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HomeMy WebLinkAbout032-1091-30-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_ ~ ~ ~ I ADDRESS SUBDIVISION / CSM# Ot' 3 7~LOT # SECTION T31 N-R_fi_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM IV p,ro p~~ CIV5 6e 0 3$ 6 ~o ySr K A. s~ s per, c l INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r BENCHMARK: ICS ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: L&I5,(-✓ Liquid Capacity: I ► CcY)Ir"' Setback from: Well 10®I House 6 ( q~ther Pump: Manufacturer /t//1¢ Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM ~1 I Width: Length !5* Number of trenches g, Distance & Direction to nearest prop. liner ► ~b f Setback from: well:~po House Other ELEVATIONS Building Sewer /00i~ / I ST Inlet. 10(91gl ST outlet jOel©b,, PC inlet- _ 4~,4 PC bottom Pump Off Header/Manifold Bottom of system I Y7 ~ ' rS Existing Grade 101,15 Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: ~1 W1 ~I/<<g 5p V\ 3/93:jt j Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: PeftflMder'fAam: ❑ City ❑ Village `7i Town o : State Plan WO CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic c Benchmark Dosing ox/ d5. a Aeration Bldg. Sewer 5 28 d~, Holding St/ Inlet K SETBACK INFORMATION St/ Outlet 0/' /pv,d6 vent TANKTO P/L WELL BLDG. A irl to ntake ROAD Dt Inlet Air Septic >!570 NA Dt Bottom Dosing NA Header / Mom_ ' 198.23 Aeration NA Dist. Pipe 3,3 Holding Bot. System X80 2 8, old' , PUMP/ SIPHON INFORMATION Final Grade 9Z D . M urer Demand O-r 5' 3-:2 3~ d a " Model Number GP 'a 7 ZZ ' TDH Lift Fr' n System TDH Ft .~5 103 S~Z ead oss Forcem Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION 1-2 SS DIMEN I SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA M urer: SETBACK INFORMATION Type O ri aA, ER Mode Number: System: belcl Q ~,5 OR UNIT I DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. 7 Length a~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syst Depth Over Depth Over xx Depth Of Seeded /Sodded xx Mu Bed / T6enter / - ,3 7 Bed / TF1WE+rEdges1 3 7 '1 Topsoil C] Yes No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Somerset.33.31.19W, SW, SW, Lot 2 4 s Street 0, I-6c ato Plan revision required? ❑ Yes c0'Iq Use other side for additional information. 02 0. "9 - SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I' i SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY E IT # -Attach complete plans (to the county copy only) for the system, on paper not less than (8V 8'h 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 OWI!L / PROPERTY LOCATION c ~11' V~ 4~'/a G/'/4,S 33 T 31 ,N,R )W SS LOT # BLOCK # 79 PROPERTY OWN R'S MAILING ADD O •/4 CI AT ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER O 3 / r //iII sso$~ cola Y33 770 0s='~ vol~ 43 1:1 CITY NEAREST R l D II. TYPE OF BUILDING: (Check one) State Owned VILLAGE : ~r~4ti-St 3 VsL ❑ Public k1 or 2 Fam. Dwelling-## of bedrooms 3 PARCELTAX NUMBER(ti) ~q III. BUILDING USE: (If building type is public, check all that apply) v3~ jQ f ~~V 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. New 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 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) q ELEVATION ~p • / 7 Feet 1604 Feet VII. TANK CAPACITY Site in allons 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 Holdin Tank OB /;kd0 / e 15 r, ✓ 25 F1 R . F1 Lift Pump Tank/Si hon Chamber E] I El 0 El I El F-1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sew a system shown on the attached plans. Plumber's Name (Print): Plumber's Sin (N Sta ) rMPRSW No.: Business Phone Number: ~G.EQ S / m . p 5- G 439 6 / Plumber's Add ss (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary P rmit Fee (Includes Groundwater Date Issued Issu' g Agent Signature No Stamps) urcharge Fee) Approved ❑ Owner Given Initial / ~ , It/-f 3-g /y Adverse Determination 14 V 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% 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 i 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) Cott/ 4 14 ,lam« 33 T3I -4,lL M-ff ftvmwNl3 ca lEff XOLST OWNER 1SW n6rM If. NORTH Sr LLWA JLA' 35082 /doo c~- -1 71, 3 13-f,4C reo w, /~j To aL J,, 4 c. eff- I of Al' (91 too t% p w~i 1 ~8ry*t~ S -to se, I Tt weize, 1 0 , t -Tom 1xv i Ale to~ %c Its'- -21 ~rtQ G "`c /aN q av~ ~Nar~t D- 6 4N 0. do Ar- j 4 1 vnscunsuiudparuil"mVi muuauy' ,UIL ANU 5I I t tVALUAI IUN HLF'UH I rage 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code . ti " COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St. Croix 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. 032-1091-30 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Steve Olin GOVT. LOT SW 1/4 SW 1/4,S 33 T 31 N,R 19 xk(or) W PROPERTY OWNERS MA!I.ING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # Box 609 2 na csm 1 1 129 of 3-30-75 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE N NEAREST ROAD Stillwater, NIN. 55082 (612) 439-5730 ~rrvt [x New Construction Use [ Residential / Number of bedrooms 3 [ J Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate _,_bed, gpd/ft2_,$_trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.11 It (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem as ❑ U 14S ❑ U -3aS ❑ U Us ❑ U ❑ S j U ❑ S J@U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmxxbiy Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rt3tcfl 1 0-10 10yr3/3 none sl 2mgr mvfr if .5 .6 C-. 1 2 10-84 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 100.91ft. a l Depth to limiting ! factor E 84 Remarks: 'P 5 Boring # 1 0-6 10yr3/3 none sl 2m r mvfr Crw if 1.5 2 z> 2 6-84 7.5yr4/6 none co s Osg ml na na .7 8 ~w ?Cti•.?v Ground elev. 101.1A• Depth to limiting factor +84" Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave., New Richmond, WI. 54017 Signature: Date: CST Number: Qic.c 9-7-94 cstm 02298 PROPERTYOWNER Steve Olin SOIL DESCRIPTION REPORT Paget of 3 PARCEL I.D.# 032-1091-30 s Boring # Horizon Depth Dominant Color Mottles I Structure ( GP /ft in. Munseli Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence N Roots Bed ITrench 1 0-11 10 r3/3 none sl 2mgr mvfr gw if .5 j .6 .<l 2 11-82 10yr4/4 none co s Osg ml na na .7 .8 i Ground 100.6. i Depth to limiting - factor +82" Remarks: Boring # K%qM;::0 1 0-21 10yr3/2 none sl 2mgr mfr gw 2f .5 .6 wn 4 2 21-3 10yr4/4 none sl 2mgr mvfr gw if .5 .6 3 35-74 10yr4/4 none co s Osg ml na na .7 .8 Ground elev. 99.11 ft. Depth to limiting factor +7411 Remarks: Boring # 1 0-21 10 r3 2 none sl 2mgr mfr gw if .5 .6 S 2 21-39 10yr4/4 none sl 2mgr mvfr 9w if .5 .6 3 39-78 10yr4/4 none co s Osg ml na na .7 .8 Ground elev. 98.51ft. I Depth to limiting factor +78" Remarks: Boring # a~« Ground elev. ft. Depth to limiting j factor Remarks: SBD-8330(R.05/92) f STEEL'S SOIL SERVICE Gary L. Steel Steve Olin 1554 200th Ave. CSTM2298 SW4SW4 S33-T31N-R19W New Richmond, WI 54017 MPRSW 3254 town of Somerset (715) 246-6200 1 N 1'=40' BM= top of sw lot stake at el. 100' Mo'~ `k 100 n ~1 9 6-75 'Ph X ~ !3m• G e 32 3%1 M` Do Gary L. Steel 9-7-94 327331 ST. CROIX COUNTY CERTIFIED SURVEY MAP NO. vol. 1 Page 129 Part of the SW-, of the SW-4 of Section 33, T.31N., R.19W., 4th P.M. Somerset Twp., St. Croix County, Wisconsin. PREP. BY DIRECTION OF: N MEL TOBIN S 86049' 46"E I/16 LINE 1745 UNIVERSITY AVE. ii 408.92 ST. PAUL, MINN. PROJ. N0. 2375 50 ti FLD. BK 5 PG. 14 - 18 5 /9/ 75 J.T. LOT I ~ell , 217, 796.83 sq. ft ~ C.S.M. 4.99Acres .Z~ MO ro ~.So 2 6Dr q;l N N 74027'23"EQa 123.22' 01 © ~o~A ~0l 0010 Q S 82038'45"E ao0 0~ to JIBEARING REFERENCED TO THE EAST LINE 5 lam' LOT 2 OF SEC. 32, ESTABLISHED BY CE. COULTER 167.95 2~ I'4p~ 2010 217,799.03 sq. ft 3 WI AS BEING N 00038 23"E ~o 5.00 Acers = I,-I p0 4 N 87054' 41 "W , Q I o loo 200 300 400 500 600 w r.> 90 o J N w 0 1 574.41 0 CL ~I C.S.M. a M 1 ~ ?I SCALE I 300' 0 1 N 13q 37'S9'O~ `rnl 3 195015 51" N 8 0 K) LOT z o ' 220,502.60sq.ft -0 0 o LOT 3 -0 *-_-1 1/2"x 24' IRON PIPE SET Acq.ft o MIN. WT. 1.13 LBS. / L. F. z 5.06 Acers 0 a 0 219,4 04 .26 1: 5.04 Acers Ci , N 00 98 g 249.52' 66042 470.63 9Q000 N 1 Qj'" 66 90op0 532.03' 952. >148.71' TOWN S 87054'41"E ROAD l0 3233 POINT OF BEGINNING 6 UNPLATTED LANDS SECTION CORNER IRON PIPE FOUND CURVE DATA CURVE LOT RADIUS CENTRAL CHORD CHORD ARC NO. NO. ANGLE LENGTH BEARING LENGTH 1-2 4 300.00 840 44'01" 404.32 S 40016'42" E 443.66' 3-4 3 366.00' 300 31' 43" 192.71 N 13010'32" W 195.01' 4-5 2 366.00' 180 04' 05' 114.94' N 3702828' W 115.42 5-6 I 366.00' 180 04' Od' 114.94 N 550 32'33" W 115.42' SURVEYOR'S CERTIFICATE I, Forrest G. Robinson, a Registered Land Surveyor, hereby certify: that I have surveyed, described and mapped a parcel of land in the SW'-, of the SW'-, of Section 33, Township 31 North, Range 19 West, 4th P.M., Somerset Township, St. Croix County, Wisconsin described as follows: Commencing at the southwest corner of said Section 33; thence N00o38123"E 148.71 feet; thence S87-54141"E 249.52 feet to the Point of Beginning; thence N05o22141"E 539.03 feet; thence S8203814511E 167.95 feet; thence N7402712311E 123.22 feet; thence N30030102"E 674.31 feet; thence S86049146"E 408.92 feet; thence S00°55'11"W 1145.66 feet; thence N8705414111W 1068.66 feet to the Point of Beginning. Containing 20.10 acres not including that portion to be used for Private Road as shown on this map. I further certify that I have fully complied with h provisions of pte=236.34, consin Statutes in surveying and dividing the same. ~ ate Forrest o inson 4 3~ 7331 FORREST G. F FEED ROBINSON MAY 301975 s-7o7 AWs 0. CONN BROOK, w &&via ELE ~ir~ ~ Spa Wl$. r f 0 ®4 ` a►. CroixoCouN o 4, 40 1 b Wisconsin Y d°°a~ ROBIN Volume s e c ~ I NC 11 ~T 6 S ii0ga1fQ8~QQ 8 ASSO C P.O. BOX 498 BALSAM LAKE, WIS. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT I A V V1St. Croix County OWNEWBUYER I)Ctoij , 0)1-l" MAILING ADDRESS _)4q55 PROPERTY ADDRESS `f xo ocation of septic system) Please obtain from the Planning Dept. CITY/STATE W PROPERTY LOCATION Sk) 1/4, 5(A) 1/4, Section 33 , T~N-R~W TOWN OF &A , ST. CROIX COUNTY, WI SUBDIVISION 'v/A- , LOT NUMBER CERTIFIED SURVEY MAP 59'7331, VOLUME , PAGE la - I , 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. UWe, 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.. I / SIGNED: ICJ C/ DATE: d~V 1-2 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, Wl 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 -bQ y i j W, 01(A) Location o"ropert 5W 1/451 1/4, Section -33,T3/ N-R~W Tow hip (pia Mailing address k) 56 92 Address of site 4 20 1 Subdivision name Lot no. other homes on property? Yes X No Previous owner of property _~~(c S Go ye K o Ns k, Total size of property Cj acGV-- > Total size of parcel c5 ar-"e S Date parcel was created Ct,H ~j0, 1 S Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? x Yes No Volume 61g and Page Number 505 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. Cjao~ a'~ a' 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. 52-a a52- Signatur of Applicant Co-Applicant lo- la-q~ Date of Signa ure Date of Signature 109 3oS DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECOROING DATA STATE BAR OF WISCONSIN FORM 2-1982 s~aasa lc)17lqV- JZ T FRANK J. GOVERONSKI, widowed..and_.unremerri.ed.._...__._.....----•......_.........._ 0 conveys and warrants to DAVID W.__ OLIN- and_.QQL.QRE$._J,_._QL 1N,_.... _ husbatld._aad_.wi_fe------._....._......._........... t~ . • . RETURN TO First State Bank of Bayport 950 No. KV.95, Bayport MV 55003 the following described real estate in t., ..CroiX ........................County, State of Wisconsin: Tax Parcel No: 032.1091•= 30 Part of SW 1/4 of SW 1/4 of Section 33-31-19 described as follows: Lot 2 of Certified Survey Map filed May 30, 1975 in Vol. 11111, Page 129. This is not homestead property. (is) (is not) Exception to warranties: 4th October 19..... 94.... Dated this day of (SEAL) (SEAL) . /rank J. Goveronski ._._.(SEAL) ..............................•------•-.............................(SEAL) * + AUTHENTICATION MINNESUWLEDGMENT Signature (s) STATE OF IVISCGIMM19 ss. Washi.ngton......... County- authenticated this ........day of ..........................1 19 Personally came before me this _.4th........ day of .............October................, 19..94.. the above named Erank_-1•-•-Graver_nnski.,._wi_dowed_.and..... i TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the forego' 179P ' str ent an ackno the same. THIS INSTRUMENT WAS DRAFTED BY . A:.- 5:.. Peterson- of..Fi rst.-State--Bank-•of Bayport L * ...............Astr_ida..S_..:eterson._.._..............------ BaypQrt,..... N 55003• Notary Public Washi_ngton............... County, Wis. MN (Signatures may be authenticated or acknowledged. Both My Commissio ~ykjJ~ t ion are not necessary.) date: Ma 1 ASTRiD- $ PFTFR, NOTARY PUDUC-MINN~S(►TA WASHINGTON COUNTY -Names of persons signing in any capacity should be typed or printed below their signatures. My Comm. Expires May 15. 1998 STATE BAR OF WISCONSIN HGMillsrCompsry~ FORM No. 2- 1982 Stock NO. ~3~ Z