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HomeMy WebLinkAbout026-1127-39-000 ` \ � C. ! » � $ r \ ° a \ ) m 7 � \ §t m �c kk }% � 2 D CO \ ) \ ) / �\\ � \ \ ) Cl) f_ \ % z \ \ \ § » \ \ ; \ p) § IL m § � \§ /\ \ ) z 2 2 k c N _ \ » ) a - / § / \ 0 \ o z m = ; _ _ . } \ 2 ° 0 §® CL M k \ \ § k a ƒ / ) m P P k E / 2 \ \ § § \ E z o \ 2 a a a .� � k t B ( J - m -j o \ \ \ § \ \ \ \ \ _ _ % \ t Oo < / \ z @ co _ . , _ G \ \ Q / / § \ / \ ƒ o § 1 8 § \ E \ / # j f 7 \ . \ / \ 2 $ > § 2 § ) / \ / Cl) o ) / } ) / � ® � ° \ ® \ CL » a \ k a § o 0 a \ 0 I A ST. CROIX COUNTY WISCONSIN - - - -. ZONING DEPARTMENT IININNNN■ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 June 17, 2004 Oranzo Oevering 838 Summer Pines Circle Hudson, WI 54016 RE: POWTS Installation Inspection for Oeverin Builders - Permit #430134 p g Location of Property: St. Croix County, Wisconsin Municipality: Richmond Township Subdivision or Plat: Richmond Hills Certified Survey Map: N/A Lot Number: 39 Address: 1339144 th Street, New Richmond, WI Dear Applicant: A septic inspection of the above referenced property was conducted on January 4, 2004. This property is located in the NE 1/4 of SW '/4 of Section 25, T30N, RI 8W, Lot 39 of Richmond Hills subdivision. At the time of the installation inspection, this Private On -site Wastewater Treatment System ( POWTS) was found to be code compliant for a three (3) bedroom home. The inspection report and related documentation of this POWTS is on file at the Zoning Department. If you have any question regarding this system, please contact our office at 715.386.4680. Sincerely, a Zoning Specialist Cc: file Safety and Bwl mp Division camnty xxvR f���� Lott, 201 w. wasbington Ave., P.O. F3wc 7162 , wt 53707 - 7162 samimry Perasit Number (m be filled in by Department of Commerce ( 266 -3151 3 0) 3 Sanitary Permit Application 1 st>~e Phu LD. Number In accord with Comm 83.21. wis. Admt. Cade. pu3cmd information you >wMe Ll�l may be used for sectworLry Purposes Privacy Law. s15.04(l Projea Address (if d4firent than mailing address) L Appficaflon hdim madam — Pieave Print AN Infmvnetion _ /339' /I/ Property - Owmes Na we U 17-1 Pared 0 Bloch r/ � r Property Owner's M art Address jUIN ` 1 20 3 A hr .N� �t,'sermn ls' Sty, sine z 1�1 r cR T 3 a N; Rlf'_ EL Type of B61ding (check all that apply) 91 or 2 Family Dwd ft - Number of Bedrooms 3 sniffivisim Name CSM Number D Public/Conumercial - Describe use .. _- D Stale Owned - Describe Use a ! O 91 Ocky Dvdlase QI of m. Type of Pest (CFU a dy one bon on Now A. Complete Fine B if appBeable) A. g System 0 Reghcememt System 0 TMMWW ld ttg Tent Replac w t oily 0 Odter Modification to &umg System B. ❑ Permit Renewal D Permit Revision ❑ Cbamge Of D Peru Transfer so New i ivc P,evioms Permit Number and Dane Isssed Before Eapindon Pb®ber owner IV. Type of POWTS - (Check M that ) Of4on -Pressttrmed 1wGround 0 Mound > 24 in. of saiable sal ❑ Mound < 24 ®. of unable sal 0 Ac -Grade ❑ Siggle Pass Sand Pier ❑ Com ma*d wetland D Presnemed m4rosmd ❑ Hoi ft Tat* 0 Peat Ftaer 0 Aerobic Tweatmmt unit 0 Rig said Fdta 0 Recimdaft Symbolic Media I1er I.eaxd lumber ❑ Lane D Gravel-lea P;Pe D V. Dispersalffrewbuent Area 'm: / How WM > sad Arm Re (so I Ele 9y o' r �7 - 701' �Y VI. Tank Info Capacity in Total Number ManwhCuffer Prefab Site Sled ter p>a Gallons Gallons of units . )O Cou _ mle Comm coed Glans New rC/ i Tads Tads �( nwou� YMMUeat Usk Dadft Chamber !�/ 1 VII. RewonSi6llity sbden mt - I, thevmders*wk asstme for hashalMsn of the POWs Amm ea the attached plans. Plumber's Na me (Pr®t) 's Si I Number Bnviaess Phone Number Fogerty Plumbing - �.2 0 — EB �z� staoG 24 ) Spooner, WI 54801 VIII. � Approved D Sunday Pamir fbe Oncludes Grovndwmer Date S• Stamps) �7 0 Owmer Given Ream for Denial SurehuW Fee) "ir 22 S . `5 DL Cone of Apprev OReupm f / r Disapprwd I d 19 la, � "" reed s�+ds B Z qB �, � X*O( sys,��r.. .��, z ,ct- • �s�'c��wc.Q.Q � �a Graz -r! a s � P�}�!�'c� � �'�f�%� � � - ��� ►�/ � �� y � ANN& ,>bw gd Lv� Cowiw -tai✓' �dw sys" � = i s ,o �- 3, ,F3 ' e A 5 co 1 4 ►�• . _ it a. I t O rjQ CD 0 CA CD CD �- a • .__ C) O tq QQ CD CL CD co CA s. •• b � O C a c� IX o W �,' O O N CD `�� N O O ►Z j ` II �"h � ��•�++ r © Oo OD m cr c � N o .. ►� CD fin4 p co (D cr A .. (D C) R w w� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430134 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide maybe used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holders Name: City Village X Township Parcel Tax No: Oeverin , Ken Richmond Townshi 026 - 1127 -39 -000 CST BM Elbv: Insp. BM Elev: BM Description: Section/Town/Range/Map No: tro - If CV •0 CS1 11bW* if 25.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 14 1 Dosing Alt. BM Aeration Bldg. Sewer S•�� Q � ' � r Holding St/Ht Inlet �y qt S. 13 ! f0 • - 4Z. f TANK SETBACK INFORMATION St/Ht Outlet + � `j!�•SZ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > O f` © ! Dt Bottom Dosing 1 Header /Man. `ll0 Aeration Dist. Pipe Holding Bot. System .o Z• • 1 x•90 9`f � PUMP /SIPHON INFORMATION Final Grade Manufact rer St Cover 1 GPM 2• 100 Model Numb TDH Lift ion L System Head TDH Ft Forcemain r Dia. SOIL B RPTION SYSTEM 20 RENCH idth a gth 1 j No.0f Zranches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI f + (OZ.S� Z) ( b ob. SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufa cturer. � UNIT M INFORMATION Type Of System: I 1 CHAMBER OR odel N '-'K umber: ' Z t DISTRIBUTION SYSTEM Header /Manifold tF Distribution x Hole Size x Hole Spacing Vent to Air Intake ]� t Length l`�` ' Dia Length Dia Spa 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 R No 0 Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: zil%I Inspection #2: c Location: 1339 144th St New Richmond, WI 54017 (NE 1/4 SW 1/4 25 T30N R18W) Richmond Hills Lot 39 Parcel No: 25.30.18. 1.) Alt BM Description = 2.) Bldg sewer length = - amo nt of cover = w ., 1 Plan revision Required? ❑ s EM] No Li Use other side for additional info ation. SBO -6710 (R.3/97) t _n_ Insepctooess Signature art. No. Jan 06 04 03:35p FOGERTY PLUMBING 17156355286 p.1 i FOGERTY PLUMBING & PERK TEST 28288 McKenzie Rd. Spooner, WI 54801 RECEIVED (715) 635 -9609 (715) 749.3656 Fax (715) 635 -5286 jAN 0 b 2004 ST. CROIX COUNTY /d ' ,fc�.orxv — sT. c�s�� �prs„�� ZONING OFFICE I ,� u9rLlF� 2NN�s7/f �Alr+DrsowJ �� /"� j" z- �avc�ivrJ • i 5/g j „ FZ � / S GLeS`�fT c E1L iriM /� .2A " li T A`j SL ox -L-C h6C" f��1>� 7"/1�j' rr&fif7T a v?r- ZT wR l cT svoc - f By fdto vD cA�ilysa3 A , firi A edm.CDS �L hr /die! / i¢jp!?' / c/fA� c."ars s rI�GL.�O /✓ � irlF T '' � .tir r yrisrs mac. cw 1[ 0*#C tF ' � W K AaAof- A441 /srer.�' lorrccicwJS _ . fish Fogerty Plumbing #221180 ,,, AA r 28288 McKenzie Rd. 14 Spooner, WI 54801 (715) 96 3a Y /1AI%IW { a I i000 K Q / X ' s-3 I - Fdy tt/D !eT Lo A*rx 4*L. s.T �.v' s� s yrs�++•� I Z ` v p, COPY , ■ 0) o , R R ■ ° 0 . � T��i� g @ ; — z j # o ;a % 2 , t 2 a o 2 � w - . { 7 / E i 2 § E § @ 2 \ 2 § @ 7 o t rr to f E = z > k / E £ >® j \ ° 8 / ® CL % \ { 0 § % n r ■ % �- ■ � f o 0 0- / 2 m 0 \ / o ƒ E e o E ■E2® CL ' A I � Z a { .. E k z . k g R ( g z k\ $ ƒ�tZ/ k \§ ° � m a ;u ^ @ %k \£ j& 0M �E = ; ; § o — I ■ � a � f a� B k�■ 0 / % / k / E f77 �2 2 A w U C I ® 2 \Kk 0A �§ kS 7 �2 $ f k §nk CD � ��; e . � CL V) g§ > W � %E § E NJ �) a � ■ o � 0 % f ? % . � Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 • (715) 635 -9 x x s y -1 /JAS! \ 1 a,r 2 = ,frr AW, T� .s `� ✓c �N X Qa X ,B ^3 I r - �yyr� SOT torr�R• © / Poo rw. s7. w /it Vmv fZ4*rI. Q =- w�tG, se' ficor. Aw Ile - 2 � ' Awr.RJ. 9y dw? Ot4� U (,Ls 0 .7 vx. saw. a,� �P #V f I I I, Vlrsconsin Department of Comrnerce SOIL EVALUATION REPORT Page 1 —of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must St. Croix 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. endiri Please print all informatlixii eviewed y Date Personal information you provide may be used for seconda7 p`�I�tss Y� rvacy taw, s. 1 S'.04 (1) Property Owner r , Y ✓ 1 EProp Lpca tbn R J C Develop Inc. g -- Lot E 1/4 SW1 /4 S 2 T N R or) W Property Owner's Mailing Address •Black # Subd. Name or CSM# 1868 Cty. Rd. C � � i ' a Richmond Hills City State Zip Code P onsNumber sT ;; �; ity` ; ❑ Village ® Town Nearest Road New Richmon WI 5401 ( �' •',v El New Construction Use: ❑ Residential /Number o )?dryd�Tns- 4 _4� � `Ogde derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - De�nha_:, Parent material Tl a c i a 1 d rj f F Flood Plain elevation if applicable n a ft. General comments and recommendations: trenches spaced to code 3.50' below g4rade F-1 I Boring # 11 Boring - 0 v , ® Pit Ground surface elev. 99 ft. Depth to limiting factor +96 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 -15 10 r 3/3 none L 2 2 15,24 10 r if 3 24 -80 7.5 r 4/6 none P. 1.2 4 8- 6 5 r 4/6 none na a Boring # tn. Boring D: : Pit Ground surface elev. 9 9 . 10 ft. Depth to limiting factor + 9 6 in. Soil Applicationjate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 1 0 -10 10 r 3/3 none L 2msbk 2 10 10 r 4/4 .0 .2 3 2 .5 r 4/4 non ' ' 4 783-96 .5 r 4/6 non 1• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L uent #2 = BOD < 0 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature . CST Number Gar L. Steel 02298 Address Date EvdluaUon Corlducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 1 - =1 9-2000 715- 246 -6200 • Property Owar J C Development, Inc. Parcel ID# lien in{j Page 2 of 3 ] F Boring # r ❑ Boring LJ Pit Ground surface elev. 09.40 ft Depth to limiting factor + 9 0 i 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 1 0 -13 10 r 3/3 none L DSH CS if .5 .8 2 8 10 p4l 2msbk mfr UK if Ft 3 28 -80 7.5 r 4/4 n mvfr 4 80 -90 7.5 r 4 sl 2msbk mvf qs 3 Boring # F Boring 4 Q Pit Ground surface elev. 9 9 . 1 0 ft. Depth to limiting factor + 9 9 1 On. Soil Ap lication 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 I 'Eff#2 1 0 -13 none L 2msbk mfr Mg if 2 13- 3 10 r 5/4 none sil M na 9w if .0 .2 3 -4 7. _ 7. .7 1.2 LAV a I Serer Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soit 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 Effluent #1 = BOD, > 30 < 220 mg/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 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 (R.6 /00) • STEEL'S SOIL SERVICE Gary L. Steel RJC Development, INc . 1554 200th Ave. CSTM2298 NE S25- T30N -R18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #39- Richmond Hills N 1 BM, = top of 1" pvc pipe @ el. 100.00' �1 Alt. BM.= top of 1" pvc pipe @ el.99.25' loo 5g � o► Gary L. STeel 10 -19 -2000 I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /$tyer 'F ,n,�7/�';�� Mailing Address p fi�:r <�a�r( /�t�r/t3' ��,,�_ j , /sue _C:l4 Property Address 13.3 7 � sT - A Z?/ /N (Verification required from Planning Department for new construction) City/State Parcel Identification Number Ate 2 7 � LEGAL DESCRIPTION Property Location mE '/,, Sec. z.' , T Yo N -R /L W, Town of Subdivision �4 6*209d) Lot # . Certified Survey Map # . Volume , Page # Warranty Deed # Zr 3 Volume _i r0 7 Page # /� Spec house O yes C/no Lot lines identifiable 1�J yes O no SYSTEM MAI 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, 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards .set forth, herein, asset by the Department of Commerce and the Department of Natural Resourcet, 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. vPA PV "; " #; ^ �.•_ SIGNATURE OF APPLICANT �! j,( /L�i� t DATE OWNER CERTIFICATION �Zv� 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. l / SIGNATURE OF APPLICANT DATE * «•••• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depa * "" " 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 .r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 'ME WFORMI4T(ON _ SYSlHYI SP 7 own er /� Septic Tank Capacity ®0 ga l p NA Permit # Septic Tank Manufacturer ls' p NA DESI(,'N PAfU1METERS Effluent Filter Manufactur r Z p N A Number of Bedrooms 3 p NA Effluent Fka Model - 00 p NA Number of Public Facility Units )CNA Pump Tank Capacity NIA Estimated flow (average) galiday Pump Tank Manufacturer Q NA Design flow (peak). (Estimated x 1.5) Pump Manufacturer 0 NA Soil Application Rate _ g aWayW Pump Model b NA Standard Influent/Effluent Quaky Monthly average` Pretreatment Unit CI NA Fats. Oil A Grease (FOG) 530 mg/L p Sand/Gravel Filter p Peat Filter Biochemical Oxygen Demand (BODj a20 mg/L ❑ NA 0 Mechanical Aeration p Wetland Total Suspended Solids (TSS) 5150 mgA- r) qkt-Ground fection p Other. Pretreated Effluent Quality Monthly average al Cell(s) p NA Biochemical Oxygen Demand (BOD 530 mg/L (gra'vity) p In- Ground (pressurized) Total Suspended Solids (TSS} 530 mg/L p NA rade p Maud Fecal Coliform (gam mom) 5l0` cfuu/1 O(kmI p Drip - Line p Other: Maximum Effluent Particle Size Ys in dia. p NA Other: p NA Other: p NA Other: p NA `Values typical for domestic wastewater wastewater and septic tank effluent. Other. p NA MAINTENANCE SCHEDULE Service Event Service Fnmpnncy Inspect condition of tank(s) At least once every: FEVes !(s (Mmdammrn 3 ) p NA Pump out contents of tank(s) When combined sl and scum equals ore -third %) of tank volume p NA Inspect dispersal cell(s) At least once every: p month(s) (Ma idinum 3 years) p NA Yeer[s1 Clean effluent filter At least once every: p months) O NA I 2 years) 0 month Inspect pump, pp controls & alarm At least once every: p V�(s) s) CIA pump Flush laterals and pressure test At least once every: p months) Q NA p year(s) Other p month(s) a NA At least once every: p y ear(s) ELNA MAINTENANCE WSTRUCTIONS 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 massing or broken hardware. identify any cracks or leaks, measure the volume of combined skidge and scum and to check for any back up or ponds ng 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 pond'xng of effluent on the ground surface may indicate a f con dition 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 512 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. FROM :OEVERING HOMES LLC FAX NO. :7155311282 Jun. 20 2003 12:21PM P1 Jun 20 03 I79_- 4Aa ' VOCEPTV PLUMOINO 171593ci ,eea P.2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /%M Mailing Address ...le w.JCr nt► /.tom � � � i.e. �� /G_ AV Property Address 2 y 21 sr. (Verification required from Planning Department for new construction), City /State Parcel Identification Number dI�QLj!T Property Location ,Q/_ '/., _ '/., Sec_ z.i' . T 76 N - /.r W. Town of " - Subdivision -,sue /�1`L��' . Lot #. Certified Survey Msp # ~"" _ _ , Volume , page # Warranty Deed # g6 zxz 3 � Volume /xo 7 � _ page Spec house D yes Vno Lot lines identifiable tD y s O no SYSTEM AWNTEN _ CE ` 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 prunper. What you put into WON= can affect the function of the septic tank as a treammat state in the waste disposal system. The property owner agrees to submit to St. Croix Zoning DepartmtOt 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 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private towage disposal system with the standards -set fortk herein. as set by the pcparamot of Commerce mad the Department of Natural Reaeureel, State of W iaeomsin, Certification stating Wet your septic stemf has been maintained most be completed and manned to the St. Croix County Zoning Office within 30 day so tMee ♦ / /% 0 3 SIGNATURE OF APPLICANT DATE OWNER CTMF,jCA�T ON 1(we) certif all statements on this farm are tme to the boat of my (our) knowledge. I (we) am (are) flee owners) of t de7sc ' d a ve, by virtue of a wan*ty deed recorded in Register of Deeds Office. 4 he /P/ O SIONATURB OF APPLICANT DATE •••se• Any information that is min- represented m ay result in the sanitary permit being revoked by the Zoning Dep Arm; ent, eefe•s •• Include with this application: a stamped wstranty deed from like Register of Deeds office - a copy of the certified surmy rasp if reference is mode is the warranty decd �„_ J 2239x' 087 ? tf 2 1 1 7'8 . STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. W ALSH 1 Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between RJC Development, Inc., a Wisconsin RECEIVED FOR RECORD Corporation, 05/13/2003 09:00AN WARRANTY DEED Grantor, and _Km er 0.Y 1 EXEMPT # REC FEE: 11.00 TRANS FEE: 99.90 COPY FEE: CC FEE: Grantee. PAGES: I Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area L Q9, Richmond Hills in the Town of Richmond, St. Croix County, Name and Return Address Wisconstn. 1 55p Frvir-L M k) ss S 026- 1127 -39 -000 _ Parcel Identification Number (PIN) This is not homestead property. 04) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of April 2003 RJC Development, Inc. « « B Roberta J. Carlson, Vice President AUTHENTICATION ACKNOWLEDGMENT Signature(s) RJC Development, Inc., it Wisconsin Corporation, STATE OF WISCONSIN ) by Roberta J. Carlson, Vice President ) ss. County ) authenticated this: f June 2003 Personally came before me this day of the above named « Kristina Ogland — -- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT Wg DR %TED BY « Attorney Kristine Ogland 3 (Q�B 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. Information Professionals company, Fond du Lac, Mn WARRANTY DEED STATE BAR OF WISCONSIN 800-655-?()21 FORM No. 2 - 1999 INO.Y JL JJ n 6�. 507.23' ric I I ' �- • 17 i 1 �� � P f ' 1s • j LOT 37 g � TOTAL AREA: r . 0 3.3 I �f.°� 96,183 SO. FT. OD N ^ 2.21 ACRES f2 • N89'52'55 "W 538.62' 15 g ' r � N LOT 38 - - - • 33' TOTAL AREA: LO 97,727 SO. FT. BENCHMARK: - 2 24 ACRES ELEVATION - 1018.00 I M I • I I N89'52'55 "W n I 1r7�0,� I 1 ' 540.01 I I N ° LOT 39 1 I o I ' I � o TOTAL o 06 97,742 SO. FT. 2.24 ACRES I ►`� I N89'52'55 "W i J O I 540.01' O 0 I p i Lrj I� if) 04 Z I O Q 3 ' LOT 40 o N Z 0 I 00 TOTAL AREA: ° I I i 97,742 SO. FT. 00 W I 0 i 2.24 ACRES LO I I Z I j7 I I - - - N89'52'55 "W O 540.01 O o I I OI ( I I N I 66' LOT 41 - 33' 133' o I o ...................... OTAL. 4R � i4: ... ............................... v l *. JR.? SO. FT. Cam I 2.44 ACRES I i W I m ' - - - - - -- - - - -- M I • N89'52'55'W 540.01' M c F- -- TOWN ROAD • M N89'5255 "W 540.01' L • (n �- -99.24 --- - - - - =- -- - - - - - -- - - - -- �. W Q ---- - - - - -- - - - - - -- . 0 i ! H.W.E. ,'olo.0 \ _ I LOT 42 I Ti