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HomeMy WebLinkAbout042-1043-20-000 vj C-0 O 0 i o 0 m i ti y i O c Z 76 LL c O "O Q Cl) z E z = o v o z rn l a m z 0 o Z d c ~ O G7 2 c CD z CD E N N O M _ N O O U) C C c U O 2 Q O Z H Z N 0 c N N E v~ N O 67 d a~i U IL CL M LO U') An 1; ED C) 0 O > G O 0. 2] N 2 0 0 EI U N N N ' Z N -0 d J O O O O O a a a • N (D ° c 3 c N a to U CF) rn o v °o C0 'a c °o °o p^1, 04 N N O ~ E N CO CO .0 N O N 'O d Q ~ i0 5, 41 O 7 O rV O ~ Y1 N p w C N C O c c n M r C OOi O O pO - O 3 U O s a V N N O 12 a I!I p N N In C; ~ ~ C O O O M 01 (O O V ° c o r t Q n N o F- F- c N N O rn E E U • L' O > Z N O N=5 i=3 Y) r ~ M a • a m m 3, A t~a~ ''oin0 f i t STC - 104 AS BUILT SANITARY SYSTEM REPO zq' ^F ,°`G s t °sS' - t r ~M OWNER ( Pr C~~_ S A t, f "4, fr ADDRESS SUBDIVISION / CSM# LOT # SECTION _T 0(N-RW, Town of -e-i l' ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A' ,V t ~ 64 sv. r 6 60 1 ell 8 IV -e INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tail}, manhole cover. PUMP CHAMBER Manufacturer: Liqucapacity: Pump Ilo- del: Pump/Siphon Mf'act.: Pump Size I Elevation o ~,knlet•:(J]Ctom of tank elevation Pump on elev.: off elev.: Gallons/cycle: Alarm: Man.: itch Type: Location Distance f m nearest prop. line: Fr6ht,,_._ Side, Rear-Ft. Dista a from: Well Building IL ABSORPTION SYSTEM Bed: Trench Seepage Pit: Width:_ Length Number of Lines:_3_Area Built Exist. Grade Elev. 41 (0,13 Proposed Final Grade Elev. Fill depth to top of pipe: 4071, No. feet from nearest prop. line:Front;'00 / Side3o Reap Ft. r ~ No. feet from well: r.~No. feet from building Gjp HOLDING TANK Manufacturer: Capacity: 100a C5 No. of rings used: Elevation of bottom tank: Elevation of inlet: e7 q.(r7 No. feet from'nearest prop. line:Front side , Rear Ft. No. feet from: Well building nearest road Alarm Manufacturer: INSPECTOR: 1 ICY\ DATE : PLUMBER ON JOB : v~ A S k LICENSE NUMBER: 00 ( 0130 6/90:cj Wiscorisin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor ane,011°umanRelations INSPECTION REPORT ST. CROIX S,rety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Pelrsn~liH~lslgj'' NCY & JOYCE ❑ City ❑ Village © Town of: State Plan D o.: CSIITVV BM Elev.- Insp. BM Elev.: BM Description: } 1i Parcel Tax No.: le-lj,6~ A94011711398 TANK INFORMATION ELEVATION DATA / / TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic es Benchmark 41 i Dosing 4:~,/s ' /Z rr/ as Aeration Bldg. Sewer Hol St/ tV Inlet 3'~p f7~ _ r TANK SETBACK INFORMATION St/ F e, outlet y'z/z 9,3 $Z' r !I1 TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic a ' NA Dt Bottom Dosing NA Header / Man. n. VIL Aeration NA Dist. Pipe V tin H OM-1 Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift F ' on 5yste TDH Ft Forcem Length Dia. H Dist. To Well OIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of renches PIT No. Of Pits Inside Dia. squid D th DIMENSIONS 75i DIMEN 1 N SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING u a urer: INFORMATION Type Of rim, Moe Number: System: Ere-maci} C R . OR UNIT DISTRIBUTION SYSTEM Header / Man fold Distribution Pipe(s)/ d / x Hole Size x Hole Spacing o it n Length Dia. T Length Dia. Spacing 414 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S ms Depth Over „ n Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched -l4-/'Bench Center B%t/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.)`f{ S l3 l°3 LOCATION: QWarr n .16.29.18W, NE/, NW, / Lot 2, 10th Avenue a e- I '~G ~ /C.7 r1 r+. /,Lf x Z't? eni- ~t ~Ca J.~ Plan revision required? ❑ Yes M_lq_0, Use other side for additional information. ~a kdAA SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: - ' . to `viz'" w'Z 7Y YX 7 ®ILHR SANITARY PERMIT APPLICATION . In accord with ILHR 83.05, Wis. Adm. Code Cod M7= - STATE SANITARY PERMIT # -;,-Attach complete plans (to the county copy only) for the system, on paper not less than P I q 00 g 8%x 11 inches in size. ❑check f revision to previous application -See reverse side for instructigns for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION =PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PR~Of RTY ATION / JOCc /vlle, 719% Y,,,S r1b T.V,N,R E(or)PROPERTY OWN R'S MAILING A DRESS IV LOT # BLOCK # m it q A* CITY„ ErTATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER o✓"~ f 9 331 11. TYPE OF BUILDING: (Check one) CITY NEAREST .1 ❑ State Owned VILLAGE . WARN A 'a 7 17,4 4,.e ❑ Public 1~ 1 or 2 Fam. Dwelling-# of bedrooms- A DIM 111. BUILDING USE: (If building type is public, check all that apply) ` , /CT 4Y 3 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 S° 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 r REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 9X p a, 1?4§VATJO Z~ rL J 0 q0-0 'o p 't Feet `Y `Y, 7,S" `>•FSeeet VII. TANK CAPACITY Site INFORMATION in gallons Total # of Manufacturer's Prefab. Fiber- Exper. New istin Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank / eI-C Lift Pump Tank/Si hon Chamber F] El 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 Stamps) MP/MPRSW No.: Business Phone Number: C,4 R 4/p 4 Plumber's Address (Street, City, State, Zip Code): 7 3 0 S?,v~,A~ i' o© IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa ry Permit Fee (includes Groundwater Date ssuQ Issuing ent Sign m Surcharge Fee) 9 / Approved ❑ Owner Given Initial / ./LC Q Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. -You :r sanitary permit may be renewed before the expiration date, and =,t tha time of renew d any new criteria in the Wisconsin Administrative Code will be applicab":u. 3. All revision`-; to this permit must be approved by the permit iswig authority. 4. Changes in ownl-rship or plumber requires a Sanitary Permit ''r,. nsfer Renewal Forty Rr = 6399) to be submitten to the tole prior tQ instal!ation. 5: Onsite sew;_-; s ' '91 must be prope6y maintained. The rn.: t be ! r f: y a i censetd pumper whenever r ec,;ssary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, ~.r: ntact your local code adwirlistrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provice the legal description and parcel tax number(s) of where the system is to be installed. If. Type of building being served. Check only one and complete # cf bedrooms f 1 or 2 Family Dwelling. 111. Building use. If building type is Public, check all appropriate bcxes that apply. IV. Type of permit. Check only one in line A. Complete ine B if permit is for tank: replacarr,ent, < connection, or repair. V. Type of ;;ystem. Check appropriate box depending on system type. VI. Absorpticlr- system information. Provide all information reques''A! in #1-7 VII. Tank inforr, iaticr Fill in she capa.it;; 0 every new and/or' ex e,,ck, :Ist t' e total ;i k: i rnher of tanks and ,.-actuler's name. rie.!cate prefab or,clte cons..ar?tn arlk material. G rnr't all septic, puroisiptlon and holding tt;nk far this system. Check c:x,~E-rirlcs=ri.ai approval , is arias received expert,;?<;s =al prOdUct approval fn nr DILHR. Vlll. Respo-i-b,iity statement installit-i pluornher is to fill in name 6 - i-se nr.rrnber with appropri21u prOix (e.g. (VIP, etc.), ~;Jdress and pF one nur~br: r Plumber must sign apps :.r~ irm fe°+n. IX. Countyi[)epartment Use Only. X. Countyl°epartment Use Only. _,ompii, ('.'ins and ;pec fi`, 3t'or t r than 3% l i.. '.t bf. ti< .+)E ltv. The. Flans r"tecst ocludc, lh( fit Hc: ving ) p:Pie dr: Wll t0 r~-pJf to dl, in of holding t.x . septi,,, ?a ik;s) or il< "lF tanks, bu. - ve service; Stream!:-. dP pUrnp iir RIf,ihCNr tcLt i.+IbUtrOn bt3K ~t;- ~Yt!~ foil 3y5tE?i~1w Sy1't@rn ~reaC, ..fit ~.t~ I.:Cdt1.7n C' thi? bUl ..'>`=C., I-3f hO~iZOntB t!;8 <iIF?t/?ti.,.n er~~ ,r~t,,• C) compieste specificatior3 for pumas and controls; rose voiumE, e!avati.rn di ferences: friction loss; pump performance curve; pump model and purnp manufacturer; D) cross section of the soil tabrorpt:ion 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 inclj, ed the creation of surcharges (f yl fir :b°;? >r ; reg .laced pr, f ,;es which :-a cti rt ThF ;isecl for waiei- contarnir tion wvosr ;i) ;tilts}S ants e'Stahl;-• hri sr': of stanrJard SBD-6398 (R.11/88) t~w S N ~ ® W a ~ I ~ I ~ a l 0 0 o ~At o w Y O ~ Q I 1 b a y ~a ~ r10/l PA&C of c Fresh Air Infelt And Observation pip, 1_._J"~ Approved Vent cap MINw~wn T 20 - e2' Aba' Cerl Ire" To Final OVeal Pipe Marsh Her Or sprllhelk CY1" 2~ Ae0•w Pip• OhU1~e1hM Pip• Too - Q Alogref►wlweled Pipe Below B4nGelh PCeylln~ Tw inlnollnd AI V Oe11M1 01 system i v r, ~ 4 W O ~P) os 11 C) ar SOIL FILL DISTRIBUY101.1 PIPE A o-- s' X 2"OFAGGRUMIE F~ S,1{P~ _ Y/•J'^~ - D reed p~~ '101 ELF v. OF' FEET - TI•,Al r1.rt T(,, At AT LEAST © WLI-IES $,C,LOW O I&I&A•A~L. 411.tA,09 A~,ylill Aj L,EA SI'Lt? I!J,CMfS. M T AI,O J-No%G 7,f1A1d 42 11AIC*Ei IpF,L0W FOA.A;111 ri1~'~OyD,E MA)clj, - ,,DCp rij or- F-)(CAVATIOO FROM ORIONAL 6KAoi: WILL BE Iuc1+•E.5 MIAM►'PO gt£prli O-CACAMAT1ON FROM 0~14WINL C,84,9,E WILL BE 30 INCNES SIGAICO: VY• LIGEAISC A.IUMBER: _IV h 2 DATE: Ll~Z2 ~~o x Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 • Lglyz-r and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Sr 7 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. $O~L DA.' Si7E Gd APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION 446*F1C-4-70w REVIEWEOBY DATE PROPERTY OWNER: PROPERTY LOCATION GE~ij LD /v~~~'7 17. GOVT. LOT 4/r 1/4 V&) 1/4,S/(, T 2-f N,R /00 E (ooW PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ,MOWN NEAREST ROAD S4L 46 -3 <yi/F f3 yo 7 ( -Z) GuARREAv //o tf^ '41I& . [kJ New Construction Use Residential / Number of bedrooms 3 tv y [ J Addition to existing building j J Replacement (J Public or commercial describe / Code derived daily flow s &00 gpd Recommended design loading rate A/* bed, gpd/ft2 • trench, gpd/ft2 Absorption area required ~ bed, ft2 trench, ft2 Maximum design loading rate /4/,* bed. gpd/ft2 •3 trench, gpd/ft2 Recommended infiltration surface elevation(s) $-e-0- P A - 3 ft (as referred to site plan benchmark) Additional design / site considerations -1-4eQ- P S - 3 Parent material SG 5 y //Vt?/3-f0p - °~`w~Stf Flood plain elevation, if applicable / It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for system S❑ U IRS❑ U ~f S O U paS❑ U S U ❑ S 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 Trench 1. ; 0-12. /o y 3/_3 - S 2, , sh/c '.k" C'S f ::v: z- /o X *lee /S a,f le X1,2 S Z of Ground ~z. y1'S6 /p iC S~ ©,-f ~1+►y-~R CS ~u~ / ,S elev. ft. G' D -l /b Depth to limiting factory ~S 1J /G ~G~JQ ,J (r- TF G d Z Remarks: f bR'i ZD,y C - S72'd rf%ED w~- /.gvDS of /o/'.~ 4/(, S Boring # 16 M Y13 Ground elev. - D S~- ft. Depth to j limiting factor „ Aar a con tin al SBOlle SY9 I'ft: Remarks: S/ ~i/TE f CST Name: Please Print L FLOW-SITE SEPTIC PLUMBING C Phone: / , g~~s Address: 855 O'NEIL RD., HUDSON, WIS. 54016 ✓ (O d Signature: NIS. MASTER PLUM8ER LIC. NO. 3307 M.P.R.S. Date: CST Number: f2 ~.yp -,42_F6LLFQ Z. PROPERTYOWNER G0049 (9,nE4-"t SOIL DESCRIPTION REPORT Page Z ul_3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o .sue C S Z / ~3~~ o~ ~o 3 L 5 ~ Ground lg , Z~- ~O yie S , l`,e S f . elev. s/ f s 6K ~►r►fie c s of / s ft. 132- yo-01149 ye 41& i Depth to C S' 90 /0 Y2 s/ s a, f gR nMfL . • . G limiting - fact ZD C Cd N7~f i v f u 7 S f/je /3.~ ps i Remarks: ` Boring # 2) ~►.t, sb~ irrt,2 CS /Z 3 -F / - 2 uf 6- loxe 131 y 3~ 7 s re y sbk vf~ e s I u f, S Ground . elev. /3z, 7-Y !/iE' f1 ~S 01 6" 411.,t CS / - 00 ft. - ' - s o, , s sz yap-IT is ye S/1? Depth to limiting 'ct ,i o% Dye 416 boo SE /s Remarks: Boring # To ~r~ Ta ~ ~F ~ Ground elev. ft. Depth to limiting factor Remarks: ~E~"liI7QiCS MOUE- Z/,U°~e 13 # 3 Boring # Ground elev. 1 ft. Depth to - - - limiting factor - Remarks: SBO-8330(R.05192) aLF- U, iiG'Vs 73 , ~y, yo " ~3 z 9y o ' T3 3 ~s so 13 5 3a S 95 7 Z /3,j ot-Aoc /0i'7-5 ~ TES" i ~/EU~iF% ~o-c~ S ~f~'G ~ . TiP~.u ~ sz • b 6-0 ~or,~ TiPc -u a L 33 1 2Ep~,q-c ~ ,-r~ti T I '13.M . = Tyr ~1 PE~9 j p~~,c 303-3 Ir92,0 SYsr~ ~r .sv~ f'ESrE~ rio b I ; 36' . A-AST 1-o 7- Power ~1o/E s HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT LLBRIGHT AAA. MPSTER PLUMBER LIC. NO. 3,107 PA.P.R.S. nt 1!7P& OFGIGNER LIG. NO. 00663 7_t.6 ; 64-- p5. 3 e f 3 i~ C Sf f STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER RAC fl MAILING ADDRESS -f .~)y~Z3 PROPERTY ADDRESS ( N W 11,4 N W 11 l I(o -r 24 0 - 2 12 w war1-e.r1 L~ ~k 2 =A Aire. (location of septic system) Please obtain from the Planning Dept. CITY/STATE o-k s r PROPERTY LOCATION N \,I 1/4, N4 1/4, Section 1 T Z9 N-R W TOWN OF V/ e,r revs ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER Z CERTIFIED SURVEY MAP 3 313 89 , VOLUME 1 , PAGE Z 1 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. Me, 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: to St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, Wl 54016 11/93 B T C - 100 This application form is to be completed in full and signed by the L owner(s) of the property being developed. Any inadequacies will r 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 I RAC _ V ` CjE- - - , 9 Y Location of property ~►%1/4 N w 1/4, Section I T 2 N-R U_W Township \"arre Mailing address ~^7 fill Address of site o z 1 vcacc--4 Lc-•.a Subdivision name a Lot no. Loi 41 Other homes on property? Yes_ No Previous owner of property p,.,,„, +o 'i►m~( Get-god 00-8e- Total size of property i, b9 A cQES Total size of parcel 1. 54 A y-E.S Date parcel was created n6 -r - 9 1,e,, %4- :le" , ,-p ,ply wo Are all corners and lot linese a ent liable?~' 1915 -k Yes No Is this property being developed for (spec house) ? Yes x_No Volume 1101 and Page Number 4-*66s 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. 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 office of the County Register of Deeds as Document No. ignature of Applicant - plicant tV a 5 - Date of Signature Date of Signature DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 523083 - Timothy Banker fior ~ erd J~ - NOV 1 1994 M~ convey and warrants to T racy...S_...__IVelson an-- Ne~ ~ 1j• 30 A _,Toyce I s--.o-n -•-2- husband. and---wife-I , '.a . RETURN TO the following described real estate in St.. Croix County, State of Wisconsin: Tax Parcel No: Part of NWl40WU, Sec. 16-T29N-R18W described as follows: Lot 2 of Certified Survey Map recorded in Vol. 1 of Certified Survey Maps, page 216, as Doc. No. 331389. +~r r,}- r--.er. w a ! „ This is.._n-Q.t------ homestead property. Y=X(is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of ---------N ber 19..94._. (SEAL) - - - - --...(SEAL) Timot... - -nk.er------------- (SEAL) (SEAL) " AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. ~M , n~ authenticated this --------day of 19------ Personally came before me this Q~ --day of Nuvemb.er------------ 19....94 the above named ----'limo-thy---B-an ker---------------------------•-------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. State.) to me known to be the person who executed the f going instr ent and c nowledge the same. THIS INSTRUMENT WAS DRAFTED BY ~ ~ Kris.t_ina_.Ogland------------------------------ rs i ce-1o_x-Cvru>~o ----------------lic -----------•-At.t.ar.nay. a_t. Law-------------- Pub Notary Public y g}inty, Wis. (Signatures may be authenticated or acknowledged. Both My Commissio is perm~ner~ . ~jj xpiration are not necessary.) _ / date: . .t0.. 19 JU_.) *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WTSCONSTN Wisronsin Legal Blank Co., Inc.