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030-1021-95-100
n ■ o ■ - � c \ m � k 0 7 s 0 R] 2 = c f} E 2 k 0 \ j \ \ � ° / '0 CD / } G_ E 2 Q @ \¥ e A ~` E E§ k k r _ [ § } a © ; m z > E o @ ¥ ; e, �. / 2 ¥ ° \ / 3 \ 2 E 9 /� ® \ft § § ƒ § E _ CL ■ .. rr § \ 0 0 0 c ] § r ƒ § § CO) \ / § OI Q g = : � § \ ) ( ° 7 §\ §!/ & j / a .. S § { 0 @ c 0 % � ` \ \� m 5 \ (a \ & 2 E � f , % k / E P 2 � w u � q d c E § k 7 $ » , { $ $ \ c w a % / 0 � � 2 \ § � I � � % � \ � e 0 < § % _o �$ /i �) Parcel #: 030 - 1021 -95 -100 04/27/2005 12:07 PM PAGE 1 OF 1 Aft. Parcel #: 06.29.19.93B 030 - TOWN OF SAINT JOSEPH Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * WALDROFF, DAVID J & JULIE A DAVID J & JULIE A WALDROFF 398 RIVER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1160 TROUT BROOK RD SC 2611 SCH D OF HUDSON _- SP 1700 WITC Legal Description: Acres: 3.162 Plat: 0902 -CSM 13/3702 SEC 6 T29N R19W SE NE FORMERLY LOT 1 CSM Block/Condo Bldg: LOT 1 13/3702 NKA LOT 1 CSM 13/3703 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 06- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 4891 148,500 Valuations: Last Changed: 07/0712004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.162 77,500 68,600 146,100 NO Totals for 2004: General Property 3.162 77,500 68,600 146,100 Woodland 0.000 0 0 Totals for 2003: General Property 3.162 46,100 56,800 102,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/29/1997 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner f✓� /���,�� � Property Address City /State Legal Description: Lot Block Subdivision/CSM # i NGQ FFjrti , , l '/a ' /a, Sec. T2&N -RAW, Town of T, SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer e.5'T` Size ST/PC 1,nodl Setback from: House / 7 ' Well j o o P/L ` d Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: 'r%,v dl Width S Length — Number of Trenches - ;I— Setback from: House �s o r Well o PAL g D Vent to fresh air intake ELEVATIONS Description of benchmark Elevation l oer ° Description of alternate benchmark ,l3 ,- Zq-'©--, Ir g Elevation Building Sewer s. 5� ST/HT Inlet ST Outlet /-'5 Inlet PC Bottom �- Header/Manifold 9, o / Top of ST/PC Manhole Cover Distribution Lines R3 Bottom of System( ° e' Final Grade Date of installation /, Permit number ) W � State plan number Plumber's signature License number ;2-7`l f� Date Inspector he Z'i , , f/ Complete plot plan � NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 41 �nV i Qt INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT -GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: ST CRO X Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Per � n ALDROFF DAVID me: El City El village gl Town of: State Plan ID No.: W ST. JOSEPH CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9900363 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t6r <°eO Benchmark Dosing -�. Q� ro•SF Qle - Aerati n Bldg. Sewer •2Z s S3 Holding _ St/ Ht Inlet `1.YZ 23. 3 3 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air I to ntake ROAD 9+ lmlet ir Septic �p' r� _- NA Dosing NA Header /Man. 3 ' } •c / - . o S /3.4z 3 Aerati NA Dist. Pipe 4. S Holding Bot. System 11 4� $ IS.�3 x.01 PUMP/ SIPHON INFORMATION Final Grade 5'.;904- ��.,.; �-•�S gq, 9 0 Manu rer Demand 4Wy f O Model Number GPM TDH Li Lriction TDH Ft Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM B'EB Width Lengt No f enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION 2 DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of model Number: System: 3c r CHAMBER ID - —! OR UNIT DISTRIBUTION SYSTEM Header/Manifold �i Distribution Pipe(s)� « x Hole Size x Hole Spacing Vent To Air Intake Length Dia- L Length 10y Dia. Spacing �gD� 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 6.29.19.93B 1160 U BRO K ROAD L T 1 rK 7-- 2 — ( 00 Plan revision required? ❑ Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: € = E 6. r a m �� em », , 3 x 5 e 3 I s j S„ »» >_.. � «..,.... ,...�.�» „,__ -,." �m ',..�. ,m� ,. , Y E E � a w 3 3 1 s r y A a € 3 i i F € c•} Aga, E E 3 -j", ,., . ».. e..... .... F .... .... ,." 4 ,w..... ...A,.y a e S 4 a n ? c e- ..,.,,.. ,. ,� e m ............ .......p " . ..., t .«w 5 � � .... p.:« ».... .. .«. �. ,.... _n -..may v .. »,.... __�..,. �_ ., Pm ,a. �a ,,�.�..m. ,.... �, , �n »,,..,.,. S ». w� _, ,.._,A. - t m.»," , ..L.. a,. ..m._.„j s c k 3 i , p , T { i g Safety and Buildings Division Visconsin SANITARY PERMIT APP 201 W. Washington Avenue Departure t of Commerce In accord with ILHR 83.05 `)u�Jm 'Cgtte'"' P O Box 7302 Q, Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the stem, on { ap�not IeSs County r than 81/2 x 11 inches in size. • See reverse side for instructions for completing this appfitatior - = „.” :St to Sanitary Permit Number Personal information you provide may be used for secondary urposes ` t' El heck if revision to previous application [Privacy Law s. 15.04 (1) (m)]. / /G� g . (( to Plan I.D. Number I. APPLICATION INFORMATION =PLEA E PRINT A ' N ` Property Own me W Prop _Location I f „ 14 t/4, S T,2 , N, R �8` E (o49 Property Owner's Mailing Address Qt m.- Block Number Cit , State Zip Code Phone Number Subdivision Name or CSM Number er ssol T YPE F BUILDING: (check one) ❑ State Owned 0 Cil Nearest Roa p Village Publi 1 or 2 Famil Dwelling - No. of bedrooms 3 Town OF '� 1 , & e A& 7 o 0 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 436 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 ❑ 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(2] Seepage Trench 22 ❑ In- Ground Pressure i 42 ❑ Pit Privy 13 ❑ Seepage Pit �OZ �� 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 WSstem Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 4? 40 Elevation yea v� S7 d ,vim- , o d Feet /.'a ae Feet Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App Tanks Tanks S ptic Tan X �(>� �' �o ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I I ❑ I Ejl ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signat e: (No Stamps) /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): R r 6 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit F (Includes Groundwater j D at I ssued , J ISSUIn nt g ture No Stamps) Approved I ❑ Surcharge Fee) Owner Given Initial �S'6a / � Adverse Determination J X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, 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.i.�svinq- ahtthority. 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 pumpe'r'Gvhenever 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. Complete plans and specifications not smaller than 81/2 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 115 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. r �-G � f�a/ /eta % /� v�� -/ /��`'� S G ���' ✓� � L� �� �t/N !J/ S"T L�D S�/Oli -- - -_ ,� Q,� a ,• S- r • 7 Trc,u��. �e S �� - off D \ C {�4 i Yl 3 �r , • d e �.✓ .� �/ 3 D � ` Td 7rar. wt !fir o c e� lz't� /�,lcv jOd.� i �e ✓i0 All, 13 a Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in aCCOrdar qvl .,'Itll48 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 1 K� h#§ in slzq, PI must `� County include, but not limited to: vertical and horizontal refere s.pofnt (BM), t�ti6and percent slope, scale or dimensions, north arrow, and to and istance tt3.tji t road Parcel I. D. # APPLICANT INFORMATION - Please prinnformi v � R� wed hN Date Personal information you provide may be used for secondary p os;(P�t 04 (1) (m)) Property Owner X Ff roperty,L " ation o J 1/4 �JC_ 1/4,S l0 T 29 ,N,R 19 E(or)( Property Owner's ailing Address Block# Subd. Name or CSM# ' ��9 & � 6 City State Zip Code Phone Number ❑ Ci El Village Town Nearest Road tad ors, W� 540 �(o (`115 )5q9- (060 e e,r• Trou f &ook 12d. New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement El Public or commercial - Describe: l Code derived daily flow Aso gpd Recommended design loading rate bed, gpd /ft � trench, gpd /ft Absorption area required _ (P bed, ft �(DS trench, ft Maximum design loading rate bed, gpd /ft • trench, gpd /ft Recommended infiltration surface elevation(s) e �1 o Goux r ff 7. a a ft (as referred to site plan benchmark) Additional design /site considerations pq . e Parent material Q�Qc iI a) ou Flood plain elevation, if applicable IV A ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system Os ❑ u ©S ❑ u O s ❑ u ® S ❑ u ❑ S ❑ s ® u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1�w5 r 31 z LS l rn InJPr LS ! J 2 5- -39 IU r`fly m5 s ,rnI �s Groundg elev. Depth to limiting factor 150 in. Remarks: Boring # mclr c N � • 3 2 so 1 �I /�I — r~5 Ground elev. Depth to limiting factor 12 in. Remarks: CST Name (Please Print) Signature J Telephone No. A d G rn `�' c h e,r 0 Address Date CST Number 0 S Cedar 54. *q So r l LoZS (0-/9-99 2 5 3 3 o i 1 SOIL DESCRIPTION REPORT PROPERTY OWNER Page Z of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 v ( r31 — 5t- 1 c �v�' 4 • 2 IS -2q t v r H 1 4 m m l CS Ground 3 24 lb r y ( L5 km 5 m CS I v. 9� L4 Mfrs t p r 41 y m &Sq C - 7 Depth to limiting ( factor �� 1� in. Remarks: Boring # I -� 3/Z I ab m r v �' y y 2 -sJ i r k I mt c5 s 3 3J -I I 10 y �� m•S O Ground elev. Depth to limiting factor I/O in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # I _ - -4 � ►z I r cS Z 1Z- lG r3ly S� 1 Z,r�G `�' (o _ 1byr y ((v cn5 M1 Ls Ground elev. C IO .`t Depth to D limiting factor II in. Remarks: Boring # QQ tmabk m-',r c5 Z ,3 I U r ,5 k S; 1 2 M F C S - 5 Ground LA 1- (j i< `� (D SL 3m6bk Ek elev. Q 3.50 ft. i Depth to limiting factor 91D in. Remarks: SBD -8330 (R. 07/96) f N jt-e- v, o * qo (o o Arlo- I I x arr R p�`�✓' 85 • �� 63 a� a tSm Z. a �n �tvt�x Sh"p G arr\ � I I S ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailin g Address v 5o1� Property Address UP (Verification required fr om Plann!g�Department for new construction I (i a r o of' Br P®cx o City /State _?{ em u Z Cex) e Parcel Identification Number LEGAL DESCRIPTION Property Location ,:LL V4, ` 4, Sec. 4,' T 9 g N -R Q W, Town of Subdivision �' �e ' Lo Lot # Certified Survey Map # 0 f , Volume , Page # Warranty Deed # _ 'YV , Volume , Page # Y �l Spec house ❑ yes Zno Lot lines identifiable ❑ yes N-no SYSTEM NL 40UENANCE 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, restrictedplumber 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, -as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days �three ea r exp' tion date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the erty described abo by virtu of a warranty deed recorded in Register of Deeds Office. SIGNATURE 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 • DOCUMENT NO _ � TPS $A$ WISC N - IiDIa 11[° • :7 reu spats aesuavw F OR aceORDINO DATA 114► lit A {��1 . ,� 1 _ "_- ~` - REGISTERS OffICE This Deed, made between --- .J•..,Leslie .and...._._.. 4 Rat d. frx Reaord,t�.�s ISv DAyid. J.- lia♦ldroff,� - • ss.. joi?rt tenants { r - -... ..- - -•• -• n ......................................... ............................... .I......... ............. ! 'icy of Ma�� A.D. 1 _ .... ............ .... ....., Grantor, 1 and .... David .. J., Waldro. f. f.. aod., J. uli - . A }. - Wsldrof.f,- .husba,nd- - - - - -- ! 3:30 and .wife. -aa.. joint..tsinant;!._ -.. _ .......... ....... .. .. ._.............- _.......... ...... .. Grantee Witnesseth That the said Grantor, for a saluable consideratic,._ ... •s to Grantee the followin described real estate in $.t.: Cro- lx- , -...._ .. " 'TUnrt ro conveys One Dollar. - .01..00).- And_Q.`hex. good . -and _ va_luable.- considerat' County, State of Wisconsin: ! SEE LEGAL DESCRIPTIONS ON REVERSE SIDE Tax Parcel No: ................................... ii is !� {, I! i I� This deed is given in satisfaction of that certain land contract between the parties }; dated May 9, 1979 and recorded May 11, 1979 in Volume 11 593 11 , page 481 as Document No. 356779. i " X. �,gT 1� it This _ . s..nOt..._ homestead praperty. t' (is) (is not) .� ` Together with all and singular the hereditaments and appurtenances thereunto belonging; 1 And.. -_J,. Leslie W _ _ Waldroff and David J. Waldroff _. _ ,- _ - - .__.,_. warrants that the title is good, indefeasible ir. fee simple and free and clear of encumbrances except easements and zoning ordinances and building restriction; of reeord, any f and will warrant and defend the same. �f Dated this - - --- - - - - -- 1 -... ...... day of _........ .. • .! ...- 15. 8 �t ,.... (SEAL) - -- - -- -. Leslie .tial.dro.f ..- .. . �( (SEAL) �"s :O(0 (SEAL) - - ..... - - - ... - - - "avid. 1._ Waldroff - .......... AUTHNNTICATION ACKNOWLEDGMENT is Signature(s ------- ..Leslie Waldroff and STATE OF WISCONSIN Dayi. Wal off ss. I � -- --- -- - - -- !t t --•---- •--- - ----- ---- -- ---- ---- ------ C ount y . �_ auth ticated is _.' -� of. _. , " )_87- Personally ,ame before me this ................day of .... 19 ........ the above ray 1p1 .... .---• ••-- - -••- -- ----• .. .................. Douglas R ilz - - - -- .. _ •- - - -- -- -- -- -. - -- - ----- - --------------- .----------- - .. t� TITLE: 3fEil'BER STATE BAP. OF WISCONSIN ii (If not, - -- --- ---- -- ---- - - ---- - --------_ - -- t authorized by 1 706.06, Wis. Stats.) to ne known: to be the person .- .- .. -. -. -. who executed the fo.e�oing instillment and acknowledge the same_ THIS INSTRUMENT WAS DRAFTED BY DOUGLAS R. -..1 [.Z, Att ° -' nay- at-- LaW- -- - --- ------- -- ..... .. ....... Hud3. Q(t._. WiscOn S.-- - - - - r 4w .... .......... Notarp Public --- _ - - -_- --- -- .- .-- .. ------ -- County:, Wis. (Signatures may he authent cafe +i or acknow :c: ged. Both M Commission is permanent. Of not, state expiration are not ntssary.) date: - _ __ -.-__ ....... ._., i Yames of pero-�•,a signing in any .m,ity sho be tY-ve' ur r: ced t•:•1 ,•r it-, aiK �. •� _.. NAG I.411rr ® STATF ;'Aft OF 'i :,: :.'�3 ti. :' :•: Na. - 1982 Stoc 5 1 3001 NO. � 3.11 , °. �:- r �.d.` « ; - "�. >'3: "?c�`k�C'7'•�"�"" s2 x ,k.ce "T'� „ "� r° ��'t . _ "'� r.' �m?� ^E`<C$`+ia:�'- "^ -a^7^ _�_�--- °' -�-'�" U 0 low 7 ftexao l SE -1/4 of the SE -1/4 of 31- 30--•19, St. Croix County, Wisconsin. and t" SE -1/4 of the NE -1/4, of Section 6- 29 -19, St. Croix County, Wisconsin. and NE -1/4 of NE -1/4 of Section 6- 29 -19, St. Croix County, Wisconsin. and SW -1/4 of the NE -1/4 of Section 5- 29 -19, EXCEPT Lot 1 of Certified Survey Map filed May 2, 1978 in Volume '2" CSM, page 585 and EXCEPT Lot 1 of Certified Survey Map filed May 2, 1978 in Volume "2" CSM, page 586, St. Croix County, Wisconsin. and SW -1/4 of the NW -1/4 of 5- 29 -19, EXCEPT Lot I of Certified Survey Map filed July 21, 1978 in Volume 0 3 " CSM, page 641 and EXCEPT Lot 1 of Certified Survey Map filed on July 21, 1978 in Volume "3" CSM, page 642 and EXCEPT a parcel of land situated in the SW -1/4 of the NW -1/4 of Section 5- 29 -19, commencing at the centerline of the N and S road on the W edge of said property; thence E 424 feet along the N edge of the E -W town road a distance of 424 feet to a place which is the point of beginning of this parcel; thence N at right angles and parallel with the W line of said quarter section a distance of 217.4 feet; thence E at right angles and parallel with the S lir.-- of the E and W town road a distance of 200 feet; thence S at right ang <<s with a line parallel with the W line of said parcel being conveyed a distance of 217.4 feet to the N live of the E -W town road; thence W along the N line of said E -W town road to the point of beginning, St. Croi GoMnty W onsin. G08054 THIS INSTRUMENT DRAFTED BY ED FLANUM JOB NO. 99 -82 DATE 6 -28 -99 0 - BEARINGS ARE REFERENCED TO THE : EAST LINE OF THE NE1 /4 OF SECTION 6, ASSUMED TO BEAR N00'29'33 "W N O ° in ' o fl UNPLATTED LANDS F o co N Z m OWNED_ BY PLATTER N o co m e Z g v- �� 0 < oz o o S00 "E 210.00' m r� zZ m M - M > �y n ;om n 'i -1 D v Z 0 z J m (O m = 0 6m V S O X V z �W� ( y c .Lm7 �Az NOD Dmz °mm A W�► Z Oo m `7 '� II ,.� to L< r4 P .. i N � N �..� tzi ' N (D `tl p b i y m , c b cl m N `'' O w N y b y CJ) � v `y ► '� '� ' y �i b Ln 00cnZmr � t m2 °vcvDi� O rn N4 'iCrri J x O� rn o z m y N N 2 n ........................... y O En �Q��� � m ,y n LA 12.49' D L4 L64 N00 W 210.00' t M - N00'29'33 "W ° EAST LINE OF THE NE1 /4 N00'29'33 "W 29 O L 416.51 00''33 "W 210.00' �- 2038.99' Z tom w NZ m �_ m m m � TROUT iBROOK ROAD NORTH o °' -------- - - - - -- +-------------------------------------------- � o LO-T--2 107 — 3 =wo 0 ° F1LE NCD5 C.S.M. VOL.' 1z, - -PG. -- -3301 AUG 0 419 + D 0 �CCp c.�n o g 0 0 ` a ° i q a - -- - e d Q)o ri lot I I I l Z ,Z �v w` Gt & SANITARY PERMIT APPLICATION S afety and Avenue n 201 W. Washington N4 4cons i n P O Box 7302 Departirrent of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. 5; G o r x • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location L r1A 1 6 �e v4, S T , N, R E (or) Property Owner's Mailing Address Lot Number Block Number 6 City, State Zip Code Phone Number Subdivision Name or CSM Number s �'�l (.ski' . II. TYPE OF BUILDING: (check one) ❑ State Owned 0 Ity Nearest Road /1 0 Vil Public 1 or 2 Family Dwelling - No. of bedrooms _ate Town of III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) � . ?Jl - l9 • 9s 1 ❑ Apartment / Condo 6&6` r l O" 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. 0 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 Q Holding Tank 12 RSeepage 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. S stem Elev. 17. Final Grade Required (sq. ft.) Pro (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) or a Eyl ra . 4L_ 87. d Feet 00 Feet Ca acit VII. TANK in gallo Total # of Site INFORMATION Manufacturer's Name Prefab. Con- Steel glass plastic Aper. New Existing Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank Or Holding Tank a.� e# ❑ 11 C3 C1 Lift Pump Tank /Siphon Chamberl I I I ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signat :(No Stamp PRSW No.: Business Phone Number: Plumber's Address (Street, City, St to Zip Code): 1 0-7d SZ. d &✓-` 5 IX. COUNTY / DEPARTMENT USE ONLY isapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps) Surcharge Fee) []Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & ladifW DiVsion, Owner, Plumber INSTRUCTIONS 6 1. A sanitary permit is valid for two (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 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 -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. VI k information. Fill in h capacity of ever new /or existing tank list the total gallons, number of tanks and I_ Tan the , Y 9 9 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. Complete plans and specifications not smaller than 8 1/2 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 115 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. Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Ase6nsin In m. P O Box 7302 Department of Commerce accord with ILHR 83.05, Wis. Ad Code Madison, WI 53707 -7302 0~ Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number L APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location A �� 1/4, S T , N, R y E (or) Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number l II. TYPE F BUILDING: (check one) ❑ State Owned E] it( N Road Public or 2 Family Dwelling - No. of bedrooms E] own of ' 1-ae III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 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 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box online A. Check box on line B, if applicable) A) 1 New 2. [] Replacement 3 E] Replacementof 4_ [] Reconnection of 5 E] Repair of an �Sy tem __ 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 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp.'Area 4. Loading Rate 5. Perc. Rate 6. S stem Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) g , d a EI xa -, t'J r W 1 s t 7, d Feet o D 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 Tank or Holding Tank l fir. El El 1:1 El El Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. 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 PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): d .sue - h_ �� �, c,) z- Yn1 IX. COUNTY / DEPARTMENT USE ONLY Isapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) [:] Ap p roved ❑Owner Given Initial ----°� �•- R.-� -�— - -� �- Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: �,; :.� , �r u . ` tc • �e Q wQ �.., 4 i � 1 Y�r7� .. ,f� � . / 7,15 �d 11 4 V7 SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & in Di 'ion, Owner, Plumber INSTRUCTIQNS 1- A sanitary permit is valid for two (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 (SBU-6399) to be submitted togthe- 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 -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. Complete plans and specifications not smaller than 8 1/2 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 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices - W ich can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination` investigations and establishment of standards. ST. CROIX COUNTY WISCONSIN ZONING OFFICE rrrrNrrrr ST. CROIX COUNTY GOVERNMENT CENTER ...:,, 1101 Carmichael Road In Hudson, WI 54016 -7710 (715) 386 -4680 June 22, 1999 David J. Waldroff 398 River Road Hudson, WI 54016 Dear Mr. Waldroff: Your plumber, William Schumaker, submitted an application for a sanitary permit for property you own located in the SE % of the NE % of Section 6, T29N -R1 9W, Town of St. Joseph. Records indicate that the parcel you own is 40 acres and that a residence already exists on the parcel. St. Croix County Land Use Ordinance, Section 17.15 (1)(d) allows one single family dwelling on a parcel that exists within the Ag Residential District. Therefore, you must create a separate parcel for the second residence. A certified survey map creating a separate parcel must be approved by both the township and the county. If the lot is more than five acres, both portions of the 40 acres would become lots and must meet the criteria for minor subdivisions. When the certified survey map has been approved, the sanitary permit may be resubmitted for review. Should you have any questions, please feel free to contact me at the above number. Sincerely, �.� -cam- - v Ma . Jenkins Assistant Zoning Administrator C: William Schumaker Clerk, Town of St. Joseph File ��G G J�a /Ge ✓a r� �'��/ %11.�r 6 G `���dP,[� � 'r kJ� G/ 5��� .S'��h ya 41 a -SX T Trc.j d / �1. i 8� ��gm t �/n a • D ° Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page I of Bureau of Integrated Services in accorda 83.09, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 (4' �S in siz PI must include, but not limited to: vertical and horizontal refernt (BM) and `• percent slope, scale or dimensions, north arrow, and t istance' n�t road.° parcel I.D. # 4 00 0 APPLICANT INFORMATION - Please prin ormati f" � : ' Reviewed by Date Personal information you provide may be used for secondary p4 (1) Property Owner roperty,L'd ation n 'C" , L 5E 1/4 �J. 1 /4,S �p T 2_I ,N,R 9 E (or)�V Property Owners M ailing Address -1 Block# Subd. Name or CSM# i C4. Ci State Zip Code Phone Number ❑ Ci ❑ Village Town Nearest Road SOn �l ( 5Lta 'I(.D (-, )549- 0, . Q CS 0 h t l • Tr -ou & 00k R d- New Construction Use: U Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd /ft - trench, gpd/ft Absorption area required bed, ft 5(o-S trench, ft Maximum design loading rate bed, gpd$ .trench, gpd/ft Recommended infiltration surface elevation(s) uppZ X9 UO L ocrlGr V. a c, ft (as referred to site plan benchmark) Additional design /site considerations 1�/rl . C 1C iJ Parent material q�QCIQ C)0 " _DSh Flood plain elevation, if applicable K)A It S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fili Holding Tank U = Unsuitable for system ®S ❑ U ® S ❑ U © S ❑ U ® S ❑ U ❑ S ®. U ❑ S ® U SOIL DESCRIPTION REPORT Bonn # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots x in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 4 f v -� O ,r 31 Z — L5 l m rn -Pr LS I g � -39 44 y - 5 ip r iYl S S � Ground 3 elev. Depth to limiting factor _I '�bin. Remarks: Boring # L S 3 m 3 12 y I m rn ( `j Ground elev. Depth to limiting factor J .S in. Remarks: CST Name (Please Print) Signature Telephone No. Adc r SC-11 er C Z4 7 - q Address Date CST Number 4o � (P -19-99 25S3o r SOIL DESCRIPTION REPORT PROPERTY OWNER Page Z of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench C 2 - . '9 - 2-q 10 r `I iq m nnl C S — $ Ground 3 Z4 IQ r yl L S l m C-5 O ��"oa y Depth to limiting factor Remarks: Boring # lm abk mfr c v Ll 2 + 3I r-51 i t M _ 3 31-1 Ovir 1 4/6 m5 I c S � B Ground elev. Depth to limiting factor Loin. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ( D_iz Irk r3 Z I CS 14 4 .5 M.'r ne 5 Z ... .., z -11% ICS Yr `I (� O Ground elev. 9 u •�t Depth to limiting factor 11 in. Remarks: Boring # 1 0 - 1 I O r3 l2 5L i rn m - 'r I v `{ ;- 5 2 +8 -90 I ( rnabk nn -Pr G 3 146 -51 10 r 3i s; 1 Zrnabu, M F c S — 5' Ground L A 151 - R(, 1 0 r y I 5L 3� bk Q1 e -P ele i 9 yo ft. Depth to limiting factor 9U— Remarks: SBD -8330 (R. 07/96) oe rfAZ v Pi D `7, av' SeC� qo , (,6 Go 4exaj-1 x ` � uE � ary Q 5 tot 83 of c 2 am Z. i Onrn �fiv►zi'�. S 6ar'h I GJ ' Cr 3 : v� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A LJL�a Mailing Address v ` Property Address 2!iF // _I a/1 / /-,G JO (Verification required from Planning Department for new construction) City /State � ZE --irox) !.J r Parcel Identification Number LEGAL DESCRIPTION Property Location , ' /.,, '/4, Sec., T a 9 N -R Town of Subdivision L 67 Lot # Certified Survey Map # Volume . Page it Warranty Deed # -Yv a 6r,- g , Volume Page # Spec house ❑ yes 9 no Lot lines identifiable ❑ yes ,-no SYSTEM 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 masterplumber, 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days a three ear exp' tion date. '' / / i SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the erty described abo by virtu of a warranty deed recorded in Register of Deeds Office. SIGNATURE 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 DOCUMENT NO. TE BAR WISC RM.1 I�`THis MACS Rt — FOR R[C01101N0 DATA MACE -- REGISTERS OffICIE Thia Deed made between .... d Leslie. Waldroff and . ST CROIX CO., WI& David. -J.. lialdrof f, as oint tenants �I Rac'd for Record lhk ........� ................. .... , 22nd l .............................................................................. ............................... i I ................................................................... ............................... Grantor, day of Mai► A.O. 19 87 and..... f.. sad. .Julie ..A,..Wsldroff,•.husband. „- I! 3:30 P and.. wife ..aa..JQint..tlgnant9 ......... .................. ............................... j .......... . ......... --- ............ ..................... ..................... — ........................ ' Book of .................................................... ............................... ......... Grantee, ! I Witnesseth That the said Grantor, for a valuable consideration.. One _Dollar. (S.l. AO�..and..Qthez..g- d.. And.. - Croix f oo, and valuable_ considerat on conveys to Grantee the following described real estate in St. .. R[TURN TO County, State of Wisconsin: SEE LEGAL DESCRIPTIONS ON REVERSE SIDE Tax Parcel No: ................................... I. �i is i This deed is given in satisfaction of that certain land contract between the parties dated May 9, 1979 and recorded May 11, 1979 in Volume / page 481 as Document I � No. 356779. i I � ' (II This .. .i s.AP t........... homestead property. f (is) (is not) j, Together with all and singular the hereditaments and appurtenances thereunto belonging; And.... J,. Lesl,ie and David J. Waldroff warrants that the title is good, indefeasible ir. fee simple " a ' n free and clear o f encumbrances except easements and zoning ordinances and building restrictions of record. any I and will warrant and defend the same. Dated this ......... ........ ........ ......... day of .......... ... .' ._ .... .... ....... ......... .. 19.8 .. _....... (SEAL) I.Y It . 'Y- f .. .. . ....... (SEAL) • _ Lesli. e.. FLal .dro.f .................. ............................... ............................... . ...... -(SEAL) Aw�`9r0(/ �. .... - (SEAL) I'. • ...... . . . . .. .. .... avid. J.. Waldroff._.. .... ...... ......... I !; AUTHENTICATION ACKNOWLEDGMENT Signatiire(s Leslie Waldroff and STATE OF WISCONSIN ..... ............. ................... II - Davi . -- . . • ,Wag - -- off . - ,_ -. - as. � i .... ...................................... County. } auth ticat" is __�.9.. of. ..... ' i_a Personall came before me this ................day of • ... ...................................... 1 19..---... the above named r ............................ Douglas R ilz TITLE: MEMBER STATE BAR OF WISCONSIN �) (If not, -• ..................... ..........................._..• authorized by § 706.06, Wis. Stats.) to me known to be the p erson who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFT ED BY ............ ......... ............ ..... .... I ........... I ...... .. ... I DOUGIAS..R,... LCZ - ,. - Atto.rne at_ Law .......__ .. .... Huds.9(l,- .W} scOtls_in 5401- 6 ......... ---- --- -••...... ...... Notary Public ... ....... - .._... County, Wis. (Signatures may he authenticated or acknow; ^deed. Both M} Commission is permanent (If not, state expiration are not necessary.) date 19 . ..1 i •N.mes of Per—s signing in any CA ;,Acity sht be t)Ued or Printed b,L— tt•:r siRcat -res. N.C.11MIttr STATE PAR OF {;IISCOS:i:Y FU No. 1 —1982 Stout No. 13001 zr , �. , .s... .... r+.. ._r..A' I R OO w' i JtA- t 1 VV - o Y C _ ZOO Yl�l �w 02 cw