HomeMy WebLinkAbout042-1104-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
538819 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No
Farrill, Sharon Warren, Town of 042 - 1104 -80 -000
CST M Fv: Insp. BM Elev: BM Description: Section /Town /Range /Map No
� 5 �� -r Z�� 20.29.18.578
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic I _ Benchmark
D Y Alt. BM ' — qj 7 75 <
Aeration 16 W VJ n� I W Bid .
Holding {/ St /Ht n `�
('/lN 2 _
Gullet I
TANK SETBACK INFORMATION St/H NW <,-7
TANK TO P/4 WELL BLDG. Vent to Air Intake ROAD
VV 2b 15 95 5
Septic [ t 2 �� Dt Bottom
Dosing > n Header /Man. p 1 7 Z( g
Aeration w Dist. Pipe s,`,/„ 7' � . -31
Holding B ot. Syste wl�
Final Gra n L (
PUMP /SIPHON INFORMATION /J/J •
.(J•��f (- t' -�-e.
Manufacturer GPMand St er 2 Ig &
�j
Model Number
TDH Lift Friction Lo System jTDH Ft __ ft
Forcemain Length la. Dist. to
1
_1
SOIL ABSORPTION SYSTEM
BED /TRENCH Width 3 f Length No. Of Trenches PIT DIMENS DNS No. Of Pits Inside Dia. Liquid Oepth
DIMENSIONS �- 3 //
SETBACK SYSTEM TO P/L P BLDG WEL LAKE /STREAM ACHING Manu �r ;
INFORMATION T e Of Systte�m: I r {� /� CHAMBER O
r'�1�1�J�'w� "�1t W "' I�V, Model Number:
DISTRIBUTION SYSTEM W — >
ead r/ anifold I D istribution N x Hole Size x Hole Spacing V to Air Intake
/ 6l pipe(s) beC�GI / PiLt�
Length Dia� Length is Spacing
SOIL COVER x Pressure S s ms my xx Mound Or At -Grade Systems Only > 109 , 41,
Depth Over Depth Over xx Depth of xx Seeded /Sodded x ulched
Bed/Trench Center ' f Bed/Trench Edges Topsoil `__ Yes N Yes -!.,j
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: a O / (I 0 /I Inspection
Location: 1080 89th Av enue /I Roberts, WI 54023 (NE 1/4 NE 1/4 20 T,,2�9,N,/R118W) Pleasant Acres Lot 6 Parcel No: 20.29.18 578
1.) Alt BM Description = Y"�6 k'.OIti7 �.G� r fZ� , ty'c� Gtf���� ✓�-p( ,�'(ln�j j (iL. �!�'1�V4 �6?�
2.) Bldg sewer length = ,�QQ,�Q x 4 0 -
- amount of cover A X
r
Plan revision Required? Yes No
Use other side for additional information, _
SBD -6710 (R.3/97) Date Insepctor's ignature Cer1 N
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
538819 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No - -�
Farrill, Sharon Warren, Town of 042 - 1104 -80 - 000
CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No
20.29.18.578
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt, BM
Aeration Bldg. Sewer —�
Holding St /Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
J
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
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 j
Bedrrrench Center Bed/Trench Edges Topsoil
Yes No Yes N
J
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection 92 /_ /___ _
Location: 1080 89th Avenue Roberts, WI 54023 (NE 1/4 NE 1/4 20 T29N R1 8W) Pleasant Acres Lot 6 Parcel No: 20.29.18 578
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ❑ Yes Fff� No h�
Use other side for additional information.
Date Insepctor's Signature Cen No
SBD -6710 (R.3/97)
commerce.wi. Safety and Buildings Division County j� 2 1 W. Washington Ave., P.O. Box 7162 St. Croix
C n �7 ■ Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
TUL A R rbnei rt f Canmerce 5 $ /
nib a >it plication State TransactionN er
In accordance with s. Comm. 3.21( on of this form to the appropriate governmental Project Address (if different than mailing address)
unit is required prior to obt plication forms for state -owned POWTS are
submitted to the Departmen ersonal information you provide may be used for secondary Same /�u A $ /
purp oses in accordance with the Privacy Law, s. 15.04 1 m , Slats. 0
I. Application Informat' — Please Print All Information
Property Owner's Name Parcel #
Sharon Farr` 11 042-XI 104-80-000
Property Owner's Mailing Address Property Location / 7g
1080 89 Ave. C O
City, State Zip Code Phone Number Govt. Lot
Roberts, WI. 54023 NE ' /4, NE' /., Section 20
(circle one)
II. Type of Building (check all that apply) Lot # T 29 N; R 18 W
0 I or 2 Family Dwelling — Number of Bedrooms 6 ) Subdivision Name
Block # Pleasant Acres
❑ Public /Commercial — Describe Use Na
11 City of
❑ State Owned — Describe Use CSM Number ❑ V age of
Na G�'To. of Warren
�.` GeIC �✓ ZO+-Zb +
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number an Date Iss d
Before Expiration Owner 149,0
IV. Type of POWTS S stem/Com onent/Device: Check all that appl
Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component ❑ Pretreatment Device (explain)
V. DispersalfIrreiliment Area Informat' n: A0 Infiltrator " - 4 Plus" Standard cbAmbers & 6 endca s, P 1 Lok PL - 525 efllue filter
Design Flow (gpd) Design Soil Applicatio persal Area Required (sf) Dispersal Area Propose (sfl 794.00, s a evatio
600 gpd 0.50 gpd/sq. ft. 1,200.00 sq. ft. 1,230.60 sq. ft.
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o ,d,
New Tanks Existing Tanks o Y .� p
a U nn rn w C7 Ci
Septic or Holding Tank 261 1,000 261 2 Weeks Concrete X
Dosing Chamber Na Na Na Na
VII. Responsibility Statement- I, the and rsigned, ass me responsibility m lation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumb Vs Sign MP/MPRS Number Business Phone Number
James K. Thompson MPRS 30021 (715) 248 -7767
Plumber's Address (Street, City, State, Zip Cod
340 Paulson Lake Lane, Osceola, WI 54020
VIII. Coun /De artment Use Onl
pproved El appro
Permit Fee Date I ssued Issuing nt Sign
❑ tven Reason o nial $ / � 5 ' 1 "
VL Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1. .Septic tank, effluent filter and
dispersal cell must all be serykes l maihta
as per management plan provided by plumber.
2.- All st�at:k fegt Veherfs trust be..maMtained
as pa � cxtde / adinelsres.
Attach to complete plans for the system and submit to the County only on paper not less than 8 t/2 a 11 inches in size
SBD -6398 (R- 02/09) Valid thlu 02/11
e r/a /ua -t o / o; , (_
Ck r
<e, - � .5u I
/DO. ov .'
I 1c8o c�P t - .4
EY /sFl� a� ; spa /w/.
ra�4�jPc �rtnc�ds 4
a Ged o / /'oq t4e6e/ Ltil / .- iR E Cam, a EoF / r
7 �9q.,
_ _ _ � •uer �� � ` BOG/ �a5i.2 - / /05 - cc�
1 r
1 Proposed \
fJraP�S �fxrs4,� 6-d/ 1i'Ce,�3,� ` diUQ!'5,wr \ io� S
7q'
DL-� Ujr! fit✓' .5 s2i �,,, a (err ,
y
1
i
t t crec
r � • StQGrC fsn� \
r
a � road �s.-�., ✓� �
9 7.3..x s
J e -Sac
00 ���.
Conventional POWTS Index & Tilte Sheet
Project Name: Ferrill 4 bedroom Replacement Conventional POWTS
Owners Name: Sharon Farrell
Owner's adress: 1080 89th Ave. Roberts, WI 54023
Site address: Same
Project Location:
Subdivision: Lot 6, Pleasant Acres
Legal Description: NE1 /4 NE1 /4, Sec. 20, T.29N., R. 18W., Town of Warren, St. Croix Co., WI.
Parcel ID #: 042 - 1104 -80 -000
Page 1 Index and Title Sheet
Page 2 Site Plan
Page 3 Dispersal Cell Sizing Calcualtions
Page 4 System Cross Section
Page 5 System Management Plan
Page 6 Filter Specifications
Page 7 Filter Tank Cross Section
Page 8 Parcel map
Page 9 Septic Tank Maintenance Agreement
Page 10 Certification for Utilization of existing septic tank
Page 11 Waranty Deed
Attachments: Soil Evaluaiton Report
Mater Pl her Restricted Service: James K. Thom son, Dept. of Comm. Credential #30021
Signature: Date:
Page 1 Of 11
Design pursuant to In- Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD- 10705 -P (N.01 /01)
12 „� el crron
-*- 3v
¢,nc 6AP -i %o o-G \\ �c{'A S'7
m- nsu \
160. 00
.S�4ro� Frr� / /�oi
�C80 tw s4oe
Y a ce0/ 0, - & 11 eAel i
i i Proposed \
,Oro diVelVin \ L S
G�'ewcf�ESa t .3`,'�e f�' / � � va �� \ �
6 c 5e r
�! •� /a��rP s Cord
� � 5epbrt fsn� \
r �
a�vve �ou..,d �s;.l�.i ✓cc
pa o /• \
, d.,P(= o of
Lo t 7
cue -sac
89
�. 2 o� //
DISPERSAL CELL SIZING CALCULATIONS
1. (4 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 600.00 Gpd design flow
2. Infiltrative capacity of native soil = 0.5 gpd/sq, ft.
3. Absorption area required: 1,200.00 sq. ft.
4. Absorption area as proposed: 1,230.60 M. ft. (60 chambers total)
Infiltrator "Quick 4 Plus" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4 Plus" end cap = 5.10 sq.ft, EISA
1,200.00 sq. ft. — (6 endcaps)(5.10) = 1,186.60 sq. ft.
1,169.40 sq. ft. /20.00 = 58.47 chambers required
Number of trenches: 3@ 20 chambers per trench (60 chambers total)
Trench width: 2.83'
Trench length: 83.00'
Trench spacing: 9.00' on center
Total system area w/ 6' trench spacing: 21.00'x 83.00'
Pg. 3 of 11
i
Soil Absorption Svatem Cross Section
44 9 9.25 g
98.25 it
4' Sdiedule 40 Final Grade
PVC Vent Pipe 95.00
With Vent Cap ft
Leachng Chamber —► f— 94.0 ft
Systern Elevation
2 .83 ft 6 .00 ft ft
Soil Absomdon System Plan View
ft
2 .83 ft
6 .00 ft Leaching Trench 1
Chambers
4 Die.
Trench 2 Header
Vent Or Observation Pipe
MT
Trench 3
Leaching Chamber Specifications
Manufacturer And Model
EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.50 gp ft
600.(A g pd Design Flow .L 0.50 Soil Application Rate + 20.00 EISA = 58.47 Chambers
3 rows of 20.00 chambers each
Page 4 of 11
Conventional Septic System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD- 10705 -P (N.01 /01). All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with.
Septic Tank
Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR
113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are
not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be
needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank
that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be
serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water
tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater
than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS
component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October - March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contineency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715)
248 -7767 or the St Croix County Zoning Department at (715) 386 -4680.
Pg. 5 of 11
EFFLUENT
FILTERS
"The PL -525 has 525 linear feet of 1/16"
slots. It has an automatic shut off ball. When
the filter is removed for cleaning ball will Alarm a Accepts PVC
:1 extension handle
float up and temporarily shut off the system
so the effluent won't leave the tank. No other
525 linear feet
filter on the market can make that claim!" of, /, 6'
Iittretlon slots - Ratetl for over
-• 10,000 GPO
E,
Acceprs 4" & 6"
SCHO. 40 Pipe '
"t
a�
Gas deflector
Automatic shut•oft
ball when titter
is removed
"The PL -122 has over 122 linear feet of 1/16"
slots. Rated for 1500 gallons per day, and < Handles 112" PVC
can be manifolded together with other PL- Alarm
122's to double or triple the GPD. It has an Switch
122 Linear fl.
automatic shut off ball that stops flow when •of1 /16inch
Filter Slots
the filter cartridge is removed for cleaning.
Comes complete with it's own housing, no
A Filter Housing
gluing of tee or pipe and no extra parts to with 3-
Pipe Adapter
buy.
t
Gas D.A.M.,
Automatic
Shut -Gff
• Bell When
Filter is
Removed
From Tank
Order # Model ;# Description List Price
PK -525 PL -525 Effluent Filter System 203.50
PK - 122 PL - 122 Effluent Filter System 62.50
6 -10
P' war
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r / /&•/z G�oN�i4r�/E/ o w �4
t ► !
t �
t t
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r�
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H lit
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WEEKS GO"
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i
i
RAY L kNiEK
i� 1832 2150 St.
[��- 7aF11
H H 65 of 6, 0 and 236 ions to t0 tfll4 plot •, ect t
with to 5.3. 236.1 d PLEASANT ACRES
236.16, 236.20 and (1) and t w Wis 51.1
. and Hy 3 and
65 of tM WiL Admin. Code os provided by Sec. 236.12 161,
�. Wls. Stots, ./
Z a ined . o�/�NVday a( ....C7GTQG�Y. 19. LOCATED IN THE
! W . FA..9
D•pan
i Dlncroq E•glonal Plennlnp i C D wnmuniry Anislany E 1 /2 O F THE N E 1 /4 O F SECTION 2 0
m•nt of Local ANRIn i .vk+pmlN
o T 29 N , R 18 W, ST CROIX COUNTY, WISCONS
0
a
NI /4 CORNER OF
LLJ SECTION z0,T29N, UNPLATTED LANDS
�R18W NB 9 _2625_17_______
C' ao SOUTHERLY RIGHT -OF-
a
L rn N 69 35 "E 960.59 WAY LINE
_ 9 64.76 215.00
0 1' q , ` 190.02 p `fl° 190.02 190 O.
9h 03 ^� 't
___
° 0 - __- _- _____.0_ ) f
n BUILDING SET LINE /
la
W
F- 05 z .0
5 4 3 2
X25. �6 •-� > _ .N .e
S L 1,01 ACRES 31 ACRES N O 'n 1. ACRES M 1.48 ACRES a I49 ACRE
Z +n r
� �' N SS • 42.56' ,
2g 2 0 1
6 3•�N. I tio' g
L.LJ o� •N sa patio
LLJ - bo °Q' Ig2 'y ° 0 a
N � N2 • +y ?5' M 94.76 1 90.00
7 N 69 W - 6576
Q n n e PLEASANT ACRE
Z; 1.19 ACRES 844.6E
Q' O 2 '9 045 'n N89 "W 65i 5F
JI v -
�� m X00. NT 42 A :O 94.56 9� 190.00 :90 :.
0 Lj' 3 •J A4 CDT 4 Pp 07
0 IN
F N 'i 1 26h to
Q
35.00
0
2E �; z 8 9 1 10 .o II 1 - 12
°. 0
2.84 ACRES 2.32 ACRES i 2.39 ACRES 1 1.56 ACRES I r 1.56 ACRi
In v
i In
LOCATION SKETCH a
o
r I
it ry0
O' yl p al
V /
SE 1/4 SWI /4 .O N .3 =�
A
O nl N 190.00' 190.00
Z 17 21 M N In
F.� 21
a a 2 N 69'59:
c I �
L
NE 1/4 NWI /q
Li
4_ SCALE 1 "•2640' - m
a
rn
254.12 *30 O _ T 5 59 �C
- _ 55.00 I 0
Cl) _ ONIOA 178 I0' O 9 ph
1 eq V
ti
/ J'• NORTHERLY RIGHT
\ - 2'CONTOUR ABOVE
�• SCALE IN FEET \ ` HIGH GROUND WATER
N 3•
0 loo zoo 300 400 UNP LA.rTep \ ^ \
I 1 ,Cg ��,\•`rh'We
, it . - �
W CURVE DATA TABLE
CURVE LOT
�NFF RADIUS CHORD CHORD CENTRAL TANGENT LEGEND
N0. - N0. LENGTH LENGTH BEARING ANGLE BEARING
COUNTY SECTION CORNER MONUMENT 2
I"TIl N 0.00'35 "E 215 N72'20'35'E WE
I -2 80.00' I52.45' IGHING 3.63 LBi /LINEAL FOOT WITH BERN TSN
0 2 "X 30" IRON PIPE, WEIGHING 3.65 LBS. /LINEAL.
O .ay
4 5 44, IG' N00- 19 '25 "W 32.00'00" ALL OTHER LOT CORNERS STAKED WITH ! 'X 24
p' B 6742' S50. 40'35 W SO. 0000" PIPE, WEIGHING 1.68 LBS. /LINEAL F00T.
)'. Yi
7 „ 80.00' s4.19'z3 "w 60.00'00" NOTE
t ;,
! 67.62' 339 23 "E 50 00 00"
ALL DISTANCES, LENGTHS AND WIDTHS ARE NEA
! S2.lS' NBY 00'36 "E 23-20 TO THE NEAREST ONE HUNDREDTH OF A FOCT
yv.{ 5778.tf' 339.OA' N TO' 4W 50'W 3.21'40" N76 °29'40 "W ANGULAR MEASUREMENTS HAVE BEEN MADET
-- NEAREST TWENTY SECONDS AND COMPUTEC T
I{4:!!' N7! "W 1 VALUE SHOWN.
!. +l4.9p NT3•Sa05 W 1
' '". 32 O
' I"
4LL BEARINGS ARE TRUE FROM SOLAR C6SER.
;13 .fi - -_ ON SITE.
v ..
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 168o ,99,�r�. ,�06 r.J /. S' �o located
at: 4 E ' /4, rl� /4, Section ;2z , Town 2 N, Range /® W,
Town of c.,-rey-) , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service Q.u.�. �
VI
Did flow back occur from absorption system? Yes t;- No
(if no, skip next line.)
Approximate volume or length of time: 7 gallons minutes
Tank Capacity: 1 ,600
Construction: Prefab Concrete i,- Steel Other
Manufacturer (if known):
Age of Tank (if known): ��Yea -rs
P it umber (if known) _24ZV96)
icensed Plumber ignature) (Print Name)
y�, {• a
(Title) (License Number) b
' //
(Dat
Form to be completed by licensed plumber (Dept of Commerce Chapter 5
and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
Administrative Code)
Rev. 9/2008
1 l hill llll l 11111 Ill! l II!!1 lull Ill
!111!1 Ill! 11!1
* 8 6 9 2 3 8 1
889238
State Bar of Wisconsin Form 1 -2003 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
DocumentNurnmr DocumentName RECEIVED FOR RECORD
02/21/2008 03:45PM
THIS DEED, made between Joseph S, Krauss and Gina L. Fuchs - Krauss, WARRANTY DEED
husband and wife EBEMPT 9 8
( "Grantor," whether one or snore), REC FEE: 11.00
and PAGES: 1
Sharon L .D. Farrill, a single person
( "Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real
estate, together with the rents, profits, fixtures -and other appurtenant interests, in
St. Croix County, State of Wisconsin ( "Property") (if more space is Recording Area ,
needed, please attach-addendum)i �
�. -�
Lot .6 and West 20 feet of Lot S in Pleasant Acres,in the Town of Warren, St. Croix lO p �,
County, Wisdonsin.
Wl: 5W01
042 -1104 -90-000
Parcel identification Mimber (PIN)
Thu is; homestead,prouedy.
(is) (is not) '
Grantor warrants that the title to fiie Property is good; indefeasible in fee simple and free and clear of encumbrances except:
Roadways, Easements and Restrictions of Record.
..Dated
(SEAL) f (SEAL)
oseph S: Krai#ss * Gina L. Fuchs - Krauss
(SEAL) (SEAL)
AU.THEN WATION ACKNOWLEDGMRNT. .
Signature(s)
STATE OF WISCONSIN }
authenticated on ) ss.
ST, CROIX . COUNTY '}
* Personally came before me on
TITLE: MEMBER STATE BAR OF WISCONS ve -named .
(If not, VEL-IN M PU osep S. KrausSand Gina Fuchs -Kraut
authorized by Wis. Stai.; § 706.06) Noll
as Ywisco known to be the persons) who executed the . foregoing
State oS ins t an ackn wle d the acne,
THIS INSTRUMENT DRAFTED BY:
Michael H. Foreeki, Attorney s Evelyn M. J ger
Eau Claire, W1 Notary'Pablic, State of Wisconsin
My Commission (is pennanent) (expires /12/08 )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
Type name below signatures.
1. of.1.,...._.. .. ........ �.. ... . ... —..
- iloFil
2257
Wisconsin Department of Commerce SOI��+`�rEPORT Page 1 of 3
Division of Safety and Buildings accordance with omm Ms . rr P � f LL "tit A.C.E. Soil &Site Evaluations
Attach complete I r not an 8%: x 11 inches in ize. Plan must unty
include, b t not t : verti horizontal reference point (B ), directyp� 1 St. Croix
percent slope, di ions, north arrow, and location and istance t66 t� 2 t� reel I.D.
042- 1104 -80 -000
Please print all information. ST. 0kUix COUNTY
PLANNING NG OFFIC evi d By Date
Personal information you provide may be used for secondary purposes ( d // _
Property Owner Property Location v (O
Sharon L.D. Farrill Govt. Lot NE 1 1 NE 14 g 20 T 29 N R 18 W
Property Owner's Mailing Address Lot # Block # Subd. Na or CSM#
1080 89th Ave. 6 Pleasant Acres
City State Zip Code Phone Number J City Village t/ Town Nearest Road
Roberts WI 1 540231 Warren I 89Th Ave.
New Construction Use: yJ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
W1 Replacement J Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable Na
General comments
and recommendations: Site suitable for conventional POWTS dispersal cell with 0.5 gpd /sq.ft. /day loading rate. Proposed
system elev.= 94.00'.
Boring # J Boring
e Pit Ground Surface elev. 98.13 ft. Depth to limiting factor >103" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 - Eff#2
1 0 -14 10yr3/2 none sit 2fgr mvfr cs 2vf,f 0.6 0.8
2 14 -30 10yr4/4 none sil 2fsbk mvfr cw 2vf,1v 0.6 0.8
3 30-42 10yr4/4 none sl 2msbk mfr ci 1vf 0.6 1.0
4 42-49 10yr4/6 none Is Osg ml ci - 0.7 1.6
5 49 -74 10yr5/4 none start. s Osg ml aw - 0.5 1.0
6 74 -103 10yr5/4 none s /Ifs Osg ml - - 0.5 1.0
H #5 Loading rate reflects reduced permeability of horizon associated with textural changes. H#6 contains irregular, discontinuous bands of 10yr 4/4
7 Ifs.
Boring # I Boring
✓_ I Pit Ground Surface elev. 98.42 ft. Dept to limiting factor > 107' in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHt'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
1 0 -14 10yr3/2 none sil 2fgr mvfr cs 2vf,f 0.6 0.8
2 14 -27 10yr4/4 none sit 2fsbk mvfr cw 2vf,1 v 0.6 0.8
3 27 -37 10yr4/4 none sl 2msbk mfr cvv 1vf 0.6 1.0
4 37-42 10yr4/4 none Is Osg ml cvv - 0.7 1.6
5 42 -80 10yr5/4 none strat. s Osg
A 5 - .
1 ml aw - 0.5 1.0
6 80107 10yr5/4 none s /Ifs Osg 0 ml - - 0.5 1.0
111#5 Loading rate reflects reduced permeab" horizon associated with textural changes. H#6 contains irregular, discontinuous bands of 10yr 4/4
Ifs.
* Effluent #1 = BOD? 30 < 220 mg /L a d TSS >30 1 150 mg /L ' Effluent #2 = BOD <30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Signet e: CST Number
James K. Thompson � 3602
Address A.C.E. Soil &Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 8/6/2011 715 -248 -7767
Property Owner Sharon L.D. Farrill Parcel ID # 042 - 1104 -80 -000 Page 2 of 3
]Boring # J Boring Illel Pit Ground Surface elev. 97.78 ft. Depth to limiting factor >101" in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -14 1Oyr3/2 none sil 2fgr mvfr cs 2vf,f 0.6 0.8
2 15 -35 1 Oyr4 /4 none sil 2fsbk mvfr cw 2vf,1 v 0.6 0.8
3 35 -42 1Oyr4/4 none Is Osg ml cw 1vf 0.7 1.6
4 42 -70 10yr5/4 none gr s Osg ml aw - 0.7 1.6
5 70 -76 1Oyr3/6 none Ifs Osg ml aw - 0.5 1.0
6 76 -101 1Oyr5/4 none s Osg ml - - 0.7 1.6
H #5 Loading rate reflects reduced permeability of horizon associated with textural changes.
❑ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777.
SBD -8330 (R.07 /00) A.C.E. Soil & Site Evaluations
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER M1
ADDRESS
SUBDIVISION / CSM LOT
SECTION c9,0 _ T Z N_R� W Town of C{
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM P e
• Exl wP
iJis c. ce �rom h hi ,.sa ► ( I It I� y
zz
a .
i
17 rqp �DX
U
0
I
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
r
Wisconsin Department of Industry, PP'VATE SEWAGE SYSTEM County- CROIX
Labor and Human Relat. o� s I NSPECTION REPORT
• Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -:
Pe rmit H GINAf KRAUSS JOSity El Village Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / Benchmark
00_
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet - �1rg�" en,
TANK SETBACK INFORMATION St/ Ht Outlet ' oql qG "75
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic > , p , NA Dt Bottom
Dosing NA Header / Man. g' S�� 9S.
,Irs- 4S.Ru'
Aeration NA Dist. Pipe
Holding Bot. System � � Qom
io, iy q y ,
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift L System TDH Ft DfvZ- 8 yG' X10,
Forcemain Len Dia. m ead Dist.ToWell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SETBACK
SYSTEM TO P/L BLDG I WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION TypeO 7r CHAMBER Model Number:
System: �(� ` (� /l ,�/ OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
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 3,- IV ' Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.)
LOCATION: WARREN.20.29.18W, NE, NE, LOT 6, 89TH AVE
iyi = /" -
Co-%,sue
Plan revision required? ❑ Yes O No
Use other side for additional information. aq 1 ,9�.,
SBD -6710 (R 05/91) Date fins ect6's Signature Cert No.
Safety and
ofBuil Bui Wa Div
SANITARY PERMIT APPLICATION
Bureau of Buildin Water System
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. - St , er'pi ](
• See reverse side for instructions for completing this application State 4it ryPermmiitt Number
The information you provide may be used by other government agency programs E] Check vts�ion c o IicaTion
(Privacy Law, s. 15.04 (1) (m)].
State Plan LD. Number
L APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Pro rty Owner Name (�' m TKas • Q((: }, Property Location
9� 6 i�/Lc(� Y11 1 /4 N6 1 /4, S ) T -;: . N, R 18 * S,(or)
Propei� 7r
wner's Mailing Address � Lot Number Block Nurr��
' �(J.
Cit State Zip Code Phone Num b r Subdivi ion Name or CSM Num er
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ cit Nearest Road
L❑ Village ` (�
Public 1 or 2 Family Dwelling - No. of bedrooms .3 Town OF (,✓atreats I3 r / t4u
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 1 40 Woo' — go
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 _ XNew 2_ ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only 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,KSeepage 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
�!a Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
d s4 0 �(' . 7f 7 Z Feet !. ! Feet
VI Capacit
TANK in allon Total # of Prefab. Site Fiber- E x p er.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic A p p
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank 0 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ I ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum Name: (Print) 4 Plumber' Signature: (No S amps) MP /MPRSW No.: Business Phone Number:
LUC
Plumber's ddress (Street, City, State, Zip Code):
IIr�
IX. COUNTY / DEPARTMENT USE ONLY
(Includes Groundwater ate Issue Issuin A nt Si re N
Disapproved Sanitary Permit Fee 9 9
am
Surcharge fee)
Approved [:]Owner Given Initial }_
Adverse Determination O �/
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
JOB 1 �u /an �'v rr 1 Sow x ASS
TIMM EXCAVATING SHEET NO. I I �—
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY ' ' DATE
(715) 772 -3214 (715) 386 -5443
MPRS 03224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 205- 1 1nc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1- 8*225-M
JOB -� l'✓�C'r�Y( r ° "Lt -rr� �l �/� h I�LcGcS
TIMM EXCAVATING
Route 1 BOX 192 SHEET NO. OF
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772 -3214 (715) 386 -5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 205-1 Inc, Groton, Mass. 01471. To Order PHONE TOLL FREE 1800-225 -6380
` MGscorissin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations g —
Divigion 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 (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 042 - 1104 -80
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Joe Krauss GOVT. LOT NE 1/4 NE 1/4,S 2 29 N,R 18 for) W
PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM #
642 Laurel Ave. 6 na Pleasant Acres
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE DOWN NEAREST ROAD
Hudson Wi. 5401 (71J Warren
] New Construction Use [ ]d Residential / Number of bedrooms 4 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd/ft
Recommended infiltration surface elevation(s) 94.72 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK
U = Unsuitable fors stem i] S El :E1 S ❑ U CAS El E ❑ U �S El ❑ S ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jfi6rch
U 1 0 -12 10 r3 2 none 1 2msbk mfr cs 2f .5 .6
2 12 -40 10yr4 /4 non 1 lfsbk mfr qW if .2 .3
Ground 3 40 -82 7.5yr4/6 1 1 0S9 mfr na na .7 .8
9 8.05 ft.
Depth to
limiting
factor A_Nlik�
Remarks:
Boring #
> > > > >> 1 0 -11 10 r3/2 none 1 2msbk mfr CrW 2f .5 ':.6
2 2 11 -30 10 r5 4 none sicl lfsbk mfr cfw if .2 `:.3
Ground 3 30 -88 7.5 r4/6 none s oscf mvfr na na .7 1 .8
elev.
99. l ot.
Depth to
limiting
factor
+88
Remarks:
CST Name: — Please Print Phone:
Gary 715 - 246 -6200
Address:
1554 20 th Ave, New Richmond, WI. 54017
Signature: Date: CST Number:
r>( - 4 -17 -96 cstm 02298
STEEL'S SOIL SERVICE
Gary L. Steel ,Toe Krauss 1554 200th Ave.
CSTM2298 NE4NE4 s20 T29N -R18w New Richmond, WI 54017
MPRSW 3254 town of warren (715) 246 -6200
t lot #6 -Csm Pleasant Acres
N
1 =40
BM.= top of NE lot stake @ el. 100'
x"I #iz OM
�i
A l'
�2
24\
A,
4i
Ga L. WeA ac(
4- 17 -96\
STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County [
OWNER/BUYER h r � l , "VIA � ll s (n �Y 1 Qkdk
MAILING ADDRESS
PROPERTY ADDRESS p ip* a-t'c
Q (location of septic system) Please obtain from the Planning Dept.
CITY /STATE
PROPERTY LOCATION 114, /UE 1/4, Section Zo , T Zf N - W
TOWN OF �5 , ST. CROIX COUNTY, WI
SUBDIVISION ) -- k j n , 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 prior 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 proper 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: lr
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
' This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner /contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
-------------------------- ----------------------------------------
Owner of property �� n ' S• V
Location of property_IVE 1 /41/4, Section c2c) ,T ;19 N -R 1-26 W
Township Mailing address
Address of site 68�
.
Subdivision name S Lot no. 4;'
Other homes on property? Yes ^/ ,
Previous owner of property t (� I��1 p u u
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for (spec house) ? Yes SI_ No
Volume and Page Number as recorded with the Register
of Deeds.
-------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition -, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owners) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. ff'�t4l_47X , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
i Applicant
3 199(A
D to of ignature late • ! Signature
-ector, Regional Planning & Comm AssistanCo
partment of local Affairs &Development E 1/2 OF THE NE 1/4 OF
T29N, R18W, ST CROIX C
N 1/4 CORNER OF UN PLATTED LANDS
SECTION 20,T29N, --- -------- - - - - - -- ------------
R 18 W N 89 2625.17'
ro
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M
N 89 °2035 "E 960.59
t 164.76 � , �h 215.00' O ` 190.02 O bo
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DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2 -1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
von 1181 REGISTERS OFFICE
Gerald L. Nadeau ST. CROIXCry..,UW
Rw�dAxlMooid
JUN 3 1996
at 9:15 Am
conveys and warrants to `;KAQ,- , * LUk•
Sharon L D Farrill/ AN UNMARRIED WOMAN RotONde
Gina L. FUU11S— KLdU66
RETURN TO
the following described real estate in St Croix County, I
State of Wisconsin:
Tax Parcel No:
Lot 6 and west 20 ft of lot 5 in Pleasant Acres in the town of
Warren
TYANYgER
is not
This homestead property.
(is) (is not)
Exception to Warranties:
/Datjd this 25th day of May 19 96
,� �s"16
A (SEAL)
Gerald L. Nadeau
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OFAo%4S0
ss.
dil�c�c,e County.
authenticated this day of 19 PersonaNy came before me this ^ day of