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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER STL° lJG r/1ir'r-L
ADDRESS
SUBDIVISION / CSM# LOT # ~dQoveS
a
SECTION Tae N-R W, Town of
1C`jo,.r~l
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
.y
/GOG
. b ~ ~ e~O7rr~
~ 93
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: _ Spin g S ,/f~~"
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well-!!~-e5'_ House /0" Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: l~ Length ~YL-/ Number of trenches
Distance & Direction to nearest prop. line: 5-a
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/ManifoldBottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: ` 7`-
LICENSE NUMBER: ,?~~je~2
INSPECTOR:,
3/93:jt
` Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI
WHITE, STEVE & TERRY X
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
J ' O~ err
TANK INFORMATION LEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark -
Dosing /lSJ` Q C` x,35
Aeration Bldg. Sewer
Holding St/Ht Inlet ,6,3'
TANK SETBACK INFORMATION St/ Ht Outlet 4~/ 3 ' ge
Vent
TANK TO P/ L WELL BLDG. Air Ito ROAD Dt Inlet
ntake 11-,3 Septic y~Qa >la6' ~2-5- NA Dt Bottom /yl py
Dosing yid J' Y , NA Header / Man. 95--y g'
Aeration NA Dist. Pipe 6b fir, -
Holding Bot. System 93
PUMP/ SIPHON INFORMATION Final Grade o~
Manufacturer Demand
Model Number GPM
TDH Lift f O Friction System TDH/~IfIB Ft
Forcemain Length Dist. To Well },SO
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 Moe Number:
System: Z~" v -3,00' -306 X)114 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: RICHMOND.23.30.18W, NE, SE, 140TH STREET
1217
.J~
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:
Safety and Buildings Division
t~~~Zr■r'3 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-n~ittaa~ry 4rrmmit Number
w
The information you provide may be used by other government agency programs ❑ Check if revision [O~ vious application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
S77 c r 4) #'1'e F 114E 1/4, S ZS T_?Q , N, R jr E (or (
Property Owner's Mailing Addres's Lot Number Block Number
.G 7`4 S 70'_ City, State Zip Code Phone Number Subdivision Name Or CSM Number
t_4) d ",017 ( / Z 42 c
II. TYPE F BUILDING: (check one) ❑ State Owned o C tyy Nearest Road
❑ V illage
Public 1 or 2 Family Dwelling - No. of bedrooms own of kjCA
B l yO't S'
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo G a e
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. EX Replacement 3. ❑ Replacement of 4. ❑ Reconnection of S. ❑ Repair of an
System _______System_____________TankOnly______________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 $4 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) ~s O Elevation
0-- ' Feeti Vg, 5' Feet
VII. TANK Ca
in sacitilo 5 Total # Of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank or Holding Tank k l y.,,J 91 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber PC d f o ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) P/ PRSW No.: Business Phone Number:
12Z - ' r S e ?I - P6~ 3
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A nt Signature (No S)
Approved ❑ Owner Given Initial] Surcharge Fee) 3//3/4
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.
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PAGE GF
PUMP CHAMBER CROSS SECTIOIJ AUD SPECIFICA,r10AJ5
VEIJT CAP
`"C.I. VENT PIPE
WEATHERPROOF APPROVED LOCKMIG
> Z5' FROM DOOR, JUWCTIOAI BOX MAIJHOLE COVER
WIWDOW OR FRESH I2"MIU.
AIR INTAKE
I
GRADE
I `i" MIIJ. ~
I 18" mim.
COIJDUIT PT--
18"MIN. ~
11~
10.1LET PROVIDE (
_T AIRTIGHT SEAL i III
I
I I (
I I I ALARM
B I Ii.
I I
N
*APPROVED I FI> o
C JOINTS WITH ELEV. FT. APPROVED PIPE
3 ' ONTO PUMP ~ OFF
D SOLID SOIL
COUICRETE BLOCK :A
-k RISER EXIT PERMITTED OMLy IF TAWK MAWUFACTURLK HAS SUCH APPROVAL
SEPTIC f SPEC.IFICATIOUS
DOSE
TANKS MALI UFACT LIRE R: - ''itlJRs~CIA~ IJUMBER OF DOSES: -PER DAS
TAWK SIZE: GALLOAIS DOSE VOLUME /
ALARM MAMUFACTURER: ~~dC~`•fi/-k^n-~ INCLUDIMG BACKFLOW: Aw4r. 9.9~--GALLONS
MODEL ►JUMBER: CAPACITIES: A= aG. WCHES OR 3 GMGALLOUS
SWITCH TyPf: en¢' C 13=9 INCHES OR rii,? GALLOWS
PUMP MANUFACTURCR: &L. C= IMCHES OR ~~,~•.yy~~
O' L(2SG- GALLOWS
MODEL NUMBER: D- INCHES OR GALLOWS
SWITCH TYPE: IJOTE: PUMP AMD ALARM ARE TO BE
MINIMUM DISCHARGE RATE -~s GPM ~ INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF ARID DISTRIBUTIOW PIPE..%rgil FEET
+ MIMIMUM NETWORK SUPPLY PRESSURE . ~ FEET
♦ FEET OF FORCE MAIL X FT✓ g
~IooFLFRICTIOU FACTOR. a1.FEET
TOTAL DyIJAMIC HEAD = FEET
f
INTERAIAL DIMEWSIoMi OF TAIJK: LENGTH ;WIDTH-(,"/"
;LIQUID DEPTH
SIGIJED:A LICEOSE IJUMBER- -,w arc _
. s
WIW pmt= o~-
1-- f'
w HEAD/CAPACITY CURVE 4;A 6'
MODEL 97 45k J.
30' I -
8 0 45A
25'
i 14. tiPT
a 20'_ 1 I m
6 43/16
w I i •
x
U
z 15 34141
O 4
J
Q '
0 10'
F-
8. 0S
• -
2-
'
5
Z8• S
0
uS 10 20 30 40 50 60 70
GALLONS
LITERS 0 80 160 240 1011/16 1
FLOW PER MINUTE
TOTAL DY A VC IIEADORAW PER MaIyTE
1011.4094T AM DEVATEFAFIG
CAPACITY
HEAD UNrTSIMW 35/16
FEET METERS GAL LTRS
5 1.52 56 212
10 3.05 46 174
15 4.57 35 133
20 6.10 15 57
Lock Valve 23.75'
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available • Mercury float switches are available for controlling
and supplied with an alarm. single and three phase systems.
• Mechanical alternators, for duplex systems, are avail- • Double piggyback mercury float switches are available
able with or without alarm switches. for variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard All Models - Weight 33 lbs. -1h HP 2 Single piggyback wide angle mercury float switch or double piggyback mercury
float swildL Refer to FM0477.
s7 Series control Sekcdon 3. Mechanical alternator 10.0072 or 10-0075.
Model YOlta-Pfl Mode Amps Simplex Duplex
4. See FM0712 for correct model of Electrical Alternator, "E-Pak".
M97 115 1 Auto 120 1 or 1 of 7 - 5. Mercury sere" float switch 10-0225 used as a control activator. specify duplex (3)
N97 115. 1 Non 120 2 or 2 3 6 3 or 4 6 5 or (4) Hoar system.
097 230 1 Auto 6.0 1 or 1 b 7 - 6. Four (4) hole -.l-Pak"• junction box. for watertight connection or wired-in simplex or
g97 230 1 Non 6.0 2 or 2 3 6 3 or 4 &5 2 pump operation' 10-0002.
7. Two (2) hole -.141ak for watertight connection or splice, 10-0003.
CAUTION
For information on additional Zoeller products refer to catalog on Combination All installation of controls, protection devices and wiring should be done by a
Starter. fM0514; Piggyback Mercury Float Switches. FM0477; Electrical Alternator. qualified licensed electrician. All electrical and safety codes should be followed
FM-0486; Mechanical Alternator, FMO495; Alarm Package. FMO513; and Sump/- including the most recent National Electric Code (NEC) and the Occupational
Sewage Basins, I M0487. Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
~O 7J7X"11J_JV r17 3280 Old Millers Lane Manufacturers of
P. 0. Box 16347 - Louisville, Kentucky 40216 -
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
vDivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
S c tLo l x
Attach complete site plan on paper not less than 8 x 1 i ust include, but PARCEL I-D. #
not limited to vertical and horizontal reference point (B e I P scale or
dimensioned, north arrow, and location and distanc est roa .
APPLICANT INFORMATION-PLEASE PRI INFO ' REVIEWED BY DATE
PROPERTY OWNER: PROPE ATION
STEozE f bib TER-C~ r S, t~F 1/4 SE 1l4,S 13T 30 N,R t E(o 1►
PROPERTY OWNER'-.S MAILING ADDRESS T # K# SUBD. NAME OR CSM #
Nk1q`13 lqo `Rf sT-V'r i_? 14, - I -
CITY, STATE ZIP CODE PH ER by ILLAGE ®I OWN NEAREST ROAD
l u lJ sr.
NQ)1%j IV-LCAA h >wb w L4 t, L-1 l s tui c M o
kit)
[ ] New Construction Use [JQ Residential / Number of bedrooms 3 [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow q S O gpd Recommended design loading rate O S bed, gpd/ft2 trench gpd/ft2
Absorption area required 6 q'S bed, ft2 S 63 trench, ft2 Maximum design loading rate o • bed, gpd/ft2 0 - $ trench, gpolft2
Recommended infiltration surface elevation(s) °t S. O ft (as referred to site plan benchmark)
Additional design / site considerations ?_'Mv'1y&kU1b \ K Sp ae-~ M I )Q , 1~t D = 1 b, y- I6, B V_~
Parent material S Pry a R-/t-U0- 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 s stem NS E]U N S O U 121 S❑ U R1 S❑ U 05 ❑ U EIS k] U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tivirch
GhgZw.Sbk Y-%''r- 0-5 - o. S o.
Ground
elev.
It.
Depth to
limiting
factor
? `z3D•.
Remarks:
Boring # S a 6
_ b_~i \O`1Q Z!1 ~ ~
Z z $-az t o -,cz- 31( - S E.(S e s~ ► _ 'o. g
Ground
elev.
X17-8ft.
Depth to {
limiting
factor
?Z"
i
Remarks:
CST Name-Please Print Arthur L. We erer Phone: 715-425-0165
emgerer soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: p Date: CST Number:
aal~ oZ °l. S-11 8 J1-1) Pty 3 L' [9,9S M 0 0 5 7 6
t
PROPERTY OWNER w*t\ CM SOIL DESCRIPTION REPORT Page Z. of ~
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
::.k~~ 0_8 lo`-t2 2.L1 ~ GtiS' Z~sb1z w~`Fh arg _ D.$ o.(~
3
K 2 3!6 _ S 0 Gil, Q~ sg ) - o- n. 8
Ground
elev.
98• b ft.
Depth to
limiting
factor
8
Remarks:
Boring #
Zwt 5b~z a,3
y Z cl -I b l0 t)- 3[ 6 S ~c Gt, p s9 rn 1 - o. u, a
f
Ground
elev. ~p R V-5 M'l
9b 1 ft.
Depth to t- V S V \
limiting
factor
Remarks:
Boring #
I
Ground
elev.
ft
Depth to
limiting
factor ri. I
Remarks:
Boring #
n::s
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
3 of 3
' y Page
PLOT PLAN
SCALE 1"= 30 '
L''ktS 1l1G SLPi"1C S`15TS 1 LS 3 ov!U~ of
S~`T'E
i
~z c
8.2
a
9s
0 - . 1OU ,4~ ON 8 OF p"1~L
N
e•4 S~p~jvr. 3L~~ l~rgOU~ GRoUrvQMme'
o,
I
O
q s-tl~
3i ~~tg5 ( 715 4 .5 _ M00576
CST Signature Date Signed Telephone No. CST #
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix Con
OWNER/BUYER ~i
MAILING ADDRESS
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE 1"2
PROPERTY LOCATION 1/4, 1/4, Section L, T - N-R 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 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 ri ate s age
disposal system in accordance with the standards set forth, herein, as set by the isc i DNR.
Certification stating that your septic has been maintained st be co Ofeted and ret me t Croix
County Zoning Officer within 30 days of the three yea
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
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.
N/~
Owner of property'-5 /ti Location of property /y'• 1/4,5.,. 1/4, Section p7~ ,T362 N-R / W
Township Mailing address
Address of site AS ACS/e% -
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property ~7ZJ~
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 /DUl and Page Number 2$-5~ 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 o;f-ice of the County Register of
Deeds as Document No.~ Tl7 S 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 jadd to , and the same has been duly recorded in
the office oy Register of Deeds as Document No.
Signature of Applicant ~a-Appl nt
Date of Signature Date of Signature
IDgCLI ENT NO. WARRANTY DEED TWIS SPACE RESERVED FOR RECOROING DATA
STATE BAR OF WISCONSIN FORM 2-1982
497J L75
LGiSTCR'S OFFICE
Patrick J. Cullen and Kathryn M. Callen, Sr CROD(CO.,WI
;
husband and wife as joint tenants - PsedtorRecord
-
APR 91993
- -
conveys and warrants to S.t-even- D-...Wh~.tie-and_-T~r.y...... g-pp q
--L....White,~..husband---and--wif-e------------- V~ r
~E1-'letdDeedf
. RETURN TO
- .
the following described real estate in S.t.....CrQix------ County,
State of Wisconsin:
Tax Parcel No:..............................
The East 700 feet of the Northeast 1/4 of the Southeast 1/4 of
Section 23, Township 30 North, Range 18, West.
F
i!
II I
I~
jl
This .......i3 homestead property.
(is) (is not)
i
Exception to warranties: easements, restrictions and rights-of-way of
record, if any.
Dated this - . day of ----------Harsh----- 19..93..
..--....(SEAL) / ..SEAL)
--•--Patr••ek-•_~T.--Cullen ' ---Rat--. ._Cu_lien.......- .
il
• .............••-•------....---------•-•-----•--....(SEAL) . ------(SEAL)
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~~,••'~ty, AAI ENTICATION ACKNOWLEDGMENT
ti 'C4#- ' Cv(STATE OF WISCONSIN
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It. f county. ~I
istI%ereated~is: day oi_ 19 3 1?ersorally came before me this ________________day of fi
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~Ja ~C - , 19 the above named it
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C/13
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
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sntborized by $ 706.96. Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
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THIS INSTRUMENT WAS DRAFTED BY
Kristina OQ1and i