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HomeMy WebLinkAbout030-2139-07-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Bid Iding Division INSPECTION REPORT Sanitary Permit No: 463311 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: Miller, Sam I St. Joseph, Town of CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: / 04.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic y Benchmark LX e5e,f 2: I2-50 (�,3$ 16 3� /ad l3esing Alt. BM 6.35 16(, 63 Aeration Bldg. Sewer c , 15 9-7. 2-3 Holding St/Ht Inlet '' rr TANK SETBACK INFORMATION St /Ht Outlet 14 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet S t, J A, Septic 3 c o ' ! J n " ' 1 Dt Bottom t'f � Dosing Header /Man. /� • 3s 9� a3 Aeration Dist. Pipe - to •�5 9S. y3 Holding _ - Bot. System 11 Yz/, 93 6 PUMP /SIPHON INFORMATION Final Grade T-b Manufacturer Demand St Cover fO / CJg ' GP Model Numbe TDH Lift Friction Loss System H j TDH Ft - Forcemain Leng Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMRJ ISIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 7 1 4 Z, 1 Z \ \ \�,_ SETBACK SYSTEM TO P l L BLDG WELL LAKE /STREAM LEACHING Manufacturer:p INFORMATION CHAMBER OR rJ� v eY• h./ Type Of System: UNIT �5 5)' A'Q Model Number: . /n DISTRIBUTION SYSTEM /s c'.wc� 3 0 % dak Header /Manifold Distribution x Hole Size x Hole Spacing Vert to Air I ake 1 p ipes) Length Ct Dia 4 Length \1 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 4 1 1 Bed/Trench Edges \ Topsoil \ Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / ! Location: 1178 56th Street Houlton, WI 5408 (SW 1/4 NE 1/4 4 T29N R19W) Park Hollow Lot 7 Parcel No: 04.29.19. 1.) Alt BM Description = l a Kw` � IArm. C�,, �� 3 t _t, o% 2.) Bldg sewer length = 33 1�5 n J. - amount of cover Plan revision Required? Yes Use other side for additional information. — Date Inse tor's nature Cart. No. SBD -6710 (R.3/97) ' Safety d gs Division . County �+ � - - -- W/4 as} itg o P.O. Box 7162 J /v N) Pisconsin n, Sanitary Permit Number (to be filled ili by C De artment of Commerce zbo fill 3 311 Sanitary Permit App 'eaCion State PIanI.D.Number In accord with Comm 83.21, Wis. Aden Cocle,•pers informatforf�ou pr JidE l,I may be used for secondary purposes Privacy w, s15,04(!xm) Project Address (if different than mailing add: _si 1. Application lnformadon - Please Print All OF) t(�I ^� P- operty Owner's Name M Parcel q /� Ss/ �1�1 �f /�_ Od von Property Owner's Mailing Address Property Location 2a v" Section City, State Zip Code Phone Number 11. Type of Building (check all that apply) T N; R 7 E w Subdivision Name CSM \u -mo.i ❑ I or 2 Family Dwelling - Number of Bedrooms �Q'r PubUcJCotrwwcial - Describe-Use I . / 1p cO ❑ to Owned - Describe Use z^ y C OCity_OVillage�ToNvmship of Od�Q e • _ 111, Type of Permit: (Check only one boy on Ilne A. Complete e B if ppllcable) I A. ` New System ❑ Replacement System ❑ Treatmemt/Holding Tank Replacement Only O Other Modification to Existing System b ❑ Pet Renewal ❑ Permit Revision ❑ Change of C3 Permit Transfer to New List Previous Permit Number and Dace Permit is iucd Before Expiration Plumber Owner I IV. Type of POWL'S System: (Check all that apply) _ C Non - Pressurized In- Ground O Mound > 24 is of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade 0 Single Pass Sand Filter LJ Coastnrcted Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Rtewculating Synthetic Media Filter L Caching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaL/7reatment Area information: L esign Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) ispersal Area Proposed (sf) Sys= Elevation 60 © (Poo 19 76 `�33 `�Saoo - -- S'1. Tank Lnfo Capacity in Total Number Manufacturer Prefab Site Steel Fibe. Gallons Gallons of Units Concrete Constructed Glasi New I Existing Tanta Tarns _ Spiic of Holamt; Tank O +`.' . 5 Cn Trcumcot Unit W Z A80 -- A -to Q T rs `i 11. Responsibility Statement - 4 the undersigned, assume responslbW for installation of the POWrS shown on the attached plans. _ Plumber's Name (Print) Plumber's Signet MP/MPRS Number Business Pboae Num ba 3 � z �S `S-- / 9 Z. 7 Plumber's Address (Street, City, State, Zip Code)) �--�/ L FILL County/ artment Use Only_ (Approved =;ed Sanitary Permit Fee (includes Groundwater Date Issuq� lss Agent Signature vu S amps; Surcharge Fee) Real or Denial io 2zoS 1X.. Condidons o Approv SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach compete pleas (to the County only) for the system on paper not less than 81/2 s I I Inches in site SBD -6398 (R. 01/03) v M N u� �I o i o 09 -0 qj 4c- cvj Ai d Q d �i UA Ci O �ti Q \ r M� M \ lC N � LL —< W a in M��o � o �cvj O + VA po La Cs c 4�11 RECEiVE� 1753 Wisconsin Department of Com IL VALUATION REPORT Page 1 of 3 JAN 1 6 20(10 0 Division of Safely and Buildings in accordance with Go nm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations ST. CROIX COUN - i Y County Attach com ete site plan on not ' rt�he3 in si .Plan must Pi IX include, but not limited to: ve direction and St. Cro percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Pending from 030- 1014 -50-000 Please print all information. J�A iewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.14 (1) (m)).� Zz Property Owner Property Location Sam Miller Govt. Lot SW 1/4 NE 1/4 S 4 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# P.O. Box 151 7 Park Hollow City State Zip Code Phone Number City Village ✓ Town Nearest Road Hudson WI 1 54016 1 (715) 386 -2769 St.Joseph I River Road ✓ New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elev. 95.00' using 28 leaching chambers. a Boring # Boring r ' °O 2,M4._ ✓ Pit Ground Surface elev. 98.54 ft. Depth to limiting factor >108 in. Sal Application to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 10yr3/2 none sil 2fcr c'� ' ds as 2fmc 0.5 0.8 (� 2 6 -14 10yr4/3 none sil 2fsbk ds cs 2fm,1 c 0.5 0.8 3 14 -22 10yr5/4 none sit 2msbk dsh cw 1fm 0.5 0.8 t 4 22 -34 7.5yr4/6 none Is 0 s dl cw 1vf 0.7 1.2 ah 0 5 34-48 10yr4/6 none s & gr 0 sg dl 9w - 0.7 1.2 "Cb 6 48 -108 1 r5/6 none strat. s 0 sg dl - - 0.7 1.2 , Al ' Boring # Boring ✓ Pit Ground Surface elev. 100.26 ft. Depth to limiting factor >116 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 *01#2 1 0 -10 10yr3/2 none sil 2fcr ds as 2fmc 0.5 0.8 („ 2 10 10yr413 none sil 2fsbk ds cs 2fm,1c 0.5 0.8 b 3 28-44 10yr5/4 none sil 2msbk dsh cw 1fm 0.5 0.8 �crl. 4 44 -51 7.5yr4/6 none Is 0 sg dl cw 1vf 0.7 1.2 5 51 -77 10yr4/6 none s & gr 0 sg dl gw - 0.7 1.2 } 6 77 -116 10yr516 none strat. s 0 sg dl - - 0.7 1.2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD <30 mg/L and TSS <30 mg/L CST Name (Please Print) 5ignatur : CST Number James K. Thompson 0 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 11/132003 715 - 248 -7767 L Property Owner Sam Miller Parcel ID # Pending from 030 - 1014 -50 -000 Page 2 of 3 F31 Boring # Boring ✓ Pit Ground Surface elev. 102.19 ft. Depth to limiting factor > 125" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-6 10yr3/2 none I 2fcr mvfr as 2fm 0.5 0.8 2 6 -23 10yr4 /4 none gr sl 2msbk ds Cs 2fm 0.5 0.9 3 23 -30 7.5yr4/6 none gr Is 0 sg dl Cw if 0.7 1.2 -� 4 30-58 10yr4/6 none gr s 0 sg dl Cw 1vf,f 0.7 1.2 5 58 -125 10yr5/6 none s 0 sg dl - - 0.7 1.2 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ' Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 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. I�� SOr�2(/4fC�a�'on • /o ca.fe. d / oro�o. 5�u�t'c ' /ot 7, Wci r jyS 3 6 . K i o2.o'r,,,, ntvu.r � a3 roi.o• Rewe W,,ok a'sp¢rsa/ ee // 99,0' 62, 0 d Top of At A 7f. (3tnr ,-K: To e cgr V rebQs eaSe,,,anf - /otS �5'A td e It rf = /O 0 0 .z5 ' /off. s- r � BioDiffus Sp �� �� �. ra. ri t•ra try .�..�. r• ta• �.. �.� ri �.. r= tZD .�.� ■.t.. t!• �• .� .�.� ��. ..� rare �� chvtw En Ww Universal End Cap Chamber 11" Stan• 14" High Capac Ava SizeS Dimensions dard Capacity t r t t• a.• -4 � t l ��, ' , �.��. < t - ,.< 7 • 1 >F v�i,�l� *)� 1 ' ` `." 1 < ' t F��=, rt � �r 1+��' � y 'f'. i 'Mh��.,:�Gf ; �iM'dWls �_.��:� �tleHiJ4� * � 4!'ji+d� �..�� 1. �.J • .4 ,er fi � 1 1E.: �,� ; �1V•l' �' tl., .� ��.y:_�F.' ..e "1 *�.� +.1`:IY � f [e,;.i. lW�f�G:�t:ti.�. Q1"�G 11g PAO '' 1/ PO OZNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner /Z L�/Z_ Septic Tank Capacity Z S Se ti � al ❑ NA Permit tJ 46 3311 Septic Tank Manufacturer O- s ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer A $ L ❑ NA Number of Bedrooms 4L ❑ NA Effluent Filter Model A _ J a O ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) d g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) C5 O g al/day Pump Manufacturer ❑ NA Soil Application Rate D. — 7 gal/day/ft, Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L AIn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510" cfu /100ml ❑ 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 SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: O months) (Maximum 3 years) ❑ NA JKy ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: [3 months) (Maximum 3 years) ❑ NA .� 18 year(s) Clean effluent filter At least once every: / , Z ❑ month(s) ❑ NA jW ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: O 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 dispo&ed 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 rovided to the.local regulatory authority within 10 days of completion of an service event. P 9 rY tY Y P Y i ` S UP AND OPERATION Page o f ?/ ,new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals hat may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) 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, slope of an pact, the area P mound ea within 1 5 feet down Y and 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 replace ent system: replace suitable replacement area has been evaluated and may be utilized for the location of a system. The replacement area should be protected from disturbance and compaction and should I not be infringed 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. O A suitable replacement area is not available due to setback and /or soil limitations. Barrin a v / technology a holding tank may be installed as a last resort to replace the failed POWTS. g dances in POWTS T alua b re wit FRD8 Tf� O X0,2 N� CNS712 c/ C71� W1 dank e ate CaN O 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 TREATMENTJANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER �� Name POWTS MAINTAINER � ��� C�K.o 1 G.C._ {��boN6 L Name Phone �z . O t0 �� I ! 2 Phone /2- L SEPTAGE SERVICING OPERATOR (PUMPER) LOC EQULATORY AUTHORITY Name Name Phone Phone — 7 / This document was drafted in compliance with Chapter Comm 83 .22(2)(b)(1)(d)&M and 83.64(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S /n // L 4� Mailing Address 4 " 71-' c Property Address - 7 5 ^ �- ��` 5 7 C E- Z! (Verification required from Planning Department for new construction) r , City/State Gv Parcel Identification Number TCAlk LEGAL DESCRIPTION Property Location S W ''VA,/ - %,, Sec. � T -MN -RZ W own of Ss t : Te3 5 a- --p , � Subdivision Pa-rk- H O LL O W , Lot # 7 Certified Survey Map # 7(P 3 S / , Volume , Page # 6 Warranty Deed # �7 / 0 2 — 'V5 , Volume z _, Page # 00 Spec house 0 yes ❑ no Lot lines identifiable Xyes ❑ no SYS'T'EM MAINTENANCE 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, as set by the Department of Commerce and the Department of Natural Resources, 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 year a Hon date. NA P APPLIC DATE OWNER CERTIFICATION 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 rope described ve, by virtue of a warranty deed recorded in Register of Deeds Office. o ;� /oSOS SIGNA APPLIC DATE • • • • • • Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ' •' •• 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 J 2 2 14 P 0 0 3 - 7 1 8249 jl KATHLEEN N. MALSH STATE BAR OF WISCONSIN FORM I • 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., MI Document Number RECEIVED FOR RECORD This Deed, made between James E. Ebbe, an adult single man and 04/21/2003 03:00Plf Thomas A. Ebbe, as custodian of Theodore A. Ebbe, a minor, under t he Wisconsin Uniform Transfers to Minors Act WARRANTY DEED EXEMPT I Grantor, and Sam E. Miller FEEi 1.0 TRANS FEE: 1 COPY FEEL CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): R ecording r a Name and Return Address Sam E. Miller P. O. Box 151 Hudson, W154016 The SW 1/4 of the NE 1/4 of Section 4, Township 29 North, Range 19 West, St. 030 - 1014 - 50.000 Croix County, Wisconsin Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except continuing easements and restrictions of record, if any. Dated this 17th day of April 2003 �*/ &L a ames E. Ebbe • Thomas A. Ebbe custodain for Theodore A. Ebbe ty(, ACKNOWLEDGMENT AUTHENTICATIQ$!•' '� PU I signature(s) = 4C ' lff�,• St Cro ix WISCONSIN j ss. i County. ) EBC f rf Personally came before me this 17th day of authenticated this day of P April, 2003 the above named 7 James E. Ebbe and Thomas A. Ebbe '�ll�lgr_ ,.cO�sT TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me k own to be the persons to executed the foregoing ins It nd ac o ge t authorized by § 706.06, Wis. Stals.) THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich, Attorney at Law 502 Second Street, Hudson, WI 54016 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is ermanent. (If not, state expiration date: necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DUD -STATE BAR Or WISCONSIN FORM N. 1 • 1 99a INFORMATION PROFESSIONALS COMPANY FOND DU LAC. 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