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HomeMy WebLinkAbout020-1289-70-000 ~C o N o 3 6 M 0 m on 4 0 ei o ' 0 0 ~ r C m ~ RR _ ~ o c ~ c H ~ .0 i a z C LL c o Q - 3 CO Z W O U1 E w O t z rn CL m N 1- Z c O O Z a U N y0 U O 0 a~ Z ? H rn Z E -o '0 N M O N ~ N 0) CY O C O o N Q 0 z m z o N = z I~~ C ca > \T 3 £ c N '0 m O L (D CL (a (1) U c g cD m `m vS g L o a c a = M a a Z 0 00 •N ~ oaaa I CL v o m rn J U7- rn rn z N CN O a) Q O CD m N c CJI a) a7 Ul (D O O Q U) Q ~i Z O O M W c O M CC Oi c ^ U O O 0 = ol O ~T o aa) ` a ga O (0 00 co n _ 7 N • G Q) N Y N '00 F- C N N ]^~)1 ~ O N E O Vl t E U C14 (o 0 (a a Q a r CL CD E c c Q `~1 A U a 2 0 m C0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Tq M-eS y6V-~, ADDRESS 31-) (J l~V. A)J~Ms 1Q~ . t~J~ 5 ~b SUBDIVISION / CSM# It ►Megcl ®w LOT # SECTIONQL T N-R f W, Town of ( S ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1Rh we~Jg 39 t INDICATE NORTH ARROW N t :0~ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. • BENCHMARK : .S Leo 1-n = e/ Jan ' 01 ALTERNATE BM:- p p 9 d a 9 'd SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: L,LSQ H Liquid Capacity: JOOd Setback from: Well House 39 t Other Pump: ManufacturerAJIA, Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Z Length .5,3 Number ofd Distance & Direction to nearest prop. line: g~ .5 Setback from: well: House 99" Other X09 ELEVATIONS u • Building Sewer ST Inlet ST outlet /07, 5 PC inletA• PC bottom Pump -.ST Header/Manifold Z07 ZI Bottom of system /'04•3 Existirist~ Grade /o• Final grade 16 P, 3 t..~ 3 DATE OF INSTALLATION: PLUMBER ON JOB: ^ illy LICENSE NUMBER: INSPECTOR: 3/93:jt 3s Y1 Lq)QA44A* QKiar PA1P&;?#.29.19W.NPgWA E SEWjd SY MRIVE County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 999$1 Permit Holder's Name: ❑ City ❑ Village k Town of: State Plan ID No.: YORK JAMES 1HUDSON E ley_: A Insp. BM lev.: _ BM Description: Parcel Tax No : t1a. C60 - ~7tr 202=1289-70-000 TANK INFORMATION ELEVATION DATA A94 011 3 !}S . TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /66,42) Dosin //Z, Z-5 Aeration Bldg. Sewer Holdin St/ Inlet g //0,/57 TANK SETBACK INFORMATION St/ Outlet ,6z 7s, TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet rl Septic . SJ0 4 NA Dt Bottom i Dosing NA Header / Man. e Aeration NA Dist. Pipe .:J 3 00 Z Holding Bot. System 2 g i PUMP/ SIPHON INFORMATION Final Grade ~,vd 27~ Manu a A-urer Demand Model Number GPM TDH Lift Friction S ea Loss Forc ength Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width J Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f 53 DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING nufa SETBACK CHAMBER INFORMATION Type 0 h,fw C 6 Mode Number: OR U /4 System: A =aai ~tO DISTRIBUTION SYSTEM Header 4A*"4@4~ By Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length SC.,/ Dia. Spacing CA SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems On y Depth Over Depth Over ~E c{ y xx Depth Of xx Seeded / So xx Mulched ;30 o Bed / Ueoeh Center yp Bed / T-n n_ Edges ` a Topsoil C] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.26.29.19W,NW,SE,LOT 34,MEADOW DRIVE r 4 I JJ Plan revision required? ❑ Yes 0011-0-- other side for additional information. Use SBD-6710 (R 05/91) Date Inspector's gnaturL'f Cert. No P r SANITARY PERMIT APPLICATION COUNTY DILL-R In accord with ILHR 83.05, Wis. Adm. Code 21= -f -5 / 6 r, D13( STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than If 91?dpl 8% x 11 inches in size. ❑ Check 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 25 yi~ r i< S -)L T?,' , N, R or) W -TIT tr PROPERTY OWNER'S 114AUNG ADDRESS OT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~l s o~ 7 ws II. TYPE OF BUIL NG: (Check one) ❑ State Owned O VILLLLAGE NEAREST ROAD G,/ /17 silo ,D~~ ❑ Public N 1 or 2 Fam. Dwelling-# of bedrooms R&YERUMM77- Ill. BUILDING USE: (If building type is public, check all that apply) 2 0 42 q 70 0-20 / a & 9 7 C 0 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1,,5d New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 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 El Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ 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 ~0 ~ /s 4, A/40-4 eet Feet VII. TANK CAPACITY Site In gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Hold! n Tank yA Lift Pump Tank/Si hon 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: o tamps) ip/MPRSW No.: Business Phone Number: Plumbe s ddress (Street, City State, ip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sagjtary Permit Fee (includes Groan water Date issued INVU Agent Signature (No Sta s) Approved E] Owner Given Initial Adverse Determination x'05 7 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: VVV SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a 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. Ill. 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. S;o The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) sale, .3 y4 7 a4' f~ ~~,lsa SGa4a /1' -41D r I~ Plus ~ /.S'G..~ i sQ~~"`\ ~r` lUe s Q~Qp w q Oc 3 ooh ~ t 00 fi 1 ' . : ILI a' .t I ♦ . ti ' '~1 s Y' a r . . I . . / _ t y r ~ , s ~ w ;N • f,. t . • J .w, 4r ncrV~• I vs s vve.. _ O.t3G' 7969 • KRCOLATION TESTS (115) ""'-d MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) - 0 0.: l.)C. NO.: SU, 0 O N r RE WG- N: TOWNSHIP/WNtetPALKY: 1/4 6 /P1 I~/R E tor) w UASo~ i G-f-t 1-r~~I)owS MALN A R . TY: CRoI' K CU19X0.v 72 Cp C-0UJ7r/ '~o• u b Sow W S Sya~ , ^22 S DATES OBSERVATIONS utADE OMME N` u esidence D t4~ t5 991 J'ua ~ t5 I~ R 4 • ~ ~ 4N*w ❑Replace 7 I . , , ~5~ R~RkhhRt~T S~ ING: S- Site suitable for system U- Site unsuitable for system F LL IOL01 G TANK: RECOMM NDED SYSTE (option EQ VE A MOU D: tN•GRbIJIJ c ,1 -~RC1 e$ wiTk oX S Clu ®S ❑Y ©S ❑U ❑S EN ❑S I tans DESIGN RATE: II any portion of the tested area Is In the rcolation Tests ere NOT required e. 1- A 55 S r s. ILHR 83.0915)(b), Indicate: IFloodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ING TOTAL ('R UNOWATER•INCHES HARA TER OF S01 WITH HIC - 'SS, OLOR, TEXTURE, AND DEPTH Jam jjQ BER DEPTH IN. ELEVATION V p ZMMMI- TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.I r p_G /oY ) f IS, plocue:0 G'I?' 7,5'yA IV/& 1P, 4.+ J / (Io /off,3i >IID Ip--..Ito"7.5yt t;/y cs. Q 9• YR /qI is, P ow<+v 7 S Y4 31y S Z. 120 101.30 > (2Ol AAVFR11C,"-3o''I.SYR y/~/SI,Zn.,sbk,/'`I~j j0 -/Zo 4 le, .S 0-60'' 7 5' YR 3/y s p/a4,cv • 4-~s" 7,5, Y it 3/y S a- 9R 3 ~~3~ ~1• > 120 /^VIC A~ fS 2y„ 7.51/JR -f /.4 S/, 2a.sbx,n..,FR 2N 120' 1-5 gR 4 r~~ - S. G-/O" 7.5 Yie 3/Y , PIows.0 /o - 2-01, 7.S Ye G I i 5 I rL 95 7~0 > (IS -2011- ►IS /C YR Y14 I r 0-12" 'I,S yR 511. P/0W AA; r="- rp-~a YR 7/4 -1 11~ 10g•Sz 7'tb >ll8 2 p -Fsbk n«fR• 100 qP"/o Ye 3o'ad,-k tF~'i'• 0e Aeg- S4 VAT/o,u S o f 10C;VC5 PERCOLATION TESTS DEPTH. WATIER IN HOLE 11 TEST' IME D WATER LEVEL-INCHES RAPER E-M INCH S BER INCHES AFTER SWELLING INTERVAL•MIN. PE 00 2 1!20 3. / (0 0 mss- io • 5 z 3 -too 2 Y T PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distanced. Describe what are the hori tal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and parceni land slope. 1116-AE57- TiPE.UC.t L ^ og, Q ' LE TQ~N 1 Cp . 30 STEM ELEVATION. 3' 5 o 1E I- j. I, the undersigned, hereby certify that the soil tests reported on this lorm were made by me in accord with the procedures and methods specified In the Wisconsin dministrativil Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: TO /7 HOME SITE SEP1lC.P..Ll11,dt3llgaLO._._ ' ADOR S 665 O'NEIL RD., HUDSON, WIS. 54016 CER F5:: i n~ON NUMBER: P 3 ~~UM ~ lol?t~onvtl ROBERT ULBRIGHT 4 -2- WSEA LIC. NO.3307 M.P.R.S. CST V AnTU-Rr~. n 1,11NN. INSTALLER 5 f,ESIGNER LIC. N0.00663 ~•l'i~ f / pL-A&~ 3 5c.4cE~ ~ 1C = I~RC ~ OG~TIO►~S ~ J a P ~ r 3 I 8 C I 49 33 5vv-t~ LOT Li NE SoqueyoR'3 L_oT ~t?va ~ r GO . LOT /0010 HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. OI ~1W8 Z ROBERT ULBRIGHT MINN MASTER INSTALLER &DESIGNER LIIC.. N0. P00663 30~ SC.4LE~ . Li•gc~//oE PITS 1C = I RC l ocAT10 N 9g ~ W O (t3 v b0 23 i w 49 Svu-t~- LOT Li r~E. S~R~EyoR~S u.~0 S LOT' cor~a R . HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, wls.G 7 ~ LW8 i ROBERT ULBRIGHT - ►~a ,R LIC. NO. 3307 M.P.R.S. . ' ..0.00683 r i j 8 p SS ~ ~ tt N,y•ap0w # Y 6 5 i ~1 gXi C-4 d i w: ~i i / N s~.r~b 1\ 0 0 o I ~ ~ y 2 1KU i 41 / N r ) A 8 U i I 9 W Q $ w Q J~- I \ Nw~ ? ~ ~ H pp ~ y~ Its ~ ~ ~ ~ ~ `~y l J O 6 A MI.OOII „ ,OL'GZC M.CI,YI.OON I \ \ duz OL•tOt M,CI,L N ~ vGf. F1 \ FJ- EEi j b N r a Ii yy I ~u t L 0 Q O ( . l F~S L le ?a 1 ,ef'o1f . w,e,n.oow ,L►'CfL M,i1,Y1.OON 1 Iot ` ,tr•eot Y L I t9 cr N i g I I Qzw i Ol I C~ CJ MCE M I { a. Ln zuo a O,•~ ° s8 ' I 1 X ~ZG N~ Ji t- _ .IA'f-0T t7 MOON Cj u~` w.u,w. ---T= MOOV3W -H1a0N 'b - r ~c V, 8u x C\" 1 N t QL I i Qd MA"J M~ e Rfi , B ql I r wu r I g~ F # y y ~j je W "Cl I I i i J• J r.l T U- Ln lL N~ 1 O0-- Z 1 .08 ,601 U. , W O w u wou7s .o wut WL wo 7Yn iww a z ~bAd1 d~Iiv idAr~ ~OppJ p 3 o x ~ t G I A ~ $ I 7 Q u.lc.wf. YY71 OL 07w"itY 'fi W~l)It b )MIl M ~~pp •if L•11Y7 Ml Ol 0)Y.WLW WY rW1YY7f ~ N - i 0 ` CrvSS ; ~~C~IOf'1 0~ 13th Sys~~~-~ fresh Alt Inle1► And OD►etrallon Pipe / 1 Appro.ld Vint Cep Mlnlmv,n 12' Ado,. Met Grad. 20. 42' Above Pip' _ 4* Cool Ire" To flnel Ored• Vent Plpe on Het Or Stntnelk Ce,erlnb kin 2' ApprepeU Over Plpe 1ifilb 0 v110n Plpe e e o Tee I I e' Aaar.oa. Bene►le Plpe I- Perloret ed PIP, 6e1,r '-~Ce.ptln/ Termtnellng At BOllem Of Sl►tun 00A son SOIL FILL OISTRIBUTIOF.1 PIPE r Y, APPROVED S49THCTIC COVCR 2' of AG G R GA1 E 1 AT E R I At. OK 9" OF sT R p W OR MARSH HA`J ELEV. OF~---I °EY____ L"OP2AGGREGATE a=~ DISTR15UTIOM PIPE TO DC AT LEAST - 11JCHE5 BCLOw ORIGIWAL GRADE AQU AT LEASTto IIJCHES BUT 1.10 MOKC THAI) 42 IIJCHES BELOW FINAL GRADE M MMUM M rH OF EXCAV T100 r o o • A Fr(M ot(IGYJg1. 6~ApF WILL BE, IIJGHES PVI?IMVM DEPrN OF EXCAVATION r'POM, OAkl6WAL C,RADf- WILL »C INCHCs i SIGUEO' t < C~ LICCIJSC l1UMBE11: _'9 DATE: !~l`~y 110 J, STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER A Me Yd r ~ MAILING ADDRESS 17 W ! # o~ W1.lr~ ~1 PROPERTY ADDRESS 738 , AI/ LtA (location of septic system) Please obtain from the Planning Dept. CITY/STATE GrJ1'~~~~ PROPERTY LOCATION 1/4, .S 1/4, Section ,~io , T 2 ` N-R_W TOWN OF B r. 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. SIGNED: A~A , DATE: fyZ3~y~( - 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 b the owner(s) of the property being developed, Any inadequacies will only result ~n delays of the pormit issuance. ,should this development be intended for resale by owner/contractor,(spec house), thena 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 A m (2 >c Location of•property /Vii1/4 x` 1/4, Section W Z'~~N-R~ W Township Z~ -a yam, Mailing address z-w Address of site 7 _ /i~~py~o / 3 Subdivision name Lot no. _ other homes on property? yes-X- No Previous owner of property _ .Q V1 Total size of parcel qC yeas Date parcel•was created 'Are all corners and lot lines identifiable? Yes ~ No is this property ) peing developed for (spec house)? Yes No 1 4 Volume -j and. Page Number c2~/ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICA'T'ION THE FOLLOWING: A "WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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) own the proposed site for the sewage disposal system orr I e(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 county Register of deeds as Document No. 0,4 gnature of pplicant • co-applicant Date of Signature Date of Signature - a DOCUMENT NO. STATE'B'AR OF WISCONSIN FORM 1-198a TNI! arAC[ R[sERV[o FOR RECORDING DATA - V 109~.)PA E22~.EED i 51004`7 REGISTER S OFFICE This Deed, made between • Glenn Waxon and V........... cella M. ST. CROIX CO., VW r' Recd lion Record ' Waxon,._husband. and_wi.fe.............................................................. DEC 6 1993 Grantor. . 10.00 ' A and .............lames__H...York.and.Leslie-A...Ynrk,..husband.and---- M hY; dif,e----------••--------------------------------------------- R~btdDeeds Grantee, y; Witnesseth, That the said Grantor, fora valuable consideration...... ii I RETURN TO ~ ' conveys to Grantee the following described real estate in ._St.._CrQix........_... i~ County, State of Wisconsin: s1t Tax Parcel No: Lot 34, High Meadows III in the Town of Hudson, St. Croix County, Wisconsin. f ~ SS FEE z t This .._..iS_ nOt.......... homestead property. i . O$~ (Is not) a, Together with all and singular the hereditaments and appurtenances thereunto belonging; Glenn Waxon and J rcella M. And Waxon { I warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any; I 4, I I and will warrant and defend the same. ~f Dated this ................3...`~.------•---••--••••.. day of .....Decemb?r---••-.......••--•---••-•--•••--•- 19.93... jl x~ (SEAL) i . y o!/r ........(SEAL) k lenn.Waxon.................................... ' ycella.rt_..Waxon........ Ii i -(SEAL) ----•-•----•----------------------•--............(SEAL) ~i s . % F. AUTHENTICATION ACSNOWLBDGMBNT j Signature(s) G1enn..W,aXQn_,.--Vyr.e11a..K............ STATE OF WISCONSIN `t as. C1ll-•----...°----...-° County. q 4-' _..day of authent ted this day of----- DeCember...... 19-_93 rsonally came before me this --------_d--/=~-=°------------•------ 19--2.3 the above -flamed ♦ I a_A-d '---Fx sUua•-Ogland------------------•- •-----11 y_r,c-L1 .t..1h: l a_ a - l} I TITLE: MEMBER STATE BAR OF WISCONSIN h__~g-.K/_-Qf _-i__•--_- Z:-_-__ ` (If not, j authorized b . y § 706.06. Wis. Stats:) I y to me known to be the person 15 wl~b~zecuted the foregl`ing _instrument and acknowle a the game f THIS INSTRUMENT WAS DRAFTED BY I!•`--=~~ r Krishna..Ogland -I-e ...........County, Wis. I 4' ttorney--at-_1. Notary Public ......----4.. (Signatures may be authenticated or acknowledged. Both My Commission is ermanent. (if not, state expiration ` Q 4 are not necessary.) date: G fit. i P _ .Names of persons signing in any opacity should be typed or printed below their signatures. I. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. t,.. FORM No. I - 1982 Milwaukee. Wis.