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Parcel #: 030 - 1060 -20 -000 03/17/2005 01:05 PM
PAGE 1 OF 1
Alt. Parcel M 23.30.19.208 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): " = Current Owner
RYAN J POLCIN " POLCIN, RYAN J
722 143RD AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.741 Plat: 0959 -CSM 13/3760
SEC 23 T30N R19W PT GL 8 BEING LOT 7 CSM Block/Condo Bldg: LOT 7
13/3760
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
23- 30N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
11/05/1999 613390 1468/579 WD
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
5232 315,900
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.741 157,500 153,300 310,800 NO
Totals for 2004:
General Property 0.741 157,500 153,300 310,800
Woodland 0.000 0 0
Totals for 2003:
General Property 0.741 102,700 124,200 226,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M
Specials:
User Special Code Category Amount
040 -OTHER ASSM'T SPECIAL ASSESSMENT 543.47
Special Assessments Special Charges Delinquent Charges
Total 543.47 0.00 0.00
Parcel #: 030-1060-40-000 03/17/2005 01:05 PM PAGE 1 OF 1
Alt. Parcel M 23.30.19.210 030 - TOWN OF SAINT JOSEPH
Current 1 X', ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 3
Tax Address: Owner(s): * = Current Owner
*
STEPHEN K VAN SLYKE VAN SLYKE, STEPHEN K
2553 MALLARD DR
ST PAUL MN 55125 -3826
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.500 Plat: 2512 - STEVEN$ & SHIRLEY'S NKA PT CSM
SEC 23 T30N R19W LOT 4 OF STEVENS & Block/Condo Bldg: LOT 4
SHIRLEY'S PLAT IN GL 8 NKA PT OF CSM
13/3760 Tract(s): (Sec- Twn -Rng 401/4 1601/4)
23- 30N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 01/19/2000
Description Class Acres Land Improve Total State Reason
Totals for 2004:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2003:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel #: 030 - 1060 -30 -000 03/17/2005 01:05 PM
PAGE 1 OF 1
Alt. Parcel M 23.30.19.209 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 3
Tax Address: Owner(s): * = Current Owner
*
STEPHEN K VAN SLYKE VAN SLYKE, STEPHEN K
2553 MALLARD DR
ST PAUL MN 55125 -3826
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.440 Plat: 2511 - STEVENS & SHIRLEY'S NKA CSM 13
SEC 23 T30N R1 9W LOT 3 OF STEVENS & Block/Condo Bldg: LOT 3
SHIRLEY'S PLAT IN GL 8 NKA PT OF CSM
1313760 Tract(s): (Sec- Twn -Rng 401/4 1601/4)
23- 30N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 01/19/2000
Description Class Acres Land Improve Total State Reason
Totals for 2004:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2003:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
FED 1 f a.% MS
SL Gtr [.X cou'�JTY
SlIRwcy
CERTIFIED SURVEY�1iI'""
LOCATED IN GOVERNMENT LOT 8 OF SECTION 23, T30N, R 19W
TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN; BEING
LOTS 2, 3 AND 4 OF STEVENS & SHIRLEY'S PLAT.
NOTE: This Certified Survey Map was drafted to combine OWNER
the above said existing Lots 2, 3 and 4 into one Lot STEVE VAN SLYKE
and is exempt from the St. Croix County Subdivision Ordinance. 1812 OAKDALE AVE. APT. 305
WEST ST. PAUL, MN 55118
W1 /4 CORNER
SECTION 23 LOT 1 O C•S•M, IN
-- --------------------
V. -3, - PG. 644
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ALUMINUM COUNTY SECTION CORNER 0 '
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0 1" X 24" IRON PIPE WEIGHING N
1.13 LBS. PER LINEAR FOOT SET z
SW CORNER ' " "' ' 108' ROADWAY SETBACK FROM CENTERLINE _
SECTION 23 . SOIL BORINGS ~
Vol.13 Paae 3760
Parcel #: 030 - 1060 -20 -000 02124/2005 08 :15 AM
PAGE 1 OF 1
Alt. Parcel #: 23.30.19.208 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): " = Current Owner
RYAN J POLCIN ' POLCIN, RYAN J
722 143RD AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.741 Plat: 0959 -CSM 13/3760
SEC 23 T30N R19W PT GL 8 BEING LOT 7 CSM Block/Condo Bldg: LOT 7
13/3760
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
23- 30N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
11/05/1999 613390 1468/579 WD
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
5232 315,900
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.741 157,500 153,300 310,800 NO
Totals for 2004:
General Property 0.741 157,500 153,300 310,800
Woodland 0.000 0 0
Totals for 2003:
General Property 0.741 102,700 124,200 226,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M
Specials:
User Special Code Category Amount
040 -OTHER ASSM'T SPECIAL ASSESSMENT 543.47
Special Assessments Special Charges Delinquent Charges
Total 543.47 0.00 0.00
i'
Jon Sonnetag
Subject: Ryan Poscin
Entry Type: Phone call
Start: Mon 07/24/2000 12:01 PM
End: Mon 07/24/2000 12:01 PM
Duration: 0 hours
Categories: Steve
Steve - Th
is entleman spoke with Judy his morning nd said that he needs his silt fence inspected. His address is 722
143rd Street Somerset. Do we do these types of inspections ?? His excavators will be there August 1 st to begin
construction. Ryan's number is 381 -3265.
b (_ S.7� - SHIT �Gr,C� ��eo«cC JYJ °e UC'i'�
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l e 1`e 6 %nS ,PtC'(-;0.. 4/41S 60"alu -c'#d ih a�car�a.,,ce
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y:
1._ Safety�end Buildings Division Count
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 363913
Permit Holder's Name: ❑ City ❑ Village ❑ Tbwn of: State Plan ID No.:
Polcin, Ryan St. Joseph Township
CST BM Elev.-.- Insp. BM Elev.: BM Description: Parcel Tax No.:
9 a7•9 CST lam -- 2 t u 030- 1060 -20 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION K HI FS ELEV.
Septic Benchmark $1 & 1021
Dosing Alt. BM
Aeration Bldg. Sewer C1 .qr'
Holdin St /Ht inlet ,0� 9-t,48
T ANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. vent to ROAD Dt Inlet ---.
Air Intake
Septic > �� 31 3 NA Dt Bottom �----
Dosing NA Header / Man.
Aeration A Dist. Pipe 9.35 a s
3•'f5
Holdin Bot. System
eo.t,S 2. I
PUMP/ SIPHON INFORMATION Final Grade ,, b
Ma acturer Demand St cover ( �73
Model Numbe GPM
TDH Lift rlctio ! stem TDH Ft
Loss ead
F -main Length Dia. To well
SOIL ABS PTION SYSTEM
BLED TRENCH Width Length ,s 10.Of renches IT No. Of Pits Inside Dia. Liquid Depth
IM 3 • Z.9 DIMENSI
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING 1 nu ` rt rer `
INFORMATION TypeO `�f�r qct t .� �r �� T CH A M BER o e Num er:
System: 1
DISTRIBUTION SYSTEM
Header 1 ni old 9 - Distribution Pipe(s) a Size cing Vent To Air Intake
Length'' i Dia. Length Dia. Spacing > BS
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over 7Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: 11 / 3o /(T9Inspection #2:
Location: 722 143rd Avenue, Somerset, W. 54025 (SE 114 SW 1/4 23 T30N R19W) - 233019208 -Lot 7
1.) Alt BM Description=
2.) Bldg sewer length= 31 `
- amount of cover=
0 Io2.?`t
Plan revision required? Il gee ❑ No
Use other side for additional ir�Formaterr1 1 l o T5T
-q
SBD -6710 R.3/97 --�J Dat nspector's 5i n ure No.
s —is > 3` " b.,Qer.,,� r �►s� -- �-
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
_
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Safety and Buildings Division
11 N K;consin SANITARY PER APPLI ' N 201 W. Washington Avenue
"�! . P O Box 7302
Department of Commerce In accord with Corry. 83.05, Wis. Ad. Code ' ,) Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the syste j[4140not less . :County Cr han 8 vi x 11 inches in size. ` o
• See reverse side for instructions for completing this I icatiAw N 7 ZQQ� tate Sanitary Permit Number
t- ST CF"X _? 3 `?(3
Personal information you provide may be used for secondary purposes'N, '; CDOM
(Privacy Law, s. 15.04 (1) (m)]. --
T 2Z Z i y3' � Ve . -' LI�QQ�►�' Check if revision to previous application
t � ,, State Plan I.D. Number
1. APPLICATION INF RMATION -PLEASE PRINT AL
Property Owner Name to a yfocation
_'W 114, S A3 T 3 0 r N, R 9 E (o W
Property Ow er's Mailing Address Lot Number (3 ) Number
33 = iYA
City, State Zip Code Phone Number Sub Ivis on Name or CSM Number CS/11, 1 3 3 0
1 ( 7 , / , T ) C - LAST
II. T YPE F BUILDING: (check one) C] State Owned 't Neare Road
❑ village u ^
Public 1 or 2 Family Dwelling - No. of bedrooms _ Town OF 7.�iQrJ
III. BUILDING USE (If building type is public, check all that apply) / Parcel Tax Number(s)
,fh e , z3.3 l4- Zcam"
1 ❑ Apartment/ Condo P 1/40 60 0
2 ❑ Assembly Hall 6 ❑ Medical Facility / Nursing Home 10 ❑ Outdoor kecreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
S ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV TYPE OF PERMIT (Check only one box on line A. Check box online B, if applicable)
A) 1. W New 2 ❑ Replacement 3_ ❑ Replacement of 4, ❑ Reconnection of 5 ❑ Repair of an
------ System System -_ Tank Only System ___ _ Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 []Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 CR Seepage Trench 22 ❑ In- Ground Pressure r r 42 ❑ Pit Privy
13 ❑ Seepage Pit Z C 1 , 3 k r Z s 43 ❑ Vault Privy
14 ❑ System -In -Fill v �( r S
VI. ABSORPTION SYSTEM INFORMATION:
sori�,f y,
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) P oposed (sq. ft.) als/clay /sq. ft.) (Min. /inch) Elevation
8 ,/ FX ..feet Feet TANK Capacit VII. INFORMATION in g Total # of Manufacturer's Name Prefab. Con Fiber- Plastic Exper.
New Existin Gallons Concrete strutted Steel
Gall Tanks glass App.
Tanks Tanks
ptic Tank r He4 wq Shk f ®�" ❑ ❑ ❑ ❑ ❑
Li r ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plu is Signature: (No St ps M PRSW No.: Business Phone Number:
G 7 = ��6
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate I ssued issuing Agent Signature (No Stamps)
�A pproved []Owner Given Initial Surcharge Fee)
L-11. ` Adverse Determination � 2 -� 0 d 6 Z dV
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: s per,- r tDl va ex c
-� L � � rte- e� r' 9 � � +Yam eX� St�iw�y Gr✓[1z'erj:H c a,rCl
eros — Girt_ ,-o( n� ¢.t SG. rGS r►ti ti�� Ss :K Sl /��p r-
sa¢tvt• lsvve- &kk.3f 6.e ,4tec-( Iv. ? sP loadl� Sa�'ls.
SBD -6398 (R. 4199) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
r; - tMSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed ref ie�e4irlotii?n date and at a time of renewal any new criteria in the
Wisconsin Administrative Code wilhbeapplicab(� 7
3. All revisions to this permit must be ap,�'r ed by vheppl issuint authority.
4. Changes in ownership or plumber requi ar.X- Permit Transfer / Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintaineZ. septic tank(s) must be pumped by a1icerised pumper whenever
necessary, usually, every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and- Bui14ings.-Div+4on, 608 - 266 51.'• --- - - - - -� - - - - -•
To be complete and accurate thissanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
111. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc,),
address and phone number. Plumber must sign application form.
IX- County/ Department Use Only.
X. County / Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The-plans must
intrude the following: A) plot plan, drawn to scale or with complete'dirnensions, lo:Stion of holding tankj's}; septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; frictionioss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by thew 7SCj) soil test'data on x form; and - F) all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges {fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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1028
REPORT Page 1 of 1_
SOIL EVALUA
Tom Schmitt
Wis. Adm. Code
Wisconsin Department of Commerce County St. Croix
and Buildings in accordance with Comm 85,
Division of Safety parcel I.D. & 40
not st road. Less than 8' /, x 11 inches i g } on and 030 - 1060- 20,-30 Date
Attach complete site plan on paper
n orth arrow, and location and distance to nearest Reviewed By
include, but not limited to: vertical and horizontal reference Po
percent slope, scale or dimensions, �n78tion.
Please print all i
`log secondary purposes (Privacy Law, 5. 15.04 (1) (m))•
W
he use T 30 N R 19
p rovide may ProPeftY Location SW 114 S
23
Personal information you p 8 SE 114
Govt. Lot Subd. Name or CSM# s plat
property Owner Lot # Block # Stevens & Shirley'
Polcin, Ryan J. 2,; & 4 NA Nearest Road
Owner's Mailing Address �F city _j Village ✓j Town 143Rd Street
Property Y
1336 Carriage Dr. Code Phoae Number St.Joseph
State Zip 450 GPD
,.r1'g
city \,540 Code derived design flow rate
Hudson ber of hedroo's _ -3�
Use: Reslde0t�� l { meFr { NA
l6 New Constr
cia1= Describe: if applicable
uction J public or coirrmer Flood plain elevation,
j Replacement stem elevation. The first 5 horizons of
ower the Parent material Outwash Plain
General comments rofile damestThompson do h s epori
and recommendations: The description were done by >142 in Soil Application Rate
.
factor - -- — ' GPDIit�
ft. Depth to limiting Boundary Roots *Eff#1
Ground Surface elev.
yj Boring 100 Structure Consi
� stence
Boring # Pit �
Redox Description Texture m 0.5 0.6
Gr. Sz. Sh. � 2f
Depth Dominant Color Qu Sz Cont. Color 2fcr mvfr 0.6
in. none
Horizon �unsett sl 0.5
0 -5 10yr3 /2 sl 2msbk mfi gs 2fm,1c if 'm 0.5
2 5 -17 none sl if 0.6
1 none cw
10yr4 2msbk dsh 0 7 0
(,3 17 -27 10yr413 Is dl gw 0sg - - - - -- 0.7 0.8
r4/4 none dl
4 27 -41 7.5y Osg - - - - -- 0.7 1.2
10yr514
none s & gr. Osg dl -__
5 41 -121 s & gr
10yr5/4 none
102 -1 f !/ < 30 mglL
6
Dc ,� � � � � , < 30 mglt- and 7SS _
��,n * Effluent #2 = BOD _ CST Number
x` �I 1 1/P�f I ' < 150 mg /L 227429
fa+ > 30 < 220 mg /Land TSS >30 _
�� W * Effluent #1 = BODS Signature: Telephone Number
CST Name (Please Print) Date Evaluation Conducted 715 -549 -6651
Thomas J. Schmitt 11/30100
Address Tom Schmitt WI 54025
586 Valle View Trail, Somerset,
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`ow �8`t SS
$ ti -t 9 �S /oboe �
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•, Elegy- = 9 r. 9/.'
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wisconsig Department ofCommerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code
A.C.E. Soil &Site Evaluations
Attach complete site plan on paper not less thain 8% x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, a � on and distance to nearest road. Parcel I.D.#
030-1060-20,-30, & 40
APPLICANT INFORMATION k%ase print a , orm,=n. d B Date
Personal information you provide may b+ir usW for secondary purposes t taw, s. 15.04 (1) (m)).
F1336 ner / i . - r1 Property Location
olcin t Govt Lot 8 SE 1/4 SW 1/4 S 23 T 30 N,R 19 W
ners MaiNng Ad Lot # Block # Subd. Name or CSM#
ria e Dr. 2, 3, &4 NA Stevens & Shirley's Plat
'State Zip (fig "honeNumber [] City [� Village Town Nearest Road IN
WI 0M6ur
St.Joseph 143Rd Street
New Construction Use: =1 /.N f bedrooms 3 ❑Addition to existing building
Replacement [ riescribe
Code Derived daily flow 450 gpd Recommended design ding rate •7 bed, gpolitz .8 trench, gpd
Absorption area .8 trench, gpd/ft°
orb required 643 bed, It' 562 trench, ttz Maximum design loading rate •7 bed, gpolMP
Recommended infiltration surface elevation(s) 94.25'. ft (as referred to site plan benchmark)
Additional design / site considerations Install trenches using high capacity infiltrators. Dosing may be required to reach system location.
Parent material Glacial outwash Flood plain elevation, if applicable NA ft
S- for system Conventional Mound in- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system I ® S U N S U I ❑ S U I ® S❑ U ❑ S® U ❑ S N U
SOIL DESCRIPTION REPORT
Boring# Horizon
Depth Dominant Color Mottles Structure Consistence Bound Roots GPDff
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Bed ; Trench
6 1 0 -5 • 10yr3 /2 None A 2fcr mvfr cs 2tm 0.5 0.6
2 5-17 10yr4/2 None A 2msbk mfi gs 2frn,lc 0.5 i 0.6 ✓
Ground 3 17 -27 10yr4/3 None st 2msbk dsh cw lf,m 0.5 0.6 ✓
elev
100.62 ft 4 27 -41. 7.5yr4/4 None is Osg dl gw 1 f 0.7 0.8
Depth to 5 41 -121 10yr5/4 None s & gr. Osg di - - 0.7 0.8
limiting
factor �' 2- s
>121' �L �
r2.
Remarks:
7 1 0 - 10yr3 /2 None sl 2fcr mvfr cs 2fm,lc 70.75� 0.6
2 5 -14. 1Oyr4 /2 None sl 2msbk dsh cs 2fin,lc 0.6
Ground 3 14 -37• 7.5yr4/6 None gr. A 2msbk dh aw lfm,c .5 0.6
eiev- - -- — - - -- -- - - - - -- — -- _ - -- - -- -- - - - - -- - - -- - - - - -- — - -- -- --= - - - - --
100.17 ft 4 37 -51. 7.5yr4/6 None s & gr. 0 sg dl cs 1 f 0.7 0.8
Depth to 5 51 -110 10yr6 /6 None s & gr. 0 sg dl - - 0.7 0.8
limiting
factor - L
>110" �l. ° •,
�6
Remarks:
CST Name (Please Print) Signat Telephone No.
James K. Thompson 715- 248 -7767
Address A.C.E. Soil & Site Evaluations Date CST Number Ref #
340 Paulson Lake Lane, Osceola, Wl 54020 4 /5/00 3602 1192
PROPERTY OWNER: Ryan Polcin SOIL DESCRIPTION REPORT „s2 Page 2 of 3
PARCEL l.D # o3o- to6a2o. -30. & ao A.C.E. Soil & SiEvaluations
te Eva
Horizon Depth Dominant Color Moores Texture Structure Consistence Boundary Roots GPD/fr�
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
g 1 0 -5 10yr3/2 None sl Her mvfr cs 2fm,lc 0.5 0.6,/
2 5 -15 • 10yr4/2 None sl 2msbk dsh cs 2fm,lc 0.5 i 0.6
Ground
elev 3 15 -36 7.5yr4/6 None gr. sl 2msbk dh aw lf,m 0.5 0.6
98.67'ft 4 36-62 7.5yr4/6 None s & gr. 0 sg dl cs if 0.7 0.8
Depth to 5 62 -116 • 10yr6 /6 None s & gr. 0 sg dl - - 0.7 0.8/
limiting
factor l
>116'
Remarks:
Ground
elev
Depth to
limiting
Factor
Remarks: _
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
U - 3W 3
Oua n2.r - : .LoGa -� u»
,L ori s 2, 3, *,(/ 61ec/ews d, :5 'rze
P (�•�, Located %.� Gov• God e', .�� l obsa/'Ua vr, P:�
5 , tC- -73,7 /� /90.,T -o{
,c
g� v
Jac 0 h
i n Iq
Qccct �-rtt. EIeW= 9F26' �} ♦ 4,%We 7 /24/f9
w
83 Z
W
C Qn
Z �
ri
B1 . —
�' ■ Pine. Asswvtd elegy: = 1000'
t, �� • 1� SS �0.7C C.
c
h
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!1z "6Lue ateiO pine,
P79/'
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0
.25 �+
SOIL AND SITE EVALUATION 1192 Page of 3
PROPERTY OWNER: Ryan J. Polcin
PARCEL I.D.# 030-1060-20,-30, & -40 A.C.E. Soil & Site Evaluations
REPORT MEMO
This report is an addendum to an earlier report dated 7126/99, ref# 1079. The proposed house location sits over
borings 1, 3, & 5 of that report. Borings 2 & 4 are sufficiently setback and are to be used in conjunction with borings 6,
7, & 8 of this report to define the primary and replacement system locations.
i
I
I
whin Department of commerce SOIL AND SITE EVALUATION Page l of 3
Division of Satiety and Buildings in accord with Comm 83.05, W is. Adm. Cod p `
Soil & Site Evaluations
Attach complete site plan on paper not less then 8% x 11 in q size. Plan must tParcel
include, but not limited to: vertical and horizontal ref and St. Croix
percent slope, scale or dimensions, north arrow, ylc nearest road. APPLICANT INFOR MATION - PI rriiirt I iflik ath,. 0 -1060 20, -30, & to Personal information
you provide may be used soAdary pu Law, s. 15• (t) (m)). Date
• �Z` c�1aDZ�
Property Owner r , �. __ rty Location
Steven K. Van Sl ke fx* oxt• of 8 SE 1/4 SW 1/4 S 23 T 30 N,R 19 W
Property Owner's Mailing Address ST CROix Block # Subd. Name or CSM#
607 N. White Bear Ave. , Nn' r 2 , &4 NA Stevens & Shirle s Plat
City State Zip Code Phon um i� City ❑ Village ❑Town Nearest Road
Saint Paul N4N 55101, — St.Joseph 143Rd Street
❑ New Construction Use: ❑ Residentiai7Num edrooms 4 []Addition to existing building
❑ Replacement ❑ Public or commercial describe
Code Derived daily flow 600 gpd Recommended design loading rate •7 bed, gpd/ft .8 trench, gpdff
Absorption area required 857 bed, fF 750 trench, ft Maximum design loading rate .7 bed, gpd/ff .8 trench, gl
Recommended infiltration surface elevation(s) 92.60 It (as referred to site plan benchmark)
Additional design / site consideration tinstan trenches u s i ng h ig h c apacity infiltrators. Dosing may be required to reach system location.
Parent material Outwash s & gr. Flood plain elevation, If a NA ft
S= Sultable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ®S ❑ u ® S❑ u N S D U ® S❑ U ❑ S ®U D S® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft'
Boring#
Horizon in. Munsell Qu. Sz. Cont. Color Texfure Gr. Sz. Sh. Consisten Boundary Roots Bed Trench
1 1 0 -9 10yr3/2 None sl 2fcr mvfr cs 2fm 0.5 i 0.6
2 9 -16 10yr5 /3 None sil 2thinpl dsh cs 2fin,lc 0.5 0.6
Ground 3 16 -25 10yr4/3 None sil 2msbk dh gs 1f,m,c 0.5 0.6
elev
98.60' ft 4 25 -57 10yr4 /4 None sil 2msbk dh ai 1 f,m 0.5 0.6
Depth to 5 57 -109 10yr6 /4 None s & gr. 0 sg dl - If 0.7 0.8
limiting
factor 42.40
>109'
�Z lb8
Remarks:
2 1 0 -6 10yr3 /2 None sl 2fcr 7dsh 7CS 2fin,lc 0.5 0.6
2 6 -17 10yr4 /3 None sl 2msbk 2fmjc 0. 5 0.6
Ground 3 17 -28 7.Syr4/6 None gr. sl 2msbk dh 1 f,m,c 0.5 0.6
elev
98.64' ft 4 28 -63 7.5yr4/6 None s & gr. 0 sg dl cs 1 f>m 0.7 0.8
Depth to 5 63 -112 10yr6 /6 None s & gr. 0 sg dl - if 0.7 0.8
limiting
factor Z•'F8 l08
>112'
Remarks:
CST Name (Please Print) Signature: Telephone No.
James K Thompson 715-248-7767
Address A.C.E. Sod & Site Evaluations Date CST Number Ref #
340 Paulson Lake Lane, Osceola, Wl 54020 7/26/99 3602 1079
j PROPERTY OWNER Steven K. Van Slyke SOIL DESCRIPTION REPORT tope page 2 _ of 3
' PARCEL LD .# 03 0-1060-20.-30. & -40 A.C.E. Soil & Site Evaluations
Horizon
Depth Dominant Color Mottles Structure GPDM
- - - -T - - - --
in. Munsell Qu. Sz. Cont. Col Texture sistence Boundary Roots or Gr. Sz. Sh. Bed Trench
ill 0,6 1 0 -7 10 r3/2 None sl 2fcr mvfr cs 2fm,lc 0.5
3 y '
-------- - - - - -- ------------ - - - - -- - - - - - -- ----------------
2 7 -25 1Oyr4/3 No ne sit 2 dsh cs 2f,m,c 0.5 0.6
Ground -- - - - - -- -- - -- - - - - --
elev 3 25 -36 7.5yr4/6 None gr. sl 2msbk dh - aw 1 f,m,c 0.5 0.6
97.41' ft 4 36 -58 7.5yr4/6 None s & gr. 0 sg dl cs I f rn 0.7 0.8
Depth to - - _
5 58-102 1 Oy /6 None s & gr. 0 sg dl 0 0.8
limiting
- -_ - - --
factor
>10 2'
Remarks:
4 1 0 -8 I O yr3 /2 _ None _ sl 2fcr mv fr - cs 2f rn - 0.5 0.6
2 - 8 -19 1Oyr4 /3 None sl 2msbk dsh ^ cs 2fm,lc 0.5 r 0.6
Ground -� -- -- - -- -- - - -- -- -- -___. _-
elev 3 19 -24 7.5y r4/6 None gr, sl 2msbk dh aw If,m 0.5 0.6
96.68' ft 4 24 -76 7.5yr4/6 No ne s & gr. 0 Sg dl cs 1 f rn 0.7 0.8
- -- --- --- - -- - - - -- - -- - - - --
Depth to
5 76 -9 7 1Oyr6/6 None s & g r. 0 sg dl - - 0.7 j 0.8
limiting
factor
>9 7" q 1 - - - - -- -- - - - --
_._ 2 u
sip
Remarks:
5 1 0 -7 10yr3/2 - None sl 2fcr mvfr cs 2fin,ic 0.5 0.6
2 7 -17 1Oyr4/3 None sit 2msbk dsh cs 2f,m,c 0.5 0.6
Ground - - -- - - - - -- - - - - - -- - - - - -- - -- --
elev 3 17 -28 10yr4 /6 None sl 2msbk dh aw I f,m,c 0.5 0.6
97.02' ft 4 28 - 4 1 7.5yr4/ None gr. si 2msbk dh cs 1 fm 0.5 0.6
Depth to 5 41 -69 7.5yr4/6 None s & gr. 0 sg di gs - 0.7 0.8
limiting _ __- - -- - -- -- -- - --
facto 6 69 -98 IOyr6 /6 None s & gr. 0 sg dl - - 0.7 0.8
Remarks:
Ground _
elev
Depth to -- - -- - - - -- -- - - -- - --
limiting
factor
Remarks!
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer $1,4n/ / c/n/
Mailing Address
Property Address Al a-.
(Verification required from Planning Department for new construction)
City/State , S2/V,67-22 S` -T L/ �` Parcel Identification Number 030 - W40 -1,0 -yl
LEGAL DESCRIPTION
Property Location 5E %, ,54 y, Sec, A.3 T .30 N -R�_W, Town of
Subdivision -- C :Z 5 1EUe d l s .c e 14 s /JL. T Lot #,g-3 .
Certified Survey Map # Volume - -- 13. . Page # 37 G o
Warranty Deed # 6, 1 33 9 6 Volume Page # 5 7 9
Spec house 0 yes 0 no Lot lines idantifiable (' yes ❑. no
.Imlmoperaseaadmu oeofy +omupticsysbemconldnemkiaits tohaadleWas$=Preper
f waists of P mrpiag oat the Septic tank every *my= yeas or sooner; if needed by a What Yon put mto 1h SYSIAM
can affeahe . mc6m of the septic tank a treatment stage m tha waft &Rwalsysbem
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lu POPCOY owner app to submit to St Croix Zoning Department a certification fwA signed by the owneec Ad by a
is P - ]�ymmP r�odpb�ora ixmdpim�parvcci4 *6d(1)6con=site�rftwater system
in PwPec oP=R&g condition and/or (2) after won and pumpiag.(if necessary). Ere septic-tankis less dean u3 . 6611, of hdoe.
ifane, tare =designed have read the above requits and agree to maintain the private sewage disposal system with ' 91c
s
dards
d fords berein, act by the Department of Commerce and the Department of Natural Resources-, State of Wisconsin.. Ceti �cx�
d* You septic system leas been mairW=d must be completed and returned to the St - Cmix County Zoning Office 30
d y= year lion date.
SI O APPLi DATE '
t
OWNER CERTII�CAZTON
I (we) oe that all on this form are tare to the best of my (our) knowledge. I (we) am (are) the o s) of
$re prope above. of a warranty deed recorded in Register of Deeds Office.
APP ' CANT DATE
ass «ss � information that is misrepresented may result in the uattary- permit being revoked by the Zoning Department s «ss«
" Include with this application: a Stamped warranty deed from the Register of Deeds office
a copy of the cutifrod survey map if reference is made in the warranty deed
rc,
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CERTIFIED SURVEY MAP
LOCATED IN GOVERNMENT LOT 8 OF SECTION 23, T30N, R 19W
TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN; BEING
LOTS 2, 3 AND 4 OF STEVENS & SHIRLEV S PLAT.
NOTE: This Certified Survey Map was drafted to combine OWNER
the above said existing Lots 2, 3 and 4 into one Lot STEVE VAN SLYKE
1812 OAKDALE AVE. APT. 305
and is exempt from the St. Croix County Subdivision Ordinance. WEST ST. PAUL, MN 55118
W1 /4 CORNER
SECTION 23 LOT 1 ❑F C,S,M. IN
-- -------------------
V__3,__ PG,
__644
= i
1101 0 S 89'36'17" W 142,90'
a
52.88' 0
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ALUMINUM COUNTY SECTION CORNER
0
MONUMENT FOUND z
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1" IRON PIPE FOUND
1" X 24" IRON PIPE WEIGHING v
1.13 LBS. PER LINEAR FOOT SET z
• • • • • • • 108' ROADWAY SETBACK FROM CENTERLINE rn
SW CORNER F
SECTION 23 . SOIL BORINGS
Vol. 13 Page 3760
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 informa-
tion 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 Fronion Control Plan 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 application. (' �
Site Diagram Scale: 1 inch - feet
EROSION
CONTROL PLAN
LEGEND
PROPERTY
- - LINE
EXISTING
C M ' DRAINAGE
- -- - ` -- -- - -- TD TEMPORARY
DIVERSION
RL FINISHED
-' DRAINAGE
LIMITS OF
-- GRADING
SILT
FENCE
STRAW
BALES
- GRAVEL
i VEGETATION
O SPECIFICATION
TREE
PRESERVATION
STOCKPILED
ji SOIL
F Al
i
I
- Please indicate north
_ by completing the
arrow below.
4 N—
PROJECT LOCATION i4'src.L sr
BUILDER OWNER
WORKSHEET COMPLETED BY 2 yAA DATE
EROSION CONTROL PLAN CHECKLIST
w� ? Check (✓) appropriate boxes below, and complete the site diagram with necessary information.
4
CY�� Site Characteristics
191 Nullll df1uW, widlo, doul rillri Iitnuulrniy hiffilktlti mill 11rUllri itilliluriiil ttlltutl•+ to ttnalwtly -k
06 ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells.
❑ 91 Location of storm sewer inlets.
W Location of existing and proposed buildings and paved areas.
M The disturbed area on the lot.
1% Approximate gradient and direction of slopes before grading operations.
® Approximate gradient and direction of slopes after final grading operations.
❑ 1A Overland runoff (sheet flow) coming onto the site from adjacent areas.
Erosion Control Practices
❑ Location of temporary soil storage piles.
Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be
covered with a tarp or more than 25 feet from any downslope road or drainageway.
W 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).
❑ LIS Location of sediment controls (filter fabric fence, straw bale fence or 10 -foot wide vegetative strips) that will pre -
vent eroded soil from leaving the site.
❑ 59 Location of sediment barriers around on -site storm sewer inlets.
❑ ❑ Location of diversions.
Note: Although not specifically required by code, it is recommended that concentrated 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.
❑ 56 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- vegetat pn by sodding or by seeding with use of erosion control mats.
❑ M Location of practices that will control erosion in 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 no be installed in perennial streams (streams
with year -round flow.)
❑ X Location of other planned practices not already noted.
r c °a Indicate management strategy by checking ( ✓) the appropriate box:
ob ° = o Management Strategies
1 I I�1 Itillil ►►►aly alal►III >all►ni ►t ►Iltilinl.►t rv�rtn
Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized
by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching.
RI Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment).
Indicate re- vegetation method: Seed ® Sod X Other ❑
Expected date of permanent re- vegetation:
Re- vegetation responsibility of: Builder ❑ Owner /Buyer X
Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? Yes I, I No I _ I
i ❑ CK Use of downspout and /or sump pump outlet extensions.
� Note: It is recommended That flow from downspouts and sump pump outlets be routed through plastic drainage
i pipe to stable areas such as established sod or pavement.
7
❑ 7; Trapping sediment during dewatering operations.
Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until
most of the sediment settles out
I
Proper disposal of building material waste so that pollutants and debris are not carried off -site by wind or water.
tK 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 barrier's height.
{ - Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be
replaced (typical bale life is three months).
1 - All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday.
I
- 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.
i
r
For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code,
the DNR Wisconsin Construction Site Best Management Handbook, and UW— Extension publication Erosion Control for
Home Builders.
E The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available
through State of Wisconsin Document Sales, 608/266 -3558.
Erosion Control for Home Builders (GWQ001) can be ordered through Extension Publications, 608/262 -3346 or the
3 Department of Commerce, 608/267 -4405.
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LOCATED IN GOVERNMENT LOT 8 OF SECTION 23, T30N, R19
TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN; BEING
LOTS 2, 3 AND 4 OF STEVENS & SHIRLEY'S PLAT.
NOTE: This Certified Survey Map was drafted to co mbine OWNER
the above said existing Lots 2, 3 and 4 into one Lot STEVE VAN SLYKE
and is exempt from the St. Croix County Subdivision Ordinance. 1812 OAKDALE AVE. APT. 305
WEST ST, PAUL, MN 55118
W1/4 CORNER
SECTION 23 LOT 1 OF C.S.M. IN
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Vc Page 3760
SEPT 1 :I PS SSPVFY MAP
SEATED IN O❑VEIRNM LOT OT 0 OF SEETI ❑N 23, T30N, P19W
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STS 2, 3 AND 4 OF STEVENS & SHIPLEY'S PLAT
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the above said existing Lots 2, 3 and 4 into one Lot
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W1 /4 CORNER
SECTION 23
VARIANCE REQUEST FOR H.24 FOOT VARIANCE FROM 03 FOOT CENTERLINE SETBACK,
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PERMANENT EROSION CONTROL SC'HFrnn F
CONSTRUCTION SEQUENCE
1) INSTALL PERIMETER SILT FENCE �, SITE MAINTENANCE SHALL INCLUDE: REMOVING
2) BEGIN SITE EARTHWORK OPERATIONS SITE DEBRIS do DISPOSING OF MATERIAL OFFSITE.
STURBED INSPECTION OF EROSION CONTROL MEASURES AFTER
3) PERMANENT TURF ESTABLISHMENT OF DI
SOILS ON EMBANKMENT AND SIDE SLOPES IN MODERATE RAIN EVENTS. THE GRADING CONTRACTOR
ACCORDANCE WITH WISCONSIN DNR STANDARDS IS RESPONSIBLE FOR THE MAINTENANCE AND REPAIR
OF SILT FENCE UNTIL PERMANENT TURF
4) BEGIN HOUSE CONSTRUCTION ESTABLISHMENT THE GRADING CONTRACTOR IS ALSO
s 5) COMPLETE SITE EARTHWORK RESPONSIBLE FOR THE REMOVAL OF SILT THAT MAY
lMa:n 6) COMPLETE HOUSE CONSTRUCTION ACCUMULATE BECAUSE OF FAILURE IN EROSION
7) • REMOVE ALL SILT DEPOSITS FROM SITE AND CONTROL MEASURES.
145 Street
REMOVE PERIMETER SILT FENCING UPON FINAL
P.O. Box 252 Land Survcyors ACCEPTANCE OF PROJECT.
lfoodville, MI 54028 Construcuon Managers
� ,
Bus: 715 - 898 -3440 Fax: 715- 898 -3441 No - te; Tk eo wun e r ► s re s po h s b to - Fo r t e I n s i"a.IIcch
.of cc.n_cz � -t ro-;l my t0 protect Vehl'oes
�01- 1468 "
613390
if STATE BAR OF WISCONSIN FORM 2 - 1998 FE H. WALSH
GISTE DEEDS
WARRANTY DEED
ST. cRazx CO., wz
Document Number RECEIVED FOR RECORD
This Deed, made between 11 -05 -1999 4:10 PH
Stephen K. Van Slyke a single person WARRANTY DEED
EXEMPT #
CERT COPY FEE:
Grantor, COPY FEE:
and Ryan J. Polcin a single person TRANSFER FEE: 240.30
RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix
County, State of Wisconsin:
Lot 8, Section 23 -T30N -R19W being part of Lot 2,3
And 4 of Stevens and Shirley's Plat described as Recording Area
follows : Lot 7 of Certified Survey Map recorded Name and Ret A ress -
in Volume 13 of Certified Survey Maps; page 3760 EAU��E�iALLEY BANK, N.A.
as Doc 612888 1301 Coulee Rd., Unit 2
Hudson, WI 54016
030- 1030 -20 -000
030 - 1060 -30 -000 030 1060 40 000
Parcel Identification Number (PIN)
This is homestead property.
(is) (is not)
Exceptions to warranties:
Easements, Roadways And Restrictions of Record
Dated thi day of Cc'� u , /�`�
* * Stephen K. Van Slyke
* *
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ) ss.
St. Croix County. )
Persqnally came before me this a-�� day of
authenticated this day of n C 1 � the above named
Stephan K. Van Slyke
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person who executed
(If not, the foregoing instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.) al
THIS INSTRUMENT WAS DRAFTED BY )
* 1 a r l e n P 71e- C__- / 1I r)
Michael Fo:recki Attorney Notary Public, State of Wisconsin
Eau Claire, Wisconsin My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are ,_:;sa'� _sue 1.�4:;9t) )
not necessary.) Notary Pur:iic- state of 'Niscoilsin
My Commi Expires �
F4P RR
*Names of persons signing in any capacity must be typed or printed below their signature. 0001
STATE STATE BAR OF WISCONSIN 10-1 lsss
WARRANTY DEED FORM No. 2 -1998
'I
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