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HomeMy WebLinkAbout022-1008-80-300 Wisconsin repartmentof Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 506293 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Vorwald, Susan Louise I Kinnickinnic, Town of 022 - 1008 -80 -300 CST BM Elev: Insp. BM Elev: BM D scr'p5on: —� f, �� � S� y0 Section/Town /Range /Map No: .B, • ` ! N 04.28.18.54C TANK INFOR ATION ELEVATION DATA 9( •8T QW TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM ��o .S_,�- /03.3 9kp, er Aeration (� t , A� '4 , Bldg. Sewer O Holding Ht Inlet 30 t Outlet TANK SETBACK INFORMATION 'a 5S. 6 S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �8y 93 -� Septic ( 0 { k- Dt Bottom Dosing Header /Man. Aeration Dist. Pipe f) y- 7/ y•� t) 98 98• 8 98. M. 14- . y b Holding Bot. S stem )) S• ys � � y9 � � �� t Final Grade PUMPISIPHON INFORMATION Manufacturer Demand St Cover _ S GPM S O `_+ ad Ofl 0m 7. VS 4� Model Number 1 f3 TDH L Fric + ^n I n System Head T D�j1H;� ()0 Ft `/ 1 •`F, a /tp° Forcemain Length I Dist. toWell p�( 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 Typ Of System. A I y O rv-{` ,�. •� � UNIT Model Number: DISTRIBUTION SYSTEM = ,� So Ba I (�; ft- a ) .9 Header /Manifold CL Distribution x Hole Size x Hole Spacing Vent to Air Intake 11 t u Pipe(s) / Length Dia Length 8�'� Dia S� Spacing i' S �S 7 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 11 Yes [] U No Cj Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 3,1 _D77j Inspection #2: Location: 576 Fairhomeefka Cty Rd. N) I�ob s, WI 54023 (NW 1/4 W /4 4 T28N R18W) NA Lot 4 1 7 Parcel No: 04.28.18.540 1.) Alt BM Description = I' D ��m 9n � I�I f� / 2. Bldg sewer length = 1 � � ' I ( 1 - amount of cover C�C�C� (Y� S v�u�0\_ ZX_' ���5 ( a� �a ------ Plan revision Required? ❑ Yes No Use other side for additional informal io _ SBD -6710 (R.3/97) Date Sign. ure Cert. No. CO merCe.wl. OV Safety and Buildings Division County e A m g 201 W. Washington Ave., P.O. Box 7162 i s e o n s i n Madison, W 1 53707 -7162 Sanitary Permii Number (to be filled in by Co.) Department of Commerce _ z9 - State Transaction Number Sanitary Permit Application / 4 / ! �ld5 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to dye appropriate governmental ni Application to rrts for state -owned POWTS are ct ess (it diCl'erent than mailing dress) unit unit is required prior to obtaining a sanitary permit. Note: Pp submitted to the Department of Commerce. Personal information you provide may be used for secan ry .y u uses in accordance with tiv Privacy Law 15.0 }(m Stats. l i t I. Application Inform ion - Piease Print All Inform n Prop 11 Owner's Nance (� ✓1 Parcel K �7& v'`✓ct /,� UG 14 2007 a22 —�o0 -�sv -30� I Property Owner's Mailing Address Property Location ® r�" B� S T. CROIX COUNTY Govt. Lot _ City, State Zip Code Phone Nu ) y,' , Section r �� /. n ,L A ircle one T .?Zf ti, R L� — E [I. Type of Building (check all that apply) r Lot ,% 3 Subdivision Name I orr 2 Family Dwelling - Number of Bedrooms Block If ❑ Public/Commercial - Describe Use 0 City of L ".SM Number ❑ Village of ` ❑ State Owned -- Describe Use o To wn of �.����.. , III. Ty of Per (Check only one box on line A. Complete fine B if applicable) A. ❑ New System Replacement System ❑ TteatttxntlHoldingTank Rep{acettxnt Only D Other Modification to E System (explain) List Previous Permit Number and Gate sued B• D Perpit Renewal ❑ Permit Revision i ❑ Change of Plumber ❑ Petmtt Transfer toNew /�l� Before Expiration Owner / op W. Type of POWTS S stem /Coin onent/Deviee: Check all that a ll ' ❑ Non•Pressurized In - Ground ❑ Pressurized in Ground ❑ At - Grade Mound > 24 in. of suitable soil [] Mound < 24 in. of suita le soil / i ❑ Holding Tank 0 Other Dispersal Component (explain) � � P r e treatment Device (explain)_ V. Disp ersal/Treatment Area Infor mation: -- Design Flow (gpd) Design Soil Application Rate(gpdsrj Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation VI. Tank Info r Capacity in at A of Manufacturer j Gallons Gallons I Units s , w k New Tanks ExistwS Tanks aU rn N � ti w G% Septic or Holding Tank Dosing Chamber V11. Responsibility Statement 1, ate undersigned, assume responsib for in stallation of the PO WTS s wo on the attached plans. j !'lumber's Name (Print) Plumber's Signature tP PRS Number Business Phone Number i Plumber's Address (Street, City, State, Zip Code) Vlll. County/ e artment Use Only _ / m Approved O Disappro Permit Fee Dace sstted [sluing ent Signatu e S ��. g /5 d7 ❑ iven Reaso r Renia{ IX. Conditions of A rovisbReasons for Disapl.rovai O AA 1. � t�IMc,. /l m nt tiller a st all he a rty vt �� �G Nt � � 3 3 ' titapersal call mu taces ai_ rtfairt�d � If-0 as par Management plan provided by plumber. Z. AS sdtbeck requirements Must be maintained t , to system and submit to the County only ou paper not t s an s — 112x I I Inches ' si 12 y JO n ` /',���� ' `�' "` rw 513D 6398 (R. 01/07) Valid thlu 01/09 � � L, 7 r � ' �liL/L�t�7r�— . 1��t _J2, r,7 � 0� 0hQ wTf /or�q vorccile /� N� °/a`.itY /ION 17 sec. y 7. 16� 71 . '7rliC/�i i1 /7 Pct �ozz ioa8 -go -coo - �oa� So; l CAAAa16,'cn P, g rade e /tr/.' ii'r>G} r ."ce-� �o�sPd rrrou n d a 23.$7;r /aO s/o c•� 5.so'x &.2.cc 'a'. spersa/ ce //. 7Z)o(z) _ _ x A , fsa6 /d,Z'x SP a c f 0.6 /. f2: eXi:5 - 5 , - / 06 - c fa,, Ks.. .2 " — d SEo - y d e u' /gba,7 don a 5 04 cc de. co nc r ei e" o be /ow ca.t 9 rode A m mar• b �` r.-, o oc L'jcod,d /6r u.s4y s, o�IrlA.A5SUm e&4/4t&.` - /e9 1 103-S • � " � �` banes . \ gy.so' 95. �' - ` E,C�s�.� " o • 97. fra' lee R ,// bt b.ss' Sept;�fa++,C �o 444 �- 5 /u 'B`b /off /o�ov 97-S CL atz." douo�►++f� throc S rea (� f .2'Sc.(. fl0 f� ✓. C. ProPo seal �J�'e se-r Gn, er+e Tr'e 5 *i3onot d;54::—r6 wct�ded /L3ruSl.y 75��a��ou�.yoG1�a�►t6cr lE. 8. Tp oF1S `8✓A s�� y0 opeT e.lee. Cor,er4; EIeLAA � d ar4�t e s 3 d 99 3 /a�e.' Q// /o� /firesceec✓ Cor» rf C412,0"'a-,- 63 Se tlxtc,� P. 8 0� 9 Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wl.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i sca n s i n www•commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary July 23, 2007 CUST ID No. 227990 ATTN: POWTS Inspector WILLIAM C SCHUMAKER ZONING OFFICE SCHUMAKER PLUMBING ST CROIX COUNTY SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/23/2009 Identcation Numbers Transaction ID No. 1418105 SITE: Site ID No. 728037 Gloria Vorwald Please refer to' both identification numbers, 1108 CTH N above, in all comes ondence with the agenc Town of Kinnickinnic St Croix County NW1 /4, NW1/4, S4, T28N, R18W FOR: Description: Three Bedroom Mound System / Replacement construction Object Type: POWTS Component Manual Regulated Object ID No.: 1142576 Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01101), Pressure Distribution Component Manual -Version 2.0, SBD- 10706 -P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 component manual(s) referenced above. • 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 area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Comm 83.22(7) - 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. P Q.W.T S. C011d tionally APPROWED nFPAQTAArA1T nr WILLIAM C SCHUMAKER Page 2 7/23/2007 Owner Responsibilities: • 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. • Comm 83.52(1)(a) - 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). • 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. 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. • 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. 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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 .,.� Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMARTicode; 763 3. jeny.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN E Residential Application W INDEX AND TITLE PAGE 0 Z 0 . Project Name: Gloria Vorwald 3- bedroom residential mound m Owner's Name: Gloria Vorwald U °6 qJ Owner's Address: 1108 Co. Rd. N Hudson, WI. 54016 ca Parcel Address: 1108 Co. Rd. N Legal Description: NW1 /4NW1 /4, Sec. 4, T.28N., R.18W. Township: Kinnickinnic County: St.Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number: 022 - 1008 -80 -000 Plan Transaction No.: Page 1 index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Bill Schumaker License Number: 227990 Date: 06 /19/07 Phone Number: (715) 386 -3121 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.01 (R. 09/04) Pagel of 9 DIVISWN OF SAtLI Y AND BUILDINGS SEE C RRE ONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) _ R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 In -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 % coliform of <= 36 inches. 450.00 Design Flow (gpd) 10.00 Site Slope ( %) 96.55 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) r- 0.4 In -situ Soil Application Rate (gpd /ft Distributio Cell Information 8 Dispersal Cell Length Along Contour (ft) = 5.50 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft _ 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution L _Y Pressu Disribution Information network? Enter Y or N (c or e) el Center or End Manifold 2.75 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 1 .90 Estimated Orifice Spacing (ft) = 5.24 fe /orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y _ 89.50, Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 7.55 Vertical Lift (ft) 73.99 5x Void Volume (gal) 1.05 Friction Loss (ft) 80.51 Minimum Dose Volume (gal) 15.10 Total Dynamic Head (ft) 35.43 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 1.25 x 1.00 i 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x ' �_ J Gallons /Inch Calculator (optional) p ) T reatment Tank Information 750 376 Total Tank Capacity (gal) 1000.00} Septic Tank Capacity (gal) I 37.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 26.281 gal/in (enter result in cell B49) Dose Tank Information Effluen Fil ter Information _750.36 Dose Tank Capacity (gal) P9!yL9k ! Filter Manufacturer L525 20.281 Dose T ank Volume (gal /in) P _ ] Filter Model Number `W Concrete Manufacturer Project: Gloria Vorwald 3- bedroom residential mound Page 2 of 9 Mound Plan View ... T 1/10 B • s J . Observation Pipe �] ' l K cr ..... . ....................... • I L Mound Component Dimensions A 5.50 ft E 18.60 in H Mft ft K 9.20ft B 82.00 ft F 9.50 in z 1ft L 100.40 ft D 12.00 in G 0.50 ft J ft W 22.97 451.00 (ft Dispersal Cell Area 1 1449.64 (ft) Basal Area Available 5.49 (gpd /ft) Linear Loading Rate 1 8.20 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.34 (ft) --► •rig G * H t riiriir� 2 riiriir •j �rrrirr r rrr,! F Dispersal Cell 98.05 (ft) Lateral 97.55 (ft) —111 — Invert Dispersal Cell Elevation E D ... ,. i. .-J •_; by .j. ._ - K • ' ti'+t `` _ - i J 7 J J ] ] J 7, ] ] �] i ] ] J ] ] � ] J ] ] •] J J ] ] i �i . is ,i. ti. •.� ,_: �: {, % q •+`; � .,;_ ..rl r+ . ,_� .. `_.], _ { : _ , i. ,i 1 .'). _ .: ...: •.: .. . 96.55 (ft) Contour Elevation 10.0 %Site Slope Geotextile Fabric Cover Shading Key. Dispersal Cell See lateral details on Q — Topsoil Cap a 1.5 ft Page 4 for number, size, Q rriii Subsoil Cap a ': and spacing of laterals. ASTM C33 Sand 1° ` '•'•. Laterals are equally Tilled La er 0.5 ft :' Typical Lateral spaced from the Y c • �• •• • •• ••• .�,� distribution cell's Q'•: Aggregate �* centerline in the A. A "" —'—"* distribution cell (AxB). Project: Gloria Vorwald 3- bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered overthe A mension 0 = Turn-up -adball valve oroleanoutplug ` I =Forc emain P cal IE X >I Hol es drilled on the bottom of the lateral equally spaced tion via tee or cross to manifold at any point. Laterals @ force main of PVC sch 40 (per COMM Table 84.30 -5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 1.92 ft Lateral Length (P) 80.64 ft Orifices per Lateral 43 Lateral Spacing (S) 2.75 ft Orifice Density 5.24 ft'/orifice Lateral Flow Rate 17.71 gpm Manifold Length 2.75 ft System Flow Rate 35.43 g pm Manifold Diameter 1.50 in Total Dynamic Head 15.10 ft Forcemain Velocity 3.62 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --� Comm 6.28 AC 4 in. min. 1 W Disconnect Tank component is properly vented E — Alternate outlet location Forcemain diameter Wieser Concrete nufacturer 2 in. Ca aci 750.36 G Ions o al /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.03 385.93 C B 2.00 40.56 Pump off _ elevation (ft) C 3.97 80.51 90.50 D 12.00 243.36 D Total 37.00 750.36 iF Do se tank elevation (ft) 3" Bedding uncTer tank. 89.50 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Goulds 3871 Pump Model Number EP05 Pump Must Deliver 1 35.43 gpm at 15710 ft TDH Project: Gloria Vorwald 3- bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Bill Schumaker Phone (715) 386 -3121 POWTS Regulator's Name St. Croix County Zoning Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 451 ft' Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank p p Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished XMGrade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral g Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Gloria Vorwald 3- bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)) and local or 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. 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. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet finer shall be cleaned as necessary to ensure proper operation. The filter cartridge should 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 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 sludge and scum 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 a triennial 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pm Tk Pump a n 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. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound 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 mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg /L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg /L BOD 30 mg/L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution 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 if orifice clogging has occurred and if orifice leaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically logged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Gloria Vorwald 3- bedroom residential mound Page 6 of 9 GouLDs PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING manual operation. Auto • Farms superior strength and corrosion • Heavy duty sump matic models include resistance. SP Canadian Standards Association Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron Goulds Pumps is ISO 9001 Registered. Dewatering assembled and preset at the for efficient heat transfer, factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and •Solids handling capability: float switch attachment points. maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1' /z" NPT, seal protection. • Mechanical seal: carbon - rotary/ceramic-stationary, BUNA -N elastomers. • Temperature: 104�F (40 °Q continuous 140J (60 °C) Intermittent, METERS FEET • Fasteners: 300 series 10 stainless Steel 9 30 ��. -5GPM • Capable of running dry without damage to 8 z s FF componen s. 25 ._ — - -- o 7 a Motor: _ • EPO4 Single phase: 0,4 HP, U 6 zo 115 or 230 V, 60 Hz, 1550 c RPM, built in overload with /S)O` z s automatic reset. A • EP05 Single phase: 0.5 HP, 0 4 EP O5 115 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with automatic reset. z EPO4 • Power cord: 10 foot 5 standard length, 16/3 1 SJTOW with three prong grounding g P g P 0 0a 10 zo 30 40 50 GPM plug. Optional foot len 16/3 SJTW with 3S,S�39 y o. M. ;f "I" ,s,i — I e three prong grounding plug lstandard on EP05). 0 2 4 5 4 10 12 m /h CAPACITY G Pumps 2002 Goulds Pumps ITT Industries Effective September, 2002 O� 83871 AlJyf /!t<J / /f/ SaC. �/ 7'28A.,/�IK.• 7 --1K 'cN:�17 ra.,c lod. " -- /006- So -CCO- voauo So; / ea/a /aa6 ;&n Psi- ♦ EX.3d'.� ?rude e ked.' - r�— Elc.�F.'nq �enee %ief (iCcE /cf /:ir. 416' �e �DGS� �opost-c 3.971'r/dv.t/o� �.� sso'xaz.co'd ce //. 7Zx(z) /a �e�u,/s a_ � /ice `X 80.6 S�' w/ %� o/'r{i Ct.S S,oac a /.�Z G.tisv�n��Se�•c fan Ks. Z " — y decx /fbrsndon a 5 Ptf- Code. C� nc! eke P a b o be /ow a.t9�a.de . u�cotjc�f /6� 145su. c /tom r,'X-a- o r_ �A•Sx 7- 30 3f eO(,C/u enE Pro 17ce • ;�3s 3 6adry Y 97. t!B' i� ° • - - 1_ rePoxd WieSe� y�oy Rdrntc c�ii y .97. 'ca rrtour /?J.c. ; 0 �' th�o4�s,� S .sL�.n � "sc.(. flo P. ✓. C• y s � c - re - �e r�vrce w�a;n. ( nwt Tre�S ". Gei iFt�o d�S�u�b U),O kd /8rusAY 75t'P`c�,°cc"�° "' ope.r, f I e-lec. Cor,�/4i�, E levy = 9(o.BS.' E"fiSt;nq 8 aia�e lz it e �I d 3 (o e •' Q// /o es -ceec/ C44,0-r- B3 S ice I 2004 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8%: County x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road, Parcel I.D. 022 - 1008 -80 -000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Vorwaki Trust - Gloria F. Vorwald Govt. Lot NW 1/4 NW 1/4 S 4 T 28 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1108 Co. Rd. N City State Zip Code Phone Number J City I Village yJ Town Nearest Road Roberts I WI 1 54023 1 Kinnickinnic 1 1108 Co. Hwy. N J New Construction Use: a Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD yJ Replacement J Public or commercial - Describe: Parent material Glacial till over limestone bedrock Flood plain elevation, if applicable na General comments and recommendations: Soil suitable for mound with 12" of sand fill placed on 96.55 contour. System elevation to be = 97.55'. F -T] Boring # - Boring y Pit Ground Surface elev. 98.11 ft. Depth to limiting factor __ 24" in. Soil Application Rate i Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fy I in. Munsell Qu, Sz, Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 1 1 I 0 -8 1 Oyr3 /3 none sil 2fsbk mvfr Cs 2fm,1 c 0.6 0.8 2 8 -12 10yr4/4 none sl 2fsbk mvfr gw 2fm,1 c 0.6 1.0 3 1 12 -24 7.5yr4/6 none sl 2fsbk mfr gw lfm 0.6 10 4 24-28 7.5yr4/6 f2f 7.5yr5/8 scl 2fsbk mfr gw if 0.4 0.6 5 28-40 7.5yr4/6 f2d 7.5yr5/8 scl 1csbk mfr aw 1f 0.2 0.3 6 40-51 10yr6/4 none LSBR Na Na - 0.0 0.0 Limestone bedrock observed in Horizon #8 consists of >50% loose, fractured limestone ra ements a rox. 2 "x2 "x " to 4" x6'k1" thick. g pp Voids between plates filled with 10yr4/4 Om sl & 7.5yr4/4 Om scl. I T] Boring # I Boring 16 Pit Ground Surface elev. 94.24 ft. Depth to limiting factor 28° in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDV in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 1 0-12 1Oyr3/3 none sil 2fsbk mvfr I cs 2fmc 0.6 0.8 2 12 -22 1Oyr4/4 none siCl 2msbk mfr I aw 1fmc 0.4 1 0.6 3 22 -28 1 Oyr3 /6 none scl 1 csbk mfr aw 1 fmc 0.2 0.3 4 28 -43 10yr6 /4 none LSBR Na Na - 0.0 0.0 I H#4 consists of hard limestone plates 2" - 4" thick, ranging in size from 3" x Y to 12" x 16 ". Voids between plates filled with 10yr4 /4 Om sl :& 7.5yr4/4 Om scl. 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) Sigpature: CST Number James K. Thompson s 3602 Address A.C.E. Soil & Site Evaluatio Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/9/2006 715 - 248 -7767 Property owner Vorwald Trust - Gloria F. Vorwald Parcel ID # 022 - 1008 -80 -000 Page 2 of 3 a Boring # J Boring Pit Ground Surface elev. 96.23 ft. Depth to limiting factor 24" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3/3 none Sil 2fsbk mvfr cs 2fmc 0.6 70.8 2 9-15 10yr4/4 none Sid 2msbk mfr aw 1fmc 0.4 0.6 3 15 -24 10yr3/6 none scl 1 csbk mfr aw 1 fmc 0.2 I 0.3 4 T124-37 10yr6 /4 none LSBR Na Na - 0.0 0.0 I � i ! I I i H#4 consists of hard limestone plates 1" - 2" thick, ranging in size from 2" x 2" to 4" x 8 ". Voids between plates filled with 10yr4/4 Om sl & 7.5yr4/4 Om scl. ❑ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I I I i ❑ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I i i I � i ! — i ' Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 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 (R.07/00) A.C.E. Sal & Site Evaluations G/orlq Von" /d AtJy�lAw //y Sec. y 7 Z,9 A., T.,• c,F%Orb c, SE. crd ,x .2' l" r! SC�Ei'C �an KS.. d e c i4ba�Q'00 as s ,oc code. Cancfe.'.e P0.6'o b[ IOcJ 0.t9/'a�c o Or ( �' u�co4'cCf /L�/ opt S � / i e7m S3 9�.ss' 96.s3' 97.Sd'COrrtour �(�o d s�urb wwcicd�8eUSAy f i y a d 3 �o P .30.�3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C RTIFICATION FORM � caner c[yer e, Mailing Address Property Address p � o r S p rtY `S�� qtr /�/ 91� 11D �S1& �d � (Verification required from Planning Department for new construction) j City/State Sdox- 1w Parcel Identification Number LEGAL DESCRIPTION perty Zc cation 0 %<, '/., Sec. , TARN -R L W, Town of SubdiYLSi� d r� Y - Cc� t��� y Lot # - Certified Survey Map # Volume Page # ee } 0b0ac � a 71 (o Warranty Deed # Volume Page # e� a ►O —T S 4 00 a 1008 -go - c2� per- house ❑ yes ❑ no Lot lines identifiable ,! yes ❑ no SYSTEM MAINTENANCE c 8 ASS Improper use and nuantenanceof your septic system could result m its prematuref inure to handle wastes. Propermaintenan ce consists of pumping out the septic tank every three years or sooner; if needed by a licensed pumper. Wbat yen put into the system can affect the firattion of fire septic tank as a treatment stage in the waste disposal system. The F%mt -owner agrees to submit to St Croix Zoning Department a certification firm, signed by the: owner and by a mastcr plumber.joumr.ymmphmd)cr,resftwtodpl u mberarahcemedpumpervm*mgdiat(l) the on-site wastewaterdisposal system ism proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 fall of sludge. Uwe, the undersigned have read the above requirements and dagree to maintain the private sewage disposal system with the standards set forth, heuein, as set by the Depart of Cony and the Department of Natural Resources, State of Wisconsin. Certif 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. 1 - 4 a rr X10 L16 A 01F APP CANT DATE O ;R CERTM AT I We) certify that all statements on this form are true to the best of my (our) knowledgedtwe(am) s) of the p described above, by virtue of a warranty deed recorded in Register of Deeds Office. vv a owne 1 a /Q� NATURE OF APPLICANT DATE « « « «« Any information that is mis- represented 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 a copy of the certified survey map if reference is made in the warranty deed I - 2004 Wisconsin Department of Com OIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings i th Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 2 -1 - 80-000 Please print all information. Rev' d By Dat Personal inforna6on you provide may be used for second s. 15.04 (1) (m)). IZ // tP Property Owner Property Location Vorwald Trust - Gloria R Vo Id Govt Lot NW 1/4 N 1/4 S 4 T 28 N R 18 W Property Owners Mailing Address O CT 1 20 Lot # B iotic # I Subd. Name or CSM# 1108 Co. Rd. N City Sta Zip d_�t ggcl9Llh1 City _J Village Town Nearest Road Roberts i WI 54023 Kinnickinnic 1108 Co. Hwy. N New Construction Use: 0 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement -J Public or commercial - Describe: Parent material Glacial till over limestone bedrock Flood plain elevation, if applicable na General comments and recommendations: Soil suitable for mound wit 12" of and fill placed on 9 6.55 contour System elevation to be = 97.5 Boring # J Boring vi Pit Ground Surface elev. 923.11 ft. Depth to limiting factor e- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots G in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 1 0 -8 10yr3/3 none sil 2fsbk mvfr Cs 2fm,1c 0.6 0.8 2 8 - 10yr4/4 none sl 2fsbk mvfr gw 2fm,1 c 0.6 1.0 3 12 -24 7.5yr4/6 none sl 2fsbk mfr gw 1 fm 0.6 1.0 4 24-28 7.5yr4/6 f2f 7.5yr5/8 scl 2fsbk mfr gw If 0.4 0.6 5 28-40 7.5yr4/6 f2d 7.5yr5/8 scl 1csbk mfr aw 1f 0.2 0.3 6 40 -51 10yr6 /4 none LSBR Na Na - - 0.0 0.0 Limestone bedrock observed in Horizon #6 consists of >50% loose, fractured lime eiragementsapprox . 2' )Q "x " to 4"x6 xl" thick. Voids between plates filled with 10yr4/4 Om sl & 7.5yr4/4 Om scl. Fi-] Boring # J Boring 0 Pit Ground Surface elev. 94.24 ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G P Ift in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - E 1 0-12 10yr3 13 none sil 2fsbk mvfr cs 21mc 0.6 0.8 2 12 -22 10yr4 /4 none sicl 2msbk mfr aw 1firic 0.4 0.6 3 22 -28 10yr3/6 none scl 1 csbk mfr aw 1 fmc 0.2 0.3 4 28-43 10yr6/4 none LSBR Na Na - - 0.0 0.0 H#4 consists of hard limestone pla es 2" - 4" thick, ranging in size from 3" x " to 12" x 16 ". Voids between plates filled with 10yr4/4 Om sl & 7.5yr4/4 Om scl. - Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD <30 mg/L and TSS 1 mgtL CST Name (Please Print) Sigpoiture: CST Number James K. Thompson S 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, Wl 54020 9/9/2006 715 -248 -7767 Property Owner Vorwald Trust - Gloria F. Vorwald Parcel ID # 022-1008 - 80-000 Page 2 of 3 ` Boring # - I Boring Ei 0 Pit Ground Surface elev. 96.23 ft. Depth to limiting factor 24" in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff*2 1 0-9 10yr3/3 none SH 2fsbk mvfr a 2fmc 0.6 0.8 2 9-15 10yr4/4 none Sid 2msbk mfr aw lfmc 0.4 0.6 3 15 -24 10yr3/6 none scl 1csbk mfr aw Ifmc 0.2 0.3 4 24 -37 10yr6/4 none LSBR Na Na - - 0.0 0.0 H#4 consists of hard limestone plates 1" - 2" thick, ranging in size from 2" x 2" to 4" x 8 ". Voids between plates filled with I Oyr4 /4 Om sl & 7.5yr4/4 Om scl. F-1 Boring # I Boring _I Pit Ground Surface elev. ft. Depth to limiting factor in. Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 i ❑ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAE in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff #2 I I *Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD < 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 (R.07/00) A.C.E. SON A, Ste Evaluations r ' 4 W � wyy Sec. 5; 7..28 X, A /6c.; 7 cjr' �;•qq %ct �%r�►c, ,56. Grd�,c c • Exi36'.� grtade eltc� N 17777 �¢ 0 5 Get/ A de ar i4brrndo,�as Ptrcode. C�ncfv�¢ pn.60 bt /ow a-t 9rap[c . t mr bo t�� o F ( • u 143ru -S4 Y r - op 3 6.or - - r - 97. t33 96.ss' 9G.s3' Aps - /oho // - - 97 SO 'Cerrtour 0 t�vocc� S tin (.r. b..�r► t.� � LT S I �. p of �BYA Sc�. y0 op e e fec. Cor+ctai�. It L A $ &fit eEc : 3 a v a r P. 3 0�3 0 y O 0 co O 3 - V n d j O d f ',. O d f C m 0 ro v s� • M n v i c v CD CD !. Cl) Z Z y Z 0 G Cn Z w O < _T N girl • I n O O N O -' O h tar O O N O Cn O � P. 3 7 C N =r 3 C F O 7 N N FBI V V a CD CD Cd1 O N W a- *'" Z CD N Cda CT d n 0 a O N N C CD E 0 d N C (D fD fl ;� Co p O cc, OD C> m 0. � 3 m m o�� o 3 a w I O C °D rn `° CD " ` rn c CD" ` o 3 a ° 3 O N O N O C d d O yr Z D m o CD . ° 3' m o 10 CL 3 c \ o 0 3 w w o ! V N N N (D O O a L •-" Oo QO O. o CO 0 1 N CD co o (0 00 0 C c ao w o o Cn o ., a CD CD n I f�/1 Cl) (n cn o c N y to cn o N O I O' "a G C O N �� T O G O n p Q 7 @ C !� N N Op C) fD .�i N N fD m w m e 3 fD w N C1 to N CD 01 N N CL a i Z Z z D D o = D D o O C) O v O � o a a ° l�r • o m CD CD @ CD c c � w m w m n 3 n 3 Z CD zt a m o z +' Z CD A v ii; z 0, o 'I Z � A W M (D M 00 G 3 � a '+ ZZ ° o " °o " z ao 3 CD CD �. 7 N _ N C N N a �^ p O n CD a CD N O ,+ CO o ao n c O v c u < m o ° N a SDi o a �03 m m N m�_ m N C _ fn ill N (D CD CD OnK O N n.. N III N7 O OW O CD o Q0 x (D a CD _ fp 7 N 7 N O• O 4 03 00 .Z7 p 0 � I p ��j N J C cn �\ c d 7 N G C N N O al — , r1 W '2 . n CD ;0 N \ N a O _ V CD O o A 0 0 A I (D C C� O CD o 0 � w Cl Parcel #: 022 - 1008 -80 -300 08/17/2007 09:51 AM PAGE 1 O F 1 Alt. Parcel #: 04.28.18.54C 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/04/2006 00 0 Tax Address' Owner(s): O = Current Owner, C = Current Co -Owner O - VORWALD, SUSAN L SUSAN L VORWALD 1110CTYRDN ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 576 FAIRHOME RD SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.010 Plat: 5229 -CSM 21 -5229 SEC 4 T28N R18W NW NW CSM 21 -5229 LOT 04 Block/Condo Bldg: LOT 04 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 04- 28N -18W NW NW Notes: Parcel History: Date Doc # Vol /Page Type 08/02/2006 831180 TR 06/27/2006 828355 CSM 09/26/2003 741459 2420/375 SC AF 03/20/2003 713950 2178/89 QC more 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/07/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.010 100,000 164,000 264,000 NO Totals for 2007: General Property 5.010 100,000 164,000 264,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Q Z B .IJ KATRLEEK R. _ WALS11 State Bar of Wisconsin Form 7 - 2003 REGISTER OF DEEDS ST. CROIX Co., WI Document Number Document Name RECEIVED FOR RECORD made between Jeanne Williams 08/1)2/2001; 1@: S@AM as Trustee of The Gloria F. Vorwald Revocable Llvincr TRUSTEES DEED Trust ( "Grantor," whether one or more), EXEMPT # aa([ : S� h Vcsr�ra:l.d a airse�le meson. REC FEE': TRANS FEE: 266.4.Z ( "Grants" whether one or more). COPY FEE: Grantor conveys to Grantee, without warranty, the following described real CC FEE: . .estate, together with the rents, profits, fixtures and other appurtenant PAGES: 3 interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Part of the W 1/2 of the NW 1/4 of Section 4, Township 28 North, Range -18 West, Town of Kinn1ekinnic, St. Croix County, Wisconsin described as follows: Lot 4 of Certified Survey Map recorded Recording Area June 27, 2006 in Volume 21, Page 5229 as Document Name and Return Address No. 828355. RAVER VALLEY ABSTRACT & THE Together with and subject to a 66 foot wide private 1200 HOSFORD STREET, SUITE 201 1 road as shovers on said Certified Survey Map. HUDSON, WI 540 C4 1 Part' of PIN 022- 1008 -80 -000 Dated & �U S i r (SEAL) .(SEAL) Jeanne Williams. Trustee (SEAL) (SEAL) * s AUTHENTICATI ON ACKNOWLEDGMENT Signatures) �.• STATW F WISCC&4SIN ,t _� ss. authenticated on ri t/`+�+' C �{ ersonally came before me on 7w`` the above -named Jeanne coil Tams * Trustee TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the persons) who executed the . (if not o going . d acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INS'T'RUMENT DRAFTED BY- D. Peter Seguin, Attorney lic, of Wisconsin � Hudson, Wisconsin 54016 MY ission (is permanent) (expires: (Signatures maybe authenticated or acknowledged. Both are not seeemary.) NOTE. THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM_ SHOULD BE CLEARLY IDENTIFIED. TRUSTEE'S DEED STATE BAR OF WISCONSIN FORM No. 7 -2003 *Type name below signatures. Madg% Penw. Landow PO amc 969 tWdaw. WI 50160969 PYwt (915) 386 - 3200 Fac (715)386-SW VemmMl dead tl. POW Seguin , - Ro&jwd wish Z(pFo1m- by RE FamnNK LLC 79025 Fftm Mob Rmd. Chin Tcw Oikk MWdd 99035 i Y n. 49 ­248 a 628355 _ CLEA gy(e. Rte° - 6 -12 -o fp VOL 21 PAG MCI y' �9�,0' •... E KATRLEEA H. YAI SA S REGISTER of DEEDS Ua�p�riM ST. CROIX CO., VI RT 1 F 1 E D SURVEY MAP RECEIVED FOR RECORD 06/27/2006 03:25P?I NTHWEST LOCATED IN PART OF THE NW 1/4 OF THE NW 1/4 CERTIFIED SURVEY MAP CORNER ND IN PART OF THE SW 1/4 OF THE NW 1/4 OF Copy : 3300 NI IN IC - ST. CTION 4. T28N, R18W. TOWN OF KiN CK N AGES: 2 OIX COUNTY. WISCONSIN. M( 1f°�f�QCis® I��° mns P PARED FOR: Op F Oo WNE r°i ; NE WILLIAMS 108 C.T.H. 'N' ' ROBERTS. WI 54023 _ _ _ OWNER: GLORIA F. REVOCABLE LIVING TRUST EACH PARCEL SHOWN ON THIS MAP IS TOTAL AREA REA BUILDIN S".+ SUBJECT TO STATE. w 5.01 ACRES - i - COUNTY AND i (21 _6.287 SO. FT.) G� TOWNSHIP LAWS, g AREA EXC. PRIVATE __ 33 00' O'W RULES AND ROAD R/W '; -"N86.59'3 R WETLANDS. MINIMUM 4.92 ACRRES __x.00. LOT SIZE. ACCESS TO 78 S07 FT.) �� N86'59'30 - W PARCEL. ETC.) BEF PUR CHASING OR DEVELOPI ANY PARCEL CONTACT THE . ST. CROIX COUNTY ZONING OFFICE AND 514.68 THE TOWN OF 33.02' --f an 6 KINNICKINNIC FOR I 1 1 a W ADVICE. NOTE: ¢ -A TURN- AROUND IS s A v i -+ 4� 4 REQUIRED TO BE ' CONSTRUCTED PRIOR : Q • ; ; 17 --l TO ISSUANCE OF A BUILDING PERMIT. CID s o LOT 3 ,a '� PosSSIBLE rn j C-11 TOTAL AREA I W VIOLATION OF �' 9.74 ACRES 7E I op THE ST. CROIX COU NTY ZONING (424.269 SO. FT.) >� ' v s -2 + , � ORDI NANCE m AREA EXC. PRIVA E N 1A I BE CREATED IF % z �.+ 9 R E I - � T EXISTING (396.069 SQ. FT.) 1 STRUCTUR $ WITHIN ' � �--` '� "' w PROPERTYLI E N p. EVER �OK OR v POULTRY. q\ I gs SCALE IN FEET 1" 150' - 1 0 4 mod 150 O 150 LEGEND ( 50339 03 W FOUND 1' OUTSIDE d'7 •,1 33,04��_,� DIAMETER IRON PIPE �0 V N88'5012 W 519.90 SET 1' OUTSIDE DIAMETER BY ^ O 18' LONG IRON PIPE. WEIGHING J PL ll K ED ��° b ©� �c �+ 1.13 LOS. PER LINEAR FOOT ------ -------------- - - - -- ��� I _ N � o� SET 1 DIAMETER STEEL w SURVEY MARK NAIL FROM TIES ' A SOIL BORING CD _ N 5 8839'0 6' E 66 0 9'- � ==-� WEST 1/4 C.T. 'N" ° coON _ _ to SECTION 4 ' - - -- "- -- � CENT THIS INSTRUMENT DRAFTED BY: WILUM�i A N ' JOB NO. 6514 -01 DATE: 06/08/2006 SHEET 1 OF 2 1 °f2 Vol. 21 Page 5229 cw • I n LE 3 5 0 4'7 2 ST CROIX COUNTY SURVEYOR'S RECORD ERTIFIED SURVEY MAP' Z RAY VORWALD Part of the Southwest 1/4 of the Northwest 1/4 of Section 4, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wiscons N 89 300.00' 0 2 0 ' LOVED Z N o 150.00 1.50.00, W o. , �J = 1- 0 WL 99 1978 0 � O ST. CROIX COVr U: W Z CO MPREHINSIVI PARKS PL W v1 0 z 1.0 ACRE5 1.Q G RE AND =ONINO COMMIT kC p� § W ui N �� oA = V 5 N O Z Z V1 rsl APPROVAL OF THIS IN SUBDIVISW < O N DO "S NOT MEA P VAL O N 3 JILOI,gG SITE OR EPTI . T� W OP Z Rif�R TO H62.20. W 40 SCALE 1 "_ IOO 1 50.06 150.00 ' 1 1 5 89 °4 ' 50 "E 300.0 0 N T A 6 l= ' 1 Access N 00 53'34 "C ID I + 83.00 ---r ---�- - - � - --- W 1 /4. Cog.. s&c . 4 - C..T. H NO ACCESS G.T. H. " o Indicates 1" x 24 iron pipe stake set weighing 1.13 lbs. /ft. Description: That certain parcel of land located in the SW 1/4 of the NW 1/4 of Sec. 4, T 28:N, R 18 W, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows; Commencing at the West 1/4 corner of said Section 4, thence go N 00 82.00 to the POINT OF BEGINNING of the parcel to be herein described; thence go S 89 41 300 .00 1 ; thence go N 00 292.00 thence go N 89 "W 300.00 thence go S 00 along the West line of the NW 1/4 of said Section 4, a distance of 292.00 to the POINT OF BEGINNING of the above described parcel containing 2.01 acres, more or less, also_-there being a. frontage road adjacent to and South of the abovd described parcel, such frontage road also continuing Easterly of the Southeast corner of the above described parcel running adjacent to the North R.O.W. of C.T.H. N for a distance of 160.00 such Frontage Road being 50' in width. (for purposes of this description all bearings are referenced to the North line of the Northwest 1/4 of Section 4, Township 28 North, Range 18, West, assumed N 90 State of Wisconsin) St. Croix County) ``�����unnnnnuru I, James L. Murphy, e L S �y, ister and urve or, Motion Register Y do here cart � of the Owner, Ray Vorwald, I have surveyed and divided the "§Tia'wn..,. �� in accordance with official records, Chapter 236 of Wiscons,131 Spa and'-! e Ordinances of St. Croix County; and that the above map L des c� t� -•aAq true and correct representation thereof. _= P/;URPHY _ Dated: 28 April 1978 4 2 James5,�Mur 0 . Q, 1 Re isterec� �� }� Vol. 3 Page. 61;7 g WI y Certified Survey Maps % �t�'''•. • ��1�'�``� St. CrbU County, Vi.sconsin, volume 3 Page 647 �•,,,�����QFD•,..., •SV�```��. LAND