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Y U ~ tB O f6 N Z e d Y U ~ (n cc ^ ~ it ~ ' Y ~ I r ! ~ .~ ~ a m ~ ~ a ~ t A ciao !,ov,c°~ Wisconsin 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 Christensen, Kurt Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: C~.o~ ~.0~ ~ ~uL ~ . csv- #1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTU I _ CAPACITY Septic t,.~ 1 ~S~2.. / S~ S Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ / , , ` -~/ 0 t _ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer nd GPM Model Num TDH Lift Friction Loss System Head TDH F Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM (~,'iol-1~'e(~~Jdr~,wt.b~r~ county: St. Croix Sanitary Permit No: 479315 0 State Plan ID No: Parcel Tax No: 020-1066-10-050 Section/Town/Range/Map No: 24.29.19.254A20 STATION BS HI FS ELEV. Benchmark 1, sZ o/•5z. ~ ~ • D , Alt. BM Bldg. Sewer 9•t 2. SUHt Inlet l0.~3 `~o. ' SUHt Outlet tl•i t •3 Dt Inlet Dt Bottom Header/Man. Dist. Pipe ` Bo .System /2•S~- / ~S~ts Final Grade ~ A - - c •I St CovZ.o ~ r ` S , r- ~ T 'o 7' / 3. ~g r R NC Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia.. Liquid Depth DIM ~ 3 ( z, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer ` INFORMATION CHAMBER OR ~ Type Of System: ' t t ___ UNIT ModeLNum ~ ~ 3S -__ ~ .. DISTRIBUTION SYS.T~EM Header/Manifold istribution x Hole Si e x Hole Spacing Vent to Air Intake ~„ ~ Pipe s) Lengt Dla Leng Dia ang SOlL~:E?VER r Pressures Svsfctmc Anly YY Mound Or At-Grade SvstemS OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded ~ xx Mulched Bed/Trench Center Bed/Trench Ed es g To soil p ~ Yes ~~ No Yes ~ No C M N S: ( elude s e discre enci persons present, etc.) Inspection #1: NIDU , 0 l t/~oS~ Inspection #2: 3 L~ation: 8 7 Wyldwood Lane udH son,W1~54016 (NE 1/4 SW 1 4 24 T29N R19W) NA Lot 2 Parcel No: 24.29.19.254A20 1.) Alt BM Description = 5'r'/'"'`'`~'"'~'`'~'~'"~°'`~'~ ~~,L ~^Ste'~xusx ~ '~S C,~G-S c!.%l- ~rGOCQ.., 2.) Bldg sewer length = z~ L *~Cr~^+`v''"'4• ~9-~•qr2 tM.O~~~ -amount of cover = ~ ,, q Plan revision Required? ~~ ~ No Use other side for additional it~formati ~ SBD-6710 (R.3/97) Date S t~sepctor's Signature _ ~r ~ ~ Cart. No. • Z S~ 2~ .~s~ N ~~, ~~ 7~ `~~, ., ' Safe d vision County ,y', ! ~ 201 W. W 'ngton Ave., P.O. Box 7,162 ~ Madi n OT~ 7~6~ WI t~~4~ Permit Number (to be filled in by Co ) Sanitar i~eons~n , . j 2 51 3 ~8 y De artment of Commerce t t ( ) Sanitary Permit Applie~tio~otu,N~ a~Flc~ State Plan I.D. Nu[nber /,1//~/~1-' In accord with Cotnm 83.21, Vdis. Adm. Code, personal info ovtde may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing a~dldressO I Applic9tion Information -Please Print All Information ~ $~~ (~/5r ~~trlo~l L..-a Property Owner's Na me N Block # arcel >Y /' / ~ ner's M ailing Address ~ Property Ow Property Loc n Q I V c^A, S4 ~' f Section j~ , , , _ City, State Zip Code Phone Number ~ / (circle e) R E r W T~ N II. ype of Btlilding (check all that apply) ; Cik `~ sv~` ~ CSM Num r i N bdi i S or 2 Family Dwelling -Number of Bedrooms ~~f ~ v on ame u s , r~ ~( a"~J ^ Public/Commercial -Describe Use ' " ~ ^ State Owned -Describe Use ~ ~,~. ~~~s r_.__~. ~ ~g'f"l~ t"r/~ ^Village~.T'ownship of ^City -- _ . _ GO Sf1r(~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ~ New System ~~ ^ Replacement System ^ TreatmentiHolding 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 POWTS S stem: (Check all,that a 1) t t2 J Non -Pressurized [n-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter i ._i Conswcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil A pplication Rate(gpdsf) Dispersal Area Required (sf) ispcrsal Area Proposed (sf) Elevation System ` ~ t~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Galloru Gallons of Units Concrete Cortsrructed ~ ~ Glass New Tanks Exisung Tanks ~~ ~~~~ ~~ (^j, //~ty~,~ s%~+C_ / 'l 1 LV ~~ ` _ Septic OC FFeldi~tk ~~r "'""~- ~ dst,~~iG ~~ r .C ~ ~ ~ Aerobic Treaement Unit i Dosing Chamber VII. Responsibility Statement- [, the undersigned, assume responsibility for ' tallation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature P PRS Number Business Phone Number 1 ~Z 4~~/ ~~ ZS~?v Plumber's Addre ss (Street, airy, State, ip Cod VIII. Count /De artment Use Onl pproved ^ isapprov Sanitary Permit Fee (includes Groundwater Dat Issu Issuing eN Sign tur ( o Sts ps) ^ Surcharge Fee) ~ ~y~ ~J ~ /~ O C J O r n Reas or Denial IX. Conditions of ApprovallReasons for Disapproval SYSTEM OWNER: 1. ~` Septic tank, eHlueM lifter and ~~ dispersal cell must ail ~g services / maintai~d as per management plan provided by plumber. Z. AN ~bacit raquinrrlents must be maiMairtad i >r pet tppiicaWe code / o-dinances. ~ 1 Attach complete plans (to the County only) ror the system on paper not less than 81R z 11 inches in size -~, 9 SBD-6398 (R. 01/03) ~' N 3 ~ ~ ~ r A ,~ ~ ~ ~ ~ ~~ ~ ~ ~ ~, ~ 3 ~ ~ ~ ~~ ~~ ~~ ~ti ~ ~ ~ ~ r -.--~- / 4d, f? ~ y ~~~./~ \ V 0 0 3 ~~ ti 3 • ~~ ,~""~,. ,m' :. ~o ~~ ~ ~ N ~ ~ I roQ a ~ ~ 1 ti' ~ ~~ ~ ~ ~F II ~ -~ i ~~~ M ~ ~ I~ ~ P~ I'I '~~ (i ~ I~ ~ i ~ ~~ ~ b o~ M ~ ~- r N o }J ~ .r ~ v w ~ ~' `~ `~ `~ M N N •~• a ~ ~ ~ ~ v- ~ .7 ~ ~ ~ ~ lJ M (~ p ~ '~' m ~ I.' ~~ ~~ N v ` ti ~ ~ ~ ~ ~ ~ 7 ~ ~, .~- ~ 3 v ~" ~ ~ o ,~ ,~ ~ ~ W ~ ~ ~ ---{~- s~, ~~~~y w 0 0 3 ~ ~~ 3 ' ~, tia °~ F~. ~ I N ~ v I ~ ~ ~ ~4Q I I ~ m~ I m ip d I i~ l ~i ~ I~ ~~ ~~ ~ P' ~~ M~ ~p I ~° ~ ~ ~I I ~ i~ M ~' ~ ! ~ N ~_ ~~ o J ~ ~ . ` ~ ~, d -- h Or ¢ `M N ~ ~ a v ° ~ ~' ~' ~ a , ~ ~ ~~ ate" ,. ~' ~ t~ m ~ ~~ t~ s' N a fy,. /a, ~~.~ " ~ ALU TI in ~r~r a with C mm 85, Wis. Adm. Code Department of Commer ~ ., • + ~ . ~.. ,, Division of Safety and Bui ings ~_ ~ =T,,~t: .1~.Jt_ -~ '~ /-U ,.. - Coun_~y Attach complete site plan on p per,gpt,,esSfi~ian 8'/z x 11 inches in size. Ian t i01X OUN~~ include, but not limited to: verti nd horizontal reference point (BM), dir~ctiorta ~~`~1~~ I LD. percent slope, scale or dimensions, north arrow, and location and distance to near Please print all information. Reviewed ey Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Pro erty Location #11 Page 1 of 3 Northland Plumbing, Inc. St. Croix Date 5 Property Owner p Kurth $1 ^($ic~il Govt. Lot NE1/~, SW1~4, S24, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 8 a d 2 "~ City State Zip Code Phone Number ~ City ~ Village 0 Town Nearest Road D LANE ~~ $o1J wt' e/~ IS- -G3 New Construction Use: ~ Residential /Number of bedrooms ^ Replacement ^ Public or commercial -Describe: Parent material Sandstone General comments Conventional System and recommendations: I 1 I Boring # ~ Boring _:' Pit Horizon Depth in. Dominant Col Munsell 1 0-6 10YR3/2 2 6-16 10YR3/2 3 16-25 10YR5/6 4 25-90 10YR7/3 Boring # ~ Boring n Pit Horizon Depth in. Dominant Col Munsell 1 0-7 10YR3/2 2 7-10 10YR3/3 3 10-35 10YR4/4 4 35-43 10YR5/6 5 43-90 10YR7/3 sil sicl sicl s s * Effluent #1 = BOD s> 30 < 220 mg/Land TSS >30 < 150 mg/L CST Name (Please Print) Signatur Michael J. Myers Address Northland Plumbing, Inc. E 1556 State Rd 64 Boyceville, WI 54725 Hudson WYLWOO 5 Code derived design flow rate 750 GPD Flood plain elevation, if applicable ft• Ground surface elev. 96.14 ft. or Redox Description Texture Qu. Sz. Cont. Color sil s s s Ground surface elev. 89.34 ft. or Redox Description Texture Qu. Sz. Cont. Color Depth to limiting factor >90 in. Soil Application Rate cture St Consisten Boundary Roots GPD/ft2 ru Gr. Sz. Sh. "Eff#1 "Eff#2 2sbk mvfr cs 3f .6 .8 Osg mfi cs 2f .7 1.6 Osg mfi cs .7 1.6 Osg ml cs .7 1.6 Depth to limiting factor >90 in. Soil Application Rate Structure Consisten Boundary Roots GP D/ft2 Gr. Sz. Sh. "Eff#1 *Eti#2 3sbk mvfr cs 3f .6 .8 2sbk mvfr cs 2f .4 .6 2sbk mvfr cs im .4 .6 Osg mfi cs 2f .7 1.6 Osg ml cs .7 1.6 * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Number 267985 Date Evaluation Conducted Telephone Number 7/5/05 ~/ $'- 6 4~ = Z52U Property Owner Kurt Christianson Parcel ID # Page 2 of 3 3 ^ Boring Boring # pit Ground surface elev. 91.29 ft. Depth to limiting factor >95 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 1 0-il 10YR3/2 sil 2sbk mvfr cs 3f .6 .8 2 1i-20 10YR3/3 Is lsbk mvfr cs 2f .7 1.6 3 20-24 10YR5/6 s Osg ml cs .7 1.6 4 24-43 10YR5/6 s Osg ml cs .7 _ 1.6 5 43-95 10YR7/3 s Osg ml cs .7 1.6 4 ^ Boring Boring # Pit Ground surface elev. 96.50 ft. Depth to limiting factor >95 in. ~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsel! Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10YR3/2 Is isbk mvfr cs 3f .7 1.6 2 10-14 i0YR3/3 is isbk mvfr cs 3f .7 1.6 3 14-41 10YR5/6 s Osg ml cs .7 1.6 4 41-95 10YR7/3 s Osg ml cs .7 1.6 "Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L 'Effluent #2 =GODS < 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) Northland Plumbing, InC. Property Owner Kurt Christianson Parcel ID # Page 2 of 3 3 Boring # ^ Boring ®pit Ground surface elev. 91.29 ft. Depth to limiting factor >95 in. Soil Application Rate 'Horizon Depth Dominant Cafor Redox Description Texture ' Structure Gonslstence ~OUndary Roots ' GPD/ft2 in. Munsell , Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#t `Ef1#2 1 0-11 10YR3/2 sil 2sbk mvfr is 3f .6 .8 2 1i-20 10YR3/3 Is isbk mvfr cs 2f .7 1.6 3 20-24 10YR5/6 s Osg m! cs .7 1.6 4 24-43 10YR5/6 s Osg ml cs .7 - 1.6 5 43-95 10YR7/3 s Osg ml cs .7 1.6 ,4 ^ Boring / Boring # ®pit Ground surface elev. 96.50 ft. Depth to limiting factor >95 `~ gyn. Soil Application Rate MDrizon Depth. Domira~nt Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. 5h. _ 'Effi#1 •Eff#2 1 0-10 10YR3/2 Is lsbk mvfr cs 3f .7 1.6 2 10-14 10YR3/3 Is isbk mvfr cs 3f .7 1.6 3 14-41 10YR5/6 s Osg ml cs .7 1.6 4 41-95 10YR7/3 s Osg ml cs .7 1.6 * Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 <_150 mg/L * Effluent #2 =GODS < 30 mg/Land 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) Nortfilarb Plumbing, Int. ~ 3 , Q` . Y ~ ~ ~ ~ ~ * Q- ~ ~ a A 04 Y ~ h ~ ~ h > ~ ~ ~ 3 ~ ~ ~ w Q~ . w ~ ~ ~ ~~ ~ o~ w z ~ ~ z ,o v~ 1 Y i O 3 ~~ r- 3~ ° ---~- .z P Q~ ~~ i °9O ~aE- ~ I ~ ~a ~ 1 ~ , _ m ~o o ~ ~ ~ ~ II i ~~ ~ sl ~ ' lh ~ ~I ~- I~ (~~ ~ ~ ~ l I ` ti ~ '~ ` ~ pa ~~ ~~ 1 J 1I ~ ~ 111 .. ~P ~ ~~ ,~ ; ~ ~ ~~~ ~ > N ~! ~ ~ , ~ ~' ~ a ~ a- Q.. ~ a' L ~ ~ ~, ~ ~ I~ ~ a ~ ~r ~ ~ ~ ~ M '~' ~ 04 ( ~q oa N bO M ~- \ .. ~-. '~ 4" w Page 1 of 4 SYSTEMS I N C Errvlronmantsl Onske YVestewater Solufion•4" Leaching Chamber Design Spreadsheet Project Name: Christigns@n-Conventional Owner's Name Kurt & Elizabeth Christi@ns@n Owners Address _877 Benoy Hudson, WI Legal Description ~ NE~ '/., ' sw ~'/< Sec 24 T 29 N, R 19 ~ w Township Hudson County ~ Sainr t Croix Subdivision Sunridge III Lot# 2 Parcel I D# Table of Contents p9 1 Cover page 2 Calculations and Drawings 3 Management and Contingency Plan 4 Plot Map total # of pages: 4 Designer Name: License #: Date: Ph. #: Signature: Lyle J. Myers 224617 7/5/05 715-643-2520 Design Methods Used "IN•GROUND SOIL ABSORPTION COMPONENT MANUAL FOR PRIVATE ONSITE WASTEWATER TREATMENT SYSTEMS" (Version 1.0) SBD-10705-P (R.6/99) sYSrenns we Infiltrator and the Infiltrator logo are trademarks of Infiltrator Systems, Inc. "~""'"""~'"•'""'"`"""'~""' Spreadsheet provided under license to Infiltator Systems, Inc by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 ., ~. SYSTEMS INC Calculations and Drawings Page 2 of 0 Site Conditions Infiltration Elevations Site Type: private ~ Trench #1 Trench #2 Trench #3 %Slope 20 % Contour Elev: 93.17 91.17 90.17 Ft # of Bedrooms 5 Infiltration Elev: 89.17 89.17 89.17 Ft Depth to limiting factor 90 inches Limiting Factor Elev: 85.67 83.67 82.67 Soil Application Rate: 0.7 gal/ft^2/day Treatment and Dispersal Zone: 3.50 5.50 6.50 Effluent Quality Effi #i ' ~ Cover Material Required: 0 0 1 In Design Flow: 750 gaUday Finished Grade Over Cell: 93.17 91.17 90.25 Max BOD 220 mg/I Max TSS 150 mg/I Distribution Cell Choose chamber type: SeptlC Tank -- - - -- Infiltrator Quick 4 Standard ,- ~ Manufacturer: W rESEfL # of trenches: ~ 3 _' ~ Volume Chosen: / ~` S Chamber Length: 4.00 Ft Effluent Filter Selected: Zabel A100 Chamber EISA: 19.1 Ft2 Note: Access opening of sufficient size to be provided to allow removal of filter. Endcap EISA: 5.8 Ft2 opening to terminate at or above grade. Required Infiltrative Area: 1071.4 Ft2 Actual Infiltrative Area: 1087.0 Ft2 Total # of Chambers: 56 Cross Section of Septic Tank Total # of Endcaps: 6 r, Combined Length of Cells: 230.0 Ft 3" Bedding Under Tank 8" Min 13034 or Sch40 Pipe Cross Section of Cell Cover Material Observation Pipe {if required)~~ _ -Final Grade -. Ground Contour Leaching ` System Chamber 1 Elevation I.englh ~ ~ i< 6 ~ I V 9v Wed A5'17+/1 ~~~ Obeerwat~at t~rrvaUat a 5ch ~O ~t" 1'Ipa 1'Rx F'VC I'ipc Infiltrator and the Infiltrator logo are trademarks of Infiltrator Systems, Inc. Spreadsheet provided under license to Infiltator Systems, Inc by: 3bAdvisement N12466 220th St, Boyceville, WI 54725 Page 3 of 4 In-Ground System Management Plan pursuant to Comm 83.54 W. A. C. Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1!3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1 /3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Absorbtion Cell The absorbtion component must remain free of ponded surface water prior to_pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: if the septic tank or other components therein (including floats, alarms, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the absorbtion component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by removing the clogged bacterial mat, aggregate/leaching chamber cell, and distribution piping within the cell and replacing failing components in order to return system to proper working order as required. If repair is not feasible, a new system is to be constructed in a designated replacement area SENT BY: ; (R~~w P fll[fi:a' a ~4 wV 5 ~ Nt7RTM I /; pRePawEO pow: CpWNER OP $TE'V8 !i LAURA JAC4FISCJN LO'Y A1~MJ1 TA1rLE ~SiC. as 046 OADLAND9 RoAb Lat tM ACRES SC• FT. .~ j ; WUPSON, wt SaD,6 LOT 1 Z.o3 88.37a ~t ~ ~ ~ 'vwv':~~R= LQT Z 2.62 i14.1S9 7 tom' LOT 3 3.OD 13D,a3S I Ire ~ I DCVt~4'<S J. ~hHLER 'LOT 4 29.90 1.OOA.040 ~ ` ~) ~ ~ i v i $ b N LAND SUA,yEYINCi, .NC. tti~~tt ^~q~ ~' i ° ; ?p34 ENLQF STREET ~ lY"~~• li ~~ _ ~ ~ ~~ ~~ 1 ~ MW9CN• W13d076 _'~ ~(~D~l~la®C~IC~ ooa __ 1 t NW CORN@A 7.t6' i i _ {1t f WE NEtI4 N9D' 8~ 3~ ~•. •• ~. r`' OM' Tli9 SWt/A NN~,7'99"~ 1 •~ EA$T-WEST ,/4 LtNF t rr i / OF gECTiON 24 - - ~gy. t 8• 715 3S1 6764; MAY-17-05 4:05PM; ~~~~~~ urs~_ ra pwar ____-- ~~RTIF~ED $r11FtY~Y MAID LaCAT~d IN PaRT DF TNT NEUd OF TtlE SWTl4 rWD /N P~4HT tX= THE S6fla +~ THE 3W>'14 OF SECT-ON 2d, T29lY, A79W, C~ISIN F NL~pSOhf, ST CROlX COU~1`. ~ wEST t1a I^ CGRNEp of ss:c. ~• o l i ~'~' a~~ ~~~; 5L;~, ~~ ~ r.., II~Y,~.1~{ JIAi 1 0 ~~ ~~~ ~I ~ ~N[GT 201' J 1r7EG'ti'2 FOR LOT DIAAENSIONS .... 'r ~ LQT 3 ,S ~' EXISTING QgAYEL DnlvEw~Y - - ~ ~., SOT 4 rlpusE ~ 3EF'TICvElvT9- -+ ~_weLL SQUTN PR4P0'6E0 C51A NOL. 3- RO. +~ LINE ~ tN7:ST iJNE DF LOT $-, y. NEtI~ GF TFIE $tAl11A ~ = ~ _ filcts'T1NO FENCH . qF sEC. a• ~ _ a.a': NoRTW or NOS LNVE i pROPEttT"~ UNEQ 8MC0 o~LaT 2-, LC/7' 1 ~ ~~ ~. ~ iYrLV~ N PAl3E 6/9 RAp ~~ m R i~ ,t4 CNea ~Q ~ . {,OT $ ~NQR'i.H gFLOT ~- VOL 3, ,'s i t ~4'Q4°N WFi.l.7' ~ t NOO'00'+~ ,,/~ ~' ~ I ~1 ~ ~I ~~~~~ I O~ ~ J' ~~4 c ; ~ ~+I ° 43~7~~' ~~ ~ ~t~~ X0''1 ~ ~ f ~ • i r.,r~ a SCaLE !N FEET ~" = 300 ~ 30 ~3G0 + ~ ~ TW1S INSTRUty,ENT GRAFTED By BIiV+NA CEI9EINOER J09 NG. 6288~Di GATE: 077t11/FO03 R6VISED:08lpM~Q04 p ge SINE ~ - ~EX13'CINGiTLNCE 3. ra eee ttNf~ F IouTia , v$RTY ---~~ Maa~~~ia'w EKis`tni~ - a0i.q' F6NCE 1'e - ~~4~ ~~ ~~ r~ y,ISgT OR $~ 'Oy'-1 ,ice PROPERTY ~. ~ ` ~' ~ ~E ~ ~ ~' .~e ~t ,~ r rrEOUTN 7N CORNEA pF $EG• 2~ L~4iN0 -'punD ,gLUMINUti ST. CWOIX GCUNi 9CCT1+~ OOFNiR t,,iOlyU1,AENT POUNp t" g1,iTSIOE DIAMETER IRON SET 1" gUTS10E DIAMETEN BY 1®" ~RpLINEK PFOOT~EIGHMG 1.73 LB' FtUAGWAY ggTp/~GK I,INC (Bt,,' FROM RIOH7- OF'- WAYS t2' NA4E UTIt_ITY [AgEMENT • FOUND 3!4° REROD FOUND 1" OUTSIDE pIAME'i'ER IRON FOUND 11/4" OUTSIDE vIAMET~ PREVIOUSLY R[GORDEW pATA SHEET 1 OF 4 GSM1R IRON PIPE FOUND CNCF , 9+,T'69'et"E t5.2S' ~ FaaM sar , • IliGiN a1Pe wt ~ ~~ PIPt TS .~ ST CROIX COUNTY , SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM OwnerBuyer fl UST ~ ~.(~z.¢.Q~s~ t ~~s~~..,~s~ Mailing Address ~7~ Property Address ~- ld ~ t_ (Verification required from arming Department for new City/State ,l oso.~ c~/ ~ Parcel Identification Number LEGAL DESCRIPTION Property Location ~~ %., _~ '/., Sec. ~ T~N-R~W, Town of _~~o.~-. Subdivision ~ __ .Lot # ~ Certified Survey Map # `7 ~J5t75 .Volume _,~ ~ ..Page # Warranty Deed # ~~$ ~Q3 .Volume a?S Page # ~0~•.. Spec house ~ yes J~ 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 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 owrfer and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposalsgstem 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 foith, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da a three r expiration date. ~~ ''+C ? l/ Z/ a5~ SIGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th operty describ ove, by virtue of a warranty deed recorded in Register of Deeds Office. ~ ~ /~, SI AT(JRE OF APPLICANT DATE ****** Any information that is mis-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 is the warranty deed ~~ Qr .. Document Number Document Name THIS DEED, made between Steven A. Jacobson and Laura A. Jacobson f/k!a Laura A. Genoskv, husband and wife ("Grantor," whether one or more), and Kurt Christensen and Elizabeth Christensen husband and wife ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants 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 needed, please attach addendum): Lot 2 of Certified Survey Map recorded in Volume 18 on page 4769 as Document No. 765505 being a part of the Northeast Quarter of the Southwest Quarter (NE'/ of SW '/.), and the Southeast Quarter of the Southwest Quarter (SE '/. of SW '/,), Section 24, Township 29 North, Range 19 West, Town of Hudson. St. Croix County, Wisconsin. 788 1 tZ~3 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO.. WI RECEIVED FOR RECORD 02/23/2005 12:05PtI WARRANTY DEED t: ~tx'~r REC FEE: 11.00 TRANS FEE: 30.00 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address ~ ~,, ws o2o-to~ao-ooo Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warran/ties: Easements, restrictions and rights-of--way of record, if any. Dated ~ 'L l ~ ~ ~t! ~~ Yl; ~~ l AUTHENTICATION Signature(s) Steven A. Jacobson and Laura A. Jacobson f/k/a Laura A. Genoskv, husband and wife authenticated on a,` ~ ! '~ ~ t7 Y i .. .` ,, *Kristina Oeland TITLE: MEMBER STATE BAR OF WISCONSIN (lf not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: *Steven A. ACKNOWLEDGMENT STATE OF ) ss. COUNTY ) Personally came before me on , the above-named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Attorney Kristina Oeland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) L) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: TIfIS IS A STANDARD FORM. ANY MODIFICATIONS "f0 THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM N0.2-2003 ,U, 275~iP 102 State Bar of Wisconsin Form 2-2003 WARRANTY DEED A. * Type name below signatures. INFO-PRO'" Legal Forms 600-655-2021 www.infoproforms.com i1 7 76°5S>ml~ a CERTIFIED SURVEY MAP o, w ~ O~ I zZz I [~' `u1 w ~I ~ i ~ 1~1 ~~m STEVE & LAURA JACOBSON LOT AREA TABLE CORNER/OF w ~ 846 BADLANDS ROAD SEC. 24 N Lot ACRES SQ. FT. `~ ' HUDSON, WI 54016 ~ ~ I i ~ ~ LOCATED !N PART OF THE NE1/4 OF THE SW1/4 AND IN PART OF THE SE1/4 OF THE SW1/4 OF SECTION 24, T29N, R19W, TOWN OF HUDSON, ST. CRO/X COUNTY, PREPARED FOR: WISCONS/N. LOT 1 2.03 88,378 SURVEYOR: LOT 2 2.62 114,136 LOT 3 3.00 130,535 DOUGLAS J. ZAHLER LOT 4 29.98 1,306,040 S & N LAND SURVEYING. INC. 2920 ENLOE STREET 4N]G PL~G1°.4 OO Cr HUDSON. WI 54016 _ ------- ------ ---- l - 1320.00' i ~ WEST 1!4 1` CORNER OF SEC. 24 I I I ~i~ ~iLwl i~ I ~~0~ a.° ~ ~ ~, ~In~^J4 `rte. ~ I a Ivv I I 1 ~ I - Z VOL ~ 8 PAGE 4769 KA1'RL~:Elf H. 1f~" REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR ~tECORD 06/10/Z004 11:15AM CERTIFIED SURVEY MAP REC FEES 17.00 COPY FEE: 5.00 PAGES= 4 0 1 u I~1 ,~,I,~O l o I v0 ~ ~;a~ (~I~1 I 1 -'~~` m ~ N I ~` J 2657.16' EAST 1/4 CORNER OF SEC. 2a 4G~(~ CPC~Q4 OO [~ ~[6D~000D -------------- I ~_' ~ o - ~ - W YLD,LNQQ Ii~.AN~ ~~W ~ e ~~lf~?dG~J44[~D ' ~ ~dLQG~JD~ OUII~GD ~ a~ o~ac~a~ ~~ ~= EXISTING FENCE 1"IRON PIPE FOUND r S87°59'52"E 15.25' FROM SET 1" IRON PIPE ~~aao~c~c ooa ~~ - :~ -- -------------------- NW CORNER ~~~~ _ __OF THE NE1/4 i OF THE SWi/4 N89° X33" 5297.16' i / OF SECTION 24 N89°2T33"E 1320.00' EAST-WEST 1/4 UNEZ ~_~ 787.34' ~. ~71r-rRi/ ' .~)IW 1 02004 Q Sw N w ,ty [~ ~ ~aU~IMaMpwrali~itme Z ~ ~~HEET 2 OF 3 ~ SHEETS FOR LOT DIMENSIONS EXISTING GRAVEL \ / DRIVEWAY ~--y, ~---^ LOT 4 HOUSE ~ ~ SEPTIC VENTS- ..e ~-WELL PROPOSED ROAD PER. SOUTH _ CSM VOL. 3. PG. 658 j LINE OF t NE1/4 OF WEST LINE OF L07 3-,. _~ _THE SWi/4 EXISTING FENCE `--- OF SEC. 24 ^_2.5'± NORTH OF NORTH UNE j PROPERTY UNE OF LOT 2~i C~ SHED •~ .. , ;.~ LOT 1 !~ \ .~~ / , .LOT 3 `~ ~~ •~ ~ ~ ~~ ,1 LOT 2 ` I I -- 0o i ~ N89°4A'04"1AI 943.93' ~ i ~ NI ( NOO°00'49"E ~] I v c.il 183.80'<<. ~ ,~-~ Ynl L~~ l~ b I ~ (N RTN) ~- of C~o~o~ilo I b04~,~d ,~ ~ s - I `(J, ~ ~ I g` 6'~'33~ NORTH LINE ~ _ OF LOT 3, CSM ,°„ VOL 3, PG 658 c4i ~_EXISTING FENCE ~~ 1'~ SOUTH OF :,PROPERTY LINE 66' ion ~-=_-_- A I ~ _ _ 0 ~~EXISTING u'f ^ FENCE 1'± ~~ WEST OF PROPERTY _. ~ LINE. ~~ Q~o ~ • /~ i y 1 ,; ,, O SCALE W FEET 1 " ~ 300 O x O'"w~` ' 6 ~~.:,~ E i ,_ ~ THIS INSTRUMENT DRAFTED BY: IAN ~ ,t ( JOB NO. 6288-01 DATE: 07/01/2 3 REVIS 1 y~',`7~ try ~, N89°24'19"W 305.63' a9°Za'E 321.00') 1 'G` ~/ '` "" ~~ SOUTH 7/a CORNER OF SEC. 24 LEGEND FOUND ALUMINUM ST. CROIX COUNTY SECTION CORNER MONUMENT FOUND 1" OUTSIDE DIAMETER IRON PIPE SET 1" OUTSIDE DIAMETER BY 18" LONG IRON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT ROADWAY SETBACK LINE (50' FROM RIGHT-OF-WAY) 12' WIDE UTILITY EASEMENT FOUND 3/4" REROD FOUND 2" OUTSIDE DIAMETER IRON PIPE FOUND 1-1/4" OUTSIDE DIAMETER IRON PIPE PREVIOUSLY RECORDED DATA SHEET 1 OF 4 SHEETS i(~ ~ru~ ~s ~~,~I CERTIFIED SURVEY MAP LOCATED IN PART OF THE NE7/4 OF THE SW1/4 AND IN PART OF THE SE1/4 OF THE SURVEV®ii' SWl/4 OF SECTION 24, T29N, R79W, TOWN OF HUDSON, ST. CRO/X COUNTY, PREPARED FOR: WISCONSIN. SURVEYORa STEVE & (AURA JACOBSON DOUGLAS J. ZAHLER 846 BADLANDS ROAD S & N LAND SURVEYING, INC. HUDSON, WI 54016 LEGEND 2920 ENLOE STREET HUDSON, WI 54016 OF WAS • FOUND 1" OUTSIDE DIAMETER IRON PIPE ,~~ C'~ SET 1" OUTSIDE DIAMETER 8Y 18" AP ~' y DOUt3LAS J. ~~ ~ j °o i ~ LONG IRON PIPE, WEIGHING 1.13 LBS. 1 ~H~R ,Z oU I ° I PER LINEAR FOOT 7~ X21 ~ I ~ ~ ® FOUND 2" OUTSIDE DIAMETER IRON PIPE H 3 Q i Q ~ ( ) PREVIOUSLY RECORDED DATA ~dj~1 1 ~vi~i / ~MGvJG3UDCf~ 000 I ~ ' - 3~/ ~~ N89°2T'33"E 1320.00' -- -~ , .. ~ 33' r N~~ w~ U w Z ~ LL ~¢~ ¢ Q ~a~ ~~~ '~ ~ N ~" 787.34' w 66.00' ' \ 488.68' (466.81') ~ F. ~ ~ Ct ~ $ ~ ~ R=233.00' `~ c~$ \ C) \ A=.59°54'48" \ ~, ~ I 0 33' 33' ~\ \ CH.8=S60°35'02.5"E ~ ~ IO ` ~~~~ C \ CH.L=232.70' ~~ ~ ~ i °O ~ i ~ ~ ~ ~ v \~ ~ ARC L=243.65' /~ ~~~CCC I ~ 1 Q j ` / ~ I ~ TAN. IN=N89°2T33"E /y!r ~ ~ i ~ 1 ~"~ N `~. \\ \ \ TAN. OUT=S30°37'38"E V "~ 1 0(~1 t [o r $ ~o I ~ ~I~I ~~ z( I ca \ c~ ~~ I 1 c5 Z ` ~ R e 1 s7,oo' LOT '1 ~ ; ~ i R=233.00 0=59°54'49" C2 0=42°41'13` CH.B=N80°35'02.5"W ~ y R=167.00' N WI CH.B=N20°48'09.5"E ~ CH.L=186.78' Q ~=58°01'53" ~ ZI CH.L=169.60' ~ ~ ARC L=174.63' ~ ~'a~ CH.B=S60°08'34.5"E `r ARC L=173.59' ~ TAN. IN=N30°3T38"W ~ ~ O i~ CH.L=164.55' I TAN. IN=N42°o8'46"E /y / TAN. OUT=S89°2T33"W `G': a Q \ ARC L=172.08' I TAN. OUT=N00°32'27"W U / ¢j TAN. IN=S30°3T38"E ,i % \ r'-~ t~ ~TAN.OUT=S89°39'31"E ~I ~ \ `Py 31 ~• ~ JI ^, ~ . 5 `~ `" I ~~1~ ,' / LOT 3 v i ~ ~ , `\ ~\ o I I / C3 \ \ ~ r / R=233.00' \ \_ ~ r 3 ~ 0=59°01'53" ~ - e~' CH.8=N60°08'34.5"W ~ • \ ~ ~ ,~ `~ ~" ~~ CH.1=229.58' ~ ~ ARC L=240.06' ~ `' / T TAN. IN=N89°39'31 ~~ SEE DETAIL ~ ~ ,Y TAN. OUT=N30°3T38"W BELOW I ~~G' DETA1 L ~ I NOT TO SCALE DI Lwll ~ ~I ~I ~i ~~ ~~ • ~ \~DOO 1~1 IYLDWOOD ~ ~I ~i 1 O i LOT 4 ~ LOT 2 I c3 F ~ ' LANE ; C'I ~I +I~al ~I ~I ~ S89°39'31"E~c~ i ~ ~ ~~~ LOT 2 o.sT ~~ ~ .~_EXISTING `-------^-- ---'•-~' r` ~ FENCE i~ ~ S85°10'41"W 470.41' 307.4T,~-~ i ~~ THIS INSTRUMENT DRAFTED BY: BRIANA GEISSINGER SCALE IN FEET 1 " = 100' 15.1'±~' JOB NO. 6288-01 DATE: 0 7/0112 0 0 3 REVISED:os/04/2004 100 0 100 SHEET 2 OF 4 SHEETS Vo1.1 S Page 4769 N N O 3 ~ ~ n N O 7 ~ 7 cn Z ~ a D W O r. Z 0 ~D C Q r CD K N O m m C CD 3 O N ~ n N ~ J fl- ~ y ~ O. Q ~ ~_ O ~. O Z =~ 3 maZN 0 o m ~ ~ ~~~ ~ y y ~ ~ (~ j ~ N ~ y j~ O, N -' 3~ ~ O N U1 y ~~ ~. ~ ... tD O O F 0 L c ~ ; ~ ~ -; ^' C v n ~ ~ ~ ~ N C H tll ~ ~ a ~ a ~ o ~ o w a ~ 0 on ~ W 2 c a O O O o ~ ~~y ~ p_1 ~ O y ~ rn N w D ~, o ~ ? o N p c _. N C1 N A d n ~ S ~ °' a ~_ W a !WD A d O '~ N Z A C~ C 7 a 3 m o ~' ~ ~ ~ ~ ~ C .Np N y ~ p ~ ~ ~ N ~ J Q Q M Q y o c 3 !'! ~ .. ~ rt O N D A V CO --1 fn A Z ~ ,A.. A 2 0 •• p m N ~ Z ~ ~ d P'+ a O K '~ ~1 ~• t~~ C ~• O ~• y A 'O R tT A N N O t~+i C M ~1 Q ~V Parcel #: 020-1066-10-050 osi28i2oo5 08:32 AM PAGE 1 OF 1 Alt. Parcel #: 24.29.19.254A-20 020 -TOWN OF HUDSON Current '~~ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/10/2004 00 0 Tax Address: Owner(s): O =Current Owner, C =Current CaOwner O -CHRISTENSEN, KURT & ELIZABETH KURT & ELIZABETH CHRISTENSEN 855 BENDY DR HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.620 Plat: 4769-CSM 18-4769 020-04 SEC 24 T29N R19W PT NE SW CSM 18-4769 BlocklCondo Bldg: LOT 2 LOT 2 (2.62 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 02/23/2005 788103 2754/102 WD 06/10/2004 765505 18/4769 CSM 07/23/1997 2000/329 WD 07/23/1997 955/586 more ~nn~ ci mnneeav Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Ciass Totals for 2005: General Property Woodland Last Changed: 03/09/2005 Acres Land Improve Total State Reason 0.000 0 0 0 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00