HomeMy WebLinkAbout026-1290-11-000 rosin Department of ' :ommgrce County:
b PRIVATE SEWAGE SYSTEM St. Croix
ty and Building Divisiofl '
INSPECTION REPORT Sanitary Permit No: 479462 0
,ENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
'ersonal 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:
LeQue Builders LLC I Richmond, Town of 0 Z0
CST BM Elev: f Insp. BM Elev:� BM Description: Sectionlrown /Range/Map No:
• C C50 .O G� S = C.STTB►U l 22.30.18.
TANK INFORMATION Ll ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark ( I
W �S� ZSfl fl Ilfl. 1 1 00,0
Dosing Alt. B O t L `,
CA —VIP43W . 33 q
Aeration Bldg. Sewer s,�8 'OS• P I
Holding St/Ht Inlet (o • T 0
TANK SETBACK INFORMATION St/Ht Outlet • 2. 0 3 •s3 r
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ,S� r Dt Bottom
Dosing Header /Man. $ , q� O •��
Aeration Dist. Pipe
Al ►
Holding Bot. Syste �• a �•V8 !o! o
Final Grade
PUMP /SIPHON INFORMATION 01 J
Manufacturer GPM Demand St Co �•D r-``\
Model Nu!S ^
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. ist. to Well
SOIL A
ASORPTION SYSTEM -7 1
BEi'J EN Width Length ! No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 60
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufactt er.
INFORMATION CHAMBER OR
Type Of System: , ( UNIT Model Number.
v . J 3v $ o, o S s
DISTRIBUTION SYSTEM -}o
Header /Manifold t , Distribution Ix Hole Size x Hole Spacing Vent to Air Intake
>�5 Pipe(s
Length Dia Length 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 Bedlrrench Edges Topsoil
�' ; Yes [] No L] Ye
COM ENT (Inclu a cod d'scre encies, per ons pre ent, etc.) Inspection #1: K0 • C* / � S inspection #2:
Loc�on: 1422 129th Street New Richmond, WI 54017 (S 1/2 SE 1/4 n 22 T30N R18W) Lundy's North Lot 11 Parcel No: 22.30.18.
1.) Alt BM Description
,
2.) Bldg sewer length = I a
-amount of cover=
Plan revision Re uired. �: � Yes � No p � '
Use other side for additional information.
q 1
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings si
!� r 201 W. Washington Ave., P.O. Box 7162 County
�/�►/� SA
Madison, WI 53707 - 7162 t
Department of Commerce (608) 266-3 S Peru Number ( ,�q be filed in by Co.)
Sanitary Permit A
PPiieati n n f State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal informati � —
may be used for sewn you provide
dary Purposes Privacy Law, s15.04
Xm) roj
I. Application Information — Please Print All Informati P Address (if different
on than mailing address)
Property Owner's Name l . CROIX COUN
NG OFF,C l / h Sr ,
R t 1 cW Lotq I P
�.J� O�b_IOie ll B k #
PiOPeltY U,t �lJ Ma'';ng Address _ `� S
j ' R Jam
� Q Property Location
City, State
n Zip Code Phone Number (' /,, Section O�a
II. Type of Building (check all that apply) 0 T N; R � c E or )
/{�\ PP Y) pp �
�'�L or 2 Family Dwelling - Number of Bedrooms I - S v
lJ Pubhc/Commercial - Describe Use Subdivision Name CSM Number
❑ State Owned c Use `k Q c S NO /, N
III, T 0.S f El ❑Vi
age ow of
Yale of Permit: (Check only one boa on line n
A. Ple line B if applicable)
New System ❑ Replacement System �
Y ❑ Treatment/Holding Tank Replacement Only er Modification to Existing Sy
B• ❑ Permit Renewal
❑ Permit Revision ❑ Change of Previous Permit Number and Date Issued
Before Expiration g ❑Permit Transfer to New List P
Plumber Owner
IV. T ofPOWTS S stem Check all that a p p
1
F ol. NNon - Pressurized let -Ground ❑ Mound >24 in. of suitable soil
❑ Mound <24 in. of suitable soil ❑ At -Grade 11 Single Pass Sand Filter
Recirculating Synthetic Media Fil
Constructed Wetland ❑pressurized In- Ground El Holding Tank El Peat Filter ❑ Aerobic Treatment Unit Recirculating Sand Filter ❑
ter ❑Leaching Chamber ❑Drip Line Gravel -teas Fi
V. Dis ersaUTreatment Area Information. Pe ❑Other {explain)
Design Flow (gpd) Design Soil Application Ra
PP re(gpdsf) Dispersal Area R aired
1 0 s
e9 (f) Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity i ` S o C) ISO
n p
Total Number
Gallons Gallons of Units la Manufacturer Prefab Site Steel Fiber
New E— %�(,
L� S' Concrete Constructed plastic
Septic Holding Tank Tanks Glass
Aerobic Treatment Unit I �.Q Y
Do>u118 Chamber
VII Responsibility Statement - 1* the aadersign
Plumber's Name (Pr' t ' re tae
lumber's Si asibiGty for i tioa the POW" show" on the attached plans.
P "lu
e /MFRS Nu ber Business Phone Number
Plumber's Address (Street � ,S Code)
l S tate, ors- s
VIII. Coun /D v d
rtmenf Use D ul
Approved ❑ Di
t sappio Sanitary permit Fee (in des Groundwater
❑ en Reason Denial Surcharge Fee) Date Issued Issum Agent Signature o Stamps)
IX. Conditions Ap rev _
O
SYSTEM NER: 3J S Ct t
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained c
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach campkte plans (to the Coumy only} for tte system on a r not
p pe teas than 8lft x 11 inchq ie aize
SBD -6398 (R. 01/03)
s a � G tv P. «S tom}
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Wisconsin Department of commerce Sr. cH�PIL EVALUfTION REPORT Page of
Division of Safety and Buildings ZON
in a L0 U� +V��`'' Wis. dm. `� Code
County CC
J c..
Attach complete site plan on paper not less than 81/2 x 11 inches in size. an must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Revi ad by Date
Personal information you provide may be used for secondary purposes (Privacy law, s. 15.14 (1) (m)). \?
S
Property Owner Property Location
e c Govt. Lot S 1/ S 1/4 S Oo�T30 N R/ E(
Property Owner's Matting Add r ss L t Block # J CKN�d Name CSM#
city State zip Code Phone Number ❑ city ❑Villa a To Nearest Road�
191461 ( )i
New Construction Us¢ Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercl Describe: __ —__ __ ,_ __.
Parent -- - teria L�r G�� `� Flood Plain elevation if applicable ZZI- ft
and recommendations: s �, S l.�P�� dti✓ 1' D �' v�lb �'
D�
FT Boring # Boring L�
Pit Ground surface elev. 0 Y. Z ft. Depth to limiting factor �' y in.
Soli 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
Z- b r 0 S
Fa-I Boring # ❑ Boring
X Pit Ground surface elev ft. Depth to limiting factor in. Soil Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2
I D`IZ 3 --- S(
G
o r N/ s rn v rr o ,0 l i s L
• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Si CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conduc ed Telephone Number
1008 192nd Ave, New Richmond, WI 54017 •Z l
715- 246 -4516
Property Owner _ Parcel ID # Page of
Boring # ❑ n9
Pit Ground surface elev. � ft. Depth to limiting factor ,�- D in.
Soil kVication Rate
Horizon Depth 1 Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2
1
A le-
- r
�I2Z 5 y �- S 7 I ra rY, c a-
71
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
a Boring Boring #
❑ Pit Ground surface elev. ft. Depth to Iiimiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/f>:
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
Effluent #1 = BOD- > 30 < 220 mg/L and TSS >30 < 150 mgt. ' Effluent #2 = BOD 5 30 mgt. and TSS 5 30 mgt.
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.
SOD4330 (8.60)
Soil Test Plot Plan
Project Name Environmental Holdings LLP Sha i
Address 706 19th St.
Hudson Wi 54016 M #226900
Lot 11 Subdivision Lundy's North Date 12/1/04
S 1/2 SE 1/4S 22 T 30 N /R W Township Richmond
Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron
System Elevation 102.0/101.5/101.0 *HRpSameasBenchmark
Alternate Benchmark Top of 1/2" Pipe C 100.3'
261' Prop Line
Scale is 1" = 40'
unless otherwise
50' noted
Please note: soil test
> 30' B -2 70' B -3 may not be suitable for
owners desired
building location, Soil
.;� test was done to
�d.
0' satisfy zoning
requirements, please
8% Slope 106' verify system location
B -1 before excavating.
246' 104'
Property
Line
Alt.B.M.
B.M. 274' Property Line
I
r
iI
L au
EZ1203H
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OvOVOVR _ t .•h' ' :•, ., �lS._. RR►OR RR
vOOOPOV '� t Ovv000v
v •'"�,;r: 'vvvvvvv �} ^tt
vvv vvP
24" vR. `+ .R.
vev vVv
vvT
Rao
4.625" p: T
vvR VWV W T o v 0 j n 1/2 Circ. = 18.84"
avv vRT
sed eov
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24
• Bottom
36
12 -1/2" DIA. (tYP.)
Void Volume
S oil Interf Area h. V
Void Coefficient in Aggregate given at 57.4%. Sidewall (2 Sidewalls) 2 18.84in
O.D. 0 {4" pipe = 4.625 inches
12in — 3.14
lfi
Void volume per linear ft. = 3.14 • 2.3125in Ifr - 0.117 W Bottom 2.00
12in / ft
O.D. of center cylinder =T2.5 inches Total Sell Interface Area 5.14 SQ.FT
Void volume in aggregate orcenter cylinder = 3.14 • 6.25in _ 3125ia
3.i4• ',374 A22 ft'
l (l2in /ft� (IZin /fr )-
O.D. of outside cylinders- 12 inches Projected Trench Area
Void volume in outside cylinders - Z - 3.1 btn 574-,901 ft' Sidewall Height = 12 in. •2 - 2.00 Sq,Ft,
�Utn l ft)
Bottom = 36 in. = 3.00 Sq.Ft.
Void volume at bottom between cylinders - f 24tn • 6m a /� bin 1
I2i�ifc t2in /fr) n/Rj,l =0.215 ft' Projected Trench Area SAOSq.Ft.
Void volume at outside bottom comers (117 of void volume between cylinders) 0.21512 - 0.108 fP
Total void volume - 0,1 17 + 0.422 + 0.901 + 0.215 - 0,108 a 1.763 cubic ft 1 ft
Gallons per ft - 1.763 X 7.48 - 132 gallons Per linear f[
!f �
.3 6
EPS Aggregate
Trench System
EZ1203H E;4j 0W
Ring Group
65 Industrial Park Rd.
Oakland, TN 38060
SCALE fRX NAM2: EZ12WH —va1 SHEET; 1 of 1 11 -27 -01
I
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pag of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner — )_ el r - R. ` PPS Septic Tank Capacity ❑ NA
Permit # q J� gal
J �— Septic Tank Manufacturer S rS ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model L 0 NA
Number of Public Facility Units A Pump Tank Capacity al A
Estimated flow (average) Oo g al/day Pump Tank Manufacturer q
Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer I)rNp
Soil Application Rate al /day /ft2 Pump Model A
Standard Influent /Effluent Quality Month14 average* Pretreatment Unit NA
Fats, Oil & Grease (FOG) <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD <220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) - ❑ NA
Biochemical Oxygen Demand (BOD <_30 mg /L X In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids ITSS) <30 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) <10 cfu /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other' ❑ NA
MAINTENANCE SCH EDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ?> ❑ monthis) (Maximum 3 years) ❑ NA
earls)
Pump out contents of tank(s) When combined sludge and scum equals one -third (3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once ever y' ❑ month(s) (Maximum 3 ears) ❑ NA
W year(s)
Y
Clean effluent filter At least once every: ❑ month(s) ❑ NA
years)
Inspect um ❑ month(s)
p pump, pump controls & alarm At least once every: ❑ year(s) ❑ NA
Ins
Flush laterals and pressure test At least once every: ❑ month(sl ❑ NA
❑ year(s) '
Other. ❑ month(s)
At least once every: ❑ year(s) ❑ NA
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tanks) removed by a Septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 75 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTA POWTS MAINTAINER
Name U O W e rs Name
Phone `"� S f Phone
SEPTAGE SERVICI OP ERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name' ,/�� Z �
Vi t
Phone Phone t 3 saocn_
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
- Sr CROIX COUNTY
SEP I C'TANK MAIN ENANCE AGREEMENT
AND
• r�
OWNERSHIP CERTIFICATION FORM
Meiling Address C`
1,1
FrOperty a - 2
Nutficauft MPMW f:lm PbRoft Deputment far new )
aty/swe Ideattificati _ C�
LEGAL D Mt-�tr>n�t ��'`^
� �
Property Location 43% E /., Ste• T N- R, TMM Of 11
Subdivision ' r
Lot #
Cerdaw Survey Map # Volume Page #
Warranty Deed # 9 S3 35 V0h1me Page #
Spec house 0 yes no Lot titm identifiable M yes 0 no
caosrs� Improper use and asiwemm�xofyaar s�sy caald resuk m its p +e faamn to hayrdle Wastes. Pnoprrrn
can affeu On *e septic talc eva3 t1 we years Or" if Heeded by a Iieeased p What You Pm iw the System
Auction of the septic tu& as a ft" MV is the waste dbpow systan.
The iw party orwne agceos m sI'm it to St Craft ?smog Depwtmamt a eeeWwation gun. skpad by dw am= and by a
is Pa`�*�5►ft 9wC1) itte onabe sal system
PEAS (i' y ),the Seeptic tam is h= arm W tbb ofsl dge.
set hak hwei as ham need the Wkm re g bacmeggg gad agree to mnh&& the p� . 1. anth ffie sdeda:ds
by the of C=mam mid tic Dqm mess o£I [ gam, Stake of Wb...r.. G1a W..f ao
has been maiadained xmw be eoaapletad sad nt wncd to Abe SL Croft awa Zaniig wrbiin 30
dates
Tw OF
DATE
he r we) Y dint all on this term ate tree to the best of =y , (am) . I (vm) am (are) the a�wnw(s) of
abav96 by virtue of s
Y deed t+000cdal is Ragnaer of Deeds Offxe:
F3 12qt Q5
7 � OF APPLICANT
DATE
iiii+► Any dt is �� � � m d0 M being j by f. ?. aha ssiiss
•"al �^ws9i
'nelw with thb aPPHextiow a shoupod waninty deed f am the Regaftr of Deeds office
a copy of die andrwd Horny map if te&MM is made is the waomay decd
U. 2805 P 2 7 2 795
State Bar of Wisconsin Form I - 2003 KATHLEEN H. YALSH
WARRANTY DEED REGISTER OF DEEDS
ST. cRO>ix CO., vi
Document Number Document Nanrc
RECEIVED FOR RECORD
THIS DEED, made between Environmental Holding Company,
LLC a Wisconsin Limited Liability Corporation , 85/ia/2885 12s45PS
( "Grantor," whether one or more), WARRANTY DEED
and LeQue Builders, LLC EXEMPT #
( "Grantee," whether one or more). T M FEE : 11.88
TRAlIS FEE: 758.80
COPY FEE:
Grantor, for a valuable consideration, conveys to Grantee the following CC FEE:
described real estate, together with the rents, profits, fixtures and other
PAGM: 1
appurtenant interests, in St. Croix County, State of
Wisconsin ( "Property") (if more space is needed, please attach addendum):
Lots 9, 11, 12, 14 and 15, Lundy's North, Town of
Richmond, St. Croix County, Wisconsin. Recording Area
Name and Return Address
C-PAo-t- 0'1-� sn
7 84 / ?16* St
g i- ti a•-,n- 01 s yotG
Part Of 026 - 1066 -95 -00
and 026 - 1067 -30 -000
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:
Roadways, Easements and Restrictions of Record,
Dated May, 17, 2005
Env' ding Company, LLC
(SEAL) (SEAL)
* * J arren President
* (SEAL) (SEAL)
s
AUTHENTIC �ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN ) ss.
authenticated on st Croix COUNTY)
Personally came before me on Mav, �� , 20os
the above - named Jeff War TITLE: MEMBER STATE BAR OF to Me known to be the person(s) who executed the
(If not, f instrument and acknowledged the same.
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
s
Michael H. Forecki, Attorney at Law Notary Pu lic, State of Wisconsin
Eau Claire, WI 54701 My Commission (is permanent) (expires: 11/20/2005 )
(Signatures may be authenticated or acknowledged Both are not necesaary.)
M.
NOTE: THIS IS A STANDARD FOR ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2003
*Type name below signahms.
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St. Croix County Map Output Page Page 1 of 1
St. Croix County Ma in
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413.85 _
Richmond 13
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MurvUpal Bctndar�rs
y. St. Croix County Planning Department l6dlvl7lpv
1101 Carmichael Road [er�yea arverrwsys
Hudson, W1 54016 C7 rarslr
Phone: (715) 386 -4674
Fa�raad
Oral riage
DISCLAIMER: The information contained on this map is advisory. Map Streams
accuracy is limited by the quality of the public records from which it was D ,
prepared. It is not intended as a substitute for an accurate field survey. F* rrcrval c*rann
thlemn111cn1 ^tram
AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist
presently in the County may not be present in the photos.
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