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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNE
ADDRESS
SUBDIVISION / CSMI LOT I N
SECTION _T 3D N-R~W , Town o f h► r a r
ST: CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
o~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover-
R
BENCHMARK: &4-
C~'U
ALTERNATE BM:
K / PUMP CHAMBER / HOLDING TANK INFORMATION
Manu cturer: W,Q-,. - Liquid Capacity: 76'0
Setback from: Well House 51 Other
Pump: Manufacturer ouug--s Model# 3£~g Size
i
Float seperation /d Gallons/cycle: 7
Alarm Location
SOIL ABSORPTION SYSTEM
/ts2~S ^y
Width: /CZ Length 5 / c/ Number of 4" fs cam`
l
Distance & Direction to nearest prop. line: '7
Setback from: well : L/oa House Other
ELEVATIONS
Building Sewer ST Inlet. Al ST outlet ~ .
PC inlet 8 9, PC bottom S 7, .Z Z Pump Of f
Header/Manifold Bottom of system
Existing Grade 9 Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
WiscAnsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
PeKERNI,der' NOa~m pH E] City El Village M Town of: State Plan V Erin grair-is CST BM Elev.: Insp. BM Elev.: BM Description: X Parcel Tax No.:
/0C) A96_00098
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic, Benchmark 10
Dosi ng ' S o
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Ventto
TANK TO P/ L WELL BLDG. A
ir Intake ROAD Dt Inlet 13'5-L 8'q, 7 7
Septic NA Dt Bottom 7
Dosing ?a~' S7-1 5! NA Header/Man. ,-73 974
Aeration NA Dist. Pipe 7, V7
Holding Bot. System G-71 q
PUMP/ SIPHON INFORMATION Final Grade 3,U3 aj
Manufacturer Demand (t1 ~S./
Model Number 38g 'o GPM
TDH Lift p~'aY Friction b System TDH -)"64 Ft
u
Forcemain Length Dia. N Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width f Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /P _
-~DIMENSION
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Number:
System: 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 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Erin Prairie.6.30.17W, SW, SW, County Road GG
Plan revision required? ❑ Yes ❑ No
i
Use other side for additional information. J 1{ to
Fov
SBD-6710 (R 05/91) Date In a is Signature Cert No.
- SANITARY PERMIT APPLICATION
couNTY
In accord with ILHR 83.05, Wis. Adm. Code ~qt ~ ~ p, a tX
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 5m4i
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPER OWNER PROPERTY LOCATION
,Q _SV3 %5c.~ S T 3t'~ N, R f fRor) W
PROPERTY OWNER'S MAILING ADDZr ! LOT # BLOCK #
I S a c l?
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD
( ❑ State Owned ❑ VILLAGE :
.a TOWN OF: 41
❑ Public 1 or 2 Fam. Dwelling-# of bedrooms 2;~_ PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) r~ I 10 1 1 C)
1 ❑ Apt/Condo lJ
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. r4 Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 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 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
(sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) q ELEVATION
CZ O
"7"✓ O y3 lp r Feet GM J Feet
VII. TANK CAPACITY Site
in al Ions Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber 0 El Fj
VIII. RESPONSIBILITY STA E ENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): P~llu is Signatur . (No mps) rMPRSW No.: Business Phone Number:
1 5 3.5
Plumber's Address (Street, City, State, Zip Code):
t ~
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sa ry Permit Fee (Includes Groundwater ate Issued Issuing A pent Si atur (N Stam
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) 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 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, 608-26§-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 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.
SBD-6398 (R.11/88)
1
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171
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CrvSS S~c}IVr'1 0~ ~ l~Cl~ S~s~e~-~
Fresh Air 1111616 And OC►arvalion Pip• jos \ ~P1,
Approrld vent Cop
• Mfnlm- 12' More
Final Grad.
. 5~,, Sw SvoJ
Y~ YY sty, ~ ~ .
20' 42' ADora Plpp _ 4' Cott iron r ark UD
To final Gross Vent Pipe ^ 1
1
Li..
►tor t~ Itoy Or Sr4AjQs6qat@-I
OOltlriDullon
pipe Tea s
V BPerloroled Pipe halo.
-"Co.plna Termina
llne At
Balloon Of Slalom
1 /
~~cJ..T ton / .
SOIL FILL
DISTRIBUTrio .1 PIPE
`r APPROVED ,S4)JTIIETIC COVCR
2" of 1>,GGREGA?E r MAT~FZIgI OR 9" OF 57RAW
OR MARS" HAY
n
ELEV. O fe~0Fl2-2t/2 AGGREGATE
9 1; F EEC"-~
i
DISTRIBIJTIOU PIPE TU BE AT LEAST _ IUCHES BELOW ORIGIIJAL GRADE
Al,IU AT LEASTLO IUCHES BUT MO MORC THAIJ tit INCHES BELOW FINAL GRADE
MAXIMUM MrH OF EXCAVAT100 FROM ORI& NAL (iiWF- WILL BE IAJCHES
T1 N)MVM CKFni OF EACAVATIOW H\OM 0,16NAL GRAPE WILL 6E INCHE S
SIGUED:
LICEUSE IJUMBER: IJlO~_
DATE:
I PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS PAGE
• ~ ~ VENT CAP
N
'i°C. I. VENT PIPE /
WEATHER PROOF APPROVED LOCKING
z5' FRCM DOOR, JUNCTION BOX MANHOLE COVER
WINDOW OR FRESH 12"MIU.
AIR INTAKE
GRADE
I
I `i"MIN.
CONDUIT IB"Mlu.
le"Mrnl•
thil-_l, PROVIDE I 111
AIRTIGHT SEAL I III
APPROVED JOINT I III `wf
A I I I
W/C.I. PIPE. I APPROVED JOIAf
CXTENDIM(• 3' I I I W/C.I. PIPE
OMTO $01.10 Sc:;. I II ALARM EXTE)JDIIJG 3
9 I I ONTO SOLID S01
I 1
ON
• I
1~1 PUMP
0 ` OFF
CONCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL.
SEPTIC AND ' t SPEC-IFICATIOMS
DOSE TANKS MANUFACTURER:
NUMBER OF DOSES:
~__pER pAJ
TANK :IZE: 7Sd GALL0QS,
DOSE VOLUME /
ALARM MANUFACTURER: INCLUD!!!C
...,C':FLOW: GALLONS
MODEL NUMBER: _ ZLV A
CAPACITIES: A=~CHES OR 3 TQ GALLONS
SWITCH TYPE; '
PUMP MANUFACTURE R. B = -IIJ-WES OR GALLONS
MODEL NUMBER: IS-k - C' ~O IAICHES OR GALLONS
wt ~ 3//.L D= J.
SWITCH TypE: b INCHES OR GALLONS
NOTE: PUMP AND ALARM ARE TO BE
PUMP DISCHARGE KATE GPM IN5TALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE pj'z~Wrcli PUMP OFF AND DI5TRIBUTI0N PIPE.,
+ MINIMUM NETWORK SUPPLY PRESSURE FEET
} FEET OF FORCE MAIN X /j FEET fir
01' F T. 7 lid ~M
----~ori.FRICT1o1J FACTOR., FEET
I~ TOTAL DYNAMIC HEAD ~a_ FEET
INTERWAL. RIMENSIONC OF TANK: b') WM><..~ ~/1
;WIDTH ;LIQUID DEPTH 7"b✓
SIGkIEDt LICF-QSE NUtABEPR', S
DATE:
-117-
.t
Wisconsin-Qepartment of Industry, SOIL AND SITE EVALUATION REPORT Page 1of 3
'aho!r Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
r COUNTY
Attach complete site plan on paper not le 9a x 1"fncj(e size. Plan must include, but St. Croix
not limited to vertical and horizontal ref a poin BMA, direction's % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and locatio distan to~ dues roa 012-1018-10
rest t REVIEWED BY DATE
APPLICANT INFORMATION-PL PtirrrrALl IRM N
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT SW 1/4 SW 1/4,S 6 T 30 N,R 17 k (or) W
PROPERTY OWNER':S MAILING ADDRE Oi LOT # BLOCK # SUBD. NAME OR CSM #
1530 Co. Rd. #GG na na na
CITY, STATE ZIP COD ❑CITY [-]VILLAGE ®[OWN NEAREST ROAD
4017 - 337 Erin Prarie Co. Rd. #GG
New Richmond, WI. 540171
[ ] New Construction Use Jc~ Residential / Number of bedrooms 3 [ J Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 •7 trench, gpd/ft2
Absorption area required 643 bed ft2 563 trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2 •8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 96.50 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material stream terrace Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for system nS El U Z3S ❑ U MS ❑ U taS ❑ U OS U ❑ S 43U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botrldafy Roots GPD/ft
in. Munsell Gu. Sz. Cont Color Gr. Sz. Sh. Bed Ttendt
1 0-10 10yr3/3 none 1 2msbk mfr cs 2f .5 .6
2 10-44 7.5yr4/4 none sl 2msbk mfr gw if .5 .6
Ground 3 44-88 10yr5/4 none co s Osg ml na Eq .7 .8
elev.
100.30ft.
Depth to
limiting
factor
+88"
Remarks:
Boring #
1 0-18 10yr3/3 none 1 fill 2cpl mfr cs 2f np .2
2 1 2 18-26 7.5yr4/4 none sl 2msbk mfr gw if .5 .6
w
3 26-31 7.5yr4/6 none is Osg mvfr gw na .7 .8
Ground
elev. 4 131-96 10yr4/4 none co s Osg ml na na .7 .8
loft.
Depth to
limiting
factor
+96"
Remarks:
CST Name:-Please Print Gary L. Steel Phone. 715-246-6200
Address: 1554 20 th. Ave., New Richmond, WI. 54017
Signature: ~ Date: CST Number:
L a2 6-3-94 cstm 2298
PROPERTY OWNER Joseph Kern SOIL DESCRIPTION REPORT Page2- 013
PARCEL I.D. # 012-1018-10 r
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITwich
1 0-8 10yr3/3 none 1 2msbk mfr gw
3
2 8-20 10yr4/4 none is osg mvfr gw If .7 .8
Ground 3 20-28 7.5yr3/4 none co s Osg ml gw na .7 .8
elev.
100' ft. 4 28-90 10yr5/4 none co s Osg ml na na .7 .8
I
Depth to
limiting
factor
+90"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
w
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev. i
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Joseph Kern New Richmond, WI 54017
MPRSW 3254 SW SW4 S6-T30N-R17W (715) 246-6200
town of Erin Prarie
N
L
1"=40'
BM= top of Well at 100'
~I
l-XSi." , n 5
~ az
~ 1°10
I~5r4v
C~c~12d
Gary L. Steel
6-3-94
Y I '
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ROUTE/BOX NUMBER S 3 C:A~CD C 6. FIRE NO.
CITY/STATE eL -5 I ZIP S
PROPERTY LOCATION: .5t-~ 1/4 -5 1/4, Section T.30 N, R__Z 7 _W,
Town of I'<<d1) St. Croix County,
Subdivision IVIA , Lot No.
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 a 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
$3000 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
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master 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. Certification form will be sent approximately 30 days prior to
three year expiration.
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 Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
°
SIGNED Y L1
DATE
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
(715) 796-2239 or (715) 425-8363
Sign, Date, and Return to above address
APPLICATION FOR SANITARY PERMIT
ETC - 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
ownet/contractoc,(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
w S 1!4, Section LO • T_~N-R~V
of pro art
Location p p Y 1/~
Township f"%
Mailing address S- _
N .Q-Lo ~ -s o
Address of site :Za , -
lubdlvision name N 1 "
Lot number p
previous owner of property Tcoal L"P~can
Total size of parcel NO
Date parcel was created
JAre all corners and lot lines identifiable? y _Yes No
to this property being developed for resale (spec house)?_Yes _N0
Volume _ and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DRRD which Includes a DOCUMENT NUMBER, VOLUME AND PACE NUMBER, and
the ORAL OF THS REGISTER OF DRRD8. 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 Ceitified 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 (out)
knowledge= that I (we) am (are) the owner(s) of the property described In
this Information form, by virtue of a warranty dead recorded in the Office of
III the County Register of Deeds as Document No. j and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
eonetcuctlon of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No. 1.
gnatut of owner Signature of Co-Owner (If Applicable)
~ G
Date'of Signature Date of Signature
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 -'U6--5 j2 residence located at:
tt1/4,S c"-1/4, Sec. T 3DN, R__LZW, Town of
t-i;. X It, ~-Q 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_4No (if no, skip
next line)
Approximate volume or length of time: 024V gallons minutes
Capacity:
Construction: Prefab Concrete- Steel Other
Manufacurer (if known):
Age of Tank 'f known):
(Signature) (Name) Please Print
(Title) (License Number)
,-/1 v.2Jc-, Or
(Date) Y/
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, Wis. Adm. Code (except for
inspection ope ng ov r outlet baffle).
Name Signature1-21 /MPRS is~b~
5/88
• DOCUMC.!`iT No WARRANTY DEED YMS SIAC.1 RESERVED FOR RECORO,NO OATH
STATE BAR OF WISCONSIN FORM 2-1982
406,1002 vcl__ S91PmE~'7~ REGISTER'S OFFICE
Todd LaBlanc a/k/a Todd J. LaBlanc and ST. CROIX CO., W1
Jodi C L* LaBlanc, husband and wife as . Recd for Record
marital.property with -nights of _ survivor-
J;~12 91531
ship
. at
conveys and warrants to 110
...Joseph.C... Kern. and..Cary...L... Kern....husband............
and_w.ife_as..survi.vorship. Bari.tal...property xgisterofDeeds
_ .
RETURN TO
. -
.
the following ,escribed real estate in St-,---CL O1X_______________ ___County,
State of Wisconsin:
Tax Parcel No:
Part of SE 1/4 of SW 1/4 of Section 6, Township 30 North, Range
17 West, St. Croix County, Wisconsin described as follows: Commencing
at the intersection of the West line of said SE 1/4 of SW 1/4 and
the centerline of County Trunk Highway "GG" as presently laid and
travelled; thence proceed South 87°18' East along said centerline,
a distance of 250.80 feet to the point of beginning for parcel
to be described; thence due North, a distance of 351.00 feet to
an iron pipe set on the bank of the Willow River; thence North
83°42' East on a meander line, a distance of 86.00 feet; thence
North 47°03' East on a meander line, a distance of 59.12 feet;
thence due South a distance of 386.49 feet to the centerline of
County Trunk Highway "GG"; thence South 86035' West along said
centerline, a distance of 128.99 feet to the point of beginning.
TRANS 0
This is. homestead property.
(is) (is not)
Exception to warranties: municipal and zoning ordinances, easements and
restrictions of record.
.
Dated this day of . January 1991
(SEAL)..ti^ (SEAL)
Todd LaBlanc
(SEAL) /W` (SEAL)
~odi.L. LaBlanc
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
ST. CROIX
......County.
authenticated this day of...-......_.__...._._, 19 Personally came before nie this i....--- day of
J.anuar-y----------- , 19.91._. the above name.i
Todd ..LaBl.an.c_a./kl.a. Todd ._J,_.L.aBlanc
.and Jodi - L. _ LaBlanc,. husband. and
TITLE: NIEMBERSTATE BAR OF WISCONSIN wife -as- marital.-property.-with right
(If not. - - of- survivorship
authorized by § 706.06, Wis. Stats') to me known to be the person . S Wl:o ^xecuted the
foreuoin;[ instrument and acknoH ledge the same.
TT4:3 INSTRUMENT WAS DRAFTED BY ! ! ~
...J.ud.i,th_ A.....Ren,.J,ngton.__.. . _ Mary J: Strohbeen . MANY J. STRO"SEEN
REMINGTQN LPW OFFICE 7t~+Iy Ft1t.'7-st2ie 11117IS MSM
Me W_ R1c oa .,._.WI.......- 4017..._._...... Nota-v Public St. Croix ountF, is.
(Signatures may be authenticated or acknuwled~_red. Eoth DIY G,min .iinn i; pernianent.lif not. state e%p.raton
are not necessary.) date: June 26 19 94.)
'Name. 4 pennn3 +ig-,inR in any capacity 4,-,A h, !t: r,,A m-1 h- 1-w +h. i, - I:! tr
WARRANTZ DEED STAYS BAR Or WISCONSIN 'A , 1•¢xI I'd:, -
FORM NO 2- I,•