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HomeMy WebLinkAbout032-2157-70-000 ANO' A A cn O 3 c °: f l ° c l c> c, 3 h. 7 3 T T 6f I m ID �_ 3 wo X _ I O N N O N C I 3 - 0 z N O w d I w V=i O O W C� O N N v • A W i C n 0 � p coi y w n p N w° ° N. M CD CD _ V Pr 7 ' O a 0 W v I (D O O O CD a I a co o 0 y C t�D N C y N y r O ~• Er O r �i c . C m - co D N a a o l D O O w D y d a o CL IW o < CL I- ou - a 1W N OD CD O N O 0 O 0 O O) N I CO S I .. tD T O o w f o a CD I o � CD CO) 0 c_ �. CD l CD 3 0 0 0 3 O O O 1 0 0 0 f CD rr aft J 1 :2 a n n c to to to Sr 3 to to to l c to to to ? CD 3Q '.,00v� 30. - ovv3 3v �v _q3 = N 0 ID H :2 N lD tti O N ID w y 0 cc _ P a g 3 -4 o 3 d g 3 d y 3 o 3 0 Q U O V : =� o V O D o 0 N N N y N ;o C ;o C ;o p C C N C ; N C N• _ N A n n CD = CD ' N N -i to N a a s A G 3 I I I CD A 0 (D A N m O N CL c o, a z a a a z A C o u3i m z N °' o@ II W� A a r2 �y�� a c a) o oa a Q. a � m c (D o m c �o ny 'm c nom,_ _ � c o a 7 g c o a a o a m N cc 53 K] Q 3 (D O N V7 fD Q m Q I CD y 3 fi cr rr m to 01 v O ��• N so t7 cr 3 m (0 b 0 CA .� s CO 0 _ � v 0 3 3 O's (DD o c vi 0 c '� = N �• b 3 cD O .� �p N qb O CD ? 0 O O O O (D CD Op O N 0 O C as r - �. � _.._ ;, _ `` �� � / -�' ` 1 "1� U � ` Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Saet and Building Division INSPECTION REPORT Sanitary Permit No: 463243 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: Gra Properties L.P. I Somerset Township 032 - 2157 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 9 9th , g I 1?� •- , CST 12.30.19.1359 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �.+ Benchmark 1]osiay- 1 n � Alt. BM . ,t Ccit.— Fd" Aeration Bldg. Sewer I o f - 5 Holding St/Ht Inlet Z 1 3 TANK SETBACK INFORMATION St/Ht outlet 1) TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` `\ n• Septic ` . / Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System (� PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover - -- GPM Ito < <c Model er 93. �k TD ft Friction Loss - Head TDH Ft 57 Forcemai ia: Dist. Wen SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / i No. Of Trenches PIT DIMENSIONS No. Of Pits_ Inside Dia. Liquid Dept DIMENSIONS 2 - K+ - C1_Z Z TI SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ` Z 7 z I UNIT Model Number. DISTRIBUTION SYSTEM / ZZ 96440" -- 4g." ib" Header/Manifold � 7 Fistribution x Hole Size x Hole acin Vent toq Intake ipes )`f Length 9 Dia ength Dia Spacing I P0 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of ] 7x Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ?�, � Yes 0 No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 891 170th Avenue New Richmond, WI 54017 (NE 1/4 NE 114 12 T30N R19W) The Highlands Lot 17 Parcel No: 12.30.19.1359 1.) Alt BM Description =" 2.) Bldg sewer length � - amount of cover Plan revision Required? Yes �No l Z I h / Use other side for additional informs lof n` _ • " - Date Insepct s Sign re Cert. SBD -6710 (R.3/97) i G e S a 7 >r 7 - 4�i„ 'r T t� � � v , 1D �- IirQi l .� �o, oe h� - Iv Ultsfi r _ - Safety and Buildings Division County Ise Madison, 201 W. Washington Ave„ P.O. Box 7162 Madison, WI 53707 2 Sanitary Pe i Number (to be f I in by Co.) Department Commerce (608) 266 -3I� 3 Sanitary Permit Application O State Plan I.D. Number k In accord with Comm 83.21, Wis. Adm. Code, personal information you provide � may be used for secondary purposes Privacy Law, s15.04(1 m) Project Add re (if different than mailing address) I. Application Information - Please Print All Informati n Property Owner's Na me `h O g 204 Parcel # Lot �- DE C or Block # z t'V 71 17 Property Owner's M ailing Address Property Location ZONING OFFICE _':�1/6_7- 7o.d GQ-� cL �,g � /�cv� ` C ity, state �� • 13 ' Zip Code Phone Number '/,Section �„Z II. Type of Building (check all that apply) T N; R 1 or6sP 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSIM Number ❑ Public /Commercial - Describe Use C�- ❑State Owned - Describe Use ❑City_❑villageX_4ownship o Type of Permit: (Check only one box on line A. Complete lin B if applicable) A. — - — New System ❑ Replacement System ❑ Treatment/ Hoiding Tank Replacement Only ❑ether Modification to Existing System -- - B. ❑Permit Renewal } ermit Revision Chan a of ❑Permit Transfer to New List Previous Permit Number and Date issued Before Expiration �— P lumber Owner )i5 - 3 b IV. Type of POWTS System: (Ghee!: all that apply) W Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil L, Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland lJ Pressurized in- Ground i❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter I LEI Recirculating Synthetic Media Filter &Le aching Chamber _ Line ❑ Gravel -less Pipe ❑ O t>cr (explain) V. Dispersal/Treatment_ Area Information: D esifn F low�� )�Design Soil Application Rate(gpdsf) Area Required (0) Dispersal Area Proposed (st) j lion t �� ✓ '1 r �� ,3 _ 3 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site tecl Fiber Plastic� Gallons Gallons of tints i Concrete ' Constructed ( Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treaunent Unit - Dosing Chamber { VII. Responsibility Sta tement - I, the undersigned, asswtte responsibility for ' ta llation of the POWTS sh own on the attached plans. Plumber °s Na me (Print) I Plumber's Si gnatur P . PRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) 1 Id VIII. otutt iD epartment Use Only Approved �❑ Disapproved Sanitary Permit Fee (includes Groundwater Date 4sued Issuing A ni Si ma Stamps) Surcharge Fee) Up ❑ Owner Given Reason for Dania] ��, -- �"� - b IX. Conditions of A for Disappro� - Q Atta complete plans (to the County only) for the system on paper not less than 8112 x II inches in size SBD -6398 (R. 01 /03) i'G ,ofN s > 1 O-o ;, is- e � t+ x 1 � • ter' ap wft, t � 1s b 1 • 1 C i �� i3�--- ---�4� �? � -- ��� �t� � ��' �� °��. l� � - - -- - -._ 0 Wisconsin Department of commerce SOIL EVALUATION REPORT Page ) of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code S . f C raj x 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 Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. viewe by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G� Property Owner Property Location 2 �C�'�LJ�► q S" [OtJ�- Govt. Lot /&/� 114 S /Z T 3 a N R E (o Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 13 5 3 A Tr . 1 - The -H i hlarnd5 City State Zip Code Phone Number ❑ City ❑ Village [2:fo Nearest Road HtAdS6h W 1 I (p i C )-54q - (0"131 I �(J [ New Construction User Residential / Number of bedrooms Code derived design flow rate 4'SO GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material o,247:1A S a 5 (\ Flood Plain elevation if applicable General comments � � 5 �� Y1(� d R-, V' � 4-o P "t" �V � � - and recommendations: 4 t-+, e l e UU 40'e - ST CRUX F ❑ Boring ' Boring # f ® pit Ground surface elev. ,Od ft. Depth to limiting factor i r'� in. \1 `Rate P Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I 0- 10 1 I 5.1 Z m�r CS kJ 5 Z 1 - 1 4 — Sig 2 mCr c5 3 19 ,116 , to Boring # ❑ Boring �CG ® Pit Ground surface elev. D ft. Depth to limiting factor I 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 I 'Eff#2 2 q- y 1 S i c.-1 Zrn b cs 3 yo- i M5 o rn ' Effluent #1 = BOD > 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) gnature / CST Number d6L" Sch e % G Evalu zs 330 Address Da a ation Conducted Telephone Number 21 1.5 967� S� S, w I 5tfo2 /4-30 C 715)Zq'7- 4008' SBD -8330 (R07 /00) Property Owner S 46u l Parcel ID # Page G of F-31 Boring # ❑ Boring pit Ground surface elev. �5� ft. Depth to limiting factor I_ Z�_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color i r_ Sz. Sh. 'Eff#1 'Eff#2 m r c5 IJ 5 . 3 z- I to h os m I ! . 2 /, 3' ❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 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 GPD/ft 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 -8330 (R.07 100) i Property Owner S ,48ul Parcel ID # Page Z of 3 ❑ Boring # ❑ Boring 3 [ pit Ground surface elev. lS Y6 ft. Depth to limiting factor I Zd in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I 0 -10 Icy 1 5' m r c 5 Iv.0 5.$ 2 — (O y I _ S i LI m�' SS — 3 Z-I Urns, F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ ❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EffV 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. � a � A te. \. i '.a •, :� ,� . SBD4330 (R.07/00) Property Owner S46L t Parcel ID # Page of 3 F- Boring # ❑ Boring [$ pit Ground surface elev. S ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 *Eff#2 I 0 -10 jour3lz. s' m r c5 Iv.0 S 2 - f() 5 I ' d YYN C-S - 3 Z-I rn S OS m 3� 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 GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i I F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i - T - Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/t. 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. ssn.as 0 1 .t• S r PAGE 3 OF--f>- NAME u LOT# LEGAL DESCRIPTION&F- VE t /,S /ZT50,N,R, f�f E(or SCALE: 1 "= qo BM 1 ELEVATION JCQ • (3 BM 1 DESCRIPTIO Q ., 3 ``,p�c 1P, 62e — t I. BM 2 ELEVATION q -7 ,q6 BM 2 DESCRIPTION d„ c - L- Orr P� e SYSTEM ELEVATION ,6e qy ao " r c' 3• 3 m ALTERNATE ELEVATION .ppf z.,5p. 1,ower ye. CONTOUR ELEVATION 16•rr6 d- qj?, 6c) --- - - - - -- IGNATURE ���� DATE J2 z p': GO o< _ >rn-I� O � Cl) �, z O c �vo �n z m p z m El h .. m � � � n = v o m o� m •► O m X •O K �a > 0 2 � m n m( z c O z --� a Cl) p c X o O r . Z - p � Z z z G) m to C --� Q) Z o -o m ;a 0 C X rn _ r - z � � �l j� rT1 O m .,, C --i z 0 O `y O v m z O O C oo C m s ? In G) M X n g a s a, CD Wn x C LA 0 o C P E R O__' z Parcel #: 032 - 2157 -70 -000 12/08/2004 05:03 PM PAGE 1 OF 1 Alt. Parcel #: 12.30.19.1359 032 - TOWN OF SOMERSET Current XX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * GRAND PROPERTIES LP GRAND PROPERTIES LP , 712 RIVARD ST 300 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 891 170TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.287 Plat: 2090- HIGHLANDS,THE 02 SEC 12 T30N R19W NE NE LOT 17 THE Block/Condo Bldg: LOT 17 HIGHLANDS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 30N -19W NE NE Notes: Parcel Hist ate Doc # Vol /Page Type 7/15/2004 768929 2617/521 WD 1743/196 WD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 11751 63,600 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.287 53,900 0 53,900 NO Totals for 2004: General Property 3.287 53,900 0 53,900 Woodland 0.000 0 0 Totals for 2003: General Property 3.287 53,900 0 53,900 Woodland 0.000 0 0 Lottery Credit: Claim Count 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Suildin� Division INSPECTION REPORT Sanitary Permit 0 GENERAL INFORMATION l TO PERMIT) State Plan ID No: / Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 1lJO Permit Holder's Name: City Village X Township Parcel Tax No: Grand Properties L.P. I Somerset Township 032 -21 7 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 12.30.19.1359 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft I I I Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. 7 id Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil T Yes No � Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 891 170th Avenue New Richmond, WI 54017 (NE 1/4 NE 1/4 12 T30N R19W) The Highlands Lot 17 Parcel No: 12.30.19.1359 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? rx� Yes E No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 5. . N visconsin Madison, W1. 53707 — 7162 Sanitary Permit Number (to be filled in by Co ) (608)266 -3151 S 3 L 13 S Department of Commerce State Plan 1.9 Number Sanitary Permit Application N I In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s A4(1 Xm) Project Addre s (ifdifferen han mailing address) 1. Application Information — Please Print All Information Property Owner's Name Parcel k of Block H maw /1CD/O f� i 0 e0 Property Owner's Mailing Address Property Locati 2 R/ A/1 f _ V. 6 '/., Sectio City, State i Pone Kum r 7 `J :Z y7� J{ )' OCR T R /9 E o II. Type of Building (check all that a pp l y ) CSM Number o/) 1" Subd' sion Name 10 1 or 2 Family Dwelling — Number of Bedrooms ❑ Public/Commercial — Describe Use � ❑ State Owned — Describe Use o2 D 1ST• G�S ity_ ❑Village ®Township of Q/' III. Type of Permit: (Check only one box on line A. Complete 'ne B if applicable) A. ■ New System ❑ Replacement System ❑ Treatment/Ho 'ng Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision Change of Permit Transfer to v List Previous Permit Number and Date Issued Before Expiration lumber er 30 3 IV. Type of POWTS System- Check all that appl Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 . of sui a soil ❑ At -Grade in s ilt Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter Ae is Treatment Unit ❑ t Ling Sand Fi r Recirculating Synthetic Media Filter > 11 u � -chingCKamber ❑ Drip Line ❑ Gravel - I ipe ❑ Other (explain) V. Dispersal/Treat ent Area I for ation: 0 ) 1 .5 Design Flow (gpd) Design Soil Application st) Dispersal Area Required (s Dispersal Area Proposed (sf) Etc v tion VI. Tank Info Capacity in Total Number Manu turer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass /� New Existing Tanks Tanks Septic 4 Holding Tack ity. Z o o Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibili or installation of the PO ITS shown on the attached plans. Plumber's Name (Print) PI 's Signature M RS Nu ber Business Phone Number Plumber's Address (Street, City, State, Zip Code) c, / &iv 7K VIlI ounty/De artment Us Onl Sanitary Per it Fee (includes Groundwater Datf ftued Issu ent Signature (No tamps) Approved ❑ Disapproved rcharge ) ` /S r C/V g ❑ Owner Given Reason for Denial J V Su A Y la. Conditions of Ap e roval/ easons Tor Disapproval / TEM OWNER: r` 1 Septic tan , e uen 1 er ancf _,, 3 dispersal cell must all be serviced / maintai d as per management plan provided by plum r. 2. All setback requirements must be maintai d�.� per applicable code /ordinances asp . -n 7 . pp Attach complete plans (to County only for the system oa paper n t than SY2 :11 inches n size SBD -6398 CR. 01/03) � Un S(,c t°/yr\ (�— Qt �O i 1 1 { ' r K r. t� ��^ � �� ��.� � � i t I I y' vc vE� N sp ow; : ! 6 S -- - - � S�CSTb lEi�li.nAU - y' j , I L -- I I — I -� 0 7E cr u Sy Ec = 9� i2,S C1- - -- - Y -- sic D /1 7/� /Pi Ui4�A S7 �O�E/21�E7 �i' .s Yo2s= _ �O�E�QS�� - T �i • - Sf��'.�5: - -' ��2l7Y� quo 3° 3' S CS7 71 EG. .0CU S y S E77 r hel . ya. 7S' 93.7 gay' 9c' 98 � ' r'k -op�Y c'.k� 3�• - - /- 3`'XG.�,l 7a &NO Itn 3 0C-,p 7 f a /aoa G s- �-4 Sao r <<.e4 Z ; l / g 2 4 - - - 19)7 7o e- _ y �° J -_ Y YO 7E - 9 8 � -- sGylrcrr�_Ja�.� _ S r�i7 �c _ � 9�Z. �s " � _ _ _ Sy�s�i -►r e�c� . kAWIM(- f og, _ &A .nc�,,r F <!lU RA '_J,7- _ S Ug�c Y f/ « LUT2 r i � _ _ ______ __._ _ ___ __ __ ...___. F _ -_ _. _ _. _.. _... _.... _. _. __ . _... -_. _ _. __._ __. _. _ _.. _. ___. ___ __ ___ ___ __ ___ ___ ___ _.__. ___ _ _ _.. ___ __.__ _ _. _.._ __ I _ _._ __. _ _... _._... . _. __. -.. _..._ __. _. _. __ _. . _ ____ _. y r PAGE 3 OF DAME LOT# LEGAL DESCRIPTIONAE `/ uff_ %,S /ZT So,hLR, l q E(or_ SCALE: 1 "= qo I 1 BM 1 ELEVATION 100 (3 BM 1 DESCRIPTIO k `` dOyc P .P e BM 2 ELEVATION gq.y0 BM 2 DESCRIPTION p Q.0 -3 /u" OirG P g SYSTEM ELEVATION ,6,e quo Lu��r Y3•� ALTERNATE ELEVATION I,«„er.gZ,0 CONTOUR. ELEVATION 26•ap 6- qg, cc) 4 (,00 L���ao iZ�r j �1 X76 o 3 1 01 i (J L TUkE DATE /8O 46 t Lrrr� �tm si ,ter t� �/ E�/ v- S CldG� 6 7 P S Z 1 STATE BAR OF WISCONSIN FORM 2- 1998 - 7 6 4 9 g WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between _ _ ^ -__ -- 7/15/2004 12:40PM RTrMARn n _ cmnrjm and JANET _gam - STOUT -, — WARRANTY DEED h usband anA w� fgr — ---- EXEWT # Grantor, and REC FEE: i1. 00 GRAND PROPER?tTEC , T.P - TRANS FEE: 194.10 COPY FEE: CC FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate In Gt ST'n1x Co unt y. State of Wisconsin: v Lot 17, Plat of The Highlands, Town of r;nc >ra�� �rra Somerset, St. Croix County, Wisconsin Name and Return Address rr A "t G-t e 7 R, UAR0 STR- S SomefseT wl SY6LS' 032- 2157 -7 -000 Parcel Identification Number (PIN) This i s not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, righto -of -way and covenants of record. Dated this 14th day of Jules 2004 f� (SEAL) C��t t , / (SEAL) . Richard O. Stout Janet P. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St- _rro i x County. authenticated this day of Personally came before me this day of .Tu I V _ _. 7 Q 0 4— the above named _ — Ei nhard C)_ Rtrint and .Tanpt R Sto ---------------- yp TITLE: MEMBER STATE BAR OF W to (If not, a known to be the persons who executed the foregoing authorized by §706.06, Wis. Stats.) } AMY J. trument and acknowledge the same. McCUNE THIS INSTRUMENT WAS DRAFTED BY ''iy d'tf a Janet P. Stout l C C1� 1 O G Hudson, WI 5401 6' Notary Public, tale f Wisconsin My commission is permanent. (If not, state expir 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. - r % 4 s :i. Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Building Division "%' , 11, INSPECTION REPORT Sanitary Permit 027 0 (ATTACH TO PERMIT) GENERAL INFORMATION i • State Plan ID N� 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: �4�t; -r��_ Somerset Township 032 - 2157 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 12.30.19.1359 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO I P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length 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 Bed /Trench Edges Topsoil Yes [] No [-] Yes 7, COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 891 170th Avenue Somerset, WI 54025 (NE 1/4 NE 1/4 12 T30N R19W) The Highlands Lot Lot 17 Parcel No: 12.30.19.1359 1.) Alt BM Description = NOE t aa � +0 - 2.) Bldg sewer length vx - amount of cover = P la n Use other d Yes No e for additional information. l _ SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County 1 f 201 W. Washington Ave., P.O. Box 7162 s% Visivonsio Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) DDepa rtment of Commerce ((608) 266 -3151 3092:7 r z Sanitary Permit Application State Plan I.D Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide _ may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Information Property Owner's Na me - N K - V L. Parcel # Lot # 'Sleek I Property Owner's M ailing Address A '.j is i L, � Property Location 3 `A,Section City, State Zip Code one 1` (circle o CI.t� J y� _.r. t - ,_ - T 3 � N' R E or H. Type of Building (check all that ply) r t-- -AA 1 of Bed ms 3 1� Subdivision Name CSM Number or 2 Family Dwelling - Number ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use ❑City�❑Viltage Township of �nG/ifG M. Type of Permit: (Check only one box on a A. Complete linefi if applicable) 032 vs cm • A. WNew System ❑ Replacement System ❑ Treatment/14 ing Tank Replacement Only Other Modification to Exist' B. 1 Permit Renewal El Permit Revision ❑ hange 11 Perm1 far o New Lis rev' s ermi m Is Before Expiration Plu r Owner IV. Ty of POWTS System, Check all that apply) Non - Pressurized In- Ground ❑ Mound > 24 in. of suits s ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ ding ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leachin C r ❑ ri Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal /Treatment Area Information: Y ` " I- X Design Flow (gpd) Design Soil Application Rate(gpd spersal ea Required (s Dispersal Area Proposed (st) System Elevation yip �• �3 � � �� Z Q� 3 VI. Tank Info I Capacity in Total Number Manufacturer fab Site Steel Fiber Plastic Gallons Gallo of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank l Aerobic Treatment Unit Dosing Chamber i JStmate,p VII. Responsibility Statemd, assume responsibility for lion of the POWTS shown on the attached plans. Plumber's Na me (Print) gnature /M S Number Business Phone Number - 713 Plumber's Addre ss (Str eet, C VIII. Count /De artment Use Onl Approved C1 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Iss i gent Signature o Stamps) Surcharge Fee) ❑ Owner Given Reason for De 'al 2 SD IX. Conditions of Approval/Reasons for Disapproval Attach complete plans (to the County only) for the system on paper not less titan 8112 x 11 Inches In size SBD -6398 (R. 01/03) i 2 H y ti `''+ r ,:. v h T i i, s ti >6o�r6S s'E�� G✓� z� b� { fa /60 v a �V h 83 Il r � AM j i � ' 1 f l l k YY A J j*--. G R 1JanUj o c Q - s o cu ;. 0 ?_ j c ! O i .--� cc s C G = r i co Ci o EE:S� -a X I acm c o U u, co co CD . � r U, co CL m0EL.?' aD� Q U"F —Q CO U A Cl) U C/) 4 L E CL o j u- - o U .= x s c a� �. - � L y L cis ,- (2 a IL I �I) A ` t ,�; IJI 3•. E R 0 LO /r N 11J.! E ��- L .Y m � � Zw C o # o �; urd. ' I 1 w UJ s • 4 J` N 1� (, W� � � � f LLJ m m N � p W Ili �� I--- a a Ek � . LL Ij i1����LI✓ ` C m i a cs xm ' VY... �•�� m �• Vi •, I m J i r - SE TANK PUMP CHAMBER CROSS SE CTION AND SPECIFICATIONS 4" CI' VENT PIPE "12 'Mfrr. `ABOVE GRADE WEATHERPROOF >_ 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE C OV E R FINISHED GRADE WARNING LABEL 7 4" CI RISER _ j r '4 11 MIN. 18 IN. 6 MAX. 'NLET WATER TIGHT SEALS GAS- ; ' TIGHT i �1 APPROVED A SEAL JOINTS WITH PPROVED --L + ; ALM APPROVED PIPE IPE 3' B ' ON 3 ONTO pro SOLID �'" � soilD so lL OIL PUMP OFF ELEV . FT. OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: /, NUMBER DOSES PER DAY: TANK SIZES: SEPTIC /ddd GAL, DOSE VOLUME INCLUDING DOSE �S`d_ GAL. FLOWBACK: ,L __ GAL. ALARM MANUFACTURER: ��� U �la.v s� CAPACITIES: A = ILL INCHES 2 1pGAL MODEL NUMBER: 2 INCHES = 32 GAL. SWITCH TYPE: B --- PUMP MANUFACTURER: 007, C = F , INCHES = , � GAL. MODEL NUMBER: j Sg e 4 1 SWITCH TYPE: 1yyvey'G D = (s INCHES = _ GAL. REQUIRED DISCHARGE RATE �d GPM PUMP E ALARM WIRING AS PER ILHR 16.23' WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . �/ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . .gliff FEET + FEET FORCEMAIN X g. FT /100 FT. FRICTION FACTOR . . FEET TOTAL DYNAMIC HEAD 13 -s7 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH DIAMETER,_ LIQUID DEFTFT� 'l e,&� , ( , SIGNED: yr/ LICENSE NUMBER: ?P4 DATE: 3 D+ 1/88 ` Submersible Effluent Pump ' EPO4' Epoa 11tN1� • iro: 300 eetles • �i ulbrr�+�f �+ ��'+ � ' � Cut Iran • dp�ed fa�'N �` � tur �df tort�flcfetrt � ihd du �. • C*e of running 1y�ems (w dtmape 10 heat tnt�i . v fN�`�orr►r; Nrmop— w" loo A"Ifabib for aWl"M aw t w 1 int" handle told liatsw�oh ri�tatrtit cPQ+4 8 N base: 01 HP, 1�1NI R W 6rMWIWI 113 or V, 60 Hz, 3lSO tet�t�wl�b Nr blMl try! ■ PoMr�t Cam. • RPM ttt Il In rW wilt prM/d at lbra i�o tr. d W wsbr rosWta • �P06 ie phue: d.5 HP,� lower 1PSOfPICAI' Itt 1i5V�OQHz, Igo RPM, b t�ttiti� e � l 4 MrA�tNr Thermo- • lltlg b1 Y; plug miwplrt duign AMY LtIMNO !�` mudmtmr. • Pow M: 10 foot , Rwnp out vines fpr ,w- up to 56 GPM. 1t1t1du+d IWIVU11 i 8/3 SJTG mechurfcsl iNi pmtawon• so" IMn�wwY A tlga tm rmmd!np � • T . hssdo, up to 24 Pr�� 4 • DW* sia . . ca t+1irr lonO, N ph 8JTW with dstlG sa�V * rrn tO wW In "AT r ) umturs M�i u11 Cerbun• thrlr Grounding plug imaroW " ro � oo JcMtrttla�tlonary, , M C� 6w Rugged 51 11�N a{uton 4 on )' thermop design pmAfs • T eu�br strength and ww aue 14" (1K htsrnOnt, t�rrolfOri•tM�Ce. • Fit; 3M w* NlvM PUT • swdut ne'tNrsg � o � � �I,._. __..� •, dfVv dsmsye to pump ra No #• • �i * d mg *0111y: 0 7 c1paAft. up to 60 GPM, TOW h" up to 31 filet • �lI� st 1 NPT s ---t• rblii0nlN, ; 4 6 �'' Bt • ri c T �q� ' to � 1Q+i�� oas�inuoua � 1 14trF� �terrs�nt, s .^.. I b j '.. j q q 4 • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ( o FILE INFORMATION SYSTEM SPECIFICATIONS Owns; — (l;ff t�� /� Sid t�tT Septic Tank Capacity Qd gal Permit # 3 p Z Septic Tank Manufacturer ,'C ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 406 g ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ad ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity Q al ❑ NA Estimated flow (average) 4 15 - 0 g al/daV Pump Tank Manufacturer Zj ' mdoy ❑ NA Design flow (peak), (Estimated x 1.5) �'Q gal/day Pump Manufacturer � a O NA Soil Application Rate galiday /ft' Pump Model O NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit M NA Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand IBOD 5220 mg /L © NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L O Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Call(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ in- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Collform (geometric mean) :51W cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA _j - *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency mov (s (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 3 earls 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: earl }(s) (Maximum 3 years) O NA month(s) ❑ NA Clean effluent filter At least once every: earls) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: r" ❑ earls) ' ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ ear(s) C3 month(s) ❑ NA Other: At least once every: ❑ yearls) Other: © NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or ce Lo cation ery : Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintalner; Septage Servicing ope inspections must include a visual Inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure for an back u or ponding of effluent on the ground surface. asure the volume of combined slu e and scum and to c heck y P e g 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 disposed 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 S12 months, shall be performed by a certified POWTS Maintainer. 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A eui weeds iaieM alsenn 94 wvi; Bu!MOIIo; eyi ;o uo1l9 u!wl19 io uolionpea •eeie uolidiosge 1!os OPLJB - le io punow Aue ;o edols u lae; 9 u14Mm eDie eyi 'loedwoo io gmislp asImJG43o io 'ieno )Iced io 9Alip iou oa sliso Iesiedslp pue s>lusi 19 n0 9010140A Mied i0 gnup lou Oa , 4usi dwnd eyi u1gtim slene) I9uuou g i ol sei of sloiiuoo dwnd eyi Sulleiedo Alienuew ul 391999 of i9uleiu!e1N S1MOd io iegwnld a ioeluoo io dwnd Juenl ; ; 9 41 of i9mod ue dwnd e 1 o siva3uoo a41 aA94 uolieni!s slyt Alone o1 •3uensi4e Bulioisei of loud ioieied0 BulolnieS eBeides a Aq penowei 3 4 1 P 1 I )II 1 P 4 4 o a i Bu eo ieno 'eso gels euo ul s ea esiadsl 9 1 0l p9Bis os l p ug s e !P I u� Heel A p 1 !ll 4 o aBie os� eoe ns io dniloeq 941 , it Bu in 4 p eno e i Aew s uei dwnd seBeino ismod ! a ie enn ei 6wiou q II,; �I aq 11lnn ieisnneisenn ssaoxe eyi peioisei s1 iennod uayM •slenel 3 4 .4 l 'eoe}ins enllsill! }ul 0 41 10 u9zoi; ais suoli Ilos u94m in000 iou Ileys do vals weisAS •99n of loud io3eiedo Sulolnies eBeldes a Aq penowei (s)Juel 9 41 }o siueiuoo ayl eney p9i063ep Big suolieiiueou00 4614 }I 'islllao iesiedslp 943 98ewep io /pus sssaoid luewls9.4 941 opedwl A9w 1941 919011J3940 18430 io sionpoid Buliuled ;o souesaid 9141 io; (B))luei iuewle913 10040 S1.M0d 941 ;o esn of io! 11V�d0 Q m u JOA NO ;o'2 abed otMAIT1QKCr r mMDinq FAX NO. . 7153863121 Jun. 10 20K) 02.�:'i'tl SEPTIC TANK VIAINTENAN'CE AGREEMENT A!YL O CERTIFICATION FORM Owner /Buyer s�c� Property Mess Ncifati©u required from Plattttiag Department for new cotauuction)_, Oty /state Parcel Ideatiri mtion Numbs _ P roperty Y.008ti0tY '�4, ,4 t /4, See, TSd N.R Town of Subdivision �M.9 � P Lot K-1— rl- It Cerdfled Survey Map # , volt=* , , ,�., page # Warranty Dead # —_... (a 1_ � `� � Volume A Le3 , �, Page # Spec house 11 yes 0 to Lot lines idondf D yes [I no AYIT= MAY=N ImPloper use and -- int'�"' ttGeof your septic system eauld result iA lU pretztstrzre f&ui3 to handle waste&. Proper maa: en�n. cnupisr.6 or*passrpitsg out tlsa septic rank ovary three years or ammer, if naaded by a Iiae►used pumper. What you pat ir tL S:.3rt:c aaa affeot the fat d= of tba septic tattle as a treASzrsaat stage in tsc waste disposal eystam 0 T12 property owner agrees to submit to St Croix Zat ing Deparement s eart form, signed by tlta ow = an c trtastcrpluraber, journeymanph=ber, restriatsdplum -'w or licensedpt =per verify* that (1) tho on-site wumwaterei� poi- is in proper operatic oondidon au&w (2) after ia"tian and pumping (it nocesswy), the aaptic tsa is leas than 113 ii ll o IV", then wularsianed have read the above req%4ram6nts and agree to maintain ti a privets sewage disposal system wit. he r.: C.: -t' 7> eat forth, hor+ein, ae sat by tlae Depattutent of C.atluttsrce sad dte Dapartraent of NAtt:tstl I sources, State of 'isennsin Cart . "C stotirsg that ycrcr Septic system bes beeu mainUinedmust be eomplatad and ret=sd to the St. Croix Co =ty Zoc4 Once diva- of the IM year Vi" date. 03 S IONA71M O F APPLICANT DATE 0M Ms— U��A°!2:9 1 ('we) orrtify tba# aU statAmws on this form, are tnra to the best of my (our) Itowledge. i (we) are (are) the cot -.:'. ; the property deseribe d cbove by v'iztua of a werranty deed recorded in Register of Dee& off rc. SIGNA'TM OF APPLICANT DATE v +Yirrwa Any idomgtion jUt is na;8- repr e6aretad ma y resul in ibe ssnitar; pam being revoked by the Zoning I7epaztr',g:!.. w Include with this appliesdau: a sumped wanonry deed h-am the 12agiater of tide of'ltce a copy of the certified survey map if rafeTence � mri a in the wantmty deed Vol. .11 `3P1+cr 19 INK 6 STATE E-AR OF WISCONSIN FORM 2. 1999 659804 Document Number WARRANTY DEED :CA i HLEEN H. WALSH a REGISTER OF DEEDS 3 T. CROIX CO., WI This Deed, made between Thomas M. Boumeester and RECEIVED FOR RECORD Elizabeth C. Boumeester husband and wife, _ — 10-2.i -2001 8:00 AN 1lARRANTY DEED Grantor, and Richard 0. Stout and Janet P. Stout, husband and wife EXEMPT N -- CERT COPY FEE: COPY FEE: - -- TRANSFER FEE: 1530.00 RECORDING FEE: 11.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area NE 114 of NE 1/4 and NI/2 of SE 1/4 of NE 1/4 of Section 12- 30 -19, St. Croix Name and Return Address County, Wisconsin. KRISTINA OGLrAND ESTREEN & OGLAND 304 Locust Wi WI 54016 032 - 2044 - 10 & 032 - 2044 - 40 _ Parcel Identification Number (PIN) This is homestead property. (is) 08?100 Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of October 2001 • —._ _ • Thomas M. Boumeester _ •• lizab �umeester AUTHENTICATION ACKNOWLEDGMENT Signaturc(s) Thomas M Boumeester and Eliz C . STATE OF WISCONSIN ) Bo umeester, husban . wife, ) ss. _County ) authenticated this () of October 2001 l Personally came before me this _ day of � the abov_ e named • Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by 0 706.06, Wis. Scats.) instrument and acknowledged the same. THIS INS'rRUMENT WAS DRAFTED BY Attorney Kristins Ogland Notary Public, State of Wisconsin II dson, W 54011: My Commission is permanent. (if not, 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. NW"W N0468 rab campy, FwW e, Lac, N STATE BAR OF WISCONSIN eto assa�2t WARRANTY DEED FORM No. 2- 1999 g 1 � z VIA. i1 =1 g« Sd 0 CO O PaO.. rj�b pWp2 P i m�Omaos n C r =C na�i As o$ a p � w swssa O W O Z �zt b5►_ • as+ozoo t �� W W Q J Z L OIN 1 z 1 r C � O T. C , � cn W W IL L 7 ' i S01 281.71' 00 � oa+ asc L J 2 F Z •��� $ ?_ < �ZI� x � O egg ®I OO Z a W l� % 'ti LL� I , C Z �I rags A I i I 81 1 I F W Q PI %1 �� ee.on 1� ` � O � �`•� �ti�r �' �� � Y3 I r♦o`w O F v JO OD _ 1b% gg �� gp31'E 519.77 p e -�_ q la µ.OSCaaOL zt a do «t3Po aludo3n., HUM a ll au at aN ee l 1 z� �I I�