HomeMy WebLinkAbout020-1395-55-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safxb} ai'IJ 6udl9ing 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)j.
Permit Holder's Name: City Village X Township
~4a.1 ~~ S • Hudson Townshi
CST BM Elev. o, Insp. BM Elev~ BM Descri do
• ~ •~ 'Ra- ~ l h ~ ~ CST e~~ 2 `
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY
Septic , 1 ~~~_
W (Z
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic tJ, f • ~ ~ Z 1 ~,~.
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufa turer Demand
GPM
Model Nu er
TDH Lift riction Loss System Head T H Ft
For main Length
SYSTEM
s~ ~rv~ vviam t
DIME S '.3
SETBACK SYSTEM TO
INFORMATION
Type O_ f System:
DISTRIBUTION SYSTEM
No, Of Trenches
3
P/L BLDG
to ,~, ~ ~ ~'
~ L. P1c..
county: St. Croix
Sanitary Permit No:
4304 7 0
State Plan ID No:
Parcel Tax No:
020-1395-55-000 ~
Section own/Range/Map No:
auR~ 25.29.19.2449
STATION BS HI FS ELEV.
Benchmark n Z~
t.~
, os? .7~
~ o~ -v
Alt. BM
Bldg. Sewer
SUHt Inlet .Q
l!
qz•~s
SUHt Outlet
t~
9Z.2o
Dt Inlet
Dt Bottom
Header/Man,
Dist. Pipe
sot. System
l'2• `{.V )3.S ..~Y I
Final Grade ~~ (o.
3~$0
9~ . o
St Cover S J ~~~ ~c p,_ ~ , /p f
i~{
3 ~o
C
~ - .-
PIT DIMENSIONS INo. Of Pits
LAKE/STREAM LEACHING Manufa~r~~•
CHAMBER OR yy~~--++
„_-~ UNIT Model Number: ' ~~~
Header/Manifolc~~ u
Length ~ Dia Distribution
Pip
Length is Spacing x Hole Size x Hole Spacing Vent to Air Intake
SOIL COVER
x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
BedlTrench Center Bed/Trench Edges Topsoil
0 Yes
~ No
~ Yes
~
No
/~{o~~E~ S, (Inclu de discre }mss, rsons present, etc.) Inspection #1 • ,~~ Inspection #2: ~
(` i; ~yllrgJZ acs ~~1,t9~ ~ c/'
ocation: 863 Highlander Trail Hudson, WI 54016 (SE 1/4 NW 1/4 25 T29N R19W) Scenic Hills Lot 55 Parcel No: 25.29.19.2449 ~.
~/ p~sea~~f ~-o /tee ~ o2v~e~ rt e~ ~'
1.) Alt BM Description =
2.) Bldg sewer length = 7}Z ~ /,/~~ ~ ~ ~~ ~ ~/D~ca/ ~7"-"
- amount of cover = T~"
Plan revision Req fired? Yes No ~ ~ ~ -~ ~~ ~--~
Use other side for additional information. i~l ___ -_____ ~_~ _ _.
SSBB ~1 Date r 1 ~ Ql~n~s~e~p~cto~r's Signature ~ Cert. No.
7 ~ -6~2~ R.3/97) A u~}-J,.,_ Q A A ~ n~~~,,,_ ~„r GY -~j \ZJ -~g'~"~'"" (~,v` ` °Q ~~ ~ t' ~~
-~.~~J~ ~~Q~ r""'"'"` ~~\s Imo! S) /Jo~'{~,,~..~-s ~ws~ cd...tRa~~,, ,,~,e
~A 1 ~ 2~Q'ety a Buildings llivision County
a ' „ 201 W. Washi ton Ave., P.O. Bo ~~
' ~ ~~Y~~ ~°
hadtso WI 53707 - 7162
ISCa/tS/ ST. C OIX COU(~l~ anitary Permit Number (to be filled in by Co.)
Department of Commer ZO ING OFFICE 8) 2ti6-3151 ~s~ _ Cllr-2
7 ~ T
Sanitar
Permit A
li
ti state Plan 1.D. Number
y
pp
ca
on
In accord with Comm 83.21, Wis. Adm. Code, personal inforntadon you provide ' "
may be used for secondary purposes Privacy Law, s15.114(1)(m) Project Address (if different t tan mailing address)
~~
I
A
lic
f
ti
I
ti
Pl
.
pp
on
a
n
orma
on -
ease Print Alt Inform
Property Owner's Na me Parcel X S Lot;Y ~ lock /i
~ZO- /39
-~
Ca Y r,t .e ~P~~ s ~. ~+,J~-~ f~~ ~' /~~e y s ~ ~
Property Owne s M ailing Address Property Location r -^~ /~'/
~ t
'~ '
~~
Cit
te
Sta k,
~
.4,Section
y,
Zip Code Phone Number
/
a c! c~ f,3a, ~, ~y ~I~1 ~
- d
~ (circle o )
T
~ N; R~
E o~
II. Type of B il
ng
(check alf that apply) ~ ~~ dy _,
_
~
i
!S
bdi
N
CSM N
be
~l or 2 Family Dwelling -Number of Aedrooms u
vis
on
ame
um
r
^ Public/Commercial -Describe Use _ __ ~ _
~ / //
~,~/,' ~ l/rf/( s
^ State Owned -Describe Use .~~~ IiCC.L--S ~~1~~ ^Village ^Township of ~
L~City
~S'O~
_
i _
,
-
III. Type of Permit: (Check only one ox on line A. Complete line B if applicable)
A' I (>~-New System ; ^ Replacement System ^ Treatment/1lolding Tank Replacement Only ^ Other Modification to Existing System
B. ^ Permit Renewal Permit Revision
"~~~'- ^ Change of ermi[ T
ra
nsfer
to
New
List Previous Permit Nu rand to su r~
Before Expiration -
~
~
~
Plumber Owner i~i"Ls0 GW ~ ~~ ~®
IV. T of POWTS System: (Check all that ap pl~`__T ,S
`~-P1on -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter
I ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aembic
' Treatment Unit ^ Recirculating Sand Filter
^ Recirculating Synthetic Media Filter Leaching Chamber
^ Drip Line ^ Gr vet-le ^ Other (explain) ~Q,C~
_
V. Dis rsallTreatment Area Information: ~e..v a r y
Design Ftow (gpd) Design Soil Application Rate(gpdsl7 Dispersal Area Required fsf) Dispersal Area Proposed (sf) stem Elevation 9f~! Q
QD ~ . ~ ~ ~_ g~a g ~ ~ 0 9S.o'
VI. Tank Info Capacity in Total Number Manufacturer Prefab ' e Steel Fiber Plastic
Gallons Gallons of• Units Concrete Constructed Glass
( New Existing
I Tanks Tanks
Sep[ic or }ioiding Tana
,SD
I
~,'es~ ~ -
Z `
Aerobic Treatment Unit
i Dosing Chamber
~'
I ~
~~- -
--
Vi II. Responsibility State - I, the undersigned, assume respmtsibility For ' allatiun of the POWTS shown on the attached plans.
Plumber's Na me (Print} Plumber's Si gnature M PRS Number Business Phone Number
~, l ~.`a vvr S'G~l, ~~c ~JI,~.C~~~ ,?2? Gi ~/ Q 7! - 3 mil- 3 / 2 l
Plumber's Addre ss {Street, City, State, Zip Code)
lp 7d
VII Count /De artment Use Onl
5arritary Permit Foe includes Groundwater
_ Approved ^ Disapproved
Surcharge Fee) Q_O
^ O
Gi
~ Date Issued Issuing Age t Sign re S mps)
`
`
wnor
ven Reason for Denial ~5
~~~~ .Approval/Reasons for Disapp .~
eptic tank, effluent filter and 3 ~ c
dispersal cell must all be serviced / maintal ~/
as per mono ement Ian r L~~ ~~ ~ ~3•
fZ
t be maintained
i
t
2
k
A .
.
remen
s mus
requ
.
se ac
as per applicable code/ordinances.
,~'~u~~l ~ ~sys~ ~t'71.~~'~a~~~~~ ,6~~oh,Q~
,/ ~, ,~- ~ A Jt tpiete
SBD-b3 (R. Ol/03} ~ Get `
T
~~
;~¢.
w.
~/
thr C not ly) fu t o ystem~on r t 8112 fs s
~ off. ,
~~_ _ _ - ~-
~r-E76-04 03:46F~ joe ban,Fe 651 734 9836 ~~R.O1
a°~~ ~s'~~ r ~ ~-~r~
,CCU •' H.W L.:. ~1~;~.:~ Nrl `~~3~
g$~'
l~ ~ TOI' OF HU[S
4'-' t x, r
'K TOP OF HUf i
' ' fe.--I I V-~J1,b0
TOP OF HlIF3_~4
FlV_100112 ` 2Z ~ BZ ~~ N~i~~
x, w /':
~- ~x `----' c
4s3 ~ ~
~J~J~ l H.W 1. = 965.5 ~
s,` ~
Jn, ,'`- o ~ ~'~
-g t ~ t ~,
~ i~
~~ ys'
N89"G4'G9'F 94,76'
~'~~ ~s
I, Douglas J. Mahler, Registered Wisconsin /)
Land Surveyor, hereby certify that this - ~ ~ C S'['~~ 2 ~_; Q
Stake-oupt Plan was prepared under my ~~~~ n s~°"`'~~
direct su ervision and is correct to the ~~ e~-
best of my knowledge and belief. ~ ~ ~- tl~t~ _ p3 )~w~
ca a
LOT 55 ~~ ~~ ~ (~ ~
~r ~~nA ~ ~~
QFFSET STAKES ANE 15' \,~~ ' /\,0~ (~
k, CIENOTES WOOD STAKE 5FT CZ, g~~^p Z ~~
113£3.3h C}EN(7~ F" Fxl;;;iING ELEVATION QN OFfSF'I HUti
~TM
p
~ ~ ~
~ ~ ~ Q ~! 4
~^o ~~ ~
~~~ ~~
i
~ ~ ~~
~~
~~ z~
a
O
`~' U
tai -
ZW
•~ ~ ~
1.
~ a _ ~' ~ a yo ~d' ~^~~ r ~~s/ 1~~L__s?.."J~_SG Gam/ - G Y~ ~- l<-~' ! OCV A/_t2~` ~ c= ~~'P L/
~ i -
alccr~,c /' =YOB
~~'I.lia,'1 ~'-d TrC~ !AO
,~
4
~ S~
~~
~C
i
~~ ~~,4
~,~ s;t
~'~
.~~! ,~'
~~ _ ,~,~
y ~~
1~
j
r
i
I
J1
1
i' ~S.
fi; .~ Z c-~~ ` I~
".,~,~ ll
l~~ '~ld®
N
`)
~ ~.
-- .~
~_ ~-~
,~.
__.__
~' ( '~~
YZ
~II~
~, .~,,~
~<
~ ^ c.
~' ~Q~~if'~'s ~ /~' h ~ /~ ~A ~ ~~ SSG Cil~r`G ~/` l C r ! d A/ !J~ l~~.s'd ~
/ / ~Urr~ e(~ ~/
ar'~~~ /' =Y4.
~fir,UR,'~ ~'~/ 1'ro.s lDJ.
PAGE~OF~
N,pME;_Q~~~ LOT#~_LEGAL.DESCRIPTION:~i/4A~G.lU4,S,~ZT~,N,R,,j~E(or)Vw
SCALE: i"~ W!'
(~p,,\ ELEVATION: I~~ ' ~
BM i DESCRIPTION: (10. ~ ~ r`!l ~~ r ddvh~ 00. -1-~~
BM 2 ELEVATION: lCX~ ~ ~ <~
BM 2 DESCRIPTION: hu ~ (~ ^ ~ Z ~ aa~'
~,,
SYSTEM ELEVATION: IOr U U °"~
SYSTEM TYPE: ~~ iP~~'a nc..(~
r~
I
Z ' ~.
/ ~ ~~Y
I~r~
q~ ~ ID k ~ aid
~ z ~~ ~
/ ~ t~
~r ~
~~ ~ ~pJ \
/6~ ~ ~~
,~, , y ~ !/i - .
\ ~ ~ r
~-~ ,~~
~~J~~r~ea ,~ ~ ~ ~
~ ~ ~~ ~
~ /~ , .~ 2
~ ~~ ~~ ~ N
~ ~ ~~ ~~
~~ ~'~~ - ti~ ~ 1 ~ , -~
~ y ~ _ _ ~~'
SIGNA _ -- DATE: 1 Z O
~ ~ ~, ~ ~
~~ ~ s~
~ ;
3
°~~
,~
~ ~ - 11.0
12.1 x 6
~~ . x
~ ~'° 1 E
~~ ( ~ . x
7X , 0 2.5
H
f
,~ ' " ~ .
I.
•
~~~ N 01.9
X
7 AC
C13
®° S19,
995.9 . ,
.~ _~ ,.
1 1
'~~r ~ 9 1
r 1%~r/ / 156.2
~% ~ f
r X~ ~~
"`1051516
j
~ 1'
j 1054.2 ~
I x ) -.
// / --
t ~- !.~'~
3 `~ ~
p o H
ca D'y
o. 1W
0 ~
O
n ~
~ ~
x `~
m
d
S
N
N
C
N
N
n y J I'il to O W D
y >' 0 0~ `< 7 C d
d o f7 N~~~ G d
m ga~ 0 3`°•~ ~
_ ~ ai uai' -OO n N ~ o
m ~
~ ~ ~~ ~ as y
~o$y~~~~
.~ g~ ~
lD N y
a~~ ~ w o ~
~ ~ ~o.~ m
~'-' ~ ~ 7 y NN ~.
~ N ? O O 01
O~ ~ ~~o.~
O O.
~ N ~ y ~ N N
~ O N ~ v A0O ~
07 ~ tD O 0i ~
=~ d W W 7
o m a ... °c
~ ~
O
N
O
O L
°c ~ ~
~ ~ ~
~ ~
s
o w n
m
~ 3.
V ~
2
3
y
~+ C O
_ ~ O
Tw
J Z
0 ~
W ...~
o~
O ~ a
N
~~~~
~ v v ~
d ~~
C
~ ~~ ~
w
7 O O
~ 0I 7
O ~ ~
~ f~
N
n C
S
7
a
C
a
`~ A
3
w Z
A
c
c
a
3 d o
~ n 3
~ v
C GNJI N
c ~ Q
~ ~ ~
O ~ ~
co
o
d1 .'O'.' C
3 ~
':
CST ~
x
(n
J
A Z n
~ ~ ~.
A Z O
.. ~
m n~i cNi+
J
Z
A
W
A
d
I^
!~
I~
L7
O
A~
~•
0
O
•
~a
A
fi
ti
H
~d
O
A
i ti
p
Op ,~+~'
A O
~' V
~ ~ .. ^~-~.. 1
r
Wisconsin Department of Commerce
Division of Safety and Buildings
SOIL EVALUATION REPORT
Page ~ of
m ac~.vroancz vain ~.or nm ate, vns. vwm. was
County r
Attach complete site plan on n.
spar i~~'~ ~I 1 in sin size
Plan must
indude, but Trot limited to: ve 'cal and horizontal reference poin .
(BM), direction and Parcel I.D. 420 ..
~
~`
~ ~~
percent slope, scale or dime sions, north arrow, and location a d distance to nearest road. .
,
PI se p~i ~al~ i~foon. evie by Date
Personal information you provid
may be used for secondary purposes
fusty Law, s. 15.1M (1) (m)). ,/
~ ~ ~ 7
Properly Owner ZONING OFFICE Property Location
0~ r t C G~~ Govt. Lot s~ 1/4 1/4 S Z j T N R ~ Q E (or)aov
Property Owner's Mailing Address lot # Block # Subd. Name ar CSM#
' S v w o~~ ~ 5 sc~e ~ °~ , 115
City State Z'ip Code Phone Number ^ City ^ Yllage ®Town . .Nearest Road
~rJVC1~ u~ (~) 73`1 q ~ o ;
(~ New Construction Use: ~ Residential / Number of bedrooms _~ Code derived design flow rate ~~ ~!~ GPD
^ Replacement ^ Public or commeraal -Describe: ~ y.
Parent material _ (~ J i~ c~ Slp Flood Plain elevationpif apJplicLable ~~~- R
~ mendations: ~STQN^ ~-~ZV.~~.oo ~/ ~~~/~q 4'>'7 GO'Yt'~/~
r ~2 ~J ~ ~ -`-l•~~ i-Z-~l~`~ crl~0~
~~~ ~~~ U'Sz~/ G~TS~
~ ~~
Boring # (~
t,~i Pit
Ground surface elev.? S ~ ~ ft. Depth to limiting factor in. '3 3 ~~ Sf~/!n'
Sod Application Rate n Doi
Horizon Depfl1 Dominant Cd Redox Description Texture Stnxxure Consistence Boundary Roots GP D/ff
in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 •Eff#2
Z b "3Z G l S~ G( ~ A r
~ 3z -II v 1 - - ~ ~
q~
• Effluent #1 = BOD, > 30 < 220 mgft. and TSS >30 < 150 mglL ' Efl9ueM #2 = GODS < 30 mglL and TSS < 30 mglL
CST Name (Please Prirrt) re ~ - CST Number
//~~ ~~ Z
Address `'~~~ ^ ~ v~ Date Evaluation Conducted Telephone Number
a I (3 ~~:5-~, ~r~-~, crsl. -Sz/oz,~ i/-/7- ~' ~ his'-7Gd -BZ ~~
2 Boring # ~ Boring
~ pit Ground surface elev. . ~ v ft. Depth to limiting factor l~ Z in.
Sod lication Rate
Horizon Depth Dominant Cdor Redox Description Texture Stn~cture Consistence Boundary Roots GP D/fP
in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2
Z q -~1Z - ~.~ Zms ~ C - ~ ~ ,lo
N2-II d` (~ ( --- -
u ,
BZ
Y
Property Owner f~O /~ t ~ Parcel ID #
r ~,:r `
Page L of
® ~~ # ^ Boring
® pit Ground surface elev. 9~ ft. Depth to limiting factor ~_ in. son ~~ Rata
Horizon Depth Dominant Color Redox Description Texture Struchne Consistence Boundary Roots GP DlfF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `EtT#2
~ -~ 3i - s~' I ~ ~ ~ s -~ , s" ,. 8
3 ~' ~ // Q s / r 1 ~~ f~ / w~
cif- ®. D `--`- a rr ~ <,
^ ~~ ~uw~
Boring #
^ Pit Ground elev. 8. Oepth to limiting factor in. Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Struchue Consistence Boundary Roots GP D/ff
in. MunseO Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
~,~# ^ ~~
^ Pit Ground surfar:e elev. ft. Depth to limiting facdor in.
Soil ication Rate
Horizon Depth Dominant Cd Redox Description. Texture Strucdue Consistence Boundary Roots GP D/ff
in. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eif#1 'Eft#2
• Effkierrt #1 = BODE > 30 <_ 220 mglL and TSS >30 < 150 mgA. ' EftlueM #2 = BOD, < 30 rngll and TSS < 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
seo.e3w (te.wao>
°Mf
• { '
SCALE: I"= ~~ _
:~~ ,
~~~ELEVATION: Ian' ~ ~'
BM 1 DESCRIPTION: f10. << r'rl 1~ ~~ doh o c.~a~ ~1-~~-
BM 2 ELEVATION: JCS ~ ~
t
BM 2 DESCRIPTION: hu ~ (~'~ ~ Z ~ d0. "°"
SYSTEM ELEVATION: qOr 0 ~ - ~~~
SYSTEM TYPE:_~~ni/c~~(~
PAGE' OF~
NAME: ~.~~ LOT#~_LEGALDESCRIPTION~I/4~AM1'l/4,S,~T~,N,R,,~,E(~)~
~~~
f~,yL9`-
oQ
SIGNAT
DATE: /I - Zl.~ - Q 3
~i
U 2434P 517
STATE BAR OF WISCONSIN FORM 1 -1998
WARRANTY DEED
020-1395-55-000
Paroel Identification Number (P0~
TIdLS DEED, made between Carriage Homes XXI, Inc., a Minnesota
Corporation Grantor, and Bonfe Home BnBd~ i++r. s ... snore
Corporation, Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate im St. Croix County, State of Wisconsin (the
"Property':
SEE ATTACHED EXHIBIT A
This is not hotneatcad property.
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in
fee simple and free and clear of encumbrances except
Dated this 10th day of October, 2003.
Carriage s XXI, Inc.
(SEAL)
• Kellei St. Martin, Vice President •
(SEAL)
r •
AUTHENTICATION
Signature(s)
suthendcated this 10th day of October, 2003
•
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stars.)
THIS INSTRUMENT WAS DRAFTED BY
Greg Booth, Attorney 1900 Silver Lake Road New Bright
Mnssllz
Recording Area
RECE p Cpg
10/13/2003 12:30PM
MARRANTY DEED
EXEMPT #
743496 ~~
REGISTER OF DEEDS
ST. CROIX CO. , MI
REC FEE: 13.08
TRAMS FEE: 300.00
COPY FEE:
CC FEE;
PAGES; 2
Name and Return Address:
Land Title lnc.
1900 Silver Lake Rosd Suite 200
New B~rigGhton MOn 55112
~~-o~ l~
ACKNOWLEDGMENT
STATE OF MINNESOTA
}SS.
WASHINGTON COUNTY.
(SEAL)
(SEAL)
Personally came before me this 10th day of October, 2003,
the above named Kellei St. Martin the Vice President
of Caniage Homes XXI, Inc. a Minnesota Corporation, to me
known to be the person(s) who executed the foregoing
instrument and acknowledge the same.
r
t ~
Notary Public, State of MINNESOTA
(Signatures maybe authenticated or acknowledged. Both are My commission is permanent. (If not, state expiration date:
mot necessary.)
'Names of pe~som signing in any capacity must be typed or printed blow that
signature.
• ~•
NANCY J. LENTZ
-®.~ NOTARY PUBLIC-MINNESOTA
My Gahm. Expiroa Jan. 37, 2005
f Kut't ~l.r.•..~I t,G r.Gt t r uu,t. i, r1 t r~ . . ,~. , a ~~•1~~.~i ~-Y• l~~ .-u':+1 u~• tr:A~1'1 1'-r
OwaerBuyor
4AOi1~ VV Lilt i i
~l3P~rlc raNlc 11~TBNANCA af~ltLEMENf
OWNERSHIP CERTIFICATION F~R,~.-=
~6N~ ~~~~ ,~~/iL-,D~zS
Meiling Addrt:ss ~ ?S® S l lw~v ~ ~ ,A/b ~~d Cues vLth Ss'4~22
Property Addross ~6 3 ~ ~, i a v~~ r 'Try; ~- f
(Vctificstioa roquicod tinm Planniag Department for new Cogstrltetion)
(xty/s~ t ~ G Parcel Identification Ntunber
Oz° ' 139x` _ SS-~ ~ . 2 `(`f ~ I
~.EG1AI1, D Q~ s,~r ~,~f~cl,~a L l'.o-~ v,c~ t~ «~, .
Proptxty Location ~„ '/., '/., Sec. . T N-R~,_iW, 7bwn of
• .-
Subdivision •~CE~l1~ ~L~.4 ... .Lot # ~ ~
Certified fiucvey Map #
Warranty peed # _
Spec house ^ yes ~. no
'Volume , .Page # . ~~~!
Volume =~ ~~ ., Page # ~.~,~~~3' ' ~
Y.ot lints identifiable ~ yes ^ no
SYST~1Vt MA.YriTIrNANCE
~p~ trse and try of your septic system eaald result in its premature failure to hat~a wtttOss. Ptnper ttsAintenancx
wusists of pumpi:rg oat the septic tank every three years or sooner. if t~eded by a licensed pumper: What q~ott pat into the system
caa affoct the fuactioa of the septic tank ss a trCat<ucnt stage in the reasto disposal systettr.
'ire property owaar agtbes to submit to St. Crofx 7auing Depazttncnt a ccttifcatioa tbrm, dg~Cd 6Y &O ovruer aad by a
plumbed jaurpeymaaplambet, restri,ctcdphunberora ucensodp~rvaifying that(1) tho oa~itewattewatecdisposal system
3s in proper operatir~ ooaditiou a<ad/or (2) ai~er a~spoction and pomnpiag Crf aeoasaty), the septic tank fa less i~ l/3 full oaf sledge.
Ilwe, tbn egged have trad the shave ncqu;rcnnarts gad sgroo w ~taamtaia the private sewage disposal sgttetn Witt tam aaada:ds
set forth. herein, as sat by the of Commerce and the Depattmeut of IQatural Resources, State of Wisconsin. CetHficadon
stating that your septic bocu maintained must bo complctod and returned to the Sr. Croi~c County Zot1ing Office within 30
days of ~j4xp date.
>;I F LICANT UA1`13
Y (wc) certify 11 etatcaacnts oa this form are trot to the best of my (our) imawledge. I (we) am (are) the owaet(s) o
the pro des 'bltd ve, by virtue of a warranty deed recorded in Register of Deeds Office.
APPLICANT pA'I'B
•tr+•' Any information that is mss-rteprosented may result in the sanituy permit being revoked by the Zoatng Deputmeas. «~`""`
'`• Iac[ude with this :pp[Ication: a stmmped wsttanty deed froar the Register of Dce~ds afiice .
a copy of the cccttfi,ed sarvcy map if referenco is trade in the vvatzaaty deed
POWTS OWNER'S MANUAL & MANAGEMENT Pi.AN Page of Y
SPSCIFtCATt!ON$
Number of bedrooms ~ d NA
Number of Public Facility Units A
Estimated lbw tavera$e} ~/ /I,~~..~~
~v al/da
Desbgn flow (peak}, (Estimated x 1.5} ~~ Q' al/da
Sog Application Rate al/da /ftz
Standard tntluent/t:ffluent Cluatity Monthly average'
Fats, Oil S Grease (FOG} 530 mglL
Biochemical Oxygen Demand it30De} 5220 mg/L DNA
Total Suspended Solids iTSS} 5160 mg/L
Pretreated Effluent Quality Mortthiy average
Bioohemioal Oxygen Demand tBADs} 530 mg/!
Total Suspended Sonde tT58} S30 mg/t. DNA
Fecal Conform tgaametric means 510° cfuN OOrnI
Maximum Effluent Particle Siza Y` in dia. Q NA
~~' ^ NA
°fYaluas typical for dorneedC vraetev~ratsr and septic tank effluent.
rank Capanity ,~ p' al DNA
rank Manufacturer , O NA
Effluent Filter Manufacturer ~ ~ n NA
Effluent Filler Model S4' d NA
Pump Tank Capacity al O NA
Pump Tank Manufacturer rLoS ~,Y. DNA
Pump Manufacturer ~,,~,~/ ^ NA
Pump Modal ~ DNA
Pretreatment Unit
D SandlGravei Fllter
D Mechankal Aeration
O plsinfeotion
O Peat Filter
D Wetland
O Other: 0 NA
Dbpersai Celf(s}
^ !n-Ground tgravltyi
D AL-Grade
d D-ip-Line DNA
I~ in-Grotmd (pressurized)
O Mound
^ Other:
Otlwr. DNA
Otl~er: DNA
~~~ ^ NA
MaarEntAf~cE BCIit~JLE
8srvif:e t:wM Senrke Frsqusnoy
inspect condkion of tank(s) At least once every: 3 ear ai lMaxinwm 3 yeah} O NA
Pump out Contents Ct rankle! When combined sludge and scum equals one-third tYs) 4f tank volume ^ NA
inspect dispersal Ceil(a} At least onus every: ~ ~~~al tMddmuni 3 years} DNA
Clean effluent fEter At least onoe every: monthts}
o ~" er(e) O NA
Inspect pump, pump controls & alarm At least once every: monthts}
"" [] arts} O NA
Flush laterals and pressure test At least once every: .-- mon ta}
O sots! O NA
other: At least once every: „f. monthta)
D ate) ^ NA
Otlwe:
0 NA
MAINTENAtrtCE lasTRUCnonis ,
inspsationa of tanks and dispersal ce8s shall be made by an individual canyinp one of the following licensee or certifications:
Master Plumber; Master Plumber Restricted Sewer; POW'fS inspector; POWTS Maintainer; Septsge ServicMg Operator. Tank
inspsctiona must include a visual inspection of the tsnktsi to identify any missing or broken hardware, identffy any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up a pondinq of effluent on the ground surface.
The dispersal celits} ahatt be visually inspected to check the effluent levels in the abaervation pipes and to check far any pondittg
of effluent an 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 lY~} 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,
Wisoonain Adminlatrative Code.
Alt other servlaea, inoksding but not limited to the servicing of effluent ftltars, mechanical ar pressurized components, pretreatment
units, and any aervick-g at intervals of s12 months, shall bs performed by a certified i'OWTS Maintainer.
A service repots shalt bs provided to the lace! regulatory authority whhin 10 days of completions of any service event.
DESIQN PARAMETERS
•apoa aRliaJistuwlpV utsuooslM 'tE! ~ tG! '1l)4t3'E8 Pus t~1~8tR-ttllq!!Z)ZZ'E8 wwaa ,aideyo yyM aouslldwoa to pai{eJp sen- uiauJfwop sell
~ ~}~ ' ~ ~ ' S1-~ Fwd ~~a
h jYln~t .J~1dV ~ JoZ!'J awely ~ ~ awsN
~traoktnr Aaoirnnoa~ ~aoo~ ali~awn~i aoivaaao ONi0iAf;lis 31:1V1d3S
euoyd
vws{y
a~Nnr~.N~rW tslnnoa
r ~~ -~, ~ - .~ c auoyd
>~'11r1SN1$1MOd
V S1N3WWO0 '1VNOlltOgv
'31~18SOdWi !30 1ltt0i3dlq 39 AVW ANrl d dO >liOla~l.Nl 8N1 WO!!d NO8><Hd
~ d0 3!1033!! `11nS3a AdW Fl.LV30 'S30Nr1SWnOli10 ANr a3QNfl ~INrl 1N3W1r3>E!1 a3H10 !fO dWnd 'Oll.d38 r l131N3
lON OQ 'N3011X0 1N3i0l3di13N! li0/CINV S3SSr~11VH1.31 NIr1NO0 JIVW S?lNll/1 1N3W1V13!!1 li3tW10 qNV dwnd 'aI1d3S
< <oNtNarnn> >
•awli !eyi is ioa;;a u! saln, oyx yxlM dldwoo lsnw suteis~ts yens ;o suotloru3suooea 'eoelJns rsnlieJill;ul
ayi ie ieutolq ayi ;o lenowaJ 6ulnnollo; aaeld u! peionJ3suaooJ aq tisw ruJaxsAs uolidJOSgs !roe ops.-B-1a pus punayy p
~luei
alts P 1
'S1MOd palled ayi ooeldoJ of uosaJ isel a se pollsisul eq itew ~lusi t3ulploy s At3olouyoai
S1Mt7d ul saausnps t3wJJea •suollsilux!I Iloc Jo/pue ~loegxas- of anp alge!lene iou sl saJe iuau.wosldao olgsilns y p
•awli isyl is taa}ja u! selnJ ayi yilM A~dwoo
lsnw su~ais,ts iuawaaslda}~ 'e®J+s iuawousldaa olgeilns s ysllgeisa ox uol3esrlsno ails pus !roe Mau g Jod peso 9yi u- iinse~
pIM eaJe ivawaasldaJ ayi i~lOJd ai oJnlls~ 'sllsM pus sou!! ioi 'aJnias~Jxs pasoclad pus dulislxo usoJ; sxasgies paJlnbeJ
Aq uodn po9uudu, eq iou plnoys pus uaioedwoo pus eausgxnisip u,oJ; paioaload aq pinoys saxs iuewfosldaJ ayl •luai>:As
uolidJOSge llas iu®tuaasldex a do uolisiool ayi tad p8xlltln aq Aew pue paienlene uoeq say ea,~e 3uvuJaosldot elgsitns y~
:wo3eM iuowaoe{deJ
iuelldwoo apoa a aplnox! of 'ue~lei oq isnw Jo 'uaaq eney soJnssaui Bu-MOllad ayi paJlsdaJ aq iouueo pus s!!e; S1MOd ayi 31
Nr'k! JlON3ONIlNOO
'ts!Ja3ew linos xJaul Jayioue Ja pnarx6 •llos
'~Y!M Pal!!d seeds plop ayl pue ps~nouJeJ sJanoa Jlay1 Jo panouJaJ pus palpnsaxa aq llsys sill pue e~luex }le `6uldwnd Jsi;d a
JoieJedq 8uralneog aBsldag a Aq do pssodsrap ~tlJadoJd pue panouaaJ eq Heys sild pue s~usl f!g do aiuaiuaa e~ o
•palaos s8usuado adtCl pauopusge ayi pue paiaauuoaslp aq !lays sild pus s~lusi o3 9ur~dld Ity o
:apo0 enl3eJislulWpd utsuoas!/~'£>r'gg wuao0 Jaideyo yilM aouetldwao ul ps~uopuage AlAdes pue /yaedoxd
sl uJaisns ayi !eyi aJnsul ox ua~lei aq !lays sde;s Bwn~ol)o; ayi a:,ln.~as do ino ua~lai ~lliuausuuod s! Jo/pus ells} glMtad eyi uoyM
~iu~wNOaNrar
•awJq Jeuax;os JaxaM puo :suodwex :sul~d8u ~Jeilues :saploltsad :sxonpoJd $ul2ulad
:Ilo :suotxeolpau,t :sdeJas ieauJ :saplalgJay :asseat3 :oullose6 :sBullead olgeiaben pus ilftJd :JaxeM {dwnd dwns) ulaJp uol~punod
:ie! :s~ueioedulslp :sJedelp :ssoid lelu®p :s~esseJBep fsgenns uoixao :suJOpuoa :sunq aueJebld :sadlM Ageq :saliolglius :g1MOd
ay; ;o a~,ll aye t3uolaJd pue aaueu,uo~ad ayi anaJdwl Asu~ uisaJis JaxeMaxssM ayi wad 9ulnnollo; ayi do uolisulwllra xu uolior-ped
•aaJS uolidaosga floe apaJ6-is ~a punaui Aue ;o odale unnop iaad g t ulyilM
esJe ayi yor3duaoa •a q,nislp oslMJOyio xo 'Jano ~lJed Jo anup iou o0 •siloo lesJOdslp pus s~luai Jano salolyon ~Jsd io onlJp iou oti
•~1u93 dutnd Ay1 ultli)M slen~ lswJau 6ta1BaJ
of sloJiuoo dulnd aye 9uliBJ®du ~tpenuQUS ul islsse of +auleiu!sW S1Mbd Jo Jagwnld a ioewoa Jo dwnd loan!;da oyi of JaMad
BuuoisaJ of JalJd JoieJadp sulolnJeg e6eideg Q Aq panaweJ ~luei dwnd ayi {o slueiuoo ayi eney uolieni4s slyi plops of •iuonl{{s
do abxeyoslp aas~ns ~o dn~oeq ayi u! ilns°J Asw pue islllao ayi DulpeolJeno 'asop ebJel goo ul (s)Ileo lesJS-dslp ayi of peSJSyoslp
aq lltM 18I~MaiSeM SSBO%A ayi peJOlsa~ SI 1aMOd Uey(y~ 'Slane! JsieMy6ly let1J10U anoge lil- /1Bw S~lUSi dwnd seBeinO 1AMOd t;ulanp
•eae}xns ontiex~t!lu! eyi is uaxwd oJe suali!puoo llos ueyM Jrsooo too ilQys do iasis wais~g
•asn ai aolJd ~o3eJado 8ulolnsos edeidas a Aq ponouaJ ~sy~luei ayl do
siualuoa ayi eney peioaiap ae suolisJiueauoa ygl4 d! 'lslllso lesJadslp ayt a8su+ep eo/pus ssaooJd 3uaLUieeJi eyi spadtul AsUt !eyi
slealuJaya Jayio J4 si~npoJd t3ulluled do aaueaaJd aye Jod {sl~luet xuau.~39aJi ~~yo S1MOd ayx do osn of JolJd 'u0lioMlRUO~ MOU JOB
Nouraiao qNr do ~.aer.s
®~ e$ed
Safety and Buildings Division County
,. ~ 201
W. Washington Ave
O
P
Box 7162 ~
' .
.,
.
.
,,,~CO~~
,n Madison, WI 53707 - 7162 Sanitary Permit Number (w be filled in by Co.)
De artment of Commerce (fig) 26b-3151 ~3D ~--' I
Sanitary Permit Application state Plan I.D. Number
In accord with Comm 83.21, Wrs. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, si5,04(I}(m) Project Address (if different than mailing address)
I. Application Information -Please Prlnt All Information ~ ~ 3 f {-~ ~ {( L>~ ~_ (~Zy4 ~
~
. ~Y m ~~
Property Owner's Na me '" -
Parcel # Lot # Block #
Property Owner's ailing Address ,__!~-- propQrry Location
~~~ ~'r'l/~~~eY .~ c~c~ .~ ~
Ci
S
ue '
s
ty,
k•~w ,'k,Section .~`
'
tate Zip Code c>~'~itixitiei `
~--
.~......~ (circle o )
~` ~~-`~,~fi' d'J'2-'~ ~~ ~
'
II. Type of Building (check all that apply) T ?~~ , N; R~E o~
°~ p~ S ~ s .
1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number
-^ Public/Commercial- Describe Use p _~~ - fj/~~•
^ Stale Owned -Describe Use Z) 3 (~ O ~ S
^City ^Village Township of ff4~
-
2
III. Type of Permit: (Cheek only one box on line A. C lete line B if a plicable) ~j ~ _ _ SS ~ . 2
A' ~, New System ^ Replacement System ^ Tre nUHolding Tank Replacement Only ^ Other Modification to Existing S rem
t B • ^ Permit Renewal ^ Permit Revision ^ C ange of ^ Permit Transfer to New List P io a ued
Before Expiration Plu bet Owner
i IVY Type of POWTS System; (Check all that ap pl
Non -Pressurized In-Ground ^ Moutuf > 24 in. of itable soil ^ ound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter
^ Constructed Wetland ^ Pressurized In-Ground Holding Tank ^ ea[ Filter ^ Aerobic Treaunent Unit ^ Recirculating Sand Filter
^ Recirculating Synthetic Media Filter ~eaching tuber ^ Drip Une ^ Gravel-less Pipe ^ Other (explain)
V, Dis rsal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate( sf) Dispersal Area Requir (sf) .Dispersal Area Pr s (sf) System Elevation
VI. Tank Info Capacity in Number Manufact ter Prefab rte Steel Fiber plastic
Gallons Gallo of Units Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
~
ev~"~fr
Aerobic Treatment Unit
Dosing Chamber ~ ~ `
i
~
_ I ~i
'2 t5 ~1~'
VII. Responsibility Statement- I, the u dersigned, assume re,,ponsibility Fur ' allation of the POW'i'S shown on the attached plans.
Plumber s aN me (Print) Pl bet's Si gnature 4P PRS Number Busintss Phone Number
Plumber's Addre ss (Street, City, State, Code)
~~~2 ~a 7~~ ...~ c~~~ L~~`
~`s~'o
~~
,
.
. VIII. Count /De artment Use Onl
Approved ^ Disapproved Sanitary Permi[ Fee (includzs Groundwater Date Issued Issuin Agent Signature o Stamps)
Surcharge Fee) ,
^ Ow
Gi
~
-
ner
ven Reason for Denial
--- , ~ ~ -
2~ ~
IX. Conditions of Approval/Reasons for Disapproval \ ~-
3 5 ~
SYSTEM OWNER
: ~ ( ~ ~ nth
` 4, dG
1 Septic tank, effluent filter and ~
=
'
f
-
__
dispersal cell must all be serviced / maintainel ~ Si
~
~
as
~~"'~~
~
,
p ~19M~~
per management plan provided by plumber.
~
'
-
-t
~
2. All setback requirements must be maintained ~~ ~-
as per applicable code/ordinances.
L
Attach complete plans {to the County only) for the system on paper not less than 81/2'x 21 inches in size
SBD-6398 (R. O1/03)
~'~ t~ ~~ ~ ~~~7 '~ s ~.v ~ ~e '7"' S~ - ~" c -e..v r C" f~/,' /l6' ~lctl~r`a ~
G. ~ '
. ~~~'.~~~/ ~:v '~ ~~`/s~ IUD ~ d
O
~~~
M~` ~~L~s
~ ~' ~ fy
~~~
~~
rQ~
~/
~~
~''
`~ >a~~~~ wf ~
~~
~~y
,~
C ppY
W~c9onsinl5epartrrrent,ofCommerce - SOIL EVALUATION REPORT page 1 of~
Division of SateN and Buildings
IR eOCOrr/enC@ wmr c:orrrrrr tf.7, eves. Aom. t,oae
t
Pl
i i
1
1 y
5-f-. c ro ~'
ze.
/2 x
1
Attach complete site plan on paper not less than 8 an mus
,,include, but not lenited to: vertical and horizontal refere
percent slope, scale or dimensions, north arrow, and n ( and
to, rest road. Parcel I.D.
~~ ' (3 ~ ~ - ~ ~ ~-t~o
Please print all i n. .~ \ by Date
y
Personal informatlon you provide mey be eased for ~rres _' ~ ~
. a.15.p+{~N~,lm)).. L,(,(itivy.,' / a- 6 Q
.
Property Owner - ~ ,
J ~ ~
Pcation
- ~ ~ . „~.~ ~ ''~ 7.. ot; ~ C 1/4,(/w 1/4 S Z ST Z, q' N R j q E (orj t~
Properiy Owner's Mai~rrg Address '°•~
~uN?y Lot # Subd. Name or CSMIf
CO ~ Z. O s'f i ~ ~ Wa~~{-e r~ '
~raGOFfi~, S e
City Sfate 25p Code Ph N t9nber ` ~ ^ Ydlage (~ Town Nearest Road
<St i' I l wa.~-c r 1!M rt . fSo X Z ( ~'~ } _
~ T ~ s~ +~ ~' _~ s ,' ,~ r~
® New Construction Use: ® Residential / Number of bedrooms 3 _ y~ Code derived design Claw rate ~Sd ~~o O O GPD
^ Replacement ^ Public or commercial - Descr-be:
Parent material Ov fc~.ta.S l.. Flood Pla~r elevation if ~p~abfe a w y'/!/~ ft. ,
general comments S S ~ rrt e. ! e ~af,~ n - ~~ 4'I- d U G o ~.... < r moo. o o ,a.~ a. ~~~
and recommendations: ~ f., ~ 2, l ~..~ 0. J<-.`o ~ _ ~o" p ~ ~. ~~~ ~ o w e ~ ~ S • S o - a,f 9 3.3 Qlo v
--~ i~ ~~ ~i~~~~1~-°'t/ "'"' Sam , •-N^~--u~
~ Boring # ~ Bornrg
~ Pit Ground surface elev. 93 3o tit. Depth to iimidng factor ! 0 Co in.
Sal ' n Rate
Horizon Depth Daninant Color Redox Descrtption Texture Structure Consistena: Boundary Roots GP D/fl?
.
in. Mansell Qu. Sz. Cart. Color Gr. Sz. Sh. 'F~t#1 •Eff#2
!~ ~-12 1 ~ ~ Jz - ~ ~ 1 Zr~bk ~ -~- c 5 l v-~ . ~
~ ~l~ -iota 1~~, ~!1 -- m3 ~J~ I -. . ~ 1 .2
~ . S ~ S,G ~, ~, ~~ ~, ~ 'r s~.z~.
~~ ~~ 7<0 ,~ c/3 (a ~
a.-
Bonng # ^ Bonng
® Pit Ground surtaos elev. 4S. ~- ~ it_ Depth tiD limiting fatrtor l i 3 in• Sod Rate
Horizon Depth Dominant Cob Redox Description Texture Stnrt~ure Cons~enoe Boundary Roots gP D/ft?
in. Munseq Qu. Sz. Cont Cobr Gr. Sz. Sh. - 'EtT#1 *Eff#2
1 t7--Ib 1~~~,-31z - ~ SI 21~~ k ~- ~ Ivy •5
2 i0- 4 2. I(j r y f y _ Si 2ra~ b k rr , ~r c_ s
____-
rP(, 2- `i ~, 2
' Efflr~nt #1 = BOD_ > 30 < 220 mo1L and TSS >30 < 1 50 mgll ' FJfluent #2 = BOD < < 30 mgll. and TSS < 30 mglL
CST Name (Please Prot) S~'g~a re .~ CST Number
Address Date Evaluation Conducted Teleptrone Number
2113 ~T`' `~ . Sa~-~c~-~-~, ~~ 5yc~25 ~'l`_~/ C_~15~2'-l~-yCY~~S' i
...
property Owner I~.r ~~- <
Parcel ID # .
Page z of _ 3
Boring # ~ Boring "
3 ®Pit Ground surface elev. ,~G ~ Z d ft. Depth to limitng factor i ~-~ ~ in. Soil lication Rate
Horizon Depth Dominant Cobr Redox Description Texture StructurB Consistence Boundary Roots GPD/fi? `
in. Munseil Qu. Sz. Cont Color Gr. Sz Sh: "Eft *Eff#2
~ o-~g 312 -- 5~ I Zr~bk m-~r ~S l ~"~ , 5~ ~ ~
~
~-9/ o ~-'L. '' y~, y `' - ~ c1~,6~ `~ S rub _. ...
~~,
~~ Borinc -1
esonng
^ pit Ground surface elev. ft. Depth to limiting factor in. ~~ ica0on Rate
Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GPD/tf
in. Munsell Qu. Sz. Cont Cobr Gr. Sz Sh. 'Eff#1 *Eff#2
a Bor`n9# ° B~
^ Pit Ground surface elev. ft .Depth to limfirg factor in.
Soil licatbn Rate
Horizon Depth Doninant Cobr ~ Redox Description Texture Structure Consistence Boundary Roots GP D/ff
in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. *Eff#1 "Eff#2
* Effluent #1 = BODS > 30 ~ 220 mg/L and TSS >30 <_ 150 mg/l. * Effluent #2 =GODS < 30 mglL and. TSS _< 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need as§istance to access services or
need material in an alternate format, please contact the departmerrt at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R07A0)
PAGE ~ OF~_
NAME -4 r K -e- ~ ~ LOT#,SS LEGAL DESCRIPTION SL- '/,~jc~'/4 S Zs TZR N R 19 E (or)
SCALE: 1"= yd ,
I
BM I ELEVATION Apo- O -
BM 1 DESCRIPTION nay l i n 40" Gu k , ~ ~
BM 2 ELEVATION loa- o ~
$cc- ZS"
BM 2 DESCRIPTION {1a i l i /~ ~( ~ ~~ Wl
SYSTEM ELEVATION ~v~ 91• C>U Gou. R ~ q 0 •C3y
ALTERNATE ELEVATION -Eo ~ 8 q~ Sp Gvw s r 8 ~• S~
CONTOUR ELEVATION 43. cs~ - qCs • o ~'
/:~ ~,,
~3.~ ~ ~
/~
°~ `~~
et p,, q sod ~~,
~~ o
~'
,~ .3
n ~
o ~°
~~
o ~~
U`~~
G-G-o
--. ~~ t~ ~~ ~ ~/rJ-1 ~ s ~•u ~. ~e ~' S~~ S" c ~.' G ,~:` /l~s ~ alto ,.J
.,:--~ ~Ga_ /, J ~` :-NCO ~ _.
~~ ~
-_-~
G
r
~~ - ~~
~ ~r~~
~~~
`5
*~~.f e
8
s ~ ~-~-
a~B ~r
~~y
.~
~ ~ ----
........
••} .~ j::~~K G G,~:~' ~~i~?"'B~R ~:P~~~. ~~CiiG:~" .4J ~'?"^_:i'~~Ai"iC?~~•
4 °` cz v EN; ~IP~
~ 25' FROM DOUR,
FRESH AIR INTAKE
12+~ MIN. ~+80vE GRADE ~
WINDOW OR
FINISHEw r,RAI~E ~~!
~ 4t C I RISER --~--+~
:.8" J'11N. 6" MAX, I
,. +' 1
/''~
WATER TI~iiT SEALS i ``
~~RROYE3
~IpE ~~
INTO S~~i. Z ~1
-0: L
~'UMP vFF I;LEV . „~,,,~F T .
i~~A1'N~RPRQt?~
JL'NC T ION 8~X
WITH CQNDL'TT
.,
.`
---~,. ''
~~
GAS•,; '
TIGHT ~ '~ ,
~~
A~.M
F ! !ON ~
~ _~
w~-~OF; j
:!
APPROx1ED
MAN~?OLE CflV ER
W / PADLOCK &
WARNING LABEL.
....~.,. ~ " M i h ,
~~
~APROV~D
JOINTS. i~?T~c
APP~YEQ PIF~
3' ONYO
SOt»t8. SOSE,
~a RISER EX«T
PERMYTTED ONLY
TP TA?dK
MANUFACTURER
HA5 APPROVAL
A
8
"'~""
"~"
D
3" APPRuVED BEDDING UNDER TANK
t~''PECIFT1rAb .~i V~~1i.~+
.+.-.~r-
~rPTIC i DOSE
'ANK MAN~FACT'JRER: ,f~~,.~.....,.,`..
~,~, S,r, ZE8 ~ 6Ei~TI C ~ d ~ GAL.
DOSE dc~ GAL,.
.L.AR,M MANUFACTURER: ~~`.~..,.
SWITCF~ TYPE; _ ~:rc
UMp MANUFACTURER t
'~ MQDEL NUMBER
SWITCH TYPE;
EQUIREA DiSCIiARGE 1~AT~~'p~,PM
ERTICAL DIFFEREIICE
,.Dlv'..RETE PAJ
h'ukBER DOSES nER DAB: ~~
DOSL' VG:.,U,ME II~C;~UD=NG
FLO~r'9ACK: 1~/ 9~ GA:~ .
CAPA~ZT2E5: A : ~,2 .i.~iCl:ES ~ ....~1~...o..._GAL.
9 ~ ~, 2 I 4'C HE S ~ ~~ A , ,
C = ~ INCriES ~ ,-(-- G~GAL.
P'JMP ~ ALARM WIRShG AS rER ILHR 16.23' W~-"
MINIMUM NETWORK SUPPLY PRESSUREO£F ANA D?'STF.I$UT2ON FiPE ~,~ I"EET
-~~ FEET FORCEMAIN X„,,,,,~d FT/1J0 ~p^, ` . FEET
FR: ~ 7: c~N FACT4P. 7 FEE?"
TOT4L DYNAMIC FIEAD FE;,T
+='~NAL DIMF:h',r,IgltiS OF PU?~? :Alr'K: T '
~EtiGiy' ._ ~ WIDTh ~' ; DI ,L'^'ER '^
~~ % ~ '~
G h'Ep : rr1 t~_~` ~ ~_...-yam'' ? i w: E N ~ w Iv `' M 8 iR
88
is»~ _ -
~~~
•
i= A
m
~= ~
:1~ " ,
s•
N
~ ~_ ~ x
~z
r ~
~'a ,~, b
N CD
~: ~~
~ ~~
~~ •
t~ ~ ~
~~ ~~
~~ ~
_~
~y ~m~
-o
r ~
~_
~~ W
~~
'~
II ~~
~~
~~
r~
Z~
~~
~~
z
i
Y
r
3'
r
m
a
0
m
c
G
mm
~~
4
~ ~J J ~
d
~ ~ •
3
°~ ~
O
N
m
3
N
~ ~
O ~~
cp'
coo ~
x
r
x
..~
CJ1
A~ X
y C71 ~C
w ..s
ca
W
~ ~ ! ~
~zO-nr ~
2
~ c[i a ~ cn ,
c
~ ~ ~o~ ~
~ ~
? -~
? ~ ~ g ~°
-
"
~ '
ago-~ c
stn ~~~m~o
~
c
~ ~
~
~~
~ .°CO~
~
y ~
~ ~ ~ ~
~ ~ ~ ~
'
~
~ ~a~v,
~a3~
.
~ Q
A
c~ m ~' ~
~' ~ ~ a
~ ~ ~
•
~
(Q ~
~
~ ~ ~
~'
m
a
4
i
~~
Invert 11'---}~
i
,,.
~
~ ~~~
~' woa~r
~ ~1~ ~
~ ~' ~11
,
~
~'i p
~
Q
CD ~n
n
~~
I'~°li
~~
~.
~ - ..
~
,,,
~~,~ 1GG2P~~289
W a r r-c~r~ / ~cc~
~. }',.:
648644
YRTHLEEN H. WRLSH
DOC1IDep«~e REGISTER OF DEEDS
S'i. CROIX CO., WI
kECEIVED FOR RECOkD
46-18-2001 12:45 PM
WAkRANTY DEED
EXEMPT N
CERi COPY FEE:
COPY FEE:
TRANSFEk FEE: 9900.00
RECORDING FEE: 14.OD
PAGES: 3
Raordiat Atea
i~.
Name and Ra6urn Addrast -~~-
~,.~ T.~+Iz, Ire.
1900 s'ilvc.r L.~.kc ~wd
OZO - J 064' - 70 - Oo U
raKa Idmti&atimr xmaa~ pru~
c~z~-tn6~_~So~-vao
OZ o -- ~ ~76°I -~10 - ono
~ iv - J ono - coo - ~,o
020 - 1070 ~ ~v -cwcJ
U2o - ~o'7f~ -zo -~
rrTHIS PAGE IS PART OF THIS LEGAL DOCOMENT - DO NOT REMOVE^
7Lir iofanudaa mart be aomplated by mbmwrr: doaeaou aGte
ar fhr t~~^t da~rra, ktat drxrJPctp~. ~ Le ~c & rcmm adGrerr and PjN (~/nq~dredJ, Odirr,4s/are~oa rucl.
CaCUaenL (/e~.i UJr of rhlt MMGf ~ lllar P~~ OA rhfr~&r/ Pets ~A,e Aoaanou or 1AO) br pfaccd rM ad~dana! pate of !hr
Pat addr oae pose ro yowr dacw~av and S2.A7 w du neordG. r . ~~~;,~ Jraaaes, JP.Jl7. WRIlA 2lSK
~~ K DOCUMENT NO.
i
VQL ~~UzFa1Gf
THIS INDENTURE Made b RICHARD N. PEARSON and JEAN M.
.............• ~. usband and ife, --....----..................._.......---•-----..........
PEARSON h ..............
grantor-§.. of..._St. Croix ..................•-----•~--............................Countyy, Wisconsin,.
hsteb conveys and warFants to_.._~~?IAGE .HOMES XXI INC:. , a ,~
.. ...._ ,
MLnn~sota corporation, ..................°!......-...-
WARRANTY DEED
STATE OF WISCONSIN-FORM 8
T,rr[ [FAC[ R[[ERV[O FOR R[COROINO DATA
Wasfi~irigtoii minxte
......._ .:............................_.............---.....................County, 7Rd(Yd6)i or the sum ofd;
png_Qollar-.and- no1100.---01.00). and-_other--good.and-valuable---b RETURN TO LL\n-'f:~ T.f/a_
......... 5; ~ v c
the following tract of land in.....$t.,-,-Croix.---- ~' •' - yvF ``'~ r'r { J ~t+°'`~ a)/t~
' - - ------° ...................................County, i 5'// L
Wisconsin: .Al.~...4~...khe--{~iorthwe$,f:--Quart=er-•-LNW;~.•and,-North-_Half (N~) of the Southwest
Quarter (SW's) of Section Twenty-Five (25), Township ~tventy-Nine (29) North, Range
Nineteen (19) West, St. Croix County, Wisconsin, except Lot One of Certified Survey
Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register
of Deeds, as Document No. 518444.
See Attached Exhibit A
Parcel Identification Number
This is not homestead property
In Witness Wheteof the said grantors.. ha°e...... hereunto set......... their hands... and seals.... this
....._......_.._. day of......ay-•-------~......---° .................. A. D., Y#C--2.(l0~.
BIDNEO AND BDALED IN PRESENCE OF
~9~~~,~ ,.
M. ~t50N. ................ .
St~ce of M>.n~gSpta
`
~
E eb~
W
,_
ast7ingt
O
n
County. `
Personally came before me, this.? :.`.~`., day of.. ~.`..~ ..............
y~C
2
Q01
A. D.
the above named..RICHARD N.- ,
,
,
.
EARSON dad JEAN M. PEARSON, husband and wife
to me known to be the persons.... who executed the foregoing instrument and acknowledged the same.
...........................
.............. . .
THIS INSTRUMENT Aq DRAFTED SY
Richard J. Ga~riel, #3286 9ti
` k~FLY-.MOUNTAIN
4 ;~;>
880 Sibley Memorial Hwy., #114 NOTARY Notar Public,. ~' NOTARYPUBUC-MINNESOTA
SEAL Y ~r.~, ...------ .........................-°-°- County, Wis.
My Comm. Expkea Jao. 31, 2D05
P9andei:a Fleir}hi:s, p~I--S~~-~@ -1736 DSy eomrnission (e?t '
(Section 39.31 (]) of the wiscomin
the names of the grantors, grantees,
mental agenq srhuh
drafted s
ch Statute Provides that all imtruments to he recorded shall have Plainly printed or types.riKen thereon i
wnncarei and tart', Stttion 39.ri3 sindl>dy requites that the name of the person vho, or govern
i
h
l
.
u
WARRANTY DEED nstrument, s
a
l he panted, typewri!t<n, stamped or written thereon in a IegiLle manner.)
STATE OF WISCONSIN
Wlsconaln Legal Blank Comvavy
rOlia[ No. a >lllwaukee, Wls, (Job 3JSIl )
"~ i
\ \\\ \ 24 / / '~ Ns7°~4'09"w e6.5a'
\ 97419SQFT
\\\,~ 2.236 ACRES .' '~ ~,~~ ~ ~ -~--~---.J
` 1\` . /
. .` .
~ H.W.L. =992.2 .~..~- •~`ah ,,y'` / 1
' • i'` h"` ~~~~~ H.W.L ~ 993.5 ) 2.049 ACiRES
~ ` , / ;. ,.
~.-, •
,~
1 - s~.oo' . • 55
S81°41'07'N`~ ~ ~ .
~.~-~~ 11 FT
s 1 • , • ' 2.735 ACRES
1 .-
33' ,',
3~ ~ _ ~ ~----''
i
~~: ~9~. ~
4~F
I ~ ! ~ /1 54 `~?r0' ~~ H.W.-.5;: ~j
~ `" ~~ '~ 89.522 SQ FT
~. N ~ o ~i '~~` 2.055 ACRES ~
~ ~ 1012.0• ~~ I
.I 1 ~~ L-_ ar
573.19'
N89°54'59'E 667.95'
o ~
M w
U
53
I
SEE SHEET 4
JOB N0.6o~o-Ot DATE: 06/07/2001 REVISED: 06/'31/2001 ~;
94.76'
T
~1
1