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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS ,
SUBDIVISION / CSM#_,~'~~-;lam f LOT # 3
SECTION._ 3j_T -34 N-R1Z W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
5-5 i ✓G
GB
,4/A,
°j~utJZ
~lJrsl~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse o this form-
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: IAF~ Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
-:SOIL ABSORPTION SYSTEM
Width:- /-.2_ Lengths Number of trenches
Distance & Direction to nearest prop. liner 'z?
Setback from: well: House Other
ELEVATIONS
Building Sewer IeS; RT ST Inlet, ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade /~yS Final grade
DATE OF INSTALLATION: -
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR: ,
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations ST. CROIX
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Pe &Ae,'s ~I Era' ❑ City ❑ Village ITown of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
DC~, /00
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic y" Benchmark '
/ 00.
Dosing /o -2.13
Aeration Bldg. Sewer
Holding F St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
,9 /n F. 1
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet
Air I
Septic aS , NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe G,j U• '
Holding Bot. System '7 ;),3 03. 6 a '
PUMP/ SIPHON INFORMATION Final Grade 35 ' u mot, S'
Manufacturer Demand
Model Number GPM
TDH Lift `rictio System TDH Ft
Forcemain Leng Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS a 0--l- DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM,, LEACHING Manufacturer:
SETBACK
INFORMATION Typeo CHAMBER Moe Number:
System: Y-,& /a ' GFS' D OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center °7 v Bed/Trench Edges Topsoil El Yes [I No ❑ Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STANTON.32.31.17, SE, SE, LOT 3, COUNTY ROAD K
Plan revision required? ❑ Yes eNo H Use other side for additional information.,
SBD-6710 (R 05/91) Date I pector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
I
'v~i~•1~ir"i SANITARY PERMIT APPLICATION BureaSafetyu of and B uiildiinng Water gs Division t Sy
stem:
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.
• 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 E] Check it rel' io to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Prope y Owner Name Property Location
1/4 - v4, S T , N, R(or~
ion
P perty Owner's Mailing Address( Lot Number Blo
-2
Ci y State Zip Code Phone Number Subdivision Name or CSM Number
r ( )
Ill. TYPE OF BUILDING: (check one) E] State Owned ❑ !t~ Nearest Road
❑ VII age
Public 1 or 2 Family Dwelling - No. of bedrooms Town of _4::~/
-.,f I M~ I
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
®~'-~~-goo
4 - / C'
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)
A) 1. M New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System____ Tank OnlyExisting 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 J4 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 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
I Z- -V q Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./'nch) Elevation
Feeti o,,o97, _5- Feet
VIL TANK in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, th ndersigned, assume responsibility for ins Ilation of h onsite sewage system shown on the attached plans.
Plu er' Nam t) Plumr's Si /te ' a mp MP/MPRSW No.: Business Phone Number.
Plumber' Address treet,Ci Stat Co
IX. COUNTY /DEPARTME USE ONLY
❑ Disapproved San ary Permit Fee (Includes Groundwater ate ss Iss ng Agent Signature (No Stamps)
X Approved E] Owner Given Initial Surcharge Fee)
Adverse Determination fly
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divmion, 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.
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 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.
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'WiscohsinDepartment of Industry, SOIL AND SITE EVALUATION REPORT 3
°~g• - of
Labor aid Human Relations
. Dibision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
OL1
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 f~AfCEL I D' l'C f'
dimensioned, north arrow, and location and distance to nearest road. pe4.0,i
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION VJEWEQ,+nj~4 I k }
PROPERTY OWNER: PROPERTY LOCATION
Joseph Ulrich GOVT. LOT SE 1/4 SE 1i4,S 32 T-.l for) W
PROPERTY OWNER':S MA!IING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
1555 St. Hy. #64 na na csm pending
CITY, STATE ZIP CODE PHONE NUMBER OCITY VILLAGE MOWN NEAREST ROAD
New Richmond, WI. 54017 (715) 246-6948 Stanton Co. Rd. #K
[xpew Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building
( ] Replacement Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft2 -8 trench, gpolft2
Absorption area required 643 bed, ft2 553 trench, ft2 Maximum design loading rate ' 7 bed, gpd/ft2 -8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 103.65 ft (as referred to site plan benchmark)
Additional design / site considerations alt. site=102.50'
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system I CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for system EIS ❑ U [LS D U ZI S ❑ U ESS o u ❑ S ®U ❑ S IN U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trenctl
1 0-11 10yr3/3 none sl msbk mfr gw
?'0`0 2 11-22 10yr4/3 none scl lmsbk mfr gw if .2 .3
Ground 3 22-82 7.5yr4/6 none is Osg mvfr na na .7 .8
elev.
105.0 ft.
Depth to
limiting
face
+
Remarks:
Boring # 1 0-13 10yr3/3 none sl 2cp1 mfr gw 2f p .2
2lii"
` 2 13-26 10yr4/4 none sicl lfsbk mfr gw if .2 .3
3 26-84 7.5ry4/6 none is Osg mvfr na na .7 .8
Ground
elev.
107.5 ft.
Depth to
limiting
factor
+84"
Remarks:
CST Name _Please Print Gary L. Steel Phone' 715-246-6200 C2r Address: 1554 200th. Ave., New Richmond, WI. 54017 10-2-95 cstm 02298
Signature: Date: CST Number:
PROPERTY OWNER Joseph Ulrich SOIL DESCRIPTION REPORT Page'2 _of 3' '
PARCEL I.D. # pending
Borin Depth Dominant Color Mottles Texture Structure Consistence GPD/ft
r. Sz. Sh.' Roots
g # Horizon in. Munsell Qu. Sz. Cont.Color G Bed
iTrer>cfi
3 1 0-11 10yr3/3 none 1 2msbk mfr gw 2f .5 !.6
2 11-33 10yr4/4 none sicl lfsbk mfr gw if .2 j.3
Ground 3 33-84 7.5ry4/6 none is Osg mvfr na na .7 .8
elev.
106.4ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
y~ 1 0-8 10yr3/3 none sl 2msbk mfr gw 2f .5 .6
IMMM
4 2 8-20 10yr4/3 none scl lmsbk mfr gw if .2 .3
3 20-88 7.5yr4/6 none is Osg mvfr na na .7 .8
e~GLfround
107eV2 ft.
Depth to
limiting
factor
+88"
Remarks:
Boring #
1 0-11 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
5 2 11-31 10yr4/3 none scl 2msbk mfr gw if .4 .5
3 31-36 10yr4/4 none sil lfsbk mfr gw if .2 .3
Ground
elev. 4 36-80 7.5yr4/6 none is Osg mvfr na na .7 .8
105.2 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
:Xx
Ground
elev. i
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Joseph Ulrich 1554 200th Ave.
CSTM2298 SE4SE4 S32-T31N-R17w New Richmond, WI 54017
MPRSW 3254 town of Stanton (715) 246-6200
t
N
1"=40'
BM.= top of 111 steel pipe at NE lot corner C el. 100'
A'
o q+
X70
c~o OK
Gary L. Steel
10-2-95
co
SEC ~ 3 1995
H
1l KAR ~ of
SL CA»
C~
537431 ti
CERTIFIED SURVEY MAP
LOCATED IN THE SE 1/4 OF THE SE 1/4 OF SECTION 32, T31N, RIM TOWN OF STANTON,
ST. CRO I X CO. W I .
PREPARED FOR JOE ULR I CH r.... ,
NOTE BEARINGS ARE REFERENCED TO
THE SOUTH LINE OF THE SE 1 ,14. 195
(RECORD BEARING)
x °
r
z r
UNPLATTED LANDS
WEST LINE OF THE
0 SE-NE r;ii i+G
N 90° 00' 00' E 609. 26'
364.26' 245. 00' ; :•.f
LOT 2 N LOT 3
5.78 ACRES 4.50 ACRES
(251,809 SO. FT.) h (195,856 SO. FT.) U);
N: 5.47 AC. EXC. R.O. W. y 0:
4.23 AC. EXC. R. 0. W.
LQ Z:
Z: zo (238,252 SO. FT.) v
184,343 SO. FT.) o
Q: M e J:
_j N rn N
~~o ~rn p:
N a N N LU:
w: ao ~p O W F-
l'-: cn C0 r4 E--'
F-• 2 Q;
Q r BARN W a;
d; cwi, V' Z:
Z: $ g
N 90° 00' 00' W
22. 00' SHED
GARAGE W
O N O MOBILE HOME L I N E
HWY. SETBACK r) co
I HOUSE M r( TO BE'REMOVED)""
DRIVE I I N 00000'00'E
O N90000'00 W O 5. 00'
339_55' 2 129. 39' 90°00' 00' _
140. 19' a
1317.94' =q4 . 01 ' 338.33' 40. 00' 270. 93' 45. 0/' 708.68'
E o N 90°00' 00'W 609.26' C T H " K" N90° 00' 00' W
a H.
S 1/4 CORNER OF SOUTH LINE OF THE SE 1/4 SE CORNER OF
SECTION 32. (1" IRON SECTION 32. (1"
PIPE FOUND). IRON PIPE FOUND).
UNPLATTE•D••4ANDS.
co iki , 410
0.1 r
t~
DI✓ S CR I PT I OIV
A parcel of land located in the SE 1/4 of the SE 1/4 of Section 32,
T31N, R17W, Town of Stanton, St. Croix County, Wisconsin, being Lot 1 of
the Certified Survey Map recorded in Volume 4 of Certified Survey Maps,
Page 909, more fully described as follows:
Comnencing at the SE corner of said Section 32:
Thence N90000'00"W along the south line of the SE 1/4 a distance of
708.68' to the point of beginning:
Thence continuing N90000'00"W along said line 609.26';
Thence N01026'28"W 735.00';
Thence N90000'00"E 609.26';
Thence S01026'28"E 735.00' to the point of beginning.
Contains 10.28 acres subject to C.T.H. "K" right-of-way over the
southerly portion as shown. Also subject to any and all easements,
right-of-ways or conveyances of record.
SURV1✓YQfZ ' S CL12T I F I CAT1✓
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 Joe Ulrich, I have surveyed, divided and
mapped the above described parcel of land and that this map is a correct
representation of the boundary thereof. mt"Vam-
Dated this t3~` day of oc~o3~ 1995.
James M. Weber S-1804!
NELSEN-WEBER LAID SURVEYING,
Air t Z -`•j -S j rte 1;:•'Jl v
SpRirk,u VALLEY
WIS. J ~f` nw
NOTICE: THE PARCELS SHOWN CN THIS MAP ARE SUBJECT STATE, CCUNTY AND
LOCAL LAWS, RULES AND REGULATICNS (I.E. WETLANDS, MINIMLM LOT SIZE,
AMRCC Tn DADr01 ❑TP` 1 000e"nC n rnruAC rntn /%n r\,"JYnr nnrwv. AnrV nAnr+nr
it
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERIBUYER caw V;;, J
MAILING ADDRESS 2 QG ` Z 3 9 Z
PROPERTY ADDRESS S
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE ~ 1 '1
PROPERTY LOCATION ` C 1/4, ~p 1/4, Section ~J_ T __at N-R_j_W
'S'OWN OF
~tti~~ ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP_ ;1 r VOLUME 11 ,PAGE't ,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 yea expiration date.
SIGNED: l
DATE:. - `1
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 -Saw~e`~ q. e L~~~'S
Location of property 1/4 1/4, Section T 13i N-R I'1 W
Township Mailingaddress
Address of site
Subdivision name Lot no.
other homes on property? Yes vl No
Previous owner of property -T`,~~~,
Total size of property 11,t5o r_,crr_S
Total size of parcel
7
Date parcel was created 10 111
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? _Yes ~ No
Volume IL~Z 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.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.
- - - -
plcant Co- Ica t:
sic ature of Ap pp
Date of Signature Date of Signature
WARRANTY DEED
' STATE BAR OF WISCONSIN FORM 2 - 1982
115'i PAGE z, 3
Joseph A Ulrich and Elizabeth M. Ulrich, JAN 1 5 1996
husband and wife
conveys and warrants to James A On Ifs and Mary Kaye Ohlfs, 10:30 A.
~
husband and wife as survivorship marital - - -
property Y - -
D
RETURN(. TO ` ♦ U v Jai ^ i
'f 4°pLY-+ r✓
the following described real estate in St. C r o i x County, t",e~f'-' 1~'L" `s",L'
State of Wisconsin:
Tax Parcel No:
Lot Three of the Certified Survey Map that was recorded in St. Croix
County Register of Deeds Office on December 13, 1995 in Volume 11, page
3024 as Document #537431.
Said land parcel being located in the Southeast Quarter of the Southeast
Quarter of Section 32, Township 31 North, Range 17 West
(ER
This i s not homestead property.
(is) (is not)
Exception to warranties: recorded easements and rights of way.
,Led this 10th day of January 19 96
(SEAL)
-4jtA~ u'~_ A - (SEAL)
Jos ph A. Ulrich lizabeth M. Ulrich
(SEAL) (SEAL)
*
AUTHENTICATION ACKNOWLEDGEMENT
mature(s) STATE OF WISCONSIN
ss.
St. Croix County.
Personally came before me this 10 t h day of
henticated this day of , 1 g January , 1996 the above named
Joseph A. Ulrich and