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HomeMy WebLinkAbout020-1337-80-000 ti ST. CROIX COUNTY ZONING DEPART AS BUILT SANITARY REPORT Cb Owner 1,?3e /tD Address �'�/�� aoT l� lZp c� 4 F t City /State o r ; c�P' sap /0 r ��� , Legal Description: Lot ,� Block — Subdivision/CSM # G' l?�A VQc ' /4 / ' /4,t/�J, Sec. /, T 2fN -RW, Town of c�ti�fo.t/ PIN # 620 — 4T37 —80 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer &,,C 5' Size ST/ - Setback from: House .z Well P/L -- Pumtj manufacturer Alarm location (HOLDING TANKS ONLY) Setbacks: Service roa Vent to h air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: eF'y Width /— Length �S - .0 Number of Trenches Setback from: House �� Well � P/L Vent to fresh air intake > e ELEVATIONS Description of benchmark - 7 o L P C?;e G Elevation nc Description of alternate be ark Elevation Building Sewer ST/HT Inlet '7. f IC ST Outlet 7 7Z PC Inlet PC Bottom Header/Manifold 93..P Top of ST/PC Manhole Cover T�•3'.� Distribution Lines ( ) g �- ( ) S'�• () f . �_ Bottom of System Final Grade ( ) b�. D f ( ) ( ) Date of installation g / X/f Permit numb -r - State plan number Plumber's signature License number > s /! �' Date Inspector ki Complete plot plan R • � r 1 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 VIE s . r - 778' ► �� INDICATE NORTH ARROW f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ST . CR Ix Permit Holder's Name: El City [] Village � Town of: State Plan ID No.: C APIERON BRAD & CINDY I HUDSON CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: LrD UL TANK INFORMATION ELEVATION DATA A9900116 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 12 Benchmark Dosing ,�� 01 0"+ Aeration Bldg. Sewer .(o Holding St/ Ht Inlet jp . oa" TANK SETBACK INFORMATION St/ Ht Outlet �G.3.6 TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt I ir Septic ��S r >90 f NA Dt Bot Dosing A Header / Man. Aeration NA Dist. Pipe — o Holding Bot. System `f• 1 `1 W. 9 .3 PUMP/ SIPHON INFORMATION Final Grade �.�L q4 q& Manu rer De� Model Number GPM TDH Lift Fricti estem TDH Ft Forcema' Length Dia. Dist. To S ABSORPTION SYSTEM B IMENSIONS 19 DIMENSION Width l Lengt 1 No Tr nch s PIT No. Of Pits Inside Dia. Liquid Depth y Z � SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O f � � ' CHAMBER Model Number: � System: v . o?q 3 g� OR UNIT DISTRIBUTION SYSTEM Header / anifold « Distribution Pipe(s) u x Hole Size x Hole Spacing Vent To Air Intake i Length Dia. Length 4 0 Dia. Spacing .r Ica.* 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) L5 LOCATION: HUDSON 1 4.29.19,NE P N 982 I?Ri1vEfc TRAIL — GRASS RAN Y ® Ae 6.1 36 . � + (;.e,,.— � eu� bl�C l0Ur_"c- o�'�e�°� �z • = �4 . *Z Plan revision required? ❑ Yes ❑ No �r Use other side for additional information. SBD 6710 (R.3/97) �` l( at�e ^ Ig spec tor' s Sign a ure�� l Cert No � a ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �m,.__m.m __._ ,... ...... we.. .. ... . ............. _ E H i F s E i g _ F [ 3 d F t a...�....m .. ., mew ... .e..me_. 1 �... .. .,. .� .. «... ..,., �... s 3 DA.e...ma,,. .y.... ....M „q.....mee ...... -,.. Ae. F. .... ..�..e���.�. _ F { [ d F F { F .,..... .. _.. ..mow ...g ._ .,..... ........ »m.. d. __ .a. .. ... m. . _ b r .. ....... ... . s +mm . m E F F c #_ F a � . .. 3 III yee.mee.a.„ w. ,....... € .w<. 9 em »i..m...e.e t ..i:..«... .......i .®.. _�.._. � ..... »€m .,.e � .».....�,. ma€_.s..e.... .....q ...n . .. ......... .... ..,.... ,.. . and ., � � ,..� —.d 3 E { S k _... ;r .rw.m. i _ 4 .. ...... .... ... ....... .. ._ ... . ..,,,_...... .. a.,,......m- ,e,. _�... .... .,.....e....... .w.............. ,.. E d ._tee...... ,._...,..... ...�.a.�. ... ... .... ..... ... .. ..... -, } s Vi SANITARY PERMIT APPLICATION 2 01 afety and E. WsBn n Ave s ion sconsin ) h ILH i . A m. Code P.O. Box 7969 Department of Commerce n accord with R 83 O5, W s d Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 3-3 s Y5� The information you provide may be used by other government agency programs Q Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION operty Owner Name Property Location -- 114 W1i4, S ly T ,Z , N, R E (orer roperty Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number . TYPE OF BUILDING: (check one) ❑ State Owned ❑ it ie Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Tow N of s'p c - C C�irOS'1 III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 14. Z /. 1 q .' -1q L f 1 ❑ Apartment / Condo ZO — —S? 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. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System ________System _____________ Tank Only______________ Existing System ________ Existinc�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 11 Seepage Bed 21 [] E] E] Mound 30 Specify Type 41 Holding Tank 12 gSeepage Trench 22 ❑ In- Ground Pressure f 42 ❑ Pit Privy 13 ❑ Seepage Pit lfX-S0 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. AB SORPTION SY STEM 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) Elevation ke I e37 5 910 .7 ' Jp Feet 5?,S a Feet Capacit VII. TANK in allon Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin strutted Tanksl Tanks Septic Tank or G{j�,E S El El El El El 1 Lift Pump Tank /Siphon Chamber El El 11 11 11 El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of tA onsite sewage system shown on the attached plans_ Plumber's Name: (Print) Plumber's Signature: (No Sta MWMPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code). O 04; Z IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Issuing Age t Signature (No Stamps) Approved []Owner Given Initial O� Surcharge Fee) Adverse Determination � X. CONDITIONS OF APPROVAL / REASONS FOR DI APPROVAL. U�%�� oC r SBD -63W (R.11f96) DISTRIBUTION: Original to County, One copy To: Safety G 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 Yp Y 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) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) 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. DAVE Its 6 Plumbs' d✓ d� I ioe i320 � Road 5 ROBE At �e Y171ff �1 /Z/r t N Za rvp oP ter Ls.vE ,q p' 3/y f�Y � /d ✓ OL 2 rip eF' ` S° �,co •u f• T• ® c w E[G 7 � 1a' � e r FOR) 9r C � Wiscondin Dgpartment of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page —4 of s Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # o zo- /33 8'd APPLICANT INFORMATION - Please print all information. R ie d y p ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot ti ,E 1 /4 1 /4,S T N,R / E (odD Property Owner's Mailing Address —Co—t# Block# Subd. Name or CSM# City State Zip Code Phone Number Ci ty ❑ Village V1 Town Nearest Road ❑ Z New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow j �0 gpd - Recommended design loading rate s 7 bed, gpd/ft .I? trench, gpd /ft Absorption area required bed, ft trench, ft 1 1 Maximum design loading rate . 2! bed, gpd/ft gpd /ft i Recommended infiltration surface elevation(s) _J"Z Jl/ARt1 T AVeleY b ft (as referred to site plan benchmark) r Additional design /site considerations F - 4z) �1i9CE'y =X) G ter Parent material 4c Z6G # Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U 0 S ❑ U 0 S ❑ U V S ❑ U ❑ S P U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench f........ 0 75 — 5 Ground elev. Depth to limiting factor / �_7 ) in. Z, Remarks: Boring # .5 - ©S Ground elev. �ft• , .Depth to limiting }� factor > 7� in. Remarks: CST Name (Please Print) Signature Telephone No. tea/ ,, )3, DaC' r 3X s Address Date CST Number Ya13 ? .2 i .10 PROPERTY OWNER &T416 L/5�,�VICAN SOIL DESCRIPTION REPORT Page -:;- of .� PARCEL I.D.# O.?o - / 717 Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Ground G e el lev � Depth to limiting factor >_I&Lin. Remarks: Boring # Z nr Z y 2 6 45 6 S .?M 5 v/:W b Ground _ _ M ell Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # s - 3 8 6- 3 rG FR . S. Ground Al FZ �elev. d ��ft• Depth to limiting factor L-' Remarks: Boring # (� Z , C ', Ik CS .7 O Z's — o M4 S . O Ground S .O elev. S _6 gift. - - ; •�' Depth to limiting factor ' Remarks: �/ Or5 r - To eE ,w.c 4/TEj) r / -A SBD -8330 (R. 07/96) A DAVE FOGERTY PLUMBING Licensed Pork Tester & Pkxnber ' 53233 #3289 Road ROrtwWiW' 54023 �o i � /, \ \ a / a 1rol OF 1 "p VG r RM , Tod DP LeT ,f / d ✓ = Tod d F r# STE'A'L Fs>wcs /. /d4.0 / oa "- 1 Q �, 7 - 0 1 0 o F &A b, V,.-- 4vr wrA-, /av o �oaiv0 4O T - to"CAIC ti� Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of -1 LabV and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST_ Crnix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. C Z C ^ /O Z 67 " 7 0 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Kernon Bast GOVT. LOT NE 1/4 NW 1/4,S14 T 29 N,R 19 for) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # na Grass Rancte Addn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD Hudson, WI. 54017 h15) 386 -7775 1 Hudson McCutcheon Rd. ( New Construction Use [x] Residential / Number of bedrooms 3 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate _ bed, gpd /ft g_ trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate _,7— bed, gpd /ft - 8 trench, gpd /ft Recommended infiltration surface elevation(s) 98.10 ft (as referred to site plan benchmark) Additional design I site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable fors stem I ®S ❑ U ®S ❑ U ® S ❑ U jEI S ❑ U ® S ❑ U ❑ S '1711 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed jTwich 2 17 -80 7.5 r4 6 none ms osa ml na na .7 .8 Ground elev. 10 ft. Depth to limiting factor +80 Remarks: Boring # 1 L4 1 Oyr'1/3 none 2mc;bk mfr 9W ?f 6 2 14 -30 10 r4 4 none sil lcsbk mfr if .4 .5 Ground 3 30 -80 7.5 r4 4 none ms oSQ ml na n .7 .8 elev. +.- 10 ft. Depth to �� limiting �r" factor +8 0" MN 21 1997 COUNTY Remarks: E CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th e. New ich WI 54017 Signature: �w� _ Date: 5 -2 -97 CST Number: m02298 I PROPERTY OWNER KPrnon RAGt SOIL DESCRIPTION REPORT Page 2 6f - 1 PARCELI.D.# Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0- 2 1 12 -27 10 r4 4 none sil 2msbk mfr Crw if .5 .6 Ground .7 .8 elev. 1 01.9 ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -17 10 r3 2 none sil 2msbk mfr 9w 2f .5 .6 2 17 -36 10 r4 4 none sil lcsbk mfr qw if .4i .5 Ground e 3 36 -80 7.5 r4/6 none ms os ml na na . 7 .8 101. fit. Depth to limiting factor +80 I Remarks: Boring # 1 1 n—in 1 C)yr!/ 2fl ...::............. S 2 10 -24 10 r4/4 none sl 2msbk mvfr if .5 .6 Ground 3 24 -80 7.5 r4/6 none ms osg ml na na .7 .8 elev. 1 01. it. I Depth to limiting factor +80 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Kernon Bast 4NW4 S14- T29N -R19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246 -6200 lot #8 -Grass Range Addn. t N 1 =40' BM.= top of 211pvc pipe C el. 100' Alt. BM.= top of nail in Elm tree C el. 103.20' 270 g ,2 a � c � A-0 a 3�1 L �c ZO Gary L. Steel 5 -2 -97 r r 6 �- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM C Owner/Buyer AIA r,4 Goz ,t CA,-' Mailing A d d r e s s . Property Address 1RZ bX0 Ll nt ,yra.2 L (Verification required from Planning Department for new construction) City /State 14cr&e2 W.t S% /d Parcel Identification Number ©Zo ,C,z Z 7 LEGAL DESCRIPTION Property Location &F, /4, A'kl ' /4, Sec. / `/ , T�_I�T -R/9 c W, Town of e re,05 t/ Subdivision sA .�.r.G,�' ,Lot # 8 Certified Survey Map # Volume , Page # Warranty Deed # -5 O /,'K , Volume / 7 L/ , Page # S' 3 `I Spec house ❑ yes 0 no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master lumber, journeyman lumber, restricted lumber or a licensed pumper verifying that (l) the on -site wastewater disposal system F �J YAP � F P P �g ( ) is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, f Natural Resources , State of Wisconsin. Certification herein, set b the Department Department of Commerce and the o � � Y F stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 dayss of the three year expiration date. 7 I /J SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. � /( SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.*** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM 1 — 198' 591U13 WARRANTY DEED DOCUMENT ^!O. VOL 1 4 PAC.IJ J� This Deed made betwe n_ DOna da T_ - Speer -East and- ST. CROIX CO., 1YI —_ NOV 0 6 1 998 Grantor, �+w and -Cindy K Grantee, Witnesseth That the said Gtani T, for a :alliable ctxtaderatio2 —__— THIS SPACE RF.SERVEO FCH RFCOROING OATA conveys to Grantee the following described real estate fit S_ Crn i x — _ -- NAME ANO RETURN ADOWSS County, State of Wisconsin: Cindy Cameron ' Lot 8, Grass Range Addition in the Town of 491 County Road A Hudson, St. Croix County, Wisconsin Hudson, Wi 54016 r .t na o - PARCEL IDENTIFICAT ^GN NUMBEH TRANSFER FEE _ F. is n This homestead property. (is) (is not) Together with all and singular the hereditaments and )urtenances thereunto belonging. And -- - -- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except a easements, restrictions, rights -of -way and covenants of record, if any. and will warrant and defend the same. - a Dated this 3rd day of Novem 44L--� _ (SEAL) (SEAL) Fta�t �= D onald .T PPr — dC 13 (SEAL) (SEAL) x 4 AUTHENTICATION ACKNOWLEDGMENT � t State of Wisconsin, `. Signature(s) _ ss County authenticated this day of 19 Personal;; came before me this — 3- - � - - -_ day of ; y �xt 19.q_R, the above named CITLE MEMBER STATE BAR OF WISCONSIN (If not, — — — - - -- � 3 authorized by §706 06, Wis Stats) ��y� me nown to be the person _— soh i executed the fore omg, # . i r nt and acknowiedge he THIS INSTRUKAENT WAS DRAT ED BY /� IFQ — _Kernon �1 otirn Public, (Slgnan mati' be auu.:•nt.cated or acknowledged. M. �Iv ��mn.I n -� pennane t .If n. t. �t ,c � it;,I i etc y � rte »an ) ro -, in dm. ho-d o; :} kj or r :.d + 1 (AtF B%R Of wt�T.Ura� r_a _ h :,. w 1RRAN 1 F n ` Uy fit D Form o. t - 1 t - . 'E OF TH NWI /4 N89 0 43 3 45 "E 680.21 x x 4 10. 00 ' x 158.39` _ r �p� ui M B � ` I \\ HWL = 886.0 N I �Oc �♦ N O 0 1 � K 1 O O � �� ♦ LOT 8 LOT, 2.10 L ♦♦ /� 91 1.86 < 80,99 / G 3.61 ACRES I S O S 157,109 SO. FT. 2.52 AC. EXC. ESMT. 109,697 SO. FT. ' ro )I .% v %�` LOT 9 � II g 0 4 2.02 ACRES O 6 6' D� 88 SO. FT. i� A