HomeMy WebLinkAbout042-1056-95-300
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 538843 0
GENERAL INFORMATION 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:
Willi uett, Christopher J. Warren, Town of 042-1056-95-300
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/01,L`j Goth 6F 131 20.29.18.317A30
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark G
Dosing 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 (b t A Header/Man.
Aeration Dist. Pipe /S 9g •
Holding Bot. System 7 , O I
Final Grade
PUMP/SIPHON INFORMATION `7
Manufacturer Demand St Cover J GPM /a Z y
rr; 1,. ~ove~. to
Model Number a~ 9 9~! S
TDH ift Friction Loss System TDH Ft
Forcemain Dist. to well _
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length 4, n No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth L\aA DIMENSIONS 3 3Z EJ1 1 6cot-c,
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: /1 /
INFORMATION ~ CHAMBER OR /..1 f i•/ firr
064 J11119
UNIT Model Number:
Type Of Syste't') nJr • Z 9.3 j
DISTRIBUTION SYSTEM e~ g xyl = 32 dad-a,Q,
Header/Manifold Distribution x Hole Size 17"z Vent to Air Intake
I Pipe(s) /
Length J7i Dia r Length Dia \ Spacing~_ L~~_ G 5
SOIL COVER x Pressure Systems Only xx Mound Or -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded Mulched
Bed/Trench Center R d Bed/Trench Edges Topsoil
'tgjes E] No r '_Ms E] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: \j / Inspection #2: / /
Location: 836 110th Street Roberts, WI /54023 (NE 114 SE 1/4 20 T29N R1 8W) NA Lot 8 Parcel No: 20.29.18.317A30
1.) Alt BM Description t LA GD 0CA_
2.) Bldg sewer length = i 1
- amount of cover = 547
Plan revision Required? Yes No ~j Zz l0 ~I 7 5
Use other side for additional information. I J
SBD-6710 (R.3/97) Date Insep or's Sign re Cert. No.
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 538843 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: Village X Township Parcel Tax No:
Willi uett, Christopher J. City Warren, Town of 042-1056-95-300
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
20.29.18.317A30
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing 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 Ts-eededlSodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil F Yes R No Fv~ Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 836 110th Street Roberts, WI 54023 (NE 1/4 SE 114 20 T29N RI 8W) NA Lot 8 Parcel No: 20.29.18.317A30
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? 0 Yes Ed No
Use other side for additional information.
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
commerce.wl.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 ;
i RrItment co n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.)
of Commerce 3Y_" 3
State Transaction Number
Sanitary Permit Applie o-]!'
In accordance with s. Comm. 83.21(2), Wis. Adm Code, submission of this form t-o-tke >mmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for stAB-o-wned 'POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you p opt be used -for secondary
purDoses in accordance with the Privacy Law, s. 15.04(1 m), Slats. * V
I. Application Information - Please Print All Information
Property Owner's Name Parcel #
Property Owner's Mailing Address Property Location
t GFt ~b~ { i' ~rto i n Govt Lot
7 ~ ~ik' Nit Jim
City, State Zip Code o lCF. N y, yy Section
r (circle one
T,,?2N; RE S
II. Type of Building (check all that apply) Lot #
rv Subdivision Name
1 or 2 Family Dwelling - Number of Bedrooms)
Block #
❑ Public/Commercial -Describe Use ❑ City of
CSly1 Number ❑ Village of
❑ State Owned -Describe Use
®Town of
III. Type of Permit: (Check only one box on line A. Complete line 11 if applic le)
A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner 3 _
IV. Type of POWTS System/Component/Device: Check all that apply)
D4 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soon n , l
❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) t1 L 01
V. Dispersal/Treat nt Area Information: , I &
Design Flow (gpd) Design Soil Application Rat gpdsf) Dispersal Area Required (sf) Dis rsal Area Propo (sf1 System Elevation
` fo ~i0' 9~1~
Tank Info Capacity in Total # of Manufacturer _
Gallons Gallons Units a U° u
R V V yy N
New Tanks Existing Tanks 2 c °.t S m
a U ti h ~ w C) 0»
Septic or Holding Tank zwk2
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume respons' ill for installation of the POWTS shown on the attached plans.
Plumb r' ame .nt) Plumber's S, 2 MP/MPRS Number Business Phone Number
Plumber's dares treet, City, Stat , Zip Code
VIII, Court /De artment Use On
d Issuing It Signature
Approved ❑ =ved Permit Fee DGatr1,3
Al Ub
•.5' !
iveSRewo. ~for Denial $
IX. Condit WW r easons for Disapproval
I.' `eptic tank, effluent filter and I 4~'
<;dISpersal cell must all be servk:es / maintained 1 ~~t 1 1
0 per management plan provided by plumber.
2.0 setback requirements must be maintained
to eomp p or a system and submit to the County only on paper not less than S la z 11 inches in size
SBD-6398 (R. 02/09) Valid thru 02/11
~,C.c~1`~ S~szj /Yltf ~r.~'.A~Pc ~ s. _ ~,9 a I / ~trrlc2eTi6,~ - - r~a» w~GC~as+ ~y~rC~• ~3-GCS -
_ °7cg ~C/1 .c
f
A41,sl
-33 4~X ~ ~
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name:
Owner's Address: gs/- /jam b
Legal Description:
Township:
County:
Subdivision Name:
Lot Number:
Parcel ID Number: 6--V
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing
Page 4 System Cross-Section
Page 5 Filter Specs - ta,S4 /06
Page 6 Maintenance & Management Plan
Page 7 Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Designer/Plumber: ✓ / License Number:
.4 2 ~ zl
Date: - - Phone Number 79
/7
Signature x~//
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101).
Page 1
C~'fj~ STd~`'~,ce' - ~>fi ~V ; c~ ~c.E7T iy~ ~ - .S~'~~/- ~'~C - T~1~✓- J~/8uJ
/ ~,~,~Y~/ //,Z~~ /l/T ~o~s'.•~.Pm-~}~ - ~ r ~mculrzr~O,a - i~ /'fo~» ~~b~C~• 8-60 -
~a
ia(J
~e~lG IJ~~J.rw~~r
3 a a.
/ sT
30.4 VVV n I
Soil Absorption System Cross Section
L ft
4" Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap ft
Leaching
Chamber ft
System Elevation
ft -3 ft 3 ft
Soil Absorptlon System Plan View
ft
3 ft
U111101111 I
_ft Leaching Trench 1
Chambers
4" Dia.
Trench 2 Header
Vent Or Observation Pipe • aJ~~ps
Trench 3
Leaching Chamber Specifications
Manufacturer And Model- -7
EISA Rating,~Q sq ft per chamber Soil Application Rate gpd/sq ft
gpd Design Flow + ,Z Soil Application Rate + EISA = Chambers
3 rows of --4zz__ chambers each.
Page of
YUW TS U W NER' S MANUAL & MANAGEMENT PLAN Page of
PILE INFORMATION SYSTEM SPECIFICATIONS
Owner ) Septic Tank Capacity gal ❑ NA
=ermit H Septic Tank Manufacturer ❑ NA
S
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
!Number of Bedrooms 0 NA Effluent Filter Mode} ❑ NA
Number of Public Facility Units C~(NA Pump Tank Capacity gal ❑ NA
Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA
Design flow (peak). (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA
Soil Application Rate of/day/ft2 Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA
Fats, Oil & Grease (FOG) <30 mg/L Q Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) <220 mg/L 0 NA Q Mechanical Aeration ❑ Wetland
Total Suspended Sorrds (TSS) <150 mg/L ❑ Disinfection ❑ Other:
"
Pretreated Effluent Quality Monthly average Dispersal Ce8{s} ❑ NA
Biochemical Oxygen Demand (BOD5) _C30 mg/L 6K in-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (T SS) <30 mg/L J9 NA Q At-Grade Q Mound
Fecal Coliform (geometric mean) <10` cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Y$ in dia. ❑ NA Other: Q NA
,her: ❑ NA Other Q NA
Vaiues 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: ❑ ears} month(s) a)°mam 3 years) ❑ NA
Lurnp out contents of tank{s} When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
-specs dispersal cell(s) At feast once every: ❑ month{s} (Maximum 3 years) ❑ NA
0%-year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
6 year(s)
least once every: ❑ month(s) NA
nsect Dump, pump controls & alarm At ❑ year(s)
luSt la-e-als and pressure test At least once every: ❑ month(s) ®NA
❑ year(s)
` At (east once every: O month(s) ® NA
Q year(s)
Othw-, [A NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shaft 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 ceif(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 fairing condition and requires the
immediate notification of the focal regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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 <_12 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.
Page of
START UP AND OPERATION
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 fast 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
2OWTS INSTALLER/ POWTS MAINTAINER
Name J Name
Phone _ Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
`his document was drat:=-: c_-~ ance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST, (11MIX It"Our`i`VY
St i' 1 iG AINit k,!AINITI'NANC.1.~ ~.(_~1Z1 1?1vI';'iv l
VN D
OWNERSHIP C'E104FICATION FORM
Owner/Buyer 7-°i f rc is/7~(ff (L- •1_.__L_ _L Ate . _.__._.._r
Mailiiig Address 93 YJ__ ? 1± t 6 _":27 Property Address 3 ~o ! O ST ~ FIq ° 2-3
(Verification required from Planning & Zoning De rtinent for new rumstruction. j
AiZ lo'-h gY-000
City/State Parcel lu,:iititication Number
LEGAL DESCRIPTION
Property Location NE _'/4 Sec. Z,.I_N R_ tr W, Town of WA-J-*4-~
,Lot Certified Survey Map 63 # Z 3 7(o2- Votunle / t' tge # Z 1'7 L
a
VI/arrauty Deed # Volume Page # _
Spec house y~s C-11 Lot line:; idcutifiabl 0s nu
SYS'T'EM MAINTENANCE AND u WNEIZ C'ER`I' .jQATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Departmemt a certification form, signed by the
owner and by a master plumber, journeyman plowber, restricted plumber or a licensed pumper vei ilyiug 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.
vve, the undersigned have read the: above requirements and agree to maintain the private sewage disposal system with the
standarus set forth, herein, as set by tile lhfrtrttitent of l onnr'icr~.r and the Department of Nantral Resources, State of Wisconsin.
Certification stating that your Septic System h,,.! been maintained riiust be completed and retiuntd to the St. C ofx ` ouluty Planning &
Zoning Department within 'x0 days of the thi % ear expiration d:;tf
I/we certify that all statements on this Corm are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by -irtue of a warranty deed recorde(' ill Register of Deeds Office.
Nuniber of bedrooms
_,_._.AN DATE
NATU OF APPLIC
***Any information that is misrepresented may result in the sanitary permit being revoked by the. Planning c~ Zoning Department.
a
Include with this application a lQcorded N~,o1,ww deed t'rom tlitl wgistrr of t)ccds Office and a ropy of the certified survey map if
erer'.,rce IS rrrdoe rrr tnc wal l'aud' Geer:.
(REV. 08/05)
I
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence: ' ks //qua
(Street address) ~f?/ ;`~+~f located
-
at:/'/a, Section , Town_, ~N, Range__/~W,
Town of /,~,~~E„i St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service
Did flow back occur from absorption system? Yes No X
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity:
Construction: Prefab oncrete Steel Other
Manufacturer if known):
S
Age of Tank (if known):
Permit num er (if known) 99,E
-(Licensed Plum er Signature) (Print Name)
(Title) (License Number) MP/MPRS
(Date)
Form to be completed by licensed plumber (Dept of Commerce Chapter 5
and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
Administrative Code)
Rev. 9/2008
V01-160SPAGE198
11 STATE BAR OF WISCONSIN FORM 1 - 1999 4 ZS WALSH
WARRANTY DEED REGISTER H. DEEDS
Document Number ST„ CROIX CO., WI
This Deed, made between Gary D. Nelson and RECEIVED FOR RECORD
Jillienne J. Nelson husband and wife
03-27-2002 9:45 An
Grantor, YARRAKY DEED
and Christopher J. Willicquett and Aimee T. Williquett EXEMPT H
husband and wife as survivorship marital property CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 557.70
Grantee. RECORDING FEE: 10.00
Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 2
described real estate in St. Croix County, State of
Wisconsin (the "Property") (if more space is needed, please attach addendum):
That part of NE1/4SE1/4 Sec. 20-T29N-R18W described
as -follows: Lot 8 of Certified Survey Map recorded'
in Vol. 14 of Certified Survey Maps, page 3862 as Recording Area
Doc. No. 6237 62 . Name and Return Address
DAVID J. ESTREEN
304 LOCUST ST.
HUDSON, Wl 64016
Ce-!-7 11
042-1056-95-000
Parcel Identification Number (PIN)
Together with all appurtenant rights, title and interests. This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Roadways, Easements, and Restrictions of Record-
Dated this 22 day of March 2001
Ga N on
* Jillienne J. elson
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ) ss.
St. C=ol x- County. )
authenticated this day of Personally came before me this 22 day of
March 2001 the above named
Gary D Nelson and
Jillienne J. Nelson
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person s who executed
authorized by §706.06, Wis. Stats.) the fore . g instr}ttt}ent nowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
* Ka a m
Michael H. Forecki Attorney Not P ic, State of Wisconsin
Eau Claire Wisconsin My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) December 12 2004
WARRANTY DEED STATE BAR OF WISCONSIN Ka V, Palm
FORM No. 1-1999 y
*Names of persons signing in any capacity must be typed or printed below their signature. AA''^^..~~ Public
Produced with Zj,Fonr" by RE Fo-Net, LLC 18025 Fifteen Mlle Road. Clinton Township Michigan 48038, (8044g9~A~arY
Att,-y Michacl H Forecki 1310 tl-kctt Ave, Eau Claire Wt 54701-4627 Phone: (715) 835-3029 Stato dif"wNbonsin 03324763.OF
s FILED
MAY 2 6 2000 s ~
8 KATHLEEN H.t:ALSH
L SL Croix Co., VYl /rr V ~v
i
Certified Survey Map
Daryl Jones, etal°
Part of the Northeast 1/4 of the Southeast 114 of Section 20, Township 29 North, Rang o
18 West, Town of Warren, St. Croix County, Wisconsin. I 2
N SS°10 D6 `E 5220.36'
UNPLATTED LANDS
OWNER'S ADDRESS: ,
?
N 89° 14' 06" E 430.01'
171 13 Stone Pine Bay n a 397.00'
33'01'
Hudson, W1 54016 3 Q4790.3b' EJVy!/4 LIE
Uj r4
This instrument drafted by cc v y 2
Laurence W. Murphy Y 2f T
x LOT 6 , LO w m
16- C4 Uj
Dated: February 17, 2000 d j 3.240 ACRES, 141,121 sQ. Fr. h y
rv 2 .907 ACRES, 130,096 SQ. FT. y,.
"Revised this 22nd day v EXC. ROAD R. O. W.
of May, 2000." ~j H i 4 1ti 'QGj~
Z as 2
h
V Q y N 89° 14'46"E 430.00'
i m 395.88 i I
APPROVED 3# W 34.12 I
ST. CROIX COUNTY J 'LOT IF 117 33 33{ u~
$ a
PbArNttp Zoning and Parks Committee I
MAY 2 6 2000 tij 2.320ACRES, 101,041 SQ. Fr. a j
g N 2.133 ACRES, 02,929 SQ. FT. ~ . 04
h q
EKC. ROAD ~RO. W
Z ; O 1321 ° O e. cn, not recorded wltNn 30 days of Z h !u
M W S
approval date approwu Shall be N 89° 14' 46 E 430.00' ~
null and void o
39eO8' 34.92' sa °
LEGEND: g LOT 8 0 4 a l 6 o
z ut
'd 2.32OACRES, 101,041 SQ. 0-T, H i C p
-ci - v- 2129 ACRES, --92,742-SQ.-~ r
• 1' X 24" IRON PIPE KWGNING fWC. ROAD R. O. W N N S
1.13 LBS.&W FT. SET Z ~O
Jf 1. IRON PIPE FOUND 1 m O
35.72
SOIL PORING 394.28' Z,_ co) C
f W W ul
4 OESIaNATEO OR/VE. S 69° 14'46" W 430.0' C LU
WAY LOCAT/ON UNPLATTED LANDS gN~ 89° 14.46'E 430.00'- y
V) ,°~4 n \ 394.06 35094' v°i g O
ROAD SETBACK LINE
2
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2.920 ACRES. f 01, 0 i1 SQ' FT CX
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t _Ts~~, EXC. ROAD R. 0. W x ~f O 3 4i p,t
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"soo"sir' oepanment of Commerce PRIVATE SEWAGE SYSTEM ounty-
` Saf#ly and Buildings Division
• INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sane r
Personal Information you provice may be used for seoonclW purposes [Privacy Law, x.15.04 (1)(m)). 3 1 S
Permit Hol er s Name: ❑ City ❑ Village Tovvno State 1
N~ 0 L-1- X
X"WREQUY Insp. BM Elev.: ription: Warren Township Parcel Tax Nn
BM Desc
' I a~ Spa = cs-r B►AL.1-
V 042--95-300
TANK INFORMATION ELEVATION DATA 5
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing ~•(Z it, , 29
All. 151VI
Aeration Bldg. Sewer 0.36 I .05 "
Holding St/Ht Inlet SS-0 9. I~
TANK SETBACK INFORMATION St/ Ht Outlet ~.~0 9 g •a-1'
Vent
TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air
Septic y 5ID' ' NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe .qlf o q 9.-54
Holding Bot. System is . +1 q8-OD
PUMP / SIPHON INFORMATION Final Grade ,qg (ol.'~ 3
Manu urer Dema d
Model Numbe GP t cover
TDH Lift riCtl S stem TD Ft
Forc In Length Dia. Dist. To well
SOILAB PTION SYSTEM
*EO TREN Width I ength Nq f Trenches PIT No. Of Pits Inside Dia. Liquid Depth
( DIMENSIONS
DIMENSIONS LEACHING Manu adurer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM _ Alz
INFORMATION Type O CHAMBER Mo a Num er:
System: nJ. V 13 (-k OR UNIT -C tsL~
DISTRIBUTION SYSTEM
Header/Manifold „ Distribution Pipe(s) x Holes* x Hole Spacing Vent To Air Intake
,
Length Dia. ~ In9 z2
~
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.)
~Q V•
Inspection #1: \2-1 Ot Inspection #2: 1 I
Locatton: 836 110th Street, Roberts, WI 54023 (NE 1/4 SE 1/4;0 9N 8W - 202918317A30 -Lot 8
1°~O`~-~•
1. Alt BM Description= NtJ ta--v- - A-T
2.) Bldg sewer length = (o •
S txs~er✓'t'a'n
= S~,~,;w~
-amount of cover "
l") 3~ wdQ_v Gtr•'~`~"
Plan revision required? ❑ Yes No Z
U,w _of er side for add~*i ~'pnal i f ation. 12 Ice va
im tr y t'[ O gton 1 Inspector's Signature Cert. NO-
31313-6710 (R.3/9~ µ ZA,,-L r-G6k.h.ai;6
.
~36 /,O Sanitary Permit Application Safety & Buildings Division
201 W. Washington Ave.
In accord with Comm 83.21. Wis. Adm. Code
See reverse side for instructions for completing this application PO Box 7302
114sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707-7302
Department of Commerce (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)] state owned.)
Attach complete plans (to the county co only) for the system, on paper not less than 8-1/2 x 11 inches in size.
County State Sanitary Permit Number I►}'l<~ it;reyis~brtkO previous application State Plan L 1). Number
! w
't Cjq 57
1. Application Information - Please Print all Informa ioti Location:
Property Owner Name , ri rim Property Location
1/4 1/4 ,N, E or I
Property es ailing Address P 7 L, of Number Block Number
du
~ S1 CROIX
City, S Zip Code mber Subdivision Name or CSM Number
s
/Jr
II Type of Building: (check one) u \ ❑ City
J
❑ l or 2 Family Dwelling No. of Bedrooms: ❑ Village
o
❑ Public/Commercial describe use Townof
❑ State-owned
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road
A) 1. ANew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Num cr(s)
System Tank Only Existing System I ;Z2- -
B) Permit Number Bete-tssaed
❑ A Sanitary Permit was previously issued o
IV. Type of POWT System: (Check all that apply) -tot)
,(Non-pressurized In-ground ❑ Mound ❑ Sand Filter ❑ Constructed Wctland
❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At-grade (Z)3 K S , } ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
C:5 S <u)1, X 3~•Sb
V Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. DispersalArea 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
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
,a ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ Off--t
VII Responsibility Statement
1, the undersigned, assume responsibility for installati f the P S shown on the attached plans.
Plumber's ame ( rin Plumber's MP/MFRS No. Business Phone Number
3 5`-
Plumber's Addre tree[, City, St te, Zip de
2-1
VIII County/Deparfinent Use Only
El Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
,I Approved 13 Owner Given Initial Adverse Sarge Fee)
Determination s.Ob 2tZo `
IX. Conditions of Approval /Reasons for Disapproval:
be-- &LW_-(1 st~u~ M&a.0 - 6rv~n Ma;otM4, z ga c•e,e-
~s eo~2 U
SBD-6398 (R. 07/00)
' a'te'
'61 A
6
d ,
vJ
~r g
130 XE2 &A/e)( NEL. so,v 3
Wisconsfri ; rirtment of Industry, SOIL AND SITE EVALUATION Page of
Labor and Human Relations
Division of Safety and Buildings in accordance w' 83.09, Wis.
r
Attach complete site plan on paper not less than 8 1/2 x 11 Inches I Plan m t County
GRa l
5-F.
Include, but not limited to: vertical and horizontal reference point I`I),Arect .r~°°Iercent slope, scale or dimensions north arrow, and location a S nce to biteribfitf.
P ~ f ~ - Pa el I.D. #
q 5 0 o c~
APPLICANT INFORMATION -Please print all inf -11 tiol!t.` ~!7 wed by^ Date
Personal information you provide may be used for secondary purposes (Pd dew, s. 15.~~ '.Z
Property Owner \ Z tfor,
D AR yL 70 f) E 5 QQY.t,.LoF,. 1/4 SE' 114,s 20 T Z f ,N,R E (or)
~
Property Owner's Mailing Address Lo k# Subd. Name or CSM# our Qf-'
17113 STOa E7 N ►J E BAY '/-2 NP1*A) r CSM 3-9'4Cas
City State Zip Code Phone Number 21" Nearest Road
~V PS D Gv/. 5 Y01ly ( 715) 3 R1 •'fpJ0v ❑ City ❑ Villa Town //D ff4, s''
AVA New Construction Use: esidential / Number of bedrooms ! Addition to exisnnting building
❑ Replacement ❑ Public or commercial - Describe: &4 , - T L T
Code derived daily flow y6F#Q gpd Recommended design loading rate bed, gpd/ft2-1-92 trench, gpd/fl2
Absorption area required ll bed, ft2 7~0 trench, it 2 Maximum design loading rate _bed, gpd/fl2-trench, gpd/112
Recommended Infiltration surface elevation(s) 5 e'L 3 it (as referred to site plan benchmark)
Additional design/site considerations - NW45- PX E/334~035) (Z6& V t R E 5 MOUND 5Y,5 T .
Parent material Alm - NOT Flood plain elevation, if applicable h
S = Suitable for system Conventional Mound In-Ground ressure. AT-G a Syste n FIlI Holding Tank
U = Unsuitable for system 9191" ❑ u 0'~ ❑ u s ❑ U Ch's ❑ u C s p u ❑ s U
SOIL DESCRIPTION REPORT kk
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/
Gr. Sz. Sh. Bed , Trench
In. Munsell Qu. Sz. Cont. Color s
l c~ i ioYA SL /fshx -v //R w ~ • q
Ground 3 y~3 /0 2 Y14 D, s ,C 4:5 s - , • ~
elev
/o ft. 3 s/
Depth to
limiting `I• 0
factor '
~ n. 2 q it D
Lls:
Boring # 0.IV /0 yR 2/Z SL ~fjk Ma PR 4/
Z y - t /0 3/ 511- 1 fSfijlt ^4 fl' ~ - . S ' • L°
3.3 / SG 1f5h f q ; . S
Ground 7-113 /o R 514.1 9"V et R i Sl L/ f S//f`- 7~i' 4 5 - • Z 3
elev -7 •5YA Y I&
Depth to
limiting
s8 actor in. Remarks.: Ir /A" R"--/t 0MAYS-5 • *,62- y - fARV ! All </ /3, f v1~
CST Name (Please Print) Signature ( - Telephone No.
5
_ RC)BERT' ztc.QR cHT- 1 Y~~ ~r 5.38ee • 0 18
Address Date CST Number
M4A~& -AM-Z> 2-2.4t 3-15
rc
Private Sewage Consultants
655 O`Neil Rd.
Hudson, Wis. 54016
I
r
• J19 N SOIL DESCRIPTION REPORT
PROPERTY OWNER
O \ Page 2 of
PARCEL I.D.# ^ d s G SC1 U (p 5\ L O g
Boring # rHodzon Depth Dominant Color Mottles Structure p
in. Munseli Qu. Sz. Cont. Color Texture ry Roots
Gr. Sz. Sh. Consistence Bounda
3 / Bed Trench
IkO
2/ °Z 2 tsar • m & s-
Ground - b. I
elev. S~ Z, ~ ~ ~Jti►'F/•
Depth to /D s S 0. G[ .C. - . ; b
limiting O 1
factor
In.
Remarks: /o yip 4F/2- ^"pf- s 'VA f/!,o tears Ri 2 .
Boring #
F 2 • 27 /0 31- S/L ZfS KfR ctJ , S •
7 • y /D s - S~~ '
94
elev. Ground . b l0 ~1 2~ V 51L Msk M4 -F~ f ' Z 3
ff.-U ft. /D R s - v~ 5 d,Q Q-c' • S
4X 2
Depth to of 40o
limiting
factor 5 Y)e 14(d,
'
Remarks: Y vI;PES 'j SYST,
Horizon Depth Dominant Color Mottles Structure
In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz Consistence Boundary Roots GPMe
Boring # . Sh. Bed , Trench
t 49- 2-/3 - SL ifs ; vyt
/OYX 31!K
3 5L yrshk-
'3 io y S. D. ao,Q - .
Ground
elev.p
Depth to
limiting
factor
> in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
In.
Remarks:
S13DW-e330 (R. 09/95)
I '
4 ~
If
m ~ ~ o ~ w o
~ Lv ~ ~ v1 `ti, ~`A.. rtl ~
G
~ o a o
M o0A-1~ v
~ 'I` s y s T- o~
Q o
0
0
1
W
cs • ° _ p
w ch~~ =cQ
o
d
0
//0 s
r ,
,
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 Specifications
Sanitary Permit Number 19-
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal) v N
Soil Absorption Component Size (ft2) S 2 ► , es
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) 31241- cep
Maximum Influent Particle Size (in) 1/8
Maximum BOD5 (mg/L) 220
Maximum TSS (mg/L) 150
F_ I
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
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer X..) C- C_ 5 C) IV
Mailing Address /a x /007-A 5-t. D 9 ?`S tx-,! S L0 2 3
Property Address -/RG s ew_ 7-S 3
(Verification required from Planning Department for new construction)
City/State R0 ,9 12~_fZTS W2 Parcel Identification Number 7. U,S(o C1 S- d 00
LFGAL DESCRIPTION
Property Location /VE7- '/4, SC- '/4, Sec. ZO, T aq N-R/9 W, Town of C~V
Subdivision , Lot #
Certified Survey Map # c~ a 3 ? (o 2 , Volume Page # Rg7
Warranty Deed # 6,;~ C q G,S , Volume I S V3 , Page # CS
Spec house 0 yes 13 no Lot lines identifiable Ayes O no
SYSTEM MAINTENANCE
Improper use and maintenanceof 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
masterplumher, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposaI system
is in proper operating condition and, or (2) after ui.spection 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.
Q l S OO
SIGNA 0 APPLICANT DATE
OWNER CERTIFICATION
1 (we) certify that all statements on this form are tnre to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the prope described above, by virtue of a warranty deed recorded in Register of Deeds Office. 00 91' l 15 7 Od
SIGN URE OF APP1_iCAN"i' 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
1543PAGE 95 IL)
• vol.
I X629965
STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
Document Number RECEIVED FOR RECORD
This Deed, made between Daryl L. ,Tones, a married 09-15-2000 12:50 PM
person WARRANTY DEED
EXEMPT #
Grantor, CERT COPY FEE:
COPY FEE:
and Gary D. Nelson and Jillenne J. Nelson, husband TRANSFER FEE: 210.00
and wife as survivorship marital property RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix
County, State of Wisconsin:
Part of the Northeast 1/4 of the Southeast 1/4,
Section 20, Township 29 North, Range 18 West, now Re;ordingArea
known as Lots 8 and 9 _of Certified Survey Map Na ne and Return Address
recorded in Volume 14 of Certified Survey Maps on or,-,-
page3862 Q
To' I T
L ~A'-) 6sor'-
42-1056-95-000 (part of)
Paiccl Identification Number (PIN)
This is homestead property.
(is) (is not)
Exceptions to warranties:
easements, roadways and restrictions of record
Dated this day of C= N
V~ L
* *Daryl L. ones '
I
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ) ss.
St. Croix County. 1
day of
P hall ame before me this / 541,
authenticated this day of he above named
Daryl L Jones
TITLE: MEMBFR STATE I3nR OF WINC'ONNIN to me known to I,r the twrson executed
St. Croix County. 1
P Hill ame before me this / day of
authenticated this day of 4 ~he above named
Daryl L Jones
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person who executed
(If not, the fore in;; instrument anri, wledged the same.
authorized by § 706.06, Wis. Stats.)
L--_IAI~4- / T
HIS INSTRUMENT WAS DRAFTED BY tr• v
*Tracy L. Turner
Michael H. Forecki Attornev Notary Pubi c, State of Wisconsin
Eau Claire, Wisconsin My Com 'scion is _permanent. (if not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are 1-S - )
not necessary.) '
$Names of persons signing in any capacity must be typed or printed below their signature. racy urn@r
WARRANTY DF,F.D STATE BAR OF WISCONSIN Notary Public
FORM No, 2-1998 State of Wisconsin
Produced with Zipfam TM by Vertisoft Irtc. 19025 Fifteen Mlle Roed, Clinton Township, Michigan 49095, (900) 3833.9805
Anmcy Michael If Forecki 1830 Brackett Ave, Eau Claire WI 54701.4627 Phony (715) 835-3029 Fax: (715) 835.4112
OM9 *(ON , •LiaAW- o
s FILED
MAY 2 6 2000
8 KATHLEEN N. WAM
ftisterof Deeds 6
SL CroixCo.Wl
L
Certified Survey Map
Daryl Jones, etal.
Part of the Northeast 1/4 of the Southeast 1/4 of Section 20, Township 29 North, Rang
18 West, Town of Warren, St. Croix County, Wisconsin. t a a:
, Q
j N 8$10'08"E 3220.38, - ~ 2 Z
UNPLATTED LANDS
OWNER'S ADDRESS: N 89° 10'06" E 430.01' E' ?
o'
c~
17113 Stone Pine Bay o 397.OOI { t
33.01'
Hudson, WI 54016 f9~FT 0.3E1W 114 LflyE v y
t" Q ? t y
This instrument drafted b 0 2
y 4
lu
C1
Laurence W. Murphy a Q t LOT6 a m
N N op tu` W
M y
Dated: February 17, 2000 Cr j 3.240 ACRES, 141,121 SQ. FT. tu
N %I ?.987 ACRES, 130,096 SQ. FT.
"Revised this 22nd day W = EXC. ROAD RO.W ; O
of May, 2000." co t4 , 97' I '
I
h
Q y N 89° 1_4'46" E 430.00 %
o► w 471
m ZI ~ 395.88 1
34.12'
APPROVED 3 ac~ tu
I33 ~j
ST. CROIX COUNTY ° ~,OT / 33 w
4.
Planning Zoning and Parks commMee Q g g o L is
?.320ACRES, 101;041 SQ. Fr.
MAY 2 6 2000 ( N 2.133 ACRES, 92,929 SQ. FT. N N q
o E9C. ROA%R.O. W. lrj
Z %132 r., y
If not recorded within 30 days of a~ 2
approval date approval shall be Z N Sr 14'46" E 430.00' W S
null and void QI 39408' ' p o $
1: 34.92' c a $
_ v$ g
o P g ~ w
LEGEND: S LOT 8
W 2.320 ACRES, 101,041 SQ. FT. y h i O
-n 2.129-ACRES,-92,742-SQ.-O.
c~ tNV O
• 1' X 24" IRON PIPE WEIGHING ~ EXC. ROAD R.O.IV T ~ 2 •Q
' I
1.13 LBS./LIN. FT. SET 1000
m
1- IRON PIPE FOUND 394.28' t 35.72 `D y Q
SOIL. E30RIN0
S 89° 14'46- W 430.00' 13
o X
* DESIGNATED DRIVE- W
WAY LOCAT/ON UNPLATTED LANDSN89° 94'46"E 430.00' c
b 394.06 100' o ° O 'q
35
ROAD SETBACK UNE .9 4j'
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Vo1.14 Page 3862