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HomeMy WebLinkAbout018-1083-05-000 ~ O S{ ~ e .. ~ W ~ O ~ ~ Cf A 'O ~ ~ 0~1 ~ 1'D :~ ~k O 91 ` N O .. O O d O O ° o m ~ c ~' I (n m £° G a y ~ m 3~ ~ c o w m m ~° ao o ~ ~ w c O O V A ~ ~ ~ O ~ ° I ~ m ~ o ~ ~ ~ ~ ~ ~~ I v~za ~ 3 a a I ~ W N c m ° ' I ~ ~ o o_ a c m w I c 3 ~ ~ a ~ ~ '~ °: o ~ ~ ~ ~ ~ ~ O1 N 3 N N N O cn ~ ? N p ~ ~ ~ G1 y a ~ ~ ' m -_ m ~ 2 N .. 3 ~ _ y O. w I Z .. ~ C 2 z =i 0 7 ~p O ~ ? 7 I ~ ~ I ~ ~ ~ v tin ~ A C '~ N C ~ W O N =f - Z 'N ~ 0 -' ~ fA ~ K y ~ ~ ~ 'a ~'~~ I o 7 .. _ ~ ~ o> .o I a~ -.z I g z Z ~ a ~ ~ z ~ W A d ~ f D y n G p y g a O ~ 'C ~ N T C ~~ o a ~° I ;~ ~ I ~~ x I ~ x O y f~D A y O y ~ C C N ~ ~ ao I c ~ I I o I I fD ~ ~p ~ F °o a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division, INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village x Township Bonte, Ron Hammond Townshi :ST BM Elev: Insp. BM Elev: BM Description: Gv 5 `~ 'ANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic e~ Dosing ~ Gr OU Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic >5(~ r y ~~ r ~Sd Dosing ~ ~® , y SSG , ~ ~~, Holding PUMPlSIPHON INFORMATION Manufacturer Demand GPM Model Number 3 TDH Lift Friction Loss System Head TDH Ft Forcemain Length /Dia. Dist. to well y f ,s d Z `' SOIL ABSORPTION SYSTEM / ®' . / _ L _ ., _ _ . BED/TRENCH Width / Length N . Of Trenches DIMENSIONS 3 Z •s / SETBACK SYSTEM TO P/L BLDG WELL INFORMATION Type Of System: DISTRIBUT ION SYSTEM county: St. Croix Sanitary Permit No: 395218 State Plan ID No: Parcel Tax No: 018-1083-05-000 STATION BS HI FS ELEV. Benchmark ~ ~ ! s l av Alt. BM L Bldg. Sewer r~ ~ ~ Ht Inlet I Z-r ~ ~' a SUHt Outlet Dt Bottom 9~ o~ Header/Man. Dist. Pipe ~ u~ ~. ~s qG . s Bot. System L ~ M O 9S, Final Grade ~ St Cover Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake l~ Length Dia Pipe(s) ~ ~ ~- ~ Length ~ L. S Dia Spacing~_ ~~ ~ 7 7Z~ SOIL COVER v Procenro Rvetumc rfnly uu Mnund (1r At.Grade SVStemS Of11V 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 discrepencies, persons present, etc.) Inspection /~ ~J ~ / /~ Inspection #2: / / Location: 1717 96th Avenue Ha~mond, WI 54015 (SW 1/4 NW 1/416 T29N R17W) Pheasant Hills ~I Parcel No: 16.29.17.577 1.) Alt BM Description = ~S~ Ti°d~ y~~6t0 (~vl~~ ~/ 't~`ha~ _ / ~ 2.) Bldg sewer length = ~~ S,~ ~ u,r,,,~ ~a.v..1= WAS u0"o' ~ ~P~~ i - amount of cover = > (~ l >7 D f x-<<G~~a+- -;7 7° lof p~~- t7 ~5 d ?'~B10SCv(/ ` Pt~r,~s ~w~{~o0 ~ ~uy"1° QarVe U ~NP °,` 3~' ~a~~~ fir-- ~~ Plan revision Required? ~ Yes ^ No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~:~ Safety and Buildings Division County ~~. /~~„~ r C ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~ ,S~Ons~~ Madison, VVI 53707 - 7112 . Site Address //~~ De artment of Commerce '~~"'~~' ~ ~(-t~'e Sanitary Permit Ap lication ~~y Permit Number ' p ~p Q a In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ~ / S l U ~ Check if Revision ma be used for seco ses Privac Law, s15. 1 m I. Application Information -Please Print All Information State Plan I.D. Number PropertyPP is Name I~~ ~T~ ~i~wt~l-~r~ Parcel Number dl~ /f1~~-DS=O~a Property Owner's Mailing Address roperty Loc a tio P n CC ~ ~ t Q City, State Zip Code Phone Nttmber Lot Nt~ r Block Nttmber Subdivision Name CSM Number wwN. ~p ~,t1~ $ o t ~ "'Z!~-'79~ -5~ b ~~ r~r' S II. Type of Building (check all that apply) ~jJ ~ '~ ~ ~ ^Ciry ` "'"" ~~Oi or 2 Family Dwelling -Number of Bedrooms ^ Village ^ PubliclCommercial -Describe Use ~~ r 1e11ownship v ^ State Owned Nearest Road ~ ~a s ; III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if appli , .., ',' 1,{~'~New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For Cotmty use \Y. ~, ..' - / J/ S stem Tank Onl Eris ' S stem '~,i B. ^ Check if Sanitary Permit Previously Issued Permit Number ed Crel~[O .. ~ Lt,C L S ~ IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) rn~ A ~ ~~ Q ~ ~QO1 ~ w . 44~Non -Pressurized In-Ground 21^ Motmd 47 ^ Sand Filter 50 ^ Cons Wetland S7 (~~ ;`--- 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Lin „~'~ (Y~UtITY ;t..~ 45 ^ At-Grade 46 ^ Aerobic Trea ent Unit 49 ^ Recirculating 30 ^ Other ' `~ ` V. D' al/Treatment Area Informat ion: -- a.. ~ 3 ~.1 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Eleva Required ~ Proposed~~ ' te(Gals./Days/ .Ft. .Mch) ~ evation ! ~,~a ~~ pia. 98 ~ 3 9~~ 3 f 9G ~ . VI. Tank Info Capacity in Total Number Mamrfacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or-FkMi~anle / f~v .'. 1~Q0 ~ /?~L.l~~ Dosing Chamber VII. R onsibr'h'ty Statement- I, the tmd , t7ity for installation of the POWTS shown on the attached plans. Plumber' Name (Print) PI r' Si MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Z' Cod r S^,o~ 9 -7D ~ ~~®~~~~ w~ 5~7~ VIII. Coun /De artment Use Onl roved ^ Disapproved Sanitary Permit Fee (in¢hrdes Groundwater Surcharge Date Issued su A ent Signature (No Stamps) ^ Owner Given Initial Adverse . ~_~ ~ / g W (O ~ i Determination ti O~ 1X. Conditions of Ap~p~ro~v/aUReasons for D' royal _ / ~» .~J ~ [ / ~.L - v..~, ~5~ ~- ~P NK.L~,J47CN(i~~ (~ Iv'c G ~v/~ ~1~~~~/(.~ ~ Nla ~ ` ' ~C ~ ~2 . ^ ~ ~ ''~ a~%LC' l t~i..C. ~ ~< >:i ' .~ : :: - Attach complete plans (to the Comty only) [or the system on papa not las than HS/Z a it Inches In alze SBI}j6398 OS/Ol) ,.:. '~ t?, T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 Fax: (715) 235-2592 w~vw.tlsinzplumbing.com _~ ~' 3 ~ r 9 ~ ~ ~ ~ ~ ~ i~ ~ ~ z s ^~ `=~ ~ ~z 0 ~ s ~- ~ -~ 3 ~ 3 Q ~u Z ~- ~_~o .~ ~o ~l- d- J ~ ~ ~ ~~ ~ ~ -~_ ~ ~ N J ~ ~' ~ {- ~ , X ~J 8 ~ ~- ~ J~ ~ ~ ~P,~ "5 ~ ~ ~ ~ ~ ~ ~~ ~ M 2 ~ ?~ ;~ ~ ~ ~ ~ ~~ . ~ ° ° ~ `~~ o~ ~ ~ ~~ ~ V ~- f ~ ~D 1 ,~°f ~ ~ ~ ~ _ , ~ ,f ~ ~ ' o ~ ~ ~~ ~ ~ s~ ~~ ~~ ' °°z O' i~ ~ ~ 2 ~ ~ M M ~ ~ -_. N ~ 3 ~ ~ ~ ~~ - Wisconsin Department of Commerce OR~GIN~~~ AND SITE EVALUATION Page 1 of 3 Di~rie~on of Safety and Buildings rd with Comm 83.05, Wis. Adm. Code ,,,r Certified Soil Testing Attach complete site plan on paper not less than s~/z x 11 inches in size. Plan must Count y include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope scale or dimemsions north arrow and location and distance to nearest road , , , . __.. Parcel LD.# _ APPLICANT INFORMATION - P~se~ pr~nt ~T ormation. , Personal information you provide may be us~dfoF sACOndary purposes(P~i , y Law, s. 15.04 (1) (m)). R "Wed y ~ Dot to Q t ~y Property Owner 3 A ` ~ ` Property Location Bonte, Ron ' ' - 3 SW 1/4 NW 1/4 16 29 17 W Govt, Lot S T N,R Property Owner's Mailing Address ,~ ..... ~ Lot # Block # Subd. Name or CSM# 1011 170th St. {' ~.._ . , 5 Pheasant Hills City ate Zi Code _Pf_~lumber H d ' S~O ~ 'f ' 4 '' ~ City n Village ®Town Nearest Road ammon n15 - ~ , _ 77Q~-52 0 , I~aammond 170Th St. New Construction ~ 'Residential / Number's bedrooms 3 ^Addition to existing building Use: Replacement `~-4J1''c or_~omm,`ceal describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpd/ft2 •4 trench, gpolftZ Absorption area required 1500 bed, ft2 1125 trench, ftZ Maximum design loading rate •5 bed, gpolft2 •6 trench, gpolft2 Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar install 2 - 5' x 112.5' shallow trenches on contours for 3 br Additional design /site considerations Parent material till Flood lain elevation, if a licable Np' ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ~ ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ~ U ~7VIL LJ G~7 ~-Rlr 1 IVIV RC~-VR 1 Boring# 1 Ground elev 94.7 ft Depth to limiting factor > 64' 2 Ground elev 95.0 ft Depth to limiting factor > 60" CST Name (Please Print) Signature: Telephone No. Henry F. Grote ~ 715-665-2681 Address ertt to of esttng D to CST Number Ref # P.O Box 57, Knapp, WI 54749 417/2000 222774 1078 Horizon Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPDIftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ~ Trench 1 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 4-11 7.SYR 3/1 - sl 2 f sbk mvfr cs if .5 .6 3 11-25 7.SYR 4/4 - sl 1 m sbk mvfr cw If .4 .5 4 25-35 7.SYR 4/6 - sl 1 m sbk mvfr cw If .4 .5 5 35-50 7.SYR 4/6 - Imcos 0 sg dl cs - .7 .8 6 50-64 l OYR 4/6 - s 0 sg dl - - .7 .8 Kemarks: .,.,..~...~.a~,~ s, ~. ~.,~ ~~~~W ~., 1 0-3 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 3-10 7.SYR 3/1 - sl 2 f sbk mvfr cs if .5 .6 3 10-22 7.SYR4/4 - sl 1 m sbk mvfr cs if .4 .5 4 22-29 7.SYR 4/6 - Imcos 0 sg dl cs 1 f .7 .8 5 29-50 SYR 4/4 - sl 0 m dvh cs - .3 .4 6 50-60 SYR 4/4 - sl 0 m mfi - - .3 .4 Remarks: PROPERTY OWNER: Bonze, Ron SOIL DESCRIPTION REPORT ~ Page 2 of 3 PARCEL LD.# Certified Soil 1'i:~ung. 3 Ground elev 96.3 ft Depth to limiting factor > 64" 4 Ground elev nc~w Depth to limiting factor > 86" 5 Ground elev 95.5 ft Depth to limiting factor > 62" Ground elev Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft2 Bed Trench 1 0-3 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 3-11 7.SYR 3/1 - sl 2 f sbk mvfr cs if .5 .6 3 11-34 7.SYR4/4 - sl lmsbk mvfr cs if .4 4 34-43 7.SYR 4/6 - Imcos 0 sg dl cs if .7 5 43-64 SYR 4/4 - sl 0 m mfr - - .3 ~~ D~ r<emancs:......~.... ~ ..~, ~.,...., ~ ............ ..., ... ~,., ,...,r....., 1 0-27 7.SYR 2.5/1 - sl 2 m sbk mvfr cw if/m .5 .6 2 27-38 lOYR 4/4 - sl 2 m sbk . mfr cw if .5 , 3 38-70 lOYR 4/6 - is 1 m sbk ds as 1 f .7 / ~! 4 70-76 SYR 4/4 - sl 2 m sbk mfr cs - .5 5 76-86 SYR 4/4 - sl 0 m mfr - - 3 ,~, ~`(" (sue" 1 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 4-10 7.SYR 3/1 - sl 2 f sbk mvfr cs if .5 .6 3 10-30 7.SYR4/4 - sl 1 m sbk mvfr cs if .4 f-r 4 30-43 7.SYR 4/6 - lmcos 0 sg dl cs if .7 5 43-62 l OYR 4/6 - s 0 sg dl - - .7 ~. `Z~ S •~ ,. Depth to limiting factor N •~ .~ ~. 3 ~ __,- ~ 4 r~ ~ ~- ~ ~' ~ d 9 6 ~ , ,~. 3 ~,~~ Z i o ,~. ~, r_ <,~ Q ~g ~ O ~~ t e .~ of n~ J t fl C~ t 0 i Y ~ c~ v K 1`L +~ ~ ~ ~ s ~ ~ ~ ~-` ~' .~ ~' ° ~ cr, f & `~ ~ '' 1 s~ a °~ ~~ ~ a (~ d ~ d / O r ~t 4 ~. +a ~+ ~ - ~ f ~. v d~ ~ / ~ ~ v d' ~ o V ~~ J ~ n ~ 4 d ~ I u ~~ cr ~-~ ~.a 4 ,~ t Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 3Q'So~/~ Number of Bedrooms 3 Design Flow -Peak (gpd) ti Estimated Flow -Average (gpd) ~0 6~-L l~/= s!'yr ~ Septic Tank Capacity (gal) q~ Soil Absorption Component Size (ft2) ® ~ vT Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) D /d SGT' Maximum influent Particle Size (in) NA ~ 18 Maximum BODS (mg/L) NA 220 Maximum TSS (mg/L) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall. be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm~is activated continuously. Intermittent filter aiarms may indicate surge flows or an impending continuous alarm. The septic Management Plan for a Septic Tank and Soil Absorption Component tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within-the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible, Tank abandonment shall be in accordance with Comm 83.33, Ws. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be voided since root intrusion into the co~Ponent may obstruct wastewater flow. _._. ~ ~v- .- 'fit S '-z-3'S--Z.(o `f'1- 5-E- • C ~ off. r, J ~n,~ ~ 2 ST CRQfX troUNTY . SEPTIC TANK MA]LNTENANCB AGRBBMBNT ' •-AND OWNERSHIP CB,R'IZFICATION FORM +wnerB er Clan ~c~n~' ytiling ddress ~ n l '~ O}" ~~~ 171.7 ~4 v2 pp~y ddress--,~~~~3 ~ ..~. I-l-avn mc~ ,-~d , +~ ~ ~ ~ j ro (Verificatiaa required from Planning Department for new constructeon}__ --: ~tylStat ._ tlY1 VY1 ~ i~l ~ Parcel Identification Number ~ ~~ ~ DR ~ ~ ~ ~ O ~.,.,.j,~,.. ~~ __.__ --- ~ T ~ N-R W, Town of ~~A(m YVm o n CJ . 'taapt~p 'on ~ ~1 ..~1~, ~ '/~, Sec. _~, ..._.~. _1..~-- iubdi ' n ~ h ~iQ-Y~-~' t-~ i 1~ ~ Lot # . ~ Gcrfiifi Survey Map # ,Volume _________ ,.Page # 7. Page # __~~~'___. S~O Warren Deed # o ~a~~ Volume Spy ~ ^ yes L~no Lot. lines identifiable ^ yes ^ no SYSTE • - A.ivc:~ roper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance eansists gimping out the septic tank every three years or sooner, if needed by a lixnscd pum~ger. W1tat You pat into the system pmt the function of the septic tank as a treatment stage in the waste. disposal sys~- prapezty owner agroes to submit to St. Croix Zoning Departrneat a certification form, signed by tho owner and by a mash journeynsanplumber, restiactedplumber or a lip vcnfying that (1) the on-site wmstcwaterdispasa-t.sYstcm ys ~ operating condition and/or (2) after inspection and pumping (if necessat3'). the se~ic tank is Less than 1/3 full of sludge. to maintain the private sewage disposal system with the standards i~ ~ ed have road the above requircnients amd agree t of IQatural Rcsourxs, State of Wisconsin' Certification ~ f~, as set by the I:~cpartment of Commerce and the Dupattmea- to the St. Croix County Zoning Office within 30 sptlmg t your septic system has been maiiitaiued must be coinplctcd and returned of three year a lion date. ~ g,~, a r DATE ~t~A OF APPLICANT p g R CATION I (we) cearEify that all statements on this form am true to the best of my (our) knowledge. i (we} am (are) the owner{s} o the icy 'bed ve, y virtue of a warranty deed recorded in Register of Deeds Office. ~_ ~/~~d~ DATE SI4IZA ©F APPLICANT Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. **s'`'`'` ss4t4~t ss Iacl de with this appticaUon: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if rrfereiice is made in the warranty deed ~n~.15O1P~~f372 6209Es3 `, KATHLEEN H. WALSH ' r REGISTEk OF DEEDS ST. CkOIX CO., WI RECEIVEI FOR RECORD Dine M. Borate, as Trustee and Ronald C. E3ortte, first alternative 01-10-2000 10:30 AM Trustee of the Karl M. Ulferts and Katherina G. Ulferts Family ~ DEEb Trust, for a valuable consideration conveys without warranty to EXEII•DT if Ronald C Borate and Dine M. Borate, husband and wife, Grantee, CERT COPY FEE: the following described real estate in 5t. Croix County, State of COPY FEE: TRANSFER FEE: Z/0.00 Wisconsin. RElX1RDIN6 FEE: 10.00 PAGES: 1 Thomas A. IAcCormadc 102010" Avs. Baldwin, WI 54002 018-1034$0, -70 (Parcel Identification Number) The North Half of the Northwest Quarter (N Y4 of NW'/.) of Section Sixteen (16), Township Twenty-nine (29) North, Range Seventeen (17) West. Dated this 24thday of Maz'ch AUTHENTICATK)N Signature(s) authenUcaled This ____ day of ignalure type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (I(not, authorized by § 706.08. Wis. Stets.) ~;'• ~ J •' 7Fi15 INSTRUMENT WAS DR~,r, ,-0~ , ~ Thomas A. MCCo a ~ Baldwin, WI 540Q~' 0 t ~ ,~ : `: Q : i .' ` ,.• 2000. •Oine M. Borate ~ J Trustee 'Ronald C. Bonle Trustee ACKNOWLEDGMENT STATE OF WISCONSIN ST. CROIX COUNTY Personally came before ms this 24ttaay of Marth 2000 the atwve named Dine M. Borate, Trustee and Ronald C. Borate, is first altsmstive Tnutee of Karl M. Ulferts and Katherina O. Ulferts Family Trust, to me known to be the person(s) who executed the fore9oinq Instrument and adcnowledae the same. _ spnature DaleJensen type a print name Notary PubUc SI. Croix County, Wisconsin, MyO~rnnlisalQn is permanent. (If not, state expiation date •Names~lolLpsrOOsSosna cfgninp in any upscity should be typed or printed below tMir sgnsWna. warmrwn rror«.av~. como.rw Fow a ~.~. vn.wwn aooass T t-'h~.~;.~~ty r al ~~ '" I ~, E 1 i4 OF THE NW t i4, THE L Ue,ATED S E I i4 1 N OF THE THE N NW l i4 AND PART OF THE SW I i4 OF THE NW t i4• AND PART OF THE NU`~ i i4 OF THE NW I i4. ALL t N SECT 1 OrJ T. 29N. , R. t 7W. , TOWN OF HAMNiOND, 5 T. CRO I X COUNTY, W t SCONS I N fOOT-r AtrEf+uE - - .~... T . ~. ~E T LOT 23 ~. • 4 ~ ~~ ~Pa F'%® ~~ / / ~ / 4 ~ . s, i / ~',• N LOT 17 . ~ ~? . _ N J N V 10 ,~ f•~ b b ^~ ~~ LOT 1 5 v i -----~- I- ---_....i-------- ~ u_,. sru Jr>.,r { , LOCATfOM SRE itM u c r ~ a ~s. r. »r.. R. ~ -w.. ror a ~w..r+ frpJ JO 7cYf1 v Y 7 lo, uTrL rTY EasE~Nrs x0 POLE ~ R 9uR ~ FP CABI E5 ARE TO 8E PL ACf 0 SKf+ TNA i ?'~£ 4LONGL~YrLOT~Mf ~ysiREE~1.~NfRVEY STAXF. 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