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HomeMy WebLinkAbout020-1049-40-000 3 0 o p e» Oq > h O C E O O d) a o of m 3 T, N N a a O L L U N ,n O 2 0°30 .p 3 3 N O N 3 I p as Y > C a N O 3 0 o m n _ `Q O X a ' W a N N .0+ N C 0) O N m O O N i a N 3°oa a=i a N OppQ) Q) o p > C ~'~(V _0 L co 7 N O Y N° X- 3 LL w C C X o _ a _ N (0 N E O U N L) C N fOEaair3a>CD n o a > E Q m> 3 U C m in N U (0 V a a~ ~ N E OO Z = Z m ° H w a Z c 0 o z v v o d Z c O fA F- ~ O ~ Z c E -o a co N N ~ cu 3 ~ O `n N N ~ C • N U) ° O m Q o z m z o LO z a E E = 3 C M E Z Q) N 10 0. c N 2 0 d N ° N (D a .0 E E o w o E co H FN- FN- 0 0 0 Z o •N m a a m a N CL x N D o vgi o 0) ° N J U rn rn Z a v 04 m ~2 o 0 0000 ;5 0 C:) E U N N a) 00 r"a • i i " a o 3 00 ° m " o = E 0) r- 9 m o 0 3 c N y B a) o r \ V O C O- 0) N ] 0 ~ J (n c E Q) In O y C - N O 3 N ~I W W 00 Z' ~ N N N Z) j N m E U • b?' o °N S Y N o N o E d rn m a V cr c A ; m o A U a O m U STC - 104 AS BUILT SANITARY SYSTEM REPORT ti OWNER N N KKU CK ADDRESS VB~y WI~IUIJ R1~Gz KOA0 kk OSU N ! r(-- SUBDIVISION / CSM# W'111ow U r LOT SECTION -10 T a9 N-R_IL_W, Town of 60soN ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN.100 FEET OF SYSTEM 800 yn! Sept 39, ut a o Q a3 3S 7' fume vaywel~sJ 30, wd , 8 ~ e° b~11~PWq Note : RolA d-c one stet c 1-ak) k i s 0V rg outlet 64W-P n✓ INDICATE NORTH ARROW a Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r 7 BENCHMARK: Blom ✓ N cokh(K of vng i Q Y =10G ALTERNATE BM: 10 USeb U(d SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION C : /060 of pODcd Manufacturer: wt-'-KS Liquid Capacity: OU y$OU yp, Setback from: Well0V(F S6 House aY Other d~ '1 O MPK~ Pump: Manufacturer Model# Size V)enV-60r' Float seperation ~ Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length__~a Number of trenches Distance & Direction to nearest prop, line: `7 Setback from: well: OVCN 50 House 9(•`f 5 - q ~ S 7 fj other 16 8' keAOCR ELEVA i QNS Building sewer +1 Cuve2 g ST Inlet a 4--1 93.98 ST outlet d - 93-7a 99.31 PC inlet PC bottom r.. Pump Off vAlve Header/Manifold Bottom of system90-33 93.7a New G14 Sy S. j-em Existing Grade Final grade 3$ DATE OF INSTALLATION: g 13 T(0 DArPA Sy Qm PLUMBER ON JOB: ' f - ~S WAS LICENSE NUMBER: INSPECTOR: 3/93:jt ' Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page j of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, 'It . UNTY~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. P st i CYO x not limited to vertical and horizontal reference point (BM), direction and % e, sch L I.D. # dimensioned, north arrow, and location and distance to nearest road. t\ AU G INFORMATION-PLEASE PRINT ALL INFORMATIO BUG Z i 19 r R ED BY DATE -A OT PROPERTY OWN Z : Bit PERTY All 11 "P V9F1`L ' 1:W4 S ZOT' 2_9 N .R E (or)ffl ORERTYOWN6k:ShAAIL1NGqJ_w NG RESS L y taLpCK ErOC r# CIT)(,~TATF ZI CODE PHONE NUMBER []CITY VIL GE ®fOWN NEAREST ROAD j,Ld 1^ [ ] New Construction Use ( Residential / Number of bedrooms [ J Addition to existing building Pi Replacement [ j Public or commercial describe Code derived daily flow 400 gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area requited F SS bed, ft2 0~ trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 740%, It (as referred to site plan benchmark) Additional design / site considerations 191111, Parent material Flood plain elevation, if applicable ft S s Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM FILL HOLDING TANK U- Unsuitable for system J'S ❑ U ❑ S W S❑ U 0 S 'EAU ❑ S ❑ S loU SOIL DESCRIPTION REPORT Boring Al Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o- s o w 3l;,, 7/ 7- w lr l y Ground H /35 __7 S r s r►^ Depth to limiting' lJ it~tr+-, Jactor rM Remarks: Q, Boring # VYt z `'-2e ' /p 'Yory S or-S Ground G v .Q ZIA Depth to limiting Sfacs_ Remarks: T Name: e/ TIT, 4)e Phone: 745 9v a 0 Address: Signature: Date: CST Number: ~-~,4~ 4Z G 0 0 301f 17 PROPER`rYOWNER SOIL DESCRIPTION REPORT Page-of PARCEL I.D. ! Depth Dominant Color Mottles Texture Structure Consistence Bourxby Roots GPDJft Boring Horizon In. Munsell Qu. Sz. Cont Color Gr. Sz./Sh. Bed Wendt Ground o ey S s H s I - `7 cSr ft t Depth to tlmidr~g, Remarks: Boring # C&6 2^~7 0 t S 9 C.c.s - S I G o Ground elev. ft Depth to _ Mrig fagot Remarks: ~ Boring # L.J Ground elev. ~ i Depth to dtrddng factor t -A I Remarks: Boring # i . i Ground elev. ft. Depth lb ' Nntidng facbr Remarks: sso-e3MR.06roz) Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor andNumanRelations INSPECTION REPORT . er0 -Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.: r r 6 19 CST BM Elev.: Insp. 13M E1 6v.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA pq&p p 50 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic naG,5~ //60 Benchmark ' w s e. ~ 3,~6 lcJ. C;~ Dosing Aeration Bldg. Sewer Holding St/,wf Inlet TANK SETBACK INFORMATION St/ Outlet 90, 7-2 TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet Air l Septic NA Dt Bottom Dosing NA Headers S i~ 30' Aeration Dist. Pipe Hold in Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ~aG ,f~7 < 9S 3 S! j 3 Mo el Num q, S3 9 v't 3 TDH Lift Lriction TDH Forcemem Length TDia, Dist. To wen' } fi ' C~,/~ z s!54S 9~ 3/ SOIL ABSORPTION SYSTEM BED / TRENCH Width Length 7a , No. Of Trenches P No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~a DIM SYSTEM TO P / L BLDG WELL LAKE / STREAM urer: SETBACK INFORMATION Type O i T Model Number: System: /t ~oE ? 5S~ ~4 OR UNIT DISTRIBUTION SYSTEM Header elder Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Y Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Depth Over Depth Over xx Depth Of xx See Sodded xx Mulc e Bed /Trench Center Bed /Trench Edges Topsoil L'ET-Yes ❑ No ❑ Yes ❑ No COMMENTS: (include c►/o/de discrepancies, persons present, etc.) ~0 11aA, 12-112 Plan revision required? ❑ Yes ❑ No Use other side for additional information. I F SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System- 2Q1 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 81/2 x 11 inches in size. Sf . CK6 • See reverse side for instructions for completing this application State Sanitary Permit Number a&?5g7 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. APPLICATION INFORMATION -PLEASE PRINT ALL INFOR TION Property Owner Name Property Location N tK 114 W 1/4, s T Q9 , N, R 9 E (or)Q Propert Own 'S Mailing A dress -p~ Lot Number Block Number e 1 A W R A A, pog Cit State Zip Phone Number Subdivision Namg or SM Num UD3o~ ( M~ W~ f o 1~ e II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City '-J I Nearest Road Villae Public 1 or 2 Family Dwelling - No. of bedrooms E] pl~Towgn OF WpSohJ ItJ`(A a1.i ;I 't ilp III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ©;,0- J10415-L16 (1?043~ 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. ❑ New 2. [Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an System ystem 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 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 / Re wired (sq. ft.) Prop seclsq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 1-Po ~ qZ .J)8 Feet (?(--3k Feet 1 -7 VII. TANK Capacity gallons Total # Of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concr to con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ 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'sS' nature: (NO Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address{Street, City, State, Zip Co` 1" 1W6 HW 5 Null 414 ~ ).SC- S U IX. COUNTY / D ARTMENT USE ONLY ❑ Disapproved Sanitary 7Permit Fee (includes Groundwater ate Issued I ng Agent Signature (No Stamps) Approved ❑Owner Given Initial raiVA Surcharge Fee) l 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- 11. 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, etcj-, 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. P (3 6-7 _ PLOTA 1-1 NAME N- N~A M E yT m n I4' L 0 C A II O ,Nl_.Q'i 1.1Q 1_ . LICENSE / Nofic n4ceNfi lour l,Jells' pry ' t{,~ , T A n~ G.c {Z 'f ~ p,••I /V IJ , ~{CU ~ S P ~ ~ ~ ' . 5-,j P 1' t ~n rr S.j~ a -S~sfiM K Boo Ca~N arc o 6pa fey - I OU .Q . 0. o.;:. o- B Pik Y115 . 1 • • O8 O fxi~~~ ti R,,u Q I ftiq I Q00 jPI S I.L FRESH All' INL['TS AND ODSEimrioN PIKE w _ CROSS SECTION Approved Vent Cap Minimum 12" Above ~~wb 4" Cast Iron Above Pipe Vein Pipe To Final Grade' - Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor P,%4 Human Relations •~Dn ..-kn of Safety 8 Buildnps 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 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVI DATE Al; 117 PR ERTY OWNER: PROPERTY L ATION .i ` ~ JAI GOVT. LOT ;114 t 1/41 (Jl ,N. E (or) 'W kr LL to- 67 or d I PROP RTY OWNER': ILING fDDAV.d LOT # BLOCK # D. >>;,SM # \ CI ATE ZIP COD PHONE NUMBER ❑CITY ❑V LA E NEA D J (l5 > 3Sh - 3/ I~/1 New Construction Use Residential / Number of bedrooms (J Addition to existing building pGf Replacement (J Public or commercial describe Code derived dally flow W _ gpd Recommended design loading rate _ bed, gpd/ft2 • trench, gpd/ft2 Absorption area required J bed, 11:2 7~a trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation() Uft (as referred to site I benchmark) Additional design / site considerations S S ti tii 1 U' Parent material Flood plain elevation, if applicable Al/A _ ft $ =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE '7SYSTEM IN FILL HOLDING TANK U = Unsuitable for system ,aS ❑ U ❑ S U S ❑ U 13 S 'PU ❑ S ❑ S P~rU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bou fty Roots GPD/ft Boring # Horizon in. Munsell Qu. . Cont. Color Gr. Sz. Sh. Bed Trench o.-~ S /h ✓ L -A t7 3/2,, 13 0 fd s 1 c~ - , s 5,. Ground 3 113~420"ALX S s r ft• Depth to limiting factor 33 , Remarks: Boring # bl. 3 f,"-,Z p S C L S c Ground 1 - y l2q -7 11/ im 41, Ors t"I Depth to limiting factor l 5 > A Remarks: T Name:a PCt• t e' ( Phone: ! jS G 2 v ftnadue' Date: 7 6 CST Number: ~7i1 06 jX3 PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boux>ary Roots GPD/ft~' Boring # Horizon in. Munsell Chu. Sz. Cont Color Gr. Sz. Sh. Bed Trtch 40 1 1 61,d Ground -3 01 / 7 g !K4 Depth W limiting IaCtDr Remarks: Boring # A Ile E E3 ~ l~S D W1 - 4 ~2 s Ground elev. . K Depth ID limiting factor Remarks: S CtiG a-e Boring # Ground elev. It. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth 10 limiting factor Remarks: SBD-8330(R.05/92) P C -30~3 ,YP I ~l i 1 r ~ a a ~ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving 1.he LN N K~1a; Q 11 residence located at: Sec. a , T ~4 N, R_1 W, Town of ~uIDSpM , St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and ti n, and it appears to be functioning properly. baffles to be in good cond~10 Last time serviced 3 Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: / Construction: Prefab Concrete ✓ Steel Other Manufacturer (if known): Age of Tank (if known): - (Si ture) (Name) Please Print MfgA-('C- ~c iK A na ~ ~ -SV()y (Title) (License Number) ~ 1a (Date Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature MP/ RS 3 i i i STC - toS SEPTIC TANK NIAINTEIN, NCF', i,,G l-'.v"N1 E'N'T i St. Croix Coranty 7 OWNER,L3UYER s I IMLING ADDRESS ( PROPERTY ADDRESS %zt (location of septic system) `lease obti~n tip.: '1mming Dept. CITY/STATE, Q~J' ~_~.L S yd!(p PROPERTY LOCATION b W 1/4, ItAd 1/4, Section c2O 1'yl ~~tl ?-IZ ~y TOWN OF 0L10411lc2y ST. CROIX COUNTY, WI SUBDIVISION LOT N-UNWER CERTIFIED SURVEY MAP 42411 , VOLUME-,PAGE - LOT NUMBER - I 751 36 _ a i 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 I 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. t 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. llie 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. U\Ve, 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: - i DAM:: 4 St- Croix County Zoning Office ! Government Center 1101 Carmichael Road z I Iludson, W1 54016 I I/`)3 i 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.~ir~itJ£L4 C 1sfJ~~ Location of 37opertyt)c&1/4 1/4, Section aN-R W s Mailing address LCDc_ ~ T n hip U~~ Pc9~ Address of site sf~ Subdivision name ltlo cle Lot no. Other homes on property? -Yes No Previous owner of property t - ~ A ffAQ641 Total size of property A ,:r- /4!, -y Total size of parcel c,'2:fs Date parcel was created Clylt`Nc9tv,J Are all corners and lot lines identifiable Yes No Is this property being developed for (spec house)? Yes _ No i_ume 71 and Page Number 35-6 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 recorde ` n thi~ 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. Si` ature of ppli.cant Co-Applicant 19& (~~l ~1 A q4 (~6 ~1 Date Signature a Si at rle • I 1 DOCUMENT NO. WARRANTY DEED THIS t►ACt RtttRVto roo RtcoROIMG DATA STATE BAR OF WISCONSIN FORM 2-1982 41Is"O8a BOOK 151 PAa 356 RE61STERS OFHCE ST. CROIX CO., wt& ' Rec"d. for Record lbb 21 s t WILLIAM.-.D~...MAKI__and. KARE,N..A,..MAKI1...~tA~ a??cd... ....Aad..VifQ..A%VjLQ .nt...tenax%to d of Aug .A.0. 1 a 1:00 P W conveys and warrants to LYNN..B,•-,KRU.FiCT.FiA...aRd 4 G]r EL.T&. A..-..KRUEGER,...husband..and.-wife ..as QUA UX.Y-iYorshi.p.. maxi-tal..proper.ty FIRS] FEDERAL SAVINGS b t0AN RtTUR 610 2N0 STREET ..............................9t..... amok imsmon sell the following described real estate In . •....'+rOiX .........................County. _ State of Wisconsin: Tax Parcel No: Part of NW 1/4 of NW 1/4 ?n Section 20-29-19 described as follows: Commencing at NW corner of said NW 1/4; thence S 0003140" E on W line of said NW 1/4 1072.72 feet to Place of Beginning; thence N60056120" E 98.0 feet; thence'NEly on curve to left, radius 433.75 feet, central angle of 37055100", for 287.04 feet; thence N23001120" E 101.43 feet; thence N 79040'25" W 319.46 feet, more or less to W line of said NW 1/4; thence 50003140" E on-said W line to Place of Beginning. SUBJECT TO street purposes over SEly 33.0 feet thereof. Outlot 6, Willow Ridge Second Addition, located in the Southeast Quarter (SE 1/4) of Section 18, the South one-half ( S 1/2) of the Southwest Quarter (SW 1/4) of Section 17, and the Northwest Quarter (NW 1/4) of Section 20, all in Township 29 North, Range 19 West, according to the recorded plat, St. Croix County, Wisconsin.' Together with a permanent easement over that part of Lot 70 of the above plat occupied as a permanent driveway transversing said Lot 70. Main- tenance to be the cost of the grantees. TRANSFIN This is homestead property. $ .7 (is) (inimet) ti Exception to warranties: recorded protective covenants, easements and restrictions of record, if any. Dated this ay of .................August............. 1986.... ............(SEAL) • AL) • • ...William..D...Maki....... 1 (SEAL) ~~---..4!. t..-k+~ (SEAL) ! Karen A. Maki ~I AUTHENTICATION ACENOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. authenticated this ........day of 19 Personally came before me this -_-A~....... day of August 19..86_ the above named AY PO o e1 liam D. Maki and TITLE: MEMBER STATE BAR OF WISCO I .1ilat ; ren A. Ma 1 (If not............................................. E -51 1 _ authorized by 706.06, Wis. State.) XHOMN'O (g a known to be the perso g.......... who executed the egom en nd ~rf1~C1n/Qwledge the same. THIS INSTRUMENT WAS 172RAFTM RV /1 is