HomeMy WebLinkAbout012-1017-80-000LaGAtr'I'QllpfrqetD[ I^BBAFIE 06 - 30 ffvfl?t SEWAGE S'STEMLabor and liuman Relations;;i".y;;';;',j;hs' Drvrsron INSPECTION REPORT
GENERAL INFORMATION (ATTACH T.O PERMIT)
TANK INFORMATION
TYPE MAN U FACTU RE R CAPACITY
Septi c
Dosing
Aeration
Holding
TAN K TO PIL WE LL BLDG.Vent to
Air lntake ROAD
Septic NA
Dosing NA
Aeration NA
Holding
PUMP / SIPHON INFORMATION
Manufacturer Demand
GPMlModel Number
TDH Lifr Friction
Loss
Svstem
Heacl TDH Ft
Forcemain Length Dia Dist. To Well
SOIL ABSORPTION SYSTEM
ELEVATION DATA A9 3 0027 4
Permit Holder's Name:
IE|'T']T!E|DT E'I\, l'T EIFDITI N
! City I Village fl Town of
EII)TN DI2ATI2TE
CST gMEIilI - 'Tns[. SM EIev BM Description
unty
n v
Siate Plan-iD-l'J-oI -
ParcelTax No.:
n1 )- 1 O1 ?-8fl-Ofl0
STATION BS HI F5 ELEV
Benchmark
Bldg. Sewer
St / Ht lnlet
St / Ht Outlet
Dt lnlet
Dt Bottom
Header / Man
Dist. Pipe
Bot. System
Final Grade
BED / TRENCH
DIMENSIONS
width Length No. Of Trenches PIT
DIMENSIONS
No. Of Prts lnsrde Dra Liquid Depth
SETBACK
INFORMATION
SYSTEM TO PIL BLDG WE LL LAKE / STREAM LEACHING
CHAMBER
OR UNIT
Manufacturer
Type Of
System:
Model Number
DISTRIBUTION SYSTEM
Header / Manifold
Length Dra
Distributron Pipe(s)
Length Dra Spacrng
x Hole Srze x Hole Spacing Vent To Air lntake
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over
Bed / Trench Center
Depth Over
Bed /Trench Edges
xx Depth Of
Topsorl
xx Seeded / Sodded
!Yes DNo
xx Mulched
fl Yes E No
COMMENTSI (lnclude code discrepancies, persons present, etc.)
LOCATION: ERTN PRARIE 06. 30. 17. 884
Plan revision required? [] Yes f] No
Use other side for additional information.
sBD-6710 (R 05/91)Date lnspector's Srgnature Cert No
TANK SETBACK INFORMATION
tr
--
trIILHFI SANITARY PERMIT APPLICATION
ln accord with ILHR 83.05, Wis. Adm. Code
-Attach complete plans (to the county copy only) lor the system, on paper not less than
8%x 11 inches in size.
-See reverse side lor instructions for completing this application.
I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORT,IATION.
COUNTY5t . 6.^. .;
'uYaryr
Check if revision to previous application
STATE PLAN I.D. NUMBER
PROPERW OWNER
O lh--.f R.l*on/e,PROPERW LOCATION
Su yr/€ y.,s L r 20, N, R / 7 Por) w
PROPERW OWNER'S MAILING ADDBESS \ , ,//szs & p*9 GG
LOT #BLOCK #
-'CITY. STATE /
tlhrr P,rlrr'.",*a WL
ZIPCODE
sy0t)
PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
ll. TYPE OF BUlLDll{G: (Check one)State Owned NEAREST ROAD ltAo(_
VILLAGE [,GE prori.
(r-,
1 or 2 Fam. Dwelling-$ of bedrooms
lll. BUILDING USE: (lf buitding type is public, check allthat apply)Olc -./ot7 -9o
1
2
3
4
5
tru
ApUCondo
Assembly Hall
Campground
Church/School
Hotel/Motel
6
7
8
9
Medical Facility/Nursing Home
Merchandise: Sales/Repairs
Mobile Home Park
Off ice/Factory
10
11
12
13
trtrtrtr
Outdoor Recreational Faci I ity
RestauranUBar/Dining
Service Station/Car WashtrOther: Specity
lY. TYPE OF PERtllT: (Check only one in line A. Check line B if applicable)
4r("connection of
Existing System
A) 1.E x"*2. aReplacement 3. E Replacement ofSystem Tank Only
5. E Repair of an
Existing System
B)A Sanitary Permit was previously issued. Permit #Date lssued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental
30 E Specify Typer rffs"epage Bed
rt l) Seepage Trench
13 ! Seepage Pit
14 t-l System-ln-Fill
21 E uound
22 a ln-Ground
Pressure
41 fl Hotai ng Tank
42 Pit Privy
Vault Privy4tl
V!. ABSORPTION SYSTEi,I INFORMATION
. ^r?8*i^T=oEnoposeo (sq. rt.)oelF
2. ABSORP. AREA
REQU!RED (sq. ft.)a1@p
4. LOADING RATE
(Gals/day/sq. ft.)4,7
5. PERC. RATE 6. SYSTEM ELEV 7. FINAL GRADE
ELEVAT!ONt'r,riyryn)
? F"ot Feet ,/7 Feet
v[. TAI{K
INFORTIATION
CAPACITY
in qallons Total
Gallons
#ol
Tanks Manufacturer's Name Prefab.
Concrete
Site
Con-
structed
Steel Fiber-
glass Plastic Exper
AppNew
Tanks
Existing
Tanks
Seotic Tank or Holdino Tank X ,/oza I
Lift Pump TanUSiphon Chamber
V!II. RESPONSIBILITY STATEMENT
l, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's NaflIF{(nt):
O^Lr,#^r e-rs :I^'
Plumber's Si (No Stamps)tOlupnsw No.:
l5 _63
Business Phone Number:
( 7/r l?/6 -9/3-9
/ %7 /P g! ,+rr,*- A)r4 fl p'1r,-*rl /LO - s fot l
rx. CBUNWTDEPARTMENT USE ONLY I
Xr*o,"0
EE Disapproved
Owner Given lnitial
Adverse Determinalion
Surcharge Fee)
ng (No
X. COIIIDITIONS OF APPROVAL,REASONS FOR DISAPPROVAL:
SBD6398 (formerly Plb{7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Salety & Buildings Division, Owner, Plumber
Other
n L]n
I
1
2
3
4
5
b
INSTRUCTIONS
A sanitary'permit is valid ror two (2) years.
Your sanitary permit may be renewed betore lhe expiration dale, and at the linre of renewal airy new
criteria in the Wiscorisin Administrative Code wrll be applicab!e.
All revisrons to this pernrit musl be approvej by lhij peri.I!it issuiog authcritv
Changes in cwnership or plumber requircs a Ssnitary Eermit l-ransk.! /llen(,\..iti Fc:'m iSFO 63!9t :o :tr
submjrted to the co,.rrt! p!'iur to rnstallation.
Orrsiti -ewa..le sy::yrrrs ItrLlsl bir p.tlp-.r,r'r,r,,',:l iE.c -!tc:' .l.J lco-r-) mi.t t..: it,::.:):C b) - r'..:,:,: '.-t
pumper whenever recessi.jry, usually every 2 to 3 year:
It you have questions concerning your onsite sewe:je syste'rr, contacl your local code edm,,:islrator or the
State of Wisconsin, Safety & Buildings Division, 608-26G3815.
To be complete and.accurate this sanitary permit applicf,tion rnust include
Property owner's name and mailing address. Provide th€ legal description and parcel tax number(s) of
where the system is to.be installed..
Type ot building being servad. Ctretl oniy one and complete # of bedrcorns iI 1 or 2 Famrly Dweil.ng.
Building use. lt building type is Public, check all appropriate boxes that apply.
Type ot permit. Check only one in line A. Complete line B il pernrit is for tank replacement, reconnection, or
repair.
Type of system Check appropriate box depending on syslem t).-pe
Absorpticrr systcm rnlarrna1i.n. Pfcvide all informri;gn re.iuest:J-.' ,'r #,1 7
Tank;r,furiiratron i:iii i,-, lne .apa,'lyat e\ilT':,!ievr ;..Jjor ir..-' ' .r :.i li,:: ..-, 't j ions ,'.,r,i,c.,'l
tanksann i.,arnUiactUrf'r I na:rr,. 'n6,,'rtn prt:f,rl' oi :;,it),,,rr!\l'Li(l.r,.i rrIr: ir-i,K,.,i-;!,i:rl t.rta..- 'i.- l:,t 'cll
sepi.:c. f,rrnl rSrphcr and l:rl:iLngr.i:r!ks fot !iri:..-.ySte.i,. CIr.:ck ri..-,,:,'i!r'r ' -,1 'itat:ir2:!.it I1.,;: r?(;r.,i\,,,,r
exp€.rrliellal p' o.i:"j,r.t enp,rival II(jm Ol{-hR
ReSponsihlii!y Slai?!'i!ent lrrslallii,ir plttmt'er rs i,' :ili it! .1 ,r\,.. r!,'!ii :: ri ,1.r: . $,rth ar'.Jr,)i:'i::,.. ,'.dil e g
MP, etc.) address an,J ijiJnc number. Pluinber l1'trrir sigr .rf ;)iii:irt,r, ;r r.n.
CountylDepartmcnt Use Only
County/Degsrtment UsP Only
.
t
VI
vti
v i
tx
X
Conrp,ere l;lan.., at!i .ipe.jili:aiil)r: clsm;:!ler thi:lri ij': r 1j !rr.:l'.{i.r.,-,r5{.r:i)l!.rl,..,ilnrhe,..,,illv Tt,..
pilrls n:i,.i !rlci,-,.ir? j!,c fr!low.,. I i)lol il i^. :lr,ir,' 'ii i,- 1i, :' .'irl t.l,::, i, , , 1:.:r i,ri r'i.',.: /-ri
SIlean15an!i|a..,q..lUln.,(,l(il]i|,\.,idnkS,'jis|',llt,i,,,:r]l'}i.i.l,l'ri,,;''.,.,.
ai.:.ai ,l .i ;lte:)ajr: :.:n (rf .',r lji.l' ltg S.--..r.' I :r: f.(j.i.., ii."';, ..,.jit..ri t!' :ti - .t,.r,"..-r, i-'-
C) oonr;-,iete spe\:iircairi);ri fir,-puil.ps and co!-rlrcis, dose r!iir,,a i,'.rval',;, Li,liere,r{,es.. lr,!liui, .css. uullrp
perfornrance curve: pulnp rrodel and pump manirlarturer, D) cross secf on of the sp{ absorptron sys.tffrtJil
required bi the county; E) so\l test data og a qlslorm; and F).all iiiing informatlcjr*\I' . .. . *\-\
GROUNOWATER STJRCHARGE
'1983 Wisconsin Act 410 included the creation ol JLrrch.rr{ii.i (Iees} lo' o .:rriri:!:," !i
regulated praclrces 1nhich can efeal gi'oundwater.
Tlre nioDies c"lr{rcted ihiou-rJh these s,;'.hargec irl, (r:r!--,i ii)r r,r',,, l(:
waier contanlinaiion inveili,gattons and establishn,efl,-.1 !r.riJ'l;t'-!(
'i :l\ttllr I :r ;irli
sB0-6398 (R.11/88)
7
IUIIE,iI
tI
II
I
Pt**?/c,--,
' S'foi")
L,,1lo- Rt+o-
L
I
elho_t G*ffi,q
l s3y q FO. '6e-
/U,,n fi,r/Adt Q)r
I
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,
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#tr*''fun*----
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6-r rn ?t* Yt''t e
St' C*t-* '
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#a
OI'INER
ADDRESS
AS BUILT SANITARY SYSTEM REPORT
TOT.INSHIP
sT. cRorx couNTY, wrscoNsrN
LOT LOT SIZE
Form STC
sEc. / r gN-R)7 w
SUBDIVI SION
PLAN VIEW
Distances and dlmenslons to meeE requlrements of ILHR 83
SHOI^I EVERYTHING WITHIN l OO FEET OF SYSTEI'I
#lur<
Bn
/69'
BENCHMARK: Desrrlbe the vertlcal reference point usel
ElevatLon of ve tlcal reference point:o I)roposed slope aE site:
lquld ('apaclty: 14Sa
7
8l
{
/o//:
/?
SEPTIC TANK: M rnufacturer
Number of r,lngs used:
Tank Inlet :ilevation: ?),71
From rearest proper
Number of I eet from: well
Tank manhole cover elevatlon:
Tank Outlet Elevatlon:7),53
@
,@ "i'o 9C feet
,/oo . oS
Number of fret from nearest Roadi Front Stde Rear,feet
ty lin Front Slde Re
, bulldlng:
2 reference dimens loirs to Bep!: ! c rank)(Include thls : nformatlon of the CL bove plot plan) (
SF]"- RFYJR.SF SID!
'*"r/
I
PU,IP CHATAER
llanufecturer !Llquld Capaclty:
Pr.op llodel :Prnp/slphon t anufacturer 3
Elevat lon of lnlet:Botton of tank elevatl.on:
Punp off Bt,ltch elevatlon:Gallons per cycle:
AlarE llanufacturer:Alaru Swltch Type:
Number of feet fron neareat property 11ne3 Front,Slde,
Nunber of feet fron well:
Ntrmber of feet from bulldlng:
(Include dlstancea on plot plan).
SOIL ABSORPTION SYSTEM
Puop Slze
On...,O FE.
Bed: f Trench:_
I{1drh:Lengih:Number of Linea:) Area Rrl].r.,l /?-
F111 depth to top of plpe:
Nunber of feet fron neareat property 1lne: Front,stde, @Rear,Or. .;ff-
Nuurber of feet frou well:
Number of feeE from bulldlng:
(Include dlstancea on ploE plan).
SEEPAGE PIT
Slze:Nrnber of Dlts: DlaEeter 3
Llquld depths Botton of seepage plt elevatlon:
Area Bul1t:
2Z
lles alther a drop box
absorbtlon aytems? (Check one).
HOLDING TAI{K
Manufacturer :
or dlstrlbutlon box been used on any of the ebove soll
Capaclty:
Nunber of rlngs used: Blevatlon of bottom of tank:
Elevatlon of lnlet 3
Nrrober of feet from nearest ProPerty llne:
Number of feet from well:
Number of feet fron bulldlng:
Nunber of feet from nearest road:
trront ,Slde,Rear ,Ft ._
Alarn Uanufacturer !
InBpector:
Plumber on Job:
License Nuober:
Dated :
3/84:u1
, DEPARI'MENT OF INDUSTRY,
LABOR & HUMAN RELATIONS
P.O. BOX 7969
INSPECTION REPORT FOR
PRIVATE SEWAGE SYSTEMS
rEkorrrvENTroNAL E aurERNATlvE
D Holding Tank E ln-Ground Pressure E Mound
a
SAFETY & BUILDINGS
DIVISION
BUREAU OF PLUMBING
UIL
AIR INLET
MADISON WI 53707
sEL+, sw%, s 6, T3oN-Rl 7I^I
Town of Erin Prairie
County rrccrr
SEPTIC TANK/HOLDING TANK
DOSING CHAMBER:
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing
or excavation. (lf soil can be rolled into a wire. construction shall cease until
the soil is dry enough to continue.)
TIONAL EM
eleE
D SYSTEM
PRESSUR IZED DISTR IBUTION SYSTEM
ELEVATION AND
DISTRIBUTION
INFORMATION
COMMENTS:
ll
tb
,,PIIS
NT TO T IIE S}{
AIR INL I I0b{
0q)
L/'l
)
Sketch System on
Reverse Side.
Retain in county file for audrt.
(lt atsrg^ed)
State Plan I
INSPECTION DATE
8:3oIt-3-97Route 1 , New Richmoqd,_ l,l_I_14
AOORESS OF PERMIT HOLOER
0L7
NAME OF PERMIT HOLDER
Albert Betterley
ST REF T ELEVFEF. PT. ELEVMAR K (Permanent r porntl OESCRIBE lF OIFFEFIENT
EiililTfTcm Numoe,
I 02801
County
St. CroixCalvin Powers Jr.
Name o
1 s63
Nombe
ElvEs E ruo Dvrs EtrN
PROV IOE O BOVIDED
KING COVERLIOUIO CAPACITY
/0e
TANK OUTLET ELEVTANK INLET ELEV
,go
a<L INE
ROPERTYVENT DIA
4
VENT MATL
CZ E ves
LARM BE F
FEET FROM
NEAREST ?s
ROADBE DOING
D ves B rrro
MANUF ACTURE R BEOOING
E ves E rvo
LIOUIO CAPACITY PUMP MODE L PUMP/SIPHON MANUF ACTTJRE R WARNING LAEEL
PROV rOEO
LOCKING COVER
ROV IOE O
Dves Druo E ves NO
GALLONS PER CYCLE:
(DIFFERENCE BETWEEN
PUMP ON AtlD OFF)
PUMP ANO CONTROLS OPEFIATIONAL
E ves E rvo
NUMBER OF
FEET FROMNEAREST4
PROPE R T Y
LINE
W€LL EUIL DIN(;N
AIR INLE T
FORCE
MAIN
LEN(ITH DIAMT TE f]RIAL AND MARKIN(;
LI UI
DEPTTI
IN:iIDE OIANO OF
TRENCHES
OISTR PIPE SPACING(r'*ATERIAL PITBED/TRENCH
DIMENSIONS
ENG TH
))l'
WIDTHioI .L-
EUrLOlN(;
JUP8
PROPE FI TY
L INE
W€LL
D/A
NUMBER OF
FEET FROMNEAREST-+L,, *
GRAVEL DEPTH
8E LOW PIPES VE COVER
L
b ?b,Q
EL€V ENDELEV INLEI
t)I
I
bISI RrYNO
PIP
Mound site plowed perpendicular to slope
and f urrows thrown upslope:
Check the texture of the fill material for
mound systems to make certain that it
meets the criteria for medium sand.
PROVIDE A DIAGRAM OF SYSTEM
ON REVERSE S!DE. SHOW ELEVA.
TIONS MEASURED.
D ves Eruo
TEXTURE PER AN S VATIoN WT LI.S
E ves E rrro E Yes I rrro
OEPTH OVER TRENCH'8EO
CENTEF
OEPTH OVER TRENCH/8EO
E DGES
OEPTH OF TOPSOIL r DDE D
Eves Eruo
SE t)I)ULCHT I]
Eves flruo E ves [-J rvo
FILL OEPTH ABOVE COVTII
l*'o"
BED/TRENCH
DIMENSIONS
LENGTH NO. OF
TFIENCHES
DISTITIBI/TION PIPE MATTt,IIAI & t\'IAHKIN(i
EL DEPTH AELOW PIPT
PIP€S
TH
IAOISTR. PIPE
ELEV
MANIFOLO
ELEV
PUMP
EL€V
MAN I FOL O
olA
HOLE SIZE SPONDS TO APPRoVT OES
PLANS
D ves D rrro
WELL UIL
E r.ro
NG L L L
NO
toN
D ves D rvo
WE
S NEARE
PROP€RTY
L INENUMBER OF
FEET FROM
DTLHR SBD 6710 (R.01/82)Zoning Administrator
,
)
f-t
I
,)
LA I THAL SPACIN(;
(
t-t
IIln accord with ILHR 83.05, WE. Adm. Code
-Attach complete plam (to the county copy only) lor the system, on paPer not less than
8!4 x 11 inches in size.
-.See r€v€rs€ side lor lmtructiom for completing thls application.
I''TI-'IITIIII]]1IfitrNM m
cour{rY o
/o2
STATE PLAN I.D. NUMBER
YES [ard
PET]TION
FOR VARIANCE
,N,R iPR@ERTY L@ATION
s
OI'rlLEl
.T[IELOTOr'Ir{flTItrIIllTG
,)OR LANDMARKzlrlqtlill<4t?TII;]^IE VILIAGE
Publlc (Specity):3 OBNumber ol Bedrooms il 1 or 2 Family
ffi
lll. PURPTOSE OF APPLICATIOI{: (Ch3ck only ono rn #1. Ch€ck # 2,3 or 4, i' applicsble)
r. a. M te* b.
System
Replacsment c.
System
Replacemento, d.
Septic Tank Only
Reconnectionol e.E Repair ot an
an Existing Systsm Existing Systsm
2.
3.
4.
A Sanitary Permit was previously issu€d. P€rmit #Dalo lssued
-
D
An Existing System has been inspec-ted and soil conditions meet minimum r€quiremonts.
Ths System is shar€d by mor€ tfian one owner/bullding. Attach Common Owne6hip Agr€ement to County Copy.
Ni OF SY3TEI: (chck only on6 ln #l and only on€ ln #2)
1. a. Elconventionat b. E A[ernative c. E Experimental
2- e.System-
ln-Flll
Holding c.E elt eriry
Tank
d vautt Privy e. E uound r. E leP
V. ABSORPTKTI SYSTEII l FORllATlolrl: (check ono)
1 tr-l:|til u.E Trench c. E
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPIION AREA 5. SYSIEI{ EI.EIr'ANON 6. WATER SUPPLY:
p€r nch)(Square Foet):PFOPOSED (Square
2 E Private Joint E Public
vr. TA t(CAPACITY
in oellonB Total
Gallons
#ot
Tanks
taq
Pr6rab.Slle
Con-
slructed
Fiber-
glass
Exp6r.
App.Manulactu16r's Name St6€l PlasticN6w
Tankg
)r*,
L[r
irm
l, the undersigned, a$ume r€spomibility ior imtalla on ol the private sewago system shown on tho atlach€d plans.
Plumtrar'a IEmffijTlll
* /<'/"
Bualnara Phong Numberi
:l :l 5
csT #
,s--r--<:< /
T3
Oisapprovld
Owner Glwn lnltlrl
Adv.tu fl.t rmln.tl^n 4)
l$uing Ag6nt Signaturo (No Stamp8)
W.A4*,
?lar., ao4t'o,td. q W 3. (l.llv''..1,ffi
.i 1(..l
/e?er?
SBO{ls (foim.rly Plb{7) (8. (BrEO) DlgTRlBUn(}l{: O.iglnal io Counly, One Copy To: Bureau ol Plumblng, otlnor, Plumbo,
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 belore the expiration date, and at the time ol renewal any new
criteria in the Wisconsin Administrative Code will be applicable;3. All revisions to this permit must be approved by lhe permit issuing authority. A new permit may be needed
i, there is a change in your building plans, system location, estimated wastewater llow (number ol bed-
rooms, etc.), depth ot system, or type ol system;4. Changes in ownership or plumber requires a Sanitary Permit Transler/Renewal Form (SBD 6399) to be
submitted to the county prior to installation;5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a ticonsed
puniper whenever necessary, usually dvery 2 to 3 years;
6. ll you have questions concerning your private sewage system, contact your local code administrator or the
State o, Wisconsin, Bureau ot Plumbing, 60&26&3815.
To be complete and accurate this sanitary permil application must include:
L Property owner's name and mailing address. Provide the legal description vyhere the system is to be
installed;ll. Type oI building or use served: It public is checked, indicate type ol use (i.e. 1O unit apartment,30 seat
restaurant, etc.). Fill in number ol bedrooms il building is a one or two lamily dwelling:lll. Purpose ol application: Check only one in #1. Complete #2 il permit is tor tank replacement, reconnection or
rcpair;
lV. Type ol syslem: check all appropriate boxes depending on system type. Ch€ck experimental only it project
is in conjunction with University of Wisconsin;V. Absorption system inlormation: Provide all inlormation rgquested in #1-6;Vl. Tank inrormation: Fill in the capacity ol every new and/or existing lank, listthe total gallons to be instatled,
number ol tanks and manutacturer's name. lndicate pretab or site constructed and tank material. Complete
lor a//septic, lilt/siphon chamber and holding tanks tor this system. Check experimentat approval only i,
lanks received experimental product approval lrom OILHR;
Vll. Responsibility statement: lnstalling plumber is to lill in name, license number with appropriate prelix (e.9.
MP, etc.), address and phone number. Plumber must sign application lorm. Fill in designer name il
applicable:
Vlll. Soil test information: Certiri€d soil lester's name, certificalion number, address, and phone number.
lX. County/Department Use Only;X. Comment area lor use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8% x 1'l 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, 't983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2 years of steady negotiation and public debate. The groundwater bill
included the creation of surcharges (fees) for a number of regulated practices which
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that
is used in your building is returned to the groundwater through your soil absorption
system or the disposdl site'used by your holding tank pumper.
Ground
Wisco
buried
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground-
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
sBD-6398 (R.03/86)
1
ffilrCth
APPLICATION TOR SA}IITAKT PERHIT
src-100
Thla appllcatlon fom le to be conpleted ln fu1l and algned by the owner(s) of the
propert, belng developed. Any lnadequacles rtl1 0n1y result ln delays of the pernlt
Leauancc. $hould thls developnent be Lntended for resale by owner/contractor, (t'epei
houre")r thcn a aecond form ehould be retalned and completed trhen the property ls
rold end rubEl,tted to thls offlce lrl.th the appropt'late deed recordlng.
Orrnsl of Property hdl
[,ocatlon of Property 5E k 5 d _.1 , Sectton b , T <o N-n /7_U
Tornahlp ,C nln DUto \ )-t€
llelIlng Addrcee /?R )
t4^J
Addrere of Sltc KR I
\2.-l)
Gj..,a<,
Subdlvklqn lloc
I
fr
: ht tlrrubor
Prevlout Orrner of property
Total Slze of Parcel -#r{/e€ I r" $--
Date Parccl rac Created Ps<- t7 x gJrs
Arc all cornerr and lot linee ldentlfiable? X Yee
rr thtr propcrty belng developed for reeale (apec houee) ? _Yes X
volqc );2 7 . and Page Nuurber /db ^" recorded wlth the Reglster of Deeds.
INCLUDE T.IITH THI S ,\PPLICATION THE FOLTOWING:
A tlarrantv Deed rhlch rncludes a Doeument number.volume and paRe number , and the
Seal of the tete r of Deeds. In
No
helpful ro r! to avold delaya of
encer to a Ccrtlfled Survey H"p,
No
addltlon, e cert,ifled survey, tf avarlabre, would be
the revlewing process. rf the deed descrlptlon re[er-
the certlfied survey Map shall also be requlred.
PROPERTY O(I,NER CERT I FI CATI OAJ
I l(tre I co-niL[y thaf. d.tt E t,
hnatsfe-dge; thdt I lwe I anr
\nioamd,Uon 6onn, bg vin-tuCotutl! R,egi-,tten o( Oeedaa,s
crun the pnoposed ai_t.e 6oneat anen-t , to nun wi-th thetyttutr, and the Ectme hat b9lzdt ) oA goettnert No.
bo.st o$mg loual
enLbed i n thLL
6 6
(wel p\QA entl
ice o I the
vhave obtained an
tltuel.Lon o d 6eid
Cowttq R egi,e tel o I
SIGIIATI'RB OT O{NER STGNATURE OF CO-olrNER (rr APPLICAELE)
DATB SI,GNED DATE SIGNED
t_-___-;-. DOCUMENT NO.WARRANTY DEED
ATE BAB OF WISCONSIN FO
THIS SFACE RESERVED FOR RECOROINC OATA
RM 2 - 1082II4082o6i',
Ulir,
A1bert D. Betterley
conveys and rvarrants to....Be.ins.t.rf,r-..V.an.-.Dyk-..&...N.eedham*..-..
.. S-,. C.,-, . . - a. - -Wis con s.i n -.9 o rpor at ion
,,iZ$t;r4{i0 trGls]tfts clftcE
5T. cRolx @., wrr
RoCd. $or Rccord fr{r 2ni
of;lg-ABl t-gu
sl [LB
6T
R€TURN TO
tho following described real estate in ..........St--..Croix.
State of lilisconsin:
Tar Parcel No:
fhat part of the Sortheast QrlarEer (SEL), section six (6), Townstrip Thirt!, (30) l.Iorth,
Range Seventeen (17) West descri.bed as follors: @irurilg at a point on the South 1i-re
of said Southeast OrarEer (@) South 88" 00' 59tr L'ibst, 573.58 feet frcrn the SoutlEast
correr thereof; thence North 0o 00r 01" IEst, 258.13 feet; thence North 6o 41' 10" IGst,
202.04 fet':, thence l.Iorth l5o 46' 53" I{est, 333.37 feet, t}rence North 11o 56' 15" west,
220.58 feeq tllence South 75o 50' 49r [Gst, 517.48 feet; t]rence South 3o 50' 58" I€st,
2L4.27 fe1c; thenc€ south 66o 45' 45'' !,lest, 362.22 fe1ci thence Scuth 85'21' 39t' West,
65.00 feet to tie centerlirp of the Willcm Riveri therrce with said centerlire of the
Willq.r Ri'rzer to the lEst line of the Sortheast AuarteI (S*) ; ttence South along tlte West
line of said Southeast Quarler (Sft) to the Sdrth line thereof; ttEnce East along said
South lhe to tle Point of Beginning.
1'RA}I sk5&
$j L .0Tl
rEE
This --.is..nol-.----.--- homestead property.
(is) (is not)
Exception to warranties:
Dated this 2Brh day of .De.qembe-r -., 19..85.
_- (sEAL)( SEAL)
,,, Albert D. Betterle
( SEAL ). (SEAL)
County,
December""-'81'6ci 19rt D. Bett er Ie
ss.
this 28rh day of
B5 - the above named
t
+I
AUTIIENTICATION
Signature(s)
a
TITLE: MEMBER STATE BAB OF WISCONSIN
(rf
a bv $ 706.06, I[is. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Reinstra, Van Dyk & Needham, S. C.'Ac rneys a aw
. New- -.Ri-chmond r. -.Wis con.si rr. - - - - 5 4 O-I 7 -=- O I 2 7
(Signatures may be authenticatcd or acknowledged. Both
are not necessary.)
ACIINOWLEDGMENT
STATE OF WISCOI,ISII.I
- . - -9- -t-
=
- . . -9.f 9-l- I- - - - -. - . - - . - - co u n tv.
Personally carne before me
t:o
...
.t:-
. r,) l: r', '.. :
't ..'
. '\ ; i--'
.t;
to me own to be the person who execut{d the <1
g ins th -same. lf , -
4()3 ,:)
-:-------- -r,-------
2f - G.T ya L. Glaser
Notary Public - -. -. S-t^- - -Cr.o ix - - - - - - -- - - - - - - - Coilntt, Wip:'' .
My Commission is permanent. (If not, statc expiration
date:
l\o-J
il
!)
.Nemer ol pereonr algniagl in any crprcity ahould be typed or printed below their si8inaturea
r aArta
-l
I
I
FE EN iAD AD U'TCAAIICII?
, DEPARTMENT.OF
INDUSTBY,
LABOR AND
HUMAN,RELATIONS
REPORT ON SOIL BORINGS AND
P E RC?I#iPTI,JF-P,Tf ( 1 1 5)
SAFETY & BUILDINGS
DIVISION
P.O. BOX 7969
MADISON, WI 53707
N LK.SUBD NAME
r{/R (oE
ITYIPM
N
/
D
FResidence
NO. BEDRTV}S.
.T 8ru"* Eneptace
USE
STC 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
DATES OBSERVATIONS MADE
PROFILE DESCRIPTlONS
8',13- P7
PERCOLATION TESTS
,?- /i-&?
Fire Number
7, LP s/o)7
R(7
H
-za
Fl
t-t*
H
Hoz
(,
H
tr,OWNER/BUYER
ROUI'E / BOX NUMBER
C ITY/ STATE d^r^ry^D UJk)
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester
DTLHR-SBD-6395 lR.O2l82l - OVER -
il/ft
pRopERTy LOCATTOx: 2E r<, 4__\, Secr ion (o,
Town of E.r^?nn,r,r(-. )
-3O
Subd lvis lon ,u 1*Lo t numb er AJ
7
Improper use and malntenance of your sepric system could result in
its premature fallure to handle wastes. Proper maintenance con-
slsts of pumplng out the septic tank every Ehree years or sooner,
1f needed, by a llcensed septic Eank pumper. What you put into
the sysEem can af fect the funcElon of tl.re sepEic tank as a treat-
menE stage 1n the waste disposal syst,em.
St. Crolx CounEy resldenEs may be ellgible t,r-r
a maximum of 607" of the cost of replacement of
which h,as 1n operatlon prior to July 1, 1978.
accepted thls program 1n August of 1980, wlrh
o$rners of all new systems a gree to keep their
maintalned.
The property ou/ner agrees to submit to Sr. Croix County Zoning a
cerriflcation form, slgned by the owner and by a master plumber,
journeyman plumber, restrlcted plumber or a licensed pumper veri-
fying ttrat (1) Ehe on-slte wastewaEer disposal system is in proper
operatlng conditlon and (2) after inspecti.on and pumping (if nec-
essary), the sepElc'rank is less than L/3 fu11 of sludge and scum.
CertlflcaElon form w111 be senE approximately 30 days prior to
three year explra[1on.
I/WE, the understgned, have read the above requiremenEs and agree
to malntaln the privaEe seLrage dlsposal system in accordance with
the standards seE forEh, hereinr ds set by the Wisconsin Depart-
ment of Natural Resources. Cert 1ficat ion form must be completed
and reEurned Eo the St. Croix CounEy Zoning Of f i.-ce wiEhin 30 days
of the Ehree year explration date.
\TCNED
D A'I' E
St. Croix County Zoalng Office
P. O. Box 98
Hammond, WI 54015
7 L5-7 96-223tt or 7L5-425-8363
Sign, date and reEurn Eo above addres s .
T N
St. Croix CounEy,
receivc a gralr[ [or
a failing system,
St. Croix County
Ehe requiremenE thaE
syst.ems properly
>Jo
a-,z
U)
r4a
H
FO
/,> -)r - F7
v
I
t^l
,rflrr7
82/ 'a 7,/
6'ei
tb/
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F
tl/
cz-s/ Psr44
7 /a le -aF-Q/
7.u",7.,, /
Ltey's
o*8
,r4F '-7y ,rW 7t/:// ,)//// faf/.5/ f
/,C *rf/ao/ _rrrr/ ?E /rS.
,i/2 =, tT^, t?/ ?2/e o-zr
\
'7 "/'W
tl.rrry/ n17V
fv t t/ /yvo5at' y a zi/V rv{V "25'-
4'"**'% n',f
dTzTrzg ,;{f ,
a
t.osS
//r,* fi,/,,Li/t
,/t, {r,.*,r![,,
Frorh Alr lnlrlr And 0bscrvollon pipr
Approvod Vrnr Cog
lllnlmun lA'Abovr
Fln od.
2o - q2" Abovr ptpr 4'Corl lron
Vonl PlprTo Flnol Grodt
tlorrh Ho, Or S ynl hrl lc Covrrlng
APPF.cvED S,iyTltErrc covEtr
-/4ATER1AL
cR g" oF srR Av/
oR frlARSlr HA:
S*.l,D11 oC AB.o Sy:Ie.,1 T
Olrtr lbutlon
Plp r
rtn 2" A gg..got.
Ovor Plgt
6'Aggrtgotr
Etnroth Plgr
_ T..
Prrlorolrd plpr Bolor
Cogllng formlnorlng At
Botlom Ol Syrtrm
c't( D F,^.-l
t I c..l .-
2" oF A66g EGAIE
ELE v. oFKS-FEET.-
Pn, p .ir"cl<
I rorr t
DISTRIBUTI.)U PIPE TO DF- AT LEAST IUC HES BELO\^/ ORIGIUAL GRAOEAUIJ AT LEAST20 INCHES BUT KIO AORE, THAN L{2 INCHES AELOW FI].JAL GF.AOE.
nAImUr4 PePrH OF EXcAyAfro;3 FRo/,t oRr6w{r 6RADE wrLL BE
ruillnufi 9'€? nt oF EXcAVAftoN FAotr. 0('6rNAu 6Rnpf wruu BE
SrGuEo:
LIC E U SI. [JU/^ABE R:
IUCHES
INCHE S
'
i
l
_l
I o
DISTRIBU-TIOI.I PIPE
SOIL F ILL
't?Ym,6'*';'alAGGREGATE
.:l?
DATE:/o tr7
110
-"I
l
PAGE OF
-
-----)
I
(
re
e/e-/D/7-8o
(r-l
sTc 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
db-a'
owNER/BUYER 6o-# *l -,
S c,\ROUTE/BOX NUMBER
CITY/STATE
d
7
b FIRE NO._s3t(
ztp Sy o/f
PROPERTY LOCATI 0N : S u:f Z I
Town of
n b , rlou, n [Y rr,
E St. Croix County,
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 SBPTIC TAIIK PtI{PER.
tJhat 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 t{AI be eligible to receive a grant for a l{AXII{tl{ of
$3000 of the cost of replacement of a failing system, which was in operationprior to JuIy 1, 1978. St. Croix County accepted this program in August of
1980, with the requirement that owners of Att NBf SYSTB}IS agree to keep their
systems properly maintained.
The property olrner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master plumber, )ourneynan plumber,
restricted plumber or a licensed pumper verifying that ( 1 ) the on-site
wastewater disposal system is in proper operating condition and (21 after
inspection and pumping ( if necessaryl, the septic tank is less than L/3 full of
sludge and scum. Certification form wiII be sent approxirnately 30 days prior to
three year expiration.
I/t{8, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance with the standards set forth,
herein, as set by the Wisconsin Department of Natural Resources. Certification
form must be completed and reLurned to the St.Croix County Zoning 0ffice within
30 days of the three year expiration date.
S I GNED
DATE 2-
St. Croix County Zoning 0ffice
P.0. Box 98
Hammond, WI 5{015
( 715 ) 79 5-2239 or ( 715 I 425-8353
Sign, Date, and Return to above address
S
\a
4/r .Sectr$ rQ.-f \
t ta
APPTICATION FOR SANITARY PERMIT
src 100
This application form is to be completed in fuII 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.
Oyner of property c,\ b*F\ B"-t\o&.r
Location of propert, S ur f/n St^r t/{, Section t@ r 3 O N-n-l-Yw
Townsh ip
Mailing address
f\
Address of s ite So-v\,--a--
6-L
Subdivision name N Ir+
Lot number ru IA
Previous owner of property
Total size of parcel $(- C\c
Date parcel was created IC\ K TA
Are all corners and lot Iines identifiable?
Is this property being developed for resale
Y Yes No
( spec house ) ? Yes Y uo
Volume 7 3..1 ana Page Number 39,1 "" recorded with the Register of Deeds.
INCTUDE WITH THIS APPTICATION THE FOLLOWING:
A UARRAIITY DEED which includes a DOCI I{ENT Nt I{BBR, V0tt tlE AllD PAGE NLrl{BER, and
the SEAI OF THE REGISTER 0F 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 Hap, the Certified Survey
Map shall also be required.
PROPERTY OSINER CERTIFICATION
I(Ue) 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 corded in the Office of
and that I (We)the County Register of Deeds as Document No.o
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 unty Reg ister of Deeds r ds Document No.).
sig na ure of Owner Signature of Co-0wner (If Applicable)
Date o fs gnature Date of Signature
/
DOCUMENT NO w diiANrY DEE
IT
li THIS SPACE RESERVEO FOR RECORDING OATA
D
Anita T
Ari i ta"'T
qorzos];;|??'oT'* iv 'i'
$If; 3,fi: : .
rlr*e r lY .$'ri .r-Tffilsn$rl i
IIEGISIfrt CMCE
6Tr CFII @', WIL
Roc'd fs Recor6 lf it 2-nd
Y Jan D. 1996
o 8:30 A
of
conveys and rvarrants to Albert D. Be !!.er.}ev
the following described reai estate iti
State of Wisconsin:
S fl:"'Ctoi x
Tar Parcel No:
lhat rrart of the southeast qrarter (sEJr),-section six (5), TcrdnshiP lrhirEy (30) North,
n ng"-Grr.rri*r't (17) lcsi aEscrj-bea as follo'rs: Beginning-at-a -poi"! on the South fine
of said Soutleast O,r"rt i iSSti -S""tL 88o 0O' 59" S6st, Sig.Sg feet frcrn the Southeast
corner tlpreof; thence Nortf, d; Ogt O1r' Idest, 258.13 feeq thence 1dort'h,6o 41r 10" !'lest '
202.04 f*Li tfrence porth- ii" ae ' 53rt $trest, 333.37 feet, thence North 11' 56' 16" Irest'
22.0.58 feet; ttrence souttr 75o 50' 49" West, 517.48 feeti thence south 3" 50r 58" !{Iest-,
214.2L feti thence Sout-h 6io 45, 45" West, 362.22 f*"1- thence Sorth 85o 21' 39n West,
55.00 feet to the centeiline of the $Iitlovr River; thence w'ith said centerl.jre of the
Willcr.r River to tfie llbst fine of the Southeast C\rarter (SEk); ,tience Scnrth along the I'Eest
lj]le of saiil southeast q.larter (sEli) to the South line thereof; thence East along said
Sout-h line to the Point of Beginning.
st Orarter (SEk of S!{k) , Section Six
(17) !,i€st, Iying South of ttre Willot^r
County,
That part of the Southeast Quarter of the Souttrse
(6) , To,vnship Ttrirty (30) North, Falge seventeen
River, D(CE[{I the West 508'02 feet thereof .lL'{5,i,,
t
luv
4
This ....is not homestead propertY.
(is) (is not)
Exception to warranties:
27ill day of -..NovernberDated this .
, 19..9.5
ss.
( SEAL )
. (sEAL)
ti * C,,*fn- Trar'tlr*t
,, Ani ta Turnharm
.. (SEAL)
-.. (SEAL)
+*
AUTEENTICATION ACKNOWT,EDGMENT
STATE OF WISCONSIN
?. !.:...9f 9..+.f ... ... -- - -- - -- -countv.
Signature (s)
authenticated this .---.---day of----'------ ', 19"""PerqonallY came bef
Novembe r
An a Turn EIIn r
ore me this
_-_--. 19-aka Ani
..?.7.Y.}-.-..day or
the above namedta Turham,
TITI,E: MEMBER STATE BAR OF WISCONSIN
If not,
by $ ?06.06, Wis. Stats.)a'uthorized
-'f of iiidi'Iy'-'k hown as An 'i'I ta getterl
1.,, e
to me to be the Person -----.--- *J-r'oJ ex
fo instrument edge thg s 0()4 a
9vtI
t.
th6)
THIS INSTRUMENT WAS DRAFTED BY
Re inil;a,'- Van DYk & Needham, S ' C '&
* Tan L. Glaser {r?Sa. croix Coup
on is permanen t. (If not, state ex
$
'Attorneys-"at-
New Richmond
"Laol"-"
. wisconsin 540I7-0L271-----..-----Notary Public -..
--;'J:-{1,
l[r^Y'itMy Comm
date:
(signatures may be authenticated or acknowledged. Both
are-not necessarY.)
issi!:
ll rNrmec ol perrona rlgnius ln eny capocity rhould be typed or printed below their aisnatures'
ti
Ct-
ItrDIIeftkrCqrrq'tr\:'I,
STATB BAR OT s'laCONgIN
F'ORld No' t- letz
AL
RETURN TO
.)
BEARINGS REFERENCED TO THE EAST LINE OF THE IEI/A OF
SECTION 32 ( WEST LINE 0F THE tllll/4 0F SECTTON 33 ),
ASSUMED TO BEAR SOOOT5O8"H.
IHE I{ISCOhEIN IEPARTIENT OF TRAI\ISPMTATIOI{ HAS GHANTED A SPECIAL
rxcEpfioH io rmlus aag ron oNE ( 1 ) AccESS To S.T.H. €4'. AmIJIoML LAID
OtVrsroHS, ormm IN LAND t.EE OR FUTI-E HIGIi{AY PRo.ECT (S)_i!AY FEoUIE
A PLBLIC ROAD INTERSECTIO.I OR RELOCATIOT.I OF THE DRIVEI{AY TO AN
IITTRTIITTVE Pt-BLIC MAD AT TTE DISCRETION G T}f TEPARTI€NT.
NE CORNER, SECTION 32( ESTABLISHED FHS,I
TIES OF BECORD )
UNPLAflED I-ANDS
N1/4 COFhTER, SECTION 32( ESTABLISFED FROM
IIES OF RECOHD )
NffiTH LINE OF THE NE 1/ 4 OF SECTION 32
I
CERTIFIED SURVEY MAP
LOCATED IN THE NEL/A OF THE NE1/4 OF SECTION 32
ef EEeT'gll A* T31N, R15hl, ToWN oF FoHEST. ST. CHoIX CoUNTY, I4ISCoNSIN.
o|{NEBS / SUBpIVTDEFS
GIFY & FEANCES HEII.EUCH
7@5976_
YOL 17 PAGE 4443
KATflEEEf, II. YIf,ST-
BEIiISTER OF DEEDSsf. cRolx co., II
RECEIYED FOR RECORDOl/ L5/2OO3 O9:3DAll
REC FEE: 13. OO
C0PY FEE: 3. Oe
2929 STATE ROAD "64"
EITIERALO. WT. 54012
N1/4 COBNEF, SECTION 33
ESTAE_ISHEO FROT,{
TIES OF RECORD )
UNPLAIEq tArlDS
NI{ COHhEH. SECTION 33( ESTABLISFIED FROM
I TrES OF RECORo )
OF
OF
EASEMENT DES(FJBEJ
IN VOLUME ?qN__,PAGEIL-L1I5:r - _
i=
l
-N-
I
SURVEYM FOR
=MATTHEW & STEPI-IANIE SINA
1885 C.T.H. "0"
GLEN}{OOD CITY. I{I. 54013
SIATE TRUNK 7-
EIuJlaFat
Ero
@r
Gtl66'
NOTE: WlD O.T.
CO!EI'IANTS
SIGNED BY THE
HEINBUCHS STATE
TTIAT ONLY THE
EXISTING CHURCH,
LOT I OF THIS MAP
ANDoNE(1)
ADDITIOMT
RESIDENCE MAY
USE THIS ACCESS.
AI.{Y FURTHER
SUBDMISION OF
THE REMAINING
HEINB(rcH PARCEL
MAY MAKE THE
ACCESS EASEMENT
SHO\^N HEREON
SUBJECT TO ROAD
STANDARDS OF ST.
u9e Fcr lr;
#
NE COBi.ER,
SECTION 32
s.T.H, '64'
CROIX COUNTY.sie niFroAVff oF
o
51'11"1{ 747 .10
IINPWIED t-AllDl
I.EGEND
- IhDICATES SECTIoiI CotrlER
MCNWENT ( AS hDTED )
INOICATES I' X 18' ( OUTSIE
DIAIETER ) IMN PIPE I{EIGHIIS
1.13 LBS. / LINEAB Fo(]T SET.
N890 51
14'16'E
266158'
X SEE "DET
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T7' sr[rE (r Hrsco\EIN Hrct{l y 717 '8,2
1OO' BUILDING SETBACK LINE FRO},I F
57A,277 SOUARE FEET ( 11.898 ACFES )
INO-UDING ACCESS EASEMENT :
480,075 SGUARE FEET ( 11.021 ACRES )
EXCLUDING ACCESS EASEMENT
33.00
LOT T
66.00'
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ACCESS RESTRICTED
* SEE NOTE
777.8,2',33.00's3.005'
L
+
u ?130P 606 7@BA5 1
I{ATHLEE}I H. IALSH
BEGISTEB OF DEEDSsT. cRoIX CO., rI
RECEIVED FOB BECORD
OU$UZAO3 lt rleAi
EIMT I
t1
!
REC FEE:
TRAIIS FEE:
COPY FEE:
CERT COPYPAGES: 2
t3.oo
FEE:AffiDAWT OFCORRECNON
AFFIANT, Joseph W. Granbwg, hereby
sluoars or affirms trat a oertdn fuiment recordod on tE
15h day of January, 2003
in volume 17 page 4'113 recorded
as dosment number 705876
wtridr was recorded in St Croix , Comty, State
of Wisoonsin, contained tre following enor:
At tre Decgmber 17tr 2002 St. Croix Carnty Planing, Zoning and Paks Committee meeting he above
mentioned Certified Survey Map was approvd with h€ condition that a 100' sehack line be placed parallel
witr he 66' wide Accass Eamment as droryn on sairi Cortlfi€d Survey M4. After frJrftor review at he
January 28rh St. Croix Planning, Zmirq ad Paks Cornnrittee nneting tre boad agrd to remove his
setbaci ftom the property wittrthe mndilion that tre NOTE regarding lhe access easement be anrended to
read as follows: The a@ess Easement as Srown ircross tre East side of Lot 1 is rn€ant as a sinole future
residential accoss to trose lands Soutr of Lot 1. Wl D.O.T oovenarts signed by tre Heinbudrs state hat
only the exisling cfiurdr, Lot 1 of this map and one ( 1 ) addilional resklence may use this access. This
restriction limitstre use of tris acoess to a jclint driveway at a maximum. Any fuhrre development requiring
joint access rtould necessitate trat he acmss b€ fuilt to foint roadnay standards of St. Croix County.'
Appo\,€d ry Sr€ St Croix Comty Zu*ng Offce 0ie ,4 hyd 2003.
AFFIANT is he ( check one ):
I Otrn t of tre docurnent being conect€d.
-
Ovrner of tre property doscribed in the doqlnpnt beirg conected
-
Other (explain
*"36xr-f;rcument ( in part or whole ) K is
-
is not attached to this Affidavit ( if original document is not
aftadred, plem attafi legal desuiplion md nrrns of grertors and
Signed
RlFr- '.ffiffi1'v,t f.-l*rQ t h//: 5q4l 7
)
State of Wisconsin )
SS
)os6p
County of St. Croix ) -*
Subscribed and &vom or ( o ffinned ) befure me tris 4 / q
Oay ol
Notary Public, State of Wisconsin
f\,ly Commission expires e.
This instrument drafted by: Joseph W. Granborg
R.ooZ
,.rr. rt'
2ji
S 1
This instument is not a comeyinoe of red property as per s. n.U ( )
,((
o
/r1.,, ^, u(
U. Graab*J
KnYlnL.e" *- ' ' (. h
lz ln/^
CERTI FI ED S[.J RVEY MAP
THE NEl/
. TOt,'lN OF
AOF SECT ION 32 AND THE
IX COUNTY.
uurt/A oF THE NW1/4
wrscousrx '
TED IN THE NE 1/AOF FORF.ST. Sr. CHO
LOCA roN 33.T3TN.R 15W
OF SE CT
NE 1/40F
,Et'i*h)}'#'
IHE
ION 33
F*iffi'?T'f#TJb
TO THE SECT
INE OF
o51 '08"w
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I
UNLLAI-IED tAt'lDS-
(tFis}'EB'l'fl,32 oN 32
N1 NORTH LINE .6t rsrAtE
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GHAPHIC SCALE
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