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030-1030-40-000
ti ~o C) h O d O a o w a`~ H c N mr~ N m€oaLO v of o ! ca 4 g Z Z C w.N C y a w U y f E ~ ~ y C O C N 3 C U y O O_ C m C Z .-f0 O L LLO N C O a > w o m m 3 o w E 8 w O L Q L C . C I zt z rn Z o z °'w am co FN- z 0 C d m O z C N O el' O` N H rn N Z c E -2 '0 N co w _ C 01 O f6 w N N O L_ 0 aa) a ° z co z o N Z 0 C: (V O H m co w ` E CL ° v n d ° ~n G G a E c o -5 co :3 cc a ~ o 0 0 0 0 z f ~ a o. a N O N N N 7 O co J 0 rn rn ~l -o m aD O ° j O ° E m y a a N w N fA $A C) c c 0 3 o a E 9 0) 12 - CD :3 CD u 0- 11 L Q O C N O M N O y G ti H O N O 0 V) N 04 z co w N C w 0 E M h CO O c E tN U O o o cn Q N O z_ 2 In r \ 0 E v r/~ d R a a ` IL (9 CL 'E I c 2 r`I~i 3 Parcel 030-1029-30-100 05/20/2005 04:58 PM PAGE 1 OF 1 Alt. Parcel 07.29.19.108D-10 030 - TOWN OF SAINT JOSEPH Current I X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * MEYERS, MICHAEL S & DARLA J MICHAEL S & DARLA J MEYERS 1098 GOLDE C401 LA HUDSON WI Districts: SC = School SP = Special Property Address * = Primary Type Dist # Description * 1098 GOLDE OAKS LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.380 Plat: N/A-NOT AVAILABLE SEC 7 T29N R19W NW NE AS DESC IN VOL 609 Block/Condo Bldg: P 283 ALSO REFERRED TO AS PARCEL #21 ALSO BEG NORTHERN COR LOT 20 CSM 1/92;TH Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) S 27 DEG E 247.96';TH S 31 DEG W 63.81' 07-29N-19W TH N 27 DEG W 277.21 ;TH N 59 DEG E 55.18'POB (.332A) Notes: Parcel History: Date Doc # Vol/Page Type 01/05/2001 636344 1572/579 WD 07/23/1997 1172/143 WD 07/23/1997 1158/16 TI 07/23/1997 609/283 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.380 132,100 242,600 374,700 NO Totals for 2005: General Property 5.380 132,100 242,600 374,700 Woodland 0.000 0 0 Totals for 2004: General Property 5.380 132,100 242,600 374,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 302 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-1030-40-000 05/20/2005 04:48 PM PAGE 1 OF 1 Alt. Parcel 07.29.19.109F 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner " TOWNSEND, TERRY L & LISA A TERRY L & LISA A TOWNSEND 1098 GOLDEN OAKS DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description ` 1098 GOLDEN OAK DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.040 Plat: N/A-NOT AVAILABLE SEC 7 T29N R19W NE NW LOT 31 OF CSM 1/91 Block/Condo Bldg: EXC PARCEL B OF CSM 6/1775 ALSO THAT PART OF NE NW DESC AS FOLLOWS: PARCEL A Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) OF CSM 6/1775 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1180/208 WD 07/23/1997 770/272 2004 SUMMARY Bill Fair Market Value: Assessed with: 4979 410,900 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.040 100,100 304,100 404,200 NO Totals for 2004: General Property 5.040 100,100 304,100 404,200 Woodland 0.000 0 0 Totals for 2003: General Property 5.040 58,600 225,800 284,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 312 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT OWNER G~✓~ TOWNSHIP SEC. _T 2- -RN ADDRESS COUNTY; WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIET4 Distances and dimensions to meet'requirements of H63 R EVERY ING WITHIN 100 FEET OF SYSTEM I J k Idiae Llo~thj Arrow SC L BENCHMARK: (Permanent reference Point) Describe: Elevation.of vertical reference point: Slope at site: iC,V Liquid Capacity : 0 SEPTIC TANK: Manufacturer: Number of rings on cover -Tank manhole cover elevation: Tank Inlet Elevation Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal..pump set or a cycle gallons; total capacity o distribution lines gallon:. size of pump head; gallon per minute horsepower ran name of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons 1 Elevation of manhole cover Type of warning.device SEEPAGE PIT SIZE: Number o pits eet diameter feet liquid dept seepage pit inlet pe-elevation bottom of seepage pit elevation ~feet. U~, SEEPAGE BED SIZE: number of lines wnth letigth~the depthd SEEPAGE TRENCH: width length PERCOLATION RATE A ARE AREA AS BUILT 00 DATED PLUMBER ON JOB LICENSE NUMBER PA '17EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, Wh-53707 : gICONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number III assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: BENCH MARK (Permanent reference pom DE C IF DIFFERENT FROM PLAN : REF. PT. ELEV.: CST REF. PT. ELE V.. t) z h1l) Svc. 7 TACI Name n1 Plu mben MPlMPRSW No_ County Sanitary Permit Number: 3 81 SEPTIC TANK/HOLDING WK: MANUFACTURE ~ LIQUID CAPACITY TA K INLET E EV.: TANK OUTLET ELE V.. R ING LABEL L// / ` P NDIED: G Pjt 'a0v ftf Cad <(E (~'J YES ENO NO G: VE TTO F SH EDDIN VENTDI : VEN A L HIGH WA ER NUMBER OF ROAD: PROPER Y WELL BUILDIN OA B ES ~~d f /(IN ALARM FEET FROM LINE ENO ❑ do- NEAREST-- S .0 ( /LVr D61 NG CHAMBER: ANUFACTUREH IBEDIIIN13. LIQUID CAPACITY JPUMP MODEL PUMP/SIPHON M FACT EH. WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: EYES ENO EYES ENO EYES ENO PUMP AND CONTROLS OPERATIONAL. ER PROPERTY WELL BUILDING GALLONS PER CYCLE: LINE I AIR INLET (DIFFERENCE BETWEEN T F PUMP ON AND OFF) DYES ENO A S --i~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing MErER MATERIAL AND MARKING O or excavation. (If soil can be rolled into a wire, construction shall cease until MA the soil is dry enough to continue.) CONVENTIONAL SYSTEM: ,NIDTH LENGTH NO. OF DISTR. PIPE SPACING COVER r INSIUE DIA. ITS LIQUID ,7 I THEN ES Mar R I A L PIT DEPTH. BED/TRENCH DIMEN SIONS - `It ILL DEPTH UISTH. PIPF DIS7R PIPE DISTR. PIPE MATER IAL: NO. R NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BE LtPIP S - ABOy,~c v R~I~~1 EL .E PIPi FEET FROM iL Y1 L/F Alylr. L d S Z 7 2 p{V 147 --I a NEAREST--~ - MOUND SYSTEM: Q,00 1'1.33 Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound syste s to make certain it ON REVERSE SIDE. SHOW ELEVA- meets the cri 'a for medium s TIONS MEASURED. DYES ENO SOIL COVER TEXTURE PERM ENT MARKE S OBSERVATION WELLS ❑ S ENO EYES ENO DEPTH OVER TRENCH BED DEPTH OVEN TRENCH BED D L SODDED SEEDED MULCHED. CENTER EDGES Y ❑ EYES ENO EYES ENO PRESSURIZED_ DISTRIBUTION SYSTEM: , VI DTH LENGTH NO.OF LATE AL SPA NG. GR EL DEPTH BELOW P F. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHE . DIMENSIONS MANIFOLD PUMP MANIF DI TR. PIP MA IFOLD MATERIAL. O. DI LE V.ELEVDIAE EVIPELEVATION AND, DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION '10LE SIZE HOLE SPACING ORIL DCOHHE TLV OV MATERIAL PLANS EYES ENO _ EYES ENO COMMENTS: PERMANENT MARK RS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING: E: ` EYE ENO EYES ENO F N E EA ET R FROM ILIN 6.11 1 Sketch System on ain in county file for au Reverse Side. / SIGNAT TLE- D7:1 ILHR SBD 6710 (R. 01/82) I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS LOCATION: SECTION TOWNSHIP/ NICIPALITjd: LOT NO.:BLK NNAME: / T N/R /SE to Y. e ~/nl COUNT t 7W&4 UYER'S NAME: MA ING DDRESSIlaisod ~1 ss 14 « USE DATES OBS ATIONS MADE NO . MS.: R IAL DESCRIPTION: R ULAI~N TESTSResidence tMNew ❑Replace GL FNP RATING: S= Site suitable for system U= Site unsuitable for system QJ~JVENTIONA ROUND-PRESSU HQLDI C MS EJU • MM S. ❑U IN GK S ❑U RE: SYSTEM-NU I El SG®U : REC6, R E fM:(oPtional) If Percolation Tests are NOT required DESIGN RATE: SYSTEM 'r ELEV. If any portion of the lot is in the under s.H63.09(5)(b), indicate: 3 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS J'j g /"4 e Y BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, C LOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. O BACK.) B- B- ~If 3tl ?/~rt "!J1 S1 I 11 EgCU' '61A sqdr -S I B- 711 ? Ott 9t1~) 3"~ r B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERT D PER INCH P- P_ 1I ~d f~ lr p v P-. P- P- - _ PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION _w. pe- 7 106':_ ~ 3 ~ c .1S~x 4~ _ ~eua e __tQgi Ale ~Al I wet ~a _ ` ~ • p~'il, a { a Qr0 b~S_~ X X f TN x . I l E I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (pri i TESTS W E COMPLvRETED ON: /~/O ADDRESS: CERTIFIC TI NUMB R: PHONE NUMBER optional): ~ CST SI RE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. ')ILHR-SBD-6395 (N. 03/81) i PLB 67 State and County State Permit Permit Application County Permit # tb~ # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 4 4 lh?.~S5;q ro, I Vye4 ~rS '~d16 B. LOCATION: '/4, Section , T N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township 37. JD Se C. TYPE OF OCCUPANCY: Commercial *Industrial `Other (specify) Variance Single family _ Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY d Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete ~k Poured-in-Place Steel Fiberglass Other (specify) New Installation 2S Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area - New ft. New X Replacement Alternate (Specify) Seepage Trench: No. of LiinneItFt. Width Q~epth Tile depth Pc )-No. of Trenches Seepage Bed: -~Length 'Width d'l' Depth 96 Tile depth (top► No. of Lines Seepage Pit: Inside d' meter Liquid Depth No. of Seepage Pits Percent slope of lands Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the CerjLed Soil Tes er, b and other information NAME OM4 S k C.S.T. # obtained from t9QA -e (owner/builder). Plumber's Signature MP/MPRSW# Phone # Plumber's Address d PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. o f e 3 9 4 a 3 t e E F 3 E r 3 3 3 F :t 3 E ` € I t c 3 i r ,r .a. ..e ewe Do Not Write in Space Below FOR COUNTY AND ST T~ E DEPARTMENT USE ONLY Date of Application Fees Paid: State County Da Permit Issued/.Rejeeted- (date) Issuing Agent Name Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 5,3701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/l/ E r `T Owner's name San. Permit No. H63.05 PLOT PLAN Show: Location of building served 0 Dosing chamber Septic tank Vertical reference point Building sewer Horizontal reference point Effluent system r '-1 Well 116t Or . lei Replacement system area Property lines w/in 50' of system Q Distribution boxes Scale /,0,9 or dimensioned Pump and controls: Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal-per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: Elea- Box ►ao' P.~.. eMtn ~ errs Elev. 93 1/ _ _q P ps ° ISO ~ roo` of X x r o vbS4 x y ~ 53 ► beC~ dome K x v y''~rrforq f ed 6 e x 0o e e X 3 ~~~m~/tdlnu FD+~~ x ` bJooc~ O I~ S e ~ay`r o ~ Fen~e rl e c WLI S61:1 M'l c n lL. ~b 1 C ~~.7~ c~ 1z u~ ~ti ~1 Se cm is c- A t 1 t... , s l 1.., 1 , n t. b) ,...~'Wl,lr.•w "],C; ~Ovxx riu By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, Pierce County and the Pierce County Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan 'omission, examination oversight, construction, or any d ge that may result in or after installation. Plumber's signature ~ 1/82 . STC 104 AS BUILT SANITARY SYSTEM REPORT OWNER .GACE6r~PEEi 3 -75.9,5> ADDRESS a ~ 8 GO (Pe'o CqA 12 . RoDS o.) 491' S 5 g o, t SUBDIVISION / CSM# L)C h d LOT # 31, SECTION. T 2f N-R W, Town of ST' • 7TOSEp H-- ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • ©Lp DR/fi~ F1 Z_. %v lu4v - COvE l04 2~ i -5'~PTic- Ts~~k NoT~S T~aK c tE~t~~v ~ s ~vi~~v ~'RY l°.. t94`f CTie i_ *ov,o~y SX17 SOTk' RA F1=L~s 1~ ~ ~JC n; a ~D - L3 0If, f0 0-0 l) T-v (3E t'~ ~oaPhh L c~o►e t~r''O(,- o RD&! R . GI055E01 SCAleL9-vP f" EK1'STi:vG- T-4 A-'& cz; 0UTL-T' ~ILO/t5 1?CH0 ED 3 ~E~IhcEO P LX C/1 .vELv 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: -7 f ~ SEPTIC TANK / PUMP CHAMBER / HOLDING-.TANK INPORMATION ST- w~ S FA !~2 12- o d " Manufacturer:) wLE~S Liquid Capacity: /000 > 1 5T. 15 ' Setback from: Well House P~ . ID 7 ' Other Pump: Manufacturer ZoellE~ Model# X18 Size '/Z IMP 11SU g• 5 ~O Float seperation Gallons/cycle: Alarm Location :[70 ~+o 'A E- -:SOIL ABSORPTION SYSTEM tl Width: 5' Length s y , Number of trenches 7 Distance & Direction to nearest prop. line: Setback from: well: 7 Zoo House Other ly >C 15rlN ELEVATIONS (3 v ~I ~D Ex/y TiNlr C3 rev y.~• , Building Sewer ST Inlet': ST outlet / lop PC inlet PC bottom g7• Z Z Pump Off S 00' ~d SEE -P[.OT' PL-/IAN . SEE' Do ,~J Header/Manifold Bottom of system 7- 9 7 7 v Existing Grade . Final grade DATE OF INSTALLATION: MAY ~ U- 1 PLUMBER ON JOB: VO Q E R r -2A L ~i p. I' C, k-r LICENSE NUMBER: M WS 3 3 0-7 INSPECTOR: ~Y1.M -T-k4 p S A-) S r • C P-0 I ~O L) T/ 3/93:jt z8~1 6- OW 7- a /N L ET 2(s' E c7 y'.Veac7 0 if 5'A 41, Avg 2-r ~O 07 L&-T `lrtSf'E% V u a M o M Pooh t S~ ti,e cJ ioao Ste. BM '#2 krEEk-S 4o-k cay,( ~O CDJ6)tntij - 'Deck u"D eR L:>iv►N!r BOARD 97. 76, che.L ~QbP QoX C ,r M A NerD w (*t%- ~7! J~'/E'E(~i}TE ~d E~PEl7 Lv i °Pct~ 5-E ee L ,64 4 5 1x5..y, cS75 rep OF 3/N" Pvc -Teen c ki SPecs p ~ pe N~~ r ro ToQ Of ysTed - To sF~E Zi?eN~~. P P' P P ( ) Oezl) ~ feva. posr. Z /00.0 1 5-0 95- 31, 7' 3 y y~ ~S.3y yy',/7 y 9y 9.5~ T f3 ~y 0 I~ ~D RoP I C3oX specs SCAcL_ ~ • I Ny y0 ruLET El~uht~o~J f3oX t 973y ' Y, 2- f .57 2- f3ox 3 7s- 72- ~s /3 4- T I'Go7- S'Iy' f~_ I,(r[,@~Tp~rcn~rotl~jPh. 7.29 I,~TEtlV/ 5~ Elden Oa y4va Labor and Human Relations INSPECTION REPORT .'Safety and Buildings Division GENE (ATTACH TO PERMIT) sanitary ermit o.: hAL INFORMATION Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.: R"Rmev.:RrYft. / Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400085 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 00 Xi 5 E'er ~r~C . 'ZCZJc, 1/, 7Z 62 ) Dosing ( I s c c i Gad' Z6, 4111(. 9G' ci 74 Aer Bldg. Sewer Holding St/ Ht Inlet / 20 TANK SETBACK INFORMATION St/ Outlet TANK TO P/ L WELL BLDG. Ve Intake ROAD Dt Inlet Septic NA D Bottom k"Id Dosing >16 5 ~ NA Header / Man. R vt Aeration Dist. Pipe Holding Bot. System PUMP /6rd INFORMATION Final Grade Manufacturer Demand ~~,r 9lS Model Number GPM op ~`S r ZD 71 TDH Lift 1 Loss System Head TDH Ft 17d , PT 7/ i Forcemain Length ~ /O Dia. oZ " Dist. To Well y/(7 1-5)1 3 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Tr nches No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N - _ SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC Manufacturer: SETBACK Mo u INFORMATION TypeO CV CHAMBER i "n System:iCWU ,b-- 6/~ a6 V S/Ca + OR UNIT DISTRIBUTION SYSTEM Header / - Distribution Pipe(s) ~r x IS x H e Spacing Vent To Air Inta Length Dia- ~ Length S/ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade ms Only Depth Over fe r, Depth Over y xx Depth Of Seeded /Sodde ulched F=L !Trench Center - R¢1-Trench Edges Topsoil El Yes [I No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION; St. Jaseph.7.29.19, NE, NW, Lot 31, Golden Oaks Drive Plan revision required? ❑ Yes Vo Use other side for additional information. z-r. 7 SBD-6710 (R 05191) _ ~a~~ Inspector's Signature Cert _ No ADDITIONAL COMMENTS AND SKETCH ° SANITARY PERMIT NUMBER: 3 125'z' 72- x F2 / n du ~ J7 Z 2 ' E:E DILHR SANITARY PERMIT APPLICATION :67- In accord with ILHR 83.05, Wis. Adm. Code COUN STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 'P0,996 a 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE P N I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. /v PROPERTY OWNER PROPERTY LOCATION G-XE6- N£ Y. &&,/Y., S 7 T~ f, N, R /~7 E (Oro PROPERTY OOf OWNER'S MAILING CTV o1N RE LOT # 31 1~~K # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER p j9f0.✓ 0 -25' fo' c S.rt i,*/•/ FO 5 O d 11. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ) ❑ State owned LLAGE c1 o s jqt~ O_S ❑ Public LJ 1 or 2 Fam. Dwelling of bedrooms - R A N u 111. BUILDING USE: (If building type is public, check all that apply) d 3 o / O -30 q 0006) 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. ❑ New 2. ~Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - 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 El`ieepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill y 71 1W4ZZ5 25~tG4 J4 x ~d rk d , 7,r, 0 VI. ABSORPTION SYSTEM INFORMATION: 95. 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) y S 1;7 , VATION 1P,<0 / &0-152 ! 00 a /L ft/ d Feet G - S Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank or Holdin Tank 20 D 12d O t E'S Litt Pump Tank/Si hon Chamber 000 lb 00 ( W > VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) f*P/MPRSW No.: Business Phone Number: ?-,Dose r ?e V"T-t &47- 330 7 3 Plumber's Address (Street, City, State, Zip Code): ~s0~! IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater so Issued Issuing Stamps) Approved ❑ Owner Given Initial Q~1 co `Surcharge Fee) 1-1 9 i Adverse Determination ICU l X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A.san'star.y permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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/Rerrpwal Form ;3131) 6399) to be submitted, to the county prior to installatiqn. _ 5. Onsrte shwa+ige systems must be properly maintaiired. '"lie 4i:ilptic tank(s) rv,.st be e r' r sd 's;y a licensed pumper whenever necessary, usually every 2 to 3 years. , 6. If you have questions concerning your onsite sewage system, contact your Focal code a6m,nistrator or the State of Wisconsin, Safety & Buildings Di"uisioo•, 608-266-5815, 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 nomber(s) of where the system is to be installed. 11, Type of building being served. Check only one and --omplete 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 in 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. Vt. Absorp?io^ system information. Provide all information requested ir, #1-7 Vil. Tank info; , tion. Fill in the capacity of every new and/or exist;-?g ',ink, list the tof g.: "i _ is number of tanks and .-ranulacturer's name. Indicate prefab or site const,u,-J d and lank rylatterial T,-)r all septic, pu!r,c-s;phon and holding tanks for this system. Check ex;;~~ ime ita.l approva, oni, f ani<s received 2Xp ri r,.~ product approval from DILHq VIII. Responsibiiity statement. Installing plumt?gar is to fill in name, lire F? n±, rube- with aof)ropr!~oe prefix (e.g. Mi' et ; address and phone number. Plumber must sign applicafir , fcrrrr. IX. County/ iepartnient Use Only. X ounty/L"le-partment Use Oniy. Ccsrrf,?st e l ,.^ris and spf-^ f~e,ations not sn^a?ler than 8'/2 x 11 inch s rs-rr-i;t hF: subMitied to the county. The fans r sf tnc`ude the•,R)liowing: A)-.{plot pian. drawl, to scale, c, vwit!~ dime 1;rc 75 ,cation of 1<71dE .y "?t~.(S), .',eptiv ar}c`s .or.`othe'r treataicit tanks; blur'Y~~+3~:,cra.t i J~ hell `-w1tl?i ~1 x 1':; v lfer SErVI~e; w re8r'r~arlnrjakes; purnn ~-.,r 4.iphon tanks; distribUtlon boxes, oli ~ ~=,3tiOr1 8ystem3 rs'o;:: i ent system `areas; ar'd th6,lecation of ;wilding served, 3) horizontal ai.d 'we:lhea ;'r?vaficr rr f=`r{--ce ,)~linr3; C) complete specifications for'purryps and controls; dose volume, e;evatior: differences; frict:i--n loss; pump perfor-man46brve; pump model and pump manufacturer; D) cross section of the soil absorption system•ifi- required by the Bounty; E) soil twit data on a 115•torm; and F) all siztno information • - - - - - - - - - - - - - - - - - - - GRO1JND4A1'Ei1' 1URCHARGE a 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a nurriner of regulated practices which can effect groundwater. Them r ies collected through these s{ir4harges are used for Fnogl~to`ririV gs a id•water, r.jr:an' water contamination investigations and establishment of standards. SBD-6398 (R.11/88) N L D T . SCAUi . l yo" No ~ = ~~ci S tIa (r- g ~hDE I✓ >;(ruJrT~o~S 'J 413AANDoN Sy5ifiN Cpy~l,;4a1` 11p ~ ~ ' .O SePTCC TAA3 y . / o U•t LET 9G . O ' o 56 3 0~ II N~ LC>bo r u 1 0 0 . v. e"3 1O`------ iA.) Le7- To k(*51%EST' OROF 3 w/ (0 A%fti•N#•A0m c5r's am - 311("Poem q 6 posr. 67 1 L' L)A r CO A-) / U0. D ` ya. -SYSTEM ElevAT i'aN 5 - -TRewc& I f ~ s " 2 O 3 Sys' 5y0 TintNG~- l Approved V441 Cep s-i,L Minimum 12" Above Final Grade Fj~v1-5 eE-Z? o 2-U " Above Pipe _ 4" Cost Iron . 1o Final Grade Vol Qlpi SyL20Aggregate ja miODistribution Tee Pipe 1 Aggregate 0 Putbraled Pipe Below Beneath Pipe 0 -Coupling Terminating At S Y S M Z» Bottom Of S,yslem 93,. !570 . 2 Fresh Air Inlets And Observation Pipe Q.- Approved Vent Cap Minimum 12" Above Final Grade Above Pipe 4" Cost Iron 'To Final Grade Vent fIpe' Synthetic Covering min. 2" Aggregate Over Pipe Distribution . Tee Pipe 0 0 0 0 0 , G I Aggregat• 0 Perfbrated Pipe Below Beneath Pipe o Coupling Terminating At SYST~ 2---~ Bottom 01 System 9 y~ ~ ! 72EN ~L,.. 3 . Fresh Air Inlets And Observation Pipe Approved Vent Cop Minimum 12" Above Final Grade/,(l/•f YI'L-r 7770 _ 4° Cost Iron Above Pipe Vent Pige "To Final Grade Synthetic Covering min. 2" Aggregate Over Pipe Distribution - Tee pipe 0 0 0 0 0 (o ' Aggregate o Pertotaled Pipe Below Beneath Pip• -Coupling Terminating At 0 S~/$7r 2--~- Bottom 01 System Approved Vont Cop S } Minimum 12' Above / final Grade r l ~ . SO 44 Coif Iron Above Pipe 'lo final Grade Veal pipe Synlhelk Covering win. 2' Aggregate Over Pipe Oielribulion - Toe pipe 0 0 0 0 0 Aggregate U00. Perfbrate0 Pipe Below Coupling Tuminoling At 8eneolA Pipe s'ls T~~ 130110M Of Syslem I - . ...y.. ....,.:~rv$.s..:.,.:a•rit4+eY~~nerw'~..;•at s,.ua+r+. PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS OF S_ VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUWCTIOKJ BOX MAWHOLE COVER 25' FROM DOOR, rF7I,/ wVNW&- IAMI WINDOW OR FRESH I AIR INTAKE I ADS 6~E vi1T~O~ GRADE I 4" MIKJ. ZJ I I IB" MIIJ. f51 I CONDUIT IE114rl 04/ (3.0 PROVIDE I INLET AIRTIGHT SEAL I III I III E I I I APPROVED JOINTS APPROVED JOINT A IN.A I III W/C.I. PIPE W/C.I. PIPE O t ( I i EXTEWOING 3' EXTENDIMC. 3' .p0 ALARM ONTO SOLID SOIL OWTO SOLID SOIL B I II y) I I 79.q 50.. C~ I I OW C ELEV. FT. ' I PUMP , OFF r p & A) 6- BLOCK I ,(I~N k ~~DOI lEV~ ~iD,J RISER EXIT PERMITTED ONLY IF TANK MAWUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS SEPTIC E DOSE TAWKS MAWUFACTURER: W~~~S WMBER OF DOSES: PER DAy 1 so p TANK SIZE: / GALLONS DOSE VOLUME It ALARM MAWUFACTURER: i•gvc7l IWCLUDIWG BACKFLOW: I L o GALLONS MODEL NUMBER: T). U•s: CAPACITIES: A= 26 INCHES OR 7~d GALLONS SWITCH TYPE: rEp-e-o Ry Rohr 5 = -Z INCHES OR GALLOWS PUMP MANUFACTURER: C,= b 7 INCHES OR l ~G a GALLOWS MODEL NUMBER. 90 ~2 ~p 11.5 D= INCHES OR 3 1 Z GALLOWS SWITCH TYPE: PI"J5JY (3/kGK ME~OU~~ /a47-MOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE 30 GPM INSTALLED ON SEPARATE CIRCUITS Q VERTICAL DIFFEREWCE BETWEEW PUMP OFF AWD DISTRIBUTION PIPE.. (O • 1 FEET TAAJk SPIEc5 + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . 2.5 FEET EAGIn, I of --t){ P + 1-10 FEET OF FARCE MAIN X s y Fp ,FRtCTIOW FACTOR.. 1.7 FEET T z 0 7 is TOTAL DYNAMIC. HEAD = FEET r ROUAV Sa IUTERNAV DIMEWSIONS OF TANK: LENGTH ;WIDTH -~jLIQUID DEPTH HEAD CAPACITY CURVE 3 7/6-►I+- 6 1/4 MODEL "9€3" I 30 4 5/8 a e I _f. 25 3 5/8 ftftft% 6 + + U O 1 15 4 3/16 A 4- All 10 1 1/2-11 1/2 NPT 2 • .c I ' U.S. GALLONS ~ 10 20 30 40 :i0 60 70 BO 0 j LITERS so 160 240 `i 1110 FLOW PER MINUTE: y , ,r TOTAL DYNAMIC NEADIFLOW PER M-WTE EFFLUENT AND DEWATERING CAPACI1Y 12 HEAD UNITS/MIN 4 f FEET METERS GALS LiRS 5 1.52 72 2.13 ~ 10 3.05 61 231 15 4.57 45 Ito 3 5/16 20 6.10 25 95 Lock Valve 23' CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, fo. duplex systems, are av:Ailable and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. r O Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float swhches are available for without alarm switches. variable level long cycle controls. a~ SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weiaht 39 lbs. - i/z H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model Volts-Ph Mode Am; a Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. r M98 115 1 Auto_ 1 9.0 . 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". N98 115 1 Non 9.0 2 or 2 8 6 3 or 4 & 5 5. Mercury sensor float sw.'tch 10-0225 used as a control activator, specify duplex (3) or (4) float system. 4 1 or 1 & 7 - sim- ~t1 230 1 Auto .5 _ 6. Four (4) hole "J Pak", junction box, for watertight connection or wire/-in elf, 'E98 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. r< I CAUTION For Information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All Installation of controls, protection dev~ces =rd wiring should be done by a qusli- Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO486; Mechanical Alternator, tied licensed electrician. All electrical and ra,*,Ay codes should be followed inetud- fM0495' Alarm Package, FM0513• Sump/Sewage Basins, FM0467; and Gimplex Control Box, ing the most recent National Electric Cods {NEC) and the Occupational Safely and FMO732. Health Act (OSHA). RESERVE POWERED DESIGN For'unusual conditions a reserve safety factor is rfngmeered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Manufacturers of . Louisvci KY 40256-0347 o OELLE/P O. SHIP T0: 3280 0;1. 1 P5,'116 s Lane P S /9a~9 Loki<viJe, KY 4;i?16 ,~L/AL/fY UMOS /NCF (501) 718-2731 a FAX 1502) 174-3624 X-r 4 `s.consin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3 ~L.- )or and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST. cRA lx 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. o 0 - 113,21S t3 O APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION G 2Z r,. F_1ZE1nR GOVT. LOT IvE 1/4 Vaw 1/4,S 1 T Z9 N,R 19 E (or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # lOga GoLb~v 3t - CSI1 vot. 90 CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [TOWN NEAREST ROAD 6u )SUty I JAJ ] Stj01 6 (71S) 386. X588 ST• SbSL~N 6u~pt Ott►zS DR• [ ] New Construction Use Residential / Number of bedrooms 4 Addi*n to ehastug building Replacement [ ] Public or commercial describe Code derived daily flow boQ gpd Recommended design loading rate - bed, gpdt2 d .:!~trench, gpcW Absorption area required - bed, ft2 N'QOo trench, ft2 Ma)dmum design loading rate o - S bed, gpd1R2 e . 6 french, gpolit2 Recommended Nitration surim elevation(s) S e'IE P ara E 3 o t= 3 It (as referred to site plan bendunark) Additional design / site considerations v r1 C1kA't~h e~zR CrJ.~ WjE To - -t++csnau bl F_V evCk Parent material ou LR SyYh/fl * G V-tye'. Rood plain elevation, d applicable N - it S = Suitable for System cOwwnONAL MOUND "110IM PRESSURE AT-GRADE SYSTEtd IN FLL FIOLDING TAN( U=Unsutiable for ® S ❑ U Ns ❑ U ®S ❑ U ®S ❑ U ❑ S WU ❑ S EmU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Con tce Bouhdaly Roots GPD/ft in. Munsell Qu. Sz. Coin Color Gr. Sz. Sh. Bed tench 0_1 %.o-hL Sty - sl Z,( 3bk MQ ~s - o•S z.L 1 Z -ty ~:s~tz 3/y Gv. Is 2 c ~bk vvhv cs - o o b Ground 3 )y-qo X'3 4t L,/6 - S~G~ o s KI ~ es o•~ u.`d elev. _ ct7•l It. 14 L/6--) t~ 31 1Z 31y - S O S9 tyl o-~ 0 $ Depth to limiting factor Remarks: Boring # o-YZ 10`112 3 ty St zT3bk O -S _ p• S v• 6 -t.. Z ~Zyo ~o~~3lb - si) z.~sbk eft. cs o.so.L 3 b--)p ~•S`1R3Jy _ S o Sg VV) o ~ o.$ Ground elev. gs.on Depth to limiting factor 4 2 70 Remarks: TName:--Please Print Arthur L. We ever one' 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: q 3_ 115 Date: 1 l~ l'` 9 3 CST Number: i PROPERTY OWNER i~CZ -R SOIL DESCRIPTION REPORT Page? of,.3 PARCEL I.D. # 0 3 0- 10 3 O- X10 9 Depth Dominant Color Mottles Texture Structure Consistence Botxxiay Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 l o - q ~o~~ jly si 1 ~`fsbk w. ~s o S ab ::w:: Z q-LS "~•S`ilZ Sty - Gh is ZMsbk vnvih CS o• u 4~ Ground 3 1$- sb tio~-tIZ 3/6 S ~~s o s~ vvti e 5 - 1 o• S o. b elev. q'6-14 ft. S6-moo Z:S `i 2 ~!y - E'SKV~S vn U'FI~ - o ; o. S Depth to limiting i factor ' Remarks: Boring # ` 1 0-11 io-•tR 3/y 1 Sj ~ Z~sdk vvt~~ c S - o.S j o•6 El Z \I-3o loyR 3l~ - Sl ~ Z'FSh1z twt `Fl~ CS - o,S Fu•b 3 3o-b5 -).S`1tZ 3Jy - S o so) o,d Ground ggele`vv.. ft. bS . S 723/y - aU s ow. YM ui~ ;o-S Depth to I limiting i factor 7 7 O~' i Remarks: Boring # + 1-4 eMbilvvikU V LS C ohv U ev Utv L S S v= r~ u S I U- I Ground elev. V S, %i C ~ ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= X40 ' 3 ~L V O / D G PCB L x S,~rJ« V TT p O X We:LI. %--Lets! C~ il) X96 Y SO a' 9 ~o'r'CO M OF T1Z ~wGb L'Z LL P~(l orv S 6' Svi °1 S. S ' s' © °15.0, ay-S' , Q.1 6' 014-ID, b LTL.98.0 ' ~1O so' 6. y t~C~ P - ~l11Z.1N G Ul- L-b ~ ~3~"'t- Ls1. 1ou.o'orv s"~~6N ~~v"~~t~• 3-`~ S • - ~vC ~tP~ w/Y-)VMt FE)vGC P105 7' Z It- 1-1--R3 (715 ) 42J-D-169 M00576 CST Signature Date Signed Telephone No. CST # VEYED FOR: K. B. PRIESTER, 619 2nd Street, Hudson, Wisconsin 54016 CRTPTION: arcel of land located in the NE1/4 of the NW1/4 of Section 7, T29N, R19W, n of St. Joseph, St. Croix County, Wisconsin described as foliows: Commencing 'the N1/4 corner of said Section 7; thence 1189°51'40"W (true bearing) 1325.37' rg,the North line of said NE1/4 of the NW1/4; thence SU°10'W 525.83' along West line of said NE1/4 of the NW1/4 to the point of beginning; thence ?10'W 788.25' along said West line; thence N89°47'E 809.721; thence N13°48'E .'801; thence Northwesterly 398.13' along the Southwesterly right-of-way line ,;a 391.10' radius curve concave Northeasterly whose chord bears N47°O2'1S"W .161; thence S88°55'30"W 660.61' to the point of beginning. ,"Certify that the above description and map are correct and that I havejully hnplied with the provisions of Sec. 236.34 of the Wisconsin Statutes. - 7 47- -73 )ate: February 13, 1975. FRANCIS - Job o-. N890 51 X40" W 1325. 37 NORTH LINE OF NE 1/4 OF THE NW 1/4 N I/4 CORNER CURVE DATA TABLE SECTION 7 CURVE 1-2 R = 391.10' T29N, R 19 W Central Angle = 58°19' 30" GON Chord = N47°02' 15"W 381.16' `,.`~~",r.. ih Tangent Bearing = N17 52 30 W /FRANCIS H. LOT 31 R = 391.10' ? OGDEN S-882 Central Angle = 22°07' 30" : RIVER FALLS, i Chord = N28°56' 15"W 150.09' WIS. 10 LOT 32 R = 391.10' • Central Angle = 4°24' ~~~'1~~'--..._...~~1~•~• Chord = N42 ° 12"W 30.03' R LOT 33 R = 391.10' Central Angle = 31°48' ~ 3 Chord = N60°18"W 214.29' LEGEND 3 o NE 1/4-NW 1/4 z - Z - SECTION CORNER MONUMENT 30- Is s 1 z o 0 - 1" X 24" IRON PIPE WEIGHING POINT F BEGINNING 1 1 cn ~ 1.68#/LINEAL FOOT. U. S 88-55'30"W 9/° 660.6 1' A CENTERLINE OF EXISTING W 30SOUTHWESTERLY \ TOWN ROA D z RIGHT-OF-WAY LINE U. in 1: 31 0~ W M 5.05 ACRES ~y 6. QD' J o0 '3j~ O°~a 00914D ~ ~ N 88°55'30"E X63 3 476.07 3 W O _ 0 0 0 - `1- 32 a°. n 33- V' 00 34 °0 Ki 5.05 ACRES 11 _ 5.05 ACRES o - co ~t °p a' 2 TRUE BEARING z 00 /04° SCALE -49 476.25 333.47 0/, N 89° 47° E 809.72 ' 0200' 400' S0 UTH LINE OF NE 1/4 OF THE NW t/4 h~vv so-v 3 P6 - -7S A09' ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the G"REG" ~le eiE-R residence located at: A )k 1/4, 'VU) 1/41 Sec. 7 , T?f N, R III W, Town of -ST. JoSEpl-~- _ Upon inspection, I certify that I have found the tank' and baffles to be in good condition, and it appears to be % functioning properly. /61~Last time serviced [3.-O y S 1~ 13 )X0 10 S . Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: [ 20 0 9&-Q , Construction: Prefab Concrete ' Steel Other Manufacurer ( if known) : APPe"S 1`0 (s-,P-- 4-9 1'&-S C,,-e fR- p°~ Loop-K) Age of Tank (if known): lq 91 (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (x.145.06,. Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name _Signature _ M'PyMPRS 5/88 r y STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS lof/~>~~ PROPERTY ADDRESS ' / " ~ `D"J I S . S~D/ /SAME (location of septic system) Please obtain from the Planning Dept. CITY/ST TE PROPERTY LOCATION NC- 1/4, 'U 1/4, Section 7 , T Zf N-R f W TOWN OF ST ` J , ST. CROIX COUNTY, WI ''~7 LOT NUMBER 3 ~ SUBDIVISION C'SM I/,,/. P 9 CERTIFIED SURVEY MAP , VOLUME , PAGE ~~LOT NUMBER 3 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 hasbeen maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year tion d SIGNED: DATE: CI `7 c St. Croix County Zoning Office _ Govemmoxxt. Center 1101 Carmichael Road Hudson, WI 54016 11/93 STC-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 1a 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 1W. Ae 5, C-- 114r, /4 4, Section ~7 Location of .property , T ZfN-RW Township 5T. S Mailing address Address of site Subdivision name Lot no. 3 l Other homes on property? yes No Previous owner 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 & 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 County Register of deeds as Document No. 4 _ Sig of applicant: Co-appl an GI'~ cl~C~ G( Date of Signature Date o Signat e 'DOCUMENT NO. „ WARRAM DEED TNII SPACC RESERVED FOR RECORDING DATA • 4228 c~ STATE BAB~'f OF-WISCO PAu ~r 1 rr ORM 4-i98s t ,t VV ~~~R !V R _ REGISTERS OFFICE ST. CROIX CO., WIS. Ap.~~.~tpy R. R• AlmassY. and Sandra A. AlmassY..e Recd. for Record N3 2nd as his wife and in her own right Ma yof rch AC 1927 A!40 A • convoys and warrants to ....Gregory Mark Freer- and Jessica -,.,.F•g~f, ~IUSb urvivorshi s • ; ......-..@Ln.d Bitd.. Mi. f -q .....B .s ........................P_.. " afar "..magi, a1_ prQBer.> X ' Gregory M. Freer RETURN TD Rt. 2, Box 212A -Hudson, WI 54016 • County, the following described rea! estate in ............St. Croix State of Wisconsin: Tax Parcel No------------------------------- Part of NEJNW4 Sec. 7-T29N-R19W described as follows: Lot 31 of Certified Survey Map filed March 12, 1975 in Vol. 1. page 90, Document No. 325980, except Parcel B of Certified Survey Map filed February 2 1987 in Vol. 6, page 1775. Document No. 421926. Also, part of NE4NW4 of Sec. 7-T29N-R19W described as follows: Farcel A of Certified Survey Map filed February 2, 1987 in Voi. 6, page 1775, Document No. 421926. S .~O This s--not ----homestead property. - - OX (is not) Exception to warranties: Existing highways, easements, rights of way and restrictions of record. e t Dated this - . t day of 1s.8-7.... r 1001, .-•--••---•......•------.......(SEAL) ' Amt Alm sz-y...... ................................•----••-•-•-•••---(SEAL) . .....go • • ..Sand AUTHENTICATION ACHNOWLBDOMBNT Y Signature (a) STATE OP 0994i" I --------------------------------------County. authenticated this ........day of 19. Personally came before me this day of F e-- r u a r - V---------------- 19. $ .T. the above named r-A mthan..y_..8---•llmassy...an-d--gan-dra.-..A_ e .._A-Lma.ss. husband.-.ai.d---wifan.:'._."::.... TITLE: MEMBI_R STATE BAR OF WISCONSIN ~+k - . (if Iw - » . authorized by j 706.06, Wis. Stats.) foregoing to me known to be the persons........... o , a Qd,the instrument and acknowledgeh~ ' . • THIS INSTRUMENT WAS DRAFTED BY W `~t Attorney J Estreen = s' .......»...•.----=ti a , i Secod St.. Hudson WI 54 - Pk . . n•-----•--------------------------t---------------- 016 Notary Public r p Dh a S~ ~ County . NJ (Signatures may be authenticated or acknowledged. Both My Commission i permanent. (If not, state expiration are not necessary.) A -:z le date: + 19.g 7..). •Iraao of peeeons signing in any aDuity .bold be A. LAR Vit typed or printed below their signate.es. NWARY (UJC ()Fi1t`W/ Aft:Ky _ Mee1611ft Wrok 8.-1 STATE BAS OF WISCONSIN •nald !I!~. I98S Stock No. 13002 :A AS BUILT SANITARY SYSTEM REPOR OOP OWNER TOWNSHIP SEC.^ T N-R_W ADDRESS 06 OUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIE{ Distances and dimensions to meet requirements df H63 R 0- NG WITHIN 100 FEET OF SYSTEM I di aye o th Arrow SCAL : BENCHMARK: (Permanent reference Point) Describe: Elevation.of vertical reference point: Sloe at site: SEPTIC TANK: Manufacturer: • Liquid Capacity: Q r0 Number of rings on cover Tan manhole cover elevation: Tank Inlet Elevation / Tank Outlet Elevation: PUMP CHAMBER 4 Manufacturer: Number of gallons Number of gal. pump set or a cyc a gallons; total capacity o distribution lines gallon:: -s ze o pump head; gallon per minute horsepower ran -name 'of pump and model number Type of warning device i HOLDING TANK: Manufacturer Number of gallons_ Elevation of manhole cover Type of warning.device SEEPAGE PIT SIZE: um er o pits eet iameter feet liquid dept seepage pit in e~ t pipe-elevation bottom of seepage pit a evation feet. SEEPAGE BED SIZE: number of lines -width _ lengthS~tile depth SEEPAGE TRENCH: width length PERCOLATION RATE_ AREA REQU RED AREA B _ DATED 0 " PLUMBER ON B LICENSE NUMBERS t• w S n r ti, ~I ^Owner•s name San. Permit No. H63.05 PLOT PLAN Show: srr-I erved Dosing chamber Location of building Vertical reference point Septic tank Building sewer WI Horizontal refere~wncc)e point Effluent system Well A 0 t yr 1 1 ~W C2 Replacement system area Q Property lines w/in 50' of system 1A , Distribution boxes ~ Scale = - /D or dimensioned o Pump and controls: Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: EIeZ gox I00' P.l•• ~eMtn* A'/~` 1Cm Elegy, 9~31~'~ ~ 3 IQ 1060 S. - - -~8 ~ X X ~1ome x av'~ s3 bed X 'TL ~a w X ~ v''PC~{orgf ed x 6 ~'ee x 0 , 3 x ltlmu PD~~ 1 , b,,so04 oL set, Oaffoi Fehte b \ • . d. 11 c:- r ~ ~ ~ ~ J 1 1 r A C b~ ~ w.~r~.n~'>.-._.[1LyC• b l~~l ►W~ua G) ~Q~ ~JGGn I~~r~`~ By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, Pierce County and the Pierce County Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan -omission, examination oversight, construction, or any damage that may result in or after installation. Plumber's signature < n N.. * c 0 ~ d d 3 CD a m a -0 .5 e 0) m ^ Cl) L` m Z O O O! O~ C4 eC • 0 Da 3 3 w O W O m< CD COD M 7 CNO ~ A A O_ CD S- i N N O CO CO O O O O O CD O W CD Di 3 Cn O O. 'S CO NO C1 3 'O 'O p CD OL co O co O Q O O A'+ J O 7 O O t ~ O o n n a m W ° o 'I c m CL m co O O A a O p N C rr a- fA Ul fA CPO 1: O n o o I~ v M m m n y o_ cc N ~ ~ T O I, O C z N ° z z 0 n n m R O O ter m CD U n N Vy c N N CD CA C]. Z CD (6 --4 :3 ID fyi n z a ? O v 3 o0 Z v W T M N CD CD ~ Z i a 3 a ~ o Z 3 " A d N ~N O5 n 3 a 6,00 n 0' CD =3 n (D Q COD ;,,~3 N it C D 0 CD <A CD O CD 3 cymsn0i y < o N a y W _ O A 3 C1 =r + ~ N r' ~ N A S O , N 3 O pOD O CL O 3(a CO O W ~ O A O O 6q a f0 'O 0 ? a O CD ►ti' ti Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of Libor and Human Relations ~rvision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY sT- c\ab lx Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and /o of slope, scale or dimensioned, north arrow, and location and distance to nearest road. ~ O - 10 30 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION G 2 Z ~ GOVT. LOT llaE 1/4 MW 1/4,S 1 T Z-9 N,R 19 E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # Nv3% Go%.-bQM op\1T s DtZ- 3l - 01SM Vot_ ) 90 CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®rOWN NEAREST ROAD ~UDSOfv I LJ j 5y01 (a ())S) 386•-1588 ST. soS`~N 16m-bet-3 QW5 DR• [ j New Construction Use [~cJ Residential / Number of bedrooms 4 [ j Addikn to existing building D9 Replacement [ j Public or commercial describe Code derived daily flow boo gpd Recommended design loading rate bed, gpolftt2 0 , b trench, gp(lft2 Absorption area required - bed, ft2 Novo trench, ft2 Ma)dmum design loading rate o - S bed, gpd/ft2 0 - b trench, gpo1ft2 Recommended infiltration surface elevation(s) S t P r'ca e 3 o F 3 ft (as referred to site plan benchmark) Additional design ! site considerations N---- v r-1 Chef B LR \Z."~ 1~y~ ~tiZ,row 01 rrF~l2 @v~b Parent materiat 7-t%-L- o u Qm SftN/S~p * G R^veL Rood phain elevation, •d applicable N R ft S = Suitable for system CONVENTIONAL MOUND WaIOUND PRESSURE AT-GRADE SYSTEM IN FILL. HOLDING TANK U = Unsuitable for tem ®S ❑ U IRI S ❑ U ®S ❑ U ® S ❑ U ❑ S OU ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Co zisienoe Bould3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed mnch 0-1 v o~Ltz 3 ty - s 1 sbk w~v cS - o. S o, L 1 sx,.x z -ty S` 1?-3/y Gv-Is 2. c:Sbk vnUf~ cs - 0 1 0.~ Ground 3 1u-~lo 1bIt2 J/(, - S~Gr o s Kj C-S elev. _ - S 0 9 9 ►yl 0.1 ; 0. $ C711 ft. 40-1(~ - S `11Z 31Y Depth to limiting factor Remarks: Boring # sek~~ a s 0.6 1 Z- Z ~z-~to ~o 3 /b - s i 1 z s b~ s t,. S Q. c. 3 b70 ~.S`123JY _ S Ground elev. 01 S.0ft Depth to limiting 33-_ factor 7 7o j'c" Remarks: CST Name:-Please Print Arthur L. We erer Phone' 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,Wi 54022 Signature: Date: 61_ 1--93 CST Number: PROPERTY OWNER 1~-R SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D.# 03O- 1030 LIP , Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0 :"wo,N C $ - D S 0 to 1 0-9 \'O' 31Y st l z 5Nhk w. v 3 M 11.."..: Z cl-18 ~.S`itz- Sty Gr 15 ZMsbk w,v~1~ cs o•1 0,~ M, Ground 3 1$- sb tio'nIZ/(, S g~s o s~ v,~ e S - o• S 0.6 elev. q,6.14 ft. 4 S6 --m -:S `12 ply ~Sauis o vK Uf1^ - o,~(? o. S Depth to limiting factor Remarks: Boring # 1 0-11 ~o-rta 3/y S1 1 -L ~ vt w~ ~h c s o .S 0 6 El Z \t-30 toy2 - s i l Z f s tik w► `F~. c S o• s 0.6 3 po.6S R 3) y - S o sq ag - o.') o,f3 Ground 9elev. S 723/y aufS Ow. YM U` " :U.S Depth to limiting factor Remarks: Boring # .mss>x~.;; z S wtv Pc 9 r~'+v . 14 \'S~u Irv Sv t t_ ~t« Ground ~O FN C 0KJ U ev Utv S S U 0 - S 1 V i elev. u S S C 4~ r ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) r PLOT PLAN Page 3 of 3 SCALE 1"= q0 ' .5 l 3 z / Q~ v V` J G PCB Cs ~vp V E ►T p d~ ~O %--L at s so` $3 ~~"r'tv►rt OF T-JLEWCa L~LL►~ j1o►vS S, © 016, o' ay-S~ Z-1 6 C'f~ 01\1.0' 'S• qb ~l q-t so c°"i YOV~Z l'L . 98.0 B. aL 4 v Win. `gl~~'t1ti 6 w'1- Lsl lOU - O, VN S~ LN 6N 2ov " k-)) Y) . 41 s 11-1-1-011 (715 ) 42A-0169 M00576 CST Signature Date Signed Telephone No. CST # Wisconsin 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 S-r- c';~_.o lx-. 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. o -_'3 o - l0 30 - O APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION G 2Z-C. F-AZ.EkDR GOVT- LOT NW E 1/4 Mvj 1/4,S -1 T Z9 N,R 19 E (or) W PROPERTY OWNER :S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # toga Goy~Nj,,~ 0,\ 3t - CSM vat. ,90 CITY STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE fBrOWN NEAREST ROAD ~ )aL))v r Iti! 1 SyoI (o (')15) 386,-1588; . ST. SoS`~N 160%_bl~ ORtZS DR• [ ] New Construction Use [~J Residential / Number of bedrooms 4 [ ] Ad ' n to eidsting buildiitg D4 Replacement [ ] Public or commercial describe Code derived daily flow doo gpd Recommended design loading rate - bed, 9PRI 0 trench, Absorption area required - bed, ft2 'vooo trench, ft2 MaAmum design loafing rate ° - S bed, 9p(* 0 ' b trench, OW Reed infiltration surface elevation(s) S eE P At?; 3 o F 3 It (as referred ID site plan benchmark) Additional design / site corusiderations v r-l CLkKh~ a~R t?.M D ~v~ ly tiZ,t'~fiu ► 01 R@vcb Parent material -T-tA L, o u k-E-Tc- S vt+v fl * G R.01rueL Flood plain elevation, ff applicable M R - ft S = Suitable for system CONVENTIONAL MOUND W010 NO PRESSURE AT-GRADE SYSTEM IN FU HOLDING TANK U =Unsuitabb for qsliam ®S ❑ U 9S ❑ U ®S ❑ U ®S ❑ U ❑ S IR'U ❑ S o u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Motfles Texture Structure Cortstenoe Boundary Roots GPD/ft in. Munsell Qu. Sz. Coin Color Gr. Sz. Sh. Bed iendl o _'t to,tR 3 I 'q - s 1 z- j 3 bk m y S L 1 z -Ly 7:S`11Z 3!y Gh 1S ZcSbk vnQ I,, CS o l o•~ INS ` eS o•~ u.~3 Ground 3 uy-~lo 1b`t2'/6 - S~G~ (339 elev- Co. ft. 14 I-,Ib f, -1 - -S ~Z 3 J y - S O s 9 1n ( ~ O' ~ Depth to limiting factor Remarks: Boring # o _tZ 0 `11Z 3! - s 1 Z 3 e>z Yn O• S o• 6 Y 0-S Z Z tZyo ~oti~3/b - S1) Z~sb~c +~►ft ng o So.c. 3 b7p 7•S`11Z3Jy _ -S o g~ M1 0•-7'0.$ Ground elev. 01 S. 0 ft Depth to Nmiting factor -7 7 70~ Remarks: CST Name:-43leasePrint Arthur L. We erer Phone- 715-425-0165 Address: Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: g 3 _ 1-) _S Date: CST Number: ,c. 1.1--0--93 M00576 PROPERTY OWNER V?- -R SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D.# 030- 1~3~ - CIO t Depth Dominant Color Mottles Texture Structure Consistence Bourday Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench cgs <gggg C'S - o. S c, p. 1 o - q \oKCz ~(y s~ t Z~sbinc w. r.~,,w>>v Z q - la -~•S `i tZ 3 t y Gr 1 s S 1 13,% Ground 3 1$- Sb Lo`'►~2- 3/t: S ~~s 0%-, 0.5 n.l~ elev. _ Of,6-14 ft. Ll S6--70 -:S 11 t-?- qty fs~vFs oyv. vK uf~ o,11 o. s Depth to limiting factor Remarks: Boring # ` 1 0-1l ~o`-t2 3/y S1 Z~36k vvt~h S o .S f o.6 El Z 11-3~ toyR 'slf~ - S 1 ~ Z "~3bk ~ `FI• c S _ o• S ~ 0.6 3 pro-6s ~•SYft 3Jy - S O sq al - o•,) toad Ground elev. 2 3 /y aufs 0v, yn u f 9 814 ft. _ Depth to limiting 'factor 7 Remarks: Boring # 3v.. tv~ t)t wk ! 4EL LV j &J S ` is wVQ rw k,% L ft-1-4 i [ , . Lj3---: I Ground !~O C VU U ~1 UIV L S$ V= t~ 0 S! V- i elev. V S~ S C~ ~y _ ft. Depth to limiting i factor I Remarks: Boring # } I Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of--3- SCALE 1"= 140 ' 0 ~r VI 1 ~j V a`/ / D G KV- / Y 5 Ca ,~.p V ~hlT p i x lr..)E'.ll. I I!LatS°- t3.Z _ Q _ VVI ~ v • ~-96Y B. 3 ~o'r'tro OF TV-EwC.a L~ LL [1 U+v S 5 Q 01 S. s s' © °15,p ct \4 - S' b L&. 98.0' q ~b q el '1 , so s c°,.fto~z B. y q1 t ti G • _ ~vC ~~PF w~r~~-t, F~vc-~ Posr ~3-Z7 S l-1.... q3 (715 ) 425-0169 1400576 CST Signature Date Signed Telephone No. CST #