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024-1010-40-100
0 0 °o I op i N a O � O (U 'O W a H N O N O w O CA - N III N 0 L W M (1 L o:? (D- 3 orn - Eo ca 10 o c c ;v 11i c T N o y lV O > y 3 U (y a° 3 o 0-aNm E a C fCt N N U N C6 N 0) y•0 C M w 0 O T O Oy1 0'0 3•y •-' (U 0 C N N U) �U°� 6 w y o „OMEcEaEi'0 C Z y 0 O W O 0 T C N C m v =$ am 3 m o0 3M00 0 v Hoc ID rn•3 Q N L O c 0 i' M Lu Z Z = O 0 Z E 003 am r U) I 0 z '� c 0 0 Cu Z :!t rn c rn CD E N M U 7 V 0 N •�l L N t t L1 C 0 � i O CU 'O Z F- Z N o E 00 w E •' m ru N (0 E U 2 m y co a w < o �T v� ta CO) _j a�i Z N > F- 0 3 3 3 a 3 • M a M a CL v_ 0 O N y M M rn 0) 0 N J U 2 Z w ~ o m U o � Q v E m o LM 72.6 t n Q a w C o O N C CO _ 0 7 a 4) o E o) 0)2 o a 0� a (D rn o_ w E C m co W O N 7 0 L CO Y N I- d C N L.I N f0 c 7 0 L N f6 •O �' lo o CL _ O Z N '.y Z 2 CO v � M € a 3t ° ` a 2 rr`Iwr ji +�+ E 'c s _1 A vat !, O (n ci o o N 0 V� H 4 0 a p'o E p u' EM �� L w8wQ r U 0 CL' S m O C ' O � O� N _ C 7 C w L H f6 N n N C M f0 ` O OL_O"O E 3 N N Cm a) N E N > O N- U) U C C +..0 C f6 y a8� T N CL-� td'O ¢Cc N E1j C C N 'X w C O m C O >� p �p0 NOO'C� Z N .O. V > X O N c U) N.0 N C L O;t'O N O L>i 4 'fp X N C_ C N U T U.O C Z N3e 3 M> .5; N O O O f6 - C— O c N LL C N 7 .p+0 C m> a p_ C f0 > 3 d 3 nsHOZ Em N O m N C m V N E m 0 V' O E ¢ O N co L 7L Nk 7L Lo f6 v CL H I W E z € y r- F- aii'' CL m r- F- U) 1: am I O Z a c E N N O C N Lo to d O 0 0 0 0 a (Di L ;�. O O O CO N ¢ O w O 0 Z m Z p Z o o N 0 Z co E U N ca_ U 7 O) M d d m a O O O X 'ooa N > C ►- F- I-- 7 Z N (v ' 3 0 3 a � •N o M a a a CL L v 7 0 y y Obi 00) w t/� V 2 rn o) ~ U 0) O) 0 0 0 0 O w 0 N p 0 0 0 0 0 0 0 O r- O N N N N N N N N c2 O OD d 7 N N N O m CO N N O n O Lo 3 $ ¢ U) o cc C O y #A v M C `O C O U ? i''', a) U Ci p M 00 O N Cl) cD > _ m 0 0) a °o °O oo 0 C) 0 0 o N M co O O V C C C C O) �_ 00 L7 00 ai a V7 ) W W y r N rn O - N N C O N co .a+ 7 'O 'O C L V R € .. dt all da ° c c :: i t A ciCL 0U)it FILED o SEP 3 01993► 11 mix JAMES O*OONNELL 506385 ,� � CM, Wl �z CERT I Fl ED SURVEY MAP w ry LOCATED IN THE SW4 OF THE NE4 OF SECTION 7, T28N, R17W, TOWNS P OF PLEASANT VALLEY, ST.CROIX COUNTY, WISCONSIN. Prepared for: Herman Heinbuch /GZ y 1�( w z, 1l nq' tv/ xl ;kill � N 1/4 CORNER SEC, 7. NOTE: Bearings are referenced COUNTY MONUMENT to the N -S Quarter Section Line. FOUND). ' (Record bearing) �r = N O M y�M •N 33' 33 UNPLATTE •LANDS. 8ti etlsi +'! .I_c: inch Pu, Co Mr. ilttc t1 , DRIVEWAY EASEMENT• 'f not recorded S89 "E 243, 50 wl6njn30 days of 33. 00' 21 0, SO' o ?}; : D' CI3te W E I o m m p ? M M M M $ " S8 9 0 47'2 7'.'•E 210.50' : Z. 1A' p J. fit': O C4' O p O _�. L0T 2 P C9 : N p W. 0.1 w 0 I. 34 ACRES 0 1~-• 2 _�• l 1 58,440 S0, FT.) 0 F-- i r p 1.00 AC. EXC. EASEMENTS a N 1 43,573 SO, FT.) N Z J F- �• � L j. � I OO ; �• 8UILDINC S ETBA C 33.00 2 10.50' N 8 9'47 27" W N 11 9 27 "W 243.50 ' 2406,151' 4,- E - W OUARTER LINE E1 /4 CORNER SEC. 7. 33' N33 f 2" IRON PIPE FOUND). N U P E LA NDS to f � Y� JAMES hC WEBER SI /4 CORNER SEC.7. s S• 1804 t RAIL ROAD SPIKE FOUND), g SPRINGS VALLS)V W 13. • 0- SET 1 "X 24° IRON P1�E WEIGHING 1.13 LBS.PER R ` V LINEARPoor. • ��j� SU G `� *i SCALE 1 "= 60' tlhl 4i ® ®� JAM S M. WEBER S 1804 6' 30' 60' 120' SHEET I OF2 DATED g - B - 9 3 VOLUME 9 PAGE 2689 63-131 THIS INSTRUMENT DRAFTED BY J. W, ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT 8 1 T Owner ► lV'�1°1 Q 1 j?�'111. %'�j� \y Address .� City /State avimt-'nt %�,� �ast, 5 yc t3_ Legal Description: } Lot �- Block ff� Subd'v' >tsion/CSM # \ '/. ,S 'w , '/. AlL Sec. -9-, TAN -R ,Town of N i Y►1mo d O SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: 104W00 �, X00 3� Tank manufacturer '' '� �Jtrl) Size ST/P - Setback from: Hous W 1 �� Pump manufacturer A A e 1 P/L Alarm location Model Al iT -- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: N" l og, / Width, `/ f ' -�� L ength - Number of Trenches Setback from: House _ Well 72oo P2 ( C) Vent to fresh air intake g.7 ELEVATIONS Description of benchmark � v Elevation 1 / Description of alternate benchmark �v0 yr (tiy '� { Elevation Building Sewer ST/HT Inlet 0 P ST Outlet. � PC Inlet PC Botto --_ Header/Manifold r Top of ST/PC Manhole Cover Distribution Lines (4) 7. 7, ( ) Bottom of System ( ) ib - 1y 6 O ( ) Final Grade () + () ( ) Date of installation /�g i f State plan number J Permit number ) T �6 Plumber's signature License numbed Date Inspector U -- 1 Complctc plot plan e � 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. _"_Count Road _J County Road - J I 24 b — 63 drain field I -- '``TURN r— f o m L Ac+. +gam o O P P .+ 3 �+ .+ s "� * x -� � 3 - 0 0 � ° z - z h rexlstin9 = s 0 I ro 3 a ! home - g 0 �_ I 1 I G s o �J n I a top of cement wall r . C) p 3 P on I horizontal reference cF Q� I I o o elevation 98,08 3 M Q W #SY�Ce k�Is -£enco LA �pp�f#- Esa#_c£ -lo# li Q a ON Q � 14'D AS BUILT FOR HERMAN HEINBUCK LOT 2 is Q I SW 1/4 of NE 1/4 S 7 T 28 N R 17 W 3 rn Pleasent Valley St, Croix m m I � I I I I • • Wiscgnsiti Department of Commerce PRIVATE SEWAGE SYSTEM Count v Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 31586 Permit Holder's Name: ❑ City ❑ Village n Town of: State Plan ID No.: HEINBUCH, HERMAN PL. VALLEY CST BM Elev.: —40 -100 BM Description: Parcel Tax N .: Q �J insp_BMEIev.: 02�- 1010 TANK INFORMATION ELEVATION DATA A9800249 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic f Ben m Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Ktet y il TANK TO P/ L WELL BLDG. Air Intake O D ,Bt Inlet Septic 7 T d ' NA Dt Bottom Dosing NA Header/ Man. Aeratio NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Dem nd� JA � 2 j . ��• � �p Model N ber PM a 9 s' �Sl ;F TDH Li Friction S ste TDH Ft �f L oss Forcemain I Length Dia. Dist. To well 501 BSORPTION SYSTEM BENCH Width , / f Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Dep h MEN I N`f DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM ACHING Manufactur INFORMATION Type O y AMBER Model Numb Syste "I [�/�/ _ OR DISTRIBUTION SYSTEM 6 S � Header / Manifold 9 Distribution Pipe(s) j of , x Hole Size x Hole Spacing Vent To Air Intake Length �; v Dia Length -4?1 Dia. r ' Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only [ Depth Over Q� h Depth Over xx Depth Of xx Seeded / Sodded xx Mulched ed /Trench Center � r" (U Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) I�2 Z LOCATION: PLEASANT VALLEY 7.28.17,SW,NE 453 CTY RD J - 0-4 WA Plan revis on' equirpd? ` 0 Yes No Use other side for additional information. SBD -6710 (R.3/97) Date nspector's S44dure ert. No. SANITARY PERMIT APPLICATION 20Safety and Buildings 1 E.WashngtonAve�� Visconsin In accord with ILHR 83.05,Wis.Adm.Code P.O.Box 7969 Department of Commerce Madison,WI 53707-7969 • Attach complete plans(to the county copy only)for the system,on paper not less County than 8 112 x 11 inches in size. fX • See reverse side for instructions for completing this application state san tary Permit umber The information you provide may be used by other government agency programs ❑C eck if revisio to previous application [Privacy Law,s. 15.04(1)(m)]. (f0/vL rK J State Plan I.D.Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION ` Property Own r Name Pro erty}ocation i U 5%4/ 1/4 riE1 14,S —7 T ,N, R17 O Propert Owner's Mailing Address Lot Number Block Number ov City,$tat0 1 t.V�� Zi Cod� (h V one umber Subdivisi� mQOrN�rlumber t J-+7 n u Nv c, II. TYPE F B1 III DING: (check one) ❑ State Owned ❑ !t� I_ I 19 ]NearestRoad Public 1 or 2 Family Dwelling-No.of bedrooms Town OF � st► -U 111. BUILDING USE: (If building type is public,,ccheck �allthat apply) Parcel Tax Number(s) u 1 ❑ Apartment/Condo 07.- Q • 17. �7 /C 09-4- 10-10 —' _!o 00 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 online B,if applicable) A) 1. ❑ New 2AReplacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an _____System _________ystem _____________ Tank_Only______________ Existin_System_ _______AA B) Sanitary Permit was previously issued. Permit Number l�(p Date Issued fif 3 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 1 ❑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 y 5-0 1 Required Isq.ft.) Proposed(sq.ft.) (Gals/day/sq.ft.) (Min./inch) / Elevation / 2, Feet l Feet VII. TANK Capacity INFORMATION in gallons Total #of Manufacturer's Name Prefab. Con- Fiber- Plastic Exper. New Existin Gallons Tanks Concrete strutted Steel glass App. Tanks Tanks Septic Tank or Holding Tank >< X11" / e Q 11 ❑ Lift Pump Tank/Siphon Chamber ❑ I E VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name:(Print) II Plumber's Signature:(No St mps) MP/MPRSW No.: Business Phone Number: u � el, bf r 3 7�s Q d Plumber's Address(Street,City,State,Zip Co e): I` /� IX. COUNTY/DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A nt4igu t re No a Approved ❑ Surcharge Pee) Owner Given Initial - l�/�1 Adverse Determination "Zoo /7 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-63M(I'LT 1y8) DISTRIBUTION: Original to County.One copy To: Safety&Buildings Division,Owner,Plumber Road J County Road J _1-) field to be installed at 86.46 24 by 63 drain f field to be adde valve or similiar to be added 1000 gallon septic z o Q .+ M � -he+ Q x X o + existing = m Q horse N -6 3 O o o Q fo ° top of cement wall m -F n Q horizontal reference r te° < o elevation Y8.08 z line PLOT PLAN FOR HERMAN HEINBUCK SW 1/4 of NE 1/4 S 7 T 28 N R 17 W Pleasent Valley St. Croix Wisconsin D�'aartrnent of lndusvy, SOIL AND SITE EVALUATION REPORT Pa a of Labor and Human r-'(4ktions g — Division of Safety&Fluildings in accord with ILHR 83.05,Wis.Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan'must include,but r Cv0, not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.# dimensioned,north arrow,and location and distance to nearest road. 02-y-101() 3C) APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION r pvr aw Nr/,4"Cf GOVT.LOT SV 1/4 #JE1l4,S? T),r ,N,R PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# R �• 2 Vo(�7�t 7 /9 S�-3 CITY,STATE ZIP CODE PHONE NUMBER r Cl❑ TY 44VILLAGE OWN NEAREST ROAD r?1►M a 01 wl"re n lh (X15 9 5 SZ �f P �y} t!q t��u co U Dq New Construction Use( Residential/Number of bedrooms 3 ( J Addition to existing buildirq < [ ) Replacement [ J Public or commercial describe - Code derived daily flow gpd Recommended design loading rate d S bed,gpd/112 0"� trench,gpd/ft2 Absorption area required 0 bed,ft2-f59 trench,ft2 Maximum design loading rate L,5— bed,gpd/ft2 06' trench,gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material_ t oe!a Flood plain elevation,if applicable ft S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem N S O U as ❑U as ❑U IN ❑U ❑S U ❑S}° 41U 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 Trertch {.>>, Ground 9 )b " 61V �' a d S r Cdr? o.�' 93V ft. It0 33 10 71 Depth to J� 53�b 3 !l r13 limiting factor Remarks: Boring# _ 0 -10 91 5 1312-- � 2 ^�a�r� �, F✓ s � o r5 � �,, If 13 Ground .41-V L D R `l lq S '9_ fat r►, Pr ai 1. ©,S-06 e/2.1 rt. Y 2 7l `-S ) r�r � 1r L1,7 Depth to '�" limiting _ fact Remarks: CST Name:Please Print Q tU ph Phone: 21T M ?Jaen Address: a2 F'115wo►4 W15 fl W/ Signature: Date: CST Number: PROPERTY OWNER HeVM0 7 Kf�'� Sri SOIL DESCRIPTION REPORT PaOD_of PARCELI.D./ Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary sRobts GPD/ft µ x. in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed JTmnch 1p �f y13 Ground (aYR '"__"_ 1� 4tr elev. qqj ft. Depth to ' limiting factor - - . Remarks: f- 9�A�c Boring# ` Ground elev. * " I-).1 it Depth to limiting i tactol„ i Remarks: �% �! a r std ?Y �a 0 `I Boring # i xi Ground elev. ft. Depth to limiting factor Remarks: Boring# Ground elev. ft Depth to limiting factor I T Remarks: tytfb-e��o(R,o5re2) I ' � ° N 1 � cc '` n t I f d —I i +f C i L I nt- 'ID 'y.. P4 11 " "'� " """' SUIL ANU JI I t tVALUAI IUN HtN Page �o(� or land Human r4la - dons ion saft:ry a Fluitdings - t accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach coinpleto site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but v G O J not limited to vertical and horizontal reference point (BM), direction and % of slope, W PARCEL I.D. a dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPER ATI �y g v M (�t/h Luc T . ' V4 NE 1 /4,S T �.`6 ,N.R , ( W PRO RTY OWI ER':S MAILING ADDRESS BLOCK 0 SUED. NAME ORCSM CITY, STATE ZIP CODE PHONE NUMBER []VILLAGE. OWN NEAREST ROAD rbt'chS! N 6 - 5,5 2-1 Plat I e Ceun¢ [)New Construction Use V 1i Residential / Number of bedrooms 16 Addition to existing building Replacement q ; [ ] Public or commercial describe Code derived flow / gpd Recommended design loading rate - bed, gpd /ft a' trench, gpd /ft Absorption area rwuir bed, 4 J-W trench, ft Maximum design loading rate ::: = bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) q 1. l 90 • , �,Q It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable W k S = Suitable for system TS EN ZONAL MOUND ROUND PRESSURE T- RAD SYSTEM ,IN FILL HOLDING TANK U= Unsuitable fors stem O U S O U S- O U S :C U ❑ S U O S .. SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Borin g # Horizon Texture Consistence Bouridbry Roots m. Munsell Qu Sz.Cont:Color. Gr. Sz. Sh. Bed tTmrich > ^' 4 -16 5 1 3/3 Sal 1- 4 ab w Os 6, ' 2 16-28 5 R 113 A a w I 2-F O's Ground 28 10 YP Sf 4 S Nf adlr �S t v I F 0 .7 0 elev. . y 31- Y3 R 8 - S- I �F ��k :s F 0.9 '0 ,f Depth to 5 f13 -5 1 1 0 117 .3 S vE d� s d I v F I 0,g limiting �' t/Q foYR 8 -2 -- -- vF factor V - 60 7 VFaA , dS `V ivr+ hA5 IR crj p fwo cokys of s- trod'. h gr;g. Remarks: Boring # 64 k . 619 f le'/;9# 7 44 A,% � k/ Ground elev. n ft. _ Depth to limiting fac or Remarks: EXHIBIT CST Name =Please Print phone: Vy ice Address: - �+ 3 B • 3 ! -- — /Is a l 144s J *21/ Signature: Date: — c .soh s��ewad L ' Ana 6uq!w of yidaa Il nala d punoig AI £¢ # 6uuog P1 A 4641 6 6uglwl, of I,pdap � q�9 �01 �l� —� 8 �0 w� �jb� l 101 �,- 4{ .� •nala 9 ° j 1 f puno,S c 1 s a 4 IBWa�{ r 9 6uq!wf of 4idaa punoig A r 1 A � 9 # 6uuog X P I :S)ij'L)waa 8 -© ,17 y P ay 76 , 6u41w11 � S IP 19 dA of o9 - �i � � °Itpdaa 9 q p q y / SO 'V `�+ yrb ' ' 9/ 9 YA 01 �I,-Zti il 9 -0 S' �,� w b s V � v� 01 Z ti -h� punaE) Aag � s � � � � b ' 4 / -- 11 V tt - - suoO •4 S 'zS hf y — t — f- - o alnlonjls em7xal 'zS' IlasunW ul - - lo NV Joloo 3ulculwo0 41daa uozuOH # 6uuog ed - 0 130dVd 1H0d 3Fi NOI1dIll1OS �,� �nll u /aN 1 4vW vN H3NM0 AW3dO8d �a to r --0 i t co / v i J.3 W o i s ip S C i o s� z cv -r y _` J ? �► v � v J 0 Co ° vo N G _ n f1 0 s r Ni `^ C s 1� "1 to I 0 w � � • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND �f OWNERSHIP CERTIFICATION FORM Owner/Buycr rma I tP� Mailing Address r � y ' av,•N.r,� z / I kf,r�wH� Gt✓ ✓� Property Address Address C �vh aq T i' (Wrificatioa rcquirrd from Plwniag Dcpartmcat for new construction) City/State /' nA /Y) Wv I Parcel Identification Number 0 �- q 0 ✓ L ✓ _ Q LEGAL UMQRrP 1 / ON Property Loeation I°� V y4, Sex. � F N -R 7 I W Town o 4 h Subdivision Lot # - 2 Ce�ed St aTey Map (I / 6 y Volume 6j / . Page # Warty n eed # . Volume Page # Spec house ❑ ycs no Lot lines identifiable yes ❑. no S YS' 1' E N i t SAI t 1 U� IA N C E k q -m p er=aad makft=ccofy=zcpdcsyso= ooaldWsultmits ooarisis of to handlcwast�.ProPcrmaiaterance P o tam thnx yc= cc zoaaer, ifaaedcdby1tIiecascdP=pc= Whatyonpat.intotiesystem eaaaffoct fim tibesc - as. :�iat5etaasGc�osaityst�u, .. - . � PL earner agrees to submit to St Cbaix Zodiag Dcpatfmcd a ccrtificitioM form, signed by tie 4m= and by a p 3 P restdctedpluabaoriUccasodPumpatrc ifyingthit(i) theou- itcwas =zkr cys is is Pwper opendiag condition, and/or(2) after inspxtioa and pumping (if neexssary), the scpt rAn k less Jran w full of slue. Yl ? uigned Inc Brad the abm tnquir snd to maimFsia tau pizvatc sewage disposal system wi& tfu standards fo b by of Cb�anc and the DcpuWunt of Natural F=omrocs,; State of W isoowin- Coed ,nation systun bas beemmaintaincd mast be CWVIctod and tct mmed to the St Owix.Connty Zoning Office wi diia 30 der ycar expiratiog0a A GNATURE OF APPLICANT / ATE OWNER• G'`ER' CANON I (we) c"* that all statcmcats on this form arc hne to the best of my (our) tarowicdgc. I (we) = (arc) the owucr(s) of the property described above„ by virtue of a wartaaty dcod tcoo &d in g egisGer of Docds Office, SIGNATURE OF APPLICANT ATE s « « « «« My information that is VLkA prescdcd may result is the sanitary permit being revoked by the Zoning Department • • "•' «« Indade with this aPPlicatiow a ctanpod warranty deed from the Register of Doody office A Copy of the Certified turvcy map if reference is =dc in the warranty deed 54G743 VOL REGIS i c ri 5 $LCR WARRANTY DEED !ht'd'�r Ra u HERMAN R. HEINBUCH and DELORES C. HEINBUCH, husband and waft, hereby warrant and JUL 12 19 convey to HERMAN R. HEINBUCH or DELORES C. HEINBUCH, t nutees, or successor 9t 9:30 All trustee(s) of the HEINBUCH TRUST DATED JULY IC% 19%, (1►ereinatter referred to as .�K -% 0, "Assignees "), the following described real estate in St. Croix County, State of Mraconsin.- raqwff c o NE 1/4 of Section 7 -28 -17 EXCEPT part to William R. Volkert and Deborah J. Voikert in Vol. "630 ", Page 447, Doc. No. 371376. This I s rL.- s" homestead property. Dated this 10th day of July, 19%. HERMAN R HEINBUCH JCL DELORES C. HEINBUCH STATE OF WISCONSIN ) SS: A) FEE COUNTY OF EAU CLAIRE ACKNOWLEDGEMENT Personally came before me this 10th day of July, 19%, the above named HERMAN R. HEINBUCH and DELORES C. HEINBUCH, to me known to be the persons who executed the foregoing' acknowledge the same. •Or ••b lic ff me� L on l{n MkCiissran expo 26100 4 �1 v � E This instrument wad Colleen A. Cowles, Afton - 1324 W. Clairemont Avenue, Eau Claim, Wisconsin 54701 co t� 9 FILED S SEP 3 01993► 11 JAMES O"OONNEII Fi gMw of Deeds 12 506385 �o �•�co., CERTIFIED SURVEY MAP w N LOCATED IN THE SW4 OF THE NE4 OF SECTION 7, T28N, R17W, TOWNS P OF PLEASANT VALLEY, ST.CROIX COUNTY, WISCONSIN. Prepared for: Herman Heinbuch � NI /4 CORNER SEC 7. NOTE: Bearings are referenced ( COUNTY MONUMENT to the N -S Quarter Section Line. FOUND). (Record bearing) a = N ! _ OD I r' O N N:M 33 33 UNPLATTED LANDS, DRIVEWAY EASEMENT' not reciwded S89 "E 243, 50' wt. ^in 30<:_rsaf 33.00' 2,1 O, 50' y W E 1 00 M M o m to ro S to S6 9. 47'2 "•E 240.50' O '-- �. Z. K) p .1- rn, 0 0 o " C, L0T 2 w �; 0 1. 34 ACRES °o !--- Z ( 58,440 SO, FT.) f-- r lo I.00 AC. EXC. EASEMENTS a q. 1.. N 1 43,573 SO, FT.1 N = J at Cc 1- �t z >: 0 m U; �c-- --- too. — . f. • Z , �• BUILDING� � )' SE T 0 A C I 33.00' 210. 50' N 8 °4T' N89 0 47'27 "W 243.50' 2406.81, t E- W QUARTER LINE I l E I/4 CORNER SEC. 7. 33 N33 r 2' IRON PIPEFOUND). N ( UNPLATTED LANDS 0 � CON `� '3r XI JAMES M. WEBER SI 14 CORNER SEC.7. s 5 I RAILROAD SPIKE FOUNO). SPRING ISAL� Oz SET I "X 24° IRON PIrE W NIEARPOOT13 LBS.PER �•M�SUvt l SCALE I "= 60' nal JAM S M. WEBER S^ 1804 o' 30' so' 120' SHEET I OF2 DATED VOLUME 9 PAGE 2689 93- 131 THIS INSTRUMENT DRAFTED BY J. 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TO auTI UOT}oaS .raixerib 1say -1ssg ayj uo JUTod E of ,00 HLfYJS aouayl f , OS' £t►Z 3 „LZ , Lfio68S aOuayl ! ,00'M auTJ pries BuOTe H.L2i0N BUTnuTjUOO aoUayZ :ONINNI039 d0 JNIOd aye. BUTaq osJE :.UTod plies 'L UOT109S piles To .rau.roo VI 3 94Z 01 ,Z5'5L9Z Jo aousjSTp E aUT UOT109S aaiiierij q�noS -y:�sON aye. SuOJe HIAON aouayl :L UOT:�oaS pass To .rauroo fi/J Say} TIP Butouauwo:) :smoJJoj sE pagyjosap ATJnj asOW 'UTSUOOSTM 'Aluno' x IA9TTEA Zussie9N 3o d MIA 'N8Z1 'L uOT}oaS TO t/I 3N ayj jo t/I SAS ayj UT pa }EOOT PuET TO J a o jed y 1`+IO I .Ld I2T�S3Q �i 4I 0 SANITARY PERMIT APPLICATION DILHR In accord with ILHR 83.05,Wis.Adm.Code COUNTY /��a) STAT SANITARY Pkif ERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ AFt,8%x 11 inches in size. ` eprev ious application -See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. PROPERTY OWNER 1 LA :LOCATION rl .e IhkpC EIA.S T� , N, R ' r) PROPERTY OWNER'S MAILING ADDRESS i q BLOCK# zt CITY STATE ZIP CODE PHONE NUMBS CSM NU BER q/3/0'i m�n�^) Irks lS 79 Sr q 2(,89 II. TYPE OF BUILDING: Check one p NEAREST ROA ( > State Owned � I �� Crpv►7 Public 1 or 2 Fam.Dwellings of bedroom M III. BUILDING US : (If building type is public,check all that apply) Q��f—I 0 - L-10 16 1 El Apt/Condo / ` 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 in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑Replacement of 4. ❑ Reconnection of 5.❑ Repair of an ystem System Tank Only Existing System �I Existing System B) ❑ A Sanitary Permit was previously issued. Permit# Date Issued l/ V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 El Mound 30 El SpecifyType 41 El HoldingTank 12 Seepage Trench 22 El In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY LREQUIRED ABSORP.AREA 3,ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE 11 (sq. .) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) cj0,� ELEVATION �-o V itch fee, Feet q�jr,%,,-Ty Feet VII. TANK CAPACITY Site in oallons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 00 Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Nam 'int): Plumber's Signature:(No S m ) MP/MPRSW No.: Business Phone Number:a ruc �r3 lT ►y'/f! P mber's Address(St ee City,State,Zip Cod b): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(includes Groundwater Date Issued Issuing Agent re ps) ❑Approved ❑ Owner Given Initial �'_ Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber IM"RUCYIONS L 7 1. A 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. n 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 r' 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 & Buildings Division,608-266-3815. To be complete and accurate this sanitary permit application must include: r, 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. IL Type of building-being served. Check only one and complete ##of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 informattion requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/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 is to filf 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% 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; 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, ground- water contamination investigations and-establishment of standards. SBD-6398(R.11/88) t L_ b INSTRUCTIONS 1. A 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. 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 & Buildings Division; 608 -266 -3815. 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. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 in ##1 - 7. VII. Tank information. Fill in the capacity of every new and /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. Vlll. Responsibility statement. Installing plumber is to filf 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. r ' Complete plans and specifications not smaller than 3% x 11 inches must be submitted to the county. The plans must 'include the following: A) plot plan dr �rxr- to scale or with cor q leek di�r�en,i -��ns, location of holding tank(s), septic tank(s) or other treatment r.silding w a?�r �,a!r —.',vaterservice streams and lakes; pump or siphon tanks; distribution boxes; soil absorptionyste +n5; repra(.ement system areas; and the location of the building served; U) 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. --------- - - - - -- -- - ----- -- ------- — ---- ------------------------------- L— ___ ----_ 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, ground- water contamination investigations and-establishment of standards. SBD -6398 (8.11/88) Wisconsin Dr�paarb"ent of Industry `SOIL AND SITE EVALUATION REPORT Page _ of Labor and H*nan r4ktions Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COU Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but r GO not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. d 2 y -/ 01d 3 (� APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE r PROPERTY OWNER: / PROPERTY LOCATION Pvem pit Jll /4, GOVT. LOT 5 V 114 #,P-1 /4,S? T,�r ,N,R 7 (or60 PROPERTY OWNER':S MAILING ADDRESS L07 # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUM []CITY PVILLAGE IVOWN NEAREST ROAD I -del mtm o n J W r5 co n ► ( �l�) 9G — 5� r� t� f •t CD v„ fir$'' T Dq New Construction Use ( Residential / Number of bedrooms 3 (J Addition to existing building (] Replacement [ j Public or commercial describe Code derived daily flow _ gpd Recommended design loading rate O , S bed, gpd/ft 0 rC trench, gpd/ft Absorption area required ©p bed, 0 trench, ft Maximum design loading rate 0 t5 bed, gpd /ft Ot� trench, gpd/ft Recommended infiltration surface elevation(s) it (as referred to site plan benchmark) Additional design / site considerations Parent material _toPj Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I T -GRADE SYSTEM N FILL HOLDING TANK U= Unsuitable fors stem S Cl U a s O U a s O U S O U ❑ S U O S =° O 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 Trench o - 8 �.SY 31X Ground b ci s r 0 -70-9 9'3; ft p 53 / S c ad G d r -- o,� o1g Depth to 3 � S S �_ — 0, 7 limiting � factor� Remarks: Boring # 9, 4 F,/ 2 6• r . 0 I ,S I ^ r 3 )q D R ---- S I r a.s6 � G j round T ft. Depth to n limiting - factor, Remarks: CST Name: — Please Print Q f ' P Phone: 7 J�y 308 Address: / F/$we Wf5 Signature: Date: ,, CST Number: t /9 J soy o�.. PROPERTY OWNER H Pvw7q� _ �f f�1, �� . SOIL DESCRIPTION REPORT Pa�^.__,_of PARCEL•I.D.S o �' 10 10 Depth Dominant Color Mottles Structure r GPD /ft Boring # Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bmndary Roots B T ed reridi .s�o :` Z to Ground 3 10YR S �4� �� O,? O• elev. Depth to limiting factor w Remarks Styurfilyt P �tlr v PJ? 4 , fe S= c rf!4 Boring # Ground ON �V V � " F elev. ��• ft. Depth to limiting tacto�,� Remarks: Boring # e5xe >r9:gx Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground j elev. ft. Depth to limiting factor Remarks: �gb- 1�330(pA5/92) E l al -S c C _ J k -- J z s (T t i i l l ° 0 f o ' �I v ~r 1 - i- i L { - lJ � SANITARY PERMIT APPLICATION DILHR COUNTY In accord with ILHR 83.05, Wis. Adm. Code C r0) . STATE SA 1fr A ERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than �( � 834 X 11 inches in s ize. c eck evis on to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LO TION I ��t4 �'► /a ;S Tv ,N,R / W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY STATE � ZIPCODE PHONE NUMBER SUBDIVISION NAME 61 CSM NUMBER II. TYPE OF BUILDING Check one E] CITY NEAREST ROA ( ) ❑State Owned VILLAGE f � ('0v k ❑ Public or 2 Fam. Dwelling — # of bedrooms — FRARIMEL TAX NUM III►. BUILDING US 16. (If building type is public, check all that apply) — "" 1 1 ❑ Apt1dondo 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 in line A. Check line 8 if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ystem System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## r 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,Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-in-Fil VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY, LREQUIRED ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE (sq' .) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min./inch) _ '70,5- ELEVATION J fife rh Ar -7 Feet 0. Feet VII. TANK CAPACITY # of Prefab. Site Fiber- Exper. m gallons Total Manufacturer's Name Con- Steel Plastic INFORMATION New xistin Gallons Tanks Concrete structed glass App. Tanks I Tanks l - A Septic Tank or Holdi no Tank f P 001 m f 6 Lj Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (P inq: Plumber's Signature: (No S m MP /MPRSW No.: Business Phone Numbs Q� � � - K3 s may P ber's Address (St e ip Cod : fi /sue f IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date issued Issuing Agent S re ps) Surcharge Fee) ❑ 1 Approved Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Pib -67) (R. 11/88) 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 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. 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 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 & Buildings Division, 608 -266 -3815. 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 numbers) 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 in 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 in ##1 -7. VII. Tank information. Fill in the capacity of every new and /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 is to 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% 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; 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, ground - ' water contamination investigations and%esta.blishment of standards. - - SBD -6398 (R.11/88) 7 LHA SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code r4 ) STATE SAfNAP Y MIT # –Attach complete plans (to the county copy only) for the system, on paper not less than ` 8% x 11 inches in size. k evision to previous application -See reverse side for instructions for Completing this a pplication. STA E PLAN I.D. NUMBER I. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION. PROPERTY OWNER 1 PROPERTY L TION , e r r►, f'n �vr /a S T N, R r W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY STATE ZIP CODE PHONE NUMBE SUBDIVISION NAME CSM NUMBER }} Check one CITY NEAR ST ROA4 11. TYPE OF BUILDING ( ) ❑State Owned VILLAGE S ► r j ji ❑ Public Vior2lFam.Dwelling4ofbed oms — PARCE TAX NUMBER 111111. BUILDING US (If building type is public, check all that apply) -- 0.� 1 ❑ Apt/Condo 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 in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 511 Repair of an ystem System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## Date Issued U V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 El Holding Tank 12 eepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit_ Pressure 43 ❑ Vault Privy 14 ❑ System -In- Fill VI. ABSORPTION SYSTEM INFORMATION: GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6 SYSTEM ELEV. 7. FINAL GRADE (/�} REQUIRED (sq, f /t_) PROPOSED (sq.,ft.) (Gals /day /sq. ft.) (Min. /inch) 114,) ELEVATION v ^ j �'t -- Ads Feet Ili : Feet Vll. TANK CAPACITY Site INFORMATION in gallons Total It of Prefab. Fiber- Exper. Manufacturer's Name Con- Steel Plastic New istin Gallons Tanks Concrete structed glass App. Tanks 1 Tanks Septic Tank or Hold! na Tank to 0Q I T K/t' `{PM+ r t Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name ( int): )� Plumber's Signature: (No Sta MP/ //MPRSW `Noo..: Business Phone Num i�k D . A4 sod ✓ 1 1 4 0� r J 15 � P is Address (St a City, State, Zip Cod -r X ;;l3I y0 IX. COUNTYIDEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issuing Agent Sipatune jNo S ps) ❑ Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber � 1 INSTRUCTIONS 1. A 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. 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 concern ing,:your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 -266 -3815. 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 numberjs) 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 in 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 in ##1 -7. VII. Tank information. Fill in the capacity of every new and /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 is to 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% 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; 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, ground - water contamination investigations and establishment of standards. SBD -6398 (R.11/88) I LQQ&T l ;,, t RUA , 5"W y , VALLEY 7- FMVX1E% *AGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and- Ruildings Division (ATTACH TO PERMIT) Sanitar rmit GENERAL INFORMATION Permit Holder's Name: []City ❑ Village n Town of: State PI n o.. lev.: nsp. B lev. E: [BDecription: Parcel Tax No.: I TANK INFORMATION ELEVATION DATA A9300271 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto Air 1.+ *-' Septic Dosing Aeration -. e Holding PUMP / SIPHON IN FORMATIO N Manufacturer Model Number p cem Lift Friction 5yster ain Length Dia. Fi SOIL ABSORPTION SYSTEM BED/TRENCH Width Length „ r No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Model Number: System: 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: PLEASANT VALLEY 7.28.17.51A Plan revision required? ❑ Yes ❑ No 7_1 F Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I " P. E DIL' H v SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code ....�,�.,e. S -f C STATE /�JIT�IRY P RMIT # –Attach complete plans (to the county copy only) for the system, on paper not less than ` /' k /j /y re l J X f n l ( 16 / r n ( S 8% x 11 inches in size. ❑ ch ec if s to previous application –See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP RTY OWNER PROPERTY L ATION d f) �f b (� G % A lt Y4, S T,9 , N, R' 7 X(oifW PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # -- 6- CITY, TAE ZIP CODE PHONE NUM R SUBDIVISION NAME OR CSM NUMBER 1s 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned VILLAGE P'�R �'►'� V n ❑ Public 1 or 2 Fam. Dwelling -# of bedrooms ) III. BUILDING USE: (If building type is public, check all that apply) ().2 i f — 10 1 0 2i�j OQ� 1 El Apt/Condo v cJV' 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 in line A. Check line B if applicable) A) 1. ❑ New ZX!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 # — 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�Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 /�t' REC (sq. ft.) PROPOSED (sq. ft.) (Gals /da /sq. tt.) (Min. /inch) Cf j, t 9 a I Q 3 E�EVATION V I 1 l V d. S Feet �� OO Feet CAPACITY VII. TANK # Prefab Site in allons Total of . Fiber- Manufacturer's Name Con- Steel Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Pr' t) S Plu er's Signature: (No Stamps) MP /MPRSW NI Business Phone Number: ,. 3 J j /` S Y ��ry ( `�(J Pum rs Ad ress ( Ste7 , City, State, Zip Code): 9-3 :eu riA li IS C1 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sagitary Permit Fee (Includes Groundwater Date Issued Issuing Age Sig No mps Approved D Owner Given Initial SrP /Fl}J Surcharge Fee) Adverse Determinatio 1fi u X ONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: s� �..�► SBD -6398 (formerly Plb -67) (R. 11/88) 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 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. 4. Chanpos <n ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SFID 6399 to be subru ttF ll to the ce;_ of - ;prior to install�ifion. 5. Or'aitte sE w systems must be property maintained. The septic tar i• ,si mu -.t b v Vie,; ay a Ii(e" sed purrip& whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, coutw t your !oca! . ocle adwinistrat:or or the State of Wisconsin, Safety & Buildings Division, 608 - 266 -3815. 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 bedrooiTrs if 1 or 2 Family Dwelling. III. Building use. if building type is Public, check all appropriate boxes that apply IV. Type of per rnit. Check only one in line A. Complete line B if permit is for tank. replacement. econnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Abs:arrf' ))- system intormation. Provide a!1 information requesfnd n ##1 -7. V!!. Tank lrJormation. Fid in the capacity of every new and /or exist_ ank, list t' tul�il gallons, numb =r of tanks and manufacturer's name. lridlwat;, prefab or site constructed and tank matey ial. C oi for :ill septi , purnp /siphon and holding tanks f )r this system. Check eyp approvai dilly if tanks rei:eived eypt:rirnental product approval from DILJ VIII Res!-rorsioihty statement. Installing plumber is to fill in narne. 1 -ense number with aopropra;xte prefix (e.g. MP c;tc i , address and phone number. Humber must si,; a p r !1r at;on form. IX. Gountyll) Use Only. X. Uou ,ty /D - partment Use Only. Complete plans and specifications not s ;2tf)rr than 8'/2 x 11 in-11 as -rr,r >t be sr;br i E!d+ to the county. The plans rnl)��' include the following: A) plo' pian .r; v" to scale r ;r rvith .,n�r3ple'.. a�; ���r�r;'nr location of holdinc <: `s? septic; tank's} c i,?er treatment tanks building & w,= e- r.,a,r s water service; StrEams .r} iak „ c oomp or S;r4ion tanks; dist0iition boxes; soil 3LiSr r ,� r ri .yctrtr,c re)li P:ystem 3r d-?d the IoCn'fCin of the hull -ing served, 3) horizo r?tal poinl,i; G) compete specifications for pur,.ps and controls; dose volume; e". c, !ere: fr;c.: ion loss; pump performance curve; pump model and pLImp manufacturer; D) cross seann of the soil absor,)tion 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 mon,t.s c':) through rtrese s'.echarges ar . L;,eA f rr�n �;tt. !rgs��av�F� ter g`ouna water contaro: nation investigz4ij rrs anwestablishn -Pr•' > f _; )6arrf` SBD -6398 (R.11/88) i Wisconsin Dr tiartment of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Hurnan t;2k; tions _,� Division of Safe I ty & Fuildings in accord with ILHR 83.05, Wis. Adm. Code . COUNTY r Attach complete site plan on paper not less than B 1/2 x 11 inches in size. Plan must include, but � Q J not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: I PROPERTY LOCATION �t vm N tih bvC GOVT. LOT W 1/4 N F, -1/4,S 7 T 0 - 6 �5 y ,N,R , (o W PROP RTY OWNER MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE WN NEAREST ROAD Isroh,� (2/S) 6 -552 Pl (e? Ccun¢ [ J New Construction Use Residential / Number of bedrooms [ J Addition to existing building Replacement [ J Public or commercial describe _ Code derived daily flow gpd Recommended design loading rate — tied, gpd/ft2 a' 6 trench, gpd/ft Absorption area requir bed, ft (SOV trench, ft Maximum design loading rate bed, gpd /ft LU trench, gpd /ft Recommended infiltration surface elevation($) 91' - 1�, 90 , , WtO ft (as referred to site plan benchmark) Additional design / site considerations _ Parent material o rss Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND ROUND PRESSURE AT RAD SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stern S❑ U S❑ U S [] U S U El [is SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots ................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrerd 5 YR 3l3 S. '1. F a bt� w ' a •6 2 16-Z� 5 t R 41 VF Ground 2g 3q 10 YR E14 S 1 o 61 ds w F U.? 0.9' elev. 9 ft. y �9 y� R 8 -2 s t,F �� .s b F 0.9 O,f Depth to 5 9 - 51 ►o; T 7 3 s I W b4 d s d I �F -9 a ,g limiting f o YR 8-2. _ f actoQ 5 7. 6 1 V Fqd , d S d b e Q�� 01 �O (4 ras 01 t tW C kyS 01 ,Sgkj n birA h Cifinek4t Remarks: _ Boring # -/ 2.5 8 S � caG 3 fi0 sr � rar7 -- LU 6 ft�r�� 7 ties f�,, 4wo 1� T vP� a pr.,� J Ground ---- - elev. _f�j ft. Cn l ip 1 eln L C Depth to — limiting factor - — Remarks: CST Name:-Please Print r Phone: u e_Iltn ` l! V� G 3 FPv _ 3D Address: K+ 3 �! • , 3 f U / /51, 6 WS ,s y(7/ f Signature: Y � goA4SL, AL" n Date: s � CST Number: (ZN50'd10EE8 ue aoh :s�JBUlaa ,opal 6uulwg of �dad nala • punojd 11ll 5� SA YAR �,&6 n-C J 7SA 9 u yl k AO y L � t 1 fiu :s�la�waa i / Jo,os, L.,q 4 1 ,8 - gw � P � ! � i � �9 9 0l 6u 41de( .I a, - �.� punojS LO 0� �''� S �19 �•� ��� �� s (I�P ( #v'6u1Jo8 Pc4 b N led si aoaln :s�lrewat� oe! 6uuiwll oa 41dad YY ! P •nala 11 x ► saw S b/9 YA 01 61 # 6uuo8 :s�laewaa s q J( e✓' C I q 6ulllwg 01 "lid► o14jdad I 9 -1) w '1 `fb , S 9f S v� 01 7, h�h� punaE) Q l Pa8 4S . zS 'a0 �olo'J'3uaJ'zS'nO IlasunIN 'ul 11 /adJ s�oob MW% aoua4slsuoO aan�on��S ainixal sap�oW aolo� ;u2uluaod y ;d' uozuOH # 6ulao8 #'Q'I'133dVd Io 'd lUOd3H NOIldIa0S30 IIOS ����urdN `4 v a3NM0Ala3dOdd g �T Cnz Hr , - n -- I z M -e -42Cp n r-- O ZE o / I 0 < c. (d c 3 s" -i F co r � „ •: c E 1 Q / v v K , IZZ °4 0 ° _ N S V r 1n C \h f { -IP A 0 � � n w N c n c w . X ppre[� N' co 9 FILED o 5 SEP 3 01993► >> JAMES ObONNELL FogbW of 099ds J2 SQf g5 SL Oft Co., wi CERT I F ED SURVEY MAP 4► N LOCATED IN THE SW4 OF THE NE4 OF SECTION 7, T28N, R17W, TOWNS P OF PLEASANT VALLEY, ST•CROIX COUNTY, WISCONSIN. Prepared. for: Herman Heinbuch N 1/4 CORNER SEC. 7. NOTE: Bearings are referenced COU N TY M to the N -S Quarter Section Line. FOUND). (Record bearing) 0 = N O A (n:M I 33 33 UNPLATTED LANDS Corry DRIVEWAY EASEMENT S89 °47'27 "E 243. 50 w,ir,in3G' sk ;s of W E 33.00 2 1 0. 50' p 'ill: d * e 10 m O „ M _ S " S8 '•E 210.50' K)' O of : O �. O ° O " L0T 2 N U.): O, w .�; 0 1.34 ACRES o F--• Z _ n 1 5 8, 440 SO, FT.) {-• S lp 1.00 AC. EXC. EASEMENTS Q. 43,573 SO. FT.) LU cc .J`. p I O Z . >: p u, U; loo' - . T 1 � - Z �• 8UILDINC S ETBACK 33.00 ' 2 1 0. 50' N 8 °47' 27" N89 °47'27 "W 243.50 2406.8i' E- W QUARTER LINE E1 /4 CORNER SEC•7. 33 ' N33 ( 2" IRON PIPE FOUND). N UNPLATTE LANDS a ; N ��►� G o S� iF X`l JAMES M. s WEBER I� SI /4 CORNER SEC. 7. s 5-1804 ( RAILROAD SPIKE FOUND). $ SPRING Wis. Q • 0 = SET 1 "X 24 IRON PIPE y WEIGHING .13 LOS. PER LINEAR FOOT. SUvkvi�' SCALE -1"z 6 0 ' Its JAM S M. WEBER S -1804 o' 30' s0' 120' SHEET 1 OF2 DATED VOLUME 9 PAGE 2689 93 - 131 THIS INSTRUMENT DRAFTED BY J. W. o 0 o" v LDE�SGR I 1=>T I C1V A parcel of land located in the SW 1/4 of the NE 1/4 of Section 7, T28N, R17W, Township of Pleasant Valley, St.Croix County, Wisconsin, more fully described as follows: Conynencing at the S 1/4 corner of said Section 7: Thence NORTH along the North -South Quarter Section Line a distance of 2675.52' to the C 1/4 corner of said Section 7, said point also being the POINT OF BEGINNING: Thence continuing NORTH along said line 240.00'; Thence S89 "E 243.50'; Thence SOUTH 240.00' to a point on the East -West Quarter Section Line of said Section 7; Thence N89 "W along said line 243.50' to the point of beginning. Contains 1.34 acres subject to C.T.H. "J" right -of -way over the westerly 33' thereof. Also subject to existing easement over the northerly 33' thereof. SLJF V 1EYCl2 ' S C)FrRT I 1F I CA=_ I, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin 'Statutes and the provisions of the St.Croix County Subdivision Ordinance and under the direction of Herman Heinbuch, owner, I have surveyed and mapped the above described parcel of land and that this map is a correct representation thereof. �,�gd9t3�ifdt� Dated this day of R���S� ,1993v4"� r'Ad+''�,. a s JAMES M.' `�^ a WEBER James M. Weber S -1804 S -1804 NELSEN -WEBER LAND SURVEYING, INC. SPRING VALLEY 1 Wis. � ` moo aS U `ems NOTICE: The M parcel shown on this map is subject to State an County laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St.Croix County Zoning Office for advice. SHEET 2 OF 2 93 -131 This instrument drafted by Jim Weber VOLUME 9 PAGE 2689 P/ / c 07/ I i� S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWN ER /. - N ev ►�r� � I T �'j � L ADDRESS ��� FIRE NUMBER� CITY /STATE 179M1V0h i LA S ZIP PROPERTY LOCATION :S1 /4 , 1/4, SECTION T2 — K -1 N -R_W ) TOWN OF 11'as - eo* l f , St. Croix County, SUBDIVISION /V , LOT NUMBER 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 60% 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater 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. I /lie, 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 S T C - 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 ,n delays of the permit issuance. , Should this development be intended for resale by owner /contractor,(spec house), thenia 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 411 Location of propert 1/4 ►ylZ 1/4, Section, T�LO N -R 17 W Township I JPkl A 1/1 , f Mailing address Address of site Subdivision name Lot no. Other homes on property? — yes . No Previous owner of property Total size of parcel acP Date parcel -was created 0 C - r - 2-3 1 'Are all corners and lot lines identifiable? Yes � No Is this property being developed for (spec house)? Yes ! No Volume and Page Number of Deeds. as recorded with the Register --� � )O [ L , "' C C INCLUDE WITH THIS APPLICA'T'ION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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. PROPERTY OWNER CERTIFICATION+ eW 4 50C,385— I(we) certify that all statements on th form are true to the best of my (our) knowledge that I ( we ) m ( are ) the owner(s) of the property described in this inform ion form, by virtue of a warranty deed recorded in the off of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of Count Register of deeds as Document No. Signature of applicant -,c. Co- applicant J L 2. L) ( '.2 Dat of ignhture Date of S i DUCUMENT NO. STATE BAR OF WISCONSIN -FORS! 3 GU1T CLAIM OEEO _ o7 V U 0 FACE OS THIS SPACE RESERVED FOR RECORDING DATA Herman R. Hei and Delores C. Heinbuch REG4STERS OFFICE husband and wife, as joint tenants ST. CROIX CO., WIC Recd. for R-_�cord this 6th quit - claims to Herman R. Heinbuch and Delores C. Heinbuch day of � A. D. — husband and wife, as tenants in common of a n undivi g 30 A one -half interest each M. Myhtr o! DNd� the following described real estate in St Croix County, State of WISCOI: sin: RETURN zo GAYLORD The NEIL of Section 7, Township 28 North, Range 17 West, I. ATTORNEY AT LAW except the one -acre parcel of land conveyed to William R 113 E. ELM ST. Volkert and Deborah J. Volkert by deed recorded in Vol. RIVER FALLS, WIS. 54022 630, page 477, Document No. 371376. Tax Key No. 8 The E� of the SE of Section 6, and the SW14 of Section 5, all in Township 28 North, Range 17 West. 1 The S� of the NEk of Section 32, Township 29 North, Range 17 West. That portion,of the E� of the NWT of Section 5,.Township 28, Range 17, lying South of Interstate Highway "94 ", consisting of ten acres, more or less. NWZ of SWiy and West 2 rods of SW!4 of SW of Section 4; W!i of SEk of Section 5; ALL ` in 28 -17. j Subject to easements and rights of way of record. 1 (This deg o sever t tenancy ownership of the parties and to s create a ancy in common ownersh one -half interest each.) This is homestead property. (is) (is not) l Dated this 4th day of Januar 19 , (SEAL) P\ P N'�ji c'``'� (SEAL) Herman R. Heinbuch (� (SEAL) �(� i.: ` ,t3 c +.� (SEAL) Delores C. Heinbuch i � AUTHENTICATION ACKNOWLEDGMENT 1 Signatures authenticated this _ - -_ —day of STATE OF WISCONSIN I _. I SS. 19 ' Pierce County. I Personally came before me, this 4th day of * Ja nuary, 1983 the above named TITLE: MEMBER STATE BAR OF WISCONSIN Her R. Heinbuch and Delores C. (If not, _ Hei nbuch authorized by § 706.06, Wis. Stats.) This instrument was drafted by to me known to be the person who executed the fore - C. L. Gaylord, A ttorney a �4t a giffig inst ent and ackngA- edged the same. River Falls, WI 54022 j T, — (Signatures may be authenticated or acknowledged. Botlb Not�`y Pub3ic _ . Pierce County, W. are not necessary.) �'. v 14y CorQinission is permanent. (If not, state expiration date, +' June 22, 1986 .) QUIT CLAIM DEED -STATE BAR OF WISCONSIN, FORM N 3-1977 STOCK NO. 13003 • DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2 �OL 645 WARRANTY DEED THiS SPACE PESERVED FOR RECORD1✓3 DATA ROBERT J. PHERNETTON, Grantor ZRS OFFICE -- -------- ;T. CROIX Ca W - C i-x Record 1A 21st o f April conveys and warrants to IlErU-IA - N --- R. -_ HEIN - BUCH and A. D. 1982 DELORES C. HEINBUCH, husband and wife as of 3:00 P po ter!,nLs, Grantees Reshfor of De bi j RETURN TO the following described real estate in St. Croix County, State of Wisconsin: Tax Key No. The Northeast Quarter of Section Seven, Township Twenty-eight North, Range Seventeen West (NE; of Sec. 7, T28N, R17W), except the one- acre parcel of land conveyed to William R. Volkert and Deborah J. Volkert by deed recorded in Volume 630, page 447, Document No. 371376. Opal Phernetton, wife of Robert J. Phernetton, ;uit claims to the above- named Grantees any interest she may have in the above-described real estate. (This Deed is given in full satisfaction of a Land Contract dated April 18, 19 recorded April 22, 1974, in Volume 510, page 51, Document No. 321415 in the office of the Register of Deeds for St. Croix County.) This iSq9tionnestead property, (is) (is not) Exception to warranties: _ in Dated this 13 th il 82 da of Apr 19 (SEAL) (SEAL) Robert J. Phernetton (SEAL) (SEAL) Opal Phernetton AUTHENTICATION ACKNOWLEDGEMENT Signatures authenticated this 1-3-th day of STATE OF WISCONSIN 19 NT co Personally came before me, this day of Hugh F. Gwin TITLE: MEMBER STATE BAR OF V41SCONSiN 74XAWx__ the above named authorized by § 706. 06. Wis. Stats) This instrument vas drafted by Hugh F. Cwin, Attnrn Gwin, Gilbert, Gwin & "Mud7te P.O. Box 106 to r� Kr to ce the -,er Arm execut in , j:�e foregoing - Hudson, lo;isconsin :-4016 ,nt and (Signahjres ma be authenticated or 3ck.r!( Bea^ are r', , t necessar late Stock No. 13002 o s�� s �y 2D 0 °2