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HomeMy WebLinkAbout018-1094-15-000 n§ o ■ T 0 e o , ■ c m � ■ k � i 7 � 0 (D / E \ $, E \ e y 0- E m E @§](\ o § S - \ \ j / ° 8 j \ \ -4 3 © ® 0 - F I ¢ o & � o E§ %:e © ` Cl) >cn E e >� E I $ c @ § \ o E ƒ \k] z o o 0 . � ° i S \ � & \ "411, � z o 0 o I, O » o 1 § § ca CA ° / E ] S v v m & g d \ R § § § 3 (_ � & � { a i\0 . \ S' o [ @ \ ° \ \ % ( § \� ON CD CD 0 3 2 0 # !- w cn E 8 E \ $ - - ; M = 23 \ § 9 E / ■ M 2 § -4 CL � z o F z 2 z # U) % ® _ > k 2. ■ a } k � { / .. / J \ C � $ � 0 \ � CD § \ _o �% §� �# Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: t 430051 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: _ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Klinger, Scott I Hammond Township 018 - 1094 -15 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: CS�O (SO.O� CSTgV"(= 2 r 17.29.17.755 TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark i W E- �cIC -S �0 2� Oka? Dosing Alt. BM (e'LZ �dt•� Aeration Bldg. S0yer O • IS O Holding St/Ht Inlet -t 1(•06 s zz' � TANK SETBACK INFORMATION St/Ht Outlet (•29 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , O r 12 r Dt Bottom Dosing Header /Man. Aeration Dist. Pipe IZ,6Z. Z Z. 3• t?�o Holding Bot. System I r :�o 9Z,c. PUMP /SIPHON INFORMATION Final Grade i $.91� q � • 32 Manufa urer Demand S over r Model Numb M TDH Lift F 'on Loss System Head TDH Ft Force in Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM RENCH Width Length, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S 2 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man pturer: INFORMATION CHAMBER OR - I L Type Of System: ' j m: �, �Z ,'w� UNIT Model Nu r: -� 1 DISTRIBUTION SYSTEM Header /Manifold tl Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) g Length Dia Le is acin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil E_1 No Yes [ No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1 � / : QC �� Inspection #2: Location: 956 167th St ammond, WI 54015 (SW 1/4 NE 1/4 17 T29N Rn1�7,(W)) 'r ine Run Lot 15 ) 1 Parcel No: 17.29.17.755 1.) Alt BM Description = ,�(. �'�'/ 2.) Bldg sewer length = 12 - amount of cover = ? f ��• Use other side No de for additional information. Z / , _ SBD -6710 (R.3/97) Ne f) ^ S Insepctor Signature I Cert. N�o. L.� J =_J �.�((� Safety and 134 ddiiip Division county 201 W. Washingto; A . c., P.O. Rox 7082 visconsin Madison, W 5:: 707 - 7082 Sanitary Permit Number (to W filled in by co.) Department of Commerce (608) , 61 6546 c S Sanitary Permit Applieatlo n �, sa te Plan I.D. Number In accord with Comm 83.2 1. Wis. Adm. Code, personal informatio, yo , prow may be used for secaidary purposes Privacy Law, x15.04( xn) Project Address (if different than mailing address) I, Application Information - Please Print All Information — Property Owner's Name _ E C E i V E D Parcel a Lot a 1,5 We" Property Owner's Mailing dress Property Location �- J � N 0 2 2003 /on City, S zip code �,Ph:uc. l � V., �� Section �_ —;? t�t N ' O FFI CE Crrr LUNING O F!CE (circle ) I. PP Y) pe of Building (chec all that ap T, N; R r [ or6V Su.�e 1 or 2 Family Dwelling -Number of Bedrooms � . Subdivision Name 014, wabn ❑ PublWCommencisl - Describe Use 0. State Owned - Describe Use ( 0" ? ' . rZ k 2 T ' Wlc oCity_oV U a 1&ownship of III. Type of Permit: (Check only out box on line A. Complete line B .i w pliable) 1• D. D 8 5 6 57 : 757 Qpp A. —.. Now System ❑ Replacement System o Tratrmont/Holding ran,. Replacement Only ❑ Other Modification to Existing System B' ❑ Permit Renewal o Permit Revision ❑ Change of ❑ P rmit Transfer to Now List Previous Permit Number and Date Issued Before Expiration Plumber pwucr IV. Type of POWTS S stem Check all that A I ,&Non - Pressurized In -Ground o Mound > 24 in. of suitable soil ❑ Mounc: < 2 in. of suitable soil o At-Grade o Single Pass Sand Filter o Cooslruated Weiland o Pressurised In -Ground o Holding Tank ❑ Peat i' itc o Aerobic Treatment Unit ❑ Recirculating Sand Filter 0 Recirculating Synthetic Media Filter ❑ Leaching Chamber o Drip Line C' G1 vol.ias Pipe o Othu (explain) V. Dis ersal/Treatmeat Area Information: Design Flow (go) Design Soil Application Rate(gpdso Dispersal Area Requi - (so Dispersal Arta Proposed (so System Elevation VI. Tank Info Capacity in Total Number ,� afacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructod Glass New F�rlstial Tanks Tanks Septic or Holding Tank Aerobk Treatnxra Unk _z6W 14 Doing clamber VII. Resp onsibility Statement- 1, the undersigned, a ume responsibility for 11- allation of the POWTS shown on the attacbed plans• Plumber's ame (Print) Plum 's Si re M !MPRS Number Business Phone Number P umber's Address S / (eras, City, State, Zip VIII. Coun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Foe (incl..dca Groundwater Date Issued t uin ent SiBnnaturo 900 Stamps) Surcharge Fee) o Owner Given Reason for Denial 2 2 �9 IX. Conditions of Approval/Reasoas for Disapproval k (— t A-Cl t au�;i;dJ No a .A.�/ o .Yes Niy) fowtu ry {CM, on M SBD -6398 (R. 08/02) �1 I N Imo\ r I \ I I I i I I i I r — 3 r r h � ' r I I _ I r r i O I r - -_- , j q \ - •-- �_ --�_ --- � . _ --1- mil. -QyC -�- -. _ -_-� - �__ --, . -_ _ --♦ '. -_- _ -._ ._-�.- � __ -.� -..-. ___ _._.- _ _`- - _- . r o _ - - r ' M Ni� 3 SL lb M Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, 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 not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. a C Please print all information. Re ewed by Date Personal information you provide may be used fo 15.04 (1) (m)). ttnfL09 Property Owner ° -1 V a—Lj 0perty Location r ovt. Lot 4j 114 1/4 S N R (or Property Owner's K46illng Address J 0 2 2003 t # I Block,# Subd. Name or C-SW A z 4 I City State Zip Code Phon 4 Cit Villa e [Town Nearest Road �. , OFFICE ❑ Y ❑ 9 ( ) - 7� New Construction User Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material / Flood Plain elevation if applicable XIL ft. General comments and recommendations: F/_1 Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor } in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. C nt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 7 i q3 - c- Boring # ❑ Boring MI I Pit Ground surface elev. 97s ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 3 s — S� • � 93 • c. * Efflue , p6l = OD > 30 < 220 mg /L and TSS >30 < 150 mg /L * E ent #2 = BOD < 30 mg /Land TSS < 30 mg /L CST Nam (P se Pri Signatur c CST Number Address Date Eva uation Conducted Telephone Number �' SBD -8330 (R07 /00) a Property Owner Parcel ID # Page - ,,-) of F7 Boring # 1:1 Boring �� 7 jZ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 / c °12 • �o � Z� F] Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) M M "� v 1 '1'S OWNLR'S MANUAL & N11ANAGLMLNT PLAN ruYo ja . FILE INFORMATION SYSTEM SPECIFIC TI Owner �' Septic Tank Capacity al o NA Permit #� eon Septic Tank Manufacturer a NA Effluent Filter Manufacturer o NA DESIGN PARAMETERS Effluent Filter Model o NA Number of bedrooms o NA — Purnp Tank Ca acit al ON A Number of Commercial Unit NA Pump Tank Manufacturer 6-NA Estimated flow al /da Pump Manufacturer A Design now (peak), Estimated x 1,5 al /da Pum Model ANA Soil Applica Rule Sul /du /ft Pretreated Unit Influent /hfl'luow Qu;tlity Munthly AVVI -ego* a S;utd /Gravul Diller to Nvut I'iUvr t=uts, Oils & Grease (1"00) :530 nrg /L rt Mochunical Aorolion u Wvtltuul Biochemical Oxygen Demand (BODs) 5220 mg/L o Disinfection o Other: Total Suspended Solids (TSS) <150 m L Manufacturer Monthly Average•* Dispersal Cell(s) Pretreated Effluent Quality DNAln- ground (gravity) o In-ground (pressurized) Biochemical Oxygen Dcmmnd (BODs) :530 ink /l, o At -grade o Mound Total Suspended Solids (TSS) S30�mg /L o rip-line o Other: Fecal Coliform (geometric mean <10' cfu /l00mL Maximum Effluent Particle Size I '/v inch diameter Valucs typical for domestic (non - commercial) wastewater and septic tank efi'luent• •• Values typical forprouated wastewater. MAINTENANCE SCHEDULE Service Event Service Fre uenc Inspect condition of tanks At least once every o months ears Maximum 3 y rs Pump out contents of tanks When combined sludge and scum eq uals one third %, of tank volun Inspect dispersal cell At least once every o months cars Maximum 3 r� Clean effluent filter At (oast once every o months our s Inspect pump, p ump controls & alurnt At loast once oyory u months o ours aNA Flush lutcruls and pressury test At least once evory o mont a y ur(s2 jzNA Other; At least once every o months o year s ) 6 NA Other; At least once every o months o ears A MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certificatior Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on t ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may.indicate a failing condition and requires the immediate notification of the local regulatory authority. When -the combined accumulation of sludge and scum in any tank equals one -third (A) or more of the tank volume, the ent contents of the tank shall be removed by a Septnge Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code, The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer, A service report ,shall be provided to the local regul;itor•y nwhority within 10 days of completion of any service event, START UP AND OPERA'T'ION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s), If high vonoontr Ogns tiro detected hay the contents of the tanks(s) removed by a septage servicing operator prior to use, Owner: ._51!e _,_, .a,�te Page ¢�of System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent, To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells, Do not drive or park over, or otherwise disturb or compact. The area within 15 feet down slope of any mound or at -grade soft absorption are, Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed, • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and Jy be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. o A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. o' The' site fias "not'been evaluated'�to identify suitable replacement area. Upon failure of the POWT S a soil and`site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. o Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. DONOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COKMENTS , POWTS INSTA POWTS MAINTAINER Name Name Phone - _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Namel Name Phone Phone i g,� ST CIZOIx COUNTY SEPTIC TANK MAINTENANCE AGREEMENT .-AND OWNERSHIP CERTIFICATION FORM )caner /Buyer -� Mailing Address 'roperty Address (Verification required from Planning Department for n ew construction) amity /State Parcel Identification Number - �� 1 o /S- l 5� -1s J LEGAL I�ESCItIPTION `)i � N -R �Zw� Town of property Location tal - /+, 1 /,, Sec. ,d -��' . Lot Subdivision Certified Survey Map It , Volume Warranty Deed # Volume / 9/9 • Page // 9 Spec house ❑ yes 0 no Lot lines identifiabI yes ❑ no SYSTEM MAINTENANCE remature failure to handle wastes. Proper maintenance Improper use and maintenanceof your septic system could result in its p What you put into the system consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper can affect the fi metion of the septic tank as a treatment stage in the waste disposal system- sign b the owner and by a The property owner agrees to submit to St. Croix Zoning Department a cede on-site ' wastewaterdispasal system mast�erplumber, joumeymanplumber, restrictedplumber or a licensed pump sary), g that the septic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and (if neces sal system with the standards Uwe, the undersigned have read the above requirements and agree to maintain the private sewage , S tat Y set forth, herein, as set by the Department of Commerce and the De returned to the SL Croix County Zoning Office within 30 ent of Natural Resources, State of Wisconsin- Certification t your scpti stem has been maintained must be complet ed a nd tie e r expiration date. 3 / / O DATE p • ICANT _. OWNER CERTIFICATION am are the owners) of w) certify at 1 statements on this formed eorded egister of Deeds office I (we) ( are) the p DATE pert desc ' e, by virtue of a warranty d 3 if7iU \_ SIGNA RI? Or PLICANT t « « « « «« * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depa�e n «* Include with this ApplicAtion: a stamped warranty decd from the f gister Deeds offi the warranty deed a copy of the certified survey map x Z° %6 v Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code c / - Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County cJ� crQJ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner � Property Location tJl � S Govt. Lot 5 V 1/4 ,Vt/! 1/4 S T Zq N R J ;Z- E (or) W' Property Owner's Mailing Address Lot # Block # Aubd. Name or CSM# 9-7(P 17 t�' 1 IJ Q` i n City State Zip Code Phone Number E] City ❑ Village aTown Nearest Road ✓l1 (7 /S') 7�i(a -Z 3 F - 3, �a man New Construction Use: Residential /Number of bedrooms 3_ y Code derived desi w•rate GPD ❑ Replacement ❑ Public or commercial - Describe: �t ! Parent material T1 Flood Plain elevaf n •applicable� J ft. General comments S �k ✓. �/ S. J70 ` ' and recommendations: P] Boring # n ❑ Boring Z LS2F Pit Ground surface elev. 1 ft. Depth to limiting factbr. _in.� ; Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence un ary Roots GPD /ftz in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - b S i t za - 4.bL wtfr c5 I v �' 8 sil ZmabL (y4 C-.5 - 8 10 mS — /. Z a Boring # E] Boring p/ ® pit Ground surface elev. 101 3 d ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 O - lD 1 Si I c v • 5 � Z (0 Aa 10 g ki 14 r 3 9 s 0 rn * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signature CST Number �— 2 Address Date Evaluation Conducted Telephone Number 2-I 6 I ��vZ� 11 -2 -off (71 2y7 - SBD -8330 (R07 /00) ,< a Property Owner qa Whl Parcel ID # Page of 3 F --sl Boring # I❑ I q Boring � Pit Ground surface elev. 6 � Gd ft. Depth to limiting factor / 5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 D -�2 I 3�1 Sil eS I 4 Z 12 -15 5 i I 2 vr�ab c 5 8 3 is - 9s M5 as F-1 Boring # F1 Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) J 19191 199 DOCUMcNT NUMBER 6 8 3 Ql 4 2 KATHLEEN H. WALSH WARRANTY DSED REGISTER X OF DEEDS RECEIVED FOR RECORD William E. Hawkins, Grantor, conveys and warrants to s `ott Klin eoe 07-01-2002 9:30 AN Granree, the following described real estate in St. Crmx County, state of Wisconsin: C ITV DEED EXEWT i Lot Fifteen 115), Prairie Run, Town of Hammond. REC FEE 11.00 TRANS FEE: 149.70 COPY FEE: CERT COPY FEE: PAGES: 1 NAME AND RETURN ADDRESS WESTconsin Credit Union P.O. Box 269 New Richmond, W1. 54017 Part of 018- 1037 -90 -000 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, restrictions and rights -of -way of record, if any. Dated this Y day of June, 2002. �C- C.r_ -� L _ �Q1►� --+ (SEAL) (SEAL) William E. Hawkins (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ! y_ I ) ss. COUNTY ) ��ll 11.,,,,,.�,, authenticated this day of 20_ Personally came before me thisc�l `. lof� [ �. Q uv2 the above named William E. Hawkins (Signawre) to me known to be the persons(s) who'Y�w��)ted the foregoi instrume t a d acknowledge Lye � vV •,1 NNme Prrntatl or 'IYOed) 'f;TLE: MEMBER STATE BAR OF WISCONSI isi n (If not, authorized by 5706.06, Wis. State.) Name Printed or ea THIS INSTRUMENT WAS DRAFTED BY, Notary Public County, Wis. Leo A. Beaker, Attorney at Law My commission is permanent. (If not, expiration date:) Rodli, Beskar, Boles & Krueger, S.C. /S P.O. Box 130 River Falls, WI 54022 r -� I 06, •� z IE oir 10 0 0 LL ' lu h I f / NOO 00' 00' E 220.26' n ao ; - --- -- 99.6 - - - -IZO. 62- j Ot O C • �i ® F 01 — I Cp a ' ........................ ...` .-rs.............. I ti 1 • W ►- . too uj r� alb M of vi N `•, '�; ` b i d 'i+e:••.'�' ti w A. ib "cap,`., d• 4p Lju LL . cc o uj cx Lo O a a • ` •`. Q , � O o ar �� � •ga -... ' is to cc Q gA 8 � � ( i N O `O ► � ID H i 1 i h ry L � � OJT Q � � • � � h It o W cr. 1 2 = h n N -S QUARTER SECTION L IN Q = •o RZ �� ' N01 ° 01'49" W o H 1231. 04' 30. 266. 1 I ' 88.71' 414. 88' N01 ° 01 ' 49" W 1962.04' ( TO NW COR. PLAT) 63' (TO NORTH QUARTER CORNER) UNPL A T TED LANDS ........ .. ...... I... ............. I,.,..