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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER piv p. y M LS
ADDRESS ,2,/
SUBDIVISION / CSMf / LOT
SECTION ~ 0 T 2 Q N-R / W, Town of ( K,
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
h~
i`
kot S G
I
qA
%
.-INDICATE NORTH ARRo
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: (3otow,` a~ sue/ (J
ALTERNATE BM'
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:- m e-d w d s cc-~ Liquid Capacity: w G
Setback from: Well House Other
Pump: Manufacturer a (`G Model# /r Size
Float seperation Gallons/cycle:
Alarm Location
L SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
it '
Setback from: well: p House Q 2. Other
ELEVATIONS
Building Sewer q j . ? ST Inlet. -l 3 ST outlet
PC inlet PC bottom- Pump Off
Header/Manifold ~~e L Bottom of system
Existing Grade Final grade
DATE OF INSTALLATIO L Cf S~
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
LaboY3nd Ouman Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
' GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Pe;rpji f Id~'s,plw. ❑ City ❑ Village C1 Town of: State Plan o.:
RATaDWTN
CST BMtlElevU: WAtY Insp. BM Elev.: BM Description: / X Parcel Tax No.:
92
TANK INFORMATION ELEVATION DATA ~//7/~~:_
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
~ b~ CGS tv~.✓~'
Dosing
Aeration Bldg. Sewer '
A, 9! ?o
Holding - St/,W-Inlet
TANK SETBACK INFORMATION St/,Hf Outlet
TANK TO P/ L WELL BLDG. Airinta to ke ROAD Dt Inlet
Ar I
Septic NA Dt Bottom p7 ; 14 Dosing NA Headerf-
Aerati NA Dist. Pipe 9`(
Holding Bot. System
PUMP /-S~ NFORMATION Final Grade
Manufacturer r ,'fir Demand
Model Numbers ] GPM
TDH Lift Friction Syestem ,,1 j TDH Ft
oss
ti
Forcemain Length Dia. ; `r Dist. To Well
SOIL ABSORPTION SYSTEM
411-6-/TRENCH width Lell1(( No. Of Trenches PIT No. Of Pits Inside D Liquid epth
DIMENSIONS 33 `VF DI I N
SYSTEM TO P/L BLDG WELL LAKE STREAM anufacturer:
SETBACK
INFORMATION TypeO P h CHAMBfiX'
Model Number:
System: ' -r 1-. El>/ ASV OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold r Distribution Pipe(s) i x Hole Size x Hole Spacin ent To Air ke
Length Dia. Length 'X37 Dia. Spacing 19
SOIL COVER x Pressure Systems Only xx Mound Or At- Gra ys nly
Depth Over / Depth Over y xx Depth Of xx Seeded/ Sodded xx Mulched
oB french Centerolio -3a ' -tor" Trench Edges ~6 Topsoil E] Yes [j No El Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) 4/ , / ~1
LOCATION; BALDWIN.18.29.16Wr,--NW,,,NE,,-,COUNTY HWY. E
Plan revision required? ❑ Yes "O
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signatu a Cert No.
Safety and Buildings Division
ng Water Systems
SANITARY PERMIT APPLICATION Bureau of Bulldi
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 1/2 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
A3341gq
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
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Pro rty Owner Name Property Location
S N 014 N 1- 1/4, S I~/ T 2 Y . N, R E (or
Property Ow er's I a~ng Address Lot N tuber Block Number
Stat r/1 L Zip Cod .Phone Number Subdivision Name E CSM Number -I, I cc [.t/t S ! you 'Z (2i> ) 4 y y-, a'
City c
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it( Nearest Road _
❑ VII age / Y G
C
Public 1 or 2 Family Dwelling - No. of bedrooms wn of 4 / 44
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
062 -~Z- 166 - 3~-tGa
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 __-__Exlsting-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 IA 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
n Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
J U0 `ij YO 3 X15, o ~q,U Feet 44, U Feet
VII. TANK Capacity Site
INFORMATION in gallons G otal Tan of Manufacturer's Name cone e . Con- steel y ass Plastic EAxppepr.
New Existin strutted
Tank Tanks /
srx~ L~ ❑ ❑ ❑ ❑ ❑
Septic Tank or Holding Tank 16 UU , `aq e- ¢w p ~7-~
Lift Pump Tank /Siphon Chamber 25& t t ❑ ❑ ❑ ❑ ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility or install n of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum is Sign atu Stamps) PRSW No.: Business Phone Number:
1a~ Stan " ?l~--
Plumbgr s Address (Street, C, State, Zip Code :
c/ . /le Lit' s ~fG Z
IX. C NTY / DEPARTMENT USE ONLY
Disa roved Sa Itary Permit Fee (includes Groundwater Date slue alssuingA Signa re (NO St ps)
❑ pp ~j Surcharge Fee)
Approved ❑ Owner Given Initial y~// p/~,,,
Adverse Determination D
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:
L Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed-
11 . 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/i 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 applicat on form.
IX. County / Department Use Only.
X. County / Department Use Only.
C: d
ns no, smaller'h )n 8 12 x 11 : i _hes fn; st be suf. to tc r -~ty. The plans must
n. ".1 ";of. [!,)n;, t_) ajv n (-tale or with corn p!ei.£ :,Iinq tc:nk(`-ti), septic
_ ,1): d 1 `==1:~ r wel>, `N U i. L::' iil.il7rp or sIphon
iGtl .V~ !IOr~ >y< 'r15; replacemer ~y,ai ' ~~re,a'; JL "i4 2 `iu`ldkng',erved,
v l
;OiUrl.l'.
. .
n%r; °r`nceCar~.~~. N r"...I~ ~a er; :r) crosssec ions
5(2 t1 If r:_qU '..vuil svi; k2st data rl alt f Uil ?inq information-
GROUNDWATER SURCHARGE
19B~~ V isco 7~i i`,.ct 410 included the creation of surcharges (fees) for a numoer of reg, rated pr.ic:icts ivhich can
F
effect r~rou~ctuv.at< r
ie~ _o.;ef t.ed through these surcharges are used for rnDnitcring groundwatr : (C)n~ia~ iii ~,o,, -vestgations
and establishment of standards
Wisconsin, Department ofIndus", SOIL AND SITE EVALUATION REPORT Page of
t.ahor an.+ iauman Relations
^Ditiision 61 Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
' COUNTY _
Attach complete site plan on paper noeance1% i Plan must include, but X
not limited to vertical and horizontal re, direction o slope, scale or PARCEL I.D. #
dimensioned, north arrow, and locatioear oad.
REVIEWED BY DATE
APPLICANT INFORM ATION-PLE 4IN ATI
PROPERTY OWNER: & PERTY LOCATION
-7~s\'3 ft 4 K-~ ` NW 1/4 N 1/4,S 18 T Z9 N,R 6 E (04 :6
PROPERTY OWNER'-.S MAILING ADDRESS T # BLOCK # SUBD. NAME OR CSM #
CITY STATE ZIP CODE PH_, OCITY OVILLAGE ®fOWN NEAREST ROAD
~'CL-~W1Nt ►4J1 Sq Z. ~ L1~w11'j e.o► L
New Construction Use [A Residential / Number of bedrooms Z [ ) Addition to existing building
D< Replacement Public or commercial describe
Code derived daily flow 3Qo gpd Recommended design loading rate o - bed, gpdtft2 q b trench, gpd/ft2
Absorption area required 44Z3 bed, ft2 3-)S trench, ft2 Maximum design loading rate Its 1 bed, gpd/ft2 0 • $ trench, gpdAt2
Recommended infiltration surface elevation(s) G. S -b - ~ • O ft (as referred toJ a plan benchmark)
Additional design / site considerations S ~ f`1 C Ve ~fy p t~LS k 3 o F 3 , ~Z l~Z Ctk MR 5 ~ 3 L rjkx)
Parent material S 4 Ov'TWhV Flood plain elevation, if applicable Q.A, ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for s stem 0 S 0 U L,S 0 U OS 0 U OS 0 U as 0 U EIS RIU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounder/ Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
z 13 bk t,.s t,- b
Z 1 Z-Z Z Z D `t R 31L S/ 1 Z S d k ►n `F1- ~S o. S o.
Ground 3 ZZ 3Z ~.SyR 31y - Gti-~S s~ wt CS
elev.
A6.0 ft. 3Z10I R- yl6 Q) S5 v,-,1
Depth to
limiting
factor
7~6
Remarks:
Boring #
1 Gw
O-t3 l0`ttZ3lZ s~ Z'F3hk ti`~~'~ o. S 0.6
3 5~tQ 3! StG~ O 59 cS o,'1 qA
Ground
elev. 1-f Illy
i
Depth to
limiting
factor
7 O
Remarks:
CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165
dress:
egerer boll Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date: CST Number:
CtS-18~ 6-19-9-5 M00576
PROPERTY OWNER ESN SOIL DESCRIPTION REPORT Page 1.013'^
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Norizon in. Munsell CQu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
' o-~Z 1 ~ `i ~Z ~ 1 Z ~ S Z'Fs~lrt w~.~~.-- Gt-v - v_S , o• ~
Z ZZ Z`~ ~Z 3l s i~ Z 5b~ >M C-S o
Ground 3 Z~f-SZ lu`1 VL vl~ - S eL p g,) yvt 0.7 p.
elev. '
oo, e ft. y 514 9 do lZ - s 1 z-g~h w► u
Depth to
limiting
factor
Remarks: -
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks: -
Boring #
Ground
elev.
ft. -
Depth to
limiting
factor
Remarks: -
Boring #
Ground -
elev.
ft. -
Depth to -
limiting _ -I -
factor
Remarks: -
SBD•8330(R.05/92)
PLOT P LAN Page 3 of 3
SCALE 1"= 10 '
IVA
I ~ 1 RA►~ ~ LPE
B,Z
J
` 9 2 BDRm 3
'o
z4"rte it 2 \Z'7
.Q ~ ~'tctiJtt
-;~k y.` D Q~1.k11~-L
NpLsQGRuvUD 't 1. '~1t1n1E Smut l l~l~ CU SS9'% `1~ ~-Ttat~
MZ~ , e~►v'rt~~ V`n ~ l'h ~ ~ ~Y~1~ ~ v ~ 8 '1'R-~. c~ 0~;
' 1 P~ ~-\P c`tt~YM3E~ 91,j~) PvMP W) U ~t 1? Q ut.R D 1~
~~.`S 1~►~ G Z'n'~uks t't•tzE 'TO 8 F ~ ~ti ~Ok/ ~ ~5 P~'R C.t) p
q~'1 - Lam. • l0 0 , p01J B ~T~ 1~ 01 S XW M G RT S W E ~vv S C JJI /W M
6 (715 ) 425-ni 65 M00576
CST Signature Date Signed Telephone No. CST #
0W* lash
2~c1%• rt rya n,,~ S- 3 .
/v~,'dcv a xoc ~n lvUri• S"u t 6
a ~
3
tc
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Page Of
COMBINATION SEPTIC TANK/PUMP CHAMBER
(No Scale) 4" CI Vent Pipe with
Approved Locking Manhole Cover Approved Cap, +250
With Warning Label Attached From Buildings
Weatherproof Approved _
Warning Label Junction Box Vent Cap
12" Minimum
Final Grade 6" Minimum 4" Minimum
6" Maximum
4" C.I. Quick
18" Minimum Insp. Pipe Disconnect
i
1/4" Weep
Hole
n
Baffles jJ
~ A 4
i
Alarm B
On
6
C
*APPROVED Off O''
JOINTS WITH
APPROVED PIPE D
3' ONTO Conc. Block
SOLID SOIL
3" of Bedding Under Tank-/
Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day
Gallons Per Day/ of Doses: ISV Gallons
Tank Manufacturer: /1/~,dt~este-~ r1 Volume of Backflow: + T-Gallons
Total Dose Volume:........= /5~2- Gallons
Tank Size-Septic/Pump: 5-b Gallons
Alarm Manufacturer: S3 tE Ito 5, _S
Model Number: l&I Capacities: Ainches or Z G Gallons
Switch Type: of e ,,e u rt + B-1inches or--TIT-Gal Ions
Pump Manufacturer: _2s,~4 Zod/e + C a " i nches or / 5 g Gal l ons
Model Number: s- 3 + D / 4, i nches or~sT f_Gal 1 ons
Minimum Discharge Rate: L/ GPM Total.....= inches or ,(g ~Gallons
Vertical Difference Between Pump Off and Distribution Pipe: Feet
Minimum Required Supply Pressure: Feet
10 Feet of Force Main x ~-49- Friction Factor/1QO~Feet: + ~gleet
Inch Diameter Force Main
Total Dynamic Head:...= Feet
Internal Tank Dimensions: Length Width Liquid Depth J I7 d(57
Signature License Number Date
LU
W W HEAD CAPACITY CURVE 61/4
f-
U.1 "53-55" SERIES 4%
25- 1 1-
TOTAL DYNAMIC HEAD/ I 4%
FLOW PER MINUTE
EFFLUENT AND DEWATERING o
CAPACITY {
W 6 20 HEAD UNITS/MIN 11/2 _
11'/z NPT
FEET METERS GAL LTRS 43/is
= 5 1.52 43 163 •
V 10 3.05 34 129
15 4.57 19 72
15 19.25 5.87 0 0
a -
} 4
D
J 10
I_w 8.8 y
O
I` 2 z3 Ito
5
9'Y1e I
0
US 10 20 30 40 50 33/32
GALLONS I
LITERS 0 80 160 -1
FLOW PER MINUTE
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Piggyback Mercury Float Switches • Available with special cord lengths of 15',
available. 25', 35' and 50'.
• Variable level long cycle systems • Alarm systems available.
available. • Duplex systems available.
Standard cord length - automatic 9 ft
Standard cord length - non-automatic 15 ft.
SELECTION GUIDE
M53155 SERIES Control Selection 1. Integral float operated mechanical switch. no external control required.
Model Volts-Ph Mode Am Sint x Duplex 2 SinglapiggybackwtdeangbmercuryfbatawMrhordoubbpiygybaekmerauyfloat
M53/55 115 1 Auto SA 1 a 1 77 switch. Refer to FMO477.
N53/55 115 1 Non 8.0 2 or 2 & 6 3 or 4 d. 5 3. Mechanical alternator 10.0072 or 10-0075.
DW/55 230 1 AUt0 4.0 1 or l dx 7 4. See FM-712 for conact model of Electrical Alternator. -E-Pak'
E53/55 230 1 Non 4.0 2 dr 2 $ 6 3 or 4 dx 5 S. Sensormercuryflo tswitch 104M used asaca uclaeWator.withE pale
float system. or (4)
53 Series - Wt 23 lbs. -.3 H.P. 55 Series - Wt. 25 Itu. -.3 H.P. 6 Four (4) hole -J-Pak. function box forwatertight connection or wirod-In simplex or
duplex operation. PM 100002
7. Two (2) hole 'J~. function box. for watertight connection orsp,ke. PM 10.0003.
For k*rmation on addkionai ZoaperProduW rolerttoatdOg On Combination Starter. FM0514; CAUTION
Pxggytack Mercury Host Switches, FMO477: Electrical Alternator, FM048t Mechanical Alterna- All Installation of controls, protection devices and wkft should be
ndor ox,F~ Alarm Packne.FMOS1~Sump/SewapBasins. FMW8randsimpimCa*N licensed electecyan, AN electrical andsafNycodssshould bef d~Irk additio~ntoified
B
the
most recent National Electric Code (NEC) and dw Occupational Safety and Health Act
(OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
AWL TO: P 0. BOX 16347
LOld v&. KUIZM5 p3t7
!O Manufacturers of...
s1/rP roe 328o del Ayers Lane
Ladn* KY40216
® ZZ7ZZZZj-ff O (502) 778-2731. 1(800) 928-POMP ~ UAUTY VMPB /MCE O po
4 P .i /s73J
Wffia2) 774-3624
FILED
8 JUN 291995► 2
KATALM KWAM
530675 L SL Q* 00-. V"A
CERTIFIED SURVEY MAP
DWAYNE ASH
3 Part of the Northeast 114 of the Northeast 114 and the Northwest
e w 1/4 of the Northeast 114 of Section 18, Township ?9 North, Range
16 West, Town of Baldwin, St. Croix County, Wisconsin.
.Q
2 k OIndicates 1" x 2411 iron pipe weighing 1.13 lbs./lin. ft. set.
pp
ALL BEARINGS REF. TO THE NORTH LINE OF THE b
j q NE 114 OF SEC. 18, r 29 N, R /6 W, ASSUMED
S 87.22'// "E
2 p
W
h O
O 2 ~ O
Ci s3 \
ly F.
W
2 2 s X833\
3 33 30~ Q .
PROVED
6 61 4110 k
\ F
JUN 2 9_1951 lu o 2
^ I \ 3 N N
= N
O ~ I \
ST. CRax COUNTY ~ ~ o o > _ W
Gorr'iX9hensive Pianr4c W „
Zoning and x 3 a \ 7 o
Parks Contrnittes 141 I \ o
\ k
Owner's Address:
If "at recorded J I Z i~ 1 2127 C . T . H . "Ell
within 30 days a*) N I N \ Baldwin, WI 54002
approval date I 3 \ This instrument drafted by
twoval-Shalbk, to Z + o ~ Laurence W. Murphy
~uq g void QI o I t~ItttN/rt
v " o Q 3 \ 4`CON ~y~'•
I V O h
W_ ~c 2 ~ v O ~ L
I^ A W Q _r y,~ a LA N E%
~ U PHY
R ~o W W~W~ M
v a~~o I I o° Q 1713
N e} V cn V
4 -J Q Q ^ W I --RIVER FALLS,,
ZI ^ ao bm ?Q 3 I 0A~►' Wisc.
ti I ¢ ` tttu •N~
I m =
1 o W ~m N urence W. Murphy
'Registered Land Surveyor
z
b i W J a N Dated: June 5, 1995
h W
N Y I' R 1 ~H 6 , at 0
Q
r. o Q W a0 Q WQ:
0 (n Z3
Qt (0
Cn H 2
2
O 424.36' 6ry \0 4863.2
LU7
m 33.04' 39/,32'
14 N 00•/9'56"W' 5287.63' NIS I/4 LINE
UNPL A T TED LANDS SHEET 1 OF 2
Vol. 10 Page 2943
Certified Survey Maps
'St. Croix County, Wisconsin
CERTIFIED SURVEY MAP
DWAYNE ASH
Part of the Northeast 114 of the Northeast 114 and the Northwest 114 of the Northeast
114 of Section 18, Township 29 North, Range 16 West, Town of Baldwin, St. Croix County,
Wisconsin.
Description:
That certain parcel of land located in the Northeast 114 of the Northeast 114 and the
Northwest 114 of the Northeast 114 of Section 18, Township 29 North, Range 16 West,
Town of Baldwin, St. Croix County, Wisconsin, more fully described as follows;
Commencing at the North 114 corner of said Section 18, the POINT OF BEGINNING, of the
parcel to be herein described; thence S 87022'11"E (assumed bearing on the North line
of the Northeast 114 of said Section 18) a distance of 1460.971; thence S 34058'33"W
307.841; thence S 4603510111W 300.131; thence S 55033'24"W 269.661; thence S 84045'43"W
178.081; thence N 81059'10"W 231.701; thence N 60048'58"W 310.701; thence N 62000'00"W
183.571; thence N 00019'56"W 424.36' on the North/South 114 line of said Section 18, to
the POINT OF BEGINNING, containing 16.614 acres, being subject to easement over the
Northerly 33.00' thereof for C.T.H. 'E" R.O.W-.:purposes and,ialso:-.bein~ subject to--..
eosements..of record.
Note: The parcel shown on this map is subject to State, County and Township laws, rules
and regulations (i.e. wetlands, minimum lot size, access to parcel. etc.). Before
purchasing or developing any parcel, contact the St. Croix County Zoning Office and the
appropriate Town Board for advice.
State of Wisconsin)
County of Pierce)
I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of
the Owner, Dwayne Ash, I have surveyed and divided the lands shown hereon in accordance
with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of
St. Croix County and that this map and description are a true and correct representation
thereof.
`,,\`0%%111111
This instrument drafted by Laurence W. Murphy \SCONS/+
LAU N
Dated: June 5, 1995 m W R Y•
i
S 713
N, FALLS, •
F isc. , 0
,~Ai-~PROVEa %9FO LAND
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JUN 2 9 95J Laurence W. Murphy
istered Land Surveyor
CROIX COUNTY
#,~Cy;,tx+rhensive Plannit
Zaning and
Vol. 10 Page 2943 Parks Committee
Certified Survey Maps tf not recorded
St. Croix County, Wisconsin. within 30 days of
SHEET 2 OF 2
approval date
•0P04va;,*NW be
"A A void
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERIBUYER h r! ✓~S
MAILING ADDRESS l Z fi t L^ p / k
PROPER'T'Y ADDRESS S M "r-
(location (location of septic system) Please obtain from the Planning Dept.
CITY/STATE 134 I ! 2 ' e~ 1S
PROPERTY LOCATION N /w 1/4, 014." 1/4, Section T__2_~_N-R G W
TOWN OF 134 ST. CROIX COUN'T'Y, WI
SUBDIVISION LOT NUMBER
CERTIFIEDSURVEY MAP S3 4G ? S , VOLUME, PAGE 21A 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.
"fhe 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.
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 MR.
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 yea piration date.
SIGNED:
DATE:
St. Croix County "Zoning Office
Government Center
1 101 Carmichael Road
Hudson, WI 54016 11193
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 0 w y h e 4y x
Location of property N !LJ 1/4t4 C 1/4, Section y , T _~LN-R4L W
Township f A_ /o( k/ r c~ Mailing address 1.2 trap
Address of site ~ A-1 {
Subdivision name Lot no.
Other homes on property? Yes L'No
Previous owner of property
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? es 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'd h ~ ~ff ice of the County Register of
Deeds as Document No. `mil( 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 the County Register of Deeds as Document No.
39~
Signatu of Applicant Co-Applicant
v~~ s
Dat of Signature Date of Signature
f
• DOCUMENT NO. STATE BAR OF WISCONSIN FARM 3-1962 THIS SPACE RESERVED FOR RECORDING DATA
QUIT CLAIM DEED j
443949 BOOK 829 PA t 596 per.v
_ FIaraaret Ash RE'STEROS OFFICE
ST. MIX Co., WI
Rfe~cd for Record
quit-claims to Dwayne Ash JEC2 019M
~t• 8:30 A. M
n.yn.. of
the following described real estate in St. Croix County,
State of Wisconsin:
I RETURN TO "
West one-half of Northeast Quarter (W}-NE4) and West
one-half Of North-east Quarter of the North-east One
Quarter (WI-NE-NE) all in Section Eighteen (18).
Townsh tp Twenty-Nine (29) North, Range Sixteen (16) West Tax Parcel No-
The grantor is releasing her life estate on the property.
rF~
~x
i
This is not homestead property.
ps) (is not)
Dated this
day of_ Deoenhor,
, (SEAL) (SEAL)
:1argaret Ash
i~
(SEAL)
(SEAL) II
i
AUTHENTICATION ACKNOWLEDGMENT
I Signature(s) i
- STATE OF WISCONSIN II
ss.
Croix -County.
authenticated this _.dayof_ _
Personally came before me this day of
~I -e~eTber 19 the above named
I `:Ir -3rgt: Ash
~ TITLE: McMBERSTATE BAR OF WISCONSIN
(lf not.
- to ma o1 to be the'person
authorized by § 706.06. Wis. Slats.) who a cured the
fore sV menf ndack e' d1h6sam
,•~>';.:~.~E^1rwiASDRAF*EDt3i
Dwayne Ash -
I
Notary Public _ _ _
iS gnatures may be authenticated or acknowledged. Both My Commission Is County, do
are not necessary) permanent . tit not', state expiration
dale
✓ ~ . i:ro ,:a b. t, .etl by nus~ - I,,,
NTF 2281
IT CLAIM DEED STATE BAR OF WISCONSIN
FORM No. 3-1982 NPh~o Fo-s D So. 1075. G,eer, Bay, WI 54305.1075