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020-1342-10-230
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J \ % # � 2 W isconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM 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 Holders Name: City Village X Township Weiseme er, Christo her I Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: DD v e) ' oa" TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic MVEMEW-Aillin. F1 0 Dosing �- 3 �v Aeration A lt. BM S T M1 Holding mm= System, H gd 713 TANK SETBACK INFORMATION "�Mm L Demand FS MVEMEW-Aillin. F1 0 M F I - M Parcel Tax No: i n A lt. BM S T M1 m mm= System, H gd 713 ' Ft I 1 Dia. (r I Dist. to W St/Ht Inlet 4 JBLDG A045 9 SUHt Outlet IN Typ f System: PUMP/SIPHON HON INFORMATION / Manufacturer L Demand FS GPM q0 Model Number Inside Dia. Parcel Tax No: i n A lt. BM S T TDH Lift r Friction Loss to & System, H gd 713 ' Ft Forcemain Len h Dia. (r I Dist. to W St/Ht Inlet 4 JBLDG A045 ELEVATION DATA County: St. Croix Sanitary Permit No: FS ELEV. 463254 0 State Plan ID No: Inside Dia. Parcel Tax No: DIMENSIONS A lt. BM S T 020 - 1342 -10 -230 Sectionlrown /Range /Map No: 32.29.19.1839 STATION BS HI FS ELEV. Benchmark No. f Pits Inside Dia. Liquid Depth DIMENSIONS A lt. BM S T �S✓ iJf clq 9s Bldg. ew r o SETBACK St/Ht Inlet 4 JBLDG A045 9 SUHt Outlet IN Typ f System: Dt Inlet j C Model Numbe DtBotto �I�sl �- -0 X3•(05 b1 Header n. Dist. Pipe F 7 Bot. System Final Grade q, St Cover,� r C ( SOIL ABSORPTION SYSTEM IAJOA nl D�. ()t7 in. _` <I1f min, 1 m„ Sll�trd� G'cev� BED/TRENCH Width Length No. Of Trenches lVent to Air Intake PIT DIMENSIONS No. f Pits Inside Dia. Liquid Depth DIMENSIONS �S✓ iJf SETBACK SYSTEM TO P/L5 JBLDG LAKE/STREAM LEACHI Manufac rer :�� IN Typ f System: (M j C Model Numbe / I Z / ' i� DISTRIBUTION SYSTEM /I .e a Header /Manifold t *Q Distribution Pipe(s) t) Y6* �v x Hole Size x Hole Spacing lVent to Air Intake Ldia Length Dia Spacing -- 1:1 Yes [] No Yes No SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bedrrrench Center , I Bed/Trench Edges Topsoil 1:1 Yes [] No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:��/ I S / Inspection #2: I / Location: 455 Carriage Lane Hudson, WI 54016 (NW 1/4 NW 1/4 32 T29N R19W) Wi ndsor He igh t s Lot 23 Parcel 2.29.19.1 39 1.) Alt BM Description = �� 2.) Bldg sewer length= ( GD y ` Jt - amount of cover = _ ,(/ G,(lLt�t - ;k4 C4d4l 4 a�+` j Sb Gtd d (0 syS 6 U- a -ue. � s� Plan revision Required? Yes VN (� Use other side for additional information. — � J (� SBD -6710 (R.3/97) Date In epctoes Sign A r7 t ,-/_ Can. No. � . a �_ r 3V .2 \ L b Nr- �b 1111>0 N ev J 'I �L 1S a �= 1 r ra j`: r � � � �r � ;:;�• r I �{ 9 ham" 4� '? C � (� e ( oun ly) for the "em oo prt r no !1001; t ��x ll � size SBD -6398 (R. 0 IJ �L U o�>�L�� F6e slTEF I lrl-r ildin s Division County W 201 W, Washingto ve , P.O. Box 7262 C% Y 11 8C D� �• �a�s I 7 - 7162 Sanitary Permit Number to be d ed in by Co.) Department of Commerce a Sanitary Pe mitT S tate Plan 1.D. Number in accord with Comm 83.2 1, s. W/A prov may be used for secondary purposes Privacy Law, s15.04( )(m) Project Address tf different than mailing address) I. Application Information - Please Print All Information 4/5S— Property Owner's Na rtte / Parc ! N Lot # Block # Property Owner's M ailing Address operty Location e} �3 U, -e Ci City, State Z C �k, ,,tJGd k,Section S,.Z er (circle o ) II. Type of Building (check all that apply) T _ , 2 9 N; R / 9 E or duJ / I1 or 2 Family Dwelling - Number of Bedrooms v �'� Subdivision Name CSM Number ❑ Public /Commercial -Describe Use _ , VeJss I ❑ State Owned - Describe Use „�jrs Ca 2 Z, t 2�3 j City_❑village�RTownship of IVAL III. Type of Permit: (Check only one box on line A. Complete li B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System i B. ❑ Permit Renewal Permit Revision ❑ Change of Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration �— Plumber Owner L/`/ ! D (� �(7I 3/ V 710 0 / / IV. Type of POWTS System: (Check all that apply) i WNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade (J Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized n round ❑ Holding Tank L7 Peat Filter ❑ Aerobic Treatment Unit 71 Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑Drip Line _E] Gravel-less Pipe r xplain} V. Dispersal/Treatment Area Info= adon: y— - Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Re- fired (sf) Dispersal sed (sf) System Elevation 3 ,o d . 7 �-5 J � 7 7 %.5-.- = c� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic; Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank - — " Aerobic Treatment Unit ! _ r J ` Dosing Chamber x VII Responsibility Statement 1 , the undersigned, assume responsibility for u allation of the POWTS shown on t attached plans. Plumber's Na me (Print) Plumber's Si gnature - �P-I PRS Number Business Phone Number Plumber's Addre ss (Street City State, Zip Code) i VIII. unity Department Use Onl Approved ❑Disapproved Sanitary Permit Fee includes Groundwater Surcharge Fee) (fU Da Issued ssuin gent S' atur Stamps) _ ❑ Owner Given Reason for Denial 5D �0 � IX. Conditions of Approval /Reasons for Disapproval E R: i k effluent filter and =S!e� dispersacell must all be serviced / main ain ment plan provided by plum 2. All setback requirements must be maintaine as er applicable odelord' ances (/n S /JYt "Y�Q � ysT "? 1 ao o U r i /� Al/10 (� e ( oun ly) for the "em oo prt r no !1001; t ��x ll � size SBD -6398 (R. 0 IJ �L U o�>�L�� F6e slTEF I lrl-r 0 �l vo ,.V- v L O , T Ir" - -0:; , 11 1 1 7 0 Z. k 4b -FZ WINDSOR HEIG LOCATED IN PART OF THE SE 1/4 OF THE NW 1/4, PART OF ' F' OF THB NB 1/4 AND PART OF THE NE 1/4 OF THE S1I1 1 4 01 r r 82, T29N, RIPW, TOWN OF HUDSON, ST. CROIX COUNTY, Wl INCLUDING LOT 1 OF CERTIFIED SURVEY 1UAP RECORDED D 11, PAGE 3232 AT THE ST. CROIX COUNTY RBGISTER OF DBE RECEIVED , a Wisconsin Department of Commerce [) — C r 0 7SO0 E �i REPORT Page _L of Division of Safety and Buildings in tcc 85, Is. County C I Attach complete site plan on paper n less thal96 * x(WFriAs in siz . Plan must include, but not limited to: vertical and horizontal re erence point irection and Parcel I.D. 7 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Qp�U 3 �d -/o ' ) 3 Please print all information. Re ' ad b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 9 0 Property Owner Property Location - S G 1 ?"' Govt. Lot S � T 2 N R E (or)( Property Owner's Mailing Address Lot # Block At Subd. Name or CSM# l ! ? 1 1 6 City State Zip Code Phone Number ❑ city ❑ Village 9 Town Nearest Road 55 New Construction Use: (5 Residential / Number of bedrooms 3= Code derived design flow rate G/ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material o cf4w -- S k, Flood Plain elevation if applicable ft. General and � j� e ( el / t �^, � O d and recommendations: 1/ TT `7 ory t7 36 s F71 Boring # ❑ Boring ❑ pit Ground surface elev. U ft. Depth to limiting factor l a in. Soil Aedication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF `Eff#1 'Eff#2 c - 1 U 3 1 iv rv. r C S. Z ;; I 31 1 ✓ ` 7 0` w1 I — � r s v/ F -ort I Boring # ❑ Boring ❑ pit Ground surface elev. US - 0 ft. Depth to limiting factor / o q in. Soil Aodication Rate Horizon Depth in. Dominant Color Munseh Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fP 'Eff#1 •Eff#2 c - 1 U 3 1 wt rv. r C S. Z ;; I 31 1 ✓ ` 7 0` w1 I — � r s v/ Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1 150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST Name (Please Print), Signa CST Number !!f: c ZS 3 G Address Date Evaluation Conducted Telephone Number a - o z ?. C( Property Owner _ LI/ e - ( R K Parcel ID # /t, D 153 Boring # ❑ Boring pit Ground surface elev. �fa. ft� Depth to limiting factor C7 9 in. Page �- of Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots — GPDM , 'Eff#1 'Eff#2 n U1 i s ' S Boring # ❑ Borin [) Pit Ground surface elev. ft. Depth to limiting factor in. Boring # ° Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L . EftlueM #2 = BOD < 30 mg& 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. SM- 9330OLUM) Redox Description. QU. S7- COnt Color Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L . EftlueM #2 = BOD < 30 mg& 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. SM- 9330OLUM) PAGE OF NAME 4,jL2 al I& LOT# Z_ 3 LEGAL DESCRI0TiON& 3er2!2,N,R E(OR)W)_ SCALE BM I ELEVATION BM I DESCRIPTION C 4' 0 Lf rld ck BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION SYSTEM TYPE 0 n C N L-O'c- 2 d tin L6 J33 X47 4 I M 1 0 cl � C) - 7 C4 L DATE SIONATURE ST. CROIX COUNTY SEPTIC TANK MAINMANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM er uyer CW T sTopl't o-- W e S C Mailing Address Property Address 'ASS (Verification required from Planning Department for new construction.) City /State /k& DA I Uff -, Parcel Identification Number a 2 -0' l 3 LEGAL DESCRIPTION Property Location / , L /. , Sec. T �N R _LW, Town of I-ND Subdivision wl Af l d� YTs - , Lot # 3 Certified Survey Map # , Volume q , Page # Warranty Deed # — 7 - 7 10� , Volume 2 (P I , Page # L/a 3 Spec house no Lot lines identifiable(5 no I b 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 Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 15 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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 Department within 30 days of the three year expiration date. SIGNATURE OF APPLIC DATE OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office SIGNATURE OF APPLICANT DATE « « « « «« Any information that is misrepresented 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 and a copy of the certified survey map if reference is made is the warranty deed. ad UJ :4 "iz a NO a z a CO Lij U Q ` V/ N Iii ■ v O� Zi_ V) D O W w IL w LL. Z 0 � = �0 O as 0 - IC CL A E € W 's mi O� $ CL S a s s c 3 ti aC W Z O w m M J IL LL � J Z O W Z Z 0 D m Cd LU w LU V LL O z w N R O 2 H Q_ 0 Q H w 0 m D w Z w J m U) w FL x w w IL U) W z Q J II H Cn O a Z O F- U N � L 1.1. CO Z O � V Z D H O J w 2 Z H Z O w LL Q O w w F- 2 O Of LL 00 0 00 0 a U 2689P 4 23 STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number I WARRANTY DEED This Deed, made between West Lake Builders, Inc., a Wisconsin CQMPration Grantor, and Christopher J. Wiesemever and Kendra 4, Wiesemever, husband and wife Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 23, Windsor Heights in the Town of Hudson, St. Croix County, Wisconsin. KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 11/04/2004 11:15AN WARRANTY DEED EXDPT ii REC FEE: 11.00 TRANS FEE: 269.70 COPY FEE; CC FEE: PAGES: 1 Recording Area Name and Return Address Wets Lake Builders PO Box 703 Hudson, WI 54016 020- 1342 - 10-230 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this K) day of --TL.l 'i , 2004 * * We Lake B Inc * AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF W1 (If not, authorized by § 706.06, Wis. Stats.) * ACKNOWLEDGMENT STATE OF ) f � Off 4_P_ ) ss. County ) FtHONDA M Personally came before me this day of BENJf�lilliN — 2004 the above named est Lake Builders, Inc., a Wi sconsin Corpo Wi ration Richar J. Grek ONSIN ' 0 W S its Presiden -- ._,. _ It to me known to be the persons) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY �1Q�c1_ Attorney Kristin" Oland * v Hudson, WI 54016 _ Notary Public, State of (A� 412;S j My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) b`j * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800.655 -2021 WARRANTY DEED FORM No. 2 - 1999 J Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide M rfbe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. it �Name We City Village X Township Hudson Townshi CST B lev: Insp. BM Elev: BM Description: TANK INFORMATION P/L TYPE MANUFACTURER CAPACITY Septic Septic Friction Loss Dosing TDH Ft Forcemain Aeration Dosing Dist. to Well Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Friction Loss System Head TDH Ft Forcemain Length Dosing Dist. to Well 32.29.19.1839 Aeration SYSTEM TO P/L BLDG WELL LAKE /STREAM Holding Manufacturer. INFORMATION PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model Number Vent to Air Intake TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary P' it No: No. Of Trenches Vent to Air Intake 4 3 8 0 State Plan ID No: Inside Dia. Parcel Tax No UUj Length Dia 020 - 1342 -10 -230 Section/Town /Range /Map No: 32.29.19.1839 STATION I BS I HI I FS I ELEV. BM t. Sewer St/Ht Outlet Dt Inlet Dt Bottom Header /Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches Vent to Air Intake PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Length Dia Length Dia Spacing SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR UNIT Type Of System: Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Bed/Trench Center Pipe(s) Topsoil Yes E] No [E Yes [ No Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes E] No [E Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 455 Carriage Lane Hudson, WI 54016 (NW 1/4 NW 1/4 32 T29N R1 9W) Windsor Heights Lot 23 Parcel No: 32.29.19.1839 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? I:.;1 Yes [] No Use other side for additional information. D E SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 � Scon$jn Madison, WI 53707 - 7162 Sanitar rmit Number (to he filled in by Co.) De artment of Commerce (b08) 266 -3151 9/0 Q Sanitary Permit Application State Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(!)(m) Project Address (if different than mailing address 1A I I. Application Information - Please Print All Information 1 / ^� Property Owner's Na me r Parcel # Lot k Block tf Property Owner's M ailing Address t � Proper cation i City, State Zip Code �`"` � '�,�'k,Section ..tJ , /G!(tF �X� • -7� (circle GnQ II. Type of Building (check all that apply) s T a f N; R�E o 44b, J Ur ❑ 1 or 2 Family Dwelling •- Number of Bedrooms a Subdivision Name CSM Number - ❑ Public /Commercial - Describe Use t � I ❑ State Owned - Describe Use _City_�7V illageTownship of &/� III, Type of Permit; (Check only one box on line A. Compl line B if applicab ) A. New System 020 - l �L -10 -230 ❑ Replacement System ❑ Treatment/Holding Tank Repl ement Only ❑ OLier Modification to Existing System I $• ❑Permit Renewal ❑ Permt evision ❑ Change. o 0__ f� p t Transfer to New Lis re ous Pe �;t Ny�p a Issue d Before Expiration Plumber IV. Typ of POWTS Sy stem: (Check all th a 1) Y _ A L Non - Pressurized In- Ground ❑ Mound > 24 in. suitable soil ❑ ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ ding Tank ❑ Recirculating Synt hetic Media Filter ❑ Leaching Chamber ❑ Drip V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) I Dispersal Y e t? ) _ e la? VI. Tank Info Capacity in 'Total Number Gallons Gallons of Units Septic or Dosing Chamber I _ 11L Responsibility Stateme I, tht t ntdersignt Plumber's Na me (Print) Plumber's Si I_l l,� Plumber's Addre ss (Street, City, State, Zip Code) s' � �' < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Filter ❑ Aerobic Treatment unit ❑ Recirculating Sand Filter D Gravel -less Pine ❑ Other (exnlaim Required (st) Dispersal Area Propos System Elevati n Gap vu r facturer Prefa Site Steel Fiber J Plastic Concrete I Constructed I I Glass i bility for ' allation of the PO WTS sh n on the attach plans. ' M /MPRS Numt>Pr Business Phone Number ;7 f f� S 3 C1_ 21.zC VIII. Count /De artment Use Only 8 1 Approved I ❑ D' pprov . Sanitary Permit Fee (includes Groundwater Daze Issued Iss in gent Signamr ( Stamps) _ F] Ow, iven Reas for Deni Surcharge Fee) IX. Conditio c o v SYS`E 3� J-� i S i e 1 Septic tank, effluent fitter and r ��� . dispersal cell must all be serviced / maintained t, as per management plan provided by plumber. 2. All setback requirements must be maintained v �' 13, ZW as per applicable code /ordinances. I SBD -6398 (R. 01/03) T) YV� ► CLkCOL (to the County only) for the system �n piper oot Iess than 8112 1 es size S F% / vi�consin Department of Commerce Division of Safety and Buildings Bureau of Integrated Services in Attach complete site plan on paper not less than 8 1/2 include, but not limited to: vertical and horizontal refer percent slope, scale or dimensions, north arrow, and lo APPLICANT INFORMATION - Please prini.A Personal information you provide may be used for secondary pump Property Qwner Mailing State Zip Code SOIL AND SITE EVALUATION ance with `s. ILHF�'1 Wis. Adm. Code ~ ' County finches inp ,.' kormust ` 1�oint (BM), dit6 cti9iVand Y )n arf?ppta a to nearest roikd:1 Parcel I.D. # TW Pfor/nr .1' i " Reviewed Py d0Pn ".QMA*(1) - Phone Number Page of - Pr qAocafion 9) v Lot i 1/4 1/4,S T ,N,R Lot # I Block# I Subd. Name or CSM# 0 ❑ City P Allage ED Town Nea lJ ' J4 New Construction Use: Z Residential / Number of bedrooms �_ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate gi bed, gpd/f1 _,,�Z— trench, gpd* Absorption area required gi bed, ft C� trench, ft 2 Maximum design loading rate . _ � bed, gpd* . trench, gpd P Recommended infiltration surface elevations) _ �� y ft (as referred to site plan benchmark) Additional design/site considerations Parent material /� l�l� Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = unsuitable for system [,�S ❑ U El S ❑ U Q S ❑ U ®S ❑ U ❑ s U ❑ S Eau SOIL DESCRIPTION REPORT Boring # Ground elev. &_4ft. Depth to limiting factor bin. Boring # Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 Bed , Trench (� • s S O- / b a g6.Y a- Y 23• 6 `( 3 Remarks: Ll Ground elev. 1 Depth to limiting factor min. Remar : CST Name (Please P mt) Signature Telephone No. i Address Date CST Number l' PROPERTY OWNER PARCEL I.D.# Boring # Ground elev. ft. Depth to limiting fact Boring # 13 Ground elev. ft. Depth to limiting factor j in. Boring # Ground elev. �ft. Depth to limiting factor �_ in. Boring # L1 Ground elev. ft. SOIL DESCRIPTION REPORT Page --.I?— of Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 2 Bed , Trench MAMMM . s %w 1 Remarks: Remarks: Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots PD /ft2 Bed , Trench MAMMM . Remarks: 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 1..� limiting factor in. Remarks: SBD -8330 (R. 07/96) ' , �fsr�9yS'ic .C�ci•(dx:�s' W-6 c. /J- 60,W) G�sT,e�as�9 4" Cl s!£NT PIPE 12" MI ABOVE G RAD£ b 25' FROM 'DOOR '„jN:)OW OR FRESH AIR INTAKE F;NISHE GRAD 4 9t C y R I S ER �---« L`T WATrR TIGHT SEALS A �PPROVE�J j �.i 'IPE 31 1 JRTO slit 10 •- -- PUMP OFF ELEV. C , � D 4£ATHERPROOF JUNCTION B WIT)3 CONDUIT � 4 1 { i 1 I GAS- ' Tl'GHT , 5 EAL t i " APPR BEDD NG UNDER TANK pEc ri wCAT ' S StPTIC / DOSE "APPROVED `ANX MAN'JTACT'JRER: AVe -rseer. SIZES: SEP"'IC 40 GAL. DOSE ,..,... dca GAI.i. %L/ARM MANUFACTURER: MODEL N°JMBEiR SWITCH TYPE :w V. MANUFACTURER MODEL NUMBER: SWITCH TYPE: " �QUiRED DISCHARGE R.AT� GP*� A PPROV ED `rSA.NPi0LE + OV F.F W1 PADLOCK 8 WARNING 1ASEL .......4" M ::lr. *h F Ai.M �( 40INTS WITH APPROVED PIPE 'ON j SOL SOIL � 0 RISER EXIT I i PERMITTED CNLY i IF TANK MANUFACTURER KAg APPROVAL %ONCRETE PAD JMBER Z OSES PER DAY: DOSL' V 4'i.umz xI�C uJDrNG FLOWBACK, Imo.... 9...... GAL. CAPACI A : ZNCHES * i aAL B '� x INCHES a .......... GAL. C INCHES : PUMP E ALARM WZRZ AS : ER Z 1 Z3' WAf £R I` +CAL D IFFERENCE BE:w,EU,Y,�0FT AND FACTOR ^ISTRZSUTION FIPE , MIN.MUM NETWORK SUPPLY PRESSURE f^� FEET — 4 FEET FORCEMAIN X �. - ....�'� FT <1J0 r -- . f'R:C7 *.sprit . . FEET «. , TOT &.L P. YNAMIC HEAD r r E£T "Al. DIMENSIONS OF rump W *DTM — �Z .— .�.......� f R 'b "APPROVED %ONCRETE PAD JMBER Z OSES PER DAY: DOSL' V 4'i.umz xI�C uJDrNG FLOWBACK, Imo.... 9...... GAL. CAPACI A : ZNCHES * i aAL B '� x INCHES a .......... GAL. C INCHES : PUMP E ALARM WZRZ AS : ER Z 1 Z3' WAf £R I` +CAL D IFFERENCE BE:w,EU,Y,�0FT AND FACTOR ^ISTRZSUTION FIPE , MIN.MUM NETWORK SUPPLY PRESSURE f^� FEET — 4 FEET FORCEMAIN X �. - ....�'� FT <1J0 r -- . f'R:C7 *.sprit . . FEET «. , TOT &.L P. YNAMIC HEAD r r E£T "Al. DIMENSIONS OF rump W *DTM — �Z .— .�.......� f R 'b �RGOULDSPUMPS • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. 3871 EP05 APPL Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 'la" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: V /2" NPT. • Mechanical seal: carbon - rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 1041 [40 continuous 140OF (60 intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EPO4 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 S1TOW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). Available for automatic and manual operation. Auto- matic models include Mechan'uai Float Switch assembled and preset at the factory. FEATURES ■ EPO4 Impeller: Thermoplas- tic Semi -open design with pump out vanes for mechanical seal protection. Submersible Effluent Pump to ■ EP05 Impeller. Thermoplas- tic enclosed design for improved performance. ■ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ■ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ■ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ■ Power Cable: Severe duty rated oil and water resistant. METERS FEET 10 9 0 x a 0 J la 0 ■ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING a ' CanadWn Standards Association (CSA listed model numbers end In •F° or •C•.) Goulds Pumps is ISO 9001 Registered. 30: 8 25 _.. ® 2000 Goulds Pumps ITT Industries Effective February, 2000 83871 uick4� STANDARD CHAMBER Quick4 Standard Chamber SIDE VIEW BtC:I IVN VIEW FRONT VIEW MultiPort End Cap z 12` Siz (W x'i_ x H) , , . 52 "`x 12 , A Size W x L'x N ( ) ` ' ``�34' x`16 "I Effective Length 48" Invert Height 8" or 1.25" Invert Height g° INFILTRATOR SYSTEMS - INC STANDARD LIMITED WARRkN (a1 The seub" [oral IMogr,'ly of each chamber, &iii pule, wedge and eiher accessory manufaciuleo try liiii wr ( 'Units"), wi— Intallro and opereted ul a ,oaUnlield of air erratic sopl!r, sysfem in accoidance with plAaot's rnstructrns, is waaarw ,' to ma m final pwonasor (Hcklw °I .-, Sit Uefeciiva nae and Nxkmanship for one year from the date that it seplb pennil is isserau for tire septic syslan caveRing the Ural;; pr(wldetl, hbwwver, II Wt it e septic permit Is not required by applicable law, the warranty period will begin ,I Imo Cale that wsta�labon of the sepic system commences. To exercise IS warranty lights. Hpltaot must nobly Intiftrafrx in writing it its Corporate Heanyt'1rI S ur Old Saybrook. GnneChcul wimt) 1!teen (151 days of the alleged defect. Infltratrn will supply replacement UrWS for Units det(rrnined by mr arafor to be cowered by this Uthilexf Warranty iM lt(atpr's iabiWy sf.ofit;arty axcnrdes the cost of mmiwal and /or installation or the Ui lb'I THE LA41Fr) WARQAN1Y AND REMEDIPS IN SUBPARAGRAPH Ia) ARE D.01 -I rSNT, l IA :-Lit ARE Ni) 01 HER WARRAN 91 WIT It HES4'EC"1 1'p rHE I1Nf ri, iNCLUUINC, NO IMPLIED WARRANTIES OF MERC :HANTABILITY Oft FITNIi FOR A r AR PURPDSE. ir,) 111lB Luttled War ar ly shi be volt t any part of the cha user system is min t t,.te.,l by y - ,e o ther ilten utit :tor The Lu 1 lexl Wa rani•. does ^ct mend to inn dental cen"uenjet, speotai or Indlrer:I da nai I flit to sl not be Cal I t Prnal as a liquidated damages 'ncludmg loss of production and profits, labor and matenais, overhead costs, a other losses W oxpGl, Hs InCu.ret3 uy the Holder or any thud puny spe.irGelly axckrtltd Hum trinlod Warranty ctb erage are damage to Nre Units due to broil nary yea( v d feat, i!n,afion, acctderd, misuse, abuse or negia+.;l of the Units. the Units bang n:biaelad to veltdo traffic or other Conditions which are not net nitlen by the inslalWtior Instructions; failure w maintain the minimum ground covers set III uI the installation instrociIii the placement of improper real this into me s cca4aning IM Untie, fail of ire Units or the septic. system due In Improper situp or imrxoplr sV.nd, excessive w,aler uSai impoopot grease disporial, or Improper operation; or any other ovens not cased by Infiltrator, This Limt13d Warranty shall be va,d if tire Holder fails 9, compy with all of the fern's set forth in this Canted Warranty, F,.aV+e,, in —avant shall InWi alor be responsible for any loss x damage Io the Holder, the Unlls. or aay third parry resulting II Inslalletion or Ship - rnenl, or from any F 4,,cl liability claims of Huldur or any third party. For this I_irriled Wanvty to APpy, the Utvla must be r.M;tatled :n wColda, wile all site n0holions required by slate and fdbal poles; at bitter applicable laws, and Intipralli — witallon insiructruns. lot No mpresismaiirvo of N,i,anala has the authority to change nr copilot this Umited Warrv, y, No warr:lnly appUas to any party .,I than [ha orlyr rat I-Iplrf ,,, The above represents the Slandom Lim,ted Warranty offered Cry Infillrat- A Iit t .hr,' ,tales .11 counties haw dikerent warranty retti meals. Any Purchesor of Ui should CCmtact Infiltrator 's Corporate Haaddu3rlets m Old Saybrook, COmitt :al, prix la such purchase. to obtain a copy of the applicable warranty, ano should carefully read that warranty plot lu the purchase cl Lhi SYSTEMS INC Environmental Onsite Wastewater Solutions'" 6 Business Park Road • P.O. Box 768 Old Saybrook, CT 06475 860 -577 -7000 • FAX 860-577-7001 800 -221 -4436 SIDE VIEW TOP VIEW u,yco, u,.nw,v� r; o,MUt, I In; o,yul,vp,r b,bf I,yui b,r III It"; b,bbo8, IT8; 5,1339,844 Canadian Patents: 1,329,959; 2,004,584 Other patents pending. Ir;iitrator, Equalizer any SideWinder are registered tradercrarks of Infiltrator Systems Inc. infiltrator is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark In Mexico. Contour, Contour Swivel Connactical, Microl-eachii PolyTuH, SnapLock, ChaniVerSpacer, Posil I,uickCul, OuickPlay RECYCLCO PAPER a+ld Oulck4 are tradernar'Ks of Infiltrator Systents Inc. 0 2003 Infiltrator Systerns Inc. Printed in U.S .A. Ml POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page of FILE INFORMATION Owner ' Permit # DESIGN PARAMETERS Number of Bedrooms ;{ p NA Number of Public Facility Units ❑ NA Estimated flow (average) p allda Effluent Filter Model Design flow (peak), (Estimated x 1.5) 0 NA Pump Tank Capacity Soil Application Hate al /ds /w Standard InfluentJEffluent Ouagty Monthly average* Fats, Oil A Grease (FOG) 530 mg /L .t u / Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA Total Suspended Solida (TSS) 5150 mg /L ❑ Peat Filter 0 Wetland ❑ Other: Pretreated Effluent Quality Monthly average 0 NA 0 In -Ground (pressurized) ❑ Mound 0 Other: Biochemical Oxygen Demand (800 S30 mg /L 0 NA Total Suspended Solids (TSS) $30 mg /L O NA Focal Coliform {geometric mean) 510° cfu /100mi ❑ NA Maximum Effluent Particle Sits Y in die. 0 NA Other: 0 NA "Values typioud for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer 0 NA Effluent Filter Manufacturer L' C3 NA Effluent Filter Model dv 0 NA Pump Tank Capacity & al 0 NA Pump Tank Manufacturer re s e 0 NA Pump Manufacturer .t u / 0 NA Pump Modal months) eerie) 0 NA Pretreatment Unit 0 Sand/Gravel Filter ❑ Mechanical Aeration 0 Disinfection ❑ Peat Filter 0 Wetland ❑ Other: 0 NA Dispersal Collis) 0 In- Ground (gravity) 0 At - Grade ❑ Drip - Line 0 NA 0 In -Ground (pressurized) ❑ Mound 0 Other: Other: At least once every: 0 NA Other: 0 NA p NA Other: ❑ NA Sointbe Event Service Frequency Inspect condition of tank(al At least once every: 3 ear h s {Maximum 3 years) 0 NA Pump out contents of tanks) When combined sludge and scum equals one -third %) of tank volume 13 NA Inspect dispersal collie) At least once every: onth s) (Maxhnum 3 years) © NA Clean effluent faker At least ones every: .l months) eerie) O NA Inspect pump, pump controls S alarm At least once every: _-- month(s) D is) O NA Flush laterals and pressure test At least once every: �— month(s) is earls) 0 NA Other: At least once every: 13 mont j(s) O NA Other: �C) �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 tankla) 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 "I(&) 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 falling 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 cantente of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized Components, pretreatment units, and any esrviciny at intervals of 512 months, shalt 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 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanktsl for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cellist. if high concentrations are detected have the contents of the tank(*) 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 call(s) in one large dose, overloading the call(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 safety abandoned in compliance with chapter Comm 83 .33, Wisconsin Administrative Code: e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. e The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e After pumping, aN tanks and pits shelf be excavated and removed or their covers removed and the void space fitted 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 replacement system: 70 A suitable replacement area has been evaluated and may be utilized for the location of a replacement sod 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, 0 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The l ip site ® tank © Mound and at -grade soil absorption systems may be reconstructed in piece 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 `� /�� e4 Phone 5 3 �6, 6 POWTS MAINTAINER Name Phone SEPTAGE SERVICINQ OPERATOR (PUMPER) LOCAL REGULAT AUTHORITY Name Phone Name �, C (OLL O I FY �fj Phone 5 3 �6, 6 This document was drafted In complience with chapter Comm 83.22(2)(b)(I l(d)&(f) and 83.5401, (T) & tai Wisconsin Administrative Code. ST CROIX COUNTY SE PTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address _ -- / 7 /q yP Property Address (Verification required from planning Department for new construct City /State _ 44 c/ 5cr� , :; .Parcel Identification Number LEGAL I), SC;)kt.11'TION b2o -13yz - /o - 73 183 Property LocatiorW w y,, ,y w r /<, Sec. . , , "i' N -R W, Town of /-/U c)s o N-\ Subdivision _� � • _ j � -�� -� - , Lot # 2 .3 Certified Survey rvlap # __.., Volumc , Page Warranty Deed # _ 3 , Volume - - �-- .(..__, Page # e Spec house yes v no Lot lines identifiable K yes 0 no SyaF, X1AI N EC>E Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consist„ 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 srsterrr. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owrr_r aitd by a master plumber, journeyman plumber, restricted plumber or a t.icerised pumper verifying that (1) the on - site wastewater disposai system is in proper operating condition and;'or (2) after inspection and puntpin? (if necessary the septic tattle is less than 1/3 full of sb.tdge. lb,ve, the undersigned .have read the above requirements and agree to maintain the private sewage disposal system with the standards set foitli, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic systern has been maintained must be competed and returned to the St. Croix County Zoning Office within 30 days of (lie three year expiration date.. SIGNATURE OF APPLICAN 4JQ -a 12 co , rs Z DATE O CERT IFIC:'ATIUN I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) ani (arc) the owner(s) of the property described above, by virtue of a warranty decd recori;d in Register of Deeds Office. c SIGNAT(lI2.E Of APPLIC.,�r c�Je T Lau,1 t DATE _ - - -- c Any information that is misrepresented may result in the sanitary permit bcin�l t +`•••� re�'oked by the Z oning Department. . •` Include with this rapplication: a stamped warranty deed front the Register of Deeds office a copy of the certified survey ma p if reference is made in the warranty deed ,� . , .fir uQ� �.37q►a�E ?5 3 STATE BAR OF WISCONSIN FORM 2 — 1982 KEGIS OF DELDH WARRAM IN DEFD ST. CROIX 'C0. , uI DOCUMENT N O. RECEIVED FOR RECORD Cavid A raf and Ttlosc " M . 17 - - .zntccys and warrants to Inc a _ _ — ��t 59- 104 11- 20-!996 6:30 4N WMANTY DEED RECORDING FEE: 10.00 PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA the following described real estate in St. Cro i _County, Statc of W;sconsin: NAME AND RETURN ADDRESS EAGLE VALLEY BANK, N.A. 1301 Coulee Rd., Unit 2 Hudson, WI 54016 pARCEI iDENTIFFCATiCN NUMBER -- Part of SE1 /4 of NW1 /4 of Section 32, Township 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey hl: p filed April 8, 1997, in Vol. 11, page 3232, Doc. No. 557676. Together with the right of ingress and egress over the 66 foot access easement as described in Vol. 1231, page 531, Doc. No. 557661. Rp�SfER a E This iS n homestead property: X0= (is not) Exception to warrantees: Easements, restrictions and rihts- of -;aay of record, if any. November Dated this day of ( 0 4 , Ij / (SEAL) David A. Graf AUTHENTICATION Slgnalure(s) _ ACKNOWLEDGMENT state of Wisconsin, ss. County f , authenticated this day of 19_ Personally came before me this day o! t lttnuur„ Nov ember 19 the above named .>`FNEK''� - David A. Graf and Thomas M. Graf TITLE: hiEMBER STATE BAR OF WISCONSjiV authorized by §706.06, Wis. Stats.) = THIS INSTRUMENT WAS DRAFTED BY i O Attorn Kristina 0gland ���''''tot #1111% Y � Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) 98 -- A, D., 19 i e _ (SEAL) Thomas M. Graf I (SEAL) (SEAL) to me known to be the person who executed the foregoing instrument and acknpwledge the same Notary Puhli . ' r County, Wis. My commission is permanent. 0i not, state expiration date. • Names of persons sigmng,n any capacity should he typed or printed below their signatures. STArE BAR(* sVISCONSIN Wsconso Leo Blarit Cc, M WARl4ANFY ULt-.D l No. 2 - I482 W a -fay. W9 .. t. �7 i��: �• .��'.� % A' ..�g�� Y �- ..!* � I STATE BAR WARRANTYIDEEDM 2 — 1982 555130 2 1 PAGE Ofi� DOCUMENT NO. VOL �„� Mary K. Kral, a single person, conveys and warrants to W est Lak B uilders, Inc . , a Wisconsin corporation, the following described real estate in St. Croix County, State of Wisconsin: (See Attached Exhibit " A rt ) This is homestead property. (is) ST CROIX CO., Wl litw'dbr FEB 3 1997 V 10:00 A. M Ropstx of Dwdtl I I _ THIS S PACE RESE F OR RECOR04N DA NAME AND RETURN ADDRES /i S I) v 020 - 1093 -10; 020 - 1093 -60; PAR EL ADEN A ACA R N NUMBER �A � �I II i $ Z ANSgEER oo 'r ! u I ' .I �I Exceptiontowarranties: Easements, restrictions and rights -of -way of record, if any. , Dated this / day of -- January _ A.D., 19 97 (SEAL) ! ! — H R • 1(^ (SEAL) Mary K. Kral AUTHENTICATION Signature(s) (SEAL) (SEAL) authenticated this day of ' 19— TITIE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wes. Slats.) ACKNOWLEDGMENT State of Wisconsin, ss. St. Croix C Personally came before me this o day of 1 ra 19.4 -. the above named Maly K Kral, a singles person, to me known tc be L119 person who executed the foregoing instm awledite the same. THIS INSTRUMENT WAS DRAFTED BY At tnrnPV Kri c t i na Ogl anri !�� /y /�yt• Hi ids 67T 54016 Notary i (Signatures may be authenticated or acknowledged. Both are not My o necessary.) _ -- - �( Name of persons signing in my capacity should by typed or printed below their signatures. WARRANTY DEED STAT Forrm No. 2 — 1982 (If not, state County Wis. VViltaren Legal Bill* CA, VC. MiwsMee. VW,. • VOL 122 PA 065 EXHIBIT "A" SEI /4 of NW1 /4 EXCEPT the South 66 feet of West 660 fast thereof and EXCEPT the East 3 -•1/2 rods of South 20 rods thereof and EXCEPT that part lying Ely of O'Neil Road; The North 66 feet of East 678 feet of NE1 /4 of SW1 /4; Part of SW1 /4 of NE1 /4 described as follows: Outlot "1" of Certified Survey Map filed October 15, 1980, in Vol. "4", page 1001, Doc. No. 367079. All in Section 32, Township 29 North, Range 19 West, St. Croix County, Wisconsin. Part of NE1 /4 of SW1 /4 and part of SE1 /4 of NW1 /4 of Section 32, Township 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Commencing at the N1 /4 corner of said Section 32; thence S0 (bearings referenced to the N -S1 14 Section line of said Section 32, assumed S0 0 12 1 40 "E) 2698.18 feet along said 1/4 Section line to the point of beginning; thence continuing S0 0 12 1 40 "E 35.40 feet along said 1/4 Section line; thence N89 0 57 1 50 11 W 678.01 feet; thence N0 0 16 1 48 "E 132.48 feet; thence S89 0 37 1 30 "W 647.66 feet; thence N0 0 05 1 05 11 W 19.24 feet; thence N89 0 09 1 26 "E 660.06 feet; thence S0 "E 66.01 feet; thence S89 0 09 1 26 "W 12.09 feet; thence S0 0 12 1 40 11 E 66.00 feet; thence N89 0 09 1 26 11 E 678.04 feet to the point of beginning. TOGETHER WITH AND SUBJECT TO A non - exclusive easement for ingress and egress as described in Quit Claim Deed dated January 12, 1987, recorded January 15, 1987, in Vol. "716 ", Page 200, Doc. No. 421395. 57423-5- nuN 32 J 1 RADIUS I REGISTER'S I ST, CROW C73 , V V% . M T$ CROW f., R Chu day I /J Rcc ..d >� r d LGT1_ D., 19 [ Y.._ I J 6} M Realyded 1 1 V okme s co' TANGENT N 'r TEMPORARY CUL -DE -SAC TO BE REMOVED `O 1 I N � Rcaaea dD6-16 •m / UNPLATTED 2 ll NUMBER DIRECTION DISTANCE 2.50' t Lt N76'4ra3 - Y/ 2256' 1 1 1Q 7 LECEND r r r ALUMWUM COUNTY SECTION CORNER _J WI UONJMENT FOUND c� I `- 29AL 1' IRON PIPE r OUNO TRACT 3 , PR'1POSED DRIVE p� Lijl ' � 1 1 C. S__ � 50' ROADWAY SETBACK UNE OR AS SHOWN 1 3 \4' IRON PPE FOUND i -- —_ - - 1 w= w - — - DRAINAGE AND UTILITIES EASEMENT jr ° I fr I O WADE ALONG R \W AND 6' ON 0014 SIDES OF LOT. LINE OR AS SHOWN 1 LOT I ' N.W.L. H.W.L - NIGH WATER LINE 100 YEAR ST'IftM EVENT T 1 ; ,` 1 NOTE: - -- - - - - -- — 1-- -- - - -- NO BUK.Oft;, CRA01NG OR ANY OYNER VOL . P C I IMPROVEMENTS LL ALLOWED VA--IN THE . 1 'YtAIt AGE AND U71UTIES EASEMENTS 3 I 1 ao n I LOT Q 2' X 30' IRON PPE SET WFIGMC 3�Lg5_PFQ Fno I 01 NOTE: - ALL OTHER LOT CORNERS MONUMENTED WITH 1' X 24' 1 I IRON PIPE NEIGHING 1.66 LBS --- - - - - -- PER UNEAR FOOT I a: :N.I -- x EXISMA; FENCEUNE r n n SMALL CURVE DATA FOR DRAINACE TRACT h AN UTILITY AREA WITHIN LOT 24 -- - - - -- — _ NUMBER C62 RADIUS 167.00 CE14TRtAL ANGLE 5r36'27' CHORD BEARING 1426 E CHORD LENGTH 160.92 ARC L04GT14 167.91 TANGENT NO21503'10 TANGENT N5571'24'E TkAe are no objections to this plat with respect to Secs. 236.15.236.16.23(.21; arwi 236.21 (1) and (2). Wis. Stars., and ch. Comm 85 oldie WI& Admin. Code as provided by Sec. 236.12 (6), Wis. Stats. Certifi , 19qg or <Juvm-AA Deparmlent of Administration REVISED THIS ISTN CAr OF dANuART.1996 I � WEST LAKE BUILDERS, INC. in 1094 (OLDEN OAKS LANE 1 N Co' ir� SMALL ► I sI NOTE• ''� F TRACT 1 a 'f NW CORNER OF LOT 4 - N2"2'46'[ 97.66'. ; Zr I ; 1 TEMPORARY CUL -DE -SAC TO BE REMOVED u% W - 1 s � . 1 .,MALL TRACT 49'43" W 2� NUMBER DIRECTION DISTANCE 2.50' t Lt N76'4ra3 - Y/ 2256' 1 1 I RAT �. i I 1 E Lijl ° j V, 1 1 C. S__ � : 49'43" E 1 >1 ---- - - - - -- ty 7.75' VOL - 3 : ! 1SOU I LINE OF THE OF THE NWt /4 LOT W - I I I -- - - - - -- — i0 I rn o ao n o .1 1 OITNr_'. WEST LAKE BUILDERS, INC. N 1094 (OLDEN OAKS LANE 1 HUDSON, Wl 54016 NOTE• ''� F CEWER OF TEW ORARY CUL -OE -SAC TO THE a 'f NW CORNER OF LOT 4 - N2"2'46'[ 97.66'. W TEMPORARY CUL -DE -SAC TO BE REMOVED u% W - UPON EXTENSION OF ROAD s � 2� NUMBER DIRECTION DISTANCE Lt N76'4ra3 - Y/ 2256' 2� AREAS otrrtor r 0.139 ACRES 6.034 SO. FT. ourwr 2 0.241 ACRES 10.511 S0. FT. ovnnr s 0.246 ACRES ima6 S0. FT. ODTLor 4 0.660 ACRES 29.640 SQ FT. NOTE: BUILDINGS FOR HUMAN HABITATION ARE PROHIBITED ON OUTLOTS 1, 2, 3, AND 4. OUTLOT / TO BE USED FOR AN ACCESS TO LOT S. LANDSCAPING, LIGHTIriG AND DRAINAGE. OUTLOT 2 TO BE USED FOR AN ACCESS TO LOT 14, LANDSCAPING, LIGHTING AND DRAINAGE OUTLOT 3 TO BE USED FOR AN ACCESS TO LOT 18, LANDSCAPING, LIGHTING AND DRAINAGE OUTLOT 4 TO BE USED FOR PRIVATE PARKING ANC RECREATION. LOCATION SKETCH 1 - 94 ° ----------- J "' �5Q N •- cj Q (n W I Q /y� H W En . �- iA 00p`rN O 1j _ +t�AO 0 , 5 WN_ J - 5d M ono N I O ,� '- to N Ln ..f� Z \ • a0 � I Ln I cc ca O< l • a, V 6 Z �,�,I 62,9 S C4 6 41 ' /i 41 I O8 W IX ,_• O A) W� OO�f G ' \ i �� �I- ^ /' •� ,M N �\g oaf Z Q N N v /,' •• \'\ o / N 1'35'1 �j 00 0 U1 CD N v o / d �g'I �°�• �� 0a ���115.71' --J ao a � I - ,, E �• � —187.31 - 5 .N 05'02'29 W o ,n V) 32 .-a 3. 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