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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER o rr e » r y2 e,
ADDRESS 2 7G ~v 90"
Z
~t/o v Gf G ~Z uj. 'S
SUBDIVISION / CSM# LOT #
SECTION l T1~9 N-R W, Town of spR R !5 ~,'c, l ~
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
0
v
i
I
ICI
ir
is
~r 1
W
f
a INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: SP k e- 0 m Pa,5 i ' ) 4` /00
e,
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: W e--d 4J e S Liquid Capacity: / 0 OLI
~ G
Setback from: Well House 0 Other
Pump: Manufacturer Model # Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: ~r Length U Number of trenches 3
Distance & Direction to nearest prop. line: 2 O
Setback from: well: q House /2(, 0 Other
ELEVATIONS
Building Sewer 103,33 ST Inlet,-/ 03t k2 ST outlet / 0 S
PC inlet PC bottom Pump Off
Header/Manifold qC Bottom of system g ? - 9 S - cf3
Existing Grade Final grade
DATE OF INSTALLATIYt- PLUMBER ON JOB: , • t
LICENSE NUMBER: )~'L t~ G (
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and +,jman Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
PeFRYEder's aamee: ❑ City [I Village Town o : State PI o..
, WARREN X
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/do, G' /r14', Qs ~ d
TANK INFORMATION ELEVATION DATA F' 03
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /
Dosi
Aeration ng-
Bldg. Sewer 75~ /O~/ 33'-
St/#f inlet TANK SETBACK INFORMATION St/ Outlet 3,513 /U3,~5'
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air intake
Septic '>/,O NA Dt Bottom Q
Dosing Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
M er Deman° d 5 T
Model Number GP
TDH Lift Lriction System TDH Ft
For ain Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / Length / I W. Of Trenches T No. Of Pits nside Dia. Liquid epth
DIMENSIONS 5 DI N
SYSTEM TO P / L BLDG WELL LAKE / STREAM G Manu acturer:
SETBACK CH BER
INFORMATION Type Of It y Model Number:
System: 51,70 /elo / O UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Ho Size x Hole Spacing ke
Length / ~q
Dia- Length ~ Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade st, s Only
Depth Over Depth Over xx Depth Of xx Seeded /Sod a xx Mulched
Bed/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No Es ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION; SPRINGFIELD.18.29.15W, SW, SE, 90TH AVENUE
Plan revision required? ❑ Yes [-fo
Use other side for additional information. 3 9
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH ' -
SANITARY PERMIT NUMBER: "
I 9.~,~ 9,191
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water System
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
G~ x-
• than 8 1/2 x 11 inches in size. !
01 See reverse side for instructions for completing this application State Sanitary Nrm Nqp er,
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 Property Location
Warren Frye sw 1/4 SE 1/4,5 18 T29 r N, R 15 E (or) W
Property Owner's Mailing Address Lot Number Block Number
2766 90 th. Ave.
City , Sta~te Zip Code Phone Number Subdivision Name or CSM Number
WOOClville, WI. 54028 1(715) 698-2346
11. TYPE F BUILDING: (check one) ❑ State Owned ❑ C ty Nearest Road
❑ VIl age
❑ Public 1 or 2 Family Dwelling - No. of bedrooms- Town OF S rin fiel 90th Ave
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1❑ Apartment / Condo U 3 7- 16 2, ' g V
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. ❑ 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 ❑ 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
450 900 900 X •S %3_0 95 Feet Feet
VII. TANK Ca
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Constructed Con- Steel glass Plastic App
Tanks Tanks
Septic Tank or Holding Tank x 1000 1 Midwestern ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VI11. RESPONSIBILITY STATEMENT
the undersigned, assume responsibility f instal tion the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumb Signa mps) MP/MPRSW No.: Business Phone Number:
Joe Stang MP 6646 698-2266
Plumber's Address (Street, City, State, Zip Code):
506 Willow Drive, WOodvi le WI. 54028
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Sta S)
~
pproved ❑ Owner Given Initial Surcharge Fee) 7--
z
Adverse Determination z_
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: original to Cnun1 y, One u)py To: Safety & Ruildings Division, Owner, Plumber
1
INSTRUCTIONS y '
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.
11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling-
Ill- 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, purnp/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR
VIII Responsibility statement. Insta ling plumber is to fill in name, license number vviih appropriate :,refix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
°t_ _ ic.atic,r;s ~uc-:- srns _ that. R x 1 1 inches mu ,t D c:1 r~ty The plans must
or Vllih cor7lpletF J septli=
r i 7llrrlpOrSlphr?!'1
SG '3 r)'.It:,)I1 _ _yilvrT Ie Lpi ldirig servf_'d;
.lose vo;urr'.a;
J xc,
ifllo;"matio-l.
GROUNDWATER SURCHARGE
i~38?' . r, n 4 ncluded the creator, a ch, ge<_: ('mot s~ for a nUi" OE-f late., c -,ct r. which can
e`ieci. roundvvar
i!`f L,gf1 these :.,,rchurges ai`, sed fot monitoring grol. ;,`i_oc- +nVestig3t!ons
and es 11ii=' met,!: of s'andards-
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page !f of 3
` Labor a^ct 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. 3~{ L 0 y Z- ~D
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
W N %kEr~ ~=Ivl 1~i GOtf. . L9T S I0 1/4 SE 1/4,S 1Q6 T Z N,R 1 S E (o W
PROPERTY OWNER':S MAILING ADDRESS LOT # LOCK # SUED. NAME OR CSM #
2'-16 L q o 'nt PNe . - -
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD
W06bv1~,-\J' w1 S4o2Z 015) 648- Z35p~«C, FLtD-b CY O 1 e'
[ j New Construction Use [X] Residential / Number of bedrooms 3 AddibQn to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow 4S O gpd Recommended design loading rate 1 bed, gpd/ft2 y _S trench, gpd/ft2
Absorption area required \\7Z S bed, ft2 Roo trench, ft2 Maximum design loading rate o - y bed, gpd/ft2 0 - 5 trench, gpd/112
Recommended infiltration surface elevation(s) S kFN~j- P 61 3 ft (as referred to site plan benchmark)
Additional design/ site considerations 3> C_Vyt= ele-14 S 'x l 6r," LO AJG
Parent material C~ Lam! L 2LFT Flood plain elevation, if applicable N A ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for s stem WS ❑ U [2 S ❑ U S❑ U S❑ U ® S ❑ U ❑ S o u
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 Trer>ch
0-1$ l0`LR. 3 ~ 3 ~ Si Z `~S ~~2 `"'i'F1, c.,S - o• S o. b
Z \Ib` kt L 3L fo ~s s9 1yr 1 Cg - o.$
Ground 3 6d-73 `1 \Z l6 ~S O S9 vv~ - o .S o- 6
elev.
All 1 ft.
Depth to
limiting
factor
7 7 3"
Remarks:
Boring # a _1,S lD 3 S I o, S i ci ~
Ground
elev.
j
1177- 1
Depth to
limiting ST
factor
? 7 6
ttt+t
VIN
Remarks:
CST Name:-Please Print Phone: 715-425-0165
Arthur L. We erer
dress:
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date: CST-Number:
- S-t~C3 6 2 °J- 5 M00576
PROPERTY OWNER SOIL DESCRIPTION REPORT Page?- of 3,
PARCEL I.D.# 0114- IO qZ- ct0
Depth Dominant Color Mottles Structure GPD/ft
Boring # FHorlzon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
3 n.< o-i8 1O`t[~ 313 - Si Z JUG M CS C" o• 6
i
`e rs#
1B-bb 10~11L ~L~ 1S O s w►) cS o•~ o. g
Ground 3 6b 18 lb`1 3L S, S U S
%
elev.
1eb l ft. c p}v 1*7 W O, t,r"~ -t R- 4r ~-S m y
Depth to G N LO 1 0. S C.
Iirnjting
factor par S I L 0 1 to
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft,
Depth to
limiting
factor
Remarks:
Boring #
y~'mt •v
Ground
elev.
ft.
Depth to
limiting
faMr
Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of 3
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CST Signature Date Signed Telephone No. _ CST #
Vdisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page C of 3
Labor and Human Relations
Division of Safety & Buildirgs in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but PARCEL I.D. #
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road. C111-14- 1~ ~1J
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION JREVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
W PN ~Z2 f 11~ Gfff. tr3T S I.v 1/4 Se 1/4,S 116 T Z N,R 1 S E (0148
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
Z---) 6 L q o `stF PNIZ .
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [9rOWN NEAREST ROAD
Woopvlk-V W1 S4.v?_8 ()15) 08- 2,3~1o SP1Z-l~G F1%D-b 010`1" e~
New Construction - Use Residential / Number of bedrooms 3 [ J AdditiQn to existing building
14 Replacement [ J Public or commercial describe
Code derived daily flow 1AS O gpd Recommended design loading rate - bed, gpd/0 - S• trench, gpd1ft2
Absorption area required \\ZS bed, ft2 Roo trench, ft2 Maximum design loading rate o • bed, gpd/ft2 0.5 trench, gpd/ft2
Recommended infiltration surface elevation(s) S 1?" 1 3 ft (as referred to site plan benchmark)
Additional design/ site considerations 3 i~CWt - e2.tA S '>c 6 6' Lb N 6 -
Parent material ~-f► R LFT Flood plain elevation, if applicable N A . It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem RIS ❑ U ®S ❑ U MS ❑ U M S El U ®S ❑ U ❑ S WU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Botrrlary Roots GPD/ft
Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
b-t8 l o`tR 3 ! 3 Si Z ` 3'oz 0-S 0_`1o
-x Z -1a6 %A&Ak 31 ~s sg r►f cs o.~ o_~
p S9 t 6
Ground 3 bb-73 Lb 1Z \4 yn 0 .'s o_
~
elev.
Z,1 It
Depth to
limiting
factor
Remarks:
Boring# o_1.S lw R 313 S I Z'nSb z S
Z'-`' Z 1$_7(0 l~`l2 31` iS ~S ~1 Z'-) `0.b
>ti
Ground
elev.
Depth to
limiting
f>t76
Remarks:
CST Name:-Please Print Phone- 715-425-0165
Arthur L. We erer
Vdress: -
egerer Soil Testing & Design Service-P.O. Box.74 River Fa1ls,WI 54022
Signahxe DaW CST7Vumber -
• a; '
Ii:l •
PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of
PARCEL I.D.# 0314- 10 q L- °YO i;
Depth Dominant Color Mottles Structure GPD/ft ,
Baring # Horizon Texture Consistence Boundary Roots
g In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed . Trench s~•
f" o_ l 8 1~ `ic L~ 313 s i Z 31a1~ M CS o b
3
Q PLC, 1s o s
Ground 3 b0 18 llli`tL 3L~ S U S rvi o•1 o S
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M.-I ft. Co1v w 0 LO 4 R- Y 1 C ~ yn v 1 t'
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fact N
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Remarks:
Boring #
kk:} i II
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Ground
elev.
ft.
Depth to "
limiting l
factor
Remarks:
Boring #
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Ground
elev. 1
Depth to
limiting
factor r~
Remarks:
Boring #
fti~ E f ,
Ground
elev. f!
ft. j
Depth to
limiting
fat:tor
s'f
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Remarks:
SBD-8330(8.05/92)
PLOT PLAN , Page 3 of 3
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CST-Signature Date Signed TeIephone`No. CST#~
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Warren Frye
MAILING ADDRESS 2766 90 th. Ave.
PROPERTY ADDRESS 2766 90 th. Ave.
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE Woodville, WI.
PROPERTY LOCATION SW 1/4, SE 1/4, Section 18 T 29 N-R 15 W
TOWN OF Springfield ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME 851, PAGE 566 , 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.
J_
SIGNED: cc,vt,v~~
DATE: 7-0'- q5
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 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 Warren Frve
Location of property SW 1/4 SE 1/4, Section 18 , T 29 N-R 15 W
Township Springfield Mailing address 2766 90 th. Ave.
Woodville, WI. 54028
Address of site 2766 90 th. Ave.
Subdivision name Lot no.
Other homes on property? Yes x No
Previous owner of property Eva Nelson
Total size of property
Total size of parcel
Date parcel was created 1989
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for (spec house) ? Yes X No
Volume 851 and Page Number 566 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. 451693 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.
451693
~e C~ lUltlti ~ M. SZ~
Signature of App icant Co- pplicant
7.- . 95 ~ _~.s_
Date of Signature Date of Signature
DOCUMENT NO. THIS SPACE RESERVED FOR RECORDING DATA i,
I,. WARRANTY DEED
i -
-19821
STATE BAR OF WISCONSIN FORM 2 451.693 i i_ wcI CJIPAE U~rJ REGISTER'S OFFICE
ST. CROIX CO., WI
Recd for Record
! SE
Wa .tex..lY~1s.Qn.,---Pex_s.onal---1~ res.entati.ve_..of._Eva. SL h~ 1198
..Nelson._Es,tate., . . . ct 10.45 A. M
4
~i ~~riMQ
conveys and warrants to .Warre11X__B..._.Frye ..s-ma.sune._X._..Frye, RegisterofDee&
I husband. and..wife_,...as...joint._ten t-S
i' •
RETURN TO
(I the following described real estate in ~5tr.._Cr.QiX County,
!
State of Wisconsin:
Tax Parcel No
it SW- of SE4 of Section 18-29-15, subject ~I
to easements, right of ways and privileges
of record.
That the property taxes for the year of 1989
jl have been prorated and paid to grantees; the
grantees are liable for the payment of the
1989 property taxes.
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NNSFZ$
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This _...S.._riat...... homestead property.
(is) (is not)
Exception to warranties :
Ii
Dat is day of September 109....
I' it
is
j
------(SEAL) (SEAL)
* .Walter.-Ne]~sQ1~.
l
---------(SEAL) ----(SEAL)
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*
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AUTHENTICATION ACKNOWLEDGMENT
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Signature(s) ._of. .Walter .Nelson,. Personal STATE OF WISCONSIN
ss.
$el?1<eseSl atiY_e._ of Y_?_._~Ie. s4 .qta-te
County.
7
authenticated this ._Lt:_U-•day of._._►ptember, 19..8.9
Personally came before me this ________________day of
18 the above named
>1
. John.-G._ Nestingen
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the I
j foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY I'
Attorney...........
i
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Baldwin ,__Wisconsin 54002
Notary Public --County, Wis. Ii
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are are not necessary.)
date: 19--------- )
H
j
•Names of persona signing in any capacity should be typed or printed below their signatures.
m~~ STATE FORM No. 2 WISCONSIN
SIN Stock No. 13002