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006-1016-60-000
II ~ o a~3i ° I II o O F» I oa c: o _ ~o c o a c o m $Q.v e°y ° a E o rnHcma) a~Lo I ~I _o p m -0 m 3 Ya ° aci °c a> » a CD E 20Ef0Em3m~ mw CL :3 •p 3-0 C D o m S 1)2 a) 2 go r- Z 0 m o- CL Z n u? co v, c - O NtiL".~ 0 U. C O y c c 3 o E0~ m CD c cm y E o cc a E ¢ V y m a m - M d H co Z C Z m co H a m o I ~ li c O z U m N w o d z Z a fA H ~ N Z E ~ M Y ~ m •N c t o 22 O z z Q Z i, N N f` - N ° m E N ! m C a m ,n H d C L o° N G D a .nom '~N w m v~ v) v) v> j v ~0_ a m "~J a m aooo Z°o •N (DaIL IL y 0 U) U) o 0) 0) 0) U) -1 0 65 L r2 ~2 v v v v in V) LO LO LO 0o u~ '00 o 0 0 0 0 0 0 0 4) 0 0 0 0 0 0 0 0 0 0 I[1~ Q N N N N N N N N N N N O co E CO lf) M M O M co O N N N N N N co •O _m C~ I~ a-• a (D i~ N o d Q to m p N 7 O III U) N c O O p °ZS O f- f-_ I- co ao co ao co O~ m N a 0 0 0 0 0 0 0 0 0 0 0 O ! C 00 O O O O o O O O O r p m j~ C N N_ N N N N N N N N N V co F- n ~O N d O N N N N N N 42 L.: CO ° o "c}' .y°. m Z c m a v r~ rn a 4 co rn • O 06 V CD co 0 en N O Z C fn ~ d .m .I y d CL a W- d c r A c0a2 0U)0 Parcel 006-1016-60-000 01/04/2006 07:38 AM PAGE 1 OF 1 Alt. Parcel 8.31.16.108B 006 - TOWN OF CYLON Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - WEBER, SHERI J & MARK D SHERI J & MARK D WEBER 2264 220TH ST DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description " 2264 220TH ST SC 0119 AMERY SP 1700 WITC Legal Description: Acres: 6.060 Plat: N/A-NOT AVAILABLE SEC 8 T31 N R1 6W 6.06 AC E 200' OF SE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-31 N-1 6W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 106 TI 07/23/1997 4/04 07/23/1997 778/435 07/23/1997 696/571 2005 SUMMARY Bill Fair Market Value: Assessed with: 157 227,800 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.060 25,000 173,500 198,500 NO Totals for 2005: General Property 6.060 25,000 173,500 198,500 Woodland 0.000 0 0 Totals for 2004: General Property 6.060 25,000 173,500 198,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 State of Wisconsin \ Department of Industry, Labor and Human Relations ar~aarry ? , SAFETY & BUILDINGS DIVISION ~1 8 Surea i of PIAMLing. f 20 East WashiugtarIi Aw"we P.O. Box 7969 haditea, Wisconsin $3707 ` / Aft 23~ Viers Cement Products \ NeW M CtkAGnd, iii scOnsi n 5,j Plan Identification ~t3A• Ad~ ~~~'T :parr" Sirftlar l '22(o q 22 to Ana/ Pe: Swanson, M-491as L. Fesideme Private Sewage System SE,l~r ,C,31,lf;6 7aa i of Q~1op, St. Croix County, W1 Review of our files indicates that 6C days or more have lopsed since your plans were r eiv by tits office on august 12, 1983. Ttw last correspondence was darted Re st 12,o 1983. Since no additiatiael inforutiea has been received in t be Interim period, this office &ssuc- s the project has acs pest ear caae7 If #dditfmml Information has not been rece#ved 14 this office whin 20 days fro the date of this letter, our -S#te Waste Specialist for this are at will b;,; motified investigate the stags of this pr , oct. The +aadditi l iof do requested shall s itte to the Department at the a b tioned ad:tress. VC -tmr k rAy c ce, or si dri'%Ar Its e issued until tho plans are approved by this office. si merely, Jews Quinlan Sectic" of F-rivate Sewage, and Platting d+E~~s cc: Leroy Javsky, Ov-Site Waste Specialist - District , 'f ippere Falls Harold C. Barber, Zerti(tq Administrator - St.. Croix County Mr. uql as L. a risen DILHR-SBD-6423 (N. 04/81) r t i r. e ;`J 8130,6678 (9/811 fF~lb 900 Detach. ` ST- Portion Of This form Wi 'BUREAU Pl. C)M811413 #t 201 E. WASHINGTON AVE. RM 78 Any Return Correspogde S P o mac 7969 VA6i1,,w1 53707 r~ p jQ~~ 1 606-266-3815 DATE: $ O4~ O "1T PROJECT: s PLAN I.D. DETACH HERE - PROJECT NAMES. nk_ ' - '~S ' f, J PLAN ID..#'. 'ZC Al This is to acknowledge receipt of your plans and specifications for the above-indicated project. r k Preliminary review indicates the required fee is $ 70. 0 d Fee Received is i Underpayment - Please submit the additional fee. Overpayment Refund fortheon Plan accepted for review. g Plans being returned. ❑ No fee has been remitted. Puns submitted with no fees will be ❑ . Adtlitionai information requited . SEE Bl held in abeyance: 1 r 1. Plan Submission ❑ Con*ete data relative to anticimaw use of I g: lAdditional information shall be submitted in duplicate un ❑2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 col3y ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. -1l'copy) . . ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.0$e(2)(e) Wisconsin Administrative Code. ❑Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent manhole alarm and malufacturer if precast. Complete construction details if It- Pressurize Distribution Systems (Mound or in Ground'oressure) site constructed. Apple atiorl foy use of An alternative systerrrafgned by owner ❑ Holding tank agreement signed by owtxer:,and,Ipcal unit` of and 66iariied: tt eopn~y ❑ County i?rtslte government (sample enclosed). required Zl copy). ❑ Design calculations ❑ Reason for installing balding t2tnlC 9lili'fil,sr statertt#nt for pressurize distribution. 0 Soil boring & percolation COPY _Ceatdata,. from county (1 El Crass section of s stem. ❑ ❑ Plot plan showing(4catn of-hok,)►ngtbtj}~ (atQr dlst- y Pipe lateral layout. , ances to any-building, wells, water- w ng w#er ❑ P n view of system, ❑ Plot plan. course, lot lines, swimming pools; a " ~ ' tervice road, ❑ Verification of Exception Status Form by County. ( copy) Etc. Provide benchmark with elevation`referenee point. vc~R, N4% C.)ZAV \C_ N7 r' Ill. Private Sewage lIspasal Systems 4 v. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp tion system extending 25' on all sides. E-1 Calculations for total lift }dump nd gell"s Elevation of pwmanept reference point (bendhma{k)., pumped per cycle. © Size, lepgth & depth of force main. t, ❑ Location of area..suitable;fx►r replacement system- provide sail data, ❑ ©btaif & model of ponnp r-Aut***ft ~ includ g size, pump curves, drawdown and rays f#t rlste GP!E' ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or seW disposal system to buildings, lot lines, well, water siphon(s). course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precut. V1. Systems In Fill (Fill must faA placed pp pr. ! wiot ! D Construction detail and doss-section of soil absorption ❑ Total area filled (fill to,e)oend 20' beyond"edga of tretvch system. before side slope begin)-.- -Soil boringand percolation test on 115 completed by cer- ❑ Depth and type of fill, tified soil. tester (1 Copy). Copy of onsite report 6y,.county or fi r. y zx t r.x 3;fir „i r Ah ~t Alm ~.;.3 , J+. . .lvrt ~d yp r .W Y~ 4 { •y R" " • _ F"~ :Su „'V ~•5.a<rd '.~d, ~ ~L.. ;*4M, is r '3' l ZIH1T'3 1 iV ~ Y. ii C'~'4>t'r' P' 7. ~ ~ ~ , 'f''- ~ • : # \ WIT M1 xr y '~'1d. o 1~ ~.,p Y;k'r"= ♦ "lT.a'W~ 'I,~' T~ f.~ ~c+~ Tn+ w,r r ♦ ~F.`i y., .;t~4~.i~'. ~~t. ,.7 ~ _ ~ E; h, -4 9r~..1 ~ :.pt~ la, All 7 • A -.3 f3~ ``~t~~9 i5si'~ < ~~kj' '~'F'~.~~~"ii t~°,~'!~ ?.'is -i lt3ri ,($sY~ ~"'t~ t .w~ ~ ~Y , P.HFYU♦ 7.Y~ t ~ ~~'Y h.q/. } "."1 ~{[F ~ fK .qI~ _ey ~ qm ~ a ~ ~ ~ 3• 4 ,c 1 lT ~'l it ~y'S ,a . t5 ~tt$~"~.~5~'}a~,{~ }~y 'j~ _ k .~A ~~.wF ~j~,p i~ k~~,,~~ ~ •{.N- ~ ~ ? 1.•y. . T:''~" c , ~x i» ~ a Siy, !s 'r z ~ ,j,.~ 9•'ll.i'~ i~ZZ t - t 1t+ fy-' ~y~ a ~a3 ~t$3 s' } k^~ fit, _ ~ ,r-. . f "ilt! •~jF,~ •,Tnl'ft W.i iSK~ *y fG .a~.; ,s? i,~{`'.• it, rt 7'7 c ' q~,•'If s3` ;.T al3'x~ f 'q1 ).,r', ill?t'? IfF. ♦ f N, ID 9t - - tr i .'4n ' h,tY °*41 y~ }L"F .,~,1.s rya Jr 1•W,~F7( P 4kt-~" WF -r ?s S`~ si., - .i .t ~~'f ; ,F •pC.r'wr"x „ t ti TtF ;.i ~ .w a 7 ~•ys •y({,g± - ~ .~"""i;x~~~ kA1~L? ¢j r) ~~s"~Yr } "4'$y •ai~ 5 G+ sy ~+;-~-i',sr1, . it'i`} a * ~j~! f,E rr`~",^$ ~a ,tyft 7z r ~~'ra~~3ALi'k'"~ ~ ''~~r Y ~~aic ~d '~t f t~ ~ -•Z°"''#" * s~_: t * 4 - ~ a q3 s 'Sr?5{'A cA f.. < x _ '.y1 'r, .E.~•r 4 c ; ;r•-,~+!#}i1 e~,fii x`4!3 14 i yE - w z 5 s+- v q ~,.PP ~rt 5 4Z+?b 1 i. x' Y f } *411"ll,Fi ~4y .y`v y r~} 1•.1fYcr'~ ,s - ~ ~ 1~`/Y tF✓>jJii 7 ~~1 } 3 jc `"W~ i•'~ 'y~'{'~'~~ ~'i~} y~ Df~ +~~b -i J~ ~ 4~'A?i~~ull'flr F r• ,~i'hy d' ~~zA- t 'i - ~ d ~~7 il: 2~ a fc t~i~. i- ~ _ ,e f9~~ 8 r.' , +r R. - se r` s t ~ ,t 11,S - ,z4_ a -J •~-.:'t4' i'+` .Qs}' ! - 3Fd .4a A4r~~b. s x t t f. J F ,"t ~ L f A A.. Y ST. CROI X COUNTY WI SC O N S I N ryes d~ . ~ ZONING OFFICE -imago 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, W1 54015 August 9, 1983 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear sir: An on site investigation for the Doug Swenson property located at the SEk of the NEB of Section 8, T31N-R16W, Township of Cylon, St. Croix County revealed suitable soils at a depth of 1.83 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Yours truly, Thomas C. Nelson Assistant Zoning Administrator TCN:mj t t ~I 8z- STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township/ K4ddkA0&MYf4 SEA NEB S 8 T 31 N/R 16 K0afJW Cylon St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Doug Swenson Deer Park, WI 54007 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises'are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monituiine of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location SE 1/4, NE 1/4, Sec. 8 , T 31 N, R 16 XE(X)b)tX W Town Y&XI XTWX# Cylon Street Address Lot No. Block Subdivision Landowner's Name: Doug Swenson The application for this site is for: ❑ new construction use. replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: I lto have one of the first five approvals guaranteed for this year. This is numher - - of those applications. (Use one of the first five quota num ers slue-d to you.) ]one of the applications needing a quota number. The quota number assigned to this application is - - (_]for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. .for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. I_-]for an application on file prior to February 1, 1980. (___.ifor a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: [kla failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here. F] I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Signature (JR~ k- County Official) V Title Assistant Zoning Administrator Date 8-9-83 DILHR-SBD-6158 (R 12182) - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, e DIVISION " LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 7969 `HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNS HIP/?0tfN+G41A-6SY: O.: BLK. NO.: SUBD-JV ION NAME: E 1/ IVi4 F /T31 N/R (/,l O W C L o n -5, v COUNTY: OWNER'S/ MAILING ADDRE : c_o tX o J w e USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMEAC}AL DESCRIPTION: PROFILE DESCRIPTIONS: PEATION TESTS: XResidence ❑ New Replace /R- RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MpUND: ❑U IN GD ROUND-PRA RE: TA~NK RECOM~ NDED SYSTEM: (optional) Jd E: ,~/~J If Percolation Tests are NOT required DESIGN RA ~ If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 3. 9 7' 2 n)r r 1 o-' 1 z' -1,3? ;1i7 A ~ 4 33'-326- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 4=92:&- AFTERSWELLING INTERVAL-MIN. PER10,13 1 PE 100 PERT PER INCH P- 7 P- 9 P- P P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION or~~c Way i : n 1 I- ` N co i - - - a 9 01 , e,~~' 7 y 5-1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABON AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: t' TOWNSHIP,~MtiiV+6F?,4t+~Y: LOT O.:BL~NO.: SUBD~V ION NAME: 1/IVI4 8 IT31 N/Rjtl( )W C Lo COUNTY: OWNER'S/ MAILING ADORES S'T G o ►X IQOtjg S w e USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMME C AL DESCRIPTION: I PROFILE DESCRI TIONS: ER LATION TESTS: Residence ❑New Replace ~ _3 ' _ 2 -931 3 el? 1 S= Site suitable for system U= Site unsuitable for system J J CON❑VENTMU MOUND: E] IN-GROUND PRESSURE: SYSTEM-IN-Fj LLHOLLDING~NK: RECOMM NDED SYSTEM: (optional) S MS If Percolation JTests are NOT required DESIGN RAZ: If any portion of the tested area is in the n under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 7 B 9 7./ 2 0 r~ B- B- B- PERCOLATION TESTS F7_ TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 4=2129 - AFTERSWELLING INTERVAL-MIN. PERIOD 1 PE I 2 PERT PER INCH P- 7 Z71 P_ 9 is P- 9? P P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 4 en c,~_nsa r k- n-p c. r n _Tee..'l D c C~ - - ; N H_ J7 Q Oef, x _ I ~n~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRES~ SUBDIVISION / CSM# LOT - SECTIONN-R/L W, Town of lD~i ST. CROIX COUNTY, WISCONSIN PLAN. _VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~t 3 2I' t9u ~i 34 ` )S X INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 'aENCHMARK: ALTERNATE 13H: tZ' :SEPTIC TANK / PUMP CHAMBER HOLDING TANK INFORMATI Manufacturer:-L2 quid Capacity: a2-/o2cge Setback from: Well 7 House Other Pump: Manufacturer Eodelf Size Float seperation Gallons/cycle: I Alarm Location l SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: wellWZ2- House Other ELEVATIONS = Building Sewer , 5ST Inlet: FS' ST outlet:,----. S~ .Z ~so2 PC inlet PC bottom 'r Pump Off Header/Manifold Bottom of system a~ Existing Grade Final grade r~ DATE OF INSTALLATION: R-5 PLUMBER ON JOB: <~G ! LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: 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 Lay, s.15.04 (1)(m)]. 289457 Idler I & MARK t(§Willage ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T x N 1016-60-000 TANK INFORMATION E EVATION DATA A9700273 3 : 30 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~ GF~ J Dosi ng Aeration Bldg. Sewer Holding /Ht Inlet 7, a S a< 78 TANK SETBACK INFORMATION -ft/ Ht t , ` a Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift I Loss Friction System Head TDH Ft Forcemain Lengt Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Model Number: System: , 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 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: CYLON 8.31.16.108B,SE,NE 2264 220TH STREET Plan revision required? ❑ Yes E~No Use other side for additional information. `y SBD-6710 (R.3/97) Date i° ctor's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i i I I I I i I I ERMIT APPLICATION 20Saf 1 E w nngtonA eiviswn Visconsin SANITARY P In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce 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. • See reverse side for instructions for completing this application State Sanitar Permit Number 9Lh-~_-7 The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION S Property Owner Name Property Location .I.Kti 1/4 1/4,S2 T j, N, R E (or)~V Property Owner's Mailing Adddrgss Lot Number Block Number City ate Zi Code Phone Number Subdivision Name or CSM Number ( I )a II. TYPE F BUILDING: (check one) ❑ State Owned it Nearest Road Public L8C1 or 2 Family Dwelling - No. of bedrooms E] Torag OF ~ y /0 CJIC26~~4 A/ 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Num r(s) 8 ,3 - 1&0. 10 g e 1 ❑ Apartment/ Condo 00 ~ -/c7/ 16 - 66 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 2Replacement 3 ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System I- 1)`5_ystemTank OnlyExisting 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 411l6Holding 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 K c5 0 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min_hrich) Elevation l A/ ) vV Feet r Feet VII. TANK Capacity + INFORMATION in gallons Total # of Prefab. Site Fiber- ass Plastic Exxper. New I Existin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Tanks Tanks Septic Tank or Holding Tank 1K ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber IY4 I J ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) P=mbe'sS" ture: (NoSta s) MP/MPRSW No.: Business Phone Number: -,;2- - 4 r ~a C.9 I ?,Is Plumber's Ad ress (Street, City, State, ip Cod IS-4100 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater 97M Issued Agent Signature (No Stamps) XApproved E] Owner Given Initial Surcharge Fee) . C,2Q&jh&, Adverse Determination ~ Au X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: V 'IV L/ SOD-SM (R.f f/9B) DISTRIBUTION: Original to County. One copy To: Safety S Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership,or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to instailatinn 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. 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. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance crve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fines) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue IN P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations July Z4, 1997 13 4o EasL -3reen Bay SLreeu SUITE 300 Shawano WI 54166 BIRD, BYRON TR 896 68 AVE AMERY WI 54001 RE: PLAN S97-30755 FEE RECEIVED: 60.00 WEBER, SHERRY & MARK SE, NE, 8, 31, 16W TOWN OF CYLON COUNTY OF ST CROIY HOLDING TANK The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, anu chapters Con= Q11i and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 62 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, V_A?_ Karl Schultz Plan Reviewer Section of Private Sewage (4141 424-3311 4716Ri 1 SUDA-6928 (x. 10/94) E S- Page Of E ~ ~ E •r V L W co C v r• 4- O r ro U S. c -0 c r > O > "a F~ • O L7 -n O c O U v L W V) N CL u Y Ql U w a x 0 C r ro > Q W" ro -C a) CD C= c¢ a 4J a _ m -C N 7 a a r~ ivi ~ o 4J L O r ai ~ ti N m r-• 1, c LO r J U U 2 2~ 7 0 C: yt: ~r O C S C ~y -P r I L 0 b v roO d o cla Ca. 4-J 4- d •r ' G ~Q O a-•l I d 3 E y Ln .r • y ~y M W L Q1 Q1 (V N ' r~W d N Q) i -0 n. L :3 E O C) : N -F> > I- O rN. O Z U•r ro zs O O U W -4 4- N = v iU-+ m W 1 ¢ 3 c c rCO 0 3 a N U (v ro ro N O z i f _N N N CD -0 1 M W rr g W O co -j U i b LUiJ Y ¢ J CJ CL. < Z r O cw N d Z C7 Q ro is F- c a p+ ) C-D -14' ~ ✓ ~ N O 2 i C 1 : 11 L U \ ta- X 4-) O m 3 N J c ~ E • a c Qt L 00 v c _ U o a s m c H V v a v > ~•r~~~O 1 O c S- U c b~ M = CL o ° ° w ti a Q a' 4--) U -t. Z L E s- vi E ro U W PQ z~LA~ o vz N N Q •r Q' ~ Q1 T7 d 77-41-1 W 4-3 N ro L a N r0 C > U Q) L t0 C C C N , C Q~ 3 0 _ 0) U a o o J ~v n c i O d J F- U 0- cn J D a N r. ¢ ] N r ro ro v PLOT PLAN PROJECT Sherri and Mark Weber ADDRESS 2264 220th St. Deer Park Wi 54007 SE 1/4 NE 1/4S 8 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX MPRS Shaun Bird 3532 7/3/97 BEDROOM 3 DATE CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK XXX MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 2-1200 LOAD RATE N/A ABSORPTION AREA none BED SIZE none BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark SYSTEM ELEVATION N/A G,. 200' Property Line Low 'ea 1 RcE 00 dge and i coy g~~~ a~N R~ovl F V PND1~ ~t'T P OF SP ~ - B-3 Ri O~v~s~aN C~ No~N ~ G ~R SQO E 00' Low Area With Flooding and'Standing Water 3% Slope 0, Well Located 6' From B-2 50' Garage House, Existing Sewer Line Does not Driveway to Serve as Meet the 8' Setback Service Road 5' From the Well w N o Old System to be Buried T 10 28 44% Slope 00.4 30° 15' Existing 3 0 Failed System HT HT Bedroom 1' Seperation House Between Tanks 60' r 27' 80' B.M. Sp, B-6 15' B _ 1 'Tanks to be Properly Bedded 28' and Provided with Approved Lockdown Covers with 150' Warning Labels 4% B-4 50' Slope New Sewer Line to be 00' >8' From Well and ~be Tanksto >25' ll B-5 From W Low Area with 170' Flooding 200' Property Line HOLDING TANK SER /ICING CONTRACT Contract Date This contract is m; ie between the Holding Tank Owner(s) Name(s) and I umper's Name L-4 fhek i Idle r ;truce i,UQrd- I 12, &C, 'VICC We acknowledge the installation of (a) holding tank(s) on the follow[ g property: (Provide legal description:) 50~731/,~ 1(~ 6-aoo~ aF ENE----------- 1. The owner agrees to file a copy of this contract with the local gc ~rnmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b) Vis. Adm. Code and with the County of Sfi - C U I X 2. The owner agrees to have the holding tank(s) serviced by the pu per and guarantees to permit the pumper to have access and tc enter upon the property for the purpose of servicing the holdini, tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s Nith the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank( ) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has sign j the pumping agreement required by s. ILHR 83.18 (4) (b), Wis Adm. Code, and to the county, a report for the servicing of the he ling tank(s) on a semiannual basis. The pumper further agree: to include the following in the semiannual report: a. The name and address of the person responsible for servicir the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is inst ed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holc ig tank for each servicing; g. The disposal sites to which the contents from the holding tan 'Vere delivered. 4. This agreement will remain in effect until the owner or pumper t minates this contract. In the event of a change in this contract the owner agrees to file a copy of any changes to this service c, [tract or a copy of a new service contract with the municipality and the County named above within ten (10) business days from,, a date of change to this service contract. Owner(s) Name(s) (Print) I Owner's Signature(s) I Mar K We bef Subscribed and sworn to before me on this date: - ~rnJ Notary Public Pumper's Name (Print) I Pump is Signature , I My commission expires: Pumper's Registration Number 175:3 SBO-7574 (R. 09/88) This instrument was drafted b, the State of Wisconsin Department of Industry, Labor and Human elations 562901 HOLDING TANK AGREEMENT This agreement is made between the government (Document Number unit & holding tank owners(s REGISTR'S OMr-'F ST. CROIX CTY. VA Holding Tank Owners: MOS K. 4 4f-ri Weber INL 2 8. 19971 Agree ent Date: Townshi : loll ^9.05 A. We acknowledge that application is being made for the installation of (a) holding tank(s) on W,4& the following property: (Provide legal land description. Use extra sheet of paper if more 0908W of Deed4 spa C/V -31) 05-84 ce is needed.) ~2b^ ` S E N L ' . . Pc~ #~~•3I . I b, I D ~6 Name & Return ) AAddress: f/ or that continued use of the existing premises requires that a holding tank be installed on the ~I L Y I NIGCJ F--- w` property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under ~f _ , - Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Stats. a ~Q 7 St. &V k As an inducement to the County of Pe& to issue a sanitary permit for the above described property, we agree to do the following: [Parcel ID Number::.. (,-.10'966- relating 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code M -3-T-1 relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the govemmentai unit to prevent or abate a human health hazard as described in s. 254.59, Stats., the governmental unit may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by lacing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60. Stats. 2. The owner agrees, pursuant to s. ILHR 83.18(10), Wis. Adm. Code, to have a water meter installed in a new building or new structure. The water meter shall be insialled by a plumber authorized by the State to conduct such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be finally responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit to enter the above described property on a regular basis to read and/or inspect the water meter. ~ 3. Owner agrees to pay all charges and cost incurred by the governmental unit for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the,owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, except as provided by s. 146.20(3)(d), Stats., agrees to contract with a person who is licensed under Ch.NR 113, Wis Adm. Code, to have the holding tank serviced and to file a copy of the contract or the owner's registration with the governmental unit. The owner further agrees to file a copy of any changes to the service contact, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch.NR 113, Wis. Adm. Code, who shall submit to the governmental unit and the countyon a semiannual basis a report in accordance with s.ILHR 83.18(4)(a)2., Wis Adm. Code, for the servicing of the holding tank. In the case of registration under s. 146.20(3)(d), Stats., the owner shall submit the report to the governmental unit and the county. The governmental unit or county may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch.ILHR 83, Wis. Adm. Code. In addition, this agreement may be canceled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit the agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) name(s) - Please Print Governmental Unit Official Name- Please Print Subscribed and swom to before me on this date: o fa4 0 4 991 M Vk+ we-6fj' Notarized wner(s S(s) Governmental Unit Official Title -,'Please Print No Public vaturc d~ r Governmental Unit Official Signature y commission pires 9!10:96 c:\wp51Xfonnsth1agr (Drafted by Zordng Admin) Personal rnformauon you provide may be used for secondary purposed [Privacy Law, S.1504(1xm)l. Wiscon§in Department of Commerce Division of Safety and Buildings SOIL AND SITE EVALUATION Page of ' Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County r include, but not limited to: vertical and horizontal reference point (BM), direction and --JN 4 , C 1A percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 00;~- 1 APPLICANT INFORMATION - Please Print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1) (m)). Property Owner Property Location s 4- IPM11- "'L4.0 Govt Lot E 1/4 f)~1/4,S $ T31 N,R E ( Property Owner's Mailing Address JJ Lot # Block# Subd. Name or CSM# ,2.2 6 Y 1.~-p d, T - r - s ity state I Zip Code Phone Number ❑ city Village Town Nearest Road ❑ New Construction Use: ,Residential / Number of bedrooms Addition to existing building eplacement ❑ Public or commercial - Describe: Code derived daily flow //50gpd Recommended design loading rate bed, gpol W-,,0-trench, gpd/ft2 Absorption area required bed, ft2'!1✓ 11 trench, ft2 Maximum design loading rate bed, gpdfft2Zj/ trench, gpd/ft~ Recommended infiltration surface elevation s) ft (as referred to site plan "mark) 1~ Additional design/site co siderations -1 2 roir-' Parent material Flood plain ele on, if applicable / ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system El S U ❑ S E5U El S W ❑ S, U ❑ S U ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I Q ° ~r /n / J AS- Ground elev. Depth to limiting ; fa or , ~in. Remarks: Boring # 6- O ,a 2 1 r~ 4C2 V~ :51 Ground Depth to limiting f or in. Remarks: CST Name (Please Print) Sig Telephone No. Addre Date CST Number Ale- PROPERTY OWNER {S~ f, DESCRIPTION REPORT Page of , PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GVp/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench ZZ: Ground elev G~ ft. Depth to limiting f or in. Remarks: Boring # Ground Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # -m- / Ground Depth to limiting factor in. Remarks: Boring # 1 r , 7 / Q^- ldyro?1-2 r Jo< O O< Syr ~i[ Ground Depth to limiting fa tin. Remarks: SBD-8330 (R. 07/96) Soil Test Plot Plan Project Name Sheri and Mark Weber Shaun it Address 2264 220th St. Deer Park Wi 54007 CSTM #3922 Lot Subdivision Date 7/3/97 SE 1 /4 NE 1/4S8 T 31 N/R16 W TownshipCylon Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Base of Siding System Elevation N/A *HRPSame as Benchmark 200' Property Line 00' Low Area With Flooding and Standing Water B-3 Ridge 00' Low Area With Flooding and Standing Water 30' Well Located 6' From 50' Garage House, Existing Sewer Line Does not B-2 Meet the 8' Setback 3% Slope 1From ° the Well w N 40' 1 28 - o 4% Slope Failed System T 15' Existing 3 0 Bedroom 60W' House 0' 27' 80' B.M. 50' B-6 5° CD B-1 28'- 1505 B-4 50' 4% lope 00' B-5 Low Area with 170' Flooding 200' Property Line 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 Location of property~1/4 A;1/4, Section ,T-22_N-R W 2CZ 94- Township C~ O c--✓ Mailing address Address of site .5a H~7 Subdivision name Lot no. other homes on property? Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created G - 3- Are all corners and lot lines identifiable? '>e- Yes No Is this property being developed for (spec house)? Yes _Z_No Volume &_Z/ 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 owner(s) of the property described in. this information form, by virtue of. a.' warranty deed recorded 'n the office of the County Register of Deeds as DocQpent No. 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. Signature o Applicant Co-Applicant Date of Signature Date of Signature A eel QUIT CLAIM DEED F Document Number Sheri J Ness _ APR 91996 ' 9:45 A. Sheri J. Webe quit claitrs to r a . n d Mark D. Weber, 'ier husband _ Recording Ares _ _ Name -!^d Return o i x County, . r the following described real estate In.. L State of Wisconsin: East 200 feet of SE1/4 of NE1/4 of Section 8/31/16. Town of Cylon. 8.31.16.1089 (Parcel Identification Number) g FEE This . s.. ».»...homestead property. Dated this..._»~_..».......-day of_ 9_1 ~ L.._ ('u) or (is not) _ - ! . 51 ~E i" ' ~ .be r....................................................... AUTHENTICATION AMNOWLEDGMENT Signature(s)....... STATE OF WSCOHM » _ » ..County. Penonalty came authenticated this...........day oL......... »,19_ before rae ~*R --ice 19.1k-the.b. named sl~turc type or print name c T»»» TTnIE MEMBER STATE BAR OF WISCONSIN (if not,»..„..»»»».»».... » _ - » _ who executed the foregoing authorized by SS 706.06, Wis. Statutes) to me known to be tfac instrument and aide the same. . it S :