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Home My WebLink About038-1198-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building D0.4sion INSPECTION REPORT Sanitary Permit No: 420590 0 GENERAL INFORMATON (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: Wells, Terry I Star Prairie Township 038 - 1198 -70 -000 CST BM Elev: Insp. BM Elev; BM D scription: 'v0�o I D •U) I i � TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , /, /D Benchmark l / v Dosing Alt. BM--� � op G , Aeration Bldg. Sewer ('(V dl� luw a, Holding SVHt Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 5 151 No Septic > / �/ ) f Dt Bottom Dosing r• Hea a /Man. v r Aeration Dist. Pipe r Holding Bot. System �i ` PUMP /SIPHON INFORMATION Final Grad Manufacturer Demand St Cover 0- Model Nu er ! TDH Lift oss System Head TDH t Forcemai ength I Dla. Dist. to well SOIL ABSORPTION SYSTEM JZ,�, BED/TRENCH Width / Length r No. Of Tren PIT DIM S S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �� //GG__JJ SETBACK SYSTEM TO P/L BLDG WE f LAKE /STREAM LEACHING ct /// Iv1afa ✓ . �37O[ INFORMATION CHAMBER r ' J. Type Of System: o el Number: DISTRIBUTION SYSTEM Header/Manifold / Distribution )p� x Hol x Hole Spacing Vent to Air Intake 41 Pipe(s) pg Length �Dia Len th Dia SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx ulc ed Bed/Trench Center Bed/Trench Edges Topsoil 5 Yes jj No [] Yes `J]No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:_1 / O'�> Inspection #2: Location: 2150 134th Street New Richmond WI 54017 (NE 1/4 NW 1/4 13 T31 R11 8W) Pine Acres LV Parcel No: 13.31.18.1051 So � � - �i'�(d �Gr� Sol 1 � (9 1.) Alt BM Description d ��or f� �� / 6 �, Sy/�/'~'� 2.) Bldg sewer length = Z5 colt, 4 d 7"s� 0 j >94;� t +d• u "es�� 5 k 6 - amount of cover = / `4D -AV �w r: j � �� ` e � '��s` SieS � �SGh' �i�(� fl (QR. d0J -� '7Q CIrGt rS� vt„7• . Plan revision Required? L Yes No Use other side for additional information. Date SBD -6710 R.3/97 Su r{�u.1 1l ^ I Insegtur� sys 1�%� e I e ve lour -+� ' r' L vl. "C rim„ No. P na s P l � , �.S• vu f - ,J - - - , -1-e C I O/ I P -(?A: � rs ems, ry'-of ur�4 ; >, s i � it l ol l 1 _ I j i I I j i I I A = - wt 1 i L g 67- to 1 - - - - SA -- r i I - �! - - - - -- - 30 AAJ 1 � 73 NA QA- SP z Al o �. 1'*. 1" a cP ` it.. , r i too 30 Oy i pi -- - -- /3y j i _ __ � � I � � � � � _ - 1 � ,_ _ _ � �� I � �, f i i � '' _ _ � � �� r � - � �� I � 1 � _� I 1_ _ - � - ' ' ry _ -, ,,• i � � • � I t � I � � - � r _- _ � - - -L I i � i i i - I' � I I i, ._ - _, ._ � � t � - - I 1 i ,� � � � ' ' ' �_- �� I � � i' � -_ - �� - - - -- ' I i t i ' - - - � - - - �,` 1 I i - -- ', � ', ', i , � _ _ i i i i i� i i � I i � i i it i i i _.- _. i l I i i I } � i I �� I i i i � � I I � i i I '� � I I '. _. I, � I I L . i i I I � I I � �. ', i � i �. � � � �. ' �. '�. �' _. I I i �� -. ' � I i '� - I. � '� � - - � i i I I ! 1 '� ' � � _ � ' I f i ., I I I ' ' ', QL C-1 \O SS h � Cl i � r o o \Q 4 IQX n �- Safety and Buildings Division County _ 201 W. Washington Ave., P.O. Box 7082 J; N) Pisconsin Madison, WI 53707 Site Address Department of Commerce -Ofd -D .3 f 7`L- 42-(S Sanitary Permit Application S anitary PermicNwiaber 0 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Check if Revision I. Application Information — Please Print All Information State Pl an I.D. Number Property Owner's Name Parcel Number q Property Owner's ailin ddr ess Troperty Location .3 S4 'k;S� T / N,R/p E City, State Zip Code Phone Number Lot Number Block Number Subdivision Name CSM Number G T sVa r7 � � /�i II. Type of Building (Check all that apply.) 2s per 5 "" ` ❑ City ❑ 1 or 2 Family Dwelling - Number of Bedrooms ❑Villa e In— ❑ Public /Commercial - Describe Use g 49Townshi ❑ State Owned Nearest Road 6?1 7119 CIA IZ4 4k III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. New 3 ❑ Replacement of T6 11 Addition to System 2 ❑Replacement System Tank Only Existing System For County use B ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) * 4 P, — IJ'r Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 1 46 ❑Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Sept or Holding Tank /LioG /00 Z 1 Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installs 'on of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature PRS ber Business Phone Number 0�Ahit's G'i /�e �.�-. 9 z - Z- /'V -7 ��r- a6 �-• G G 3 7 Plumber's Address (Street, City, State, Zip Code) 3 I ( l o ?! A ^e .� (�s.c' Syoo / VIII. County /De artment Use Onl Disapproved Date Issued Issu' Agent Si lure (No Stamps) ❑ FS__= Fee (includes Groundwater P9- Approved Owner Given Initial Adverse ge Fee) r— Di' o Determination u IX. Conditions of A al/"o for Disapp oval � d�! t`t I� f ' "e. cac�" w t�� b e s�`(eQ - ':�.► y Attach comp ete p e ounty or ystem on pa n ess uie es in . SBD -6398 (R. 05101) Y Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of J� Division'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 1,1s in size. Plan must County include, but not limited to: vertical and horizontal rp€�t`eri a pOlnf (BM), direction and percent slope, scale or dimensions, north arrow and 1 0 and distance to nearest road. Parcel I,D�_ — APPLICANT INFORMATION - P /e8." prf aff informatio Pending p � is • eY B Date Personal information you provide may be used secondary 4i> (priva cy Law s. 1 04 (1) (m)). Property Owner ., , . p perty Location -- — Lakes &Hills Develo meet - Lot 1_/4 N_ 1/4,S W� Property Owner's Mailing Ad L t# Block # Subd. Name or CSM# Pine Acres City St to Zi 56 _ ' J p�r� ode' PhoneNumber City ❑ � aqe Town Nearest Road ��dx 134 TH. ST. New Construction Resdentiaf T 1Vllmber of bedrooms Use. 3 ❑Addition to existing building --- ,—, U Replacement LJ Public or commercial describe Code Dedved daily flow 450 gpd Recommended design loading rate .7 bed, gpdM__-____ trench, gpdff Absorption area required 643 bed, ft 562 trench, fF Maximum design loading rate .7 bed, gpd/ft .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) 97.0 ft (as referred to site plan benchmark) Additional design / site considerations t larent material- ------- - - - - -- Flood plain elevation, if applicable -- --- --- ft ble for system Conventional I Mound I In - Ground Pressure I AT - Grade System in Fill Holding Tank itable for system N S❑ U 1 ❑ s E I ❑ s❑ U ❑ S❑ U ❑ S® U ❑ s® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. IConsistenc Boundary Roots Bed Trench 1 1 0 - I 10Y R3 /3 ------- - - - - -- I lmsbk mvfr as if .4 .5 2 10 -21 10YR4 /4 ------------ - - - - -- 1 lmsb mvfr gw lvf 4 5 Ground r � fi -- -- � t - -- - -- 3 21 -39 10YR4 /4 ------------ - - - - -- cl lmsbk mvfr as - - -- 2 3 elev -- - - -1 - - - - - -- - - -- 101.7 ft 4 39 -60 7.5YR4/4 ---------- cs osg ml cw - - -- 7 8 5 60 -97 10YR5 /6 ------------ - - - - -- cs o sg ml - -- - - -- 7 .8 Depth to -- -- - -- -- - — — - - limiting - -t - `te a I (� r s tf factor > 9711 Remarks: - -- 2 1 0 -11 10YR3 /3 ------------ - - - - -- 1 lmsbk mvfr as if .4 .5 2 11 -19 10YR4/4 ------------ - - - - -- 1 1 msb mvfr gw I 1 of .4 .5 Ground 3 f 19 - 39 10YR4/6 I ------------------ I cl lmsb - - -__ mfr — I_ - as_ - - -- 2 3 elev � 101.7 ft. 4 39 -59 7.5YR4 ------------- - - - - -s osg ml gw - - -- .7 .8 - - - -- Depth to 5 C 59 -99 10YR4/6 ----- - - - - -- -_ cs osg ml - - -- - - -- 7 8 limiting - -� ,.� z. � - fac — - - f I - - -- -- - Remarks: — - -- -- -- - - -- — CST Name (Please Print) Signature. Telephone No. J a c que Hawkins a r __ Y]Z - J I Y� Address y1 Date CST Number Ref # S ?( Qv c': kvc Gv) Su6,S,3 4/12/00 7 7-- 429 PROPERTY OWNER: Lakes & Hills Development SOIL DESCRIPTION REPORT Page 2 of S' PARCEL 1.D.# Pending Depth Dominant Color Mottles Structure GPDIfF Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3 1 0 -9 10YR3 /3 ------------ - - - - -- 1 lmsbk mvfr as if 4 5 2 9 -19 10YR4 13 ----------- - - - - -- 1 lm mvfr gw lvf .4 .5 Ground elev 3 19 -36 10YR4 /6 ------------ - - - - -- c1 lmsbk mfr as - - -- 2 3 101.4 4 36 -53 7.SYR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 .8 Depth to 5 53 -9 4 10YR4 ---- ------ - - - - -- cs osg ml - - -- - - -- .7 ! .8 limiting — - — factor >94 11 — — -- — Remarks: 1 0 -11 10YR3 /3 ------------ - - - - -- 1 lmsbk mvfr as if 4 .5 2 11 -20 10YR4/4 ------------ - - - - -- 1 lmsbk mvfr gw lvf .4 .5 Ground elev 3 20 -35 10YR4 /4 ------------ - - - - -- cl lmsbk mfr as - - -- . . 3 100.9 4 35 -60 7.SYR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 .8 Depth to 5 60 -89 10YR4 /6 ----- ------- - - - - -- cs osg ml - - -- - - -- .7 .8 limiting -- -- -- - - - -- - - -- — -- factor >8911 -- — Remarks: 5 1 0 -11 l 0YR3 /3 --- - - - - -- 1 1 msbk mvfr Fa if .4 i .5 2 11 -19 10YR4/3 ------------ - - - - -- 1 lmsbk mvfr gw lvf .4 .5 Ground -- -- -- - -- - - -- elev 3 19 -39 10YR /4 ------------ - - - - -- cl lm mfr as - - -- .2 .3 100.9 4 39 -54 7.5Y ------------ - - - - -- cs os ml gw - - -- 7 8 Depth to 5 54 -88 1 0YR4 /6 ------------ - - - - -- cs osg ml - - -- - - -- .7 .8 limiting -- - - -- — factor >8811 — -- -- Remarks: Ground elev — - -- - - - - -- — - -- - - - - -- - - -- -- ft - Depth to limiting - -- - -- - -- - - -- — factor Remarks: a - � x u QL U oj �� Uj 77 o 7` n �- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __L of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a l O NA Permit + p Septic Tank Manufacturer FFC.�. 13 NA DESIGN PARAMETE Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A-- I cTO ❑ NA Number of Public Facility Units 1XNA Pump Tank Capacity a l P NA Estimated flow (average) -j W gal/day Pump Tank Manufacturer [�-NA Design flow (peak), (Estimated x 1.5) al /da Pump Manufacturer 'KNA Soil Application Rate 0 . 10 gal/day/ft' Pump Model l NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit I�LNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 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 " - 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: 3 ❑ month(s) ,,(,, (Maximum 3 years) ❑ NA earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 3 0 ❑ month(s) ❑ NA Clean effluent filter At least once every: ja years) ❑ month(s) ;WN Inspect pump, pump controls & alarm At least once every: ❑ year(s) ' ❑ monthls) A Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) A At least once every: ❑ year(s) i - I X " — Other: A MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carry ing 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 s g condition and requires the of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing 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 -- Zof Z— START UP AND OPERATION - For new construction, prior to use of the POWTS check treatment tankls) 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: 1�r 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 h kLL-&' Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name N , (u tX ie -ts &r ti' �w //U6 PhonPho : 3�6 q This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), 12) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address P, `q r P Awym N #:: / � kui R/�jii ! d i / 44 � 7 Property Address �L�� fi ��f �_ 1 1(`ll (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION Property ' ' L 5 T , , j C N -R�W, Town of 5, 1 - Pro Location � /., /., Sec. , Subdivision ' il1 ' n c, A Lot # . Certified Survey Map # l , Volume , Page # Warranty Deed # 0 0 3 , Volume 20 �- Z , Page # 4 Spec house ❑ yes no Lot lines identifiable ,'yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in 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 wastewater disposal 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. � O S GNA 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 corded in Register of Deeds Office. described above b virtue of a warra g the property Y h' deed re O � � SIGNATURE OF P IC 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 699GD 73 • U 2 0 5 2 P 4 5 0 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO.. MI Document Number RECEIVED FOR RECORD This Deed, made between Lakes and Hills, Inc., a Minnesota 11/19/2002 11:90AN Corporation EXElPT # REC FEE: 11.00 Grantor, and Terry L. Wells, a single person TRANS FEE: 77.70 COPY FEE: CERT COPY FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Return Address Lot 5 Plat of Pine Acres in the Town of Star Pratne, St. Croix County, Thte {RT✓E Z N K Wisconsin. ^;7 b- —18, Q p SG E 6 1 4 W = 15 038- 1198 -70 -000 Parcel Identification Number (PIN) This is not homestead property. pt) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 4 day of November , 2002 Lake and Hills, Inc. AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. 0. Grc . y County ) authenticated this day of r•� Personally came before me this day of November 2002 the above n# Lakes and Hills, Inc., a Minnesota Corporation •� its TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the who exec (If not, instrument and acknowledged the same. `. rn '. A authorized by § 706.06, Wis. Stats.) V 8 l% ; • THIS INSTRUMENT WAS DRAFTED BY • 41�" �•� ;gGr' Attorney ristina O land y g Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. O;f• not, state. t ate: (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. Id"mation Protauiormis company. Fond du tae, N STATE BAR OF WISCONSIN 800ese -2021 WARRANTY DEED FORM No. 2 - 1999 RLS 2362 210 TH j A VE N U E_ Land Surveyor, oy of • 2001 SECTION 13, T.31 N., R 18 W. SCALE: 1" = 2 000' / C / - --- -- MATCH LINE — SEE SHY AT 2 OF 4 -C42_ C43 C77 J C75 — oo� lb r y D � - -- PROPOSED c DRIVEWAY _1 a CO 54 67,766 sq. ft CO 55 1.56 acres 65,437 sq. ft. tis9. 1.502 acres �/e 08. I l_l I 4 9 S 2 / M 27 5.29' � 5 °� �� 00 y 100, 8,507 sq. ft. 65,f 'C sq. ft. 1.57 acres '�° °`� 1.5C acres -- P ROPOSED, r a DRIVEWAY p C' 2 " 2 iron pipe found _�o 0 227 2,7' io -', 2" iron pipe found 53.61' '�Q 66 00' South line of NW 1/- i 66, of Sec. 13, T31N, RIB x � PREPARED BY. _ 12_ _ 13- _ 14_ � i E- SURYI YOR. IwhID Todd M. sendershott l I IIJ /_ dt ENC' equired separation Metro Lai;.J Surveyin & Engineering osely adhered to. 412 Coun Road D� 9 driveway locations Little Car, dc, MN 55117 n order to - -- - - -- Sheet 1 of