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HomeMy WebLinkAbout038-1113-40-200 - Wiscwnstfl Department of Commerce Count ' Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix ti INSPECTION REPORT Sanitary Permit No: 420399 0 GENE�RAL- 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: Hosle , John Jr. I Star Prairie Township 038- 1113 -40 -200 CST BM Elev: Insp. BM Elev: J _rMD . I - BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark + V Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet 3 ' 9 a - 97 - az TANK SETBACK INFORMATION St/HtOutlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Z'� 6C 23 t �- Dt Bottom Dosing ) Header /Man. Aeration Dist. PiRe q I , ' t • .02. Holding Bot. System 1" a S-Ir S:OZ PUMP /SIPHON INFORMATION Final Grade at Manufacturer Demand St Cover PM Model Number TDH Lift Fricti s System Head TDH Ft Forcemain Len Dia. SOIL ORPTION SYSTEM f TRENCH Width Length No. Of Trenches r PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM /2 1 67 r LZ SETBACK SYSTEM TO I P/L JBLbG IWELL LAKE /STREAM LEACHING Manufac r. INFORMATION CHAMBER OR Type Of System: o ` t UNIT Model Number: l tr DISTRIB SYSTEM S HeaYM7 4 L u Distribution x Hole Size x Hole Spacing Vent to Air Intake Pip t ia Length Dia Spacing I 3S + SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of x xx Mulched Bedfrrench Center Bed/Trench Edges Topsoil -i to Yes U No (] Yes j No C MM NTS (Include co c sere engies, pers pre etc.) Inspection #1: OYl/ Of '/ Inspection #2: ' f CaE� -- t& � (Ps �J X �r S? r Location: 1054 192nd Avenue New Richmond, WI 54017 (NW 1/4 SE 1/4 28 T31 N R18W) NA Lot 5 Parcel No: 28.31.18.480B20 1.) Alt BM Description =TV( 2.) Bldg sewer length = 2 q N v^ amount of cover = 7 C-t. � 1 Plan revision Required? " Yes X No S Use other side for additional information. Nu1T�: 0 �i l�- I SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. /° 92, KI & - Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 14 a & qnsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce rivac Law, s. 15.04 1 O1 (Submit completed form to county if not .s [Privacy W404O state owned.) Attach complete plans (to the county copy only) fo systeai,�,a.pa er not less than 8 -1/2 x 11 inches in size. County F I State Sanitary Permit Number eck i , 4 #i ��evious app ion State Plan I. D. D. N1 X z� 3 I. Application Information - Please Print all Information Location: Property Owner Name a ?(��)� Property Location ,1 (�� Q 327 464 _!, V4, S,4T OE( ( Property Owner's Mailing Address Q Lot Number Block Number Ci State f Zip Code Phone Number Subdivision Name or CSM Number 6�1017 � (4�a 074- #&'/ C.0%'-o �99403 II. Type of Building: (check one) V A4 p4r. S low,- ❑ City -11 1 or 2 Family Dwelling - No. of Bedrooms:_ ❑ Village ❑ ublic /Commercial (describe use):_ �j O a Town of ❑ State -Owned Nearest Road / P cel Tax Number(s) III. Type of Permit (Check only one box on li e A. Check box on line B if applicable) A) 1. JgQ4ew 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) -16 - I ` I7lon- pressurized In- ground ❑ Mound ❑ ' d Filter ❑ Constructed Wetland 0 Pressurized In- ground ❑ Holding Tank ingle Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit Recirculating ❑ Other: V. DispersalITreatment 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) Elevation O 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 c ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement 1, the undersign assume responsibility for installation of the POWTS shown on the attached plans. WPI)A bees m ae (print) Plum ignature (no s s): MP/MPRS No. Business Phone Number ddress (Street, City State, Zip Co e ; r IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued IZ .,A ' AA. g Agent Signature (No stamps) 5tApproved ❑ Owner Given Initial Adverse Surchar Fee) Determination 5 W , 2-3 zm? X. C of�lpproval�easons prov 1: (I�� ,, � , � ¢.� C.- t'JlO+n. ►��U�- �T�.tnn �- l �L L� 0L4rX I S SBD -6398 (R. 07/00) PLOT PLAN PROJECT .John Hoslev ADDRESS 916 170th ave NewRichmo W i. 54 NW 114 se 1/4s 28 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX c MPRS Byron Bird Jr 2205 DATE 6 - - 02 BEDROOM 4 CONVENTIONAL XXX A rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE o LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 IL BENCHMARK V.R.P top of white pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL - H.R.P. same as Bm Vent SYSTEM ELEVATION T- 1= 95.2T -2 =94.7 >12" Sidewinder High Of Capacity Leaching Cov Chamber with 17.2 6" t ^2 per chamber Long 34" Elevation 192nd ave veway garage 4 bed house Private Rd 20' 4' 6' 20' 200' 1 87' S , B 75' 99' B11 100' 98' B 100 e PL 97' -g � PLOT PLAN PROJECT John Hoslev ADDRESS 916 170th ave NewRichmond Wi. 54017 NW 1/4 Se 1/4S 28 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX c MPRS Byron Bird Jr. 2205 DATE 6 -3 -02 BEDROOM 4 CONVENTIONAL XXX A rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1 260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ❑ LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 IL BENCHMARK V.R.P top of white pipe ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. same as Bm Vent SYSTEM ELEVATION T- 1= 95.2T -2 =94.7 O f Sidewinder High C ov Capacity Leaching Chamber with 17.2 6" ^2 per chamber Long 34 " Elevation 192nd ave veway garage 4 bed house Private Rd 20' 4' st 6' 20' 5 B 200 1 75' � 99' B 1 100' 98' ..- B 100 e PL 97' Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code r� / Cir o f Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Re iewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 'j -0 4 1 O 6 �s2 J!^ , Govt. Lot /A/ 114 1/ So,$$( CON E ( W Property Owner's Mailing Address Lot # I Block # I Subd. Na OFFICE City State < Zip Code Phone Number ❑ City ❑ Village To Nearest Road ' Sf 0 /7 1 vr� i�6`f�i` kY � New Construction Use: Q? Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commerce I - Describe: Parent material C�'T�- c r c� ��L �_c,5 Flood Plain elevation if applicable ft. General comments and recommendations: F/I Boring # E] Boring s 3` 0 pit Ground surface elev. y- 7ft Depth to limiting factor e' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell / Qu. Sz. Cont. Color Gr. Sz. Sh. T 'Eff#1 'Eff#2 ✓ ')S 2-o f W Boring # ❑ Boring (� pit Ground surface elev. fa ft. Depth to limiting factor in. 44ti Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 3( a Z— ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg /L and TSS _< 30 mg/L CST Nam lease Print) � Signature � CST Number �: ��oZ Address a Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner �/ Parcel ID # Page - of U1 Boring # ❑Boring ® pit Ground surface elev. ft, Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 3V F-1 Boring # Boring ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) Soil Test Plot Plan Project Name John Hosley Byron d Jr. Address 916 170th ave New Richmond Wi. 54017 CST #220527 Lot -- -- --- Subdivision ---------- Date 13 County CROIX NW 1/4 S E 1/4 S 2 8 T 31 N /R W Townshi Sta Pr R Boring Q Well PL Property Line# Alt. BM top of white pipe Elv. 100' ,BM or VRP Assume Elevation 100 ft top of white pipe System Elv. T- 1= 95.2T -2 =94.7 H.R.P. same as BM 192nd ave veway garage 4 bed house Private Rd 6' 200' 1 15 50 B2 75 , 99' B1 100' 98' B3 100' PL W , POWTS OWNER'S MANUAL 8t MANAGEMENT PLAN rage of RILE INFORMATION SYSTEM SPECIFICATIONS Owner. Septic Tank Capacity ai ❑ NA Permit # �� 3 Septic Tank Manufacturer e Q ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 17 NA. Effluent Filter Model �� E3 NA Number of Commercial Units ❑ NA Pump Tank Capacity gai ❑ NA Estimated flow (average) Pum © gal /day Tank Manufacturer [3 NA ! Design flow (peak), (Estimated X 1.5) gal /day Pump Manufacturer ❑ NA Soil Application Rate gal/Tay/ft' Pump Model ❑ NA Month) average* Pretreatment Unit ❑ NA Influent/Effluent Quality y ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oil a Grease (FOG) 530 m ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids ( TSS) s 150 mg /L Manufacturer Pretreated Effluent Quality ' ❑ NA Monthly average* * Dispersal Celi(s) Biochemical Oxygen Demand (BODs) :_30 mg/L �In- ground (gravity) ❑ ground (pressurized) Total Suspended Solids (TSS) S30 mg/L ❑ At -grade ❑ M ound Fecal Coliform (geometric mean) s1.0 cfu /100m1 1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event Inspect condition of tank(s) At least once every ❑ months Wyear(s) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume inspect dispersal cell(s) At (east once every 3 ❑ months l&.year(s) (Maximum 3 yrs. ) Clean effluent fliter At least once every — 13 months PI inspect pump, pump controls 8i:21arm At least once every ❑months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every ❑months ❑ year(s) ❑ NA Other: At least once every ❑months C3 year(s) ❑ NA Other: At least once every ❑ months CI year(s) ❑ NA MAINTENANCE INSTRUCTIONS made by an i Inspections of tanks and dispersal cells shalt be Individual carrying one of the following licenses or certifications: Mast Plumber; Master Plumber Restricted Sewer; POWTS Inspect or; POWTS Maintainer; Se Id Servicing Operator. Tank inspection must include a visual Inspection of the tank(s) to Identify any missing or broken hardware, identify any cracks or leaks, measure tt volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate nodflcadon of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one -third (�i) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wiscon Administrative Code. pressurized POWTS components, pretxeatement components, and any other The servicing of effluent fllters, mechanical or maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION cts • For new construction, prior to use of the Poea cell(s)� o l high concentrations are detected have the con e that may impede the treatment process and/or dama the di M rl+e rantail ramovPd b y ;% S entaF e servicing opera prior to use LL Page — of .— System start up shall not occur when soil condltlons are frown at the Inflitrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(:) In one large dose, overloading the cell(s) And may result In the backup or surface discharge of eftent. To avoid this situation have the contents of the pump ta nk removed by a Septage Servicing O perator prior. to restorinti power to the effluent pump or contact a Plumber or POWTS Milntalner to assist In manually operating the pump control, to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise dtswrb or compact, the area within 15 feet down slope of any mound or at-trade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; tat; foundation draln isump pump) water; fruit and vegetable peetings; gasolne; grease; herbicides; meat scraps; medications; oil; palntinst croducts; pesticides; sanitary napkins: tampons; and water softener brine. ARANDONEMENT When the POWTS fails and /or Is permanently taken out of service the following steps shall be Liken to insure that the system is properly and safely abandoned In compilance with ch. Comm 83.33, Wisconsin Administrative Coder • All piping to tanks and plu shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property. disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space Oiled with soil, gravel or another Inert solid material. CONTINGENCY PLAN It the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system; d A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed strucwre, lot Ones. and wells. Failure to protect the replacement area will result In the need for a new soli and site evaluation to esubllsh a suitable replacement area. Replacement systems roust comply with the rules In effect at that time. O A suitable replacement area Is not available due to setback. and /.or soil limitations. 8arrtrtg advances in POWTS technology a holding tank may be insulted at a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be Installed as a last resort to replace the failed POWTS. O Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the Inflitrative surface. Reconstrvcxlons of such systems must.comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER IWATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM TKE INTERIOR OF A TANK MAY !tE DIFFICULT OR IMpr1KIR1 F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Na med Phone 'Phone SEPTAGE SERVICING O ERATOR (PUMPER) LOCA REGU LATORY AUTHORITY F Name Agency U�"o i_.C' Zorn — Phrint fbont 4 ref ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer --1ID/7 /� y s y r Mailin g Address Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location L '/4, ' /., Sed. . T N -R�W, Town of Subdivision Certified Survey Map # fey 0 �, Volume Page # Warranty Deed # (0�`1 , Volume �1 Page # S Spec house ❑ yes J4 no Lot lines identifiablef 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 masterplumber, joumeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal 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 three ear exp' n date. SI URE OF APPLIC 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 owners) of the prop descri ve by v a of a warranty deed recorded in Register of Deeds Office. ATURE OF APP02kft DATE g y * * * « «* « « « « «« Any information that is mis- represented may result in the sari permit being revoked b 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 tt U 1974P 055 a STATE BAR OF WISCONSIN FORM 3 - 1998 QUIT CLAIM DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between ii 09 -11 -2002 10:20 AN ' rdHnl A M.0 SL 6 - /I o pdker#V 4. QUIT CLAIM DEED i HDSGES� H uS d IAIV fIN4 W //=� Grantor, EXEMPT # 9 j and j REC FEE: 11.00 To /t N '4. Host - E S' �}N.0 se coeR. /E S • #6S LC - :' TRANS FEE: fituSgAN�O �ti cOiFE COPY FEE: 2.00 PA E FEE: Grantee. Grantor quit claims to Grantee the following described real estate in i 5T eoeo /X .County, State of Wisconsin: Recording Area /4 tolweeL O L /9N ,0 /N 1 A) d1eTNW6_ST Name and Return Address 4uNR�ER OF TNT 5'curh'�'ftS7 QUi9� II S ©t/ /q, tfDSL AvE �Nwr� of SEi� of SC = eTioN TG�tNT }�- �/6t/7 ,t1Gto Kt LJO C a? ot) 7 W A) S HI i°i TH /oe 7 y -ONE (3 1) A1 0,e T�/� S^ j / 7 RWIJ(6E E/C h - 4!F6W 0 8) WEST, S e,eo /,r N bud - b `� 177 3 Gra u.VTY� W /sC oN SI,v loele C Eye rlFlED p of 0 3 8- //!3- LI/o -.0 0 d S U R. 0 E y / Parcel Identification Number (PIN) This /S N G 7' homestead property. 407 S' (is) (is not) 93s6 ii I i I I ii Together with all appurtenant rights, title and interests. v Dated this �! � day of -� i , i I ii (SEAL) (SEAL) i 70 Hnl /9- KoSL( _ (SEAL) 0/1 4 Y Y4 d (SEAL) I 40A 7 y 1. 1/064. 6' AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, ss. yl COUII� authenticated this day of Personally came before me this day of _ ���►bcr the above named a 1f N A. 116 S L E ,g,u a Ao 2y7 V � �• ffOSLty tfuS/3flN� flNA W /FE I 1 I� TITLE: MEMBER STATE BAR OF WISCONSIN —_ to (If not, me known to be the person S who executed the foregoing ii authorized by §706.06, Wis. Slats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY _ JUDY K. TANNER go�aTrry is11Aeie j Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: (Signs authenticated or acknowledged. Both are not �tIIM.Q S 003 ,) in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FORM No. 3 - 1998 Milwaukee. Wis. CERTIFIED SURVEY MAP Located In part of the Northwest Quarter of the Southeast fuarier of Section 28, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. being that property described in a Warranty Deed recorded in Volume 476 Page 531 In the Register of Deeds Office for sold County. SURVEYOR'S CERTIFICATE: I, Ty R. Dodge, a Registered Wisconsin Land Surveyor, do hereby certify that by the direction of John Hosley, I have surveyed, divided and mapped a parcel of land located in part of the Northwest Quarter of the Southeast Quarter of Section 28, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, being that property described in a Warranty Deed recorded in Volume 476 Page 531 on the Register of Deeds Office for said County, described as follows: Commencing at the South Quarter corner of said Section 28; thence, on an assumed bearing along the north -south Quarter line of said Section 28, North 01 degrees 06 minutes 47 seconds East a distance of 1325.81 feet to the point of beginning of the parcel to be described; thence, continuing along last said Quarter line, North 01 degrees 06 minutes 47 seconds East a distance of 1325.81 feet to the east -west Quarter line of said Section 28; thence, along last said Quarter line, South 88 degrees 28 minutes 25 seconds East a distance of 585.00 feet; thence South 01 degrees 06 minutes 47 seconds West a distance of 1320.45 feet to the south line of the Northwest Quarter of the Southeast Quarter, thence, along last said south lire, North 98 degrees 59 minutes 54 seconds West a distance of 584.99 feet to the point of beginning.Containing 774,001 square feet (17.77 acres). Subject t nd 192 Avenue (A Town Road) along the most southerly line of the above described property. Also subject to all easements, restrictions, and covenants of record. I also certify that this map is a correct representation to scale of the exterior boundaries surveyed and described, that I have complied with the provisions of Chapter 236.34 of the Wisconsin State Statutes and the Subdivision'Ordinance of the County of St. Croix and the Town of Star Prairie in surveying and mapping the same. R E +•rso 1- z 3 -oZ 4 onsultdge— Registered Wisconsin Land Surveyor No. 2484 Date ing Group, Inc. P.O. Box 325 New Richmond, WI 54017 SC0 N,9N`'4,,���y TY R. t DODGE _ S -2484 CLEAR LAKE, WI ' ! ••.. ». % ...• Q. �� ' 1 4f, 3 r Vol. 16 Page 4356 Sheet 2 of 2 Nr r 1rV V h— ``\����' ,`��jlrVlyJ^z , ST. CROIX COUNTY VV , VV planninq Zonlna and parks Committee ! * /;' TY R. ; DODGE c z_ o �✓' 68843 AUG' 2 o ZQO2 = S- 2484, utir "1 �OL 16 PAGE 435 CLEAR LAKE, -2 If not recorded within 30 days of "yam% approval shall be WI KATHLEEN H. MALSH approval dat R. .� REGISTER OF DEEDS / y .St1 RV�' nulI qnd void �, y �� rrr/1r111jjj111,11 " \\ � ST. CROIR CO., MI C E R T I R! E Q IS U R V E i M AL RECEIVED FOR RECORD Located in part of the Northwest Quarter of the Southeast Quarter of Section 28, 08 -28 -2002 9:15 AN Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. CERTIFIED SURVEY MAP being that property described in a Warranty Deed recorded in Volume 476 Page 531 REC FEE: 13.00 in the Register of Deeds Office for said County. COPY FEE: 3.00 NORTH 114 CORNER 200 PflGES: 2 200 Prepared for and at the request of: n SECAON 28 -31 -18 OWNER: / (FOUND ALUM /NUM r GRAPHIC SCALE John Hosley N COUNTY MONUMENT) 1058 192nd Avenue SCALE IN FEET: 1 inch = 200 feet New Richmond, WI 54017 I 3 EAST -WEST 1/4 LINE I EAST 114 CORNER Drafted by. Ty R. Dodge .SEC77OW 28 -31 -18 UN LA (FOUND ALUMINUM Z I S88 - 25 "E 5274.88 COUNTY MONUMENT) J I N S88'28'25 "E 585.00' L S88'28'25�633.31' 5' N88'2825 57 6 W V o 205. WEST f/ 4 CORNER I LOT 4 SEE NOTE "A SECAOW 28 -31 -18 Q ►�) (FOUND ALUM /NUM a I T67AL AREA LOT j: 00 COUNTY MONUMENT) az I 581,,358 SO. FT. M I 13.35 ACRES A AREA EXCLUDING R.O.1V • Q 3 577,777 SO. FT Q o n . 00 13 26 ACRES a' _ U (n o ]YiL. � ,I, In - 0 U N U J ]u�L� I W I o ° L ai �I U I Q W .d I ORO /NARY HIGH W.Q lER-� j ', N U> -� ° Q M, iv ,STARK- ELC1/A r N 4:.:.. 9 O c° m > � °oo� W ? N rn I ad / . TOP OF /ROW P /P£• U - U o n• cn a; E � f'LE A71GW 490.87 �Ma7 pl + ° ark p d N W ORD INARY HIGH WATER \ Q QI ° E o ~ =2 l ~ I • , MA K -ELEVA AAN 465.40 \\ 1 I 'c ° a m m 3 Z oI ° E c U M n O Q 0I E W WI N M N dI (nl N a0 �Z W N M •• �� WI m 3 N n. I W W F� WI I ^i—I M ^ ° a?va in Z W O I AL TOP .AF /RAN PIPE ` W I v `� 0 0 a W in cn , I * 2 I -1 I •ELEVA nON 465.50 I E c 0 (n in O = a! � :t N88'52'16 "E 343.8 8' QI 04 ` t ° ° U rD . — v W z i O Z� P b, 230.16' I 113.72. N ~O ° o, o M :3 W � I z I >� -' I L. w C4 O o0 TOP OF /RAN P/PE,-' I o n y m e ELEVA 77OW 466.93 O I O ''" • II r: o a U; Mao _ o► 9 TOTAL AREA LOT 5 •' a ,�i � CL 31 � p o N o 192, T. in 653 SO. F W .� 4.42 ACRES 11' N W �r uv W I'_ > AREA EXCLUDING R.O.W. 2 iV w c °n x W LOT 4 C.S.M. r 185,992 SO. FT iMV NO TH 0 a o W z VOL UME 11 4 �7 An' S z ►-° ° U �c 0 v N O PAGE 3183 : . . . . . . . . . . . . . . . . z 410 I ova w o a 1 S88'55'24 "E 84.98' 3 0 o a _� 376.9 208. (L a en — 378.08 _ o W — -I-- . -- N88'59'54 "W- 584.9906.9 c�v1 ie c/NE r- Q Ir 0 Z 192ND A VENUE UN£ OF 7HE NW 114 vii z = UN PLATTED LANDS M — — — - — — OF 7HE SE 114 zz o _j F UNPLATTED LANDS - - - - -- IFrFNn ORD INARY HIGH WATER MARKS Section Comer Monument d WERE ESTABLISHED 8 -20-02 of Record JOB 057SU91 . ro BY Sr CROI!X COUNTY ZOW/NG •P DEPAR7MENT. • Set 1" x 18" Iron Pipe weighing Prepared by. 0 1.13 pounds per linear foot z J Consulting Group, Ina SOUTH 1/4 GARNER O Found 1" Iron Pipe Phone No. (715) 246 -4319 SEC77OW 28 -31 -18 R= Recorded As Fax No. 715 (FOUND 3' D/AMEMRP, A Denotes Wetland ( ) 246 -3830 P.O. Box 325 6' HIGH /RON PIPE) ayildin Setback Line New Richmond, WI 54017 (iv� 0' fom Right of Way) Sheet 1 of 2 (75 from navigable waters) Vol-16 Page 4356