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HomeMy WebLinkAbout018-1041-00-100 0 � rM / Lo� � ��•• 2�/ — @ � C/) S= z o e M _ o n,} E o a 2 ' 90 $ P. 2 e\ e a § \) k \ R \$ k w W c, -,_ m o E o 2 / 2 2 2§ 2/ J/ 2 E§ $ J a 0 /§$ § 0 0 0 0 0 0 0 0 0 0. n m Q 0 0 0 2 § g , 2 a- N) � N - - - - 00 � o E E 0 4 k Q E § # 0 ® ¢ £ E � E a $ CL < ® ° e Q N) a N) rl) e o - e . e 8 8 8§ 8 C. 8 8 8� ® $$ k . � o CO a / ) ) / 0 0 CO) 00 O jC T 'D I �. 0 0 0 § § CO § § 2 0 § \ m ° G 0 i cr J % § \ � \ 7 0 \ > k 0 kfu R3 k \ { \ (A 2 N Oro . 0C 2 Dw a ■ , 0 a m $ E ¥ § 9 � a 7 » i z 3 - § C ® . � eta \ 3 ] 4CL , CD 3 E c 0 % . ;J #ƒ ] CD 3 \ cr $ § \§ § § � 9 w Ch 2 � ■ 0 � § % a ? ~ % S � 2 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division CountbT . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarIMf.: Personal information you provice may be used for secondary purposes [Privacy Lq s.15.04 (1)(m)). Permit Holder ' Name: e C] Town of: State Plan ID No.: PEPER, R�CK & LORI 4iN{�)' CST BM Elev.: Insp. BM Elev.: BM Description: Parcel TY181041-00-000 6 /00-00 TANK INFORMATION ELEVATION DATA A9800279 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Q Benchmark Dosing z /8. g /d.o8' /oo.00 Aeration Bldg. Sewer Holding St/ Ht Inlet g' . ao TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt Inlet ir Septic > 3 36 'a 5 NA Dt Bottom q.36 917.17 Y Dosing NA Header/ Man. 9. -7;2,' es• 8 " Aeration NA Dist. Pipe .9 s.7a [ Holding Bot. System �� 5" • 93 7s' PUMP / SIPHON INFORMATION Final Grade 'ZI's 9 44 sa -, 1�.o G.ov Manufacturer Demand `" ,, 7.6 Model Number GPM TDH Lift Fri 'on System TDH Ft H ead Forcemain I L gth Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION j DIMENSION SETBACK SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Number: System: V /7 x200 OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HAMMOND 18.29.17.285,NE,SE 946 160TH STREET �asv y 4 �r1 7 9� �.y i- tI�' -til) i / UU Plan revision required? ❑ Yes M / N0 j Use other side for additional information. / ljld 6_1 Z ` SBD -6710 (R.3/97) Date I spector's Signature Cert. No. SAN PERMIT APPLICATION 201 and shnlgtonAve sion Wi s consin in P.O. Box 7969 Department of Commerce accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County sT X than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information ou p rovide may be used b other g overnment agency p rograms r T y p y y 9 g y p g ❑Check if rev sion o previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N N Property Owner Name � t Propert Location 'G �GD/l 1 t /a, S If T 2 – f , N, R Propert Owner's Mailing Address Lot Number Block Number rRe s r. Cg 't State �/. Zip Code Ph ne Number '— Subdivision Name or CSM Num er Dr,r�/• Z d � Sv,✓ 1 Otter (�YS S ,pc o r, 11. TYPE OF B IL N : (check one) ❑ State Owned ❑ I Nearest Road ❑ Village ,t9v X(o' 57-- Public 1 or 2 Family Dwelling - No. of bedrooms wn o f 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) / 1 ❑ Apartment/ Condo d/P ' /0 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 P RMIT (Check only one box on line A. Check box on line B, if applicable) A) 1 ew 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Trench 22 ❑ In- Ground Pressure �� rc 42 ❑ Pit Privy 13 ❑ Seepage Pit u$,� 70T fZ_ 3 Q y � 43 ❑ Vault Privy 14 ❑ System -In -Fill 3 •-tk/ ,6.0 &4g $ L Q 3X J C tl 3'X j?o ` 3 3 '.<'7Y' VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. vi Elev. 7. Final Grade tp� Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) E levation, 1 /2,010 / T> �— 9li •.�a Feet J Feet VII. TANK Capacity gallons s Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App Tanks Tanks eptic Tan l N ❑ ❑ ❑ ❑ I ❑ Lift Pump Tank /Siphon Chamber _tLe -S 7 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signa ure: (No Stamps) I%P /MPRSW No.: Business Phone Number: Plumber's Address Street, City, State, Zip Code): L -,- l ' �O! to IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate I ssued Issui gent Signature (No Stamps) Approved E] Owner Given Initial Q� ca Surcharge Fee) >�j/94 e G/ Adverse Determ W �D // V CJ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber ATTW A7 7Z��v ST. CROIX COUNTY ZON1 �';i _Ati'f'L'k AS BUILT SANI'I• t.RCI' Owner SITE Address D ,S! R ' n 8 ?— City /State — ST CROIX 1 :_ , ��/ �i� COUN r� ,` ZONING OFFICE i` •� Legal Description: Lot Block Subdivision/CSM # �� ' /+ S4 Sec. i8 , T N -R ! W Town of r�iov _a , l� PIN # �i� • /dY/ D'o SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer ! � &71, 6-16:2 e Size ST/M --f— Setback from: House • Well ~ O P /L Pump manufacturer Model Alarm location (HOLDING TANKS ONLy) Setbacks: Service road ento fresh air intake Water Line Meter location Alarm location 5 SOIL ABSORPTION SYSTEM: p Type of system: fjE,ud•l S Width 3 Length O Number of Trenches 3 Setback from: House � 2.&)o Well -/,,L P/L 1 10 Vent to fresh air intake 1 -- �a No ELEVATIONS: c'S%'S /3,� -t 'S ",DUG AVIS) Description of benchmark y - '! �O Elevation Description of alternate benchmark boa d� r1 �30�i�- rfj�D • LoC� Elevation �/?• G7 Building Sewer / ST/HT Inlet ! Zd ST Outlet ��� s'y PC Inlet PC Bottom Header/Manifold 117 Top of ST/l�' Manhole Cover Distribution Lines ( ) �' y' Bottom of System (1) / S'7 ( (� r Z'3.7�0 (3) . Final Grade ( ) � ( ) S� ( ) ff•� � $ 3 t S_ 9�0 Date of installation �/ �/ Permit number y State plan number Plumber's signature License number 2)4 Date 8 / 7 � ' d Inspector Complete plot plan .r x NOTICE: Please providc the f¢llowing: • 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 p INDICATE NORTH ARROW , s T N ��S �G�LT� F:- S� • L dT -• P r s g 14 - Al �v 0 9 Ze Vw 1 v�� Q r r L OT o .. l3oX Es , .,� � «�� • / 3 d ulbr►cht Ass a Consultants r , rt p sewto 05 O'Neil Ad. v� -Gtn. stn- Nudsont Wis. 54016 s ys r4V G. s 2 9 ' Y. �A i dwo �►N r� „ S t�sT a' 3 XIS ` 3y4,1 3�� � lD� b•4 �,vct r Tv p b o x * - z? qS �a T h CIL c 37 �S --- -_` pit l lpletvA� 8MW �- o 170 , 7eO 7- L . o d LN o . 1 ' va clk kL 0 C-,410 NO N Lk rie-7D Ti &V4� so Cho SS SECTioA ©` Tlf E6 �ls 7e of 7 - 0�e,5 19PiAMAi!P UEti 7 cA jd 1I 1A/ . 2 1ff j j I /i/ fiE"D rEl N I� s ' r5. y CRo S SEC Tiov o, TI'C�v�s I N i L 71',4 7 ,5 UA-v T CA Iff _ c �.. s pT, y r _"1 w Wmeonsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of safety & Buikings in acxord with ILHR 83.05, Wis. Adm. Code 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 point (BM), directio % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to a rold. wO APPLICANT INFORMATION- PLEASE PRINT L' N ORMATION [ RrITEDf - DA PROPERTY OWNER: S.> -. PR(5PEFITY LOCATION tv�Z_ 1/4 Sir 1/4,S 19 6 T 2° l .,N,R 1`1 E( W PROPERTY OWNER' MAILING ADDRESS LOT # - # I SUBD. NAME OR CSM # -- :-Rei POSeb esr1. CITY, STATE ZIP CODE PH NUMBER ❑CITY ILLAGE (TOWN NEAREST ROAD � stvv w sit o 16 f�l4i ,3I��w_, ; ''b3 R`►�wl !tip 1 �rJ Ttt ST. M New Construction Use k] Residential / Ni m f 4407. _.;, [ ] Addikn to existing building j [ Replacement [ I Public or commercial d ` esaibe -- `- Code derived daily flow b lib gpd Recommended design loading rate bed, gpd/ft "S trench, gpd/ft Absorption area required S 0 0 bed, 11: `ZOO trench, 11 Maximum design loading rate y bed, gpd/ft ' S trench, gpd/fl Recommended infiltration surface elevation(s) SEe� V"- rtGL -- �s r ft (as referred to site plan benchmark) Additional design / site considerations 3 77LQrJeW,S - LT)"�VQN S x fb0 l-ovsj G. Parent material SV�`T't oy 1z_t1L ' vS pv h3tl Rood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑ U NS ❑ U ® S ❑ U N S ❑ U ❑ S IN U [IS Ri U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boui Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ffpiUt o -$ tio Z - Z s1\ Z'Fsb V ell z� •s .d Z $4b 1b`l23! S Zwl Sb1z yrl�- C w l�� S .` Ground 3 1b -68 10�-( \Z 31 b S 1 C g Dec l4 'I) � - . y . S elev. R. • O ft Depth to limiting factor Remarks: Boring # o -tu +uti�7 t, Si - Li sbk mfr- as z� � Z l0 -l$ ll�`1tZ��6 - S11 ZYnS�k, Yt'1'�1- °�► 1v'� • 5•� CLS "6w, 1NIV V e S ..\4 • S Ground elev. 4 L4 L U`1 RL/ /6 - S d G US 9 M •z ft Depth to limiting factor Remarks: TNarne: Please Print Arthur L. We erer Pine 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 ftn ahue: 8 _ 4 Q Date: - 3 CSTNwn -y �, M00576 U PROPERTY OWNER SOIL DESCRIPTION REPORT Page Zof 3 PARCEL I.D. # 1 Aj C Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxdary Roots GPD /ft In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 0_9 tio��z — s 1� Z ��ic mph �S Z�. , S •6 Z q -2 3 L�`lR 3! !, 1 V`f • 5 • ` Ground 3 S `FN �S •�! • 5 elev. Cis .o ft. y - >o l L -- SttG>• u 9 � Yh - .� .� Depth to limiting factor I i Remarks: Boring # ; b -1 b \u`1, 2. 3 ! Z s11 Z'�s �k 1M �y- c s z.� • S 6 4 Z �g z 10 �1 tZ 3 l 6 — s 11 Z v►1 g 1�4 >71 `F1- w l v 4S i. d Ground V �. �g � , �( • S elev. 4 L t0\1 R V /6 _ s\ L asblz !n V �1. •`( S a� ft. Depth to c� o NS °� o $ L t Wl t- �l �'S I limiting I factor y 6£3 Remarks: Boring # �-11t 1 z - s 1 Z`Fs b 'F�- �-S z� . s• 6 E l Z soh mfr �k, 1�� .S i•6 Ground 3 3 V -�9 � b `� fZ- 31 to S � � °t_Sblrt YVl U �t'- - . \(� , g elev. ° t6•1 ft. i Depth to limiting j factor , 1 i ; Remarks: Boring # , ; ; ; Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) µ x. PLOT PLAN g Pa e 3 of 3 SCALE 1 "= L 1 /U of l ZI IY—ZLZ � t L17 01 O � Ft-°tS °- � o.y 5' s� 5 5 � r in -gt,, 1 S D ' \\` 1— I b 6 O S? 31y PVC PIPE 3� b1f l�bC 'P'M (715 M 00576 CST Signature Date Signed Telephone No. ` CST # WmwnsinNpartmentoflndustry, SOIL AND SITE EVALUATION REPORT Page ! of 3 Ukor and Human Relations Division of safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 812 x f 1 inches in size. Plan must include, but not limited to vertical, and horizontal reference point.(BM), direction and % of slope, scale or PARCEL I.D. # , climensioned north arrow, and location and dstance to nearest road. TX?_ ) Pic -.' APPLICANT INFORMATION - PLEASE PRINT ALL'INFORMATION EDGY ' TE PROPERTY OWNER t0_' C'ON PROPERTY LOCATION 10ff. - 1v�X_ 1/4 S E 1 /4,S WS T Z!'[ .,N,R 1`1 E (a UWW PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # Iio6 (!N r6Z — I — �R es" . CITY STATE ZIP CODE PHONE NUMBER OCITY DVIUAGE (MOWN NEAREST ROAD �1 w Q % w 1 s4 o i6 nts) 3 86. B �b3 l-}f�`f'1m'1 Kz I I 1 b LJ Ttt ST M New Construction Use [X] Residential / Number of bedrooms y [ ] Addtttltxi to existing building L ] Replacement [ ] Public or commercial describe Code derived dally flow b Ob gpd Recommended design loading rate bed, gVW vS trench, gpd1ft Absorption area required \ S 00 bed, ft `ZAO trench, ft Ma)dmum design loading rate y bed, gpd$ - S trench, gPdffl Recommended infiltration surface elevation(s) SEC- P f16e -- 3 It (as referred to site plan benchmark) Additional design / site considerations � JeEt'�S — �het4 S ' k f G. Parent material St ov t!�-t S frrvpy 0y'T-JYvM4 Flood plain elevation, if applicable It S = Suitable for system COMMONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TAM( U= Unsuitable fors stem ®S EI U NS ❑ U ®S ❑ U NS ❑ U EIS ffU [IS 0 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouffiry Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed IT iench Y m •s .d F g_1. lb`AV (a Ground 3 16 -68 >0`1�3lb — S� 1 X4\3 — , . S elev. R, ft Depth to limiting factor Remarks: Boring # o -tu I1lm Z Z s j Zj sblz rn`�r eS 1� `� Z r_ a' Z � to -t8 1j -q-7 I Q�-f ti-U L ` G %l l e Sl�vc >4 VT-ti- C S .` • s Ground elev. 4 L4­1 - tCN4CLV / — S d G USA oj5 ?.fl Depth to limiting factor >Z3� Remarks: CS T Name— PlasePrint Arthur L. We erer� 715 -425 -0165 V e r eserer Soi Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022' Signahn. i Date: -CST Number: . M00576, PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z- of PARCEL I.D. #I IVZ ) tv G Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench 3 0- 9 ti0`-t R - 3 l Z — S j 1 'L `F �b wt 'F►- L� S Z�' . S � 6 Z q - z3 Lo�R 3!L tin sbh >n' - cuY 1v� • 5 .1, Ground - S Z3 2$ 10 3/ S, 1 e s %k 171 d- -S — • .S elev. Ct S.o ft. y - t.ki -1 vt_ -- s � �� L) s-, Depth to limiting factor Remarks: Boring # 1 0 -t \\wK2 31 Z si 1 Z'Fs �k Wl'Fh s Z� 5 •6 4 Z A 0 Utz X16 — s, I Zwi % mfr �w 1 �f . S Ground V'E�y. elev. 4 41- t,B Lu' I? M (, � _ s1 L a s bt z. m V �►. l .S °!t3• ft. • Depth to 0-0 NS O °10 $ L l M 'limiting "factor „ I y bFs • � Remarks: Boring # z 1.6 5 Z vL- y vo\-l X16 — SO I Zvn S\l m�� �lti tv� • s • 6 v `Q _ - • `J • S Ground • elev. ° tb• - ) ft. Depth to limiting factor q i Remarks: Boring # 13 lf { , f (:Ground x elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) PLOT PLAN Pa E. of 3 SCALE 1"= rj i O� 2 Sp %.q c t 1 b d fit. \00.0 ON 8Yt�1.6}j iL'L . °tl.o' ON �p \� 1614 � I 31y DtR• PV C PIPE 31y � Otfl I�VC PtP� � UVS F �O SF f f r 1 . - ` ' r ZS' tAje%1 oi= S� t ZT01 rvTL A '4 Z3 -076 (715 ) M 00576 CSTSignature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 3 �l • �� �� Owner/Buyer K .4ovi 7; 0, 3�� ' Q 3 �3 Mailing Address a ��` �• ��� �''� �/ s ya Property Address �` /`� D ` //- (Verification required from Planning Department for new construction) City /Stat // `c*fO '� �'l/� ' Parcel Identification Number LEGAL DESCRIPTION Property Location NO Se ' /,, Sec. , T - N -R l 7 W, Town of Subdivision , Lot # Certified Survey Map # s 'f©o(l , Volume / Z , Page # 3 y� Warranty Deed # , Volume 133 7 , page # S � 2 S ec house ❑ es C�no Spec Lot lines identifiable ;yes ❑ no Y SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance j consists of um in out the septic tank eve three ears or sooner, if needed b a licensed pumper. What you put into the s P P g P every Y � Y stem P P Y P Y 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 wastewaterdisposal 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 thr ear ex P iration date. 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 p e descri bove, by virtue of a warranty deed recorded in Register of Deeds Office. /z6 / 9g 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 582293 ' STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO. VOL 1337PAGE2 5 .John. J - Dalton and rarol vn c- nal ton, ST. CR()J)( CO., WI h> s h- -a d—an d w i f e , Asctd ftt Record I JUL 0 2 1998 conveys and warrants to Ric -hard n . P p p r and Lori L 12:30 P peper, husband and wife, Re Ittof of 4eods THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, fi.r ✓. L State of Wisconsin: / / F' /�C�JOir ji. �•.. S. f0 /� 00 PARCEL PARCEL IDENTIFICATION NUMBER Part of the NE1 /4 of the SE1 /4 of Section 18 -29 -17 described as follows: Lot 1 of Certified Survey Map filed June 1, 1998, in Vol. 12, page 3460, Doc. No. 580069. - $ TR,JNSFER F This is not homestead property. X1XXX (is not) Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 2-A day of July A.D., 19 9 8 (SEAL) (SEAL) John J. Dalton Carolyn G. Dalton (SEAL) (SEAL) , AUTHENTICATION ACKNOWLEDGMENT Signature(s) John J. Dalton, State of Wisconsin, ss. C.�r�n1wY1 G na1 tnn County. au��ent , ated this day of July —19 98 Personally came before me this day of 19 , the above named . K Osti ' , gland ' - ,VLE:' tMEMB �STA i BAR OF WISCONSIN � Jlfnot, T authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 Notary Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) 19 ) • Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leal Blank Co., Inc. Form No. 2 — 1982 Milwaukee, Wis. 584469 CERTIFIED SURVEY MAP Loacted in part of the Northeast Quarter of the Southeast Quarter of Section 18, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin. Prepared for and at the request of: OWNER: John Dalton :I 1794 110th Avenue Z n v'_ Hammond, WI ~ w Drafted by. Kristi A. Eylandt m j j Q t: �g NS �' = o UNPLATTED LANDS OF OWNER r m� RONALD F. - JOHNSON N00'13'47 "W 440.00' AM,RY. W 8. ti I� NO S U R ` o- S L) I I ���arsee F�LE® i� a0 O • t7 1 1996 10 0 -0 T -M 0 CA 0 0 JUN WN_stl m f m ° c 'm B M � o Re9 ster of Deeds .r: a 8 . 0 O co C o r m a St.C(OiXC0.,W1 1y to to o I U1 ~� 0n m� o 0 0 �" a� - ti I Nom_ CD O M _0 o m - -I R1 00 rt a N N i t0 ;► p v ❑ _ IC �N OW I �O n m �m F W o n O j� a �io otr N c IC cD to r t0 D OD M Z I Z a fi ❑ O O p m I D 0 to X Dui D r to O n1 I m o o O U� M n 0 M � to � I a n n T a m O I O W t0 Ln O LA C m O D O to N v I - ❑ � W L c I N J W I �� 1 0 m x W 3 CD I D C,+ t:7 o m I n I r (b z c o o �� — I� I O I z cn 2 I 0� rn I m o � O I 00 � 10 n 0 l0 O O I j-1 LO c F I rrl I. I O I I CD rt I .Z1 I I m ��❑o I m 0 ❑ I < SD I am '.c1 L❑ B N�� L! Q a � n BUILDING SETBACK I n O O _O .. v w p R. 0. W. 160th St. O 0 o i S00'08'34 "E — 439.99L - N0013'47 "W 2191.09' - w S00'13 47 E 440.00 - - t -------- - - - - ---- - - - - -- - - - ---- S0013'47 "E 2631.09' STREET CENTERLINE 160thSt. EAST LINE OF THE NE 114 OF THE SE 114 UNPLATTED LANDS o 150 0 150 JOB #98059 (R14) Prepared by. A & E GRAPHIC SCALE LAND SURVEYING & CIVIL ENGINEERING SCALE IN FEET: 1 inch = 150 feet Phone No. (715) 246 -4319 BEARINGS ARE REFERENCED TO THE EAST LINE OF THE 109 East Third Street, P.O. Box 325 SE 1/4 OF SECTION 18, TOWNSHIP 29 N., RANGE 17 W. New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR SOO'13'47 "E. Sheet 1 of 2 Vol. 12 Page 3460