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Parcel 036-1023-45-000 09/2412007 07:53 AM
PAGE 1 OF 1
Alt. Parcel 11.31.17.151 C 036 - TOWN OF STANTON
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
O - SIR, JOSEPH C & SHANNON L
JOSEPH C & SHANNON L SIR
2265 CTY RD T
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2265 CTY RD T
SC 3962 NEW RICHMOND
SP 1700 WITC
SP 0033 DEER PARK FIRE DEPARTMENT
Legal Description: Acres: 3.770 Plat: N/A-NOT AVAILABLE
SEC 11 T31N R1 7W SW NE LOT 1 CSM 7/1975 Block/Condo Bldg:
3.77ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
11-31N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/05/2005 808627 2903/457 WD
05/03/2002 677969 1883/467 WD
10/18/2001 659423 1740/333 CORR
03/30/2001 641690 1610/276 WD
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/05/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.770 25,000 130,400 155,400 NO
Totals for 2007:
General Property 3.770 25,000 130,400 155,400
Woodland 0.000 0 0
Totals for 2006:
General Property 3.770 25,000 130,400 155,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
t
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER;, ]4e
ADDRESS', Ieed
SUBDIVISION / CSM# LOT #
SECTION
1/ T/ N-R / 7 W, Town ofl~ 4,y 7 4,)
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
4,,I
w v
J A
23
INDICATE NORTH ARROO
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK. 4G, /yt 4S l ~S
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: 06
Setback from: Well S-0 House 1-7 Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length S 7 Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: o House '~O" Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
s
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: `T Z
PLUMBER ON JOB: oz,-
a
LICENSE i
LICENSE NUMBER: INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Lat4,randHLopanRelations INSPECTION REPORT ST. CROIX
Safety and"Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
PerrmiittAHNK is NaaIe: C] City Village XTown of: State Pla
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Ta
1-J-1111 _ A9500015
TANK INFORMATION E EVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark os~ 900
Dosing
Aeration Bldg. Sewer 48 9 3
Holding St/,Hf Inlet /Z Q 9,K fX
TANK SETBACK INFORMATION St/alt Outlet 9J 3a~
Vent
TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air
Septic >sv a3 ya S ' NA Dt Bottom
Dosing NA Header/ Man. q' 6 S v
S v 95,(- y
Aeration NA Dist. Pipe 9 8z 45.3
q, 9,) 5.3 3
1 Bot. System /A/21 c4
Holding
9/./ od
PUMP/ SIPHON INFORMATION Final Grade 95 ~9 d3
Manufacturer Demand
Model Number GPM
I Loss Friction System TDH Ft
FTD7HLift
mead
n Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length ^ , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS a DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Mode Number:
System: =A _!0 `TO ` 3 OR UNIT
DISTRIBUTION SYSTEM
Header/manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over a .l « xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center' Bed /Trench Edges o Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons resent, etc.)
LOCATION: STANTON 11.31.17.151C,SW,NE,LOT 1,CO. RD. T
GL.~.I~ ar. • I 7 ~ /
J's
~.5
Plan revision required. ❑ Yes ❑ No -
r~
Use other side for additional information.
SBD-6710(R 05/91) 1i0 Date Inspe or'sSignature Cert. No.
42
ADDITIONAL COMMENTS AND SKETCH
z
SANITARY PERMIT NUMBER: "
Safety and Buildings Division
~~■~Priii 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. /'01
• See reverse side for instructions for completing this application State Sanitary Permit Number
a ~83a.1
The information you provide may be used by other government agency programs ❑ Check it 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 Property Location
` 1/4 1/4, S T , N, R E (010
Property Owner's Mailing Address Lot Number Block Number
f t0
City, State Zip Code Phone Number Subdivision Name or CSM Number 7
r Gv 40 (eT)iy?-3t1 s- 1jAf ;F
?
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ~ E] ToVillae
wn OF p
411. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 0.96
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. ga 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 ❑ 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. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
SO Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
. r Feet * Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel lass Plastic ANew Existin strutted g pp
Tanks Tanks
Septic Tank or Holding Tank 0 s ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ I El
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: o Stamps) P PRSW No.: Business Phone Number:
f -
0Z 0-
Plumber's Address (Street, City, State, Zip Code):
s , j-
IX. C UNTY / DEPARTMENT USE ONLY
El Disapproved Sa tary Permit a (Includes Groundwater ate ssue suing A nt Signat a (No St ps)
Approved E] Owner Given initial 4- jSurcharge fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS *4
10
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, pu rp/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 wi':h appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
1X. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 11:2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or %vith complete dimension,,, locatic r•, of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water sere-ice, stn.ms ar d 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 purr,ps an( controls; dose volume,-
elevation differences, friction loss; pump performance curve; pump model and ;)urnp rranu la(,urer, D) cross section
of the soil absorption system if required by the county; E) soil test data on a 1 15 `orm; and F) a~l sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of fegilated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
i
I
i
Gil
e~
14
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page i of 3
Labcr.and Human Relations
Division of Safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY
'Attach complete site plan on paper not less than 81/2 x hes in size. Plan must include, but St. Croix
64,40
not limited to vertical and horizontal reference po i d % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and d' a 036-1023-45-
REVIEWED BY DATE
APPLICANT INFORMATION-PLEAS T ALJ,, R
PROPERTY OWNER: ~OVT. ROPERTY LOCATION
Mike Frank r-N LOT SW 1/4 NE 1/4,S 11 T 31 N,R 17 ME (or) W
PROPERTY OWNER':S MAILING ADDRESS /LOT # BLOCK # SUED. NAME OR CSM #
1510 220th. Ave. na na csm vo -
CITY, STATE zip CO PH KC'E' ❑CITY ❑VILLAGE MOWN NEAREST ROAD
New Richmond. 54017 2 1 48- Stanton Co. Rd. #T
New Construction Use [ Residential / Nurh of dedroorfi's 3 [ ] Addition to existing building
[ ] Replacement [ J Public or commercial describe
Code derived daily flow 450 and
Recommended design loading rate .5 bed, gpd/ft2 .6 trench; gpdtft2
Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2_. 8 _trench, gpd/ft2
Recommended infiltration surface elevation(s) 93.80 It (as referred to site plan benchmark)
Additional design/ site considerations pj,oP el. a 95.67. extra rock will ht- rE=ui ri-d in ahcnr= t i nn a rc-a
Parent material pitted outwash -plain 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 MS ❑ U as ❑ U I@CS ❑ U ADS ❑ U ❑ S x~l U ❑ S E3d.l
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. Bed Trench
1 t 1 0-7 10 r3/2 none 1 2m r mfr Cfw 2m .5 .6
°i#t<A 2 7-15 10yr4/2 none sil lfpl mfr gw if np .3
Ground 3 15-31 10yr4/4 none sicl lfgr mfr gw if .2 .3
elev.
98.97 ft. 4 31-38 7.5yr4/6 none Scl 2msbk mfr gw na .4 .5
Depth to 5 38-62 10yr3/4 none cob. sc Osg mvfr gw na .2 .3
limiting
factor 6 62-75 10yr5/6 none cob. S Osg mvfr gw na .7 .8
+106"
7 75-10 10yr4/6 none S Osg mvfr na na .7 .8
Remarks:
Boring #
1 0-8 10 r3 2 one 1 2m r mfr 2m .5 .6
2 2 8-15 10yr4/2 none sil 2msbk mfr gw lm .5 .6
3 15-26 10yr4/4 none sicl lfsbk mfr 9w if .2 `•..3
Ground
elev. 4 26-50 7.5Yr4/4 none scl 2msbk mfr gw if .4 1.5
99.07 ft. is
Depth to 5 50-57 10yr3/4 none cob.sc Osg mfr gw na .2 .3
limiting 6 57-10 10yr4/6 none ob. is Osg mvfr na na .7 .8
factor
+1001,
Remarks:
CST Name:-Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 200th. Ave., New Richmond, WI. 54017
Signature: 5 9 Date: CST Number:
5-20-94 cstm 2298
PROPERTY OWNER Mike Frank' SOIL DESCRIPTION REPORT Page 2 _,Of 3
PARCEL I.D. # 036-1023-45 i '
s
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench
3 « 1 0-7 10 r3 2 none 1 2m r mfr crw 2m .5 .6
2 7-14 10yr4/2 none sil lfpl mfr 9w if np {.3
Ground 3 14-27 10yr4/4 none sicl lfgr mfr 9w if .2 ~.3
99e1T7 ft. 4 27-56 10yr4/6 none coblsc Osg mfr gw na .2 .3
Depth to 5 56-10 10yr4/4 none cob. 1 Osg mvfr na na .7 .8
limiting
factor
+100"
Remarks:
Boring #
`1 0-9 10yr3/2 none 1 2m r mfr 2m .5 .6
4 2 9-16 10yr4/4 none sil lfpl mfr gw lm .5 .6
3 16-27 10yr4/4 none sicl lfgr mfr gw if .2 .3
Ground
elev. 4 27-33 7.5yr4/4 none scl 2msbk mfr 9w na .4 .5
99.07 ft.
5 33-57 10yr3/4 none cob.ls Osg mfr gw na .7 .8
Depth to
limiting 6 57-10 10yr4/4 none cob. 1 Osg mvfr na na .7 .8
factor
+100"
Remarks:
Boring #
1 0-8 10 r3/2 none 1 2msbk mfr lm .5 .6
2 8-15 10yr4/2 none sil 2msbk mfr gw if .5 ~.6
K 3 15-24 10yr4/4 none sicl 2msbk mfr gw if .2 .3
Ground
elev. 4 24-34 7.5yr4/4 none scl 2msbk mfr na .4 .5
99.07 ft.
Depth to 5 34-10 10 r3/4 none cob. fl Os mvfr na na .5 .6
limiting
factor
+100"
Remarks:
Boring #
Ground
elev.
ft. ~
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Mike Frank 1554 200th Ave.
CSTM2298 SW4NE4 S11-T31N-R17W New Richmond, WI 54017
MPRSW 3254 town of Stanton (715) 246-6200
1
N
1"=40'
BM= top of 1" steel pipe w/marker at el. 100'
alt. BM= top of SW lot stake at el. 100.07
N )U 9 )wZ 9 r
4 r71 ro
138 r , I
X31
8.3
rv)
Gary L. Steel
5-20-94
F 0 L
JUN 21988• Ov
JAL' `6 ww VELL
G Rezister of Deeds
4379' St Crcix Co" WI
NI/4 CORNER
SEC.I1-31-17
POC _CERTIFIED SURV in part of the SouthwesUol • ar erQOf the
~.L 2-N• LINE OF SW 1/4 OF THE NEI/4 -NOrthe"as.t Quarter of Section 11, Township 31
rn ttt OF~„ SSE ~ 11, T.31 N., R. 17 W. y a _ _.N88°4*ikk 289.62-- North., Range 17 West, Town of Stanton,
POINT OF -R St. Croix County, Wisconsin.
BEGINNING 50.01' I(k 239.61'
N/S 1/4 4..1
LINE O 0
00 LEGEND
O .b 3
50' I 1- PUBLIC LAND CORNER tli •r-i
„ N OF RECORD, A FOUND U r1 . -I
COUNTY MONUMENT. ~i
:O = II/4" BY 24" IRON PIPE N
W WEIGHING 2.27 LBS./LIN. H ~ z Ln
r N FT., SET. i4 ri ~
NI 1 a . N O z I" BY 24" IRON PIPE M °
. CD
Z I to WEIGHING 1.13 LBS./LIN. M +J E-
41 l a L 1 FT. , SET.
wZ
J M
164,264 SQ. FT = 3.77 ACRES N ~-R FENCE LINE. N~ bNOC~ r1 'd
m F"' INCLUDING C.T.H.."T" RIGHT-OF-WAY zi '
w c 3
NORTH ~ 4-1 v ~
F ~0 14k213 SO. FT.= 3.24 ACRES 588054'57"E 159.90 0l Z U)
JI 3 o EXCLUDING C.T.H."T" RIGHT-OF-WAY FI
zI _ ° >tf -X1
-.1
w I z i~ Z~ SCALE: I"= 100'
C"
°
0 00 - O 50' 100' 15d
N Z 50' I OWNER:
ID John J. Dupuis
I 0RIVE "WAY ° 3259 Churchill St.
N Shoreview, MN 55126
422.56'
50.06' I
472.62'-
_ I - - S 86° 560'09"W LANDS _
UNPLATTED_ _
SURVEYOR'S CERTIFICATE:
1 I, Ronald F. Johnson, a Registered Wisconsin Land Surveyor, do hereby
M I certify that I have surveyed and mapped a parcel of land located in
M the Southwest Quarter of the Northeast Quarter of Section 11, Township
SI/4 CORNER 1 31 North, Range 17 West, Town of Stanton, St. Croix County, Wisconsin
SEC.11-31-17 described as follows : Commencing at the North Quarter Corner of said
Section 11; thence, on an assumed bearing and referenced to the north/south
Quarter line of said Section, along the said north/south quarter line
S00110156"E a distance of 1397.73 feet to the point of beginning of the parcel to be
described; thence N88°45'26"E a distance of 289.62 feet; thence S01°52'29"E a distance
of 270.81 feet; thence S88°54'57"E a distance of 159.90 feet; thence S05°06'41"E a
distance of 169.83 feet; thence S86°56'09"W a distance of 472.62 feet to said north/
south quarter line; thence, along said quarter line, N00°10'5611W a distance of 461.83
feet to the point of beginning. Containing 164,264 square feet (3.77 acres) more or less
Subject to County Trunk Highway "T" along the west 50.00 feet of the above
described parcel. Also being subject to all easements, restrictions and covenants of
record.
I further certify that I have complied with the provisions of Chapter 236.34 of the
Wisconsin State Statutes and the subdivision regulations of the Town of Stanton and
St. Croix County in surveying and mapping the same.
Z 19®8
Date y 14, 3 /9BB R ald F. o son R.L.S. No. 1186
It C; 0 Ron Johnson Land Surveying
P. 0. Box 194
Amery, WI 54001 Tele. (715) 268-2601
RONALD F. e
JOHNSON APPROIlD
A.A'i£i7Y, i
Wis. JUN 02 W
Vol. 7 Pg, 1975 ST. CROCK
.,k4® SUR ~71J(~ANGWN .
This instrument was drafted b R.F.J.
t^ .
.
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER A„ L- k
W 89Yh9r4
MAILING ADDRESS K/0 ,2 Th yve l1 ~ /3JL ti rnGh~ !-~i S
PROPERTY ADDRESS aZ o~ (D S boo h f ii l ia~ T
(location of septic system) Please obtain from, the Planning Dept.
CITY/STATE Deck- 1044 GIJi S. J N O0 7
PROPERTY LOCATION _ 1/4, JVE 1/4, Section T__2/_N-R_j 7 W
TOWN OF S7'5ii Kati ST. CROI K COUNTY, WI
SUBDIVISION twp,~ (S m LOT NUMBER
CERTIFIEDSURVEY MAP y3 7y , VOLUME _7 PAGE ~s 7-5,-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 expiration date.
i
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - loo
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 -MCA4el 6e(rb4r4 L ryhk
Location of propertyylell 1/4 lVe' 1/4, Section ~l ,T N-R_)7 _W
Township 2?7ja 6>n Mailing address 111e) Nc- i4,. c ~o GU,'s . SAG/ 7
Address of site x265 %
Subdivision name 0- 5m ~ S7 Lot no.
Other homes on property? Yes No
Previous owner of property 4ed-- .'r
Total size of property 77
Total size of parcel 77
Date parcel was created Jvhe
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes 4Z No
Volume 7 and Page Number //r7S 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.
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. T)99 7 3 , 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.
57W73
S gnature of Applicant Co-Applicant
Dat of Sxgnar.e Date of Signature
i
DOCUMENT NO. WARRANTY DEED R-
STATE BAR OP WISCONSEN FORS{ 2-1982
REGISTER'S OFRCE
John J. Dupuis and Marilyn I. Dupuis, his wife ST CR= CCLO fted ox how-4,
JUL 11, 994
- ~ ' 8:30 A.
conveys arid warrants to 14sichael--ft. Frank and Barbara -L.
Frank,. :husband-.aAcl dire,_ as. survivorship..Mari-tal d
prpperty - -
-
. . . - R'E'TURN Tp
- . . .
- - -
she iollcwing described real estate in ...County,
State of Wisconsin:
Tax Parcel No: 036-1023-45
ti
f
Part of Southwest Quarter of Northeast Quarter (SW 1/4 NE 1/4) des-
cribed as follows: Lot 1 of Certified Survey Map filed June 2, 1988
in Volume "7", page 1975.
=s
t '33 OD
F~
This iS not homestead property.
(is) (is not.)
Exception to warranties: Subject to municipal and zoning ordinances and
recorded easements and restrictions of record, if any.
94
ly _ '19.
-
Dated this _ - day of ;ohn
.--....(SEAL) yyc~f _ Icr AL)
- - Dupuis
-
-
- - - - - (SEAL) (SEAL)
;
7~ ~/G~ /AGO
y ._Harilyn_I_. Dupuis
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
SS.
POLK
County.
authenticated this day of 19 Personally came before me this day of
Ju.1y - 19.9'4.- the above named
John---J-v---Dupuis--.and -1!Iarilyn--I'
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
- - - -
authorized by § 706.06, Wis. Stats.) m own to be the pe• who executed the
instram a no er ~e the same.
C
THIS INSTRUMENT WAS DRAFTED BY
a Daniel H. Byrnes of CWAYNA s
s~ uya
- -
P-._ 0---Box 1.79,. _Ameryi _WI- ubllc PQ County, Wis.
(Signatures may be authenticated or acknowl$dy7e (Pnmission is pern:anent.(If not, state e:: ;ration
are not necessary.)
- - - -
-Names of persons signing in a-7ny capacity should be typed or printed below- th r Ign.tur-
WARRANTY DEED STATE. BAR OF W ISCOKSIN Wisconsin Legal Blank Co, Inc
Milwaukee. Wisconsin
FORM No. 2 - I_+92