HomeMy WebLinkAbout030-2106-90-000 wwoo 0epartment of CO
Safety and Buildings Division PRIVATE SEWAGE SYSTEM County:
INSPECTION REPORT t. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal k9orrnation you prvvice may be used for seoondwy purposes [Privacy law. s.15.04 (t)( 84296
Permit Holder's Name: 0 city 0 Vi Otge Town o : State Plan lD No.:
Kro Schroeder Jer St. Joseph Township
CST 8M Elev.: Insp. BM E v.: 8M Description: Pare Tax No.:
U a iaiz 5 ' " 30- 2106 -90 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 5 GO Benchmark
y
Dosing c S Ov ( BM4'oy4 3�
Aeration , _ Bldg. Sewer 15 v s z F'P
Holding , – g' Ht Inlet z Z 3
TANK SETBACK INFORMATION t g/ Ht Outlet j L2 p
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake 3 • t
Septic S fy� r — NA Ot Bottom 12,
Dosing > 7t;(
NA Header /Man. /G, OZ f 0 ' 3 e
L or'
NA Dist. Pipe / o �i • 3 g
Holding Sot. System 1111
PUMP/ SIPHON INFORMATION Final Grade m .�-• -/ -7 s �'
Manufacturer �l D t Cover R
Model Number GPM 3 7
TDH Lift Friction System TDH Ft
Forcemain I Length f9r' Dia. Z Dist. To well
SOIL ABSORPTION SYSTEM
BED / TRENCH Width Length 47 No. Of Trenches PIT NO. Of Pits Inside Dia. Liquid Oeptt
D IMENSIONS M 3 DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA Mau ufe
SETBACK B ��
INFORMATION Type r � 7 v I �_ IT M Num r:
System: wN �S 3
DISTRIBUTION SYSTEM
Header / Mani o d r Distribution PiRe(s� x Hole Size x Hoe Spacing Vent To Air Intak
Length _455'_ Dia. , Length ��� Dia. Spacing .6/
I / f 1. ,
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 Q Yes Q No Q Yes Q No
COMMENTS: (include code discrepancies, persons present [rf4pbCtion #1: ) 13 /0 Z Inspection #2: �z
�5
Location: 360 River Road, Hudson, WI 54016 \ (SW 1/4 NE 1/4 6 T29N R19W) - 062919893 Everg e
Ridge -Lot 9 yJl�nn�s� �ze p
1.) Alt BM Description = a� S'd "`f
2.) Bldg sewer length = _57 ' , } "0 well `�
- amount of cover = > (� /�, Sce ')V.5Pec4;r . wofe ooh �q°Y W °� P� -
3 ��' v .ee 4
Plan revision required? ❑ Yes M No /
Use other side for additional inform tion. Z
Sg0-6710 (q Oat Inspeccor' s S4natuf e
Cert N<
k
3eo � Safety & Buildings Division
Sanitary Permit Application 201 W. Washington Ave.
PO Box 7302
NY Asco ' nsin In accord with Comm 83.2 1, Wis. Adm. Code Madison, WI 53707 -7302
Department of commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)]
state owned.
Attach comp] te plans to the county copy only) for the s t o e t s 8 -1/2 x 11 inches in size.
County' C � State S Permit Number El Check if previous app 4 a State Plan 1. D. Number
UT /'or C(
I. Application Information - Please Print all Information cation:
P Owner Na me Qerty Location
t 11 2 1/4 AIZ 114, S T ,N [t/ or
Property O er's iling Address ? S G , N Number Block Number
O *t00^rT"
City, State Zip Code Phon
9 Sub Name or CSM Number
�� — C
II Type of Building: (check one) ❑ City
J�' 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village
• Public/Commercial (describe use): JwTown of f _
• State -owned
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Neare ad
u o
A) I. ,"New System 2. ❑ Replacement 3. ❑ Replacement of 4.. ❑ Addition to Parcel Tax Number(s)
System I Tank Only Existing System
B) Permit Number D to Issued
13 A Sanitary Permit was previously issued G 0 O - , OU 06 3
IV. Type of POWT System: (Check all that apply)
Non-pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ ressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate . System E evation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
9 3 - 15 - y I a.� -u -`7 I ') \ 81rA. '3
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing Crete structed
Tanks Tanks
6 ❑ ❑ ❑ ❑
0 ❑ ❑ ❑ 13 kM C�ati I a4U ( Wt? ek3
VII Responsibility Statement
I the undersigned assume resDonsibilitv for installation of the POWTS shown on the attached plans.
Plumber's N rint) Plumber's Signpq,.g(tto stamps):. MP/MPRS No. Business Phone Number
— go 745 35 ,6 -9 ,D 01,
Plumber's Address (Street, City, State, Zip C odW
ho 7D w ud �jo ,v t!�l �j
VIII County/Dep tment Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issue g Agent,Signa (No stamps)
Approved ❑ Owner Given Initial Adverse Surc a Fee)
Determination Z Z (
IX. S Co� Conditions o�ro�va /R,@asons for Disapproval::'
�{- - o.� f sus i
S c�CeU vvluc`x S
e- f _���11.1�2b
Zozla-Loa �31,to �44
d1 d• (3,;,Id I , s CS7 C�
0v 5 Y
Goi
fi b
3 X
R3 �
Q1 ,
�j00 g0 ) PUM
4 �zv
ti
' T
- - - -- ,� F► � �-3� o o
«S O C
c c zo
c E c M
,aav_ wpm n vi
LO Aa e E Co N x
V
i See ee i' 7 O Ci ~ cL` t1j
E E v c L x 0) M
co T
LU
�, S C
oo co
�
7 5 E
L.. b °- D -0 Q.
LLJ� Q 1 - -._.. rn >roc� U
O - - r x
Cl) U = _.._ - - - - - -- \\'VVVVVVaav v- -5 O = n N_ O
�J vvv l O (!) (n
I
�cjL a inn
QED
Gy
° RS �rx
z Nr,
avhN
G .,
OF FA
Wt } )3ro
p 1 yy � F-� I I 4 C'
DP�v4h /'�pR1` S
f3M1
Q � 3 ,(
N N l.S _
�►,�, •
q 3.7 S'
v0,0 ) �r(D 3 k S
s�
?01
R3
� PuM
AD
11
ouU yAl
Se pfi ;
S
3 �c���ur•7
0
N
5 �
� l-ev 88, oc)
-EN C
CE N `
LO (v N E cd Co N x to vi to
1_ E `O 0 x CD M
LU cy
cl3 'a to L - .
N N _
i _ ' N O O C p
N
j i —
M p� b O
C YU� TNn.
U N C � a U U •�
E n 1 co �a���c x
c c
173 LL 0 x
i
'`il - a
rl a�C , d e c� i nd e r,5 - - -.�?1 ,
v
L._..
D-T--- -A
�►� �� "t1d�N � s ps'
GOAA
B�
�N�� morlc
Nail 15" Elm -- - - --o
� fly; �UU•U
. 7 0 1
°,Uu gp� P �w•� p
I uD O�A� L
W�PiW �
3 ��ou r►�
rlwo &ZO U-39 ca
ill
fV
i
N
Ccv
c�
�Ec� `T M
ate w 3 id c N x iri vi
I eddd° �. C U 0 ` Q
Li. C z
E E x M
a_ v t
W a )
t �i7 v1 M
N
' cn O O O C p
` Q cTj CL
Z �N
[d O
�� O i O% B h !n V
n'
� O Q _ Fn
ujm U 7 ) L _, (U :L
a)
Rf
U U- N O V N L V
N L C 0 v p) Q1
U = J ti O = cn cn Cn 4
° II Q-
• • • •
Wisconsin Department of Commerce SO D SITE EVALUATION
Division of Safety and Buildings n pa _1_ of EL
Bureau of Integrated Services in 9 R 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 102.X'11 Plan County
include, but not limited to: vertical and horiz �
on reTelerxe // ,
�iort arKi '7" c r0 1.
percent slope, scale or dimensions, north arrow fir` drsiance to nearest r+ad.
Parcel I.D. #
i APPLICANT INFORMATION - Please _ all inn.. R by Date
Personal information you proMe maybe used for secondarypyipos 15.5+4 ))• /'
Z
Property Owner P lA location W il y
Govt Lot SCI 114,(/ff 1/4,S . e To/Jrf30N,R / S!Zo E (or)o
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
l 1 S 3 M c, : n ►- I -R O . I Ev e r -•e_ q 12 n `eQ
City State Zip Code Phone Number ❑ City D village [g T own Nearest Road
(� New Construction Use: Residential / Number of bedrooms 3 + 7 Addition to existing building
D Replacement ❑ Public or commercial - Describe:
Code derived daily flow 0 0 go Recommended design loading rate , Z.bed. gpd* — Ltrench. gpd*
Absorption area required r( bed, ft — trench. ft design loading rate 7 bed, gpd* trench, gpd/ft
Recommended infiltration s A ntion(s) . l ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material /de 1 . K �� 4S Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In -Ground Pressure, . • AT -Grade System in Fill Holding Tank
U = unsuitable for system O s D u ®s ❑ u ®s D u m s D u cis [XI u CIS [R u
SOIL DESCRIPTION REPORT ; 6ACk -- 75 l ZRX C
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
` in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed . Trench r
I aiz o /z e s
Z 3 3 r — i "C_/
Ground 3 S l .6/<
elev.
1
tM { es •�
Depth to
limiting
factor
Remarks:
Boring #
r GS P �C'
Ground �j 63az/ 10 rn Q m ( �S ;
el ev. '
Depth to
limiting
fa,
1L in. Remarks:
CST Name (Please Print) Signature Telephone No.
Q C 1w elek0- k c /
Address Date CST Number
V,!9 /7 - X? ,sr336
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of
T
PARCEL I.D.#
Borin g Horizon Depth Dominant Color Mottles Structure 2
g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
t o - ; 7 /o �3 /z S,` �a d e. S / -�' : .2-
Ground j /�. r Y -5 l m Y C .5
"�' . $ .�, • `I
elev.
Depth to
limiting
fac)or
1 ( in.
Remarks:
Boring #
Ground 771% /U M/ c, .S
elev.
9 ft .
low Depth to v.9 Z r
limiting
factor
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
/ z
Boring # a_Z/ p r ! JYl r C G •1� Z
Y
.�
Ground
elev.
Depth to
limiting
factor
—L Remarks:
Boring #
13
Ground
elev.
ft. ,
Depth to
limiting
factor
' Remarks:
SBD -6330 (R. 07/96)
W -*
o T"r`a e w r r� erg jet
in �z -
i
,v
4
lo-
v
t
4 • //
1
of
6m Z j
f
ism ' 1
0
82 PRIVATE SEWAGE SYSTEMS - II
PAGE OF
PUMP CHAmb[R CROSS SECTION AND SPECIFICATIONS
VEIST CAP
4 C.Z. vE'JT PIPE WEATHER PROOF APPROVED LOCKING
JUNCTIOAI BOX MANHOLE COVER
� ' q . - RCM ODOR,
r �!DCW OR FRESH I2�MIU.
AIR !ti'TAKE
GRADE ( 4" MIM.
IB 'MIU.
CONDUIT ---- - - - - --
18"P11
ll�
PROVIDE I - - - --
INLET AIRTIGHT SEAL
I I v
APPROVED JOINT/ A I III APPROVED -01 KITS
N75
PIPE I I E%Tr
EXTENO!uG 3' I I) ALARM EXTENOlu6 3
I II ONTO SOLID SOIL.
010TO SOLID SCIL B
I I ON
C I 1
I
LLCV. FT. PUMP J
OFF
D
CONCRETE BLOCK
RISER EXIT PERMITTED C UL'J IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC e SPECIFICATIOUS
DOSE
TANKS MANUFACTURER: UIZ UUMBER OF DOSES: PER OAS
TANK '_!ZE : FaU GALLONS DOSE VOLUME
�Ve A S INCLUDIN BACKFLOW: GALLONS
ALARM MANUFACTURER: " y
MODEL kJUM6ER: a � v OL' CAPACITIES: A= 1 INCHES OR r� NALLCU5
SWITCH TYPE: B= 3 INCHES OR 1 j " ) ' GALLONS
VUMP MANUFACTURER: ���'�'� C= 1 �'NCHES OP. �� ,A_�OUS
MODEL UUMBER: p,� 0 = `,
' INC HES :R �i GALLONS
SWITCH T'JPE: 1 AIL AIOrE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE GPM
o,> Q INSTALLED ON 5EPARATE CIRCUITS
/�
VERTICAL DIFFZKEAICE CETWEEN PUMP OFF AND 015TRIBUTION PIPE.. 13,w FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . 2.5 FEET
+ FEET OF FORCE MAIN X ` F ooiT.FRICTIOU FACTOR.. 3 b FEET
TOTAL OtWAMIL HEAD = FEET 1 4 6 -6
INTERNAL CIMEIJSIONS OF TAUK: LE,I.IGTH ;WIDTH ;LIQUID DEPTH
SIGH EC: LICEQSE NUM» R: �aa9�� DATE:
yams �tl
x
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).
Tabl 1: System Design Specifications
Sanitary Permit Number 2
Number of Bedrooms 3
Design Flow - Peak (gpd) Y5 0
Estimated Flow - Average (gpd) 300
Septic Tank Capacity (gal) 1000
Soil Absorption Component Size (ft J
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) IS
Maximum Influent Particle Size (in) I b 1/8
Maximum BOD (mg /L) 30 220
Maximum TSS (mg /L) sw 30 150
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 filter shall be cleaned as necessary to ensure
proper operation. 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
upon
u
soundness. Access openings used for service and assessment shall be sealed watertight P
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 ent ry into the tank.
No one should enter a septic or other treatm ent 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 ank may contain lethal gases, and rescue of a
9 Y 9
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
i w
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.
When system fails, we will replace with another system
at owner's expense. Alternate area must be left undisturbed.
St Croix County Zoning Office 386 -4680
Boumeester & sons Excavating 386 -9020
Tri- County Sanitation 386 -2130
3
• ST CROIX COUN1'V
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer )20 rat
Mailing Address PO &X U 9
Property Address el VC - g - t� s
.w Verifreption required from Planning Department for new construction)
O
City /State �� 1 Parcel Identification Number C
LE DFSC tPTUrtw
Property Location %,,` %,, Sec., T N_RjW, Town of _ S r J o5E'P4
Subdivision 9 /0 Gam'
Lot # _
Certified Survey Map # --Y , Volume , Page #
rl
Warranty Deed # _ w `- 7T / Volume Is2 , Page # �o
S pec house D yam ° Lot lines identifiableXyes O no
InVcom use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance
consLb 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 limclion of the septic tank as a treatment stage in the waste disposal system.
TU PWP"tY owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner by a
sad uterpluttrber, joumeynranplumber, restcictedplumber or a lice
and pumper verifying that (1) the o"ite wastewaterdispoeal syet
m
is +ma
is proper operating condition and/or (2) � lagdon and pumping (if necessary), the septic tank is less tban- ai" of sl
Uwe, the undersigned have tend the abov
'' ..
set forth, herein, as set b the D and agree to maintain the private sewage disposal y standards ePartment and the Department of Natural Resources, State of Wbcootin(ptiOn
statiRg iltat 1 Se p t ic sri been maiay� =4 ttmst be completed and returned to the St. Croix Coun
days of the three year expiration da te. w t, OM= within 3Q
4 AQ � O M P M A � PPLICA � NT �
DATE U
'.
1 � C AMN
1
I (we) txrtify first all statements Q . 0M are true to We best of my (our) knowledge. I (we) am (am) the owners) of
e Property described above, by virtue of say deed recorded in Register of Deeds Office.
GNATURB OF APPLICANT 6
DATE
•••• +• Any information that is mis - rep v pusy�ntult in the sanitary permit being revoked by the Zoning Ekgmrtmmt. *•• + +•
Include with this 11
PP cation: a sta
mped:.trsNgtY deed from the Register of Deeds ofFico
a copy of dro�eettitied survey map if reference is made in the warranty deed
i I
!II Q �� =NO C7
t BROKEN b y j p lp l �
7F {d 7. 50
UcKINU:Y DR ' 3 `v ~ '� W it
� O
1` `. n
�v
° z U
z
,1 (rl 4. In
_
_ 31' 37171
y I f T. N.
F
T TROUT BR RJ40 N.
I I I
UNPLATTED LANDS
N z
YcKINLEY DRIVE = (Q
North - Sautb 1/4 line
N
Ek15TINC CENTERU —_ _ — _
S (1011'12
"rte -- - x'------- - - - - -- �— _--- _- - - -� — _
- _ -U— S00'11'12 "E 1305
�I - I AD 0 E PJBUC - - -_ -_ -- - -- - _
1 4 f
a6J.00' .__._ '°I JJ I JJ'
I S� I t, • N I T^.
........... .. ...............................
1 ° b t .......... �( . p .. �1 I • - I
l' C O O /� 4 1 f) r 0 44 x 1 I r I
33• 33' N \ ��• fl r `. Y , '•"'; - - -- - m 25 ' I '(�J�o �r
n ° I
W l7 I
y / 1
L
b J Ir
rI
LO
4 b 1 E3 11
/� / I16TJ �� IrL
0 _
1 0
11 11
S 1 N 00 W 447-
n m
---� C 1 _�!� ��� ♦ $ ( . J J N 011335 E 426.0a
S Qa-7 W • 1 'fw 1 ti 1
N O
1 0 m UT 1 •Ia3.9B' I r � - -- - - - --
M A
N N
C 4 70
N a 2 D r- 6 f m !n 4E
rr 1 D xl / II of / m f
N 0010'37" W 407.a1' m T .;u O I 1 O)
N QO ' W 440,13'
cr)
1 1 C
g i
I u
Ln
3F
JA
N0070'34'W 407.74' / v l �• f^ 1,i r1 CAD g I O
b I N00'20'34 "W 481.84' s
c r�l m (N0014.3e•w) 4a.vo' 1Y 2x1.37: 1 I Iti I
--- - - - - --
It
= u X ' 1
= m N - - . _' .. �.h p `'1 00'06'44 w 441.41' / *�I'�
< Z t
I IC ID !O Z.� ' i
I i
Ifs `a -- �! P I F 1
M Y 73
u
I :co z * I I w TTT (n
III l
C
I ro u N D L ��' J� W Z> to
t ;3 ! ° I I D A Ih
I a
tt7 1 1 J 1 I A n Imo' �
Uj
---------------------- _ - -- 30x.21' 7 7'
� -
I
. _ — . � . _ �.
1'30 "W 834.90' —
EAST U NE OF THE SWI /4 OF THE NEI /4 0° n -Z-0 p c 7 7°
.Z1 - U g A R r w A A t r (N L^ U
T*T m 7'O to 3 r1• ;� z °
I I UNPLATTE L 4 0 °
O w !, 1 3.
N ➢ O
o
a Z 1 I 1 1 C < ,z< SO� 91
O• _' oc 30
rtl I i V1 �C � n :r: pno a!',. .
1 1 6f ° O ry 77 ao ^
n r 11 1 1 1 Q O �) 1 II— 7 Z..^ � r ? m >> n� <7 ^A
II i i 1 i o Op IIW � ,+ N w.^ f
a
D IWID c� T ' 0 .u3N» ^ ^ act °°o �`i'!
y r1 ID I t/1 I o °° Q N ^ p N _ n
K1 m D 7 p N ,4 Z N ^ n ^ p 1n 7 x_ 5. `^ .
y - 1 l l fTl ° � m0 � ' 0 0 vDow•iB e a 0 , ,
3
p z z I /n z -v $ �[z }'' h m Ir ?, .. �A/f`1 j'�O ^ V_ - , h0 O f
1 A O O LI p OO A N 8 7�6� pn1 C� 7 O I _
A A D 1 ( 5 4(� uK r a N ' 7 G1.10 p m p O 1A ._ � v �
v rn z (2 Q 8 o p $ y�i [�' Q c R1 Ta n, a z o n - O.,
Xi f" r rl ryiz fn P i ' E y nT IQp 3 10 �,o o _. ° o C R H
�� �� ,� -• b I � 4. oN QS ° n ao
x 55 s $ c > in o p QQ u ^ o �• ^ o m A.• p 00 0
on• y � n psi I I O Z= � J M " 10 .Z1A ft - rb r�(7
� � _ o a
y0i_ �1J,.3PAGE Job
STATE BAR OF WISCONSIN FORM 2 - 1998 X25 ? ?3
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number ST, CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Sam E. Miller, a single person 07 -03 -2000 9:30 AM
WARRANTY DEED
Grantor, EXEMPT D
and Jerry Roy Kromschroeder and Sharon Susan CERT COPY FEE:
COPY FEE:
K romschroeder, husband and wife, as survivorship TRANSFER FEE: 159.00
marital property, RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
Croi described real estate in St. County, State of Wisconsin:
Name and Return Address
Jerry R. and Sharon S.
Kromschroeder
10823 32nd Street
Lake Elmo, MN 55042
030- 1021 -90
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Lot 9, Plat of Evergreen Ridge
in the Town of St. Joseph, St,
Croix County, Wisconsin.
Exceptions to warranties:
Subject to easements, reservations and restrictions of record.
Dated this -� day of V LF 2000
— (SEAL) (SEAL)
* SAM E. MILLER
(SEAL) r � SEA0
l� �=
AUTHENTICATION ACKNOWLEDGME&''•••• ,
Signature(s)
State of Wisconsin,
ss.
St. Croix County.
authenticated this day of Personally came before me this day of
wiz J wy' 2000 , the above named
Sam E. Miller.
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If not, me known to be the person who executed the foregoing
authorized by §706.06, Wis. Stars.) instru ent and acknowledge the same.
r
THIS INSTRUMENT WAS DRAFTED BY
STEPHEN J. DUNLAP � � '0 , J41 11'oe
Notary Public, State of Wisconsin l�C�
Hudson, Wisconsin My commission is permanent. 11f not, state piration 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.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
FORM No. 2- 1998 Milwaukee, Wis.