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Parcel 016-1045-95-000 04/28/2008 08:21
PAGE 10F 1
Alt. Parcel 20.30.15.331 B 016 - TOWN OF GLENWOOD
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 - MIANECKI, GIRARD J
GIRARD J MIANECKI
2884 CTY RD G
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2884 CTY RD G
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE
SEC 20 T30N R15W W 1/2 OF SE SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
20-30N-15W SE SE
Notes: Parcel History:
Date Doc # Vol/Page Type
03/23/1992 480799 941/32 WD
10/10/1991 474512 918/303 QC
07/27/1988 439856 817/562 LC
09/28/1987 396665 697/255 TI
2008 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 10/18/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 25,000 105,800 130,800 NO
AGRICULTURAL G4 9.000 1,500 0 1,500 NO
UNDEVELOPED G5 4.000 5,800 0 5,800 NO
AGRICULTURAL FOREST G5M 5.000 7,500 0 7,500 NO
Totals for 2008:
General Property 20.000 39,800 105,800 145,600
Woodland 0.000 0 0
Totals for 2007:
General Property 20.000 39,800 105,800 145,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 08/09/2007 Batch 07-11
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
~ i
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER_ A1~p/ A/
eey « RQi r
SUBDIVISION / CSM
SECTION_ 2C T 0 N-R16~-_W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
FF ~ j
,z
R/Opfi0x~ ~~GG
3
19"
O)v
INDICATE NORTH AF ROkti
Provide setback and elevation information on reverse of this f01-11'-
Provide 2 dimensions to center of septic tank manhole cover.
r BENCHMARK:
ALTERNATE BM:Li
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
~j3 Ma nufacturer: /c=/~ Liquid Capacity: 472~~~ Setback from: Well /fl!~ House Other
L
Pump: Manufacturer yd,?eM,fJ`iL_ Model# S'~tr~2h Size
T
Float seperation_ / Gallons/cycle:
Alarm Location lL-
SOIL ABSORPTION SYSTEM
Width: Length/ Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well:T House 7 Other
ELEVATIONS
Building Sewer I ^ ST Inlet. p ST outlet
PC inlet PC bottom Pump Off
Header/Manifold 1041, Bottom of system r
Existing Grade qd, Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: M /y 6 y~
INSPECTOR : '}y~,y✓~,-.ter
3/93: jt
Wisconsin Depatmenei 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.:
P%h1W1r kJa`me~IRARD ❑ City ❑ Village Town of: State Plan o.:
CST BM Elev.: 1L Insp. BM Elev.: BM Description: Parcel Tax o.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic
Benchmark 164113 / o
Dosing /a 31
Aeration Bldg. Sewer
Holding St/ Ht Inlet -2, 6 7G
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet
Air l
Septic rs 0 NA Dt Bottom 11,5-17 q
Dosing ✓ ✓ NA Header/ Man.
Aeration NA Dist. Pipe a, 1 /oo,
Holding Bot. System 2,6 gC1,Z '
PUMP/ SIPHON INFORMATION Final Grade /v
Manufacturer Demand 16 f a 3
Model Number GPM ~/J6~11_ S3, $
TDH Lift Friction on System TDH Ft 0/ S~ l Head Forcemain Length ~ 0 " Dia. ~ Dist. To Well w"~,c})
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS q( ' DIMENSIONS
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION TypeO q, + CHAMBER Moe Number:
lucl~ OR UNIT
System: -7 4
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pie(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing . ~ ,Y#
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 Bed /Trench Edges Topsoil ❑ Yes ❑ No Q Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
All~
LOCATION: GLEN//WOOD 20.30.15.331B,SE,SE,CO,. RD. G
r
jiq
6.v~ nevi
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. I F
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
f L
ADDITIONAL COMMENTS AND SKETCH tz
SANITARY PERMIT NUMBER:
rvis ' v 'd- y^..~ _ _ _ _
~~q>1
DIL• HF~ SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ca)90 I-
8% x 11 inches in size. Check If revision to 7revious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBBEE~R
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. ~7
PROPERTY OWNER PROPERTY LOCATION O« G
rs 4 Rol M 7q e C f' S: F %7a '7a, S L~ T.--?,0 , N, R OW) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
J
CITY, STATE ZIP CODE TpHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
11Ne. Lv i ' a _ i 6` . -1-4`73
II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD
nn ) ❑ State Owned VILLAGE G1eyl~ve d C ® o~ ~
❑ Public 10 1 or 2 Fam. Dwelling-# of bedrooms ~ AR EL AX QF: NUM ER( )
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ ApVCondo d
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 80 Mobile Home Park 120 Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 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 9 Mound 300 Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ 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
-5--6) I / e i, ~2_ 99 y3 Feet 10a4AK Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New kiting Gallons Tanks Manufacturer's Name oncrete structed Con- Steel glass Plastic App
Tanks Tanks
Septic Tank or Holdin Tank - 5 R
Lift Pump Tank/Si hon Chamber Ale, 7 G L'*
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/F3iifiWNo.: Business Phone Number:
M7I~~ s' ids =
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY/DEPARTM T USE ONLY
❑ Disapproved Sa Try Permit Fee (Includes Groundwater ra;e sueIssuing Agen o Stam
Approved OwnerGiven Initial agv ~ Surcharge Fee)
-9 y
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS " - = x
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 (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.' years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator 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 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; (lose 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, ground-
water contamination investigations and establishment of standards.
SB" (R.11/88)
1F ? ~ yy~^i t, ki D9~'$ +
'Gl Aq~ ~e <§~h~ arr. y h r
t -
Hoy, Or
Straw, Marsh
Synthetic Covering
Distribution Pipe
Medium Sand
G
Topsoil = - F
E
-J + ~
3
% Slope
Bed Of 2- 2 (Force Main Plowed
Aggregate From Pump Loyer
D /1. i
E i
Cross Section Of A Mound System Using F
A Bed For The Absorption Area
G ~O_
A Ft. I{ ~!J~--~
Signed: Ft.
License Number:
Date: ^.Z
L1t
60 Red MA
It io xa a
- \ K -
r EPA. of FS, AND DUy~D~cit:s
G D1VtSODN F SA
REiE~+irS 1%Fear'
Disiribution Bed Of
+ b >1 +pe ,ers
i
* 9. P
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b n9"
J~`v+Yaf~'~ ~ ~~Muwsl+r«~.
Page it?_ Of4
Perforated Pipe Detail
~0
End View
ErC Cap t VC pe
75l ~o< or,
Noses Located On Bottom.
Are Equally SpoceC
i~
i
{
t.ert T0.-^,
Ft.
z x-
7 Inches
i ;ned: pp Wile Diareter ~ Inch
Lateral Inc
License Nu-111wr: Manifold Inches
Date: /Ior-„~~~ ` force Main Inche
of holes/pipe ,2 L
u~ gI%vdr [le~vation of Laterals~O4 3Ft.
~ E1l4iLi}iRii.,z
p4U
Uf is>Bi4~'saiY,
t1tuE5i'~~1 Oi` SR~E~Y
0NWESC
S94 a 1189
-116-
PAGE OF
. PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS '
VEIJT CAP '
`"C.I. VENT PIPE APPROVED LOCKING
WEATHER PROOF
JUUCTIOAI BOX MANHOLE COVER
~ 25' FROM DOOR,
`s',NDOW OR FRESH 12"MID. '
AIR 11JTAKE
GRADE
`I" MIN.
COIJDUIT ` _
\
4,? PROVIDE I
1JLET
AIRTIGHT SEAL I III
I III
aFPROVED JOINT A APPRDVED I'
I
C.I. PIPE ( III w/C.I. PIPE
E (TENDIIJG 3' I I I ALARM EXTENDIUG
CI~TO SOLID SOIL I I1 ONTO SOLID A
B I I
I I o N
c I 1
I '
ELEV. ~FT. fl1MP
OFF
Ar.t, ~
D
3 N4/l~e4
RISER EXIT PERMITTED GIJLy IF TANK MAIJUFACTURER HAS SUCH APPROVAL.
0~_60o CoM6o
SEPTIC 5PECIFICAT10KJS
E
DOSE
TAIJKS MANUFACTURER: ~ri~ C'S ems? IJUMBER OF DOSES: -PER DA.y
TANK ;,IZE: AV04- I" GALLONS DOSE VOLUME Q
ALARM_ MANUFACTURER:.SS.7"L-LeG7`fe0 INCLUDING BACKFLOW: GALLOI S
MODEL WUM6CR: laI H W CAPACITIES: A=_;2- 7 LIMCNESORGALLOti
SWITCH TYPE: M'eR a 4 A? B= IMC14ES OR ~ 6ALLOf_'S
PUMP MANUFACTURER: 0o a Md Lie, C =1 IAICHES OR fps GALLOI.: S
MODEL IJUMBEK' 's,t!/ 2, D= 6 INCHES OR _ GALLOVIS
SWITCH TYPE: -sT164ectda MOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE GPM INSTALLED ON.r~AnnEPARATE CIRCUITS
VERTICAL DIFFEREUCE BETWEEN PUMP OFF AUD DISTRIBUTION'PIPE.. FEET rNM p 7wf~Nf~
+ MJUIMUM METWORK SUPPLY PRESSURE F.LCT
+ -FEET- OF FORCE MAIN X L'J~.FYoortFRICTIOU FI06R.._iA4 FEET..
s TOTAL MIUAMiG HEAD rT FEET S94-,911 89
IAITERAIAL. DIME.0610NS OF TANK: LENGTH 38 ;WIDTH -;LIQUID OEPTH
SIGNED: ~7b LICENSE DUMBER: S69o DATE: ~0 ~~9~
4419 x
-all * VIA Y , E DS ~ WERE
4kAND 3'HP 4ANDI/3HP
~650`RPM 1550 RPM
PRODUCT
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FEATURES • For sump and effluent use • For sump and effluent Use
• Automatic models available with • Automatic models available with
wide-angle piggyback float switch. diaphragm piggyback'-type switch
Also available in manual • 1 /4 HP (SD25) or 1 /3 HP (SD33),
` • 1 /4 HP (SW25) or 1 /3 HP (SW33), heavy-duty, 115V oil-filled motor
heavy-duty, 115V oil-filled motor with thermal overload protection
with thermal overload protection • Rugged cast iron construction
• Rugged cast iron construction • Non-clog vortex thermoplastic
• Non-clog vortex thermoplastic impeller
impeller • Long life lower ball bearing
• Long life lower ball bearing Sintered top sleeve bearing
Sintered top sleeve bearing • Carbon and ceramic mechanical
• Carbon/ceramic mech. shaftseal sh eal
• 1-1 /2" NPT discharge • PT discharge
• la rd 420 er rd.:(20'
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SOIL AND SITE EVALUATI REPORT Page_[_ of 3
ON
(~l I~HR in accord with ILHR 83.05, Wis. Adm. Code COUNTY
oaamvaa.
WILR/.I/g116 HlAMllHAIQS
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but G w
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. -
REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
PROPERTY OWNER: PROPERTY LOCATION
C If A D GOVT. LOT SE 1 /4 SF 1/4,S p T p ,N,R 1_5- W
PROPERTY NER.'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
CI ATE ZIP CODEf PHONE NUMBER []CITY []VILLAGE RFOWN NEAREST ROAD
New Construction Use I ] Residential I Number of bedrooms [ ] Addition to existing building
] Replacement [ ] Public or commercial describe
Code derived daily flow 4JV gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2
Absorption area required bed, ft2 -7 Z6' trench, ft2 Maximum design loading rate A--bed, gpd/ft2-trench, gpd/42
Recommended infiltration surface elevation(s) 8. !7- 1 ft (as referred to site plan benchmark)
Additional design / site considerations M 0 4 llvd e 'Z " ~ S A Mod iLL
Parent material GL A C /CFA ood plain elevation, if applicable ft
S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U =Unsuitable fors stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed' Tmrtct
S/L 6 M w 6
Ground 7zr C2S
elev.
q6 a- ft.
Depth to
limiting
fact
Remark s:ee W_Ro6s eS /-2 a// A . %N
Boring # ,L s6 f C Gri 6
0 -10 /D 3 2
/-0-10 z5yla 411d, Sd A,
cad ~~s ~ ~M I-! - -
L 3
Ground
elev.
Depth to
limiting
factor
Remarks: ge IV 9 oaIr S ~ /A 01/. %N 1211
CST Name:-Please Print C-1-kol e- It/ S- ~ Phone:
Address: # w 17k G e w 00 0~ G~ 2/c L•/
O/ .3 -7- f Signature: CST Number:
PROPEIW WNER. SOIL DESCRIPTION REPORT Page? of 3
PARCEL1.D.tr
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
Am't' ,2 y 6 s L ash
y "e Ground % a r 1 d ~rs►rvdS C .Z <l,b C
ele
~fjla . it.
Depth to
limiting
fact „
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Remarks: rc°lri f3o d /('S 6 ^~o? ~c~!%~ i!y' -Z V-.,:? /i dA? Zo ti
Boring #
i
I
it
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
if Al C-' G A~
OWNER/BUYER e5;7/ f1 If 11 144
MAILING ADDRESS % /~2 z d > L~ • 6 3
PROPERTY ADDRESS Cr
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE C9, ~ e--IV Uy~~U °l f1~ Ly / L/G/3
PROPERTY LOCATION .S,5: 1/4, ✓ 1/4, Section , T __70 N-R__1_5__ W
TOWN OF (f =jeiv (,i0a ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
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 year expiration date.
SIGNED: L
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.
Owner of property ~1 / R fE R~ /~1 /A N &C
Location of property_5~5 l/4 SZ--~ 1/4, Section ~20 IT-,?O N-R W
Township 6~e Nzoned Mailing address
Address of site
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property
67
Total size of property O Gz~~
Total size of parcel ;2- c> Czc~t~
Date parcel
was created
3 .2
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes No
Volume 110.1q7 and Page Number f-~= 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. L and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an
easement,
to run the above described ProPertY, for the
construction of said system, and the same has been duly recorded in
the office
of the County Register of Deeds as Document No.
12-2
Signature of Applicant
Co-Applicant
q
Date of Signature Date of Sianatur.e
~ 3
'
":V.
• DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
• ~
STATE BAR OF WISCONSIN FORM 2-1982
ST. C
Kraig K. Konder and Maureen Konder, husbandX(*atVA
~Er ~.'!f Racor+Q ,
and wife -
-
OCT 91994
i ,
!i i
i
A.
O 10:30M
i ii a
conveys and warrants to G.........ra. ...rd . J. Mi...•-------•--anecki
-
a 4
'I RETURN TO
I
.
the following described real estate in St.-.Craix ...............County, -
State of Wisconsin: ~
Tax Parcel No:
West Half of Southeast Quarter of Southeast Quarter ji
(Wh of SEh of SEh), of Section Twenty (20), Township Thirty
(30) North, Range Fifteen (15) West.
Ij
FEE
i
'I
This is---not homestead ro ert
- P P Y• r
lSf4Q (is not)
Exception to warranties: Easements and restrictions of record.
it
18th
Dated this October 94
- - . day of . . . _ _ 19.
- ......(SEAL) . - (SEAL)
i
it Kraig Konder
- -
yr i -(SEAL) J .LW.U_-..(SEAL) +I,
Mau en Konder
AUTHENTICATION ACKNOWLEDGMENT i a
Si atere(s) STATE OF WISCONSIN
sa.
.,z .
St. Croix.... County.
day of
- ,
authenticated this day of 19...... Personally came before me this 18th
October-------------------- 19.94.. the above named
r-.and-_ Maureen-..-•__--.--_
4 . Konder-, -Husband Wife
TITLE: MEMBER STATE BAR OF WISCONSIN _
(If not,
authorized by 1 706 06, Wis Stats) d A '
to me known to be the persolr.j.. _ w1SoJex ted the
nstrument and kite , hdg the sail'~pp~+`
for n
THIS INSTRUMENT WAS DRAFTED BY
' Thomas A. McCormack
ane Terkelsen
Baldwin, WI 54002 ' ~.S,rbiJ
• • No ry ublic Sti )r Oix Colfnty, Wis.
(Signatures maybe authenticated or acknowledged. Both 14IY mmission is perman T~(If ~Ptt,;tatr;expiration
are not necessary.) - Ma
~;19.g5....)
date: if -
- ~t
•Nams or persona siraing in any capacity should be typed or printed below their signatures.
WARRA_VTT DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
FORM No. 2- :J82 Milwaukee. Wisconsin
I
. S ~
FRIENDSHIP HOMES
z. OF MINNESOTA, INC.
P.O. BOX 91 ERN CLASSIC
MONTEVIDEO, MINNESOTA 56265 WES PHONE so-nIg
W~H CLOSET ij, CURIOS I i 1
1 II , I KITCHEN I ui BEDROOM
UTIUTY OOPT ; I 11' 9" 1 9'-O" D p O 2" so,'-g" 10'-,10'
p=2"118'_0' I oTN ,
OWING ROOM I $T0. OATH.. STO. CATH
W , O 1
`!3` 71F I
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_ 1 I I ESTON
1.., STa tATH.I I , STD.'CATH.
ti 1 1 1 I I 1 I I 1 ODEL NO. 5228 I I
N 2ndGEOROON I I LIVING ROOM ~`D."aH; DER NO. 26,006
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FALLS HOURS
P.O. Box 219
St. Croix Falls, W1 54024
1
OPT'Cuw W,H (715) 483-3238.1-800-221-805
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NOTE: FORMODELDIMENSIONS, OURSTANDARDSANDSTANDARDSOFTHE INDUSTRYGENERALLYINCLUDEAFFOOTALLOWANCE FOR HITCH LENGTHANDALLOWANCE FOROTHERAPPURTENANCES FORWIDTHAND FOR LENGTH NORMALLY 4/94
INCLUDED IN MEASUREMENTS FOR HIGHWAY MOVEMENT. REAR BEDROOM DIMENSIONS INCLUDE SAY; UNLESS BAY IS OPTIONAL ON PARTICULAR UNIT OR IS OMITTED BY SPECIAL ORDER. DESIGNS. SPECIFICATIONS,
AND PRICES SUBJECT
TO CHANGE WITHOUT NOTICE. SOME OPTIONAL ITEMS SHOWN. SOME TIRES, WHEELS, BRAKES, AND AXLES ARE REUSED AFTER CAREFUL INSPECTION.
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