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HomeMy WebLinkAbout012-1017-80-300 L~~sf►p' I~IE 06.30 County: Labor and HumV Relations SEWAGE SYSTEM Safety and Buildtsigs Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary mit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City -1 Village Town of: State Plan o.: ev.: Insp. ev.: BM Description: Parcel Tax No.: (1"1-1017-80 000 TANK INFORMATION ELEVATION DATA A9300274 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: OR UNIT 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.) LOCATION: ERIN PRARIE 06.30.17.88A I Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH . SANITARY PERMIT NUMBER: y. DILHR SANITARY PERMIT APPLICATION v. In accord with ILHR 83.05, Wis. Adm. Code CouNTY~ STATE /~(JIT~IRY QER # -Attach complete plans (to the county copy only) for the system, on paper not less than (;j `1,T Cd%(/ 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 h ~e SW '/a51F S 4 T 30, N, R 7 or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # /5-3 1? 12.19 1 CITY, ST TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER W~ SY00 101r).Ry&-7..9V5 II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD ( ❑ State Owned VILLAGE: N w ,EGG LAPAX 1 or 2 Fam. Dwelling-# of bedrooms AR NUMBER(b) ❑ Public Pli 111. BUILDING USE: (If building type is public, check all that apply) 7 8~ 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 4,8rReconnection of 5.0 Repair of an System System Tank Only n Existing System Existing System B) L2/A Sanitary Permit was previously issued. Permit # ~l Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other Seepage Bed 21 r-1 Mound 30 ❑ Specify Type 41 ❑ Holding Tank Aseepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: r~ 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSO . AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min 'nch) ELEVATION ady L y Feet p Feet CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks oncrete structed glass App. Tanks Tanks Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber [E] El n I F1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Na` Int): Plumber's Sig qdra M. (No Stamps) I&/MPRSW No.: Business Phone Number: "~l a v~5 1 S 6_ 7 - a~6 - S/~3S Plumber's Address (Street City, State, Zip Code): IX. LINTY/DEPARTMENT USE ONLY ❑ Disapproved San' ry Permit Fee (Includes Groundwater ate Issue ssuing Age Si ture (No S ps) ;(Approved El Owner Given Initial /Surcharge Fee) Adverse Determination 11J11JffiK~~~~~ (0177 G l7~1 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber INSTRUCTIONS `r 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 iris permit must be approved by the permit issuing authority 4. Changes in ownership or plumber requires a Sanitary Permi° Transfer/Rer,.>w r.l Form (SBD 6399) to be submitted to the t;ounty prior to installation. 5. Onsife a w -ve. systems must be propeny maintained. The = ptiu tank(s) must be rcu;iz )ed t- !icensed pumper whenever necessary, usually -every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your iocai code adry; rrlstrator or the State of Wisconsin, Safety & Buildings Division, 608-266-38:15. 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_ Absorptiar% system information. Provide all information requested in ##1-7. VII. Tank inforrrration. Fill in the capa(-,ity<)f every new and/or existin +',e to al g,~ ;lon s. ~itimber of tanks any, i%ianufacturer's name. Ind"c9to prefab or site constructed and a ik 1-:aterial. Corn--ate for all septic, pur-ip/siphon and holding tanks for this system. Check experirou-'al ,pprova only ? tanks received expe~in;>~tal p-ocl1..r.A approval from DILH. R. Vlll. Resnons;!_'i:ity to--nent Installing plumb-!r is to fill in name, license with a ryrr,~ ,N prefix (e.g. MP, et(;.), i.tsdr;ss and phone number. Plumber must sign application f m. IX. County/Uepartment Use Only. X. County/Department Use Only. Compete plans and spe;;Ilicafions not smaller than 81/2 x 11 inches must be submittc>c4 to th r_•.^unty. The pians rrsc;=st include the folloti r-,g: a) plot plan, drawn to scale :oinpleie di <<-: .:Lion of holding tank(s), septic tank(.; or other treatment tanks; building -;t. t rs wells; watt- raer service; streams and lakes; PUMP 01 siphon tanks; distribution boxes; soli at sy,,tern system areas. <ind the ioca'ion of t`w building served; 8) horizontal and :ticu i«,, ti-r refsrrE~slcea ,in13; C) complete specifications for pumps and controls; dose volume; e evut r,sr uMerences; fric.ti::-n loss; pump performance curve; pump model and pump manufacturer; D) cross section of the sod absorption sys, a required by the county; E) soil test data op a tform; and F)-all sizing information' - - - - - - - - - - - - - - - - - - - - - - - - GROUNDWATER SURCHARGE 1983 Wis on.cir-, Act 41i nci.jded the creation of surcharges (fees) for a numi-el c' regula ter, pr w es ` -:an effect c3roundwat r. 1-,e rifoiilosi for wa ie. i_C''~tss3'i?.ir•ct._~C3r? it;~ gations anti establishn t A, SBD-6398 (R.11/88) l i I I r ` f E r i 1 i I i 4 , I ! 7 i t E , h 3 + , } L_ i 1 i _ f1 _ i ly ! ! r 1 i r ~ ➢ t ~ f , r , r i a ; Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER / TOWNSHIP 6/ SEC. _ T N-R2 _W ,ada ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION A) LOT LOT SIZE 1/~ PLAN VIEW Distances and dimensions to meet requirements of II-HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM llJ ' ` r7I//.fiC U? 4, INDICATE NORTH A BENCHMARK: Describe the vertical reference point used Elevation of ve tical reference point: ZM.p Proposed slope at site: SEPTIC TANK: Manufacturer: iquid Capacity: A4011 Number of rings used: Tank manhole cover elevation: /00 6-5 Tank Inlet ';.levation: ,7tTank Outlet Elevation: S 3 Number of feet from nearest Road: Front,O Side, Rear, O---t=--~ feet From :iearest property 17 Front,O Side10Re r, O feet Number of feet from: well , building: (Include this Information of the above plot plan)( 2 reference dimensions to septic tank) SEF. REVERSE SIDE r a PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number'of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: l Length: Number of Lines: _6- Z _ Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, 6) Rear,O it Number of feet from well: Number of feet from building: ~ (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: h C License Number : 3/84:mj ~ M DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ION LABOR HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVIS BUREAU OF PLUMBING P.O. BOX 7969 MADISON, WI 53707 SEA SW~ S6 T30N-R17W ZYCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: > > (If assigned) Town of Erin Prairie ❑ Holding Tank O In-Ground Pressure ❑ Mound County "GG" NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Albert Betterley Route 1, New Richmond WI 54017 if-3-0. 7 gTav BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP/MPRSW No., Countv'. Sanitary Permit Number: Calvin Powers Jr. 1563 St. Croix 102801 SEPTIC TANK/HOLDING TANK: MANUFACTU R. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED ztc /011~0 9 , Q t O DYES 9VO 5dYES ON BEDDING: VENT DIA.VENT MANUMBER OF ROADPERTY WELLBUILDINGVENT TO FRESH 1 ] JALARM FEET FROM / f AIR INLET DYES NO C2 DYES O NEAREST !S 55 1 DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY JPUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED'. DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPER TV WELL BUILDING IVENTTO11115" (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH JDIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH'. LENGTH. NO. OF DISTR. PIPE SPACING. COVER DIA tPIlS LIOUH DEPT IBED/TRENCH TRENCHES MATERIA=-FIDE DIMENSIONS UMBER OF PROPERTY WELL BUILDING VENT TO FHESH GRAVEL DEPTH FILL DEPTH JUISTR~PIPF DISTR PIPE DISTR. PIPE MATERIAL. NO. ST R. FNEAREST BELOW PIPES ABOrV~E/COVER. EV. INLET ELEV. END. PIPE LINE' ^ AIR INLET FEET O M - dg ~17 e~+fo Y r r OS /o~~ yf MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES NO SOILCOVER TEXTURE PERMANENT MARKERS OBSERVATION WE11S DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVEN BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL JN" DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.' ELEV.. CIA. ELEV. PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED DYES ONO d OYES ONO COMMENTS: PERMANENT MARKERS: J..SERVATI.N'-EL. S NUMBER OF PROPERTY WELL'. BUILDING. FEET FROM LINE DYES ONO ES ONO NEAREST- 3111 I f-.J r., Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE Zoning Administrator DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION COUNTY .CD %.HR In accord with ILHR 83.05, Wis. Adm. Code °°w STATE SANITARY PERMIT # /b a . ?v -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES 5d NO PROP Y OWNER PROPERTY LOCATION '/4 T ?4, N, R/7 E (ora~j) PROP OWNER'S MAILING A ESS LOT N BER BLOC NUMBER SUBDIVISI NAME pis! AiI4 CIT , STA ZIP CODE PHONE NUMBER CITY NEARE T KE OR LANDMARK VILLAGE : t 6 ,e, 7 L& TOWN II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. ® New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. E1 Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ® Seepage Bed b. ❑ Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet ® Private ❑ Joint ❑ Public CAPACITY VI. TANK Site in gallons Total of Manufacturer's Name Prefab. Con- Steel ;be Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete App. Tanks Tanks structed Se tic Tank or Holdin Tank Lift Pum Tank/Si hon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's ame (Pri nA: j Plumber's Signatur N Stamps) MP/MPRSW No.: Business Phone Number: J ~S 3 Plum-be 's Address treet, Cit State, Zip Code): Name of Designer: VI 1. SOIL TEST INFORMATION Certif' Soi ester ( 99 Name CST # CST's DRESS ( tr t, City, St , Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial ` S94charge Fee Adverse Determination / O~ ~W ~ • C~~O X. COMMENTS/REASONS FOR DISAPPROVAL: fah C,-Wr o-ed " j. SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber - INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION • , TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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.. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundjater - included the creation of surcharges (fees) for a number of regulated practices which Wlscon(sin`s e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) APPLICATION FOR SANITARY PERMIT STC-100 his application form is to be completed in full and signed by the owner(s) of the roperty 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 1~~~Y••1 Location of Property Sf~ ~t S W Section T_.3 0 N-R l7 W Township h l h V h a% r c Mailing Address _ 73 R J Address,of Site Subdivision Base /V2119- Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created P-9-r- ( 9 1? Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes A_ No Volume 7a 19' a Page Number ;0'6b 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) cehtik that as statements on this orcm aAe. tAue to the best 06 my (ouh.) hnowtedge; that I (we) am (ahe) .the awnen(e~ 06 the pnopenty deecAibed in this .in6o4ma ion 6oAm, by viAtue o6 a waA.anty deed h.ec tided in the 066ice 06 the Coccntyy Regusterc o6 Deeds ah Document No. and that I (We) pneeentty cRUn 14 pnoposed site bon the sewage dihpoe bye em (on I (we) have obtained an saeoment, to Run with the above deAcAi.bed phopehty, bon the consthucti.on 06 said systemv and the same has been duty keemded in the 066.ice 06 the County Reg.ieteeA o6 Vetch, ab Doem nt No. J, SIGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ~II DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA Q !t^ I STATE BAR OF- WISCONSIN FORM.. -1882 II 40 ST. Ct ax CO., WI& Albert D. Betterley Recd. for Rewrd 06 2nd ~I I~ da of_ Jan A.D. 1~ 86 at 8: 0 A i conveys and warrants to ....el.il~StXas_..~Zct~i~ 5,. . + a--.Wiac_axis.in...carpraratinn sirs: w of ©oMiI ["RETURN TO I l the following described real estate in S,t_...CX_oix ................County, State of Wisconsin: i Tax Parcel No: That part of the Southeast Quarter (SE4), Section Six (6), Township Thirty (30) North, Range Seventeen (17) West described as follows: Beginning at a point on the South line I i~ of said Southeast Quarter MAO South 880 00' 59" West, 573.58 feet fran the Southeast corner thereof; thence North 00 00' 01" West, 258.13 feet; thence North 6° 41' 10" West, 202.04 feet; thence North 15° 46' 53" West, 333.37 feet; thence North 111 56' 16" West, 220.58 feet; thence South 750 50' 49" West, 617.48 feet; thence South 30 50' 58" West, 214.21 feet; thence South 660 45' 46" West, 362.22 feet; thence South 85° 21' 39" West, 65.00 feet to the centerline of the Willow River; thence with said centerline of the Willow River to the West line of the Southeast Quarter (SEn); thence South along the West line of said Southeast Quarter (SFF4) to the South line thereof; thence East along said South line to the Point of Beginning. j I -.x. TPANSOAB FEB This ...is...not homestead property. (is) (is not) Exception to warranties: I i Dated this 2.8.th.................... day of ecember 19--.85. i . (SEAL) it t (SEAL) Albert D. Betterley I (SEAL) (SEAL) i i AUTHENTICATION ACKNOWLEDGMENT ~f i Signature (s) STATE OF WISCONSIN ss. St. Croix -County. authenticated this day of 19 Personally came before me this . $ day of December . 19.._8 5. the above named ii Albert D Betterle •••-•..y ~i TITLE: MEMBER STATE BAR OF WISCONSIN f I ` jt• (If not. authorized by $ 706.06, Wis. Stats.) to me known to be the person who executod the cJ L forego' g instrument a3od wledge the-game. "'r ' h THIS INSTRUMENT WAS DRAFTED BY , t Reinstra, Van Dyk & Needham, S. C. - J T " a L. Glaser ~ n <<!: . ' Atorneys at Law . i New---Richmond,..Wisconsin'---- a4D_17-0127 Notary Public S.tx__•Cr.0ix ...............6o ntf, Wie:', (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) 5- I, date : - ) ii i 'Names of persons signing in any capacity should be typed o printed below their signatures. i~ CTATR R.AR nv wTgrnwrTN _ P._ -11- at _ 7 . 0%d%0% H . z ' H S T C - 105 r r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER/BUYER O B t2l n ROUTE/BOX NUMBER R R ` Fire Number- /V/6 CITY/STATE ZIP Sb PROPERTY LOCATION: 5W 14, Section T -30 N, R (,7 W, Town of r~__ rt Ui,*_ i r( -e St. Croix County, Subdivision Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ~v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. -~t ICNED 44/1R/_ Ai DATE /y St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECT ON: TOWNSHIP /M ITY: LOT N .:BLK. SUBDIVI ON NAME: / /T N/R E (.4 COUNTY: OWN R'S BU //ER'S NAME: AI G DDRESS: f e A,2Z 17:~al 7 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCI L DESCRIPTION: f;7I PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence ,X New ❑Replace CP-7 / RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND 111' IN-GR~OUN(~DPRESSUR_E- r YSTc -IN-FIL OLDING TANK: RECO MENDED SYSTE :(options ®((J ~U ~J ❑U L~ JS ~U F]J QU S ®u If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH W. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 7 l p// _ '~N,s, G,.3" ro.7/-iLLL'J 6. !-d Q.tlrs B-3 7 22 ? a:1 - / - 44 Z 29 -4- 7- f 4, B- / B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIO 2 PER PER I CH P_ 3 NAAIZ P ? /r I P 3 s 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 locatio on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. &-v SYSTEM ELEVATION E - I E - i _ - Y T E F i ! I QQ~~ t 4 i I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods speci ied in the Wis con irl, Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ('n NAME (pri TESTS WERE COMPLETED ON: S_ Ag~Z2 ADD SS: CERTIFICATION NUMBER: PHONE NUMB R(optional): 3 - / iss CS N TU E: r DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INST ! I TIONS FOR COMPLETING FORM 115 - SRI - 6395 To be. a corm ~jrate soil test, your report must include: 1. Complete lega )n; 2. The use se, rly indicate \A - r this is a nce or commercial project; 3, MAXIMU"" ooms or sreial use Oar A; 4. Is this ,tern; 5. Cor boxes. A SITE IS SUITABLE FOR A HOLDING TAN Y IF ALL OT- _ -TEI`".3 A`~t JLED OUT BASED ON SOIL CONDITIONS; h. -se the abbrf a" is shown here for writing profile descriptions and completing the plot plan; A LEGIBLE accurately locating your test locations. F'- ;ring to scale is preferred. A sheet may b_.. '--red; your benchmark a°7d vertical elevation reference point are shown, and are permanent; ll opriate boxes as to dates, names, addresses, flood plain data, percolation 1~ st exemp- o ch as flood n, elevation) does not apply, place N,A, in the ap[_ r, max; your can ddress and your certification number; leoil and distribui,'as required. ALL.. SOIL TESTS MUST BE FILED WITH THE )CAL A.._ rY 1VITHIN 30 DAYS OF COMPLETION, _''IATIONS FOR CERTIFIED SOIL TESTERS i Textures Other Symbols Cot) 1011) SS -ire gr _ 1 3') LS L. Pew VV _ Bldq is - Sand > - Th t!/ Loam L ; L Bn F nl BI Gy Y L,-,ate R not `l ter!' aV fff - f~ Brie, iai cc - t;ort~mor; c distinct p prominent HVt/L_ - High water level, x °r-41 soil textures Su03Ce wat£3( ~.)s II, A ,aste disposal BM - Bench Mark VRP Vertical Referee TO THE OWNER: This r^ st re°,ort is -ep in,,-(-ring a sanitary permit. The county or the Deb, ^,(Iuest F s~ re )I, to permit issuance. A complete set (1, ; ivate ern- applicat n must be submitted to the appropriate local a, )IIiJ i order to o` , p he sanitary permit must be obtair7ed and posted prior to the: start of any construction. I z. / o!wl ,fro s, /a 'y. ~e~ioQO~~D/ v~ f dcJE~S ~~C s Y i j i , PAGE OF Q 2 l C r c) 0- 4z. L) r) Q i A 4J C I) e n'1 Froch Air Inldtc And Ob6orvation Pipe APprovsd Vent Cap Minimum 12" Above Final Grade 20- 42" Above Pipe _ 4" Cost Iron To Final Grade Vent Pipe Marsh Hoy Or Synthetic Covering Mtn 2" Aggregate Over Pipe I Olurlbutloo -Tee Pipe 0 0 0 0 0 Beneath Aggregate e 0 Perforated Pipe Below Be o _ Coupling Terminating At Bottom Of System Pr~~ase ~ otn, rk l< L~eJr.Ttor1 SOIL FILL DISTRIBUTIOVI PIPE ~~NTH APPROVED ETIC COVER r',. .c O o ~'`MATf`Rllt,~ OR 9•• OF STRAW 2"OFAGGREGA1E OR MARSH HAy ti (or OF12-2t/2 AG G R E GAT E t.LEV. OF'Y•~~~2 FEET. r DISTRIg,TK')Q PIPE TO BE AT LEAST INCHES BELOW ORIGIUAL GRADE ArJU AT LEAST EO INCHES BUT AIO MORE THAI) Ha IMCNES BELOW FILIAL GRADE MAXIMUM DEPTH OF EXCAVAT1mwi FKoM OK16WAL 6KAoF. WILL BE INCHES PV141MUM ®EpTr dF EXCAVATIOW MOM 01KI61"AL GRAPE WILL BE INCHES SIGAlEO: - LICEIJSE DUMBER: ~5~13 i DATE : 110 1 L STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT ^y St. Croix County OWNER/BUYER /dam 'Ci 2 ROUTE/BOX NUMBER & ~5 3 G C~ l FIRE NO. s3 CITY/STATE ZIP 'Fy 0/ 7 PROPERTY LOCATION: ~~1/4 1/4, Section T3:;~tLN, Town of , St. Croix County, Subdivision , Lot No. 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 for a MAXIMUM of $3000 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 systems properly maintained. The property owner agrees to submit to 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 form will be sent approximately 30 days prior 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE ! G Z~ St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address APPLICATION FOR SANITARY PERMIT 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 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 _:S LW 1/4 S 1/4, PPOL, ection LO , T 3 C) N-R~W r" r? -Q- Township, i4 4 Mailing address I. S a (f~d r--5 G-;~ -2.o~c~1 r~ nc~ lam- a~ 0-t Address of site Sa-,V'.- . Subdivision name N~f4 Lot number N JJA- Previous owner of property oA% QIrk- , 'QZ Total size of parcel d.C_. Date parcel was created Are all corners and lot lines identifiable? -X-Yes No Is this property being developed for resale (spec house)? Yes _N0 Volume ] 31 land Page Number 31-31 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. 0 g a.OS ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the ounty Register of Deeds, as Document No. Signature of Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature r _ . T. w/RRANTY DEED iI THIS SPACE RESERVED FOR RECORDING DATA i! DOCUMENT NO. 1 ' i STATE BAR OF WISCONSIN FORM 2 -19821, 408205 x CO., WI& Sy 00 I Ani.t Turnham, formerly Anita: 13~1 %..a i Rec'd for Reoord ihia 2nd Anita' Tizrham ~ . I' of Jan A.D 1986 y 8:30 A N4 a I! j) Betterley.....-•-•-•-----•........ AIor conveys and warrants to ..Albert D. wow ' RETURN TO i I ! - S't. Croix .County, the following described real estate a State of Wisconsin: ~ Tax Parcel No: That part of the Southeast Quarter (SFr), Section Six (6), Township Thirty (30) North, Range Seventeen (17) West described as follows: Beginning at a point on the South line of said Southeast Quarter (SV4) South 88- 00' 59" Twest, 573.58 feet from the Southeast corner thereof; thence North 0° 00' 01" West, 258.13 feet; thence North 60 41' 10" West, 202.04 feet; thence North 150 46' 53" West, 333.37 feet; thence North 110 56' 16" West, 220.58 feet; thence South 750 50' 49" West, 617.48 feet; thence South 31' 50' 58" West, 214.21 feet; thence South 660 45' 46" West, 362.22 feet; thence South 850 21' 39" West, 65.00 feet to the centerline of the Willow River; thence with said centerline of the Willow River to the West line of the Southeast Quarter (SFr); thence South along the West line of said Southeast Quarter (SE14) to the South line thereof; thence East along said South line to the Point of Beginning. That part of the Southeast Quarter of the Southwest Quarter (SE's of S4-), Section Six i I (6), Township Thirty (30) North, Range Seventeen (17) West, lying South of the Willow River, EXCEPT the West 508.02 feet thereof. This .......S....Ot......... homestead property. (is) (is not)" + I Exception to warranties: (i 27th November Dated this day of 19._85... i k.... C14" -----......(SEAL) •-•--.----•-...........(SEAL) I j * Anita Turhham I! (SEAL) .......--••-••--•......••••-••...(SEAL) . ji AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) ss. St. Croix County. 2 7th authenticated this ........day of 19...... NO embery came before me this ................day of , 19 the above named nita `Turnham, aka Anita Turham, i............................ * formerly known.. . as Anita Better ley TITLE: MEMBER STATE BAR OF WISCONSIN ~ir:.......---• i If not. !r by § 706.06, Wis. Stats.) to me known to be the person w)tb' exes~i d thb-) `foregoj g instrument an ack edge thit s e THIS INSTRUMENT WAS DRAFTED BY n /%r?~ d i u Reinstra, Van Dyk & Needham, S.C. TanVaa L. Glaser 2 ( -t~oizeys atr...L,arou * New Richmond, Wisconsin 54017-0127 Notary Public ...St. Croix :_Cout~3'~ (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expi AYion are not necessary.) date: 4-5-87 , 19- ) I; *Names of persons atoning in any capacity should be typed or printed below their sitnatures. li ii ~ STATE DAU OF WISCONSIN cC.L^.4kWCon%Wt FORM No. 2- 1982 GM .3 ~gco/v ~y 7058-7 6 t JOS * VOL 17 PAGE 4443 KAT9= R. ALSH REGISTER OF DEEDS RICH OND ST. CROIX CO., MI RECEIVED FOR RECORD s W 01/15/2003 09:30AX REC FEE: 13.00 9 d M rp COPY FEE: 3.00 CERTIFIED SURVEY MAP LOCATED IN THE NE114 OF THE NE1/4 OF SECTION 32 & 416 WW44 OF T"r NWIM T31N, R15W, TOWN OF FOREST, ST. CROIX COUNTY, WISCONSIN. OWNERS / SUBDIVIDERS BEARINGS REFERENCED TO THE EAST LINE OF THE NE1/4 OF GARY & FRANCES HEINSUCH SECTION 32 ( WEST LINE OF THE NW1/4 OF SECTION 33 2929 STATE ROAD "64" ASSUMED TO BEAR S0045'08"W. EMERALD. WI. 54012 ACCESS FESTRI1717M MUTE: SURVEYED FOR: THE WISCONSIN DEPARTMENT OF TRANSPORTATION HAS GRANTED A SPECIAL MATTHEW & STEPHANIE 5INA EXCEPTION TO TRANS 233 FOR ONE ( 1 ) ACCESS TO S.T.H. "64". ADDITIONAL LAND 1885 C.T.H. D" DIVISIONS, CHANGE IN LAND USE OR FUTURE HIGHWAY PROJECT(S) MAY REQUIRE GLENWOOD CITY. WI. 54013 A PUBLIC ROAD INTERSECTION OR RELOCATION OF THE DRIVEWAY TO AN -N- ALTERNATIVE PUBLIC ROAD AT THE DISCRETION OF THE DEPARTMENT. N1/4 CORNER, SECTION 33 NE CORNER, SECTION 32 ui1 (TESTABLIRECORD FROM ( ESTABLISHED FROM OF ) TIES OF RECORD) w1 UNPLATTED LANDS UNPLATTED LANDS 1 NW CORNER, ISECT ION 33 FROM N1/4 CORNER, SECTION 32 II TIES OF RECORD ) ( ESTABLISHED FROM NORTH LINE OF THE NEi/4 OF SECTION 32 I I NORTH LINE OF TIES OF RECORD) THE NWi/4 OF STATE TRUNK HIGHWAY O(Am I xj 1 SECTION 33. _ N89051 ' 15 'E 2661 58 ' m - - - NB9°51'i5"E 750.82' m * SEE "DETAIL" N89°14'16"E - - - n' STATE OF WISCOWIM Hm4wAy 717.82' 33.00 X54.70' SETBACK LINE (I EM?JTS NOTE: WI D.O.T. IDn... SEE NOTE NOTE I COVENANTS Irn 1,O0 o EASEMENT DESCRIBED SIGNED BY THE 100' BUILDING SETBACK LINE FROM RIGHT-OF-WAY c I~ 1~ N IN VOLUME `aZL HEINBUCHS STATE ACCESS RESTRICTED 001 10 _P qlE 14= I ISM - - THAT ONLY THE 1 SEE NOTE ` j~ Q EXISTING CHURCH, LOT 1 OF THIS MAP ZI A? Q AND ONE (1) Q rn z ADDITIONAL J ~D _ I o I o o:) RESIDENCE MAY QI p NI ° -)zs USE THIS ACCESS. LOOT I m I z v I Fri L) ANY FURTHER m cnn I w QEn H Z SUBDIVISION OF g 0 518,277 SQUARE FEET ( 11.898 ACRES) I m 3" s< THE REMAINING rLI o INCLUDING ACCESS EASEMENT I w a g Q m r°n ~ HEINBUCH PARCEL z z 480,075 SQUARE FEET ( 11.021 ACRES) 01 cn in rn o J o~ MAY MAKE THE EXCLUDING ACCESS EASEMENT L I w o coo z J ACCESS EASEMENT o i 0 0 ? o SHOWN HEREON U) in SUBJECT TO ROAD cn I STANDARDS OF ST. 66.00' CROIX COUNTY. SEE AF-FIDAUfT OF sB1.io' I a ~c'TJ C~AJ: S890 51'11"W 747.10' F 7f5I NDTo~cALE UNPLAITED LANDS w =0 m LEGEND w co o+ w o n » a NE CORNER, m _ IMOJUMENT5 SECTION EOORNER O m r. m m SECTION 32 l o$ NOT cu u- ccn m I w m 0. Cr Z v c S o O N Ci .T.H. ~ 64~ INDICATES 1" X 18" ( OUTSIDE f7 g DIAMETER) IRON PIPE WEIGHING Z y~ 0 ~ I w Zo a c ' (N89051'I 5"E 750.82' cn 1.13 LBS. /LINEAR FOOT SET. H H a 717.82' 33.00' N89°1416'E JU Jc) m m 33.005' ! U a V 2 1 3 0 P 6 0 6 706251 I7 HATHLEEH H. YALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 02/04/2003 11:10AH EXEWT i REC FEE: 13.00 TRANS FEE: COPY FEE: AFRDAWTOFCORRECTIOM CENT COPY FEE: PAGES: 2 AFFIANT, Joseph W. Granberg, hereby swears or affirms that a certain document recorded on the 15m day of January, 2003 in volume 17 page 4443 recorded as document number 705876 which was recorded in. St Croix, County, State ~q .0 t• ~ / of Wisconsin, contained the following error. At the December 17th 2002 SL Croix County Planning, Zoning and Parks Committee meeting the above mentioned Certified Survey Map was approved with the condition that a 100' setback line be placed parallel with the 66' wide Access Easement as shown on said Certified Survey Map. After further review at the January 29h St. Croix Planning, Zoning and Parks Committee meeting the board agreed to remove this setback from the property with the condition that the NOTE regarding the access easement be amended to read as follows: 'The access Easement as shown across the East side of Lot 1 is meant as a Oncle future residential access to those lands South of Lot 1. WI D.O.T covenants signed by the Heinbuchs state that only the existing church, Lot 1 of this map and one (1) additional residence may use this access. This restriction limits the use of this access to a joint driveway at a maximum. Any future development requiring joint access would necessitate that the access be built to joint roadway standards of St. Croix County.' Approved by the St Croix Cownty Zoning Olfice this Ok day of 2003. AFFIANT is the (check one): Drafter of the document being corrected. _ Owner of the property described in the document being corrected. _ Other (explain ) TheG 0d4'ocument (in part or whole) is _ is not attached to this Affidavit ( if original document is not attached, please attach legal description and names of grantors and grantees Signed - State of Wisconsin Grkzn SS J County of St. Croix ) Subscribed and sworn or (or a(firmed) before me this ~ day of eel 02 ~ t73 Notary Public, State of Wisconsin'` SN" N/ My Commission expires s' This instrument drafted by: Joseph W. Granberg F- 03 q i c J }3 f...A This instrument is not a conveyance of real property as per s 77.21(1) S1 r r "t ~t,N a 'IO FIED SURVEY NAA CER~ 4 OF THE NW1/4 AND THE NW1/ 4 OF SECTION 32 WISCONSIN. EJ/ 4 OF THE NE1/ ST. CROIX COUNTY, ,cRS / ^„~~,TUTriFgS LOCATED IN THE 31N. R15W, TOWN OF FOREST. i OF SECTION 33. T GARY 6 FRANCES D "64 H 2929 STATE ROAD 0 E , WI. 54012 NE SECTION i/4 33 BEARINGS REFERENCED TO OF THE NWSLINE /4 OF TI EMERALD SECTION 32 2 (WE STEPHANIE SINA ASSUMED TO BEAR S0005!'08"W• MATTHEW ~ l885 C.7 .H • D 54013 A~ F- ~ N TATION HAS GRANTED A ~SPECIATI0NAL LANG GLENWOOD CITY, wI• . ADDI a THE WISCONSIN DEPARTNF 0 N(SP URE HACCESS TO S T . H. "CT6 4" (S) . MAY REQUIRE SECTION 33 FUTIGHWAY PR . ti EXCEPTION TO CHANGE IN 233 OR USE LOCATION OF THE DRIV IVEWAY TO AN Ni/4 I ( CORNERESTABLI FROM AIY~ •~p INTERSECTION OR DISCRETION OF THE DEPARTMENT. NE CORNER, SECTION 32 TIES OF RECORD -N- ALTERNATIVE PUBLIC ROAD AT THE OISCRE ( ESTABLISHED FROM Lul UNPUALTEALANDS TIES OF RECORD )I NW CORNER, SECTION 33 ( ESTABLISHED FROM UNPLATTEP LANDS TIES OF RECDRD ) I NORTH LINE OF I II THE NW 1/4 OF NS/4 COFIER, SECTION 32 I I - SECTION 33. ( ESTABLISHED FROM LINE OF THE NE1/GH~AY SECTION ~ - - - NORTH TIES OF RECORD) $TATE TRUNK HI "E 266158 K SEE 'DETAIL' +~Yj4,70' - - o - N89 51`15 N 9° 5 E - - - AY 717.82' 33.00' 77 STATE OF WISCON'3N s --7 $ T SCRIBED - RIGHT-OF% AY V.. ink N RAGS BUILDING SETBACK LINE FROM . $h - , / - 115 ACCESS RESTRICTED-_ * SEE NOTE 'XI J 0 ry ° i N a l0 N(F-~ I~ m Z N o~ LOT I in X- I N ACRES 1 mS id INCLUDING 0 518,277 SQUARE FEE ACCESS EASEMENT ) . I w m Z I J I 480,075 SQUARE FEET 11.021 ACRES) P I o to =I EXCLUDING ACCESS EASEMENT a i a 66.00' 681.10' S89051'ii"W 747.10' LANEA f NOT TO SCALE LEGEND o 1n - INDICATES SECT IOIJDO R (U V cn I U- A NE CORNER MOIJIMENT (AS NOTE b m ° ~1 0 SECTION 32 1 p $ I 11~ - INDICATES )3IRONiPIPE WEEIGHING w) 121 @LA ~ I m 3.13 18S1ER. LIAR FOOT SET. ,-1H J GT► DIAME w S.T.H. 8 tA N89°53'15"E 750.82' (n NSg°14'36"E 717.82' I 33.00' 330.0 NOTB_ w o w - THE ACCESS EASEMENT AS SHOWN ACROSS THE EAST :r. I I In$ LOT 1 IS MEANT AS UP I I~ I I c AID FUTURE RESIDENTIAL A~ cv w I ( cv dWo THOSE LANE I O I gpUTH OF LOT 1. 1 I Ei/4 CORNER. SECTION 32 / r CORNER. SECTION 33 Wi/4 ,~w ( i 114 (OUTSIDE DIAMETER) a ma IRON PIPE FOUND ) Lu a :_200 , GRAPHIC SCALE i xs:'.,;i ' D .0 .T . FILE NO . 400 600 SHEET i OF 200 JOSEPH W. GRANBERG DRAFTED By. 'THIS INSTRUMENT DR ! . ntJ r ti %Y} . ~ 4k4'