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HomeMy WebLinkAbout040-1116-70-200 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ✓a ADDRESS SUBDIVISION / CSM# LOT # c./ SECTIOND T N-R l IL W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM v I~ ~r Cy ~J INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~Cln C' :5',l l ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: >j~,`~~~~P Liquid Capacity: Setback from: Wellp/j,7-,0/,,1/~Aouse Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: -3- Length 7 Number of trenches Distance & Direction to nea est prop. line: /i✓~,i / A) ,>l M-; ale ~1 Setback from: well: House, ~ ,c Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: ,✓i'_'„~~ INSPECTOR:' 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Safety ety a and Bu nd Bufiildings ngs Divisio Division INSPECTION REPORT ST. CROIX S (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268652 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: BRZOZOWKSI, DAN TROY CST BM Elev.: , Insp. BM Elev.: BM Description: _ Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600358 Z /Z,2 7196 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i d si-P ~Pcas E Benchmark 3. lz5 ~ aD - Dosing I 1. trn . 4,111, dA? 3,9 Aeration Bldg. Sewer Y 91`9 Holdi~. St/Inlet *V I TANK SETBACK INFORMATION St /Of Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosin NA Header,- g (fir ' 95 1-2s/ Aeration NA Dist. Pipe 17 Holding Bot. System c~ S3 , 3~ PUMP/ SIPHON INFORMATION Final Grade Ma nu rer Demand' S Model Number M TDH Li Friction S stem TDH t Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM X,7-4 BED/TRENCH Width / Length / No. Of Trenches DIM No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 57 02 DIMEN SYSTEM TO P/ L BLDG WELL LAKE / STREAM L Manufacturer: SETBACK INFORMATION TypeO n / CR BER Model Num er. System:,., $o, -3~ OR UNIT DISTRIBUTION SYSTEM Header / fdtsagilld- Distribution Pipe(s) x :~e x Hole S Air Intake Length Dia. Length $`f Dia. Spacing L~ SOIL COVER x Pressure Systems Only xx Mound Or At-de Systems Only 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.) 4As 6azj~~ LOCATION: TROY.30.28.19W SE, SWGLENMONT b&e '7' Plan revision required? ❑ Yes Vo 19f 411,91 Use other side for additional information. 0 SBD-6710 (R 05/91) Date Inspector's Signatur Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i roWo, Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 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 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number y y Chec if evision to previous application The information you provide may be used by other government agency programs E] S [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATI Property Owner Name Prop ation 1/4,S3d T gr,N,Rf9E(or Property Owner's Mailing Address Lot Number Block Number .410 a a )yea p S City, State Zip Code -7P-hone Number Subdivision Name or CSM Number v -ya c )3 - Y17 5- C-5 ~ X II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ cityy Nearest Road E] Public 1 or 2 Family Dwelling - No. of bedrooms EN] Village own OF lcle d t~ III. BUILDING USE: (If building type is public, check all that apply) Parcel TaxNumber(s 1❑ Apartment / Condo 0 Y 6F l 4; t a d 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. UtNew 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 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) Elevation 15_~7d r e er'- Qy Feet , Feet VII. TANK Cain gallons Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks / r Septic Tank or Holding Tank X B T Y. f/ ILA ❑ ❑ ❑ ❑ ❑ 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) T P PRSW No.: Business Phone Number: P, -/4411~_ `F~ .2- Plumber's Address (Street, City, State, Zip Code : 4'® / 0 7 ♦ A) /J IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) ~jJ $Approved ❑ Owner Given Initial Surcharge Fee) Y I~/ Gj Adverse Determination /O X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Cotmty, One copy To: Safety & Ruildings Divr ion, Owner, Plumber INSTRUCTIONS , 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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: I. 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 8 112 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) al l sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a numberof regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ~ ~,~'~C-n1~"2 D~ g~l.s•_/!l S~~ j~s std T-~ d~ i~l~ti'~ "~dcr%,~/~'~ Td%_. i i n i /jP~ UI Jan F ~`~p 5 i 1 a i f Wisconsin Department of Industry, SOIL AND SITE EVALUATION Latror and Human Relations In t e / of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Cow t Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County _w !1A ! 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 1. - ' j- 7J _ ) V APPLICANT INFORMATION - Please print all information. Reviewed y ` ~.)NI: r a tnSV'ihJ a sr•~i~.c Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location s 44+ 1 -'U Z070GrJ 2 Govt. Lot ST 1/4 .54-) 1/4,S R E (or Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# YO - //O L, 9 z 3 D City State Zip Code Phone Number E:1 City El Village [21 Town Nearest Road oic/ Grimm 15 -yea fs6 T T/?o gr,57- New construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow y~ gpd Recommended design loading rate 2 bed, gpdfit .2 trench, gpd/ft2 Absorption area required 6' ~/3 bed, ft2 3 trench, ft2 Maximum design loading rate g =Z bed, gpd/ft2 . trench, gpd/ft2 Recommended infiltration surface elevation(s) 9511/ ` ft (as referred to site plan benchmark) Additional design/site considerations ~r% iC'EfESS•?Y RT 1oe4T_f4 f ~P Df S!i ~M 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 for system 0S ❑ U ❑ S ❑ U OS ❑ U ❑ S ❑ U ❑ S DU ❑ S [ZU 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 - 7 /o - Z& S~ L ->N) P L All FZ S Ai O. o r6, Z` - - L i I S i3 111lF c S - Ground _ GS G GS _ S O b 414- elev. ~ft. L/ V-` j- `tom a SG /V1 L S A/ A Depth to S" o G M L limiting factor _ in. Remarks: Boring # / 0 2 L Z- s s .O / 2- L o s L R ~s .2 P7,1 -5 2X lf4 F 3 - ~ .S- 3- Z ~S G ML GS . Ground 2-9 - S z S O S m L elev. ~ft• Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number 3 3 jd ~o wS 5- -3 /i?ZO z pr~f,FZSOIL DESCRIPTION REPORT a PROPERTY OWNER ~J Page 2 of _3~ PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench O-~ 0 2 SsrL z C /?-e~r 14Z5 1AA .0 _CID 3-27 5_Z3,4~ 'Ali Ground z 7 7..5-- elev. ?S _J ft Depth to limiting factor - in. Remarks: Boring # T~Sl z s oAE Ls T ti F K/LAF o cv F r 7- f r Ground r o r_ "Yew?, elev. ft• h_T { /t Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; Ground elev. ft. , Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) DAIS M MR" PLUMING Lkensed Perk Tester & Plumber F~03233y Fleigt►tRosd ROBEI fS,-YVISCONSIN 54023 Phone 749-3656 33 ' i 1,F A _ /3r 7Te1P of ,vsP 7/t.+svsfnzi„F.? Co.~G~~'TE SG~"~, 4PT f ~ S~~ucF 7/z~`Es 1.5" a7- IS' w t L /fJ o7`~ : ~E2 7-,F i 7o r1~ Cis E) IYs ~TFZ ~ r~ ,,fJ l Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT --Pg of Labor and Human Relations Division of Safety & Buildings 1 ~ in accord with II HR Al nr, Attach complete site pla~ i' not limited to vertical an _ dimensioned, north arro APPLICANT INFO (G t~~ YJ a f fE , X PROPERTY OWNER: fO~FjC~ g P OPERTY OWNER':S MA Cz $ , CITY, STATE ILA REST ROAD 6G' v > Li% ( 7- V] New Construction ilding [ J Replacement Code derived daily flow j e' Tench, gpd/ft2 Absorption area required uVaigi, judarng rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations 6 4gg Air. yI=PT/f- n .¢y6"'g Fs" ,szz;yT't0~ 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 QI S❑ U ❑ S 0 U B S ❑ U ❑ S ❑ S f~ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botatdary Roots GPD/ft in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench S Ground _34 V ER f 2. 3 elev. - I 7 ft. ,p a 4X4 r [ - Depth to limiting factor ~z Remarks: .2 .707• Ape. Boring # f>: - 2 2 3 -29 04C Ground elev. ft. Depth to limiting factor S w nj N L~ Ti9C . Remarks: 02- CST Name: Please Print ) / 7q t Phone: Address: off= I Signature: Date. CST Number: PROPEATYOWNER ,~ilr.t2FL ARZQZdW,&S,&rSOIL DESCRIPTION REPORT Page 2 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 Trench 3 r IF Z Ground 2 2 5- 7 2 ;VJ elev. Depth to limiting factor Remarks: Boring # 4 - s S . 2 .3 Y a . Ground elev. ft. Depth to limiting factor Remarks: Boring # -Z fps hLS - z -S e- M V FA 5"€€ z, 3 3 - s eF-!; 9,4 A4 L S Ground elev. L S - top I ft. Depth to L S B J- L S limiting L - , ? . Y factor - ~'Qs Remarks: U=" Ti94ZS .4C44TAAIA M AXA* Boring # Ground elev. ft. Depth to limiting factor Remarks: S13D-8330 R.05/92 A m - 10 IF b y 3 v Q n ~ ~ I NZ Z n ~ ~ ~ '~c 4 0 t ! 1 v ~ r 1 s I 2{ a Z o o r r ~ tr ~ ~ ~,rc x aq. G,,'a: x cc "~+a.:~ ~ i i_ i STC-105 SEPTIC TANK MAINTENANCE AGREEMENT / St. Croix County OWNER/B T.R ~r b" (9 fi'Z t>J 5~~ t MA ANG ADDRESS 3 3 ,1 s rl b"^• y~T J . PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE 1 \ 'Vo 4- PW PROPERTY LOCATION 1/4, ! ~ 1/4, Section j , T L ? H'R W TOWN OF re ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAPS %~d ,VOLUME// PAGES 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: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 sTC - loo 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 j)qn eg o tJ c ZDZ©CA/.S k t Location of propertyL/L 114 ,IJ 1/4, Section, , T,N-RW Township trait Mailing address 140'rn'-t Address of site a s subdivision name Lot. no. S Other homes on property? Yes-K„No Previous owner of property 6ha lS'o" . Total size of property 2 .ZZ ke Pe'5 , Total size of parcel .2 Date parcel was created Are all corners and lot lines identifiable? -K-yes No Is this property being developed for (spec house) ? Yes --Z-No Volume &~';7 and Page Number - as recorded with the Register of Deeds. ZYCLUDB WZTH THIS APPLICATION =8 FOLLOWrHG: 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 0WXZR 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 Na. S Y 1- 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. Signa of Applicant Co-Applicant ilA'E'u of Cin»a.♦+r~ +r..t.. ..r e.i....__~._____ AWN FILED AUG 1 4 1996 KATHI[~NH.%NALSN of Deeds St. Croy Co., WI 548190 CERTIFIED SURVEY MAP Located in part of the SEJ of the SWj of Section 30, T28N, R19W, Town of Troy, St. Croix County, Wisconsin; being part of Lot 4 of Certified Survey Map recorded in Vol. 9, Pg. 2509 at the St. Croix County Register of Deeds Office. LEGEND N 19 Aluminum County Section Corner Monument Found 0o (DD OWNER • 1" Iron Pipe Found Ct--; Paul H. Johnson - - - - 100' Roadway Setback Line d 382 C.T.H. "MM" N River Falls, WI a 54022 o <D CY -b o co w m Q, T I cC~ I - CD cn.I-o c,t: S"JIti1Ll_ TRAC T co 0 0 0. V01 8, PG. 2289 North line of the ~ --0 n. SE4 of the SWkr fFjLEidLQl EQ. ~o° S89047136"W 209.06' W N89°40'22"W 209.09' z- Joint Driveway N C m _ o cn ~ o C) 0 f 1P - -i I i _OI I r-+ w _OI I ~I o ~ aC. C. iA. w C. iVl. v I - - - LOT 5 m! VOL. 7, PG. 2045 V?I_ 3-, PG. 422 -P 2.22 Ac. Inc. R/W o~ - - - - - 96,765 Sq. Ft. 2.00 Ac. Exc. R/W 'P 87,122 Sq. Ft. w o Ln . ,PPROVEQ 0 AN t 4'961 ~ . m0 *1 N o ST. CROIX COUNTY s Comprehensive PtVU* Zoning and co o S89°40'22"E I 4 *1 h - Parks Cagnn* 0 *1 Ct 447.96' S89040'22"E 209.09' If not r zo C. S. M. wi , o r i Oro" /,Cf<RV[O FOR RECOROINO DATA THIS ♦ DORY 1-..198 DoCUN.ENT NO. STATE BAR WAR IR ( W DEW S1 CRW CO. VA ~ahzl~Qa__az~d.._...._. This Deed, made between . ..-ReJ &bae.-it- A0hns0ns--husband_.and_-vifAe AUG 2 7 1996 - Gr--- - • and.... DanieJ._.G.._-Brzo7aw_sk~ .-and ~ichQlleIones-r....... ~.1.130L oint tenants p,&WdDw& . - • Grantee, - . - . Witnesseth, That the said Grantor, for s valuable osaaideration R(TURN TO . ~ QXx-----•-•- conveys to Grantee the following descrcbed real in County, State of Wisconsin: -----~I~ Part of the SEk of SWk of Section S0, Croix Tax Parcel No. Township 28 North, Range 19 West, County, Wisconsin described as follows=ust 14, 1996 in Vol. "11", Lot 5 of Certified Survey Map filed Aug Page 3141, Doc. No. 548190. A§5FER s I is not homestead property. This (L not) nces thereunto belonging; Together with all and sin;ular the hereditament and =ppu joh"on _ hi~neR... fc_ And..... .:._.~0 !IISQCI.-and-..D~~A and clear of en.umbrances accept warrants that the title is good, indefeasible in fee simple and easements, restrictions, rights-of-way of record, and joint driveway Vol. 7, Pg. 2045, shared with the properthown y onnC.S.M.Lin V if i1S-Pg. 3141, Doc. No. 548190 No. t 43pJd th s DQel will warran an a en a same- 19-_9-6-• - x Dated this 2131-------------------------°_...._ day ° ^ . (SEAL) ' -•----•--.....-.(SEAL) = • - Paul.. H .k11~SS2]0~-------------------- . (SEAL) • (SEAL) elphine _ o.- nson ACSNOW L'3DGYBNT AUTHENTICATION STATE OF WISCONSIN , sa Signature(s) aul.• K!...Johnson... n Del_phine R. Joh on - Conntr' say of q of._AL!gu$.t...._...., 19__96 persoaallq came before me this ~"above named suttee It 21 - 19-------- . ...ord_.._.----- TITLE: M BER STATE BAR OF WISCONSIN (If ok • who executed the authorized me :mown to be the person by 706.06, W~ 3tats•) Swegoing instrument and a&nowledge the °~'e ' THIS INSTRUMENT WAS DRAFTED BY , . ~ -