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022-1002-70-000
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N Q O 10 p CD Ira i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 72 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Dow, James I Kinnickinnic Township 022 - 1002 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 02.28.18.21A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark i Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION LANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold I lDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / ! Inspection #2: Location: 1330 East Kinnickinnic Drive Roberts, WI 54023 (NE 1/4 NW 1/4 2 T28N R18W) NA Lot 2 Parcel No: 02.28.18.21A 1. Alt BM Description = } tion p 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax (715),386-4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sa Permit # ❑ Check if revision to previous application CC l Z I. Application Information - Please Print all Info Location: Property Owner Name a , - `� - N� 1/4 N 4, Sec 2 tbw'� r D T N, R E (or)� Property Owners Mailing Address Lot Number Block Number 1330 E. "" 1"hn` `fir Ii�v�U �---- City, State Zip C mer Subdivision Name or CSM Number PO FF-- 11 T e of Building: (check one) amity ❑ Village wn of Z1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): N 1 LU A) N' I L ❑ State Nearest Road II. Type of Permit: (Check only art lir�,4. Check box on line B if applicable) - Parcel Tax Number(s) A) 1 1.El Repair 2.X Reconnection 3. on- plumbing . ❑Rejuvenation Sanitation ex 2 — (1fl 2 — "C?tz B) ❑ State Sanitary Permit was previously issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min./inch) Elevation © 1 1 36 3 L7 t, d S 166.95' Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks S` /600 / isSC✓ ❑ ❑ ❑ ❑ f-.- r` 5' a f W; ❑ ❑ ❑ ❑ 11. Redponsibility Statement 1, the undersigned, assume responsibility for repair/ reconnenction /rejuvenationrinstallation of non - plumbing for the POWTS shown on the attached plans. A license is not required for teralift repair or the installation of non- plumbing sanitation system. P bees Name (print) Plu bees Signature o to p5': MP /MPRS No. Business Phone Number 4 Grrn c 1 Oa 715- 6fl- S"a Plumber's Address (Street, bity, State, Zip e) `1 r W Ill. County Use Only Disapproved Sanitary ' P L ermit Fee Date Issued I uing gent Signature (No stamps) Approved Owner Given Initial Adverse 12 Determination J d IX. Conditions f Approval I: SYSTEM OWNER: 1 Septic tank, effluent filter and P — dispersal cell must all be serviced / maintained � 1 as per manag ement plan provided by plumber. \ � 't��^� 2. All setback ack requirements uirements must be maintained `{ /) � S c.Yl� /� O'J as per applicable code /ordinances. ��[[ e�y 4j�aa /ay . h •tom `.,i y tJ fir; �� fhti epo f�c SJIS��+yt r S ��• � o or� c,.�rJr�f�i1� g order• CO PY � �. IL4 I qla ;1d y -T k.,.- 4y V f r: F,/ �- -A ti �-- � r s e f " 16 ,� 0 �� wa,,RjNx j ordee- Gl�� � S ha'I T`a • ` `� e 41 m ;Z 7 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CTOIX Safety and Building Division INSPECTION REPORT sanitary Permit No: 395131 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: - 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 Parcel Tax No: Dow, James I Kinnickinnic Township 022 - 1002 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: o all TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1 09. tf 4 f r a Dosing Alt. BM Aeration Bldg. Sewer ng 5Ht Inlet 7, Q L St/ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic y / O � 3 � � � Dt Bottom Dosing Header/Man. O r F y Boa' � �{ �-� N y ray Aeration Dist. Pipe .3 Holding Bot. System /0 4./ final Grade PUMP /SIPHON INFORMATION '� 5 �• Manufacturer Demand St Cover GPM 3 ,P3 2 .3 to S Model Number ,/ d 3k Z'? TDH Li Friction Loss System Head TDH Ft .3 1 5. z 5 I if, y' Forcemain Length r Dia. Dist. to well - (� `' S SOIL ABSORPTION SYSTEM BED/TRENCH Width Length r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. liquid Depth DIMENSIONS 0 2 / G. SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACH Manufacturer. INFORMATION CHOMIER OR Type Of System: 4 �. � � � � UNIT Model Numbe . DISTRIBUTION SYS EM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake if Pipe(s) ' r' r r� r q Length Dia Lengt Dia Z Spacing Z 1 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of rS ee ded/Sded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [q] Yes ® No [n] Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /� /of 95 Inspection #2: /�/ Q S Location: 1330 East Kinnickinniic Drive Roberts, WI 23 (NE 1/4 NW 1/4 2 T28N R18 NA Lot 2 Parcel No: 02.28.18..21A / 1.) Alt BM Description = , of We « 61y 10 / `� 6W her ;e 0-� P �bW� rJ ✓ 7 ►tea/ 2.) Bldg sewer length - amount of cover = S y 2 3� .0 " � e4v. = 6.05-z /ao. ty Plan rev s n Requl�L'9? [] Yes A No q� 6 Use other side for additional information. ` -� Date . Insepctor s Si ature Cart. No. SBD -6710 (R.3197) Safety and Buildings Division 2.01 W. Washington Ave., P.C. Box ^7162 ; ���'`M�� `' Madison, Wl 33707 - 7162 i Sin Address De artment of Commerce I "sf &�� -wNNk Sanitary Permit AP oil` "' 4 Sit Number In accord with iromsm U.1I. Wts. Aches. Code, per y rovide ;� Chock if Revision my be Pti w s X. Applkatloa Iris tstl� - Plow Priat AI! 9" Plan I.D. Number Na property Qw>rar's "4 4e /i S me P$roe Q _ • -5 � � �� •-,� y � � A F i Psapeny Oww's Mailing Address ,�� ProDeutY Locetian a G D a- sT e e city, 8tue Zip Code ! Lt:t Numbs Block Number i b�ttdivision Nun CSM Number 1 rs ` II Typo of BuRding (dock all ghat apply) ,/ 1 ❑City 4 i or 2 Fa:mily Dw4HIV8 ° Number of BedwOn aY � (]village ❑ PubliclGottuae ow - De$esibe Use Owned ( t i l�iestast cad 2 2 l o S"�" /— __._ 0 of Permit: (Chock out box an Iota A (numbering acbems for internal ust). Complete Una B it ap } I New 2 ❑ � Sy$:atn 3 ❑ $splacoment of 6 ❑ Addition w {I For County use i9 } , Tams Only bisda System I 3 L] Chock if Sanitary Pe=lt Previcusiy Ierued ( Pttmit umber I Dart Issued _- .I � Type of Fartatits (Chock all that applY)(manbaring scheme 1s for dntetztal use) 4 4 0 Non •- Preasusisod In -GMUW 210 Uound 47 C) SVj Kilter SO ❑ Constrazted Wetland 2213 Pressurized In -Ground 4I ❑ Idoiditt: Tack 48 ❑ Sin& Pass S I n Drip Lint 43 At -Grade 46 ❑ Aerobic Treatment Ursit 49 ❑ Rocircula ?0 Other V. Dis ttnast Area Inforatatiost --- Deslp Flow (ad) Dispersal Area I Dispersal Area Soft Application R OMI awon Rate � Systttn Elnvatiort PLuai Grade Required Proposed R *G21s.IDays/Sq.F0 Nia,flnah) Fitvati :� VI. Tank Ido Copsci4y rant Number Manuhomor Prehb Site i Steel ! Fiber i Plastic tlalioos Cia;fous of Tanica ( Concrete Consuwwd j Glass Neil Ueda i _. ! Deaias chaider �� N V1Y. 3t 8taboant I, tfto ► assume �bWb' toot at the POW TS $!tows on the attaehad Plumbwe Kama (Fehr) Plumber`s Quaws RS Number Business Phone Number gr Plumber's Address ( treat. Or. State, ) V 441 - 1 ' • arbnarlt Us 019Y D gtmuub (No Sumps? �A� � testy Patmtt Fee (iaclu�s t}rosadwater ate I$ U$uhtg en: Si llum uuge Fee) ❑ owner Own Initial Adverse Detennholion IBC. Conadolae Ap aUll; ens for Dloapp , eostpkte or, m. to alb th6 natem on popes sot ass slaw an s U Rua" in do r OBD- 4308 (R,. 03101) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 A C ro t visConsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be tilled h Co.) (608)266 -3151 Department of Commerce Sanitary Permit Application State Plan I.D. Number� In accord with Comm 83.21, Wis. Adm. Code, personal information you provide t0 J d a ► 1 may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (ifdiffere ban mailing address) 1. Application 1 nf'ormation -Please Print All Information Property Owner's Name Parcel # Lot # Block # Property er's Mailing Address Property atio�n� 1 3 ►v1 .G�� t C ��+ Y. f /. Section 2 City, State Zip Code Phone Number jap p lica b le Z8 N, R (cirAW II. Type of B ilding (che all that a Subdivision Name CSM Number or2 Family Dwelling - Num of Bedrooms ,t, El Public /Commercial -- Descibe Use �SZ ` V P 1 El State Owned - Describe Use ❑City_❑Village,�fownship Of tho - lll. Type of Permit: (Check only one bo n line A. Complete lin A. El New System ❑Replacement Syst El Treatment/Hol 6th Modification E xisting System C t' List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision Change of ❑ /Pert Transfer to New Before Expiration Pl er O IV. Type of POWTS System: Check all that a jTank ❑ Non - Pressurized In- Ground El Mound > 24 in. of o < 24 in. of suitable soil ^At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground El Holding t Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter Recirculating Synthetic Media Filter ❑ Leaching Cha Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Disp al Area RNrea Proposed (sf) System Elevation . 3`� M9 b 4 5, Ar VI. Tank Info Capacity in Total Num Prefab Site Steel Fiber Plastic Gallons Gallons of U s Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank X Aerobic Treatment Unit Dosing Chamber Wtl VII. Responsibility Statement- I, the undejfgned, assume responsibility for in allation of the POWTS s on the attached plans. Plumber's Name (Print) Plu is Signature MP PRS Number Business Phone Number ern+e�v� ��df�e� 19Da� 71� (off- l� Plumber's Address (Street, C (ty, State, Zi ode) 9 16 5 fLV Y VII1. County/ e ar ment Use ly ❑ Approved ❑Disapprove Sanitary Permit Fee (includes Groundwater Date Issued Issut Agent Signature (No Stamps) Surcharge Fee) El Owner G n Reason for Denial IX. Conditions of Appro 1 /Reasons for Disapproval Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) i4aau�lJksr Fiunbinq =L ; rJ,7. 7i538E31s .un. 22 2001 10.'%RM p1 ST CROIX Coumn SVnC AND OWN&UNIP CUTIPICAVON FORM VY4 V P�op�gr LiO�IIS� ; � 4;fi� �, � Qyp, �„�,,,, T' ���T•�W� 1b�N1� Ot' � :.�/,y,' r l�L'd/�/ G *raw, �sn4 1+ � ,.._ —. Y�ir■r ,mot 3 l�..r...�..-r 000 ban a YnAft tau use& d YNAM MA 13411111 fakow - mill mill .-own �„ r �tyil�Msrrtts.a�r��1r��1'� rs1wo ym,�u,,l,■rl�rll�rrawtrr►*r�► rrip�wasrir�d�r��irrrrw�$� ` A& dL" MOMMAMEb i�h4►1�wi�.� 1�o►�� YwtK ' �� �rD� . MM Noil cr Ol n�as Y int �! wMUMroi �► . iws iw to % tr w* of mr (04 M WWWP t ► ( ) " e " 10ada GO P"_, fmlt WAIS Kowa doo t GOAL +�wsr / � ldbadll�rrw�tarq�� IV 11 i 1 ri� t ��M�� me ZOOi ���� " «• • • {ae�Ma wbel► eW yptsNrea . 'mow Mri lour i�t IrreMc1ae =a& Its* " STATE BAR OF WISCONSIN FORM 1 - 1998 4& IE651 WARRANTY DEED KATHLEEN H. WALSN _ [� . ¢' Xurnent Number VO(. 1U 1 ( PAGE �' s T. CROI OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECORD This Deed, made between Dean anei r+ -- ='~ 07 -09 -2001 4:00 PM WARRANTY DEED _ EXEMPT A Grantor, CERT COPY FEE: and Tampa anti _ M PI i eS COPY FEE: ■ TRANSFER FEE: 21.00 PAGERECO FEE: 10.00 Grantee. Grantor. for a valuable consideratiort, conveys to Grantee the following described real estate In St • Croix County. State of Wisconsin (the ' Property -): RectxdnS Area Lot 2 of Certified Survey Map Name and Return Addess Volume 15 Page 4053 James and Melissa DOW DOC. No. 641393 26 Ida RobertsWi. 54023 Oda /o0- .2 < Cd<�� Parcel Identification NumOer (PIN) This homestead property. (Is) (Is not) Together with all appurtenant PP nt rights, title and Interests. Grantor warrants that the title to the Property Is good, Indefeasible in fee simple and free and clear of encumbrances except Dated this 0? 6 ___ day of _� c e ,9 (',o / (SEAL) – - - - -- — (SEAL) _ (SEAL) _ (SEAL) AU THENTICATION ACKNOWLEDGMENT � Signature(s) State of Wisconsin, l y ss. Lro \� County. JI authenticated this day of Personally came before me this �-- lJ f ( U" � � day of the above named * C TITLE: MEMBER STATE BAR OF WISCONSIN'S (If not. _ to known to be the person who executed the foregoing authorized by §706.06, Wis. Stats.) 1�� trtent and acknowledge the same. THIS INSTRUMENT WAS DRAFTED By S Notary Public. State of Wisconsin My coinmi 1 Is permanent. (If not, slate expi(ation date: natures may be aut en icated or acknowledged. Both are not ���L necessary) Names of peraorn stgnmg in any cap —ty m— be typed or printed below their stgnarum WARRANTY DEED STATE BAR OF WISCONSIN Co wrsconsn saga Bien. .. rnc. FORM No. t - 1998 m4wauic". W., r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 395131 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Dow, James I Kinnickinnic Township 022- 1002 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: G ,, 3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark fib`. If 9 T s� 00ci Ld Dosing Alt. BM Aeration T -=. - Bldg. Sewer �• ng S Ht Inlet SU �/ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic t / Y Dt Bottom Dosing Header /Man. �LJI loo - Aeration Dist. Pipe ' Z } /00. 9 Z Holding Bot. System �. final Grade PUMP /SIPHON INFORMATION 5 Manufacturer Demand St Cover S GPM 3 'J a 3 Model Number TDH Li Friction Loss System Head TDH Ft .3 3 - ZS Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. ILiquid Depth DIMENSIONS b SETBACK SYST M TO P/L BLDG WELL LAKE /STREAM LEACH Manufacturer: INFORMATION CH OR Type Of System: UNIT >z . Model Numbe e DISTRIBUTION SYS EM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake / of Pipe(s) r/ Length Dia Z Lengt Dia Spacing Z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [M No �+ [] Yes : 00:N.] COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:q/ / 0 9h Inspection #2: ( l /V l_ 0Z FS Location: 1330 East Kinnickinnic Drive Roberts, WI 54023 (NE 1/4 NW 1/4 2 T28N R18w) NA Lot 2 Parcel No: 02.28.18.21A 1.) Alt BM Description n =� �{ We ! Lly ° I � / 14.� � �� �- �bW�� -g d ►� 2.) Bldg sewer length = 30 31 (a� keW P / � I - amount of cover = 5 Y 2 ` C j", 04 e- r Ck) w e ia� �'er eke. = Plan re sI n Requl�efi? [0 Yes ] No c� Use other side for additional information. Date Insepctors Si ature Cert. No. SBD -6710 (R.3/97) Safety and Btuidings Division I 201 W. Washington Ave., P.C. Box 7262 I 5 7 -Y�j Z ' con 'in Mattison, Wl 53707 7162 i Site Address � De er #+ ,ant of Commerce ♦♦ S � Permit tip! Qn Ssoitctty Permit Number In spaoM t+aiya Cam 83 Ms. Aft. Code, par " ' y ravide�; 3� S 3 I MU LM Priv s L Check I! Revision I, Application Ind'+olrr adw - Plata Pr%t A3! . , 9tsta plan 4.D.: Number � 1 69D at Property Dwases Nerve �� uRG' Psrotl Number av z j Fsagerty Oww's M&MM Addnw Property L fwn ,�. S a T a7lli, R! City, saute Zip Code do Let Number � Bieck Nw - Sabdiviaion Name CSM Nunwr j TI. 'Type of 8uttding (cheek all that app ,/ i Casty I or 2 Family D" WAS - NwnWr of Bedrooms (]vWage 1 i D Public /Commetcial - Describe Use � o i� Owned i + Nears oad pe of Permits (Chock ant box on Ue A (numbering scheme for internal use). Complete line B it applicabl) IIr'oW 2 RepSacameat System 3 0 Replacement of b ❑ Addition co aystetn Task Only P.xistia system i 3 [❑ Cheek if Ssnitsrq Pernstt Prevloudy Issued Formic Number Dace Issued rIV. Type of Fermin ( kCli°c� 11 cast appiy)(numbering scheme is for internal use) 44 ±� Non _Praieurixed lm- C,lraund 210 Mound 47 C Sand Filter SD Constru.ted Wetland 4 3113 Pressurized In- Gruund 410 HEaltlittg'Iw* 48 ❑ Single Pass SI Drip Line 45A At -nude 46 D Aerobic Truwant Unit 49 Ci Rtcircula 30 Other V, truest Asba Iafortrsatiant I ulp Plow (pd) Di penal Arne Dispersal Ares Sail Application Parcol ,don Rate I System Elevation I plats Grade Required Proposed R1ta((3s1s.lDsys/Sq.Ft.) (Min./Incit) I Btevadon i �`�� r 3 � � � 34: � � � 9 � �� � q, .� s � Leo • � S Task Ido Cspsaity its Tonal Nuusber I Manufacntror FMM Site a Steel i 'Fiber I Plastic � Qsltoas CisIloas of TUM Coat;rete CDnstrwted Glass 3 S oftie at Hokft Toak apCy t 9 e Y - {-- .- ---- - »--- --4 VU. & 6tat�tlutt• 1. the . saanms rapoasibWb' for of the POWTS showA on the attached FlumbWo Nome (PrW Pkmftr's Sown R3 Number Business Phone Nwnbar k Plumber's Address {Street. City, Silts, Zip Code) arhMt RE 00 �,Appr" ad a D�,provad Sttiaitary Pendit Fes (it wdea Groandwetor Date Is IssuW eat Slimmis (No Sims) ' Sttrcharss Pee) ro Owner titvan lwcw Adverse ', ZS, (, 4 f 1X. Candittaas Q1 Ap for Dismpp aO Teti PAO (/u 9" coonta aata) ftr LU SMIM as Mw cot Ins iMiC 5w IF &A U= N ae flit ;; SHlD*b3 8 (& 05101) PLOT PLAN Scale 1 " k4pj Page 3 of • v I - .Q N 9 '/ J✓ J to L 'tiQq Lk e I SM i1 L a� J U�S11�.1 gU1Z0 Ki PIPe -, 3 A t'— SoiLZST's �H- 5��-1U - - -- $�"1S �`QrVE "'BUJ O N -- 7�"p.1k S _ L o c AM 0k] S 1z_ _ Mkt 61 1 sty \3o - r* sr- NOTES. I. Elevations shown are existing ground elevations unless otherwise noted. ; 2. Install 4" observation pipes with app roved 3. Septic tank to be 10 00/650 gallon cacity manufactur �1 1L''s COtiJCQ.P� - W/ Mo�ez A 4. Bench mark _ sla-_ �gBovF �. Divert - surface water around system to prevent ponding at the uphill side. Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Nvisconsin www.commercestscrosin.gov www.wisconsin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary June 14, 2001 . CUST ID No.691727 A7TN.• POWTS Inspector ARTHUR L WEGERER ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/14/2003 Identification Numbers Transaction ID No. 650214 ` SITE: Site ID No. 630980 JAMES & MELISSA DOW Please refer to both identification numbers, E KINNEY RIVER RD above, in all correspondence with the agency, TOWN OF KINNICKiNNIC ST CROIX COUNTY NEl /4, NW1 /4, S2, T28N, R18W LOT: 2, SUBDMSION: PENDING CSM FOR: DESCRIPTION: THREE BEDROOM AT -GRADE SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 796151 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At- grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the at- grade manual, and section VI of the pressure distribution component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Access to the filter for cleaning must be provided per Comm 84.25 (7) and (8),Wis. Adm. Code product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The well must be a minim of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. ARTHUR L WEGERER Page 2 6/14/01 • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, the owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 Charles L Bratz POWTS Plan reviewer II- Integrated Services WiSMART code: 7633 (608) 789 -7893, Mon.-Fri. 7:45 AM to 4:30 PM cbratz @commerce.state.wi.us cc: JAMES DOW TITLE SHEET Page of AT -GRADE SYSTEM FOR A 3 BEDROOM RESIDENCE This plan has been prepared in accordance with the At -Grade Component . Manual SBD- 10570 -P and the Pressure Distribution Manual SBD - 10573 -P C CL. b /aq Ctz. 6 /qq, LOCATED IN THE 1/4 -OF THE - NVJ 1/4 OF SECTION Z , T - ; - ' a N R $ W, TOWN OF- .a1`1►.► COUNTY, - WISCONSIN. INDEX PAGE 1 o 7 TITLE SHEET PAGE'2 Of 7 SYSTEM PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION - PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR cz . s9F !q �Q V b Y PREPARED BY WEGEI:kER SC3 I L . TLST S r4 CS AND. DDS S CS" S S CE P.O. Box 74 421 N.Hain St. River Falls, WI 54022 �!° com Phone 715-425-0165 Fax 715- 425 -6864 t ARMJR l . � � ME'vERER ��//����//��//��jj�� VWiNfLWnQffy = 6LLfl•VCRTN, APPROVED S IGI Rt1EMTOFCOWAERCE I G 14 g_ -ul JOB NO. _(3 _ ZJ At -grade System'Management Plan Pursuant to Comm 83 .54, Wis.Adm. Code Page of Seotic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. Tne contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. erating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The et it s hall be c:eaned as n -��s aryl ensure proper operation. The filter cartridge shout¢ not be removed unless provisions are made to retain solids in the tank that u o e filter whon removed from its enclosure. If the 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 e volume of sludge and scum in the exceeds th a tan e tank. !f the contents of the tank are not removed at the time of a triennial assessment, main enan a pers 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, I such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and euiidings Division. Rumo Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary., At- rode Com orient and Pressure Distribution System ` No .trees.or'shru s shout be plante or allowed to grow on the component. Plantings may be "made around the perimeter and the component shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the component is not allowed. Cold weather install- ations require the component to be heavily mulched for frost protection. Influent quality into the at grade system may not exceed 220mg /L BODS, 150 mg /L TSS and 30 mg /L FOG. Influent flow may not exceed the maximum design flow specified in the permit for this installation. The pressure distr system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the Initial test when the system was installed to determine W orifice dogging has occurred and if orifice cleaning is required to maintain equal 'distribution within the dispersal cell. Observation pipes within the dispersal cell shall be' Pond' checked for effluent ing levels should be reported to the owner and any levels above 4 as an impending hydraulic failure requiring additional, more frequent monitoring in accordance with 83.52 (2). General This system shall be operated in • accordance with Comm '82 -84 Wis.Adm.Code and shall be .maintained in accordance with it!s component manual SBD 10570-P- (R.6/99) and local and state rules pertaining to system maintenance and maintenance reporting.. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and Pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump 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 a tank or component Continae Plan if the septic tank or arty of its components become defective the tank or component shall be repaired or replaced to keep the ' rystem -In Proper operating conditio _ If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective corriponent shall be immediately repalred or replaced with a component of the same or equal performance . If the at -grade component fails to accept vaseiviter - to discharge wastewater to the giound surface it may be necessar y aerob - replace the component. Additional siteand soil* evaluationsmayrneed additional plans may need to be prepared and approved by the Department of Commerce, - Safety and Buildings' Division. . Quest ions .about the operation or maintenance of this system should be directed to: .: _The County Zoning Office at The system installer at - 1t $ .- 6- 31 Z/ - }uYyAk �. The tank manufacturer at - I l �a�y� The effluent filter' manufacturer at � , :3; ,P- 3 p' 8 L 0 - 4 5�BL S G0ul-lb S PLOT PLAN Scale -Page 3 of 1" =tip' � — L .Q y� 0� �� y B e B►°t 11-1 3 i %� \��� J p � S11 Z. 1 g�11'10hJ PIP�g 3^ hJ - - - - -- - - nw1 ±1: s'_ot�, 6 " S ly "�tq. P AC P�Pt W�CPr'f}j - -- - - ---------- �'`i — - -- Pr� �b At-r t l� ZS F1zvkt .7 S _ - - -- - LC. CPM 0k1 SN-C- ° l 1 / tC ►n i To strE Q -- NOTES . I. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. (Y required). 3: Septic tank to be t0 / 6SO gallon capacity manufactured by \�V ll''3 ? CtltJ CQ W M 0N - _ - Wz. A - F300 7_ert2 Z. Ft L7knR 4. Bench mark s: �. Divert'surface water around system to prevent ponding at the uphill side. ' L >5 ' .,• B , > 5' 'S I T . _ - - ►l�, _ Z 1z, A 4VC F, w,. W C: _..L_ Q . t o`3SERU'K'T►� >5 �t I/6 8 1/6 B I A G =. 5-7 pT C= f Linear . Loading Rate = 3 -q-' GPD /LN FT Design Loading Rate= 6 -31 g g - PD S / 4 FT z. ,,% _ Distribution Observation Well Lateral ELV -qq•� Fabric -= _�- .s�.,��� �. � . A �, Soil • r�� 2 Cover r ,� ��i Z 9 S t 5 A 2 C A Plan Vimi and cross Section of a Wic=nsin P_t -grade Unit with Zoo — JAJ=rption Areas With in a Single Unit on a Sa coLng Site Distribution Pipe Layout Pd&e S of -� . c Place the holes at the bottom of the distribution pipes at equal spacing. —Remove all burrs from the pipe and holes, - Fiend the end of each kteral up with the use Of long tin or 45' fi#.a to a poet within Z — inches of the final Bade. T ermLn the cads of the Iate:ZIS with a valv;'treaded or . threaded plug. Provide access from foal Bade for the valye; threaded cap or threaded plug: Lateral Manifold X x x x xfl Lateral Length P " C7 P S6 Ft, Hole Diameter 2W-6 Inch" 5 1 S Ft, Lateral a Z Inches) X = Inches Manifold " Z - Inches Force Main " 'Z Indies # of holes /pipe ?- Invert Elevation of.Latera,4 Ft. ZCYx o.66= �4.��xZ_ 3$.z� GPM Combination Sept4c;Tank and PUMP CHAMBER CROSS SECTIOU AUD SPECIFICATIOUS ' PAGE • •VEWT CAP WEATHER PROOF JUIJCTIOU BOX . ' ti C.Z. VCMT PIPE .APPROVED LOCKING 110 1 FRAM DOOR, MIIIJHOLE COVER P-?rW :ituDOW OR FRESH 1 w1{RNILIC L.N %0 ,, sP�R10U PIPE AIR INTAKE S col.�pu�r r-1 w is *M S G IzrtoE UIILET i'= PROVIDE I -- , •• �AtRTiGHT SEAL Approved zme_ H�� -� I ICI Approved PVC joint f} -100 i III ALARM PVC w/ . P • pe - II pipe C •i I ou CLEY. FT PUMP ' -� OFF 0 - COUCKETE �Z �U Cl .pp CLOCK - RISER EXIT PERP111T'ED O►.1Ly IF TAWK MA HAS SUCH APPROVAL SEPTIC. F SPECIFICATIOUS OOSE TALJKS MA►JUFACTLIRCR: L � CUNJ t g r Ql c I.JUMBER OF DOSES: P LOUD l(>Sp R OAS TA MK SIZE : GALLOUS DOSE VOLUME t ALARM MAUUFACTURCR' SS s INCLU0IAJ 6 AC GALLO MODEL wumBER: Lo j CAPACITIES: A= I �) INCHES OR 306 SWITCH TZPC: �1Z�CJ1r'Z -t/ GALLOys Z I 3 � 8 UCNES 0 R G LL01J PUMP 1AAWUFACTUREit: e4 V Lb g r 5 C s • �' _tUC1iE5 OR 10 Z GALLOWS MODEL UUM9EK: Sxpn l! , l Z _ INCHES OR =.L GALLOWS SWITCH TYPE: TzctyJ NOTE: pUHP AJJD ALARM ARE TO BE MIU IMUM DISCKARGE RATE G INSTALLED bW SEPARATE CIRCUITS VERTICAL DIFFEREUCE CETWEEU PUMP OFF Au0_DI5TRIBUTIDU PIPEL Si? S FEET t K1&11MUM IJETWORK SUPPLY PRESSURE • • • • • . 3 •2S'FLET C z- S X 1. 3, 'I' — �� FEET OF FORCE MAIM X 3-0-5 F c fLFRICTIOU FALTOR_, �• OS FEET TOTAL 0 JAMIE. HEAD . = 1 2' �SFEET As per manufacturer l+l_O gal /ili. Liquid depth 3$-`' • Y"ti5' ��Q..FpR}"zf3'h.JCt= � V`�.V�. �sE 1 o r • ' Goulds Submersible n Effluent Pump . f- 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, • Capable of running lubrication and efficient strength, and.durabili following uses: tY . dry without damage to heat transfer. •Effluent systems ■ Motor Cover. Thermoplas- components. •Homes Available for automatic and tic cover with integral handle . Farms Moto r: = , manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. - • Water transfer 115 or 230 V, 60 Hz, 1550 Power Cable. Severe d assembled and Float Swit �Y Dewatering RPM, built a overload with Flo preset at the factory. rated oil and water resistant. - automatic reset. � phase: � Bearings: - _ • EP05 Single 0.5 HP, Upper and lower SPECIFICATIONS g p heavy duty ball, N bearing - ` 115 V, 60 Hz, 1550 RPM, construction. Pump EPO4 built in overload with ■ EPO4 Impeller: Thermo- Solids handling capability automatic reset plastic Semi -open design 3 maximum° _ Power cord: 10 foot with pump out vanes for AGENCY LISTING � � • Capacities up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SP• Canadian Standards Association ptal heads: up to 24 feet. with three prong grounding Discharge size: NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- r g (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".) rotary/ceramic - stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged Temp nature: thermoplastic design provides 104 °F(40 °C) continuous superior strength and 140 °F (60 0C) intermittent. corrosion resistance. • Fasteners: 300 series " METERS FEET stainless steel 4 Capable of running 10 I '•� dry without damage to s 30 components ,- - Pump: `EP05 $ • Solids handling capability a 25 :�/ maximum a Capacities up to 60 GPM a 20 ; Total heads up to 31 _feet f a !-,Discharge size l'A' NPT z 5 • Mechanical seal: " "carbon } rotary/ceramic - stationary, ° 15 BUNA -N elastomers a 4 i emperature . ° her 3 �0 mow... 3k AlO4 °F (40 °C) continuous = 140 (60 °C) r intemittent. ,W a - v ,:... � _�v : � tea' 5 t .. 3 lu 0 10 : 20 �'r "30 40 50 GPM N .., . _ 4 ° • ;x'42' 0 2 4 6 8 0 12 -ma/h -r CAPACITY' ®1995 Goulds Pumps. Inc. Vft onsin CDepartment of commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, a I n 'stance to nearest road. Please print a �o . R ' by Date Personal information you provide may be used r ndary pur�bes nv.a l a4r, . 15.04 (1) (m)). 3 � 1 Property Owner rte + party Location 1 L o t N 1' 114 / ( / L L A / 4 ST Z N R I E (or)® Property Owner's Mailing Address me -L o t# Block # Subd. Na or CSM# 19-e ✓IG , - A.1 !o f Z ,Y • caTM Cily State Zip Code , on pFFI City ❑Village [Town Nearest Road U b t (�C.� S oZ l .')•...... ,✓) ✓1 "C ✓I 61 . k- "nek "Q ', O ✓k "C- New Construction Use: Residential / Number o Code derived design flow rate y s o GPD ❑ Replacement // ❑ Public or commercial - Describe: Parent material 7� "I ( Flood Plain elevation if applicable General comments trt 1 eU '7 �' 5 Sf-e e Od and recommendations: 064,oreleo. ag. S d Boring # Boring�� []c pit Ground surface elev. ft. Depth to limiting factor �_ in. Soil App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o- lo� d-33 S,' l Zmc'be 3 7 3 -3 - ? o — S L m r✓i r C t4 - S f /o, r 3 /CP e Z Z Boring # t ❑ Boring Pit Ground surface elev. 7'(06 ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 iN r.3/3 Zrna v T' MSIAC RIJ C ' S ' 76 360 101 113/ — S Z— * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L. and TSS < 30 mg/L CST Name (Please Print) lure CST Number Address Date Evaluation Conducted Telephone Number 2 +. 5qo i - -� Property Owner DO u Parcel ID # Page Z of 7 F Boring # I❑I Boring �u Pit Ground surface elev. q� yo ft. Depth to limiting factor _ _,� �in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I © -IO _ Z c s •� Z _mss{ c �� (o • Ll 5 2- 5- Pe / S j i y, — -- ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appi ic:ation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ❑ Bonng # ❑ B Ground surface elev. ft. Depth to limiting factor in. ❑ Pit t Soil 8Mfication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg1L * Effluent #2 = 801), 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. SBD -8330 (8.07/00) PAGE_'S OF__:� NAME LOT# Z LEGAL DESCRIPTIONNE 1 �4( oy4 S7 ToK N, K E (or) 40 SCALE: I "_ d BM I ELEVATION 0 K 0 K BM 1 DESCRIPTION 4o C 5' "Qc Qe r e, "Pe — + BM 2 ELEVATION 16 2 — BM 2 DESCRIPTION �o 16-f i cbPOP r AA SYSTEM ELEVATION ALTERNATE ELEVATION CONTOUR ELEVATION 9 �• S�d I g�I Y g.n 3 r�aaQ V, 0 o D� 1 3z�' SIGNATURE ��� -- DATE / - ° r T FROM : Sc. umakPer P;ur6tm :un. 22 2001 10:NAM p1 ST CROIX coum 3$ > SISM T "MrSWCB AOMMBN AND OWht&Wlp CS&TjFjCA'n0N POW (Yoh wow "TAW k aw i1 Wad � �N r�G � to r s° '�� Lbw - Xr L � . Lot o ,..,.,, mp Nd # iYi�. S ir�� r r a vdm 7 ll..r hr rrr. so*"= cl YnAms Lot iho mad*w yoxx wML,. ,rrtyv,ir�,� ,w�,dl�wdt�► W , WOM arrwiwlat �Mrisi�rtN4iers�anl►w/�ia► � il[ � I1�1t�ys.as�wM1i�11M��tM�MMi�N� ' �w �r r ■Twit r R ty$lii� �, rmlislo w+wrwtAft do" a 40 *Mae ndip► • ,twrtr� IN *d itx�w�t e+rp� i �ar�M�ed I of A" l�Y�e�rr���w arMlrr���rr/ �� /rL�K�M�.��►Irl A%%GovmdW i "b w SWA** illipil 11 Wwto t�irtr6�i+r/i�wM �sa do sob* M**dlt'bMl% lwtl W *V - -- swlbe �a � seii s it ie Qw4 il�I� ��i Oitiw�l�a � ""W *M�p fto im 4" OI 1D�'S Ami lm , a m G& tmm no wriiei%*8 It =v D www i GO s� Pop *Wpm* r l�1�11i{N X11 r t�M11R M dr r4' lMaM1 i�M 1i!' iris �� •� 1"Wm whit *k gplfas" • fb*VW wommh Md *90 66 AQIW oft IIt mlib Y so w 1iMd r a stlM MMM�MMa!` I o`` STATE BAR OF WISCONSIN FORM 1 - 1998 650651 WARRANTY DEED KATHLEEN H. WALSH .1677PAGE 86 REGISTER OF DEEDS YOL Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Dean and ri naa gAnqpn 07 -09 -2001 4 :00 PM WARRANTY DEED _ EXEMPT N Grantor, CERT COPY FEE: and Tames and M 1 i S_qa D03U COPY FEE: TRANSFER FEE: 21.00 RECORDING FEE: 10.00 PAGES: I Grantee. Grantor. for a valuable consideration, conveys to Grantee the following described real estate In St. Croix County. State of Wisconsin (the 'Property "): lipcordmg Area Lot 2 of Certified Survey Map Name and Return Address Volume 15 Page 4053 James and Melissa DOW Doc. No. 641393 26 Ida Roberts'Wi. 54023 Oda /ova .2 C?aOr Parcel Identification Number (PIN) This homestead property. (Is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, Indefeasible In fee simple and free and clear of encumbrances except Dated this day of _ J c n �c _ y (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures) State of Wisconsin, lI y ( } ss. \ ` J �� County J authenticated this day of _ Personally came before me this C -U� (7 �-�) can 1,.• the above named TITLE: MEMBER STATE BAR OF WISCONSIN �� " to (If not, 6LLE known to be the person who executed the foregoing authorized by §706.06, Wis. Stats.) Ml ment and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY � 1-7 ti `Ili Notary Public, State of Wisconsin C, j? My comm 51 s permanent. (If not, state expi ation date: gnatures may be aut en icated or acknowledged. Both are not G C necessary) — t`— —'`--� --�) Names of persons algnmg In any capacity muu tx typed or pnnted below their signawr<. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin regal 61anK Co.. mc. FORM No. l - 1998 MIK — kae, ws. APPR{ V—E x cn ti ST. CROI X C Oiwn '; M (nA3 o Planning MAR 2 7 2001 30 o r X sn to LY If not recordea wi:: , ir: ;.0 c-,ys c' approval date approval shall ba �JNU n �n " null And %-4+ TH �� CERTIFIED SURVEY MAP Dean and Glenda Hansen Located in part of the Northwest % of the Northeast % of Section 2, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. UNPLATTED LANDS S 00°48'50" W 165.00' ■ E4STLNIENw1AW114 MEWS ADDRESS ° M 636140th STREET ° 3 ROBERTS, WI 54023 cni It O; p �i g' z � LEGEND O NvO1CA TES I'x24' IRON PPE SET � 2 (NIN. WT - 1. 13 LBAiv, Fr.) Q: _ 0 MYOCA TES 1'RONP1PEFOUNO N T ° ( PR SM Inc srS LO / Z r � 2� 3 7� 0 sECnoN CORNS? MONUMENT 611,617 SQ. FT OR 14.041 AC. 6 4 Z; (AS NOTED) o co (580,971 SQ. FT OR 13.337AC. z 0 5. YJDICA TES FENCEt wE �, E)CCLUDiNG ROAD EASEMENT) I s m Uj LU i_■ Wi W N 00°29'20" E 464.48' 66'PRNATE u o -- DRIVEWAY -75, NORTIk%XTH1.4 SECTION UNE E4SE1MENT 4' Z� p fwl euu .aNCSET rtacuLnoE NCRTH 114 COWER g $ z SECTION Z T28 N R f e W s 8 zrw E Saim 114 Cowa;t ALUM UM M 0-T —'- -- - ---- ^— SECTKWZ T284 R 18 e!i) (SEEOETAL) S (1T393B' W NEW 1, � � N� 4840• W ALUM BEIWTSEN nnarH S�uTH 1a s�cnoN LrnE N 00 E 464.48' s amJ M w W a 111 - sWV35' W mzv- 1 6 1 6 ' UNPLA I 4 c 9 . Av -" TTED LANDS b3 31 �, v ■ � i I �� ** a nnurzP r v * � � p 3 PR/VATEDR W AY I W r —� I I VOLUME 1182, PAGES 100,101 LAND p It VOLUME 1174, PAGES 110,111 I I � :s •oo� VOLUME 1287, PAGES 341, 342 I I DATED FBRUARY 5, 700/ REVISED TH IS 14TH DAY OF Ib3 133 MARCH, 2001. THIS dvS Bv jSMD L. LAR Sau l I SHEET 10F 2 Vol -15 Page 4053