HomeMy WebLinkAbout038-1207-80-000 Wisconsin Department of Commerce Count
Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix
INSPECTION REPORT sanitary Permit No: 430261 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:
Klemmensen Builders Star Prairie Township 038 - 1207 -80 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
10D . O ICO. p 1 CSC' w►• 1 14.31.18.1123
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /
Dosing Alt. B 3� 3 Z O. ,2 1
Aeration Bldg. Sewer
( Af z q g �'3
Holding St/Ht Inlet ,7 39 . �� t
�. /
TANK SETBACK INFORMATION St/Ht Outlet `S
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic > s 0 2 3 Dt Bottom
Dosing I t leader /Man.
Aeration Dist. Pipe 0
*�.• s r
Holding Bot. System
•40
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM 16 1 ft .91
Model Number
TDH Lift ri ' Loss System Head TDH Ft
Force Length I Dia. Dist. to well
r
SOIL ABSORPTION SYSTEM
BED /TRENCH Width + Length No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
? T
DIMENSIONS 3 •Sb �• 23
SETBACK SYSTEM TO P/L JBLDG IVELL LAKE /STREAM LEACHING
INFORMATION CHAMBER OR
Type Of System:
UNIT Model Number: 2 r/
hV.
DISTRIBUT N YSTEM
Header Distribution x Hole Size x Hole Spacing Vent to Air Intake
it Pipe(s)
Lengt Dia Length Dia 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 -
Yes =! No Yes No
COM Include de dis
� cr���,, cies perjon�(e�s+nntt ,eetc`) ns ction 1 / 3 Inspe 'o #2: /
/
Location: 11258 217th Avenue ewRichmo 5401 (T SW 1/4 NE 1/4 14T 1N ) P airie iew s tes o Parce :14.31.18.1 23
1.) Alt BM Description( - vat � t�"��� �- �fr> 4) S l � A 6 S( Z 2 .) Bldg sewer length = ' ' S "T"'�
amount of cover= � 8o•F. „�,.�. ""���� C�•/Z S.4t/S.
4 —too c -x&e.* 4 � , 11�•� dus� act It V0P-__hT _
Plan revision Required? Yes X No 0i \ �'
Use other side for additional information. �1
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SBD -6710 (R.3/97) CA G Insepctor's Signature Cart. No.
j
PROJECTi`C�iyr� c ADDRESS ,C G '�, �l�a
j LrJt l4�/� 1 /4 /S,��(7 / N /R,-�W ` TOWN a COUNTY ;2
MPRS Byron Bird Jr. 3318 DATE — Q
BEDROOM ` CLASS PERC CONVENTIONAL IN -GNU PRESSURE /
CONVENTIONAL LIFT_ MOUND_ HOLDING TANK
:SEPTIC TANK SIZE LIFT TANK SIZE /
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA PERC RATE BED SIZE
\ Benchmark V.R.P. Assume Elevation
Location of Benchmark e-� .
* H.R.P.
a Borehole Q Well Scale = Feet
0 Per Hol System Elevation
y
• V
S l
=.0 r� y
a WW
Sanitary Permit Application S ety & Buildings Division
In accord with Comm 83
1 4 ��� 201 W. Washington Ave.
`� mpl
See reverse side for instructions for or completing ting Cod this app t tion PO Box 7302
isconsrn Personal information you provide may be used for secondary p ;/ Madison, Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
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 states i � Permit Number ❑ Check if revision to previous application State Plan I. D. Number
jC
I. Application In - Please Print all Information Location:
Property Owner Name Property Location
G s2s e` 7 C �G C �°' 14�/ 1/4, S T - R - E
Property Owner's Mailing Address Lot Number Block Num er
City, Stat Zip Code Phone Number Subdivision Name or CSM Number
R C E N4 y,?o— 67 75;; rrcJ 4757 (
II. Type of Building: (check one) " 5 � ❑ city
1 or 2 Family Dwelling - No. of Bedrooms : a Z O O ❑Village
Public /Commercial (describe use):_ a 1 pgown of
S ❑State -Owned ? C ;.`.x. C�" N; � �--
r'' Nearest Road
20 3 t r, / C� tAI —4-1� Parcel Tax Number(s) 7- -
III. Type of Permit: (Check only one box on line A. Ch box on line B if applicable) 17
A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
$Ion- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed ,8" Rate (Gals. /day /sq. R.) (Min. /inch) r _ _ ! I Elevation
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
w( —� ❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigne assu responsibility for installation of the POWTS shown on the attached plans.
Plum Name (print) Plumber gnature (no stam s): MP/MPRS No. Business Phone Number
or
Pl is Address (Street, City, State, Zip Code)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui Agent Signatu (No stamps)
Approved ❑ Owner Given Initial Adverse Surch V- S-0 ) I--- %5X0 Determination
X. Conditions of Approval /Reasons for Disapproval:
'�^
-
' e -, _ . �, at O tUU
t • '�.'�'� .
SB (R. 07/00)
PLOT P A
PROJECTS c `ADDRESS
N /R 'TOWN �J�cc- COUNTY _ Groi
MPRS Byron Bird Jr. 3318 DATE
BEDROOM CLASS PERC CONVENTIONAL,,< -G ROU PRESSURE
CONVENTIONAL LIFT, MOUND HOLDING TANK
:SEPTIC TANK SIZE r a o LIFT TANK SIZE
DOSE TANK. SIZE HOLDING TANK SIZE
ABSORPTION AREA PERC RATE BED SIZE
► Benchmark V.R.P. Assume Elevation 1.00'
Location of Benchmark
* H.R.P.
0 Borehole Q Well Scale = Feet
0 Perc Hol System Elevation
rr /q •,
y el
I � Ek f ' f
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ 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.
percent slope, scale or dimensions, north arrow, ar1d foo9lion and-distance to nearest road.
Please print a1i'ililf6rmation a wed by
' Dat
Personal information you provide may be usedior`3800ndary pt*pses Pnvacy Law, a 15.04 (1) (m)).
Property Owner P f , LU P perty Location
Men Prope rties. Ltd Gov'<. Lot SW 1/4 1/4 S T N R ,)ftor) W
Property Owner's Mailing Address Let Block # Subd. Name or CSM#
1430 220th. Ave, 8 na
City State Zip C ` Phone N C, OfftCE City [j Village W Town Nearest Road
New Richmond WI. 54017 C+ 48 -7313 F ' " "
[I New Construction User Residential / Num ` f e r4 s Code derived design flow rate 600 GPD
❑ Replacement . ❑ Public or commercial - Describe:
Parent material —Effltioash Flood Plain elevation if applicable
General comments � J G�,� �G rr . �b ✓
and recommendations: L
trenches @ el. 95.30' 7-7
F-il r
Boring # Boring 99.60 +100
® 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 /f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2
1 0 -12 10 2/2 none L 2msbk mfr CS 2f •5 .8
2 12-28 7.5 4 none 1 2msbk mfr crw if 4
a --
Boring # Boring `
® Pit Ground surface elev. �( 98.90 ft. Depth to limiting factor +100 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Descripli Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
2 11 -30 7.5 4/4 none scl 2msbk mfr qw if .4 .6
wo n=
Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L = BOD < 3# mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature . ST Number
Gary L. Steel 02298
Address a Cvaluafion Conducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 12 -3 -2000 715 - 246 -6200
Property Owner EWlen PrOnPrtieG .. Ltd. Parcel ID # . pendi n[3 Page 2 of 3
E Boring # ❑ Boring 99 ® 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
8
2 12 -26 7.5 4/4 none sicl 2msbk mfr gw if .4 .6
3 26 -10 7.5 4/6 none HIS os ml na na • 7 1.2
a` Boring # ❑ 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 GPD /fP
in. Munsell Qu. Sz. Cont, Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fY
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 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.
SBD -8330 (R.6/00)
I
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•
,
STEEL'S SOIL SERVICE
Gary L. Steel Ewlen Properties, Ltd. 1554 200 #h Ave.
CSTM2298 SW4NE4 S14- T31N -r18w New Richmond, WI 54017
MPRSW -3254 town of Star Prairie (715) 246 -6200
lot #28- 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 " =40'
BM.= top of 1" pvcpipe @ el. 100.00'
Alt. BM.= top of 1" pvc pipe @ el. 98.50' k
1
0
1
1d .
Gary L. Steel
12 -3 -2000
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity /' Q
a l ❑ NA o
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer �� ��.e ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model BE, ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l A
Estimated flow (average) al /day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer PQA
Soil Application Rate gal /day /ft2 Pump Model ),NA
Standard Influent /Effluent Quality Monthly average" Pretreatment Unit XNA
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 S30 mg /L A n-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: month(s) (Maximum 3 years) ❑ NA
ear(s)
Pump out contents of tank(s) When combined sludge and sc m equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ ea th(s► (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑ month(s) [3 NA
year(s)
Inspect pump, pump controls & alarm At least once eve ❑ month(s) year(s)
❑ NA
Ins
P p P every: ❑ years)
❑ month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: month At least once every: ❑ year(s) ❑ 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 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
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)
I
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 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:
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.
EY 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 O �� Name tJ o e e,�e
Phone $��61 , Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name C ;" eic eo
Phone �� 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.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer
` Mailing Address fo�5�� 17 / 7 70!:�1 /6e. _-
Property Address C
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number �6'"`l��
LE GAL DESCRIPTION
n
Property Location '/4, ��r' /4, Sec. _Z T N -R ,Town of
Subdivision ��"a r �" r �� 0 ('e - '.CJ � 50- __ _ _ Lot
Certified Survey Map # , Volume r— , Page # �—
Warranty Deed # � 3 �v , Volume Page # l `
Spec house Oyes ❑ no Lot lines identifiable jam: 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.
dDYt 1 ,2l
SIG ATURE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
/ /
SI ATURE F 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
• 1 2392P ly7 73 �v
32PJrb �
STATE BAR OF WISCONSIN FORM 2 -1999 KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between EWLEN Properties, Ltd., a Texas
Limited Partnership, 07/31/2003 03:45PH
WARRANTY DEED
EXEWT #
Grantor, and Klemmenson Builders and Designers REC FEE: 11.00
TRANS FEE: 93.00
COPY FEE: 2.00
CC 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
: 2scon ) sin. 8 rairie View Estate Township of Star Prairie, St. Croix County, Name and Return Address
Esheen & Ogiand
304 Locust Street
Hudson, WI 54016 34e -
E> l z,o'7 - g (j -
Parcel Identification Number (PIN)
This is not homestead property.
0() (is not)
Exceptions to walTanties: Easements, restrictions and rights -of -way of record, if any.
Dated this 2 , � `` day of July , 2003
EWL Proper' Ltd.
• +
By: Johnson
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
.C&'13 r x County )
authenticated this day of Personally came before me this gip.{ day of
Judy , 2003 _ the above named
•
Ewlen Properties, Ltd., a Texas Limited Partnership, by Foy
Johnson
TITLE: MEMBER STATE BAR OF WL o be the persons) who executed the foregoing
(If not, acknowledged the same.
authorized by § 706.06, Wis. Sta .) 5�,�
THIS INSTRUMENT WAS D BY
Attorne Kristina Ogtand Notary Public, State f Wisconsin
Hudson, W1 54016 My Commissio is a anent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both arc not necessary.) � )
• Names of persons signing in any capacity must be typed or printed below their signature. klo m.ua, wa..,toow caov Fond W tK WI
STATE BAR OF WISCONSIN 600855 - 2021
WARRANTY DEED FORM No. 2 - 1999
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PRAIRIE VIEW ESTATES
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2392F' ly7 li
STATE BAR OF WISCONSIN FORM 2.1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX Co., WI
This Deed, made between EWLEN Properties, Ltd., a Texas RECEIVED FOR RECORD
Limited Partnership, 07/31/2 003 03 :45PM t
I
WARRANTY DEED
Grantor, and Klemmenson Builders and Designers g °" EXQPT #
_ I ..,
REC FEE: 11.00
TRANS FEE: 93.00
COPY FEE:
2.80
Grantee. CC FEE:
PAGES: ES: 1
Grantor, for a valuable consideration, conveys 10 Grantee the
following described real estate in St. Croix - -..
State of Wisconsin (if more space is needed, please attach addendumC� -,
Lot 28, Prairie View Estates, Township of Star Prairie, St. Croix County, Recording Area
Wisconsin. Name an & Ogland
304 Locust Street
d Retum Address
j EWee
Hudson, WI 54016
C: 3S- 1-2 - 0 '7 - S 6 -
Parcel Identification Number (PIN)
This is not homestead property.
Exceptions to warranties: Easements, restrictions and rights -of -wa of rec) (is not)
y ord, if an .
Y
Dated this day of July 2003
EWLF Properti s Ltd.
•
+ B : Johnson
I
+
+
AUTHENTICATION
Signature(s) ACKNOWLEDGMENT
STATE OF WISCONSIN )
� ) ss.
authenticated this Y
da of
County
Personally came before me this -P day of ..
July , 2003_ the above named
amed
+ Ewlen Properties, Ltd., a Texas Limited Partnership, by Foy
Johnson
TITLE: MEMBER STATE BAR OF
(If not, ENDERSON t me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Sta .) i State of Wisconsin ment and acknowledged the same.
THIS INSTRUMENT WAS D gy
Attorney Kristine Ogland
udson, I S4 1 Notary Public, State of Wisconsin
(Signatures may be authenticated or acknow {edged. Both are not necessary.) My Commiss o is per ent. (If not, state expiration date:
'* Names ofpersons signing in any capacity must be typed or printed below their signature.
IMormatlon Profea+lonab Cp,iprny. Fond du Loc. WI
WARRANTY DEED STATE BAR OF WISCONSIN a pp.� y ��
FORM No. 2 - 1999