HomeMy WebLinkAbout030-2126-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
514858 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:
Zifko, Gary St. Joseph, Town of 030- 2126 -70 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
`72.7 - 3 GS ( 25.30.20.1031
TANK INFORMA 3 E L E VATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic n Benchmark
9e�h It r�csJ IAr- ic %4 - Z / ZO6 $ . / • 1 9 z 7a
�3es 5 Alt. BM
f t C�� /a F► I� Ce�e.•. 3. 17
Aeration Bldg. Sewer
5. X5.3
Holding St/Ht Inlet l ; ' /
7 , 7y, z
TANK SETBACK INFORMATION St/Ht Outlet 1
( .7
TANK TO f P/L WELL B Air Intake ROAD Dt Inlet Septic 27 Dt Bottom Dosing Header /Man. q
7 7. G 3 Z
Aeration Dist. Pipe 7. - 7:1. Z
,tc 9
Holding Bot. System I s - LP ° 1'z .
Final Grade % Z
PUMP /SIPHON INFORMATION y S
Manufacturer Demand St,(.oigr J 3 • • 17 Z
GPM �{•�,�
Model Number
TDH 1 1-if Friction Loss System Hea TDH Ft
Forcemain Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width f Lengt No. Of T rench es PIT DIMENSIONS No, Of Pits Inside ia. L
DIMENSIONS ":Z ,r6 Z , "'C ---
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION r 5 7z CHAMBER OR
Type Of System: 3 / UNIT Model Number: y`
Car.,�e,�r �a / W�
DISTRIBUTION SYSTEM �` ZZ-1 — ZZ
Header /Manifol I Distribution x Hole Size x Hole Spacing Vent to Air Intake
' pe
L / P
Length 1O Dia e Le s) \ Dia \ Spacing ` \ z� a "�'l
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Sys On ly e'ti 5
Depth Over ) Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched
Bed/Trench Center 7 Bed/Trench Edges Topsoil � Yes ? "sl No es s>! No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1329 Birch Park Ridge Houlton, WI 54082 (E 1/2 SW 1/4 25 T30N R20W)) Birch Park Lot 27 r _ Parcel No: 25.30.20.1031
1.) Alt BM Description=
2.) Bldg sewer length =
- amount of cover = n ^
'Sl
Plan revision Required? J Yes to
Use other side for additional information.
Date Insepctor's 5 nature Cert. No.
SBD -6710 (R.3/97)
04/22/08 TUB 08:30 FAX 715 386 4686
@001
Cor1�IMOrCS.w1 .p01/ Safety and I3u7din vision CO �' C ` p
201 W. Washing Box 7162
Madison, Wl 33 —716 Sanitary Permit N wrdw (tobofitkd in by Co.)
Sanitary Permit Application StateTME$Actiwi
In accordance with s. Comm. 6321(21 W's. Mrs. Coto. submissios of this die
unit is reqored pia to obninng a soa tasy permit. Nobs ApplscaGoa PO Pfaject ddress (if diffaemt than mailing address)
submitted to the Department of Commerce. Personal infotmatton you do � 2
ourrioses
in accordance with the Priv Law s. 15.04 1 m Stan. "I 1 S 9 g ,
L A a lafermatioa — Pkaae Print AY ties
Property Owner's Name 4P lrlc� parcel a
Property Owntes M"-Addmy -09 Property Location
503-5 X��� Govt. Lot
City. Staff Code T y zy, �t�
IMI QCZ E� /•' J'Y� (J [ M o (Peijcieone)
T R L" EorW
IL Type of Building (eheett all that apply O ft.. e d Lot a
2 Family Dwelling — Number of ! Subdivision Name
'f Np�Ki a f4� Block
❑ Public/Cotrmmrcial — Describe the Q City of
State Owned — Describe Use CSM Number ❑ Vitter or
Z Q'
f,Z. f'ZZ G wo O
1
III Type of Perrait: ( Check only otae bo oo line A. Complete kee B if applies y
A. System ❑ Replacro ent System ❑ TreaoneriVW ding Tank Only ❑ Other Modification q Existing System (explain)
B. 0 Permit Renewal F] Permit Rovisrai ❑ Change of Phnba ❑ Permit Transfer to New List Previous Permit Number and Data [sued
Before Expiration Owner;
IV. T of PO tN'IS etalG - eo: Check all that
on Pressurized 1ti Ground O Press rized in- Ground O At -Grade ❑ un
Mod > 24 m of suitable soil ❑ Mound <24 in. of sait�e w
tit
❑ Holding Taint ❑ OMer 'spasal Component (explain) ❑ Rareatrrias Device (explain)
V. rsaV! ea Ar loformatiew. cv
Des Des' Soil Appl Remo Dispersal Area Required Disposal Arm Proposed (so S em Elovatiov
7F7 , 1
VL Task Info Capacity in Total car of Manallidurar s
Gallons Gatos Units 1 a V a$� V
Tanks New Fxisli aTaslcs sIV ' ta rgc
W y +�. C7
r i (
Septic or Holdog Tank
VII. sib' ' Statentest 616e sadcrsiphei, atsaae for lastnRation of Noe POWTS shows on the sttuhcd
Plumber' Name (Print) Plumber's Sig MP/MPRS Number Business Phone Number
�c2 111 B l z2 x --
Plumber's Address (Street, City, Stare. Zip Code
V ill. Cone q nt Use On
Approved aPPr Permit F Date I s [ssuin t Signature
❑ rGivenResson Denial
IX. Conditt�y a i � gons for Disapproval
1. Septic tank, effluent filter and
dispersal cell must all be services I maintained
as per management plan provided by plumber.
2. All sd back requirements must be maintained
UPW
sad ssaadt N 1►e Gently aaly q pipe+ case ks 16as a r/s s 11 iactirs `sh
SBD -6398 (R. 01107) Valid thin 01109
P T PLAN
PROJECT GarvZifko
ADDRESS 5035 Nokomis Ave Minneapolis Mn 55417
E 1/ 2 SW 1 /4s 25 /T 30 /R 20 W TOWN St. Joseph COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/24/08 BEDROOM 4
CONVENTIONAL )00( IN- GROUND SURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallon LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
BENCHMARK V. R.P. Top of conduit ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 93.0/92.7 4.5' below g rad e
Well is to meet all
setbacks required by
WDNR Vent
> 6» Quick4 Standard -W
?4'Long r Leaching Chamber
with 20.0 ft2 of Area
o4 5.8ft ^2 /pair of end caps
ro "
Be 12
Hou Grade at System Elevation
34"
3 0' ` r
ST
-2
39
p B -3
Plans Designed Using
Conventional Powts 150' C.
Manual Version 2.0 5 Slope ' �Q 40'
4 0 2 -3' X 90' Cells with 80'
>3' spacing
3'
B.M. #1 60'
Property Line Ecop
P T PLAN
PROJECT Gar vZifko ADDRESS 5035 Nokomis Ave Minneapolis Mn 55417
E 1/2 SW 1/4s 25 /T 30 R 20 W TOWN St. Joseph COUNTY ST. CROIX
4/24/08 BEDROOM 4
MPRS Shaun Bird 226900 DATE
CONVENTIONAL )00( IN- GROUND SURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallon LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
BENCHMARK V.R.P. Top of conduit ASSUME ELEVATION 100' Filter BEST Filter
❑BOREHOLE O WELL H. R. P. Same as Benchmark
SYSTEM ELEVATION 93.0/92.7 4.5' below grade
Well is to meet all
setbacks required by
WDNR Vent
>6 » Quick4 Standard -W
of Cover Leaching Chamber
with 20.0 ft2 of Area
Bedroom 12,E 5.8ft^2 /pair of end caps
4 Long
House 3 4 Grade at System Elevation
30'
ST
30'
B -2
B -3
Plans Designed Using
Conventional Powts 150'
Manual Version 2.0 5% Slope 40'
2 -3' X 90' Cells with 80'
>3' spacing
13' B -1
B.M. #1 60'
Property Line
' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code Coun St. Croix
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 Parcel I.D. 0
l I r d im ens ions, n arrow, and l o cat ion perc s s lo pe, sca le o d mens rt ocat n and distance to nearest road. o
Please print all information. Re ' we Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Quest Development, Inc. Go . t E 1/2 1/4 SW 1/4 S 25 T 30 N R 20 E
Property Owner's Mailing Address ;7 i Block # Subd. Name or CSW
Suite 150 10700 Old County Road 15 Birch Park
City State Zip Code Phone Number y village Town Nearest Road
Plymouth MN 1 55441 ( 7¢3 - 595 - 9512 County Road E St losea
New Construction Useo Residential ! Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replacement Public or commercial - Describe:
Parent material T .oess over out wash sands Flood Plain elevation if applicable ft.
General comments f`
and recommendations:
This site is suitable as a below grade conventional system
I A L11 QO
❑ in. S
Boring oring
X G�tX �;ti
g # El Q pit Ground surface elev. 97.85 ft. Depth to limiting factor >
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary o * `k
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. !* 2
1 0 -94 7.5yr5/6 s Osg ml - - .7 1.2
,v
2 Boring # Boring 97.15 >94
pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -94 7.5yr5/6 s Osg ml - - .7 1.2
tl
�
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BO 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Signature C �. CST Number
Thomas C Nelson
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 10/23/01 715 -246 -2454
l
Property Owner Quest Development.Inc Parcel ID # Page 2 of 3
3 Borin # Boring
g 0 Pit Ground surface elev. 92.70 ft. Depth to limiting factor >98 in.
Soil Applicabon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -9 10yr2/2 - sil 2msbk mfr cs 2f .5 .8
2 9 -16 10 r4/6 - sil 2msbk mfr cs if .5 .8
3 16 -40 10yr4 /6 - sil lmsbk mfi cs - • .3
4 40 -98 7.5yr4/6 - s Osg ml - - .7 1.2
❑ Boring # U Boring
n pit Ground surface elev. 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
Q Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
El pit 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
* 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- 8330Test (R.07 /00)
3 3
�ICA I �
ti
oa
Q� t - 4AUQ&,.. J loo
504)
_ s'u
ti
komks n Is�
2Z -7 3 V 7
7'v l3 E �- SS�'(r�v F-O roR 1:5y
c' 30 • 2 ,03 • L o • oOv
o30- Z o.3 y. so • nory
0 3 2.0 3T /o
aaV
3& U 70 0VV Ulbricht & Associates
Private Sewage Consultants
3 0 2 a yd �jD �J 655 O'Neil n, W is.
Q v � " Hudson, , is. 54016
- 715 , 3S?G• /gs
7 - ? �.' 11 4 1 - 2—
� 5 ? 3
OF THE E 1/2 o f THE S00 "E 250.82'
SEC. 25, T. A R- 20
S00°00'11'E 250.82'
81.5Y 169.29'
, `- 1 SETBACK UNE
�'V 7� -- 1- - - --
co
» ® % N
a
i a r
m ' C► C O N co
I O tp ' CT co
�` , `V (A y O Q Of CD
CN N W 1 V y .�.r' O?
IV 'O 777 �.` / w yf
7'0.10W 401.73' X'
25TH,
° i7'01'E 413.26'
_ _ e lf
f
225.02' i 12729'
78401 UNE
( � .'... ♦ `ter � `, 1 I y -
' 1 ® I 29 dO
co
T
I
v m _t. M T w it I r
I 66, !%
R.
>,
UY
r
-Ph-
rn
ti
S0 !¢• _ m V
ao 27'W
Ob
r
. 1
—
(� Av, _ 1 _
4.
. ?� S �p4a
o
p° o BIRCH PARK
RJUN {WNW tocvled h the SW 1/+ d $1 NE 1 /e, ad se NW 1/I of 0e SE 1 /1, and tie NE 11e of the SE I/4, and the SE 1110
he SE I/1, oM se SW 1/4 of the R 1/d, ad the 4 I/1 of EW SW 1/4, ad IN K 1/1 of the SW 1/4, and the SE 1/4 `
of fee NW I d, ah B Scalia 1S, iaashi ]0 Nalh, R 10 Weft, loon n SL 'I
I yl i�P I D � daeph, SL Gain fanll , WataWn,
d
�I aP1WNC Rtf[RDICE
IN 50 IN of IM 9 11I aI $e ri (SEE SHEET 2) W aEtIOWS OEI ]N'dr as W em
- - + -- Won W.W k" d SWWa 1.50 us Pp"PoOI WNW
& nw" M wr f. , -- MATCH LINE B - - \ I motetwo him MRIeSEtRa
� I
Im r
� 0WRZ71 YEalpl
SCUP IN PER / 1 \ \ \ 7 �.._ dllWlEd WM aNae IOgWWI
- 1- 1 - ' —fWSaa W LK
sa++vsw I Wnnrt
ml NOR. Wv bb.4 Y Mot 1, W.
low In"N.4
I t ++Z 9 I f wod.
ally i' I 1*Nd sit 25 w
1 y �� LOT 27 r j i F 1 9I� LOT 5 j ®I o - mw M ow *.W.
1i I, town . k KOO �1I
x-
"We cit q bW roW NWI
I ar LOT 25
wl" L ' OI Ni 901111 W1131dIR
1 �`::,wn /'+� .... •� , ' I ' / ' Q° xdw 0 i � �,:� ruoWN Nr u
NYr r r r l `1 - -�
nu I 1 N �I [ WIN ++
\1 1' - -- -- '�' /' , ® i ,� m G. "zl Rai 11 FM W 'la a man I
LOT 26 ( d LOT 6 i PauWauuWWOnal 9 -
® N` \a"; �r'Rx u9WrWaRWnWI.
4 9 WAIU �! I
��R� SIP � �•�•� �," ` �al.er - - - - e � t iu m l
LOT 12 SAM � >W ; '' LOT 7
4 I(/ r p � 1 a, f I i 19 IOJ,EI' 1 1[.J NAd�W t 'h Iz 1 W I
XN'Of21'W Y y'1.� i.
Q' 1� II � ��J� 1'I•�I h Mrl •a�MYYMF1�Mr.�W1�
MIY a,.r Wrt 1 Yw. w .MIWr.YY.Y��. squ
WWTIAt NIAD i a aWM.Wrr Ya.aWrwr
� I Wrw.
Wwa'dvt Alm ,.un ;,; q, Mpwra.rW1yr11r,•W�w
\F A d ,, Wt� ;/ I •W.I...+ way.►
g j.
I ' xWW I ,
}P naWn J'� r +l ' !7� •nr w�rrY+www
w ! Q .w Y,+rw+WwkwlrYr
°s b m LOT 11 5 LOT 6'�
I c lp �; %41,
q p N1,OA WW 09 aN F(W ry Wwp a. �nlw l.�rwr P.hrWe
64. I N 1QI +W
�,, Iw �, Y Mn r,rr.xwr YYY I
' W1AY Pxr ^ •,/,' Q I " +.� W ..w. r+,r+Mw 1
I. late IBi,W
norm r W18 9 Q
0.1 #•aIAIDLN W[ ' I f \ \1 MY AwAWY�I�111Y1
uuUUrowWOVWY.• 1 I '� r i / I
j LOT lO d ; a �,nuRWaWI �«,� CU
y p A YY4M1M.. Y.Ir I{
o i AtWrPW p LO 9 I ; =/ ' Wr4 1 W i W w� W1 �1 hd �a
ul a. IW 1 r 27TH Wan OpNi00
ro + ans�
maw
rrwri� 4i
- ----'
— STR E 1 E t T nTU ` �.Y�
— — — L 9M !
; ••Q ; auo oea It SIT S � 551 . -W moarrrynr 1 IpSW' I I .IauW =dllw Yr+a �1 0
I. . i 0¢W A.I- ASIA -Ne P r � N,% - - a.Y..& � a
k' "�Mn ODES' LANDS
LD
NaINNIaW T Sl �� INN , mau
.
� ' � ar aW1A W �_ � -. YY rrw ��8U8
atM kE1t01 " f[a WI.9WW WI i I C.S.I e1 pWa l(l JWe 9W � / r-- aMiR aw "�� a
NPLAIIED
""" — r - -- — — — +, 5N ATIED LAND$
U
6 PC_IJ —1 UNPIAIT LANDS , — I - ----- I
mm A R003 VIES, INC,
I fi.rtserWeW
SID38T3OFI31®'I'S
1
!
't V) U) ^ o LQ
r, a e ^ C- i
cn -
a) I OD
z
✓ ( W
0
'4
l g0
\ 1�
Q
O
U') N
N \
� \ N 00 O
O O
W V p O
U
Z \ O N W .:
W
� LLJ � 3 y �
LLJ LL_ C O Z N [.� .a o °°
LLJ Q N r � ` c .�
w
W co UO 0
C7 O Q O
Z O O C U
Q c j E O
LJ CO CO 3
m .�' O N cF
= N
O c v
V) O N
F_r p \ N }
LLJ
ti
3 �
a 11
—
A. HZ — — — % it i
3N17 H3V&13S" _ K
! � s k
1 0
i -
'as Facz
L,OOo00S
u z
°z ! Y� � ��\ ,ZS'05Z M�, l 1,00,00N
F - -- \\ - - - -- - - - - - --i
—- -i - --a
I �r
I
I
I
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer �42 r
Mailing Address
Property Address artment for new construction)
(Verification required from Planning & Zoning Dep O
city/State Parcel Identification Number
LEGAL DESCRIPTION /
Property Location _��, 5 1 /a , Sec. . T N R
d W, Town of J7 � 0
Lot # °�
Subdivision: -
r , Volume _ Page . #
Certified Survey Map # (( 11 )
Warranty Deed #
,Volume Page4 _
Spec house yes no Lot lines identifiable qes no
s
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Imgrope
r use and maintenance of your septic system could result in its premature failure to handle tS W r put into
maintenance consists of pumping P
out the s tank every three years o r sooner, if needed, by a Pumpe
ranee
responsibilities P
the system can affect the function of the septic tank as a treatment stage in the waste disposal sys��Ow mainte
bilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary
Department a certification form, signed by the
The property owner agrees to submit to St. Croix County Planning & Zonin g v that (1) the on -site
lumber, restricted plumber or a licensed pumper verifying is
owner and by a master plumber, Journeyman p in ( if necessary), the septic tank
s stem is in proper operating condition and/or (2) after inspection and pump wastewater dispo y
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 Planning &
Zoning Department within 30 days of the three year expiration date.
ents on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the
pr e of a warranty deed recorded in Register.of Deeds Office.
P
CANTS) DATE
*
Any information that is misrepr esented may result in the sanitary permit being revoked by the planning & Zoning Department "
copy and a co of the certified survey map if
Include with this application a recorded warranty deed from the Register of Dee ds Office
reference is made in the warranty deed.
(REV. 08105
i
e r
7
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Je7mi Plan
n 1. system-fails, determine cause of failure, use alternate area and install new
tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715- 246 -4516
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CRO I X CO.. WI
DOCUMENT TITLE
RECEIVED FOR RECORD
02/07/2007 11:00AN
WARRANTY DEED
EXEMPT #
Warranty Deed from
REC FEE: 13.00
BIRCH PARK, LLC TRANS FEE: 420.00
COPY FEE:
to CC FEE:
PAGES: 2
GARY R. ZIFKO AND MOLLY C. ZIFKO, HUSBAND AND WIFE
Recording Area
Name and Return Address
Premier Title Insurance Agency, Inc.
7300 Metro Blvd, Suite 300
Edina, MN 55439 -2302
Return to:
Premier Title Insurance Agency, Inc.
7300 Metro Boulevard #300
Edina, MN 55439
952- 842 -8489 030- 2126 -70 -000
Parcel Identification Number (PIN)
THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE
This information must be completed by submitter. document title, name h return adtress. and EM (1frequkra). Other bifornmtion such as
the granting clauses, legal description, etc may be placed on this first page of the document or may be plated on addkional pages of the
document. fie; Use of this cover page adds one page to jour document and x2.00 to the recordmr lee. Wisconsin Stahaes, 39.43 (2+n) WRDA 2/99
tt l' • STATE BAR OF WISCONSIN FORM I - 1998
WARRANTY DEED
Document Number
This Deed, made between Birch Park, LLC, a limited
liability company under the laws of the State of
- MInne so to
Grantor,
and Gary R Zifko and Molly C Zifko husband and
wife
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County. State of Wisconsin
(the 'Property "): Recording Area
Name and Return Address
Premier Title Insurance Agency
Lot 27, Birch Park 7300 Metro Blvd., #300
Edina, MN 55439
File #23876
030- 2126 -70 -000
Parcel kWritiftation Number (PIN)
This is homestead property.
(is) (is not)
i
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
1`.
Dated this S day of February 2007
(SEAL) BIRCH PAIWA LLC (SEAL)
Sam s M. Waters, Its Chief Manager
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of ' Minnesota
ss.
Hennepin County.
authenticated this day of Personally me before me this a*
ry day of
3a:zy 4_-'Q r uc r � M _ , 2007 the above named
James M. Waters, hieanager of Rirnh
Park, LLC, a limited liability company
under the taws of the State of Minnecnra_
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If not, me con t o be the person who executed the foregoing
authorized by §706.06, Wis. Slats.) ir14[rument an�ackn edge the same.
THIS INSTRUMENT WAS DRAFTED BY
Premier Title Insurance Aggncyt, Tjri�,
Not Public S to f -
7300 Metro Blvd., #300, Edina, MN 55439 My commiss e. rma~. f#rYWNQtate a tration date:
(Signatures may be authenticated or acknowledged. Both are not y Notary Public )
necessary.) M (:ommh,bn 31, 2070
Name, of persons signing in any capacity must be typed or printed below their signature _ - - -__—
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Go.. Inc.
FORM No. I - 1998 Milwaukee. Wis.
APR. 24.200$ 11:44AM KRAUS- ANDERSON CP N0. 2265 P. 7
f I G
K►2 Mon '8 AmJ
�1 �N1Hrr� MW9 r r
M
J O
i
! I
i
i
i
APR. 24. 2008 11:45AM KRAUS- ANDERSON CP N0. 2265 P. 8 -
71 F I M 1p7uo1 1S INNS VB6l
GYAZ AII o1N '8 kBJ j1
+�auaAw.daWlov F BI E
0 ! �
w
_ e
t OD �+
.i
APR. 24. 2008 11; 45AM KRAUS - ANDERSON CP N0. 2265 P. 9
S
m %wown Inv
ovl7 NtaW '9 give ;
wwlw�cwl.aMwev
w�
0
--- - -- - - - -- —` ------ - -- - - - - - - 1
1 1
' - . -----�1 1
i
1
1 �
1 � 1
1 _
I I ;
1
1 � 1
- _ lif 11 - - - - --
1
1
1
-
lei _ ,\
1
1 1
; 1
\` f
i