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HomeMy WebLinkAbout040-1034-95-006 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER I ~u. Z ^---4 ADDRESS ~/7 s ✓ti , ~,PQ/ SUBDIVISION / CSM# /v Pay a2g~~ LOT SECTION -T Z? N-R /f W, Town of ire ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • EK e s/~° t.J e ~l fa A ltcj fiL f M L 7~ i i 3 8M £L= ►b~ INDICATE f10RTH RR Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. i BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: C,/,) Liquid Capacity: /mod Setback from: Well 73 House 16' Other Pump: Manufacturer IV IV Model# Size Float seperation 11.4 Gallons/cycle: Alarm Location ~09 SOIL ABSORPTION SYSTEM Width: S Length 7j Number of trenches Z Distance & Direction to nearest prop. line: Setback from: well: ~lv House 6o Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: y ,~-yS PLUMBER ON JOB: LICENSE NUMBER: /J11',ej INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan CERNOHOUS, PHIL A CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax ~9!= 10 3 4-95-0106 6b /V kol TANK INFORMATION ELEVATION DATA d - TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 6L_) Cone- Benchmark Dosing 0. ~ 103.77 /60 Aeration Bldg. Sewer , r Holdin St/ Inlet 99 63 TANK SETBACK INFORMATION St/~(t Outlet /Z~ y TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet AL-A Air Intake Septic 0/ NA Dt Bottom Dosing NA Headers Aeration NA Dist. Pipe 3y~ U Y ding Bot. System PUMP/ SIPHON INFORMATION Final Grade 37 ' i Ma facturer nd Model Number GP 7 O TDH Lift Lnction (IM s' ~79a~ Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7,5 -2 DIMEN 1 N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LE-A-CHtN acturer: SETBACK AMB ! d- Mo e INFORMATION Type of par- CH System: ~Yta, 6 T OR IT DISTRIBUTION SYSTEM :h~~ aid fJ Distribution Pipe(s) Hole Size x Hole S ng Vent To Air Inta Dia. Dia. ! ~ Spacing r Length Length SOIL COVER x Pressure Systems Only xx Mound Or At-Grade ste Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched No I Trench Center ~,LTrench Edges To E] Yes ❑ No E] Yes El COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.8.28.19W,NW,NE,LOT 5, COUNT ROAD FF eaf Z,41:M ®f . Plan revision required? ❑ Yes L P46- Use other side for additional information. Q(~ k/d F~ M SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i i 1 R SANITARY PERMIT APPLICATION fi■ILnIIIR In accord with ILHR 83.05, Wis. Adm. Code CO STATE SANITA 22PE,,R,,MIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a a`)v 3 8% x 11 inches in size. ❑ 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 OWNER PROPERTY LOCATION t 6r A) W 1%a S T , N, R (Dr PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 7.5 r AA CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM N7BER S~D~b y y7 53 II. TYPE OF BUILDING: (Check one CITY NEAR ST ROAD ❑ State Owned ❑ 511 401WN VILLAGE : r ❑ Public ❑ 1 or 2 Fam. Dwelling-#~ of bedroomi~ PARCEL TAX NUMBER( 1C.GL Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ ApVCondo 7 T ~b 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 100 Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ 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.E] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 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. S STEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION (O ~ 756 V,& A/a z3 Feet ?6Feet VII. TANK CAPACITY Site in al Ions Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumygr's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: / 77 Plumbe s Address (Street, City, State, Zip Code). 696 1,4 196 - - 4--J., Q.~ off/ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee (Includes Groundwater Date Issued Issuing Ag t Si tamps Approved ❑ Owner Given initial 7, .~V u charge Fee) 7 Adverse Deter minati n / (o W /5~_ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08193) DISTRIBUTION: Original to County, One Copy To: Safety R 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 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 and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% 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) 1 JOB ALI(- I GLr~cof~S TIMM EXCAVATING SHEET NO. G OF Z Route 1 Box 192 Y WILSON, WISCONSIN 54027 CALCULATED BY DATE ' r (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE : r ✓2~r Ins. ......~,-4 d ~iecc~'>~ 7'S , Ac. f6l ! f II T ~ I i 1Ir~ C~c~ r Q d U Y w4 . PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE I-800-225-6380 JOB / `U I✓~lbil U .S TIMM EXCAVATING SHEET NO. 2 OF 2 Route 1 Box 192 to ~m w, DATE WILSON, WISCONSIN 54027 CALCULATED BY (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE . ...............................i................... ..........s . , . . _ i~ 4 'j _ 2-7 >v~.~o.. - c~u wr l m t,.. ` - - - - - - - - - - - - - - - - - - - - - - - PRODUCT 205-1 ~Inc., Groton, Mass. 01471. To Oder PHONE TOLL FREE 1-BW225-6380 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page /of 3 Labor aryl Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 'ST C go x 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Q J , o O v - GOVT. LOT NL,U 1/4 AJIl 1/4,S I T *2% N,R / E (or) W PROPERTY OWNER':S MAILING ADDRESS „ LOT BLOCK # SU . NAME 0 M # C6QAJT_Y71eQ4J'~, nz- CIS 16 CITY, TATE ZIP CODE PHONE NUMBER ❑CITY OVILLAGE OWN NEAREST ROADJ~ New Construction Usem Residential / Number of bedrooms IA A JV, Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate ®.7 bed, gpd/ft2 O % trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd1ft2 Recommended infiltration surface elevation(s) SEE A4E 3 n ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MO ND IN- ROUND PRESSURE T- RADE Y TIM IN FILL HOLDING T K U= Unsuitable fors stem So U IS ❑ U S❑ U S U S ❑ U 0S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ;:;rs::: ~sx -I I dY+~ 2 I - L Z aL r~ o.< 0.6 l I I Dl/ rrr sly >r C S O. 0.6 Ground s --~3 pv 3 SX14e Q C S 2 01 elev. 002-7 ft. ) y Q _ S D N/ 1 169 Depth to limiting Tor 7S Remarks: Boring # / I 1-0i F9P, -Z s Ground elev. -11q 1 l6%/4 4 ►v, I I' 4. 1p¢_23 ft. Depth to limiting .,f Z~ 4 2 .Sy z 5 Y£ 4 6 S/ "v 0, 1 Remarks: 46Ta'- Dq taA-_ A K&TPA tZ 1WCUS ►p^J p 1 A-2'7 ;n► 5A jJ ~14 Li4 ya-A CST Name:-Please Print ovay )6tar,)S6 N Phone:, 40t-0 Address: ,DUX U 4S6 AJ IAJ 1 Signature: Date: Z3 p4- CST Number.g~ PROPERTY°OWNER ,•~varlfJc SOIL DESCRIPTION REPORT Page Z of Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Boundary Bed Trends <r / C S 2 d S L~ V11 V-- 16Y k Ground - ~dy 4 ® elev. lob 3Cft. Depth to limiting fac o 7 Remarks: Boring # A - >byk I Z y►., r frr r C S 2 p S p .6 ti. ' fbyk 3 SL nt h M~f` C w p.S ip 6 _S by3~ - S n~I c s I :7b Ground elev. /OYf 4- / f D~S ft. Depth to limiting > fact/ r Remarks: Boring # -10 (4:1 $z S3 a3~ S p m~ CS D.7 b.g Ground S ~ 7 d elev. -/2 k © rvi I f Cd.2( ft. Depth to limiting fa for /~.0() Remarks: Boring # a ;;y lei Ground M elev. , , U771 474, ft. . .r . Depth to limiting factor Remarks: SBD-8330(8.05/92) J..r P,4ec ci 2 i;z 2 Q 4 w ~ 1- 2 m r F ~ `2 cJ ~ n7~ M Qp c4 El 01- lop Li > 14C C~ V3 C~o \ 10 ,gip, FILED 0121 12 9 994 ► JAMES -CON Regis- NE ter0of DeedsLL 52424' c, Sc Croix Co., Wf CEP T I F- I ED SUP V E Y MA Located in the Northwest 1/4 of the Northeast J/4 of Section 8, Township 28 North, Range 19 West, Toavn of Troy, St.Croix Co.inty, Wisconsin, NE Corner East line of the NW 1/4 of to Im Section 8 the NE I /4. m '(D LO N M N U N P L_AT_T E D LA_N_D_S_ s00°01'28"E S 00.01'28"E Done under the direction of, 3 523.98 317.72' and Owned by:, QI J. Cernohous CD Wi 455 Cty Trk "FF" `c LOT 5 N Hudson, Wi, 54016 co N 413,331 - v~F(2.60 A e 1~ (J~ Z. ineluding a N1/4 Cor 111,060 Sq,Ft, (2.55 Ac.) ~I <1 •~`'~`coN LO Excluding right -of -way. S CU HARVEY G. Lnl JOHNSON - - 0M01- S-189 -+I HUDS 0) IS Q' ca o.%' u7 RJ ~k io S 00'09'49"E 251.72' I I6 0) v ro m 21 (D ~ItD C;0 3 0 01 NI APPR OVD Iw lLO 6 ra M-0 01 a~ 104,, 0^e.Ft. 39-Aram- 00 ,i•) Irteluding right 9~ way. ao ° DEC 12 '941 o Wig 87,570 Sq,Ft, (2,01 Ac.) m N <1 ,°o ~IQ Ex;luding right-of-way, °o alb m m I Sr . Grioixcoutir"Y P4 m m w W1 ; oanprehensive NaMPH 2I ' CO > Zoning and Z a v - ~I Parks Commillee 0 ' m o v N , Ol not recorL3 A 100 ROADWAY CO M (0 ao ° W1 rn I within 30 days Y•i SETBACK ° o I - -1~.......amo..z ~ wI aijprovaldatz? N cu H 01 i4pprowat shelo'be 01w v W I ~l I ,rka 8 void o M UI w ° d W - - - - - - - - 251.72' 66.It- Z o N 00'09049"W 317.72 - Access easement fro_m_ W to °o OUTLOT 1 (RESERVED •1~~o_- vv% 5 - 1385 , Q N to FOR FUTURE ROAD) (n g -7 N • 00•40949W ' - (D 246.34 M Lo _ _ _ _ + ° N 00'09' 49"W 3 - (NOO°00'00"W ) 0 UNPLATTED LANDS o 0 o 0 (0 * OUTLOT I CONTAINS 18,607 SQUARE FEET(O.43AC.) LEGEND Outlot 1 is aubject to public access easement Bearings referenced to the North Section corner monument, line of the NE1/-4, assumed to be Aluminum cap. N89'58452 "W 0 1 "X24" Iron pipe weighing 1, 68 lbs per lin, foot set. • 1'' Iron pipe found, (R) Previously recorded information. This instrument drafted by: J51 4942299 Vol. 10 Page 2853 i DESCRIPTION A parcel of land located in the Northwest quarter of the Northeast quarter of Section 8, Township 28 North, Range 19 West, Town of Trop, St.Croix County, Wisconsin, described as follows: Commencing at the North quarter corner of Section 8; thence South 89 degrees 58 minutes 52 seconds East 1326.785 feet along the North line of the Northeast quarter of Section 8; thence South 00 degrees 01 minute 28 seconds East 523.98 feet to the Point of Beginning; thence continuing South 00 degrees 01 minute 28 seconds East 317. 72 feet along the East line of the Northwest quarter of the Northeast quarter of said Section 8; thence South 89 degrees 48 minutes 03 seconds West 657.79 feet; thence North 00 degrees 09 minutes 49 seconds West 71.34 feet; thence South 89 degrees 50 minutes 11 seconds West 33.00 feet; thence North 00 degrees 09 minutes 49 seconds West 246.34 feet; thence North 89 degrees 47 minutes 56 seconds East 691.56 feet to the Point of Beginning, con- taining 217,237 square feet (4.987 acres) more or less, and being subject to all easements, restrictions and covenants of record. I, Harvey G. Johnson, registered Wisconsin Land Surveyor, hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed and that I have fully complied with the provisions of Section 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision Ordinance and the Town of Troy Subdivision Ordinance to the best of my professional knowledge, understanding and belief. .57 ~~111NHq~~ Harvey ohnson S-1899 aarHA ~GQNSj Johnson Surveying, Inc. 216 Meadow Drive Hudson, Wisconsin 54016 < ~e This survey was performed under the direction of Julie Cernohous, owner of said land. County General Notice Note: The parcel shown on this map is subject to State, County and Township laws rules and regulations (i. e. wetlands, minumum lot size, access to parcel, ect.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. Vol. 10 Page 2853 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT / / P St. Croix County OWNER/BUYER /it- J (..r2'r/l ~'z~. MAILING ADDRESS PROPERTY ADDRESS y7 ~,t(llocation of septic sy m) Please obtain from the Planning Dept. l17'~ fl 5`1~' CITY/STATE W "el PROPERTY LOCATION r V&) 1/41 AJL 1/4, Section, T_!~_N-R /!$r W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP ayZV7 VOLUME ID, PAGE.7 8'53, LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper- What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60%. of the cost. of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year e p' tion date. SIGNED: DATE: %02 /~2 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 • S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property j ~~/u~~Ca~cS Location of property f ,l/4_tk1/4, Section g T -49 N-R__Z~7_W Township_ r~ Mailing address Address of site 476- 4/24a, Y- - d Subdivision name a V~5/7 col /J P4 ;~t6:3 Lot no. Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? ,C Yes No Is this property being developed for (spec house) ? Yes A No Volume IM 4-2 and Page Number 6JI-) as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner (s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. ~52~1Z y , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Sign ure of Applicant Co-Applicant 0-/d-9L/ Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED Y. w 524271 11 VOL M PaSE i I r F i , ~u\ QY, nt~ 1%r) I, < DEC 1 3 1994 73'"\ quit-claims to Philip C Cernohous 11:15 A. iJ . the following described real estate in St. Croix County, State of Wisconsin: RETURN TO Tax Parcel No: ~7d_ /03 7~ A parcel of land located in the northwest quarter of the northeast quarter of section 8, Township 28 north, Range 19 west, Town of Troy, St. Croix County, Wisconsin, described as follows: Commencing at the north quarter corner of section 8; thence South 89 degrees 58 minutes 52 seconds East 1326.785 feet along the North line of the Northeast quarter of section 8; thence south 00 degrees 01 minute 28 seconds East 523.98 to the point of beginning; thence continuing South 00 degree 01 minutes 28 seconds East 317.72 feet along the East line of the Northwest Quarter of the Northeast quater of said section 8; thence South 89 degrees 48 minutes 03 seconds West 657.79 feet;thence North 00 degrees 09 minutes 49 seconds west 66 feet; thence North 89 degrees 47 minutes 56 seconds East 380.89 feet; thence North 00 degrees 09 minutes 49 seconds West 251.72 feet; thence North 89 degrees 47 minutes 56 seconds East 277.67 feet to the P-o7-rit of beginning, Containing 113 ,360 square feet (2.6 acres) more or less, and being subject to all easements, restrictions and covenants of record. (Also known as lot 5 of St. Croix County Certified Survey Map vol. 10 Page 2853) Lot-"'S is here by assigned 66' roadway easement by the Grantor (Julia Cernohous Heir of Virgil Cernohous) of s%.'~,'✓I>'T St, Croix County certified Survey Map vol. 5 page Thi13p ~WF < 390459 . homestead property. (is) (is not) Dated this 13th day of December 1994 (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE ~O:F WISCONSIN -Y (.itytyL ss. County. 9 authenticated this day of 19 ^}Rersonally came before me this_/j day of v~G'CC /t `2-k 'L! 19_th`f eabovenamed l;g hOtf,~g TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to J~a•the perpson who executed the authorized by § 706.06, Wis. Stats.) foregoing in wtt{ ent~atctra~K wledge the same. THIS INSTRUMENT WAS DRAFTED BY CCf, Ilk Notary pl7~f J County, Wis. (Signatures may be authenticated or acknowledged. Both My if n ot, state expiration are not necessary.) date. 19~.) 'Names of persons signing in any capacity should be typed or printed below their signatures. SB3 NTF 0023 STATE BAR OF WISCONSIN QUIT CLAIM GEED FORM No. 3-1982 Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307-0208