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HomeMy WebLinkAbout040-1036-20-000 County `82 )y cx , Safety and Buildings Division (S 201 W. Washington Ave., P.O. Box 7162 .S` Sanitary Permit Number (to be filled in by Co.) Madison, Wl 53707--7162 ~SLONAti~(•J~ 16 S _ 1t Application - State Transaction Numb r - In accordance with SPS 38322( is. . Code, submission of this fbrar to the appropriate governmental ' _ is required prior to obtaining a sanitary pemiit. Note: Application forms for state-owned POWTS are sobncitied to cidress (if dii] - - tile Department of Safety and Professional Servies. Personal information you provide may be used for se,, ndary ' Yerent than mailittg address)-_ ul c!ns in accordance with the Privacy Law, s. I5.04(1 (m , Stats. Application Information I'll ease Print Al for ~ Oil 1-7 -1 J Property Owner's Name J T C^ Location / - - - - PAM Govt. l..cti City, State Zip Code Phone Number d~ 11. Type of Building (check all that apply) Lot or 2 Family Dwelling - Number of Bedrooms v Sub[iivision N tme Block Public/Commercial - llescribe Use ~ ~ n~~~! - - L 1 City of - - State Owned - Describe Use CSM Number L1 Village of _ Igo i'lCQ _C. vw~Townof- _CAJ~_ III. Type of Permit: (Check or y one box on line A. Complete line B if applicable) ❑ R lacement S lem .A. )F;-New t Rep ys ❑ Treatment/Holding Tank Replacement Onl) El Other Modification to Existing System (explain) ---13. ❑ Permal ermit Revision U Change of Plumber ❑ Permit 7'rarrsfer to flew List Previous Permit Number and Date Issued Before Owner - - - - ---~/1.~ ]iV. Type of POWTS System/Cum anent/Device: Check all that a r lye - - tin-Pressurized In-Ground 11 Pressurized In-Ground U At-Grade U Mottnd 24 at. ol'suitatrk: sod U Mound 24 in. of suitable soil & W1.11 Holding "Tank O Other Dispersal Component (cxplairl)_- _ ❑ Pretreatment Device (explain),- _ V. Dispersal/Treat t Area Intormatio_n: - - - - - ~G Design }'low (gpd) Design Soil Application Rate(gpd rhspc rsaf Area Requrr ed (sf} / hrspen al Area Proposed (sf) System ) lcvat m r/ VI. Tank Info capacity in Iota! V of Manufacturer - - / Gallons Gallons Units ~y ~A New Tanks ~ Existing Tacks U vi rri w r7 n, Sspiic or Holding Tank basiug Chamber- VIT_ Responsibility Statement- I, the undersigned, assual ponsibility for installation of the P0VV'rS shown on the attached plans. ,-Number Plumber' Name(Print) Plumber' attar ------•77 MP/MFRS Number Business F hone Number Plumber's Address (Street, City, State, Zip Code - - VIII. County/ erartment Use Only Approved tsa P tmnit Fee Date I "ued Issuing it Signature - - - - ~ --J-- - - - 55 iveu Reason fbr De. ' v UO ~3 IX Condid$l~~easons for Disapproval 1 ` 1 eptt~ tank, eftlt nt filter and d e ` t,~[o Y o !J t d~ AeAj p dispers ueB must all be servkes /maintained W ;Y~ i al iwi+4~~O~• as per management plan provided by plumber. r, Ml* be maintained ~5 , - otda ttir1~0 _ 4) o P~ O I'' S 3f?~►~. Rf 61L.. r ~ ~(`Qa~ Attacb to complete prune for the systelu and snhwit to tine County only un prier mess than 8 112 ill inches in size - sa~tra~.~~. SBU-6398 (R 11/11) PLOT PLAN PROJECT Oeverina Homes f;/ ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 /R 19 W TOWN Troy COUNTY ST. CROIX SE 1/4 NE 1/4S 8 /T 28/* f' 5/28/13 3 MPRS Shaun Bird 226900 _ DATE BEDROOM CONVENTIONAL XXX IN-GROU RESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of stake ASSUME ELEVATION 100' Filter BEAR Filter F BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.2/95.1 4' below qrade Jordyn Lane Vent All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. >6„ Quick4 Standard Well is to meet all of Cover Leaching Chamber setbacks required by with 20.0 ft2 of Area 5.6f02/pair of end caps WDNR 4' Long 12" Grade at System Elevation 34' Scale is 1" = 40' unless otherwise noted Drainage Easement 46' Area of poor soils B.M.* 10' 150' 125' 3% SLope B-2 20' 10' B-1 70' 30' ST Vents 20' 88' Pro 3 00-20' 35' B-3 Bedroom House 2-3' X 66' Cells with >3' spacing COPY 717' Property Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings n a rdance with Comm 85, Wis. Adm. Code i~ounty ~ . ~ ~ v Attach complete site pta p not s than 8 1/2 x 11 inches in size. Plan must include, but not limited to. I a orizontal reference point (BM), direction and Parcel I. b.`, ~//I percent slope, scale m sio north arrow, and location and distance to nearest road. Oy (ease print aH information. sT R FU/j ;Z~ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). R JL- LM Property Owner Property Location ~.,MO N P J Govt. Lot 1 /4 F1 4 T Z O N R (orb Property Owner's Mailing Add Lot # Block # Subd. Name or CSM# 17c.1.~2J T 2 U u i ~tc~ City State Zip Code Phone Number ❑ City ❑ Village own Nearest Road 71-~2 \r6 r4&101"e, Construction Useesidenfial / Number of bedrooms Code derived design flow rate IYJZ~ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material r'/c t~`1-'~"e~A~ Flood Plain elevation if applicable ft. General comments and recommendations: Q q System Type_ c System Elevation / J Z/ < S 1 F ] ~Vl Boring # ❑ Boring Q pit Ground surface elev. v ft. Depth to limiting factor a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. 'Eff#1 -Eff#2 8-30 ❑ Boring ` Fc,] Boring # pit Ground surface elev." ` ft. Depth to limiting factor Arr' % inSoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efff##1 -Eff#2 S- n,,, ~J f tca l2 2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 11 50 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST flame (please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5 7 715-246-4516 ,perty owner _ Parcel ID # Page of Ong # j Boring ry pit Ground surface elev. [ U 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 r 3 z, I E 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 ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30:5 150 mg/L ' Effluent #2 = BODS 130 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 (RAM) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of bivision of Safety and Buildings n a ance with Comm 85, Wis. Adm. Code n Attach complete sit d p not s than 8 1/2 x 11 inches in size. Plan must `s include, but not limited to. I a orizontal reference point (BM), direction and Parcel Lb.° percent slope, scale m sio , north arrow, and location and distance to nearest road. py 6.- 2 /ease print all information. R ~Y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).`ST Property Owner Property Location hey Pv Govt. Lot S 1 /4 1 /4 T Z N R (or Property Owner's Mailing ~Add Lot # Block # Subd. Name CSM#I , y C L~ G7 C/ t L~c/ City ~f State Zip Code Phone Number ❑ City ❑ Village own Nearest Road 71-~2 4-2 \T6 ew Construction Use): Residential / Number of bedrooms Code derived design flow rate J'Z~ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable a// ft General comments and recornmendations: p System Type 42i_74 System Elevation Q / ~ Z/ (S l FTI Im Boring # ❑ Boring Q Pit Ground surface elev. v ft. Depth to limiting factorin. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 /Z 3-30 Boring # ❑ Boring pit Ground surface elev. ft. Depth to limiting factor ,Z/D 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 0~` z S- 2- Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 11 50 ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 6__~ 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 546'7 / 715-246-4516 o N n N 0 1 3-0 n d C c c C fD ~1 M n I c M CD M CD d 1 N 5' Q. C N n 3 CD CCD UI n K~ Q 0 o a m m a x z n y x o c O w m ip m j ^ C- 0 C) C) a CD -0 CD 0 al a CD CD 0 CD 0) W CD 3 G) 6 0 a rn 3 o p a~ rn y y rn ch c c u> D ° a (n f D Fr cD _ tD (O m 0 a (D O CO a O O y W W 7 co co W CD pow a x 11r I N 3 O O V CD =4 cil 0 =4 C.0 o o a ((o co a n r fA N c °o a N -4 -J CL 3 K Q N N :9 Z I N~ 3 ulfAfA ~ o I3 D a v v o m cr v v o! o cn _ m m o u~ m m o w - n 3 3 U N m m I n ' f O M lv ca z Si y_ o D m 0 0 O , O ° v m o m' m ccn ;U 1 ~ v CD f0 m O N N C S CD C CD m w n a d d 0) 7 7 z (D CD N v a a A z 0 0 Z ao ao w V M 00 I a m CL 0 B o I c c z I 3 B co ~ w z I v I m i s O N a 3 D _ cu m o ~ c a CD 0 Er Q ~ ~ N C C CD 0) Cl) fD m, 0 a oz a < n m (D CD rn N ° 3 y CD 4z o m a I a b 7 I 0 I ~ I < I o- ~ t I 0 I N I ~ N O I fD p CL A O O b I m m a 69 O 69 O I p p NO AS BUILT SANITARY SYSTEM REPORT ER elA , T04JNSHIP SEC, A T7- N, A_W J. ADDRESS/~ ST. CROIX C UNITY, 1 ISCONS N. :DIVISION , LOT qLOT SIZE . PLAN VIEW -Distances 6 dimensions to meet requirements of H62.20 SHOWEVERYTHING WITHIN 100 FEET OF SYSTEM I I FF I i 1 I r I !T' I I i ~ 1 ~ I ~ I ' ;'TIC TANK(S)MFGR. P,raP . J ,,pp -CONCRETE ri STEEL Indicate No tth AtAow S cat e NO. of rings on cover Depth _ DRY WELL "'CHES NO. of - width length area no. of lines 1-2' Iength_._ area depth to, top of pipe ;NEGATE /11 :.4.: RATE AREA REQUIRED t_ j K AREA AS BUILT ;claimer: The inspection of this system by St. Croix County does not imply complete ;.Dliance with State Administrative Codes. There are other areas that it is not possible - inspect at this point of construction. St. Croix County assumes no liability for I.tem operation. However, if failure is noted the County will make every effort to --,ermine cause.of failure. '.1ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM* '-INSPECTOR DATED zQ=c2 7 - ZZ PLLfiiBER ON JOB Z <u 60 j as -je LICENSE NUIMER I - z - I~FFORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM Sanitaty Penm.i-t/// State SQp.tic r NAME L-,I rown.6 hip ~ St. CAo.i.x County Location ection SEPTIC TANK 'F Size 00 gattonz. NumbeA ob CompaAtments j Distance FAOm: Wett 12%, on gteateA zZope ~t Bu.itd.ing it. WetZands ~ • H.ighwaten _ it. DISPOSAL SYSTEM Distance Fnom: WeZZ it. 12% o,t gneateA scope fit. Buitd.ing elf it. W etZands Ft. H.ighwateA it. FIELD DIMENSIONS: Width o6 tAench /L it. Depth o6 rock below .tile /12-in. Length of each tine it. Depth ob Aoch oveA t.iZe ~ .in. NumbeA os Zines Z Depth ob tiZe below grade 7,Q.in. Tota., .length o6 2.ines it. Stope o6 .tAench do-W in pen 100 it. Distance between Una ~ .t. Depth to b edno ck .Mo.--, it. Totat abs o&bt.ion aAea 6t2 Depth to gtoundwateA it. Requ 2 Type aj CoveA: a eA A Stxaw .iAed area it p PIT DIMENSIONS: Numbe& o6 pits GAavet around pits yes no Outside d.i,ameteA t Depth below .intet it. 2 TozaZ abs oAbt " a it A AAea %eq Aed bt2 ny INSPECTED BY TITLE t4 74 APPROVED , DATE 19 7-7. REJECTED DATE 197. i p P '67 7 1 A,.; State and County State Permit # / Permit Application County Per t F for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Addr s: - 2~6 Z 5 G~-ke I ~ ~4.4 hntx--~ 5 s// 9 B. LOCATION: Section T,?JN, R (or) \L Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. T P F OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family _ 4 Duplex No. of Bedrooms,.~ No. of Persons _ D. SEPTIC TANK CAPACITY 00 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Y Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rat ' ' -.Total Absorb Area- New- t. -Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: X_Length -Width-.47'0 Depth - ?G " Tile depth (top) wW' No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land- Q -Distance from critical slope WATER SUPPLY: Private W Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Cer 'fled Soil Tester, NAME C.S.T. # S2 "-64,2 and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# "L Phone #~G Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. W_ n E i s S F 3 i f a _ a ~ a $ e € Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application -51-7 Fees Paid: State/0,0o o `1 . Q 0 D, e -7f Permit Issued/ (date) S /-7 5Issuing Agent Name Inspection Yes No State Valid# Date Recd 1. county (wh to copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. Plumber (canary copy) Revised Date 7/1/78 EH 115 ` WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 y REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION :4 G '/o, M4, Section f-, TA, R I E (or) W, Township or Municipality f r%~ a Lot No. _i~_; Block No. 94)044 Su15AiV/flO-A- 7- County C 1 Subdivision Namgg Owner's Name: A RES A-V n ERwi ZA p pfd 4. 4! Mailing Address: RT I R WY FF kiU psoN L015 5 q d)1(0 ~ 2 ~ r TYPE OF OCCUPANCY: Residence X No. of Bedrooms 3 Other` EFFLUENT DISPOSAL SYSTEM: NEW 1< ADDITION REPLACEMENT ` DATES OBSERVATIONS MADE: 'S'OIL BORINGS VA&4 2-7 '7? PERCOLATION TESTS 197 01 IF SOIL MAP SHEET S(f 5 SOIL TYPE Z3 X )9 I?R/<j4ARD T- 5A1'r9F_ PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 of. /0-4 0 es -3 hgL Ap P-y 34 ~N. L, lo''4" 4L S a 3 j f G 2 P-3 36 /Y AN ~i~ f "7 Z SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO-BEDROCK IF OBSERVED) 72- A1d___A_)6- 2 z" L_ a Z 51- h e, 10/0,44 r. B Z to if to YAW 1-16 n sL " 121_5". W i V h r. to " AAA L O" " B -1 lri to 13" BAI, /Ke 7 PLAN VIEW (Locate perco lat ion tests,soi I bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indite number of square feet of absorption area needed for building type and occupancy. V ' I 'r--1Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. o T 61 -A 06 A/A ~D_ I U_ I? - ~k tT S I E' 6 N 10C B3 V 9 00 OI 4-TH tN u AT Q It= K1o I A o a= of `r T' •N ! si P y COR h3 E.- R E~ o r I' o 0 Itu y - o ~o0 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) oAa7- 74,11tf Certification No.~ Address Rr / -Up s12/2 &AS . 4,41b 16 Name of installer if known COPY A -LOCAL AUTHORITY CST Signature r E ST. CROIX COUNTY 4 SURVEYOR'S RECORD CERTIFIED SURVEY MAP FILED AUG 24 1978 ~s a B ~ L LEGEND INDICATES I"IRON PIPE FOUND 0 INDICATES 1"X24"IRON PIPE WEIGHING 1.13 LBS./LINEAL FOOT SET N 89°0202 'E 1327.07" , ,h { SECTI LI NE \ \ LOT NO. AREA TO R.O.W. AREA TO C.S.M. MONUMENT AT THE NW CORNER OF mss' ` I 5.536 ACRES 5.805 ACRES SECTION 8,T28N,R19W 2 2.319 ACRES 2.508ACRES -3 3 2.025ACRES 2.214 ACRES M 4 Z003ACRES 2.265ACRES S. \ N z z 3g s \ `s3° W~~ 'SO. z to 2F ~ r _ 3 LOT I ~o3s \ W, 09 CD 2 z SS _j °D 2? Y to 0 4, z O,~ z LOT 2 b ` ~Q 2s o4i c( S55055'40'E 18.38 LOT 3 0 . 10 d\9 o \ 2 SO oo' = LOT 4 c0 \ cV SCALE IN FEET ~~og26 00 o M 200' IOC 0 200 ~~~BR~C~ 33goq'' mm "o h CURVE DATA TABLE gA s2'3` pm - ~.~V CURVE RADIUS R~IORDr CHORD AR CENTRAL 'n M 1 1-3 7482.58 S54°3521"E 349.60 349.63• 2°40.38• ' 1-2 S 53°4601"E 130.52' 130.52 0°59 58" ~ i 2-3 S55°05.2d'E 219.10• 219.11' 1°4040• \ 4-5 550.00 N69°4'7'5dW 94.74 94,82' 9°52.4d; 1 6-7 583.00 N70°16'06W 109.93 110.10' 10°49'12• Volume 3 Page 659 tic -7a_- an 0 0 r 0 -a 0 0 d col c ~ ~ 3 r► c o w -I o 0 g T Z 0 D OD ? < y O V C y a N Q OD - N OAO N O C <D ~'*J G) 0~ O n 07 n (T Q Cj O C !D C ~y " 3 a ti O CD O to rn O to D eD a a f CL m W rn rn W CL 0 0 N O F~ 0 j 0 Z o o n O o °o N Q• y 3 y. 7 Z 001 Oro C r IT S. c vi vi (A j' D o 3 3 o v v o 7 m CA CL Z C = z o o I O o s - . 0 I y j~ C O N CL 3 m Z. -4 N A Z 0 N C = M e+ y n 7 0 Z ~ OD ao T m NO CL N \ z c z t W d I ~ O N O. N a N o w m c 0mo " ID a D fD o Z CL y o l A I g a o N II o 7 ,A ti ~ N O CD A 9 O CD ~0 V I ~ A ti sa e pp"rm~, C f ~E'wu~, STC - 10 4 AS BUILT SANITARY SYSTEM REPORT JUN U00 ~ S OWNER S~ Cl~ C396. F;2z ADDRESS -/7 'Ile, UPS SyD'/ 69 SUBD I.0N / CSMg LOT SECTION L4 T -2'b N-R W, Town of I e ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I CpA 0 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic Lan}; manhole cover. I L n BENCHMARK: 7-O 19/'.Z cS .Qy s = ~Od- ALTERNATE BM: Top b2 C5,YI'S 17'0y~~ DN olgrx_ 7 2 6X(5 / /,vS SEPTIC TANK /-pump eH2U4BER / ION - Manufacturer: pD40as etWC. /Q~j] Liquid Capacity: Setback from: Well 62- House 16 / Other &40. 4e~ Pump: Manufacturer Model# Size Float se eration / P Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM i C4e4, Width:. 3 Length 5 Number of trenches (T~ Distance & Direction to nearest prop. line: 22 `fZ~ -t3~1S Setback from: well: 7/~ ' S 75 House Other ,1l's T/ A)(r' ELEVATIONS S!'7,vG- Building Sewer /V ST Inlet: N ST outlet N/ PC inlet PC bottom Pump Off Header/Manifold Bottom of system E.UI~r,~ ii l~y.Z_Q Existing Grpde Final grade 13 DATE OF INSTALLATION: /3' PLUMBER ON JOB: ZtL/,~/P(G~l-~ LICENSE NUMBER: 22L~3 S Uibricht & Associates PNwtts Sewage Consultants O*Neil Rd. INSPECTOR: k~Eyl;o H Huudsondson, , Wis. 54018 3/93: jt 3A6 TIS 5 NN _ ~ G LAI \ -nz h - ~ ~ N ~NJ' d ~4 lJ1 rC c,. 1' .lam y O; j m ? ~ Cl V1 a Q m $ c - CD a 1 0 / 1 • N v ~'11 I i ~I W N loi •=101Q I i y., I I 1 _ 1 i I I 1 1 1 I w 1 1 ~1 I N 1 - 3 °Jc 1 Al 1 1 1- - I I w V1 N , \I N 4~ ~ y - p \ cn rA c p ~C m Vi , , V1 Q5 ~jl o a A -x k ~ o ~a~ W n -h J a M (-A II ' ~ n O Wiscontin Department ot Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division St INSPECTION REPORT . Croix GENERAL INFORMATION (ATTACH TO PERMIT) SanitarX~erg vo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SS UUGL4422SS Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.: Anacker, Jack Troy Township CST BM Elev.:. / Insp. BM Elev.: BM Description: Parcel Tax No.: ~'D !Vn, c cs7~0~`( 040-1036-20-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~,-f-„j C, I'R9W ce-s Benchmark b a v. U Dosing Alt. BM Aeration Bldg. Sewer 1 Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet t~ vent TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic 5-p f w 6 z - - NA Dt Bottom Dosing NA (&~!o Aeration NA Dist. Pipe .a , Holding Bot. System _5 J PUMP/ SIPHON INFORMATION Final Grade Manufact Demand St cover 3," Model Number I ~ GPM 16, , y3 TDH Lift Lriction System TDH Ft Fort In Length Dia. Dist. To Well Fi SOIL ABSORPTION SYSTEM BED/TRENCH Width Length o. Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION 'ti DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHING Manufacturer: SETBACK CHAMBER / .0• SiDEW/0NJ,17 INFORMATION TypeO r r Moe Number: System: krf v .Z19 6b OR UNIT DISTRIBUTION SYSTEM _`tor.6a Header/Mani f I Distribution Pipe(s) Hole Size x Hole Spacing Vent To Air Intake I __J--,( Length ia. ia. Spacing ~S 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 COMMMENTS' (1 lud~ cod discre~ac~c,es, rs a tc ns ec ion : V t, ns ec i n ff 2_; 'le/41~ 1/4 8 T28N R19W) - 08.28.1~j~115G -Lot 4 Location: ~4bWea Bnck/~oaa, Hudson, V~I (NE l~/~ 1.) Alt BM Description= 2.) Bldg sewer length vuu0[ c Q,~- A5 -amount of cover Plan revision required? ❑ Yes X No - Use other side for additional information. • ,oil ?.rto` ~r _ 6 SBD-6710 (R.3/97) or u c" Inspector's signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I I - , L 6 3 I s i E s ! j 3 13 Safety and Buildings Division Visainsi~ SANITARY PERMIT APPLICATION 201 Bow302ngtonAvenue Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system 4e County s7-• C/PO/• X than 81/2 x 11 inches in size. ber • See reverse side for instructions for completing this applic St to Sanitary Permit F REr''EIUEp ~ Nu Aber - -0 Z 1( Personal information you provide may be used for secondary purposes Chock if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State'Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT AL FORMiA U Property Owner Name TA~` - ' Location _ o~ /4~i~Ge~ 1Ai T 24 , N, R /FE (or) Property Owner's Mailing AddressD tot Number., Block Number l ' City, State vOSo~ F Zip Code Phone Number Su C e or CSM Number 4;,P/. 3 p1 . Gs- F T/ oar 1(3,0& szzo sir 35115 91 r 11. TYPE F B ILDING: (check one) ❑ State Owned E] City Nearest Road illage Public or 2 Family Dwelling - No. of bedrooms '3 ❑ v5 wn of T~OI R&A9 ik4 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 8. Ok /1? • G- ' 41j0 • /030 • 20 • d~t~ 1 ❑ Apartment/ Condo 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 S 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. ❑ 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) 1114 44*,-lY /fT~~S ,3~•~s4•`~i~• AftGC& Non-Pressurized Distribution Pressurized Distribution Experimental Other 6: ;L " 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [Z-Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit Ref Ally . /9 "Sick bR /1A X 3 To74~ 43 ❑ Vault Privy 14 E] System In Fill A 7A_144e5 r Age-,k 3 X s ~ 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 y~~ Req el (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./in ) ~l5•sd Elevation y SS 572- g Feet /L940-0 Feet VII. TANK Cagallo in acitns Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. Tanks Tanks 3 strutted Septic Tank or Holding Tank 144 l IO.~G•lft ~ ❑ ❑ ❑ ❑ ❑ li Lift n am er ❑ ❑ ❑ ❑ ❑ ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signatur : (No Stamps MP/MPRSW No.: Business Phone Number: you 2j%_atl41 -2_1,,-3_7_5 pis •3d'>6 • d'/,'s Plumber's Address (Street, City, State, Zip Code): / rS IX. COUNTY / DEPARTMENT USE ONLY CPJ GE' ❑ Disapproved itary Permit Fee (includes Groundwater ate Issued Issuin Agent Signat re (No Stamps) C Approved E] Owner Given Initial Surcharge Fee) Adverse Determinati X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit i.s:vglid fortwo (2) years. 2. Your sanitary permit may be 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 < + t x r 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. Ifyqu have gVestipns corlcgrning your onsite seyvage system.. contact your local code administrator or the State of_ Wisconsin, Safety and Buildings DiJisiirn, 668 266-3151. - - To be complete andaccarate this sanitary permit application must include: 1. Property owner's name~and m6liling addr-eu ` 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. j VI. Absorption system information. Provide all information requested for numbers 1 through 7. V11. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and mianufa twe6 mire, i►idicate prefat :onsi.t44 constructad,and tarrk.materjal, Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from `©ILWR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc,), address and phone nuniber`: Plumber.t't Ist"Sign applitiortform. IX. County/ Department Use Only. . X. County/ Department Use Only. ,Complete plans aspecifications not smaller than $ lJ2 x 11 inches must;be submitted:to tFve county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference pot,£Y~complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and puwp manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 forn'i; and F) all sizing information. GROUNDWATER SURCHARGE P 1983 Wisconsin Act 410 includedthe creatign of surcharges (fees) for a dumber of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. F • 1 n I' i O N I O rn ~ v1 ~ ~,1 i~ I ,1 I I l I a i t %0s KA p y O O n C % w ZoN p n - ~PP~arr4P v ti T C> jd ff 99=7 ~i~v, 9~ S a Cho SS SL cT1010 o"c TIVEti64~s /jO,04ALP v5-v 7- c 4 jd U,v Its x!:51NI~#4 A9 M 3-Is iv~7XfTo~' I , 13. - TES , $ -Ae 1 '5 ,5'a Wisconsin Department of Industry, SOIL AND SITE EVALUATION 3 Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 5'f• cxo/ X_ include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # v - 1036 - -20 • ov-0 APPLICANT INFORMATION - 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)). Property Owner Property Location j,#, o< A vAck'ER Govt. Lot N f, 1/4,4/al 1/4,S T 2- S N,R / 9 E (or )(D Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# A/ 6,S 7LV City State Zip Code / Phone Number Nearest Road HtjPSV~ 0/• Syo/(o (7/S )3~'y22o F_1 City El Village L7 Town 1?&, 13AOi'cl<- ❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building [Replacement ❑ Public or commercial -Describe: Ai/ _ /VDT ee 6*r ,I^ eAPP Z2 - Code derived daily flow 7SD gpd Recommended design loading rate _!d-bed, gpd/ft2 • k _trench, gpd/ft2 Absorption area required A/M bed, 112 5.0 trench, ft2 Maximum design loading rate L4/,R..-bed, gpd/ft2 . k_trench, gpd/ft2 Recommended infiltration surface elevation(s) 5 u ~G 3 It (as referred to site plan benchmark) Additional design/site considerations •s~" fjoTa v ~ ~z,-, g- Parent Parent material 7' s ~y/fo 101CSJ lood plain elevation, if applicable it It S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system S❑ U El U V s ❑ U 64 ❑ U ❑ U El S a] U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ' is /oyR 2.12-- - 31 L . • S s r'ioye S/L sfsbf s Z 23 314Y P d1t C5 Ground 3 2 • /ay SiL !fs !e as : • 3 - • z 7 elev. q.gf. q Depth to limiting factor 7rl'6 in. ' Remarks: Boring # o./ loyR 2 S/L If SJ,-- ,S C S . S ; • 6 Z •j io e 3 S/(_ f sh GeA cs . s : • /o he S/L l~5hk .3 s - • 7 ' O Ground S/49 slay. /00. ft. , Depth to limiting factor 7/ OV_in. Remarks: CST Name (Please Print) Signature Telephone No. 15-..3.06 • .0/p s- Address Date CST Number R i l 2'1. 2o~t7 ~.~Ci3 '7 S Private sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 (or7y7) yor/s alle- ~x s ri • ,v - ccx/,s r/&~ G-- s frsT-~-w`, Fu hue- • t 7 PROPERTY OWNER A//h C e& SOIL DESCRIPTION REPORT . L 3 Page of PARCEL I.D.# O 7 co ' /0 3~ ~ ~ • &Zxv Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 0 Io ye z/ z sL /fSk& s Cs /f • (f . s /b %e 3A( S/L /fS /c ('S - . 2' . 3 Ground 10y/C 5141 e /~''`A' • 5 D., S' Gr ' d elev. /bl • fin. , Depth to limiting factor in. 77y- Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. n. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) w W O N I 1•=1 r Q ~ I 1 - 1 I I 1 ~J 1 ~ I I I \ 1 ~ I I 1 1 ~ I I IW 11 I 1 1 I ~ ~ I I I I I ~ I ~ N ~ ~ I I i i C~ 1 1 ~ G N ~ 1 I m a b ~ ~ cn ;b p y p ~ ~C r- o O I W o~ o y n • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A Mailing Address 7y~ Rep 18te/ek-, ~P - ShNE • Property Address zo/• S~/O f & (Verification required from Planning Department for new construction) City/State Parcel Identification Number OM 103& • .20 ' OVV LEGAL DESCRIPTION Property Location N~- Y,, NU) 1/,, Sec. S , T_2-_g N-R Town of Subdivision CSA ✓ 5 /!S Y , Lot # Certified Survey Map # e5lif 3,5 11,5y , Volume 3 , Page # &5 Warranty Deed # 3.5,? 2 Ce L , Volume .S f ? , Page # Spec house ❑ yes K no Lot lines identifiable Ayes ❑ no SYS'T'EM MAINTENANCE 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. The property owner agrees to submit to St. Croix 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 wastewaterdisposal 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 in at your septic s tem has en maintained must be completed and returned to the St. Croix County Zoning Office within 30 ys of three y ar x iration C. NATURE PLICANT DATE OWNER CERTIFICATION (we) certify t a all sta ments on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of t e pro e y descr' e b ve, b irtue of a warranty deed recorded in Register of Deeds Office. psi ~D~ GNATURE OF APPLICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed X12 - 2i.o 396 y 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 TA t e AVA L~~ residence located at: NL'i 1/4, IVA 1/4, Sec. , T 26 N, R /r W, Town of Tlw ! 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 Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /0-0 W Construction: Prefab Concrete-Steel Other Manufacurer (if known) : P4Wi S CQw~nR P~9~G~S A e of Tank (if known) : 1-yi d1 G o. c L ltit c: ( gnatu e) (Name) Please Print (Title) (License Number) (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 inspe~cptAioon opening over outlet baffle). 5 N ame "BEP71 'Ul]N RI (4Signature MP/MPRS 2Z03 ` 5/88 .,w 351154 CERTIFIED SURVEY MAP FILED Aus 241978 p in a o0 B ~ LEGEND 0 INDICATES I''I RON PIPE FOUND O INDICATES I"X24'IRON PIPE WEIGHING 1.13 LBS./LINEAL FOOT SET N 89002'02''E 1327.&T SECTIO LINE C.S.M. MONUMENT AT LOT NO. AREA TO R.O.W. AREA TO THE NW CORNER OF Is' ` 1 5.536 ACRES 5.805 ACRES 2 2.319 ACRES 2.508 ACRES SECTION 8,T28N,RI9W T 3 \ 3 2.025ACRES 2.214 ACRES O 74 2.003ACRES 2.265ACRES ~ m 91 SSS ` \ 3 0 •~9, s -to ti Sa° N Z Z w o7+ ,ri ~SOCTy~ z co ro LLI to (0 0 3 LOT 1 .0 \ W oo °8 Z !n SS J ~ 2?- F o ` rn 0 W Z 4t/ ~ 4,31 © ©~$g°Z At LOT 2 O . N. S55055'40''E ~i~^~ © 18.38 LOT 3 1,10 2 ~ 2 LOT4 \/o 0~ SCALE IN FEET ?6' 00 0 ~.RF ro 3 M 3 20d 10d 0 2od 3 40 Cb- N CURVE DATA TABLE ~qo 3 6 ~o CURVE NO RADIUS CHORD CHORD AR CENTRAL cn M 1-3 748258 S54°3521'.E 349.60 349.63' 2°40'38' 1 - 2 S 53°45'01"E 130.52' 130.52 005156' 2-3 S55°052d'E 219.10 219.11' 1°4d40' \ 4-5 550.00 N69°475dW 94,74 94.82 9052'4d; 6-7 583.00 N70°16'OdW 109.93 110.10' 10°49'12 Volume 3 Page 659 Il ov_, --,ea_ i DOCUMIEN C NO. WARRANTY DI CUD A riGTAT[ OF WISCONGIN-FORld t . • IVi i • s ~j, J~ l r: j n.ts s.rwcs ws ""Veo root fmcowot«o swta 3 820 2 Val V V THIS INDENTURE, Made this.-120..... day Of....AUY A. U.19.79-., REGISTERS OFFICE between ' ST. CROIX CO., Wis. _h?s-_ P-Ps.._srA_Ca.thgrina_.PP~:._hu~band and - REC'd. for Retort ifiis lath .._..._t if4..................... day of Jul~_A,D. 1939 part.AA of the first part, and A~?acker~............_......_......, at • tenants _...part..._.. s. of the second part, W'Itnftseth, That the said part.. M. of the first cart, foc and in consideration = _ = - - saruww TO of the sum of_.._----....._ ve undred Do7lars•.------------------•----.....___.._.._....._._........_.._.._.._... Bank of Osceola Thy-._F it--------- H a to..._Nhil... in hand paid by the said part-A".. of the second part, the receipt whereof is hereby confessed and acknowledged, ha..Y!._. given, granted, bargained, sold, remised, released, iltened, conveyed and confirmed, and by these presents do.......... the grant, bargain, sell, temise, rdca:e, alien, convey, and confirm unto the said part.i88, of the second part,.........._..._.._...•.------- heirs and assigns forever, the following described real estate, situated is th^ County of..._$t~.•Croix _ _ and State of Wisconsin, to wit: Lot #;.of the certified survey map as recorded in Vol. 3s Page 559 in the Register of Deeds Office for St. Croix Conntg# Wisconsin. TRANSFER FEE (IF NECESSARY. C:INTINUF. DESCRrt•TION oN Puv-r R98 SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, :fight, title, interest, claim or demand whatsoever, of the slid part--4... of the -first part, either in law or equity, either in possession or expectancy of, in and to tt-ie above bargained premises, and their hereditaments and appurtenances. To Have and to Hold the said premises as above described with the hereditaments and appurtenances, unto the said part-U9.... of the second part, and to..._..th.0-ir------- heirs and assigns FOREVER. And the said Jam199_..ZaPpoL..arA. 4-1!lI .Q I.....-•-----...._......_......_ .................._......................................----..-.............._..__g._........__..-~ for...-theR9I, s,p ..xheir_-__ heirs, executors" and adm:nistrators, do.......... covenant, rant, bargain, and agree to an .1 with the said part.iea.__ of the second part, heirs and assigns, that at the time of the ensealing and delivery of these presents tha7_are....-.......... well seized of the premises above described, As of a good, sure, perfect, absoiute and, indefeasible estate of inheritance in the law, in fee simple, and.that the same are free and clear from all incumbrances whatever, _ and that the above bargained premises in the quiet and peaceable possession of the said partA011... of the second part, heirs and assigns, against all and every person or persons lawfully claiming the wha(r or any part thereof, ....they........... will forever WARRANT AND DEFEND. In Witness Whereof, the said partjea___ of the first part ha-'.M Hereunto set thOAX hand-.1- and seals-_ this.] th....... _ day of-...... 1U3-Y-_--------------_- A. D., 1979-•-•• - SIGNED AND SEALED IN PR74SENCE OF 2.a ~a LrGu r? _ .2----_ -._.(SEAL) (SEAL) ( SEAL ) State of Wisconsin, County. Personally came before me, this, _12th_.-day uf...... A. D., 19-79, the above harried ; y.-- Jams - Zappa..asld-:Cathe-s m-Zapps-, - bushand..aAd...vlf9 tQ d1•e' now: tq §eihhr pe sons who executed he foreg ent and a o edge' t same.- . , TH16._tNSTR'lMEYT WAS OAA FT ED BY Tttoti r1' vcrr 'aY N County, Wis. ,.-J. 0ityt. SEAL i;tary Public , Hudsary -Wiscongin' _ AfY comrrissre-•°(ea (isl----211IIt.___..: (Sectros `9.:1 f;) J •1• t',. .,u " ~ - N pr(wides thxt &;I insmments to be recorded shall c..e pl nlf r.inted of "p rotten thereon , the names of the rant- ra-:.s rte, a,.nnses and notaxp. Section 59.513 similarly regw:es Lat the ,...r of the pe-n who, or gave-n- menta( agency which, drsrtcd rs i, •r:-r=crYt , shall t printed, typewritten, stamced of -=i sherern in a legible manner.) STATE OF W'111WONSIX Wigco nctn Le" thank • .ImpnnY ) A+.&RRANTY DF,F,D FORM No. 1 Milwaukee. W17. ( Job 30624