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030-2006-95-005
O 0 C C 0609, 1 0 ° ° > 4i w Gt O T b _ -r- (o O� y `) co q o C V N 3 N N Ol C 0) °C O > N N Y ° N 2 N S N o N I0 ° co L w CO `mV J - E Lrn c ° �3 0 C& s ° N c 0 3 E 1 o C ' ° y o 3 8 c z .19 E z aov, U. ° ° n CD ti Q Eo 0'2 0 •° 3 w ` v 3 ° U 7 3 _0 70 Q aU °c °z ce ` Z N Z N ` O w z € d 1 € d m 1 chi H Z a m a m N ` o g 1 0 Z U V r 16 U O *_ N z 1 'O CO O N a) z as T ° N 0 w co N N U U • 7 L_ "O -C d N 1 N O U j O U N w a z z - z z z o z N7 0 7 CV d E C W J a o ° co dr m '! 0 D D d •N Z R .- CL CL E�N N N T L N N; m_ ma°'D C FL 0 a = U co co ) 1 y �_ co ° o - O >. p ° I►y ; o o -0 E ° o o n E a p m Q z U) m c o d >- � m 1 0 ! � c.4 a �j O � C N C co N N �p 3 O N E E co CL TO ^ M ~ 2 O C C a0 N L Y 0 C N l i.r fp M d, 1 � vi co 0 m 0 O N C N l6 V O O T N C N G 5 — S N N 0 N O N F N M -°j .I N N Z ° C N j N N Q7 � Z C N r°� v a� o w o o O N ° 0 co U •O �' o c) U) m o z F- z cn <n co o z ►- cn I c r Cd I cn d m € a da m at a 1 L (L L: CL • a d ;� d d c w E ',� o > m ; —1 A 00 a N C) O N U k Parcel #: 030-2006-95-005 01/31/2006 02:48 PM PAGE 1 OF 1 Alt. Parcel#: 34.30.19.373K 030-TOWN OF SAINT JOSEPH Current X' ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner O-SORUM, GERRY A&CATHY A GERRY A&CATHY A SORUM 658 PINE VALLEY TR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "658 PINE VALLEY TR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.310 Plat: N/A-NOT AVAILABLE SEC 34 T30N R19W NW NE 4.31A LOT 1 CSM Block/Condo Bldg: 7/1948 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1014/62 07/23/1997 93 07/23/1997 07/36 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 84126 388,600 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.310 116,400 237,000 353,400 NO Totals for 2005: General Property 4.310 116,400 237,000 353,400 Woodland 0.000 0 0 Totals for 2004: General Property 4.310 116,400 237,000 353,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 119 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ti '3 4 _ 10 r7 C7/3� 100 7/%�f�FILED HAR 2W i35643 JAMES 'CNN Register of Ofteeft CMW Co..WI 65si,1 C.S.M._Vo l_ 3, Page 602 West .line .of._the;.NEj of Section 34 "—�—� SOle ' "E S010061 2511E 597.00' 2 = Z D ft 0 191.75' o \,I to rl-• .n (q Q f ._.p ., rA•t• r0i• o ' 7,p� A X71 C`"% "r wi w -n 0 �lroe 1 0 N 1 y m h- C, Co r x - o O to a ►-' r Cr co t rt .n w M 0 w w w a n N 'C rt N Ot N o N - 7 /D r• o O l0 n C Co 0 I �-• > > o t-• O V f..r 0 CD a 0 0 = = lD 0 g 1 3 i N N I— rt' 1• 1 _ r Co.. M w m. w fD . ' m o rn w �. a H CL c o 0 0 `�°, c 0 0 0 s 0 N. 0 10 I-h SL 7 t.n t0 1--• 7 A v SOl000100IE — — O q 63.981• r-- o C, N Cl) � 0 rt C-) CD Ir, 0 —I N ' m oo cn fD (D . �o — — y Z mc, > � -n v Co Co m s 4 �_.4 -Ij v to a o rn 4 ul P— a rt 0 tc rn 41 :1j M , rt n- 4 - Co •N 0 (D 4-� n o m �C 0 to O m 0 O 'r r i w 01 v ( 0) to 10 Cn to W.. N 7 O A� D 0ti p txi c0i _ ';" o 0 0 ) to �o O y c c I r,, tc"c ni vFi =• o 0 0 Ln y`r6 lk A F i v tv_ rn to I C V1 r N Cn N W —1 �i I V M V V N 1. TI N • o � 0 0 1v ` C4 N r 1 o rt " N W 1'• v• .F_ A N 1 0 m m m r.. W o I O I• I i Ito N01 029'27"W. .233.30' O CA 1 I Small Tract C� v - ----------- > t o Bearings are referenced to the H west line of the NE of Section - � _ � W. E z 34 assumed to bear S01o0612511E. a A to S ' m • s 2 •.. 'TJ ' CT1 O t+7 z w o C6 ;U o [� r - W: o W H v n x Cr w cn W Co o AFFROVID O W 28 VOLUME 7 PAGE 19118 0 ST.C�Zpp(CpMy QONWR3ti1Bd9N PAM* � This instrument was drafted by Fran Bleskacek Job No. 81-09-187 AfIDZOWMlr;3 PART %_0 1 • V V %00 L. 1 1 1 1. L--�W %•J V 1 V. 1 N.1 47 V V. TH a SEE PAGE 5 AVE. - ti Ram :2ufh eba :: 40 Rich ut, Picha /e /tou/e Hou/e �� /'a,- q � em/ .DS lnon man 40 4o Hou ~ tl v go ss/s • Hau/e Rivar ,efrz/ •C tl I f .�a /,y '�{ �a.�c .bbe SairJi. � • I.�0 d1'a ¢n .azk �: si etux Fal'm 60 4a Bo �� to 40 /- 0 MTN •' ! rem. R/GH DJ d th T h f E. hn; eo7�i�e '. � L.ubhnB cSchmitf �rq'i'�C Est oom B/>s i t. uftk cS ott/e/' .('alfi/een �ScFio"ff/cam ¢ •r7 / 40 //9 40 .. .!.. 222.42 n 237 TIL io E/mei- •s W¢/tee ...... j'Mary. cSonta :::�,� on HeZZ'/vik `h h�icde //y Jahn S GL y Cjaoiy:./e .. ::s:� • h '�'u �+e ° l/o-n 1Jyk tu ® • tSchotf/er- • Steven J •9' p� t'laA AS 160 4 • .e. 4,e.ro ... a {� a i ° a 'Z e_ /32/ .:SMALL: L' 3 Plan C W 67os .2icha d 99/ b fi-on ::'7K�:ci� 6l Me 5 H W z f�Siawai'f dtlW� 40 132ND K PE H L. Qi'va�d q @ Tank K1t V soo A z71 W 6 P a l 37 %a a TH AVE. m i ¢0 8 B W f 170-a z-zt ��: i/eira'i,.oi., Hib f y� • /ya y m.0 n h Sei, �4�., w v .-m.Tf •� Em_meft S aE.� M`Kay •�l 4 Edwa�i �'c D"C L.E h � LQl7 /72 Smithe � a.o �C3 0 H¢i- C OQ 9ness A A3 v�p o son p • h� (,.�V s>z � `C 760 //7 VAv. Q Esther' h Ge .Pay R.� lTo res ��Hoa - L ry r Q E /49.85 I i C) 99 /ZOn V C T v '�: 0.,7: .. �s q� .D b9 •.,�Says.oi.!f Q�, �. dNQ n 0 N v 0 0 . 5 - Fnden Luep/c Pia �n e n}ai.fYfTH oahwt ek trih ze�e sFi.e o n coramcehress a.� Durn7n / re ;27�P;;: -k: p/i/cishm a ae pr d%7 -7ezoriss e aam sp • • E YT tEbe sf ......... Ry es/ AML aN. ::.c$ta�of'/NisconSin,:::. C�ale W o-Natural /is /L PON J�rit r /Qesou/c t/unt.ii`y G'/u6, Q WILLOW RIVER Inc. rame�y STATE PARK Cor/s.Corn 1 4071,9 Lu 9 @L/T. __ URKH 3� as_�o a ieo y FALLS P • C ice ze Pa/5 e v r9'�'a /b 0 A A Qa 3G 2 //8.72 ©/9BSRocE a d MaP Pub/sz c. SEE PAGE 27 cSt.0 o x CowsWis. HUDSON WILLOW RIVER Reinstra, Van Dyk ELEVATOR, INC. INN Burkhardt, Wisconsin & Needham, S.C. "Never a Loss, when yz Mile Northeast of you Feed with Foss" State Park GENERAL PRACTICE OF LAW L. R. Reinstra - Hendrik W. Van Dyk Horse Feed Our Specialty Old Time Scott R. Needham Country Tavern PHONE: 386-2883 On-Off Sale Liquor 201 SOUTH KNOWLES ® HUDSON, WISCONSIN 386-2201 NEW RICHMOND 246-6806 r DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&f4UMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P`.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NW1,4,NE4}S34,T30N—R19W EN CONVENTIONAL 1:1 ALTERNATIVE (If assPI.nI.D.Number: Town of St. Joseph El Holding Tank El In-Ground Pressure 1:1 Mound County I & 130th Avenue NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: p, Stephen & Debra Berger Route 1, Box 177A, Baldwin, WI 54002 7 — g-q /" BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: 7T P7.ELEV.. Name of Plumber MP/MPRSW No. County Sanitary Permit Number: John P. Sykora III 3212 St. Croix 112648 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. ITANKOUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED DYES ONO 10YES ONO BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. (VENT TO FRESH ALARM FEET FROM LINE: AIR INLET DYES ONO I DYES 1:1 NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY. PUMP MODEL JPUMPISIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ON DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO.OF DISTR.PIPE SPACING COVER INSIDE DIA tt PITS LIQUID BED/TRENCH TRENCHES. MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR PIP' DISTR.PIPE JOISTR.PIPE MATERIAL. NO DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV INLET ELEV.END. PIPES FEET FROM LINE AIR INLET NEAREST-i MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS JOBSEHVATIIIN WELLS 1:1 YES ONO DYES ENO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES DYES E:1 NO EYES 11 NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING (TRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL.&MARKIN(, ELEV.. ELEV.: DIA.. ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY 7MATIRIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES 1:1 NO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER F PROPERTY WELL: BUILDING FEET FROM LINE OYES 1:1 NO DYES 1:1 NO N Sketch System on Retain in county file for audit. Reverse Side. rNATURE TITLE. Zoning Administrator DILHR SBD 6710(R.01/82) i SANITARY PERMIT APPLICATION COUNTY (� DILHFR In accord with ILHR 83.05,Wis.Adm.Code cRelvi'l STATE SANITARY PERMIT# i 960 VF —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. S88-40 —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ® NO PROPERTY OWNER PROPERTY LOCATION f r Nth '/4 N E 1/4,S344 T 317, N, R E (o W PROPER OWNER'S MAILING ADDRESS LOT�MBER BLOCK NUMBER SUBDIVISION NAME 0 I e ,mow/7-7 A I W/�' CITY,STATE ZIP CODE PHONE NUMBER CITY o NEAREST ROAD,LAKE OR LANDMA K 71r 25—3 ❑ VILLAGE : � ( CK rt .i II. TYPE OF BUILDING OR USE SERVED: - ►7� / l Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): �< III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. AJ New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected,and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in 1 and only one in##2) 1. a. F-1 conventional b. Alternative c. ❑ Experimental 2. a. El System- b. 1:1 Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Q�s� �D2•S ��e2•j '�•�O� Feet Private []Joint ❑ Public VI. TANK CAPACITY Site in all ons Total ##of Con- Steel glass Plastic App Prefab. Fiber- Exper. INFORMATION New sting Gallons Tanks Manufacturer's Name Concrete Tanks Tanks structed Septic Tank or Holding Tank ypo a 4 LCC/S r [V ❑ El El ❑ Lift Pump Tank/Siphon Chamber 94 ilf " ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) M PR Business Phone Number: MSW P. S Plumber's Address reet,City,State,Zip Cod Name of Designer: OF- A x 7 ,7zq- ML P. VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## e.. zzgs CSTp's ADDRESS.r(Street,City,State,Zip Code) Phone Number: AV. S�16 Ctwf i / S ©17 7�s Z e'�OZ O� IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Iss ' g Agent Signature(No Stamps) Approved ❑ Owner Given Initial 11 rcha ge� Adverse Determination `` -v" �� ' X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT, APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form ($BD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tahk(s) should be pumped by a licensed%'y+ = pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your.local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a//septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and.phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. i 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; dosing or pumping chambers; 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. ----------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate.The groundwater bill Ground tx9r included the creation of surcharges (fees) for a number of regulated practices which Wisco a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried r>9a sure ' is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) Parcel #: 030-2006-95-005 10/19/2006 05:02 PM PAGE 1 OF 7 Alt. Parcel#: 34.30.19.373K 030-TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner GERRY A&CATHY A SORUM O-SORUM, GERRY A&CATHY A 658 PINE VALLEY TR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *658 PINE VALLEY TR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 4.310 Plat: N/A-NOT AVAILABLE SEC 34 T30N R19W NW NE 4.31A LOT 1 CSM Block/Condo Bldg: 7/1948 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1014/62 07/23/1997 930/521 07/23/1997 807/36 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.310 116,400 237,000 353,400 NO Totals for 2006: General Property 4.310 116,400 237,000 353,400 Woodland 0.000 0 0 Totals for 2005: General Property 4.310 116,400 237,000 353,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 119 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 N "• vlr � 4T p. . dt. s kph a �Y �{ �� `� { 'V.. }, '• �.' rP ,.1P it{ l�`PiY�' s.# �, '_'.'���i��tT � �� a,s Y t•� Z14�`lS, P d, }� f y ""±�'_.�'. 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"`j ,J' s f �.. a �. ���yY�'� �''A �n nr��i4 � r i• „J rtrf .� '`ice" - v ` ' t ,1 ,�� R µ7 '' z. + • 4 " r , t ,Y, A I 'll 1,11. 11 YSTEI \ r< ++ 'RRTMkN T G 1.r"u s �, yd AN.. !,n,p�4 66,iL � t � •,.�,.. SEE GORRE-SP sy t ro s S. CA -yz At`� _ _ _7=42 3 k mow . �.4 i 41 L�- S ' W p � C cltl� Perforated Pipe Detail Q End View " Perforated End Cap �� PVC Pipe ce Holes Located On Bottom, S Are Equally Spaced S P P PVC Manifold Pipe Alternate Position Of Distribution Force Main Pipe Last Hole Should Be Next To End Cop End Cap � Distribution Pipe Layout P 9 5Ft. r R J S Ff Xfo Inches Y Inches y Signed: - _ Hole Diameter _ Inch Lateral Inches) License Number: 9�f' �t2- Manifold 2 Inches Date: 11�)'/9 Force Main 2 Inches ONSITE SEWAGE SYSTEM # of holes/pipe -7 n Invert Elevation of LateralsWA Ft. j1t l„Y R 131 DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY AND B#ILOINGS �. SEE CORRESPON0ENGE 1 -116- prt�l (?_C,_� -(?-ci S'tC'�t%tnEin '7t PE qzl PUMP CHAMBER CR055 SECTION AND SPECIFICATIONS ' 10soft'� ► n I,�� VENT CAP ` 4 C.I. VENT PIPE APPROVED LOCKING WEATHER PROOF JUNCTION BOX MAWHOLE COVER 25' FROM DOOR, WINDOW OR FRESH 12"MILI. ( " AIR INTAKE GRADE I y"MIKI. I B°MIN--• CONDUIT--/"' --------- l� PROVIDE I _ INLET AIRTIGHT SEAL Uo %5C APPROVED JOINTS APPROVED JOINT A + W�C.I. PIPE /4a�-.kite- I III M/IC.I. PIPE EXTENDING 3' / / I II ALARM EXTEAIOING 3' OWTO SOLID SOIL B l r -r ONTO SOLID SOIL ONSiTE S GE SYSTEMS ow . I I:LE.V. PUMP_____ --� OFF rp, rpm np{ i114 RELATIONS CONCRETE BLOCK DEPAR7 Oil 0„� iNOUST y C)iJislioN OF A�ETY ANDbOIL01145 3”APf�RovE RhSEF��E �PERMIT'fED TANK MANUFACTURER HAS SUCH APPROVAL gE,ppANQ rw=W i� QNpENCE SEPTIC ESMWRTrl " SPECIFICATIOUS 005E S 311 ' ,1 TANKS MANUFACTURER: C] aa` '�� "ct f'7` Co, NUMBER OF DOSES: �' PER DAS TAWK SIZE: 12 M GALLONS DOSE VOLUME ALARM MANUFACTURER: .,INCLUDING BACKFLOW: ��G GALLONS MODEL NUMBER: CAPACITIES: A=INCHES OR �(� ��,�_GALLONS SWITCH TYPE' M E-y_Q 4 T�L�,L g=INCHES OR !�L�aALLONS u 11 ale ..n�~L� , C= �INCHES OR S. C GALLOUS PUMP MANUFACTURER: � � z ,:j ,��/ MODEL NUMBER: ��t��� D=INCHES OR A.r=�'"JGALLONS SWITCH TYPE: VkE1_C te-'e-l- NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE-GPM `�f /_~ INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF ANO DISTRIBUTION PIPE.. C.S FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . , , . . . . 2.5_ FEET + FEET OF FORCE MAIN X 3.�lILFjoFLFRICTIOU FACTOR.. • `� FEET TOTAL DYNAMIC HEAD = - `9 FEET,/%, , , INTERNAL. DIMEIJSIONS OF TANK: LENGTH WIDTH ;LIQUID DEPTH E D: `" �`�' LICENSE NUMBER: M RS DATE: �r Y.� � alp '_ .�, �, } «�'r � x� � ., r.r• r FULL COAO AMPS AT ac U.S.GALLQNS Pep fgf NutE w -, C'AS71P+Ca J1M '!AY V,A.f+Y r Distritioed by:, THE MiALFy PUMP COMPWY ,r « f fit'" n i8.3• _ � Ur WVD Ane-PUMPS _. > «+Defeuies 21p 7 a 25F ' r7' S. f.'.fNu x ^F;F"`RS4 LxM_t•zM1. � ,• r 9 Q r f4' S tfT!"t.'�• Jc, j•: •:gP. g � t+ .-b.+a, f '$ , ` r,?6• pp r� w•'��° t E{�''�t ," t �irw xa w >. y t T e x ,W ,¢t '',`. v '*"t-N. t s�' _•� P� y try pit.. � '� #'t , r \ ,.,�. `1>i ry�p„Y,. , r l • «Z - �,; Alto ,. ti"0 �, "•"' n d "i 't %'e' it ' , f• ` tH �. 1 1. oumo S,ii�: - .. b�}tdlti: }r•..=.,..-•..,� � �. ;Pu�����tt�lthif'p it trait tom++ ay��:.� { � r s�li�5 . �,r _ t, .R �• 1't.lOti��YQ�t1Z6'}IE� � .r. �►y�� � ,.,. : s .<: • p ,� ��( r a � w x to'tlt,ltrs.v,oFe Walunis ert t���•, sttrt�VdUM g J f w r` ft, Ipdptytl , y1 Is •1't4 .' ?k- , r.'.,r. 4 C"iV" } z� .'' , *`•U' PwP� :if�O�yly�y��Fd ' ,Sp H �. �MAC��K� ••A. t, � � 'f' .S` '� ... a^�. CItP an "t o0irtttt-> P h Oc ,...,,�.,, it. f<. Qom!GI+ be r•, i 5 t,,J� fat iW; .ettq�hr **ttd COfi1VEKttbtilll..PRtYATE SEWAGE SYSTEM Wastatr �%Otai 04 low ft -r-. 3a`• fJ fFi� of �tfoter `actor- �.._ ._ Use sei*4iti 43.a1 l30 kf it►?s: I tidy et Width(11,' , tt• 11drn.Cede and Pik+Ift,DETAILED i --w- QbM�itdpe CorrtsaRi>rt Factor s ` ' �_ _ CAT CW 51wic tali Pipes. P"ns"e Width fl) - i:_ 2. f3tt I,t d_%4fic Trek Capa.:ItY 4otai Mound Width(14th= . .. fc. i. PcrenIttlod,Rate+l t4.. 04at Alto: 4- �r+et sham: 104tratf o Cagattty+orf` Afrr tv affil!2 In chaptof ti 63 tvacrratSoii= pat.jsq:tt/dav Ind PIROVIOV A t}ETrkILEO LIST Of nasal Area Requirsd=� _.__ V_ ,q, ft. SIZifdrt ON PLANS. basal Are%Avattable r t _..�....o.._, sq,ft. � �egLkadlgrtr= - �. �.`t. !. I?. if StOtdard'Tibtcs from Ch%tytbf . with= �_ ft H,6 ar;uard indkktt TAW Na. i YYldtq _. _ ft 2. Ir4►r ittislr iwilnttwn l�iet,>strorkt l*N*mtors S.14 in Sect:Zr. ii. "`'"t1 irk � Numbew of Aes 4 y ` � t Trey.h SptidirlSe' ' f I. tfW4RO11 $PRES%URE 9Y5TEM 1• �trK tr.4. Disvibut►an System; 1. tll t4OnIl ing F;clot r ti, Lattrri Leng!h• �.,_ _..__. 2. 'Landslepl q Numbir of Lattrais 3, Percoia#art Rata min.iln. La,er4t Spacing- Ir. 4. llrropbstyal Systt Alovativn ft. Olstan"fro)t�S!acwail ze Pipe a ___.. ,— M. 5• Vas4t P#,sad.T01*0ittlr r.low- Sol tiystafi.lr rttton _ _. t'. ' hdep,Code ana P6tOY1pE A EfTgtGEA ", }Y. SYS3EfiO4-Fttl `' t:# T a3 ► iMSG f 1 PLANS: Fick tb 3f;l,terrts'�roxs 54+ Dn 1N z -ACWd t Sttpill 72titt *adty r So 1. �. ri 6. Rbsrirpew>;ArsaS aY: Y Sc PIC YANJC AJ�1'a Rsquind a .a". s SQ.fit. 2.F.=M4j4ut4 cturer 5y tet►Larr;4h 9 1t "show Site Constfgtsd ra#, tletslt!on fun f t#(-1 bude"PI.n^Slrl": Zia t�l,',15RiG TANK 4ir+11t . !)algSJr�Y" s• + �„ "(, i 2.'' afiefsf�!►gr: 3: Pvmt7 Mat►utacitunxr'.�,,.:_�.� _v__ __�._. f s+tri^at Siic - n+° 4. fillip 14.41 ,•::g tli.ttfitaa itstiu 4141rii+.A1 Qu�'i}►r "• ttt, , 1'. �'idttt'�iu '' ,^.:........... g'vt:�. aa. Blatt „1�1'1srr bC.ttas;� `r' ',� " `� .%tijlt�r° Tatrk°1�lt{tltt aa,1!`,fenf •4 ��h �> "� AUK ��* ��'� � •72psid Vii# -t��t)i!!�7'7tt4�'' .: a ,' wo ,r +• •F.+W1• ~ r f S�; vl i10�1��' .. +f�v�'� �.r.-...�... $if.:. _iy�.' rV, MRR � `"' a z' it;p fk� ;�•� i p "'. fa .)+� •,y ; � > v .a C.f't�,• } .,��;, � Zli�. `�,-^>k'�'`tJ . , "� :• � f=i. • +r p 7� ,jar, . rr ..F. re .': � �+t r'!N�.... ,}�s�• � ,� fir-t ��.5,M'!S!:v +q�t , r��. r s r{ 2.P w�n� i s ,�_ t"R'� '1'` " n�., �a y. i�'•�.' �r -.y, 4t ',a 5 1 y • I ,, .... • !"� �".r y: .a T .+ r; 2 { ft,,c fi `r1 ' � ~ Wisconsin State N� Department OfIOdUStrV ���O� @O� Human Relations PRIVATE SEWAGE PLAN APPROVAL� . ~ oAFerv&au/uz|mma omm/om office of Division Codes and Application 2,01 East Washington Avenue P.O. Box 7060 Madison, Wisconsin 53707 � JOHN SYNORA III Owner: STEPHEN & DEBRA BERGER ROUTE 2, BOX 75 ROUTE 1 BOX 177A � ' BLOOMER, WI 54724 BALDWIN, WI 54002 RE: Plan Number: Date Approved: May 25, 1988 Gallons Per Day: 460 Date Received: May 13, 1988 Project Name: BER(ER, STEPHEN & DEBRA Location: NW,NE,34,30,9W - LOT 1 Town of ST. JOSEPH County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved' . This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected . All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one, met of plans with the department' s approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit in obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. Theme plans have not been reviewed for the code requirements net forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. ~' This approval is for the following components onlV- . �~ - NEW ALTERNATIVE Inquiries concerning this approval may be made by calling (608) 266-6952. v � Sincerely, � ALLEN WENDORF Section of Private Se ago Division- of Safety a Buildings PPP020/0009n/15 cu: STEPHEN & DEBRA BERGER Primate Sewage Consultant County ___0^-SSWMP ___Plumbing Consultant ___Owner Plumber _—Environmental Health ono'o*uxm.10/87) | REMINGTON LAW OFFICES ATTORNEYS AT LAW 150 WEST FIRST STREET NEW RICHMOND,WISCONSIN 54017 TELEPHONE (715)246-3422 JAMES T.REMINGTON JUDITH A.REMINGTON 7;,—..LICENSED IN MINNESOTA April 27 , 1988 Ms. Debra Berger Route 1, Box 177A Baldwin, WI 54002 Re: Real Estate Matter Dear Debra: Enclosed lease find the affidavit of Allen Nyhagen correcting P which shows that it was recorded title to the Certified Survey letes the "missing link" in the on April 20, 1988. This comp continuation of your abstract. roadway, and will show up on any Please call if you have questions or concerns. Sincerely yours, REMINGTON LAW OFFICES J ith "Reming'to JAR:nf Enclosure - A P R i98& _ eoo� 8�8 RAr��05 43G425 REGISTER'S OFFICE ST. CROIX CO., WI Reed for Record APR 2 01988 A F F I D A V I T al 2:30 PM Reghter of Deeds STATE OF WISCONSIN ) SS COUNTY OF ST. CROIX) I , Allen C. Nyhagen, Registered Land Surveyor No. S-1407, hereby depose and say that I am a land surveyor registered in the State of Wisconsin and that I have surveyed and mapped St. Croix County Certified Survey Map volume 5, page 1473 and volume 7 , page and that in the description of such maps should be included the words Together with a 66 foot wide Private Road Easement as described in a deed recorded in volume 804, page 566, 567 and 568, Doc. No. 435091 in the office of the St. Croix County Register of Deeds. " That I make this affidavit for the purpose of correcting said Certified Survey Maps and for no other purpose. Allen C. Nyhag n Subscribed and sworn to before me this 2a-cl. day of No ry Public, St. Croix County, Wisconsin My Commission expires 36 J o M C to o�s•i K' STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNE /BUYER �.�' ©L� '� �P_ IPCL P( ROUTE/BOX NUMBER Rbk 1-77A FIRE NO. .� CITY/STATE 1JQ14; L(): c_ 4 '' 667_ ZIP S` M c. PROPERTY LOCATION: AIAW 1/4 t6i /4, Section 34 T 30 N, R /9 W, Town of s'ez , St. Croix County, Subdivision , Lot No. �. 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 for a MAXIMUM of $3000 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 systems properly maintained. The property owner agrees to submit to 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 form 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 Department of Natural Resources. Certification form must be completed and returned to the St.Cr 'x County Zoning Office within 30 days of the three year expiration date. p( SIGNED DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address -=DEPARTMENT 0F"".a, s r:. . ;, _ r R PORT �0 ` SOIL DIVISION LABOR INDUSTRY, � P.O. BOX 7969 HUMANR AND PERCOLATION TESTS (115) MADISON,WI 53707 (H63.09(1) & Chapter 145.045) - LOCATION: SECTION: TOWNSHIPtt. XZ ktM'ITY: [OT NO.'BLK.NO: SUBDIVISION NAME: ?VW �/ TE t/4 34 /T30 N/RL9 fir)W St Joseph n a n/a n/a COUNTY: BUYER'S NAME: MAI LINIs ADDRESS: 8t. Croix Richard Stout R.R.#2 Box 340 )iudson Wi. 54016 SSE DATES OBSERVATIONS MADE Tt�f-i.fi=if rrth7f `t;i<ifilftTiiiFt�LAResidence a I W' New Ulleplace 1-=3=87 10-20-87 l RATING:S-Site suitable for systarn U-Site unsuitable for system CONVEN I NAL: MOUND: IN•GHOUN�FtfRt: ,�YSTEWi�IN"FILL IOLDING TANK: HECOMMENDED SYSTEM:(optional) ❑S ®S 0� S 0U ❑S ©U 0 S PU In- round pressure /limited area motuid used lor alternate area If Percolation Tests are NOT required DESIGN RATE: I It any portion of the tested area Is in the under s.1-163.09(5)(b),indicate: n/a LFloodplain,indicate Floodplain elevation: n/a decimal PROFILE DESCRIPTIONS page 42 MB BORING TOTAL !:PTH TO GROUIVDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH 'NUMBER DEPTH W. ELEVATION BSFRVED FST. IGHE TO"EDROCK. IF 01?SEIIVED '.SEE ABBIiV.ON BA;;K.)_ i B-1 6.50 102.18 none >6.50 1.08bl.1. 5.42 bn.s.l. 13-2 6.34 101.46 none >6.34 .75bl.1. 1.42bn.sil. 2.67bn.l.s. 1.50bn.s.1. +13-3 6.25 101.12 none >6.25 .67bl.1. .75bn.sil. 4.83bn.s.1. B 4 5.16 104.86 none 2.66 .58bl.1. 1.081)n.s.sil. 1.00bn.s.l. 2.50bn. mot.s. 135 4.75 104.86 none 2.50 .50bl.l. .83bn.s.sil. 1-17bn.s.1. .2.25btt.mot.s. B-6 5.59 105.14 none 2.59 .67bl.1. 1.92bn.s:1. 3.00bti.mot.s.1. PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. p m PER INCH P . 3.50 none 30 2% ' 2 p. 2 2.78 none 30 11; 11; 1% 24 -r, ,.TIT, nnnp 30 1 1 /$ J._1/lb ... 1 1/16 _._.__..20 P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hot tontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percei of land slope. SYSTEM ELEVATION 98.68 - -r-� -_ _-. _ - _ . ti1 ---�-- - -- - )--r t I I ' 1 I --Qe 1,the undersigned,hereby certify that the soil tests reported on this fort"were made by me in accord with the procedures and methods specified In the Wlsconsi Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print tESIS WERE CUMPLEI ED ON: Gary L. Steel 10-20-87 _ ADDRESS: CERTIFICATION NUMB Eri: PHONE NUMBER(optional) 988 N. shore Dr. New Hiciuilond Wi. 54017 _ 9q8_ - - CST SI(j 1 NTUHE: DISTRIBUTION: Original and one copy to Local Authority.Property O.vner and',oil Tester, ntt ua 0an.a-10c (R-njJRat _ov;,R _ l 4• 1 er, ±r 4 ,q. C.S.M._Vol. 3, Page 602 a., '0 West line of the NE} of Section 34 r--r- ,. 0 1 11 n--• 90100612511E 59Y.001 SO I 191.75 IN •' c to r. y / ` .� � � to f"i 1d . A It J� 4 e Co 1� 1N N ia_ 0 e O N H 7 fV 1•••1 .rt• � rt M O O �C 1 0 - t0 O to Z tD 1 Cr n O O W W n n ♦ - A C rt N Of N D N Ca t1 O O O T N '7 1 CA r Co 7 O a+ O O N N A d 7 - - 0 1 , 1,?r s {� ° m 4M w o W M rt o rn :., n. H W I � r• IO-• O O O T to O Cn 1 T •-. of w re -7 " SL 1• ; t11 40 .-• 0 Ikj i rn crn s s (A rt 1 r IS0100010 0'IE n fi 63.98' .. r ..._ N M to 7 O ` o • N m y � 2 z z z m > e, T v W N M PC •--"+ i J. N O1 .11 U U .•• t-i 11 o o /+'� o w +.1 .► m {to ut 1+1 cn O M nod1 2 2 2 m •--1 ti CD pp p0 y rn 5:0 4 N i 1 0 w 40 '° rt rt i h i d0.q ;o--} �• C i N rn tc 1 0+ C71 'i 'i r w W d 7 U) 0 1 n 33` 331 o v U, o M A z • 1 0 1 N 10 rt O r Ito 1 �' r N .b. 1 1 - - A m m to 1►-• 111 1"F j) � C) I tJi //v, . . o�'= N01029'27"W 233.30' O 'r ~ Small Tract r 'n c c tJ Bearings are referenced to the H west line of the NE} of Section F _ Z 34 assumed to bear S01006125 11E. r a t, Di C:0 tij _' ....r z CA) ° ? N a 7d c M m ,,3 V Z O to to _ .-. x .Hr = O O 1,11 N ' O ' O This instrument was drafted by Fran Bleskacek Job No. 81-09-187 4 'uvNUlV.cIY t Ivv• J I A It:UAH OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED -435897 eanN $07 MIN 36 REGISTER'S OFFICE $T. CROIX CO., WI Recd for Racord ana JANET F. bTUUT APR 419$8 of 3:55 P/n�M�A conveysarldyyatrffR't o q.". 0 a, .t�C�C K 2t�tilr�lt u n � v v mariTaI P y Re9kler of Deedl RETURN TO the following described real estate In St- Croix County, 170 State of Wisconsin: PART OF NORTHWEST QUARTER of Northeast quarter Tax Parcel No: of Section 34, Township 30 North, Range 19 West described as follows: Lot 1 of Certified Survey Map filed march 29, 1988 , in Vol. 7 page 1948. TOGETHER WITH AND SUBJECT TO a 66 foot private road easement as shown on said Certified Survey Map and Certified Survey Mapsfiled in Vol. 4, page 1063., and Vol. 5, p. 1473. Lot 1 CSM,,Vol. 7page1948is served by a private roadway. Purchaser agrees to pay a prorata share of the cost of maintenance of the private roadway. TOGETHER WITH PRIVATE ROAD EASEMENT as shown in Land Contract between Richard 0. Stout (vendor) and Sandra G. Kidd (purchaser) recorded in Vol. 804, at pages 566-568. $_ This is not homestead property. (is) (IS not) Exception to Warranties: easements, restrictions and rights-of-way of pp record, if any. Dated this JlV day of April C� 1988 il (SEAL) '' Q (SEAL) Richard 0. Stout (SEAL) / ITltiX' (SEAL) Janet P. Stout AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN as. St. Croix County. authenticated this day of 18_ Pgrsonally came before me thlit 29th day of arC 19 68 the above named Richar2l 0. Stout and Janet Stout TITLE:MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the persons who executed the authorized by§708.05,Wis.Slats.) foregoing Instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout Notary Public Croix County,Wia. (Signatures may be authenticated or acknowledged. Both My Commission la permanent. (If not, state Iration are not necessary.) date: ��yd .EJ. _ ,1g .) NOW •Names of persona signing in any rapacity should be typed or printed below their Signatures. NTF 22e0 WARRANTY DEED STATE BAR OF WISCONSIN Nalco Forme.P.O.Box 1075,Green Bay,W154305.1075 Form No.2—1852 ���ri • r APPLICATION FOR SANITARY PERMIT 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 �7teo . ��b'm Oey`zgg Location of property 1/4 1/4, Section _, TAN-R_jy W Township S7L, aa5eQ6 Mailing address Rt i Boy- 17-7A ga/ w e'4 r.j sc Address of site > Subdivision name Lot number Previous owner of property RiC4a+-A siow� Total size of parcel -AA1 . 42:11-a _ re � S Q Date parcel was created Anir JOB Are all corners and lot lines identifiable? _Yes No Is this property being developed for resale (spec house)? Yes N0 Volume land Page Number lq#' 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 1(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. f4 a 5 8 c�7 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of th ounty Register of Deeds, as Document No. i ture of Owner Signature of Co-Owne (If Applicable) 06 -5- -/ 7 '0� Date of Signature Date of Signature