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HomeMy WebLinkAbout020-1353-21-000 \y /$ K f i \ a \ \ k \ / ai m a { L. ] r oc — \ »/ oo \ \ { \ \ — o \% / G & \ \ 2 § p er 2 2 { } 2 \ \S ) /2�j- 2 / ) / { / \ <0_ CO n j E , § \ { § - % N j O. 0 §a _§ \ & ez< §_ k $ \ ) \ � 2 F- = / E ,,cog / ! g 0 \ \ N r 3ƒ ƒ ƒ\ ) 0 6... ) { / (3, ± / 3 k \ ) - ) \ k \ z \ LN / T k m 2 o t an tit r, 0 a 3 a - y tiZt j & a ca 0, § 0 0 E 5 •� 4.; = a a a © E f ¥ vre. / j k ) \ \ \ ° /z N. tt } j } ` o c c \ \ - I / 4 ~ ~ § 11 . � 2 ii < A ® W 0 2 0 ? k G @ e \ - - ) E 0 o E & \ 0 / / / ( \ \ \ NI .100 L. § $ ° CO 3) ) 0 \ o o { \ '4'. s..; > \ ] Q a • / 0 R I 0 % \ - 7) ) \ / Pi 'E w : i k _ E c k « 2 \ \ E J § k a § . . A 0 a k 0 3 0 i , o 0 3 0 d d 0 a O va E» ea ea _______ a o) c o c C 0 C O M C H N w N E. c0 - GL �_ce C-.. N C • 00 \ ) _ � = T m <- N CO N Of •ti C 7 r CO E . v a) L ;a C y C N C 7 p o _ p U . ` • @•p L. O E � ti N C C 0 .. E a c 3 a � N 1 if , Akeud 40-444 4-6 v i C 6 . , iOAS / 1 k() eti 5(1401- /` )i Z t % t 0 ..-- Ok) a_ 71- 4 I D 0 2 1 i . ) d ' \ ' M Z r 0 4 .. ts i as R. ,, m 1 , , :-.- .._... 2 = o u) U.)2 5()' 1 4 rji. g i \ V • o I _. _ . o I I E 01 6 N n. O O M N .o _ r N U O • �. •` 0 c d C d 10 N W 1 Z Y d 04 1440010, glib d 1 corl A�ag 1 f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM " ty cl y ; -� • Safety and Buildings Division INSPECTION REPORT t. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar 384 Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). . Permit Holder's Name: - ❑ City illa Town of: State Plan ID No.: Creager, Tanya y p Hudson T ownsh i p - CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020- 1353 -21 -000 TANK INFORMATION ELEVATION DATA 14. 29 f9r .26.21 TYPE MANUFACTURER CAPACITY STATION 85 HI FS ELEV. Septic w eA -s,2-,C 10-00 Benchmark a . q, 102,1* 1 co .0' �. Dosing , f Alt. BM `• q° Aeration Bldg. Sewer (o • 25. Holdin _ St/ Ht Inlet '4-.5b TANK SETBACK INFORMATION St/ Ht Outlet .4`i TANK TO P/ L WELL BLDG. vent to ROAD Dt Inlet -- - -_ Air Intake Septic >5r y) I (p t -- . NA IX Bottom -- 1 D NA Header / Man. 3•/7 9.•21 Aeration NA Dist. Pipe 9,st Bot. System 9. VD 9Z . 3 1 Hold ys 11. 3A 9'/ PUMP / SIPHON INFORMATION -. Final Grade . 7.22. Manu : cturer De nd S' Cover Model Nu • - PM T i Lift riction I System TD Ft • L• Head _ Forcemain I Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM ! c ,� , isso 1; j Width i Len // / N Of Trenches PIT ' No. Of Pits Inside Dia. I Liquid Depth DIMENSIO S 3 I lo$ - I DIMENSIONS Manu turer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING - &�Q9 w L INFORMATION Type Of CHAMBER l Num r: System: Com) • _ 1 59 a9 (x) �, OR UNIT i - Ca{)a. DISTRIBUTION SYSTEM Header / Manifold I Length Dia. I Distribution Pipe(s) x Hole Size x Hole Spacing I Vent To Air Intake Dia. Dung SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over I xx Diith Of xx Seeded /Sodded I xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No --- (Include code discrepancies, persons present, $g ection #1: 041 )$/ 0 Inspection #2: -----/---, ., Location: 662 Hillary Farm Road, Hudson, WI 54016 (NW 1/4 NE 1/4 36 T29N R19W) - 3629192021 1 Cottonwood Ridge -Lot 21 1.) Alt BM Description = �rY 2.) Bldg sewer length = - amount of cover = s ,,, ; Q •64-- •. =fib A ,........k.t- . Plan revision required? ❑ No ' ,,,I Use other side for additio . ormatio . ' SBD -6710 (R.3/97) ' `e.Fa Date s pectors gnature 0 �� 4 ; r ;. r .. I kw l l-M • 0 F3 Sanitary Permit Application Safety & Buildings Div In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington / S reverse side for • r Instructions for completing this application PO Box 7 \M P g PP ication Department or Commerce Personal information you provide may be used for secondary purposes Madison. WI 53707 - (Privacy Law. s. 15.04(I)(m)1 (Submit completed form to county it state own Attach complete plans (to the county copy only) for the system, on paper not less than 8 - 1/2 x 11 inches in size. Count _ y C State Si ary p Sit Number 0 Check ifrevision to previous application State Plan I. D. Number 3 r I. Application Information - Please Print all Information " Location: • Property Owner Name Property Location T (,N, F C4-52.431 J� it 1 / SIP tE pi Property Ownc Mailing Addres NW I/4 Lot Number Block Numb 1a 20 3 nu. Ai a 1 Cit y , State Z ip Code Phone Number Subdivision Name or CSM Number P' / � s X % s• 038 �, (4" ) a y( -57� , t 1 I Ty of Building: (che one) 0 City I or 2 Family Dwelling - No. of Bedrooms: 3 ✓� ' ,!� - /00 2 0 Village O Public /Commercial (describe use): H - /0 S ` iirfown of 0 State -owned 111 Type of Permit: (Check only one box on line A. Check box on line B if applicable) Neare" silai A) I A New System 2. ❑ Replacement 3. 0 Replacement of 4. ❑ Addition to arcel Tax Number) -F� 0 System l Tank Only Existing System 0 ,96— /3.'3 — 62L z- B) Permit Number Date Issued O A Sanitary Permit was previously issued 3 6 . a 9. f 9• g o a t IV. Type of POWT System: (Check all that apply) Non- pressurized In- ground 0 Mound 0 Sand Filter 0 Constructed Wetland O Pressurized In- ground 0 Holding Tank ❑ Single Pass ❑ Drip Line O At-grad / ❑ Aerobic Treatment'Unit 0 Recirculating ❑ Other: C 3 A 3S" 4-yeA t -s V DispersaVrreatment Area Information: - I Design Flow (gpd) 2. DispersalArea 3. Dispersal Arca 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposcd Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation VSO 3 Z 3N - Ft z- o _ .- t(/, 2) 0 . -(-- 81.1 i VI Tank Capacity in Total # of Manufacturer Prefab Site fiber- Plastic Information Gallons Gallons Tanks Con- C o 1 12 ` New Existing Crete sty •• Tanks Tanks , sr / / =' I :, EbNi 1 i 0 ❑ t. 4! ' ❑ , ■ ■ I "❑ V1 Responsibility Statement ' x.: I, the undersi.ned assume res•onsibilit for installation of th POWTS shown ■n the attached .tans. r Plum. c P�(D�int) , r7 / / �umbersr atur/ o st p='i�' v P PRS No. \ :: a one Nu• Plumber s Address (Street, City, State, Zi e) r y r� !' • ' J VIII County/Departmerit Use Only 1 0 Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I suin Agent Sign tur o stamps) Approved ❑ Owner Given Initial Adverse Suipharge Fee cyp Determination ermination 3 ?2 u • 1 IX. Conditions of Approva /Reasons fqr Disa r ov I: / /� N« .1 i - Ip� 'S d _tat • l�J. L. aAQq %Z.-0 /�� .� ob o-44 w �a X il* k- DU o ' 6 ks wu444 -- Ice-- ti a �o� , x'- P r �o.� (� st� s�.w, t w�-t-..�XiL �'t`evt . r ,r,M,�sF ILA- �° r • , bid •% i , ' , ( - ; s CA&440/wtw� 44,46 5„e)j in f aao3s 7 p o- -- oi-te-e 3- i )Loo sr; al A - /A zo -&- = 50 -NI = 9 /. ? a y t/ -/o s 4 'At = /66 ' N .,--., al' `1. 14 -tirgh = rfrotp,j,-L o 4 0 I 1 f i t 1 r - -x c9” - c i 9i, za' i 3 -5 G ,_ Pte. l )0 �,,Ta X A - )3 9 .- A 4 La-0----i -F.6%- -- -- ------' per u � ,c),, I� 1 aao.3s 7 ' 3- I&-t loon .5.7: al l 5-a / ' / Zo-Or 1-4 = 91.yb _ r�1 /0 a . /1_/0 5,:,32.12_,L,J,_ 4 //4 _ /)6 '/vj 4 /4 %I, . 0 4 0 r - - _d 0 / 9) 3 -5 Pte. r 0 \)).- 1 ■ A — )69 ,Ta /r I X A 6 1 3 a t i . i dL o _ 4 _, / -FaLAA,,__ - a . ---' . A Wisconsin Department of Commerce SOIL AND SITg..gVALUATION Division of Safety and Buildings -.. Page I of Bureau of Integrated Services in accordanc ,*6 $. IL` HR 83:09 ? .,Wis. Adm. Code • Attach complete site plan on paper not less than 8 1/2 x 11 inc A i n , size. P giu - - .,County include, but not limited to: vertical and horizontal reference po , 4 ), directi� tti ' .' ` � S . ( rU ( y percent slope, scale or dimensions, north arrow, and location rithilistarf%t nearest road. f'rcel I.D. # • Et APPLICANT INFORMATION - Please print all i ornation ' C hf Yr, viewed by ',/ Date Personal information you provide may be used for secondary purposes ( acy,La itly (rn `� ,/r ' if GO�� lJ ' 04 7 6, /5'p Property Owner , { , Property Loca)i p � \ (A / � r 1 S I) �,. 1 �oVt. Lbt 1/4 A m 1/4,S 3 ( T Z -1 ,N,R l et E MO (Ai Property Owner's Mailing Address rot fr Block# Subd. ame or CSM# City State Zip Code Phone Number City ❑ Village 8—Town Nearest Roa I] ❑ U< on 1 tdi 1JS�-{V°f l 1 (1 /� )6'1 l -6 1- 4Iac1 -`4 n 1 caFfonwo00_ -1•r New Construction Use: residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 1000 gpd Recommended design loading rate • 7 bed, gpd /ft • O trench, gpd /ft Absorption area required kS bed, ft `i D trench, ft Maximum design loading rate ' / bed, gpd /ft • F trench, gpd /ft Recommended infiltration surface elevation(s) vpt-r 91.76 Lower 81. go ft (as referred to site plan benchmark) Additional design /site considerations upper $e 4 d Lower 86, 70 / Parent material 6 b (al ()( ).. L-0 11k h Flood plain elevation, if applicable h • f4 Wo ft S = Suitable for system Conventional ' Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system © S ❑ U © S ❑ U Q S ❑ U IX S ❑ U ❑ S [X] U ❑ S © U SOIL DESCRIPTION REPORT Boring # Hori Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench i ( 0 to y r 3 /z. _i 1 ii-roil f rri r (S 1 r . Z ,. 13 IC) - ir LIfq L �} 1iYl�; rp1 cS , 1 , .gi elev. 3`J f2(� I� yr `, t IY)`� 6 S 3 1 Y1( r 3 ( .8- q57 ft. Depth to , - ' limiting wil Sr( (ii) factor 124> in. 18 %I0 'i ' Remarks: Boring # 0 - 7 1 — �..3 L i 016.0C m-C r c S 1-C • 4 , 5 -7-`!e IQ yr S /4 .._if 57r, t. r nvf , c S • 5 • ( ` 15-1 - /U y r t-I m s ash c-)1 C S - 1 Z Ground , elev. g.LgUft. ' Depth to , limiting factor l 'XNn. Remarks: CST Name (Please Print) Signature Telephone No. iqda.r-1 5ch i..: _ e — - .1 - (, zy 7 - Address Date CST Number C O K ( r . . -`/ 3Or?Cr'V4 , LJl 550 4 -{-/5 - 253305 4 —L .t SOIL DESCRIPTION REPORT 2 3 PROPERTY OWNER Page ° of PARCEL I.D.# Boring # H orizon Depth Dominant Color Mottles Structure G D /ft 9 Texture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench O - b /�3/z. SL /rc b)L m-Tr c 2 I U-4p (D yr 5/4 `— S; I Srrab k cn' - F < CS — • Ground 3 40i /6 yr I ep r Y)S 059 7Y1 ( c elev. 7 SC Depth to limiting factor [ 3 J in lo , � `b v Remarks: Boring # U -`t 10 'ir3 / 5C_ 1rrtcbC mf c 5 i- ,y ; ,5 Z 9 - - "IS sic) s s 1 5 nma b ft rnv-€ l c5 — . 5• 3 W /6-,(1- y 14 1715 5 Ground elev. 9 Depth to limiting factor / ./l in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # d_i .31 �Z- _ `- ' rry )Y)�r I Z 3 7 ICI �r .t (. Z 17 -147 IU 1 r LI iy - -_ L I rr,< , rn c 3 yi -128 10 . ir fns Uci r n ( c-S — 1 . Ground elev. - q7. zcft. Depth to (p limiting (Q� factor i Z din Remarks: Boring # Ground elev. ft. . • Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) )o t -.3 S* u - !-ofz ( CG+-fo r∎wavk IC L -d.c.2 • X Sec.(-e_ ( "_ /Go' net tG ari.. . -el-C.v ioc0 .0 rot ,. (3mZ eAeu, to-o.0 Syslew. c,PDe / 9O Gow cr 21.90 (Ow 4.ower Amt. eAe t fsSt. 90 34.7 • • 0 4- '4 ovnt • �w L at C3 • • Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 05 Number of Bedrooms 3 Design Flow - Peak (gpd) LIS-0 Estimated Flow - Average (gpd) 3 C1D Septic Tank Capacity (gal) tstr0 • Soil Absorption Component Size (ft l 2 r S er ` Type of Wastewater DoMestic �� Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) 1 tz0 31-4 2- - as � -f / � Maximum Influent Particle Size (in) 0 -- ' 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septi . nd outlet filter shall be assessed at least once every 3 years by inspection. The I utlet filte shall be cleaned as necessary to ensure prop_ en ration. The filter cartridge shoul • not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 s • Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep -rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. A il..t-e&AA-0-it-9-- sc 04_ f �� L ov.,. s � i�� ak eivv.-6--/+a, 6U1/4-1-4 /LA-1 /44i_ N 4(9 P- uccr-ag 6 7/ 5) aZ g � 6 ,sO (7/5) 3 (...t..0-4-cc 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP Ci:RTIFICATION FORM Owner/Buyer , h C GL far &. C e1-- Mailing Address j Z b A 7. • 1 AI kti go e Property Address - 002 Cdr ' ,. i ■ al • h (Verification requited from Planning Department for new construction) City /State TO W h C` ) U CI S 0 YV Parcel Identification Number n 213 -135 0 0 r1.5r) r LEGAL DESCRIPTION Property Location V4, /, Sec. , T N -R W, Town of )7 Lt-d So /1 Subdivision .• i II i , Gt A ' Lot # a 1 . Certified Survey Map # _ , Volume . Page # Warranty Deed # L` , Volume It ) , Page # 1 - 7/& Spec house ❑ yes ❑ no Lot lines identifiable j) y es ❑ no SYSTEM MAINTENANCE Improper use and maintenaneeof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tack every three years or sooner, if nettled by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St Croix Zoning Department a certification form, signed by the owner and by a master Plumber, joumcymanplumber, restrictcdplumber or 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. 1/we, the undersigned have read the above its 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 Office within 30 days of the three year expiration date. • (MR4C61.,¢1) lv / S/ 0/ SIGN OF APPLICANT DATE OWNER CE1 1IcICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (wc) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded is Register of Deeds Office. 0/ SIONAIfr OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** * * ** *f 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 �d Wti60:60 ZOO? TO 'unf 002_S9PZSIL : 'ON Xdd 9NlltifltiDXB '110e171 : WO&J r - , vol 1651 4 29 ( ° . STATE BAR OF WISCONSIN FORM 2 - 1998 6471 46 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number 5T. CROIX CO., WI RECEIVED FOR RECORD This Deed, rnade between — 06- 04-2001 10:00 AM RINIA D O. • _ • • •U bucband and wife, _- WARRANTY DEED Grantor, EXEMPT A - -- -- — CERT COPY FEE: and . • • . _ . _ • • e _ CZARDNER - - COPY FEE: CREAGER ,husband _and wife, TRANSFER FEE: 173.70 survi vorhi p marl a property. RECORDING FEE: 10.00 — — PAGES: 1 , Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate In fit. Croix County, State of Wisconsin: Lot 21, Plat of Cottonwood Ridge, Town of Hudson, St. Croix County, Wisconsin. Name and Return Address LAND TITLE, INC. Grantee, its successors and assigns hereby SUITE agree that a single family residence only will 1900 SILVER LAKE ROAD WBRIGRTO MN 512 be constructed on the subject premises. FILE NO, 1C c ,,( 0711- 1 35'1_71 -non Parcel Identification Number (PIN) This i q not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 1 - day of J l\ • 200 1� l �1 . (SEAL) / • ,d-r) _- (SEAL) Rioharr3 0 Stout ` ,Tinpt P_ Stout (SEAL) - (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, ss. St. Croix County. authenticated this day of Personally came before me this / day of , 2001 the above named $ir•harri Cl_ Stout anti Janet p _ Stout TITLE: MEMBER STATE BAR OF WISCONSIN ���tt++ to t g me known t be SwYfe' executed the foregoing a not, instrument ah�TtQkTgvQI a WI ONSIN authorized by §706.06, Wis. Stilts.) KERNON J. BAST THIS INSTRUMENT WAS DRAFTED BY - ' ' hff 1 Janet P. Stout ., 1353 Awatukee Tr. " • Hudson, WI 54016 Notary P ,bile, State of Wls in My co mission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not , . necessary) Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee. Wis. UNPLATTED LANDS N88'52'42 "E 2571.60' . U.S. INTERSTATE 94 12' TYP, TRANS 233 -, i i O i 1 t I - -- ____�__ i i i ................ '\. H.W.L ; 960. �,. ; ; TWIN HOME , , ♦ ) ;� ' ' TWIN HOME ,_„ TWIN HOME , • !o 21 :RES i i 3. i ! , 22 001 ACRES i I o ' ' 23 SQ.FT. c); ; 1 SQ.FT. ! ! - , � ' ' ; ,� 3.036 ACRES ; ;w 3.014 ACRES WI i i i i iw 13Z236 SQ.FT. i ;o i � ■ - 131,286 SQ.F1 Z i i H.W.E.i = 962.0 10 ) I. ii i! ;;w 5' TYP. i ,, i �o 5 ' TYP. *** **a. w.eMPID ' ooli .menu. i i ii ii i i ii ii :: !i �i i.....i i 1 i! i i , ! . i , I I i N88•15'10 "E 322.93' - -_ _._ ' i ••••.. •,,, 1 i .. S93•4513 -----4-.- 584.47' , L - i- _ f 1004.25 SOIL EVALUATION REPORT page 3 °f - 3 - Wisconsin Department of commerce -9,-e 1,25 / Division'of Safety and Buiklegs in accordance with Comm 85, Ms. Adm. Code County 5 f, C I t X Attach complete site plan on paper not less than 812 'Mel inches in size. Plan must indude, but not tinned to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north anoW, and location and distance to nearest road. pate Please print all information. Personal hrfonnafbn you provide may b , RevielAktL/--- I e used for secondary puns (Privacy Law. s. 15.04 (1) (m)). Property Owner Property Location T 4- /U.C.k. C. r P Govt. Lot g 1/ 4 Name or T N R E (or) W Property Owner's Mailing Adder �1 I I g 'lad loo fvvvinaa(e. Gak-t Rfucl Svi'iiso Z( e0+-1,0(-\ W a a `�� NearestR d o Ci State zip Code Phone Number ❑ City ❑ Village CTS rh ,,'1,1i7.2 pot ' I Inn vii 5 ?-i vas ( )-'/t hicidsv r 1 Cof-fert w o o dt -4-r Resident al / Number of bedrooms 3 - `/ Co de derived design ` 3' °�`r- .a GPD GA Nei Construction Use: CA � ` o Replacement ❑ Public or commercial - Descbe: [ ft. material . O u +w c..S l� Flood Plain elevation if ''' '. ' - R rri / — < Lc ' General comments S y i.e. rrL e(e J , fo P 9 OO LcW e aqs o --_ ry l and recommendations: 4 `.� el e v top 4/ o a L- q 0 . - )j j I i i 2 5 2001 '.. _ : 0 /., ZON 4uuFnCL X.,(\ # El Boring = d ' i ns Pit Ground surface elev. 9y d O ft Depth to limiting ,' c Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ff Gr. Sz. Sh. 'Ef 1 'ESP in. Mansell Qu. Sz. Cont. Color CAS I � S _ , g 1 p -11 IOyr�Z •( 5� ama,bk. rnt-Cr Z — .5,../ 2 m.4 k yvv-C r c3 I v-C . y . Co. 3 38 -1/0 /oyryy/ — 01,5 0 � c J in i. I I I Boring # ❑ N Pit Ground surface elev. 9y. 76 ft Depth to limiting factor /0'/ in. Sok Application Rate Horizon Depth Docent Color Redox Description Texture Structure Consistence Boundary Roots GPD!W in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Efftl *Eff#2 I 0 - lcyr3 /L , — .5,1 Zn1abL v -C r - G S 1.G. .3: , $ a 1 Z -3o 10 y r y /4/ — S, c-/ Z r✓Jabk. -C r c> ! t1 • `-/ • to 3 30 - /oy to y rV /(o irt$ c WI — — ,- 7 / 7 • Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mglL * fluent #2 = BOD, < 30 mglL and TSS < 30 mg/L Name (Please Print) re CST Number CST ( ) Arab m , hl i rvrf ker / A � 25:3,0q Adder Date Evaluation Canductad Telephone Number 1-,) .S - z6 - U 1 (115)2 1 • 2113 � 3+ :��r�r� +. C,� �i `� . • Property Owner Parcel ID # of I 1 3 i Baing it ® Pith Ground surfac v. 9Z. Yd R. Depth to limiting War /o in. Sod Application Rate Color Redooc Description Texture SI uct ime Consistence Bogy Roots GPDR Dominant 'Ef�1 'Etf#2 Horizon Depth Gr. Sz St in. Noosed Qu. Sz. Cant Color l a - /C( /4 Y1 3/z — S,' ( Z wtabE w\Cr 6 5 I (T-C- , s , f - s,� 1 z k Yrx. -Ce r S - - 5' , 6 , Z !0 3o ioY�� /y - , ?- / a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. 1 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture S6nxtwe Consistence Boundary Roots GPD/IF in. Munsel Qu. Sz Cord. Color Gr. Sz Sh. "Eii#1 *Elfi2 I Boring # ❑ pit Ground surface elev. R Depth to limiting factor in_ ❑ Pit Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD!W in. Munselt Qu. Sz. Coot Color Gr. Sz. Sh. *BM *Eff#2 Elduent #1= BOO > 30 < 220 mglL and TSS >30 < 150 mgIL " Effluent #2 = BOD < 30 mglL and TSS < 30 'mi. 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 60& 266 -3151 or TTY 608- 264 -8777. SBD4330 (ROM) 1 r i PAGE 3 OF 3 NAME LOT# Z LEGAL DESCRIPTION Ai E 'ANE. /4,S6T21 ,N,R 19E (or) e SCALE: 1 "= yD 1 1 -K BM 1 ELEVATION /OO . 0 BM 1 DESCRIPTION /la 1 in, a O" cc . k Ttre c — BM 2 ELEVATION /(O. O Ste- 3 6 BM 2DESCRIPTION Aai it\ to''O0. k fee_ e_ SYSTEM ELEVATION -(o p 9V • 0 0 G,O,..te r $ 9,9'4 ALTERNATE ELEVATION 40p (4/•c0 L-O e r90• S O CONTOUR ELEVATION qZ, S 0 , 9 6-6 $ • N III . 2 ■ -3 S L o li T ?3 0 A h � p A SIGNATL,RE i/Oe: - > � Ge DATE G - -0/ r