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028-1037-60-000
n ■ o ! ■ 0 2 E & § 2 ° } ;i$ 7 k \� e m z & (' £ % 8, q�\ \ k g ] 9 g U � ; } ° x j C', 7 2 £ ; B g § ) U / § 8 20 2 2 R 2 ® \ / OD \ - @ \ ƒ / k � ° 10 0. d$9 a ®� �mrj / m I n r ■ 2 k ] & \ k o o 0 § rr � 0 0 o a � � � � � � � / � i Oro a 4N. § � g §Io . a CL �- \ ( Oro � g � � 2 \ __ � ■ / z 0 � ■ � ƒ ¥ § 9 C w M g w § k FF � / m � § ; r 0 2 �M 0 >CL 7= 2 ®� z a Cl) . O M Ma0 / §a »; ID C,)0 OD \ -4 § to j� § (= � `2 $ 7 U)i F g ; o CL N. 0 � _ o � Parcel #: 028 - 1037 -60 -000 o1/os /2t) P E I OF F 1 PAGE 1 Alt. Parcel M 27.28.17.228C 028 - TOWN OF RUSH RIVER Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner 0 - VANG, WANG X WANG X VANG C - VANG, CHUE CHUE VANG 1877 18TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 1877 18TH AVE SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 17.006 Plat: N/A -NOT AVAILABLE SEC 27 T28N R1 7W PT SE NE BEING LOT 1 Block/Condo Bldg: N E 1/4 CSM 2/302 1.5AC & INC COM OR;TH S C 89'W 740.09FT TO POB; TH CONT S 89'W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 571.69FT;TH N 00'W 1294.34FT;TH N 89'E 27- 28N -17W SE NE 573.74 FT; TH S 00' E 1292.67FT TO POB 17.006AC Notes: Parcel History: Date Doc # Vol /Page Type 12/05/2008 885090 QC 11/09/2004 779515 2692/624 WD 04/02/2002 675119 1865/112 QC 03/31/1999 600384 1415/055 WD more... 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 8947 Use Value Assessment Valuations: Last Changed: 04/11/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.500 25,000 176,300 201,300 NO AGRICULTURAL G4 15.506 3,200 0 3,200 NO Totals for 2009: General Property 17.006 28,200 176,300 204,500 Woodland 0.000 0 0 Totals for 2008: General Property 17.006 28,200 176,300 204,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 t LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF RUSH RIVER COMPUTER NUMBER 028 - 1037 -60 -000 Parcel Number 27.28.17.228C OWNER NAME: First ROXANNE M Last KALK PROPERTY- -- 112-PD---Street Name -- T p p e SD A rtmen,tl� 1877 18TH AVE X ��/ SECTION 27 4 NE'�440"SE Line Description Line Description TOTAL ACREAGE 17.006 PLAT LOT BLK 01 SEC 27 T28N R17W P SE NE _ 15 02 BEI �CO SM 2/302 1.5A 03 f INC E 89' �17 04 740.09FT TO POB; TH ONT 18 , j 4 5 05 S 89'W 571.69FT;TH N 00'W 19 06 1294.34FT;TH N 89'E 573.74 20 07 FT; TH S 00' E 1292.67FT TO 21 08 POB 17.006AC 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit x LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF RUSH RIVER COMPUTER NUMBER 028 - 1037 -60 -000 Parcel Number 27.28.17.228C OWNER NAME: First ROXANNE M Last KALK PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 1877 18TH AVE SECTION 27 TOWN 28N RANGE 17W %160 NE 1 /440 SE Line Description Line Description PARCE L VOLUME & PAGE HISTORY TYPE VOLUME PAGE DOC# NOTES . ►.QC 1865/112 675119 CILEK BARBARA TO KALK ROXANNE .. WD 1415/055 600384 MONI K N .1QHW & SHELLEY TO KALK ROXANNE & CILEK B ..AFF' T4II4T_44 598055 PT SE NE TO CS QC 873/ 565 0 QC 873/ 565 0 1 .. 808/213 0 � 1. 7_ Use Use Arrow Keys to Select, F7 -ROD, F10 -Exit I ds At � sy� vw VOL 1415ME055 State Bar of Wisconsin Form l - 1982 600384 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO. RECEIVED FOR RECORD THIS DEED, made between John .M. .M.onlckea and . Shelley 03 - 31 - 1999 11:00 AN , Moni.cken, husband. and. wife......... ... . ....... .. 1. ... WARRANTY DEED ....... .. ..... EXEMPT 4 ..... .. _ . .. ...... ... ... CERT COPY FEE: COPY FEE: TRANSFER FEE: 440.70 Grantor. RECORDING FEE: 12.00 and Roxanne M.. Kalk,. amarried person,. and..Bar.bara A. PAGES: 2 .Cil.ek, a..single person, as joint.tenants, wit.h.right .. ...... .......... ....... .. ....... ...... ..... ... ..... ..... THIS SPACE RESERVED FOR RECORDING DATA ............ _ .. ..... . . .. ..... .. ... .. Grantee NAME AND RETURN ADDRESS: WITNESSETH, That the said Grantor, for a valuable consideration ...... .............. River Valley Abstract & Title, Inc. conveys to Grantee the following described real estate in St. Croix P.O. BOY 149 County, State of Wisconsin: Hudsom6 WI 84016 028 1037 -40_ 028- 1037 -5 PARCEL IDENTIFICATION NUMBER Legal description attached as Exhibit "A" This ...... Is........ .. homestead property. (is) (ICxt�t) Together. with -all -and - singular. the_ hereditaments_and.appurtenances thereunto belonging: And .. Grantor. .. .... ... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, roadways and restrictions of record and will warrant and defend the same. Dated this ...... ........ 30.th .. ..... .. .. . ...... day of .... . March............. ... _ ....... ..... 1999 . . (SEAL) o (SEAL) 70 I1, . ?'�An nke?1 ............... . ........ . (SEAL) (SEAL) • .. ............. . .............................. • ' .. Steel... y. Mo icken.... ........... ... AUTHENTICATION ACKNOWLEDCMEl" ' S2 Is , U • O Signature(s) ... ....... ....... ....... ............ .......... STATE OF WISCONSIN i 412 3 r County.. authenticated this .... , day of 19 .... Personally came before me this.; -. • Q y of 'h ......... .... ..... .... John, .M.. Monickers. and , Sh'�3•.. :!�. ken . . +. ..... . ... ..... ............................. TITLE: MEMBER STATE BAR OF WISCONSIN ............................... ............................... (If not . .. ............ ......... . authorized by Section 706.06, Wisconsin Statutes) to me known to be the person .S . ... .. who executed the foreg ' .g instrument and ac owledge�ttte ame. THIS INSTRUMENT WAS DRAFTED BY II Michael H; Forecki, Attorney Kai h.l e.en. R...V.ldeen ....... ......... Eau Claire, Wisconsin Notary Public P41.k. .. .. .... . .. County,Wis. (signatures cosy be authenticated or acknowledged. Both are not necessary) My commission is permanent. (If not, state expiration date: Names of persons signing in any capacity should be typed or printed below their signatures. .Mile 24 . ............. .... _ *¢z 09 1) VOL 141.JPAGf656 LEGAL DESCRIPTION That certain parcel of land located in the Southeast 1 /4 of the Northeast 1 /4 of Section 27, Township 28 North, Range 17 West, Town of Rush River, St. Croix County, Wisconsin, including Lot 1 of that Certified Survey Map recorded in Volume 2, Page 302 of St. Croix County Certified Survey Map records, more fully described as follows: Commencing at the East quarter corner of said Section 27; thence S 89 degrees 28'26 "W, 740.09 feet (assumed bearing on the East - West quarter line of said Section 27) to the point of beginning of the parcel to be herein described; thence continuing along said East -West quarter line S 89 degrees 28' 26 "W, 571.69 feet; thence N00 degrees 07'29 "W, 1,294.34 feet to the North line of the Southeast 1 /4 of the Northeast 1 /4 of said Section, being also the centerline of 18 Avenue, thence along said North line, N 89 degrees 3 "E, 573.74 feet thence-S00 02'00 "E -, 1 feet to said East-West quarter line- and-the -point of beginning, containing 740,789 square feet or 17.006 acres, being subject to an easement for Township roadway purposes over the Northerly portion of said parcel as shown on this map, and subject to all other easements and restrictions of record. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ` (k INSPECTION REPORT Sanitary Permit No: -- 463136 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s'15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Kalk, Roxanne Pleasant Valley Township 028 - 1037 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 1 Q� n ( ��t 27.28.17.228C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � ! ' Benchmark Dosing Alt. BM �� , Ae +l. Bldg. Sewer Holding SVHt Inlet / 9' TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \v Septic 7 5 � / Dt Bottom t •3 ,w Dosing O i / Header /Man. 1 _ Aeration Dist. Pipe Holding Bot. System zo PUMP /SIPHON INFORMATION 0 K Final Grade Manufacturer Demand St Cover 5 c b I GPM r 7 • C 71 . C � dC Model Number c 'I TDH Lift Friction Loss System Head TDH Ft ZZ 1 , 3_z5 tL °I1 Forcemain Length. r Dia. i Dist. to Well 40 7 50 SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. O\ is Inside Dia. Li uiq d Depth DIMENSIONS ( ' 0 . ©`Z F1 L. SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer. �\ INFORMATION T e Of tem: y CHAMBER OR YP O (0 / J� UNIT Model Number. DISTRIBUTION SYSTEM 2- ' v Header /Manifold ( ,1 Distribution I / x Hole Size ti x Hole Spacing Ve to Air Intake . r Pipe(s) y � -� L a I�' Length - 1 Dia , I� Spacing �.� `� C� 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 / Z- Bed/Trench Edges \ Topsoil \ - � es No es [I No COMMENTS: (Include code discrepencies p ons p es t, etc.) Inspection #1: /p [ 8` Inspection #2: Location: 1877 18th Avenue Hammond, WI 54015 (Unknown R17W) NA Lot 1 Parcel No: 27.28.17.2280 1.) Alt BM Description = C�•• �:..5 d L-t< �S �fe�- , C' n 2.) Bldg sewer length = 2_6 ��- . O ,� Q L v , 5 L . - amount of cover = "T -- -- - -- Plan revision Required ?' Yes No , I 3 q Use other side for additional Information. b ''`� �__ —_� I SBD -6710 (R.3/97) Date Insepct s Sig tore Cert. No. JJ 1 F ECEIVE® CT p 2 2oa CROIX COUNTY Safety ty ` 201 W. Washington Ave., P.O. Box 70 — / 7 T Ccz I cons in Madison, WI 53707 - 7082 Sanitary P it Number (to be filled in by Co.) Oe artment of Commerce (608) 261 -6546 3 /3 Sanitary Permit Application S to Plan I.D. Number Q In accord with Comm 93.2 1, Wis. Adm. Code, personal information you provide 1 0 5- 7.5 5- t J "� � i p�> may be used for secondary purposes Privacy Law, s15.04(Ixm) Project Address (if different than mailing address) I. Application Information — Please Print All Information Property Owner's Na Parcel N Lot N Block N Property Owner' ailing Addr Property ah / 2? /; . City, State Zip Code Phone Number Ka Section _ IL Type of BuildIng (check all that apply) T J_ R / r E o 4 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name umber ❑ PublidCommercial - Describe Use ? Q 6� ❑ State Owned - Describe Use <'p 0 2 • ^ DO lagekownsbi f III. Type of Permit: (Check only one box on tine A. Complete line B If applicable) o 2 8 110 5 _ 60 , 22X A ew System ys Replacement System ❑ TreatmendHolding Tank Replacement Only ❑ Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl ❑ Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil Amound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip lane ❑ Gravel -less Pipe ❑ Other (explain) ✓ V. DIs ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rat si) i ersal Area Required (st) Dispersal Area Proposed System Elevation 00 ,Bier f ° Oo VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I , the undersigned, assume responsibility for 1 stallation of the POWTS shown on the attached'p'lans. Pl apte rin "umber's S' lure M PRS Number Business Phone Number Plumber's Adaren (Street, City, Stat ' Code VIII. Court /De artment Use Onl %Approved ❑ Disapproved Sanitary Permit F (includes Groundwater Date Issued I ui Agent Signer e o Stamps) Surcharge Foe) er Given Reason for Denial �- Ix 9 Septic an c, effluent filter and 3� dispersal cell must all be serviced / maintained S t n prov ided b as per managemen pia prov e y plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. a 0 35 7 r 7 VO ov a < . o , 0 G 0 s Safety and Buildings ov 1 HAY RANCH ROAD commerceml. g HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsin www.w w ww.ce.wi.gov/s / isconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary October 18, 2004 CUST ID No.220357 ATTN: POWTS Inspector ZONING OFFICE BRADY J UTGARD ST CROIX COUNTY SPIA 110 KELLER AVE N APT 112 1101 CARMICHAEL RD AMERY WI 54001 -1034 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/18/2006 Identification Numbers Transaction ID No. 1057582 SITE• Site ID No. 689113 Troy Kalk Please refer to both identification numbers, 1877 18TH Ave above, in all correspondence with the agency. Town of Pleasant Valley, 54015 St Croix County , S27, T28N, R17W FOR: Description: Replacement mound, 600 GPD Object Type: POWTS Component Manual Regulated Object ID No.: 978970 Maintenance required; Replacement system; 600 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD- 10691 -P (N.01 /01) 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: P General Approval Conditions: o11dil • This system is to be constructed and located in accordance with the enclosed approved plans and with the t design manuals noted above.' • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard the ro, a owner must follow the contingency plan as described in the approved plans. In addition P P rtY g Y P pp P , ��.. the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upo completion of the project. Key Item(s) • The length of the dispersal cell (B) shall be at least 102' long to compensate for an apparent 8.3% deflection in the concave slope. The lateral length and pressure system design is suitable as designed for this system. • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • The revised soil test on which this approval is based shall be recorded with the original soil test. An additional boring was done. • The. designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. l BRADY J UTGARD Page 2 10/18/2004 r Reminder • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be properly abandoned per s. Comm 83.33 Wis. Adm. Code. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to which include local inspectors. All permits of the Department, h ma inspection by authorized representatives p y P P required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 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 r2 4 , Balance Due $ 0.00 - W. Patricia L Shandorf POWTS Plan Reviewer, Integra a ervices WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 I I � MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: TROY & ROXANNE KALK Owner's Name: TROY & RACHEL KALK Owner's Address: 1877 -18TH AVE, HAMMOND, WI 54015 Legal Description: S27 T28 R17 W Township: - U&&RiYER I'eOLSO_n Y CjJ(, -2.V County: ST. CROIX Subdivision Name: CSM2/302 Lot Number: 1 Block Number. N/A Parcel I.D. Number: 028 - 1037 -60 -000 Plan Transaction No.: _ .T:�• t1 Page 1 Index and title fly Page i Page 2 Data entry Page 3 Mound drawings , Page 4 Lateral and dose tank J Page 5 System maintenance specifications Y Page 6 Management and contingency plan -- Page 7 Pump curve and specifications Page 8 PLOT PLAN�'O� Page 9 soil test 0 Designer: BRADY UTGARD License Number: 220357 Date: 08/1 W4 Phone Number: 715- 268 -6995 Signature: Designed rsuant 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 3.11 R. 06/01 Page 1 of 9 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 Table 8344 in sal treatment for fecal 400.00 Estimated Wastewater Flow (gpd) 44-3 n of r - 36 inches. 1.50 Peaking Factor (e.g. 1.5 = 150 %) 600.00 Design Flow (gpd) 1.00 Site Slope ( %) 94.601 Contour Line Elevation (ft) 28.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information r 6.0 Cell Width (ft) 100.00 Dispersal Cell Length Along Contour (ft) = 1.00 Dispersal Cell Design Loading Rate (gpd /ft 2 L ) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) C Center or End Manifold If N above, enter the elevation ft 3.00 Lateral Spacing (ft) 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 9.38 ft /orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back? Y 86.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 8.67 Vertical Lift (ft) 62.81 5x Void Volume (gal) 3.60 Friction Loss (ft) 79.12 Minimum Dose Volume (gal) 15.52 Total Dynamic Head (ft) 41.94 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection Fin. dia.__L options choice in. dia. options choice 0.75 1.25 1.00 1.50 x X 1.25 x X 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 1 800.001 Total Tank Capacity (gal) 1200.00 Se tic Tank Capacity (gal) 35.97 Total Working Liquid Depth (in) WIESER Manufacturer 22.24 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) lZabel I Filter Manufacturer 22.241 Dose Tank Volume (gal /in) IA100 Filter Model Number WIESER Manufacturer Project: TROY & ROXANNE KALK Page 2 of 9 Mound Plan View T :� J 1/� 10 B Observation Pipe 3 _ 1 L L .. • L . • L • L • L r r L L r r •K t }r. •r•l•�•f •r•r•r•r• :, ��, r ti{ 1i • ,•ti•L• A L• • .•.• ... L•L•L L L L L• 5 . . . .r•r•r•r•r•r•r•r r r•r• . . .r•r• r r r•r•r•r . r r•r•r . • L L•L• r•r•r•� r r L•L•L• L•L•L•L•L•L•L•L• L,L,L•L•L•�•S,•L•S,•L•L•L•L L L r�r•r�r.r; r�r�r• r• r• r; r• r •r;r•1'.r.d"r'r.'r'r.'r'r•'r•r: r•r •r; r�r•r "r,•r' W �. B I U . L ' r C, Component Dimensions A 6.00 ft E 8.72 in H A1.00 ft K 7.40 ft "B ft t o -2, F 9.25 in 1 ft L D 8.00 in G 0.50 ft J ft WI 17.82 ft 600-001( ) Dispersal Cell Area 1217.78 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 96.94 (ft) -% _ H I I . . 2 rririrrr.. rrii�ri I F Dispersal Cell 95.67 (ft) Lateral 95.17 (ft)-�* invert Dispersal Cell : 3 Elevation E D -- 4 4 - - - 94.50 (ft) Contour Elevation 1.0 % Site Slope Geotextile Fabric Cover Shading Key �. T Dispersal Cell See lateral details on 10 _ Topsoil Cap a 1.5 ft Page 4 for number, size, Q C . + r•r•r•r•r, © ririr Subsoil Cap w 5L �' Lr fir and spacing of laterals. +� ?:; :r•rf }� { r:'rtir Laterals are eq ually ASTM C33 Sand .5 ft L L:�:: ' :L•L•L •• eg m 0 r'r� Typical Lateral :. ;; :, spaced from the Tilled Layer c �, f� r; f : •f; rs r distribution cell's Aggregate a c r$:r:rtir�rtir:r;f:r•r, 5. • centerline in the �---- A distribution cell (AxB). Project: TROY & ROXANNE KALK Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical � p 5 AL •- Turn -up netball valve or If X- 4IExf2 I r12+1 Laterals & force main of PVC Sch 40 0108noutplug per COMM Table 84.30.6 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.18 ft Lateral Length (P) 49.29 ft Orifices per Lateral 16 Lateral Spacing (S) 3.00 ft Orifice Density 9.38 ft /orifice Lateral Flow Rate 10.49 gpm Manifold Length 3.00 ft System Flow Rate 41.94 gpm Manifold Diameter 1.50 in Total Dynamic Head 15.52 ft Forcemain Velocity 4.28 ft/sec Dose Tank Information Locking cow with �ing label and locking device and sealed watertight Disconnect Electrical as per NEC 300 and --► Comm 16.28 WAC 4 In. min. �— Tank component Is properly vented �— Alternate outlet location Forcernsin diameter WIESER Manufacturer 2 in. Ca aci 800.00 Gallons Volume 22.24 gal /inch A fl Weep hole or anti - Dimension I Gallons B siphon device A 18.41 409.52 C B 2.00 44.48 - t P um�_e ievation (ft) C 3.56 79.12 87.00 D 12.001 266.88 D Total 35.971 800.00 Dos tank elevation (ft 3" Bedding un er tank. 86.00 Alarm Manuaaacturer LEVEL Alarm Model Number DLV Pump Manufacturer GOULDS_ Pump Model Number [EP05 Pump Must Deliver 1 41.94 gpm at 15.52 ft TDH Project: TROY & ROXANNE KALK Page 4 of 9 Mound Svstem Maintenance and Operation Specifications Service Provider's Name UTGARD PLUMBING Phone 715 - 268 -6995 POWTS Regulator's Name ST. CRO ZON ING Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity . 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft' Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank 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 monthl Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other 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)(1), 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 ................ Grade 6-8" Diameter Lawn . . . . . . . Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral — Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: TROY & ROXANNE KALK Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.64, 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 84nches in diameter shall be secured by an effecth a 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, Slats. 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 fitter shall be cleaned as necessary to ensure proper operation. The fitter 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 finer shall be serviced If the alarm is activated continuously. Intermittent filer 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. Puma 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. 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 same 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 S , 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 flaw 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 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 shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contlnsrency 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 clogged 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: TROY & ROXANNE KALK Page 6 of 9 Goulds Submersible Effluent Pump C� } EPO4 EP05 • APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage tb heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle • Farms Motor: Available for automatic and and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. • Water transfer 115 or 230V60 60 Hz, 1550 models include Mechanical • Dewatering RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with to EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi -open design 3 /4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM, standard length, 16/3 SJTO mechanical seal protection. • Total heads: up to 24 feet, with three prong grounding Co Canadian Standards Association • Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for (CSA listed model numbers rotary/ceramic- prong g plug improved end in " F" or "AC ". ry, p g groundin lu p performance. ) BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. to • Capable of running d without damage to s 30 y components. Pump: EP05 a • Solids handling capability: o i 3 /e maximum, a 7 Uj • Capacities: up to 60 GPM. _ i � - • Total heads: up to 31 feet. `—' s 20 • Discharge size: -1'/z" NPT. • Mechanical seal: carbon- } rotary/ceramic-stationary, ° 4 15 --- BUNA-N elastomers. o - - - -- - - - -iEP05r --- • Temperature: 3 10 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. 2 i_... -- Q j - P 4 ' -- - - 5 i - 0 00 10 20 30 40 50 GPM Q Ion N� � � � a s 7 1 v ' 0 � /le 110� V now- c OR CO ���S � U � c � ms 's a`' e o , 0 4 s w,scoysin b epair t me nt 0f Commerce SOIL EVALUATION REPORT Page l of 3 Division of Safety and Buildings • in acco►dace n with Comm 85, Wis. Adm. Coda County Attach completelte . s plan on paper not leas than a 112 x 11 inches in'size. Plan must include, but not limited W. vertical and horimntal referertce point (BM), direcdon and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print ap Informadon. Reviewed by Date Peraonar I Own ation you prwWe may be used For secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 1 I'- u 7 � f 1f - Govt Lot 1l� 4 S a� T N R 1 E( °rN Property Owners Matting Q �sa � Lot # Block # Subd. —7 City State Zip Code Phone Number City ❑ VII a Town Ne e. 4 vuo- ❑ New Construction Use: W Residential I Number of bedrooms -y Code derived design flow rate — t/ �n GPD [� Replacement C1 Public or commercial - Describe: -tom Parent material _ 1 J ( _ Flood Plain elevation if applicable _ ^ ' � ft. General comments and recommendations: T II O Boring ❑ Boring # ® Pit Ground surface elev. �' ' ft. Depth to limiting factor _ in. Sod Annfication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o - {Z o i Si ms k �r �S v ,S '5 Z. tz-Z8 � — �'( k wl-�r- c S Boring Boring # L ® Pit Ground surface elev. J' a _ ft. Depth to limiting facto in. S A Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft= in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 I a 317- , J a MS✓ L rn - - e cs V , 33 -5 5 r IG C3P7 SL mSbk jr Effkmrit #1 = BOD -> 30 220 rng/L and TSS >30 <_ 150 mg/L ' Effluent #2.= BOD 130 mg/L:and TSS <_ 30 mg/L CST Name (Please Print) 51griature CST Number Q 4d sc- �v a -5 Q l Addr 1 Date Evaluation Conducted Telephone Number Z 1 1 C ><. a waf .So-f w 1, 5 4 1OZ 5 - g- OZ( 71S-2&0 Parcel ID # page _ of property Owner r� Q F31 [] Boring � Z_ !— �A �catian Rate Boring # 0 Pit Ground surface elev. gy � d ft Depth to Amiting factor Boundary Roots GPDIff Horizon Depth Dominant Color Redox Description Texture Structure Consistence �' .EfF#1 •Eff#2 Ou. Sz. cost Color Gr. Sz Sh. in. Munsell _ N1 J Z Z3 fo r l l a 37- p C.I P .5 S L �,11sb�c -� i �' . • ❑ Boring ❑ Boring # ft Depth to Ianrting factor — in Sol A ication Rate ❑ Pit ;Ground,surface elev GPDIFP Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Efl#1 'Eff#2 in. Munsell Ou. Sz. cunt Color Gr. Sz Sh. ❑ Boring EJ Boring # El Pit Ground surface elev. ft. Depth to limiting factor v — in. Sol icatron Rate Horizon Depth Dominant Color Redox Description Texture G r. Stru re Consistence Boundary Roots •Eff# 'Etf#2 in. Munsell Ou. Sz Cont Color Ef luertit #1 = BOD > 30 220 mg1L and TSS >30:S 150 mgIL • Fffkient #2 = BOD <_ 30 mgtL and TSS <_ 30 mglL 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. saD.ow (RMMM PAGI✓_�_Ora NAME: LO'l'!l�L.[:GAL. UL• SCR1 P'1' ION:_ __ I /'1__ I /'I,S_ _ l _,,l`!,[Z,;E(ar)W SCALE: 1'� Orn( ELEVATION: 100 • O BM I DESCRIPTION: h a" I i n I Z M912 BM 2 ELEVK ION: 'T 7 Yo BM 2 DESCRIP'T'ION: Qo4 SYSTEM ELEVA'T'ION: SYSTEM '1'YPI;: W1OV r, ��� � t� ' 1 i (a pt J t l g -Z 2 0 \c-. o 0 a U � • � SIGNATURE: D E: wisconewe Depentinent Commerce SOIL EVALUATION REPORT Page l of 3 omsion of safely and Buildings in accordance with Comm 85, Wis. Adm. Count Attach complete, .site plant on paper riot lass than 8 W x 11 itches in slim. Plan must include, ft - fared horixorrtai reference point (BM), direction and Parcel I.D. percents Irr>rr rth attow, and location and d to nearest road. a8 lnfonr►atit ZR* Date ParaorW irrformedon you provide nwY be used for Law. 15.04 (1) (m)). 1 Owner rLrda 1I443L,/4 Sal ra$� N R 1 E (ore Lot Block # strbd. Property ame or CSM# y M( 9 � ��', .�GG CE i,....t> M Z• /3D 2- City `( State Zip Code hone NG City Q Y e Town Nearest (n oIS ) l� ft lM- Use: P Residential I Number of bedrooms — Y Code derived design flow rate !v_ Replaceme Q Public or commercial - Describe• Flood Plain elevation if appl'icat#e General comments and recommendations: S ST G N1 >°il2 C o r y6o f- el e-U �7zf -S " Boring # ® Pit Ground surface elev. _ it. Depth to limiting factor- � Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f(r in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff# `Efi#2 0-1Z o 1-3 /z ~- S k ( g L Z -28 Id f —" Ic vv1-�r c- 3 .50 z pj .s, 1t V o 51- ® Boring # Boring a Pit Ground surface elev. ', ' -- ft. Depth to limiting factor in. Sol Application Rate Horizon Depth, Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDifTr in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 `Eti#2 r t o 3 z 5 "1 a msb k C-S v , 33 ro r 5 L ms • Effluent #1- BOD .> 30 < 220 mg/L and TSS >30:5 150 mWL ` Effluent 42. = BOO < 30.mg/L. and TSS <_ 30 mg1L CST Name (Please Print) a CST Number q 4C, S� a Q l Address D Evalu Cond Telephone Number Z 1 o,� w 5 a � —01 7 /5 7& o 4 w ..w., PW Z o f 3 Parcel 10 # a' Properly Owner ❑ Boring , d ft• Depth to knifing factor i Sol action Rate a Boring # � Pit Ground surface elev. Horizon Depth Dominant Color Redox Description Texture Structure Consister►ce Boundary Roots GPD *E1f#2 Qu. Sz. Cant. Color Gr. Sz Sh. in. Munsadl C 3lZ Z r, Zm Z3 to / l L 39- o CIP -6 SL 3m5 b1C -t i `• � ' � �' in. ❑ Boring # ❑ Boring .Ground, surface elev. R. Depth t limiting factor Sol i icatiaa Rate ❑ Pk G Roots GPDM Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary 'Eff#1 'Eff#2 in. Mansell Qu. Sz. Cont Color Gr. Sz Sh. Boring Depth to limitin factor in. F—I Boring # Ground surface elev. ___� ft• P g — Sol ication Rate ❑ Pit Texture St Consistence Boundary Roots GPDI(P Horizon Depth Dominant Color Redox Description Gr. Sz Sh. `Efr#1 'Efr#2 in. Munsell Qu. Sz Cant Color * Egluernt #1 = BOD > 30 <_ 220 mglL and TSS >30 <_ 150 mgiL ` Elilua:nt #2 = BOD < 30 mg1L and TSS <_ 30 mglL 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. seD.cuo rR.mrom ' T , t PAGE_OF-3 LO I'11-1 — LEGAL 1)ESCRII' "I'IOI !: I �'J__ _.I - -- I - - - - - -- N K -- I " " NAME: r SCALE: " EVATION: /00. - BM I DESCRIPTION: n a tt I i i I Z o - BM ELEVA'I ION:_ BM 2 DESCRIPTION: Qo44,✓Y` SYSTEM ELEVA'1 "10N: -- m o (1- sy5t-e- A a-� \? z o Q { �d a\a e �� k� v v � �E: SIGNATURE; - - - - - -- + fo- B, Parcel ID 0 Property Owrw ❑ BoMO Ciirarta+d Iurfaos —�`i�- �' Sol Raw D Horlrg� 0 Pit ' ft DePtfi BD�Y ROM GPDAf Tlodtee Stucbm Cam Noriaon Depla Oondrant Color Q sr- � Cobr Gr. �. ML _Ip z �• rn _ CS .D 23 I ,„sblc �i bo M. owing ° ' 4 l Sa t Depth b Tirl "fselor _ - p Sod tlon Rate P Bering 9 a ; Grpld.sutau alev. 1'I } T Sonr�mra Consslmca >+��Y� 6POfn' DomrNnt Color Red= Dosaw- •EIlK1 "2 Hoii:an Ckpth 00. St» Cont. Color Csr Sz Sh- 6n. Mlunsel C � , �Y8 v r 3/ 2 � �•' - SL Boring Boring f Ground surface etov. tl. Depth 14 g factor en. Sol iesfiorr Rate O Pit � Gpppp TaIIVe SaucWm Consistenm Boundary ltorinon Dsoat pomiantCobr �x Gr.StSh. �tllf7 'Efdl2 pt, muns" f1Y. St Color _ > 5220 and TSS >30 <150tagIL °WD' S30mg,&ud TMS 30 MWL aerviocs or T Mparmteat of Commerce is ut eVai a"" mtity service pm id,, and emplayer. if yon aced assisw m access T peed material is an Ilteiaate format, please cootacl isle t at 609 "266 - 31St or TTY 609 - 26.9777. seo•wo�a.m�aei .. IT'd eb2 :60 40 02 daS v. r Ulr L. ww•f tu. JU 1'nA 1 Gl0 U Y JGUY a1.rIIValrIA nrIDUAl L// V1 FROM (TUE)RUG 31 2004 9:43/ST. 9:42/No.6802888735 P 1 �(..� 6 3� Sr Marx C OUNTY SEPTIC TANK MAU4TENANCE AG REEMENT AND / OWNERSHIP CTATI PICATIO N FORM 4WnerlBuyer !.� U a / k a e t Mailing Address 11 V N o I DP fVQ - - 8RUR'#e N S4 4a 3 PropOrt9 Addrm l 7 7 1g'�h q i 1 4NMOM'D 0-T S o s- (Verification requited from Plannin, Dcpartz teat for new construesiott) city/s Parcel Ide nificatiott Number 6 d- atr4 LWA Praperty Location /, 'V,, Sac. , 'Y', k W. Town of . Sub4visiou Lot Ct:rd&d SiarvW map # - Volume. Wacriuty Deed # L 3 volume Page # ©SS Spec house 11 yeas [ no Lot Bees idcatifiabic Cr yes O no ooas o ttsa ssmd ARM&KCZ of ymtt septic syat eattid revolt ie pem�,pnt fiulure oo handle amseex. can fists o the of the septic tank ve a thwe years or , if waded by a liceesed pampa. wbat you put tfo the sri� tream t sage in des sect• disposd system master p POty ewaei agrees to sob=k to St. Croix g a certi&ati m f,� signed[ by dw *wow amd a °'o'cY=np and o restricted ar a is is pt lieemmi paw" v dybw that (l) the as -dit wasec.U."daspacal q... aope; opting aoOe4itioa aadlox (Z) after iaapectiop wad pm1ping (if O ry). the txptic tank is less Q= I/3 hn of :fridge. Uwe the =W=fPjbd have toad the above tcquzmm us and agree to taaiaam the set fat* hfte* as set by the Vq mrrmem of CoMn we and the D erA ofNt y a sewato difpossl syslpia with tl a ee>�a:ds stating that your septa sy== bas been mmt&iaed must be � State of Wiia wasin Cetdllesdoa da of am thm year e�ration date. � and rc urged to !fie St Croft CatmtY SOS ONce within 30 SIGNATURE OF APPLICANT DATE O A77_�N the I (one) ontify that all statements on this form am true to the best of my (our) knowledge. I (we) am (are) the owrnet(g) of Ply deaeabed abovo, by vimc of A wramuvy deed terort+ded'in Qeaistcr of Deeds Office. 5 IGNATURE OF APPLICANT DATE Any Wonnation that is riffs- reprecentedMsy result io the smitar7►Pemu being tevokcd by the Zooing Depart�rneat. •••••• • Include with this applit atioa: a stamped watnnty decd from the Ragisw of Dew office a copy of the certified sun, o!' map if reference is made in dre wammy decd Single Family Residential Status: Active, List Price: 240 s y ct e, $ 000 , Style: (SF) Split Entry (Bi- Level) List #: 2254336 Construction Status: Previously Owned Bedrooms: 4 Map Page: 00 MLS Area #: 805 Total Bath: 2 Map Coord: 00 Garage: 2 Lot Size: 16 +1- Year Built: 1976 Acres: 16 LakeMaterfront: Foundation Size: 0 Lake Name: AbvGrd Fin Sq Ft: 1392 County: STCR - St. Croix BelGrd Fin Sq Ft: 816 Tax Year: 2003 HS: Yes Total Fin Sq Ft: 2208 Tax Amt: $ 2,900 Property ID: 028103860000 Tax wlassess: $ 0 List Date: 41512004 Assess Bal: $ 0 Market Time: 95 Assess Pend: No Assume: 1877.18th_Avenue RRT - Rush River Twp WISCO 54015 Directions: 194 to Hammond; South on T to 18th; East to home Legal: Lengthy School Dist #: 9005 - Baldwin - Woodville Common Wall: No Complex /Development/Subdivision: Restrictions /Covenants: Lot Description: Tree Coverage - Medium Association Fees 0 Frequency: N/A Approved Financing: Fee Includes: N/A Public Remarks: Very nice country home with georgous views and tons of wildlife. Baldwin/Woodville schools, Open kitchen, dining room, $ living room. 30 X 45 shed plus attacbedgari&W. Great for animals or toys Room Lev Dim Desc Lev Dim Heat: Baseboard Living Rm Main 13x23 Fuel: Electric Dining Rm Main 12x13 Air Conditioning: None Family Rm Lower 13x23 Water: Well Kitchen Main 13x12 Sewer: Private Bedroom 1 Lower 15x11 Garage Stalls: 2 Bedroom 2 Lower 12x11 Other Parking: Bedroom 3 Lower 12x11 Pool: Bedroom 4 Lower 9x11 Baths: Full: 1 314: 0 112: 0 1/4: 1 Bath Characteristics: Main Floor Full Bath, 112 Basement Dining Room:Separate /Formal Dining Room Family Room:Lower Level Fireplaces:No Fireplace Characteristics: Appliances: Basement:Waikout, Full Exterior:MetaWinyl Fencing: Roof: Asphalt Shingles, Age 8 Years or Less Amenities - Shared: Amenities - Unit: Parking Characteristics: Detached Garage Shared Rooms: Special Search:3 BR on One Level If Under Construction: Proj Comp Date: Lot Price: $ Low Price Rangers High Price Range:$ Cooperating Broker Comp: Buyer Broker Comp:2.4% Variable Rate:No Sub- Agent:2.4% Facilitator Comp:O% Type: Exclusive Right To Sell Listing Agent: ROGER JOHNSON ROGER JOHNSON Listing Office: REMAX TODAY Office Phone: 715- 246 -7125 Appt Phone: 715 -246 -7125 Prepared by:SEC_SEC Information Deemed Reliable But Not © 2001 -2004 Regional MLS of Minn., Inc. All Guaranteed Rights Reserved . � & �9 g � % 4 -0 %� � � Y d) z � Parcel # : O28 -1 037 -60-000 10/25/2004 08:35 AM PAGE 1 OF 1 Alt. Parcel #: 27.28.17.228C 028 - TOWN OF RUSH RIVER Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * = Current Owner * KALK, ROXANNE M ROXANNE M KALK 1877 18TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1877 18TH AVE SC 0231 BALDWIN- WOODVILLE AREA SP 1700 W ITC Legal Description: Acres: 17.006 Plat: N/A -NOT AVAILABLE SEC 27 T28N R17W PT SE NE BEING LOT 1 Block/Condo Bldg: CSM 2/302 1.5AC & INC COM E 1/4 COR;TH S 89'W 740.09FT TO POB; TH CONT S 89'W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 571.69FT;TH N 00'W 1294.34FT;TH N 89'E 27- 28N -17W SE NE 573.74 FT; TH S 00' E 1292.67FT TO POB 17.006AC Notes: Parcel History: Date Doc # Vol /Page Type 04/02/2002 675119 1865/112 QC 03/31/1999 600384 1415/055 WD 02/18/1999 598055 1404/447 AFF 07/23/1997 873/565 (�C mo ... 2004 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 09/03/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.500 10,500 107,600 118,100 NO AGRICULTURAL G4 15.506 1,900 0 1,900 NO Totals for 2004: General Property 17.006 12,400 107,600 120,000 Woodland 0.000 0 0 All 17.006 12,400 107,600 120,000 Totals for 2003: General Property 17.006 12,400 107,600 120,000 Woodland 0.000 0 0 Total 17.006 12,400 107,600 120,000 Lottery Credit Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 YOL 14 1.5PacE055 �- 6OIO384 State Bar of Wisconsin form l - 1982 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO. RECEIVED FOR RECORD THIS DEED, made between John .M. _Monicken and. Shelley 03 - 31 - 1999 11:00 AM Monicken, husband. and.wife YARRANTY DEED EXEMPT V CERT COPY FEE: COPY FEE: TRANSFER FEE: 440.70 Grantor. RECORDING FEE: 12.00 and Roxanne. M...Kalk,..amarried person, and..Barbara A. PAGES 2 Cil.ek, a . single. . pe. rson,.. as _ joint ,.tenants,..with..right o.f..survivarship .. .. ..... . .... ..... .. ... ..... ... ... ...... • - - - - THIS SPACE RESERVED FOR RECORDING DATA ... ..... ....... ..... ... .... .... ... .... ............ . . ..... .... ... .. Grantee, NAME AND RETURN ADDRESS; WITNESSETH, That the said Grantor, for a valuable consideration River Valley Abstract & Title, Inc. conveys to Grantee die following described real estate in St. Croix P.O. Box 148 County, State of Wisconsin: Hudson, W11 54OI6 028- 1037 -40; 028- 1037 -5 PARCEL IDENTIFICATION NUMBER Legal description attached as Exhibit "A" This i9.... ... .. homestead property. Together with - all - and - singular - the thereunto belonging: And . Grantor, .. ... .. warrants that the tide is good, indefeasible in fee simple and free and clear of encumbrances' except easements, roadways and restrictions of record and will warrant and defend the same. Dated this .... ... _ ....30.th ........ ... .. ...... day of .......March.... ........ ... ... 19 99. . (SEAL) u - (SEAL) « Monicken --------------- - --- ------ - ... --- — ------- -- -- ----- --- ----- -•- --- (SEAL) (SEAL) ........ — ........ .. ............. *.. &hel...y -Mo jcken......... - -- - V AUTHENTICATION ACKNOWLEDGIVIEN S' G' U '• t7 ' Signature(s) ... ........ STATE OF WISCONSIN c r J c .... ...... .. . .. ,•�" St...C.ro.ix .. County.. L J �C authenticated this .... day of 19 Personally came before me this,,' 30ti �. Q y of March.../ 'Eltartl 3 'amed _4 John, M, ..Monicken, and $h'L�i ., cken TITLE: MEMBER STATE BAR OF WISCONSIN (If not . . .... ... ....... ................... . .. _ . . authorized by Section 706.06, Wisconsin Statutes) to me known to be the person .s......... .. who executed the foreg tin instrument and Towled ttte. THIS INSTRUMENT WAS DRAFTED BY Michael H. Forecki, Attorney « Kath.Xe.en ft,_Videen Eau Claire, Wisconsin Notary Public Polk. County, Wis. (Signatures may be authenticated or acknowledged. Both are not necessary) My commission is permanent. (If not, state expiration date: ' Nantca of persons sianins in any capacity should be typed or printed below their signatures. . June 24 _ ... _ . - - _ 4%2001) e j %j i io ol rz i