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HomeMy WebLinkAbout032-2125-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Coun Croix Safety and 'BuildinoDivision INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita04NO.: Personal information you provice may be used for secondary purposes (Privacy Law, 15.04 (1)(m)). r t Id 'a me: ❑ cit State Plan ID No.: y � `� 8�i'i�s � CST BM Elev.: Insp. BM Elev : Description: Par d1 r+�,.r Ptre ref,*! C i `i�• L TANK INFORMATION ELEVATION 115AT A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2.0 4 N . Dosing W c ol G3 •S'r Aeration Bldg. Sewer 1 14- 92•ZZ' Holding St /Ht Inlet $.Q g0••jo TANK SETBACK INFORMATION St/ Ht Outlet E c t . 02. *.53' TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet I2.o $:.S - S' Air Intake Septic S 5D 2 NA Dt Bottom �S• , • p� Dosing S ck > � ? (00 NA Header /Man. �Z.in Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade �- t• G • ° y 9S� Manufacturer Demand St cover 05,-, Model Number S GPM TDH Lift Lriction 1 System TDH Ft Forcemain Length ' Dia 4Dist.ToWell SOIL ABSORPTION SYSTE � THE Width c es PIT No. Of Pits Inside Dia. Liquid Depth I DIMENSION LEACHING Man ��cture� l SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM ! 71erP- INFORMATION Type O p . CHAMBER o e Num er: System: v, 8 � OR UNIT DISTRIBUTION SYSTEM CT cl• + 1&- - +5' Header /Manifold �/ Distribution Pipe(s) x Hole Size x Hole Spacin Vent To Air Intake Length / Dia. L ! 3d SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc. i nspection #1: 0b /31 /EL Inspection #2: Location: 423 172nd Street, Somerset, WI 54025 (SE 1/4 SW 1/4 5 T30N R19W) - 0530191124 Chabr Lot 16 / 1.) Alt BM Description ` �Q,oa ✓� lWs .r�5 4'(" 2.) Bldg sewer length z,q-.o ` - amount of cover = (S"4 -• qZ,� (o•� $• °3 " �(•�• i n revision requ Pfa red? ❑ Yes *9 No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No v�Q y-Z3 I T2 Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permi Number ❑ Check if revision to previous application State Plan I. D. Number 5't Tcet( '3g39 2 I. Application Inform - Please Print al l Information Location: Property Owner Name erty Location t 1/4 1/4, S � T d ,N, Rfit (or Property Owner's Mailing Address Lot Number Block Number 6 City, State Zip Code Phone Number Subdivision Name or CSM Number GG ( C AAg/re II. Type of Building: (check one) as s , (, -a ❑ city X 1 or 2 Family Dwelling - No. of Bedrooms : � � ��o�s . 0 Town of ❑ Public /Commercial (describe use):_ ❑ State - Owned Nearest Road 3 q ( - — (3) A /) �r l Au 10-�/s ' '� 3 r X �� . ZS ' '� l.t eJ� c X- Parcel Tax b (� Zi2-5 (00 — 0'B0 III. Type of Perm ( eck only one box on line A. Check box on line B if applicable) S . 34D.19 112 A) 1. f K New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) - — m . KNon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) 9,6, Elevation G o .S a) 2 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks as ❑ ❑ ❑ ❑ i ®CJ / e ` VIII. Responsibility Statement , I, the undersigned, assume responsibility for installation of the POWTS shown on th ched plans. Plumber's Name (print) PI b is Signature (no stamps): M P Business Phone Number --/ n � Plumber's Address (Street, City, State, Zip Uodc "i6 LIA&c&)e v - IX. County/Departmeift Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ss 'ng Agent Si (No stamps) P4 Approved ❑ Owner Given Initial Adverse Su harge Fee) Determination Z ZS- t� �Z ?fit l X. Conditions of Approval /Reasons for Disapproval: - is ;s fi� 1MCUrM vte� yes paw lnne e?s , wtatb►�s. SBD -6398 (R 07/00) I ! I c �QN/> 9S y " rG'G /NI�c ?riir•�V + i J i f A/L 3 g9E �,• p ! i i .' ` . off r T .. ; ( ! t V i OA• //v � _C R Sant _ eona s n i S 'G t11EW 7 . ( i $. 'c cv�u•T` --/�� ;�rtC ssoB.Z �S'�'r�Ens� r� C.(�2 Sy�zs . I � I I r { I i q e } � � i i { ' j �� � �� �(VGic rR F► T4g� � . i 13 � �r9'� I "_ . i I�Q,,�CG�:DE�/Z j t��•Li • I Q'� O !'� j � , `� 1 i 113v� 444 , L; /0f f ' r I ; i �.....E t ! 1 T 6 f I i 1 , A lacon'si Department of Commerce SOIL AND SITE EVALUATION Division of Sarety and Buildings Page of Bureau of Integrated Services in accordance with s A.�Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches irksize .Plan must,c,T 'C ounty include, but not limited to: vertical and horizontal reference point (Omj', direction and . percent slope, scale or dimensions, north arrow, and location and - distance to neatest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (fn)). Property Owner Property Location 1�a c1 v -1 Govt. Lot 114 1/4,S T ,N,R E (oQW Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# J5 rA X e _Tr . I to City State Zip Code Phone Number ❑ City ❑Village [�R Town Nearest Road I ® New Construction Use: ® Residential/ Number of bedrooms 3 /_/ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: /,3 G 3 1 ,/' Code derived daily flow 1 .� gpd Recommended design loading rate bed, gpd /ft? _trench, gpd/ft Absorption area required bed, ft2 7Sj-_) trench, ft 2 Maximum design loading rate - oed, gpd /ft ' trench, gpd/ft Recommended infiltration surface elevation(s) C11 St+ Gaw 'et- QO• TV ft (as referred to site plan benchmark) Additional design /site considerations 51) Parent material :6 U Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U ii] S ❑ U k9 S ❑ U 'p S❑ U ❑ S G; U ❑ S KU SOIL DESCRIPTION REPORT Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft oft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Lodi LU 2 -zq 3 S1 2 C5 — s ; .(P . Ground 3 9 36 - �� r m ,' C 's elev. - q S OU ft. Depth to limiting factor Remarks: Boring # S 2 2 -,o s Ground elev. 6o ft. Zs� Z Depth to limiting factor Remarks: CST Name (Please Print) Si a Telephone No. Address Date CST Number +� �,, �� � S d 25 i SOIL. DESCRIPTION REPORT i PROPERTY OWNER Page Z of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots 1—f t. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench code ow 3 s' Ground 29 -�q elev. Depth to limiting factor . in. Remarks: Boring # 1 i r -� I ov(-Nq S° 2ff bL , c 4 C t3 u Ground elev. 31.2 n , Depth to 2 limiting flictor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # ( q �` 2 � C , S h' - ry4r Ground elev. 9 �i6 ft. Depth to limiting factor . _ 1 in, Remarks: V1 L.1 Co de Boring # (� z 3/� S L- mfr , 9 `/ q/ -C�- Ernst yYl , 9 ✓ Ground e�leX NT'1_ft. Depth to limiting factor in. Remarks: �o' r � �Q cs ✓l - d SBD -8330 (R. 07/96) - s PAGEOF NAME 5 -f��'� LOT# (O LEGAL DESCRIPTIONS ,j ' /*,w' /a,S E, T ,N,RagE (orI w) SCALE: F'= 12 5 BM 1 ELEVATION BM I DESCRIPTION BM 2 ELEVATION IUC) - y BM 2 DESCRIPTION h a i (+ n BOW e 1 C' 'e SYSTEM ELEVATION ,q(,S6 j (- 9CLS'o ALTERNATE ELEVATION _ � o.owcr 71.6- X CONTOUR ELEVATION D o s ed a� of SIGNATURE DATE � J PA&E Of PUMP CHAMBCR CROSS SECTION AMD SPECIFICATIUMS VEUT CAP Y "C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING JUIOCTIOM SOX MANHOLE COVER *11muuw uK t i t L611 I Alit IN TAKE I GRADE I M"MIN. ' I COWDUIT ♦\�` PROVIDE I INLET AIRTIGHT $GAL. APPROVEC JOINT A I .) (I APPROVED JOINTS W /C "Z. PIPE I ! I Evc PIPE ><TENDIW4 3' I II ALARM C i:><TE�IDIUIb b' ONTO SOL-10 %OI I I ONTO SOLID SOLI. s I I I ( ON C I 1 E. L C V. FT. rump—,- Of F CONCRETE BLOCK $ AYPAdIllit4 RISER EXIT PLRMlTI'EG OiJL:i IF TAIJ9t N'AAiJUFACTURCR HAS SUCH APPROVAL. SEPTIC SPE C IF I C.ATIOM S DOSL TA jK% MAAIUFACTUR&R: W ��� s NumbER OF DOSCS: PER DAIII TANK 51zc 9 .jQa _. GALLOWS DOSE VOLUME ALARK MAWUFACTUR.&R: — 4a L A .92m IMCL.UDIM& BACKP4OW: 1 ���sD � 6ALLONE MODGIL NUMBER: CAPACITIES: A= _12 imCHCS OR 32Z ys GALLONS SWITCH TyPt: U12 L l IUCMES OR y ?, 7 : , f4LLGAJ5 PUMP MANUFACTURER: ? d aL-.hl 2 C R (a _ IuCNES OR .L /� c.L� J -�� MODEL WUM SLItt ,/ 2 D- l - - II1IC14ES OR 1 GALLONG SWITCH TAPE: f 6FI?e ag 4 MOTE: PUMP AMD ALARM ARE TO OC M1101AWA DISCIARGE IRATE 36 GPM INSTALLED ON S CIRCUITS VERTICAL DIFFEREIJCE bETWCEU PUMP OFF AIJO ..DISTR40UTIOIJ PIPE.. 0 FEET ♦ MINIMAUM NETWORK SUPPLY PRESSURE .. . . . .. .. . . z 5 FEET ♦ A d FEET OF FORCE MAIN X L YlooftFRICTIOU FACTOR— .12 FEET TOTAL DtJW&MIC. HEAD = � FEET INTERMA - 67 OF TAWK: LENGTH ;WIDTH — _.ILIQUIO DEPTH y t 91GWED: LICEOSE MUM9ER: / DATE. V 6 l ' PAGE or PUMP CHAMBC R CROSS SCCTcON AMD SPE:CIFICATIOWS VCIJT CAP H VENT PIPE WEATHER PROO APPROVED LOCKING 11610c 7MA►114OLE COVitR 041MUUW UK f Nltibll �r •'� AIR IAITAKE ` GRADE `!" MIN. 1e•'' 1u. COWDUIT IO�MlAl. It PROVIDE I lNL.ET r AiRT168T SEAL I I v APPROV[O JOINT A I I ( I AP PRPVLD JOINTS W /C,Z. PIPE I II ExTE PIPE CATENDIU& 3' I II ONTO G ONYO SOLID S OIL I I ONTO O SOLID OLLIO S SOIL s I 1 c I I L L C V..,..,�.� F T. PUM P -_ J OFF 0 COAICKETE BLOCK F A M PPkoVKD R15ER CXIT PCKMITfEG OWL4 IF TANK MANUFACTURER UFACTURR HAS SUCH APPROVAL. gEppl� StPTIt SPECIFICATiOMS TO_�. MAMUFACTURCR: IS uUMbER of DOSES: PER DAN TANK 61ZC: C GALLOWS DOSE VOLUME ALAR MANUFAcruKrR: _ 4&46aL ACAr2/'l iNCLUOiAiG bAGKP 5 ..� ...... 6AU O Ns MODOL NUMBCR: CAPACITIES: A _,L7 IMCNfS Olk fGALLOMS !WI TyPL: aLa C," Ll 5= ��IIJCNESOR y ? G�1LLOi►1S PUMP MAMUFACTURER 51'' C =— INLRES Oft � OALLOUI '+�� MODCL WUMSER.1 139 D - �____IMCRES 01( 12YAGALLOUG SWITCH TUPE: L & MOTE: PUMP ANB ALARM ARE Tff & MINIMUM D ISCIARCK R ATE .._.36_____ INSTALLED O SEPARATE CIRCUITS VERTICAL DIFFEREWGE DETWEEAI PUMP OFF AUD,a1STRIBUTION PIPE.. —L_ FEET + MINIMUM NETWORK SUPPL l PRESSURC . . . . . . . . . . . • FLLT + -d—O FEET OF FORC MAIN X 33c3 F Y o FtFRICTIOU FACTOR. FEET TOTAL. DyWAMIG HEAD — FEET ,2� is//NL. INTrs. Al. D IJS10NJt OF TANK: LEN(PTH ;WIDTH _ iLIQU10 DEPTH . tT y L ICLOSE 1JUM9E R: -) V 7 / / DATE: o 'r ■ ■ ■■ MEMO ■■■ �MEMO M■■■■■■■■ ME .. �.. ■ ■. G ■ ■E ■MM . .M;. . ■. ■ ■■ ■E■ ■ ■G■ No 1, 1 ■E► \I1��� \ \ \ ■ ■ ■ ■■ MEN ql 'I immom m ■■■MOM■■■■■■■ . ... ..... ... . :. .. .. . ... ... ... �C�CGGGGGGGCG��GG� ©om ----------- - - - - -- - - - -gym --------------- - -_ - -- -gym 8 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specification Sanitary Permit Number 2 Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) 6o W r Soil Absorption Component Size (fh) Type of Wastewater Dom stic ca Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) k 2- QUO) (, z - * Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge 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 an 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. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 r Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. I I 3 i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C A,? 51) /V C 0/V!5 7 - , C �'wisan/ Mailing Address AQ ?!?,0 A01ECV 000 06 A4 571 7, n Property Address y a 3 / 72 ,+rn A - (Verification required from Planning Department for new construction) City /State <1(7"elffff/ Parcel Identification Number !j•3 I2�' LEGAL DESCRIPTION Property Location Sr- _ V4, g W V4, Sec. T -RAW, Town of Sama-A s T Subdivision gf h 13 R L' . Lot #. Certified Survey Map # , Volume . .Page # Warranty Deed # gv h/0 / O B , Volume —1 j , Page # Spec house K yes ❑ no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system 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 certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a li pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA11M OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 03 T1 E 1.1 :38 FAX 1 i I:i 3N6 0360 FSTREE \8()GI.. \ \1) 0003 1599PAGC 82 640 o� STATL• 13AR OJ` WISCONSIN I'OR \1 2 - 1999 Y A? HL.EEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI This Deed, made between Richard U. Stout and Janet P. Stout, RECEIVED FOR RECORD husband and wife, - _ - --__ -_- 03 nq - a , 101 9:30 AN WARRANTY DEED _ EXEnPT R — Grantor, and Carlson Cons[ruceion Services, Inc., CERT COPY FEE: _ COPY FEE: TRANSFER FEE: 170.70 RECOIRENG FEE: 10.00 PAGES: I Grantee. -- - - Grantor, for a valuable consideration. conveys to Grantee the following described real estate in S t, Cron Countv. State of Wisconsin (if more space is needed. please attach addendum): Recoiling Area Lot 16. Plat of Chabre in the Town of Somers: St. Croix County, Name and Return Address Wisconsin. KRIS" "GLAND ATTC AT LAW P -"( 359 HUL. WI 54018 Pt of 032- 2125.40 Parcel Identification Number (PIN) This is not -_ - - homestead property. - - - - 0() (is not) Exceptions to warranties: Easements restrictions and rights -ot =way of record, if any. Dated this day of 'March 2001 ` _. -. _ - __ ... _._ • Ujoard O. Stout * + Janet P. Stout AGTHENTICA rION ACKNOWLEDGMENT Signature(s) Richard O. Stout and Janet P. Stout, hu sband a nd STATE OF WISCONSIN ) wife, ) ss. -- - - -- ... County ) i authentirpted - this day of March 20111 �C/ - "— Personally came before me this day of the above named . Kristina Ogland - --- TITLE: MEMBER STATE RAR OF 1 4TV ONSI\ --- - -- ----- --- --- (It nut, to me kno,vo to he the person(s) who executed the foregoing authoriccd by ? 706.06, Wis tic,u instrument and acknowledged the same. i THIS INSTRUMENT \',SAS DRAFTED 8y' - -- — — ` Attorney Kristian Ogl _ Notary Public, State of Wisconsin Hudson, R'l 54011, My Commission is permanent_ (If not, state expiration date: (Signatures may be authenticated or ackncwledgea il�, th arc not necessary ) ___._.__— — .__..... -._ ) Names ; ( ptsuns signing in wit capucil uw,t be t,p: d of printed Belo„ their signature hfur eor Prorssimais C=pW,y Fu,d du Lac, W S I At L BAR OF W'ISCONSI\ 900555.30], WARRANTY DELI) FORA1 No. 2 -1M9 I .r M MAN F7Bf FLOOR ELEVATION CHABRE OR WNDOW ISMAT10N 'a SW1 /4 OF THE SW1/4 AND PART OF THE SE1 /4 OF THE SW1 /4 �; go; )W, TOWN OF SOMERSET, ST. CRODC COUNTY, WISCONSIN. o 1 W O '"0 �� �/�19� / L0T5 967.0 L 1 L!! ! � 2 L WA \ ` LOT WA C»S.Y IN VOL 8, PC 1589 1 Af To M ------------ ---- -- �_S_fL___IN i!OL 8._ -- - ---- aT„ 9,6.9 LOT 12 999.0 LDT 13 WA 9,QrtTT, W9EOFTHUSINOFTHESWIM \ Qryl/ Y188.D4' LOT 14 ow om LOT 1e 979.0 LOT 77 972.0 LOT 1S 9720 WT 19 WA .t LOT 20 SIM 21 M 4 y L 2 A 3 ? �24 mA 1750 M R v H 130Me SO R "SITE A $ "sn. = A 7 b "SITE OF y A • 3 i r19111H,10� [ b M = = H.W.L. . 963.00 t 2 A • ` H.W.L. 964.00 tsoea9r ' 20• DiWNAIiE KAIMMENIT r w .W WA9 tl MMeW S 70..7 - m C P. r - A A J A 13 18 N.W .96aoo 1(I H On 14 SAM AC9O j,'T'ly &D"ACI 70 1307 60 FIT e y 1 � � '�G,_ 130535 SO IT (� I SEP% SITE i r Ilk S 15 1 17 M 3.007 ACOM 7309 SQ FT • s B 3.990 ADM= A 19 S loon SOFT B 005 ACSMa 10= SQ FT 996.00 A "Sm v 4TE .4 ltM� AY SETBACK PER TRANS 233 1 ACCESS ourkw N882 8'1 • 816. 88 ' SOUTH LINE OFTNESWIV4 7x9• PROPWZD 35 64 STAra rMJNX XIGhWAT ----------------------------- D.O.T. NOTES PER TRANS 233: SCALE IN FEET 111" = log' AS oer I hereby reskkt al M tots and Blocks so tt Out ra omw, possessor. wn user, keneee Of other peraon may hNe NN right Of dkec, vakular Wgm Ir mor eGrem to any hWwW WQ WIM the d0d-Veyot Stab Burk Hk ftm3y 35 6 64, as sham on the tared dNslon map; I is sipessy 100 O 100 200 300 k9erlded 9W tlds reshictlon constitute a reatrk tton for ttu benelt of in pubic as pmvlded In s2362M, Stab., and shat be eMorceable by the deperknent at Is asslpru. U19ITYLASELBe9 NO POLE OR SUED CABLES ARE TO BE PLACED SUCH THAT THE 9STALLAT97N WOAD The klb d Oda tarts d wElon Troy slpederae noise at heels MCeedAG DISTURB ANY SLMYEYSTAIF. OR OBSTRUCT VISION ALONG ANY LOT LINE OR STREET LSE. 111E DWMINIANLE OF SLIRJE/ MOM By ANVO E o AVIOLATION OF SECTION =32 the Ievele in 4 Trans 406.04, Table 1. These Wels are based on OF WISCONSIN STAn1IE3, UTILITYEASELEWIS AS N3BIt SET FORM ARE FOR THE LEE OF I standards. OWrwo of dww kots am responsible for sbaft PUBLIC BODIES AM PRIVATE PUBLICUTa111E3 HAVING THE gOHTTO BERNE THE AREA. raise sufficient to probcl home kola. EACH PARICa311Dya1ON THE fLA1)S alieJECI ro STATE, COIACCAND89 i0 PARCEL E LAWS, ACCESS RF1911ATIONS QE.. WElIMD9, ASaIAIIM LDTSLi7; ACLElB EM). BEFORE PIIRGWSSM OR DEVELOPSMVVFI' PNICH.OF LANG CONTACT THE ST. CRM COUNTY ZDI NO OWICE AND APPROPRIATE TOM BOARD FOR AD VM SAN" 1 OP 8 S"m