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HomeMy WebLinkAbout038-1112-80-000 STC - 104 AS BUILT SANITARY SYSTEM REPORi~r- OWNER, ADDRESS SUBDIVISION / CSM# LOT # SECTION_.,,.~~T.Z~ N-R__) W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHI G I K_,100 FEET OF SYSTEM t i ~4s INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. s BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: I14'S Liquid Capacity: Setback from: Well_42~ _ House /S Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM , Width:R Length z~ Number of trenches Distance & Direction to nearest prop. line: /71) Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet; QST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: i LICENSE NUMBER: INSPECTOR: ism r 3/93:jt s'sn~~parttrln~i~s rr1e.28.3~1~IV►#EEI~VAG SEM County: Labo?-and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) SanitaryPerm it'No.: GENERAL INFORMATION 2 08948 Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.: T PRE ev.: , Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400071 (7~/2,c! TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~r 0 Benchmark 03,03' Aeration \ Bldg. Sewer 3, Z2 Holding St 0 Inlet j~ e?~' 3,pfL TANK SETBACK INFORMATION St/ IOutlet TANK TO P/ L WELL BLDG. ventto Air Intake ROAD Dt Inlet Septic 51 Q 3 NA Dt Bottom Dosing NA Headers Aeration N Dist. Pipe y 90? 09 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Man fu ctu Demand's /a2 rz c / r lr<F f Model Number GPM T H Lift ~~~M ea TDH Ft oss Force main Length Dia. Dist.Towell SOIL ABSORPTION SYSTEM BED/TRENCH Width/ ^ Length_ No. Of Tenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION DIMENSiON _t SYSTEM TO P/ L BLDG WELL LAKE/STREAM HING acturer: SETBACK CHA INFORMATION TypeO r<<., ~N/, , tuber: System:E OR UNIT DISTRIBUTION SYSTEM Header Distribution Pipe(s), x Hole Size x Hole Spacing Vent To Air Intake u r (p Length Dia 1/ Length 7;7 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems O Depth Over r, Depth Over xx Depth O.f eeded /Sodded xx Mulched Bed /-TCenter Bed / h Edges Topsoil ❑ Yes ❑ N ❑ Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) -k L' Lfir OCATION: Star Prairie.28.31.18W, NE, SE, Lot 1 z f r Plan revision required? ❑ Yes a <o Use other side for additional information. ~02 c~ SBD-6710(R 05/91) Date Inspector's Signature Cert No. DiLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITA Y E T # -Attach complete plans (to the county copy only) for the system, on paper not less than a 0 J TI 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, us T,3/, N, R (or PROPERTY OWNER'S MAILING,, ADDR SS LOT # BLOCK # d✓ Ir, 9Q 14L CI , STATE 94 ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : NEAREST ROAD ❑ Public CA7011 or 2 Fam. Dwelling- # of bedrooms 3 PARC" 0 40 111. BUILDING USE: (If building type is public, check all that apply) 10 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 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.1o New 2. ❑ Replacement 3.E1 Replacement of 4.0 Reconnection of 5.E] 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 M Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 120 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 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION [Thanks ew istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks strutted Septic Tank or Holdin Tank leg 1:1 El . El El 1:1 1:1 Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installati n of the onsite sewage system shown on the attached plans. Vbe s Na (Print): Plumbe 's S' na e: S ps) MP/MPRSW No.: Business Phone Number: L Plum 's Addr (Street, City, te, zip cope): IX. COUNTY/DEPARTMENT USE ONLY 1 ;7 ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date s ue Issuing Age3ft Sig re (No S Approved ❑ Owner Given Initial Surcharge Fee) 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 s Buildings Division, Owner, Plumber INSTRUCTIONS 1. ,A,Sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewd any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to J;is permit must be approved by the permit issuing authority. 4. Changes ;n «-,,F~.> s?1ip or plumber requires a Sanitary Perm '+ansfer/Renewal ;,r i3 + 63G9) to be submitted ir% the Lounty prior to installation. 5. Onsite sems°. ge systems must gyre- ;rt-operiy frraintaineci. The tar ~ cl m,-1 be i t pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage systern, co -;tact your local cc~de tdir + .qtr°ator or the State cf 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 arnd pare:-1i ;ax ni inber(s) of where the system is to be installed. It. Type of building being served. Check only one and complete of bedrooms ;f 1 or 2 Farrny vvehing. III. Building use. If building type is Public, check all appropriate boxe3 that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank: replac me it, , ;-.connection, or repair. V. Type of system. Check appropriate box depending cn system type. VI. Absorption system information. Provide all informat on requested in #,1-7. VII. Tank information. Fill in the capacity of every new and/or existing L nk, list the total gr !'.:1!ns, n;jmaer of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. C orrr, ete for ali septic, pump/siphon and holding tanks for this system.. Check experimental approval drily if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropria.e 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 3% 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 mans/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; reoliw=!merjt system areas; and the location of the building served; B) horizontal and vertical elevation reference . amts; C) complete specifications for pumps and controls; close volume, elevation differences; ft icti,. n 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 run -:i4,r of regulated practices :which can `ffect groundwater. The monies collected through Mhese surcharges ai. used, rar water contamination investirfativns ami establisher sta~,~ia SBD-6398 (R.11/88) Isive 5L 0 /O' o ~ S ~e C.[.f/d~.SrDG I /r/TER'.t1A-~ii i ~CA I d 0 olof ~ 7,*i.s ~9h' ,~oata . 94 7 s - 9s % - I r V , ~3 ` PAb c 0IF fit M. Ak IAI~i1 At11 0►N/t~11N1 pipe t.. •+Apr••iA Vol" Op j • MMtwrru•.Ia4AD••0 i' ~ • • ' =0. 4ir At•+• /1! 4• C••1 Ir•• , 11• Il•N'4I440 V•M Py WrM INr W ~r•+Mlk C•••H 1nr f 0•N /y• . p•uNNI~ " h►• Too 4 ' ►Ni•I.1•f /1/• YN•• • ~C~Ir, Trwl•••Me Al s•11•w 01 i/N••1 Pro: us t p Final 9 r,, A-c p . sole F i lt•• • ®ISTR18UT101.1 PIPE • APPiIO`lCp S'IUrICTIC cove OF I\Gri K4AlF. ~r MATRRIJ%. OR V OF STRAM OK MARs1. N,AELEV. O •d~~ ~In~CPYt =~/s FAG GI~TC E F~ FES-Y ..w~ .w~. CISTRIOUTI01,1 PIrt,TV bC AT 4CAIt~r ,_,/n IhdGNE3 5CLOW ORI&IWA1, • .tAOC ~UII AT LCAST t® 10.1CHCL OUT 1.10 M011C THAW 41 IWC►iCS OLLOW FINAL G►tAOG MtVcUwM "PT•H•0F F-Xc/lVATIOP FKoM oK10Wg1. 61t~o. w111. ec lucks 1'1lfl,r'1uJh pEPr1I OF EXCAVATION 0~'41I1gL G~Rnv iL Wit.t. SC INCHCs 81GI.IC~ ~ .•a} ; LIcCusC uUMatlt: - 9 OgTC: - 9 e flT0 5 )epartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page of Human Relations Vivi vision of Safety & Buildings s C t~ t 83.05, Wis. Adm. Code • 1© COUNTY Attach complete site plan on paper not le 8 1/ ?,x 4&nches i Plan must include, but not limited to vertical and horizontal refe ft point on an f slope, scale or PARCEL I.D. # dimensioned, north arrow, and location istance to neare APPLICANT INFORMATION-PIL PRIM' INF~80AT REVIEWED BY DATE t"I PROPERTY 0 ER: ~OtatdTYt r~ PROPERTY LOCATION r ,~nEr!`.t GOVT. LOT 1 /4 LC 1/4,S T N,R E (or)® PROPERTY OWNER':S MAILING ADD SS LOT # BLOCK # SUBD. NAME OR CSM # C" 15, 'Z- I CITY, STATE r ZIP CODE PH~3fGf= f~FfbIBEFf ❑CITY VILLA~E MOWN NEAREST ROAD Sys - J~ pCJ New Construction Use b(] Residential / Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow -S~SD gpd Recommended design loading rate _.~bed, gpd/ft2_trench, gpd/ft2 Absorption area required _ bed, ft2 '4 trench, ft2 Maximum design loading rate bed, gpd/ft2__trench, gpd/ft2 Recommended infiltration surface elevation(s) 9/r~;2 ft (as referred to site plan benchmark) Additional design / site considerations Parent material - - Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem [Z S ❑ U [Z S ❑ U [Z S ❑ U ® S ❑ U ❑ S CA 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 Trench Xii~ Ground _ a elev. 14- T 2LZ- ft. 9-9 1 Depth to limiting factor > Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: CST Name: Please Print Phone: 7 _ Address: i _ Signature: / Date: CST Number: - (P J PROPERTY OWNER ~ E JAI SOIL DESCRIPTION REPORT Page PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourg Roots GPD/ft in. Munsell Qu. Sz. Pont. Color Gr. Sz. Sh. Bed Trench Mffi.~jl WK ME ti ..v J r Ground M11 S/2L 101 C elev. ~Zft• Depth to limiting facto, Remarks: Boring # / +i zoz Ground lv 2a ft. Depth to limiting factor Remarks: Boring # Ground elev. Rya ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) ~G.c' fur S X, A,-` i I 73 i I I c /D9 b AUG fs o 1919 h7'' Rog/,, C of 0 (c. CERTIFIED SURVEY MAP I UNPLATTED LANDS 5035 S89 053'E S 89-5- SE 663.00 363.00 300.00 46 0ti 1 I 66 I I I I - I cD I co w I I 0) it N I I ~t 2 w I , ZI c°'o 2.6:8 ACRES 2.42 ACRES t=- Q I o (D _ I 1 0 w m I I WI a6 -In _ w I I I--1 (n jD O CO Z (D i -001 Q i J C~6 '0 zz SE-NE-SE I 6 °cr .1 a_ JI w I wZ'llz I o I 11 N 89°53 W 300.58 cn I- cr H~ 176.30 124.28 R=80 X1 z I t- 1 N89-53 'W 220.62 I N I N 130-23 90.39 M I 16 I ~w o Z I ° I _ N O I W 0) J I z I W I Z' z Q / O° O 4 616' O JII w 1 2.16 ACRES S>o ~ 02~ _ S I N N I I 1.52 ACRES C) I I I _ I I M M_ NORTHERLY W NORTHERLY Qi I RIGHT-OF-WAY LINE 'In o RIGHT-OF-WAY LINE zlI I p`I' ~0 6600 pm e9c Zl I 6 6 19 o,~ N89°53 W 330.00 z N89° SW z N89-53W 267.00 `~9• _ ~I ~ M 66.00 , 'co M N89°53 W 663.00 M 97.18 to CENTERLINE OF EXISTING TOWN ROAD cD m r ;>i' O POINT OF UNPLAT_TED LANDS_ %vemegM~ N BEGINNING SCALE IN' FEET 00 z EAST LINE OF mmmmmmi iy SE 1/4 SECTION 28 O 100' 20o APPROVAL OF THIS MINOR SUBDIVISIO WALTER I SECTION N 28 Owner & Subdivider DOES NOT MEAN APPROVAL F GREGORY T31N R18W James Long BUILDING SITE OR SEPTIC SYSTEM; ~~U Box 205 REFER TO H62.20. VtIM Roberts, Wisconsin 54023 A. .1 0~1 _APPROVED LEGEND ' vo u.+ ' • Existing 1" Pipe. AUG 07 1979 0 1"x24" Iron Pipe, Weighing 1.68# 1 lineal foot, set. COMP.tEHENSIVE PARKS PLAN;-•,G Existing Fence AND ZONING COMMITTEE Thi4 ,,inSt,r.ument Was Drafted By Wade Hartenstein. TRUE BEARING X tyo b 9 b •asuadxa 3TTgnd aq pTnOm za~~sazau~ sqsoo aouLeuaqulvw 'psoa OTTgnd s SP J qTTsdzotunw s Kq zano uaxL'q aq XsMpvoa auk. pTnouS • saauMo Xgaadoad 2uiuiocpa auk Xq &qvx-oxd paxeus aq TTsus 'pso.z p.zupue: s 7e ss ao:.s.zgSTUTUzpy SuiuoZ auq dq Tsno.zddp sqT aaggs 'XPMpEOa aqEATad aqq go sgsoo aoupualuisuz duy •duMpsoa agvAiad s sz dsui szuq uo uMous Xvmpvoaz.aus M,S000S „OT,VOoSt g„SO,LZoZZS ,T£'T9 100'08 V-£ ,90,LVo£8' d„L£,SOo£S ,£8'90T 100'08 ,VO,LToIS M„8Z19Zov9S ,VZ'69 100'08 £ ,OT,TSoZ8 1A,,SZ,6Zo8VN LS'SOT 100'08 Z £ToZS g„Oti,Z0o6TN ,Tb'OL 100'08 T g„OT,6S,VVS .0Z,80o0LZ M,SS.o68N ,00'£TT 100'08 £-Z g„0T,60oSVN ,OT,VO,SV Q,,SO,L£oZZN T£'T9 100'08 T Z-T SNIEV-2q g'IONV 9NIEV99 H,LONgq H,LONUq ' ON ' ON .LNHONVI 'I` -dINQO GUGHO QUGHO Sf1IQd2i .LO'I aMdf1O HggV Vi,wR aA!,:n'J •pasog uMoy aqj Xq panoadds uaaq ssu duu< siui sub ~C~t~aao ~Cgaaat{ I ZZOVS UTSUO~)stM `STTud aaAtg IS IuTa 'U £ZTw .OD fUTaaaUTfUg uapg0 L68-LL 'ON OP VZ -S ,Caogaa9 aaITsM 8 L 6 T ` L T sn~n~ -5v2/171Y •aousuzpa0 j?uzuoZ XjunoO xioaO *IS auj 3:0 •Z•V•Su0z40aS pus saInivIS uzsuoost a o uotIoa o suotstAoad a q az duioo X n M uI ti£ 9£Z S J u u P T TT ansu I IsuI pus joaaaoo aas dvw puu uoT4dtaosap anogs au; ivgi XjTl xao I •4uauuassa psoa uMoq aoj , u1nos auj jdaoxa gutuuzfaq go juzod aui off. , 69' SS9 M, S000S aouaq; `.100'£99 a,£So68S aOUaiP `•,69'8S9 Q,SOoON aouauP `.puoa uMO:. 'dUTIStxa us Jo auzTaaIuaO iuasaad aui fuoTu ,00'£99 M,£So68N aOuag4 Sutuuz2aq go jutod auk. off. V/TQS pzus Jo OUTTIsug auk guOTs ►T9-SSZT (8utasaq anal ) g, S0o0N aouaql `8Z uotIoas piss go aauaoo as G114 4V fUTOUaunuoD :SMOTTOJ ss pagtaosap uzsuooStM "lllunog xtoaO *IS `azasad as~.S Jo uMOZ 'MOTE `NT£.L `8Z UOTIOaS .o V/T- auk go V/TJN GLP ut paIuOOT pusT Jo Taoasd y NOIZdI2IOSSQ i T rS9-03c C STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /YI c4 19E ~ /.927, ljvy MAILING ADDRESS 32 ~ ~ wT PROPERTY ADDRESS _ X X14 19 ) A-.) VqV F_ IU€w g,'G rx-0 (location of septic system) Please obtain from the Planning Dept. CITY/STATE Ni5W 9-1 J7 VV" i%d C.V 1" PROPERTY LOCATION 1U,15- 1/4, S t5 1/4, Section ; , T_3~N-R l~W TOWN OF 574/t rP1z4rrt "E ST. CROIX COUNTY, WI SUBDIVISION y nJ L LOT NUMBER I CERTIFIED SURVEY MAP VOLUME-3 , PAGE F-55 , LOT NUMBER I 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: 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 117 (c 4/i c ernAv✓ Location of property NF- 1/4 94~7 1/4, Section ZY T 31 N-R AF W Township S7,9tL Pfl,4Z r2; c Mailing address (-0, /Scot :?;t(, SaM,c25°6T{ w LrlA~2TMr9K/ eo•vsT) Address of site x x-,c i 9 a td 4 vtr ~tl~cci X'-C- '*tadj" Subdivision name NO'V 4 Lot no. Other homes on property? Yes ')C No Previous owner of property !Am65 L~N9 Total size of property -2, AC Total size of parcel ,Z A C. Date parcel was created 1 8- 7 - -75 Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house)? X. Yes No volume 3 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. ya ( 3 2&s c. F35 , 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. Si ature of Applicant Co-Applicant Date of Signatu e Date of Signature F • DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA .STATE BAR OF WISCONSIN FORM 2 - 1982 09,5.3119 ua PAGE- 48 E ,1 Q CO., W1 James G.. Long i`~i ~b,rRscocti _ APR 1 3 1994 - - _ t 7.~t' 8:30 ~ AM conveys and warrants to Michael., J.. Hartman t..r _ _ i~ . RETURN ToMichael J. Hartman 103 Main Street Somerset, WI 54025 the following described real estate in ..............St. Croix County, i State of Wisconsin: i Tax Parcel No: A parcel of land located in the NE1/4 of the SE1/4 of Section 28, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey Map dated August 17, 1978, recorded August 7, 1979, in Vol. 11311, page 835, Doc. No. 358851, in the office of the Register of Deeds for St. Croix County, Wisconsin. ALSO, A parcel of land located in the NW114 of the SW1/4 of Section 27, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, described as follows: Commencing at the SW corner of Section 27• thence NOD051E (True Bearing) 1285.61 feet along the West line of said SW1/4 to the point of beginning; thence N00051E 658.69 feet along said West line of the SW1/4; thence S890531E 50.35 feet; thence S30591E 660.38 feet along the centerline of an existing Town Road; thence N89053'W 97.18 feet along the centerline of another existing Town Road to the point of beginning, except the Easterly 33 feet and the South 33 feet for existing town road rights-of-way ii TOGETHER WITH the right of ingress and egress over the private I; roadway as shown on said Certified Survey. ' This is not homestead property. XW (is not) Exception to warranties: i; Easements, restrictions and } ' r rights-of-way of record, if any. y Dated this - f` day of 1994... ...............(SEAL) (SEAL) li -~EJ I'' I James G. Long- (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT I I II Signature (s) James G. Lon STATE OF WISCONSIN ss. 4 ` - ----------------------------------•---County. authenticated this ......day of... TP ~l...I......•, 19•._94 Personally came before me this ................day of I • 19........ the above named - - TITLE 1MEMBE.1 77STATE BAR OF WISCONSIN ii (If not- authorized b - II y § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. I THIS INSTRUMENT WAS DRAFTED BY Kristina 0. land i Attorney at Law - - - it . Notary Public .............County, Wis. II (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: - 19- ) ,Names of persons . s:.gnin_g. in any capacity shou--:_.-ld be typed of printed below thew signa tin cs. - - - WARRANTY T)FFrf cma•rr. nnn no .ancr n.~~,.. Wicrnncin I onal RIan4 Cn In