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HomeMy WebLinkAbout042-1053-20-400 0 to O 3'o n m o c > > ° ,. co a c ° 5 , o A y o .� n p�j N [ (D � CD N N f0 CO 0 a 0 N � r ��� C (D 0 C C- G1 -0 0 O m f O O O c O 7 7 Nl W U) C tD ° cn v D a K m cQ w a cc D ' po co O °o° o-4 w "I m oZ o°\o w a i N N D O O c D N N C N Q ° CD III 3 v I o 0 0 0 m 0 A 2 (A 'D 0 � fn fp f/l � I O D CO C N f0 N 3 m w 4 Ia N M z w z Q D o' O w O p ' s • U) lr ° y (D m (D ; N i c m I Lo - n 2 - 3 ° o (D D (6 -1 N CD V) c M w a A GZj _. W m M co co 0 A A C '► M OD M C w U) Z < m A � I I " w D CD y a I B v c N C1 - C L Z C O_ U1 O cl N CD O N t N -N O n O O O O V O � O 7 n � N cn A N O O a < N N N CD o =ra A 0 w 0 CD oo w CD A ti Fn O ° O � �' C FILED MpR ' 01 c►c T 0 S 1999 ► 4 KAT+«N w 1ai.5'7`7 ReQfs,2rof D ol, ST, CROIXC RECORD E, Croix Co S SURVEYOR S �at� UNPLATTEdW Z�'q p ,o O -- LANDS �N t�n� shb 3333 A > 0 P 9 rn 0 1 'o �s2s' � � p �'o � 0° �,d to � � K1� O ff ► �N p p _i ' � N N N / � m m .A I' O w tO -1 2A O ° - r"A m �� �rn w D *3 ° sX 0 9 0 \'_ y . �_ O - � c M IC m wo 0 ��\ �' ��:A �"� �F 5 01 f11 z t�7 lO p / N m IW v M �`/ = ` ci ��� y C oy cs bb M tri �! / W_ i ZV toy ` 0 �N y 5Z'St'ti M ..Z£ 100 000 S a " r+ 6g \ 0 co 1 io I W r i iv �, 6.6 v -► p 0 116.5 � 0" O�r"gz�g0 'q� BMW 00 °46'32 �i n�'C a a a _ a � a c yy a a a °� m 0 C11 N~ ' Cnb Z r — I MI � O �Fri �oy IC cn co N I m $ SAo I Z C � N eq O � � � � � � � � I rTl GOi D -I m v � n! � " 00 0 9 0 O 0@ l r55 '0 z y r N I °! M— M M C4 +n p a tdp m l m' (I%) I z s w m z I O O I i vo 1N 24 CA Co o � m I I N 00° X46' 32" E APPROVED = CO ml� sT. CROIX COUNTY ° n I p m" co 1 y °D I Planning zoning and Parks ConttA' D co M w .L>�'86Z I I ;�, N v m Cti r M °Z£ .9ti °00 S ! v it t°iv v C OCT 0 5 1999 0_' �' O ��I (0 8 Aoo �� 2 T ('1 N " "W r- I D •^+�1 D If not recorded within 30 days m t=rl N rn O� Q n '' (� m N v o approval date approval shal9 m v ..,� D C y �� 4 cn -n .� I: null and void '� m ° b ° v v v , p " m ~ v R ' r" VA I f j --I m I m ly co N M '�" m I ,Z'F 6 L Z 294 4 M ..Z£ .917 000 S M 0 N b z o S 00 46' 32" W - m cj > M (9 UNPLATTED LANDS C m � C rr-0 N o �9 ' __j ° o OWNED BY PLATTERS n - 0 o � _ W� - — - - - yz to .� nZ O C� - tD 1321.37' S 00 00'29" E 1,321.37 2642.74 L EAST LINE OF THE SE1 /4 THIS INSTRUMENT DRAFTED BY: JOSEPH W. GRANBERG SHEET I OF 3 �� %1M 112 Dtinn Z711C. f Cl) y 0 m a n d [� O C O A �< A CD gk •k O of O O Q (D n N N) fQ L O W N CA , 3 ' ° O co CL y C O O to m cn D ti CL a c0 C C� ° V ' CL = 4 CO V W 4 D �1 Z c < N 3 T 0 ! h CD O O O //yy�am,� N o A D vQ (A co CD C W A rn N D D 0 O O T !�I CD c N C N N d m c p -4 U1 a A z 0 I Z � W m cc CL Z g I A � °o � M w IA Z � A A � I Q c Q G I v o a CD I I a I 4z I � ti I a N p A 0 W O_ CD < d0 A O ffl Q ° o CL ti I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 408216 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information YOU provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Albright, Jim & Shelley Warren Township 042 - 1053 - 20-400 CST BM Elev: Insp. BM Elev: BM Des cripti n: - TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / / / DO Ben mar ( f Dosing Alt. X . 3 rl r o I Aeration Bldg. ewer i OS-S� 7• dS Holding St/Ht Inlet / G TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Ve t�Air Intake ROAD Dt Inlet /J6 Septic] � I Dt Bottom Dosing Header /Man. / o-60 ?� Aeration Dis 444- / It. " k y -�3 Holding _ Bot. Sys %m Final Grade PUMP /SIPHON INFORMATION Manufa urer and S> ver q Model Number TDH Lift Fri Los System Head TDH Ft Forcemai ength Dia. Dist. to Well SOIL ABSORPTION .SYSTEM BED(TRENCH Width k / Length / No. 0f Trenche PIT DIMENSI NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' C SETBACK SYSTEM TO J P/L 1611PLDG IWELL 0 LAKE /STREAM Manuf ��l urer: INFORMAT ION Typ Of System: �� J/ Model Num1b�� r / 12M J DISTRIBUTION SYSTEM Header/Manifold I Di str ibution � x Hole Size ! x Hole Spacin Vent to ntake A Pipe(s) /!/S � � Length Dia Length Dia pacing 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 L _] No � =, Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: dP/_V_ Inspection #2: / / Location: 987 83rd Avenue Roberts, WI 54023 (NE 114 SE 1/419 T29N R18W) NA Lot 4 Parcel No: 19.29.18.301 40 1.) Alt BM Description = !0 p sft KAOs4' COi . � 2.) Bldg sewer length = 2 - amount of cover = > ,L + Z of Plan revision Required? Yes o �- Use other side for additional information. L_ SBD -6710 (R.3/97) Date Insepct s Si nature Cert. No. W/A ��7 �sb \ j ` c41 °° flu u0 � v t� ru� 41"m Safety and Buildings Division County N 201 W. Washington Ave., P.O. Box 7162 V%iconsin Madison, WI 53707 - 71 ss t � De artment of Commerce V p p �- �3 TY 18q g 3 i2D � — Kb 1 Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, rsonal information J you provide - Pe Y p 2 7 0;?4U if Revision NC21 maybe used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number i It not recorueu w ihii? 3u F;r operty Owner's Name null nn r �m sh�t1� \ b ►�� h a 2 -ios3 ,2a jbo Property Owner's Mailing Address Property Location L O 7eY Y CS (D' S+. N % St; 'A, S f T 39 N, R 0 L - City, State Zip Code Phone Number Lot Number -T Block Number 6140 a 3 Subdivision Name CSM Number &/ / ,5 - - 7 7 H. Type of Building (check all that apply) ❑City 1 or 2 Family Dwelling - Number of Bedrooms / ❑Village ❑ Public /Commercial - / ascribe Use , " / 1 " " " o�hip a V ❑ State Owned - C�L��y�W`�� F2G��(,c {/u— 1 �� Nearest Road 9� 02 3 2 83 l_d AV 1 III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 4 New 2 ❑ Replacement System 3 C1 Replacement of 6 El Addition to For County use S stem Tank Only Existing System B • ❑ Check if sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ,CCA , - /0 i 3YO�A 7 . 1 44 � Non - Pressurized In- Ground 210 Mound 47 El Sand Filter 50 11 Constructed Wetland 61SA 22 Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 3�•y/ �w 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other / Z CD ; 31. / = 36 S `I V. Dis ersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Z Rate(Gals ./Days /Sq.FQ (Min./Incb) 7 „ 1 Elevation t 660 �"Y .S - 9 3�.D - VI. Tank Info Capacity in Total Number anufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks � /� Q �/�1 (� G✓ Concr Constructed Glass New Existing Tanks Tanks - e,� =l"/ � Septic orifeldi* Tardt-. Aptoo We is - Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl is SignaV MPA�ber Business Phone Number Tktc cS+et (' aas4/SI 7 y2 SSL Plumber's Address (Street, City, State, Zip Code) N 8'a 3o o1 y S - � - Fa!li , Gel z s o Z VIII. Coln /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued su Agent Signature (No Stamps) - Surcharge Fee) ❑ Owner Given Initial Adverse . C� Z 2 S , D Determination IX. Conditions of Approval/Reasons for Disapproval p�� o - �� ��• 3 Attach complet plans (to the County onlo fir the system on not less than 81/2 x 11 In size SBD�6398 (R. 05101) _ t , I rz N a 12S J ! 1 ko y Wisconsin D9partment of Commerce SOIL AND SITE EVALUATION ^� Division of Safety and Buildings Page of .S BureaV cf Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plaa pmt .. , County include, but not limited to: vertical and horizontal reference point (BM), di4 and''' , percent slope, scale or dimensions, north arrow, and location and dist�rYCeYO DeSF6st road. reel I.D. # APPLICANT INFORMATION - Please print all info' tin. '- geuie�we y Data Personal information ou rovide ma be used for seconds oses c Y P Y rY Purp ( Priv Y w, s. 15.04 (1) m 3 t" rl 7l Z� G i Pro ertty Owner ,+ - Pro a ,"ation GdX y 3y'v C. ,.i /4�Ye:1 /4,S �9 T a9 .N,R /F -6 r & Property Owner M Address °' . �. / M i R / dC: �6b # 610d. Name or CSM# IrJK V O Ae i / r! / I V Q3e C State Zip Code Phone Number cam`... ❑ village Town Nearest Road i w4 1 5`XW3 (76r ) 7S/ -3n?�� t c� 80'` /5ve ® New Construction Use: DiResidential /Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate _ bed, gpd /ft trench, gpd /ft Absorption area required Y - - 00 — bed, ft 0 ^trench, ft Maximum design loading rate g g bed, gpd /f1 . _ trench, gpd/ft Recommended infiltration surface elevationn(s) s� � e 3 ft (as referred to site plan benchmark) Additional design /site con ff < considerations rP�„cAes /Vcc ,P,p,...�e� e - c,&_se d /C S Parent material G lc- �� 6 .1WCL5 /�� k Flood plain elevation, if applicable / �f ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system [rS E] U [M S El u as El U [as El U I ®'s El U ❑ S R U SOIL DESCRIPTION REPORT , Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench l i - /1 .4 Ground _ , S" Iz �/� © 1'? �✓ elev. WI -ou 9,a o vo e s/A/ - ---- -- S . Depth to limiting factor ,9�in. I° L Remarks: Boring # r/ / ms6 1-) Ground elev u ;L . o go, limiting factor factor / t in. Remarks: CST Name (Please Print) j� Signature Telephon N 7 Address Date CST Number PROPERTY OWNER f<�6/ i SOIL DESCRIPTION REPORT Page - � of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench a 7- / O K9 9 tj Ground j 7,S S�/ --.r. afi� 6� k- ' el v Depth to limiting t}b $ 1 $ 3,o — � � ctor in. > 3 Remarks: ` /; ouf 7 5� /Yo�,'Zr,, awe "��ds c� lyywo/Al .5Z •�i»S6/� Boring # Ground - e0 L7 3/ L: '� 2 ,66k 9 !.J �jelev. // / Depth to limiting factor in. ReXa Q k s: o letlr3/V s, A, S -4 4, Ae'- O" Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground ! 3 /0 i"r v elev. 16 ft. S 10 vX C/A Depth to limiting fa for 9 �f in. Remarks p�5 tl' �df 3/Y aZ A Boring # Ground elev. ft. ' Depth to limiting factor -- in SBD -8330 (R. 07/96) i - 3�.3 I o - 9_a% in Poloar -free co' d �� y - - Ai C� er � � es Su s e -- s onel .�. -- All- � I i I i ('Ght1 r v rC�•�1J � ' � 6 /'� ►mss' �✓' �' 27 -f I I I t I I , I t. I I I I I I , I I j I I I I I , r I , r r I I � � r I 1 I ' I I , i I I ' r � I ! I I I I I , , I L ' I 1 I If I I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa J of Z ' FILE INFORMATION SYSTEM SPECIFICATIONS Owner E - d S Septic Tank Capacity X00 (p06 al ❑ NA Permit # Septic Tank Manufacturer �QIS �r ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer b ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A - Mo ❑ NA Number of Public Facility Units l NA Pump Tank Capacity a l A NA Estimated flow (average) - 6 - 6 gal /day Pump Tank Manufacturer C9 NA Design flow (peak), (Estimated x 1.5) &00 gal /day Pump Manufacturer A(NA Soil Application Rate ..5f gal/day/ft 2 Pump Model Or NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit :4 NA Fats, Oil & Grease (FOG) :_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L X In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510" cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other. ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: p month (Maximum 3 years) ❑ NA ump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA fnspect dispersal cell(s) At least once every: p mon 1(s) (Maximum 3 years) ❑ NA lean effluent filter At least once every: ❑ m ❑ ye aars) r( ) ❑ NA s) n out ❑ yeaar(s) r(s) p, pump controls & alarm At least once every: ❑ m 1 NA Flush laterals and pressure test At least once eve ❑ mo year(s) NA P every: ❑ yearlsl Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the 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 notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. GMW (4/01) / START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative 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(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls 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 disturb or compact, the area within 15 feet down slope of any mound or at -grade 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; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly 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 filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: • 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 structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as 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. • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions 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 TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Sf Plh�r J D/ u4bt k , , 15 c ,ZIN Name Phone 71f 1 -12 1- � All Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Da re & S e 40 fA Name Phone 7/ /p Z Phone - This document was drafted in compliance with chapter Comm 83.22(2)(b)11)(d) &(f) and 83.5411), (2) & 13), Wisconsin Administrative Code. 08/22/00 FRI 14:46 FAX T1S 386 4686 ST CRX CO ZONING tool ST CROIX COUNTY SEPTIC TANK MARUMANCE AGREEUMW AND OV44EPSM CBRIUICATION FORM Owner/Buyer Mailing Address �� I�(J _ 5,qoc Property Address I Z cativn required from Ptanmg Department for new r�sa,rction�, GVty/State otk t Parcel Identification Number L99AL DESC.RVUON Property Location AE %., , ' /,, Sec. T_a N -R _&W, Town of \bAT - Subdivision . Lot CertMed Survey Map # Lk . Vohune . page # Warranty Deed # "A 9 4 J . Volume „� Page # Spec house 0 yes M no Lot lines identifiable yes Q no SYSTEM Improper use and mainteasoce of your septio system could result m its premature faiWre to bandle wastes. Proper maintenance eoasises of pumping out the septic tank every three years or sooner. if needed by a licensed ptanper. What you put into the system can affed the further of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Ooix Zoning Department a OeMcatiOu form signed by dw owner and by a mswphaaber, journeynaa phanbm mkicted plwsuber or a hc=WA pumper vectfYft tut (I) tub ott W"terovate *Vosal system is in props operating condition aodlat (2) after inspection and pia Ting (if necessary), the septic tank is less than 1/3 full of sludge. LVe, the undersigned have read dto above re"=wcats and agme to maintain the private sewage dMMI sysm6m with dw standards act forth, herein, as set by the D6parUwM of Commerm sad am Deparameot of Natural Resourcm Ststa of Wisconsin. Cetti�n dating that your septic system has been waintained must be cmVletsd and whaned to the St. tCrotuc Co unty Zothing Office within 30 days of tie time year expiration data. /0 SMATURPF AJM DATE OWNER CERTOCATION I (We) cutify that all statements out this form are true to the beat of my (our) knowledge. I (we) am (an) the owner(s) of the property desm a ve, by virtue of a wamnty deed mcotded in Register of Deeds Offtoe. !{ 1 SIGNATU APPLI DATE Any infonaatioa that is mis-represented may unroll in We csaituy permit being revoked by the Zoning Department• " Include with this appUcatioa4 a staaspcd wmntq deed fkom the Register of Deeds office a copy of the certified survey map if tefetepoe is trade is 1116 warranty deed ., � co !! 3 FLED 0l OC r o 5 1999 0 , h KAT Of D RoOister of E SL Croix Co, S bd UNPL ATTEd , tb z - - - N m O LANDS y 5� I .� 3? � mz r � 0 0 . 3 3� � A � En N plC,M � N m N� 9�N r ICO 0 1526, C o .a 20, 00. ' s O C4 17 pw �0I ° N =m \ \N O -� rj r CD C u, J i w z �. ��,� O� �Q O s,. z m R, 0 Z: 0 CO - n ,w M � . �; mo < , m e CD w. / Zt�'LOti n \N s M Z6.00 °00 S � � IL p ° � y w` l 0 ° 6 _ 4' 20 cl) -' ID Or ! ^' 116.5 ' �'- 6.63 � con b D _ _ _ d O C1z�C7 mmW �£ 00 °46'32�E lC nC C C9 1 y �0 -n mmy c v ml W b ow �v' c cn IC CO Z bpi - r Cv w p ���►� m rn y p o Z O co c �" ° cn ° n c lo y o I� = co v Ao z co ncl CDmvrn w t7d 'bL oo Z O I r w p I m c I� j m K, m zj -n co D cn � ' �rn m I m ' w lw l M- , -' BIZ 0 � 'b c,, m z OO Z A I O r . I -+ i �; 1N 240.00' 00 T I� o� APPROVED N �Z m w I moo °14s' 32" E m m ST. CR01X COUNTY cp Planning Zoning and Parks Conti a I (q m w Lti'86Z I ! c � N � ° v ° v - Z i 12 � b. r M„Z£m? °00S ! . Nco w c m o N N ° _ Z n Nrn OCT 0 5 1999 l w0 c) 0w rn X07 D c ° S If not recorded within 30 day} m = w �� V Z n N I � approval date approval shalg m m D p i i. m' null and wid t m D pp (J) m D m v m I �l -� m C) m Y m ' ! Zti' 61 i� z -A. z O 294. 4 " \ �. �, M "Z£ ,9ti °00 S �� ;U 0 0 �Z o S00 ° 46'32 "W co Z co m z O y D m N 0 c m UNPLATTED LANDS pxCd r- tv - - - - - - CO m o OWNE=D BY PLATTERS � = Ile' O - ca -' - - - -- - - - O O D ? o ry z !32!.37' S 00° QO' 29" E 1,321.37 � 2642.74 �l �- EAST" LINE OF THE SE1 /4 TMS INSTRUMENT DRAFTED BY- JOSEPH W. GRANBERG SHEET 1 OF 3 Vol. 13 Page 3746 u _r U7 i=1:3 A3A . W N = "S� x •. r q O+ W �C W LLJWO WF � 1 L. t ~ JGQU F py "r> ���js cn {nf C7 • � t)WUt��I --OC YIQWF- Y OC Cn CERTIFIED SUR VEY MAP Located in the NE' /4 of the SE 1 /4, the NW '/4 of the SE 1 /4 and the SW '/4 of the SE 1 /4 of Section 19, T29N, R18W, Town of Warren, St. Croix County, Wisconsin. CUR IN FORMATI ON CURVE LOT CENTRAL CHORD CHORD ARC NO. RADIUS DIS T. _ 8EAB IG LENGTH TANGENTS C-1 634.00 20 12 2.22_.22 N7U UI 44 W 22 3.37 N59 ° 56 08 W N80 °07 20 W C -2 3 667.00 18 °3328 215.10 N70 216 N61 °33 5 2 W N80 ° 07 '20W C-3 BNDY. 533.00 3 , 9 0 y9 56 361.6 7 N35 " E _ 368.99 N 15 0 26 21 E -- - -- - - -�..- -- - - - - -- -- - -- N 55 17 E C-4 BNDY. 333.00' 35° 40'15" 203.99 ' N 72° 5 6 '24.5 "E 207.32 N 55 06' 17 "E S89 0 13 28 E C - 5 1 233.00 12 _ 4 8.7 7 NO5 ° 13 54 W 4 6.86 N00 ° 46 32 N 11 W C -6 80.00 270 113.00' SUU W 377.18' N45 E N44 W C-6 2 80.00 6 ° - 5 39� 82.26 N ° 3842 .5 "E 8G.40 N4!5 2 2 3� E - - - -- - - - -- - - -- _ S72 58"E C -6 BNDY. 80.00 99°53�48� I ?.2.47 S22_ °28�04 13 9.48' S72 °24 58 E S27 0 28 50 W C - 6 4 8 0.00 108°21 52 129 S81° 39 4 W 151.30 S27g28 X 50 W - - -- - - - -- - - - - - -- - - N4 4 °09 18 W C - 7 2 80.00' 4 5 �� 61. 32' N 68°14 1 27.5 " E 62.93' S89 2-8 "E - - " - -- - - -- - -- -- N 4 5° 4 2 2 3 E C -8 4 80.00 45 °04 10 61.32 N6°4C23� 62.93' N44 "W - -- - - - -- ---- N 8 9° 13 1 2 8 W -,� - - -- o _ - -,r- C- 9 3 267.00 35 °40 15 163 S7 2_5624.5 W 166.23 N89 °13 28 W S55 W C -10 3 467.00' 39 316 .88 ' S35°16'19 32 3.30' S55 0 06'17 W SURVEYOR'S CERTIFICATE I, Joseph W. Granberg, Registered Wisconsin Land Surveyor, hereby certify that by the direction of the owners, Robert and Sandra Albright, I have surveyed and divided the lands described on this map in accordance with official records, Chapter 236.34 of the Wisconsin Statutes, the Town of Warren Subdivision Ordinance and the St. Croix County Subdivision Ordinance and that this map and description are a true and correct representation thereof. THIS INSTRUMENT DRAFTED BY: JOSEPH W. GRANBERG. 1��iC0"&'T DATED THIS 24 DAY OF JULY, 1999. r pti W GRANBERG S -2295 = NOT SCALE RWNMDND f , N ° p - O .S 0 0 co N u� N o 2 u � � 5 2 7 * 08 "E 2 19 2 CENTERL BQ�H Ngpo AYE -- 3 96.75 SHEET 3 OF 3 NDS RQ- ypi 176 5PAGE 505 STATE BAR OF WISCONSIN FORM 3 - 2000 Document Number • QUIT CLAIM DEED 662465 KATHLEEN H. WALSH REGISTER OF DEEDS This Deed, made between Robert L. Albright ST'. CROIX CO., WI a Sandra J. Albright RECEIVED FOR RECORD Grantor, 11 -19 -2001 10:00 AM J 0 CLAIM DEED dS Mai bih FY-NPT CERT COPY FEE: Grantee. COPY FEE: Grantor quit claims to Grantee the following described real estate in TRANSFER FEE: 30.00 RECORDING FEE: 11.00 St. Croix County, State of Wisconsin: (if more space PAGES: 1 please attach addendum): Lot 4 coated in the NE 1/4 of the SE 1/4, the NM of the SE 1/4 and the SW 1/4 of the SE 1/4 of Section 19, T29N, R18M, Town of Marren, St. Croix Recadi%Am. County, MI being CSM 6611557, Vol. 13, Page 3746, 987 83rd Ave. Nam and Return Address James Mark Albright 962 80th Ave. Roberts, MI 54023 Together with all appurtenant rights, title and interests. 042- 1053 -20 -400 Parcel Identification Number (PIN) This is not homestead property. Dated this 10th day of NovmmbeK_ 2001 -7 (M) (is not) • 8obert L. 111bright zr • Saadra J. ikibriahi AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) SS, Sh CC County. ) — authenticated this day of Personally came before me this �� day of SN wnmk ,ter the above named 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. Slats.) TInS INSTRUMENT WAS DRAFTED BY a Sandra J. Albright Notary Public, State of Wiscottsi My Commission is permanent. (If riot, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) JULIE C DODGE Notary PublWState of Wisconsin *Names of persons signing in any capacity must be typed m printed "w their signature. QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 32000 Phone: Fax: P vwO Zpfwmw by RE Formerlet LLC 18028 Frew Mae Road. Clinton Tewshp, wmwn 48M. (800) 3819505 L