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AI.SH REGISTER OF DEEDS CERTI FI EC S V RVEY MAP RECEIVVEEIDxFOR" fiERCORD 89/2672095 03:66PM LOCATED IN PART OF GOVERNMENT LOT 1 OF CERTIFIED SURVEY MAP SECTION 28, T29N, R18W, TOWN OF WARREN, REC FEE: 13.60 ST. CROIX COUNTY, WISCONSIN. COPY FEE: 3.00 PAGES: 2 OWNER SURVEYOR DAVID COYER EDWIN C FLANUM 1122 76TH AVENUE NORTHLAND SURVEYING, INC. ROBERTS, WI 54023 P.O. BOX 14 LEGEND ROBERTS, WI 54023 X SECTION CORNER POSITIONED FROM WITNESS MONUMENTS OF RECORD 0 1 5/16" O.D. IRON PIPE FOUND SCALE IN FEET 1"= 100' 0 1" O.D. IRON PIPE FOUND 100 0 100 O V X 24" IRON PIPE SET WEIGHING 1.13 LBS. PER LINEAR FOOT • • • • • • • • • • 100' BUILDING SETBACK UNE NW CORNER N1/4 CORNER ` SECTION 28 SECTION 28 1 S89°41'48"E 2649.14' ` 531.10' ~ 2118.04' 1 NORTH LINE OF THE NW1/4 L(~~0n4n 9 ~ C71 92 ' oo ~ a m n oo` ~g\ WELL 11 ,ice RECEIVED►~ 3~I1.1 LOT 7 Z®~ N. N taa 2.60 ACRES INC. RNV 11j N fig? 113,195 SO. FT. (u C `I~ Q Q 2.45 ACRES EXC. R/W j • • w Mai! I S 106.782 SO. FT: • SEPTIC i ST. MOW COUFRY I ' SURVEYOR`S FEWW lid 1s1.a8 -I a_1 33.°a 46'08"E 194•'48 _ - I~ ao~ ~ ~ coo= OR ' 1 G_o3_ of~tla DGvJ m `I MOO - 9 ~s - - -s o T m 'N N ~m c) ~;Z~ y p ~ 1 m CURVE DATA TABLE I' NUMBER C1 RADIUS 1017.00 1 ' CENTRAL ANGLE 14°23'15" ` CHORD BEARING N74°34'30.5"E 1 ' CHORD LENGTH 254.71' ARC LENGTH 255.38' THIS INSTRUMENT DRAFTED BY SAM ADAMS TANGENT IN N81°46'08"E JOB NO. 05-75 DATE 7-28-05 SHEET 1 OF 2 SHEETS TANGENT OUT N67°22'53"E ' Vol 20 Page 5076 Parcel 042-1076-90-125 01i03/2008 03:47 PM PAGE 1 OF 1 Alt. Parcel 28.29.18.437A-09 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09/28/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - COYER, DAVID D & CAROL J DAVID D & CAROL J COYER 1122 76TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ` 1122 76TH AVE SC 2422 ST CROIX CENTRAL ~i SP 1700 WITC ` C f Legal Description: Acres: 2.600 Plat: 5076-CSM 20-5076 042-05 SEC 28 T29N R18W PT NW SW & GOVT LOT 1 Block/Condo Bldg: LOT 01 BEING CSM 20-5076 LOT 1 (2.600AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 28-29N-18W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 05/26/2004 763951 18/4760 CSM 08/19/2002 687470 1952/259 AFF 08/19/2002 687469 1952/257 WD 07/23/1997 1077/415 WD more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 226873 267,100 Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.600 41,000 156,100 197,100 NO Totals for 2007: General Property 2.600 41,000 156,100 197,100 Woodland 0.000 0 0 Totals for 2006: General Property 2.600 41,000 156,100 197,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/0312006 Batch 06-15 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 435 3 435A-20 P-1-it Yso 32() 32 aii 4, 7 I 2 Dpi II 436A-10 1., 1 1 CSM 18-4760 - - 11 ' •1 .0~~ - ~ sal _ w 1 QU' - 438A-05 05 436A-05 1 ~ ZLt ' io ~ LO' co 1k52/2 4 1952/259 cli 1 ~ CSM VOL 11 P X206 N i 437A-06 i 438A-02 _4.370---.- I LOT 5 i j 437E Col 1 1 CSM VOL 14 PG 3840 I I 509.3 1 ' 1 CSM VOL 10 PG 2747 I ` 1 ~ of 437C EAST TWIN LAKE NI LOTS 1 1 j 333.64 1 '~1 r4 -04 s o a' n Q. s v Q. n r- ;o i p r0 -h O O O 3 I-< 'Z rD ID P ID z ~ 0 301 +n3'Dnf.+Q~o t:j p p n t+ 1 a N r0 BEARINGS ARE REFERENCED TO THE D ~o e+ 3 to O c NORTH LINE OF THE NW1/4 OF SECTION -5 '3 In ~rt p 'D C m '0 p 28, ASSUMED TO BEAR N89'41'47'W. In0 '0 3<Q S -R ip r+ Q 3 p 3 rF L rq~ O m Q o '3 < 0- Ul O q F r" co ro ro -3 In N O n p rp 3 p 3 3 z 0 3 ~0 p fD (D CO CD Q MOO 41, 9- ID < W41 8 In 0 p, > 0 ffl r+ CL rD NH S o ~ - o _ a /O~~atP ON-0 b m 00~~ M 0 _ m z ZS/ cu 90'L89 L N z o O Z 10~ 1N3WN>=13/00 4~Oa 2N1 ; 3.004 O 0 =10 3NI11SB so m to Z~2 mzm V) 0 -q Z INS r -4 W N i z o Q I c c C7 1'S I - z A N A3;2 I L`~"~~N 681 n<516£40 ~A R3 m 1p1 , V 414 eeo ~ilj,cayss z > o~ opf m _4 N OD Om ORD7 ~~p a 1~ AO AI'I'IIIIIII'~' a pw w w w m E D A o N111 rn 1111'I'r'1' 1 O S$ grn ,~1' f ta, 1 1 1 1 1~ , 1 1 1 1 1 1 -4 0 ` Q O D m! I~Illllllllllllt I~ N 'nom ~((D 11//~1~ ~O ~S , I, I, I, I I I 1 I 1111 Ica A m 0 i ° °°9Z7 1/ '7 II 11'1'1'11111111 Z I V 00 O G? 9 Oi$m I 1 n 1 1 1 1 1 1 1 ~i'11III I W (A 1 co N N ~ III 1 1 1 I I I I b° I 9 on C~ A 171 I e IIIIIII1111 ~ I Z ZZZz9)o^ i SC 111,1111 I,VIII ono v rn v ~o D I- o w 1, V I I I I I I I rn IQ 9 N 4~? 46 4: Q r r ~a m IIIIIIII VIII O ~ I I I I I I I I W CA vi A ( I I I I F- I I I bb N A GO I- ro I I I I I I Qp I 9 0 m m m m ' I 1 1 1 L f' ~.~r ' 111111) 'I'I'I ~ I~ 01 I I ,6Z' L6 l 3.90I90.90S I I I I I 1 1 1 1 1 1 I I 1 I I I m N Ill I I I I I I g6.90S)I 1461-1 ' ' I' I' I IAn 0 0 (DD oN Nr VII'I' I I'I'I I'I I I I 1~~ 1 I I I I Ivv ~'n -4 -4 4p I I I 1 1 1 1 1 1 1 1 1 1 'I~I'I'I'I'llll ~ CC) W W g = I° I I I I r 1 I I 1 1 I I 1 1 I I I I I 1 1 Q N ~I 1 1 1 1 1 1 1 1 1 1 1 1 mm v N CJ Q I~ I I I I I I I I I I I I I III', I,' I I I ct) 'i A ig I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I I III 00 I Q +11111,111111111111111 I I I 1 1 1 1 1 1 1 r _ -A :0 m A 19£'LO£ l9tLC*ZOS Z o <Z w rn C5 C m -n 9-1 m~ (A CA (A (A ~ ~cwnvyAa~ ul rwfi rrl rr-4 Z 11 M m A > os m zz~z -I~ 1 1 1 mo m~ 4 co c2 ° 7° w 0 ocn, I I I ND Ch 0 (D V W W -4:3 1'1'1 O • O t; di g 4 I I Of (40 9 co I I I Z T T T vr~ ':'a`t Parcel 042-1076-90-400 06/30/2005 04:53 PM PAGE 1 OF 7 Alt. Parcel 28.29.18.437D 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner " COYER, DAVID D & CAROL J DAVID D & CAROL J COYER 1122 76TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.450 Plat: N/A-NOT AVAILABLE SEC 28 T29N R18W PT GOV LOT 1_& 2 BEING Block/Condo Bldg: OUTLOT 1 CSM C YTract(s): (Sec-Twn-Rng 401/4 1601/4) 28-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 1.450 1,000 0 1,000 NO Totals for 2005: General Property 1.450 1,000 0 1,000 Woodland 0.000 0 0 Totals for 2004: General Property 1.450 1,000 0 1,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 FILED ~ 97 U4 JAN 1 1 1997 r► " OR 14 19 MTHLEEN H. WALSR ' Register of ST. CROIX COUNTY 554947 6 sL Croix SURVEYOR'S RECORD This instrument drafted ~ leskacek Proj. No. 96-67 0- "110M n Bearings are referenced to the east-west CA :E ,b 1 /4 line of Section 28, assumed to bear F) t9 Oy /ED N90°00'00"E. O 0o H qq . z OND' 19 ,v JAN 2 8 '"g]' ri) t_ o tzj 0 4 iz4iX COUNTY ~ ° ) n Go jt estsive Ptannie °a 1 0 ~ / O• R+ ...Oning and x1 w ParKS Covnmitteg Z to z C1 0 Vi0 0 0 '"a z 94 not recorded < ' ~ 1 0 W W"I'P:n 30 days of rt, g o jap •J M date °o N orr,yal shad be ~ .4 P- (D rii 0 z c Q311d n o En 0 (D 0 SQNd1 0 - ~ oW ~ _ ~ r - H1Zt o 13 S . o, = o r r'r W CD t1i Ua - - r O W W Peoi UM04 }o aU l l v c 0 W M -3 C1. C ~ ► EZ • 6+►S ~ ~ Q 70 00' b ogON m coo 0 o C 0 ~ M++ ` t a c o (D 0 In 0 c+ h1 TI cn w 00 i~ 0 0. ~a 0 F0 17~ /r0r~ (D d o ® w ni 1~ (t C/) ? C 0, wkE ` Its Z ; r a~ o < 0 ` \ Ir rt m la ~ Z IZ N OD `G wo woo Ifi 'O -O 10 m O w\~ ~~4 IC rt oJ9 00 i~ . o N to fn 0 \ tp - N 01 \ W N I~ 00 W 4- Z 00 o ~2 IM o o A- oo O m I G ` C2 -P P- q0 o to - m to 1 t- tD as E IA z c*tij ' , IZ ~tatf':. IO N N l Ir - td M IC/) Parcel 042-1076-95-120 07i06i2005 12:47 PM PAGE 1 OF 1 Alt. Parcel 28.29.18.438A-02 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * COYER, DAVID D & CAROL J DAVID D & CAROL J COYER 1122 76TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.966 lat: N/A-NOT AVAILABLE SEC 28 T29N R18W PT GOV LOT EXC CSM Block/Condo Bldg: 11/3206 & EXC AS DESC IN WD-1952/257 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 08/19/2002 687470 1952/259 AFF 08/19/2002 687469 1952/257 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/22/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 5.000 700 0 700 NO UNDEVELOPED G5 12.090 1,200 0 1,200 NO AGRICULTURAL FOREST G5M 23.876 47,800 0 47,800 NO Totals for 2005: General Property 40.966 49,700 0 49,700 Woodland 0.000 0 0 Totals for 2004: General Property 40.966 97,400 0 97,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 03/31/2005 02:12 PM Parcel 042-1076-90-050 PAGE 1 OF 1 Alt. Parcel 28.29.18.437A-05 042 - TOWN OF WARREN Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 05/26/2004 00 0 Tax Address: Owner(s): Current Owner " COYER, DAVID D & CAROL J DAVID D & CAROL J COYER 1122 76TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 4.464 Plat: N/A-NOT AVAILABLE SEC 28 T29N R18W PRT SW E OF HWY & PT GL Block/Condo Bldg: 1 EXC PT TO CSM 9/2418 & EXC PT TO CSM 9/2691 & EXC PT TO CSM 10/2747 & EXC CSM Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 11/3206 & EXC PT TO CSM 14/3840 & INC PT 28-29N-18W CSM 11/3206 DESC AS COMM NW COR SD CSM; TH S 24'E 311.12FT;TH ALNG A CHORD THAT more... Notes: Parcel History: Date Doc # Vol/Page Type 08/19/2002 687470 1952/259 AFF 08/19/2002 687469 1952/257 WD 07/23/1997 1077/415 WD 07/23/1997 686/171 LC more... 2004 SUMMARY Bill M Fair Market Value: Assessed with: 38488 219,900 Valuations: Last Changed: 07/11/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.464 47,300 146,200 193,500 NO Totals for 2004: General Property 4.464 47,300 146,200 193,500 Woodland 0.000 0 0 Totals for 2003: General Property 4.464 47,300 146,200 193,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 T T ITV ~ ~ T T T T i o U VRI UNon ~ 86th Ave 20 9 21 - 800 c & e42• ;JAI e. 14t Av 836 aJ~ C o • -F-~ C 0 62 8 ~ 8 C 0 818 . 818 C CD aTo T 81 T T T O O ~O T ~ .T-T g T 18oth Ave. A °o c~ rn T r~ 796 M c 794 c 7 792 o c a M V) T o o 786 , ~ - 78 781 N 775 76 n N 767 760 757 V A • 759 29 • • 753 75 28 750 752 7 . 737 746 736 743 740 738 .i 728 T- 733 Twin es ~I I~ 722 721 722 00 714 7 721 4 ( u o n T T T Hall T / i . 7th e 7o6 a sss T M M N r~ N O O T T '.+^.i 667 VJ T co 33 T 651 32 - s43 T 3 ER • T 632 T 4638 6r 631 -OD 0 = 615 621 0-0 M m A O • p m r r r 0 607 605 601 n N O s m n C ~1 ° ro _ 1 (DD v oM i ~ ~ .0 ! m m m O CC m O+ girl 3 N C W r. ~ N N I~ tD a co Ao m co p O_ CD N O > _a O r O ^ (D 0) N - 01 O co r 00 cQ (=D ~n J J ~O O. 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O'r7to?- /07&-8;0-0700 1121,P-4-10 ~639s i P I~ VOL 18 PAGE 4760 D~ KATHEM H. pp REGISTER OF DEEDS RECEIVVEEDD FOORR•RECORD fi CERTIFIED SURVEY MAP 05/26/2"4 04t15PM LOCATED IN PART OF THE NW1/4 OF THE NW1/4 CERTIFIED SURVEY MAP AND IN PART OF GOVERNMENT LOT 1 OF REC FEEL 13.416 COPY FEE t 3.60 SECTION 28, T29N, R1 8W, TOWN OF WARREN, PAGESt 2 ST. CROIX COUNTY, WISCONSIN. S89°41'48"E NORTH LONE OF THE NW1/4 N1/4 CORNER 531.10' 2118.04' SECTION 28 UNPLAT'TED LANDS o N Z y PLATTER o N OWNER N m 889902wW 329.32' ( 3.28 296.04' t.f DAVID COYER II 1122 75TH AVENUE g ROBERTS, WI 54023 1 G SOIL BORINGS ~ • (TYPICAL) 1 Z SURVEYOR EDWIN C FLANUM 1 NORTHLAND SURVEYING, INC. 856 A HWY "65" ' 'l l• 1 w"l z ROBERTS, WI 54023 ~n 0 fn 1v LOT 2 m~ N ' 2.9 ACRES INC. R/W 129,354 1 Z 129,354 SO. FT. . Z 1 v m Q 2.66 ACRES EXC. R/W (q 1 ) _ 115,697 SO. FT. w 1 n Z Q 1 g EXISTING FIELD DRIVE p 1 Z m 6 5 -TjZ 1 m o „ 1 m o C4 P - Iv Z 0 1 r ~O A 301.85 ' • N~.2N20"E 334.85 11 O 1 Z Go- 33.01' 0 N % r 1~ 1 m~ I 1~ 1 Cp 1 Tn 111OT 1 APPROVED 1~3 .75 ACRES WC. R/W ST. CROIX COUNTY 1 119,897 SO. FT. Ph nnino Zoning and Parks Committee 1 2.45 ACRES EXC. R/W 10 MAY 2 6 2004 11 (n ' oPROPOSED 106,589 SO. FT. 1 O pRIVE If not rsoorded within 30 days of 1 approval data approval shall be null and void 1 Z ; 11v LEG END l ~ 11 + ; ~259~ 38p $6. ~y X ST. CROIX COUNTY StCTION CORNER 1 att POSITIONED FROM WITNESS O 1 % MONUMENTS OF RECORD 11 ,~a. 1 ~Arg ~vOw~ 0 1" X 24" IRON PIPE SET WEIGHING 1 TI7 T 1.13 LBS. PER LINEAR FOOT 1 `A ' 1O1►~ J i • 1 5/16" O.D. IRON PIPE FOUND 1 N 11 ~1 / / • 100' ROADWAY SETBACK LINE 33' 33' SCALE IN FEET 1" = 100' 100 0 100 200 SHEET 1 OF 2 SHEETS Vol 18 Page 4760 n CO) p C T n C7 _ 1 C d _ 1 p rJ 3 m (D T 5 o 3 •Z' : 3 a N A~ N N O p. p (D w - fD c_O r O y O ` N = _O p OD J C \('1,1 N C' a O 0 A CD Q O C D 3 a o N x p 0 CA N O O ~1 d V t l~ri z D ° l G io D m CL 3 CD N CD ~ o o h n r ti N A A Tl fJ7 O = CD (D O O O N E - z U1 to f/1 ca cn p D - CD Cr ( G A° 2 (D N OD ~1 T. w !V co CD - N N A CD D1 O _ 0) CD 0 D o O iO n a . CD lv p N N I~ x p_ O A - FD ~ 7 ~ r FD O d Z N C A ~ n N r c0 3 p z a 4 to N z 0 3 a 3 z w z CD w m D (D a (D O - 7 N O C (D O. v CA) A 0 1 Sr ~ T 3 N a rZ C w O O Olt A O ~ ;A A Q It ° C) lam. o cn O I 3-a n d ~ ro ro I ~ ro o A'+ • (n 3 Z O I. n 3 u o w ~ d o ro' ro H w ID CD `O N a_ ro pI~ o o o A N O 7 0 7 O O O O A 7 O W V 3 w y C C V CD Cn Z D eo C j m G, D w a M co CD c " lo 3 n c qEF V i O N N O Opp 0 r, CA N A A O.Z1 3 CO) .!T a -0 M M • z 00 o 0 (D 4 <~Z a ' co co CO) to n D ro Q G O o (D .ror. 2). T 'y0 W CA W of H N j 3 a) m C. 0- m z r! N Z 5 Z c D -R O a~ O @ 3 7 O y N c c(o p N S. N 0 CD W (3 ? a 7 z CD =r (a --I CO) O C1 R y CD a p (Z O O 00 A CL Z A X O Z m z (D A W W D CD CL o ~a ro m n(~ A 0 y y 3 y C7 a A n III .S W ti N O O A 0 N (CD Op i co rs+ O r v o ~ b o ro 0 C- ti, STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS_ 7,1 SUBDIVISION / CSM 44 /-A:) l~u LOT $ I SECTION o2d" T V N-RZy_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN. VIEW . SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r ~ del' • ,k 13 1 ~ f i o ' i yT C ~ C. ~ -~CATTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. `EENCHMARK: ALTERNATE BM:, , kt► :SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:- 4L~Zze,& 9 Liquid Capacity: /&<DZ) Setback from: Well-,06 ~ House Other Pump: Manufacturer 4 :Model Size Float seperationGallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: yr Length 5 7 Number of trenches Z Distance & Direction to nearest prop. line: SozJA y?' Setback from: well: = House 3 5l 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: Y7 PLUMBER ON JOB: lee, LICENSE NUMBER! ~fpl~S 3~ INSPECTOR: 3/93:jt • STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS 7` //Z r`ti fL SUBDIVISION / CSM# / Crc5 LOT # 141r4 SECTION T may, N-R /mil W, Town of L h.~irrvi ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • 3 14 i 0 i t i Lo~ Liu INDICATE NOR ROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: %a Scc;, 4) 60"-,W" Z;J", i.,~, 7 ~ u -ti ~G.c.u-C~ ✓ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: %C'00 Setback from: Well House /vim Other Pump: Manufacturer 4/9 Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: 5 ' Length Number of trenches Z Distance & Direction to nearest prop. line: jL `/7' Setback from: well: House 31" 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: ~'7 PLUMBER ON JOB: ✓.s / ,z LICENSE NUMBER: INSPECTOR: ~J 3/93:jt Mscon;in Departmentof Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division ST . CROI X INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarli".: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. C6Y~R,de6XrVTe. illage Town o : State Plan ID No.: CST BM Elev.: AV Insp. BM Elev.: BM Description: INAKKLIV Parcel bi4Ptq.:1076-90-000 D0 1 /,!i'J TANK INFORMATION ELEVATION DATA A9700268 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic a4z Benchmark Dosing 17 LID Aeration Bldg. Sewer Holding St/Ht Inlet 'G'y TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic F 3 NA Dt Bottom Dosing NA Header/ Man. `3'~ /oo. vs Aeration NA Dist. Pipe 17 T Too, 321 YZ g- jab ' Holding Bot. System TD is ~rs~ .~3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Fric n System TDH Ft Forcemain L gth Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION TypeO CHAMBER Model Number: System: 117' 311 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center `r Bed /Trench Edges flv Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN 28.29.18.437,SE,NW 765 112TH STREET Plan revision required? ❑ Yes ❑ No a Use other side for additional information. 0 CJ7 SBD-6710 (R.3/97) Date is Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH 4 } < SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION 201eE. Wand a hnilgtonAve sion Visconsin with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce In accord w Madison, WI 53707-7969 L % • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Num r The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. r tate Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property ner Name PropertyLoVation 1 /4 / W 1/4, Sn.V& T c L , N, R (or) Property Owner's Mailing dre g Lot Number Bloc Wl City tate Zip Code (hone ;umbftr. Subdivision Name or CSM Number 7 Acres IL TYPE F BUILDING: (check one) ❑ State Owned ❑ !t~ Nearest Road ❑VIage ,Lk Public 1 or 2 Family Dwelling - No. of bedrooms rvf-Town OF ukt-re //2 Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Z -10710 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 on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an System System___ Tank Only______________ Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 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 6 742 '70 WA1_ Feet ~5 Feet VII. TANK Capacity Site in gallons Total # of Prefab. Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tanker Cr c ❑ ❑ 1:1 ❑ Lift Pump Tank /Siphon Chamber ❑ ~ El ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb ' Name: (Print) Plumber's Signature: (No Sta ps) MP/MPRtW N0.: Business Phone Number: / 7.72- 3 zi Plumber' c dress (Street, City, State, Zip Code): U,e Lam: l 6 - -711,129 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Sta. nps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber T INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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. + t JOB A Q C IJLi . y TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE 7 - (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY D SCALE I` i ra . i ~s....rrlrn ll..... . Via.. .41 'v a tJ Ca . ~~,..3. _ a..~ C...x 5....... db!....., y- . 1 1,° . o i/ . b J y ~y . . ! f I~ PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE I-800-225-M Y _ ,lave CUve~ JOB TIMM EXCAVATING SHEET NO. Z of Route 1 BOX 192 DATE WILSON, WISCONSIN 54027 CALCULATED BY (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE j r 01 . VI r C~ c ` PRODUCT 205-1 ~ Inc.Groton,Mass. 01471. To Order PHONE TOLL FREE 1-800-225-00 • .Wisconsip Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code .z - Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ' percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # \ P'A APPLICANT INFORMATION - Please print all information. Reviewed by tiv Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location COUNTY ~7~ Govt. Lot S~ 114~V46,) 1/4,S OF ME L O I Z Property Owner's Whiling Address Lot # Block# Subd. Name r CSM `6s rzE y - I A' 77A~n~w#_C City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road O (4-Z - foi~ s CZ New Construction Use: [Z Residential / Number of bedrooms- Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow SO gpd Recommended design loading rate ~7 bed, gpd/ft2__ trench, gpd/ft2 Absorption area required KV3 -bed, ft2 SL3 trench, ft2 Maximum design loading rate _ 7 bed, gpd/ft2_s~ -trench, gpd/ft2 Recommended infiltration surface elevation(s) R = 9,P 3 3 s! s = y 9. 3 ft (as referred to site plan benchmark) Additional design/site considerations 6le /,6vL !emu Ofd LF Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system 0 S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U 0S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench a-a /O- - rL 4- , 4 2 s F L- s /,,'-::7 Ground S .7S S D ~r IV) L fps - - o - elev. CIS er' /Y L - - Depth to limiting factor in. Remarks: #3 ~Ze<1Z roil x 7`,fQA..47G rZ 7_--61V7_ Boring # 2 - -3 6 - L s © _ L -0 on 5/O 3 =/o _ y S o L - - Ground elev. Depth to limiting factor in. Remarks: 2 t,. )l CO/~ Z - v/r /Zf t 7 CST Name (Please Print) Signature Telephone No. /J / . Address Date CST Number 30fr 470, O 151ZTs Y~~3 8 ~f! x`3133 PROPERTY OWNER -4 &L- e*o/ /L SOIL DESCRIPTION REPORT j ` Page -Z of ~ . PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure Mft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 26 A /Y F/Z 175 co © ,o P?3 z - 3-1 - t S .L lr_ Ground S ~o S - L elev. 3 - S - /o2h.ft. _ 9 6 - G IV(L -7 Depth to limiting factor in. Remarks: 4-c_3 r- Boring # ' - /4 9--7 3 SQL /Vl'C /z S / ; . Z 7-04) i y srL .2GS6X mkt ' Z _ 3 -2 .i ~S s le 13 0,& 67 M 4. s .0 0 Ground 411 S S~ /VI L elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # S L _ /0-6 ZZ- s Os~ ili/ L - - /03•/ Ground elev. Ap Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) DAVE FOMM PIMA Lice T ~ PkWOW R"d ROBERT", MRt $023 Ph*" 749.3656 f1719~ 3`70 ' fJT # y , ,z. / Ac~ES it s'CifL£ L r. _ ~o r d = 7rp of s w 407- CORNER ,eon fiSraMr ~cd.a ; o ~ ~ D kN~ L AT c OIZ ~~'~f ~ DD ~zE✓ s = 3 y,~ 99.3 ~ (3 ava~v~~ ti PoTf- - i9LL Ts StI3LED, POO XR % ~ 110 t Z i 1 t y bs+®p' 4 3 'i a~ ' ~ 'V .a i L9-96 'ON qof wnue13 P3 Aq paq;ejp 4uownu:lsu} s}yl O O M ~ O r N oil o \ 0 A °O ~Z~• 0 F^ w w C) w \I z a LL. \ 5 cn 1 y \ p.\\ H O R I N Q \ Mo \ IY\ 3 O N m \£c CSI lJ N N 00 c,4 1 ~o L. o II 00 ~~oft 7 U 00 N W N n I roq4z W t O m ql 0 00 Z ~ n ,99 QI w Cr)I 3 N !t1 I a~ p ~ 0 '3u0M006N ueaq o4 pownsse tqZ o frl ~gON 0 a i uO poas }O au t L h/ L 4saM-4se3 ° M~►Lfi►£ ° -j p, do 044 04 paouaja}ar aie s6upeaa b z O cMn 5 L9 0 dJ 0 m U co C*4 U) H .,.I M C. I I ° o F r-I ~$1~ m 4J 00 O N z w A -P -P O 0 Q) 4J U C u L 01 A 0 4) co ,rl - u i s - c c N W W a.. O . O O U 1~ y L ,a'" R o 5 i U 4) (D J 3c 0 Q N • N n.c x d, u F_- 44 k = 7 O N ~4 3=5 w e e ; - , b +J N E N > 04 r. ~4 C N N 7 O d L. LA V) a) E 0r O O - r- z q ~ Z W 0 P-4 4) 44 fo > STC-105 SEPTIC TANK MAINTENANCE AGREEMENT P St. Croix County OWNERBUYER paolc/ aJ %lf MAILING ADDRESS ! 6 (~/~S//l/~r ,Dr' /%l~~~s'h'~ f'45W9 PROPERTY ADDRESS 766 ! la- (location of septic system) Please obtain from the Planning Dept. CITY/STATE b~f liY6s~ PROPERTY LOCATION 5-A," 1/4, W 1/4, Section Z~ T_?::I___N-R W TOWN OF 1 JAO"/ , ST. CROIX COUNTY, WI SUBDIVISION AV LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, 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 y pi SIGNED: DATE: /7- 2-272 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 t S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result 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 _ P Q;;~f Location of property fj' 1/4IVk,- 1/4, Section 2-9' , T 2-'j N-R le W Township Wilt-A/ Mailing address Z .i", Address of site -7(a S- / )cZ ~f Subdivision name Lot no. other homes on property? Yes __,_No Previous owner of property ~//-'LIAI Total size of property AQCP :7 - Total size of parcel ld d 7 4 --/1 Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes X No Volume 1071 and Page Number 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. :526d / , 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. Signatur of Applicant &Co-Ap::~p!:lica 67 P- 22,99 7 Z2 - 47-7 Date of Signature Date of Signature DEEO TW5 SVA(:E RESERVED FOR RcCORDING DATA • ~ DOGUM~NT NO. wAA~Y - STATE BAR OF ISCONSIN FORM 2-190 Von 1077wA 415 f:.::~:3 s uZ'S MR( 51fi 0i St. CR=t04Wl py elyn C Brathall, a widow and- not rrried Rood i br RromrO . MAY 61994 - at 1:45 Q -~'Y!erl conveys and warrants to ~Vld D ~'Y'er . i - - - .....his.wife. as 3oirt__tenants fNlem too& A • - 1 RET'GVffn & Wertheimer, S.C. 430 Second St R O. Box 106 - - CSroiz _ - - county, the following described real estate in 042-1076-90 State of Wisconsin: Tax Parcel No: - of NHS of N W% and all that part of went Lots -1- and "2- All that part of Centerline of Tbwn Road. (S' of Frtcl. NW4) of Section 28-29-18 lying Easterly ~r par This deed is given in satisfaction of a Ind Oontract between ge171, as dated April 3, 1984 and recorded April 2o. 1984 in vb of 686 st~Pa4et. Croix Oatr<Ity. Doct»nt No. 392632 in the office of the Pegis Wisconsin. This 1$---- homestead property. (is) (OCMA TO any other easementse covenant•S' Exception to warranties: WITS AND ~ u this shall not be deemed to eic eI any reger~Tdti0I18 or restrictions of record, if law therefor. such other recgrded enct><Ihr nces beyond the tJem est~:blished by 19 94. L `~fy A4~'•. l EALI . i~ - -(SEAL? _ - SEAL1 II it (SEAAL) i 1! ' . AUTSSNTICATION ACKNOWLEDGMENT ~I STATE OF WISCONSIN f Signature(s) -----m-a--•----- II St_ . P?P -------_--_-County. !l Personally came before me this ---------.-day of 18.... the above named authenticated this --------day of----------•--------------• it- Y lyn M, grathall a TITLE: MEMBER STATE BAR OF WISCONSIN not. - (If . to me known to be the person who executed the authorized- by-¢ 706.06. -Wis.- Stats.). foregoin trument a n le~b.. the same. THIS INSTRUMENT WAS DRAFTED BY J - -