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HomeMy WebLinkAbout042-1024-70-300 o (1) O h ~ O d o o 0 N N 41 r y d N I N O C Z U. C i p I a 3 Cl) z 3 E U) = °o z r ~ d d rn F ~ a co 0 0 c C7 -o m o z a w m z a ° c ° rn z c E 72 .O N M N C C13 N N C pftb N N d7 00 O L) O O N Q w z co z o N _ _ Z d co E N % ~i a c LO W d N C O D c c a ~ CO N Z M > V1 d1 fA 3 V 3 3 a o It • 4i ~ a a a IL a o N r fDJU zrnrn Z Q O O m U) At .2) 2 O y d Q CO a O 04 y C O O 0 M U 4) a) 0 O O C O -O F- 0 r V N p N O w C 06 a) 0 C C N O U W L; M V) N 'O N • V pj O m 0O0 O c 0 U cO yr 0 0 Z N O z- Z Cn it v ~ L: CL cl CL .2 c r`1~1 E r A ciao ',~v~ci Parcel 042-1024-70-300 06/28/2005 04:56 PM PAGE 1 OF 2 Alt. Parcel 09.29.18.140C 042 - TOWN OF WARREN Current XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * LIPINSKI, LARRY & KATHLEEN LARRY & KATHLEEN LIPINSKI 1128 100TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1128 100TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 4.900 Plat: N/A-NOT AVAILABLE SEC 9 T29N R18W PT SE SW BEING LOT 3 CSM Block/Condo Bldg: 11/3198 2.17AC & INC COM SW COR SEC 9; TH ALNG S LN SW 1/4 89DEG E 1572.80FT TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) SW COR LOT 3 CSM 11/3198 & POB;TH S 09-29N-18W 89DEG W 40 FT;TH N 00'W 800.20FT; TH N89' E 267.00';TH S OODEG E 800.20FT; TH more... Notes: Parcel History: Date Doc # Vol/Page Type 04/11/2003 716883 2203/147 WD 01/26/2000 617483 1486/392 WD 07/23/1997 1235/265 WD 07/23/1997 1235/261 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.900 48,300 218,600 266,900 NO Totals for 2005: General Property 4.900 48,300 218,600 266,900 Woodland 0.000 0 0 Totals for 2004: General Property 4.900 48,300 218,600 266,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 302 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 042-1024-70-300 06/28/2005 04:56 PM PAGE 2OF2 Legal Description: cont. S 89' W 2.00 FT TO SE COR LOT 3; TH ALNG E LN SD LOT 3 N 00' W 420.20 FT TO NE COR LOT 3; TH ALNG N LN LOT 3 S 89' W 225.OOFT TO NW COR LOT 3; TH ALNG W LN LOT 3 S 00' E 420.20FT TO POB Pa e of V IOnsin Departrnent of Industry, SOIL AND SITE EVALUATION-RE PORT L<.bc,r 2s.~ H~man Relations Division of s.,fety 8 Buildings in accord with ILHR 83.05,-WA- X ao (~dlt { O'er ~ a COUNTY 'Attach complete site plan on paper not less than 8 1/2 x 11 inches in si an rp►~Sk?d~, but rralor' ARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction an f slo~a~ ' dimensioned, north arrow, and location and distance to nearest road. /o o7 - 70 APPLICANT INFORMATION-PLEASE PRINT ALL INFORM N~~` ,f ~WEDBY DATE PROPERTY OWNER: % PROPERMLgbC TION 4.5 jt) r 1/4,S T N,R I~ W SL ~S OR O L" O' / VGOVT.'L 9 PROPERTY OWNER':S MAILING ADDRESS T# BLOCK # SUED. NAME OR 1111.2 aid e *NM, i9~ CITY STATE ZIP CODE PHONE NUMBER ITY ❑VILLAGE OWN NEAREST O D o Z! ~ 5- /S~ S" Do7 (x•1.5) N9- 3,-bg New Construction Use (?(J Residential / Number of bedrooms ed 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow :50 gpd Recommended design loading rate bed, gpd/ft2 . s trench, gpd/ft2 Absorption area required bed, ft2 M trench, ft2 Ma)dmum design loading rate bed, gpd/ft2 . S trench, gpd/ft2 Recommended infiltration surface elevation(s) 99. ft (as referred to site plan benchmark) Additional design /site considerations S&~' C dram art 1(j Ca ja Parent material (r CI! / (1c.W cvc s'h Flood plain elevation, if applicable ft MOUND 71NOGSIOUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK S = Suitable for system CONVENTIONAL 7 is U=Unsuitable fors stem ❑ S ~1 U S ❑ U U El S O U ❑ S (~1 U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bandary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed TwIch 0 6ije 13 11. nw ffl=_ .2 011- 1-1 o 3j4 -14 17) 56,E C S 3 r►~ • 5 Ground 3 / -3~ , 5J_ l rn S 6pip" Fe As ~ .'y • 5- elev. ft. -38 7. S -1'14, S % i X15 1Z Depth to 5 .j15 0 216 S D v r►'1~ IBS Z-F limiting factor 3 p D 5 n'11.. - v vtr rh _ S 0► fir? s }c, B~~s C~ IN ecCq~ r*K Remark Boring # :K,.,,..,,,.... 3 3~ 7-S e ~l S.C / m Sa, mye C S ZM S Ground o 7 , g elev. 610- /0 le - ~(Q S ltd I m 1 sbk n'I rr,' 1 v~ z .3 Depth to s. :5e limiting factor Remarks: 1 IPs yh o 1/ r C e5krt 1 aLVE CST Name:-Please Print--,71, `be,_+ 4 ~1SL Phone: (2/4- Address: ~0R ~ tLV ce /SC_ -s O . Signature: ~G` Dat'1O f CST Number* PROPERTY OWNER -~~ca~~~rc~~11 SOIL DESCRIPTION REPORT Paget c PARCEL LD. # C-V/V- ° /0-2 7 0 - ; Depth Dominant Color Mottles -Texture Structure Consistence Bounda.y Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed TniU , s v 3 I o- ~0 3i m s6k m F g e, -2 m sbk in Ae a J1-a j y/~/ c Ground 3 V- Yl 7-5ig- 5 1 m lbk in PS 2 rov, -z . 3 el Sbk pir 1F2 145 •Z-F A • S Depth to lv ~6$ 2j s Q ,F s m~. l~S .8 limiting factor - , 5 2 ,c S,C 01 VF jr m Fr- Remarksd&e- d(~pSl /O9 Boring # ►x'-d taind op ar -4 h~ V one st~rdS _ firths sa w1ev "MIN haadr- Ground elev. ft Depth to limiting factor Remarks: Boring # / p ~J3 D/a S6 C Sin , S MIMI, S 3 a7 Jaye Co Ground ~i . s eleV.- 15 D S.C l s~~ /71J~it' .r ~n - o S 0 of )c Depth to L lim li.-73 factor 3 Remarks: (b m j Ac-L35 t"i l inL~ rse 56mds Boring # © r'~i r' q -10 Sar)ds i r S o I Wars& sari in 7 i . y i xN~ y MIA Ground elev. A ,el ft.. kk Se An Depth to limiting factor Remarks: co n_ooanra- (LS1921_- t X47 u04 I 3 of I r I -Z rR V- ~;l -1 iz e, hl v z + 0 h DI 1 VLL23 ~a d U CA, 0 4 e 0 _1 00-~ ~ I s f i ~ l' I 40 yam' i ~ o L l cr- a1 ? h ~ P , s~~ v .Fay „:g ; 6 T) T 29N 18 V NOT TO SCALE ST CROIX A R R EN+ V N CROP YR 14, IRV s t aFrr xhsL"y3`y 7L 4.i ~ ~ 4 V «t ' ~'tu1S~jy 7 Y' U V ~ lL. -F/ ~ ~ • ~Oi(V ' ~ ~-E./-~ ~ ~ ~r ~Y - Ova ~'TC At- .gyp - ~'t~~► • ~ ,:''~~'Y . : - .:u„~: x: f ifr y~ A~ f aso INL }Iif" ~ tea. +i~.~;rw ' F • ~i~~v~.._ : y~ ~y~- . y t i tyi .P 441 il'-.1- ~ r. ~ y~• R t !F ..~1 ~ ~ ~ T~. F T t. M STC - 104 AS BUILT SANITARY SYSTEM REPOR 7 OWNER ~ . RE9 C ADDRESS f SUBDIVISION / CSM# LOT # SECTION n _z>29 N-RjS_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 1 0 FEET OF SYSTEM ~.K~ 1100 LL 6, 75- INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. A yr;~„o f c ~C1 BENCHMARK: ALTERNATE BM:Pa~ ~z~6a o,J ~C ~~,Glxcol~ S--rY SEPTIC TANK .PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length S7'~ Number of trenches Distance & Direction to nearest prop. line: f ,~f / Setback from: well: House_ Other ELEVATIONS Building Sewer^ ST Inlet: ^9/_~S^ ST outlet: PC inlet PC bottom Pump Off Header/Manifold c Bottom of system Existing Grade 9~A Final grade 97E2 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Hum*n Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 289358 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: NELSON, GARY WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: , ~ i 042-1024-70-000 4,00" ak lag 4t!t± /44 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J Benchmark Dosing o2 Aeration Bldg. Sewer Holding St/ Ht Inlet .33 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic y 3 NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe /,7 .6 Holding Bot. System 3 f PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand pg QQ. Model Number GPM TDH Lift Fr' ion System TDH Ft Forcemai n Len th Dia. Dist. To Well Head SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 e DIMEN I N LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O 4U_40 CHAMBER Model Number: System: xJ ,4 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges - t' Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN 09.29.18.140,SE,SW 1128 100TH AVENUE LOT 3 Plan revision required? ❑ Yes L7 No 1,411 Use other side for additional information. (a ~v 7 SBD-6710 (R 05/91) Date pe r' , ignature Cert. No. ADDITIONAL COMMENTS AND SKETCH a = SANITARY PERMIT NUMBER: I Safety g l SANITARY PERMIT APPLICATION Bureau o Building Water System! 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 Sa~trsiOnl/tci itary Permit Number The information you provide may be used by other government agency programs ❑ Chec'K pr~evi5 application (Privacy Law, s. 15.04 (1) (m)J. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prop rtyOwner Property location 1/4 1/4, S T , N, R V(or Property givner's Mailing A~1 ss Lot Number Block N ber City a Zip Code Phone Number Subdivision Name or C umber Ill. TYPE F BUILDING: (check one) ❑ State Owned ❑ !tr Nearest Roa Public 1 or 2 Family Dwelling - No. of bedrooms O Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) &x/ 7 1-251 E] 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. LA New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _____System________System______ ____TankOnly Existing System _____Ex)stingSystem 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 [N 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. nch) Elevation 97 VII. TANK Capacity Feet 9_-2 Feet INFORMATION in gallons Total # of 's Name Prefab. Site Fiber- Ex per- New Exist in Gallons Tanks Manufacturer Concrete Con- Steel glass Plastic App structed Tanks Tanks Septic Tank or Holding Tank G S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the dersigned assume responsibility for i allatiom of onsite sewage system shown on the attached plans. Plum er' a M 1_~ - Plum r' gna N a S) MP/MPRSW No.: Business Phone Number: / l Plumber's Address ($t~et, Ity, State p ode): ' ,CC ra IX. COUNTY f DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial Surcharge Fee) > Adverse Determination p 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. Changesin 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. 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 isto 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. u pc t2s ' I L t 7~Z 1 I I rn- j } i~ r INI . . 7= 9 - f. f Ili1 ~ ~ Wisconsin Department of Commerce $ TE EVALUATION 'Di'vision i6f Safety and Buildings llPage _'L of Bureau of Integrated Services in ths,~ IL 83.09, Wis. Adm. Code .L/. County Attach complete site plan on paper not less than 8 1 incf i ~plar m J Coun include, but not limited to: vertical and horizontal r f ce point (BM), direction an percent slope, scale or dimensions, north arrow, a atioq ~rW diftwcei"ares a . Parcel I.D. # JJ I`a Q0 ORO!)( APPLICANT INFORMATION Please P " H inforac l m. Reviewed by Date c~E . 1 ,{J) Personal information you p vide may be used for secondary urn (d~i►~~d s ► Properly Owner erty Location Govt. Lot 1/4 75~j 1/4,S T N,R (oro Property ner's Mailing Address Lot # Bloc Subd. Name or CSM# l S S - City Stat zip Code Phone Number ❑ City ❑ Village [Z~ Town Nearest Road New Construction Use: ECI Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2_, _~__trench, gpd/ft2 Absorption area required _bed, ft2_2_ trench, ft2 Maximum design loading rate bed, gpd/ft2-., Z trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site conss.derations Parent material ze cz~«~ 9Sr~ 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 ❑ s ❑ U ❑ s ❑ U ❑ S ❑ U ❑ S ❑ U 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 44 Ground 3 ~ft. W7 Depth to limiting factor in. Remarks: Boring # f h '2 Ground / i , s a .~as elev. i zL'a 9ft. 19- Depth to limiting factor ~in. Remarks: CST Name (Plea Pr' t) ` Signature / / Telephone No. Address Date CST Number V 1 _ 9412 SOIL DESCRIPTION REPORT PROPERTY OWNER Page '-1-2 of ~ ' PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trend -2 Ground / Z7S 'plev. ft. Aiz c Depth to limiting factor Remarks: Boring # Ground elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground ; elev. ft. Depth to limiting ; factor 'n' Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor 'n' Remarks: SBD-8330 (R. 07/96) / , J./a al 4: 4114 G, yo : . L 4 : . I f ~ f ~ t , ~ 1 i I I 1 i I r t ' f t ! ' I i i ~ ~ I I- I-- j- j 1 I ~ f j r { i i } 1 ~ I 1 j I j ~ ~ ~ E } i i ' ~ , { I ~ + I i 1 i i . ~ i ~ } + I ~ ~ 1 r t ~ 1 I I , ~ f f . I ~ ~ , ~ ~ I ~ I ~ ~ ► i ! ~ ~ f I ~ f i f ~ ~ ~ ; _j ~ ~ i ~ } - - 1- ~ - 1 f { ~ ~ ~ 1 ~ t I r j j I I ' ~ 1 f 1 I _ - _ - ~ ~ i i t. I . ~ , i i i ~ ~ i i i ; I i i l , 1 1 i ~ f ; s~ I 1 i ~ I r t r ~ ? ~ ~ I i f' I ` I!`? f~ 4~ r j t 1 i ~ i ~ . I , ~ F - _ { - I f ~ , ~ ~ ~ i ~ t ~ I i ; } 1 ~ ~ ~ ~ ; ~ ~ ; ~ i ~ i ~ ~ I ~ ~ ~ r # ( 1- t i ~ _ I i ~4 ~ ~ a , , J I ~ I i } ~ ~ ~ ~ I I I i ~ I } I I ~ ~ ~ i ~ I 1 I { i ~ i 1 ; ~ ~ i ~ ~ + ~ I _I i ~ ~ ~ f _ _ - i I I ~ y _ r ~ ~ { I r ~ f , ~ j ~ ~ ~ C ~ ~ ~ ~ ~ jl - I 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 289304 Permit Holder's Name: ❑ City ❑ Village TI-Town of: State Plan ID No.: NELSON, GARY WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 042-1024-70-000 TANK INFORMATION ELEVATION DATA A9700118 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Verit irito ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Septic NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syestem TDH Ft Forcemain Length Dia. FFii Dist: To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN 09.29.18.140,SE,SW 1128 100TH AVENUE Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I i i Safety and Buildings Division ~ii..'r'■ : SANITARY PERMIT APPLICATION Bureau of Building Water System: 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 sa ~y7erNu~rlber 30 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. APPLICATIOAll INFORMATION - PLEASE PRINT ALL INFORMATION Properyyj0w er Na Le Property Location ,j' _ 1/4 1 /4, S T , N, R ,E (or~ Propert y is Mailing E}ddr ~ss Lot Number Block Num er Z42 6k Cit to ))E I Zip Code Phone Number Subdivision Name or_CSM Number ( ) 111. TYPE F BUILDING: (check one) ❑ State Owned City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 ❑ VII age Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo/may 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. CX New 2. ❑ Replacement 3- ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System SystemTank 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 g 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./i ch) Elevation Feet W, C9 Feet 911%, q11111 9~7' VII. TANK Capacity in gallons Total # of r Prefab. Site Fiber Ex er. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic Appstructed Tanks Tanks Septic Tank or Holding Tank s ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber El 1:1 13 El ❑ VIII. RESPONSIBILITY STATE-MENT I, the ndersigned, assume responsibility for insta ' i th n ' e sewage system shown on the attached plans. Plu er' ame- (Pri Plumber' Si ur t s) MP/MPRSW No.: Business Phone Number: P umber's dress ~et, State Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sagitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) A IApproved 4 Surcharge Fee) E] Owner Given initial do Adverse Determination 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- 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. ~17f as . 4 7s- - . sir' Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labpr 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 St. Croix 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. 042-1024-70 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Gary Nelson GOVT. LOT SE 1/4SW 1/4,S9 T 29 N,R 18 ]&or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 414 S. Division Apt. #2 3 na csm 11-319 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE nOWN NEAREST ROAD Roberts, WI. 54023 (715)749-3001 Warren 100th. Av.e [ New Construction Use [x] 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 • 5 bed, gpd/ft2.6 trench, gpd/ft2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.30 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material glacial out-wash Flood plain elevation, if applicable na ft 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 CRS ❑U (RS ❑U ❑S JZJU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-12 10 r3 3 none S1 2csbk Mfr 9f 1 2 2-42 7.5yr4/4 none sl 2csbk mfr gW if .5 .6 Ground 3 42-57 7.5yr4/6 none fs Osg mvfr 9W na .5 .6 elev. 100.8 ft. 4 7-80 7.5yr6/4 none ms Osg mvfr na na .7 .8 Depth to limiting factor +8 Remarks: Boring # 1 0-11 10yr3/3 none sl 2csbk mfr cs 2f .5 .6 2 2 11-20 10yr4/3 none sl 2csbk mvfr gW if .5 .6 3 20-72 7.5yr4/4 none sl 2csbk mvfr gw na .5 .6 Ground elev. 4 72-82 7.5yr4/6 none fs Osg mvfr na 5 .6 100.9 ft. Depth to limiting ,r factor +82" F Remarks: S, t;FOX CST Name:--Please Print Gary L. Steel Phone: 715-246-6200-'? ' \ 4 Address: 1554 200th. A New Richmond I 54017 Signature: Date:4-11-97 CST et! m02• PROPERTyOWNER Gary Nelson SOIL DESCRIPTION REPORT Page 2 . of 3 PARCEL I.D. # 042-1024-70 ' Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD/ft Boring # Horizon in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed Trer 1 0-16 10yr3/3 none sl 2csbk mfr cs 2f .5 .6 3 2 16-5 7.5yr4/4 none sl 2csbk mvfr gw if .5 .6 Ground 3 55-8 7.5yr4/6 none is Osg mvfr na na .7 .8 elev. 100.9 ft. Depth to limiting factor +8 Remarks: Boring # 1 0-12 10yr3/3 none sl 2csbk mfr gw 2f .5 .6 2 12-2 7.5yr4/4 none sl 2csbk mfr gw if .5 .6 3 25-57 7.5yr4/4 none sl 2csbk mvfr gs na .5 .6 Ground elev. 4 157-82 7.5yr4/6 none fs Osg mvfr na na .5 .6 100.7 ft. Depth to limiting factor +82" Remarks: Boring # 1 0-18 10yr3/3 none sl 2csbk mfr gw 2f .5 .6 2 18-58 7.5yr4/4 none sl 2csbk mvfr gw if .5 .6 3 58-78 7.5yr4/4 none fs Osg mvfr na na .5 .6 Ground elev. 100.3 ft. Depth to limiting factor +78" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Gary Nelson 1554 200th Ave. CSTM2298 SEgSwg S9-T29N-R18W New Richmond, WI 54017 MPRSW 3254 town of Warren (715) 246-6200 Jot #3-csm 11-3198 N 1"=40' BM.= top of Mid-lot survey stake Alt. BM.= top of Tel. ped @ el. 99.90' ,,~la G 6\ 22' r1r7& ' Gary L. Steel 4-11-97 PAEiE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEWT CAP 4 " VENT PIPE rFj WEATHEKPKooF APPROVED LOCKING JUWCTIOM BOX MA►JHOLE COVER W ITM 25' FROM DOOR, WARNING LABEL WINDOW OK FRESH ItMIU. I AIR INTAKE GRADE I y" Mw. I6/`'IW. COIJDUIT 15'MIN. 11~ INLET PROVIDE I--__ AIRTIGHT SEAL I I i I ~ I I I \v/ APPROVED JOIW7 A I (I I APPROVED JOIWTS W/ PIPE I III W/ ' PIPE EXTENDIIJG 3' I II ALARM EXTEUDIUG 3' 01JTO SOLID SOIL E I II ONTO SOLID SOIL I I I I ON C CLEV. FT. PUMP-_ b OFF 0 COUCKETE DLOCK RISER EXIT PERMITTED OWLy IF TANK MAUUFACTURCF, HAS SUCH APPROVAL APPAOVEN BEDDING "ndcr 'Irr4paK SEPTIC E SPCC.IFICATIOIJS DOSE TAUKS MAWUFACTURER: IJLIMBER OF DOSES: PER DA-4 l TANK SIZE: GALL/!DQS DOSE VOLUME ALARM MAUUFACTURLR ~ /`~/il mfr NC INCLUDING 6ACKFLOW: l~ GALLONS MODEL WUMBCR: CAPACITIES: A= INCHES OR GALLONS SWITCH TYPE: g=_2 INCHES OR GALLONS PUMP MANUFACTURER: r C =IWCHES OR GALLOU,S MODEL NUMDCR: D- _INCHES OR~ GALLONS SWITCH TJPE: AJOTE: PUMP AUD ALARM ARE TO DE MWIMUM DISCHARGE RATE GPMLD/S"~ IN5TALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKEIJCE DETWEEU PUMP OFF AUO DISTRIBUTION PIPE.. FEET + MIUIMLIM METWORK SUPPLY PRESSURE/. . . . . . . . FEET 14!24-- FEET OF FORCE MAIN XF/Ip~ rr,FRICTIOU FI.CrOR.. FEET TOTAL Dy1JAMIC. HEAD FEET IIJTERAJAL DI- MEIJ OAJL OF TA t,E►.1GTh -1~(IC)TN -;LIQUID DEPTH SIG~JE _ LICENSE NUMBER: IDATE:~ r luent Performance z ubniersibl ff Curves Pumps METERS FEET 90 MODEL 3885 25 80 SIZE 3/4" Solids WE15H 70 S 20 - WE10H 60 0 -WE07H 15 WE05H 40 10 30 WE03M 20 WE03L 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L i i 0 10 20 30 m'/h CAPACITY (]DGOULDS PUMPS, INC. Sek(:A r-AUS NEW YC);M ai, METERS FEET 120 MODEL 3885 35 110 WE15HH SIZE 3/4" Solids 100 90 25 80 70 Z 20 60 O WE05HH 50 -Ti 15 40 10 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L i 0 10 20 30 ml/h CAPACITY • 1985 Goulds Pumps, Inc. Effective July, 1985 C38AC S g FILED DEC 2 6 1996 ► sa Reg st r ° Deeds 553663 St MixCO.,WI ~I r' CERTIFIED SURVEY MAP GORDON TRUESDILL JR. Part of the Southeast 1/4 of the Southwest 1/4 of Section 9, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. UNPL A T TED L ANDS Owner's Address : N 89 ° 44 ' 34 "E 1112 100Th Ave. 225.00' Roberts, WI 54023 O o W 2 O O J M ° yl N W a mm LOT 3 O a OI N ZI L 94,545 S0. FT. (2. 170 AC.) - k m INCLUDING RIGHT-OF-WAY 'n O i Z N 87,120 SO. FT. (2.000 AC. J O I Q g QI ^ EXCLUDING RIGHT-OF-WAY N O QI W j p h o of = Q~ O N QI ~ J~ ROAD SETBACK LINE O JI Q ~I W ) 2 d jl =I /001 JI Q O W W Driveway position N B9° 44 34 "E m h 225.00' L /572.80 M s~ ~ l9K 225.00' T M 858. 80 /00TH S 89* 44 ' 34 " W -_R fN90-00100"W). R(NB913110011w) AVE. M SOUTH LINE OF THE SWI14 SW COR. SEC. 9, T29N, R/BW, LOT S 114 COR. SEC. 9, 7-29 N, R/BW, (COUNTY SURVEYOR'S MON. ) 4 OF (RAILROAD SPIKE SET FROM CERT/F/ED SURVEY COUNTY TIES 1 MA PN_VOL PAGE 216 ``,~N~uuNep~,'i - S G O NSA INDICATES SECT/ON CORNER ftMENT Vv • ( AS NOTED) ~ O /ND/GATES / "X 24" IRON PIPE z LAUR NC•. t~1~ t1 • WEIGHING 1.68 LBS. /LIN. FT. SET. y4 g ~Ll~ m W M Rp Cm 40 R (N90'b') /ND/GATES PREVIOUSLY RECORDED - S ~3 CERTIFIED SURVEY MAP GORDON TRUESDILL JR. Part of the Southeast 1/4 of the Southwest 114 of Section 9, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. Description: That certain parcel of land located in the Southeast 1/4 of the Southwest 1/4 of Section 9, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, more fully described as follows; Commencing at the South 1/4 corner of said Section 9, thence S 8944'34"W (assumed bearing on the South line of the Southwest 1/4 of said Section 9) a distance of 858.80' (recorded as N 90'00'00"W and N 89' 31'00"W), to the POINT OF BEGINNING, of the parcel to be herein described; thence continue S 89° 44'34"W 225.00' (recorded as N 90'00'00"W and N 89°31'00"W); thence N 00°15'26"W 420.20; thence N 89 44'34"E 225.00; thence S 00'15'26"E 420.20', to the POINT OF BEGINNING, containing 2.170 acres or 94,545 square feet, being subject to easement over the Southerly 33.00' thereof for town road purposes and also being subject to easements of record. Note: Each parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developin an arcel the St. Croix County Zoning Office and the appropriate Town Board for advice. g y p contact This instrument drafted by J.W.G. Dated: October 17, 1996 State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Gordon Truesdill Jr., I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and correct representation thereof. LAU N ~ r m W R HYI • 713 N RI FALLS,r <4 F WISc. Q`J 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 recording. Owner of property -L:;_ Location of pr perty:jl/41/4, Section N-R_& _W Township ,C Mailing addr ss Address of site 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 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume Z2,.~ and Page Number l ' 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. Sig to of Applicant Co-Applicant ems' - l` 9 ~ Date o ig ature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS Z 1, / 1 ROPERTY ADDRESS (1 ation of septi system) Please obtain from the Planning Dept. CITY/STATE IA'l PROPERTY LOCATION 1/4, Sw 1/4, Section 'I' N-RIg-,' W TOWN OF 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 I, 1978. St. Croix County accepted this program in August of 1980, with (lie requirement that owners of all new systems agree to keep their system properly maintained. 1-he 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) aficr 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: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 is P~ r, 558513 WARRANTY DEED DOCUMENT NO. VOL 12-35 PAW?65 This Deed made between GORDON A. - REGISTER'S OFFl^ TRUESDELL a/k/a Gordon A. Truesdill, Jr., Grantor ST CROIX CTY., WI and GARY D. NELSON and J. NELSON, ►+dcar+ husband and wife as survivorship marital property, AP R 2 8 199'T, Grantees, 11:2o A.M Witnesseth, That the said Grantor conveys to 44 ldAit 18 Grantees the following described real estate in St. Croix tieplster of DeeCounty, State of Wisconsin: SEE ATTACHED LEGAL DESCRIPTION PARCEL NO. 42-1024-70-000 RETURN TO: 1_ 7'--06&, AVAlvay IT IS AGREED AND UNDERSTOOD THAT PARCEL B IS BEING ADDED TO PARCEL A~ TO CREATE ONE PARCEL UNDER CHAPTER 18 OF THE ST. CROIX COUNTY LAND USE REGULATIONS PURSUANT TO SEC. 18.05(A)(3). TRq~SFER This is not homestead property. fir.. Together with all and singular the hereditaments and appurtenances thereunto belonging; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. ~-W Dated this y day of April, 1997. Gordon A. Truesdill a/k/a Gordon A. Truesdill, Jr. STATE OF WISCONSIN )SS ST. CROIX COUNTY Personally carne before me this a S day of April, 1ih a above nam Gordon A. Truesdill a/k/a Gordon A. Truesdill, Jr., to me known to be the person executed the going instrument and acknowledged the same. Notary Public, Sate Wisconsin My Commission expires: / / j C0v THIS INSTRUMENT DRAFTED BY: Robert W. Mudge Brenda Poulin MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. Notary Public 110 Second Street, P.O. 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