HomeMy WebLinkAbout030-2094-90-000
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
. Dlvisiol of Safety 8 Buildings in Ci4i 5 Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than st include, but
not limited to vertical and horizontal reference po f6 of sfp's 6A ale or PARCEL I.D. #
dimensioned, north arrow, and location and dista ED BY DATE
APPLICANT INFORMATION-PLEASE PRI r"
PROPERTY OWNER: P TY LOCATION
~crai 'Y VT OT NE 1/4 SW 1/4,S29 T 30 N,R 19 E (or) W
Jo Ann Persir-o/Brurp -=t.P_r-,c)n ~eZINGOF- F ' ^c
PROPERTY OWNERS MA!IING ADDRESS c~'0 # BLOCK # SUBD. NAME OR CSM #
#328co. Rd. #F i 18 na Highland Hills phase II
CITY, STATE ZIP CODE PHONE NUMBER" ❑CITY ❑VILLAGE EYOWN NEAREST ROAD
Hudson, WI. 54016 (7151 386-8236 St. Jose h Co. Rd. E
[x] New Construction Use I ] Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd/ft2 •6 trench, gpdtft2
Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 •6 trench, gpdt t2
Recommended infiltration surface elevation(s) 107.88 It (as referred to site plan benchmark)
Additional design / site considerations na
Parent material glacial till _Flood plain elevation, if applicable na ft
S =Suitable for system CONVENTIONAL MOUND 7IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ~S ❑ U giS ❑ U &S ❑ U :us ❑ U ❑ S &U ❑ S -tau
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bartdary Roots GPD/ft
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trertdt
1 0-10 10Yr3/3 none 1 2msbk mfr 9W 2m .5 .6
t;~ 1
•ti}ti
2 10-27 10yr4/4 none sil lfsbk mfr gw if .2 .3
Ground 3 27-86 7.5yr4/4 none sl 2msbk mfr na na .5 .6
elev.
110.8811.
Depth to
limiting
factor
Remarks:
Boring #
1 0-12 10yr3/3 none 1 2msbk mfr gw 2c .5 .6
2 2 12-28 10yr4/4 none sl 2msbk mfr 9w if .5 .6
3 28-82 7.5yr4/4 none sl 2msbk mfr na na .5 .6
Ground
elev.
110.8 ft.
Depth to
limiting
factor
+82"
Remarks:
CST Name _Please Print Gary L. Steel Phone' 715-246-6200
Address-
1554 200th. aVe., New Richmond, WI. 54017
Signature: Date: CST Number:
Q~~Zt~ 26LLL 6-27-94 cstm 2298
Persico/Peterson l
PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2,_ of 3
PARCEL I.D. # .r *Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench
1 0-10 10 r4 3 none 1 2msbk mfr if .5 1.6
Li 2 10-3 10yr4/4 none sil 2msbk mfr gw if .5 1.6
Ground 3 33-86 7.5yr4/4 none sl 2msbk mfg na na .5 j.6
elev. ;
111.8
Depth to
limiting
factor
+86"
Remarks:
Boring #
;,;;;W1 0-12 10yr3/3 none 1 2msbk mfr if .5 .6
e s i l l fgr mfr gw i f . 2 .3
Lj 2 12-40 10yr4/6 non
3 40-8 7.5yr4/4 none sl 2msbk mfr na na 5 :.6
Ground
elev.
112.511.
Depth to
limiting
factor
+85"
F
Remarks:
Boring #
:1 0-9 10yr3/3 none 1 2msbk mfr 2c .5 :.6
2 9-35 10yr4/4 none sil 2mgr mfr gw if .5 :~6
3 35-80 7.5yr4/4 none sl lmsbk mfi na na .4 .5
Ground
elev.
112.38 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting f
factor
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Highland Hills phase II 1554 200th Ave.
CSTM2298 lot #18 New Richmond, WI 54017
MPRSW 3254 NE4 SW4 S29-T30N-R18W (715) 246-6200
1 town of St. Joseph
N
1"=40'
BM.= top of SW lot stake
~D
~ b 3 Ills
I C
5
2)'
Gary L. Steel
6-27-94
r 'a
STC - 10 4
r r c t
AS BUILT SANITARY SYSTEM REPORT
OWNER
6- CZ_ w yy ~fi '13S E r..~9J
ADDRESS
~1L
SUBDIVISION / CSMg LOT
SECTION T_ ~,e~ N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVE YTHING WITHIN 100 FEET OF SYSTEM
171
,s
gs- G -
.f
1'/u S.E
i
pone CAT Tti hRR01~'
Provide setback and elevation informatihis fotm-
Provide 2 dimensions to center of secoVe1
BENCHMARK:
ALTERNATE BM: ,n 71 lz27=)
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width:_ Length g5- Number of trenches
Distance & Direction to nearest prop. line: 4
Setback from: well:.-_ House' Other
ELEVATIONS
Building Sewer ST Inlet 7 ST outlet
PC inlet I PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE=. OF INSTALLATION: -
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93: )t
Wisconsin Dep&tment of Industry, PRIVATE SEWAGE SYSTEM County:
Laborand'Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
Peft1 iMpK'?; eLEONARD ❑ City ❑ Village R Town of: State Plan o.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/00. 1 1 A9500322
TANK INFORMATION 41, ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / 7enchmark o; /00
Dosing ---Gem 6¢,_,
Aeration Bldg. Sewer
Holding St/ Ht Inlet 7 '
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe 3~ /oa, qS
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand aS e o s
Model Number GPM
TDH Lift Lric ~ n System TDH Ft
F
Forcemain Leng Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length _ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 85 / DIMEN I N
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type Of 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 I 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 ~j 6 Bed/ Trench Edges a Topsoil F] Yes ❑ No ❑ Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: St. Joseph.29.30.19, NE, SE, Highland View
of 11~
Plan revision required? ❑ Yes (]/No
Use other side for additional information.
SBD-6710 (R 05/91) Date nspector's Signature Cert No.
Safety and Buildings Division
~~■■_r■r~ 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
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sani!y~rfrt't~uum
The information you provide may be used by other government agency programs El Check ii~]t revision to previous application
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Pro erty Owner Nam Property Lo ation
1/4 1/4, 5 T , N, R62 (or
Prop rty Owner's i in Addres Lot Number Block Number
City ,S to zip code Phone Number Subdivision Na or C Number
S ( )
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City IN ear t R ad
Village
Public 1 or 2 Family Dwellin - No. of bedrooms Town OF
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment / Condo 0so
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. k 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
11 Xseepage 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. 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./ ch) Elevation
Q Feet / Feet
VII Capacity Site
. TANK in allonTotal # of Prefab. Fiber- Exper.
INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete stru~ted Steel glass Plastic App
Tanks Tanks
Septic Tank or Holding Tank - - ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, th undersigned, assume responsibility for' stallation o the onsite sewage system shown on the attached plans.
Plu be s Na : (P nt) Plum er's Ig ur . to ps MP/MPRSW NO.: Business Phone Number:
2 -
PILimber's~Addre-ss(St re ,City, tate, Zi ode):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sapitary Permit Fee (includes Groundwater Date Issue Issuing Agent Signature (No Stamps)
C~yJ, AO Surcharge fee)
XApproved ❑ Owner Given Initial f1~~
Adverse Determination
X. CONDITIONS OF APPROVAL/ REAS NS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to county, One copy To: Safety & Ruildings Division, Owner, Plumber
l
INSTRUCTIONS t.
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe 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.
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 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 orefix (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 county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimension,, locatirori of holding tank(s), septic
t, "k(s) or other treatment tanks; building sewers; wells; water mains/water se-ice; strE - r s ;and lakes; pump or siphon
tz- Mks; distribution boxes; soil absorption systems; replacement system areas, an;l the loc:_t o , of the building served;
B; 'wrizontal and vertical elevation reference points, Ci complete specification. for purips and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump m;:nufacturer, D) cross section
of the soil absorption system if required by the (ounty; F-) soil test data on a 115 form, anu! 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 contamination investigations
and establishment of standards.
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Wisponsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
tl*r and Human Relations
'Tio~sion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than t ' Ian must include, but St. Croix
not limited to vertical and horizontal reference direction slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and dis a to , rrest~~ccrQ~5d. 030-2094-90
APPLICANT INFORMATION-PLEAS ~eNTIWkaNFG MAT10 REVIEWED BY DATE
PROPERTY OWNER: OPERTY LOCATION
Leonard Diethert VT. LOT NE 1/4 SW 1/4,S29 T 30 N,R 19 x5 (or) W
PROPERTY OWNER':S MAILING ADDRESS OT # BLOCK # SUBD. NAME OR CSM #
38 Peterson, 0 18 na Highland Hills phase II
CITY, STATE ZIP CODE []CITY []VILLAGE EFOWN EST ROAD
Houlton, WI. 54082 ( 4 St. Joseph 7CoW. Rd. #E
[ Tlew Construction Use [ Residential I Number of bedrooms 3 [ J Addition to existing building
j I Replacement Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd/ft2 •5 trench, gpdtft2
Absorption area required 1125 bed, ft2 900 trench, ft2 Maximum design loading rate • 4 bed, gpd/ft2 - 5 trench, gpd/ft2
Recommended infiltration surfaceelevation(s) 106.04-102.11' It (as referred to site plan benchmark)
Additional design / site considerations step down trench system
Parent material pitted alacial drift 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 fors stem ( ®S ❑ U ES ❑ U as 01.1 JaS ❑ U ❑ S ElU ❑ S EFU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trt>rtrtl
`r~:.... 1 -7 10yr2/2 none L 2mgr mvfr gw 2m .5 .6
2 -21 7.5yr4/4 none sl 2mgr mvfr 9w lm .5 .6
Ground 3 1-45 5yr4/4 none sl lmsbk mfr 9w if .4 .5
elev.
107.06 ft, 4 5-96 7.5yr4/4 none sl 2mgr mvfr na na .5 1 .6
Depth to
limiting
factor
+96"
Remarks:
Boring #
,..~r:{ 1 -7 10yr2/2 none L 2mgr mvfr gw 2m .5 .6
"ry 242 -31 7.5yr4/4 none scl 2mgr mvfr gw lm .4 .5
3 31-90 5yr4/4 none sl lmsbk mvfr na na .4 .5
Ground
elev.
107:41
Depth to
limiting
factor
+90"
Remarks:
CST Name:-Please Print Gary L. Steel Phone' 715-246-6200
Address:
1554 200t l-#. Ave. New Ri hmond, WI. 54017
Signature: Date: CST Number:
5,30-95
L_ ae~"W_A~
PROPERTYOWNER L. Dietherd SOIL DESCRIPTION REPORT Page 2w, 40f 3~
PARCEL I.D. #t 030-2094-90
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed iTrerch
1 0-7 10yr2 2 none L 2msbk mfr 9w 2m
3 ,5 ;.6
2 -35 10yr5/4 none sijCl lfsbk mfr gw lm .2 1.3
Ground 3 133-90 7.5yr4/4 none s1 _ I. lrhsbk mfr na- na
..4 ~ .5
elev.
105.11 ft.
Depth to
limiting
+901r
Remarks:
Boring #
1 0-7 10yr2/2 none L 2msbk mfr 9w 2m .5 .6
4 2 7-24 10yr5/4 none sil lfsbk mfr gw lm .2 .3
3 24-47 10yr4/6 none sicl 2msbk mfr gw if .4 .5 ?
Ground
elev. 4 47-84 7.5yr4/4 none sl lmsbk mfr na na .4 .5
102.26.
Depth to
limiting
factor
+84"
I
Remarks:
Boring # 1 0-7 10yr2/2 none L 2msbk mfr gw 2m .5 .6
5 2 7-30 10yr5/4 none sil 2fpl mfr gw lm np .3
..mGtatiti:::::
3 30-84 7.5r[J4/4 none sl 2msbk mfr na na .5 .6
Ground
elev.
102.06 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting I
factor
Remarks:
SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Leonard Diethert 1554 200th Ave.
CSTM2298 NE4SW4 S29-T30N-R19W New Richmond, WI 54017
MPRSW 3254 town of St. Joseph (715) 246-6200
lot #18-Highland Hills Phase II
N
1"=40'
BM.= top of 11'steel pipe @ el. 100,
Alt. Bm.= top of 1" steel pipe C el. 97.36
t !41
zz
.~M 13 - 5
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S•Z .
GAry L. Steel
5-30-95
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER .
I
MAILING ADDRESS _
PROPERTY ADDRESS
(location of septic stem) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION _ 1/4, ~u l 1/4, Section, T/t N-RW
'SOWN OF ST. CROIX COUNTY, WI
,p .
SUBDIVISION LOT NUM 3ER _
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 ear expiration da
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
J
Ownerofpropert~ait,,4~r
Location of property l/4, ~w 1/4, Section,__22_, T,_~N-R__/_ W
Township Mailing address
Address of site / I _ 1,7/(1 h0ify Subdivision name Lot no.
Other homes on property? Yes----,X, -_No
Previous owner of property i"),J_ - _ - -
Total size of property
Total size of parcel
Date parcel was created Are all corners and lot lines identifiable? __>C Yes _No
Is this property being developed for_ (spec house) ? Yes X_No
Volume /,,/7;~~ and Page Number a::; recorded with the Register
of Deeds.
INCLUDI; WITH THIS APPLICA'T'ION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME, AND PAGE
NUM131., Z AND THE SEAL OF Till., REGISTER OF I)1 EDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the decd 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 ar.e 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. 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 . C lature of ppl at Co--Applicant
(0
Datc of Signature D(-Ite of Signature
State Bar of Wisconsin form 2 1982
5291.41
WARRANTY DEED UIEGISTEA's
DOCUMENT NO. SE CROIX
_ Highland Hills,, a Partnership- consisting_ MAY 19 1995
_of
JoAnn Persico_ Roger uelin and Bruce a~ 1:00 P
Flit rsoE___
conveys and warrants to Leonard D _Diethert-and-_-
M,_Detherta__husband_and_wif.a,-
Tills SPACE nESFnvEo ron nEConDINO DATA
NAME AND nETunN AoonFSs
file following described real estate in St. Croix
County, State of Wisconsin:
(Parcel Identification Number)
Lot 18, Highland Hills First Addition in the Town of St. Joseph, St. Croix
County, Wisconsin.
'MMSF_EB
FEZ
This is not homestead property.
W (is not)
Exception to warranties: Easements, restrictions and rights-of-way of record,
if any.
Dated this day of Maw - , 19-95...
Highland Hills,; a`-Partnership
(SFAL) (SEAL)
• JoAnn Persico Roger Rued i n--- ---U
By _ye p - - - (sr-At.)
Bruce Peterson
AUTHENTICATION ACKNOWLEDGMENT
STATE: OF WISCONSIN
i5.
s t r Croix _ CDullq.
authenticated (his _ day of - , 19 ---Personally came before me this day of
May , 19-95_ the above named
JoAnn Persico Ro er-Ruelin
--Bruce Peterson
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not. - pabllc----._.._._.
authorized by §706.06, Wis. Slats.) ?,,'o ``-~~Io me known Io he the persony~'1who executed file
for ping msfrumc t and nckr c the same.
Ti11S INSMUMENT WAS DFIAFTED 13Y
Kristina 0 gland - - -
Attorney at Law
Notary Public - - County. Wis.
(Signatures may be nuthenticatcd or acknowledged. Roth are not My commission is permanent. (If not, stale expiration (life:
necessary.) 19 q_~
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