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HomeMy WebLinkAbout038-1193-50-000 a i % < � j a � \ (D 4 0 \ � f � q � ƒ � 2 � 7 � 0 % z 0 f � ce) � k \ z / ® o z \ ( 2 Q § $ B z 2 t§ 2 ® e m % ) / (D § $ I § p § .2 k k z \ z k z \ „ z 0 I k E §�..2 ! L) L , � k @ k § o a R ° ■ ■ § / E © f -� k \ 2 a a . § � ■ � � 2 v ƒ } § k } § § ® a / % 2 @ I \ k $ z / i § $ o k ° 2 k © k§ §\ k ) t k k CD @ m 2 % % §\ E§ ■\ k 2 k k CN - §§ k 3 m o z/ z � EL . 4) — , _ = a . E J k a § / L) a 2 A V) 0 Wiswnsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399651 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 Taz No: DamiceTravis I Star Prairie Township 038 - 1193 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: M .ta I 1 Lon'.) . O Z" FU L. 'w- C Sr erµ bL I TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I � Benchmark Dosing Alt. BM Aeration Bldg. Sewer ►p�+ Holding St/Ht Inlet ' tr z 8.1 -4 hf f `%( .`` St/Ht Outlet TANK SETBACK INFORMATION SS �� $•` 9�{.3� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �, 2 Dt Bottom Dosing Header /Ma 2 L� 06f !"f 5r Aeration Dist. Pipe R 't y 4 ;at'o�v Holding Bot. System l b'( , " �t). 42. t3 Final Grade N PUMP /SIPHON INFORMATION `ti* 5 �', 8•e8 Manuf urer GP Aa St Cover �� l Model Nu m er J TDH Lift riction Loss System Head TDH F Force Length Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width 1 Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING Maefac INFORMATION CHAMBER OR Type Of System: �� f \ UNIT l Model N mbar: Con y DISTRIBUTION SYSTEM W L Header, anilp � Distribution x Hole Size x Hole Spacing Vent to Air Intake (0� Pipes) Lengt Dia Length Dia Spacing 'fT 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 Bedrrrench Edges Topsoil I Do Yes No Igo] Yes X No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1 r► / u. / Z" 0r- ' — Inspection #2: Location: 2163 134th Street Unknoown� (SE 1/4 NW 1/413 T31N R18W) Pine Acres Lott 5 Parcel No: 12.331..18..11�0,00�� 1.) Alt BM Description = TOf �e[ T °""" .� 2.) Bldg sewer length = Z3 , J p�,,,�.,..� 6t'u bau.eq J - amount of cover = '`" - cs ewe .sal rep.') .J 3 ) 4w " A- -too ET; Plan revision Required? "A j YesVNo Use other side for additional information. L o 0 7_-I SBD 6710 (R.3197) Date Insepctor's Signature Cart. No. 1 3q z4 Sanitary Permit Application . Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. • `��COns�n See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes G� �� Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)( i (Submit completed form to county if not l { r i - � state owned.) Attach complete plans (to the county copy only) for the s t paper not thhtt -1/2 x 11 inches in size. Count-- State Sanitary Permit Number s ❑ Chec f ion to pe4ous application` ,,State Plan I. DV Number ( ( , /el & I. Application Information - Please Print all Information Location: Property Owneoftine °'1 '' Property Location C/ �ir►zc.G C� 1 . � /4 4/4, S T ! ,N, E (o W Property Owner's Mailing A ss� Lot Number Block Number City, State Zip Code Phone sG'3 u divisio 4Lj, II. Type Building: (check one) ❑ City ❑ 1 or 2 F amily Dwelling -No. of Bedrooms: \3 �.lit� ❑Village ❑Public /Commercial (describe use):_ 'Town of < ❑ State -Owned Nearest Road 03 - Ict -so -Cow 13 q t 1 Parcel Tax Number(s) _ III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. New . ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV Type of POWT System: (Ch all that apply) Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Inform i H ,, /� ,,�, o t i4 S . 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 1 Perc ation 6. System Elevation 7. Final Gra e Required Proposed Rate (Gals./ y /sq. ft.) (A'n,.Jinch) Elevation 37S` 377 Z VII. Tank Capacity in Total I # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass S New Existing crete structed Tanks Tanks w X 100 '1 ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on. hed plans. Plumber's Name (print) P1 er's 'gnature ps): Business Phone Number n41 (?� /-e ?i,- ,.2 65' -C6�� Plumber's Address (Street, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit a (Includes Groundwater Date Issued uZA�gt Signature (No stamps) pproved ❑ Owner Given Initial Adverse Surcharge Fee} e. Determination X. Conditions of Approval /Reasons for Disapproval: l� J � u ��yi L p r '� i. �� ��✓l ✓ / S / -�4��n S; ✓ k-a ih 11�t rc c� t� v �( a SGPhZ�sk (Ltii9" �Hlkr 4l�C✓ !'-" yr.ai.. r.L I`✓LGt� ��}6Gr�G�✓+jMt k CST- v .{ 2314 cl a i -C d1�G S V . u S� be VAC / i fl- d' "� a �t �, 1 �'►L�S , W IjQ f C p.� �l�cr lw� �pT �6 #I..R- 1..51 - 11 a_t"" (Ut- t 01" 4 1 � ��3� ; "(� so<<.&.j &(U��w-u .61 't. Gro�lit U J, A t I wn• t; K e �vF Cis v�r a let - A je4 c � vu•� µr�.� SBD -6398 (R. 07/00) Pia aT dnzeo V 2 JP-k A/00 r/ — - — — !or,L &,g,m ion: �.m I I r T q A sue _/ m fas4 c i I a t 12, {28/,2001 15:13 7152686637 HI/ GILLE TRUCKING PAGE 01 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INPORM4XION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity A600 al ❑ NA Permit # Septic Tank Manufacturer 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms O NA Effluent Filter Model A Q NA Number of Public Facility Unite &KNA Pump Tank Capacity al R Estimated flow (average) gal/day Pump Tank Manufacturer NA Design flow (peak), ( Estimated x 1.5) gal/day Pump Manufacturer A�NA Soil Application Rate i al /day /ft2 Pump Model E%NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L 13 Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOD 5220 mg/L ❑ NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSSI 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cells) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L Ain-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids ITSS) 530 mg /L ❑ NA ❑ At- Grade n Mound Fecal Coliform Igeometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA other: ❑ NA Other O NA * Valu ®e typical for domestic wastewater and septic tank affluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: !3 e ars (s) (Maximum 3 years) ❑ NA Pump out contents of tankls) When combined sludge and scum equals one -third (Y of tank volume 0 NA Inspect dispersal cells) At least once every: C� 3 h(s) (Maximum 3 years) 0 NA ' y ear( earls) Clean effluent filter At least once every: ❑ th(s) ❑ NA earls) 0 monthls) U NA Inspect pump, pump controls & alarm At least once every: Q ears) Flush laterals and pressure test At least once every: C3 month(s) D ,� A ❑ earls) Otf° At least once every: 13 month(s) NA E3 year(s) Other: D 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 call(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 (a /011 12 {28/.2001 15:13 7152686637 GILLE TRUCKING PAGE 02 Page - ! L of Z START UP AND'OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal call(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 cells) in one largo 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 lie 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 repla ccern nt system: 7 G�' 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 walls. 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. 0 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. 0 Mound and Y at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the g p 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 Olt 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 POWYS IN ER POWTS MAINTAINER Name Name Phone ?, &( Phone SEPTADE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(bl(1)(d) &(f) and 83.64(1), (2) & (3), Wisconsin Administrative Code. Psconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of Wsion of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and loc„snd distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Pl �Y R$ +idfeicmon. Fendin Personal information you provide may be used for pu (PrivaCy Law, 15.04 (1) (m)). a to e. D Property Owner �� i ' " .: i , Property Location Lakes & HilIs Develoment Gdvt. Lot 114 NW 1/4,S 13 T 31 N,R 18 W Property Owner's Mailing Address ! ',W'00 Lot # Block # Subd. Name or CSM# k 62 v ,, A 5 - -- Pine Acres City State 4 Phor b�vT. City. Vfllage ,KTown Nearest Road /3 New Construction Use: R 3 []Addition to existing building - --- Replacement El Pubffc o tror cuo esc�o Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/f'tz 8 trench, gpd/fP Absorption area required 643 bed, fF 562 trench, ffz Maximum design loading rate .7 bed, gpolft .8 tr ench, gpd/ftz Recommended infiltration surface elevation(s) 93.6 ft (as referred to site plan benchmark) Additional design / site considerations Parent material ---------------- - - - - -- Flood plain elevation, if applicable --- ------ ft S= Suitable for system Conventional Mound In Ground Pressure AT Grade System in Fill Holding Tank U= Unsuitable for system N S u ® S❑ u N s❑ u ❑ S❑ u ❑ S® U ❑ S N u SOIL DESCRIPTION REP RT Depth Dominant Color Motfies Structure GPDtfF Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistenc Boundary Roots Bed Trench 1 1 0 -10 10YR3 /3 ------------ - - - - -- I lmsbk mvfr as if .4 .5 2 10 - 20 10YR4 /4 ------------ - - - - -- 1 lmsbk mvfr gw 1vf .4 5 Ground 3 20 -51 7.5YR4/6 ------------ - - - - -- cs osg ml gw - - -- .7 .8 elev -- - - - - -- 97.9 ft 4 51 -93 10YR4 /6 s osg ml - - -- 7 .8 Depth to limiting factor >93" Remarks: 1 0 -11 10 YR3 /3 - ---------------- - 1 lmsbk mvfr as if .4 S 2 11 -26 10YR4/4 ------------ - - - - -- 1 lmsbk mvfr gw lvf .4 .5 Ground 3 26 -48 7.5YR4/4 - - -- cs osg ml gw - - -- .7 .8 elev 97.3 ft 4 48 -86 10YR4/6 ------------ - - - - -- s osg ml - - -- - - -- 7 8 Depth to limiting �3 factor >86" Remarks: CST Name (Please Print) Signature: Telephone No. Jacq Hawkins V ?z -- j V V t Address a f Date CST Number Ref # .s YPJ - j 4/8/00 a 87 377 OPERT.Y OWNER: Lakes & MUs tevelou ent SOIL DESCRIPTION REPORT Page 2 of 3 ARCEL LDJ Pending Depth Dominant Color Mottles Structure { I GPD/ftz Horizon in. Munsell Qu. Sz. Cont Color Texture Sz. Sh. onsistence Boundary Roofs Bed Trench 3 1 0 -12 10YR3 /3 ----------- - - - - -- 1 1 msbk mvfr as if .4 .5 2 12 -25 10YR4/3 -- -------- -- ---- 1 lmsbk I mvfr gw 1vf 4 5 Ground 3 25 -50 7.SYR4/4 cs osg ml gw 7 .8 elev ------------ - - - - -- - - -- 97.3 ft. 4 50 -85 10YR4 /6 ----------- - - - - -- s osg ml - - -- 7 - - -- 8 Depth to limiting s L L factor >8511 — I Remarks: � 4f� AAA 1 0 -11 lOYR3 /3 - 1 lmsbk mvfr as if .4 .5 - 2 11 -23 10YR4 /4 ------------ - - - - -- 1 lmsbk mvfr I gw 1vf .4 .5 Ground 3 23 -49 7.5YR4/4 - - cs osg ml gw 7 8 e ev ----- - - - - -- - - - -- - - -- 97.3 ft. 49 -84 10YR4 /6 - ----------- - - - - -- s os g ml - - -- - - -- 7 8 Depth to limiting - — — _-- - - - - -� -- - -- - __ -v factor >84 Remarks: 5 1 0 -10 10Y R3 /3 ------------ - - - - -- 1 I msbk mvfr as i f .4 5 2 10 -23 10YR4 /3 ------------ - - - - -- 1 lmsbk mvfr gw lvf .4 .5 Ground - - - el 3 23 -53 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- 7 8 97.3 ft. 4 53 - 88 10YR4 /6 s osg ml - - -- - 7 8 Depth to limiting -- -- — factor >88't — Remarks: Ground - -- - - elev ft. -- Depth to limiting - - - - - - - -— - - - - -- factor Remarks: �l1 bj CI bu z z� T� _ m 4 I A C O � Q R c I S T CKOIX COUNTY SEPTIC :'ANK MAINTENANCE AGREEMENT AND OWP CER'TIFI FORM i Owtter /Auger - -- �aC eSk2 Mailing Address .333 ._ 0 l � � �_ �I,() � L Property Address oZ .5+ . /�QW (Verification required frou i Planning Department for new construction)„_ ^� _ City /State LtJ 3�� /o �`/- �s = � O 6 � Parcel Identification Number L EGAL DESCRIPTIO Pre Location X 1 1 4, t � 3 � _ pt;l-ty � - -- /,, bi C . � . T_..._.._..�`l �__ ��W, T own of � Subdivision 1 (he Gre S T_.ot # Certified Survey Map # _ _ _ Volwne �, Page # Warranty Deed # _ 6 �/l /� . Volume � . Page # _-3 Spec house ❑ yes 13 no Lot lines identifiable C) yes ❑ no SYSTEM MAINTENANCE Improper Use and maintenanceof your set pc aystom eeuld result in its premature failure to bandre wastes. Properrua.iAteaance consists of pumping out the septic tank every thrt a years or eoaaer if needod by a licensed pumper. What you put into th system can affect the function of the septic tank as a tma onent stage in the waste disposal system. The ro owner agrees to submit to St. Croix Zonis Q artmeat a cortifiWian form, signed by the trwmcr and by a P ply S � master plumber, journeymmplumber, restrietedpl: umber or a licenaedpumpor verifying that (1) the on - site waatcwaterdisposal system is in proper operating condition and/or (2) after in:'peedon "d pumptag (1f n ecessary), the septic twok is less than 1/3 full of sluelge. Uwe, the undersigned have read the above require hents and agxao to niaintaia the private sewage disposal system with the standards set forth. herein,, as set by the Departmeat of Com- oome and the Deparu :iont of Natural Resources, State of Wisoousla. CE t4iSiCetion st4ting that your amtie system hag been maintainer I inust be completed and rcturnod to the St. Croix County Zoning Office Within 30 et year expiration date. L SIGI�T OF APPLICANT D ATE O -- R CEIR EICATION I (um) cerdfy that all atatomonts on this ; ►ran axe tm6 to the best of my (our) laaow ledge. I (we) am (are) the owner(&) of rty described above V virtue of a watTa tty deed recorded its Reg;stcr of Deeds Office. I f GN OF - UPLICANT DATE •..F ". Amy information that is mis- represeatnd a ay result in the sanitary permit being revoked by the Zoning Department. •••••• '• Include with this application: a stamped Warr inty deed from the Register of Deeds afore a copy of the c, rtified survey mop if reference is made in the warranty deed D'EC =07 -01 12:06 PM MCCORMACKS 6514394209 P.01 pASE . s'rATE BAR OF WISCONSIN FORM 2. 1999 t& s..4 1 3- Es Docvtllcnt Number WARRANTY DEED KA': ALEEN H. WALSH REGISTER OF DEEDS $T- CROIX CO., WI This Decd, made between Lakes a n d Hills I nc., a Minnesota Corporation, RECEIVED FOR RECORD _ — — 12 -OS -2401 9 :30 AM _.. . —_...` WARRANTY GEED Grantor, and Travis D. Damico and Suza nne M. D atnic o, husband EXEMPT N and wife, -- — — — C£RT COPY FEE: COPY FEE: - — -- TRANSFER FEE: 79.50 — — RECORDING FEE: 11.00 Grantee. _ —. — PAGES: 1 Crantor, for a valuable consideration conveys to Grantee the following described real estate in St _ Cr _ County, State of Wisconsin 01'ntore space is needed, please a " _addendum); Recording Area Lot S, Pine Acres, Town of Star Prairie, St. Croix County, Wisconsin. Name and Return Address KRISTINA OGLAND ATTORNEY AT LAW R.O, BOX 359 HUDSON, WI 54016 -�. O3`� -I I`i3 -So -•oo I boo Pt o1 8-1 - 9s -000 —_. _ ... Parcel ldrnlification Nurnbcr (PIN) This i not homestead property. (76) (is m.)() Except ions to warranties; Easements, restrictions and rights- ol'•way of record, if any. Dated this �� — day of Decem 2001 Lakes And Hills, Inc. -- . ___ ' By: Rich ard S. Nelson r•es ent AUTHENTICATION ACKNOWLEDGMENT Signatu,rc(s) Lakes and trills, iuc., by Ri chard S. Nel son, its STATF OF WISCONSIN } resident, ) ss. County authcnlicatcd this day of December 2001 - - Persormlly crone bcforr tne; this day of - -.... _ — _.._.... _._ —... — the above n,amcd . Krishna 0�lan l - .. - -... —.._ _.... ... TI CL..F.: MEM STATE BAR OF WISCONSIN n — (If nail, to me know to be the persim(s} who exccuted I },c foregoir+. , authurirc�l by 7UG.06, Wis. Stars.} -' instrument and acknowledged the same. THIS INSTRUNIFN l• "'AS DRAFTED BY Attorney 1Kristina Uglaend Nolary Public, State of Wisconsin _ Hudson, Wl 54'1)lti — _•• •._ _ - -_ — -- My Commission is permanent. (If not, state expiration date: (SignalureS ulay be autlt¢nlicated or aeknow1cdged. Both are not necessary.) } + Namcs ol'person; signing in any capacity must be typed or printed below their signalurc. infaimation professlonai+tomoany. Pond du Lac. W STATE BAR OF WISCONSIN 800 WARRANTY DFF.t) FOR.Nt No. 2- 1999 UA3 s� P.K. Nail Found E i/4 Comer [[[ n• C OWNERS: t Q Sec. 13, T31N R18W. Lakee and N:IIe Inc. to SW 114 of the NW P.O. Bo. .0622 South tine of NE 1/4 in Sect 13, MIN, white Bea Lake, MN 55110 of Sec. 13, T31N. Rt8w 'isco George M. Blrkholz ar] n a East iine of NW 1/4 Marlon V. 94 East !ine of SW 1/4 - -- Y oi; yr of Sec. 13, T31N, .R18W 2775 31rd Street Of Sec. 13, T31N, R ?8W � a '0 a S00' >6 ' n 4e» Raymond. NI. 5017 1 '00 < 2150.25 SE Comer of NW 1/4 ' ° or Sec. 13, T31N, R1 8W. - -- ` 163 244.48 - t, •, 257.01' 249.46' t 19. tY 147.71' - 1758.01'- . i ce . , 5 W 4 65,459 sq.ft. ° ae 65.340 s ft. 1w ' 1.503 acres T ° q' $ 65,381 sq.ft. i N 1.500 acres a 1.501 acres 3 ;j 65, 589 sq.ft. t ' a 1.51 acres �+ . 2 -- 1 yr b 65,458 sq.ft Q 1 503ocres a o 8' 80 acres _ —s9— Ce 200.90' 10889• (�( �� • C6 NO2T6'441 J09 79' _ STREET \a s� L Z '06�'W� 309.79' ej 2 — �C CIO 1 _ 41 9 _ l - F 363 1 > l J�B? 8 - -.- - I I C7 ' 65,679 sq.ft. 34TH 1.51 acres w ^ H : N0032'3a� g N (� 30 �3 65,992 sq.ft. Z, ! 67.922 sq.ft. `` - - -- , : ' �\9 F 1.51 acres f 1.56 acres LEGEND: 2 Fran p:oe fond--' A It S08 tV w Oa Denotes County Surveyor's Monument ? Z 4 \�. *, d j s Aluminum Cop Found ± O.� �/ /p- �^ ess noted, 31 1 w a Denotes 2" X 36" 'ran � a'p Set ?� - -- - I� �' 67,93r sq. I JJ'�IU We:^ 3.65 Ibs /ft. o :� 1.56 acres t 1 • Denotes 1" iron P :p -C, nd it �I (Unless noted) C46 Cerotes Curve V.Tbe• c \` ^ C si.g4� J6799�j ( i � Denotes drainage do ,.£ �-ty easement • - 1 SOJ367t'w I I ( 12ft. in w`dth UNLESS NOTED) � a - 177 69- -.� - J I I � CID Z 25 �•� ^ `(� p Denotes Build :n9 Se!.ack Line o y �' z 220 s 67,q. ft . a `` yA ti J �— i ' 3 Denotes Total Lot A-ea 76.537 sq.ft. I 1.54 acres r 5 32 1 (rec.) Denotes recorded rrecsuremerts ' 1.76 acres 67,082 sq.ft. ul i P � � rn h a ti 1.54 acres I ; (.^ eas.) De notes measured Caton es crd anq es o Vert:cai Datum s U. S.G.S. ?929 Ad ust.r-ent o 7 "/ a I I i All Other Lot Corners Are Vcn: rnented Mth J nI 362.BJ N00'49'40'W �6* n 1' X 24' Iron P pe We gr;ng 1.68 'bs /ft. ? P o 734.06 21477' 1 'a I^ Distances cre computed to the Necrest 0.001' and mecsured to .he - errest O.C7' 24 _ .n ��" 1 r Any e9 are Orr OU fed !O I le 1'!Cr °St 129 sq.ft. a° ` :, ( % „nd measured to tre rec est 2D °JO LS" n .84 acres `/ • i _J ^ ' I n ' F I 2 a °' • a ^! P I of 34 I .S9 �.,__.. 294.70 3 o I 5.768 sq. 77,778 sq. ft. 1.51 acres �� 1.79 acres :f o' STATE BAR OF WISCONSIN FORM 2 - 1999 6641 15 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Lakes and Hills, Inc., a Minnesota RECEIVED FOR RECORD Corporation, 12 -05 -2001 9:30 AN WARRANTY DEED Grantor, and Travis D. Damico and Suzanne M. Damico, husband EXEMPT N and wife `� COPY FEE FEE: Y ' TRANSFER FEE: 79.50 RECORDING FEE: 11.00 p" PAGES: 1 Grantee. t Grantor, for a valuable consideration, conveys to Gram 'A following described real estate in St. Croix State of Wisconsin (if more space is needed, please attach addendw �� ..cording Area Lot 5, Pine Acres, Town of Star Prairie, St. Croix County, Wisconsin. Name and Return Address KRISTINA OGLAND ATTORNEY AT LAW P.O. BOX 359 HUDSON, WI 54016 Pt 038-1054-95-000 Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 3A— day of December 2001 Lakes and Hills, Inc. * * By: Richard S. Nelson, res' ent AUTHENTICATION ACKNOWLEDGMENT Signature(s) Lakes and Hills, Inc., by Richard S. Nelson, its STATE OF WISCONSIN ) President, ) ss. County ) authenticated this day of December 2001 Personally came before me this day of the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN — (If not, to me known to be the person(s) who executed the foregoir.,; authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) , ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals company, Fond du Lao. WI WARRANTY DEED STATE BAR OF WISCONSIN SM-e55-2021 FORM No. 2 - 1999