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Home My WebLink About020-1166-40-500/* 'Nsconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s_15.04 (1)(m)]. Permit Holder's Name: Van Dyke, Douglad & Susan ^ City ^ Vill ge ^ T n of: I~udson ~ownship CST BM Elev.:. Insp. BM Elev.: BM Description: TANK INFORMATION y ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ` (~j ` ~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~" ~ ~'t.~~ -3 f - NA Dosing • P/L NA Aeration NA Holding PUMP /SIPHON INFORMATION Manu er Demand Model Number GPM TDH Lriction tem TDH Ft Forcemain Length Dla. Dist. To Well County: St. Croix Sanitary~P~~r,P ixjVo.: State PlaSn ID33N4o1 /.: Parcel Tax No.: 020-1166-40-500 STATION BS HI FS ELEV. Benchmark [o3,`f~- ~ ,~ At.B Bldg. Sewer St/Ht Inlet ~` St/ Ht Outlet Dt Inlet ~- Dt Bottom Header /Man. `~. 35 ~~• f2 r Dist. Pipe - ~jD 3 ~.l~r Bot. System l~'~'O q2• ~ ~ Final Grade 3• ¢o UD , O ~ t St cover v~ ~-os ~~•~Z' SOILABSQRPTIONSYSTEM X11 ~ r'~~.._~~c ~~,.~~.,.e.Q___ / ENCH Width r Leng h ~ No. f T ~ enches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 3 8'~'f , DIMEN 1 N SYSTEM TO P/ L ~BLD WELL LAKE /STREAM LEACHING Manua re ~~ SETBACK -- ' " INFORMATION Type 0 + r ' R Mo a Numbe System: ~[ ~3 OR UN T DISTRIBUTION SYSTEM ~"~ f° ~"`"''~ ~~~-) v Header! M nifold u r~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. ng ~ 33 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 ^ Yes ^ No ^ Yes ^ No ~" COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1• ~0/3l /~ Inspection #2• / / Location: 469 Brookwood Drive, Hudson, WI 54016 (NW 1/4 SE 1/4 17 T29N R19W) - 1729191029 Parkview Estates Addj . IV -Lot 112 p we+"~- ~`~" ~ ~n'~ ,s o,,,, ~5~ `F ~ t ~3 1. Alt BM Descri tion = f i3 2.) Bldg sewer length = -~- l3 ~ ~~~~ 1„ ~~~`b,,~ , ~.~' -amount of cover = Plan revision required? ^ Yes ~ No ~ ( 0 I op P/~~ ( 5 2 U~ )oth S fide fo~ ddi i~on~aS ~ f r ation. ` S~ SBD-6710 (R.3/97) ~,~ S~-,`~(~ ~ ~~ ~t~.,«,~, O • ~ SPA [o ~ I•ry~ is Signature Cert. No. .'~~ ~~ ~ v ~c.r .r•~1v~e._ :~s~lle0 a. E E-~-1.~w.,-4- ~ [,~v ~a s w, , ~ L~ ~ ~c ~s sYsk^^~. ~p,~r~ ou.s s ~C s-~*-w• . ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ', ~ Safety & Buildings Division , ~ Sanitary Permit ApplicaNan 20I W. WashitrgWa Ave. ~ ~ S`'"(~/:f ~n In accord with Comm 83;21, Wis.,A"~q~a °'~, Po sox 7302. Madison WI S3Z07-?3Q2 f?epsrtment of comet®rce Personal information you provide maybe ;f'bN u es , (Submit completed form to county if not :...[Privacy Law, s. 1 S rate owned. Attach com lets lens to the coon co onl for em less t 1 /2 x i 1 inches in size. Coon ~ ,ry - State Senile Permit Number ^ C revisio ous applicati fate Plan i. D. Number 3 t, I. A lication Information -Please Print. all Information ~ ~ :". cation: Pro y Owner Name SS vA ~ ~ perry Location ~ t?~ OCji)N ~ - ~ ~. ~ ' k~G 7 ' SL ~ •~ ' 1/4 ~ 1/4 S N or Property er's Ma' ing Ad ress ~ ~~ Lot Number 81ock Number -~ ~ r ~,-Z q ~~a City, StatMe Code Zip~ Phone Number Subdivision Name or CSM Number j / ? .~ TYPe of Building: (check one) o Ciry '.~ 1 or 2 Family Dwelling - No. of Bedrooms: ~,.~ O Village D Public/Commercial (describe use): D State-owned #~•Town of CX ~C'~~~ ffi Type of Permit: (Check only one box on line A Check box on line B if applicable) Nearest Roa/`'/~~,~-~~/J~~ Jam/ VLJ/ V^ i / i / f- 1RA~ ~~~ ..~J /J~ ( ~ A) i. ^ w System 2. l~Replacement 3. ^ Replacement of 4., t7 Addition to Parcei Tax N a m ber( s) S feet Tank Onl Existin S st m Q' - ~ ~ ,- ` . $) Sant Permit was reviousl issued Pem»t Number U ~ ~~ ~'~' ~ ~ l Date Issued ~ , ~} , °f ~ P ~ p IV. Type of POWT System: (Check all that apply) ~ - lC0 ~h cM ~ Non-pressurizai In•ground D Mound O Sand ilter ^ Constructed Wetland ^ Pressurized In-ground ~ Holding Tank O Single Pass D Drip Line D At-grade i , ` ~ I~ gerobic Treatment Unit ^ Recirculating ^ Other. )3 x68-~-~ V Dis ersaUTreatment Area Information: 1: Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade ~~ ~ .Required ~~ Proposed Rate (Gals./day/sq. R.) (Min./inch) Elevation 1~ 3 ~~~ ~.~ .~ ~a-oc~ t~.c~o VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallo Gallons Tanks Con- Con- glass New xisting Crete structed Tanks Tank Sc ~~'l ~ - ~ (UUU ~ ~ ese R ~ ° o © ^ D D ^ VII Responsibility Statement " I the undersi ed .assume res nsibili for installation'ofthe POWTS shown on the attached lans. -Plumbc-'s lYame Tint) Plumber's SigtrAtu~~w ): , MPlMPRS No. Business Pbono:Ntnnbor'' Plumber's Address (StreeE, City, State, Zip C ~_ _ , ~ l //` ~ /~, •~ (•'~ l1 VIII County/Dep rtmeat Use-Only • C1 Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing AgentSignature (No statrgis) ~7j,Approved ^ Owner Given Initial Adverse S _ ; ge Fee) Determination o~.~.~. QD O -(6 - Ztxro IX: Conditions of Approval /Reasons for Disapproval• ~: „ ~ , _. ~ ~. ~.~ . ~ v ~~ ~~, P~~ ~, p2~p l;Na (0 D _, .~ -3~ a-i~N~~J 3x(o~ ~S m ,~, ~ ~~ Q ~w~ p1 s+~~ >` o ~-(3w~1 Pu-~ Value r B' r ,.1- QASIN wl~~, 1 i~ lid p-~~u d 3 C3Qo~oon-, N~~ z Ass~-~~d ~1~v=1uo•0 ~' f~e~ c ~ Yhp,~, k ~ pa.v~ °W~-, ~: in~ti5 ~ la~~l ~o' ~~o~, S~s~'~~• N ~RW~ W6Ub ~(l1J-~ - ._ ... ~ O ~~ ~r., ~"~H ~,~ ~ qa~ - ^ __-. ~~)Nbl G~ZpRp ~9~.(Iv ~ ~ ~~m°~ ~ ~ ~=~~ `~cb~ vEc~ ~ ch ~ ~ ~ c ~~:~ x ui v; ,. E o c°~ in ~ "" E'v~~, a~ - coo ?3 3 at'wi ~ 'y r" K. n',. Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT n..r'lanro ~.ritl~ r'rxnm AF Wic Aram C:flffP. 1309 page 1 of 3 A.C.E. Soil & Site Evaluations County Attach complete she plan on paper not less than 8'/: x 1.tinc!>es_in size. Plan must St. Croix include, but not limited to: vertical and horizontal refE~enQe padt (lil~;,direction and ' parcel LD o nearest road. art~ dtstan percent slope, scale or dimemsions, north arcow~.and !gcatioa . 020-1166-40-500 ID#17.29.19.1029 / Please prlnt all inf6im~on. .., ,,~ Revue gy Date Personal information you provide may be used fqr secondary Privacy Law;`: 1 (t) (m)). • p .. 6 Property Owner ~ ~ Location `~'~ Douglas R. & Susan F. Van Dyke: , : '• Lot NW 1/4 SE 1/4 S 17 T 29 N R 19 W Property Owner's Mailing Address >" ~y, .,:.~• ,~ G~ S.t ~ Block # Subd. Name or CSM# 469 Brookwood Dr. `~~ F~ S~~ ~~F~G '-'~ f112 4th Addition To Parkview Estates City State Ph r J City ~ village Town Nearest Road ~ Osceola I WI 154 ~ `~~ - 78~~ Hudson Brookwood Drive f J New Construction Use: ~ Residential / Number of bedrooms 3 Code ~~ design flow rate ycso c~ru ~ Replacement ~ Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install bull-run valve to allow future use of existing hydrollically failed sysem. Existing system elev. = 93.00'. _____--- ^ _ j Boring ~~ # ~ Pit Ground Surface elev. 99.30 ft. Depth to limiting factor > 125" in. Sal Application Rate l ti D i R d T xture Structure Consistence Boundary Roots GP D/ftz Horizon Depth Do minant Co or on ox escr p e e 1 0-5 10yr3/3 none sl 2fsbk ds as 2f 0.5 0.9 2 5-16 7.5yr4/4 none Is imsbk ds cs if 0.7 1.2 3 16-32 10yr5/6 none s Osg dl cs - 0.7 1.2 4 32-81 10yr6/6 none s Osg dl gw - 0.7 1.2 5 81-125 10yr6/4 none s Osg dl - - 0.7 1.2 a~-' 42. o ~ } ,. 2 .6 Boring # .-1 Boring /~ Pit Ground Surface elev. 99.72 _ ft. Depth to limiting factor > 130" in. Sal Application Rate l D i t C i tion D R d Texture Structure Consistence Boundary Roots GP DIft' Horizon Depth or om nan o p ox escr e 1 0-6 10yr3/3 none sl 2fsbk ds as 2f 0.5 0.9 2 6-25 7.5yr4/4 none gr.ls Osg dl cs if 0.7 1.2 3 25-50 10yr5/6 none gr. s Osg dl cs - 0.7 1.2 4 50-88 10yr6/6 none s Osg dl gw - 0.7 1.2 5 88-130 10yr6/4 none s Osg dl - - 0.7 1•z qS~ oz 131 • d`f H#3 contains 10% cobbles. ~~ * Effluent #1 = BOD ~ 30 < 220 mglL and SS >30 < 150 L * Effluent #2 = BODS < 30 mglL and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number ]amen K. Thom son ~- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number Osceola, WI 54020 9/19/00 715-248-7767 property pwner Douglas R. & Susan F. Van Dyke Parcel ID # 020-1166-40-500, ID# Page 2 of 3 Bering # ~ Boring Pit Ground Surface elev.. 100.02 ft. Depth to limiting factor > 132" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 1 0-10 10yr3/3 none sl 2fsbk ds as 2f 0.5 0.9 2 10-27 7.5yr4/4 none gr.ls Osg dl cs if 0.7 1.2 3 27-53 10yr5/6 none gr. s Osg dl cs - 0.7 1.2 4 53-83 10yr6/6 none s Osg dl gw - 0.7 1.2 5 83-132 10yr6/4 none s Osg dl - - 0.7 1.2 gb•2~l 3?.z H#3 contains 10% cobbles. ^ Baring # --) Boring _( Pit Ground Surface elev. _ ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' *Eff#1 *Eff#2 ^ Borin # ~ Boring - g ,_f Pit Ground Surface elev. _- _ _ ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mglL and TSS >30 < 150 mglL * Effluent #2 = BODs < 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. M S h P,f'vhl;Li1 Road .Z., ~ rva~i.~cLbl ~~. ~~q P~. 3 o~F'3 ^ 5oil Obs«/a~o~ P,~~ • Eleva~'~ .~ ~cn~ nq C/w~ q ti~ v '~ ~.iB.c~' Fx,'s~%~q 18'X36' Soll ab3'a~pbro„ cr//. o ^ 8~ EkiS'~i nq ~ O 1 rc s,lder~ce ` ~a~9 e Bc cJ+ 8o~o.r) oFSid%n~. Assc...ned ¢ler. • ~cn. ~.' -EXis~nq ~~;c-EanJt'. ESE. a%av`a~ ou'~~a~s9S! v ^~ 83 ~o4q ~ 51.a~iF ~4nJ.Jrt~C Plop. 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Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity fn-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: Svstem Desian Specifications Sanitary Permit Number - ~- Number of Bedrooms Design Flow -Peak (gpd) "~ Estimated Flow -Average (gpd) Septic Tank Capacity (gal) - ~.~s ST. Soil Absorption Component Size (ft2) z ~ ~~ Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) ~ ~ z - a ~ Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 ;1aQQ Tab le 3: Maintenance Scnedute Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank sha11 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 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 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 enfer 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 sepfic 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, 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 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. ., 2 ST CROIX COUNTY .. SEPTIC TANK MAINTENANCE AGREEMENT .AND OWNERSHIP CERTIFICATI N FORM ~/ OwnerBuyer _, ou ~ ,~~ ~ ~~5~~ ~/Jl /~ ,~ Mailing Address _ ~~ `~' ~,.E''~JO/~/~1~~ C~_~it~/ G~(~ ~/L/~'~,~~ //~ Property Address ~~ ~ ,s ~~ ,~~~E~~~ ~.~ (Verificatioa required from Planning Department for new construction) City/State -C Parcel Identification Number ~D ~ % /!o ~ - ~"O ~Q ` ~ LEGAL DESCR~PTiON Property Location %,, '/,, Sec.,_,/ _, T N-R~•_W, Town of ~~~=,,~i~,~•,~.-• Subdivision ~~ !~' S ~-4~~5 ~ ~~ ~o~. ,Lot # /~~- Certit'ied Survey Map # ~ ~ Volttme .Page # .n Warranty Deed # -_~y~5~cl (o • Volttme g ~ ~ .Page # 35 Spec house O yes O no Lot lines identifiable f~ yes O no use ami mnintenanceof your septic system could rrsult in its premature failure to beadle wastes. Proper amtintenanoe c~ansists.of p~una~ng out the septic tank every throe years or sooner, if needed by a licensed pumper. What you put i~o the system Barr atlec! the fttnetion of the. septic tank as a treatment stage in the waste disposal system. The propatty owner sgras to submit. to St. Croix orm, signed by -the owner sari by a ~~. lumber ?rontng Dep~;tment a certification f P . jean plumber, restricted phunber or a ticedosed pumpor verifj-ing that (I) the on-fife watewatordigsoai syslssn is hi Pt'oP~ ~~8 e~ndition and/or (2) Inspection sad puatpiog (if necessary), the septic tank is less thttn:~ s-t shsdae. .. ...,, . ~~r~ ~;~. Uwe. the tmdersi~ned have read this abor : and agree tv raaintaia flue private sewage disposal ` ~' staadatds set Earth, heraln, u set by ~ Dtb and the Llepartrrtent of Natural Resources, State of W~hconsfist~tiHpdioo tuatiag that your septic system has beat utaiatalned~must be compteted and returned to the St. Croix County ?.onin~ Office writhin 30 . days of three year expire dale. . ';. ~ l jy ~J 3IQNA OF APPLICANT DATE 7, ,,_ I (we) ratify that ail: statements on;;th,~a form aro true to the best of my (our) knowledge. i (we) am (sue) the owner(s) ~' the above, y virtue of ;wuranty did recorded in Register of Deeds Office. SIONA OF APPLICANT DATE ~- Any infomutioa that is tnis-rep~rosea uuy tesuit in the sanitary perniut lieiug t~evokttd.by the ~8 Department. •••••• .~ ~ _.. .. ~- ** i(ucittde wlth this a ice : A s ~~ ~ _~_4~ PPl tampeds~-arranty deed from the,Register of Deeds office a copy o! the certified sunray s„up if roferonce is made in the warranty deed ~ ti ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXIS'T'ING SEP'T'IC TANK This is to certify t at I have inspected the septic tank presently serving t,~ie ~~~U ~- .5~,}p~ ~ p~~ ~ residence located at: G? 1 Sec . ~? , T ~ 4 N, R~~W, Town of C~u ~S uN , St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good con it'on, and it appears to be functioning properly. Last time serviced ~ (~ ~~ Did flow back occur from absorption system? Yes line. Approximate volume or length of time: Capacity: Construction: Prefab Concret Manufacturer (if known): Aqe of Tank (if known): Na~ ( i f no, skip next ~~~ gallons minutes ~_ Steel Other ~ ~. ,. alb, (Signs are) - ~ ~~ - ~~ 13 v~ (Date) J i M ~C~ u Yh Q.~ S ,~- (Name) Please Print ~~a9~~ (License Number) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank ;condition, I certify that the tank, t© the best of my knowledge, will conform to the requirements of ILHR 83, Wis.`Adm. Code (except for inspection opening over outlet baffle). Name ~i rh ~o~~,-e~ j~~ Signature ,.. ~~ivw~~~ `'MP/MPRS D - r ~, ~ . ::~~~. ~ ~ •- Rn '~ ~~ DOCUMENT NO WARRANTY DEED rH~s srA,.c RES~RVCO roR RIGOR~ING o.r• STATE BAR uF WISCONSIN FORM 2-lYBf 441496 a o 8~3 .~~~ 3~ tiara G. Puller, ~ tiinale p~rsua ___. _. _ __ conveys end a'arrAUGs to llull~,l,l5 K. V~tnl]yke- .tnd 5us~u1 [' VanDyke, husband and ~ti.fe. as sure i~urshi.p .~ari.-.a.l - ._. pr~.uer.ky the follns~ng described real estate in _5L. CCUI X __- ,_. ,..County, State of Wisconsin: I~GiSTER! OFFICE ~T. CkOtX (]~.. WtS. Rac'd too. Rmao.d Mats t 9 t h day of Sept. A.D. 19 88 10:00 A. • Douglas R. VanDyke RETURN TO ~~ t ~Zyy~r~ - •y` ~/' BIO,,~~dOf6r ~"r~77 I ~ J 1. ~ ~ v~ Hud~un, kI 540L6 Taz Parcel No: ---- ......................... Lut 1.1 ', [)ark~•iew i•at.flrs 4th :ldditiun in the n.n of [ludson. ~D FEE This 1s tlU_C - ~ jaj (is not ) Exception to \carranties listed lets ~ ~ ex ADTHENTYCATION day of (SEAL) (SE.aLi Signature{s) . - -- - - - - _.. -- authenticated this ..--.. day of.._..-_.. - _.-.-_ - , 19 TITLE: ~IEifBER S. ATE BAR OF ~tISCOV>f~I (If not... _-_ ____ __ authorized by ~ 706.06, Wis StatgJ Tq;S INSTRUMENT WAS tlRA F'ED dY ---;1tL~rney_~ay-i-1, _1-..-;,sLrec;;_ .-.621 ;~ecun :_~L- , urf S!an-.--,. [ .__i!,r).I i~- (Signatures may be authenticated or achnotvled~ed, R-,tr are not necessary.) homestead property. (:xistin~ hi ;hv~a~~s, e<,senents, rights of way and res~rictiuns of record. September 19 ~~ . o~t~ YYU `~ ~ ' ' t/ ~C~/`'~"' t S E A L i • 5a:n E. `li I ler (SEALt ACHNO W LEDf3MENT STATE OF WISCONSIN ss. ~C. I,XUIX County. __..._ 4 Personally came befc,•e me this .. ~ rO_ ... .day of Seutember 19 ~?.- the above named _~_ _ _ - 5~3r1 ~. .'[i 11er, a sin~Ic pF'rs~m _-. . - to me known to he the per..<on who executed the fare~oin~ instrument~,agd acknowle~ite the same. r" `~ ir; ~ rui X _ ;< ~I~. C•nmmi~?iAr1 t~ly{~t!an~nt.. if not, ~tat~~ e'<I~~rntinn date: ~~. ~ ~ l9~_d/ .1 F ~~ ~~8 oa O ~~~ ~ rn I N ~''-m I ~ .p ~ i i ~m I I I I ~~ 1 N I I I ~ S 0°06'30' ~W 300.00' i i ~ ------S-O°.06~3011W- --- ---- g~ i ~ ------210.00` "- --------- -- ~ -- I ~ I I ~ o _ ~ I ~ ~ ~ - ~ c z ~- I O a -- ~ O I l 'A ~ ~ V N ~ o ~ A ~ w I I _ ~ ~ tmn p I ~ ~ ~ IN ~ ~ ~ i~ ~ ~ m ~ V .p A I I I ~ ~~ ~ R I~ - ~ 71 f~1 ~ N I S 0°06'30" W , 300.00 I I j1! I ------------ -- -------- --- I ~ ~ 9 ~ I 4°'~,1 ~ I NO°0~ N „E ~,4„, O ~ ' BR OOKWOOD .~ j , ~ I < . DRIVE a K ~ I rn 4---~- - - ' c ~- • r o I ® ~ ' ~ ~ , i A . 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