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HomeMy WebLinkAbout231-1037-60-000 ~ 1 -0 0 N O ~ O °o O Ci 0 0. 0 ti N C! ~ O N O 0 c y n e 3 C E N CL M L r U cc c U 0 3 0 C Z O N c c '2 o LL C 1 O co ~ - M_ I ~ ~ N Q C O otS I v Q) uJ II, Z ~ Z O M Cl) a m N I- Z c O I C z p U O Z d' C w a~i Z d' ~ c O fn 1- rn N Z c E m v M (D Q 3 J W ti N c •N d v ~ o c O O N d c O y Z H Z ~ ~0 M a N w Z 'D N lC c N E CM U) =m co CD (0 3 H m U` c Op 00 a' s c C O m nl t 0 N N H H F- ~y O d Z O O ►i 3 O O O CL U o N ' rn N N M 00 ~ y O I O 1' 'd rn rn E p p T O N IL 7 m N wi" 3 d v~ o U, O O 0 N N c d. O j O N ca 00 0 0 c U N O O O W C O C c n- p 0 O CO N m cn cn Y N 'J M U2 2 2 co C N N CO N C 0 0 O .r p O Z O p rl M w 00 ((D cn O (6 U cyi N N U cc) N O y H fn ~ l r V (D R £ a a d • a d .0 d y A a U 2 0 v) 00 ~r 7'ESP ti- 1 63 VOL 19 PAGE 4977 KATALEM H. REGISTER OF DEEDS CERTIFIED SURVEY MAP NO. QECEI ST. VED V FORCo. ° RECORD VOLUME 19 PAGE 4977 05/05/2005 10-30AN Rep me CERTIFIED SURVEY HAP BE-INC LOTS 2 AND 3, CERTIFIED SURVEY MAP # 32~~Y F ° LOCATED IN PART OP THE NW 1/4 OP THE SE 1/4 FA" R ED, T30 N, 215 W, CITY OP GLENWOOD CITY COUNTY, WISCONSIN. i APR 2 S66- 4 ST. CROIX COUI , SURVEYOR'S RECORD EXIST. ASPHALT o wl A DRIVE SEPTIC LIDS N ul!S Vet: EXIST. - q/ y~ty9. i o l°°~°i~ p rTi - q5 a~ .Z~Q 7a '..GARDDR'1 ELL NOOSE 1 pIi rl o - tJ'14 5 8 w ~IW ~I EXIST. LOT 13 'a ASPHALT cY 'A W q2,308 C7. FT. i~ DRIVE 3i SHED 'v ' «I WELL ~~9 WiJ- , yw 2.12 12 A AC. w i ..I..I 1a i of it 3 o p HOUSE . o o vl M p 589° 23'04"W 297,50' o V SEPTIC p LOT 12 VENTS ZtEa ; ! Z X15,978 50. FT. 2.20 AC. N N ~w~ i i O i V7 i 589°23'04"W 318.64' t1N~ r~g~O 2& c -is Pd. t CURVE DATA 8intin1"'""` CURVE RADIUS CENTRAL ANGLE CHORD LENGTH CHORD BEARING ARC E.T. BEARING F.T. BEARING 1-2 633.40' 03° 23'52" 37.56' N73° 18.02'E 37.55' N74° 59'58E N71°36'06"E 2-3 633.40' 18°41'24" 206.62' N62° 15"20"E 205.70' N71 °36'07"E N52° 54'43"E 3-4 185.50' S8°26'31" 181.12' N82°07'59"E 189.21" 868°38.46"E N52°54'43'E 1-3 633.40' 22-05-15- 242.67' N63-5721T ?44.18' N52° 54'43'E N74° 59'58"E OWNERS: NOTE: The Intent of this survey is to = James R. and Christine L. Vandyke certify the location of the lot line between So 421 Walnut Ridge Drive recorded Lots 2 and 3, Certified Survey Mop Glenwood City, WI 54013 No. 3223. There was o deed recorded S" Tom Carlson (Vol. 1979, Page 220) that realigned the P 423 Walnut Ridge Drive common line between Lots 2 and 3. o Glenwood City, WI 54013 St. Croix County Zoning Deportment c' o° requested to hove a survey performed h PREPARED FOR: to certify the lot line location. Edina Realty Title N 6800 France Avenue South ~ \ o Suite 410 Edina, MN 55435 tQ = o DRAFTED BY: in Ronald D. Jasperson § I a tl'z- \4- 05 LEGEND SCALE: 1" =100' ' - iil~ ........Government Corner (as noted) l~ 1.5 1 o.......... Set 3/4" . x 24" Iron Rebar Weighing I{O 02 (b lbs/lineal ft. - 1.5 W t 0' 100' 200 Found 3/4" Iron Rebar (7 Vol 19 Page 4977 Sheet 1 of 2 r :A w t r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER, 14 L, / N C~~`'~ ADDRESS SUBDIVISION / CSM# LOT # SECTION 13 T~N-R _W, Tv. t f- f NG~% ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a I~ Y " ~ yl AA~r I INDICATE NO TH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. W BENCHMARK: ~L i,r/ ~!~~Ly ~G 'G C C~~ ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: r Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation 6a='on/cyc_le: Alarm Location SOIL ABSORPTION SYSTEM I ✓ Width: Length q, Number of trenches Distance & Direction to nearest prop. line: Setback from: well House G Other ELEVATIONS Building Sewer r ' ST Inlet: ; ST outlet:- Zq,12 PC inlet om Header/Manifold i, ; ~1 d otVo of system .y Existing Grade Final grade YZ.z~q, DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: Al P INSPECTOR: 3/93:jt rWisccnsinDepartment ofIndustry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division Sanitary Permit No.: GENE~AL INFORMATION ATTACH TO PERMIT) 268648 Permit Holder's Name: EM village Town of: State Plan ID No.: MARVIN BOOTH L~NWOOD SIT CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600344 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >a 5' a5 - NA Dt Bottom Dosing NA Header / Man. `a'ny 8 v Go'3Y' It, Aeration NA Dist. Pipe g~,3C !r-/ ra•r~ ~ gn; go Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS .5/ .3 13 1 DIMEN I N LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type O CHAMBER Model Number: System: ~v ~~f ° ~O• y. 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 N Bed /Trench Edges I> Topsoil ❑ Yes No ❑ Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: GLENWOOD CITY.23.30.15W, NW, SE, WALNUT DRIVE dJ, ~ w~ Plan revision required? ❑ Yes of No 6 Use other side for additional information. [41 SBD-6710 (R 05/91) Date I e or's Signature Cert . No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 f • Attach complete plans (to the county copy only) for the system, on paper not less County , than 8 112 x 11 inches in size. S L' O/ • See reverse side for instructions for completing this application State Sanitary Permit Number A; , (O 7e The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location V/ O D 4f1A 1/4, 5 .2 Tao , N, R /,S 06r) W Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDI G: (check one) ❑ State Owned it Nearest Road E] Village ,~',C7 G~eNwooo~~~~' Public 1 or 2 Family Dwelling - No. of bedrooms Town OF G~/AJN~ 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ~ 3~` ~d 97"- 0/10 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. X New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 1`13 Seepage Trench 22 ❑ In-Ground Pressure 42 E] 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) ~8. S3d~l~r8 Elevation ~O J 6 Jr 70 ' r,7, Feet 9.x z' 901Ffet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks ❑ E] El Septic Tank or Holding Tank dZra I ® Lift Pump Tank /Siphon Chamber ~yi 1 ❑ El ❑ 1:1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: ( Stamps) MP/hi~No.: Business Phone Number: 4 5-M Plumber's Address (Street, City, State, Zip Code): 2 w 70 6:1 (E~ 4,v o In IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Santary Permit Fee (includes Groundwater ate Issue Issuing A nt Signature (No S mps) C Surcharge fee) Approved E] Owner Given Initial ~&Me~ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SRD-639R (R. 05/94) DISTRIBUTION: original to County, One copy To: Safety & Buildings Di--ion, Owner, Piumkkr INSTRUCTIONS L " 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 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 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 8 112 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. 'ru?-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 contaminatio-) investigations and establishment of standards. ;77 o i 1 - Vii' ~ - - r _ ~ - - - ~ _o = A 111 a _.L_ --e - le e ; 4e-i-2 I a l i ~ I I -i~ - - - -i--- ! L7 - - t e e a - l_- - - b D _ J - - - - - - - - - - I F- 44 I i i PRO ~ i I I_ i ~ -Idly O ~a - - - - - -1- e - - - L f - Pp- [a ?A Al ' - L -a - - -I --l I 7Fj-4kd 13 L J'a 7 - - - - h~ ~'L L - - - --1--1- i ~ r- - 1. --r- II ' - I L , I - - - _ I j I f i ~ I II i I ~ - - I I I I ~ C ~ I I , I : - : - I- - - j j - i I 1 I I I ~ t i -i is--I -~_L-_. I-~ ( - - - T yNr. Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and S percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # rr APPLICANT INFORMATION - Please print all information. Reviewed H6 I jQCQate TO-I Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). r yL,. Cdr Property Owner Property Location ' , Govt. Lot 1/41/ , TO ''abr) W Property Owner's Mailing Address Lot # Block# Sub( Name or C .4 /ci~ty~ --te Zip Code Phone Number D Nearest Road [M a C-li Woo / ( ;?/J-) tyA G El Villa0 e El .Town d New Construction Use: ❑ Residential / Number of bedrooms- Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: pp Code derived daily flow. !g gpd Recommended design loading rate 7 bed, gpd/ft2~_trench, gpd/ft2 Absorption area required d y 3 bed, ft2 .1~:X3 trench, ft2o Maximum design loading rate bed, gpd/ft2 ! Of trench, gpd/ft2 Recommended infiltration surface elevation(s) . 7.S r4i~. yf ft (as referred t site plan benchmark) Additional design/site considerations x 8 ne y N e ACS B' Re. M .4 R K 5 Parent material G A 1+L L Flood plain elevation, if applicable N .4 ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system 00 S El U ® S El U ® S El U ® S ❑ U ❑ S ® U ❑ S Z U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure GPD/ft2 Boring # Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed 1 Trench / •JZ o S/ L .2 Sb M0.r a fir' S s' /.2 SVA- Al A4 F s i F A w ; .s Ground 3 e ev Depth to limiting f Actor in. Remarks: Remove. /op sal'4 FOR M~i~C ~`dLoF "oven Srrs1'c~f Boring # ~Z C ; _ ,4 r qGround / I""T I Depth to limiting factor -in. Remarks: CST Name (Please Print) w Signature J , Telephone No. SAL Gv S i Address Date CST Number 3.r2 g / 76 GL e Gv o a o~ i1` i o/ / PROPERTY OWNER MAID V /N 840 SOIL DESCRIPTION REPORT Page of PARCEL I.D.# ~2 - Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 0~ /,L 6~'~t Mr~'r .2 a-S s- A-1 1,V 10 R 3147 - L s t o Gv Ground S M L elev. Qft. ; Depth to limiting factor Yd, in. Remarks: Boring # o-/ o S ZS /r Mrr ;2 m 6S 57 6 y 2 -6 4 s5,61r- / w 21-f Y& S Ground elev. 17 t. Depth to limiting factor ~f 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 # O -12 149k IR ?/-T IX- S'6A A-1 C", S -f-: a~ S' /2-70 o VA _?/X asd k M - t F A w ; S' o- S M L - 7 8 01 Ground elev. 8 "'M ft . Depth to limiting factor /L-L-in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) i ear ' 1 1 1 i p / - - - - f- i s r I 1 ~ ~R r 1 - I _ i 1 : - ~I j I i I I- - I it -I-j -i-- - --J - i 1 I I I I _ i I. r I I Y - 1 ' I I i I I . I --I I i I I - - I i ~ I I ! I ~ I I T i ' I I I i l I I I i I ! ~ i I : i i ! I 1 i ~ i I ! i i , I I I I I C.T.H. "X" col I~~ ~~/AI~I JIy x Vy I / 4. I ~ I c~ I D I m xl f~ II O QI I ~ I I I 3 .80,E1.00 S ,26'ITI 3 .80,E1.00 S ,66'E99 M .8000 N \ \ \ \ m N LI 10 W 1 ` - W Ln r o N m ? P S W 3 .80,01.00 S 10 ,92'6L6 M .80,E1.00 N ,62'BOE P 1 Q n O W O : V I A r 1 N O n) N m P O t I o ~ ~ N \p A ~ m " T M ,SlL2.80 N v ,ZE'6LE Lei v 3 .92,61.00 S M .92,E1.00 N ,82'S91 ,l0'S22 ~ ~ N in r H \ u' O o r \ n z A N W W o t " 11 I I ru ny I 1 m / M .92,E1.00 N M .92,E1.00 N 2 17, ,82'S91 ,81'40E / l At 14-4 c3 I STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERMPAW M A /9 L/ N Z~D D f' /I MAILING ADDRESS - ZJ A N G/ 7' PROPERTY ADDRESS SISI /UI (location of septic system) Please obtain from the Planning Dept. CITY/STATE eN Gc~ o e d C / LY PROPERTY LOCATION A/V 1/4, S,e5 1/4, Section,, T 20 N-R W C OF G-l e/V w o O S 1-7, ST. CROIX COUNTY, WI T4MAM SUBDIVISION LIW If/ N G1 It R/d a,"_ 5t14 f'e_ Ly/ LOT NUMBER W ©2 CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the 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. 4', SIGNED: O DATE: / -1,2 Z 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. Owner o f property Location of property~1/4 S]_P 1/4, Section ,~3 T ZEN-R__Z,~__W Mailing address ~2 / lv /f ~Nu 1L fv Address of site Subdivision name l,-z,),4 A A t u f ,~/dge ~S7~7`2 o~f~=Lot no. Other homes on property? Yes__Z_No Previous owner of property ~~1 o~L SC'`i w A 7~Z 2 L1 e Total size of property o? Total size of parcel Date parcel was created /~'~f! y y t 996 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes _ )(_No Volume P fo 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. Z&! /Z~ Z , and that I (we) presently own the proposed site fo tr he'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. S ature of Applicant Co-Applicant _ q- Date of Signature Date of Signature DOCUMENT NO. _ -TATE BAR OF WISCONSIN FORM 1-1982 i ~ HIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED REGISTERS OFFICE ST CROIX CO., W1 j This Deed, made between Recd for Record k JUDY A SCHWARTZBAUER ~ J MAY 2 9 19961 A SINGLE PERSON ' and Grantor, at 9:30 ` A. N1 MARVTN f 1300TH AND JEAN M BOOTH, ~~~w~- HUSBAND AND 14TF AS JOINT TENANTS Register pfDeeds _ Grantee, Witnesseth, That the said Grantor, for a valuable consideration RETURN TO 1ST NATIONAL BANK conveys to Grantee the following described real estate in_ ST. CROIX CO. OF GLENWOOD County, State of Wisconsin: 204 E. OAK ST. ~~ITY 611 54012 LOT 36: Outlot "36" Glenwood. Begining at the S corner of the Section 23-30-15, thence E along Tax Parcel No: 221-1037-60 & S line of said of sub-division 40 rods; thence 231-1037-70 turning right angle n 462 feet, thence turning rightangle W rods; thence turning right angle s 462 feet to place of begining, excepting highway on W side above described land. 1 LOT 37: NE Quarter of the SE Quarter (NE 1/4 of SE 1/4) lying West of highway; Also E half of NW Quarter of the SE Quarter (E 1/2 of NW 1/4 of SE 1/4); Also SW Quater of the NW Quarter of the SE Quarter (SW 1/4 of NW 1/4 of SE 114) except a strip of land sixteen and one half (16 1/2) feet wide on West side: Also S half of NW Quarter of the NW Quarter of the SE Quarter (S 1/2 of NW 11of Nw 1/4 of SE 1/4) all being in section number twenty three (23) township number thirty (30) North, of Range number Fifteen (15) West. $ T A ER This IS NOT homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And_ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except i and will warrant and defend the same. ~ Dated this 10TH day of MAY 19 96 (SEAL) (SEAL) JUDY A SCHWARTZBAUER i -(SEAL) (SEAL) i i i AUTHENTICATION ACKNOWLEDGMENT j Signature(s) STATE OF WISCONSIN i ~ St. Croix County. SS. authenticated this day of .19 porgy ten,, r o tier ~ti, 10th