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HomeMy WebLinkAbout038-1180-80-000 t > ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner : Property Address / - City /State -,j , Legal Description: Lot -F'2_ Block — Subdivision/CSM # t /4 d,( A j t / 4, Sec. s , TAN- R,26 Town of PIN # r_L?2 -,-0 -400 I5•31- «,9U3 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Size ST/PC, / Setback from: Housed Well PAL 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: o Width 1,� Length S' Number of Trenches Setback from: House .-?8 Well 2 P/L _-AP ? Vent to fresh air intake t, ELEVATIONS Description of benchmark _ Elevation Description of alternate benchmark Elevation le-2, Building Sewer fa /,/& ST/HT Inlet 9gLR ST Outlet 22 SZ PC Inlet PC Bottom Header/Manifold � /s Top of ST/PC Manhole Cover l ee, �R _ Distribution Lines O 9 7,,- O ( ) Bottom of System O 91 O ( ) Final Grade a () ( ) Date of installation 3/ / Pe it nu r State plan number Plumber's signature License number ,,Z2;Z2Z, 3 Date r 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. PLAN VIEW Ar J 5 �Bu °L� 1i0 y � INDICATE NORTH ARROW r Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Countg.T . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitay0f 9 �l)�o.: Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)]. Z 4 bb Permit Holder's Name: ❑Tit �Vil�l�gg Pown of: State Plan ID No.: & G INC. SS AAKR tt<�All CST BM Elev.: Insp. BM Elev.: BM Description: ParcelZac�l o.118Q_8a_p00 led. Ld �t CS V TANK INFORMATION ELEVATION DATA A9800573 3 9 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic B enchmark f! p SC G& s, 2 /Gb . co 2.�6 Aeration Bldg. Sewer 2 Holding St /A Inlet TAN TBACK INFORMATION St r outlet // 99 ? TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet i irl Septic 1 s�/'t 2.2, NA Dt Bottom Dosing NA Header� . 7. 1 57 7. 6 5- 1 Aeration NA Dist. Pipe 8 97 Holding Bot. System $, 518' PUMP/ SIPHON INFORMATION Final Grade L� Manufacturer Demand t Mo el Nu GPM TDH I Lift riction Ft Loss For ain Length Dia. Dist. Towed SOIL ABSORPTION SYSTEM BED /TRENCH Width t Length No. Of Trenches No. Of Pits Inside Dia. Liquid Depth D IMENSIONS Z 5` DIMEN I SYSTEM TO P/L BLDG WELL LAKE /STREAM LE Manufacturer: SETBACK HAMBER INFORMATION Type O OR UNIT /19 r Moe Number: System: Wd Sad 3�' DISTRIBUTION SYSTEM HeaderY46sai oW A/ Distribution Pipe(s) // / x Ho Size x Hole Spacing I Vent To Air Intake Length Dia. Length 5 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade em 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, LOC ' TAR TION PRAIRIE 15.31.18 , E , SW 1114 212TH.AVEIVJE 7r Plan revision required. �es❑ No Use other side for additional information. 3 1,�? 2,3rx=�- I PWM SBD -6710 (R.3197) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION Safety Washi lgt nAvenuen Vi scons i n 201 W. Washin In P O Box 7302 Department of Commerce 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 C than 8 112 x 11 inches in size. J • 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 Prope ner N e Property Location N, R �(O► - _ 1 /a va, S - T , Property O ner's Mailing Adc►ress Lot Number Block Number G — Cit , tote Zip Code Phone Number Subdivisio am or CS umber F /. A ( ) n. TYPE OF BUILDING: (check one) ❑ State Owned o vitro a Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Cog //g©^ ,g G 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. jg[ New 2 ❑ Replacement 3 ❑ Replacement of 4, ❑ Reconnection of S ❑ Repair of an ____ _System ________ System - _- Tank Only --- ---- -- Existing System __ - ---- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number ;L24 I Date Issued f 9 V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 H Seepage Bed 21 []Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 E] Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Per c. R to 6. System Elev. 7. Final Grade Z 1 Require -�. (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i h) Elevation s -� � Feet _ Ioe , l Feet Capacit VII TANK in gallons Total # Of r Prefab. Site Fiber- Expec INFORMATION Gallons Tanks Manufacturer Name Concrete Con- Steel glass Plastic App New Existing structed T nks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ 1 ❑ Lift Pump Tank /Siphon Chamber 1 12 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for in§Jallationof the onsite sewage system shown on the attached plans. Plumb is ame• (Pri )^ Plumb is a o s) MP /MPRSW No.: Business Phone Number: Plum er's Address (Street, Cit State, Zip Co IX. C UNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing A ent Si nature (N t ps) A roved Surcharge Fee) pp ❑ Owner Given Initial ,SOS c / Adverse Determination /� 7 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washing ton Avenue ��SCO/1Sl/1 P O Box 7302 Department 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 8 112 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 if revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION PLEASE PRINT ALL INF RMATION Propertyp Name _ Property Location - 1/4 1/4, S T , N, R iltor Property wrier s Mailing Address Lot Number ? Block Number AT / t [i City, ate Zip Code Phone Number Subdivisio ame or CS umber ! ( ) . TYPE F BUILDING: (check one) ❑ State Owned o it yy Nearest Road ❑ Village �� El Public 1 or 2 Family Dwelling - No. of bedrooms __ Town of 111 BUILDING USE (If building type is public, check all that apply) Parcel T Number(s) 1 E] Apartment/ Condo V -?g' llgz� _ g - 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. p 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 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 0 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. R to 6. System Elev. 7. Final Grade Require (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /irlc�i) Elevation / c Feet 1 lf Feet TANK Cap acity VII. INFORMATION in g a llo n s Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Exper. Gallons Tanks Concrete glass Plastic App New Existin structed Tanks Jan k Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber El 1:1 El E] ❑ 13 VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins Ilation of the onsite sewage system shown on the attached plans. Plumber's me: Pb 's S' a o s) MP /MPRSW No.: Business Phone Number: Plum er's Address M reet, tit State, Zip Cod IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate ssue Issuing A nt Si nature (N tamps) F 1 pp roved ❑Owner Given Initial Surcharge Fee) c � Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: DISTRIBUTION: Or to Count One co To: Safet & Buildings Division Owner, Plumber SBD- 6398 (R. 11/97) g County Y g //' � � • � S�� - �e _S = Tom/ - � vvl �j 3 J <% S 1 - !8 wKl� I 30 .Es :36 ' .3 4, Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department 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 8 112 x 11 inches in size. ly • See reverse side for instructions for completing this application State sanitary Permit Number 3:;L(fG 8„ Personal information you provide may be used for secondary purposes [:]Check if revision to previous plication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Prop y caner me Property Location k` (Or)�11( �t /a 1/4, S T , N, R Property Owner' Mailin Addres Lot Number Block Num r e r Cit ,State zip Code Pone Number Subdivision ame r CS umber If. TYPE OF BUILDING: (check one) ❑ State Owned 't�+ Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF r Ill. 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 on line A. Check box on line B, if applicable) A) 1, 0 New 2 E] Replacement 3. [] Replacement of 4 E] Reconnection of S ❑ Repair of an - _____System ________ System_____ ________ ______ l�r______________ Existing system ___ _ Existlncsystem 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 ❑ In- Ground Pressure r / 42 ❑ Pit Privy 13 ❑ Seepage Pit 12 ' S 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Abso . rea 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min-h h) Elevation mss- x Feet Feet Capacity VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank Ing Tank �. ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT 1, th undersigned, assume responsibility for inst lation of the onsite sewage system shown on the attached plans. Plumbe Name (Pr t) Plumber's Si n �ur( S ta ps) MP /MPRSW No.: Business Phone Number: Plumber' Address (Street, C y, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag i nature (No Stamps) IdApproved [_ Given Initial ryk surcharge Fee) Adverse Determination 0 / U f X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber L it t�sut� � li �1 N 30 3p k Wisconsin Department of Industry SOIL AND SITE EVALUATION REP OR- Page / of 3 Labor and Human Relations Division or safe a Buildings in accord with ILHR 83.05, Wis. `- .Code' - — �' 7, CRO rx Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Pia inclpdo not limited to vertical and horizontal reference point (BM), direction and % of scalebr PAR • # dimensioned, north arrow, and location and distance to nearest road. j Ll APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION y`y REVI Y DATE Y .. PROPERTY OWNER: SM A OR PR C k'i'G h �9 RD 5 . 7 - o u T GO 1/4 5 T JV ,N,R / E ( VU PROPERTY OWNER':S MAILING ADDRESS t� , 35'3 14 cv,4 7_0 )e LOT #� TAP, 'O CITY, STATE /S q ZIP CODE PHONE NUMBER ITY []VILLAGE N NEAREST ROAD 1}u So,.) 5yofCo i�i5)5�- (P731 T: PRhtR,: / /Wy. cc (pt'14ew Construction Use ( 4`0esidential / Number of b6drooms 3 to 4 (� Addition to existing building ( J Replacement ( ) Public or commercial describe Code derived daily flow ' Z L10 gpd Recommended design loading rate �' bed, gpd/ft • S trench, gpd/tt Absorption area required 95& bed, 4 7410 trench, ft Maximum design loading rate • 7 bed, gpd/ft2 . trench, gpdM Recommended infiltration surface elevations) SE, 3 ft (as referred to site plan benchmark) Additional design / site cons rations Parent material 5CS I I /3uR,L'Gr ,q n D T Flood plain elevation, if applicable ft S = Suitable for system [mss 0 U � �p-p U PR ESSUR E AT_ gaDE s as 0 U L 11 S M TAW = Unsuitable for stem ❑ U C`]'S ❑ U SOIL DESCRIPTION REPORT NO Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlory Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tionch El o -� /oYR 3/� — S //w /e -way i2 S 3 �F . 7 .8 7- s- 3/ Y� y - s/ lf s he Ground 7'.5 vl e ✓� S . d , 5 �� i ? elev. 99. f 0 It. Depth to limiting facts Remarks: Boring # 9- /� /e 0 .3/� /j /iwr �� �U�R S 3 . 7 .8 Z y /0 V11? y/Z( /s /f ew if- S Ground elev. y/� /00 . zo tt. Depth to limiting factor 7 Remarks: CST Name: — Please Print R n 8 R T L Q R 1� Phone: 71 3 8& _ 8 165 Address: g - ( q J& L'-M' 1 I/o. — Signaturt r c Date: CST Number: Private Sewage Consultants ; 655 O'Neil Rd. PC Hudson, Wis. 54018 ORIGINAL i PRomrryowm P6c4 ¢,pD SOIL DESCRIPTION REPORT Z 3 Page _ of PARCEL I.D. tT 1 - 0 7 — 37 R l v e - r- 84! - A;P Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends :.3.. G - 8 /o y/2 31,K — �s /., /�' 1 v / C S 3 f . 7 , 8 Ground 3 PIO 7 S y(� S .$ elev. — /o �� ft. Depth to limiting factor Remarks: Boring # / 1 ,0-9 /o ye 3/ AT �iwr A" tl� a S 3 Z 7 sa y s/ /�sh,� f� s if . y • s Ground 3 V 7- io Yle Y1 s/ 17e elev o ft. � Y-36 7•5 yR y /C� s ,/ Depth to 36 -� �� !� 1 /�' — s. , s Jc� — , 7 •O limiting � factor 1 i Remarks: Boring # � 3 W — s % /*toIX' a 3-F .7 . S z 7-le Ground elev. - 3 75 yR 6 — S. D 5 c Depth to d - p /0 f12 ' S 49 s �� — • 7 •8 limiting = factor Remarks: Boring # t3 ----------- i 1 Ground elev. ft. Depth to limiting factor Remarks: 00M 077n/O ncMM I 0 kA i 1 � EA n 0 0 o � y � T w N o UQ Vi , !"ava O n fi � C 0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND } OWNERSHIP CERTIFICATION FORM Owner/Buyer G er, ` ;" Mtu 11 _ ► r l ( ✓w/ l Mailing Address ( 5 � a l U k_" TYZ ca Property Address wf 't a I a.. +44 7A ip . (Veriftc lion required from Planning Department for new construction) City /State T Parcel Identification Number -.) X06 LEGAL DESCRIPTION Property Location j Zf ' /a, �, ' /a, Sec. ,� , T-.ZLN -R_Z W, Town of Subdivision ' /4� ^ c , ;o , Lot # �� 7 Certified Survey Map # >�� f , Volume , Page # Warranty Deed # 5'9L��� , Volume / "S , Page # Spec house W yes ❑ no Lot lines identifiable M 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 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 that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. 0 &05� J I i v 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 property described above, by virtue 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 I c' STATE BAR OF WISCONSIN FORM 2 - 1982 I' KATHLEEN H. WALSH �1 WARRANTS DEED REGISTER OF DEEDS I � ST. CROIX CO., WZ DOCUMENT NO. °4i �� I� RECUU0 FOR REM (I RICIIARD O. STOUT _ � '9 8 eJc 3 - � 11- 17 -1998 2.45 PR VNZRNM convey and warrants to ` �� RECORDING= 10.00 y t; PAGES: 1 l THIS SPACE RESERVED FOR RECORDING DATA i t _ (NAME AND RETURN ADDRF86 the following described real estate in St. Croix County, State of Wisconsin: � tGk ��OU Lot 37, Plat of Apple River Bend first 1353 �wacckee�r. Addition, Town of Star Prairie, St. Croix HkdSon, W X sv ii County, Wisconsin. ` 038 -11 -80 -000 � TRp PARCEL IDENTIFICATION NUMBER I! , l I l , r I ' I I I f� ' This-.. is not homestead property, �1 (is) (is not) ' easements, restrictkons, rights -of -way and covenants Exception to warranties: of record, if any. l ` 9 8 �) I' 17th November r Dated this day of , A.D., 19 I1 Richard 0. Stout if ................ (SEAL) (SEAL) Sr , I I 1 AUTHENTICATION ACKNOWLEDGMENT I State of Wisconsin, f St. Croix authenticated Lhis day of , 19,__ Personally came before me this -7IYh day of I+ November 19 the about named i+ A. BR Richara7 0. S I TITLE: MrMBER STATE BAR UE WISCONSIN , I I (if not, authorized by §706,06, Wis. Sots.) - 4 to own to btc the person _ - who executed the foregoing j 7 PUB ientand acknowledge Elie same. I THIS INSSFtUMENT WAS DRAFTED BY � O I' i Janet P. Stout O p W i`' Hudson, Wi . 54016 Notary Public, �_.,, s'T � ��� County, Wis. I� II (Signatures rnuy be authenticated or acknowledged. Both and not My commission is permanent. (if not, state expiration date: necessary,) -- Zo 1 .9 I _...._.. _ ................_ _....._.....__..__..._ ._._..__.._.__._�_............. • Names of persons signing In any cqactcy should by typed or printed below Ih6r'FlgnJ 1 1 it STATE BAR OF WISCONSIN W*Xr*ln Leant Blank Co., Inc. �� WARRANTY DEED Form No. 2 — 1981 WAw" it I �)CATED IN FLIRT Of THE NWIA1 OF Ill(_ '�V,/ H7 t '.WI (1' I • :''i 1 I.. - I I71 I frt 1t li'r Vr Ir,L .iml -t, ­urf v� r OF THE SWI /4 ANp IN TSAR 1 OF 10 f( I rn vj I' , I ;IN, R18W, 70WN OF S 14H PRl1IRIE, T. CROIX COUNTY, WISCONS;N 'a -- a� LOT 27 ! LOT 26 LOT 39 „ ,,. •. °.r , r , ., x f.a �,., "� •i _ _ � LOT 2s LOT o„ 1 n e.c LOT \ , 38 l - J, L OT :�24 � 1 LOT 29,, r �n, r i u vu vcs_ Ix' A V s � • I — � , LOT 23 •+ LOT 37 m e LOT 30 1 OT 22 CA LOT 36 1 LOT 31 LOT 35 LOT LOT \. 32 33 LOT 34 \ �l 7 i , a i I ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER M�rrpppp " " "• 1101 Carmichael Road Hudson, WI 54016 -7710 - (715) 386 -4680 March 25, 1999 REMAX TEAM 1 REALTY Attn: Mike Germain 103 Main Somerset, WI 54025 RE: Septic Inspection for M & G Inc. located at 1114 212`" Avenue, Lot 37 of Apple River Bend, Town of Star Prairie, St. Croix County, Wisconsin Dear Mike: A septic inspection of the above referenced property was conducted on March 19, 1999. This property is located in the NEl /4 of the SW' /4 of Section 15, T31N -R18W, Lot 37 of Apple River Bend, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, J es K. Thompson ning Specialist .J