HomeMy WebLinkAbout038-1121-90-000 I
Q
o
4n 0
c
b N
O Y
O °
co
m
t3 o� I
U° c
WL. o `
°) 3C >
y C:
� C N
a) Lo " (n
a E
o c o o 0
o Co c c
LL c W
0 o U N
.�7•am
coa) o
E Q or N=
U
@ N
CL
co Z ` C
Z m m
r°> cWi� a m
0
o z a
°
y z v ° o
V) F- Z
° E Po
yU� 0 M
CO
N
N C
•womb N °
CL c O Ira
O Z F� Z
N z '
V Lo N E C N
..
d Ln
CL M O
N N �+ Q1 C
N o d N o
O LO O O a Q o
Z M > _ fn fA fA v
• ;; 000
Z
R ` a a a
CD
N ° 00 0)N
N J U O °) }
N 0 a)
> O O O E
O
a
o
O 0 3 ate) H e
LL 0 c o d r)
Or O N N C N U 0. 0 o 0
U o C W a R ° N N
W •C N C E N
W N.. r N (D N = y � N N N
C"" d •�_ d N Z H C N N O O
co o f° `° o U) o E f0 u
o Z N g UJ
CA
y = I
E as
+) #t a y a
• a v 'E� d m c
`Iv
c m 3 w o
r A U (L ov� U
ST. CROIX COUNTY
SURVEYOR'S RECORD
MATCH \I E N 56cm-3 1'-5 MATCH LINE
\ ;Z£ >0, 84.05' 0O
N o/:o o z
9 O w
° O
O N ° O N
top
w 0
1 W ?9O Oi A
O?, m
OD c'S,
Z o
o - m zo �o - N �£Z \3
T J
— — �— 9�o n
_ N o = rnOF) m 'o m
zw 0 C7 _ o o S• z
Z G)
_v � r' Qwv o v m
N — — `2��' m
p Z Im
in x v m — °.ISU" v -0 p
ow =m N oxi ,, m
r N O D Z r
r- 4b No o z
`n m m ,, O Cl) Cro y z z m
r I m � � cn.. v v n Z
CD rm o
CD — 'v
-n m D ?°°\`n5\ON U) z -zi D
o w �p FOR w m
o-4 -mi 15 N`\ vP� � o Dx (y) 0 -M
-M
N co NK,P Seej a A z-' N O z
N r1% O'X w w w x
OD
5RE tiR 10 rb2.1 RO`'GO m r
A e VL = 'D
� 1� 191� 00 -9 (A U)
P �_ :emrn
Y NwO M,ltet m W .p
rot-` to
GO N P' 10N,�G Z Z
PN * m —
iy Z£ zz zz m
(A (j)
m m (f)
C
w N W
1, c�0 0° (C O
1O •� -I m
z 4? °.o w_ w
W
3 T
v N D z� � 10 o O (33
Y—Z
Y Z
N O Wp r
>c
0, °
O /\5 0 OD O
O /Q O
m o to
v O O 0
z �
Im ,
C,
(!1 A > � Q m Z A A Ln Ln o C�
• NZ N �� O (0W
v �- zs Z • (/� S o co v w W <
,
rn Oco _
wo Co, m D p ',
VOL. 2 PAGE 596
CERTIFIED SURVEY MAPS
ST. CROIX COUNTY, WI.
� SO•Nd�• "_'
a3lid!i 4h 04
SHEET 2 OF 2
1
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER r)(t3�L/c'Z A/r/ZF��AJJWNSHIP SJ/j/; �/��'14aj= SEC. 0 T AN-RJLW
ADDRESS ST. CROIX COUNTY, WISCONSIN
IV/ 1 ' (2�m ;/516�
SUBDIVISION AAA LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 11HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Al U) d. . L .
®t7 M
i
i
30
I
�J
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used Nu) /.0; 5Ld t&t
Elevation of vertical reference point: ,/t)Q,Q Proposed slope at site:
SEPTIC TANK: Manufacturer: � � Liquid Capacity: /000
Number of rings used: _"Afl_ Tank manhole cover elevation: (2,j,3 7
Tank Inlet Elevation: Tank Outlet Elevation: /Q 0 J16
Number of feet from nearest Road: Front,Q Side,Rear, O 33 feet
. From nearest property line Frontlo Side,u Rear,O 33 feet
Number of feet from: well f , building:
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
T
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: -.Pump Size
Elevation of inlet: Bottom of tank elev on:
Pump off switch elevation: Gal s per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest roperty line: Front, O Side, O Rear Ft.
N er of feet from well:
Number of feet from building:
nclude distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: S Length: Number of Lines:� Area Built: 330
Fill depth to top of pipe: 73 6 A, E/1 GL-
Number of feet from nearest property line: Front, O Side, Rear,O Ft ._ 0
Number of feet from well: �Q-f-
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 a of the above soil
absorbtion sytems? (Check one) .
HOLDING TANK -
Manufacturer: C acity:
Number of rings used: Ele tion of bottom of tank:
Elevation of inlet:
>larmManufacturer:et from ne est property line: Front, O Side, O Rear, 0Ft.
umber of feet from well:
Number of feet from building:
ber of feet from nearest road:
pp
Inspector:
Dated: �� yV /a Plumber on jqb:
License Number: 3,20-5
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
' LABOFs&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707
S�4NE 4,S30 ,T31-R18TinT El CONVENTIONAL El ALTERNATIVE (Itf'assigned)
a lan I.D.Number:
Town of Star Prairie El Holding Tank ❑ In-Ground Pressure El Mound
C
NAM OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA E:
re 'ean R. 1 Somerset WI 54025 �d ZS 90
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: C T REF.PT. LEVI
Name of Plumber: MP/MPRSW No.: County Sanitary Permit Number:
i Schmitt 3205 St. Croix 128646
SEPTIC TANK/HOLDING TANK:(o' 6 r ✓� r
MANUFACTURER: LIQUID CAPACITY TANK INLET ELE V.. ANK OUTL .. WARNING LABEL LOCKING COVER
I PROVIDED: PROVIDED:1,6bb os r I YES ]NO ❑YES XNO
BEDDING: OIA.: ihEMi-MATE: HIGH WATER NUMBER OF ROAD: PROPERT JEIL�, BUILDING: VE TO FRESH
e..V. Z/ Q,�. ALARM. FEET FROM LINE.
AIR INLET
❑YES NO 7 s ❑YES NO NEAREST 33 O
DOSING CHAMBER:
MANUFACTURER IBEDDING. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
YES
NO DYES ❑NO DYES ONO
GA SPER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF IN WELL: BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN ET FROM LJNE AIR INLET:
PUMP ON AND OFF) I ❑YES ONO NE
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH METER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to conti MAIN
CONVENTIONAL SYSTE B.9 r_�) _
WIDTH: - JLENGIH. O.OF DISTR.PIPE SPACING. COVER INSIDE DIA.. #PITS. LIQUID
BEafrRENCHI THE NCH ES'. MATERIAL: P
DIMENSIONS (D yq /
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MA ERIA NO.D S R NUMBER OF PROPERTY WEL BUILDING: VENT TO FRESH
BELOW PIPES ABOVEICOVE 4 ELEV.INLET ELEV.END w PIPES. LINE: �, AIR INLET:
I �r Cs��C FEET FROM r
60 3Z-'40 la G.S3 v NEAREST 0.. >s�' aS > O '
MOUND SYSTEM: Z= /2
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
OYES 1:1 NO
SOIL COVER ITEXTURE: PERMANENT MARKERS: OBSERVATION WELLS
ES ONO DYES O
DEPTH OVER TRENCH/BED EPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED D:
CENTER. EDGES.
❑YES ❑NO ❑YES ❑NO ❑YES E NO
PRESSURIZED STRIBUTION SYSTEM:
y WIDTH. LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER.
BEL1/TRI" }{ TRENCHES:
DiMEI1ISl S
MANIFOLD PUMP MANIFOLD DISTR,PIPE MANIFOLD MATERIAL: JNO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING:
ELEV.: ELEV.. DIA.. ELEV.: PIPES. DIA.:
EI:E\fA It3N AND
#ISTIF3UTION.
NFIORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED
❑YES ONO El YES NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMIIER C1H' LINE:ERTV WELL: BUILDING:
❑YES El NO ❑YES NO NE/IREST
Sketch System on % • in county file for audit.
Reverse Side. TITLE:
SIGNATU �
DILHR SBD 6710(R.01/82)
SANITARY PERMIT APPLICATION
DILHR In accord with ILHR 83.05,Wis.Adm.Code couNTY
- v
STATE SANITARY PERMIT#
–Attach complete plans(to the county copy only)for the system,on paper not less than ❑ 44F-,�Lfn�vi-us 8%x 11 inches in size. application
—See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
Y. /C'/a,S 3 Q T , N, R If E(or
PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK#
T
CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: (Check One) ❑State Owned Q VILLAGE: EAREST ROAD
rW C7 r
❑ Public V1 1 or 2 Fam.Dwelling–#of bedrooms� PARCEL TAX NUMBER(
Ill. BUILDING USE: (If building type is public,check all that apply)
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. K7 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.El Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit## — Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION
3clo 3.3 a Feet lie Feet
VII. TANK CAPACITY Site
in gallons Total #Of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Se tic Tank or Holdin Tank 66�� /
Lift Pump Tank/Siphon Chamber.-X+-.-
VIII. RESPONSIBILITY STATEMENT
1,the undersigned,assume responsibility for installation of the onsite sewage system shown on t ached plans.
Plumber's Name(Print): Plumbe ' gnature:(No Stam s M RSW No.: Business Phone Number::
lumber's Address(Street,City,State,Zip Code):
L s2 —7— C �s
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee(Includes Groundwater a e ssued Issuing Agent Signature(No Stamps)
O
A Surcharge Fee)
pproved ❑ Owner Given Initial -� 7
Adverse Determination /tJd /� �•
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 Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. 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 tine 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. 06mplete 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'f x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers;wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398(R.11/88)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
• INDUSTRY, DIVISION
LABOR /�
c
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ TY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
SE 1/4NE1/ 30 /T31 N/R18>&.,)Wj Star Prarie n/a n/a n/a
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
Croix Robert Maitre 'ean .R.>a�l Somerset Wi. 54025
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DES RIPTION: PRO N A TESTS
[�R nce 2 n/a ❑New �eplace 4-21-88 4-22-88 :
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional)
®S ❑u � ❑u x I S ❑u ❑S 2u IS S ®u conventional
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: n/g I Floodplain,indicate Floodplain elevation: n/a
decimal' PROFILE DESCRIPTIONS page 19 BrB
BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHS ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 1 7.17 none 5.67 *less .75bl.s.l. .75bn.s.1. 4.17hn.c.s.&gr. .75 bn. mot
99.55 than 1.00' s.sil. .75bn.m.s.
B_ 2 7.00 100.74 none 5.75 * less 1.00bl. S.1. 1.00bn.s.1. 3.75bn.c.s.&gr. .25bn.mo . 'I
Ilan 1 -00' s.sil. 1.00bn.c.s.&gr•
B- 3 7.16 99.60 none 4.83 * less .58bl.s.l. 1.00bn.s.l. 3.25bn.c.s.&gr. .83 bn.mot
than 1.00' s.sil. 1.50bn.c.s.& r.
B.4 6.42 99.80 none >6.42 .50bl.s.1. 1.25bn.s.l. 4.67bn.c.s.&gr.
B- 5 6.50 100.99 none 2.77 *less .83bl.s.l. 1.92bn.s.1. .75bn.mot. s.sil.
B-
decimal' PERCOLATION TESTS
TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER MXXNS AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PER PER INCH
p- 1 3.50 none 3 4-2 4 4 1
2 3.45 none 3 3 22 2 1
P_ 3 3.25 none 3 32
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.
SYSTEM ELEVATION 96.05,
1
i
1 l I
I ._
Qjz IK i -h
tNi
# A
f
,
I I 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 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 WERE COMPLETED ON:
GARY L. STEEL 4 722-88
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
988 N. Shore Dr. , New Richmond, Wi. 54017 2.28 71 246-6200
CST SIr, �U"R�E:
( --
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
L
H
a
STC - 105 r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
t7
OWNER/BUYER hG 1 74 r/ ), J1 / h e�
ROUTE/BOX NUMBER AaA /y �119 Fire Number
CITY/STATE Sd e,rS-t �� ('1/ _ jIP
PROPERTY LOCATION :156 �4, 14, Section- 30, T3_N , R _W,
Town of � �1/�f , St . Croix County ,
Subdivision_ A , 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 I`
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 e igible 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 ttie 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 . H
0
I/WE, the undersigned,, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth , herein, as set by the Wisconsin Depart- ro
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 .
SICNED(/ U' ' I� Apt
DA'Z'E 7 ZZ-
St . Croix County Zoning Office
P . O. Box 98
Hammond , WI 54015
715-796-2235 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 7 '17
/• ,e I'1�
Location of Property �k N6 1%, Section 30 , T_,V_N-R` W
Township S ERA 44
Bailing Address - 6�/ ��` g- /� _ �� y��27
Address of Site
Subdivision Name — A(A
. Lot Number �-
Previous Owner of Property
Total Size of Parcel > 17e e
Date Parcel was Created 9
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number 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 (eve) cv ti6y that a.Cf, d,tatemen{Js on .this ohm ahe thue to the but o6 my (ouh)
hncwtedge; that I (we) am (she) -the owneh(j o6 the phopehty de c&i.bed in .thjA
i"AalmaLion 6ohm, by viAtue o6 a WaAAanty deed neconded in the 066ice o6 the
Cc mty Rrgihteh. o6 Ve.e& ah Document No. ; and that I (We) pheeentty
sun the phoposed e.ite bon the eevage di�spoe dye em (oh. I (we) have obtained an
fdAt Pint, to nun with the above debCAibed ptopehty, 6oh. the eonat.Auct;i.on o6 aa.id
a y,s tem. and the dame hae been duty neconded in the 066ice o6 the County Reg•id•teh. o6
Veeda, ae Voemnent No. ) .
SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
I
I
:
i
r
r
:
I � I
I - I
7 � �
,
� I
j
� I 1
-
L±
I � ,
}
i
cio
- - f , - - - - -- - - -
I
: � I
- -- Q�
� it r
a
t
Y i !
I
i
f
I �
,
9Y,(0:
I � +
„
I
' 30
Aarllr j -
I
,- -r
� I
r
tII I i
� 1tltIl I 1 i � � II j I (
, {
t I I I I i I I
I
-
' t
I I I
I
II
I
_ I
}
I , I
, l-
i
t ,
� I
t i
I
i -
t
-
,
l ,
1 _
i_ -_ I - -
:
-
I I
-
I
, III I I
f ,
I 1 I
_ o
F►�
. D 1`L MAR 41996 i„E® t
JAN 2 1996 ►
NX ST
KATHLEEN H.WALSH
Q 0 � Register of D�
C7 SL Cron to W�
CERTIFIED SURVEY NAP
ROBERT AND DORIS NAITREJEAN la•6 d
part of the Southeast 1/4 of the, Northeast 114 of Section 30, Township 31 North, Range
18 West, Town of Star Prairie, St. Croix County, NE COR.SEC.30. T 3/N, R/0 W,
Wisconsin. (COUNTY SURVEYOR'S MON,1
Owners Address: PRIVATE DRIVEWAYEA.SEMENT
1974 C.T.H. "C" VOL. 1153, PAGE 380
Somerset, WI 54025 IINPLA TIED LANDS L� __q'± SHED ENCROACHMENT (SHro TO '— —B£ REMOVfO /
S 69' 4/ ' 36"E 346.6.4 ' M
Q.
a SHED 11L-_O-T _5/
O LU V' ^ 2.392 ACRES /
O , ,
/ASS F T. ROAD SETBA;/K
J
'3711E lJ� �fL/NE .i/ OS
Q
ti 3 76.39 / /00• p�/
ze
Q ARAGE y, V
OI r I SEPT/C
ku
WELL
n ` Q
R OR/VEWAY
w O 4, v -- - _ DWELL/NO
b lu = 2 N
v, p 4
� O iF• /y / �a1
J Ill 1� ...•:.,R,. }�`"h: ��
LOT 4. C.S.M•., \ / Dr/ x
VOL. 8, PAGE 2260
PRIVAFE ROAD EASEMENT SHOWN ON -J n
C.S.M., VOL. 8, PA6E 2260, NO VEHICULAR
ACCESS TO LOT 6, UNTIL DEDICATED AS 3otrrszitte
A TOWN ROAD.
This instrument drafted ty Laurence W. E 114 COR. SEC. 3o, T3 1N,R 18W,
Murphy ( COMPUTED POST ION) V. 30")days of
'wl plate
i'ddl I13ii be
SCALE / " = •700'
,,��111111/UIti�
O 25' 50' /00' 150' 200' 300' Iy 111P
G O NS A
0 Indicates 1" x 2,411 iron pipe weighing 1.13 lbs./lin. ;'LAUR NC
ft. set. m i W M R�
• Indicates 1" iron-.pipe found. C�3: 713
0 Indicates 2" iron, pipe found. v N I FALLS,•:•,, s
Dated: September 19, 199E F •'•.,,WI$C,' •••' , �� •�
Vol. 11 pace 3034
Certified Survey Maps
St. Croix County, Wisconsin. Laurence W. Murphy IL
Registered Land Surveyor �-
SHEET 1 OF 2 M
pro
A
r