 1/2 x 11 inches in size.Plan must
include,h44 n� ed to:vertical and horizontal reference point(BM),direction and Parcel I.D.
percent slpNscale or dimensions, 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)).
Prope Owner Property Location
Govt.Lot 114 ' 1/4 Ta N R E(orV
Property nees Mailing Address Lot# Block# Subd.Name or CSI#
r / r
City State Zip Code Phone Number ❑City ❑Village
( g own Nearest Road
New Construction Use: Residential/Number of bedrooms 3- Code derived design flow rate — GPD
❑Replacement / ❑ Public or commercial-Describe:
Parent material Flood Plain elevation if applicable ft,
General comments �, �� 9s
-
Boring recommendations: �ee�+° �° �s /�"'
Boring#
F/I
Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Co t.Color Gr.Sz.Sh. * ff#1 102
6 d
9
-. "
Boring# Boring
® Pit Ground surface elev. 9 -ft. Depth to limiting factory in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 * ff#2
q 9
_ _ a o
*Effl ent =BOD >30<220 mg/L and TSS>30 <150 mg/L nt#2=BOD 5<30 mg/L and TSS <30 mg/L
CST Name(P e e Print) Signature CST Number
Address ate Evaluation Conducted Telephone Number
7
SBD-8330(RI 1/11)
el
Property Owner Parcel ID# Page of
Boring# r�7 Pit ng
—F] Ground surface elev.�_ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Donsistence Boundary Roots GPDtft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. -fF#1 CO2
1 CZ-5
5
-3 - g i S
et P
F-1 Boring# E] Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil—Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 01 ff#2
Boring
❑ Boring# Ground surface elev. ft. Depth to limiting factor in.
Soil
El Pit lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDtft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 02
"Effluent#1=BOD 5>30<220 mg/L and TSS>30 <150 mg/L " Effluent#2=BOD 5<30 mg1L and TSS <30 mg/L
The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay.
SBD-8330(Rl l/11)
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