HomeMy WebLinkAbout020-1060-40-000
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS 8/0 SUBDIVISION / CSM# LOT #
SECTION ZZ TAN-RW, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Oll r
N1
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
J
BENCHMARK: T G, i r Lam.. - i
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: kS 6.4'' Liquid Capacity: /ooo
Setback from: Well House 3c> Other
Pump: Manufacturer / Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: 3 r Length -7 ~ Number of trenches
Distance & Direction to nearest prop. line: Sow/~ ZI'Le
Setback from: well: 67 House Vr- Other '~-L ~n hS 2U
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet A- PC bottom A4 Pump Of f 41,4
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: I 7
PLUMBER ON JOB:
LICENSE NUMBER: I?'1f~RS 3 2 7
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Huq,an Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 289309
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
AUSTRENG, DUANE HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/CIO: 119d / I 42,_ 020-1060-40-000
TANK INFORMATION ELEVATION DATA A9700123
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark - -7
/c7o: o
Dosing Q 7~ 6 '
Aeration Bldg. Sewer
Holding St/Ht Inlet y Q?,193
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet.
Air Intake
Septic _ S 30 r , NA Dt Bottom
Dosing NA Header / Man. G•3 Z
q, q( ,3 Z
/o?
Aeration NA Dist. Pipe o ~ 9G~ i
9,~4 9G . 9 "
7 11 Holding Bot. System 1/10 15.1?
PUMP/ SIPHON INFORMATION Final Grade g, r2'
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Loss H
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 17 91 DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
Model Number:
INFORMATION Typeo
d2 OR UNIT
System:
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.)
LOCATION: HUDSON 22,29.19.229B,SE,SE 810 KELLY ROAD LOT 1
4.
(~D 010 4L&t at
Plan revision required? ❑ Yes ff"No
Use other side for additional information. !Z A/11 fo
SBD-6710 (R 05/91) Date ns e s Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: `
I
I
Safety and Buildings Division
~•■■_r■r. SANITARY PERMIT APPLICATION Bureau of Building Water System!
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 8 112 x 11 inches in size. ~n x
• See reverse side for instructions for completing this application State saniti ry~Pe~rrmi~tlNuumber
The information you provide may be used by other government agency programs ❑ Che&?f Ili i p evious application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property 4SLocation
t/4, S Z 'L T ZQ , N, R Jf '(or
Property Owner's Mailing Address Lot Numbe7 Block Num~ I& ~ AL 1
City, State Zip Code Phone Num er Subdivision Name or CSM Nu ber
(7,5 )
83 es/01 32-- -
II. TYPE OF BUILDING: (check one) ❑ State Owned E] Ity Nearest Road
❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms- Town OF
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo f ~o 10
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreati nal Facility D
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. gkNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
-----System --------System Tank Only______________ Existing 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 0 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
nl ~5• Z- Feet _ Feet
-75 D o 17,104-
VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank z!60~ 6ip,b e, El El ❑ El 1:1
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATE-MENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumb 's Name: (Print) Plumbe 's Signature: ( Stamps) MP! PJVI RSW~Iw.: Business Phone Number:
Plumber' Address (Street, Cit State, Zi Code)-
1Z f
1Z lI Z, k g5QZ
-3 S> IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater jDate Issuing Agent Signature (No Stamps)
Approved F1 Owner Given Initial Surcharge Fee)
p
Adverse Determination ~p
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is kaIid for two (2) years.
2. Your sanitary permit may be renewed before the expiratior date, and at a time of renewal any new criteria in the
Wisconsin Administrative Cade will be applicable.
3. All revisions to this permit must be approves: 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.
& 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.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
111. 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 8 112 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.
<w s,L~7~L.S~t~icl~
JOB
TIMM EXCAVATING SHEET NO. f OF 7
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE 7- / / -
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 205-1®Ilm , Groton, Mass. 01471. To Order PHONE TOLL FREE 1-800-225-6380
JOB
TIMM EXCAVATING / of z
' SHEET NO.
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY( DATE 7- S'7
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
l
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Rr--dt
n
6 / /r
1
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P~`' .
C
76 e
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t6 L f fti!! l . ~1a
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PRODUCT 205-1® Inc., Groton, Mass. 01471, To Order PHONE TOLL FREE 1-80D-225-6380
f Wiisconsin Department of Indus
Labor and Human Relations °y' SOIL AND SITE EVALUATION REPORT Pie ~ of 3
Division of Safety & BuiklMs
in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 1'~W { K
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: }'1 R rob G I u GM s P x rj► -C s PROPERTY LOCATION
: FN.STR --Aj r. 6eW-WT S~ 1/4 SC 1/4,S Z ZT Z Ot N,R CL E (00A
PROPERTY OWNER'.S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
6g8 ~LR1vi~s RoP<~ I _ ~nos~ s Y"►.
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD
`cYv scAj L-J1 Sg61~3 (1LS) 3$6. 83Z•$ ~-1vDSbrv \-z--Lu-jr
[Z01~
~Q New Construction Use [Dq Residential / Number of bedrooms 3 [ ] AddWpn to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow ~A S O gpd Recommended design loading rate 5 bed, gPI ' 6 trench, gPdjft2
Absorption area required c t 100 bed, ft2 1 S 0 trench, ft2 R-Wmum design loading rate 5 bed, gpd/ft2 b trench, gpolft2
Recommended infiltration surface elevation(s) 9 S • Z ' ft (as referred to site plan benchmark)
Additional design / site considerations ?-qtp" Y4 @,~b Z 11te)-i CWt!S - t?Re N S S 'LV4 w / t o s C?~~t P
Parent material s 1 -TLt pU R S Pr"\C 4 ovT w >~S N Flood plain elevation, if applicable 'f N, N - It
S = Suitable for system CONVENTIONAL MOUND I"ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ® S ❑ U as ❑ U ®S ❑ U WS ❑ U STS ❑ U S PTU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench
riM
0-9 1 o~tiz 3 1 Z. L S) 16
Ground 3 2~(-31 ~.S`tR Sly _ S cSb~ ~v C_w - .8
elev.
9a.S ft. y 31-gZ S -1 p- V!6 - fS o s9 m 1 _ s :.tom
Depth to
limiting
factor
Remarks:
Boring #
D-10 1O 2 31Z
Z~ Z lpZ2, tb`fQ 3l` - St( 2 ~5~h M~ti_ Cw ,S
3 2 Z 31 • S 9 2 )j y
_ s c s k b►q V `F~ C I,v 1
Ground
el 5 4 31-93 ~.s,-lR Yl6
19
Depth to
limiting
V±L I -j
Remarks: '
T Name:-Please Print Phone:
Arthur L. We erer 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022
Signature:
[ -7 Date: -1 7 CST Number M0057 : 6
8U`1 L'~t
PROPERTY9WNER ~UST'R-E-,"J 6 SOIL DESCRIPTION REPORT Page--Z Hof 3
'PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botridary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
o_~~ ~o~~i 3Cz 5iI 777
Z ~3 . 1 0 2 3 l` S ZM S6 iM F►- C"j . S
Ground 3 28-3~' S~ttZ Sly ~g C9~1Z ►r~ U TL- C~ - • 8
elev. Wt. y 3~-$6 • S Y2 ~lG - ~s c~ sg 1
, .b
S
Depth to
limiting
factor
> 8G"
Remarks:
Boring #
o-L1 1D`-tiZ 3!Z ~ st 1 Z~S~h yr1,`~'~-
Z 1i-21 lrA `t 2 3~~ S)) Zvh Sblz Im `FI- CS
-3 zt-Z9 7.5Y23ly - 1 c,sb Y4 U'-9- es .y'.S
Ground
ele 98uS ft. ZQ-~5 -7,S Y2 VA - ~S S9 ~ S
Depth to
limiting
o~ 5 y
fact
Remarks:
Boring #
0.~3 ~oti~ 3lz s~ 1 Z'~sb►z vut~~- ~S • S . ~
Z 13-3y Lo`~IZ 316 CKj • S
3 Y-c~3 S`rR ul6 ~S o ag 1 - . s - b
Ground
elev.
'I
8_L
ft.
Depth to
limiting
i
factor
83y
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
PLOT PLAN Page 3 of 3
SCALE 1"= 40 '
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~v SE 'm BE FiT U~:ksT Z s ' Fl?-01-1 `TIz-EkJcWE! s .
f} ~oSC ~~~,MP w~~~ 6~ 4~~Q D lv Pier p~ $~-SO~►evT s~~~~. ~
1
C,Z ~2 ~h,~6y 1 Y r~, )22-7 (715 ) 4L-0165_ H00576
CST Signature Date Sign Telephone No. CST #
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
✓✓1St. Croix County
OWNERBUYER VCW4 ize f-✓/.r `Sf~~nr
MAILING ADDRESS C~~B e 1fr d5
PROPERTY ADDRESS k? Gc/ I~
(location of septic s stem)~~Pleasee obtain from the Planning Dept.
CITY/STATE F "d' &G k_ 7~U /Co
PROPERTY LOCATION .5"C 1/4, SC 1/4, Section 22 T 7- N-R_& W
TOWN OF AfGu ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIEDSURVEY MAP VOLUMEdjL PAGE , 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 must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expi n date.
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
-Aso
S T C - 100 d 20 - ~`~5' q0
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 kevt4
Location of property S~ 1/4 cl 1/4, Section Z z ,T~~_N-R_ZY_W
Township Mailing address
6'~g eV
Address of site
Subdivision name Lot no.
Other homes on property? Yes A,-, No
Previous owner of property
Total size of property
Total size of parcel
Date parcel was created 31"a 6 ~~7
Are all corners and lot lines identifiable? A Yes No
Is this property being developed for (spec house) ? Yes _'X No
Volume 2 and Page Number 1as 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. $-'7/ Z~o , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
A F
Signatu e of App ant Co-Applicant
Date of Signature Date of Signature
Fj
MARS e
LED
Z 6 1997
Mi ttMH. WALSy
iorof Deeds 9
557126 W,
CERTIFIED SURVEY MAP ti
Located in part of the Southeast Quarter of the Southeast Quarter of Section 22,
ship 29 North, Range 19 West, Town of Hudson, St. Croix County Wisconsin; also being _a_
part of Lot 1 of Certified Survey Map Volume 2, page 327 as recorded in the office of
the St. Croix County Register of Deeds.
Ei Corner
Prepared For Owners: Merle Jr. & Imogene Spinks Section 22
698 Badlands Road T29N, R19W
LEGEND Hudson, WI 54016 \
Aluminum County Monument. SCALE 1" = 100' \ WOMENd
Set 1"x24" Iron Pipe weighing
O 100 50 0 100
1.68 pounds per linear foot. I
a Found 1" Iron Pipe w
-3c--)o Fence UNPLATTED LANDS ~.I
J
S88-1110011W 654436'
00 - 410.95' 33.01'•
--624.85'--
33' 33'
N N N
~ N
ore W/$ ~c o
C0 z o 0 o LOT 1 . 94,383 sq. ft. (2.167 Ac.) Inc.;R/W
Q~ ° u' 87,120 sq. ft. (2.000 Ac.) Exc. R/W 0. Ln zn :4
1C-- N DOUGLAS J. N ON
1z ° cn ZAHLER %0 -
I 0 100'
ro S-2145
y - HUDSON, o I
o f WIS.
id N89°43' 40"W 443.87' 0 i1M=I
,a 410.87' i 33.00' rt ~ V) o
3121/9'7 o
ICl~ LOT 2 z ° E''~ N
0
CD tj
C) 94,119 sq. ft. (2.161 Ac.) Inc. R/W o N N %0 rt o0
N 87,121 sq. ft. (2.000 Ac.) Exc. R/W N N N o m 1<
o owl,-.
rn - o o - 0 1M
0 0% 0.1 1:
O
- - A 1 N
G I 0.
:4 J w I~ In
rl V+
r
It7 ~O
164.74 N89°43'40"W 443.87' i~ -
Iz I
S89°43'40"E 410.87' 1
33.00 O
~ 1 I
N LOT 3
Q 239,750 sq. ft. (5.504 Ac.) Inc. R/W
z o 12 ~ N 229,615 sq, ft. (5.271 Ac.) Exc. R/W llwl 0
co 0 t H 1'd W N ON o
m ° M rr
N) M F4.
a - rt w Qo IH - I Pool I t o z
C) o M I ~3 E Ct - 0
Im p septic dwell a N rh c~ IC1 1 O Id v
House & '~P VE~'
rt ~t iy~ nwi garage °
C M IU Building Setback
o to MAR 2 5 97 6 6'
P
',AI E BAR of ~%I~,( LT\SIN I OVA 2 - 1482
WARRANTY DFFD
VOL 1211 PAU 49-4
- --Merle Lee Spinks and Imozene__L. Spi=nks: WE T C'0XC7',1'A
'a tirr■rt
us and and Vile-, - - -
- - APR ? 199'
Lonveys and warrants .,1 _ Duane L. Austreng _ - yl 10:45 A.
---Melissa L_Austren2, husband and wife, -r *4,1.
as survivorship marital propert-y nuyglw,tLM,.
-HAS SPACE RESERVED FOR RECORDING DATA
•.AW AND RETURN ADDRESS
the following described real estate in St. Croix County. %
State of Wisconsin:
~aaCEL IDENTIFICA7ION NUMBER
Part of the SE1/4 of SE1/4 of Section 22-T29N-R19W, Town
of Hudson, St. Croix County, Wisconsin, also being part of Lot 1
of Certified Survey Map in Vol. 2, Page 327, described as follows:
Lot.1 of Certified Survey Map in Vol. 11, Page 3226, as Doc. No.
557126.
I
FEE
tt EXEMPT
This i s Tin t homestead properly.
Exception towarranues: Easements, restrictions and righ _ Lccora,
if any.
Dated this `tee L-- day of A. D., 19 9 7
L i - (SEAL) /
L)
Me le Lee Spins 1. Imog ne L. Spinks
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
ss
tit. Croix
d ~ Q ~f County
authenticated this 2 d day of /IA~C-N f9! 1 PerstxLnh- came before me this _ day of
mrkic-6 1997 the above named
_ M 1 Spinks and Imogene L-
S iinkc. husband nand wife,
TITLE: MLMBER STATE BAR OF WISCONSIN
(II not,
authorized by §706.06, Wis. Stats.) to me known to he the person, ho executed the foregoing
x3d- led , he s
THIS INSTRUMENT VVAS DRAFTED BY
Attorney Kristine Ogland _
CLINIr- %01A
UT T