Loading...
HomeMy WebLinkAbout030-2028-90-200 (2) C o I ~ ° I p ° m o C o N (D 4) N m 3 P- 3 0 O in OM w "6 O v E O r N N O M'O O (n <6 - N (D c LV1 LL O V p) C O O ,2 CL lz~ 'O C p Y N _YYY 2 N O & O 3: \ O O O U C C ' L O) a) N V O N Xx C • ~ N O O Z N O U C N 2g °•O'O li U. C 3 0 M C° U / O O - E•nYin ~Ei N Q d It U O_ J.. I j M ZE J C) 4j :tl S ° o a m N I- ( C U O Z d Z d' li 2 'U (n F- m d N ! C (6 .o U E I (D r_ y _ Ili N O 3 N C N O O O • N O N yi O P%il 0. U U N C y:. E O N I Z Z O Z o z LO N E N 14 E m d N N d M co d 'm w N v 0 c) N 0 d d Q N UO 'o o a z o j (n U) v> ~ a 0 c 0 0 O •w ° a a a a o j tV ~L = v 00 to J U m rn rn ° ~j -O Z (D 0) ~V A N N ;5 _0 I a 0 0 CL 0 Q N N O 0 C) O (D C14 0) c d (N p m a N o ! C) d Q Z 0 m o U ~ \j °0 3 N U) O N _ O ~ U N N C) O N E O O~ C N C N V a C) C) o 0 0 L oo D_ N N C E N N N! v N O N N C N O C 4o (D N (y 7 N N C) (n CO -0 Tr N O O Y M N N FL- C N m LO O! Frl M -7 O) G OM (V (0 CO O N m E RS • O N U) j M N O Z ' O i~+ a i ~ ~ E d I a ° L a. w • CL N 4) j E 2 , C C 2 LSArr(s,~ rt9,%tof4Q~t , H. 22.30. ?p A E SEWAGE 'S(5 TOP RI ounty: Labor and Human Relations INSPECTION REPORT yafety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.: Insp. BM Elev.: BM Description: Parcel Tax No.: T BM ev.: I 1 030 0--24W- 4/ 152 TANK INFORMATION ELEVATION DATA A94000 TYPE MANUFACTURER CAPACITY STATION BS HI FS Septic Benchmark Dosing Aeration Bldg. Sewer Holding St / Ht Inlet se.( o(0 ~ TANK SETBACK INFORMATION St/ Ht Outlet ~4 30 /o/. Vent ir Ito ntake ROAD Dt Inlet T TO P/ L WELL BLDG. A Air / I eptic NA Dt Bottom Dosing NA Header SSA 7 d Aeration NA -8+5- Iding Bot. System PUMP INFORMATION Final Grade Manufacturer Demand , Model Number GPM Friction System TDH Ft TDH Lift I Loss I T_ Forcemain Length FD i 7a. - Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length ~ No. Of -Trenches PIT No. Of Pits Inside Dia. Li uid Depth DIMENSIONS 37%c 34 4/3, ENS SYSTEM TO P L BLDG WELL LAKE STREA LEACHI`N nufacturer: SETBACK CHA R INFORMATION Type O try we/ 5 Model Number: System: Ef DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) S _4.e j A LOCATION : ST. JOSEPH. 2 2.3 0 ..2.0W_, / GOV. 140T 4, HILL TOP RIDGE ae w c Cyr 4,11,d- 4~,, 9 a Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. i :DIL:ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couNTY~t- STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~ -6J J~3 3 8'f x 11 inches in size. E3 Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWN PROPERTY LOCATION P. N AR1 S L.0' V Y., S a~ T 3 p N, R a O E (or) W PROPERTY OWNER'S A,fyl~ ~II~O DDRE~,S' ~ LOT # ~ ~ BLOCK # CITY, STATE V H I ZIP CODE PHONE NUMBER SUBDIVISI N ~AM YR CSM U BER 0 _Oq II. TYPE OF BUILDING: (Check one) ❑ State Owned CITY NEP JTR!f =N OF: TAXNUMBE N 'r ❑ Public M or2 Fam. Dwellin of bedrooms PARCEL III. BUILDING USE: (If building type is public, check all that apply) C)3 U - Q 4 a $ 0-DC) 0 9 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 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. ❑ Reconnection of 5.0 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 120 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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.) PROP SED (sq. ft.) (Gal / ay/sq. ft.) (Mi ch) ELEVATION ,7 ~ • 7 9 Feet /60.9 d Feet CAPACITY VII. TANK Site in allons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks one ete strutted glass App. Tanks Tanks Septic Tank or Holdin Tank QUO (e S Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (N Stamps) Mov MPRSW No.: Business Phone Number: ~M &kf~ee3jeR 1S 3800a0 Plumber's Address (Street, ity, State, Zi Code N /09 rrii4rtj S WIADJoN W►5& S o) IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a Issue lasing Agent Signature (No Stamps) Approved El Owner Given Initial d7 Surcharge Fee) , Adverse Determination In 2 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber 'INSTRUCTIONS t { 1. A sanitary 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/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 & 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 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. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/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 holding tanks for this system. Check experimental approval only if tanks received and 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% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) • ~11'~' e f BI L.~ PLOT~- f I-~, V ~ ~ ~ J I ~ ~ I ,I 1 I\I_ rJ ~j 1( A I,! I - ID L AM. `T A M E ~U ~N s N~•l~~M .N• .Q~>~M e l: i 1 C E N S E : f _ y--~ l_._....... f~.. 0 C A -1 0 P 'L,0 _ NK O) ,s #n ry /f 93 50 ~r,~ Se a c a S y r, eOkIvE J I(As (Jell s 2 ll.l )oa be C) p s ► ;P3 85 e + 31oSlo Q . S~ 'cI-W 10010 is 3 e aom ' N la„ POPLAR Nom ~ N T FR);Sfl A[1: Lf;LI:'1'S-AND OIISE1tVATI~N PI.C~1 - C1;QSS SECTION I\pprDvrcl VenL Cap Npl Minimum 12" Above ~V~• 0 i r) px 4" Cast Iron Above Pipe Vend Pipe To final Graclr- _ Marsh ilzy Or Synthetic Coveri.n(J Min. 2" Aygrcg."I Over Pipe Tee I Distributioi _.I pipe ,;r 1 Aggregate - Perf.orat-ed Pipe Dclow Ag enca r Pipe Coup).-in ' rcrmina(:i.nq 1) .T ~ ~ • . Rol• l-om. ot: System • Mot, ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner S ~U N P 1 Property Address 1 ~ - ti City/State 0 0 BSc ~ Legal Description: n l~ Lot 10 Block Subdivision/CSM # v 1'' d t/4 '/4, Sec. Q, T3 4N-R) O W, Town of S J aS e k_ PIN # 03 _ Oa '-a 0 y zz . 3 0. zo.y~(6Lc SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer W -,~-e t Size STNG 0 p Setback from: House L-L Well 5+ P/L `J t = Pump of t1 dCtMW Mode (HOLDING TANKS ONLY) Setbacks: Service road h air intake Water Line Meter lNatien Alarm 1 n SOIL ABSORPTION SYSTEM: <0?gVgW ~)6WPA a- 37.50 Type of system: T )IIKAoff Width _ Length Y3-s o Number of Trenches ' 'f Setback from: House TS' Well 9 S' P/L 10 8' Vent to fresh air intake 50 ELEVATIONS: Description of benchmark Rb\o RoA r) 5 2) ~a y Po plor, Elevation OU Description of alternate benchmark Elevation Building Sewer ST/HT Inlet U 3 y ST Outlet WHO PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) T I a 0 ( ) I A Bottom of System 9 ~ Z 11~ S (L) 4lO ' 9 Final Grade ( U S U ( ) U 1 Date of installation Permit number a 0y 33 State plan number Plumber's signature License number ~aa I U Date Inspector Complete plot plan NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. a PLAN VIEW X1411 N ~ ~ ~ - 00 Se~~~c, Sy 3~~~. INDICATE NORTH ARROW DEPARTMENT OF REPORT ON SOIL BORINGS A 6 /A S BUILDINGS INDUSTRY, F DIVISION LABOR AND PERCOLATION TESTS (115) 10 BOX 7969 HUMAN RE~,~TIONS~ WI 53707 on (H63.090) & Chapter 145.045) do 0,~~ I9 LOCATION: SECTION: TOWNSHIP/401010 4; OTNO.:B SION A r`Le4 2z AloN/R%# I (or) W ST. Jose P// ! T. sa y app COUNTY: OWNER'S NAME: MAILING ADDRESS: Sr. C A#1j( G Ed `c yoL c e~r18 . / Mr/ //*--A 7W-4 8rz USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: I N TENS: Residence ®Nevv ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONNCJVIIEA`NTIONAL: MOUND: 1I IN-GROUND-PRESSURE: SYSTEM-IN-FILL cHOLDIINGTTAANIK: ~%1/ MENDEQ$YSW12ptior-/P'r'0 A NS ®S DU x ~ V EIS X V EIS Dd S111E/i/ll ~!!F Ale 7----- 1 f Percolation Tests are NOT required DESIGN ATE: I If an L y portion of the tested area is in the under s.H63.09(5)(b), indicate: //A Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS T BORING TOTAL D PTH TO GROUNDWATER 'Nei 4- CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDRO K IF OBSERVED (SEE ABBRV. ON BACK.) n f n z +a. , 4Y O 3 g, o, Bn C.0- B- ! B. O 1,11, 6 NONE 7 g O ki Gob sY` . B- Z 8.0' 99,E /VO NE 7 8. 4 e4 44 ' 3,r .9,12 / ! t 6 s yc , S-' co A,p sE /i y4 B'rJ 4:'1'A7-- 4-f7. B- 3 No Nom' 7 9.O ' /oA.x '5"4 'V'0 a/ ca e '-74 •S Br! FIAIZ- mss' O.S LISh'7- All -"'AO W /1"'T B- 8 41 98, NO Nom" 8 O d B/. Co'gose /a B- 8.4' /D NDitlE 2•D~ L/If,/~ 8., / E ..Q, j ¢.p CO404-ff 0.8 4 W cob St - e O Bh /.d, , B- 8,0' 9ig, ~ No ~v~ 7 e'0' , o PERCOLATION TESTS EE. TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER W&ffr3 AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PER PERINCH P- 4:3 Ale /o 4 4 z 2 P-2 Z•/ NO /D 2 3 2 2 /Z It P- z, o Al d P-- P- P- PLOT PLAN: 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 slope. SYSTEM ELEVATION 96,6 0 qirr- &46 T A_____~a,D,► T~G~ • -4-- f o _ i 0 i I ,39e 3o D,~ ~ l _ 3 a LOT. " TN Z' L k I le IrAO :24 E J7 L Tom' 4e AO. 2--~.~ 8J?,p 2 E ; 101 ~©r Le T e; I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and met ods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: t/. ~j •Q,Ec, 0.2 8/~f 8 3 ADDRESS: Q Zr414/Al CERTIFICATION NUMBER: PHONE NUMBER (optional): 12 Af-. 4e5Z M sr, X0 ,e F/JL6s s- dz J5~ - S8g ?is-$2s-'763/ CST SIGNATURE: 'TRIBUTION: Original and one ^npy to focal Authority, Prope y Owner an6 Soil Tester. INSTRUCTIONS FOR r)MPLETING FORM 115 - SR®- i To t'se a cc a ' accurate soil to report must include; _ r 1. Complete I n; 2. The use ser' a clearly indica < whether this is is residence'ttr commer ~I <-ject; 3. MAXIP. ' of bedroon- innercial use planned; 4.. Is t`' ~;~tacement s~ 5. co rpl [iability ratir A SITE IS SUITABLi DR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RUL UT BASED ON SOI` TIONS; 6. PLEASE use the abbrevia i here for writing profil ascriptions and comptr otplan; 7..(V1AKE A LEGIBLE diagram , furately locating your test to cations. C erred. A separate sheet may tk(., used if desired; 8, Make sure your benchmark and vertical elevatior reference paint are clearly rnanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain c rco1< ~:emp tion, if appropt , e; 16. the ocrl plain, elevation) does riot apply, place N_A. it the app, 11, ~n the form t went address and your certification number; legihif, I t` ;tnhute as required. ALL SOIL TESTS MUST BE FILED WITH THE Lr~CAL AUTHORITY ITHIN 30 DAYS OF COMPLETION. f ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols qto x,) B iron s _ HE need s I gv' Bldg si Cay Y t mot y vRP y I at b. Cat.. It iEPAR OF REPORT ON SOIL BORINGS AND SAFE TY & BUILDINGS `lUl,~•ST.H Y, DIVISION N R AN ,~JMOAN REDLATIONS P-ERCO"" `TION TESTS (115) B.3MADISP.O. BOX ON W 53707 (H63.09(1) & Chapter 145.045) .OCATION: SE TION: TOWNSHIP T NO BLK. NO.: SUBDIVISION NAME:-- % ~.4 2,2 /T3o N/Ry 1 (or) W .sr dash PW 6 H/,, C.,CT, sa,e ray ntA, .UUNTY: OWNER'S NAME: IMIL A I ADDRESS: ~.~o erz S r. ~',Pe / X 5; r L F 1710Z c a I" S f? . / ST It-,q TWe ,22 /N N. SE DATES OBSERVATIONS MADE ICOMM ERCIAL DESCRIPTIO : PROF DES RI IONS L I N TTS: Residence I//4 ®New ❑Reulace I ~i tATING: S= Site suitable for system U= Site unsuitable for system / a ;ONVENTI NAL: MOUND: N GROONDM_E U S E -IN-FILL HOLDING TANK: COMMENDE YS l ptioi ) Esau ®s _-VT ®s au as~u asp dAI &-°4/o72-S.. 67,0 1 Percolation Tests are NOT required. D:SIGN RATS: If an any portion of the tested area is in the ,ndor s.1-163.09(5)(b), indicate: ~ Floodplain, indicate Floodplain elevation: .411A PROFILE DESCRIPTIONS iORING TOTAL DEPTH TQ R U ATERrfPF@HE3- CHARACT R OF SOIL WITH THICKNESS,.COLOR, TFX'I-URE, AND DEPTH dl1MBER DEPTH ELEVATION Qy RV~ TO BEDRFlO K F OB E,I)VEO (SEE A(IBFJV.ON BACK.) i 9 7''' Bra%n e !Q , -,4 ¢~o, 6r, c a 3- 8, 0 /o/, 6 A/o~v~ > 8.0 cob sr . L:3. 8-0 99.g A/C NE 7 8. O lyh on r1"-7e_ /-a, 3.0 j /.S, e0'9-PSE• 64 ' 7-3 B / W ~'ob 57`. /i,9-t :,7-,e. /..Q, co,a,eSF B. 3 9,Q 97 z/5 /V a /V 7 9.O 110A s s,r va H/ co b • _ ' 'X-8.7 lve /a Bra Goff M AV mer' B- 4 9,0 98, No N_F ~ B D z a 9/7 co A,osE~/~a~ 21 L/6ti? 8r~ F/~Ye~` /,.r p ~%I' COp.PS~r B- 8.0 /40.8 V o vf' /d p ~i 9~ n fvN~ ..a.• ~ o f o f ivc~ 6 8.0 96, I A10 Al _15 7 8.0 / A/ Cob s PERCOLATION TESTS 6 . TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER FN6Ftf!'S AFTERSWELLING INTERVAL-MIN. t p€RpTo2 _ PER INCH P. 'f 3 /i/D 2 P Z. / N O / d 2 3 Z Z %2 ~i P Z,O /✓o /O 7'. z P_ -P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- Dntal 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 f land slope. 3 'YSTEM ELEVATION 96 ~ 6 d NE G~,e . i L dr11!~ o W b So 1 Bo.C' /ice c i4!k p..e f I O ~ DI z4- 3 A A/ ,O. Z V C A 7-/,0,(/, I v v po/ lp~eile NZ4 /?I 1 14 BE~I/c of SGe ~~o . 1 ~ ELEY~- _o.oo P®i Z4 L" r6:c' A,1,4 Tom' / e ,47„ 2%, 87 2' !J o sue- T, L,9.P,J x -,e 7",5'4 41 /V .SssA f! N s ZcT,4 I, thie undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proc,!dures and met ods si-cified in the Wisconsir Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: "Z- 7_,,f,& ~',2EG a f 93 ADDRESS: 0 ~7 DE it/ EA/Cr IVffEF.P/Al CERTIFICATION NUMBER: PHONE NUMBER (optional): 'e x fy S--6O Z JAB Q - 7/s _ "t2 S ^'76 3/ CS1 SIGNATURE: NOW KNOWN AS LOT 10 F FILED 77 Z Joc 2I1992•. 8 E;_ ~ONNELL SL CtoLv Co., vv 4902'79 CERTIFIED SURVEY MAP 9-2556 LOCATED IN GOVERNMENT LOT 4, SECTION 22, T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. UNPLATTED LANDS S1/4 CORNER CENTER OF - SECTION 22, SECTION 22 T30N, R20W S T H "35" & " 64" EAST LINE OF GOVERNMENT LOT 4 w - - . . - . - - - - Il- NO° 35' ZO"E 743.60' ~ - - - S.T.H. CD 580 52.43' 0°10'20" 113511 NE CORNER 'POINT OF 1 136.4 ' © > - - GOVERNMENT LOT 4 IBE I 30' ► F o 1 1.30' CENTERLINE GINNING g o rtv o S .T.HICICE wC, \ ~"64" ~ I w I "CREAM RlGNT RLY I H1 ~I _ : M STOR LINE pF WAY ~ i I gal l ^ I M _ ; I 00 I w I 1_ o ao I of ( ZI M REMAINS OF HOLCOMB'S CO C4 I ~I .----LY- I 'n SUPPER CLUB o O I NI DESTROYED BY FIRE w I w Ifli~ •11d¢ I CI-41 ° CD Ga I I ¢ pa" o, LOT 11 STEEL HI ~I I a-1 - T I CD ; Irn SHED ° al zl I o -I MI w z _ N0°26'06"E 00 z1 a1 I H JI Ji ob AIR lI I 496.17' g i z o ~t•:x Ma~fi_ j g GARAGE _ g 4w 1 ¢I J.43TI 10 N NO°26'E dl °40'20"E I~ 250.00' c°5 o ~ 1130.00 w i N 1 Lij o >i of .NOTE____: • UIYEW o' o / o, /Ipp~ ENCRCC ;1E tip' 3 z =I -jI cf) I I ~ 0- .n - - - ,:I x-10 ho LOT 9 a cn I S I (F-I~I 1 57'40 w ~2~~4•~~•bo W o wI w - 0 1 I U ¢ 121.07' 1 R=80' ° '-'I w v I zlai LOT _ r LOT 6 ~ Of I CD l01~1 C S. M. 1 C.S.M. I Grp 'M S7°041W W, ~I I QI i VOL. 3, jV. 6, P.17661 15-- 8.. 70 _ ZI JI - - - I SIC) I P 822 IPART_OF IC.S.M. VOL,3, P. 822 r ' - j LOT 3 I - , I TRUE BEARING I C. S. M. I LOT 2 I LOT 1 I 1 UNPLATTED V.-3, P. 822 I I LANDS LEGEND I I ST. CROIX COUNTY SECTION CORNER MONUMENT, FOUND. • EXISTING IRON PIPE. O 1"X24" IRON PIPE WEIGHING 1.6841/LINEAL FOOT, SET. ,0' 2"X30" IRON PIPE WEIGHING 3.6541/LINEAL FOOT, SET. WISCONSIN D.O.T. RIGHT-OF-WAY MARKER, 3/4" REINFORCING ROD WITH CAP, FOUND. 66' ROADWAY EASEMENT GRANTED TO THE OWNERS OF THE LOT DESCRIBED IN V. 879, P. 128 - - - CENTERLINE EXISTING DRIVEWAY. BUILDING SETBACK LINE. OWNER AND SUBDIVIDER ,Gr\ RAILROAD SPIKE, FOUND. V. STUDTMAN, INC. ---X EXISTING FENCE. HIGHWAY 35-64 HOULTON, WISCONSIN 54082 715-549-5578 THIS INSTRUMENT DRAFTED BY CHRIS NEPERUD PAGE 1 OF SHEET 1 OF 2 SHEETS VOLUME 9 PAGE 2556 77 Continued SURVEYOR'S CERTIFICATE I, Francis H. Ogden, Registered Land Surveyor, hereby certify that I have surveyed, divided and mapped this Certified Survey Map located in Government Lot 4, Section 22, T30N,.R20W, Town of St. Joseph, St. Croix County, Wisconsin, being Lot 5 Certified Survey Map recorded in Volume 6, Page 1765, Document Number 420950 of the St. Croix County Register of Deeds, described as follows: Commencing at the S1/4 corner of said Section 22; thence N0°35'20"E (True Bearing) 743.60' along the East line of said Government Lot 4; thence N89°19'40"W 52.43' to the point of beginning; thence N89°19'40"W 699.741; thence N0°40'20"E 130.00'; thence N89°19'40"W 215.141; thence S1°57'40"E 121.07'; thence Southeasterly 129.45' along an 80.00' radius curve concave Southwesterly whose chord bears S45°36'20"E 115.78'; thence Southerly 168.15' along a 265.29' radius curve concave Westerly whose chord bears S18°54'30"W 165.35'; thence S37°04'W 127.321; thence Southerly 279.66' along a 534.11' radius curve concave Easterly whose chord bears S22°04'W 276.48; thence S7°04'W 158.70'; thence S89°15'E 416.50' along the South line of Government Lot 4; thence N0°26'E 250.001; thence S89°20'40"E 612.88'; thence Northerly 363.33' along the Westerly right-of-way line of State Trunk Highway "35" and State Trunk Highway "64" on a 1382.69' radius curve concave Westerly whose chord bears N7°42'E 362.28'; thence NO°10'20"E 136.47' along said Westerly right-of-way line to the point of beginning. This parcel contains 13.178 Acres, more or less, being 574,066 Square Feet, more or less, including roadway easement and 12.982 Acres, more or less, being 565,502 Square Feet, more or less, excluding roadway easement. Subject to easements of record. I certify that I have made such survey, land division and Certified Survey Map by the direction of the owner of said land, that such map is a correct representation of all the exterior boundaries of the land surveyed and the subdivision thereof made, that I have fully complied with the provisions of Chapter 236 of the Wisconsin Statutes and the Subdivision Regulations of. St. Joseph Township and St. Croix County in surveying, dividing and mapping the same. Date: June 18, 1992 Revised: Francis H. Ogden S-882 Job No. 92-1942 July 31,`,~~~~m~'~ Ogden Engineering Company 1991. 113 West Walnut Street River Falls, Wisconsin 54022 MANCIS H. OGDEN OWNER AND SUBDIVIDER a omm ° V. Studtman, Inc. lift Highway 35-64 Houlton, Wisconsin 54082 SURV715-549-5578 ~iu'umniu► CURVE DATA TABLE CURVE LOT RADIUS ARC CHORD CHORD CENTRAL TANGENT NO. NO. LENGTH LENGTH LENGTH BEARING ANGLE. BEARINGS 17-2 10 80.00' 129.45' 115.78' S457361 20"E 92°42'40" T8-87 2'20"E S0°45'00"W 2-3 10 265.29' 168.15' 165.35' S18°54'30"W 36°19' S0°45'00"W S37°04'00"W 4-5 9 534.11' 279.66' 276.48' S22°04'W 30°00' S37°04'00"W S7°04'00"W 6-7 11 1382.69' 363.33' 362.28' N7°42'E 15°03'20" N15°13'40"E N0°10'20"E PAGE 2 OF SHEET 1 OF 2 SHEETS o 57 2- VOLUME 9 PAGE 2556 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS: D FIRE NO: LOCATION: 1/41 1/4, SEC. T 30 N-R&Z~ W,__T 11 TOWN OF: ST. CROIX COUNTY SUBDIVISION: eSd4 e1902-.7 gll# CASY~OT NO. li 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 a 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification from will be sent approximately 30 days pricy to three year expiration. 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. Certificaticn farm must be completed and returned to the St. Croix Count, Zoning Officer within 30 days of the three year expi x: ~&tion date , r SIGNED: DATE: St. Croix Covinky Zoning office 911 4th St. Hudson, WI 5403.6 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 Location of property 1/4 1/4, Section T o N-RA V W Township gy• ~b.SP Gf • r Mailing address LG D O~ Z-~ t n Address of site CZ eke ~ o " 179Gel, .2 s o u- Subdivision name6C, `•~0 ' - a Lot no. Other homes on property? xes o Previous owner of property /,446L/y 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 volume ~,_and Page Number 2 S 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(*W certify that all statements on this form are true to the best of my (ems-) knowledge that I bm4 am ( ) the ownerlW 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.9Qo2.2 , and that I (ffla) presently own the pr posed site for the sewage disposal system.~Cfe-(N~ @6 ' ons r cti s o lti s7 m e e c b r S s b y ec de n e ofd i e of nt a isomer os eye ent a o No. ISi ature o pplicant Co-appl cant Date of Signature Date of S gnature DOCUMENT NO. II STATE BAR OF WISCONSIN FORM 1-1989 it THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED - - = 490282 - - -1 _ c 976PAGE 135_ REGISTER'S OFFICE V. Studtman Inc. This ST.CROIXCO, This Deed, made between a Wi sconsin Corporation Reed for Rewd CT 211992 Grantor, I! and____-___-_-_-5 anl_ey-._D,___Hanks 8:30 A. All +j Grantee, j 1! Doe& Witnesseth, That the said Grantor for a valuabl consideratio of of I' Twenty Thousand ana no cents 20 000.00 t _ I Cd. RETURN TO conveys to Grantee the following described real estate in _......J..l._-.--v_ ____r01X +.on /a D- /~/an kt County, State of Wisconsin: /1ivP C i! A PARCEL OF LAND LOCATED IN GOVERNMENT LOT#4 Tax Parcel No_ SECTION 22, T30 N R20 W DESCRIBED AS LOT OF CERTIFIED SURVEY MAP BEARING DO CUqENT #490279 FOUND IN VOLUME # 9 PAGE# 2556 TRAN Slj~ j~ This NQT-------------_ homestead property. ~C (is) (is not) Together with all and singular the~hereditaments and appurtenances thereunto belonging; ~j And.---------V. STUDTMAN INC... - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except all recorded easements and covenants. it and will warrant and defend the same. I~ Dated this 1St day of ---------------OCtO1Jer 199...... _ V. STUDTM INC. ....(SEAL) BY-------- - (SEAL) * -Verl.i Studtm n , sa-d BY / EAL) ~ -----•---(SEAL) . Wilemar W. Studtman Vice President j AUTHENTICATION ACKNOWLEDGMENT Signature (a) STATE OF WZSMXKM MINNES A ss. • Washington----_____•---County. authenticated this day of 19 Personally came before me this 1st day of ---------OCtob2r------------------- 1992-... the above named Verl-+n Studtfflan--and--------------------------------- TITLE`--------: MEMBER STATE BAR OF WISCONSIN W~l-emar--W -;.--§tadtman--------------------------------- (If not, authorized by § 706.06, Wis. State.) to me known to be the person -.-S who executed the foregoing instrumenWan acknUlledd ssune. THIS INSTRUMENT WAS DRAFTED BY / I WA-boar_.5tsjdtuan----------------_ race K. Wakeling - Notary Public -----Washington----------------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) 8-1-97 date: - 19 "DI. of rIrsons signing In any capacity should be typed or printed below their signatures. Sr '1' S}; S ATF: III ~ Q- 14 . "9( ~ it 1L :;k ,