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HomeMy WebLinkAbout020-1077-80-100 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SA44 /n I L Lr-12 LC)~`i~l k S ADDRESS 7`?Ga CRoj a lf b (Z "J EL P L.) O 5 0 m w I .T' yo SUBDIVISION / CSM# 1/0(, P4, 3 Z sCJ LOT # Z_ SECTION T .2-91N-R~Town of PyDSOA( ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 14 I/ly 'w /0 , JYd`rE: Ce-T 7o F~C 1)1)11,f re G~R~cE (~e'\Vr -JAY Zy 432 14DUSE , - - J £ ~ I a ~rfxsd ~ 9 ,T A ~AA'1E A E A a fog M y DES kaa~ tk~~rE) E.M• spiKt „ a 2 0 o pow tQ ? e i 'n a l souTH Lor LIA(Z I14DICATE NORTH ARROW Provide setback and elevation information on r-ever-,e of this form. Provide 2 dimensions to center of septic tan}: m,~nholc cover. BENCHMARK: SCIK~ /N O tcl V o LE oN EA sT LOT- ALTERNATE BM: To P p F w r LL 1. 11 Z~ 10' •A C SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: WC / g E 4- Liquid capacity: 125-0 Setback from: Well '79 / House Z Q' Other SS's 7'0 _ Tic.ENc ~ Pump: Manufacturer Model# Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length 7S' Number of trenches Z-- Distance & Direction to nearest prop. line: / 3 " Tc 5oJt N LpT L/N C Setback from: well: 7 y House 3 7 Other S ~a S T ELEVATIONS Building Sewer ST Inlet Q,.1(ezq'S; outlet g*, #1 X FS-D0 PC inlet PC bottom Pump Off /;,v ~~Ef Header/Manifold Bottom of system D410„ Existing Grade, 4a'" ~ Final grade -r DATE OF INSTALLATION: PLUMBER ON JOB:' LICENSE NUMBER: -r INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LaHuman Relations Safety fety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284343 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: MILLER, SAM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020-1077-80-100 TANK INFORMATION ELEVATION DATA A9700110 ~/i3/9 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3, IJv.C~ Dosi n Aeration Bldg. Sewer;, Holding St/ Inlet TANK SETBACK INFORMATION St/ Outlet S/8 Vent TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet /l Air Septic 79~ CPO NA Dt Bottom yl Dosing NA Header/Man. Aeration NA Dist. Pipe Holding Bot. System lD, pS 1 L11, Ile PUMP"/ SIPHON INFORMATION Final Grade Demand° X7 Manufacturer l~ I Mo e-IN u-m a GPM TDH Li Friction t e m T H Ft LOSS e Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length , No. Of T enches DIME No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type O t,,L - C ER Mo er: _ ) System: OR UNIT DISTRIBUTION SYSTEM Header Z&iiagF l/ Distribution Pipe(s) Hole Size x Hole Spa Vent To Air Intake Length Dia. T ' Length Dia. / Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gra a tems Only Depth Over Depth Over xx Depth Of xx Seeded / ed xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) .LOCATION: HUDSON.28.29.19,NW,NW 796 CROSBY DRIVE LOT 2 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: r i SANITARY PERMIT APPLICATION Safety and Building l ng Water Sn Bureau o of f Building Water Systems 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. C1 0J • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if 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 Z 9 /9 E (O .5 I~ t~ lM I L N~1 /4 /Y C,() 1/4, S Z. 8 T N, R Property Owner's Mailing Address Lot Number Block Number 2- 1 d x Z S. 2--_ City, State Zip Code Phone Number Subdivision Name or CSM Number 0 0_s .1 nt wl D /fe (.3x(. ) z?<~. 9 c51h4& Ss88F~9 II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village cJ DSO N C,2ps Q y !>Q / v E 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) o Zo_1o7-7-00/0 0e 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) 19 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an A) 1. 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 MSeepage 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 ('00 -7S0 -7.S6 .g 9,00'Feet 98.3 Feet VII. TANK Ca in galloacitns Total # of Prefab. Site Fiber- Ex er_ INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank x ZSD WEI 5 E /Z [R ❑ ❑ ❑ ❑ ❑ 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/MPRSW No.: Phone Number: iV) IKE `OvN4LL /ozzsa3 ~TBuis7es~s o"ek9L Plumber's Address (Street, City, State, Zip Code): loin 14L) N7'E~L- kit)& CID H JDSoN 1 yQ~~ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee (Includes Groundwater Date Issue Issuing A Ag nt Si ;nature(NoSt ps) Surcharge Fee) pproved E] Owner Given Initial Q~ Adverse Determination /U y melee X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-6398 (R. 05194) DISTRIBUTION: Original to eouniy, One copy To: Safety & Ruildings Divi 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- ll. 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; welis; 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,l 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. . SAI'V► MILL ~E2 C SM # SSgg'8'~j LoT Z Sr~cE ~iy„_ /cJ SY SiEn~ F_r : 9y! po, ~1'1 c.~~ TLt r T D Z Z:5 o 344, 79(, C~~C'OSBy/~ L'L= CovN_Ty' -r~uNK f{ i6rr w~,Y vy" n/o~2rf/ c0T 4- Alf o?90, co' h N OQ w U { ~o N - o y n I r' fv fl r ~o G~ ta4,~ "x~6" ~j c~ of w.4y I-Ious E ~ ~ ~.M. S~/Kb ,.8'xso, ~ ~Npp(.ve~ /n ~t~rEa N~r~ Qt-- 30 6D S s I a - Gt4 l . S:T. ~ s ~ i { ZO 7-N ceT Z/,VE ?e;. C.0 _ I Wisconsin Department of Industry, LaboranrmanRelations SOIL AND SITE EVALUATION REPORT Page_of 3 biwsion of Safety 8, Buildings 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 Crr CRO IA 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. (0 Z-6 " /0 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION S ,M A ) LLCR GOVT. LOT N W 1/4 N t..J1/4,S'Z8Z T Z 9 N,R 9 E (or) W PROPERTY OWNEIT:S MAILING ADDRESS LOT # BLOCK # SU AME OR CSM # - o~sr~p CSI~t CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VI) AGE E70WN NEAREST ROAD New Construction Use [f% Residential / Number of bedrooms Gt t -)X [ J Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 0,1 bed, gpd/ft2C$.% trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 MaximLffl design loading rate O ,7 bed, gpd/ft2_` trench, gpd/ft2 Recommended infiltration surface elevation(s) O W &Eli 94 .7,og YZZ It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL ll 0 ND IN- ROUND PRESSURE AT- S SYSTEM IN FILL HOLDING K U = Unsuitable fors stem s ❑ U ®S ❑ U 9S ❑ U S ❑ U ENS ❑ U ❑ S ( U 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 TmrK:h / Yte 4/2 M SU r s 1~ a.Z p 3 Ground $ 22 -SS M 414- CS 7 O. elev. ft 2 'Y Z S d~ a^ l'►'►1 b, Depth to limiting factor > id.17 T-- Remarks: Boring # 1 s .31-79 i&X4 S A Ground rwev~ 7~-IZd 7-!!~Ype4A s- -n Ph Q, A 6.7 16 -S It . .y N 1 Depth to r limiting factor Remarks: CST Name.-Please Print A Q NNS~~ t coo Address: -&.X 9 S~nature Date: •.,0 9 CST Number: 34'4 PROPERTY OWNER SOIL DESCRIPTION REPORT Page -Z of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour~iary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch C,,e 6. s- 61 s h rn 1 C- s r a j 656 Ground $z -7 o e-9 4 ev. $ -126 7- 5' S ro r Ili a.7 It, 74 , yso ep to ' limiting facia ?fD,SO Remarks: Boring # Ground D z -76 yk 4 4 5 6, r- N CIS 16.7 0elevt'1 I27 7S Y 4 S rk r /h O ,7 b 8.5 ft. Depth to limiting facto Remarks: Boring # n fil ~i ~ ~ ~ Cr y►'t Y' CS Z~ s $ , Ib-3L P 4 s, L / Sbt: ~ c5 a,2 .3 Ground / 2,24 4 S a et r rh Cs 0,7 D ~S AN tt ` Depth to limiting Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: SBD-8330(R.05/92) LO J • 2 4 w ~ a b~ Q ~9SQ2tc7 E 7 m ~ N ► N A3 i 1 ► ► I m LA . C% I y L~ 7 . c~ g - n Tq , r I w I o I r 4 rri I ~ I r I ~oo b0 0 ~ i o y z -n 1 ~ N N i v I ~ ~ w ~A m _ N I Z rh I Z I Li I m i - Z ~ p ~ O o o ~o .1 z 'm LA 1~, 0 o> MQ . w, 0~ N X- ~ a l 5 1997 cl; nw. CL cc 0. WAL g SLCrok cods 558889 ` ;his instrument drai ,d by Fran Bleskacek Pro o. 96-117 O x n Or :rl v> z 0 m =E pi t-l ~ a o ~z to 00 ca cn D O F i :3 w t o 0 0 oZ - o r SMALL TRACT 701 701 MW _ F1 IN VOL, 1118, PG, 583 7 j X IO I- •m No o-+ tiJ ICD 13 to`•` 4~ > >I-c: to N00°09' 22"W 353.50' CD --v-0z t0 1-h. ro 301.061 'o a 3 rn m rt g Iz Cn -n -n -n ~-Vaaa (D IO Ir-fD~o°O° I r- 10 m v' O1 I- I---! cot N Z cD I IM IkA 1M" I` y m c Ir 1 1 n I'U I-h 1-I IM n 1-I 60' 70' I O IM O Ivy Ir- ao -4 IVl V IZ n n m r- I I-I I I CD V1 1:;o ICS Lln N ( N z -p- 1C .P ICn iD co io IZ N o m - N o0 o I~ -n X -n 0 z ~r ~ h ~ v, = Fh A z CD. C'-) 10 co E E m ao o (D M I r- k.0 0 ~ rt. I- F- y ago I-' r- m Y 0 ct F' -n 100 Ln CD 0 Cl I~ J o C 100' I trJ S C' 0o C/) IG~ ~ m C c oNi y < N I-~ 4N. Noy o %D M 100 to to -p 0 W z < 10 0 300,68' 52.82' o N m ~0 3 n S00°09'22"E 353.50' In N IC/) 1-3 00 o IM 1Z 4 O N W IS I-cc N O v Q1 0 M M o o IC) Io 01 (n m -O1 0 1- I-I o Q' -n m - ~i o_ 1M 100 o fi a N Q z I` OAS O 1 00 W - I-0 qu~ C, I E E 60' 50' IG~~"n `s C2 Z, I- T~ ?a do SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that by the direction of Sam-Miller, I have surveyed, mapped and described the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows:. A parcel of land located in part of the NW1/4 of the NW1/4 of Section 28, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; being that land parcel recorded and described in Volume 1203, Page 576 at the St. Croix County Register of Deeds.office;.further described as.follows: Commencing at the NW corner of said Section 28; thence N89012157"E, along the north line of the NW1/4 of said section, 5A3'.00 feet to the point of beginning; thence continuing N8901215711H, along said north line, 745.50 feet; thence S00009122"E, along the westerly right-of-way of the town road (Crosby Drive), 353.50 feet; thence S89 12'57"W, along the northerly line of that'land"parcel recorded and described iii Volume 358, Page 480 at said office, 745.50 feet; thence N00009122"W, along the westerly line of that land parcel recorded and described in Volume 1118, Page 583 at said office, 353.50 feet to the point of beginning. Described parcel contains 6.05 Acres (263,513 Square Feet). Above described parcel ,is.subject to right-of-way for County Trunk Highway "UU" and all easements of record. I', also certify that' this Certified Survey' Map is "a`'correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions-of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. Each parcel shown on this map (plat)'i6 subject to State, County and Township laws, rules and regulations (i.e., wetlands-; minimum lot size, access to parcel., etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and appropriate Town Board for advice. STC-105 i SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County I OWNER/BUYER S 6 )11 IyJ I L L S I MAILING ADDRESS X '4- Z 8 Z PROPERTY ADDRESS -79CA G 8 ie (y~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE 0 S© N LcJ r !'°L/O l./.. PROPERTY LOCATION A K/ 1/4, A/ ui 1/4, Section L 8 T 15 N-R / ! W TOWN OF 14 ✓ 0 -So A/ ST. CROIX COUNTY, WI SUBDIVISION C Z 411 '*1 S` S LOT NUMBER Z-- CERTIFIED SURVEY MAPS gBq,VOLUME / PAGE 3 a.slQLOTNUMBER Z- 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 expiration date. SIGNED: ~9 n n DATE: S~ _~--`I 7 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 5'/4 ►M /'14 I L L F 2 Location of property__A/ u-) 1/4 Al cc,/ 1/4, Section TZ 9 N-R / W Township H L) D z o rl Mailing address Rn)( Z F Z ~lv~Se tea` 5 yQlc- Addressof site x'40 f I,; D Q E ' on name C S In =t 5 S g ? ~?9 GSM VW Q133-P-S-0 Lot no. Z- other homes on property? Yes X No Previous owner of property R o +3 r_ ,4 -T' S C k c~ (e w s k ~ Total size of property -2 , 3 {Q Total size of parcel -2 , 3 G A t Date parcel was created 10 - I,: - I - Are all corners and lot lines identifiable? k Yes No Is this property being developed for (spec house) ? X Yes No Volume lZo3 and Page Number S74 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. s5o873 , 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. Sriq ature of Applicant Co-Applicant Date o Signature Date of Signature 5508 13 STATE BAR OF WISCONSIN FnRM 1 - I"Z WARRANTY DEED F::S ST. CRC;X CO., v11 • DOCUMENT NO. Razt br Remo This Deed, made between Robert J. Sokolwski - -OCT 15 1996 at 11:00 A. M Grantor. Pa?u•t d OnlGa t SAM R, M4110 n and - - r Grantee, TM15 $VAI RESERVED FOR RECORDIN'. DATA Witnesseth, That the said Grantor, for a valuable coasi~ >O AMP .L NAME AND RETURN ADDRESS / roffmays conveys to Gnatee the fallowing darn'bed real estate in -Cr Croix , YW000 b I eD;.nty, sate of Wiacoosio: HE204 L 0 S.0..C. Box 125 H , WI 54016 All that part of NVh of Section 28-29-19 described as follows: Beginning at a point on North line _ of said Section 28, which is 533.0 feet East of n 1077-8n - ~ 7 -10217-g Number) r• NW corner of said Section 28, thence South 353.5 feet m parallel with the West line of said Section; thence East 165.5 feet parallel with the Northti~eto of a s point on Section; `forth line t of 3said feet parallel with the West line of said Sec Section 28; thence West 745.5 feet along the North line of said Section to the point of beginning. -f •1 l~a~ a..al ~ , FEE a s not homestead property. This (is Together with all and singular the herediaments and appurtenances •hereunto belonging: And all easements, warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except covenants and restrictions of record, if any. and will warrant and defend the same. October 96 11th Da this day of ~i(SEAL) (SEAL) ii (SEAL) (SEAL) } AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Sigoature(a) Robert T lo SL Coaty. 19 96 Personally come bdos rare this day of Sn 46,is 19_ the above named R OF WISCONSIN (If not, who executed the authorized by $706.06, Wis. San.) to me known to be the person foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BV -