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ST. CROIX COUNTY ZONING DEPARTMENT ✓;`` r - �'
AS BUILT SANITARY REPORT
I E! Ll
Owner�
Address
City /State /]/,�, 2;r l �! ( - y ts� s1 CRol
w+,r� d S �� COUNTY
✓`� ZONINGOFFICE
i J
Legal Description:
Lot — Block Subdivision/CSM #
'1+ '!+ �, Sec. _/—, T 3 V * - RZ2W, Town of - r PIN #
SEPTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manu`Iact�x er � �A Size ST/PC/ Setback from: House Well P/L
Pump manufacture_ r Model
Alarm location
(HOLDI15G. _TANk ONLY)
Setbacks: Service road Vent to fresh air intake _' Vater Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: Width Length Number of Trenches
Setback from: House f Well P/L _ 1X,0 Vent to fresh air intake
ELEVATIONS
Description of benchmark' Elevation /- �7
Description of alternate benchmark Elevation,
Building Sewe;� S v- 5, ST/HT Inlet 4A, -, ST Outlet PC Inlet
PC Bottom Header/Manifold / Top of ST/PC Manhole Cover
Distribution Lines
Bottom of System
Final Grade O O ( )
Date of installation 6 erm7nupber_?/ plan number
n Plumber's ' tore License number
� Date 6 1 1 "
Inspector •
Complete plot plan �
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.
6�
PL W
b
r� 60
ex '. s� �� 0 ^�
3 ik U
,a
6
✓&W)t
C
INDICATE NORTH ARROW
II
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y:
Safety and Buildings Division Count
INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 15830 :
Personal information you provice may be used for secondary purposes [Privacy Law, S. 15.04 (1)(m)].
Permit Holder's Name: Cit �/ p Villa a Town of: State Plan ID No.:
WALTON, KENNETH �Rl>� PRA E
CST BM Elev.: Insp. BM Elev.: BM Des i tion: 6 Parcel Td# fyo_:1007 -80 -000
t� l 6t> a 1L
TANK INFORMATION ELEVATION DATA A9800220
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic X Bench r S�- /00 /Da
Dosing
Aeration Bldg. Sewer Qkr5 T,
Holding 6*l nlet
TANK SETBACK INFORMATION t utlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic e n NA Dt Bottom
Dosing NA Header / Man.
LHI tion NA Dist. Pipe ,7 78
ing Bot. System q'.Q
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Dem d
Model Number GPM
TDH Lift Friction S Ste TDH Ft
oss
Forcemain NL np_ ia. Dist. To well
S ABSORPTION SYSTEM
E / TRENCH Width I Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid D pth
'--" ENSIONS DIMENSION
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION SyPeO. r g ' OR UNI CHAMB Model N er:
DISTRIBUTION SYSTEM O
Header / Man)fold Distribution Pipes) / 1 r x Hole Size x Hole Spacing Vent To Air Intake
Length �� Dia. Length W Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: ERIN PRARIE 01.30.17.16A,SE, 1720 HIGHWAY 63
(,) - 1 " ") [�.�,�, a '�' ( �` ,, - ( VI
(%� � Ltl!it (�✓ ��, In
Plan revision required? E] Yes XNo � � �� Ke d Use other side for additional information. 1 &L, / 3
SBD -6710 (R.3/97) Date Inspecto ' Signature er .
Safety and Buildings Division
SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue
1*4consin
In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302
Department of Commerce Madison, WI 53707 -7302
• 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. r
• See reverse side for instructions for completing this application state sani ry Permit Number 5, -
�a
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
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N
Property Owner Name Pro pert Location
:K10ab?,� Wak4:XT -_ . ,
v4 3€ 1/4, 5 T 3O, N, R I (or
Property Owner's Mailing dress Lot Number Block Number 4._� fo I
City, State Zi ode Phone Number Subdivision Name or CSM Number
10 .� Q ( ) ' f
Ill BUILDING: (check one) ❑ State Owned a !t Village
Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms �j p own �r
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) It
1 ❑Apartment /Condo
dtC9- -140
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2>poeplacement 3, ❑ Replacement of 4 ❑ Reconnection of 5, ❑ Repair of an
Sy tem _System Tank Only______________ Existing5ystem Existinc�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
11'12(6eepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
1:f[] 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 5. Perc. Rate 6. System Elev. 7. Final Grade
Y5 6 Re uired (sq. ft.) Proposed (sq. ft.) (Galsiday /sq. ft.) (Min. /inch) Elevatio • — 7. Feet Feet
Ca al cit
VII. in g allo ns Total # of Prefab. Site Fiber- Exper.
INFORMATION
g Gallons Tanks Manufacturers Name Concrete Con- . Steel glass Plastic App
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank El 11 1:1 1 ❑ 11
Lift Pump Tank /Siphon Chamber ❑ El 0
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
P mber'ss Name: (Prin ( /JJ // /�, /4f Plumbe , ignature (No Stamps) MP /MPRSW No.: Business Phone N uu mber - YJ�I
Plumbe80dress (Street Cit Xte, Z Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sa " ary Permit Fee (includes Groundwater Date I ssued Issuing A entSig ature (N t s)
Approved ❑ Owner Given Initial U Surcharge Fee)
Adverse Determination v
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber -
PLOT PLAN
PROJECT Kenneth Walton A DDRESs1 720 Hwv 63 New Richmond Wi 54017
SE 1/4 SE 1/4S 1 IT 30 N/R 17 W TOWN Erin Prairie COUNTYST. CROIX
° 5/29/98 3
MPRS BYRON BIRD JR. 3318 DATE BEDROOM
CONVENTIONAL XXX IN-GR46UND PRESSUR CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 128 BED SIZE 18 'X63'
BENCHMARK V.R.P. Base of Light Pole ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *H,R,P, Same as Benchmark
SYSTEM ELEVATION 94.4
Alternate Benchmark TOP OF SEPTIC TANK COVER
PL
V
AD
OVERING
12' EXT. DF 12" 3' ' 3' ® 3'
A
Y °0 30'
v
30'
B -2 -3 4ti
0
90' \ � °S � 18' X 63' Bed
�
Line to be Vent P
ON w Insulated under \ \
Driveway _ 1
x 75' BM 0 >500
DRIVEWAY s
25' 40' 20' 40'
SEPTIC AL .
TANK BM 5 ,
L
A
0 3 BED
0
V HOUSE
PL
• Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page t of
Bureau of Integrated Services kc�hrlCg S. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not les ' 41�1/2 11" in size. PI must County
include, but not limited to: vertical and h zohtal refer �!t M), direction and S C_/� p/
percent slope, scale or dimensions, northlafrgiiv, and location and distance to ndarest road.
Pmel I.D. #
� � 1
APPLICANT INFORMATION - 'P�� 9e print all GrSMhnat - 0 Rev d b Date
-r
Personal information you provide maybe used fo�s660 ary ur��f � +��iaw(s, l (1) (m)).
Property Owner Property Location LA
�" r Govt. Lot �� 1/4 j�i /4,S / T ,N,R E (ql
tee; 3 /7
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
FC1tV St re Zip C de Phone Number ❑ City El Villa e
Town Nearest Road
❑ New Construction Use: U4esidential / Number of bedrooms �— Addition to existing building
.Replacement ❑ Public or commercial - Describe:
Code derived daily flow �5 O gpd Recommended design loading rate = bed, gpd /ft 5 trench, gpd /ft
Absorption area required bed, ft ,�'G'�" trench, ft Maximum design loading rate !/ bed, gpd/ft 5 — trench, gpd /ft
Recommended infiltration surface elevation(s) - Z7 ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system S❑ U S❑ U S❑ U X S 1:1 U ❑ S U ❑ S JK U
SOIL DESCRIPTION REPORT
Borin g # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
j in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
l 0.4 r li a S� -
n
Ground /
elev. s f
��ft.
Depth to
limiting
factor
3 Remarks:
Boring # /
/0 Q
r S tj ,a
/L !tea VV .J /3-
Ground
elev.
Depth
limiting
factor
> -in. Remarks:
Name (Please Print) Signature Telephone No.
c 2fJ f`� Jr- - �-l l e
Address Date CST Number
� I CQ f -j F - a'--e L-02 52"a,0 51
3 , SOIL DESCRIPTION REPORT
-��/
PROPERTY OWNER 2N� � '�-' Page of
PARCEL I.D.#
Boris # Horizon Depth Dominant Color Mottles Structure 2
Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
j 64 o ,. 3 �c.� v.,� Ic- m r -fi •S
Ground d -1
elev.
Depth to
limiting
factor
0 ," - in.
3- / Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # ;
E3
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
E3 ,
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
3 3
Soil Test Plot Plan
Project Name KENNETH WALTON Byron Bird Jr.
Address 1720 HIGHWAY 63 '
NEW R I CHMO ND, WI 54017 CST #3479
Lot -- ---- Subdivision ----- - - ---- Date 5/ 1 9 /98
S E 1 /4 1/4S T 30 N/R 17 W Township ERIN PRAIRIE
F - l Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft.BASE OF LIGHT POLE
System Elevation 94. *HRP as B
Alternate Benchmark TOP OF SEPTIC TANK COVER
Od
PL
12'm. DF 54'
A
Y 30'
B -2 -3
30'
Q 63 yo4ti P
a` w
x 75' BM >500
5 '
DRIVEWAY
eSE
25' WELL 409 ;BM 40'
L
n
PL
s ,
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer i2
Mailing Address
Prgperty Address
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number
LE GAL DESCRIPTION
Prop Location '/4 . ' T -R / , ; 7 W Town o � � ✓ -�
p y /4, Sec. �fIGN ,
Subdivision , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # , f Volume , Page #
Spec house ❑ yes o Lot lines identifiable)E�-es ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
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.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
da jf the three year expiration date.
SIGNA 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 property described above, b virtue of a warranty deed recorded in Register of Deeds Office.
SIGN 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
,._.
( `OOCUMCtN1r ^ NO. ATZ BAN Of WIWONXX FOJLX I— •.!*ass deserves.va uess«w eaves
WARRAWY OM
vot
L
� y m . ade wt.., . .. j rt �. . ,� _.. r .......... RN"Int o
. ... A . * .IRts�sn!�#__ .- !�A!!!r .M._' s -: Sr . Q War r
( ................................ �t'd.1ar Reowd f 2ltt
.4 - elaet�t r.. .11 a... .. cisastoer, daq► qf�,,,,,, y 19.!4
Y_ a t3tr
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. - a _ • ...a. ...... r»..•. h
........... ................ »»..........•.... •._....• ...._ .. » ....•.• ......., R i.`
Va ,n ,N t the said Grantor for i vahiiDi!
u1! OthLe »
1 It conveys to Grantee fbe fol)owias described teal estate is ......1 w. ' ..... 21 l� laid
`. ..... asrusK To
i= ceaaq�, eau d w;.�nain: f�a t� saou'�
1
Tae Parcel No-
The NEk of the SEA of Section 1 -30 -17 , E1CUT the South 330 feet of
the West: 660 feet thereof. Also, the North 330 feet of the East
k
It 060 feet of the SEk of the SEk of Section 1- 30-17.
j
it Subject to recorded easements, reservations, and rights oLf wily.
i sc
D
F
r
it Thies ..... ........... homestead property.
(is) (is not)
Together with all and singular the hereditaments and a pertenanees thereunto belongin
Robert J . NUl ler and Nan Muller
e g.
And__..-_...... title go - •-
..... -- --- -- --� --- •-- ••• -• ---- - -• ---
i warrants that the title is good. indefeasible in fee simple and free and clear of encu mbrances ezeept
a first mortgage to Federal Land Bank of St. Paul, dated 4 Mar 80,
recorded 17 Mar 80, in Volume 609, page 389, as Wo ment #363247,
which mUWg d t e same. G f ntees agree to assume and pay. {
and will warrant and a n !
Dated this .... _ ....... . 8 ............................. day of .................... ....................... ............
_, 19. ►_..
(SEAL)
.......... P
.... ....(SEAL)
` Robert J.
i . y ...... ............................. ...............................
(SEAL) .......
(SEAL) I
AIIThYSNTICATION
ACHNOWL$DO![SNT
Signature (a) ._._... .............•___.._.. ..__- ___._.- •._-- •_•_- _-- _..... STATE OF WISCONSIN
----------- •------ • - - - -- ....................................................... St. Croix "'
.......... ..... •------••• •••- - -- County.
authenticated this -------- day of_ _....- __• ............... 19 ...... Personall y
came before me this ...... �� . ...... day of
�x --- ----------- ------ _! �the a bove named {
Robert J, jer..__ ;
--- - - - - -- ....................... .• - -- -• -- -- •- - -• - -- •?�- e -----------------
TITLE: MEMBER STATE BAR OF WISCONSIN h •
._..- •••- -- -•-• S e
(Ii not, .................. .......
authorized b ----•---- ..... —
---••--
to me kn to be a so
Y 1 708.06, Wis. State•) ._
�_ ejecuted the
forego! natrumen an R{d 94 e.
THIS INSTRUMENT WAS DRAFTED 9Y
Eric J. Lundell BOx 157C�' Id�f- SCO,
..... -._ .. - ••- ••-- •••--- • - - - -•.
New Rich nand, W'sconsin 54017 •- _---- _----- Betty. l.. ....... ...... s•.. ..... ___ ._...- ........
.................. .........
Notary Public ..._. St... Cz'Oi .. . ............
._ _..County, Wis.
(Signatures may be authenticated or acknowledged. Both MY Commission is permanen. (if not, state expira )n
are not necessary.) date:
•Nimes of persons signing in ^ny cspsrity should be typed or printed below their signatures.
xChMN"Cor.wrM� eTA :'F• BAR OF W 1 1 4CON N as SIN
. . FORM .. 1— les Stock No. 13001
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I ave inspected the septic tank presently
serving the residence located at:
Section Z R W, Town of
Upon inspection, I certify that I have found
the tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced:
Did flow back occur from absorption system?
Yes > -*'— No (If no, skip next line)
Approximate volume or ength of time: gallons minutes
capacity/��(��
Construction: Prefab Concrete Steel Other
Manufacturer: (If known) c,0
Age of Tank (If known):
(Si na ure) (Name) Please print
(Title) (License Number)
I c
Date
Form to be completed by licensed plumber (s.145.06, Wisconsin
Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative
Code)
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge Ta?.; 1
conform to the requirements of ILHR 83, Wis. Adm. except for
inspection opening over outlet baffle).
d� /�-<
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ST. CROIX COUNTY �P �
SURVEYOR`S RECORD
ERTIFIED SURVEY MAP
0 GATED IN PART OF THE NE1 /4 OF THE SE1 /4 AND IN PART OF THE
SE1 /4 OF THE SE1 /4 OF SECTION 1 T30N, RI 7W, TOWN OF ERIN
PRAIRIE, ST. CROIX COUNTY, WISCONSIN.
OWNER D.O.T. APPROVAL NUMBER 55 -63- 2997 -2000
EC.
KENNETH WALTON 1
SEC. 1
1720 HWY "63"
NEW RICHMOND, WI I Z
54017 I
I
I
M PRACUTi GD LLMDO OM_I Mr. CD �`I pdpu�C Gi
-------- - - - - -- S89 0 09'59' 600.00'
I
550.00' / 50.00'
• I
CAUTION - HIGHWAY SETBACK RESTRICTIONS PROHIBIT IMPROVEMENTS.
SEE BACK OF THIS SHEET FOR THIS AND OTHER D.O.T. RESTRICTIONS AND\ I m =
OR NOTES. m> ;E
mcn �
Dlz
z
� � • I m -<
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# // 1 LOT 1 �''' SEPTIC Mr- �i a
I VENTS _m 61 :9 50'
Gam` �/ AREA INC. RNV / I cn 8 T o_ I
362,626,-40 FT w n D
i 8.325 ACRES TRAILER S `' 0
AREA EXC. R/W
HOUSE
335,433 SO FT
7.700 ACRES 0 I I I =+ Z C
O �7
I� p .__ 100' - = Z C
z 0 I m cn i I�
1 cn 0 ° o I=
o POLE — I = 1 I I O°
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POLE SHED 0 m � I
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SHED cn 10.09 141 I
o CONCRETE z I m o
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HOUSEi I CA) I;
I I I
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/V i W I g
SEPTIC O F o
VENT Nnl
IN I�
I
THIS LOT IS BEING CREATED UNDER THE ST. CROIX COUNTY FARM I I 40 60
LAND CONSOLIDATION ORDINANCE.
560.00
\ ,4 0.00'
° „ .00'
N89 09 59 600 00•
I
I
MMpdQ D dGQm@ Ol mzo MV Puma
= I
C- , LEGEND I
APPROVED I N
r. Z ST. CROIX COUNTY i N
M m C, 1" X 24" IRON PIPE SET WEIGHING
00 1.13 LBS. PER LINEAR FOOT Planning Zoning and Parks Committee
00 -- m
m : JAN 2 5 2000 I
c 1" STEEL SURVEY MARKER SET FROM SE COR. SEC. 1
� WITNESS MONUMENTS
Z " If not recorded within 30 days of
8 0 zo m PK NAIL FOUND
4 n m approval date approval shall be
O m 0 null and void
90 ROADWAY SETBACK LINE
5 --4 = (DISTANCE AS SHOWN) SCALE IN FEET 1" = 100'
Zm
100 0 100 200
THIS INSTRUMENT DRAFTED BY ED FLANUM JOB NO.99 -146 DATE 1 -17 -00
Vol.14 Page 3795
• AS BUILT SANITARY SYSTEM REPORT
AnER , TOWNSHIP SEC. T�N R_N
0. ADDRESS l , ST. CROIX'COafTY, WISCONSIN.
. , LOT LOT SIZE
PLAN VIEW
-Distances b dimensions to meet requirements of H62.20 -
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
All
- f
roc �t
C
Y _
p 2 p
i
f i
Iridipa oXth Azr j
SCALt :
QTIC TAh'K(S) MFGR. CONCRETE STEEL
NO. of rings on cover _�. Depth DRY WELL
MNCHES NO. of width length area
Lo no. of line widt lengt area
dept a�to top of pipe �S/ •
a6REGATE 3
U RATE AREA REQUIRED AREA AS BUILT
hsciaimer: The inspection of this system by St. Croix County does not imply complete
;o+ with State Administrative Codes. There are other areas that it is not possible
t inspect at this point of construction. St. Croix County assumes no liability for
Stem operation. However, if failure is noted the County will make every effort to
ietermine cause of failure.
AEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. f
1 -
f C .. `INSP C��
DATED - - -_ YL ER ON JOB
LICENSE NUMBER /�S"l
EH 115 Rev.
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION:' /a,Sk' /a, Section &N,R_L7J (or) W, Township or Municipality &I)( /��
Lot No. , Block No. I County
u ivision ame
Owner's /Buyers Name:
Kc 1A
Mailing Address:
TYPE OF OCCUPANCY: Residence 19 of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
Q
DATES OBSERVATIONS MADE: SOIL BORINGS 8 17—&Q PERCOLATION TESTS $=C7 R O
SOIL MAP SHEET ZQ NAME OF SOIL MAP UNIT SAJJ,uQ0 S.AF 1 e04m
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- SINCE HOLE HOLE AFTER INTERVAL
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN
P _ /
P_ ,
P
P_
P_
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES
OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B— 7 -T'
B— '
B— R >
B—
B—
B—
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan th''e/ Jo!�ttjjon and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy — .Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
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I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods
specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my
knowledge and belief.
Name (print) - Certification No. SS''
Address
Narhe of installer if known
Copy A —Loca Authority CST Signature
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
S ani t:an y P enmit
State Septic
d * ��
NAME Towns hi St. Cno.ix County IOL
Locatio
� D, S e c t.f, a n Lot # - S ub'di vid i a n
SEPTIC TANK
Size j L gat2anb Numbers o6 eompvitvfe:n.ta
Distance nom: Wett /" Building - -Z2% bLope
H.ighwaten
PUMPING CHAMBER
Size ea.E.2on "� Manu' aa� nen t xr ,, ,
p Made - 'Nccmben
HOLDING TANK
Size gattons FNume Comp an.tmenU Pumpers tem
Distance 6nam: W ett ui.td.ing 12% '6Zo
Highwaten
ABSORPTION SITE
Bed Tneneh
Distance Sham: Wett Buritding / -2 � 1.2% •6Zope
H.ighwaaen
ABSORPTION SITE DIMENSIONS
W ' dth o xne j 2 6t Req anea tSx
LengTh o6 each tine _o� St Depth o6 no c betow tite in
Numbers o6 ti-nes 2 Depth o6 %ock oven Cite 2 .in
Tota.E kength o tinez Z> 6.t Depth o6 ti.te betow gnade in
Distance between Unes 6t Stope o6 .tneneh - in. pen 100 St A
Tota.E absonpt.ion ane.a_ 4 1 6t Type as Coven: ape 6tAaw R�
PIT DIMENSIONS
Numbers o pits Gn t a ` and pit,6 y no
Outside d.iameten p h :�bt ow intet St
Tota.E absorption area it
Area nequ,ined
INSPECTED BV TITLE
APPROVED DATE 19 8�
REJECTED Z DATE 198
REASON FOR REJECTION
PLB State and County State Permit # l
67 Permit Ap County Permit
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION:' / _S4 _ ' /4, Section __/ , T-in N, R J (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township Liu
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance
Single family _ Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete ^ X Poured -in -Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate tal Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Line 1, Ft. Width Depth Tile depth (to No. of Trenches
Seepage Bed: Length--A Width e Depth Tile depth (top) _.o� No. of Line _c3(
Seepage Pit: Inside diame er Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope
WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑
Owners n a m e as li sted on E H 115 if other than present owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared
by the Certiiied Soil T ter,
NAME . — C.S.T. # js- ,S'.3/ and other information
obtained from J . I AJAO (owner/builder).
Plumber's Signature MP /MPRSW# ���� 3 Phone �I�
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE OINI
Date of Application ,-,�J _ Fees Paid: Stat eF 1 3Ae County �—� Date
Permit Issued /Rejected (date) Issuing Agent Name
Inspection Yes No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78
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Parcel #: 012 - 1007 -50 -001 05/31/2005 04:13 PM
PAGE 1 OF 1
Alt. Parcel #: 01.30. .136 012 - TOWN OF ERIN PRAIRIE
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
* VANG, TOU & PANG M
TOU & PANG M VANG
1720 HWY 63
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1720 HWY 63
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
egal Description: Acres: 25 Plat: 0994 -CSM 14/3795
SEC 1 T30N R1 7W E SE BEING Block/Condo Bldg: LOT 1
T 1 8.325AC
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
01- 30N -17W
Notes: Parcel History:
Date Doc # Vol /Page Type
02/07/2000 618048 1489/034 WD
07/23/1997 839/49
07/23/1997 688/272
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 05/21/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 9,000 144,100 153,100 NO
AGRICULTURAL G4 5.320 400 0 400 NO
Totals for 2005:
General Property 8.320 9,400 144,100 153,500
Woodland 0.000 0 0
Totals for 2004:
General Property 8.320 9,400 144,100 153,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 550
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
2 9
5 � 5
AW 14M
SURVEYOR'S RECORD / 35
ERTIFIED SURVEY MAP
QJ GATED IN PART OF THE NE1 14 OF THE SE1 14 AND IN PART OF THE
SE1 /4 OF THE SE1 /4 OF SECTION 1 T30N, R17W, TOWN OF ERIN
PRAIRIE, ST. CROIX COUNTY, WISCONSIN.
OWNER D.O.T. APPROVAL NUMBER 55- 63- 2997 -2000
KENNETH WALTON E1 03
1720 HWY "63" SECC. . 1
1
NEW RICHMOND, WI I =
54017 I $ I
U .
I N o I
i � I
UHpdA r�GD dAH[O@ 0° M H[ED [BU
---------------------------------------
S89 °09'59 'W 600.00'
550.00' / 50.00'
• I I
CAUTION - HIGHWAY SETBACK RESTRICTIONS PROHIBIT IMPROVEMENTS. 1
SEE BACK OF THIS SHEET FOR THIS AND OTHER D.O.T. RESTRICTIONS AND\ I m =
OR NOTES. mD XI I
m� Iz
� I m0 his 11
F LOT 1 SEPTIC z I d I
VENTS: m 6I 51Y
Gam` AREA INC. R/W / o
362,626 SO FT w -n
8.325 ACRES TRAILER S `'' p
AREA EXC. R/W HOUSE
1 335,433 SO FT 1
1 7.700 ACRES O I I I o ;C l
D 00' Z o 1' I �
I N Ilo
Q o ❑ POLE - D I l e i o
m POLE SHED m N8 *1 1'35'W
I SHED Z ( 10.00'
o CONCRETE Er
1 R .p a
PAD •HOUSEI I oo
oo — 1 i I oa
� ��b, �xisrrN� I z I I D
to
1� ��� WELL
SEPTIC I 1
y O VF l o l
VENT
i I
GJ I I O
i
THIS LOT IS BEING CREATED UNDER THE ST. CROIX COUNTY FARM 1 i 40' 60'
LAND CONSOLIDATION ORDINANCE.
560.00' \
89 0 09'59" 600.00'
I 00 ' I
NN
N -� u LEGEND APPROVED
� — ST. CROIX COUNTY ( N d I '
m O Q 1" X 24" IRON PIPE SET WEIGHING planning Zoning and Parks Committee
n � 1.13 LBS. PER LINEAR FOOT
M
CD c m 1" STEEL SURVEY MARKER SET FROM JAN 2 5 2000 I SE COR. SEC. I
m WITNESS MONUMENTS
z A z If not recorded within 30 days of ,
g O O PK NAIL FOUND
m
n m approval date approval shall be
null and void mOmp
m O ROADWAY SETBACK LINE
Z m (DISTANCE AS SHOWN) SCALE IN FEET I"= 100'
100 0 100 200
THIS INSTRUMENT DRAFTED BY ED FLANUM JOB NO.99 -146 DATE 1 -17 -00
Vol.14 Page 3795
Form - STC - 04
AS BUILT SANITARY SYSTEM REPORT
OWNER T O WN SHIP ���"� /1°'i �, SEC. TJN -R W
ADDRESS �f���( IBC' ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT �/�ZE
PLAN VIEW G�V
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
•7 !
0 2 0
INDICATE NORTH ARROW
r
BENCHMARK: Describe the vertical reference point used 4xr.
Elevation of vertical reference point: Proposed slope at site: 3
SEPTIC TANK: Manufacturer: Liquid Capacity: _� ��'✓ 5.,
Number of rings used: O
r - .,._Tank manhole cover elevation:
1
Tank Inlet Elevation: Tank Outlet Elevation:
g. t
Number of feet from nearest Road: Front,Q Side,U Rear, O 77 feet
From nearest property line Front Side,�Rear,O
";7 feet
Number of feet from: well , building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
S EE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump /Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: X Trench:
Width: 02 Length: Number, of Lines: Area Built:
Fill depth to top of pipe: - r' -
Number of feet from nearest property line: Front, O Side, Rear,0 it t.
Number of feet from well: 114 u),21 d
Number of feet from building
Include distances on lot plan).
( P P
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: —� Plumber on job:
/
License Number:
3/84:mj
i
1
DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS
ON
I
LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMB DIVIS
P.O. BOX 7969
' MADISON, WI 53707 ��,yy�� State elan I Number:
SF%,SF%,S1,T30N -R17w MCONVENTIONAL ❑ALTERNATIVE (lfatePlanI.
Town Ub EA in n Ptccutf i e ❑ Holding Tank ❑ In- Ground Pressure El Mound
State Highway 63
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Kenneth Wa,ftan I Route 1, Box 30, New Richmond, W1 54017
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.
Name of Plumber-. MP /MPRSW No, . Coumy: Sanitary Permit Number:
Bynan &Ad Jn. 3318 St. Cna�,x 11277
SEPTIC TANK /HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
DY ES ❑NO — ]YES ❑NO
BEDDING. VENT DIA. VENT MATT. - . HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. JVENTTOFRESH
J ALARM FEET FROM LINE AIR INLET
❑YES ❑NO ❑YES ❑NO NEAREST
'NG CHAMBER:
CTURER BEDDING'. J ILIOUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO DYES ❑NO
R CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
LINE AIR INLET
BETWEEN FEET FROM
UMP UIN AND OFF) ❑YES ❑NO NEAREST
OIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH: LENGT NO OF DISTR. PIPE SPACING COVER INSIDE DIA -PITS [1 ID BED /TRENCH S3 TRE PIT PTH
DIMENSIONS
GRAVEL DEPTH :ABOVE L DEPTH UISTH PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. TR. NUMBER OF PROPER TV WELL BUILDING V NT TO FRESH
BELOW PIPES L/ COVER. ELEV. INLET ELEV. END PIPES FEET FROM LINE AIR INLET
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES 1:1 NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WE LLS
❑YES El NO ❑YES 1:1 NO
DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL SODDED 1 111131D MULCHED
CENTER EDGES.
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVEN
BED /TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE J MANIIOLD MATERIAL NO DISTR UIST R. PIPE DISTHIBUTION PIPE MATERIAL & MARKIN6
ELEV.' ELEV.. DIA. ELEV. PIPES DIA
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED
❑YES ❑NO I - ]YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING
FEET FROM LINE:
❑YES 1:1 NO 1 YES NO NEAREST
1. '7J- o 41
L•aa 'I•�� o
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE TITLE
Zoning Admi.niZtw
DILHR SBD 6710 (R. 01/82) I
ILHR SANITARY PERMIT APPLICATION COUNTY
Gro
In accord with ILHR 83.05, Wis. Adm. Code STA 9ANITARY PERMIT #
7 Co
— Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER
8% x 11 inches in size.
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION FOR VARIANCE ❑ YES ® NO
PROPERTY 9WNER PRO LOCATION
A g) , Q, p ; '/a ' /a, S 4 T D, N, R 1 E (o
PROPERTY OWNER'S M&LING ADDRE S QQ / r T NUMBER BLOCK NUMBER SUBDIVISION NAME
�4J /C rc/J
CITY, STATE ZIP E PHONE NUMBER CITY EAREST ROAD, AKE O LANDMARK
Pll ILLAGE : rl �., , h
(/
11. TYPE OF BUILDING OR USE SERVED: ' d 00
Number of Bedrooms if 1 or 2 Family 0 OR ❑ Public (Specify):
III. PURPOSE OF APPLICATION: (Check only one in P. Check # 2,3 or 4, if applicable)
1. a. New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously Issued. Permit ## Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2)
1. a. $Conventional b. ❑ Alternative C. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In -Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ASeepage Bed b. ❑ seepage Trench c. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): /
Q f0' D4et Private ❑Joint ❑Public
VI. TANK CAPACITY Site
INFORMATION in gallons I Total # of Prefab. Fiber- Exper.
New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank
Lift Pump Tank/Siphon Chamber I I ❑ ❑ LJ I El ❑
VII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber' ame (Print): Plum=�� MP /MPRSW No.: Business Phone Number:
Plumber' r s (Street, Ci State, Zip Code): _ Name of Design r: _
'
!J .7 /., /
Vlll. SOIL TE T INFORMATION
Certified Soil Tester (CST) Name CST #
ar /P�7
CST's ADDRESS (Street, Gjfy, State, Zip Code) Phone Number:
�r Poi , G 02 as
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Samlary Permit Fee Groundwater Date Is ing Agent Signature (No Stam s)
pproved ❑ Owner Given Initial 9 L S charge Fee r /�
Adverse Determination �� / �• /�
X. COMMENTS /REASONS FOR DISAPPROVAL:
SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
TO THE APPLICANT:
1. This sanitary permit is valid for two (2) years;
2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
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. Private sewage systerns must be properly maintained. The septic tank(s) should be pumped by a licensed
' pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewage systern, contact yorjr fiscal code adnsinistrator or the
State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815.
To be complete and accurate this sanitary permit applica.ton must include.
I Property owner's name and mailing address. Provide the legal description wt:ere the system is to be
installed;
11. Type of building or use served li public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
111. Purpose of application: Check only one in ##1. Complete ##2 it permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1 -6;
VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County /Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service;
streams and lakes; dosing or pumping chambers; 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.
------------------------------------------------------------------------------------------------------------- - - - - -- -------- - - - - -- --------------------------
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was ''he
result of over years of steady negotiation and public debate. The groundwater bill Ground* 8t8G —
included the creation of surcharges (fees) for a number of regulated practices which Wisc:o l
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water tha buried reaSUre
is used in your building is returned to the groundwater through your soil absorption - o
system or the disposal site used by your holding tank pumper.
0
The monies collected through, these surcharges are credited to the groundwater fund adn inis-
tered by the Department of Natural Fesor_crces. These funds are used for monitoring grour ;e - - t
water, groundwater contamination investigations and establishment of standards, roundwater,
it's worth protecting.
SBD -6398 (R.03/86)
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of
the property being developed. Any inadequacies will only result in delays of
the permit issuance. Should this development be intended for resale by
owner /contractor,(spec house), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
-------------------------------------------------------------------------------
Owner of property �� n n e a h a 71 s M�
Location of property 6k 1/4 1/4, Section 1� , T d N -R 7 W
Township IC' r a 1'►"iy
Mailing address 13 o x 13 O
lV e-u) A0o(?A W, s V 6f7
Address of site SG( m e
Subdivision name
Lot number
Previous owner of property e Q,6 't M y I I e ►�
Total size of parcel o _a G r c- s
Date parcel was created 54
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for resale (spec house)? Yes SQ No
Volume L 9 8 and Page Number a as recorded with the Register of Deeds.
-------------------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
---------------------------------------------------------7---------------------
PROPERTY OWNER CERTIFICATION
1(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No. 3 ?,3 36- ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No. ).
Signat a of Owner Signature of Co -Owner (If Applicable)
Date of Signature Date of Signature
PTA
sfssfils botnlae .... .. �dlw and
.....
y]� ,3i�1- .!!�!!!�f...r ./AA._47fµt,iFbj ........
sad.. � L Stan.. r
.....
y -i
r ................M. .........is .. �x
a
rb�pnd -aid �_ _A .. bec>taiuts klr
wife as o t
am
� ..............
- -- ------------- ---- - -- - -- -- ----------------------- ......
. ...... .......•.................... ........_.. ---•_. SSW
- -.. wi tllar-.a><a otr v 1�1�e ' oonsi t '` i °' ::: : ::
Qne
Ii CORMS to Grantee the following deseribed real estate in ...... ,Stn...0mu- "TURN To
County, State of Wisconsin: enttay 21,
Tax Past No:.4..._;M;. t F
!fir M i
w k
2W � of the Mt of Section 1- 30 -17, SRDEFf the Smith 330 feet of � �
thee -West 660 feet thereof. Also, the Nord 330 feet of the East r:
660 feet of the SEk of the Sk of section 1- 30-17. }
Subject to recorded
easements, reservatio apd rig#�tts of MW.
k } 5 {
This >3 homestead property.
,
ViDVdw the hereditaments and a purtensam thereunto belonging
And J. Muller and - Nancy Holier V
warlranrts teat the titlE' is p f of t - -
indefeasible m f l a B ik Of St. path da _.... ..
s
4 Mar 8D •
i first 1�rtOW I�
to dzral
reoorded 17 Mss 80, in Volume 609 page 389, as Document #363247, :
� 1d ch
and will warrantNW' e tas t0 assume and pay
+ ,�•
nd t same.
t >Anbd this .. ... _ .......18 day of $l
(SEAL) -� -- f
_ _..
Robert leg
_.. (SEAL)
r ..
a
r
- cy le r
r
AIITH =NTICATION AC=NOWL=DOURNT
133gsaiors(s)
.. STATE OF WISCONSIN
............................ St. Croix
authenticated this ---•-- -day of... Con
nty
19_.._.. Personally came efore me this ..... �
b
e "
x . -• --- ---- -••-•- aw
a
.. ... ... .. p T
- -- .-- .. - - - -- -- i r 5
TITLE: MEMBER STATE BAR OF WISCONSIN
E .. ...............
(If not. w
v ... - --
authorised by $ 706.06, Wis. StataJ - f
to me k to be e f
forego trumen a
THIS INSTRUMENT WAS DRAFTED BY
J. Lund
Eric Jell �.. --
_ ._..
....... �.. I57 - + . _ Sc _ �" -�"'- -
, Wiscansin 54017 � I
New Richmlxnd • -. BettY ..............
_
Notary Public .. St . Grroix
' if (Sii(natures may be authenticated or acknowledged. Both MY Commission is
are not necessary.) permanent. ( not, ,s
F ua- life expi
date: - Janu=Y..3
'otdatnea of Mr,ons aitnfae in an -
.. T- t�pacity should be type.i r,r printed below their ,itnaturee.
itGMdN. STATIC *Ar or wismNa1N
MON K&
A — lflfq
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
L I
OWNER/BUYER C? n n °c_ h �`)
ROUTE /BOX NUMBER D X 3 o FIRE NO.
CITY /STATE A(� Lt) P) d✓b n) c) n G1 h s ZIP -5 17
PROPERTY LOCATION: _EF_1 /4 5 k 1/4, Section 1 , T N, R
Town of �„h,i n P ro I r( e� , St. Croix County,
Subdivision , Lot No.
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 SEPTIC TANK PUMPER.
What you put into the system can affect the function of the septic tank as a
treatment stage in the waste disposal system.
St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of
$3000 of the cost of replacement of a failing system, which was in operation
prior to July 1, 1978. St. Croix County accepted this program in August of
1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning 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 (2) after
inspection and pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification form will be sent approximately 30 days prior to
three year expiration.
I /WE, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance with the standards set forth,
herein, as set by the Wisconsin Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date. /
SIGNED 6" Z"/
DATE q
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386 -4680
Sign, Date, and Return to above address
6 7
I NDUS TMENT OF REPORT ON SOIL BORINGS AND S BULL N
INDUSTRY, ,9420 O�
LABOR, At .'13 1 C P.O.
HOMAN RELATIONS PERCOLATION TESTS (� i�) 1bM DISOQL� )-
(H63.09(1) & Chapter 145.045) vy O� G f ti
LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISIO ME:
/T30 N /R/j(or) W Zr ► Y 17r 1Z y '
1
COU TY• OWNER'S i W5 NAME: MAILING ADDRESS:
P01)f_ A6� k_114 /v &xv 0/,
USE DATES OBSERVATI NS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: � PROFI D IPTIpNS: PERCOLATION TESTS:
Residence y5New ❑Replace I �/^ /�` r /
zO —
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN- GROUND- PRESSUR_ : S STEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
S CJU ES DU ®S ❑U S �U ❑ S,t/
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: I Floodplain, i n d icate Floodplain elevation: �}
PROFILE DESCRIPTIONS �� Z
BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- (�, ° -° ��93 014 }6�
B- 3 � s_ �i9 50 '�.[. 8 � n s,L , 2,5„4, !s.,c,. mom.
7 7 1 �o z , i 177- �' a �[
r
S'o Z �
co— `� BB,5 � � �i y 7, CC3 ()
o r3 .5" ,.( I s ,x Vii, I r . S k. c.Jl►y��
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- r Z� d 18 2— Z Z G
P _
P_
P -_
P_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 76
o J, .
-__l, 4 �.. .� . ._ _ E _ _ __.
,
/ 8
E
A .�
1J("
C IO
_
j -
i
f
{
a
z ........_ I_e ,.,.._6 ._ _.._. .. ......mL........., n )_._ _ .. _ ..... ..........�._..,.a.... .,.,... �...._... .. .._w..., _ z i p _..,...A ..
_. ,.... �.,...._.3.._... ...._. ,, ..�......_ ....,... ........
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print);, TESTS 7COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIG TU
QUTION: Original and one copy to Local Authority, Property Owner and Soil Tester, j
D -6395 (R. 02/82) — OVER —
PLOT PLAN
PROJECT ii_ /� _ADDRESS
S�1/4,�1/4/S `!f� N/R 1,7W TOWN ►� rug; OUNTY Ge 4e
MPRS Byron Bird Jr. 3318 DATE
BEDROOM CLASS PERC_iCONVENTIONAL ,4IN- GROUND PRESSURE
CONVENTIONAL LIFT_ MOUND_ HOLDI TANK
SEPTIC TANK SIZE IFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE �-
ABSORPTION AREA _ 6,3� PERC RATE BED SIZE /o`��•�3
► Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark
IM Borehole We I Scale = Feet
O Perc Hole Zu` System Elevation
Y
2"
12"
3' 4 6' 0 3' \
6' Sewer Rock
1 12'
r 4e AIR"
I
�
d
> y zo
b �L .
Parcel #: 012 - 1007 -80 -000 05/31/2005 04:00 PM
PAGE 1 OF 1
Alt. Parcel #: 01.30.17.16A 012 - TOWN OF ERIN PRAIRIE
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
* VANG, CHING & TOU
CHING & TOU VANG
1720 HWY 63
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST S &VKa-
SP 1700 WITC
Legal Description: Acres: 35.001 lat: N/A -NOT AVAILABLE
SEC 01 T30N R17W PT SE SE COM SE COR SEC Block/Condo Bldg:
1; TH N 00'W 996.12FT;TH S 89'W
600.00FT TH N 00'W 326,21 FT; TH N 89'W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
714.36FT; TH S 00' E 1306.84FT;TH S 89' 01- 30N -17W SE SE
E 1313.12 FT TO POB (35.001AC)
Notes: Parcel History: (,t Q
Date Doc # Vol /Pageype
02/07/2000 618047 1489/033 WD
07/23/19
07/23/1997 688/272
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/14/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 33.001 3,800 0 3,800 NO
UNDEVELOPED G5 2.000 200 0 200 NO
Totals for 2005:
General Property 35.001 4,000 0 4,000
Woodland 0.000 0 0
Totals for 2004:
General Property 35.001 4,000 0 4,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
T -30 -N • R -17 -W - T -31
See Page 112 For Additional Names. See P:
CYLON PAGE 70
1800 1800 2 000 180th AVE S
—
o �" ' Olson a o + James Richard 1 t---=
r tarry 50 & Carol & Patricia
J
66 ` ''r o 1 Hesselink Dittman 76 Casey 149
■
1 & 4 & icki Olson 3s h& Mary John a navld ¢ --1 --
1 2 E 5 R&J OC Carolyn a N
�$ E"a rocrat Tr Kathleen Ddron �
67 : .::: I w 80 Monty 40 m 36
Vernell & Faims �ohn & Trust 00 Larrrie Dav1d s I
LyylJe bona In dy Kenny
c ank Quam tans
I�iippoldt T �koglund
Jesse ems«, oqy y
125 Smith
a JL a''° , °o Daniel
239 160 120 Gwen 40 240 226 �,,� A'w
2 S m 170th AVE gi , ■
Chay & Richard fame a _
GrOon 42 O ti N .at, �' v1 Rochelle Tr g a Karl Rani G
�j Henry Her,
D
n5 30 m Oa Joseph & y Ha`ue" 39 aerroa 40 ■ Ronal
SE Susan Lorraine u7 Beauv
Dunn
Matthew n
90 0 o f Gillen °' Farms a Thomas A ■ Lynn
Mach- eledt Gillen Inc 58 � ¢p Tare etal � jr rn
I V_
Emmert Jerry 1 1 1 A "aml`en ..
239 40 280 157 40 0 m` , Z Laurie ,
Eleanore 30 Joseph & snKe: D whma Quan
Bergstrom Gillen r r el a a Ob
160 160th AVE ,
AB Gillett C nda _
158 6 ao csm� „� 40 3 197 105
ne & in 3 TF 3 Rick a {
and Ter 15 Shirle `
80 40 r Rae `"�` 40 '
Farms
to & earmryes & Inc Stoddard a R ace ° ohr
i ue 1 `+ Emmert 1 5 1 A 127
Speer ■ m � Sula
V 1 't
160 200 E IN 105 w
Wesley p j ams , ■ Mic
-kink 0 � 40 C�RNERS 634 Emmert 40 r 558 280 A Pete
g Jr. �`- G z 1 Q BIKEV
`) Donahu 9
40 a, 110 o Dairy C1 U f Chris
John- ° Gerald & Inc ' a i Berte
son o o I Helen tP
40 4 78 Clemas 80 n A 0
Vernon & K ka
Rebecca co Donavan & Donavan & 320 '
Karen Karen
Nagel LE 239 rn Helen Kamm Kamm Gerald &
T
240 G 160 u 160 320 70 1 160 Clemas 80
$ 'Angela a Laura Roger &
Lurie & Paulson .. n Doma Hell ■ Jef
/ Reneeea Wayne 0 40 s g w g 4o drung ao Ba
17
John 75 Knizenga ae g Y Y a 1 ■ is p t,
/ 240 schottler ' C z c 6 g as Vi S 5 63
Dennis & ° Rohe & V Jeffrey Duane �� ■■ .
Grace a Fern m warner 11s
Emmert qi� u t� 36 190 40 40
RLm q Thomas Lyle & otaas a PMP a si Paul &
H & Carol HoIl 1 w�tr ° oor°�° k A r i d H Korn Jo f _ M
9 43 8 80 80 Kamm 170 dorf 40 4o CT 5 35 120
Ames Carl Wd alke
=ert I Dennis L &W Kuhlman R
Stoddard POD Howard & f
I 13ahaela Walker
12 1 1 1601 12 n A 75 155 4o 120 ■
e 139
. N m 4 Davi & 3
V ernon Mark & aradley a Larrie a '
H n ° Melinda Qualn A sneney &'O� yo
40 John & Lux 40 120 40 a?J u Roar ■ 1■
wd & Dalton F 0 V °8 & 8 Arthur il
m i°°� _ yw■
ert i $
FE
ric]l 20 : C At �t1 a T 2 il 20 1 �
E 120th AVE 120th AVE 205th ST
HAMMOND PAGE 36 I
v nL 1487 PAGE 49 `
6 Z - 70F t1S itl 3
Document Number WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed made between KENNETH L WALTON and
RECEIVED FOR RECORD
PHYLLIS M WALTON
husband and wife Grantor, 01 -31 -2000 10:00 AN
AND DAVID H. YANG AND KAMAY YANG EXEMPT T DEED
�^''' EXEMPT N
CERT COPY FEE:
COPY FEE:
husband and wife, as survivorship marital property Grantee, TRANSFER FEE: 165.00
RECORDING FEE: 10.00
Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 1
dollar and other valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of Wisconsin:
Recordina Area
This IS homestead property. Name and Return Address
EDINA REALTY TITLE
Together with all and singular the hereditaments and appurtenances 400 SECOND STREET SOUTH
thereunto belonging; And Grantor warrants that the title is good, HUDSON WI 54016
indefeasible in fee simple and free and clear of all encumbrances except
easements, covenants, and rastvictions of record,
and will warrant and defend the same.
A parcel of land located in part of the NEV of the SE'/ of Section I . 'I'o�w"Ship 30 North.
Range 17 West, Town of Erin Prairie. St. Croix County. Wisconsin. described as follo ws: entifi n
012 -loo - 0 012 - 1007 -
Commencing at the SE Corncr of said Section I; thence N00 °50'111 "W, along the cast line of _50_000 & -
the SE' /. of said Section 1, 1,600.50 feet to the point of beginning: thcnce continuing
N00 1 50'01 "W, along said east line. 994.26 feet to the 1 "/4 corner or said Scction; thence N89 °07' 18 "W, along the north line of said SE' /., 1,316.13
feet to the west line of the E1 /2 of the SE'/.; thence S00 °53'52'T. 1,291.29 feet; thcnce S89' 11'35 "E 714.39 feet: thence N00 °50'01 "W 278.17
feet; thenccN89°09'59 "E 600.00 feet to the point of beginning. Parcel contains 35.001 acres, and is subject to U.S.H. "63" right -of -way.
Together with an casement for access, ingress and egress. described as follows: A 66 liiot wide strip of land located in part of the SE'/. of the SE' /.
and part of the NE'A of the SE'A of Section 1, "Township 30 North, Range 17 West. Town of 1.irin Prairie. St. Croix County. Wisconsin, described
as follows:
Commencing at the SE Corner of said Section I: thence N89° 15'53 "W. along the south line of the SE'/. of said Section 1, 1.313.12 feet to the
west line of the El/2 of the SE'/.; thence N00 °53'52 "W, along said west line. 33.01 feet to the northerly right -of -wad ore town road (170th
Avenue) being the point of beginning thence S89° 15'53 "r. along said right -of -way, 66.03 feet. thence N00 °53'52' W 1,273.74 feet; thence
N89 1 1 I'35 "W 66.03 feet to said west line; thence S00 °53'52 "E, along stud west line. 1.273.82 feet to the point of beginning.
Dated this ll �9ay of -*0 2000.
KENNETH L WALTON ' PI [Y16CIS M WALTON
AUTHENTICATION ACKNOWLEDGMENT
WISCONSIN
Signatures) ATE OF
ANEUF UNTY OF ST CROIX
NOTARY PUB
STATE OF WISCONSIN sonally came before me this ZLay of .� 20Da
authenticated this ` day of " above named KENNETH L WALTON and
PHYLLIS M WALTON
_ to me known to be the person(s) who executed the foregoing
signature instru nt nd acknowledge the sa
type or print name
signature
TITLE: MEMBER STATE BAR OF WISCONSIN type or print name
(If not, Notary Public ST. CROIX County,
authorized by §706.06, Wis. Stats.) My commission is permanent. (If not, state expiration date:
fii
THIS INSTRUMENT WAS DRAFTED BY 2 --4 •)
Robert F. Wall 'Names of persons signing In any capacity should be typed or
printed below their signatures.
VOL 1489 PAGE 33
618047
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between KENNETH L WALTON and
PHYLLIS M WALTON RECEIVED FOR RECORD
husband and wife Grantor, 02 -07 -2000 3:10 PM
,
AND WARRANTY DEED
CIUNG VANG and TOU VANG EXEMPT R
- L Q CERT COPY FEE:
COPY FEE:
as tenants in common Grantee, TRANSFER FEE: 165.00
RECORDING FEE: 10.00
Wltnesseth, That the said Grantor, for a valuable consideration of one PAGES: 1
dollar and other valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of Wisconsin:
Recording Area
This IS homestead property. Name and Return Address
Together with all and singular the hereditaments and appurtenances EDINA REALTY TITLE
qO0 SECOND STREET SOUTH
thereunto belonging; And Grantor warrants that the title is good,
indefeasible in fee simple and free and clear of all encumbrances except HUDSON WI 54016
easements, covenants, and restrictions of record, �,�.Q a�
and will warrant and defend the same. vv
A parcel of land located in p ert of the NE %4 of the SE' /. and part of the SE' /. of SE %. of Section
1, Township 30 North, Range 17 n o in P af l ,1't CF ix County, winZi gI f-
described as follows: ( (Parcel Identification Number)
Z1h
L OT- 012 1007 - 50 - 001 & 012 - 1007 - 80
Beginning at the SE Comer of said Section 1; thence N00 °50'01 "We east line of the 012 - 1007 -50 -000 & 012 - 1007 -80 -001
§E.: of said Section 1, 996.12 feet; thence 589 ° 09'59 "W 600.00 fe N00°50'O1 "W 326.21 feet; thence N89°11'35 "W. Z14.39 feee
we f the E 1/2 of the SE' /.; thence S00 °53'52 "E, along` sA2ttVbst line, 1,306.84 feet to the south line of said SE' /.; thence S$9
ong said south line, 1.313.12 feet to the point of beginn Parcel contains 35.001 acres, and is subject to right -of -way of U.S.H. "63" and
170th Rro ue.
Said parcel being subject to an easement for access, ingress and egress, described as follows: A 66 foot wide strip of land located in part of the
SE' /, of the SE' /. and part of the NE'K of the SE' /. of Section 1, Township 30 North, Range 17 West, Town of Erin Prairie, St. Croix County,
Wisconsin, described as follows:
Commencing at the SE Comer of said Section 1; thence N89° 15'53 "W, along the south line of the SE' /4 of said Section 1, 1,313.12 feet to the
west line of the E 1/2 of the SE'h; thence N00 ° 53'52 "W, along said west line, 33.01 feet to the northerly right -of -way of a town road (170th
Avenue) being the point of beginning; thence S89 "E, along said right -of -way, 66.03 feet; thence N00 °53'52 "W 1,273.74 feet; thence
N89 °1 1'35 "W 66.03 feet to said west line; thence S00 1 53'52 "E, along said west Iine, 1,273.82 feet to the point of beginning.
Dated this4(. day of ,� �cj 2000 .
KENNETH L WALTON *PHY19LIS M WALTON
AUTHENTICATION ■ ACKNOWLEDGMENT
Signature(s) PHApEUF STATE OF WISCONSIN
t4OTARY PUBM COUNTY OF ST. CROIX
Personally came before me this -44 da of .J&e"0'T 00 0
authenticated this _day of sv the above named KENNETH L WALTON and
PHYLLIS M WALTON
to me known to be the person(s) who executed the foregoing
signature instru nt and acknowl get me.
type or print name
signature -S.
TITLE: MEMBER STATE BAR OF WISCONSIN type or print name °lam C"
(If not,
authorized by §706.06, Wis. Slats.) Notary Public ST. CROIX County,
My corJtmlesion is permanent. (if not, state expiration date:
THIS INSTRUMENT WAS DRAFTED BY / 4 e7;1- — 443. )
Robert F. Wall *Names of
persons signing In any capacity should be typed or
printed below their signatures.
VOL 1489PAGE 34 6154$
Document Number WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between KENNETH L WALTON and RECEIVED FOR RECORD
PHYLLIS M WALTON
husband and wife ,Grantor, WA RRANTY Sao PM
AND E
TOU VANG AND PANG M. MOUA X DEED
EXEMPT N
CERT COPY FEE:
Grantee, COPY FEE:
husband and wife, as survivorship marital property TRANSFER FEE: 420.00
RECORDING FEE: 10.00
Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 1
dollar and other valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of Wisconsin: Recordin Area
This IS homestead property. Name and Return Add s
res
EDINA REALTY TITLE
Together with all and singular the hereditaments and appurtenances 400 SECOND STREET SOUTH
thereunto belonging; And Grantor warrants that the title is good, HUDSON WI 54016
indefeasible in fee simple and free and clear of all encumbrances except $ 4 H ��
easements, covenants, and restrictions of r ®cord,
and will warrant and defend the same.
t parcel Identification Number)
012- 1007 -50 -001 & 012 - 1007 -80
012 - 1007 -50 -000 & 012 - 1007 -80 -001
Lot 1 of Certified Survey Map filed January 25, 2000 in Vol. 14, page 3795, in
Certified Survey Maps as Document No. 617359 located in part of the NE 1/4 of
SE 1/4 and in part of the SE 1/4 of the SE 1/4 of Section 1, T30N, R17W, Town
of Erin Prairie, St. Croix County, Wisconsin.
Dated this a 7 day of S a "� 4 ' d-' `1 2000. 4P Gil ZZ
KENNETH L WALTON ISM WALTON
ACKNOWLEDGMENT
AUTHENTICATION
JATE OF WISCONSIN
Signatures) = CA dPH ANEUUNTY OF ST. CROIX
NOTARY PUBLIC
SIN nally came before me this o � 7 day of�4M }/ . 200 authenticated this day of _______• above named KENNETH L WALTON and
PHYLLIS M WALTON
to me known to be the person(s) who executed the foregoing
signature
a �acknowledg the e.
type or pr name signature '[ �U
TITLE: MEMBER STATE BAR OF WISCONSIN
type or print name a
int " r
(If not, Notary Public ST. CROIX County,
authorized by 6706.06, Wis. Stets.) My commission is permanent. (if not, state expiration date:
THIS INSTRUMENT WAS DRAFTED BY
Robert F . Wall - Names of persons signing in any capacity should be typed or
printed below their signatures.
1