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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER CSury /l~~l~~
ADDRESS _ ~ f~
SUBDIVISION/ ''CSM# LOT #
00, /X
SECTION _ T-~LN-R r D W, bf J/a r°~~~i^~ C
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
t I ~Jy~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:
SEPT C T
K / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: /
Liquid Capacity:_
Setback from: Well p1i/`//House U / Other
Pump: Manufacturer
Model# Size
Float seperation
Gallons/cycle:
Alarm Location
:SOIL ABSORPTION SYSTEM
1
Width: Length
Number of trenches l
Distance & Direction to nearest prop, line: 01 Setback from: well: 6~&Lt//ouse
Other
ELEVATIONS
Building Sewer~~- _
C
ST Inlet : ,,:-5; ST outlet
~.S S s--
PC inlet PC bottom
Pump Off
Header/Manifold Bottom of system 7
Existing Grade /
Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: -'7
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Laboraid umanRela INSPECTION REPORT ST. CROIX
Safety and~uildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village C1 Town of: State Plan ID No.:
NELSON, GARY R
CST BM Elev.: IBM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark ~ / I&A
Dosing U•, 1.76
~ r- i
Aeration Bldg. Sewer d, a/ 96, A)~
HoldingSt/ Inlet /
TANK SETBACK INFORMATION St/)K Outlet (a, 9~ t 46~
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Septic > 37 ' 4 NA Dt Bottom
Dosing NA Header(,- 5~
Aeration A Dist. Pipe P
D'
Holding' Bot. System e, 7f 3 7
PUMP/ SIPHON INFORMATION Final Grade
Ma facturer Demand 4,a
Model Number Gp -&p00s, T
L'~ea.c (Z' 7 D SOS 162, A2
TDH Lift Friction System TDH Ft
F main Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION SS
SYSTEM TO P/ L BLDG WELL LAKE 1 STREAM LEAC_ anu acturer:
SETBACK
INFORMATION SypeeO ntw CanU ti i CHAMBER Moe Nu
System: OR UNIT ,
DISTRIBUTION SYSTEM 36'&
Header/ Manifold Distribution Pipe(s) j x Hole Size x Hole Spacin en Air Intake
Length Dia. Length Sa Dia. JL Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S s ms
Depth Over „ Depth Over xx Depth Of Seeded / Sodded xx Mulched
Bed / T*Qfmh
Center - tU Bed / Edges ~ ~6 Topsoil - ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Star Prairie.1.31.18W, Lot 1
r
Plan revision required? ❑ Yes No
Use other side for additional information. 902/
S[A 0// 1
BD-6710 (R 05/91) Date Inspector's Signatu a Cert. No.
I
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
I
I
Safety and Buildings Division
r.~■~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, Wl 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County ;x
than 8 1/2 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary PermitJ~t er
The information you provide may be used by other government agency programs ❑ Check if re'`vviisiiioojvonn/ to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Na a Property Location
a 01/4,5 l T3/ ,N,R/
eE ( r)
Property Owner's Mailing Addre / Lot Number Block Number
, o ,S~
City, State d Phone Number Subdivision Name or CSM Number
II. TYPE BUILDING: (check one) ❑ State Owned ❑ it~ Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ilage F
III. BUILDI G U : (If building type is public, check all that apply) Parcel Tax Number(s)
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/ 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.~ew 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
1>Tg~eepage 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
Requ d sq. ft.) Proposed (q. ft.) (Gals/day/sq. ft.) (Min./inch) q~vati n
Feet Feet
VII Capacity Site
. TANK in gallons Total # of Prefab. Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New ExlStin structed
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
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) Plum bd'rs gnature: (NmSta s ) MP/MPRSW No.: Business Phone Number: e-A
92~ a
Plumber's Address (Street, C Stat , Zip Code):
IX. COUNTY/ DEPARTMENT USE 'ONLY
❑ Disapproved Sa ry Permit Fee (Includes Groundwater ate Issued Issuing Agent Signat a (No Stamps)
,4Approved E] Owner Given Initial F Surcharge Fee) ~JO&I r
Adverse Determination ~~o
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) 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 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.
Vl. 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 county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number_of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
PLOT PLAN
PROJECT Gary Nelson ADDRESS 880 E. 6th St. New Richmond Wi 54017
SW 1/4 NE 1/4S 1 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
T 8/15/95 3
MFRS BYRON BIRD JR. 3318 DATE BEDROOM
CONVENTIONAL XXX IN-G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE. TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 BED SIZE 12'X 54'
BENCHMARK V.R.P. Base of White Stake Red Ribbon ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark
VENT SYSTEM ELEVATION 93.8
GRADE
TYPAR COVERING
1 T 3' 6, ®3,
i SEWER R K
12' Road 70'
180'
0
cv
30' B-5 40'
B-2 r
12' X 54' I I Vent CD
30' Rep A
Fe I 0,
I B-3
Pro 3 Bedroom 30 8%
' ( I Slope
Ouse
15' - -4
T 15' 30'
15'
B.M.
r
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page - of
'Labor and Human Relations
Division of Safety $ Buildings in accord with ILHR 83.05, Wis. Adm. Code
' COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but e/ o fIX
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
GOVT. LOT 1/4 el,114,S T jr/ N,R / D E (c(LV
PROPFRTY OWNER':/S MA 11 I ADDRE LOT # OCR # SUBD. NAME OR CSM # 7
CI TAT IP CODE PHONE NUM ER ❑CITY ILLAGE OWN NEAREST ROAD
07
X New Construction Use ~4 Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow~b'(V gpd Recommended design loading rate . -7 bed, gpd/ft2 - trench, gpd/ft2
~
Absorption area required 7`3 bed, ft2 5.,6 trench, ft2 Maximum design loading rate-,7--bed, gpd/ft2 trench, gpd/ft2
Recommended infiltration surface elevation( i 1P- It (as referred to site plan benchmark)
Additional design / site consideration
Parent material u Flood plain elevation, if applicable It
S = Suitable for system C VENTIONAL UND 4hLIGROUND PRESSURE ATGRADEo U SYSTEM ILL O S DING TANK
U = Unsuitable fors stem S El U El U S ❑ U ~U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound ry Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
ti RIl /4 3 z. s~ -s ►ti-- 5
.r:.........._ 1 - s x S
Ground X - A/ I
I
Depth to
limiting
L
Remarks: /
Boring # 0- ld 1 S ~M^- ✓ • J~
0~
S s i
Ground
Depth to
limiting
a
Remarks:
CST Name:-Please Print Cj_ Phone:
Address:
Signature: fj Date: ,9 CST mber:
1
PROPERTY OWNER ,Gt.Y SOIL DESCRIPTION REPORT Pageot
PARCEL I.D. # ,
Depth Dominant Color Mottles Texture Structure Consistence Bourry Roots GPDM
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
0-12 A .S
AA
Ground -
elev
Depth to
limiting
Remarks:
Boring #
Ground' gr ~ 7
ley.
Depth to
limiting
factor~
Remarks:
Boring #
NY-3/7- eo~
ti..:.
4w5 fo d s, ~s b K 5 .
Ground
ev
Depth to
limiting
Remarks:
Boring #
\v
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PROPERTY OWNER r-jo-rl SOIL DESCRIPTION REPORT Page_of.
PARCEL I.D. #
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerh
L-k }\4 -
:h•: Aa ,/D
Ground 1 0
elev
Depth to
limiting
3
y Remarks:
Boring #
J - A
IM,
:.v. r
c2
g/
Ground
ley.
A
Depth to
limiting
factor~
Remarks:
Boring # I
'2e`' 3a s, K 5`.
J14v- 71-4 0-,' 0,5 m W4 7
Ground
ALA.
Depth to
limiting
3 Remarks:
Boring #
Ground
elev.
ft
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
f
Soil Test Plot Plan
'project Name Gary Nelson Byron ' d Jr.
r
Address
CS #3479
Lot Subdivision Date 6/3/95
SW 1/4 NE 1/4S1 T 31 N/R18 W Township Village of Star Prairie
Boring O Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft.Base of White Stake Red Ribbon
System Elevation 93.8 * H R P Same as Benchmark
Road 70'
180'
0
c~
B-2 30' B-5 40' r
c~
30' Pri A Rep A
Garage 15' B-3 60'
8%
0 3 Bedroom 30' Slope
House
35' B- -4
0'
15'
B.M.
i
531685
CERTIFIED SURVEY MAP
Located in Part of the Southwest Quarter of the Northeast Quarter Section 1, Township 31 North,
Range 18 West, Village of Star Prairie, St. Croix County County, Wisconsin.
--lot..---NORTH 1/4 CORNER OF SEC. 1
Prepared for and at the request of
if rd
County Section Corner Monument Rlou0 Nelson
of Record Star Prairie, Wi 54026
3 • Set 1" x 24" Iron Pipe weighing
co $
Drafted by. James M. Brault
1.68 pounds per linear foot.
N
NOTE "A" THE AREA BETWEEN NORTH LINE OF LOT 1
r) N O Found Iron Pipe & FENCE IS AN AREA POSSESSED BY OTHERS. THE
ADJOINING LANDOWNER TO THE NORTH SHOULD BE
00 - x- Denotes Fence CONTACTED BEFORE REMOVING FENCE OR CONTACT
N AN ATTORNEY.
DENNIS & LINDA SK_IFSTAD
SOUTH LINE OF PARCEL DESCRIBED IN
1
VOL_ 578 PG _79 A DEED RECORDED IN VOL 578 PG. 19
w f- 66.00'
11 I I - S 87'50'57" E 324.26' -
N W W I I y'~ x--- x x- x
00 1 ' NORTH LINE OF TH
U W iv N 269.05-- x
0 N Gj 1 FENCE , SW 1/4 THE NE 14
o I I 7SEEX
NOTE "A"
i to 0 0 I I SATELITE DISH
W J Cf)N
33.00' -i K Nl
I~ V) W I V) 7 I co
N W; O r N LOT 1 IT N <I
A
WAL ARpERK TEST
to 3 N O
6
M N o l 0 64J2J ft. n I
0 Ln I w o f I Z 1.57 acres N <I
W I~ ~I
? O ~ I M 7orAL AREA Exaummo R.aw zI 15 56,661 ft.
I sq. O GRAPHIC SCALE
z
z
~ I~n1 j FENCE 1• JO acres N 0 50 100 150 200
--266.56'---
/ N 85'32'04 W IN FEET )
N w 324.87'
1 inch 100 ft.
z M '-I 33.00'
V 3 o BEARINGS ARE REFERENCED TO THE WEST LINE OF THE
o UNPLATTEO LANDS NE 1/4 OF SECTION 1 TOWNSHIP 31 N., RANGE 18 W.
1 th WHICH IS ASSUMED TO BEAR S 00'37'27W
11 ISOUTH 1/4 CORNER OF SEC. 1
:3
V,
SURVEYOR'S CERTIFICATE
I, Douglas J. Zahler, Registered Wisconsin Land Surveyor, hereby certify
that I have surveyed, divided and mapped a part of the Southwest Quarter of
the Northeast Quarter of Section 1, Township 31 North, Range 18 West, Village
of Star Prairie, St. Croix County, Wisconsin; described as follows:
Beginning at the North Quarter Corner of said Section 1; thence, on an NO). TH
assumed bearing along the west line of said Northeast Quarter, South 00
degrees 37 minutes 27 seconds West a distance of 1529.68 feet to the north
line of said Southwest Quarter of the Northeast Quarter, this also being
the point of beginning; thence, along last said north line, South 87 degrees
50 minutes 57 seconds East a distance of 324.26 feet; thence South 00 degrees
37 minutes 27 seconds West a distance of 217.34 feet; thence North 85 degrees OF W/,&
32 minutes 04 seconds West a distance of 324.87 feet to said west line of the
Northeast Quarter, thence, along last said west line, North 00 degrees 37
minutes 27 seconds East a distance of 204.22 feet to the point of beginning. DIRIUM J. N
Containing 68,323 square feet (1.57 acres). Subject to right-of-way for 5th ~AHIER
street along the westerly side of the above described parcel, and subject to S-2145
all other easements, restrictions and covenants of record. HUDSON, 71C
I also certify that this Certified Survey Map is a correct representation'!. WIS.
Q`
to scale of the exterior boundaries surveyed and described; that I have .'4D "tom
complied with the provisions of Chapter 236.34 of the Wisconsin Statutes
in surveying and mna ' Douglas ZhahlWrkerit~ No. 2145 ate
A & E Land Surveying Tele. (715) 246-4319
109 East 3rd Street, New Richmond WI 54017 cn ;c
A & E LAND SURVEYING 2
PHONE # (715) 246-4319 J(/t ~N 6 1995
109 EAST 3RD STREET W
NEW RICHMOND, WI 54017 St A
~ o
LVol. 10 Page 2966
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 15 0 o'
MAILING ADDRESS
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
r
CITY/STATE
PROPERTY LOCATION 114,,,~ 1/4, Section T_! ZN-R / -6 W
'T OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP VOLUME /l , PAGE,,M'_, 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.
SIGNED:
DATE: 15' R 57
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property r So
Location of property
1/41/4, Section T~~ N/-R W
Township f~ jai Mailing address in~rzyl
Address of site c-5 y 1-a 4 - ~Jl
Subdivision name CS /K a 9 ~O 6 Lot no.
Other homes on property? Yes_ No
Previous owner of property C/i•T-'-for of /V6kd--
Total size of property 1, S 7a-c*--cs
Total size of parcel
Date parcel was created 8- / 7 - p~
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes No
//3G
Volume and Page Number 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. , 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.
Signa e of Applicant Co-Applicant
s///s In-
Date of Signature Date of Signature
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2 - 1982
532658 V01.11361PAGE " u..,
0.2
.-Clif ord-Nelson--and__Eldora.-Nelson,. husband and wife Reed furEi~:~ar•-
AUG 7 199
,
1:15 PM
conveys and warrants to ..Gar Nelson __and Connie N_ elson
-
Y.... . _ . . 2------
husband_and.wif.e,..,as..survivorshiP ..marital..pr9perty
rTGR TO - RETURN TO
/01 OO
~~'~-a<.~-•'D• v
the following described real estate in S-t:-,.- Croix________________________County, -8$p ! (Otl~-
State of Wisconsin:
Sg01a
Tax Parcel No: ~I
Lot 1 according to Certified Survey Map, recorded July 26, 1995, in Volume j
10 CSM, page 2966, as Document No. 531685, located in the Southwest Quarter
of the Northeast Quarter of Section 1, Township 31 North, Range 18 West,
Village of Star Prairie, St. Croix County, Wisconsin.
~,•~LL: ~I
EXEI~'ii T'
I
i
i
I'
This ia.-nQt------ homestead property.
(is) (is not)
l
Exception to warranties: Subject to all easements, restrictions and covenants
of record. it
.
Dated this 1-7th day of August 19_95
- jJ a
42,4 14-"
11 (SEAL)~~:/ - - - (SEAL)
Clifford Nelson Eldora Nelson
- -
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(SEAL) (SEAL)
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AUTHENTICATION ACKNOWLEDGMENT
1
Signature(s) STATE STATE OF WISCONSIN
ss.
-----•••--•----------•-----•-----..County.
authenticated this day of 19...-_. Personally came before me this 1----- day of
Au$ust--------------------------- ls_ 95--- the above named
_.Q1 if f or'd..Nelson__ and__ Eldora--Nelson
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
authorized by § 706.06, Wis. Stats.)
to me known to be the person S who executed the ~
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
, .
REINSTRA & VAN DYK, S.C. ---------y ••4•-
,
Kni 71es Avenue t
New-- Richmond,•.Wl..5-01-7.-- Z
Notary Public'------------- ~ - •---County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commissi~i is' 'INtmanen~ f -.not, state expiration
are not necessary.) A V C '`-r
~ date v' 8 L1 - - - 19_g~-,)
-Names of persons signing in any capacity should be typed or printed below their signatures. OF NIISC~~
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.