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HomeMy WebLinkAbout020-1291-00-000 s^ T d Y, r STC 104 AS BUILT SANITARY SYSTEM REPORT ER S ~/Yj /Y1 / Lf2 RESS " 1,6 # y ",rpUBDIVISION / CSM# ~~~(~/QQ {IIG~~ LOT ,J6ECTION___3L7_T Z~N-RZf rg), Town of SD /Y ~;T. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM No7E As of -7 - l1- 9 t( i h~ WELL NA S ~0-T y~T BEEN 7,fsTAIt-4b ~o - A c TC,etUATE e ~ as ma=y' 72 14 11 Seu~~ Lv ~ L~ h 0 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form .~S Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: Tc> C7r TO. ?f D i1r S W ii►mr E/ /DO, oa 7.5'S" ALTERNATE BM: Tom o~ ~o~ Fow. ~c%G 1 = 1 •(o SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:_W,L,S ¢ r Liquid Capacity: Joao 51, Setback from: Well 9S~ House Other 72ra 7::,j', Pump: Manufacturer-- Model# - Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: J$ Length yo Number of trenches Distance & Direction to nearest prop. line: 71 o u/fs7f /off Setback from: well: House ?S Other 7 z " To ELEVATIONS Building Sewer-- ST Inlet J0,(,3 ST outlet oa / PC inlet _ PC bottom - Pump Off Header/Manifold A96 Bottom of system ✓ j_ z - S-Existing Grade c/. o o" Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt ' Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Wuma,n Relations INSPECTION REPORT ST. CROIX Sarfety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Perrmit HolddE~r's Nasme~: ❑ City ❑ Village ~ Town of: State Plan D No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ' or lea -S o,/ v TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~j Benchmark 0d Dosing /0/,70 /o p Aeration Bldg. Sewer Holding St/Ht Inlet /0,7d-- qg TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 7a y b- p ' NA Dt Bottom Dosing NA Header / Man. A/ q7, IF Aeration NA Dist. Pipe /a,0'3 94,79 Holding Bot. System 15, 5P 95. 7 PUMP/ SIPHON INFORMATION Final Grade .5.q /UO, ""2 41 Manufacturer Demand g /b/, 73 Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Dist. To Well Fi SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of T riches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION /s L/D DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK _ INFORMATION TypeO Model Number: System: Y,-a CHAMBER M OR UNIT ~tl DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. I 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 f lr'' Bed /Trench Edges 0 u Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.27.29.19W, NW, NE, Lot 10, Hill Farm Road 2 - It~k14 °11.83 G -evision required? ❑ Yes ❑ No per side for additional information. 7 i o J 05/91) Date a nspd6 'S Signature Cert No. ADDITIONAL COMMENTS AND SKETCH y SANITARY PERMIT NUMBER: ' I f F .t SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code 0 , &00~ STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than o~ f~~ 8th 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 SAAR ^41-LLER W % iE, %,S Z-1 TZc1,N,R 1 01 E(or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ox Z~Z CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER uDSON WX 1,54L ~t~ 46 )?-1 (A JM tRD jtLs IL TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE : O MLI VA R M IKo f* D JS TOWN OF: CELTAX NUMBER( b) ❑ Public N1 or 2 Fam. Dwelling- # of bedrooms 3!-- PARCEL III. BUILDING USE: (If building type is public, check all that apply) ©Z - I,>-91- 60 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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. New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 Reconnection of 5. ❑ 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 ❑ 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 ft.) (Gals/day/sq. n.) (Min./inch) ELEVATION So REQUIRED (sq. ft.) PROPOSED AREA 7 -z-O ` Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank X 1000 V0 E\ 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: (No S ps) MP/MPRSW No.: Business Phone Number: bo v 6 ?,.D i`l Z -LL3 Plumber's Address (Street, City, State, Zip Code): o 4 1-Lx- AT--W ONE W-1- s c711 IX. CO NTY/DEPARTMENT USE ONLY ❑ Disapproved Sani 5F mit Fee (Includes Groundwater Date Issue issuing/ gent Si re N Surcharge Fee) Approved ❑ Owner Given Initial S or k A4.111- a Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & 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. III. 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'/z 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) SAM' HUM131t2}~, H1J-L 5 1.O- Sys~Fm cIV= 9 o o 0 sue.+~E r3.t~~To'C o 7¢ta. ~T S.W. Co/Nar FI. too,e ' Sy~-1 EM £l. ZIWE 2i7.sc' 7Q ~i II ~a✓►~ ~d. 282't cor LoT Loll zyo AL 0. S ~ WEAL t Y~ f S t ~n 4- z T- 440 ~ 2y X32 7,e k4 R e \ I I ~ s9' ~ 9 E r Rio' f.~'s- s I 1 ~ S3 ~ - - - L?- ALTER NAT E f RFA I ~.z. I:I. =9Z- so - i3- 110 ~ ~ ~ yS 1$I B.M. Top o~ , ! -rte A~.~ E r. loooo \,k s --7 ' - WAST COT & W F ?/4, /3 H(LL FARM ROA D Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT (~,e Page l of ~ Labor anr! uman Relations - IVision of'3afety 8 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 'S~ f X 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNE PROPERTY LOCATION c1 ~ Q jiC~ I~}! I r; ( 2 GOVT. LOT t~ tN 1/4 N if 114,S 27 T Z- N,R / / E (or) W PROPWTY OWNE ' S MAILING ADrESS LOT # BLOCK # SUBD N MEARMtk j f/BLS CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VIL GE OWN NI~QREST ROAD vAsrJ d~ f s ( ► d LSdb~kla6s New Construction Use Residential / Number of bedrooms W [ ] Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow gpd Recommended design loading rate © -7 bed, gpd/ft2 0 $ trench, gpd/ft2 Absorption area required 69 S bed, ft2 S` 1!~ trench, ft2 Maximum design loading rate a, bed, gpd/ft2 4 •T trench, gpd/0 Recommended infiltration surface elevation(s) C16.00' j-C'/t Sr" ft (as referred to site plan benchmark) Additional design / site considerations 9 Z , 4 W4~i7 Parent material Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL MOUND IN ROUND PRESSURE AT BADE Y TEM IN FILL HOLDING T K U =Unsuitable fors stem Fr S ❑ U KS ❑ U PKIS ❑ U [S ❑ U KS ❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo~ Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench L -7 7K C -0 joy f°9 s S;L O'LK m r C 1 ..Z Ground B ,7-33 yk + S oi 'h, , c I .7 r7 g elev. 7: 0 16yk4l f: Depth to limiting fac1f, Remarks: Boring # QA L / n, SbIC r'►1 r C 'z C) s0.5 ti R 0-Y ll~ .6r i v<v g 34 3 sY,e 3 3 S c, 1 I 4.S q0 M 1 C Ground elev. 3-SC 7.~y~ 3 3 _ S D I C l ? 14 ft. 70 16-1 ii~ Std 12 A, < < as Depth to facrorg o -Ifs /,D '14 S r~. /h ) 7 0.'% > 9'i3 Remarks: CST Name: Please Print 144 A QSc---J Phone: 4 49-0 Address: v-&Sn*j U1 s4o i-~ 6 Signature: Date: c~~ CST Number:.,A 'i4 t., PkiAc PROPERTYOWNER S*►S' ~`1►(Z~~ SOIL DESCRIPTION REPORT Page of PAIRCCzL I.b. # Loy ) ~ l~ L1'~~ ~ Boring # Horizon Depth Dominant Color Mottles Texture Structure ConsistenceBoundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rends aka O~4~; 67 Ground ~S 0-33 n, r G O ? O.~ elev. ~9.7Z.,ft. rh Depth to limiting factor Remarks: Boring # t;} /ov '7 Ground elev. j pl. eft. Depth to limiting factor > /b ~ 12_ Remarks: Boring # L -Z, c 1 z p.3 ZI >oY 3 4 S,C swk /I-Fr ©.q a Ground z 3kft. $-sal 4 s (3 ^ t C p Depth to $ 27 y~ 3 i s s0 limiting factor Remarks: Boring # a:k > ti Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) n ~ . P.. ~ rlp t ~ ~ ~~VVi 1 07 711 Wei to l0 0 t, ID D ~ G r r G U1 14- -NO I m :I I I I I~ I' O .I I I I r' z ~ _ ~ I I S ~ 1T1 I ~ I I I O ol I I I C I I ~ I I ~ I j O F3 I I I m I I I m I z ~ ~ I I I `o m i ~ m I I I I I U I rn I rn I W s I I j N I < I I I ~ 1.^ I D j co I I I ~ cn I m j I I I y I I I j m I I -o n I 0 z I I E rn z I I 'v W I \~V r~ I I I o I ~ ~ o I I I W .ti I i I i If II m I - ~Z m 0 W I -i z Od N I -o cp i m I Z 'I's R" x o -PY 01 --f 0 Q O v 0 O 00 . g F ' 1 ^ < NO M N Nz m -u b v m ~l ^~7 0 -p 0 '*l m r', m i i I i f 962 AO' 3 •N Drainage ami ponding easecrienta to elevation shown SL Section"corner monument - Aluminbm cap found (356.67') Previously recorded information. it Bd .e. f - P CURVE DATA TA LOCATION SKETCH y Curve Lot Central Radius A Number No. Angle L NE CORNER 1 Bndry 46.00'00•• 167.00' 1 SECTION 27 46.00'00" 233.00' 1 T29M. R18w 2 6 20.31'02•' 233.001 ;A 2 Road 16 17'08" 233.001 4NPLATTED'- LANDS 2 7 .9.11150" 233.001 wi OUTLOT - 2 ZI. I. 6.300 S0. FT. - Q 14.14' 0.144-AC. JI S 00'001f4'M 898.38 .96• 21776•. 217.546 JII q~ . 217 a4.00 884.24' - of I AS o ~M±~ s3~ o I °~.I S OFFICE. o <I o o `1 I ` a}/ 4: e-j 12 0 11 ° 10 ~ a - ; I 'Ids C; C; 'SW • 97.560 S0. FT. 9T.5QS0. FT, t 97 SM FT. _ 97.56390. FT. I ~p O -2.240 AC. v 2.240 AC. W - ;.240--AC. ' U 2.240 AC. °a f ( ~1 ~ °o OT '~I I I = I 1 V. t.l I o O o Z W. Z 0l I. WI 01 BENCHMARK- TOP Of CNCRETE O I 0 1. OF SOUTH POST OF M61R4 vl a { HILLS'. SIGN. ELEV.. 5.02 ..•881.54'-•' - I j" - 14.00 8 6 1 C'°' 216.13' 216.13•. 216.13 216.17• S 00*00.14-N 302.86• 14 E 01.97 A_"~_. p. 2057 _ N 00,007 12 WW to ~.I,.(. ~g FPM ROAD -to ale- 21.51'" 9" 00'00-24-14 1202.27 .206.31' 200.00• I ' 200.00! - 200.00 200.00• I 160.47' ' o ( ~i 14.OJ' - I ( ~ If83,7 - - ~I 1 938. . _ - ross~KS t. Ky 4O* X 40' JOINT - - ' r--ORAINAGE EASEMENT - DRIVEWAY EASEMEN .I. - - RUNNING 40'ALONG- I 1 'HUILOING COMMON LOT LINE \ - SET6ACK AND 20. ON EACH .-LINE ! ( LOT. - ~ i O O I ;O ~ O A 11 1 g N\ - I ^ f 66.39 SO. FT. 66:39 q. FT. 66.39 50.. FT: - rl • 8..3 SO. r"L 116103 $O. FT. 69.791 SO. FT. n 2.029 AC. n I -2:029 AC., 2.029 AC n - - 2.029 AC. w 2.711 AC. 2.061 AC I _ a of s . a a e e. I o o • I _ ' e e J 0 ~ I I ~ t( - 27.62 1281.34'.._ 200.00• 200.00' I I - 200.00" 200.00' 200.00' 267.34' 14.00• N 00'00' 14'E 1309.16' l ( VNPLATTE9_ OUTLOT I _ C 6.166 S0. FT. _ • 0.142 AC. : - - - - NI/4 CORNER SECTION 2T - - STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S A ✓I'1 M (L LZ R_ MAILING ADDRESS 13c~/C L 8 Z._ . U S © V.' vi l yo / PROPERTY ADDRESS g / N 1 L L F+ 2 hA R . , s a wz SS/O lra (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~4J `s©,~. w S o t k PROPERTY LOCATION N L kJ 1/4, w F- 1/4, Section 7 T__L7_N-R. TOWN OF Il± u ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 1 , CERTIFIED SURVEY MAP `I 9 710 7 , VOLUME IN a /,PAGE f LZ_,LOT NUMBER i b 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 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 S. k%_ Location of property_ 1/4 R~__1/4, Section 11T 'tc~, N-R iq (W Township 2 ~UDSON Mailing address~pX ~ Address of site $y \\\~L F A M ~ ubso " vil syjjl L Subdivision name ~~MB (2 D KILL 5 Lot no. tO Other homes on property? -Yes No Previous owner of property WO lAB I Q_ 3> ~A ~!D CO, Total size of property 2_,140 A-C, Total size of parcel ' • z ~ p d1 Date parcel was created 1 4, 3 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume 01 2,~ and Page Number 2,g L 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. 57p L Z pq , 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. S' nature f Applicant Co-Applicant Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1988 THIS APACE RceERVED FOR RECORDINO DATA WARRANTY DEED ' 502209 von REGISTERS OFFICE LL 10212AGE2R2 s~. cRo►x co., ati~i This Deed, made between ..Humbird Land Corporation, Fl:;c'd for record A Minnesota Corporation authorized to do business JA _.Wisconsin---.•--••••••-•-••. JUL 12 1993 .20 P. • Grantor, VR.SI, and Sa>t} E,~ Miller,. a * 777, tor of Deeds 3 Grantee, 5 WitneSSeth, That the said Grantor, for a valuable consideration...... RETURN TO conveys to Grantee the following described real estate in . $.t .t Ci_..rO1X County, State of Wisconsin Lots 1, 2, 3, 4, 5, 5, 7, 8, 9, 10, 11 and 12 Tae Parcel No: d Hills, Town of Hudson as filed in the Plat of Humbir and recorded in the office of the Register of Deeds for St. Croix County on April 7, 1993 in Vol. 5 of Plats, Page 99, Document No. 497107. Lots 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 and 25 'in the Plat of Humbird Hills 1st Addition as filed and recorded , in the Office of the register of Deeds for St..Croix County on April 7, 1993, in Vol. 5, Page 100, Document No. 497,108. f~~~•'~y~Y.r `~„'"5'- R'.~: .;~1 yam: ~•,,,,ro. ar~-',~~ ' ~kx r'k` ?s._g„~.~ ~ L r` - ~,.r „,i`u•","4?~s''~'~-,~ _ YY•rU This ii..nt......... homestead property. " (is not). Together wish all and singular the hereditament, and appurtenances thereunto belonging; i And...titwlbi ~d..LaAS~._^.FPOraton warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except .easements shown on the above mentioned plats. and will warrant and defend the same. Dated this ........12th day of ...JuAY........................................................... 19..93... Humbird Land Corporation, a Minnesota Corporation authorized to do business in Wisconsin (SEAL) By (SEAL) Austin J. Baillon, President ....(SEAL) ....................(SEAL) _ t • AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN r ss. -~_5,w..County. authenticated this ........day of 19...... Personally came before me this /Z- day of --JUIX....................... , 19..93.. the abbae•1wkned • • .3 ..1 ........:..l _ ' ...AU$tjU._j:.. Ba} llgn,•-President .o ~~~t ~~y ti, TITLE: MEMBER STATE BAR OF WISCONSIN HLlL4b kFd__nd-_CQrppratiorY.••;':•~•j-~•~-- (If not, a . t^. w f authorized by § 706.06, Wis. Stets.) o to me known to be the person xvh~G/y ecuted the foregoing • strument and acknowledgePI& satT14 Q H t THIS INSTRUMENT WAS DRAFTED BY H N V f/I D'Q Q •~•~Uf .........11. .........k_ .Kueppe rs r-.Hackel..&..Ktmp.pLets................. . , - Notary, lie /.IL_._.-._._.-.-...County, Wis. 1350•-Capital--Centtet._St...pauL,..Jdli_.55_LOZ_ . (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (1f not, state expiration are not necessary.) date: 1 19.........) Names of persons sienina in any capacity should be typed or printed below their sisuatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leval Blank Co. Inc i FORM No. 1-1982 hli,wsukee, Wis.