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HomeMy WebLinkAbout038-1196-80-000 F „sconswoepartment of Commerce PRIVATE SEWAGE SYSTEM County - Safety and Buildings Division St. CTO1X INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarKPprmitNo.: Personal information you provice may be used for secondary purposes (Privacy Law, x.15.04 (1)(m)). 370364 Permit Holder's Name: ❑City El Village ❑ Tvwrto State Plan ID No.: Kopp, Steven Star Prairie Township CST SM Elev., Insp. BM Elev.: BM Description: Parcel Tax Nn 038-1196-80-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic da a Benchmark , Z a °'a Alt. BM Z U Aerati Bldg. Sewer Holding )/Ht Inlet TANK SETBACK INFORMATION (fit/ Ht outlet TANKTO P/L WELL BLDG. Airi to ntake ROAD irl Septic >2s 'l NA 4 NA Header / Man. Aeration N Dist. Pipe g Holding Bot. System qz . PUMP / SIPHON INFORMATION Final Grade M r mand St cover l) Model Number M TO ift Friction tem TDH Ft Loss Forcemain Length Dia. Dist. o SOIL A SORPTION SYSTEM BED / NCH Width Lengt No.Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME 3 DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/ STREAM LEA ING Manu cturer: INFORMATION Type o r BER Moe um er: System: tm � � — DISTRIBUTION SYSTEM Header if Manifold �� Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. 41L Spacing 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 C] Yes C] No ❑ Yes ❑ No 6> COMMENTS: (Include code di panties, persons pr sen ) I j4.v0 t� cst” Qu.- �a� Iwo � (iC�` � ns ec ion i1 t Location: 1332 216th Avenue, Star Prairie, W1 54026 (SW 1/4 N 1/4 13 T31N R18W) - 1331181032 Pine Acres - Lot 37 1.) Alt BM Description =1' „; s ed 116 /• �h0 /✓��� 21L IC/ 2.) Bldg sewer length= �'� Qla w4e "PL s uywr .`f � V si, - � 1 - amount of cover = y � C k , fe ; v. A, (y ;(aw s 0� eat Plan revision required. Yes [�Jo Use other side for additional information. SBD -6710 (R.3/97) Date inspector's Signature Cert. No. k r '133Z_ 214, E - Sanitary Permit Application Safety & Buildings Division ton Ave. h W. Washington In accord with Comm 83,2 1, Wis. Adm. Code 201 g 1; ; Visconsin See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(I)(m)) (Submit completed form to county if not 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 Sanitary Permit Number 0 Check if revision to previous application State Plan 1. D. Number i t I. Application Information - Please Print all Information Location: Property Owner Name �� t Property Location i `/l x I/4 A 1 0 4, S 13 T ,N, R E (or) W Property Owner's Mailing Address AP. Lot Number Block Number «_, R ECENEO 7 City, State Zip Code Ph ne Number f, Subdivision Name or CSM Number CL A lc� fflr)�In Wl� s4c) 1 - 7 ?WC &EC-Is 11 Type of Building: (check one) '�, t COLN? t O City 1 or 2 Family Dwelling — No. of Bedrooms: =c,rc , ❑ Village Public /Commercial (describe use): t 11, of ❑ l� State -owned ..i III Type of Permit: (Check only one box on line A. Check box on line Nf pplibable) Neare t Rgad6 t / A) 1. { New System 2. ❑ Replacement 3. ❑ Replacement of 4. , C Addition to Parc Ta Number(s ) V rr \\ I System Tank Only Existing S stem 0 °i (, := 000 B) Permit Number D W-Rd ❑ A Sanitary Permit was previously issued [ 3. 1 1c:bYL_ - IY. Type of POWT System (Check all that apply) on pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland D Pressurized In- ground ❑ Holding Tank O Single Pass ❑ Drip Line O At -grade �OA e ob }c T eatm .• it D Recirculating O Other: V Dispersal/Treatment Area Information; w l t"' 15 r! 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate x =` '7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min.linch) �? Elevation ..`3ou l�l 2. I z VI-Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks ❑ ❑ ❑ ❑ o VII Responsibility Statement 1, the undersigned, assume responsibility for installati of the P wn on the attached plans. Plumber's Name (print) Plum be Signatur n MP /MPRS No. Business Phone Number 7 1 5 - c7Zp Plumber's Address (Street, City, State, Zip Cod 1 - - (. VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) % Approved ❑ Owner Given Initial Adverse Sulbirge Fee) 1J OS Determination a-S • C� 3 "fit` �R�. IX. Conditions of Approval /Reasons for Disap rov I: "v�f —' S SBD -6398 (R. 07/00) PMT; } + t S i, <1JJY. 0 + F ,c�= .�y f J o a (?w t,Q Se P4 ; +. snn e - • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of J Division of Safety and Buildings in acm elwfthGomm 85, Ws. Adm. Code .. ' _ County S t. 9_0 , Attach complete site plan on paper not less than 8 112 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. 3 8 f -'' gd ..- 00 O Please print all information. i Reviewed by Date Personal information you provide may be used for secondary purposBS j►frvacy L,aw, : 15.04 (1) (m)). Property Owner roperty Location t 7--% s r ty f,.' -} �,. , r�� 7 �r tt '` , Govt. Lot s W 1/4 QW /4 S 13 T31 N R E (,r.0 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1, 6 c vw it - 7 p : rile City Stile Zip Code Pho ❑ City ❑ Village ® Town Nearest Road nW J, ;"h w 6 ► (71s aft -vos3 I 6tot r Y- (?- I A I L t7V e. 1,�A. New Construction Use: I`_* Residential / Number of bedrooms —,J— Code derived design flow rate 4 $ 0 GPD ❑ Replacement 0 Public or commercial -Describe: Parent material r, , Lh ` t �c $ Flood Plain elevation if applicable -` General comments ,�, r r and recommendations: M a-`.1 T 5 u g oZ .s 1t 6 S -ref- y 0-c.1n 5; -te T a ��.��`� b t� T. Y g 3.5 -9 51 Boring # Ej Boring 4 il 51 pit Ground surface elev. 7 4, a 7 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 0 -1 i u 1 R. 3 1a --- ---- -- S Q F �, vi �. 5 . I t .1 .3 D - ).5 YR, yl - 5 b -5 Cl n4 L cw ir j 1. 3 0.2 15 10)V --- ...... J -S L W tJ F /. Inn az. -f sa•f Boring # ❑ Boring pit Ground surface elev. _ S +�J ft. Depth to limiting factor eZ O _ in. 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 I 0 -10 -t 3l L a i' a2 -3 - 7.5 1016 5 6 ML G w V . 5 SID-0. 7.6 '00 1 1 G 0 -5 4-1 w 33 •`fa �k. L( 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 Name (Please Print) N Signature CST Number . p y dress b �. r St, , Date Evaluation Conducted Telephone Number rx ��� 5 -.�y8 -352 1 Property Owner ��C J C, Parcel ID # d 3 G �' 9(p — 2O O ' D O a Page of _ 3__,_ F-31 Boring # C3 Boring � pit Ground surface elev. /. 6 7 ft. Depth to limiting factor a in, Soil A lication 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 1 6 - g 10 -1 3 f 'S F6 k iM r 4 a F i - 7.5'1A I b -5 c, L I F 3 3 -5d - 7,510/4 ,ti, L 4w I vF - 1 y e M L 7 /. a Boring # ❑ Boring Pit Ground surface elev. ��• 83 ft. Depth to limiting factor 1 3 O in. Soil Application Rate Horizon Depth . Dominant Color > Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 6-13 t a .$ 3 7'! Y tr d 6 v►. is 0Y I .s ti 6 -SCA hi I- aka Boring Boring # Ground surface elev. ft. Depth to limiting factor in. 11 pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ` Effluent #1 = BOD, > 30 1220 mg/L and TSS >30 1150 mgA. ' Effluent #2 = BOD _< 30 mg1L. 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 (11.6100) tse-vc Kopp �• � > Yy� Sec. 13, ,, Cstm a L 10+ ?' L `A x �r 37 f 4 St t ii ► 33a ' So T r+e� It . BM 1 - To p �� 1 stet'1 M h O. DO � JG'r'� �Co , PL v F 4: r-4 s -t lot 1; r+f -/tjv ;k(2KP Ff N o. (o+ ; T c $1 91�. 0 f33 - �! 7. to7 � B4 100.83. w r ' o 1 0 QD 4 \ s'� i t ti Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 esiri ihe.. ; Plan must County include, but not limited to: vertical and horizontal r renp point (SM); *60on and �f � percent slope, scale or dimensions, north arro , , rtd (ovation and distance tu\nearest road. Parcel I.D.# Pendin APPLICANT INFORMATION - PI Orin i*rfr5r�ation. Personal information you provide maybe used ror�,-_ dary puiZ" (Pnvacy Law, s. 15.04 (1) (m)). R vle>Ned By Date ���..._ Property Owner ", Property Location Lakes & Hills Develo ment Govt. Lot 1/4 NW t t4,8 13 T 31 N,R 18 W Property Owner's Mailing Address ; Lot # Block # S or CSM# /37 -- Pine Acres City / State Zip Code{' }�oneNumber City ' ape (Town Nearest Road Ie �a /t '� A' ) a ` Y' V Vd,c- ,C d 4 21b TH. Ave ❑ New Construction Use: E Residential / Number of bedrooms 3 ❑Addition to existing building --------- ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ftz .8 trench, gpd/ftz Absorption area required 643 bed, ff 562 trench, ftz Maximum design loading rate .7 bed, gpd1W 8 tr ench, gpd/ftz Recommended infiltration surface elevation(s) 93.7 It (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 , 2 S❑ U Z s❑ U ❑ S❑ U N S❑ U ❑ S® U ❑ S® U SOIL DES CRIPTION REPORT C„ ur Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Bounda Roots GPDfftz Boring# in. Munsell Qu. Sz. Cont. Color e t e Gr. Sz. Sh. Bed Trench � 1 0 -10 10YR3 /3 ------------------ 1 1 msbk mvfr as if .4 .5 . �{ 2 10 -21 10Y R4/4 ----------- - - - - -- 1 lm mvfr gw lvf .4 5 Ground 3 21 -39 l 0YR4 /6 ------ - - - - -- cl 1 msbk mfr as - - -- .2 .3 . 2, elev - -- - -- - - -- �� -- — 98.2 ft. 4 39 -6 7.5YR4/6 --- - - - - -- cs os ml cw - - -- .7 .8 Depth t0 — 5 64 - 95 10YR4 /6 ------------ - - - - -- s osg ml - - -- - - -- .7 .8 limiting factor >9 5 " Remarks: - - -���— - -- — — -- - 2 1 0 -11 l 0YR3 /3 ------------ - - - - -- 1 1 msbk mvfr as if .4 5 2 11 -23 10YR4/4 ------------------ 1 msbk mvfr gw 1 of .4 .5 Ground 3 23 -40 10YR4 /6 - -- ---- - - - - -- -- cl lmsbk mfr as elev -- 2 3 2 98.2 ft. 4 40,_59 7.5YR4/6 --------- - - - - -- cs osg ml gw - - -- .7 8 Depth to 5 59 - 96 10YR416 ------------ - - - - -- s osg ml - = -- - - -- .7 .8 limiting factor >96" SY o Remarks: CST Name (Please Print) Signature: Telephone No. Jacque Hawkins / - C .,,_ `^ Y 7 L -F V Y4 Address Date CST Number Ref # 0 �u Lt/ - 4/10/00 -7 Z 410 .PROPERTY OWNER: Lakes &Hilts Development SOIL DESCRIPTION REPORT Page 2 of J a PARCEL l.DJ Pending Depth Dominant Color Mottles Structure GPDr Horizon Texture insistence Boundary Roots in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed I Trench 1 0 -9 10YR3 /3 ------------------ 1 lmsbk mvfr as if .4 2 9 -20 l OYR4 /3 ----------- - - - - -- 1 l msbk mvfr gw l of 4 5 Ground elev 3 20 -40 10YR4 /4 ------------ - - - - -- Cl 1 msbk mfr as - - -- .2 .3 .2, 97.8 ft. 4 40 -56 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 .8 Depth to 5 56 -89 10YR4 /6 - --------- - - - - --- s osg ml - - -- - - -- 7 8 limiting - - - - - -- — factor >89 - Remarks: 4 1 0 -10 10YR3 /3 ------------ - - - - -- I 1 msbk mvfr as If .4 .5 , 2 10 -23 10YR4/3 ------------ - - - - -- I 1 msbk mvfr gw 1 of .4 .5 Ground . elev 3 23 -34 1OYR414 ---------- - - - - -- Cl lm mfr as - - -- .2 3 .2 96.9 ft. 4 34 - 7.5YR4/6 ----------------- cs osg ml gw - - -- 7 .8 Depth to 5 57 -80 10YR4 /6 ------------ - - - - -- s osg ml - - -- - - -- 7 8 - limiting — — factor 38 • `� �Y• `f >80" -- Remarks: 5 1 0 -9 10YR3 /3 - 1 lmsbk mvfr as if 4 .5 -� 2 9 -18 l O YR4 / 3 ------------ - - - - -- I 1 msbk mvfr gw 1 of 4 .5 ' Ground -- — — - - -- -- -- -- elev - 3 18 -32 10YR4/4 - Cl l mfr as - - -- 2 3 2, - 2 6 - 9 ft- 4 32 -59 7.5YR4/6 ------------------ cs osg ml gw - - -- 7 .8 Depth to 5 59 -79 10Y -- -------- -- - - - - -- s os g ml - - -- 7 8 limiting - - - - - - -- — - �- -- - - factor 3 f >79" -- - - - -- - -- - - - -- Remarks: _- - - - - -— - - - -- - - -- - - - -- - - - -- Ground_~ - __ -- -- - - -- - - -- - - - - -- - - - -- - elev ft. Depth to limiting - -- - - - - - -- - - - -- -- - -- - -- -- - -- factor Remarks: Cj Cl Li rA I AN � 3 i i a i i L W i o- 2 k �3° 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 Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) UO Septic Tank Capacity (gal) Soil Absorption Component Size (ft) qOU JK Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorp ion Component Design Flow - Peak (gpd) Z&O Z Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 T able 3: Ma intenance Schedule Septic Tank Inspect and /or service once every 3 years Ou tlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se . tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet d r s hall be cleaned as necessary to ensure roper operation}„ The filter cartridge shou 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 t Management Plan for a Septic Tank and Soil Absorption Component w + 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 r �? 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 j CERTIFICATION FORM c. h Owner/Buyer .�. uyer � ..� .: �? �_. \"'A Mailing Address v� _ (� �aEU 13 �, Property Address T LJL (Verification required from Planning Department for new construction) City /State ; ��� LzJ \ parcel Identification Number L 6 LEGAL DESCRIPTION Property Location •, A—W/, Sec. — Na, T-31N -R__� W, Town of "'�Tv e 9_ Subdivision N `� c (t ' Lit # Certified Survey Map # , Volume , Page # Warranty Deed # 436 2 1/ 3 Volume `s37 , Page # Spec house O yt o Lot lines identifiable es O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result w 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 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewa ter disposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 foil of sludge. I/we, 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. stating that your septic system has been maintained must Certification days of the three year ex iration date. be completed and returned to the St. Croix County Zoning Office within 30 p SIGNA PPLICANT `U / S / C��) 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 APPLICA I DATE .till. Any i6o�tion that is mis- represented may result in the saaituy permit being revoked by the •i/l.l Zoning Department. :i Include with this application: a stamped warranty deed from the Re a copy of the certified surve Register of Deeds office ey map if t�eference is made in the warranty deed i544p 232 630243 KATHLEEN H. WALSH Document Number Document Title REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09 -21 -2000 9:30 AM WARRANTY DEED EY.EMPT M CERT COPY FEE: COPY FEE: TRANSFER FEE: 90.70 RECORDING FEE: 12.00 PAGES: 2 Recording Area Name and Return Address Northwest Title 6 Escrow Corp. 3535 Vadnais Center Drive Suite #120 Vadnais Heights, MN 55110 03�- 11`11(- -k -000 Parcel Identification Number (PIN) This information must be completed by submitter'. Qn tc tment title name & rgturn addre s , and PN (if required). Other information such as the granting clauses, legal description, etc. may be placed on this first page of the documcnt or may be placed on additional pages orthe document. Note: Usc of this cover page adds one page to your document and $2. 00 to the recording fce Wisconsin Statutes, 59.43(2m) WRDA 2199 x541 (7/�1 Form No. 7 -M— WARRANTY DEED Minnesota Uniform Con ve ancin Blanks 1978 Corporation or Partnership to Individual(s) Vol. 1544 PAGE 33 No delinquent taxes and transfer entered; Certificate of Real Estate Value ( ) filed( ) not required Certificate of Real Estate Value No. , 19_ County Auditor by Deputy STATE DEED TAX DUE HEREON: $ (reserved for recording data) Date: September 19 20 00 FOR VALUABLE CONSIDERATION, Lakes and Hills, Inc. under the laws of , a Corporation Minnesota Grantor, hereby conveys and warrants to Steven F Kopp and Megan A Kopp tees) real property in St Croix County, Wisconsin, described as follows: Lot 37, Pine Acres, St Croix County, Wisconsin together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions: Easements, covenants and restrictions of record. Lakes a Hills, Inc. / Affix Deed Tax Stamp Here By: (Richard S. son Its President STATE OF Wisconsin ss. COUNTY OF The foregoing instrument was acknowledged before me this 19 day of September 20 00 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 NOTARIAL STAMP OR SEAL (SN�y, • It T1T RANK) 'l ' r C (,'•` SIONATUAEOF E 'ON E NQTARY � Tax Stat�nenty fa the real pr y dam in t mew • s m hould be sent to (Include name and address of Grantee): �'!'.•PUBL%G: "y THIS INSTRUMENT WAS D DRBSs)- Steven Kopp Northwest Title & orp. 3535 Vadnais Center Drive Vadnais Heights, MN 55110 61089 dt abstract (roan No. 7- M— WARRANTY DEED Minnesota Uniform Conve ancin g Blanks 1978 --Cock oration or Partnership to Individual(s) No delinquent taxes and transfer entered; Certificate of Real Lstate Value ( ) filed( ) not required Certificate of Real Estate Value No. ,19 County Auditor IL by r Deputy STATE DEED TAX DUE I IEREON: $ (reserved for recording data) Date: September 19 ,20 00 FOR VALUABLE CONSIDERATION, Lakes and Hills, Inc. , a Corporation under the laws of Minnesota , Grantor, hereby conveys and warrants to Steven F Kopp and Megan A Kopp Grantee(s) real property in St Croix County, Wisconsin, described as follows: Lot 37, Pine Acres, St Croix County, Wisconsin together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions: Easements, covenants and restrictions of record. Lakes and Hills, Inc. Affix Deed Tax Stamp Here By: Richard S. Nelson Its President STATE OF Wisconsin ss. COUNTY OF The foregoing instrument was acknowledged before me this 19 day of September 1 20 00 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 NOTARIAL STAMP OR SEAL, (9,5 x IEr TT I SANK) i . SIGNATURE OF E ON 'LAK G ACKNOWLEDG ENT 1. ( Tax Statements for the reai pad A� e bed in this i strwi�nt ) / should be sent to (Include name and address of Grantee): THIS INSTRUMENT WAS D ` 4! DRrSS): Steven Kopp Northwest Titl%& ��sw Corp. 3535 Vadnais Center Drive Vadnais 1-Icights, MN 55110 61088 dt abstract II� Q ;pND3Nm O'er N h Z I I 13' -9' - C� 7C C3 , N ;0 N N AH -5866 9' -7 112' D 3 3 r A m D z TILE ^' AH- 5866 -+ z r r z tzi O a W r � n �a�4. 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