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HomeMy WebLinkAbout040-1192-30-000 0cn0 13 tw �1 m 3 .4 n _ M m o !* M i c g m m y Z o w o A O • m m° w o• o S < < 7 C .< N Y_1 m Q >> m y j c CO R i C tIr IV �'9 N N N a 3 Q O' y O 7 OD (a 0 0 W O N W C C C n 7 I !Z V O Q� c o R ° � = a cn D t �. W CD 0 CD z co A CL O N N < O O N lV N m Q O f l N ' O ' C c v 3 Z O O O tr m o co - -c -� -1 to N o' 3 T O m Q . 0 v o d x �+ N ffi y �, p 0 0 0 fD O H N• _ y lt CD = c ro c S fD N n Q 0 m d ? ID a 1 A z I w N m N A OD CL ? 2 C y Z 2 CD A A � < a CD CD a N W C O OZ d l O 7 N OZ I � O C.) C1 � N I y co s 0) cr CD y O m O N O O S � O Al O_ CD dC V < w to O O CD CL O � C b o m ti r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division County{ Croix INSPECTION REPORT S GENERAL INFORMATION (ATTACH TO PERMIT) SanitW"ItNo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. Permit Holder's Name: ❑ City ❑ Village s� 't own of: State Plan ID No.: onhus, John Troy 1�ownship CST BM Elev. :. Insp. BM Elev.: BM Description: Parcel Tax No.: j 9 Lf- _�#Z 040- 1192 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic z5� Benchmark Dosing Alt. BM !0(•93 Aeration Bldg. Sewer Holding St/ Ht Inlet TANKS TBACK INFORMATION St/ Ht Outlet 9•SO q3 ` TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake �- Septic %> 6o >6v a5 NA Dt Bottom -- Dosing A Header / Man. lL.. is f� Aeration NA � s L3 •Sd Holding Bot. System f 3 ' f S n .20 PUMP/ SIPHON INFORMATION Final Grade rL -3s� 41.ao Manufac Demand St cover Model Number GPM TDH Li Friction m TDH Ft orcemain Length Dia. Dist.Towe SOIL ABWRPTION SYSTEM C��c4&,vJ e ,4-GQ,4i'� - -. ITW�RENCH width Len ¢rtcln No O Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 3 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Mari f cu t 'firer: S ` INFORMATION Type Of r CHAMBER Model Number. ` L System: t 3 X15 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) xHole Size x Hole Spacing Vent To Air intake Lengths Dia Dia. Spacing ?j 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: a /?- (-/ c' #2: - 4--4 - Location: 215 Plainview Dr e, Hudson Al 5 16 (SE /} 4 SW 1/4 24 T28N R20W) - 24.28.20.859 Croix Ridge -Lot 13 1.) Alt BM Description = 6 S' , � \­j UAL; 2.) Bldg sewer length - 2 - t - amount of cover= 5 36 4 5,e- 1 Levu �) S,4 wad w c��t *- �tb^ - �c � , Plan revision required? ❑ Yes [ANo Use other side for additional infor ation. W � U6 � SBD -6710 (R.3/97) Date Inspector's Signature Cert No. 1 � ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _... ._ m b 1 1 , t a i 3 r t y n .. _ .. a .t r t 5 _a ®e ,. m ... .. m .gym : .. ....., eve e i i E aim �. ..e -... �., a.a me _w e ��p E �.w t r �...,u.... . ... _..: DESe, .�..._,� .... ..om.. „. ... ..r...._, eme ? e ; i d f , m edam. i• m om... e t .. �. .e..e a e m e �e e e .tea »® F f E Imm � a f _ , k 3 t j F a c f i 1 � i S � mm F� ✓ a E 3 ems... q 3 � 6 F . a 4-1--_ � te.. � n 2 , E , F 3 a Z!S PEA- irl/V! EW .� l2 , Safety and Buildings Division `�SCO/1S %/1 SANITARY PERMIT AP PUCATION 201 W. Washington Avenue , P O Box 7302 Department of Commerce In accord with Comm UVis,_Adm 644. , f Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) forth stem, tpr not IeSs.. County than 8 112 x 11 inches in size. ".` C ` • See reverse side for instructions for completing this a atio "' ors ate Sanitary Permit Nu ber Personal information v' 35 3 3 �- o you provide may be used for secondary purposes Check If revision to previous application [Privacy Law, s. 15.04 (1) (m)l. 9 d tate Plan I.D. Number I. APPLI TION INFORMATION - PLEASE PRINT Prope O ner Nam Prop.ert LOCO on to 1 /4,5 T a&, N, R fir) W Property Owner's Maili Address rot Fier Block Number J! City, State Zi Code Phone Number Subdivisi Name or CSM N bel� �9 Yr1 N S'! ( ) d 11. PE B ILDING: (check one) ❑ State Owned [I ity I Nearest Road (� El Public 1 or 2 Family Dwelling - No. of bedrooms ° Tow OF �J 11, 111. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Numbers) t • n g gsq 1❑ Apartment/ Condo O J4 O —tic a— 30 —0 0 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. Ja New 2. ❑ Replacement 3_ ❑ Replacement of 4 E] Reconnection of 5_ E:] 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 E] In-Ground Pressure 42 [] Pit Privy 13 Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill __� ) C r� s Is VI. ABSORPTION SYSTEM INFORMATION: A1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate m E ev 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) Elev_9 �m 5'0 9 y i 'o Feet 9' , 0 feet VII. TANK Capacity in g allons Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- .Steel glass Plastic App New Existing structed Tanks Tanks Septic Tan or �' t ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for i allation of the on ite sewage system shown on the attached plans. PI ber's Name: (P ) m2zv! MP /MPRSW N Business Phone Number: rr f A& i!� 1 . Plumber's Address (Street, C1 y , State, Zip Code): if S'�` LA-a. Z 5 w7 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) 4 Approved []Owner Given Initial Surcharge Fee) Adverse Determination �" 1 X. CONDITIONS OF OVAL / REASON P S OR PIS PPROVAL: � t Iry la-e- trot - a,.. low st�.e -�- �- -b I:�DK �� - Nlo�,-� sY sP�� r.�•. i .fit c�o -wtc�l o a�2� �S'. SBD -6396 (R. 4/99) 'ER STRIBUTIOW Original to County. One y To: Satetyll& Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may 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 vGheriever 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- 3151. - 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 numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. a Complete plans an'd Aocifications not smaller than 8 112 x 11 inches must be submitted to the 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 points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a'1 15 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. J I, �oAh s / s YY say7"�2a� U-) mN y ro ✓ ro; �a 6 a J Wisconsin Department of Industry SOIL AND :8IT E EVALUATION _:REPORT' P age ,� . of 3 tabor and 'Human 'Relations Division of safety & Buildings in accord with ILHR 83.05, Wis. 'Ad rrt. Code` COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but % C4.MX not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. G q O - 1 l q APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION MD BY DATE 1_ PROPERTY OWNER: PROPERTY LOCATION Z3U` !Z Z b'dt� -eOW=W S 1 7. It S W 1 /4,S Z T Z�b ,N,R Z-O E( W PROPERTY OWNER':S MAILING ADDRESS. LOT # BLOCK # SUBD. NAME OR CSM # 3(3 4 .) � 3VQ 6Vt `t>Nz.. \3 __ -Ce") x CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE MOWN NEAREST ROAD W06bbv"N ( )L-IlV Ss 12,5 (W)S X2.0 t lvvttnv b1Z . [ New Construction ' Use [>J- Residential / Number of bedrooms y [ I Addition to existing building [ j Replacement [ I Public or commercial describe Code derived daily flow bow gpd Recommended design loading rate bed, gpolft trench, gpd/ft Absorption area required $-% bed, 1 - i S tr�n aximum design loading rate •� bed, gpd/ft 8 trench, gpd/ft Recommended infiltration surface elevation(s) S to site ri benchmark) Additional design / site considerations INS (Yv VW 6" Mjj�& 4aL�u Parent material S Ov S H Flood n elevation, ' u�ble "A S = Suitable for system COWENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM W FILL HOLDING TANK U = Unsuitable fors stem E) S 11 U EIS ®U ®S ❑ U EIS R U ❑ S ® U [IS IO U SOIL DESCRIPTION REPORT 1A�'�' W- 6ti.fiD� it SLfs W Fa L v►�surik, X 10 \..t w1IM tnL%A t L"S ok-'T Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour Roots GPD /ft in. Munsell - Qu. Sz. Cont Color Gr. Sz.. Sh. Bed Tiench <va:S<:riM Kik 1 o--7 l Z- z r z s l ` Z`�Sbk wl v Pt cs 1 � • 5 • � Ground 3 ZS _gS �.S `iR 31 �( S fit- o sos rit — • . elev. ft Depth to limiting fact Remarks: Boring # S •� n c -_z lo\ -t,N2 "2.,Lz - sl1 Z`Onbk fn vlzI, 0S 1`M si.1 Z•Qsbk wt�'t �S l� - 5 - � i Ground elev. g 4 52-1 it. Depth to limiting. factor >4 (f w Remarks: •`b "� T Name — Please Print Phone: / Arthur L. We erer 715.,�+�'� �..'. ress. egerer Soil Testing & Design Service - P.O. Box 74 River .Fail. Signature: C O ` I Z y Date: 6--s- CST Number 2 2025 4 1 /i PROPERTYOiYPFER• BD1JYrUS SOIL DESCRIPTION REPORT Page Z of PARCEL [1), # © Ll O - t - 30 Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Bourxfary Roots Bed Trench Z�s ►nbi es 1k, > > > }? •��..�:<.�, < �::.< Z � .3a tio� -ttz. 316 • s i I Z `P' 3 bk, ,, ��- Cs t � - s . J; Ground 3 3 $ $3 1. S I2 31 v 9 1� ` _ • - 1 • a elev. S ft. Depth to limiting factor Remarks: Boring # •' •.�?• 1 � -� Lo��z iLz � sib Z�sbi� m��„ �-S �� , s I•� as 1 .S -S 'Ground 3 ?� -3v �•S�2 3jy S O S9 M CS • �•0 elev. 011 ft. S O 8 h'1 - •� Depth to j limiting factor 9Y 0 J i Remarks: Boring # u`�� Z s11 Z�s w�v cS W) • s ' . b - ':��• - > o��Z 316 — s i 1 Z`�s'�� r� 3 Uo g4 A -S`J 3lY — S S I Ground 9 wl � - .") , • � eI vr - a� ft. Depth: to � limiting fa ctor. i Remarks: Boring # Ground elev, ft. Depth to limiting factor; Remarks: _ PLOT PLAN g Pa e 3 of 3 `SCALE 1"= ZO v Kati i O 6� 6� o Q' 01J mff A L Z' ptL0\11 F G1 UND - LILT �` bifl RIV14 ., 3 ` g -5 QM*—? -- l o-" 0 04,T oN NftiL IV t W\)Z G"Lxv a Cl- 914 8 - -; ry 'two N - I ' Z) g 8 t VI-c\4 lmeti . Gov s E O� R'` L hs'i Z S' �izowt `i1z c tiff 1►J c�� 3 c4� S , 3'x ssrA' lA (s wl H crt'Pl� - ��� OET�'2M'�1h1� `� °�t4 �L�"V ►Yf1Uhl S 197 T)1�L OF C �TZVC�OtV A fi F1PRfX1h� S`-tS'1'E7"I ALP�L�v U l� D (Z qQ -IZy ( 715 ) 423-0169 - CST Signature Date Signed Telephone No. CST # Wisconsin )eQarhYSent of Industry; S O.I L AND $;I TE E V A LU ATLON R'E'PORT P e of 3 Labof aixl Human Relations _. ag DivWon Safety Buildings in accord with ILHR 83.05, Wis. Adm'` tle ` COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S` `QLX not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D.� dimensioned, north arrow, and location and distance to nearest road. O fl l Mz APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION -- REVIEWED BY DATE PROPERTY OWNER: 'Z fNNJ Q .A} P t l_ PROPERTY LOCATION av�l :S* b era S w, vas ZY T �_ ,N,R Z-o E ( W' PROPERTY OWNER' :S MAILING ADDRESS- LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER EICTTY []VILLAGE MOWN NEAREST ROAD W000 b$iJ", X-ity SS IZS (6 S 6467 itvvtt b1Z . [q New Construction Use [ Residential / Number of bedrooms 1 4 [ ] Addrti;T to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow boZ gpd Recommended design loading rate bed, gpolft trench, gpolft Absorption area required 858 bed, ft 1 S O trench, ft Maximum design loading rate bed, gpd/ft - 8 trench, gpd1ft Recommended infiltration surface elevation(s) S� rJp`i )'O ft (as referred to site plan benchmark) Additional design /site considerations 1" s � dJ Parent material Flood plain elevation, if applicable IQ Pj ft S = Suitable for system" CONVENTIONAL MOUND W- GROUND PRESSURE AT -GRADE SYSTEtd W FlLL HOLDWG TANK U = Unsuitable lor stem ®S p U ❑ S ®U ®S ❑ U ❑ S U [] S ®U [IS U SOIL DESCRIPTION REPORT t' SLa W RLI 7&3Sw7r3 b�X` Ltlyth� k1�A t Lt Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistecce Boundary Roots GPD /ft .... in. Munsell _ Qu. Sz. Cont Color Gr. Sz., Sh.. Bed tenth l?ti.:: r_A" l wt . S •b a m'PI•• �S t � Ground 3 ZS -°l .� S `ifL 31 �( _ S 6t- o S°� m — •1 elev. 8 - 1, - 7 ft Depth to limiting factor Remarks: Boring # <�.M. _ Z= k4 3 6 =9y y Ground elev. l32-1 ft Depth to 9 limiting j factor > 9 Remarks: T Name: — Please Print Arthur L. We erer 100e 715 -425 -0165 gerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI. 54022 } Sgnature: /� i ` l Z y , Date: 6 _ S —� CST Number. 1 ' 220254 i PROPERTY OWNER ��1.tJl�jS PARCEL LD.# C4 0 SOIL DESCRIPTION REPORT Page Z of � - LE`1Z - 3 Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft In. Munsell Gr. Sz. Sh. Consistence Roots .. >, >,:. Qu. Sz. Cont Color Bed Trench ail ♦. �l Z wt 'F�• cs 1 � . s • 6 'Ground 3 'a—q - I • S `-t rL 31 S C�l SC) 1� _ •'1 •8 elev. ft. i Depth to limiting factor Remarks: Boding # 2 Z 3!6 — si 1 Z� 'Ground 3 Z6 -3°� -S �l IZ �� S O S9 ►� CS .� elev. y 3g �1(o t ` t 1Z y! 1 i Depth to limiting .factor > Remarks: Boring # s 1 z s �� Ground 3 UD -9�{ l •S `-1 l �l y — g p S9 ,,,. . elgv., Depth to limiting factor.. h Remarks: Boring # Ground I elev, ft. Depth to limiting factor; , Remarks: _ ,. PLOT PLAN Pa 3 of 3 SCALE 1 "= LO ' \j t3 3 Va \ 6, 6, o d yl - urL 100.p a Q NPRL V pv1 L0 F Gluum:) - IYQ z btfl slP-� Tgkre oN NML 2-8" I'cwE 6241JtiA gL948 try �w�N 1` bi►1 Bt�ZCN 't'1��, ZS' w '71 ict ATE `ZU t N s1`R1.lS,�1� � ►� �� � 3 u-i (s wl �" cI4 0 -�rr� l`rtr S LDE wu. r�� LCkt eY'13L1"L S . `R c )U v'. ��" D '�> >"`fi llt'l t�nwrJ S9 v .. �'P2ox�w� Q L am* 4 "H s ' ALP+�L1v U l�1 D R zz oZ 5� ( 715 ) 425 — A5 CST Signature Date Signed Telephone No. CST # c 0 C C I llanuI -- —bl E ni Ems °' 0 co� N E Tl co U X (0 vi - O W o U U fJ ti r X _ -_ - -0 L V N V) _ O C p 0>1 ct3 �f E€ c w o oF a = - d _0 Q = N U ? .r co U i - co 0)-0WC a) _ PG - U- N U-0 6 C (D L i C] N U y O :J J 0 w 5 pp♦ O � u. - O N O m i. r 1 ) lJ v 156, t I W6-4i 3 E O t� O co W ++ f Cl- co a Cl O T 1. •�1O Y �V ( � G u) i y I t � • I i f Fronn CALVIN POWERS Fax: +1(716)246 -518 To: DAN Fax: rl(DOl)rJ•viw • -�- - ST CROIX cour4TY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ° 55.1 t:in� Mailing Address Property Address (VerirwAftn required ton► Planaleg Depattema for now CQnd uetioa) City/ W$ Parcel IdaltiScation Nulnbct �� � � 1 � �� �• � = �� 1r t29.AL D aCIZPTION Ptoparty Legati �.' /w .'/�, Sec. �, T�.N.R�W, Town of Subdivision C� Qr e — Lot # Certified Survey Map # . Volume pee # Warranty Dad # �� c'� FS U . Voituna rf � page # Spec house ❑ yes no Lot lines identifiable I$ yes ❑ no ese and maintenance of your mph eould:csult is its peematura fatiiltra to iaadieW� �' VW the consists of putapins out the septic tack every three yew or sooaarr if seeded by a flt P uma. caa amt the tonatlon of the septic tank as a treaow stage in the mile 419 IYOML a eerdfiea" forte. signed by dm owner asst by a 47te pmpeely owner agrees to submit to St. Croix ZoWN DePa that 1 tie ca melts w"11OWNtardi�l s *m } muter plumber, jmmsyman p1m�, teatdctedpinmber or a limudpmnpar t1►lai (� took t: less than 1/3 full of dud=e. is in proper operatiag ooaditloa and/or (2) altar impaction and pumping (if tutce7►). i/wo, the undersigned have road the above tequirco go sad agree to maintain the private W*W dbpoW qot m with the standards ent of Commerce and the Depattlnunt of Natural Rasonraas, State of Wisconsin. Certification . at talk heroin, asset by the Deparun Office rrithia 30 stsift that your saptie system has been mintained taut be completed and Whueed to tie St. Croix County Zottiap days of th waaffeViration date. SIA OF APPLICANT DA'!'8 4 (We) to meats on this tam m true to the beet of my (our) ksooWkdSe. I (we) am (an) do owaa(s) of the arty virtue of a WaeaMy deed reeaded in Regleter of Deeds Offke. 3 &1 ©� SMN C DATE . •.. a My iafonaation that is mirnpresented may result,0 the unitary permit being M"ked by the Ztmft Depubont, •' "• • •e Include with this application: a stamped warranty deed from the Register of Deeds OMN a copy of the certified survey map if reference is made in the Warranty deed _ e" 1447PAGc 5f 4 KATHLEEN �H WAL8H rt REGISTER OF DEEDS Document Number WARRMITY DEED ST. CROIX CO., YI MMYED FOR AEL'dill This Deed, made between Dave Heupel, Grantor, *-W19" 9130 M and John Bonhus and Lisa A. Bonhus, husband and wife as AAA Nly ND survivorship marital property, Grantees. E T tro sI P Y FEEs Ntriesseth, That the said Grantor, for a valuable CM consideration conveys to Grantees the following described TrtAlCiFElt I9l.00 KW real estate in St. Croix County, State of Wisconsin: I NB FEE` it0 Lot 13. Croixridge Addition to the Town of Troy. Together With a non - exclusive roadway easement over that part of Lot � aW Return AdO — 13 Croixridge Addition described in Volume 573, Page 69. KRUTINA IDGLAND Acceptance of this deed shall be indicated by its recording Zi17# Estreen & Ogl with the Register of Deeds and shall automatically and P•0. Boa 359 irrevocably make the Grantees, their successors and tudse'l, Arl 54016 assigns a member of a non - profit, non -stock corporation known as Croixridge Homeowners and entitle them to the 040 -1192- 30-000 benefits and privileges of said association and bind them to cPgroW n Nunes the terms, conditions and obligations of said association. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Dave Heupel warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, conditions and restrictions, and will warrant and defend the same. Dated this _L day of 1 �- *Dave Heupel AUTHENTICATION O ACKNOWLEDGMENT Sipnatu'r STATE OF WISCONSIN ST. CROIX COUNTY f came before me this day of 1 personally 4998, the above named Daw Heupel to id t •day or . •, , , � .- � me known to be the person who executed the toregany inabument and acknowtedse the same. TI , e4EMBE4 STATE BAR OF WISCONSIN Notary Public, State of Wisconsin. ( nok My commission expires • authoraed by X708.08, WIS. Stals.) THIS INSTRUMENT WAS DRAFTED BY C. L. Gaylord, Attomey at Law �d be tjW o<v� Wow River Falls, Wt 54022"` °r P e10 °'"° WV apaah tlrir sgrot�uw• k3gneturoa mar he a&mAU Wed Of ad uvvAedd2W- Boat ra nd nacaaaaiYJ • W-w 5o p,d.w.nN. C—P-y Pond du Lao- W!�cwnin WO- OW2021 P_02 MAR -29 - 00 05:25 AM r d,, � / r rr' 1.60 ACRES • OR r ol / i / f 0 � if of r ol X3. ,?' / 3 +a- 2.43 ACRES "00et, 0040 40 ae. O N 1.69 AG' �p3 1.73 ACRES � .4� x°160°'` 14 *'� �ry�.+p S0'g W r r$r °p3�21" 3pT06' .X 3/3,60, % w 1 \ W s J� �D h• \ % \ n i ' �' r` 1 5 `. %. `\ 14 .o ° N 1.48 ACRES u.49 ACRES ° 9 c \ i 108.89` 66.00 134.00` N 89 W D R - \ \\ 309.89 °032 ` 309.$9 ° 57' 32 " N 89 W ` . b � °15 - 109.89 200.00o� co y O co W w s � � •,ten � �"' . a - a o m � o i,28 � N 1.49 ACRES � C\3 1.19 ACRES z z • A lb�b 294.98 20Q00 N 89 46 97`31 "W NORTH LINE OF THE M