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CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o Dv£? /SO' To /7(c C~~JfcYj 4L)j0e407(ff/..iVcs N ~/J /ivy /oo0 6•rc S/~iuK / \pp f~ v✓L 36 eir uz-.-7 4iNP ~~SIG~NCd © r7r7' ~o 33. i i aOLP ' ~PK~ ice/ ; ,:x,ucM~~tPK ; / VEAJrs GLe'J. n ~pe~.o0' I elfH av ©~PTY 4^0 ~v o S~/fiz c INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. f BENCHMARK• : _Z5~0j Z' [gyp ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: f' Liquid Capacity: loon Setback from: Well House 3/ Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: !S Length '!!~O ' Number of trenches Distance & Direction to nearest prop, line: C~ Sc~ u T?/ Setback from: well: House /e_ Other ELEVATIONS Building Sewer _ ST Inlet; 9~- ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade !-~7 .9y Final grade DATE OF INSTALLATION: ~r- PLUMBER ON JOB: _ I LICENSE NUMBER: INSPECTOR: 3/93:jt ~ Wiscontin 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_: Permit Holder's Name: ❑ City ❑ Village p Town of: State PI o.. THAKE, GERALD/ANTONETTE X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA ~Xl3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Septic Benchmark O$'' 0,d i Dosing U ( - je, "x - lU/, SSA Aeration rv4 Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent t TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet G / Septic ? 3/ NA Dt Bottom Jl~ Dosing NA Header- Aeration Dist. Pipe Holdi Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufa r Demand Model Number 'G o TDH Lift Friction System TDH Ft Forcelmain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS s 6-/' 1 3 - SYSTEM TO P / L BLDG WELL LAKE/STREAM LE ManufaEturer: SETBACK CHAMBER Mode Num er: INFORMATION Type Of news UN System: t.-e, l OR DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Ven take Length 5 Dia. ~Z Length 4ZIS Dia. ~f Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys Depth Over Depth Over xx Depth Of xx ded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.30.20.19W, SW, N , Lot 2, Valley View Trail a:J Plan revision required? ❑ Yes G-14o Use other side for additional information. Io--- SBD-6710(R 05/91) Date Inspector's Signature Cert. No. DILH Ell SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COu STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 416-71/Q_2_ 8% x 11 inches in size. 1:1 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 6wYkAJ-0Y4,S 30 TRO,N,R /F E(o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ZC6 1Z CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME O S UMBE p 7 II. TYPE OF BUILDING: Check one CITY PEAREST ROAD ( ) ❑ State Owned O VILLAGE ❑ Public ,N1 or 2 Fam. Dwelling4 of bedrooms 3 PARCEL TAX NUMBER() V ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/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/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.N New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 511 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 420 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.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ysa 7So s pr, 17_Sos- rr. q!a? BPS Feet q ~ 9G • 90' Feet CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holdin Tank /02 /Ooo (.JiESE Lift Pump Tank/Si hon 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): Plumbe ' ig ature: to ps) MP/MPRSW No.: Business Phone Number: ,4 dos -:7~_C_. 3396- ~•s~-a~sa Plumber's Address (Street, City, State, Zip Code): sS ST. At. Soa/ ~yae IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved San~QJitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ~~e /Jd[J Approved I El Owner Given initial Surcharge Fee) Adverse Determination 1?-/ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb$7) (R. 11/88) 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 (3BD 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 years. 6. If you have questions concerning your onsite sewage system, contact your local code adm°nistrator 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. 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 compir)te dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water n ains!water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorptior system replacement system areas; and the location of the building served; B) horizontal and vertical elevation re!,.-encc! points,; C) complete specifications for pumps and controls; dose volume; elevation cifferences; 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 Aci 410 included the creation of surcharges (fees) for a nurnhor of regulated practices which can effect groundwater. ,#or mapitoring groif:tdIter, ,gio..,nd- rn opE es cr*E ;,^fied through these surcharges are used water rontarn inahon investigations and establishment of standards. SBD-6398 (R.11/88) -PLB 67 PLOT & CROSS SECTION PLANS ZAPPA BROS. EXCAVATIN1i INC PLUMBING UNIT OV£R /Sa' i4~'t car /f'? P~PoQErrY ~ "Jes ,./PR4JE . y 51rf'~o ~~C SEt~EQ ~ iNE JE Y/ ~KE ~i¢~ off[ ~irl~J l_C .EG, / c -/Ooo qfl'. ZPT,t TitAik ow or'~T sc PgoQoSEn L v Etc Al PJC 3031/ EFrZ444'U t X 1NE -5~ ` u x ecPa T J Qk~vEwAY E/t5T ,N E 4 , as Sa v o 3° 1r0 5<o~E i i yfnl f5 ' _ A Q A• 4 C~z I ~ e c~~K ~ipcE E<E1/, s /ov, oo' CALE FRESH AIR INLET AND OBSERVATION PIPE APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL-GRADE 4' CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE PIPE TO FINAL GRADE Fal D: MAR SH MAY OR SVNTMETIC COVERING SE: 1I~Q~S 33 g~` MINIMUM 2' AGGREGATE DATE: /31 /9S OVER PIPE DISTRIBUTION PIPE I_, TEE SOI TESTING BY: ELEVATION BED 0' AGGREGATE • BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TEST 13 • COUPLING TERMINATING • a S FT. AT BOTTOM OF SYSTEM Al, 3 `!-~.Uc hFE S Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page ` of Labor and.irluman Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Ctk Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 0df' M /Yf C /31uelp-y N A kC GOVT. LOTSw 1/4 WC 1/4,S3o T 'Zp N,R I q E (or) W PROPERTY OWNER':S MAILING A DRESS LQT # BLOCK # St~p NAME OR CSM # T"w6ASSI:6 C5M CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [:]VILLAGE OWN NEAREST ROAD, p~'J New Construction Use [I Residential / Number of bedrooms UN K [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2-Ttrench, ft2 Maximum design loading rate QS bed, gpd/ft2 0.6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 01) ~'144+E 3 0r- 3 ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system 0 VENTIONAL M UND IN-GROUND PRESSURE AT-GRADE SY TEM IN FILL HOLDING T NK U= Unsuitable fors stem S❑ U S❑ U S❑ U S❑ U S❑ U El S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tre & ,z3~ /bYreS,,3 SjL n, sb n,r CS 1 2 0.~ Ground $ -It' ,SY 3 S r f S v. . OZft. Depth to limiting fact r 7 ~`7 Remarks: Boring # p-2S /AYQ L rv► f*r- rfr S 1 ,S O, 6 S, L -44 4 -12 S YR 4 3 S r - d S 0.6 Ground elev. 47.76 ft. Depth to limiting factor > Remarks: CST Name:-Please Print Phone: 4a S-G & ,~0NCI sou Address: P. 0 I O bSL% ►J (~9, Signatur Date: 4Z/g/9 S CST Number: PROPERTY OWNER CAAk0J,u1MMLc1ch SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # 30 `20 - 19 i4 K C Depth Dominant Color Mottles Texture Structure Consistence Bounck3y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench o w•..\:C. ry - I / 7 ~J ti, c r- ^1 CT INN. ' g JZ 3~ 3 S j n, s b rr, r s 1 p .2 3 Ground D2 37- Z 7 S Y S, S t n, Ji Q,S 0.6 elev. q~ ft. Depth to limiting factor 7 Remarks: Boring # X44 /bye SrL r" sbK m S 1 0.2 03 -0 7,SYk s r n, >S >6 Ground elev. cg:A t. Depth to limiting 'fct~Z Remarks: Boring # Z /h Cc- lr- S D,~ JhC y:tfi. $ Z-q I w s, ~ / Sb~ nh ~r es 1 0.2.:013 O 1^ i' 1 I 0 S i~, - a ,S Y R 's L Ground elevd. qi ft. Depth to limiting factor F Remarks: Boring # Ground elev. ft. Depth to limiting factor ~Lj Remarks: SBD-8330(8.05/92) 4 _o a i.v Q a . `p` A N 1 ` 40 \ 1 M 1 d~ a M N C4 N t4o I 72 M 4 Ir Q ~ CIO M FILED F JUN 3 0 1995 ► 8 ;z 530687 KATHLEEN H W" Repisterof Deeds a Croix Co., M ~O J N C EP T I F- I ED 5 UP V E Y MAP Located in the Southwest quarter of the Northeast quarter of Section 30, Township 30 North, Range 19 West, Town of St.Joseph, St.Croix County, \ Wisconsin. y \ Owned by: Carroll Emmeck ~ 398 Valley View Trail ~C~~\ Houlton; Wisconsin. OF E't PP \'C / \ \ CEO %U~J ~ ~Z t ~ ~ ~ ~ iEE~'~ 1 pP~E i m 2 D\ o Easement corded Zog r 52 -"ql Volume 1123 page 22 61 ' - ~ S 226 5\?i od LEGEND Section Corner Monument. 100' building setback line. 0 1"X24" Iron pipe weighing 1.68 pounds per lin. foot set. 0 1" Iron pipe found. N Bearings referenced to the North - South quarter sectio line, previously LL-® N recorded as N00°27153"E. 'I 2 out'RE FEEL LO l0 \35133600 4'CRES 3 0 SCALE IN FEET I" : 100, 0' 25' 50' 100, 200' 300' APPR01M V Q N Unplattgd lands- JUN 3d.15t LO ST. CROIX COUNIrY Z Comprehensive Rlanna Zoning and Parks G nnldttm If not recorded within 30 d4"Wf oval'ddts ``tt~~~„i~i sh3itttio Unplatted lands 3, 50NW ,it'~`~`5 N g3 1 96, 1 HARVEY G. fit 223• ` z JOHNSON S-1899 :S HUD ON W SU ° ` ;~E'jts t' 6~ir~9S z North-South 1/4 section - 1 line. 2027,97' 3326.33 N 00° 27'55 E S 1/4 COR. N 1/4 COR. SEC. 30 DRAFTED BY SEC. 30 495-2397 J.S.I• VOL. 10 PAGE 2947 aD Lh6Z d9Vd OT "IOA •aOTAp'e zo; pzsog unnoL 94sTzdozdds aq4 pu'e OOi;;o SUTUOZ &4Ur.02) xTozo•;g aq; ;os;uoo 'Iaoaed Awe 2UTdolanap zo 9uTS'egoznd azo;ag • o;a 'Taoabd of ssa00'e 'azTs 401 XUULUTUTUZ 'spus14am •a•T) suoT;slnBoa pus salnz 'smsl dugs -UtAO,L pine A4UPOO 'a4s3g o;;oafgns sT dsuz sTq; uo utAogs Taozsd aqL :gLON ,,Ig111IN~~~, o)- ~~ans oN~~ 40 N s' ~y % 9TOfg uTsuoosTM 'uospnH 668 1_S 2 g4aON ansza tnOpsavq 9IZ NoSNNOr Q7S~~3~ •ouI 12uTADAanS uosugor '«AU 66sI-S uosu •o danxeH 56/0/5 `\9F~N-nA-7/ •;aTlaq pus 2uTpus4szapun 'a$palmoux lsuoTssalozd AuT;o ;saq oq; o; aousuTpzp uOTsTATpgnS gdasor•;S;o utAoL alp pus aousuTpao uolsTATpgnS A4uuoo xtozo•;S aq; 'sa;n4s;S uTSUOOSTM 9q; 3o V£' 9£Z uopoaS ;o suolsTAozd aq4 q;Tea paTlduzoo Alin; 9ASq I 4sq4 pus :padanznS pusl aq;;o SOTzspunoq zoTza}xa aq;;o uopie4uasazdaz4oazzoo pus anz; s ST 4sld guns 4sg4 :A;zadozd pagTzosap aAogs aq; paddsLU pus peAanzns ansq I ' a- nzo 'NoaLUuzg TTozzsZ) ;o uoT4oazTp zapun ;sg; A1T4za0 dgaaaq 'zoAanznS pus-I uTsuoosTM paza;sTBaz 'uosugor 'D AaAZBH `I 'pzo0az 1O s4usu9nOO pus suoT40Tz4saz 's4u9uzassa TTs o; 4oafgns Supq pus 'ssal zo azoLU (sazus OOT'£) ;aa1 azsnbs 9£0`g£I SuTuEe4uoo '2u-ruuE29g ;o;ulod aq; o44aa; £Z•OZ9 4salA spuooas OI sa;nuTuz 9i, saaz4ap 9L q;noS aouaq; !auTl 4so W pl-es 2uore ;ea; T9'9ZZ ;ssg spuooas LI sa;nuTuz 00 saaz2ap ZZ q;nos aouaq; :ZISI 92sd '9 auznTOA uT papzo0az drys AgAang paT3T;zao ;sq;;o ouTl ;salA aq4 o; ssal zo azouz ;aa; 99•g8g 4ssg spuooas OI se4nuTLu 9{, saaa2ap 9L g4zoN aouag4 :;aa; 96•£ZZ 4saM spuooas 09 sa;nunu £I saaz2ap £I g4zoN aouag4 :BuTuuTBag 10 4UjOd aq; o; ;aa; £g • 96£ ;ssg spuooas Ol so4nunu 9T, saazgap 9L q;zoN aouag4 :ausl uoT4oas za4zsnb g4noS -g4zom ago 2uOle 4091 L6'LZOZ ;s9M spuooas £g s94nuiuz LZ saazSap 00 g;noS aouag4 :0£ uopoaS ;o zauzoo za4z'enb g4zoN aq4 ;E SUTOUa UILLiOO :smollo; ss pagTzosap 'uTsuoosTM 'A;unoo xTozo•4S 'gdasof •.4S 1o uiAO L ';saM 61 a2weg 'g;zON O£ dTLlsunnoL IOC uopoaS ;o za4zsnb ;ssag;zoN ag;;o zo4zsnb 4samL14noS ag; uT pa4s0ol pusl;o laozsd V • uopdTzos aQ J STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ` L ► 1 fit` e OWNERBUYER S. nn+cr)elqc MAILING ADDRESS "Ii~2& S ~5 f . S Om e ap S PROPERTY ADDRESS I (location of septic system) Please obtain from the Planning Dept. CITY/STATE t~1 © (,-A TC_ n 1 (01..- 5 q R Z PROPERTY LOCATION S- W 1/4, N- E 1/4, Section 30 , T ~j o N-R__L3_W TOWN OF 1 t O u- I +O rl ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER v CERTIFIEDSURVEY MAP VOLUME lO, PAGE / S) 2rLOT 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. 1/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 piratio te. SIGNED: DATE: ►5 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 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. ----------------------------------------------~1--------------------LL- Owner of property Ge r nI cA. S Th oa.ke i- ~-tY) AOn e i-& Location of propertyS 1/41/4, Section 30 ,T 30N-R_L2W Township Sj. .Apr-,ejhMailingaddress SOmPr-c 4- V//_& S~ 0,3 Address of site - p Subdivision name Lot no. Other homes on property? Yes ✓ No Previous owner of property C r rn E-M Total size of property .35 - ~..44r , Total size of parcel Same' Date parcel was created 5Zj / .96- Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes __L,-' No Volume (0 and Page Number 15)2 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWINGS A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. , 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. Af)Aly( -.41L J, 'L - T-, Z Signature of Applicant Co-Applicant ~G QA---) Date of Signature Date of Signature State Bar of Wisconsin Form 2 - 1982 1+ ~ WARRANTY DEED DOCUMENT NO. VOL .1134PAG,L441 RIEG1 -v ST. ITV! 011*l .I.~ Reed for Carroll _ Gene . Emmeck, AU G 9 1995 11:55 A conveys and warrants to Gerald S Thake and Antonette C w- b~E.3fCT.~ r Thake, as i:oint tenants and not_as tenants in common THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS /,Q r the following described real estate in St. Croix - County, State of Wisconsin: tY yi~> (Parcel Identification Number) Lot 2 of Certified Survey Map Filed June 30, 1995 in Volume 10, Page 2947, as Document Number 530687, together with the following described property: A parcel of land located in the Southwest Quarter of the Northeast Quarter of Section 30, Township 30 North, Range 19 West, Town of i St. Joseph, St. Croix County, Wisconsin, described as follows: Commencing at the North quarter corner of Section 30; thence South 00°27'53" West 2027.97 feet along the North-South quarter section line to the Point of Beginning; thence North 00027'53" East 230.51 feet along said North-South quarter section line; thence North 76046'10" East 342.26 feet to the Northwest corner of a Certified Survey Map; thence South 13013'50" East 223.96 feet along the West line of said Certified Survey Map; thence South 76046'10" West 396.83 feet to the North-South quarter section line and the Point of Beginning; containing 82,764 square feet, (1.900 acres) more or less. Together is not with a driveway easement described on This homestead property. the attachment. (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. Dated this 14th - day of July 19 95 (SEAL) a_Y EAL) CARROLL GENE EMMECK (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Carroll Gene Emmeck STATE OF WISCONSIN ss. County. authen ' aced is 14th day of 19-----9-5 Personally came before me this day of 19 the above named P TITLE: MEMBER STATE BAR OF WISCONSIN Vila, ~tyC}}6~i,~e,Q/t}~/g1~p¢~~4 J6}/./${f~!)/ to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY STEPHEN J. DUNLAP Hudson, Wisconsin Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) , 19 'Names of persons signing in any capacity should be typed or printed below (heir signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co . Inc. Von 1134PAGL- 442 A parcel of land located in the Southwest quarter of the Northeast quarter of Section 30. Township 30 North, Range 19 West, Town of St.Joseph, St.Croix County, Wisconsin, described as follows: Commencing at the North quarter corner of Section 30; thence South 00 degrees 27 minutes 53 seconds West 2096.08 feet along the North - South quarter section line; thence North 73 degrees 49 minutes 52 seconds East 1037.34 feet to the West line of that Certified Survey Map recorded in Volume 6. page 1512 and the Point of Beginning; thence North 22 degrees 00 minutes 17 seconds West 66.34 feet along said West line; thence North 73 degrees 49 minutes 52 seconds East 66.34 feet; thence South 22 degrees 00 minutes 17 seconds East 90.96 feet to the centerline of Valley View Trail; thence southwesterly 72.47 feet along the are of a 450.00 foot radius curve concave to the Southeast whose chord bears South 43 degrees 44 minutes 40 seconds West 72.39 feet to the West line of that Certified Survey Map recorded in Volume 6, page 1512; thence North 22 degrees 00 minutes 17 seconds West 61.09 feet along said West line to the Point of Beginning, containing 7136 square feet (0. 164 acres) more or less, and being subject to all easements, restrictions and covenants of record.