HomeMy WebLinkAbout193454 032-2070-10-051
STC - 104
AS $UILT SANITARY SYSTEM REPORT
OWNER &,;D
ADDRESS SCOttt
( 1
SUBDIVISION / CSM# LOT #
SECTION . 1-3 T~N-R_ZaW, Town ofS -S-41OUff, A i
ST. CROIX COUNTY, WISCONSIN
A PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
5-" 'Ile
70°
r
is rte, -
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this-form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: r(9
ALTERNATE BM:
TIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: W P4 Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer Model# / Size
Float seperation Gallons/cycle:
Alarm Location
:SOIL ABSORPTION SYSTEM
Width: Length ms's Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
I
/ p
9/~ g
ELEVATIONS q
Building Sewer ST Inlet: 6 If ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system j'"~ Sig ~6 •
Existing Grade Final grade
DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER:
INSPECTOR:
3/93:jt
13.30.20pWIGA)Jft Glpffi E" 6AMP RD County:
Labor and Human Relations
Safety and 5uildings Division INSPECTION REPORT
GENER (ATTACH TO PERMIT) Sanitary Permit No-:
/~L' INFORMATION 54 1934
Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.:
?fflhfIC,v.: MARK SOMERSET
Insp. BM Elev.: BM ascription: Parcel Tax
G - ~lJ~• as 032-2070-10-000
TANK INFORMATION ELEVATION DATA A
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 4 60 4;W, Benchmark e- r ?,D CD /
Dosi
Aeration Bldg. Sewer 933.7
[Holding St/ t Inlet 3,
TANK SETBACK INFORMATION St/ t Outlet Vent TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet
Air
Septic }"M 7 3 NA Dt Bottom
Dosi NA Headermi, 7.37
/ 3fl'
Aeration A Dist. Pipe 7 6z ~L2, /P r
Holding Bot. System 9/ ,3O'
PUMP/ SIPHON INFORMATION radeX' 3,,9s! ! 55.77 '
Manufa er Demand T 4.091 9946.
del Number GPM
TDH Lift Loss riction m TDH t
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length / No. Of T enches PIT Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Ma acturer.
SETBACK
INFORMATION Type Of Q,a CHAMBER ModelNum
System: /,/l~ OR UNIT
DISTRIBUTION SYSTEM
Header /idral~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Sot Dia. Spacing
~ S6
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/
Bed / fre rah Centera,</- Bed / T Edges o~~' ra Top ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SOMERSET 13.30.20.769A,NE,NE, SCOUT P RD.
73
Pla re Ision required? ❑ Yes o
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No
D LHR SANITARY PERMIT APPLICATION
7PJ[LHF In accord with ILHR 83.05, Wis. Adm. Code COUNTY !5,rr G, /x
STATE SANITARY PERMIT #
-Attach-complete plans (to the county copy only) for the system, on paper not less than ❑
8% x 11 inches in size. Jkf liokn pr evious 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
u,01_ O 4e_ t/a a,S T `V,N,R E(04
PROPERTY OWNER'S MAILING ADDRE T# BLOCKKA
fo CO~C7 / V_ 1 00-11
CITY STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
~D4 / III. TYPE OF BUILDING: (Check one) ❑ State Owned VILLLLAGE ~ NEAREST ROAD
❑ Public ~1 or 2 Fam. Dwelling-# of bedrooms PARCEL AX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) 0302 ~p 7 Q ~O
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 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 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. 4S New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 6Seepage 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) ELEVATION
i
S 6) 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
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' ame (Print): ,9 Plumber's Si nature: (No Stamps) MP/MPRSW No.: Business Phone Number:
r'trrl ~t Aq~~ l 6S
Plumb Address (Street, City/, Mate Zi CC de): ,
v ~ G if c--- 0 1001 IX. COU /DEPARTMENT USE ONLY
❑ Disapproved KSa - ryPermIt Fe (Includes Groundwater [Date Issued Issuing A nt Sign
Approved El Owner Given initial urcharge Fee)
Adverse etermMation
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
6 -93
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1 ;sanitary permit is valid for two (2) years.
'
f.. 1 ) . s i-..'
2.+ Y&r''s nitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wlst;O rsin Administrative Code will be applic ab'se.
All revisions to this permit must be approved by the pe, ,a} issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form RD 6399) to be
S bmiitvc' to the count riot to installation. T,, i ,
5. (~nsite s r *e system spiust b'~ proper ^rnarnta`t,teci. tanrr:.^, n'*r _ ,:y a licensed
pumpE:, kr,=~ enever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage syst, rn, contact-your focal code cirf,ir'ristrator orlWd'-
State of Wisconsin, Safety & Building, Division, 608-266--'.8 15,
~
To be completV and accurate thjs..sagitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel ta.x number(s) of
where the system is to be installed.
Il. Type of building being served. Check only one and complete •#r of bedrooms it 1 or 2 Fancily Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that appl'y'.
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 a!I information regcjar.f-tr in ##1-7
V11 Tank ,ni,.)t r,~Ation. Fill in the capacity of ever,. new and/or ex -lank, list the total 9a - number of
tanks :;n ` 7--inufacturer's name. indict, Tt larefab or site cot >d and tank maieriai ii ;eta for all
seat„.. (.,;t ,'si)hon and holding tanks ici- system. Check -rro,,?- pinks received
IX0 C;•=r duct approval from Dlf r-Oi
Vhi. Hesponsibiiity ~-ta_.ternent. instellincd plumber fill in nan tr4 ,se number with acpr . r rrs ie prefix (e.g.
kr'P, etc.;', a 1rr?Ss and ptic,rr , number. Pla-Tyner must sign „6 r ation form.
IX. County/Department Use Ordy;
X. County/M-,,.:; r`rnent Use Oriiy., .
Compiete i ion, a ,t~cifications not sm3.!ler than 8'/2 `1 it c! i s rnu,E t,c =;tabrnitted tt- r-ourty. The
Y•ir'.nS rni st includf: A) pl,., "i. :;law! t0 JltFy ~Q~,I~',{ ~ li"~ensil: 15- '7caticn of
ding tank(s), SE } . K( -),pr other fr <e1 rl~ =1t tare. ~ vcr V4,a e! fYlc , F~ "If r service;
str>,am5 ~iioa lak'? e r 9iPhor `rr +ist6btjtiort Sti{•w_ .r~~,a(t :dcta ~ y
r:t,,,~-,t s tam
ar+:i.2 ~.n 3hy-. i
oc , of rr ui --T 8) hcr.z::rni .li: r..<. ,
C:) ccrnp! f.: ,pec. i c$li?ns for''purripsFand controls; dose voiur < '.evat`o d`i'feronces; In i' ciss; pump
perfoirularice curve; pur?1p model and pomp rypufacturer; D) ,tor section of the so ! abryc,rptlon system if
required by the County, EJ soil tpst data on a 5,form; and r) ai sizing information. C-
- - - - - -
GROUNbwAfe R SURCHARGE 1
1383 Wisconsin Act 410 inciuded the r: reation of surcharoes Oer. t ,r a number of
regrjl tcd pr oboes ca {fc~r:t rg,-. )uldN ester.
s.
Th rrronies coile%te l f~, ~.gr the sa rr.harge,ruset+ ro*ror, _i s.ta g ;:ri'~ ti r
wa#c•rY:ontarnrnation invF-= riati,-,ns anti establishn i l)f Tanr;n•,+r - _
3
SBD-6398 (R.11/88)
3 C7,
J4
5-
Y ~ FY7/jZ-,
!S
(I r, s
iV~ 9 ~ F O,.L
8 g
0 \
~ b
PROJECT ADDRESS 26 7
/V1, 1 /4 yV
1- 6 1/4/S 13 T3 d N/R 2- 0 W _ QWN 3, , rr^~n 1~ n
6 COUNTYSf. Cro x
MPRS Byron-Bird Jr. 3318 DATE ,3
BEDROOM U' CLASS PERC~ CONVENTIONAL), IN-GROUND PRESSURE
CONVENTIONAL LIFT MOUND_ HOLDING TANK
SEPTIC TANK SIZE ao dea, I LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE ,
ABSORPTION AREA 4 j;j PERC RATE ,'7 BED SIZE f ~y
k Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark s , La~,, . e S 1< p L f. ed
* H . R . P. ScZm_e, czd r ► c'~ r ~
O Borehole Q Well Scale Feet
O Perc Hole System Elevation
Vent
12"
rp-radp
TYPAR COVERING
t 2"
12" 3' O 6' 0 3'
6" Sewer Rock
1.2'
A- ~ t w C
4" " jy_
!Sr / 3a
r
30 44
Wisconsin Department of Industry,
Labor and Human Relations S IL AND SITE EVALUATION REPORT Page _of
Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but l^a/
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. If
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,S/ TN.R 520 E (o
PROPERTY OWNER':S MAILING ADDRESS / LOT # BLOCK # SUBD. NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®rm NEAREST ROAD
(j New Construction Use [>q Residential / Number of bedrooms [ j Addition to existing building
(j Replacement (j Public or commercial describe
Code derived daily flow -17I~5~10~g-pd Recommended design loading rate bed, gpolft2 trench, gpd/ft2
Absorption area required bed, ft2,{ trench, ft2 Maximum design loading rate gybed, gpd/ft2_:5fo_ trench, gpd/ft2
Recommended infiltration surface elevation(s) ~~e,*'. r/may 2 It (as referred to site plan benchmark)
Additional design / site considerations
Parent material ~u Q Flood plain elevation, if applicable ft
S =Suitable for system ONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE 7 SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem S❑ U S❑ U ,g[ 5U U efsS ❑ U ❑ S I U ❑ S _i~3'U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trertdi
/ a- 7 v z x
Ground /
elev.
ft.
Depth to
limiting
factor /
Remarks:
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft
inTexture Consistence Boundary Roots
. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
d 6 / G A'o7
Ground 3 o 3 L w /vim
elev.
-
ft. ep loe Z-v ~7 4/4
Depth to
limiting
factor
D
Remarks:
Boring #
Ground 3 1 ° /Z r d L~
ele.~
_&ft.Jr`
Depth to
limiting
factor -Q F
Remarks:
G
CST Name _Please Print Phone:
Address:
Signature: Y Date: T Number:
3 7
PROPERTY OWNER _ SOIL DESCRIPTION REPORT Page _of
PARCEL I.D. #
Boring # Horizon Depth Dominant Color . Mottles Texture Structure Consistence Botrx " GPD/ft
f~uy Roots
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trnch
}v i•}:v:•yti
zs~,Tx 717
;x
r•
K` 02 6 ` r Y L4~ /yl
Ground p L~ 3~ f U
elev.
Depth to
limiting
factori
Remarks:
Boring # /
Ground
elev. 6 2 y
Depth to
limiting
factor
Remarks:
Boring #
k*X
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
/ado
.3-~
4,m
4
4, /1
~ J '
FLU U PLAN
PROJECT. w_ADDRESS
'1'/4 )W 1/4/Sf3 /T?a N TOWN COUNTY Groi~'
MFRS .Byron Bird Jr. 3318 DATE
BEDROOM CLASS PERC c
,,-7,-_ CONVENTIONAL-IN- ROUND SURE
CONVENTIONAL LIFT MOUND_ HOL NG TANK
SEPTIC TANK SIZE LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA PERC RATE _ , ,ABED SIZE
Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark
* H. R. P .
M Borehole Q Well Scale = Feet
0 Perc Hole System Elevation
Vent
12"
Grndp
TYPAR COVERING
12" 3' 6' 4 3'
1 6 „ Sewer Roc
1.2'
~ 3
a
36 ,
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
• COUNTY ~j
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but GYd / 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 OWNER: PROPERTY LOCATION
dr GOVT. LOT 114 1/4,S T a N,R Q E ( W
lolze- d2o y
PROPE OWNER':S MAILING ADD S LOT # BLOCK # SUBD. NAME OR CS #
to' -2 ~w u
CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ;FOWN i N ARESIJI(~4D
9 Lz 1cla
New Construction Use Residential / Number of bedrooms (]Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow gpd Recommended design loading rate s 7 ed, gpd/ft2 Y trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate !7 bed, gpd/ft2 1~trench, gpd/ft2
Recommended infiltration surface elevation(s) Z ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material ~s f K~ r Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem I P9 S ❑ U S ❑ U Jg S ❑ U S ❑ U ❑ S RU ❑ S Fkftf
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground 44/f, AIX 7 `
elev.
t.
Depth to
limiting
fact
Remarks:
Boring #
: ( ' to • S~
\4 p
- L-I
?:•}:4~:tititi 4titi;:ti
A
6- /a 5T y..~
Ground
4e,v.
ft.
Depth to
limiting
~ fagtor
.3. b~ Remarks:
CST Name:-Please Print Phone: r
Address:
v
Signature: Date: CST Number:
w 7
-
PROPERTY OWNER l-2dk Z, SOIL DESCRIPTION REPORT Page of
PARCEL I.D. # '
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon n. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bour>dary Roots 'Bed Trench
~ - 6 au S~ Gw , 5
Ground 3 o
elev.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
tiv
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
kLSBD-8330(R.05/92)
i
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER_
ADDRESq-,2K'1-) FIRE NUMBER --20
CITY/STATE ZIP
PROPERTY LOCATION:/ 1/4 ,jO€1/4 , SECTION 4_3 , TFgN-RHO W
TOWN OF St. Croix County, '
SUBDIVISION , 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 a 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 Co. zoningfficer within
30 days of the three year expiration a e
SIGNED:
DATE:
St. Croix co. Zoning Office
911 4th St.
Hudson, WI 54016
J '
S T C - 100
This application form is to
be co
the owner(s) of the property being completed in full and signed by will only rESUIt n delays of the Any inadequacies
pormit issuance. , should this
development be intended for resale b ow
ne
r/coat
by ractor,(spec
house), thena 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 -Y -e-
Location of property2Z/
~Z_1/4 ~1/4, Section T.,.&N-Rv2fW
r
Township _ y,frs G
Mailing address ::,2,<_7
Address of site
Subdivision name Lot no.
Other homes on property? yes___,"( No
Previous owner of property
Total size of parcel two
Date parcel ,was created ~2
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes _ )(No
Volum~nd,Page'
Number " -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 & 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. `4 7 - , 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
record904 rd- office of County Register of deeds as Document
No.
nature o applicant Co-applicant
1
Date of Signature Date of Signature
I
- THIS SPACE RESERVED FOR RECORDING DAtA
DOCUMENT No. WARRANTY DEED
STATE BAR OF WISCONSIN FORM 2-1982
I 479096
OFFICE
°I Milton E. Meinke, a single man REGISTER'S i
I
ST: CROIX Wl Co. ,
Re
c d for Record
-•-•--••-1e---•--..----•__---•••_____.
Mar k K. Do as FEB 12°1992', ,
I
conveys and warrants to --y-----•------------------------------•-------"-- 8.30 M
-
0 6
Register of Deeds-
- •
RETURN. TO
-
. Croix
the following described real estate in •-_...___County,
State of Wisconsin: 032-2070-10 ~
Tax Parcel No_
The NE of the NE 4 of Section 13-30-20 excethencecWe along Wirth line
Commencing at the NE corner of said Sec. 13, thence c e.'North
of said Sec. 13, 601.39 feet to the point of beginning;
West along the North line of said Sec. 13, 300.00,feet; thence S 00=27 30,E,=
440.70 feet; thence N 89-27-49 E, 300`.00 feet; thence N 00-27-30 W,`437`.89'feet
to the point of beginning. ,
1
t i.
G
,y ~ I t f 1
E "
. ~M1
i
tl~
.
M:a
18 not
This - homestead property. s r ar "xs '
(i (is not)
Exception to. warranties: together with and subject to any ,Other easements covenants,
reservations or restrictions of record, if ...any, but this shall not.?bew,deemed: to 'exLen
any such other recorded encurrbrances beyond the term established by law' -(iiF. e 01 _2
- --•-January 19
day of
Dated this
I
(SEAL)
II -------(SEAL)
Milton E.•_Nleinke
-•--(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Milton E. Meinke a sin le man STATE OF WISCONSIN _~s
Signature(s) g.
- - - - County.
- - -
- 92 PersonallY came before me this - day of
t_y Janua
auth icat t - day 19 .
of------------ -
- 19 the above "named
I,
* H H . Gtain
-
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
Atty . _ Hugh_ H . cnrin, Gwin _ & Wertheimer, S . C .
is.
430 Second St., Hudson, T,7] 54016 Notary Public { o' W is.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent (C If not state' expiration
19 )
are not necessary.) date. ° ' '
il
i •Names of persons signing in any capacity should be typed or printed below their signatures.
STATE BAR OF WISCONSIN Wisconsin Legal 13 !ank Co. Inc.
WARRANTY DEED FORM No. 2 - 1982 D1thvaukee. ! Wis.
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