HomeMy WebLinkAbout020-1369-04-000 I
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division �
INSPECTION REPORT Sanitary Permit No:
' (ATTACH TO PERMIT) 420317 0
GENERAL INFORMATION 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:
LaRocco, Rick & Shelle Hudson Townshi 020- 1369 -04 -000
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION el-EVATIOWDATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Ben c ark /
) o 7i 0 / 062 0
Dosing Alt. BM
5 , CrT yq, Z
Aeration Bldg. Sewer 7 D
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/HtOutlet Jc�I e1d X . 7 93
TANK TO P /L WELL BLDG. VW to Air Intake ROAD Dt Inlet
Y� �Sf COr �1d9
Septic �/ S � On s Dt Bottom
t�
Dosing Header /Man.
Aeration Dist. Pipe ( OC "7-
Holding Bot. System r K d: (.S
Final Gr e
PUMP /SIPHON INFORMATION /QU•
Manufacturer Demand St Cover
GPM 3 R/ - 7 • 0
Model Nu
TDH Lift Fri ' n Lo System Head TDH Ft
Forcemain gth Dia. - - --
St. to weft —
SOIL ABSORPTION SYSTEM
BED /TRENCH Width t Len th f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L .,j BLDG WELL LAKE/STREAM LEACHING a
INFORMATION CHAMBER OR
Type f System: �
�' UNIT Model Number:
DISTRIBUTION SYSTEM W fo ,1 � a is
Header/Manifold Dst
I P:pe(s) ribution („ x Hole Size x Hole Spacing Ven o Air Intake. kIntake.
/ /l �;��,
Length ` Dia_ Length tF� Dia y �"Spaang
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only v4 dLct
Depth Over IDepth Over xx Depth of xx Seeded /Sodded Mulched
Bed/Trench Center S � Bed/Trench Edges Topsoil Yes [] No T ❑ Yes Lip] No
COMMENTS: (Include code discrepencies persons present, etc,) Inspection #1: i 20 / 0 Inspection #2: / /
Location: Parcel No: 10.29.19.2194
685 Ofd Hopkins Place Hudson, WI 54016 (NE 1/4 SE 1/410 T29N R19W) Hopkin s Prarrre Lot 4
1.) Alt BM Description= -!;'T. CA V(: U 01 -
2.) Bldg sewer length = D /2 Z �
3 d Wi,� SeaL 5.,r
- amount of cover
Plan revision Required? Yes (
Use other side for additional information.
_
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SBD -6710 (R.3l97) Date Cert. No.
Insepctor's Sig ature
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Safety & Buildings Division
r Sanitary Perm 201 W. Washington Ave.
Permit Application PO Box 7302
MIS �i�litli Sjlf1 In accord with Comm 83.2 1. Wis. Adm. Code Madison, W1 53707 -7302
Department of Corn ores Personal information you provide may be used for secondary purposes (Submit completed form to county if not
_ [Privacy Law, s. 15.041(1)(m)) ��� Mate owned,
Attach com fete plans to the county copy only) for the system on paper not lesi then Lu x 1 I inches in size.
County State S tary Permit Nu er ❑ Check if re fscipu�s�}n{�Qi� Sue Plan 1. D. q r
I. Application Information - Please Print all Inforutaliott GGllrr ii �t � -- Lo atlon: /V $` 04Z 0 iIV
Property Owner—Norm — —� -- - Pro eft Location
` c ��e �t� c�c,c ��.�C7; 01 zoo2 y .a�
_ ___ I/4 S 1/4 S to '1704 N Rl I W
Property O er's Mailing Address ST. CR: r ` Lol umber 81ock u
qlcl -,/,o � IING L - ICE
Y '517 108� o P_
City, St ate Zip Cade Phone Nmnber Subdivision Norm or CSM Number
_ r ,
II ype of Building: (check one) 17tH e e 8P— ❑ City
4 1 or 2 Family Dwelling - No. of Bedrooms: — _ Vr} pj r dtktP, s i'n 3o X 5D ❑ Village
O Pubiic/Commerciai (describe use):_ i� (,vl' _t►�_. _-h?_ La-4-1, I (8 'I'ovm of
O State -owned
I w III Type of Permit: (Check only one box on line A. Check box on line B if appl' abdV "�� earest Rd1 G t L K
A) 1. *ew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Nunrber(s)
S stem 'tank Onl _ _ Existing System __ 04 0 - / - O
B) Permit Nuurher Date Isaued
❑ A Sanita Permit was reviousl issued
IV. Type of POWT System: (Check all that apply)
11 Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Weiland
C3 Pressurized In- ground ❑ I lolling Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic'Trealment Unit ❑ Recirculating ❑ Other:
V Dia ersallTreatment Area Information:
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation. 7. Final tirade
Required P oposed Rate (Gals. /day /sq. It.) (Min. /inch) Slevat'
9so 0 3 4S 3�� JT9
VI Tank Capacity in Total N of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons "Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
S C ) ��b _ - -❑ ❑ ❑ ❑
11 ❑ ❑ ❑ ❑
VII Responsibility Statement
1 the undersi ned assume res nsibilit for installation of the POW'I'S sho on (he attached glans. _
Plu"fnes Na print) P tuber's Si o ttarrgn): MP/MPRS No. tduelnen Phone Number
S"'
Plumber's Address (Street, City, State, Zip C — -
VIII County/Depart ent Use Only
O Disapproved Sanitary Permit Fee (Includes Groundwater [1)t Issued suing Ag 1 Signature mps)
U'A pproved ❑ Owner Given Initial Adverse Surcharge F�` Qlj
Determination
Conditions of Approval /Reasons for Disapprovalt -l vn$�Lfut7c�Si7i Nom l
•So /t.' sTlubrc �aas�S mss, Wkt04 ReRu /P- &0 td s sler•
��W -M Il o p .V �` a F Co s s'`-""f M611 �s �o� i � Ares ;.+c0me.s, sac
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2 uuDSv WrjZav,r.r - � sr � evx ?o i�i o A�rr�s vFZb/�rQrr ,L,oeir 7Zi,4 only Dw�t,c,N� f
6L � /PW-0A1&1 c;r PeXM rr r RtVUr k rWD GuN� Nea Krrustr Is e7 MAy R1�m4n ✓ iN hr
j4#M6D t,rW 6?2- tnU5 -F IZEr-'C V 6 Ca)O O,G Atirr ai Fied7-
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1578
Wisconsin Department of Commerce SOIL EVALUATION REPORT pa _ 1 of 2
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations
Attach complete site plan on paper not less than 8 x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and p� I.D.
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 020- 1369 -04 -000
Please print all information. y Date p
Personal information you provide Law, s. 15.0411) (m)). ` 7
k
Pro perty Owner Property Location
Rick & Shelly LaRocco Govt. Lot NE 114 SE 1/4 S 10 T 29 NR 19 W
Property Owners Mailing Address Lot # Block # Subd. Name or CSM#
912 10 1/2 Street S.E. 4 Hopkins Prairie
cit �j City _;; j Village 16 Torun Nmest Road
C Sate � ONlIdG r
Rochester - Hudson 1 685 Old Hopkins Place
A New Construction LIM Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
; j Replacement , j Public or commercial - Describe:
Parent material Glacial outwash Flood plain elevation, if applicable na
General comments
and recommendations: Soil evaluation completed as documentation of soil suitability 5.0' below proposed system elevation 96.30'
as per Comm. 83.44 -3.
Boring # _j Boring
I I Pk Ground Surface elev. 100.52 ff. Depth to limiting factor >1 16" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIftz
*Eff#1 *Eff#2
1 0 -11 1Oyr3/2 none sil 2fsbk mvfr cs 2f,1vf 0.5 0.8
2 11 -30 1Oyr5/4 none sil 2fsbk mvfr cs 2f,1vf 0.5 0.8
3 30-46 5yr4 /6 none Icos & gr Osg ml cw 1 of 0.7 1.2
4 46 -78 1Oyr5 /6 none gr. cos Osg ml cw - 0.7 1.2
5 78 -116 1Oyr5/4 none med s Osg ml - - 0.7 1.2
F1#3 contains approx 15% gr. & cobbles, FW4 contains approx 5% gr.
F2 Boring # � Boring „
Pit Ground Surface elev. 99.13 ft. Depth to limiting factor > 112 in. Soil Application Rate
Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD1fF
"Eff#1 - Eff#2
1 0 -9 1Oyr3/2 none sit 2%bk mvfr cs 7 2 f 0.5 0.8
2 9 - 1Oyr5/4 none sit 2fsbk mvfr cs ,vf 0.5 0.8
3 23 -38 7.5yr4/6 none Icos & gr Osg ml cw ,vf 0.7 1.2
4 38-85 1Oyr5 /6 none gr. cos Osg ml cw - 0.7 1.2
5 85 -112 1 Oyr5 /4 none strat s Osg ml - - 0.7 1.2
fi#4 contains rox 10% r.
F{fKi contains ox. 15 o r. &cobbles, app g
� 9
• Effluent #1 = BOD ? 30 < 220 mg/L and TSS < 150 #2 = BOD < 30 mg/L and TSS <,30 mg/L
CST Name (Please Print) Sig ure: CST Number
James K. Thompson _.__, 3602
Address A.C.E. Sal & Site Evaluations ate Evaluation Conducted Telephone Number
340 Paulson take Lane, Osceola, WI 54020 8/23/02 715 - 248 -7767
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Wisconsin DepIrtment of Industry SOIL AND SITE E V A L U AT 10 "E P O R T Page _ of
Labor.anc+ Haman Relationp
Divh* on of Safety & Buildings in accord with ILHR 83.05 /'dG1 e
COUNTY
j St. Croix
Attach complete site plan on paper not less than 8 112 x 11 inches in size. , an mt�sk+p . 40&ibut
not limited to vertical and horizontal reference point (BM), direction anc��!a of slope£ mI ' PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. ? _ ;;' 020- 1010 -70 - 000
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION r?3C
,,� D BY DATE 2—
PROPERTY ST CRotx
PROPERTY OWNER: .,PROPERqY N
Kernon Bast GOV 1/4 'S / 1/4,S 10 T 29 N,R 19 14r) W
PPfiAR jY NEgeS �A�LING ADDRESS L #p ` BLOC Hopkins RPrarie
CITY STATE ZIP CODE PHONE NUMBER MCITY []VILLAGE [TOWN NEAREST ROAD
Hudson, WI. 54016 (715 386 -7775 Hudson 1 01d Hopkins Plc. R4.
[I New Construction Use [ ] Residential 1 Number of bedrooms 4 [ ] Addition to existing building
I ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate ' 7 bed, gpd /ft ' 8 trench, gpd /ft
Absorption area required 858 bed, ft2 750 trench, ft Maximum design loading rate * bed, gpd /ft2 *8 trench, gpd /ft
Recommended infiltration surface elevation(s) 96.30 ft (as referred to site plan benchmark)
i
Additional design / site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING NK
U = Unsuitable fors stem ®S Ow ' ®S ❑ U ®S ❑ U 3S ❑ U CJ S ❑ U ❑ S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bouldahr Bed Trench
1 -10 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6
1 <-
2 10 -24 10yr4/4 none sil 2csbk mfr gw if .5 .6
Ground 3 121 a9 5yr4/6 none co s Osg ml na na .7 .8
elev.
9 9.7 ft.
Depth to f 4(0.$ cl
limiting
facto 00
Remarks:
Boring # 1 -12 10yr3 /3 none 1 2msbk mfr gw 2f_ .5 .6
2 2 12 -24 10yr5 /4 none sit 2msbk mfr 9W if .5 .6
3 2 7.5yr4/6 none co s Osg ml na na .7 .8
Ground
lev.
00.4t.
epth to
miting ( `Z
ctor
90"
Remarks:
EMI Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. Ave. N§w Richmond 54017
ignature: Date: 11 -16 -99 CST Number: m02298
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PROPERTY OWNER Kernon BAst SOIL DESCRIPTION REPORT Page.? , of 3
PARCEL I.D. # 020- 1010 -70 -000
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munseil Glu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -12 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
3
................. 2 12 -32 10yr5 /4 none sil 2csbk mfr gw if .5 .6
Ground 3 32 -96 5yr4/6 none c S Osg ml na na .7 .8
elev.
100. 4#.
Depth to v
limiting
f +90 - p Z
Remarks:
Boring #
1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6
4_ 2 12 -36 10yr5/4 none sil 2csbk mfr gw if .5 .6
La
36 -96 5yr4/6 none co s Osg ml na na .7 .8
.............. .
Ground
elev.
101.0ft. —
Depth to -
limiting
factor
+96" T-T
Remarks:
Boring #
1 0 -10 10yr3 /3 none 1 2msbk mfr yw 2f .5 .6
5< 2 10 -24 10ry5/4 none sil 2csbk mfr gw if .5 .6
3 24 -96 7.5yr4/6 none
Ground co Osg ml na na
.7 .8
lev.
9.3 ft.
Depth to
limiting
factor
+90"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Kernon Bast 1554 200th Ave.
CSTM2298 NE4SE4 S10- T29N -R19W New Richmond, WI 54017
MPRSW -3254 town of Hudson (715) 246 -6200
lot #4- Hopkins Prarie
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This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 „ =40'
BM.= top of 1 pvc pipe C el. 100.00
Alt. BM.= top of 1" pvc pie C el. 101.55'
32
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A ,41
GAry L. Steel
11 -16 -99
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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 (POWTS) 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-
10567 -P (R.6/99).
Table 1: System Design Specifications
Sanitary ermit Number
ry 31
Number of Bedrooms "'
Design Flow - Peak (gpd) ,5 U
Estimated Flow Average ( pd) p'D
Septic Tank Capacity (gal) 1 000
Soil Absorption Component Size (ft
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Com onent
Design Flow - Peak ( pd) 4 1,5 0
Maximum influent Particle Size (in) 1/8
Maximum BOD (m /L) Im.21,110 220
Maximum TSS (mg/L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Fitter Inspect once a year a 3 yegrs
Soil Absorption Component Insp ect once eve 3 ye
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Slats. 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
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1i3 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 may be difficult or Impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. 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
p tion p onent g
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
r proper The longevity of a soil absorption component depends greatly y on p p er 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.
2
Management Plan for a Septic Tank and Soil Absorption Component
+ Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
When system fails, we will replace with another system
at owner's expense. Alternate area must be left undisturbed.
St Croix Count Zoning Office -
Y g 386 4680
Boumeester &
Sons Excavating 386 -9020
Tri -Coup
ty Sanitation 386 -2130
3
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND,r` {.
OWNERSHIP CERTIFICATION FORM
Owner/Buyer `� �cx t tic LOS'r2 r C o
Mailing Address Q ( `/ `� ��� t r r f A)
Property Address Lo 0 cQ o n.S j
(Verification required from P arming Department for new construction)
City /State J AL a4 Parcel Identification Number 00
LEGAL DESCRIPTION ,
Property Location 1V V ' /,, ' /,, Sec. ,1�,, T�,N -R�W, Town of on
subdivision
Certified Survey Map # ; Volume __. Page #
Warranty Deed # ,X� a? S `? /� , . Volume Page #._
Spec house 0 yes_l�no Lot lines identifiable yes O no
SYSTEM - CE
Imprapa use and maitenance 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 pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees,to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewaga disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days th a ye piration date.
NATURE OF PLICANT DATE
�: r0WNER CERTIFICATION
'-i; Ilwe) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the .descZnbeve, by virtue of a warranty deed recorded in Register of Deeds Office.
ATURE df APPLICANT DATE
•••••• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ••••"
•.• Include with this application: a stamped warranty deed from the Register of Deeds office
-a copy of the certified survey map if reference is made in the warranty deed
6o
STATE BAR OF WISCONSIN FORM 2 — 1987.
W�� DEED ��s���
t• PAGE KATHLEEN H. WALSH
DOCUMENT N0. REGISTER OF DEEDS
ST. CROIX CO., WI
Kernon J. Bast,a[k . Kernon_Bast and Donalda RECEIVED FOR RECORD
J,___Speer -Bas a /k /a, Don Speer -Bast 06 -30 -2000 3:30 PIE
tiAMTY DEED
conveys and warrants to Richard A La� EXEWT N
_^ CERT COPY FEE
== COPY FEE:
TRRRSFER FEE: 138.00
RECORDING FEE: 10.00
MOOS: 1
THIS S PACE RESE F RECORDING DATA
NAME AND RETURN ADDRESS
the following described real estate in St __ Croix County County, 7 "T&
State isconsin; O S n
+L8/
Lot 4, Plat of Hopkins Prairie, St. Croix n St014
I
County, Wisconsin. g 6 o29g8�e�
020- 1010 -74 -000
PARCEL IDENTIFICATION NUMBER
I
This is not homestead property.
I
Exception to warranties: Easements, restrictions and rights -of -way of record,
if any.
Dated this n 26th day of June qp /
(SEAL) (SEAL)
Dnnalrla . / ?. Sneer -Bast + Kernon Bast
(SEAT) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
ss.
St. Croix County
authenticated this day of 119- Personaltv came before me this 6+ h day of
_ June Y9 above named
Ker on -,. Bast and Donalda J.
Speer-Bast
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by 11706.06, Wis. Stats.) to me known to be the person s� who executed the foregoing
instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Xnrnnn .T_ $a,St
Notary Public, County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (if not, state expiration dale:
necessary) — _ 34 r 4 r. k .A
N,mes of persons sitnin6 ln,ny npactty should by typed or printed below their sltoatures. Notafy PUD11110
WARRANTY DEED STATEBAIt OFWISC01®tr'- of Wisconsin wtseonsrn L"M Staple Co.. Inc.
Form No. 2 -1982 era J. Burke M#.&.& .Wis
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