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HomeMy WebLinkAbout038-1087-90-100 A O 60 ' i 0 N y a ~ a~ a~ c a O V o U A cu o n c V) N ti c In o E d a 3 co v ~ z N co > E z O O z a m N z a m c C7 -O o z d c .vW - o N ~z c F N O CD Q N O O O ` U = U N a N c -O O 4- O O Q - 0 0 z co z O _ Z o 0 c m m N N a C O W A .R O N L d d N N o O G a n Y N ~ fn U) (n ~y Z ~ H I- H [1 cn O O O •ti a a a a a O Cl) M N vJ J U o rn a) o) rn ~ I "w Q; o w o 0 Q _O m N 2 ~ r r~r, N i N -8 N Q ~ (b L+ O Lf) 7 O C O N C C-, 3 o E c Y O 00 a °o o °o v M a L y c O s M L N Y q N o N '(4 CO C N O v N ~2 -5 00 .2 M m ~ '7' v co E c> • 0 L. o N cn a r' O N cn V a d w CL 7@ a "~1 2 U a 0 in 0 i l8.3~t i 1 STC - 104 s: AS BUILT SANITARY SYSTEM REPORT OWNER 1057 2/ O . e, e r.f o ADDRESS a p 7cx j- iC c,, v 6 ~~~I a7~ ~/Qvn ~T0 SUBDIVISION / CSM#r p 1 LOT SECTION. T 3 ( N-R J W, Town of ST. CROIX COUNTY WISCONSIN o2/t~J'dt PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r~ JJGUse CJ 1 ) INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form Provide 2 dimensions to center of septic tank manhole cover. • BENCHMARK' J-0 42 U IV r )00 5- ALTERNATE BM' CHAMBER / HOLDING-TANK INFORMATION SEPTIC TANK / PUMP Manufacturer: Liquid Capacity: /0 b C~ r Setback from: Well't 6 House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM t? Width: Length b a Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ec 3 ~-ST Inlet;- ~ J4: ~ ST outlet ~ PC inlet PC bottom Pump Off ` Header/Manifold ~Nottom of system Existing Grade Final grade rf J DATE OF INSTALLATION: PLUMBER ON JOB: *0,-X LICENSE NUMBER: S 3~0 INSPECTOR: 3/93:jt LCdGA;t'JAQ#p;ertw5WirR RIE. 21.3 T VISAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary ermit RPTX Permit Holder's Name: El City I-] Village R Town of: State Plan I No.: 1 121rX STAR PRAIRIE 'Ff ev.: r Insp. BM Elev.: TB M escripti ~i 1 Parcel Tax No.: G~®c TANK INFORMATION ELEVATION DATA A9300320 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic, Y r J GW Benchmark ' ~Ov Z 72 Aeration Bldg. Sewer 2, V7 Vd, 3 J" Holding St/ Inlet 8.9~ T K SETBACK INFORMATION St/ Outlet Vento TANK TO P/ L WELL BLDG. Ai Intake ROAD Dl Inlet / Septic --so Loi ~ ~ NA Dt Bottom Dosing NA HeadertB& . )d~ Z5- Aeration NA Dist. Pipe sss, Holdi Bot. System PUMP/ SIPHON INFORMATION 140Gracle 0 ' Manus urer Demand's 6X' 10.2, 01/ Model Number GPM TDH Lift Fricti System Ft Fie Forcemai ength Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width -)Lengtho. Of Trenches PIT No. Of its Inside Dia. Liquid Depth DIMENSIONS /2 60 I DIMEUSLOKS- SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHIN cturer. INFORMATION Type O a,,,-) `o-IV CHAMB Model Number: System: :{y t' *f -.A O T DISTRIBUTION SYSTEM Header /114arrrFd}d Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length -&Z Dia. Length Dia. Spacing s- SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems On y Depth Over „ Depth Over xx Depth Of xx See ded xx Mulched Bed/ TimrkuCenter „ Bed / TAQar.Ja Edges,-?~/ ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE.21.31.18W LOT 1 Plan revision required? ❑ Yes 2<0 Use other side for additional information. SBD-6710 (R O A/91) Date Inspector's Signa ure Cert No. J/Qt 'n h ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code / STATE SAN A Y P RMIT -Attach complete plans (to the county copy only) for the system, on paper not less than / 8% x 11 inches in size. ❑ Ch6Ck i re ous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPE!gY OW R PROPERTY LOCATION ~l A " % al%, S T N, R (Or) W PROPERTY OWNER'S MAILING ADDRESS LOT # / BLOCK # ~1 r o. - f I ,STATE , R A ZIP ~ as J J PHONE NUMBER SUBDIVISION NAME OR SM N, UMBER t ~ ~ C Q D 4 t W s V l/ OF.E T 11 AD 11. TYPE OF BUILDING: (Check one) ❑ State Owned i~ CITTY.AGE h e , N R ❑ Public X 1 or 2 Fam. Dwelling-# of bedroom PARCEL AX NUMBER( 16 111. BUILDING USE: (If building type is public, check all that apply) ~i 7 2 0 r0 1 ❑ Apt/Condo v 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 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. RNew 2.E] 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) 9 Y ELEVATION 7,~0 1.7d a fo , / Feet Feet _3 9~vb VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank A6 Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of onsite sewage system shown on the attached plans. Plumber's Name (Print): PI bar' Sig lure: Stamps) MP/MPRSW No.: Business Phone Number: M4 Plumber's A ress (Street, City, State, Zip Code): l?,:, a d 4 e 'a IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary,Permit Fee (Includes Groundwater 7Date ssue Issuing Agent S natur (No Stamps) ❑ Approved El Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVALlREASONS FOR DISAPPROVAL: V t ` SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber r 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. Onsife 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. 11' 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 systerr. 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 cave; 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) -7z d O 4p e 1 N 0 ID o (ID 4 c~ ~o ~ ~ b e a 14 3k QL ---AN• C a c~ l° ~lj o 0.1 a DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 3707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: p TOWNSHIP/ ICI PALITY: LOT =IVISION NAME: Nf ~ NLJ V/ ~ ( /TY N/ROBE (or COUNTY: MAILING ADDRESS: Z y7- 339 L J" dZ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R FIL DESCRIPTIONS: 1PERCOLATION TESTS: Residence New ❑Re lace p i9 i9 p RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) P 1S ❑U XS ❑U J YJS ❑U ©S ❑U ❑S If Percolation Tests are NOT required DESIG RATE: / If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 13- > B- Z ? s 7• S~ > ` a617 >d8- ?s s B- 3 6'9 Q~, d > fj -9'16/x, e e- S, y- h .s 4,57- B B- S 78 9 Gulp ~ ? Lq l -7 . 6,7 iiL - d 7 - ° C' ..si - " Gt r1 C S 37 - 78" ,5 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 2- ter-. Z_ 4 P- Z 3,5- P- S Z_ Z-- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION _ 9 l 3 I I E l I E i I- 12 /oo q"3 - 1 I . F g p- , 4 1 , AV Aj I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures d methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print) TESTS WERE COMPLETED ON: u£ w"n /9 /9~3 ADDRESS: CERTIFICATION NUMBER: PHON NUMBER (optional): o 44 c ~~s3 ~39d J-) V 72 - XX6 CST S TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned: 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS: 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 6. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point I TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County; OWNER/BUYER_ Ki c 9`' /qih i 1'"C feRSor~ ADDRESS_ .1/d ter Awet. FIRE NUMBER AD.S CITY/STATE_ a,0mek5P / . LJ1S ZIP---S PROPERTY LOCATION: ~1/4 , UO 1/4, SECTION A) T__ILN-R l f W TOWN OF_ 12 Pi2A i , 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/Ile, 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. Zoning officer within 30 days of the three year expiration date. SIGNED: fN DATE:_ /l) St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 STC-100 This application form is to be completed in full and signed by fthe owner(s) of the property being developed. Any inadequacies will only result ~n delays of the permit issuance. ,should this development be intended for resale by owner/contractor,(spec house), thenla 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 _ tr-K Awty P4PRSOA Location of property-AJIEl/4 .NJA/1/4, Section , T,, ??-It_jLw Township Mailing address ~QQS.aeA~ LA i,e_ Address of site subdivision name Lot no. Other homes on property? yes-___X __No Previous owner of property _ Qobe~2~ Lia~se~J Total, size of parcel _ el 94' x29(a' . Date parcel -was created 91J7 93 Are all corners and lot lines identifiable? _Yes No Is this property peing developed for (spec house)?____Yes J~No Volume- 2__and, Page Number ---699 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 REGIS'T'ER 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, thc, 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 creed recorded in the office of the County Register of Deeds as Document No.- .r0 ?O 88 , and that I own the proposed site for the sewage disposal system) orr I e(we) obtained an easement, to run the above described property, for the construction of said system, antl tho name har3 boon duly recorded in t e office of County Recjiatez of deeds as Document No. _ SQ'T08 Signature of applicant Co-a pli a -ad-9 10 Date of Signature Date of Signature II ii DOCUMENT NO. WARRANTY DEED II THIS SPACE RESERVED FOR RECORDING DATA Il STATE BAR OF WISCONSIN FORM 2-1982 5U8Ury ! 6 I ZO~$zaPAGE 62 `J Robert L. Larson and Patsy A. Larson, husband and wife Rtl"`S OFFICE as joint tenants Co., W1 . I' Re@' for Record " - I OCT 2 9 1993 I- . of conveys and warrants to .__________2:45 P. /W II Petexsgn,-.buaband.and..T yifs.-a-s_.gury_iyorship_ marital proper V R~DtiterOfDeedt - . RETURN TO the following described real estate in St,.. C1:Qix .....................County, State of Wisconsin: - - - Tax Parcel No: I A parcel of land located in part of the Northeast Quarter of the Northwest Quarter (NEJ of NWT) of Section Twenty-one (21), Township Thirty-one (31) North, Range Eighteen (18) West, described as follows: Lot 1 of Certified Survey Map filed October 12, 1993 in Volume "9", page 2699 as Document ~I No. 507088. ii I~ III' I EXE PT ! I~ r This ..._iS__not---- homestead property. (is) (is not) i I' Exception to warranties: Dated this 1. th-- day of October 19.93.... ii 0 9X -(SEAL) - (SEAL) *Ro - x-t- J1-•--L.ar.som---------------------------------- - ---------------------•------_--------(SEAL) --------(SEAL) * Patsy-_ Larson AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN i ss. St. Croix County. authenticated this ..-...-day of 19....-. 'I Personally came before me this 15ti?___day of Oc.C_obex 103-__ the above named ~a ~gABER * ,~A bext--L.__Larson__and__Patsy__A,__Larson ®•y~ TITLE: MEMBER STATE BAR OF WI N_--- TA (If not- II authorized by § 706.06, Wis. Stats.~ - a t~ wry to be the person S.......... who executed the o- 't 'PUBLIC Jre n instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY eve .1f l f Reinstra, Van Dyk & Needham, S.~'p 0 W - _ f 4i 201 South Knowles Avenue, Box T271►k,~~rtNN°°° : Kimber Ta New--Ri-e+imand-3- WI-----54OL7-----•----•---------- Notary Public ..----•-St_.__Cro ,x------•------.-CountYWis. , I (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) / date- ----------------------------------------YJ- 19AI..) '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 I- II DOCUMENT NO. WARRANTY DEED I w THIS SPACE RESERVED FOR RECORDING DATA l i STATE BAR OF WISCONSIN FORM 2-19821!1' i i Robert L. Larson and Patsy A. Larson, husband and wife it as ..3'oint tenants. ~I I I I conveys and warrants to ...Ri.chard..A,.-.Pexexsoxl..axld_.Arpy__1.,_•_-__-__•- Pete7Ce4~?..heb.eD_.ad-•fe..s.•sury_ivorshi _•marital it .....................p ly I I RETURN TO I I~ ' .I II the following described real estate in ........S1~,...QrQ1X ......................County, - State of Wisconsin: Tax Parcel No: A parcel of land located in part of the Northeast Quarter of the Northwest Quarter (NE} of NW}) of Section Twenty-one (21), Township Thirty-one (31) North, Range Eighteen (18) West, described as follows: Lot 1 of Certified Survey Map filed October 12, 1993 in Volume 11911, page 2699 as Document No. 507088. I I I I i I I I This is..not............ homestead property. (is) (is not) Exception to warranties: Dated this day of ..........October.......... 19.93. I e... I (SEAL) ; (SEAL) *Ro . xt._L....L.arsou..... (SEAL) (SEAL) * * Patsy_....:.- Larson I AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN ss. St. Croix ---•--.County. authenticated this - day of 19 Personally came before me this ................day of 011 SaeHl9lt#p" . - = aa~~ BFR QCtab'.r-....................... , 19.91-- the above named • i2~x..L :-•Larson and Pats A. L - -arson '`O'••Oj••. '¢i0 1' - - - - - - - TITLE: MEMBER STATE BAR OF WIO N tr g-------------------------------------•-----•------------------•--•------ /hoA0%----~ (If not 1*2 e authorized by § 706.06, Wis. State.;: . ..A a . g~ to nown, to be the person § who executed the bd~'ores mg instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY instra, Van Dyk & Needham, S. ~'4v~OfS C a~t 201 South Knowles Avenue, 96:i'1277 144is "i" K n?ber y_ Tam i~e9v•-ititfisncmel•~..~ITL.... .~4~a1.7............ Notary Public U.,... roix (Signatures may be authenticated or acknowledged. Both County, tion My Commission is P are not necessary.) permanent. (If not, state ex iration date: ni 'Names of persona signing in any capacity should be typed or printed below their signatures. - I I II WARRANTY DEED STATE DAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. i FORM No. 2 - 1982 Milwaukee. Wisconsin f ~A . y, 4. ~ '17 ~ ' i 1... ~,I ai ..'k i R j W,p.~ ,~Lr'~' 1~1 ! r~ r3 ~ • .r;;~a°~R ~ t., ,i,~ ~ I 7. I r i V° ~ ~ ~I t J , ss CERTIFIED SURVEY MAP, Located in part of the NEh of the NA of section 21, T31N, R18W, Town of Star Prairie, St. Croix County,.Wisconsin. t~5S41'~'~'rr!q .:r , Ci~l N Ny i GrI G~ U ~ d S-'I~Q7 3 d s N 7 to r- U~ `r HUD5014, ; o 0 o a i WIS. i ! 1s A, t.• o m 4't7 ...w• 1 . rr -n • o i 'Q 1 Al Cr 5. of , 4 i 6 I d TTrr 1, 19 H I~J1P I ~ ~ ANN-' W CORNER NORTH LINE OF THE NWI/4 OF SECTION 21 c a SECTION 21 - PICDTH AVENUE NI/4.CORNER e H o SECTION 21 cn 0 rt NW29'53"W to c= I A Ire 0 rn N89o29'53"W 296.00 o~ - 2378.06' NW29'53"W 296,00' w o Ic 0 o ° Z m I t. O cDn I't~ N N r I ~ . I> v' LOT l i~ I-- Qt o I-i I -I N N a roi jM w 2.01 Acres Inc. R/W w m = I M Ili N o 87,605 Sq. Ft. Inc. R/W o z IL IV CL o 1.79 Acres Exc. R/W tD ° IT- 77,838 Sq. Ft. Exc. R/W I> 1< 1~' O O Imo? a I~ (n IG K-1 I i(!) a. 0 S89°29'53"E 296.00' z 0 I INPL AT I ED LANDS r W LEGEND OWNER ® Aluminum County Section Robert E Patsy Larson Monument Found 1021 210th Ave. O 111 x 2411 Iron Pipe Set, weighing Somerset, Wi. 54025 1.68 lbs. per linear foot 1001 Roadway Setback - Existing Fenceline ■ Masonry Nail Set NYHAG2N S-j 407 H IUD Z*, t. <tit'1 SCALE IN FEET 0 50 100 200