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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 f C/~ y { J - - - - - . , - 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 . . Rr--dt n 6 / /r 1 . P~`' . C 76 e 0 ~s/s t6 L f fti!! l . ~1a C- 5!r #v 1_rur X ?S~ . 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~-$6 • S Y2 ~lG - ~s c~ sg 1 , .b S Depth to limiting factor > 8G" Remarks: Boring # o-L1 1D`-tiZ 3!Z ~ st 1 Z~S~h yr1,`~'~- Z 1i-21 lrA `t 2 3~~ S)) Zvh Sblz Im `FI- CS -3 zt-Z9 7.5Y23ly - 1 c,sb Y4 U'-9- es .y'.S Ground ele 98uS ft. ZQ-~5 -7,S Y2 VA - ~S S9 ~ S Depth to limiting o~ 5 y fact Remarks: Boring # 0.~3 ~oti~ 3lz s~ 1 Z'~sb►z vut~~- ~S • S . ~ Z 13-3y Lo`~IZ 316 CKj • S 3 Y-c~3 S`rR ul6 ~S o ag 1 - . s - b Ground elev. 'I 8_L ft. Depth to limiting i factor 83y Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 40 ' f7 ~II~ 9S' e 8o~uwss m P ~.aq 5 \ 0 F3•! \0 qs.z, ~j e• a Qg s s ~ tz ~ -l3 writ w / c.>°►fir} . NO aL 018 8. ~~j ~o%•S J ~ - Q$C T y. b I IF-,1 q.S z' 3.y .LL Cl b I ~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