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HomeMy WebLinkAbout032-2124-30-000 (3) g Im o / � R ; 3 � $ % A c k M ® © \ (w A !Vf /so \ I 4 °§§ / / E 2 g 2 ° © & 4 § E § a ° m ■ f ° § 3 E E OD \ \ Q § § J ° ■ , @ v > E A CL E e,® E > 3 \ CL ® k % Q iZj F3 o // oo3 r■ 8 8 & t i a z CL o o o Oro & / \ (A CA (A § / $ 7 0 0 ■ § E _ & 0 .. E2( \ R / n $ 2 0 \ k • C.) ( E E z 2 § -q ca . ■ © . ° k § { z � R 2 / Cl) 2 ° � k ■ F c 7 co z E � CL m § > / � — E0 % �$ z Q ° 7 ; \ � A � $ � § � 8: �\ W isconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) P Personal informatio you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City []Village ❑ T n of: State Plan ID No.: M & G Inc., Somerset Township CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: I/ b Z „ 1 032 - 2124 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark l c OD � Z, L Alt. BM 2. ID y 1(3 Aerati Bldg. Sewer 1 AM 9 Holding t Ht Inlet 1y TANK SETBACK INFORMATION Ht Outlet TANK TO P/ L WELL BLDG. Air i to ntake ROAD ir Septic 0 / r �� NA Dt—Bettom NA Header / Man. (Z -5 31 JA) /y. s S- / ry Aeratio NA Dist. Pipe Holding Bot. System i 3 PUMP/ SIPHON INFORMATION Final Grade x Z 9a. facturer Demand St cover 3 �L: Model Number PM TDH Friction tem TDH Ft L oss e F remain Length Dia. Dist. To e I SOIL ABSORPTION SYSTEM BED/TRENCH) Width Length No. Of Tr( PIT No. Of Pits Inside Dia. Liquid Depth DI E DIMENSI SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM j��A NG Manu cturer: INFORMATION Type of } 4� r oe Numb System: C Oh j M 1 2-1 IT M DISTRIBUTION SYSTEM i10 d w"'f`'' '`^" a -leO Header/Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _4,C2� Dia. Length Q3 - Dia. A Spacing -f� A, 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 1 ❑ Yes ❑ No []Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1• / lv /oo Inspection #2• / / Location: 418 172nd Avenue, Somerset, WI 54025 (SW 1/4 SW 1/4 5 T30N R19W) - 0530191111 Chabre -Lot 3 1.) Alt BM Description= 40v o p f }�0 - Aff� - q. ) 3 r ` ( 6i. w 6a We 5 ih 5 2.) Bldg sewer length =Z. / - amount of cover 3) wo w�1 ' j Plan revision required? ❑ Yes M No ��— Use other side for additional information. (p A. SBD -6710 (R.3/97) Datet Inspect ;7s Signature Cert. No. � a � ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: w .. W - E gp � _» gem m� y ,. b . � mom , . p ma�. k. �e,�. € °.nm ..» � . [ __ �(„ mm .✓ ... � .,�; m ° �. ,.� n � . °e « .. � 3 n t i x z + 4 9 & � i i 4 E _. _ ¢ i 1 3 J p 44Sk l id ��� E 1 z s N i i a � — �, Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. `� seons - See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison. WI 53707 -730' Department of Commerce (Submit completed form to county if r [Privacy Law, s. 15.04(1)(m)] state owner Attach complete plans (to the count) cop) only) for the r not less than 8 -1/2 x 11 inches in size. County State S anitagi Permit Number O C K krkv%i6Aojpr v�604�plication St Plan 1. D . Number I. Application Information - Please Print all Information Location: Property Owner Name tC ; ` Property Location Plat 6 INC 1 / 4 f(JI /4, S S T ,N, R (or )(0 Property Owner's Mailing Address L Lot Number Block Number r>> ST CA .)LK 13 12 COQ r City, State Zip Code Subdivision Name or CSM Number II Type of Building: (check one) ❑City I or 2 Family Dwelling —No. of Bedrooms ❑ Village Cl Public/Commercial (describe use): V•Town of ❑ State -owned Q E _ III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road UC A) 1. 0 New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Onlv Existing System 03 — B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued 1 . 30 .19 IV. Type of POWT System: (Check all that apply) a fl l X Non - pressurized In- ground ❑ Mound ❑ S d Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade o2 3 f I , ❑ Aerobic Tre en Unit ❑ Recirculating ❑ Other: 3. V Dispersal/Treatment Area Information: t S /NFi;i� — Crk- 1. Design Flow (gpd) 2. DispersalArea 3. Disp ea 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. R.) (Min. /inch) 0,35- Elevation 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 ❑ ❑ ❑ ❑ /L MOO too ❑ ❑ ❑ ❑ O VII Responsibility Statement I, the undersigned, assume res on ibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) PI er's Signature (no scam s): PRS Business Phone Number i'Y� -a-- -c Plumber's Address (Street, City, State, Zip Code) J !' VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Sign ture (No stamps) Approved ❑ Owner Given Initial Adverse S arge Foe) Determination $-� _ ( — Z O kaw& IX. Conditions of Approval /Reasons for D Sy 'sf. ,ire So 5 �..�z has ux`r lu �, ,(moo iojt; / 6 Aays S s S41" SBD -6398 (R. 07/00) j O +- f i - -- -- -- - - -- -- - , /;i , , - - -_ r � l lx; f � MAI. 3 --�-� �-- + : lip — - - - - -- ypor p7R , -� - - - ;— � �GT-- �- � �_-, i� �• tL. �e '- Q-- _.Z` ld - - - -- – - - - -- - - _— _.-._. _ - • r , i G - - -- , j 1 , i 1 -r - ,- -- 336 NO IVA : , I - - - - -- -- a/ --- 1 -. -'- iii -� -.- -- __ _- _. _ __- Y ._ ._-�r -'�-..r._�- _�."•.-. -. :- ..K.L. `__�._ �_- _____'__. __ -.. 1 r � - t -� - t �--- - - - -+ � -- � --E -- - -�— — --� - -- � s � � � i � � � �. + I � p � � i � � - , _.._. __.' -- —_ - _ -- _ —.. _._.._ .. _. 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I ' � I S , i ' r � � f p __ ... .. .. _ _ _ .. � I } 1 r �_ � _ _ � � � r � � _ � ' � I � � � r � ; P � I . , _ � _ _ I _ _ , f _, _ . i . _ �_ - - � � � i i t o L,� i S 1.5j 1015 Wisconsin Department of Commerce SOIL EVALUATION REPORT (5-- (Y' _ *0) Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 032- 2124 -30 -000 Please print all information. R viewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location M &G Inc Govt. Lot SW 1/4 SW 1/4 S 5 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1359 Awatukee Trail 3 G k,6.rl V A /S Yo & syb City State Zip Code Phone Number J City J Village ✓J Town Nearest Road Hudson I WI 1 54016 1 715 - 549 -5971 Somerset I 172Nd Ave 0 New Construction Use: 6el Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD I Replacement _J Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable NA General comments and recommendations: Conventional Sy5fem (Step Trenches) Possible System Elevations 88.35'& 86.15" Boring # I Boring Pit Ground Surface elev. 95.23 ft. Depth to limiting factor >90 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 0 -9 10yr3 /2 none sit 2fsbk mfr cW if .5 .8 2 9 -16 7.5yr4/4 none scl 2fsbk mfr gw - - - - -- .4 3 16 -90 5yr4/4 none sl 2msbk mfr - - -- - - - -- .5 r Boring # Boring ✓l Pit Ground Surface elev. 93.15 ft. Depth to limiting factor >92 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3 /2 none sit 2mgr mvfr cw if .5 .8 2 8 -28 10yr4 /4 none sicl 2fsbk mvfr gw - - - - -- .4 3 28 -92 5yr4/4 none sl 2msbk mfr - - -- - - - -- .5 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD <30 mg/L and TSS .5 30 mg/L CST Name (Please Print) Sign re: CST Number Thomas I Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number Somerset, WI 54025 9/6/00 715 - 549 -6651 Property Owner M & G Inc Parcel ID # 032 - 2124 -30 -000 Page 2 of 3 a Boring # Boring orl Pit Ground Surface elev. 89.21 ft. Depth to limiting factor >91 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 1 0 -7 10yr3/3 none 1 2fsbk mvfr gw if .5 .8 2 7 -16 7.5yr4/4 none �j 2fsbk mfr gw - - - - -- .5 .9 3 16 -91 5yr4/4 none S1 2msbk mfi - - -- - - -- .5 .9 ,4- �5(o •IS I r 3h . �Z � •�Z F-1 Boring # I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Ef1#1 *Eff#2 ❑ Boring # —j Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G P 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 <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 nlease contact the denartment at 609 -266 -3151 or TTY 609 -264 -9777. 1 4 C P,t+ _ i I - _ n 6 - - -, — - -� _ _ _ {{ ' , ,MN ' b �, ,�.. a s � GAY (Od r r _ re ., 5 0,E ou I i, � I � i -_ � � I r i i ` __ �.. 'i �' I i � i i � __ 1 �. �, �: � ' i � _ I _ � � ' � � I ' � i , i '. i i �. '. i I r i ,... � _ '� �, �. - �� _ � '. i '. ' i i r r i i r r �� r r r r r r r _ � � � � _ _ :,Wisconsin Department of Commerce SOIL AND SITE EVALUATION 1 Division of Safety and Buildings Page 1 of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis, Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ,C 00) percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ,,�; / yr, •' 4 � "` APPLICANT INFORMATION - Please 9' jft a0niormation. Reviewed by Date Personal information you provide may be used for secg daFypurposes (Plmcy J aw, s. 15.04'(1) (m)). Property Owner C F ; " Property Location Govt, Lot SW 1/45 1/4,S s T �,N,R / Cr E (or)FV Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone q ter -`,' -E] City ❑ Village Town Nearest Road uC n l�l ! ) J �JI ` f ,e kLc(. It ASP� Construction Use: residential / Number of bedrooms ? S - �:t Addition to existing building Replacement ❑ Public or commercial - Describe: p Code derived daily flow OU gpd Recommended design loading rate "-) bed, gpd /fi O trench, gpd/ft Absorption area required S� 7 bed, ft ft2 Maximum design loading rate bed, gpd /ft ___&_ trench, gpd /ft Recommended infiltration surface elevation(s) r►O� r G0 -J $ rXy.G a ft (as referred to site plan benchmark) Additional design /site considerations r4 G�• a %✓ 3•� O Go�u�(" �3. /C� Parent material Flood plain elevation, if applicable • -e-1 14- ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U S U [�3 S ❑ U I [e S❑ U ❑ S FK U ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench id r 3 ! ( �;1 2 mfr cs 2 IC iC� `I t`I 2 m '►� c s Ground 24-10( ­ CC) LS S -1 elev. •6o ft. Depth to limiting factor W in. Remarks: Boring # 5 2 �l -2 8 l G -- S I 2 x' 3 2 oA - �Ito -- ; Ground elev. $fL-71 ft. Depth to limiting factor -1 f O n. Remarks: CST Name (Please Print) Signature Telephone No. ADO rvi 56 GN U M 11 Address Date CST Number 5467 - lS- 6o Z PROPERTY OWNER ���,y� SOIL DESCRIPTION REPORT page Z. of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench -� /Ovf Z elM I , I r tQ — L C — 7 Ground elev. Depth to limiting f ?Kin. ' Remarks: Boring # �- t r -313 --- s•i 2 �^n -fir �� � � . � ;. z —r2 yl q -- Sit - -Idi to 31 L s Ground elev. ft. Depth to limiting factor _vLin. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, Bed Trench Boring # 1 L -`-f I 14 Y, Ground elev. EO ft. Depth to limiting factor 9 ' n • Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) � w PAGE - �,_OF_,� NAME .S 1 60+- LOT# 3 LEGAL DESCRIPTION.51v ` /,Sw' /4,S T 3p ,N,R! Q E (or) Q c SCALE: F'= (py BM I ELEVATION 100 • (� BM I DESCRIPTION Ac4 l k ' pule 1 BM 2 ELEVATION 400 • d BM 2 DESCRIPTION 1,.,,, Fj "p, lc w Ff" I SYSTEM ELEVATION Yf, r ow-r Y l- ( ALTERNATE ELEVATION 83. (q ta 73. lV ' CONTOUR ELEVATION ,e, 14. • Pr'33► a I SIGNATURE DATE 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 Number of Bedrooms Design Flow - Peak (gpd) 5 O Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft eo -- 9 s = Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) I bOO ?" 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 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 r - �► 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. 9 99 9 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer - - - Mailing Address �wl� -1'tnk ere � l� �w cJ Property Address is 119L (Verification required from Planning Department for new construction) City /State SO` irvQ1 'Se Parcel Identification Number n3a - al ail 30 - 000 LEGAL DESCRIPTION Property Location '/,, '/ Sec. S , T _"-R 19 W, Town of �trer Subdivision YukT C Wk�r c , Lot #_. Certified Survey Map # , Volume , Page # f SB9 Warranty Deed # (q 2L \\-Ikit ® , Volume I S_Y 0 , Page # 5 fo Spec house - �Q yes ❑ no. Lot lines identifiable W yes ❑ no SYSTEM .MA.INTENANCE :. "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 wastewaterdisposal system is m* 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 three year expiration date. %, q i Cu /Oo SIG TURF O APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. t_rl %\ a - / / 00 SIG ATURE OF APPLICANT DATE t•s'sa 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 t540PAGE 546 \ c STATE BAR OF WISCONSIN FORM 2 - 1998 629440 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST CROIX CO., WI RECEIVED FOR RECORD This Deed, made between 09 -07 -2000 8:30 AM RICHARD 0. STOUT and JANET P STOUT, husband and wife, WARRANTY DEED Grantor, EXEMPT R CEkT COPY FEE. and M & G, INC COPY FEE: TRANSFER FEE: 142.50 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 3 , Plat of Chabre, Town of Somerset, Recording Area St. Croix County, Wisconsin. Name and Return Address i3S"�1 AW p,' M. w I V 032 - 2124 -30 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) �i �I i 'i Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 6th day of Sentemb r 2000 �a�V�9t.� —�L �• \��l�l (SEAL) (SEAL) * Richard o- Stott * Janet P. Stout (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, ss. St. Croix County. authenticated this day of Personally came before me this 6th day of p t emhe r 9000 , the above named Richard 0. Stout and Janet P. Stout * TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person S who executed the foregoing authorized by 5706.06, Wis. Stats.) C instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY $ HNC a JAC OBS Janet P. Stout ate o/ Pubbb EN 1353 Awatukee Tr. nsin H udson, W1 b Notary Public, Stat of Wisconsin My commission is permanent. (If not, Q 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. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis. l .00N OYF1>Mfl0 /O��{MO.Ol .CL•LL L 1 i.l L.t LrOM Ig ]..tLIl.00N r5 � r c �... 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