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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER a, ~ , /t r
ADDRESS
SUBDIVISION / CSM# ® LOT #
SECTION__T__ ?ZN-RW, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Sly
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK. 31 -
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
'Z; ixA/
Manufactuf'er•Liquid Capacity:
Setback from: Well-/ House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 1__2 Number of trenches
Distance & Direction to nearest prop. line: Setback from: well: , House_ Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet -
PC inlet PC bottom Pump Off
Header/Manifold 9 s'g Bottom of system 57
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: 226-2
INSPECTOR:
.
3/93:jt
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 residence located at:
1/4,// :5 1/4, Sec. , T_ Jl N, R_21 _W, Town of
Upon 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 'z 22z
Did flow back occur from absorption system? Yes No>~ (if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete Steel / Other
Manufacurer (if known):
Age of nk known ,
i
(Signature) (Name) Please Print
(Title) (License Number)
zn -l-
( Date )
Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
Wis. Adm. Code (except for
conform to the requirements of ILny4/VMP/MPRS
inspectio o M-,v- over outlet baffl-~ , Name Signature ,
5/88
I
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 218987
PeWA& INaMANE ❑ City ❑ Village E:kTown of: State Plan ID No.:
Somerset
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 1 _j 1001 6
00, a str Cc,,~,..~ A9400376
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 0/, q7 NO,
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P / L WELL BLDG. Airito ntake ROAD Dt Inlet
Ar
Septic NA Dt Bottom
Dosing NA Header / Man. 2 $ q q 3,5-Y
Aeration NA Dist. Pipe ,63 q13, Spy
Holding Bot. System q~ S' rI
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Head
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS A* / i DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER model Number:
System: J`^0 /L) 114 OR UNIT
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 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Somerset.33.31.19W, SE, SE4'Lot 14, 49th Street
I
Plan revision required? ❑ Yes ❑ No 1 /
~t~
Use other side for additional information.
SBD-6710 (R 05/91) Date inspector's signature Cert No.
ADDITIONAL COMMENTS AND SKETCH a
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code couNTv
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than I gQ
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
'/4 '/e, S T,3/ , N, R(or
PROPERTY OWNER'S MAILING-ADDRESS LOT # BLOCK #
,in
tom/ l
Z&3 :Z 2
CITY, STATE ZIP CODE PHONE NUMBER SUB IV SIGN NAME OR CSM NUMBER
0 CITY NEAREST
ROB
IL TYPE OF BUILDING: (Check one) F-1 State Owned 0 VILLAGE:
❑ Public ,01 or 2 Fam. Dwelling-#of bedrooms _~K PARCEL TAX NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply) V 3Z ' 10q+_
W t.J
1 ❑ Apt/Condo w
20 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) 1.0 New 2. nj Replacement 3. ❑ Replacement of 4.E] 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./' ch) ELEVATION
~3 Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holding Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installa ion of the onsite sewage system shown on the attached plans.
Plumber' Jam (Pri I Plumb 's S' n r • (N ps) MP/MPRSW No.: Business Phone Number:
r
Plumber's Addres tree , City, Sta e, Z' Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanity Permit Fee (Includes Groundwater Date Issued Issuing Agent Si s)
pproved El Owner Given Initial ' . OVSurcharge Fee) LIT m -Adverse Determination / 0-19
X. CONDITION OF AP ROVAL/REAS NSF R DISPROVAL:
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, 60-8-266-3815.
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.
Il. 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
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)
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
Labor and Human Relations
pivision of Sa,'ety & 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.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT 1/4 1/4, g T N,R Aorto
PROPERTY OWNER':S MAILING DRESS LOT # BLOC # SUBD. NAME OR CSM #
CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®fOWN NEAREST RO
i-)
[ ] New Construction Use ~J Residential / Number of bed ms [ ] Addition to existing building
bQ Replacement [ ] Public or commercial describe
Code derived daily flow SO gpd Recommended design loading rate 1bed, gpd/ft2 JTtrench, gpd/ft2
Absorption area required IJ-,?-S- bed, ft2 trench, ft2 Maximum design loading rate ~-J/ _bed, gpd/ft2 ,suetrench, gpd/ft2
Recommended infiltration surface elevation(s 2.2 ft (as referred t ite plan benchmark)
Additional design / site consider ions
Parent material Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND 7IN-,GI;OUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ERS ❑U [OS ❑U ❑U ®S ❑U ❑S ®U ❑S ICU
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 Trench
92,<1 zu
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Al~
A1101 Z5
Ground
elev. _
z ft.
Depth to
limiting
fact` Q
Remarks:
CST Name: Please Print Phone-
Address:
~
21,61
Signature: Date: CST Number:
PROPERTYOWNER~~c SOIL DESCRIPTION REPORT Page~-,w of
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
- D
Ground I
ele .
ft' - v 'If
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
~ifoE 3ef 3
0
Se~
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l~
f
i3y `
CENTERLINE
TOWN ROAD SCALE
_C' 200 0 100 200
0a
2~9° ►n 1401"°s o N E 1/4 - SE 1/4
v 118 I ~$,A R C- 4 0.54'
Q1( Lh E 1/4 NER
z ti~ (yo0l5 006 SECTION 33,
140' 0~-- N89031'25"E 901.37' ej;0 T31 N, R19 W
-~/L - - - - --t5- W
0 K)
Q 0)
S89031'25"W 903.58'2y 1 W 15 _ N
1,-a.
2 IS
?11 16 0 N O 1 0
It N
N 1 tt o (n i
01 (n EAST LINE OF SE 1/4
It 1 I 2 od SECTION 33
LEGEND 40.02 I 9\°y 423.24' 268°22'40"
463.26'
190 ° 3 O 'E POINT OF
SECTION CORNER MONUMENT. 3b 00 S 89 BEGINNING
N O
o 1" X 24" IRON PIPE N ° 00
0 01
WEIGHING 1.68#/LINEAL FOOT. z M
14
SE 11--SEI/4 6,17 ACRES
N W
CD a
w N TRUE
,u t- P O BEARING
FRANCIS K NORTHERLY RIGHT-OF-
OGDEN WAY LINE OF RAILROAD
. { $-882
• ♦ RIVER FALLS, (r 460-60'
'9► W'S' 269°06'35 70°38'45"
S 89°31'25"W in:
w_ ~.,~2 1U)
CENTERLINE OF WISCONSI CENTRAL
RAILWAY CO. 8 MINNEAPOLIS,ST. PAUL
>URVEYED FOR: GEORGE HOLCOMB AND STE. MARIE RAILWAY CO.
R. R. #1, STILLWATER, MINN. 55082
DESCRIPTION:
k parcels land located in the SE1/4 of the SE1/4 of Section 33, T31N, R19W,
town of Somerset, St. Croix County, Wisconsin described as follows: Commencing
at the E1/4 corner of said Section 33; thence S1°07'20"E (true bearing)
1884.93' along the East line of said SE1/4 of Section 33 to the point of
)eginning; thence S1°07'20"E 577.82' along said East line of the SE1/4;
thence.S89°31'25"W 460.60' along the Northerly right-of-way line of the Wisconsin
entral Railway Co. and the Minneapolis, St. Paul and Ste. Marie Railway Co.;
thence N1°22'W 585.751; thence S89°301E 463.26' to the point of beginning.
I certify that the above description and map are correct and that I have fully
:omplied with the provisions of Sec. 236.34 of the Wisconsin Statutes.
)ate: February 17, 1975 );;~Z-
882 Map No. 3-
rR4r y Qcsd~ ,
"1 1 V 11(~~ l~
j, J Vol . re T Page 84
.
y'
SOUTH ERLY . RIGHT- SCALE
WAr-LINE 200 100 200
- t,ya i
ENT R
4 TOWN .ROAD 5
I o 5 g 10
CURVE DATA ~~aMNk~ FI L E U
a I ' 379°08*gG AIIAR 4 1975 -
19
40 .514'- CHORD JA" CONNELL `
I .504'- ARC TRUE FRANCIS H. flower .t 5°'d,
~ Crow Cow,
1267.00'-RADIUS BEARING QaDEN W h,
I 3 S78°I3'20"E TANGENT 5.882 .S
BEARING $
W 18 VO 1 °50' CENTRAL ANGLE RIVER FALLS,
( 1 WIS. 10Z
0 91~ ~:•.1,~,,,~ T31N,R19W
a
Vll SEt- z NE SE _ ao
o
M co O N O
a o
M V'
In 10 a
Be 2.d' CV
1320.00' to
S 89°30'E S 89°30'E
854.33 M
465, 67' M
7 o 16 2.52 ACRES ti O
Z
P INT F
ti 0 S89°31`25"W 861.37' N - S8 ° 1' " BEGINNING P
LL U
N
SSE - 1. 31- 40.00 Z
18 1.87 ACRES
>l S 89°31' 25°W 903.58' °5 5„ F-
9C 15
0 <W
4 5;61 ACRES wtn
i~ O
s I SE-SE 0Ipq M_ o
3 N 01 N ~C o
iva 4N U0
LEGEND N o a (n
z
,SECTION CORNER MONUMENT z J°v
o, ti
M
;oil" X 24" IRON PIPE WEIGHING
1.68#/LINEAL FOOT. 40.02 423.24' ti
268008'Od N 89° 3O' W
SURVEYED FOR: GEORGE HOLCOMB 4s3.2s' ,
R.R. #1, STILLWATER, MINNESOTA 55082 14 1
DESCRIPTION:
' Ea c6l'of land located in the SE1/4 of Section 33, T31N, R19W, Town of
-tgmexset, St. Croix County, Wisconsin described as follows: Commencing at the
El/4 corner of said Section 33; thence S1°07'20"E (true bearing) 1320.00' along
the East line of said SE1/4 of Section 33 to the point of beginning; thence
S1°07'20"E 564.93' along said East line of the SE1/4; thence N89°30"W 463.261;
thence N1°22'W 404.251; thence S89°31'25"W 903.5$1; thence N1°45'40"E 731.531;
thence Easterly 40.54' along the Southerly right-of-way line of an existing town
road on a 1267.00' radius curve concave Southerly whose chord bears S79°08'20"E
;0.541; thence S1°45'40"W 548.141; thence S89,°301E 1320.00' to the point of
beginning.
I certify that the above description and map are correct and that I have fully
complied with the provisions of Sec. 236.34 of the Wisconsin Statutes.
Date: February 17, 1975
FRANCIS H. DEN S-882 Map No. 73-142
Volume I Page 85
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER _IJ L) A ,U~
MAII,ING ADDRESS /f 7J2~T
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
>NI
PROPERTY LOCATION SIF- 1/4, `jam 1/4, Section 2L T N-R__/,,__W
TOWN OF _ Jo M X12 5 E-7- 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 y iration date.
SIGNS .
DATE: 0 ;
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
•r 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 -1) y4 ,Ut /A CiC-J
Location of property f>' CC 1/4 1/4, Section IT 3L N-R_lg W
Township 0me-p-mss -T Mailing address ~/q ,
t-72 ~ C-TT U) e 5 /o 15
Address of site SAIn c 4s 4
Subdivision name kte'Ai 67 Lot no. AJZ4
Other homes on property? Yes, l~_No
Previous owner of property Jo t4 y K ~C'10
Total size of property ( ( AC .
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes No
Volume IO&C and Page Number 5 as recorded with the Register
of Deeds.
----------------------------------------------7--------------------
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 ffice of the County Register of
Deeds as Document No. t5i7 3 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 offic of the County Register of Deeds as Document No.
r
Signature of Ap cant Co-Applicant
fT~ /C
Date of S i anatl~f? 11atn nf s i onatiirP
I~. DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
~
STATE B44,0 WLS ONSI O M 2 - 1182
.PAGE _
51 01 John K. Echo and Virginia R. Echo, husband and wife,
JUN :1,494
Duane J. Macie, also known as
-
- - - - i 1
conveys and warrants to Duane
M_,] _ rson 4
- .--e _ x
- -ane - c?e-a __a _.s .inl
- -
RETURN TO
the following described real estate in S_t-._- 0:0i.2C------- ...---...County,
State of Wisconsin:
Tax Parcel No:
Part of SE 1/1+ of SE 1/4 of Section 33, Township 31 North, Range 19 West,
St. Croix County, Wisconsin, described as follows: Lot 14 of Certified Survey
Map filed March 4, 1975, in Vol. 1, page 84, Doc. No. 325866.
Together with a non-exclusive roadway easement over Lot 181of a certain
Certified Survey Map recorded in Vol. 1, page 85, Doc. No. 325867.
This is homestead property.
(is) KXXR~
Exception to warranties: Easements, restrictions and rights-of-way of
record, if any.
19.94--
Dated this - - -----~-1-------•------------------- day of May -
- -(SEAL) - ~ - K- IM - - - -(SEAL)
n K. Echo
-
(SEAL) 1C. -------(SEAL)
Virginia R. Echo
-
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) JOht1---------------------------------------------------- .__cho-andSTATE OF WISCONSIN
Virgi.nia__R?. __EqhQ--------------------------- ss.
-----------------p------------------County.
• Ma .G 94
authenticated this __r.___..uay Personally came before me this ________________day of
19 the above named
Kristina l9gland
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland
-
Attorney at w
Notary Public -------------------------------------.--County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date: 19---------
)
*Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
FORM No. 2 - 1982 Milwaukee, Wisconsin