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HomeMy WebLinkAbout020-1075-10-300 C) 3: ci 0 eq, c CC 0 04 C)(D qb N Z D CD CL E 0 §g co CD 0 'n U (D z c LL c '0 a) 0 0 0 'a Cc 0)x CD z CD E U) 0 z CD w z .0 It 0 z 0 z :!t co F- CD E 2 Cl) � \ � j � L) z m z 0 z 4.; c '0 m E C>a c 0 CL C 4) 0 < 0 Cf) CO) cn Z > 0 z 0 0 0 (L CL CL CL 'p C- 0 U) 0 00 00 00 00 0 cm 0) U) _j z tt-- (D 0 't 00 4) (n co c? -2 00 0) U') co C) E Cl CD (D CL C) CD 0 c c cl a 0 0 C C4 o LO r- or 'm C-0 c cr cq Q) CD 0 CO Z Z CD E E CN rN— z 0 o 0 t 6 EL L: CL 4) o u CL o U—) Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 'ri �n._,� ���L�ct ' TOWNSHIP4e SEC. T N-R W IF ADDRESS � �� ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �j 5 too,& ICY !3 I R I I PtG INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used /14V 407- COMEgr Elevation of vertical reference point: �Q0.0 Proposed slope at site: SEPTIC TANK: Manufacturer: l,(1 CE_111�'S Liquid Capacity: 1= Number of rings used: A16NL: Tank manhole cover elevation: /©1f.®� Tank Inlet Elevation: Idoz Tank Outlet Elevation: 061 �0 7 Number of feet from nearest Road: Front, Side, Rear, O feet From nearest property line Front 10 Side,®Rear,0 feet Number of feet from: well t building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 1 J �I umber of feet from nearest road: arm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3 �s 3/84:mj SANITARY PERMIT APPLICATION COUNTY /� � DILHR In accord with ILHR 83.05,Wis.Adm.Code "s V Rell STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. S"7 g_ —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERTY OWNER PROPERTY LOCATION C'/4 '/a, S A7 Tg57, N, R / E(or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME r 14 AA �,4 CITY,STATE ZIP CODE PHONE NUMBER-7nCITY NEAREST ROAD,LAKE OR LANDMARK 1 VILLAGE: 1Z TOWN OFE 4t1jQ5QA1' LI s 111. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR Ll Public(Specify): JA1000AD CIEMNIS CO'wf 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. Dc New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. %Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 54 Seepage Bed b. ❑seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutesper inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 0th/C� / Are Feet CK%Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks strutted Septic Tank or Holding Tank X i ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber /,10o ❑ 1 E El VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plu a 's Signature:(No Stamps) M PRSW No. Business Phone Number: Dora u,(A< c %t T ,.t.�. a / S 6S Plumber's Address(Street,City,State,Zip Code: Name of Designer: ^ ! A i VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# 6A I? CST's ADDRESS(Street,City,State,Zip Code) Phone umber: C L9p /?/if wlymiled IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater E4-31,f'r te Issuing Agent Signature(No Stamps) [XApproved ❑ Owner Given Initial S rcharge Fee /� ( ,� �I Adverse Determination 12o,o 0 Z�GL� ' ` ��'� �j� 660,-O X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system Iccation, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank's) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. 'f you have q.restions concerning your private sewage systei.i, contact your local code a0miristrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include. 1. Property owners nar, e and mailing address. Provide the legal description where the system is to be installed; 'I. Type of building or use served: If public is chocked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depend,ng on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check: experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h 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 o" holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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 curve; 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. -------------------------------------------------------------------------------------------------------------------I------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground Ater,— included the creation of surcharges (fees) for a number of regulated practices which Wiscorn's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buriedQBStItQ is used in your building is returned to the groundwater through your soil absorption � o system or the disposal site used by your holding tank pumper. a Tiye monies colle..!ec! thrOUgh these surcharges are credited to the groundwater fund adminis +,gees by the Department of Natural Resources. These funds are used for rioniiorir,g ground- t ated, grrlunldwater contamination investigations and est:-iblishment o' standards GroundwatFSr, . t i 's worth protecting. SBD-6398(8.03/86) IE-- ,oat cr voa j a.L*n idd SS-S�� So��oS�d lJ '»_a = �,d rn koi���S SSOtI� cle so del ud '7V-? port .7v:g �1 ,Ur I 0// 7V Z l \� 4 to { b ° 9 ` Q. at h4 £of 7_g G✓_al s A S �d Ojv `O ®nt '�� f ! d 1 cc IV 1)? In Q � k e Z ho O © o �� ~ o b kr lz ce Ic 3 � v W4 o +� -_ 06694 llvlvoie 7elill,111 Cc,(11?F- ICS 1101 V 5172�e7 u 4 t)J"V A JV5 7)9 0 R S rjol? -5 -/Ic;t- JA4)e?, X "73 ;AOu�,q REOUIPeV zF/11-TAC T14 N r /7z o vo 3y 6Z A 19 CALS TO 14 L'4 rl 1-i 5 Ci" 14 Ol 0 0 a r TA 0 0/4 1- /,FL) 6-A 4- OAC pac 411. rya)X 16 V 3), t - 5 P,00,f ' k A` State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY&BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 I DONAUIN SCI-AMITT Owner: RICHARD STOUT ROUTE 2 BOX 295A ROUTE 2 SOMERSET, WI 54025 HUDSON, WI 54016 RE: Plan Number: S88-00694 Date Approved: April 15, 1988 Gallons Per Day: 370 Date Received: April 1, 1988 Project Name: STOUT, RICFIARD Location: SE,SW,27,29, 19W INDOOR TENNIS COURT'S Town of HUDSON County: ST CROIX The plumbing plans and specifications for this project: have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved' . This approval is contingent upon compliance with any stipulations shown on the plans. All items that are rioted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires . The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: — NEW CONVENTIONAL NOTE: This approval does not include plans for the general plumbing systems or sewer piping to the septic/holding tank that is required for this project. Those plans must be submitted and approved. I SBD-6423(8.10/87) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION DONAUIN SCHMIT'T Page 2 Inquiries concerning this approval may be made by calling (608) 2.66-3937. Sincerely, 4 � � �-y� JAMES QUINLAN Section of Private Sewage Division of Safety and Buildings PPPO12/0009n/ 9 cc: RICHARD STOUT" ___Private Sewage Consultant County Uk_SSWMP Plumbing Consultant Owner Plumber Environmental- Health I I I I i I, I j I I I I i I i I I SBD-6423(R.10/87) T OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUS INDUSTRY Y,, DIVISION LABOR AND PERCOLATION TESTS P.O. BOX 7969 HUMAN RELATIONS. (115, , \ � MADISON,WI 53707 (H63.090)&Chapter 145.045) LOCATION: L OT NO.:BLK.NO.: SUBDIVISION NAME: SE 1/4 SO/ 27 /T29 N/R 19f(or)W Hudson in ja COUNTY: 0 ER'S NAME: MAILIN AD—DRESS: St. Croix Richard Stout R.R.#2, Box 340 Hudson Wi. 54016 USE DATES OBSERVATIONS MADE NO.BEDRMS,: COMMERCIAL DES RIPTION: IPR FI t A TESTS: ❑Residence n/a 11 It ennl3 COUrts FC]New ❑Replace 11-12-87 n/a RATING:S-Site suitable for system U-Site unsuitable for system CONVENTI NAL: MOUND: IN-GROUND-PRESS UR :S STEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) S ❑U iaS ❑U I 39S ❑U I EIS 9U I EIS iE]U I conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Class2 Floodplain,indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS Dage 66 PIA BORING TOTAL_ PTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH—THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH4%'-ELEVATION OBSERVED EST.HIGHEST— TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B-1 6.67 105.01 none >6.67 1.00bl.1. 5.67bn.l.s. 13-2 7.16 107.00 none >7.16 1.08bl.1. .83bn.s.sil. 5.25bn.l.s. B.;3 7.33 105.94 none >7.33 .75bl.1. .75bn.s.sil. 5.83bn.1.s. B 4 7.75 107.02 none >7.75 1.08bl.1. .75bn.ssil. 5.92bn.l.s. B-5 6.83 105.17 none >6.83 .83bl.1. 1./00bn.s.l. 5.00bn.c.s. B- PERCOLATION TESTS TEST DEPTH- WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p I D 1 PERIOD 2 PER1003 PER INCH P- P- P- P-_ P- P- 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 103.44 -- I , `-+ S ,` 20 r _. i _ ..____.. I,the.undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and 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: Gary L. Steel 11-12- ADDRES : CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. Shore Dr. , N 171,5=246-6200 CST PI T RE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02/82) —OVER — '_. DEPARTMENT OF• REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION 115 P.°. BOX 7969 TESTS ( HUMAN RELATIONS• 1 � MADISON,WI 53707 (1-163.090)&Chapter 145.045) OCAT ON: E TOWNSHIP/MIPYkt LOT NO.:BLK.NO.: SUBDIVISION NAME: SE 4 27 /T29 N/R l9f(or)W Hudson COUNTY: O ER'S NAME: MAILING ADDRESS: St. Croix Richard Stout R.R.#2, Box 340, Hudson Wi. 54016 USE DATES OBSERVATIONS MADE NO.BEDRMS.:IGUMMERCIALDESCRIPTION: I R ONS: R AT ON TESTS: ❑Residence ❑ New Replace 11-12-87 rr,/a n/a tennis courts RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND RESSUTE. SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) J S ❑U � ❑U 39S ❑U ❑S gU ❑S gU conventional If Percolation Tests are NOT required. DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Class2 Floodplain,indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS a BORING TOTA!_. DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH-THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HE TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B-1 6.67 105.01 none >6.67 1.00bl.1. 5.67bn.l.s. B-2 7.16 107.00 none >7.16 1.08bl.1. .83bn.s.sil. 5.25bn.1.s. 63 7.33 105.94 none >7.33 .75bl.1. .75bn.s.sil. 5.83bn.l.s. B4 7.75 107.02 none >7.75 1.08bl.1. .75bn.ssil. 5.92bn.l.s. B5 6.83 105.17 none >6.83 .83bl.1. 1./00bn.s.l. 5.00bn.c.s. B- PERCOLATION TESTS 8 TF�-r DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES v R E NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PER o 2 PERIOD 3 PER INCH P- P- S P- P-. P- P- 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 103.44 vo 1 — S- — - ._ I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and 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: Gary L. Steel 11-12-87 ADDRESS: CERTIFICATION NUMBER: I PHONE NUMBER(optional): 988 N. Shore Dr. , New 7L5=246-6200 CST SIG T RE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — L- H z cn H 9 ST C - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT Ho St . Croix County z d a OWNER BUYER , l r C 1?�/ l 1(• (1141 LL- ) / AID ey'1 J �L=/��1�/r �' LG s' 9N� M ROUTE/BOX NUMBER 9 1-j Fire Number CITY/STATE 0/q,/ /` ZIP _i yl�/ PROPERTY LOCATION : Section , TN , R —W, Town of #4e12 00,1 St . Croix County, Subdivision P111,114 /11_ L✓ Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists 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 treat- ment 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 systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . yo I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth , herein, as set by the Wisconsin Depart- ro ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED DATE 1- St . Croix County Zoning Office P . O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . 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. Should 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 Property �,� Z C 7/ Location of Property S�� k s�jJ , Section ? , T_;- f N-R W Township 1�611aiclly Mailing Address r( /,d !V 429 d X 3 '10 four. �• � �c✓. L..�i', ` Address of Site X T, Subdivision Base //A . Lot Number &A Previous Owner of Property A %:/t/ t)_�'�Pt k'rZ: Total Size of Parcel Date Parcel was Created - l 22 '7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume 0 and Page Number -1:12-Y 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) Ceh.ti.6y that att itatemen,t�s on t►t" �onrn aAe t�cue to the best 06 my (OUA) hnowtedge; that 1 (we) am (ahe) .the ownen(a o6 the phopenty deAchi.bed in thiA i"604mati.on 604m, by viAtue o6 a waAAanty deed &ecoAded in the 066ice 06 the County Regis•ten o6 Deeds ah Document No. , and that I (We) phew en tPy avn •the phoposed 6 to 6oh .the sewage d-i�spoA syA em (on i (we) have obtained an CoA tment, to nun with the above deg cAi.bed pnopen ty, 6o L the conatnuc ion o6 eaid a ya.tan, and the game has been duty keeokded Xn the 066.tce o6 the County RegiAteA o6 Veeda, as Poement No. 3 SIGNATURE 01? OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED i { ' DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1—1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED REGISTER'S OFFICE II _ AQ4ft ��� f, 9 ST. CROIX CO., WI Recd for Record This Deed made between Alle>Z--jn1:___B_ akkg•_sBSI_____••"___________ January 5, 1988 PatX1Cia:_A..3,rakke _-_"_ -------------------------------- ------••--•-- " -------------------------------------- '7t 9.50 A M ----•-----rq ----------ley------ -------------------- .........................._•' Grantor, Ij and-__St,,_-Croix•_Valley- Indoor• Tennis"-Club, Inc_.• II Register of Deeds �+ ------------ V�p7wlzl •--•-• -------------•--- • ---------•-••--•- -_._•--., Grantee, Witnesseth, That the said Grantor, for a valuable consideration------ --------------------------------------------- • ------------••-- -------------------- conveys to Grantee the following described real estate in L+ _St• CrOlX RETURN TO County, State of Wisconsin: jl A parcel of land located in the N - E� of the SW� of Section 27, Township 29 North, Range 19 West as described in the Certified Survey Map filed in the Office Tax Parcel No_ f of the Register of Deeds for St. Croix Count in Volume ___7__ of C.S.M. Page _ y 1921 Document __432856_ together with a non-exclusive easement to use as an access road: The 66'roads referred to in Paragraph A, 2 and 3 on page 1 of the Grant of Easements and Release of Prior Easement recorded in the Office of the Register of Deeds i ' for said County on October 17, 1986 in Volume 757, Page 213, Document No. 418254. 1 EXCEPTED from this grant are all interests of the Lessors and Lessee and their i respective successors in interest under the terms of the Oil and Gas Lease recorded in the Office of the Register of Deeds for St. Croix County in Volume 694, Page 88, Document 395426 as assigned of record by the document recorded in said office in Volume 699, Page 506, Document 397597. ts 0 ii I �f This ------------- ------ -"----- homestead property. i (is) (is not) Together with all and singular the hereditaments and a ppurtenances thereunto belonging; And.....Allen W. Brakke and Patricia A. Brakke warrants that the title is.good, indefeasible in fee simple and free and clear of encumbrances except - any easements of record i and will warrant and defend the same. i �i iDated this ...___.__..•_..__. 1-4,Z d December I) aY of 19 87 ----------------------------------------------------------- _.. _. •---------------------- .......(SEAL) - - -- -'--- • •--•----- •.. .. ...... ......(SEAL) I� * ----------------•---"--------------------------------------------- AAlen.iol._--Rr_akk ----------------------------- i ----------- ------------------------------------ (SEAL) L1?2r. ------(SEAL * -•--"---"---"---------"-----""-"--".._._---••-.._.__.--•------•-- *Patricia A. Brakke --------------------------------------------------------- AUTHENTICATION i ACKNOWLEDGMENT i Signatures) Allen__4dx__Brakke•-and ____________________ STATE OF WISCONSIN f i . atrir_.ia_A.__Bsakka---------------•-------------------------- ss. I --------------------------------------County. authentic"this . day o _--_December , 19$7___ ~---- Personally came before me this ____ _ day of - ---------- ......... ------- . -I' -----, 19-------- the above named -------------------------------------------------------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ------------------------------•----- -- •""--."'-"--- ------" authorized by § ?06.06, Wis. StatsJ _..-----------------------------------------•------------------------------------ to me known to be the person ------------ who executed the THIS INSTRUMENT WAS DRAFTED BY foregoing instrument and acknowledge the same. John D. Heywood, Heywood, Cari & Murray ----------------------•------------------------------------------------ P.O. Box 229, Hudson, WI 54016 "------------------------------------------------------------ ------ Notary Public ------------------------------- '' (Signatures may be authenticated or acknowledged. Both MY Commission is County, Wis. are not necessary.) g permanent.(If not, state expiration _. date: kk , 19......... *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1--I qs2 Wisconsin Legal Blank Co. Inc. Nlilwankee, Win.