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HomeMy WebLinkAbout002-1067-70-000 moo STC - 104 r ~ AS BUILT SANITARY SYSTEM REPO ' -\i OWNER 2 41 , ADDRE ~yG T`] S7GP~ zC~r ;-i~~: /~,-F r GG i,yi 0 SUBDIVISION / CSM# LOT # SECTION_T ll N-RW, Town of/LL3i~ ST. CROIX C6TY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM IV t i i L~ pIy v\ Jai I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 4 BENCHMARK: c) U c cv- 41c, r J ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / OLDING..TAN .'INFORMATION Manufacturer:, Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer I ST Inlet: 7 3 ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system i Existing Grade Final grade III DATE OF INSTALLATION: ev -3 PLUMBER ON JOB: -e LICENSE NUMBER: INSPECTOR: tv~ 3/93:jt L®tf3Ebrt$A~,b3111~$Ntry27.29.16 . WAATE SEWAGE SYSTEM County: Labor~*mcl Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar rrnit t Permit Holder's Name: [I City ❑ Village ] Town of: State PI 'JIM.BM Elev.: BM Descriptio Parcel Tax No.: wm' ;717 TANK INFORMATION ELEVATION DATA A9300221 O TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ Benchmark Dosing Aeration Bldg. Sewer S Holding SC~O / Ht Inlet 74 ~ 8. ~3 TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 90 ` .3 V A 3 (p NA Dt Bottom Dosing A Header/ Man. Aeration Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final de Manufacturer Demand Model Number GPM TDH Lift Friction a TDH Ft Loss ead Forcemain Length Dia. Dist. To We SOIL ABSORPTION SYSTEM BED / TREh(CFF- th Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN~ I SYSTEM TO P / L BLDG WELL LAKE / STREAM LE NG Manu acturer: SETBACK INFORMATION TypeO a Num er: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribu Pipe(s) x Hole Size x Hole Spacing Ve t To Air Intake Length Dia. Length Dia. Spa SOIL COVER x Pressure Systems Only xx Moun -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seede o e xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: BALDWIN 27.29.16.409C Plan revision required? ❑ Yes I/o % Use other side for additional information. 116) 9 SBD-6710 (R 05/91 z Da Inspector's Signatu a Cert. No. DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY lz:i .o..~,..a....,..,...,,e . ST. CROIX STATES PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. JITARY f 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. S93-40591 PROPERTY OWNER PROPERTY LOCATION ANDREA HOI?SE14AN NW %a SW '/a, S 27 T 29, N, R 16 E (or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # j29XX40TXXXVNj; X% 729 240TH S-IEE~ N/A N/A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER BALDWIN WI 54002 715 634-223 N/A 11. TYPE OF BUILDING: (Check one) 1:1 State Owned ❑ VILLLLAGE NEAREST ROAD $AL])IAIIQ 240TFI i IM TOW OF ❑ Public ❑ 1 or2 Fam. Dwelling- # of bedrooms 3 A EL Ax NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 002-1067-70 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 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. 1:1 Reconnection of 5. El 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 300 Specify Type 41 2 Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy 130 Seepage Pit Pressure 43 ❑ Vault Privy 140 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 450 N/A N/A N/A N/A N/A Feet N/A 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 Holdin Tank 2600 2600 1 HUFFCUT IN C 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 Stamps) MP/MPRSW No.: Business Phone Number: BEigi,1IE HF,LGESON 3215 715 772-3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE , St RING VALL 't , T JI 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Sign tur ❑ Approved I ❑ Owner Given Initial Surcharge Fee) `7- 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. 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 hermit must be approved by the permit i suing authority. 4 (,hang.-;. in ownership or plumber requires a Sanitary Pern-w.. Transfer/Renev'al For in iSR - f ,?t19? to be iubmitte to the i.lounty prior to installation. 5. -Onsite sr je systems must be proper=; maintained. The . tar,><. s) mu i be t:•1, .l. I,, licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code r! {:trator 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 nl,mber(s) of where the system is to be installed. II. Type of bolding 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. Absorpticn sys'err, information. Provide all information requested in ? 7 VlI_ Tarp Fill in the capacity of !wary ;rew c,nd/or ex•- ,tl ?ist file t tt d ydjer of t-4-k:a etc,,' ..am,';Ac'turer's name. Indicate prefab or Site coCIS-I uz. and 8 s p` t': -,p si' hcan and holding hanks his system. Ch:erk t!!perkr:. ,jval e rireceived approval from DIE_4- R vlh t'S! f:r`~.1 't ttV Statern. Installlno piun^ber is to fill in f = rt 'Ire.-ns? , Wltr` 8S.{" ~r'i`''• ")`(fix (e.g. MP, et(;.;, a arc-~ and phone number. Plumber must sign app'ic aT :°ft . _n IX. Countyli?t:pattrr+t nl Use Only. X. rou oty,~l3ca.rtrret: t ':,se Only. Gom;-, ~ -,rh j{: cabor;s not smaller than 8'/s • 11 inct«a rye: suer lt::-ai n,;rrty The `t. f"olk.;wifig: n~) plcf plan, drawn to scale or on of hr ';?rsk(s) or ()thee treatme,'it tanks; huildlny Ai. 'r , ".ervlce; stee'af, ' <t r' jeae f)iq-sn or siphon tanks; disVibution boxes, gore It r•ft ay~fN~i°. -r;:rt~,, H•;!t 9ystem ar' t, i tax °1<e building served- Rj hor*?ontai F. ti ~t r.»trs C) com=i(-, pec,fications for pumps and controls; dose volume; :.i vat. )r, 6ffe once { c' ,,r-. ass, pump performance curve; pump model and pump manufacturer; D) cross section of the sci`; ar:serption 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 r,urrrl~ar of regulated pr_.ictices which can affect groundwater. The nonies: collected tt`rouglt these: st?rcha.git-`. Pi. 'v?r ett'r ilf)rl?iirlil';cltlOn irtivwciit3Ations and estah'ishn SBD-6398 (R.11/88) Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labbr and Human Relations Division of Safety & 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 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCELI.D. # dimensioned, north arrow, and location and distance to nearest road. ©p Pt - I UCo'~j - f7 d APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER PROPERTY LOCATION t40 rS t- Vv`C.- GOVT. LOT A) I) 1/4 S ' /4,S 27 T N,R ! ( E (or W; PRO ERTY OWNER':S MAILING ADDRESS LO~,f~ BLOC[C # SUBD. , ME OR CSM # SAO f~ v e-- /f CI T TE ZIP CODE PHONE NUMBER ❑CITY VILLAG WN NEAREST ROAD New struction Use [ esidential / Number of bedrooms __-s [ ] Addition to existing building [ eplacement Public or commercial describe Code derived daily flow 5C~ gpd Recommended design loading rate - bed, gpd/0- trench, gpd/ft2 Absorption area required - bed, ft2 trench, ft2 Maximum design loading rate _ bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) - It (as referred to site plan benchmark) Additional design / site considerations zn .ih ~ % n 9 Parent material / Flood plain elevation, if applicable 41.4 ft S = Suitable for system CONVENTION MOUND - / IN-GROUND P URE 0 S DE SYSTEM IN FILL HO_LDNG TAN K U= Unsuitable for system ❑ S 11 S L~ U El S E] S el e S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoLrldary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw& 4kMYT~fi^t{~ 4 •`GL':h:titi L 1 2k O ` C a a O oR~ t ~g S Ground n ~f elev. ft. Depth to limiting factor Remarks: Boring # w. 3 Ile I Ground elev. R C ivE : - ft. 03 Depth to r. 1 7 ~93 limiting g C.R4I~ c., fact „ ~ ZONING OFF ^E Remarks: 9 I CST Name:-Please Print Phone: Address: 107k Y t t ,mot Signature: Date: CST Number: 16- PRUPERTY OWNER n( rec.. ELL eeu a SOIL DESCRIPTION REPORT Page of .7 PARCEL I.D. # 7 0 , Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxlday Roots Bed Trench in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerxh F s i ,o iMU S Ground elev. ft. Depth to limiting factor ~r t Remarks: S Boring # of h n.?::•:}iv1} Ground elev. ft. Depth to limiting factor Remarks: 7' Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Ala n~ y fie, [A c>~ g e VN- o-v-,, i e Pro l r. J SL,G~ b I (sow S 10 I' ~ gda slip La-w~~ a~ )tk ,c m P Ell e r F, ~14 Si De S ~o4ac(ol I • (33 ST. CROIX COUNTY k WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 14, 1993 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite soil investigation of the andrea Horseman property, located in the NW;SW;, S.27, T.29N., R.16W., Town of Baldwin, St. Croix County, WI., has been conducted with the assistance of Bennie Helgeson, CSTM# 3094. This onsite revealed that there is no suitable soil for onsite sewage disposal at this site. Holding takes are the only available alternative for this property. Should you have any questions, please feel free to contact me at this office. nc ely, es K. Thompson Assistant Zoning Administrator cc: file - w', to 'C5~ _U 3 i3C~4 M'" P as 'I ~ ~IC~I/h O f t~QclS 2 ~idLl.. .C ¢ , ,),6Q CIIJ R~MJ,~~3 ~~te E~~s-.,ar.•. Y~a~ P~ Yf1~T1to'u S?GGFuEp W ILt"? 83.a3 ONSITE SEWAGE SYSTUA A P P R DEPA 'ENT OF i-ND STRY, l.A.;1SP ~NEa ail`„ (fi~V i~''iIY ii-1:W_t....r 61c1'3 t. aHOLDING TANK CROSS-SECTION AND SPECIFICATIONS Approved -P Approved Locking Vent Cap Weather Proof Manhole Cover „ Junction Box with Warning Label 4 C.I. 12" Min Vent Pipe 4" Min Final Grade'' 11 ~ ~ Approved Joint 18" Min Water Tight Seal _ High Water Alarm Switch Approved I ~~•>P Joint w/ . Qi~'c1t~f'€. ~E 'VAG S1 S E - 'A C.I. Pipe Extending 3' Onto e~$1.{t~• Solid Soil ' vh -Di _ A &)L t~~ 81 " DCP;~ L.i{13l)8 A ID cTY AND 13Ui U1NGS V t. C . G 3 r. rou ¢ &kT) SPECIFICATIONS TANK Manufacturer: Tank Size: D4-00 Gallons ALARM Manufacturer: SA, elec va ~r C Model Number: l~l.) Switch Type:• NUMBER OF BEDROOMS: 3 OWNER'S NAME : e u-nc-v\ ADDRESS : 7Aq -t O a LEGAL DESCRIPTION : ::5W 4 , Sec . TAN , R I(. W TOWNSHIP MUNICIPALITY:(d~„oi,~ C S t 0Ro u SIGNED: - LICENSE NUMBER : S- DATE : - 9- 9 3 S J 4 01~9 n 501759 `73 I.,,u:,nnnnl No This space reserved Ior recording data IIOt_DINC TANK AME-EMENT , fit (into This agreomenl Is made between the _ - - - - - - - - - - - - - - - - County or Local Governmental Unit I Holding Tank(s) Owner(s) REGIS (f- ('J C i`F IC 4 C F ' ST. GCEX CO., W1 Rcc'J fcr Rccerd (Called Municipality below) I J U L 2 1993 We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property, (Provide legal land description:) at 11:00 A • M Register of Deeds Return To or that continued use of the existing premises requires that a holding tank bz. installer; on the property fcr the purpose of proper containment of sewage. Also, the property cannot now be served by a municipai sewer, or any other type of private sewage syslern as permitted under Ch. 11-HR 83, Wis. Adm. Code, or Ch. 145, Slats. A an inducomont to tho County of _C t ' to lasuo a sanitary pormit for tho abovo describod proporty, we agree to the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and 146.14, Stats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60. Slats. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauling or otherwise servicing and maintaining llm Iwl,lliiU Ituk Ul tiuch a metmitlr ati to prrivntll of abald any nulcance or health hazard caused by Ilia holding tank. 1lie munidipallly shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess- ment for the abatement of a nuisance, and the tax shall be collected as provided by law. 3. The owner, except as provided by s. 146.20 (30) (d), Slats., agrees to contract with a person who Is licensed under Ch. NR 113, Wis. Adm. Code to hava Ills holding Idnk harvicod And to Ills a ropy of Ih0 ronlract or tho ownor'fi rogltttrallon with Ihfi munloipallly find with tho county, Tt►0 owner lot ther nprnos to file a copy olvny changes to the service contract or a copy of a new service contract with the municipality and the county within Ion (Ill) IIIIhlimott f14y4 1111111 Ills flglP of 01411y11 to Ills tiolvivo vollil taro: •t 1 l,o c,wnar aprooo to nnotraul with a naronn llnanaod nndar Gh Nn 11:1, Win. Adm. Qndo who shall atihmil to tho munlolhallty and In Iha aotatly n ruport lit accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of roglatralion undor a 140:20 (3) (d), Slats„ the owner shall submit the report to the municipality and the county, 5. This agroomont will ramain In affect only until tho local govornmental unit responsible for the t`ogulation of private sewage systoms cortilios that the property is.served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this egJ100111rilll Clay ha uatloollod by okoliulint) sail Iotoldilu a4id lintlilittaliun Willi falotenoe to thilt 401001I01t1 in aurh 1114111101 wilibil will 10011101 the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) (Print) I Owner(s) Signature(s) Subscribed and,swgF' Ao before me on this date: Municipal Official Name (Print) I Muni 'pal Official Signature Notary Public 6/ I My commission expires: 71U'}s Al'O fQY /s 7 _ me- ell, a oir-1 6, Municipal Official Title (Print) +~ilC~ as qtr r~ SBD-6123 (R. 10/85) This instrument was drafted by the State of isconsin Department of Industry, Labor and Human Relations. Bureau of Plumbing. r APPLICATION FOR SANITARY PERMIT STC - 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. Stduld 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..Propertyt,~~ M F~~ :.Location. of Property Nuj ~--14, Section, T_; Ot_N-RW Township Mailing Address Address of Site, ~1'( its C-4 ~T I T :.Subdivision Name. Lot. Number Previous' Owner'.of Property -~7 RJL-~1►J` Total: Size— of" Parcel ~TL~O r2LF1S .Date Parcel wa.s,Created 11 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes_ No Volume' and Page NumberI 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 refer- ences.to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTy OWNER CERTIFICATION I (We) ee tit y that at t .6tatement6 on thin bosun ane tAue to the but o.b my (oun) k.nowtedg e; that I (we) am (ate) the• owneA (a) o6 the pno pW y de.6 cAib ed in th i.6 .in6otunati.on 6o1un, by vdntue ob a.watvcanty deed neconded in the Obb.iee ob the County Regi4ten ob Deed6a6 Document No. tf-I and that I (We) pne.6entZy own the pnopod ed .6 to bon the d ewag e. d,[Z poz a yb em (on I (we)- have obtained an easement, to nun•with the above des ni.bed pupenty, bon the con,6tnuction ob said a yetem, and the dame had been duty neconded in the 0 4 b.ice a b the County Regizten o6 .Deeds, 4 Document No. 1. SIGNATURE OF OWN R SIGNATURE OF CO-OWNER (IF APPLICABLE) ATE SIGNED DATE SIGNED DOC:UMBNT NO. »IIS ssACC wcsawvw row wccowo K4 o:7A WARMWY OM STAT& BAR iWSCONSIN FORM q-lfp ►dt " (WE REGISTERS OFFICE 4 :a ST. CROiX Co, WI& u and 'Wdi for Retort.' th 4th RAx2Bx ...L.A.-R A~.S7t 4...And-.CAIK.Q~,Y.i1...J I~... ........1 I bushansl--and.. wife...ns..join...•tenants dtn►pfD 1>^$7 8 : 30 A s ms : } - eoav:ys and warrants to ......Andrea..H.orsewAn_s...a...sinGLle.......... ....$@L8GA ~ SOX 16. wg•ruww . V FALLS. WISCONSIN 540 s t6i following•described real estate in _......St...._LYroi•x--• .--.........County, T. Slate of Wisconsin: Tax Parosi No: South Two Hundred Ninety-three (2931) feet of West Two Hundred Ninety- three (2931) feet of West One Half of Northwest Quarter of Southwest Quarter (W'h of NWk of SA) of Section Twenty-seven (27), Township Twenty-nine North (T29N), Range Sixteen West (R16W). i• ~ O This 9 homestead property. Exception to warranties: Easements and restrictions of record. D ted this day of 19.87 k ~ 4 (SEAL) (SEAL) • .Rohert..L,..Ruland a ..Carolyn... ..Ruland....................... ................................(SEAL) ....................................................................(SEAL) I ' ~I • " • SSurl f; AUTSBNTICATION l'J No0 _LZDGKZNT STATE OF 1KffilS6N9R 3ignatnre(s) sa II I _ - - County. 1I authenticated this day of 19 Personally came before me this ..A.7_ ....day of I~ ..119..87 the above named i~ Ro ert L. -Ruland and Carolyn i ' - Rulan..... ~A i TITLE: ![EII[BEIi: STATE BAB OF WISCONSIN ~1~-rt I4 authorized by 1 706.06, Wis. Stats.) to me known to be the person$........... whoa e foregoing instrument and acknowledge the ~d~fl THIS INSTRUMENT WAS DRAFTED BY i' Thomas A. McCormack ..............^..x...1,1 . ~ " . Baldwin, WI 54002 l Notary Public ..........County. "WISXMO (Signatures may be authenticated or acknowledged. Both My Commissi080 0Tpey l ER. f not, state expiration are not necessary.) date: ...VOTARY.PUBIic,.STATf•OF.Mi3SOttRI.........-, 19.........) it li1Y COMMISSION EXPIRES APR. 12, 1991 •Namr d yariooa signing In any capacity should be typed or printed below their signatures. ST. LOUIS COUNTY . STATE BAR 01 WISCONSIN N +_'eggrCtiai/ry® FORM No. X - 19811 Stock No. 13002