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TC 104
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AS BUILT SANITARY SYSTEM REPORT
OWNER ~o~ G~K•als Ta / r
ADDRESS Cd Ro~ T ,11 lam!'-~
fr
SUBDIVISION / CSM# LOT #
SECTION 3!5;- T N-R- /7W, Town of ~i`~•~~o►1d
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
'C
+ U~1
a°
i~
say f`t~~ , y o ~d
Ta ~ y ~l.e G, s ~ o~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: • r
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: 16ro,0
Setback from: Wel1,_~S ' House a p ' Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: ,Z V Length d Number of trenches ,C,;rrey
Distance & Direction to nearest prop. line:
Setback from: well: 5S House :~-d Other
ELEVATIONS
Building Sewer ST Inlet; ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: 9Z '/Z/ Q 15-
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
I
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT $T. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village n Town o : State Plan o.:
WAUGHTAL, JOHN
HAMMOND
CST BM Elev.: Insp. BM Elev.: BM Description:
j 1 Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER n CAPACITY STATION BS HI FS ELEV.
Septic r~ / cu Benchmark ~S
Dosing
Aeration Bldg. Sewer
Holding St/ffl inlet
r G~
le, cc
TA SETBACK INFORMATION St/ Outlet 1
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic --10 NA Dt Bottom
Dosing NA Header 51 33
Aeration NA Dist. Pipe j5 03 9~, /S
Holding Bot. System 53
PUMP/ SIPHON INFORMATION Final Grade
Ma facturer Demand
Model Num GPM
TDH Lift Lrlc S stem Ft
Forcemain L th Dia. Dist. To Well
SOIL A$ ORPTION SYSTEM
BED/TRENCH Width Length No.Of renches PIT No. Of Pits Inside Dia. . eptl
DIMENSIONS DI N
manufacturer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM
A R
INFORMATION Type 0 CH
~ 9 NIT Mo a Numer:
System: k3~
DISTRIBUTION SYSTEM
Header / Ma7ilold d Distribution Pipe(s) „ r x Hole Size x Hole Spacing Vent To Air Intake
Length Dia Length --;2 / Dia. Spacing
y
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade System n
Depth Over Depth Over xx Depth Of xx Se ed / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil Yes / ❑ No ❑ Yes ❑ :No:]
COMMENTS: (Include code discrepancies, persons present, etc.)~SA'
LOCATION : HAMMOND.,.3 5. 2 9.17W NE , E, CTH J
0
Plan revision required? ❑ Yes 9,140 d
Use other side for additional information. 11,3 ka~ 0
SBD-6710 (R 05/91) Date Inspector's Signat a Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Safety and Buildings Division
ri~~■7~i SANITARY PERMIT APPLICATION Bureau of Building Water System
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. 2KQ /
• See reverse side for instructions for completing this application State Sanitary Permit Number
ado 7I4
The information you provide may be used by other government agency programs ❑ Check if 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 GL. Est 4efLocation
1/4, $ Tig ?I , N, R E (or)tv
Property Owner's Mailing Address Lot Number Block Number
1 3
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cityy Nearest Road
❑ village
❑ Public 1 or 2 Family Dwelling - No. of bedrooms _ Town OF G
Parcel Tax Number(s)
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apartment / Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel / Mote[ 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. ❑ New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5- ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GallonTPer y 2. Absorp. Area 3. Absorp- Area 4. Loading Rate 5. Perc- Rate 6- System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft-) (Min./inch) Elevation
ell?, e F eet O Feet
VII. TANK Ca
in gallons Total # of Prefab. Site Fiber- Plastic Exper
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
New Existing strutted
Tanks Tanks ry~
Septic Tank or Holding Tank 1131 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature No Stamps) P/ PRSW NO.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
q1 Surcharge Fee)
Approved ❑ Owner Given Initial Y~ ~}~~('-(YIN
Adverse Determination
X. ONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SHD-6398 (R. 05/94) DIS HUTION: Original to Cauniy, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1 . A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any 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.
11. 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 1/2 x 11 inches must be submitted to the ~cunty. The plans must
include the following: A) plot plan, drawn to scale or with complete dirnensions, locatio; of holding tank(s), septic
tank(,] or ether treatment tanks; building sewers, wells; water mains/water service; sfre~ir is (:.:n~j lakes,- pump or siphon
tanks, distribution boxes, soil absorption systems; replacement system areas; and the loc.:tior cf the building served;
B) horizor!ial and vertical elevation reference points; Q complete specifications `or purnps and c ont-ols; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manuft;cturer; D) cross section
of the soil absorption system if required by the county; soil test data on a 115 `orm; and F) al' sizing information.
-
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (-fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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7'Q m~ ,v7a .ve-' r, /n ~ 1G CO v -el/ o U Cy ~i'C°-~
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
4
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the f ,A Al W«wg residence located at:
1/9,x/1/4, Sec.Tam N, R~_W, 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.
Last time serviced s
Did flow back occur from absorption system? Yes NoX(if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacurer (if known):
s
Age~~o~f Tank (if known) :
(Signature) (Name) Please Print
(License Number)
(Date)
Form to be completed by licensed plumber (s.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 opening over outlet baffle)
Name/- Signatureli V'ctiu~ P MPRS 2=-
5/88
•wmonsin Department of Indusvy, - S O t L A ND S IT E -E V A L U AT#ON- R E PO RT Page- of 3
Labor and Human Relations
Division of Safety & Buildings
in accord with ILHR 83.05, Wis. Adm. Code-
COUNTY
10 S`r- c-tu~ l x
Attach complete site plan on paper not less than 81 / 1 must include, but
not limited to vertical and horizontal reference poi irection and scale or PARCEL I.D. #
dimensioned, north arrow, and location and dist c nea 46.
(~f.7
APPLICANT INFORMATION-PLEASE P ALL 1 ON REVIEWED BY DATE
PROPERTY OWNER: PR LOCATION
W
!t N k> lpcV G ~T ST C+'+iD;X i~~ 1/4 NE 1l4,S 3 3T Z of N ,R 1-1 E (ofd
PROPERTY OWNER':S MAILING ADDRESS cowey BLOCK # SUBD. NAME OR CSM #
M y _
19.89 Cou"N . -S
CITY, STATE ZIP CODE PH , []VILLAGE MOWN NEAREST ROAD
~I~)l lv 1,~1 t 5 g U o Z ('t S} 44 0;~ ~~Ir'1`f'1 OlU C`R~ S 4
New Construction Use'[A Residential / Number of bedrooms 3 Addition to existing building
D4 Replacement [ ] Public or commercial describe
Code derived daily flow LISO gpd Recommended design loading rate o •-1 bed, gWl? - trench, gpolft2
Absorption area required 6 y3 bed, ft2 S6 S trench, ft2 Maximum design loading rate 0.1 bed, gpd/ft2 0.8 trench, gpolft2
Recommended infiltration surface elevation(s) `a Cl - S ft (as referred to site plan benchmark)
Additional design/ site considerations Z14"Ka1~ 8(!!~eli!' Ml vVCV- S`c' ~101e' c ~Kt 3
Parent material s fo ` o`►-\~h Sb1 Flood plain elevation, if applicable N • ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem NS :❑U Rs ❑U ®S ❑U ®S ❑U ❑S ®U ❑S ®U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G ---F-
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
l><r;~:- ' p ~ 8 lb`1.2 Zf* Z. - S L ~ Z, `~S ~~'C 1'vl ~ L°-S ~ • S n-
<`v `1 tz 3 J V s 1 } Zwt s b1-t vrt 'F> ~S - o . S o. L
Ground 3 3y 10 `1 R 3J L _ JS d S ~ owN wi C g - o- 3 0-y
elev. _
ft. '78-132 VIS4 fZ V sg
Depth to 3 ~pV-L 3 0~= c. QoTu IV G lu S LA) L
limiting
factor S - doo Uw G 1vu
>l32"
Remarks:
Boring # Sb Q - o. S o~ b
>.><::<.~x>:. ► o- ~ y l~~l 2 Zc z - s i 1 Z~ 1~ wt S
3 3b--n I Z'-f k VL - ~s 1 b-y' M► C - o-1
Ground 8
elev. L/ ~~-138 10y1Z y/L - S ~LGh O S~ YA o` - o•-?
q-7.0 ft.
Depth to
limiting
factor
l a(61
Remarks:
CST Name:-Please Print Phone:
_ Arthur L. _ _[.T e -e r e r------ 715-425-0165
ergerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: C) S- Z 3 5 Date: b~V ZZ `1-1 Cl CST Number:
3
PROPERTYOWNER ~.JPNGttI'1~L SOIL DESCRIPTION REPORT Page t -of
PARCEL I.D. #
GPD/ft
Depth Dominant Color Mottles GrStru Sz. Scture
Boring # Horizon in. Murtsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots
. .
h Bed Trench
€r o-~Z LO`t~2 z(2 si 2.`E-Sbk v~ `~1,. cs - o.S o-6
3 Z ~z-33 IW1M 31Y Sit. 2.wtSbh m`f~ cs - o.S o.6
Ground 33 \ O`'l 3 - ~S ~{S O vin I' C g - 3 U, Y
elev.
q~.o ft. y 6$-138 X0`1 R VI(, S el Gtr V 3 yn) - o•~ c
Depth to
limiting
factor
? 13$
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
~2e
s to r:,e
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
i „Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
PLOT PLAN Page 3 of 3
SCALE 1"= 3131
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~Jo 9E puw! ih ! O TL wl ltv i~'r ~t 1Z q S _ Z 3 S
1`wE- LZ, U:Hs (715 ) 425-0165 1400576
CST Signature Date Signed Telephone No. CST #
fo
CO F I L E D APPROVAL OF THIS MINOR SUBDIVISION
JUN 201977 DOES NOT MEAN APPROVAL
1C) JAMES O' CONNELL OR SEPTIC
11101111161. of 00648 SYSTEM. F REFER TO 1162.20
0. Croix Couety,
CERTIFIED SURVEY MAP
-3406 l 1 OSWALD NELSON
Part of the Northeast 1/4 of the Northeast 1/4 of Section 35, Township 29 North,
Range 17 West, Town of Hammond, St. Croix County, Wisconsin
NC Coe. s r/ 35-29-17
to m
~C.T.H...J•• c-)89o340Q W 174.30 S89°3400 W- B14.o&
to N. LtNL oc fJG%4-
of StG.3S.
O S~ ~~00 1~ N CMOU•)
o APPROVED
O : N
N
JUN 15 1977
A OD UnIPI, ATTt=D I.-ANO
Q . 1\ QW Al t?~ t'3Y OT14E2S
O ST. CROIX COUNTY
UNPL.ATTE.G LAND p P 1 • Z,4- COMPREHENSIVE PARKS PLANNING
o QO A C 2tR S O AND ZONING COMMITTEE
OWN"=o gy PLATTC{2 O N Z 589°34.00/
90.56
. ll1 0 3 p0
11 s$°~ 30' Ay : <v
It, o ?
,cp
a7L 3s3 oo Y
1 T4. 30 41.45 m /y vtt..t_P,Cne, oc
? J
J 5AI-TWIN
N 8,5054 00" G 215.75 a y
U
• BE AlkitlIG.5 R-CF., To NORTH
LING Ot= NC1/4 S9-C-.-a t
R- V-C0w-IJC-D 589°34'00'1W
o Indicates 1" x 2411 iron pipe weighing 1.13 #/ft.
Vl= too' • Indicates 1" diam. iron pipe found.
Description: j
That certain parcel of land located in the NE 1/4 of the NE 1/4 of Section 35.
T 29 N, R 17 W, Town of Hammond, St. Croix County, Wisconsin, more fully described
as follows; Commencing at the Northeast corner of said Section.35, thence o
S 890 34, 00" W (recorded bearing) along the North line of said Northeast 1~4 of
Section 35 a distance of 314.00 feet to the Point of Beginning of the parcel to
be herein described; thence S 890 34' 00" W 174.30 feet;
thence S 000 071 00" W 280.00 feet;
thence N 890 341 00" E 215.75 feet;
thence N 310 09' 30" E 93.75 feet;
thence S 890 341 00" W 90.56 feet;
thence N 000 071 0011 E 200.15 feet to the Point of Beginning,
the above described parcel containing 1.24 acres, including the Northerely 41.25
feet thereof presently part of C.T.H. "J".
State of Wisconsin
County of St. Croix)
I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction
of the Owner, O.G. Nelson, I hove surveyed and dividbd the lands shown hereon
according to official records and in accordance with provisions of Chapter 236 of
Wisconsin Statutes and the St. Croix County Ordinances; and that the map and
description shown hereon are a true and correct representation thereof.
Dated: 29 April 1977 Vol. 2 Page 392 J~3r1e~L: Murphy
Certified Survey Maps Regis a ed L d, carve r
L.
St. Croix County Records fOUPL IY
St. Croix County, Wis.
:xq S 1 042
q- ~F
~ y'. RIVER FALLS, ; (z;
tlx.: • WISC.
R
LAND
4
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER. JOHN WAUGHTAL
MAILING ADDRESS 1989 COUNTY J, BALDWIN, WI 54002
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION NE 1/4, NE 1/4, Section 35 T 29 N-R 17 W
TOWN OF HAMMOND ST. CROIX COUNTY, WI
SUBDIVISION N/A LOT NUMBER N/A
CERTIFIED SURVEY MAP _ N/A 4 VOLUME: , PAGE LOT NUMBER -
s - 61
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 ye expiration date.
SIGNED:
DATE: ! S
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
h
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 JOHN WAUGHTAL
Location of property NE 1/4 NE 1/4, Section 35 , T 29 N-R 17 W
Township HAMMOND Mailing address 1989 COUNTY J,
BALDWIN, WI 54002
Address of site $cvr--z a -9 J~,6o
Subdivision name Lot no.
Other homes on property? Yes 'L- No
Previous owner of property ~/GlSax~'
Total size of property
Total size of parcel f, 72 Date parcel was created 1977
Are all corners and lot lines identifiable? b----Yes No
Is this property being developed for (spec house) ? Yes L- No
Volume and Page Number ns recorded with the Register
of Deeds. s~
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 ff'ce of the County Register of
Deeds as Document No. 3 ~4 D c/ `l , 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.
S gnatur of Applica Co-Applicant
nat.c, of Sionattire fat's. of ;ic7n.,tiit-~•
' i,~•+..~ j WARRANTY DEED ~i
ij• DOCUMENT NO. FORM aal i
{ I O` 5 „J VJ' 1 ~E 1 "'l~li 1.19 sr.ca nla[nV tD Pro" N[COItD IN6 DATA
4090^ I/
i
J i
aof...June_ - - , A. D., 1977 REGISTERS OFFICE I;
22 d
MM e tbi
l THIS I1VDE swa d- I Pslson y j
ST CROIX CO. WIS
Between
Rac'd, for Record this
22nd ~t.
day of June A .D. 19 77
r y f~h he firs ar - and
.v p. N1. '
John H. Wa.ur-'rst~'L .ind ni; Yf i nd < r.~ rie Ij ate
James OtCoruiell
4-CTUaRN Rpb« Dana
as joint tenants. parties of the second part
. _ - t
Witnesseth, That the th_ fiysi ~afFr., ad to consideration TO,
axs
of the sum of.. ~I
in hand paid b) the said parties of the second part, the receipt - - -
whereof is hereby confessed and acknowledged, ha-R-..- given, granted, bargained, sold, remixed, released, alieeed,
i conveyed and confirmed, and by these presents does_._ give, grant, bargain, sell, remise, release, alien, convey -Ind i
f
~ confirm unto the said parties of the second part, in joint tenancy, the survivor of them, his or her heirs and assigns
j forever, the following described real estate, situated in the County of... Via: 2i ,
_ . and State of Wisconsin, to wit:
_ _ 3 h
That cerfa. n parcel 6r -and 1oca~ed in the 11E, of t' erNEi of Section , T 29 ri, ji
R 17 W, Town of Hammond, St. Croix County 'Is+onsir more filly Se c-bPd asfollowst j;
{ ?ommenc;ir. at the Northeast corner of saiA section it, thence 890-14' 6V' W recorded_bearin)) along the North line of raid Nort5east ; of Section .5
a distance I~
of 314 .00 feet he Poin6 of Bef~i.nning of the parcel to be herein. described; ~
thence S 89 34' !)0"' W 174.30 "eet;
thence S 000 07' 00" W 280.09 : eet; TRANSFER i
j, thence N F90 34' 00" E 2)5..751 feet;
thence N 310 09' 3G" E Q'_1 f---t;
thence S 890 34' 00" W 90.56 feet;
ii
thence N 000 07' 00" E 200.1 Pet to the point of PPS nnirC
.the above-described parcel containing, 1.~4r3cres, including the 1lorthereiy 41.25
feet"thereof presently part of C.T.N. "J".
i Lot 1 is C.S.Y. in velwile 2 Pap
j (IT NECENAIU. ffi D=CRI O N RAIVEP-M BID!) - F -
iil it2'
Together with all and singular the hereditaments and appurtenances thereunto belonging of is any wise
it "!appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part_p of the
first part, either is law or equity, either is possession or expectancy of, is and to the above bar lined remises, and
t 'their hereditaments and appurtenances.
.'e To Have and to Hold the said premises as above •lescribed with the hereditaments and appurtenances, unto
j the said parties of the second part. 1s jo nt nl~tnts, and to the survivor of them, his or her heirs and assigns FOREVER
1j And the said _Cswa .d _ 7e-son _ w._ -_M..~-
for.._.._.._.._---•-•---_- heirs, executors and administrators, do ..es-.. covenant, grant, bargain, and i;
i agree to and with the said parties of the second part, the survivor of them, his or her heirs and assigns, that at the
j time of the ensealing and delivery of these presents...- S well seized of the premises above
i l described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, is fee simple, and ;
i that the same are free and clear from all incumbrances whatever - - _ {j
±1 and that the above bargained premises in the ouiet and peueable possession `of the said parties of the second part, i
I! the survivor of them, his or her hairs and assigns, against all and every person or persons lawfully claiming the whole
or any part thereof, .__......ZL............ will forever WARRANT AND DEFEND.
In Witness Whereof, the said part _...y....... of the first part ha-.._&.... hereunto set •.-...his-•- - hand_ and
19....?? L l .
seal this._._.._...22t>d.___. day ot_....1uAe -
+
t ..61!-crr~V
f SIGNED AND SEALED IN PREBSINCIF. OF
j ---a-S.-Ke]scg
~j
-_-_-(SEAL)
A., it I
I State of Wisconsin, x
County.
Personally came before me, this........... day of....._.._..__.__....----..»_._......alulid...___ A. D~ 19•-a7
° I
_.4sNald._ ~'....Hs18ot1.. ~
..a•..i r. 4
the above named
>t
-•-•••--.••-••7, =
to me known to be the person.... who executed the foregoing i stru ent and kncl ed the same. 1 7 v
s_
THIS INSTRUMENT WAS DRAFTED BY - • `
NOTARY ~3.
j SEAL Notary, Public . ..............St....cra1x-- ...NuaY )'W
1 ~
{
My commission (expires) (i3)_•-•-_----1!•297$,1'` - 'A•.»._:__
( } i' (Section S9.S1 (1) of the Wisconsin Statutes provides that all instnsrncnts to lie recorded shalt have plainly tinted at typewnttav Owe Ii - the names of the grantors,
grantees, witnesses and notarT. Section 19. a13 similarly rc-;owes that the name of the twson who, `ryb ~
mental agency which, drafted such instrument, shill he printed, hp, vritten, stamped or written thereon in ■ leq,bie mann".7 Tww -
t ..-al• 441
AV SttR \NTY fsFFT)Tewwa•F