HomeMy WebLinkAbout030-2095-00-000 R ST. CROIX COUNTY ZONING DEPAR' T
AS BUILT SANITARY REPORT
Owner N &.�..�,
Property Address (6 11 U A
City/State I t i
Legal Description:
Lot Block AIA. Subdivision/CSM # 14 �' �, ✓
i.
W- V4 S 4- 3 1 /4, Sec. 91 , T N -RAW, Town 6 f S_t'. � _ P 3� a
SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION
Tank manufacture Size ST/PC /41 /;.o aSetback from: House /l Well P/L
Pump manufacturer Model N S 7
Alarm location 8 -'
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: Width 3 Length 7 5 Number of Trenches
Setback from: House /ao Well 7 loo' P/L q3 ' Vent to fresh air intake >* �a o
ELEVATIONS
Description of benchmark S W t.7�1,. 5tKA Elevation 1 0 o
Description of alternate be nchmark v Elevation 1 as ?
Building Sewer 91 ° ST/HT Inlet 7 ,0 S 3 ST Outlet q o . & q PC Inlet 9 ' ,
t 47.31
PC Bottom 9�4 -' Header/Manifold q 109 Top of ST/PC Manhole Cover A L-1-
Distribution Lines (/) `�'1 + (�� `I f , A � - ( )
qs,a�
Bottom of System
Final Grade () q 9, `I9 () qv ?
Date of installation /c bs Permit number ki q 5`94 State plan number 09 .
Plumber's signature Lx) ate V k n - " License number oLA "! "7 1 Date 1 A4 / If
Inspector �'� ���'� �=--�
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.
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INDICATE NORTH ARR W
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM County:
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No,:
X
Personal information you provice may be used for secondary purposes [Privacy L Z s.15.04 (1)(m)j. 344596
Per1p�� to ' m I NTHONY & AMY E] Cit l] vii r H wn o f: State Plan ID No.:
CST Elev.: Insp. BM Elev.: BM Description: T Parcel Tax No.:
. Q J&L 4AJ 030- 2095 -00 -000
F== r As 900353
TANK INFORMATION ELEVATI N DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic (� - 0 Benchmark • l0 a�(,�8 p!_ r3 e
Dosing In,t dQu �� zaD A-•8h^ /• `11 laz - �-
Aeration Bldg. Sewer 12..'$ q (, 2.0
Holding St /Ht Inlet 13.2(. ?D
TANK SETBACK INFORMATION St/ Ht Outlet 13 0 461
TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet Q`
13.108 .S»
Septic > wo D ,�� NA Dt Bottom
Dosing y „ 30 . 0 38 NA Header /Man. S Al 3 z �.tZ qr,�
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grad OL; L, 4 111 +;} �. I q - q
Manufacturer .2e� Demand �.$ 99 .3 fi
Model Number A -- F \ 7- . GPM
TDH Lift , Friction J . Z� S stem TDH .( Ft O - q�, p �•
L Hy Iq
Forcemain Length] f Dia. Dist. To Well
SOIL ABSORPTION SYSTEM .�. �b.
TRENCH Width r Len th i No. f enches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEN N 3 b DIMENSION
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM
LEACHING Man fa rer• ^
INFORMATION Type Of p ...r t ) (10 l OR UNBT R M del N tuber:
System: (.b��`^' `Z
DISTRIBUTION STEM
Header/ anifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Di
�►
n in
Length a Le gth is Spac g 7
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only sZ
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil E] Yes No Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.) �,� 2r
LOC TION: ST. JOSEPH 29.30.19.793 446 HIGHLAND VIEW
"L b..., =
b. 4 — (OD
tob ” `
C•
Plan revision required? ❑ Yes '� No t( Vi 9q Use other side for additional information. l
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No
Ill�vu;� Safety and Buildings Division
�� ■�r■r. SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. C (B`
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information y ou p rovide may govern ent r ms �%
y p y be used b y other g rr� agency y p ro g /� &TI ❑Check if revtston to previous application
IPrivacy Law, s. 15.04 (1) (m)). /7 /� /A L f ��1State Plan I.D. Number
I. APPLICATION INF RMATION - PLEASE PRI�L INF
Property Owner Name roperty Location
fig 1/4 5 t 1/4 S aq T 3 , N, R 1 9 0(or) W
Property Owner' Mailing Address V V Lot Number Block Number
V 800 R6" 31 /9 1 NA,
City, State Zip Code Phone Number Subdivision Name or CSM Number ,
0 - All'v 6 fts\, SS /A7 3 N' bl,�gL
II. TYPE OF BUILDING: (check one) E] State Owned El Cit Nearest Road )4 Vil ❑Public
Ig 1 or 2 Family Dwelling - No. of bedrooms ❑ Town OF
III. BUILDING USE: (If buildingtype ispublic,check allthatapply) Parcel TaxNumber(s)
. Coo N
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Ou & r Recre &g ,Facility
3 ❑ Campground 7 F1 Merchandise: Sales/ Repairs 11 ❑ R tat rant/ ar/ DiniN
4 ❑ Church / School 8 F1 Mobile Home Park 12 El r ' Station /� Wash
5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ O specifySr lr
IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) N�� �'
A) 1 _ % New 2 E] Replacement 3. E] Replacement of 4_ E] Reconnectl 5 an
______System ____ ___System ____________Tank Only______________ Existing Syst__ _ _ _ I g System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date
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
1219 Seepage Trench L.� .41 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit $ 1 43 ❑ Vault Pri
14 ❑System -In -Fill 3 X 90 •/ c
VI. ABSORPTION SYSTEM INFORMATION: /1,��, �4g �# A�,
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required s . ft. Propose s . ft. Gals/da /s . ft. Min. /inch Elevation .
( ) ( q ) ( )
q q p q
75 / ®1S /�08 s r � �lA, q7r Y5 Feet 1% Feet
capacit
VII. TANK in Ca allo Total # of Prefab. Site Fiber- Ex p er
INFORMATION g Gallons Tanks Manufacturer's Name Concrete con steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank /65_ ❑ ❑ ❑ ❑ ❑
-/-+
Lift Pump Tank /Siphon Chamber / 00 Y✓j ❑ 1 ❑ ❑ ❑ El
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 Signature: (No Stamps) FM P RSW No.: Business Phone Number:
O /I/eckv�l�e l.J a� ?!0 7/a - 7YY -33
Plumber's Address (Street, City, State, Zip Code): .
96 7 K G 5 Q,-�-� 1.,7 5" 'Y a 02.3
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (No Stamps)
WA Surcharge Fee) ❑ Owner Given Initial ,& ^ 6;�
Adverse Determination � � ° `
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R. 05/94) DISTRIBUTION: oliginal to County, One copy To: Safety & Buildings Divit-ion, Owner, Plumber
a ... d
INSTRUCTIONS
1 _ A s a nitary 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 -3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for 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 (Q.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 8 112 x 11 inches must be submitted to the county. The plans must
include the follc A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other Lreatment 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 ar d 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 absortion system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
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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.
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t JUNCTION BOX
'�. C.I. VENT PIPE APPROVED LOCKING
MANHOLE COVER
25� FROM DOOR � AND WARNING LABEL
12 MIN. 1
WINDOW OR FRESH GRADI
GRADE AIR INTAKE I I t i ;,. " 4 MIN. i
-- • , IS" MIN.
�18� MIN.
„ :.: .r• s• 1 •.
F VATION I =__=
PROVIDE I 8 �Inle AIRTIGHT SEAL I
=! A I II APPROVED JOINTS
APPROVED JOINT I IIII .a WITH C.I. PIPE
I � ALARMo EXTENDING 3'
> i = WITH C.I. PIPE ;i 8 I ONTO SOLID SOIL
EXTENDING 3 I I ON
ONTO SOLID SOIL �; C PUMP 1
.x ?
ELEV. 87'I�O FT. �� OFF
.1 i•
' O C . BLOCK
TANK BEDDING .::
ELEV. 8 7 �
*,. 9E RISER EXIT PERMITTED ONLY ►G TANK MANUFACTURER HAS SUCH APPROVAL
TANK
•e A
FACTU.RER `►^'l. Po-c_a, $" NUMBER OF DOSES PER DAY
TANG ` SIZE ( GAL 1,7-o a DOSE VOLUEIE
INCLUDING BACKFLOI:' V GE;L
ACTURER Q QQo• C�, CAP_'�CIr! TLS
X16DEL NUMBER D Vt- 24, /61 INCHES OR 6 GAL
SWITCH TYPE `rat 7 A B -L " " 60
(r w. �f S �t tl, .1-017 41
' FACTURER J /Y•3s" °' " �1305 '�
t DL NUMBER A16 NOT Pump and alarm are to be
:'ITCH TYPE instwlled on separate - circuits.
NIMUM DISCHA RATE GPM
VERTICAL DIFFERENCE BET'W'EEN PUMP OFF Ai DISTRIBUTION PIPE !91 FEET
f MINIMl7M NETWORK SUPPLY PRESSURE 2.5 FEET
13 5 FEET OF FORCE MAIN X � � �° � 1 a'�100 FT
?.
FRICTION FACTOR -- 3 FEET
TOTAL DYNAMIC MEAD - / S . 4. Y FEET
. SPECS:
'j ZACH 1 INCH OF DEPTH EQUALS 3 O GAL
INTERNAL DTNiENSIO:.S OF TANK: <<
•'' T LENGTH /a _
,., k IDTH (vi-i "
LIQUID DEPTH q6
PUMP CHAMBER CROSS SECTION AND SPECI' �i ^IOi'JS
,J#-
1
HEAD /CAPACsTY CURVE
EFFLUENT and E)EWATERING
A CAUTION Model 185/4185 should not he subjected to less than 30 feet TDH.
• __ _ __ -_.._. __., _. __.— �..__ -____ — 185. 186. 188, - T - 89 1 - - - �
MODEL 42 48 ib3, T165, t9t
4140 4161 41 53 4165 4185 4186 4188 1 4
W Fr 1 1{A GAL, R$ GAL. GAI
5 LT1tS GA LTR$ 'LTf{$ GAL t,TR$. CAL }�'R$ GAL. [ GAL CAL CPL T GAL GA[ GAl
15 .15 " 32 S ?4• 43 16? 1 1 275 91 100 61 j; 61 58 145 145 45
W ` 4J 10 £ .§ 11 25 =. 34 t. 61 2J1 1 2x9. 84 •'J�' 93 6t 61 59 140 140 2 45
Ly 15 6 .23, 15 W 19 Z2 170 24i 7 6 286: 85 60 61 \ 58 134 135 1'f 45
20 µ, 25 95 136' 68 238 79 '. 59 "'j 60 58 128 131 45 ,>T
140 25 R J ',9 223 70$ 57 59 * 55 122 125 4$
42 30 49 186 fit 55 58 27 " 85 58 �, 1 116 120 45
135-- 40 ': 2 70':. 45 _46 55 1, 7o 58 104 ,09 ( 45
50 20 ` 33 2 S0 51 58 l 90 97 45
1 40 60 _ - 15 39 32 x 58 71 85 45
130 JO 23 9 52 51 69 45
80 a 10 45 2B 51 45
90 ,r,;; f 31 2 34 45
38
125- 00 - 6 v .o
4 P.. 30
120
120 30
115 1u l - e 10 s6
36 197 OCH VALVE. 9 19 1925' 23 i.., 1 26 _1 4F� 6' 66' 1 865' 3' 4 9 1 tlo' 1 _ 137' J
-- - - �_- - -- - --
34 110 - — - ------ -
32 105 -
i
30 700
95
i
28
1 R6,
26 4186
85 - i
I
24- 4 165. _ - -
416
75
22 1
70 -
x
S2 20 65 — 1.
z
z
60 163,
0 18 4163 189,
- 4 i 89 1
0 55
50 - �- --
14 45
I
f
12 40 -
140, 188,
35
4140 4188 j
-
10
I
30
185, �✓ i
8 137,139 4185 _ 3
25
6 20- -
4
10 42 -�- -- --
161,!
2 5 48 416 }} ,
5 55 98
7 59
0
U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 11 120 130 140 150 160
LITERS -- i-- _- -r_.._ T
80 160 240 320 400 480 560 640
FLOW PER MINUTE 009922a
of 6 7
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
.` Division of Safety 8 Buildings Wis. Adm. Code
in CR;8 COUNTY
Attach complete site plan on paper not less than &ize. Plan t include, but St . Croix
not limited to vertical and horizontal reference poMo¢m of sloppale or PARCEL I.D. #
dimensioned, north arrow, and location and dista d. APPLICANT INFORMATION- PLEASE PRI BY DATE
PROPERTY OWNER: "' PRORfRfiY LOCATION
�:' klf+tGt?F GOVt.iOT NE 1/4 SW 1/4,S 29 T 30 N,Rl9 xk(or) W
PROPERTY OWNERS MAILING ADDRESS BLOCK # SUBD. NAME OR CSM #
#328 Co. Rd. #F * , t r t F �, z 19 na I Highland Hills phase II t.
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE JaOWN NEAREST ROAD
Hudson, WI. 54016 (715)386 -8236 Co. Rd. #E
P* New Construction Use M Residential/ Number of bedrooms 3 [ J Addition to existing building
I J Replacement [ J Public or commercial describe
Code derived daily flow 450 gpd mound Recommended design loading rate • 3 bed, gpd/ft2 .4 trench, gpd/ft
Absorption area required 3 75 — bed, ft2 3 } 75 trench, ft Mai imum design loading rate • 4 bed, gpd/ft •5 trench, gpd/ft
15 68 Recommended infiltration surface elevation(s) 97.45 con . 102, 00 hound ft (as referred to site plan benchmark)
Additional design / site considerations recomment use of mound system at el. 102.00
Parent material outwash & Glacial till Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for sy stem ia ❑ U S ❑ U S ❑ U IRS D U ❑ S] U El ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP
in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. Bed
w 1 1 0 -12 10 r3/3 none 1 2msbk mfr gw 2m .5 .6
IMM
:{ „� 2 12 -35 7.5yr4/6 none scl 2msbk mfr gw if .4 .5
Ground 3 35 -84 7.5yr4/4 none sl 2msbk mfr na na j .6
elev.
1 01.3 §
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2m .5 .6
2 $ 2 12 -30 10yr5/4 none sil lfsbk mfr gw if .2 .3
4 C\
3 30 -84 7.5yr4/4 none sl lmsbk mfi na na .4 % .5
Ground
elev.
10
Depth to
limiting
factor
+ 84"
Remarks:
CST Name:— Please Print Gary L. Steel Phone. 715 - 246 -6200
Address:
1554 200th. Ave w Richmond, WI. 54017
Signature: Date: T Number:
6 -27 -94 cstm 229
PROPERTY OWNER Persico /Peterson SOIL DESCRIPTION REPORT Page 2 of .
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence , Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITmr&
3 1 0 -8 10 r4 3 none 1 2msbk mfr Qw 2f .5 .6
2 8 -15 10yr4 /4 none sl 2mgr mvfr gw if .5 I.6
Ground 3 15 -52 7.5yr4/4 none sl 2msbk mfr gw na .6
99 ft. 4 52 -83 7.5yr4/6 none co s Osg ml na na .7 �.8
Depth to 30
limiting
factor
+8
Remarks:
Boring #
MM ,.,.,. ; , 1 0 -14 10yr3 /3 none 1 fill na cs na np np
4 2 14 -27 10yr5 /4 none sil lfsbk mfr gw if .2 .3
3 27 -80 7.5yr4/4 none sl lmsbk mfi na na .4 ':.5
Ground
elev.
99 ft.
Depth to
limiting
factor
+8 "
Remarks:
Boring #
1 0 -19 10yr3 /3 none 1 fill na cs na n n
,ivJ: \tiff:: + ?:•:
5 2 19 -31 10ur4 /4 none sil lfsbk mfr gw if .2 .3
3 31-81 7.5yr4/4 none sl lmsbk mfi na na .4 .5
Ground
elev.
ft.
Depth to
limiting
factor
1 F --- 1 -
Remarks:
Boring #
Ground
elev.
ft. i
I
Depth to
limiting
factor
I
Remarks:
SBD- 8330(8.05/92)
i
STEEL'S SOIL SERVICE
Gary L. Steel Highland Hills phase II 1554 200th Ave.
CSTM2298 lot #19 New Richmond, WI 54017
MPRSW 3254 NE- S29- T30NR19w (715) 246 -6200
f town of St. Joseph
N
1 " =40'
BM.= top ofSW lot stake at el. 100'
( 70
D'
46 � �51
eD -/0 12, A n,±-
IY�owj� us � d
i
53
�}Z A42
Gary L. Steel
6 -27 -94
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer _ �, o�,� Qom, n , Q
Mailing Address _ `� S o O A - 0 9"" AAR 4 ?
Property Address Q U,�,,�
(Vuificatioa rcquird from Plaaaing Dcpartmcnt for new coastructioa)
Cit3�tatc Pamei Identification Number a..3 a 0 4 S - 0 0 - 0 o v
LEGAL ))MSCRIPTTON
Property Location _LIC %, 6 %, Sm. a q , T 3 o N -R 19 W, Town. of 5 t.
Subdivision _LA4,2L� N;j�.d P ,A-0�, a Lot #
Cerffied Sarvey Map # Volume . Wage #
Warranty Deed # , b d 5 , 7 7 Volume / `� 3 8 , Page # 3 tp O
Spot house ❑ yes ® no Lot Bats ideaffiable (3 yes ❑. no
SSCSIF.M W NG19
= Impmpara9esad y �uP�= ���Itmitsptraat�fa�C ,etollaadte�rastcs.Proper _
consists of pawing out &C septic tank every throe y C= orsomw. if=c&d a Yi=scd What
cam affoct6 of &C - . P y pat.into tlbe system
rcptic tank as_r tstage is the vrastcd"isposaicysk�L
11ae p owner agcres to submit to SL Crone Zug D4arta a 3i =fficatioa loan, sipa by _the own= and by a
P 7 a bcr sEcto dplvmbmoriUc= scdpmmpervrafyingtbat (I)& spcualsystcm
is m paPer V=tmg condition. and/or (2) after inspection. and pumping (if nemsary), the scptie•tankis icss than W - full of d edge.
Ywc. tlu un dca5e=d hararad the abort rcquic==& and #gene to m tibia de pcirate sewage disposal systca wi& Sue standards
set forth, luau, Ys set by &e Dqmwwdof t7ommaoe and the Dqutmeut of Nab=d Resources; Statc of Wisooasin- Cuomfioa
that you =Pfic system leas bocce maiaWned must be compkLod and zetumed to the SL Croix.Couaty Zoning Offrce within 30
days. of &o three year expiration.
Of
4 S ijAkd Z .3
DATE
OWNER. CE =IffCA.ZTON
I (we) oatify that all tta CMCn s on. this foal an tau to the best of my (our) knowledge. I (we) am (arc) the owncr(s) of
:bore. by roo
of a warranty dood oc+ded in Register of Deeds Office.
• OF I� /
DA
s « « « ««
Any infoanation that is mis «sssss
- c+tod may result is the sanitary Pmt ��$ trucked by the Zoning DepartnlenL
ss Indeed" wlth this appGcatlon: a tutupod wamaty deod fcom the Register of Dcods otlicc
a Copy of the certiCod vmcy map if rcfcroaco is made in the warranty dood
V0 1438PAGE 360 t
STATE BAR OF WISCONSIN FORM 2 - 1982
WARRANTY DEED 605971'
KATHLEEN H.
DOCUMENT NO. REGISTER OF DEEDS
ST. CO., WI
RECEIVED FOR RECORD
John D. Diedrich married
06 -30 -1999 11:50 AM
WARRANTY DEED
EXEMPT #
CERT COPY FEE:
conveys and warrants to Anthnny F._ RPasl Per and Amy N. Beasley. COPY FEE:
husband and wife as ioint tenants TRANSFER FEE: 150.00
RECORDING FEE: 10.00
PAGES: 1
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN DRESS
the following described real estate in St. Croix County, C /
State of Wisconsin: (�'���� D � ff11 t 4v_ 6
Lot 19, Plat of Highland Hills First Addition in �yv`�`�T1� Lc1�lUlb
Town of St. Joseph, St. Croix Cunty, WI. 4 7, )5�
eye
PARCEL IDENTIFICATION NUMBER
t
i
This is not homestead property.
(is) (is not)
Exception to warranties:
Dated this ` day of -June , AT) -g 99
(SEAL) (SEAL)
0 D. Diedrich
(SEAL) (SEAL)
- AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
A 4V A "Z SS.
Coun authenticated this day of 19 Personally came before me this day of
June , 19 99 the above named
Tnhn I) T)i Pr1ri rh .. _ married • .
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing
DIANE M. BARRON instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED Notary Public
Kristina n At tor tate of Wisconsin
Hudson. WI Notary Public, — County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permane t. (If not, state expiration date:
` necessary)
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' Namrs of persons signing in and• capacity should by typed of printed below their signatures.
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