HomeMy WebLinkAbout026-1127-05-000 Wisconsin Department of Commerce
PRIVATE SEWAGE SYSTEM County. St. Croix
Safety and Building Division
I INSPECTION REPORT Sanitary Permit No:
395109 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:
Halverson Homes Richmond Township 026- 1127 -05 -000
CST BM Elev: Insp. BM Elev: BM Description:
ii
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � ) Benchmark
w�Cb Z�� r 2•l Q '
Dosing Alt. BM 3S f3
eration — Bldg. Sewer
-� 9 73 qz..5
Holdi S Ht Inlet
St/Ht
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 4- / Dt Bottom
�lOo' - s ' 3.5" �o
Dosing > (00 Header /Man. r
- Dist. Pip M t fz s sZ
Holding Bot. System L yZ 9y PZ
L ,
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer DemanU St Cover
GPM
Model Number
TDH Lift Friction Loss
=system T V Ft
Forcemain Length Dia. Z � Dist. o ell
g /
SOIL ABSORPTION SYSTEM (J CIL
BED/TRENCH Width Length No. D f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 7" 4 "5 , / 3
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM IN G Manufa er•
INFORMATION CRAM OR
Type Of System: > / l � / IT Mo e�u ` ber:
,
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
�/ ��
Pipe(s)
L Dia I L Dia r S acin
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of TSeededlSodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil [i Yes [#1 No [] Yes [# No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / l( / 0� Inspection #2:
Location: 1441 131st Avenue New Richmond, WI 54017 (SE 1/4 SE 1/4 25 T3�0,N RR1L8�W) 25301 Richmond Hills Lot 5
1.) Alt BM Description = r41+' o O Oo✓ Sr - `' /I /� /�/
2.) Bldg sewer length = �/� P � y �*�^•
- amount of cover = > S p '� / /alert i� 4>L[ �lc d � i� ,/ n, :5.
3�o66e,uol.� /df"e -, %ws7 id A, s'�Sy -4f.— 0,-16 dIt, Ivan
Plan revision Required? f] Yes [ No
Use other side for additional information. w
Date I Cert. o
SBD -6710 (R.3/97) _—�
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Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
e d
j n Madison, WI 53707 - 7162 Site Address
De �rtment 4f Comm ®rce
Sani tary Permit Apps s anicsy Permit 1• umber
39s DI
In MOM wilt Cotmn 33.21, Wig. Adm. Cods, par f o e
bs 813. 1 m ❑Cheek if Rev; -,i.:
.......
I. Appmeatbw Infornaetiatt - Please Priest All Inf
a LI
Property Owner's N / � Parcel Number
02l, - ID _ oV
Property Owner Mailing Address �' Property 14catio.n.
70 —r17 0 f ft 'A 5 / S Z5T3�A, a /V iff
City, Zip C Phone Lot Number Bieck Number
Subdivision Naw "SM Number
83-92 No
II. Type of Building (check all that apply) c, s P.r S ww ❑City
or 2 F Dwell' - Number of Bedrooms
Family mg - � ❑Village _
❑ Public /Commercial - 'Describe Use Al
,�FFla, �_.�. �__..�_._
❑ State Owned Nearest Road
T
III. Type of Permit: (Check only one box online A (numbering scheme for internal use). Comple w tine B i ^ r flier )
i a
A. R For County use
1 Nsw 2 ❑ acetnent stem 3 � lacement of 6 ❑ Addition to Re
.p� � Sy P
Y°'
system Tank Only Existing System
B. ❑ Check if Sanitary Permit Previously Issued Perini Number DatE Is . ed
—
IV. Type of Permit: .(Check all that apply)(numbering scheme is for internal use)
44INon - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed ",N' _anc
22 ❑ Pm anized In -Ground 41 ❑ Holding Tahk 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Geese 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ O her
V. DIsisersaVIregKo Area Informations D L / N eG f -
Design Now (go) Dispersal Area Dispersal Area Soil Application Percolation Rate st m ti rir�l �F J �
Required Proposed Rate(Gals./Day .Ft.) (Min./Inch) Q 9s E os
'F5 C'r
('� 9'Y, s 91 s
0V 7 VI. Tank Info ity in Total Number Manufacturer Prkab Sia
atlons Gallons of Tanks Concr 6,.-d j lass
New Existing
Tu �
Septic or Holding Tank —
Dosing Chamber ✓1/y� D — { _____ --�
VII. RUPOWUN k Statement- I, the undersi ed, assume resmsiblIft for hrataBOtion of the POWTS shown on the as w And r d w. _
's Nsms (Print) P 's SignaAU lupaber Bus n s Ph
z �,6 2 Z ? 3 X �/
Phta*ar's Address (street, City, Stets, Zip CA) --
VIII. Co a ent Use o nly
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Isar m,- =. AgeL t S ig air e (Na Stamps,
Surcharge Fee)
❑ Owner Given Initial Adverse
Determiaaation �S
IX. Conditions of A � brz a r easons for a roval - - -
�- , N� Q• she -I bl,� CL&9-.t.- w-�-
41f Af o tj 4 0.� ,Q� s s�tM..
l S - ' (5 . o S sly JL�fJV{ Z"
S � ,
t complete plans (to the Canty nub) for the "em on papa nQ0 leg than 81/2 u ! ucba in sbx G
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1_ of -3L—
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must St . C ro ix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, andlor and distance to nearest road. pendlri"
Please print,, nfdhW bri. - R iewed by Date
Personal information you provide may be upd'fo, $ebondary urposes (Privacy1,aw, s. 15.04 (1) (m)). , '
Property Owner `� ,.� i `; { Property Location
R J C Development, I C . Govt. Lot SE va 1/4 S 25 T 30 N R 18 K(or) w
Property Owner's Mailing Address f Lt� l 4ot # Block # Subd. Name or CSM#
1868 Ct . Rd. C ' -- 5 na Richmond Hills
City State zip o cb Pho
11 W R
El City El Village ® Town Nearest Road
�,.,
t WI. 54,023 7r��i r���lZ
Somerset, +� Richmon d
® New Construction Use: ❑ Residential l Number of �dFRQm .4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commerdlaf - beseritfe:
Parent material gl ari al drift __ Flood Plain elevation if applicable ft.
General comments
and recommendations:
trenches spaced to code 3.50' below grade
F-1 Boring # Boring
❑X Pit Ground surface elev. 97.40 ft. Depth to limiting factor +94 in.
Soil Application 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
1 0 -9 10 r 2/2 none 1 2msbk DSH 9w if .5 .8
2 9 -18 7.5 r 4 none sicl 2msbk mfr 9W if .4 .6
3 18 -30 7.5 r 4 none sl 2msbk mfr qw na .5 .9
4 30 -94 7.5 r4 6 none ms os ml na na .7 1.2
Boring # F1 Boring
[-2] ® Pit Ground surface elev. 9 8.70 ft. Depth to limiting factor +96 in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I `Eff#1 `Eff#2
1 -14 10 r 3/3 none 1 2msbk DSH 9W if .5 1 .8
2 14 - 10 r4 4 none sicl 2msbk mfr qW if .4 .6
3 3 -63 7.5 r4 4 none sl 2csbk mvfr qw na .5 .9
4 3 -96 7.5 r4 6 none ms OS9 ml na na .7 1.2
` Effluent #1 = SOD > 30 < 220 mg/L and TSS >30 < 150 mg /L nt #2 = BOD 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Gary L. Steel f 02298
Address DaZEva tio n Con ucted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 10-12-2000 715 - 246 -6200
Property Owner RJC Development Parcel ID # pending Page 2 of 3
Boring # F1 Boring
3] ® pit Ground surface elev. 96.80 ft. Depth to limiting factor 4 .gj)— in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 1 '092
1 0 -14 10 r3 3 none 1 2msbk DSH qw if .5 .8
2 14 -24 10 r4 4 none sicl 2msbk mfr Qw if .4 .6
3 24 -33 7.5 r4/4 none sl 2csbk mvfr gw na .5 .9
4 33 -90 7.5 r4 6 none Ms OSO ml na na
a Boring # Boring
❑X pit Ground surface elev. 98.40 ft Depth to limiting factor +86 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I r-4 ff # •Eff#2
1 0 -11 10 r3 3 non
2 11 -15 1 r4 4 none sicl 2msbk mfr iw 1
15 -25 7.5 r4 4 none sl 2csbk rnvfr Q w .5 .9
y d'
2•$ 8�•
Boring
❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfB
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 5 220 mg1L and TSS >30 < 150 mgll- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L
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, P lease contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (86/00)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 RJC DEvelopment, Inc. New Richmond, WI 54017
MPRSW -3254 SE4SW4 S5 T30N - R1 8W (715) 246 -6200
town of Richmond
lot #5- Richmond Hills
N
/ 1"= 40'
A BM.= top of SW lot stake @ el. 100.00'
Alt. BM.= top oft" pvc pipe @ el. 97.80'
X 016
�i
Gary L. Steel
10 -12 -2000
- so AJ
Combination Septa c' Tank and
PUMP CHAMBER CROSS SECTIOM AND SPECIFICATIONS
VEU WEATHER
T CAP PKOOF
JUIJCTIOQ BOX
4'C - I. VCAIT PIPC APPROVED LOCKIIJG
t1,,0J 0LE COVER P
' —
TO' FROM ODOR. u,ARNISJG L.�BEL.
u�3P�Ct10>J �' iPE '.IINOOW OR FRESH
AtRIUTAKE
ri
-
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I8'nIN.\ ________
i ., PROVIDE ( - - - --
INLET )� _ �; %�� -- 'T'gIRTIGHT SEAL
APPROVED JOIJJT:
APPROVED JOINT ZPtB�t Ft� I I W /C.I. ?IPE
PIPE DR n Tank construction ( (II
ALARM
shall comply with I II
ILHR ()3.15 and 33.20 o I
C
I
OFF
0 COIJCRETE
�Z .O 5LOCK
3 APN
R15ER EXIT PEF fr ITi ED ONLY IF TAIJK MAUUFACTUREK HAS SUCH APPROVAL BED017vG
SEPTIC r SPECIFICATIOfJS
005E W 1� �C -�-� jjUmb[R OF DOSES: PER DAB
Tnr`1K MAlJUFACTURS:R..
TAWK :,IZE: GALLOIJS DOSE VOLUME
ALARM MAWUFACTURCR: INCLUDIIJG 6ACKFLOW: /5z — GALLONS
MODEL ►D UMBER: tol Nw CXPALITIES: A = Z UCHCS OR /5 GALLONS
SWITCH TyPC.: 1 A(5Z2C.?_Y 8 =p Z_ IWCHES,OK �2�,Y_GrLLOUS
M
PUMP AMUFACTURCK: M( -jE�� s C= / G - 3 IUCHES OR . - kGALLOIJS
MODEL IJUM5F -F,. � 't! d D- Q✓ IniLHES OR I ZGGALLDMS .
5WITCH TYPE: Y-1 ev,-_U2 NOTE: PUMP AUO ALARM ARE TO 6
MIAIIMUM D15CKARGE 'RATEGPM INSTALLED OW SEPgRATE CIRCUITS
VERTICAL DIFFEKEIJ DETWEEIJ PUMP OFF AlJ0..D15TRIBUTIOIJ PIPE.. FEET
t M11.1 II'MUM tJETWORK SUPPLY PRESSURE / FCET
+ FEET OF FORCE MAIN Y, 1j2eY0 fLF RICTIOU FACTOR.. �O6 FEET
TOTAL OyMkMIC. HCAO = FEET
gal /in.
As per manufacturer �.< a
0 ki A-e ollr- 5
M E40 series N"s
4/10 HP Effluent
and Drain Water Pumps
Performance Curve
MODEL ME40 EFFLUENT PUMP
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
40
12
35
IO U)
30 1 0
Z 25 t3
Z
20 6
15
F
� H
10 0
h-
5 -2
0 Ll
0 10 20 30 40 50 60 70 60 90 100 0
CAPACITY GALLONS PER MINUTE
F.E. Myers, A Pentair Company • i1o1 Myers Parkway, Ashland, Ohio 44805 -1923
419/289-1144 FAX 419/289 -6658 Telex 98 -%443
K3326 7/91
Printed in U.S.A.
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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
Number of Bedrooms
Design Flow - Peak (gpd) do
Estimated Flow - Average (gpd) c o
Septic Tank Capacity (gal) 1Z. YU
Soil Absorption Component Size (ft o z
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component onent
nt Soil Absorption Com
P P P
Design Flow - Peak (gpd) Zsb z
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 septi nd outlet filter shall be assessed at least
once every 3 years by inspection. T outlet filters all be clean as n Pssary to ensure
proper operatio The filter cartridge s e 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
y
• ' Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
PaR Al' 27
4kO 6((773// (,����
3
ST C R OIX COUNTY
SEPTIC "DANK MAINTENANCE AGREEM} N 1
AND
/ OWNL-RSHIP C}. RTIFICA FORN1
Owner /Duycr 0/ylof�
Mailing Address . - �ptGl ..T• �2 r�
Pr <lperty Adtlress Ldf —..lt' �ij�ia� -'L✓ 1 �� y X S4
-_._ ..
(Verification required from Planning Department for new construction) � p
l'ity" r ro; eZ�,'►uN -` Parcel Identification Number
S � S ,y ri,' R ��% f Al k' `/y �/
Property (•exation Sit- %', S e ' /,, Sec :. T 30 N -K W, 'i'owtl of C Irk f �,�
�;ufxiivision n. C�f Lot ,J
Certified Survey Map N Voltune _ —, Page ii
Warranty Decd ft (pS� 3 Volume 6 0 }'aKc tr I `�
Spec house yes f I no Lot lines identifiable ves nu
x
SYST MAINU kNAN(."t
Improper usr and rnrintenanccof your septic system could rtsuIt in its prematire (ailurc to handle istc Pr l,c; I :Iaurtcnancr
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper Ybhat .mi pw ,tit„ the s,sl r,n
can affect the function of the septic tank as a tr eatment stage m the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, stl,ncd by the , kricr and h a
rna.ster plumber, jourlreyrriarlplurnber, restrictcdplurnber or a lieensedpumper verifying that (1) the on - site wastewater disposal systctr
IS in proud operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1'? Itrl! of sludKr
I /we, the undersigned have read the above requirements and agree to maintain the private scxabc disposal ;vstcrr: v ,li, the <tan(1a,
set forth, herein, as act by the Department of C'ortunerce and the Department of Natural Resnurces, of Wiso)fisw et f fi::an(w
stxtiUg that yOw septic r:yvcm has been maintained must be completed and returned to the fit, Croix Comm Zoning t.)fficc withut lu
days of the three year expiration date
StGNAv!'IiRi (>tr AN I(AN1
()V P R, C 1!Ir,lCATIQ
1 (we) certify that all statements on this form arc true to the best of my (cnu) k1)uw1nivc I «,• ,n, .,,r F. „•.�,,,•,�,;.
the property ir•xrihrd ahc,,r, by +,rtuc of a wwrranh- dcrd recorded in Kcgrstcr r>f 1 )rnl, Ultra
SIC,1 4 IZ!R£ 01 APPLICANT
(�
" " »" Any informatu,rr, ttu,t is mrs- roprucntcdinay result in the sanitary permit being revoked by the lonut ch;,rvncnt ••••"
Include with this appticutlon a Stamped warranty decd from tlic Kcglstcr of Dccds offtcc
l Copy of the ccrt7tteC1 survey rnap if reference ,s mrsd, ir1 the v
vi, 16 6 PAGE 619
' .STATE BAR OF WISCONSIN FORM 2.1999 650633
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX Co., WI
This Deed, made between RJC Develop Inc., a Wisc RECEIVED FOR RECORD
Corporation, — —
07 -09 -2001 12:45 PM
WARRANTY DEED
Grantor, and H alvorson Homes Inc., a Wisconsin Cor poratio n , EXEMPT 11
1.
— CERT COPY FEE:
- - --r -- ----- - - - - -- -- COPY FEE:
TRANSFER FEE: 90.90
— RECORDING FEE: 10.00
Grantee. PAGES: I
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (ifmore space is needed, please attach addendum):
of
Recording Area
l of Richmond Hil ls in the Town of Richmond, St. Croix County,
Wisconsin. Name and Return Addres
KV' i 5 + 1 na
3v� ��St
I�.sQr1 w i `f o�L,
026 - 1127 -05
Parcel Identification Number (PIN) —
This is not homestead property.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. (E) (is not)
Dated this 6 day of July 2001
RJC Development, Inc.
___ • By: Joh H. C arlson, President
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) RJC Development, Inc., a Wisconsin Corporation STATE OF WISCONSIN )
by John H. Carlson, President ) ss.
_ County )
authenticated this T �ay of July 2001
Personally came before me this day of
G the above named
* Kristina Ogland -
TITLE: MEMBER STATE BAR OF WISCONSIN
Ofnot, to me known to be the person(s) who executed the foregoing
authorized b y tt 706.06, Wis. Stats.)
— instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Notary Public, State of Wisconsin
Hudson, WI 54016 My Commission is permanent. (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. iMormanon Proresai —la company. Fond du Lac, vh
STATE BAR OF WISCONSIN e00-655 -2021
WARRANTY DEED FORM No. 2 - 1999
I
PRELIMINARY PLAT OF.
RICHMOND HILLS
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