HomeMy WebLinkAbout040-1157-50-500
STC - 104 ' `tom
AS BUILT SANITARY SYSTEM REPORT REcavED
OWNER QL 0 1 1997
ST CROIX ca
COUNTY
ADDRESS
Cs,1 sit 3a
SUBDIVISION / CSM# VD/• !O i" q . 21 LOT /O
SECTION- T 2? N-R 2-0 W, Town of Timor
ST. CROIX COUNTY, WISCONSIN OVO _ 05-1" 5° - Soo
af.2-&•~~.
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/11d C~~`ZL f~rt'ill~?' 7 )
Gv%!f 75
ORIGINAL
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
R ti
Sv~'~'~/D~ "S Z" •O- rtT ~ T coiP,v~ ~S/-~
Av&--;z7-" 7a /00 • p '
BENCHMARK:
tpye Top op :PovR_eA ,4S 5
ALTERNATE BM: Zd
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: 1122-4 2!5 A'6457-Liquid Capacity:
Setback from: Well N/4"' House 2O Other
Pump: Manufacturer
Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: S Length '7S Number of trenches
Distance & Direction to nearest prop. line: > 6D
Setback from: well: House 1-0 Other • Lo-r- ~j ELEVATIONS
/vo
Building Sewer O . FO ST Inlet: 12-
o
ST outlet:
PC inlet PC bottom
Pump Off
Header/Manifold Bottom of system pLOT pig
Existing Grade Final grade I
DATE OF INSTALLATION: /flow'
PLUMBER ON JOB: F0131927- ~G~/ll'GLl
LICENSE NUMBER: /Lf/de.5 3 3 6 -7
INSPECTOR:
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Wisconsin [department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ~~T. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) SanitaryP9e§rnitJ4
GENERAL INFORMATION
PBARBEermit GEORGE & MARY ll+RO)Pvillage Town o : State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: 5 Parcel UOR4157-50-500
~0. 00, TT W ~fv d5 pipe- CST' v
TANK INFORMATION ELEVATION DATA A9700362
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ID 1Zv~ Benchmark 75- iooq / OCV
Dosing ^ I ~f° q(o Ub g 751 9Z
Aeration Bldg. Sewer i
Holding &,WInlet 67(" 60, Y. DI , Y$ OSr
TANK SETBACK INFORMATION Oor Outlet 96_c>6 a! 8'7 f 41
Vent
ir Ito ntake ROAD Dt Inlet
TANK TO P / L WELL BLDG. A
Septic +15, NA Dt Bottom
~ee d box
Dosing NA avii~t
Aeration NA Dist. Pipe q(o .a( 23 ro&' .
Holding Bot. System ~,6'
PUMP/ SIPHON INFORMATION Final Grade q`.~-2I' gar
T
Manufacturer Demand A.L}. 130M h~w ~ M,; - %PoQo .q3 • Cf
Model Number GPM q(,.o6 (o.n gq.l~
TDH Lift Friction System TDH Ft ~7
Forcemain Length Iia. Dist. To well
SOIL ABSORPTION SYSTEM
BED / C Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 1 S Z DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufa rer:
SETBACK CHAMBER Model umber:
INFORMATION TypeO System:corvao, tyo no( OR UNIT
-i~Wl
DISTRIBUTION SYSTEM AsM Z-7 Z-01
Header/ Manifold P"t Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- Length -70' Dia. q_~ Spacing 7
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over A epth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges oil E] Yes No E] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY 24.28.219tA,SW 231 WOODVIEW TRAIL LOT 10
I) r~~n~~►es VicevC r nSte1tccl rA+r 4I e 32me ele✓e+io✓1 r!0e -to a C hapile iii
-the- Mou5e l oc t-h ovi
rivirl 1I• 13-6
Plan revision required? []Yes ❑ No
Use other side for additional information. 113 97
SBD-6710(R 05/91) Date Inspector's ignature er
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Vsc'onsin SANITARY PERMIT APPLICATION 201eE. WashnlgtonAve ision
P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County ST' CtY
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Numb r
a47go.R
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)]. Statte I n I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION rL
Property Owner Nam Property Location
~d . /y'>~ A4k8C,j NW114 S&') 1i4, S ~ T 2!l , N, R 20 E (or
Property Owner's ailing Addres Lot Number Block Number 77 ~A- 1 &efg 0/E~ 0
Ci State Zi Code Phone Number Subdivision Name or CSM Number ~7Zd
A Qi.,. %y -GK~YI~ - 1~s 1 2.3 ((t2-)q52. • 2S 6SAA s!l3 0S ?)61. !O `
II. TYPE F B ILD G: (check one) ❑ State Owned it Nearest Road
Public 21 or 2 Family Dwelling - No. of bedrooms 0 Vown of 27ROY
1111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo ~lS 7 •
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 (Check only one box on line A. Check box on line B, if applicable)
A) 1. e~ERMIT:
2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Exi sting 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 [~S epage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 2 43 ❑ Vault Privy
14 ❑ System-In-Fill I el4 S ~ 5 X ? 5 "
VI. ABSORPTION SYSTEM INFORMATION: 3'?• po e -L .j . 1• p
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) es-0, Elevation
7Sa 750 .Q Feet a .0 Feet
VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tank Tanks
Septic Tank or Holding Tank 11.0'0 200 /?~LJ.erf j~P~tt,~ ❑ ❑ ❑ ❑ ❑
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) MPRSW No.: Business Phone Nu ber:
o el ee-T 7ALB . i C (A-1- 33 0 171.5 • 3 T OOS
Plumber'_s A.' dress (Street, `it~ State, e- Code): _ ^ + `t, I o ~s0~ '5 ~c
C~CJ
IX. COUNTY / DEPARTMENT USE' ONLY
❑ Disapproved Sant ry Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
[',Approved ❑ Owner Given Initial vi) Surcharge Fee) q C
< Adverse Determination L?
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 p rrnit rpq; a renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Adrrriilistt"at~V ;die 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 onsiie sewage system, corltact.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 must be submitted,to tfie, county. The plans must
include tFie 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.performake curve; pump.model and pump manufacturer; D) cross section
of the soil absorption system if required by the c.guQty; Q 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.
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Fresh Air Inlets And Observation Pipe
b Approved Vent Cap
Minimum 12"Above
- Final Grade
~t J
4" Cast Iron
Above Pipe -
-to Final Grade Vent 'Pfpe'
Synthetic Covering
min. 2" Aggregote
Over Pipe
Distribution Tee
Pipe 0 ,
6 ri
Aggregate o Perfbraled Pipe Below
6eneolh Pipe
0 Coupling Terminating At
5y5T. Bottom Of System
Agaoctates ltants
V1brlate Sewage °nsa
pdv ''4911 Rd• 16
655 W S 540
N~d$on.
33
O~ Fresh Air Inlets And Observation Pipe
L
Approved Vent Cap
• Minimum 12" Above
Final Grade ~j V/'Sff
00/1-0
Re:, " Above Pipe 4" Cast Iron
19A
• Le ( z' 4 5 2 .5 PG SS l i3
Wisconsin Department of Industry, SOIL AND SITE EVALUATION 3
Labor and Human Relations Page of.
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
57- ,~O/ X
Include, but not limited to: vertical and horizontal reference point (BM), direction and G
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
0w- //5 7-
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal InfonnaWn you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location ,
G O G S ~Tz~ R Govt. Lot *W 1/4 -`~1/4,S l` T N,R ZD E (or W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# '
2'7Z d
3o(P C'ovl= ~D • /D CS~t s/~36s ~/o~ /d p~
CStat e Zip Code Phone Number/ El El V , 3o T Nearest Road
Oa W/, .5y01& (715 ) 3glo '973 City ill ge l~ sown
New Construction Use: Residential / Number of bedrooms 3 Addition to existing building
❑ Replacement y~~ ^ ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate ~ bed, gpd/fl2 d trench, gpd/fl2
Absorption area required ed, ft2 trench, ft 2 Maximum design loading rate bed, gpd/I`F -9 trench, gpd/fl2
Recommended infiltration surface elevation(s) • _3 ft (as referred to site plan"benchmark)
Additional design/site considerations ZjSE LD-VCr N,4,eea(•j 7-&0 _va4. -5
Parent material Y M Flood plain elevation, if applicable N ft
Holding Tank
S = Suitable for system Conventional MMo~ In-GGrro90 Pressure AT-grade System Will
u = unsuitable for system ~ El U L~"s 1:1 u 0"s El u 2 s El u C,sp u ❑ s
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
l I o-9 /oYR 3/3 ~S anv~ 5 a>c •7 : •S
•8
Z -)I 31 e5'' IL
Ground
~D , j S D 7 r:7
3
elev.
Depth to
limiting
factor
7 In.
Remarks:
Boring # / 0-5 /D y~2 3/,L
G•.S f f1le of 1A" s :.or, 3A
-7 W. 412 /0 YYP_ 314, 51 zf slr~ m ye GL.S 5-
Ground ~Q J D ? 'o
elev.
ft.
Depth to
limiting
factor
y In. Remarks:
CST Name (Please Print) RO Q£ I' T I'w 1 G~ Signature Telephone No.
z6ffA444- ~ 3 S0L • oO/oO S
Address Date CST Number
Ulhrinht A AQmniataa 3' 1 ~ ^ Q 7 csT,-l Z7 d 2--
PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 3
PARCEL I.D.# GO /0
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
E31 o-¢ /0-1*8 3/ 3 LS 1p, /M &,/X~
/1 /0 a 1141 It-"fAe 40741
Ground /0 YA 11141 ZTS,~ A, ~ b
elev.
n. /D .,S d S ' i i 7 g
Depth to
limiting
factor
7 `C In.
II oo Remarks:
Boring #
A 1401 1*1"
v o 3 SL /~S/ G / 5
3 d• ZOVA 3/V / s /w >-R ez
s .Z -3
Ground
elev. u
n. ,
Depth to
limiting
factor
in.
Remarks:
Horizon Qepth Dominant Color Mottles Structure p
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
d' ' ~~.L O ~1y► S , S
Z 0 VP ;A/
L 5
0 / ~S •3
/-Q vk
Ground , 7 ,
elev.
n. '
Depth to
limiting
factor
G(12 In. Remarks:
Boring
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SQDW-8330 (R. 08/95)
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S FILED 9
JAP13 (R9Y p- 0
JAMES O'CONNELL
5111305 Register of Deeds
St Croix Co., Wi l!
CERTIFIED SURVEY MAP
Located in part of the NWa of the SWk of Section 24, T28N, R20W,
Town of Troy, St. Croix County, Wisconsin; being Lot 8 of Certified
Survey Map in Volume 7, Page 2015. 4.1 0
-f4 41
3
W1 Corner of N -0
d N
Section 24 OWNER
d s
L CO
W N N
L'
Robert Setzer & George Setzer c
a i l Route 3 N m e c~v !n
o wi Hudson, WI 54016 - N
M I W I O .-r
p t; j W i y
01 0 41 C)
QI C
W U N
i--, 1 W I ..-2 d
1Lot a7, C_S_M- in Vol. 79 P9• _2_015 m 4J o a
N 66' I _
(recorded as N
I I Lot 1, C.S.M. -
_ 840
8-3028'0311 41 281'W)
66.64'
0 320.001 731,, 66 Vol_ 2, Pg. 329.
d
-
-->r- 345.02' 44 OVER
o 3 W 1 j 0
W N
a 1931
W M
4- LOT 8 1.I
z Q J'N p 1"° VN
d O O 1•
+b.Wp,4ionsive QlOrr.Nr
N a-
d c S88°07' 0011W 435.82' 1 `frr 2 Cr1itg am)
3 tl r, C i:e.:~ onw C..e2
O
_ N 2 ` La11~
Sro 4 ,21 If not ri e6' ~v
y4thin
Won e g
zb _ o ? lorovaf -hA'I*
v i m e D rn N nA & void
c I \ ~ %J 0-
1 N W LOT 9 N- -1
~I o_
`ter, '
bi Sul F L°o i3
dl 'C W , N•
~I v N J ~,r ,r 10
E M
O
r.{ "o
ai
` H M d 0mmon N87046' 3011E 424.24'
\ FlVeWay iK 144.54' 279.70' w v-
1v
It Lo
.
JJ w
M 11 N
Ol 1,0
to
3
co -
0 co LOT 10
Ifi
LOT 11
Z
I
R 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 /4/7/t
Location of property 1/4 5W 1/4, Section 2 ,T_aN-R2-0 W
Township Mailing address
.
y5^2 I /~dE /J Dry ss 1 2-3
Address of site dbp(~IC-J C/TX R i U121CS 4j S~bL'L
subdivision name e" 511305 06/ • I() N9. 2720 Lot no. A0
Other homes on property? Yes t/No
Previous owner of property a 0 3 §e -f 2 x A--
Total size of property 2 +
Total size of parcel
Date parcel was created I 1 ^ 7-& -
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes ✓/No
Volume .9'Zo 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. 5"5' il) ' 5 , and that I (we) presently
own the proposed site for the- e~ 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.
Signatu e of Applicant Co-Applican
8A7 yc ~y 7
Date of Signature Date of, ignatur.
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
WNERBUYER G,F0In ? / i~ ~ )
A O
Teu ""'v~. SS / L
MAILING ADDRESS 7 s Z /?/19
PROPERTY ADDRESS W 6 d 0 V 1 eW P47-
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 4/40 1/4, Sw 1/4, Section - T 4 N-R L6W
TOWN OF 7' ST. CROIX COUNTY, WI
SUBDIVISION 51t3057 PC/ -10 Z? 2-0 LOT NUMBER 0
S c d 02,0
CERTIFIED SURVEY MAP 3 / , VOLUME 1 , 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 expiration date.
SIGNED:
06a~
DATE: 9
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
ar!"~93 VOL P-10pn-473
SLATE BAR OF WISCONSIN FORM 2 11 2
WARRANTY DEED
DOCUMENT NO. r_...~_
C J.,1'JI
ST.
---Sena _.SeLzer , -as._ Ancillary .~ersnnal_--- f.roa FMA^
- Repr e_s_~_,n t_a><iv_ e _ _o f__th_e _Es_t.at e-_ f. _G e o re e_ F - MAY. 2 2 1991
zer~_de_ceaaed}_and_Robert _J___S.e_tz_er_,____
3:30 P. M
romevs and warrants to George_.A.~.ar..beH~ and_-_ )
Mary -Barbee, husband-aad__wife,_as it ~ .~.k
prry,abi it t,..a.
----s_urmivarship_marita-l-p_roperty,
SPACE RESERVED FOR RECORDING DATA
_ _ _ _ NAr.F_ j.•.C -E%RN ADDRL IS
the.ollowdng de;lnbed real estate to St- C1rO i x _ ountc P` ff-e-r
Slate of Wisconsin, *5
°AFK;g- L'ENTIFICATION NUMBER
Lot 10, Certifiad Survey Map, recorded January 3, 1994, in Volume
10, page 2720, Document No. 511305, being a part of the Northwest
Quarter of the Southwest Quarter of Section 24, Township 28 North,
Range 20 West, St. Croix County, Wisconsin.
0
-Chts i s not _ homestead property
X)()XX us noo
Exception toAarranties. Easements, restrictions and rights-of-way of record,
if any.
Dated this day of May
_
-7AD, 1997
Estat of George F. Setzer
B 'L a
- ISE. L) - 1 iSEALI
G e n a Se z e r , Robert J Se er
0,9
o U~Ll (SEAL)
T
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
>5
- - - - ~ti l - County
Sr
au[henucatcd this _ da? of I'~ fl-rsona:!-. me this day of
Maw-----.___ 19 97 , the alxwe narned
-
_ ena_._ etzer~ as Anci.__ary_persoaal
Representativeof Estate-of_-George
111LE LIE.1IBERSI,-kfEB.~RUF%l.ISC.)VSIN Notary Public F,__Setzer._ deceased. and Robert J.
of Wisconslrts e t z e r,
authorized by S70(,,06, Wis Stats) Diane M. Barron to r', _ _ :r Y - %%h exe.atrd the !orcgoin
mart. -..n ix ame
THIS INSTRUMENT WA:; DRAFTED By n )