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HomeMy WebLinkAbout042-1043-50-000 .7, - - STC 104 .q} AS BUILT SANITARY SYSTEM REPORT J OWNER ~av o /'l S©~ ADDRESS SUBDIVISION / CSM# LOT # CO SECTION )~,_TPq N-R f ~ Town of (~y k^V`;V/ ST. CROIX COUNTY, WISCONSIN I it -~.N LAN VIEW SHOW 7ERYT IN ,WITHIN 100 FEEETOF SYSTEM o os~ 9~ UAl 40 i 1P ry ~ I l9 % ~L~ 1 p - 170 1 1 107/ X44 ~ A u .~v6' z 1 ( 9 r C~ N © ~qQ~ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: Cpl ToA SF~~ 9 J~,Q~IQ ?~9,,y ALTERNATE BM:- If0 BA.~ SEPTIC TANK / /PUMP CHAMBER I/ HOLDING TANK INFORMATION Manufacturer: IVIFE k5 C©N, / rDG U GtSLiquid Capacity: s ipoo P yt,Apo S T , C. Setback from: Well >SO House '71 q$ "Other Pump: Manufacturer Model# 9 ~ Size k )4 P /I S-i/ Float seperation Gallons/cycle: ~g Alarm Location, SOIL ABSORPTION SYSTEM Width: Length L6p ~a~Number of trenches Distance & Direction to nearest prop. line: e S Setback from: well: House- Other ELEVATIONS Building Sewer 3, 7Y' ST Inlet q 3. - ' ST outlet 9 0CP9 / PC inlet PC bottoms 75' Pump Off Header/Manifold 1 9/ Bottom of system. 9-3,3 Existing Grade 9'7,.30 Final grade/ q 9 3, 3? Imo,, 1. q 3 ~ Q 3, 79 DATE OF INSTALLATION: PLUMBER ON JOB: _ #A14A4e~ LICENSE NUMBER: ® r? S INSPECTOR: 3/93:jt Wisconsin Uepartmentof Industry, PRIVATE SEWAGE SYSTEM County-ST. CROIX abor and Human Relations INSPECTION REPORT :aiety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION P rmiklH gr Narpe ROY ❑ city Village Town of: State Plan I No.: Warren CST BM Elev.: Insp. BM Elev.: 7BM e scription: Parcel Tax No.: ~ 25 a - J S Aq&n 477 141,9 LCl TANK INFORMATION ELEVATION DATA 2 r TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Lr Benchmark/ `7 Dosing of'. 0, 9 e:,?, Aerati Bldg. Sewer St/ Inlet ~J' TANK SETBACK INFORMATION St/ Outlet e, 90?.~ xj- TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake d Septic p' yz /',9 NA Dt Bottom "Dosing NA Header/Man. Aeration NA Dist. Pipe l t,: CTS Hol Bot. System PUMP /51e~6NF INFORMATION A0 I Final Grade Manufacturer Demand ~JQCoz.I_ Model Number L2'_ gy L90 GPM TDH Lift U~ Friction System A TDH Ft Loss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width _ Length i I No. Of Trenches PIT No. Of Pits Inside Dia. DIMENSION ,3 DIMEN I M acturer: SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEAC 171461 SETBACK CHAMB a Mo a Number: INFORMATION Type Of System: Sd/`~ Yi. OR T DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) /i x Hole Size x Hole Spacing r Intake Length/8 ~Zf Dia. Length Dia. 7 Spacing/f 12/ SOIL COVER x- Pressure Systems Only xx Mound Or At-Grade Sys s Only Depth Over Depth Over xx Depth Of Seeded/Sodded xx Mulched go/ Trench Center 4Zd4Trench Edges 5 Topsoil ❑ Yes No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Warren.16.29.18W, SW, NW, Lot 0, 110 ph Street 1 yiy GG:x/` ~~''~9"-°'~'C~~`t ~ t-;e".y_ 4R j ; Plan revision required? ❑ Yes &N Use other side for additional information. d~ SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 3(v W~ 12.9 ~ ~ ,may ' mac' , z" Z i~,d2 oLC~ fr~h3 /p 9D Safety and Buildings Division • v~G~~liPn SANITARY PERMIT APPLICATION Bureau of Building Water System- 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, Wl 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State SanitaarryyJ P~eerrmit N'uumbeerr The information you provide may be used by other government agency programs ❑ Check it revision to1reviouapplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Obner Name Property~L"o"cation /I0 W 1/4; 0l4, S T;' / q , N, R f0a E (oAZ Property Ow er' Mailing Addres_ ` Lot Number Block Number Ci St to !r Q Zip Code ~ (hone ;umber Subdivision Name or CSM Number 5-171091 If. TYPE OF BUI ING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Vown of 6000-k~=- 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 /a 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 _ [lew 2. E] Replacement 3. E] Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System ----------------------------------------------7------------------------------------------------ B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ S epage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Wepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. f . Proposed (sq. ) (Gals/da /sq. ft.) (Min./inch) A 89.8o' I vatio tS~ I C 3o Feet ssa Feet TANK Ca tt V 4-- 7 77, Site VII. NFORMATION In gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Exper. Gallons Tanks Concrete glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank /Dow Lift Pump Tank /Siphon Chamber gt~o VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PIumbe s Signature: (N Stamps) MP/MPRSW No.: Business Phone Number: h I EJ.3 7/5% Plumber's Aclres (Sttrreet, City, Sta Zip Code): ~j (v lt.l ~ ~f/~~ ~S IX. COUNTY/ DEPARTME USE ONLY ❑ Disapproved Saptary Permit Fee (Includes Groundwater ate ssue Issuing Ag nt Sig re (N tamps Surcharge Fee) Approved ❑ Owner Given Initial •1,/1/J~~ ~S. Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Divmion, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date and at a time of renewal any new criteria in the a Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. 1 To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 'I through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, numbe- of tanks and manufacturer's name, indicate prefab or site constructed and tank material Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP,-etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to'he cc :rity. The plans must include the following: A) plot plan, drawn to scale or with compcte dimension;, locatii_;n :-,J ho ding tank(s), septic tank(s) or other treatment tanks; building e%fvers; welk, water mars/water service ,lrE <,iir An. '-ekes; pump or siphon tanks; distribution ioxes, soil absorption systems; replacementsys-f,m areas,; a~ia tf"c is .3r: the building served; B) horizontal and vertical elevation reference points; C) complete specifica_ion, for pumas controls; dose volume; elevation differences, friction loss; pump pe"ormance curve; pump model am-11 purr p manufa( firer; D) crosssection of the soil absorption system if required by the eou-r,ty; -7) soil test data on a 11 form, and F all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SP r . ~•eD lu D • L.OT L z JQV..S - n E.LE VA•T io,J 5 13 .,90 I 13 T3. go' j 13, 97.30' 4 y 97, 50 scALE : ► - yo S 9 y O 0 • = /3AGKka~ ~~'TS ~ Sob6eSTED TReA3e-L ,jyPa 13A,Ser. -'op of ~98.s S~fSTE~-1 EIEU~tTIO~JS 0 3/y" • ~ ,yam ' t-V 5;3. 3c a of W a ,p 0 0 o G 74/ ro c~ po, g3 LL o 13S a° 13M 0 1 _ • o zp 50. LOT 379.5 Fdu..j31y ti rop Ar S IM- LOT O COR,.~ C R A lye 1 PAGE OF PULP C M ER CROSS SECTION AND SPECIFICATIOW a VENT CAP 4,~ WEATHER PROOF APPROVED LOCKING , t' JUIJCT10A1 BOX MAWHOL,E DOVER it 12"M11 U. GRADE MIN. COIJDUIT - F z . y' PROVIDE - AIRTIGHT SEAL I' lNT A ~t + I ( APPROVED JQIiI^~ , W/C.x. PIPE b S `7 s ► .ALARM EXTE,4011 u co OUTO SOLID SOW, „ I PLJMR--~, M~J OFF h5 y s x: COKICKETE BLOCK 3 'I R4cK EXIT PEItMi°TrEA OWL4 IF TAIJK MANUFACTURETZ HAS SUCH APPROVAL SPECIFI'GATIOAIS ~►ii~UUFACE TUP.ETZ• A v NUMBER OF DOSES; PER DAJS 4 TAf K GIZE GALLOtJS DOSE VOLUME: 1191,49 ~ GALLONS 1 ~ , . fy r :PkWL1FWTURER: V 1. -1Q ~ CAPACITIES: AaoJYy,-,'~'^'CHES OR 3©Q 'BALL. 4 L; 4 l1~ B~ ACHES OR ~L. faP1.L' r ~ IT'~I~,;,~">;kkPt:; he c.~h v.~` `•I~lCHES oI~`~.._•I.Ldr AtJUF4TURfR: ' Dx '.IIJCHES OR YZ CALL4Fi l$4 "p "1 kfJneL iJllM1$ER: v NOTE: PUMP AND ALARM ARE,'To BE IMSTAL.LE OU SEPARATE CIRCUITS a : ` 5W'ITC H TUPE: Q_a _ C u j~ PUMP D/SC.HARC..E. RATE/ S GPA 1 kL DI}FEKE k + ? NCE BE T WEEI`I YUMtP 'OFF AUD MSITRIBUTION PIPE; FEET UM NETWORK SUPK9 PRESSURE . , . , FEET FEET OF FORCE MAIN F r/o p,FlttCTIOOJ FACTOR... OEET TOTAI; Dy1JAMIG +iEAfl 701- IEL DIMEIJSItS of TAIJY(:E1~1GTH ;WIDTH ~L14uIO DEPTH t LICMSE HUMBER: DATE' ' 1 HEAD CAPACITY CURVE 3 7/e 6 1/4 MODEL "98" 30 4 5/8 8 2 b -y' /8 20 + l I 3 55 6 m f 15 4 6 4 3/16 10 2 1 i/2-I1 1/2 NPT 5 0 U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS I so 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEADIFLOW PER M1,4UTE EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITS/MIN • , FEET METERS GALS L(RS 5 1.52 72 779 10 3.05 61 271 15 4.57 45 I/O 20 6.10 25 95 - 3 5/16 Lock yAtve ;,7 r f ' I CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are av:.iilable and • Mercury float switches are avails controlling* pp ed with an alarm. lots for single and three oublenase systems. • Mechanical alternators, for duplex systems, are available with or • D `..without. alarm switches. piggyback mercury float switches are available for variable level long cycle controls. SELECTION GUIDE Standard all models - Weight 39 lbs. - /z H.P. 1. Integral float operated 2pole mechanical switch. noextematicontrol requited _ 98 Series 2. Single piggyback mercury float switch or double piggyback mercury, Spat Control Selection switch. Refer to FM0477. Model Vwin-Ph Mode Am s Sill) lox Ou lox 3. Mechanical alternator 10.0072 or 10-0075, M98 115 1 ~u10 9.01 1 or 1 d 7 - 4. Sec FM0712. for correct model of Electrical Alienator, "E-Pak" 115 1 9.0 2 or 2 6 6 3 or 4 6 5 5. Mercury sensor float switch 10-0225 used as a control actHFator 098 215 1 Aulo 1.5 1 or 1 & 7 - duplex (3) or (4) float system. ' A E98 230 1 Non 4.5 2 or 2 IL 8 3 or 4 6 5 8. Folu (4) hole "J•Pak", junction bpx, for witad in siin plex or duplex operation, 10.0002, 7. Two (2) We "J-Pak", for watertight connection or splice, For Information an additional Zoeller products later to catalog on Coml>;n.:uon Starter, FM0514; CAUTION PimbWA Mwcwy Switches, FMO477; Electrical Alternator, FMO4116; N+-:chanical Alternator, All Installation e ccian. , All protection *Ie Mort l and a and whiny ahoyld be dale by a nosy. FM04aa; Alone Package, FM0618; lied licensed r* ctricisn All electrical and FM07~. ~ Basins. fM0467; arW :;1mpkx Control Box, ing the moat recent Ns1lorlel Electric Code codes ehO11M M followed fnged• Health Act (OSHZ. (NEC) aM tae oowPwosel Sal.h sad RESERVE POWERED DESIGN For unusual conditions a reserve safet factor ' r t s dogm Y ~ eered into the design of eery Zoeller pump. ~ MAIL T0: P.O.80X 16347 ~O 70. 3 4,',, Mi 0347 Manulactuiers o/.. , SNIP IP T0: 3280 80 0%:' I'vtil,'ers lane Loci,•vidr', XY 4L?16 . Qa~ulrAWAS ' KY Aff Z911 -V - (501) 778-2731 • itA.Y 150?) 774-3624 C S94=01R~~ Wisconsin Department of Industry, SOIL AND{'1 rF'L.U~.`` 'lON REPORT Page of -3 Labor and Human Relations Division of Safety & Buildings in a Q4~4~ith Rr83.05, t/ais' drn Code : j COUNTY ~~ST,, C-Rol 'K Attach complete site plan on paper not less than &14/9 11 i"s in size~*hn mli i lude, but not limited to vertical and horizontal reference poi f3 directian'r Ab ~o of slope! =41e or PARCEL I.D. # dimensioned, north arrow, and location and dista e near~#t ri3ad. , " } t ~`rf REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRIN z+INFOR1iLf' p~ ✓ PROPERTY OWNER: RTY LOCATION LE ROY ;Y6 d ~f N 5 O ! _f7 =",LOT SW 1/4 N W 1/4,S IG T 2 N,R to' E (o0 PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK If SUBD. NAME OR CSM # F$70 u O tc, sr. c, c s,y - I'Ea A36-- CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ❑MN NEAREST ROAD 120aEkPs 4)1. SY0i3 (715)7y?-36412- cvARREa 1/0 +e sr. [ New Construction Use [ Residential / Number of bedrooms (J Addition to existing building j ] Replacement [ ] Public or commercial describe r Code derived daily flow (~o gpd Recommended design loading rate gybed, gpd/ft2 trench, gpd/ft2 Absorption area required i bed, ft2 trench, ft2 Maximum design loading rate / bed, gpd/tt2 ' ~ trench, gpd1ft2 Recommended infiltration surface elevation(s) See- P5 • 3 ft (as referred to site plan benchmark) Additional design /site con' rations?NSfi,4// c,u s/~~ w/ O,t'o/~ ~Ox OiST72i~vTjo,J 5 materiis S C-5 5 5 A r T R E' - Sf'/t ~ ld~,., Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem IM ❑ U [as ❑ U C,S 11 U C- S' ❑ U [2- U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell flu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch 51//, f, 56k '.1" 7~e 4S a VT b / '4 0-g /oY,e 3/2-Ground -I-e, 7S Yee Y16 - S Z ,f, S 6 k r. ~2 S- lv f . 5 elev. ft. 2c, 2,6 - y0 5 YR y ~o n~► 5 . O , s 6e C S 7 . b' Depth to 2 C z o - 90 -7• sYig Y/G ANl~~D S. S d 2 5 - 7 ~ Igor 75 Yo y s/ f,sik WS-A `f 5 Remarks: DES~G-.~ /'~~vrs r /O'oivq /pir ot~ • S " 7C0/P ~lo~t°E ~ESY;pillivF 5'/. Boring # p J1 -5 , SDK ,,~►~,e s f . S 44Ni+ z /o yR 41/4/ 2-. C3 17-32. 7.5 VR Y161 4f, s 6,k r>ti, u4R c s . S Ground elev. .1-9d S mt'0/I''*WP1- 5 Yf s`"t d'54 4 .C 2C~ yiP y~y y ft. / 7Yyle Depth to limiting factor N Remarks: CST Name:-Please Print Ro a E ter u4_113R i C.4%T' Phone: ?1S- 3 Pe ' QlJ0 S Address: (o5 S tisti 'W- 4ODSO-) cJ 1 . SyO/t+ y- 7- 9~ CST~1 yy~i Signature: ' p Date: CST Number: / ca Ttft test site APPROVED for fa conventional septic. system. ORIGINAL 3 PROPERTY OWNER L ' 76/7~,uSO~ SOIL DESCRIPTION REPORT Page Of PARCEL I.O.. 40 f 1~c 6e csM p ~;a(.r-- Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rend o/b /o Yee 3 /i 50- Tb e n, -f P- CS 2 u f . ~ s .3~ 0.2/ yR y/y s6& . 6. Ground LC t Z/~ 5~~ 7 S YR L11' 5 , C' , S aQ~ C S ~7 .9 elev. ft. 2c 7 s yR y A 4,vo~ s I f 5 dK e~es A a_ y S Depth Io 7-5 vg Y/6 M.S. O's c~ G(,~ 'e limiting faces I Remarks: Boring # a _ 7 /O y~P 312- 56,E C S Z o f E 7 Z y y e f ~/y .s,~ 2. , s hk C S (U- S G El- t3 y 3 7 sYle s/ z.f, shy s s lvf •s Ground elev. 2 C , 3),• 9 7$ y4 f//C~ ~3Ra0~ 5l sb,~ ~5~j ~t.c' • S Depth to limiting factor Remarks: Boring # ~I 0-/0 /0 2 Uf N N Ll ~ 0 -ZG /0 y/t' `S~ 2, n+,, S~j,~ iw.'f ~p C S of .S zG 20 - -7 s (Ig t//,U BA-NO E,9 51 /,1~s6,e GPs a - y •S Ground elev. 7-S y2 y CQ ~Ant 5'.S. it Depth to limiting factor „ Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: eon ooon,o ncMO% JAW10190 1'' ' NO' LOT 4.. , Ire s ELE VATl0X15 f3,90. 13,T3. Po' 133 Y 7.30 C3 y 97. 50' SCALE 0 0 = QM.SET'. -'op pF 50b6CSTED TReAaeL X985 S~~STErI ~IEUhTio~S 0 3/q of =P. e I Munn o,3 = /00.0 ' a 9/.3'0 r C 9 3.3 o A d 1% t °a W Yo ~ / c Vi 81. I3y s &o 7y N 10 3 Pa •Q' x,10 / y , QQ I / , ye " s • )3M 19Li c l • o zp V) 50. LOT r... 37`i. 5 ti Fou,j0. 31y PiNL~ r rop Ar s c- DoT CDRatR O w P1+oaE ( 3~9- 5~ fg ~ •r CERTIFIED SURVEY MAP Located in the NWh of the NWT and part of the SW;A of the NWT of Section 16, T29N, R18W, Town of Warren, St. Croix County, Wisconsin; being Lot 2 of Certified Survey Map recorded in Volume 3, Page 791. NW Corner of Section 16 ss ~ c s orn M v H LQT i LCj i 1 ho Q. N.. IN C -1. -IN W 0 CD \ V 33 v 1? 697 I P 791 \ 4 v -W 0 N88o59119"W 670.74' p 90 635.47' 35.'271- y' a 0 m y~too% .o s . A \ . v b y s o o • r m s LOT 5 I J 13.03 Acres Inc. R/W I c .567,447 Sq. Ft. I UJI 12.40 Acres Exc. R/W I 41 co 540,160 Sq. Ft. ti ~ LI cli 4, 3L V - O ~ o 3 N rt ' O M ` O O^ s S8902415111E 626.53' `O ~ 4- 588.541., , LEGEND ° 37.99- / Masonry Nail Found ~ 5O i L 7-&-5 T • 3/4" Pinch Top found 41 CO 0 LOT 6 v • 1" Iron Pipe Found 39 ~o o' x 24" Iron Pipe Set, 0 5.0'0 Acres Inc. R/W ' o, Q,' r.. o 217,846 Sq. Ft. /w oh~~Tj Vj~ neighing 1.68 lbs, per o~ L~/ 47 linear foot 4.62 Acres Exc. 'R/W *."'o -k--- Existing Fenceline 201,393 Sq. Ft. / 100' Roadway Setback line 37.99'- 341.50' S8902415111E 379.49' LQT I 3~~'/ • C.W.IN - 0 Scale in Feet P 751 0 100 200 400 o rn o 0 ~n OWNER LeRoy ohnson and Mary Jo Johnson 990 110th Street ^wy. W} Corner of Roberts, WI 54023 Section 16 -This instrument drafted by Michael Erickson Job No. 94-23 Parcel 042-1042-60-000 09/10/2007 10:00 AM PAGE 1 OF 1 Alt. Parcel 16.29.18.246A 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - TOKHEIM, DANIEL, &NATALIE A HOPPE DANIEL, &NATALIE A HOPPE TOKHEIM 990 110TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 990 110TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 13.030 Plat: N/A-NOT AVAILABLE SEC 16 T29N R18W PT W1/2 NW1/4 BEING LOT Block/Condo Bldg: 5 OF CSM 10/2767 13.03 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1100/278 WD 07/23/1997 934/305 07/23/1997 829/320 2007 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/11/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 9.030 60,500 158,400 218,900 NO AGRICULTURAL G4 4.000 600 0 600 NO Totals for 2007: General Property 13.030 61,100 158,400 219,500 Woodland 0.000 0 0 Totals for 2006: General Property 13.030 61,100 158,400 219,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 141 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 g JAMES O'CONNEII l Fe9~ster of Doeds ~ sc.ao~xco.,w1 c, 51L7081 CERTIFIED SURVEY MAP Located in the NW k of the NW -3-4 and part of the SW 34, of the NW a of Section 16, T29N, R18W, Town of Warren, St. Croix County, Wisconsin; being Lot 2 of Certified Survey Map recorded in Volume 3, Page 791. NW Corner of Section 16 O I~ ~ C 3 O In N O C) M 3 ' o L=1 I I Ll)i l M - - I +1 N M C.C.IN I?6 °r I 1?791 \3 33 3C \ 9 670.74' Q y N88o59'19"W 1 41 635.47' ti o 0 35:27' - ✓ ✓ p0 aa J` ~ ® v•.Ci w WELL iD01~\ 'O S A OGARAGE `fl s d% Jr, c. .a.+ s 'F +F a~i ayi ° HOUSE LOT 5_ L-J AREA SEPTIC I 13.03 Acres Inc. R/W ~.i ° .567,447 Sq. Ft. n I ~ ~ i Ito c co 12.40 Acres Exc. R/W n 1y, 40 .I /V I I 41 fl jl C 540,160 Sq. Ft. -JI Y _ ~l~ lJl c° a0~ I I' L.1 L. -N C. ry°s >i . Lj P C~IJ Yi 5-1407 N 3C C) s S8902415111E 626.53' ~O ~ 4- 588.54' LEGEND ° 37.991- © (9 Masonry Nail Found ■ 3/4" Pinch Top Found _ ~ „h'~ • LOT 6 1" Iron Pipe Found o ~ L0 5.00 Acres Inc. R/W:' ` ~Cb•~ 0 1" x 24" Iron Pipe Set, weighing 1.68 lbs. per 217,846 Sq. Ft. ~o~V /oti linear foot APPROVED 4.62 Acres Exc.•R/W Existing Fenceline 201,393 Sq. Ft. i 100' Roadway Setback line MAY 2 6 '94! 37.99'- 341.50' © / S1. CROIX COUNTY S8902415111E<~>379.491 Comprehensive Plannir LQ) I I 33 ~ Zoning i&M 3 C. P 1. IN /s Pa;ks Cotntrftte• C" o _ Scale in Feet 1? 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IK I m ~ QN ~ I SCALE /tea 2070' N L 07- z 41 J • Indicates 1" iron pipe / 9 7 A C F?ES Q N ' found. W I/ o Indicates 1" x 24" iron 0 0 1 / pipe weighing 1.13 lbs./ft. Z V 0 ' SR ° U N Se` tivoiI nOR►n~~/i~/// / zS 3S / I / 0S,.. 1, % V) N 4°JAMES L'. MURPHY _ 3 0 vo S- 1 042 V:, RIVER FALLS, 4 Wisc. James urphy ister~e'and Su yor 00 4`. 00~ ~ 2 (Description on reverse) 0 II s 89°27 aO"w Vol. Page. 40 I Certified Survey Maps (REG. AS ~V 90°0o ppw, f St. Croix County, Wisconsin s. M. % APPROVED vnL. 3 I PAG E 757 illl AP R 2 6 1979 APPROVAL OF THIS MANOR SUBDIVISION DOES NOT MEAN APPROVAL FOR Volume 3 Page 791 S1. ;;;.SIX COUNTY BUILDING SITE OR SEPTIC SYSTEM. COMP.,E)IMSIVE PARKS PUNNING REFER TO H62.20: AND ZONING C0AWTTf# ' STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER G /1 4/0' MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from tale Planning Dept. CITY/STATE TO 0-1 PROPERTY LOCATION S OJ 1/4, IVU.) 1/4, Section , T_ ~N-R W TOWN OF t~-~ Ct.~1,~1yQ►~Yl„~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUM13ER _ CERTIFIED SURVEY MAP VOLUME / PAGE,2'767LOTNUMBER CA Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive,:a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date SIGNED: -i~PJ 1 -Gdcg~?!lJ DATE St. Croix County Zoning Office Government Center 1101 Carniichael Road Hudson, W1 54016 1 1 X93 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 4.=-- ,3v / l=g alY Location of propertyS U) 1/4 1/4, Section ,T,99N-R Township lDy1-r`. Mailing address Address of site 7el-' /I , rs j j6L- rr15 Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property S Dc7 Total size of parcel ,~t.m.... Date parcel was created Are all corners and lot lines identifiable? t-0001Yes No Is this property being developed for (spec house)? Yes ke No Volume and Page Number-gor 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 irk th office of the County Register of Deeds as Document No. 4 7 Q 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. I Sign ture of Applicant Co-Applicant >D -2-72-- Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORK 3-19U 1NU 'PACK R`6`R"Q 'oR RLCOROrNO DATA QUIT CLAIM DEED 479045 m 34FAGE 12% _ REGISTER'S OFFICE etar• 10 Johnson ST. CROIX CO., WI .t. Recd for Record FEB 101992 Y..-p,...Johnso.».. at 11:00 A. M quit-claims to LgRO 0 1"ARgistar of Deeds the following described real estate in St. Croix County, - State of Wisconsin: R[•URY ro Warren W. Wool, Ltd. P. 0. Box 99 New Pichmon(l, 111 54017 042-1042-60 042-1043-5f) Tax Parcel No: Part of the West Half of the Northwest Quarter (W-1/2 of NW-1/4) of Section Sixteen (16), Township Twenty-nine (29) North, Range Eighteen (18) West, described as follows: Lot 2, Certified Survey Map, recorded May 1, 1979, in Volume 3, Page 791, as Document No. 356550, in the office of the Register of Deeds for St. Croix County. This deed is giv-Bn in satisfaction of divorce judgment. 9- rxafPT This _ _.iS..... homestead property. (is) (is not) Dated this day of - C~ \\k--._C 19.-~ -L~ l3EAL) (SEAL) „~r.y Jo Johnson (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT r 1 i; " • STATE OF WISCONSIN Signature(s) r - } ) - County. authenticated this 19-!--- Personally came before me this day n 19 the above named - ~ rte, - - - TITLE: 3TEMBER STATE BAR OF'QV CONSIr not. - - _ - - - - authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the fore~_Wng instrument and acknowledge the same. 71+ ; WSTRU"FNT WAS CJRAFTFO BY T, T,ICD. W. won,D, " ew P ichmo Cl 54017 Notarv Public _County, Wis. tr drat ;re: ninp he authenticated or acknowle(lved. Both NT' Cnnw i<sion is permanent. i If not, state expiration datc: 19 _ ~;r~• tint •Names of Der%on3 sixninR in any canal ity sh-iil he tsped - i.rintel b,k,w th, it 'iRnat :r~~. STA I F B Vt OF W IS( ON%r N Stock No. 13003 - 199: FiC fTYttar FORM No. 1