HomeMy WebLinkAbout020-1437-02-000 I
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Wisconsin D• partment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building fNvision
I INSPECTION REPORT Sanitary Permit No:
453469 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:
LaCasse Development I Hudson Township 020 - 1437 -02 -000
CST BM Elev: r Insp. BM Elev: , BM Description: ` 1 Sectionrrown /Range /Map No:
C V• a 0'O . a .d�t9� as C -etµ f 22.29.19.2707
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic fZ. Benchmark • � CS ' � �
Dosing t Alt. BM ,
Z- OS.
Aeration Bldg. Sewer • 2- r
p,
Holding St/Ht Inlet •
St/Ht Outlet D ewl
TANK SETBACK INFORMATION 7�•�
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ' O Dt Bottom
yRC ---- --
Dosing Header /Man. •
Aeration Dist. Pipe 9 3 n` •
Holding Bot. System YIO '
O �•
Final Grade
PUMP /SIPHON INFORMATION I 3 M.S
Manufacture and St Cover
GPM
Model Number
TDH Lift ti ss System Head TDH j Ft
Forcemai Length Dia.
SOIL ORPTION SYSTEM Z3 Q
RENCH Width , Length I No. Of Tre ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM 3 1 9 2. Z
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Man re
INFORMATION CHAMBER OR
Type Of System: 1 (to �� UNIT Mode�mb�rG
�t • 1 50 > 64,, <
DISTRIBUTION SYSTEM
Header /Manifold t� Distribution x le Size x Hole Spacing Vent to Air Intake
Pipe(s) ` • O
L Dia Len is Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
fir] Yes ] No L] Yes [ No
O_ MME�IT�S` (include! d
c�g,dis�p ncie$, , persons present etc.) Inspection #1: 2 Inspection #2: -��
tocatlon: 804 Ross Rd Unknown (SW /4 SE 1/4 22 T29N R1 9W) Kelly Estates Lot 2 Parcel No: 22.29.19.2707
1.) Alt BM Description =_�vto}- - �Owwnolf • ot, LL S?.ps@".
2.) Bldg sewer length = -.. -70 QQQ
- amount of cover
Plan revision Required? i_ ] Yes No
N
Use other side for additional information. _
SBD -6710 (R.3/97) `� D te► e - _ ( Insepctor's Signature Cert. No.
i
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
�Oi��� Madison, WI 53707 — 7162 Sanitary Permit Number (tq filled in by Co.)
De artment of Comm ce (608)266 -3151
Sanitary Permit Application U )44� 0
State Plan I.D. NumberIn accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sl 5.04(1 xm)
Project Address (if different than mailing address)
I. Application Information - Please Print All Information -
Prope Owner's Name Parcel # Lot Block #
Coo —1 q;T c o- 0 = (,viov- ) -.
Property Owner's Mailing Address i Property Location `! .
_.. _
City, State Zip Code Phone Number - — V4, Section
y
circle one)
II. Type of Building (check all that apply) � 5 T N, R E or W
1 or 2 Family Dwelling - Number of Bedrooms ��+ asa` $ , SubdivisI05IName 66 A. t 611 igmbee
❑ Public/Commercial -- Describe Use
❑ State Owned - Describe Use _ ❑City 13 VVJA9e .E�Township of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. New System ._....�
y ❑ Replacement System ❑ TreuunenUHolding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of 1.1 Permit Transfer to New List Previous Permit Number and Dato Issued
Before Expiration Plumber Owner
PP
IV. Type of POWTS System: (C hook all that apply) y)
Non - Pressurized In- Ground ❑ Mound ? 24 in, of suitable soil ❑ Mound < 24 in, of suitable soil ❑ At -Grade . ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter , kLeaching Chamber ❑ Drip Line ❑ Gravel -less Pi ❑ Other (ex lain)
V. Dispersal/Treat ant Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (so Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in Total Number ufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Respo nsibility Statement- 1, the undersigned, nAwne responsibility for Installation of the POWTS shown on the attached plan&
Plumber' ame Prints Plumber's Si r MP/MPRS Number Business Phone Number
Number
!
Plumber's Address (Street, City, Sate, Zip ode
VIII. County/Department Use Onl
R Approved ❑ Disapproved Sanitary Permit Fee includes Groundwater I Date Issued Issuin gent Signature (N stamps)
I Surcharge Fee) rn 23
❑Owner Given Reason for Denial J V
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
I Septic tank, effluent filter and
dispersal cell must all be serviced /main fined
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per appifable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 z 11 Inches in siza
SBD -6398 (R. 01/03)
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Wisconsin'Department of Commerce SOIL EVALUATION REPOR Q (� Gil P 1 of 3
Division of Safety and Buildings in accordance with Comm 85, W is. Adm. Code Steel Sal Service
Co4nty
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
pending
Please print all information. R -awed By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` 1); � zac
Property Owner Property Location
Reliant Developers LTD Govt. Lot SW 1/4 SE 1/4 S 22 T 29 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
9900 Valley Creek Rd. Suite 135 2 na Kelly Estates
City C 0665 do- ( State Zip Code Phone Number City M Village j6 Town Nearest Road
MN 55125 651 731 - 3174 Hudson Ross Rd
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe:
Parent material outwash plains and stream terraces Flood plain elevation, if applicable na
General comments
and recommendations: System elevation 96.05ft, trenches spaced and depth to code 4.50ft below grade
❑ Borin g # "` Boring
it Pit Ground Surface elev. 99.75 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tP
"Eff#1 I 'Eff#2
1 0 -14 10y13/2 none sil 2msbk mfr cs 1f .5 .8
2 14 -25 10yr4/4 none sicl 2msbk mfr gw 1 of .4 .6
3 25 -36 10yr4/6 f 7.5yr5/6 sicl 2msbk mfr gw na .4 .6
4 36-48 7.5yr4/4 none sl 2msbk mfr gw na .5 .9
5 48 -96 7.5yr4/6 none ms osg ml cs na .7 1.2
I
I
2 Boring # M Boring
Pit Ground Surface elev. 99.75 ft. Depth to limiting factor 96 in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
*Eff#1 I "Eff#2
1 0 -16 10yr3/2 none sil 2msbk mfr cs 1f .5 .8
2 16 -26 10yr4/4 none sicl 2msbk mfr gw 1 of .4 .6
C o rr ) 3 26 -36 10yr4 /6 f2d 7.5yr5/6 sicl 2msbk mfr gw na .4 .6
4 36-48 7.5yr4/4 none sl 2msbk mfr gw na _5 .9
5 48 -96 7.5yr4/6 none ms osg ml cs na .7 1.2
" Effluent #1 = BOD 5> 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) Signature: CST Number
David J. Steel C � ��� 248956
Address Steel Sal Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 10/20/2002 715 - 246 -5085
Property Owner Reliant Developers LTD Parcel ID # Pending Page 2 of 3
I 3 ( Boring # Boring
I_J id Pit Ground Surface elev. 100.55 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
*Eff#1 *Eff#2
1 0 -10 10yr3/2 none Sill 2msbk mfr cs 1f .5 .8
2 10 -22 10yr4 /4 none sicl 2msbk mfr gw 1vf .4 .6
C af ", 3 22 -36 10yr4/6 :2d7.5yr5/ sicl 2msbk mfr cs na 4 6
4 36 -96 7.5yr4/6 none ms osg ml na na .7 1.2
S f P /qO ,
F 4 Boring # 7 Boring
Pd Ground Surface elev. 100.55 ft. Depth to limiting factor 96 in. Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
*Efl#1 *Eff#2
1 0 -20 10yr3/2 none sit 2msbk mfr gw 1f .5 .8
2 20 -30 10yr4/4 none sicl 2msbk mfr gw 1 of .4 .6
3 30-42 10yr4/4 none sl 2msbk mfr gw na .5 .9
4 42 -96 7.5yr4/6 none ms osg ml na na _7 1.2
�JO .
F-I 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/ft
*Eff#1 *Eff#2
* Effluent #1 = BOD ? 30 < 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
Page 3 of 3
STEEL'S SOIL SERVICE
David J. Steel 1564 Cty Rd GG
CST- POWTSM Reliant Developers LTD New Richmond, Wl 54017
Lie. # 248956 SWl /4,SE1 /4,S 20,T29,R19W (715) 246 -6200
Town of Hudson, St. Croix Co. (715) 246 -5085
Kelly Estates lot 2
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 soil test was conducted. Legend
1 = 40'
♦ =Benchmark El. 100.00Ft
Top of 1" steel pipe
• = Alt Benchmark E1.99.0517t
Top of 1 /2" pvc pipe
o = Borings
Boring Elevations
B1 = 99.75Ft
B2 = 99.75Ft
B3 = 100.55Ft
B4 = 100.55Ft
9, 7Sft 133
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POWTS OWNER'S M NUAL & MANAGEMENT PLAN Pag t..1.
FILE INFORMATION -/ SYSTEM SPECIFICATIONS
Owner l , Septic Tank Capacity, ,,., al O NF
Permit # L :Septic Tank , ` - , �" O Ni.
DESIGN PARAMETERS Effluent Filter Manufacturer ' ' "J O Nk
Number of Bedrooms O NA Effluent Filter Model 0 Ni-
Number of Public Facility Units A NA Pump Tank Capacity gal --eNA
Estimated flow (average) Pump Pump Tank Manufacturer. ; l Ni- .
Design flow (peak), (Estimated x 1.5) g al/da y Pump Manufacturer'"
Soil Application Rate al /da /ft2 Pump Model JS�NA
Standard Influent /Effluent Quality Monthly average' Pretreatment Unit A
Fats, Oil & Grease (FOG) 530 mg /L O Sand /Gravel Filter O Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L O NA O. Mechanical Aeration Q Wetland
Total Suspended Solids (TSS) 5150 mg /L O Disinfection O Other. .
Pretreated Effluent Quality Monthly average Dispersal Call(s) O NA
Biochemical Oxygen Demand (BOD 530 mg /L 4-In- Ground (gravity) O In- Grouhd (pressurized)
Total Suspended Solids (TSS) 530 mg /L O NA O At -Grade O Mound
Fecal Coliform (geometric mean) 510 cfu /100m1 O Drip -Line 0 Other,
Maximum Effluent Particle Size Y in dia, O NA 000r: - , O NA
Other; O NA Other: , n. ; •� . O NA
"Values typical for domestic wastewater and septic tank effluent, Other: O NA
r
MAINTENANCE SCHEDULE
Service Event Service Frequency
—7 13 month(s)
Inspect condition of tank(s) At least once every: `j ear s w rz, (Maim 8 years) O NA
Pump out contents of tank(s) When combined sludge and scum equals one -third .(Y,) of tank volume 0 NA
Inspect dispersal cell(s) At least once every; O earls) $) / (Maximum 3 years) 0 NA
Clean effluent filter At least once every: O month(s) O NA
ear(s)
Inspect pump, pump controls & alarm At least once every: r on O � -0 NA
Flush laterals and pressure test At least once ev monthls ,C .� >;1'�5',„ ., , ..A _Q NA
sty: O earls)
Other; O month(s) At least once every:. O year(s)
"' ? O NA
O NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licensea or certifications
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servlaft Operator. Tan,
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 chpok -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 (Y3) or moro of the tonk .voksme, the ontirc
contents of the tank shall be removed by a Septage Servicing Operator and dieposed of In accordance With ter 11 3,
Wisconsin Administrative Code. .: _�, .:. -,.. ,» , ...: ,.,, ,� �s#..�
All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretrestmv
units, and an servicing at Intervals of 512 months shall be performed b a certified POWTS Maintanner.
Y g • Prf Y
A service report shall be provided to the local regulatory authority,within 10 days of completion of, any serVigo.tvM1>4•
OMW (4/01
Page of ,, 2
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 chemica
that may impede the treatment process and /or damage the dispersal cell(s). If'high concentrations are detected hive 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 Gu
discharged to the dispersal cell(s) in one large dose, overloading the cellls) and may result In the backup or wrfaoe discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator pilot -to restoring
power to the effluent pump or contact a Prumber or POWTS Maintainer to assist In manually- opersting_ the pump'oontrols 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 aruo
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; herbicide* ;;,meat scr&ps;..Moications; 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 sealod.
• The contents of all tanks and pits shall be removed and properly disposed of by a;Septago Servicing._Qperator,
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and.the:yold 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 bei 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 availabiR a JWIding 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 INSTALLE POWTS MAINTAINER
E e .Namo e = — Phone bky
SEPTAGE SERVICING OPERATOR (PUMPER) LOC L REGULATORY AUTHORITY
Name Name
Phone Phone
This document wa drafted in compliance with chapter Comm 83.22(2)(01)(d) &(f) and 83.64(1), (2) & (3). Wisconsin Administrative Code.
II
ST CROIX COUNTY
SUPTIC TANK MAINTENANCE AGIUMMENT
AND
OWNERS1111' CHRTIFICATION DORM
Otwncr /Lltiycr __ZA G . tf S!t Ac t) _ 1 A/cM
Mailing Address ;7 7 3 GO
Property Address
(Verification milliled fioul Planning Department for flew cons(mcfion)
City /Stale (titL, __ 1 Itlel►liiic;►liitn Ntuultcr ozO OZ- am(, 24 0 T)
L1,GAL DESCRIPTION
Properly Location S W ' /,, '/4, �,ec. 2 Z , 'I' N -It IO W, 'Town of 8
Subdivision , /,L I,ot #
Certified .Stu vcy Aifip �/ gi 7 -4P&2, p ? — Vulurtic Pago /t
Warranty Decd /I %�� , VoIIIIIIc e � �5 . Pago 11 '�✓
Spec house R( yes ❑ rlu 1-fit lilies ((leill(Itilllle yes U no
SYSTEM MAINTENANCE
Improper use and mainicuanceof yom septic sys(cn1 clnllil Icsult in its plema(me tailute to handle wastes. Properniatulei ance
consists of pumping out (lie septic tank every tbtce years or sooller, if needed by a licensee{ pumper. What you put into (lie system
call affect (he function of file septic (auk as a lreatnicia stage ill (ire waste disposal system.
The property owner agrees to sullntit to St. Croix Zoning Depaitnrcnt a ceitiiicalion form, signed by ilia owner and by a
utaslerpluutber, Journeyman plumber, ics(lictcd plundicr or a licensed pumper vet ifying (hat (1) (lie on -sile was(ewatprdlsposal system
is ill proper operating condition and /or (2) after hispection and pumping (if necessaty), the septic tank is less than 1/3 full of sludge.
I /we, file undersigned have iead (lie above ic(plilcntcuts and agree to maintain (lie private sewage disposal sysletu with ilia standards
set forth, herein, as set by the Depaitmell(of Conuucice and file Depattment of Na(ural Resources, Slate of Wisconsin. Certification
slating that your septic sysletu has been luaintained must be conlplcled and Iewincd to (lie Sl. Croix County Zonhig Officewithin 30
days f file (life year expiration dale.
c
SIGN RIC DATE
O WNI!,R CI!,RTIFICATION
I (we) certify flea( all slatenielt(s on tills Bunt ale title to Ilse best of Illy (onr) knowledge. I (we) alit (are) the owuel(s) of
file pro tarty dcscrib d above, by vilttic of a watlalily (Iced lccolded ill Rcgis(cr of Deeds Office.
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5 1-3-
S[ IATUR APPLIC DATE
" * * **
Any information titan is niis- Icprescnlcd play tcsull ill (lie sani(aly pc►nii( Icing revoked. by (tie Zoning Department.
** Iriclude IvUlt tills sippli ^_iltioll: a s(aitll)cd %vailant} deal from_ thin- 1 -Ostcr of Dasdg Office
'. - a colLv:u;" Elic Cc.iiticcE siil'vcv tiinl if r f31 Oli Es ulaii' ili tilt vriitraii(y°clecd -
U 2 5 3 5 P 4 9 5 -7!5 Z3 6> i
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD
Document Number WARRANTY DEED 03/29/2004 09:10AK
WARRANTY DEED
THIS DEED, made between Reliant Developers, LLC, Grantor, and EXEWT #
LaCasse Development Inc., Grantee. REC FEE: 11.00
Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 4074.00
the following described real estate in St. Croix County, State of Wisconsin: COPY FEE:
CC FEE:
CLoD 3, 4, 5, 7, 8, 9, 11, 13, 14, 15, 16, 17, 19, 20 and 21, Plat of Kelly PAGES: 1
Estates, St. Croix County, Wisconsin.
Recording Area
Name and Return Address:
Edina Realty Title, Inc.
400 S. 2 " St. — ,Suite 115
Exceptions to warranties: Hudson, WI 54016
Easements, restrictions and rights -of -way of record, if any. 423495
020- 1060 -30- 050,020- 1059 -90 -0 Q,0
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 26th day of March, 2004.
Reli evelopers LC
B
* Rick Toston, Chief Manager, Reliant Developers, LLC
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
ST. CROIX COUNTY. ) ss.
authenticated this 26th day of March, 2004
Personally came before me this March 26, 2004 the above
named Ricer oston, Chief Manager, Reliant Developers, LLC
* ,Wffie - known to b the person(s) who executed the foregoing
TITLE: MEMBER STATE BAR OF WISCONSIN instrument an d ackn ledged the same.
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY *Tuci` Zarrleu
Peterson Frain & Ber otary Public, State f Wiscons
gman — Steven 0 1 Bruns My commission is enl!+(VIi't1tll' MEU t ate:
50 East Fifth Street, St. Paul, MN 5510 11/4/2007 / J UDY I A RRI U )
Notary Pu Ic
(Signatures may be authenticated or acknowledged. Both are not necessary.) °` State of Wisconsin
*Names of persons signing in any capacity must be typed or printed below their signature r r
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000
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