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HomeMy WebLinkAbout040-1043-30-000 ` °h 0 d 00 oq N ~ Y 3 I ~ c o ~ c o I M M O L O C Z: 0) CL i > N 4)(0 - 01 CO LM N c~ ? n U O C H N O Ev~C9 vno 2 i am ~oU Nw rn OD c CD 0 co jOJ N O - p .o c x > C Z N O(pA CL 3 m LL c 'D N N o u) i°L O 0 8,0 3. L U U ~n aci v cw 4) Worn E Q 3 a N ~ M I aa) w N o, w E o Z a m rn H co O z :i c v~~ 'o y N Z :t c N H E 5 N co O Z4: 2 U) N d L L I O Z 1- Z O N n ~ I M £ co L R m N o a o Q - w ~ o G IL E -6 3~ rmr m al 5 Z j N O • ~ 0 0 0 a = I > o m NJU ~°.rnrn C O M (D co ^`l o > ` N V O O O O O O O E N N N r- a) c,4 N 7 N a N N m O1 c in o n '0 W CD LM Z p N Q > (n co O eC O U .O-• O O N 7 O N (o a C> 0 M N C (6 N n n C a 0 0 0 0 r _ N N N N N V O M O O O C C N a n- N N N r r N 0 C ~ N co N N H F' C Lo O n O • O O O H J~ O Z 2 (n .w ~ I w m € CL L a • eed a N .V N E ` c c 3 ~1 A 0 a 2 O N U ~~//~C~'~'JE'.c9% ,S~pTI C SXS T~•~-1 /N S f ~Fl/~f~ /O - /3 - ! 3 T'o STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ✓~OS ADDRES SUBDIVISION SECTION. T N-R I W, Town of T~Oy I C- ST. CROIX COUNTY, WI tONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S ~ Sip ~r~ 1S Rule-7- INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 i Tod ~~~e o f s~v~~1, /Poe)/ ""00- - o BENCHMARK ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION FX/5Tl:uCr JAA.) c - w~ sEn /dad Manufacturer: ZO&EA S C6-, Liquid Capacity: Sao Setback from: Well House ~y Other N~ Pump: Manufacturer Model# Size Float seperation ~r Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM / &0 ' 3 Width: J` Length ~O~ G3 Number of trenches Distance & Direction to nearest prop. line: 20d ' Setback from: well: /20 House ~O Other ELEVATIONS log, 2 • Building Sewer ST Inlet: ST outlet PC inlet I---- PC bottom Pump Off - Header/Manifold Bottom of system Existing Grade Final grade d /3 /y - sry3 DATE OF INSTALLATION: PLUMBER ON JOB: Z h e, " 7- LICENSE NUMBER: lyoe5 33e 7 INSPECTOR: ~'m T kOM n So A.) 3/93:jt w a o ti cA N ~ o r ~ O W - ~ o e J ~i3~y 09 W a i -44 H x a w o c x° ~ \0 a ~ L r- ~ o Q 0 d. ~ ~(w nt ~ W w w~. h W h ti V1 'Zi S "i w ~ ~ ~ N LQQAWAWbrt` Wdyf InQL2tty28' 19.112$RIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety arod Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) sanitary ermit o.: Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan o.: v.: Insp. BM Elev.: BM Description: Parcel Tax No.: 60,L~ la amQ 05 an - - TANK INFORMATION ELEVATION DATA A9300285 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r r Benchmark no, Aeration 61-)l Bldg. Sewer Holdin St/.~X Inlet TANK SETBACK INFORMATION St/* Outlet Verit TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet Ar Septic ~>/o NA Dt Bottom Dosing-------- - NA Header' Aeration Dist. Pipe Holding - - Bot. System PUMP/ SIPHON INFORMATION Final Grade 20 ' Manuf er Demand D Model Number GPM TDH Lift I Friction stem TDH Ft L - Ex. >er 553 Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width / Lengt f No. Of Trenches PI No. Of Pits Inside Liquid Depth DIMENSIONS DIMEN SYSTEM TO P/ L BLDG WELL LE I nu adurer: SETBACK Q4A IB a Num er . INFORMATION Type O y., , R' / f System ' _ j ~115~ OR UNIT DISTRIBUTION SYSTEM Header. Pftpt kl- Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length %f u"'l®1 Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade-Syste'-fn y x Mulched`"` Depth Over Depth Over xx Depth Of xy- Seeded /Sodded Trench Center wed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 09.28.19.142C / V All l / 1 r i-Plan revision required ❑ Yes No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 3 7"-- 9 SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY :57; STATE SANIT YPRMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ Nkc Q 8% x 11 inches in size. c k if r v si Urvlous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. Al,+ PROPERTY OWNER i PROPERTY LOCATION 1UA-t- -EX JUh v.✓ LON Cr- ~ $ AW Y. AW-%, S A' TV, N, R / E (or )o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # f 6101) e?e D ' CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER PJ'O.✓ 401. 15'10,(6 1(3X) 05 13 CITY ✓ NEAREST ROAD N. TYPE OF BUILDING: Check one ( ) ❑ State Owned ❑ YJLLAGE : T)pQ! G6o v . ❑ Public L~ 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NU 111. BUILDING USE: (If building type is public, check all that apply) d y© - to 413 - 3 cD 49 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 onl ne in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 epage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 LJ'seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit 2-4. Pressure ^ f ❑ Vault Privy 14 ❑ System-In-Fill 3 J;R NC f E- S '6~4 61("- x 'C VI. ABSORPTION SYSTEM INFORMATION: 911.0 - S~ Q 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE (6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) G ELEVATION &o o ~ QS 7 P7 0 .7 A IA_ U Feet / Z• d Feet CAPACITY VII. TANK Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks A2XI577~6r- structed Septic Tank or Holdin Tank OD 16oo OO 2, Gu !A6f9 Cav - 404--m-W5 'cc, 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) *P MPRSW No.: Business Phone Number: T~oa T Z1~,6i~1 < 7- ~ ' Zu.G~ `G - 3 3 O 7 Plumber's Address (Street, City, State, Zip Code): Co YS / S LZ~Lo IX. LINTY/DEPARTMENT USE ONLY ❑ Disapproved Bury Per it ee (Includes Groundwater Date Issued Issuing ent S / Surcharge Fee) Approved ❑ Owner Given Initial Adv rse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: ,s SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority.. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to $ years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include., 1. Property owner's name and mailing address. Provide the legal description and parcel tax-number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit, Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mainsiwater service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) - \S o 0 rr o <1A b p ~ ~ p Ili o ~ ~ ~ n , 1:3 b o N d g Y tz) O N / o cl rh ~ ~ fA I O m -.4 y p c~ 63 G) GO rr v, w N - rn ~ c w v ~ x Approved Vent Cep Minimum 12' Above Final Grade /U/S ffEU _ ICS SO , 3 (p 'Above Pipe Cost Iran Vent 4'ipe' 1o Final Grade Synthetic covering win. 2' Aggregate Over Pipe Distribution - Teo pipe 0 0 0 0 0 6S Aggregate o PerfOrotel Pipe Below -I I Beneath Pipe 0 - -Coupling Termineling At Bottom Of S.yslew sysr~~ 2~ - Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12' Above /~'1I v 7/lbE.tJ C 7~ Find e ~ i u / S /fE l~ 3(0 _4• Cast Iron • Above Pipe 1o Final Grade Vent "t Synthetic Covering min. 2' Ate ODistribution -Too Pipe 0 , 6 Aggregate o P erfbraled Pipe Below son*alb Pipe o -Coupling Twminofing At s Y S y~,~,1 Bottom Of S.rstem Fresh Air Inlets And Observation Pipe Approved Vent Cop Minimum 12' Above Final Grade- 9y0 , _ 4' Cost Iron ' "Above Pipe Vent Pipe' -to Final Grads Synthetic Covering Min. 2' Aggregate Over Pipe Distribution - Tee pipe 0 0 0 0 0 (o ' Aggregate 0 Perforated Pipe Below Beneath Pipe o -Coupling Terminating At Bottom Of System 9D-o • ti -f r' Wiisoonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and H urnan Relations Division of safety & 134kings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST ci~°oi X 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 pant (Blue, 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 Grrq GTE~P J o fI ti~ G o/v G6-.v GOVT. LOT 1/4 1/4,S T Z? N,R I? E (o~W PROPERTY OWNER':S MAILING ADDRESS LOT 11 BLOCK # SUED. NAME OR CSM ff / G/o,P ~P' hla'49'r e Aj/. c- yOC%6E 1 77HON 15) NUMBER Sens OLLAGE owN v~ o 0 ( I New Construdion Use Resides fiat / Number of bedrooms Addition b erase t 1 rr1g hftV L A *cement [ I Pudic or =nmeraal l describe Code derived daily flow &00 gpd Recommended design loading rate 41 bed, glxw 7 trench, g XVR2 ~~caM.~~-,~oev . Absorption area regtnred NP bed, t't2 1P17 trench, ft2 Maximum design loading rate 7 bed, gpd/ft22 trefK*% WW Re=nn ended infiltration surface elevation(s) .5f.F_ P ~ , 3 ft (as referred b site plan benciveN Additional design / site wrsiderations -IAJ c y 7 ~PE.u GG, ES I~'l~ l iz°op Q o X -PIS 7 -le /3 y Tla.v Parent ma ter d SAS 130A?rhVO7`- 9/44,,ftl -46rr- Flood plain elevation, d applicable IV,4- ft S - SuiWe for systsystein 08 em Cd2Vy no U ❑ U I~5 ❑ U PRESSURE ATmWDE SYSTBA IN Fl FOLDING TAW U - Unsuitable for BI ❑ U ❑ S C~II ❑ S Ott- SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mollies Texture Structure Consistence Bourtclay Roots Diftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Mvich 0-/& /oXR 312- JoAM sb& IM 111OR ~S zf s -G U73, /6- zy io YR 31y 51, i ~ sbX f/P S Zf s - G Gmund /3z i y 3 iD YR y16 s 0, elev. ft. C' 37-,?0 /O %i2 S/~l R' 5.6 ir►~v~~' P ~P Depth to G 7 " Cov Ri /,3 /gar 9 limiting Ey7Tpe~,jE E~cT~R//tL ~4.v ~tT 3 - 2 -7 N `L C /o o~ /5 az 49 Remarks: O•vGy {e-,le 1410uvP S//S7 Boring # ~ ~ 50, L 2 Zovs ~t T / ~4f,~ E- PI 'T J~E 7-t%o 12 Ground elev. t/30V /ACNTif i ,j ft. Deo i to fffiting GT I AV!, tailor - CE Kd~ Remarks: ' 2- SCE /'T7fd /f- O v4 T Name.-Please Print F'z0'B wiz T -41 /~~P! GG/T- Phone: Tess: / Z Signature: Date: CST Number: NBT,E- ,:5-x4 ~ / t-4 T sa, /s - F , SQL c~ /o,~ o cwt G~JGQ ~'f ~ z ~S I'LOULQ R~ C" 'j S-cR UtZ' Vt"ZY USED ~(10/'~M/'YL -jc1+r7z)R . 7*45 4~ ~o y~JE.u s~tTE- f o~P 'L ,q ,v S/ Gl'~EZ t~ /,v Tom? VP7_1 o.v OF ZfA,11 - Wf S'r4,v0 72-rX rv ,e°~ . PROPEBTY0WW.0/f /7FR Lo.v f ,'57N SOIL DESCRIPTION REPORT Pale? d 3 PANCa LQ ~ Depth Dominant Color Modes Texture Structure Cor~erxe BourrdarY Roots GPD/ttz Boring aizon in. Munsell cu Sz. Coat. Cola Gr. Sz. Sh. Bed rends p- 77 /O Y 3 12 /OAM 2, f, 56K /ha C5 5- , G .8 19-3G &1 ye 3/y - S/ IM-IR 57 Ground ,~10 /o /D R y116 elev. epth to _ D litniting belor 00 #OX/ Ze.U ° /jitS fI/d2~PT ,ad C,~~TS of $'i'/ /O/ie S/y ,Sdt~, -~i Boring o-ia~ la4ti, 2 , ~6,~ vF s /o YAP 3/.2- Ye~e ~s zf 5- 23 )-232- -s ye 5/~ ~s o q,~ ~►„2 cs z Ground i,f sd~ cs . y I's 03 3)/o Yre ~ 9.0 YR Depth ID bcw J ~N Remarks: Boring # 4 y/? -2--t Ap N P 31~1 %-5 .3,n v7W Ground /D ~/e y o dev. ft hbn ~ 13 z h s ~F~-w eon. vov ~~N~ e Depth 10 -,qF /a Y, to 00 Remarks: ,Boring #1 [31 Ground elev. K Depth to ir►~pr+9 facw Remarks: CIOM 0oen,o nc/no% DR, n' 1 p ~ N o N ~ N w b Ri y 0 ~ co rn o CA x 0110, as ~ LM o ~ W I ~ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the tyiIl e residence located at: 1/4, sal/4, Sec. T 21? N, R /f W, Town of ? ~O Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. ~ p - f 3 Last time serviced Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons 3 y minute, Capacity: lOVv A4-e C.¢S Construction: Prefab Concrete y Steel Other Manufacurer (if known) : ItAl), ,WS 7a 4-e_ GlJ/ Age of Tank (if known): (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary Permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name OR~T ;Nh/PlG0T 3 Signature ~~►(~'a^'~ ~P/MPRS 30 7 i 5/88 30000 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER j V A~.✓ ~ 0 '4j d2!2 Al ADDRESS V`` FIRE NUMBER CITY/STATE ZIP Y' ir a_ PROPERTY LOCATION: 4071/4,1/4, SECTIONT ~ N-R rt TOWN OF_ 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 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 scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED:_k_Jd2 c e - _ DATE : I 0 - St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), thenia 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 J0 /P"-/- Location . Sul S , of* property 1/4 /4, Section T~LN-R I W Township T" Y Mailing address A_/`/ 6:~_10&265x Address of site Subdivision name Lot no. ~V• Other homes on ProPertY? yes P- No 7- Previous owner of property I )yaVc.o J~4ti,s, -7 T, Total size of parcel Date parcel-was created I ` 7 Y' Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No volume 5W and Page Number 6-7,4 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map- the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(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. 36 0 L. L , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. ~ A 4~VX, - - Si ature o p icant Co-ap icant I Date of Signature Da of Si nature i 1 i i I Nli t L DOCUMENT NO. I it WARRANTY DEED _r r I THIS SPACE RESERVED FOR RECORDING DATA 336U2~, Yct S•! ~ PAQ REGISTERS OFFICE THUS DEED, made betweenFranC13 C. Dyer, Jr. and Janet ST. CROIX CO., WIS. __as -joint tenantsL____-_ Recd. for Record this.:LLtb,_ ! P. 1) husband and wife, - - day ofOctoLer A.D. 19.7E ---Grantor ` and -.-Walter Charles LongenLJr. and Beverly -Joanne at 9:30 A. I' Longen~. husband _and wife,_as joint_tenantsG_ Janss O,Conllell - _ Grantee Rf.r of Dood. Witnesseth, That the said Grantor for a valuable consideration S1Xt ~ five thousand dollars conveys to Grantee the following described real estate in__qtt_CrQX---County, RETURN TO State of Wisconsin: I St. CrD..X (;a Abstract Goa A parcel of Land in the SW4 '-SE4 Section 9-28-19 Tax Key 9 described as followst Colrar_encin at the SE This is homestead property. j corner of Section 9-28-19 go N60 13'00"W 2542.83 Ik feet to Point of Beginning of parcel to be conveyed. Thence South 1251.05 feet; thence N43043'00"W 615.48 feet; thence North 4i 797.05 feet; thenceN88046'00"E 425.45 feet to Point of Beginning. j TRANSFER $ .0a FEE !I Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; And_F'ranr'i 4 C Dver jane_t_EQyPr ' warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except eXlsti nea emEn't:G for public roadwavs and public_utiliti, recorde orotherwise, mineraL_ j i~ rights under RR ROWS and l;.ro~tnnk easement recit` ,r LC recorded Vol. and will warrant and defend the same. 5001 Pp. 119-120.{`I Executed at this day of 19,41f • II _ I SIGNED AND SEALED IN PRESENCE OF (SEAL) 'j I, FrancisG D er~Jr.~~ (SEAL) Janet P. Dyer (SEAL) j (SEAL) I 'i r Jr/c .ems - a/ C,-4 c.t~ can ,y-- Signatures of authenate¢this ~tO - day of _ILS~L_j? 19_i Ip • q Title: Me+nber Stat u of tit' on a-- Other Party r-' t 'ft Authorize.' under Sac. 706.06 viz./ /eT y 4~-ts--- A I' OF WISCONSIN t C ss. - T-CLC~~ - County. day of - 19 - , Personally came before me. this the above named to me known to be the person who executed the foregoing instrument and acknowledge the same. I This instrument was dratted by Ralph E. Senn, Attorney-at-Law River Falls, 41, Notary Public County, Wis. My Commission (Expires) (Is) The use of witnesses is optional. Names of persons signing in any capacity should be typed or printed below their signatures. NGM.t.r comiaw WARRANTY DEED-STATE BAR. OF WISCONSIN. FORM NO. 1 - 1971 Parcel 040-1043-30-000 12/30/2005 08:02 AM PAGE 1 OF 1 Alt. Parcel 09.28.19.142C 040 - TOWN OF TROY 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 - PARNELL, KIMBERLY J KIMBERLY J PARNELL PO BOX 523 RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 411 N GLOVER RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 6.540 Plat: 3317-CSM 12/3317 SEC 9 T28N R19W SW SE BEING LOT 1 CSM Block/Condo Bldg: LOT 1 12/3317 679/62 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/19/2002 687363 1951/360 QC 01/15/1998 571350 1288/390 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 102342 280,300 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.540 79,800 190,000 269,800 NO Totals for 2005: General Property 6.540 79,800 190,000 269,800 Woodland 0.000 0 0 Totals for 2004: General Property 6.540 79,800 190,000 269,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 217 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Qw, AUG 1 5 1997 SURVEYORS RECORD 563131 L ~eA ICERT IF I ED SURVEY MAP LOCATED IN THE 1/4 OF THE SE 1/4 OF SECTION 9, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN PREPARED FOR WALTER LONGEN I GLOVER HILLS NORTH LINE OF THE SW-SE S 88 ° 55' 08' E 422.82' I REC. AS S89@ I 1'02'W = ' r z m I { I m HOUSE LOT I •Z r I / 285.088 S0. FT. NOTE: BEARINGS ARE REFERENCED OR 6.54 ACRES cn TO THE SOUTH L 1 NE OF THE I w (278, 279 S0. FT. SE 1 i4 (ASSUMED BEAR I NG). .pm , m ro I OR 6.39 ACRES EXC. R/W) c I 276,102 SO. FT. r- N OR 6.34 ACRES EXC. :D .i I R/W AND EASEMENT 0 • SET I' X 24' IRON PIPE :Z w WEIGHING 1.13LBS PER LINEAR N I~ EXISTING DRIVE FOOT. 'cu ;C I I N 890 16' 05" W 292.57' r i SCALE I" = 150' f 0' 75.' 150' 300' LOT 2 :Z ~ ww p 149,666 SO. FT. N OR 3.44 ACRES ` .W (0 ( 135,648 SO. FT. as •w 3. 11 ACRES EXC. R/W) 4 05' `r♦ , .••UD/NT DRIVE EASEMEN 8 FILED 's~, ro JUL 3 1 1997 ► _ ~ • ` ~Ay 5E'~ a~ N v L KATHLEEN H. WALSH- 50. 17' RagftolD" I SLCtdxCO..WI • I ~ tea, ♦♦yR~• sF ~ ~ U~ C) to J! > C n C , ,tea ♦ a+ cb, yF`'•. °z c I M ,O•..Z• • :F,p♦ ro w `~1`~ ~G~Ci 0, V~r! 'aid WEBER p~ ♦ SPRING VALLEY m SOUTHEAST CORNER • Wis. I SECTION 9 - FOUND .v { ,I COUNTY MONUMENT 18.29 2626.02' \ s~~~ S U Ry • S88059' 554E 2645.3 JAMES M. WEBER S-1804 :1 mx~ SOUTH LINE OF THE SE 1/4 NEL SEN-WE ER LAND SUR EY 1 NG SHEET I OF 2 DATED 97054C THIS INSTRUMENT DRAFTED BY JIM WEBER Vol.12 Page 3317 TROY E PLAT W E T -28-N • R -19-W ® Farm & Home Publishers, Ltd. See Pages 115.116 For Additional Name& HUDSON 'E' PAGE 30 am 900 F 20 1 5 4 m IOn & a w. xo6edt d r„tyerc o G~Se v s 2,m • Maxine ¢ , wpm,-,. wa0aee oac a u • x. - r+ E d oatxs Schiitgen w 1•.a xa awean cs 3 Ts 12 c 196 f t R& t mdt a Sarb 40 2 at4e w u. 2. 3 iM t,i u ra43 I DRERWODD -ltz m 7 t z t cis axs 2 2 TOWER RD Cordon CP ~i; oaDas Z 3 C law a Mark David St W j Z Gordon Helm Knott wPa~ ee Cut 2 & Marie Larsen Diane 20 Trust4o 40 r n ' to sw 4 2 3 0 ~ Knott Family Sklarov z 2 3 3 3 Trust Trust 79 F BID 3 t ' 147 So U Lmertr os s 8-4 a SO 75 t David& a ` shadi `r Marjorie a 3B 36 James & LLC is 32! ihle so 3 z ' 10 Schreiner 118 40 Y~ o..es 3 tuv Susan Leog W o tTHcust °ss 103o 45Ronalg BBort J, 32 S 10 Trust s9 Ro5-1 ¢ David 37 tt 39 40 83 u~ 73 = 1 t. Roeker R& 2 2 aohh~ e 114 Frederick ~-I-, Barbara ~ m.t 3s O p I & Ruth Garbe 90 q- 10 E ' 85ing American 'r g Materials O ~ p L 35 _ 35 _ so' LLC 180 SNP 6z _ 6_6 6 s 20 d, I G Moelter s - 5°8 S.MWd -hh A Martha F=11, 35 Dev Inc I 90 saeaton 63 I Caro & t TrRohl ust 102 I Sen. Hr.. 118 120 I Trust s'ww`. w.,mo r65 wa k.d- ie9 zo tM t t t 92 w 11 . a a ` Ittahoa hi 'z v 3 3 GLOVEfl RD roes 3 4 lii01 DeK )one, ID 2 Clair & v 4 voy.` I Ela Donna Allen& ,y o s s Hue 3s David Wilcoxson 133 g M Ronald & Sarah Christie Irma . iuvme Hanson W , 1 d to na. 145 65!L) Screaton B ^ 5' Fam~ildar I a4 •B 160 6 aa•Q r 4°G ,r 15 r.ws 40 1x Ka,n 3 D Trusty80 3i r?~ cyS ] a3xa.Hm~oe`u _ SWth 9 Ikan<ne 4- z 17 80 35 v)i1eO Btrousme O I CH NOOK LN s83 . Dean t TS& ~ls BS siu+ B& was HE • \ W' Albert 3 3 A. 2 3 PPJJ 218 12 a3 AS " 1t 195 I 1 67 'z 19 z \ N ~1 Donald ROLLING Gary & jDaniel & \ 2 I & Mary MEADOW Marlene ,Teracita ' Chapman t +41v DR Duclos 76 Pearson 66 192 h Donald Orin & \ Rent zo • fit ui Brown Norman \ s>na~de. 163 le Johnson rer zo a 11, 80 ~ nowt- 12-9 . H 2 was 2 o _-t i « g I Carl &r 5ne M ww Qeoor- caw w: I 4 Horde Dntton Ry g8 1 Kilkarne , „ xt ~3a Hills I • 'a.._. ' 40 40 \ 8~3 40 79 4 a Golf y in Larry i&)'4 t 1 Inc I t s t^E Bauer I versity 150 A ~y~ 2 158 F['eUS, 1 Wisconsin ~ • WERSTEDT 10 240 D3 65 Daniel & O e. .n.m LN p 1 Daniel ¢ David Ia,,,,w PhBip & ¢ 4 Teracita E5- r & Sarah ~n Patricia O 2 i 11 9rson z~ Screaton Ewl w,u...usw oM~n' Feyerdsen -p 35 Q 153 - 0 111 ' 43 He I l as 65 g - - - s - _ _147_ 57 V Rut w I - v Orin & H1°' David & asa Mark & Nan sryon I 6°v` i" Cheryl xuold -A- Lynn & T, S uarie 4 94 ~j June 60 ohous 16 (.90 I Brosi I Dianna. 3 80 40 201 I Kusilek o.. 101 31 « Helen jo P& v...r I MM Nekon a ca. t ; E .d I S4 WdU f3 -9~ D Edith 4 m..rmme ' - e 1 u A gM~, I Nelson, S+ w Ir - Z 4 t 1 r. Nelson Scott & 1Y~e~ Cut. 2414 ♦ r BO Kristin 9 ss, /sy M«iter I- rkk~~TTyt~~ts s.. - s. ras 3 Anders O ON 34 113 L,~'IrE,,,L„3` r ~zo 180 x i M -.f 37 o b PIERCE COUNTY - - _ u Furniture • Appliances • Accessories LEITCH INSURANCE AGENCY INC, ~ • Sleep Shop • Carpet • Linoleum , i • Ceramic • Hardwood Floors H • Custom Design work • Professional Installation 174 E. Pine ME FURNISHINGS Where You WIN Find Name Brand ~ River Falls, WI 54022 155 State Rd 35N MerchandlIfe At 111111111-Direct Prkft5t River Falls, WI 54022 Hours: (7l5) 4250159 (715) 425-2782 M-F 9-8:30 Your One Stop Home Sat 9-5 www.Leitchlnsurance.com 16 M"ratsng Sp"Wr's# ` IN 1 ~ IVM ~ a d 1 ' Tpa < YMtiy AUG 1 5 1997 0 < . .v ST. CROIX COUNTY 5631..1-~~', SURVEYOR'S RECORD CERTIFIED SURVEY MAP T28N,R R 19W, TOWN LOCATED IN THE 1/4 OF THE SE 1/4 OF SECTION , OF TROY, ST. CROIX COUNTY, WISCONSIN - PREPARED FOR: WALTER LONGEN I GLOVER HILLS 12-Djw_ll_l . NORTH LINE OF THE SW-SE S 88 ° 55 08' E 422. 82' I REC. AS S890I 1'02'W = Z ~ 4f 2 ~ I m HOUSE LOT •Z e I / 285,088 SO. FT. NOTE: BEARINGS ARE REFERENCED OR 6.54 ACRES cn TO THE SOUTH LINE OF THE I w (278,279 SO. FT. SE 1,-4 (ASSUMED BEAR I NG). .0 m ro I OR 6.39 ACRES EXC. R/W) c I 2T6,102 SO. FT. r ro OR 6.34 ACRES EXC. I R/W AND EASEMENT o - SET r" x 2a" IRON PIPE :z co WEIGHING 1. 13L BS PER LINEAR EXISTING DRIVE FOOT. :a I to I~ N 89016'050W 292.57' I ;m SCALE I" = 150' n 0' 75' 150' 300' I LOT 2 wN :Z p °1 149,666 SO. FT. ° J : to ( w OR 3.44 ACRES o ^ ^ ` \~i9• ~O- ( 135,648 SO. FT. ro ~s 3. 11 ACRES EXC. R/W) cn "6 lt. O 405' U s , FILED c~ S ;JD INT DRIVE EASEMEN J U L 3 1 1997 ► C: S ap' ~y9`~ 4, ro rn L KATHLEEN H. WALSH • I 50. 17' 4~ cn SRegistKO(Daeds L Croix CO. WI • •y``~c~• .sue., 9c~. U ? CnC ~•C ~ a+ ~ Zio wrki z o .?2a' •.0,90 ` V JAm s #t. g Z 0 IZ . wave& WEBER 8-1804 SPRING VALLEY ~Z SOUTHEAST CORNER Wis. 4t I SECTION 9 - FOUND COUNTY MONUMENTd 19.28' _ 2626.02' S88°59' 55'E 264-5. SI`' SOUTH L I NE OF THE SE 1 i4 JAMES M. WEBER S-1804 SHEET I OF 2 NEL SEN-WEBBER LAND SUR~EYING,.Z 0% 0% DATED 97054C THIS INSTRUMENT DRAFTED BY JIM WEBER 1Z•cv.~~ ~O b~ Vol.12 Page 3317 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION VESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: NSH /MUNI IPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: I~'/~/a /Ta N R / E (or QsT arrtro ' - CO NTY: ` OWNER' UYER'S NAM ` MAILING A DRESS: ST Cro ~ ~ s °I r 5'~ nl ~ 1Q~~r kd . l sa DATES OBSERVATIONS MADE USE NO.BEDRMS.: Comm ERCIALDESCRIPTION: PROFIL SCRI TIONS: PER OL TION ESTS: ® New ❑ Replace J 3 'Residence RATING: S= Site suitable for system U= Site unsuitable for system rZSEIU ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMME~NC~ED SYSTEM: (optional) ®S ❑U NS EA ❑S EU ❑S ~ l~i es __J If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: t-"--~-^ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED ES~jT. HIQGHEST TO BEDROCK IF OBSERVED (SEE ABBRV./ON BACK.) B- 6 l4,(3 / 0 ~l X ~f ed ~i l It k B- (5 -ip lr-pe of med Al B- 9x 6-19 "B /s ( 19 -It'` & s g,~-,r ed Yt S B- 5 b s( /0 -N "B', s 'm e d 67 S B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATTER IINCH NUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER I 5b-T-- P n ID 3 > S - P- tl P_ P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 07.5 14 y`am'. v SYSTEM ELEVATION' c Lt, 4 ei 15 S_ ~ 12"1 4 Se ~6 l e . V Tie C60,s e l^ PBS d 3. A - 3 3 _Ink , - A1be+0tt r A►nLD~) ; C7 d I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print):. TESTS WE e PLLEET DON: r> ADDR CERT)C T N NU BER: PHONE NUNj ?E ptional): Ulf CST SI U(RE~: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - r I G 6 g ti _ COMPLETING I M 115 e S D- 5595 5 S1 I ~ ` J r 1 ALL C V= i TIC a L T~4 C Pt TC This soil test report is the first step in securing a ; county or the Department may request verification of this soil test in the field prior to perr "t complete set of plans for the private sewage system and a permit application must be submittaca appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and p:. ; 1 =,rior to the start of any construction. Parcel 040-1043-30-000 03/28/2006 07:49 AM PAGE 1 OF 1 Alt. Parcel M 09.28.19.142C 040 - TOWN OF TROY ST. CROIX COUNTY, WISCONSIN Current [_X; 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 - PARNELL, KIMBERLY J KIMBERLY J PARNELL PO BOX 523 RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 411 N GLOVER RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 6.540 Plat: 3317-CSM 12/3317 SEC 9 T28N R19W SW SE BEING LOT 1 CSM Block/Condo Bldg: LOT 1 12/3317 679/62 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/19/2002 687363 1951/360 QC 01/15/1998 571350 1288/390 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 102342 280,300 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.540 79,800 190,000 269,800 NO Totals for 2005: General Property 6.540 79,800 190,000 269,800 Woodland 0.000 0 0 Totals for 2004: General Property 6.540 79,800 190,000 269,800 Woodland 0.000 0 0 I Lottery Credit: Claim Count: 1 Certification Date: Batch 217 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00