HomeMy WebLinkAbout040-1022-90-300
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER IlIV57 T-,Jp 7- 72-
ADDRESS
SUBDIVISION / CSM# LOT #
SECTION S T 2152 N-R W, Town of -if or
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3:et 14
~ ~ bra 7!
ORIGINAL.
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
t
Tod of Sv~p U ~ ydiPS ~ ~ ~ ~i° T SE ~.o T
BENCHMARK:
G~iP11~~ ~IElJ~TiO J /O O
ALTERNATE BM:
3, f0 '
SEPTIC TANK ION
Manufacturer: LUEE~s *104/7(4 YJ Liquid Capacity: l6-VV
Setback from: Well House ~G 2 Other /
Pump: Manufacturer Model# Size
Float seperation allons/cye -
Alarm Location
SOIL ABSORPTION SYSTEM
Width:) Length X06 Gy Number of trenches Z
Distance & Direction to nearest prop. line: 3~ •fo SO. Go7- L ,
Setback from: well House 7 l Other
No (oE// Aelll Ed -a
Aid, 11445 eoUu, 103, 3i
ELEVATIONS C X~-~,PS~
i
Building Sewer 102,,P'~ ST Inlet. X62, e ST outlet- 16I'J~L
o tom ump
Header/Manifold Bottom of system
Existing Grgc~~ Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: -Pbac-xT 2rG/t3~'i /
LICENSE NUMBER: /WT 330 7
INSPECTOR:
3/93:jt
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Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County
:ST. Labor and Human Relations INSPECTION REPORT CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 224661
Pef#rbt klff bye ERIC ❑ City ❑ Village [ Town of: State Plan ID No.:
CST BVI Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
1~~, U~ ~Qry!~ Q~ ' ~j; : ter; A9400289
TANK INFORMATION ELEVATION DATA 71W"
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Q , co
Septic Benchmark I j
Dosing r,,` , yC7 O
Aeration Bldg. Sewer s y~ ' dam,
Ho ding St/,~K Inlet DoT OSL
TANK SETBACK INFORMATION St/V Outlet 6,~43' /01. '
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic > ~ NA Dt Bottom y°
Dosing - _ NA Header /,AMM_
Aeration - N Dist. Pipe ' 4.9
35'
Holdin Bot. System v.SZ
PUMP / SIPHON INFORMATION Final Grade
Manufa rer Demand 1'r ~ d 7.37 /~.~5
Model Number GPM
TDH Lift Friction m TD Ft '
Force Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Len th / No. Of Trenches PIT No. Of Pits Inside Dia. uid Depth
J
r'v
DIMENSION DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHI nufacturer:
SETBACK
INFORMATION Type Of (fM r CH R Moe Number:
System: t/tr<c~i+c5~ `~S UNIT
DISTRIBUTION SYSTEM
Header;^aa'd Distribution Pipe(s) x Hole Size x Hole Spacing Vent Tor Intake
Length ~ Dia. LengthS/~VC/ Dia. Spacing _JL
SOIL COVER x Pressure Systems Only xx Moun At-Grade stems Only
Depth Over „ Depth Over n .i xx De Of xx Seeded / So xx Mulched
Bed/ Trench Center,',0 Bed /Trench Edges Topsoil ❑ Yes ❑ No es ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY.5.28.19W,NW,SF,LOT 2,TQWER RD
~it 7C / r Z- ,y, ,/~,ti'% X2.7 "C'✓I i
14
Plan revision required? ❑ Yes "0
Use other side for additional information. 117
SBD-6710(R 05/91) Date Inspector's Sign ture Cert. No.
I
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i
I
SANITARY PERMIT APPLICATION
' ■
V'~L■7■'fil In accord with ILHR 83.05, Wis. Adm. Code COUNTY
57=
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size. ❑ 6-hy ~ kision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. Allt-
PROPERTY OWNER PROPERTY LOCATION
~fQ1C 4) ff AISr.11)7- NWY. S& S 5 T Z~ N, R E (or l~
PROPERTY OWNER'S MAILING ADDRESS LOT # Z BLOCK #
32, 1 1: -A ST N -
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
N. RvP.Sa.J 4/. S Y4'1 G ~ P2 G O C-S Al .67-705-P 00/40 .2'74
❑ State Owned ❑ CITY LAGS Q NEAREST ROAD
11. TYPE OF BUILDING: (Check one)
.
❑ Public 1 or 2 Fam. Dwelling-# of bedrooms - PARCELTAX NUMBER( )
III. BUILDING USE: (If building type is public, check all that apply) C)`7 G - /o;? S- l0 - l0
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home - 10 ❑ Outdoor Recreational Facility
30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF ERMIT: (Check only one in line A. Check line B if applicable)
A) 1. New 2.E] Replacement 3. ❑ Replacement of 4. ❑ 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
130 Seepage Pit Pressure L„ r 43 ❑ Vault Privy
14 ❑ System-In-Fill 2 7'E.v61WS 7 x .7-1 _00?
VI. ABSORPTION SYSTEM INFORMATION: ?7:57o
1. GALLONS PER DAY 12. 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
y~0_0 7 G TO / Feet Feet
VII. TANK CAPACITY Site
in al Ions 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 GQ~
Lift Pump Tank/Si hon Chamber F-I
VIII. " RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) 4*WMPRSW No.: Business Phone Number:
'gdg ,~T I bye i 1 t'~Zre~l~( 31 0 7 ~~s 3g4-
Plumber's Address (Street, City, State, Zip Code):
I~
655 0 ' vxt z- ,2~Q . So-,_J 4U15, 5-4,6l ~
IX. COUNTY/DEPARTMENT USE ONLY
e ssue Issuing Agent Signature (No Stamps)
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Vn*
41 fV Surcharge Fee) WApproved ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: V el
SBD-6398(R.08/93) 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 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 Iicensed
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 & Buiidings,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.
111. 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; 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)
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Fresh Air Inlets And Observation Pipe
A 11
Approved Vent Cap
Minimum 12".Above ,
lcp
F
inal Grade 'ge•--' Ono 4" Cost Iron 4
3(p " Above Pipe
Vent flpti
'to Final Grade
Marsh Hay Or Synthetic Covering
min. 2" Aggregate
Over Pipe
Distribution - Tee
Pipe 0 0 0 0 ° '
(v Aggregate v Pertorated Pipe Below
Beneath Pipe 0 Coupling Terminating At
Bottom, of System
'5Y 57 FAI
t77. 5'a
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Fresh Air Inlets And Observation Pipe
Approved Vent Cap
Minimum 12" Above
Final Grade %UIs f=v I Eno " Cast Iron /D 21,
5^
i 3(0 " Above Pipe Vent Plpo'
'Io Final Grade
• Marsh Hay Or Synthetic Covering
Min. 2" Aggregate ORIGINAL
Over Pipe
Distribution Tee
Pipe o io 0 0 0
~P a Aggregate b Perforated Pipe Below
s' y57" Beneath Pipe 0 Coupll:#g Terminating At
.Bottom Of System
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13u~E12. c Rt'L H 0 s T.4j> T--
Wisconsin De
Humanpartment of Relations Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and -
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
of, x
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 5-'. C R Q
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
W Am • C N Lo E GOVT. LOT All) 1/4 S~ 1/4,S 5- T 2V N.R (9 E (or W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
'/75" TbwE F, RC)- Z CsM Fie A.) CITY, STATE DS o S ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAD
SYo 1(o (769 3P4 -3q(3 -t' oy Totwelz f2D
( qNew Construction Use ( Residential / Number of bedrooms (J Addition to existing building
j ] Replacement (J Public or commercial describe Fop 'A- g eA 3 3 , 13 y - (3 5 0,j c y_,
Code derived daily flow &00 gpd Recommended design loading rate L bed, gpd/ft2 • e trench, gpdtft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate - ? bed, gpd/ft2 • 00 trench, gpddt2
Recommended infiltration surface elevation(s) -s-ee- P% • 3 It (as referred to site plan benchmark)
Additional design / site considerations 5,z2- A''•o •f-e S 4 r T-4 ct-a-Q-
Pare t material SCS 7!/ 13 &RleA "r Flood plain elevation, if applicable /V+ It
TY t'c L v
S = Suitable for system CONVENTIONAL MOUND INN--G UND PRESSURE AT-GRADE SYSTEM IN FILE HOLDING TANK
U =Unsuitable fors stem 2t ❑ U ~ S L7U [3S 1:1 U 2-s- 11 U 13 S C~ lT ❑ S rr1 tj
~Z'E aoT' StmTitd3l6' 41=6K .Ya►avp-
p~(rf,,~tc Y-- t- -,y, SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. reed Tmrlu, r
o-11 loVR 212.., uf-Iey ~a N,c s,/ l,~►, sh& WU-FA 4 2-f- I . 2 .3
!o Y,e zli RA
Op- -t l4,.E f 5~ Z' , ;Q ,►~-F /2 ~t -C • ~ Aj N
Ground Q.1 18-30 to VP- 3/L Si l 2 f ShK n+• ~~Q S . 5
elev. ft 13 0- Y3 /D R V/3 5d j L f 5h& ot. s .5-
Depth G
Depth to 2.C y3 •y~ /o YA Y/41 limiting
factor 9
L--fB-
Remarks:
Boring # + o -37 /0 YX z/2- 1 s,/ / ,w shie i . 3
, ' 2 (3, 37-q5 AD ►/R 3/2 S~ / z.►r, b~ n~► ~'i ' s S
. 31~s s. "a 2
Ground /J
elev. 2 C / O y/,~ y S C~ S
ft.
Depth to
limiting
factor ,r
!/b
Remarks:
CST Name:-Please Print Ro QE ler UL,13 Rt C t%T" Phone: 71 ? a/ -R/605--
Address: c~d(OS S; ~ 0' ~A-) t- (mac C f f 019,5c .7 C,c.9 r S . 5 z10-1 6, y - 2_3 - ~F Cs 77/y
Signature: Date: CST Number.
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FJOrx To
COUNTY
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V
PROPERTY OWNER X-- SOIL DESCRIPTION REPORT Page 2' Gi 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. • Munsell tau. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ev-~ Z O-6 /o'e z/Z „M fR Zz .3
A ►y y~ Z~z s, 2,,~, 'e- Mn4e- Q~. Np
N
Ground /U ye 3/2- 2bK ,,,,.,-FR S 5
elev.
ft. Z e- 37 Yk- ~/3 S~'/ Z f 56k C s . S G
Depth to z C- 7- /o M Y CQ S O. 5 ~-2 _ . 7
limiting
factor
Remarks:
Boring # _
of o to yie z/z 4-1, shy 4*t 07CR s 2.
f . z • 3
/o y,2 y3 SAW "Ocie Cs 17` • Y S
Ground
elev. 2C- /OlliQ 0, S G(~Q • 7
ft.
Depth to
limiting
factor „
Remarks:
Boring #
t Oz 0-10 / v y/Z i/Z 51/ 4 f, s6~e fop S Z Z 3
y S 51 2.0-y/ /Oya 7c, sAk ~►~R cs . 2- 3
/4 7. S- YR
Ground
elev.
ft.
Depth to
limiting
factor a
Remarks:
Boring # C~z 0-))
/DYR 2Z S',die f~' . 2 3
Ground
elev. '/9 Ic_ 1,02 G 57` v c /v 167-Z-2 Ile ft.
Depth to
limiting , O.z'd 'c ri w /`i :v / ,'O T 5.0/' /3 :
factor
017X I J T
:
Remarks:.
OWN 079/1/D Acin'"
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FILED
MAY 2 6 1994 0-
JAMES O'CONNELL
Register of Deeds
SL Croix Co., WI
51'058
N
CEP T I F- I ED SUP V E Y MA P
Located in the NW 1 /4 of the SE 1 /4 of Section 5, T28N, R 19W , Town of
Trov, St.Croix County, Wisconsin. E1/4 Cor.
Enloe, 475 Tower Road, Hudson, Wi. 54016
Section 5
T28N, R 19W
_ Centerline of
2007.80' 590°00'00"W
S 9o~.od`bo`0 S 90' 00' 00"E 314 47'
2960.29"" cd El/4 Cor.
N 89'30'25"E 315.05' - Sec. 5
W 1 /4 Co:• .
co
Sec. 5 I
L ® _T 2 ~
92, 011 Sq. Ft. (2. 112 Acres) CU
• Including right -of -way. W I aI
^O 87, 164 Sq. Ft. (2. 001 Acres) CU O aI
Excluding right-of -way. o O QD
a ~I
n _J1 L100' SETBACK NOTE: Driveway must N 00 Q1 I W'Nj
LINE c~
W - ♦'60111NtfyN go on West 178' of this G WI I Vial
♦ ~I lot. 4
tnl ~y fn ONS~ III ° J1 w''01
ZI a o .r ti yI N a-
-Ji (D IT HARVEY G.' cr. >i
u7 = JOHNSON I W
W S-1899
a. ° ti H w s°
a1 z .•r' a ti~
V~ SUFR Jr 3yA0s~ LEGEND
,!~!!!t!!WON Section corner, Aluminum cap.
61' 1 NPR 0 1 "X24" iron pipe weighing 1.68 lbs
per lin. ft. set.
• 1" iron pipe found.
Bearings referenced to the E-W 1 /4
Section line of Section 5, recorded SCALE IN FEET I"= 80
as West. O' 20' 40' 80' 160'
DESCRIPTION
A parcel of land located in the Northwest quarter of the Southeast
quarter of Section 5, Township 28 North, Range 19 West, Town or Troy,
St.Croix County, Wisconsin, described as follows:
Commencing at the East quarter corner of Section 5; thence South
90 degrees 00 minutes West 2007. 80 feet along the East - West quarter
section line to the Point of Beginning; thence South 00 degrees 00 min-
utes East 219.87 feet; thence South 67 degrees 14 minutes 29 seconds
West 354.13 feet; thence North 01 degree 56 minutes 21 seconds East
357.07 feet to the East-West quarter section line; thgnce South 90 degrees
00 minutes East 314.47 feet to the Point of Beginning, contka.ining 92,011
square feet (2. 112 acres) more or less, and being subject to all ease
ments, restrictions and covenants of record.
I, Harvey G. Johnson, registered Wisconsin Land Surveyor, hereby
certify that I have surveyed and mapped the above described property;
that such plat is a true and correct representation of the exterior
boundaries of the land surveyed and that I have fully complied with the
Note: provisions of Section 236.34 of the Wisconsin Statutes, the St.Croix Co.
General Subdivision Ordinance and the To'-,vn of Troy subdivision ordinance to the
notice state- best of my professional knowledge, understanding and belief.
ment on back-Harvey G, Johnson S-1899
Johnson Surveying, Inc. Surveyed for: William J. & Shirley Enloe
216 Meadow Drive North (Jr.)
Hudson, Wisconsin 54016 475 Tower Road
Hudson, Wi. 4942292
This instrument drafted by: 35I
VOLUME 10 PAGE 2766
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dtgsum oy pine Aluno:) 'areas o3 4oaCgns st d-eu.t stg4 uo unnoijs jaoard G.q j, :a4oN
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Cr/oiix County
OWNER/BUYER 1 C, i~ J T /9 L
MAILING ADDRESS Z ( Y S 7- 920' 4--;1' S 4/0/
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE //y J) 5 CN CA-) T7. 5-q,21 &
PROPERTY LOCATION N kJ 1/4, s E 1/4, Section T 7-b N-R/~_W
TOWN OF rw ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER 2-
CERTIFIED SURVEY MAP , VOLUME PAGE L7&LOT NUMBER.Z
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: ' a
C L~_ 24. -
DATE: 7_1' I h ~~y
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
' S T C - loo
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property ~z l c c, No dti S i A
Location of property /V IJ 1/4 s [ 1/4, Section T Z N-R ! 9 W
Township o P Mailing address
2. A, 5'r - n. Dom- 4> S. s y 6
Address of site ffi2 v J S yGl
Subdivision name n!~ i? Lot no.
Other homes on property? Yes X No
Previous owner of property -5, E~jz_."E _73-zr
Total size of property 2,// Z AcreS wi 7-i4 (L,vilrogto±y Z, 0t l Ace-5 cj/Q ec / ~rwi~
LUG/ ~ 7 co Sr.
Total size of parcel
Date parcel was created 141719 7 Z4' / ~ 2 y
Are all corners and lot lines identifiable? x Yes No
Is this property being developed for (spec house) ? __Yes )4~ No
Volume and Page Number as recorded with the Register
of Deeds. /.0172- 3'`'615-
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. S10 (o (P / 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.
Signature of Appli ant Co-Applicant
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
(STATE BAR OF WISCONSIN FORM 2 - 1982
520661 -
1G '
5'T. CROIX CO., WI
WILLIAM J. ENLOE, JR. and SHIRLEY A. ENLOE,
. . . - Rec'dforC.:ord
huS. b .and and wife
I
G 26 g
~
8:30 A
conveys and warrants to -..._ERI-C--C,___HOHNSTADT,__asi_ngl_eperson__.
Register of 0esds
;
-
I~ RETURN TO
i-n--consi.derati-on.-of..$20,000::00-------------
~ - - -
the following described real estate in St. Croix
....County, -
State of Wisconsin:
II
Tax Parcel No:...
I
A parcel of land located in the NW4 of SE4 of Section 5, T28N, R19W, Town of Troy,
it St. Croix County, Wisconsin, described as follows:
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The lot shown on the Certified Survey Map filed May 26, 1994, in Vol. 10 of CSMs,
Page 2766, as Doc. No. 517058, in the office of the Register of Deeds for St. Croix
County, Wisconsin.
I,
I;
;I
Together with and subject to any easements, covenants and restrictions of record.
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!
This ------------is
homestead property.
(is) (is not)
Exception to warranties:
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Dated this ....---.....7_ day of August 94
19
- (SEAL) . - ,-(SEAL)
- -
* William J. nloe, Jr.
I~ - -
- --.-----(SEAL) sc C r
(SEAL)
* * Shirley A. nloe
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF MINNESOTA
. klas_h_'-n`-~•t9!?--------------- County. ss.
authenticated this day of--------------------------- 19------ Personally came before me this day of
---August 19..94__ the above named
•
- - William J. Enloe, Jr. and
TITLE: MEMBER STATE BAR OF WISCONSIN Shirley A.Enloe
(If not,
authorized by § 706.06, Wis. stets.) -
to me known to be the person who executed the
foregoing ' trument and acknowledge the same.
THIS INSTRUMENT WAS GRAFTED BY
..Will i_am J. Gilbert, Attorney - -
206 Second __Street, Hudson 54016
Nota y ublic County, Mi n. n.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. ( not, state expiration
are not necessary.) date:
IfATHLfNiw
-.=NOTAFitf I*Names of persons signing in any capacity should be typed or printed below their signatures. WAMING
WA"
My Comm. EWARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1982 Milwaukee, Wisconsin