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040-1034-95-010
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Q0 b CD a o c t z e 0 =r 0 y o m o (n CD 0 0 b fD m N O 69 0 ti N ° g ° ° o a ° o CL • F Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count St. Croix , INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitay1n9jNo.: Personal information you provice may be used for secondary purposes [Privacy Law, .15.04 (1)(m)l. /VG Permi Holder's Name: ❑ City ❑ VP e Tow of: State Plan ID No.: Cernonous, Julia ro �wnswip f .- CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel �c,Npo34 -95 -010 too TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ��� ?�� QQ Alt. BM Dosing ST Co (D0. ?7 Aeration Bldg. Sewer Holding St/ Ht Inlets 4 11b" y - I G -Sq TANK SETBACK INFORMATION St/ Ht Outlet q(� , �S TANKTO P/L W BLDG. Ventto ROAD Dt Inlet �- Air Intake Septic < < ?�� h x NA Dt Bottom Dosing NA Header/ Man. �j (, q S" - 7 - 7 r Aeration + NA Dist. Pipe °{� �j �7 %y '] Holding Bot. System G / �;`' I 19 • 41 W PUMP/ SIPHON INFORMATION Final Grade � 3 'V A ManLq D and OVer p -7 100, 't Model N PM TDH Lift Friction System TD Ft ss H ead Forcemain Length Dia. Dist. well SOIL ABSORPTION SYSTEM BED /TRENCH Width — Length r No. Of �{ enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 d` Dtf N I N - SYSTEM TO P / L LQG WE LAKE / STREAM EACHING Manuf cturer: SETBACK _ CHAMBER INFORMATION Type o I t Model N ber: cps System: f OR UNIT DISTRIBUTION SYSTEM Header / ifpld rr r � Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. '7 Length �+ Dia. r '�� acing �— 70 / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over I xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil � ❑ Yes E] No El Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc. ) Inspection #l: V� /o?7/ b A nspection #2: Location: 480 Virgil Road, Hudson, WI 54016 (NW 1/4 NE 1/4 8 T28N R19W) - 082819112N -Lot 8 1.) Alt BM Description = ST CdW y- 2.) Bldg sewer length= - amount of cover = r >2 Plan revision required? ❑ Yes U/No Use other side for additional information. k e : Tp a I pdd� SBD -6710 (R.3/97) Date Inspecto 's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ---- e , �e ...... .. a F 3 e } 9 f , .. ° s E a 4 d � j � 1 ®tee E ° i E i i a ; 3 e i- c t E r ....... °.. t ° 4 k a 3 e> k I { E d�mK .... .. i S � t e .�.... � t' ,...,. � �. .. �.«. q �°�...,,....«� t 3 1 ¢v E t k e g a' l k i .a,.. . .... $ ° ° ., e .. .. .. ° ;- °m .. _ °. i P � b S P w � 1 € � a m .... k � t t E S E g Safety and Buildings Division SANITARY PERM[ SON 201 W. Washington Avenue NVAsconsin . f _ -; , _ P o Box 7302 Department of Commerce In accord with ILF1 ' 6 , ,V�r ABifla Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system,r0�9not less , County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application;Jtt4 State Sanitary Permit Number Z_ I Z Personal information you provide may be used for secondary purposes,_ >LrNz. Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. �,/ / t�J v.r � -/ �� s.+--= �.;���� c�`'FiC,E ,�' `» State Plan I.D. Number I. APPLICATION INFORMATION - PCEA SE PRINT A INF RMATI OW Property Owner Name � ion t 14, S S T Z , N, R 117 Vor) Property Owner's Mailing Addre� Lot Number Block Number City, State Zip Cod e Phone Number Subdivision Name or CSM Number cy vo f z P 3y7 11. TYPE OF BUILDING: (check one) ❑ State Owned o it Nearest Road p Village � — Public 1 or 2 Family Dwelling - No. of bedrooms Town OF rD 91 111 BUILDING USE (if building type is public, check all that apply) Parcel Tax Nu ber(s) �/ ; Z�. t Y, /� Z A/ 1 E] Apartment/Condo yo `' 163y 7 5 - 0/41 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. J& New 2. ❑ Replacement 3. [:]Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an - _____System ________ System _____________Tank Only______________ Existing System _,______ Existing --- - stem 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 Seepage Trench 22 ❑ In- Ground Pressure 42 [] Pit Privy L- 13 ❑ Seepage Pit Z 0 43 ❑ Vault Privy 14 ❑ System -In -Fill 3 Z gL4 k, Les VI. ABSORPTION SYSTEM INFORMATION: as ��✓ °� .� /+ 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 1 6. S��((stem Elev. 7. ( Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Y3 . S Elevation O� ✓ 000 /0/ o j ✓ -- Feet �8, 6 Feet Capacit VII. TANK in gaIIo s Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Exist in strutted Tank Tanks Septic Ta orlix�ak ZOO e,7 9 ❑ ❑ ❑ ❑ ❑ an r ❑ 1 ❑ 1 ❑ 1 ❑ ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatio of the onsi sewage system shown on the attached plans. Plumb is Name: (Prime Plumber's Signature: (No ampS) MP IMPRSW N o.: Business Phone Number: 71j- - 77 z — .?z/ Plumber/S Addresse�, City, Ste, ZiD de _ IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issui Agent Signature (No Stamps) Approved []Owner Given Initial Surcharge Fee) Adverse Determination -S, ©c) 3d U X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: Gaf;re (0c u�v 5�¢-�� �r,< �r.51`a(leG/ i,, s �;�s loaci�ealJ �.s /4 SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3_ All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requiresa Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed 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 Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. 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. III. 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 include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(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; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 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. I JOB cllr4s TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY Aa5 4 ,r I / DATE 3 ) a s (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE .......... ............................... ... .... .... ..... ..... ..... ..... .... ..... ..... ... ... ......i... 1 .......:............ . .....................`......... .......... —�,r ` .. .... .... ..... ..... ..... .... .... .... .... .... ..... ..... ..... .... .... .. .... .... .......... ........... ........... . ........ ............... ........ ......... I ............ ........... W ................. .................. .... ..... .... .... .... .... .... ..... ..... .... .. .... ... i ............... >..... .. . -�� .................. r ... ... ..... .. ..... .... ... .... S :...... `k ..:.. ............ .... .. ..... .. .. .... .. ........ >....... ....... i. :...... .... ... _ .. .. .... .... ........... ..... .... .. �..: .......... ....................5.......... ................... ..... ... ... .... .... .... ............................ .... .... .... .... ................ ..... ........... .. .... .... ll� ......... ... .... A j ..... .... .. .. ...... ...:.... .... ... .. '� ...... .... .... ... .. .. .. a ... ..... .... C�+ .................... �✓ 4 .........,.. �. ... tom, x'.... ; ,.. ,� �. - .. . .. .... .... .... ..... ... ..... ....�4J . .... ................ ................... z ........ ° .,... Cl . _ -. ... .......... .__. o ...... ... ... - -cam ud -►� 416 • , ... .... ✓j _ s ...... ... .. ..... x-- ....... PRODUCT 205 -1 Inc, Groton, Mass. 01471 . To Order PHONE TOLL FREE I -800- 225 -6380 Wis-,onsin'Department of Commerce SOIL; AND SITE EVALUATION Page I of 3 Division of Safety and Buildings in alrCdtil With Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 6% 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, and location and distance to nearest road. Parcel I. DA TY VI r y� APPLICANT INFORMATION - Plea R�TlT farmation. Revi y Date Personal information you provide may be used f ngiurparses (Privehy Law, s. 15.04 (1) Property Owner Property Location Cernhous Julia `! Govt Lot NW 14 NE 1/4 S 8 T 28 N,R 19 W Property Owner's Mailing Address —_� r r, , _ '"'-` = Lot # Block # Subd. Name or CSM# 455 CTHW FF 4 } 8 CSM Pendin City State a- Code S PI{o 98 ❑ City ❑ Village ®Town Nearest Road Hudson WI 3 ,0 ��& 6 -3476 Tro CTHW FF ®New Construction Use: Replacement ntial / Numlerof be 4 ❑Addition to existing building ❑ Replacement ❑ ic�4rq�r�je�c�al` 'be Code Derived daily flow 600 gpd Recommended design loading rate .5 bed, gpd/ft' .6 trench, gpd/ft' Absorption area required 1200 bed, fe 1000 trench, ft` Maximum design loading rate .5 bed, gpolft= .6 trench, gpolft' Recommended infiltration surface elevations) 94.5 ft (as referred to site plan benchmark) Additional design / site consideration a . nstall 2 - 3' x 96' Sidewinder, Hi capacity "turtle - shell" trenches Parent material sandy/loamy outwash Flood plai n elevation, if applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ® 8 E U ® S O U I ® S U ® S❑ U ❑ S® U ❑ S® U ' SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/fts Boring# Horizon in Munsell Qu. Sz. Conk Color Texture Gr. Sz. Sh. Consistence Boundary Roots Trench ......1....., 1 0 -9 10YR 3/2 - sl I m sbk mvfr cs If/m .4 .5 2 9 -21 10YR 3/4 - sl 1 m sbk mvfr cs lm 4 .5 Ground 3 21 -39 7.SYR 4/4 - is 0 sg ml cw lm .7 .8 elev 97.5 ft 4 39 -95 10YR 4/4 - s/mcos 0 sg ml - - .7 .8 Depth to limiting factor 3. > 95" Remarks: ................. 2 1 0 -18 10YR 3/3 - sl 1 m sbk mvfr cs If/m .4 .5 >: 10YR 3/2 - sl 1 m sbk mvfr gs lm . .4 .5 Ground 3 32 -58 10YR 3/4 - sl 2 m sbk mfr cs lm .5 .6 elev 95.7 ft 4 58-64 10YR 4/4 - is 0 sg m1 cs I m .7 .8 Depth to 5 64 -71 10YR 4/4 - A 0 m mfi cs lm .3 .4 limiting 6 71 -85 SYR4 /6 - s 0sg ml cs - 7 8 factor > 100" " `' 85 - 100 10YR 4/4 - s 0 sg ml - - .7 .8 Remarks: CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715 -665 -2681 Address P.O. Box 57, Knapp, WI 54749 Date CST Number Ref # 4/13/98 222774 290 PROPERTY OWNER Canh .tuna SOIL DESCRIPTION REPORT 290 Page 2 of 3 , PARCEL I.D.# Depth Dominant Color Mottles Structure GPD/fla Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. " nsisterice Boundary Roots Bed :Trench .....3 ' 1 0 -8 10YR 3/3 - s1 1 m sbk mvfr cs lf/m .4 .5 2 8 -24 10YR 3/4 - sl 2 m sbk mvfr cs lm .5 .6 Ground elev 3 24 -30 5YR 4/6 - sl 0 m mfi cs if .3 .4 98.6 ft 4 30 -36 5YR 4/6 - is 0 sg ml cs - 7 8 Depth to 5 36 -96 10YR 4/4 - s/mcos 0 sg ml - - 7 8 limiting factor Q 3, > 96" b (, z �Z Z Remarks: ......4 1 0 -12 10YR 3/3 - sl 1 m sbk mv& cs lf/m .4 .5 2 1 -28 10YR 3/2 - sl 1 m sbk mvfr gs lm 4 5 Ground elev 3 28 -57 10YR 3/4 - s1 1 m sbk mv& cs IM .4 .5 97.0 ft 4 57 - 67 l OYR 4/4 - is 0 sg ml cs - .7 .8 Depth to 5 67 -72 l OYR 4/4 - s1 0 m mfi cs - 3 4 limiting factor 6 72 -93 5YR 4/6 - sl 0 m mfi cs - 3 4 > 99" 7 93 -99 7.SYR 4/6 - s 0 sg ml - - 7 8 Remarks: ...5...`` 1 0 -14 10YR 3/3 - sl 1 m sbk mv& cs lf/m .4 .5 2 14 -33 10YR 3/2 - sl 1 m sbk mv& cs lm .4 .5 Ground elev 3 33 -59 1OYR 3/4 - sl 2 m sbk mvfr cs lm .5 .6 96.7 ft 4 59 -77 7.5YR 4/4 - mcos 0S8 ml cs - 7 8 Depth to 5 77 -100 10YR 4/4 - s/mcos 0 sg ml - - 7 8 limiting factor qy a; 3. J > 100" z `z.y Yy Remarks: oversize system to account for moderate sl at depths ................ Ground elev Depth to limiting factor Remarks: II r c 4 f d a CA 3 f � • �i ,�r '4 9 0 3 j_ e ,► gi r J "' Gll c + o u P ci d c3 .3 n d cl J r s � G J f 0 �a d M 3 90 ri o 0 g A - . ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer - u- - C"" LL4 Mailing Address V Y J :1 Are - Property Address (Verification required Planning Department for new construction) T City /State d,,-,Lm LJ Parcel Identification Number / (2 - ''5"- 6 1 0 LEGAL DESCRIPTION ,, �� Property Location � -%4, /Uri '/4, Sec. . TN -RW, Town of Subdivision . Lot # Certified Survey Map # �';' l gr , Volume C Z , Page # 3V7(o Warranty Deed # 5��/51 , Volume /07 , Page # Spec house ® yes ❑ no Lot lines identifiable a 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, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system ism proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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. GNATIM 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. GNATIJRB 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 TERMINATION OF DECEDENTS PROPERTY INTEREST • Joint Tenancy or Life Estate Termination [s. 867.0451 or _ • Summary C onfirmation of Interest in Property [s. 867,0401 REGIS S CF FiCE EAugu e ST. CROIX CO., W1 , Cernohous Pec•dforP - ord ert a Dam d Nair CRY Slte 21p ty Road FF Hudson WI 5401E MAR 2 51994 Social sscuily Nunber at 8.30 5, 1991 387 -42 -1549 7Ce* Iq 1 � 1A�M�rdDlNda Aresentotion of Math Certificate 1 m 1 have vwved a certiW = Z ZLEA Cs death certificate. �Ad� Ca �' This Interest In real estate Is terminated nder (check one): Record s, a joint tenant,* lo the this �� #with the Regist b of Dee. X s. 867.045 which pertains to real property in which the decedent wa mortgagees interest, or had a We estate. • ding A i * two ttb reel estate is bW7.;�ts; had a vendors or *(You trxist Prt�� a tAPY d Records A n is t25 as per s. 867.045, 867.f}1i the deed establishing joint tenancy:) Return to: s 867.046 which pertains to (1) real property of a decedent specified in a marital property agreement, and also to (2) survivorship marital property. (You must provide a copy of the deed establishing survivorship marital property.) Presentation of real property tax bill. Present with this document a copy of the real property tax Dill for each parcel for the year imrrediatety preceding decedents death. Presentation of deed edWAsI ft Joint tenancy or arrvivorship marital property. 1: 663 1. 399 This deed a bond in vokxne/red 2. 479 page/image 2. 255 ol ( o pAwrds X Di Description of the now estate. Awkide &* the extent of ownership for vendor or mortgagee's interest) in land at the tune of the decedents death. It the extent of land is exactly the same as on the deed, a copy of the deed may be attached to describe the real estate. The legal description of the property is as follows: (h more space is needed. attach pages.) See attached sheet for legal description. DECCARATKW I. we declare that this document is, to the best of my ( our) knowledge and belief. true. correct and complete and is in conformity with the provisions and limitations of the Vifisconsirt Statutes. N more s e is needed attach Name and Address of Person Receiving Property Relationship to Decedent a (Notarized) Date Julia Cernohous 403 Highway 35, Lot 26 Spouse 3 -n-4 Hudson, WI 54016 AUTHENTICATION or ACKNOWLEDGEMENT �/ The above named person(s) was sworn lo biter. me on (dell) 3 - 2 z , � 7 This document was drafted by (print or type name below) Signature of r"" or other pen Q • _ aurtarizect b adntirtieMr an oath Joseph D. Boles - Attorney at L aw (as ps 706.06,706.07) printar"nwm J oseph D. Boles slat d wisaanin, Cmx*y d r i t4C,9i ..-_____ � e... .....�.,.n__._.__.r:_.u_e.� -.•r .......,.,, r.�v_ �-'--- n_.t��_ r..,.� �:.,., -• °Yy is normsnunt NUMBER Vot 1070PAU 39 1 8, 4 0 9 RIVER VALLEY ABSTRACT & TITLE, INC. ST. CROIX COUNTY, WISCONSIN Part of the SA of NEk of Section 8- 28 -19, described as follows: Lot 1 of certified Survey Map filed April 18, 1983 in Volume "5 ", page 1273, Document No. 383971 (No. 57). 220 LOCUST STREET P.O. BOX 149 HUDSON, WI 54016 i ALL OF THE NORTHWESZ QUARTER OF THE NORTHEAST QUARTER (NW$ OF NEk) OF SECTION EIGHT (8) LYING NORTH OF THE FOLLOWING DESCRIBED LINE: Commencing at the North quarter corner of said Section 8; thence S 00 0 09'52" W 1322.51 feet; thence N 90 "00'00" E 1326.73 feet to the Southeast corner of said NWk of NEt of Section 8; thence N 00 ° 10'39" W on the East line of said NWk of NEt 476.0 feet to the point of beginning; thence N 90"00'00" W 657.99 feet; thence N 00 "00'00" E 71.34 feet; thence N 90 ° 00'00" W to the 'lest line of said NW# of NEk and the point of beginning. ALSO THE SOUTHWEST QUARTER OF THE SOUTHEAST QUARTER (SWt OF SEk) OF SECTION FIVE (5), EXCEPT commencing at the center of said sectton 8; thence North along the quarter Section line 1675.42 feet to the centerline of C.T.H. "FF" being the point of beginning; thence North along the quarter Section line 1000 feet; thence East 85.0 feet; thence i South 1068.56 feet; thence N 54 O 32 . 00 1 W 104.36 feet to the point of beginning. ALL IN TOWNSHIP TWENTY -EIGHT (28) NORTH, RANGE NINETEEN (19) WEST. St. Croix County, Wisconsin. I FILEE) JU y 2 9 1998 ► KATHLEEN H. Wg1SH Register of oeeds St. :81914 Croix Co., M '' I CERTIFIED SURVEYMAP Located in the Northwest 1/4 of the Northeast 1/4 of Section 8, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. a (R N058'52 "W ) S89°58'52 "E OWNER / SUBDIVIDER 85.00 2568.47' 'r J. Cernohous N North line of the NE1 /4 Section r 455 C.T.H. "FF" N 1 / 8 Hudson, WI. 54016 co Section SCALE IN FEET 1" =150' 8. 0 0' 75' 150' 300' 450' rd N CURVE 1 CURVE INFORMATION UNPLATTED_ LANDS OWNED BY PLATTERS Radius" 80.00' — — — — — — — — — — — — — — CURVE 1 Delta- NS N 89° 47'38" E 549.54 Chord 1$4,46' Arc�le gthh- 34 925' Tan. in- N00 W48"W OUTLOT 2 an. out- S6n, 8'28"W col LOT 7 .237.86'. CURVE 2 130,779 square feet W N ,. ti N ( 3.002 awes) �. ; �„ ZS.. Area of Outlot 2 = -di rt C71 W to $ ' ' A m �7,$52square feet (0.639 acres ) -Qj � U — � 0 3 N 89 47'38" E 550.09 66.00 20_11_ — W W I - S89°4 56 "W U LO m x .6 6 c� A Z $ V UI �I LOT 8 N ; � — URVEY MAPIFI — 130,910 square feet `' 3.005 acres ) VOLUME 10, PAGE 2853. N ( r 246.33 S 89° 47'39"W 550.64 �- ( R N9"0'00"E 583.55') 33.00' j LOT 1 I LOT 2 I S: i I I 3 3.W CERTIFIED CERTIFIED SURVEY MAP VOLUME 5, PAGE 1385. LEGEND Bearings referenced to the North line of the NE 1/4 of Section 8, indicates 1" iron pipe found. assumed S89'58'52 "E (previously • - recorded as N89'58'52 "W.). o - indicates 1" X 24" iron pipe CURVE 2 weighing 1.68 lbs. / tin. ft. set. CURVE INFORMATION Radius- 80.00' -40- - indicates section corner Delta- 65 86.72 _ N Chord- 86.72 monument. ( Berntsen cap) S32'�9'20'V Arc length- 91.65' (R) - indicates previously recorded Tan. in- S65 "W information. Tan. out- S00 GRANBERG SURVEYING 1239 C.T.11. `E" New Richmond, WI. 54017 Phone ( 715 ) 246 -7529 This instrument drafted by Joseph W. Granberg Job No. 98 -006 SHEET 1 OF 2 Vol. 12 Page 3475 i Parcel #: 040 - 1034 -95 -010 12/09/2005 11:37 AM PAGE 1 OF 1 Alt. Parcel #: 8.28.19.112N 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner PHILIP C CERNOHOUS O - CERNOHOUS, PHILIP C 475 VIRGIL RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.005 Plat: 3476 -CSM 12/3476 SEC 8 T28N R19W NW NE BEING LOT 8 CSM Block/Condo Bldg: LOT 8 12/3476 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 09/26/2005 807579 2896/297 QC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 102270 62,900 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.005 60,500 0 60,500 NO Totals for 2005: General Property 3.005 60,500 0 60,500 Woodland 0.000 0 0 Totals for 2004: General Property 3.005 60,500 0 60,500 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 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 95 a GENERAL INFORMATION (ATTACH TO PERMIT) state Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Cernohous, Julia Troy, Town of 040 - 1034 -95 -010 CST BM Elev: Insp. BM Elev: BM Description: SectionITown /Range /Map No: 08.28.19.112N' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing . 2cb Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM �- BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 E] Yes [] No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 480 Virgil Road Hudson, WI 54016 (NW 1/4 NE 1/4 8 T28N R19W) NA Lot 8 Parcel No: 08.28.19.112N 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? I ] Yes jxmfl No'i i Use other side for addifional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Parcel #: 040 - 1034 -95 -010 12/10/2007 04:24 PM PAGE 1 OF 1 Alt. Parcel #: 8.28.19.112N 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - CERNOHOUS, PHILIP C PHILIP C CERNOHOUS 475 VIRGIL RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 480 VIRGIL RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.005 Plat: 3476 -CSM 12 -3476 SEC 8 T28N R1 9W NW NE BEING LOT 8 CSM Block /Condo Bldg: LOT 8 12/3476 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 09/26/2005 807579 2896/297 QC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 208538 149,900 Valuations: Last Ch ed: 08/24/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.005 60,500 73,200 133,700 NO t 7 .l .. Totals for 2007: C General Property 3.005 60,50 ,200 133,700 Woodland 0.000 0 0 Totals for 2006: General Property 3.005 60,500 18,000 78,500 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 , I1I County Sanitary Permit A lic ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sa itary CRKP� IVE® ZONING OFFICE Personal information yo ravid ay used f r secondary purposes ST. ROIX COUNTY GOVERNMENT CENTER G [P S.1 04(1 1101 Carmichael Road 1 o, (1c, ���' Hudson, WI 54016 -7710 (715)386 -4680 Fax(715)386 -4686 Attach complete plans for the system p r not If G0WNTYnche in size. County Sanitary Permit # ❑ Check if revisi to pre$rM 1. Application Information - Please Print all Information Location: Property Owner Name r 1/4 /tf� 1/4, Sec 8 T 7 N. Af R /q (or) W Property Owner's Mailing Address Lot Number Block Number 1Z I r 4' 1 if 4 City, State Zip Code Phone Number Subdivision Name or CSM Number � ��olta ?15 - 38(" 7z 3 5g .� t/I Z 3y76 11 Type of Building: (check one) ,/ Q,,,,, / amity ❑ Village JKTown of X 1 or 2 Family Dwelling - No. of Bedrooms: �r9�fAQ ��^� El Public/Commercial (describe use): i ❑ State -owned Weal est oa II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) v 1 !!ij ti Parcel Tax Number(s) A) 1.0 Repair 2. K Reconnection 3. ❑Non - plumbing 4. ❑ Rejuvenation r Sanitation o ` �3 — � _ d!U B) Permit Number Date Issued ❑ State Sanitary Permit was previously issued 6 - T 06 IV. Type of POWT System: (Check all that apply) / Non - pressurized In- ground ❑ Mound ❑Sand Filter ❑ Constructed WetlaJGrade El Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating 11 Other (v V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation 6W ")Ov /oil, . 59 �' s 981�e I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks a 4d 'S C, O ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ II. Responsibility Statement 1, the undersigned, assume responsibility for repair / reconnenction /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing sanitation system. Plu ers Name (print) Plumbpes Signature (no. tamps): MP / MPRS No. Business Phone Number V ��- 2 Z ! - 3 z� Plumb is Address (Street, City, State, Zip Co ) 31 Zg 11 �J `! �y�z III. County Use Only Disapproved Sanitary Permit Fee Date Issued Issuin Agent Signature (No stamps) t< Approved El 0 er Initial Adverse Determination / © 27 2'tc IX. Conditions Approv SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 1 2. All setback requirements must be maintained as per applicable code /ordinances. J JOB 344 e 2 xe a ho e� TIMM EXCAVATING Route 1 Box 192 SHEET NO. OF WILSON, WISCONSIN 54027 CALCULATED BY er DATE A-2 �5 —�✓%� (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE i i i ..................... .. ..... ......... .......:. ...... ... .... ..... .... .... ..... ..... ..... -... ..... .... ..................... . -... ..... ..... ..... .... .... .. -. j �: i [ � r .:........ ........................... .. ..... .... ... 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OF Route 1 Box y 540'7 CALCULATED BY DATE 192 ,� jD WILSON WISCONSIN (715) 772 -3214 (715) 386.5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ......... . ....................:.......... d ........... .... ..... .... ... .... .... ..... ..... ..... ... ..... .... ..... .... ..... ..... ..... ..... .... .... .... ..... ... .... i .......:.'........... i... .......,i...........i.......... i ... .... .... .... .... ..... ..... ..... .... ............ . . .. .... .... . .... ..... ..... ......... .... .... ... ..... .. .... 1 i i .... .... .. .... ................................. ........... ........... ... ................ ........ ....... .... ............. ..... :... .. 1 e_ T l :............................ .....:............i..........5. ..... ........................ ............................... ..... .,.. , i i y .... :�'�`� r i i i ... .. .... .... .... .... ..... .... ..... ..... .... .... .... ..... ..... ..... .... .... .... ................!.... ` : .... .. 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