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STC - 104
A BUILT SANITARY SYSTEM REPORT
OWNER-
ADDRESS
Di5L,,CJA. in~ fA~
3y
SUBDIVISION / CSM# LOT #
49
SECTION ~T
N-R_L~_W, Town f- fj
f
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
O rrn
will ,
e~be~ I'
~i°rnK
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
?mot d
BENCHMARK: Icao ~Z in FI/Y\ inve
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid capacity: 1006 (p
Setback from: Well 5y`0, House. L5 F1_ Other
Pump: Manufacturer UTAC 6✓AA+( Model#,SZc4_~~. Size
Float seperation Gallons/cycle:
Alarm Location "kha2-e_ o2Lr,-n 0 ~4 /qalm~
SOIL ABSORPTION SYSTEM
Width: Length 0 Number of trenches I
& F4
Distance & Direction to nearest prop. line:
Setback from: well House Other
q ELEVATIONS
Building Sewer ! ST Inlet: ,5• T~ ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold 21 of Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: - -7✓ 7
cJ
PLUMBER ON JOB: /~W/! vl r' ~
LICENSE NUMBER: ~cJ C
INSPECTOR:
3/93:jt
Wisconsin Department of industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations
Safety and Buildings Division
INSPECTION REPORT ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 284157
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
JAMES, EDWIN SPRINGFIELD
CST BM Elev.: Insp. BM Elev.: r BM Description: Parcel Tax No.:
) TANK INFORMATION ELEVATION DATA AQAnnAnQ ~7_
TYPE MANUFACTURER CAPACITY STATION BS HI FS E .
Septic Q/Sc Benchmark
Dosing
y 3 s
Aerallkamn- Bldg. Sewer 9 p'r
Hol St/ I Inlet%j 9S. 7?"
TANK SETBACK INFORMATION St/$ Outlet
TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet
Air Intake
Septic Qtr c~2~ 4~5 yt NA Dt Bottom
Dosing 20 NA ice/ Man.
o~z" 9 9.9Z
Aeration NA Dist. Pipe 99.9,?,
Holding Bot. System % 9~),
P P /SIPHON INFORMATION Final Grade
Manufacturer Demand
-ell
Model Number GPM
TDH Lift F
Loss riction System TDH Ft
Forcemain Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O A
CHMBER Model Number:
System: f J`~ OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing r'
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 E] N ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) 4S Ark ,C✓W
LOCATION: SPRINGFIELD.1.29.15W, NW, NE, COUNT ROAD W
/ I--~ r°r>Ce r~T l nGL Syr tti t, ,c2": ( l'J~ C>>7 ~1/ r'~ 11a y J' C . l'r k c ;I N~eJ
0~~. /J
";V_~an vision re ired?~ ❑ 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:
SANITARY PERMIT APPLICATION Bureau and uildildirg Waater Systems
Building 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 n~
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sani ar Permit Number
q1 5'1
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 INFORMATION
Property wner Name Propert Vocation
kf% 1i4 I 1/4,S T , N, R
1QW Pelty ner s M fling Address Lot Number Block Number
Qty, State V Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE F BUILDING: (check one) ❑ State Owned icy Nearest Road
❑ le C12 village elD
Public 1 or 2 Family Dwelling - No. of bedrooms Town of
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo d 3y /coo C;~(:)
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- K 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 ❑ Seepage Bed 21 X 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
Requir d (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
• ~w Feet Feet
-Is -7.5 0-9
VII. TANK Capacity acitns Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank 000 (bbd Q 'f E3 El El ❑ 11
Lift Pump Tank /Siphon Chamber 0 I ",e ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumb is Signature: (No St ps) PRSW No.: Business Phone Number:
31;~o `71S X35 -
Plumber's Address (Street Cit , Sta e, Zip Code):
A) q(2-1W IX. COUNTY / DEPARTMENT USE ONLY
r~- ❑ Disapproved sani ary Permit Fee (Includes Groundwater ate Issued Issu ng Agent Signature (No Stamps)
Approved Surcharge Fee)
❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-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 nevv 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 Dw(-l' ing.
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 13 if permit is for tank replacement, rec-innection, 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 sewtic, 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.
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
October 7, 1996 2226 Rose Street.
La. Crosse WI 54603
RED CEDAR. PLUMBING
N 4676 471ST ST.
MENOMONIE WI 54751
RE: PLAN S96-41283 FEE RECEIVED: 180.00
JAMES, EDWIN
NW,NE,1,29,15W
TOWN OF SPRINGFIELD COUNTY: ST. CR.OIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire On the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify 'the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincerely,
-yard M. S im
lan Reviewer
Section of Private Sewage
(608) 785-9348
SBDA-7987(8. 10184)
Edwin James - Mound
596-41283 RECEIVED
SEP 3 0 1996
SAFETY & BLDGS. DIV,
Location: NW 1/4, NE 1/4, Sec. 1, T 29 N, R 15 W
Town: Springfield
County: St. Croix
Date: October 8, 1996 3`96-41283
Owner: Edwin James
Address: N 9602 CTHW Q
Downing, WI 54734
Plumber: Kevin Lannon
Signature: License # MP 7320
Attachments: 6748-Plan Review Application
SBD 8330
page 1: cover
2: calculations
3: plot plan
4: system cross section
5: plan view, lateral detail
6: pump tank exit detail
7: pump curve
SSW p,~E S~sT~M
T -~~bnally Page 1 of 7
VI)
Ep gptl
VVq of
p1V c
v
System Calculations
One family residence bedrooms
i
Loading rate S gallons/sq ft per day
Depth to ground water 3 3 in
Depth to bedrock in
Cross slope %
Force main length ° ft of Z- in
Manifold/header length Ka ft of in
Drainback 3'2 g gallons
Lateral length @ ft of Z in
Lateral elevation ft (bottom of pipe)
Lateral hole size in @ in ft) spacing
holes/lateral, holes total
Lateral volume gallons
Total lateral discharge rate gpm @ 'Z~ ft head
Elevation difference ft
Friction loss ft @ gpm
Total dynamic head + ft
Pump/si~fion I5 gpm @ ft of head
wr p a ~,w 1.~. w -Z,~~
Manufacturer , Model #
Dose volume gallons
Lift/si}yhon tank to , G `T`om gallons
Septic tank gallons
Measurement pump on & off in
Height alarm from tank bottom in
Reserve capacity gallons
calcs page Z of
_
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Y A-. -i I G
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WEATHERPROOF
LOCKIuCs COVER 1UNLTION
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SEPTIC t 11CATIOkIS
U
OOSC M
TAWKS MAnlUFACTURER. IJUMOER OF DOSES: PER DAU
TAIJK SIZE: - ~'v'~"~ GALLOWS DOSE VOLUME
S~ Ll~ Itq
ALA" MNJUiACTYKGR: IAICLNOIAICs BACK/LOW: GALLONS
AODEL NUMOER: CAPACITIES: A= z~'O WC1I15 OR Sot 1G GALLOUS
SWITCH Tura: g = INCHES OR 3 t GALLOWS
PUMP MAAJUFAGTURCR: ~"w`'• C IULHE5 OR I `C( CALLOUS
MODEL NUMpCR:
0~ ~ INCHES OR ~O Z GALLOWS
SWITCH TWPE: MOTE: PUMP AWO ALARM ARE TO OE
MINIMUM DISCHARGE RAT 1 g 6PM INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFEMICE DETWECty PUAF OFF ANO DISTRIOUTIOIJ PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRCtiURE 2.S FLET
+ 20 FEET OF FORCC MAIN X F~00VxFRICTIOU FACTOR. O FEET 2
U~
TOTAL DyWAMIC. HEAD = I S'`S'~- FEET
1 4 1 ~N .
MITERNAL. DIM[W610Nt OF TANK: LEW&TH~._;WIDTH .6 ;LIQUID DEPTH 39
~Au.l 6 pF
~ r(
Performance Data
Pump Characteristics 32
Pump/Motor Unit Submersible
Manual Models SW25M1 SW33M1 W za
LL
Automatic Models SW25A1 SW33A1 W 1/3 HP
s
Horsepower 1 /4 1 /3 f 16
Full Load Amps 8.0 10.0 z 1/4 HP
Motor Type Shaded Pole (4 pole) °
a
R.P.M. 1550 o e
Phase 0 1
Voltage 115
ELL #-...N# -
Hertz 60 0 0 10 20 30 40 50 60
CAPACITY-U.S. G.P.M.
Operation Intermittent
Temperature 120" F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24
NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0
Insulation Class A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10
Discharge Size 1-1/2" NPT
Solids Handling 1/2" Dimensional Data
Unit Weight 30 lbs. 1. All dimensions in inches
Power Cord 18/3, S1TW,10, std. 3-1/2 5-7/8 2. Component dimensions may
(20' optional) 4-1/2 vary ±l/8 inch
T 3. Not for construction purpose
1-1 2 NPT unless certified
3-1/2 DISCHARGE 4. Dimensions and weights are
Materials of Construction approximate
5 OWN level adjustable
Handle Steel 3-1/2 6 We reserve the right io Lubricating Oil Dielectric Oil nukerevisionstoaw
products and then
Motor Housing Cast Iron specifications without notice
Pump Cosin Cast Iron
Shaft Steel - - -
Mechanical Seal Faces: Carbon/Ceromic
Shaft Seal Seal Body: Anodized Steel
Spring. Stainless Steel 11_,,a
Bellows: Bum-N PUMP
10-1/8 ON
Impeller Thermoplastic 9-112
Upper Bearing Bronze Sleeve Bearing DISCHARGE
HEIGHT
Lower Bearing Single Row Boll Bearing
3 3-1/2
Strainer/Base Plastic PUMP
1 OFF 1 t r
Fasteners Stainless Steel
AURORA/HYDROMATIC Pumps, Inc. }
1840 Baney Road, Ashland, Ohio 44805 OT _
(419) 289-3042
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR $3,09,_Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size I'st
include, but not limited to: vertical and horizontal reference point (BM), rqc and o;.r
percent slope, scale or dimensions, north arrow, and location and dis nearest
Parel.t.Q. #
APPLICANT INFORMATION - Please print all inform ReviAVVecby Date
Personal information you provide maybe used for secondary purposes (Privacy w„c~ 15.04 (1),~rrr)).. °'1
Property Owner ~ro Location
y
~~N 13 t 1%4, 1/4,S / T~9 N,R )W
Property Owner's Mailing Address t.pf # JI Efiock# 8Lbd. Name or CSM#
qll~ OG2 Cc Rol 0-
City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
w/V/N bu a ( 7/,4')26,5" a 41o SP IN F G~Ld de" fTd GrJ
New Construction Use: [ Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow IV 3-0 gpd Recommended design loading rate !Y bed, gpd/ft2_ r trench, gpd/ft2
Absorption area required IYA_bed, ft2 2Z5- trench, ft2
Maximum design loading rate / bed, gpd/ft2_,_trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred t/o site plan benchmark)
Additional design/site considerations ,f
Parent material ~4 14 e i,4 / 12 Flood plain elevation, if applicable A 4 ft
S = Suitable for system Conventional Mound In Ground Pressure AT Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S 0 U ~ S ❑ U ❑ S ® U ❑ S ® U ❑ S W U ❑ S 1B U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
Consistence Boundary Roots
in. / Munsell Qu. Sz. Cont. Color Texture Grp.. SLz. Sh. Bed Trench
o" 0 / D 3 Y14 2 4,G AK6R C J M
® C ),4,h Ire M VAS C S ✓F 4/
Ground 3 S M S
elev. '
NA4
Depth to
limiting
factor
11,4 in.
Remarks:
Boring #
0-.20 /0 3 Si,L 46 -M F -C5- 2 tit ,37
6
YZI a 3~ io c ~ 6A 41 M vrr eZ s -VF . s
Ground
elev.
Depth to
limiting
factor
,?.~_in. Remarks:
CST Name (Please Print) Si nature _ Telephone No.
(!2A X e S l 1-h
Address Date CST Number
1
PROPERTY OWNER 6dWiN "-TAM eS SOIL DESCRIPTION REPORT Page 2 of
PARCEL I.D.#
Horizon Depth Dominant Color Mottles Structure 2
Boring # Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
a :2 /O 3iL .2 46,4'M lv1 FX Gr .S 2 ,S"
2 zs 6i 3 C G A6~"C /►-VJZ% G'S v
Ground IVA- ; IVA
elev
ft.
Depth to
limiting ;
factor
in.
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
factor
in. Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Ur d cd ce \ c-w. P G w rc c
MAILING ADDRESS N q r- 0 C4 c. \&I V
.
PROPERTY ADDRESS _ (v C v y.', \ a S n e \d
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 1/4,/1/0) 1/4, Section TN-R1~W
TOWN OF S r c, e ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIEDSURVEY MRP , VOLUME 33 , 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.
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.
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 expiration date.
SIGNED: X
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
i/ 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.
Owner of property
Location of property 1/4 1/4, Section ,T N-R W
Township _ G Mailing address t~l q ~d a C~
T
Address of site
Subdivision name Lot no.
other homes on property? Yes__.X__No
Previous owner of property C\„Ae A a ,e s
Total size of property \ y C e s
Total size of parcel ~ y o c' c
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes K No
Volume :~L 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. 2-Cy 9F? , 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.
Signature Applicant Co-Applic nt
/'417 / y /Ul -7 /
Date of Signature Date of Signature
rl' . t r., DOCUMENT NO.
26496
U n'
This Indenture, Made by Clyde M,~m .s and Leora R.s.ames~ H>.1`ghanft and
Wife, as Joint Tenants
grantor 3 of Dunn County, Wisconsin, hereby conveys and warrants
to Edwin James and Ardyce James, Husband and Wife, As Joint Tenants
rantee S of Dunn Count Wisconsin
for the sum of Eighty-five Hundred (8500 00)
the following tract of land in D11nn~3c St,. Craix County, State of Wisconsin;
,IN ~T'GQUNTY: North West Quarter (NW4) of North East Quarter (NE);
cept the North_ 32-6 thereof;
Also etc6pt that, part of said Forty North and West of County Highway Q
as located on Jamie 11, 1947.
ALSO
The East Half (EJ) of North East Quarter (NE4) ;
ALSO
The South West Quarter (SW4) of North East Quarter (NE4); All in Section
six (6)-'.::Township twenty-nine (29) North, Range Fourteen (14) West, Dunn
i
County, Wisconsin.
IN ST. CROIX COUNTY: North West Quarter (NW4) of North East Quarter (NE4)
!I except N 83 feet thereof;
North East Quarter (NE4) of North West Quarter (NW4) except N $3 feet there-
of and North Half (NJ) of South East Quarter (SE4) of North West Quarter
~i
(NWT), All in Section 1, Township 29 North, Range 15 West. Continued from
October 30, 1935 at 3:00 otclock P. M.
.I
South East Quarter (SE4) of South West Quarter (SW4) of Section 36, `town-
ship 30 North of Range 15 West. Continued from May 26, 1950 at 2:45
otclock P. M~ (SEE REVEt1UL STA1,TS ATTACHED TO REVERSE SIDE)
I I
IN WITNESS WHEREOF, the said grantor A ha_ Ve hereunto set their hand $ and seals this
day of April A. D., 19: 61 .
(SEAL)
N D AND S L-E .~Ai'pItESENC OFlyde M. James
~176 (SEAL) i~
Richard P. Rivard I,eora R. James
(SEAL) ~I
Velma Mouw _ I'
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