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HomeMy WebLinkAbout038-1063-20-100 Q 3 o n O ° h ~ I I r ' 0 0 N O G ~ I N O ~ x I a i ~ ~ Y h ~ I ~ O c z N C co LL O OI Q ~2 3 ~ v ~ _ Z y W 00 U) w ° z y y W a m o I o zv' o d Z ° c N H r m N Z c E S N O O C N ~ ~ N O m a o z o z co z N z O ICI C N Cl) O > d L CL m in U) a (b N C) 0 N z o ~ fA N N d o o 0 E 3: k 3: N Z> O O O Z° 0 0 • +ri a a a ° O W Z rn rn N in J U U rn rn ~ ^V N N M O 0 0 0 0 j N N C 0 CO ^"7 m N d 00 co o U d Q 0 O N 7 w Q ° 3 in E ° o c E 0) N O O © N U O N 0 0 0 0 r a~ Q a c o a) o 0 0 N N Y - N N N pp (6 C N CO N_ 00 O C O N L p 00 O W 00 a ( .r ~ m E m .c ~ M L;?2 (.0 V) O y r w w E 4k G ! i a Cl a y a .d E i c C _ 1 A L) a 0 i 00 t STC - 104 AS BUILT SANITARY SYSTEK-rREPORT OWNER YTIes ADDRESS_ SUBDIVISION / CSM9 LOT SECTION /25 T 31 N-R_1 Town of Qr v. )-T )N4 1 ST. CROIX COUNTY, WISCONSIN J-trt A, ~ 0 PLAN VIEW SH V THING WITHIN 100 FEET OF SYSTEM fi .o A Yt i Q+ V S'C'0-4 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. lb- I BENCHMARK: AI J ALTERNATE BM: SEPTIC TANK / R INFORMATION Manufacturer: Uj LLa&^---) Liquid Capacity:. p_ Setback from: Well House. Q9 Other Pump: Manufacturer A11A Model# Size Float seperation Gallons/cycle: Alarm Location „1A -:SOIL ABSORPTION SYSTEM Width: 19 Length ?a Number of trenches Distance & Direction to nearest prop, line:_ 41 /jSZJK Setback from: well:-_, House. _FL_ Other ELEVATIONS Building Sewer ST Inlet:_3T outlets 3) PC inlet LVZA PC bottom Pump Off Header/Manifold 3 Bottom of system Existing Grade Final grade DATE OF INSTALLATION: 13'9~c- PLUMBER ON JOB: LJeVr s LICENSE NUMBER: INSPECTOR: 3/93:jt R Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LAorand Human Relations INSPECTION REPORT ST. CROIX Safety,and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 24 7 2 P rmiitt Hol~der'sNamgES ❑ City ❑ Village Town of: State Plan ID No.: HMM I STAR PRAIRIE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: i TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septicv Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. A irrito ntake ROAD Dt Inlet A Septic NA Dt Bottom Dosing NA Header / Man. Z 9' 3- ~ Aeration NA Dist. Pipe . 51 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade a^ k3 Manufacturer Demand } aR~~ gg Model Number GPM TDH Lift Friction Syestem TDH Ft Forcemain Lengt Dia. FFii Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' /2-2i DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Number: System: .d. ,(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 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 ^ 3 J Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE,15.y3~1,18W, SE, SE, CTY RD C /V y~"L_ ~'L-~.-~/Lf, ~/C--t-.t1 ~2..d.C.t •a-r:s',. ~1 . If' Plan revision required? ❑ Yes ❑ No r Use other side for additional information. SBD-6710 (R 05/91) Date ,p %s Signature Cert No y Safety and Buildings Division ~~a~r■r. 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 e than 8 1/2 x 11 inches in size. C • See reverse side for instructions for completing this application state sanittaar Pee mit NA.vo" umber The information you provide may be used by other government agency programs E] Check if rev. or`Tto p V c tion [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property O ner Name Propert Location Hof I -le- S 1 /4 5,E 1/4, S 1-5 T , N, R W Property Owner's Mailinq,qddress Lot Number Block Number f aYJ~ilw h l ~ Cit MAL%s y, Stag ` Zip Code `h~ne Number Subdivision NamQ or„C JVumber 3 0 7.S) CS / . 11. TYPE F BUILDIN : (check one) ❑ State Owned ❑ 't~ Nearest Road ❑ Vd age pp ~ Public 1 or 2 Family Dwelling - No- of bedrooms Town of 511-2" rq F-u III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 63 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1.j New 2. ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an A 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 6 11,9Seepage 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 1958 6 9P Feet / ✓5, Feet VII. TANK Capacity in gallons Total - # of Prefab. Site Fiber- ExPer. Manufacturer's Name INF RMATI N O O Gallons Tanks Concrete CO"- Steel lass Plastic App- New Exist in strutted g Tans Tanks Septic Tank or Holding Tank ❑ . ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Pri t) Plumber's Signat o Star ) )&/MPRSW No.: Business Phone Number: er 7 Plumber's Address (Street, City, State Z' Code IX. COUNTY / DEPARTMFWT SE ONLY ❑ Disapproved Sag Lary Permit Fee (includes Groundwater ate ssue Issuing Ag nt Sig ture (No Sta s Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination o X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05194) 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 ne,,v 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 nurnber(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. IlL 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 dirri'>~nsions, 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. F 1 /off, i ~sTin ~?3y!~ / S/' ~ T AIO f7d IIS.t ~j \1cG, ,o. low i m C), • ~ ~ ~ J.J„Qrrt GI &)wund a)tst- Y~t 7 /Uru / ~l 7r, w, 9,%/0 7a p p ` -l IS 19 5 E ' ' 0 PAGE OF CroSS Sec 10n J, A Systeen ~ i( Fresh Air Inlels And Observalion PIPS Jam~S c(..Le n Approved Vent Cap Ill ~~r Mlntmum 12" Abave final Grade Slf O 7 20- 42" Above Pipe _ 4" Cost Iron yEf To Final Grade Vent Pipe Marsh Hay Or Synlhetk Covering "In. 2' Agireg'ate I Over Pipe Olitrlbullon Pipe 0 0 0 0 --Tee s 6' Aggrogate Beneath Plpe 0 Perlorated Pipe 8e10w o Covpling Terminating At Bottom 01 System d re,C< Pro OS e D la,eA SOIL. FILL DISTRIBUTIOKI PIPE APPROVED $~YPETIC COVER 7"-MATERIAL OR 9" OF STRAW 2" OF AGGR EGME - - . OR MARSH NAy' ►I7 ~~.OFl2-2tl2 AGGREGATE ~LEV.OF~ EET- . DI•STRl5UTIOIJ PIPE TO BE AT (.EAST -36 INCHES BELOW ORIGIMAL GRADE AUU AT LEASTLO INCHES BUTIIO MORE TRAM 42 Mr-IAES BELOW FINAL GRADE MMIMUM WN OF EXCAVAT100 FROM ORI&NAL (RADF. WILL BE IMCNES, MllilMVM BEFni OF FACAVAncm f,ROJA. 047,I41WAL ~R~p€ WILL BE INCHES SIG1~1E0: LICCUSE IJUMBER:. a DATE : _ m c_7u,_~ 19 ~Q • Wisconsin Deprtment of Industry, SOIL AND SITE EVALUATION REPORT Page j of ,Labor and Human Relations Divisiim of Safety & Buildings in accord with IL R 83.0 Wis. Adm. Code , , C~ ~L Tj COUNTY Attach complete site Ian ~on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point d % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dist ~o t APPLICANT INFORMATION-PLEASE LL NFORM I REVIEWED BY DATE PROP RTY OWNER: JOPYELRTI LOCATION s S' 1/4S 1/4,S S T N,R f?`(or)r l~' IL J nu PROPERTY OWIxER':S MAI G DDRESS BLO # SUBD. NAME OR C SM # CI STAT ZIP COD .°PHONE NUI~IBE1i VILLAGE MOWN NEAREST ROAD 1.51, 6 Y&V i [Q New Construction Use M Residential / N'U ` f o b4dp~ [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow ALL gpd Recommended design loading rate bed, gpd/ft2_ls_trench, gpd/ft2 Absorption area required bed, ft2.,5~J trench, ft2 Maximum design loading rate gibed, gpd/ft2_,,'?trench, gpd1ft2 Recommended infiltration surface elevation(s)ft (as referred to site plan benchmark) Additional design / site considerations Parent material 62c1Tr~i'// Flood plain elevation, if applicable jv7A ft S = Suitable for system CGONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U 0S ❑U •E] S ❑U ®S ❑U ❑S ®U ❑S 91U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. C nt. Color Gr. Sz. Sh. Bed Trench Ground _ y 8 elev. C zft. _ Depth to limiting factor Remarks: Boring # ZIZZ Ground / elev. Depth to limiting factor }VZ' Remarks: CST Name: Please Print Phone: 4 /77 Address: Signature: Date: CST Number: - / - 40_1 _j L_ L PROPERTY OWNER ~~i`_S SOIL DESCRIPTION REPORT P3ge,_-,~'of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxiary Roots GPDJft in. Munsell Qu. Sz. Cont. Color. Gr. Sz. Sh. Bed Trends et) - z--2 41t,"(1 445 .X zl~ Ground 8 elev. Depth to limiting factor Remarks: Boring # A 10 Ground s elev. _ Depth to limiting factor > 9l Remarks: Boring # j .4/2 ••••.V y~}~. Ground 3 J540 Z, 8 elev. / - - Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) y, 1 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County p OWNER/BUYER ~ A M S k 8 e LL J O D 1fn,_ 1_r-_ MAILING ADDRESS PROPERTY ADDRESS (location of (septic system) P ase obtain from the Planning Dept. CITY/STATE (V -e 2.) _R . 50 o~ -7 PROPERTY LOCATION_ 1/4, 1 1/4, Section T__E_LN-R__LB_W TOWN OF 2jaL_ pp-A I P..1 c-, ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP 5 31 ? VOLUME I , 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 expiration date. SIGNED: l DATE: ! z z to St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 A 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 ~.JM ~ in peg MeL-e Location of property 1/4 SE 1/4, Section T_3LN-R W Township AIRIL- Mailing address ~4 q D&r p (ce b ~ Al ED) tc 6710A) D 01 -5k1 Address of site Subdivision name Lot no. Other homes on property? Yes No Previous owner of property _ -rn-e-s A. ~'C~ ~L ESRUp Total size of property AC, CCQ Total size of parcel i Date parcel was created A-Y 2:-, Are all corners and lot lines identifiable? ->I-' Yes No Is this property being developed for (spec house) ? Yes No Volume and Page Number 0 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 i the office of the County Register of Deeds as Document No. _s 31 and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Si atu e of.Applicant Co- plicant Date of Siqnature Date of Signature FILED S MAY 0 3 1996 ► M VLEEH N. WALSH SLCMhC0'Vh 1 543174 ~ CERTIFIED SURVEY MAP Located in part of the SEJ of the SEJ of section 15, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. UNFL/ATTL-D LiaNDS S89°47'09"E 300.00' N 56'± I 0 m I Oi s „ m N -'lo v m 3 n c _..H = N m N x ° 9 C) 0 a 0 N 7 M LOT M 1 1- z 3 Z ° ~ . I C= 0(D 0 N o a z I ;ti fi > > O vin J -v o o _ 4.13 Acres o x a 0 n (n ~L w 179,995 Sq. Ft. Cl ~y c~ N 0 I L W ~I V( O CD 3.92 Ac. Exc. Water I _I 00 fD 170,587 Sq. Ft. j-: 11 1-1 rn " 0 n t J~ N N co o CD I I -I txj \ : -I 0 '~1 \ l-'ROBED :3 T co i CD r- rn o l MAY 0 3 '961 11> I;z (A -n ( I L7 co ' I ~ < rn co a O rn M O I-~ I 1 r. CR'OIX COUNTY o Z N a O Ij o ("'acnprahensive Planni o °m N CD X ;toning and . T / Parks Cornmitteo a o , ° n4~ti 7 A fD i / not recorded H i %Arf`hin 30 days of ;44 -!;4 -'4 o i approval date ; a.. ~~v d:~ lrt s o n :rproval shag be Ai°lSP- .0 't m• D W %V19 R, •unid ~:p q1 "'f Sr ii: 3 z 1-9 t 230.82' 69.18' y 11 '1 N89°47'09"W 300.00 T' cr M J4 rr S•~'v n M 0i rt Z IJNP /aT i ED Lai^~nc Q ~o m o .0"- W ~G V N /"-'66' Wide Access M Easement Recorded in / % •V01-' 1176 rP9- 01 X60£ 9S?d TT 'TOA •aoznp- zoj papog umol aluz.zdoadde pup aozj;0 BuiuoZ Aquno0 xtoz0 • IS auj JOVIUOo Taoxed Auv ButdOTanap :10 Butsvuo.and a.zo~ag •(•oa a 'Taozed oi ssaoop ' azzs IOT wnuizuzui 'spuPTlaM ' • a • T) suozjpTn6az pie saTrLz 'sMpT dzusuMOs pup A-juno0 'agpjS of goaCgns sT (gRTd) d2u1 szu:l uO uMO'qs T90a' uovg -auips Buzddsm pup BuTAan_ans ui xzo.z0 •qS go Aquno0 auk _40 aouEUTpzp uozsznzPgnS PUPq aul pup sainipis uisuooszM eqq 3o VE'9EZ .zajd~u0 jo suozszAO.zd qua.z.zno Oql glTm pazTdiuoo ATTnJ aAP-q I gEuq : p@gTaOsap pup paAan_ans Aappunoq aot.aagxa aqq go aTEDS oq uoilpquaseadaa loa.z.zoo V ST dpW AaAanS paTgrgz90 stuq IEul AJilzgo OST2 'I •pzooaJ 90 sluautasPG TTY' 01 1091gns sz Taoavd pagzaosap anogv •(*qa 'bs 566'6LT) SGaDV £T-t suzPIuoo Taoaed pagzaosaa 9,qq oq gaaj 00'00£ 'M..60,Lfi068N aouatIq 'laag 00.009 'M~~ZT~GE000S 90U9ul ::199_4 00'00£ 'g,►60,Lto68S 90uau-4 :laaJ 00.'009 'auzT Is9m PIPS BUOTP 'g„MGE000N Buinuiwoo aouagq :BuYuuTBaq go iuzod aul of lea; Z/.•TZE 'auzT gsaM PIPS Bu0TP 'S,,ZT,L£000N aouaul :"i/T$S auk .40 V/TES Uill go auzT gsaM auq oq 1999 0Z'06ZT 'uozgoas pzES 90 V/tg•S auq 90 auzT ugnos auq VOL 1176PAGE 149 53175 QUIT CLAIM DEED Document Number ERG T5 ~4FVS 0 ST, GRODC OW-9 N Redd forRcxwod MAY, 3 1996 .~..Y...c~-....~'~.:.smr! E e-........................ OL/.......C yy.(~~ ..C.......1.11 ....Gh...... 7 'i 10:30 ~7.Air f J w bem quitclaims to......i'r! ................................o v,Y........A.......................................................................... r/i!...o2..H../..'....... r4A..L..t9....~- Recording Area ....................................Un.................... Name and Return tlddress County, ....o~.J~ the following described real estate in...... State of Wisconsin: ' Q /N f~~T- Off= T~ 567 DF TME~ -F 1¢ O/F (Parcel Identification Number) e~eo)l 49' 7- I FEE Gfr7T 7-1 F/ E.0 SvX J gy /1).#P ---EXERMFF 1' ~o 6, vm f^J T 4~=5V3 V74 P 0 re, L_ f-, This . ~~!7 iomestead property. Dated this .............................day of...... !9 19.... i.4P (is) or (is not) M s t--~.......................v. ............C •.....-o.y....ti......,m.......~M..s.. AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ................CM2 ..........................................County. Personally came authenticated this .............day of............................................... 19.......... before me this dayof....MAy................ 19?.4 theabovenamed y e5. rc.,.........a xz. ~1611UiU:C .~..y..~..~ ...........:..•..l&...........1 type or print name ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r r a r p ~_w w NtNN~I ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 November 6, 1996 Attention: Becky Hartman Homes P.O. Box 326 Somerset, Wisconsin 54025 Re: Septic Inspection for Property Located at 1182 County Road C, New Richmond, Wisconsin Dear Becky: An inspection of the septic system installed to serve the above described residence was conducted on August 13, 1996. This property is located in the SE-'4 of the SE%, of Section 15, T31N-R18W, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the installation, this septic system was found to be code compliant for a four (4) bedroom home. If you have any questions with regard to the above, please do not hesitate in contacting our office. Sincerely, , 6(_ Mary J. Jenkins Assistant Zoning Administrator pe