HomeMy WebLinkAbout022-1041-80-000 I
rY o (D o
00 �" 0
m
a
h
O
O
N
N
d
ti
0�1 �
O N
Z �
0
c z
� m
ti c
0
3
Q
M
N
Z
W �
ao Z « G
Z �
Go N d m
0
0 z
0
N F N O
Z
E - 2
N M
N
• N 0
O
U
Q z z O _
N Z
V O d N
Cl) H
m d — m E to
a. v N
p p d O p
D D a m N
Z 0 fA N N j
FL3 -o
00
z
•N �aaa N
CL LL
o y (D rn rn N
to U rn rn }
6
O N O 0 N
to
0 0 m N( d
N ) N
(n co
O N 7 w O
CD cl
O I- C O� E
Q O` n~ I M •�• 0' O
O N U C V d 0
ro i N C N r
C 'O N
it t o C O N p
W Y V p V O m tD
H N C N C d L
C p V) t6 C-
• Q ice. o- Y O m p Z g cn
d €n
3 a ` a
Ln A 8a Oai0
Parcel #: 022 - 1041 -80 -000 06/28/2005 02:34 PM
PAGE 1 OF 1
Alt. Parcel #: 15.28.18.227C 022 - TOWN OF KINNICKINNIC
Current , X'' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
CHAD L & WENDY A OLSEN ` OLSEN, CHAD L & WENDY A
370 CEMETERY RD
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
I
Legal Description: Acres: 2.974 Plat: N/A -NOT AVAILABLE
SEC 15 T28N R18W 2.1A IN SW NE LOT 1 CSM Block/Condo Bldg:
VOL 2/370 ALSO COM SW COR LOT 1 CSM
2/370 POB;TH S 87 DEG W 1 00' TH N 02 DEG Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
W 381.14';TH N 87 DEG E 100';TH S 02 DEG 15- 28N -18W
E 381.14' POB
Notes: Parcel History:
Date Doc # Vol /Page Type
06/02/1999 604114 1430/359 WD
12/29/1998 594686 1391/139 WD
09/21/1998 587448 13581479 LC
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/10/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.974 30,000 197,100 227,100 NO
Totals for 2005:
General Property 2.974 30,000 197,100 227,100
Woodland 0.000 0 0
Totals for 2004:
General Property 2.974 30,000 197,100 227,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 516
Specials:
User Special Code Category Amount
I
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Departme
Labor and Human Relations nt of Industry SOIL AND SITE EVALUATION REPORT p age / of 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
70
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference poi rection and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and iisfattoe jo ad. O 2- 2- - /Q ��• �fJ
REVIEWED BY DATE
APPLICANT INFORMATION - PLEASE PRINT ALL TION
PROPERTYSWNM: /3uyE� - . Y� PROPERTY LOCATION
GOVT. LOT SI&l 114 N,E 114,S /S T 2-P N,R /,f E (o Wi�
PROPERTY OWNER .S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM If
53 4S.q 34 0/ 2 - 3 7
CITY, STATE ZtP CODE PHONE, NUMBER, OCITY []VILLAGE [GOWN NEAREST ROAD
[ New Construction Use [esideraljal / Number of beds 3 �a j j Addition to existing building '
[ ] Replacement [ J Public or commerelel d escribe
Code derived daily ow Sv . S 2 ,
Y _ 9Pd Recommended design loading rate bed, gpd/ft 6 trench, gpolft
Absorption area r e q u ired 3� 2 2 - S 2 -Co
p eq — bed, ft ` trench, ft M cimum design loading rate bed, gpd/ft trench, gpolft
Recommended infiltration surface elevation(s) • 3 lab 90 ft (as referred to site plan benchmark)
Additional design / site cons D id�ef ations SATE DES G; vi 71,Q F" r 1 Of
Parent material JO s / f Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL M OUN, U I ❑ S [�
_PRE,SSURE AT_GR�DE SYSTEM IN FILL HOLDING TTAW O Q -16 [�-S
U = Unsuitable for sy stem S lT [�S ❑ U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Twich
A 31-1— 15 fe %57
Ground .Xj / Of J1 �iJ>er �S f /yi+f S
elev.
ft. ifs N N
Depth to
limiting
factor „
Remarks: ! /�i� 24-J y
Boring #
{f -. i o /oy/1 3 /� /s 1401 SiO& 1,vf e s 3f . 7
Ground 3 �" �O /d yje .3�1— .s/ l - 7 " S6j(�
fo ft.
Depth to S
factor g � O .3 7S V it? W&
� Remarks:
CST Name: - Please Print �o�E T' Z(LQ d� T-- Phone: ' : j �� . 0 04>6 -
Address: G JlJ D'tiCr'L �L� Shc' 016 iG - �� - rs ef7f 1 VP Z--
Signature: Date: CST Number:
��GIN
PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z' of 3
PARCEL I.D. S /W --- --?f— CS,y 3 yd / L S 001-2 I � . 37 O
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo rdary Roots GPD /ft
;
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends P:N
AM Sk 4$ vrk i s
Ground 3 2" R /o y,P 31 S/ Z f dv� 's • G
elev.
1293• Gg ft. 3y /0Y 3 S�/ z.wr ,6,� iy►�, CS _ S
Depth to 7 SS A0 yl� Si47`4 Af V {, J'k 6o fie
limiting /
factor p lov,,e 3
- — P 'n; €N
sss
Remarks: � /ZO.✓ �D� �it.� =� S > 9/ 11,4f fo is /s •A,
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
con 000nio nrinn%
0
z
Q
o a
,.�
W
G� r L
lb
R �
� o
c
_ - --
s
�. o 4-s\
O -f►
. t
3401
CERTIFIED SURVEY MAP
GERALD EMHOLTZ
Part of the Northeast 1/4 of Section 15, Township 28 North, Range 18 West,
Town of Kinnickinnic, St. Croix County, Wisconsin.
Z V 8
0 ��� �&
�. ,i
�4PROVED F ! l ED
Y MA
C)
18 1977
0 /`...
0 >= O ST. CROIX COUNIY
0 h C"PREMENSIVB PARKS PIANNWO N \
Z 4 (N Z O NIN G COMAUitL�
n. u
to <
r 00 N
"- > W Bearings based on Solar Observation } o l ��� W
o � U- z l >il
O 0 o ��.
,' 0
W V) L LJ
$ I J
w I -
Q n Indieates 1" x 2 iron pipe stake M N W
weighing 1.13 # /ft. to �;
oN Q M \ W
n `'�
\\`\\\``\`��`��ttuntnu►rr / /u/ r
.. G O /�/ ''�'�� oz° z3'. oo' w
`\mo . ... . S ��'' %� 38�.•►4 0
.!A';1 ES L. O o
N
MURPHY o w 0
S•1042 = a ° N a 0�
�'• IV FALLS, Cl
Wr \` N
t .f / ���
James 'wiir II ►» o o _ a o a
Registered Lana urveyor r _ w o
►n � r nj 0
lo -► < Nr
Dated: 16 August 1976 a
38t • )4 �
Description: X,{ oe oo
That certain parcel of land located in the NE 1/4 of Section-15, T 28 N, R 18 W,
Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows;
Commencing at the East 1/4-corner of said Section 15, thence go N 52 06' 16" W
a distance of 1402.13 feet to the Point of Beginning of the parcel to be herein
described; thence go S 87 37' 00" W a distance of 834.82 feet; thence
N 02 23' 00" W a distance of 381.14 feet; thence N 87 37' 00 E a distance of
645.18 feet; thence S 28 50' 28" E a distance of 425.74 feet to the Point of Begin;.
ning, together with an easement for roadway purposes over and across a 66 feet
Wide right of way, 1)9ing 33 Feet on either side of the following described center -
line;
Commence at the East 1/4 corner of said Section 15, thence go N 00 07' E along
the East line of said NE 1/4 of said Section 15 4 distance of 1557.54 feet to
a point on the centerline of an existing Town Road and the Point of Beginning of
the centerline to be herein described; thence go S 87 5 8' W 785.32 feet; thence
S 02 17' E 687.35 feet; thence S 87 37' W 1372.67 feet; thence S 49 21' W 456,79
feet; thence S 88 21' W 148,26 feet; thence S 00 07' W a distance of 559.48 feet
to the centerline of C•T.H. "J" and the termination of the roadway easement.
Vol. 2 Page 370
Certified Survey Maps
St. Croix County, Wis.
See Reverse Side
�A
State of Wisconsin )
County of St. Croix)
I, James L. Murphy, Registered Land Surveyor, do hereby certify that by
diredtion of the Owner, Gerald Emhol.tz, and according to official records
I have surveyed and divided the lands shown hereon and that this map and
description is a true and correct representation thereof; and that I have
complied with Chapter 236.34 of the Wisconsin Statutes and the Ordinances
of St. Croix County in surveying, dividing, mapping and describing said lands.
Dated 16 August 1976 N1
s, ed� AgS4rvex
MURPHY fir
�'•
RIVER F ALLS,
4 2 `
ALLS,
.� J'j • wisc.
�a
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner x K)HO IS
Property Address /O"' 66 0 t ' f (
City /State Y6 3 2 i
Legal Description:
Lot Block Subdivision/CSM #
t /4 AE ' /4, Sec. L TON -RA_W, Town of Z i e PIN # '�- - - - -_
-- DOSE CHAMBER -- HOLDING TANK INFORMA
SEPTIC TANK � E9 ,
Tank manufacturer A13 OE Sf fre& 1'4ize ST/PC lhgol -5�U Setback from: House el PAL
Pump manufacturer a U Model
Alarm location
TANKS ONLY COu ��` :
(HOLDING T ) �
Setbacks: Service road Vent to fresh air intake Water LuF�
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: Width Length Number of Trenches
Setback from: House Well �'�� Vent to fresh air intake
ELEVATIONS
Description of benchmark Elevation
Description of alternate benchmark Elevation
Building Sewer d �� b T/HT Inlet , � ST Outlet PC Inlet
PC Bottom Header/Manifold 0 Top of ST/PC Manhole Cover
Distribution Lines O IG O ( )
Bottom of System(
Final Grade O O ( )
Date of installation / / Permit number State plan number
Plumber's signature License number fY� Date
Inspector %,—
Complete plot plan
r
NOTICE Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
0 / o 0
�n
r
i
ai
i
f� g�
INDICATE NORTH ARROW
Goulds 1 b Ot` 6
Submersible
Effluent Pump
T
�L
EPO4
EP05
8 z
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
stainless steel. grade turbine oil for for eff.
Specficallvdesia�edfoi.tk�„ � .+ogQt
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer.
• components. - ■ Motor Cover: Thermoplas-
Homes Available for automatic and tic cover with integral handle
•Farms Motor and float switch attachment
• Heavy, duty sump • EPO4 Single phase: 0.4 HP, manual operation. Automatic points.
• Water transfer 115 or 230 V, 60 Hz, 1550 models include Mechanical
• Dewatering RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty
automatic reset. preset at the factory. rated oil and water resistant.
SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower
115 V. 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing
Pump: EPO4 built in overload with construction.
•- Solids handlin g ca pability: automatic reset. • EPO4 Impeller Thermo -
314' plastic Semi -open design maximum. Power cord: l0 foot AGENCY LISTING
• Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for
' • Total heads: up to 24 feet. with three prong grounding mechanical seal protection. $p Canadian Standards Association
• Discharge size: l' /i NPT. plug. Optional 20 foot ■ EP05 Impeller. Thermo-
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for (CSA listed model numbers
rotary/ceramic-stationary, three prong grounding plug improved performance. end in "F" or "AC ".)
BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature: thermoplastic design provides
104 °F (40 °C) continuous superior strength and
140 °F (60 °C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. to-
* Capable of running
dry without damage to 9 30
components. I ; -►�� SGPM
Pump: EP05 a i _ _ ' . _ ..___ ___ .._ +-2S Fr
• Solids handling capability: 0 2s
YV maximum. a z
W --
• Capacities: up to 60 GPM. s 20 I
• Total heads: up to 31 feet.
• Discharge size: 1IN NPT. a
z 5 ----- • Mechanical seal: carbon- 0 15 --
rotary/ceramic- stationary, 4
BUNA -N elastomers. i5 -
__�. - - - - -- - --j-•— - -- - - � -.. - EPOS
• Temperature: 3 10
104 °F OM) continuous i 1 i
140 °F (60°C) intermittent 2 --- — -_- __- _ —�— _ _.. _ _ . EPO4 ._
5 i
0-
0 0 10 20 30 40
50 GPM
0 2
4 6 e 10 12
CAPACITY
19% Goulds Pumps, Inc
Wisconsin Department of Commerce County:
PRIVATE SEWAGE SYSTEM
Safety and Buildings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: ST. CRC IX
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338826
Permit Holder's Name: ❑ City ❑ Village IN Town of: State Plan ID No.:
OLSEN, CHAD KINNICKINNIC
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
0 � tdd e� e sGC �a 022- 1041 -80 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY ST TION BS HI FS ELEV.
Septic cs tr'F QQ� c mark b
pp
Dosing
Aeratiom Bldg. Sewer a
Holdin Q/ Ht Inlet 16
TANK SETBACK INFORMATION tl /Z Y
TANK TO P/ L WELL BLDG. Air I ntake ROAD t jF C
Air
Septic A)4 NA 1913ottom
Dosing l I NA Header/ Man.
Aeration Dist. Pipe 3, 6
[ Holding Bot. System ,IS
PUMP / IPHON INFORMATION Final Grade O T ° Z
Manufacturer (2 V-5 /- Dem �r,--
' Model Number pot Z,�7tPM
TDH Lift Z 2(v Friction , 3 Sy , TDH Ft
k Z Forcemain Length / Dia. t Z r � Dist. To well Aj
SOIL ABSORPTION SYSTEM 2
BED / Width ( Lengt f No. Of Tre the PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION era DIMENSION
SETBACK
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer:
INFORMATION Type 0 l CHAMBER mod Number:
System: G — �U �l9 OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold r � Distribution Pipe(s) ] x Hole Size x Hole Spacing Vent To Air Intake
Z Ir
Length Dia- Length Dia. Spacing 3011
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.)
LOCATION: KINNICKINNIC 15.28.18.227C,SW,NE 379 CEMETARY ROA /
U ( -O r 5 �v = /�( , 0 3 �a you 6�► a 1°k v
V l���f �"" i� � I - �bW i� �P /1�9�j roc '�v°"`� �•,S�e _-=
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. 3 00 �.
SBD -6710 (R.3/97) D to Inspect r' Signature Cert No
L
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
§ h �
... ♦ ;...,. . s .:�... . w 5..m .. � .a.... r .. ate.... .. e......, m . , _ ... .,. _,..,. ....em 5' ..
e
c
w
1 t
t
w ..... —_._ .,. ......m.w ,. ___ ,a_.._ �....... _ ... i... ,._— .. j .. .,, ., ... .._ .. ._ ....... _..
.. . . . ,....,.�. m
[1-1 s
. v . .. ... ,. ... ..
[ 9
._... .. .. 4 _Vj_.._ _
.�...� ,. _...�
i �
z z s 3 € �
,w
..�m,.,._ .., ,.. 7
F
tl ..m ,.
A.. I
mm_ 1. e4a� �, s. ., e_,
1
e ._ w
f
., �,..... ..,, ......... ... �,.... ,.,,._ ..ate._ ...... .. .< ,. _..... ,.., ,
y
1
p -L-L-L-1-4- ;I � �b - t i a t
t
e £
t t �
9
i
... -wa. �. �....- ,..,.,
q ldam. .... ... k ... .,., ..a.
E j
e ..m....f ._..._ wm..w ....... ....e .....__, ,....., ots., , _. ... A �.3M.....� .._ _ .e. „ .. _.J ,� ,._ E ., .- .... ,�
j
s e � � . e
I
{
1 4- 7
F e
3
Ll A-44-4
s
t
E
�l
S }
3 A e.»mm m.
Ji, . � a
S
.� .�. .. �am�,
-- +t -
e � nmsd ..... ........ ,.
3 e
_ E
Safety and Buildings Division
NVIsconsin SANITARY PERMIT APPLICATION 201 Box Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code
Madison, WI 537.7 -73.2
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. -
cx
• See reverse side for instructions for completing this application State sanitary Permit Number
�V 58
Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N
Property ner N me Property Location
SB 14 — 1/4, l T d� , N, R ` ?E (or
Property Owner's M 'ling dress Lot Number / Block Number
b a
n 4 R Ed -
Ci State Zip ma P ne Number Subdivision Name or CSM Num er
o t ( > d s�
11. TYPE OF BUILDING: (check one) ❑ State Owned' it Nearest Road
El Public 1 or 2 Family Dwellin - No. of bedrooms d ro w a n OF /l i � ri , B r
111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) 15 7 . 2 - 1
1 ❑ Apartment/ Condo DZZ —1
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 Q 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. ^F;a New 2. ❑ Replacement 3. (] Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an
system -------- System ------------- Tank Only --------------- Existing System -------- Existing System
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 Q Seepage Bed 21 J9 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2_ Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
® Requir d (q. ft.) Proposed (q. ft.) (Gals/day /sq. ft.) (Min./' ch) Elevation
// JJ 1 Feet Feet
Ca acit
VII. TANK in allo Total # of Prefab. Site Fiber- Exper.
INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App
Tanks Tanks
Septic Tank or Holding Tank 1 r lJE$ I"EC�CfS ® ❑ ❑ 1:1 ❑ ❑
Lift Pump Tank /Siphon Chamber 1 1 1 (J ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewa m shown on the attached plans.
Plum is Name: (Print) PI r'S Signature: (N Stamps) M CM
No-) Business Phone Number:
b 0
Plumber'sAddrg�ss( t, it ,State, i C de;: A Q
W yy 6 s
IX. COUNTY/ DEPARTM USE ONLY
❑ Disapproved S nitary Permit Fee (IndudesGroundwater ate ssue Issuing Agent Si nature (No S
Adverse Determination )
Surcharge Fee)
'
proved
[]Owner Given Initial - c-t7
12- �.
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11197) 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 requires a 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 isto 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 andaakes; 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.
j
• Safety and Buildings
2226 ROSE ST
LA CROSSE WI 54603 -1905
Visconsin Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
Department of Commerce
March 17, 1999
CUST ID No.267341 ATTN.• POWTS INSPECTOR
WEGERER SOIL TESTING & DESIGN ZONING OFFICE
421 N MAIN ST ST CROIX COUNTY SPIA
PO BOX 74 _ 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
RE: CONDITIONAL APPROV
Identification Numbers
APPROVAL EXPIRES: 03/17/ 1 :.;: ''' Transaction ID No. 214728
Site ID No. 1 68322
.. 7 7
SITE: `'�^ Please refer to both identification numbers,
F
Site ID: 168322 '" � above, in all 'correspondence with t he agency.
St. Croix County, Town of KznnicI nrii "Nt; OPF
SW1 /4, NE1 /4, S15, T28N, Rl
Facility: Chad Olson
V.
FOR:
Description: Mound
Object Type: POWT System Regulated Object ID No.: 454925
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
M..Spection by wathorize representatives of the Departricnt, which may include local i speetors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 03/10/1999
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
Gerard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM
jswim @commerce.state.wi.us Wi3" code: 7f
i
' Page of 6
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
LOCATED IN THE Sw 1/4 OF THE 1/4 OF SECTION 1S , T N, R 1Q, W,
TOWN OF LNrN1.0 —. -..l AJhJ LC , ST. C,bze1LX COUNTY, WISCONSIN.
INDEX
PA GE 1 ' of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW -CROSS SECTION:
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PA GE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
ClfAD Ol_S ON
POW :cn lly
Gajzd �ID C U
of IoM p1N� q
F N
v1S�o NOENG�
GoR PTZEPAPM BY SAFETY & BLDVS. ITV.
WEGEF�EF� SQ I L _TESTING ®a � ®a���� ®ey
AND SC # 'lo
I3E� 2 CGtV SERV I CE ®� • ®•• """'••.
P.O. BOX 74 421 N. 11AIN ST. Td' aarHUa
® WEGEP.n
RIVED FALLS. MI 54022 '' ? D4 P
i� • EllSi'JURTH,
715 -425-0165 S w's
`�.4"p
JOB NO. Qg —z'p
PLOT PLAN Page Z of
Scale 1 "= 4Q) r
rvoT 10
v--
,MQI+ C
sp o F 1 4 � P�j C
K), q L" CA Vim
� B.1
\S • pF � �
c� UC r—. N,
"Wr bq -
-
&0
O
l'LLb3� Q \S�► \Z6 �T�-T R
NOTES
-1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be tWo /60o gallon capacity manufactured by
W VZS tz_ Co�v e tZ+�TE, t� tzu�� e-1"3 L,v l.pcT - I600
5. Bench Mark j 1 0 n' ch+J ' of ML — 7) , FIlR1"I Qox
6. Divert surface water around system to prevent.ponding at the uphill side.
Page 3 Of 6
Approved Synthetic Covering
i� Ft - r" c. 33 Distribution Pipe
Medium Sand
i
G
Topsoil -_ -_ F Elev O
D
3 E
b
7 % Slope
Bed Of 2 2 -2 (Force Main Plowed
Aggregate From Pump Layer
D 1.O Ft.
Cross Section Of A Mound System Using E Z.s 4t.
A Bed For The Absorption Area F Ft.
G to Ft.
A Ft. H l- 5 Ft.
Linear Loading Rate = ° �t�GPD /LN FT 8 Ft.
Design Loading Rate= O.4.GPD /SQ FT j 1 b Ft.
J `7 Ft.
K l Ft.
"' Position
L _ 69 Ft.
of
Force Main W 3 1 Ft.
L
Observation Pipe
A
I0 - - -- ----- - - - - -- ----------------- - - - -�i
Distribution Bed Of 2 2 2
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
pa L4 Of _6
Perforated Pipe Detail
0
End View
)Perforated
End Cop- die �" PVC Pipe
� oc e
asp° Install permanent - marker
at end of each lateral
Holes Located on Bottom,
Are Equally Spaced
Q S
Q
PVC
Manifold Pipe
PVC Force Main
Distrt ution
Pipe
Lost Hole Should Be
Next To End Cop
End Cap
P Z1.ZS
Distribution Pipe Layout S 4 Ft.
X 3Z Inches
Y 3O Inches
Hole Diameter <<y Inch
Lateral llty Inches)
Manifold Z Inches
Force Main Z. Inches
# of hol eslpi pe 0 1
Invert Elevation of Laterals 113
,
Place lst hole 1S from center of manifold with succeeding holes
at :S& intervals. Last hole to be next to the end cap.
Combination Septic-cTank and
PUMP CHAMBER CROSS SECTION. ARID SPECIFICATIONS PAGE S OF �
-VEIJT CAP WEATHER PROOF
JUIJCTIOIJ BOX
4'�C.I. VENT PIPC APPROVED LOCKING
—•Z O
' FROM DOOR. MAIJHOLE COVER PQ1V
'.11WDOW OR FRESH wARNIi.J6 L.l46EL.
AtR WTAKE S cowDulT
I
�L. tr�, F� 6 f✓IRX• �.,MiN. SKIS Da
I V
16 "IKIAI.\ ---- - - - - --
y'�►us�c'ttiwa PIPC Y PROVIDE I - - --
I1J AIRTIGHT SEAL I I I
A I I I APPROVED JOIIJ
APPROVED JO I E1T I I I W/ C.1. PIPE�pJo
W /C.2• PIPFO Tank construction I I II
ALARM
shall comply with
ILHR. 1;3.15 and 33.20 b I I
c •I I
oIJ
�Db 62 I
LLEY. F7 PUMP � -'�
` OFF
0 COIJCRE re
� tom► - l O U. O I
BLOCK
3° 1►PPRti+tEC
RISER EXIT PERMINED OIJLy IF TAW MAIJUFACTURE.R HAS SUCH APPROVAL Ef- DD ING.
SEPTIC
SPECIFICATIOKIS
DOSE
f
TAWK MA>J UFACTLIRCR: Wl ��TM C2j C- tzj1 My WUMBER OF DOSES: PER DAy
TANK SIZE: tw(3 / GALLOWS DOSE VOLUME z l33•�
ALARM MAW U FACT UR. `R: S.S. S.-n It`-" INCLUDIME, B ACKIFLOW: CGAI.LONS
MODEL WUMBER: ")l "w CAPACITIES: A= �� IAICHES OIL 301 `u GALLO1,15
Wl �ccc� -Y
SWITCH T�PC: $ = Z IAICHES ` OK G61-1-OLIS
PUMP MAWUFACTURf R: � �Z' S C r g ILAHES OR 133 ` GALLOWS
MODEL UUMBER: S 1z N1 D- INCHES OR ` GALLOWS
I'�1 NIZCC�R ` ul - , tCc L�UZ,
SWITCH TYPE: Y ►DOTE: PUMP AMD ALARM ARE TO bE
MINIMUM DISCHARGE RATE Q Z' tiz GPM INSTALLED OW SEPARATE CIRCUITS
VEKTICAL DIFFERENCE DETWCEU PUMP OFF AI,10.015TRIBUTIOU PIPE.. 6 ' &3 FELT
+ MIIJIMUM WETWORK SUPPLY PRESSURE , . , , , . . . . . . 2.50 FCET
1 F T. O'S
- F EET OF FORCE MAIN X 3 " oofi.FRICTIOU FACTOR.. FEET
TOTAL Dy1JAMIC HEAD = FEET
Pump chamber DIAMETER 3�
IMTERIJAL, DIMEW5101J OF TAWK: LEAIC.TH ;WIDTH - ;LIQUID DEPTH
BOTTOM AREA - 231= _ GAL /INCH
AS PER MANUFACTURER lV•12� GAL /INCH
SH313W NI OV3H 1b101 —
m fl- (D LO d- M N — O
O
O
W
M
O
0
O
N
M
O
I �
LIJ
N
O z
W H
O
Z ,
CC
O w
�, co CL
a
I N O Z
W LO 0
f—
H
J O Q
0
- O
U
Q
EL
O H
� N
U _ o U
7 - M Q
6`
o U
m A 1 0
N
i
O O
O g o
O In O LO O LO O
M N N - -
K 3476 1/94 133A NI ad3H -lVlO1
t1 ,411, 8 WED 14:08 FAX 715 386 4686 ST CRT• CO ZONING 001
L t n Huma Ra tmel arians of industry,
L i d, Huma SOIL AND SITE EVALUATION REPORT P ag e �! _ of
3
ebo
Divis :4S afety & Buildings in accord with ILHR 93.05, Wis. Adm, Code
COUNTY Y
Attar smplete site plan on paper not less than a 112 x 11 inches in size. Plan must include, but 5 'r. Cx
not I Rid to vertical and horizontal reference poi rection and % of slope, scale or PARCEL I.D. #k
dim( ic north arrow, and location and didfi , 40, s oad. J 2.z - 10 4 1 1-
APF GANt INFORMATION-01 � ..J~ � : _ TION REVIEWED BY DATE
j �
[P 'rR'ry : av
,
r ,y_' PROPERTY LOCATION
GOvT. LOT S&t 1/4 N 114 S / ,N,R /,0 E {o W
iICiY OWNER' ;S MAlLfNO ADDq�SS ; # BLOCK # SUBD. NAME OR CSM #
PATE 3 5/ cal S GO/ � ZIP CODE PWONE t�UM$fe[� []CITY UVII,UIGE [;;MN NEAREST ROAD
,.,14
01 Construction
11 01 Use (�esidenRia4 l Number gf'bt#dr�tS's 3 _A> (] Addition to existing. building
( j ;lace O Public or eoMm i erew del Ibe
Coc arrived dally flow v gpd Recommended design loading rate ' S bed, gpd /ft �� trench, gpd/ft
Abs tam area req uired 37 -� 2 2
5�� b. h _ trench, }t mum design bading rata � bed, gpdfft �' trench, gpd/ft
Rec "minded infiltration surface elevation(s) SAf- 3 /O!a •QO ft (aS referred to site plan benchmark)
Add iiA design /site consid�ef allons S Tom" P1 fi l - 4.p - fo�.u10 of
Pan material �7 `�- i Flood plain elevation, if applicable it
S = t�Ible for system CONVENTIONA F�MVO IN- GROUND PR URE AT -G E SYSTEM IN FILL HOLDING TANK
u = luitabte fors stem q 5 ( l,} El [ °El U ❑ S [�W 0 5 C �
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure �GPD/ft in. MtJnsett 4u.'$z Cont. Color Texture Gr Sz Sh Consistence Barday Hoots
_�- - /�d�' 3/.� -- S /m„ foe dip $
Ground 'xy /D `/o? J/ -
elev.
N 0 l Aj
Depth I• , •
limiting
tactor , •:
F�emarks: /?�� i S ..� L C�f�.vj - �� fv �t •
Boring
/0 14M
r
6
Ground 3 "~ /6 `/ .3 /z_
elev. 39.1
Depth tc ��T' 57
limiting � C / v
factor � II /6 g �
f' �'f •v7x" +�,
h
6�55 Rem arks:
rddre � - Please Print
' � Yl, eA T Phone: 7/��
' r' ' Date: CST Number:
tt
Wisconsin Department of Industry SOIL AND SITE EVALUATION / 3
Labor and Human Relations Page of
Division of Safety and Buildings p p paper x 11 ac'cb, ides in size. ce with s. ILHR 83.09, Wis.
A
Attach complete site Ian on a er not le County
��` /2� , must S C ISO l' )C..
Include, but not limited to: vertical and hori s nYrefereclp ), dir8 and
percent slope, scale or dimensions, north r and location ANI tance tone rest road. Parcel I. D. #
02-2--10 10
APPLICANT INFORMATION - Pl aj� print 0 Waroa ton ,-- Re 'awed by Date /
Personal information you provide may be used for ary purpQQS ftCy Law, ' . (1) (m)).
r
Property Owner ! .� . ��� Property Location
Govt. Lot N9 1/4 /V£ 1/4,S / T Z( ,N,R /� E (or) W
Property Owner's Mailing Address ,� I t ✓ Lot # Block# Subd. Name or CSM# �/ IOTS
I i5 o COO.OT T f C5M ?e) 7
Ciy State Zip Code Phone Number Nearest Road
12 I U E �. fh l(S lv (. I S ya 1Z 1 0 1 5 ) y2S - 3 ❑City ❑Village Gown C'E.NET/j/E' Y Ri
(- New Construction Use: al6aidenfial / Number of bedrooms 3 ( Addition to existing building
❑ Replacement YSo ❑ Public or commercial - Describe:
-
Code derived daily flow 6P gpd Recommended design loading rate / bed, gpd /ft ' s trench, gpd/ft
Absorption area required 4W bed, It s tSD trench, It 2 Maximum design loading rate bed, gpd /ft2 - trench, gpd /ft
Recommended infiltration surface elevation(s) " Pg— 3 It (as referred to site plan benchmark)
Additional design /site cons ions XNS411 v -0-v e" /e/ * w /LIDV .
L Pa,e material • i Q.4, sue! '�AZ4 fs Flood plain elevation, if applicable N ft Suitable for system Conventi Moun In- GroundPresss a AT -Grade
System Filll Holding Tank Unsuitable for system El LET U ❑ U ❑ S L'f U ❑ S U ❑ S ai" El S
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
1 fisbk � f P
0- /oYR 3/3 L c s if` • �(; • 5
2
f- ioVA 3 / 1 ( L I f Shl< fl2 05
1 • �f . 5
Ground 5 . if /0 YR 7/ 2 f S b le nM - F t • C W
/D3
eft. *• /D Ye // 5L / f Slk vu-FP- CW _ • q: .5 mom
Depth to
Y9 ' %Vlam . S t S / - f •►.rfit — _ . q: . 5
limiting 2• S Y 715
factor
Remarks: llbleiztw -5 S 7
Boring #
t 0 -/1 IOYR 313 7�,P Cs Z f ; • s
Z z �• /8 �o Yee 31 / f sd.e .� �,e e s if ' . 5
Ground c /0 5 L If R.. �w.'�/2. G c� - • �f ; • S
fl -F M rs
Depth to
limiting
factor Ri, -5,
S
'�
3 5 — In. Remarks:
CST Name (Please Print) Signature Telephone No.
12oRFt�r uC.c3R iCA,? .7 1S • 3?4 L PI 65
Address Date CST Number
UlbdchA /f - f 0 0 cs 7 3. y -I -.-
Private Sewage Consultants
665 O'Neil Rd.
Hudson, Wis. 54016
ORIGINAL
i
G . E/`f/�faGTZ SOIL DESCRIPTION REPORT Pag 2 of 3
PROPERTY OWNER g
PARCEL I.D.# d 2 Z. " O g l• 1
Boring Horizon Depth Dominant Color Mottles Structure 2
g Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
3
Al
0- /o Vr 3 L H's6.r 1h, -fA s z-F . q :. S
Ground 3 L�. Q
elev. 6 ' 4 L.; -- - 5
ft. O 5 L �{
hid
Depth to IO 1' J 0T- / v f �►-w f l ' -- �l ; • S
limiting 02 S Y2 �l T
factor
in.
y S.S
J! Remarks: /� /Oe y
Boring #
Ground
elev.
n.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. t)lunsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Im Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor '
in. Remarks:
SBDW -8330 (R. 08/95)
30
teU'
� � o
5UjyEsTEO u(JI �Wll
to
_
�G�VrFTi�.c1S '—
/03. 76
/3 �a 3. 9a
/3 ,� �o� . 775
I ,
5 YS T �' 40
1
I.)- SA AJ D /Oq , 8�
2 )A ,r
suP0 -- l� S I
p .- 100 • d
So G o 7- �-
Fetes 8
�, pscoe con$u lts�t
O'Ne{1 tsd 5406
Hudg °�' W 1
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNER SHIP CERTIFICATION FORM
Owner/Buyer , d`
Owner/Buyer I(- � 0 //s e A,
Mailing Address 10.93
Property Address 2� G 70) >r
(Verification required fr om Planning Elepartment for new construction)
li p City /State C � tr entification Number _
LEGAL DESCRIPTION 4( ,j p
T as N -R�W Town of �l t�
Property Location � '/4, '/4, Sec. ? , W.
Subdivision �' lrl� ( F ✓'e Z P C S Z 3 7Q Lot #
Certified Survey Map # Volume o . Page # .�
Warranty Deed # lD Volume 1391 ^, Page # 3 7
Spec house ❑ yes A no Lot lines identifiable ® yes ❑ no
SYSTEM NLAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary) , the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date. �r p
S IcA
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pr9efty described abov by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE 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
DOCUMENT NO. WARRANTY DEED S EN 6 $ 6
KATHLEEN H. WALSH
594686 VOL 1 REGISTER OF DEEDS
�91PACE ST. CROIX CO., WI
Gerald A. Emholtz and Jean E. Emholtz, husband and wife, Grantor,
RECEIVED FOR RECORD
conveys and warrants to Chad L. Olsen and Wendy A, Olsen, husband and 12 -29 -1998 4:00 PM
wife as survivorship marital property, Grantee, the following described
real estate in St. Croix County, State of Wisconsin:
WARRANTY DEED
EXEMPT N
Commencing at the SW corner of Lot One (1) of Certified Survey Map in CERT COPY FEE
Volume Two (2) of Certified Survey Maps, Page 370, as Document Number COPY FEE
340125 the point of beginning, thence S 87 0 37 1 00" W a distance of 100 TRANSFER FEE: 12.00
feet; thence N QV 23100" W a distance of 381,14 fact; thence N RECORDING FEE: 12.00
87 °37'00" E a distance of 100 feet; thence S 02 °23'00° E a distance of P AGER: 2
381.14 feet to the point of beginning. All in Section 15, Township 28
North, Range 18 West, Town of Kinnickinnic, St. Croix County,
Wisconsin.
NAME AND RETURN ADDRESS
C d R a /- 0/- s 'FAI
ti 0 t d'ov Rte`
Riv�K 4,605, W ! 5
This is not homestead property. Parcel Identification Number (PIN
Exception to warranties%
All easements, restrictions and rights -of -way of record, if any.
Dated this ' day of November, 1998.
(SEAL) 4 (SEAL)
Gera d A. E o tz
(SEAL) (SEAL)
A � n �ot �j
AUT HENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
ss.
COUNTY )
authenticated this day of 19 Personally me afore e this LL day of m
O (� , 19 the above named
Gerald A. Emholtz and Jean E. Emholtz
to me known to be the person(s) who executed the
foregoing instrunient`lan ac nowledge the same.
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,'_ —
authorized by §706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY: Notary Pub c County, Wis.
My commission -is pe aricht: " not, expiration date:
Joseph D. Boles /Go )
Rodli, Beskar, Boles & Krueger, S.C.
P.O. Box 138
River Falls, WI 54022
. o� 2391��c�140
Affidavit, Part 2
The parcel shown on this document is being added to the
parcel shown on the document recorded in Vol. 1358 , Page
479 , Document No. 587448 described as a parcel of
land located (See a ow -
to create one parcel, and
this transaction is thereby exempt from Chapter 18 of the
St. Croix County Land Use Regulations pursuant to Section
18.05 (A) (3) .
Lot One (1) of Certified Survey Map in Volume Two (2) of Certified Survey
Maps, Page 370, as Document Number 340125, filed in St. Croix County
Rgister of Deeds Office on May 19, 1977, being located in the Northeast
Quarter (NE 1/4) of Section Fifteen (15), Township Twenty Eight (28)
North, Range Eighteen (18) West, Town of Kinnickinnic.
340125
CERTIFIED SURVEY MAP
GERALD EMHOLTZ
Part of the Northeast 1/4 of Section 15, Township 28 North, Range 18 West,
Town of Kinnickinnic, St. Croix County, Wisconsin.
Z V &
F" . i
Uj APMOVEp �, F , l_ E D
J
o _ PriA Y 0 1977
.SAY 18 1977
0 > 0 ST. CROIX COUNTY
O N Coaprt liENSIVE PA RKS riAr
Z cr CV `'AND
ZONING COMANH
0- b
E_- q 0 °' N
"' "' W Bearings based on Solar Observation
� r
> O °� ��►' ac
O N � J
W
Q 7ndieates 1" x 2 iron pipe stake M N \
weighing 1.13 # /ft. to 0 �. M
o N < M W
\ \1ti1tt }
5 G O / w
/V '' ////, 19 M Ge z3' oo' 3
`.� 6(.14 a
O
JAMES L.
MURPHY = 4 w v
S•104'2 r N . °N � ro t9
'• IV FALLS, 4
W N oZ° - Zv 00'YY
�a� o
Registered Lanc�I`I It � 4 - w 0 o
o � N Q d M
Io
N
Q o
Dated: 16 August 1976 -! �
3 8 � • 14- �E
Description: u o2° ?V 0O'W
That certain parcel of land located in the NE 1/4 of Section-15, T 28 N, R 18 W,
Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows;
Commencing at the East 1/4 corner of said Section 15, thence go N 52 06' 16 W
a distance of 1402.13 feet to the Point of Beginning of the parcel to be herein
described; thence go S 87 37 00" W a distance of 834.82 feet; thence
N 02 23' 00" W a distance of 381.14 feet; thence N 87 37' 00" E a distance of
645.18 feet; thence S 28 50' 28 E a distance of 425.74 feet to the Point of Begin-
ning, together with an easement for roadway purposes over and across a 66 feet
wide right of way, being 33 feet on either side of the following described center-
line;
Commence at the East 1/4 corner of said Section 15, thence go N 00 07' E along
the East line of said NE 1/4 of said Section 15 a distance of 1557.54 feet to
a point on the centerline of an existing Town Road and the Point of Beginning of
the centerline to be herein described; thence go S 87 58' W 785.32 feet; thence
S 02 1 E 687.35 feet; thence S 87 3 7 1 w 1372.67 feet; thence S 49 21 w 456.79
feet; thence S 88 21' W 148,26 feet; thence S 00 07' W a distance of 559.48 feet
to the centerline of C•T.H. "J" and the termination of the roadway easement.
Vol. 2 Page 370
Certified Survey Maps
St. Croix County, Wis.
I �
See Reverse Side
288.00'
{
r � {
vJ {
N
v 381.14
D 391/ 13 9
° o
N
11� ,� t• ts� N
V O
.A In
Itn
N I O N r' N I
o IN v o I
v N
1D st•tsF
ao Im
J
0
1--4 N
00' i N
w
0 �
00
QJ a O
--I
9'60Z
OD { /
N
Na Ln
00
S'�OZ V 3.3 324.93'
`Q.
N I
342,00'
D
i N