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STC - 104
AS BUILT SANITARY SYSTEM REPORT rV p~,~V~,~
OWNER p~ i
S71 c a f?
ADDRESS- , Z®ly~ O
oil
SUBDIVISION LOT
SECTION_T_N_R- W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
=1/D Sc~/.e
o?f'
~i
~~O ~t~rlk INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:/~fnr~
s
ALTERNATE BM: l')"J 1
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: jz-hk-ls Liquid Capacity: .62
Setback from: Well House /6 Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width:
Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House_,..F~ Other
ELEVATIONS
Building Sewer ST Inlet: 96_-<' ST outlet: PC inlet PC bottom Pump Off
Header/Manifold Bottom of syste
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
46
LICENSE NUMBER:
INSPECTOR:n
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~19`§Ilbgj
Personal information you provice may be used for secondary purposes [Privacy La , s.15.04 (1)(m)].
Permit
HECHT der GNI me, E . ❑S~t jV61`V E] Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: U.d ~c~'T e5 Parcel Tax No.:
goo r / 0 k I ~ . belive 413 - le -100-3
TANK INFORMATION ELEVATION DATA A9700481
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic I 00v Benchmark - U9 ! Da
Dosing
-i3~ o $3
Aeration Bldg. Sewer
Holding t Jr Inlet C1 4f t 'D. S!r-
TANK SETBACK INFORMATION o/ Outlet g•77/ q0-11
TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet
Air Intake
Septic Zqj' -r 70 -7 4 27~ 1 NA Dt Bottom
Dosing NA Header/ Man. ~61 0 (10~
Aeration NA Dist. Pipe ' r°
Holding Bot. System 16-7g,, 8,7. ! S,` ,q,
PUMP/ SIPHON INFORMATION Final Grad 5 (~{q~ 913.77'
Manufacturer Demand 5f, YK11. 92 •
Model Number GPM Al+ I T-f .d t 91_(," q/7-
TDH Lift Fric ' System Ft
mead
Forcemain Length Dia. Dist. To Well
SP !,L ABSORPTION SYSTEM
ED TRENCH Width Length enc es PIT No. Of Pits Inside Dia. Liquid Depth
bTMENSIONS- DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA ING nu ure,:
SETBACK CHAMRE_
INFORMATION TypeO ( Model Num er.
SystemroM.,~r"~.w? 3~7 -E' VU A. OR UNIT
DISTRIBUTION SYSTEM 6e,7-A,4 V7 Or
Header / Manifold Distribution Pipe(s) ` x Hole Size x Hole Spacing Vent To Air I nt ake
t✓ 7 S
U Spacing
Length Dia. Length Szf Dia.
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edge it ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SOMERSET 26.31.19,SW,SW 1909 60TH STREET
gl~ ~x-,,,/'W = 20.,E-•
Plan revision required? ❑ Yes No ~O~
Use other side for additional information. lL- I
SBD-6710 (R.3/97) Date Inspector' ignature ert. No-
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
Safety and Buildings Division
N)Lconsin SANITARY PERMIT APPLICATION 201 E. Washington Ave.
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 81/2 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
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
L APPLICATION INFORMATION PLEA RINT ALL INF RMATION
Prope Own ame Property Location
1/4 ; 1/4, S T , N, R orw
Prop Q%Kner's Mailin Addr ss Lot Number Block Number
City, ll Stat((eff yy Zip Code Phone Number Subdivision Name or CSIVI Number
II. TYPE F BUILDING: (check one) ❑ State Owned fl Nearest Road
Public J?g 1 or 2 Famil Dwellin - No_ of bedrooms : ❑ OF
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)' ;q
1 ❑ Apartment/Condo o~LP• 3 f gw c 3 - (Q e- jf
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. 9 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System_____________TankOnly ___________ExlstingSystem Existin~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. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min. 'rich) Elevation
Feet Feet
Vi f TANK Capacity Site
INFORMATION in gallons Total # of Prefab: Fiber- Plastic Exper.
Gallons Tanks Manufacturers Name Concrete Con- steel glass App.
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank El ❑ ❑ 1:1 ❑
Lift Pump Tank /Siphon Chamber ❑ El ❑ ❑ Ij
VIII. RESPONSIBILITY STATEMENT
I, the ndersigned, assume responsibility fo ins Ilatiora o onsite sewage system shown on the attached plans.
Plum Nam t Plumbe s nat tam s) MP/MPRSW No.: AJBusiness Phone Number:
Plumber' Ac dress (Treet, Ci y, State, kF~Code):
✓~1Z
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Ltessued Issuing Agent Signature (No Stamps)
Surcharge Fee)
Approved ❑ Owner Given Initial ~
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: V L/
SBD-6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & 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 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 81/2 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.
`l„~ ,o ~l~ Rio
/G /o-97
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tlousK-
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Wi!~coTsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less 1 size. Plan must include, but
not limited to vertical and horizontal refere (BM) direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location tanc o;&rest road.
APPLICANT INFO RMATION-PLE yPRINT' ]ThFORMATIO•N REVIEWED BY DATE
tw '4' YE
PROPERTY OWNER: PROPERTY LOCATION
Sr c GOVT. LOT 1/4 1/4,S T N,R ~or~
PROPERTY OWNEF':S MAILING ADDRESS r tf~ TY LOT # BLOC # SUBD. NAME OR CSM #
CITY, STATE ZIP COD []CITY []VILLAGE MOWN NEAREST ROAD
[A New Construction Use fx] Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flower gpd Recommended design loading rate ed, gpd/ft2 ,S trench, gpd/ft2
Absorption area required bed, ft2 _!~Z-, ? trench, ft2 Maximum design loading rate ~Zbed, gpd/ft2yEtrench, gpd/ft2
Recommended infiltration surface elevation(s) S9:z ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material /S -5L,2 Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem 0S ❑U MS ❑U OS ❑U as ❑U ❑S ®U ❑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 Trench
Ground _ s
elev.
ft.
Depth to
limiting s`'s Cif q "7 Lef
factor N _
Remarks:
Boring #
n! /D / ~i•:
n - 9 e'- A d
Groundv - <
elev.
ft. jW) 71 A If
Depth to _6~ /Z A114
limiting
R-7 Z2
factor _ _
S7
Remarks:
CST Name:-Please Print Phone:
'dress:
Zj,
,ture: Date: CST Number:
PROPERTY OWNER - SOIL DESCRIPTION REPORT Page of
#
PARCEL IA
/f t2
Depth Dominant Color Mottles Texture Structure Consistence Bourday Roots Bed Tre Bed TIMnch
Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
Z4 A114
tµ.4.•..3.. nv... /
A/ 1,4
Ground AIZ
b
elev.
ft. - -
Depth to
limiting
factor
Remarks:
Boring #
110,9 -2-
Ground
elev. - -
ft.
Depth to
limiting
factor
Remarks:
Boring #
;Y
24 ~e~
..v .
Ground
elev. - -
ft.
Depth to
limiting
factor
Remarks:
Boring #
~•\\{i:::i::>};iii
4::i. ....nv •\yi
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
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FILED 9
OCT 0 8 1997 ► 10
KATHLEEN N. WAM
WSW of Dmft
(NLCroIIxC
X71. CroGc (i0a W1
666
CERTIF IED S VEY MAP
LOCATED IN THE SW 1/4 OF THE SW 1/4 OF SECTION 26, T31N, R19W, TOWN OF SOMERSET,
ST. CRO I X CO., WI.
PREPARED FOR: GERALD HECHT f
w 114 N CORNER OF
26. ( COUNTY NOTE : BEARINGS ARE
SECTION 26.
MIONUAENT FOUND). REFERENCED TO THE
WEST LINE OF THE SW
WEST LINE OF THE SW 114 114. (RECORD
BEARING). I
g CERTIFIED SURVEY. MAP
I
8 o• .
6 ~ Za EAST LINE OF THE SW-SW '
HI 1 ,
I ~6 cn
I VOL. 8, PAGE 2240 3`''~ k1,
I I ~3 Z$ $ I
N N\ m I
S 89°46 25"E 475.00 -oA
N I
16. 65-- 458.35' I Y HIGHWAY SETBACK LINE
100' W .2
LOT 2
I _ I U 16.72 ACRES MEANDER g
p (729,066 S0. FT. ) 1 0
Z z 13.45 AC. TOY L. EXC. EASEMENTS AND R IW L INE70, psa~a 6 ,
16.0 AC. +i- TO WATER'S EDGE ' ao
:D I oa •~6 p~ s ~ '
co p9e 6 pro S 71.09-33-
:m I d p. IP4. • 124.37'
O V8' WIDE PRIVATE DRIVEWAY EASEMENT Zh F~
e .
r I g~ N 88. 15' 37' E_652.51 ' L 0 T 3
66. 08' S `3, M
;Z 2
S 88.15, 337'W 651_15'_°' 6.54 ACRES X33•
cn ( (284, 764 $0. FT.)
O %Ii
co tco 4.90 AC. TO MEANDER LINE ;
,m (213,244 SO. FT.) g
33 3~ w g N '$N 5.5 AC. +i- TO WATERS EDGE g
n~
H
33. 01':
646.99' 2 649.54'
14 \T-$W CORNER OF S 89453' 16"W 1329.54'
SOUTH LINE OF THE SW-S
I
SECTION 26. f 2"
IRON PIPE FOUND). UNPLATTED LANDS
I I
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i `~~~K/INNgM,,
*taL
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croat County
O WNER/BUYER r n e6-4-
MAILING ADDRESS 54' (o Lk) 0 It _5 V k.Q L6 C tck YYI nlr 03_ i Sc
PROPERTY ADDRESS Cq Sob;S~
(location of septic system) Please obtain from the Planning Dept.
v YY~ Y S e W i
CITY/STATE
PROPERTY LOCATION Lk.-) 1/4, S ~ 1/4, Section T U-N-R I W
TOWN OF 50M. YS C> ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAPS Gl1,-? , VOLUME,/, PAGE, LOT NUMBER r
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 (I)
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:
DATE: -27
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
8 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 recprding.
Owner of property a e r U A cc k-k-
Location of property 1~-
1/4 5W 1/4, Section c'~~ ,T 3 I N-R IC W~
Township Mailing address IQ (')Cl
Address of site G( (n r) f>o 0,\-Q r- 4- (A)
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 /0-09-1/1?
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes No
Volume, 2 9 and Page Number ~S3 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 the 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.
Signature of Applicant Co-Applicant
12Y
Date of Signature Date of Signature
sss 29 VOL 1269Pac[453 la"
STATE BAR OF WISCONSIN FORM 3 -1996
DOCUMENT NO. QUIT CLAIM DEED
RFGiSTfR s oFFJWI
v'X cv.. 41PI for Record
OCT 0 9 1997
quit-claims to ~/,•L,/5' ~Re efer o/ Desde
the following described real estate in County,
State of Wisconsin:
RETURN TO
G c r~ c n /{e c a •r`
~'3 6 cdQ LC S w e w lelc4
T A sFER Uj /5 C S-yo X 7
Parcel Identification Number (PIN)
Part of the SW} of the SW} of Section 26, Township 31 North, Range 19
West, Town of Somerset described as follow:
Lot 3 of Certified Survey Maps filed October 8, 1997 as
Document #566612, Volume 12 of Certified Survey Maps, Page 3359.
A-
%0* homestead property.
(is) is not)
~`a`t,~{6d this - day of ,19
ill
I OA' L) MlAaAl. cax~lfj (SEAL)
a .7
SuZC1V1 -e ~r
Nl~ JENSEN
ARY PUB IC - MWN ZI. SEAL
m~ Ex"&ALm.at,20M JUDY . TANNE
i " Notary Public-State of Wisconsin
WDY K. TANNER a V-ee _
T
°/~9 l0 - 3 ~J r/
Notary Public-State of Wisconsin
APTHE"CATION r d AC~yOWI,ED MENT
tLy s No 4.17 ot?V H-ech
~coCUV~f~ceP !~fCc~'I
-Signature(s) STATE OF WISCONSIN
ss.
St. Croix County
authenticated this day of ,19 Personally came before me this day of
,19 the above named
Z;
DESCRIPTION
A parcel of land located in the SW 1/4 of the SW 1/4 of Section 26, T31N, R19W,
Town of Somerset, St.Croiz County, Wisconsin, more fully described as follows:
Beginning at the SW corner of said Section 26:
Thence N00°00'00"E along the West line of the SW 1/4 a distance of 794.46' to the
southwest corner of the Certified Survey Map recorded in Volume 8 of Certified
Survey Maps, Page 2240;
Thence S89°46'25"E along the south line of said Certified Survey Map a distance of
475.00';
Thence N53°13'35"E along said line 460.00';
Thence S23°00'36"E 518.04';
Thence 941°40' 19"E 249.60';
Thence S71°09'33"E 124.37' to a point on the East line of the SW 1/4 of the SW 1/4
of said Section 26;
Thence SO0°00'44"W along the East line of said SW 1/4 of the SW 1/4 a distance of
361.93' to the SE corner of said SW 1/4 of the SW 1/4;
Thence S89°53' 16"W along the South line of said SW 1/4 of the SW 1/4 a distance of
1329.54' to the point of beginning.
Contains 23.26 acres (1,013,830 sq.ft.) subject to 60th Street right-of-way and any
and all additional easements, right-of-ways or conveyances of record. Also subject
to any rights, both public and private, by virtue of the flowage of the Apple River.
SURVEYOR'S CERTIFICATE
I, James M. Weber, registered land surveyor, hereby certify: That in full
compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the
provisions of the ST.Croig County Subdivision Ordinance and under the direction
of Gerald Hecht, I have surveyed, divided and mapped the above described parcel
of land and that this map is a correct representation of the bound `rqj,*~t
Dated this Z•-d, day of~ 91996.
JAMn a&
James M. Weber S-1804 ; s E8~
NELSEN-WEBER LAND SAYING SPRING VALLEY
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NOTE: The parcels shown on this map are subject to State, Cou~i~trgipaws,
rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before
purchasing or developing any parcel, contact the St.Croiz County Zoning Office
and the appropriate Town Board for advice
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