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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cf0]X
Safety and Building DivisionZ
(,� r INSPECTION REPORT Sanitary Permit No: 420534 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. /V
Permit Holder's Name: City Village X Township Parcel Tax No:
Rolling Hills Development Troy Township 040 - 1189 -60 -000
CST BM Elev: Insp. BM Elev: BM Description:
q 9-1 q �..7 2" v
TANK INFORMATION IF ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Bench rk
xj TK, CEr Ci 81hZ l o 3,
Dosing � , J /1 / O , � Alt. BM
Aeration /'t� — Bldg. Sewer , l 0/d
Holding 77 S Ht Inlet
/3. illi
SVHt Outlet
TANK SETBACK INFORMATION /
TANK TO P/L / fflELL PLDG. Vent to Air Intake ROAD Dt Inlet �—
W r
Septic C � t4 > � Dt Bottom q2 "P /7-7 5 �
I �' -X
Dosing > 7i 6� ea H r /Man.
Aeration 15ist. Pipe / p P. , 6 —, I
Holding Bot. Sys V y(r
2
Final Grad
PUMP /SIPHON INFORMATION Z 2 9�
Manufacturer S / GPM Demand St Cover
Model Number Z�� (] 121 Qe ot� ty
TDH Lift Friction Loss System Head T Ft 0
/ Z,/� S 2 -5 /6 L1
Forcemain Len / D 4, Dist. to Well
SOIL ABSORPTION SYSTEM // C�
BED /TRENCH Width 31 Length No. Of T�ches PIT DIME IONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS (�
SETBACK SYSTEM TO 1 P/L tBLD WELL LAKE /STREAM LEACHING Mufactuy�f�� V �/ /2
INFORMATION CHAMBER OR =L yr >` JTaF
Typ (System: L yw � / � ( 2 -C �
7l U It S Model Number:
DISTRIBUTION SYSTEM
Header /Mani Id Distribution x Hole Size x H 1aSpeeing Vent to Air Intake
l✓ l Pipe(s) l„ C, r /' l 1
Length Dia Length F/ Dia paan
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched r
Bedrrrench Center ed/Trench Edges Topsoil �—
� ®Yes D No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: �� l l Z( // OZ� Inspection #2: / /
Location: �2 County Ro M River Falls, WI 54022 (SE 1/4 NW 114 28 T28N R19W) Oak Rid a Acris Lot 86 t_ Parcel No: 28.28.19.839
1.) Alt BM Description =T.p 4v
2.) Bldg sewer length =
- amount of cover = > f/ �_ S S- �l�v►� 1�,� SQ v
Plan revision Required? Al Yes W
4L
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's ignature Cert. No.
E1 9t/l E�l`1 S r
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7082 `3T. U_a tX
*is consin Madison, WI 53707 - 7082 Site Address 11 n
Department of Commerce i/ r I —r Z `3�402_,�, 3
Sanitary Permit Application ermit tuber
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide h �tevisi
may be used for secondary purposes Privacy Law, s15.04(l)(m)
I. Application Information - Please Print All Information State Plan I.D. Nu b
Proper Owner's Na me
11' & ev�� e en 1� Z o -
Propert Owner's ailing Address Property Location
S L 1f�
r ( �a /o /(/ /a ; T OV N, R 1 C
City, State Zip Code Phone Number Lot Number p / Block Number
010/ �y ion s N me M Number
rl F11s lljj - Yo�� ���� a�oo
�� �C're
II. Type of Building (Check all that apply.) ❑ City
k' 1 or 2 Family Dwelling - Number of Bedrooms ❑Village
❑ Public /Commercial - Describe Use OTownshi
11 State Owned / 1 Nearest Road
III. Type of Permt : (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.)
A. 1 ❑ New 2R eplacement System 3 ❑ Replacement of 6 ❑ Addition to For County use
System Tank Onl Existing System
B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV, Type of POWT System: (Check all that apply. Numbering is for internal use.) '� PS 68� OhQ IV/ 71
44 Non - Pressurized In Ground 2111 Mound 47 Cl Sand Filter 50 ❑ Constructed Wetland J
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line ��r tlrt1OdlL ►1 C°��,�(`t� k
45 13 At -Grade 46 ❑Aerobic Treatment Unit 49 ❑ Recirculating 30 Other IGG11 6?rS �A
V. Dispersal/Treat ent Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required &q3 0 Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) / n Elevation
% .
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Dosing Chamber
�Xe sc r x
VII. Responsibility Statement- I, the undersigned, assume responsibility for insta n o OW'L'S shown on the attached plans.
Plu ber's Na me (Print) Plu Si gnature M MPRS Num Business Phone Number
fi � �6 �s -�
Plumber's Addre ss (Street, City late, ZiX e)
� 9b �7� YetUer �A
VIII. County/Department Use Onl
Disapproved Date Issued Issu' g Agent Sig ture (No Stamps) 11 ❑ Sanitary Permit Fee includes Groundwater
Approved Owner Given Initial Adverse �� Ij
Determination Surcharge Fee) �S . / �
IX. Ci I nditio saf Qppr 1 /Reasons for Disapproval
1
u , Ire
tk
Attac complete plans (to the County only) for the system on paper of I than 81/2 x 11 inches in size
Y
s �, u ",. b, j W adAS Ij 4_4�_ i s `l
d
SBD -6398 (R. 05101)
-- - ---- - - - - -- - - - - -- -------------------------------
03/12/2001 20:45 7154252160. FOX ENTERPRISES PAGE 03
Soil Test Plot P1a
Proiect Name Rolling Hills Development Sha irk'
Address 84 Woodridge Drive
River Falls Wi 54022
L TM #226900
Lot S Subdivision Oak Ridge Date 10/22/02
SE 1/4 N W 1 /4S 35 T 28 N/R 19 W Township Troy
Baring Well PL Property Line County ST. CROIX
`BM or VRP Assume Elevatio 100 ft. Base of Siding g,�
Svslem Elevation 96.9196.6 *RRpS as Benchmark
Alt. BM Top of Porch @ 99,7'
Cty Rd MM
well
50'
Existing 3
` Bech - oorn
House �?
Deck
0 $
s 9 T
0$ a
V Approximate old
dri)i.iifield location,
W no vent pipe
a foLind, only a
round
e ression 1
an conversation
wit owner
, V
3% L a , F; tn. 9 �'s .StA.✓t ;AJ
Slope
171 tire to 44.
2cr' 100' 9 s. �14L)5 9b► q d �d, b
_ _ _ _ _ _ _ _ _ _ _ --- _ -- _ -----------------
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ �� - - - _ _ - - _ _ _ _ - - _ _ _ _ - - _ - - - - - - - - _ _ _ - - - - - - _ - - - - - - _ _ _ - -
- - - -- ------------ - - - - -- -------------------------------------------
03/12/2001 20:45 7154252100. FOX ENTERPRISES PAGE 03
Soil Test Plot Pla
Prolect Name Rolling Hills Development Sha irk
Address 84 Woodridge Drive
River Falls Wi 54022
L TM #2269Uf)
Lot 86 Subdivision Oak Ridge Date 10/22/02
SE 1/4 NW 1/4S 36 T 28 N/H 19 W Township Troy
Boring Q Well PL Property Line County ST. CROIX
BM or VRp Assume Elevatio 100 it. Base o I
Smem Elevation 96.9/96.6 *Hpp as Benchmark
Alt. BM -� Tap of Porch @ 99.7' E ^ Cty ltd MM
� P
well
20 1
50'
^a Existing 3
j 2a' Bedroom
* House ,
� L-Ck /
0 0
D a?
T
v 95'
5 ' Approximate old 7 ��
dranilield location,
W no Vent pipe
8 found, only a
round
PUS; ression /
an conversation
6 � wit owner fi►r �1 S C� ", / 4'ryt l• �
J ,
b F rn. —_- Slope 6 �I� �! ,
tir &-td,
20; log° s.
-- ------------ - - -------------
- - - -- - - ---- z 0
---- -- -- -- �r•� -1
BZ
Wiscunsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 81/2 x 11 inches ' : Plea rrwst- - County ol
Include, but not limited to: vertical and horizontal reference point (B ), dir ion #Ad p� I.D. $Z p V 14Y Yn M
percent slope, scale or dimensions, north arrow, and location and stance to nearesf road.'"
Please print all information. Revie ed by Date
Personal information you provide may be used for secondary purposes (P y law, s. 15.04 �) ( )
Property Owner Property Location
�drt tot c 1!4 !4 S T N R E (or
Property Owner's MailingWdress If Lot # Block # Subd. Name or CSIM �
City State Zip CUde Phone Number ❑ City ❑ Village own Nearest Road
2r ; a
New Construction Residential / Number of bedroom _ Code derived design flow rate GPD
eplacement ❑ Public or ommercial - Describe:
Parent material � y -l"� -� FFl
loodd Plain elevation if applicable A4125�
and recorri dons: /yam �i tom 9
and % // b. !e
B or i ng #
Boring
Pit Ground surface elev Depth to limiting factor y — in.
Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
S i 3
q�, o
`�16
Boring # �] Boring
0 pit Ground surface elq/ Depth to limiting factor /�/ `� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
.q{ &c.
Effluent #1 = BOD > 30 < 220 mg1L and T < 150 mg1L ' Effluent #2 = BOD < 30 mg& and TSS < 30 fug&
CST Name (Please Print) _ Si ture PST Number
s �� �� 2 2
Address Date Evaluation Conducted Telephone Number
f
4
Property Owner Parcel ID # Page of
F3-1 Ong # [] Boring
Pit Ground surface elev. L ft. Depth to limiting factor in. Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •EffQ
4� -
34 2
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
F 9RApplication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. •Eff#1 •Eff#2
Boring # a Boring
Ground surface elev. ft. Depth to limiting factor in.
❑ Pit
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BOD 130 mgA. and TSS < 30 mg1L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
sso4330 lR6(00)
Soil Test Plot Plan
Project Name Rolling Hills Development Shaun Bird :, '
f�
Address 84 Woodridge Drive
River Falls Wi 54022 CS 226900
Lot 86 Subdivision Oak Ridge Date 10/22/02
SE 1/4 NW 1/4S 36 T 28 N/R 1 9 W Township Troy
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevatio 100 ft. Base of Siding �
System Elevation 96.9/96.6 *HRpSame as Benchmark
A t. B Top of Porch @ 99.7'
Cty Rd MM
Well
20'
50'
Existing 3
;.� 20' Bedroom
a�
B Ouse
a
° g Deck
c 10' Alt
95' T
5' pproximate old
drainfield location,
D W no vent pipe
found, only a
inground
depression
and conversation
with owner
3%
Slope
0' 100'
B ; 1 F 20' 20'
10' 15' 30' B -2
15' 101'
100' Property Line
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to c that I haveed t e septic tank presently serving
the L a LkQ CC esi.d ce located at
Sec. 3(,:5 , T a ff N, Rjq W, Town of t�G' St. Croix
County, Wisconsin. Upon inspection, I certi4 that I have found the tank and
baffles to be in good condition, and it appears to be functioning properly.
Last time serviced 2 ��
Did flow back occur from absorption system? Yes Nok (if no, skip next
line.
Approximate volume or length of time: gallons minutes
Capacity: e z) I
Construction: Concrete Prefab �_ Steel Other
Manufacturer (if known) :
Age of Tank ( if known) :
(Signature) (Name) P / a f s G e � Print
�� %7IJ!
(Title), (License Number)
"at)
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or
licensed disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
-
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank condition, I
certify that the tank, to the best of my knowledge, will conform to the
requirements of ILHR 83, Wis. Adm. Code (ex c t for inspection opening over
outlet baffle).
Name 6 Q Signature
MP /MPRS
PAGE OF
�. .
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VENT CAP
4 VENT PIPE APPROVED LOCKW
w WEATHER PROOF
JUNCTION BOX MANHOLE COVER W
28' FROM ODOR, IZ'MIU. wo►ret'�'il ;,�Ibr./
WINDOW OR FRESH I
AIR IfvTAKE
GRADE I y" MIN.
(
CONDUIT — " _ — —
18 "MIN.
, PROVIDE I -- --
INLET AIRTIGHT SEAL
II v
APPROVED JOINT A I I APPROVED JOINTS
I W /C.I. PIPE
WIC.I. PIPE (
EXTENDIUG 3' I ALARM EXTEMIDING 3'
ONTO SOLID SOIL B i i I ONTO SOLID SOIL
i ON
C
LL.EV. FT. - -j
PUMP --� OFF
D
CONCRETE BLOCK
/� IO . APPRoV
�- RI
SER EXIT PERMITfEO 7,y IF TAIJK MANUFACTURER HAS SUCH APPROVAL gEpplN�
SEPTIC E SPECIFICATIOUS
OOSE
TANKS MANUFACTURER: NUMBER OF DOSES: PER DAy
TAWK 51ZE: GALLONS DOSE VOLUME �� j 4a
ALARMI MANUFACTURER: +" - fiI INCLUDING BAC�KF�LO GALLONS
MODEL NUMBER: CAPACITIES: A= ao, g INCHES OR 3 51 CALLOUS
SWITCH TYPE: h7e r f 4 INCHES OR ..�Z� O GALLOMS
PUMP MALIU FACT LIKE R: c" , 1 1t C= ` - IN / CHES OR 1. GALLONS
MODEL NUMBER: D- INCHES OR r • GALLONS
SWITCH TUPE: MOTE: PUMP AND ALARM ARE TO BC 17,00 ql rth,
MINIMUM DISCHARGE RATE ^? GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEU PUMP OFF AUD .DISTRIBUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPL?! PRESSURE .. . . . ... . .. 2 . 5 FEET
♦ EL `:EET O F FOR M AIN X Q' r F /IOOFEFRICTION FACTOR.. FEET
TOTAL DYNAMIC. HEAD = /L 3 FEET
IMTERNAL DIMLIJSIOWS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH
SIGNED: LICEWSE NUMBER: DOW DATE:
S tib me rsibl e MODEL: 3871
SIZE. 3/4p SOLIDS
F.Iffluent P RPM: 1550
HP: 0.4
METERS FEET
8
25
7
0
W g 20
� 5
Z 15
p 4
3 10
2
5
1
OL 00 10 20 30 40 50 GPM
0 2 4 6 8 10 12 W/h
CAPACITY
LDS
U� M ,
Epacdw, Ock6w,1988
O 1988 GOUMS Pump. Inc. 9PECIFlCA7WW ARE 9ULIECT TO t�1A M WITHOUT NOTICE PRINTED IN U.5A.
C3871
r
`ateC System Management Plan
Puuant to Comm 83.54, Wis.Adm. Code -
"ecti_ . c'iank
The septic tank shdfbe maintained by an individual certified to service septic tanks under s. 281.48. Stars. The contents of the
septic tank shag be disposed of in ac drdance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter $14011 be assessed at least once every 3 years by inspection. The outlet flue.• stall be craned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that
may Stough off the filter when removed from its endesure. if the filter is equipped with an slam, , the Cater shall be serviced if
the alarm is activated continuously. Intermittent filter alarms may indicate surge bows or an impenifing continuous alarm. The '-
septic tank shag have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of
the tank. lP the contents of the tank are not removed at the time shag advise
of a triennial assessment, rttairttenartca personnel
ehe' h when the next service needs to be performed to of fens than maximum srrm and sludge acarnndadon in
the tank. The addition of biological or chemical awes to enhance septic tank perkrmance is generally not required
HmG s D r Producs are used they shag be approved for septic tank use by the Department of Commerce, .Safety and
g,
Pum° Tank
The pump (dosing) tank shag be inspected at least once every 3 years. All Michas. alarms, and pumps shag be test6d to
Proper operation. If an eflkrent t3iter Is installed within the tank it shag be inspected and serviced as necessary.
At- rade Component and Pressure Distribution system
No -trees or s ru s soul a Plante or al owe to grow on the component. Plantings may
be made around the perimeter and the component shall be seeded and mulched as necessary
to prevent erosion and to provide some protection from frost penetration. Traffic (other
than for vegetative maintenance) on the component is not allowed. Cold weather install-
ations require the component to be heavily mulched for frost protection.
Influent quality into the at -grade system may not exceed 220mg /L BODE, 150 ag /L TSS and
30 mg /L FOG. Influent flow may not exceed the maximum design flow specified in the permit
for this installation.
T he Pressure disinbntion system is provided with a bushing point at the end of each la teral
Literati be flushed of ac=nulated solids at least once When a p ressura test is , and g is recomme Performed ft should be
shou that each
compared to the k" test when the system was installed to aine g ortfice
re9� to maintain sq� disbtbution wftftfn the dispersal cell• mi g cc =red and if orifice cleaning is
Observation pipes within the dispersal cell shall be checked for effluent ponding.
Ponding levels should be reported to the owner and any levels above 4 inches considered'
as an impending hydraulic failure requiring additional, more frequent monitoring in
accordance with• Comm 83.52 (2).
General
Ms system shall be operated fa accordance with Comm '82-84 Wis.Adm.Code and shall be
maintained in accordance
state rules pertaining to with it!$ component manual SBD 10 570 - P /99)'and local and
system maintenance and maintenance reporting..
No one shdwld ew enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
P tank aba*rrnent shag be In accordance with Comm 83,33, Wis. Adm. Code when the tanks are no longer used as
aunponents. .
Septic or pump tank manhole risers, 2 dx 53 3 risers and covers should be inspected for water tightness and soundness. Access
used for service and assessment shag be sealed watertight upon the completion of service. -Any opening deemed
edive, or subject to fagum must be replaced. Exposed ad s$ o�ten6gs greater than 8- frmhes in diameter shall
be secured �onttnn a 9 device b prevent ac�denhat or iutairtitoctzed entry into a tank or camportertt.
!Effie sepBc tank �
any of its components become d = _ -a•. ,.r,.. •_
efec5ve the tank or component shag be repaired or M?Wcgd to keep the '
'1n Piper operating Condition. _
ifthidoft tank, gyp. P Controls, alarm or related
Coking becomes defective the defective component shag be
If t r�with � with anent of the same or equal perkm ancL - — • _' _ - -
f,►r pone`at` fails to accept wastewater "os beg3aa - to dis arge wastewater �tdi
the ground snrfaee, it may be necessary to install as aerobic pre - treatment snit or
.replace the component. Additional site and soil•gvaluations may need to be done. and
additional plans may - need to be prepared and approved by the Department of Commerce,.
Safety and Buildings Division. .
Questions about the operation or maintenance of this system should be directed to-
- The County Zoning office at
The system installer at "�L$_ Z,$- q.Q Wpthj .,
The tank manufacturer at 1S66 ,3 ZS_8 -s
The effluent filter' manufacturer at _h - ZZI - S` (I I Z.!L
"�� C �ry„e.h • .� - 6 3 C1- .82o -4a t•1 � Ca4�� -t�s
V
ST CROIX COUNTY
SEPTIC TANK MA114MANCB AORI1I3MENT
AND
OWNE CERTIFICATION F
owu 11in d
14
Mailing Address a �` 4d
Property Address - f►��
(Vui &eatioa rcquic+od from Ptaaoi,o� Dgmtmmt for um ooastCUdioa
h) atyaatc � ` 1 c , Pawl Idm ificatiou Number
A
,LEGAL lD 0 10 - 1(gg - be) - ow C. 83 q)
Property Location c %<, / ) V, Ste 3 . T o N R W, Town of /4
subdivision AL (ida Aorl"�
Lot
Vobi= Pago #
Watraafy Deed # Volumo
Page a
speohoum a yes a no
Lot iii
)EI yes a. no
:i4tA'ri11'T�rhtirr� .
oo eofynarap�c aoalidt bait I MF. fszAl=toba�ie.ra�cs. m oca:noe
amdktd= clan **=JLftatmQ or era" die�a ��
p av= to sAwk to SL Cook 74ca i=dfi=fi fG0336 b98re4== and by- :
pi��bee t& at( I��eonanbeirasGea�oerdisisysocm
him Fc a�er�p(���� ksstlim ll3�aIIofe.
iat ,b=kvtsct do a0 •era[,�xtoms�xintbepdra�eso� age syzaem.rilhe�c�d�md�b�
�' of oe.ad+�eD ofN i SWCofw Coidodn
dayrofdw Gm tbcSLl0mixComairZadug0WmvWm30
Am
lif)
�ati�o�da�tc. �
OF
DAZE
Y � ) oaKify tFwt all Baum oa t6is form arc ku to the best of nW (oo b wvv6o r— I (m) am (are) the oarnu(s) of
the .
I '' }} b y c1ra r &av Dec& Om
S[( to OFAPMOANT
DATE
ss ssss AV ��� �t is mis- trptesCaledmay iot tt�e staibtiy pcaoutit bci�og i�CtlolGOd by t8c 7ooiAS pcPacCmeat. s��s••
" Yc "e Wl& U& won; a ftwpcd Y flood fi m ft Ro of Doods otc
11 ooPy of the CWYwd wnW trap if acfcrmoo is M& is Gut vruc ty dcod
Dmumg 7`NO, .. WARRANTY 0990
STATE OF WISCONSIN —FORM 1
yt r THIS SPACE RESERVED FOR RECORDING DATA
28.427
y <` THIS INDENTURE, Made this...... V.rd ........... day of ...... .- Ilug uat ... -- ._._ ..................... REGISTERS OFFICE
A. D.,19..f�.a...., between...s ndra_C. ^�hultz, ST. ettolx co., wla.
6E
husband ... and ... w1fe ?tei ... loInt ... tene nt.s... .. ............. ............. ...... Reed for Record this_ 26th
...................... ..•-------- ...... . ........ .. ....................................... . ....... ... ...... _._........ ..
day of- _Aucus t __ A.D,196
- - - _.
_.....- ...... - ..Part..les_.of the first part and at_. .2-- n - --- A'a M
tenant in
........ 0=0n . ................. . ....................................
-- ... .
Reg tW 31Oeed•
part 1. .....of the second part, RETURN TO
W I t n e s s e t h, That the said part. a s. -..of the first part, for and in consideration
of the sum of...... Three-- Thciusand. Tiro .. I ?u "ndred Fi - fty Dollars °- no/100
� -.gg�
...... - - -.- .. . . . ... .............. to ..th! @nM .. in hand paid by the said part 1.eR.of the second part, the receipt whereof iso is i r 4
confessed and acknowledged, ha.V!o..- _.given, granted, bargained, sold, remised, released, aliened, conveyed anti confirmed, zinc( by these presents
do ...... ......give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part '"'.. of the second part,....____herrs and assigns
forever, the following described real estate situated in the County of. .`' _ TO Y. ... ..... .-..and State of Wisconsin, to -wit:
Fart of SV of ?'t.'' of !�eetion 3r� -28 -19 der- crihed
Cowience-. at 17'.' corner of I,ot. 1 r, Dana± ' art, In ���0 'rG':r -
180 feet= thence 492.F fee +; ttienr•c 1 ` =0 r •et +t �n ^,> _ o +^ �I
of Dal Pidae Drive; thence I 520.3a icet 'o place n:
"3.80 reven affixed and can^ -I'ed,
(IF NECESSARY, CONTINUI ON REVERSE SIDE)
Together with all and singular the hereditaments and app nance
urtes thereunto belonging or in any tti :ippertaining; and all the estate
right, title; interest, claim m
or deand whatsoever, of the said part = Sof the first part, either in Lac or equity, either in po- cssion or expectancy
of, in and to the above -bargained premises, and their hereditament, .tad appurtenances.
TO Have and To Hold the said premises as above dc,rritxd with the hi•n•dit.uncnts and appurtcnan e,, unto the ,aid part - -' 'of the
k
second part, and to -.th , r.. .heirs and assigns bOREVEIR.
r
And the said.- _ _...;��.P,ni.S � i ; ��� �� ^, �,., t ,.tS' -�r.c ?� 1 w '. as „±
f or.- ------------ - ----------- _ the : r_.- --.................---........_ heirs, executors and adntinistr.ttor,, do .-- covenant, grant, bargain, and agree to and
with the said parti.e.3...of the secon
d part,.......tl i_ heirs and a> igns, that at the time of the ciisealing and delivery of these presents
. __were . , ......... well seized of the premises above described, is of a good, sure, perfei t, absolute and indcfea,iblc estate of inheritance
in the law, in fee simple, and that the same are free and clear front ,ill incumbrances whatever
.._ , ns
heirs and ass
...__ a_ part,'.
and d that the above bargained premises in the quiet and peaceable po,x•s. ion of the said part..:,.,." of the set and t , art,'. g i
against all and every person or persons lawfully claiming the whole or any part thereof,._1.1..., will forever �VARRAN 1' .AND OFFEND.
In Witness Whereof, the said part{ CS.._of the first part ha'LL'_- _. tier trnto set - _. hand 5 . and seal this
day of_._- !UCJUE1t ....... - ... ...... A. D., 19._E.'�_.. /
SIGNED AND SEALED IN PRESENCE OF ` % (SEAL)
,
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c nr'- -
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f (SF.A1.)
.......... ......
STATE OF WISCONSIN,
Fierce ss.
........................ __........ --- ° ° . ......................County.
Personally came before me, this .............. ........ ...day of ...... ..... i tlguet ........................... ...... A. D., 19._.F. ..
the above named•...... Denhis R rchultz and Sandra lch,.lt_, • hut�} . r,.,and to o -s joir+ tenants
.... __ ........................ ..._._ ...... ... ........ .. .............................. .. ........ ................ .....------- .......... .......... ......
to me known to be the person. e___.who executed the IIA?0AQ nd acknowledged the me.
4&
J. . "urry
r10T Y t
This Instrument drafted by JNotary uc..........Frce
$ d I �.
s Pbli ie .... .....'---......---- -•-----..... County, Wis.
w ; ...�...- P....- .►.. y... y •,. .,- My CommissionR ( e)--- -r� _neut.... ............ . .....
River Falle, Wisconsin �n ��' »' � � �
(Secd•ft wit (u @1 am w1208044 1� po•W ttthat tW I�ttuoswa ns M r•t>a•0•d stsw have p1.ws Vt1ot•0 a tay.wdtt.o tb•t•oo the nwt«
•t � Wnoot•� tmats" wita•rr MA WSW),
WAR&WTY DsXD• -"4kT; or w110 1,4M haltlit
x "� A r w :q $ x Y , 416 F4 287. ` r. t. ruur rssyruws