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HomeMy WebLinkAbout030-2016-10-100 1 -a o a~ o ck~ M ti O fin~ m ~ I (D I ee ~ I 0 c ~ N ' O o 0 co ~ I > Z 3 I c L m O LL O = Q N V y M z N W E ~ = O z d ° m a°i H a ai I I c o z Z ~ c M co c N D Z H d 2. E ww N ` I N t O ~J O N N N N O N Q O O z m z N I n ~ I ~i `O ~a E C-4 (D a O L H N N o! c o a ° o zcn>° ~0 0 0 a~ N _ ►i a = q LO O O y N M U rn rn } (D 0) co N .ti' N pO pO N ° O N N 0_ O O O N a 0 m 0 N r 'p ~~p QI } (A (0 O 7 41 ai ~ O co N Iq r.+ O O 3 M C O C O o o F- Q "i to 0 a i C u d°° N O O O * t C 0 CL E Y = 'O N N N_ V O O N O C O N = 7 M co O h O M' T W .a0.. j ) ~ • O co (n J N O Z N ri' fn V a O a CL 1 4) rr`~1v o ~`v 3 o ~1 A U a 0 U) U i STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER t :-54-M rN l (,L Ee_ ADDRESS $o a Z 1-(J D S O W S y o i 6 SUBDIVISION / CSM# SO Ljq ,S8- LOT Cc~ FiP-E SECTION . - T 30 N-R /9 Q, Town of 57- TO S rzP µ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 10t--FEET OF SYSTEM i - 7- *44fN LOTL/NE. N .~LD[J Rll/F,Q ,e0.4 p _ Z V I S c,41F za WEL HODS E -,fly 50 7s i r fil F v loflRfl6E \ , ~ ~ e - (L I 4F _ / Otl.doINDICATE NORTH ARROt,' Provide setback and elevation information on reverse of this form- Provide 2 dimensions to center of septic tank manhole cover- _ i BENCHMARK: TOP Of jE4,,T Lo T /NE F1 _ (,`9f Z - /tee ' ALTERNATE BM: TOE o~ f/OrJSF fovkAAr/oN 3,3 Z _ (03,6 SEPTIC TANK / UMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~E /SEee Liquid Capacity: /ODO CAG, Setback from: Well 7s' House 3 S Other 37 ' To s~ ~oAP~V~iQof Nav.SE Pump: Manufacturer - Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: I $ Length y0 Number of trenches Distance & Direction to nearest prop. line: / Setback from: well: House ADS Other /Z)' 78 t(ct7# e47 /-//j/6 Hol E SAE s y 9e) = /d Z L ELEVATIONS , qq 0 Building Sewer ST Inlet. V. Z -~0~ SST outlet z- PC inlet PC bottom - Pump Off Header/Manifold =9$?ZBottom of system Existing Grade S-~ 9 D Final grade 5 • ~ _ (pl ,N Z DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor'add Hurr$n Relations INSPECTION REPORT ST. CROIX SafeV and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town of: State Plan o.: LEYS, JOHN & SAM MILLER St. joseph CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark )4,7 ioo , Dosing Aeration Bldg. Sewer LJ =Holding St/ Ht Inlet g,13 98, 5y TANK SETBACK INFORMATION St/ Ht Outlet qq q a 3 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 35' > S ` NA Dt Bottom Dosing NA Header/Man. 3,$ q79 a- Aeration NA Dist. Pipe • °/5 C17,77 Holding Bot. System c~(o, PUMP/ SIPHON INFORMATION Final Grade 99•~ 3 Manufacturer Demand 'ly I Id 1, 7, Model Number GPM TDH Lift friction System TDH Ft Forcemain Length Dia. k Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 8 '/0 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Number: System: yl CID /l S~' NJ,Q 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 a Depth Over u xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.36.30.19W, SW, SE, Lot 6, Willow River Road ~ 4 L I- 8Z Plan revision require l? ❑ Yes 2 No Use other side for additional information. 167 IQ % SBD-6710 (R 05/91) Date Ins d s Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUS STATE SA VMPEFIMIT# -Attach complete plans (to the county copy only) for the system, on paper not less than ~5 8% x 11 inches in size. ❑ 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 T k r% La. S SAM I LLF_~L_ 5W'/4SE'/4,S 3lP T30,N,R E(otCD PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK 2 y I A r e la 'rid ' I '''TT CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER SsD Y Z GI Z y- DG G 5 ~ow OF: ILLA GE NEAREST ROAD 11. TYPE OF BUILDING: (Check one) El State Owned 0 V E iv K o" ❑ Public W 1 or 2 Fam. Dwelling-# of bedrooms AR ELTAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 0 - /6 o- 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 80 Mobile Home Park 12 ❑ Service station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 1~ 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 Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 I~ Seepage Bed 21 ❑ Mound 30 ❑ 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 SQ & y 7 © z p . T / 7i 07 Feet Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank OAU / L(J S E~--1:1 Ll Lift Pump Tank/Si hon Chamber F1 Fj VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. _7 I Plumber's Name (Print): Plumber's Signature: (No St mps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): jb 8ox-#lz z- AKc 141, /o IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved San' ary Permit Fee (Includes Groundwater Date Issued Issuing Age t Signa raps) Approved ❑ Owner Given initial 60 Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber J 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 (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 & 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. IL 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. Vlll. 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'/s 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) V /M i t~2 I m IN ILA how#~ a ITI W 0 v dm L - - ~m a t, cd q~ H m 6D t, o m 43. Nk nQ, E-gsr SOT ~ ENE ~6a 4s- 'lya s~AtEJ Wisconsin Department of Industry, -SOIL AND SITE EVALUATION REPORT Page 1 of 3 L.-Human Relations ,JKwion 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 St. Croix 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 John Leys GOVT. LOT SW 1/4 SE 1/4,S 36 T 30 N,R19 f(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR CSM # 12461 Arcola Trail 6 n/a csm vol. #4-page 1114 C~~~~YY TATE IP CODE PHONE NUMBER []CITY []VILLAGEJfOWN NEAREST ROAD Stillwater, M. 5508 (6121439-0641 St. Joseph Billow River W. New Construction Use [x Residential / Number of bedrooms 3 ( ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/0 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.04 ft (as referred to site plan benchmark) Additional design / site considerations n a Parent material outwash Flood plain elevation, if applicable n/a ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem GM ❑ U [k$ ❑ U [ ❑ U ❑ U ❑ S Eau ❑ S j3U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bax>daly Roots Bed Trend 1 0-10 1 3/3 none L. 2/m/gr mfr c/s 2/f .5 .6 ft::.<< 2 10-24 10yr4/4 none scl 1/f/sbk mfr g/w 1/f .2 .3 Ground 3 24-54 10yr4/4 none Is. 0/sg ml g/w n/a .7 .8 lev. 99 e74 ft. 4 54-84 I0yr4/4 none co.s. 0/sg ml n/a /a .7 i.8 Depth to limiting factor >84,, Remarks: Boring # 1 0-9 10yr3/3 none L. 2/m/gr mfr c/s 2/f .5 .6 <2 9-27 10yr4/4 none scl 1/f/sbk mfr g/w 1/f .2 .3 3 27-30 10yr4/4 none Is. 0/sg ml g/w n/a .7 .8 Ground elev. 4 30-80 10yr5/4 none Co. S. 0/sg ml .7 .8 99.74 ft. Depth to O limiting E~ factor >80" Remarks: - CST Name:-Please Print Pho` Cary L. steel Address: 1554 th. Ave., New P.' chmond, WI. 54071 w , Signature: Date: CST Number: 7-21-93 csrm 2298 PROPERTY OWNER John Leys SOIL DESCRIPTION REPORT Page ` of 3 PARCEL I.D. # Borings Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour~y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench = 1 0-8 10yr3/3 none L. 2./m/gr r~ifr c/s 2/f .5 .6 2 8-24 10yr4/4 none scl 1/f/sbk mfr g/w 1/f .2 .3 Ground 3 24-38 10yr4/4 none Is. 0/sg ml n/a n/a .7 .8 elev. 1 00.64ft. 4 38-84 10yr5/4 none co.s. 0/sg ml n/a n/a .7 :.8 Depth to limiting factor >84" Remarks: Boring # 1 0-10 10yr3/3 none L. 2/m/gr mfr c/s 2/f .5 .6 4 10-2. 10yr4/4 none scl 1/f/skb mfr g/w 1/f .2 .3 3 22-45 10yr4/4 none is. 0/.sg ml /w /a .7 ':.8 Ground 4 45-84 Z r4/4 none co. s 0/s ml na/ n/a .7 .8 elev. 0Y g 100. Not. Depth to limiting factor >84„ Remarks: Boring # 1 0-9 10yr3/3 none L. 2/m/gr mfr c/s 2/f .5 .6 2 a-lo 10yr4/4 none scl 1/f/sl.b mfr g/w 1/f .2 .3 3 19-36 10yr4/4 none is. 0/s- ml g/w na/ .7 .8 elev.Ground 4 36-8 10yr4/4 none co.s. 0/sg ml na/ n/a .7 .8 100.54t. Depth to limiting factor >86" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE ]r5~~?(~rh n.To Gary L. Steel SAO C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 Jo~ i,ys SF ;SW<~, S36-T30N-R19W (715) 246-6200 town of St. Joseph lot #6- Vol #4-page 1114 3.00 pfe/V~3 . 3-z Gary L. Steel 7-21-93 :z H" A w ^ o m .I --L z° i < I I I I : I 1 I N UI ~ j ~ ~ R° I I I I n m I I I ~ I rri ° m I z I 1 > I • `o I I I m I 1 (S m j I I I 0 W I 0) 0) I I w ,C~ O I ~ I I I O• a) I ~ I I I ~ I r I I I v 1 D I I I j I I I I I I ~ n j -v I I I m -o n O , z I I= I I ~m j r i vw -o i I I ~ I p m i I I W 1 Z Cd N s I m S~ X PY C: 0 O r~i Fn o m 0 Azz `o T m (zr .f' m =O -p c h: . U) F . ~ v FILED ~ R • AUG 2 6619930 © JAMES O'CONNELL Reglsto( o1 Deeds 504 458 WI This instrument drafted by Fran Bleskacek Proj. No. 78-85-192 N ~ O ro N Cn 7 ro rt C7 a 0 MATCH o' 3 (See 110' I o Sheet 'ZNE 2) rn ' N 1 105 j105 W ,CO ca w v < a rn ro / W N 1 to I r o) I I C i t7 _ I r, O ao' so' o \CC, 1 r rC, v 6LI Z s a n 33.33' f _i w CO co oto N ~O `N <L Irn v) ~ 0 to I- I j~ r N I m 4, . N"I f- Ni I V n N ICJ s n \ \l ° I I fir) i -i o to 00 'y O c~ 70 Iy IZ N-\ IL -P, f n o° o i.i I`n 12_ \L%\\~~~ICn m ~SiloSj,p I ac o~ ix ~~o z N 60 . CO I I N ~i f~, A G\J, V n rt r D N I! a w ~a \ y \ \C \O ~Q Q- o M o) \S O f x''03 i `S>~ ` S C cn b I I ! l ? \~~q c9t6' \ ~ ° w r- ti w 14 o Cl) 'off, fI1 tp" \ \`\C7 y v'ps FQ s/~y \ \ L'1 vii 'ff, o CO Ln Il w 16' ~f,S vwi eD 0 ct I \ 60~ 'B0, a N se' 'i fD 0, "0 X 0 N, 0, dF C7 t I~ N, 0- 0 w f / Ct Ct :~r O CO N \\~C1 N£ O N, 0 N- 0 N \ \ \ o - W lam!) O (n ~ FN M \ w ~ 0 w Ln O f t t1 I Lr' \ \ O (D -t rn 'C Ct En n O rn. a Oo O. M n w M r LJ W Ct O 4 O H- (TI R~ ~n LTJ O W . ti U CO C.7 O N CF D c~ C: 0 C1) 0. O Y.r, . a a (0 a tij 'Tj 2C + N S ro O l.I~ 4.1 'S. ' f '~f O - c -1 O v° - m O O cn w 01 , 0 r'~ to . • o t+1 CO Ct N y 1.1~ Ca O O ~h cn <n N ro M (D rF rt C') b O o Bearings are referenced to the south line O of the SEJ of Section 36, assumed to bear ~ N89023145"E. t1- Vol. 9 Page 2674 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County oWNER/BuYER TD 14 K L e_= V-5 Zs-419 MI l_ c F-2 /L S`7`%/~w<~~✓ /YI/V Ssb Fj Z MAILING ADDRESS / 2 2 L O L A T R4 PROPERTY ADDRESS S& 7 WILLOW I NE PL j~OA D (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~ L) D .S a N W -1-- s V a/ PROPERTY LOCATION S LO 1/4, S E 1/4, Section 3 k T 3 a N-Rlf W TOWN OF ST- -Fe S ,F P 14 ST. CROIX COUNTY, WI SUBDIVISION e 5 ,AA Vo / # y ?,4 r- F LOT NUMBER CERTIFIED SURVEY MAP ; O it yr9, VOLUMEj PAGE 247y , 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: - vt l y 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 Soo N L E' 5 IZ541n MILLS Location of property : ~yj 1/4 1/4 , Section 3T 3o N-R~ Township 5T `I'-O S E /eg Mailing address / 2 X4 TLc-i I S7 i 11 Wd'( V /Vl I~, s S- Q uz Address of site Sto7 UJ I U-00 21UE2 too 4Q HOD.So N w-T syolL Subdivision name ~-S M '-OL # Z/ _ -PA 61E / I / V Lot no. 4o 4 Other homes on property? Yes 2 No Previous owner of property R 16 _ N 14 ►2 0 51A t= S N o C7' Total size of property 3,00 A C-- Total size of parcel -3 00 14 e- Date parcel was created 3- 7& Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? X Yes No Volume 5")v and Page Number 0,041 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. 3 5(89 '39 , 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. ~ys~39 Si ature of A plicant Co-Applicant q1-2-1 A/ +f- Date of ignature Date of Signature ~a• ~ "1 DOCUMENT WARRAN'I'1 DEED NO. 11(1! ~ ~ V ~ ~ ~ ~ ~ - - STATE OF WISCONSIN-FORM 9 (9 THIS SPACE RESERVED FOR R[CORDINO DATA i THIS INDI?NTURI,, Made byy..._.Richard John Stafsholt and REGISTERS OFFICE Judi K. Stafsholt, husband and wife. . C"rOIX CO., WIS. • . ST grantors... of t.••Croix_.._...._._._._.__........................County, Wisconsin, Rec d, for Record this 3Q hereby conveys and warrants to...... aQb.?..I ys day of ?,a? AD. 1978 AA. at 8-n L . ....._...............:.....gratltee........ of Replafet of Deeds ~ J( l Cro.ix County, Wisconsin or the sum o - S.t.- ...C---.. x...-•--------....••••••-•-•••---••-••-•_... .One _Dollar..._(1. 00) and Other Good and Valuable RETURN TO Consideration First National Bank 109 E. Second St. the following tract of land in St.- CYOix...•••.................... -,..County, Nei, Richmond, Wi. 54017 Wisconsin: South East Quarter of the South West/ _Quarter; South One Half of the South East Quarter and the North East Quarter of the South East Quarter of Section number Thirty-Six (36), Township number Thirty (30) North, of Range number Nineteen (19) West; Also North West Quarter of the South West Quarter of Section number Thirty-One (31), Township number ~ Thirty (30) North, of Range number Eighteen (18) West, Excepting and reserving from said above described premises a piece or parcel of land heretofore conveyed to Daniel Donohue by warranty deed recorded in volume "L" of deeds, on page 191 described as follows: Com- mencing at a point in the center of the road on the Town line between Townships 29 and 30 of Range 19, thence running west on said Town line 8 chains and 38 links to the quarter section corner on the south line of section 36-30-19; thence west on said line 20 chains thence North 12 chains and 80 links; thence east, parallel with said town line, 34 chains and 35 links to the center of said road; thence south 250 west along the center of said road to the place of beginning containing 40 acres, more or less, and also excepting any lands heretofore conveyed for railway right ht of way over and across said remises or any part thereof and also excepting that part hereof lying Southerly and Easterly of the Railroad right of way. Said lands being in the Ccurlty of St. Croix and State of Wisconsin tz' being in total 72 acres more or less. EXCEPT, Part of the Southeast Quarter (SE 1/4) of the Southwest Quarter (SW 1/4) of Section 36, Township 30 North, Range 19 West, described as follows: Commencing at the quarter section corner on the south line of said Section 36; thence West on said line 20 chains; thence North 12 chains and 80 links to the Northwest corner of the parcel of land conveyed to David F. Anderson and Susan C. Anderson, by deed from Melvin R. Moodie, and wife, re- corded January 23, 1976, in Volume "533", page 219, Document #33,1226, which.corner is the POINT OF BEGINNING of this description; thence North 150.feet;rthence East parallel with the South line of Section 36, 291 feet; thence South 150-feet; thence West along the North line of the parcel described in Volume "533"„ page 219; 291 feet to the POINT OF BEGINNING. ALSO, that certain parcel of land located:1ri the Southwest Quarter (SW 1/4) of the South- east Quarter (SE 1/4) of Section 36, qLwnship 30 North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin, more fully described as follows: All that part of the South 12 chain 80 links of said Southwest Quarter (SW 1/4) of the Southeast Quarter (SE 1/4) lying. East of a line described as beginning at a point on the South line of said Section 36 a distance of 430 feet East of the South quarter corner of said Section 36; thence bearing N32018'50"E across said South 12 chain 80 links. (The South line of said Section 36 assumed to bear due East). In Witness Whereof, the said grantors.. ha. Ve... hereunto set...... their•.____•....__. hand... 9 and seal... . this ' day ofuv'---•-------•-•-•....••- A. D., 19 -Z$... TRANSFER SIGNED AND SEALED IN PRESENCE OF ..................----..................----..........(SEAL) Richard John Stafsholt dD SE 1L Judy K. Stafsho_lt 1...... 1 L ...:.:...........................(SEAL) (SEAL) State of Wisconsin, St.•.C:rOlX__.._.__.__County. Personally came before me, this ...?~~t~l... day of A. D., 19-.78., the above named ..chard John Stafsholt and Judy K. Stafsholty to me known to be the persons.... who execut- 4,,thq jp.regoing instrument and acknowledged the same. ,'S, . r n c - Thomson THIS INSTRUMENT WAS DRAFTED BY : 1~-; `t;: s - .?~aT^u~Y Noarj Public, . St. Croix .......................Count, t`✓is. RICHARDS & WATT, '..A ~N -t3GtitSG' " ' . All commission (expires) (is) a?,Ii,..~Stp? °_F:cn 4: iA7L j apt MV,Dn fef>, ' (Section 59.51 (1) of the Wisconsin Statutes provides that all instruments to be recorded shall have plainly IiLntor typewritten therein the names of the Brantors, grantees, witnesses and notary. Section 59.513 similarly requires that the name of the person who, or govern- mental agency which, drafted such instrument, shall he printed, type-;tten, starnpcd or wr4ten thereon in 1 I, Ole .rarner.l