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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division + INSPECTION REPORT Sanitary Permit No: 408278 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)]. 7 Z .?, — Z' Permit Holder's Name: city 9 p Vil Towns No: Simone, Jim & Brenda Kinnickinnic Township Parcel Tax 022 - 1059 -60 -180 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic B7, ,c:,-,, hmark - �f g /0�. U l 00 , p Dosing / Alt. & 4 M a • D d y Aeration Bldg. Sewer Holding SVHt Inlet St/Ht Outlet f ! —_ TANK SETBACK INFORMATION c.Qt 8b -�° a 6 2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic !� / j�2. Dt Bottom o Dosing �^� , f Header/Man. y Z6 3 -6 / e Aeration Dist. Pi V fi 6 f 8' 63 /o b �'s Holding Bot. Syst $ /dD�c� PUMP /SIPHON INFORMATION Final Grad 07A-aL h9 Manufacturer Demand St Cover �IL GPM �p.S/ 6 1, Model Number m-E� L/ TDH Lift LLenj Frict ion Loss System Head TDH Ft Forcemain th Dia. �� Dist. to Wel IL ABSORTION SYSTEM a 0 BE /TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ENSIONS /D /d / &14 / SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM L CH Manufacturer: INFORMATION T CHA R OR TyMOf Syste �D/ Model Number: DISTRIBUTION SYSTEM T Header /Manifold Distribution x H Size x Hole Spacing r Air Intake { J Pipe(s) 1 / I f� / �( !� -]J Length Dia � Length � Dia / Spacing 5 f I t) Gr`• SOIL COVER /') x Pressure Systems Only t xx Mound Or At -Grade Systems Only Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed ench Center I OA- Bed/Trench Edges Topsoil �w] Yes # No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: /�/ v Inspection #2: Location: 1195 Short Drive River Falls WI 54022 SE 1/4 NE 1/4 21 T28N R18W NA Lot 4 p Parcel No: 21.28.18.324A1 'M Description Or / a'�fc ^- w1 � Gwa — b �-' SC length /ZO l C &616 a-#- 161 l' J �+ --� -__ y �./i _ S zonal nl Yes No formation. L p I � Date Cert. No. r 1\ Safety and Buildings Division County Viscons 201 W. Washington Ave., P.O. Box 7162 C Madison, WI 53707 - 7162 Site A ddress / _ Department of Commerce 0� OL SS31'.� l 1 f' Q12 a- p f2 / V C 1/ Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary ses Privacy Law, sl5. 1 m I. Application Information - Please Print All Information tax Plan I.D. Number 5( 6 7/ perry Owner's Name Parcel um r Property Owner's Mailing Address (( j� Property Location V CJ (� ©o(D 2( D 6 E {� C S4 ;S2 T N,R City, State Zip Code Phone Number Lot Number BledcXamber f y` Sgb ne CSM Number �U�'l2 �c�S G J( l/D z H. Type of Building (check all that apply) }° " t ' h ❑City 1 or 2 Family Dwelling - Number of Bedrooms g ❑Villa e r ❑ Public /Commercial - Describe Use / J, 1 L . o }llp 1 /JIVJG J� / ,�/,t/( C El State Owne !�/�GG�S f• �� xl 5 i Nearest Road III. Type Permi . (Check only one box on line A (numbering scheme for m eIRtnat' mplete line B if applicable) A. 105 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use Sy stem I Tank Only Existin & System B • ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) _ _r c (p " Sin Q/, 4 S I 44 ❑ Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 5o ❑ Co ructed Wetland 4.4 22 ❑ P In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 0.At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other reatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate S stem Elevation 1 Grade Required Proposed ate(Gals. /Days /Sq.FtJ (Min./Inch) i Q 1�' evation r0 ( - 2- a-0 l 20 . iy log VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank (24" _ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. PI ber's Name (Print) Plum 's Signatur MP/N~ Number Business Phone Number b Z� Z 2b Plumber's Address (Street, City, State, Zip )6de) VIII , /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ent Signature Stamps) Surchar y e Fee) ❑ Owner Given Initial Adverse Determination TTTT IX. Conditions of A easo for Disapproval ,44U 65d P1941 -A9 041. "� Esc s. 2 'Y s 3 ` Attach complete plans (to the County only) for the system on per not leas than 81/2 s 11 lyches in size SBD -6398 (R. 05101) PLOT PLAN Scale 1"= S0' Pale 3 of �N �0 UDT �1N1.P'P'ceT viZ � �11�� o� s`MzB �a o • s 6A , AV tf 4 8 Y -1 ,� L Ll hJ @. r o r t o • i3N1�#' - Z W El.0 3� 7 LO 0 SO S - , -- �3Mji-1 = �tTL; 1U0:0` Ow (�`�'['PR!✓ 3t.�j "�tA--- Pv -C_� t �_�.1- 1_l.P_s1�. -- -- �oict t �3 • IQ' LOT UQQ: NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be 1 ZOo / 800 gallon capacity manufactured by 4. Bench mark S �. Divert surface water around system to prevent ponding at the uphill side. - Safety and Buildings ' REC N D 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Visconsin UL 0 9 2002 www.commerce.state.wi.us /sb Department of Commerce ST. www.wisconsin.gov !� - SIX Cl��i � Scott McCallum, Governor ZU: �IivC! OFHC z.- -- - -•• -• - Philip Edw. Albert, Secretary July 02, 2002 CUST ID No.267341 A7TN.• POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/02/2004 Identification Numbers Transaction ID No. 762432 SITE: Site ID No. 646571 Jim & Brenda Simone Please refer to both identification numbers, Short Drive above, in all correspondence with the agenc Town of Kinnickinnic St Croix County SE1/4, NEIA, S21, T28N, R18W FOR: Description: P roposed Four Bedroom At -grade System Object Type: POWT System Regulated Object ID No.: 857389 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • 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). -__ 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. • 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. Owner Responsibilities: • 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. .T.S. .0. C Carzditi A R% ai. — t ARTHUR L WEGERER Page 2 7/2/02 Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is 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. 7:30 am to 4:15 pm WSMART code: 7633 jswim@cominerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 f TITLE SHEET Page of AT -GRADE SYSTEM FOR A 4 BEDROOM RESIDENCE This plan has been in accordance with the At -Grade Component _ Manual SBD- 10570 -P 'and the Pressure Distribution Manual SBD- 10573 -P LOCATED IN THE SE 1/4 OF THE tie 1/4 OF SECTION Z 1 , T Z8 N, R l8 ` W, TOWN OF k-l►J- jLO 1z IQ C , S 1". C6Z.a W COUNTY, WISCONSIN. Lor Ll o r C S P1 1 .4J V0 L �S Pc L4 6 6 Z INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT 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 Sv" 1 Rub 3� Z�iDi� S t�OrJ� PREPARED BY - LJEGE F:;� 1 SO 2 L . TEST S NG AND. DES 2 G;d SF—=RV S CE P.O. Box 74 421 N.Main St. River Falls, WI 54022 Phone 71 -4 - ••""� 5 25 0165 Fax 715- 425- 6864�� \' ^RTMUA i WEGEREA } DP14 C � Su.SwORr", DEPgRC DIViS�D NT D N OF fETY COM MERCE A D BUILDINGS a SEE COHRESp� NCE JOB NO. 0 Z l ' 3 O At -grade System'Hanagement Plan� Pursuant to Comm 83.54, Wis.Adm. Code Page 2, of 7 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. Cade. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The cutlet filter sh all be leaned 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 enc:esure. If the filter is equipped with an alar;,�, the filter shall be servicad 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 acccrmulation 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, Safety and Euildings Division. Pump 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 -grade Component and Pressure Distribution System no trees or shrubs should be planted or allowed to grow on the component. Plantings may is made around the perimeter and the component shall be seeded and mulched as necessary Prevent erosion and to provide some than for vegetative maintenance) on thepcomoonent isonotrallowed. Coldoweatherfinstalle_ ations require the component to be heavily mulched for frost protection. Influent quality into the at -grade system may not exceed 220mg /L BOD, 150 mg /L TSS and 30 M g/L this l s installation. FOG. Influent f S ow ma for thiy not exceed the - maximum design flow specified in the permit The pressure distribution system is provided with a flushing is recommended that lateral be flushed of acr,rmulated solids at least once eve 18�months. When a pessure s�perform d it should be ecch compared to the initial test when the system was installed to determine if orifice clogging has acarrred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be'checked for effluent ponding. Ponding levels should be reported to the owner and any levels above 4 inches considered 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•(11..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 rises, 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 t , o failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by li effective locking device to Prevent accidental or unauthorized entry into a tank or component Contlnoon w Ptan' If the septic tank or - ` -- - any Of its Components became defective the tank qr component shall be repaired or — re — to keep the ' system -in proper operating condition. _ imme diately k PAP' Pump controls, alarm or related wiring becomes defective the defective component shall be Y r e p aired or replaced with a component of the same or equal performance. If the at -grade component' fails to accept wastevater'or�eR3ris - to discharge ter to the ground surface, it may be necessary wastewato install an aerobic pre - treatment unit or -replace the component. Additional site and soil evaluations may need to be done and additional plans may to be prepared and approved by the Department of Commerce, Safety and Buildings- Division. Questions - about the operation or maintenance of this system should be directed to The County Zoning Office at - A 15 -- 2> , 66 - Q 6 80 • & <�I�te V The system installer at -713 _ Z7 3 _ 11 4y 1U SON The tank manufacturer at _ $n(3 -- 3 ZS - $L6 6 w 1 The effluent filter - manufacturer at 0 — ZZj S 7t.1 Z. Z,PI'13kEL PLOT PLAN ' Scale 1"= SO Page 3 of vo U OT r- 1K? Pve U(Z �►V ar'� o�s8`�115 �ao.�s EWE •� L4T Ll hl Q / / // o. b�ST•PtpE eL. lw.s i oA i' )a goo n F y p V C ? V)0'_sp s - - -- t3M# t = tt: t Ov 6``,Tfk 1y DI -A P_4_CPL -w_L I - - -- - -- t l NOTES: � 3. 10i, LoT Uhl E 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3- Septic tank to be 1 10o / $00 gallon capacity manufactured by w t CU�.JGZL Pr— lgoa ZP\a EL t=c� 4. Bench mark S = `3 PrEO UC 5. Divert surface water around system to prevent ponding at the uphill side. r - Page of L > 5 B > 5' > 51 r 2' � I 1_ — _ o 5' °$SE�tu "w k'V-U - ? c U. 1/6 B l I/6 B /A= ( 10 1 )Feet _ ✓ B= \ZO Feet Linear Loading Rate= S- ' /LN FT L= 13C� Feet Design Loading Rate= D•S GPD /SQ FT W= ZZ Feet Fabric Distribution . Lateral i �G2t6P�` L��v. 1C70 S Observation Soil Cover Well ' 1 21 V, hi �,� s Y 2" "4 �, >5' A =2 � >5 � Plan View and Cross Section of Wisconsin At-grade Unit with a Single Absorption Area on a Sloping Site Distribution Pipe Layout Pace S o 7 Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and "holes. Extend the end of each late. uD with the use of Iona turn or 45 ftting to a point within six incises of the final grade. Telninate the ends of the laterals with a valve,: threaded cat) or threaded plus. Provide access from final grade for the valve; threaded ' or, threaded plus. FVC Lateral „ 4` jUterml nU C T X z x xr x!Z z x z x Lateral Length Lateral Length - P Distribution Line � 0-- f ACL�s3 e oX I P 59 Ft Hole Diameter " Inch Lateral n ) Inches) X 2� .. Inches - -- Force Main Is Z Inches ' I of holes /pipe 30 Invert Elevation of Laterals Ft. 6Py-I ME40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 U) W 30 "Z 25 9 Z p a. I 20 6 J 15 J F- 4 10 F- 5 2 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company - 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 3326 7/91 Printed in U.,�.A. Combination Septic; and PL1MP CHAMBER CROSS SECTION AND SPECIFICATIONS PAGE OF 1 VEiJT CAP WEATHER PROOF JUIJCTI01.1 90X -(C.1. VEM7 PIPE APPROVED LOCKING 1 10' FROM OOOF- MANHOLE COVER .hMDOW OR FRESH wARtJ1sJG LP.$EL. ua P tPE q1� 1NTAK6 cor.�putT w /PrtSZTl GtP s , I F1 NLsHfl 11J PROVIDE LET •• t ^ AIRTIGHT SEAL I I Approved Z �'` - A I I I 1 Approved joint w/ I joint w/ PVC pipe �--lc� Oq . 1 ALARM PVC pipe a i 1 1 • I 1 ou - C F I I • CLEY. __J PUMP - � OFF D - COUGRETE �L 0 1 S 60 DLOCK 5 . RISER EXIT PERM1•ITED OQLy IF TAWK MAIrUFACTURER HAS SUCH APPROVAL 3 «ApPQotFp . BEOD I Iv4 SEPTIC F SPEC-IFICATIOKIS DOSE TAAIKS MALI UFACTURER: W��S�Z ��C°- l3� WMBER OF DOSES: 1 -4- PER DAB TAMK 51Zr : �� b 0 f g Or-) GALLOQS DOSE VOLUME r �( ALARM rLAUUFACTURER: S•�•�Ln`T () S`1 IT INCLUOIUG 5ACKFLOW: 133 ! GALLONS MODEL WUMBER: tOl HA) CAPACITIES: A- 1� !' - 11JCHES OR yob- 3 GALLOL15 SWITCH TtIPE : �-1 8- Z 1)JCHES'0R L ��' PUMP hLAQUFACTURER: 6 RUCHES OR 'y GALLOUS MODEL UUMDER: SRh1• �4 1O LZZ., Y INCHES OR r6ALL0lJS SWITCH TYPE: MOTE: PUMP AmD ALARM A TO 6C MIAIIMUM DISCKARGE RATE Z4' GFK INSTALLED ON 5EPARATI< CIRCUITS VERTICAL DIFFERENCE GETWCEU PUMP 0 1 J0- 015TRIBUTIOW PIPE., -7 FEET t MI&JIMUM METWORK SUPPLY PRESSURE , ; . . . 6 -S O � . FLET f Z S FEET OF FORCE MAIN X 1 31 F �p fsFRICTIOU FACTOR.. 0 ' 3 ET TOTAL 0tWA.MIC. HEAD = 4� SI ET 13•� As per manufacturer gal /in. Liquid depth 3 6 �� � M P -_ ? ER.FOIZ w� A uCL Gu�y ��� of 7 TOTAL HEAD IN FEET V6 /l UVE)l $ O cn O Ul O CTI O _ o 0 o � 0 (V O �p T D w (7 o FT 1 1 1 N H O D D n -P H o O - D r o r O o z O cn TA m — M O N H + ' Z 3 O c H �! m Z o m O 0 w N O co O W a _ 1 O O O O - N W -;1- Ul m v m (D TOTAL HEAD IN METERS EROSION CONTROL PLAN COMMENTS: For Lot 4, 1195 Short Drive., Kinnickinnic Twp. Plan for owners Jim & Brenda Simone 1. The main source for construction site runoff will be the house foundation excavation and any soil stockpiled until final grading and stabilization is complete. Apply seed and mulch as soon as grading is done to minimize erosion. 2. Divert runoff away from adjacent Lot 3 driveway and road drainage ditches by installing temporary earthen berms ALONG CONTOUR between construction activity and Short Drive right -of -way. Silt fence may be required to prevent sediment from moving onto Lot 3 — vegetation alone cannot be expected to provide sediment control. Maintain existing vegetation between house/ mound septic system excavation and road drainage ditch. 3. Construction equipment and vehicles must use only one stabilized driveway access that is designed for heavy equipment; this will avoid muddy, rutted conditions that allow contaminated runoff into the road ditch. 4. Stabilize new mound septic system with seed and mulch immediately after installation — do not wait for final stabilization/landscaping of entire site to cover exposed soils on the system. 5. If builder /excavator grades the site to create temporary berms, as recommended to contain sediment and leaves adequate vegetative cover between work area and road ditch, installation of silt fence MAY not be necessary. Silt fence will be required if sediment cannot be contained on the property with diversions/berms. Septic system inspector will evaluate ESC plan effectiveness and make recommendations accordingly. Please feel free to contact me with questions or ask for assistance with erosion & sediment control installation. Pamela Quinn, Soil rosion Inspector #665054 J V t►� C � r A ' C. th c L JtL _ n c - b Co to �► N � '� Zt - - , i O Cb t w 'R ig - 45* S = A-77 -9 ! ON 17,0 `.At A d JV `,Q l Standard Erosion Control Plan for 1- & 2- Family Dwelling Construction Sites According to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, soil erosion control information needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1- & 2- family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control flan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit Ipplicat PROJECT LOCATION Nu � P-- Please indicate north BUILDER ,,,J ie"Z nt OWNER �[•�n, S f '-o by completing the arrow. WORKSHEET COMPLETED BY 'T -'�'' � DATE 7/ j6 /d � -N- SITE DIAGRAM scale: I inch = feet I EROSION CONTROLPLAN LEGEND PROPERTY LINE EXISTING i —� DRAINAGE TD TEMPORARY DIVERSION FINISHED —� DRAINAGE LIMITS OF GRADING SILT —� FENCE �� STRAW BALES GRAVEL I O VEGETATION SPECIFICATION TREE PRESERVATION STOCKPILED { (D SOIL m Ui EROSION CONTROL PLAN CHECKLIST iR Check ( ✓) appropriate boxes below, and complete the site diagram with necessary information. z Site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. I TV ❑; Location of existing drainageways, streams, rivers, lakes, wetlands or wells. Location of storm sewer inlets. Location of existing and proposed buildings and paved areas. The disturbed area on the lot. Approximate gradient and direction of slopes before grading operations. Al Approximate gradient and direction of slopes after grading operations. Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices ❑' Location of temporary soil storage piles. Note: Soil p storage piles should be laced behind a sediment fence, a 10 foot wide p vegetative strip, or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. Location of access drive(s). �' Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). ❑ Lo tion -- QLsediment controls (filter fabric fence, straw bale fence o 10- foot -wide vegetative strip that will prevent eroded soil from leaving the site. Location of sediment barriers around on -site storm sewer inlets. Location of diversions. fiTi -o L ' Note: Although not specifically required by code, it is recommended that concen- trated flow (drainageways) be diverted (re- directed) around disturbed areas. Overland runoff (sheet flow)from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. ❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re- vegetation by sodding or seeding with use of erosion control mats. j Location of practices that will control erosion on areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap. When used, a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In- channel practices should not be installed in perennial streams (streams with year round flow). I ❑. ", Location of other planned practices not already noted. i r w f� Q ' j - Indicate management strategy by checking (✓) the appropriate box. Management Strategies .:: z i Temporary stabilization of disturbed areas. Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1 and September 15), or by other cover, such as tarping or mulching. Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment). • Indicate re- vegetation method: Seed ❑ Sod 71 Other • Expected date of permanent r - vegetation: Od • Re- vegetation responsibility of: ❑ Builder O ner/ uyer • Is temporary seeding or mulching plann d if site is not seeded by Sept. 15 or sodded by Nov. 15? ❑ Yes o Use of downspout and /or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed p through plastic drainage pipe to stable areas such as established sod or pavement. p g Trapping sediment during de watering operations. Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until most of the sediment settles out. Proper disposal of building material waste so that pollutants and debris are not carried off -site by wind or water. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the height o f the barrier. • Breaks and gaps in sediment fences and barriers will be repaired imme- diately. Decomposing straw bales will be replaced (typical bale life is 'i three months). Xn • All sediment that moves off -site due to construction activity will be cleaned u before the end of the same workday. I p y j All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday. • Access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. For more assistance on plan preparation, refer to the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW— Extension publication Erosion Control for Home Builders. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through the State of Wisconsin Document Sales, (608) 266 -3558. Erosion Control for Home Builders (GWQ001) can be ordered through Extension Publications, (608) 262 -3346 of the Department of Commerce, (608) 267 -4405. i EROSION CONTROL REGULATIONS Erosion control and stormwater regulations can be complex. Local, state and, in some cases, federal regulations may apply. Before construction make sure you have the appropriate permits. LOCAL ORDINANCES Check with your county, city, village, or town for any local erosion control ordinances including shoreland zoning require- ments. Except for new 1- & 2- family dwellings, local ordinances may be more strict than state regulations. They may also require erosion control on construction projects not affected by state or federal regulations. UNIFORM DWELLING CODE (DEPT. OF COMMERCE)' CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT: • Silt fences, straw bales, or other approved perimeter • Local building inspector measures along downslope sides and side slopes. . Department of Commerce, Safety and Buildings Division, • Access drive. P.O. Box 7969, Madison, Wis. 53707, (608) 266 -2128. • Straw bales, filter fabric fences or other barriers to protect on -site sewer inlets. • Additional controls if needed for steep slopes or other special conditions. STORMWATERiPERMIT (DEPT. OF NATURAL RESOURCES) CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT • Erosion control measures specified in the Wisconsin Department of Natural Resources, Storm Water Permits, Construction Site Best Management Practice Handbook. P.O. 7921, Madison, WI 53707 - 7921, (608) 266 - 7078. • Measures to control storm water after construction. I This publication is available from county UW- Extension offices or from Extension Publications, 45 N. Charter St., Madison, WI 53715. (608) 262 -3346 or toll -free (877) 947 -7827. A publication of the University of �- „u, Wisconsin— Extension in cooperation with the Wisconsin Department of Natural Resources. - `Ens %on ©1999 by the Board of Regents of the University of Wisconsin System. Send inquiries about copyright permission to: Director, Cooperative Extension Publications, 201 Hiram Smith Hall, 1545 Observatory Dr., Madison, WI 53706. University of Wisconsin- Extension is an EEO /Affirmative Action employer and provides equal opportunities in employment and programming, including Title IX and ADA requirements. GWQ001A Standard Erosion Control Plan for 1 bt 2 Family Dwelling Construction Sites h' Printed on DN R WT 458 -96 R- 02- 02- 2M -10 -S Editing and design by the Environmental Resources Center, University of Wisconsin— Extension. 01.4 recycled paper Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Building'. • in accordance with Comm 85, Wis. Adm. Code County i `C Z 0 l Attach complete site plan on paper not less thar1l ize include, but not limited to: vertical and horizontioed n and Parcel I.D. percent slope, scale or dimensions, north arrowna distance to neares road. Z Please print all in Revi ed � y Date Personal information you provide may be used for se 2 O t (Privacy Law, s. 15.04 (1 (m)). vvv v 1 Property Owner ST C N ,;lX 0 Property ocationS �uC' t I. 1/4c 1/4 S Z T 1 � 3 N R E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# b - �\�2l G � � ��IZ.I U — CS V v t_ 1.S 1� t � M � g Llo6Z City State Zip Code Phone Number ❑ City ❑ Village a Town Nearest Road FPu I I\j sVU Zz- I (-- l5) q ZS - S7 69 N - cImp, L()ZliJO1C 'S1��T�n�vE . f New Construction Use: g Residential / Number of bedrooms Code derived design flow rate 00 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 1'\x,1.. C� V 1L OOLdM I`t i Flood Plain elevation if applicable General comments Sv � . Rj Z ti M� I," / 6 "x l U p � ' I S M-Ul Q'NJQ aELL and recommendations: 6 k O F s A" Ft L_l- a r. Pf 1 ti Pfr 2 +" - bE S k s `l51 w/ 10 ` x k Lo D� S`Cr2� aQ nUQ CAL_ F1 Boring # ❑ Boring ® pit Ground surface elev. � 0.0 ft. Depth to limiting factor �3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 -9 - .,SLl 12- 3 - 1s Le-� -sb M il ew 1 �` .� �. Z Z -Z3 Z S`llZ 3l _ Y 1 s l es bh rn � . -7 1. Z 3 Z3 - qL - )•S , -j�- 16 — �s 6t1 + - _ Y c 1� s 1 L 1v1. e� Z 3 F1 Boring # ❑ Boring CG, pit Ground surface elev. `fib- O ft. Depth to limiting factor 10 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-\ LZ " -31z - S l 1 Z MS bl' Yvi`�� N l.v �'F • S - `c'� Z 12 -Z7 Z •S `� R,31. - s 1 �, cs bl2 w) `� h C�J — • �j - � Si, c1 elf -S 1D Krz 6 13 - LS 3R - - - — • o ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 _< 150 mall ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si natur CST Number Arthur L. Wegerer w j. OZ" 1�0 220254 Address 1,j e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Main St. River Falls, UI 54022 � -3 -oz '.715 -425 -0165 iL Property Owner Slh'ly�� ParcelID # UZZ - 1 OSg —��• ��10 Page Z ' of 3 F�] Boring # ❑ Boring Pit Ground surface elev. 1 - S ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-9 - 1 .S �I D-31 Z - S l 0--S Vk Y>7 � cw l '� • - 1 I. Z Z 9 -Zq v)-ARV \S 1 esbk yo v c �,, - . +- z 3 z4 -(40 -). S -Irz yr \S -1 I 1 0,sbk * v' y 40-0 ' - SYP VA — sc1 csb wa`�r Cs • Z - 3 S 10`12613 — LS BR F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 F Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 • 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.6/00) PLOT PLAN Page 3 of 3 Scale 1' = SO' \ Z,�, J� � E r -k Pie a:� L07 .ate • 3� # 0 t j S u 1Tv�3�z PC%XE F 1Z Wt U�► 6 R-A-D S`2 3 Tk-Z . > �o n / `3• Z " L�jVg E C3 1# l LL: Iuo Q' Ong 6```[ L-. 3 t�f"D1A , __PV.C_?! t'QF LPG Lju7 LW e � ��������220�254 p2 — l 00 CST Signature Date Telephone No. CST No. Job No. • Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 ff TDD #: (608) 264 -8777 \*iscons�n -�-- - www.commerce.state.wi.us /sb Department of Commerce R EC EIVED www.wisconsin.gov Scott McCallum, Governor JUL 0 3 2002 Philip Edw. Albert, Secretary ST. Ci OiX COiJiV �. ZONING OF-HCE July 02, 2002 CUST ID No.267341 ATTN: POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN ST CROIX COUNTY SPIA SERVICE PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/02/2004 Identification Numbers- Transaction ID No. 762432 SITE: Site ID No. 646571 Jim & Brenda Simone Please refer to both identification Short Drive numbers, above, in all Town of Kinnickinnic correspondence with the agency. St Croix County SE1 /4, NE1 /4, S21, T28N, R18W FOR: Description: Fnur Bedroom At -grade System Object Type: POWT System Regulated Object ID No.: 857389 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • 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). • 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 ARTHUR L WEGERER Page 2 7/2/02 provisions of Sec. 145.20(2)(d), Wis. Stats. shall Comm 83.22(7) - A co of the approved plans, specifications and this letter copy pp p p be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • 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. Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm p 9 p P 83.55, that is 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 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 Wisconsin Department 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 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D, . D Z 2 /� S 9 • �/ O percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 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 P4 T O ' a yy of f Govt. Lot sU) 1/4 /V� 1/4 S T 1 N R /8 a•( or) W Property Owner's Mailing Address Z ��W t/ 5 N Lot # Block # Subd. Name or CSM# `/o - A/r!6. 140VAY 7 � �/ . pENn %k&- CSM City State Zip Code Phone Number [:]City E] Village KTown Nearest Road VE12 •t! /S w/. S•yO zZ c 715 J Z,S 4 iJ K i G f� i.vN /'C ,vA Riv�L'12 R a • c [� New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate V "' d 0 9 GPD Re lacement� ❑ P / ❑ Public or commercial - Describe: t , Parent material `OFST O / S/1,OD 00ZW -- - Flood Plain elevation if applicable General comments 5' &�' and recommendations: !;ax veV60> t'1o P /if •6w s F 1-1 Boring # ❑ Boring / �./3 > / oo Pit Ground surface elev. 7 ft. Depth to limiting factor O in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 s / f /Wf Z 2.0 /o yR Y 3 y :. 3 /D Y K 3/ SL i1`5'd, M,vfx 2S 75 79 �o yR s/& � s. of s � — - .77 �. z A N 3 tr " • ti (ooro a) orca-aus `/ / /4= 4707 -4A0 ITT In I C'I C -AA7 -011n IV innitnivr1i7n Tin tivmnl f%cvwl l ivnnnT niviTi -mv Yin in ivy immii nnniT P Property Owner Parcel ID # � • /O5v . 46 / Page Z of [-3] Boring # ❑ Boring f�Q a Pit Ground surface elev. c / ft. Depth to limiting factor T 6 in. Soil Application Rale Horizon Depth Dominant Color Redok Description Texture Structure' Consistence , Boundary Roots GPD /ft= In. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 �l•;r 7.s t,e s , Boring # ❑ Boripg q-7- lj (O0 > C� Pit Ground surface elev. ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description VTe xlure Structure Consistence Boundary Roots GPD/ft' In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 • Eff#2 , o /a Y i/3 h�Sf✓,� �, v�� w z � s o a / Xx I'S Y 1/ •l /D f Sjie Q Sq s G /o I F-1 Boring # ❑Boring' ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'P-ff#t •Eff#2 t i Effluent #1 = s > 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 °services or � D l P G� P6 S / /V � • 007 b� �e age � 5y O � N � a S� � Iii � Iii I ADS I ST CROIX COUNTY SEPTIC TANK MAINTEI? ANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ,L C D A S OI/ G Mailing Address Property Address f 1 S240 ✓z "�` R t V c� (Verification required from Planning Department for new construction.) �Q -- City /State Parcel Identification Number ©Z - Z l0 �'9 -- (oG —/Oz� ✓ LEGAL DESCRIPTION Property Locatio '/4, �'' /a, Sec. , R Town of � l�/(Jf'CKlNN / efC Subdivision , Lot #. Certified Survey Map # Volume _ 15 - - , page # _ 1 1 - 06 Warranty Deed # , Volume _ :4 , Page ! /85- Spec house O yes�l_no Lot lines identifiable � -yes O 110 SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to hand:e wastes. Proper maintenar..ce consists of pumping out the septic tank every three years or sooner, if needed by a licer..sed; - Umper. `;''':at yoL: put :nto the systerz can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certificatioa form, signed by the c,vaer and by a masterplumber, journeyman plumber, restricted plumber or a liceasedpumper verifying tLat (1) :he on -site wastewaterc_sposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is 1--ss than v uil of sludg Uwe, the undersigned have read the above requirements and agree to maintain the private sewage dispwai sys:e ni wit;: the standards set forth, herein, as set by the Department of Commerce and the Department of Natural T:eso.:_ ces Sta.. <:i 1�,'iscons r_. Ce7tificatien s stating that our septic system has been maintained must be completed and retuned to the St. Croix. Cc .:r; , �o.iing 0__ within 30 da the thr ar iratip,R date. � OF APPLICA DATE OWNER CERTIFICATION Pe certify that all statements on this form are true to the best of my (our) know'eJge. I (v/e', am (are; property d ibed e, byevirtue of a warranty deed recorded in Register of Deeds Of'' "'e. I OF APPLICANT D A E * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the 'oning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if referencY is made in t1ie warrar:,: de�.d U 1856P 187 � DOCUMENT NUMBER LAND CONTRACT x6 NLE H SH REGISTER OF DEEDS ST. CROIX Co., YI CONTRACT, by and between C aiq P. hy, a married man with RECEIVED FOR RECORD sole management and control of the su act p operty. (Vendor) and 03-19-2002 9: AM Brenda L. Simone and James E. and and wife as survivorship marital proper y urchasetl. Vendor sells and agrees to convey to LAW) CONTRACT Purchasers, upon the prompt and full performance of this contract by EXEIPT = Purchasers, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property "), REC FEE: 15.09 in St. Croix County, state of Wisconsin: TRANS FEE: 231.00 LOT FOUR (q OF CERTIFIED SURVEY MAP IN VOLUME FIFTEEN (15 o COPY FEE: CERTIF SURVEY , PAGE CERT COPY FEE: FILED IN PAGES t 3 ST. CROIX COUNTY REGISTER OF DEEDS OFFICE ON APRIL 5, 2001, BEING LOCATED IN PART OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER (SE 1/4 OF NE 1 /4) AND THE SOUTHWEST QUARTER OF THE NORTHEAST QUARTER (SW 1/4 OF NE 1 /4) OF SECTION TWENTY ONE (21), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC. Gwen Kuchevar �. Subject to North River Road, to all easements, restrictions, express or RODLI, BESKAR, BOLES 6 KRUEGER, S.C. implied, and subject to covenants of record affecting the subject 8 $OX 1 P.O. Q, 3 property, receipt of which is acknowledged. P P. O. Falls, WI 54022 -0138 St. Croix County, Wisconsin. 022 - 1059 -60 -100 Parcel Ident cat on R r This is not homestead property. Purchaser agrees to purchase the Property and to pay to Vendor at such place as he shall direct the sum of $77,000.00 in the following manner: (a) $20,000.00 at the execution of this land contract plus (b)the balance of $57,000.00, together with interest from date hereof on the balance outstanding from time to time at the rate of seven percent (76) per annum until paid in full, as follows: monthly interest -only installment payments of $332.50 each, payable prospectively, and due on the twelfth (12th) day of each month, starting on March 12, 2002,and continuing for twelve (12) months thereafter. Provided, however, the entire outstanding balance shall be paid in full on or before March 11, 2003 (the maturity date(. Following any default in payment, interest shall accrue at the rate of 12t per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). (Vendor hereby excuses Purchaser from the requirements of this paragraph). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate and in the manner specified above, and then to principal. Any amount may be prepaid without premium or fee upon principal at any time after December 31, 2002. In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as U 1856P 188 first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded here from. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on the date this agreement Is executed. Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, extended coverage perils and such other hazards as Vendor may require, without co- insurance, through insurers approved by Vendor, in the sum of $77,000.00, but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances except any liens or encumbrances created by the act or default of Purchaser, except P and e � Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 30 days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 15 days following written notice thereof by Vendor (delivered personally or mailed by certified mail); then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to an limits on j y ti s rovida b law or in equity; i Vendor P Y law) in addition to those provided b Y 9 Y. ( ) odor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if Purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet -title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), iii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or notl to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the e Property (by assignment o£ an of Purchaser's rights under this Con _ 9 Y 9 tract or by option, long-term lease or any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes u -zss6P z89 timely payment of the amounts • then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this /�`' day of 2002. Craig P.- (SEAL) urphy (SEAL) Brands L. 3 m ne (SEAL) as E. none (SEAL) AVgi1LNTIGT ON AiClQ70WLZDQK9NT Signature(sl !w' y. h11 �6�� -ati �k�e STATE OF WISCONSIN ) A \ 4.a•i Z' �Q `` . 0 . k.•"t,K• as. COUNTY auth4u<Nateg.'.6hf'9, * day of IZ.t..an c 4, 2002 Y �'• Personally came before me this day of C.' j.►.d i� , 2002 the above named L4 � w to me known to be the person(s) who executed the � �A' ""' C foregoing instrument and acknowledge the same. TLTLE1 ��•t1EM8BR'�S$ATE BAR OF WISCONSIN (If nd authoYiadd.by.5706.06, Wis. Stets.) a THIS INSTRUb=T NAB DRAFTED BY: Notary Public County, Wis. River Falls, , Boles a Krueger, S.C. River My commission is permanent. (If not, expiration date: W1 54022 , 20 ) `� . tL. v " .yi � r:i .•.:; yaTHIfEN H. WN.SN l Nxoh ti LL� pr / /� W 2 W r+ N a n LL W Q • 51.1.101X CO.,'A7 1 � W Cl Uj cn u w o tf u Lai -'L- Certified rf Survey W r NE " ' " ' C.al, 7ZON, R/ew, y I /8£RNrS£N NAIL /O!/ND/ rA°OFP /PE ELEK +919.8? Judith Bruce NORrN ,?/,ER ROAD Part of the Southeast 114 of the s of •TT Ia °f T6J oI' _ a0. 00' Northeast 114 and the Southwest 1/4 —!— o-� — of the Northeast 114 of Section 21, 7l6'• or I o J Jr k Noo•.J Ja ' w.TZ7n `o t LIN Ne 11I I ^ ri IF C �•'� 8 - h Township 28 North, Range 18 West. I i a • h h Town of Kinnickinnic, St. Croix h � �� County, Wisconsin. OWNER'S ADDRESS.' o v� C/O CRAIG NuRPNY —) O .y� O1 Sg6 li ICHWAY 65 NOR — — — — -- il- b 2 I' � h O R/VEN fALL S. — .14022 ` © l Q C IND/cArEs I "X21" /RONPIP£ wf76N/N6/,IJLdS. L/N. /Fr. 500•/6'06 "[ JSZ. 00' ya b y b i 1 O w sz ♦ /NOI CA U S I "IRON P /PE r+ w w • /. O A \ b FOUND. O O ^ K h h W r, +� o • b W v W O h ♦ /NO /C4 r[S SO /C T£S1 Q W tL Q) O O ti 3 FOR sEW S/r£. C W APPROVED h :t a b ST. CROIX COUNTY Mann= Zonino anti PaAs Cor -itlee APR 0 5 2001 Q ° ° I CI v ° If not recorded wilttin 30 clays Of „ ;t v o ) Z approval dale approval Snail pe j} a u a I null and void t Q t W l h !V 2� o J ti C A ,.L BCaR /NGS RGFFR£NCE0 r0 ln'E Q i law //♦ L /N! Ui S£C7/0N //, 72d N, R /d �', ASSUN EO N BS • /�' 39 "W / Z I O rNIS /NS /RU,vfNr OR Af7f0 ° � V i BY LAU.PENC£ W NURPNY b i OArCD: sE /TEVg Ee /g, T0Oo t J O n f ♦ h ` A N 1 .� ` VOr ^"a 1 w .! 3 + It pyq LL 4411 � h I F j � ti W . r•, • O o t 3 •r. ?SO.dO' JOO.OU' vO /•JJ' d "tntmnOAn bNPL A S ti'EET ! 4F3 Vol. 15 Page 4062 St. Croix Valley Title Services, Inc. ' ld�y 10 0 .71elv 11 11, 4 J W 3 a $ FIL 3 O�Z- / D1 ll� 1 7 0 •3.2`!� /7 3AO o .. APR 0 5 2001 Q . U. L) M KATHLEEN H. Y" N =(D f `� Register of Deeds N W W a `` a '- .. _ SLCroixCO31M ;=W, ix, - M �� i --V Cerhfled Surv Ir� y /�}��yLj1 NE COR. SEC. ? /, r 28 N, R/6 W, 1� N r7 p// /8ERNrSEN #A IL FOUND, TAP OFP /PEELEV. :949.8? Judith Bruce f/NPL4rrE NORTH RIVER ROAD Part of the Southeast 114,6f the SO/ •?3' /9 "f ?617.0/ oo' Tk Northeast 1/4 and the Southwest 114 2/ 67.0 h �, N 00 "W 4 ?2. the Northeast 1/4 of Section 21 E L /NE NE //4 Township 28 North, Range 18 West, I W Town of Kinnickinnic, St. Croix County, Wisconsin. `^ '^ ` � OWNER'S ADDRESS.' CIO CRA /6 MURPHY __ _ _ _ ^) V O �►h 4 O Z 286 H/6HWAY65 NORTH .__ 1 ►� r N RIVER FALLS, W /140?? O ``� ♦ � LEGEND.' ��N?k yt C /NvIcArES /"X24" IRON PIPE Q b J N Z WE /6N /N6 /. /3LOS. L IN. /F1: s 0 • /6'06 "E 352.00' 0 v b O h 'b t �. SET. b1 a M O ,„ b M f q • IND/CAres /"IRON P /PE y "� o ^ O q FOUND. O Q %^ h W W ~ 2 tw ° -A- INo1CArESFENCE. • /ND/CAres SO /L rESr ; j 41 't FOR SEWER S /r[. O W C % ;^ q 1. = W h • b APPROVED a : W° ST. CROIX COUNTY ' a Plannino Zonino and Parks committee APR 0 5 2001 ° o V H CA W I a o o Z If not recorded within 30 days of b = W ° approval date approval shall be J' : null and void VVV / i Q b '° I a a C l ' f �A S.0 1 E ? 33.6 v� 4 it j1 ALL BEAR /Nes REFERENCED ro rHE E/W 114 LINE of SECr /ON? /, r ?6N, / ~ R/8 W, 4SSUMf0N89 "W // 2 O TN /S /NSrgUNENT ORAF7E0 o v 6Y LAURENCE W. MURPHY A W h OArEO: SEPTEMBER /8, ?000 W h W "Revised this 11th day of b Q W � UP.Cefrlbei', 2000." ♦ � � � y h � Or � in O N ao O q 0 Q q w 44 a 0 b r +� •� N y a1 W ♦ z N W f p N h V11 � Q 1- h i • o o coo 1 4 n LAUM •� r � & " 14 +' ._.-_• 4.80' JO0.00' A• ? ! a ►an/ UN P_LArTEO LA a o SHEETlOF3 Vol. 15 Page 4062 • Certified Survey Map Judith Bruce Part of the Southeast 114 of Me Northeast 114 and the Southwest 114 of the Northeast 114 of Section 21, Township 28 North, Range 18 West, Town of Kinnickinnic, St Croix County, Wisconsin. CURVE DA TA CURVE CHORD BEAR /NQ cmoROO /Sr. .4RC O /Sr. I cENrR4L ANGLE R.00/us Is TAN. BEAR /Ne 2N0 r4N.8E4R /N6 / -2 S55.47'32.5 "W 1 86.72' 9/.61' 65.36'/7" 60.00' S88'36'4/ "W S22• ?6'24 "W 2 -6 N34•12'27.5 "W 134.46' 342.96' 241.38'17" 80.00' S22.16'24 "W N88.36'41'E 2 -3 S76•/8 13/.6/' /S4. SS' //0.4/'//" 60.00' S22• ?6'24 "W #46.Z0 P d- NZ 0 10 , 12.5"W 68.03' 70.29' ?0'20'2?" 80.00' #46 #04.00'00'E 4 -1 N29• /5'00 "E 68.25' 10.30'00 80.00' N04.00'00 "E N14 0 30'00 "E 1 -6 N7/•33'20.5 "E 46.93' 47.63' 34.06'41" 60.00' N54.30'00'E N"*J6'41 "E Owner's Certificate As owner, I hereby certify that I caused the land described on this Certified Survey Map to be surveyed, divided, mapped and dedicated as represented on this Certified Survey Map. F Witness the hand seal of said owner this aa�ol J 2000• �� 0 � " L Craig P urphy a nal Reprfe a of Judith Bruce) State of Wisconsin) St. Croix County) Personally came before me this ?-j day of VA�.C- ( - 1. . 200$, the above named persons to me known to be the same persons who executed the foregoing instrument and acknowledged the same. VAOL - . N t ry Public, gka c O 6otmty� sconsin. y mmission expires I 's fv. K• This map is hereby approved and accepted by the Town Board of Kinnickinnic S 1 o CarokHoopman Town Clerk Dated. � LAU W. MWU Y This instrument drafted by Laurence W. Murphy 1719 FA" VA Dated. September 18, 2000 "Revised this ilth day of December, 2000. � SHEET 2 OF 3 Vol. 15 Page 4062 Certified Survey Map Judith Bruce Part of the Southeast 114 of the Northeast 114 and the Southwest 114 of the Northeast 114 of Section 21, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. Description: That certain parcel of land located in the Southeast 114 of the Northeast 114 and the Southwest 114 of the Northeast 114 of Section 21, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows; Commencing at the East 114 comer of said Section 21, the POINT OF BEGINNING, of the parcel to be herein described, thence N 89 (assumed bearing on the East/West 114 line of said Section 21), a distance of 2012.69; thence N 01"33'04'W 534.80; thence N 45 °4532 "E 234.94; thence N 81 757.10; thence S 89"3643 "E 73.94; thence N 67 "E 48.92; thence N 806'11"E 480.40; thence S 00 0 16'06 "E 352.00; thence S 57"38'40 "E 225.06; thence Easterly on a curve concave to the South, having a radius of 80.00; whose chord bears N 71 a distance of 46.93', thence N 88"3641 "E 270.00 , thence S 01 490.00' on the East line of the Northeast 114 of said Section 21, to the POINT OF BEGINNING, containing 33.203 acres or 1,446,328 square feet, being subject to easements of record. Note: Each parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the appropriate Town Board for advice. This instrument drafted by Laurence W. Murphy Dated: September 18, 2000 " Favised this 11th day of Deced)w, 2000." State of Wisconsin) County of Pierce) 1, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Judith Bruce, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236,34 of the Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and connect representation thereof. Surveyor's Notes: The shown flood contour on Lot 2 has a range from approximately 926 feet on the West end of the lot to approximately 928 feet on the East end of the lot. The St. Croix County Zoning Office should be contacted once a building site has been chosen to determine the exact flood elevation to use for that particular building site. An Wosbn control plan will be required by the St Croix County Zoning Otfioe prior to any construction on this site. GoNa LA W. 713 FA", Wt . LAND SWEET 3' Vol. 15 Page 4062