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HomeMy WebLinkAbout034-1000-40-100 1 STC - 10 4 AS BUILT SANITARY SYSTEM RE ECEIVEQ r OWNER on h y Lore r4 ~ ` 0 X997 ' X01 45 s, ADDRESS &y7q l µwy 7-S X01 SScf SUBDIVISION / CSMJ LOT SECTION I T o7 9 N-R J 5 W, Town of. Dv , ca ~c; l~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N l`tx7a 3 3 30 99 loco I ;0 w 4 \ f X -j a^cl, ~ Tit"c~t~' INDICATE NORT ARRO Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: - ! -3YZ ALTERNATE IIM• - Lb ? pF 3, SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Hv FF vTT .rt Liquid Capacity: /Oop (~Af Setback from: Well Be House 2~D" Other Pump: Manufacturer Modell - Size Float seperation Gallons/cycle: - Alarm Location SOIL ABSORPTION SYSTEM i _ Width: Length 130 ' 0 Number of trenches w Distance & Direction to nearest prop, line: Setback from: well: 4 So House S.i . Other ELEVATIONS Building Sewer S ST Inlet: S - ~ T~~. ST outlet: PC inlet - PC bottom - Pump Off lop o:= PIRC, pr. jq~ 1o=8/~i'►~-q"Z_.. Header/Manifold- ►i=glr%ottom of system . IL=1Dh Existing Grade -3ZZ Final grade ~31z DATE OF INSTALLATION: PLUMBER ON JOB: fc-lac LICENSE NUMBER: P QD 110 4~3 INSPECTOR: 5; rn 1 M a So h 3/93:jt WisconsiiKDepartment of Industry, PRIVATE SEWAGE SYSTEM County: taaborand Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299073 Permit Holder's Name: ❑ Cit ❑ Village Town o : State Plan ID No.: LARSON, BRYAN & WENDY ISPRINGFIELD CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9700396 D D/~ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmark Septic 3%~ /Gd. Dosing ~a~:.r►2. ~6~5/r Aeration Bldg. Sewer Holding St/ Vlnlet x'73 TANK SETBACK INFORMATION St/Pt Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe HOldf g Bot. SysterriZ, / 2Iv PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand n^ /e / M e r GPM TDH LifiLt;;F! S stem Ft Forcemain Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches No. Of Pits Liquid Depth DIMENSIONS DIM N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM CHING Manufacturer: INFORMATION TYpeO CRAM System: j~ OR UNIT DISTRIBUTION SYSTEM Header /-%%w4q0d e/ Distribution Pipe(s) x Hole Size x Hole Spacin ent To Air Intake Length 11 Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gra yste I 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: SPRINGFIELD 1.29.15,SE,NE 1155 CTY RD W 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 SANITARY PERMIT NUMBER: k t SANITARY PERMIT APPLICATION 201eE.Wand ahnllgtonAve sion N Visconsin In accord with ILHR 83.05, Wis. Adm.,Code P.O. Box 7969 Department of Commerce Madison, WI 53707-7969 0 Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. St_ 451AMIX • See reverse side for instructions for completing this application State Sanitary Permit Number ag9ol)3 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 L APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Ow r Name Property Location .0 ~.tse.J Sd-1 i4, S f T . N, R /,5A(or Property Owner's Mailing Address Lot Number Block Number s: 47- " City, Sta a Zip Code Phone Number or CSM Number rc , II. TYPE F BUILDING: (check one) E] State Owned' Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3- Town of SAiflW14r/t"~aJ Co• III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) X122 1 ❑ Apartment/ Condo rJ 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. jg New 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 30E] Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench „S /X pd22E] In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit 43 ❑ Vault Privy 14E] 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) y,T.S, Elevat}on ySo s9d0 S30o ; 1. Y Feet ~je_ i Feet VII. TANK Capacity in Total #-of Prefab. Site Fiber- Exper. INFORMATION gallons Gallons Tanks Manufacturer s Name Concrete strutted Con- Steel glass Plastic App New Existing T nks Tanks Septic Tank orcWaWlc" ppp i wJ~G ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) LX Plymber'sSpnatui (NA Sta S) /NUWSW No.: Business Phone Number: Plumber's Ac dress (Street, City, State, Zip Code): .?.P8 o?S .4+0 IX. COUNTY/ DEPARTMENT USE O LY Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing gent Sig 4roved Surcharge Fee) pp E] Owner Given Initial c0 Adverse Determination / X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, 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, 608-266-3151. 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. 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 mast 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; replacerent 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. ' ~7 N 3 '7 z H C) o /Cu J tiG f~ D. > 0 c ~T r a o~ N > r.~ a O z ~eur~ Pet! t ' ~ f RILI ~ ~ \r ti I Ss:o 1 6Ar GAp J~~e~ w l;T pvL ~r /rl S ~"YPA~. / ' G /l0 S.f ~ ~L'r L T~iow! ~NO SG ALd~ ►i / = yo > g~.s 0 Q 'dW oe've L d C✓i rs r i rL,o 1g /'7 - 14.0 - Gsoua d vAr ~d.I/.✓ rsD o.tortE~ eyr~4 1 fpI rip ~ ► J 70.8 (,~ppd3 LAOUIO Etdd. A / aY P/Od. i/ PvG -al ~S y !Ia 61L• / S. T. 47 Ll ~/POG / ~.voPvsco 3 -Lfa. i7a6ic d rve.y! ®j R~~s wA LA./df `/fLD !J/YIEF.s 'Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page - / of 3 Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code 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 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 YA.✓ V .✓OY Z44a.✓ Govt. Lot SE•- 1/4,t/,5r- 1/4,S T ~ 7 N,R 15- # (or&V Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 9l Sr, r Le r s y City State Zip Code Phone Number ~-6ity B_Vnage ® Town Nearest Road u .r E5✓o/ra.✓i! ..B'' Sy7S/ ~ 7/-s' ~,I33'- l S7 ~ CO • o• l✓ 0 New Construction Use: © Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow SO gpd Recommended design loading rate , y bed, gpd/ft2 . S trench, gpd/ft2 Absorption area required . / .?S bed, ft2 11PP trench, ft2 Maximum design loading rate bed, gpd/f(2 . -r trench, gpd/ft2 f / "Ow- Recommended infiltration surface elevation(s) T If/ f, - ,30 ,GJ- ow'C44ze o.✓ sawaft (as referred to site plan benchmark) Additional design/site considerations "60,,✓ 'VWY fitao /llGe~/►'lyo I? - lS x.910 7-4d'A'-.yr. Parent material U, Y-" SN Flood plain elevation, if applicable 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 ® S ❑ U ® S ❑ U ❑ S ©U ❑ S Ci U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 9 in. Munsell (]u. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 70C V r' If J Ground _ e 7 elev. i /SA.✓Oi+O .0/ OJ -p/ lvv P- - qsa Depth to limiting factor X72 `in. N „ Remarks: /o/~r ~1G /s /l~.✓rs >T.~.~.~ ~...,Y-7 Boring # p a,vN..o , - - ~ y S oY'r - s S Ground elev. ~m a ft• ' Depth to limiting os.rgJ factor „ „ ,rla.~s~ r r RA >7L in. Remarks: o L .r 11'2 /-l .Yip fdd;r 1 - ,✓twt~s f ~oE~rN CST Name (Please Print) Telephone No. /e L /y'•v-ssErr - fSf/- 8tio Address Date CST Number - s ~~yf~y / SOIL DESCRIPTION REPORT PROPERTY OWNER G ~/~t ss.✓ Page of .3 y PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure D/ft2 in. Texture Consistence Boundary Roots w.: Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench -3 o- o - of .S' 3r IV m QI ✓~ra ,vv Ground 3 W 7-7 elev. , S ✓r 9/. 3 ft. Depth to limiting factor ~7L in. ; Remarks: Boring # a_s 7 y nnr a Ground y _ ."'Voro A" A- elev. 'r f 9~ft. Depth to limiting factor >>Z in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr: Sz. Sh. Bed Trench Boring # o rr C ,6A Ti' s - -5' , 3 17- io rat Ground y/ _ _ r U" 570 /0 YA elev. 9.T s ft. I-VP, 7 e yt - s - M P s Depth to limiting ; factor X72 in. Remarks: Boring # 13 Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) a cn n 'b 'b ' u s M H D 1-4 O O C n ~ H n „ ~ z r z Lo. l10. ~ ~ 9 ~ cs H H ~ t • ~ o ~ ~~'Go/7/YdNO j`Adn/LN<1 - ,~o ,lsfLotl LRAO!' n c ON 40../ Tou,L ~ a ON f!. 9 te,.i rir.c i tro" 0 3lOV ro r a z GS ~ it ~ / = yd If yS ~ o ,7o yo 8~ Q = ~SAcK~vocE firs a r i r ~ ~ Sf•~ ~P,Ii,✓r!O O,rs,✓s!~ .4(,4,4 AAnr of yd g, • ~ ~t [ tom 83,/o sErrlst~ %j 908 /lEquiitiirf.✓T~ ivi'f /I y s.9 1114Y c 47r % ail.N > Soo / ad"'. f ii/Oi1IE GAASf F/fG6 a!/ rA!<I s , SEP 2 4 1997 ► KATHLEEN H. WAM Register of pew >p wI X65821 ~ SL Croix co, N CERTIFIED SURVEY MAP BEING THE SE 1/4 OF THE NE 1/4 OF SECTION I, T29N, R15W, TOWN OF SPRINGFIELD, ST.CROIX COUNTY, WI. PREPARED FOR= KEITH LARSON SECTI 1. NOTE: BEARINGS ARE NE CORNER UbENTN y REFERENCED TO THE EAST (COUNTY MONUhENT °0 LINE OF THE NE 114. FOUND). o ro (ST. CRO I X CO. COORDINATE M.NPL AIND ..0NRS 44- SYSTEM) NORTH LINE OF THE SE-NE w N 89009'56'E 1315.47' ^l m 28.22 1287.25' y GARAGE ZDR I VE; 133 3$' : HOUSE rn 1 b.. m Z I. 40= h 1~ I Z LOT '2^ Iw 1 ° 26.69 ACRES A:PR VFJ) 1, 162, 768 SO. FT. I I N z 26.01 AC. Exc. R,W SEP 2 4 X97 I, 132, 928 SO. FT. y IX I = n 8 c z 18 1 too' • :z Cornareat,~,fw= .r s~'Wing:"Wic :D IW I co : n Pai# wNnrr~ittur m --1-I : z withinm of ro :r :m I : IAA tbA!cifAtt: IRF~~ltitllitke. q z r I co rRUIl~tstt~+uSitt! Q :a _ , ;N I , Q N 8 ° 1316.71' 40.68': = :yl I ly. L5 6. ' =r I31W 2 << w ` I I CRES / cc I' 1 ® SO. FT.) EXC. 1 I 1 p 6. 43i 1270. 87' S 88°59' 18'W 1317.30' N 88059'18'E E-W QUARTER LINE E 1i4 CORNER SECTION 1. (1' 3952. 73' IRON P-I PE FOUND). W 114 CORNER SECTION UNPLATTED LANDS i CURVE RADIUS LENGTH DEL TA CHORD CH. BEARING TANGENT BEARINGS 1-2 17847.98' 216.50- 0041'42a 216.50' N 00054' 34' W AT 1- S00033' 43" E 3-4 10699.83' 193.80' 1002' 16" 193.80' N 00°44' 17* W AT 2 8 3- NO I 0 15' 25' W AT 4- N00013' 09" W DESCRIPTION A parcel of land being the SE 1/4 of the NE 1/4 of Section 1, T29N, R15W, Town of Springfield, St. Croix County, Wisconsin, more fully described as follows: Beginning at the East Quarter Corner of said Section 1; Thence S88°59'18"W along the east-west quarter line, 1317.30' to the west line of said SE 1/4 of the NE 1/4; Thence NO0°20' 13"W along said west line 1325.59' to the north line of said SE 1/4 of the NE 1/4; Thence N89°09'56"E along said north line, 1315.47' to the east line of said NE 1/4; Thence S00°24'53"E along said east line, 1321.50' to the point of beginning. Contains 39.99 acres (1,742,209 sq. ft.) subject to right-of-way for C.T.H. "W" as shown, also subject to any and all additional easements, right-of-ways or conveyances of record. SURVEYOR'S CERTIFICATE I, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Keith Larson, I have surveyed, divided and mapped the above described parcel of land and that this map is_a correct representation of the boundary thereof C, 0 IV Dated this V1 day of 1997. 1P JAMES M. r`~I s WEBER S-1804 z James M. Weber S-1804 SPRING VALLEY I Wis. NELSEN-WEBER LAND SURVEYING gem ~ !J ~"r ~A ~,Qeerea tea ' 8 T C - 100 This application form is to be completed in full and signed b the owner(s) of the property being developed. An inade y only result in delays of the permit issuance. Shoutd s will this development be intended for resale by owner/contractort Sec house), then a second form should be retained and completed (when the property is sold and submitted to this office with appropriate deed recording the Owner of property L4-Zg~J Location of property-SE 1/4 1/4, Section Z'N-R W Township , k n)F Eia~1 ___Mailing address Address of site - - C •r `,j w n ~ Y1 Subdivision name CSC /a Other homes on Lo o . property? ___Yes k/ No Previous owner of property - Total size of property .3oAceEr Total size of parcel 3 , 2O Date parcel was created Are all corners and lot lines, dent ~ ifiable. Yes No Is this property ilbeing developed,6 Volume pec house) ? Yes ~_No (s _ Ad Page Number as recorded with the Re of Deeds. La gister INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DO NUMBER AND THE SEAL OF THE REGISTER~OFT DEEDS R, VOLUME AND PAGE In ad, a certified survey, if available, would be helpful so asdtol avoid delays of the reviewing process. references to a Certified Survey If the deed description shall also be required. y Maps the Certified Survey Map I PROPERTY OWNER CERTIFICATION (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) described in this information form the owner(s) of the by irtue warranty deed recorded in the office of the Count y vRegister of a Deeds as Document No. _y_ of own the proposed site for the sewage ~disposaltsystem) orr I e(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 ~'7 .-3 Slgn ure of Applicant - pplic to of S'gnature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 13 eAJ Lfieg vJ MAILING ADDRESS D-S C-erf Sa IIA = N~on~ , S+4' PROPERTY ADDRESS C W Q W l +'1 I Yl (location of septic system) Please obtain from the Planning De . Sq7 V CITY/STATE DOW N i M 60 II0.Z PROPERTY LOCATION S E 1/4, E 1/4, Section TL-9- q N-R__j 5 W TOWN OF S.PL 10 (~F1 C CD ST. CROIX COUNTY, WI SUBDIVISION '>c LOT NUMBER CERTIFIED SURVEY MAP~~ ✓ g~ / VOLUME _L_, PAGE 3353 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 expiration date. SIGNED: A_Vz:'f111_1 DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 yon ~,26~ ~acE ~.6~► i J), 565893 STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO. KIETH M AND CAROL J LARSON, HUSBAND AND WIFE REGISTER1 OFFICE ST. CROIX CO., WI Reed 4 ,Rsoar1 S E P 2 5 1997 conveys and warrants to 9:30 A M BRYAN K AND WENDY i I AR(;nN, HII4RANn ANn WTFF W~ls~ ` R Cads THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in ST .ROIX County, FIRST NATIONAL BANK OF GLENWOOD State of Wisconsin: 204 E OAK ST Pb BOX 338 GLENW00D CITY WI 54013 NEW PARCEL IDENTIFICATION NUMBER LOT 2 OF CERTIFIED SURVEY MAP DOCUMENT #565821 RECORDED SEPTEMBER 24, 1997 &-1AJ6 1-~K SE l/y, aF 1-ttr NE yy of SCC-nOrJ I, Tag N, 9-15 W, '►'DUJA1 0 F SP21 tj & PIED I ST. C P-c IX CotArJT~ , uk=- $F This IS NOT homestead property. (is) (is not) Exception to warranties: Dated this 24TH day of SEPTEMBER A.D., 19 97 SEAL) (SEAL) KEITH M LARSON CAROL J ARSON (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. ST CROIX County. A A-