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HomeMy WebLinkAbout030-2034-10-000 4) 0 � � k• � 4) Lo 0) '6 (D a C E cli ca 0 ou 64 0 0 cc : 0 , 0 0) 0 Z ;t- C c c . - 0 (D OL U. C 0 0 0 ■ E 0 o z c) W z . 0 z 't W. 5E '6 z U co cc z c 72 E to .0 C 0 0 r z — z 0 z cli E E Lo C,4 'A I co w 0 0 b C. 0 o c IL a. 0. El IL 0 rr 0 U) i ( 2 w U) j 0 CD 0 :3 C-4 0 LO f a) (D 0 — > 0 0 < E :3 M . a. LO A CD (a C ; U) cli C (A cc 0 0 —0 E ca m 0 V 2 2 ( D LO A 0 %k /1 1 0 (9 =3 — a 04 0 0 CN V) 4) a) 6 0 0 C T: z Y U) 0 CL r r - s E cu 0 m 0 0. 1 0 wsoonsin Depaf" of Commerce PRIVATE SEWAGE SYSTEM County Safety and Wsion I St. Croix .• INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal IMormation you provice may be used for secondary purposes (Privacy Law, s. (1)(m)). 384124 Permit H r s Name: ❑ City ❑ Village ❑Mown of: State Plan ID No.: inz, Bob /Linda I St. Joseph Township T BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: dD ( C70 , 030- 2034 -10 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L,) 12 Benchmark �(. }'{ A lp ' Dosing Alt, BM 01 .32' Aeration Bldg. Sewer 5-- 9• Holding St / Ht Inlet �2 / TANK SETBACK INFORMATION StIHt Outlet 7.c. f IT.fa ' TANK TO P/ L WELL BLDG. A,intake ROAD Dt Inlet Septic > 2CD` *200+ 3 f NA Dt Bottom Dosing NA Header / Man. r Aeration NA Dist. Pipe 9' S3 jss ZI / Holding Bot. System 1 1 0 - %3 1 3, PUMP / SIPHON INFORMATION Final Grade 7.1 C r' � Man acturer and St cover t� • 6 0 / Model Nu r M TDH riction System TDH Ft orcemain Length Dia. . owe f SOIL ABSORPTION SYSTEM �G $EB INCH Width L gt �� I N Qf Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 DIMEN I ONS SYSTEM TO P / L BLDG WELL LAKE / STRE LEACHING Manu acturer: SETBACK INFORMATION Type Of CHAMBE R � oD/ � Model Numbe System: CA5.kw I S'"� OR UNIT Z IP`�'� DISTRIBUTION SYSTEM Header / Mawi Distribution P x le Size Hole 5 cing Vent To Air Intake 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 ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: O.-/ l5/ of Inspection #2: — 1--4 Location: 293 -150th Avenue Houlton Wl 54082 (NE 1/4 NE 1/4 24 T30N R20W) - 243020461 1.) Alt BM Description = $i 2.) Bldg sewer length = v - amount of cover P n revision required? ❑Yes No Use other side for additional in II ii0x i 1 110 SBD -6710 (R."7) Date Inspector's Signature Cert. No. Sanitary Permit Application Safety & Buildings Division rd accord with Comm 83.21 Wis. Adm. Code 201 W. Washington Ave. Sec reverse side for instructions for completing this application PO Box 7302 Visconsin pe Madison, WI 53707 -7302 rsonal information you provide may be used for secondary purposes Department of Commerce (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned. Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanita Permit Number ❑Check if revision to previous application State Plan I. D. Number 38 I Z I. Application Information - Please Print all Information Location: Property Owner Name Property Location �} 114 1/4 N or Property Owner's Mailing Address Lot Number Block Number City, to 'Lip Code Phone Number Sul5division Name or CSM Number e), U, f ( ) 1 II Type of Building: (check one) ❑ City ❑ I or 2 Family Dwelling — No. of Bedro ms: ❑ Village Public /Commercial (describe use): l tI�wl a, ,✓s,� Town of ❑ State -owned N III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road A) 1. 0 New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued 0, IV. Type of POWT System: (Check all that apply) ` IgNon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank O Single Pass ❑ Drip Line ❑ At -grade t ❑ Aerobic T eatment Unit ❑ Recirculating ❑ Other: xl 2 S o V Dis ersaVTreatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inc) Elevation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks vixvk VII Responsibility Statement I, the undersigned, assume resp onsibility for install ion of the POWTS shown on the attached plans. Plum�re7ame pr int) Plumbe Si t s�tam MP /MPRS No. Business Phone Number Plumber Address (Street, City, State, Zip Code) 1S'Q VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu�A ent Signature (No stamps) Approved ❑ Owner Given Initial Adverse SurAbarge Fee) ,. Determination CID 0Z -o -o1 TON k IX. Conditions of Approval /Reaso r Di sap f prov p y A - p, �, s "^�{ O%¢ - ► `^w �lr it9 ��f1 t t 6±1s S '� cry kn_ "' /' �( r 5 ff�� s tns� A 6- o u c Qd� ' #� mot" r�crs��etnQct�'lex5. - sr SBD -6398 (R. 07/00) r - i t c - I lk - Vc l , 1 � � f u: D i f ' i I II i 1 , I Q , i _ : Q i , � � M U M f Safety and Buildings ' 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 Visconstn www.commerce.state.wi.us /SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary January 26, 2001 CUST ID No.224263 ATTN.• POWTS Inspector ZONING OFFICE KIM A O'CONNELL ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/26/2003 I dent ific n umb Transaction ID o. 609839 Site ID No. 62564 SITE: Please refer to both identification numbers, SITE ID: 625640, BOB HINZ above, in all correspondence with the agency. ST CROIX COUNTY, TOWN OF SAINT JOSEPH; 293 150TH AVE, HOULTON 54082 NEIA, NEIA, S24, T30N, R20W FOR: NEW NON PRESSURIZED IN- GROUND SYSTEM, 150 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 777797 ➢ This approval is for a non pressurized in- ground system to serve a work shop for owners' use only with no JP employment or self employment taking place in the building. c The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Rj MEt +1 0 pF SAEE� The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. R 2. The maintenance plan for this system must be given to the owner of the POWTS. e_ COR 3. This system is designed for wastewater strength with monthly averages of less than or equal to 30 /L of fats, oils and grease, 220 mg /L of biochemical oxygen demand and 150 mg /L total suspended solids. 4. The designer proposes to install an outlet filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. 5. The system elevation shall be 93.92 , 6. Maintain well and waterline set backs per COMM 83.43(8)(1). 7. The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and COMM 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. 8. The trench shall be long enough and wide enough to accommodate 10 High Capacity Sidewinder Infiltrators. 9. The replacement area shall not be disturbed per User's manual. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. KIM 'A O CONNELL Page 2 1/26/01 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 01/12/2001 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 PATRICIA L SHANDORF BALANCE DUE $ 0.00 POWTS PLAN REVIEWER, INTEGRATED SERVICES (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 cc: BOB HINZ 7 r rc.c 1;. -ax - - - -- _ COM cf' /: alp✓ - � � ,N� Sp! QNbEN. 3 C :S,F � yawl- .Ciy [ ! _ /�,�.rk� �%�,✓. (.�c� 431 - }-_- - , , _ I y , IR w IA It IN , I i - 1 o A ' i I d _ o , t ; I Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Des i n Specifications Sanitary Permit Number Number of Bedrooms ALL Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (al) Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absor tion Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (m /L) 1 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 for a Septic Tank and Soil A Component Absorption Com Management-Plan p p P Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. ( 4��aV:� Zdod.' 3 � r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page --/— of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). Property Owner Property Location Govt. Lot AIZ 1/4 VA 1!4 S T N R (or Property Owner's Mailing Address Lot # Block S . Name or M# City Sta a Zip Code Phone Number ❑ City Village Town Nearest Road 2 ' New Construction Use: ❑ Residential / Number of bedrooms _ . Code derived design now rate /1'D GPD ❑ Replacement Public or commercial - Describe: Parent material _ Flood Plain elevation if applicable ft. General comments and recommendations: G a Boring # � Boring � 9d, U � Pit Ground surface elev. � ft. Depth to limiting factor /in _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 c Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor �� /d _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. C nt. Color Gr. Sz. Sh. •Eff #1 •Eff #2 a Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1 150 mg/L nt #2 = BOD < 30 mg/L and TSS < 30 mg/L CST N I ig a CST Number Address Date Evaluation Conducted Telephone Number Property Owner Parcel ID # �D�D s' L�lL _ Page J of 5� 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff #2 l Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor >l /O in. Soil Application Rate Horizon Depth . Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu: Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 J- ) ✓ l9 P Boring Boring # � Pit Ground surface elev. �G ft. Depth to limiting factor �LQ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 al 9 • Effluent #1 = BOD, > 30 1 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 m g/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, SB0.8330 (R.6=) , D u Al- - - -�� t n I I , , I i , i I � ' t I i I , I I I ' ' i I I I - I I y I� _ - ; , I I ice_ I ; ; t I a 4 - - --- _._ - ! -- -- 1 I I i I I 1 i. L - __ �_ _ _ .�� r — Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). p2_ r Q Property Owner Property Location Z::� / Z. , Govt. Lot AIZ 1/4 AIA 1/4 S T N R (or Property Owner's Mailing Address Lot # Block Su . Name or C M# a Sta e Zip Code Phone Number ❑ City Village Town Nearest Road New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate -- : '6 GPD ❑ Replacement Public or commercial - Describe: - Parent material _ Flood Plain elevation if applicable ft. General comments / and recommendations: 5 Boring # Boring ® pit Ground surface elev. 2 ft. Depth to limiting factor S / /tom in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff #2 7 Boring # E] Boring pit Ground surface elev. ,� ft. Depth to limiting factor >Z,&::2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. C nt. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 o� - 7 � Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L nt #2 = BOD < 30 mg/L and TSS < 30 mg/L CST N m I ign re CST Number 3 Address Date Evaluation Conducted Telephone Number f , Property Owner i,,gl� Parcel ID # ' ma Page _ of _ Boring # E] Boring T Pit Ground surface elev. ,7� ft. Depth to limiting factor } /� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring # Boring ® pit Ground surface elev. ft. Depth to limiting factor > /ih — in. Soil Application Rate Horizon Depth . Dominant Color > Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Boring Boring # Ground surface elev. � ft. Depth to limiting factor >�fD in. 10 Pit Soil App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 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) I� �r a v � a �M h n O o �- � ` a�,✓iy Nly � ,, 0 Z_J p ill ";✓ 'a A , - -_ , Alk .46 ST CROIX COUNTY !� SEPTIC TANK MAINTENANCE AGi:i-l"NILN "l ;� l AND OWNERSHIP CERTIFICATION 1`01yM Owner/Buyer / \i(��,'�J _� �✓�� {` 1/ V 1�t� �" ' t /V Z , Mailing Address Property Address --- - - - - -- (Verification required from Planning Department for new con,t:ucttonj Iq -1p - - 00 G City /State 77011 1�p'N � Parcel Identification Number 39 '-� ' 4 4 # �oSEp-H- 1bW N�tkt P 3© o - b LEGAL DESCRIPTION Property Location 14— '/,, ' kc- - /'4, Sec. ,,�? "fawn Subdivision —r Lot ## Certified Survey Map # _, Volurnc , Page 0 Warranty Deed # Volume " — Page t# Spec house ❑ yes q no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in ns pre nriture la11UrC to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if nt•ede,i by a lt. cn,Cd pumper. What you put into the system c,in affect the function of the septic tank as a treatment stage in the waste disposal 5y tcm. The property owner agrees to submit to St. Croix Zoning Department a ccruticauon fond, signed by the owner and by a master plumber, journeyman plumber, restricted plumber Or a licensed pumper vrrilti uti drat ( 1 ) the on - sitc waste water disposal systcur is in proper operating condition and /or (2) after inspection and pumping (tf necess:ny the septic tat:k is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to ntauu,un the In I - atc ,� w�t��,c (lnposal system with the standa>ds set forth, herein, as set by the Department of Commerce and the Department of NaU;nJ kc- -tcc,, statc of Wisconsin. Certificatu,n st,,t.ug that your septic system has been maintained must be completed and rrtuntr.f t;, tl;� �;t 'rou i'ounty "tuning Ofti. e wit}iiu U da , of the three year expiration date. 4SIGNURF OF APPLICA DATE OWNER CERTIFICATION I (we) certify that all statements on tits form are true to the best of my (Onu (wc) at11 (arc) tirc owner(s) (A the property described above, by virtue of' a warranty deed recorded in Register of l )cc( Is C)IftcC. P 1 /6 /l0 /GJ r SIG 4TU APPLICAN , DA' •� * *' Any information that is mis represented may result in the sanitary pertmt I,ctn}' 1 --ke,1 try the Zoning Department. •' Include with this application: a stamped warranty deed from the Register of lleecls t ifice a copy of the certified survey map if rcfeience deed Document No. IMAM D= RGTEA'S Oiiti.? BQ§= J. BIn and LINDA C. HISS, husband and ST. CROO(CO.. Wt � hdiltrlhaoM wife 'OCT 31 1996 At 9:00 •_ _ . A. M conver(s) and quit claim(s) to R3Mz '� —% Il�elyd0r�d. Yeasdia/ � aw aai Emu= hmnw Janes F. Lamers the following described real estate in 1835 Northvescerrn Avenue Stillwater M 55082 9t. Croix County, State of Wisconsin. I & 03[1 2Lo34-j0 arw1 2a�wtiliwefa� M. trite Sast * of Northeast W( of Section 24, Township 30 North, 20 West, St. Croix C6%inty, Wisconsin X r *,gi 5 'Phis is homestead property. - 1 / MW d Domed this o!``' egy L C. s t aos�s ©s=on fi9oatstsets3 STM or l A4 4, C4& county RREed s y of 1!! i ` personal cans be es, the aDoae� iad nre ZA I is an or N=SOM= the low"oUg L=Mr:■aat and aolisimlefta the of not . sass.- antb"4 197 N . !tats. 'i"* or �s at8:7ro�s Ndi ORLP ► sirs „„ II r• , hr coawise : ; f. t=t eat.' a s n l►vem �rat te: � — ex0e ater. 1M 55093 I f