HomeMy WebLinkAbout024-1010-40-000 (2)SI'. CITOIX COUNTY ZONING DEPAITTMtrNT'
AS I}UII.T SANITARY RtrPORT .u8J
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rcrtslTank manufac *r"rU,^r\,
Pu*p manufacturer
Alarm location
Date of iustalration 6 /6
Plumberts signature
lM 11000 ,oc
D G N
Setback from: Ho
T N:
t-
,,W?*"il;dod ptgaSize ST/PC
Model fr/a/N
(uoronc TANKs oNLy) ,
Setbacks: Service road ' '' '
Vent to fresh air intake
'f(
77,'l (()
()
Meter location
Alarm location
Tlpe of
Setback
ELEVATIONS:
Description of benchmark
Dascription of alternate b
Distribution Lin", tl I
Bottom of System ( )
g(,Y6 ()
Final Grade ( )
g g,'l 6 ()()
Permit nu*tr.. '3
/r7(;State plan number l,/ 0-
o",.( ff, lTrr
Water Line
of Trenches tVt
Elevatio ' fY'27
Elevation V?, V 6
,,/L
g r
Building Sewer srlHr Inlet trf ,lo ST outlet trY, 0 tr PC Inlet 4
PC Bottom B-Header/tlanifold g (,Top of STIPC Manhole Cover {
,l
8 7,30
8
lnspector
License ou^a"rfu I {r 31
('omplctc plot plan c
Addrcss
\
b\
.t\
i\
tl
a
o-
NOTICtr: Plcasc provide the following:
' A plan view sketch showing cverything within 100 feet of the system.
' Two horizontal reference points to center of septic tank manhole covcr.
. Show alternate benchmark, if applicable.
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AS BUILT FIR HERMAN Hf INBUCK LIT ?SW l/4 of NE L/4 S 7 T AB N R t7 VPteosent Vottey St, Croix
top of cenent wotlhorlzontot reference
etevotlon 98.09
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4pp-Zjusot- 6fl161 11r.,"
,. . Wiscensifi Department of Commerce
Safety and Buitdings Division PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH To PERMIT)
County ST. CROIX
Sanitarv Permit No'315861
State Plan lD No
Parcer'fff8 r r. o 1 o- 4 o- r- o o
Personal information you provice may be used for secondary purposes [Privacy Law , s.15.04 (1Xm)l
Vi e Town o
TANK INFORMATION ELEVATION DATA A98 00249
PL
TANK SETBACK INFORMATION
PUMP / SIPHON INFORMATION
HEINBUCH, HERMAN
rm HO s Name
CST BM Elev :.qff.oy lnsp BM Elev
Qt,oY
BM Description-Tot A- c u*]a
TYPE MAN U FACTU RE R CAPACITY
Sep_tic ,l6caC*w##) 6()D
Aeration
Holding
TANK TOAt a PIL WE LL BLDG
'Ye#&o
Arr lntake {o/o
lvvly
Septic 7 sb'+6b'tl''S?'NA
Dosing
1---
/NA
Aeratio v -- NA
--/Holding\
STATION BS HI F5 ELEV
B"Drllfub,,?r,la q2,u"? *,otr
-ll e
Bldg. Sewer
St/ Ht lnlet t lx /
, srtHt &J$t"1"'r il 1'1,,J,at t*.45
lan tntu,4'4"43 x fi.bb
Dt Bottom /
Header / Man
Dist. Pipe s4 g1 -v/
Bot. System I G.L 16{L
Final Grade ,t t{?tLt
<1,h,*lr*lrhw (m 3L ,4'/b'
1o nJn ^ "ln gl),. t€/t*h.,u-$/,l-Yf 81 sl'@w{nv
Manufacturer De d
PMModel N
TDH 'JYFriction
Loss TDH Ft
Forcemain Lengt Dia Drst. To Well
so SORPTION SYSTEM
DISTRIBUTION SYSTEM s-7'
-BE.D,fiRENCH
afrurrusroNs
width
er-{ 'Lrquid ,ynLength G-r,No. Of Trenches PIT
DIMENSIONS
No. Of Prts lnside Dra
5Y5TEM TO PIL BLDG WELL LAKE / STREAMSETBACK
INFORMATION pe
ste
IrTI b tr,oo o
Mo e Num
Manu
AMBER
CHI NG
Dra _4:
eH a e n
n thLEg
D ron Prpetstrr
Length _q:b'Mrn b /oSDra
eI/
Spacr ng
xHo e Srze Vent To A r lntxHoe Spacrng
ur
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
;"T:i :::' n," n," 9*,' ^ lt,Depth Over
Bed / Trench Edges
xx Depth Of
Topsorl
xx Seeded /Sodded
fl Yes D No
xx Mulched
! Yes fl No
COM M ENTS: (lnclude code discrepancies, persons present, etc.)
LOCATION iii"tiil,l"f iii;'i#J',;:W: a*pu tu *qw^^/,
l,lolr, ,',1( Ur-l Le+^tb) l"'a,tl",-k d'^xzus'1eka3 ' t
,,u^,",f,r**[rk W (%,
", M ruo
Use other side for additional inform/aiion.
tf l,tz a'7-
-l 7 1A 1 lt
ert NosBD-6710 (R.3i97)Date spector's S ure
f clr""*tst-
\%r"r*-
Department of Commerce
SAN ITARY PERM IT APPLICATION
ln accord with ILHR 83.05, Wis. Adm Code
Salety and Buildings Division
201E. Washington Ave.
P.O. Box 7969
Madison, Wl 53707-7969
o Attach complete plans (to the county copy only) for the system, on paper not less
than 8 vz x I I inches in size.
o See reverse sade for instructions for completing this application
The information you provide may be used by other government agency programs
[PrivacyLaw,s. 1s.04(t)(m)1. SAtnO
County
State Sanitarv Perm-D-sLl Check il revision to
t58b/
previous applicat ion
it berm
l.D. Number
ProPert,'1T',JTL* ll ol uboc h si'il^""1/ffi,tis a r 2€, N, R I 7A"@
Prooertv Own-er's Mailino Addressl*Lq Co,ni R^r,A Z Lot Number L Block Number
zi
CrI
City
0 I
Phone Number()subd,vry?i'fryumber 571 Q v g
ll. TYPE OF BUILDING: (check one) [ State Owned {[] Public fl 1 or 2 Family Dwelling - No. of bedrooms a TrNearest Road
n
I a9e
10 tr Outdoor Recreational Facility
1 I fl Restaurant/ Bar I Dining
12 D ServiceStation lCarWash
1E2tr3tr4trsD
Apartment / Condo
Assembly Hall
Campground
Church / School
Hotel / Motel
6 fl Medical Facility/ Nursing Home
7 ! Merchandise: Sales/ Repairs
8 ! Mobile Home Park
9 [ Office/Factory
lll. BUILDING USEI (tf buildingtype rspublc,check allthatappty)
07. eg.17.5lc
13 E Other: specify
lV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
XfiKS"nitary Permit was previously issued. Permit Number /B)
2
mS
tr !rrl
4
em trNewacement 3 Replacement of Reconnection of 5A)t
ExistitemTank Onl
Date lssuedL
ir of an
V. TYPE OF SYSTEM: (Checkonlyone)
Non-Pressurized Distribution Pressurized Distribution
rffi""page Bed 21 flMound
lTZSeepage Trench 22 [ ln-Ground Pressure
13 E Seepage Pit
l4 E System-ln-Fill
Other
4l E Holding Tank
42fJ Pit Privy
43 D Vault Privy
Experimental
30 flSpecify Type
2. Absorp. Area I l. aUsorp. Area I a. loading Rate I
^"jviifq ft ) f,ir;Ttr ft )
|
(G$st.daytsq Irt
I
| 6. System Elev. I
I Bt,'ti ,"".1
5. Perc. Rate
(Min./inch)
--
7. Final Grade
Elevation
K 6,76:sn
VI. ABSORPTION SYSTEM INFORMATION:
Caoacitv
in jalloris Exper
App
VII. TANK
INFORMATION New
Tanks
Existino
Tanks-
Total
Gallons
#of
Tanks Manufacturer's Name Prefab.
Concrete
Srte
Con-
structed
Steel
Fiber-
glass
tr n tr trSeptic Tank or Holding Tank \4 twl A D
tr n tr u D uLrft Pump Tank l5iphon Chamber
VIII. RESPONSIBITITY STATEMENT
l, the undersigned, assume responsibility for installation of the onsite sewage syrtem shown on the attached plans
MP/MPRSW No
tlp (g 37
Business Phone Number:
Tte rV/ 708O
Plum ber's Name: (Print)
BrunDllr, tl*hPr
Plumber's Sionature: (No Stamos)
C.un'l/a,4il1;
Pluhber,sAddress(Street,City,State,Zipeode):^
fv 3517 Co "ur+W;)C. €lroo*t u)t>,?AIT\'t%-lzg3
tx.NTY DEPARTMENT USE ONLY
rovedM,I Disapproved
fJOwner Given lnitial
Adverse Determination
Sanitary Permit p"" (lncludes Groundwater
6ltd%;"rseree)
lssu rng
DITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:,7x. coN
s8D63S (R.11A6)IXSTnBUnOil: Original to County. One copy To: Safety & Buildingr Division, Owner, Plumbcr
Tax Number(s)
o2^q-b-lo -yo-00
tr Ex !ys_t_e!1
G Ia Perlons1 Day
7
Plastrc
EK
Roo.d J Count Road J
f leld to be lnstolted ot 86,46
to be odde volve or slnlllor
to be odded 1000 gotton septlc
top of cenent wott
horlzontol reference
etevotlon t8,08
llne
PLIT PLAN FIR HERMAN HEINBUCK
SV 1,/4 of NE 1/4 S 7 T ?8 N R 17 V
Pteosent Vottey St, Croix
z.En
--{I
-->
?4 by
droin
63
f letd
"6ot4
xlstlnge
h
O 9.+O-b+p x
" -ilX\O +;kEd
!l*
E_E*E
fr a'g'zuo6q.'-
Wisconsin O"ei?bnent of lndusw.
Labor and Hilnan F<)htiors
Division of Salety & Buildirgs
SOIL AND SITE EVALUATION BEPOHT
in accord with ILHFI 83.05, Wis. Adm. Code
Page _ of
Attach complete site plan on paper notlessthan 8 112x11 inches in size. Plan must include, but
not limited to vertical and horizontal relerence point (BM), direction andY" ol slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRTNT ALL INFOHMATION
couMry>f lro
PARCEL I.D. #
02Y-tolo ad
DATEHEVIEWED BY
e
PROPERTY OWNER:
Nevmau Hrt,,L,rl
PROPERTY OWNER':S iIAILING ADDRESSRr L LLOT #BLOCK #SUBD. NAME OR CSM * ^,, N
Vo(on1o7 ?,*l7Y)
CITY, STATE
H aYfifho n ) , ,,r1c ,t \rL,
zlP coDE ii'iiyill',,o t il)DcrrY
f I Co
OWN
o ,
EARESTN RLI.AGE
vrl
ffi New ConsEuction
[ | Replacement
Code derived daily flow
tSEU Besidential/ Number of bedrooms J I 1 Addition to existing buildinp_ .x
I Public or commercial describe .
gpd Recommended design loading rae O '-f b"d,gpilnl-2 I Eench, gpd/n2Td
Absorption area ?equirro?0 0 OA,nz/ fl-wa,,nz lraximum design loadi ngate 0 ,f H,gfin2 !6_tenctt,gpile
Recommended infiltrafion surface elevation(s) ft (as refened to site plan benchmark)
Additional design / site considerations
Parent material Loeqs Flood plain elevation, if applicable ft
S = Suitable for
U = Unsuitable
svstem
loi system
CONVENTIONALIs tru
MOUNDLS DU
IN.GROUND PRESSUREts Du
AT.GRADEEs tru SYSTEM
DS
FILL
U
IN6 HOLDING TANK
ES,^ OU
SOIL DESCRIPTION REPORT
Boring #
Ground
elev.
13'1n
Depth to
limiting
lactor
=?6
Remarks:
Horizon Depth
in.
Dominant Color
Munsell
MoSes
Qu. Sz. Cont Color
Texture Structure
Gr. Sz. Sh.
Crcnsistence Borrcary Roots GPD/ftz
Bed Trendl
1 o-g ,7,5Y( 3 /*
-
si/Lc "lk h{r qs Z+0,9 c I
2 821 or(YlJ <;l LFrlt.thQ q I IP o,r 0.d,
j l?-ya t0 YP elv f I FqLh J-s q r
I lr o.7 0.8
4 't053 to rPllr
-
s €qlLL )-r v
dl o,rl ',0,tr53/{r rft f l:
--
s t {qL[ds /0,7 ior
Boring #
Ground
elev.
49,1 n.
Depth to
limiting
lactorro1t
Remarks:
0'10 q., rfi lt e; I 7 €"i[rn f,'gt IL 0,f o.i)
2 10.1,l0 fl vls (---_s;)AFaLQ ,1.,Fr q:t{i
o.9 i.0.6
3 11-tll L0 Yn 'l /,1 sl 2lott,}+l Q,
v
a r
I tf :o,f O'5
I lt-ril IrY R 7lt j t tqlh )C
IJ
q
r
I t?0,7 o{
r 67:17 rY 613 Ft+ ),xR,tlt S drle o rqin ))
V
-\I I
Signature A$!"*--c,f Date
T Name:-Please Prinl
B 'tf flr 3'xlc>Phone
]I E w0 r'fwSS
/CST Number:
"
i' , t',792*
i::ll r n if]:l.ii: I ll :iiilii:i: lU!:i'ji
$iii , t+tit::'.1 -Gi[,
PROPEHTY OWNER Hevmq,i lttirfuh SOIL DESCBTPTION REPORT
PARCEL I.D.I ATtt-tot0 -jo
Boring #
Palp of
i::::J r ) r$:-tiiii {lfjrRf:,ii .-2s,.'::r'
$*1i:l:i:::::::ii::,::lf
Ground
elev.
1't.l ll.
Depth to
limiting
lactor
72-
Boring #
luri+,nq I f-a i''"r,Remarks
Remarks
Remarks:
,t.V r'o':4
iiii""-.'"'i.::ii::::I i r-:::.;rIiii Z, i,:itz.i: l :r
.ir.i$._...L...iit
t) rt
Gror*,.
,%
1',1i:5li::$:i*+:ilii:
Boring #
Ground
elev.
Tl.',l tt
Depth to
limiting
Ground
elev.
ft.
Depth to
limiting
factor
o,?r t O
GPD/ftzHorizonDepth
in.
Dominant Color
Munsell
' MoUes
Qu. Sz. Cont Color
Texture Structure
Gr. Sz. Sh.
Consistence Bqndry Roots
Bed Trerrfi
t 0-lF 7,frR )[,5/l I € qlt,h €,r Qq cL o,r 0 ,,t
oL lf-rl 0fl( rlt L A(ol,l(n {n 49
(/
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t
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14
t:.I rtla
*i{ !',,Pd
iiii !.::1:
i,::::::-.-.-..1.-.......-)::+
elev
Ground
_lr
Depth to
limiting
lactor
Flemarlts:
sED-8330(R.05n2)
.. . , :1,.,.
I
i_l
Boring #
c,!
\-
J
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h
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or ard Hu.nan l-.!kdors
ir.rn ,.1Saflity & Buildings
sUtL ANU st I h EYALUA I tuN Hh,PORT
r accord with ILHR 83.05, Wis. Adm. Code,
Page / .ot _/.
.ttach co,nploto site plan on papor not loss than B llz x 11 inchos in sizo. Plan must i,ncludo, butnot limited to vertical and horizonlat reforence point (BM). direction and "/" of slope,dimonsioned. north arrow, and location and di stance to noarest road
APPLICANT INFOBMATION-PLEASE PRINT ALL INFORMATTON
SOtL DESCRIPTION REPORT
Boring #
elev.
1l,t tt.
I
Ground
Depth to
limiting,ru
Remarlcs:
COUNTY
S tot
PAffCEL I D f
REVIEWEO BY DATE
l'lcirvrn
PROPERTY OWNER:
ilLrl4,s ? t /( ,N,a 11'1t4GOW. LOT
PROPE
OWbIER' :S l,/Al Ll NG AD D RESSPRry LOT f BLOCK f SUBD. NAME OR CSM f
ZIP CODE
L
CITY, ST
c (?/t)-F
PHONE NUMBER LI.AGE
e
ROADN
rut gpd
Parent material {-,fss Flmd plain elevation, if applicable ft
I J New Construction Use Residential/ Number of bedrooms t I Addition to existi.ng building
J Public or commercialdescribe}( Beplacement
Code derived daily flow
trench, gpd/n2Becommended design bading ratelb *,n O,rr@
Absorption area requir r@bed, ft2 lr00 trench, ft2 lvlaimum design toading rate
-
bed ,gpttP0r6_trench, gpdttr2
Recommended infi ltration surface elevation(s)l,l (as refened to site plan bendrmark)
Additional design / site considerations
S
U
foruitableS
uitableNSU S DU s nu S^XU
PRESSURE
NS
FILL
U
TAI.JK
trS
a,
Horizon ogptn
in.
Dominant Color
Munsell
MoUes
Qu. Sz. ConL.Color .
Texture Structure
Gr. Sz. Sh
Corsistence Bffrhry Roots GPD/ft
Bed Trrrfi
0- t6 -51! )t3 .$',L+
^bh d I qw ?1 O,C
Z t6-29 ,jR, tls 6il L{ nlk )t
V
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J 28-37 tO YR s l,t
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Boring #
Ground
elev.
11I_u
Depth lo
limiting
factor
68-
Rernarks:
CST Name.-Please Prrnt
ress
_Al, LtEy_(-F1u-o
ft+ 3 0,v _21 Ellsv o/t'\ lils t{ot/
Date .
1 I t( 14 t
'1,6S-?l !-5 I th,'t
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5 hr^Lrfo q,l,'l\it )l
tl
rYR' 6 li tln>n^7 ho, ilot +* b,rl ,Jl*1o,r- ,er / waLb t ,^^fr)
EXHIBIT
Signature fi*u ^n^ nl-LrZ-1-Cht An?
o,c
Horizon Depth
in.
Dominant Color
Munsell
M
_arr.S.. /
Texturd
I 0-27 ,YR 1l)CoEbhrbe
Boob
)-11-31 t|fi slt
0,f31-'lL 0 t IIt2 Y?tow 6lc h, f.t vtA0 I Y 6 I Fql
6 601\t0tR 6,16
1 e t{g ?Ilo !fr gl t .,,.
I
PARC EL I.D. '
PROPE RTy owNER lls rja l,lt1,ttN. t ,
Remarks
Remarks:l>or, e is veaL
Bo ng#
Groud
elev.
114 n.
Depth lo
limitng
tactcr(O
Remarks:
Boring #
SOtL [p]19ry BEpORT
PQB-.--
o,
Boring #
Gmund
elev.. Ai.r r
Deplh to
limiling
w_
Boring #
Gmund
ela/.
81lu
o€ph h
lmiling
Yro-
A
lr ?l+
ffi
Ground
elar.f'l.1rt
Deph b,rrilP
4
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fr ?l-7I)LYi ClT v
)o 7742 trut g 13
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S8PTIC TANK MAINTENANCE AGREEMENT
AND
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Parccl ldcutification Number oLt- lo -10 *40 -l0o
propcrry Locarion S W vr,N E y., s*.0- &*-,7*,rown or q
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tt Indudc wt(h rt'1. epptice(ou: r tuqrcd rlnrnaty dccd tlo thc Rcgistcr of Doc& oflioc
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d 9:30.
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NEU4 of Scclio 7-2& l? EXCFPT Fr io villirtr n. Vo&qr td Dcbonh ,- Yolltr h vol' '5!0',
Prtc 417, Doc. No. t7 I 376.
nt ri ,.-, tooc*ra nropcrry.
DrEt thb loli dry of tuly, 1')6.
HERMAN N. HEINBT,rcH
DET.IXES C. HEIXB(rcH
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cllflc t forG mc lhit lfit &y of ht, t995, 6c Solrt HERMAN R. HEINBI,CH Td DELORES C.
HEINBUCH, b DG t[ovn to he thc Dcrrms u,to .rc.rbd Oc rtao*lcd3c tfu trrc.
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TOWN
Section Line.
\
l &r?*ta //sn f/Jur.r
506385
CERTIFIED SURVEY MAP
LocATED rN THE swt oF THE NEt oF sECTroN 7, T28N, R17w,
OF PLEASANT VALLEY I ST ' EROIX COUNTY ' WTSCONSIN.
Prepared for: Ilerman Heinbuch
N
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F O U N D).
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! 20'SHEET I OF
VOLUME 9 PAGE,NSTRUMENT ORAFTEO AY J,W.
2
2689
sEP 3 01993 >
JAITES roNNEtt
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LqGbTilA[f,.tB[rF&$AHTy. VALLEY 7 .ffivllrtttvac E sysTE MLabor.and Human Relations
Safety andlurtdrnss Drvisron INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT).
TANK INFORMATION
TYPE MAN U FACTU RE R CAPACITY
Septic
Dosing
Aeration
Holding
TAN K SETBACK INFORMATION
TANK TO PIL WE LL BLDG Vent to
Arr lntake ROAD
Septic NA
Dosing NA
Aeration NA
Holding
PUMP / SIPHON INFORMATION
Manufacturer Demand
GPMModel Number
TDH Li fr Friction
Loss
Svstem
Head TDH Ft
Forcemain Length Dia.Drst. To Well
SOIL ABSORPTION SYSTEM
ELEVATION DATA A9
TFTNETTII^EI }IIII}T TN D f. TdF
Permit Holder's Name tr City I Village l-l Town ofx
DT ETl.qATI.T TTIT
CSIBM Ele-v.l'msp. BM-Elen 8M Descriptioi-
ounty
na
tate
oPa rce Tax
ELEVB5HIF5STATION
Benchmark
Bldg. Sewer
5t / Ht lnlet
St / Ht Outlet
Dt lnlet
Dt Bottom
Header / Man.
Dist. Pipe
Bot. System
Final Grade
I
BED / TRENCH
DIMENSIONS
width Length No. Of Trenches PIT
DIMENSIONS
No. Of Prts lnside Dra Lrquid Depth
SETBACK
INFORMATION
5Y5TEM TO PIL BLDG WE LL LAKE / STREAM LEACHING
CHAMBER
OR UNIT
MEnuJacturer
Type Of
System:
ModelNumber
DISTRIBUTION SYSTEM
Header / Manifold
Length Dia
Distribution Pipe(s)
Length Dra Spactng
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
Topsoil
xx Seeded / Sodded
IYes ilNo
xx Mulched
fl Yes E No
COMMENTS: (lnclude code discrepancies, persons present, etc.)
I,OCATTON: PLEASANT VALLEY 7 .28 . 17 . 51A [tO frlporJ,'cr.:, /r1/4) 4-{- /",,.'/+
s
bul- Z h-u,r/^ ryt #,r-^ w/ /o0O gil
ihi.+v/bJ fe,,-t T+io'+r/.r-l-wa
iq7 ( /nrtnt*1t'k //^ ,
Plan revision required? ft Yes ! No
Use other side for additional rnformation.
sBD-6710 (R 05/91)Date lnspector's Srgnature Cert No
r-
I(--trITLHFII-ffiCl-@-.ffrml
SANITARY PERMIT APPLICATION
ln accord with ILHR 8i1.05, Wis. Adm. Code
-Attach complete plans (to the county copy only) for the system, on paper not less than
SlLx 11 inches in size.
-See reverse side for instructions for completing this application.
I. APPLICA]IIT INFORTIATION - PLEASE PRINT ALL INFORT,ATION.
COUNTY iC.o
'iru,(R:::,"appca,.nSTA
STATE PLAN I.D. NUMBER
PROPERW OWNER
f l-rma,r 4. inLtr|r :Z"i,7|'fff;:i 7 -'Afl*,* l7n{,fu
PROPERW OWNER'S MAILING AODRESSArJ.t?vfie
LOT#L BLOCK#
1tf,y-t-^rl
CITY. STATE 1 .""Adiior) \)ts
ZIPCODE (7rPHONE .ifrT-rftt sue,VrsronTAfiF'rcs"i1TLf q
,_q /r/ tqq Z
rEzZsE+EsE
t'lo - lo oo),t 10ty
6
7
8
9
trtrtrtr
trtrtr
Owned ?
bedroom {
State
Outdoor Recreational Faci I ityroE
11 RestauranUBar/Dining
Service Station/Car Wash12
13 Other: Specity
P n
II!. BUILDING (lf building type is public, checkgl!that apply)
(Check one)
Public
Medical Faci lity/Nursing Home
Merchandise: Sales/Repairs
Mobile Home Park
Otf ice/Factory
ApUCondo
Assembly Hall
Campground
Church/School
Hotel/Motel
II. TYPE OF BUILDING:
1 or 2 Fam. Dwelling-f of
TYPE OF PER
,.M *"*/ \ystem
B) E n Sanitary Permit was previously issued. Permit #
Existin g System
tv
A)2 tr
Date lssued
Tank Only
Reconnection of
Existing System
s. E Repair of an
MIT: (Check only one in line A. Check line B if applicable)
Replacement 3.
System
E neptacement of +. E
11 E Sr"o.oe Bed
rzfise"p"i" Trench
13 LJ Seepage Pit
14 lJ System-ln-Fill
Other
ar E Hotdino Tank
42 Z Pit Priv-v
€ E Vault PiiryPressure
V. TYPE OF SYSTEII: (Check only one)
Experimental
30 E Specity Type
Non-Pressurized Distribution Pressurized Distribution
21 E uouno
22 Z tn-Ground
3. ABSORP. AREA
PROPOSED (sq. ft.)1r0
5. PERC. RATE
(Min./inch)
-
6. SYSTEM ELEV.
"i;lq Feet
7. FINAL GRADE. ELEVATIONhfr FeetfirAld
REQUI RED (sq. fl.)
ff€hch
VI. ABSORPTION SYSTEM IiIFORUAflON:
2. ABSORP. AREA 4. LOADING RATE
(Gals/day/sq. ft.)
CAPACITY
in gallons Prefab.V!!. TANK
INFORTIATION New
Tanks
Plastic Exper
App.
T
Total
Gallons
#ot
Tanks Manufacturer's Name
Site
Con-
structed
Steel Fiber-
glass
Seotic Tank or Holdino Tank )C t?00 I
Lift Pump TanUSiphon Chamber
,
VIII. RESPONSIBILITY STATEMENT
l, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
MP/MPRSW No.:/a/r37Plumber's Name ffirint): t
R ruce-l] l,l/obrlor
Plumber's Signature: (No SJanpf)
Arr, il, (U/t-Business Phone *":ffJ, l{DJ/r t971
I 0
tX. COUNW'DEPARTMENT USE ONLY
Date lssued
/a-5-r)E Rpprovea
Disapproved
Owner Given lnitial
Adverse Determination
Etr san itary Permit F"" ('S"[f,f$'p::f*",r,
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
-
II r.I
SBD€398 (formerly Plb{7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
t
t-t l-t II IIt-t
tr
--
trIILHFI SANITARY PERMIT APPLICATION
ln accord with ILHR 83.05, Wis. Adm. Code
-Attach complete plans (to the county copy only) for the system, on paper not less than
8%x 11 inches in size.
-See reverse side for instructions for completing this application.
I. APPLICANT INFORMATIOil - PLEASE PRINT ALL INFORTIATION.
COUNTY
Croi
sraiesan[ABY FeRur #lqqQ/{'
K t#. li r#3.,i" previous apptication
STATE PLAN I.D. NUMBER
PROPERW OWNER
'A*r,,.aq fl einbc?PROPERW LOCATION lfr t '1 t-s
-eLrh l.lfu,s ,U,I,N,R i/A&)w/
BLOCK #PROPERTY OWNER'S MAILING ADDRESSftr :L Vol",n l?'13
LOT#L
CITY, STATE ZIP CODE PHONE NUMBER
( )/r | fit-Ef)l
SUBDIVISION
Plrcfrr'
NEARESTROAD
Co, n lr
1
2
3
4
5
6
7
I
I 13 E Other: SpecifyE not"uMotet
trtr
o),{10tb la - 0 00
(Check one)
III. BUILDING (lf building type is public, check all that apply)
State Owned
,"J_Public or 2 Fam. Dwellingrff of bedroo
10
11
12
Outdoor Recreational Facil ity
RestauranUBar/Dining
Service Station/Car Wash
Medical Faci !ity/Nursing Home
Merchandise: Sales/Repairs
Mobile Home Park
Otf ice/Factory
II. TYPE OF BUILDING:
ApUCondo
Assembly Hall
Campground
Church/Schoo!
(Check only one in line A. Check line B if applicable)
2. E Replacement 3. E Replacement of 4. E
B) E n Sanitary Permit was previously issued. Permit #r6f 0
Existin g System
IV. TYPE OF PERMIT:
Date lssued
A) 1.New
System Tank Only
Reconnection of
Existing System
5. E Repair of an
Other
41 E Holding Tank
42 l) Pit Privv
€ E Vault eiivy
Seepage Bed
e Trench
Experimental
30 E Specity Type
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution
21 E Mouno
22 Z tn-Ground
Pressure
't1
12
13
14
3. ABSORP. AREA
PROPOSED (sq. ft.)
-7q0
5. PERC. RATE
(Min./inch)
F+F#
6. SYSTEM ELEV.
?o,f^Fl,{i Feet
EDREQUIR (se"q.)
fa rhforr
VI. ABSORPTION SYSTEM INFORMATION:
7. FINAL GRADE4. LOADING RATE2. ABSORP. AREA
(Gals/daylsq. ft.)fi,4 ELEVATI
Lr;P
ON
Feet
CAPACITY
in gallons Steel Fiber-
glass Plastic Exper
App.
Vll. TAlrlK
INFORTIATION New
Tanks
Existing
Tanks
Total
Gallons
#ot
Tanks Manulacturer's Name Prefab.
Concrete
Site
Con-
structed
Seotic Tank or Holdino Tank X { p00 I ,fq
Lift Pump TanUSiphon Chamber
VII!. RESPONSIBILITY STATEMENT
l, the undersigned, assume responsibility for installation ol the onsite sewage system shown on the attached plans.
MP/MPRSW NO.lffir77Plumber's Name (P4in9: t
Q r uce- l) l,lhbter
Buainess phone *"W l{OJ/r | 97i
Plumber's Signature: (No Stampq)
/gn^* il#,, /i&b
I f14 ()
zipt
x. COUNw/DEPABTME T USE oNLY
Date lssued
/o--f 1lE tpproveo
Disapproved
Owner Given lnitial
Adverse Determination
EE
sanitary Perm it t"" (,S:1.t1flfff"'F:lf *","'lssuing Agent Signature (No Stamps)
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD6398 (formerly Plb€7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Salety & Buildings Division, Owner, Plumber
(.
3GE :
UN NE:lP
CSM
/
Seepage Pit
System-ln-Fill
II ft ntt
(St6erCity, State,
,
Pltrfnber's Addreisfi
,
a e.'
tr
--
EIIL HFI SANITARY PERMIT APPLICATION
ln accord with ILHR 83.05, Wis. Adm. Code
-Attach complete plans (to the county copy only) for the system, on paper not less than
81Ax 11 inches in size.
-See reverse side for instructions for completing this application.
I. APPLICANT II{FORMATION - PLEASE PRINT ALL INFORIIATIOI{.
fi#
to previous application
Croi
ST
rev
srete PLAN r.D. NUMBER
PROPERW OWNER
L) " , hq't lf e in Lrc.t'3l1'tirfl:i 7 r;r,N,R i7x'
PROPERTY
R
OWNER'S MAILI NG ADDRESS1?-A
BLOCK #
f6,ll,*,r fpql\'132-
LOT#
CITY, STATE ZIP CODE PHONE NUMBER
( 7/r | 7?6- qrll suBDrvrsroN NAME 6H csu NUMBER
Plar*,r
1
2
3
4
5
6
7
I
9 rg E Other: Specify
VILLAGE "'^ri'jffi
,l-lr,)u il,0 00I!I. BUILDING U : (lf building type is public, check all that apply)
OF BUI
Public ,T::;::,J-
LD heck(c one)
r Fo2 am Dwe nI
II. TYPE
10
11
12
Outdoor Recreational Facility
RestauranUBar/Dining
Service Station/Car Wash
Medical Faci lity/Nursing Home
Merchandise: Sales/Repairs
Mobile Home Park
Otfice/Factory
ApUCondo
Assembly Hall
Campground
Church/School
Hotel/Motel
B) E n Sanitary Permit was previously issued. Permit #r6f a
Existi ng System
2.
Date lssued
IV. TYPE OF PER
Tank Only
Reconnection of
Existing System
5. E Repair of an
MIT: (Check only one in line A. Check line B if applicable)
o,,A;J[",Replacement 3.
System
E nepacement of o. E
Other
+r E Hotdin g Tank
13
14 tr Seepage Pit
System-ln-Fill
42
43
11
12
Seepage Bed
Trench
Experimental
30 E Specity Type
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution
21 E uouno
22 Z tn-Ground
Pressure
Pit Privy
Vault Privy
3. ABSORP. AREA
PROPOSED (sq. ft.)
1q0
4. LOADTNG RATE
(Gals/day/sq. ft.){),4 (
5. PERC. BATE
(Min./inch)
,--d
7. FINAL GRADE
ELEVAT!ON'lA.t/ Feet
6. SYSTEM ELEV.
Feet
REQUIRED,(sq*f.)
fa rhf t t
VI. ABSORPTION SYSTEM INFORMATION:
2. ABSORP. AREA
"lihCAPACITY
In oallonsVII. TANK
INFORIIATIOil New
Tanks
Existino
Tanks-
Exper
App.
Total
Gallons
#ot
Tanks Manufacturer's Name Prefab.
Concrete
Site
Con-
structed
Stee!Fiber-
glass Plastic
Seotic Tank or Holdino Tank X { 000 I lem )te
Lift Pump TanUSiohon Chamber
VIII. RESPONSIBILITY STATEMENT
!, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
MP/MPRSW No.:fr/fr77Plumber's Name (ffint1: t
R ruce l/ llbbrPr
Plumber's Signature: (No Slampg)
Brr*, il, $1M"4--
Business phone ""Vj l{0J/r t r71
I 0
ress p
IX. COUNW'DEPARTMEilT USE ONLY
Date lssued
/Approved
lssuing Agent Signature (No Stamps)EE Disapproved
Owner Given lnitial
Adverse Determination
lSanitary Permit Fee (lnctu<tes Groundwsterl. Surcharge Fee)
I
I
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
IITI
580-6398 (formerly Plb{7) (R. 11/88) DISTRIBUTION: Original to County, One Gopy To: Safety & Buildings Division, Owner, Plumber
TOWN OF:
trnutrtr
trtrntr
tl
\lr't 1t r
'w,..onr,n
o"ni?urrent of lndustrv.
Labor ard Hrrlnan F<)tstions
Oivision of Safety & Buildirgs
. SOIL AND SITE EVALUATION REPORT
in accord with ILHFI 83.05, Wis. Adm. Code
Page _ of
Attach complete site plan on paper not less than 8 112 x 11 inches in siie. Plan'must include, but
not limited to vertical and horizontal relerence point (BM), direction and"/" ol slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFOHMATION
SOIL DESCRIPTION HEPORT
Boring #
Ground
elev.
? J:-l tt,
Depth lo
limiting
factor-7(
Remarks:
r Cr"/
PARCEL I.D. #
o 7Y - t0l0 a0
OATEREV]EWED BY
e
PROPERTY OWNER:
lrl evmdot ileu[,rst,6U //E,o,J ,2f 17,N,@1t4
PHOPERTY LOCATION
GOW. LOT ,N,R
PROPERTY OWNER.:S MAILING ADDRESSRr L LLOT #BLOCK #",13i)ll':i?l*t ? r 3 N LrJq^A
ffi New Consfiuction Use [,f, Besidential/ Number
[ | Replacement I I Public or commercial
code derived dairy flow '/f 0 nW Recommended design loading ae O ,f ba,gilllnz 0 (-[ench, gpd/ft2
Absorption area rEuir sd?0 0 6A,Xz7 f0 gsndt,nz ila{mum design loadi ngrute 0 ,f H,g@ue !6-uencn,gpdti
Recommended infiltration surface elevation(s) ft (as refened to site plan benchmark)
ZIP CODE
Ir/ ttcc n
Flood plain elevation, if applicable
CITY
P I
ft
/ site consideratlons
)P
(tlHONE
,
N EAREST
hvCo rOWN
of bedrooms J
describe
CIW, STATE
wlrho n
LLAGE
nl
Additional design
Parent material
S = Suitable for system
U = Unsuitable foi system
CONVENTIONALIs tru
MOUNDls nu IN.GROUND PRESSUREXs Du
AT.GRADEXs Du
INe FILL
U
SYSTEM
DS
HOLDING TANKfl s,^ Eu
Horizon Depth
in.
MotUes
Qu. Sz. ConL Color
Texture Structure
Gr. Sz. Sh.
Consistence Bo.rdary Roots GPD/ftz
Bed Trendr
JJ-0-9 ,7,rYR 3li
-
sil Lc ulk th {r qs 2+0,,o,4
Z 821 nr(Vls <;)LhLI rhQ
v
I I tf o,r 0,4,
3 !T,y0 t0 ?P 6 /,t t t PqLh )r q r
I lr o.7 0.8
I 't0t3 to rP tlr
-
s lqlLt )s v
dl 0,1 ioar53/{r rt f ls s t {qIL ds 0 0,7 od
Boring #
Ground
elev.4t.l n.
Depth to
limiting
lactor(?
0'10 ?., Yfi I-s;l 7 Frlit tn f,'gt )tr :0,r i o.t,
2 ,0'ly to fR vls (--.--s;l 2 (alQ ,), cn q;t,{
:
o.9 i|.d
3 2l'Lll r0Yn th I sl 2lobl^/rt Cr
<r/
a rI tf :
o,s^ O6
I It 6l IOY R 7ll --eJ l l:qLt,)c urq,l"0,7 io {
r 6?17 rY 613 il[ ),n^,{lt S ilnle orq;n )s
v
t- I
Signature:
Bemarks:
&t Dale n7i
B 7tf fl l0toT Name;-Please Print Phone:
E]fwr0ss
\
CST Number..
l:l:i:l I fl 3i;:;i;iiii, lDiiiilr :.;.
Dominant Color
Munsell
tiii , tl*t$'i$€":l
GPD/ft2HorizonDepth
in.
Dominant Color
Munsell
' Mo$es
Qu. Sz. Cont Color Texture Structure
Gr. Sz. Sh Consistrance Bordry Roots
Bed Trcrrfi
I 0-lF 7,frK il,s/l I €qtt,ln €,r 4s 2f-o,r o,6
L I f'fr t0rR r/)L 2l ol,lr n ,4.49
(/
2,*0,r 0.6
3 il'rt to'rt f[,t 5 t{ilt,)
II q(
7 t+o,7 o,tr
7 fi-\7 ", r ft{3 s I lrlt ),s
u-g0.7
t
PBOPERTY OWNEB Herw,t- lkit,L,th SOIL DESCRIPTION REPORT
PARCEL.I.D.I O7l-t0t0 -7o
Boring #
Pab
-d
$:'::.'.1t.'.'.'.'.'. .'."]ii:!:.t ar+;::{i:i,ii 1l$:ll:::ll cJaitl
$*iilt::lil:iiii:ili
Ground
elev.
1,t.1 ll.
Depth to
limiling
lactor
_..1
Boring #
c rqto
i::::t i i:*i::ii ZJ i.i::tz.:i I ;ti!i::::l I i:::.j
iiii..,a..'.1.........i:;:t
Remarks:St hri)t"Y t"Q f-, 9)n
q "r
,%
Ground
elev.
D"{ rt
Depth to
limiting
Ground
elev.
It.
Depth to
limiting
factor
Remarks:
Remarks:
c"^eh r.Jhr 0 ,l
Boring #
ON PRTV)WW PFM kr
r'l
Boring #
t.i:{ !:ii,i::, ::s:+lx !!1+
Ground
elev.
,t.
Depth to
limiting
lactor
i
Flsmarks:
sBD.8330(R ,05n21
I
-1
\
," = 40'
lt,
\,/
5
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5063S5
LOCATED IN
OF PLEASANT
CERTIFIED SURVEY MAP
THE StV'a OF THE NEt OF SECTTON 7, T2BN, R17W,
VALLEY, ST. CROTX COUNTY, WISCONSIN.
Prepared for: Ilerman Heinbuch
'\arr./
NOTE : Bear ings are
to the N-S Quarter
( necord bear ing )
TOWN P
re ferenced
Sect i on Line .
:
Ilc- lrvr-l
=1.olo
vr"a
:61
+
NI/4 CORNER SEC,7( COU'!TY MONUMENT
F O U N D).
oo
rr)
ro
b L$'n
0/(- /0lrs- )YofO
.u. N? l-A.TIEq .L,A.N. q 9.
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.';;ahensi', r:
.llt.r:'.!ng :-,: :
lc, i:: Con;r;i:t'i.:,
,f nOt f CC,:,;ried
Itr.i'ii!'l 3O u::',,5 Ol
i:.';' . ".-:',1,::] li,]18
co
*
q
SUllitrt
M. WEBER S.I804
!a- B-a3
iL
33 '33',
33. Oo'
33. OO '
OR IV EWAY EASEMENT
S89o47'27"E 243.5o'
2t
s99.47,27t'.8 2to.50'
ra
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14
Ll 45) .. LOT 2
,.34 ACRES
( 58,44O SQ. Fr. I
OO AC. EXC. EASEM ENTS( 43,573 SQ, FT.)
z
33'.
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r
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- 33
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BU'LOINC
S ETBA CK
st/4 coRNER SEC.7-( RAJL ROAD SP' K E F OU NO)
2 t o- 50'
N89047 27
E-W OUAR'ER L'NE
UNPLATTED LANDS
Y ?'i1i;2,1i\,Y 't-g
h
E t/4 conNER s ec.t.l
( ?,, I BON PIPE FOUNO)
l,
{D
o = SEI l"X 24P ,RON PIPE
WE'GH'NG I./3 LES.PER
L'NEARFOOT.
scALE --_------_.------1
"= 60'
0 !2o' SHEET I oFz
r N srRUM ENr'ro^l'Jll ogrr r:#:t 2689
DATED
sEP 3 01993>
JAT{ES @fiHELLEglld Ooods
St Oots Co, W,
FILED
JAXES U.
WEBER
s - 1804
SPRING VALLfr
wts.
93 - '3r
30' 60 '
rHIS \i
t-
tr,-=-
w 243.50
{
(
--T_---?.
t'
a
Nls
DESCR.IP:TIOX\
A parcel of land located in the Sfl l/4 of the NE l/4 of Section 7, T28Nt
Rl7[, Township of Pleasant Valley, St.Croix C-ounty, Wisconsin, nnre
ful ly described as follows:
Ccnnrencing at the S l/4 corner of said Section 7: Thence tlCRTtl along the
North-South Quarter Section Line a distance of 2675.52' to the C l,/4
corner of said Section 7, said point also being the POINT OF BECI f,0,lll€:
Thence continuing lffiTH along said line 240.00';
Thence S89o47' 27"E 243. 50' i
Thence SCUTH 240,OO' to a point on the East-Vest Quarter Section Line of
said Section 7;
Thence N89o47'27'\[ along said line 243.50' to the point of beginning.
Contains 1.34 acres subiect to C,T.H. "J" right-of-way over the westerly33' thereof, Also subject to existing eas€rrent over the northerly 33'
thereof,
SIJR.\,ZEYOR- ' S CERTIFICATE
I, Janns M. Veber, registered land surveyor, hereby certify: That infull ccrpl iance wlth 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 Hernran Heinbuch, owner, I have surveyed and
napped the above described parcel of land and that this nBp is a correct
representation thereof .lrll'ico
Dated th i s_gR_day of_SsS:sL_, 1993
I
*JAMES M.!..I
i
e
b
tI
WEBER
s . 1804Jarnes M. Weber S- 1804
NELSEN-VEBER LqI\D SL.RVEYIT€, IT{C.
l.{OT I CE: The parcel shown on this nBp is subiect
laws, rules and regulations (i.e. wetlands, min
parce'l , etc.). Before purchasing or developing
St.Croix County Zoning Office for advice.
to State
imtm lot size, access to
any parcel contact the
SPRI
a
st{EET 2 0F' 2
93-l3l This instrurent drafted by Jim Veber
VOLUME 9 PAGE 2689
J
T{c
SUilftr County
tr
--
LHFI SANITARY PERMIT APPLICATION
ln accord with ILHR 83.05, Wis. Adm. Code
-Attach complete plans (to the county copy only) for the system, on paper not less than
81Ax 11 inches in size.
-See reverse side for instructions for completing this application.
I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORiIATION.
o
STATE S^f.flTARY PERMTT #
z"l?t,#{,(a,#"",.."application
STATE PLAN I.D. NUMBER
PROPERW OWNER
Herrnar, rlt ixb u c\';';;TilV;:i rt rAg,N,Rt7 x(
PROPERW OWNER'S MAILING ADDRESSRrL vkq6)t LOT #BLOCK #
'fl',ihL*l v)$
ctw ZIP CODE PHONE NUMBER0t, 1g
I SUBDIVIS]ON NAME OR CSM NUMBER
UILDING USE: (!f building type is public
E noucondo
f] A"""rblv Hall 6
E c"rpgrouno l
ll Chrrch/School I
E not"uMotet 9
II
VILLAGE:
2
3
4
5
ROAD f-n
II. TYPE OF BU!LDING:(Check one) tr
Public 1 or 2 Fam. Dwellingr.ff of bedrooms
Other: Specity
State Owned
, check allthat apply)
10
11
12
13
il.B
1
Outdoor Recreational Faci I ity
RestauranUBar/Dining
Service Station/Car Wash
Medical Faci lity/Nursing Home
Merchandise: Sales/Repairs
Mobile Home Park
Otfice/Factory
o2Lt-1010 - 30-
rv. wPE
A) 1. I
B)tr
OF PERlllT: (Check only one in line A. Check line B if applicable)
New zffn"ptacement g. E neptacement ofSystem 'System Tank Only
4.5.tr
A Sanitary Permit was previously issued. Permit fl Date lssued
Repair ol an
Existing System
Reconnection of
Existing System
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution
11 E S""o"oe BedriXse"p"i" Trench
13 LI Seepage Pit
14 U System-ln-Fill
Other
41
42
€
trtrtr
Experimenta!
30 E Specity Type Holding Tank
Pit Privy
Vault Privy
Mound
ln-Ground
Pressure
21 tr
224
2. ABSORP. AREA
REOUIRED (sq.ft.)
lT00
3. ABSORP. AREA
PRQPOSED (sq. ft.)
t rT0
ls. penc. RAIE le. sysreMELEV. 17.
I ruin nncrrr
llf [ ?r,!"",br,. ft.)
VI. ABSORPTIOil SYSTEM INFORMATION:
FINAL GRADE4. LOADING RATE
ELEVATION,l 7)'?..,
CAPACITY
in oallonsVII. TANK
INFORMATION New
Tanks
Existing
Tanks
Tota!
Gallons
#of
Tanks Manufacturer's Name
tt I l',
Prefab.
Concrete
Site
Con-
structed
Steel Fiber-
glass Plastic Exper
App.
Seotic Tank or Holdino Tank x lM I lTia trI
Lift Pump TanUSiphon Chamber x LW I ho xl'
VIII. RESPONSIBILTW STATETIENT I
l, the undersigned, assume responsibility for installation ol the onsite sewage system shown on the attached plans.
wriy7
"Hffffi66
titt'w
Plumber's Name
Brr**. L
Plumber's Sionature: (No Stamos)Bru;,Lf,*M
o Wrs
/DEPARTMENT USE ONLYtx.
Approved
Disapproved
Owner Given lnitial Surcharge Fee)
DITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
J-?)
Pz- 4 4,?Meu*Z/4"
SBD-6398 (formerly Plb€7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
D
C
W
trtrtrtr
nwt tr"cLsl I]
;
Wisconsin Dc'artrnent of lndustry,
Labor and Hu'nran F,;btiors
Division of Safety & Buildings
SOIL AND SITE EVALUATION REPORT
in accord with ILHR 83.05, Wis. Adm. Code
Pasel ot-.L
"a
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal re{erence point (BM), direction ando/o of slope, scale or
dimensioned, north arrow, and location and dislance to nearest road.
APPLICANT INFORMATION-PLEASE PRTNT ALL INFORMATION
SOIL DESCRIPTION REPORT
Boring #
l::
Ground
elev.ql.l n
Depth to
limiting
U
factor6L
Remarks:
S o
PARCEL I.D. #
REVIEWED BY DATE
l'lcir, Lrc!
PROPERry OWNER:PROPERTY LOCATION,r@_* Ue1l4,s 7 T
^(
,N,R )1 N(,
OWNER':S MAILING ADD RESSP LOT #BLOCK #SUBD. NAME OH CSM #
CITY, STATE
lqnn) t4./,scohlt
ZIP CODE PHONE NUMBER(?/n ?q6 -55 Lt nCITY DVILIAGE Etrowr,l
P lmc e h; tl a.llev
NEAREST ROAD?Ltuntr )
Recommendeddesignloadingrateab,o,gNn20,-Ltrench,gpd/ft2rut1X
gpd
I
ft
New Construction Use |<f nesidential/ Number of bedroomsil I ] Addition to existing building
Heplacement Public or commercial describe
Code derived daily flow
ftz1t00 trench. ft2 lvlaximum design loading rate
-
bedAbsorption area requi bed,, ggtfizQ-L fench, gpd/ft2
Recommended inf i ltration surf ace el evation (s)l,l (as referred to site plan benchmark)
Flood plain elevation, if applicable
Additional design / site considerations
Parent material f-r r.r,
S = Suitable for svstem
U = Unsuitable fo? systern
CONVps ENTIONALtru .MOIJNDIas Eu EIS"BPRESSUHE I Hry'F;l SYSTEM ,IN FILLtrs Eu HOLDING TANKDS EU
,)
Horizon Depth
in.
Motfles
Qu. Sz. Cont. Color
Texture Structure
Gr. Sz. Sh
Consistence BofiCary Roots G P D/ftz
Bed Trefffi
I 0",6 5 fR )i3 s;,L{ obh ,) s qw 21 o,f 0.6
Z tk29 5 r', 113 sil L{ nlk )'
V
Aw 2{0,{06
J MI
3?-tJ
tO YR slq i vf qlh )s
V
qV I
yF
F 0,1 0,9
1 ls Yfr 8-2 s I ,t oL\)t ")L
I
vF
F 0.q !0,{
5
"J
5l t0Yfi 7-J
-
5 I ,f qhk )s db l'f 0,1 i0,g
6 5l-/;8
IO YR 8.L
7,5YR h 6
-
.5 I vfq[h ds db I
v Fl.A,rl io.g
It l"?*G hor;zu^ f,l* ltyr,5 ol- +lo ;c ll.no Ct ,hrs of srn);" L^ruI hotr) Ct ,ln/ttC /
Boring #
Ground
ft
elev1L
Depth to
limiting
faclor6s-
Remarks
,l 6,8'?l 2 5 Y ah,,t r-r-5 hrqLt fo *xl '/lt?,,) )l >(i x
tl rYR 6 l9 llwr*,7 ho, fLat fro lnd +ar vel
-D)t
/ walb t 'r^nlr/
INI lw *F(EF D 'l nz
^
/\l'D/') l)t!\,/ |tF v
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7F U/,\Y f lkt tt v ((L
-v^
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()ai CPTNA I '-o c A1 T()Al
I
\AJ4 _k yb olt* tt v,v I t,f
CST Name:-Please Print
Bvv& t lilln We Ltte,Etr#1 n
Address fr+ 3 $,,Ellsvo*\ lt4s 9{ot/
CST Number:cfLtllLSignature:(Lr**u afl- /U.0F Date: .
? I trlf 3
Dominant Color iMunsell I
5
,
T:mLmi1(ililFfi']Ha
PA8CEL I.O.
Boring #
Gmund
eiev.
.. a1.\ it.
$rrvt SOIL DESCRIPTION REPORT .- P*ol-
Deph lo
limilingW
Remarks:
Horizon Depth
tn
Oominant Color
Munsell
Moffes
Qu. Sz. Cont Color
Texture Structure
Gr. Sz. Sh.
Consistsnce erday Roots GPD/'tZ
Bed lTEdt
D-)2 tYR llt sJ
l*2fol n(r
2fcth n(r
-f I e 4b )s
t F qllr
7f d sl.'su
s b"t' n I
2+0'r
I
0.,
0..6
11-11 t0w, sl,l 2{a(
3 51^\L IO YR EI6 w 2(0,$
q 12-1?t0Yl6l€2f 0,1 a3rfi.t0 t0 YR 6lq {,t),g
6 e0'6\totR 616
1 e |ig to Yfr, el t t/x
YL
Boring #
Ground
elerr.
3/.f fi.
Deph to
limiting
Boring #
Ground
elev.qn fi.
Depti to
limiting
tebr(o
Remarks
Remarks:
l>0,, 6' is reqL lin,
g 6g1t to Yl, 7/J 5 h".tt *w't )l X x
q ?,-71)0YT C/LI s t
hl077-[2 l(tYt slt S
04t ,tk 3lJ dt 2 fqlk )s 3
F-
c0 0.f i 0.4
2 tl-]4 tYl I til 2f ,(.
llch
I Fql|,h
b )g11
3
F-0,f 0.6
3 2618 , YR 'II s 2n 0,1)0.9
,,fl'60 tlYl 6lv s w lf 0,1 0,9ro${to.fl t 16 J 2.rf Xir
6 6nl frlslt s
s
lrqll"h I IL l#x X
tl ?l-lI SYI II'l Vl Rlt I l"ll,r nl l,rf xi x
Boring #
Ground
elev.
f ,t.1tt.
Deph h
limiting
lacbr
Remarks:
sBD.S330(R.05/92)
Hcd;ls )^ kl \0 ,' rolt
mI)rn rYl il 3
s
w lyl
q n4l 7 l(olk nl
rlo,
sd il+
lop trr"tt'
",J[ ?,r,n
bOttr'" Jre' 6
Lr}fo>'fr?r.cLt'
qt.l
qo, r
?o,o
,*,J l+"1
13' I
f2,f
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plol yla^ t' 9o'o l")-,
f 66q f r on l,,n ll*'nqn H' ir' !"tn
Loc okJ ;'n sv'/v at N E ',/l |ec 7
T ?gu K:TV
To* n ol flnopnt* \)rrJ fS CrotY Gtntu
rr 62V -t o lo' 'o'lJ,''" nop 5l'r t * 76
bvurc- ,y' ,rr.Lgn C sr ,50'!!?
$vutn t w'L''t''' flt'-l2t- roP6g3?
frtC
o
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R
LI
ilt
qlQ
uh,L
6 b)'-
t '' t!'tt! ['"
2 lp 'i{{
-r"
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e --03 q\'1 f r,l fl^1 51,.. t Jb
ffi 1
tr(tz
6?,f
6t)"rrt)lt'n P*t'ct
10009e)) ft $attt1
1t tooo r le|ttc
14rltrtxln
lve co
3 uJ^ [o,;-O
60'
sourlr Fence Lire o* ti"g sW /v oF +l''e ]lE !/'1 sec 7 r28N n,U vt
(t-
F ,f to" t'/t7r4;,.-1)
S T C 105
SEPTIC TANK MAINTENANCE AGREEMENTSt. Croix County
OWN ER
ADDRESS
YA
.)3
et4
,5
L, c\
(/5IIRE NUMBE
CITY/STATE
PR'pERTY LocATr oN \5 L/ L/ 4 ,UL r/0,
I J ?n'fTOWN OP e
SUBDIVIS ION
30 days of the three year the SL.
expl ratl
SIGNED:
DATE:
St. Croix co. Zoning Office911 4th st.
Hudson, l.ll 54016
CroIx Co. Zoning offlcer withindate.
SECTION
ZIP
,12{ x-a17 w
, Sts. Crolx County,
, LOT NUMBER_.
Improper use and maintenance of your septic system couldresult in its premature failure to handle wastei. propermaintenance consists of pumping out the septic tank every threeyears or =:o.:.f , i f needed by a licensed s.pl,i. tank pr*p"f . Whatyou puE into the system can affect the function of the =!pii" tankas a treatment stage in the waste disposal system. ist. croix county residents may be eligiUfe to receive a grantfor a maximum of eo* of the cost of r"ptacement of a failingsystem, which was in- operation prior to .rury 1 , Lgzg . st. croixcounty accepted this program in August of lgBo, with therequirement that owners of aII new =yJt.rn=.gr". to keep theirsystem properly maintained. -
. . T!" property owner agrees to submit, to st. croix zonirg acerti fication 'form, signed . by the owner and by a mater plumber,journeyman plumber, restrict,ed plutnber or a ricensed--prr*perverifying that ( r ). the on-site wastewater disf"=Lr system ^ i= inproper operating condition and (2) after inspection and pumping (ifnecessary ) , the septic tank is less than i/l f u1l of '=rtiag" andscum.
T- /He, the undersi gned have read the above re quirements andagree to maintain the private sewage dis posal system in accordancewith the standards se t forth herein, as set by the Wisconsin DNR.Certification stating that your septic has been maintained must becompleted and returned to
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vcr 657 mm4i
STATE EAR OF IISCOTSIN-FORiI 3
olJI' CLAIX OEED
,xrs sr^ct lasEf,vto toa ttcololic oata
REG{SIERS OFFICE
sL cRorx co., Yvf.
lec'd. for Record
Jan.HerDan R. Helnbuch and Delores C.tlelnbuch -ouil.cl.ina io' husband and slfe a5 tenan I of 8:30 A
f the parEies and to
-half interest each.)
tt"'" C L. GAYLoRo
AITORNEY AT LAW
ll3 E- ELtl sT.
RIVER FALLS, WIS. 54022
,rLone-half lnteres t
lhc lollowint dc3crib.d rc.l .slat. in St' Cl.olr County,
St.l. o[ lliscorilini
The NEt, of Sectlon 7, Tounshtp 28 North, Range 17 l'rest,
except the one-acre parcel of land conveyed to UllllaE R.
Volkert and Deborah J. Volkert by deed recorded in Vol.
63O. page 477, Document No. 371376.
the Et of the SEt of Sectlon 6' anJ che St{t of Sectlon 5,
all tn Townshlp 28 North, Range 17 l{est.
T5x IGy No. :q--
The Sk of the NE& of Sectlon 32, TolrnshtP 29 North' Range 17 Uest.
That portion of the Et of the Nt$6 of Secllon 5, .Tovnshlp 28, Range 17, lylng South of
InEeratate tiighway "94rr, conslstlng of ten acres, Eore or lesa.
NUk of Stdc and llest 2 rods of SlIl of S[Jtr oi Section 4; Ut of SEk of Sectton 5; ALL
ln 28-17.
Subject to eaae ents and ri.Shts of t,ay
(Thls de
create a
of reco
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1
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c Ln co@on olrners
i':-:f
li:'iji,!-PT
This 1!-- homestead proPerty.
(is) (is not)
Detcd this 4th day of January , 19 58
G\.L)(sEAL)
AUTHENTICATION
SiJnatur.s auth.oticatcd thi.
--dry
of
-
ro-
TITLE: ME BER STATE BAR oF wtsCONslN
fil
^on
.
-
authorizcd by ! 706.05, Wi3. Stots.)
This instrument was draftcd by
AC(NOIILEDGITENT
STATE OF WISCONSIN 1"..
Pierce County.l
Personally came before me, this ------4Lb-day ot
January, L983 th. above na.ed
Hernan R. Heinbuch
Jit Ja-(; 41.,,1..[t-(SEAL)
Delores C. He lnbuch
Herman R. Heinbuc h and Delores c.
Heinbuch
to me kno*n to be lhe pelsonE- who executcd lhe fore_
C. L. Gaylord,At to rney +)'2g
,ilb,,
er
2f
e&Te inst ent
Rlver Falls tll 54022
(Sign.tures may bc aulhentic.ted or acknowledged.
atc not n€cessa.y.)
QUIT CLAII OIED-lr^tE EA,t Or TISCONSII{. aoira JO. l-r0r'srocK No. r 3ql3
i
t tenanc y osnershl
r.il
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ql l:00 P ,lla
tr
oocu E r tlo.
ROBERT J. PTIERNETTON
i0L 645 ,'.t{{9
STATE BAR OF WISCOflSIN - FORM 2
WARRA{TY OCED
txrs sPAcE PEsaavEo Foa eEcotoo:3 oltl
Grantor
llE:r.t!t^N R.INBUCH and
ii;:Cll'iiJiS OFFICE
:iT. cRotx co., \ryE
le<'d. icr Rrsd .!I 2tst
,J,:r cf__[p} !_AD. l9 !2convay! and warranls to
DELOI{ES C.
-lo L nE ten l
E
lha tollowing do3cribsd roat €ltata rn
Slel. o, Wisco.3in:
(This Deed is given1974, recorded Aprilin t.he officc of the
Thr3 i s_ _n_o_b!omos read property.
(r3, ('s nol,
Ercegtron to. arranl.es:
_ St. Croix counry,
The Northeast euarter of Section Seven, Tov/nship Twenty_eight North,Range Seventeen !.rest (NEy of sec. 7, T28:,1, R17wi , .*..ie t.fie onel-'-acre parcel of land conveyed to t{i j.Iiam R. VoIkerE and Deborah J.Volkert by deed recorded in volume 630, p.age ,147, Document. uo. iiffZO.
Opal PherneEt.on, wife of Robert. J. pherneCton,
named Grantees any int.erest she mav have in the
Ter Koy No.
---_
in EuIl satisfaction of a Land Contr<1ct dated April Ig,22, L974. in Volume 5lO, page 51, Document No. 3214I5Iteqister of Deeds for St. Croix CounEy, )
,uit. clains to the Jbove-above-described real esEate -
i:li r,R
o"t"o rn," - 13 9!l day or iI 8219
(SEAL)
(SEAL)
(SEAL)
. Robert. J. Phe rne t ton
(SEAL}
. qp-ql !l1e r.!let!q!r
ACKNOWLEOGEMENT
STAIE OF WISCONSIN
. Ca,r.ly
Personaly came betor; me. thrs
,9
. _H99! _,q: cwil
TITLET MEMBEB SIATE BAR OF yJISCONSIN
Ir(llitx
aulhorzed by S 70606 Wi3. Stals I
AUTHENIICATION
signatures aulhenttcaied thrs Ll-!h day or
-_-_
ap ! i_l
/-'
*,i--r./rg 32
- day ol
tlugh E. Cvin, r\ t. to r n.: i'cr.rin, ci lbert, cwin & ,.tudi,c
P. Q. Box 106tlu.ison, l,i'i sco ns i n ,loIG
lsrgnat,rgs ma7 b4 rrrngnt,aatr4 0r 3.rna.t e4qe4 8,,,. )t,! | .l
l.I.) r.,)/v. ta a,9Ine aerlo. ?vno erfi:ut;.d lFe toreqorng In.
),,..,.!nt .Ir, t i. tu ettc.jT tr4 \,, oe
This rnslrument xas dra,ted by
:;,./1\
tlt a Fn, ,, .. .s i.,_rr-. r^enr
C,,,"ty 'r.,/,s
_. i.,j -..!,r, . lirtE
rl ,
sto(k No. 13002
[.5 2
,8
44
' 6l\
c-7 z._
?. c3 Z /t
,?2D
8-t-:r
I 7 c/
oo-
o 2o
s T c - 100
'This apprication form 1s to b.e .completecl in furl and signed byItht owner ( s ) of the property
^
bglnl 'J*:loped .- Any inadequaci eswl11 only result In &qrtvt i,r tfin'peimta i*.unn.n. , should thlsdevelopment be intended for resaie by gwn er/cohtractor, ( specItouse ) , then t a second f orm shourJ'rr" rdtuined- Lna compreted whenthe property-' is sold and submltted to this office with theapproprlate deed recordlng.
#prgperty evrnct h l-/.,1,L,,hOwner of
Loca tion
Township
Mailing
tn
addres s
or pro o"rr$hl L/4 hll- ,tn ,Section I
?
Lr/J-v,l
Address of site R.Hr*ro .) (M'i
Subdivision name
Other homes on property?
pert,y peing developed for
and page Number UC? aE+l\hN ovt lo
( spec house ) ?-yes X_*"t'
recorded wlth the Register
of no.
62q0
Yes _No
%8
es o I
Prevlous owner of property
Total slze of parce).qc rcs
Date parcel .wael created LE
Are all corners and lot r"ines identlflable?
Ie this pro
Vor "^drqof Deeds.
Uot,*S,tt t 7
INCLUDE WITI{ THIS APPLICAT,,ION THE FOLLOWING:A I{ARRANTY DEED whlch incrudes a DocuttENT NUHBER, voltrHtr AND pAGtrNUHBER & TtlE SEAL oF THE REGIsTtrR oF' DEEDS. ,Ih addition, acertified survey, if availabre, would be herpful so as to avoidderays of the revi.e.w-!ng process. rf ttr" deed description:;:il":i:: ;" ,-insi*l:te6 3urv.v Map, rhe cerrif led- i"""v lrap
Ul't" e
e
property abscrlbed I h thls lnf orm
mlon f orm, by vLrtue of aranty deed recorded n the of of the Count y Register ofds as Document No , and that I ( we ) presentlythe pro posed site f or the sewage disposal s ystem or I (weained an eas ement t o run the above de scrlb ed property, foconstructlon o f sald s ystem, and the Eam
r
orded I the offlce of e has been dul v
r(w
bes
the
war
Dee
own
obt
therec
No.
PROPERTY OWNtrR CERTIFICATIO ,*# ,0e 3Ar
e ) certify that alI statement sonth form are true to thtof my ( our ) knowled ge that I (we)( are ) the owner ( s ) of
3BF
Reg lster of deeds as Documen
a
sl gnature of appl J-cant
(J 2c ff%
Co-appI ican
jrl 2ttDatof slg ture
C.ountv
N", I 506
Da te ofS gn a ture
t
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\r.i./(353U9
OWNEN I S ADDRESS:
Route I
Hammond, uI-I 540f5
ence W. Murphy
e8 stered Land Surveyor
CERTIF'IM SURVEY MAP
JERRY AI{D I(AREN LIDDI,E
O SHEO
o
8tN
sr.Croi.v Co.,
:cdr
/ 'u, r v-_.-__
2
N t/4 co?. sEc, 7, r 28N,
R I z w, I colJHr Y suavEroP's
*t o N.)
Part of the Southeast l/4 of ttre Northwest L/4 of Sectlon 7 ,'Townshlp 28 North, Range IJ West, Town of Pleasant Va11ey,
St. Crolx County, Wlseonsln.
UNPLA TTED LANDS
Olndlcates 1" x 2l+" lron pl
weighing 1.IJ Ibs. /tin. f t.
get.
s og' 4z'22"8 6a3.43t
602,18
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PAGE 998:-
LOT I
to.ooo AcRES
43.5,599 SO.Ff,
NE7' 9,447ACRES
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UNPLATTED LANDS
Joo' 4oo'600'
s t/1 coq.SEc.7, r28N,Pl714
IRAILROAD SPIKE SET)
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Description:
That certai.n parcel of 1and, Iocated in the Southeast l/4 of the Northwest lA of
Sectlon J, Tor,rnshlp 28 North, Range L7 West, Town of Pleasant Valley' St. Crolx
Cormty, Wlsconsln, nore fuI]y descrlbqd as followol Commenclng at the North 1/4
corner of said Sectlon 7, thence S OOtOOtOOuw ( asstuned bearlng on the Norttr/South 1/4
Ilne of sald Section 7) a dlstance of 1961-.49r to the POQT 0F BEGINNING, of the parcel
to be herein d.escrlbed: thence contlnue on sald llne s oo"Ootoo"}J 577.00'; thqnce
u 89o47'27"y 6\1.4)'-on the East^,Iest 1,/4 }1ne of ga1d. section ?; thence 11 99ug6t99rtg
677.oot; tlence s 89"47'27'1 641.\1, to the PorNr oF BEGTNNTNG ' contalnlng 1o.00o acres,
belng oubJect to easement over EasterLy porttons of sald parcel for C.T.H. "J" R.O.W.
purposes and also belng subJect to easementg of record.
Dated: February 24, 19BB
State of Wlsconsin)
Cor:nty of Pierce )
I, Laurence W. IfurptlJr' Reglst€red Land Surveyor, do hereby certlfy that by dlrectlon
of th€ owners' JerrJ, and Karen Llddle, I have surveyed and dlvlded the lands shcfim
hereon 1n accordance w'ith offlclal records, Chapter 216.14 of the Wlsconsin Statutes
and the ordLnances of St. Crolx County; and that thlo map and desorlptlon are a true
and correct representation thereof .
VoI. 7 Page 1943
Certlfled Survey Maps ,St. Crolx County, Wtsconsj.n ru
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gt, cRoD( cowtY
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