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REPORT OF 74SP€CTION_INDIVIDUAL SEWAGE SYSTEM San.itany Penmit • State S P ptic% r KAME� ��...`,; -� �_-i, , :�;.,T�rownahip S C,%oix County Locat.i.oK l (; Section r — SEPTIC TANK i Size gattona . NumbeA o6 Compantmente�_ ViAtance FAOm: Wet t I 12.1 ox gneateA atope--- 6 Buitd.ing it. Wettand.a — #. H.ighwaten = it. DISPOSAL SYSTEM . gAeateA atope Oaf n. v it. D.cstanee FAam: Wet /� �#. 12% o Bu.itd.ing�o it. Wettand.6 a-- Ft. . I H.ighwateA St. FIELD DIMENSIONS:Width o6 then ch / it. Depth. o6 Ao ck b etow t i.te_42__-i.n. P— Length a6 each tineTG it. Depth o6 Aock oveA ti.te 2 in. NumbeA- o6 ,t.inea Depth o6 t.ite b'etow grade 3 f .in. 1 Totat .length oS tined it. Stope o6 thench in pen 100 it. Di4 tanee between t.inebit. Depth to b ed to ck St. Totat abzonbti.on an.ea Gad 6t2 Depth to gnoundwateA Requited area 6/ S it2 Type o6 Coven: Paper oA PIT DIMENSIONS: Hum be& of pit-6 GAavet atound p.itb yea no Outd.ide d.iamet' A t. Depth betow' intet 2 Totat abaoAb "on aAea it z A 2 Area %equi;xed= it 1 NS PECTED TITLE APPROVED _,DATE 1 3 ` 197 8 REJECTED ,DATE 197 �` EH 115 Rev.9178 ,. .� REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O.BOX 309,MADISON,WISCONSIN 53701 LOCATION:_SC Nom'/.,Section I�p� ,T Z8 N,R t9 W,Township e1-Munieipality - Lot No.- ,Block No. l9 L.oVerZ SZA-r1 O M County �� �'�` rvision ame rw Owner's/Buyers Name: �IVPi►S Q . G 0vT"2 Mailing Address: -Z_7- S ,Alto <-C- 12\ /��c c.S 974oz- TYPE OF OCCUPANCY: Residence No.of Bedrooms 3 COMMERCIAL ' EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 11D! 119-1 q PERCOLATION TESTS t-A' A' SOIL MAP SHEET �Z NAME OF SOIL MAP UNIT _50e� i"941-Y (Sa-c-r9 PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- Lr G Q L(a^a'�o wrt `%TS 'vv"C Cm tJ u t�(3' g t SIPS t iV 0 C+e tx1 P- Sol rJ A criatj• ►S AS C.00r-114 T» We J LLr 0 I` 4LA4. "Odr P- Q so vL aoatl.L— S'I'TS „ P (9 Q V ll-fL TO `Z� N w R � t.�T O N I� Ott 10 y(N td iv P- �Q �C'Zly �t212kk}19�Dr St?ll.S A ® v-�I� •r= I 61 T o " rN0 Ott �r6. A,T OZ710-04 VOL 3o" -ro Go" SOIL BORING TESTS US-,V CLASS I TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- (< -7Z MoNcr y -T 7- L I" s I(., B- 2 -74 Note 7 `7 4-" L_ 104A s I 'z r�' 3 44-" B- 4 `7Z NoNI?' B— S N L 7 '72`" L- t® s, B- PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy P6 .D 3XZa"a� 1S Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. e.Q ' T IA srau.a-ri N 4A0a4'4.6'AV4 -}- 7 ( •o : � wo►nJ t�PT1� f L.� e { 4 t o2 L`�►5 ..�s SAD 3 r X� _ _, . ... +4 Soo Frl`" i 1 -- _ I -{ V N 0►4-�-trs too, _ S i "F6 1 ' S I 9 p,, .�3• 13S X13 $ $( e R g I,the undersigend,hereby certify that a soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) '• ""7 �` AA Certit cation No. Address 3 1 Name of installer if known Copy A—Local Authority CST Signatur kA i PLB State Permit 67- State and County Permit Application County Per for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY aih Address: y� CC[ -v 2-- ��lA t l U( 1�� �/�,+2A-tom$ <<S, � N�fs B. LOCATION: 0 Section T_N, R_ E (or) W Lot# `r City Subdivision Name nearest road, lake or landmark Blk# Village y0 )C_ 2 „ &I,L,Tt4 6A At �4C 14-iC_ Township � Y C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family K Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY r©d U Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete ✓✓ Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUE_fyl DISPOSAL SYSTEM: Percolation Rate t Absorb Area sq.ft. New Replacement Alternate (Specify) Seepage Trench—_No.of L�Peal Ft. Width 4ppth Tile depth toy)—No.of Trenches Seepage Bed: Length -5 �-- Width��Depth Tile depth (top 'Z No.of Lines Seepage Pit: Inside ia ter Liquid Depth No.of Seepage Pits Percent slope of land_ rs Distance from critical slope WATER SUPPLY: Private I& Joint❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effkuent disposal system from the EH-115 prepared by the Certifi it Test ��� NAME �M�=S 1,/of C.S.T. # Z0�,7 and other information obtained from yt kl (owner/builder)" �� Plumber's Signature MP/MPRS # �j/ Phone # 7'•� Plumber's Address GS Z PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20.Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. 3 T, a t a I B Im faA .. � ti a. ed { a a.. .T a....., a,.> ..,. ..,«a.e... a ... _. . ... .. ... -. .... .. ._... ,. _m._. E , Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENY USE ONLY �. Date of Application C .- Fees Paid: State t . C' qount)i 4 q,0 O Date 013 Permit Issued/fiaiid ( ate) 7Z Issuing Agent Name - Inspection Yes No State Valid# Date Recd 1. county (w ite copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 PUMP CHAMBER Manufacturer: Liquid C pacity: Pump Model: P p/Siphon Manuf turer: Pump Size Elevation of inlet: W Botto of tank elevation: Pump off switch elevation: Gallons per cycle: e Alarm Manufacturer: Alarm Switch Typ . Number of feet from neare t property ine: Front, O S de, O Rear,0 Ft. Number f f et from well: Number of f et rom bu• ding: (Include distances n p of plan . SOIL ABSORPTION SYSTEM Bed: Trenc : Width: Lent : Number of ines: A a Built: Fill depth to top of ipe: Number of feet from n arest p o rty line: Fr nt, o Side, O Rear,0 Ft . Num)er of f e from well: ,. Number of feet om building: (Include distan es on pl plan). SEEPAGE PIT 1 Size: Number o pits: Diameter: ` Liquid depth: B ttom of seepage pit elevation: Area Built: Has either a drop box or di ri4A Wn box been used on any of th above soil absorbtion sytems? (C eck one). HOLDING TANK Manufacturer: apacity: Number of ring used: Elevat' n of bottom of tank: Elevation of i let: Number of -fee from ne est property line: Front, O Side, Rear, O Ft. Numb r of feet fr m swell: 4" .•. Number f feet from uilding: N tuber of fe t from nea est road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj • Form - ST C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 7-/®/nom cs_ o ,TOWNSHIP SEC. /G T -R 19 er ADDRESS 38 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT �_ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW I BENCHMARK: Describe the vert al reference po nt used Elevation of vertical ref ere ce oint: Proposed s o e at site: SEPTIC TANK: Manufacturer: Liquid Capacity Number of rings used: Tank anhole cover elev ion: Tank Inlet Elevation: Tan Outlet Elevation: Number of feet from ne rest R d: Front,O Side, Rear, feet From nearest pr perty li e Front,O Sid ,O Rear, feet Number of feet from: well building: (Include this informati n of the a ve plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING ` MADISON,WI '53707 ' SE4 fVE%,S16 T28N—R19W CONVENTIONAL Repair El ALTERNATIVE State Plan I.D.Number: If assigned) Lot 17 Glover Station ❑Holding Tank ❑ In-Ground Pressure ❑Mound Town of Troy NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D T Thomas & Jane Hoffman Route 3, Box 207, Hudson, Wi54016 I I � BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PL ELEV.: Name of Plumber: imp/MPRSW No County: Sanitary Permit Number: Henry Nechvil.l.e 3258 St. Croix 95990 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO I DYES ❑NO BEDDING: VENT DIA.: I VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM. FEET FROM LINE: AIR INLET. ❑YES ONO 1:1 YES ONO NEAREST DOSING CHAMBER: MANUFACTURER. 7ING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ES F-1 NO OYES ONO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBEROF PROPERTY WELL BUILDING. V (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES E NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (if soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING. COVER INSIDE CIA.. *PITS- LIQUID J301T# b►Ctf° TRENCHES MATERIAL: PIT DEPTH: i I4"toN3 GRAVEL DEPTH FILL DEPTH IDISTR.PIPE DISTR.PIPE DISTR.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 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. ❑YES ❑NO' SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS ❑YES ONO OYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED =TOPSOIL. SODDED SEEDED MULCHED. CENTER. EDGES. DYES 1-1 NO 1 1:1 YES ONO I ❑YES ED NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: 9e s MANIFOLD PUMP MANIFOLD DISTR,PIPE MANIFOLD MATERIAL: NO OISTR, DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.: ELEV.: DIA. ELEV.: PIPES: DI A.: IAI< TI € U `iN y�RIB y�. HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED , yIMTl7 PLANS: ❑YES F-1 NO El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMOE'R©F PROPERTY WELL: BUILDING: FEET FROM LINE: [!]YES El NO El YES 1:1 NO INEARE� Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE: DILHR SBD 6710(R.01/82) Zoning Administrator INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION • t� 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 (SBD 6399) to be ' submitted to the county prior to installation; 5. Private sewage systems must be•properly maintained:The septic tank(s) should be pumped by a licensed 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. Prcaerty owner's name and mailing address. Provide the legal description where the system is to be installed; II. 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 all 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; I I I . , X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimeri'sions, 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 ateir included the creation of surcharges (fees) for a number of regulated practices which Wisco ICI's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried IeaSttFBI is used in your building-is returned to the groundwater through your soil absorption ' a 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- - t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) D1LHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code �.R.,...,.e......,,o� STATE ANITARY PERMIT# 19,C) -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. -See reverse side for instructions for completing this application. PETITION �+ 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ONO PROPERTY OWNER PROPERTY LOCATION Ja m arc Ste '/4 414 '/4, S /l T;B, N, R J9 E(or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER I BLOCK NUMBER SUB I I ION NAME_ CITY,STATE 12!IP CODE PHONE NUMBER 17n CITY NEAREST ROAD,LAKE OR LANDMARK O 1` S ❑ VILLAGE 0-'MWN OR 11. TYPE OF BUILDING OR USE SERVED: I�2G Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. ❑ Replacement C. ❑ Replacement of d.❑ Reconnection of e. epair 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 SY EM: (Check only one in#1 and only one in#2) 1. a. Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPT!9XSYSTEM INFORMATION: (Check one) 1. a. `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: (M. t per inch): REQUIRES{ are Feet): PROPOSED(Squ a Feet): /TY Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tank structed Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber EHE-4=1777� EJ ti VII. RESPONSIBILITY STATEMEENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plu mber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: #,--Alp /V. cX y/�4 L,c- _!9_2? 7 /S 7y 9— 33� Plumber's Address(Street,City,State,Zip Code): L Name of Designer: ., VIII. SOIL TEST INFORMATION CertifiTW ster(CST)Name CST# CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) LIN Approved ❑ Owner Given Initial r CN - Fee Adverse Determination ' I I 1r1� X. CgrENTS/REASONS FOR DISAPPROVAL: ICS v I b �` h�,�S , f j I�So � a � SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT 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 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 Location of Property ,5 J k, Section , T=N-R W Township IV, !4 Mailing Address Address of Site Subdivision Name Lot Number Previous Owner of property Total Size of''Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number _�e.'_L__ 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) ceh tib y that att statements on this bonm ane t tue to the best o6 my (ouA) knowledge; that I (we) am (are) the owner(s) o6 the pnope t ty described in this .inbonmation boicm, by viAtue ob a wa,,ftanty deed neconded in the Obb.ice ob the County Reg-iisten ob Deeds" Document No. © ° p ; and that I (We) pne�sentty own the pupo.aed site bon the sewage dispozat system (on I (we) have obtained an easement, to nun with the above de,6chibed pnopexty, bon the consthuction ob .ba.id system, and the same has been duty neconded in the Obb.ice ob the County RegisteA ob Deeds, a.a Document No. ) . IGNATURE OF 0 E ' SIGNATURE OF CO-OWNER (IF APPLICABLE) DAJE SIGNED DATE SIGNED DocuMENT Plc. STATE BAR OF WISCONSIN FORM 1—fMt(� TMa sawca sstssaraa 0"1011�10110e aaa WARRANTY DEED �40'�030 1u� 126PAGE247 REGI5TEO Or"C! This Dom, made between ..Dennis R. Schultz and ST. CAOIX CO., WfEIi G Sandra Sdzultz his wife ....................................... - ... . .-. ...... .r. . ... .@, ai� .?:n �. own.right, ------- -------- Recd. for Rowd IN3 13th '..Grantor cY of��10P 5 and nxnas Hoffalan and• Jane-Hoffinan,..... f.. . . ...... .. . . .. .twsblarri and wife, as joint tenants, Grantee Witnesseth, That the said Grantor, for a valuable consitsration..... 010" wad I conveys to Grantee the following described real estate in - St. 6:6ii-... ... . asruaN' AS IATION OF EAU CLAIRE County, State of Wisconsin: 5,('2V$laffl Tax Parcel No: ................................... Lot 17, Glover Station in the Town of Troy. Zhis deed is given in satisfaction of a Land Contract between the parties dated February 24, 1981 and recorded with the St. Croix Oaunty Register of Deeds on February 25, 1981 as Document No. 369523 in Volume 625 of Records, Page 611. This is homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantors warrants that the title is good, indefeasible in fee simple and free and clear of encumbraulea except for easeiments, restrictions and covenants of record and will warrant and defend the same. ,,// p hated this day of Alov 191�JS . Q C (SEAL) ,J�LW1A(�� v` . ^�► (SEAL) Dennis R. Schu tz (SEAL) � lJ� c (SEAL) . Sandra Schultz AUTHENTICATION ACKNOWLEDGMENT Signatures) _Penns R...-Schultz and....... STATE OF WISCONSIN ' Sandra Schultz Sg __ . . L County. authenticated this I� day of..A!bl1 194U 1'ersonally- came before me this ............. day of �•. r �45�p - _ .. . 19 ....... the above named M " . TITLE: %1F:�NIBF:R STATE BAR OF WISCONSIN .... authorized by '� 7iif.0c, R'is. St:Its.) to me known to be the person - s who executed the fomgoin); instrument and acknowledge the same. THIS t-Rl;r; n," V%AS Li AF7 FD t:Y C. f Bye, Attorne at Law PO ik.)x 167, River Falls, WI 54022 N..L. I'nhli' Counhv. It n r a} I r it 00.vritwatod .r acknow•II•d 1•d. lloti• \l. I r win'inn i wrtnan,tit. of a' f not, slat/. ,s;I.rat,­1 Il l:• •ti.^.•r ' ...L> .,[n:cR u• .r., rrr�:r n- l Irr ty,. I .. ,.r.t.,� t.. .ie:_ r•- CMB:.'•,- H C W.*'Crn�.arry M STATF B1H OF NIhf115�15 ® FORM ,.. I—19yY Stock No. 13001 + H ' to H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT c St . Croix County x V a OWNER/BUYER -�s's��t �.9�-„L_ �e��,.���-e H ROUTE/BOX NUMBER ;21!9 7 Fire Number $ .CITY/STATE / / . ZIP PROPERTY LOCATION: 5S= , , Section , T S N, R /2—W, Town of �. k ;`/ , St . Croix County, Subdivision /, f is ,y , Lot number J7 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment 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 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , 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 . 0 I/WE, the undersigned , have read the above requirements and agree H to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- o ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE 6 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 . a U� 61-� 76 V,-.4 C S i NSA i i OQT 3 Aok po y z 3 7 E 9ft