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HomeMy WebLinkAbout038-1088-40-000 o N O m N N a o I g ~ I °o I N ~i o I ~ I ~ I ~ I i I I N I z U. C O C E Q c+) I C I 3 E w z I = $ I z ~ ~ € d I c~ F tp a m I o I H z ~ c U1 FZ- ~ O c Z I c E ~ I ` N N 7 N n c IDI • IV I a cn t r '0 0 0 cp O O N Q ! z m z N z co N C R E C (mil S] d y lC T to ~ ` V C O co N N y 4) 0 0 IL C14 O Q~Q1~ t d .00 O Q. a U) U) U) E E ! 3 3 3 a s ° o o l z - O o o •At IL IL y E I E co U) J U rn rn M ° 0) 't G> C N O 0 cn co E j O y O O -D $ a I C: w (D U co 0 0 Q > cn co C o o N N C C~ 4 m U O 4) O N 'O co CO N y C E C OOi O V ~ C O .2? v O V I~ N ay+ O O ~ d 0 I~ y N H fD I • , M y N O co O E R U O N fn W N O z_ z:9 fn v~ R € a I 0 L: IL • c~ CL m 0 E rr`Iw~i c 00 _1 A ciao 0to0 4k. 4 0 o M ~ 03 ci eF ao (1) 0 es h O N N d w I C N N C Z 7 (0 LL c O 3 a Z y ~ fn O Z M w ) a co co H Z 0 c C7 -o iu o z a w o y 1 d Z ° c N F r C ~ z N tm 7 ~(~1 C fC N y y C •N a ~ L o 0 o d a w z co z o N Z E co co E cu N N y w C ~ O) CL o a :3 ° o co H m T O O o a a co 04 N N N fA j o _ ~ ~ ~ d m Z a O •N 3aaa CL d 0° a) co 00 o M J U to 0) m z maa c Y 0 o m d Q Z (n m v O C ~ N C O O 3 N y j N0 N CO H C LL O r CR C N V 0) p C T 40. -7 -6 C~ CL CD • O o o U) 0) to 16 L) o z S Z to V ~ T m € n. • a d .0 d a • Parcel 038-1088-40-000 12/08i2006 01:00 PM PAGE 10F1 Alt. Parcel 21.31.18.363B 038 - TOWN OF STAR PRAIRIE Current Xl ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ASHE, DOUGLAS F & SUSAN B DOUGLAS F & SUSAN B ASHE 2060 COOK DR SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2060 COOK DR SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 21 T31 N R1 8W N 200 FT OF S 433 FT OF Block/Condo Bldg: W 217.8 FT OF SW NW Tracts : (Sec-Twn-Rng 40 1/4 160 1/4) 21-31N-18W Notes: ~j-G a Parcel History: Date Doc # Vol/Page Type l(P /^t V 03/03/2004 755763 2520/514 WD 1191/311 QC 1188/599 AND V 927/161 more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 175393 163,400 Valuations: Last Changed: 10/29/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 25,000 119,400 144,400 NO Totals for 2006: General Property 1.000 25,000 119,400 144,4000 Woodland 0.000 0 Totals for 2005: General Property 1.000 25,000 119,400 144,4000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 108 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~"ACQ ADDRESS D (off Cow k fir, Somme r S-a_~' C.y i ~S! O as SUBDIVISION / CSM# LOT SECTION a1 T 30 N-RW, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW l SHOW EVERYTHING WITHIN 100 FEET OF SY#EM 1 -53 3 60c1 v ~ 1 el s( t INDICATE NORTH ARROW Provide setback and elevation information 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: Liquid Capacity: Iona Setback from: Well 71 House aZ Other Pump: Manufacturer A- Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: Length l a I N Distance & Direction to nearest Pro 0~7 P• line: /Un~• Setback from: well: 7.3 House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade- 22, (o DATE OF INSTALLATION: !6 PLUMBER ON JOB: LICENSE NUMBER: 156a INSPECTOR: 3/93:jt 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 ❑ City ❑ Village R Town of: State Plan ID No.: Pefiyq d6& , meTRACEY I STAR PRAIRIE I CST BM Elev.: i Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA GF G TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic z,h re Benchmark 3 ~p~ ldU, Dosing Aeraticift- Bldg. Sewer u - { Holding _ St/ Inlet u.,^ r'(2-14 SETBACK INFORMATION St/W Outlet TANK TO P/L WELL BLDG. Airi to ,take ROAD Dt Inlet Ar I I ; Septic a5 >2Scj NA Dt Bottom Dosing A Header/ Aeration NA; Dist. Pipe Hal~ffn'g Bot. System PUMP/ SIPHON INFORMATION Final Grade M facturer Demand Model Numb GPM TDH L' Fric ' S stem H Ft L ~Forcema!in Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt No. Of Trenches PDIT No. Of Pits Inside Dia. Li uid Depth DIMENSIONS ~a 7` a nufacturer: IN SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM INFORMATION TypeO n r , , CHA R o System: A UNIT DISTRIBUTION SYSTEM Header/Man Id z~ Distribution Pipe(s)~ x Hole Size x Hole Vent Intake /if o Length CO Dia Length Sr Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At- de Systems Depth Over , / Unty- Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Yw Bed /Trench Edges VO - > Topsoil E] Yes No E] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE.21.31.1814, SW, NW, COOK DR ~c ,v,-,,C.=;.{-!",.,1r1~ +C.='~`^'-•...;,7 , ,L C~ Plan revision required? E] Yes O r. F&To Use other side for additional information. I WA SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION V'~~nn In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. Ch i lout pr io u2 larp/ plication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PRMTYae OWNER PROPERTY LOCATION *2 o1 SJaK IVU.%, S T N,R iW)W PROPERTY OWNER' AILING ADDRESA LOT # BLOCK # tK_J COO - CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~S- -540 1s 3 c? 11. TYPE OF BUILDING: (Check one) El State Owned VILLAGE ftrti rte NEAREST ROAD, R71 MI TO N OF~ .0 ❑ Public Lpa 1 or 2 Fam. Dwelling- # of bedrooms PARCELT4AX NUMBBER((S) h / l 111. BUILDING USE: (If building type is public, check all that apply) 0 3d _e"~' v ( gto 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 M Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 _~j REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) c~ELEVATION . ~ -5 p63 J~C~ 1 Feet /7. 7 Feet CAPACITY VII. TANK Site in allons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete glass App. Septic Tank or Holding Tank Tanks Tanks structed fJ~'K 1:1 E] Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signatur : ( amps) MP/MPRSW No.: Business Phone Number: r 1 1s~3 _7 i s cis! Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S~nitary Permit Fee (Includes Groundwater Date sue ing Agent Signature (No Stamps) )(Approved ❑ Owner Given Initial ~j~ Surcharge Fee) 4C U a„4 Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber 3 INSTRUCTIONS , 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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 & 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 insfalled. Il. 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% 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, ground- water contamination investigations and establishment of standards. SSD-6398 (R.11/88) f ~7l --t en. r E 1 , I , STS , 1 , r { j G r , - : f , , : : i r { I PAGE OF Cro5S Secjlvn O4- Sys~en cc Frech Air Well; And Obcervation Pipe 1 . Approved Vent Cap Minlmwn 12- Above a(\ tg) \~OV, Final Grodo ~ 20- 42" Above Pipe 4" Caen Iron To Final Grade Vent Pipe f w 1 - rig Math May Or SynlMllc Covering ,V l Wn. 2' Aparegale - over Pipe Olilrlbulion Pipe 0 0 0 0 Tee BeneoAggtA Aggregate Be a Perforated Pipe Below o -Coupling Terminating At Bottom Of System fir 1D cal qrf%cl< 1 ~ cJ._1 t crl I'll SOIL. FILL DlSTRIBUT10f.] PIPE • APPROVED Sy)JPETIC COVER 2" OF A6GR EGA?E "''-MA7~RI~!- OR 9" OF STRAW OR MARSH HA`j (oOF 12-21~z AGGREGATE"tt ALE V, of FEAT.-.. 74 r-:3 DI•S-1-1115rJTIOU PIPE TV BE AT FEAST IIJCHES BELOW ORIG'IQAL GRADE A►JU AT LEASTP-0 IAJCHES BUT lt0 MORE THAQ Li2 mci4ES BELOW FINAL GRADE M91MUM WN OF F-XCAVATIOP FROM OKI&INAL 6KADR WILL BE 34 INCHES MINIMUM 9EPrtt OF rACAVATION FROM. 0IR14IMAL GRADE WILL BE 'yLe INCHES SIGIJED: LICEWSC DUMBER: DATE: e~g-. ~ C( l Y 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 ~11'e residence located at: ~1&4 1/4, Sic. ~T~ N, R_RW, 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. 4 Last time serviced Did flow back occur from absorption system? Yes No,,~L(if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete, steel Other Manufacurer (if known) : N/ j4. Age of Tank (if known) : ap y Cwlv~~ \O~.?~ll`~ V I~ _ (Signature) (Name) Please Print jrrgS(J 1.5&-3 (Title) (L icense Number) s -94. (Date) Form to be completed by licensed plumber (x.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, is. Adm. Code (except for inspection opening over outlet baffle). Name rna-,aSl1g 9L Signature MP/MPRS 4563 V% U 5/88 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of 3 Labor.and Human Relations Didision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY rt J~ i Gv`t1~ Attach complete site plan 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 (BM), direction and % of slope, scale or PARCEL I.D. # _ dimensioned, north arrow, and location and distance to nearest road. ' 0 - PO APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY ATE PROPER OWNER: PROPERTY LOCATION +~pr) W Q O ' GOVT. LOT Lc~ 1/4 A) 0/4,S a/ T 3/ N,R /J' PROPERTY OWNER'. MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # X060 r• CI STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 00fOWN ,"5jkr NEAREST ROAD W 5YOQc (Ws) 6-3-59 rr' G'po ~:)t- [ ] New Construction Use [ Residential / Number of bedrooms [ ] Addition to existing building (Replacement [ ] Public or commercial describe Code derived daily flow .50 gpd Recommended design loading rate 1 7 bed, gpd/ft2_trench, gpd/ft2 Absorption area required 4 V3 bed, ft2 .54.3 trench, ft2 . Maximum design loading rate bed, gpd/ft2 ~ ktrench, gpd/ft2 Recommended infiltration surface elevation(s) a ft (as referred to site plan benchmark) Additional design / site considerations 4A+ Parent material 6u:* k+Jo~s 1. Flood plain elevation, if applicable A AM, S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem s ❑U 0S ❑U 5g S ❑U ®S ❑U ®S ❑U ❑S J91 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 Trertch -ad /o None JC Sbk f r C W I rv~ ~ S Ground 3 ~o-_tvl None G v C s m ~Lj 'g elev. q _ 7J, ft. /OXFA N d AP S s M l~ ~ r ~ / 7 r Depth to limiting factor Remarks: Boring # A) drQ 5/ 1 f s k m cw 1 S k .a... > jl S Q ar~._ Sbk M4 r G L-) Ground 15 .9& ),.5 s o M U ~h -6~ / elev. T Depth to limiting factor Remarks: CST Name:-Please Print - ~r Phone: / S..- a,yb _ 5~3s- J Address: W_r7 _5'! et Signaturei.~ n Date: CST Number: PROPERTY OWNER -&,C-ey kUb) SOIL DESCRIPTION REPORT Page _na of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundwy Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. :<.1<:«:K Bed Trench X•iG ::'<'r><€; -off ~f on e S ` yK Cud i rh , 5 , Ground 3 g 5 d r12 66 O C 5S [A elev. 7, ft. 7- 0 O 1~2 .S C Vr 7 . Depth to limiting factor Remarks: Boring # 44 4 y . jinn ¢:i... ti-vvn-ti : Ground elev. ft. Depth to limiting factor Remarks: Boring # k tiiti v;:::::: :h4 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor L L.- Remarks: SBD-8330(8.05/92) 3 J I ! , I , j , f I , -7 0 jr- .S3Y ! i , , ~a o AWA t) a Itif j 4 ! I Y . ! I 1 ( I i , + IK t f .-_I i i I ' I I i t I ~ _i k I I ITIE I f ;J6 - t , 1 t ! i ~ j ~ ~ I i i I 1 J.. i STC-105 SEPTIC TANK MAINTENANCE AGREEMENT j St. Croix County OWNER/BUYER i^ CLC- e ),e a MAILING ADDRESS O L9© .od PROPERTY ADDRESS ce (location of septic system) Please obtain from the Planning Dept. CITY/STATE So r, '0- ir-S s~ O o f PROPERTY LOCATION S w 1/4 N ~1/4, Section T N-R 1 W TOWN OF ~t V l(11 c~ _ ST. CROIX COUNTY, WI I SUBDIVISION GU~ l4 . 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. i 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 maintai a co pleted and returned o the St. Croix County Zoning Officer within 30 days of the thre year p e. SIGNED: r ' 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. l Owner of property i Location of peat Sw ],/4 1/4, Section T_11 W n. Township Mailing address a 0 to COOK Address of site Subdivision name Lot no. other homes on property? Yes_ No Previous owner of property ~'l Total size of property Total size of parcel L/b ~'Ti2~ Date parcel was created Are all corners and lot lines identifiable? _Yes No Is this roperty being developed for ('spec house) ? Yes __2~ No Volume ~ 0g I and Page Number SS"3 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 i1 Deeds as Document No. L~ 7) 7i1 '~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 of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co-Applicant Date if 'gnature Date of Signature THIS SPA(E RESEPVED FOR RECORDIN' nATA WARRANTY DEED DOGUMEPIT NO STA. E BAR OF WISCONSIN FORM 2-1982 471'45 553 VOL 909P REGISTER'S OFFICE ST. CROIX CO., W( Robert J. _Cook and Marjorie E -Cook, husband and wife; . Recd for Record - Theodore. J._ Cook and Susan D Cook, husband- and wife, JUL 2 31991 - and.~ary L,--Cook and Nancy-J. Cook, husband-and_wife C1 8.30 A. M coneys and warrants to Tracey- L. - Elleyold_ and 'iichelle M Ellevold,..husband..and..wife,-__aa..marita1_property- -with g► Re~isterpfOeeds rights-.of-survivorship RETURN TO Eel C~CS~ . i3vr y~G - SOAW eA SET, G Sf~itt the follt wing described real estate in $t....Lroix---------------------- County, State of Wisconsin: Tax Parcel No:....---------------------•---- Ii A parcel of land located in part of the Southwest. Quarter of the Northwest Quarter (SW} of NWI) of Section Twenty-one (21), Township Thirty-one (31) North, of Range Eighteen (18) West, further described as follows: Commencing at the West quarter (WI) corner of said Section 21; thence South 89° 05' 40" East, along the South line of the Northwest Quarter (NWI), 219.80 feet to the point of beginning of this description; thence continuing South 89D 05' 40" East along said line, 344.39 feet; thence North 010 24' 58" East, 355.05 feet; thence North 89° 051 40° West, 349.32 feet; thence South 000 37' 16" West, along the West right of way of proposed 66 foot roadway, 355.04 feet to the point of beginning. Parcel deeded to adjoining owry.r. FEB Via This is..nQt------------ homestead property. (is) (is not) Exception to warranties: 28---- - day of ' - June..._._-- - 19... 9L Dated this . . . . . (SEAL) _ .(SEAL) • .E:~~ - Mar' tie E. Co k Robe o i (SEAL) .(SEAL) Theodore . C Sus D. Cook (SEAL) F J (SEAL) a L. THENTICATION an J.ACte OW L E D G M E N T Signature(s) STATE OF mseo Slhi ss. __St,-.Croix------- County. .28 authenticated this day of______________________ 19 Personally came before me this . . . .day of ..-..June 19.91. the above named Robert:_.J__.Cook _,.-Marjorie..R..-Cook-,--------•-•--- _ Gary--_- TITLE: MEMBER STATE BAR OF WISCONSIN L.~•_Cook--and-.Nano _ J - - (If not, authorized by § 706.06, Wis. Stats.) to me known to b. the person __g.-...._ who executed the foregoi i~ instrument annackno dge the same.