HomeMy WebLinkAbout032-2093-50-000 (2)
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS/9 7A
SUBDIVISION / CSMJ
~~L4 LOT ~
SECTION_0 !j T 3 N-R__Ly W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVEF3YTHING WITHIN 100 FEET OF SYSTEM
E Ott
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1 ~I
-X7,5"
T/1 INCH ~c-S
~ ~j ~ Q a c~ ~ P~Nc
e~oa
~~GC
s
=yon
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK : ~Dn J" % l( OAl, s TA-JL L Z_ =/DO O
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: - - Liquid Capacity: /O(Q
Setback from: Well House Other
r
Pump: Manufacturer ~~yCcJ - Model#16 3_ Size / R
Float seperation Gallons/cycle: /
Alarm Location 7/'
:SOIL ABSORPTION SYSTEM
Width: Length :2 5 Number of trenches
Distance & Direction to nearest prop. line: ~j
Setback from: well : _ 100+ House_Z,2 S Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system 9 y Od
Existing Grade__ Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3 / 9 3 : j t
Wiscc_WsinDepaY,tmentof Industry, PRIVATE SEWAGE SYSTEM County:
Laborand Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 268532
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
STEPHENS, MICHAEL W. Somerset
CST BM Elev.: Insp. BM Elev.: , BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA AQAnn1AA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic r) Benchmark 3.33 AZ/, Dosing, SSA , Sly i
Aeration Bldg. Sewer 7 9 t3/
Holdi St/ Inlet 1d.6:S 79-33
TANK SETBACK INFORMATION St/)`Outlet v W' 7~, /D
TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet
Air Intake /!S-B -7 • 7
r r
Septic ,q,4 NA Dt Bottom 7-3, 9,3
Dosing > "d -0 NA Header-
Aera 'on NA Dist. Pipe ?7? A0 9#~ _5Ar
Hol Bot. System 9.70 7~
PUMP/ SIPHON INFORMATION Final Grade S Ud~ 9X..33
r
Manufacturer Demand ° Ca 5 53~ 3, 55
Model Num
TDH Lift Friction System TDH Ft
Loss Fmead
in Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length _ , No. Of Trenches P No. Of Pits Inside Dia. Liquid Depth
DIMENSION S 7, a DIMEN I N
SYSTEM TO P / L BLDG WELL LAKE /STREAM LEA G M
SETBACK
INFORMATION Type O ()g,, Q CHAN E Number:
System: J-4-11L OR UNIT
DISTRIBUTION SYSTEM
Header/ N4aa494cl- Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length _1a Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grad tems On y
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Somerse~t.24.31. 9W, SW, SE, 80th Street
Plan revision required? ❑ Yes 0--No
h4d1191
Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert.No -
ADDITIONAL COMMENTS AND SKETCH r
SANITARY PERMIT NUMBER:
r, SANITARY PERMIT APPLICATION
v~~llnllr~ In accord with ILHR 83.05, Wis. Adm. Code COU3
' oI
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than (p 95-3 OZ.,
8% x 11 inches in size. ❑ Ch k if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
~l EL - - .S t/4 = Y,, S 7 5( T , N, R E (or
__C1 ~Tep PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
a Tff
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
o p - L E fIiLLS
III. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) ❑ State Owned VILLAGE : ER O 71 ❑ Public L1 or 2 Fam. Dwelling- # of bedrooms 3- PARCELTAX NUMBER(S) J ,
III. BUILDING USE: (If building type is public, check all that apply) Q -,Zo 9,3 _ So
1 ❑ Apt/Condo
20 Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurfint/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. VN New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 511 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit 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 X Seepage Trench 220 In-Ground 420 Pit Privy
13 ❑ Seepage Pit Pressure 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
D 75-0 _215-0 .6 6 9 Feet 99 r Feet
VII. TANK CAPACITY Site
in allons Total of 's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Manufacturer oncrete stCon glass App.
Tanks Tanks
Septic Tank or Holdin Tank
N
F-1
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on a attached plans.
Plumber's Name (Print): Plu e s Signature: (No Stam s) M /M W No Business Phone Number:
r o S 66S
Plum er's Address (Street, City, State, Zip Code):
0A1_ Z,9 1 - Ya2
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanjbry Permit Fee (Includes Groundwater ate Issued r1iftirip Agent Sig a (No Stam s)
Approved ❑ Owner Given Initial Surcharge Fee)
77~`~~ Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: avu
SBD-6398(R.08/93) 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 the 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 & 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.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit: Check only one in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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% 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
y" scs~ yo vE~vr ~ /rvsP T i/~~
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S'or~~~ scT ~ ~i s' ~o s s sd~iL 2S ET CQJi' _ .s 4ooz ~
w..-
I PAGI, GF
PUMP CHAMBER CROSS SEC-low AI\IG SPECIFICATIOUS
to
VENT CAP
j' 4'C.I. VEMT PIPE
WEATHERPROOF APPROVED LOCKING
JUNCTION BOX MANHOLE COVER
25~ FROM DOOR,
WINDOW OR FRESH 12"MIU.
AIR INTAKE I
GRADE I
y" MIIJ.
COWDUIT
18'MINI.
{ ~ lh
3 IAILET PROVIDE
~ AIRTIGHT SEAL
* A I ICI
I I
ALARM
B ( I.
I 1
C *APPROVED I I ON
JOINTS WITH I
ELEV. FT. APPROVED PIPE
3' ONTO PUMP OFF
D e~ SOLID SOIL
~7 I G PL COAICRETE DLOLK'
r
RISER EXIT PERMITTED OMLJ IF TANK MAIJUFACTURER HAS SUCH APPROVAL
SEPTIC E 8PEC.IFItATIOK.IS
DOSE _
TANKS MAMUFACTURER: IJUMBER OF DOSES: PER DAH
TANK SIZE: ffQQ GALLONS DOSE VOLUME
ALARM MAMUFACTURER: TANK ALE.f INCLUDING ISACKFLOW: 37 -GALLONS
MODEL NUMBER: CAPACITIES: A=1=IUCAE5 OR y2J ALLOUS
SWITCH TYPE: 21E9 G G2
g =2-._INCHES OR ~,'u3, 9 `GALLOWS
PUMP MANUFACTURER: - z Ot= / 4e2 c, INCHES OR _Lq? GALLONS
MODEL NUMBER: 163 D=-,fa INCHES OR p GALLOWS
SWITCH TYPE: C41A k.4 WOTE: PUMP AUD ALARM ARE TO BE
MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFEKEWCE BETWEEU PUMP OFF ARID DISTRIBUTION PIPE.. 21 FEET
♦ MINIMUM NETWORK SUPPLY P..~~/RE~~S~~SURTT,,E//.. . . . . . 2.5 FEET
♦ FEET OF FORCE MAIM X G~~_F/pO fxFRICT101J FACTOR.-50 FEET
TOTAL D!0JAMIC HEAD = FEET
ffE-/Gf{7
1UTERNAL DIMEWSIONC OF TAUK: O
;WIDTH 77 .;LIQUID DEPTH .37
to 31GUED: C'-~ !C i IrcLlcr \IIIM4CD.
HEAD/CAPACITY CURVE
EFFLUENT and DEWATERING
WARNING: Model 185 should not be subjected to less than 30 feet TDH.
TOTAL DYNAMIC NEADXAPACITY PER MINUTE
EFFLUENT AND DEWATERING
53.55 165
.BERIE6 -42..._ 8__.._ -59 - 99- 117-139_ 157_-- 3- --.1fl6--- -
FT. M. G4 Lin. Gal. Un, Gal. Ltra Cat. 'Ltra Gal. LUs Gal. LUa G9 LUa Gal. Ltn. Gat. LUG.: Gal. LUa. Gal. LUa. Gal. Lln.
5 1.52 15 57 28 106 43 163. 72 273` 104 394 106 401 61 231 61 231` 58 220 155 .587 155 567
M_ 13!$ -25 95 34 129 ki g3i 72 ~W - - _]00,4I$.
IS 4, L 9 M IS " 19 72 45 170 64 7A9 8115 An 197 60 227 58
20 6.10 2 8 7_26 25 95 36 136 82 310 59 223 60 227 58 220 136 315 140 530
25 7.62 8 30 74 280 57 216 ' 59 223 58 220 126 48! 133 603
30 9.14 65 246 > 55 20658 220 90 5340 58 1220 121 458''-127 481
K 40 12'.19 46 174. 46 172. 55 206. 75 .263 58 20. 105 7 114 431
W 50 15,24 21 80 33 125 51 191 56 .219 58 220 90 341 100 .379
M U_ 60 18.29 15 57 43 161 36 136; 58 220 71 269 85 32
70 21.34 30 114 10 36 52 .197 51 193 70 5265
115- 80 24.39 14 53 ' 45 170 28 106 S 54 204
90 2743 32 : 121` 2 8 37 140
34 100 3048 - - 18 '68 21 79
1 16-- 110 32.00 - - 7 26 8 30
32 1 05 L0 Valve: 21' 22' 19.25' 23' 26' 56' 66' 87' 73' 115' 91' 112'
100
30
95
28
90
26 85
24 BO
75-
22-- 186
= 70
V 20----
:F 65 165
18 60-
55-
16-- 163
50-
14 45
12 40
35 185
10
30
189
8 25
6 20
161
15
4 188
10
2 98
5 42 4 53,55 hL
13 ,139
0 57,59
U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160
LITERS 80 160 240 320 400 480 560 640
0 FLOW PER MINUTE
Note: For Head Capacity on Model 112, industrial column-explosion prooof pump, see FM0219.
W;sconsin Department of.lndustry, SOIL AND SITE EVALUATION REPORT Pa9a of
L; 'boy and Human Relations
Divisi n of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
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 ne*1 ad.
APPLICANT INFORMATION-PLEASE PRINT ALL INF, TION REVIEWED BY DATE
PROPERTY OWNER: 4 PROPERTY LOCATION
GOVT. LOT 1/4S-_,- 1/4 S T, N,R or G
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
CITY, S ATE ZIPiSODE; PHONE NUMBER4-4 []CITY VILLAGE OWN NEAREST ROAQ,
New Construction Use JX] Resideftta[( Pluintie~r o t ooms [ ] Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily 5ZSer gpd Recommended design loading rate bed, gpd/ft2__,_~trench, gpd/ft2
Absorption area required 09® bed, ft2 S a metre"n/ch, ft2 Maximum design loading rate . S bed, gpd/ft2-, / trench, gpd/ft2
Recommended infiltration surface elevation(s)f ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material, Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ®S ❑ U OS ❑ U [0 S El U A S El U S 5 EIS IOU
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 Trench
Ground S 1 , 1
elev.
Depth to
-711
limiting
` - -
factor _ T '5 -k
- s
Remarks:
Boring #
/
ze)
Ground `
eft. / , s
Depth to
limiting
factor
T8~'
Remarks:
CST Name: Please Print Phone:
Address:
Signature: Date: CST Num er
.3~-
PROPERTY OWNER //~E ~z~o ~1S SOIL DESCRIPTION REPORT P.age?,of_
PARCEL I.D. # ,
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
u • J
r
25- 5 4/
Ground S
elev.
~Q ft.
Depth to
limiting
factor
>R ~
Remarks:
Boring # /
- 3
2S le
7
Ground
elev.
ft. '
Depth to /
limiting
factor
c~S!
Remarks:
Boring #
Ground
elev. s. J
Depth to - / /
limiting -
factor S
T~~S
Remarks:
Boring #
F
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
X ~GOC~',vp~J o fns ; tc7
o2l
=7l~ S'Cit
?ue
gA?
I
0
r I
i
-,~-70;"
• 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 PIjGlfA-EL M). S % ' ogle As
Location of property &_l/4SE 1/4, Section _I y , T_2~_N-R---Lf_W
Township dl~'7 2 c--7 Mailing address _ 2 z y ~fQ 7
Address of site ~D?A
subdivision name ///cC5Lot no.
Other homes on property? Yes__No
Previous owner of property CfIA& LNE 4S,)0/-041RO4
Total size of property /Q,l4 AAc &s
Total size of parcel /62,6 A r26--;5
Date parcel was created - -
Are all corners and lot lines identifiable? X_Yes No
Is this property being developed for (spec house) ? Yes No
Volume /D8L and Page Number 31.7 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. T186 72- , 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.
_sZ, a_.
T ` y, , 1
Signature of App icant Co-Applicant
b' 7
Date of Signature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 4 1_cl{ H t_F L. 1,0 ST Tc a he_,E: -S
MAIIdNG ADDRESS C/ T~ sT • S,O l%E/IS~ T ~i ~~O,Z 5"-
PROPERTY ADDRESS l 9 9~ ~D TO 5/. ;S~ frE2s~ r Sy~z 5'-
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE _SOf`?~2SET !'.Uf Srft?.~S
PROPERTY LOCATION `510 1/4, ,SC 1/4, Section z T_VN-R_ f f W
TOWN OF L D /'~l~~SFI- ST. CROIX COUNTY, WI
SUBDIVISION ff*Vs'Err `5~ fg TLC L, ,r - L Ls` , LOT NUMBER --12
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 be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE: 19
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
VOL PAPE u `
547048 QUIT CLAIM DEED .
Document Number TiEGITE1~'SOFFIC9
y. ' St.CROIXCTYaW1
..b.yr..~o.n. ..........S.:........p1 vrd~ ~.'~J~L 19._1996; I
i 3:00 Pt.' M. .
`J 'Register of Deed6
41 quit-claims lo.....rr.. M1.....MC. ?.A. L....~...... 5. lp ...A- N
'
1?.~ONATA....... A..r........ T .P... f. N ...~........L~.v.. .N..
i 16ND....r...W..t c
Recording Area
Name and Return Address
I..........
p
the following described real orate In.....~,f.~.~ J....~.41~...•...... ••••••••••Counry,
rl
State of Wisconsin:
(Parcel Identification Number)
FEE
EXEMPT
'Iliis ..............................homestead property. Dated this..... Z' ...........day or........ .}......1........ 19...Rk-5 K
(ir1}ir (is not) C4T 1 v ' R LEN E 3- 1 ' LO 1K
......r......••...........• 1..111 N1N.NI1111..1.1NNM
..........i1R......I. .1.1 .111..1 ..11111111111111111.~IIN1
..r......r ......................r..................r.................................................................... .r.
r.............................................111.11111.1111111111111111.1111.11111
.r................•............................................................. ..........r...................
1...•...••............r........••..• . 1................................r..............................................................................1...............1....1.
AUTHENTICATION ACKNOWLEDGMENT
Signature(s).. STATE OF WISCONSIN
Ct? / ~c
..............County. Personally came
r° 1
before me thisL..9dayof .
day of 1919 Aheabovenamed
authenticated this........... r L0 t /ZDC
!y. ~
.ilgnJ.U1•G
1,`a '
uoL319OpacE13 •
PARCEL LQN
A parcel of land. located in part of the SE1/4 of the SE1/4 and the SWIM of the SETA of
Section 24, T31N, R19W, Town of Somerset, St. Croix County, Wisconsin; being part of
Outlot 1 of the plat of Hansen's Turtle Lake Hills First Addition; further described as follows:.
Commencipng at the NE corner of Section 25; thence S01053'25"W, along the east line of the
NE1/4 of said Section 25, 111.74 feet; thence N87057'05"W, along the south line of Lot 12
of said plat, 472.15 feet to the SW corner of the plat of Hansen's Turtle Lake Mills First
Addition; thence N07024'33"W, along the west line of said plat 462.67 feet to the NE corner
of a parcel of land recorded and described in Volume 1086, Pages 317 and 318 at the St..
Croix County Register of Deeds Office; thence N69044'03"W, along the north line of said
parcel, 380.28 feet; thence N34042' 17"W, along said north line, 102.56 feet; thence
N54019'39"W, along said north line, 58.46 feet; thence N64055'40"W, along said north line,
77.36 feet to the point of beginning; thence I~W002'43"W, 205„29 feet; .thence
S82001'01"W, L4- feet to a point on said north line being a meander point being 12• feet
more or'less from waters edge (Turtle Lake); thence S84 07'25"E, 266.44 feet; thence
S72047'35"E, 76.03 feet, to the point of beginning. Described parcel contains 0.12 Acres
(5,037 Sq. Ft.).
NOTE: Above described "parcel to be deeded to an adjoining landowner.
A-E7 WAIVER "
I, Allen C. Nyhagen, and I, Michael W. Stephens agree to waive the requirements for land
surveys as set forth in A-E7 of the Wisconsin Administrative Code as the corners of the land
parcel described above have not been monumented.
Allen C. Nyhagen Date
-21 19 ~ 6/
Michael W. Stephens Date