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HomeMy WebLinkAbout020-1342-10-040� � � � 0 2 [ C, S. /ate 2 E § \ ° § 2 ; 3 I = CD / > \ 3 0 C @ / � m i J ( - / \ \ � ƒ ƒ 7 7 CL 2 z a & { 0 m m £ � � � [ E 2 � � � 7 [ � � � � ; §20 mCD C L 99 =/0 �CDE m _& { {k * k`§( 0 0 CD � \k =r\ Ga2j CL (D 6a °g \ mm 0E � m [ m � ?? k m C / J };� � % � c t � \/ K) / cc E E $ cn \ � E $ S o § 2 E CD0 i S [ T T T \ 0 0 0 CL ) 2 2 / \ 7 , c ) E § z \ % $ k � � / N 3 E kr � � C { k ■ , z � k ■ � E o , ; e EEC k�� f � E / 8 � � 9 � \ / § § k = A e g E c � � ) ■ � ¥ § 0 / ƒ � z Cc, f z E 0 2 § § / 2 § \ / 7 2 g � � i § � �ƒ co� � � � � � � O �. Oro J � � k ; i � � K § � � \ 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 Kin sborou h Homes I Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: 1 0-U' 0 / D -r aJ_ kl Vy I eb" . vb TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ELEV. TDH Dosing W System Head Aeration Forcemain f ength Holding Dist. to Well 32.29.19.1820 TANK SETBACK INFORMATION PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model Numher ELEV. TDH MOM== n Loss System Head TDH Ft Forcemain f ength I Dist. to Well 32.29.19.1820 Bldg. Sewer Soya --,L- SETBACK SYSTEM TO P/L BLDG St/Ht Inlet 3, st 3 6W ACHINI, Manuf pr: �'� S l� s� INFORMATION SVH Outl Ty e Ofy e Of 5 �� t -2, PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model Numher ELEV. TDH Lift n Loss System Head TDH Ft Forcemain f ength I Dist. to Well County: St. Croix Sanitary Permit No: FS ELEV. 430502 0 State Plan ID No: /1►. Parcel Tax No: /�D. [7 Alt. BM 0, '5-.4r 020 - 1342 -10 -040 Section/Town /Range /Map No: 32.29.19.1820 ELEVATION DATA STATION BS HI FS ELEV. Benchmark AaK4y, IZ;- d 11- _1Z' /1►. Liquid Depth /�D. [7 Alt. BM 0, '5-.4r �a� `D q_ Bldg. Sewer Soya --,L- SETBACK SYSTEM TO P/L BLDG St/Ht Inlet 3, st 3 6W ACHINI, Manuf pr: �'� S l� s� INFORMATION SVH Outl Ty e Ofy e Of 5 �� t -2, Dt I let 00 Dt Bottom Header /Man. i � v 1 l el Dist. Pipe y .b e'er Bot. System 6W 2, Final q rade rw,.; Ct lit Z D 1 Z C er / fl (a r- ) SOIL ABSORPTION SYSTEM 3 l�tQiwt (a.P�(3� BED/TRENCH Width Length A No. Of Trenches V ent to A PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 Cy ( � SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM ACHINI, Manuf pr: �'� S l� s� INFORMATION CHAMB NIT Ty e Ofy e Of 5 �� t -2, Model Number: DISTRIBUTION SYSTEM (Z „S' SGF l avt e-�-Jc 1,,v. e�(r /�M(aanifold Y( I�Vt Distribution / / x Hole Size x Hole Spacing V ent to A A L ` r 1 Dia y n � Length � 9� g yia �' A Spacing -�- L ]Yes L', No = `; Yes _ _ No SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only apt'd GO��tvrllh '-E Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched ` Bed/Trench Center / I Bed /Trench Edges Topsoil L ]Yes L', No = `; Yes _ _ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ Inspection #2: Location: 675 Cottage Lane Hudson, WI 54016 (NW 1/4 NW 1/4 32 T29N R1 9W) Windsor Heights Lot 4 Parcel No: 32.29.19.1820 1.) Alt BM Description = So*vw of S/d ­s- a� ID a l-4 2.) Bldg sewer length = ? — r ' y � yt ` Z 4 R W�1 'P4 a f @� Y - amount of cover 13 �_ / q 0 - Lf, 1Y i >b t tM �2 / - -� -- -- —— -- -- - - -- ` -�- - - - - - - — Plan revision Required? �n Yes No f —3 I� —J II`�„II�,,� .� Use other side for additional information. L_ /4�� SBD -6710 (R.3/97) Date Insepctor's Sig ature Cert. No. 44w 6L teach eaarplete phuns (to the Ci n ity may) ter the n � ei PWC*F d jp= 0041 ilia z il� �FN . Satexy and Buildings Division County VI 201 W. Washington Ave,, P.O. Box 7082 ST. CROIX Sanitary Permit Number (to be filled in by Co.) Madi%in, WI 53707 - 7082 (608)201 6546 Department of Commerce Sanitary Permit Appl�c State F IMI Number � In amord with Conan 83.21. Wis Adm. Code, inforn ` ion y OE ' V G D A ngtxt Ad&en (if different than mailing address) may be usW [br secondary purposes Privacy tzw, sl 1 t)(m) _ 675 COTTAGE LANE � L Application Informalkw — PlIme Ptiat All Information `2 8 2 � Property Owtrer's Nance ST. CROIX COUNTY Parcc1 # 20 1 040 N 4�4l+' ZONING OFFICE KINGSBOROUGH HOMES Propaly Ownct's Mailing Address Propetty Location t7 8750 - 90TH STREET NW v, NW 32 City, Stats: zip Code Phone Nub COTTAG GR OVE MN 5501 rattle nee) T 29 N, R 191 fV � eir W IL Type of Bulldit (check all that apply) Sulxtivision Name CSM Ntunbex 911 or 2 Familv Dwe ing - Number orBedrooms 4 !/ ❑ Pubiic+Coriuraer - l3cwtib: Use - WINDSOR HEIGHTS ❑City_LIvittage LL4owttstiip of HUDSON ❑ state Owned t�ribc I tae 3 ISfi C LS 3 - ..G✓ — III. Type of Permit: (Check only one Mix on line A. Complete line B if applicable) A- Pq New System ❑ Replacement System ❑ TreahtmMohling Tank Replacenacxit Only ❑ Other Modification: to Exisiius system 8 • F] Permit renemw Fed Kevision El rm ❑ Change of U Permit Tranffer to New I ist rtevioi>s Pentut Number and Date Issued Retire Expiration Ytu nber Owner IV. Typ of P0W'!S S tem: Check all that i f A N - Fr essauized lud3r U U..d , 24 ia. ofsuitable sail ❑ Mound < 24 in. ofsuitable soil ❑ m -Grade ❑ single Pass Sand Filter ` Cointnrcted Wetland ❑ I'ressurhxd ln- (board ❑ Flnldirig'r nk ❑ Pess Filter J - j Aerobic Treatment Unit U Rewculating sand Filler ❑ Rrrirrnintirttr Synt 4ic Media T i&er leaching Crravet -less Pax ❑ t niter (explain) ZA13EL FI orati V L ALARM - All 00 3 - 81' trenches - 13 cha ea. usin 39 Sio Defus chambers V. Din rsal freatment Area fm Design Flow (gpd) Design Sail Application Rate( nrsperI I Area Required (sf) 1 7 �1 ersal Area Proposed (st) b'yst 97.1 3 600 .5 1200 228. 5 VL Tank Info y in Total Number Manufacturer Prefab Site steel Fiber Plastic Gallo Galk wo of I inits � Conavte Constructed Glass New Existing. ! Q � Tanks Tw*s SWic or Holding Tm* X 1250 1 WIESER X Aerobic Tmmbnent Lrni( T)minp ('tsuntnr VII. Responsibility Statement 1, the widersigw#mnume respomibaity for hu*W&Wkn of dw POWYS shown an the attached pintos. Plumber's Name (Print) P MP /MFRS Number i Azaincge tXme Number TODD FEATHERSTONE 242514 X715 -1 704 — Plumber's Address (Street, City, State, ) P.O. BOX 467 HUDSON, WI 5 401 6 V Count !De artrnent use Only -- - Approved U Disapproved Sanitary Permit Fee ( chides Groundwater Dalf issued mg Ag Sigpat (i) Stamps) ❑ Owner Given Reason for Denial #X. Conditions of ApprovalfRessons for Disapproval YS�TEM OWN�ED• Q(t� V � �— dYV`Q17W 7N 1 1 epticeffluent filter and p3 dispersal cell must all be se ced / mfint as er management plan provided by plumber.. / 15;X •61 A I setbac requlreme s e main lned ,,//,, �� — - 7 _/' p N? e applicable code /ordinances. 6 � 7 Z W) > N.. S5 S/3 / . -fV m& -7i �. 44w 6L teach eaarplete phuns (to the Ci n ity may) ter the n � ei PWC*F d jp= 0041 ilia z il� �FN . •6M 21 Sew ,g I c t A ga I i m 9a ,o - �ba,�J�6Lt �7 Satz.. �o,2i�r.a Wisconsin Department of Commerce Division of Safety and Buildings Bureau of Integrated Services Attach complete site plan on paper not less include, but not limited to: vertical and hod; percent slope, scale or dimensions, north ai APPUCANT INFORMATION - Plea Personal inforrnation you provide may be used for ; Propertyp"e. 1 – / / SOIL AND SITE EVALUATION in ILHR 83.09, Wis. Adm. Code r Count I/�L;1i�11 i size. im Terence t A l d location and distance to road. Parcel I.D. # BE } 1` 0 : 1 ,9 -97 }.. OZD -1 nt all idta�q on. } � _' ;:; R #ewwe/d by Y purpo ,g Y_eaw, s. 15.13a t1), rr /L_ )Lt /let Ciiyr / State Zip Code Phone Number rty location Lot / 1/4 1/4,S Lot # I Bk�# Subd. or CS 1 7 7" , ra ❑ City / Village y5 Town Page-4 of - d �d Date T� c, ,N,R � jil(06 // , i New Construction Use: CZ Residential / Number of bedrooms Addition to e)dsting building Replacement ❑ Public or commerdal - Describe: Code derived daily flow _ gpd Recommended design loading rate bed, 9P ti'ench, gPd Absorption area required _ �Q� bed, ft /o�J t� tmnch, ft 2 �d� design k>ading rate _ bed. 9Pd/(1 trench, 9pd1fi Recommended infiltration surface elevation(s) ft (ds referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional lubund In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ca S ❑ U EO S ❑ U ❑ S ❑ U 1 ® S ❑ U ❑ S [A U cis [9 U SOIL DESCRIPTION REPORT Ground elev. �&Zft. Depth to limiting factor ?�in. Remarks: Boring # 13 Ground � eleev. � ..emu-- ft. Depth to limiting 0 Dominant Color Munsell Motiless Qu. Sz. Cont. Color =Mom= M IMAMM WIMLWMA M �I.; � LWMA M, �WON W - AM mm mm Remarks: Boring # 13 Ground � eleev. � ..emu-- ft. Depth to limiting 0 factor ,in. Remarks: V CST Name (PI Print) Sign re Telephone No. Address Date CST Number 3 WIMLWMA M �I.; LWMA M, factor ,in. Remarks: V CST Name (PI Print) Sign re Telephone No. Address Date CST Number 3 PROPERTY OWNER PARCEL I.D.# Boring # 1 1 " a Ground elev. /daft. Depth to limiting factor in. Boring # 1 3a Ground elev. WL Depth to limiting factor �r7 in. Boring # 1 F ' 3 Ground elev. "wi ft. Depth to limiting factor Z Boring # Ll Ground elev. ft. SOIL DESCRIPTION REPORT n.,. — - Page -,-,�Z of Remarks: MM r / �MMtMA GM I M , M�— ''MMO M Remarks: 1 d a q f� l / Horizon Depth in. Dominant Color Mottles Co Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots PD /ft2 Bed , Trench WAMM Remarks: MM r / �MMtMA GM I M , M�— ''MMO M Remarks: 1 d a q f� l / Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots PD /ft2 Bed , Trench Remarks: Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) ar r caG�BN GJ.r S� /6 XV -ZT 9AI - li9Al / / -Ad -97 I t 78' 4 v t �s T a� '/- 11�,es S � i Im �2,-4fs SYSTEM CROSS SECTION MAN HOLE .L INSPECTION PIPE SYSTEM ELEV 13 - 11" BIO DEFUSER CHAMBERS PID #020 - 1342 -10 -030, 020 - 1342 -10 -040, 020 - 1342 -10 -070 plp * 020-1324-10-130, 0 -140 NW y NW /..S 32 T 29 KR 12WE LOT 4 BL _, SUB WINDSOR HTS C T gg HUDSON /lam / ��. �I�RSW 242514 1250 �.--- U 13 -11" BIO DEFUSER tHA E co 0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION' Owner Q rn�S Permit # L 30 S Z DESIGN PARAMETERS Number of Bedrooms ❑ NA ❑ NA Number of Public Facility Units ❑ NA ❑ NA Estimated flow (average) Effluent Filter Model gal /da Design flow (peak), (Estimated x 1.5) Pump Tank Capacity g al/da y Soil Application Rate 0 . gal/day/ft' Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg /L Pump Model Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA Total Suspended Solids (TSS) 5150 mg /L Dispersal Cellls) In- Ground (gravity ❑ At -Grade ❑ Drip -Line Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD 530 mg /L Other: Total Suspended Solids (TSS) :530 mg /L NA Fecal Coliform (geometric mean) 51 Q`_ cfu /10 1, Maximum Effluent Particle Size Y in dia. ❑ NA Other. ❑ NA "Values typical for domestic wastewater and septic tank effluent. 11 A11117C111AN/%C 09%YC11111 C SYSTEM SPECIFICATIONS Septic Tank Capacity ga l ❑ NA Septic Tank Manufacturer UJIE3j0 — ❑ NA Effluent Filter Manufacturer 236 ❑ NA Effluent Filter Model �� l(� ❑ NA Pump Tank Capacity a l ❑ NA Pump Tank Manufacturer ❑ NA ❑ NA Pump Manufacturer ❑ monthls) / — .Z years) ❑ NA Pump Model At least once every: ❑ NA Pretreatment Unit ❑ Sand /Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Filter ❑ Wetland ❑ Other: I X, , N A Dispersal Cellls) In- Ground (gravity ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In- Ground (pressurized) ❑ Mound ❑ Other: Other: At least once every: ❑ NA Other: Other ❑ NA Other: ❑ NA ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) 2 3 ear(s) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) Z— 3 ear(s) ❑ NA ^- � Clean effluent filter 4S &e1)E� At least once every: ❑ monthls) / — .Z years) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ❑ NA Other: At least once every: ❑ month(s) ❑ year(s) ❑ NA Other ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispo *ed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of 2 - T START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant rep ac ant system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. r/ N i aluat a o ing ank S b ' e a� ?fZD44181Y � VbR_ A 45NJ5T dC�t0 l, N ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name 15t L' ( ZD/Jl�tJ " Phone _"' /S— 3e(0- fo Z) POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name 15t L' ( ZD/Jl�tJ " Phone _"' /S— 3e(0- fo Z) This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AG NT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address N City /State lkt � U) Parcel Identification Number ©Z0 -/ 3 C/a '/0 D �D LEGAL DESCRIPTION 17 Z-( P Location NU) Y., Al U1 %, Sec. 2 A . T-.,L1 N R LW, Town of h Subdivision G)/ so n IJ e Lot # Certified Survey Map # 5 'a300 . Volume . .Page # Warranty Deed # c03 401 , Volume 15-qJ? , Page # I� Spec house ❑ yes 0 no Lot lines identifiable Ryes ❑ no SYSTEM MAHM ANCE Improper use and maintenanceof 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 fimetion 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 masterplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fords, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning office within 30 7 of the th��yemar expiration date. j / 0 SIGNAtIME 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 the p erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. 9/�i� SIGNATURE OF APPLIC DATE * * * * ** * « « * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ro ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 4t 1593PAGE 167 STATE BAR OF WISCONSIN FORM 2 - 1999 I WARRANTY DEED Document Number This Deed, made between West Lake Builders, Inc., a Wisconsin Corporation Grantor. and Kingsbrough Homes, LLC a'j° 6409 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI REaIVED FOR RECORD 02 -28 -2001 11:45 AN WARRANTY DEED EXENoT I CERT COPT FEE: COPY FEE: TRAMPER FEE: 1438.20 RECORDNG FEE: 10.00 PAMS: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Return Address Lots 34,, 13, 14 and 1 s, Windsor Heights in the Town of Hudson, St. EAGLE VALLEY BANK, N.A. Croix .ty, Wisconsin. 1301 Coulee Rd Unit 2 Together With the right of access over Outlot 2, Plat of Windsor Heights in Hudson, WI 54016 the Town of Hudson for the benefit of Lot 14 of said Plat. 020 - 1342 -10 -03 0204342- 10-040 20.1342-10-070 020- 1324 -10 -130, t 0,020- 1342 - 10-140 Parcel Ideatiliation Number (PIN) This Is not homestead proms 06) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 1 day of February 2001 West Lake Builders, Inc. AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. County ) 10 authenticated this day of 1- ersonaity came before me this day of F 2001 the above named p West LAke Bsildcrs, Inc., a Wiseossis Corporation b it's tics. De'N r — TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (if not. i ent and acknowledged the same. authorized by § 706.06, W is. Stats.) T F , THIS INSTRUMENT WAS DRAFTED BY /ila t nom - L ' r't n Attorney Kristin' Oglasd Notary Public, State of Wisconsin udsos, 16 My Commission is permanent. (if no t state expiration date: (Signatures may be authenticated or acknowledged. Both arc not necessary.) 3 /1 a printed below their signature. atonnat m P`a°L cO" p° r Fond do Lar, 2ml • Names of persons signing in any apteky Rug be 41K STATE t STATE BAtt OF W iSCONStN WARRANTY DEED FORM No. 2 -1999 PIONEER engineering Certificate of Survey for. House Address: KINGo o 625 Highway 10 N.E. Bloine, MN 55434 (763) 783 -1880 FAX: °783 -1883 O UGH HOMES 675 Cottage Lane s � �.0NEIL s - ROAD S11 °13' o �� _ 125.9 j �6' , R' F DRAINAGE AND UTILITY EASEMENT NO2 ° 15'43 "E N x 1 119.73 -- - - - - --r r -- -' I I I6 12 i I I i i I I x I t'O gq.lO ## 0 !. i � V 1 942.6 I 1 .. ���, e� 1943.0 x 942.0 .941.6 v TERRENCE E 1 i TREE TINE r m 1 WTHENBACHE S•2300 °. M �� COLUMBIA HEIGHTS D I i �" 946.2 I I +;' ® 0 , MN 1 0 - 0 ; 41 ) i ®! i i'�tp I x o 946.3 W 1 N N g 952.5 �1J 4 I- LO 0 00 I 0 53.9 I 1 956.1 / �. / A� 952.4 00 Z l x 10 j 955.3 0 / I 954.4 N /N14' ao 956w 1 rn u� .Jr I PRO 954.0 2Q.0'� 2422 Enterprise Drive Mendota Heights, MN 55120 LAND SURVEYORS • CIVIL ENGINEERS (651) 681 -1914 FAX:681 -9488 LAND PLANNERS • LANDSCAPE ARCHITECTS Ouse D 958.4 BENCHMARK TOP OF PIPE EL a 960.23 • 01 Io I N rn 1 0 i rn 958.7 - 950.3 965. 1 963.7 N 121OTB� I 969.6 954.1 i )956.1 1 12 I _ X 958.5 I � I rnl of r MI 96 4 1g.0� I O , V o1 �0 20 c G o, L 964.1 ,p 967.4 ` � 1 HOUSE DETAIL 8 00 d '0 0 $ 1800 g 1, 0p 8 1. b; DO 9 P 0 f0 N0U5 N P �CH Ot l WALK L , a _VT,. / M C� O �E 7a . SCALE: 1" :e 30' 2 .00 o � r >� IJ i "3 > TOP OF BLOCK - 961.2 \ O GARAGE �', A�TvST HouSE E'�EVR1'IuNS PER. Sol ANp DRAWAGE 1 30 2 `ry 4 XL� 971.1 970.5 ' `32 �3' %0 967.8 BENCHMARK �p f�t1►c6MEK f TOP OF PIPE OW NE R- EL = 964.11 P6 R CO �'+` 6 '' PROPOSED BUILDING ELEVATIONS T/� � 969.4 � \ Lowest Floor Elevation: 000.o Denotes Emergency Overflow \966.6 `\ Top of Foundation Elevation: x 000.o Denotes Existing Elevation 'Nev\ Garage Slab Elevation: %Z-8 (at door) Denotes Proposed Elevation NOTE: Proposed building site grading is in accordance with the Denotes Drainage Flow Direction grading plans approved by the city engineer. - - Denotes Drainage & Utility Easement NOTE: Contractor must verify all dimensions & driveway design. --o-- Denotes Monument NOTE: Driveways are shown for graphic purposes only, final driveway Bearings shown are assumed design and location will be determined by contractor. -+- Denotes Offset Iron LOT 4 WINDSOR HEIGHTS ST. CROIX COUNTY, WISCONSIN We hereby certify to KINGSBOROUGH HOMES that this survey, plan or report was prepared by me or under my direct' supervision and that I am a duly licensed. Land Surveyor under the laws of the State of Wisconsin. Dated this � 3 OR, day of ; ��EP9'E X 6C tZ_ A.D., 2003. Signed: PIONEER ENGINEERING, P.A. Scale: 1 inch = a feet By. 1945 200493.05 JFW Terrence E. Rothenbacher, L.S. Reg. No. S -2300