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HomeMy WebLinkAbout020-1073-50-000 a o -0 o I ry 4 O C C O fn N O N N U 3 'o N ooL I O O O t N f0 p C O N u 3 a I c E ~aIL- co w- co 'a 0 r a c o co 0 Z N~ N c _ LL c 3 3 0 z c ~a ° cO O cD Q .L tOdN I i ~ 3 `r Z y rn W E z N N ~W a m o I c co o z !t o to FZ- c Z Y, o E Cl) 'a 0) N O N • d O L_ c O O Q w 0 Z H Z N z CNI c E 0) R r o > CL c 20 (L a FL LL z %Ira a 0 ° I y M M 7 O m C) 0) fq J U = rn rn M I N 0 O O O N J O O E ,n c N co c (L wl " c 9 N 2) rn w o Q LO rn o o a°i c N carna l v a c t \ ~ N . i- C N ` N O c O N N CD U) x I~1 p m N C M a~.r 7~ C L • O O N 2 2 O 2 rL Cn CL • a 2 m a = e~ d E r A v a 2 Il 0 Y Parcel 020-1073-50-000 05/22/2006 09:09 AM PAGE 1 OF 1 Alt. Parcel 26.29.19.293A 020 - TOWN OF HUDSON Current FX-1 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 - MONETTE, ROBERT K & CHERI ROBERT K & CHERI MONETTE 717 PENNY LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 717 PENNY LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: (:3:.6700 lat: N/A-NOT AVAILABLE SEC 26 T29N R19W SE SE THAT PT OF SE SE Block/Condo Bldg: LYG N OF INT HWY 94 EXC W 76FT OF N 312' & PT TO HWY & EXC P293C & D EX Q Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 5/1299 ALSO EXCEPT CSM 6/169 26-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1016/601 LC 1997 83 LC 07/23/1997 (-100/66 lfql L C w,o 2006 SUMMARY Bill Fair Market Value: Assesse with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 23.670 138,300 298,700 437,000 NO Totals for 2006: General Property 23.670 138,300 298,700 437,000 Woodland 0.000 0 0 Totals for 2005: General Property 23.670 138,300 298,700 437,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 543 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS ~5 ~ lD I SUBDIVISION / CSM# LOT il~fl~e SECTION.2k Tg_~'_N-R /~'_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW © W SHOW EVERYTHING WITHIN 100 FEE OF SYSTEM i INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. f BENCHMARK: ALTERNATE BM: kl&e SEPTIC TANK / PUMP CHAMBER / HOLDING.TANK INFORMATION Manufacturer: A4elCS Liquid Capacity: Z J Setback from: Well House o?/ Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: _ Length /j/0 Number of trenches Z Distance & Direction to nearest prop. line: > ,.?5- Setback from: well:. > l~ { House Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off /o©. 96 21- Header/Manifold j.>, $P7,5-x_ Bottom of system 4t Existing Grade /o 2 Final grade y 9,S`- Y9 - S- DATE OF INSTALLATION: I PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: iwt ~LG lrr~ 3/93:jt LO'MA1 IONDar-HUDSOibus".29.19.290*kr* ~)?&jFfy County: Labor and 46man Relations INSPECTION REPORT Safgty and Buildings Division (ATTACH TO PERMIT) sanita nni GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P I . Trftp. BM Elev.: BM Descriptio . X Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300171 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic d t1', G ` ? Benchmark S 5S G~.~~ r Dosing j 06, G Aeration Bldg. Sewer r ~pc~ ~S [Holding St/ Inlet 03 3S TANK SETBACK INFORMATION St/)E Outlet 3' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA HeaderA~W. ~,/d ~c~,9~/7yCS Aeration NA Dist. Pipe 79 Holding Bot. System 5 d5' 7i PUMP / SIPHON INFORMATION Final Grade 6•7 Manufacturer Demand 6 ° v Model Number GPM TDH Lift Friction Sys DH Ft Loss ead Forcemain Length DI H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width i Len th, i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION S 47.S C5~ DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING nufacturer: SETBACK INFORMATION Typeo CHAMBER //ew rev =r:- System: OR UNIT DISTRIBUTION SYSTEM Header / Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length /rte Dia. Length S~ pia. A Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems 0 Depth Over h Depth Over xx Depth Of xx Seede odded ulched e.ed /Trench Center 4/Trench Edges Topsoil [ es ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ~LOCATION: /HUDSON 226.29.19.293A, SE, SE,,KINNEY ,,ROAD 7 ' 'PIn Irision/ quired ? Yes O WfIll Use r side for additional information. ACZ~i;] SBD-6710 (R 05/91) Date Inspector's Signature Air Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: To SANITARY PERMIT APPLICATION ~ o LHR In accord with ILHR 83.05, Wis. Adm. Code COUN STATE SAN ARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than f ,v3 S J y 8' x 11 inches in size. 1:1 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. PROP TY OWN PROPERTY LOCATION p .e c jQE % S zg~ T , N, R E (or PROPERTY OWNER'S AILING ADDRESS LOT # BLOCK # X70 7O , SUB VISION NAME O CSM NUMBER C, STATE ZIP CODE HONENUMBER 10 .X* aote X 7) vw 5V 7;F 07 II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE L ? ❑ Public CZ 1 or 2 Fam. Dwelling-# of bedrooms PAR EL A . U BER( III. BUILDING USE: (If building type is public, check all that apply) 16 71 -%SV 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 IV 5 ❑ 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. Z New 2. I_i1~teplacement 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 ❑ 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 -W VI. ABSORPTION SYSTEM INFORMATION: /L fit; ~t Teg* Ao#c 1(1/7" 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) vy /Op, / ELEVATION ©e ~~o 94 s Feet 02 Feet VII. TANK CAPACITY Site 's in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank Z El Lift Pump Tank/Si hon Chamber 1~~ Ej F-1 n n VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI er's Name (Print): Plumber's Signature: (No m 'f WMPRSW No.: Business Phone Number: O r .S er s Address (Street, Ci , State Z' Code). IX. COUNTY/ E ARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued utng Agent Signature (No Stamps) f Approved El Owner Given Initial Surcharge Fee) /{K.' J 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 r t, 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 systetn~s to be instcllled. II. Type of building being serVeS. Check only o 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 sipDQn tanks; distribution boxes; soil absorption systems; replacement system areas; and the location`of the b ding~eFVed;r~idrt~nfal"and=Ver~i$I 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 fqrm; and F). all sizing information. GROUNDWATEA 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) ti z All H t v ~ lop- 4. V v n o o 0 ~ x s ~ y v _v a ,,^~z R MY' 't~~ c +t4 ~ Y Y, y , . i ~ ~,r ~'^'-3 I~ R»si dk (t: is '~~r I I I ~~i Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 749-3656 DAV9 ' i iC [~s4i POc Testtr & f kimbe[ ; r 03M ee~►#3289 ROi~ERTS,.WISCVNSiN 54023 ,Phone 749=3656 Tye' ~ • ' T ~ / Ao~ e l~ v. ck7: ~e .r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS .INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/R4WWi61P+4L-44r: LOT NO.: BLK. NO.: SUBDIVISION NAME: SE 1/4 SE VA 26 /T29 N/R19 E (or) W HUDSON COUNTY: i6/BUYER'S NAME: MAILING ADDRESS: ST. CROIX ROBERT USE Phone : 612-687-9074 DATES OBSERVATIONS MADE NO. EDRMS. : COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER OLATION TESTS: [~R.icler ce 4 n/a ®New ❑Replace 4-16-91 4-17-91 RATING: S= Site suitable for system U= Site unsuitable for system VENTIONAL: MOUND: IN-GROUND-PRESSURE: TO YSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑U ❑ S ®U Cis ❑U S ❑U ❑ S ©U TRENCH 5'x 116' MIS If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: n/8 I Floodplain, indicate Floodplain elevation: NONE PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 76 98.5 NONE 76 .5'Bkls, 2.3'Bnsl, 3.5'Bums. B-2 76 02.0 NONE 76 1'Bnls 1.3'Rdms 3'Bnms. B-3 73 02.2 NONE 73 .4'Bnsl 2.6'Rdls w/gr. 4.3'Bnms. B.4 76 98.3 NONE 76 .6'Bkls.,.5'Rdls 1'Rdsl 3.1'Bnls w/gr 1.1'Bnms B,5 65 04.0 NONE 65 .9'Bkls .8'Bnsl 3'Bnls w/ r. .6'Bums. P-4 98.8 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. -PERIOD 1 PERIOD 2 P R PER INCH 28 none 3 > P_ 1 P- P- 2 23 none 3 then 6" dr in three minutes P- P- 25 none 3 P_ 28 none 3 2 3 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. #1 100.1' SYSTEM.. ELE ATION #2 96.5' 3 E r eik lo oles for' future Sc lle - 4" rs ow . o, 3 BM, aosune 100.0';To of lei P . Se , ot~tathed _p1at ~fe~encte _ steel,"p#~e, merk4.-.by--Ted_ sta*e map gor location next to steel fend a ~ost i fence line. ~ 0 peak ~ _ 3`f6 = 1 Cotton wood, tree. C alt i ~r I" i F I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. SEE ATTACHED PLAT MAP- NAME (print): TESTS WERE COMPLETED ON: DAVID IR. FWF EY T ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): FOGERTY HGTS. RD. ROBERTS WI 54023 3289 749-3656 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - Y I I I i CTCE I I I illl O T! r O ~ II DOCUMENT No. WARRANTY DFED I TH!5 SPACE RESERVED FOR RECORDING DATA Ij STATE BAR OF WISCONSIN FORM 2 - 1882 501.046 VOL 1OJGPAGE 601 REGISTER S OFFICE ~ ST. CROIX CO., WI II OR_ LOW A. W_I_DVEY a married .person and Rer d for Record ALBERTA H. WIDVEY, a.... .er_son JUN 21 1993 - - - 11.05 A. at M conveys and warrants to ROBERT- K-... MONETTE ...AND---CHERI----- ONET-TE-,---bulb-and_and._w.a.£e------------- Register of0eeds RETURN T-0- I the following described real estate in St...... .r_Q!X ..................County, State of Wisconsin: Tax Parcel No: SE1/4 of SE1/4 of Section 26, Township 29 North, Range 19 West, j St. Croix County, Wisconsin lying north of Interstate Highway 119411 EXCEPT the West 76 feet of the North 312 feet thereof and EXCEPT that part to the State of Wisconsin in Vol. "34811, Page 635 and EXCEPT part to Gary E. Affolter in Vol. 469, Page 529, Doc. No. 304126, and EXCEPT Certified Survey Map in Vol. "511, Page 1299, Doc. No. 385479, and EXCEPT Certified Survey Map in Vol. 6, Page 1693 and EXCEPT all that part lying SEly of Kinney Road. i~ This Deed is given in fulfillment of that certain Land Contract dated 23 April, 1991 and recorded in the St. Croix County Register of Deeds Office on 25 April 1991 in Vol. 900, Page 66, Doc. No. 468672. ii This is not • - homestead property. - (is) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. June 93 Dated this Y - - 19..._.-.. I (~:.~%'Z~ r/r~ CCC (SEAL) - - (SEAL) :jz -Orlow--A..-Widve-y --Alberta- -H.---Widvey (SEAL) - - - -------(SEAL) j - - I~ j AUTHENTICATION ACKNOWLEDGMENT t !j Signature(s) STATE OF WISCONSIN j ss. St. Croix ------------•---------County. q authenticated this ._..day of.... 19 Personally came before me this day of it June 19 93_- the above named j Orlow A. Widvey Alberta H Wldve I - - I' * - I TITLE: MEMBER STATE BAR OF WISCONSIN (If not- a u authorized b y § 706.06, Wis. Stats.) s . t a d person o~.. ` whop e C `'xec ed toreg known to b rumee L f s ~"r THIS INSTRUMENT WAS DRAFTED Att-Qrrre at--~!aw----------------------------- . _ - j Notary Public . i. _X___ _ ; Cou~ntv,Wis. (Signatures maybe authenticated or acknowledged. Both My Commission is permanent. (If Tic, !itttexl,iration j are not necessary.) r.~ .19- date : ----------4- il *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER kheuL -y ADDRESS: I' 111 d FIRE NO: LOCATION: 1/41 sa1/4 , SEC. N-R_J3 W, TOWN OF: 7e TAt/_9_~ ST. - CROIX COUNTY SUBDIVISION: LOT NO. G!// 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 a 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: ~Y DATE: 1993 St. Croix County Zoning office 911 4th St. " Hudson, WI 54016 e STC-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 Ia 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 e_r~ Ch, °F Location of'propertySEl/4 1/4, Section , T_(.&N-R_L'Z_W Township O'~ Lwd c Mailing address 571 "A L N✓~Q l ev~~ Fie,, ~s 5~sv? > ddress of site 2L 7 ec, Jeek_" L.", t- d,, d,~ Subdivision name_ t//A Lot no. Other homes on property? yes X No Previous owner of property Total size of parcel -94 Q, rP - Date parcel -was created a 'Are all corners and lot lines identifiable? _Yes No Is this property being developed for (spec house)? Yes No V, Volume loll and. Page Number- 01 as recorded with the Register of Deeds. ----------NCL------ ~~~~I UDE WITH IS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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 sA Deeds as Document No. 5 b f 0 N 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 County Register of deeds as Document x No. Signature of applicant applica t 7/13V93 ► 7- ~3 Date of Signature Date of Signature