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HomeMy WebLinkAbout020-1065-30-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 'ermit Holder's Name: City Village X Township Mullinax, Todd & Ja ne Hudson Townshi SST BM Elev: Insp. BM Elev: BM Des 'lion: l off' ~ (~tJ. ~ 6 ~~;~-u-~ s~~c~ SANK INFORMATION ELEVATIO DATA TYPE MANUFACTURER CAPACITY Septic 2~ Dosing ~ r Aeration Holding TANK SETBACK INFORMATION TANK TO P!L WELL BLDG. Vent to Air Intake ~~- ROAD Septic ~ 1 > ~ ~ D+ Dosing ~,~, Aeration Holding PUMP/SIPHON INFORMATION JCv U !d/,Gr,lln~ Manufacturer Demand GPM Model Number TDH Lift Friction Loss ystem Head TDH Ft Forcemain Le Dia. Dis . ell SOIL ABSORPTION SYSTEM Z ~ /ifit~iWt/,~/1/~// ~a//// County: fit. CrOIX Sanitary Permit No: 463131 0 State Plan ID No: Parcel Tax No: 020-1065-30-000 SectionlT'own/Range/Map No: 24.29.19.250A STATION BS HI FS ELEV. Benchmark ,~ b .o l~ s, V Alt. BM -S-n Coves Bld . Se er 7. ~lo• 9 f S t Inlet ~ -~ 9~. St/ t Outlet --_ ~q/ I [/h/ `}''~q/ I J r / Dt Inlet / _ Dt Bottom i Header/Man. _ ~' g. l~ Dist. Pipe $. ~S ~ Bot. System ~ ~j.~ ~ , L Final Grade St Cover ,3 r ~~ ~ ` , BED/TRENCH Width i Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ~ G1p 2 _/ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHING Manyfa F r INFORMATION CHAMBER O r Ty Of System: ~ \ ~ > t {~ ~ ~~ ~ `/ UNI Model Number: IBUTION SYSTEM 1-l. y ~.~n®~/ L S oL h L~ -~ Head anifold l lr Length~_ Dia Distribution Pipe(s) 'j / ~ Length ~ u Dia Spacing_~ x Hole Size ~/" x Hole Spacing .~ Vent to Air Intake \ / 7 ~8 SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded Bed/Trench Center f BedlTrench Edges Topsoil Yes [] No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ d / 2~/~ Inspection #2: ( / Location: 848 Yellowstone Trail H~u~,ds!o~n7W~I 54016 (NE 1/4 NW 1/4 24 T29N R19W) metes & bounds Lot -(/J/~ ; P~arnce~l/No: 24.29.~1,9,.,2,5~0A~ 1.) Alt BM Description = ~j7-. ~v G ~~ ~'"'G-r G~~~~~ ~~~~iW~ 2.) Bldg sewer length =/lr i~-~'n~~~,~ ~sl _„ ` W/_/J„~~~ ~ _ S _ / ` -amount of cover =" `~ / ~ ~ ~ ~ I'~LJ (~ I'L4liU ltiT ~~ ~ I'~~l~ld ~' Plan revision Required? L~ Yes No ~ ~S Use other side for additional information. ~.__ ~ O b ~ J C-.---~~ ~~~~/y.. f/p S lJ -,~ Date Insepctor's Sig ature Cert. No. SBD-6710 (R.3/97) xx Mulched Safety and Buildings Division CO1nty sT C ~ ~ ~ •~ 201 W. Washington Ave., P.O. Box 7162 isconsin Madison, wi 7 2 a ~S 2®~ D Sanitary Permit Number (to be tilled in by Co.) Department of Commerce ) ( 3 3 ~ Sanitary Permit Application RE ~~ Stagy P'at' I.D. Nnnuter /~ I y personal infomtation y provide Code Adm 21 Wis 83 ith C d i , . . omm . , w n accor may be used for secondary purposes Privacy Law, s15.04(lx ) qt than tnaiting address) lest O y 54't'tG L Application Information -Please Print All Formation ~ ~O • ~~G Jr . ~ 0 ~ Da'~~. , ST. Property Owner's Na me CNING pFF ~ T'o Dv ~'i4 y~ ~` /'~1~.//~.v .4 ~c. y~~ ~ Lot/~ Block fl Property Owner's M ailing Address s~~ ,el~~w s~~- T~~-%~- Property Location ,~E ,mow Zy S4, Sf,Section City, State • _ / ~(~l/..~ QN ~~ • Zip Code ~ol ~ .Phone Number T 2~ N_ R I~(E lr~j l~J (~ ll th t h k ildi ) l a a ec ng (c II. Type of Bu y aPP ~ E 1 or 2 Family Dwelling -Number of Bedrooms ~ ~~ ~ ~ ,' /3 ov.~~ ib U D i l ^ se escr e a - publicJCommerc ^ State Owned -Describe Use - ^City ^Village (fit` 'ow ~p ttf~~r ~/ III. Type of Permit: (Check only one on line A. Complete line B if applicable) A' ^ New System Replacetent System ^ TreatmentlHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Pertnit Number and Date Issued Before Expiration Plumber Owner IV. of POWTS stem: (Check all that a 1 ) Non -Pressurized In-Ground ^ Mouttd > 24 in. of suitable soil ^ Mound < 24 in. of suiraMe soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Satd Filter ^ Recirtatlating Synthetic Media Filter Ching ber ^ Drip L' Gravel-less Pipe ^ Other (ex lain) V. Dis rsaUTreatment Area Information: 7!" ~ ~ Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) rsal Area stem Elevatio ~ ~~ I o ~ 9y ~ o . . ~ ~ , ~ ~ s ~ VI. Tank Info Capacity in Total Number Manufacturer a Site SteenFiber Plastic Gallons Gallons of Units ' ~ - n rete Constructed Glass ~' "'i ~ ~ ~d.~C. New Existing w ` Tatilcs Tanks Septic or Aokling Tank a~ ~ ~ ~ Aerobic Treatmeru Unit using Chamber ' VII. Responsibility Statement- I, the tmdersigned, assume responsibility for installation of the POW1S shown on the attached plans. Plumber's Na me (Print) ~. ~i,~~~'~~.r Plumber's Si lure A4P/MPRS Number ZZU3~s Business Phone Number ~~s. ~~a• ~y~ Plumber's Addre s~ (S,n~et, City, State, Zip Code) ~ ~~~ , ~ ~ /,~ / /, s~• S' y~ ~ •~ ~. ~i i o dam- .9-v (/ ! G(/ / III. Count /De artment Use O V ,,pp rov d A tsa rov Sanitary Permit Fee C odes Grotmdwater Date Issued ing ent Signature (No Stamps) e pp ,t'y pp Surcharge Fee) mm ~ Jv"- ~ ~~ ~ Owner Given Reason for Denial • 1X. Conditions of Approval/Reasons for Disapproval 3 ~ ~~ 5~ -- ~ a~~ ~ R~` SYSTEM OWNER: - p 1 Septic tank, effluent filter and ' - i "~ dispersal cell must all be serviced /maintained ~--r`~ as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. ~O A Attach complete dens (~ the County only) Por tLe system m paper ~t less tLan 81/2 x 11 inches in size ~ ~~~ ~~ ~ ~,~ 1T~~ j3~~/~iw ~ _ pp. ~ ! a v ----------• E ~ (or ~-~- ~ f `' ~~ ALL NON-CONFORMIIUG TREATMENT TANKS SHALL BE ABANDONED PROPERLY PER COMM. 83.33. i ~, = 13.4 ~~~ ~; rs 4 ~ ~~v~v,~ ~•v~s 3lQ z~ 10 /oo, a ~, l~~~l ~a~ror{ ~~ S7"(IGGD ~ iDlcatr' w ~ ~5~ C ~~p~ 'd r s .T' 1 A, ~~ ~s " R~~N~o~~ S' 1 e' r , ,...1 , ~ ~ ~~~ ~t ~ ~ v// ~~rlue. t ~I ,`ft ~~ . ,--- 3 y ----,--.. ~~ ~ , ~ -~ ~ ~ r- r c----, ~~ i~ ~~ ;~ 4 ire-~~~ ~ ~ ; ~a `; i ~~ i D, ~~ ~ ' M ~ ~ i ( ,d ~~,',. (~ '~ 1 ~ t1 it („1 i ./' ~°~ 5 s s ~~ ~ 5a 9g-~~ q`~ ~-'''+- r ULBRICHT & ASSOCIATES CO. 2812 10th Ave. • Spring Valley, V11t 54767 Rte" o~~.~ aEng-.;ng ~ " 715-772-3442 p"'~~ $eN'~~ consultants PROJECT INDEX r PLAN ID # d1/lT-- DATE ~G~' /s ' D y OWNER ~o~v 3 Jri4yivE" ~yv/1lv,¢ ~ ~ PHONE. 3 d'<y • G S'!r ADDRESS gy6 ~~~lr1LCJ $'~it.~J~~ ~ • /~~~d.t-~ s ~O/4c LEGAL DESCRIPTION Pi9~T 0~ /d /~LcCS /~!!~ 024• I4lv,~'. ~' .N~, ,v~J, SRc . z y, 7-Z.~ /E't y cv o© c 'rOwN of _,••~'~ t>GGf>So.,J CSTM ,~. Gl~it/~t /~ T- Z2.~ ~` "') C COUNTY <5~' c~Dt`1C._ LOCAL AUTHORITY/ SUPERVISION s'~'". C~ /`X '~~"~ ~,t,) %,E1(r..- PROJECT DESCRIPTION: d~~2~• ~~ ~~Gir~~. ilibricht & Associates F~rivate Sewage Consultants 2812 1 Qtb qVe" Spring VaPtey, Wi 54767 ~rpks #- Zz43'zS Pg•1 INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN Pg•3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg . 4 ~~ ~t ~~ ,. t n `< CA °m m D x .a. m m tD ~~ C~ ~1 ~ ~. Vl~ `, ~ NNN ~~ ti ~ ~. i~ \b o o ~° ~ c n ~ y d ~ ~ ~~ ~~ A ~ ~ ~ ~ ~- ~ ~ °b ~1 ~~ ~ ~ a ~ N ~ o vJ y ~ `" y C U' ~i ~- y ,, ~~ 0 y ~t Z~ tl - -- ~ ~'~ ~ ~~ L - f~k ~~ i t------ ALL NON-CONFORMING TREAT~{ENT TANKS SHALL BE ABANQONED PRpPFRLY PER COMM. 83,33. i ~, /oa~4 ` _ ---~ ~M~1 ~e~ror- ~r ~ 57UGCD z~ ~ rDi~~- ~~~ ~ ~ ~~ . ~0 w~?s~ ~~'~ I b ~A, ~ ~,~ R~ ~j~ w ~., ~l s ~~W ~ b' ~ v~l ~,~.. tf fl ~.rt ~~ lad ~~ E!r 3z r ~` ~- r f r r ~ r r ~~~ ~ ` tt I 1 _' r r~ r It I ~ { rr ~ rot a jai i r s ~t rr ' Lr I ~ _-~ ~°~`" 5 S 5 ~~ y ~a' sa ~`~' q~. ~~- . . /.vsj~~cTr~.v c ~~' _.___._ ~~~ p 3 to 1 ~~f ~Ii.V. iz ,. t ~~~~ ._ ~ ~„ ,} ,~ ., C'~FlcvG,~~~ ~ i 5 tf~NGG d r y ~~ ~~~ ~~ '~~ "~ ~i~/sp~cT~d,,v ~o~/,te + 1/// yam. ~o ~--p~c 9~P~~~ a ~ -- ~-~ ?,P~~V off ,, , ,4- _ ----~ ~ sy~~~ ~~,~~, 5 y. sa ~'r~o SS Sic ~ ~o~ a~ T~~""~~s ~r 2~~Si~v ~.- //~~i L ?if'~4- T-~ ~ .. w~~„ ~ ~j• / .~`;Q. fir, r~,p,+°~ ~( ~ ~ ,.~ /9P~~~~1~ ~~.v ?- cep' u~ %uSld~'cT/ev p/~ K ~~ ~ ~/// sue', ~o '`z-- pv~ T~~~ ~~ ,i n .~ /, _..-_. . OWNER's MAINTAINCE ~ OF~- SEPTIC SYSTEM - _, POWTS Elandowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for. the safe healthy operation of; this system. The owner is required. by code to submit all necessary maintenance/inspection reports to the contraliing,authorities.. SPECIFIC CONTACT AGENTS ~• ~/~QjX. Cry * Governmental authors tyl inspectors : Z-O.V 1~~t1(~-- ~~~ / _ ' ~ * Licensed installer, responsible maintenance.."Users" manual: for providing an operation] ~• zf/~iC'~ GGL T-- = * Licensed serv~sce • inspect,san agent other than installer: *_ Electrician, for pump, electric controls, wiaring units: N/~ . IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1. Winter traffic (sleddin area shall not.be permigtedhQOr~frastecanjwilloss the the-cell, freezing up the system. Discontsnuos useein~the;nta winter. (a vacaction trsp, resulting''in na water use) can also lead to freeze ups . ` - ~. Water conservation needs to be exercised! Or system can be „ hydrolically overloaded and destroyed. Thss svs~em was aessgnea for a maximum wastewater flow of /~~ -s-~_- gals. daily. 3• POWTS are not designed to accamodate wastes from a garbage.: _ disposal unit, or any other unnatural sources of waste: Any introduction of -such waste materials will overload and - de~stroy this system. ~_ `~• If a power o:.itage occurs, ar a pump fails, it mayt result in a temporary averload of effluent being pumped into the cell, which may adversely impact the cell (leakage). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5• Neglect of the vegetative cover erosion preventive {the cells insulation & traffic } can lead to failure. Compaction or heavy also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYS'PEM!! Effluent fn the system beneath IS NOT sufficient ,.a lone t0 maintain a - ~ ~covmr , fi• Periodic inspections by the owner, or his a ent necessary. Inspection g ~'• ie ;.,~.,. Lz_ _ Pines anti n.,r:-a ~,:..__ z wsconsin Department of Commerce SOIL EV Division of Safety and Buildings in accordance with Comm 85, Attach complete site plan on paper not less than 8112 x 11 inches in s' include, fxd not fimited to: vertical and horizontal reference point (BM~ percent slope, scale or dimensions, north arrow, and location and distal Please print ail informat9on. Personal iltfomtation you provide may be used for secondary purp~es (Privacy t '1'apertY Owner ' owners Mailing Address .dy . State Zip Code .Phone Numb ~U9S0,~ ~ ltJ/ E SyDlLr t c11 S~ 3 ~lo • Co SC UAT{ Page ~ of e x'~ LD. ono. io~S• 30.0 a F~~ ~levi by Date 5. (t) (m)). ~ Ct . ZO rty LOCa11on ' Govt. Lot /V ~, 114 ~~ S Zy T 2 ~ N R ~~ E Lot # Block # Subd. Name a PA- T ~~ / A.~s ~ City ^ Vllage Town Nearest Road ' V fls .v , YE//o~u sfav~ `^ New Construction Ilse: ~ Residential / Number of bedrooms ~~/ _ Code derived design flow rate QZ.~ GPD (~$,Replaoement ^ Public or commercial -Describe: _ --~_.____ Parent rrsateria{ ID.eSS D U.~r ~ ~~~y Flood Plain elevation if appligble 'L ft. ,General oorrxr>ertts ~~.~~ and recommendations: f~'~E~ TE S T~ ~t~ ~' Tit/ t-~E" ~!~ ~~ ~~ y~ p vu ~ ' w,u iVE,c9 J7oc1 if- L j? p, co . ~•-.S , a ~ ~~ a ~~ # ~ Pit Ground surface elev. ~~" ~ tt. Depth to lim+tin9 factor , ~~ in. Soil ication R~+e Horizon Depth DorrNnant Cot Redox Desaiption Texture Struchae Consistence Boundary Roots GP D/ft= in. Munsep Qu. Sz. Cwlt Color Gr. Sz. Sh. •Et#t1 •Eff#2 i. la •!7 j YR s! /L /~ ~ r cs ~ • ~ . Z 3 ~7• 7•s yes ---_ ,SSG ifs ~ r ~s / . (o . .. ~. S yR S ~P t/ G D, s c S -- S /. ~- 9~ s~' ~t9.2 gs Z ng # (~ t0 PiBtnng Ground surface elev. " ~• ft. Depth to limiting factor/b ~ in 4 Sod flat Rate Horizon Depth Dominant Color Redox Desa-iption Texture Stnxxure Consistence Boundary Roots GP D/(g in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. •EtT#1 'Eff#2 ~•~o ~oVR3l ~ cw • -Z /p• I S S/G f ~ I~- . C~ • 2.. 3 ~ ~. --- ~ -f's K ~ f r• cs r rt- • ~ ~' t_.tttwr n x t - ova + .7V ~ LLV mil. anO 1.71 ~'JU ~ 1511 ntg/L. ' t1lNler1[ irL = tSUU < and T55 < 30 mg-t. csT Name (Please Print) R n ?~t L 13 R I` c~T~ z ice 3-7 S Address Oate Evaluation Telephone Nurtd~er Ulbricht & A 5 ?~ S • 77~ • 3YYZ- Private Sewage Consu{tants ~.~ ~1 ~~~ ~ i can Ave. Spring Valley, VIII 54767 ,,~,. Mull;,~~ ~.- d.~ac~5.3~•~° ''~'~,, ParGet tD # f7 2 i.. 3 Page ~ ~~ ~ , ~ , . ~ o • ~o y2 3 --- ~ Z,ws sti s w G 3 • & /~~ /~ 7.S .S/L n.1 ~ ( Q.. -- (o . ~ p ~ _.- ,S /. ~s~6 ^ # ~ ~s ^ flit t surface atev, ft D b fac6or in. s.,a e.,.d-~~s,,., o~ Q # ~ ttorixon Qepth in, Dominar~ t~Ars~seN R~edoac DescxtpGar~- llu. Sz. Coat. Color Tsocpxe Sbnidure Gr. Sz Sh. Cor>siseenoe Boradary Roots GP 'Eif#9 D1tf 'Ef~R2 • #1 = BODR a 30 < 220 rtrgll. and TSS X30 <_ 150 ntglL ' tclttuent #2 =BODE _< 30 rnglL and TSS _< 30 rrrgll f ~ ~ ~ T~ ~~~1. , 3~ ~ T~ D~ ~L~ ~ ____- ~ ALL NON-CONFORMING TREATMENT TANKS SHALL BE ABANDONED PROPERLY RER COMM. 83.33. L3.4 ~~'~e ~i ?~ r z~ y~, '/ ~ I 4~ /o~o~ a M~1 ~e~to~ £ taf 57'UGG'D ~ ~o~NU- ~~, c~~p r~; 1 ~.J /~ ~ ,---- 3z --.~ ~l3 ----=. z~,~~ d __-- a ~g.s ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailin Address gy~ ~ ~ sl "~~ T~ g Property Address (Verification required from Planning Department for new construction) CitylState ~l1~s ~ ~ '~~' Parcel Identification Number ~ ~'~ ~ ~~~ s' 3 ~ ~ ~~ LEGAL DESCRIP'T'ION , . ~y ,~j i" ~ '/. ~ w i/a Sec. 2~ T 2~N-R j ~ W, Town of ~ ~ " ~`S O N Property Locatton , Subdivision _ ~ ~~ 5 ~ ~' 0 ~ ~ ~ S Lot # ~~~ / ~ , Pa e # Certified Survey Map # ~l ~ ,Volume g Warranty Deed # ~ Z ~ ~ ~ ~ ,Volume 2 Z' ~ ~ .Page # Spec house ^ yes [,~ao Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance 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 grogerty owner agrees to submit to Stn Croix Zoning Department a certification form, signed by the owner and by a mastCrplumber, joumeymanplumber, reshictedplumber or a licensedpumper 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 is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage 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 of the three year a iration date. SIGMA OF APPLICANT /~ DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descn hove, by virtue of a warranty deed recorded in Register of Deeds Office. °~ / d J/ ! a V SIGNATURE OF APPLICANT DATE ****** ****** Any information that is mis-represented may result in the sanitary pemut being revoked by the Zoning Department. *• Include with this application: a stamped war~aaty deed from the Register of Deeds office a copy of the certified survey map ff reference is made in the warranty deed 22??P y30 STATE BAR OF WISCONSIN FORM 1 - 2000 WARRANTY DEED This Deed, made between CHARLES T. BERRES and DORA MAE BERRES, husband and wife Grantor, and TODD W. MULLINAX and JAYNE M MULLINAX husband and wife as survivorship marital property. Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): A parcel of land located in the NW 1/4 of the NE1/4 the NE 1/4 of the NW 1/4 and the NW 1!4 of the NW 1/4 of Sec. 24 and also the SE 1/4 of the SW 1!4 of Sec. l3, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin described as follows: Commencing at the N lJ4 comer of said Sec. 24; thence SOOo49'38"W 34.85' along the N-S 1/4 section line of said 24 (all bearings referenced to this line) to the point of beginning; thence S20o 15' 14"E 174.29' along a S Wly line of Lot 7 of CSM recorded in Vol. 9, page 2513, Doc. #486436; thence S61o57'28"W 1341.48' along the NWIy right-of--way line of an existing public road known as Yellowstone Trail; thence N27o59'51 "W 140.03' along the NEIy right-of--way line of an existing public road known as Chippewa Trail; thence N15o54'17"W 705.24' along said NEIy right-of--way line; thence N74o05'42"E 1298.23' along the SEIy line of Lot 5 of CSM recorded in Vo;. 9, page 2512, Doc. #486435; thence S20o 15'14"E 387.44' along said SWIy line of Lot 7 to the point of beginning. This parcel contains 21.357 acres more or less, being 930.305 square feet more or less. Subject to easements of record. '726Qi~5 HATHLEEN H. MIALSH REGISTER OF DEEDS ST. CROIx CO. , MI RECEIVED FOR RECORD 06/16/2003 11:30A1! WARRANTY DEED EXEMPT ~ 17 REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: l Area Name and Return Address ~~, "~'~ ~ ~ rI K _ ,.. ~ - Together with all appurtenant rights, title and interests. 020-1065-30-000 THIS DEED GIVIIV TN SATISFACTION OF' THAT C~I'AZrI LAND Parce{ Identification Number (PIN) CONTRACT BE'1TiTE),'~7 THE PARTIES DATED 6/13/98, REQORDID This is homestead property. 7/7/93 IN WL. 1338, PAGE 274, DOC. NO. 582529, R»GGISTER OF DEEIIS, ST. CROIX CUIJNTX, WI. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, reservations, restrictions and rights-of--way of record, if any. Dated this !~'`~ day of ~~, 2003. * herles T. Berres *Do a Mae Be es ?"'~~- :,, AUTHENTICATION Signature(s) Charles T. Berres and Dora Mae Berres authenticated this day of , 2003. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. 5tats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Bang C. Lundeen Hudson WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF Vt~I~fs61'd'3H~I ARIZONA ss. ~Srt~reix County of ~~ ~j ~ \ ) Personally came before me this I~_ day of~ , 2003, ` the above named Charles T. Berres and Dora Mae Berres to me known to be the person s who executed the foregoing instrument and acknowledged the same. Cu~~ C ~.o a • ~ ~ a * ~A r i ZO nta, Notary Public, State of~~isceusu~ ~~) mission is permanent. (If not state expiration date:(~~71 D A...,~,...~.,,,,.,.,..~.~... ~ v F,, ~. A •Names of persons signing in any capacity must be typed or printed below their signature. '~ t+;, , S:A le ~, Y WARRANTY DEED STATE BAR OF WISCONSIN `~^- ~"`fix ~ ~ it o. I - 2000 `t T-29-N • R-19-W N W d z O fn 0 J O w z J W l7 H V) N See Pace 112 For Additional Names. 900 - - ~~~ _ udea nom.. °'~ ., ON-, 4M ~ ~~ w 0 2S0 ,a X epos W J aW Q !f e9 i m F.ea ~+ x s13 lp ~mI ro a ~ a_e a .~ N DR FlOrenCe Poles ~ ~ 160 ST. JOSEPH'S' PAGE 46 nv TROY'E' PAGE Ib