HomeMy WebLinkAbout038-1206-70-000 Wisconsin Department of Commerce 1 County:
PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
420433 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: City Village x Township Parcel Tax No:
Maus, Brian ---T— Star Prairie Township 038- 1 ?06 -70 -000
CST BM Elev: Insp. BM Elev: BM I Descri
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing P1 A-1 tb Alt. BM i,,
�l
' Aeration Bldg. Sewer
7 ff 7
Holding St/Ht Inlet
97 P
TANK SETBACK INFORMATION SUHtOutlet Sb 97. 6e/
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Air .
r-
Septic / �p J pi Dt Bottom
Dosing Head an. ?— l r,� LN d q -
Aeration Dist. Pipe I Q p 7
// y --✓
Holding Bot. System
Final urau-
PUMP /SIPHON INFORMATION $.?(� /Op 3
Manufacturer Demand St ver / 3• Z, 2
Model Number
TDH Lift ion Loss System Head TDH
Forcemain Length IDist, to Well
SOIL ABSORPTION SYSTEM • 0_�
BED /TRENCH Width f f– Length No. Of Trenches PIT DIME No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO W BLDG WELL LAKE /STREAM LEACHING Manuf
INFORMATION CHAMBER TY.�TT�
Type Of System: / 7 ,�J '� Model Number:
DISTRIBUTION SYSTEM A Y el a
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Length ' i/ Pipe(s) -7 I �„ (i � L/ S f �— 7 S� f �^
Dia Len g th Dia S cm 7 5
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of T77eeded /Sodded xx Mulched
Bed/Trench Center (+ f �/ Bed/french Edges Topsoil -
Al Yes ] No U Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: ( / Inspection #2: / /
Location: 2154 1Ird Ave New Richmond, f Wl� 54017 (SW 1/4 NE 1/414 T30N R18W) Prairi View Estates Lot 17 Parcel No: 14.31.18.1112
1.) Alt BM Description = pue/C,d` i /Mt "
2.) Bldg sewer length =30
- amount of cover = 3,S fi
Use revis
de Req
information.
Yes No
formation. L -_-
SBD -6710 (R.3/97) Date ; �Insepctor's Si ature Cert. No.
• 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
lV i sconsin Personal information you provide may be used for second purposes p Madison, WI 53707 -7302
Department of Commerce Submit completed form to coup if not
[Privacy Law, s. 15.04(1)(m)] ( p �'
to -Cr—d Z j Do'T D 1 state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County , State Sanitary Permit Number ❑ Check if revision to previo nation S to Number
I. Application Information - Please Print all Information RECE IVED cation: 2/ ^ S�
Pro erty Owner Name _ / P�ope� Loc i
Gl CQ CP J •' ► U
Property Owner's ailing Address Lot Number Block Number
7 �/�C - ST. CROIX COUN7`r ` —~
Cit tate Zip Code Pho �j - c/ Subdivision Name or CSM N umber
�/C r GjP/
II. Type of Building: (check one) ❑ City SST
1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village
� l .- / 1
• Public /Commercial (describe use):_ �I'own of P ¢7
❑State -Owned
Nearest Road 0 2 h 7
G1 ct �� �jH� Parce] Tax Number(s)
III. Type of Permit: (Check only one box on line A. Check box on line B if applicable)
A) 1. A New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued 1 11
IV. Type of POWT System: (Check all that apply) r ( d awi , et
n pressuri ground ❑ Mound ❑ Sand Filter ❑ Constructe Wetland /Sf� —
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line r
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: 3 S/e4a' d.e✓
V. Dispersal/Treatme Are Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System E 7. Final Grade
Required i �' Proposed p I Rate (Gals. /day /sq. ft.) (Min. /inch) ���� ae ,Elevation
/i OlU .11 , - l00 y
- pZ < r-,A?4C,do
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks �/ /�k1x Con- Con- glass
New Existing crete structed
Tanks Tanks B4
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement Ed
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plu er's Name (print) Plum ignature (no slam MP/MPRS No. Business Phone Number
f
bees Address (Street City, State, Zip Co e
r
1X. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issu d Issuin gent Signa (No stamps)
pproved ❑ Owner Given Initial Adverse Surcharge Fee) / -
Determination If- a J a' 6
X. Conditions of Approve - � t ns f r Disapproval- . � / �iLttC- (i2'fl'rt��i�!�i't��
�t2�t/Yv�.,.�
Gd ;�.f�yt�,
4J37.
I� 4•
2 �'hivn fa t%�„ svl'��cctC f Sysf��, � 4em, . Y3, -�3 4
sBD 39ssR. 07 ) r ceo►'d cbl� -1v Ju firms m r;4 { �evld cu; l/ La- dweer 1ta7 6r-r &
�J PLOT PLAN
PROJECT 49ri a( !ij �Q LI ADDRESS
/4 t/45 1T NIR W TQWN 111TY
DATE BEDROOM
MPRS Byron Bird Jr. 2205
CONVENTIONAL XXX Cade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1v2'9!5d LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE _ �_ � ABS AREA l,�yC 2 # of chambers �rc
BENCHMARK V.R.P. T p f a — � ' ASSUME ELEVATION 1100' 61
❑ BOREHOLE O WELL sH,R,P,
AT' ent $NATION
Sidewinder High city Leachin am er
Long 34 Elevation
3�s
l
0
a � �e)
e\ y �
J'
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3�
PLOT PLAN
PROJECT 04C,LyT_ ADDRESS
/ 114S 1 NR / W TOWN r rccr�i�UNTY � jr� r<
DATE �--f
MPRS Byron Bird Jr. 2205 /"-BEDROOM
CONVENTIONAL XXX r$de CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE A;2,6'455' LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE _ ABSORPTION AREA <�� # of chambers
kk BENCHMARK V.R.P. �� — �.- !/ `
C ' A SSUME ELEVATION 100'
❑ BOREHOLE (DWELL *H.R.P. _,-I Y -,� j�
AT' t EVATION
Sidewinder High city Leachin am er
Long 34" Elevation
M It
ly
0
c
o
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. O 70— V
percent slope, scale or dimensions, north arrow, apd"location and4stance to nearest road.
Please print all information. ,' , Rev' r , ,, O� I D
Personal information you provide may be use or3econdary Apses rivacyLaw, ia 15.04 (1) (m)). ``r %'�J�"� vw� ` 3 6
Property Owner �� i , ,� � P erty Location Id p �yuw'+- S'.� _11.11 `
✓� ovt.Lot Sw 1/4 1/4 S 14 T 31 N R 1 (or) W
Pro Owner s Mailing Ad ress Lot # Block # Subd. Name or CSM#
1430 220th. Ave. t \�`:r 17 na Prairie View Estates
City State Zip Cod –Phone Nu - City ❑ Village F41 Town Nearest Road
New Richmond, I WI. 5401 T" (' 71,5 ° '�L $- 7313;'` Star Prairie cm 11 0"
[2 New Construction Use: U Residential / Number-of I}edr Code derived design flow rate " 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material outwash Flood Plain elevation if applicable na ft.
General comments QWWIW •�'L� -�+y0� l��.S/ U {'�tll�fl
and recommendations:
trenches @ el. 96.20' (p. J ��• ?i
Boring #
Boring
F—il 100. 10 ® pit Ground surface elev. ft. Depth to limiting factor +100 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
2 11 -25 10 4/3 none sicl 2msbk mfr gw if .4 .6
3 5 -10 7.5 m
4/6 none s OSCI ml na na .7 1.2
b q z.
Boring # F1 Boring
2 ® pit Ground surface elev. 1 0 0 .70 ft. Depth to limiting factor +100 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
1 0 -8 1 Qyr 2/2 none L 2msbk mfr cs if .5 .8
3 25 -10 .5 4 none ms osq m1 na na .7 1.2
- r 4 .2 t
o = (o. z q"
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L quent #2 = BOD < 30 mg/L and TSS < 30 mg/L Fl
CST Name (Please Print) Signature CST Number
Gary L. Steel 02298
Address Date Evaluation Co ucted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 12 -1 -2000 715 - 246 -6200
Property Owner Fwl Pn Pr:)pey - act Ltd Parcel ID # mn&nq Page 2 of
Boring # ❑ Boring 1 +100
3]
® pit Ground surface elev. ft. Depth to limiting factor 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
3/3 none L 2msbk mfr Cs if .5 .8
2 9 -28 7.5 4/4 sCl 2msbk mfr 9W if .4 .6
28-45 1 sicl M na qw if .0 .0
none ms OSCI ml na na .7 1.2
SI C �
1
❑ Boring # E] Boring •
Pit Ground surface elev. ft. Depth to limiting factor 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
Boring Boring # Ground surface elev. ft. Depth to limiting factor in.
F ❑ Pit
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2
• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 5 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS'< 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD4330 (R6=)
I
I
STEEL'S SOIL SERVICE
Gary L. Steel Ewlen Properties, Ltd. 1554 200th Ave.
CSTM2298 SW' TNME' S14- T31N -r18W New Richmond, WI 54017
MPRSW -3254 town of Star Prairie (715) 246 -6200
lot #17- Prairie View Estates
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 L �
" =40'
BM. = top of 1" pvc pipe @ el ..100.00'
Alt. BM.= top of 1" pvc pipe @ el. 100.85'
r
v C9 �
\ v,`
Gary L. Steel
12 -1 -2000
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
4 9 /
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address �_ C� lyi.g �
Property Address '�' S
(Verification required from Planning Department for new construction)
City /State �< C
Parcel Identification Number O
LE GAL DESCRIPTION
� //,ry /4, Sec. TN -R�W, Town of �cc � i^�t r ✓�r
Property Location ' /4, ' ,
Subdivision !l ra r y'� �� �/ �.5 , Lot
Certified Survey Map # , Volume , Page #
Warranty Deed # 6" e 15'�;'0 , Volume l S / , Page #
Spec house 7 yes ❑ no Lot lines identifiable Ig 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.
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. 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.
/ 2r)/ 'Z-
SIGNATURE 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 owners) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
2�� 9 /Zl1/ UL
SIGNATURE OF APPLICANT DATE
* * * * ** An information that is mis -re resented ma result in the sanitary permit being revoked b the Zoning Department. * * * * **
Y P Y rY P g Y
** 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
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner e'c a'X, L-11(l Septic Tank Capacity a l ❑ NA
Permit # K' 1,6 Septic. Tank Manufacturer f ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer u E3 NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA
Estimated flow (average) al /da Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) ,0 p g al/day Pump Manufacturer ❑ NA
Soil Application Rate Z al /da /ft2 Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA
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 In- 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: 0 ea�(s(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ year(s)month (Maximum 3 years) [3 NA
❑
Clean effluent filter At least once every: month(s) ❑ NA
❑ year(s)
❑ month(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
❑ month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ year(s)
❑ month(s)
Other: At least once every: ❑ year(s) E3 NA
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter. NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of• painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat .scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall tie taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another. inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
• A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
• A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNINh> >
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 6F A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name �, �/ � ��'" Name
Phone l Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name n a C Name
Phone ,— ,6 -` S Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
09/18/02 WED 14:37 FAX 715 386 4687 REGISTER OF DEEDS 16 001
e
U 19 8 1 P 9 3 7 619 �15 s�
STATE BAR OF W15CUNSIN FORM 2. 1999 KATHLEEN H. W ALSH
Document Numbcr WARRANTY DEED REGISTER OF DEEDS
ST- CROIX Co., W
This Deed, made between E WLEN Properties, Ltd., a Te xas RECEIVED nR RECORD
Limite Partnership, 09- 18- 2 @►>;Z 9:00 An
WAR
Grantor, and Country Living Builders, Inc. EXEMPT 0
REG FEE: 11.00
_..... TRANS FEE: 97.50
_ -- COPY FEE:
- ................_ .... _— CERT COPY FEE:
chautee. PAGES: 1
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in S Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Arcu
b airie View Estates, 'township of Star Prairie, St. Croix County. Name and Rcturn A dr s all 4-u-
. y" —1 1 —S 6 '��
wo t twt�
70-coo
Parcel I dentit icat ion Numbcr (PIT)
This — is not homestead property.
X (is not) _..._.—
F..::ceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this - - -�� day of September 2002
EWLEN Properties, Ltd.
* :e B
� 1"��l N DIULt RZD�/�'T7�S' LTfj
� x
AUTHENTICATION ACKNOWLEDGMENT
Signaturc(s) STATE OF WISCONSIN )
) ss.
- County )
authenticated this clay of
- -' - - Personally came before me this �_ clay of
September , 2002 the above named
EWLEN Properties, Ltd., a Texas Limited P artnership, by
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me ]mown to be the person(s) who executed the foregoing
authorized by § 706.06, W is. Stars.)
instr ent and ack wlcdg d tl same.
THIS INSTRUMENT WAS DRAFTED BY a ) -
Attorney Krigtina Ogland Notary Public, St:ttc of Wisconsin
Hudson, Wi 54016 My C nunisst n is permFrncn(, (If not, state cxpiraticln du1c:
(Signatures may be authenticated or acknowledged. Both are not necessary.) LP )
t Names orpersons signin8 in any capacity must be typed or printed below their sionaturc. Wonnation Proressinn2is company, Fonc du Les. M
000.055 -2021
WARRANTY DEED STATE BAR OFWISC'ONSiN
FORD1 No. 2 - 1999
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