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HomeMy WebLinkAbout032-2163-05-000 (2) 22 2 k e § 0 a � § � b � 2 � 2 � 2 � ? z 2 0 � § � < « § I z i % .. 0 c « e ,s Z — «_ § z k > 0 § W 0 c ­ } « — J , 2% t 2 7 QE% z $ k/{ \ I 0 § k \k $ \ < 4 k i z z D k � § \ ) C 2 £ ® ; $ \ 2 k IL k \ 3 E k 0 0 0 0 ) t $ $ j v / \ z ] © § E m 7 k 4 z f t ; 13: 2 c E _ k k j § a @ m 2 w ■ CL Lo �A - - ° ` c 2 B } j R § 0 2 / } co IL � ■ � ■ , — k .. 2 » � $ k c a § J J a� 0 2 Wisconsin Department, of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420795 0 (ATTACH TO PERMIT) l i GENERAL INFORMATION State Plan I No: Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Grand Properties L.P. I Somerset Townshi CST BM Elev: Insp. BM Elev: I�M Description: � JL Section/Town/Range /Map No: Pve— 14.31.19. TANK INFORMATION U ELEVATION DATA ' ELEV. : TYPE MANUFACTURER CAPACITY STATION BS HI FS' Septic Benchmark t W 4S �D ! �, to ,. 1 015 Dosing Alt. BM 4.30 f f .3y t Aeration Bldg. Sewer Holding St/Ht Inlet �• 5x{ a , lo' St/Ht Outlet TANK BACK INFORMATION . �2 - 103 S TANK 10 P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic f i Dt Bottom Dosing Header /Man. t Aeration Dist. Pip:fl9 • S$ t l'•�11 Holding Bot. System 15 -m Final Grade �- PUMP /SIPHON INFORMATION A ft - i qtALQ Manufacturer Demand St Cover I 5.8.x- a� • fi Model Number TDH Lift i oss System Head TDH t Forcemain ength Dia. Dist. to Well L SOIL ABSORPTION SYSTEM BED/TRENCH Width No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS V L�%W jC- Z. SD , 2 1 SETBACK SYSTEM TO I P/L JBLDG WELL LAKE /STREAM LEACHING Man cture INFORMATION Type Of Sys tem: CHAMBER OR i � O � i .... —..-.� UNIT Model Number: DISTRIBUTION SYSTEM l Header/Manifold I D istribution x Hole Size �Hole p acing Vent to Air Intake n� Plpe(s Lengt 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 1 �,. Yes No Yes i�_] No CO A I TS `(Include od Vchm e s, persons present, etc.) Inspection #1 : '.4L ! 7 J Inspection #2:= '�' — ' f " Loc Ion: 2128 62nd St New nd 1o, 54017 NW 1/4 SW 1/4 14 T 1N R19W ' Gavin's Acres Lot 5 Parcel No: 14.31.19. 1.) Alt BM Description= few N�" (� 2.) Bldg sewer length = f tt - amoun of cover = .•, t ( `` nn Plan revision Required? 1 Yes i, No c 'r ��• I Use other side for additional information, _ SBD -6710 (R.3/97) 1.. to _ (��;� fnsepctors Signature Cert. No. r — `{ t0 A Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 / _ ��� Madison, � adrson, WI 53707 - 7162 Site Address Department of Commerce Sanitary Permit App li Sanitar Permit Number In accord with Comm 83.21, Wis. Adm. Code, Pe rsonal To. I [E E D n ❑Check if Revision may be used for secondary purposes Privacy Law sl5. 1 m I. Application Information - Please Print All Information APR 1 4 2003 State Plan I.D. Number Property Owner's Name Parcel Number ST. CROIX COUNTY G t�� o 0J e F,e S ZONING 0 Property tion ` Property Owner's Mailing Address / - 7 1Z Wi -5 <5ui% loo tiJ'LO KIIA:S N,R / City, State Zip Code Phone Number Lot Num r Block : Numbe r Subdivision Name CSM Number 5 orj'1t ,, te 5/= i U1. SY�Z S 7��i co u/ti s j cee (check all that apply) s . Ci H. Type of Building (ch PP ❑ Y) .. � s«.c,��- P ty � - Number of Bedroom or 2 Family Dwelling � ❑Village ❑ Public /Commercial - Describe Use NTownship 5w; l e e S 1.1 ❑ State Owned Nearest Road 2 AW< 2( 0_ 5 T. M. Type of Permit: (Check July Ane box on line A (numbering scheme f4w internal use). Complete line B if applicable) A For County use 119 New 2 ❑Replace ment System 3 ❑Replacement of 6 ❑Addition to S stem Tank Only xis ' E System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 11 Constructed Wedand 22 ❑ pressurized In- Ground 41 ❑ Holding Tank 48 C1 Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 11 Recirculating 30 11 Other V. D' ersal.M/Tr tment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate Vgystem Elevation Fnsal Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min.flnch) Elevation L/ 5 "() q3 s 3 -- ?�'s 9, 6 6 VI, Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks K W1 Z-4 _ et e_ A -1 Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank j DO 0 J Q D rC S co t o rr Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Numixr J 4 A) 5 C H!) T T t /1 :; 7 (c 0 I/ 5 sy9 � 6� S l Plumber's Address (Street, City, State, Zip e) 16 S STN r/ r!t VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse Determination J � J IX. Conditions of Approval/Reasons f Disapproval pry f 4z" - r � � fe w oo to rnmplete plans (to C only) for the system on paper not less than gin x 11 inches in size 5101 SBD -6398 (R. 0 ) y PvCN�P- -^!�til — f V E AJr Po ---------- - - _.- - - -- - -- — - _ -- - -- PPl?ox•�n Z•7 E /y ?3 Pfo -PEer y Z N -- - - -- -- -- - _ -- b S, 3 $, o v 'CFkso,e - - - - - -� - � -- �- — - . � SLOPE 000 6- AL ti AL's. BIB 61IZA A _ -- - - -- 1 - - -- piVuFwy - _� /3� ?,_� Z'' QVC 9 9_x 7 - - .-- '- - 712- ,T ' -- -- PP¢ex• �r ��� � saner _ _ . 33 . _ 3 3 � _-P�� pE,ery- LIVE Lot- -- l Al l'' 63 f to ^qtT. I w000 CO AL 5• B !A 'r + bR X + `Y 100 joz - E - - -. - - - - 6 0 .1 peopEeTY i f vJ)N (o Fc '° - 2$ -G D k;'r N b J'; Ati _SN ---- /D d - -- �mEi�SE %. [0 T 1117 Wisconsin Depddment of Commerce SOIL EVALUATION REPORT 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 ordimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all inf0fn2afinn _ Rev'ewed By Date Personal information you provide may be used for econdar u IrC� WI&W (1 (m)). {s 3 Property Owner Prope ty Prop Location Grand Properties, LP Govt. t NW 19 SW 1/4 S 14 T 31 N R 19 W Property Owner's Malting Address Lot # Block # I Subd. Name or CSM# 712 Rivard Streeet, Suite 300 ST. CROIX COUNT` Gavin's Acres City State Zip C "OFFICE City Village ✓ Town Nearest Road Somerset WI 1 54025 1 715- 247 -5900 Somerset I 60Th St. ✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 07 gpd /sgft rating. Possible system elevation for Area I is 96.50' Slope is 6 %. Boring # Boring ✓ Pit Ground Surface elev. 100.05 ft. Depth to limiting factor >95 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 "E 1 0-7 1Oyr3/3 none sl 2mgr mvfr as 2f .5 .9 2 7 -15 10yr4/4 none sl 2fsbk mfr gw - - -- .5 .9 3 1-5-22 7.5yr4/6 none Is On ml gw _____ .7 1.2 4 22 -95 1 -Oyr&6 none ms OS9 mi ---- _ --- -- 7 1.2 9c. , S - 0 / ❑ Boring # Boring ✓ Pit Ground Surface elev. 100.05 ft. Depth to limiting factor >97 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/11 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 " 1 0-8 10yr3/3 none sl 2mgr mfr as 2f .5 .9 2 8 -22 10yr5/3 none sl 2fsbk mfr gw - --- -- .5 .9 .3 22 -34 7.5yr414 none Is 1.msbk mvfr di - - - - -- .7 1.2 4 34-97 1Oyr5/4 none ms Osg, ml ---- ---- .7 1,2 2•b �•� • Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg /L • Effluent #2 = BOD S30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt Address To Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, Wt 54025 6/12/02 715 -549 -6651 Property owner Grand Properties, LP Parcel ID # Page 2 of 3 3 ] F Boring # Boring ✓ Pit Ground Surface elev. 97.85 ft. Depth to limiting factor >95 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rood _ in. Munsell Qu. Sz. Cont, Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/3 none s1 2mgr mfr as 2f .5 .9 - - - -- 2 9 -19 10yr5l3 none s1 2fsbk mfr gw .5 .9 3 19 -31 7.5yr4/6 none Is 1 msbk mvfr gw - - -- 1 1.2 4 - 31 -95 10yr5/6 none ms 0sg mt -- - - -- . 7 1.2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP 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 in. Munsell Qu. Sz. Cont, Color Gr. Sz. Sh. *Eff#1 *Eff#2 i T * > Effluent #1 = t30D 30 < _220 mg1L and TS.S >30 < 15.0.mg11- Effluent #2-;: BOD 5 ` 3o- mg/Land TSS <30 mg/1. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or --d —f—;ol ;n n If—+r f m,ot „ 1--'n f—f a+ AAR-')f4 -I1 91 — 1 - 1'V Ang-')AA_Q777 I p � 3.42 02 p Eel Cow— ►� )31 Q 98 An 1 J ` i r l R r '�, D� -a,,,� ��► y am' C�,�.�1 pro p�r�res p�ox,.,,�,, Gy �. `�,�,,as �• � � �.n; -714 �w--d s- GS Yw� -a;7 S u.i e )6Z) ( t/4Lt L/' e-d POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Grand Properties L.P. Septic Tank Capacity 1000 al ❑ NA Permit # t1s_ 9 � 15 Septic Tank Manufacturer Week's C.P. ❑ NA DESIGN PARAM RS Effluent Filter Manufacturer Zabel ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A -100 ❑ NA Number of Public Facility Units 11 NA Pump Tank Capacity gal ■ NA Estimated flow (average) 300 al /da Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) 4 5 0 g al/day Pump Manufacturer M NA Soil Application Rate 0.7 al /da /ft2 Pump Model NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ■ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cells) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ■ In- Ground (gravity) b In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ■ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other. 0 NA Other: 13 NA "Values typical for domestic wastewater and septic tank effluent. Other: [3 NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 3 ® ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) 3 ® year(s) (s) (Maximum 3 years) ❑ NA At least once every: ❑ month(s) ❑ NA Clean effluent filter At least once every: t -1 6 year(s) ❑ month(s) ■ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ' ❑ month(s) ■ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) p NA At least once every: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of * START UP AND OPERATION ch For�new'construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other emicals :. that may impede the treatment process and /or damage the dispersal cellls). If high concentrations are detected have the contents a of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wip.be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and. may - result in the backup or surface discharge, f . effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power pump r to the effluent or contact a Plumber or POWTS' Malntainer to assist in manually operating the pump controls "to R` restore normal levels within the pump tank. vehic over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, area Do not drive or park vehlc P r LI on area. � of mound or at- p within l5 feet down slope o y at-grade soil abso 9 Reduction or elimination of the following from the wastewater stream may imp rove the p erformance and prolong the life of.the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cbtton swabs; degreasers; dental floss; diapers; disinfectants;;!fat foundation drain (sump pump► water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications;- oil; tampons; and water softener brine. painting products; pesticides; sanitary napkins; tamp , P 9 P , P ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is.,. property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. ,x • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void. space filled with ; soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant". replacement system: A� ■ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil, absorptiorn system. The replacement area should be protected from disturbance and compaction and should not be infringed uponby, required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement;.area will result in the need for a new soil and site evaluation to .establish a suitable replacement area. Replacement systems mu comply with the in effect at that time. O A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS ` technology a holding tank may be installed as a last resort to replace the failed POWTS. 13 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding.,tank may be installed as a last resort to replace the failed POWTS. O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at tha. infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. 4 < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN.. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 0FyA PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. > ADDITIONAL COMMENTS ; POWTS MAINTAINER Viz POWTS INSTALLER Name John Schmitt Name Owners choice Phone Phone r� ( 715) - 549 - 6651 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name St. Croix Ct Zonin Owners choice - Phone Phon (715)-386-4680 83.22 2)Ib)(1)Id) &if) and 83.5411), (2) & (3), Wisconsin Administrative Code ` This document was drafted in compliance with chapter Comm ( . , ; S III ST CROIK COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 2 ,e,y ,0 P eo yE,27"iES G ,0 , Mailing Address 7/Z A y ,41e Property Address { oZ g (Verification required from Planning Department for new construction) 6 33.— /'�Yo— -c o City/State Parcel Identification Number n2 z -.zau r -ia ae, JEGAL DESCRIPTION Property Location N w %4, J 6t1 %., Sec. ,1 W T j) N -R Z� W, Town of Subdivision _ �A U 1 A) S 1 C- 6 S . Lot # -S Certified Survey Map # VA 0,1 i� Volume Page # Warranty Deed # Volume `i Page # �„�• Spec house 0 yes ❑ no Lot lines identifiable ® yes ❑ no SYSTEM A�IAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mauttenance 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 )he 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 masw Plumber, Journeyman Plumber, restricted plumber or a licensed pump= verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 15 full of sludge. Uwe, 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. x 3 /2 �/s I ` SICINATURE F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. 3 SI ATURE APPLICANT DATE « « « « «« « « « «+« 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 U 1952P 585 6 8 7 5 3 7 • STATE BAR OF WISCONSIN FORM 2-1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Walter E. Germain and Debra C. _ RECEIVED FOR RECORD — — -- - - --- -- Germain, husband wife, ___- ____ �_ 08 -20 -2002 9:30 AM WARRANTY DEED - — — — - -- EXEMPT N Grantor, and Grand Properties, LP_ —. — REC FEE: 11.00 _._.— ..----------- - - - - -- TRANS FEE: —. -- — -- COPY FEE: CERT COPY FEE: Grantee. PAGES : 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in S t . Cr ___ County, State of Wisconsin (if more space is needed, please attach addendum): The W 1/2 of SW Il4 of Section 14, Township 31 North, Range 19 West, Recording Area St. Croix County, Wisconsin, EXCEPT: 1) Lots I and 2 of Certified Survey Map in Vol. 1, Page 236, Doc. No. Name and %1, r 332995; KRI�� OGLAND 2) Lots 3 and 4 of Certified Survey Map in Vol. 3, Page 746, Doc. No. ATTORNEY AT LAW 353786; P,O. BOX 359 3) Lot 5 of Certified Survey Map in Vol. 9, Page 2454, Doc. No. 480266 HUDSON, WI 54016 4) Lots 3,4 and 5 of Certified Survey Map in Vol. 10, Page 2889, Doc. No. 526637. 032- 1040 -80- 0 00;032.104 . 1 .10 - 000 Parcel Identification Number (PIN) This is not _ — homestead property. - - p(,) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. ' Dated this � day of June ^ _ 2002 ', • + Walter E. Germain 4_C - - Debra C. Germain AUTHENTICATION -- ACKNOWLEDGMENT ) Signature STATE OF WISCONSIN s) Wafter E. Ge rmain an d Debra C. Germain, — husband wife, - — _ — — — County ) authenticated this day of June 2W2 - Personally came before me this day of the above named • Kristina Ogland _— T � - -_— TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (if not, _ - -- instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY • _ —, —... —. —.— — — — — — — — Atto Kristins Ogia Notary Public, State of Wisconsin Hu d son, WI 5401 _ —, —_ — i — _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) — Intwmelion Profesabna�s Campenv. 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