Loading...
HomeMy WebLinkAbout032-2119-70-000 1�6 973 ?q �p 2, Sanitary Permit Application Safety & Buildings Division N ri�scon S In ac cord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 in Personal information ou p rovide may be used f purposes Madison, WI 53707 -7302 y p y 4x..sgcnnary p rp Department of Commerce [Privacy Law, S. 15. lr��, ' 1 (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for a m, _ paper no 8 -1/2 x 11 inches in size. County < State S *tary P 1 Number ❑ k revisio ous app ' ► State Plan I. D. Number I. Application Information - Please Print all Information Location: Property Owner Name P + �opey Location p S T /.N, lt/ (or Property Owner's Mailing Address �G+ ` Lot Number Block Number / y S . �> , City, State i Zip Code Phon uMl'r + ! Subdi ision Name or CSM Number C. II. Type of Building: (check one) ❑ ci ty 9t 1 or 2 Family Dwelling - No. of Bedrooms : ❑ village ❑ Public /Commercial (describe use):_ ATow O State -Owned / \ q Nearest Road N L 22.- J 3 I X l 3+ t Parcel. ax N e� ) III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) "7 1/ a A) 1. RNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only , 31. 1 q M Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Cr on-pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatm nt U )t ❑recirculating ❑ Other: V. Dispersal/Treatment Area Information: ✓ - >�,,�� 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (GalsJday /sq. ft.) (Min. /inch) C Elevation �S O l` �% A 3, t ib er- l VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel FPlastic Information Gallons Gallons Tanks Con- Con- New Exi sting crete structed Tanks Tanks ❑ ❑ ❑ ❑ c- ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS show on the attached plans. Plumber' Name (print) Plumb 's Signa re (nos MPYMPRS No. Business Phone Number - 1132 Plumber's Address (Street, City, State, Zip Code) f Z' /- �..�. IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Su j�charge Fee) Determination ZZC. /V( (0 2C0 X. Conditions of A proval /Reasons for Disapproval: ALL seA w.ws+ N 1 5 SBD -6398 (R. 07/00) C TL% w Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and E uildings ibivision Count §. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita�VMg�gNo -: p P�ersonaal p information you provice may be used for secondary purposes (Privacy Law, .15.04 (1)(m)]. bii55 W e1SS 1 o dM's Name: ❑ City ❑ Villoa & QrMvnship State Plan ID No.: Cl J CST BM Elev.:- Insn RM rip.. BM Description: } Parcel ,7tl_' f'19 - -000 )0 l © y. S O' I en = C_;; Tq wt -3� US LL L TANK INFORMATION ELEVATION DATA (P ` 31! t TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic SGfL Iz$� Benchmark #Z - J. 7o r lob •2a I o`f•• 50 Dosing Alt 3.4o I IDZ .R) Aeration Bldg. Sewer 5 11D l . 20 [ Holding St /Ht Inlet Ca•(o� I�•lo' TANK SETBACK INFORMATION St/ Ht Outlet to • 2$' 9 . 92 TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt Inlet ir Septic So / ] 3' NA Dt Bottom Dosing NA Header / Man Aeration NA Dist. Pipe q' 9� •ms Holding Bot. System /o •6D 9S.6o' PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Nt cover Model Num er GPM TDH Lift r Ion Syestem TD Ft Forcemain ength Dia. �st.Toweil SOIL ABSORPTION SYSTEM BEB / RE Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION 3` 93 iS 2ar.� 2 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufaocturer• INFORMATION Type O , CHAMBER Moe Number: System: �Y. $D " �{ 3 C OR UNIT DISTRIBUTION SYSTEM Header/ Manifold a� • Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _` a te/ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over TBed th Over xx Depth Of xx Seeded / Sodded xx Mulched Bed/ Trench Center /Tr ench Edges Topsoil ❑Yes E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1.05_/2210/ Inspection #2• - -f- -f -- - Location: 1961 62nd Street, Somerset, WI 54025 (S 1/2 NW 1/4 26 T3 IN RI 9W) - 2631191089 Pinecliff -Lot 27 1.) Alt BM Description = 1 &p er f swMe ` ) S� � a 2 2.) Bldg sewer length= ll • o `�'s mount `( S� c� ` S,l�low He�Pi s i 4 - - � a of cover = _ 1 g + gm. cm�e. (n 3) � GS s. Plan revision required? ❑ Yes �( No Use other side fo tional ef' addi � information. SBD -6710 (R.30) - L I ' r Date Inspe is Signa�tur � Cert N a i lx•ti f — S � f X " "° `^ �FLC . sT claw -c r'C*0 — - 6 (— S� ADDITIONAL COMMENTS AND SKETCH A. SANITARY PERMIT NUMBER: k J . E S 1 i y r, r i F 3 t 3 ... .,. y. .. e 9 P 4 j I ro k a ee w 3 r.� � t i � r � ? . �a � .. �m m.. ..;•. .,,�� �, gee ., � ....� �. a. s= . .�. ..,t ..�. ... ,.f_ �.�. .a..ma . _.,...,..� 4 S § k - .m v # ` E ( € w e i . } . } �. �m mG - m. ,�� i .. M .. , m .... a n, .... , j 1 k me�«,.w a f e t w e Q f ,.,m� arg..,..._,. :.....,, y ...... w .s.,.... # Y k k k ; d f f vo tj 04 IV �3 X t. Wisconsin Department of Commerce SOIL AND SITE EVALUATION 1 3 Division of Safety and Page of Bdreau of Integrated Services in accordance with, s. ILHIR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan most . County include, but not limited to: vertical and horizontal reference poinX (BM), directi'dn ;and C/'O i'K percent slope, scale or dimensions, north arrow, and location a6si distance to neanest'ro4i. P rcel I.D. # a,.� APPLICANT INFORMATION - Please print all information ' `,`� R vi ed by to y Personal information you provide may be used for secondary purposes (Rnvacy.,Law, s. 1Fsq 4 ). 11 v � Pro erty Owner /y `` ocat+gri" M ���i �Ge ✓ ih �; �: �. Govt. L qt 114 *W 114,S 2_ 6 T 3� ,N,R E (or)� Property Ownels iN ress L t r ck� Subd. Name or CSM# / /✓�� 2 K / 1 /1 e G Ci State Zip Code Phone Number ❑ City El Village ® Town Nearest Road D �'iPrfc�- ZUZ . YO.2 S (7 15- ) 24 17 - - S ®1»erS-e t ' i 607 /� S teC� New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: {� Code derived daily flow gpd �� Recommended design loading rate ! `! _bed, gpd /ft : Yench, gpd /ft Absorption area required �0�0 __bed, ft / ttrench, ft Maximum design loading rate& _bed, gpd /ft 6 trench, gpd /ft Recommended infiltration surface elevation(s) qv. 7 It (as referred to site plan benchmark) Additional design/site considerations �jL Parent material / �� 5 X� Z Flood plain elevation, if applicable I " ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system s U 9S ❑ U 9S ❑ U s❑ U 21 S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT a Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench �1 Ground OZ C w U � S ems Depth to limiting ; fa or in. z� Remarks: Boring # i o -7 �(��, %Z >`S �S .7 8 2 7 z2 �sy�/ SL 2Ms6� X44' cw 2 �5";. 3 z s9 1 s�IZ n7 `7 Y Ground 7 '102 141 Omy /A Depth to '-�,o limiting factor L 7 in. Remarks: CST Nam (Please Print) Signature Telephone No. Address 67 91 1 V2a v e �O/� e�Se f l,�y��G'ZS" 1 �-/1' - 9/ Z 13 17 Numbe PROPERTY OWNER SOIL DESCRIPTION // REPORT Page 2 . of Z— PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed , Tren a 12- CoyR A/A SL / 2 � lpf fr c u� zl os 6 Ground 3 2 7-3 Y .J f' v�(�� �/ / /�L a 1lIy . � y 2 ff. X- s1 7 -yW �� SL � 5 �� ��� cu -- . S ST /0 .7 �yl�' /Y S i�lS ,AIL --" -,7 of Depth to limiting � ct�r in. �' u Remarks: Boring # L /�Yi� % / S s�� OZ (f z z �f 2 -2l 2rsl 1 c �' h� ; 6 e14f A) Z 7 8 Ground � Depth to limiting f j tor in. 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 # j Q -� A i� 10 0 IS X75 r� P22- C w 2 . 73 01f / / 1 1 S%G 2 561c /0 C to ,3 33-5 — 7sy�1 % ,{ /S /s6.�r c w i-� *7.o, Ground P -103 /�T)T a7' U flew yd ° / ft. Depth to limiting factor ;'n. Remarks: Boring # .......................... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) 6 � i 3 6 SDry,p�rG,+ Gds : i CA 1 Odrne I 7 � t t f YYI I� �4,Q I f G �t }� corne. i j I , t r S � ` 1 , i ✓ - iyp I 1e' I I . I , <_ � ( J I f , t I I y I I f , 1 f t , y t , r j ;Ul e ' E i 1 I ai t : i r i t , j t , • r _ : i _ f • 1 j � I I � t I � " I « I ��1 i i I i 1 r i t : '---•. _ ._...T.. -,+. 1 i ; _..._._.. ; .may- {- �•• -'.. { ?�i t PINE CLIFF FIRST ADDITION 7C11TED 01 PART OF TFE NV1/4 OF Ti# AI PART OF Tit SVI/4 OF TIE NA14 AND IN PART OF YK SEI/4 OF YK tM /4 ' SECTmN !f. Tm R11V. 101IN OF SOMERSET, ST. CROIX COUNTY. VISC�ISDL I V. S UA PL � QF SERENITY t — — — — ` — — — — — — — N1/4 COMER _ SII.60'Ot I3r./r r- NORTH LINE tr THE MVV. 00TtL :nr iM•70'OCt SECTION Ib u S89'08'38 "E 508.31' NG MTCRLt+E N r pRRlw•t T — 1 1 1 DION PIPE 1 1 I , USGS DATUM 19" 1 21 I r•.t_ 1 ELF m.»• II 1 ' ' I 1 3.011 ACRES b i I t - - - 7 - 12LI43 So. rT. • 1 d ' 1 If" AC) 1 va.. a ra 3o3D I t d 1 I m ' im 22 QVNER --- ---- -- --- -- --- ---- -- - - - - -- KVL i tT7t \ 31611 ACRES SEC NOTES: l 1 13LIx St FT. , MICHAEL J. HARTMAN VIA • PINE CLIrr PARTNERSHIP •� PLAT OF PINE CUFF I rO 1 —\ \/ 12.45 AC) C/O HARTMAN HOM INC. W 103 MAIN STREET I 1 SOMERSET, VI 3 1 30 ' 1 LEGEND I ` 23 w 19 N � SECTION rnRMER 3011 ACRES f� 13L141 So. rT. r • I• IRON PIPE rOmD (101 AC) z• X 3r IR111 PIPE SET VEIOMNO O LIS. PER LINEAR TOOT 1 . N 0 r IRON PIPE rams / ® NOTE ALL OTHER L0 L'ORNERS 37 1.77, NOMUENTED WITH 1 1 11, / ,� �' 711.77• IIOAO' Ia0•• /- PER pe TO lit LIS PER LIMEAR TOOT .%h 0. i N. 100' ROADVAY KTDACR LINE 12• VIDE UTILITY CASEMENT Jt PROPOSED ONtK 24 Lj , 3.3e6 ACRES N- — R --11 -- EXISTING rENCLIMC III.ne SO. rT. Q I // If- AC) i IRVL • lT1D, MION WATER LIME ELEVATION - USES I 1 / ' •I A IUTC A orA THAT V ATE RE TENTION ER THE CAPACITY 1' IT , 7 • ¢r Is THE STtMM VAiq TENTtOM AREA IS PRONIItT(D Nat[ I THE wimmot SrORN WATER 26 RETENTION AREA ` KRIS . MEr fl AREA CA PER T OWN 01 O 1.L062,05 (301 K) 3 so. r T. SOME RSET RSET ORDINANC (1 KRC MMIR1q 25 nn AC) \ ` 3•n3 ACRES 14UN $0. rT. \ / • 432a ACl NORTH Link IF THE St1 OT THE NVI,1 , + m./ •/- 410.W uscs oATm r IRON S8 •03'58 "E 19 \\ \ - -- - Het ` �` Q �� rcNCttt Is 016 •/ CL- 17121' '• _ •• 1 SOU OrINC LOT CCIMER ^ .+� / � /', �� -,� _� . -�' �r ' -.-� 3.1" ACRES #' Q 147334 so. rr. Lj �, wJ I • \ to 1 , 1 `\ 3.041 ACRES 13a10s f0. rr. PLAT OF PINE CLIFF 1 _.... _ .... — ...._...._.. ; LOT 9 , (1.77 AC) / 1 / LOT 7 - �� i EASTERLY uNlns a IuILallc AREA - ---- r- - - - °- PER TOvN 6r faMERSET ORDINANCE 441 THE INSTALLATION VOILD U3 ; 3. ACRES . 70 ' .77I S0. rT. 6 AMY LOT LINE 00 STREET ZINC. 1 (01 K) vtOLAT10M Or SECTION 04.32 1 ' SET rONTH ARE rON THE USE Or 1 1 THE RIGHT To SERVE THE AREA 1 ) 0 STATE. (Y, AND TOWNSHIP 1 LOT 10 XlUNT , CI T��•. �`. N ' 1 , I LOT SIM ACCESS TO PARCEL ETCA ND CONTACT THE ST. CROIX COUNTY ICE. 70 W 1 3.020 ACRES " (613 K) ) KARIW CHORD LENGTH ARC LENGTH TANGENTS 111 v 7 rx.s•v I93•73 M0160' sir r 613'0 ert 1vr'V I" It 1102r 233 S0l•3I•I4 1' A "V /a0Y IMP 11e6- 3I.11'V 313.07•er'E • �.j N2 1'StTT fitly e11.3I' 81rO 71 fYt sot-3V34-4 ,' LOT 11 »!'Y 617.71• 631.17• NII.11'17•'V M »•e1'xv ; .._ �. 1 »arw 130163• 10.971 H »- e1•x•w Mra'3r•E � � � f w 677•Il• letAY MO'11'3r'C fIy00'00' � � � � • i .I YOtA"V ICSOO' 111.7y 14Ie•Or37"C NI1*3171r ' Mlr , 1• 1 NI 1 , 6:10"v .7341* $7 m-w 616 MI9Y t"v r373 , wtr'V ttt. %' Us. W40-A'54-4 MDO'3r3t 17•I6••V 'SM. 16.31 NI0*39•32'V SO. 00'00"V ; 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 �3 9 8 Number of Bedrooms Design Flow - Peak (gpd) 61 C Estimated Flow - Average (gpd) Z` C Septic Tank Capacity (gal) C Soil Absorption Component Size (ft) _S C 2 Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) SI TF Maximum Influent Particle Size (in) U 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 se ti and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filter hall be cleaned as necessary to ensure proper operation. The filter cartridge shou no a remove un ess provisions are retain solids in the tank that may slough off the filter when removed from its enclosure. If the I r - Management Plan for a Septic Tank and Soil Absorption Component alarm, the filter hall be serviced if the alarm is activated continuous) filter is equipped with an ala er . s Y 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. 2 E - Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 Apr -27 -01 09 :43A P "02 PAGE 4 u ALTERNATE SYSTEM AREA AS SHOWEN ON SOIL TEST, MUST BE LE FT UN01ST6RBED. ais4 IF ALTERNATE AREA IS0WXGA$EO, REPLACEMENT AREA MAY NOT BE FOUND, ANY QUESTIONS PLEASE CALL BRADY UTGARD ........ ...................(715)268 -6995 OR ST. CROIX COUNTY ZONING ..... ..... (715)38611680 r ST CROIX COUNTY WNW- SEPTIC TANK MAINI`ENANCE AORJt A ND �a 0-wNCRSHIP CERTIFICATION FORM o wner /Buyer .,, � ---- :•,.,�'. _ Mailing Address crt Address � /�, ` .Prop y (Vertricatton rcqu;rc, frum Planning Dcrartrnrnt for now c onetructio ) City /State tilt. 4 parcel ldontilication Number � c,+,t nF SCRi rTt � ; Property Locati n S 'A, ��� 1 /4, Sec. ,�, 'f3LN•R—L&, Town of —7 r Lot 0 Subdivision Certified Survey Map M , Volume , Page M Warranty Deed b �� C� ✓� Volume `1 q , rage M Spec house C1 yes �no Lot lines identiftablex yes O no S,YSTFM MAINTENANCE E h Improper we and maintenance of yew system :nuld •e.ult in its pron'aturc !Dilute to h wastes. Proper ma,nterDnett `'� co -isists of rumptn; out ;he septic tank every hrcc years cr soor•er, ir rtecded by a ii:ensed pumper. What you put into the systemic. can arfect the ruactton of the sap ,c tank as a !vestment stare in ,lie waste daposai system. r The p-operty owner agrees to submit !o St. Croix Zoning Department IS certification four., signed by the owner and by.'''; tra Ste r plumber, journeyman p! umber, re si r,c tcd p! umbe- or a L0nsed pumper verifying that ; l) the on•site wastewater disp osal systf sat in proper onerorinS condicon ancUor (2) 0c? ripection and pump mg (ir necessary), the septic tank is less Char. 113 full Of sludgi:. I'w;, ;hc stn :crs,Yrted linvc r:ad tl,c 3bovc rcy,r c i%nis and at,,ec t0 rnat�tstn ilia private scwa`c disposal syste n with the stsrdtrdt i set fonh, herein, as set by the Depart. - ncn! of C:unntcrce and the Nit irtment or Natural Resources. Stare or Wiscons n. Certtrut�on • stem has beer ma- maimed must be co an." returned to the St. Croix Courry Zoning Off(ct within 14 stating chat your sip .. sy stem '' days of t e throe yeor xpirattcn date, . ICNATURF OF API'CICANT DATE L QWb Q c^FRTtF1CA110N I (we) certify Mat all statements on .1 rorn are late to the best of my (our) knowledse. I (we) arrt (are) the owtter(s) the pro dtaCrib d above, by virtue n(' a i�6rranty decd recorded in Register of Deeds Office. D S U N1TVR1r Of APPLICANT •••••• Any information that is m,s•ro�resentcd mar result ,n the aaattary ptrtnit 5etng revoked by 1114 Zia ••• pin8 • Deputnlent. "' i •• Include with tbU tppNestion ; ct y or the eenifte dad un map t D e sii made mn,ht werror dy dad ta'd •est6lLrtLrt _i1►1�X31 311991318 W4 09=01 « -stt -4319 .1 11 `� , o I PAa 5 62 WARRANTY DEED 608266 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD 08-09 -1999 9:30 AM WARRANTY DEED EXEMPT I Return Address KRI,;'TINA OGLAND CERT COPY FEE: COPY FEE: Z..:la., F.streen & Ogland TRANSFER FEE: 113.70 P .O, Box 359 RECO FEE: 10.00 Iludson WI 54016 Parcel I.D. Number: 032 - 2101 -10 -000 Pinecliff Partnership consisting of Michael J Hartman and Wendell V. Viebrock conveys and warrants to Todd Weiss and Sherri Weiss, husband and wife, as survivorship marital property. the following described real estate in St. Croix County, State of Wisconsin: of 27 Pine Cliff First Addition to the Town of Somerset, St. Croix County, Wisconsin. This is not homestead property. Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this X�d day of August, 1999. Pinecliff Partnership B Michael J. artman AUTHENTICATION Signature(s) Michael J. Hartman for Pinecliff Partnership authenticated this _ day of August, 1999 * k, Kristin Ogland TITLE: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016