Loading...
HomeMy WebLinkAbout020-1302-40-000 \ 1 C p N O M O 3: o y o a I 4 C I N N y a ~ i x •'Y. O ` -ice (9 U U 6 O O C N LL c m O m 0 'B N 3 v Z N rn W O Z O Z d d r, N W a m N I- U) O O Z d U ~ I N O fn F- ~ ~ N Z c ~ •o N Ja N V~✓f~ Co y h ~ ~ y c • Py ~ LL (n ~ o .0 rD y O 0 O y Q U -o Z m z p N Q Z c c y c I N N 7l m O CO _ Co ~l '2 Q Z y O C O O Co v ~ LO Q a a ~ O O O _ N N N Co (0 Co H H O p"- O O N = N H O O O O 2 LL Z O O O -0 CL a. a. a = ' o N c m m N Co J U J rn a) ti m co a of 0 0 O O O C) N N_ 1 ' ~ `ti3 O M m CL CD U') 0) ~w~i O> Q G? Q m y O O U 2 C O O C 4 " p C G O C) 0 O 0 0 r c- Y N N N N V O~02 C - O c O N M M N L (gyp N H lI') O tf) 6~ NO r; N 0 N t= N U • y' O N= Q N O Cn O ~ w E O ~ Y t0 ~ ~ a a L a w r~ w ~ i C C w ~ 1 L~ u a 2 0 in 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS N syrti .5.S/13 SUBDIVISION / CSM# ~Gr/??/~Cy~~ /frGGS LOT # GIiN SECTION 2_T N-R1±_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM > ~o z SLOPE - Ao~ 0 rip of A-.OZL, 1411~ v 8 INDICATE NORTH ARR Provide setback and elevation information on reverse of this for Provide 2 dimensions to center of septic tank manhole cover. y BENCHMARK: ple- 10-1'.4-tCty ?-XA:;1 ALTERNATE BM: I-,dPAC6r- 4,,r^P SEPTIC TANK / PUMP CHAMBER / HOLDING TANK'INFORMATION Manufacturer:- Liquid Capacity: / ?CO i Setback from: Well ,n 3 House Other Pump: Manufacturer Model# z Float seperation allons/cycle: Alarm Location SOIL ABSORPTION SYSTEM -m-7`., r S Width: /.Z Length 7 $00' Number of fires Z. Distance & Direction to nearest prop. line: ! 7 3zz~ Setback from: well: House sy' Other ELEVATIONS Building Sewer" ' ST Inlet: /y p, ?Z ST outlet: W PC inlets PC bottom_ Pump Off Header/Manifold Bottom of system eg 74~ j57A1,P dro, 8 Existing Grade ~O-1 9 Final grade /0'2.6 DATE OF INSTALLATION: ,Z. PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, tabor and Human Relations PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 268679 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: ASCHENBRENNER, CRAIG HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 0 Dosing Aeration Bldg. Sewer Holding St/Ht Inlet 4.1 .S TANK SETBACK INFORMATION ' St / Ht Outlet ~ 6 TANK TO P/ L WELL BLDG. AirI to ntakeROAD Dt Inlet irl Septic ) NA Dt Bottom Dosing NA Header / Man. /00 '2 ;L Aeration NA Dist. Pipe Holding Bot. System , .2 PUMP/ SIPHON INFORMATION Final Grade Manufacturer C cs ' Demand Model Number GPM ~ a 3. 98 TDH Lift Friction System TDH Ft Forcemain Length Dia. If Dist.Toweli SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Li uid Depth DIMENSION ` ' / DIMENSIONS q SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Number: System: fok" ASV" t 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 [Bed h Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ,NE, ORIELE DR LOCATION: HUDSON.27.29.19W, SEY_4_2'5 W `Tr) 4~ /P f r.L./ iria f re •e,~ Plan revision required? ❑ Yes GT"No Use other side for additional information. SBD-6710 (R 05/91) Date InsY's Signature Cert. No. T ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~iI~i11Ti SANITARY PERMIT APPLICATION BureaSafetyu o oand ff BuiluildiinWater Systems gWater 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 51.1 • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it revision tb previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name SC Property Location e E _1i4 1i4,SZ T N,R E(or Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name oru P- S j. 1(,64&) !t( age Nearest Road II. TYPE F 'BUILDING: (check one) E] State Owned 11 Public 1 or 2 Family Dwelling - No. of bedrooms ❑ VII Town OF ,EL,E AA. III. BUILDIN USE: (If building type is public, check all that apply) arcel Tax Number(s) 1 ❑ Apartment / Condo 7 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. V1 New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 110 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./inch) Elevation 00 ,rg r_rx 7 .7 2 Feet Q ,O "Feet VII. TANK Capacity acitns Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank L(/ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of t onsite sewage system shown on the attached plans. P umber's Name: (Print) Plumber's Signature: (No Sta s) MMMPRSW No.: Business Phone Number-: Ti ber's Address (Street, City, State, Zip Code): 67 m13 IX. COUNTY/ DEPARTMENT SE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater EDate sue Issuing Ag nt Sig ture (N to ps) surcharge Fee) Approved ❑ Owner Given Initial ~ ~ Adve rse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBOTIOW-Original to county, One copy To: Safety & Buildings Division, Owner, Plumber R INSTRUCTIONS ` 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 maint4ined: The septic tank(s) must be pumped.by a licensed pVmper 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. 111. 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 experirental 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. i ~ d b 1 1 Io ~ I ~ o a S I x-74 -A j~ i N • 0 0 r.. s tit, J 4-20 Ise ~ Vl ~ ~ b ~ ~ ~ t7f2~~s © A91- 3 1Z ` I►n ~ ' ice---- c ~ u ~ ~ ~ Na ~zw~ V V1 m -4 toes 0 i w rL ~ iv Wisconsin Department of Industry, SOIL AND SITE EVALUATION Page of _ LaC ~tr al ' tman Relations Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code 10 ounty Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. P rr t include, but not limited to: vertical and horizontal reference point (BM), di oti C,F©~ percent slope, scale or dimensions, north arrow, and location and dista earest r*. r .D, # IfiaEIVF0- evi w by APPLICANT INFORMATION - Please print all inforrnOA t. Date Personal information you provide may be used for secondary purposes (Privacy ~ aw,, . 15.01 (T) (m)P. " Property Owner SL Props on ® ^ ~W C !R /-F 1/4,S 2 T Z N,R E Property Owner's Mailing Address Blo u . Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road E' /33 ( 6/,I- )GWJ'/fu/> oN o~'IEG~ ❑ New Construction Use: ,0 Residential/ Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate •.7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required ~S bed, ft2.trench, ft2 Maximum design loading rate bed, gpd/ft2- -Z-trench, gpd/ft2 i Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations "7 /3 Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound in-Ground Pressure AT Grade System in Fill Holding Tank ❑S ,0 u 2❑ U ❑s Ou ❑s O u ❑s O u U = Unsuitable for system S El 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 GS ~Si3X GJ+ L S r 7 Z -3Z_ y - ~S Z o s , Ground Y Z s j S ©SG `H~ elev. Depth to limiting factor in. Remarks: #L Boring # -I 01515-' h 7 3 829 2 L s o ~sr S . z 3 Ground elev. Depth to limiting factor r r Sri c in. Remarks: 3 CST Name (Please Print) Signature Telephone No. ~ Date CST Number Address 3.2 33 Md . ZB - w Q i x 0/ PROPERTYOWNER ,OIL DESCRIPTION REPORT , Page ~L3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench fY. 7 z - 'c CS SSG .z e'd,"- FR_ As Ground elev. 3 2_ _ FS SG L S - S G SG -L - Depth to limiting factor _ in. , Remarks: Boring # Ground elev. Depth to , limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots GPD/ft2 Gr. Sz. Sh. Boring # Bed , Trench Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) fi c i N2 i ~ w w ~ w ~ w i a y N r b N v o Z A s ; Page of 3 Wisconsin Departrnent of lh&mtry,, COIL A Nth. 'IT E EVALUATION R E P O RT Labor and Human Relator - r Division of Safety a Buildn~ in aWd with ILHR 83.05, WIS. Adm. Code [REMVNY TAttach complete site plan on paper nonwlffan 81/2 x 11 inches in size. Plan must include, but CEI I.D. # 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. IEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: 1111, 1--311 D /jFnFWP /d PROPERTY LOCATION ~/L B N e ti4GOVT. LOT S~ 1/4 N6 1/4,S T Z9 N,R /y' E (or) W PROPERTY OWNER':S MAILING ADDRESS i0'vea LOT # B# SUBD. NAME OR CSM # S~ ~ 336 *4•12og7R5 07. ~IUMQI kD H NEARESTROAD CITY, STATE ZIP COE NUMBER C]CITY ~111LLAGE [~tSW /•0V6 It1N• 55/0/ IG~) ii2-55_55 + UV-so,.~ New Construction Use ( k"esidential / Number of bedrooms ' °'P 3 Addition to existing building I 1 Replacement [ ] Public or commercial describe Code derived daily lbw Yg-oo gpd Recommended design loading rate bed, gpoltt2~trench, gp~ Absorption area required _ 7 bed, 112 ' )SD trench, n2 Maximum design loading rate bed, gP trench, ff Recommended infiltration surface elevation(s) S~ - 3 ft (as referred to site plan benchmark) o X 2S Additional design / site considerations ssP- 7Tve-,Je4-4 S o"j S /01'&_ w/ Parent material SG j -11 130 ee t~VD7- Flood plain elevation, if appli6able 414- ft S - Suitable for system MMMION►~ Mov - OMD.PRESSURE AT-G ❑ U SYST ILL HMOI G T ROE U- Unsuitable for stem [~'S a u [TS a U INes Cn O U o S SOIL DESCRIPTION REPORT GPD/ft Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed tench in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 13 S /~S~C -fie Z z -,W /6 & 31$1 S/ 2 f sh t f.~ rt s s 4 3 W-3~ , s X12, d.Q e.,5 Ground elev. Depth to limiting factor Remarks: Boring# F2- 0-S 16Vle 3lz CS El 5-11 16Y4 31S~ Ground S a( -C ~ ~ - 7 • d / C/, S . elev. 106e f S'0•o / ft. Depth to limiting factor-~"t- yr ; PROPERTY OWNER SOIL DESCRIPTION REPORT 3 Page 2 of PARCEL I.D.# 40 HVK D(P-0 Hit'-5 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft In. Munsell Qu. Sz. Gor!t Color Gr. Sz. Sh. Be n 7 7.5 v b - )6 16 Oe 3/ Sl Zf-5-ik ^-Fp2 mac. S if , 5 ~ Ground 2, S Y, e elev. Depth to 'I 7st y (e S . Q 7 = limiting ' factor 7U Remarks: Boring # 10-/~ 2-11 7 P~ Ground D 7•S y . S D S o~~ , elev. i q~ .75 ft. ' Depth to limiting f factor 11 i Remarks: Boring # D k /ole 3/-2-- S~ ~56,~ .,v► L -f- , .yi 2- Oft Ground 3 elev. 9137- i Depth to limiting facl/~ Remarks: Boring # Ground 010V i 30~ 3 - 13.2- /3-3 o/ 9-7-01 W w 13 -7 5; Sc~~E,/'' = 3 0 135 37 5 ~ 6 6~ 5 7 ~ 7P,5 Ale-k S%S TFM vet T i o-vs Cr;~ r9-- /3 r ' 13 - 133) 16 zo 'A 66 N Q i 1. C 2G 1 . R3 rro r-- 13,1 R M7 '16'E i`330.7y I ni N ' EL. = 969 / r, I I N PONDING v EASEMENT N LOT 29 N ! W 0 0- o ' a O~ 2.00 ACRES 0' w I ° N ''223.78 N89 39'42" E O 87,164 SQ. FT. A N E H ICKADEE LANE C v N89° 39'42"E 230.5l'- w Q 0 z S8.4°30'57"E G - 317.62' cn N 616 0 m w LOT 32 i _oo CD OD 2.01 RES LOT 30 N 87,649CSQ FT. 04 (D_ 2.00 ACRES D m -4 87,16 2 SQ. FT. 7 00 p L ctz ~ 15 rn 5770 - i; PONDING r EASEMENT ~i ~ 04,35 E o~ 1 l 288.80, ° LOT 31 } S 450 50'p00"W 86.82 CK 2.01 ACRES pQ 87, 556 SQ. FT 33 ~ Oaf oh 1. S 44° 1000. E - 66.00' S760274~„E 4 63./3, "Y SCALE IN FEET 200 - - oo V R > \ LOT 34 ZNDING EASEMENT •3rO • \ \ 2.02 ACRES h9 \ U \ 87,932 SQ. FT. 9y \ \ EL.=964 27 LOT i g3 2.14 ACRES PONbING, \ ` 1 i . O~ F 93,106 SQ. FT. EASENkNT i 1 EL.= 972 \ \ i ~lJ~o S89°06'22"E 299.46' \ 1\ : N84 °22'30"E I \ 198.79 00 LOT 28 \ i Q 2.23 ACRES ( I \ 97!078 SQ. FT. I \ ? Cho 4 103 .P I .13-133' 1 N EASEMEN~ o I LOT 33 w i~ 0 2.01 ACRES 87,369 SQ. FT. N87°52 18 E / 330.79' w N / I m EL. 969 I I .P / pONDING I I v EASEMENT ; 0 LOT 29 N i 2.00 ACRES o I N o 87,164 SQ. FT. N89°39'42"E 223.78' N I rwirknrnFF-1 or STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER IF~~iyletreu/l/ A, MAILING ADDRESS //jj'p'0 Tow41. C,E" rwA .yR. WAfl _5'x/13 PROPERTY ADDRESS Z AL (location of septic system) Please obtain from the Planning Dept. CITY/STATE Wtee",o r/ G PROPERTY LOCATION $L~ 1/4, V,--_ 1/4, Section _ 7 , T At. N-R_/ ? _W TOWN OF , ST. CROIX COUNTY, WI SUBDIVISION L) IYELLS LOT NUMBER .2 f 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 expiratio date. SIGNED: DATE: Z` -l St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 J 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. ---------------------------------j---------------------------------- Owner of property neAng- , tg, Location of property-.,Le 1/4 1/4, Section 7 ,TAN-R1,V W Township Mailing address jac Z-V / L~'•yl• -P/Z. !G Address of site Subdivision name f,~G~Ir~1TZ~/~LGt Lot no. T~ Other homes on property? Yes 1/ No Previous owner of property M O ,V 4!!! f? ~Z'D Total size of property - Total size of parcel 2 Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes --I/No Volume Z 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. ~"rj96S' 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. Signat re of Applicant Co-Applicant I(A/2/R& ID-Z-1CP L Date of Signature Date of Signature STATE BAR OF WiSCONSl' FORM 1 - 1982 i J~ ~ i.Jl+~ li, WARRANTY TY U€ED DOCUMENT NO. yOL 71)LJ I 417 PEG1STER-S Uri CE This Deed made between OE CKV CO., WI Humbird Land Corporation, a Minnesota Corporation ~"cr Ram SEe 2 3 1996 Grantor, 10:04 A: and Craig C. Aschenbrenner and Jodi Lee A:scht nbrenner, Husband and Wife I. A1,, Grantee, " Witnessedt, That the said Grantor, for a vahwblc .-.nsi fer vvt conveys to Grantee the following described real estate in -St . CKOIX THIS sP14^E RESERVED FOR AECUAOwG DATA Camty, State of Wisconsin: NAME AND AETURh ADCAESS Lot 29, Humbird Hills Second Addition, f Town of Hudson, St. Croix County, Wisconsin SC, / 78 PARCEL IDENTIFICA110H NUMBER i VAYFER This is not homestead property. i (is not) Together with all and singular the hereditaments and appurtenarnces thereunto belonging; And warrants that the title is good. Indefeasible in fec simple and free and clear of encumbrances except Easements, restrictions and rights-of-way of record, if any and will warrant and defend the same. Dated this 11th day of -September .1996 i k s (SEAL) HUMBIRD LAND CORPORATION (SEAL) • -by: (SEAL) Austin J. aillon, Its President -