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HomeMy WebLinkAbout008-1092-30-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT ` �• Owner Property Address City/State ty n..N Vr.X � y Legal Description: e Lot Block Subdivision/CSM # ' /4Z5' /a, Sec., T -Rf�W, Town of # D D --fa -3 a SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: .c Tank manufacturer � � s � Siz S�C Setback from: House _/ e Well �i�/L 4:9 0 Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: ,U _eco Width Length �� Number of Trenches � — Setback from: House Well / P/L Vent to fresh air intake ELEVATIONS Description of benchmark �j A � z- Elevation Description of alternate benchmark Elevatio Building Sewer ST/HT Inlet ST Outlet 7 PC Inlet PC Bottom Header /Manifold � IYI Top of ST/PC Manhole Cover Distribution Lines( Bottom of System O O G�. Y O ©• G Final Grade O O ( ) Date of installation / f Permit number .3 �?AO,6 7 State plan number Plumber's signature d �- - — License number 7 Date Inspector 1 Complete plot plan � 1 i a NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 5a o t0 INDICATE NORTH ARROW "Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Pe rsonal inf you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338807 Permit Holder's Name: ❑ City ❑ Village 99 Town of: State Plan ID No.: MARSH, RICHARD EAU GALLE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /db /Z) v r� r 008 - 1092 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W r p�O Benchmark —Z / l00 Dosi ng Aeration Bldg. Sewer fj ,. Holding t Ht Inlet r S Pe TANK SETBACK INFORMATION 5 e t , Ht Outlet • Z• 3 S, TANK TO P/ L WELL BLDG. Ventto ROAD D Air 12flGke Septic ± Z od ;;,100 t o I I NA Dt Dosing Header / Man. / Aeration NA Dist. Pipe �'I Z "3 0• �d .e Holding Bot. System ti g PUMP/ SIPHON INFORMATION Final Grade Manufacturer d ?� ZS Mode ber GPM TDH Lift L Ion System TDH F Fi Fo Length Dia. rce n SO L ABSORPTION SYSTEM RENCH width r Lenqtb No. Of Trench s PIT No. Of Pits Inside Dia. Liquid Depth DIM ENSION S DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER 'r Z� Z r 7 /O(J 7 5 OR UNIT Model Number. System: DISTRIBUTION SYSTEM Heady / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Leng; � / Dia - Length Dia. Spacing Z� 2- Z Z / Y 1 0 / 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 Bed /Trench Center Bed /Trench Edges Topsoil E] Yes El No E] Yes F] No COMMENTS: (Include code discrepancies, persons present, etc.) I LOCATION: EAU GALLE 32.28.16.488 SE,SE 8 -230TH STREET j-1 t F7 " y4Ey Plan revision required? ❑ Yes ❑ No Use other side for additional information. z7 W LI I A SBD -6710 (R.3/97) Dat spector's Sign re Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: . a T— .,...� . .... .e. _. .....- . V-i E a F v a �. esa i 1 4 em , ee. e e., __. ea ... aee e...� o ....ea ..�� .... ... �... ..., ... �- ..e.�. ,....a. ,.; .,. 1 � 9 VT t 1 m 7 t p i 4 A ti 4 T h -l-I � _ a ee. ✓.� mm�e , 1 011 — r 6 I eJ--- m . ....,:.,:m. p em. ... ve ! e t q 1 � A— j. . . ........ d .. ... �, 1 Ad i S gi ; p , ep,a S €fi A X — f a e � F i i ! w .— __.. 2 3 p 14 1 F . c F IT 1-T-10, jQ A �e�.a a ..� ,.. a. � a z v ems �._ ... t.____ .___.. _.._...__. 471-15 -A { It I t- a p n t . i 3 � f F _ p t a - - ---- lin: p 9 P 3 9 E ¢ 3 1-4 v 1 p � 3 q l f A ..e j { H ., ._.. . ... _.,.g. - - - - .,.. ..� 4 -- . 1 - 4 ... ... € e ' [ - e. a 77i x F € 3 m, ...� ,2 E E 10 —1 A T eA ..a .. .. ..... .........e.._ .... ...,,...;.. ...a ,.......e.. — ..»z..e -- ........e....s ., � .,...�..,.._, a..�.e..... € '. ._. �m..E ....n...,.. �. E.� z. _. mw,... v Safety and Buildings Division A scons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue In accord rd with ILHR 83.0 . Adm. Code P O Box 7302 Department of Commerce , Wi s Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County r than 8 112 x 11 inches in size. County j X • See reverse side for instructions for completing this application State Sanit Permit Number Personal information you provide may be used for secondary purposes ec if r isl n previo a pplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLI ATION I F RMATION - PLEASE PRINT ALL INFORMATI N Property O r Nlame pro perty Location hlis e 1/4, S 3 Z T N R / E (or Property Owner's Mailing AAd4pe$s Lot Number Block Number City ate /i�- ..•�, l! Zip Code Phone Number Subdivis n Name M Number II. TYPE B ILDING: (check one) ❑ State Owned V It illage Nearest Road ❑ n � � Public 1 or 2 Family Dwelling - No. of bedrooms Town OF G ,4_ 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment /Condo P— C o C7-2 3 d 2 E] Assembly Hall 6 E] Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ❑ New 2. I Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5. [] Repair of an ______System System Tank Only System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number 7391_0? Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 � Seepage Bed 21 ❑ Mound 30 E] Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 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.) (Gal 610 /sq. ft.) (Min. /inch) Elevation �j 4 Q r Feet 1 7 Feet Cap acity VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Exist in structed T nks Tanks eptic Tank o ding Tank Q ® ❑ ❑ 1 ❑ ❑ ❑ Li p Tank /Siphon Chamber ❑ ❑ ❑ I ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system hown on the attached plans. Plumb�r's Name: (Print) Plumber's n ture: ( Stamps MP /MPRSW Not? ��e3 usiness Phone Number: ` - s- Plumber's Address (Street, City, Stat Zi Code : 9 Z5 199f�;4111L_ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Signature (No St Adverse Determination amps) proved ❑ Owner Given Initial Surcharge Fee) q X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS A 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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 and Buildings Division, 608 -266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /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 1/2 x 11 inches must be submitted to the county,. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) Groin section of the soil absorption system if required bythe county; E) soil test data on a 115 form; anctF) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. S r ti b fy QL 11 0 aR f R J W ^ o VII y�y C> ca �'Rro � r+wuP 0 k," t 9 b J .,t ri h�� §3 " PAGE OF 1 I LruSS S`( I IUl, Froth Alr 1111816 And Obtervallon Pipe ^ J Approved Vent Cap Mlntmum 02" Above Final Grade - 20- 42" Above Pipe _ 4" Cott Iron ' To Final Grade Veal Pipe Marsh Hay Or Synthetic Covering min 2" Aggregate Over Pipe Olurlbulhon —Tee PIP 0 0 0 0 0 6" Aggregole o PnloraUd Pipe Below Ponealh Pipe 0 — Coupling Terminating At Bollom Of Sy►lem SOIL FILL DISTRIBUTIOf.1 PIPE APPROVED S4NPETIC COVER — 14ATRR OR 9" OF STRAW � 2"OFAGGR OR M ARS" HAy nr _,,'iz nccrtCCATE < -- '— . DIS RMR JITFDU Ffr F. TT(.), 9,,F: AT LE � � RUCHES SK.L -OW O,RIC - 144,L G �,�(V ? LEAS 1'Zll I f3,UT 11© /\Q 7,f +. A!\1 '!. ?_ I : ygS P,ELOW F A re NP F L G MA z)lu p��rl{ OF �XC/��AT1��^ I�Ko1w ,bKIL+I►Jgl 6�AD WILL BE _ 1U C►�.ES /1b�1:1 t t�lE d�. Xf �1vAT)O N {�OJM C'.�1� Cjg4,q;E WILL 0E ° INCNE I ' SIGUED: LIGEUSE C.IUMBER: - 72 O pA E 110 Safety and Buildings Division VL SANITARY PERMIT APPLICATION 20 E. Washington Ave. In accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County �"' I­ than 81/2 x 11 inches in size. J , ``© , -A • See reverse side for instructions for completing this application State Sanitary Permit Number y ou p rovide may be used b other g overnment agency p rograms �3��b / The information y p y y g g y p g ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Pr rty Owner Name ��//ff ,- /e 5 ! Property Location N R /b E (or� /// C 1/4 5 /-- 1/4, 5 �� T o Proper Owner's Mailing dIress -y- Lot Number Block Number City, St a Zip Code Phone Number Su i ision m r CSM Number .A- 1 - d w f w! �` ©v �- (7 /S1 G� 3 / �jl ©a�raS 11. TYPE OF BUILDING: (check one) ❑ State Owned A y � Nearest Roa Public 1 or 2 Family Dwelling - No. of bedrooms 3_ ow o f C��4 v G LL e, 3Q h III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ?j'1 24 • I (� , y'84 1❑ Apartment/ Condo 40 O yet — .3 O 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. 3 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an - ------ Sysstem ________System_____________ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure f / 42 ❑ Pit Privy 13 ❑ Seepage Pit Via- 7S 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 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) Elevatio�f D p© 8 ` C Feet 346 Feet Ca acit VII. TANK in allons Total # of Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App Tanksi Tanks Septic T in 1 1 Q Pe) ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamberl I I I ❑ I ❑ I ❑ 1 ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' Signature: No Stam MP�o.: 7 �� Business Phone Number: L - 7 69 3 730 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing nt Signature (No Stamps) }Approved []Owner Given Initial n Q� / Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SB046 (R. 11196) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division. Owner. Plumber I INSTRUCTIONS ; 1- A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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 and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on 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. V1. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /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 lumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), P Y 9P 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 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section h it absorption tem if re required b the count E soil test data on a 115 form; and F) all sizing oft a so system q y y, ) 9 information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. 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Lo .� _ ! o !� L d � m� �� N � .Y C o°. �_ .'1 m d Z car N n Q `C it O Z Z (09 C . . N N O r D o OD ^ ?,� Z cm rn z 0 IA r i q S G r K 0 � W i L (D r J' r O V) b e% cn O 0 o D '�' s N ^ z LP d �A �. n p p �d �& 3 3 A O '3 ; 7 ^ . n (�D O IT7 C f 0 G r U � °� A c t]+ 3 'O C O . �.p Z o ' W ;v GI o q rA N ` Cam. r (D . O 0 � O q A t 1 r* W o f IA n a {° O fx m , Q. m ff kA :r 0 O C O C O N O L lD CL �A v. M G r v o v OF d Ain aN � /r mom 0- + Qom_ O O x 20 tOC N N m � a .Q GI or I 0 Jo to (n © D 0 0 r O " g 0 c r Lo P ?C 1 I. O p i D c c � r+ � or 1 1 r N � N zf ) L' `^ o CA - ter 1-3 C jE rl o fD J .o v 0 z .0 o N 1 0 �-- un Lk J� v DIP U r � p m r r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerlBuyer Mailing Address Property Address n - (Wrification rcquimd frocri Planning Department for new construction) Pamd Identification Number LE GAL DESCR Property Location J. V _ � � yt, Sec. T 2_9 N -R / 6 W. Town of � �` � i�; e Subdivision +Certified Sauvey Map # Volume . Page # Warranty DC61 9 : 5�� �;�5 ��� Volume / l - Page # C 6 7 Spec how 0 y no Lot lines iden:ffiable. ®. yes 0. no �XSZENI-WAfi ;NANCE o useurd= kt== eo fyearrcpti�cspstcmeoddmmltisitst oetoDandletestes.Proper ancc Coasi�ts of f panaiving oat flan septic task evmY d= y= or wmcr if wc&d by a Uc=sod p=pca What yore pat.into tt sy lcm cam affect. finction of &c scpd c taatcas_a ftatmentsuM in the vastc &sposai system. Tlae PmPcrty ow= agrees to sobmit to St. Croix Zoning Dot it boa f0cm, signed by &e ow= nerd by a =s1crP 9 plink rtr�pt=b=or a U=scd PmmPcr Ve ifying &at(1) dw on-cite wa9cwzt=&i=d qS aac is in. Proixx opeVting Condition andr'or. (2) after inspoetioa and pumpwg nocessary), the ceptic.tank.is I= than 18 runt of studgc. 9, midc, cd have =ad &c above tegai=me is and agme to naiiXtILk the Pdv:te sewage disposal system V ttie standsztiis . 0d IbA h=ia xs cd by the Dot of Conimc c and the Dqwtuwatof Natcar d Rmomwcs, State of Wisoonsid.. Cmtific&fi6u tLat' that Par septic system has been rnaintaubod mnst be cmVIded and r tamed to the St Qvix.County zoning Office within 30 of throe irati date, OF PLl -2 /�l /%, DATE OWNER. CER.TTFICA TfON I (we) ="y that all statenicais on this form are true to the best of my (our) l movdcdgc. I (we) am (arc) the owner(s) of zpu bove.. b of deed reoordod in Rcgis of Deeds Office. GNA DAZE Any information that is mis-r prescated may rc u& i the sanitary pen nit being mvroked by the Zoning Dgwtment' "' ss Include wf(h this appticatlon: a cWnped warranty deed firom the Register of Dodds office a copy of the certified carve if rrfctenee is made ' Y � in the warran ty deed r I a JDAariN TM'r :' :';NSBERRY Data IDs HMI MOS • • I MWr NO. STATE BAR OF WCONSIN FORM 1-1982 NPACQ '�T'.WZD NOR R8Ct7RMW DATA w _ 529553 � �R-� CFC � s rr SL This Used, made between TIMOnry THORNSBERRY , unmarried Avdd !ar FLas.a � (bereinaRer referred to as Grantor, whether one or more), and MAY 31 1995 Richard L. Marsh at A.,IJ (hereinafter referred to as Grantee, whether one or more), ,c21 • �v Raptrteref Dsz Wim wth, That the said Grantor, for and in consideration of the su4 of Tea and No/100 Dollars and other W and valuable consideration, the receipt and suf6dency of which are hereby aclouwwledred, conveys to Gtantae t 6 � the following described real prop" is St. creft County, Sate of Wisconsin, �-- to-wit The SE 114 of the SE 1/4 of Section 32, Township 29 North, Rwre 16 West, Tewa of Eau Gaile, St. Ctoiz County. Wisconsin: including memberships and/or ownerships of aoa- municipal water and/or sawa systems, if any. Tag parcel No. 008- 1092 -30 t .I Together with all and Magda the hereditements and appurtenances thereunto belonghag. This is homestead property. (it) (it not) This conveyance is made and accepted subject to the lien for carrent taues and other assessments and all valid and rubsisting restrictions, reservations, eoodld=6 limitations, eaatmbraacts, eovaants, moepdoes and easements as may appear of record, if any, a> cftg the above described property. TO HAVE AND TO HOLD the said promises with their apperseaances unto the said Grantee, his bein and assigat forever And the said Grantor does hereby covenant to and with the said Granted, that he is the awns in fee simple of said premises; that they are tree from all encumbrances moept as described herein, and tb* will warrant and defend the same from all lawful claims whatsoever. % The singular number shall include the plural, the plural the singular and use of any ruder shall be applicable to all genders. Dated this day of �+. (SEAL) TIMOTHY PfOANSBERRY [CONTINUED] Sdkr: T - 'A0M f MORMBERRY DW Mt H%"1033 114►��E070 ACKNO%I,EMMENT STATE OF Ind, ana } )SL PorteL<bunty, } Personally came beibre me this 2 n d day of May . 19 - 25_ the above now TIMOTHY THORNSBERRY to me a nown to be the person who =zuted the foreloisd 6Ktrnooat sad aclmowledged the same. / V • Jan E. Blakle NotaryPWk Pnr County, Indiana My Commission is permanent. (If sot, state oTbadoa i A date: �� (�'• June 26. . 19 oS •) 2 Ls EP - sw 'Names of persons alpha= in any capedty should be typed or printed below their sigoaturm l i i i i