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HomeMy WebLinkAbout034-1073-10-000 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes [Privacy La w s.15.04 (1)(m)]. 344565 PerrrStEiVEk?T'kICK El City SPRIN 9 G ELDof: tate Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM D^scription: Parcel Tax No.: �o Uo,�S 034 - 1073 -10 -000 TANK INFORMATION ELEVATION DATA Via, z 4. /S. y�Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ��- tNo (�� Benchmark � 3 a^p • 0 5 Dosi nq (A) Aeration Bldg. Sewer A Holding St /Ht Inlet 64 B 35' S$ TANK ACK INFORMATION St/ Ht outlet TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet ir Septic > S7D 12 1 NA DI Bottom C Q) 12,24 81- [ • 3 3 r Dosing �� �� LL — I NA Header / Man. 100-64 3•t Aeration NA Dist. Pipe f M -a � , Holding Bot. System D r 9• PUMP / SIPHON INFORMATION Final Grad � ,L(� ig+ Manufacturer Demand 3,12„ 1 apes Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length. -2-�O Dia. F !k I Dist.ToWell SOIL ABSORPTION YST E J T1tENEF1 Width Len th I o. Of PIT No. f its Insi Liqui epth D EN I N •25 DIMEN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LE AMBE G Manufacturer: SETBACK INFORMATION TypeO odelNum er: System: fn y lt� OR UNIT DISTRIBUTION SYSTEM Header/Manifold tl Distribution Pipe(s�)��� nn\\ W r x Hole Size x Hole Spacing vent To Air Intake Length �•`� Dia. Z•'� Length�°`�bia. 1 /4' Spacing �• d f �I '49 rr 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.) "` ' 6 Z�/ °I , t oC) LOCATION: SPRINGFIELD 32.29.15.492A,SW,SW 2818 60TH AVENUE ! IL) � 0,+ 1��t � 9 � _ v Plan revision required? ❑Yes C No Use other side for additional information. a 2s°I SBD 6710 (R.3/97) a c 4Q cog Inspector's Signature Cert. No. r Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 201 W. Washin Avenue In , P O Box 7302 Department of Commerce accord with )LHR 83.05, Wis. Adm. Cod Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ST CROIX • See reverse side for instructions for completing this application State Sanitary Permit Number 3yys� �- Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. NUm be rSITE ID 1 75782 I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION TRANS ID 234331 Property wner Name Property ocation RICK SEIVERT SW 1/4 y SW 1/4, S 32 T 29 , N, R 15 F/(/4fYW Property Owner's Mailing Address Lot Number Block Number 184 ISABELL STREET, N/A N/A City, t o Phone Number Subdivision ame or CSM Number R �'AUL MN ' Siof 1 (615)291-8859 N7A 11 . T PE F WI (check one) ❑ State Owned itr Nearest Road Ej Public 1 or 2 Family Dwelling - No. of bedrooms 3 ° Town of SPRINGFIELD 60TH AVENUE III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 034- 1073 -10 'ja,. �j . IS, L� 2 A 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 M New 2 ❑ 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 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 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 S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 450 375 375 .5 N /A i00.5 Feet 102.79 Feet Capacit VII. I NFORMATION in gallo Total # of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. New Existing Tanks concrete structed glass App. Tanks Tanks eptic Tank an 1000 1000 1 MIDWESTERN PRECAST ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank 650 650 1 IMIDWESTERN PRECAST ® 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ Vill. STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Pgna ture: (No St s) MP /MPRSW No.: Business Phone Number: BENNIE HELGESON 0292 715/772 -3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Is u gent Signature (No Stamps) Approved Owner Given Initial ��p Surcharge Fee) �q Adverse De termination X. CONDITIONS OF AP RO AL / E SONS OR DISAPPROVAL: p1�a ;r 7 /lQq SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings 2226 ROSE LACROSSE WI 54603 -1905 05 TDD #: (608) 264 -8777 ,scons n www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary July 06, 1999 CUST ID No.268093 ATTN. POWTS INSPECTOR ZONING OFFICE HELGESON EXCAVATION INC ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL � APPROVAL EXPIRES: 07/06/2001 Identification Numbers Transaction ID No. 234331 SITE: Site ID No. 175782 Site ID: 175782 Please refer to both identification numbers, ; St. Croix County, Town of Springfield above, in all correspondence with the agency. SWIA, SWIA, S32, T29N, R15W Facility: Rick Seivert Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 477697 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The proposed well must be a minimum of 25 feet from the tank and a minimum of 50 feet from the mound system. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 06/25/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 and M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us ViS�F code: I - INDEX SHEET PROPERTY OWNER: RICK SEIVERT ✓�y 2 cD 184 ISABELL STREET S 4 1 99 ST PAUL MN 55107 A�� Q 9 PROJECT NAME: RICK SEIVERT L /I✓, PROJECT LOCATION: SW 1/4, SW 1/4, S 32, T 29 N, R, 15 W MUNICIPALITY: TOWNSHIP OF CADY COUNTY: ST CROIX CONTENTS: Page 1: Plot Plan Page 2: Cross Section & Plan View of Mound Page 3: Distribution Pipe Detail Page 4: Cross Section & Specifications of Septic Tank & Pump Chamber Page 5: Pump Specifications Name: Bennie Helgeson Signe Address: W1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: June 22, 1999 coF cli. ,iiono Ny it ERA COMM tlDtN�s ir 141 4% 1 nti- tVtS` + ONCE Sr E CvF.R ES yl te � Fj $ e t 4 < A R AP 79. 133 ►. M Y U.R.f Top of Fchce - Pos j �t3 i U.P.P. I o n. 05 n l - ` o q of � euc IV �a Lt v' y d 1 Z v lJwne�` R1G�c �e V .r� Page _ Of _ Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe J '7 Medium Sand H G Topsoil - = = =_ F 'CII-ec .-1 E D 3 1 / 1. b F-J.'u 7 % Slope 915 Bed Of 2 % Force Main Plowed Aggregate From Pump Layer D / Ft. E q Ft. Cross Section Of A Mound System Using F Ft. A Bed For The Absorption Area G - Ft. A _�, 2S'Ft. H Ft. Signed: B /D_ Ft. License Number: K 1�.5 - 3Ft. L gl• I _ Ft. Date: J !o qS �t. Ft. Force Main W 2 5. S Ft. i Observation Pipe A ( -- -------- - - - - -- ------------------ - - --+� Distribution Bed Of 2 — 2'2 Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area fs er 1 Sel ver+ . Perforated Pipe f)eloll 0 End View Perforoled End Cop PVC Pipe b �� Permanent End Markers s Holes Located on Bottom are Equally Spaced PVC Force •loin * From Pump ' S ri PVC ' ENO Monilold Pipe ` C.4 P !" P L/ C- 641,1bullon.. Pipe Lail Hole Should Us Next To End Cop Distribution Pipe Layout P R ' S 3� X _ 3� Y _ Hole Diameter meter 1 Inch Signed: .. •, License Number: Lateral Inch (es) Date: Manifold " Inches Force Main " .2 Inches TAO (e 5 � pr �a�e ra I n 0wri e,r : RiCk 6elyex'+ • SEPTIC TANK &PUMP CHAMBER CROSS SECTION AND SPEC IFICATIO *!S 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF >_ 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE V WITH CONDUIT MANHOLE COVER W1 PADLOCK & FINISHED GRADE r - WARNING LABEL 7 4" CI RISER r -4" MIN. 18" I M IN. 6" MAX. INLET , WATER TIGHT SEALS GAS- TIGHT VAPPROVED A SEAL ' JOINTS WITH - i ; I ALM APPROVED PIPE APPROVED B , i 3 ONTO ON PIPE E3 SOLID SOIL ONTO SOLID SOIL PUMP OFF ELEV . �Sd�` " T• -- I OFF' RISER EXIT D PERMITTED ONL; , IF TANK MANUFACTURER, HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE L/ NUMBER DOSES PER DAY: 3, %`/ TANK MANUFACTURER: TANK SIZES SEPTIC ice GAL. DOSE VOLUME INCLUDING DOSE �s� GAL. 30-%q FLOWBACK: /yS/. GAL. ALARM MANUFACTURER: �:�,C'� ��"� S : A = / INCHES = _3C1/. 7 S - GAL. MODEL NUMBER: 1el/ SWITCH TYPE: B = 2 INCHES = GAL. 3 y PUMP MANUFACTURER: C = 8 INCHES = /_ AL. MODEL NUMBER: W D = L_ INCHES = GAL. SWITCH TYPE: r uLv"7 � /'3J- REQUIRED DISCHARGE RATE _ 1.L/q GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE l.S FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . 2.5 FEET + / _ FEET FORCEMAIN X. FT /100 FT. FRICTION FACTOR ._. 7_ FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH .�5� ; WIDTH 79 DIAMETER LIQUID SIGNED: LICENSE NUMBER: DATE: • .1 � a ` , � ,�" a�' ' e � ` p V �L i ,'� r�r< �� it f / � � ,±r �p 1 `t��i n ti � � .L =. � � • • AL Lei ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ MODEL 388 SIZE 1 /4" Solids .......' ................... e , e e .e a .e , :e •, ee , e e e e e Wisconsin Department of Corrunerci� SOIL AND SITE EVALUATION Divisi - 4,n of Safety and Buildings Page _� of -� Bureau of integrated Service iCCOrdBnCea # h'1?'1R- $3.09, Wis. Adm. Code Attach complete site plan on pape ncrt less aiar t - 1 x 11 inches size. Plan ust County include, but not limited to: vertical ana nolizoniai reierence point (BM) dir4Non► jnd percent slope, scale or dimensions, north arrow at;c vocation and distance istance 6 joad. Parcel I.D. # P APPLICANT INFORMATION - Please print all information 7 Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy l ,. s ;1fx*, "0) (m)). Property Owner q�vdy Locat;on o n Govt. Lot Ifs 1/4 5(�(j1 /4,S �� T � ,N,R /S E (orc Property Owner's Mailing Address L Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ village own Nearest Road �i�r5dn IY02 2 1 ( 2 15 )6 2-2250 1 Cq - N,w Construction Use: E hesidential / Number of bedrooms Addition to existing building ❑ Replacement ❑Public or commercial - Describe: Code derived daily flow _ U gpd Recommended design loading rate S bed, gpd /ft . �c trench, gpd/ft Absorption area required __�7S . ____bed, ft 2 '._.___trench, ft Maximum �des rate . `� bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) .5 ts� �7 tt (as referred to site plan benchmark) Additional design /site considerations 7 S " l 6 x - - — Parent material j am-- -S S Flood plain elevation, if applicable ft S = Suitable for system Convention�al Moun In Ground Pressure AT Grade System in Fill Holding Tank U = Unsuitable for system El B U u s ❑ U El '--' " El S 2­6 ❑ S e u El �� SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench / _ - 5 lo S Vvl i.�J 1 J Ground C> elev. 9�ft Depth to limiting factor Remarks: Boring # LAJ Ground Depth to limiting factor min. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number y �`'��td 9� �1 �� ov1 SOIL DESCRIPTION REPORT _� ' PROPERTY OWNER CLeS _ Page � of — r-- PARCEL l.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 u in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench / Zo Y s rn a,S S' 6 Ground elev. v Depth to limiting fact r Tin. Remarks: Boring # �T Ground elev. ft. Depth to - - - -- limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ta Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) In f P V, 1 (JJcxx� -ems- � 9Q � � ql n z Tod of I � ' Pt)C cv19 91 blooms s a f oc -Ls r ebb o v. do OEL L " I � eKce��s {Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page �_ of , Division of Safety and Buildings Bureau of Integratea Services accordance with S. Wis. Adm. Code Attach complete site plan on papa not less czar, u v'� x 11 inches in ize. Plan must County include, but not limited to: vertical ana hoiizontai reierence point ( ), direction 004 percent slope, scale or dimensions, north arrow, ano Location and istance to nearest T d: 7 Par el D. # APPLICANT INFORMATION - Please print all infot(mation. ,, Revi wed by Date Personal inlormation you provide may be used for secondary purposes (Priv�cy Law s 15.4,(1) I► t, Property Owner / r ocatiop' o Govt. Loot .� li( 4 1/4 1 14,S 3 -St3;) T �Q N,R , /5 ' E (or Property Owner's Mailing Address o #7 B Subd. Name or CSM# City State Zip Code Phone Number ❑ City E7:1 village own Nearest Road New Construction Use: B t+esidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate S bed, gpd/f1 gpd/ft Absorption area required X75 _bed, ft trench, ft Maximum design loading rate S bed, gpd/f1 ( trench, gpd4t Recommended infiltration surface elevation(s) 2a S �T� ft (as referred to site plan benchmark) Additional design/site considerations �JS� �t � 3 7 S " l6 K' to 2 4 Parent material X.I-r s S Flood plain elevation, if applicable A .A ft S = Suitable for system Conventi,- o-,n�al Mooun In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S L_7 u U S ❑ U ❑ S E U ❑ S ©�J ❑ S 1� ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench a V !f r yl Ground elev Depth to limiting factor ,�in. Remarks: Boring If f- S Y I tjr y E Ground elev. Depth to limiting factor in. Remarks: CST Name (Please Print) Signally a Telephone No. (�• s ) 7 3. Address Date CST Number -q `>0 D PROPERTY OWNER _ �es-t- SOIL DESCRIPTION REPORT Page 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 Zog (f Ground elev. Depth to limiting fact r �in. Remarks: Boring # 13 Ground elev. ft. � Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trend Boring # Ground elev. ft. Depth to limiting factor ' Remarks: Boring # 13 Ground elev. ft. . Depth to limiting factor in ' Remarks: SBD•8330 (R. 07/96) � Itv � q9 fi 9Q. asl To 04 I V P0c w;-�►. OO.OV is unknown -�-�, ,p o� 9 je I �o OEL L I c 870' TSO— d FFKce ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer G� � 4 Mailing Address g� Lo M'1 Property Address 60 L e . (Verification required from Planning Department for new construction) City /State Parcel Identification Number d 3 /d 73 - �D LEGAL DESCRIPTION Property Location s� 1 /4, 1 /4, Sec. ,3 , T N -R �5 W, Town of � - c� Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 4 Volume /q-3�5 , Page # :59k Spec house ❑ yes ❑ no Lot lines identifiable Vyes ❑ 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 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. 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 statin g your se that ti Y stem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 P s da of th ee ye expiration date. 11RA S GNA OF PLICANT DATE OWNER CERTIFICATION I (w ) rtify at all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the op a be bove, by virtue of a warranty deed recorded in Register of Deeds Office. /r/ 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 �I tif';.141 5bS / r STATE BAR OF WISCONSIN FORM 1 - 1998 4& 05362 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This RECEIVED FOR RECORD Deed made between Ernest H. Ellefson and Gladvs M. Ellefson, husband and wife Grantor, and R_ ichard J. Seivert, a single person 06 -21 -1999 9:30 AN Grantee. Grantor, for a valuable consideration conveys to Grantee the following E li MART# D EED described real estate in St. Croix County, State of Wisconsin: CERT COPY FEE: COPY FEE:.. TRANSFER FEE: 135.00 The East One Half ( %) of the Southwest One Quarter (%4) of the PAGES: FEE: 10.00 Southwest One Quarter (%4) Section 32, Township 29 North, Range 15 West. Recordinx Area Name and Return Address v Jory R. Gavle P.O. Box 400 Spring Valley, WI 54767 034 - 1073 -10 Parcel Identification Number (PIN) This knot homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements and rights -of -way of record, if any. Dated this 0 day of June 1999 " EFaest H. Ellefson ' P"6 X >� Gli dys M. Ellefson AUTHENTICATION ACKNOWLEDGMENT Signature s s e an n STATE OF ) auth ticate this � day of Jun , 1999. COUNTY) Personally came before me this day of , the above named to me known to be the person(s) who executed the Jory .Gavic foregoing instrument and acknowledge the same. TITL EMB ST E B OF WISCONSIN au oriz d by 706.06, Wis. Stats.) Notary Public, State of TH I TR ENT WAS DRAFTED BY ory R. Gavic My Commission is permanent. (If not, state expiration date: ) rt Valley, WI 54767 (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -1998 Information Professionals Company Fond du Lac. Wisconsin 800 -655.2021