HomeMy WebLinkAbout020-1349-04-000 ST. CROIX COUNTY ZONING DEPARTME
AS BUILT SANITARY REPORT f,
I
Owner 4 ` G
Property Address z15 e,44
City /State
Legal Description:
Lot Block Subdivision/CSM # �-- '
'/a ' /a, Sec. �, TAN -R :� Q W, Town of �ec dl o , ,,V PIN # `I '0 'vd
SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION:
fib , td &l � 5Tr,J
Tank manufacturer A QW Size ST/PC lG 5 �/ Setback from: House Well P/L
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: e5o_tl Width 5 Length / Number of Trenches
Setback from: House Well P/L Vent to fresh air intake
ELEVATIONS
Description of benchmark Ti> c,/ 7 - Elevation /e - I
d
Description of alternate benchmark S'A e,,6 Elevation 9Q `
Building Sewer !6 d i�_ ST/HT Inlet 96 g f ST Outlet yg,' zG PC Inlet
PC Bottom Header/Manifold ?_ Top of ST/PC Manhole Cover _
Distribution Lines () 9.r 5
Bottom of System
Final Grade () () ( )
�4q <V 2 7
Date of installation 1 Permit number State plan number
Plumber's signature � �w � License number „?2 Date
Inspector Oa.__Q
Complete plot plan �
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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
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INDICATE NORTH ARROW
Wisconsin Department Commerce PRIVATE SEWAGE SYSTEM /
•Safety and Buildings Division Count y:
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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)]. 344583
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
Stout, Ric Town of Hudson
CST BM Elev.: Insp. BM Elev.: B / Parcel Tax No.:
r Gt 0 � 020- 1349 -04 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic _� `6, Benchmark ���� p� yC7 lob
Dosing Alt. BM 2 q2 9Y, yi
Aeration Bldg. Sewer 3. i<Z jam, oey
Holding Inlet
TANK SETBACK INFORMATION 1 , 4 , S Outlet S .6 �7 . L 6
TANKTO P/L WELL BLDG. Air Intake ROAD Dt Inlet
eptic k /✓ (��` NA Dt Bottom
Dosing NA Header/ Man. (� .11
Aeration NA Dist. Pipe G. 3 ( 9
Holding Bot. System 2� 7. 2. el- 6
PUMP /SIPHON INFORMATION Final Grade '�.5� 7$• SB'
Manufacturer Demand St cover Y. 3L
Model Num
TDH ft Friction System TDH Ft
tie
Forcemai Length Dist. To well
1 SOIL ABSORPTION SYSTEM
BED/TRENCH Width �l Length No. Of Trenches PIT No. Of Pits Inside Dia. Liq Depth
DIMEN I N O DIMEN I N
SYSTEM TO P/ L BLDG I WELL LAKE / STREAM LEA ING Manu ac urer:
SETBACK CHA BER
INFORMATION Type O Mod Nu er:
Syste : jy,l, -7 )3 ' N 4E "`�' OR U
DISTRIBUTION SYSTEM
Header/Manifold N Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length 1)- Dia. y Length Dia. T " Spacing �-� 5T Wl 'L ,7 ti r
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx DeDth Of xx Seeded/ Sodded xx Mulched
Bed / Trench Center Bed/ Trench Edges Topsoil ❑ Yes Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1:i /o- /9 Inspection #2:
Location: 715 A & n B n Blue Jay Lane, Hudson, WI (SW1 /4, SW1 /4, Section 26 T29N -R19W) - 26.29.19.1880
O +
Plan revision required. ❑Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector' Signature e
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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SANITARY PERMIT APPLICATION S afety and Buildings Washington Avenue
n
Vi sconsin 201 W. Washin P O Box 7302
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. 5'Tt A-.$ r
• See reverse side for instructions for completing this application State Sanitar Permit Number
Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)]. / /� y d � (,.din,.
State Plan I.D. Number
" ��
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATI
Property Owner Name Property Location
c� To el 7
4) 4 S� 1/4, S T bz 4 , N, R li? E (or)9
Property Owner's Mailing Address Lot Number Block Number
/ o
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE OF BUILDING: (check one) E] State Owned It Nearest Road
Public 1 or 2 Family Dwelling- No. of bedrooms �� o w a n OF �. o t- ,[
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
a d- y
1 ❑ Apartment/ Condo ® l3'y�P_a
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. IV New 2 ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
- _____System ________System _____________Tank Only______________ Existing System ________ ExistlnqSystem
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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In- Ground Pressure t r 42 ❑ Pit Privy
13 ❑ Seepage Pit 2 S k �� 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/da /sq. ft.) (Min_/inch) Elevation ,
9� !�5' ✓ f l3 O I a. �5 '0 Feet 99 Zr Feet
Capacit
VII TANK in Ca gallo s Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App
New Existin structed
Tanks Tanks
91 ❑ ❑ ❑ ❑ ❑
Li ft ra ... p*emle 6 Chamberl ❑ I ❑ I ❑ I ❑ 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's Signature: (No Stamps) P MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
/ ;7
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Aent Signature (No Stamps)
roved Surcn ge Fee)
pp ❑ Owner Given Initial 2.. Z O (oa
Adverse Determination C
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, plumber
INSTRUCTIONS f
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.
Ili. 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.
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page / of
Bure4u 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 �. `' X
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
G;2
APPLICANT INFORMATION - Please print all information. Revi ed Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ZL7
Property Owner Property Location
r i d 5" ��^ Govt. Lot S&) 1146°U)114,S ja T,,;?q ,N,R E (orA�
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
33 ,` / y
City State Zip Code Phone Number Ci ty ❑ Village Town Nearest Road
❑
New Construction Use: to Residential / Number of bedrooms 4 ' ,' Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow �O gpd '/ �t� Recommended design loading rate bed, gpd /ft trench, gpd /ft
Absorption area required _ bed, ft trench, ft Maximum design loading rate .
�r g g _ bed, gpd /fi --- 4-r - trench, gpd /ft
Recommended infiltration surface elevation(s) / oa� ft (as referred to site plan benchmark)
Additional design /site c n iderations
Parent material �¢ c.`� �� 7` Flood plain elevation, if applicable �ft
Eu = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
= Unsuitable for system ® S ❑ U XS ❑ U IX S ❑ U ®-S ❑ U ❑ S U ❑ S W it
SOIL DESCRIPTION REPORT
Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft
Boring Texture Consistence Bounda ry Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ito
Ground
9 Y"ly4 t.
Depth to /
limiting 5 6�
factor
/f -in.
Remarks:
Boring #
16 V"3 G
a ;2 -ay ,
Ground
Depth to
limiting
factor
/ Remarks:
CST Name (Please Print) Signature Telephone No.
Address ./ Date CST Number
1 2 - �l Q
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page a2 of
PARCEL I.D.#
Boris # Horizon Depth Dominant Color Mottles Structure 2
Boring Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh p Bed ,Trench
a
Ground 3 b_ t d s S In
o
ft.
Depth to
limiting l
factor
in.
Remarks:
Boring #
12 'U -g
Ground
elev.
lZ '
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring# �
3 * .�
Ground
elev.
9�oft.
Depth to
limiting
factor
in. Remarks:
Boring #
I '
Ground
elev.
ft.
Depth to
limiting
factor
' Remarks:
SBD -8330 (R. 07/96)
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Wisconsin Department of Commerce I , , L AND SITE EVALUATION
Division of Safety and Buildings :' w,.,, Page of .3
Bureau of Integrated Services s in`a �rdariC� with s. ILHR 83.09, Wis. Adm. Code
_6
Attach complete site plan on paper not less the 8 1/2 x gs size ,Plarl,must County
include, but not limited to: vertical and horzon�91 referen4 OInt( 1), direction "and St. Croix
percent slope, scale or dimensions, north crow, and location and distance to ne4rest road.
r + rN Parcel I.D.
i 5d n
APPLICANT INFORMATION - Pi a ,4e_print t tG_(()F4ta tion'.. Revi ed by Date
Personal information you provide may be used for �eCondary OKI wes '15. ' 4 (1) (m)). c fad
Property Owner �- Property Location
Richard Stout Govt. Lot ' 41F 1 /4s 4)114,S T .21 ,N,R /�j E (or�N
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
1353 Awatukee Trail 4 Brown's Ridge
City State Zip Code Phone Number ❑ City ❑ Village [ Town Nearest Road
Hudson WI 5401 6 ( 71 5) 549 -6731
Hudson I Meadow Lane
KI New Construction Use: ® Residential / Number of bedrooms 'I Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 4 5 0 gpd Recommended design loading rate . 7 bed, gpd/ft . 8 trench, gpd /ft
Absorption area required 643 bed, ft 563 trench, Maximu� design loading rate ' 7 bed, gpd /ft ' 8 trench, gpd /ft
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material Glacial De 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 ® S ❑ U K S ❑ U ® S ❑ U ❑ S ®U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
g Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
1 1 -6 10yr3/2 Sil 2mabk mfr cs IF .5 :.6
g , 2 -96 10yr4.4 Ms osg ml cs 7
Ground
elev.
_
Depth to
limiting
factor
Remarks:
Boring #
1 0 -6 10yr3/2 Sil 2mabk mfr cs IF .5 .6
2 6-95 10yr4/4 Ms osg ml: cs .7 .8
..........................
C7
Ground
elev.
Depth to
limiting
factor
Remarks:
CST Name (Please Print) Signature Telephone No.
14 111 i :am '90huaia3ke r - ''_ (71 5) 386-3121
Address Date CST Number
1 070 Scott Rd Hudson WI 54016
PROPERTY OWNER Ii: crr � _ zr rdSte it SOIL DESCRIPTION REPORT Page ;2' of
�
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3 1 0-113 10yr3/2 Sil 2mabk mfr Cs 1F ,5',6
/5 2 10-20 1 Oyr4 /4 Sil 2mabk mfr .5'.6
Ground 3 20-96 10yr4/4 Ms osi ml . 7.' .8
elev.
ff.
Depth to
limiting
factor
9 6 in.
Remarks:
Boring #
1 -10 10 r3 2 Sil k mfr CS 1F
4 2 10 -9 10 r4 4 Ms osi
;2 S"
Ground
elev.
Depth to
limiting
factor
9 6 in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /lf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring # 1 0-18 1 Oyr3 /2 Sil 2mabk mfr Cs 1 F .5 .6
5 2 1 18-3 6 10yr 4/4 Sil 2mabk mfr Cs
3 36-95 10yr4/6 Ms osg M1 Cs .7 .8
Ground
elev.
ft.
Depth to '
limiting
factor
9 6 in. Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R. 07/96)
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 0?i , °c! a y tL S'7oa. 7`
Mailing Address l,�S3 �J'�J7`Hl/� ��•�.� sue,✓ l r ` 5
Property Address -e—
(Verification required from Planning Department for new construction) �i Y C
City/State u,l arm Parcel Identification Number 9 4
LEGAL DESCRIPTION
t�
Property Location A< V4, SG) ' /a, Sec. ac , T -R Town of r4�.•- �ce ,�
Subdivision g6� wt-] -' zV,,�J- o..p , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # 1S` / �f 3 � , Volume Page # <17
Spec house ❑ yes ,& no Lot lines identifiable ® 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 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.
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
days of the three year expiration date.
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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.
19A j 0 a�0 S 99
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
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VOL 1 PACE l ) 10 0W
X81439 STATE BAR OF WISCONSIN FORM 2 - 1982
WARRANTY DEED
DOCUMENT NO.
— a singlee __ -- - REGISYEq, .UFItE
- - -- -- - -- -- ST. CRO!X CO., WI
conveys and \\•arrauts to Richard 0. Stout and Janet P S ) 1 , — JUN 2 2 199$
tLuaband —arid wife 8:00 A M
6, 6 l�.l.... �+
k ��,Jwfj
ft# 09F of Deeds
—"— " - -- -.,S SPACE RESERVED FOR RECORDIt.0 DATA
_ %.iW� XND a =TURN ADDRESS
the fullou - ing described real estate in _ St. Croi County CF f, L-
State of Wisconsin. r
020- 1072 -60 _
PARCEL DENTIF!CATION NUMBER
That part of S2SU -k, Sec. 26- T29N -R19W described as follows: Lot 2 of Certified
Survey `lap recorded in Vol. 11 of Certified Survey ?taps, page 3036 as Doc. 1141).
538112. Together with a 66 foot access easement from Kinney Road to the Easterly -
boundary of the above described property. '
a
TRANSFER
y �
This —_i $_ no .._ homestead property ;
x= La not'
Exception to warranties Existing highways, easements and rights of way of record.
` th
Dated this - - -_ day of -- June A D. la 98
(SEAL) - -- (SEAL)
.D avid J. eja _—
-- (SEAL) _ (SEAL) y.
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AUTHENTICATION .ACKNOWLEDGMENT rk
Signal u re(s) State of Wisconsin,
County i
authrnticated this —._ -- day of l9— FeTsonal!y :.imc fore me this _ —_- -- day of
- -- - .Tune _ _. 19 98 , the ab ove named
- - -- -- -- - - - - -- -- Richard J . Ca lleia, — a si pers _.
author 1,- ,70h 06, Wi< ~tats.) 10 tilt kn, kn „ ihc loi,gouh -
S P »y Pv� tile ,ante
THIS ;N••`Rl1MFNT'ViAS DRAFTED BY
_ At to me y_ Qav id -1, -.Es -t
C - ;
fJfAUREEN
_30.4. - Locust. -Street,.- UWso-0, ,rI_ 2 SHISHEI. 141L E 5_� i °__ I_y'_. - COLMIc.��i>
:rAct p rt.r: he aulh:W4.u,d Of a. n„\c!cdged of , r not
lo >L,n: 14.1 - - c'•.n„ ., er, , if•.n:n -Fa .,. ^, .,, x . i .- ,trd'xlow ��r��w.>
dart.
\\ . \RR.\ \Ia DI n farm .. \a. 2 - 1- �2 '
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*� �r�rc BAR OF: m,/ow �� po w
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DOCUMENT NO VOL �.�.�'�FA
Kristine M. Brown. as his _ - _
--�ife- arxL jahor-own_ c��ht '----- --- - ST. CqO|� CO., W � n
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Stout, husband and - 8:00 A�
--ID�D����_-------'--------'�-----------'----�-- -- '�k^-~~� ' \^/^1`
`^,m,^naEwcn^mp,~.��a.^�L"^
`°"� AND ^ooneso
the foo^"m�
State ^(viscvn^m.
020-1972-30
� ___'- '
P-at part of S- Sec. 26-T29N-R19H described as follows: Lot 1 of Certified
�
Suney Map recorded in Vol. 11 of Certified page 3036 as Doc. �o.
� 538112. Together with a 66 foot access easervnt fron Kinney Road to the Easterly
� boundary of the above described property.
JRANSFER
FEE
nx^ --__is [lot»^:'*'� P^7*n
� xnx ^=»`
cmr.!onww,um� Existing higtiwaya, casements acid ciz�hcs of t,-ay of record.
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AUTHENTICATION ACKNOWLEDGMENT
�
� So/, of Wisconsin,
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_.u,./�a-_- ..,*:^./� �^,,' /run .x' o^. __--J���- _`|x/.`/
June �_w 5tL'm',wnn^"uu
-'----- '--'------------'------- - _'Ai0bael-zu n-mod_ Eris 1ice��. --_
' huStawd »nd'Vifc
... " ^"~,. ^,`^." "`^`', `^.,-".,,., '
MAUREEN K.
./4
'v-u,^'=Y_ David -^`e`��,^�
304 Looajet Street, 8uki_�on, � � �``'.`��`� SiL�2���