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Parcel 012-1047-10-000 08/17/2006 10:08 AM
PAGE 1 OF 1
Alt. Parcel 20.30.17.315B 012 - TOWN OF ERIN PRAIRIE
Current X 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
0 - PRIBNOW, HARLYN H & PATRICIA A
HARLYN H & PATRICIA A PRIBNOW
1674 140TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1674 140TH AVE
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 15.150 Plat: N/A-NOT AVAILABLE
SEC 20 T30N R1 7W 1.95 AC S 425 FT E 200 Block/Condo Bldg:
FT OF SW SE & COM SE 1/4 COR SEC 20; TH
1170FT W TO POB; TH 500 FT W TH 725 FT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
N; TH 500 FT E; TH 725 FT S TO POB; EXC 20-30N-17W
S425 FT OF E 200 FT OF SW SE & INC COM
SE COR; TH W ALNG S LN 1170FT TO POB; TH
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
03/03/1999 598760 1408/036 AF
03/03/1999 598759 1408/035 QC
03/02/1999 598609 1407/180 WD
07/23/1997 1117/130 AF
more...
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 05/31/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.000 49,000 189,800 238,800 NO
AGRICULTURAL G4 11.150 1,800 0 1,800 NO 05
Totals for 2006:
General Property 15.150 50,800 189,800 240,600
Woodland 0.000 0 0
Totals for 2005:
General Property 15.150 50,700 189,800 240,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 12/04/1998 Batch 519
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
'`1
t
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER r j /11 b ~ CkD
t4l
ADDRESS Z~,;7/-/
9A
-L f O t
SUBDIVISION / CSM# 4Z6 LOT #
SECTION r,?g T 3C- N-R 7 W, Town of r,d t y"~
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
L .3
311
r T
~a
ao
INDICATE NORTH ARROW
I
J
Provide se ~a k and elevation information on reverse of this form.
Provide dilRensions to center of septic tank manhole cover-
q 5 , ~ ,,q 0
7 1
BENCHMARK:
1
ALTERNATE BM• % P 66"
%
SEPTIC TANK / PUMP CHAMBER /
Manufacture::
~l S Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer-) Mode 14 Size 6-5-4)116
r
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
i
Width: J~ Length `S- Number of trenches J
Distance & Direction to nearest prop. line:--76
r~
Setback from: well : o? d House 36 d Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom SS '
Pump Off
Header/Manifold Bottom of system zea /,S-
Existing Grade /6 5 Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE, NUMBER: 15-6 3
INSPECTOR:- A10
3/93:jt
{
Wisconsin Depactmentof 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-:
PUt Hol , ;am_g; _LYN El City El Village Town of: State Plan 362
CST BM Elev.: / Insp. BM Elev.: BM D cription: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA ~S
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 0 Benchmark
Dosing
Aeration Bldg. Sewer
St/ Inlet
TANK SETBACK INFORMATION St/A Outlet
Vent to
TANKTO P/L WELL BLDG. AiirIntake ROAD Dt Inlet FOB
Septic 3 { 4 NA Dt Bottom a g S
Dosing NA Header-
Aeration Dist. Pipe
Holding - Bot. System P 3~~ 63
PUMP- NFORMATION Final Grade
Manufacturer G Demandr~
Model Number lJE-QS ~ `GPM o no, 66
yS~
TDH Lift Friction9l System TDH q.4 Ft e- Loss mead
a 3, 5
Forcemain Length 3&5 Dia. 3 Dist. To Well s9 /
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length / No. Of Tr riches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 4~ ~5e DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER OR UNIT Model Number:
System:
DISTRIBUTION SYSTEM
Header / {#d Distribution Pipe(s) / x Hole Size x Hole Spacin Vent To Air Intake
Length Dia- Length Dia. Y Spacing (p
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syst s Only
Depth Over Depth Over G xx Depth Of eeded / Sodded Txx Mulched
Bed/TteriCPYCenter o2~J-/J(o Bed /7ueRCFr€dges Topsoil E] Yes E] No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) c<_~ z. f
LOC TION: ERIN PRAIRIE.28.30.17W,S SE,140 AVENUE
G
l 1.
j r -l _4: Y ~GT C% I
M ~ J
j
Plan revision required? ❑ Yes Vo
Use other side for additional information. Jr- 9 ox.~ ----I
(R 05/91) Date Inspector's Signature Cert No.
=aR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY ilk
5"r C STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than as 83(0
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.
PROPERTY OWNER PROPERTY LOCATION
V% 0 .5 (-J Y4-5S1/a,S TN,R r) W
PROPERTY OW R'S MAILING ADDUSS LOT # :ff!K #
l0 7 / >ve- N A N
CITY, STA ZIP CODE PHONE NUMBER SUBDIVISION AME OR CSM NUMBER
11. TYPE OF BUILDING: (Check one) ❑ State Owned VI AGE : r NEAREST ROAD
OWN OF. Fr, 9~4".
❑ Public N 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TA
X NUMBER( S)
III. BUILDING USE: (If building type is public, check all that apply) O, q _/o -V . /a
1 ❑ ApUCondo
2 ❑ Assembly Hall 6 Medical Facility/Nursing Home 10 El Outdoor Recreational Facility
❑
30 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) 1.0 New 2. X Replacement 3. ❑ Replacement of 4. ❑ 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
REQUIRED (sq. ft.) PROPOStE)D (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
44(3-0. ~v a -7 "VIA- /061,6 Feet G$r Feet
CAPACITY
VII. TANK . Site .
in allons Total # of Manufacturer's Name Prefab Con- Steel Fiber- Plastic Exper
INFORMATION New P-Xisting Gallons Tanks Concrete glass App.
Tanks T s strutted
Septic Tank or Holding Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name t): Plumber's Sign o Stamps) J WMPRSW No.: Business Phone Number:
- 74n, 21!!~. I / .5 ~ 3 0 IS' 3% -5/,.3S
Plumber's Address (Street, City, State, Zip Code):
kS r 7
IX. C UNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A ent Signa re (No s)
Approved El Owner Given Initial ~ ,e Surcharge Fee)
, / z 4
Adverse Determination T
X. CONDITIONSPIF ALEA-SnONP FO DID RO AL:
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, 608-266-3815.
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 Dwelling.
Ill. 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)
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ma,e,-/ Rtc-k y1,%nrf~, 1• wt ho►A All 1111816 And OD►elrollon Plpe
^ ~Q `^-r"~- APPn.I Vonl Cy
lntMm,,,,, 12' ADe.►
f 111.1 C,oO•
20. 42' Abe., Plpr _ 4' Cell iron
To flnal Otaee Vanl Pip,
liar Or SIn~M~k C• vln
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0 .r2Pips~~ep►Il
01 u~1l.Iton ' •
Plpa e o o - Tae ►
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• D►noal► Pipe Perlo1alo4 PIP$ bola.
o -Ci.ptlnl To.minallno Al .
8►llom 01 ip►lam
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SOIL FILL
DISTRIBUT101.1 PIPE
a
2"oF11,GGRE6A?F,-fir APPROVED SVT'wcnc covc
MATERiAt. op, 40 OF sTaAw
OR MARSH HA,'J
tLEV, OF- FEET : by f. •0PAGGREGATE ° NM.
1) 1S1'R16UTIIDQ PIPE To DC AT LrAST L GRACE
AuU AT LCAS7LO 11JCH[S 13UT 1.10 MORC THAI) 42EMr-gES BELOW FIIJAL GnAOC'
MAXIMUM DaMi OF EXCAVATIOP FXOM OR16 NAL 61~ADF- WILL BE
711Kar1u1~ OEp rli of EACAVATIO" r-ROP\ ,GIttA~ (jR~D WILL. BE, . --~,1NCHC s
LICEI,ISC DUMBER:
DATE:
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PAGE OF
PUMP CHAMBER CROSS "SECTION AND SPECIFICATIONS
47y i-ela Ate.
VENT CAI"~Q~
H"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
Z5' FROM DOOR, JUNCTION BOX MANHOLE COVER
WINDOW OR FRESH I2"MIU.
AIR INTAKE
GRADE 1
I y"MIN.
L
C 0U DU ►T T 19" I IJ.
16"MIN.
11~ . .
IA11..F: 1' PROVIDE
AIRTIGHT SEAL I I i I V
APPROVED JOINT A I I i I APPROVED JOIN1
W/C.I. PIPE. I I I W/C.I. PIPE
EXTENDIAJC 3' I II EXTENOIAIG 3'
ONTO S01.10 SC:;. ALARM
B ( I ONTO SOLID SOIL
I I
C I I ON
I I
1
MP
~ OFF
' PUMP OFF
D
H COUCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SPEC.IFICATIOUS
SEPTIC AND
DOSE TANKS MANUFACTURER:NUMBER OF DOSES: PER DAB
TANK SIZE: GALLOU S DOSE VOLUME
ALARM MANUFACTURER: S
INCLUe!!:C FLOW:56FA p?7'y GALLON
MODEL NUMBER: CAPACITIES: A=_L 9 INCHES OR 34P/fc2 GALLONS
SWITCH TYPE: O a~1 Adt k CLV- B= a INCHES OR 3-5,7 GALLONS
PUMP MANUFACTURER: `'l 0~1 S
C--/f IWCHESOR 92'V GALtO►JS
MODEL NUMBER: /42'F CALLOUS
~ INCHES OR GALLONS
SWITCH TYPE: -5041y MOTE: PUMP AUD ALARM ARE TO BE
PUMP DISCHARI;E RATE S GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE Bil: 1wGEA1 PUMP OFF AND DISTRIBUTIWJ PIPE.. -off FEET / ] S5 vr,
+ MINIMUM NETWORK SUPPLY PRESSURE . . . A_ FEET I
FEET OF FORCE MAIN X 109 F j
ioo►T.FRICTIOI,J FACTOR..- FEET
TOTAL DYNAMIC HEAD = .9 FEET
D) a r I&L
INTERNAL. RIMEWS10 OF TANK: l -twiBTH _ g4 yL~
,LIQUID DEPTH
SIGNED: Qt.. LICENSE HUMBER: /5(03 3-Qa
DATE:
-117-
yy~~~~ r
,v~Y• i GUt1LDS SUBMERSIBLE
. SEWAGE AND EFFLUENT PUMPS
IM1 Y ' i .
l~s,. EP0311
LIST DLSC.
aDUPE40311 142 EP0311 1/3 FiP 115 V Effluent Pimp 1/2" solids 256.80 172.10
E•16i1r- t
?:,•k i ~~~i'~: tr watt
Submersible MODEL EP0311
Effluent Pump
SIZE V SOLIDS
t r . t 1AMRS FEET
4 ` y 25
r
IY c T^r vT'f a 7+ t ti t 20
4
1ay ,
1L1 r j~~u ~
o. ,rx
i
0 OE 4 e ,z 15 20 24 ze az 36 40
GPM
0 2.5 5.0 7.5 mIM
CAPACITY
4
tit Performance
3885
Curve
men." FEET •
go
MODEL 3885
.31-11 1.
E* ES SIZE 3/4" Solid
re y ~
~fyk~(X~ i ,ZJy xo
's r ' 60
F{°
-WEo
50
WIE
40
4
w[
(r oil 10 30
w[oX -t K to
~ _ _
.
o 0
~,h', • '.~i:.;'.:'' 0 t0 20 30 u w w 70 60 •0 too 110 170 ' o"
a t 10 70
xo w'%
0
yyr~ ? CAPACITY
LIST DISC.
feYr44 1 ~r t73t)F~+E0311 , 142 HE0311L 1/3 HP 115 V LOW H 3/4' solids 491.55 329.35
"wear GXT E0311M 142 'WE0311M 1/3 HP 115 V Mod H 3/4" spuds 191.55 329.35
»"rr ik J: Q7UPaZ0,llli 142 we0511H 1/2 HP 115 V High N 3/4" solids 704.25 41.85 t
' . a CiJVPhE0712Fi 192 tiE071211 3/4 HP 230 V High W. 3/4" solids 843.65 565.25
t' fw 1 Q 1 r
1•- PFRFC tt`9+N(~ AMID SPECIFICATIUIIS
FDid.QdIPID ME FC(i
'~`f
~
Ou
~ 'tv ' DA4 % 10/88
DEPI 30 PAGE 7
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor ind Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less the~!~ { i c ze. Plan must include, but
not limited to vertical and horizontal referenc , direc of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location an ce to nearest roa : o ' 012-1047-10
APPLICANT INFORMATION-PLEA INT 1L F 44AT REVIEWED BY DATE
PROPERTY OWNER: ROPERTY LOCATION
Harlyn Pribnow 40 1OV'T. LOT SW 1/4 SE 1/4,S28 T 30 N,R 17 X (or) W
PROPERTY OWNERS MAILING ADDRESS 9 LOT # BLOCK # SUBD. NAME OR CSM #
1674 140th. Ave. ?p na na na
CITY, STATE ZIP CODE P E "•1 OCITY ❑VILLAGE GOWN NEAREST ROAD
New Richmond, WI. 54017 NUTMI Erin Prarie 140th. ave.
[ ] New Construction Use:4c ] Residential / Number of bedrooms 3 [ ] Addition to existing building
:M Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate . 7 bed, gpdm2 .8 trench, gpdm2
Absorption area required 643 bed, n2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 .8 trench, gpdm2
Recommended inf'iiiration surface eievation(s) 102.65 it (as referred to site pian benchmark)
Additional design / site considerations na
Parent material pitted aiacial drift Flood plain elevation, if applicable h
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SM I N FILL HOLDING TANK
U= Unsuitable fors stem ® S ❑ U EIS O U 91S ❑ U U U ❑ S -flu
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Motoes Texture Structure Consistence lBoundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 0-9 10yr3/3 none 1 2msbk mfr cs if .5 .6
<jp 1 ::ki
2 -18 10yr4/4 none sicl lfsbk mfr gw if .2 .3
Ground 3 8-38 7.5 r4/4 none is Osg mvfr 9w na .7 .8
elev.
105.9 ft. 4 8-88 7.5yr4/6 none S Osg ml na na .7 .8
Depth to
limiting
factor
+88"
Remarks:
Boring #
1 0-10 10yr3/3 none 1 2msbk mfr cs if .5 .6
2 2 0-17 10yr4/4 none sicl 2msbk mfr GW !F .4 .5 ,
3 7-32 7.5yr4/4 none sl lmsbk mfr gw na .4 .5
Ground 4 2-88 7.5yr4/6 none is Osg mvfr na na .7 .8
eiev. 105.9 ft
Depth to
limiting
factor
+88"
Remarks:
CST Name:-Please Print Gary L. STeel Phone. 715-246-6200
Address: 1554 200th. Ave., New Ri hmond, WI. 54017
Signature: Date: CST Number:
11-9-94
PROPERTY OWNER Harlyn Pribnow SOIL DESCRIPTION REPORT Page'2 ' of 3
PARCEL I.D.lf 012-1047-10
I GPD/ft
Boning # Horizon Depth Dominant Color Mottles Texture
I Structure Consistence Bcurbary Roots
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed IT
rencf~
ti 1 -10 10yr3/3 none 1 2msbk mfr gw if .5 1.6
3
r; 2 10-22 10yr4/4 none sicl lfpl mfr gw if np 1.3
i
i
Ground 3 2-41 5yr4/4 none is Osg mvfr gw na .7 1.8
elev.
106.9ft. 4 1-88 7.5 r4/6 none S Osg ml na na 1.7 ::.8
Depth to
limiting
factor
+88"
Remarks:
Borina #
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
ti
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Harlyn Pribnow 1554 200th Ave.
CSTM2298 SW4SE4 S28-T30N-R17W New Richmond, WI 54017
MPRSW 3254 town of Erin Prarie (715) 246-6200
I
N
1"=40'
BM.= top of 1" steel pipe by NW corner post at el. 100'
Alt. BM.= top of NW corner post at e1.105.00
surface el. fron exsisting system to new system 15.20'
S
lands owned by
Harold A. Pribnow /
I}~D
viet n~
A
kA-
lands owned by
V 7Ie7 C
Harlyn Pribnow
~z ~E ~ I
Gary L. Steel
11-9-94
Y
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
S"I fJ irlG
WNERBUYER C 1 R "I
MAILING ADDRESS 1-0 JAI I C~~ 1't y
PROPERTY ADDRESS P
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE N t,,~: C m Lo"_ J t1 C~ 7
PROPERTY LOCATION S W 1/4, C,5- 1/4, Section T_3L_N-R_L~j_W
TOWN OF : v1 T ~c . r ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER h
CERTIFIED SURVEY MAP VOLUME _N&, PAGE AJ,4-, 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 a ira 'on d e.
SIGNED:
DATE: /C~ - 7
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 of property H 61 1 r pc\tl~
Location of property S v.w 1/41/4 , Section , T AN-R~W
Township Mailing address
Address of site-
Subdivision name A Lot no. /V A
Other homes on property? Yes No
Previous owner of property << r o \a
Total size of property , q ctc:re'-4
Total size of parcel
Date parcel was created S -s '7
Are all corners and lot lines identifiable? _ (LYes No
Is this property being developed for (spec house)? Yes X No
Volume U93 and Page Number .SSA 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.
i
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. 31 00S 7 , 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 of Signature Date of Signature
` VOL 1106PAPF616
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA
524604
REGISTER'S OFFICE
7 1NI
d D L p pR / Q NV w ST. CROIX CO,,
Ree'd for Rowd
M-0 D_ EC l2 7 1994 '
quit-c A to 10:4
12 5 A. M I'RjZ)A A A? 1,0 1.4o 47 D at I•.AA~~
A,n/n wloL& .45 ?b;,yI 7')4r NA~iyTs
f1~Mer d OMas
the following described real estate in I X County,
State of Wisconsin:
RETURN TO
41V L AS c= M c, Iv 7- Fo /t cS Ltc s et
Tax Parcel No:
F(a S o u fi# / o o o Fr OA r1l o c ,a-s T Sa A= 7'
OF r#WF Soy r-W oa-s7'~ ~ua,w TC, pF pVp 0otf 7-A c,457'
tot Fla 71>s R v F 5 EG Ti d N .1O 1 TO to a 3 0 / OR7
r;5 A;7" o r 7~11a ST 2 00 1-,e 4.;-r v r#b
6 o ti r1q w i;z sr 6~ u Ae-rLptz of rtyx' s o c( 7-// µsr
0(i AnIla& or §ec-71cAj o2vI To rev ~o
/V o 4.4j c~ ! 7 \A1 eJ
This /yqr homestead property.
(is) (is not)
Dated this f aZ7 -day of cc}}
(SEAL) ~44..L t A=r.& z"s!~ (SEAL)
YA Q 0 L 19 Joe1QNyw
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
St. Croix County.
authenticated this- day of , 19 Personally came before me this 7th day of
December 1944 the above named
Harold A Pribnow
TITLE: MEMBERSTATE BAR OF WISCONSIN
(11 not, me known )d ~ 1A. persp who executed the
authorized by § 706.06, Wis. Slats.) egoing InsCr Intend =ke3ame.
THIS INSTRUMENT WAS DRAFTED BY A '
TaryNo Public County, Wls.
M Commis9jOIr 13, maTen •.~(IVnot, state expiration
(Signatures may be authenticated or acknowledged. Both Y Vl
are not necessary.) date: ADj'" ~~+sl 19_1Z._.)
Names of persons signing In any capacity should be typed or printed below their signatures. SB3 NTF OW
QUIT CLAIM DEED STATE BAR OF WISCONSIN Nelco Tax Forma, P.O. Box 10208, Green Bay. WI 54307.0208
FORM No. 3.-1992
f
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA
QUIT CLAIM DEED Rim
REGISTERS OFFICE
52'7550 Sr. CROIX Co., W1
Recd for Rectrd
Harold A. Pribnow and Gertrude W Pribnow - APR t 0 1995
at 10:00 A.M
quit-claims to Hgrl yn Pri hnnw and Patri ni n A PribnQW fl r•- 044A,
survivorship marital prnp6rty Register of Deeds
the following described real estate in St Crni x county. /DOa)ad-
Slate of Wisconsin:
RETU N TO P~br1U~
~ IV Est At1 C+ ,,„~a,
,o►~d L 54wi 7
Tax Parcel No:
Part of the SE 1/4 of SE 1/4 and part of the SW 1/4 of SE 1/4 Section 20, T30N,
R17W, being further described as follows:
Commencing at the SE 1/4 corner of Section 20; thence going 1,170 feet West
to the point of beginning, thence 500 feet West, thence 725 feet North, thence
500 feet East, thence 725 feet South to the point of beginning, except the South
425 feet of the East 200 feet of the SW 1/4 of SE 1/4.
The parcel shown on this document is being added to the parcel shown on the
document recorded in Vol. 500 , Page 8 , Document No. 317474 ,
described as a parcel of land located S 25 feet of E 200 feet of SW 1/4 of
SE 1/4 of Section 20-30-17, to create one parcel, and this transaction is
thereby exempt from Chapter 18 of the St. Croix County Land Use Regulations
pursuant to Section 18.05 (A) (3).
This is not homestead property.
(is) (is not)
10th April 95
Dated this day of 19~-
X 5~-Zj d, ~ _ (SEAL) (SEAL)
Harold A. Pr'ibnow
/
~il.~iL/rti`~Q 4(/ (SEAL) (SEAL)
Gertrude W. Pribnow
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
St. Croix county.
authenticated this day of 19 Personally came before me this 10th day of
April .19 95 the above riamed
Harold A. Pribnow and Gertrude
W. Prihnow
TITLE: MEM6ERSTATE BAR OF WISCONSIN
(II not, to me kn n to e th pe on S pdha~ tJl'ed'1't+~~'
~
authorized by § 706.06, Wis. Slats.) forego Inslr e a acknowl a 311
T S INS7 UMENT WAS FT BY
le,
D. Berkholde-; 'a • c~
= unty,wl
Notary Public St. Croix
;y~Q4 ati' V;:
3~~~~// }itbfl`
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not,,
are not necessary.) date: August 6 , 1995 ,,~r~y 3:~•
'Names of persons signing in any capacity should be typed or printed below their signatures. S83 NTF 0023
1 STATE BAR of WISCONSIN vn re•,n,
I
DOCUMENT NO. STATE BAR OF WISCONSIN--FORM 1
WARRANTY DEED
7 /g THIS SPACE RESERVED FOR RECORDING DATA
~I
THIS DEED, made between ---------Harold -A. Pribnow REGISTERS OFFICE I1
-
_ _ - Roc 'd
;J I
ST. CROIX for Record this-93.K4
- Grantor i
anc Harlyn -H-q__ Pribnow and_Patricia A. Pribnow,.__ day of---sJ_4 ly----- A.D.1973
I
husband -and-wif-e-as joint-- t~nante,-- - t----3.S~Q---- P.r M.
- - - Grantee, D S
Witnesseth, That the said Grantor for a valuable consideration-___ _ _ -
One-_{$1._00)_an-d_ other valuable consideration _ er of ~eeds
St. Croix
c onveys to Grantee the following described real estate in _ County, RETURN TO
State of Wisconsin: i
The south 425 feet of the east 200 feet of the Southwest _..;I
Quarter of the Southeast Quarter of Section 20, Township Tax Key
30 North, Range 17 West. This is homestead property. it
FEE
i
Correction Deed
EXEMPT j
'i
r'
11 Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining;
And
i warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
I,
II and will warrant and defend the same,
I
II I.
11 Executed at this _--23rd-_---day of .-----July- 1973 .
i
I i
SIGNED AND SEALED IN PRESENCE OF (SERI,)
Harold A,_-Pribnow
` (S1AL)
I
(SEAL)
it
Signatures of _Iiar9~d_ A._Pribnow
authenticated this day of - July . -19-73-.
I I
I! Title: Member State Bar of Wisconsin or Other Party
Authorized under Sec. 706.06 viz.
Ij STATE OF WISCONSIN
J} s s.
-------~ti_TQjYCounty.
Personally calf: before me, this day of 1973 , I
II the above named-- Harold A. PribII42[_.___
` ~~~rttaitb,,,~• it
to me known to be the person--- who executed the foregoing instrument+jl knowlABg4the same.
This instrument was dratted by ,r Jaa,, O'Connell
----HSro--AlbAO1P County, Wis.
The use of witnesses is optional. rjj My O-bmmon (Expires)) _.Xy-4-19-77_.
- BOOTS 500 PAVE583
Names of persons signing in any capacity should be typed or printed below their signattues.
KC M Vl lu Cmp"
WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 1 - 1971