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HomeMy WebLinkAbout022-1083-10-400 3 0 N n 04 d i l~ O ti O p x 10 ~ N a) O o c a~ y N s o 0 ~ Y 'C a) ~o I d O O C Z U 7 Co O V1 U. C Lo O O CO N a O N 3 CO v ~ Z yj z o 0 Z ~ d d O N W d co N I- Z C O O Z d C e} O fp F', O m Z c E -o a 0 w m N Q O U~~7Vl N a) w N C c U O o 2 Q w z F- Z o N C14 I N,'. N £ N ° L _ ~y a `O a Z Cc - Y c r> 2 C> ►~i L` O O O Z ° •+v a a a a ~ ~ O N co cD .Q ~ N N J U rn rn Cl) f- w O N O O O O '.,I N N O j N a0 m co ° a0 N Q O a. 4) ch Q) ~j O 3 N C ly O ham- Y ° O N c o o° w N c a°° o co C O N E C a) N N N "t cq co Y C 0 Q) :3 iz: 7- L' of .O W Op N N N c C w r • O N Y Q co O N 15 - CSS .r d ~ a L: CL • a m w r1•w.j E i c c r A c°~I 0Uu ' r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER q,,be. Y-l"' A ciic Y° ADDRESS SUBDIVISION / CSM# LOT SECTION ~9 T.27 N-R l'F- W, Town ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ,tom 1 `rLNV lti INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: A1--C- ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~i~ Liquid Capacity: /fide) Setback from: Well NGt~` ~Hou e Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length fG~ Number of trenches ~Z Distance & Direction to nearest prop. line:D _ 'e t ,,e~ , If It Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of syste- Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: l✓-- , LICENSE NUMBER: INSPECTOR: 3/93:jt i Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and I,iurpan Relations INSPECTION REPORT ~99feVy and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 262377 Permit Holder's Name: ❑ City ❑ Village $1 Town of: State Plan ID No.: ANGER ROBERT & SaUZANDT CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 77' 0) 1196001818 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing r s,~ Aeration Bldg. Sewer C Holding St/Ht Inlet 12' 99,t- TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom A9 5.o5 Dosing NA Header / Man. ("401. 4( 9 / 6-53' 9 4.77' Aeration NA Dist. Pipe s - g 317,57' , Holding Bot. System 7. v o 4 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift 10Loss riction Sy meaem 39 TDH /3,/.-Ft Forcemain Length Dia. a „ Dist. To Well 0 SOIL ABSORPTION SYSTEM BED /TRENCH Width 1 Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S 14 ~ Ili DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM INFORMATION Type O 4ct,,j CHAMBER Model Number: System a~ -,0, Z 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 Bed /Trench Edges Topsoil ❑ Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LO-_~,"'''!ON: -Ky-INNICKINNIC.29e.~28.18W, N>,, N.7, TaI'imw "O?~D Plan revision required? ❑ Yes ff"No FZI(JaW Use other side for additional information. 1/ak 1.:?71 SBD-6710 (R 05/91) Date I pe or's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Y p m 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 Count ' than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State SanitaA y Pe LP. Numb r~ The information you provide may be used by other government agency programs ❑ Check if d►~tro aioap~licat n IPrivacy Law, s. 15.04 (1) (m)] State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location n '7 d4 7ta 1/4 1/4, S vc T , N, R E (o W Property Owner's M Ing Address Lot Number Block Number 15-11 e 452!: 4/1 1 City, State Zip Code Phone Number Subdivision Name or CSM Number G 2 A 4V ;1 Z)'Z 9 Z4~ y ac dso,~1 O r ]NearestRoad Zt- II. TYPE B ILDING: (check one) ❑ State Owned ❑ !t ❑ vlliage 3 ; Public 1 or 2 Family Dwelling - No. of bedrooms Town OF c r Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 0 0 r-/6~3~~~1 ~oQ 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 r--'System System Tank Only Existinq Existing System Existing System ❑ 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 410 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.) Propos~~sq. ft.) (Gals/day/sq. ft.) (Min./inch) Q Elevation c!~~ dd 7 -7 Feet 8. 6 Feet VII. TANK Ca acct in gallons Total # of 's Name Prefab. Site steel Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Manufacturer Concrete strutted glass APP. Tanks Tanks Septic Tank or Holding Tank 641 kZ7? ✓ R ❑ ❑ [1 El ❑ Lift Pump Tank /Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached-plans. Plumber's Name: (Print) Plumber's Signature: (No S m s) / PRSW No. Business Phone Number: t r r.. zo A4 4.."P4 r _Cza Plumber's Address (Street, City, State, Zip Code): r IX. COUNTY / DEPARTMENT USE ONLY Disapproved San ry Permit Fee (Includes Groundwater ate ssue Issuing A ent Signature (No Sta ❑ pp surcharge reel Approved ❑ Owner Given Initial Adverse Determination < oCJ / ` CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL- G~ SBD-6398 (R. 05194) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divmion, 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 nevv 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 a// 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) dr 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. • w • 6I Z 5 ~ 3 ~ ~ n s ~s G~f i ei s , r-~ V / Pl1f.,F GF PUMP CHAMBER CROSS SECTIOIJ AKJG SPECIFICA-FIOkJS VEUT CAP `"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIKIG > 2Y FROM DOOR JUMCTIOKJ BOX MAMHOLE COVER - , WIMDOW OR FRESH I2"MIU. AIR IAITAKE I GRADE Y"MIN. 4/1 I ~ 18" Mlu• COUDUIT 18"MIN. 1 IMLET PROVIDE I _ AIRTIGHT SEAL ~ III I I ALARM a I il. I 1 *APPROVED I ON JOINTS WITH I I ELEV. FT. APPROVED PIPE _I 3' ONTO PUMP ` OFF o SOLID SOIL COAICRETE BLOCK RISER EXIT PERMITTED OKJLH IF TANK MAMUFACTURER HAS SUCH APPROVAL. SEPTIC f SPEGIFICATIOUS DOSE TAIJKS MANUFACTURER: IJUMBER OF DOSES: PER DAy TAAJK SIZE GALLOMS DOSE VOLUME ALARM MANUFACTURER: ~1?~ Z in2 INCLUDIMG BACKFLOW: GALLON MODEL IJUMBEK: J?~ CAPACITIES: A- j! ',yMCHESOR 414, /GALLOL SWITCH TYPE: c°Y C, B= _IMCHES OR -7i" Y GALLOL PUMP MANUFACTURER: 26J elle/s C. . G IMCHES OR 497,,d~ GALLOL I MODEL NUMBER: D= -INCHES OR GALLON SWITCH TYPE: rt' J^C MOTE: PUMP AUD ALARM ARE TO 6E MINIMUM DISCHARGE RATE _ 3d GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF ARID DISTRIBUTION PIPE.. LL FEET + MIMIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . e FEET + jQ_ FEET OF FORCE MAIN X / SY FYoFr.FRlCT101J FACTOR. FEET TOTAL DYNAMIC. HEAD = FEET I IMTERKJAL. DIMEMSIONt OF TAIJK: LEKIGTN ;WIDTH ;LIQUID DEPTH 5IGNJED: _ i irc►Icr, _ HEAD CAPACITY CURVE 3 7/86 1/4 r MODEL "98" 4 5/8 8 2 17 ` 3 5/8 3 U ' 6 20 J* a rS3 i 0 15 4 3/16 4-- 0 10 t) $ 10- ~ 1 1/2-11 1/2 NPT 2-- 5- 0- U.S. GALLONS 10 20 30 40 50 60 70 80 UTERS 80 160 240 0 FLOW PER MINUTE ToTAL DYNAMIC HEAWLOW PER MINUTE EFFLUENT AND DEWATERING I CAPACITY 12 HEAD UNITSIMIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 31 15 4.57 45 170 3 5/16 20 6.10 25 95 Lock Valle 23' ' . CONSULT FACTORY FOR SPECIAL APPLICATIONS Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without alarm switches. variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required ,Standard all models - Weight 39 lbs. - t/Y H.P. 2 Single piggyback mercury float switch or double piggyback mercury, float 98 Series control selection switch. Refer to FM0477. Model Vohs-Ph Mode Am Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. M98 115 1 Auto 9.0 1 or l &7 - 4. See FM0712. for correct model of Electrical Alternator, "E-Pak" N98 115 1 Non 900 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify D98 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim- E96 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 Plex or duplex operation, 10-0002- 7. Two (2) hole "J-Pak", for watertight connection or splice. Of W001111011013 on additional Zoeller products refer to catalog on ComtHnation Stager, FM0514; CAUTION All installation of controls, Protection devices and wiring should be done by a quali. Iggyback Mercury Switches, FM0477; Electrical Altemator, FMo486; Mechanical Altemator, fled licensed electrician Ail electrical and safety codes should be foll6wed includ- M0495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and Simplot Conhd Bcoc, ing the most recent National Electric Code (NEC) and the Occupational Safety and b1073Z Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - ' A&M TO: P.O. BOX 16347 ` Lmft tlre, KY 402584W Manufacturers of... SHIP T&. 3280 OAd M111&3 Lane 'L7 L rZ7, LWbW71e, KY 40216 Qa.,rtirrPasiPS SNCf /9x79„ ® (502) 7782731 a 1(800) 928-PUMP FAX (502) 774-3624 k o"r~rdHupainki tof In usw' SOIL AND SITE EVALUATION REPORT Pog~l_ol~._ Rulations Civision ol,Salery'8 Buildings 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 mustincluda, but St Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. I dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Steven Cudd GOVT. LOT NE 1/4 NE 1r4,S29 T 28 N,R 18 2*4'a PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK IF SUED. NAME OR CSM v 1120 Pine Ride Drive 4 CITY, STATE ZIP CODE PHONE NUMBER tbtrt146c GOWN NEAREST ROAD River Falls WI 54022 (715)425-2757 Kinnickinnic Libert Road ( 4 New Construction Usa I xj Residential/ Number of bedrooms 3 I j Addition to existing building I Replacement I I Public or commercial describe - Code derived daily flow 450 gpd Recommended design loading rate .4 bad, gpd/ft2 - 5 - Vench, gpdrtt= Absorption area required 10125 bad, tt2' 900 trench, h2 Maximum design loading rate .5 bod, gpdi0.6 trench, gpdih= Recommended infiltration surface elevation(s) h (as referred to site plan benchmark) Additional design / site considerations System Elevation 94-50' Parent material Flood plain elevation, it applicable h S = Suitable for system CONVENTIONAL MOUND IN•CROUNO PRESSURE AT-GRADE SYSTEM IN FILL MO,OCw IN.n U =unsuitable fors stem ®S O u ®S O u ®S O u ID S [3U O S ®u 0S I BU SOIL DESCRIPTION REPORT Depth Dominant Color Momes Texture Structure Consistence 80tmry Roots GPDrIt Boring Horizon in. Munsell Cu.Sz.Cont.Color Gr. Sz. Sn. Bau I1►c,o. 1 0-19 10YR 3/4 None is 2 m sbk mfr s if .5 -.6 2 9-36 10YR 5/8 None sl ' 1 m sbk mfi gs if .5 1-.6 Ground 3 6-104 10YR 6/4 None sl 0 m sg mfr gs .5l .6 elw. r 9B1591. Depth to untiting factor Remarks: Boring # 1 0-22 10YR 3/1 None is 2 m sbk mfr gs if .5 ' .6 2 2 122-36 10YR 5/8 None sl 1 m sbk mfi gs 1 f . 5 . w 3 136-96, 10YR 6/4 None sl 0 m sg mfr/' gs _.6 Ground elev. 97.55 It. _ Depth to - limiting ac_ lacto► ~o (.Ay t Remarks: r - CST Name -Pldasd Print Paul C.J. Steiner Pnond: (715) 425-5544 :Mass: 230 Ni hwa 65• River Falls WI 54022 gnatua: D~ro: CS t h,~I~:,~r: L June 1, 1993 3074 PROPERTY OWNER Steven Cudd SOIL DESCRIPTION REPORT rage -y. u; . PARCEL I.D. i Depth Dominant Color 'Moores Texture Structure Consistence Boxcuy Roots GI~D'113 Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bea ; In,.~r 6._ None 3, . > 2 32-38 10YR 4/3 None is 1 m sbk mfi gs 1 f 1.5 .6 - Ground 3 8-106 10YR 6/4 None is 0 m sg mfr .5 I.6 elev. 96.26 It. oqth to finiiUng factor - Remarks: - Boring # 1 10-18 10YR 3/2 None sl 2 m sbk mfr gs 1 f .5 :.6 _ 4 : 2 18-36 10YR 4/2 None is 1 m sbk mfi gs if .5 .6 - - ~ 3 36-10 10YR 6/3 None is 10 m s mfr - .5 .6 Ground elev. 9&A_ It. Depth to _ limiting factor Remarks: Boring # _ ;<< 1 -20 1 311 None sl 2 m sbk mfr s if .5 .6 5 2 20-38 10YR 4/3 None is 1 m sbk mfi gs if .5 : .6 G Ground 3 38-10 10YR 6/4 None is 0 m s mfr .5 .6 alev. 98.16IL - Depth to linoting factor Remarks: Boring # Ground elev. I It. O.*pth to Goofing • laclor -T_ Remarks: - PLO T PL A N Scale N°rtk BM TOP o r;s C~vc P,~e ® t~9 F)eu. 100.0' c v i x c,s' 56 SI~~F ~f 63 ~y Lot Lt3 O), r 0 -I c Lof I/ G5M Vol G P G i5`l C _ 1 2!11 L01 ;he STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER K. alkwzu_ / (LamiLb, n, Lhx~_ r , , J A , . S y0 l (o MAILING ADDRESS /S / 1~/t~ L~Jt J:~ PROPERTY ADDRESS /D~ f 11 ^ • n • Q Yy2&d+') D,-,. P l ►-t n ~a.rQ & ! 5 4lOa?~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE . o n lz l _C 1~ ~_6 rl [1~/~ PROPERTY LOCATION NC 1/4, 1/4, Section 2 ej , T z9 N-R_Z_K_W TOWN OF 1c.cn~. r m-c ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER y CERTIFIED SURVEY MAPS426 `/7, VOLUME , PAGE.?&q q, LOT NUMBERq_ 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. i 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 year exp kkk4- iration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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. Ownerofproperty PoheA K, I94avr ~ J ane-l"e /'I- So-hrar d-t Location of property h°F 1/4 NE" 1/4, Section 2--7 T 23 N-R lS W Township k; n h i c k 'n h; C Mailing address 15-11 Fi^ea r^ st l~~ on , LJ? Syol(v Address of site ~Q ( Prcl- r) e OlOnn br. Subdivision name -eS M Lot no. Other homes on property? Yes__,X_No Previous owner of property :54,e U P- n , C udA (SCLi 1 e add Total size of property Total size of parcel 3, z `I ~2 s Date parcel was created Juc- Y /11 3 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No ,tlq _ as recorded with the Register Volume Q and Page Number 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. 536Y17 0 , 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. Si nature of Ap icant -Applicant ~g1- °I 6-19-96 Date of Signature Date of Signature 50204'7 CERTIFIED SURVEY MAP LOCATED IN THE NE 1/4 OF THE NE 1/4 AND THE SE 1/4 OF THE NE 1/4 OF SECTION 29, T 28 N, R 18 W, TOWN OF KINNICKINNIC; , ST. CRO:I-X, CO:, WI PREPARED FOR: STEVE CUDD NOTE: BEARINGS ARE REFERENCED TO THE EAST LINE OF THE NE I/4 (ASSUMED BEARING). EAST LINE OF THE NEI/4. I LIBERTY ROAD SOUTH M SOUTH 689.78 39.92-~ , NORTH 885.14' SO-04- 34" W 50!8.32L IS 1. 4 0' M 1289:96 ///NE CORNER SEC. 29 ~ i -r- 48 8. 0 9 ' 78.3 12 S. 5-c 7114 CORNER SEC. 29 (COUNTY MONUMENT o N (COUNTY MONUMENT FOUND). N BUILDING so, ni FOUNDI. 11 SETBACK LINES h O~O~v 3 ry J w 0 Q i ch N 7. / 3, ro ^ ri b:7 62 ACRES (331,944 SO.FT.) M ..l: r 7.24 At. EXC. R. 0. W. ry 0' 0b ~ • 'u 1315, 399 SO.FT,1 a .y w ~•V; 'bl h 0 y 4b 0: LOT 2 I o y / 5. IOACRES o /O ss. yo/ 1 222, 328 SO.FT.1 rn + j 4.33 AC. EX C. R. 0. W. O I 188,520 SO.FT.1 ao~3 N i 20 . 03 m SOUTH LINE m OY NE- NE Z M r; 150• © O7 go fX/`..293?O. 11 N S)!3. T _ O r 43.50.w4 ?9 O O. O ' O C JJ t O N nn v r Z cam, s 3. 30 ACRES vl r J: 1 143,864 S0.FT.1 ,two" CL • 0 v . tn $T."~l~iTY ~ ~ o L O T 4 r` W. ~r 3.29 ACRES to ' ."""'A'•~ p, ( 143, 233 SO. FT.) 0 o F~„~ N• rQ.rfr~ y a. z:. Of 410*00@MW wiirliIlllllIrlll&~ ot•, .W ~dst~ i o alK1l*d40WM,b* 210.50' 4 2 3. 4 1 } ' N O 00 22"W 682.63 IRs'NO.00.00•'E1• ' ' ( Rs N0.55'52"W ) ' r' t V u WEST LINE NE-NE 41M. y 7(1 7 r' 1 CURVE DATA TABLE No Cent.Anale Radius Arc Chord Ch.Bearina. .1-2 27027'18" 141.02' 67.57' 66.93' N71001'59"W 2-3 43026'06" 80.00' 60.65' 59.20' N63002'35"W 3-13 280051'14" 80.00' 392.15' 101.93' S1045'09"E 3-4 139028'52" 80.00' 194.75' 150.10' S68056'02"W 4-5 31030'00" 80.00' 43.98' 43.43' S16033'24"E 5-6 32006'00" -80:00' 44.82' 44.24' S48021'24"E 6-7 3043'16" 141.02' 9.16' 9.16' 515035'28"W 8-9 3019'56" 2033.00' 118.24' 118.22' S12003'32"W 10-11 2055'16" 1967.00' 100.28' 100.27' N12016'12"E 12-13 46054'54" 75.02' 61.43' 59.73" N37011'17"E 13=14 62002'58" 75.02' 81.24' 77.33' S88019'49"E 6-13 77046'22" 80.00' 108.59' 100.44' N76042'25"E Tanrrent Bearlnas: At 1=N57018'20"W At 2=N84045'38"W At 13=N37049'14"E At 14=S57018'.20"E At 12=S13043'50"W At 11=S13043'50"W At 7=S13043'50"W At 8=S13043'50"W At 3=N41019'32"W At 9=S10023'54"W At 10=S10048'34"W At 6=S17027'06'V At 13=S60038'44"W DESCRIPTION A parcel of land located in the NE 1/4 of the NE 1/4 and in the SE 1/4 of the NE 1/4 of Section 29, T28N, R18W, Township of Kinnickinnic, St.Croix County, Wisconsin, more fully described as follows: Cmmencing at the NE corner of said Section 29: Thence SOLMi along the East line of the N8 1/4 a distance of 685.14' to the point of beginning: Thence continuing SOUTH along said line 689.78'; Thence 588036'10"W 684•.96' (Recorded on the•Certified Survey Map Volume 5, Page 1216 as 588033'20"W : Recorded on the Certified Survey Map Volume 6, Page 1794 as S88036'17"W); Thence S88020'10"W 67.54'; Thence S89057'40"W 553.51'; Thence N0000'22"W 682.63' (Recorded on the Certified Survey Map Volume '6, Page 1754 as N0000'00"W: Recorded on the Certified Survey Map Volume 9, Page 2543 as N0055'32"W Thence N88051'04"E 1306.12' to the point of beginning. Contains 20.68 acres.subject to Liberty Road right-of-way and existing private roadway easement. Also subject to any and all additional easements, right-of- ways or conveyances of record. SURVEYCR'S CERTIFICATE I, James M. Weber, registered land surveyore..hereby certify: That in full compliance with the provisions of Chapter 234.34 of the Wisconsin CERTIFIED SURVEY MAP Located in the NE4 of the NE4 and in the SE4 of the NE'k of Section 29, T28N, R18W, Township of Kinnickinnic, St.Croix County, Wisconsin CAMIVIER '_S CEi2T I F I C'AT>✓ OF DF_.D I C:AT I OIV As owners, we hereby certify that we caused the lands described on this Certified Survey Map to be surveyed, divided, mapped and dedicated as represented on the Certified Survey Map. Witness the hand and seal of said owners this 1st day of July 91993. In the presence of: Wilmer You en Delores oung STATE OF WISCONSIN) SS OMITY OF ST,CROIX) Personally came before me this 1st day of July 1993, the above named to me known to be the persons who executed the foregoing instrument and acknowledged the same. Notary Public My_cammission expires 6/12/94 • ' p . , .A Stale Itar o1 Wkconsin Form'- 1982 5365f0 WARRANTY DEED DOCUMENT NO VIL1150PAJ 14th f. J bteven G. Cudd and Gail L. Cudd, husband NOV Z 1 and wife as Survivorship marital property ;.t 1:00 P.;' tx,nseys and warrants to Robert K. Alger, a single I- _ - • _ . person and Jeanette-M. Schrandt, a single- person- AS Joint Tenants i '-,s SFA( .E RFSERVE0 FOR RE. ..:91Nri OA'A . - _ -u•'tw9 WO RE rURN ADORES", ^ the following described real estate in St., -Croix County. State of Wisconsin: tv - - - - set, r P'a,~el Identification Number) Lot Four (4) of Certified Survey Map in Vclu~e Nine (9) of Certified Survey Maps, Page 2644, as Document Number 502047, filed in St. Croix County Register of Deeds office on July 9, 1993, being located in the Northeast Quarter of Northeast Quarter (NE 1/4 of NE 1/4) and SoutheasL Quarter of Northeast Quarter (SE 1/4 of NE 1/4), Section Twenty Nine (29), Township Twenty Eight (28) North, Range Eighteen (18) West, Town of Kinnickinnic. ~ _KER s This is not homestead property. MAX (is not) Exception to warranties: easements, restrictions and rights of way of record, if any. a Dated this 16th day of - November--- - - .19 95. - (SEAL) (SEAL) S ven G_. ud LL (SEAL) +~!-C[~-- - (SEAL) . -Gail L_ Cudd AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF VA ISC'ONSIN ss. - - - ~7T e r-01 Coo Av. authenticated this day of 19 E Pem-wail ; came before me this -16th_ Jav of ove]>tibiir --OISON the shore named - - Z. teven G._Cudd TITLE: MEMBER STATE BAR OF WISCONSI, ~OFWIS-Gail.L Cudd (ifnot. fur - authorired by §706.06, Wis. Stats.) to me knooi so he the person who executed the t..r...~ -wnt -.l ~r4nnwlydvr the came_