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STC - 104
AS BUILT SANITARY SYSTEM REP T, "
OWNERC
ADDRESS 20, IV o~ryk
'Ps
1j, .r
SUBDIVISION / CSM# /~/q cS~~J LOT
4
/Ci
SECTION T--?) N-R W, Town of S',c r ,
ST. CROIX COUNTY, WISCONSIN 03%- 11;-41 ' 30 -~v 1 3) 3) . ~S. Sl A _Zo
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET F SYSTEM f~/x
L P/;Jf<W°y
T V3
G3F~' I
- `/o .sc1-lr
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
13ENCHMARR: S z / Z~
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: hJ~ Liquid Capacity: C_ 4
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
r
Width:- 4~_ Length / Number of trenches
Distance & Direction to nearest prop. line: A/
Setback from: well: S' 7 ' House 7~ / Other
ELEVATIONS
Building Sewer ST Inlet: i~ ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
,rues 7e7,97
Existing Grade Z,2,~/5- Final grade DATE OF INSTALLATION:
PLUMBER ON JOB: 1
LICENSE NUMBER:
INSPECTOR: ern
3/93:jt
II
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Y'
Count
Safety and Buildings Division ST. CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar099119N8.:
Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)).
Ltliub ' lde~S L1 IG ~ lp uiUaatRTLP n of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: YKti tCl Parcel bS%q-;1127-30-200
I t517 I Do, iM,der [ 2 t iA f- ~I ►rov\ 12112 e
TANK INFORMATION ELEVATION DATA A9700280
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ~/v Benchma Z''1 ,1 I •Z~
Dosing
Aeration Bldg. Sewer
Holding St / Ht Inlet 7. TV
/03_'75
TANK SETBACK INFORMATION St/ Ht Outlet '
7•Xl /o-3 4r
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic 12.0 qt1 +y2' NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe d1Z9 .sv 10-loZ.g3
Holding
7 Bot. System q. Z5' /°Z o RZ7
PUMP/ SIPHON INFORMATION Final Grade 6`30, /0y 0/'
Manufacturer Demand A14 3m s~. -2.of
Model Number GPM
TDH Lift Friction stem TDH Ft
Forcemain Length ia. Dist. To Well
SOIL ABSORPTION SYSTEM
:jMNARENCH Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS (Z ~U DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING =nufact ur :
SETBACK
IN FORMATION TypeO 1 CHAMBER er:
System(6o-,- fTb^ tZ 3 I JQ ~7 OR UNIT
DISTRIBUTION SYSTEM X157 wr z 7
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. ~ Length ~ Dia. 7 Spacing (o
SOIL COVER x Pressure Systems Only xx M and Or At-Grade Systems Only
19
Depth Over Depth Over pth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges 2N, ❑ Yes
❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) b lair se-we-f- 4t`
LOCATION: STAR PRAIRIE 31.31.1&,SW,NE 1857 RALIEGH RD LOT 4
S y s~C;ir~ rya l irE ; r lacc_ w~sn a,rec~.. ~(;fi~nc~ f s o ! 6 ~y 5 a,-c r t c~U ti~ fro K ~1
Pau c'"'"+ wu 40 df per
Plan revision Allq Iredl Yes ❑ No
Use other side for additional information. I&P 7 Rp~ / 47J
SBD-6710 (R.3/97) Date Inspect s Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
t^~~i~'r'■ i SANITARY PERMIT APPLICATION BSafeureaty u oan' f BuiluildiinWater System!
gWater 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.
• See reverse side for instructions for completing this application State Sanitary Permit Numb r
ae91b 7
The information you provide may be used by other government agency programs 0 Check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Propert Owner Name Property Location
1/4 1/4, S T , N, R ~(or~
s
Property Owner's Maili A ress Lot Number Block Number
City tate Zip Code Phone Number Subdivision Name o CSM Number
c > l0 3 /
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ it Nearest a
Public 1 or 2 Family Dwelling - No. of bedrooms R rowan O "Iellf
c
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. Yom( 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
1 1,® 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 S. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
ell,5-11 -5- Feet Feet
VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, th undersigned, assume responsibility for instal tion of the onsite sewage system shown on the attached plans.
Plu be ' Nam : (Pri Plumber' ign re' t p MP/MPRSW No.: Business Phone Number:
1<1
Plumber'sAddress(swt, ty,Sta , Code):
j4dj
IX. COUNTY / DEPART ENT USE ONLY
❑ Disapproved S~,,itary Permit Fee (includes Groundwater Date Issue Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial gj Surcharge Fee)
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
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, 608-266-3815.
i
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.
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Wisconsih Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page -L of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, 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. Parcel I.D. #
IZep~uw~ av'G& ~w 1-01
APPLICANT INFORMATION - Please print all information. Reviewed by Data
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). f, ,/Z -T• 97
Property Owner Property Location
Govt. Lot 1/4 114,S T N.R '40rtp
Property Owner's Mailin Address Lot # Block# Subd. Name or_SM#-
City State Zip Code Phone Number ❑ C Ay ❑ Village ® Town New
f New Construction Use: ~ rUl Residential /Number of bedrooms & Addition to existing building
El Replacement Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate -,I--bed, gpd0 _,1 Minch, gpd*
Absorption area required / j bed, ft2__jLL~_'_trench, ft2 Maximum design loading rate _.,__Z_bed, gpd/f2_,, f~ trench, gpd P
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material / Flood plain elevation, if applicable w -14
ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U= Unsuitable for system ® S ❑ U ® S ❑ U 0S ❑ U ® S ❑ U ❑ S 0 U ❑ S 0 U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
1:3 Z - S~
Ground -
e)lev.
~ft• ` N -
Depth to
limiting
factor
Remarks:
Boring #
s L
3 P s -
Ground ki/ql Z 5- s - 2:
elev.
.
Depth to
limiting
factor
ZZLin. Remarks:
I CST Name .(PI a Print) Signature ` Telephone No.
~S /
Address Date CST Number
_~5'67 lz / /Z- Z 97 s
PROPERTY OWNER /,~,L/ ,5 SOIL DESCRIPTION REPORT Page _'2 of S~
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
I t7 i
s w B
Ground 3 en
elev
irft• . -
7 _J7
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft. ,
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 # ;
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
'n. Remarks:
SBD-8330 (R. 07/96)
-5- X4
Gv1'sy~?S-
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'DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISO
N WI 3707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/M)OtMMLITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
1 1/4 NT 1/4 31 /T31 N/R l81qor) W Star Prarie 4 n, n/a
COUNTY: OWNER'S/*UWfXDWNAME: MAILING ADDRESS:
St. Croix hTarvin Wilberg 11869 Raleigh Rd., New Richmond, [III. 54017
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: t-i IPROFIL DESCR PTIONS: PERCOLATION TESTS:
JResidence 3 n/a kiNew ❑Replace Il 7-28-92 7-28-92
rRATING: S= Site suitable for system U= Site unsuitable for system
rONV E NTIONAL: MOUND: IN-GROUND-PRRE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional)
B S EIU U DU S DU I S U conventioanl
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the n/a
under s. I LHR 83.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS a e 19 R-IC
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WIT THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-1 86 109.20 none >86 0-8, 10yr3/2, L.; 8-23, 10yr s. gr.;-
23-86, 10ur4/4, co.s. &gr.
108.98 0-9, 10yr3 2, L.; 9-24, 10yr474, is. gr.,;-
B-2 88 none >88 24-88, 10yr4/4, co. S. & gr.
107.85 0-10, 10yr3/2, L.; 10-36, 10yr4/4, sl. &gr.,;-
B-3 86 none >86 36-86 1 4/4, Co. S.
B-4 84 106.75 none >84 -8, 10yr3/2, L.; 8-84, 10yr4/4, Co. S.
B-5 84 106.85 none >84 0-9, 10yr3/2, L.;' 9-3 o. gr.-
34-84 1 5/4 Co. S.
B-
PERCOLATION TESTS
decimal'
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
p- 1 3.85 none 3
P_ 2 3.63 none 3 6 6 6 <3
P_ 3 2.50 none 3 6 6 6 <3
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 ELEVATIO
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SOO°i8`O4"E I066.
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487626
Located in Part of
the N84, all in the SW of the
St. Croix Section 31, T3111 and in part of the
county* Wiaconain. ' R18W, To:~a of Star S8~ of
N L8G8ND Prairie,
1Y M
Aluainu! County Seetion N OR M
` • opulent Found
® 1" Iren Rabar Found Narvin Milberg
• IN x 24" Iron pi 1889 Raleigh Read
e hr linear Foot Pa Sot, Neighing 1.88 lbs. Rar Richaosd
• NI 5017
46 gam'- Existing
Fenceline _
-A
Q Existing Building
16 Psi
H ~F y
• • : 100' Poadray Setback Use
Yatsrls Edge
HA
m` lt) Nersh or Pond Area ~~r4
s _
HUDSON, t
WIS. .'r N
APPROVED
a 25 1* to F`i' llcov"t ~la~O
51992
~.Cr~NNEL~
S7. r-,AM 00LI ~ -~.~--1'TED LAIC I ~E
~W7lptNf NORTN LINE Of rm I*C4
i Z«
!1/t OF TN[ WE 1A ~
*V and! SW 735
Park! CorNn tev ~l .94 43.01.E •ge
•^i
K not re COMed 151. r:.
wMb 30 do" of $9043401 E ` 136.9,• .
approv4difte
1- 1.00 ACRES
N OPMO vr ahe•tla O 43. 3040 SO. iT.
OlNED!
16
all a
LOT 2
e9 e?` LOT ~3 3 ) sss-33/0'. Fr. $ y
M ACRE! r _ 1• .f
"a' set SO, Fr
L
00 07"W
e
•1.67//3" 91'•09. . A ~ f
M ~
• . LOT 4 S f
a.Is Apr[!
lNi. 14' !641 "1 Pr. w A , • ,
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mos•u41*W 730. j3* --e- a
_ ~s76.a~s. as,
SECTION N[R . ~1, 1 0189623141"W Ia11 SOlsaa.7['
C•5.11. IN y \ I G!T-1rElT 1/4 LI E 64 SECT
3• PG. 807 NNe ° Ny"'M"M
C.$.N. • [1A
- - IN VOL- 3, PG. 780 . 81'MONsso a
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.
---------------------------------------r--------/---------------------
Owner of property pwnw,'S, -1 ZC Q,, ml-C,hc ~lC /'-I
Location of property,S L-J 1/4 x/1/4, Section ✓ , ,TAN-R__Lg_W
Township Mailing address t/0 2- Ia•ve_
i rse f L J. - S/o Z S
Address of site L ~T G N A b
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property N(uc
Total size of property lP. , Z- A c r e S
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 /a.#9 and Page Number 6~ 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.
gnu. ure of Applicant Co-Applicant
Date of Signature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
/
OWNER/BUYER N; S Q4,9 h e P/el c e
MAILING ADDRESS Yo
PROPERTY ADDRESS l K c. I i t y e
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE -S0"N e e-sc f -5, y6 zS-_
PROPERTY LOCATION S 1/4 rV
/1",-111- , 1/4, Section ~l T ` ZN-R ~ W
TOWN OF _ 7LG . ST. CROIX COUNTY, WI
y SUBDIVISION CS -k
LOT NUMBER
7 _
CERTIFIED SURVEY MAP $ , VOLUME, PAGE 2 S31
, 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 Elie 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:
DATE: :7 / Z I
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
uaL2~Pa
!3(;1.906 STATE BAR OF WISCONSIN FORM 2 - 1982
WARRANTY DEED
DOCUMENT No.
REGIUER93 OF MC-9
5T CROIX CTYw1N1►
Daniel J. Place a single person
.
FOU13 3: 1997,
Dennis J. LeQue and Michelle M. 9:30 A
conveys and warrants to 44 JA/.
Place both single persons as ight tenants.
Hepfster of Deeds
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
the following described real estate in St. ( ; r n i x County,
State of Wisconsin: WNTOW SAWGS IMW
09 S. ONUS
-NEW RIM m, " 64017
63 St- U a't - 30 -1;00
PARCEL IDENTIFICATION NUMBER
part of the SW1/4 of NE1/4 and part of the SE1/4 of NE1/4 of
Section 31, Township 31 North, Range 18 West, St. Croix County,
Wisconsin, described as follows: Lot 4 of Certified Survey
Map filed August 25, 1992, in Vol. "9", Page 2531, Doc. No. 487626.
T A19WER
FEE
This is not homestead property.
(is) (is not)
Exception to warranties: Easements, restrictions and rights-of-way of record,
if any.
Dated this 1st day of T„ l y , A.I) 19a 7--
(SEAL) Do.,Vvj (SEAL)
* Daniel J. Place
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
.
St. Croix
_ County. ss
authenticated this day of , 19 Personally came before 'me this fit day of