HomeMy WebLinkAbout024-1041-90-100
:s>ars•r De:ot+ren.n'cr.^^.Prre PRIVATE SEWAGE SYSTEM Canty St. Croix
Sa'e:p and B~ilcmy U xelu°
INSPECTION REPORT Sanaary Per..I v
(AI IACH TO PERMIT) 605188
GENERAL INFORMATION StaIP Plan ID Na
Pesoral 1^IOr-,,vnr .e.r I mar oe used v scc-jndwy ovr uses IPrvaey la", s a oa ;11:...;. 3152267
Pe•mi7 H^Icer s Na.-e Cry V.Ill Tmvns'ap >or, Ilax NS
Jeremiah & Andrea Ganske TOWN OF PLEASANT VALLEY 024-1041-90-100
_ Suaiu ru'I OVnv Ftan9°'!.'a No.
j CSrRrst lea nsp. 9+: i BM Deserlm nn' C
c r 5 1 32.28.17.272A
TANK INFORMATION ELEVATION DATA
TYPE NL\NUFACTURFR CAPACITY STATION BS HI FS tLEV.
Septic 7T 7. S Benchmarx
Dosing Cd r 75o Alt BN1 1. 7<w 5,~•
J
I - /d Hldy Sewer 3 OS Go
7
Holding Si Into:
13,9 ~SSs. 65
TANK SETBACK INFORMATION Sb'H: Uutlet
TANK TO P+~I ^:LLL BLDG venal Intake ROAD Dt Inlet
Sopric Dt Bottom
I l 36 - - 119.7- $ 3.7-5
~
Dcs r•y I r / Header+69an • 3/L
Awat on - Dist. P pe . 377 Y
Holding - Bo: System / / c • ~j
o
PUMP/SIPHON INFORMATION Final Grade 1,3'7 14• l It: V Marufact,lre• Uj~ Demarc Sl Cover
GPM Z- 7. B6
Model Number N 15 3 9
r'
TOil Li". Fr Vion Loss System Head TDII t
If 15 3.1.6 33 -
Farremain Length, Dia + I 71s:. to bYCI
b -
SOIL ABSORPTION SYSTEM Z /pkI
BEDriRENCH V: J:0 l e-.g:~~ No U' Turlche5 PIT DIMENSIONS Nc Ol Pis aside 013 Lou J Ccpt'
DIMENSIONS ~
SETBACK SYSTEM TO P:I + BLDG 'dv'ELL LAKEiSTREANI LEACHING Pla"AacLne<.
INFORMATION CHAMBER OR
16L 117 AJA_ UNIT madel Nurnoer
DISTRIBUTION SYSTEM EGrra 3+-
Hea]ervk'a-dJi7 D6.re Gtl:icr x l•C e Size f l x -tole "Pao"' ar le' P.
3 _ 314 9S
LO1
ii ° 3.- Da I '_cngP, "O 03 /r 6 S"P ng
SOIL COVER X Pressure Systems Only xx Mound Or At-Grade systems only L'l -l
-
Deutn Oros Lig1;:0 ;Jeer xx Depth n` xx S°-edec. sucded ',x I& nhed
2ecTrcm. Ccrler Ge Jr'e^rrICie: N-~ Tr:'' 4.'i 1 Yes Nn Vus 1.
6
COMMENTS: !Irclude code disciepencies persons present, etc: Inspectcr of , ; I+Ar')O Insoect::r u2:
Location: t 170TH ST
I ?Alt B10 Descnpll -
2 i Bldg sewer Iong:h = 39 ~(A LJ it
- amol.nt of cove, =
7 / 8 a . 13d' ZO 1 f~ our ~i Z o~• f'u6~- -y
Plan revision Reaured? I Yes YfJu I t I I ~ I bg
1 ~/I
Use other side for additional informaUCn. - J
Irate 1,szpctc•' Sror3n Corr No
arint s wS
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hr •cuudancc aNt S[ S iSLJ I t : wLvnrsnm vt du. on
I, nyu Y prize tc bl m ng r vnt rnu \ m', :\ppl c Into 11mn. I Jr. '.i: cv. Ih n all:ng ,ddassi-.
the Dc;ar arcn[ of S nLtt and [ mtcs t no. lcn l Pin wnd~ otos,;,tI a 'u
p_i wca m'I. ~rdanae ~.Wth Iht Prn r c Lt ; ~ 1 <.i1i17 iir 1 SIa., T/L
i Application Informahon l lc zee Print All Information 70 -5T,
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pr nl 1'rrwiC iC'.L e, 1, uule um bne rm line \ ngrl, ~ .:r i it nupkc;Ible)
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vpc of POMTS SN,memiCompuncni/Device: (Check all lha~ J~-
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SO x,750 d Cell( / A n c_
:.cu~rror' 750 - 73"0_, 1 Conao
i. Responsibility Statement- I. u. n I Jnr,~ ~.r I! .11. nu the attach vl planes
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DIVISION Ot INDUSTRY SERVICES
)C641 N HANOI I RD
•••y`, HAYWARD WI 54543-640?
Contact Throug-i Helay
' nttp :Asps wi.gov: programs!indushy-xerviccs
i P$ w wwisccns'r gov
•'kr'_'_t,.,~,,.,.~'~ Scott Walker. Governor
Laura Gutierrez, Secretary
August 30. 2018
COST ID No. 231340 41'1'V POWTS Itrspe lot
JOHN IIERLJLRT PFLKF ZONING OFFICI(
PELKl PLUMBING ST CROIX COUNTY SPIA
NG298 ST HWY .`5 1101 CARNIICIIAFI RD
DURAND WI 547,6 HUDSON 1VI 540 1 6-7708
CONDI'I10:SAI. AI'I'ROVA1.
PLAN APPROVAL. EXPIRES: t1UW-1020 Idenlilicatiun Numbers
Transaction ID No. 315226'
SITE: Site ID An. 853437
Jeremiah R Andrea ( ianske Please rcler to both identification numbers,
1701H St above. in all c~ondence with the agency.
Town of Pleasant Valley
St Croix Counts ,
SF1'4, SIA 4, S32. I2S.\. R17W
EOR:
Object 1 ype: POINTS Component Manual Re ul,iled f_lbWt ID No.: 1795(1(16
Maintenance required; 600 GPD Flow rate: S.oten(s): F/fiow Mound Component Manua!, (R. 7.`12), Pressure.
Distribution Component AMnual - Ver. 2.0, SHD-10706-P (N.01!01, R. 10!12); Effluent Pilfer
"Hle submittal discnbed above has been Icvlewed for cozik m: nee with applicable Wisconsin Admini,suatise Codes
and 1Visconsin Staluws. The suhnoutal has been COMA IIONAL1 Y APPROVED. *I hi, system is to be constructed D[,TJ
:mJ Ioutlcd in accordance with the eeclosed approved plans and soil: arty component manual(s) referenced above. APPR
I Lv uovner, as defined in cha,,ter 101.01( 10). Wisconsin Statutes. is responsible for compliance will, &`P`090F SAFETY AND PR
icquiremmis. DIVISION OF IND
A copy of llic approved plans, specifications and this Ictler shall be on-site durin;t con;tnlction and open to
inspection try authorized tepre'entatives of the Dep rtmcnl, which nay include local in,pcctors., All permits
Icqu led by the state or the load numienp-dip shall be obmined prior to commencement of
conshucnnn!instrllrtion'uperuion. a
Li •_ramin, Ill is approval the Division of Industry Services reserves the rihht to require changes or addilions col:dniuns arise making them necessary for code compliance. As
per state. sups 101.12(2), nothing in this review SE,hall relieve the designer of file responsibility for desir,ning a safe building, slructare, or component.
Inquiries couccrnin`3 this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
I fie above left address:c shall prnv ide a copy of this letter and the POW 1S manal-ement plan to tine owner and any
ethers who are responsible li?r the installation, operation or maintenance of the POW 1 S.
.sincerely, Fee Required $ 250.00
Fee Receives $ 250.00
~ - R:duncc Duo S 0.00 A Ta\ lot
sv Services 11: iSNIAR'F code: 7633
lVaslcwaler Specialist , llivisioa of lnduV
C715631-1481 , Mon-Iii, 8:00 a.m. - 4:330 p.m.
c,lw in.t oiunai %i.suv
RECEIVED i,agc of
i2
'n ;ltt ~ .'~,~tewa er ? "atment ~ yyrst M~.
:d x and Title Page INDUSTRY FERVICES
1'ri!ji;..i N~ttnt". TEAEriAN!'/~,J,J.cEA GA.✓SKF- 5~-,Eft l
11VnCr'$ N'ame' tt Ir h
7 4)
fvL;nicipalit4': Torun., etc, t;*, of* LEASAar /IALLEY
i _Aln ty:
oiX
ut Number: CsM Number: G37N
s:tbdio;lion Name: / 70 E;y
Nutttber: /oo
1 Index and Title Pace "VALLY
,ED
2 Plu! Plan FESSIONAL SERVICES
Cross-Section & Plan Vieth of ;.Mound STRY SERVICES
d Pate Latcral Layout
Septic FMk P'.nnp Chamb: r :ess-Jcctiun L, SPce;fit; J ions
Pump i'crFormancc InF>rmalioa
POWTS Owners :\ga!ui :I & 1~t;t!ta~~r!nent P1;tn y `c -
r'ugA1 9 Filter Inform-X.!
Sitmaiurc Date: 8- 0
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approv2H
•I' 1k, 3Cn. sC P IC Tank Vona
' •t ','n dch 41) Ys 2nn V I ELECTRICAL {oaatw iY L&le Vatic 124
BUILDING SEVER rL / located t.':,hove u. vi CM < JUNCTION BOX above Realona slooa Elevo9or.
tl"" SP= 39' 30" L II ai`0 l PcSl Yoa` rlry , eP
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X+>^_' El-,1111 ICOMM
and NEC 3Pa)
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- ;JIA OF 3 OF SUITAi3i L LL;rJG Be:vtY. GI T.A).H 8 tdAY,2lIUI'.i BURY DEPTH Of 9r,
Anchorirus of lank may be regwred per SPS 383.43!8)(9)
Daily Wastewater Flow (OWF): _ _'.I CJrliliG i'4+!Ip JIZ_ _,gallcrs f4umber of dally doses.
a: i:~amJfaCturer. r" iiNo,yGas
i;I:dei Number: Force mat'volume- -/3S x . /G3 9 et: _ y?,5---_-
; .tl,V,~ /iL_
S•miRCh Type' Actuai dose volume: _ /37
!total hose volume - - -
rIb-- It - no Manufacturer. Zj, _ze,c
- DOSE TANKCAPACIT'Lr-
lodei Number _-ZS
a
Reserve above alarm ? =i','f)
scharge Rate. .7 uPfv1 Alarm float above Cn float t n = - 31.;1 gal !C1
ONOff float measuremer1 6.-,5- jr = /37 _ q.,ii Iel
:;local lift Ipunlp or-, to lateral invert).-...... _.._1 S 3 ft Off above lank bottom. _
,item head (distal pressure W-5' x 1-3 fti: _ 3 3 R
i 3S P force main x .l. S 1100 friction factor 3. y N DOSE TANK DIMENSIOI .
;le, friction loss. ft I-ength
I ,1P PER. x1'1,1/ JCF cuRVE PER MINUTE f -
hilcll[t. 151152053 L-FFLUENT AND DEV I RING
- MODEL) 15.. y 152
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1i1 N~ -I 110 W I6 SI 11'
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2 5
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L_ Model 151 Models 1521153
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supplim with an alarm.
• .amble level sonnet sNilehes are available for contrnNeg , -
;inyie phase systems. _ - _ ; - -
Double piggyback variable level float switches are available
fo? variable level long zed short cycle tontro!s.
Seated O.vik Box available for olddoor instaloutorri Si
-
f
1 S1~f1 llj~ I I-1E~.1' ll01 l a.•
H 1 I 4oltsPh lock Ai 1p. Simpl > 01 kz
fil IG 1 ii ba truuded [ r3 i -
?.1 2441 i ' w 32 1. --a + : -
JO I amo N^c \ Easy assembly` .12 n l I15 Nol 8.6 1 -s nJ rum l I 1 s: u,,
utl. I 115 Al 65 Indi d
Sir \ )
1$° 36 NO, 4 r3
1115 'S 45 -.r-i
1 1 )5 > 1 hdvPd 2, 3 yr - '„Ty r
i 3 210 - 1 _ --5i5 2ce3
k: ' 3 Fcudol r3 Il
r ,3 .no
Sn ,R pg3yhaCx rarraore level Mat svnlCh a duuul~ pggyttacic varwme'e.a
float iiii Rele'tu FLlOalz Reduces pofcn6al lai by deLris.
Sr;r• F4A71? her carats ndxiat nl Fledlral?Jtemala Pak Rep+aces rol or bricks under Ole Pump.
Made of durable roltctxral ABS.
.:,,ole lwur conlKll;vrdcAl iOil;d'.t used asa nplttd acfiva!ac.spe^:iy Q;;:.-): Raises pump T' off bottom of balm.
n1 s~•11 sysl~ PrmiI 1:e ability to rase dltake by adoillg 6eUtOns o;
or 2" PVC ptping-
?f~.uiiilN 1I Adaches seanelly to pump
AccolitiWates sump, dowatennp ardl effluent apphcatti
NOTE: Make sure Owl Is free rrom e6etructon I kill .ci,Iinlol!mrl1~'allnnfc•ll7nl?Ihxpi
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'oc~)'-up,ni?cU S!`iklsi:~~]:' f•c(i,nt Q f)iher
l Ited i I'I to lcahh yE9 it <nn!hi tr. `foil \i)sn!plutr (.cn'rivm nt to Pi;\!
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tia.f) r 1 f';K I ! ,t- tr lla : u)a nt nl rn - nr > _:'lt h
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5!\fr !1•'1;5(ar'lt!lu ~Ot( \ .rrl F~,lq~t (..ni?r~(nwa. v~.rn,Ln'b it.t_b
j30 , lh~r r [th:an?j .•J!!) h„a „lih ut Qrpv>:dt t 'ganlcnl n'Ia!t,
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',v urn. to a .i..a t n!:!. i. tft.u t panun;,
u'a a nl 1 ttsti auu UI u.1 l t (.It iitJi l I C6I;SSr li hl~!1 COIRi(1(f51(IOiLC .!}'P. UCICCiC(] 11,)\,.~
~i uxtl?tt(~ UI tr t Lnt~ Icy Itlnnvt~' h} ! i)t a "no, ;r, ~t<tenlst.l. In) shulinotocrul uiten
iiit tioil condirious art: I'rot:n
khc io r:ttit- ,tzr:ave.
rn : ❑c'[' u . pens 71 IoI lha np~rdiiiu, a!N !u:tinicl llbt n( the ;'f 111'l S t i sul)m c: t a'.' •5'cci: e .p:. 't y -a:. tU!`: ana
Iln ..I* r'!c• n,.>tt.!:;!ter Ur 'u! rdi iicCl tilt peti)I .taa er,d long:'. POs,' , ti lh.. imx:tlf~uo, n: -s❑o:r-+,^.• m~ anf!iairtc3 :md
.li !nI' S IIPIt'_ %%:[I _omly i la! t i~al l 'S ti ..L l'..'c r tul nnt. I: rIIIt prlill OI , tilt' 110171/1 ICr .ptlldlU\ I^01 1 n)n''11 uaii:.
: Ih r alr'x .:.tlu r '.uncm da .r,( I; L. da,'au ,Ira! t.:6oule Ia VIt„u : -<,Ilhwe ..r..,....', bl.:. i:r I.: Ic15 dnq Iqu
ll n I_ Id, n:ri., i;, ll` rill \:._t •1[.
tis. ui:m IN icscncd tr. handl: S,rnu:•Ii.. ,u.a •.Iil .vastca'n'r- , a':.ccc_:'. lIra-di;;pu.:al of k"A ha"'i I:I CJSCS. t111T. :c~:ClaVti'i )t'lrl! pcCh..
td: ue:nes. and lived snh 1<. :u:.it ;L<!no..: I:[udaacli a 3arn _t dispa:al sMruld I•e minimi<ed. Toilet [issue is the nnl paper Ihm .hnule;
dirahu-g'd ink. dtc s. [aut-fibber' nnn-hi: •dc}r rJa b1: ilc... such :n babv ,cipes. Innrnons. tmhnn' Introkin r;nndorr uiya!cllt buu:l.
u•I f ;Ind aoilue ,'u4•. 111nAjt1 f,)( Ul!l'. "l+l.~n" ' IP:a'. p'il:. I". 111? 1'r I~IJ 'I
,i•'.nhn uK:(rl ).L'_: ilcuntiinan_'I.;.,ur a.liIhl.:w!!,t.ar.hmvthlr,r.1,lOaII»'.:aGI,A-mid Nehiilemilfil 1AL-I
nIi svslcm eongimt,-ni>. C:ompou't,:: „ts'a.u „ya lnc;lis"Cl'ml unit r, rev cause it b, irecze up.
I\'SPVCTIONS_& \L11 N' ENANCE: lnspecti-,o shall by Lade i,v an oulivldunl caning unc uI' the lid!otrin_ liccns..:. .r
ccnitications: tv!asicr Plumber. \'laswr Plumber Restricted Scwct. POW 1'S Minnlainer, nr Scpla_.e ticrvicinl- I lpcralnr flier Inc ana,h.
\dai nletancc ~thcdulcl. I&Ik in.pccl ions, nmsf iochxiC a aisu,.I ;nSpcc.Iion ,.,I the Ian, It, idvwify any micsin -j or I n:Acn h,uc•,t;:
idcimiy ally crack, or Ic,lks, n0.7tsuic the vodnmc of coniNi ed ito(k-,c and m; o n and check IIli' ally bacliup pending of elllur:n I, .I
1•raund eurlawr and test all electrical rquipnmu such aN pumps aid aliovo5. An) dclccC<shall he promptly commd. I:apuscd 1, xi.-
_ilr,ucr Iha n X ua: hr: in diameter :I IA bL scurcd avith cl WOI%C Inckin;_. dcvires it, prevent accidental or uniurthoria:cl Cott) Uu.:,lI'-,
hen theonnhination,a,efude,-and Sean rnanv lank atccA.+,.tlc-U,irJtl ±)or Ow Junk vu?wur. the entire content,, t1:,
i,; 1, ahall bC icmovaid by .I tieptugc Stn icio i)peralnl and 0i'llOWd of in acctadancC with ('h. NR I I Wisconsin Adion,
I: 61ic secicim, Inceha»ic's must he Prot hied it rcrticai is :.I i Ice( In hhuriA,mai is : 150 Ice( atA inSlruraiuns to hr protidVE! beruty.
I to outlet liI I cris I sha 11 he inspceled andcleaned la rcmm'enm'aeeumilimcd snlidsaccordiIn to ilia nu ISel lit-Ces spec)I1calioI is. S~L•.'.
,:;:N ivd from the Rher .hall be reuainetl in 11w lank. Piha CLanin-, may be nceCSarv at more licqucnl intervak thae, slated in ;h.:
~;~inamancc >c hCduh` I„k:•cplhC:.v;lam .1~cra:uh,
6 ,mil" should by tested on n wmilar basis by the home owner. Kin alarm Sounds, contact :m individual licensed to service 11M).
' ;
i,crc is uuunall, a I (kv, reurvc under rel-ular opcnoin- cnuJitionc. itiwevcr cater shuuid be conceived until any problems with Ilia,
=.v.arnnt we rorrccwd a., prewto hack-up o,Cscwagc Ivan file kimciline of suilaoine.
NIfA,NUON_YIE:\"F: NVIwn the 1't AV f S Iaii. is 1 :rioananly ::d.cn o+.n nl-Nen ivc Ihr Ibl:'nwlnr sh•ps Ill ,,l! I',L!I .I:.
Gm>vstrtut is prnpcily and v,lclr abandoned in compli:mc, cyith I'it. Sl'S ;\?.3,. Wi>cnnsm :dodo. C:odc.
All piping to tanks and pis shall be Jisronnectcd and the abandoned pipe opiniu, s >valvd.
ILc cnownis or all tanks nnJ pith .hall he removed and properly diapnsed of-hy a Ccplagc Servicing Opci.o,,
Alicr puntpim;. all lank, and pits shall he Cvcnvincd and nnnovcd or their cIlvers rcrinwel and the eoid -ace.: 5!Ic.! o:i~.lL 1„
gravel. •,r n llc• inert mild w1wri:11
-
OM_t'INC:ENCS PLAN: I I'the Ili AVI S rails and cannel be n-paircd the li+ldoxvine w murk's have I+cen. or must Ile taken. it, !nkn iJe it
i. "rn nli:mi rcplarcotr nl rystc»I:
:uil:rhlc wplavelnenl area has been evalmuted and mu) k utilized 4111' (Ile loWtluli of :I n•placcmertt soil abN,nptimt SySicln. The
nv.m ❑m., .h,mld Lo plnb'Clcd oven dis'(wbance and compaqunt and sbmd,l tai by inliin•icd upon ho required Ctbacks
m e\Ldllt'{ bill pronosrd slruttulc. lot line, and y.eiks. I'ailun. In protect the replaccnten; larva renders it unmuble. Rcplaccincnn
AI nA must eolnph) mint file rules ht sheet at the tints of ccplacernun.
I . '+011:1bic replaccmcnl ar:a I, not avmiid>it Joy h, S,:tback and/or .oil linumtions. Bairin^ advances lit POU' hS icchnodoa) I
n,Idin_ ;:na< nm\ be in.tI.111ui a: a I:I,! resort io wplacS: the laded 1'O\l'TS.
I lie soc has tot been eealuawd to identil~ it Nuitahlc rcplaccnlatt :area. I:pon failure of [Ile POW) S a Soil mid she evaluldiun ninsl
!,r p,:r G,nln'J I" IucilC a xtitubiC reniac<nerl .rra. !i nu roP!3cvnlenl area is avmlahle a hoidim.• kink nrrv Ew installed J' a la:;l
IL:son In ikpliicc the iailyd I'( t11 1S.
\,IoImJ and al-grade soil absorption Systems may be rewnstructcd ill place following tenu,vul of 111C biumaL al the infiltrative
Sort:. r. Rcconslraciionsofsucit s):;ICnts nxislcomph'with thr talc. in Crlrytat that link.
\RNING':'t SfAlll(', Ill NIP. AND OTHI'.R TILE.\7'MUN1 I \NFS 11A), C'0\1'1 C\ I.F.Mill. (,ASSI(N '.x)/OR I\SDFFICIEN'I
O\YGI.N. UO NOI E\Ttrit A SIT*I C', I'( Nil'. OR 01'111CR *1-RCA1 IIEN1 -IANN t NUF.R ANY CIRC t'NISFAM E.S. UF:A Ill
\1:a \'Itl?SI'.L1'. ft {•:S000(1F 41'ERS(1N ITRON1TIlEt's ITRIOIt OF .\i-ANIC \L\V REi)IFFi('V[A OR I1NIPOSSII)LF..
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Document Number Document Title Tx:4460244 I
St. Croix County 1071892
BETH PABST
REGISTER OF DEEDS J
Occupancy Affidavit ST. CROIX CO., WI
` RECEIVED FOR RECORD k
e~PilYltA.lk Cji 0.ry5~~ 09/26/201802:06 PM
f
Name - (Owner) Typed or printed EXEMPT
REC FEE 30.00
being duly swom , states, under oath, that:
COPY FEE 2.00
He/she is the owner/part owner of the following parcel of land located in St. PAGES: 1
Croix County Wisconsin, recorded in Volume - Page - Document
t
Number 1664(O+1(o SL Croix County Register of Deeds Office: rtocordi area
A parcel of I d located in the SE Y. of the SE % of Section 22, TZ% N - R 17 Name and R um Address i
W, Town Ofn "1- V t Croix County, Wisconsin, being duly described ~sttn+t" 4;, 7 e_
as follows (include lot no. nd subdivision/CSM or detailed legal AoU Aick..1 W }
description) vermeils vT s-yo ak I
1,1- l of C~n~F;~ Soorue-4 ►MAP 90- E
~610A t.• 7-8 Y.~e 63`JZ U bb. /ry699Z Parcel IdentificationNumber (PIN) i
i
As owner of the above described property, 1 acknowledge that a private On-site Wastewater'l'reatment System
(POW'TS) serving the primary residence is sized for ` Ix drixnri with a design wastewater flow of 40110gallons/day I
(DWF is based on 150 gpd /bedroom (a) 2 persons per bedroom). A maximum of I occupants are permitted; if the
number of occupants exceeds the maximum for POWTS design, the system will be undersized to accommodate
increased wastewater flows and/or contaminant loads and may be subject to premature failure. I also acknowledge
that I will make this information available to any future parties interested in purchasing this property.
Dated Ls day of Sir ~I 6.~ D l d
' et~mi,l: G.n
f
f
r y
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
)ss.
St. Crol authenticated this day of _ _ -,at t t t t (l7rr', ttssonally came before me this 'Y '-day of C
``max a above named
« • 49 ; Z Z me known to be the person(s) who executed the foregoing
TITLE- MEMBER STATE BAR OF WISCONSI/t !
(a not, . A -.eWmenl and acknowledge the same.
authorized by § 706.06. Wis. Slats.) ~ iON 10
. • 2 c j
THIS INSTRUMENT WAS DRAF 7 L0 aY: '~i 0•.,•~• •••,f~Gj `S
Community Development Department St. Ci6fit I ~f```~: _
Notary Public. S e of Wisconsin
(Signatures may be authenticated or acknowledged. Both are not My Commiss Is permanent. If not, state expiration date*
necessary.) Date- _i22111111`7
{i
t
St. Croix County 1071892 Pagel of 1
• ( ROIX CM NT1'
t'III i'. AI~Vir11\IFV'A-M FA61<ii.'~lr\I
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ACdfcs 4 I I C1-I Lam. 5T (15
I I t; \I, DESCR1111'10\
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)+r)dicision
rtiGed Sun's,' Nlap 2-49 42-
I r fall :h' Used
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l'ti7 Q1 MAINTE\:\1( E A D O\\?\TR CER'UIVICATIO\
:iccI , , I t: sei I-r.•":u!resuna .~.rn I mr t: I-, r'-. l
r ants once col su ,1 r: t , n :.'~t tl c , ti Car e t ,m w w : :I roc I h , Lo. • t I ¢rpe t a ru p:rt :r::n
s t rn cas t :h s pt t..ark t ¢ca1111 nt st ec m th uas0. dspo_a! ren Ow^tct
? It.bII1:[C, .{r6 Sp flied in Li omn.. 81 52i. i i an' it muntcnaxe
•,apt t ? St Cn.I♦ t'-unry ';amt;ir, t )rdrnanG'.'.
The proper" nq y r a, qt s o "'J, Corns P ann:np & Z,nir, De a. n Itr, a m: tc v ir~;ec•1 L+}
a -cd hp a r tamer pia n`a j .r, r;; y um. Plumber, .co,ricte:I pnitn"vt rx a licensed n.r.•p,.,
Lcr 91x1 os+~ , atcm L: 1 , ..por upern`:ng condmo« and cr 121 altrr uu,:rtr.oa ar 1.L.,.
'hc unccaig w La, -I t:xne reeuurn,ent> and al!rrc ra ILnnta!s ; . i r.:.,,- r; p,..a ..,n., tr: d:r
herein. a u the Dees-1'cr, of l onunci,c and ckv Depam:,eat a r;zl r •s.:;::.a ..1 ,.;or..,n.
••:t sntt nn that pot I cpt system has Caen mainfamed meEV be corm::-1cd and -ru:r.rd '.c Jie 5:.-ro:>. !'L-•unia❑ t
•E D-rc,rnrienl AI:hn, t.,,u:av
n,y n' tht d; re year axpirau:Ir. d'<tr. .
I toes fnt, llat ;ll'Stflttutrn(a ,I r, ,
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n dcscnfx,' ahioc >,y Irw of
At:
"will) be Enon, 1
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a.r: Intumttuon rhat i< nusmnrrs: r.:rd may resutl Ir. the sani?irv pt:mtit briny revoked the P:'aunmc Zon:n;t I?; pa: e~xra. ,
BUILDING EXTENSION z
FOUND 1-V4" IRON PIPE .
I.O.H.- IOP OF WOOD HUR FIFVATION
TOP- TOP OF IRON PIPE ELEVATION y X i
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SETBACK LINE* ci s
100' FRONT c s ;
10' SIDE MIN, 25TOTAL
25' REAR
UTILITY BASLMLN I
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PROPERTY ADDRESS:
_ 170TH STREET
RIVER FALLS WI 54022
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N89°50'23"W 420.09'
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