HomeMy WebLinkAbout022-1059-85-200
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Parcel 022-1059-80-050 10/02/2007 08:24 AM
PAGE 1 OF 1
Alt. Parcel M 21.28.18.325A-05 022 - TOWN OF KINNICKINNIC
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
03/14/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - MURPHY, MARY R
MARY R MURPHY C - RIDER, STUART JR & GEORGIANA LE
STUART JR & GEORGIANA LE RIDER
286 HWY 65
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 4.100 Plat: N/A-NOT AVAILABLE
SEC 21 T28N R1 8W E PRT NE NW AS IN VOL Block/Condo Bldg:
370/97 EXC AS DESC IN QC 2763/613
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-28N-18W NE NW
Notes: Parcel History:
Date Doc # Vol/Page Type
03/14/2005 789444 2763/615 QC
07/23/1997 1201/558 QC
07/23/1997 844/605 QC
07/23/1997 558/301 QC
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: ast Changed: 08/07/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.100 80,000 121,000 201,000 NO
Totals for 2007:
General Property 4.100 80,000 121,000 201,000
Woodland 0.000 0 0
Totals for 2006:
General Property 4.100 50,000 105,000 155,000
0
Woodland 0.000 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
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER /ADDRESS a ~cy,i 6S
~ ;~.cR- a-~" ~ Z 2 -/OS~`1-~(1-O S7J/32SA D
02 2 -/0V-YO /C}/ 325/ i o
SUBDIVISION / CSM# LOT #
SECTION ~T N-R 14'f- W, Town of ,7?~JiC i 0 t7
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: 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
'
30
oas e
b
i~
~i:~waa~F ~'~cas~
f~a~r~a4
?u
~ ~aEyD'0 w f 7 of
Tb o4 PUL
~lev• I
1
1
Fe nce kof ~ln-e
,Wiscont;p Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations
Safety and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
22GS517
Permit Holder's Name: Cit~yY Village Town o : State Plan ID No.:
RIDER, STUART W JR QXIRNLICKIN- TIC
CST BM Elev.: Insp. BM Elev.: BM Description: ~y Parcel Tax No.:
c~ /G~: CPS J`a-rn e 6:5 I Z -712 1~G - Gael
TANK INFORMATION ELEVATION DATA A9600228 7
HI FS ELEV.
TYPE MANUFACTURER CAPACITY STATION RBI
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holdin St/ Inlet
TANK SETBACK INFORMATION St/ Outlet Q. 1-7
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet a
Air Intake ~.7U
Septic ~`t NA Dt Bottom A 1-Z'
Dosing NA Header / Man.
NA Dist. Pipe 9 9.20 ~3, 3a'
Ing Bot. System yp
/0• /D. U. a, a7
~o PUMP /bIINFORMATION Final Grade
a Manufacturer Demand ,-Irv C. Z, u4y
o+~
Mae 01'
Model Number GPM ~O y~07/ d ~
TDH Lift Lriction System TDH Ft 3, e?' j
< Head
Forcemain I Length rfi Dia. o? y Dist. To Well c o Cf
v
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS IMEN I
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHIN cturer.
SETBACK
INFORMATION Typeo nzw CHA ER Moe Number:
System:}"W NIT
DISTRIBUTION SYSTEM
Header Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length 1CL Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Gra ys
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) -,f 4s6cC A R LOW K
iOCAT'rON : KIIN2.Tit."ILI3;3I LA- 4.L 4 L °o3~ z NE, NW, STATE HWY 65
Plan revision required? es N.o
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
+t-Yftle-✓'
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
r Z7
-All
i
Safety and Buildings Division
V~■L■7■7 SANITARY PERMIT APPLICATION Bureau of Building Water System:
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 8 112 x 11 inches in size. St Croix
• See reverse side for instructions for completing this application State Sanitary Permit Number
268517
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
(;tu;grt W_ Rider, NE 1/4 NW 1/4, S 21 T 28 N, R 18 fD(AW W
Jr.
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
River Falls WI 54022 1(715) 425-6174
11. TYPE F BUILDING: (check one) ❑ State Owned ROK, Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms -5_ Town of Kinnickinnic Highway 65
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
022-1059-80000
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 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 210 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
750 1.500 1,500 .6 92.5 Feet Feet
VII. TANK Ca
in galloaclts Total # of Prefab. Site Fiber- Exper_
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel lass Plastic App
glass-
New Existin structed
Tanks Tanks h
Septic Tank]0d Q&bM Ijk 1500 4-5'@r 1 Midwest 1000/ZeT' ❑x ❑ ❑ ❑ ❑ ❑
Lift Pump Tank / G7C0GCDVX 1200 1200 1 Midwest 0 ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibilit for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Pant) P m nat i e: o Stamps) MP p(No.: Business Phone Number:
715 425-5544
Plumber's Address (Street, City, State, Zip Code):
N8230 945th Street; River Falls, 54022
1X. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A nt Signature (No a s)
Surcharge Fee)
Approved ❑ Owner Given Initial 9 9
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, 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:
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.
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 13 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
t
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.
Bureau o of f B Builystems
SANITARY PERMIT APPLICATION safety and Building Water Sng 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 81/2 x 11 inches in size. °>t Croix
• See reverse side for instructions for completing this application State Sanitary Permit Number
263517
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)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINTALL. NFORMATION
Property Owner Name Property Location
n 1/4 ~ 1/4r S 21 T N, R 1,3 ~ W
, ti~
stLic'3rt 't. ~iclc~ Jr.
Property Owner's Mailing Address _ Lot Number T lock Number
28) Hi-j' t '!r3' 635
City, State Zip Code Phone Number Subdivision Name or CSM Number
Pi.ve-r 1!'311c,, ''7I 54022 ( 71,5) 4/ 5-61 74
I1. TYPE OF BUILDING: (check one) ❑ State Owned Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms 1i own of '=i.nrlic w_itlr;ie ?Iichvaay 55
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1022-1 '1159-80000
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. ❑ New 2. M Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
______System________System_----- __TankOnly______________ 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 N 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
750 11500 1"500, . 6 92.5 Feet Feet
VII. TANK Capacity acctns Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks ! t-60 1170
Septic TankXWMZQURjX,1oK 1500 4__1;4)tj, 1 i:Ll< 1r1'C 1 D of ❑ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank 12013 1200 1 x-.idaiect ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibil' for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Py gnat re: NoStamps) MP No.: Business Phone Number:
Paul C.J. Gt:ein:~r 6730 (715) _425-5544
Plumber's Address (Street, City, State, Zip Code):
i:,3,3230 945th Street; River K Ils, RT 54022
IX. COUNTY /DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing AOnt Sig ture No ps)
Surcharge Fee)
Approved ❑ Owner Given Initial ;
Adverse Determination A714-
CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
X.
SRD-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Buildings Division, 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:
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.
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, locatior 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 c, 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.
PUMP CIIA1111F;R CROSS SECTION AND
SfFCIFICATIO
o~
p Sir c 0Ct y._ r
Vent Ca
T Neathtr Proof APP ed L,a. 44&ng a^
Junction Box Mani Co
4" C . I . 12" Min
,vtr~cs ore; -
Vent Pipe/
Final Grade '
' 18" Min
Conduit
18" Min
Inlet ! Approved
Joints w/
I;, C.L. Pipe
Approved Extending
Joint w/ 3' Onto
C.I. Pipe I Solid
Extending Ground
3' Onto
Solid i arm
Ground
pn
it C
Pump O Off -
Concrete )clock D
SPrCIFICATIONS
TANK • PUMP
Manufacturer:
Manufacturer:
Tank Ma terialModel -hd AM
Tank Sisa:1.2 QQ CQl1ons Switch' Tyra _ /d01-
Total Dynamic Ilcad : ! A-Ft
.
CAPACITIES Pump Discharge Rate: GPM
Total Daily Effluent: Gallons
A M r ( or 570 Callons Number of Doses: Per pay
Callons Dose Volume:' Gallons
or 190 Callons No tea: 1. See pump curve for
D ,10,or 3(e CA110n9, additional performance
Total Tank information.
Capacity Required s~-Cnllona 2. Pump and alnrm are to be
ALARM inatnlIed on acparatc circull
~ au per I LIIR 16. 19 NAC .
)innuf ncturer: ~p
111odel bomber :
,wl t ch Type, :~_oal"
page of
I
~
5.66
(144mm)
11.68
(296.5mm)
ME40 PERFORMANCE MW
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
40 12
35
10
30 w
w W
Z 8 ~
25
~ Z ,
20 6 Q
ui _ W
H 15 ..1
O 4 Q
F' O
10 F-
2
5
0 0
0 10 20 3 40 50 60 70 80 90 100
CAP CITY GALLONS PER MINUTE
23833A275 11
x 3o3Y
$ v IV
agN
C 7~
r 3
and ~i~.S•i~ SANITARY PERMIT APPLICATION BuSafetyreau o off BuiluildiinWater Systems
ngWater 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 8 12 x 11 inches in size. St Croix
• 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-k H ie ar S'-5',r vious 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
Stuart W. Rider Jr. NE 1/4 NW 1/4, S 21 T 28 IN, R 18 Xh1f) W
Property Owner's Mailing Address Lot Number Block Number
286 Highway 65
City, State Zip Code Phone Number Subdivision Name or CSM Number
Riv Falls. 54022 1(715) 425-6174 OW - ROP""N"2
II. TYPE F BUILDING: (check one) ❑ State Owned Nearest Road
1 or 2 Family Dwelling - No. of bedrooms 5 Town OF Kinnickinnic Highway 65
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
022-1059-80000
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 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
750 1500 1500 .6 92.5 Feet Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Ex er_
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel lass Plastic App
New Existing strutted g
Tanks Tanks
Septic Tank Zbd&Q&1& 1500 IWj(--,(-r 10001500 12 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) PI er's Sign ture: (No Stamps) MP/plo.: Business Phone Number:
PAW C-'-,J- Rt-p-iner I ax 6780 715 425-5544
Plumber's Address (Street, City, State, Zip Code):
IX. OUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sa itary Permit Fee (inciudesGroundwater ate Issued Issuing Ag nt Signature (No S m )
Surcharge Fee)
XApproved ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, 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:
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.
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.
Al
.
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Ar
ST. CROIX COUNTY
. ti WISCONSIN
- ZONING OFFICE
M r p r n ""ri6 ST. CROIX COUNTY GOVERNMENT CENTER
• _ 1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
PERMIT APPLICATION CHECKLIST
A. ❑ COMPLETED Sanitary Permit Application.
B. 9,---COMPLETED C 100 & 105, Property D rigina
Report, CS r Subdivision plat detailed plot plan
which mus include the following:
1. Owner, buyer (if applicable) & legal description.
2. E~-~ Project location: Provide a reference from the project
site to the nearest road intersection or section corner.
3. ❑ Lot or parcel size.
4. ❑ North arrow & Legend.
5. ❑ Scale or give dimensions from two directions.
6. ❑ Locate & describe both the Vertical reference point (VRP
or BM) & Horizontal reference point (HRP): The HRP can
be the same as the VRP/BM if so described.
7. ❑ House/building locations with reference to the HRP.
8. U- Building sewer, forcemain, el & water service location.
9. ❑ Septic tank/lift chamber, distribution box, & diversion
valve locations. Existing tanks: Provide Certification
for the Utilization of an Existing Septic Tank Statement.
10. ❑ Absorption system(s) : Both primary and replacement
systems drawn to scale.
11. Effluent systems: Distribution piping and vent detail.-
12. C~ Setback dista the system to lakes, streams,
building, r_operty lines ea ements, critical slopes, etc.
13. ❑ Adjoining property information: show setpb'&s or state
that setbacks are greater than the minimums required.
14. ❑ Pump chamber cross section, including dose volume & TDH
calculations, pump manufacturer, model # & pump curve.
15. Master plumber/designer signature, date and license
number on each page of plans or coversheet.
Wiscongin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Sr. ctz.o tx
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
C'R-N-k G GGVFt@T K )Z 1/4 N tO 1/4,S Z J T ZS N,R 18 E(01`4
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
2-86 11w •6S - -
CITY STATE ZIP CODE PHONE NUMBER OCITY []VILLAGE ®fOWN NEAREST ROAD
s~ozZ (~IS)4ZS_ 61~ ~U~IVtekl>v~,1c 6S"
[ J New Construction Use [)(j Residential / Number of bedrooms S [ J Addition to existing building
Replacement Public or commercial describe
Code derived dally flow -1 SO gpd Recommended design loading rate - bed, gpd/it2 0 • S trench, gpd*
Absorption area required - bed, ft2 ~ s oo trench, ft2 M Wmum design loading rate 0 . S bed, 9pdffi2 o • b trench, 9pd/fI2
Recommended infiltration surface elevation(s) 'D -L. S It (as referred to site plan benchmA RT S `t S Tt 1
Additional design/ site considerations Sil);E- ►JO M aJ l-rs6l` Z
Parent material Flood plain elevation, if applicable N- 1~ • ft
S = Suitable for system CONVENTION4 MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem KS 11U CUS ElU QS ❑ U [ZS [1U [I S Q U [IS MU
SOIL DESCRIPTION REPORT
Boringly Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft.Boundary .
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerlctt
ri:jTl.+ih
o-~~ 102 z/I ~ si) ZY~ b m~~ ~w o.s o-
I --al
Z» z o tz 3 - s i t Z h-I s bk m c w - a.S . o
Ground 3 ~2 lo'1fZ 31~ S ~'wl 3bA wJV~1- CW 0•4 o.S
~elov.>l: ~l8_~q to~2 s1e, ~ ~s o s~ Y" ~ - ~.so.L
Depth to
limiting
ftCtDrtt
Remarks:
Boring #
o-!.~ ~o~~ z~1 ~ st'~ Z~i3b wt'~1~ Ck, - o•So~~
z. Z 1$-~0 l0'12 31 ~ g1 I 2wt SU1'C WI`~- C+,v S
3 ~46_so to`1 R 3/L - s 5bbt hm U~1- cLj o.11 ; o.S
Ground
~t elev. ft so-8o t o`t 2 5.16 - ~S d 4 o-s
Depth b
limiting
factor
9CP i
i
Remarks: /
CST Nam-Please Print Arthur L. We erer Phone: 715-425-0165
eg rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signat+ae: Date: G_ Q! CST Number: M0057
6
PROPERTY OWNER ►'"1UR-PN 1-( SOIL DESCRIPTION REPORT Page _!of
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Murisell Qu. Sz. Cont. Color Gr. Sz. Sh.
Bed Twich
v,ZZ l~ ~tR z.ll - S 1 ZIM S~ m Cw .(3 . S a-~
- Z -z -so ll>`iR 31 S t Zw► `~tr- C~1 - O.S o,
Ground 3 So -S 8 0 `12 3/6 S~ 1 ~'►1 S bk Ivl ~-v o • O. S
eley
°I6,Sft. St-L8 10 y2 S/(_ S U s c,s - o. S o. L
Depth to S Q 4.1 ~0 `1 R 8 Z is C~ v,,, u - a c s
limiting
f~tog 3,~
Remarks:
Boring #
_ TZ-zco r'1 z k~b zs tGK) L U ) G G O .S GPD F7 Z
: , ~ l S C'~ >v w lrzl- Z u c 1'Z S ~ ` 1 U 1Z) A-) iG
Ground T PT- 7Z- N 17- _Tik'IF L8 ° F _ oS C
elev. ft. 3 C - ' X_ l Lu C se r-t 1J
Depth to
- limiting '
factor
Remarks:
Boring #
XXX:
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
• K'Y
Ground
elev.
ft.
Depth to
limiting
factor
- r -1 i i i I I
Remarks:
.-nn n^~nin nr,n~,
PLOT PLAN Page 3 of 3
SCALE 1"= 30 '
ND 'ARC" 43)q4 DwW't) POT.
-T )T
,x,100 O,P NIY-
- ~
owl
- et 4 6 s
0
B,3
so~
~l °L 4 B B. Z - S .
q2.g,
s•
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tTl. ~4 3
tiu
~Nvst w~ L i~M~ k VS"D 1v C S`lS-T• P~ ! nog F1ZO~1 ~R etr,--s .
ZBb x
511 ~ S y
j' ' L~ P ub
i Nl~'t' ~o S ~L~
J
6 Zo-~ 6 ~ 6 -coq
(715 ) 4L-0165 1400576
CSTSignature Date Signed Telephone No. CST #
V Isconsir► Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relatans
Division of Safety a Widngs 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 Sr. cxta lX
not limited to vertical and horizontal reference point (B?A), drection and % of slope, scale or PARCEL I.D. #
dmensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
C R Pr1 G i"'1 V r, ~N Y serrteT N ua N 10 uts Z l T Z 8 N,R 18 E(«f~
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
2-86 lbw '65 - -
CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE EFOWN NEAREST ROAD
~
~Q1L`j1Z 1 4US bol ST37-Z (7LS) LIZS- 61-)~cUJYJt~° ~Cc1J~1JU tC sue! 46S
[ 1 New Construction Use [S(j Residential / Number of bedrooms S A" to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow -1 SO gpd Recommended design loading rate - bed, gpd/ft2 S trerx t, gpdM2
Absorption area required - bed, ft2 Is oo trench, ft2 Maximum design looming rate a . S bed, MW _a- b trench, gpd*1
Recommended infiltration surface elevation(s) °l -L. S It (as referred to site plan Writ mado Fl-T s `t S)-v-~ 0-1EU -
Addlional design/ site corisiderations SLR, j% oN3 T-t}G~ Z.
Parent material SYthnay uT~ .1 ,gam} Flood plain elevation, if applicable N. t\ • It
S = Suitable for System CONYMONAL MOUND N GROUND PRESSURE AT-GRADE SYSTEM N F LL HOLDNG TANK
=
U= Unsuitable for stem gs ❑ u S11 U p s ❑ U ® S 0 U ❑ S Q U ❑ S tau
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/W.` ` a
Boring # Horizon Texture Consistence Bourid3y Roots i
in. Munsell Chu. Sz. Cont Color Gr. Sz. Sh. Bed ierch
0-1-7 10~1(ZZ/J Sl -LYVL U ~L^ Ckl p.S o.
Z Z t0 `22 31~r s21 Zwl Sbk =.m`~ cw - o:S. a. b
Ground 3 ~2 4$ 10`4 2 31 S `Nt S \At M V 0-1,1 - o. L f o .S
v
Depth b
6mitirg
factor
?_~tt
Remarks:
Boring 3 - • S
0-~8 ~ o~-tQ. z~ 1 ~ s i 1 Z~l b Y~1~~• Cam,
13 Z 1S-~O 1D't>Z 315f SO 2wtsbk WICW o S o''°
3 u%-So 10,1 R 3/L - S 1 1 VA lo t Vq U'E~t- c,w o. s
Ground
elev. So-c9o t O`t R 5.16 - ~S O S 9 o S o. 6
Depth b
limiting
factor
0" i
I
Remarks:
CST:-Please Print Arthur L. We erer Pine 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Sigaa~r+e: Date: CST Number:_
0 - ZO -9.6 . MQQ575-- _
- - 9 f - I
PROPERTY OWNER _ ►°'1UVL1 yl1( SOIL DESCRIPTION REPORT Page Zof
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 Trench
r.m3 v_ZZ l~ `-L2 ZLI - S t Z 3V wL ~ Cw o. S o_b'
s I Zwi Sbk w, o.S o, ~
Ground 3 ,Scl -S S 1, 0 `7 Z 3/6
ele
9Z-5it. 10 `12 SA. S U S ~ ~ ~S - o. Si o. ~
Depth to 5 Q 4- lO `1 R 8 Z S C~ vn u
limiting
factor
Remarks:
Boring #
tte TZ11 Mor1 )b QZSb @SLGQ LU ) G U O.S 6PDi Z
` ~ tiJG
v :hvv:vvv.v
Ground a lZ tv SZ 8 u m F iZ o S Tycczl~j 0-
elev. 3 -T~151vC _ ' , t Lo C
ft. MU ,
Depth to i
limiting i
factor `
Remarks:
Boring #
i
o
i
Ground i
elev.
ft. i
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
ern n^-ir, "..,n.
PLOT PLAN Page 3 of 3
SCALE 1"= 30 '
0,0 ot~ 10 ~1~0 4 7L Dono PuJT•
pUC ?1PE NAT
•IM et 46 S
B,3
q2. S, Abu' lei
fL. a4.a S,
NL 9 i. S. 6 ~
I~iu =
Yin sjT , wITIA- ~ no' F►ZOrl m~ a"-s
zBL x
o• y
I ~
~ NAT ti-o s c.i~~
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6-ZA`` 6 (7-15 1 425-0165 M00576
CSTSignature Date Signed Telephone No. CST-#-
0
OF SEi/4
_OF SW I
S 88.39,
59~tE f 1.61r A
(RECORDED A S EAST) i
L , 890 - R 893.83'- M
i
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rn 0", k0, L" _
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v SECTION 21 -,f7 tp
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f~ N 210 ;
p
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2 24 ,67 .6 1
30 00 '
O n
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i o O n 452 70 = M
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SOUTHWESTERLY EXTENSION OF p
CENTEPLINE OF PRESENT STATE OD
TRUNK HIGHWAY "65" t' A
i
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
~OWNE'UYER
MAEUNG ADDRESS 21-6 511YT 1 ~ ~ (rs 5 ~I V t irz, C' 1 / S O LZ
'PROPERTY ADDRESS S I~~
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION N 1/4, ~L f 1/4, Section -Z T Z--N-R_I w
TOWN OF ~I NI N i K j NI N i ST. CROIX COUNTY, WI
SUBDIVISION 14, A" LOT NUMBER t1 A -
WCERTIFIEDSURVEY 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 forth, 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.
1/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 year expiration date.
SIGNED: 7
DATE: b
St. Croix County Zoning Office
Government Center
1101 Carmichael Road 11/93
Hudson, WI 54016
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 o f property S Tv 11~f- C W, R t Q,!~J2 J R
Location of property- t 1/4 R W 1/4, Section 2 , T 1,7 N-RP-12' -W
Township klNN1C,k.1)4Q tt, Mailingaddress 2"S(- STA-rG 14Wy &S
'~LI11 E-)7- TA u-S S ozZ
Address of site 5l-Iv✓kG
Subdivision name Lot no.
Other homes on property? s/ Yes No
Previous oryner of property _A.vy' PiZP7 R /4-(~, p bl/~6'`2
Total size of property
Total size of parcel '7,1
Date parcel was created
Are all corners and lot lines identifiable? ✓ Yes No
Is this property being developed for (spec house)? Yes ✓ No
Volume i--~ and Page Number as recorded with the Register
of Deeds.3S7-e 0 7AL
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. , 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.
7 /t
Sig a ure of Ap ica t' Co-Applicant
Date f ignature Date of Signature
F'omi No. 29 NI gr.gr..ta Undunn c--y'"' n¢ Blank. (RrciwJ iT~I
f~ wit Claim Decd.
'•indtvidwd t0 Soint Tenaott
19 76 .
Ll ~I1t~t'iilire, :fade this . day oj" December
between Anne. Carleton Procter. (before her marriage Anne. Whittier Carleton)
and A. Wyman Procter Jr., her husband,
Connecticut..,...... part ies
Fairfield and State of h ban
rt d and
a.nd• Geo.rgi.ana C1 . Ride z......us .
of the County of
w, R~..!~ez...ar = , o the County of
of the first part, and St.Ua..
.
parties o the second pcir ,
ru fe
~
I~ Tl?~eFl.n and State of _ . Minnesota..
9
of the sum o)(
deration )T.l..lltS,
ahtneggetl), That t.4.e said parties . of the first part, in consi -
. Far.ty...Tho.usand.--and...no./10.0.....(.5 4.O....Q.O.Q.. 0,0 tthe to.........
in hand paid by flee saidtP tclai if and s Contd~ tc~ltn tdea.ci ilrpartirsroftthiecser on dcpttrt as
igns, the surc•icor of said parties, and the. heirs and
~~ed=t~_.-.hem....... hereby Grant, Bargain,
fount tenants and not as tenants in common, their ass of land lying and being in the County of
l
assigns of the survivor, Forever, all the tract wI
s€
aj~ riscribed as follows, to-wit:
St.....Croix ........................._.....and S f ME
. ate o .
All that part of the Northeast Quarter of the Northwest Quarter (NE1/4 NW1/4)
4` North, Range Eighteen
,of Section Twenty-one (21), Township Twenty-eight (28) a monument set Eighteen
1(18) West, described as follows: Beginning at an iron pip north the northerly line of said tract
and 442wfeet
thence tsouthlon a4line parallelftthe
`corner thereof, and running monument; thence
;east of the west line thereof 324.6 feet to an ion pipe
southwesterly by a deflection angle of 47o039 to the right 68.5 feet; thence
southeasterly by a deflection angle of 63139' to the lefth184 fertFtolsn iron
pipe monument set on the northerly right-of-way
Pleasant Valley Road; thence south on a lline ine arallelrto andh442 feetaeast of
e center
of said ; by 'said west line, 36.3 feet to th the center line of said road 93.8
flection angle of 116035' to the left along
feet; thence southeasterly by a deflection angle of 98042' 178 feet; thence
northeasterly by a deflection angle of 8107' 351.9 feet; thence north.:,-iy by to th a deflection angle of 750 to the left 180.6 feet, more or
center l ss ,of said rcent eader
'line of said road; thence northeasterly along said to center
iron pipe monument set
j77 feet; thence northerly along a straight
on the na::rth line of said tract
scorner thereof; thence west along
'beginning. Containing 7.1 acres, more or less.
~
Together with the rued southgofsthensaidrRiveroFalls-PleasantcJalpeyi an Road,
;connecting line leis
for the purpose. of repair and maintenance of said cesspool. and its connecting
`line.
All that part of the Northeast Quarter of theNort westNQuarteRan E171/4 hteen)
of Section Twenty-one (21), Township Twenty-eight
Beginning at a pint on the north
142
(18) West, described as follows, to-wit: Beg
'line of said Northeast Quarter of the Northwest Quarter (NE1/4 NW1 4 ,
'feet east of the northwest corner thereof and marked by an iron pipe monu-wes ment; thence south on a linparallel to an bYtaldee
thereof, 324.6 feet to an iron P Pe monumen e monument,
flection angle of 47039' to the right 63.5 feet to a7 iropip according to
thence northeasterly in a straight line to point of beginning,
the United States Government Survey thereof.
o0
FEE
To Jbabe anb to 31)olb the dame, Together with all the hereditaments and appurtenances there-
unto belonging or in anywise appertaining to the said parties of the second Fart, their assigns, the sur-
vivor of said parties, and the heirs and assigns of the survivor, Forever, the said parties of the second part
` taking as joint tenants and not as tenants in common.
1 _ - their_
3n Izatimonp M, hereof, The said part_iQ.$ of the first part have hereunto sct_
hand P. the day and year fe:•st above written.
State of Wisconsin
County of St. Croix
.
hertk certify that this instrument is a full;
VOL
CONNECTICUT
Abtate of
Y.J. Darien
Countyo/ Fairfield
q'/w ;,niw; ir,..lrnn,r•nt nv~s n kru,nle !•rreE b.-fore n,r
11,i.,, "'29th,/.,,/ o/ December /r)76
A. Wyman rrocter, Jr.
Anne Carletop Procter
bip
„ wt\ct,uE,vykNrv \I ~Nwl l.ncrul
Robert 3.' KIN(.
1
ill PEW le)Y r%A1 A\,iWl1 Ul. ~iF 11
Notary Public
. IITIP 11N N\~~1
THIS INSTRUMENT WAS DRAFTED BY
by commission expires April 1, 1977
(Nam*)
(Address)
e
sum,. -
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