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HomeMy WebLinkAbout022-1033-30-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and' Building Division INSPECTION REPORT Sanitary Permit No 488084 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Leary, Mike Kinnickinnic, Town of 022 - 1033 -30 -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: rCo - �Q�.. I cs-r "5" — Z_ 12.28.18.179A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark GS' , s# L CS i Dosing Alt. BM Aeration Bldg. Sewer v . 9 19 -ye H olding St /Ht Inlet ' 77 TANK SETBACK INFORMATION t t utlet c 7 TANK TO P/L WELL BLDG. V ent o Air In ROAD Dt I n l e t ep is Dt Bottom >,tz c• osing Head er/Man. ti era ion D ist. Pipe 7 .1 r, )(. L7 5 . C ti o ing o ys em 2 . 7 Sti G ma ra a � PUMP /SIPHON INFORMATION' manuf acturer Demand St Cover GPM 1.-:c <<.,,,�, !. Z 01 m odel u er r n oss ys em ea i - o rcemain I Lengin 1 015. 3 DIMENSIONS 3 -6 h-lcQ c' --7t:LL 7 INFORMATION CHAMBER OR 1 �� i UNIT cam.; L � - J, - , - .. , /G' c Cam' Z r) c Pd011y Pipe(s) JA I— Length '2 Dia N Length Dia Spacing — SOIL UUVER x Pressure Systems Only xx Mound Or At -Grade Systems Only R,Ptll or Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No 1 t . �OMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 'f / 5' / !� t-- Inspection #2: 464 Division Avenue River Falls, WI 54022 (SW 1/4 NE 1/4 12 T28N R18W) NA Lot 1 Parcel No: 12-28.18.179A10 igth •'� < . ,•. � . � -4 . � {r.r .�'��. L4c.�- } Sys �. �' C' � 'er c-c- v elk-. 5� e� 'L- -n- s Yes al information. No i G , O (� II ateJ Pctors Signature D - — - - - Safety and Buildings Division County 2 . Washingto - V # 6cons w Madison, 5370 VE Sani Permit Number (to be filled in by Co.) Department of Comme (608) 66 -3151 O DN Sanita i<t Appliead n 2006 State Ian I.D. Number In accord with Comm 83.2 , Wis. Adm. Code, personal informati n you vide may be used for secondary purposes Privacy Law, s 15. 1 xm)� CROIX COU Proje t Address (if different than mailing address) I. Application Information — Please Print All Information �'-fb`� Dtv/s low �6. Property Owner's Name Pazcel # Lot # ( Block # Property Owner's Mailing Address Property Location -3 57 s City, State Zip Code Phone Number w - z., 'v ` v., Section f 2 gtveI �a5 1 54 0 �l �-' yd .. 4 �t N; R L [-�( �[�cE ti �g tI� 1r -1 {7+' ircle a f II T o< . Type of Building check all that apply) f ��� ..�,rr 1 or 2 Family Dwelling — Number of Bedrooms tt, , Subdivision Name CSM Number ❑ Public/Commercial — Describe Use — pn 0 T1 ❑State Owned — Describe Use wo - -ca -& ❑City_❑VillageJZTownshipof iv Aitk,wtiz-c III. Type of Permit: (Check only one bog on line A. Complete line B if applicable) A. stem ❑ Replacement stem New S Re S System p y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision El Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System- Check all that a 1 e� u lJ ITS 3p 111 [I QC et Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound <24 i . of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding"Cank ❑ Peat Filte ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter ❑ Drip Line ravel-less Pip ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (so System Elevation & 1 , 010 1 o 1 15 00 1 1 Boo 1 24- N VI. Tank Info Capacity in Total Number Manufacturer ' I Prefab Site Steel Fiber Plastic Gallons Gallons of Units l Ppt�I�S�I�C�) Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank O f7 A erobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number L 4 C ar l P eis� AW �� ©mss 7�� 4V -4��2oa Plumber's Address (Street, City, State, Zip Code) l04Z s. 01' 5; : R,uer 1h �s ✓�4'G zv VIII. Countyffiepartment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu Agent Signature (No Stamps) Surcharge Fee) ❑ eason for Denial � . 29 IX. Conditions Ap ro val /n� ^^ n nn SYSTEM OWNER: 3) � (S. � c �r m D , z 44 1 Septic tank, effluent filter and n dispersal cell must all be serviced / maintained S � I as per management plan provided by plumber. �(�Ai 2. All setback requirements must be maintained S s4ew as per applicable code /ordinances. ' J c t� /1 1 tUr t Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD -6398 (R. 01/03) t T�6 S WL L EARr PLOT PLA N SCALE 1_ 90 zo a a M 0 orosi p i7r v w writ ° i. 4F.�trm ol fl t.TE& ol /a E7— FLOW5 0' TOTTAL U S I CE 6BA * j TOP 3/4" PVC PIPE - 7 "HIGH EL 16,0 PRIVItrE BM 2 TOP *4 PVC PIPE 5' HIGH EL 10 NiUETC 5 ' Q }d►510� A vel O 3q.�.G4 MIKE- LEARY PLOT PLAN SCALE I -90' 20 a M 0 c� �9 i PROPoslep ^�-- -- ----- �E1L ° 1250 SEPTIC Wfp6Gl+t o , i c IN TALL 3 CELL5 W/8 E -Z FIOW5 t I CE1-1- W /o EZ FLOWS 300' TOTAL GPCLS TOP 3/ 4" PVC P 7 "HIGH EL 96 PRIVATE 8M 2 TOP 314' PvC PIPE 5' NIGH EL. 1 "0 ' 091E TC � pi�is�oa A ve. , 4 u rya 3Q�. G4 i POWTS OWNER MANUAL & MANAGEMENT PLAN Page _L of � 7 FILE INFORMATION SYSTEM SPECIFICATIONS Owner rA i ze Gc.�, V Septic Tank Capacity a l 13 NA Permit # 2LU Septic Tank Manufacturer ` -7S ay ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model Z ❑ NA Number of Public Facility Units (XNNA Pump Tank Capacity al J&NA Estimated flow (average) 400 gal /day Pump Tank Manufacturer J2( NA Design flow (peak), (Estimated x 1.5) 00 gal /day Pump Manufacturer kJ NA Soil Application Rate Q, gal/day/ft' Pump Model b-NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A"A Fats, Oil & Grease (FOG) <3`0 mg/ ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (B0D " 220 m /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ARQn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size a in pia. ❑ NA Other: `, G,EcA _ I U ❑ NA G Other: ❑ NA Other: owS a ❑ NA f%�l -Io * Values typical for domestic wastewater and septic tank effluent. Other: 7 w 3 ❑ NA MAINTENANCE SCHEDULE " Service Event Service Frequency Inspect condition of tank(s) At least once ever ❑ month(s) (Maximum 3 ears) ❑ NA y' � JR year(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dis ersal cells) At feast once ever ❑ month(s) p y ears) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: hs f O month ) w / 111 ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month ❑year(s) ) NA Flush laterals and pressure test At least once every: ❑ month ❑year(s) ) to NA year(s) Other: ❑ month(s) At least once every: ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. - -- A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP, AND OPERATION Page _L_ of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. - Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER N � ame T er f• Name Phone 2r� 425 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name �d' Z �'n r Li Phone Phone 3 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 08/24/05 WED 08:12 FAX 715 386 4686 X1001 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Cr,.r 7 _ _ Mailing Address Property Address �4 I -�- (Verification required from Planning & Zoning Department for new construction.) City /State R i o c;r Fo A (j-)J _ Parcel Identification Number 6:3 LEGAL DESCRIPTION Property Location (N '/a , % , Sec. , '1' N R_2 Town of 1 � w � 4 r-t r.� j" c Subdivision , Lot # Certified Survey Map # Volume .Page #t 46 4 2 z X 91 `Warranty Deed # 7Z � — Volume _, Page Spec house yes Lot lines identifiable 1 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and n 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. pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary O rdinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, ,journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on - site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources,' tate of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge, i /we anVarc the owner(s) of the property &c scribed above, by virtue of a warranty deed recorded in Register of Deeds Office. A zzzc�> —z � L /lam lCre SIGNA OF APPLICANT DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.*' Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of ;Jie certified survey map if reference is made in the warranty deed. (REV. 08 10S) Wiscdnsin Department of Commerce SOIL EVALUATION REPORT Page 1 of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code S't Cj lK Attach complete site plan on paper not !ess than 8 1/2 x 11 irtiGMes•iR.sj.;�e. Plan must County include, but not limited to: vertical and horizontal reference O-Qjn�-gg)j, i and Parcel I.D. 130 � 6 percent slope, scale or dimensions, north arrow, and Iodation and distdn�e.to. iearest road. 22 -r' 3 - 3c�-2oo Please print all i ,dr iation: eviewed Date Personal information you provide may be used for edondary purpq�sriJacy Law, s 15.04 (1) (m)). Property Owner r Property ocation C l0 ,(lei C6LC�C C St3 1/4 Prz 1/4 S 1Z T Za N R 1 S E (o Property Owners Mailing Address _ C OU •FF, . eot # �/ Block # Subd. N a ame or CSM# rc City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road I sL�oz3 ( :.s S��q ktirv�i\'0 1Q , 4c �Av`sto�, A v�Ue New Construction Use: Q Residential / Number of bedrooms _4 Code derived design flow rate 60o GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material L O E�n S O V LCL OUTLJ r S Flood Plain elevation if applicable Iy ft. General comments and recommendations: ����'l r'1 � cel� rz�e 4 3 rX 8 I IS � L G j4 tPmPc e l rl LLeI� L1� 1 L`12s. rh Ql:tQiLD u� � OF - M - tie ❑ ❑Boring �-- S Boring # _ o• ,,w� �t 1 ®pit Ground surface elev. � S' S ft. Depth to limiting factor � �� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roo GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ` p_t3 Lp`1 SZ 2LZ — S I Z blZ »1: CLV - Z 31 — s i I Z'Fsbh lvL`P1- - • S - B 3 Z� 3$ 1p ��z y JL S 1c5 m Cry — . .� t/ �-`�i7 1 0 `1 R4/1 b �g �S � - • t 7 Boring # ❑ Boring Z © pit Ground surface elev. 1 �� S ft. Depth to limiting factor 7-1 f� in. it Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roo GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E `Eff#2 C:i- I n-2 Z l — sl I Z mfg O-w zf Z )y -31 cc - 3 31 -4�/ loY23l — s1 Z.x ynft ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg /L ' Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) ignatu CST Number Arthur L. Wegerer aa? Ul`y k4_ � 220254 Address W e g e r e r Soil T e s t i n g & Design Service D a Evaluation Conducted Telephone Number 421 N. Bain St. River Falls, WI 54022 0 715 -425 -0165 l Property Owner 1 8aj &r3kj ' IS Parcel ID# Ply ►z)DUG Page Z of 3 a Boring # ❑ Boring ® Pit Ground surface elev. �! ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 p_ 1 1 p`11Z 3 L Z 9 Z`�Sh1z m'F1- `) Z '� S • B Z t1�33 lo2tz3�L s!! ZW1 we` - • S • 1AI-sh m u - f1 , Y S3-8b !o `�VZ�Ll6 L S o 9 r►�►) _ - ��Z. ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure e Consistence Boundary Roots GPD /ft 2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 F-1 Boring # ❑ Boring El pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, i 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.6100) PLOT PLAN Page 3 of -3 Scale � M'A-) - EL. q 6.0 ' ory - 1 " L`tq o I . ?\J C Lam L PF w/ L FV 3?^-1 t+Z - �L, 100.0 + OU S '� L+dGL+, 1Pv C P t l't wl LPr1�} CsPsuF - Z> Ivor L�LShJ�Zt3 ,, - ti L uu lz� a F LoT' • r3 � 8e3 a SU - mssl NIL* r-w- °`� HL1�1Z�ut� S`1STC�.r 2eS.q9' r� 0 �i OD \ N_ O s ITS- Lo ENn S Yuem bA I� �R a vvL 3_21 1 715- 425 -0165 220254 01 _4 - I CST Signature Date Telephone I•do. CST No. Job NO. 1 2268 y91 725114 KATHLEEN H. WALSH DOCUMENT NUMBER REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., MI RECEIVED FOR RECORD 06/10/2003 09:30AN Thomas O. Benson and Jane Benson, husband and wife, Grantor, conveys WARRANTY DEED and warrants to Michael R. Leary and Shirley C. Leary, husband and wife EXERT holding as survivorship marital property, Grantee, the following described real estate in St. Croix County, State of Wisconsin: REC FEE 11.00 TRANS FEE: 225,00 LOT ONE (1) OF CERTIFIED SURVEY MAP IN VOLUME FIFTEEN (15) OF CERTIFIED COPY FEE: SURVEY MAPS, PAGE 4094, AS DOCUMENT NUMBER 646717, FILED IN ST. CROIX CC FEES PAGfi5: 1 COUNTY REGISTER OF DEEDS OFFICE ON MAY 29, 2001, BEING LOCATED IN THE SOUTHWEST QUARTER OF THE NORTHEAST QUARTER (SW 1/4 OF NE 1/4) OF SECTION TWELVE (12), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC. Together with easement along the South line of the Southwest Quarter of the Northeast Quarter in Volume 1678, pages 461 -463, as document number NAME AND RETURN ADDRESS 650907 and as shown on said Certified Survey Map. Fir MTTCWL P p St. Croix County, Wisconsin. FO BCN 166 KM FAILS, WI 54022 022- 1033 -30 -200 Parcel Identification Number This i of homestead property. is sn to et . P P Y Exception to warranties: All easements, restrictions and rights -of -way of record, if any. Dated this day of May, 2003. (SEAL) (SEAL) Thomas G. Benson (SEAL) a •� -ri.�0 tir YL..� (SEAL) Jane Bent n AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ S'i'A"t'S OF WISCONSIN ) ) so. COUNTY ) authenticated this day of 2003 Personally came before me. ..day of May, 2003, the above named Thomas o tF��Y!ffi., Bane Benson (Signature) to me known to be the pe *Ao s :}ho ercfcdted the fore oin instrument aryl Z e' ame. (Name Printed or Typed) � All TITLE: MEMBER STATE BAR OF WISCONSIN _ . • *' (Signature (If not, G authorized by 5706.06, Wis. State.) * Rime Printed or ea THIS INSTRUMENT WAS DRAFTED BY: Notary Public le i S L a , County, Wis. Leo A. Banker, Attorney My commission is perm n F�•( f,A .te ration date:) RODLI , BESKAR, BOLES & KRUEGER, S.C. 219 North Main Street, P.O. Box 138 _ ! '�../.... .... :�``` River Falls, WI 54022 S Cn ►-� L5 CtJA3 o 0 �_]W QW w z a � . o �_ � u WW �LYe mob' wae'' aea S1 SURV 'f ¢w� RTIFIED SURVEY MAP Gerald and Kathleen Benson, etal. Located in the Southwest % of the Northeast Y4 of Section 12, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin OWNER'S ADDRESS 651 150TH STREET ROBERTS, Wl 54023 NORTH 1F4 CORNER SECTION 1z T28 N R 18 w NOTE REGARDING NOISE LEVELS (FOUND COUNTY BERNT SEN NM) "The lots of this land division may experience noise at levels exceeding the NORTH -SOUTH levels in s. Trans. 405.04, Table 1. These levels are based on federal standards. g; 114 SECTIONUNE The Department of Transportation is not responsible for abating noise from a existing state trunk highways or connecting highways, in the absence of any m ;. increase by the department to the highway's through -lane capacity." U D.O.T. Approval No. 55 -94- 3231 -2001 N ° MAIMS ARE WWROM Z TO THE NORTH -SOUTH 1/4 UNPLA7TED LANDS SECTION LINE of SECTION 12, OWNED BY PLATTER T n K R 8 ASSUM®AS ,. e.0' N 88 °41'32" E APPROVED 205.49' SCALE /N FLEET I a m' ST. CROIX COUNTY w + c Planning Zoning and Parks COrgm", itt 39 3 \ c m o 0 100 0 1 0 200 + g MAY 2 9 2001 If not recorded within 30 days of LEGEND approval MCI Wma shall be S Z; t - O INDICATES 1 "x 24' IRON PIPE SET 3 Te to ' ' p (MIN. VVr -1.13 LBAIN. FT.) ;Z I I 41 A SOIL BORINGS (PROPOSED SEPTIC SYSTEM) Uj Z '� SECTION CORNER MONUMENT (AS NOTED) Z� LOT 1 p ` --+, .,10 x INDICA TES FENCELINE I �i I COO' - I 212,420 SQ. FT OR4.877AC. A a, , 4. I W; 00 1 C) Z ,I� o. Lf) � ;° PRIVATE DRIVEWAYEASEMENT I m! ° ^ �j� N PER VOLUME , PAGE EASTUNE z OF ST. CROIX COUNTY RECORDS SW114 -NEW SIN coRNER - - - - -- ' 33.01 ._ I a sw1 w NE1�I — — — — — — S 88 °5 E 960_85_ _ — _ O; 69 69.64' `O------------------ 927 - 84, - - - -- N 395 _� SOUTHU SWI94 _ _ _ 9 06.90 '_ - �' p -2.0' x — — - k N 88 °5843" W 939.91' g ,. -r t 4 - - L UNPIATTED - LANDS CORNER 1 ( p, NORTWSOUTH OWNED BY 07HERS SW I144EI14 w 114 SECTION UNE - ---- - - -- -- -- - -- ------- -- - - -- ��op000O V Oppppppp ,!3 133 QI ° S� S OS 0 �+; 0 00 $ I I (Q 0 LAUR ° E" 00Q S co I cy o PHY S 1713 e I I a SOUTH 114 0 RIVER °.' SECTION 12 T�29 N, R 18 IN Q ° °° F W I. (FOUND 1'NtON PIPE) DATED: � ° ° ° . , ... , . MARCH 8, 2001 OOp p 00p � N m0 0% ) OOa o0 ODOOo THIS INSTRUMENT DRAFTED BY JERALD L LARSON SHEET I OF 2 OL Vol . 1 5 Page 4094 so