HomeMy WebLinkAbout026-1127-46-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
463036 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:
Marek, Todd I Richmond Township 026- 1127 -46 -000
CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown /Range /Map No:
�b 6b U i Li 25.30.18.856
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Z (a 0 3. � 3, L
Dosing Alt. BM
1 1 vn 9
Aeration Q f / Bldg. Sewer
�..{ YD F . 3 jS. o
lnlet 14 q S ,
TANK SETBACK INFORMATION S Ht outlet
TANK TO P/ WELL 5BLDG1 Vent to Air Intake ROAD Dt Inlet
Septic � Dt Bottom -_
Dosing Heade /Man. S-r /j. v 9 Z•
Aeration Dist. Pipe
Holding Bot. System
Final Grad
PUMP /SIPHON INFORMATION Grad 3 2
Manufacturer Demand St Cover
GPM - 2 11
Model Number
TDH Lift Friction Loss m Head DH Ft
Forcemain Len D Dist. to well U
SOIL ABSORPTION SYSTEM /
BEDITRENCH Width r Len h No. Of Trenches' PIT DIME NSI No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 v
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING actur
INFORMATION CHAMBER O 7
Ty Of System: / U
Model Number.
DISTRIBUTION SYSTEM
r Lengt n ifold Distribution y le Size x HoleHole S t to Air Inta Pipe(s) 11 a l p � 1S 7 ./ h 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 (F Bed/Trench Edges Topsoil
Yes No n Yes L No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:�/ D Inspection #2:
Location: 1309 144th Street New Richmond, WI 54017 (SE 1/4 SW 1/4 25 T30N R1 8W) Richmond Hills Lot 46 Parcel No: 25.30.18.856
1.) Alt BM Description= S ?* �✓Gf" �A D (� / (GV�? /Y�
2.) Bldg sewer length
- amount of cover
Plan revision Required? _ _ Yes ,;No r�—
r ! � &
/ --
Use other side for additional information.
/ JQ — ��►-
SBD -6710 (R.3197) Date lns ins ture Cert. No.
I
Safety and Buildings Division County G ,
201 W. Washington Ave., P.O. Box 7162 / lx
' ��C����� Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
(608) 266 -3151 4/( 0 3(0
Department of Commerce
State Plan I.D. Number
Sanitary Permit Application
In accord with Comm 83,21, Wis. Adm. Code, personal information you pro ' Project Address (if different than mailing address)
may be used for secondary purposes Privacy Law, s15.04(1)(m) J
I. Application Information — Please Print All I or M
C�D
Property Owner's Na me S P Parcel # Lot k 6 I
Opp 0 9 C00 Vz6 - 1/Z - 2
Property Owner's M ailing Address ST. C40/ Property Location
XCOUNT� G � S
t7 ®� ZONING OFF /C^ 1/ , � /<,Section
City, State Zip Code
l � v" kw� uo b v` 0 017, 7/l �7 �® T �N; R / O (c E ircle one)
0
h 1 w-�
11. Type of Building (clieck all that apply) S 'a' er
Subdivision Name
or. 2 Family Dwelling - Number of Bedrooms S
❑ Public /Commercial - Describe Use ��eff�d N/4 IL G,)
El State Owned - Describe Use _ ❑City_ ❑Village )township of /2lGfF�^
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ly New System ❑ Replacement System p y • ❑ Treatment /Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑Permit Renewal ❑Permit Revision 11 Change of ❑Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that a 1 )
9 Non - 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- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter Leachin a b V ❑ ri ine Gravel -less Pipgr ❑ Oder (e plai
V. Dispersal/Treatment Area Informatio G
Desi n Flow (gpd) Design Soil Application R e(gpdsf) Dispersal Area Required (sf) Dispers 1 Area Proposed (st) System Elevtiot 9
� T.S 6twck
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site STC l Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plum er's Na me (Print) Plumber's Si gnature MP /M'M Number Business Phone Number
D 6 01t 2 to 5/1 - 2 K1
Plumber's Addre ss (Street, City, State, Zip C e)
0 l�
VIII. County Department Use Onl
Approved ❑ Di pprov Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent Signature (No Stamps)
Surcharge Fee) l Io 2M !
El Owner Given Reason for Denial
IX. Conditions o pproval
SYSTEM OWNER:
1 Septic tank, effluent filter and OlnQg S
dispersal cell must all be serviced / maintairnfd
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
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Wisconsin Deyartment of Commerce SOIL EVALUATION REPORT Page _ —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 8 1/2 x 11 inches in size. Plan must St . Cro ix
include, but not limited to: vertical and horizontal refere I q t ��Ii7t1 direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, ar)06ZttoNahci 6taince le nearest road. p endin ct
Please print all ipfic;,;1ion. a iewed by Date
Personal information you provide may be used for �econoary pur ryv aw, s. 1¢.04 t1) (m)). , 12
Property Owner ; " Proper
1/4
R J C Develop Inc. I { = l,s ovtiLQt` SE 1/a S s25 T 30 N R 18 ¢;(or)
Property Owner's Mailing Address L jcy x Lot - Block # Subd. Name or CSM#
1868 Qty Rd. Q , CouN'Y na Ri chmond Hills
Cityr State Zip Code Phone Nu_ ❑ Village Mown Nearest Road
New Richmond WI 1 54017 1 ( 1 ),•\ ~ Richmond
® New Construction Use: El Residential / Number of bedrooms -- 4 Code derived design flow rate ti GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material glacial drift Flood Plain elevation if applicable Ila ft•
General comments
and recommendations: (,,
trenches 4 below grade, spaced to code —vNk ( J-4 I
-�p s ( V;16
Boring Ou � �f S
❑ Boring #
® Pit Ground surface elev. 98 ft. Depth to limiting factor +86 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
1 -9 10r33 n m
L -19 7.5 r 4 •8
3 19 -36 7.5 r4 4 none sl 2msbk mvfr OW nA •
4 6 -86 7.5 r 4 none •7 1.2
a+
a Boring # ® Boring
Pit Ground surface elev. 98' 70 ft. Depth to limiting factor +96 in Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fY
in. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#
1 0 -10 mfr c
2 0 -23 7.5 r 4 •5
3 W na . 5 .9
4 5 -84 7.5 r 4 none .7 1.2
none s '
s�
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < AP mg/L and TSS 5 30 mg/L
CST Name (Please Print) Signature CST Number
Gary L. Steel 02298
Address valua'on Conducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 10-18-2000 715- 246 -6200
Property owner R J C Development Inc. Parcel ID # pending Page 2 of 3
F Boring # Boring
3 [ pit Ground surface elev. 94.20 ft. Depth to limiting factor + 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 10 r 3/3 2 .5 .8
2 110-28 sl 2 .9
ml 1
F4] Bodng # Boring 94.50
® pit Ground surface elev. ft. Depth to limiting factor +84 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 I, if .5
2 sl 2msbk mfr Mi if r, .9
3 4 -43 7.5 r4 my 1.2
443-84 ms os .7
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 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 (k&=)
. STEEL'S SOIL SERVICE
Gary L. Steel RJC Development, Inc. 1554 200th Ave.
CSTM2298 SE'SW4 S25 t30N - R18W New Richmond, WI 54017
MPRSW -3254 town of Richmond (715) 246 -6200
lot # 46- Richmond Hills
j. t tBM M 40'
O
f 1 pvc pipe @ el. 100.00'
-top of 1" pvc pipe @ el. 89.00' /
Sy�
�l
Gary L. Steel
10 -18 -2000
4 "I /c*ue UW
ick4
STANDARD CHAMBER
52"
Ouick4 Standard Chamber 48 "
(EFFECTIVE LENGTH)
e
12 " �� g
8 " _� =��
Z 111111 Will a 11 it
34' SIDE VIEW
SECTION VIEW
MultiPort End Cap
A
O
16"
12"
34" SIDE VIEW TOP VIEW
FRONT VIEW
H to I
INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY
(a) The structural integrity of each dumber, and plate, wedge and other accessory manufactured by Infiltrator ( 'Unitsl, when installed and operated
in a leaohfield of an onsite septic system In accordance with Infitrator's instructions, is warranted to the original purchaser ('Holder) against defective
materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided, however,
that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences.
To exercise its warranty rights, Holder must notify Infiltrator In writing at is Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) - • .
days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty.
Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. O
R
(b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT SYST� M S INC
TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
(c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does
not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, Including loss of Environmental Onsite
Wastewater Solutions'
production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Specifically
excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of
the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instruction; failure to maintain the 6 Business Park Road
• P.O. Box 768
minimum ground covers set forth In the Installation Instructions; the placement of improper materials into the system containing the Units; failure of
the Units a the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or Old Saybrook, CT 06475
any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holler fails to comply with all of the terms set forth in this Limited g60- 577 -7000 •FAX 860
- 577 -7001
Warranty.
Further, in no event shall Infiltrator be responsible for any loss or damage to the Holler, the Units, or any third party resulting from installation or ship- 800_221
ment, or from any product liability claims of Holder or any third parry. For this Limited Warranty to apply, the Units must be installed in accordance
with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's installation instructions.
(d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the origi-
nal Holler.
The above represents the Standard Umited Warranty offered by Infiltrator. A limited number of states and counties have different warranty require-
ments. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a
copy of the applicable warranty; and should carefully read that warranty prior to the purchase of Units.
U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844
Canadian Patents: 1,329,959; 2,004,564 Other patents pending.
Infiltrator, Equalizer and SideWinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc.
is a registered trademark in Mexico. Contour, Contour Swivel Connection, Microl.eaching, PolyTuff, SnapLock, ChamberSpacer, PosiLock, QuickCut, QuickPlay RECYCLED PAPER
and Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP -0
•�� Jf
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).
Tab 1: System Design Specifications
Sanitary Permit Number to
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd) c�J
Septic Tank Capacity (gal) Z
Soil Absorption Component Size (W) Q °'
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) O . q
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 filte s hall be cleaned as necessary to ensure
P roper operatio 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
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.
PI, 9 6 171s -
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION' POTIUM
Owner/Buyer d _ /qttzi
Mailing Address Y � ?, Z� /(V 6-W R(C- f, FO/ 7
Property Address _ O & — - --
(Venfleatioq required from Planning Department for new construction)
0'7 6..11z� "D�'��•�st°)
City /State Pat-cal Identification Number
LEG AL JUE&C-RI
Property Location %., 5 ,;, Soc. Z 5 " T
'Town of R(Cg„f AAWS
Subdivision _ lG6( S
Certifled Survey 1#Iap # ,Volume - - Page # --
Warranty Deed # Z 1 7 _, Volu'nc � page #
Spec house IM yes ❑ no Lot lines identifiable f$ yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintcnanco of your septic system could result in its prernature failure to hand' e wgstcs Pruper rnaiLteuan to
consists of pumping out the ae ptia tank every three years or sooner, if needed by a liccpS3d pumper. What you lint ii:;q ; :�e systurt
man affect the funatiort of the sept tack as a treabnent Stage in tl3e waste disposal system.
The property owner agrees to submit to 3t. Cmix Zoning Department a cenificativu form, signod by the owner asd by a
master plumber, journeyman plumber, restticted plumber or a licensedptimptr verifying that (1) rho vii -site wastewater dsposal systeul
is in proper Operating condition and/or (2) after inspeorioa Brad ptunpimg (if necessary). the septic rank is less then. 1!3 fall or sludge.
liwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal systen% with
set forth, herein, as set by die Depnrtinont of Commerce and the Dcpaitmort or. RGSDUrUCS, State of Wiscun in Certification
stating that your septic system 1324 been maintained must be completed and re:umbd to the St, Croix County Zo :Ling Off % :3itin 30
da s e three ar expiration date.
SIGNATU OF APPLICANT ATE
UAT'1:
OWNER CFRTj MQI TTION
I (we) certify that in stataments on this form arc true to the best of illy (our)1tn.owledge. I (we) em (uro) the m n c:r(s) of
fife ro dese ibe above, by virtue of a warranty deed iworded in Register of Deeds office,
SIGMA" 01- A'P CANT
"` Any information char is this -r resentedma rewlt in the sanity p ermit bein revc4e b the amine De panl
� y ryl' � d y i ,.. y rIee nt.
,
*• Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the conified survey amp if reference is made in the warranty decd
Td Wd2P:0T 0ti0z 80 -d aS 'ON Xdd WOdj
U 2493P 132
75 1 9a6
STATE BAR OF WISCONSIN FORM 2 - 1999
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed made between RJC DeveloMent. Iaa. A Wisconsin RECEIVED FOR RECORD
Corporation Grantor, 01/16/2004 09:36AN
and Todd Marek
' Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT #
the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00
(if more space is ne, please attach addendtmt): TRANS FEE: 465.60
Lots 10, 19, 20, 46 nd 48, Plat of Richmond Hills in the Town of COPY FEE:
CC FEE:
Richmond, St. Croix County, Wisconsin. PAGES: 1
Recording Area
Name and Return Addr s
KRISW A OGLAND
ATTORNEY AT LAW
P.O. BOX 359
HUDSON, WI 54016
026- 1127 -10- 000; 026- 1127 - 19-000
026 - 1127 -20 -000: 026 - 112746 -000: 026 - 114748-0
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this 4A- day of January . 2004
RJC Development, Inc.
_ v
* * - -By — ---........ _.------ ------ - --------- - - - --
- _.
- •-- -• - - - . ............... -.............. -- ............. . ................ .___ .................. — .. - ............ — ........... - .......... _ ................
. ............ _... _... ............
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) RJC Development, Inc., A Wisconsin Corporation STATE OF _ )
By: 1 -o f, ) ss.
County )
authenticated this A of Janua , 2 004
Personally came before me this _ day of
—_ the above named
* Kristin 0 _ - -- - - - - -- __— .�` --
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Slats.) -- instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland
Hudso WI 54016 — _ _ _ Notary Public, State of
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 Co., Fond du Lac, wl
STATE BAR OF WISCONSIN 800- 655.2021
WARRANTY DEED FORM No. 2 -1999
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TOTAL AREA:
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i 540.40 i
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98,284 SO, FT
Z 26 A4R£5 set
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