HomeMy WebLinkAbout032-2167-33-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 463424 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:
Hartman Homes I Somerset, Town of 032 - 2167 -33 -000
CST BM Elew Insp. BM Elev: BM Description: Section/Town /Range /Map No:
10Z4 1 Z• 4t,!�jY] 6k -2, 26.31.19.1413
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / / � � � Benchmark Q � Z
Dosing Alt. BM I�J� r D 1 /
st' s o�
Aeration Bldg. Sewer
3 Q 3 s & ., -- 7
Holding St/Ht Inlet
� l0.27 9b�•
St/Ht Outlet �L
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
/
Dosing Header /Man.
�
Aeration r l Dist. Pipe s i 5; UK4 1:
Holding Bot�
Final Grade k
PUMP /SIPHON INFORMATION
Manufactur Demand St= r
GPM �� �' f7
Model Number /mo '! [
TDH Lift Friction Loss System Hea TDH Ft T �f
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width 2 Lengt h / o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
di
7
DIMENSIONS _ I /[
SETBACK SYSTEM TO P/L BLDG WELL ` KE /STREA ffEA G Manufec5rrer. Tj'0 V(
INFORMATION V
O h
Type Of System: / J , D� ? Model Number:
DJS IBUTION SYSTEM f o
Header/ nifold y Distribution x Hole Size x Hole S pacing Vent to Air Intake
L Pipe(s) 6�
Leng Dia Length_ Dia Spacing — i
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
3 , - 1 1 J
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: /?�>Q/ 6_r Inspection #2:
Location: 644 196th Av d ue Somerset, WI 540255 (SE 1/4 NW 1/4 26 T31 R1 9W) Pinecliff Lot 33 � Q Parcel No: 26.31.19.1413
1.) Alt BM Description = 'v' ' �' G�iJC�G S &• W L ID ��-Q(
2.) Bldg sewer length
- amount of cover = \
Plan revision G�
Req No Use other side for additional information.
Date Insepctor's Signadire Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County
` m m 201 W. Washington Ave., P.O. Box 7162
,�����,� Madison, WI 53707 - 7162 f�nitary ermit Number (to a filled i by Co.)
J
Department of Commerce (608)26 - C�,� V 2 2
Sanitary Permit Application 1 State PI I.D. Nu
In accord with Comm 83.21, Wis. Adm. Code, personal information yo rovide R
^ O ��
may be used for secondary purposes Privac w,i15.04 I -in P Ix G Pro�egt Add ss (if different than maili addres
I. Application Information -Please Print All Information - ZON1 FIG 1� �K
Property wner's Name Parcel # J t # Block #
YZ 03Z- 21 49 - - ate
Property Owner's Mailing Address Property Location
' ( . 1 1 13 )
City, S e Zip Code Phone Number v � � A�9L Section _
A. 119 S circle
II. Type of Building (check all that apply) S T �L N; Rm
I or 2 Family Dwelling - Number of Bedrooms S Subdivision Name r
❑ Public /Commercial - Describe Use
❑ State Owned - Describe Use ❑City E ownship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ' New System ❑ Replacement System y ep y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that a pply)
19 Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter Yl,eachingChamb Drip Jjne ❑ Gravel -less Pipe ❑ Other (ex lain)
V. Dis rsaVrreatment Area Information: Z 3 Z S
Design Flow (gpd) Design Soil Application Rate(gpdK Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevatio
7
VI. Tank Info Capacity m Total Number Manufacturer Prefab Site Steel Fiber Plastic UQA Gallons Gallons of Units �' , l _ ^ _ 1 oncrete
Constructed Glass
New Existing �o�b�L
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Resp sibility Statement- I, the undersigned, nine responsibility for installation of the POWTS shown on the attached plans.
RPIuAibers r' am ( ' t) , Plum is S ' ure MP/MPRS Number Business Phone Number
v l _
Address (Street, City, te, Zip
VIII. County/Departnfeit Use Onl
Approved ❑ Sanitary Permit Fee includes Groundwater Date Issued Is uin oAgent Signature o Stamps)
Sur Fee) 2
nReason ,Denial
IX. Conditions o Appro I/Reasons for Disapproval
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances
Attach complete plans (to the County only) for the system on paper not less than SM x 11 inches in sin
SBD -6398 (R. 01/03) `
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1Msconsin Department of Commerce SOIL EVALUATION REPORT Page / of
Division of .Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 5- 0
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. Rev' wed by ate
Personal information you provide may be used for s p purposes (Privacy Law, s. 15.04 (1) (m)).
Pro Arty Owner /r !! °w y, c Prop Location 1�
/! 2 I , Ft " �r 1 �rS Govt. Lot ,S,c 1/4 /' 9/ 1/4 S2 6 T 3 N R K (or)®
Prop Owner's Mailing Address ;) tb Lot # Block # Subd. Name or CSM#
is v rIJu r
.fir l l /I e c kfi
City State Zip Code P one N.lmb I ❑ jity ❑ Village fo Town Nearest Road
j�>6 14
® New Construction Use: 2 Residential I Number of bedrooms Code derived design flow rate 16 D o GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material _ _S'h6 O CC&X-ce 1 Al 7 �b,C1s & Flood Plain elevation if applicable
General comments S y/SrP� � L, 92
and recommendations:
Boring # ❑ Boring
® pit Ground surface elev. S e 7 ft. Depth to limiting factor
8 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 d - /OYX 3/ A4- Z- Z .0 0-5 -Z
Z 2 -Z l Y't Y y" L r, fA& c 7--
3 77 - 68 ' X s7K.W AIA /r2 J,�/c L c G - l 6 0, / , 2
75rR�I � os � — - 0,-7
92. YY
Boring # ❑ Boring / p
® pit Ground surface elev. 6, / ft. Depth to limiting facto 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
l 6 a S� Z o, s a r 9
2/- ,, 't c '-- 2 '- O ' s - O f
3 32 6 o 7Sr i s ,/ 1^ f�A /.gr 0,-7 /,2
y 6x98 ,-f- N s bs Z- _ — 0,-7 z
S
' 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 N me (Please P ' t) Signature CST Number
�r`ari Ain t�
- ?-313
Addre C� Q Date Evaluation Conducted Telephone Number
6 - 2- 0 �! Z C �O✓ti >c�J aCr wT — O Z 7d 2 V7 -jZ 01
SBD -8330 (R07 /00)
a �
Lo 33
Property Owner P,'j4 e C �� P� Parcel ID # Page of 3
F-31 Boring # ❑ Boring !y
13 pit Ground surface elev. 1 ft. Depth to limiting factor 7� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ tz
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
0� -� / R 3 /Z SL �rd� 65 z •� Or O .
0 C 4, Z -n O' O,
3 ZX- V7 7,5 rV i 0, 11 Z
8z
-7,5 `i NA rzl OS rZ L � s (� � 0.7
s J? 97 srW 0, /- 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 1ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
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 /11
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 /00)
OWNE Page 3 of 3
Nam; -?e
hf Brian Parnell
Address _& CST 231314
Date
Benchmark 1 J e 4 L,
Benchmark 2
❑ r Soil Boring
-i Suitable Area
1 40' Scale
2
-----------
--A
12,0
CtIqV0
JO
a� koe�
----------
- T
T
7- 7
- -------- -
7 - ------- 7--,
POWTS OWNER'S MANUAL & MANAGEMENT PLAN_ Page 01
FILE INFORMATION' ,C SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity go , O Ni
Permit ? 2 Septic Tank Manufacturer _ S O N "
DESIGN PARAMETt:R5
Effluent Filter Manufacturer " ❑ NA I
Number of Bedrooms
NA
Effluent Filter Model O NA
Number of Public Facility Units ANA Pump Tank Capacity al NA f
Estimated flow (average) gal/day Pump Tank Manufacturer
Design flow (peak), (Estimated x 1.5) al /da Pump Manufacturer l
1&' N!
al /da /ft
Soil Application Rate s Pump Model {
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg /L O Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) 5150 mg /L O Disinfection ❑ Other: j
Monthly Cell(s) ❑ NA
Pretreated Effluent Quality y avers g e
and (gravity) C3 In-Ground (pressurized)
n -Gro !
I Y
530 m L
0 g
Biochemical Oxygen Demand lBOD 9/
Total Suspended Solids (TSS) 530 mg /L ANA Cl At -Grade O Mound
Fecal Coliform (geometric mean) 510' efu /100n11 ❑ Drip -Lino C3 Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: p N
Other ❑ NA Other: C3 NA {
i
*Values typical for domestic wastewater and septic tank effluent.
Other: O NA I
F
MAINTENANCE SCHEDULE
Service Event Service Frequency
C3 m (Maximum 3 years) O NA
Inspect condition of tank(s) At least once every: $� ear(s) ..
Pump out contents of tank(s) When combined sludge and scum equals one -third .(4) of tank volume O NA
month(s)' (MeArnum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: year(s)
�
Clean effluent filter At least once every: ❑ month(s) ❑ Ni,
❑ month(s) Ni.
Inspect pump., pump controls & alarm At least once every: O y ear(s)
Er
O month(s) ANA
Flush laterals and pressure test At least once every: p y eads )
Other: 0 month(s) D NA
At least once every Cl ear(s)
Other: 0 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
must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks,
insp ections P
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.
GMW (4 /0 1;
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or, other,chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
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 will be
discharged to the dispersal cell(#) In one large dose, overloading the cellls) and may result In backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually the pump' controls to
restore normal levels within the pump tank,
Do not drive or park vehicles over tanks and dispersal cells, Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides ;, meat- scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the systern is
properly 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 �aaled.
• 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 suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by
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 rnust
comply with the rules in effect at that time.
❑ 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.--
�-
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a. soil and site
l i
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.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at,that time.
so
< < 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 OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALL
POWTS MAINTAINER
Name Name
I
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name r
Phone
Phone
this aocument was drafted In compliance with chapter Comm 83,22(2)(b)0)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code,
ST. CROIX COUNTY
SEPTIC 'DANK MAINTAIli ANCE AGREEM NT
AND
OWNLrRSHIP CERTIFICATE FORM
OwnenBtryer :' 5 O C. °
Nbiling Address V� WAI
Property Address
(Va£c m
._ haw Flaunting atsneai for new cawwKtim)
City /State T ` Parcel Identification Number O 3 Z - 21 b 4 -33 — 000 `f 3
LEGAL DESCRIPTION
Property Locatio ++ n�* /s, A Sec. _3LN KAw, Town of
Subdivision 1,vi & �� f 2 loo D Lot# 3 3
Certified Survey Map# Volume Page
Warranty Deed# Volume 2 `Koh Pa ( 2 9
� $ 16 3101 `f)
Spec house yes no Lot lines identifiable eyes no
SYSTEM 1k1A)FNTENANCE
Improper use and maintenance of your septic system could result 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 fimchon 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 austerplumber, journeyman plumber, restricted plumber or a licensed pumper verifyingthat (1) the on-
site wastewater disposal system is in proper operating condition and/or (2) after inspectiotr and pumping (if necessary),
the septic tank is less than 1/3 fWl 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 th Department of Commerce and use 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 hin 10 days of the three year expiration date.
SIGNATURE OF AMICAXT 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 property described above, by virtue of a warranty deed recorded in Register of
Deeds Office.
SIGNATURE OF APPLICANT
DATE
-***" Any inforn atim that ismum eprwsr.d may reilt o tho rosary Powik be" revok+ahy the Zmmg Deparom��`
e + Include web this apptio a saimtpad wrrraety deed &an the ReFsew o f Deeds $ce
a copy cf the certified earvey tmq if rafirwwMzM de m the Mwrary deed
S ' d 886 *1 -L�lz ( S T L) AOeepp I a2uu d9!; c 6 O S0 t' I udFJ
n1 2466P 629
X48113
AFFIDAVIT OF WALSH
Document Numba CORRECTION REGIST O DEEDS
REGISTER OF DEEDS
ST. CROIX CO., MI
�AFFIANT, Michael J. Hartman _ — _ RECEIVED FOR RECORD
hereby swears or affirms that a certa.n document which was titled as follows 12/03/2003 11:30AN
Warraa Deed (type of document), recorded
Jaaua , 2001 (year) is CORRECTIVE AFFIDAVIT
on the 2nd day of
_�_ EXERT ft
volume 1 571 page 42 4 as document number
636104 and was recorded in St. C roix _ _ TRANS - -- TRA CuLtity, FEE: 13.00
— — FEE:
State of Wisconsin, contained :tie fellcwirg error (if mere space is needed, COPY FEE:
please attach addendum) CC FEE
PAGES: 2
The name of the grantee was incorrect.
Recnrding Area
Mime and Roum Addm�s
Laux Cutler S.C.
P.O. Boa 456
Osceola, Wl 54020
I
AFFIAN"I' makes this .A for the purpobe o` correcting :he above dccumert 032- 10 -60 - 000 — e _
as fellows .'If ncic space is nccdcd, please attach adicndum;: Pisa! t de7 ri — rn3 icr r.mh- •;1'
The correct name for the grantee is Pineeliff Partnership
I
I
A copy c! :he original document (in cart or whole) [9 is is not attached to this Affidavit of a copy of the original document is not
attached, please attach legal description and names of grantors and grantees).
I Dated: No vember 25 2003
Si nod.
f Micha J. H artm an, p artner
I AFFIANT is the (check ene):
State of Wi &consin )
_ ) �. C3 Drafter of the da:ument being co-rected.
Count } Ste ' of f' � � ` ® Owner :)f the property dc.Ncribcd in - he document being
i --
corrected.
Subscribed and sworn to (or affitsced) befora me this ❑ Other (explain:
�. day of oV t w.� t r - -- , 2003 ----- - - - - --
ce— ----- _ _ THIS INSTRUMEN WAS DRAFTED BY:
Notary Public. State of Wisconsip. Prisci R D orn Ctttler
t Osceola Wisconsin 54020
My commission (expires) ;is): q_ d Io �
THIS FORM IS INTENDED TO C'ORAECT SCItMNER'S ERRORS AND VDT FOR THE CONVEYANCE OF READ � • � s7�%
Wormat Ptoratai ht'Co.
• Names of pertons signing in any oapaoity mat be tyaed or printad beksw #Kir signamra.
; 7 $ • G ;'
1 2466P 636
VOL 1571PAu 424
STATE BAR OF WISCONSIN FORM 1 - 1998 656104
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number CORRECTIVE ST. CROIX CO. WI
RECEIVED FOR RECORD
This Deed, made between ANTHONY TEASLEY AND 01-02 -2001 12:00 PM
D'ARCY ALLISON- TEASLEY, HUSBAND AND WIFE
U111"TY DEED
EXEMPT 1 3
__ Grantor, CERT COPY FEE:
and AKA PINECLIFF PARTNERSHIP COPY FEE:
TRANSFER FEE:
RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor. for a valuable consideration, conveys to Grantee the following
described real estate in ST. CROIX County, State of Wisconsin
(the -Property-): Recording Area
SOUTHWEST QUARTER OF THE NORTHEAST QUARTER, SECTION 26, Name and Return Address
TOWNSHIP 31 NORTH, RANGE 19 WEST. HEYWOOD & CARI, S.C.
204 LOCUST STREET, BOX 125
BY ACCEPTING AND RECORDING THIS DLED, THE GRANTOR IMPOSES ! HUDSON, WI 54016
AND THE GRANTEE ACCEPTS THE FOLLOWING COVENANTS AND
RESTRICTIONS WHICH WILL RUN WITH THE LAND AND BE BINDING
UPON GRANTEES AND ALL FUTURE GRANTEES OR OWNERS: '- - -- --
1. USE OF THE PROPERTY SHALL BE RESTRICTED TO SINGLE 032- 1072 -60 -000
FAMILY RESIDENCES AND MULTIPLE FAMILY OR OTHER USES SHALL parcel identification Number(PIM
BE PROHIBITED. IS NOT
This homestead property.
(is not)
2. THERE WILL BE A ONE- HUNDRED (100;) BUILDING SET -BACK ALON ) THE ENTIRE NORTH
.BOUNDARY OF THE SUBJECT PROPERTY TO MAINTAIN A BUFFER BETWEEN THE SUBJECT PROPERTY AND
ADJOINING PARCELS LYING NORTHERLY THEREOF.
3. HUNTING ON THE SUBJECT PROPERTY SHALL BE PROHIBITED.
THIS DEED IS GIVEN TO CORRECT A CERTAIN DEED DATED OCTOBER 23, 2000, RECORDED OCTOBER 24,
2000, AS DOCUMENT 632297, RECORDED IN VOLUME 1553, PAGE 138.
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
EASEMENTS, COVENANTS, AND RESTRICTIONS OF RECORD
r
Dated this day of DECEMBER 2000
(SEAL (SEAL)
ANTHONY TEASLEY
(SEAL) C Le t:e C<2 ^ --MAL)
D' ARCY ALLISON - TEASLEY 2=M
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) ANTHONY TRART.RY A1Vil
State of Wisconsin,
D'ARCY ALLISON - TEASLEY �r � _ as.
. . Count .
authenticated this day of D . MRF.R 2000 Personally came before me this 77'tpl day of
rA aYtit Ltv 6 100 O , the above named
OuYt�t.l'LC'Yt, -t.r I PCt�e2 <r
�`[JRtJy TITLE: MEMBER MEMBER STATE BAR OF WISCONSIN ) to
(if not, me known to be the person S who executed the foregoing
authorized by §706.06, Wis. Stats.) Instrument and acknowledge the same. JUDY K. TANNI
1 r Nogn Pubiic.State of Y
THIS INSTRUMENT WAS DRAFTED BY \ - i` ) `-°'/)"'�`"� -
HEYWOOD & CARI, S.C. 204 LOCUST STREET
S Cx C iY V � l a.n r'Fr
HUDSON, WI 54016 Notary Public, State of Wisconsin
My commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
• Names or persons signing in any capacity must be typed or printed below their signature.
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