HomeMy WebLinkAbout020-1359-13-000 I T
1
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County
Safety and Buildings Division
INSPECTION REPORT St. Croix
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)l. 353245
Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.:
La Casse Richard I Town of Huds
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
.D f loove &P-L 1 020- 1359 -13 -000
TANK INFORMATION ELEVATION DATA II , act, (9, at 09
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosi ng Alt. BM
Aeration Bldg. Sewer 93 • r
Holding St Ht Inlet (( g2,g�r
TANK SE CK INFORMATION
TANKTO P/L WELL BLDG. to
A i ntake ROAD
r
Septic .y Sb � ? ` - - NA Dt Bottom S 3 Z_ g$ (g
Dosing > 50 r I t 7 NA Header/Man. ("2_(0 9 7.4Y r
Aeration NA Dist. Pipe .600 ql �01
C* •6o
Holding Bot. System :?' 7a l�o.lD f
PUMP ' /SIPHON INFORMATION Final Grade Z ir /em , so ,
Manufacturer "' L Demand St cover S, yD qg (0 0
b y Model Number a �� GPM
TDH Lift$. Lriction TDH J. &t
Forcemain Lengt / Dia. a u Dist. To Well
SOILA45ap TION SYSTEM
TRENCH Width Leng / No f enches PIT No. Of Pits Inside Dia. Liquid Depth
DIME DIMENSION
SETBACK SYSTEM TO P/ L I BLDG WELL LAKE / STREAM EA NG Ma�yre� r:
CHAM l t-
INFORMATION Type O � >� / OR NIT IT
e Number:_
System: ;
DISTRIBUTION SYSTEM
Header / I�panifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. L �f0o
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) nspection #1: IL/$ /71 Inspection #2: -- i
Location: 518 Green Mill Lane Hudson WI (SW 1/4 /4 Secti 16 T29N -R19W) - 16.29.19.2109
1.) Alt BM Description
2.) Bldg sewer length -
- amount of cover
3, No � a �eia.
Plan revision required? ❑ Yes tRr No T 8 4
g9 �(�'
Use other side for additional information. -+ � 1-44-4
SBD -6710 (R.3197) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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F
515 G Safety and Buildings Division
Visconsin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
Department of Commerce In accord with Comm 83.05, Wis. Adm, Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the syste I n 4 sIs, C- -gunty
than 81/2 x 11 inches in size.
• See reverse side for instructions for completing this applic �� y `� stat anitary Pe rmit Number
Personal information you provide may be used for secondary purposes f i t r ��� ❑yGMe if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. ,.' .
X Stote an I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL RM
Prop e Owner Name L ! ory R / A
CLL T , N, R (or
Pr p ert Mailin Address Plu Block Number
1 t
City Sta a Zip Code Phone Number Subdi ion N a or CS Numb r
V-0 s6p
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ its Nearest Road
Public 1 or 2 Family Dwelling ❑ VII age
- No. of bedrooms Town OF
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers r 1 1 �. 19 . „q
0 210 _ 1359 3-06 " 1
1 ❑ Apartment/ Condo
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. E3 Reconnection of 5. E] Repair of an
____ --System 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
11 Seepage Bed r r 21 E] Mound 30 E] Specify Type 41 E] Holding Tank
12 Seepage Trench 5,x,22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit // 43 ❑ Vault Privy
14 E] System-In-Fill - l p� c�k�- aZ _ 24 , 2 / - _
VI. ABSORPTI 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 (s _ ft.) Proposed (sq. ft.) (Gals/da sq. ft.) (Min. /inch) Elevation
66n 1 �-- �0 Feet Feet
Ca acit
VII. TANK in allo Total # of r Prefab. Site Fiber-
INFORMATION g Manufacturers Name Con- glass Plastic Exper.
New Existin Gallons Tanks Concrete structed Steel
App
Tanks Tanks
Septic Tank or Holding Tank 1aCO ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber (� ❑ 1:1 El E] 1:1
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
PluWrName: (Print) Plum Sign ure: (No S ) A MP PRSW No.: Business Phone Number:
26
Plumbed' Address;Stree ' y, State, ip Co
// ,V i
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuin Agent Sig natur (No Stamps)
roved
App ❑Owner Given Initial surcharge Fee) I I
Adverse Determination pas -Q
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe 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 orthe 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.
11. Type of building being served- Check only one and complete # of bedrooms if 1 or 2 Family Dwelling_
111. 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 rep(acement, 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;
P Y p Y 9
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction IQss; 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 stipndards.
IaCasse Custom Hoimes, Inc.
SW�NW.g S16- T29N -R19W
town of Hudson
lot #13- Parkwood Meadows
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot linea.were not established..at the time the test was conducted.
N
1 =40
BK.= top of NE lot stake @ el. 100.00
Alt. BM.= top of NW lot stake C el. 97.20
A d
� 21 1p ' e+n
/J
Ala
V 1
5 �1
ao357 �
D
(s-
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Wisconsin papartment of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Man 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. Croix
not limited to vertical and horizontal reference point (BM In and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and dista a o 020 1029 - 00
A �.
- � "' IEWED BY DATE
APPLICANT INFORMATION - PLEASE P fN`�.�41L INFORMAf�IQ
ti
PROPERTY OWNER: r/� VT LOCATION
LaCasse Custom Homes Inc '/ l// �� VT. LOT SW 1/4 NW 114,S16 T 29 N,R 19 Ikor) W
PROPERTY OWNER':S MAILING ADDRESS I t �, ^ j j j ; :y T# BLOCK # SUBD. NAME OR CSM #
521 McCutcheon Rd. c ,� 13 na Parkwood Meadows
CITY, STATE ZIP COD CITY ❑VILLAGE �Y f TOWN NEAREST ROAD
Hudson WI. 54016 - 715 G 405 " Hudson Meadowood Ln.
[ �} New Construction Use [ Residential / df erQciais 4 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial e e
Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd/ft
Recommended infiltration surface elevation(s) 96.10 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash Flood plain elevation, if applicable na It
I
S = Suitable for system CONVENTIONAL F UND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ®S ❑ U ®S ❑ U ®S ❑ U CI S ❑ U [X S ❑ U ❑ S M
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0- 1
1
2 10 -29 10 r 4 4 none sil 2msbk mfr crw 2m .5
Ground 3 29 -88 7.5 r 4/6 none ms 0SCr ml na na .7 .8
elev.
100 ft.
Depth to
limiting
factor
+88"
Remarks:
Boring #
1 0 -12 10 r 2/2 none 1 2msbk mfr C1W 2f .5 .6
2 2 12 -27 10 r 4/3 none sit 2msbk mfr gw 2f .5 .6
Ground 3 27 -39 10 r 4/4 none sil lcsbk Mf 9W if .2 .3
e lev .
4 39 -96 7.5 r 4 none m 0 m na na
1 2 ft.
Depth to
limiting
f %6"
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715 - 246 - 6200
Address: 1554 200th. v New Richwond, WI 54017
Signature: Date: 7_7 -99 CST Number: m02298
1
1
PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT Page 9 of _
PARCEL I.D. # 020 - 1029 -00
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxfay Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
LN 1 - 1
2 9 -23 10 r 4/4 none sil 2msbk mfr gw 2m .5 .6
Ground 3 1 23-90 7.5 r 4/6 none ms Oscr ml na na .7 .8
elev.
10 ft.
Depth to
limiting
facto
Remarks:
Boring #
1 0 -8 10 r 3/3 none 1 2msbk mfr 9w 2f .5: .6
2 8 -16 10 r 4/4 none sicl 2msbk mfr c1w 2f .4 .5
Ground 3 16 -29 10 r 4 4 none sil 2msbk mfr 2f .5 .6
Y60. 4 29 -84 7.5 r 4/6 none co s Osg ml na na .7 .8
Depth to -
limiting
factor
+84"
Remarks:
Boring #
1 0 -8 10 r 3/3 none 1 2msbk mfr 2f .5; .6
5 2 8 -19 10 r 4/4 none sicl 2msbk mfr qw 2f .4 .5
Ground 3 19 -27 10 r 4/ none sil 2msbk mfr crw 2f .5 .6
elev. 4 27 -90 7.5yr 4/6 none co s Osg ml na na .7 .8
1001 ft.
Depth to
limiting
V
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel LaCasse Custom Hoimes, Inc. 1554 200th Ave.
CSTM2298 SW 4NW4 S16- T29N -R19W New Richmond, WI 54017
MPRSW -3254 town of Hudson (715) 246 -6200
lot #13- Parkwood Meadows
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 =40' -
BM.= top of NE lot stake C el. 100.00
Alt. BM.= top of NW lot stake C el. 97.20'
2�
Gary L. Steel
7 -7 -99
ST. CROIX COUNTY
WISCONSIN
1� ZONING OFFICE
xx
ION AND SIZINCsjC& I WERNMENT ENTER
mber Soil Absorption System*101 Carmichael Road
_ Hudson, WI 54016 -7710
1 11 /29/ tjlte386 -4680
X X. Gravity Distribution
only 1 Pressure Distribution
3 ft Suitable Soil , Note 1: Bury depth as per manufacturer
18 in Chamber Height 2
8 ft Maximum Bury Depth 3
600 gpd Estimated Daily Peak Flow
0.80 gpd /ft Wastewater Infiltration Rate 750.0 ft Code SAS Size
40 % Down Sizing Credit 300.0 ft Reduction ( -)
450.0 ft Min. SAS Size
96.10 ft Proposed SAS Elevation
Soil Surface Acceptable Finished Grade EL 4 (ft)
Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum
Number Elevation (ft) Depth (in) Lowest7 Highest Elevation? 99.10 105.60
1 100.20 88 95.87 98.03 Yes
2 1 100.20 96 95.20 98.03 Yes
3 100.00 90 95.50 97.83 Yes
4 100.10 84 96.10 97.93 Yes
5 100.10 90 95.60 97.93 Yes
1. Depth of suitable soil required below the infiltrative surface for treatment.
2. Total height of chamber in inches.
3. Maximum bury depth as per manufacturer's recommendations.
4. Based on chosen system elevation, and chamber height. Top of chamber is
equivalent to top of aggregate. The addition of fill for cover or the reduction of
finished grade may be required to meet minimum or maximum code standards.
SBD- 10553 -E (R.05/98)
• Sep- .01 -99 10 :30A P-02
_ -••• _ " .n „aa rc LK05S SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" MiN. ABOVE GRADE E WEATHER PROOF
!25' FROM DOOR, WINDOW OR
FRESH AIR INTAKE JUNCTION BOX APPROVED
WITH CONDUIT MANHOLE c
FINISHED GRADE 4 Cl RISER W/ PADLO(
7 6" !THIN. WARNING 1
ABOVE G AD E
le" IN. 6" MAX.
INLET
WATER TIGHT SEALS GAS- 1 •
4 T TIGHTS
CI PIPE BAFFLE A SEAL AppROYED
3' ONTO B LM JOINTS W/
SOLID -�- ' ON PIPE 3' 0
�0lL C ' SOLID SO!
PUMP OFF ELLV . - FT. +- aFF RISER
D PERMITTED
IF TANK
MANUFACTU)
3" APPROVED BEDDING UNDER TANK HAS APPRO'
SPECIFICATIONS CONCRETE PAD
EPTIC / DOSE - - -- - ....._........... .
'DANK MANUFACTURER; NUMBER DOSES PER DAY. _
T ANK S2Zts: SEPTIC GAL. DOSE VOUJ.ME INCLUDING
DOSE ��n GA L. F
LOWBACK: g, /..5
ALARM MANUFACTURER Q�f
MODEL NUMBER: CAPACITIES: A = �4MCHES
SWITCH TYPE:
-' B = 2 INCHES = , ,RG
PUMP MANUFACTURER:
MODEL NUMBER: Q90 C =
SWITCH TYPE:
D = INCHES = 1
REOUIREO DISCHARGE RATE � GPM PUMP 6 ALARM WIRING AS PER ILHR
16.23
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ��
• MINIMU NETWORK SUPPLY PRESSURE --�-" FEET
FEET FORCE,MAIN X -FT/100
S FT. • FE ET FRICTION FACTOR -"�'
TOTAL DYNAMIC HEAD - �EET
INTERNAL DIMENSIONS OF PUMP T LENGTH WIDTH f'EET
•
DIAMETER
LIQUID DEPTH �� �/ •
iGNED:
ICF4j3E NJMOgt :
� urn� CUB V
6 F 7
MO
M ODEL -
Vertical . Pump EPO4— •0
Submersi
Cellar Wirer
DVP
f
xr . ?us ..
e
I '
I
Pump Specifications
METERS FEE1
1 h H P
Up to 40 GPM Y - ` - -' - "- MODEL 3871
, I
Discharge size 1 NPT 9 30;_ -
Solids: IN' maximum
25 j I
Motor r' 7 - -
Single phase: 115V t - - - --
6 20
Materials of Construction I 6
Brass /thermoplastic EPOS
Features and Benefits o 't•s8
— -
• Top suction eliminates
impeller clogging. 2 6
—
• Corrosion resistant
construction. 0 0p - - 2 0
40 50 U S GPM
-Float actuated switch. 0 2 4 6 8 10 12 rrdmr
CAPACITY 5 0
METERS FEET
26 -- -- Pump Specifications Features and Benefits
MODEL DVP03 ' and 1 12 HP • EPO4 impeller- semi -open design
61 20 Up to 60 GPM with pump out vanes to protect
5 t5 _ Maximum head to 32 mechanical seal.
4 ` Discharge size 1'12° NPT • EP05 impeller - enclosed design
0 3 10 Solids 'i, maximum for improved performance
0 21 6 - _ Motor • Rugged glass - filled thermoplastic
All motors feature ball casing and base design provides
0 0 —.. ---------- - - ---- _-- _ _:
bearing construction superior strength and corrosion
p 5 10 16 20 26 30 35 40 U S GPM resistance.
Single phase 115V
0 2 4CAPACITY 6 a Materials of Construction 'Cast iron motor housing for
efficient heat transfer. strength.
Cast iron
Thermoplastic and durability.
Stainless steel •Corrosion resistant threaded
stainless steel shaft
• Available for automatic and
manual operation
• CSA listed models available
All Models are designed for continuous operation and feature stainless steel hardware.
I
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address 62. me i " .
Property Address {j I Kam- �Q G G 62 'L 1164
(Verification required from Planning Department for new construction) 5-n^ L
City/State 9 , a4 ZA Z Parcel Identification Number 0 2 O – /o R� —
LEGAL DESCRIPTIO
Property Location '/., 9_ '/., Sec. 1 In . T2_f_N -R-4Si W, Town of
S 17 pa r b-'' 1A3go in^ a a d.11A' Lot # �.� —•
Certified Survey Map # /0 -A . Volume , Page #
Warranty Deed # J"? F3 / / 7 , Volume l yo , Page #
Spec house ❑ yes Kno Lot lines identifiable ❑ yes Ino
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 plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
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.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
iS the three yea expiration date.
NA O LICANT ATE
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
7 rty descri dab e, by virtue of a warranty deed recorded in Register of Deeds Office.
l / /
S16 ANT DATE
* * * * **
Any permit information that is mis- represented may result in the sanitary peit 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
i
VOL 140U619
STATE BAR OF WISCONSIN FORM 5
- 1982
6
PERSONAL REPRESENTATIVE'S DEED KATHLEEN H. WALSH
REGISTER OF DEERS
DO UMENT N ST. CROIX CO., WI
C O
i
--- _ 'i RECEM FOR.RECDRR
Howard LaVenture 02 -19 -1999 11:30 AM
j
PF1!<.,OMRL REPRESEHTRTIV
;I as Personal Representative of the estate of EXEMPT R 17
[tea LaVenture i CERT COPY FEE:
COPY FEE:
j TRNISFER FEE:
( "Decedent "), RECORDING FEE: 10.00
li for a valuable consideration conveys, without warranty, to PANS: 1
IaCasse Custom Hanes, Inc., a Wisconsin Corporation
Grantee,
the following described real estate in St' Croix County THIS SPACE RESERVED FOR RECORDING DATA
State of Wisconsin (hereinafter called the "Property"): :;NAME AND RETURN ADDRESS
I I
Heywood & Cari, S.C.
Boot 125
Hudson, WI 54016
i
SW : of NW's of Section 16, Township 29N, Range 19W, St. Croix Colony 'I
a... ._ .. ......... -
Wisconsin. .._. - - --
�i THIS PROPERTY 19 IN THE WELL ADVISORY AREA. 020- 1029-00
:I I ATION NUMBER
�I
I
I:
Page is n partial satisfaction of a Land Contract dated February 18, 1999, Recorded in Vol /
r
I
i
Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately
prior to Decedents death, and all of the estate and interest in the Property which the Personal Representative has since acquired.
Dated this 18TH day of Fe b r uary 19 99
i
(SEAL) (SEAL)
Howard IaVent
Personal Representative Personal Representative
AUTHENTICATION ACKNOWLEDGMENT
Signatures) Hnwaxd 54aieof Wisconsin
ss.
County
authe ncated this__ 18 ty of February ' 19 - 22 - Personally came before me Ibis day of
19, the above named
StmleI R. Cad
is
TLE: MEMBER STATE B OF WISCONSIN
, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing ,
instrument and acknowledge the same.
• ,i THIS INSTRUMENT WAS DRAFTED BY i
I Heywood & Cari, S. C. Box 125
Hudson, WI 54016 Notary Public, County, Wis.
c
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date:
necessary) 19 )
Nampa ut persons signing in any asperity should be typed or printed below their signaton".
STATE BAR OF WISCONSIN Wisoomn Legal Blank Co.. Inc.
PERSONAL REPRESENTATIVE'S DEED Form No. 5 — 1982 Milwaukee, Wis.
UU-Uu ,.� �r 1261.40' c! " Li
2 00.00' as 0
894 0 W�97.40'' - - 20 0.00' n ° F-
N 89 ° 46' 00" W I 216.00' • _' 00.Q . N LL
1 75.15' f 216.00' 216.0 c
I 216.00' C
7 5' 218.00' 3 M
2.099 ACRES 3 = "N? ch
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Op, 91,438 S.F.
10 N
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0 - `- 0
9 °46' 00 z
195.01 ^ z ;o
AGE - 5' o �^ �� �^ o M $
NT 3 5 ' 10 0 1.1. o" 12 0a $ gn W
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