HomeMy WebLinkAbout032-2023-60-100
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
SUBDIVISION / CSM# LOT #
SECTION_TN-R_'Z~ W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i~~lan
br
~ n
i
1
,a l ~ yo SrA~
Zlw
IND ATE NORTH ARROW
Provide setback and elevation informa ion on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: y~,1&4 Liquid Capacity:
Setback from: Well Z_~2_ House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 7~' Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: /2y House__Z,4~_ Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
S~
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system ,9
Existing Grade Final grade
DATE OF INSTALLATION: -
PLUMBER ON JOB: '
LICENSE NUMBER:
r
INSPECTOR:
3/93:jt
y 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 284177
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
LETOURNEAU1 CRAIG SOMERSET
CST BM Elev.: Insp. BM Elev.:/ BM Description: Parcel Tax No.:
G is , C( U- GU J~ ~s
TANK INFORMATION ELEVATION DATA A9600428
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer ("o -
Holding St /E Inlet (l
TANK SETBACK INFORMATION St/ Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet --7
64-
Air Intake
Septic >07 NA Dt Bottom
Dosing NA Header / Man.
Aeration )NA Dist. Pipe
i
Holdin Bot. System
PUMP/ SIPHON INFORMATION Final Grade -S , 3S~
Man emand
Model Number GPM
TDH LW' Friction System TDH Ft
Forcemain Length Dia. H Dist. To well
SOIL ABSORPTION SYSTEM
IMEN No. Of Pits Inside Dia. Liquid Depth
PIT
BED /TRENCH Width Length~~ No. Of renches D
DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM G Manufacturer:
SETBACK CRAM
INFORMATION Typeo of Mo e
System: ',t 60 7SC , y OR IT
DISTRIBUTION SYSTEM
Header /-N t Distribution Pipe(s jxHole x Hole Spacing Vent To Air Intake
Length ~P Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade ems On
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx MulcflQd---..,,..._.-,
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SOMERSET.6.30.19W, NE, SE LOT 1, 38TH STREET
7 n2, ~ f x IN ~c>l/ e
'7 ac(l Ile /W7--
? z
Plan revision required? ❑ Yes 2-,q-0
Use other side for additional information. 96 S ~F P
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH S }
SANITARY PERMIT NUMBER:
i
Safety and Buildings Division
e-~■~r■r">i 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 1/2 x 11 inches in size. I X/
• See reverse side for instructions for completing this application State eSSaannit~arv P6rrmiitt Number
The information you provide may be used by other government agency programs ❑ ~h6ck'if ?evisio-n td previous application
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Prop
e y Owner N me Property Location
C Alf 114-;"4, 1/4, S T E (or)e
Prope y O er's Mailing A ress Lot Number Block Number
Ci tate Zip Code Phone Number Subdivision Name or C11M u ber
V7- 17 1,
I ( )
4
II. TYPE BUILD NG: (check one) ❑ State Owned it~ Nearest Road
❑ VII age
Public 1 or 2 Family Dwelling - No. of bedrooms 91 Town OF
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 0 ZI?
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 S. ❑ Repair of an
------System System Tank OnlyExisting 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
11,0 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 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 .h ch) Elevati n
Feet Feet
VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for i stallation of onsite sewage system shown on the attached plans.
Plu s Na : (P ) t Plum er's S nat e: S m MP/MPRSW No.: Business Phone Number:
P tuber's ddress jStre , City, Sta Zip Cod
O
IX. COUNTY DEPARTMENT USE ONLY
❑ Disapproved sani ry Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps)
Approved E] Owner Given Initial; f
Adverse Determination So Surcharge fee) I 30hh ~6103 4~
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SOD-( .05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
< s.
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:
L 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 sew tic, 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.
7
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Wisconpin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page -L of 3
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
/
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information. Reviewed by ` Date
Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)).
Property Owner Property Location
Govt. Lot jlf 1/4 1/4,S T N,R ,L~(o&
Property Owner's Mailing Address Lot # B # Subd. Name or CSM#
City Stat Zip Code Phone Number Nearest Roa
❑ City Village ® Town
❑ New Construction Use: Residential / Number of bedrooms Addition to existing building
0 Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate gybed, gpd/ft2L-1111'11-trench, gpd/ft2
Absorption area required 9ZO bed, ft2 7.d trench, ft2 Maximum design loading rate - _5-- bed, gpd/fl2 L trench, gpd/ft2
Recommended infiltration surface elevation(s) 919.1 ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material - d2e t• L&, 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 Q U ❑ S EZU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Co t. Color Gr. Sz. Sh. Bed , Trench
Alz
Ground 2L23- /X) 222
elev.
n~ aft
Depth to
limiting
factor
Remarks:
Boring #
AV x
3 - s
Ground r~
A,-
elev.
Depth to
limiting
factor
arks:
.>,&2in. Re
ry .4
CST Na; PI se Pr' ) Signature Telephone No.
Sr
-L - =
Address Date CST Number
4&1 4 L ~Zwe~
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GVptft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
2
Z'6 -~24
Ground
elev. 7-1/2 4
~ft L
Al /51L
Depth to
limiting
factor
&LL:1n. F-F
Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting F-F
factor
'n. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor acid Human Relations Page of
ivision of safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County r
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel
APPLICANT INFORMATION - Please print all information. Re iemetl by d; Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). J y'
Property Owner Property Location
V(r Govt. Lot 1/4,$; E (or
Property Owner's Mailing 66d-ress Lot # Block# sub d; N e V
Ile,
City State Zip Code Phone Number h i , ' a d
❑ city tillage o n ;
0~1~
L .2e7) 5 1
❑ New Construction Use: Residential / Number of bedrooms T Addition to existing building
Replacement Public or commercial - Describe:
Code derived daily flow Recommended design loading rate . bed, gpd/ft2 ench, gpd/ft2
Absorption area required &bed, ft2 trench, ft2 Maximum design loading rate o bed, gpd/fit trench, gpd/ft2
Recommended infiltration surface elevation(s) !~'7 -5-, ft (as referred to site plan benchmark)
Additional design/site cons tions
Parent material ide Flood plain elevation, if applicable ft
S = Suitable for system Conventional ZM n d In-Gro nd Pressure AT-Grade System in Fill Holding T k
-.01 X
U = Unsuitable for system S❑ U ❑ U S❑ U S❑ U El S U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground +
v9ft.
Depth to
limiting
f o
/ in.
Remarks:
Boring # I 67 - S 1 r 3 . Ur -4 YVU~ a 81-1 N\1 3
3 6~ >4 y S
Ground
lev ;
o?. '7
Dept„ to
limiting
f
,min. Remarks:
CST Name (Please Print Signat Telephone No.
7is 6 -7
7900,
Address ate CST Number
S 'IL D~S~RIPTION REPORT "
PROPERTY OWNER Page of +
PARCEL I.D.#
Borin # Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground MV
Depth to
limiting
in. '
3% Remarks:
Boring # tv- es 5:. /0
s -P - 2; • 3
ywo/
Ground
Depth to
limiting
);%V~/
n.3)q Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring # ;
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
Soil Test Plot Plan
Project Name Craig Letourneau Byro ird Jr.
Address 1727 38th St.
Somerset Wi 54025 CSAi #3479
Lot Subdivision Date 6/20/96
NE 1 /4 SE 1/4S6 T 30 N/1319 W Township S. Somerset
E] Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Base of Siding
System Elevation 95.8 *HRPSame as Benchmark
>200' B- System Area
to Road
15'
w
00
~ -2
40' B-1 5'
3%
Slope
120'
75' B.M Old System
.
Well OS 3 Bedroom
House Swim
Pool
Area
T
ST is located
Garage 10' from
Swimming
Pool
Driveway
f.:
P
34.0047
CERTIFIED SURVEY MAP
' PILED
MAY 1717
a comm
Isoftd0"6
womb cawy,
ti
s ti
' S 89°59'14" W 1332.40
,
,
I E 1/4 C0R.
• SEC. 6-30-19
• I (EXISTING PARCEL
OWNED BY OTHERS)
• I
• N 89°59' 14" E 221.70'
I • ~9 A9' '41
N
C 2/ a 6-111
O
• < ui • p O
0,_ O O
0 25 50 100 200 • ' N • _ LOT I W
SCALE: 1" _ 100' - • °O 3.038 ACRES o
o a'
.0 . (D (D
z to
0 = 1" X 24" IRON PIPE ;
WEIGHING 1:13 LBS. O• _ w
Ln et-
-
PER LINEAL FOOT N
N
a
' O o
. Z 0
.
I, Arthur L. Wegerer, registered land surveyor, hereby
certify: That in full compliance with the provisions of
Chapter 236.34 of the Wisconsin Statutes and the provisions
of the St.Croix County Subdivision Ordinance, and under the
direction of Richard E. Durand, owner of said land, I have
surveyed, divided, and mapped said parcel of land, that
such plat correctly represents all exterior boundaries and
the -subdivision of the land surveyed; and that this land id
located in the NE4 of the SE4 of Section 6, T 30 N, R 19 W,
Town of Somerset, St.Croix County, Wisconsin, to-wit:
Commencing at the East 4 corner of Section 6; thence
S 89°59'14" W along the Quarter-Section line 1332.401 to
the Centerline of an existing Town Road; thence S 0°11125" E
along said Centerline (being also the apparent forty line) a
distance of 772.701 to the point of beginningg; thence
S 89°59114}1 E 228.701; thence N 0°11125" W 564.001; thence
N 89°5911411 E 221.701; thence S O'll12511 E 630.001; thence
s 89°59114it W 450.40t•; thence N 0°11125" W 66.001 to the
point of beginning.
Contains 3.553 acres of land. Lot 1 contains 3.038
acres of land subject to the South 33t being reserved for
easement purposes.
Dated this 6th. day of Apri.l,. 1977•
Arthur L. W$g er
~t0A..S°..:`N~. S-963
Dit"tl En peering Co.
4 gi
River IF Is- DTI. 54022
-d.
ARTHUR L.
WEGERER '
S-963
ELLSWORTH w;
rSU RV
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ~1%-f-j I C- r iTA, rTa n, ,ter E4y
MAILING ADDRESS l 1 N S I
PROPERTY ADDRESS
((location of septic system) Please obtain from the Planning Dept.
CITY/STATE ~J I"i ff=S E I ( ► '~-Cbo 'Z 3'
PROPERTY LOCATION ,A/LX- 1/4, 1/4, Section , T--~~N-R~2--W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER -
CERTIFIED SURVEYMAP.W:QQVZ , VOLUKE~v-1, PAGE &'-/p, LOTNUM13ER
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 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 (I)
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.
UWe, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with (lie 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 cx)iration date.
SIGNED:
DATE:/ ~e l >f
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, Wl 54016 11/93
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 -C 16 + Q- t-i 1_7_-T() CA L4
Location of property 4-_1/4-=1/4, Section -,TSB N-R__/2_W
Township ~ !,-Ars_s 5Mailing address
.S k;-,t/Lf't 1 i L s c- rq o
Address of site I ,a 7 3 2Ttj V i _
Subdivision name 42ZEU Wo - ID-2 ~ _ Lot no.
other homes on property? Yes No
Previous owner of property 1AU , 0 n4,2' (11.1
Total size of property 3 , S S
Total size of parcel 3.S
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? _Yes --A No
Volume 25-9 and Page Number X( _ as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUML•'NT NUMDLIZ, VOLUME AND PAGE
NUM13ER AND THE SEAI, 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 dead 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. U;0/0 and that I (we) presently
own the proposed site for the sewage disposal sy::t:e,n 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.
4/
is t e o Applicant Co-Applicant:
ell
Date of S.igna G re Date of Signature
DOCUMENT NO WARRANTY DEED THIS f..'E RE''SCRVE6 IOit R!= "G
STATE BAR OF WISCONSIN FORM 2-1082
. VOL 659 PACE
REWTWS OFRCE
David R. Garrity and Gayle C. Garrity. , ST. CROIX CO., MWJ.
husband--and wife Ru'd. for Rid ilk 8th -
_ day Feb A.D` 19 83 of~
_ .and 12:10 P
. and ...Ri.ta_..M. 4!
conveys and warrants to ~>~a.i _ g. H,._ Leto urneau .
Letourneau,.. husband .and wife. as joint. ten-ant-s. '
-
. . RETURN TO
!-r 0, 1'/ Al
_ . - - -
the following described real estate in . S.t. _.Cr.oi.X .................County-,
State of Wisconsin:
Tax Parcel No---------------------------•--
A parcel of land located in the Northeast Quarter of the Southeast
Quarter (NE4 of SEh), Section Six (6), Township Thirty (30) North,
Range Nineteen (19) West, to-wit: Commencing at the East Quarter
corner of Section Six (6); thence South 890 59' 14" West along the
Quarter Section line, 1,322.40 feet to the centerline of an existing
Town Road; thence South 0° 11' 25" East along said Centerline (being
also the apparent forty line), a distance of 772.70 feet to the Point
of Beginning; thence South 89° 59' 14" East, 228..74, feet; thence
North 0° 11' 25" West, 564.00 feet; thence North 89° 59' 14" East,
221.70 feet; thence South 0° 11' 25" East, 630.00 feet; thence South.
89° 59' 14" West, 450.40 feet; thence North 0" 11' 25" West, 66.00
feet to the Point of Beginning. Containing 3.553 acres of land,
SUBJECT to the South 33 feet being reserved for Easement purposes.
This is also described as Lot 1 of Certified Survey Map, filed May 17,
1977, in the Register of Deeds office for St. Croix County, in Vol. 2,
page 362 as Document No. 340047.
~i J w! `'j v r J+M
This is - homestead property. ~J
=s--
(is) (is not)
F,xception to . arranties:
bated this 16th day of July 19 82
(SEAL) 1 _ SEAL/
David R. Garrity. . . • Gayle _C.. Garrity _
(SEAL) 4SEALi
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF MINNESOTA
W..... . _ shing_ ton - County.
-
authenticated this -.____..day of.._.__.__- 19 Personally came before me this ...1G~_-..day of
Ju_1y---------------------- - 19- 8.2.. the above named
-
__Dav.id...A.___Garzity_and._G.ay,le -
--Gar-rity...................
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not .
authorized by 1 706.06, Wis. Stats.) to me known to be the person .S-..--... who executed the
foregoingynstrument and acknowledge the same.
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 the residence located at:
1/4, 1/4, Sec. , T N, R W, Town of
Upon inspection, I certify that I have found the
tank and baffles to be in good condition, and it appears to be
functioning properly.
Last-time serviced
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
Manufacurer (if known):
Age of Tank (if known):
(Signature) (Name) Please Print
(Title) (License Number)
(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/MPRS
5/88