HomeMy WebLinkAbout030-2088-40-000 r
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Wisoonsin Department of Commerce PRIVATE SEWAGE SYSTEM ColtCroix
S and BuUngs Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) sa�rt 9 n "°.`
Personal information you provice may be used for secondary purposes (Privacy . s.15.04 (1 )(m)). 4ttSS 11
❑ City Vi I e n o : State Plan ID No.:
o gt. ,Pas �i �—
CST SM Elev.i I Insp. BM Elev.: , BM Description: � Pa Tax No.:
a�.a
« -Q � � 030 - 2088 -40 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark &. Z3
r
Dosing It. BM I.12- 0Z.((l
Aeration Bldg. Sewer (L. 4'Z, 4`1 .S1 r
Holding St / Ht Inlet , 0 �
TA ETBACK INFORMATION St / Ht Outlet Z V
TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet
Air Intake
Septic A5' }h" r NA Dt Bottom
Dosing NA Header/ Man. 9 ' ( O 3 (� 0 /
%('o
Aeration NA Dist. Pipe R(e • 3
Holding Bot. System ' 15 cj$; 08 r
PUMP / SIPHON INFORMATION Final Grade '/ �• Io0 .b 3
er
Manuf cturer Dema d
Model Nu er GPM
TDH Lift iction S tem H Ft ZI Loss— I Head
F Dist Forcemain Length Dia.
. To well
SOILAB RPTION SYSTEM
ENC Width / Length No Z f Trenches PIT No.Of Pits Inside Oia. Liquid Depth
( EN DIME I N Manu clurer:
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING 1 l
SETBACK CHAMBER M e Nu er:
fi INFORMATION Type O SO ' I OR UNIT
3 System: e,�.J' • > > 1�
�� DISTRIBUTION SYSTEM U� �""` ISO
+�h x Hole Size x Hole spacing Vent To Air Intake
Header/Mani old � Distribution ipe(s > �r
Lengt Dia. Le Ora. 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
/ COMMENTS: (Include code discrepancies, persons present,
ec Ion 1: / /D Inspection #2: ` — �'
Location: 1226 Oakwood Lane, Somerset, WI 54025 (NW 1/4 SE 1/4 34 T30N R19W) - 343019744
Deerfield -Lot 4
1.) Alt BM Description =
2.) Bldg sewer length = 44
amount of c " ov e r =
� pp�ree�� � �.. es Y. k3nlo
Plan revision required . ❑ 2tf�
U of r side for additio al ;nf /
y 1 Cert No
5 ) QL1Q (� �� ate InspedocsSignature
pl3a ! G(101 &- e.r .
12ZG Oct k.umo0 Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
lV i sconsin Personal information you ma rovide be used for second u Madison, WI 53707 -7302
Department of Commerce p y p urpose s Submit completed form to coup if not
[Privacy Law, s. 15.04 1 ( p �'
state owned.)
Attach complete plans (to the county copy only) fo a em on paper n Bess than 8 -1/2 x 11 inches in size.
County State San(tary Permit Number � 41f revision to previous.apNication State Plan I. D. Number
I. Application Information - Please Print all Information a r' Location:
Property er Name , _ Property Location
Al 17 .1
` 1/4 S T
�} 1/ N (or
Propirfy Owner's aili g Address �Q1 r �' Lot Number Block Number
.rte.
2 Y
City, S to Zip Code EI59fie Number r Subdivision Name or CSM Number
6 i
II. Type of Building: (check one) ❑City
/ ) ❑Village
1 or 2 Family Dwelling - No. of Bedrooms : t / 0T OWn of
❑ Public /Commercial (describe use):_ blosR}-
❑ State - Owned -
Nearest Road
030 o - L10 - 000
Parcel Tax Number(s)
III. Type of Permit: (Check only one on line A. Check box on line B if applicable)
A) 1. A New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
,W Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized 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. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolati n Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch E
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
-A2r ❑ ❑ ❑ ❑
✓ ❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installatigh of the POWTS shown on the attached plans.
Plumber's N e tint) Plumber' Sign (no stamp MP/MPRS No. Business Phone Number
Plumber's Address Street, City, State, Zip Code)
- / '-/. 'e J2
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Is ing Agent Si ature (No stamps)
C�Lgpproved ❑ Owner Given Initial Adverse Surcharge Fee) dD
Determination I - Z ?k r u (3 '
X. Conditions of Ap royal 1 / for app n r A*j 0
waS o Sue Q.� e, d bI "NobMA -4 Cut&.Q_t4 �� s Ss w_ A 64'&W _. r%ar%k —
°^^� ,nQ�jit,� �nN 4. s �o✓� 4o at`t'[ o .
SBD -6398 (R. 07/00)
A .yore
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS
INDUSTRY, DIVISION
LABOR HUMAN RELATIONS PERCOLATION TESTS (115) MADISON W 53707
(H63.090) & Chapter 145.045)
LOCATION: SECT-ION: TOWNSHIP / LITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
is %T 1/ sd/ 34 /T30 NCR 19 1EXor) W St. Joseph 4 1 n/a I Deerfield
COUNTY: OWNER'S B I46y NAME: MAILING ADDRESS:
St. Croix S. Henning & D. Norell 665 Walsh Rd., Hudson, Wi. 54016
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS:
tesidence 3 n/a �Vew ❑Replace 7 -9 -92 n/a
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
aJ S ❑U ®S ❑U CAS ❑U I EIS ®U I ❑ S ffU I conventional
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: class 2 Floodpl indicate Floodplain elevation: n /a,
decimal' PROFILE DESCRIPTIONS page 42 JsB
BORING TOTAL D PTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGH TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B -1 78 103.04 none >78 0 -9, 10yr , L.; - , sil.; 20-60,
0yr4 /6, ls., 60 -78, 7.5yr4/4, ls.
B- 2 84 103.04 none >84 0 -11, 10yr3 /2, L.; 11 -35, 10yr4 , sil.;-
35 -84 10yr4 /4, ls.
13-3 86 102.92 none >86 0 -9, 10yr4 /2. L.; 9 -32, , sil.;
32 -86, 10yr5/6, ls. &gr.
B 4 84 102.14 none >84 0 -9, 10yr4/2, L.; 9 -29, 10yr4 /4, sil.; 29 -39,-
39 -84 , 4 4 co. S.
B - 84 103.14 none >84 0 - 11, 10yr4 /2, L.; 11 -36, 10yr5 /4, sil.; 36 -44,-
_LL
B_
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 P R PER INCH
P-
P-
P-
P -_
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 99.42
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 7 -9 - 92
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. Ave., New Richmond, Ui. 54017 229 0 715 -246 -6200
CST SIGNAT
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR -SBD -6395 (R. 02/82) — OVER —
i
INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
1 MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5. Complete the suitability rafting boxes, A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desire(];
S. Make sure your benchmark and vertical elevation reference point are clearly shown, arid are permanent;
3, Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Skin the form and place your current address and your certification number;
12. Make legible copies and distribute as re(juired. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAY'S OF COMPI...ETION,
ABBREVIATIONS FOR CERTIFIED SUIT_ TESTERS
Soil Separates and Textures Other Symbols
St -- Stone (over 10 ") BR — Bedrock
cc. Cobble (3- 10 ") SS — Sandstone;
gr - Gravel (render 3 ") LS - Limeston
s - Sand HGW — High Grorrndvvater
cs - coarse Sand f erc Pei colation Rats
nted s _ Medium Sand W UNfF II
I's - fine Sand B =dg. - Building
Is --- Loamy Sand Greater Than
sl - Sandy Loam < Less Than}
'I -- Loam Brl - BrovvrI
sil - Si[t Loans bl - Black
si - S;ll G -- Gray
�cI — Clay Loam y - Yellov"
scl — Sarrdy Clay Loam 13 Red
sic] - Sdty Clay Loam mot Mottles
sC — Sandy Clay 0V/ Leith
sic — silty Clay fff
*c Clay cc - Como,(W= Ir
Ili Peat ni m - Many, r -AU0 ,rn
rri - Muck d - distinct
p — promine!�i
I-I kill L -- High water levf -1,
.. Six (general sw textures . 'SA face watAr
for li(juid vvaste disposal BM Send) €lark
V RP, , Vortical P eference Point
TO THE OWNER:
This soil test rep r is the first step in securing <r sanitary pet €nit. The county cot this Departmeivt: may re(luest
vc't of wis Soil test In the field prior io I:rrrmit issuanwe. A complete set of plans for the private
s€ v'V <ige systew and a l.,(.rn aIT¢:lic ['.ion IT"ust hc, St.ihrnitted to the ;ocai au( }bogy in order to
obtain a permit, The 'sanitaF> norr ,it must lie Obtained ant] j,, ?steel 171 for 1'o th , .Sri of a,ty Con5ti'uctiOn.
r _ _
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 4 of —�
Labor and Hum:. Relations
Division of -Gafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but �(
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to
APPLICANT INFORMATION— PLEASE PRI EVIEWED Y DATE
PROPERTY OWNER: PERTY LOCATION
LOT 1/4 1/4,S M (or W
PROPERTY OWNE ':S MAILING ADDR S r c� BLO K # SUBD. NAME OR CSM #
Cl TATE ZIP CODE PHO �R , ❑V E XOWN NEAREST ROAD
6C1 New Construction Use Residential / Number of bedr V [ ] Addition to existing building
.
j J Replacement [ ] Public or commerciafde! Nbd
Code derived daily flow gpd Recommended design loading rate — bed, gpd /ft trench, gpd /ft
Absorption area required ��o bed, ft � trench, ft Maximum design loading rate J _� bed, gpd /ft , trench, gpd /ft
Recommended infiltration surface elevation(s) 9 _O ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem E4 S❑ U ®S ❑ U ZS ❑ U M S ❑ U ❑ S NU ❑ S 1R] U
SOIL DESCRIPTION REPORT_ .
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. tBeTrench
O jel 6 .5
Ground Z4 5
elev.
ft. _ 7 L
Depth to
limiting
factor qS
Remarks:
Boring #
- 4
`.. r
Ground
elev.
ft. hi
Depth to
limiting
factor
?? 5(
Remarks:
CST Name:— Please Print Phone: _ /
rc�
Address: J
Signature: Date: CST Number:
1
PROPERTY OWNER � «'ref SOIL DESCRIPTION REPORT Page,-2 of
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
ry
r G 4
Ground
elev.
ft. }
Depth to
limiting
factor
Remarks:
Boring #
4Z
Ground
elev.
ft.
Depth to
limiting
factor
>.
Remarks:
Boring #
iiij 5
L
S
Ground
elev. . }
S'
Depth to
limiting et, `{
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Il S13D- 8330(8.05/92)
s'oi �� 1 nS� // ,���,5� / � / s����� TAD.✓, x°i9�/
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Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number ZZ 9
Number of Bedrooms 3
Design Flow - Peak (gpd) S
Estimated Flow - Average (gpd) 3 CFO
Septic Tank Capacity (gal) try
Soil Absorption Component Size (W) 2 - �� r C�.n•�l,�s
Type of Wastewater Do stic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) Apo .S Z- ,
Maximum Influent Particle Size (in) 0 1 / 8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Tabl 3: M aintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septi and outlet filter shall be assessed at least
once every 3 years by inspection. T outlet filter h all be cleaned as negp5s to ensure
p roper operati The filter cartridge s o 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
9 p
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.
i
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
. On steeply sloping sites, of erosion should be identified and
from the component. ,
p pY P 9
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
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.
3
05/2; U 1 `J.'ItiJ 08-'45 FAX 7083894035
DAN DRTLK Narytou 3azctyk
In re
Ss
SEPTIC TAN11C AC;fRE1rMN7
OWNERSHIP ON F1It,, I VON FORM
Owner/Buyer 6�6e&vl-> j&
Mailing Addrt r 1
Property Address
{Varifleatir n rcquErad from Planning De"rtment mr new ooneaucdon> ~
GitylState '! J O3s� � L<.i Parcel ldetttiflostion Number OR 0— 2gK br:
UAL 293—c-EM119N
Yroptarty laoaation„ %, TAN -R_/_LW, Town or 75;eLLi
Subdivisio Lot # r
Certifled Survey MAp # , Volume . Page #
Warranty deed 0 _� �,��� ' Volume page # 7�
Spec hou" p yes i Lot l ines idsr ttdtLable q yes O no
ltnproper uta and rnuinranaoccof your septio system could result irk Its premature failwti to handle wastes. i'e:7'pet
coasms of pumping out the sop ti
CM c tank ovary thtee years or $cored, if h 1)t eaded by a licensed pumper, Whst you
c atTacr the ftrnartop of the septic tack as a are atm ent sage In the waste 41sfe141 system.
The Pr "Orry owaot agrees to wbre►it w St. C*% Zoo s Dapartt eat a cordficsdorn forrn, sight j '
xneaterptember. journ <yehatx Ptuntbet. rtstTfeledpluml+erar a licartsed pvPper verll ag that (1) the art - sire ,
it in proper operstittig condition andllu (2) ahcr inspection aad pumping (if DOGaiei the septic lank is ;eti
1lwe, Osa Gnderstyned havo teas the above r'grytunehb end ages to Ineiataitt ON pttivate sawap disposal sys .:
set foall, harsh, as set by the Doptttmteat of +:'etrtettenea aad toe Dapatpnapt otNatpwti Resources. State ut wise, ..
stating that our septic sysrsrq s
day of tit three e rttafateieed roust be tompietcd and tetarnelf to the 5t. Croix Cooney ?.nn; °,�
' a ` =! � %PQ a,
1GNAT'M F APPLICANT ��CMJ
DATP
1(w hat alt ate a on tills tibUn arc tMG so the best of my (our) ks°awledge. 1
the pe y e of a warrt tty 41604 recorded In Register of Deede Office.
UNATUlU
S
DATE �
° "•e• Any fetotmatiotl that is mis•ttepreatnted may result tat the sanitary permit bohtg revoked by the zoning
,• "'elm" writ" this airp a clamped wattattty dead Thom the Registor #( Deeds office �
e ropy of the aenitted attwey map itsaferenwe is made in the warranty deed
4.c� d
%00'0111 s : 6 T 66 ` b T i nf L06 •i: T S9 : �3i 31dff NH_ G
t ` 08 PACE 226
STATE BAR OF WISCONSIN FORM 1 - 1998 Ca224�8
WARRANTY DEED KATHLEEN H. WA
REGISTER OF DE
Document Number ST. CROIX CO., WI
This Deed, made between Thomas M. Plourde and Mary Shannon RECEIVED FOR RECORD
Plourde QjL Shan a �vtfe
Marl __- '�h' husband and - - -.._ 05- 054000 9 :00 AM
WARRANTY DEED
Grantor, and Warren D. Anderson and Mary E. A nderson, husband and EXEMPT I
CERT COPY FEE:
wife as survivorship marital property COPY FEE:
TRANSFER FEE: 136.50
�— RECORDING FEE: 10.00
- -_ _ - - -- - -- - -- PUBS 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croiz County, State of
Wisconsin (The "Property"):
Rwordim Arco
Name and Raturn Addters
of 4, lat of Deerfield in the Town of St. Jo St. Croix Co warns and Mary loon
seph, aunty, Wisconsin. 399 S. Sterling St.
Maplewood, MN
030 - 2088 -40
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 fm and clear of encumbrances except
recorded eas® ads, rights of way and covenants.
Dated this 4th day of May 2000
: k� _
+ Thenss hL Plourde t s Maly ShmAon Plourde
• i
AUTHENTICATION ACKNOWLEDGMENT
S'L'ATE OF WISCONSIN )
Signature(s) St. Croiz )33.
_. County. )
Personally came before me this 4th ` day of
ATTE� Lp,N�S
NORTH —SOUTH 1 /4 11NE Of
SECTION 34 , 327.77' /
1735. \ �
e9'
NOO° 22 20 E 329.06' 1
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