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HomeMy WebLinkAbout026-1115-20-000 C o c ° I o p E» o v c er ~ y I C O O I N ~ o ~ I 0> O c c I r.. 0 a) ~ I v x iv I o I o ~ I 0 CL c z of LL L m C (a O O7 a L Q •N-- 7 z y 00 O z Lm N I Cw a m o o z l c m zz d c o U) H zz _ E o v ch N O 7 WJU m a) C CL I t►i O co o a~i Q w I N 3 z co z o c z c N N _LO N R > N > d _ d N C w .L+ U C (0 p c c o a N tw ?j E O N a IL 0 .2 0 0 0 z° rv a a a *`a a z I (0 (0 o N m N J U ~ rn rn y Q N api o o E m d 'a m co aNi ~ ,N~ .p d Q } ro O o c N c °3 as o c E N r - C? O C:) 't H U U N N U LL O O 41 C O O 04 (D ~ c II! S C ECL r- -0 " c v C 0 LO a~ r o r E r L C o ~ O M _U a) O a) m E v L~ O O U) N O I =3 U) ~ ~ I I C~ £ V~ `y L L at ° L a `Iv d m rrww L `~1 A 0 a 2 0 N v STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 1 I (C ~2' S~~ .Q v► ADDRESS'T, O 1 Imo,,, o A ~1L s von 7 SUBDIVISION / CSM# 1 Q1,J 1~2V` Da-dO s LOT # r1re SECTION l T-36 N-R_Lff _W, Town of G/'t ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t 1 n Sc G INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: /U W /d0 • / ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -.SOIL ABSORPTION SYSTEM Width: Length /OD .1-1 Number of trenches l Distance & Direction to nearest prop. line:_ tie, 51 . Setback from: well: /40 House //d Other ELEVATIONS Building Sewer ST Inlet. /00.x+ S ST outlet PC inlet A! 14 PC bottom Pump Off Header/Manifold /81 T Bottom of system g7`~ Existing Grade Final grade DATE OF INSTALLATION: -PLUMBER ON JOB: LICENSE NUMBER: IS (o~ INSPECTOR: 3/93:jt W_4,0s6sin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P STEVENS, MICHAEL X CST BM Elev.-.- Insp. BM Elevv.p:: BMCDescription: Parcel Tax No.: 1491 , , I c~ a__5 A~- I *96 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i C5~'C~nC ZS~ Benchmark (0,33' e Dosing Q dj. / Aeration Bldg. Sewer Holdi St/ k* Inlet TANK SETBACK INFORMATION St/ Outlet (0.30 03 Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic '>,-570' ? ;n-' NA Dt Bottom Dosing NA Heade an. g9! 3C Aeration A Dist. Pipe Holdin Bot. System g 7 02/~ PUMP/ SIPHON INFORMATION Final Grade o Q Manufacturer De d -6-°/° OICe ' Model Number M TDH Friction System TDH Ft oss mead orcemai n Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth S I /c;? DIM I N DIMENSION SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING urer: SETBACK HAN INFORMATION Type Of q ~J Mode Number: System: Co y)a~ NIT DISTRIBUTION SYSTEM Header / Caaa+feld' Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length9 ~O ~ Dia. ~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys s On Depth Over t, „ Depth Over << xx Depth Of x Seeded / Sodded xx Mulched Bed /Trench Center 31 - Bed /Trench Edges 3 -39 Topsoil ❑ Yes No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND.1.30.18W~j SE. SW. LOT 12. 176TH AVENUE Plan revision required? ❑ Yes to Use other side for additional information. ZZ 2L SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION BuSafetyreau o off BuiuiildiinWater Systems gWater 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 81/2 x 11 inches in size. - 5*+ C r' a ~X • See reverse side for instructions for completing this application State Saaanitary 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 Own Name Propert Location 'r Sp, 1/4 RU)1/4, S T Q , N, R J4f jor) W Propert Owner's Mailing Add- ss Lot Number Block Number umber City, St Zip Code Phone Number Subdivision N me or CSM-Al I1. TYPE F BUILDING: (check one) ❑ State Owned ❑ Ityy Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 0 Iowan OF ~lIch IY►TS~d .74 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 t1 1° - /115 - ova 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. k, 2. ❑ Replacement 3. E] Replacement of 4. E] Reconnection of 5. E] 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 ❑ 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) G~ Elevation (p©~ Aa pp 4.5 AVAI Feet ,t6# Feet VII. TANK Capacity accts Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank X ash * ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I -z-4-bj ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: nt) Plumber's Signatu Stamps) 1*115 RSW No.: Business Phone Number: a 63 7/ -o?y6 Plumber's Address (Street, City, State Zip Code): n IX. COUNTY / DEPARTM NT USE ONLY ❑ Disapproved Sanitar Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamp A roved Surcharge Fee) App E] Owner Given Initial ~ -g, /0 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) 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 seuvage 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. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 F=amily 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 8 112 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. V a ' ~w- Z4 _ , I l , < 1 , i ' 0 a 1 I i _ i v I . P 4 I -1 t i t i ! S t ' s a , , t i ! 1 , e : a + < i , , 1 ~ + t t i i i a I ! t t r. i ! 4 , = /~J/ch 4~/ 57..E u~r►s Lo cz njL~eA PAGE OF CroSS ~ee~Iun O~ SyS~en-~ -74 Fregh Air Inlets And Obceryalion Pipe 1 Approved Vent Cap Minimum 12" Above Final Grade 20-4 2' Above Pipe -4" Cast Iron To Final Grade Vent Pipe Marsh Hay Or Synthetic Covering win. 2" Aggregate Over Pipe 01itribulion PIP$ 0 0 0 0 0 -Tee i 6'AA ggrega!e o Perforated Plpe; Below Beneath Pipe o -Coupling Terminating At Bottom Of System PI^u(~vSe~ ~It,k~. gr~.~lc , . 5-1~cJ•_~ ton .SOIL. FILL DISTRIBUTIOU PIPE APPROVED ~tfNVETIC COVER OR 9" OF STRAW Z" OF A6GR EGAlF. OR MARSU HAy G-.^~ 2 f (e OF 12 -Zt12 AGGREGATE ELEV. OF /l FEET. , DI•ST-RIgUTI0U PIPE TO BE AT LEAST INCHES BELOW ORIGIIJAL GRADE AQU AT LEASTZO IAICHES BUT'F.IO MORE THAI) H2. IUr-4ES BELOW FINAL GRADE MAxIMUM OWN OF F-XCAVAT100 FROM OR~FSYJAL f RAD WILL BE i1JCHES ~It;INgL GR!4D€ WILL BE ZLI_ INCHES MINIMUM 9Ef "N of EACAVATION FROM 04 SIGFJEO: K LIC EU SE UUMBE R: a DATE . s"J -Ac, ` J - suo;r? o NU I .L. J I 1 ti.L W N V;j ,)uowyold maN ainod ~Z£Z-9bZ (SILK 41 JJ APA451H it-s2C Cron v ' . = N ~aov CO2 iy»r~V'~Pt V ~ ON O ~ 1y O ~ oM,e7rr~ t•6'tN 9y17V OKZ ~ • CQ e o ' Y1 V~ Z~ ~ N DJ 'P!! txf0o _ ° CO'lti • • 0 C. _ OOL !LL MW ~ 110'LOS , sow Oct ~ saw t t'2 y IC P I •9z 1 . puotW~y AWN P tp a:" LT cru. v 1lM 09'4t 1 = wpV an e o 9ww cc's sz • ~ . lZ m • OWN lOZ - SZ 1 c~etc 5 " MOP I 1 •~o • . o •M,wtos ~ ttz ' bZ 'oc•.os oc•oo~ at OOT • ../av ooz 1 18 ~ , , ' . Y K'OC1 sti 102• ' ftw on low OU 9"PV WT 99*cu t Nt g ~ ct.tsc r~r N oar sr ~c` +aav coz swr 1179 SMOPOSW +.t 6 L `t MW tot 9l , ft"Ars 1 tir l! ~IJIMt4opno, +It t, 1 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY -1.2 St. itroix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but pARCEI l.D: s) not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or `qt dimensioned, north arrow, and location and distance to nearest road. 020-1115-90 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION rEVIEWEDBY i f RATE PROPERTY OWNER: PROPERTY LOCATION Derrick Construction Inc. GOVT. LOT SE 1/4 NW 1/4,S 1" T 30 18<,~ (90 PROPERTY OWNERS MAILING ADDRESS LOT* BLOCK* SUBD. NAME OR CSM # - d 1505 Hy. #65 12 na Willow River Meadcivis', CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 99fOWN NEAREST ROAD New Richmond, WI. 54017 (715)246-2320 Richmond 144th. St. [ Ij New Construction Use [x] Residential / Number of bedrooms 4 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate _bed, gpd/ft2 Y6''."trench, gpd/ft2 Absorption area required 1200 bed, ft2 1000 trench, ft2 Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.30 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U ®S ❑ U ®S ❑ U CRS ❑ U ❑ S R ❑ S Ell SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trericft 1 0-12 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 1 2 12-26 10yr4/4 none sicl lfsbk mfr gw if .2 .3 3 26-86 7.5yr4/6 none co s Osg ml na na .7 .8 Ground l08eV55ft. Depth to limiting factor +86" Remarks: Boring # 1 10-12 10Yr2/2 none 1 2msbk mfr 9w 2f 1.5 .6 2 112-36 10yr4/4 none sicl lfsbk mfr gw if .2 .3 3 136-84 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 100.35ft. Depth to limiting fa%4" Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 2 New ichmond, WI. 54017 Signature: Date:3-12-96 cstm 02298 PROPERTY OWNER Derrick const., IncSOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 026-1115-20 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-8 10yr3/3 none 1 2msbk mfr 2f .5 .6 2 8-31 10yr4/4 none sicl 2msbk mfr gw if .4 .5 3 31-59 7.5ry4/4 none is Osg mvfr gw na .7 .8 Ground elev. 4 9-72 7.5yr4/6 none sl 2msbk mfr 9w na .5 .6 101.15t. Depth to 5 2-86 7.5ry4/6 none co s Osg ml na na .7 .8 limiting factor +86" Remarks: Boring # 1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 210 -33 10 r4 4 y /4 none sicl 2msbk mfr gw if .4 .5 3 33-84 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 Ground elev. 101.35h. Depth to limiting fa+$4 Remarks: Boring # 1 0-11 10yr3/3 none 1 2msbk mfr 9w 2f .5 .6 <4 2 11-33 10yr4/4 none sicl 2msbk mfr if .4 .5 5 3 33-84 7.5yr4/6 none S Osg mvfr na na .7 .8 Ground elev. 101.25 ft. Depth to limiting factor +84" Remarks: Boring # k\ Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 4 STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SE4NW4 S1-T30N-R18W New Richmond, WI 54017 MPRSW 3254 town of Richmond (715) 246-6200 lot 12-Willow River Meadows t N 1"=40' BM.= top of NW lot stake @ el. 100' eel) 3 { Ak' i Gary Steel 3-12-96 t STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER \ 4% l-W W VV-401, Jul 'rrVC&tMVLG- J M ►e r~~.~ ~.~~~S MAILING ADDRESS I\Ao "O, \ J( S4<M 1 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE `7 40 PROPERTY LOCATION 1/4, 5W 1/4, Section T 30 N-R 19 W -TOWN OF w` 04A 1'u10"jD ST. CROIX COUNTY, WI SUBDIVISION wo"QW k~Ayc ' LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , 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 a completed and returned to the St. Croix County Zoning Officer within 30 days of the three year exp' tion date. SIGNED: r~ DATE: 3 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 Wit-Low ~vaL _\_)0% tAT \/S ~V -1r2c C~O M"40'e"'t- 12 ways Location of property ~ 1/4 5W 1/4, Section ` T ',~G N-R W Township 121 Lo mo °ti10 Mailing address Pa OoK A, W-W Rc.44 Mo VkD, e 4-0 Address of site X43$ PA S, , ,c-f lua b.lt~ Subdivision name \4VL"-,0w ntvQL W-_N00u-5Lot no. Q6, Other homes on property? Yes x No Previous owner of property (~aL~-rte Total size of property Ac., Total size of parcel C., Date parcel was created to- 1q-90 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? X Yes No Volume 1~1&4 and Page Number 4fS 1 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. L! 5Z'7 (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. r ~ ! Signature of Appli ant Co-Applicant 3 s! L g~ Date of Signature ,.-..r N DCCUMLN i W-). STATE BAIL OF WISCONSIN FOWI 1 - 1982 ,.I•At I I.,',[ 1?V1-t, f RC(,C)Rniwc brain " 42'76`7 GUARDIAN'S DEED REGISTER'S OFFICE This Deed, made between ST. CROIX CO., WI ...._Gertrude ...---E. Schmit by Beverly Buckner, Guardia Recd for Record Grantor, at O V i 231989 M and_....Michael__ R_....Stevens, Will.i.a.m .H..._-Derrick 8.00 A. ~n William..M. Derrick ,..Thomas -E-. Derrick and I Can Ronald L Derrick a~ .tenants ,n•__common..._....... I Reg WerofDeeds . • Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... ._--Gertrude__.E_.._.Schm.i.t.. by.. Beverly Btackner conveys to Grnntec the following described real estnte in .....S.t.e...C.rU i,.X . County, State of Wisconsin: i Southeast Quarter of Northwest Quarter and ! Northeast Quarter of Southwest Quarter of Tax Parcel No: Section 1, Township 30 North, Range 18 West. This deed is given pursuant to the Order to Sell, dated October 16, 1989, and the Confirmation of Agreement and Order, dated October 19, 1989, both duly authorized by order of the Court and whereas the undersigned, Beverly Buckner, is authorized to sell the same by Letters of Guardianship certified on October 22, 1989. i Ftl•;~v~F This ........i S no homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And...._Gemtr_ude...E.....S.chmit...by-Bever.ly..Buc.kn.er warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. Kiv Dated this -------------Z----- day of October..............__...._......_..-....... 1989.... --------------------------------------•-•......-•-•..................(SEAL)ti! (SEAL) 5-.c,F~te~r/......... tom...:.. - Gertrude`E. Schmit by Beverly * •-••BUCknL:1r,-..Guard-i*an -------------•------•--------•..--.--------•-•----•••-•-.............(SEAL) .....................................................•.----.........(SEAL) " ' AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN