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HomeMy WebLinkAbout020-1048-30-200z y " o o ° °' ° d. ~.. ~ °~ ~ °e» 0 N 0 v N O n; ~ O O i ~ ~ ~ C O O - N ~ N 'O ~ j > V ~ O t~^ ~ _ ~ N d ~ O tOp c~ .r CQ ~ *D fi aO .J tA ~ OLD °' of ~ m ~ O "' o E ~Ow•C 7 O ~ • L N O n O N C~ O- + , c.0„ ~ c og N F '~ ~ ,~., O ~M N L E N ' OE N L C U x ~~~ .. ~ O O N 41 N ~ ~ 3 o ~l ~ ~ o oo c ~ C N Y ° c ~ _ 3~ or- o 0 U 7 N O O C N 7 LL W U m w' J 7 c` O ~ LL Q N N~ L O N N (6 N C ~ Q N U~ _ ~ '..., O- N O 'O U N C3 O O~ N D L O U O d C N N U N U ~ M f9 M ~ N N '~ ~ N ~ N O) 111 .. ' .. ~ ~ .~ O ~~ .~ O Z °' e ~ '' d a d m d d a m ° ~ z ' o z v -~ ~ i m ~ ' ' ~ ° ~ ' ° Q ~, !/~ Z -- d r ~ ~- ill ~ ~ c N C ~ C a ~ ~ ~ _-. ~ N N _ O N ~ „' ~ .7 ~ to N ~ N ~ 3 N ~ ~I N 7 O ~ O o a~i Q o o Q ~ O Z m Z i Z co Z , N N ~ I ~ M ~ ~ ~ ~ M N O) d - 4f 0I N ~ N ~ c"• iVl i d ~ O C N ' l0 N ..~+ i N O ~ O O. y ~ d ' .~+ ~ O N ~ ~. r i o c o a a E ~ o oc a ~ E Z N > ~ ~ ~ F- N H ~ H d H 'o ~ F- ~ di m •*v ~, ~ a a a ~ a a a a o M 0 N 7 fA O ~ Vl ~ V -7 2 O m O ~ y o ] S 7 V' o o U 0 Q ~ N N } Q ~ 'O N N N N } ~ I ~ O O ~ ~ O O ~.. '"s ~ I ~j 'a m ~ N m U 'O m ~ c Q ~ v ~ Q } N 4 Z ,I Q 3 r ~ ? w ~ ~0. y O ° O ~ a N C ~ m a N C ~I i„ ~ ~ ° Q CO ° C 3 °~ ~ o c °~ ~~ ~ ~ a~ a o° } L ~ M ~ ~ o I- r c cn ~ o tU N ~ c o: NI C ~ c N O a N ~/ p ~ ° ~ O i m ~ o M T: ~ a? ~ ~ __ O ty~' i.~l O' N ~p ~ ~ ~ ~ ~ ~ M ~ I ~ r ~ ] N O N U O ~ .. .. r ~' ~ ~ w .. Y ~ E :.: E ~ v /~ ~, dt to o m a m a I • ~1 ^' '~ +..~ 3 a ~ d ~ . ~ l O~ ~ a ~ a y w ~ ~ 3 ~ y m ~ aw y ~ 7 I rr~~ ~1 ~ A o c~ is a o ~'! 3 O ;? m o c~ ~ 3 O :? o cnt~ RECEIVED ST. CROIX COUNTY ZONING OFFICE u ~ i (~ 6 2004 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ~ ~ohn Cr / e5 residence located at : 1~L~1~~ ~~ 1/,, Sec . ~, T~N, R /~9 W, Town of ~~[d~p/~f St . Croix County, Wisconsin. Upon iTnspection, I certify that I have found the tank and baffles to be in good con iti n, and it appears to be functioning properly. Last time serviced ~p 3c} ~ Did flow back occur from absorption system? Yes No~ (if no, skip next line. Approximate v lu~n~ o length of tim ~ gallons ~' minutes Capacity: CC~~ Construction: Pre ab Concrete Steel Other Manufacturer (if known): ~C Age of Tank (if known) : JV' (Sig ure) t~ ~' IBS (Title) i 6 (Date) (Name) P ease Print .~1-r~ (License Number) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name ~ n~~M~. ~s~ Signature MP /MPRS - ' U AS BUILT SANITARY SYSTEM REPORT TOWNSHIP_~~~SEC. ad T~~ N, R /~ W ST. CROIX COUNTY WISCONSIN. OWNER ~,l d ~j n ~ yes ADDRESS 1~iru.~e ~ ' f~i,~ c%S~ n ~i S S~/O /(o , SUBDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOId EVF.RYTNTNC: w7TtlTU inn ~~T nr evc~rcv \ - - I -- - [~r - - - i l,J . . I ~ _ I ) ~I ~ I d a e; \ I ~ ~~. ~~ ~ ~ ~ i i -- - - i ~ --r ---~ --- -- i - _ ~~, i ~ ~ I _~__~__~__ di cate N orth; Arrow c~ 1-- --t--.~ --r--,~I _.-~___~-___,-~ SEPTIC TANK(S) _j)~MFG~Y. 1,,,) p oP s CONCRETE X STEEL NCC rings on cover ~., Depth (~ " PUMPING CHAMBER SITE PUMP MFGR. MODEL N0. GALLONS Per Cyele TRENCHES N0. of width length_ area ' BED N0. of lines ,3 width .fj~~ length ~6 ~ area ~s~ ° depth to top of pipe ,3~~' NUMBER OF SEEPAG,~ PITS Outsi e iameter total pit area AGGREGATE ~ '3` p , o, PERK RATE C1~5 / AREA REQUIRED ~ /5" AREA AS BUILT (05/~ Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes.., There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure._.._. GREASES AND OILS SHOULD NOT BE DISPOSED THROUG~I-S--"~~TE ~/ IN TOR- ._,_ ._ .__,. DATED '/ " ~..•3 ~ ~~ PLUMBER ON JOB ~~,~,, eL~„~.,.-~ LICENSE NUMBER ~'a ~.~ r'~ Z . -- REPORT 8F INSPECTi~iV INDIVIDUAL SEWAGE SYSTEM San~.zany Penm.~.t C~.Z; S~a~e SPp~t~.cN~/ ` NAb1E ~`'~~, .~ ~x-a rownbh~.p ~~~`-~~~Z:~ a~'~~.~~, S~. Cna,i,x County 1 _- "~ ~ _ ,- _ Lacax~,orc ~„~~;~;! , `~l~--Sec~.~on ~"C~ • SFPTI~ TANK •- ~~ S.~ze ~~ ~ ga.~.Lone. Numb en a~ Compan.tmen#d I fl.cb~anee Fnam: W e~.e. C o ~ ~#. • Bu.i.~d.ing .!L' ~~. t?ISPOSAL SYSTEM D.ca#ance Fhom: FIELD DIMENSIONS: H.Lgkwazen -= ~~. We~..L ! c G ~ fix. Bu.i.Ld.~ng 7~; ~.t. H.~ghwa~en ~- ~.t. 12$ on gnea~en 6.Lape _____. ~ we~~.ands ~ ~~. 12$ on. gnea~en .a .Lope •- ~~. Gle~.Landa `- F~. W.idath o ~° ~nen ch_,/~ ~~. D ep~h a ~ no c(z 6 e.2ow ~.i..~e / a ~.n . Length a ~ each .L.ine -` O ~~. Numb en - o ~ .L.in e.a ,~ ~ °, ~ U 1o.ta.~ .eeng.th o ~ •L.i.ne6 ~~~, ~.t. 2 ~ ~ ~~; ' D.%~a #an e e b ewe en .L.i.neb~.t . 3 r G Ta#a.L a64 anb~.i.an area ~~ ~ ~z2 °~ Requ.Lned anew ~~2 PIT DIMENSIONS: 1 Depth a~ noefi oven ~.i..Le a .in. Depth o~ .t~..Le 6e•Low grade 3~ ~.n. S.Lope a~ .tn2neh ~- .in pen 100 ~.t. Depth zo bednocf~ ~-` ~~. Depth ~o gnoundwa~en - ~.t. __ __._. Type a~ Coven: ~ap2n. "l` S~.aut ~.~~ Numb eh o~ p~.~ Ghave•L around p.i~ yea no Ou~a~.de d.i.amex' Depth beQaw .Ln.Ze.-t ~~. 2 To~a.t abaonb "o area ~~ . akea nequ.ned _ ~~2 INSPECTED TITLE APP V ED ~ ~ , VATF ~,1:.~ l 9 7 G~'~/ R€JECTED ~ ,DATE 191_. z A rn 1 EH-115 Rev. 9178 ' ~ REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION•,/.~'/<,~'/., Section.~,Tay N,R,~~ (or~l Township or Municipality /jam°SB~ Lot No. ,Block No. County S~~ ~Oi X .;... ~ ~ u Iwslon ame Owner's/Buyers Name: J ~/! M U- i ~ Mailing Address: ~'[ ~d ~ ~OX ~ / Dor~,~ ~ •~. ~,~LL~D.~.~,, LcJ e S. .~~Gi~ TYPE OF OCCUPANCY:. Residence_~-No. of Bedrooms -3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT 'x ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS l~ Q PERCOLATION TESTS ~~.~/~`~O // SOIL MAP SHEET S~ NAME OF SOIL MAP UNIT S/ ~ ~.SZtS/~"e S`~7~ ~C.019-M PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME NTERVAL DROP IN WATER LEVEL, INCHE RATE NUM- BER INCHES THICKNESS IN INCHES SINCE HOLE 1ST WETTED BOLE AFTE SWELLING I IN MINUTES IOD 1 PER PERIOD 2 PERIOD 3 MIN/IN P- ~ '~ sf2 @ Gore: li d ~ / r~ ~P (o . P- ~ ~" e~ o c i~ 0 3 P-,3 N ee. ~ ~ o ~ 6 . ~' P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, MOTTLING AND DEPTH TO BEDROCK TEXTURE NUMBER INCHES OBSERVED ESTIMATED HIGHEST , IF OBSERVED IN INCHES B_ ~ ~ ., o,, ~' ed S .~ s B- '" ~ 7 ,, ,, •• / " /4 a c/ S " r e S B- B- B- PLAN VIEW (Locate percolation tests. soil bore holes and suitable so il areas.) Indicate on the plan the location and square feet of suitable areas Indicate number of square feet of absorption area needed for building type and occupancy ~5~~ / ~~ vi .Indicate scale or distances Give horizontal and vertical reference points. Indicate slope.,,, / S4•fA6~2 ,~?f-ey A/a Srr~o ~ /75r~a..~~ ,~4~' 1~s•i~i9-~ C~,.1 .._~_ ~~ ~~~ i~~ yG\ 'e/f rte, ~.,~'".~ ~~ _ _.v2t9'` x..r0 f a~lr ~'M ieS /TS'e~ P~d g-'*~ State and County Permit Application for Private Domestic Sewage Systems State Permit # County Permi County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: /U~Z'/4 N ~ '/4, Section ~, T~,N, R~ ~ (or- Q Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township ~~s~ C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance - Single family ~_ Duplex No. of Bedrooms 3 No. of Persons_~ D• SEPTIC TANK CAPACITY /1100 Total gallons No. of tanks ~_ HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete~_ Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement X Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate S Total Absorb Area sq. ft. 6~S te~u,red .New Replacement- X Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (tops-No. of Trenches Seepage Bed: X Length. 3~° Width ~ ~~ Depth 'y~ ~~ Tile depth (top- ~~ ~~ No. of Lines -~ Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land_ 7- S"7e j'f1 Distance from critical slope WATER SUPPLY: Private ® Joint Community ^ Municipal ^ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I Have sized the effluent disposal system from the EH-115 prepared by the Certified Soil -Tester, NAME .~¢.n.t1 tS 1', ~ r i S ~-o „~, miS~a C.S.T. # .~jr- l S~ l~'S and other information obtained from Sak-~ (own „r/builder). Plumber's Signature MP/MPRSW# 3a~~ Phone #.~~(o - &b6~ Plumber's Address -~/' ~ S ~~sax ~°s S't/O/lo PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. /// `l ~/ ~ F ~S~'~ ' >~kSe ._ ~. /,~o ' ~, ~ ar_ ~~ /GG` ~~ ~ ~ ? ~ ~E 3` .._ ~ ~_ ._~rv ~_ _~ .W._~~__ v. ~~ 3 1 i r ~~ FILED ~ ~ JUL 2 2 rcr-~~ ~' 562'72' ~_ /'~ d,' l G CERTIFIED SURVEY MAP LOCATED IN THE NW I/4 OF THE NE I/4 AND IN THE SW I/4 OF THE NE I/4 OF SECTION 20, T29N, RI9W, TOWN OF HUDSON, ST.CROIX COUNTY, WISCONSIN. NOTE: BEARINGS ARE REFERENCED TO THE f-W QUARTER L INE. (ST. CRDIX COUNTY COORDINATE SYSTEM). PREPARED FOR: JOHN G/ES i I -~ +~ r - _ -~ ~~ ~ U -- _ - __.. N/ES TERN RA ~ t~AP _ ° _ --- - ~' CH i CAGO NORT ~.__--- -- - ~ U _~ ~_ ~' N 84° 32' 6 " E 689.94' 0 269.92 ~ 34.3 I J _ 285.64' 304.30' I 555. 5e' LOT ~2 I 4' 2.87 ACRES g h (125, 085 SO. FT.) I N 2.5 EXC. RiW I S os, T S0. FT. ) „I ~ LOT t 8 ~ ~~, 7. 13 ACRES z ' "'1 I _~ (310.564 SQ. FT.) ~(~ ~ us o I C 6.88 AC. EXC. R~IV OUSE c _ (299, 52 I SQ. FT,) ~- g I ~ g N 34°53' 45" W d ~ ~ ! ~' I :r ~6 :a c so. of D~~ N I :-~ ' m ~ HOl/SE ^ OUTBU/LDlNf3S n~ I ~~ W :r I g ~ 220.28' 34.49 0 8 DR 1 VE ' N g t ~f nl(J N 00° 00' 00" E 254. TT' I lJ6 ~ . 91.92' Z eARN~ I l uai `i (r i I~ ~~ ,~ 8 I '~ ;~ a I ~"' a. I :N :° ~~ " ~ I :w ~I a) RI A REC. AS S00°52'S0'E (' - ~~~- _ 100. _ I l w •~ i ORTH L 1 NE SW-NE '0 I ~~I:o~ ' a - .........._ HIGHWAY SETBACK LINE w ~''-' I ••~••"""•~••••• I SHED I I „P (Pl~GfiOy~, H~ I a~tjTS 558.34' 34.66' ~ SECOND ADDN. N eo• 00' oo• w 593. Qo ~ ..................... 133, 33' ,UNPLAjTEQ„4.,ANDS, ~ ~~ N 00°25'41"W E li4 CORNER OF W li4 CORNER OF SECT/ON 20. 1 l2T. P l' ~ SURVE~MONUA~E'N~FOUND ). (P. K. NA 1 L FOUND ). ' ~:-'-i A..i N 89°25' 02'E 3974.20' - __ ; S 89°25' 02"W 1335. IT' ----~-- - - - - - --f- E-W QUARTER L /N~;,y ~4 ~r~~ ~ , L 'i ~eb~1«0 O io~`~~P • iP'I ~ z ``~ ~ •r it ~' ~wEgEA ~ ~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Gies, John & Pearl City Village X Township Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE ~~ f~lA~ FA~TURE~ ~ CAPACITY Septic c Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P~ WELL BLDG. Vent to Air Intake ~~ ROAD Septic ~ l -O y 10 ~,ay~' ~ 2t~ ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION ~~ (Manufacturer Demand Loss Forcemain ll.artcftl' IDia. IDist. to well SOIL ABSORPTION SYSTEM ~ .~--'~ .~--~t - vl'~ t-{a< ELEVATION DATA county: St. Croix Sanitary Permit No: 453473 0 State Plan ID No: Parcel Tax No: 020-1048-30-200 Section/Town/Range/Map No: 20.29.19.186A20 STATION BS HI FS ELEV. Bench~ark~ L ~ ~ ! Alt. B ~ _ L_ ! b ~C7 1r US Bldg. Sewer ~ / ct SUHt Inlet _ „, 1 ~~ ~ ~ 3 SUH~t Olu~tl-se~"i,v't. J~ .Z ~S~ Dt Il / 10 ~ ~ ~~ om ~~ ~C•~S- ~'~'a I`~ H Man. ~O~ S ! ~ . p Dist. Pipe I"~ (~- fS Z_ l0 2.f~ Bot. System Ic.2 ~a~~ Final Grade (0 ~ s`. 3y St Cover ~ ~'~.~z BED/TRENCH Width ) Length ~ No. Of Trenches PIT DIME NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture r~ INFORMATION CHAMB (0 q ~ 'P~~/ Ty OfOf Sy~ r > J' r NIT Model Numb: DISTRIBUTION SYSTEM/~"' `~ ~~. C'~~"1/1 ~o-f- (w,.~r Hea mfold l ) Length ~ ~ia t j Distribution ~ Pipe(s) Length Dia Spacing ~ x Hole Size x Hole Spaci ~ 75 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed french Edges Topsoil ~l Yes No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: t / ad /a~ Inspection #2: / / Location: 466 Cty. Rd. A Hudson, WI 54016 (NW 1/4 NE 1/4 20 T N R19W) NA Lot 2 ~ Parcel No: 20.29.19.186A20 1.) Alt BM Description = 5~ ~ ~~~' Gl/k-,,/~-- ~J~~7~r~i GR~f ! ~1"-~'"J~Lr~~~t7 ~C.-~~ n2 2.) Bldg sewer length =, Q,v. is ~.,~ ,,, Q ~ 1~ ~ ,-,.. t ~ / ~ V~ ~ - amount of cover =~ r -~-t [it1~2 p f t /l5 r Plan revision Required? [~ Yes ~o /~ C~1 t ~ ~ ~' - I Use other side for additional information. ~ ~ Z gh ~] _____--__- __ 1'C.fi/liYl~ -_-- -~ ___-~ SBD-6710 (R.3/97) Date Insepctor's Si nature Cert. No. ~S Uri"" L, ng Vent to Air Intake ~r Safety and Buildings Division ~ 2 1 W County ~~ ~ i ` .. ~ 0 . Washington Ave., P.O. Box 71G2 ~ '~COn~,ry Madison, WI 53707 - 7162 Sanitary Pe/rm`it Number (to be filled in by Co.) ~ De artment of Commerce 018)266-3151 3 ~'7 7~ Sanitary Permit Application - Stag Plan L D . Number In accord with Comm 83.21, Wis, Adm. Code, personal information you provide [ r /"' may be used for secondary purposes Privacy Law, s15.(M(i)(m) Project Addr ss (if different than mailing address) I. Application Information -Please Print All Information --y °- .._ y • ---•--- • w° y Lyl~ 6 ~'-~ , ~(. s ~ + g Propert Owner's Na pS~ 4 ~ are Block g' ~.~5 ~ ~,, > - a ~~ Property Owner's M ailing Address ~ Property Location ~ ~©~ /(~~(n •~ 0'"' . ~ ~ ` r ~ Ci S - Section ~ ~'~ ~'~ _,_.a.,,_,-_,n tate {itrrrther-~ tY~ _ Zip~/~o~de ~f/'Irmte ~ ,, , _ 6~ ~ ~ ~Y . j' (/t./ 7'CJ f ~v / /.~ '~ "~~ (circle . ; ~ ~ ~ II. T of Buildin pp y) ype g (check all that a I T N; R B o ~1 or 2 Family Dwelling -Number of Bedrooms ~~~ ~~~- 5° tvisio N e CSM Number ^ Public/Commercial -Describe Use ~ J Jv ~ ~~ 7a ^ State Owned -Describe Use 3 ~S'y' : ~~.GS Gtf~~f ____ ___~~ I_ ICity,L]Village (,Township of /,(q~SUn III. Type of Permit: (Check only one box on-line A. Complete line B if applicable) A' ^ New System Replacement System --.--. ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B, ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWT5 S stem: (Check ail that a I) 3 ~. Z Non -Pressurized in-Ground ^ Mound > 24 in. of suitable soil IJ Mound < 24 in. of suitable soil ^ At-Grade U Single Pass Sand Filter ^ Coretructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ~_I Aerobic Treatment Unit (_) Recirculating Sand Filter ^ Recirculatin Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe U Other (explain) V. Dia reatment Area Infor lion: > ~g~ ow (gpd)/ Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in 'total Number Manufacturer Prefab Site Steel Fiber Plastic Gallom Gallons of unit s Concrete Constructed Glass New Existing Tanks Tanks Septic or Ilotding Tank + . ~V ' . . U S Aerobic Treatmem UnG Dosing Chamber '" VII. Responsibility Statement- I, the undersigned, assume rlspottaibilily for hnstailatlon of the POWTS shown oa the attached plant. ' Plumber s Na ~e (Print) Plu t u MP/MPRS Number Business Phone Number Plumb~er}'s Ad``dre ss (Street, City, State, Zip/~C~ ~f'~ / VIll. oust /De tarttr-e Use Onl Approved ^ Disapproved Sanitary Permit Fee (i eludes Groundw ter D ' lssu Issuing a ig re ( ) ~ ' ~ ~ Surcharge Fee) q ~ ~1 O ^ Owner Given Reason for Denial `~" ~ (J ~ IX, Conditions of Approvtal/Rt:asons for Disapproval l - ~~ ~~ ~- STEM OWNER: ~~RiYt~-!/~ ~"7`~"-~Yt``1~7~ifne'~L" ~ ~'3. 3'~ Septic tank, effluent filter and 1 ~ ~ t~o ~~~/i~~ dispersal cell must all be serviced !maintained ~ Sy'r~n. ~~ as per management plan provided by plumber. ,~~ -- ~ ~j y ~~~~ ~a ~ 3 '' ~-~~ 2 All . setback requirements must be maintained - (I as per applicable code/ordinances. Attach cmelnl.b .,la... n.. •~.~ r•.,..-•- --•-• •-- "- - -' - ' -' -- -- - - • - - SBD-6398 (R. O1 /03) • - •r ... .••. •-r. .... .... yn,.~...... .w. ..,m. oa.. n ^^ mcnes m size .P ~ ~. ..e -- ,. t~~ .- cs \°~ ¢~' ~,~. . ---- .. _ _ ~ ~ ~ 7~ /~ ~ v v'--~ . ~3~ FX~~~~ s ~~y~ ~ ~ _ ~~~i~s ~ ~ ys~~~ ~~~~~ ~~ a~ y 3 ~~~~s ~ ~~ 9C1.Tnj~ b t, LPN G ~ ~ o~ yb~ ~ ~~b)6~ ~- ~ ~~ ~ Q~ s~'\ )~ ~ ~u~l 1(..~b~, ~~ I ~ ~~ ~ ~ . ~ ~ ~~`' ~~ ~'~ ~~~~5~ ~ ~. ~~~ l~ ~ _~ ~ ~.u ~ ~' . d ~v~a~ d~ Slnl~ 3 ~d ~~e~ = ~oo•U ~o~ I Goa-~I \ .~.r--s..._..__.._...._..... _.. i ... ~' ._~d. ~ e'er:'. . ~ ~~ . _. .._ .[.../CAL./15L ~ ~~~yu...~. ._.._..__.-_ ..~ \ Pal ~ Sin ~~ r. 1 ~, ~ _ _ i ~.. ~ dT~sa l cc[/ ~o ^ q'~' ~~ • ~'~ ~ • i ~~`. o ~ ~\ °`~' ~ ~~\ ~.i ~0 • flioP~~'./~ca~6'or~ oP' x.~.~ ds~iceii 0 i~ ~SK, ~~ . • Eleva t, a., Shod \ ~ / OpC/- ylO-~d 0.~ r' . q~: ~ ~ ' ~,~ pi' 9 d ~ , i Z. n k , ~d , ~ ,,.~_ E)ciS~Eing Concrcu SGoibr.~/an~: ou#/c~ c /tv.- = ~5: sa± ~o , (i ~~ 421IG~ 1'-14t7C= l ~~~in~. ~/ '' EXi-'y,/t'J ~~ ~ _ _ _ 3 bed~aw„ C~ ~ 5' ~ res,du~ ~b~~~(`4' ~ de/ow I ~"^d ~~~ L_ __ O yE--- WC II .t ~~ C'o. '~wY ~~ „ ! r~. 3 0~3 I ~ ~kL , S ~ ~l ~ cvi ncl e rs~ ..... _. . _. ~~ .~.cs .._. -- .............._ . . ~~ d ..._--~ _. , i v v'-t.. . _ . ~ ~s~P~ ~~, ~a ~ U' ~\ ~.> ~ ~ ~ D col l~ J 1~~ ~ h~L ~ b:1,J ~, P~.rti p F,1 ) u T~Nk L~~, ~~ YY1 btiX- ~o~dh, a~' Slbl~ ~~b t, ~R.PN G l ._.._ ____ _ ~ ~u~l ~~~~~p~~~~~~b~l~ ~~ ~. ~ ~ b l p ~ ~ ''', +, ~ 3ks~..~~ ~T ~ y Gnaar~ S ~h ~' P~!~ ~U~oh., ~~~ G~1 11'~e ... _Y' ....._ ... _..._. ... I~~~~ II) ~~~I/ ,.~ ~/I~~~I A ..i'`J~. . /// .. ~ . ~~~~~5 qqp C ~ .fll ~ ~ ~ ~ U (11 ~ `3 . l0 g' rr N IA i 1805 u Wisconsin Aepartment of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Gomm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimemsions, north arcow, and location and distance io nearest road. 020-1048-30-300 Please print all information. w_.~ _.., ewewed Date Personal informetan you provide mey be~used for,Cyy Lew, s~ 15.04 (1) (m)). ~ ~ 2.0 Property Owner Property Location John Gies :, n ~ Gout. Lot NW 114 NE 114 S 20 T 29 N R 19 W Property Owners Mailing Address i ~ ~ Lot # Block # Subd. Name or CSM# 466 Co. Hwy. A 2 CSM Vol. 12, Pg. 3302 City State 'p Cod~_(Plhtl4~t~~: J City ~ village 11' Town Nearest Road ~.~.._... r._..m...=_._._.~.~ Hudson ~ WI 54016 715-386-2373 Hudson Dorwin Road New Construction Use: !~/ Residential ! Number of bedrooms 3 Code derived design flow rate /~ Replacement J Public or commercial -Describe: Parent material Outwash Flood plain elevation, if applicable General comments and recommendations: Install three trenches at elevation = 91.50' using 27 leaching chambers. 4~U c~ru na Boring # ~ Boring rI Pit Ground Surface elev. 97.16 ft. Depth to limiting factor ~ 108" in. Soil Application Rate ti D ri t T Structure Consistence Boundary Roots P D/ft# Horizon Depth in. Dominant Color Munsell on Redox esc p Qu. Sz. Cont. Color ure ex Gr. Sz. Sh. ~E~~G E 1 0-9 10yr2/1 none I 2fgr mvfr cs 2fm,1c 0.6 0.8 2 9-14 10yr3/3 none sil 1fsbk mvfr cs 2fm,1c 0.4 0.6 3 14-26 10yr4l4 none sil 2msbk mvfr cw 1fmc 0.6 0.8 4 26-30 7.5yr4/6 none Is 0 sg ml cw 1vf,f 0.7 1.6 5 30-108 10yr5/6 none s 0 sg ml - - 0.7 1.6 ~ l/ a Boring # J Boring 1~ Pit Ground Surface elev. 95.66 ft. Depth to limiting factor >97" in. Soil Application Rate ti R d D i re t T Structure Consistence Boundary Roots GP D/ft2 Horizon Depth in. Dominant Color Munsell escr on e ox p Qu. Sz. Cont. Color ex u Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3/2 none I 2fgr mvfr cs 2fmc 0.6 0.8 2 9-17 1 r414 none sl 2fsbk mfr cw 2fmc 0.6 1.0 3 17-27 10yr4/6 none s 0 sg ml cs 1fm 0.7 1.6 4 27-97 10yr5/6 none s 0 sg ml - - 0.7 1.6 'Effluent #1 = BOD ~ 30 <_ mglL and TSS < 150 m /L 'Effluent #2 = BOD < 30 mg/L and TSS <~0 mg/L CST Name (Please Print) ignature~ CST Number James K. Thompson 3602 Address A.C.E. Soil & Sfte Evalu s Date Evaluation Conducted Telephone Number 340 Paulson Lake L ,Osceola, WI 54020 6/142004 715-248-7767 property ovrner ]ohn Gies Parcel ID # 020-1048-30-300 Page 2 of 3 Boring # ~ Boring 1I Pit Grorind Surface elev. 92.76 ft• Depth to limiting factor >86" in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots •Eff#1 *Eff#2 1 0-6 10yt'L/1 none I 2fgr mvfr cs 2fmc 0.6 0.8 2 6-14 10yr3l2 none sil 1fsbk mvfr cs 2fmc 0.4 0.6 3 14-21 10yr3/3 none sil 2fsbk mvfr cw Zfm,1 c 0.6 0.8 4 21-39 10yr4/4 none sil 2fsbk mvfr cw 2fm 0.6 0.8 5 39-46 7.5yr4/6 none Is 0 sg ml cw 1vf,f 0.7 1.6 6 46-86 10yr5/6 none s 0 sg ml - - 0.7 1.6 ~ Borin g Boring # 1~ pit Ground Surface elev. 94.27 ft. Depth to limiting factor >95" in. Soil Application Rate St t Consistence Boundary ROOD Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture ure ruc Gr. Sz. Sh. *Eff#1 "Eti#2 1 0-9 10y-211 none I 2fgr mvfr cs 2fmc 0.6 0.8 2 9-17 10yr3/3 none sl 1fsbk mvfr cs 2fmc 0.6 1.0 3 17-25 10yr4l4 none sil 2msbk mvfr cw 1fmc 0.6 0.8 4 25-32 7.5yr4/6 none Is 0 sg ml cw 1vf,f 0.7 1.6 5 32-95 10yr5/6 none s 0 sg ml - - 0.7 1.6 i ^ ng Boring # ~ Bor J Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Consistence Boundary Roots Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. *Eff#1 'Eff#2 Effluent #1 = BOD ~ 30 < 220 mg/Land 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 Head material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. v ~o ~ ~ '~ ~~ irk. o ~ ~\ °~~ ~ C~ ~.~ ~Q y -l~i'oFbssol dI~54/ ecr/ ~ .o ~S~sf~Melev.~ = 91.9v' g.2 . i ed ~ ~ open yard Shod i q1• ' ~o~, q1~y d~ ,~ ~ Soy%~,/a/aa~'on~%c ~ Eleva t~'o~ N~, ~\~a, ~, ~_ EXis~%~ roncrc,6c 54o,bc. y„C out/et e le u_- = RS: Sd ,~ ~ZIIG.~I n14/Yr= l~h ~~~inde . ex~~J 3 bed~aar„ (_ _ _ - re S.drgc` ~ below ro~..~d aor L___ o~- wail I Co. fr'w y y~ i ~ ~, 3 0~'3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND i',,, OWNERSHIP CERTIFICATION FORM '~~ OwnerBuyer c~ ~ h Vl ~ ~e ~.~ l ~/~S Mailing Address Property Address _~z O 0 ~ ~ ~GC~i'~r (Verification required from Planning Department for new /l~/ / / o z v - ~Dy~- 30 /00 QZ+~ City/State _/7 ~1 c~ 5 0/? fit/ i Parcel Identification Ntunber o o - / ~_~ - 30 ~ 2 0 0 ,2a ~~r iay~'- 3a-3~v LEGAL DESCRIPTION Property Location '/,, '/,, Sec. 2 ~ . T~-R / q W, Town of c~ s ~ h ~tbdivision ,Lot # Certified Survey Map # 5~ ~ ~ 7 ~ 7 :Volume _ 3 .Page # ~,~.~ Warranty Teed # ~~ ~ G .5- ,Volume S 9 q ,Page # Spec house O yes l~ no Lot lines identifiable ~Sl yes O no SYSTEM MAINI7ENANCE~ Improper use and maiatenaneeof your septic system could result in -its premature failure to handle wastes, Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees,to submit to St. Croix Zoning Department a certification form, signed by the owner and by a maaterplumber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on-site waatewaterdiaposal:yytem is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is leas than 1/3 full of sludge. Uwe, the undersigned have read the above requir+eMtnts and agree to maintain the private sewage dispo~al system with the standards net forth, herein, as set bythe Department of Commerce and We Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to•the St. Croix County Zoning Office within 30 days of the three year expiration date. ut ~-~- ~j ~ / / NATURB OF APPLICANT DATE ~~. • ~rlOVYNER CERTIFICATION i • ' ~~; .i'(we) certify that alt statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prt-pt:lrty,.described hove, by virtue of a warranty deed recorded in Register of Deeds Office. ~ ~~ SIGNATURE OF 7~'PI.YCANT DATE •••'•• Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Depertznent.'••••• •• Include with this application: t stamped warranty deed from the Register of Deeds office .a copy of the certified survey map if reference is made in the warranty deed Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity in-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment .. System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan comp{ies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: Svstem Desian Soecificattons Sanita Permit Number ~ S ~ Number of Bedrooms 3 Desi n Flow -Peak ( pd ~ 6 Estimated Flow - Avera e( d 3 ~ b Se tic Tank Capaci al (t~uu Soil Abso lion Com onent Size (ftZ) 839 T e of Wastewater Domestic Table 2: Soil Absorntlon Comnnnnnt . Limiter of Raliahla Anora4lnn ---r ----- - - -- - Se tic Tank Component ~~'- Soil Absor lion Com onent Desi n Flow -Peak d) ~(~ 3 Maximum Influent Particle Size (in) ~ 1/g Maximum BODE (m /L ~a U 220 Maximum TSS (mg/L) ~ ~ ~, 150 Table 3: Malntenanca Schndula Se tic Tank Ins ect and/or service once eve 3 years Outlet Filter ins ect once a ear and clean at {east once eve 3 ears Soil Abso lion Component Ins ect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not' removed at the tfrne of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upgn the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for. entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or Impossible. Tank abandonment shall be in accordance with Comm 83.33. Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absoration Comaonent The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of thfs component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures ace key factors to extending the useful life of this component. The soil absorption component's operation must be assessed by Inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 7_ Management Plan fora Septic Tank and. Soil Absorption Component Plantings ofdeep-rooted trees and shrubs directly over or within ten feel of the . component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HUDSON COMPUTER NUMBER 020-1048-30-200 Parcel Number 20.29.19.186A-20 ~~ OWNER NAME: First RETIRED Last GIES PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment ~ ~~' 880 DORWIN RD ~~ ~(/ SECTION 20 TOWN 29N RANGE 19W '/<160 '/<40 O ~./ Line Description Line Description TOTAL ACREAGE 2.870 PL SM 12/3302 '97 LOT2 BLK ~ 01 SEC 20 T29N . PT NW NE 15 02 & SW NE BEING LOT 16 03 CSM 12/3302 AC 17 I /~ 04 18 ~ ~ `I' 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HUDSON COMPUTER NUMBER 020-1048-30-300 Parcel Number 20.29.19.186A-30 OWNER NAME: First JOHN & PEARL Last GIES PROPERTY ADDRESS: Hse /2 PD --Street Name-- Type SD Apartment 880 DORWIN R SECTION 20 ~ZS~T ~~SN RAI~Z~ W <160 '/<40 Line Description Line Description TOTAL ACREAGE gQQ,Q PLAT CSM 12/3302 '97 LOT2 BLK 01 SEC 20 T29N R19W PT NW NE 15 02 LOT 2 CSM 12/3302 16 03 EXC DESC O/W 17 04 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit LEGAL REAL ESTATE COMPUTER NU OWNER NAM . PROP AD ST. CROIX COUNTY, W TOW N-Of~h+,U D rst RETIRED NSIN OLD TXSCR02 :el Number 20.29.1 .186A-12 S Nam - Type S Apa ment 878 DORWIN RD SECTI 0 TOWN 29N RANGE 19W '/4160 ' Line ine_ TOTAL ACREAGE 0.000 PLAT CSM 12/3302 01 SEC 20 T29N R19W PT NW NE 15 02 8.SW NE LOT 1 ~~~3:0~ 16 03 EZ-UT-1501/149 17 04 EXC AS DESC 2059/616 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 U v" (A ~c Desch tion~ p '97 LOT1 BLK F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HUDSON COMPUTER NUMBER 020-1048-30-175 Parcel Number 20.29.19.186A-15 OWNER NAME: First JOHN & PEARL Last GIES PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 878 DORWIN RD SECTION 20 TOWN 29N RANGE 19W'/<160 '/40 Line Description Line Description- TOTAL ACREAGE 0.000 PLAT CSM 12/3302 '97 LOT1 BLK 01 SEC 20 T29N R19W PT NW NE 15 02 & SW NE LOT 1 CSM 12/3302 16 03 EZ-UT-1501/149 17 04 EXC AS DESC 2059/616 18 05 ALSO INC PT SW NE COM NW COR 19 06 NW NE SEC 20;TH S 00 DEG E 20 07 1314.36';TH N 89 DEG E 21 08 741.51';TH S ALG CSM 182.31' 22 09 TH E ALG CSM 79.03'POB;TH E 23 10 366.88';TH SWLY 416.65';TH N 24 11 12 DEG W 229.65';TH N 00 DEG 25 12 E 30.66'POB 26 13 EXC DESC 2072/182-RD R/O/W 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HUDSON COMPUTER NUMBE -30-000 Parcel Number 20.2 19.186A OWNER NAME: Fir Last SIENNA CORPORATION PROPERTY ADDRES se 1/2 PD --Stree ame-- ype SD Apartment 878 RD _~ SECTION 20 OWN 29N RANGE 19W'/4160 NE'/440 NW Line Description Line Description TOTAL ACREAGE 12~46P~LAT LOT BLK 01 SEC 20 T29N R 9'f W PT NW NE 15 02 S OF RR EXC CSM 12/3302 16 03 EZ-U-1797/610 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit • ' Ddcument Numbec '1 2059!' 61~f STATE BAR OP WISCONSIN FORM 2 - 1998 WARRANTY DEED This Deed, made between Jean Dorwin Gies, a single person, Grantor, and John Gies and Pearl Gies, husband and wifef Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: * as joint tenants See Attached Exhibit A This deed is given in fulfillment of that certain Land Contract dated August 1, 1979, recorded August 14, 1979, ,in Vol. 599, page 148, as Document No. 359015. 6~ 9 8 6 5 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 11/25/2002 10:00AM EXEMPT i B REC FEE: 13.00 TRANS FEE: 118.00 COPY FEE: CERT COPY FEE: PAGES: 2 Name and Return Address Fredrikson & Byron, P. A. 200 South Sixth St., 4000 Minneapolis, MN 55402 JSC - SMM 0201045-10-100 020-1048-30-100 020-1048-30-200 This ho tead property. <is) is not) Exception to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this vZd tl'1 day of November, 2002. AUTHENTICATION Signature(s) authenticated this _ day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.1X, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY FREDRIKSON 14c BYRON, P.A. 200 South Sixth Street, #4000 Minneapolis, MN 55402 (JSC-2712691) (Signatures may ba authenticated or acknowledged. Both are not necessary.) ~acXi>,,a, ~s'V.~c.t2d~ ` Jean' orwin Gles ACKNOWLEDGMENT STATE OF~~ ~,~((yJ ) COUNTY Ci~ ~ /gtY ) Personally came before me this ~ day of November, 2002, the above named Jean Dorwin 3eS, a single person, to me known to be the person(s) who executed the egoing instrument and acknowledge the same. ~~~ VY~Yt R1 r , RacYlael McNitt Notary Public, State of (~l~C~ t-'7t.btrn My Commi ion t permanent. (If not, state expiration date: a~~ ~ ~. RACHAEL M. MC NnT NWary Public $tHtB Oif wlsconsin ~~1 "Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE 41AR OF WISCONS191 FOAM No. 2 - 3998 InfortrBnon Professionals Company Fontl tlu Lac. Wisconsin anO-655-2021 s EXIIIBIT A The following land in Section 20, T29N, R19W, Town of Hudson: 'J 2059P 615 All those part of the Northeast Quarter of the Northeast Quarter, the Northwest Quarter of the Northeast Quarter and the Northeast Quarter of the Northwest Quarter, lying northerly of the right of way for the main line track for the C.St.P, M. and O. RR Co., and South of the right of way for the Hudson to Spooner track, also sometimes referred to as the Duluth-Superior track of said railroad, and West of the carving "Y" track running between the two above rights of way in the Northeast Quarter of the Northeast Quarter. All of the Northwest Quarter of the Northeast Quarter and Northeast Quarter of the Northwest Quarter lying South of the right of way for the main line track of the C.St.P, M. and O RR Co. The Southwest Quarter. of the Northeast Quarter. The Southeast Quarter of the Northwest Quarter, South of the railroad. The Northwest Quarter of the Southeast Quarter, EXCEPT those parts thereof described in the following documents: Deed to Harold V. Addington and wife in v.463, p.272, doe. 301385. Deed to Sam E. Miller, in v.505, p. 217, doe. 319416. Land Contract to James D. Rogers and wife in v.511, p.367, doe. 322056. Land Contract to James D. Rogers and wife in v.573, p.300, doe. 348293. The Northeast Quarter of the Southwest Quarter, EXCEPT those parts described in the following documents: Land Contract to Clifton G. Benedict and wife, in v.579, pp. 6 and 7, doe. 350723. Land Contract to David L. Brathol and wife, in v.579, pp. 374 and 375, doe. 350943. Land Contract to James T. Holden and wife, in v.591, p.564, doe. 356004. The Southwest Quarter of the Southeast Quarter, EXCEPT all land South of the public highway formerly leading from Hudson to Hammond, then designated as Highway 12, and those parts described in the following documents: Deed to Ronald Rorvick and wife in v. 362, p. 452. Deed to David A. Larsen and wife, in v. 452, p.467, doe. 296769. Deed to Richard W. Hancock in v. 479, p. 221, doe. 308116. Deed to Winnifred W. Grunke, in v, 485, p. 441, doe. 310823. Deed to Ronald Rorvick and wife, in v. 491, p. 97, doe. 313089. Deed to Sam E. Miller, in v. 505, p. 217, doe. 319416. The Southeast Quarter of the Southwest Quarter, EXCEPT all land South of the public highway formerly leading from Hudson to Hammond and then designated as Highway 12, and those parts described in the following documents: Deed to Claude W. O'Donnell and wife, in v. 463, p. 365, doe. 301452. Deed to John R. Reis and wife, in v. 465, p. 565, doe. 302456. Deed to Robert W. Jenkinson and wife, in v. 470, p. 445, doe. 304507. Deed to Elmer H. Lau and wife, in v. 487, p. 156, doe. 311524. Deed to James T. Holden and wife, in v. 591, p. 564, doe. 356004. Deed to John R. Reis and wife, in v. 452, pp. 508-509, doe. 296799. Subject to all existing highways and easements of records. All recording references are at the Office of the Register of Deeds for St. Croix County, Wisconsin. #2712543\l