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AS BUILT SANITARY SYSTEM REPORT~4 r r4~ U r
OWNER Q cwIS ry co~R0/' a
o
2p UN i,
ADDRESS I y~ NINGOF c&
s7 C.a, f ~ Snw
SUBDIVISION / CSM# LOT #
SECTION_T 8 N_R L _W, Town of
ST. CROIX COUNTY, WISCONSIN ~'l 6 (,c> -L) ?-is
PLAN VIEW
SHOW EVERYTHING WITHIN 100-FEET OF SYSTEM
Uu~ 0 V%
0
R °•o
1
a
40 ~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
t ~
BENCHMARK : ( 7t~,n, S ►qJ~,} Corw Hoy., • L 1 a p d
ALTERNATE DM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: IVh~we~T ~~rGC~~9 Liquid Capacity: )00 l.S-O
Setback from: Well 56' House 14 Other
Pump: Manufacturer 6gOW ,Q Model# 3 S 7 Size
Float seperation G. RS y Gallons/cycle:
Alarm Location b0)6
SOIL ABSORPTION SYSTEM
Width: ) Length 3G Number of trenches
.Distance & Direction to nearest prop. line: 40
Setback from: well:/ .S Housed Other
ELEVATIONS
Building Sewer_ ST Inlet: Q(_ S7 ST outlet: Coq.6 "T,,/-
PC inlet Cvv, Rio 'r4J PC bottom f 3 9 2 Pump Off 94. P a
Header/Manifold Q'q,E Bottom of system 93, a a
Existing Grade Final grade
~ ~ Scpaa~ Q4.) q
DATE OF INSTALLATION: VUp~/ G q~
PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR :A p).
3/93 j t
• ` Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 299148
Permit Holder's Name: ❑ City ❑ Village X] Town of: State Plan ID No.:
CARLSON, DWAYNE TROY
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
100(i 160f S roc a C. ~U I^ 040-1110-60-000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic MNA/ P [OVd Benchmark 1 192- lot q 1,0-0
Dosing (0 100 (070
Aeration Bldg. Sewer Ip.r3' 1 ~7°j
Holding St / Ht Inlet /0.35- °J / • 57
TANK SETBACK INFORMATION St/ Ht Outlet
Verit
ir Ito ntake ROAD Dt Inlet
TANK TO P/ L WELL BLDG. A
Air
Septic -13u, -f,-S- 1 1 21 NA Dt Bottom 14o22 7 -7,C1
Dosing NA Header / Man. -
Aeration NA Dist. Pipe .7; 1-1 9I/n esq./
Holding Bot. System V70 43 .Z-7-"
PUMP/ SIPHON INFORMATION Final Grade 2 ,5/ ~Ilo 07
Manufacturer o v kAS Demand 5+ will h.L. (allez y 73 °1 y 14)
Model Number -:3W-71 f D GPM
TDH Lift ~0.2 Friction .2 Lf System, TDH(o 6/ Ft
Forcemain Length rl?)' r Dia. Z r' Dist. To Well tDJ
SOIL ABSORPTION SYSTEM
E RENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia Liquid Depth
DIMENSIONS 3G DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufact r
SETBACK
pe O~ , Mode N er.
INFORMATION Ty CHAMBER
277
+ ~s ' OR UNIT
System z
DISTRIBUTION SYSTEMM z7 2 1
Header/Manifold Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air , Intake
_ 50
Length Dia. Length 3S Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over x pth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges soil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons prese
LOCATION: TROY 28.28.19.447A,SW,SE 105 TOWNSVALLEY RD
Plan revision3requir dJ•~❑ Yes 0 No
Use other side for additional inforrMation. 7 ICI-17 Rod j 44
SBD-6710 (R 05/91) Date Inspectors Signature e~r'I~J
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
Visconsin SANITARY PERMIT APPLICATION 20 E w shnlgtongAvevision
P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less Count
than 8 1/2 x 11 inches in size. r
• See reverse side for instructions for completing this application State Sanitary Permmit Number
The information you provide may be used by other government agency ` " 9 ~t 49
programs Check i f revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N
Propert caner Name Property Location
C o w /4 1/4, S T N, R L Q ,k(or) W
Property Own s ailin Address Lot Number Block Number
J57 ct.v~ s w - w A- ►v G¢
City tate , Zip Code Phone Number Subdivision Name or CSM Number
`vcy I'«. Its W1 $409 2 l CIS) 9-2r49 34.5 /Ic-
II. TYPE B DING: (check one) ❑ State Owned City Nearest Road
❑ Village
Public 1 or 2 Family Dwelling - No_ of bedrooms Town OF r0 ITOW,0--, V&IL C
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 040 - 1116 j~D
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 2. Cg 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 14 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
56) Req24:3 ed (sq. ft.) Proposed sq. ft.) (Gals/day/sq. ft.) (Min./inch) Q Elevation
Z 4 ~ Pi 10- 13, 2, Feet Feet
VII. TANK Capacity
in gallons Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel lass Plastic A
New Existing strutted g pp'
Tanks Tanks
Septic Tank or Holding Tank 1 006 1 00 0 a l y,, 09rttAwl'- ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 6 10 Za 0 ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Sinn ature: (No tamps) MP/MPRSW No.: Business Phone Number:
A 9 elk, I Calf
6 5 Zl 7
Plumber's Address (Street, City, State, Zip Code)
10 4 s 4S Kt v &1 1./,/; 54c2,-?
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved 5 itary Permit Fee (includes Groundwater ate Issued Issuing ent i nat a (No Stamps)
Approved ❑ Surcharge Fee) j `-5`
Owner Given Initial Q'D~ `t~
Adverse Determination "+t OO
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: yyl~
peviodc rcorro drp.
SBD-6398 (R 11`96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
i
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 li:ensed 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 nurnber(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 o' 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.
SC,a~e 1 . 4} 0
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Frssh Air Inlets And Observation Pipe .
Approved Vgnt cap fo
64lrJmum 12" Above
Final Grads Mgn~r-~~ttY~
20- 42" Above Pipe, 4" Coet I'f0n .~,(~y~t= "v~ .77
°
To Final Grade Vent Pipe - '••_.~^4,~~Q
SYnthsilc Covering.
Min. 2" Agprsgais
Over Plps
Oisirlbullon
pips o 0 0 0 Tee
6" Aggregate
Beneolh Plpe °
Vv-Alyn t Cu Y I Scwj
PACs p
PUMP CHAMBER CROSS SECYIOIJ AND SPECIFICAY101JS
~r~.', v e ►JY c
H~.C;Y.:.VCIJY PIPC
'k'A ^"y"-• E WCATHCK PROOIr APPROVED L.OCKWG
i. FtZS~FROM 0009, JUIJGTIOIJ P3 0X t MAlJ}iOLE COVER
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'APPROYlrO J011JT 'A I
APPROVED Olu1
' 4J%C:z'~ /lPC G; ( III W/C - PIPE
CXTCWDIIJG W
III ALARM EXrCUDIUG
~:,.~0 1 0~60LlG COIL. P5 I II OIJTO 3041D toll.
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PUIAP
RISGK, IXIY PCKMl7TCD OiJLJ lY YA1JK M A U U 1<AC PURri- R Hl~S SUCH APPROVAL. ~I.~PPR
Srl~Ct jj'i:' OiS P C 11+ I C A`I' I O N S'
41 ' 11'2
}JUMBCR OF DOSES PER My'
Y~►uK.'~Ix 600 C011.bo •OAl I'mii ' oos~ •voi:uMG
~ , GP ARC I; ruwuF'AcTUR>vu:' 2 I?1CLU111. -
DIWG' CACKYLOW: , l~ to GALLO!J
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".~p~j~~-1~<•.Y~ s,YR't`'''• Z k }uIMUM•01-CHARG~,'R1lYE GPM• INSYALLEO 0}J SEPARATG CIRCUITS
~`:yCRI'I•CAI.'DIP~C>~C}JC6 P~C7WCCIJ PUMP OFF AlJO,.DISYRlbgT10U FEC
PIPC, Y q 3.7`I
~w' t-i1tt1JIMUM AICTWORK' $t~f►Pl.y PR655uiLC ~?'3- ~CEY 87:6
rccT or F ORce tow,m x .2u.-Fy0Fr,FKICYIou FACTOR.: .LCoS l: ECY
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3871
APPLICATIONS Motor: FEATURES
Specifically designed for the • Single phase: 0.4 HP, 115 Impeller: Thermoplastic
or 230 V, 60 Hz, 1550 RPM,
following uses: Semi-Vortex design with
• Effluent systems built in overload with pump out vanes for mechani-
automatic reset,
• Homes cal seal protection.
• Farms • Power cord: 10 foot
standard length, 16/3 SJTO Casing and Base: Rugged
• Heavy duty sump with three prong grounding thermoplastic design provides
• Water transfer plug. Optional 20 foot superior strength and
• Dewatering length, 16/3 SJTW with corrosion resistance.
SPECIFICATIONS three prong grounding plug. Motor Housing: Cast iron
• Fully submerged in high for efficient heat transfer,
Pump: grade turbine oil for strength, and durability.
• Solids handling capability: lubrication and efficient Motor Cover: Thermoplastic
3/4" maximum, heat transfer. cover with integral handle and
• Capacities: up to 55 GPM, float switch attachment points.
• Total heads: up to 24 feet. Available for automatic and power Cable: Severe duty
• Discharge size: 11/2" NPT. manual operation. Automatic rated oil and water resistant.
• Mechanical seal: carbon- models include Mercury
rotary/ceramic-stationary, Float Switch assembled and 0-ring: Provides positive
BUNA-N elastomers. preset at the factory. sealing. No gaskets to replace
• Temperature: during maintenance.
1040F (40°C) continuous Stainless steel fasteners.
140°F (60°C) intermittent.
• Fasteners: 300 series
stainless steel. METERS FEET
• Capable of running I
dry without damage to 8
components. 7 25 - _I----- - .
;t5 GPM
~ DI I
6- 20
U
Q 5
Z 15 -1 - - - . _ . _ - -
0 4
i
p 3 10 f---- _ _ , _
2 i_
5
1 j
0 00 10_ 20 30 40 50 GPM
' 0 2 4 i 6 8 10 12 ml/h
OPACITY
L~
(0 1994 Goulds Pumps, Inc. Effective May, 1994
9 838/1
Nisconsin Department of Industry, SOIL AND SITE EVALUATION Page of
-abor and Human Relations
division of Safety and Buildings 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 s-
nclude, but not limited to: vertical and horizontal reference point (BM), direction and / , 1
)ercent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
O4.0-
APPLICANT INFORMATION - Please print all information. Reviewed by Date
'ersonal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Y I t,/' 1 • s. q7
3roperty Owner Property Location ~r
a ~J Govt. Lot S W 1/4 F 1/4,S ~ T20 N,R ( I (or) W
'roperty O `er's Mailing Address Lot # Block# Subd. Name or CSM#
) 1; -7 C is0Yv L 14 YV A Iv a 34;.5(0 fiC,
amity State Zip Code Phone Number ❑ City ❑ Village 21 Town Nearest Road
~IU U Fa S UJI S 4oi-L ( 71S-) 42.5- 925 T~0 TOWh5U41~ c
❑ New Construction Use: Residential /Number of bedrooms - Addition to existing building N A
Replacement Public or commercial - Describe: .
Code derived daily flow 150 _ gpd Recommended design loading rate j~bed, gpd/ft2 . $ trench, gpd/ft2
Absorption area required .643 bed, 0.~ ~trench, ft 2 Maximum design loading rate _ 7 bed, gpd/ft2_,_trench, gpd/ft2
Recommended infiltration surface elevation(s) q 1. 2 It (as referred to site plan benchmark)
Additional design/site considerations I X ID CA
Parent material Flood plain elevation, if applicable WA ft
3 = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
J = Unsuitable for system ®S ❑ U ®S ❑ U [0 S El U ® S 1:1 U ❑ S U ❑ S [K U
SOIL DESCRIPTION REPORT
3orin # Horizon Depth Dominant Color Mottles Structure GPD/ft2
g- in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench
I a-1 z 5 YC 2.5 I s; l Z 56,E M illy C' 5 2 V s
around 37 Z4• 7.5YR4/6 1 Z-f k n'V+ CS r tj 5 lv
elev. /
)6 rK,
)epth to
miting
actor
Remarks:
3oring # C-1z S .1,~ l S 2-1` !i IT C~
2 /Z-z ►o R 3 sl Z~ l1. of
3 -3 4 Y44 S1 7_154r G s I Uf . S ' .
around q 9-9 ti'9 g _ g
)lev. I
1719ft.
)epth to
miting
3ctor
~fLin. Remarks: t
SST Name (Please Print) natur y~ Telephone No.
Lar l i~ h),c I'S a S- 42s- Z) ? Sf-
Address Date 7 CST Number
57
ROPERTY OWNER 2,;n. SOIL DESCRIPTION REPORT
Page of
ARCEL I.D.#
oring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots ED/ft2
In. Munsell Cu. Sz. Cont. Color / Or. Sz. Sh/. Bed , Trench
• 0-11 5 2.S Si l 2~ /C r G
11-?~ l R3 - S f s1~1~ rn~~r CS round 3 -_3A -),57 Y2°~
ev. S 2 ~s h~ n1 y~r C 5 v f
S,. lU
31-94 I U Y K epth to
niting
cto '
in. ;
Remarks:
oring #
S
round
ev.
apth to
niting
ctor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/rte
in. Munsell Cu. Sz. Cont. Color Or. Sz. Sh. Bed , Trench
Loring #
round
lev.
_ft.
)epth to
miting
actor
,in. Remarks:
oring #
,ound
3v.
_ft.
spth to
citing
:tor
in.
Remarks:
BDW-8330 (R. 08/95)
sc,o-~e 1 g0
Co M M
f ~
W ELL t4 on C L`-mot ~7 tf Z u/a ~S 10 l
O b e G brarAd../
Qo d 7 ~ 2
t3
EL. 100, o o y
L
Slope. J_S n c,,7 for
Pss 7~h.,.•' t o
s
r3 3 ~ i ~
l
i ~
I ~
qqs
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER c r 9-1- Sd
MAELING ADDRESS /_~S- 7 ci,Y`/S o vt 1 e t~d'e r `w/lS , lyiS~ S P~oo~a.
PROPERTY ADDRESS X AC) is . 'S -ye.2 2
(location of septic system) Please ob m fro the Planning Dept. T-
CITY/STATE
PROPERTY LOCATION 1/4, 1/4, Section a , T_+t_N-R_J_W
TOWN OF 4 ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60%, of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year ex iration date.
SIGNED:
DATE: l1
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
rvL~sG, -571
~riaN 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 vt.'Kn e- h,
Location of property ~W114[41~_1/4, Section _~k, TAN-R_49 W
Township. l2__6 r Mailing address /S 7 ,a,r is a
Address of site l ' '?o wr, y ~a.~~ ~,/ls !~i 5 S.~~z
01,
Subdivision name Lot no.
Other homes on property? Yes _No
Previous owner of property
Total size of property /An
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 )-6 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 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.
Signatu of Applicant Co-Applicant
~D
Date ,,,6f Signature Date of Signature
TM IS gPAGESo p" IMC"OING oA T A
DOCUMENT NO. EVATF BAN OF W NCONAIN FORM I-ION
WAML4MW GEED
" REM IM OFFICE
I
W=" ~e Owd, maMbetwea► rt Gr1wnn A/k/a Se~t_H. aLa
_ ` OCT 3 01992
Grantor,
r 8:30 A. ~
Granteg,
wit, s Thd #wnW Grantor, to a rMLgbbcansWeratW
Q' a AM I arjwkd usttmbta inns; dprArleyn At nfflo TO
oonwp to emw on Wowing dewlbed real eg»te be a CMi l
s COUM41 owe et WlegoaMR:
Tax ft No•,_ - j
MW 9outhmemit Qdrter of the Northeast Quarter (SM% of W and the southeast
Quarter (00,, szoaptim the last 30 rods thereof ad also awepting a Parcel
Of 1404 in the Southrest corner of the Sout west Quarter of - the Southeast
Quarter (SK- of SB%) 165 feet Best and Viand 144 North and South, ail in j
Section ZC, Uwdilp 28 North, Ra W 19 Otis Warranty Dead is given is fun satisfaction of that LLw d Contract dated II Septemdw 20, 1973, ad recorded October 2,
1973 in Hods 503, paw 528, as
Document Number 318769.
end prop"-
angle
Tom~ wa so and ship ow Mee Iterwditwnw to seed spptwIww ou thanuMo balonpWp;
A
r.arraMS that aw Mob pod, indokwMe in tae ailnpl-Md teem and d8w of wWMllb M'lM "WW
easements, restrictions, reservations, aid cvveenmts if any of r:.-,ard, hi8himy
rig►ts-of-may, and liens or defects gated by seta or defaults of grantees. j
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and will wwrent and detelW the sons. r/
16.92._. j
Gated this--, dmwge firtMar
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AuTMENTICATM ACKNOWLED"Off II
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t:,OYflty.
ML9L' _ Pw=noy pine bdon IM th+• ew «
/p_92Low do ne named j~
-save= V /dart am _
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TlnW. MEMM sTATE MR OF WACOM1M
to an known to be the penet+ whs enaltad t11
Gtaut shed by $ M.06, Wig. raw) ta►apoklp InWvv d and ecbnowledpe the sww fl
THMINSTRUMEW WAS DF AFTW BY
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FILED Fp
AUG 2 7 1998 ►
WHLEENKwnLSH 9
~r RegisterotDeeds ST. CRQIX CQUlVTY
St.Cr0iXC0jN SURVEYQR'S RECQRD r
58594' ~o
CERTIFIED SURVEY MAP
Dwayne and Jeanninne Carlson
Part of the Southwest 1/4 of the Southeast 1/4 of Section 28, Township 28 North, Range 19 West,
Town of Troy, St. Croix County, Wisconsin.
LEGEND
O SET 1 "X 24 " IRON PIPE (M/N.
WEIGHT /3 L B. / L. F. )
COUNTY SURVEYOR'S MONUMENT
(AS NOTED)
Note: This parcel is being created for purposes of farmland
consolidation.
NORTH 114 CORNER
y~ SEC. 28, T. 28 N., R. 19 W. /"-;/00,
o (FNO. COUNTY SURVEYOR'S MOM)
0 i 0/0 50 /00 zoo
O BEARINGS ARE REFERENCED TO THE SOUTH
C 0 LINE OF THE SE 114, SEC. 28, T. 28 N., R. 19 W.,
2° UNPLATTED LAND_S ASSUMED AS N89.51'29"W.
I33 33 I THIS /NSTRUMENT ORAFTEO BY
JERALO L. LARSON
i
S89051'29"E --418.00'--
/001 S89051'29"E --385.00'-- i
WI
Zi I ? ° ~W ~j LOT
QI h1 L Y y.
J~ J I~ Q~ CONTAINS /74,724 SO. FT. OR 4.0// AC.
148,225 50. FT. OR 3.403 AC. EXCLUDING
M Q h i to ,~I ROAD RIGHT OF WAYS1 I
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a I~2 ~3 0l O NT
O MIW ml
CORN
O ILJ4 a W I I CRS BARN 3 COR
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;t ~z o I SILO - 41
Q I Q = O VESEP NT \ I METAL 8/N H h
SfT~CK s/NE _ O QI r,~
I~~ OO I 84/11 O/NG _0
SEPTIC C3
Q I 3 I OM.CrAl ACCESS GARAGE I „ ,r
j 3 I SEPT1 ❑ \ J I
Z)I (VENT HSE. OWEL L O
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DRIVEWAY
3 33 33 ` -
25= Ng9'Sl'29 'W --385.00'
N'LY R/W C.T.H"MM"- r NB9.5/'29"W
--2237.42'-
_ ~ N B9°5/'29" 6V --418.00'-- 33.00'-
AP,
S. L /NE SE 114 II II - U
SOUTH 114 CORNER C, T H, N89.5/' 29"W --2655.41' MM SOUTHEAST CORNER
SEC. 2B, T. 28 N., R. 19 W. S' L Y R/ W C. T. H. "MM " I_ SEC. 28, T. 28 N. , R. /9 W.
t run rn",vrY s"RVEYOR's