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HomeMy WebLinkAbout022-1059-10-200 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / . CSMI e Bey LOT SECTION ~e" Tgpr lFW, Town of ST. CROIX COUNTY,-WISCONSIN PLAN. _VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM g ~ _o v °U u - by lid v a INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ' . $ENCHMARR: _,SGf ~ ~ ~ S ALTERNATE BM:,t.1► ;SEPTIC TANK / PQMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /Gc)eO Setback from: Well House /G l Other Pump: Manufacturer ;Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length G Number of trenches Distance & Direction to nearest prop. line: Setback from: well: hc? -House other ELEVATIONS = Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt 0 0) 30A o I c ° 0 3 LO!L a Si T 0 12 C U) Cat O Yn O ~ O ICI j 12 N O• a - m m u~i c ' 0D c Cy 03 I N 3 N f m Sw° rKy c , ` 1 0 Np a o 0 w R S C A O (D 0 OD 0 3 ^r tr O O~ y H ~ O C I v Si A w M I m co vD c. ° w 3 a W oo<' I N3 O se e91 V ~ t W f`D cn z w co ;_u C) r ch 0 CD co c 4 -A 3 T 01 j Al • (p V T lt`iil I °PO r cn ro~I! a4 ~ cntoN ND ' c 3 V 0 0 O O d~ w N I ~ I CT O ~ ~ Sf ~ N ~ ty ~ d a i ~ !mil w N CD 01 CL 7 rn oz I D m 0 -T -b I ~ m N I M fn vi lllCD c CD 'O N• C D) W W co a i z CD C6 A 2 A I o v, a CL A I j I z w M m cl) z I a a I ° ° . z : m 3 I yr z m A N ~ I oc a I 4m y a i I O T (SD N c S. 5r O O N y I ~ o M N 0 11. 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MINN.II?,'rALIFf&DESIGNER LIC.NO.00663 I 3 - q)_.. 1 9)k.fo f1S'-fO f p 4 RI ....„..,........„) 6 m, .. 1 8 D �p Alle ie i I'll ,�/t \? o CO Al'. 4 ,,> - ,i3 i " 2 ; \ 93 2•yY G. &y -Ir LEUATlO P S ES% 4I5//ED /// �l G to ea t e kitr,Pk .Po 00 P MIA) a' c u tl 93V. 'V qi 132_ I3y 2-O • 3 C3 �13 D . �'s' �/' 99 `I R � w,�dk 9 y „ 54,0 ptm-TioA f i �3yyo " — F0 v,,,t7 , Svl'oe yore'sL -- _"� ca to t/2 I • Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division 8T. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarKP~gur~jt.NQ.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. L t5 y i / U LOW~EF,oIdW&NN ~!W1RM11 Tpwn of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tdit _:1059-10-200 TANK INFORMATION ELEVATION DATA A9700187 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic rI%'c cU eti r Y / ~iJ Benchmark Dosin Aeration Bldg. Sewer Holding St/FT Inlet TANK SETBACK INFORMATION St/A Outlet 6,/0/ Verit irIto ntake ROAD Dt Inlet TANK TO P / L WELL BLDG. A Air Septic NA Dt Bottom Dosing NA Headers 7.52 Aeration NA Dist. Pipe '7,70' -7 &4 Holding Bot. System ' 8, 61, PU P / SIPHON INFORMATION Final Grade Manufacturer Demand Model Nu M T Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well F-- SOIL ABSORPTION SYSTEM PIT No. Of Pits Inside Dia. Liquid Depth BED/TRENCH Width Length No. Of Trenches I 4 DIMENSIONS DIMENSIONS ACHING nufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O CHAMBER model Number: System:.. OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Ho x Hole Spacing Vent To Air ake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Moun r At-Grade Systems Only Depth Over Depth Over xx Dep Of xx Seeded/Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes El No El Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC 21.28.18,NE,NE 1171 30TH AVENUE LOT 2 Plan revision required? s ❑ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Chec'~it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location lj,L 1/4 1/4, Sa j T ;Z N, R k~E (or) Property Owner's Mailing Address Lot Number Block Number S ' try City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Vilage Public 1 or 2 Family Dwelling - No. of bedrooms _ Town of ,,v 'o , : . 5' 7"~Y III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo - 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. M New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an. System System Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 210 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 KUSeepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6_ System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 356 f0 "",6& r 3- Feet Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks 1~ ~L+ji r ❑ ❑ ❑ ❑ ❑ Septic Tank or Holding Tank X- Q~ ' /Yt d 4, Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps)V}LNQ: Yu,, ss Phone Number: 7 9,01'1 -2/5 Plumber's Address (Street, City, State, Zip d c Qom- S' a l? ~ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issue Issuing Agent Signat ~Approvecl Surchargeee) ❑ Owner Given Initial /go Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: original to county, One copy To: Safety & Buildings Divr ion, Owner, Plumber INSTRUCTIONS 1 . A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815.. , To be complete and accurate this sanitary permit application must include: t. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of-surcharges (fees) for a number of regulated practices Which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. J Q A. rte' ~4- K. ~~56 ~~~lad t~ v ~ ~y U x h y r ,64 ~e3 v G I Wisconsin DepartmW of Industry, SOIL AND SITE EVALUATION REPORT Page! of 3 Labor and Human Relations DiNision of Safety & Wkings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but Ste' X not limited to vertical and horizontal reference pant (BAV. direction and % of slope, scale or PARCEL 1•d• # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER ~Cb1-o tYS LO w er PROPERTY LOCATION $vk~R 0-V'T"L41 3 1.13wE GGW.IAff Ptr 1/4 IVY 1/4,SZt T Z1 N,R E( PROPERTY OWNER`-.S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [MOWN NEAREST ROAD ?,IUD FAILQ, WI 5\.oZ2 (7 IS) LLZS _SS1O ku~ C`RL evtC S`CT} (~5" P4 New Constriction Use [ J Residential / Number of bedrooms [ ) j j R cement [ j Public or commercial describe V~-GR t C u`Ty~L F BARN w eR'ft Code derived daily flow 3 o gpd Recommended design loading rate .__bed, gP( ' S trends, gP~ Absorption area required S a bed, ft2 6 o o trench, ft2 Ma)dmum design loading rate • bed, gpolft2 ' S trench, gpo1ft2 Recommended infiltration surface elevation(s) q 8.O ft (as referred ID site plan benchmark) Additional design / site considerations C o~,nM e~\jD Z Nw <-,tints, L2-r~tti S 'x 6 t s' L W c tit- ° SF IN^ P I CM b . Parentmaterial S1L~tti 3VU1KeVj oueIL Ny'r-k-5+4 Flood plain elevation, if applicable 1y- It S = Suitable for system CONVENTIONAL MOUND M-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable f o r stem JM S❑ U WS ❑ U IRIS ❑ U US ❑ U ❑ S ICU ❑ s o U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Coat color Gr. Sz. Sh. Bed lends o_lZ IIW-kZ 3Lz S~ 1 Z&, s~ Vn eg • S .6 z \.z. _.g L o't tZ alb s i Zwn s bk yn C-S S Ground 3 ~g ~o -S ~t R- 31 S I l ~sbh M v elev. loft 3 G~rv w S O1~ sytZ ~~6 `~S Depth to limiting factorO Remarks: Boring # . S , Z Z ~3 1.0 `t 2 3 ! ` ~ S l ~ Z ~ Sb1Z 1NL h Cg ~ • S - ~ 3 X70 l-S`tCL 3l S~ `CS~h lvtV`~H - •L( .S Ground elev. 3 S L` KAYL- lol-j. ft Depth to limiting factor '2 -ion Remarks: CST Nine-Please Pmt Arthur L. We erer Phone: 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Sgnadue o! - 3 Dace Z - 1--) - cY .-7 CST Number PROPERTY OWNER OWE SOIL DESCRIPTION REPORT Page Z of •3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rends 3 0 - ~'Z 1l~ ~ 2 312- s ' Z s b V~ es , s . C Z ~Z-32 10ti rz 316 s l l ZSb ~n `Fh C S • S • 6 Ground 3 3 z b 'z . S `t R 31's I C5 b~ Vvr I- • q . S elev. 100 --L ft. Depth to limiting '1lh i r Remarks: Boring # 0-14 lb `1R 3 !Z S1 J ZM s}o ~`i1- ~S . 5 I . 4 Zy 1~~R 31L si) Z` -5bk m-F. cs • S , -b -1 zy-S L -l . S I IZ-3 L -S 1 (1S M U D S c w Ground elev. ~6 _ b(. lO " l IZ 3l Scj l C-S b~ m ~ . Z ~ . 3 RR.~ ft. Deppth to i limfting j faclb`,~ I i Remarks: Boring # S Z t3 If Lv1fZ 31` - SII z 5' vyi` i, _,S •5 Ground 3 Z~f `)S S ,-f IZ 3 f - S I l C S b h m wfh • 1,5 elev. 10b.8 ft. i Depth to ! limiting factor E 7-7 Si t i t Remarks: Boring # ,13 Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) ' PLOT PLAN Page . 3 of 3_ SCALE 1"= L[O ' ZSO~~ - ~ \ . T l.ll~l-: 0~ hQ~11? ~ 1 O rre_1~~ ~,S 1~r, . L S > S O t~sT O~ S 4 S`T~'t 1''fILLs1l~ . - . Z . c \S~)u G Lv~Lt_ lS > too' Qf.~ o r- 3. S~Ct.~Pn9L~~ _t3t~J~ 1`0 3E FAT ~3T ~.~`-ti:a4Z-Tb~ vF TR-~.1C~s, - - R o o s L L> v►'i ~S D Dv~. Yti ~1:6~~ -N \~~~~e,jcj~2 -%ET-JecW \ZLtIG. \~vv SLrSTt)-t ~o . ~ 9Q Ga et-~Oty S • 1 X1,49 ~ ZL:toO.v one 8-S \ Xcl 'MCA, S 19,h'bIR. 3qo ELLOb$ WE,-%M Nt'XT P Tb hen t-- o. \~\i~I Cg L~ 4Z , s t s s g.3 ~-~01 s cao a U ~p q-1 31 . '7 (715 ) 42.5-ni~5 M00576 CST Signature Date Sign Telephone No. CST # PAC I 3 GF PUMP CHAMBER CROSS SECTIOIJ AUG SPECIFICAT10k1S VE UT CAP • 'i"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKING > 25' FROM DOOR JUNCTION BOX MANHOLE COVER - , WINDOW OR FRESH 12"MIU. AIR INTAKE I GRADE I `I" MIN. 18"h11fJ. COAIDUIT 18"MIA1. \ 11~ IMLET :~:v PROVIDE I AIRTIGHT SEAL * A I III I III I I I ALARM B I II I 1 *APPROVED I I OM JOINTS WITH I ELEV. FT APPROVED PIPE I 3' ONTO PUMP ` OFF 0 SOLID SOIL COAICRETE BLOCK RISER EXIT PERMITTED OWLH IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE ' TAWKS MAWUFACTURER: It/J~Lde4'T~4"-~ kJUMBER OF DOSES: 3 PER DAM TAWK SIZE: _ 4GALLOWS DOSE VOLUME ALARM MAUUFACTURER: _ aek faY t~ ~ INCLUDIMG BAC~KFLOW: CALLOUS MODEL WUMBER: p4 y CAPACITIES: A=~~ INCHES OR 311GGALLOUS SWITCH TYPE: 1:~-2 FQom/ %;5~IMCHESOR GALLONS PUMP MAMUFACTURER: ~i«~ IAICHES OR d76 GALLONS I MODEL NUMBER: ~D D ~ INCHES OR /9GALLONS SWITCH TYPE: Il-7 eYL( NOTE: PUMP AMD ALARM ARE TO BE MIAIIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEREMCE BETWEEM PUMP OFF AMD DISTRIBUTION PIPE.. 6 FEET + MIIAA IIMUM WETWORK SUPPLY PRESSURE . . . _ . _ 400► FEET + FEET OF FORCE MAIN X 1,27 F/loo FLFRlC71oA1 FACTOR.. FEET TOTAL DyWAMIC HEAD = `3 FEET IMTERWAL DIMEMSIONC OF TANK: LEAIGTH ;WIDTH ;LIQUID DEPTH I SIC,KIE F): Goulds Submersible Effluent Pump o C~ EP04 EP05 387' ip • Fully submerged in high ■ Motor Housing: Cast iron APPLICATIONS • Fasteners: 300 series stainlesnteel grade turbine oil for for efficient heat transfer, . Specifically designed for the a Capable of running lubrication and efficient strength, and durability. following uses: dry-without damage to heat transfer. ■ Motor Cover; Thermoplas- • Effluent systems - components. tic cover with Integra- handle • Homes Available for automatic and and float switch'attachment Motor: manual operation. Automatic points Farms • Heavy duty sump • EP04 Single phase: 0.4 HP, models include Mechanical Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power.Cable Severe duty • RPM, built in overload with preset at the factory. rated oil a"n" water resistant. • Dewatering automatic reset. ■ Bearings: Upper and lower • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, construction. Pump: EP04 built in overload with ■ EP04 Impeller: Thermo- Solids handling capability: automatic reset. plastic Semi-open design AGENCY LISTING . 314";maximum. • Power cord: 10 foot with pump out vanes for - ~.C"pacities~~ip to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. CO- Canadian StandardsAssociauon r • dotal heads' up to 24 feet. with three prong grounding Ep05 Impeller: Thermo- (GSA listed model numbers ' • Discharge size :1'/i NPT. plug. Optional 20 foot plastic enclosed design for end in "F° or "AC".) • Mechanical seal: carbon- length, 16/3 SJTW with improved performance. rotary/ceramic-stationary, three prong grounding plug to Casing and Base: Rugged BUNA-N elastomers. (standard on EP05). thermoplastic design provides • Temperature: superior strength and 104°F (400C) continuous corrosion resistance. 140°F (600C) intermittent. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running s 30 dry without damage to components. Pump: EP05 s 25 • Solids handling capability: o 7 3/4" maximum. W • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. • Discharge size: 11N NPT. z 5 • Mechanical seal: carbon- 0 15 rotary/ceramic-stationary, 4 BUNA-N elastomers. Q o • Temperature: 3 10 104°F (40°C) continuous - 140°F (60°C) intermittent. 2 5 0 00 10 20 30 40 50 GPM _ s a 1 p 12 m°Itt 0 2 4 CAPACITY Effective May, 1995 83871 0 1995 Goulds Pumps. Inc. CERTIFIED SURVEY MAP THOMAS LOWE,ETUX Part of the Northeast 1 /4 of the Northeast 1/4 and the Northwest 1 /4 of the Northeast 1 /4 of Section 21, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. oIndicates 1" x 24" iron pipe weighing N //4 COR. SEC. 21, r28N, RI &W, / 1.13 lbs. /lin. ft. set. / couNrY SURVEYOR'S NON.) LAA -f-j~Indicates fence. UN / NE COR. SEC.2/, r28N, R/BW, / , O 111 /BERN rS £N NAIL FOUND) 5 / / / VpR N 89.05'30"W 2679.77 S'T~ m N LINE NE 114 0 1736.77' © - v . S 89 3230 "E 330.86' -7V 117- AIV& - 923./0 O 6.07 °j N73'//'S3'E I ~i M 9.28, 56'59' W 100 66..00 001 o-- S-DR/VEW Y EASEMENT - - - - a N 89'32'30"W 66.07' q ~ O, b oI ROAD SETBACK LINE m p '1 b O I N N O N h O N90.00'00"E N 39. Lid' y W t QI b ~ J i b LOT 2 Z: 3 4j O /0.00/ ACRES M Jj b0 m 433,643 SO. Fr, b Q 9.901 ACRES EXC. ROAD R.O.W. W Z m J 431, 287 SO.Fr. ~I W 2 2 O O CX. m O J Owner's Address: JI 290 Highway "65" 0 2 W y River Falls, WI 54022 h JI e h 3 2 b Q 2 Q W m 2 J ~ N Q ti N 90'00'00 "W 484.00' UNPLATTED LANDS SCALE / 200 ' ^ O,YS/ 00I 0 50' 100' 200' 300' 400' 500' 600' r LAU m tPHY'•. °C r - CERTIFIED SURVEY MAP THOMAS LOWE, ETUX Part of the Northeast 1/4 of the Northeast 1/4 and the Northwest 1/4 of the Northeast 1/4 of Section 21, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. CURVE DATA: / - 2 Chord Bearing: - N 71040'43"E Chord Dist. - 106.65' Radius - 2011.05' Arc. Dist. - 106.66' Central Angle - 03 02'20" 1st Tan. Bearing - N 73°11'53"E 2nd Tan. Bearing - N 70°09'33"E Description: That certain parcel of land located in the Northeast 1/4 of the Northeast 1/4 and the Northwest 1/4 of the Northeast 1/4 of Section 21, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows; Commencing at the Northeast corner of said Section 21, thence S 89°05'30"W (assumed bearing on the North line of the Northeast 1/4 of said Section 21) a distance of 923.10'; thence S 01°56'59"E 48.39' to the POINT OF BEGINNING, of the parcel to be herein described; thence S 01° 56'59"E 288.00' thence N 90°00'00"E 39.00' thence S 01 °18'03"E 639.35' thence N 90°00'00"W 484:00' thence N 01°18'03"W 893.69'; thence N 73°1 1'53"E 9.28'; thence Easterly on a curve concave to the North, having a radius of 2011.05', whose chord bears N 71°40'43"E a distance of 106.65; thence S 89°32'30"E 330.86' to the POINT OF BEGINNING, containing 10.001 acres or 435,643 square feet, being subject to that driveway easement as shown on this parcel for the benefit of the grantor, his heirs or assigns and also being subject to easements of record. GENERAL NOTICE STATEMENT: Note: Each parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the appropriate Town Board for advice. State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owners, Thomas Lowe, ETUX, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and correct representation thereof. \SG,O NS This instrument drafted by Laurence W. Murphy / 10 10 LAU. 0 E • STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O WNERIBUYEa MAILING ADDRESS N~ ~,`G!t'Y ra ll s t✓ t ` PROPERTY ADDRESS I ~ 7 tl 3D 7"A 0~c- (location of septic system) Please obtain from the Planning Dept. CITY/STATE ` U o- ~~S l✓ 4 a PROPERTY LOCATION 1/4, V15- 1/4, Section 2 T N-R l W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMER CERTIFIED SURVEY MAP 8Y~?, VOLUME Z, PAGE3-2i/G, LOT NUMBER ~2, 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. LINkle, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expirati te. SIGNED: DATE St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 r r 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result 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. Owner of property Location of property_A/G 1/41/4 , Section T_Q~'N-R W Township Mailing address Address of site i~„p 3D 7.4 W Pd Subdivision name Sf Lot no. Other homes on property? Yes No Previous owner of property Total size of property /er,, r Y Total size of parcel Date parcel was created _-7 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes _-_t_No Volume 1.239 and Page Number J 4~ 1 _ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) 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 recorded in the office of the County Register of Deeds as Document No. SU_%G e 7 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Appli Co-Applicant ~ 7/?,;; - Date df Signature Date of Signature DOCUMENT NO. WARRASlT DAB 55900'7 Yol -1 7POT36 r_ - - .77 lhaeas D. low, a/k/a Ibmas 1. Lows and neverly A. Lmn. husband and wife, Grantor, conveys and warrants to M. Carob Iaw, Grantee, the following described real estate in St. Croix County. State Of ,ikan wa wisconsin& I ( MAY, 7 'A91 tit f.1 Part of the Northeast Quarter of the Northeast Quarts (NE 1/4 of Ne 10~:00 A * L,~w 1/4) and the Northwest Quarter of the Northeast Quusrter (NW 1/4 of NE ) 1 1/4) of Section Twenty One (21)• Township Twenty Eight (28) North, yp,.~tL~~ s Range Eighteen (16) West, Town of Kinnickinnic, St. Croix County, ►+r5t 1 wisconsi.., described as Lot Two (2) in Volume 11, Page 3246 of Certified Survey Maps recorded in St. Croix county register of Deeds Office as Document Number 558427. [-River AM6 AND RETURN ALDRESS Leo A. Beskar, Attorney RGDLI, BESKAR, BOLES & KRUEGER, S.C. .119 North Main Street, P. O. Box 138 Falls, wI 54022 ?areal :c3entification Number PINT EXEMPT This is not homestead property. Exception to warranties All easements, restrictions and rights-of-way of record, if .any. Dat-d this 5th day of May. 1997. ' M 7.w..a~ n u-~_ ( SEAt.1 (SEAL) lhanas D. Lows, a k a lhamas 1. Low (SEAL) (SEAL) fever y A. LQUIr/ AUlITMICUION ACZPMuDOCN! Signa r s) of Thomas D. Lcw a/k/a STATE OF Wisconsin 1 i s~. Coum 1 • Personally came before me this day of auth t 5th d~ of May. 1997. t9 eve named /-O to me known to the person(a) who executed the * Lso A. Nakas foregoing instrument and acknowledge the same. TITLEo MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. State.) Notary Public County, Wis. 1219 M WAS DRAr= lAo nesarf *j BY: MY comniwsion is permanent. (If not, expiration date, Le A.. Mskns, Attoterasy RGDLI, BESKAR, BOLES i KRUEGER. S.C. 19 ) 219 North Main Street, P. O. Box 138 River Fails, WI 54022 N -