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HomeMy WebLinkAbout020-1328-20-000 ~ 0 300 N pGFJ M o w C O O N N O i C 3 4L it 'tl O N I Z o C Z LL c o Q ~ 3 0 v z" rn o Z m m 0) N W a m N I- Z co 0 2 c m r ~ N w d 2 a 2 0 fq F- Z S '2 0 N Cl) N C C, R~ y ~ N 75 O .o O Z m z o Z I ~ E E N x CL d - m c 0 H o U G G d E o co w o V) to V! U n 0 o z •N aaa L CL ~ 3: c n co m N J V U) rn 0) } = N r- N O N I> 0 0 N S m N O N co N '0 QI U) co 00 O O 00 w0 N C E O O C n d D 0 0 o o 3 Y u 0- o 0 o N rn N- N N N CO C Ojy y N O N M Qj y Qj C0 N W C r 00 00 • ~ N 6 C) O m 0) O - U cO O N 2 LL N O Z_ 0' U) .w 4 G ClS E 7 # EL a .w C 6 V d `I►1 E 2 c m CL U) Q i Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page - of _ Labor and Human Relations Div€sion 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 '..Cr© f J! not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCIE` H). # MJ ig dimensioned, north arrow, and location and distance to nearest road. d3 a's", APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION =REVIEWED BY r i PROPERTY OWNER: PROPERTY LOCATION Bridgeland Development Company GOVT. LOT NE 1/4 St, 114;4 29 T - 2g 19 W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR, CSM~,,, ;,fir=} 'tt 11736 117th. St. 40 na St. Croix Estates S ddn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST,-Al Q Lakeville, MN. 55044 (612 985-5000 Hudson nr. [A New Construction Use k] Residential / Number of bedrooms 3 Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 .8 trench, gpd1ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate 1Lbed, gpd/ft213__trench, gpd/ft2 Recommended infiltration surface elevation(s) 99.8 ft (as referred to site plan benchmark) Additional design / site considerations alt area step sown trench '@ 98.8' & 96.5' Parent material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ®S ❑U ❑S ZU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& 1 0-8 10 r3 3 none sl 2mgr mvfr cs if .5 .6 2 8-84 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. 103.5 ft. Depth to limiting factor _ 8 Remarks: Boring # 1 10-12 10yr3/3 none sl 2mgr mvfr gw if 1.5 .6 2 12-84 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. 103.8 ft. Depth to limiting factor +84" Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 20th. Ave., Ne Richmond, WI. 54017 Signature:' Date: CST Number: 8-22-96 cstm 02298 PROPERTYOWNER Bridgeland Dev. rn_ SOIL DESCRIPTION REPORT Page __2_ of PARCEL I.D. # pending Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/f-t Boring # Horizon in. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench v:....3.....>' 1 0-12 10 r3 3 none s1 2m r mvfr Cs if .5 .6 2 112-84 7.5yr4/6 none ms Osg m1 na na .7 .8 Ground elev. 102.3 ft. Depth to limiting factor +84" Remarks: Boring # 1 0-9 10yr3/3 none sl 2mgr mvfr Cs if .5 .6 2 9-32 10yr4/4 none sil lfsbk mfr gw if .2 .3 4 3 32-80 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. 100.5 ft. Depth to limiting factor +80" Remarks: Boring # 1 0-6 10yr3/3 none 1 2mgr mfr Cs if .5 .6 2 6-18 10yr4/4 none sl 2mgr mfr 9w if .5 .6 5!' 3 18-80 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. 99.7 ft. Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Bridgeland Dev. Co. 1554 200th Ave. MPRSW 3254 NE4SEg S29-T29N-R19w New Richmond, WI 54017 town of Hudson (715) 246-6200 t lot #40-St. Croix Estates Second Addn. N 1--=40' BM.= top of nail in aspen tree C el. 100' 4l~ \ A_ f )o l ►5~ ` ZO o T 2o' Gary L. Steel 8-21-96 STEEL'S SOIL SERVICE Gary L. Steel CSTM2298 ?554 200th Ave. MPRSW-3254 New Richmond, W 54097 (715) 248.8200 To whoa it may concern; This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be satisfactory for your use. The location of the system may or may not be as shown, as permanent lot lines had not been established at the time of the test. Gary L. Steel f VS PI 'i. t+ STC - 10 4 AS BUILT SANITARY SYSTEM REPORT J OWNER ?cq aYV~NN71 CO ADDRESS ✓ _CF; SUBDIVISION / CSMJ ✓ LOT -77Z-- SECTION- N-R IG; W Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN I FEET OF SYSTEM Bm i /s INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE IIM:~~~ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 1i/k ~S Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: /-2 Length ,7, Number of trenches Distance & Direction to nearest prop. line:,? Setback from: well:- House- other ELEVATIONS a6dw- Building Sewer ST Inlet: ,/,L)/ .7 ST outlet: PC inlet PC bottom Pump Off Header/Manifold ~eZ.? Bottom of system 9~j` Existing Grade IA,, S- Final grade /oB, e - DATE OF INSTALLATION: PLUMBER ON JOB: ' LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT si. Y'O~ x 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)]. Za 411) (D Permit Holder's Name: ❑ City ❑ Village %,I own of: State Plan ID No.: I10' Kc FrAidl- vd sor► - - - CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: lots' 1co' 7c 010- 132 -20-000 TANK INFORMATION ELEVATION DATA A970 03 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e I t2ct~ Bench ar 94- 109,2 /00 Dosing 0 /O`f'q Aerati n Bldg. Sewer (0-97. /02-12, Holding Inlet ?Sp A06-7 TANK SETBACK INFORMATION d~~ Outlet TANK TO P/ L WELL BLDG. 7,&iantake ROAD Dt Inlet Se tlc 20~ Ir1Q. 13~ NA Dt Bottom Dosing NA Header / Man. 2. .17 <0.3 Aeratio NA Dist. Pipe 13.0 86.2- Holding Bot. System NQrj 75--/5- PUMP/ SIPHON INFORMATION Final Grade ")6 Manufacturer De and t W"hole_& 4-2o lo.3 Model mber GPM TDH 'ft Friction System Ft oss Forcemain Lengt ia. Fi Dist. To Well SOIL ABSORPTION SYSTEM QUP TRENCH Width Length i No. Of Trenches DIMENSIONS PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM ACHING INFORMATION Type O C MBER MSystem n 2~ 25' r1a- OR U DISTRIBUTION SYSTEM Header/Manifold / Distribution Pipe(s) x Hole Size x Hole Spacing VentTo Air Intake Length G1 Dia. Length 7 Dia. ~ Spacing tT ~o~ ~ST/v1 'Z72 ( J SOIL COVER ~F x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over Of xx S/ Sodded Mulched Bed /Trench Center e r psoi es xx❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) (711 CROSBY MI K I L07-44o) J Akk'-'~Mt - -r,9 P 0 f 6AACWV,4 9 &4z t F chat 41,0, W;(( foc ~ r-c~,ot -f~ wcu to ,iY~ `f'L lvt~(~~r A/m Oti v~ lov~l rt p~ 6 6-1 c Plan re~ fon ~ec~titred ❑ Yes No d Use other side for additional information. ~(O ~0 SBD-6710 (R.3/97) Date Inspect 's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r SANITARY PERMIT APPLICATION 201eE.Wand ahnlgtonAve sion ' Visconsin 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 1/2 x 11 inches in size. 9 • See reverse side for instructions for completing this application state sanSryp~ r-ii qrfiber The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Prope ner Name Property Location 1/4 4 1/4, S T , N, R E (o to Property bw is Mailing Ad ess Lot Number Block Nu ber ..C City, S to Zip Code Phone Number Subdivision 14a or CSM Numb PE F BUILDING: (check one) ❑ State Owned ❑ it~r Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms rg Town of 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condor 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. _M New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _____System ---System Tank Only - Existing System Existing-System B) ❑ A Sanitary Permit was previously issued.. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ 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. Perxv Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./) Ele vation Feet Feet TANK Caalloacct Exper. VII. . in s Total # of Prefab. Site Fiber- Plastic INFORMATION App g Gallons Tanks Manufacturers Name Concrete Con- Steel glass New Existing strutted Tanks Tanks Septic Tank or Holding Tank kn ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins Ilation of the onsite sewage system shown on the attached plans. Plu b s Na e: (Pr(nt) Plum er's Si ur No ps) MP/MPRSW No.: Business Phone Number: lumbe s Ac dress (Street, ty, tate, p Code): c S I k. COUNTY/ / DEPARTMENT USE ONLY ❑ Disapproved Sanjtary Permit Fee (Includes Groundwater EcO7 Issued NdIA4 Agent Signature (No Stamps) Approved 14 JC surcharge Fee) E] Owner Given Initial Adv erse Determination /b X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, owner, plumber r 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 installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. 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. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (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 curve; 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 (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 7~9i✓ S re rte ~O i 1 ®fx ,O ~r 'all Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings 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 Coun;i/~~ i nclude, but not limited to: vertical and horizontal reference point (BM), direction and " percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pa ff. # 8 APPLICANT INFORMATION - P/a Reviewed by Data Personal information you provide may be us ur~es Pfive 15.04 (1) (m)). Property r Property Location 'p Govt. Lot 1/4 1/4,S T • N,R (or/ Pr rty t6nees Mailing Address Lot # Block Subd. Name or CSM# ST CRUX 1~ City State Z zow"GIBM& p ^ City Village Town Near Road l n ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow Z,_tZ gpd Recommended design loading rate ~ bed, gpd/f?_ 2--trench, gpd/fF Absorption area required bed, ft2 '7l trench, ft2 Maximum design loading rate -,-z--bed, gpd* _Z-trench, gpd* Recommended infiltration surface elevation(s) ~y ft (as referred to site plan benchmark) Additional design/site considerations Parent material" Sr/ flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = unsuitable for system C o s ❑ U WS ❑ U [As ❑ U ®S ❑ U ❑ S Z U ❑ s J Z u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Col. Color Gr. Sz. Sh. Bed , Trends A~Z Ground Depth to limiting facto in. Remarks: Boring # J s E Ground _ elev. ft. , Depth to limiting factor Remarks: CST Name (P e Pi t) Signature Telephone No. Address \ _ Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER.,,~~~ l Page-,,---20i ~ • PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Geptft2 / in. Munsell Qu. Sz. Co . Color Gr. Sz. Sh. Bed , Trench Ground 51 -3 Ad- -T ele ' Depth to limiting factor Remarks: Boring # - J - -5 /?1-111 Z-Z Ground elev. ft. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # -Z Y, ri c Ground - elev. Depth to limiting factor ,~in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) ~~~-sr%y_SG9-Twirl!-e19~✓ 1-2- 91 ~o led J I l~ ' yd ~us~ UNPLATTEC 2" IRON PIPE FOUND N48°29'30"W, 0.70' FROM COMPUTED POSITION N89°27'28" E N89027'2' NORTH LINE OF THE NEI/4 OF THE SEI/4, SEC. 29 ,c 240.00' x u X 580.2: t 1-l, 3964.35' 13' o - 820. 23' - W Z1/4 CORNER LOT SECTION 29 ? LOT 41 2.12 ACF LOT 5 - 15, 92 , 147 2.57 ACRES 3s. 2,00 AC r. C 1~✓I 112,151 SQ. FT. sc' 87,243 i 1 x g A PG. 212 I s%~, V0, 87 w m Ns3 ° 00 Sq i o Osq' / m LOT 40~ LOT L x 2.21 AC R S fM+ r) 96, 144 S,4. FT. „t, O ~y / / c ' 23 S87016 21"E I 464,02' Rl.. J.' 1I v J 0 -4.29' 459.73' 11 p N 33' 33 o I O ' COUNTRY LO T 39 /m 2.47 ACRES 107,441 SQ. FT. \ E to 10 IN 8 0 v / - - 3~ T9 i \ OO6' A ? I T IL x \ 81 0 6 \1 \ F 5y s6 LOT 38 3.03 ACRES T I 30 132,073 SQ. FT. x 2.70 AC. EXC. ESMT. 117,566 SQ. FT. I p / ~ R1 F- M , / N _ . 4i Z 0 N rn oa3 1 nT 37 ` 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 pr perty1/4~ 1/4, Section q TL- -R1!2_W Township Mailing address Address of site J Subdivision name Lot no. Other homes on property? YesNo Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes 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 owner(s) of the property described in this information form, by virtue of a warranty deed recorded in e office of the County Register of Deeds as Document 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. i natur4eo A licant Co-Applicant 9'//3-C/ A Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix Cuuaty OWNEWBUYER ,/2/,,t e4a g- MAILING ADDRESS PROPERTY ADDRESS location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION_ 1/4,_ 1/4, Section T TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY M" VOLUME PAGE_, LOTNUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out (lie 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 treaunent 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 I, 1978. St. Cruix 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. VWe, 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: 3 Iq 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 CUMENT 40 STATE BAROF WISCC"'SIN FORM 11-:111111112 WARRANTY DEED ~L 1 PA~~9. 13 Y REGISTER'S OFFICE ST. CROIX CO., WI West Lake Builders, Inc. , Recd 1w Rscwd This Deed. made b- Iween _ a Wisconsin coloration SEP 0 3 1997 11:55 M Hii:hae? R. Frase and nthia M. Frase husband o ,Ksk J~ and- _ and wife with marital survivorshi rig:Tts R Irtr o/ Dd. Grantee. W itnesseth, That the said Grantor, for a valuable consideration pETURN TO St. Croix 1(t~( f;+t ¢'<<<t conveys to Granter tf+e following described real estate in County, Slate of Wisconsin: I ~ccSazl Tax Parcel No: Lot 40, St. Croix Estates second addition in the Town of Hudson, St. Croix County, Wisconsin. Together with and subject to easements, covenants, reservations, and restrictions of record, if any. ~ T j~FER This is not -homestead property. (is not) Together *A%all and singular the leredilaments and appurtenances thereasnfo belonging; And _ warrants that five site is good. indefeasible in fee simple and free and clear of encumbrances except and will warrant w%d delend the same. 97 28th August 19 Dated this _ day of (SEAL) West Lake BUilders, Inc. (SEAL) a Wisconsin corporation By. (SEAL) (SEAL) Richard J_ Grek ff, Presiden AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF y9 SCONSIN St. Croix ss. County. +++tr" - camebeforeme1h1s 28th day of "s authenticat++lans_--_dayof Personally t(J) 7 the above named I~~^+a ~ xnc~ra~i • , J1icbaX~d J____GK9koff . President of 7, * _aa d corporation. to me known to be -T- such officer. TITLE: MEMDEf1 STATE SAAB ~Y • (If not. --11 a~ee to me known to be the person who exculed the fo.egc" iw, t ument and acknowiedge the same, as the authorized by § 71)6 AS of said corpQT tion, by its authority. THIS INSTalJMENT WAS DRAT=TED deE= t r Richard J. Grekoff, P. Box 703 fiz