HomeMy WebLinkAbout010-1021-10-000 ST. CROIX COUNTY ZONING DEPARTMENT;
AS BUILT SANITARY REPORT
Owner - let r,
Address
City /State
W
z S�fD12
V . arL togs
Legal Description:
Lot Block Subdivision/CSM # -� -'
'V. A SN1 Sec., T N / n of 4, —
-R Tow /�..yt,+�r�t /� PIN # CIO !a2 f — /o
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer y/ /�w- 'rt'i1 Size ST/PC �� Setback from: House 40 Well 3 7 P/L 7
Pump manufacturer �
Model
Alarm location —�
(BOLDING TANKS ONLY)
Setbacks: Serve road Vent to fresh air intake Water Line
Meter locate
Alarm to ion
SOIL ABSORPTION SYSTEM:
Type of system: &- t :- i Width ;Z/ Len S
Setback from: House _ t &� Well S7 P/I, 70 Vet to fresh air intake Toe Z�s
ELEVATIONS:
Description of benchmark Elevation AD
Description of alternate benchmark Elevation
Building Sewer q ST/HT Inlet c /I ST Outlet
PC Inlet
PC Bottom - Header/Manifold 7 Top of ST/PC Manhole Cover
Distribution Lines
Bottom of System
Final Grade
Date of installation //2 /`e! Permit number State plan number
Plumber's signature License number of Date
Inspector
/ Complete plot plan a
K
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
V
I
0TJ 0
YD
7D i
INDICATE NORTH ARROW
.r
4 Wis4onsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division
• INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 315931
10 Permit Holder's Name: ❑ City ❑ Village ffl Town of: State Plan ID No.:
HEINBUCH, TERRI EMERALD
CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.:
010 - 1021 -10 -000
TANK INFORMATION ELEVATION DATA A9800320
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
�j " 4a 1000 Bench I. S
Dosing !"r G; 6 5 b
Aeration �...... �,�. .:- Bldg. Sewer 7. CIO
Holding ',, µ�....,.......�- St/ Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet
Air
eptic 7d' ? NA Dt Bottom p j c { l S7 J
Dosing y r NA Header /Man. t�. �� ��
Aeration NA Dist. Pipe s7
Holding �.
" .... Bot. System S Z 94, - V 96, �
PUMP/ SIPHON INFORMATION 0 1 1 3 1 V Final Grade 9K. /Z
Manufacturer l! Demand - (� r
CVlo
Model Number St"JZC— �-NPM
TDH I Lift Gj ,(� F F riction 22 Syestem/ TDH) 2 3vt
F orcemain Length ZZ " Dia. r Dist.ToWell
SOIL ABSORPTION SYSTEM
TRENCH Width Length ! No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
Dff9FE NSION5 DIMENSION
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type O CHAMBE yodel Number'
System: /. ^el ��5� 7 ._`_..__ OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia Length `�U r Dia. cP- Spacin
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over 1 xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center �7 // Bed /Trench Edges (2 Topsoil & l4 Yes E] No Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) 6 •/d
LOCATION: EMERALD 9.30.16.129,NW,SW 1639 CTY RD O
P -a -��
Plan revision r quired? ❑Yes ,� No
Use other side for additional information. g / Lf SBD -6710 (R.3/97) Date Inspe or's Signature Cert
�Ci
Safety and Buildings Division
{ -N•ISCOnSj SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue
In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. T J C11A I 1K
• See reverse side for instructions for completing this application state sanitary Permit Num .
Personal information you provide may be used for secondary purposes p Check if rib preJous at plication
[Privacy Law, s. 15.04 (1) (m)1. State Plan I.D. Number
I. APPLICATI INF R ATI N - PLEASE PRINT ALL I RMATION 1
Property Owner Pme Pr perty Loca Ion
C �(/ia A, S T3 , N, R Il E (or
Property ) , r's,[Mailin d ess Lot Number Block Nu —
50 CityrS ZipCgd Phone ;um Subdivision Name or CSM Number
Lf
I. TYPE OF BUILDING: (check one) ❑ State Owned it Ne Road
Public Al or 2 Family Dwelling - No. of bedrooms C row of / C: v a
Ill BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) I c t , 30. 1 fe.
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 ❑ New 2. ,4 Replacement 3, ❑ Replacement of 4. ❑ Reconnection of S. ❑ Repair of an ;
Syrstem System Tank Only
________ ______ __ y______________ Existing System ________ Existina 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 XMound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage 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. System Elev. 7. Final Grade
Required (s l . ft.) Proposed (s ft.) (Gals/da /sq. ft.) (Min. /inch) E
57S 6'?, �, r—• �r0�3� Feet / L Feet
at
VII. T ANK
I NFORMATION in Cap allo s Total # of r Prefab. Site Fiber- Ex er.
g Gallons Tanks Manufacturers Name concrete Con- steel glass Plastic APp
New Existin structed
Tanks Tanks _
Septic Tank lJov �(�, <�� / ❑ ❑ ❑ ❑ ❑
Lift Pump Tank f�( tS /CG ❑ ❑ ❑ ❑ ❑
ESPONSIBILITY STATEMENT
I, the undersigned, assume responsibil' for in al i of the onsite sewage system shown on the attached plans.
Plumbe ' me: (Prl P mb is S ur o Stamps) MP /MPRSW No.: Business Phone Number:
% ID L j/U z�
Plumber's Address (Street, City, Ste�ip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Iss get Si natu e (No Stamps)
A roved >d Surcharge Fee) - 7
pp ❑Owner Given Initial I;! 5�9�1
Adverse Determination
X. CONDITI0 S OF APPROVAL / REASONS FOR DISAPPROVAL:
o id uvai�,j l � nG -For old oulW 5Wee
S emit_
SBD- 6398 (R.11197) DISTRIBUTION: Original to County. One copy To: S ety & Buildings Division, Owner, Plumber
i
Safety and Buildings
2226 ROSE ST
Nvh4consi LA CROSSE WI 54603 -1905
n Tommy G. Thompson, Governor
Department of Commerce William J. McCoshen, secretary
July 08, 1998
CUST ID No.139462 A7TN: POWTS INSPECTOR
TODD L SINZ
E5612 708 AVE
MENOMONIE WI 54751 -5520
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 07/08/2000 Identification Numbers
Transaction ID No. 112315
Site ID No. 13452
SITE• Please refer to both identification numbers,
Site ID: 13452 above, in all correspondence with the agency.
St Croix County, Town of Emerald
NW1 /4, SWl /4, S9, T30N, R16W
Terri Hienbuch
FOR:
Description: Mound
Object Type: POWT System Regulated Object ID No.: 28215
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Adm. Code.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely,
/ DATE RECEIVED 07/06/1998
FEE REQUIRED $ 180.00
GERARD M SWIM, POWTS PLAN REVIEWER FEE RECEIVED $ 180.00
Integrated Services BALANCE DUE S 0.00
(608)785-9348, MON - FRI, 7:15 AM - 4:00 PM
JS WIM @COMMERCE. STATE. WI.US
Terri Heinbuch - Mound
Transaction # 112315
Location: NW 1/4, SW 1/4, Sec. 9, T 30 N, R 16 W
Town: Emerald
County: St. Croix
Date: July 8, 1998
Owner: Terri Heinbuch
Address.: 1639 CTHW O
Emeral WI 54012
Plumber: Todd S thzA
Signature:
License # MP 139462
Attachments: 6748 -Plan Review Application
SBD 8330
page 1: cover RECEIVED
2: calculations
3: plot plan JUL - 6 1998
4: system cross section
5: plan view, lateral detail SAF�Ty L„
6: pump tank exit detail
7: pump curve
i
page 1 of 7
P.O.W.T.S.
Conditionally
APPROVED
PARTMENT OF COMMERCE
IV ' AFETY AND ILDINGS
SEE CORRES NDENCE
System Calculations
One family residence 3 bedrooms
Loading rate 0 ' 31 ° gallons /sq ft per day
Depth to grouid water - in
Depth to bedrock V4 in
Cross slope 2 %
Force main length � ft of in
Manifold /header length N ft of in
Drainback S ' Z " 8 gallons
Lateral length ` @ 9 °D ft of Z in
Lateral elevation ft (bottom of pipe)
Lateral hole size V4' in @ b ° ' O in ( !!;-O ft) spacing
k c � holes /lateral, l holes total
Lateral volume �° gallons
Total lateral discharge rate ' 't '1 gpm @ ft head
Elevation difference '�- ft
Friction loss ft @ gpm
Total dynamic head 2 ft
Pump /siphon 2.3 gpm @ Ito ft of head
Manufacturer "' °"• °'"` , Model M
Dose voluige �^ gallons
Lift / si0on tank µ'�''"'�� ��°"`� 1° `' ° ' �' , gallons
Septic tank , �`° gallons
Measurement pump on & off �'� in
Height alarm from tank bottom 16.c in
Reserve capacity 3rg gallons
calcs page of
nxrl Ha 1takich
Nwtsmk 59- =N-:m
town of old
N '
EM.- top of vau ceae el. loo
Alt. HKa= comer of concrete pa 10 0 01. 100.55
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QUICK D&RC.OrvSCT—\
4" vr. hIR�Gt1�r10PY+�6
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SEPTIC i I G T)
D05F
TAWKS 1AAIJU FACTURE R. �� w `�� ���'�`� IJUMOER OF DOSES: PER DAU
TANK SIZE: , `� iv es O GA"OIJS DOSE VOLUME
ALAR MAIdUiACTV�GRi S S ��ac •``� IOICLLIDIAIG OACKFLOW: ( GALLONS
IAODCL 1JU R: 19l H W Z 1 .` 3 ST. }
P1ajE CAPACITIES: � = wcllES OR . GALLOUs
SWITCH TyP[: n " Q.% f g z IAICHES OR _I 4 GALLOWS
PUMP MAIJLIFACTURCR: ty"''° �� C. �'� IIJLHES OR Irt GALLOWS
MODEL WUMIOER: g `'� 1 D� G IµGHES OR Ao -L GALLOWS
SWITCH TaPC:''"'' IJOTE: PUMP AWO ALARM ARE TO OL
MINIMUM DISCMAlt" RAT Z3 GPh INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFEILEWA OETW99u PUMP OFF AUD ONJTRISUTIOIJ PIPE.. I 7L Z FEET
+ MIAIIMUM WETWORK" m PRCSfURE 2.5 FGET
20 FEET ' OF FORCt MAIIJ X I !/ O FEET
pp FLFRICTIOW FACTOR.._
TOTAL D WAMIC HEAD s 1 4'� 2 FEET
it ~ (91(0" .fig
IWTEKLIAL. OIMEU6tasit OF TALIK: LEM&TH_;WIDTH LIQUID DEPTH
C
Performance Data
Pump Characteristics 32
PUMP/Motor Unit Submersible
Manual Models SW25M1 SW33M1 24
Automatic Models SW25A1 SW33A1 1/3 HP
Horsepower 1/4 1/3
18 114 HP
Fug Load Amps 8.0 10.0
Motor Type Shaded Pole (4 pole) .
R.P.M. 1550 e
Phase 0 1
Voltage 115
Hertz 60 0 0 10 20 30 40 so 60
CAPACITY -U.S. G.P.M.
Operation leferaritfeN
Temperature 120 °F Ambient Total Head (feet ) 4 6 8 10 12 14 16 18 20 22 24
NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0
Insulation Class A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10
Discharge Sue 1 -1/2" NPT `—
Sagas Handling 1/r
Dimensional Data
Unit Weight 30 lbs. i. All dwwns m in WN
Power Cord 13/3, SM, I W std. 3.1/2 8.7/8 2. c onpaw I &NNim I"
(20' optieaal) 4-1/2 vary 1 1/ 1 Barb
3. No fa censVuOioa purpow
1 -1/2 NPT codas ar6 W
3-1/2 DISCHARGE + Uunnsions W �h are
!Materials o Co nstruction a
S. 0 voe level o po"
Handle Steel 6. we resew dw rirhl a
Lubricating Of Dielectric Oil 3.1/2 make rwaons 10 ow
prodwh and"
Motor Housing Cast ken I slw IKWM WWI n0w
Pump Ca ' Casw cost ka
Shah Steel
Mechanical SW Faces: Corbels /Commic
Shaft Sod Seal Body: An" Steel
Spring: Suwon Steil PONP 11 -1/8
gobws: WWII
10 1!8 9.1/2
Impeller tk
upper Bearing Brous Shove looring DISCHARGE
HEIGHT
lower B few RAN — T
3-1/2
SIrainer /Base Plastic 3 PUMP
OFF
Fasteners Stainless Steel
AURORA /HYDROMATIC Pumps, Inc. -
1840 Bonny Road, Ashland, Ohio 44805
(419) 289.3042
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
La# w ar4 Muman Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix-
not limited to vertical and horizontal reference point and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and dist
to
e$t�gad'\�
APPLICANT INFORMATION- PLEASE IN.T�ALL IN ORNII�I J REV WED I ATE
/ a
�.!1> N
PROPERTY OWNER: . ; ROPERTY LOCATION
n — OVT. LOT 1/4 1/4 S T N,R (or) W
�. SW 9 30 16 x
Terri Heinbuch 1 NW
PROPERTY OWNER':S MAILING ADDRESS P� ' L T # BLOCK # SUBD. NAME OR CSM #
1639 Cty Rd. "0" 5T CRGtx na na na
CITY, STATE ZIP CO _ - ; PH + CITY ❑VILLAGE [MOWN NEAREST ROAD
Emerald, WI. 5401 �1 '1� � �i
(] New Construction Use [ x] Residential / r d kQ 3 [ ] Addition to existing building
[K] Replacement ( ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .2 bed, gpd /ft .3 trench, gpd /ft
Absorption area required na bed, ft 375 trench, ft Maximum design loading rate ._ bed, gpd /ft gpd /ft
Recommended infiltration surface elevation(s) 96.35 _ ft (as referred to site plan benchmark)
Additional design / site considerations system el. based on contour line of el. 95.35'
Parent material glacial drift 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 fors stem cis ®U KiS ❑U EIS ®U EIS ®U ❑S ®U ❑S ®U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -11 10yr3 3 none 1 lmsbk mfr cs 2f .4 .5
2 11 -16 10yr4 /4 none sicl lcsbk mfr gw if .2 .3
Ground 3 16 -24 10yr4 /4 none sicl 2csbk mfr gw na .4 .5
elev.
9 5.8 ft. 4 24 -44 7.5yr4/4 none sl lcsbk mfr gw na .4 .5
Depth to 5 44 -64 5yr4 /4 c2d 7.5yr5/8 scl M na na na np .2
limiting
factor
44"
Remarks:
Boring #
1 0 -11 10yr3 /3 none 1 2msbk mfr cs 2f .5 .6
2 11 -17 10yr4 /4 none sil 2msbk mfr gw if .5 .6
3 17 -37 10yr5 /4 none sicl M na gw na np .2
` Ground .'.
elev. 4 37 -58 5yr4/4 wet sl M na na na .3 1 .4
94.8 ft.
Depth to
limiting
factor
37"
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. Ave, New Richmond I 54017
Signature: 2 Date: CST Number: m02298
4 -22 -98
f
PROPERTY OWNER T Heinbuch SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # 010- 1021 -10 '"
Depth Dominant Color Mottles Texture Structure Consistence Bai>dary Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 0 -13 10yr3 /2 NONE L 2MSBK MFR CS if .5 .6
3
2 13 - 10yr4 /4 none sil 2msbk mfr gw if .5 .6
Ground 3 22 -35 7.5yr4/4 none sl lcsbk mfr gw na .4 .5
94 35 v. ft. 4 35 -55 7.5yr4/4 c2d 7.5yr5/8 sl lcsbk mvfr na na .4 :.5
Depth to
limiting
factor
II
Remarks:
Boring #
Ground
elev.
� ft.
Depth to
limiting
factor
I
Remarks:
Boring #
.................
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
� L
r •
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Terri Heinbuch New Richmond, WI 54017
MPRSW -3254 NW S9- T30N - R16w (715) 246 -6200
town of Emerald
T I
N „ =40'
BM.= top of well case @ el. 100'
Alt. BM.= corner of concrete pa io C el. 100.55'
CJ��h1
b
CT 3
t p
A
Pit
f V
ti
�
Gary L. Steel
(� 4 -22 -98
6�
STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
MAILING ADDRESS
PROPERTY ADDRESS 1C4 / ('� 6 e, <1
(location of epttic system) Please obtain from the Planning Dept.
CITY /STATE �!'yl ,� D j� 5� ol &
PROPERTY LOCATION AW 1/4, ;5i 4 - ) 1/4, Section T SO N -R
TOWN OF �r�l,F�/�LD ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , PAGE LOT NUMBER
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 licensed septic tank pumper. What you put into the system can .affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on -site wastewater disposal system is in pruner operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.' ,
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
y ' 8 T C - 100
• This application form
owners) is to be completed in full and si ne
of the property being developed. An inade
only result in Y g d by the
development be delays of the permit issuance, quacies will
house intended for resale b Should this
), then a second form should be r ta ned r and com le � (spec
or the property is sold and submitted to this o
appropriate deed recording. P ted when
with the
------ - - - - --
Owner of property - =jQ1 ---------- - - - ---
Location of '����
property N�,cJ 1/4 — 1/4, Section 9
Township ��l��YL -1J
Mailing address /� 9
Address of site,
Subdivision name Y ---
Other homes on property? Lot no. ----
Previous owner of ro "--Yes-
P property Iry /�
Total size of property
Total size of parcel
Date D
parcel was created S
Are all corners and lot lines identifiable?
Is this pr _Yes —
y being developed for (spec house) ? N
x
. Volume
Page r Yes and Pa e N ' ___No
of- Deeds----- -- -- - - - - -- as recorded with the Register
INCLUDE WITH THIS APPLICATION THE FOLLO
A WARRANTY DEED which includes a DO WING:
NUMBER AND THE SEAL OF THE DOCUMENT NUMBER, VOLUME AND PAGE
certified survey, if avail would be DEEDS.
delay In addition, a
references
Y es the if helpful so as to avoid
to a Certified Process. If the deed description
shall also be Survey Map, the Certified Survey Map required.
I (We) certif PROPERTY OWNER CERTIFICATION
best of m y that all statements on this form
y (our) knowledge that I are true to the
property described in this (We) am (are) the owner(s) of the
warranty deed recorded information form, by virtue of a
in the office
Deeds as Document No. of the Count
own the P Y Register of
Proposed site for the sewage � or I presently
c onstruction of said systemn the above described ( )
obtained an easement,
the office , and the same has been du re for the
Of the County Register of Deeds Y recorded in
as Document No.
Slgnature f A
pplicant Co- Applicant
"air Signature
i
- F1 Us Vu rZjF
. 14 ?01 PACE ���
STATE BAR OF WISCONSIN FORM 1 - 1982
WARRANTY DEED
DOCUMENT NO. _
This Deed made between vim_ `%i -1-f -e I
crantat. 'OCT 10 1996
and t2 at 11:00 A•
Srnc� t � F
Grantee,
Witnesseth, That the said Gtanaor. for a vabAk aWAk erAdmL-
THIS SPACE RES ERVED FO R RECO D ATA
conveys to Grantee the following described heal estate in — ,.
County, State of Wisc onsin: NAME AND RETURN ADDRESS
T ;r , r. :
t,, !-loi b aC
TRANSFER
�—� oo .�rrlera 1 �I. &)r 5�clt�
i
The East One -half of the Southeast Quarter (ELSE:)
of Section Eight (8); the west One -half of the
Southwest Quarter (9 swh) of Section Nine (9);
and the West One -half of the Northwest Quarter
(wU,NW%) of Section Sixteen (16); all in Township Tax Key No. —
Thirty North (T30N) of Ranyr Sixteen West (R16w),
Town of Emerald, except mineral rights as held by the Feder. Land Bank
of St. Paul.
This S not homestead property. 1
(is) ( +s not)
Together with all and singular the hereditaments and appurtenances thereunto belonging
And ,
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except t
and will warrant and defend the same.
Dated this l0 f h -- - day of - ( C- 1 o _y
�, _ �L ILJI •rj.¢e n Q) (; AL) (SEAL)
4
(SEAL) - (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
State of Wisconsin,
� Signature(s) ss. (�
. CrV t X County.
authenticated this day of '19- Persona came before ttx this f day of
Qt_ be T - 19 (P , the above named
iiCt� ein t.(i � l
TITLE: MEMBER STATE BAR OF WISCONSIN
lrri L i ba t r� t
(If not, - I
authorized by 9706.06, s. Stats.) to me known to be the pe yO1L w(do exaecl�1{;ie foregoing
Wi
inurement and 1 acknowgk,��ie same.
THIS INSTRUMENT WAS DRAFTED BY i tiiA ��-e - '� '� ••• a
Nowry Public, >�> - - . - --;'— nWI 1,
(Signatures may be authenticated or acknowledged. Both are not My commission is' tImnttgt, (If - 4ct;•state ixp�ation date:
necessary.) cam.: - • 1JJ�.__) �I
-- -
• Names of persons signing in any capacity should by typed or printer below thou signatures. `. �� `
STATE BAR OF MISCONSUS +> Wtdt en LeQaI Mih,atwa Wi Co.. NW.'
Form No. 1 1982 ee, s
-
WARRANTY DEED '