HomeMy WebLinkAbout026-1165-07-000 T -
A Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
4 - INSPECTION REPORT Sanitary Permit No: 488085 0
GENERAL INFORMATION (ATTACH TO PERMIT) 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:
Dalstock LLC Richmond, Tow of 026- 1165 -07 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 6 YK k C ' —
':� ( 22.30.18.1273
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic }- Benchmark 3.3 )D$ .3 ��
,J ��j �-- 0 -Z o a
Dosing Alt. BM
�- aF Fo o.n lay: d✓l . ? /021 Lv
Aeration Bld .Sewer
H olding St /Ht Inlet
TANK SETBACK INFORMATION S t /Ht O !, gCJ 97• 45
1ANK 10 P/L WELL BLDG. V ent o Air Intake ROAD Dt Inlet
ep is 7 $� 'S�$ i Z'7 B ottom
Z7 �
osing ea er an. qt,.
I to • 9 to , w
era io Dist. Pipe (.0- 9!o•S
to • `1 9 to . 6
H olding Bot. System 7
F inal Grad
PUMP /SIPHON INFORMATION 3 • `J•
anu ac urer Demand St Cover
GPM
M odel um er
I UN IL ITE ict ion LOSS ys em ea
orcemai 1 1 - engin i a. MUM jLt!r19L11 lenuies My NO VINO DIU. Ul rl b 111bluu Uld. quid Deptll
OrLj"mc
DIMENSIONS
3 17-6 t/
INFORMATION CHAMBER OR ; O l
. nn � � C / � � � � n _ UNIT IvIudel 110111130.
Cor�,� a ✓�c� a �/� Sa^o.�n.
I Ct
PSCIlly
.1
C, 1 Pipe(s) Z w t!a
Length 1 Dia `I' Length Dia % N,_ Spacing _\ 5
x Pressure Systems Only xx Mound Or At - Grade Systems Only
Bed/Trench Center q. Bed/Trench Edges \_1 Topsoil \1 es i _1 No Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: ! / Inspection #2:
Location: 1452 129th Street New Richmond WI 5 01 (N 112 SE 1/4 2 T30N R18W) Lundy Meadows Lot 7 Parcel No: 22.30.18.1273
1.) Alt BM Description = 6 1
2.) Bldg sewer length = 2-7
- amount of cover = o� ✓`�
ov
Plan revision Required? 1 Yes No ` —1
Use other side for additional information.
-- I DO - - - -J - - — -- — rg - -- - -- o - --
SBD -6710 (R.3/97)
Safe d Bi&ingjkivi& County
_ 201 W. Was tngton Ave., P.O. Box 7162 r y
��CO�, Ma itary Permit Number (to be filled in by Co.)
(60 266- ED o8s—
�
Department of Commerce
Sanitary PP ta Permit A licat on FEB 2 8 2006 Ste Plan I.D. Number
In accord with Comm 83.2 ], Wis. Adm. Code, personal informa on you provide
may be used for secondary purposes Privacy Law, s15. (1)(trT CROIX COUNTY q 5Z, 7.14 , �S
Pr sect Address (if different than mailin ad ss)
T. Application Information - Please Print All Information
Property O is Name Parcel # Lot # Bloc
Property Owner's M ing Address Property Location
4 t )
` Aj_ , �% L�
, Section 'L
City, State 1 Zip Code Phone Number
(circl e
n
II. T e of Building check all that apply) � N; !t � E W
YP g ( d4 s
Subdivision Nam CSM Number
1 or 2 Family Dwelling - Number of Bedrooms S ,
❑ Public /Commercial - Describe Use 1 �' t u"'"r-' -"
❑ State Owned - Describe Use []City []Villa ownship of
III. Typ f Permit: (Check only one box on line A. Complete line B if applicable) Zfp - ` I b S 0- — CL 2 7-3
A.
ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV.,Kype ofPOWTS System: Check all that a 1 sq
Pressurized in- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- ound 11 Holding Tank El Peat Filter El Aerobic Treatment Unit 11 Recirc tmn d Filter ❑
Recirculating Synthetic Media Filter- ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersaVrreatment Area I ormation:
Design Plow (gpd) Design Soif Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) m Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Ate Steil Fiber Plastic
Gallons Gallons ofUni w r ( � - Concrete Constructed Glass
New Existing /
Tanks Tanks
Septic or Holding Tank
z , s
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement - 1, the undersig Aassume responsibility for installation of the POWTS shown on the attached plans.
PI is Name (Print) Plumber' Si ure MP/MPRS Number Business Phone Number 6-
Plumber's Address (Street, City, State, Zip
VIII. Coun /De artment Use Onl
I Approved ❑ D' proved Sanitary Permit Feecludes Groundwater Date Issued Issuing gent Signature (No Stamps)
Surcharge Fee) _ /'
❑ Own zven �Reaso o r Denial �� 2 p
IX. Conditions of Approval/Reasons for Disapproval . s l
SYSTEM OWNER:
1 Septic tank, effluent filter and 1 S� 1
dispersal cell must all be serviced / maintained I 1
as per management plan provided by plumber. P
2. All setback requirements must be maintained
as per applicable code /ordinances. Ye r yS
Attach complete platys (to the County only) for the system on paper not less than 81/1 x 11 inches in size
SBD -6398 (R. 01/03)
PLOT PLAN
PROJECT Dalstock j ADDRESS 1748 112th St. New Richmond Wi 54017
N 1/2 SE 1/4S 22 /T !R W TOWN Richmond COUNTY ST. CROIX
4/12/06 BEDROOM 4
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXX IN-G PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39
IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOREHOLE Q WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 96.5/96.269il8 4' below qrade
Alt. BM Top of 2" Pipe @ 100.2' Plans Designed Using
146' Property Line Conventional Powts
Manual Version 2.0
Please note: Installer must Scale is 1 " = 40'
verify all lot lines and setbacks unless otherwise
before installation. rioteCl
175' Property Line
Well is to meet all
setbacks required by
WDNR
C6��ec
1 -3' X 125', 1 -3' X
119' Cells with
>3' Spacing Vents
30' ST ,
5'
. H .flA
ST 25 1 M.El
-o
27 :3-4 — 1 F 90' -1
B -2 5% 40
Slope
Pro 4
Bedroom
House
Vent
>6 " Standard Biodiffuser
of Cover Leaching Chamber 372' Property
with 3 1. 1 ft2 of Area Line
6' Long
11"
Grade at System Elevation
34 91
PLOT P AN
PROJECT D alstock ESS 1748 112th St. New Richmond Wi 54017
N 1/2 S E 1 /45 22 /T 30 N/ W -TOWN Richmond COUNTY ST. CROIX
�
MPRS Shaun Bird 226900 DATE 2/28/06 BEDROOM 4
CONVENTIONAL XXX IN- GROUND b CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 3 9
BENCHMARK V.R.P Top of Survey Iron ASSUME ELEVATION 100 Filter Zabel -
A 100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 96.5/96.2/95.8 4' below qrade
Alt. BM Top of 2" Pipe C 100.2'
Plans Designed Using
146' Property Line Conventional Powts
Manual Version 2.0
Please note: Installer must Scale is I" = 40'
verify all lot lines and setbacks unless otherwise
before installation.
Well is to meet all noted 175' Property Line
setbacks required by
WDNR
e
3 -3' X 83' Cells with
>3' Spacing Vents
Pro 4 30' ST 25'
Bedroom
House $ f
M . M.
-1
0 40'
Slope
Vent o r: cam"
ICA > 6" Standard Biodiffuser It
of Cover Leaching Chamber 372' Property ,
with 3 1. 1 ft2 of Area 6' Long 11
Of Line
"
C
34" Grade at System Elevation
PLOT P AN
PROJECT Dalstock A ESS 1748 112th St. New Richmond Wi 54017
N 1/2 SE 1 /4S 22 /T 30 N/ W. TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 2/28/06 BEDROOM 4
CONVENTIONAL XXX IN- GROUND SSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100 Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P Same as Benchmark
SYSTEM ELEVATION 96.5/96.2/95.8 4' below grade
Alt. BM Top of 2" Pipe C 100.2' Plans Designed Using
146' Property Line Conventional Powts
Manual Version 2.0
Please note: Installer must Scale is 1" = 40'
verify all lot lines and setbacks unless otherwise
before installation. noteCl
175' Property Line
Well is to meet all
setbacks required by
WDNR
r .
3 -3' X 83' Cells with
Pro 4 30 25
ST >3' Spacing Vents
Bedroom a A
House 45 �
25' M.13
90'
-1
B -2 5% 40'
Slope
Vent 'off or'
ALo Standard Biodiffuser `
Leaching Chamber 372' Property t
with 3 1. 1 ft2 of Area Line +°
"
34" Grade at System Elevation
ST. CROIX COUNTY
WISCONSIN
ZONING DEPARTMENT
ST. CROIX COUNTY GOVERNMENT CENTER
/ N N/ N N N M N • �..r�. 1101 Carmichael Road
Hudson, WI 54016 -7710
M Phone: (715) 386 -4680 Fax (715) 386 -4686
Memo to File
From: Pam Quinn
Date: 4/27/2004
Re: Sandy loam structure misinterpretation on subdivision soil reports
Recent soil on -site determinations have brought a problem to our attention. During these on-
sites, borings were excavated to confirm soil conditions where two conflicting soil reports had
been submitted for zoning department review. The soil profiles, evaluated by myself, Dave
Fogerty, and Dave Steel (all certified soil testers) differed from the original soil reports in that
massive (structureless) sandy loams were encountered in horizons that were described as having
either moderate, medium subangular blocky (2msbk) structure by Adam Schumaker or weak,
medium granular structure (lmgr) by Shaun Bird. There apparently has been a
misunderstanding between "structure" caused by handling samples of the soil during texturing
versus the soil characteristics in situ. The soil, when chunks were taken out of the profile to hand
texture, with pressure parted into "crumbs" that appeared at first to be subangular or granular in
shape. However, these were not true peds that broke apart along planes of weakness, but
fragments created by handling. The soil when observed in the horizon did not have distinct units
of structure and should have been reported as "massive ".
Added notation: on 4/23/04 Mark Iverson (Cedar Corp. certified professional soil scientist),
Shaun Bird, and myself did an evaluation of soils on Lots 6 & 9, Richmond Meadows where the
original soil report described the third horizon as sandy loam, "lmgr ". On Lot 6 we checked
soil profiles within a POWTS distribution cell and then excavated a test pit on Lot 9. The sandy
loams in question were a weak, coarse to very coarse subangular blocky structure, where planes
of weakness were just discernible when peds were parted from the profile. The peds separated
with yerylight pressure by soil tester. Sand coatings were observed on the ped faces in the Lot 9
soils, which supported the determination that some structure existed to allow water to move
through the upper portion of the sandy loam horizon. However, below the weak - structured soil
we found massive (structureless) sandy loams and the boundary between these horizons was
irregular, which would mean a distribution cell could encounter alternating weak and massive
sandy loam. Shaun said he would amend his soil reports with a memo recommending that any
sandy loams he identified as "l mgr" or "2 mgr" be assigned a lower loading rate of 0.3 gpd/ft2
(see attached memo for Whitetail Meadows) to provide a larger dispersal area.
I
Page Two — Soil Memo 4/27/04
Massive sandy loams have been assigned a soil application rate of 0.2 gpd/ft with the code
changes in Comm 83.44 -2, effective as of 2/1/04. The application rates listed on the soil reports
were higher due to the structure having been described as either weak or moderate, which affects
the calculations for sizing of POWTS distribution cells. Obviously, one of the concerns is to
make sure loading rates for the soils are not in error and allow undersized POWTS to be
installed. For example, in December 2003, Lot 35 of Richmond Meadows subdivision had to
have its loading rate reduced to 0.3 gpd/sq. ft. when the installer encountered massive sandy
loam at the system elevation. The sandy loam horizon had been described on the soil report as
" 1 mgr" with firm consistence.
Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist, has been consulted on this
situation and advised the zoning department to require on -site verifications for any lots with this
potential misinterpretation on the soil reports. All soil reports with sandy loam "1 or 2 mgr" as
its structure will be required to use a design based on the current code's soil application rate for
massive sandy loam @ 0.2 gpd/sq. ft. unless additional soil testing proves otherwise.
Z
"Department of commerce SOIL EVALUATION REPORT Page of
afety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
to site plan on paper not less than 8 112 x 11 inches in size. Plan must
t limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
perc scale or dimensions, north arrow, and location and distance to nearest road.
Re "awed by Date
Please print all information.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �j b
Property Owner r __,, Property Location
Govt. Lot 11 - S T 30 N R E (o W
s / Giv J
Property Ow Mai Address '/ _ Lot # Block # Subd. Name or M#
City fate p Code Phone Number 0 City ❑ Village ,'ffT Nearest Road /
New Construction Us Residential / Number of bedroom Code derived design flow rate GPD
❑ R X eplacement �} y( , � -1+ Public or me - Describe: --- - - -- - - - - - -- ��- — --
Parent material - f'L° -ter"y� Flood Plain eleva " n if applicable
and
Gener
recom n
n
Boring # Boring
t
pit Ground surface elev. 0 0 ft. Depth to limiting factor in.
f 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. 'Ef'f#1 I - Eff#2
Z IL-V z z
A114 y
' �•�
® Boring # Boring Xr
Pit Ground surface elev. ft. Depth to limiting factor �'^ Soit Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
c
2 . ,� t f � ,3 Z
I �
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 15A0V ' Effluent #2 = BOD < 30 mg/L. and TSS < 30 mg/L
CST Name (Please Print) I re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 5 7 715 - 246 -4516
I�
�
u i�Q 'eP_ "P
idww
10 t,
ap
Property Owner — Parcel 10 # Page of
Boring # ❑ Boring 7
a urfaceelev. A Pit Ground s ± _�""ft. Depth to limiting factor in. Soil Application Rate
n Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if
Honzo P 'Eff#1 'EtT#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
0 2- DYY
if , C- 3
Z
-
®Boring # C:] Boring u
® 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/ff
P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Etf#2
o - ' O ., 5 C 0
Z o S L s
' � Boring
# Ground surface elev. ft. Depth to limiting factor in.
F
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 * Etf#2
Effluent #1 = BOD. > 30 1220 my1L and TSS >30 < 150 m9A- ' Effluent #2 = BOD, 130 mg/L and TSS < 30 m91L
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.
SBD•8330 (8.6/00)
I
•. 1 r
4 x r
Soil Test Plot Plan
Project Name William Stock/Steve Dalton Shaun d
Address 1748 112th St.
New Richmond Wi 54017
CS #226900
Lot 7 Subdivision Lundy Meadows Date 8 11 /03
N 1/2 SE 114S 22 T 30 N /13 W Township Richmond
F] Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron
System Elevation 96.2/95.8 *HRPSame as Benchmark
Alt. BM Top of 2" Pipe @ 100.2 Scale is 1" = 40'
146' Property Line ou less otherwise
no ed
Please note: Installer must
verify all lot lines and setbacks
before installation. 175' Property Line
Please Note: Tested area
may not be suitable for
desired building area.
Check system location
before excavating.
45' B_ M.g tIA
100' M.>3
25'
3 90' -1
B - 99' B -2 5% 5'
Slope
372' Property
Line
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Co gency Plan
zz
►"" " — c M« , 01, 0 T f , s r _
ption #1. f systerb fails, determine cause of failure, use alternate area and install new
in tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
an nsta 1,new system.
p ' #3J No adequate area is suitable for replacement area, and system elevation
<,d riont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
' Mailing Address
Property Address
(Verification required from Planning & Zoning Department for new constructio .
City /State Parcel Identification Number
LEGAL DESCRIPTI / ON
Property Location /i / 1 / i/a , Sec. � , T N R / �j
W, Town ofG
Subdivision A 1�1? � 1 �` �'� - ,Lot # —7—
Certified Survey Map # , Volume , Page#
Warranty Deed # L > Volume 21 > Page #
Spec hou yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
Commerce and the Department of Natural Resources, State of Wisconsin.
standards set forth, herein, as set by the Department of Co p
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my /our knowledge. Itwe amlare the owner(s) of the
property de ribed above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT(S) DATE
* ** a result in the sanita p ermit being Any information that is misrepresented m y ary P g revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08105)
I�
2939P 634 7443 12 ��
STATE BAR OF WISCONSIN FORM 1- 2000 KATHLEEN H. WALSH REGISTER OF DEEDS
Document Number WARRANTY DEED ST CROIX CO.. WI
RECEIVED FOR RECORD
R. ina
This Deed, made between L. Lawrence Williams and Vir a 10/21/2003 09:45Alt
W husband and wife and each in their own rip-lit Grantor, and
alstock C a Wisconsin limited liability com an Grantee. WARRANTY DEED
ntor, for a valuable consideration, conveys to Grantee the following EXEWT #
described real estate in St. Croix County, State of Wisconsin (the "Property") REC FEE. 11.00
(if more space is needed, please attach addendum): TRANS FEE: 3015.00
The South One -half of the Northwest Quarter (S 'V, of NW ' /4 of Section COPY FEE:
Twenty -three (23), Township Thirty (30) North, Range Eighteen (18) West, CC FEE:
EXCEPT Lot One (l) of Certified Survey Map recorded in Vol. 8 of PAGES: 1
Certified Survey Maps, Page 2305 as document number 465057;
AND
The North One -hair of the Southeast Quarter (N % ' ' of Section
Twenty -two (22), Township Thirty (30) North, Range Eighteen (18) West.
Virginia R. Williams joins in this deed for the sole purpose of conveying any Recording Area
interest she may have in the subject property under the Marital Property Laws Name and Return Address
of the State of Wisconsin. Robert J. Richardson
Parcel Id numbers: Bakke Norman, SC
026- 1068 -80 -000: 026- 1068 -90 -000: 026 - 1066 -80 -000: 026 - 1066 -90 -000 S233 McKay Ave., P.O. Box 399
L Spring Valley, WI 54767
Together with all appurtenant rights, title and interests. See above
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
easements, restrictions and rights of way of record
Dated this 15th day of October, 2003
* L. Lawrence Williams * Vir is R. Williams
* *
AUTHENTICATION ACKNOWLEDGMENT
Signaturefs) L. Lawrence Williams and STATE OF WISCONSIN )
Viraina R. Williams ) ss.
Countv )
authenticated this 15th day.,of October , 2003
Personally came before me this day of
2003 the above named
* ob rt J. Richardson
TI LE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the Derson(s) who executed the foreeoine
authorized by &706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
ROBERT J. RICHARDSON. Bakke Norman, SC
SPRING VALLEY, WI 54767 Notary Public, State of
My Commission is Dermanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) )
* Names of persons signing in any capacity must be typed or printed below their signature. INFO -PRO (800 )655.2021 www.infoprofonns.conSTATE BAR OF WISCO
WARRANTY DEED FORM No. I - 2000
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