HomeMy WebLinkAbout026-1115-30-000 (2)ffiilff"'"SOIL AND SITE EVALUATION REPORT
in accord with ILHR 83.05. Wis. Adm. Code
Page / ot 3
Attach complete srte plan on paper not less than 8 112 x 11 inchel rn size. Plan must include, but
not limited to vertical and horizontal reference point (BMh direction and"/o of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATTON-PLEASE PRINT ALL INFORMATION
=S/.%I
PARCEL I D #
REVIEWED BY DATE
PROPERTY OWNEB;Ju-v.,c-t( 8*rp[. Ao
PROPERTY LOCATI
Gow LovgE'
ol,o7)o,)uq,s ( r SO ,N,R lg E(o4w
PROP ING ADDRESS#b5 LOT #/3 BLOCK #lu4 SUBD. NAME OI
14/ ; / /oa)
R #
crv. Srarn
N el,rt H'rh
7 ZIP CODE PHONE NUMBER
mML-UE s Q/9 -Z3Zo
NCITY NVILI.AGE
R-Lrul ETOWNrctl
NEAREST
t{ New Construction Use ffi Residential/ Number of bedrooms 4 t 1 Addition to existing building
[ | Replacement t ] Public or commeroal describe
Code derived daily ilow 4oo ggd Recommended design loading rae , ? bed, gpdtftz , I trench, gpd/ft2
Absorption area requireo 858 bed, ft2 75o trendt, ft2 l'/aximum design loading ,a1s , 7 b*., gfilt4 , I trench, gpdft2
Reco mmen ded inf i ltration s urlace elevation(s )76 d,ft (as refened to site plan benchmark)
Additional design
Parent material
/ site considerations
Flood plan elevation. if applicable | 4 ft
S = Suitable for svstem i
U = Unsuitable foi svstem I
CONVENTIONALns Du
MoUND Iz}s-tru I
IN.GROUND PRESSURE
E€- tru
AT.GRADE.ZN NU
SYSTEM IN FILL
DS .AA
HOLDING IANK
NS
SOIL DESCRIPTION REPORT
Boring #
Ground
elev.zcszL4f
Depth to
limiting
factor4
Horrzon Depth
in.
Dominant Color
Munsell
MoUes
Qu. Sz. Cont Color
Texture Structure
Gr. Sz. Sh.
Consistence Bonry Roots G P D/ftz
Bed lTrerrfi
/o -/ Ll / ovru)/z )tJ *zr-a nSOK rn 4,4 (--2 4 .5- l, u
Z Z-ZI / o y ra+/ct flnzz Sr/R msaK rn/,-z tt)/<5 /-
:a zl-42 7, {yrzV+h rsr- r-s/a frar wr{+c)vL4 5 c
4 //<-8+) r) voV/ v n 6>17 F tus oe2 m/,U/f n/r4 t 7 I
aa
Boring #
Remarl<s:
Ground
\Lq{
Deph to
limiting
factorz/(.,
-)4 _: ,tbit(tCsm4L2mSoK)'l,gae/ o yt)/ol)),/5
/'/5i, bD/)nlLJ rn 5Als,// o yrt"/+fr,oao';+/
"i,rlt fl4 ,7i.8/.2 / ^eO SSzh.urc-*s/-rb /ort v/ b;4 6
\H \
tr-l,l
Y
^)
\e, I
Name:-Please Print
/zz-78CSTDate:ZSignature:
Remarks:
i:::i:*rJ*.......i::i:
I
i:+ E ::;::::7
\-\'Jt-t-
'll ,-
:lc.,-dt
"(-(./
-),"ltln.
rl
Dx-n'oA C"-A SOIL DESCBIPTION REPORT PagoPR@ERfl OWilEN
PAFCEL I.D.I
Eoring #
Ground
elw. , 5?i_T
Depfi h
limiling
facbr
>32:'
Remarks:
Depth
in.Horizon Dominant Color
Munsell
Modes
otl. Sz. Cont Color
Texture Structute
Gr. Sz. Sh Consistsnce anurInoor GPD/fI2
Bed lTGrdr
0-7 / nv,zV/r,y'L t-"c €->- tn.9/K ln 4-11 <l+-q b
Z-72s,7-6't**/cr he-te-</2- rn 71r mvdu G")t/I5 L
a2 582-/o/r,vl o ha-.-rz-bS O ss-
",1
/,/f14-,144 7 I
Boring #
dfli&Ns8{9|E+lS ri;
W 4i+
Gound
det n'5
/o!--f.
Dedr to
ImilinS
hcb.>&:-
Bemarks:
QtrtJdA ru6 Lso10/0 v/17/4 h.o--e-2/G
Sr/a nSoA m a_4r, )/rt vrz-(/+)/-o,-t E-/(5 ,b>/,,. 23
5/& m .fr kltd,k)1/4 b /--z2 4-114 ?,s'.trttil4 h-t*e
hs a9a /14/e.Eb /tvn*y'o Uro.-,'l,P -/lrz4 7 ,44
I rI
Boring #**w
ffS -- l+-ffi#
Gmud
datz 5
Cs "-1r
Depfi h
lirilinslftw
Remarks:
AlnSAK rnL Ls *t-l)/0 tzzz-V/z h-arte-5 ,b/4 t/2 y7s0K l/n {,)/{/irru{t-y'l s-r?I-,5i,G7_,.2+
n^S Q9-/n1 ,444-//4 :7 I4 z,t t-02-,/l v**/e U /g-.ta -
II
Boring #
ffiwEE +!i
ffi"""e
sl€v
Gound
ft.
DE0rb
limiling
hctf
Remarks:
SED{330(R.05,92}
I-II
S e,,l
5
II
STEEL'S SOIL SERVICE /l'5+ 2-oo\fu4-
Gary L. Steel
c.s.T. 2298
MPRSW-3254
Or--,v1c-4 e"-sJ GrH|rotgfrivr
New Bichmond, Wl 54017
5et/+ fla'/l S r- tut-El8D o1sl246'620o
/, ,, / /r*rro-d
tra{ta - Ur/hD rtu* l4az/st-J
T
t
N
/tt:+o'
Brvt, *ntr'tr il tr
Lpf s*rr<e- Aof
tLtZ-*l t L.l OO '
P*a..^-
lr'
3o'9f r'd '
*
7o'
lr!r
6,
,0 F \+
2Z'
tat 4t
z
L. S4acr
b b- 7/
5
Y
T,A
\,'
*
Y\
l\l
-\2o
I L2
0
r.*:!t$
h
11
4o'
G
t 3,
Gq'
lo'
'6r-
-)(-73
laf 4tz-
l6o'
(,':,I
\Y ^yd
I I
I
\no G'JT
\
,ln
t-
sTC 10{
AS BUILT SANTTARY SYSTEM REPORT
i h* stcphr^6;
ADDRESS to 5-
S oa7
suBDrvrsroN / csuf alu$.sn ,Dh r tJ{- t^fiLlro"r.r rpr f/3
sEcrrowl_L r_30 x-a_/K w,Town of
ST. CROTX CIOI'NTY, T^IISCONSTN
PLAIMEW
SHOW EVERYTHING T{ITHTN 1OO FEET OF SYSTEM
\
l
.l D
t
oB
o {
)r 4\t-,t
DICAT E NORTI] A
I8'
a,
i)t'ov rde setback clnd e I evat ron in {t iori ott teverse o f thrs forttir
1ba"'*'fr"*
I
l'r'ovide z dttnen.slo;ls; t_<t ceni,er o!:;r)l)ti{-- L.-lt}. ttlattlroie covel '
L
u,
l
Qm, ./6D-ttaJl
/a u-
N,
m
Fe3
?- )d-7
^etlotl:=-
?N,7
?&,3
/60. Z
? 5,?
?Zao
A,*
Ar-.bt
lltttltr fl
-[t
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX @UNTY GOVERNMENT CENTER
1101 Carmidtaol Road
Hudson, wl 54016-210
(715) 386-4680
Should you have any questions, please contact me.
Apri} 25, 1994
Mike StevensDerrick construction
1505 S. T. H. r55[
New Richnond, WI 54017
Dear IrIr. Stevens:
on April 22, L994, a septic system was installed on the property
Iocated at Lot 13, willo!', River l{eadolrs, sEtr Nw+, section 1, T30N-
RLBW, Tolrn of Richnond, St. Croix county, I{isconsin.
At the time of inspection this system lras found to be code
compliant for a four bedroon home.
Sincerely,
Irlary Jenkins
Assistant Zoning Adninistrator
File
lpEfifl[c&"Bs€#HesB,
Labor and Humaf\ Relations
Sarety.nd Buildrngr Division
, 01. 30. 10 pftffAfEstfrtrSxst3fE, r RD,,GG
INSPECTION REPORT
(ATTACH TO PERMIT)
ELEVATION DATA A9300371
n
GENERAT INFORMATION
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
5eptic 4/;et-,,/Lfo
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
PUMP / SIPHON INFORMATION
Ma n u fa ctu rer Demand
GPMModel Number
TDH Lift Fridion
Loss
Svstem
Head TDH Ft
Forcemain Length Dia.Oist. To Well
SOILABSORPTION SYSTEM
Permit Holder's Name:
,Tt.rrrw PT\IEP .TOTI'IIF Vtlm
*Town olB City D Village
RT(IHTIOIID
CST BM Elev.:
/o/.OO
lnsp.8M Elev
l0/ ot)
BM Oeicription
l^yf skJa - ,/,a7 r-
nty
tarY mit
State Plan lD Na
ParcelTax No.:
o26-1 1 I 5-3O-OOO
TANK TO PIL WELL BLDG.Ventto
Air lntake ROAD
Septic > to'>5o'?o,>30'NA
Dosing NA
Aeration NA
Holding
BS HI FS ELEVSTATION
/o /,Benchmark (D /oq,L
Bldg. Sewer
?E,7st / Ht lnlet 5.1
q8.>g5t / Ht Outlet 6.)L
Dt lnlet
Dt Bottom
'7. L 9t.Header / Man
77t qL.8trDist. Pipe
t,l)g 9,89Bot. System
Iti ?s.q5Final Grade
q,v I oo.-2-[]h.,i,r/, Alcv
II
8ED / TRENCH
DIMENSIONS
Wrdth,-!,Length 7?'No. Ol T PIT
DIMENSIONS
No. Of Prts lniide Dra Liquid Depth
SETBACK
INFORMANON
SYSTEM TO PIL BLDG WELL LAKE / STREAM LEACHING
CHAMBER
oR ulrllT
Manulacturer
fypeot lut&)
Sytiemi ' /?r-L 16r /og'7s'///4 ModelNumber
DISTRIBUTION SYSTEM
Header / Manilold
Length _ Dia
Distribution Pipe(s)
Length _ Dia
x HoleSiue
Spacrng _
x Hole Spacing Vent To Arr lntake
sorL covER x Pressure Systems Only xx Mound Or At-Grade Systems Only
D€pth Over
8ed /Trench Center t ") ..,
Depth Over
8ed /Trench Edges
ti xx oepth OI
Toproil
xx Seeded / Sodded
0 Yes 0No
xx Mul.hed
D Ye5 ENo
COMMENTS: (lnclude code discrepancies, persons present, etc.)
I.(r;f,Irlolt3
r-i rt - 3,4
RICIII,IOND 01. 30. 10. 565,SE ,l{IlrLcl|f rCa-^4 5L1
,J r '- hl4 n0
..hr",
x,'17 >i
(- 11."1
+J)-ql
1n 4 J"7
1iL.-'l'b
/C
t.,.,,L 3t/L-qgl8
Plan revision required? ff Yes E No
Ure other side for additional information.
sBD-67r0 (R 05/91)
CIt !,-ici ,-4 L 2-6
Oate lnspector's Signature
L
Cert No
I(--DTLHFII-ffi-l-ffiljjG.ml
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
SlLx 11 inches in size.
-.See reverse side for instructions for completing this application.
I. APPLICANT INFORMATION - PLEASE PRI]IIT ALL INFORMATION.
f o5-t FC \
STATE SANTTARY PERMTT #/fry0tr
Check ll revislon to previoua application
STATE PLAN I.D. NUMBER
PROPERW OWNER-U illob R r dq,r To, ;t U"-.-\^. Ft-5E yn lttuJyn,s I T-fu, N, R J I qrlwPROPERW LOCATION
PRoPERTY oWnen's unluric ADDRESS/\os /*ry Ls
LOT #/3 BLOCK #N/*
CITY. STATE
ih^Q,oln n rs ulD
ZIPCODE
5/d>
PHONE NUMBER
( )r rl?*-e3eo
SUBDIVISION NAME OR CSM NUMBER
(r r t (l o "t Rl u. r \rI)o<,"E or^r
NEAREST ROAD
1
2
3
4
5
6
7
8
9
trtrtrtr
I
trtr
VILLAGE:Rc[,-ot ot
aeb -/l t s-sc)lll. BUILDING USE: (!f building type is public, check allthat appty)
E not"uMotet
ll. TYPE OF BUlLDll{G: (Check one)State Owned
10
11
12
13
Medical Facility/Nursing Home
Merchandise: Sales/Repairs
Mobile Home Park
Otf ice/Factory
ApUCondo
Assembly Hall
Cafnpground
Church/School
E pruti" El, or 2 Fam. Dwettinffi of bedrooms lL
lV. TYPE OF PERlllT: (Check only one in line A. Check line B if applicable)
A) 1.,X
B)tr
2.4.5.
A Sanitary Permit was previously issued. Permit #Date lssued
Repair of an
Existing System
Replacement 3.
System
Replacement of
Tank Only
New
System
Reconnection of
Existing System
V. TYPE OF SYSTEII: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Other
41 E Holding Tank
42 l) Pit Priw
€ E Vault eiivy
E
Experimental
30 E Specify Type11
12
13
14
Seepage Bed
Seepage Trench
Seepage Pit
System-ln-Fill
21 E uouno
22 Z ln-Ground
Pressure
2. ABSORP. AREA
REQUIRED (sq.ft.)
858
3. ABSORP. AREA
PROPOSED (sq. ft.)
96?
4. LOADING RATE
(Gals/daylsq. ft.)
t/
5. PERC. RATE
(Min./inch)
7. FINAL GRADE
ELEVATION
I ?,7 Feet
6. SYSTEM ELEV.
?L'os ,"",
VI. ABSORPTION SYSTEM INFORMATION:
CAPACITY
in oallonsYII. TANK
NFORMATloN New
fanBs
Existing
Tanks
Total
Gallons
#ol
Tanks Manufacturer's Name Prefab.
Concrete
Site
Con-
structed
Steel Fiber-
glass Plastic Exper
App.
Seotic Tank or Holdino Tank x,ta5o /
Lift Pump Tank/Siohon Chamber
Vll!. RESPONSIBILITY STATEtlElrlT
l, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans
iIP/MPRSW No.:ls6s
Plumber's Name (Print):
C^l ur h ?o*".r \*
Plumber's Sig (No Stamps)Business Phone Number:
(7/t t)*5/&5
Plumber's Address (Street, pity,
/ ?6? /rr*t ) lazs flrul.orn nJ r, LL -g 7 n / )
vState, Zip Code)
tA-
x. qouNW/DEPARTMENT USE ONLY
S"'o'"0
Disapproved
Owner Given lnitial
Adverse Determination
tlE Fee)Surcharge
(lncludes Groundwater
€-r<?S--
X. CONDITIONS OF APPROVAL/REASONS FOR DTSAPPROVAL:
I.Inif
SBD6398 (formerly Plb€7) (R. 11/88) DISTRIBUTION: Originalto County, One Copy To: Safety & Buildings Division, Owner, Plumber
tr
Outdoor Recreational Facility
RestauranUBar/Dining
Service Station/Car Wash
Other: Specify
tr trtr
I,L I n t-t nlttttttt
I
P/at P)o--
t^Y,t)"^ {tr*,^ l[o, "f Uq^S.\v/,"/t.J
/so9 rtq 4s
f/N fi"l"o,*rt l
,fu-ue*t-s
ZoT/3
5E -//a) *r-l Do -/8N
R,.hmo*d
\ qrtlloo;€t* n /fin"&*o
En, *q
\
E )* frt-l^
UJL- 9/o/ 7
6 J
5b
A (t,
*.A- l"= {o
SrfT4 ,/)sB
\)& /)-ao-?s
,
a
C*lu,,- r-Q- .r T*
0
,rrytSbB
9'
-tt\
I
o
f
Dl,
t
x'
h
{r
*
\o 4 b
V"
P
lM*
pt*A\
b
p -)
E
€ l\/ao -
l
_r_.
SOIL AND SITE EVALUATION REPOBT
in accord with ILHB 83.05. Wis. Adm' Code
Page / ot 3
Wiscunsrn DePartm€nt of lndustry
Gbor anO Human Relations
Division of SafetY & Buildings
'Attach complete site plan on paper not less than 8 1t2 x 11 inches in size. Plan must include, but
not limited t,o vertical and horizontal relerence point (BM), direction and"h of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFOBMATION-PLEASE PRINT ALL INFOBMATION
.S/ , e^
PARCEL I.D. #
DATEREVIEWED BY
TIA ONwERLOCPROP
wRNTor)gII4,Su)1t4OT 3LGOW O(/uPROPERTY OWN
SUBD #RNAME O]
't /oo)BLOCK #LOT #/sG ADDRESS#b5-tNPROPERTY OWNER'5o5 NEARESTrLLqcE EtrowN
L)
A
4i)7
PHONE NUMBER
Q/e -Z3ZoztP c00E
Recommended design loading nE , 7 bei,,gpdtftz , I trench' gpdft2
trend, ft2 lvlaximum design loading nle , ? bect, gpd/ft2 , I rcnch, gpd/tt2
4
ft
rcial describet I Pubtic or comme
4oo gg
Absorptionarearequired 858 bed, ft2 75o
tt (as refened to site plan benchmark)Recommended infi ltration surlace el evation(s )
t I Addition to existing buildingUse [2{ Residential/ Number of bedrooms
Additional design / site considerations
Flood plain elevation. il applicableParent material
$,{ New Construction
[ | Replacement
Code derived daily flow
HOLDING
DSSYSTEM IN FILLES,EruAT.G
U
IN-GROUND PRESSUREnuMOUND
El-s- tr uSuilortableS
UnsuitableU
CONVENTIONALE}s tru
SOIL DESCRIPTION REPORT
Boring #
Ground
elgt.>csqqT
Depth to
limiting
lactor
>P4"
Horizon Depth
in.
Dominant Color
Munsell
MoUes
Qu. Sz. ConL Color
Texture Structure
Gr. Sz. Sh.
Consistence Boftay Roots GPD/ftz
Bed Trcrrft
/o-/L / o vru)/z /4,*t.c -a msOK rn 14 c-t 2 4 .51, U
Z Z.ZI / o y ra+/+fleoz z ,9, /d msoK rnl ,a ?)/<-
:I -12 ?, {rrzV+t/a fiar w/{?L 6)vt^5 C
4 I /<-8+,lrt va V/ U )4 6.1 F Prs oe2 m/url-/l/r4 7 ,g
v
Remarks:
Boring #
Deph to
limiting
lactor
7frF''
Gtoundqu{
)()./5 /orut/e /t,yae QmSoK rn {r.L C-s *>/r5 t?
i++// o trc"/+/Lo*o -"/ /)rt5Al ,rn{,O/D-/Q 5i, G
/-0b /otrt '// k rtwt.tus ase ln///r'/1-///r4 7 g
:
:
Flemarks:
Name:-Please Print
f17/.Ut O+d 75r{,*(ooT€SS.n ba:zz-78CSTDate:Z/
.:::::;i!X.:i.Lliiii::
!:i:i . ::::::
:::i:j / ::::::l
itii.".1*.,.,.,:i',i:
'..i...iwr.t.111'.4'.'I
(-
// rso r-
. ::l::ili.:ti+il::::':::
:::;it
- :::::i
::.:i C-'A'!:'7
.i4
t
PROPEHTY OWNEE
PARCEL I.D. f
Dtnato-Ll F rn*rrJ SOIL DESCRIPTION EEPORT of.LPage
Boring #
Ground
Depth to
limiting
factor
> s/'
elev. t 5tr
Depth
in.
lDominant Color
I Munsell
MotUes
Qu. Sz. Cont. ColorHorizon
Structure
Gr. Sz. Sh.Texture consisten* l*r*v I
noo,,GPD/ftz
Bed lTrrrft
/0-7 / n vrz-v,/ =,lLtqt €.-2- rrt SAK tn 4t cs *-q',, b
Z 725 *t )l ,+rt z 5/Z- rr7 Ar mlL 2r)//5 I
I a
4 2 5,82 /il y,z- *l r./1 o--ra.t-.OF(-o )o<?w/,/l/14-rur4 /7 I
I
I g
i
Remarks:
Boring #
..iiiiMa$lili:.iii:
;i;i;|i . :::::
:l:l , I :.i
:i::* /zA ::::i:.:i I ::,;.::
Ground
elw. rr5/ofrt
Deph to
limiting
fachr>&'-
9'/o /0 vrtT/1 /t,,*r, z Q rrtfd4 /-na Ls p/5 e
2_7, Z3 / n yrt-"(/ +//r,vt L J, /a rn ferl ,44 €L A(r)/(,;i,L
Z2 ) -un ?,t'y.LV4 h-,J,ae 5/O ,n -fr ln/ru Au)lur1 ai t,b it(a
t/+2.gh / )Vrt */ o l/ro*'lP -dos cse //)/,/t'4 ru/ts
t
Remarks:
Boring #
:::f.,1S$:$t'l,..f..Ttl::i.:::.:$':$\'$il:':':':
:::jJ t\ ':':::
11:i I t..ii
::::::'+ltta/..i::::::::::::ii
Ground
elw.z 5
Cq "-ff
Deph to
limiting
fachrru
7 --/0 /D tttr-V/z,hd-,t z &m s0n rnb Ls z{t 5
Z-/0,2+/jrr//t')4 srnf-t/2 n450K W/'A,r)/(,5i,C
4zt '-02-/a rru*le 1/ (9<?6-N^S a .<?n1 /rv*/r4 a i.8
Flemarks:
Boring #
elev
Ground
ft.
Deph lo
limiting
lactor I
I
I
Flemarks:
SBD-8330(R.05/92)
: illii):+:.lilili:
.:.:il
-...i":.::: <.:':tti::t
-./
- :
:::;!iii:i:l:::i::l:::.:;:::
,b
STEEL'S SOIL SERVICE b'5+ 2odY,a/L
Garv L. Steel
c.s.T. 2298
MPRSW-3254
&r-- r^rud €,Y-tt*/
5et/4 fl ^tV+ S /^ t'sat ,E /8D
ffiivr
New Flichmond, Wl 54017
(715) 246-6200
,4 *, / t/Uor,*d
,U{/t - U;//oD fiu** rfrs*/e,/l
N
/lt:+o '
Brrtt *q'6 N tr
-\-.--.
Qr!r
LL.loo'
td f s*,,al{*ru
I '0*"^to
\0 -P
N
(b'$
Y
N?
*
K
a'5'I
V ^rl'f
I z?o
I q)
a.
b-u
L23to\,+-(lt . -*)r
rcd '
fit",o'
7o'
,q{ {l
L. S4c €(
I
5(l'
4o'
/
Z
fi--
I 3,
G?'
lo
Co
- /(- 7 =
/,af //r-
lao'?Z'
\L
,+
h,il +B
'!C.o 5 S
_-r .$
-
0t/h-l UO+-\-+^r
S*"1'o,1 oC AB.o S Y5 tfut'\\s"l 0-*
tr
I'L,'r;3t"on"
_ {'Cort lron
Vrnt plpr
- Tr r
Pr.rf orr tr I ptpr ! rlrr
CogllaS torntartlnj Attcrrca Ot l;rlrn
cn1
oR nARsu HA:
l-"'T / 3 .
2" oF AG6n EcA't E -/
ELEV. of fEET--
t . Frcrh Alr lnJrlr And ODrrrrotlon plpr
l.llalmr.a I 2'ADort
aA.
Arprorla yoar Cop
fla
?O. {2'ADcrr ptp2
lc ftarl Orrrr
fry rh ltor OrS k Cororlnc
0l r tr t!rilol
?tpr -
I
ti'A19rr1
Eraorll p
cl alrr
7?,2
Pnopo) ( D F,.,..1 grr.d<
t,l..r^t ron
APNq6YgD SY},ITUE,TIC COV(R.\-r1ATERIAL oR i" oF srAA\../
-7
Drs.'RrBUTlou PIPE ro 0E o',-a:.1t1 au rucHEs BELow oRl6r,.JAL GR^oEAu., AT LE'ASTao lucHE'g Bur to AoRi ixeu H2 rucH.s oELow FI'AL cRAoE,
llArUrurt DEp rH oF EXcAyAIlorJ FKon o,tt6wAL 6(ADE wrLL sr 36 _ rucHEstl,il,nuH o€? rH oF ExcAvlrroN F.Aon o4,6,rr,ri ;,R^9f, wruu BE, /d/ - ;;.;.,
SI6UEO:
LICEUSC TJU^tBEII:
i
DrsTRt Burtor.t PtPE
sotL rtLL
C' or li e AG6RE6ATE.
OATE:2s
I lo
(
n-
OtINEIt/ BU'TE3
s tr?:: c''\fr [. .-"i:]:^::i"':;*u=:rErr?
bt /tlcottt,4t,rst Jo, u7 l/uN fur?EfU,U+&et-R,5feurefVS
ytrrfBEs lsc s bS
I c+tt4o ND, U/f
ROUTS/30.','-
---a,
.
--. --toit ( / ) se\ri
:\rrrub .= /76!,%5.{o I )
,. t -O
^l<,-,
??2
Sg '.--PlOPER:? LOC.L!ION:.
-
?otrn o E
sck a Scc, = :,o o t 30 lr,
SE. C=oi=
R /g
Cc un c',? L
tj
'L
-
K,* rtto N o
laorogcr 'rsc {ad rl.Ltcattanca oi your s.Ec1c lyrc.E cclrld rasu!: i=
1,Es p€.Eacrra ta1!urE co handlq ,asca! - P:opaE oe,incar,anc,tr can-ltscs oi prraolng ouc cll. saoclc cacle avarT chEaa ya5.ag of sooner,
4t1rl-OeeJ 2rrr*2.
S rr b d l'r ts io n ru€MA)S , Lo c o,uab q r
:i L:e::n s e<i sao e:c e:,nk ouroe r. l{hac yorr prrtr
at : ac:tlla cunc=:,un oE c:le sePej.c eank as a
ilte 'Jascg cl:sposa.L :tvsc3a.
f: aeq<icd.
ehe 3ysc:tEt
(!,QnC sCags
by
CAtr,
rr e!:glbta eo
eEolacsaaae o E
Ju.Lf L, L978.
oE L98O, tri.e!r
Eo karg cltq r=
LACC
f--o) ? <t- --b
ra€eivq a g=3nc ior
a Ea illrg sys c aE ,
SE. C;c!x Counclr
ehr eaqui=aEcttc elrar3yscaas .oEooarlT
Se. C--oL= CcuncT residencs rta,v ba rna-1errn of 602 ur ehc €csffieshich 're,s ia og€Eaci"on p r:o E co
acc Eo e E<i :!r.ls p Ec g=ac ln i\ugrrs c
aaie eaLr,cd -
Tha 2rsoc=:7 or.o€E ag=:a3 t. subnrj.c co Se. C=oL: CouacT Zoa:cg acea:l:1cec1on Eor.n, sigE,cd by C:rc orrn€f and b.y 4 ,as.c,a! pla8ber,
J 6rtE:l.y1nar! ?Ilr8ir.E. rasc:1.c:ad ,L':Eb.a or a Lleqas€d ptlagaa veEl-.Ey1ltg cta,c (l) clrr ott-a:.ca ?aaE.t ac.r d,:spo18! ry!cea !s:!n peopcoParac:,39 coa41c1o(t en'd (i) ai'aar lasg.c:iorr. aEd pir8olaE. (1I crc,-rssrrT), elc r.pc:e ce(tle !s L..s c5.n L/3 €lrtl oE sladgc rod sc:rsrCar:1!icaCloc eoE z'Lll. b.r a.lr,C a99Eo:<:arCa!7 30 days ptloE cc
tr:r E ee f aaa .:r?1:ec1otl.
olrtl,cEs oe a.L! cc,J sl'3trelns agrEl(!
!r/lf E, :!':s 'racicES Lt3cd. ha'le rgaci CIe
cc [a:- c:,i.* elre or1'ra c e sa'rage Clspo
chc scrEiarCs sec Eo r:!:,, hc=ele, 4silcn c o i Yae:.rra! SEsorrtrce 3. Car:1!1canci ?rc:r=:.qd eo qhe Sc. C=c l= CcuneTod :5e :Iree yaar .=?1=-clort dacr.
abovq Esqrri;enancs and rg!trr
sal sy!csa ln acscrdanee zi.:::
sae by e!ta tliscctrsLa, Dcpar:-
sclon toml arrse bc cccoLaeaci
Zon lag O e: !c e z:. c hla 30' day
Q:
^.t=:.1J o{ll l--
2 A?=
'l
trt
o
Sc 3'-::- Counc.r a
o - ::;
ct. iti ja0L-<
l-'--',- --- '
,i.-i-.- .:nrt
f l F - i ,< aY \ - -b -
cnin,.:P.0.
Ianmo
'--/
S i ':'t at-?.lt)-,thrrrrE .:.UC,:?x:i.
/L- lra -q3
!
APPLI,CATTON FOR SAIII,TAAf, PERHI,T
.gTC-100
hk epillcrtlon lotm le to be completed ln full anrl elgnOd by the omer(e) ot thc
topert, bcln3 dcvelopcd. Any lnedequaclee rtll only reeult in delaye o[ the pcrnlt
!ru!nc!. Ehould thk dcvelopnent bc lntinded for raeale by omer/contractor, (ttrpei
utQ'f) r then t tecond form chould be tetalned tnd completed rhen the property lt
ld end tubllttad to thll otflce rlth the eppropdlets deed recordlng.
ar ol Propcrty LLAi (,r* t,u L/e*t ra,4et-R Sz=r,,rsv-l
{
etlon of Propctt y S Q \ N,^J tt, secri on /
tuloND .
r2-H-R /g-l,
tp I (+l
llln3 Addrorr /SoS
Nu^,
bS
R.*, tqo ND \rV, 5r/o t 1
Addrrrr of ELtr
t utdiitilon lrar
tatlltnbrr - i> :
v+
I tr.lo N O
LLAU.)U<7L
lNt 5/or7
eA-OOtt S
?rcYlour Ornrr o[ .Dropcrty
fotrl tlro o[ ptrerl,
bst 0e tO
ALB *2
Drto hrcol rrr Grcrtcd /O -q-I
Arr ell cornrrr end lot llnea ldentltlabla? X Iee
lr thlr proprrty betng dcveloped for reealc (apee houee) |
vol..r ,Sb I ' tnd pagc Nuorbcr lK v
^, reeorded rlth t
No
-
fes
--
llo
he Regleter of Dcedr.
tlrcLUDE t{lT[TIII,S APPLI 10N THE TOLIOI{ING
lch lncludee e Documen numbe )vol UM e end Dap e nunber , and thc
bett o d ny lounl
etvi-bed in tlly;s
t
1
rce o 6 the
ttle I nel en tL vhave o tained drt
p
b
tltue,/.,l"on o 6 taid
Coutr.ty R,eg Letr"l. o(
ITGflATURS o, oI{NER
/z'/b -qb
t ran Dced
DATE 8IGTBD
e
SIGIIATURE Or co-o[rNER (rr APPLLCA8LE)
a
a
I
t
aa
E'rl ol the Battatar oa Dtcdr. ln addrtron, i certltred rurveyr ,.t cvirlablcr rrould bc
holplul ro - to arord dcleye of the rGvlcsrng proceee. rf th: dced dercrrptlon rclcr-
anc" to ' c'rtlrrad
'urva, Hrpr th: ccrtltred Survcy Hep ehall e*o ba rcqulrrd.
__:_
f i,
I{EUISILK'b UI.I ILL
8t. cRolx co., wl
Ree'd lor Recordillclrael [t. gt,evelrEr t{ltllan ll. QeIglck,
tltlllam. [t. . Derrlck,
-
Tltomag 8.. Derf lek qtld..'
Itotrald L. Llerrlek as. tetrdttte:ln:eommqll
I nllt l'! tq tlltrl 1,;11 7;1111.1: [rt
. . ..Venture
ri l iow Rlver. .l.oln i
.t
I
.l,lN lg.lSgu,.of g : 30- Il. {n\,'* 0%*{.(!
0 r' Itctttr ot Drorh
t
I
aa.a..a a.aaa.a ..a. a
illunil to
fm llrecl Not .-...-....
lhc! lnllrrrrht? rlerrtlt'rtl rcnl utnta h
Slrrtr of lf lrconrln:
rl
ou t,
€B t.
SEDB
llrtttrl lhlr .
..rrrt?.r trl nctront olqmlml! ln attr
1.16t1flfllllt nl'En
:''i.,. '"" 'll Ir:
t,[|,r, lu.. ltu.q:.,.., lohrurtrtrrl f,rr,perl.r,
lhl lh trotl
l'lircl,tlorr to rr.nttrtnLldl lnU[lOlpal
tdBtrlctlonc Uf r€cordr
s
t{
fI
I
B
o
I
lrenet, QuErter of Northwest Quarter and Nottheaat Quarter
out,rrweet euarter of ;;;[ion-t, Townuhlp 30 Northr Range
II
!r
I
:l
!
I
I!
!l
I
. ;' ,.r.
' ;ii l'idl 'ilii 'r ,' .
, llir.tilil; i',.1-r.,' t
end tonltry ordlnencet I etr€mehtg hnd
rl
rlnf ol 'Waa.....a..aa'
/
9.q.
/W(51*et*a--1s
ulphge l. !1, 9.tey.qn.g...... . it ....
lc),,|,/i t,?,^__ l/ il,,r,rL,,(, rii
, .l{llLlaq! l! , oe.ir.ls.h...
AUrllnNrloAtlotf
,il'i'itl ;t l'L, ; - $i:.}I:i ; tri-til*ifi :
* r r I r t r s ri u tt ar i' ull i-r:n-rr-Fr :tlrrYF:-^' - -'
.ffiHttfili*,nH.tifiirilii-il,,, -" : -
llll$ l$;fi.; il ;'.;i;';:'';"i'tt, r' I e';r'rn'lr' rloth
RAl,'
RA l.'
7(
, ....tl.l t ll.q11.-[:,..P.9.f f191...,r
: 'iii l,'!/t ,I,i /;.,,,"'r",t': i
. ...1'lt9l
3.
{V; t
-none
aBE a be lek
d l,
' - BTJTTE OP WlEcoNEtN
mrt{f
nll.
tlountl'iiri., iri,ii cr1'l
..""":"""t le "
- tVl'r.
I ntln'r
..... .t
rnfrrrllg llt'trl'l l'i t11r;"1 rrr l'tl'nt'd l*lrrr lhtlr lhtthlttrr'
FtAt tr tl.tl .pi ttlFr'o-unlx
a"
tl!T"l:!1 r'$ll lrtmrt l"'' lr'r'
ll
C'
a,
J .07 Ail
Outlot 1 Willow
River
Meadows
nol
a
oo
Publb
.9
-o
=q-
Highway GG
DERRICK 6
(715) 246-2320
Route t
New Richmond
Wisconsin
17
3.00 Er
ao
18
Lo:f As,r16
aot Lru 19
ll-Cl Ail
q
C,
20zql r.rr
15
al6 Ail
305
ttq
L0:l crI14
2.tf Acrtl
13 21 ;
Nttob
rt
2.ql Acrtr
9
204
aot AcrE
2ta
laGlt
I 10
2.0O Acrx
ral.
113.0 r.il
CI-
2-0r AorI12
oO-cat 22 *',(a
GIrte,
a-O Acrr
.I.7a
?,2;2 Ba7
rta
C'O(U aS A.rrB
8 23
2-S l.lr
TIO
G.
24LOr
oa
ai
CDat
r,'D
C'G'
-5
2.01 lcrr!2.,.,r,a
7t.6
o25sg
'it-
CDo 4
a0 A.r-"'l
29
23a lcrtr 2.tl 1.r..27
a, 1
rO(,'r,a
1t 7t.6
Gl
aa
atO
26alt r.tr3UI
F.
C'aa2-,i, B.
507.04
.tcl,-ra
q
C'!t
30
aoa Acrr aa
E!
o-2H
t.tl. rarr
e00.!t0
31
2.cl r.rr
&laJ7
x,t
G;n
f
221l
32s?9ofrF
200
{lq
G'
!
33tra Acr--t:,\
C't,
City oa Nr Rirrrsr<t
R4 GG
u
lA
rD
Wibu
Rivu
CONSTRUCTION rFrO-!
-q
I
6
2.&l Acrr