HomeMy WebLinkAbout038-1213-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
399697 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:
LaCasse Development Star Prairie Township 038 - 1213 -40 -000
CST BM Elev: Insp. BM Elev: IBM Description:
v� & o � 8� Av A 16r- /L/9
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / / _ Berk /-f. % � M 7. /d
Dosing Alt. BM -
/�
Aeration r Bldg. Sewer i
Holding St/Ht Inlet
c�
TANK SETBACK INFORMATION St/Ht Outlet �- I
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
r
Septic O 1 i O / f Dt Bottom
Dosing � q0 Header /Man,T � �• SS ��� `�
Aeration Dist. Pipe
Holding =j Bot. System
Final Grade / Q�
PUMP /SIPHON INFORMATION 'y AV sys
Manufacturer Demand t Cover
A0 7
Model Number
TDH L " Friction Loss System Head T Ft
Forcemain Length ell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width ILength I No. Of Trenches PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS {�
SETBACK SYSTEM TO P /L� BLDG WELL LAKE /STREAM EA HING Man ct e
INFORMATION CHAMBER OR
Type f System: -41 / �� UNIT Mog; u
C X ) 13
DISTRIBUTION SYSTEM n VIVS
Header /Manifold Distribution x Hole Size x Hole Spacing Ve Air Intake
�I Pipes) �� ((��'' ,, ��,, � f1/1 i i Length Dia Length f Dia N �Jp ,
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only d
Depth Over I L Depth Over xx Depth of xx Seeded /Sodded xx Mulched j
Bed/Trench Center T/ Bed/Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / 3/ 4;) Inspection #2:
Location: 2237 122nd Street N/e�w� Ric R1 W Richmond, WI 54017 (NE 1/4 SW 1/4 11 T31N 8 ) River IP a66 Lot 4 Parcel No: 11.31.18.1165
1.) Alt BM Description
2.) Bldg sewer length - t . -�¢qG� kf t
- amount of cover
a t f7 ; L l p G�f 1► I -}are+ � Gpdr$� 5 5 �
Plan revision Required. Yes No �) SD
Use other side for additional Information. O
Date nsepc toaso atur e Cert. No.
SBD -6710 (R.3/97)
s
Safety and Buildings Division county
201 W. Washington Ave., P.O. Box 7162 .5 7
N visconsin Madison, WI 53707 — 7162 JW Address N �
Department of Commerce L d a 9 a a 3 7 / a
Sanitary Permit A PP 9 Check if Revision Sanitary Permit Number
In accord with Comm 83.21, Wis. Adm. Code, persoml on pro d ki I si n }
ma be used for secondary purposes Privacy 1 �,
❑
I. Application Information — Please Print All Informatio ,� RECE {VET State Plan I.D. Number
t�.t
Property Owner's Name Parcel Number
ffa�
r4, E P r 2Q�2
Property Owner's Mailing Address f� Property Location
5 c'_ - rlq - 'A 11-(54; S T N, R LE
City, tate Zip Code ; ` s be
tY, p ,Phoge,Nkmber Lot N r Block Number ..:
7�%
Subdivision Name CSM Number
•
II. Type of Building (check all that apply) ❑City
9 1 or 2 Family Dwelling - Number of Bedrooms ❑Village
9 Public/Commercial - Describe Use - ownship
! ❑ State � earest Road
- /coo 7 �/- `� � /_
l '`� s�
j
III. Type & Permit: (Check only one box ,6n line A (numbering scheme for internal use). Complete line B if applicable)
A. 1 New 2 ❑Replacement System 3 11 Replacement of 6 11 Addition to For Comity use
Sy stem Tank Only Exis ' stem
B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV. of Permit: (Check all that apply)(numbering scheme is for internal use)
44 Non - Pressurized In -Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line t /y V
45 ❑ At -Grade 46 ❑ Aero c Treatment Unit 49 ❑ ecirculating I 30 ❑ Other
V. D' mdrl'reatment Area Information: —
Design Flow (gpd) Dispersal Area Disprsal Ay6a Soil Application Percolation Rate Svltem Elevation Final Grade
Required Proposed Rate( Gals. / Days /Sq.FK.) (MinJlnch) ✓ Elevation
6 0 0 5 s/ V A OR . 1 7 C/5 S
VI. Tank Info Capacity in Total Number tuner Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
_i
Septic or Holding Tank _ o / L
Dosing Chamber
i VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumbe ' S' lure RS Number Business Phone Number
oho 357 7 1-5 ° o - d
Plumber's Address (Street, City, State, Zip Code)
VIII. Coun elpartment Use Onl
Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Approved C] Disapproved Surcharge Fee)
❑ Owner Given Initial Adverse 22S Determination
1X. Conditions of Approval/Reasons for Dis_a proval
S . 1
esu� c ,�ncutit t ti T (
c�st�'l8''1 -S
Attach complete plans (to the County only) for the system on paper not less than SW x 11 loch« in size
SBD -6398 (R. 05101)
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Wisconsin DepartmentofCommerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
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. peria
Please print all information. R viewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , 0 2M Z.
Property Owner Property Location
LaCasse Developmen Inc. Govt. Lot NE 1/4 SW 114 S 11 T 31 N R 18 K(or) W
Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM#
573 Ct . Rd. "A" 4 na River Place
City State Zip Code Phone Number ❑ City ❑ Village ® Town ea ad
Hudson WI. 54016 1( 715) 381 -5405 Star Prairie ��� \ ,, E `r
New Construction Use: U Residential / Number of bedrooms 4 Code derived design flow atb � GPD
❑ Replacement El Public or commercial - Describe: tT tt `�
Parent material outwash Flood Plain elevation if appli pfe na �1 � ft.
General comments " `' 9 2001 "L._-
and recommendations: ST CROIX k�_�
co COUNTY
trenches @ el. 95.50' zoNNvGOFFICI: j
Boring 9
❑Boring # 99.80
1 ® pit Ground surface elev. ft. Depth to limiting factor 1 20 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
1 0-16 10yr4/3 none sil 2msbk mfr cs if 5
sil 2msbk mfr qw if .5 .8
9
4 45 -12 7 5 4 4 none c os ml na na .7 1 1.2
2] F Boring # Boring
g ® Pit Ground surface elev. 99 50 ft. Depth to limiting factor 120 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
mfr cs if .5 .8
7-31 10 4 4 none sil 2msbk mfr 9W if .5 .8
no ne sl 2csbk mfr qw na .5 .9
4 4 none cos osq ml na na .7 1.2
8 0
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L (fluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Number
CST Name (Please Print) Signature 02298
Gar L. Steel
Address Date 6aluaborrtonducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 6-22-2001 715- 246 -6200
l
Property Owner LaCa sse Dev -, In c. Parcel ID # Pend ing Page 2 of 3
Boring ❑ Boring
3 g ] pit Ground surface elev. 1 �� • 40 ft Depth to limiting factor 1 20 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 k mfr cs if .5 .8
2 10 -28 10 4 4 none sil j 2msbk mfr gw 1f .5 .8
3 28 -12 7.5 4/4 none gr ms /cos Osg ml na na .7 1.2
J
52-V g .8p
F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil A plication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
El Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 < 150 mg/L ` Effluent #;= BOD 5 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.
-8 30 R.6/00
S�� 3 ( )
STEEL'S SOIL SERVICE
Gary L. Steel' 1554 200th Ave.
CSTM2298
LaCasse Dev., Inc. New Richmond, WI 54017.
, ,
MPRSW -3254 NEQSW4 S11 T -r18W (715) 246 -6200
town of Star Prairie
lot #4 -River Place
Thin soil evaluation eras conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as sham
as permanent lot lines were not establisWd at the time the test xas conducted
1 =40'
= top of SE lto stake @ el. 100.00'
alt. , BM = top of NE lot stake @ el. 98.60' 4
� 5 �
�o
Gary L. Steel
6 -22 -2001
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner D L4-,Sr. Septic Tank Capacity a l ❑ NA
Permit # .3� Septic Tank Manufacturer w ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer �j_ ❑ NA
Number of Bedrooms `f' ❑ NA Effluent Filter Model . I w ❑ NA
Number of Public Facility Units b NA Pump Tank Capacity al A
Estimated flow (average) �"� al /day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) gal /day Pump ManufacturerA
Soil Application Rate ,2 �� al /day /ftz Pump Model \NA
Standard Influent /Effluent buality Monthly average* Pretreatment Unit "A
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODd :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD :530 mg /L 3i0n- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) :530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) :510 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every:
I s W
❑ m onth y ear(s) (s) (Maximum 3 years) ❑ NA
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: 0yea ()(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑ m 1 ❑ NA
Z yea r(s) rls)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) 76LNA
❑ year(s)
Flush laterals and pressure test At least once every: 0 y gyp`
Other: ❑ month(s) "A
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
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(s) in one large dose, overloading the cell(s) and may result in the 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 operating 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 system 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 sealed.
• 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 must
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
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.
< <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 INSTALLER POWTS MAINTAINER
Name Name
Phone s- . �8 6 liq _s-- Phone E
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name !�-� LQ,p I Y_ cy -oat R: 15N10
Phone Phone S 3 % .
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
S'1' CRO1X COUN'T'Y
SEPTIC TANK MA1N'1'LNANCL AGRLLMEN'1'
AND
OWNI?ItSllll' CI?1t'1'II-'ICA'I'ION FORM
Owner /Buyer e, & 4f4MA
Mailing Address S 7j C14 v R. A
Properly Address a
(Verif1ca(iou requited fionr Planning Ucpatimcnl for new amslruclion)
Illy /Slate s,�d� itl,•ar.;., U-3° - �ay8 /o
Parcel Identification Nuntl)cr
LEGAL DESCRIPTION
Properly Location �� t /,, �I,�y t /,, ,s � 1• \'
Subdivision IL J-4, [ �A, Lot it
Cerlifted Sw Mal) 11 _ Vulunrc Page 11
Warrant Y Vt)lunte llccd 11 ��� f S �
�� `2 �� Page 11
Spec !rouse byes Q no Lot lines idellliiialrle ( =1 yes U no
S YS'T'EM MAINTENANCE
Improper use and nrahrlenaaccof your seplic syslenr Could tcsull in its pt cilia ime failure to handle wastes. Properumaiutenance
cousisls of purnplug out Ilia seplic lank evcty dace years or sooner, if needed by a licensed pumper. Wlral you put into lire system
can affect the fuuc(ion of ilia seplic tank as a lrcatrucnt stage in the waste disposal system.
The property owner agrees to stlbnril to St. Croix Zoning Ueparinrcnl a cct(ificalion forte, signed by ilia owner and by a
uraslcr pluurber, journeyman plumber, reslt idled pltlrtrbcr or a licensed pungrcr vcr i fying That (I) the on -site wastewaterdisposal system
is is proper operaling condition and/or (2) after inspection and pumping (if necessary). the septic tank is less than 1/3 full of sludge.
1 /we, ilia undersigned have read the above rcgtliteutcnls and agree to maintain lltc private sewage disposal system with the standards
set forth, herein, as set by the Depadnicnt of Conuucrcc and the Ucpallurcnt of Natural Resources, Slate of Wisconsin. Certification
staling (fiat your seplic system has been maintained nursl be completed and rcluurcd (o the SL Croix County Zoning Office within 30
da a (11 e y r exp ration dale.
S n NATURE I APPLICANT DA'Z'E
OWNER CER'I'TI?ICA'I'ION
I (we) certify (hat all s(a(eructlts on this tuutl arc title to the bcsl of my (our) knowledge. I (we) ant (are) Ilia owner(s) of
(lie property described ab c, by vitluc of a wattanly decd Iccoldcd in Itcgisler of Deeds Oflice.
S ATURE OF 'P ICAN1' DA
DATE
Any information (fiat Is nris rcpresculcd Wray resull in the sanila►y permit Icing revoked by the Zoning Deparhnent. * * * * **
** Include with tills applicalloll: a stamped warranty llccd from the Register of Uccds office
a copy of the ccrlified survey map if reference is made Ill file warrauly deed
�o
d; 1�g?PAf,�4!1 6g�Cal
STATE BAR 00 WISCONSIN FORM 2- 1998 KATHLEEN H. WALSH
REGISTER OF DEEDS
ocurnent Number WARRANTY DEED ST. CROIX CO., WI
This Deed, made between Kevin Patrick Campeau, Jeffrey Allen RECEIVED FOR RECORD
Campeau and John Michael Campeau, as tenants in common, Grantor, and
LaCasse Development, Inc., a Wisconsin Corporation, Grantee. 42- 2'2441 11:04 AM
Grantor, for a valuable consideration, conveys and warrants to Grantee WARRANTY DEED
the following described real estate in St. Croix County, State of Wisconsin (The EXEMPT M
"Property "): CERT COPY FEE;
COPY FEE;
TRANSFER FEE: 1290.00
The Northeast Quarter of the Southwest Quarter (NE 1/4 SW 1/4) lying west of the RECORDING FEE: 10.00
.Apple River, EXCEPT the west three (3) rods thereof; that part of the Southeast F'AGES: 1
Quarter of the Southwest Quarter (SE 1/4 SW 1/4) lying west of the Apple River
and cast 122' Street; and the Northwest Quarter ofthe Southeast Quarter (NW 1/4
SF 1/4) lying north and west of the Apple River, all in Section 11, Township 31
North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin; and Recordin • Area
EXCEPT Lot I of Certified Survey Map filed November 3, 2000, in Volume 14 QQ Name and Return Address
Page 3988, as Document No. 632964. l r re IYN e-f' 13"x` E
5 3 2 Kr) c It=s A Je S�
Above described land is subject to an easement for ingress and egress to said Lot N _ (21 w ( 4U 1'7
1 as described on deed recorded in Volume 1555, Page 37, and subject to all other
easements, restrictions and covenants of record.
Part of 038 -104$ 10 & 038 - 1048 -40 _
Parcel Identification Number (PIN)
This is not homestead property.
Exceptions to warranties: Subject to all easements, restrictions and covenants of record.
V
Dated this —ZZP— day of February, 2001.
vin a tek tV �gTpea� John Michael Campeau
'Jej y Al en Campeau _
r
AUTHENTICATION
ACKNOWLEDGMENT
Signature(s) Kevin Patrick Campeau Jeffrey
Allen Campeau and John Michael STATE OF WISCONSIN )
Camp PAII - ) Ss.
trttt.......... County
� -� )
aa�uP11 £�t�iidxb� I diof February , 2001. Personally came before me this day of
2001 the above named
'K t t., 'O grand to me known to be the
n �
7Y1 P. ^M B$R SV,9 TE BAR OF WISCONSIN person(s) who executed the 1•oregoing instrument and acknowledge
the same.
i,
•anthnrized'by § 706.06, Wis. Stats.)
• , THIS INSTRUMENT WAS DRAF'rED BY
Hendrik W. Van Dyk '
VAN DYK, O '
Notary Public, State of Wisconsin My Commission is permanent.
BO YLE & S1LER, S.C. ry
Post Office Box 118, New Richmond, WI 54017 (If not, state expiration date: )
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
*Nair:, of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM N.. 2 - 1998
INFORMATION PROFESSIONALS COMPANY FOND Do LAC, WI 800 -855 -2021
P 6 ---'
STATE BAR OF WISCONSIN FORM 2 - 1998
Doc
This Deed, made between Kevin Patrick Campeau, Jeffrey Allen
Campeau and John Michael Campeau, as tenants in common, Grantor, and
LaCasse Development, Inc., a Wisconsin Corporation, Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin (The
"Property "):
The Northeast Quarter of the Southwest Quarter (NE 1/4 SW 1/4) lying west of the
Apple River, EXCEPT the west three (3) rods thereof, that part of the Southeast
Quarter of the Southwest Quarter (SE 1/4 SW 1/4) lying west of the Apple River
and east 122 " Street; and the Northwest Quarter of the Southeast Quarter (NW 1/4
SE 1/4) lying north and west of the Apple River, all in Section 11, Township 31 Recording Area
North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin; and Name and Return Address
EXCEPT Lot I of Certified Survey Map filed November 3, 2000, in Volume 14,
Page 3988, as Document No. 632964.
Above described land is subject to an easement for ingress and egress to said Lot
1 as described on deed recorded in'Volume 1555, Page 37, and subject to all other
easements, restrictions and covenants of record.
Part of 038 - 1048 -10 & 038 - 1048 -40
Parcel Identification Number (PIN)
This is not homestead property.
Exceptions to warranties: Subject to all easements, restrictions and covenants of record.
Dated this Z& day of February, 2001.
vin a tck C pea John Michael Campeau
*Je ' ey AI en Campeau
*
AUTHENTICATION
ACKNOWLEDGMENT
Signature(s) Kevin Patrick Campeau, Jeffrey
Allen Campeau and John Michael STATE OF WISCONSIN )
I CgMppan ) SS.
�Q� County )
authenticated this`'" day of February , 2001.
� Personally came before me this day of
2001 the above named
Kr sting IO,land to me known to be the
TiTL E: MEMBER STATE BAR OF WISCONSIN person(s) who executed the foregoing instrument and acknowledge
(If not, the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Hendrik W. Van Dyk
VAN DYK, O'BOYLE & SILER, S.C. Notary Public, State of Wisconsin My Commission is permanent.
Post Office Box 118, New Richmond, WI 54017 (If not, state expiration date: )
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
*Names or persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No.2 - 1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800- 655 -2021
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