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HomeMy WebLinkAbout032-2068-90-000 i~ Q ta M ~O b4 N M y N W I Q ~ I N CT Cl) M '6~i. 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CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r IND CATI' NoRTti AIPPO~~ Provide setback and elevation information on reverse of this form Provide 2 dimensions to center of septic tank m()nhole cover- i T ~ BENCHMARK: ALTERNATE BM: ~p~Q D ~ra a l~ SEPTIC T / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: -1/gyp Liquid Capacity: Setback from: Well-13.6, House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: - Alarm Location r' SOIL ABSORPTION SYSTEM Width: l O Length Number of trenches Z beJ Distance & Direction to nearest prop. line: Setback from: well: 13S House Other l]ELEVATIONS (,c- hr ,a (r. 9 'btu ue,+C~r a^n. ~ ~ Building Sewer / ST Inlet ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system 4v. Existing Grade v Final grade DATE OF INSTALLATION: PLUtIBER ON JOB: 0,4, LICENSE NUMBER:( INSPECTOR: 3/93: )t Wisconsir.Department of Industry, PRIVATE SEWAGE SYSTEM County: and Hua Relations safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermitNo.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI . LARSON, OLGA X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: o sQ~L?i r J -4 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 23,32 - . 6 4 , goo. Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet S,7a y C 7 TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet rl Septic y - 35 /~0 }aS NA Dt Bottom Dosing NA Header/Man. (,39' 7q,0 Aeration NA Dist. Pipe 7 ~ 3.k; Holding Bot. System 0,7,1 PUMP/ SIPHON INFORMATION Final Grade 8;39 " 5-v Manufacturer Demand Model Number GPM TDH Lift Frith n System TDH Ft Lo Head Forcemain Len gth Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length 1 No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _/91' DIMENSIONS SYSTEM TO P I L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER ;v /A OR UNIT Model Number: System: 3 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 Bed /Trench Edges (i; 3~ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Somerset.12.30.20W, SW, SE, Anderson Scout Camp Road Plan revision required? ❑ Yes E No Use other side for additional information. SBD-6710 (R 05/91) Date nspector's Signature Cert No. t ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' ~i~'■a'iR SANITARY PERMIT APPLICATION Bureasafetyu o oand ff BuiluildiinWater S ngWater Division ~ stems 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. , C `X • See reverse side for instructions for completing this application State Sanitary?eerrmit 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 Owner Name Proper Location a TS2~1~- 5W1142JF 1/4, S la, T , N, R E (or W Property Owner's Mailing Addr s fl Lot Number Block Number cG C~:Ile-r Q/ZJY, Cit), state Zi Code Phone Number Subdivision Name or CSM Number fJnw l (,J z `~0 Z. (7► ,e-)SY9- II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Public 14 1 or 2 Family Dwelling - No. of bedrooms Toan OF rN-er5 er yv DLUt III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 F1 Apartment/ Condo o3 go(, 8 _~o am 0 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. I] New 2 XReplacement 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 1 l jZeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1 :F❑]Ieepage 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 Gra e Req/u~'r~e/d (sq. ft) Pro osed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 63, 7 Elevatiorg~d ~,,5 b l3 ~j ~j Feet Feet a VII. TANK Ca in allons Total # of Prefab. Site Fiber- Exper. INFORMATION g cit Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank coo is ❑ ❑ ❑ ❑ ❑ 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) Plu r l 9nature: (No St PQ_ MP/MPRSW NO.: Business Phone Number: Plumber's AfJdress (Street Cit , Sta~, Z Co e). 1 )o IX. COUNTY / DEPARTMENT USE ONLY fir ,-m zz~, ❑ Disapproved Sanitar e it Fee (includesGroun ate Issued suing Agent Signatu a (No Stamps) Approved ❑OwnerGiven Initial Surc gere Adverse Determination X. CONDITIONS OF APPROVAL / REAS FOR DISAP R AL: S8D-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Di-ion, Owner, Plumber i r 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: 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. Corr plete 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 game, license number with appropriate orefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX- County / Department Use Only. X. County/ Department Use Only. Ccfnplete plans and sped fications not smaller than 8 1/2 x 11 inches must be submitted t-: the cc;unty- The plans must inoude the followinq: A) plot pian, drawn to scale or with complete di;nerisior,s, IocGr.io: -:)f h<,Iding tank(s), septic t k (Q o! I,w e~, n 0u [_;nks; budding se., ors; wells; water maws v4aLc, se! t,e, s.,,c.~, _r - lakes; pump or siphon ks; Jis,":; tuun absorption sy,,k:ms; replacement system ar.-'; tl,c ci the building served; cl...Vat;on rP_feren .i'.S, COrr!pieteSpE'U`Ii:~3ilOnS tor pUr'Ip a!"1,:'. COntrGiS; dOSe VOlurne; _vation (Jif `erences, friction loss; pump pe tfc,rr Zanc~_ --urve; pump model anc t111jmp m:_nu.a'.turer, D) cross section o= the soli ~Llsorpuon system if required by the (ounty; soil test data on a 1 ~ orm, a! r4 f) Ji 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. PLOT PLAN PROJECT Olga Larson ADDRESS 264 Anderson Scout Camp Road Houlton Wi 54082 SW 1/4 SE 1/4S 12 /T 30 N/R 20 W TOWN S. Somerset COUNTY ST. CROIX MFRS BYRON BIRD JR. 3318 f DATE 6/7/95 BEDROOM 3 CONVENTIONAL XXX IN-GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE Existing 1000 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE.7 ABSORPTION AREA 648 BED SIZE 18'X36' BENCHMARK V.R.P.Base of Siding ASSUME ELEVATION 100' ❑ BOREHOLE WELL •H,R,P, Same as Benchmark O VENT' SYSTEM ELEVATION 83.5 12" GRADE TYPAR COVERING 2, 12" 3 6' ®3' 3' ® 3' d SEWERR 18, 12' 10- a Borings Located >6' from Old Drainfield xisting 3 Old Drainfield Area Well 10' edroom 100' T 30' o Ouse ' 20' 0' 20' 15' 10 arage -2 Driveway M. b 25' \ B-3 \ Vent a 18' X 36' Bed \ \ f 6' B-1 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of Labor and Human Relations Division 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 nearest road. o fj Q APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT f 1/4 1/4,S o2 T,,:767 N,R E (o PROPERTY OWNER':S WAILING A PRESS, L # BLOCK # SUBD. NAME OR CSM # CITY,.ST TE / ZIP CODE PHONE NUMBER` ❑CITY VILLA E MOWN EAR T ROAD [ ] New Construction Use j) Residential / Number of bedrooms [ ] Addition to existing building ( Replacement [ ] Public or commercial describe 'Code derived daily flow S~Q gpd Recommended design loading rate ed, gpd/ft2 trench, gpd/ft2 Absorption area required6 Y3 bed, n2,5 63 trench, ft2 Maximum design loading rate gybed, gpd/ft2:trench, gpd/ft2 Recommended infiltration surface elevation(s) ~r, ~3• ft (as referred to site plan benchmark) Additional design / site consi erations Parent material t Flood plain elevation, if applicable 1AZIA ft S = Suitable for system CO VENTIONAL MOUND GROUND PRESSURE A-TGRADE SYSTEM HOLDING -WK U = Unsuitable for system S El U WS El U W_S El U aS El U El S ULL ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tmrtdit Al -312- 4 Ground Depth to limiting fact Remarks: Boring # s :a; - ~ L3 MA~ Z; i 4 J~ ^ L -5 oGrouun~di eley- Depth to - limiting aT Remarks: CST Name:-Please Print Phone: rvw v' r~ ) Address: ~l(i `e Y tt r / Signature: Date: CST Number: 6- 2 PROPERTY OWNER CC/ 14cc- h ce.- 50y- SOIL DESCRIPTION REPORT Page of PARCEL I.D. # 1 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouiclay Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 10 3 S rv~ C' S PIP J-~ Ground elev. ft. Depth to limiting 3,3 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor FT Remarks: Boring # 4rf~:: Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Soil Test Plot Plan Project Name Olga Larson Byron B,i~d Jr. Address 264 Anderson Scout Camp Road Houlton Wi 54082 CST #3479 Lot Subdivision Date 6/7/95 SW 1 /4 SE 1 /4S12 T 30 N/R20 W Township S. Somerset E] Boring Q Well PL Property Line County ST. CROIX Assume Elevation 100 ft.Base of Siding BM or VRP System Elevation 83.5 * H R P Same as Benchmark Borings Located >6' from Old Drainfield xisting Old Drainfield Area Well 10' edroom 100' 10~ T 30' o ouse 10' 20' arage 30 15' -2 30' ` Driveway M. 25' B-3 8% 0 Slo e a 6' B-1 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the q2 k CpA, residence located at: J 1/4, 51E~ 1/4, Sec., T,310 N, RL2D W, Town of I-)oy ---el Ir5Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced_ 6 _02cc ' 75 Did flow back occur from absorption system? Yes No/ _~L(if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: i Construction: Prefab Concrete X Steel Other Manufacurer (if known): Age o ank ( i f known) :awye'a.rl "43 r (Si ture) (Name Please Print /d/-T 3316 (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin statute, or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tall condition, I certify that the tank to the best of my knowledge aril conform to the requirements of ILHR-83, Wis. Adm. Code (except to inspectiJp.p opening over outlet baffle) Name d Si~ct Signature P MP/MFRS 5/88 L STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS ~6~ 19ir~~E'✓.~. ~C-nom. T7[?'t_~-C~~' SYO~a~ PROPERTY ADDRESS Sirn.a-, cL4 jj L 22-e_.- (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 56LJ 1/4, 5E- 1/4, Section J T30 N-R oa6 W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION 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 be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. 1 SIGNED: DATE: 4;~-/ AY .7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 -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 ~h a ~S Location of property.2g_) 1/4,54:-' 1/4, Section / Z , T3()N-R_a,_0_W Township S f Sf,-i(:: Mailing address SP na'A' Address of site Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property sd6 ,~-a~° Total size of parcel mot ~~'C5 Date parcel was created cc Are all corners and lot lines identifiable? Yes No I this property being developed for (spec house) ? Yes No Pr ~y~Vb~u ne f- 7I and Page Number T 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,~/Zand that I (we) presently own the proposed sitefor 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 of ice of the County Register of Deeds as Document No. / Signatu a of Applicant Co-Applicant Date of Signature Date of Signature 1058PASE 374 TERMINATION OF DECEDENT'S PROPERTY INTEREST • Joint Tenancy or Life Estate Termination [s. 867.0451 or • Summary Confirmation of Interest in Property [s. 867.0461 REGISTER'S ~~CE Decedents Name Arden V$ Larson $T. CROIX CO., W1 state Zip Recd for Record A Decedent at Date of Death city _ nderson Sct Camp Road, Houlton, WI 54082 JAN 3 1994 lh SOCiat Security Number 2-10- P M ember 21, 1993 477-09-5617 ation of Death Certificate Register of Deeds I cert hat I have viewed a certified copy of the decedents death certificate. Dale Register Deed's Signature This interest in real estate is terminated under (check one): Record this document with the Register pf Deeds X s. 867 045 which pertains to real property in which the decedent was a joint tenant,' in the county where the real estate is located. had a vendors or mortgagee's interest, or had a life estate. '(You (rust provide a copy of Recording fee is $25 as per s. 867.045, 867.046. the deed establishing joint tenancy.) Return to s. 867.046 which pertains to (1) real property of a decedent specified in a marital property agreement, and also to (2) survivorship marital property (You must provide a copy of the deed establishing survivorship marital property.) Presentation of real property tax bill. Present with this document a copy of the real property tax bill for each parcel for the year Immediately preceding decedent's death Presentation of deed establishing joint tenancy or survivorship marital property. This deed is fou:,d.n volumel 00 Pa9e/i~Ja 327 of (check one) Records X Deeds- Description 5 Description of the real estate. Indude only the extent of ownership (or vendor or mortgagee's interest) inland at the time of the decedenrs death It the extent of land is exactly the same as on the deed, a copy of the deed may be attached to describe the real estate. The legal description of the property is as follows: (it more space is needed, attach pages ) See attached DECLARATION: I, we declare that this document is, to the best of my (our) knowledge and belief, true. correct and complete and is in conformity with the provisions and limitations of the Wisconsin Statutes. If more s ace is needed, attach pages. Date Name and Address of rson Receiving Property Relationship to Decedent Signature (Notarized) AUTHENTICAT Nlo;ACKNOWLEDGEME 2%28/93 The above named person(s) to-opfofe me on (dare)- _ This document was drafted by (print or type name below) Signature of notary or olloer p autionzed to adrriff-dwer an oath (as per :L 706.06. 706 07) Olga Larson Print or type name- J 0 4 (,b hne 11 stare of wlsconn. county of Q Crto~X Notary y 267 9 7 Date. rrxnrntcsirm extw e, Wisconsin Register of Deeds Assooainn Form t17 t in 11921 Title fj'~.'~ OOC. MENT NO. I STATE BAR OF WISCONSIN -FORSt 1 WARRANTY GEED (L q ty - _ !o1iS $PA(-I NfStn: tc,n Pit l'r~:lr~b,t~ nar,1 S .■i Ljl • - - - _ _ H!`GrsT R~ OF= ~7ICE' THIS DEED, mode Jetwoen 'di11i 1 1'. r': tlieroe j a S lf)p~,1F? mian ST. anoix CO.. Wis. z Rec'd for Record this_ 1Qt l,r., day Of-__&1-Y AD. l9_13 Arden Lririonand"w~fa •Olt*a, hus hand and wi~~b t__ _ s00 P• M. _as joint -tenant 3 G, (TI Wilneaeiefh. That the haul (ir.inl ur G.r v.t1u.,Lle r"o, m , Five thousand four hunt.red bollars (,.51`41'().~f)} convarys to G-ritee the following Ar•:cntxdrr:d.:a.tl. iii :;t. ~•()ix C~nudy. Mt TURN TO StaLe of•Wrs.unsin: p.trcel of l:a,c loc-, tcd 'it tl. t:.. aectioTi 12, jo-, r t, .it. Tax Ki-v a County, 1i:consin .'encif:. I'li- h„n,. at the - corner of' tic ;rc-tion 1' iii • li.t! Dint of beginning; thence da::t, .ai, uru:d bc::rin 161. -5' lon tit line of i,: &I, to "t'!!( : oi:.t t}, , i7 r the r Dint oft knit:, c t o .~t. .ri . 5outh5' :ore or ire,:. i. , Yn Together with all and sinular the herud,L:n'.rnt-, •.ml ' K ..pp urtP. th, rvunto 1K•I,in,:in,; or in anY wisr app. rLUn,n And warrants that the title is good, indele-il,le in (cc tiunplc and tr.-,. an.f rl-r,,l r imbr. n-, except ii and will warrant and defend the -.nii Executed at 1 - d.:y ,r July 1,,7j II lrr~?nt', 1 r, SIGNED AND SEALED W PR ESb:N('F: OF i t ~ lJkC (SF :A L) i (SEAL) ~I (,FAL) i i :SEAL) Signatures of authenticated this _ d.w „t tit j F , I ii St Av Mir Wi-on-ri ~~r ether Party . Awls, .1 undor 5,.. 'Ob Oti i I' STATE OF WISCONSIN 1 _St C ro ix e. county. I - I~ Personally came before me. this - 16th •t:,Y ,f July `t,v."e S„^ .'•'••,•7 •w i j, the above named -dilliam D Fathyreo a _ zingle it - - - - _ _ - • ~ ~ to me known to he the pers.,n_ who cxrcu/cJ the foregoing ur.trument and 0 T nnwl. 1geJ the same. ' I; 0` y P H `'.t I~ This instrument was drafted by - - - ••ti • t William D_Fatherae .St• CI'Olk, $ ~otary Public '~.....,,Gwd2y, Wis. i K ~ I n F i My Commission (Expires) (!s) v/i /L~ L~_7_ jl The use of Witnesses is optional. 80~)K 500 Names of persons Signing in any capacity Should be typed or printed below then Signatures. NGW~irCanpnr