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CD A t CA CD X N p O ~ � � (D N O I A o o N (D pp ti I rsa O o 0 ° o * b ° O a ° O a r - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety dnd Building Division `4 & INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430595 0 GENERAL INFORMATION 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: Dunn, Bill I St. Joseph Township 030 - 2003 -80 -200 CST BM Elev: Insp. BM Elev: IBM Description: Sectionfrown /Range/Map No: 00 , o /U 1� S 33.30.19.364D TANK INFORMATION V ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark i//V�-&J- Alt. BM 3-b-51 Aeration_ / Bldg. Sewer 51'� /Q .O Holding St/H"t y' r TANK SETBACK INFORMATION St/Ht Outlet r� „ 6 Z v d 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet /" 0 Septi t b - Dt Bottom Dosing eader/ an. D Aeration Dist. Pipe Holding 7 7 i" , Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer De M St Covgr Model Number ((\/ +> TDH Lift Friction Loss ystem TDH Ft r Forcemain Len Dia. Dist. to Well a �A SOIL ABSORPTION SYSTEM M j k — S b BEDITRENCH Width Length No. Of Tren PIT tDIM No. Of Pit Inside Dia. Liquid Depth DIMENSIONS � 5 i � /' SETBACK SYSTEM TO I P/L JBLDG IWELL LAKE /STREAM LE HI Manufacturer: INFORMATION Type Of System: CHA R OR / NI 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 Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes �! No Yes ` ,j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1239 54th St Hudson, WI 54016 (NE 1/4 SW 1/4 33 T30N R1 9W) NA Lot 3 Parcel No: 33.30.19.364D 1.) Alt BM Description = YT (-V V e 2.) Bldg sewer length = c-1 - amount of cover Plan revision Required? ;, ;Yes :; No Use other side for additional information. L" SBD -6710 (R.3/97) Date Insepctor' Signature C ' l 4 i STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM / /U p, 9�2 LOT SECTION 33 `1' 36 N -R Town of ,��� ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM L 5 p �Rl r INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. h JOB TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE 12 (715) 772-3214 (715) 386-5443 - DATE MPRS #3224 WI MM CHECKED BY A #696 MN SCALE . .......... .......... .......... ........... .......... .......... ........... ......... . ......... .......... . ........... ........... .......... ........... .......... .......... ......... .... ........... ........... ...... ......... ........... ........... .......... .......... .......... .. ...... .......... ........... ........... ....... ........ ........... ........... ........... ........... ... . .......... ........... ..... ..... ........... ........... ........... ........... .......... . .......... ........... .......... .......... .......... .......... ........... .......... .......... ....... .......... ........... .......... ... ...... ........... .......... .......... ............ ............ .......... .......... .......... ........... .......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . ..... . . . . . . ..... . . . . . . . ... . . . . . . . . .... . . . . . . .... . . . . ... . . . . . . .... . . . . . .... . . . .. . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . .... . . . . . . . .... . . .. . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ...... .. .......... .......... ........... .......... ........... .......... .... ..... . .......... ........... ........... ..... ........... ........... .......... .......... .......... . ......... ...... ...... ..... ........... ........... .......... ........... .... ....... .. . ..... ..... ..... ..... . .......... ....................... ........... ........... ........... .......... . .......... . .......... ........... ........ 80. J� ..... ........... . ... .. ...... ........... ........... .......... .......... ............ .......... ............ .... ........... ........... ... ......... .. .. ........... .......... ........... .... ...... ........... ........... .......... ... ........... ......... . ........... ........... ........ .... .. ........ .......... .......... . ..... ........... ........... ........... . ..... ........... ........... .......... .......... .......... .......... ........ .. ........... .......... ........... ....... ... ................... ......... ... ........ ....... .......... ........... ........... ........... .......... ........... ......... ......... ............ ........... .................... ........... ..... ...... .......... ........... ---------- .. ....... ........... . ............ ............ z' . ........... ..... ........... ........... . ............ .. .......... .... . ..... .......... ................ ........... v -4 � ........... .......... ...... .......... ........... .............. ................ — ........... ........... .......... ... ........ ........................ .... .. .... .................... ........... ... ....... .......... ................. .......... ..... .......... .................... . .. .... ...... ......................... ........... ............................ ................... ......................... ........... .............. ................ ...................... ........... ............. ............. ....................... .. ........ ...................... ..... ..... . .......... ......... .......... ........... 4A .......... .......... ............. ........... .......... ................... .......... .......... ........... .......... ............ ........... ................................... ..................... ........... .......... ........... - .......... ........... ....... ......... ---------- ....... .... ......... ...... . ....... . L boo .................... .................... ............ ............ .......... ................. ........... ..... . .......... ... - .......... ...................... ........ .. ..................... ............... ... ............. .................... ........... .......... ................. ............... ........ ... .............. ... ......... ...... ........... ...................... ---------- .............. ................ ........... .......... ........... .................... .......... ........... ........... ............... ........... .............. .......... .......................................... ......... ............. . ...... ......... ............ - .......... ................ .......................... ......... ....... ........... ............. .. ......... . ............ ................... .................. PRODUCT 2061�1x.. Won. Mm. 01471 To Ordw PHONE TOLL FREE I-M2Y 4X N Safety and Buildings Division P County /► Q m 201 W. Washington Ave., P.O. Box 7082 7 eonsr►n Madison, WI 53707 - 7082 Sanitary Permit Number (to be in by Co.) Department of Commerce (608) 261 -6546 Sanitary Permit Application State Plan I.D. N mber In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide A may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address if different than mailing address) I. Application Information - Please Print All Information D Property Owner's Name 1%- Lot # J ? Block # (tJ i l D DEC 0 8 2003 perty Owner's Mailing Address Location ST. CROIX COUNTY 1,9 / ZONING OFFICE 5 (,i� Section City, State Zip Code one Number I 2 T N; R /L yel g (circle o 7 II. T Buil g (check all that �E ot1+ apply) t 19 1 or 2 Family Dwelling - Number of Bedrooms �y (�� � �p Subdivision Name / J / CSM Number Q ^ 2 9 - ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use 4 4 k U ❑City ❑Village ownship of -f , III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New Sy ys ❑Replacement System ❑ Treatment/Holding Tank Replacement Only Z Other Modification to Existing System L41 l v. B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New List Previous Permit Numiller and Date Iss Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl on -P urized In- and ❑ Mound > 24 in, of suitable soil [I Mound < 24 in. of suitable soil El At-Grade El Single Pass Sand Filter ❑ s� - Construc ed Wetland Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elevation T/ lvO. jG v v VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank a Aerobic 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/ Number Business Phone Number I f -2 -'77 2 - 3Z-1 Plumber' Address (Street, City, State, Zip Code) VIII.,county /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Psued ssuing Ageq Sign re raps) Surcharge Fee) / 010 / er Given Reason for Denial & - %Mt@W rovaVReason for Disapproval j 1 ep Ic tank, effluent filter anc� 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. l�ili4� pt� /J Attack comp�Ians(to ounty onlo for the system on paper sio than 81 11 Inches In sift SB76/W R. M) ST. CROIX COUNTY WISCONSIN ZONING OFFICE { / N / / N ■ N N �n�r ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road r •` � ..._ �—�-- Hudson WI 54016 -7710 ..,.= (715) 386 -4680 FAX (715) 386 -4686 July 01, 2003 Bill Dunn Or Current Property Owner 1239 54th St Hudson, WI 54016 Dear Property Owner: On June 19, 1996, a private sewage system was installed on your property at 1239 54th St * Hudson, WI 54016. As per 145.245(3) Wisconsin State Statutes and Chapter 15.05 Sewage Disposal, of the St. Croix County Zoning Ordinance, you are hereby notified of your responsiblility to provide maintenance on the system. If the property was sold, the owner was to provide written notification of the maintenance program to the buyer. Proper maintenance will help to ensure maximum service life of your private sewage system and avoid premature failure. This maintenance program requires inspection of or pumping of the private sewage system at least once every three years at owners expense. Inspections may be conducted by a licensed master plumber, licensed journeyman plumber, licensed restricted plumber, licensed POWTS maintainer, or licensed septic tank pumper. The inspection shall certify that the system is in proper operating condition and the septic tank is less that 1/3 full of sludge and scum. If the inspection reveals sludge and scum volume to be greater that 1/3 volume of the tank, the tank shall be serviced by a licensed septic tank pumper. If you do not return this notice, the maintenance program requires that we follow -up to enforce these requirements, so your prompt response will be greatly appreciated. Please cut off at the dotted line and return the information below to: St. Croix County Zoning Office, 1101 Carmichael Road, Hudson Wisconsin 54016. ST. CROIX COUNTY SANITARY MAINTENANCE CERTIFICATION FORM Last record of maintenance: Yes No } The septic tank was pumped by a licensed septic tank pumper on 1 > 1 (Date) The inspection revealed that the septic tank was less than 1/3 full of sludge or scum. The tank shall be inspected again by . (Date) The private sewage disposal system is in proper operating condition. i Signed by: %!� -.._ Title: �L License No. �_�0 - -__ _ -- Da1�� 1 2 - Signed by Owner _ - - Date: Parcel ID: 030 - 2003 -80 -200 33.30.19.364D Sanitary Permit #: 262374 Property address or any address changes: JOB TIMM EXCAVATING OF Z Route 1 Box 192 SHEET NO. / WILSON, WISCONSIN 54027 CALCULATED BY `� DATE b 12 (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE 1 ! ( ..... .... .... .. . .. Wv i : [ i i t I € � i , I ......................,. :........... :.. .. . ... . ,..........>.........:...........,..........;...........,...........,..........:.......... a..........:. ....................�.a- ...._a` .... ti= t. 1. i..... .....................'......... : r i f i `k i ................. .... .......... i I i ....'..-- ....... .......... ......... .......'...........:........... i. ..... .. .... . . ..... ..... .... .... .... ... CC . .... ..... .... .. r : ... � . . ....a .......... ....................... ....... ...................a.......... ....... .... .... ..... 1. .. ..wl. M ..:X... ... ... v� ... .... ... _...... .. ......... i .............._. ... ....... . . .... ... ... ... ... .... .... _. ..... ... .... ,. .. G — I vQ r ... .... .......... : : : : : : : :.......:... ; i ._......i..........i.... ...... .. ...... ....:... ... ... ... ... .. .. .. .... .........:......... .. ... ....... ....<.. .. «. 1 .......... .......... ............. ........... .......... ( 7 i � *....... ..:. .. ..... .. ... .... ......... ..... .:.......... .. - ......... _... ... .... .. .. ._.. .. .... .. .. ...... a. .. ... .. .. ........... . .......... ........ .......... ............ .. ..... .......... .......... ........... .......... - .... ........... .......... .......... .......... . .............. ............. ...... ; .......... 0- .......... . ......... .. ... .. ........... ........... .............. .................. ........... .......... ° o �� d o .. .......... ........... ........... ........... .......... ..... ... . . ,. �� , ��� �� ..... .... Nl .......... .......... ......... . .......... ............ ........... .... ............. ............ .......... ........... ........... ........... ... ........... .......... ...................... .. ..... ..... i JOB TIMM EXCAVATING Route 1 Box 192 SHEET NO. OF WILSON, WISCONSIN 54027 CALCULATED BY :rl DATE (715) 772 -3214 (715) 386.5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE yv . SCALE ........:...........:......... ..... .... ..... ..... .... .... II ! i S ..... ..... ........... .... .. ..... ..... .... ........... ........... ........... ........... ........... .. ......... > ... ... ... .... .. .. . ...... � ..... . .;... ..........:...... ; ...... .. ...:. ..i............... .> .. .... .. ... .... ... .. ... .. ........... .........L....... ... .. ........ ..... .. ..... ..... ..... .... .. ---------- . ........... T C1�4(� �4..c.t� ..... .. .... .... ----------- .......... ...................... .......... ............ ..... . ........ .. ... .. .. � G.► �° .......:......A... . .... ... v "7 A h . O rb do : ....... .. ....._.. /.... ..._ .. O / ......... ........ ` � . ... ..... l;c, G�G.. PRODUCT 205-1 Inc, Groton, Mass. 01471 To Order PHONE TOLL FREE 1.800-225-6380 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the i J S ) 1 Q"14 n residence located at : yV V., S (�iJ V., Sec. 3�3 T c _ N, R ' W, Town of cat 5� St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Gov / Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minute's Capacity: /2pO Construction: P efab Concrete Steel Other Manufacturer (if known) : Age of Tank (if known) : (Signa ure) (Name) Please Print (Title) (License Number) /'�-S_c3 (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Sign e MP MPRS 2 System Management 'vlanaeement of this system is critical. As a condition of approval of these plans this system management section must be rep iew ed w ith the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715- 772 -3214, or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the berter and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump an controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. Install water- saving appliances whenever and wherever possible. Repair even small water leaks as soon as possible. a Lever pour grease or oil down any drain or stool. Garbage disposals are not recommended; if you must have one, use it sparingly. 6 \o paper products other than tissue should go into the system. ` chemicals should go into the system. A o.d surge tows of water, try to spread laundry throughout the week. y g /" n G � Maintenance The septic tank must be inspected every three years by a properly licensed person. I f necessary, the septic tank must be pumped to remove solids and scum; pumping is r(uired if the combined scum d solids volume equals one third of the tank volume. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6 The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows resen e apacit,. to accumulate some necessary flow until normal service can be restored, this volume is minimal, and no more than one or .�•� da,, s should pass before any necessary repairs can be made. oij compaction such as vehicle traffic within 15' down -slope of the adsorption system. S A o d disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. v Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10 Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 i?) Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and. or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 i a' 3Gy V "'' a 20 03 S0 1049, IR# Al A Y 2 3 19 "` �c+t r2 t'S� « /29ZL Register p Lsa 494 Co,, 529251 �' '� t3 e�M �� /y 00 CERTIFIED SURVEY MAP- ,l Located in part of the NEo of the SWa of Section 33, T30N, R19W, Towp� of St. Joseph, St. Croix County, Wisconsin. "'���111""" OWNER !l N Tom Seim 529 County Trunk "E L, T Hudson Wi. 54016 N S 7• LOT T 1 \° ;b MAY 2 3 95: o A C�RTIrIED SURVEY_ MAR w r - - - - -- — - TI CROIX COUNT f VOL. 4, IoG: 9 1 \ ^ 'o\ � I LOT I �v _ :ornprehensive P:anrir 0 0 le - -- — -- — \tP CERTIFIED SURVEY MAP Zoning and o �� - - -- - '- -- - -- Parks Committee r rt rt Vo . 4 , PG. 902 `° 1 If not recorded _ within 30 days of approval data ALUMINUM COUNTY SECTION �` tit �oProval shaft b3 1 MONUMENT FOUND o 0) 1� rn�p & v Ald • I" IRON PIPE FOUfyp ff N 1/4 CORNER SECTION 33 o I" x 24" IRON PIPE SET, WEIGHING PNo M I 1.68 LBS. PER LINEAR FOOT. p ` I � v I >< EXISTING FENCE .LINE rn M b N ............•• 100' ROADWAY SETBACK LINE M Z / g Z c Irn n �1'✓i�l 7 �; �i s �Cb IU I - � m I - 61, S7 1 / ® l o I ire �- o 10 " LOT 2 3 p I Z' I Ir- c I - Z ro c A % 3.12 ACRES Z IG) I;0 I-- z 135, 934 SO. F7 r�ls 7 w y IN �- S7qo 1 is `((- 2� LOT 3 \ (�SOy�, 3.37 ACRES � i. Cl) 1: �C� 0 146,718 SO. FT. J4 l ip M � o N SI /4 CORNER SCALE IN FEET �� © �/ SECTION 33 N65 0 37'42 'W 100 50 0 100 200 300 70.51' SHEET 1 of 2 SHEETS VOL. 10 PAGE 2922 t; t STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Lt/ ADDRESS /sue 3/r SUBDIVISION / CSM �/ /U /�� �9a2 LOT 3 SECTION 33 T 36 N -R 1Z W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM U+ 2 � �a o \` J J INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ti a BENCHMARK • ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: tdeehs (', p Liquid Capacity: /49 Setback from: Well 7y' House 2/ Other Pump: Manufacturer rl/ll Model# Size Float seperation Gallons /cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: S" Length 73" Number of trenches Distance & Direction to nearest prop. line: ,7y' Setback from: well House S3� Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: /h- G1 f 4 PLUMBER ON JOB: LICENSE NUMBER: In t/k 1 INSPECTOR: 3/93:jt WisconstA Department of Industry PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 26237 Permit Holder's Name: ❑ City ❑ Village [R Town of: State Plan ID No.: DUNN I WI I ST JOSEPH CST BM E lev.: Insp. BM Elev.: 7 0 - 4&U, M Description: Parcel Tax No.: / d"O r J TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic o Benchmark ,ZS 106. Dosi ng Aeration Bldg. Sewer Holding St/Ht Inlet 2.09 ' /0 TANK SETBACK INFORMATION St/ Ht Outlet a 5� TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic �� NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe x.96 , a9 Holding Bot. System /0, 71 PUMP/ SIPHON INFORMATION Final Grade S' 1 0 4(, Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Forcemain Length Dia. I f Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 1 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Of /A Mo el Number: System , ' -/0 v A OR UNIT D IBUTION SYSTEM Header / Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 3 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST JOSEPH.33.30.19W, NE, SW, 54TH STREET Plan revision required? ❑ Yes [a No Use other side for additional information. 1 ; 2 - 1 SBD -6710 (R 05/91) Date 1 ` or ignature Cert. No. it - -- ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I ' E E r E s i I i ro�u Safety and Buildings Division e-� ■�r■r. SANITARY PERMIT APPLICATION Bureau of Building Water System-. 201 E_ Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 t Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. O f • See reverse side for instructions for completing this application state sanita ar r �PPermmiitt Number The information you provide may be used by other government agency programs E] Check it revision to prevwus'appl tion [ Privacy w 1 4 1 l acy La , s. 5.0 O (m)1. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert Owner Name _ Propert Location i i4:?4GJ 1/4,5 33 T 3 r N R /9 h(or o Property Owner's Mailing A Lot Number Block Nu_n�b City, tat Zip Code Phone Nu Subdivision Name or CSM Number � 6 / ( > S I/ / io i2 II. TYPE OF BUILDING: (check one) ❑ State Owned it ge Nearest /Road Public 1 or 2 Family Dwelling ❑ Villa - No. of bedrooms � Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number( 1 ❑ Apartment/ Condo 1 0 — al a� 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 box on line A. Check box on line B, if applicable) A) 1 jQ New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an - ----- System -------- System Tank Only ___ - - - - _ - -_ Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number 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 Pressure 42 ❑ Pit Privy 13 Seepage Pit 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) -j" r top,( Elev�alion '7=10 '7 �c . Feet 14`l• 2 d Feet acct VII. TANK in Ca gallo Total # of Site INFORMATION Manufacturer's Name Prefab. Fiber Plastic Aper. Gallons Tanks concrete Con Steel glass App. New Existin strutted Tanksl Tanks Septic Tank or Holding Tank ,� �rti ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Pl� er's me : (P ) _ Plumbe ' Signature: (No amps) MP /MP NNp .: Business Phone Number: cal t4,4/ ��'� ai 5 - 77) - Plum r`s Add (Street, City, gate, Zip ode:. 1`' e, ) h. � IX. COUNTY / DEPARTMENT USE ONLY E] Disapproved Sanit r Permit Fee (Includes Groundwater D ate Issue d Issuing Agent Signature (No Stamps) Surcharge Fee) _� ^ y Approved ❑Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to Court y, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1- A sanitary permit is valid for two (2) years. 2 - Your sanitary permit maybe renewed before the expiration date, and at a 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 and 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 on line A. Complete line B if permit is for tank replacement, reconnection, or repair - V Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for nu the s ? through 7. VII. Tank; information. Fill in the capacity of every new /or existing tank, list the g al'ons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material ,alete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks r c c ;r +. experimertal product approval from DILHR VIII Responsibility statement. Installirg plumber is to fill in name, license rumb -r ih appropriate prefix (e.g- MP, etc.), address and phone number. Plumber must sign application form. lX County! Department Use Only. X. Count, Dep Iment Use Goly (_ <tr �!:�� .. ^.C. Sp_Cil; r —i smailt P 1/2 X n(. : ! "ed ?,;: t _ :'JUnty. ThP rl,ns r"'u "_ Aj o 'n , iravvn to SCc ":`c: or W,Lfit cri�np _. o l r _)i holding tank(_, ) septic - _ � `, •_:; _n: ,� r3 �c •ra�r�- v�el1 _ _ ,t _ :c {aloe , pui i :p or 4- �, s i 5' �� �„ if r, �7: .:C r� t ��� �_s , �''c3 �n °or °�alion_ I GROUNDWATER SURCHARGE 1953 Asa �sc�n �,, Act q 10 inciuded the creation of s� it charges (fees) for a nurr :i * -e(' p which can effect groundwat 'e moi cu!1C(ted th,r )Ijgh t1), se surchargesare used `.or mo ^Itcr,ng yrC,1n'ir r' 1fi ✓C�ti� „t,.,''.� and estololtshrnent of standards JOB t r /. % / /rc sn 1Jl nrI TIMM EXCAVATING S HEET NO. OF 2 Route ,1 Box 192 r--- 6 Z WILSON, WISCONSIN 54027 CALCULATED BY AV Q DATE (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE .... .... 1'�fX1 ILK, ........................ ...:................... :...........:....... ..... .... .........:........ f C 41, ly'j T j .. ........ . . ...... ..... ...i... ...: ..... .. ........... .... .. .. ..t G < i ;.. • .......:.................. .................... .... ... ..,. ... r,�t�s lras ...... ......... .... . .: ............................... f .. /D.......: .............. ... ....... .... ....... t�� .. .. : ............. . . 5 :.. ... .. ... ....... ........... .... . ........... ........... ........... ---------- ............. .......... . ....... �3'; .... ............................. ...................... .. .. ........: ... : ._. ....... ... - ...... ..... .... ........... .......... i ........... .......... a �® .... .............. ......... ........... ..................... . ..................... ----------- .......... ----- ----------- ........... ......................... ...................... . ... ....... . ........ .............. ........... C' y� , ................ ............... ............... .......... .....__ ! ... _! .... C ._ .._._ ... ..... ........ a ........................ ............ ................ Z' , ' ... .......... ........... .....> .. ........... ............ .................. .......... ......... ....................... ........... ........... ............... . ©,� .... ................... ............... ........... ---------- ----------- ........... .............. ----------- ............... ----------- ......... . ...... ..... .................. . ....... ........... ........... ........... ........................ .......... ........... ............... .......... .......... ---------- ..... . .... . . ........ ........... ^°�. ........... ............ .......... ------------ ---------- ........... ................ . ............................ ............................... ........... ........... ........... .................. .......... ................... ....................... ............... .................... ............. ........... ............. - ........... .......... PRODUCT 205-1 Inc., Groton, Mass, 01471, To Order PHONE TOLL FREE 1- 800 - 2256380 l i Joe TIMM EXCAVATING -z SHEET NO. OF Route 1 Box 192 WILSON, WASCONSIN 54027 CALCULATED BY DATE (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ..... .. . � .... .... ..... ..... Q`,....... ........ .... , . ... .. ...... .. .... .... ..... f 1( � � .. �� '._t. �� r . ' I ` c . r I `�U ��� ✓ ... r _. t L ~� ...... . ... ... .. PRODUCT 205-1 Inc., Groton, Mass. 01471. b Order PHONE TOLL FREE I - 000 - 2256380 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor aM Human Relations , ;MhAsion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Co Atta''ch complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must, ut St (Irc not limited to vertical and horizontal reference point (BM), direction and % of slope, ah$, r PARC a: , ° +, dimensioned, north arrow, and location and distance to nearest road. _�(� _ _ .030 3 - APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION tT + f AEWED�- DATE PROPERTY OWNER: PROP T,Y OCATtOK William -Dunn GOVT. L � 114 SW: 5'3 T'_�0 ,N,R 19 for) W PROPERTY OWNERS MAILING ADDRESS LOT # # SUBD.'NAME 9 # 2753 41st. Ave. S./ 3 `: csm_v:. 0 pg 2922 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY Y NEAREST ROAD Mp1s, MN. 55406 (612) 729 - 9203 ;,a. Co. Rd. #E [�] New Construction Use [ )d Residential / Number of bedrooms 3 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft . 8 trench, gpd/ft Absorption area required na bed, ft 563 trench, ft Maximum design loading rate • 7 bed, gpd /ft — , 8 trench, gpd/ft Recommended infiltration surface elevation(s) 102.38 starting e] ft. (as referred to site plan benchmark) Additional design / site considerations trenches 3.5' below surface spaced to code Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem CAS El U :E] S El UFS El M ❑ U ® S E:] U EIS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botrtday Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench <....1....' 1 0 -9 10 r3/2 none 1 2msbk mfr cs 2f .6 2 9 -26 10 r5/4 none sit lfsbk mfr qw if .3 Ground 3 26 -80 7.5 r4.6 none elev. 1 0 5.48 ft. Depth to limiting factor +8 0" Remarks: Boring # •4= = -> <- 1 0 -12 10 r2 2 none CIA 917 ;< :..... U 2 12 -24 10 r5 4 none S il 1f 3 24 -36 10 r4/4 none is os mfr crw if .7 .8 Ground elev. 4 36 -84 7.5 r4 6 none s 10 5.38 ft. Depth to limiting factor 7_1 1 +84" Remarks: CST Name:— Please Print Phone: Gar. L. Steel 715- 246 - 6200 Address: 1554 200th e., New Richmond WI. 54017 m02298 Signature: Date: CST Number: 5 -22 -96 PROPERTY OWNER Tom Sime SOIL DESCRIPTION REPORT Page 2, PARCEL I.D. # 030 - 2003 -60 '. Lot #2 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlaty Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench iv.,i vvv.v.vvv.t± t 3 1 0 -10 10 r2 2 none 2 10 -24 10 r5 4 none sil m mfi qw if n .2 Ground 3 24 -32 10 r4 4 none is os mvfr C1w na .7..8 elev. 10 ft. 4 32 -84 7.5 r4/4 none s osg mvfr na na .7.8 Depth to limiting factor +84" Remarks: Boring # 1 0 -12 10 r2/2 none 1 2msbk mfr cs 2f .5::.6 4 >: 2 12 -42 10 r5 4 none sil m na if n .2 Ground 3 42 -84 7.5 r4/4 none s osg mfr na na .7.8 elev. 98 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -13 10 r2 2 none 1 2msbk mfr cs 2f .5.6 I> 5 ........s:: 2 13 -40 10 r5 4 none sicl m na if npi.2 : ........... .. Ground 3 40 -82 7.5 r5 4 none s 0SQ ml na na .7.8 elev. 98 ft. Depth to limiting factor +82" Remarks: Boring # r :...........:. ;:.::r:<.. Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEELS SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 William Dunn New Richmond, WI 54017 MPRSW 3254 �4�4 s33- T30N -R19W (715) 246 -6200 town of St. Joseph t lot - csm vol.10 -pg. 2922 N 1 =40 BM.= top of PC survey stake @ el. 100' G � 5 ��3 Gary L. Steel 5 -22 -96 STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY /STATE " PROPERTY LOCATION _ 1/4, ScLj 1/4, Section _ T 36 N -R ___/ , ' f _ W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION - LOT NUMBER CERTIFIED SURVEY MAP , VOLUME ld , PAGE ,XZZ LOT NUMBER -3 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained mtkst a comple returned to the St. Croix County Zoning Officer within 30 days of the three year ia SIGNED:" DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C — loo This application form is to be completed in full and signed by the owner(s) 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 &411,'A -� d4,c-W..,z_ Location of property Af£. 1/4 Z�L 1/4, Section . ,T_!:�D N -R JC7 - W Township Mailing address Address of site Subdivision name Lot no. 3 Other homes on property? Yes � No Previous owner of property Total size of property Total size of parcel Date parcel was created -;Z - l Are all corners and lot lines identifiable? 7C Yes No Is this property being developed for (spec house) ? Yes Lc No Volume / /yd and Page Number / 2- 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) an (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. - 77 7 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. *Sgna u Appli nt o Applicant Date of ignature Date of Signature rp ,` co J i KATyt 1 995 r 17 RegisleN N. wA[S11 .11 11 . Crorx Co. WI 52920 ti /y°v CERTIFIED SURVEY MAP Located in part of the NE4 of the SWh, of Section 33, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin. p OWNER N Tom Seim �� ` ; 529 County Trunk "E W o C" \•• H• �,, Hudson, Wi. 54016 j�f`�'�� rt \� \\ ri P P l V Y ED m �- r• N � 7 • C O N X < \ � MAY 2 3 '95; rt LOT I \ �;r\ O �; CERTIFIED SJ� " ✓E'( MA0 r --- -'- --- - -- - s7 . CROIX COUNT z - V -- -' -- _ _ \-v \ = - .:Of nprehensive Pdam 0 o co CIZR T IFIED SURVEY MAP Zoning and CD 0 � - -- Parks Committee G. 002 VC 4 rn r• s -' — — — — If not recorded within 30 days of LEGEND i� approval data !9 ALUMINUM COUNTY SECTION �1 11 -3op roval shall bo MONUMENT FOUND o 0) " �� ' v • I" IRON PIPE FOUND N I/4 CORNER 111 SECTION 33 o I" X 24" IRON PIPE SET, WEIGHING r � I 1.68 LBS. PER LINEAR FOOT. O I 4O I ti v EXISTING FENCE .LINE N ON M D "'....."•'.• 100 ROADWAY SETBACK LINE m Z ! _ z v' IV O° 1 Oi O — z Irn /o/ 9� " ✓r 0 IX --4 vo Jr /N N / LOT O1 ! r 1 zI C N / 3.12 ACRES g Gl j `��eii�v-M Y� p!� 9 135,934 SO. FT. m I l rn rn W qk im z 22 J I °. ab ` I.EP C x 1 �`' w h9 5 a9 z 1> c+ 13 'Q 0 2 t \�� N LOT 3 'lJ ;`;' \ �\ \v'� �`�,, 3.37 ACRES \ ° J' $fi r ` � <1 .0 146,718 SO. FT. 8 . p Ov i i ' - 01 - \ \ \ N) / SI /4 CORNER SCALE IN FEET �� ® ,! Q SECTION 33 N65 0 37'42 "W 100 50 0 100 200 300 ' 70. ' 51' Vie. SHEET 1 of 2 SHEETS VOL. 10 PAGE 2922 ' b. • SCite Bar of k1'i Form '_ - 198: 5`33'7'7 i WARRANTI DEED REGISTER'S OFFICE DOCUMENrNO t ___ _ - _ 1011-114QPA E _ 1 _ ST. CROIX CO., Wt - - Recd for Record - - I SEP 1 3 Thomas W Seim and Donna Mae _Seim, husband___ and wife, at 12:05 P. M Reg�tar of Deeds .'`� .: convcvsand Aarrantsto - _. W71llam C` Dunn and Sara E. Dawn. _ - _ - husband and wife,_ as survivorship__ 3 • THIS SPACE RESERVED FOR RECORDING DATA - -_ -- - - — — — — - -- — -- NA.ME AND RETURN ADDRESS t r f t 4 the following described real estate in ._--- St__CrQiX__ —. Ae J Z m L , County Sate of Wisconsin: j 7 t ,• Q ,AA / (Parcel Identification Number) Part of NEIA of SW1 /1•- oL Section 33, Township 30 North, Range 19 West, St. Croix , County, Wisconsin, described as follows: Lot 3 of Certified Survey Man filed May 23, 1995, in Vol. "10 ", page 2922, Doc. No. 529251. t TOGETHER WITH a 66 foot wide road easement as described in Vol. "1122 ", e 627. and re-recorded in Vol. "1138 ", Page 525, Doc. No. 533431 Pag A TOGETHER WITH a 66 foot private road easement as shown on W ;< Certified Survey Map in Vol. "4 ", Page 901, Doc. No. 361931 and =F`, in Vol. "4 ", Page 902, Doc. No. 361932 x 4 _ f' This is mo homestead property. �•' }( (is not) Exception to warranties: Easements, restrictions and rights -of -way of record, if any. __ .4 Dated this -- -- __ -- day of _ _ - -- _- �� ± _ -- -- _ -- -• 19_ 95. i -- (SEAL), — = - - -. (SEAL) y 1, ! E7 s W. Seim (SEAL) - -- � (SEAL) • Donna Map Spi_In AUTHENTICATION ACKNOWLEDGNIENT. � r �+ Signature(s) STATE OF WISCONSIN o ;! � 1 _St_. Croix - - - - -- County. '•' t ' authenticated this ___ day of 19__. Ptrsonally came b me this - -LH =� — day of �p 19_ 95 the above named ti Thanas _im _a_nd Donna Mae_$Qim, husband an wife_ , TITLE: MEMBER STATE BAR OF WISCONSIN - — - - - - (If not. authorized by §706.06, Wis. Slats.) to me known to be the PAW TOy �gC /y� who executed the �"�•� - f ro m stru nd a � THIS INSTRUMENT WAS GRAFTED BY } t� Kristina la �\ t, I Attorney at Law -- -- - -- "�" _.. - - - - -,_ - - -- - -- Navary Public - - — —._ -- County. Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. / (If not, state expiration (late. `I necessary.) - -- 5,: .19 M . P' ♦ .tK printed . _ _ -- - _ -- __. - - - -. - ___. -- ;' ♦:. t i I Names ul nuns s to any ca aaty hould he t� d or brio% their a g natir + "' WARRANTY DEED STATE BAR OF %1SCOU4% Wisconsin Legal Bank Co.. Inc FORM Nm 2 — 1914_• Milwaukee. W,s II },