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HomeMy WebLinkAbout020-1372-06-000/Wisconsin Department of Commerce ~~~ ~~~ r Safety and Buildings Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. Permit Holder's Name: ^ City ^ la e ^ own o : . owns i ~ ~ filler, Sam p son u CST BM Elev.: , Insp. BM Elev.: / BM Description: /~ ~~ • C7 ~ ~2,1r0 ~ ~ Q~ TANK INFORMATION r ~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic 2 Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic ~ ` 3~ / - - NA Dosing NA Aeration NA Holding DI11-AD / ~IDLJAIU IIUCADI-AATIAAI Manufact Demand Model Number GPM TDH Lift Lriction m TDH Ft Forcem n Length Dia. Dist. TOweu 1 1 {~ Countgt. CroiX Sanita~lrr~rn~t No.: State Plan ID No.: Parcel,7~x NP372-~6-~~~ STATION BS HI FS ELEV. Benchmark 2. S. 3 r cos. 3 /~ ~ o ~ ~, n o2,3S' Bldg. Sewer St/ Ht Inlet g.SZ., Gi(o•83 r St/Ht Outlet ~. 8~ (~~,~' --- Dt I n I et --- - Dt Bottom -~- ----'- Header /Man. 9 ;So RS. SS r •~~ ~ . ~ o Rs. }.s Bot. System lD :q~ 9y. ~ o' Final Grade t cove ~~.,1 6 , 0 99 , 3s' SOIL ABSORPTION SYSTEM ~ ~ 1 ~•~ ~„_ ~,,,~ ~,,,~ _1.,~ , _ „ ~ B{~/ RENC Width t Len th No. f renches PIT No. Of Pits Inside Dia. Liquid Depth DIME 3 `~ 3• ~'`' DIM N I N SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: Dl~1r'F SE2 INFORMATION Type O r / CHAMBER o el Num er: n~ System: t_.o J. O ~p~ ~""' OR UNIT DISTRIBUTION SYSTEM Header / I)Aanifold u Distribution Pipe(s) ole Size x Hole Spacing Vent To Air Intake Length Dia. ~ Length Dia. Spacing ~j SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~~ Depth Over xx Depth Ot xx Seeded /Sodded xx Mulched Bed /Trench Center to f Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ~/~ // ~Olnspection #2: -t-T Location: 534 Raider Drive, Hudson, WI 54 16 (NE~/4 21 T29N R19W) - 2129192226 Raider Estates -Lot 6 1.) Alt BM Description = b 5 -~'"~ ~'~ 2.) Bldg sewer length = 3 i / .~ Ota~+~ eti. ~ ~ `~-~' -amount of cover = 3(0 . nn n ~l~ 3~ 7~~ ~ ~ t rv i;--1 s ~ S~ Plan revision required? ^ Yes ~No Use other side for additional information. SBD-6710 (R.3/97) o~ L e o I 6 Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~ , ~ I . ~~~ - i ~- ~2-2~~ Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 ~~,~~~~~~, See reverse side for instructions for completing this application Madison W[ 53707-7302 personal information you provide may be used for secondary purposes aepdrtment saf-Garnmerce [privacy (1)(m)] , (Submit completed form to county if not ~ state owned. Attach com lete lans to the coon etn *on a er not less than 8 -112 x 11 inches in size. Coon /',. State S itary Pe ^ beck if re ~ Boa taprevious application State Plan I. D. Number I. A lication Information -Please Print all I ation 4 -. ~ ~~---` Location: Property Owner Name n ~-' +~ I ~ ~-~ ~ f f I ~j 7 ZUQ~ ' ~-~ ( J ~P/roperty Loca~t~io)n /~' ~Y~1/4 ~'r/4, S ~ N, R /~ W ss S i ~ RC?I x j_, re dd Owner's Mai ing A Pr iope,~ity Lot Number Block Nom ~ ` Q~ ~ ~ +.I ~ ~ ~.~ COUNTY ~~rt City, State Zip Code Phone N Sub ivision Name or CSM Number 5a ~ uv ~ l ~ s? ~ ~ ~ 2 ~s~ r~ I Type of Building: (check one) (~ ~ C'ty ^ V 1 or 2 Family Dwelling - No. of Bedrooms : I ~ own of ~ ~ ~ v ~g O ^ Public/Commercial (describe use):_ !x ^ State-Owned oad crest a~al ~~ ~ ~ ~ ~ ALlt.. ~ . ~, . ~; i. r < a ~2o- -teco- III. T e of Permit: Check onl one box on line A. Check box on line B if a licable ^ Addition to 6 . p) 1. ew 2. ^ Replacement 3. ^ Replacement of 4. 5. Existin S stem stem S stem Tank Onl Permit Number Date Issued B) ^ A Sanita Permit was reviousl issued IV. Type of POWT System: (Check all that apply) ion-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland i ne 'Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip L '~^ At de ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatment Area Information: Pj.r d i a s W D ~ Y /7• ~ S Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. ystem Elevation 7. Final Grade I . Required Proposed Rate (GalsJday/sq. ft.) (MinJinch) Elevation ~ o~ s- doe ~--- ~i ~ , , D o ~o~ ~- 531 ~ ~ ,. ~ ~/. ~. - Tank VII Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic . Information Gallons Gallons Tanks Con- Con- glass Crete structed New Existing T a nks Tanks ^ ^ ^ ^ r -~^ / ~ ~ ~ e / X Z_ ~~ ~ ~ ~ 5 ~ C.-- I t e . ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersi ed, assume res onsibili for installation of the POWTS shown on the attached lans. r Business Phone Numbe ~~ Plumber's Signature (no stamps): MP/MPRS No. Plumber's Name (print) ( ~' ®• Plumbers Address (Street, Ciry, State, Zip Code) IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ent Signature (No stamps) ~, . d ^ Owner Given Initial Adverse Surcharge Fee) ^ _ , /D CJ A ~ 7 ~ L pprove ~Z ~d~~ ~ Determination X. Conditions of Approval /Reasons for Disapproval: ,J~ ~ ~~/ ~ /~ ~ ~,~,~ ~ b~ ~~~~ !~. d U~ ~h ~~ L~~~~ ~~,,~ ~-~ ~ b~ ~y~i~( ~"' Mew e f~ ~ ~>tiG ~ 9 ~F(o~~(P~~~ W k ~~ ~ ~ ~~~= ~~~~ boo ~ P~ / (.-Z, ~ ~~ ~~k = S~~-~ ~ Rwr~e,~ w Inc., , ,,~,r ~ ~,,,,. ~~• j der P b0 s ~ y r2 ~ ~ ~ ~ r2 D ~- ~ ~~ I~IIU ~* v z o - ~ o ~ Z 'o~-c~oo ,~--~-~. 4~T ~.~,; TaQ ~~ Rt~~~. r~ = ror,as' ~zso ~+4 ~, ST cv/zg73 EL ,~. , ov ~<c rF~ 3~ r ~ ~_ c(~3,~~ ~- 8~~~ S~cI~ 73. s ~ Flo SCoP,~ Q -__.___~~~ ~~Tf,~,~pr~ ~,e~;~---.~v..~, ~~ ,~ t ~~ , ~~~~ ~~~Z ~` P, ~i r_Q~ .~;~ ~~~_-_~ ~; , -I s` ? E% S ~b ~~, ~~a~~ ~~ ~,,I1.1, i cP of 3~gRFi~4 FI, = /Dd, ov ~i3-{-ri loJ~rd~ c.~.Q yti°`O~e . .~~~ Q ~,.- PJ ~ 8t2. . ~' ~k~/~' Cv /- 4~c ~ ~ '~C ~ ~ ry1 /'Yl lL L ~/~,,,,,. ~ ~ i ~ Lc ~.. 5 T T,.~° 5 ~o T ~ ~ BioDif f user Specifications '~ p -~' N~A1$£ RS ~(`aTp~. /S ` ,~AcN T'R~1yGl{ N----- 34" 76" OD Oil OD Old ~~ OO OD OO ~~ ~o 00 00 00 00 0 00 00 00 00 00 00 00 00 00 00 00 00 0 OD OO OD OD 00 00 00 00 OD 00 DO 0~ OO 00 00 00 OD 00 00 oi~ o0 oa o0 00 00 0o Do 00 ors o0 00 00 00 00 00 00 OD O~ OD OO OO OO Old OO OO All three BioDiffuser sizes can withstand H-1Q loads when installed with properly graded and compacted soils. Amini- mum of 12" of Cover is required for H-10 Ioads,The 14".High Capacity ESioDiffuser is designed far H-20 loads. A minimum of 18" of cover is required for H-20 loads. Chamber Height \~ Chamber Height ;i ~ End View 4" Knockout Universal End Cap available Sizes Length 76" 76" 76" Width 34" 34" 34" Height 11" 14" 16" Invert 6.5 9 11.3 ~wisconsinDepartmentofCommerce SOIL AND SITE EVALUATION ,Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Page 1 of 3 AC.E. Soil & Site Evaluations Attach corr~lete site plan on paper nd less than 8'/s x 11 inches in size. PIS must County include, but not limited to: vertical ark hor¢ont~ reference point (BM), direction and St. Croix percent slope, scale or dirnerrrsions, north arrow, arxi k~cadion and distance to nearest road. parcel I.D.# APPLICANT INFORMATION i 020-1055-60-000 ID# 21.29.19.2o6A - P/ea armat an, D ' Personal information you provide maybe used for.s~n~ purposes (P y Law, s. 15.04 (1) (m)). aj~ R~ ql BY Property Owner ~~,, ~ ~ Property location Miller, Sam ~,'' ~ ~ ,`~, Govt Lot NE 1!4 SW 114 S 21 T 29 N,R 19 W Property Owner's Mailing Address ':-'" - , _. Lot # Block # Subd. Name or CSM# P.O. Box 151 ' •~ ~' ~ ~'s ' ~' 6 Plat Of Raider Estates ~~ City Sate Zp Code Pho ug-ber ~ City ~ Village Town Nearest Road Hudson V1r.1 `54016 ~1 ~`~$6-27C~1~- r Hudson ~ Raided)rive .~ ~.. New Construction Use: a umber Qf ~ 4 ^Additiort to existing building ^ Replacement ~ or cx>t~mega~l d~ Code Qerived daily flow 600 ` g i~_ `-~ Recommended design loading rate •7 bed, gpd/fts •8 trends, 9P~ Absorption area required 857 bed, ftz 750 trench, ftz Maximum design loading rate .7 bed, gpolfi~ .8 trends, gpolftz Recommended infiltration surface elevation(s) 94.50• ft (as referred to site plan benchmark) Additional design / Site oonsideratiorls ~~ trenches using high capacity infiltrators. Parent material Glacial outwash Fkxxi in elevation, ff a NA ft S=Suitable f~ System ~ Conventional Mound In-Ground Pressure AT-Grade l System in Fill Holding Tank U=Unsuitable for system ~ ®S ^ u ~ ^ S ^i U ^ S^ u ~ ®S ^ U ~ ^ S ®u ^ S® u SOIL DESCRIPTION REPORT Boring# Ground elev 99.5T ft Depth to limiting factor >107° 2 Ground elev na a7~ a Depth to limiting factor >108° Deptil Daninant Coles Mottles Structure Consisten Boundar Roots ~ Horizon in. Munsell Qu. Sz. Cont. Cdor Texture ~. Sz. Sh. y Bed ;Trench 1 0-12 10yr2/1 None sl 2fsbk mvfr as 2f,1 m 0.5 0.6 2 12-40 10yr5/4 None sil 2msbk mfr aw 2flm 0.5 ~ 0.6 3 40-44 10yr4/4 None Is Osg dl cs - 0.7 0.8 4 44-82 10yr5/4 None s Osg dl gs - 0.7 0.8 5 82-107 10yr6/4 None s Osg dl - - 0.7 ~ 0.8 ~ ~ ~ / ~` ~• v./t/14~d „ ~~~ Remarks: rR c~i ., 1 0-10 10yr2/1 None sl 2fsbk mvfr as 2flm 0.5 i 0.6 2 10-18 10yr3/4 None sil 2msbk mfr cs 2f,lm 0.5 ~ 0.6 3 4 18-35 35-92 10yr5l6 10yr5/4 None None sil s 2msbk Osg dsh dl aw gs if - 0.5 ~ 0.6 0.7 0.8 5 92-108 l0yrb14 None s Osg dl - - 0.7 ~ 0.8 ., r ~ - ~~ tf 7 -~ Remarks: CST Name {Please Print) Signature:` Telephone No. James K. Thompson ~~-- 715-248-7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, WI 20 4/19/00 3602 120!1 S s PROPERTY OYYNER: Miller, Sam BARGEE I.D.# O2o-1055-60-000 3 Ground elev 98.82' ft Depth to limiting factor >106' 4 Ground elev oQ cap w SOIL DESCRIPTION REPORT 12~ Page 2 of 3 A.C.E. Soil & Site Evaluations ~~ Depth in. Dominant Cola MunseN ~~ Qu. Sz. Cont Cots Texture ~~~ Gr. Sz. Sh. sisterloe Bounder t~ GPD/~ Bed ~ Trench 1 0-10 10yr2/1 None sl 2fsb)C mvfr as 2f,lm 0.5 0.6 2 10-16 IOyr3/4 None sdl 2msbk mfr cs 2f,ltfl 0.5 0.6 3 16-32 10yr5/6 None s~ 2msbk dsh aw if 0.5 ~ 0.6 4 32-76 10yr5/4: None g Osg ' 1 gs - 0.7 0.8 5 76-106 10yr6/4, None s Osg dl' - - -` 0.7 ~ 0.8 s~. ~ `-~ ~ -- y KemarKS: N~ S 7 1 0-8 IOyr2/1 None sl 2fsbk mvfr as 2f,lm 0.5 '~ 0.6 2 8-24 10yr5/4 None sit 2msbk mfr aw 2flm 0.5 O.b 3 2428 10yr4/4 None is Osg dl cs - 0.7 ~ 0.8 4 28-77 10yr5/4 None s Osg dl gs - 0.7 ~, 0.8 5 77-102 10yr6/4 None s Osg dl - - 0.7 ~ 0.8 Depth to limiting factor >102" 5 Ground elev 98.40' tt Depth to limiting factor > 104" Remarks: 1 0-28 10yr2/1 None sl 2fsbk mvfr as 2flm 0.5 0.6 2 28-42 10yr3/4 None sit 2msbk mfr cs 2f,lm 0.5 0.6 3 42-5'8 10yr5/6 None sit 2msbk dsh aw if 0.5 ~ 0.6 4 58-91 10yr5/4 None s Osg dl gs - 0.7 ! 0.8 5 %- 10yr6/4 None s Osg dl - - 0.7 ~ 0.8 KemarlCS: Ground elev Depth to limiting factor .7 ., S S 5 .. 1 . Fj . •' Top ~, y~" /'e bar E/~ v` = /O/. ,ZS s/93. ~s * /~o S low /~. 3 ~{'3 Scal¢ : / =~ ~~ • /ocaaFed~O/•o~0, S-E~ (hero lacem~n~ Sys~cm ~4rtA ^ ~~ ~s B ench wlari~!' TP elegy = io0•c~; S/G• oY ^ 83 p • ^ I-riMQ-/'y SySUm f~r~q s~ ~~L-d<.. mac C.~wrter: p• ~. 3~ ~s~ /~K.e/so~, c.c.s/. S~F©/6 ,Loci-~~'~ Cot !a o ~'~,~ ~ o ~'~a: alp- E.S~-'des ~I El'q ~l<v~y .sc-e.. z i, •r, z9~1, ~P. ~/u': Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 3 3~~ Number of Bedrooms Design Flow -Peak (gpd) G O O Estimated Flow -Average (gpd) Septic Tank Capacity (gal) /a,Tb Soil Absorption Component Size (ft2) 3"~ Type of Wastewater omestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) X00 -' ~` -~ Maximum Influent Particle Size (in) 1 8 Maximum GODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule 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 shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the 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 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 fank may contain lethal gases, and rescue of a person from fhe 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 fife 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 CERTIFICATION FORM OwnerBuyer S ~"n"1 ~ ~ LL.~~ Mailing Address ~ ~ 1 property Address , ~""3 7 ~ l~ I O ~/2- ~~' ~ ~ (Verification required from Planning Department for new construction), A~'y City/State ~~ p s C N W ~ _ ,Parcel Identification Number ~ Z d' I d 7 2- ' ®G " 0 Q Q LEGAL DESCRIPTION Property Location/ '/4, S ~ '/4, Sec. ~' ~ _ . T Z ~ N-R ~ ,Town of N ~ ~ S O 11~ Subdivision Q~' fA ~~ ~ ~~ S Lot # ~_. Certified Survey Map # ~o ~ S~ yy .Volume Page # / O Warranty Deed # ~ ~ CS ? S ~ ,Volume ~ y~~ .Page # ~~_• Spot house ~ yes ^ no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 mast~rplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary). the Septic tank u less than 1J3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system wlth 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 wtthm 30 da~e three year expiration date. ~ ~ ~Ov APPL CANT DATE OWNER CERTIFICATION y g ( ) the owner(s) of I (we) certify that all statements oa this form are true to the best of m (our) knowled e. I we am (are) the property descnbed above by virtue of a warranty deed recorded in Register of Deeds Office. ~ ~/©C7 A F AP ICANT DATE revoked b the Zoning Department• «««««« .««•«« Any information that is mis-represented may result is the sanitary pernrit being y «« 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 ,( ~ . ~~~ ccc:~;w•cr:r Nc7. S', '..., i3all~I' :~' .., r~o:::a 2 >.oea, 6107~~ • I p ~' it kA'•~! FEN H. WflLSH tiR~ 1~~rJFa;E tJ~7 ~~ kcGiSiEk OF DEEDS . .. - _-= = _ =1' S7, i;kOIX Cp., WI Humbird Land Corporation, a Minnesota Ccrpu: dt' :n I'II kECfiVED FOR iiECORD . .. ... ........ ... .......... .. ........ .. .... .... .. ... ...... it _ ... ... 9 22 1399 5.30 .......... .... .............................. ..... ...... ... ,~ D ~ - . A!1 . .... .... ... .... iiAkRANTY DEED .. ..... .............. ................... _.. EIfEl1PT N convt•yK ;tnd w;trnurla to ........ 5'~n =• Mi 1 ler Cf4i COP1 FEE: i.Of Y FEE: .................. ..... .........._...... .. _................. TRANSFER FEE: 51).50 ................................................... ........ REC:ikDING FEE: 10.00 ........ ................ PAGES : 1 ... ... .......... ........................ ......... .... n[tunR •o .. ............................... .. .. ~F~,G lho following deseribeJ real eslatc in ......S.L,.,Crpix .,_„..,.,(;ounty, -'- ............. State of Wisconsin: The East Haif (Elr) of the Southwest Cuarter (Siv>,) EXCEPT parcel Tax Parcel No: ~,~~OSL-i~ conveyed to Alfred L. Ekblad in .al;ane 498 n' •~~~~~'~"'~~"""' page 484; and EXCEPT (~e'~ /O~ 6 0 parcel conveyed to Leslie L. Swe^son in Volume 458, page 504; and EXCEPT parcel conveyed to Donald F. Johnson in 'Ialurne 500, page 525; and EXCEPT parcel conveyed to De^ald R. Jordan in Volume 580, page 354; and EXCEPT parcel platted as we!'s i"argo Station in Yolur-± 5 of Plats, page 89, as Document A478658, ALL in :!coon 21 (21 ), Township Twenty-nine (29) North, Range Nineteen (19) West, -Own of Hudson, St. Croix County, Wisconsin, Subject to unrecorded agreement sated October 12, 1991 by and batween Donald R, Jordan, Cail Gordan, John A, Elbert and Eric J. Lunde~l regarding fi,t:;re Lana transfers and roadway conveyances. Subject to covenants, conditions, -estrictions end easements created by preliminary plat of Wells Fargo Station First Addition. Subject to easements, restrict~_^s, res4rvations, and r~;hts-of-way of record, if any i s not T6iY ............................ ~;a^estead pro~ertp. (Mdp (is nnt) F:xcci~tinn to warrnntics: As ^oted above Dulcd this .. ...20th .._..._...__. Jay :: ............... ( 'iAL) .................................__............ . (S:.ALI August 99 __ .................................... 19... . ~UMBIRD LAND CORPORATION ..,,,,,...(SEAL) Austin J. Baillon, Its President _... ..._ ........................................... (SEALI AUTIiENTICATION Sibnaturc(s) ................... TITLE: btEM'3ER STATE BAR OF'.V(~~' ~~;~;;; (If not . ......................................_ . authorized by 6 ^,r6,Ou, Ws. S:;.s.l THIS INSTRIiMENT •,V.1 .^s vri•F'E:] BY _, Hambi.rd Land. Cor-punit.i,cr` (Signnturc3 may t;e aut'•:cnt a'_'. ..~n::ou4 r,;..' :1 r.re not r.¢cee5aiy.) ACKNOWLEDGMENT ST:1,?'F OF TN(D19idS1Y;8IlQ MINNESOT ss. Ransey .County. ........ I,rsri~i:y <~nw b•:ioro me this ..,2uth-...,-day oi` a'~9N.s*.-_....._ ............... . 1!';39.... the nbovC uamcd Austin J. Baillon President of ~H;:birA~ Land..Cocancation ................. ........................ ;e n:c kt>tr~wn to t;e the person ............ wl~o t..ecutcd the .orc~ .tir ; tnpstcument in}c aas~:~wjcdycor~R•,f?3?aRti.,~~.,ti,,~.; ~i ~G••-jam!- I~~G~ : ~ !° •' fa C'~('-~r'.N _......._....`' a: ~ a.:.lip. -: .iii • Paul !?. ~a?1?rn - vv~c7Li~JTY - i...~...,...._,....._.j...... , I t c .Hashing vrr '' ~ ~-.^..`-~.Y'bt>`ttV,xdV4(s: ~ N ~~> ;o. ,r . ,,~ n s ne. mnr.c.)t. ([f t.ot, .state ezl~irnt°on ~ ui ~ [ W ll 41 ~'.p ` i tJ W ... F4 VI S ~ [:j ~~ to ~ F: f-. 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