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HomeMy WebLinkAbout020-1359-14-000 a Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT St. C roix 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)]. 353206 Permit Holder's Name: ❑ City ❑ Village ❑ x Town of: State Plan ID No.: Town of Hudson CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: d0. d 0 0?0_1 3 TANK Ci INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 0 r t7l�CC / 21J� Benchmark 7,77 7 12 P Dosing Poo Alt. BM Bldg. Sewer ing t Ht Inlet TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Airin* ROAD Air In Septic U NA Dt Bottom �', L Dosing >j G l ^/ �1 / NA Header / Man. Aeration Dist. Pipe Z ?: 3 'ng Bot. System PUMP/ SIPHON INFORMATION ' Final Grade LUWF Manufacturer S De and , p St cover Model Number .. PQ 31 , -GPM (2 0 rh ,*1 . /' a 0, s TDH Lift -4 Friction ,4 System TDH r Ft oss mead Forcemain Length 3 p r Dia. z Dist. To Well SOIL ABSORPTION SYSTEM �_ G BE RE Width Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM 2 J DIM N 1 INS SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuactur r: SETBACK ` r al INFORMATION Type O ( ' / _ � R Moe Number: System: — ,F � a I DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length r Dia. Length / Dia. A& Spacing �/ N '7:7 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.) Inspection #1: f ( / /. Inspection #2• Lo cation: 519 Green Mill Lane, Lane udsygn,Wll1 /4el "'We-, W1 /4,S ectior>,16 T29N -R19W) - 16.29.19.2110 1. Alt BM Description = ¢ ( G�I�t,, �c ) 2.) Bldg sewer length = yb - a of cover = ' / 0�� 8 Icdir� 7t 4a of was Plan revision requife __"5 Ae' Nos efc P Use other side for additional information. Z n p (� (� SBD -6710 (R.3/97) Dat lnspectoA Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: A �m E f E � � as x E E g a I rt i I � i � Safety and Buildings Division ' `$C011S%11 SANITARY PERMIT APP P o W. Washington Department of Commerce In accord with ILHR K A�1�1Madison, WI 53707 -7302 p p y pv • Attach com lete lans to the count co onl f r h ess Cou'ctt Y ( )otes , y than 8 1/2 x 11 inches in size. � • See reverse side for instructions for completing this appl an State itary Permit Number f 7 '' - "I Legg 3 I� Personal information you provide may be used for secondary purposes ST CpO1X Q CM k if revision To previous application [Privacy Law, s. 15.04 (1) (m)]. COUNTY Plan I.D. Number I I. APPLICATION INFORMATION - PLEASE PRI ALL I . - "F Propert nerrName ' r -" ! 1' flroR. /� ,S T p? ,N,R �(or)W Propert w s ailing Address Lot Num r Block Number City State Zip Code / Phone Number Subdivisi Nam r CSM Number {o II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ❑V Nearest Road . A Public 9 or 2 Family Dwelling - No. of bedrooms Town OF 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax e I 1 E] 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) New Replacement Re lacement of Reconnection of Re A) 1. 2. p 3. p 4. 5. P �S stem System ❑ Tank Only ❑ Existing Syste ❑ air of an Existing - ------- y------------- ?'------------------------ y------------- - - E - i - - g Existi y----------- - - - - -- g S - y stem 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 h 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 EkSeepage Trench _5, _ �ry„22 ❑ In- Ground Pressure /'� � 42 ❑ Pit Privy 13 [1 Seepage Pit A CLIP_ - 43 E] Vault Privy 14 E] System -In -Fill 3 , VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 17. Final Grade ,r o Required (s ft.) Pro osed (sq. ft.) (Gals/day/ . ft.) (Min. /inch) C a Elevation t (D 3' /D et ee Ca acit VII. TANK in allons Total # of Site Fib Ex p g Manufacturers Name Prefab. Con- Steel la P E pe r New Exist in Gallons Tanks concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank �- ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber OO '—" El ❑ El ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assu a responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' am (Print) Plumb Sig ure: ( o to s M /MPRSW No.: Business Phone Number: ao3S ! v Plum a r 6s cidr s tre it , SkJte, Z' d 500e�© IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved 5 rmi t Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) Approved El Owner Given Initial Surcharge Fee) Adverse Determination � X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: DISTRIBUTION: Ori ginal to County, One co To: Safety & Buildings - 9 Y PY Y s Division, Owner, Plumber 9 SBD 639 R. 8 ( 11197) 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 purriper'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 isto 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 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 treatmenttanks; 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; b) 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. LaCasse Custom Hanes, Inc. NWkSWk S16= T29N -R19W town of Hudson lot #14- 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 mere not established at the time the test was conducted. N 1 BM.= top of SE lot stake C el. 100.00 Alt. BM-= top of 1 pvc pipe C el. 100.55' pcp to `Z3' o •. to Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor 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. Cr oix 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 �r &y rqa 020 - 1029 - APPLICANT INFORMATION PLEASE PR TEL rIVFORMATION MEWED BY DATE PROPERTY OWNER: E !'��,� PROPERTY LOCATION LaCasse Custon Homes, INc. i0T. LOT NW 1/4 SW 1/4,S 16 T 29 ,N,R lg (or) W PROPERTY OWNER':S MAILING ADDRESS LO # BLOCK # SUBD. NAME OR CSM # 521 McCutcheon Rd. `:'` 199 1 na Parkwood Meadows CITY, STATE ZIP CODE "PHO E ITY ❑VILLAGE ®TOWN NEAREST ROAD Hudson, WI. 54016 `;i7,1 1 405 ; " Hudson Meadowood Ln. [x] New Construction Use [:q Residential / d Of" \2 [ ] Addition to existing building j ] Replacement [ ] Public or commercia Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft2 - 8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, p d/ft2 •8 trench, gpd /ft Recommended infiltration surface elevation(s) 96.20 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem CRS ❑ U r7 S ❑ U [RS ❑ U ® S ❑ U K] S ❑ U EIS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Boring .................. in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench 1 1 0 -12 10 r 3/3 none 1 2ms mfr cs 2f .5 1.6 2 12 - 24 10 r 4/4 none sil 2msbk mfr gw 2f .5 .6 Ground 3 24 -90 7.5 r 4/6 none co s Osg ml na na .7 .8 elev. i 9 Depth to �x3 limiting factor +90" Remarks: Boring # 1 0 -8 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 : <:;.........;;::; 2 8 -22 10 r 4/4 none sil 2msbk mfr gw 2f .5 .6 ................ Ground 3 22 -84 7.5 r 4/6 none co s Osg ml na na .7 .8 elev. 99 ft. Depth to limiting factor +84 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave New Richmond WI 54017 Signature: Date: 7 _6_99 CST Number: m02298 azQ� PROPERTYOWNER Tarasse ctistcirn 14omp SOIL DESCRIPTION REPORT Page _21of - 3 " PARCEL I.D. # 020 - 1029 -30 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Barclay Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -8 10 r 3 1 2msbk mfr cs .6 2 8 -25 10 r 4/4 none sil 2msbk mfr crw 2f .5 .6 Ground 3 25- 90.7.5 r 4/6 none co s Osq ml na na .7 .8 elev. 9 9.7 ft. Depth to ` limiting factor +90" Remarks: Boring # 1 0 -13 10yr 3 none 1 2msbk mfr CS 2f .5 .6 4 '> 2 13 -34 10 r 4/4 none sil 2msbk mfr 9w 2f .5 .6 Ground 3 34 -96 7.5 r 4/6 none co s Os q ml na na .7 .8 elev. LQQ, — Depth to l - limiting factor +96 11 Remarks: Boring # 1 0 -10 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 2 10 -30 10yr 4/4 none sil 2msbk mfr gw 2f .5 .6 Ground 3 30 -96 7.5 r 4/6 none co s Osg ml na na .7 .8 elev. 10 ft. Depth to limiting factor +96 Remarks: Boring # ................. Ground elev. j ft. i Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel LaCasse Custom Homes, Inc. 1554 200th Ave. CSTM2298 Nw s16- T29N -R19w New Richmond, WI 54017 MPRSW -3254 town of Hudson (715) 246 -6200 lot #14- 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 "im .= top of SE lot stake C el. 100.00' t. B1�i= top of 1" pvc pipe C el. 100.55 d � ti J id � 1 1 Q� �© Gary L. Steel 7 -6 -99 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE 5 OF 6 -VE1JT CAP WEATHER PROOF JUIJCTIOKI Box 4'C.I. VENT PIPE APPROVED LOCKIMG - -- - MAIJHQLE COVER ;'JII* l —lO FROM DOOR, w ARN11JG LPgEL. '.iINDOW OR FRESH AIR IAJ TAKE S CO>JDu1T fi 5 15,Alu. y�11JSiL' =�O1J PIPt PROVIDE I - -- -- . W LET = — AIRTIGHT SEAL I I C I @iaPF�� I I I � ( APPROVED JOIUT: APPROVED JOIAIT A W /C.T. PIPEDR Tank construction I II I ALARM shall comply with 'I I ILHR ('33.15 and 83.20 a II i ow C I I I LLEV, f 7 PUMP � OFF D COU PLETE 5 3 1►APSt�r: D K 15CR EXIT PERMITTED OIJLy IF TAW MAIJUFACTURER HAS SUCH APPROVAL SEPTIC E SPEGIFICATIOUS DOSE 3 1 TA1JK MArJUFACTURtR 1'1l�bV NUMIiEA OF DOSES: PER DA4 TAWK :AZC : V?-Q0 I �' GALLOKIS D05E VOLUME r ALARM MAUU FACT URCR: SZ- IAICLUDMIG BACKI<LOW: 189.5 GALLONS MODEL NUMBER: 1O1 "W CAPACITIES: A= INCHES OR u00.0 GALLOIJS SWITCH Ttl PE: 1--\ B= I � , G�LLO►US PUMP MAWLIFACTURCK* Gov �"Q S C I OR �$ q . S GALLOWS MODEL NUMBER: 38, c �� OS D -- IMCHES OR � GALLONS SWITCH TYPE: MOTE: PUMP AUD ALARM ARE TO DE .b MIMIMUM DISCHARGE RATE 3126 GPM INSTALLED OK1 SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AU0- 015TRIBUTIOU PIPE.. 1 � � FEET f MIKIIMUM NETWORK SUPPLY PRESSURE .. . . . .. .. . . FCET + � � FEET OF FORCE MAIN X 3 ' 0 � F 0 0fLFRICTIOIJ FACTOR..� FEET TOTAL OyNAMIC HEAD Pump chamber DIAMETER 3 �l ILITERAIAL DIMLWSIOWJ OF TANK: LEKIGTH - ;WIDTH - ;LIQUID DEPTH BOTTOM AREA 231= GAL /INCH AS PER ' MANUFACTURER - 2. l : O S GAL/ INCH b c b Goulds Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor: manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset plastic Semi -open design 3 /4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM.' standard length, 16/3 SJTO mechanical seal protection. Co. Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding – ■ EP05 Impeller: Thermo - • Discharge size: 1 NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to 9 30 / ; i -► 5GPM1 components. v Pump: EP05 a • Solids handling capability: c 7 25 3 /4" maximum. w • Capacities: up to 60 GPM. _ • Total heads: up to 31 feet. 6 20 I I • Discharge size: 1Y2° NPT. Z 5 I • Mechanical seal: carbon- rotary/ceramic- stationary, 4 - BUNA -N elastomers. o i i i EP05J • Temperature: 3 10 104 (40°C) continuous –t— r O�4 — 140 °F (60 °C) intermittent. 2 i 1 5 0 00 10 20 30 40 50 GPM L -L 0 2 4 6 S 10 12 m °/h CAPACITY ®1995 Goulds, Pumps, Inc. Effective May, 1995 C -4I r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address 1 (Verification required from Planning Department for new construction) City/State A eaA,-htyL- to 1' Parcel Identification Number LEGAL DESCRIPTION Property Location /,, , Sec. G , Tz_N -R / _W, Town of Subdivision �.�r� /� ��1� Lot # _. Certified Survey Map # , Volume , Page # Warranty Deed # �O � t , Volume Page # 3 Spec house ❑ yes Kno Lot lines identifiable Oyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance f needed b a licensed p umper. What y ou p ut into the system consists of p umping out We se ptic tank eve three ears or sooner, i y P P Y P P P 8 P every y ears disposal system. affect the function of the septic tank as a treatment stage in the waste y can aff P P g 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 wastewaterdisposal 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. Uwe, 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 days of the a year expiration date. SIGNATLTAE OF APPLICANT DATE I 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 scribed above, by virtue of a warranty deed recorded in Register of Deeds Office. /0 // / SIGNATORE 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 — 1982 1! 61 X75 j WARRANTY DEED ( KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO VOL 1466PAGE136 ( ST. CROIX CO., WI �� RECEIVED FOR RECORD This Deed Howard LaVenture, three - fifths i 10 -26 -1999 12:15 PM made between (3/5) interest in and Arlene LaVenture, two- fifths WARRANTY DEED (2/5) interest in, as tenants in common. ;j EXEMPT N 17 Grantor, j CERT COPY FEE: Inc . I COPY FEE: and LaCasse Custom Homes, �I TRANSFER FEE: RECORDING FEE: 10.00 PAGES: 1 Grantee, Witnesseth That the said Grantor, for a valuable considerati 'j conveys to Grantee the following described real estate in St. Croix THIS SPACE RESERVED FOR RECORDING DATA County State of Wisconsin: NAME AND RETURN ADDRESS 14 ciwA-44 Mr cr ) LOTS 14 & 20 OF PLAT OF PARKWOOD MEADOWS, TOWN OF HUDSON, 1521 y �, �, G 4 G �Q.U1V 1�4 ST. CROIX COUNTY, WISCONSIN to PENDING i. PARCEL IDENTIFICATION NUMBER ado -,30 This This deed is given in partial satisfaction of certain land contract dated February 19, 1999 and recorded in Volume 1404 , Page f as Document Number _ 598116 which was i. subsequently assigned by assignment dated May 28, 1999 and recorded in Volume 1431 , Page 152 as Document Number This is not homestead property. $i1 (is not) '! Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except all liens, covenants and restrictions of record, if any and any liens or encumberances created by act or default of the Grantees i. and will warrant and defend the same. Dated this 25th day of October ,19 99 (SEAL) (SEAL) * Howard LaVenture (SEAL) (SEAL) Arlene LaVenture AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. County authenticate is day of October 1 19--99 Personally came before me this day of 19 , the above named rlmiipl R -7r..q r i i TITLE: MBE ATE BAR OF WISCONSIN (if not, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Heywood & Cari, S.C. by Walter Hodynsky 204 Locust St. PO Box 125 Hudson, WI 54016 Nota ry Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) 19 ) • Names of persons signing in any capacity should by typed or printed below their signatures STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. WARRANTY DEED Form No. 1 — 1982 Milwaukee. 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