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HomeMy WebLinkAbout020-1334-70-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner S An" r►a ►cjFe Address -73 Z w I `L Fly. ED Azt4 p City /State 14 J b b M vj Lego! Description: Lot a 7 Block Subdivision/CSM # 13 A P L A N 2 S 'T tz A tz r '' /,&E '/. S .Sec. 2 ? , T?,fN- R!�Town of c.�zoN PIN # o ZC - t 3 3 - 7a PTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer W E�_ (,S C'/L Size ST/PC J000/ Setback from: House .2 7 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 - HPITkA ToR- Width 3 Len 6 4 �' Len Number of Trenches Setback from: House cz_ Well P/L'V--7-- Vent to fresh air intake 39" ELEVATIONS Description of benchmark 1_ hl Elevation /00, Description of alternate benchmark T 0 4r 4 & royA497)ON 1 .44D Elevation o F. 2. q Building Sewer ST/HT Inlet � < < � ; 1 _ ST Outlet " Inlet 3 PC Bottom Header/Manifold Top of ST/PC Manhole Cover. -�� Distribution Lines r 2 ,q s ( ) 10 'gyp Z ,8 3 ( ) Bottom of System () f '' () 12 t { �1•` ( ) Final Grade O { ,` ( "a � �) 2- Date of installation � Permit number 3 /59/ State plan number w Plumber's signature W O License number P kS - U3.Zot) Date 7 ley 9 9 Inspector Complete plot plan + r 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 i I i 1,44 Q u P N,�Ill� 3 3 ° _ 5 - - -� B,IM Z A \ I Z! lao, q0 INDICATE NORTH ARROW I t r Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Coun! ft . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanital -1g591t6 Personal information you provice may be used for secondary purposes [Privacy VW, s.15.04 (1)(m)]. Permit Holder's Name: _Village ❑ Town of: State Plan ID No.: ILLER, SAM ItlllUlullb(7N CST BM Elev.: Insp. BM Elev.: BM Description: Parce bT230101334 -70 -000 TANK INFORMATION ELEVATION DATA A9800204 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , Benchmark , Dosing < irb Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet aS �37 TANK TO P/ L WELL BLDG. Air l to ntake ROAD Dt Inlet ir Septic i ij a 7 NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System a ,7 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand �� Model Number GPM TDH I Lift I Fri System TDH Ft Forcemain L th Dia. ff Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manuf acturer: INFORMATION Type O rnt c. <. „ p . 3 OR UNBT R Mod Number: System: G >;.: . �O .c� /r? DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing 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 `J� g Bed /Trench Edges `,f Topsoil es E] No E] Yes E] No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: HUDSON 27.29.19,NE,SW 732 WILFRED ROAD all /� /'Yl, /le. Plan revision required? ❑ Yes p- Use other side for additional information. SBD -6710 (R.3197) Date tl tnsp( 6or's Signature Cert. No. f , Safety and Buildings Division NVisconsi SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue In accord with ILHR 83.05, Wis. Adm. Code Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County D %, than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number y ou p rovide may be used for seconds / �� Personal information Y P Y secondary purposes heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. — 7 3 A lV1 l+ i of CI tate Plan I.D. Numb I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Prope y Owner Name Property Location #1 NC 1/45 1 /4, S Z T Z , N. R E (� Property Owner's Mailing Address Lot Number Block Number 'b© �l City, State Zip Code Phone Number Subdivision Name or CSM Num er vtD W 1 s - & ( ) t7 L-10 P 5 A 10- Ii FL II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms 3 Town OF UO- l� /LL Fe- EW III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) OC �f `? 7. a - h7 . / 7& 7 1 E] Apartment/ Condo O Z c) _ H — 7O 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 E] Replacement 3. ❑ Replacement of 4 E] Reconnection of 5 E] Repair of an j __S�rstem ________ _____________ __________ ^ ___ System Tank Only Existing System Existing x - ---- -- 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 CR Seepage Trench S 10E (, 22 ❑ In- Ground Pressure , 42 ❑ Pit Privy 13 E] Seepage Pit t Io o f ILTCA��TO (L t� �� X ,std -�S 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 r 0 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Q Elevation `'I 'S Z. - I (- G Feet q $' Feet Capacity VII. TANK in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- glass Plastic App New Existin strurted Tanks Tanks Septic Tank Joao Wes S Ir-lZ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 11 ❑ ❑ ❑ ❑ 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 Stam ) MP /MPRSW N,�Io�.: Business Phone Number: bo Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssu 106 - n - g ent Signat re (No Stamps) (� Approved ❑ Surcharge Fee) 1 Owner Given Initial � 18 ��& Adverse Determination e6ef X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue VisConsin In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce 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. ; .�'0 I !` k • See reverse side for instructions for completing this application State sanitary Permit N Personal information umber y ou p rovide may be used for seconds -31 y p y second purp ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. A PPLICATI ON INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location 5401 jZ4 1YE .S w 1 /4, S T 3X , N, R /;► E (or& Property Owner's Mailing Address Lot Number Block Number 7 City, State Zip Code Phone Number Su Name or CSM Number v05oN &.)/ _r)( (3 >t7 &9 fD L N� ;BRA /RIB /fjr PE OF : B L I G. (check one) ❑ State Owned ❑ it Nearest Road [] vll age /i10.�oN / Public 1 or 2 Family Dwelling No. of bedrooms -3 Town OF fR Q III BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 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 [�j( New 2. ❑ Replacement 3. E] Replacementof 4. ❑ Reconnection of 5. E] Repair of an ---- System -------- System ------------- Tank Only_- Existiig -_Xt -- - _____E- --- ----em 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 WIN DAR.. 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 1Z'1 I' M F1Lt2 .4'To, 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. Pert. Rate 6. System Elev. 17 . Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 4157& $ 4 512 -S Feet s 1 Feet pa VII. TANK Ca cft allo in Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ 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) MP /MPRSWNo.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 01 o O.- JkQ� f0 4 u D So N w IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Iss Z nt 'gna re (No Stamps) Approved ❑ Surcharge Fee) -Owner Given Initial `�(O Oa 00 Adverse Determination u X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber j O Lu v M a� iii s 2 z (IC L4 O na cli zr eo JC x • a t _ N N 5 T C- E C co T U) T x .n V) W M _ m C0 _0 U) « c �� � Q N o X _p O N p CU U) L - CU 75 co _ _ L :3 O - 0 O N > Z� a U X 4 L `� cZ_ E C� X m j- CO C(D U M _ cn p C U ._ 7— U L U '� C (lS .0 U CO RS ] > O a O J (0 LL E O = U 'd U C c � • • • • ro If i V) U ® — d — ( N �3. E a) V _ `D N ° m2 �S g U0 • p .0 s cD Id E ® U 6 $ - 0 Z cn W �� U) o � �,�„ m � 5 V L C m $ CL td G VJ W • (L�.� v J d - 0 eS g a �V - C � q � U o o r(t > Y Y �s W - 0 E � .6 Ij W��� Y�co TT �� r i C D #3 J �A �s I • x APFLIUAN I INtUKMAT WIN �fty rint wt i tiOM: R ed by . Data Personal inf ormation // , You Provide may ry � R,ri vacy Law; �s. 1' 04 (1) e (m)). I Properly Owner rNC pFFIG Property Location C J 4 Pv ( -e ,- Govt Lot ,(J F 1/4 /4,S T .N.R E ( or)© Property Owner's Mailing Address t Lot # Block* Subd. Name or CSM# /� Si 1 49- - 7 d City State Zip Code Phone Number ❑ city ❑ v T own Nearest Road W I I New Construction lase: Residential /Number of bedrooms '?—% Addition to existing building Replacement 9 Public or commercial - Describe: Code derived daily flow i oOO gpd Recommended design loading rate—L-2—bed, gpolfl trench, gpd/tt Absorption area required -aS 9 bed, ft ft 2 y Maximum design loading rate 17 bed, gPd 9P 2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material 6 ( 1 x C l 0 U-- W V' 9 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound I In -Ground Pressure I AT -Grade System in Fill Holding Tank U = unsuitable for system IR S El a s El � S E] ❑ U ❑ S C U ®S 4.0 E S FA-U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 13 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ll/ U n o r-4- S L- 4ma b M..0 C 1 u 2 � SL /Mo Y4 r— C — 7, Ground 3 y/ ld L n o,1-� M Q yv\ S elev. f 7aft. Depth to limiting factor in. Remarks: Boring # o-za loy /Z rto e S �' ma b m4 r 02, ZI 3( /o r. V& C 3 - /b /� Ao n a vY4 r C S _ .7 Ground elev. Depth to limiting factor 40 in. Remarks: CST Name (Please Print) Signature Telephone No. kU ✓r.a Address Date CST Number l C) S r c)4- — 9a( /><u r �,v/ �o�� '' _/ - 9?� �S"3 30 i z PROPERTY OWNER IM I f SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench j zm 1, Ground elev. -Daft Depth to limiting factor / Remarks: Boring # iU r- 3 n �� a b n�-� r u • S -7- , 02 / YX 0 c- — . `7 ; rto sn 0.5 CN rel Ground elev. q3, (o ft. Depth to limiting factor ) � n. 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 # i o r\ r C S (v+ + fo Ground S6 /y � Z6 7 ' , elev. Depth to limiting fac 1 76 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) r� 3 W5 S 7 Q Iq u w.i , -� Yta � ,' -2 /GQp-Y' lV ' X 81 � � a 3 � C' scgnsin Department of Industry SOIL AND SITE EVALUATION s Labor and Human Relations Page 1 of _3_ Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. C r o i X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please p ' all •inf4jY'l» ' n. Reviewed by Date Personal information rovide may be used for sec a You P Y �X durposes (Privy ,7/ s. 5.04 (1) (m)). Property Owner (f1 roperty Location Richard Stout �7 ovt.Lot SE 1/4 NW 1/4 S27 T29 N,R 19(or)w Property Owner's Mailing Address �qCa t # Block# Subd. Name or CSM# _i �.� .• 1 353 Awatukee Tra �' " GtX 7 Badlands Prairie City State Zip C j Phon e Nearest Road o0kc's \ City ❑ Village ® Town Hudson WI 540 ` � 7 �*49- S- Hudson Hill Farm R SJ ,, „I 1 New Construction Use: Residential rooms 3 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 0 0 gpd Recommended design loading rate • 7 bed, gpd/f1 • 8 trench, gpd/Ft Absorption area required 858 bed, ft2 750 trench, ft Maximum design loading rate ' 7 bed, gpd/ft ' 8 trench, gpd /ft Recommended infiltration surface elevation(s) 95 .60 ft (as referred to site plan benchmark) Additional design/site considerations Parent material 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 El U S ❑ U [S ❑ U S❑ U E:1 S 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 1 1 -12 10yr3/2 none L 2mabk mfr cS 2f .5 .6 2 12-35 10yr3/4 none sl 1mabk mvfr cs Ground 3 36-93 10yr4/6 none ms frti ml CS .7 elev. — 9 9. 8Q_ ft. Depth to limiting factor 90 in. Remarks: Boring # 1 -10 10 r3/2 none L 2mabk 2 2 10-35 10yr3/4 none sl 1mabk mVfr CS if 4 3 6 -9 10yr4/6 none ms ml 1 _ Ground elev. 98.70 ft. Depth to limiting factor 9 0 in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number 0 ? o S Y O7 a7 c SOIL DESCRIPTION REPORT s ?ROPERTY OWNER Rzehar -d Steut Page of 3 PARCEL I.D.# 3oring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 3 1 0 -12 10 r3/2 none L 2mabk mfr Cs 2f .5 .6 ............. 2 12 -40 10 r3/4 none S1 1mabk vfr Cs if .4 ;.5 around aiev. 3 40 -90 10 r4 6 none MS M1 ml CS -- .7 . . 8 99--20- 7epth to Imiting actor -9-0—in. Remarks: 3oring # 1 -14 10 r3 2 none 2mabk fr CS 2f .5 ;.6 4 2 14-44 1 0 r3 4 none 31 lmabk vfr S if .4 5 3 44-91 10yr4/6 none ns n1 rnl s - .7 .8 around =1ev. 10 0. 0 ft. )epth to inviting actor 9 _ 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 g 1 0 -12 10 r3 2 none L 2mabk mfr CS 2f .5 .6 5 2 12-48 10yr3/4 none 1 1mabk vfr CS if .4 '.5 3 4 92 10yr4/6 none MS M1 M1 Cs -- .7 ;.8 Ground elev. 98 , _ ft. Depth to limiting factor m in. Remarks: Boring # i_ ; Ground alev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) ct cls �ra:y, to ko r a 1D0. o Ile, p i /V ,gt �3 � � Q y � r3q A oFr Z2 7 � �.aT fat -NaY • t 1 A 11 w ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 54n i t�t Mailing Address It 4 D X /S 1 Property Address 7-32- W 1 L F/2,6,0 (Verification required from Planning Department for new construction) City /State 14 uVS o N LA-) 1 Parcel Identification Number ©2 D ` 3 y — 70 LEGAL DESCRIPTION Property Location AF 1 /4, Sw I /4, See. T 1 ? N -R y W, Town of #U0 0A( ,Subdivision DAD 1_ 4 /16 g '4V R #4 4 , Lot # Z ,7 Certified Survey Map # 16LO /f. , Volume 6 , Page # Warranty Deed # 5% ( ( v , Volume l 3 =L , Page # ` 6 Spec house X yes 0 no Lot lines identifiable yes 0 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. 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 St. Croix County Zoning Office within 30 days of th a year i ation date. 9 _ok� YJb NAT1 OF APPLICANT DATE ,' 1 QWNER CERTIFICATION :'. 1''(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 ope�rcy described ab ve, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE O PLCANT 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� STATE BAR OF WISCONSIN FORM 2 — 1982 i WARRANTY DEED 5801 i DOCUMENT NO. to I V'`11. -- u Rte "d for 8604 RICHARD O STQUT j! ii JUN 0 1998 8:30 A conveys and warrants to SAM F. MTT,T FR _� ` 1 Re to 4Ad !i !i THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in S ro i x County, ( I P? / L G F 2. State of Wisconsin: PC) ga 0 Lots 17, 27, 28, 39 and 40, Plat of Badlands ! �/aysari 0 Prairie, Town of Hudson, St. Croix County, Wisconsin. PARCEL IDENTIFICATION NUMBER i j. i TRA o DEER $ EE I� I This i s not homestead property. (is) (is not) Exception to warranties: easements, restrictions, rights -of -way and covenants it of record, if any. !! �i Dated this 20th day of Ma) A.D., 19 98 Ri Sto ut (SEAL) (SEAL) (SEAL) (SEAL) J ! AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. ii St. Croix County. �! authenticated this day of 19 Personally came before me this _2 t h day of Mai 19 9 S the above named Richard �J Stout * ii TITLE: MEMBER STATE BAR OF WISCONSIN (If not, 1 �1� (1, u authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instru nt and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY a, ; a107A'R'Y [1 7J/�lt�t� ( (� /� _ Janet P. Stout;. c- * Virginia R. Gartman Hudson Wi. 54016 q` Notary Public, St. Croix County, Wis. (Signatures may be authenticated or acknowledged,, B*arWyf, �; My commission is permanent. (If not, state expiration date: necessary) +.•..•. January 30, 2000 x ) 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. 2 — 1982 Milwaukee. Wis. 111 � '` � .. 'r9.g?,�• m / 1 u cn — �Is �• J • to c• 'L O Ln c' f p 27Y jl w / i y �n 1 ' Cfi ! i \` t 0 \� • - ( - }j , 0 � 1 67;6 rn • .pI V , W C � _ _. N ' + 1 . t -`/ _ 1z r m ro '� a - _ N a° i c II \ r \ ro % r ` f u a L__ 91.9L. S Z 4 14 N d6 9t ♦ OD '14 i .. / i ' / •. . • j\ A \\ \,`� ty T Z i k. � � . ► C k ""ter V OD 1 • a In In 1 ' ¢ Ct \ N00'0000' £�4 to I _ IN iF 57 \ \, \ 151.01 E 449 I v S 00'06'24" W 358.98' I` II. � rl m I m i CIO (� b I- �JI �• -n(�1��1 IV � _ r Li ! I,fn'. W. 7 ,, W In _ ` " — _ `,�,'' 1 -- � R I I S III s vo•o6'.��" w i �p 9:.' s': � `:,� �'ly �- �--- -_ r , ` �y I I( � (•� (� `r, �I' I r tt �'' " P _)I III ' ' ' • .. -� ro ue: -' � I , NOD' 0'00 `y O A - I r 00 L - co civ'oo"w '9 Ire I Ln '� '1i► h l , 7!' j 1 i l w I V , / / I a1 ir ,'\ rer, •\�`� '�� �r rrn �1 J P�f ' , / � � .i '•'). ? ' i w:\ ? • .yam\ \` \ 3- � � v. �.�I / S. (i.V G' `� \ y r k`.N r n _ ? l, � �C ! ' ` 1 ' t•� , t I f,r