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032-2027-80-100
C c CD ° p ea p v> c M c r- rj 0 p ~ z C a y C N I N DO Y N C O C m ~ I 00 b N S' I .3 I I CV I N N O O O Z C tin C Z 7 is 3 tU N N LL C LL C L a O O U C O Q Q N > I 3 ~ 3 ~ I 71t a) a> Z N Z Iq _2 Z O _ O It £ `O O` Z Q/ d y d z am am c 0 c C7 m O Z c U c N U~ P Z d O V7 ~ ° O c d to h N Z N C E •O C E O N M N T o a (a a) co a 7 a> (D a) N N N ~ ~ 2 ~1u N C 4/ C ° L C O L cu 0 L L O d U C C O ~ N Z I- Z o Z H Z w N Z Cl) N E N N A E N C N W L N O) O - C w Q. 4) `D a 04 a U') a L m c wo 04 W d N W a L O 0 d i N L G O a a g G o a ~ o cu E 0 U) .0 4 5 • N Z> 0 0 0 = z O O O a ti Naaa a~aaa a E co co E 7 ° N ° N O Cl) ° fn J V (n O O a) (n T Z O Cl) ~l M l0 O M O O N N y 0 0 O E co N L O O .S m a co co a) U) w ' a cn a) I CD r (0 d d) } 00 O co O O M N W M y N ~Ilij O 00 O C N C N C E a) c co N co o ° CD a•°i IV Q 3 O o U c o a o rn o o ° c a) h c~ d rn o 0 o o U0 N E a •O N N N N <n O N N 3 C p CO 3 C N t0 N in N O y t..., O N M . N L 00 27 C N O N L N D H w N O m L N O N c! E O'> :3 LO • 7~ co r O pOj w O E t3 U O y O O ~'V y~ O O U) Z col z O Z Z ~O ~ w w m m E a E a a L `L • ca a a, •U m y d y `IV E 'c c ° c rr~~ z "~1 A U a 2, 0 in t) 0 in U Parcel 032-2027-80-100 07/18/2007 03:32 PM PAGE 1 OF 1 Alt. Parcel 07.30.19.570A-10 032 - TOWN OF SOMERSET 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 - WROBLEWSKI, JEFFREY A & KRIS A JEFFREY A & KRIS A WROBLEWSKI 338 165TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 338 165TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 4.000 Plat: N/A-NOT AVAILABLE SEC 7 T30N R19W PT NE NW BEING LOT 1 OF Block/Condo Bldg: CSM 9/2643 4 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1020/547 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.000 53,000 299,700 352,700 NO Totals for 2007: General Property 4.000 53,000 299,700 352,700 Woodland 0.000 0 0 Totals for 2006: General Property 4.000 53,000 299,700 352,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 109 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 7 30.1 S~~ q - I o STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Jiff" ~ iP/S GU~PO~LL W $IE'/ ADDRESS 930 k.S 7- Zol -r „~^O '2 D "115 - / SUBDIVISION / CSM# 4101 Pg " 2 6,y 3 LOT # SECTION. 7 T J 10 N-R / W, Town of -SDI t /Pxs- 7 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S.eQ. 1'Thc tY E v P L AJ 1 P OEIVF8 SEP 2 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. T BENCHMARK: t~2 iZp-rf e.Nt 1,3vX To er ~ow 7 ALTERNATE BM : d /p, 3- SEPTIC TANK /-1441P @HM-iB--Eft / ION Manufacturer: Liquid Capacity: No r- Oel-/60 -740 P f , Setback from: Well House Other Pump: Manufacturer /y14 Model# Size Float seperation yA Gallons/cycle: Alarm Location A* .SOIL ABSORPTION SYSTEM Z Width: Length 76 Number of trenches Distance & Direction to nearest prop. line: ~~6 ~sa' LOT L Setback from: well: N House :4`10 Other W E// No T DRS!/ED -/0 P4 rE. ELEVATIONS Building Sewer 97 Z 5 ST inlet.- ylP ' ST outlet PC inlet *4L PC bottom 414 Pump Off A-1-4- Header/Manifold 101oj Bottom of system o T Existing Grade Final grade DATE OF INSTALLATION: sr3 PLUMBER ON JOB: Aad e-mP T 7 330? ~ p IP S WOtGESITE SEPTIC PLUMBING CO. LICENSE NUMBER: 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT INSPECTOR:- VIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. !'INN. INSTALLER & DESIONER LIG, NO. 0003 3/93:jt Z E F F WX0I3Z&-W y /3 ~vQM - h~oy~ l~0cv 6-PP whStC~~vf.J pA~R ~~60 6 , Ec.4s T S P _I ~,ea~est~J ~ti to ell o z~ TD p o f . ~y 2 ,efstws ) 1411.4-7- To ORo10 sox , 1 1 ' p~~ ~i p~ 9S 26 7010 Or 71,,.4 iNL 1 /3a x WI 1 1 S ~I I I 1 W I 1 1 I I I i /3/1.1 X I I rl ~ I Tor c s T s ; ~xx'l I 'I I 149 p of P~ pE vt no A.) -J 0 91~-3G ' ,opE 95!3i„_ zv SCE} LE , / , sysr&M 9y° HOMESITE SEPTIC PLUMBING CO. - 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT 5 STEM J.3,.S(,' ~~''~'tL 9~P~vE WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. y n MINN. INSTALLER & DESIGNER LIC. NO.00863 i 7. F?. 75 7'~P~',vti5` S,dEc S G w~si 3/y A55 REIro~TE ust~D ?44DEr, s~•G► • ~g SYV • ~f~' -n?Ewa,, -fe~vs /s 1- v%t- AQlo 13o K , L 'sTrr(Wprtf£QXWS&Wy;7.30.19 WMENYW R SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitar mnit GENERAL INFORMATION IQ~ Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P ev.: fliffsp. BM Elev.: BM Description- /n Parcel Tax No.: w. 3(~ TANK INFORMATION ELEVATION DATA A9300164 g,3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ;e1A 753 6-36 Dosing '1 D 31 ~<O.OS Aeration Bldg. Sewer d St/ Inlet 88•G_2 Holding I - - TANK SETBACK INFORMATION St/ ~K Outlet S d Bg. 3 a TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ->/,o ! NA Dt Bottom Dosing NA Header /4. Aeration NA Dist. Pipe 87/ Holding Bot. System o y/' 86 agS ` PUMP / SIPHON INFORMATION Final Grade Ma cturer Demand Model Number GPM o 7/Z pa IPI/i TDH Lift Friction S TDH' t Forcemain Length Di a. Dist. SOIL ABSORPTION SYSTEM BED/TRENCH width Length , No. Of Trenches PIT No. Of Pits Inside Di Depth DIMENSIONS DIMEN I SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA Manufacturer: j SETBACK CH 6W INFORMATION Type O eA Win- 16V 52 y OR UNIT Mode Number: System: DISTRIBUTION SYSTEM Header/Manifold „ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length1IL Dia. Length 8~ Dia. Spacing _ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste my Depth Over Depth Over xx Depth Of __J--,x.eQed / Sodded xx Mulched -ae, 7Trench Center ~o&/Trench Edges IJ ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET.7.30/ 19 (165TH AVENUE) Plan revision required? ❑ Yes N / Use other side for additional informob . 0 SBD-6710 (R OS/91~ - Date Inspector's Signat re Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION TDILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY 57. 696N, STATE SA IT RY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than l , ` 7 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 W V,EF j ^7.e~ J ! '/a /a S T3 N R I q E (o !C PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 330 /&S CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 2-4 6Ui S'i'c 4-5' Y v 3 el,N y o 2C Y 1/0/, cF P Y 3 II. TYPE OF BUILDING: (Check one ) ❑ State Owned V GE : L.c f NEAREST ROAD ❑ Public L~'J 1 or 2 Fam. Dwelling-# of bedrooms A L B III. BUILDING USE: (If building type is public, check all that apply) 031 - 2~ 9e ! 0, 0 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. Li eew 2.E] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] Repair of an stem System Tank Only Existing System Existing System B) A Sanitary Permit was previously issued. Permit # --1- r Date Issued 11 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 , f 43 ❑ Vault Privy 14 ❑ System-In-Fill Z ev64e5 JE-,l VI. ABSORPTION SYSTEM INFORMATION: c? 3 - 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE 4 ) REQUIRED (sq. ft.) PROPOSED (sq. ft.) (G Is/day/sq. ft.) (Min./inch) f Z s ELEVATION *750 o , Ai, -,f- Feet Feet VII. TANK CAPACITY Site INFORMATION in gallons Total # of Manufacturer's Prefab. Fiber- Exper. New xistin Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank ! Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Rt13 P`i" 2 f fit' 33L "7f5 3~ Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date sue Issuing o S ps) 3KApproved El Owner Given Initial Surcharge Fee) Adverse Determination 91 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration (late, and at the time of reiewal any new criteria in the Wisconsin Administrative Code will be appiicah'se. 3. All revisions;,to this permit must be approved by the pen-r?i* issuing authority. 4. Changes in owniership or plumber requires a_Sanitary PermiT Transfer/Renewal Form (SBD 639u) to be submitted to the - = )ty prior to i,istallation. 5. Onsite sewage must be proper y rvaintaiied. The _ tank(s) me :.:t . e f tArr a_ °.y 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 ;nformation request-:~ in #1-7. VI1 Tank informat!C.- +:l in the capacity -r new E.nd/or e ik; ist the t,t,' numt;er of tanks arid, :Rianufacrurer's name. Indio' prefab or site cons i_ ~.nd tank material. r 1,)4ete for all septic, f ucrip/siphon and holding tanks is this system. Check irnen1al approval cr i if tanks received experime,I--tal product approval from DIi x,14 Vill. Responsibility statement. Installing piur i- r to fill in name. ~-se nunbe~ with appropriate prefix (e.g. MP, etc.), address and phone number. Ph.-111;,er must sign ap :';~;;.:t,on form. IX. Cour:ty/Departmert Use Only. X. County/Department Use Only. Corrnle°.e Plans :specifications -.0 r- ller than 8% M031 be sijbrlill'plj the -ar': rnmI t incli 3 ~')o foliowrng ,{ol ~).an, draw', to h. _ .!F' corrlpl~+te E.c n~_, !OL'atlEln of holder.; 'A w.(s) tank(s) or other t.. r lP.nt tanks, r" +vr?rS: NeI S; ,r.7,E4 'T s1 S' hater SerVtCe1 Strea '~rjd IaKf-j ~eUr?1~ Or siphon'td. flistribution box,,. amert system ar oas ano the lo,.,ati n of ?he building : B) hor i7ont« C) compi=Je specs +cations for pumps and controls; dose vc afon difference ct;uri loss; pump performance curve; pump model and pump manufacturer; D) cross section of the sal' absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - - - - - - - - GROUNDWATER SURCHARGE 1983 `is„onc-`, Act 410 ri:'tiJded the creat cri of 7 ,-,h ,rges (fees) or ci numJer "a reCul; ?ed pre€cfi+:es M r' +n effect groundwater. Tf, nion«s t:c':,~~cted through these surcharges are usel for monitori`^ ,r giro indwato,.'gec.,indv water contamination investigatlons and establishment of standards. SBD-6398 (R.11/88) ELF VAT ION S - I /0d Sv~q ~sT~`D /3Z /00.0 5 y S T£M I Huh T~~~ S /33 ff -2- I-~ IGti TR ,c~ 93, o /3 y y'j'. y'~~ low Tr?CN 9z .s /3 ,s s • S, -'X /'vim A'TS ' ~~opvsEo k~El/ E•xrsT-i~G- 9v p4ato Itoo P eemovs r SEp TtC T.*tN+r .wo p Rox ~+u qtr ~ gy50 G9o ilia i 1 / I+ li ,fl + I o°' Q ~p py, ~S sysrcm 93 -o 61 \ 14, Sys TeM o z `h.s Rt pl 4Ce_414E,y T o PE/l s- ~'/E~~4-rid, = 96,31 ~ g,A,r~ / f s zP ioo • p S~ . Lo T' 4 ~P Fresh Air Inlets And Observation Pipe fT~ Cry Approved Vent Cap Minimum 12".Above Final Grade file %/(MP& 4" Cast Iron C 3(p 'Above Pipe Vent 'Pipe' 'ro Final Grade Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution - Tee Pipe 0 0 0 0 0 • it G" Aggregate 0 Perforated Pips Below ' Beneath Pipe '-'Coupling Terminating At Bottom O< System ' . sysT f3 o ' I ~ I I ' I . I DjFv,:~et Fresh Air Inlets And Observation Pipe Approved Vent Cap ~ Minimum 12" Above Final Grade C~ so Iron ' 3~o 'Above Pipe Vent P~1.e. 'ro Final Grade • Marsh Hay Or Synthetic Covering • Min. 2" Aggregate j /Over Pipe Distribution - Tee 0 o o 0 0 • ~pe Cp " Aggregate o Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At lj yST~~ Bottom,-Of System q2, s0 . %sconsin Department or Indust y, SOIL AND SITE EVALUATION REPORT P Labor and Human Relations - of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST Gif 0/ x Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION I tt F F /if>iPO13 /,C 5 / GOVT. LOT I(/E 1/4 Vw 1/4,S 7 T-30 N.R E (or) W PROPERTY OWNER':S MAILING ADDRESS /f. /S. ju//E~p LOT # BLOCK # SUBD. NAME OR CSM # y0 ,3 Z 00 Li- /3 '01f'6: ow ca- • / GS.y ~D~.vQ/iU 6 CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OTOWN NEAREST ROAD 140/1/.f S /~/TS . ~1,r, • 55 //0 (lv/~-) y~/' 3 73 3 ,$OM e-leSe-- T 166--,A [ ] New Construction Use (xJ Residential / Number of bedrooms y [ J Addition to existing building 1 [ j Replacement [ ] Public or commercial describe Code derived daily flow 6100 gpd Recommended design loading rate ' 7 bed, gpdm2 '00 trench, gpd/ft2 Absorption area required '72- 9 bed, ft2 7SO trench, ft2 Maximum design loading rate ' 7 bed, gpd/ft2 00 trench, gpd/(t2 Recommended infiltration surface elevation(s) !5 .3 it (as referred to site plan benchmark) Additional design / site consider 17SE' T c~GGi S I'P010 6 o X Qi sT~'i/,~ c~Tia.✓ Parent material -SC S z p/~f~~'~~ S Flood plain elevation, if applicable y ft S - Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable ror system J J S 11 U ®S ❑ U 01S ❑ U JR7 S❑ U Q S ❑ U [3 S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourx* Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed fenct» /Off 3L S b, f 4 S Z~' ..7 13 IF- el -2 _n "7 , P -iy y Y /s s '7 oP Ground y l4 7 S J/iP S , J~it'~ S elev. C limiting facto Remarks: Boring # 313 144 Ole 41"-( lop - I Ground 13 rcle- 7S Ono l., 7 ! elev. -l 7S ,P it Depth to limiting factor > goo Remarks: CST Name:-Please Print Phone: 711 ^2d' _ P/ -P -5 Address: GnG LSTir9 p 655 O'NEII RD., HUDSON, WIS. 54016 1 vo Signature: ~=nn ~~L~~ ~l / ROBERT ULBRIGHT Date: CST Number: WM. MASTER PLUMBER LIC. N0.3307 M.P.R.S - ti-INSTALLER d DESIGNER LIC. NO.00683 AP A) _ GURG~ Liu. i PROPERTY OWNER ~t SUIL DESCRIPTION REPORT Page I of~ PARCEL I.D. # LU Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bw-d3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed much 3 a -7 100 313 s . f G,e s Z , , 0 Ground ~ ' 3 7 ~ /le. S C, ,c° /1'i'►•e- . S ~ • 7 elev. Depth to limiting factor Remarks: Boring # _G lo ye 313 _ /s' D ,e S• , 7 24, 1-7 J0 [3 a is e'3 7, s► - /s o,C,.ye Ground dev. C ~(O -fee' 7s S Depth to limiting i factor Remarks: Boring # ~S d ~,1re A*►.t? 2~ , 7 1-7 Ground Ile rev. 4iA It , Depth to limiting ' L..w~ M Remarks: Bnr; ,g # /OY/e 313 Ar ©j- S 2 ,7 A9 R 1-2, 7, S fie 01 Ground - dev. /111 ST-IV 71 95,~~0 ft. Depth to limiting fac2~ Remarks:b CP ~t0 /2 7~` r^ ~ti 7 -/O ' ~3 eon eeonio ncinrn i l ELF Uh1'~(~~y - ~ SUy U ~s7~`D f3Z /0010 yvS TeM c` 1 a~ w4 7- 10Ao S /3 3 I•Gti TRec.)~ 93, O ` Tp NC,(L, 9Z . S- 5 ~75, 70 ' s«LE : YO' 34el< hloi5- /0/ '77,S • j ' ~~opos~ w~'!/ 13 ~ a 6 Z o a ~~a \py, f1EV'+r1o,J = 1103~ LF :YAf / ioo-O /30 Q _ Sp Lp j 4 ~P 4 IT DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE T~EF~MI -Attach complete plans (to the county copy only) for the system, on paper not less than 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. Ni~--'- PROPERTY OWNER PROPERTY LOCATION jje-pF * "Is GJ/l0/~L~ stE / /VL--~/4 IV U,1/4, S 7 T30, N, R C f E (o W PROPERTY OWNE 'S MAILING ADD ESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~,K42s'~'~- W/• 5ye y 3'733 CS,,-i S0 7-0'f5 II. TYPE OF BUILDING: (Check one) 1:1 State Owned j O VILLLLAGE :.Q ~T AD ~r ❑ Public 141 or 2 Fam. Dwelling-# of bedrooms - PARCH NUMB" Ill. BUILDING USE: (If building type is public, check all that apply) 03-),- 0 Z 1 lbo 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Ho a 10 ❑ O door Recreational Facility 3 ❑ Campground 70 Merchandise: Sale Repairs 11 ❑ estaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Par 12 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 3 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applic ble) A 1. X New 2. ❑ Replacement 3. ❑ Rep ement f 4. Reco ection 5. ❑ Repair of an System System Tank IY Exi ng Sy Existing System B) -1 A Sanitary Permit was previously iss d. Permit # D Is ed V. TYPE OF SYSTEM: (Check only one) \ Qther n Non-Pressurized Distribution Pressurized 'stribution Experiment 1 b 11 El Seepage Bed 21 El Mound 30 El eci ype 41 El Holding Tank 12 N1 Seepage Trench 22 1:1 In-Ground 42 El El Vaultvy 13 ❑ Seepage Pit 2~ Pressures / ` 43 vy 14 1:1 System-In-Fill 2EN~t~-~ X VI. ABSORPTION SYSTEM INFORMATION: /pD.IJ 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LO ING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ~1 REQUIRED (sq. ft.) PROPOSED (sq. ( Is/day/sq. ft.) (Min./inch) 961- ELEVATION wO -76'~U ' 4 , S Feet , =ws Feet VII. TANK CAPACITY 4.1 Site in allons Total # of /Manufacturer's Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Name Concrete strutted Con- Steel glass Plastic App Septic Tank or Holdin Tank Tanks Tanks /2400 Lift Pump Tank/Si hon Chamber ~-I ]EE Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for.installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP tMPRSW No.: Business Phone Number:, Plumber's Address (Street, City, State, Zip Code): G sS 0 'A)Ag7 ( /Ld . MVP Sc~ ~S 5;1101 IX. OUNTY/DEPARTMENT USE ONLY I E:] Disapproved Sa ~fr►y'/Permi/Fee (Includes Groundwater Date Issued Issuing A ent Sign S mps Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A 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 ransfer/Renewal Form (S9 D 6399) to be submitted to the g,oursty prior to installation. 5. Onsite sewage aystems must be properly maintained. The tank(s) must be pum;=eu 1.,y 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, 6C8-266-3815. 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 cn system type. VI. Absorption system information. Provide all informaton requester) in #1-7. VII. Tank information. Fill in the capacity of every new and/or ex r lank, 'ist the total gal;c;f - number of tanks and manufacturer's name, lndica; e prefab or site con r tr:d and tank mater ial. r.oinp'ete fcr all septic, ojrrrp/siphon and holding tanks €o= ibis system. Check erimertita.l appro,:a; inks received experimYntal product approval from Dil._?R. Vill: Responsibility statement. Installing plurnt-er is to fill in name, niumbe, with apprr~pri ;.e prefix (e.g. MP, etc.), address and phone number. Plumber must sign api i :.-:,nn form. IX. County/ Departrnerit Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 31/z x 11 i 7 must be su - 7 tr -J t,, the county. The plans n-LI;St include the following: plot ~)ian, drawn to sca'<-: -r, iflh co;;iplcte 'oca ion of holding tank(s), septic tank(s) or other .sr :rat tanks; buihdir v c . wells; eq . =..vater service; streams arsr_i lakes; pump or siphon iars :ributic+n boxes; ~tn.3rl sys• s,~, ; «,Erient system areas, an;1 t(?f location of the building s,,r ) horizontal az,+` ~ le:gat:' r ^a );nts; C) complete specifications for pumps and (onrscis; close volurv c; -levatio;r a;t ere r. frfc-iicn loss; pump performance curve; pump model and pump manufacturer; D) cry} s section of the soil ab:iorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - - - - - - - - - - - - GROUNDWATEIR SURCHARGE 1983 Wisconsin Act 419 included the creation of surcharges (fees) for a number of regulated practices'wf-ich can effect groundwater. The monies collected through these surcharges arc, used for monitori water contamination investigations and stahli ° E ; .:,f iarw"ards. SBD-6398 (R.11/88) Fresh Air Inlets Arid Observation Pipe I r/ l T'~N G Approved Vent Cap Minimum 12".Above ' Final Grade /00. 0 • 4" Cast iron 36 Above Pipe Vent Pipe' Final Grade Synthetic Covering min. 2" Aggregate Oyer Pipe Distribution Tee Pipe 0 0 0 0 0 's Aggregate a Pertorated Pipe Below Beneath Pipe o Coupling Terminating At Bottom Of System y5 T~~ / S ..s G o ry Ti~'~,c) G~ Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above ' Final Grade ,,_.•_;visff~J~ ~jt°/ir~Lc` 4" Cast Iron ' Above Pipe Vent Pipe 'to Final Grade • Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pip e FT0_ 0 0 0 erforated Pipe Below P (p " Aggregate Ell Beneath Pipe Coupling Terminating At S~S7Fi~'I'~- Bottom Of System ' Wisconsin Department Industry, SOIL AND SITE EVALUATION REPORT Page Relations ~ Of Division of safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Ste: cf'o/,~' Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ' APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ~tE FF U,,'POS1,C/uSK/ GOVT. LOT lVe 1/4 P4.1 1/4,S 7 T30 ,N,RE(or)W PC OPERTY OWNER':S MAILING ADDRESS y. /j. ju//Elp LOT # BLOCK # SUED. NAME OR CSM # I /O 3 z oo G~ /3 0~~ >P~ • ca- • / cs,Y Pte'-vpi~v G- CITY, STATE ZIP CODE PHONE NUMBER ❑CITY (]VILLAGE (MOWN NEAREST ROAD X40414 S l rf TS . ~'!.v . 55' //0 (611-1) h'~/' 3 7 3 3 $OM "Se T- /(D s sy, tJ v-e [ ] New Construction Use Residential / Number of bedrooms y Addition to existing building j I Replacement Public or commercial describe Cade derived daily floW &0y gpd Recommended design loading rate ' 7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required 92- 9 bed, ft2 7SO trench, ft2 Maximum design loading rate ' '7 bed, gpd/ft2 trench, gp02 Recommended infiltration surface elevation(s) 5-66 ~,A g , S ft (as referred to site plan benchmark) Additional design / site conside s 775 T ti S o y ~i S7'~i~u7'io.✓ Parent material SC S 2 P/~,v fi L`LO 15 Flood plain elevation, if applicable ysf - ft S = Suitable for system CONVENTIONAL MOUND 7IAT-GRADE SYSTEM IN FILL HOLDING TANK 11: suitable for s stem QS O U IRS O U 9S O U 0S O U ];~S O U [is U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bcuxl y Roots GPD/ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed ucft 13 F -/y ';-0 ytc' Y 15- S i Ground 7 SvX G y f ~ s ~ elev. ft G ~p 7 s yx XA, s , e Xw,,~ , 7 : Depth to limiting factat 1 i Remarks: Boring # Io X 313 i. Ground 13 G `f 7S ,e 7 elev. G' 7S - -S C ,e? Depth to limiting factor > /00 Remarks: CST Name:-Please Print Phone: Address: G OST~'9 141 655 O'NEIL RD., HUDSON, WIS. 54016 _ ' 2 11r2 Signature: ROBERT UtBRIGHT Date: CST Number: W4!/(~ W{S. MASTER PLUMBER LIC. N0.3307 M.P.R.S. S^klk!. INSTALLER b DESIGNER LIC. N0.00663 i e ~=~EV,►-r~-vvs SY S TE~y ~/E U.g T/p~5 /JZ O, D , 3 ~3 yS yy ' ~w r.tie y Sell+~c ; yp M VA 1)1'7--.s' l o \ W /30 6y by $z -R , u 5Ec r Q o n ~ A~`JE . ~/EVE-no,J = /OD•d ' welt,- -7 HOMESITE SEPTIC PLUMBING CO. 655 aNEIL RD., HUbSON, WIS. 54016 ROBERT UCBRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 'MITIN. INSTALLER A DESIGNER LIC. NO.00663 G'srf 2y~Z 66 G.o 7- L zy9 ' - .0 ,9 r' S. E • Lo T ~ a,P,v~ - PAF9EL I.D. # LU Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bw%Uy Roots GPD/ft In. Munsell (au. Sz. Cont. Color Gr. Sz. Sh. Bed rench 0-7 /O /P . , OC> 3 3 -S • f G,E s Z eo- Ground 8' - 3 7 5 /,O S D, c, .P •s 7 elegy. Depth to ' limiting factor ?LQ1L Remarks: Boring # J13 13 el~ lil Ground C elev. IL t!o-~ 7S j C 7 ' i Depth to - - limiting -L~- I Bo&- O-fJw Ground elev. ft. ' Depth to limiting factor V ° Y e~ I = Remarks: Boring # _ i Ground elev. " ft. Depth to - limiting factor Remarks: can eoon.o ncmm ~'GEI/if-Tryys ' l /OO. ~ SIJ~r'~r~STEp 23/ f3z ioD,O 3 13y 9y s e,+46 : % yo M ~E V)n = 13~4Gk h/aE ~i'TS R' D 13,Ge /oa. o 0 ;0ne- p Rox INCtT ~•s - /~l~i TjfE,vG4- gAl z SgT gL' R p O /30' i* ~.pE. 'Ile ~'/~'I/~77'O~v /G • 3G ~ p SFT I~f ~ ~ / S•f~`L l4 ~ y~o~ p~ pE . ~/EVM7o.J = /00• d ~Y HOMESITE SEPTIC PLUMBING CO. 665 aNEIL RD., HUDSON, WIS. 54016 ROBERT UtBRIGHT. WIS. MASTER PLUMBER LIC. NO. 3307 MARA 'MINN. INSTALLER 6 DESIGNER LIC. N0.00663 GG So. Go T L . Ly1r O ,4 7- S. E . Lo T C o,Pv 502045 CERTIFIED SURVEY MAP LOCATED IN THE NE 1/4 OF THE NW 1/4 OF SECTION 7, T30N, R19W, TOWNSHIP OF SOMERSET, ST. CROIX CO., WI. OWNED BY KARL E. NEUMEIER JR. CATHARINE N. BELL JOSEPHINE N. LANGFORD NOTE: BEARINGS ARE REFERENCED TO THE E-W QUARTER LINE(ASSUMED) .U. ...NPL. ...ATTED. L. ..AN. ..DS NORTHERLY R.O.W. LINE OFABANDONED S.T.H. "35"• o: >r: ~~t~1lED z O . M 0•N 19000'23"E a. 1 ^ J; Z: 86,67 Q. 0 31. CRlA MUNTY o L 0 T I 3 W ,o~,prMh.~rtii+•~Planning 4.0 0 A C R E S co w E O. 'M ( 174,242 SO.FT.) rn W ti Q. W M S 0 a If abt*mdod a' ~ ~ Z. withgtsaf, J• Z, z spp~st b~ 66.00' 249. 16' of ' IN86°22'24' W N I I 315-16 I ~3 w I~ FILED EXISTING 66'WIDE ROAD- „`0,I6'6IMm WAY EASEMENT VOL. 1ozp MI I ~NM £ PAGE JUL 0 1993® JAMES O'CONNELL z1 0 9 1 y S 26 ° 2 7'0 5"E foster of Deeds; N 26°27'05i'W 105.38' a Croix CO., WI I O1. 32 \ O s c O 0= SET I "X 24 "IRON PIPE WEIGH p~ 3 JAMES M, ING 1.13 LBS.PERLINEAR FOOT. `0'66 O WEBER of to o S-1804 o~ Igo SPRING VALLEY f z I° Wis. fry S i' x'•19 0,~: N46.06'04W \ \ 79.42' JAMES WEBER N ELSEN- • WEBER LAND SURVEYING m DATED V -~S^o3 WI14 CORNER SECTION 7, pN EI/4 CORNER SECTION.7, T3ON, R19W. l COUNTY Z T3ON, R19W.( POSITION MONUMENT FOUND) . ESTABLISHED FROM TIES). S88°46'41"Z 1563.94 N88°46'41W 3406.49' E-W QUARTER LINE SCALE- I"=200', o~0' 200T 400' VOLUPIE 9 PAGE 2643 SHEET 1 OF 2 93- 102 THIS INSTRUMENT DRAFTED BY ~.w~OEra. to CURVE DATA No. Cent. Anrtle Radius Arc Chord Ch.BrnA. 1-2 83048'08" 260.00' 380.28' 347.28' N60054'27"E TANGENT BEARINGS:-At 1--N19000'23"E At 2=S77011'29"E DESCRIPTION A parcel of land located in the NE 1/4 of the NW 1/4 of Section 7, T30N, R19W, Township of Somerset, St. Croix County, Wisconsin, more fully described as follows: C n encing at the E 1/4 corner of said Section 7: Thence N88046'41"W along the East-West Quarter Section Line a distance of 3406.49'; Thence NORTH 928.73' to a point on the northerly right-of-way line of 165th Avenue; Thence N10006'00"E 321.12'; Thence N26027'05"W 101.32'; Thence N3037'36"E 221.43' to the point of beginning: Thence N3037'36"E 335.09' to a point on the northwesterly right-of-way line of abandoned State Highway "35"; Thence N19000'23"E along said right-of-way line 86.67'; Thence northeasterly 380.28' along said right-of-way line also being the arc of a 260.00' radius. curve concave southeasterly whose long chord bears N60054'27"E 347.28'; Thence S3037'36"W 606.37'; Thence N86022'24"W 315.16' to the point of beginning. Contains 4.00 acres subject to any and all easements, right-of-ways or conveyances of record. SURVEYOR'S CERTIFICATE I, James M. Weber, registered land surveyor, hereby certify: That in full canpliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St.Croix County Subdivision Ordinance and under the direction of Karl E. Neumeier, Catharine N. Bell and Josephine E. Langford, owners, I have surveyed and mapped the above described parcel of land and that this map is a correct representation of the boundary thereof. Dated this jT` day of ,1993.'''` Y i JAMES M. r: James M. Weber S-1804 WEBER NELSEN-WEBER LAND SURVEYING VOLUME 9 PAGE 2643 g s - 1804 RIVER FALLS-KT4MMIE Spr;IN(; bgLLE" g Wis. *sQt9q~~ *r,M~'' Note: Parcel shown on this map is subleat to State and County Laws, Rules and Regulations (i.e. wetlands, minlmun lot size, access to parcel, etc.). Before purchasing or developll)g any parcel contact the St. Croix County Zoning Office for advice. SHEET 2 OF 2 93-102 This instrument drafted by S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix county OWNER/BUYER kris' l~~rn ADDRESS 33 /S ! /il.Bn FIRE N-UHEER~~ CITY/STATE Sornigrse J eC-a&6Q ZIP /~c~S PRO,PERTY LOCATION : _N-&:L14, ALA/4, SECTION- 7 T H-R W TOWN OF_ S&znaE czyT St. Croix county, SUBDIVISION LOT NUMBER-f 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 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 stun. 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 Co. Z ning £gicer within 30 days of the three year expiration e. _ SIGNED: 74,- DATF,:-- St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 STC-100 This application form is to be completed in full and si ned the owner(s) of the property being. developed. An g es will only result #n delays of the issuance. Y-inadequaci development be intended for resa le byb owner/contrachtor, this Sec house), thenla second form should'be retained and completed(w hen the property` is sold and submitted to this office with the appropriate d recording. _ deeee Owner of property ,M2 -rip y- Location of• property &C114 &_U_114, Section Township Mailing address 30 U~ 50/ti &7 Ste-" - ly j S' S y~.Z- S Address of site S 1/ neJlyQy 7 Subdivision name 6s.M 9-49 zo Gy 5 vf 9 P~ ~ y3 of no. other homes on property? Previous owner of property e Total size of parcel L L}G S Date parcel-was created t t 3 Ara all corners and lot lines identifiable? j as No is this property being developed for (spec house)? yes volume_/001nd. Page Number :l7 of Deeds. as recorded with the Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARpANTY DEED which includes a DOCUMENT NUHHER & TzIE SEAL OF THE REG23TER OF NUMBER,, DEEDS. NUMBER,, In VOLLTME ad In ad AND PAGE certified serve dition, a • y, 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- shall also be required. urvey Map PROPERTY OWN= CERTIFICATION I(we) certify that all statements on best of my (our) knowledge that I (we) this f ore are true to the the property described in this information torn, by virtue sor°a warranty dead recorded in t Deeds as Document No. i °££ice of the county Register :'oand that I t own the proposed site for the sewage disposal system) oir I e(we) obtdined an easement, to run the above described prrt, for the construction of said system, and the same has° been duly recorded in the office of County Register of deeds as Document No. S a e o£ applicant 0-app • ~ clicant' Data ofrSig stars 7i 9 Date of signature- • DOCUMENT NO. i STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA l WARRANTY DEED 502046 VOL 1020PAGE547 This Deed, made between .Karl umeer Jr,, REGISTER'S OFFICE Catharine N. Bell and Josephine Lan ford - - ST. CROIX CO., WI - as_ tenants in common 'd for Record Ree , Grantor, aria_.Jef rey:i_A_:_ _WroblewsT.:1 and l~ris JUL 8 1993 Wroblewski husband...ancl--wi£-e-----as,--survlVorshi -,p i at 9 .Q A. M martal .property-'------------------------- , Grantee, R st et Of Deeds ' Witnesseth, That the said Grantor, for a valuable conslderation...___ RETURN TO conveys to Grantee the following described real estate in St...... .rQIX..__-._.. County, State of Wisconsin: Tag Parcel No: Lot 1 of the Certified Survey Map recorded in Volume " of Certified Survey Maps on Page 'z- y3 as Document No. 5oz i , being a part of the Northeast 1/4 of the Northwest 1/4 of Section 7, Township 30 North, Range 19 West TOGETHER WITH a perpetual easement for ingress and egress to said Lot over the 66 foot wide easement shown on said map and legally described as Schedule "A" attached hereto. I' , I~ li !I This is.--n1o.t........ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And-- CTI1(?TS---•------•--- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances'?Mw 'I and will warrant and defend the same. Dated this 61-T~--•-- day of -------------.......,]lUl,-r-------•-----•-•----•-----•-•-•------- 19 ill ----------(SEAL) "J''!.. EAL) 9 Karl Ne•-meer_._~r.~.._ Jv ephne N. gin. Oxd = (SEAL) (SEAL) Ca.tliarine N.- Bell AUTHENTICATION ACKNOWLEDGMENT li signature(s) o Karl E_.___Neu?leier J'r,.=.... STATE OF WISCONSIN Catharine N. Bell & Josephine N, ss. Langford- --------------------------------------county. authenticated thisI??uly________19.3. Personally came before me this ................day of -----------------------------------------1 19 the above named j G . E. Norman TITLE : MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. ~l THIS INSTRUMENT WAS DRAFTED BY BAKKE NORMAN , S . C . - - New Richmond, WI 54017 Notary Public ---------------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: -----•-------------------------------------------------19--------•) 'Names of persons signing in any capacity should be typed or printed below their signatures. R'1on,• ~ r,n C9'. TO n~0 !1C` R„crr,.-,~,•.- ~ - - :VIOL 1020PAGE 548 SCHEDULE "A" A perpetual non-exclusive easement for ingress and egress over a 66 foot wide strip of land located in the Northeast 1/4 of the Northwest 1/4 and in the Southeast 1/4 of the Northwest 1/4 of Section 7, Township 30 North, Range 19 West, more fully described as follows: Commencing at the East 1/4 corner of said Section 7; thence North 88°46'41" West along the East-West quarter section line a distance of 3406.49 feet; thence North 928.73 feet to a point on the northerly right-of-way line of 165th Avenue, said point also being the point of beginning; thence North 10°06'00" East 321.12 feet; thence North 26°27'05" West 101.32 feet; thence North 3°37'36" East 221.43 feet; thence South 86°22'24 East 66.00 feet; thence South 3°37'36" West 203.69 feet; thence South 26°27'05" East 105.38 feet; thence South 10°06'00" West 387.10 feet to a point on the Northerly right-of-way line of 165th Avenue; thence North 46°06'04" West along said right-of-way line 79.42 feet to the point of beginning. This easement is granted to provide access to a Certified Survey Map located in the Northeast 1/4 of the Northwest 1/4 of Section 7, Township 30 North, Range 19 West, which certified survey will be recorded contemporaneously with this easement conveyance. I DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 502044 1020PAGE 546 REGISTER'S OFFICE L - - ST. CROIX CO., WI This. Deed, made betwee Karl E. Ne_um_ e ier Jr., Rec'd for Record Catharine N. Bell and .Josephine N-. f,angforc~_, as tenants in common J U L 8 1993 , - ,Grantor, at 9:00 A., and..._J-effTey A. Wroblewski anci ---ris A. ( • Wroblewski, husband and wife, as survivorship. t2egtsteroiDeeds mar..........-property............. Grantee, `7`litnesseth, That the said Grantor, for a valuable consideration----._ - - - - - - - - - - - - - - - St . Cro ix RETURN TO conveys to Grantee the following described real estate in . County, State of Wisconsin: Tax Parcel No: A perpetual non-exclusive easement for ingress and egress over a 66 foot wide strip of land located in the Northeast 1/4 of the Northwest 1/4 and in the Southeast 1/4 of the Northwest 1/4 of Section 7, Township 30 North, Range 19 West, more fully described as follows: Commencing at the East 1/4 corner of said Section 7; thence North 88°46'41" West along the East-West quarter section line a distance of 3406.49 feet; thence North 928.73 feet to a point on the northerly right-of-way line of 165th Avenue, said point also being the point of beginning; thence North 10°06'00" East 321.12 feet; thence North 26°27'05" West 101.32 Ii feet; thence North 3°37'36" East 221.43 feet; thence South 86°22'24" East 66.00 feet; thence South 3°37'36" West 203.69 feet; thence South 26°27'05" East 105.38 feet; thence South 10°06'00" West 387.10 feet to a point on the Northerly right-of-way line of 165th Avenue; thence North 46°06'04" West along said right-of-way line 79.42 feet to the point of beginning. This easement is granted to provide access to a Certified Survey Map located in the Northeast 1/4 of the Northwest 1/4 of Section 7, Township 30 North, Range 19 West, which certified survey will be recorded contemporaneously with this easement conveyance. homestead property. Exempt NO. 13. This .s.. not (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; ''i Grantor ' And...... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances n and will warrant and defend the same. Dated this day of '-!U1y-------- 19-93... I 7 ~4 ---------.(SEAL) (SEAL) .Kar.1_.E....Neume.ier.-J.r- . * ph ne_N...-Lang-.ord rr2 r&k- -------(SEAL) (SEAL) * Catharin-e N. Bell - AUTHENTICATION ACKNOWLEDGMENT Signature (s) of K...................................... l N i e r J r. z STATE OF WISCONSIN Catharine N. el& osephine 88 ~ang£brd County. authenticated this L/C?/1-flay of------ J_U1- - , 19__9 3 Personally came before me this ................day of , 19-------. the above named - G. E. Norman TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY BAKKE NORMAN, S.C. New Richmond W-- 54017 Notary Public __________________________________________County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) date 19 -Names of persons signing in any capacity should be typed or printed below their signatures. ST. CROIX COUNTY WISCONSIN - `L ZONING OFFICE r r# N r r ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road ' Hudson, WI 54016-7710 _ (715) 386-4680 November 9, 1993 O To Whom it May Concern: An inspection of the septic system for the Jeff Wroblewski property, located in the NE, of the NW; of Section 7, T30N-R19W, Town of Somerset, was conducted on September 15, 1993. At the time of the inspection this septic system was found to be code compliant for a four bedroom home. Should you have any questions, please feel free to contact this office. Sincerely, James Thompson Assistant Zoning Administrator mij Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT ® Page L of 3 Labor and Human Relations- 1 Ohrisio`n 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 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 ~'C FF F= U IkO3 /L=`GuS& GOVT. LOT /VE 1/4 VA-1 1/4,S 7 T30 N,R E (or) W PROPERTY OWNER':S MAILING ADDRESS 6. FvI16W LOT # BLOCK # SUED. NAME OR CSM # 3200 /3 o~PF "ed ° CITY, STATE ZIP CODE PHONE NUMBER OCITY ❑VILLAGE [MOWN NEAREST ROAD 91V f STS . 1,v . 5S //0 (lo~~ y6'/- 3 7 3 3 7- New Construction Use Residential / Number of bedrooms y Addition x' to existing building Replacement [ J Public or commercial describe Code derived daily flow /mDV gpd Recommended design loading rate ' 7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required ~72- 9 bed, ft2 WO trench, ft2 Maximum design loading rate ''7 bed, gpd/1t2 •00trench, gpd/ft2 Recommended infiltration surface elevation(s) s-~~ - .3 ft (as referred to site plan benchmark) Additional design/ site consider - ns S,---' t ti~ S !'~Poja C~ o X ~i ST~Pi/,~uTia~✓ Parent material G 5 Z P/~Nf~ LO S Flood plain elevation, if applicable y It r v ,.vS- v S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK JE& U= Unsuitable for system S❑ U R IS ❑ U Z[ S❑ U ~Y] []U S❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BOurtd7y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch .v-aux. C,9-,2 10 ,e 3L3 s a,-f S Z~- 7 ~ -~y Y~ y ~s ~~M'►,9j~ ~f7rf.C. s ~~►I .7 Ground y l4 7 S y~ S , f~ ire S '7 r elev. 7 Y, f L~, __11 J. Depth to limiting factor - Remarks: Boring # 62, 0-00 16'rX 313 z -G o y /s s ,mot , 7 j /3 6 --3 7, s ,e s 7 r I Ground elev. C 104 /P" ft Depth to limiting factor >_/00 Remarks: CST Name:-Please Print Phone: Address: - y3 1 y- eSrAl yJP 655 O'NEIL RD„ HUDSON, WIS. 5016 Signature: r'Cxnn~ i~~~~ ROBERT UtBRIGKI Date: CST Number. WIS. MASTER PLUMBER R LI LIC. N0.3307 4mw. INSTALLER 6 DESIGNE 0 6 1 Goa N This test site AP'PRo y RIGINAL for a conventlorW septic eyst 9 PROPERTY OWNER JtF F:- SOIL DESCRIPTION REPORT Page Z of-3 PARCELI.D.# /Of l CS~-j AE,4"P1%416 - Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwid3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends 3 0-7 to 3 75- 29,-f. , , '67 ;7- 21 10V1 A Ground 36 7 Y //P S C, ~t° /ly►•e elev. Depth to limiting factor J/DD Remarks: Boring # _G /OYe 313 12 Ong 16 /67 YX 3 7 s ~S 0,C, ye w ,7 '•P Ground elev. C ~-f 7S S i e, S , 7 ft. Depth to limiting Remarks: Boring # 0-7 /o ye 313 ~S Q•~. lr~ / Zee- 7 00 y'-10 /p /Z EC Ground elev. 7,S S d e, S - • 7 . ft. Depth to limiting fact Remarks: Boring # 13 Ground elev. ft. I i I Depth to limiting factor I Remarks: OWN 0013wo Acinn% r i i JAMI@IRO 4 P~. 3 ofi 3 ~'GEVit-T,yys /O O. /f~ SvGd-~ S ?Ed 4131 5Y S 41,9 T/O,us 132- X33 13 y 1~ 9~ , SG ' 5' CA 14F D Olt ST~4tf'~p ~ /30 . 6z / °10 s~ Q9 3 r /ev~I rio.v = 9 3 5--r PP~r / sfirEz- y /60 ` HOMESITE SEPTIC PLUM8ING CO. 855 aNEIL RD., HLR)SON, MS. SO% ROBERT UtBWHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.FM MINN. INSTALLER A OESONER LIC. NO.00663 c.ST.f z y00 Z GG Sn. 40 T L . 2- ' ,g 7- S. E • Lo T Co,Pv