Loading...
HomeMy WebLinkAbout020-1035-20-100 =Department of Commerce v SafetyaridBuildingsDivision PRIVATE SEWAGE SYSTEM County: cr,- f"ROTX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar'S619VQlo3: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. V W rIERSIGdg LL"AMe: Jim 4 ity~CL lage Town of: State Plan ID No.: CST BM Elev.:: LL Insp. BM Elev.: 7 7iption: tnlUU1J5U Parcel TU ._103 J-20-100 TANK INFORMATION ELEVATION DATA A9700520 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic A Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Dist. To Well Fi SOIL ABSORPTION SYSTEM BED/TRENCH Width I I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: OR UNIT 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) .~eSA4, % A01-a' tfte o1 At A,,. iAe LOCATION: HUDSON 1"7.29.19.151C, SW, SW 940 RIDGE PASS ~ 14 ,5_7 r b t/G . j e Plan revision required? ❑ Yes (R No Use other side for additional information. M t SBD-6710 (R.3/97) ~r1Sr_,,fI* Date Inspector's Si ature ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ E og Water Division Systems ~iipniies Safety a and Buildin ~~■~r■r. SANITARY PERMIT APPLICATION Bureau 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 1/2 x 11 inches in size. Si, 6eO1A • See reverse side for instructions for completing this application State Sanitary Permit Number 3 o?6a, 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 Propert Owner Name Property Location 6 1 4 v4, S IT Z Gf, N, R E (or Property Owner' allin Address Lot Number Block Number 1 . ?.,55 73 J / C O , Sta a Zip Code Phone Number Subdivision me or CSM Utimber C LA) n l (7is (R JV II. TYPE OF 1311,11 ING: (check one) ❑ State Owned ❑ City /rest Road Public 1 or 2 Family Dwelling - No. of bedrooms c ❑ ToVillae wn OF G 1 L. III. BUILDIN SE: (If building type is public, check all that apply) 11arcel Tax Number(s) 1 ❑ Apartment/ Condo /7.01 I. /9' /S/ 106-- 06 - 160 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) ~'av✓~ j) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. Repair of an -----System --------System Tank Only______________ Existing System B) B) A Sanitary Permit was previously issued- Permit Number ~f SDt g Date Issued a + V. TYP OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11Seepage 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 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation TANK Capacity VII. in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks eptic Tank r DA7 El ❑ ❑ ❑ ❑ 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. .Name: (Print) C ignature: (No Stamps) io~A42$$W Nn.: Business Phone Number: 386 - z 3 oss 1S= ~/L`_ 1 : - s Address (Stree , ity, State, Zip Cod / Z IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent nature (No Stamps) A roved Surcharge fee) ~ pp ❑OwnerGiven Initial Igo 1t+~~ ~Z.~2-G~'~ Adverse Determination X. CONDITIONS O APPROVAL/ REASONS FOR DI APPROVAL SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Diw--ion, Owner, Plumber 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 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 legal description and parcel tax number(s) of where the system is to be installed- IL 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.~ystem_ 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, etE.), 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 10 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 infoTmation_ 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. s • • ..~~oiL (l ~'i~i'c'~9-% ~'O.J ~~'U,glv.q ! Io ~ > Y'5~e 71-W -If - 461= 'L A2 e- U-0 0 --Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page / of Z' Division of Safety 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 ,d include, but not limited to: vertical and horizontal reference point (BM), direction and ST• 6; O/X 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 j-,,., s S / . /.E,e56?4 Property Location 0 chi Govt. Lot 51A1 1/4 5W 1/4,S /1 T Z / N,R E (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or SM# 9yo ~'i0(E- ~~-ss 73 City State Zip Code Phone Number Nearest Road -s /b / & (386) X73 E] City F-1 Village Town ❑ If, 0EN I'~ Y Nevy Construction Use; Residential / Number of bedrooms Addition to existing building C~ M'tsaeemerrt ❑ Public or commercial - Describe: R E TL)ui N:#rTro (a av Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 75-0 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2~trench, gpd/ft2 4EX.tS T'1 N Cr Recommended infiltration surface elevation(s) 2 d (3.2T' ft (as referred to site plan benchmark) /~yy Additional design/site considerations olx t/exarv~ SY T ~/fL ~ !W" "'S Parent material Flood plain elevation, if applicable ft S = Suitable for system Conve tional Mound In-Grroupressure AT-Grade System in Fill Holding Tank U = Unsuitable for system 3s El U ❑ S U U L~ 5❑ U El s U 6s"❑ U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ....4 ~ o-s 10Ye3/3 SG 2-f5 4 /OX CS X S 2- Y/e Y3 coy cTv 54 2,4-% ~rfio' CGS / ; N Ground j S~A u"t 6 Q S .S ctq. etc -ft. •io D I~ 5/ S GQ~ Depth to - or limiting factor 7 / p2_In. Remarks: Boring # r4 ()OIGINAL Ground elev. ft. Depth to limiting factor In. Remarks: CST Name (Please Print) Signature Telephone No. 'At ttT- ~4(' 7i5'.3J96 ',?/PS 2ot3E~T ? Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground elev. ft. Depth to limiting , factor in. ' Remarks: Boring # Ground elev. ft. 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 # ; Ground elev. tt. Depth to limiting factor 'n' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: . = j3~C~l~•2. T a fir = TOP o/= PA"t. P-e NC4 le s E Ld-- ~o ~ ~ o socla~e $uu~~t$ U1btlch~ ~ WsOe poo ~ X ~s T~~v P p Ne\1 Rd ~ap18 STM C v M~ 330 SO ° SC-prrc O . o~ i ~77, DTC ~ N o,AJ , 6 DS I.,JT- ST. CROIX COUNTY WISCONSIN - " ~'t ZONING OFFICE N N ■ ■ rwri ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - = Hudson, WI 54016-7710 (715) 386-4680 AFFIDAVIT OF SYSTEM REJUVENATION Property owner:_ i l ~ ) ~ t, Address:, Day time phone : (11, 3 ~3 - 3 A Parcel I.D. Legal Description of property: l,_) Sec. T. -ZC%JN., R.W. , Tn. of Tom' St. Croix County, WI As owner of the above described property, I acknowledge that the septic system serving this residence (ism) undersized by current code standards. I understand that the issuance of a sanitary permit to allow the attempted rejuvenation of the septic system does not imply that the system meets current code sizing requirements, nor does it imply that the proposed procedure will be successful. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. signature: Date: /d a y 5/97 8 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 LG c-, Location of property_LLL1/4 tj 1/4, Section W Township _ 1- d ~,,_N Mailing address Address of site Subdivision name Lot no. Other homes on property? Yes__X_No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume and Page Number 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. 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. Signature of Appl' ant Co-Applicant Date of Signature Date of Siqnature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BOOM MAILING ADDRESS CA440 ~ 1 C~~ a S S PROPERTY ADDRESS ~C7 C 1 j n G S5 (location of septic system) Please obtain from the Planning Dept. CITY/STATE 1 3 PROPERTY LOCATION 1/4, S 1/4, Section /-7, TAN-R W TOWN OF I I ti ~So"j ST. CROIX COUNTY, WI SUBDIVISION 4 ]C, ►C t ~ 46_ - LOT NUMBER CERTIFIED SURVEY MAP _9 VOLUME , PAGE , LOT NUMBER 7> 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 must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three ear expiration date. SIGNED: G DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. ~2 T ~N-R 1Z W rl •~~s_. La~~a~ ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I-LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r 7 a a INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: o Trench: Width: J Lenith: 3 G Number of Lines: Area Built:., _ Fill depth to top of pipe: 24 " Number of feet from nearest property line: Front, O Side, Rear,0 Ft . Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest r6ad: bEPARTN(ENT OF REPORT ON S I ND SAFETY & BUILDINGS INDUSTRY, - DIVISION )_ABOR. AtUD . ' PERCOLATI ) MADISOP.O. BOX N WI 7969 HUMAN RELATIONS, ` (H63.090) apter 1 LOCATION: SECTION: TOWNSHIP OT :BLK.NO.:SUBDIVISION NAME: sw 17 /TZY N/R[I E (o W u'0 w //6W A Ar TIC COUNTY: OWNER'S BUYER'S NAME: MAIL! RESS: -70 co '4f! SaN 54 Gt ot x 13vi l S 5'0 ~iP% o,edk u S•o W i S USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR FI NS: A N TESTS: K Residence 3 it, l~ IINew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system C7 ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) s ❑u ~zs [Jul © s ou a s ©u a s ®u Dr- p_ P &e,~ - Ste. A101E k(d0 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: / `O lv '2 CiA4&Q, fT'• PROFILE DESCRIPTIONS BORING TOTAI DEPTH TO R UNDWATER-IN. rT CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. E TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B / 9 D /00 yl ~ > 9 Q C S-P~ A,u. L I .7S' Sv . /s w i din 6r' 4 7• f" 25~v .y2'Z)&. a,o. L, "7`,Z3~,.L, •Y2 • Cs3 ~ B- Z y. 9. y - > S GR . 2d ?;4"v 4*w C S B-.3 ylJ /60. 2` ' 70 ~ 13o. L) •Yj,"Av,/s, 27Y'r,4v111~ c5', "A" GA). L /.og'Av• /.33" B- > . s AN C ~ • s , B- ~ /a. L) /00./0 > /p.Q .~.0'p~r3►~L w,/.i7 A3 /,P3' OA 40-4-11 B PERCOLATION TESTS TEST DEPTI j WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAT MINUTES NUMBER IN FT AFTERSWELLING INTERVAL-MIN. PERIOD p RI D PER INCH P- / i ••V T c 1 P- iv A, I I N O P- 3 Z P. 2 CS P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION ~i~ 1-0 T,1 rE- 1 ~ . F t } This test r site APE PROVED for a conventio al septic s SPECIAL NJ01E To PaSTAf(-fir o 12~ A 4kr`F4 /STAv Alt, 13 '~44 ~ 4 40 i w E o.p N . _ ....r.4__ . _6. MU- ('s Prt. S r S~-Je,.-oc~l~ , cS' s CERTIFIED SURVEY MAP r N.W. CORNER N.E.-CORNER SCALE 100' SECTION 20 SECTION 20 T2J N, R 19 W ( 0 50 100 200 300 33' 33' LEGEND ' I ,0 c>9 . COUNTY SECTION CORNER ` BERNTSEN CAP Q ' (n LOT 73 ! 2"ROUND IRON POPE FOUND rn 01 m • I" 13OUND IRON PIPE FOUND O X 30 ROUND IRON PIPE WEIGHING N ~p 3.65 LBS./FT. SET O I"X 24" ROJJND IRON PIPE WEIGHING 1 1.68 LBS. /FT. SET t,. Q LOT 72 ~cn LOT 71 i _ ` 3S' 33.t M • - 2 RT ON SOIL 13ORIN&S ; PERCOLATIO TENS Lof # 13 64/0 40 PLoT pt.AM PROTECT r. D. DArE NOMESITE TESTING CO. 11T.3, O'NEIL ROAD BOB UI,I;k1G'~. 4 AUL)SON, WIS. 54016 C5T SS-- 02 y~z PROPOSED Mouse mus r GI E 2~ Fr, o~ MODE QOM qLt TE'ST' f}~PEgS'. , PROPOSED wEu M vsr LIE 50 FT d~ /yO~E F~PO,ti ALG TEST i9,PE~S, • = ~~GE'~ PATS O = 4r1Sr1A) 6- L(~ELL X ` ~EQG /DC~~/GWf a 11Au0 f}tJ9E~PED o,Q S~io~IEL Bowes • s f~O,~iz . BN1 (lFRric~L ~PEFERt.vcE- Poi~JT' 70/' so,~agy~s LE.C END L~~EV>troA! o~ var. REF Pr. ~o o . o F~ n IkoN !Ss .133 73 51 P (0y Z~ x pL Y 13 3o' 3 ' This test site APPROVED ,fora conventional septic system. o f 73 1 o f- 7 Z~ 0 si (rN~ r IV 0 . s DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-199* TM's MACS RLf[' "n Recom's ersa WARRANTY DEED "STERS OFFKE This D bed„ MURRAY A. K_ N__E__C_H_ T AND ST. CROIX 00., WM WAYN7: M6 3s tenants in common Rec'd for Reoord Mats 1 St rf July A.0. 19 L__ J6 . , Grantor, and....-•-..JAMES L.--WIERSG ALLr1- AN PAT RIC IA M. 3:15 P. on i4 ,.WIFRSGALLA-,•.husband.-and._wifeD__as. survivorship j Grantee, WitnOSSeth, That the said Grantor, for a valuable consideration...... Grantor conveys to Grantee the following described real estate in St . C....... X RETURN TO County, State of Wisconsin: Part of the SEk of the SWk of Section 17 and Pa RX Parcel No---------------•.---------- of the NEk of the NWk of Section 20, Township 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lot 73 of Certified Survey Map fjled February 22,1985 in Vol. 6, Page 1508, Doc. 399903. J~ sm, jf I~ i{ Thisi.S._X.I.Ot--------- homestead property. O (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantors warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except j~ easements, restrictions and rights-of way of record, if any. and will warrant and defend the same. i Dated this .first day of --------July--- - 19......... ~ (!n (SEAL) (SEAL) ' y. II A Knecht Ida ne Moser Vayne Moser Murra --(SEAL) ----(SEAL) • AUTHENTICATION ACHNOWLBDGMBNT Signature(s)„ `-Ll 'Y1tl'.-,> C7 zj/-----------------•---------------- STATE OF WISCONSIN ' - GL - County. suthenticat~ this . ....day of....,_....Lf 19.x'' Personally came before me this _ .....day of ce yzti e' .illll/:, ale-- 19-------- the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 4 706.06, Wis. State.) to me known to be the person who executed the