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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
487954 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:
Pelo uin, Eugene & Darlene I St. Joseph, Town of 030 - 1019 -20 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
05.29.19.806
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht I t f
S/Ht utlet
TANK SETBACK INF6 ATION
TANK TO P/L ELL BLDG. Vent to Air Intake OA
Septic t Botto
Dosing ader/Khan.
Aeration Dist. Pipe
Holding Bot. Syste
Fi rade
PUMP /S INFORMATI N
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head DH Ft
Forcemain Length Dia. Dist. to VrIIZ
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number.
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over TBedp Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center rench Edges Topsoil
g p ' ] Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 410 River Road Hudson, WI 54016 (SW 1/4 NW 1/4 5 T29N R1 9W) NA Lot Parcel No: 05.29.19.808
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? Yes I No
Use other side for additional information.
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County
m 201 W. Washington Ave., P. Box 7162
NVIsconsin Madison, WI 53707 2 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 -3151
Sanitary Permit Application State Pan I.D. Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s 15.04(1 xm) Woject Address (if different than mailing address)
1. Application Information– Please Print All Information Sbr�,Q
Property Owner's Name s I Parcel # Lot # Block #
f_4 W A ti tN 0 .1J !I i) 03�. - do v 80
Property Owner's ailing Address Property Location
ST. CROIX COUNTY
ZONING OFFICE /V W y. Section
City State r 1 Zip Code 1 Phone Numbe
(�"�bs DU W , ! �g - � V �E or W )
T o� 9 N; R
H. Type of Building (check all that apply)
Subdivision Name CSM Number
❑ 1 or 2 Family Dwelling - Number of Bedrooms
❑ Public/Commercial — Describe Use
❑ State Owned — Describe Use ❑City_ ❑Village ❑Township of 1 0
111. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ New System .Replacement System g p y 8 Y
❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System
B. ❑Permit Renewal ❑Permit Revision ❑ Change of ❑Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expirat ?on Plumber Owner
IV. Type of POWTS System: Check all that apply)
°
WNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter K Leaching Q ❑ Dri ❑ Gravel -less Pipe W Other (explai )
V. Dispersal/Treat ent Area Information: t rrt
Design Flow (gpd) Design Soil Ap lication Rat gpdsf) Dispersal Area Required f) Dispersal Area Proposed (if) System Elevation
4So Ias Iisu - 90"0()
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units ��� p —lC0 Concrete Site Glass
New Existing
Tanks Tanks
Septic or Holding Tank
W e el.i
Aerobic Treatment Unit
Dosing Chamber
V II. Responsibility Statement- 1, the undersigned, assume responsibility for installation o the POWTS shown on the attached plans.
Plumber's Name (Print) Plu 's Si ure MP/MPRS Number Business Phone Number
rv� �u �, es`�clt as ag U�
B x-16
Plumber's Address (Street, City, State, Zip Code ^
) b? J W V OXA'P�du W j SW f
VIII. County/ /De a rment a Onl V Approved ❑ D ved Sanitary Permit Fee ' icludes Groundwater Date Issued Issuing gent Signatu ( Stamps)
Surcharge Fee) Z S
en n for Denial
IX. Condition o All it/it
SYSTE NER:
1 Septic tank, effluent filter and `C 6—
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not leas than 81/2 x 11 Inches in sin
SBD -6398 (R. 01/03)
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1915
�* SOIL EVALUATION REPORT page 1 of 3
Division of Safety and IkAdings In accordance With Wis. Awn. Code A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8 x 11 incim in s ust County
St Croix
dude, but not limited to: vertical and horizarrtal reference point (BM), din
percent slope, scale or dniemsions, north arrow, and location and road. Parcel I.D.
030 - 1019 - 2
Pka se Pd► 0 Reviewed By Date
Pier - W idormatian you i - wo may used Lan. 1 b 5
Property Owner prop`&��
Eugene Darlene Pefoquin JUN 4 2 2005 Govt. Lot SW 1/4 NW19 S 5 T 29 NR 19 W
Property Owners Aug Address ST. C R O I X 00 0 NT Y Lot # Block # I Si Name of CSf k
410 River Road ZONING 0EE1(-F =111 I
City State City _j Village r/ Town Nearest Road
Hudson WI 1 54016 1 (715) 386 -5659 StJoseph 1 410 River Road
New Construction Use: 0 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement _j Public or commercial - Describe:
Parent material Glacial tiff Flood plain elevation, if applicable na
Genial comments
and recommendations: Install conventional POWTS using three trenches with combined E.I.S.A = 1,125sq. tt at elev. = 90.00'.
Jv
FT] Boring # _j Boring
tV Pd Ground Surface elev. 93.92 ft. Doh to limiting wor >89" in. Sod Application Rath
Hon;= Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GPD/fF
inn. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
1 0-10 10yr313 none so 2fsbk mvfr as 2f,1 m 0.6 0.8
2 10-16 10yr5/4 none sid 2fsbk mvfr cW 2f,vf 0.4 0.6
3 16-27 7.5yr4/4 none sl & Is 2msbk mfr cW 1vf 0.6 1.0
4 27-89 7.5yr4/4 none sl 1 msbk ml - - 0.4 0.7
�U
1-193 consists of an unsorted mixture of 7.5yr414 2msbk sl & 7.5yr4/6 Osg ml Is. Loading rate reflects anticipated perrniabilily of horizon associated with
textural variability within horizon. Horizons #4 contains approx. 30% gravel & cobbles.
2 # Boring iI Pit Ground Surface elev. 93.59 It. Depth to limiting factor >83" in. Sod Application Rath
Horizon Depth Donanarnt Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ffT
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 *Et'r#2
1 0-6 1Oyr3/3 none sil 2fsbk mvfr as 2f,1m 0.6 0.8
2 6-16 7.5yr4/6 none Is 0 sg ml cW 2f,vf 0.7 1.6
3 16-28 7.5yr4/4 none sl & Is 2msbk mfr Cw 1vf 0.6 1.0
4 28-83 7.5yr4/4 none sl 1 msbk ml - - 0.4 0.7
C
H#3 con of an i Loading rye retlutcts attictipated per of horizon associated with
textural vaqMty within hon4on. Horizons #4 c ftT gravel & cobbles.
Effluertt #1 = BOD ? 30 < 220 mg/L and 4S >30 < 150 #2 = BOD <30 mg/L and TSS <-M mg/L
CST Name (Please Print) - CST Number
James K Thompson _ 5 -� 3602
Address A.C.E. Sod & Site Eva ivafions Date Evakratim Conducted Telephone Number
340 Paulson Lake Late, Osceola, 520/2005 715 - 248 -7767
property Owner Eugene & Darlene Pektquin Parma ID # 030 -1019- 20-000 Page 2 of 3
`v a Bonng # =�9 94.24 fl. Depth to limiting factor >94" m
le Pit Ground Surface elev. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDMF
in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 Eff#2
1 0-20 10yr3/3 none sil 2fsbk mvfr as 2f,1m 0.6 0.8
2 20-39 1Oyr5/4 none sil 2fsbk mvfr cW 2f,vf 0.6 0.8
3 39-75 7.5yr4/4 none fsl & Ifs 2msbk mfr cW 1vf 0.5 1.0
4 75-94 7.5yr4/4 none sl 1 msbk ml - - 0.4 0.7
Q ,r
�
H#3 consists of an unsorted mixture of 7.5yr4/4 2msbk fsl 9 7.5yr46 Osg ml Ifs. Loading rate reflects anticipated penniabilily of horizon associated with
textural variability within horizon. Horizons #4 contains approx. 30% gravel & cobbles.
F 9 # �9
_; I Pit Ground Surface elev. ft. Depth to limiting factor in. ,a1 Application Rate
Horimn Depth Dominant Color Redox Description Texture Stmcture Consistence Boundary Roots
in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
F-1 # Boft
I Boft
,I PR Ground Sur ace elev. fl. Depth to limiting t in. Sod Application Rate
Horbw Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPQfff
in. Munsell Qu. Sz. Corrt. Color Gr. Sz. Sh. `Eff#1 'Eff#2
' Effluent #1 = BOD 30 < 220 mgIL and TSS >30 < 150 mg/L * Effluent #2 = BOD a 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.
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner I t DPA t �Q 6 ) Septic Tank Capacity 4b ga l ❑ NA
Permit # I✓
S 3 S Septic Tank Manufacturer -fA ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer p ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model A- 10(1 ❑ NA
Number of Public Facility Units IR NA Pump Tank Capacity al $ NA
Estimated flow (average) 300 gal /day Pump Tank Manufacturer ►ANA
Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer Aq NA
Soil Application Rate gal /day /ft2 Pump Model r -ETNA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit t'NA
Fats, Oil & Grease (FOG) S30 mg /L' ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD <220 mg /L — ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD <30 mg /L 29 In-Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) <30 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) <10 cfu /100ml -- ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. — ❑ NA Other: ❑ NA
Other. ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once ever ❑ month(s) (Maximum 3 ears) ❑ NA
p y' earls)
y
Pump out contents of tank(s) When combined sludge and scum equals one -third IY of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
year(s)
Clean effluent filter At least once every: month(s) ❑ NA
year(s)
Inspect pump, pump controls & alarm At least once every: month(s) -�jNA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s)
❑ year(s)
Other: At least once every: ❑ month(s) 5b NA
❑ year(s)
Other:
5 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 <12 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 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:
�G 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
Name rl rn nbbin ,4C Name
Phone " 1� �- 3 0 4� Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Dprw lss Name V- �.ILU G N
Phone OAS - 0 a 51 Phone M• V L 8 u
This document was drafted in compliance with chapter Comm 83.22(2)(bl(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer f kxn" N AA N R I d U l K
Mailing Address b 1 V-k (z
Property Address - i � �R 1x � D o 0
ii 11
(Verification required from Planning & Zoning Department for new construction.)
City /State N ub S u N W S (; Parcel Identification Number 03 10
LEGAL DESCRIPTION $0 g)
Property Location lti� '/4 , ) '/ , Sec. 5 , T N R W, Town of
Subdivision , Lot # —
Certified Survey Map # , Volume "� , Page #
Warranty Deed # 36 S 0 1 ( , Volume 6 s , Page # Q�
Spec house yes no Lot lines identifiable ee no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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 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 Ordinance.
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, State 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 am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 3
(� /0/ 0 �7
$I GNAT99 1i APPLICANT(S) 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 the certified survey map if
reference is made in the warranty deed.
(REV. 08105)
-- - ---
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DOCUMENT NV t t 41 aTA ?[ !AR OF WITCO DEED FORM t
6Q I � VOE U�G A; E wAxstArrr,r
�7oY� i TN�e isPacs RuaRVan r"01 eolr
ReolNe DATA
I�
David J. Wald ff ' REGISTERS OFFICE }'
Thia Deed. made between ..................... .._.._,-,. ];.9 ......... 4
ST. CROU( CO., WIS. ;?
. ................ .. .. . ............
. ................................................................. ............................... ;j Reie'd. for Record l& bat
.............Grantor do Of De a. A.D.
and. ••__Eu ene A. i�eloV* i*1 and Dariena A. Y
_
Pelo n husb ..... .. ... nd aiic vrffe as oint t_nants . .. at :00 A A.
....
..............I .. _...... _ ...... ................................. . _............._... ....
...,.. _....._._. .......... . ............................................... ...............................
.................... . ............................ ...................... ............................ Grantee, ' W"M of Deeds
Wftnesseth, That the said Grantor, for a valuable consideration......
......................................_................................. .........................._.
conveys to Grantee the following described real estate in ... St,..- =
Croix._....-- -
RaTURN TO
- County, State of Wisconsin: it
A parcel of land situated in the 'Southwest I _�
Quarter of Northwest Quarter of Section 5,
Township 29 North, Range 19 West, commencing at Tax Key No .... ...............................
the centerline of the North and South road on the West edge of said
property; thence East 424 feet along the North edge of the East -West
town road a distance of 424 feet to a place which is the point of
beginning of this parcel; thence North at right angles and parallel with
the West line of said quarter section a distance of 217.4 feet; thence
East at right angles and parallel with the South line of the East and
West town road a distance of 200 feet; thence South at right angles with
a line parallel with the West line of said parcel being conveyed a
distance of 217.4 feet to the North line of the East -West town road;
thence West along the North line of said Eas.TWest town road to the 'point
of beginning
This deed is given in performance of a land contract between the parties
dated May 26, 1978, and recorded in the Office of the Register of Deeds.
for St. Croix County, Wisconsin., on May 30, 1978,, Volume 575, Page 17,
Document No. 348972.
A
This ....... °e-_AQ: t ...... homestead property. $�sLIYU' I
(is) (is no t)
Together with all and ain lar the hereditaments and appurtenances thereunto belonging;
David. Waldroff -
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
Existing highways and easements of record.
l
and will warrant and defend the same.
Dated this ....:....,._.19th ...... . day of ____ NOV I er 80
............. ... _. ..._......_..... . .............
. .... .....
f._._... - (SEAL) (SEAL)
. DAVID J. WALDROFF
.... ,..... ................____ .........._._........_._..__... ............_••-- •••- •........_
.......................... •-._...._... ..-•--••- ._• ..................( SEAL) -- • -•••. ----- -_.. ....._....(SEAL)
• ....................•--..._.._...- ---•- ----- .........._..__...... •- --..__... •.._........._...._._......... ...-•- --....
AUTHENTICATION ACHNOWLBDGMBNT
Signatures authenticated this .__ Uth.... day of STATE OF WISCONSIN
,; NQY??t►ke
......................... 19._$0. as.
County.
_. _a. ......................... ....... Personally came before me, this -_------------- 7 day of
. LOIS A. MURRAY the above named ........... ..... 1
....
.... --•--
TITLE: MEMBER ..... STATE WISCONSIN • ................................... ....•••••- •- .._...._-- •- - ----- --
(If not, .................................................
authorised by § 708.06, Wis. State.) ............................................ ...............................
l __ ......_.
' + „ • THIS INlTRUMENT WAS DRAFTED BY to me known. to be the
` person ............ who executed the
$EYWOOD CARL &HURRAY
_ ft.egoing instrument and acknowledge the same.
/_.._ ... ................... ...............................
SudLOn Wisconsin 54016
..... ............. c ,...
I.:
a (Signatures may 6s authenticated or acknowledged. Both Notary Public ............ ..._: ...County, Wis
.)
d a t e: My Commission is permanent. (if not, state expiration
are not necessary
,
� c .............................. 19
eNar of arnoaa slssbiS tf •+.T eaa+eitf should b tTDad or prlat d below their eifsaUnv .
WAELAXTT DEEP STATE BAS OF W=CO348770 wkwoneia � Hunk Ca Tee,
ifOE�a bras —la7T Hawaske., w tJoks4fai!
T- 29 -30 -N • R- 20 -19 -W ST. JOSEPH `W' DIRECTORY
See Pages 135 -140 For Additional Names.
OMERSET'S' PAGE 6 (Residents -Owner or Renter)
ANDERSEN SCO C AMP RD _ 23rd ST 150th AVE 1 '
■Ril <ma I ■Dale I 2 i! Robert I ■ HERON LN
Favllla
w` Germain 9 t
H inz i ■Ernest 'tAmes D
o ■ ■ 29 I M MMoelter I Country jr I Kluedtke iNeyers
■ ■30 z Side Q '�' EAST ■ N
2 . o i 2 ' �I D �e S Mark ■ 35 N� Estates Arbor w AVE i V Mohn i Rob<rt OAKS T i o
Q
X17 i 54 . is on- Don 24 Hill Ih6 ■, ■1 1 9 ■ I Steinmen 20 e� <I 'O
b' ^ ■ a ■ ■ Kelly BOU- Rldge is meester Q '1 144th AVE ]7■
16 Her,ty '$. F ■ Patritk David Gabs ■Jon ■78 ■ 11
�. ■ TRIANGLE I Lenfz 3+ t+ Lev O McMahon ■] Echter- I 2 5 .Y 9 /
z 78 MDR , ,sq.9 I a r Don■ ■ ■4 ■Pedro nacht ■ /''/ 1 0'f 4
it I Lentz 10 Ly C OZ o 142nd AVE RoettBer ■13 ■s �� 4
■Howard I ma - a WOODLAND Tom �O TDrtosa I ■Nt6■ B ■ nl
i Iavmtnre _ CT Weiss ■ ■b C— ] ■f5
1 _ — _ — _ — _ .�� ■ ■ 18 19 Is t Brian ■cam _ — _ — f ] ■R°be`r
RD _ — - — 1 Jeffery Knekuamv son 1� Lu«t ■ Carroll ■�.,,.�<vmem Emmeek ■ , D< ` l ` < ` LLEY ,
MIt.I. <WF R-e- 5 4 3 2 f7vexn: ■ %N ■Sb ■za s<on ■1U L3 ■
■ —J .t- 20 " F ■M�caoa,W<r lobe I Tolson VIEW
N g • is srn..a PE■ ` all ■B TRL
E s r- clmn 'Brian ■ Woodland 4 is / ■ ■ Tb.mwm ■ Duncan M h
° rn ■Anderwn Sheller s 1. n 6 z as 7 -11 24 4-8 urP y
ST URCH I AG ■TL I �� al 9 _ ■23 i 2w OXRID�E
< SDG G ffltro V ■ ■r� N� N BRO NS TRL
V' f
PETERSON Lwkkstrom ■ GOLRrom w (n ■]2 ■■ ■ \ 21 12, HIGHLAND I
m �' ST ■Edwud I rn 1 k LN ■ n 3218■ ■ / _<
]g $ gg
17 Robert I GWstrom N w° ■11 ■ i 3 g ° del 17■ \ 16I d m
as S♦benaler ■ Glom j r I < F- �1 5 3s
P I Wyss ■z9 ■ Shad ge
32� ■j O 7■homas m r .9 + ;� 300 t9 \I Ridge Belisle I Oy
Jaye Mcconaue I N 07 ■ ._ 3 w 3 err Dani ell 2 2 ■ IKEWAV SYSTEM ■ I 'd
w ■ 1 2, I Edward in 10 M 1 te ;■
CiKane OLDE ■ ■ ■ �'■z 38 t
Don 1] ■ Whi a WEST ■ rot-I hf
S1, Stanley Anderson Mark DMffner l3 ■2 1 2■ Ya WHITE ?d- I 21 ■3z ■9
O d ■, ■ RIVER- I EAGLE 33
O n ` Itl Lloyd VIEW Kent Johnson ■ � RD aMa I_. ■ ■ ■ 36■
�+ ■ iah(ke RD RES I Scott Boumee ■ (» E M�a.a, LW. ■ 31 30 2L 11 l+7
Jerry McKenzie ■ White V '"" re "' 0 10 ' / I
34 9,� ss We rA�tr 31 �i,xs,HO 15 En� 14,
�9' ■ q ' 125th ■ ■ 15 a JOHNSON DR «s ray 28 ■'
■ ` AVE 14 ■aaa William / YY
u 3 -6 ■ t< 16 Kelly ROLLING HILLS LN 7 ■ 19 m.Y P I F-
�' 4 - 20 RED PINE TRL ■ ■ .a a Steve i Parkway ■Dale ■ i c ♦ 1
` , 7 Clow Ala • _: _.. "vE ' ■ Erickson
Ramer W I al Dennis ■ Ha iu 22
-22 ■8 war ■ PlneTm BeMae� am ■Link ■ �■3m Claire L L■ J
'°° Meadows Gt® ■Best ste ■ DBts 1sia1SCY -. L .
ES '90 — — J _■ x9 1 1 € kka� — �] %,
] -6 S ■ Paul ■ M b - w- ■ w Robert 3a it ■ p Kek6 23 02 / /
Delon / L<ar�. x /�,' //
B y D hm Johnson H ld 5 ■Hochalter 1 ■ lr ■3 t ■xv
DR[ E 17 ■ Hare) Mus,ch ■Delon ■azyR Evergrten n 5 ' ■
WES smir K 9 to ■xe Imo¢
zz tt p
P Coo ; 1 =: . �11T. AVE bVE �= ■�„md a. ■ ■3zIW¢ Zon is
McDowell ■ m p
R G - w 02■ ■ ■+ RIVER RD ■ �■ ■
BROKEN
CT P OUSA E■ / ARR RD ■u ■ 170 '939 TROUT Patrick
■ts 11 ■ 20. fin Z E <aI
T PALOUSA s It; ta■ r �� i! BROOK Grif IRD ■ TROUT �m t) J
z
oAKS oa Brook �, r BROOK w Q p U) m
OLD HWY 35 _ _ _ y m ■3o TRL _Z Imo¢_
1 Tary X313 t ■
a■ ■+ 15■ _ _ — _ Robin ■ 1-9 IZ LL
Tewo and ■ ■
1. — — ■ Mew.. ■t ■ ■■3 ta■ Peter LT0Bc ■ s`
z I z■ '� ■Keller � K
RIVER HEIGHTS T GOLDEN OAKS LN
HUDSON 'W'PAGE27
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