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Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Lahor and HL rnan Relations Page / of 3_
DivisienvPealety and Buildings in accordance with s. ILHR 83.09, Wis.
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 T 70 xX
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
7,-% Govt. Lot 1/4 1/4,S/0 T N,R E O& s.F Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
G~f ,74-'K1/r 5c"077- IOU_1ej!5_
City State Zip Code Phone Number [:1 Nearest Road
/ ) City El Village Town COTT
❑ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 600 gpd Recommended design loading rate - 7 bed, gpd/ft2_L-trench, gpd/ft2
Absorption area required PSS bed, ft2 7So trench, ft2 Maximum design loading rate . -7 bed, gpd/ft2 .1 trench, gpd/ft2
Recommended infiltration surface elevation(s) /O1• S _J /0-0-v ft (as referred to site plan benchmark)
Additional design/site considerations ;,I9yA7~
Parent material Flood plain elevation, if applicable/z/. P 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 ~IS ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S 0 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
Ground 3 /7-~6 w -S S G S l - - 7
elev.
/olo ft. ,
Depth to
limiting ;
factor
Remarks:
Boring #
Z L P= 7 L -
10
Ground
elev. CEEV~
/aft.
Depth to
limiting IT CRO
factor C
--in. Remarks: ZONiINGOFFICE ti
CST Name (Please Print) Sign'iture a 4,
l E Tl J" 7
Address Date CST Number
/3J o - S~ A-7
7 3.:~1
. PROPERTY OWNER ~~~r~ lat>ST: SOIL DESCRIPTION REPORT reb
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure 2
Consistence Boundary Roots
9 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench
- L Z G S
/,OZ. s 2- 5. L NJ 1,F S .3
p-,7 0- L 6
Ground _ s Q G - - 7
elev.
Depth to
limiting ;
factor
in.
Remarks: #3 S 2 Lfi9Crf
Boring #
Ll z -z o = s s
ior. z 3 -s s lr L - -
Ground
elev.
io3sft. ;
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 # m_ L S.-L _24X - S . D D
'VIA /I -Sj-- 4- MsAt J/
OS L -
-S
Ground
elev.
/OLd-ft.
Depth to ,
limiting
factor
Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
In' Remarks:
SBDW-8330 (R. 08/95)
- DAVE FOGERTY PLUMBOG
L Lensed Perk Tester Q Plumber
#3233 03M
Phone 749.3656/ 3
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STC - 104
AS BUILT SANITARY SYSTEM REPORT / RtcaVEO
OWNER /l,41-7~ Grp L 1 1997
ST CROIX
ADDRESS_~ COUNTY
ZONINGOFFICE
SUBDIVISION-/ CSM#_LOT
SECTION 66 T 2 9 N-R /9 W, Town oftt
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVE HING WITHIN 100 E T OF SYSTEM
St~1L,~ l n' ~ /
4,r i/
+>t I
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: 1~-Crgev /Zec h® a
ALTERNATE BM: /
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: en)
Setback from: Well ~ e House Z Other
Pump: Manufacturer Model# Size
Float seperation Gall c
Alarm Location
SOIL ABSORPTION SYSTEM
Width: /L Length S" Number of trenches
Distance & Direction to nearest prop, line: S'd
Setback from: well:/,Mle House ~Y ~ Other
ELEViTIONS
Building Sewer ST Inlet: a2, ST outlet: Z, y
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system_ app,
Existing Grade /a9 r c) Final grade 1e!-,C e
DATE OF INSTALLATION: L
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR: /2®
3/93:jt
BENCHMARK:
ALTERNATE BM: /
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:- Liquid Capacity: IN)
Setback from: Weller House 2 2 Other
Pump: Manufacturer Modelf Size
Float seperation Gall c
Alarm Location
SOIL ABSORPTION SYSTEM
Width:- /L Length S-5- Number of trenches
Distance & Direction to nearest prop. line: S`D
Setback from: well:House f ~ Other
ELEIATIONS
Building Sewer ST Inlet: I
ST outlet: 1,4z.
PC inlet PC bottom T-- Pump Off
Header/Manifold Bottom of system /4p,0
Existing Grade /o r c) Final grade
DATE OF INSTALLATION: Z
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR: Z®,/
3/93:jt
Wiscoris n'Department of Commerce PRIVATE SEWAGE SYSTEM County:
.Safety and Buildings Division
INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary-pggjxh
PPperrsso~nna{l~L'1'A information you provice may be used for secondary purposes (Privacy L , s.15.04 (1)(m)].
llId66 RUCTION ❑n~bV41age Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: ftE1~~A Parcel T ff, b._1322-10-000
10(>' r s LU
100 _%1),rVC,40L
TANK INFORMATION ELEVATION DATA A9700485
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic D Benchmarl~z r
Dosing A w .77 /07 7/
Aeration Bldg. Sewer /03 DZ
Holding 0 0 Inlet /o -L7
TANK SETBACK INFORMATION lS IV Outlet sya 07-
TANKTO P/L WELL BLDG. Airlntake ROAD Dt Inlet
Septic ~'r Z L15 NA Dt Bottom
Dosing NA Header / Man. 7.
Sb /v/ oFl
Aeration NA Dist. Pipe
7 62 /oo.9.6
Holding Bot. System 7~0 /00. &g
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand ✓1 u 3~ /o /
Model Number GPM
TDH Lift em TDH Ft
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
RENCH Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid h
DIMENSIONS 12 5 5 DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufa
SETBACK -
INFORMATION Type On CH R Moe Num er:
System( OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length __~Z Dia. Length SZ Dia. q_~ Spacing 6 As,-rml G 1* 4 v c~0,
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edg psoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HUDSON 10.29.19,SW,SE 667 ODD LANE
Off QjAl Top ok fe0L)Ad `A 1Y1 X07.71 P/c Al
Z' ~j }'~4 L ~Ztn K ` 0 C_ 2. A-t 6VI G k G~ V\/C/ G z C)
f
Fined
Plan revision required. ❑ Yes ® No
Use other side for additional information. I Z- t/O 17
SBD-6710 (R.3/97) Date Inspector's Sign ure N
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
ViL'■'■ : SANITARY PERMIT APPLICATION Busafetyreau o oand ff BuiluildinWater System!
ing Water 201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 12 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Numbefill
I_qq 6
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
(Privacy Law, s. 15.04 (1) (m)).
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location `
a 1/4 ;e 1/4, S D T , N, R E (or
Property Owner' at Iing PAddress Lot Number Block Numbe
!y r
am "
City, State Zip Code Phone Number Subdivision Name or CSM Number
I. TYPE F BUILDING: (check one) ❑ State Owned E] City Nearest Road
C] Village
Public 21 1 or 2 Family Dwelling - No. of bedrooms ~_T Town OF p
I11. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) / I
1 ❑ Apartment/ Condo 24 - 3Z~ _/0
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. bqNew 2. ❑ Replacement 3. ❑ Replacement of 4. E] Reconnection of 5. E] Repair of an
-______ystem System Tank OnlyExisting 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 410 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 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
YS'D ,*A, o Feet ,p Feet
VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank JAW 4#60 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the on t sewage system shown on the attached plans.
PI er's Name: (Print) Plumber's Signature: (No 5t4 rPRSW No.: Business Phone Number:
er ~
prf 4.4 052//
PI er's Address (Street, ty, S te, p de):
d
IX. COUNTY / 13EPARTMFIOT USE ONLY
❑ Disapproved s itary P rmit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
Surcharge fee)
XApproved ❑ Owner Given Initial ID V1 j~ , ~3. G
Adverse Determination f UUU
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) DISTRIBUTION: Originatto 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 or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the egal 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.
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 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.
• DAVE FOGERTY PLUMBING
Licensed Park Tester ik Pkunber
93233 63299
F~e~y Heists Road
ROSE S, WISCONSIN 54023
Phone 749-3656
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ROSS , `fY gSCONSIN M22
Phc j ~.a 7.49-3656
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor agd Human Relations Page of 3
Divisi q4t ' ty and Buildings in accordance with s. ILHR 83.09, Wis.
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 T pX
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
020-to11-00
APPLICANT INFORMATION - Please print all information. R awed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).~ `6 11-1 3•
Property Owner Property Location
~~GT Govt. Lot 1/4 1/4,S/e T ,N,R E, &
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
.I _576277- 1A--A'Qr
City State Zip Code Phone Number Nearest Road
❑ City ❑ Village Town e77" /QA
New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 60~ gpd Recommended design loading rate 7 bed, gpd/ft2__. ~L_trench, gpd/112
Absorption area required PSG bed, ft?Z~LO-t~ench, ft2 Maximum design loading rate 7 bed, gpd/fl2 _J trench, gpd/ft2
Recommended infiltration surface elevation(s) R~ ?fir/D~• S f ~i~, S - /DO• o ft (as referred to site plan benchmark)
Additional design/site considerations AV"
Parent material Flood plain elevation, if applicable 9/~/. P ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
S ❑ U ❑ S o u
U = Unsuitable for system ❑ S ❑ u ❑ s ❑ U Os ❑ u El S [21 U E_]
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
D' - 10-312- 1 L L t j~S , o
/DYS z a - 6 ~rJ_ -P /0 s6 Fie s i,G
Ground 3 /7- & /d -S S o sC /Y1 - - 7
elev..
Depth to
limiting
factor
- in.
Remarks:
Boring #
io3•Z
Ground
elev.
Depth to
limiting
factor
in. Remarks:
CST Name (Please Print) sign ture Telephone No.
t o E ZT-~ 7 -36s ,r
Address Date CST Number
7 2 3.: ~.3
13v A-7
PROPERTY OWNER 84 Alt 120AAT• SOIL DESCRIPTION REPORT
Page ~
PARCEL I.D.# LiT/
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench NIFX s
/,Oz. .57- P- o- L 6 c s ' .3
Ground O „ L
elev. _
IKE%
Depth to
limiting
factor
in. '
Remarks: 103
Boring #
/ o s G c •S" jg~
y Z tm--42 o .z As
io~.7 3 y -s •s ~ L - ' . ~
Ground
elev.
/03.Sft.
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 # tL cf S . O D
-C Ad 4-
Ground
elev.
Depth to
limiting
factor
-in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
DRVE FOUM PLU
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ROBEIR~'S.-W~~~ Raw
X1023
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 7`•
MAILING ADDRESS J
PROPERTY ADDRESS
(location of septic s stem) Please obtai from the Planning Dept.
CITY/STATE f a--r- &~_VVA6
PROPERTY LOCATION Sif-1/4, S~ 1/4, Section !O T_~N-R__~' _W
TOWN OF c(/f~ , ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER /
CERTIFIED SURVEY MAP ,VOLUME , PAGE..,-4) J , LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained ust be completed and"returned to the St. Croix
County Zoning Officer within 30 days of the three ye expiration a~e.
J
SIGNED: - 66
DATE: _ D - 97
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/ contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property
Location of pr perty~_1/4 rE 1/4, Section io ,TAN-R__Z:~_W
Town hi Mailing address
Grp
Address of site
Subdivision name Lot no.
Other homes on property? -Yes [/No
Previous owner of property
Total size of property 1/0
Total size of parcel 4 .3
Date parcel was created_
Are all corners and lot lines identifiable? !i Yes No
Is this property being developed for (spec house) ? Yes 1/No
volume 11,7_7 and Page Number ed as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. 5"1-? 5-4 9 , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
SY 57,6 b
Siq(hatui~p f Applicant Co-Applicant
o- lo- "d7
Date of Signature Date of Signature
BEING LOT I 'OF CERTIFIED SURVEY MAP RECORUEU IN VOL. II,~
PG. 3083',' AT TFIE'ST CROIX COUNTY REGISTER -OF DEEDS OFFICE-. ' r R
4u~ t
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d ! PLAT . LOCAMN
° i/1AY3iY4A:8_CYASf.[ICATS
NOT t- ya
J Allu4 C. lytse en, luter;wJ Ntscanala land 8%rvey r, hcrNby car'
t11at !n tu11 tw:p is»:~ vlth the provtrl• •A of chapter 214 of the Niscol
6;atutas, and VA&C the dirgetion of Delta Construction, Inc., o•Mer o[
1611, dr4erlhed On thls plat, t ha.s aatwa•ad, divided and a1epw S1
AcVV; that such plat correctly tepresents the tatterior Ixnuldaries and
- sultivtstall of the land wrveyofd;'am that this plat to located In pert
o~'+ p dp the SWIM of the nx/4, in Sectloe 10 TJ1N U S10, tMn of IWAs n,
L lfT Croft County, Mlsccaalnj btrq Lot 1 0f Xt~tied surrey Nap Rocordsd
_ Volt,'!, 11, De ye 3061 et t of at. Croix County R"Idter of Dear" Oft'
further dent: as tollows.
g=' ~ /'';ltvL!ay at the Si/4 pro or of sectLrn 10;. thanes /47°13'21"1, alerg
y i South line or the sal/4 of said sectloa, 1311.21 t~et to tho "Ot M,
G W ---SE the 141./4 of the 1411•41 then,.* 10002613311, .0101g Said east line 104•
, pl toot to the ivlrth l ae.of '%bi of ab."t sold lot is thane nodb41'l!
ii a1otyg ns14 north 1tne, lslt.ll [set to tha north -South 1/4 lint' of /
ct. Ssclun; thdnee 30ot'2S'l4•M,.altxg said north -South 1lna, 200.31 twt
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WARRAN'TI' DEED
Document N,'mber
Return Address MAY 10
11.G0 A.
Parcei I.D. Number: 020-1011-00
Joseph A. Klewicki, a single person, conveys and warrants to Delta Construction, Inc., a NVisconsin
Corporation, the following described real estate in St. Croix County, State of Wisconsin:
Part of SWV4 of SEI/4 of S,ctio❑ 10, Township 29 Nt-th. Range 19 West. St. Croix County, Wisconsin,
described as follows: Lot 1 of Certified Surve} Map 111-°d April 24, 1996. in Vol. 11. page 3083. Doc. No.
542664.
~ rss~ R
This is not homestead property.
Exception to warranties: Easer-ientc, restrictions and ruts-of-way of record. if any.
Dated this g day of vlay. 1996.
(SEAL) -(S E: y L )
seph A. Klewicki
ACKNO"7LEI(K;NIENT
STATE OF WISCONSIN )
I ss
COUNTY )
Personally came before me this day of 1996, the above named Joseph A.
A Klewicki, a single person, to me known to be the pzrsan( who executed the foregoing instrument and
'e acknowledge the same. 1
Notary Public l'~~_ County, AI
My commission expires N1- ~
toy C0~►s
~ wry Pttblic
THIS INSTRUMENT WAS DRAFTED BY: ~ of Wisconsinl
Attorney Kristina Ogland
Hudson, WI 54016
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