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HomeMy WebLinkAbout026-1118-12-000 r 1* Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar ermit Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: ❑ City ❑ Village ❑ T6wn of: State Plan ID No.: Derrick Construction, Richmond Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: C� L - 0 d3 w� 1 = ( s �• -� 026 - 1118 -12 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark I L%V .O / Dosing Alt. BM 3-0 , 03. Aeration Bldg. Sewer Holding St/Ht Inlet cf. X8 TANK TBACK INFORMATION St/ Ht Outlet 1 7 -20 C1 9.0 TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic 2 NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe 5 Holding Bot. System See PU / SIPHON INFORMATION Final Grade Maftlaau D St cover Model Number GPM TDH Lift L ricti stem TDH Ft Forcemain ngth Dia. Dist. To ABS PTION SYSTEM BED /(rRENCtV Width Length , No. Of T nches PIT No. Of Pits Inside Dia. Liquid Depth DIME o -25 DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE/ STREAM LEACHING Man i ctur INFORMATION TypeO (-.i CH T MR - Mo d el Number: System: Syp 1((p DISTRIBUTION SYSTEM Header) Manifold rA I Distribution Pi x Hole Size x Hole Spacing Vent To Air Intake Length �5 Dia. ength Dia. Spacing 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• LO/ 2 Inspection #2• --f- Location: 1419 174th Avenue, New Richmond, WI 54017 (NW 1/4 SW 1/4 1 T ON 418W) - 013018692 - Lot 12 '� �� 1.) Alt BM Description = �� yam.. 2.) Bldg sewer length = 3Q 1 $,• S�Zp�._ `� . 8a �� ' - amount of cover = t8" ' (�ou� C I � V v a • IR `f �� � 3. 96 Kr. , Plan revision required? ❑ Yes 54 No Use other side for additional information. ( _ Z 6 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH 2 SANITARY PERMIT NUMBER: m� <.,._ _- $. a. } q } g T g P I e i g a i E � t ► B g , y 1 € y { a S � ,. m� 1 e t l l / "' E^ Sanitary Permit Application Safety & Buildings Division !" In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. Q to See reverse side for instructions for ti g t lication PO Box 7302 Personal information you provide '4 s o urposes Madison, 53707 -7302 Oeptirment of;Gartimerce [privacy La 1 I)( ] (Submit completed form to county if not , state owned. Attach complete tans to the county co on the r not an 8 -1/2 x 11 inches in size. Coun \ S3 Sa itary p unit Number heck if t revious ap m n State Plan 1. D. Number c t I. Application Information - Please Print all Informatio -- Location: Property Owner Name ST CPDX Property Location �Yr' .�% Ol �'r� - o t;OUAITr Nlj 1 /4Suj1 /4, S T ,N, R W oQf Pro rty Owner's Mailing Address Lot Number Block Number P9 p t ©S 11� 105 8 N 4� City, State Zip Code Pho Subdivisi Name or CSM Number tv.Q_�2 k � � s- o (7 t5 Q W U it II. Type of Building: (check one) [I City I or 2 Family Dwelling - No. of Bedrooms : ❑ Village • Public /Commercial (describe use):_ I own ` • State -Owned e Nearest 1 mad 3 I r er►c� s 3� X /o6 .� Tr Silf + v 1` 5/ C h a rn Parcel umbe s III. Type of Permit: Check only one box on line A. Check box on line B if applicable) Q 2- G I IIB -t }, (00 1 a , 1S. (7 A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to S stem System Tank Only Existin System B) Permit Number Date Issued El Sanitary Permit was reviousl issued IV. Type of POWT System: (Check all that apply) p(Non pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dis ersal/Treatment Area Information: 1 . Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (GalsJday /s (MinJinch) Elevation 974 1 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic �� 2 Information Gallons Gallons Tanks Con- Con- glass +^"' 1 T New Existing Crete structed $�P Tanks Tanks ❑ ❑ ❑ ❑ zkt S � - C�r -,k X ia� 1 t,� �.�s� r-5 - a� ❑ Fff ❑ 11 ❑ VIII. Responsibility Statement 1, the undersigned, assume responsibility for inst to f the POWTS showngri the attached plans. Mces Name (p n Plumber's Si azure s ps): RS No. Business Phone Number o •c t a a b.53 t5 -a (o -513 5 Plumber's Address (Street, City, State, Zip Code) (� to IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I�ing nt Sign tune (No stamps) Approved ❑Owner Given Initial Adverse Sur arge Fee) _ Determination _ Rac 0 X. Conditions of Approval /Reasons for Disapproval: l y ! 1 Y I v ! ! A 3 1 .3 T gyp _ r -- , i , I �jj 1 I i ! i 1 , I I i j I 1 ' -- - - - r -- -, i ! I 1 : I EEE I ; • f I I ! t t , { Col _} 1 I • I j I I I 1 • 1 If r + 1 i I : 1 i I � I r : r , i I i 1 1 I _ I I � 1. I 1 i r { i 1 : 1 : , I , , I r 1 1 - I I I , 1 • ! 1 I I I fi i- 1 j : 1 , i I 1 ! : I , 1 1 I : I , , I i 1 , r i I 1 1 ' i I i , i i l , i _ , , ! : � { I I 1 I I ' j 1 { a _ ' ! 1 I : : : } , r I 1 I � I I I 1 I 1 : Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S.� C , o X Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. p, D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ©O – 1 0 0 I — 1 Please print all Information. eviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Oy-, Govt. Lot A W 1/4 5 Q1/4 S' T N R 1 JVor) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1-5 AwybS Y o 'Uo� /a W1 �e City State Zip Code Phone Number ❑ City E3 Village R3 Town Nearest Roa kick m tmd W -/o/ ( 7/ ) "02 - n 17 y o* New Construction Use: ($ Residential / Number of bedrooms Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material loess J2.r VN Flood Plain elevation if applicable General comments and recommendations: Su yg esT E I q FT Boring # El Boring A Pi( Ground surface elev. / � ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 /o v r 3 3 / a sbk 8° 0 r 5 n "� $ f J ^ r 5bK rn'�r 3 —V AY. 8 S R m rn , r C C.7 r� I ® Boring # Boring f a ,K Pit Ground surface elev. / ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 a m e •� .� , S , ab /D _ 5 i l h, sbk n,r ,a • 5 - 6 S _ S 1 s m�� e� �7 0-55 /D r -s s ►� m ► C w 1.2 sbk, nl C 10 , M . 5 7 i, z Effluent #1 = BOD > 30 and TSS >30 < 150 mg/L " Effluent #2 = 1300 5 : 5 30 mg/- and TSS < 30 mg/L CST Name (Please Si ature CST Number r w v XA 0 S37 Address Date Eva l on Conducted Telephone Number I (R� (' ,�� 9 0 `Ood Property Owner ��¢..rrftLk `u�`� "C-�^ ,yiID# Page Ca -of Boring # Boring P1 / Pit Ground surface elev. _L�� •� it• Depth to limiting factor In. Soil Application Rate Horizo t Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff ell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1� Cce, / 3-3 f ot m k 5 Si r� < 3 30 Aur b _ M I Cu3 / 5 51 f t .5 51 r s ods - S ( $ F-1 Pi ❑ Boring t Ground surface elev. Boring # — ❑ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •EGPD/fgEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor _ in. 11 Pit Soil A lication Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 fEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Effluent #1 = BOD > 30 220 m g/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportu s contactPhe department at 608-266-3151 or TTYt608-264-8777. services or need material in an alternate format, p ease SBD -8330 (8.6/00) I i 1 I I � I 3 ;_.--- -� -�Y� r �¢.0 � - -- �- 11�k= c. L�r�- '7^ ' • {G' -+ - -, - j ;- _._; , -- I - -� -�ti - ` I n I t �- - r : I Y I ' I I r M I I : i I ( r ( I I I : t • j � i y I I `, 1 r , j — i ` 6 I : I I I 1 : � ' I 1 rIll I r-_ j ; I I 1 1 ( I R • r ff i" 1 , I D e l ' �o� n : I I II - - j • I ° i 1 . ' -. _.• I_- .. _._ 111 - . , 1 I s { 1 I �. 1 ' ' � I , I , I I I j i r I ' I S I I i ' I I i � 1 , i i � �' i + 1 I; j ' I , ! I i I I I 1 i i : , l I I ! I , I , , , I I i 1 i , 1 ' , j I I ' i 1 , I 7 1 1 _�- , I , 1- 4 i I , { , i { ' I I ' i I , I + , : I i f I , I Wisconsin Department ofCommerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental By Design Attach complete site plan, on paper not less than 8 x 11 inches in size. Plan must' x f y include, but not limited to: vertical and horizontal reference point (BM), direction phd 7 77 percent slope, scale or dimemslons, north arrow, and location and distance to r>t areg( road. r l.D.# APPLI CANT INFORMATION - Please print all information. By Date Personal information you provide may be used for secondary Purposes (PrK —Y law. s. 145 D4.(1) (m)). �' !O Property Owner obperty Loca i�. , Gavi.lot 1/4 5W 1/4 S 1 T 30 N,R 19 W Derrick Construction lt[C. Property Owner's Mailing Address Lot # Block # ubd. Name: or CSM# 1505 lhyyfi5 12 Willow Valley City State Zip Code PhoneNumber ❑ city alaUage ®Town Nearest Road New Richmond WI 54017 Richmond 140Th St. ® New Construction [:]Addition Z Residential / Number of bedrooms 3 Addition to existing building Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpdffl .6 trench, gpdff Absorption area required 900 bed, ff 750 trench, ft' Maximum design loading rate •5 bed, gpd/ft .6 tr ench, gpdfff? Recommended infiltration surface elevation(s) 97.5 & 95 ft (as referred to site plan benchmar Additional design / site considerations Trenches in the area of borings 4, 5, & 2 1 Parent material Loess Over Glacial CWWash Flood p lain elevation, if iicab NA ft S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank 7 U= Unsuitable for system N S u U El S u u E, S u U F S u u I u S t1 u S 0 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/fl? Boring# Horizon in ` Munseil Qu. Sz. Cont. Color I Texture Gr. Sz. Sh. Consistency Boundary I Roots Bed Trench 1 1 0 -8 10yr3 /2 - sil 2msbk mfr cw 2f 5 6 2 8 -18 10yr4 /4 - sil 2msbk mfr cw if .5 .6 Ground 3 18 -39 7.5yr5/8 - fs Osg nil Cw - 5 6 elev 96.51 ft 4 3945 7.5yr3/2 - gs Osg ml cw - .7 .8 Depth to 5 45 -96 7.Syr6/6 - s Osg ml - - 7 i 8 limiting factor >96 Remarks: 2 1 0 -10 1Oyr3/2 - sil 2msbk mfr cw 2f 5 .6 2 10 -36 10yr4 /4 - sit 2msbk mfr cw if 5 i 6 Ground 3 36 -53 7.5yr4 /6 - ifs 2msbk mfi Cw - .5 .6 elev 98.09 ft 4 53 -68 10yr5 /6 - s Osg ml cw - 7 8 3' Depth to 5 68 -86 I 7.5w3/4 - gs Osg I ml - - .7 ' .8 limiting factor >86 Remarks: CST Name (Please Print) Signature: Q Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 1/20/99 227387 189 t� } ENVIgONMENT BY DE51 1432120th STREET, NEW RICHMOND, WISCONSIN Last saved by Thomas Nelson 715 - 246 -2454 Willow Valley PAGE 3 - 1 80 Y,* a - rte 3t NW Y4 SW %, SECTION 1 T 30 N, R 19 W TOWNSHIP Richmond COUNTY St. Croix Wisconsin �o Q4�Z ` t�3 SCAM 1 =40 Tom Nelson BM 1. NW LOT CORNER Top of iron pipe ELEV. 100' 227387 1 4 2 ,�l ' BM 2. Ground surface next to lath with ribbon ELEV 95.40 cr) 0 0 CL. 3 ) - -- O cD CL r ......... ... fy"r 7 .......... .......... ............... ................ C/) U) 0 N X 0 r r C) E3 (0 ( CD -0 0 (0 c 1-1 (D =r =r (D =r (a o CD co ' - 3 CD 0- D C co =r x =r CD =r (D CD X CL - 0 (D C -n CD a 0 0 a' r CD U 0 CD 0 = fu 0 =1 =3 0 2: 0 zz ...... 0 :3 CD O E (a 0 9 co 0 o. ,,- -n 0 9 'm* ........ .... =r mazCD x CD— 91 R! a 07 — C-n 0 CD 0 0 < .......... rn c o 0 D r (0 G C 0 cD 3 Invert 11 =3 (D 0 • y 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 Permit Number OJ Number of Bedrooms Design Flow - Peak (gpd) c3o Estimated Flow - Average (gpd) Septic Tank Capacity (gal) 2 0 Soil Absorption Component Size (W) S� Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) DSO a S8 Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 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 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 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 CERTIFICATION FORM Owner/Buyer ��i�?il fit• F� S ��+�n Cwt �o N M . 1Z • Mailing Address RD 0 , - .b V- 4k , ��. P-4 c" n.".0 t-1 D It \1"1:7 S 4 101 l Property Address k I ck - 1 ±n± Avc (Verification required from Planning Department for new construction) City/State �-��� 1 IL-t MO"O Parcel Identification Number �K t LEGAL DESCRIPTION Property Location `s %4, 5 W 1 /4, Sec. , T SO N -R g W, Town of L4 AAO t-� Subdivision `-�-°� �� �- y Lot # t Z Certified Survey Map # . Volume . Page # Warranty Deed # d 13 � . Volume �b . Page # Spec house ❑ yes P4no Lot lines identifiable )6es ❑ 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 property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and' by a master plumber, journeyman plumber, restrictedplumber 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 is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, h ern, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of thre y e e. - 7 `L8 oC� SI NATURE O APPLIC DATE OWNER CERTIFICATION e) 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 pro descri d abov y f a warranty deed recorded in Register of Deeds Office. - 7 SI O 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 I • _ - W.r.M. COMPANY Jr. ' Mi MOMON[t PALL6 WiSCOM94" 4�Oa . 6001. iJD PME 16t ) ^ i STATE OF WISCONSIN ST. CROIk COUNTY, CIRCUIT COURT PROBATE BRANCH SALE OF REAL ESTATE OF PERSONS UNDER LEGAL DISABILITY —DEED BY GUARDIAN WHEREAS, On application to the Circuit Court of St- -C'roi Y County, Wisconsin, to sell all right, title and interest of Leo T. Domke, also known as Leo Domke Spendthrif , in and to the real estate hereinafter described, such proceedings were {dpceEt- J�Aiaef== er- 4aeoa,ew� -1— had that the undersigned was duly authorized as genera guardian to proceed in said matter; +Ir+sert j'9peeeaf tor-' 6erreret''} and whereas, the undersigned, as such guardian, has done or caused to be done all things necessary and required to be done by law in such cases made and provided, before conveyance of such real estate may be made; and whereas, the undersigned, Iris Randrahan fnrmPrl) T ni s Aat� Ld l n — - 1� 16th , as such guardian, was duly authorized by order of Court herein dated on the day of December 19 L6, to execute, acknowledge and deliver to Derrick Construction, Inc. a deed of conveyance of all the right, title and interest of said Spendthrift in and (1rvrr"MTor- - vr - th uffg3 mc. ') to said real estate: NOW, THEREFORE, I, the said T.oi c ugndraha.n n+P -, fnrr1 V T ni G Aa= 1 iincl , by authority of the Court above named and in my capacity as such guardian, in consideration of the premises and of ------------------ Si xty Thnlis C � n0p no ) _____ – __ _ _ __ Dollars to me in hand paid by the said Derrick Construction, Inc. , do hereby grant and convey unto the said Derrick Construction, Inc. all the right, title and interest of the said Leo T. Domke, also known as Leo Domke Spend hr ' f , in and to the following described real estate in St _ r X County, Wisconsin, to-wit: The Northwest Quarter of the Southwest Quarter (NW4 of SW4) of Section One (1), Township Thirty (30) North, of Range Eighteen (18} West. 96GISIT" C fFia ;i ST. CROIX OM, WI& 'M'd. for Reaorct fhb 2nd �J M N File No. r _ I � ' vocHvirw wTAms ----- -------------------- I I C) � �' erg 1 1 I •. 1 �� : 1 .b ! CID I �.. 41 t0i I / -scsr LWE or rMl s•,i• o m m" Imo i - N OTE SQOIF21 "E - 692-W � ST DEOIC TED TO ,• ME POLIC : - - - -- T � ...........a ........ ....• . - - - - - -- L 7 . n m s I it Wc F� . ► I Ya nI: a � 1 1 I NOO 34 - 06 - W 601Z f I lAT 3 i F i EAST UK Or WE WM1 /A Or "W W/4 er UCTAW ; I j ,srf,:,r Gr U�� .� ; v a'J �� 50- MW OM Sid ' E alvo :wow .or , I�