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HomeMy WebLinkAbout038-1046-20-500 0 00 o . p C) M C h ` O L C 0 iT t. U 3 C O O o" N c 0 N N ~r O CO L N C 0~ O C a O U O N o N w C) LL O c '~v E o N N .O C N mE CZ a) O Q1 O L N L Q 0i ~n c M N ~J° N L N O L C N 3 N LL c L f0 a 2 o co x ~a Q a to ry 3 M ~ o r z N _o Z C z £ YO z r d d m ui a co to c 0 c C7 -0 m O z d c = Of r 0 A O IU 2 0 c !n F- r m N z c E -o .O N M N O O O U 0 m q) O O O O z co z o a°i Q U z c ~ 00 ~ N O m N a~ ^ i a Y CL o a' CL m ` ' c D O U, N Z L U C 0 0 N 0 0 (L E o NN Z co > F IN- F-- c U o a O C E a a a z o m E u~ a c N m U (D rn rn O O N N N O O ~ O CO 0 E (n a r N O r 'irrt _ ~ ~ ~ 4 ~ o 3 cu), H c LOj LO O N O C E 6) co © N V to O 1 O O O ON 0 N Y CL 0 0 o 7 t c E N 4 'D (D 0 O a 00 L -O r r U ~ O M r O (ND to ca E U y O (n 2 N O N UJ O \V] CQ CA ~t 2- a a 0 ACC CL 4t u N y C E L C c ~ D t STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /~c'~P,e~/ ~J ADDRESS / SUBDIVISION / CSM# LOT SECTION- /l T:1 LN-R_ /k W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f SJ yy, 1~c ~f yy r / e ~m r INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK' ~Ili~, l ,~l / ~.,),,r• / -/~fJD ~'1 ALTERNATE BM: e SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Gj xE,~S Liquid Capacity: l Setback from: Well-__/3• House_ Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length z Number of trenches_ / Distance & Direction to nearest ProP• line: ' Setback from: well: House- Other ELEVATIONS Building Sewer - ST Inlet. ST outlet 3L PC inlet PC bottom Pump Off Header/Manifold Bottom of system 22-5 Existing Grade Final grade DATE OF INSTALLATION: y l PLUMBER ON JOB: / LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Doartment of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ST. CROIX ,Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: El City ❑ Village Town of: State Plan ID No.: MOE, DARRELL 9 CST BM/EEllev.: Ins/p.. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA 7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic n Q Benchmark Dosing f r Aeration Bldg. Sewer (0' 5~,l rS' Holdi w-r St/ Inlet 6271 103, V7~ TANK SETBACK INFORMATION St/ W Outlet Verit TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet Septic ~>.D' ~/3' ;0,, NA Dt Bottom Dosing NA /tIan. 9a,~~5 Aeration NA Dist. Pipe 3 9a, F3 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM T D H Friction Ft Loss e Fo emain Length Dia. Dist. To Well OIL ABSORPTION SYSTEM BED/TRENCH WidthS Length No. Of Trenches PI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS X DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACH nufacturer: SETBACK CHA INFORMATION Type O n,, ti70 r 3 / O R UNIT R Model NuMtef System: 4r DISTRIBUTION SYSTEM Header / Manifo Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Length Dia. I Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gr ystem`s"ahv- 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.) LOCATION: STAR PRAIRIE.11.31.18W, 127TH ~ s ~ ~ n. ~ b~~~cl7~. ~Q,c.c!i: c~ c>✓'6'_~~ ,Cl< c:t.:4 ~:2.'.~'..c~ ! 1 X~'.. 6k, cV,-. fV. G..~ ,2 7 Plan revision required? ❑ Yes U,b o Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cer No. f n ADDITIONAL COMMENTS AND SKETCH - SANITARY PERMIT NUMBER: : 3 Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P:O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application state sanit~taary Permit Number The information you provide may be used by other government agency programs (Privacy Law, s. 15.04 (1) (m)). ❑ Check if revision to previous application State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 1/4 1/4, S T , N, R E (or& Property Owner's Mailing dress Lot Number Block Nu ber l '2V 7/ X.TYPE ate Zip Code Phone Number Subdivision Name or CSM Number ( F BUILDING: (check one) ❑ State Owned it~r Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms E] Town OF Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax/Number(s) 1 ❑ Apartment/ Condo 0-~f 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 g 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. p 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./'nch) Elevation Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION New Exist- Gallons Tanks Manufacturers Name Concrete Con Steel glass App. strutted Tanks Tanks Septic Tank or Holding Tank - r ® ❑ E] ❑ -1`124 Lift Pump Tank /Siphon Chamber ~ ~ El ❑ 1:1 E VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Na : (Print Plum er's g ture: (N f mps) MP/MPRSW No.: Business Phone Number: l Plumber'sAddress(SUeet, ity, tate, pCode): 1 ~ 1 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S~itary P rmit Fee (Includes Groundwater ate Issue suing Agent Sig ure (No Stampst A roved /0 Surcharge Fee) pp E] Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: a IV SBD-6398 (R. 0"4) DISTRIBUTION: Original to County, One copy To: Safety 8 Ruildings Division, Owner, Plumber INSTRUCTIONS r 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, 608-266-3815. 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. i I SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations April 1, 1996 2226 Rose Street La Crosse WI 54603 K 0 CONSTRUCTION KIM 0 CONNELL 504 THIRD AVE OSCEOLA WI 54020 RE: PLAN S96-40161 FEE RECEIVED: 110.00 MOE, DARRELL SE,NE,11,31,18W TOWN OF STAR PRAIRIE COUNTY OF ST CROIX NON-PRESSURIZED IN-GROUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. - This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section ILHR 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. SHDA-7997 (R. 19/94) { 1 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations K 0 CONSTRUCTION Page 2 April 1, 1996 PLAN S96-40161 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, e and M. S Plan Reviewer Section of Private Sewage (608) 785-9348 I SHDA-7897 (K. 10M) 0 401 61 Private Sewage System Plan Index/Checklist All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plan 1D # Owner' Name Legal Desgription Address e ezef '(12 City/Village/P_ County Contents Comments/Special Instructions Page # Included Two copies needed for all plans 1 Plot Plan 2 Plan View/Lateral Return by Mail t Cross Section 4 Tank & Pump/ Fax Letter to (County) (Submier) Siphon Information Circle One and Provide Fax ( ) 5- System Sizing (Public) 6 Call for Pick-Up: ) 7 Q Other I, the undersigned, hereby certify that the Seal (if applicable) plans and specifications submitted herewith were prepared under my direction and control. RECEIVEo Plumbe signer License/Registration # MAR 2 gc u'w IRI-/. -?112s-91 d city State SAFETY ignature ~E $o Office P` 4 Attachments: Application Soil & site evaluation Cole s Fee Needed for Holding Tank Submittal: ' SS V One copy of notarized holding tank P rf ~i' , yv agreement. (Originals to County) ► t 5 1 " Needed for At-Grade Submittal: Original signed and notarized Application for "Use of an At- Grade" County on-site One additional set of plans SBD-10268 (N.01/96) -4 7-SIAI I X77/ .6?T'`''S .S•r ~,i~~ $96 4616' . - .F/wo' ;,/,g,.e" 7d ,40 e j i I la i / 774 .17 7 I I ~ i lee* ! : i /~9'1(1 /r 1414 I C!f i i L_. 'I j + V ll nd ! li g; pp! aval is r y a t : , .taa f:>> f PAGE OF CroSS J`C~IUII O f A Frg►A All 1111616 And Obwwallon Plp• ~J^- ADprored Veal Cop Ylntmwr 12' AOOre flaol credo 20 ♦2' Above PIpP 4. co++-Is+ To final Goodo `Veal Pipe 'Wr.M-1+af.Or S/nlMrk ca-lay rein 2' Aggregate Over Plpe / Olw lprUo~T Pipe o 0 0 Too + 6' Aggregate Boneelll Pipe ° Puloraled Pipe bola. o -C-01011 Tar■dnuing Al Borlom 01 Sfelam 1 / ~~cJ•.7 loll SOIL FILL DISTRIBLITIOM PIPE APPROVED .SyJJPCTIC COV - `MATERIN- OR 91" OF STRn 2"OF16GR;AE OR MARSH HA-J ',,"Yr~q f l.rOFAGGREGATE eP U ggg ELEV. OF-2-2Z FEET • ~11 DIS'TRIIjrJTIQW PIPE TC1 BC AT LEAST - 11,1CHES BCLOW ORIGIUAL GRADE AUU AT LEAST LO 11JCHC5 BUT 1.10 MORC THAW 42 MCIIES OELOW FIAIAL GRADE MIUcMUM MrVi OF FXCAVAT100 F'XOM OR16VAL 6~ AI)F- WILL BE IuCHES fVNIt uM ©CP T-VI of EACAVATImN r-KOM C+ 16 JAL_ GRADE WILL. BC ~ INCHE S i SIGUCO: LICCIJSC IJUMBE11: + r DATE: -2-::;=~- - - - 110 s J Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _L of Labor and Human Relations bivision of safety & suildings 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 riot limited to verfical 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 GOVT. LOT 114 1/4,S T ,N,R (aev PAOPERtY OWNER':S ILING DDRESS LOT # BL # SUBD. NAME OR CSM # rN 71 62 C1 17Y E ZIP CODE PHONE NUMBER []CITY ILLAGE ®fOWN NEAREST ROAD J - ~ -7 Z= - 2 142 ~7 n- bQ New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building I I Replacement Public or commercial describe Code derived daily flow _ 9,::~ gpd Recommended design loading rate 7 ed, 9pd/ft2_.,_2 trench, gPdjft2 Absorption area required 49 bed, ft2,442.:s-' trench, ft2 Maximum design loading rate _,_,~7 _bed, gpd/ft2_,,,f_trench, gpd/ft2 Recommended infiltration surface elevation(s) 9-9,19 It (as referred to site plan benchmark) Additional design / site considerations Parent material 91,R 2e, 4 4,,„ Flood plain elevation, if applicable ft S - Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem MS ❑ U OS ❑ U ®S ❑ U Z] S ❑ U ❑ S J@U ❑ S Lau SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Pont Color Gr. Sz. Sh. Bed ranch s~ Ground dl - 17 1? elev. 67 Depth to limiting factor Remarks: Boring # ' 44~ gig- Al~ Ground elev. 'Q~ft. Depth to limiting factor 9/' Remarks: T Name:-Please Print - Phone: Address: ;<d Signature: Date: CST Number: PROPERTY OWNER,,~„~p~~/~ SOIL DESCRIPTION REPORT Page,,-.2 of _.3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. nt Color Gr. Sz. Sh. Bed rends :4 M , 3 Ground - - elev. Depth to limiting factor Remarks: Boring # '101e Z/v Ground elev. Depth to limiting factor > 9l Remarks: Boring # i 92 Ground Za 0, elev. ft. Depth to limiting factor 9G Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) I I I 71 lev, { i i gyp" OCat I J3 I I i I ~ /G ,ft's i ~ I ` I ~ j i ~ ; ~ ~ I _r i I I I I ' 3G ! i I j i I I i i I r I ~ r99"~ wt Wisc. Department of Industry, SOIL AND SITE EVALUATION REPORT Pa g °•Laboi- Human Relations g Of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P .D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION WED BY . DA, PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT 1/4 - /4T T ,N R r P OPER OWNER':S ILING/jDDRESS LOT# BLO # SUED. NA ID MER 7j A/ ~4 CI STATE ZIP CODE PHONE NUMBER ❑CITY ILLAGE GOWN N HEST ROAq ()Q New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ Public or commercial describe ,o (9jTz'E _ Code derived daily flow ?,~n_ gpd Recommended design loading rate bed, gpd/ft2-,,? trench, gpd/ft2 Absorption area required 1~9 bed, ft2 1,42, sr trench, ft2 Maximum design loading rate gybed, gpd/ft2_,,.V _trench, gpd/ft2 Recommended infiltration surface elevation(s) ,9-9,19 ft (as referred to site plan benchmark) Additional design / site considerations Parent material ~~Aq, Flood plain elevation, if applicable ft OU4 S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem m S ❑ U 0S ❑ U ®S ❑ U RIS ❑ U ❑ S IN U ❑ S [&U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench s~ -Al /!qfto 5; jZ Ground elev. ft. Depth to limiting factor Remarks: Boring # 44~ A, 1,4 ~7 Ground - elev. Depth to limiting factor ~ 9/~ Remarks: CST Name:-Please Print - Phone: S~ Address: Signature: ( Date: CST Number: PROPERTYOWNER, ~Q~-/~•o~ SOIL DESCRIPTION REPORT Page 4161, PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. nt Color Gr. Sz. Sh. Bed Trench Ground IL elev. 9 ft. Depth to limiting fact Remarks: Boring # viii:.f-[:vt -71 Ground S D - _ elev. 9_ss ft. Depth to limiting factor >9l Remarks: Boring # / Ground elev. ,t ft. Depth to limiting factor > 9G Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) so.,~XX~ell '/ol St ~f; Ax cl~?:,,,?71 'cl ,y8 ~+Pe~rrs~o S~o.°~ s~~xR ,gym 3~f p~.oK ,33 104, -1-- 3Gr1 /99'./. /t by l 39&167 CERTIFIED SURVEY MAP ~ 33,46' S86023'2911E 253.43' Located in the` SE 1/4 of the NE 1/4 of D N 13°05'41" E 219.97' Section 11, T31N, R 18W, Town of Star ' /1 4,69' Prairie; St. Croix County, Wisconsin C'oi° y3~ 33 33 ~o cs 0, 60 5 6 I 6' °Q Surveyed for: Gary Moe IZ N 2 ' O o o !O O SCALE IN -FEET (I"= 100') rv ~y 0 100 20.0 300 N m ti LEGEND / N ID I W I v SECTION CORNER MONUMENT n • 1 IRON PIPE FOUND ~ I Iv O 1"x24" IRON PIPE WEIGHING I~ M 1.68 LBS/LINEAR FOOT SET Ib ® I (R) PREVIOUSLY RECORDED AS 'vm For Curve Data see Reverse Existing parcel-not subject to review process. z 0) o N ti~ vLOT I a >DW S SOD f O 8.3767 a c D o ACRES G ~ (364891 ~ ' z SQ.FT.) rngc) MAY-181984 , \CI INCLUDING RIGHT-OF- WAY - v m(f) AAM of OONNlt~ 9) OD CO m homes 4 D 7.5018 ACRES o°m M cmk +Oortr, / / ~o (326780 RIGHT- T) N vm o, EXCLUDING OF N -WAY t°~z ~l 6 rn mm my mo CENTERLINE I / L z°m. / / / RIGHT-OF-WAY LINE r-0 zZ NOTE: M LOT 2 m w 1 I (5) / 0.0825 ACRES v (3593 SQ. FT.) EXCLUDING RIGHT-OF-WAY I I i ~7 i 0 `0 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS j°fl r 77' 5 PROPERTY ADDRESS d 1f (location of septic system) Pease obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 114,_ 1/4, Section T_z:~N-R_ZZ_W 'SOWN OF ~ Ix~Ala"i6 ST. CROIX COUNTY WI SUBDIVISION LOT NUMBER CERTUUDSURVEY MAP ~y,~,/7, 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 year expiration date. SIGNED: - o/I I DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 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. owner of property g' ' Location of property 1/4'_1/4, Section ZL,T-.2/_N-R_,LZ_W Township Mai ing dress Address of site Q /olt 1771 ~i Ch/, '`fry[p~ Subdivision name-?-~`3 Lot no. Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume 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. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co-Applicant: -Date of Signature - Date of Signature I " 'UJCUMCNT NO. 4RIT-CLAI11 REER-RT Ce(NtA1148 II r T STATE OR WISCONSIN-TORM 14 VOL n• f , 658 PAuE 144 THIS 3tAC: KUUVW /Ol 190NDUK DATA REGSTERS OFFIrE THIS IND•aNTURL, Made by Vorthe-rn..-States Power_..Company.,•.,-,• `r o 'Jiscongin. Hydro .E .ectric..-CRmp.any) ST. Ce`:..,~ ._O, W16. # read. f _19th a Cmpormtun duly orgamted and existing under and by virtue of the laws of the State. of day ai__ Jan-A.D. 19U Wisconsin, grantor of. UU.Claire ..County Wiscua.in hereb quit-claime Carv 0. Moe and Cindy L. Moe, husband anc~ wife, and Clt- 8:30 A~ r lo.. Darrel J. Moe and Diane E. `toe, husband and wife n_j _ Rplata of e . - .................._._......_..............................................••---.............................._..amntee..s........ RETRt1R T~ 111IC & LUDVIGSON of... -..5t......CraiX...... County. Wisconsin, for the rum of O. BOX 337 -One. Do llar, . and- Other.- Valuable. Consideration_ P. Osceola, 3 54020 _ . _ . . the fulkiwing tract of land in __S.t......Croix_........ Count Stale of Wisconsin; Part of SE-1/4 of NE-1/4 of Section 11, Township 31 North, Range 18 West, described as follows: Beginning at the Southwest corner of said Southeast quarter of the Northeast quarter of Section 11, thence East 2 rods to the place of beginning; thence North 150 feet, thence Easi- 265 feet; thence South 150 feet; thence West 265 feet to the place of beginning; excepting therefrom the South 60 feet of the West 60 feet. Also reserving unto grantor, successors, and assigns an easement to operate rebuild, and maintain electrical facilities over, across, under, and upon the southerly 60 feet of the parcel herein conveyed. -Y• r. (r! j 1 .-A Vice In Witness Whereof, the said grantor has caused these presents to be signed by... Roland J. Jensen A-, , its President, and l cuuntersigned by..__Dr_..P...... Jolst.ad..._ ...r....~.... its Secretary, At. Eau....C.la.ire..... . Wisconsin, and its corporate seal to be hereunto affixed, this. .Q df 1 ........day of. O..V.-47M B F&........... A. D., 19. d. a`... i NORTHERN STATES P014ER COMPAN SIGNED AND SEALED IN PkESENCE OF 'Viice•"ldritt t Roland J..._.Jensen.... I . C:Uti 1'IiRSIGNED a - r t).~Ift rs D. P. Jolstad _ STATS OF WISCONSIN, ss. NEaurrscxully Clai came re before me, . this.~ _ .County. I G ~ O ✓e_ " . • . • day A. D., 19 1 , ..Boland J......Jensen... Vigq President, and.. D. P. _Jols.tail.... . , Secretary of the above named Corporation, to me known to he the persons who executed the (oreguiag instrument, and to me known to be such... VLCe.....Fresident and......... Secretary of wid Corlx.ratiun, and acknowledged that they executed the foregoing instrument as such officers as the deed of said Corporation, by its authority. DOCUMENT NO. ~j STATE BAR OF WISCONSIN-FORM 1 • J ~}v~12 d1 Voi, 63 PA. 183 WARRANTY DEED ~,l I W~7 u THIS SPACE PESERVED FOR RECORDING DATA REGISTERS OFFICE THIS DEED, made between 11~T_.Zoderberg & Tanp Soderhe_r ST. CROIX CO. WIS. hiG wi fp, as to i ndi vi dual le i nt•prs~ai- - and WTn W R~'d. • Ward and Tcahpl Ward h»chand and wi fP act joint- for Record this 2nd tenant's as to individual 4 interest Grantor day of June A.D. and GAry O MnP And rindy T Map* hush and an{Lwife, at 981 and Darrell J. Moe and Diane E Moe husband and Afe, M. Grantee, Re¢6ta o} tawd. Wi t ne s s e t h, That the said Grantor, for a valuable consideration - conveys to Grantee the following described real estate in St. Croix _ RETURN TD County, State of Wisconsin: All that part of the Southeast Quarter of the Northeast Quarter (SEh of NEIL) of Section Eleven (11), Township Thirty-one (31) North, of Range Eighteen (18) West lying Westerly of line: Commencing Tax Key No. on the North line of said Southeast Quarter of Northeast Quarter (SEh of NE4), 832.0 feet West of Northeast corner thereof; thence South N 6° 41' West, 1320.4 feet to South line of said Southeast. Quarter of Northeast Quarter (SEh of NEe), EXCEPT all that part thereof lying Westerly of highway and EXCEPT part deeded to Darrell J. and Diane E Moe in "462", page 227, described as follows: Commencing at the Northeast corner of the Southeast Quarter of the Northeast Quarter (SE4 of NEh) of Section Eleven (11), Township Thirty-one (31) North, of Range Eighteen (18) West; thence on an assumed bearing of North 881, 51' 00" West, along the North line of said Southeast Quarter (SEh) a distance of 832.00 feet to the point of beginning of the parcel herein described; thence South 060, 55', 30" West, a distance of 180.24 feet to an iron monument; thence North 860, 06', 40" West, a distance of 252.86 feet to the center line of the Township Road; thence North 13a, 221, 30" East, DESCRIPTION CQNTINUED ON REVERSE SIDE This__ s_.nxjr_homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And , warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except nis-wiWel- and will warrant and defend the same. Dated this 1`ath day of Malt , 19 ft. T. o er erg (SEAL) 4 - W (SEAL) *Wm_ W_. War t~ (SEAL) (SEAL) Jisnp Sr~dprhpra Tsahel Waxd AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 19- ss. St. Croix County. Personally came before me, thi 1 9t-hday of * May, 1981 - the above named TITLE: MEMBER STATE BAR OF WISCONSIN H. T. Soderberg and Jane Soderberg (If not, authorized by §706.06, Wis. scats.) his wife, and Wm. W. Ward and Isabe t Ward, husband and wife This instrument was drafted by r ' t+l mr..knpwnt fbpe~.the person _q who executed the fore- going instrufn~}rt~*nd acknowledged the same. e ' ~oL 630 PA-E184 DESCRIPTION CONTINUED: `.i. along the center line of the Township Road a distance of 24.00 feet; thence North 200, 031, 30" East, along the center line of the Township Road, a distance of-A76.79 feet to the center line of County Trunk Highway "H"; thence along a curve concave to the North, said curve having a chord bearing of South 820, 251, 30" East, and a chord distance of 209.65 feet, for an arc distance of 214.16 feet to the point of be- ginning. Subject to Town Road Right of Way. f 2v3F Ys 8@42!% 92!X 4E39 VOL 20 PAGE 5018 KATRLEEIT H. ALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD CERTIFIED SURVEY MAP 07/12/2005 10:30AN LOCATED IN PART OF THE SE1/4 OF THE NE1/4 AND IN PART OF THE CRERTIFIED SURVEY HAP FEE: 13. SW1 /4 OF THE NE1 /4 OF SECTION 11. T31 N. R18% TOWN OF STAR COPY FEE: 3.00 PRAIRIE. ST. CROIX COUNTY. WISCONSIN. ALSO BEING LOT 4 OF CERTIFIED PAGES: 2 SURVEY MAP. VOLUME 17. PAGE 4521. SURVEYOR: PREPARED FOR: DOUGLAS J. ZAHLER DARRELL AND DIANE MOE S & N LAND SURVEYING. INC. 2271 127TH STREET 2920 ENLOE STREET NEW RICHMOND. WI 54017 HUDSON. WI 54016 LOT3 C.S.M. IN LEGEND VOL_ 17 PG. 4521 FOUND 1' OUTSIDE 256.51' DIAMETER IRON PIPE S88 23'13'E SET 1' OUTSIDE DIAMETER BY X33.23' 2Z3. O 18' LONG IRON PIPE. NEIGHING 1.13 LOS. PER LINEAR FOOT ~M 04 ROADWAY SETBACK LINE ~W (100' FROM RIGHT-OF-WAY) LOT 4. RECORDED ( ) D STANCE BEARING AND/OR s ( 2.2x4 SQ. ACRES IN¢ R/W 2 z 2.000 ACRES Of %vis (87.1Z2 SQ. FT.) L'0 cc 6 EXC. R/W -7 DOUGLAS J. / / r ZAHLER S-2145 * "1~ / N88 23'1 sw 289.17' Cly H Dso 4 / , / / S M c~ is OS N.~,, / ' y.~ LOT 5 I r1% ,O a35 iz y-.~' 2.35 ACRES 3 .21 m~ r c9::INC7. /W S ~r ' ' • 2 . OOO ACRES r . r~ t 23 / (87.E C /W ' ~ y ~ v 171 N88 372.68 : N 338. v 3.505 ACRES / (152.662 SQ. FT.) INC. R/W : 3.232 ACRES (140.788 SQ. FT.) EXC. R/W W ►i ~IVEWAY LOT 6 cn c1 1cl 2 BUILDING 33.06• N z N88 59'01~'iN 92.16' p~ STEEL POST AT Q W1/4 (cN~8~7'29'46`VI) CORNER NOMONUMEN E1/4 COR. + SEC. 11 e a.NOOMS'l t W SEC. 11 ' ,>p?- 4267,02' V 1V89'02'57"W~ 18.24' 961.141 co s~ 287.74' `EAST--WEST 1/4 LINE LOT 2 C.S.M. S89'51.49 w s228.20 f S IN U_NPLAT_TED s„ gig -VOL. 5 PG_ 1421 1 j W LANDS in W 1 2 _ SCALE IN FEET 1" - 150' MwiiiiiiiiFmw z 150 O 150 THIS INSTRUMENT DRAFTED BY: WILLIAM KANE JOB NO. 6284-02 DATE: 04/25/2005 REVISED: 07/07/2005 SHEET 1 OF 2 SHEETS Vol 20 Page 5018 a MAY - 5 2004 -7 2RaID 4 •v. ~.VOL 17 PAGE 4527 , i ,KATA~E`~A H. W ALSH REGISTER OF DEEDS _ ST. CROIX CO., Wl RECEIVED FOR RECORD 05/20/2003 12:10PA CERTIFIED SURVEY MAP CERTIFIED SURVEY MAP REC FEE : 17.00 COPY FEE: LOCATED IN PART OF THE SE1 /4 OF THE NE1 /4 AND IN PAGES : 4 PREPARED FOR: PART OF THE SW1 /4 OF THE NE1 /4 OF SECTION 11, DIANE MOE T31 N, R18W, TOWN OF STAR PRAIRIE, ST. CROIX 2271 127TH STREET COUNTY, WISCONSIN. NEW RICHMOND, WI 54017 Z SURVEYOR: [ umlTumaDo o M - -SEE DETAIL B p N THOMAS M. HEALY CENTERLINE - R LL S& N LAND SURVEYING, INC. ,_CrON SHEET 3 o O rn 2920 ENLOE STREET LU HUDSON, WI 54016 C3 !,,.,N89°39'21"E~8.42' z J p - S05 08 30 W 50.23 8 0 cr CC w C6 I I- N89°39'21"E 124.45(L11)ro cm, LL ~ cr co -F Lcuc ~ y. w Tod . O it J O L- - GRAVEL CD SOUTH RIGHT-OF-WAY ¢ ~ DRIVEWAY r --'LINE OF COUNTY TRUNK (D w lo INII*15'19uE ~jJ~ Zug (L9)24.23' 1S) - `N W HIGHWAY "H" ¢ SEE DETAIL A p S88°23'13"E 256.52' : N m u Q ON SHEET3 , _ 223.28 w ^ 1,33.23 ?01T 3? a J T SCALE IN FEET 1" = 200' 'u~ `wcca o-~ N nn (~J~ j co N ri Z L13 VUI vV l n' ► N ' S89°48'16 "W 200 0 200 i o iN o d: Z ' 154.50 ~ QI I Z'33' I- WEST LINE OF LOT 2, (o I y f 3 LOT 4 CSM VOL. 3, PG 649 010 ~ MOLo Pa. 569L I I I z I c* I of ~i ^ NOTE: ` + THE LOTS CREATED HEREON ARE ALL OWNED BY DARRELL & a I I 3 DIANE MOE AND RECORDED IN VOL. 462 PAGE 227, VOL. 480 I h j 4) PAGE 510, AND VOL. 5 PAGE 1421. NO NEW LOTS ARE ~DI O p ZG cp) CREATED BY THIS INSTRUMENT. ALL CONDITIONS, RESTRICTIONS, NOTES, ETC. LISTED ON THE PREVIOUS i H CERTIFIED SURVEY MAP OR PLAT ARE APPLICABLE UNLESS i U) ~TH 9VIS1=INDICATE . APPROVED ON >,Z2,,) Z-OLL BY - ZONING DEPARTMENT. i LQ_1) Z No~_aUVUa OLYI -SOUTHWEST CORNER OF w C n • ~~L❑ G° ao LOT 2, CSM VOL. 3, PG 649 z M v - N cJ^c W 3 M1L?4`~G~D dLaG~JD~ N w nnnnnn rru~ng ~v7 f~ rI r~ n v 59.10' ~ww~~ U ~_~ln- - - o z. (L4) eW EAST-WEST QUARTER LINE N88°59'01 "W Z Sc6 c N PER CSM VOL. 3, PG 649 92.16' (0) r y N89°02'57"W961.35' 66' 905.51 EAST 1 /4 CORNER -N89°02'57"W - 4267.02' 287.74' (L1) - - - "t" S89°51'49"W 9961.17'1_ - SECTION 11 EAST-WEST QUARTER LINE ,