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HomeMy WebLinkAbout040-1157-50-400 6 Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 749-3656 12\2\97 Jennifer Setzer, I am writing to let you know I'm concerned about possible damage done to your sewer system. It appears there has been considerable rubber tired traffic namely, skid loader traffic over the sewer line between the septic tank and house as well as over the header. The header is of special concern since it is shallow and very easily damaged. It's function is to evenly distribute septic tank effluent to the two trenches. Two things could have happened as a result of over head traffic. One, the header pipe could have been cracked, broken and/or separated which would cause out right and immediate failure. Second, the header could have been taken out of level, causing uneven distribution of effluent to the two trenches. This would cause certain premature failure of the trench system. The rubber tired traffic over the sewer lines between the house and the septic tank and the septic tank and the header is a concern because of the increased probability the sewer line has been caused to settle, bow in any one area and thereby causing solids and/or water to remain and freeze. This would cause the system to back up into your basement. This freezing is especially likely to happen during the first winter during and/or after construction. The observed damage to the upper trench appears to have been done by a rear backhoe tires. This damage is located at the last twenty feet of the upper trench. It appears the Backhoe tires became stuck after being backed into the freshly backfilled trench. A point of information to explain my alarm; rubbered tired excavating equipment apply tremendous torque/pressure to disturbed ground. That is why we only use tracked equipment during backfill. It is also why we only use tracked equipment during construction. Please, who ever owns and/or is driving the rubber tired excavating equipment, please demand that they immediately stop driving in the immediate area of the system and especially over it!! I have one other point of concern. Since there has been considerable traffic over the system, the ground has lost it's insulating capabilities. Before you start using your system, before you allow any water/liquid to enter the system, please call me first regarding winter start up. It is imperative you do this if you hope to prevent the system from freezing up. In summary, I'm very concerned the sewer system has incurred substantial damage due to the rubber tired traffic. This spring, I would strongly encourage you to have someone verify the system has not sustained any obvious damage, that it is functioning properly. You need to do this, so that in the event there has been damage, you will be able to minimize the effect. Please call if you have any questions. y, in7Zj4 age Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: trabor and'Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299026 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: SETZER, JENNIFER TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 4 =7 040-1157-50 480- TANK INFORMATION ELEVATION DATA A9700343 s" TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3,93 /Gl~. CD Dosing l~ Aeration Bldg. Sewer Hold' g St/ I~E Inlet TANK SETBACK INFORMATION St/ Outlet X163 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet y' - Air Intake Septic NA Dt Bottom r Dosing NA Headerdft= ai Aeratio NA Dist. Pipe S'OS' ,~,I' Hj*ing Bot. System 90 os' ''PUMP / SIPHON INFORMATION Final Grade Manufacture Demand Model Number GPM TDH Lift Friction System H Ft oss mead Force ain Length Dia. Dist.Towell SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S DIMEN SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHIN Manuf rer: SETBACK CHAMBER INFORMATION Type 0 r are G. w > s r ? J OR UNIT Mode Number: System: S DISTRIBUTION SYSTEM Header Distribution Pipe(s) x Hole Size x Hole Spacing _Vej#_To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S ems Only Depth Over Depth Over xx Depth Of x Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 24.28.20,NW,SW 233 WOODVIEW TRAIL LOT 9 , Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: F ° Safety and Buildings Division R SANITARY PERMIT APPLICATION Bureau of Building Water Systems 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 Number a990_?_~o 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 INFORMATION Prop~aOwner Nam Property Location 1' r z-rr ,v 1/a 114, S T , N, R~ E (or& Pr y Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdrrisie+a-P1a+++e or CSM Number 1. TYPE F BUILDING: (check one) ❑ State Owned ❑ !ty Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms 4/ Town OF 71-&0 CGrJ 7rw,'l III. BUILDING USE: (If building type is public, check all that apply) arcel Tax Number(s) -pd 1 ❑ Apartment/ Condo &00- 4/52-62 -JVV 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. A New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ ASanitary 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: /~•o 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./inch) *t p7D' Elevation &_Q 1 5-0 v Z 01 Feet # 2 9,7.,o Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel plastic New Existing structed glass App. Tanks Tanks Septic Tank or Holding Tank j ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation o4 e onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu ber'sSignatur St ps) M?MMSW No.: Business Phone Number: .L' 2'~ C51 P er's Address ( treet, City, St te, Zi Code C) ,rr OX 3 IX. COUNTY DEPARTMEN USE ONLY ❑ Disapproved Sani ary Permit Fee (IndudesGroundwater Date Issue Issuing Agent Signature (No Stamps) XApproved I ❑ Owner Given Initial 9 Surcharge Fee) Adverse Determination `96, X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL! SOD-6398 (R. 05/94) DISTRIBUTION: Original to Counly, 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 expiratior, date, and at a time of renewal any ne,,v 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. Onsiite sewage systems must be properly maintained. The septic tank(s) must be pumped by al censed 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. 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 swelling. 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 a!l 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 41Q 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. DAVE POSY Pi. ASS Lloaa " Te Plumber sm Om !load WOW HI Phone 749-MM rNNi~y`rr Jt J t{r sc/3 1 / ~ ~ /~~s+DElz mE * , I I o [oT # 9 a, r 64It rrf/ gffnrrrt /W (orper- l 0=wve ~ f ~ Y /3~rrr , S led f / 2 ~LL /Lffw. S&T ~t~s r / 14-C"oU Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 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 than 8 1/2 x 11 inches in size. Plan must include, but - C not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 11X-7-32 S'vG APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWVO: PROPERTY LOCATION -rat e GOVT. LOT W 114 f~1/4,S T N,R E (o"QJ~ JFlOPERj~ NER':S OLING ADDRESS LOT # BLOCK # 61:1138. ft41EOR CSM # (P c d , /0- 2 .7 2Zv CI STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE WrOWN N ST OAD ram rYy z o I-RIF III r»,' New Construction Use [/1 Residential / Number of bedrooms [ J Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 400 gpd Recommended design loading rate . 7 bed, gpd/ft2__._L_trench, gpolft2 Absorption area required [5 7 bed, ft2 7S'o trench, ft2 Maximum design loading rate - bed, gpd$ - trench, gpd/ft2 Recommended infiltration surface elevation(s) f / 07_0 ,!E 2- 93. -"ft (as referred to site plan benchmark) Additional design / site considerations xP~ fi t-~GLres ac _,1vse 24 i-e S zZs Parent material 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 ❑ S ❑ U ®S ❑ U [ZS OU ❑ S ❑ U ❑ S O U ❑ S Oil 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 bin i{~iY•r: ii:tiii f 7. 3 - !x S ZGo Ground ,3 -Ss - 3 6 S I elev. i /109.2 ft. S f9 I L Depth to limiting factor Remarks: Boring # 7. 5-- jaxrZ 1,6 SM -Z -2 7/7 93 3 - 3 .7 S= S ar c F . S . Ground - / 01/ Dar of elev. .2-06 0 7Z---A6rr IF .7 ® L LS ft. Depth to S f i /k S . limiting y S B L • 7 . factor _ 7 P~ Remarks: CST Name- PI a se Print 6~C T Phone: Address: Signature: / . Da e: CST Number: PROPERTY OWNER /.ff SOIL DESCRIPTION REPORT Page 2- of 3 PARCEL I.D. # ® 0^ IS-6 ->~d Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxidary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench x j3` / o- L L As Zen R, I oy~ . xlz -4F-- Z O L V elev. Depth to limiting factor ~ 96 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: p dap R'TY PLUM M ' OSW PNm*W Perk #m 032 F~~t~ 1lO~d Rp~ERI'SM y 10 3yDo~~~ \ Q1+/'1r~ /t /Z~r Y zd~i7 /S / 4r 2s. \ o 0 ~l IY Z07- 4f Q lot I s/'rke XW` e ~Stu/1/+r ldrv.0 ~ / a . ~orvaer ~ ,p 3 ~ #2 93.9 • OMYTPJW'; AVM + s Z ,l7t ~t otwq mil"?l s,~ LhGD~ !t°° "s f i i T- - i k , Wisconsin Department of Industry, SOIL AND SITE EVALUATION L3 of Labor and Human Relations Page -of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County 5T• C f 0/•Y, 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. # 0 340 - /i57 -SO - 4160 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 /303. 56.7'Zt 5-i~ Govt. Lot A11V 1/4 SW 1/4,S Z ( T 28 N,R 20 E (o W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 364 rove ?L P - 7 csm r)36.S• Vol iv PA. 2720 City State Zip Code Phone Number Neara4d Road jV00491114 *2 H UD.S0A.) I . S 140 f(o 15)3?( 1731 ❑ city ❑ village IeTown L ["hew Construction Use: [Eiesidentiai / Number of bedrooms Addition to existing building ❑ Replacement qso - ❑ Public or commercial - Describe: Code derived daily flow, &OD gpd a Recommended design loading rate -'bed, gpd/ft2 • (F trench, gpd/ft2 Absorption area required ed, ft 2 _trench, trench, ft2 Maximum design loading rate • 7 bed, gpd/fl2=trench, gpdNi2 Recommended infiltration surface elevation(s) • p ~i 3 ft as referred to site plan benchmark) Additional design/site considerations 2( /0-4046-W 1",,f. Y5 Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mo~und In-Ground Pressure AT-Grade System in Fill Holding Tank U= Unsuitable for system 0-s- ❑ U E s ❑ U 0'19, ❑ U 2~1 ❑ U 8❑ U ❑ S 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 l ( o-(, 1 o tlg 3/ 4,*AAl ifs4,e /W fR CS Zak . N; . 5 z - L ,v y y/!, S/1- z fsbe GS /-f . s . ~p Ground 3 -3 ~o ZS i'.sH S CS • Q elev. -7: • Depth to limiting factor Remarks: Boring # s / d -Sl /O Y?_ 3 - Go r''► ->cs6,C' mn fi(' S Z~r,~ • y IS Z z -j& lo 4 3A 0 z ' -3 6.L ~L cS _ •5:.6 Ground l ! 01 S S elev. ~0'V Depth to limiting fa r In. Remarks: CST Name (Please Print) Signature •-r " Telephone No. RobeRT' ?.lC.(3Ri c~ I 7/S• 38(0, (?IP-5 Address Date CST Number I ~ PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D.# L 6 / Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Gep 2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench z /O I S/G z f s Iwo fib aS / 24 . S . Ground elev. Z / 1 S Depth to limiting factor In. 'a Remarks: Boring # 10 3 ht She Alin S Z, j o VA -2 -Fske Ground elev. Depth to limiting factor in. 7 g; Remarks: Horizon Depth Dominant Color Mottles Structure P /ft2 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench Boring # lo m 3/x- 0 /f5 A" CS 2,, 4 , S Z -15 o y 3 O Ground 4--Z-40 M& e elev. ' Depth to limiting factor ,7/0,g-In' Remarks: Boring # Ground elev. ft. Depth to limiting factor In. Remarks: t~~i~l!>YT/ONS = r n 3of 3- 131 13 Z iaa a /33 S '30 ~II 13 I~ oo, V v 5cfte : 30 ~ Q ~o . = j3A c~ho.e P i Ts RS 0 A v , (3 30 I ~r Ulbricht & Associates private Sewage consultants J ' 167 ~j 655 O'Neil Ad. Hudson, Wis. 54018 V~ V \7zOq~ 1 ~ y 3 - ~ ti cb 9 s FILED JAN 3 111"- 0 Deeds Z~U J JAMES er O'CONNEL of Deeds N C~ Register of St. Croix Co., Wf CERTIFIED SURVEY MAP Located in part of the NWa of the SWh of Section 24, T28N, IR20W, Town of Troy, St. Croix County, Wisconsin; being Lot 8 of Certified o Survey Map in Volume 7, Page 2015. 1 W1 Corner of N 3 d N Section 24 OWNER e s L a... N W C 4W 0 W _ Robert Setzer George Setzer „ O M T Route 3 CD C CIJ N O I Hudson, WI 54016 O b -1 C N ~ M Z I O O 41 - W 1 ~a,I N Q i N I rn W~ O Q I C d V N wI Lot 7, C_S_M- in Vol. d s 4_ d 7 Pg. _2_01_5 °O 4j ° N 66, I (recorded as N8404112811W) Lot 1, C_S_M_ in 66.641 8302.81031,, 731.6.6' Vol. 2, Pg. 329 41 I 320.001 o 345.021 OVED 1 Z L 3 1 W 0 t/1 1 0 1 Z - ~ aM _ 29'931 M tD O 1 ~ W M LOT 8 1• O .A -Qr - O 1 'O 1 N O tD p 10 1 • W M - yy'~ N. ~{S\}Sx COUNTY r1 Uj ~.•.~opgz4ionsrve Q}4mZIf Q - 1 t!+ 7 d H N S880 0710011W 435.82' rr 7..Ct1/i:.t and 3 d N 4` Gant AfflQ2 O 56ao24 1i~ not r ` i. 260 • o '(thin 30 At. a -a- C:) (9 Wrov W C;, A 8 0 'O 0 1 00 - 0-1 approval v:► v i - Q1 C rn N et nug & Void N J 1 O W LOT 9 - 1 ail CD ~ IN L 1 3 A I N \,F O ~I t C Li v w ~i ~N 1~ oO E N C 1 fi ;L L o ro comet _ ~ H M d om y ' N87°46' 30"E 424.24' uL+ tD, 1 N lV B r/K 144.54' 279.70' N J 1- S -eW C+ 1 N T 1tD 3 LO co Cr 0 o LOT 10 LOT 11 oM Z - STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. ~C-~-roiixx County O denn t FCC. MAILING ADDRESS f~© /~i'C _ 6 {r r r~~ 1-yo Z3 PROPERTY ADDRESS 33 a rr / (location of septic system) Please obtain fro the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, . ~ 1/4, Section y T,2_ N-R ~d W TOWN OF 1 ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP -5"//.?r S ;VOLUME _/o, PAGE. 20 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 expiratio date. SIGNED: DATE: 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 sign owner(s) of the property being developed. An inade signed by the only result in delays of the permit issuance. Shoal s will development be intended for resale by owner contractord, Should this house), then a second form should be retained and compl ted(when the property is sold and submitted to this office with hen appropriate deed recording. the Owner of property ~ L C r- Location of proper - -~1/4~~1/4 , Section T~_N_R__ Township W Mailingaddress_ X'I1111:1110, -III!, 0^,1Z tx: v I.2 Address of site Subdivision name IC Other homes on Lot no. property? Yes V No Previous owner of property e Total size of property 01 Total size of parcel c Date parcel was created Are all corners and lot lines identifiable? Is this property being developed for (spec house) ? Yes Yes No Volume Lp and Page Number ~ No k,- as recorded with the Register of Deeds. .0 s ,?45-- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DO NUMBER AND THE SEAL OF THE REGISTER OFT DEEDS R' VOLUME AND PAGE certified survey, if available, would be helpful so asdtol void In adt delays of the reviewing d references to a Certified Survey ss. If the deed description shall also be required, Maps the Certified Survey Map PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to best of my (our) knowledge that I (we) am are the property described in this ( ) the owner(s) of the warrant information form, by virtue of a y deed recorded in the office of the County Register of Deeds as Document No. own the proposed site ~0 and that I (we) presently obtained an easement to the sewage disposal system or I (we) construction of men ,system, to run the above described property, the office of and the same has been duly recordedtin the ff the County Register of Deeds as Document No. 4ur o pp ca Co-Applicant Date of Sig ature f r VOL Put? 70 5608SU ST:\CE D \'ItiC ONtiI'. 1 (74!i . - 1 Qta2 \VARP,1IN -1Y DFt•D DOCUMENT NO. Gena Setzer as Ancillar Per_son_a_l_ Rcvr =_ent-a_- ! ST CROXC Y.,~'d` - _ tive of the Estate of deceased, and Robert J._ Setzer,-_ JUN 11 1997, - - ii j conveys arid warrants to Jennifer J. Se_tzer,__ a_ zi---1e KT 11'20 A IN - , e r s on - a+ THIS 11ACE. R..ERVED FOR RECOROING DATA NAb1E AND REDiRS ADDRESS the following described real estate in S t . .._SaLD 1 x Cnunty, • `r' State of Wisconsin: MIDAMERiCA BANK N 600 2nd' 'f H s S40161` a j 040-1157-50-400 li FAR-T_ IDENTIFICATION NUMBER i~ Lot 9, Certified Survey Map recorded January 3, 1994, in Volume 10, i Page 2720, Document No. 336861 being a part of the North West Quarter I_ I~ of the Southwest Quarter (NWl/4 of Section Twenty-four (24), ii Township Twenty-eight (28) North, Ranze Twenty (20) West, Township of Troy, St. Croix County, Wisconsin. J'ij tee. TRANSFER FEE .4 k I' J' This _15 not how--stead property XXX (is not) ExcepthmtowarrantiesEasements, restrict s^ut- and rights-of-way of record, i if any. 11 Dated this day of AD_ , t9 g ~ t it Estate of George F. Setzer.,, Deceased r ii B tvk~lti .ZP dL./Q~wt~SEAL) - EA L) --5+1t& t - Robert etzer • -Gena SeTtzze~r 1-r-~ 4-1 V SEAL) - - (SEAL) r y. ILI AUTHENTICATION ACKNOWLEDGMENT J = State of Wisconsin, or.-IT. St. Croix q County authenticated this - day of 19--- rcrsot 11 camr M •re mr this day of - la97 the above named - - - p n a S e t .7e. r-,_ _,a-s__ A n-ci l l a_r.y -P_ers oral ' • 7iE.prea_entative of EsYate_of__Ge9rge 1 TITLE: MEMBER SiAFE BAR Or \\•ISCONSi"r NOWY + . -Set z e r ~ Deas.e_d,_aad Bo_bert J.. ' (If not, - - Isc t-z e r - - - - State of