HomeMy WebLinkAbout038-1193-90-000 ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
M N p M - rn�■ ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
JAM. Hudson, WI 54016 -7710
(715) 386 -4680 FAX (715) 386 -4686
May 17, 2001
PC Collova
705 County Trunk E
Hudson, WI 54016
RE: Septic Inspection for P.C. Collova Builders located at 1349 218th Avenue,
Pine Acres (Lot 9), Star Prairie Township, St. Croix County, Wisconsin
Dear Laurie:
A septic inspection of the above referenced property was conducted on 03/29/2001. This
property is located in the NE 1/4 NW 1/4 of Section 13, T31 N R1 8W, Pine Acres (Lot 9),
Star Prairie Township, St. Croix County, Wisconsin. At the time of the inspection, this
septic system was found to be code compliant for a three (3) bedroom home.
If you have any questions regarding this, please contact our office at (715) 386 -4680.
Sincere
r
J /Sonnentag
"
Zoning Technician\
/gm
cc: file
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM C ount
Safety and Buildings Division y t. Croix
INSPECTION REPORT JJ
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: ❑ City ❑ Village ❑ wn of: State Plan ID No.:
P.C. Collova Builders, Star Prairie Township
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
d L" 038 - 1193 -90 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_
Septic I Benchmark v D lJ
Dosing Alt. BM Z.
Aeratio Bldg. Sewer
olding Ht Inlet 9S
TANK SETBACK INFORMATION St/ Ht Outlet Q�
TANK TO P/ L WELL BLDG. Air i to ntake ROAD ' Pt inist
Air
Septic —7-7 -5--1 4 0 1 1 NA
NA Header/ Man.
Aeration NA Dist. Pipe
L -Y,f7 93.E
Holdi Bot. System
PUMP/ SIPHON INFORMATION Final Grade M, 5�C
Ma Demand St cover
Model Number GPM
T Lift Friction tern TDH Ft
Forcemain Length Dia Di
SOIL ABSORPTION SYSTEM s
BED / EN Width , Len h No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS Z_ DIMEN I N
SYSTEM TO P / L BLDG I WELL LAKE / STREAM LE Manu actur r: !
SETBACK HAM b
INFORMATION Type O i o e Num er:
System: C > -4.5 / 5T �760f ���i IT
DISTRIBUTION SYSTEM
Header /manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length f //' Dia. y Length l�S Dia. Ad Spacing >-0/
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 ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: 3 /ZQ /0/ Inspection #2:
Location: 1349 218th Avenue, New Richmond, WI 54017 (NE 1/4 NW 1/4 13 T3 IN R1 8W) - 1331181004 Pine Acres -Lot
9 i/ ' ,1k
1.) Alt BM Description= 6 .1To+v�. a� s;dH,f y.�SP� u.e�c5 mw 64
2.) Bldg sewer length = ! 3
- amount of cover = > le
Plan revision required? ❑ Yes 14 No
Use other side for additional information. p ll
SBD -6710 (R.3197) Dat Inspector's4gnature Cert. No.
1 -30
(�
7
/3 1 f9 218 E , r Sanitary Permit Application Safety & Buildings Division
' In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application
PO Box 7302
W isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if riot
state owned.)
Attach com lete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x I 1 inches in size.
County State Sanita Permmi umber ❑ Check if revision to previous application State Plan 1. D. Number
S t C_" c X
I. Application Information - Please Print all Information Location:
Property Owner Name Property Location
_O� '+( (� E 1/4 Pwl /4, S T3J ,N, R E or W
Property Owner's Mailing Address Lot Number Block Number
_70 c 9
City, State Zip Code Phone Number Subdivision Name or CSM Number
II Type of Building: (check one) 3 a s , S �.(..M o El C V illage
1 or 2 Family Dwelling — No. of Bedrooms: .n� s
0 Public /Commercial (describe use): .Town of
C3 State -owned P
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest R
l 3.3 I. 18 . l ooh
A) 1. New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System Tank O IX Existin System 63R S ^- 90 —
B) Permit Number Date 199a d
❑ A Sanitary Permit was previously issued
IV. Type of POWT System (Check all that apply)
V- Non-pressurized In-ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line.
❑ At -grade ' ❑ Aer bic Treatment Unit ❑ Recirculating ❑ Other:
K z
V Dispersal/Treatment Area Informati — b F
1. Design Flow (gpd) 2. DispersalArea 3. ersa Area 4. oil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
Zt5 3 08 -X z G 3:�{
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Informa tto n
Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
e— ❑ ❑ ❑ ❑
�C.P ► 1L Its Ioub
❑ ❑ ❑ ❑ ❑
VII Responsibility Statement
I, the undersigned, assume res onsibilit for inst ation of the P n on the attached plans.
Plumber's Name (print) 9�n re (nos m MP /MPRS No. Business Phone Number
?J?%ADq ?4) � 3 5 261
Plumber's Address (Street, City, State, Zip Code) \
1W) he_u_t�L. Mrtl YAm r
1
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Is um Agent Sign re (No stamps)
Approved ❑ Owner Given Initial Adverse Su Fee)
Determination aa6. c� 2 - - Loco
IX. Conditions of Approval /Reasons for Disapproval UXyC�
°,° P.¢._
SBD -6398 (R. 07/00)
ICS
yto
5le-
H-10 HID
A-51.
q3 C/'
I 1
x Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of
Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code
Attach complete site plan on paper not less than 8 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal refer direction and
percent slope, scale or dimensions, north arrow, ,lo lias�is&Ke to nearest road. parcel I.D.#
ding
APPLICANT INFORMATION - P/ jaunt aavoormartlort�, P en
Personal information you provide may be used for ry p!rrpeee,(p AC y Law, s. t5 (m)). vieWad By Date
L -1Z_
Property Owner Pro_ perty Location
Lakes & Hills Develoment r r 1 0U 10' 4 Lot 1/4 NW v4 ,s 13 T 31 ,N,R 18 W
Prope Owners Mailing Address het Block # Subd. Name or CSM#
d k / /(o Z-- ; L7� Y Y / 9 -- Pine Acres
ity State Zip`Gode PUMbA er C' illage Town Nearest Road
A1 41 ) fay / /�✓ J`Nd y�dy d� �° �, G. I 218 TH. Ave.
❑ New Construction Use: Z Residenti / fJ edrooms 3 ❑Addition to existing building - --------
Replacement ❑ Public or commercial describe
Code Derived daily flow 450 gptl Recommended design loading rate .7 bed, gpd/fta 8 trench, gpdffla
Absorption area required 643 bed, ft' 5-2 trench, ftz Maximum design loading rate .7 bed, gpdfff .8 tr ench, gpdfffz
Recommended infiltration surface elevation(s) 93.4 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material- - - - - -- Flood plain elevation, if applicable --- -- ft
F — tble for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank
itable for system FA El ❑ s ❑ u ®S [I U N_ S El ❑ S ® U ❑ s ® U
SOIL DESCRIPTION REPORT Q�
Depth Dominant Color Mottles Structure GPD/fF ,
Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
1 0 -10 1 /3 -- I imsbk mvfr as If .4 .5
2 10 -20 10YR4 /4 1 lmsbk mvfr gw lvf .4 .5
Ground __ __ ____ ____ __ _ _ __ I lmsbk mvfr as 5
3 20 -40 1 /6 - - --
4
elev -- -- - - - -- - - — -- -- - -- -- - 22-9— ft. 4 40 -58 7.5YR4/4 ------------------ cs os ml gw .7 .8
Depth to 5 58 -94 10YR5 /6 ------------ - - - - -- cs os ml - - -- - - -- .7 .8
limiting
factor
>94"
Remarks: _ -- _ _ -- --
1 0 -12 10YR3 /3 ----------- - - - - -- 1 lmsbk mvfr as if .4 5 •`�
2 12 -21 10YR4 /3 ------------ - - - - -- I lmsbk mvfr gw lvf .4 5 f
Ground 3 21 -39 10YR4 /4 ------------ - - - - -- 1 lmsbk mvfr as - - --
4 5 `{
elev -
97.3 ft. 4 39 -60 7.5YR4/4 ------------ --- --- cs osg ml gw - - -- .7 .8
5 60 -89 10YR5/6 ----------- - - - - -- cs s ml - - -- - - --
Depth to 7 8
limiting 9 3 0 fo a r }
factor
Remarks:
CST Name (Please Print) Signature: Telephone No.
Jacque Hawkins C --
Address Date CST Number Ref #
o�' v A Lt e_ yes3 4/8/00 z, 381
'PROPERTY OWNER: Lakes &Hills Develoment SOIL DESCRIPTION REPORT Page 2 of 5
PARCEL I.D.# Pending
Depth Dominant Color Mottles Structure GPDlftz c
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. C onsistence Boundary Roots
Bed i Trench
3 1 0 -10 10YR3 /3 ----------- - - - - -- 1 Imsbk mvfr as 1f .4 .5 •`{
2 10 -20 l 0YR4 /3 ----------- - - - - -- I 1 msbk mvfr gw 1 of .4 .5
Ground
elev 3 20 -40 10YR4 /4 ----------- - - - - -- 1 lmsbk mvfr as - - -- .4 .5 ,
97.5 ft. 4 40 -67 7.5YR4/4 ----------- - - - - -- cs osg ml gw - - -- 7 8
Depth to 5 67 -90 10YR5 /6 ----- ------- - - - - -- cs osg ml - - -- -- -- 7 8
limiting -
factor
X9010- - -- - - - -- - -- -- - --
Remarks:
4 1 0 -11 1 0YR3 /3 --------- - - - - -- 1 1 msbk mvfr as if 4 .5
2 11 -21 10YR4 /3 - - -- 1 lmsbk Mvfr gw lvf .4 .5 '(
Ground
3 21 - 36 10YR4/4 - - 1 lmsbk mvfr as ---- .4 .5
elev - - - - -- ---- - - - - - _
96.7 ft. 4 36 -64 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 .8
Depth to 5 64 -81 10YR /6 ------- - - - - -- cs osg ml - - --
- - --
7 8
limiting -- - --
factor R3•t0� - - - - - -- — —
Remarks:
5 1 0 -11 10YR3 /3 --------- - - - - -- 1 lsbk mvfr as if . .5 m
2 11 -21 10YR4 /3 ------------ - - - - -- 1 l msbk mvfr gw l of .4 .5
Ground _ _- -- -- - -- - - --
elev 3 21 -39 10YR4 /4 ------------ - - -- -- 1 1 msbk mvfr as - - -- .4 .5
97.3 ft. 4 39 -60 7.5YR4/4 cs osg ml gw - - -- 7 8
Depth to 5 60 -89 10YR5 /6 ----- cs osg ml • - -- 7 8
limiting -- — - - - -- --
factor -
>8911 _
Remarks: — _-- __ -_ --
Ground- - - - -- - -- - - - -- - - - - -- - -- -- - - - - -- -- - —
elev
ft.
Depth to
limiting - -- - -
factor
Remarks:
1
7v
1,2
Al
1 �v
I
4viscun!:in 111y1:nlnu nI Lot Cunnncu:u `;01 L LV; \LU /\ I IUIJ I :L=1'VI ; I I'aye — _ul --
I li�i�aun ul ;::dcl /' nrnl Iluildinys
in '11111'11.'111 �• t.ill4 1.''111114 It,,. vvi•o. A11101. 1:1'111!
1 :1111'11 >'
/ \11'14 11 lnugrlr l4'
!;Ill. Idnn tn4 I' In•1 nul Irs•: I1rr4u 11 N.' I 1 in' lu•': in !:i; 4!. I'Iml 111'1 :I -
Int.lutic, In11 uvl lindled [to: vvllic:d :'1111 Irani: tn41:'I't•1'•wot I! point 111101, diw'.1iun :nul
l,t!lu nl !:11gn!, scale ul tlinlensiuns, nul Ill ml u�✓, :11 '11 Iut:: Ili( rn mIII t1i O; 11 we to 11e :11 es 1, Itr; ILl.
Plvaselnilll all il11U111li111U11. Re iermd Ir; u:Ite
I't•u:'nc'I inlnnn;'li'n4 µn1 Inuvidu n'nl' 1'c ucrvl 1''. !:'•' '1'1'1;'11 Ir'I'Im!:1'!: (I • 'IV:4''. p I_:'u, s 1:.11.1 (1) pn)1. I
I'ngrelll U..n1'I / Ihulnnl� I_vualiun
/s J�4.�r�f%✓ I_ul li•I �(/LJI /I S 13 ► �! II It /8 G (uIQ
��rve ( ;u -- - - - --
I'lol eI1 ( IrtIIcI's L1;111iIIy F111111L ,s Lul ll Mud" 11 L ulnl. I lame 111 051.111
(,ity S1aly Zil) Uu11e I'InnI IlutI11wl I_�Uil� Village luvnl Iiealesl ItuaJ
Ilew l;uuslltualun Use: Itesillvnlial I I lundlvl ul Innhuunls --_ -- __ -- -- UUdU delivetl LJesiyn Iluvv Tale
Itellkluumenl Lj Pul,lit; ul Lulnnlcici,ll - Ucsl.lit,e: _ --
I'unuul nrllelial I Iuud I'lain elevaliun it ulli,livalile
Gunel;ll Lununonls
MILLI 1cLUnunentlaliuns:
( —` llu,iny
I� I.Ivliny 11
1.3L I'il Uluund sullaLV clue. __�� Q II. Uei,lll lu linliliny IaLlul > r Z d in. --- •�- --- °-- '•- --- -•—
- - - - - -- `iuil !1lrl,licnliun hale
I 1ulIZUl1 Uehllt Uulnlnaill Culul Ituoux UcsLli,,liull I SNuclule Uvnsislence Uvurnlaly kuuls
III. lylulls U S;.. (;y111 I ;tl lu l
/d 74
m yx sib
I_I Uulinu I f 7 i
I I lJul inu 11 —
U Vluulld sullace eluv. II. Uel,lll lu limiting IaLIuI ill.
Suil lygrli ltnle
I lullzun 1J 1 111 Uun111lanl Culul Itedux Uesulii,liun lexlulul Slludule UunsislenLU Uuundaly Ruiuls GI'U /II
In, tvtullsell 1.111. Sz. l ;unl. Cu GI. Sz. ',It. 'L "11111 1_11111
Lllluenl 1111 = HOD, > JU < .^_ZU nll /t - mid I SS >JU < 150 my / L ' lalluenl 11Z = IJUU < JU my /L am) 1 SS < JU Iny /L
ante 11 I'linl r'•y nlnel
W �i .il nalule US 1 Nu
nLlLhc. Uale [valualiun GwidudeLl lclel111une h1unl�el
0 4'74 — F y6
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 8Z
Number of Bedrooms
Design Flow - Peak (gpd) Sn
Estimated Flow - Average (gpd) 3ov
Septic Tank Capacity (gal)
Soil Absorption Component Size (ft') �S z
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) Guff 3�� Z
Maximum Influent Particle Size (in) 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 s d outlet filter shall be assessed at least
once every 3 years by inspection. Th&QqtLet fi shall be cleaned as necessary to ensure
proper opera tion. The filter cartridge should not be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
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
` 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
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer p,[ b o VA g U M S � <
Mailing Address - 706 Ov . �C' d E Al Lu L 4-0 1(
Property Address U. 1
(Verification required from Planning Department for new construction) lQ dD
City/Stat Parcel Identification Number _ 0 38 - 11 3 - 9 0 - °
LEGAL DESCRIPTION /3. 3(. I v. l ooq
Property Location %,, %,, Sec. TN - RW, Town of
Subdivision Lot #
Certified Survey Map # Volume Page # -
Warranty Deed # — Volume Page #
Spec house byes ❑ no Lot lines identifiable A yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenanceof your septic system could result in its premature.failureto 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 function 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
masterplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
r
IGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pe escn
bbd ab e, by virtue of a warranty deed recorded in Register of Deeds Office.
/d l 0 &lO d
zP
SIGNATIUM OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application; a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
Vol. 1517 PAG.291 b
r KATHLEEN H.
WALSH
REGISTfR OF DEEDS DEEDS
Document Number Document Title ST. CROIX CO., WI
11 RECEIVED FOR RECORD
Q f ffi nT � p�� 06-07 -2000 4:00 PM
EXEMPT N DEED
CERT COPT FEE:
COPY FEE:
TRRMM FEE: 304.80
RECORDING FEE: la -
PAGES: I
Recording Area
Name and Return Add
ra F
S" , kr—
g� 35 Ug4r�ts 4c- Or.
VG�rt�t3 f�ct �+�s Mn rjr -1 10
p��o oe
0 3g I ostil -9 r -moo
O 31& 1 10571-40 -oo c7
Parcel Identification Number (PIN)
b N-- 03 -00ti
qo-
-ice' A
This information must be completed by submitter: document title. name h return address. and M (if required). Other information such as the
granting clauses. legal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document.
Note: Use of this cover page adds one page to your document and S2.00 to the recording fee Wisconsin Statutes, 59.03(2m) WRDA 2/99
215-32 (Nea)
w
Form No.9 -M— WARRANTY DEED Minnesota Unirortn Con artcin a Blanks V 978 Holstad & L wm P.L.C.
Corporation or Partnership to Corporation or Partnership
VOL 15 7PAGE 2
No delinquent taxes and transfer entered; Certificate of
Real Estate Value ( ) filed( ) not required
Certificate of Real Estate Value No.
l9
County Auditor
by
Deputy
STATE DEED TAX DUE HEREON: $ (reserved for recording data)
Date: May 31, 20 00
FOR VALUABLE CONSIDERATION, Lakes and Hills, Inc.
a Corporation under the laws of
Minnesota Grantor , hereby conveys and warrants to ollova Builders, nc.
Grantee, a
Corporation under the laws of Minnesota
real perry in St Croix County, Wisconsin, described as follows:
Lot and 17 Pin�Acre St. Croix County, Wisconsin
"The seller certifies that the seller does not know of any wells on the described real property:
together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions:
Easements, covenants and restrictions of record.
Lakes and Hills, Inc.. ,
By: RI h d S Nels6n
Affix Deed Tax Stamp Here Its: President
STATE OF MINNESOTA
SS.
COUNTY OF Ramsey
The foregoing instrument was acknowledged before me this 31st day of May 19 99
by Richard S Nelson, President and the
and
of Lakes and Hills, Inc. a Corporation
under the laws of Minnesota o behalf of the Corporation
NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK) 1 /
DEBORAH L. TEICH SIGNATURE OF PERSON TAKING ACKNOWLEDGMENT
NOTARY PUBIC • MINNESOTA
MY COMM1881014 Tax statements for the real property described in this instrumaU
F XPIR EB JAN. 31, 1005 should be sent to (Include name and address of Grantee):
THIS INSTRUMENT WAS DRAFTED BY (NAME AND ADDRESS): P.C. CDIlova Builders, Inc.
Northwest Title & Escrow Corp. 705 County Road E
Suite#120 Hudson, Wisc. 56016
3535 Vadnais Center Drive
Vadnais Heights, MN 55110
58887
FROM : C COLLOVA BLDRS, INS PHONE NO. : 715 549 5911 Dec. 01 2000 12:29PM P1
Gunn No.9- M— wARIZAN Dul10) Minnrat,)le Unil'nmi Cvnvc ancin IlLuxlcc 1978 _.
llulxtad.
r Corporation or Partnership to Corporation orY?arincrshi - p
VOL 151 1 7
PAGE z z E�2•c#4��
Y.AT'HLEF6t ff. 0(4L8F)
No delinquent taxes and transfer entered; Certificate of R5 -
GJ5'TR OF DEEPS
Real Estate Value ( ) filed ( ) not required ST_ CHIIIX Co. WI
Certificate of Real 'Estate Value No, RECEIVED FOR RECORD
,19
06 07-2000 4 :00 Ph
09RRAHIY DEED
County Auditor EXEMPT N
CERT COPY FEES
OPY FEE:
TRANSFER FEE: 3�_�
RECORDING FEE;
by RAGES: 7
Deputy f
{� 1� tv
STATE DEED TAX DUE HEREON' $ Recording Area
Date; May 31, 20 00
FOR VALUABLE CONSIDERA'T'ION, Lakes and Hills Inc. .
a Corporation under the laws of
Minnesota , Grantor, , hereby conveys and warrants to P.C. Collova Builders, Inc.
Grantee, a
Corporat;,on under the laws of Minnesota
real property in St Croix County, 'Wisconsin, described as follows'
Lots 9,11,15, and 17 Pine Acres, St. Croix. County, Wisconsin
"The seller certifies that the seller does not know of any 'wells on the described real property:
together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions'
Easements, covenants and restrictions of record,
Lakes and Hills, nc�..
�s
By: chard S Nels n
Affix Deed Tax Stamp Here Its: President
STATE OF MINNESOTA,
ss.
COUNTY OF Rwnsey
The foregoing instrument was acknowledged before me this 31st day of May , 19 99
by Richard S Nelson, President and the
and
of Lakes and Hills, Inc, a Corporation
under the laws of Minnesota on behalf of the Corporation I
NOTARIAL STAMP OR SEAL (OR OTHER TITLE Olt RANK)
s - C] �
DEBORAH L. TEICH SIO Or FERSON TAKING AC KNOWLEDGMENT
NOTARY PUBuc - MINNESdTA
My COMMISSION Tax Statements for the real property described in Ibis instrument
4,; EXPIREs JAN..31, 2005 shotdd be sent to (include natne mui address ot'Grantes),
T INSTRUMENT WAS D RAF M RY (NAMR ANT) A VDRRAS)� P. C . Col lov Builders, I n c.
Northwest Title & Escrow Corp, 705 County Road E
Suite At 120 Rudson. Wisc _ 54016
3535 Vadnais Center Drive
Vadnais Heights, MN 55110
58897
r _
Z T 16 'rLL _ 0 t
Lc
3 _ � 3.9t,1'$[ag
a I L M,SZ,6S,68N
-
V) �/� 0 u i $ 13 d 4) :� N 1 - - /a
W N 4✓ p O I N I ;� Iii N C y 9z Al
n 4
M.,OR*.59N V .
\ r y
3 SZ,6S.6a5 r �y
r _
� � .N COO ° I \ c � •�S' "a+
S
N .
co N
V, V O N 1 I 1 Ic'i Via/ •: , ��f �e� �
N78'
298. 9.E
w O
Q I \ .� -
„�a\ Ti
N 66' 41
o I wee \ (o 1 \ ,89
X
w. w
j 4z
L I sl,. \ 0)
LB
Q ( , 1 11 • * \ ro
.3r+ p \
w � 9
t` .1`g.
co
Q d�
Lt. q 3
S �
^O 10 ,
CIO p
.t0•r££ 3.rO.r* 6n 012
afINLqA
Raw' to'rff 3 tO,Pf.88S '— C
N € 1 s[rft — etar oout NO OA \\
mo
D< 0 h
DI U
Z � <<
Q � CM
a 3 y $k' < a yr n
V-♦ c fj�
W W W C n IFi ^ h ►? n1 ``�u�
0-
Z
i H
V F o u ZO'lOZ L6 atL r0'[r °f c �6 •
�r < a .86 *996 -- ; � ryy R.e to
� " 3 � XP' 90e68S ,r h
' 'o
� r �. a0 pN� 10
Z
N E° a z „^�� SP Pe33ola�fl N 00.00Z
N
a o N 3.f r.90.6BS 00 rrt
C lV : N
L
C 0 C C
W ° u $
U W N N N
ti Ja