HomeMy WebLinkAbout040-1243-00-000 r
Wisconsin Department of Commerce
Safety and Buildings Division SYSTEM County:
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(1 363989
Permit Holder's Name: ❑ City ❑ Village ❑ T6vvn of: State Plan ID No.:
Wood, Thomas Troy Township
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
d' oz� . o' CST nth __ 040 - 1243 -00 -000
TANK INFORMATION LEVATION DATA �� i i9, iz3g
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Z Benchmark p , 4-10 o :To I ab , o
Dosing Alt. BM
, 75r 10 8•
Aeration Bldg. Sewer 3 j0 uG.80'
Holding St /Ht Inlet IA oS. 10 '
TANK SETBACK INFORMATION St /Ht Outlet os oS.bs
TANK TO P / L WELL BLDG. Air i to ntake ROAD Dt Inlet
Air
Septic >Sp' / NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System �' D2.
PUMP/ SIPHON INFORMATION Final Grade
M a I u f atukg r Demand St cover
Model Number GPM
TDH Lift Lriction stem TDH Ft
For ain Length Dia. Dist. ell
SOIL ABSORPTION SYSTE to cLA"e,,
BENCH Width Len th No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEN - 10 - N - 57 - SU 3 DIMENSION
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer:
INFORMATION Type O f ``L� �,,{{,�� CHAMBER M del Number:
System: Y V. Z o2T ti.t OR UNIT ' -C o , ,
DISTRIBUTION SYSTEM y �S c�l,aIrrs- }oc�.e �r�L��trv~ L�.•
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length''�y Dia. L ia. pacing' �S
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
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: 0�1l3 e Fb Inspection #2: —
Location: 518 Trillium Lane, Hudson, WI 54016 (SW 1/4 SE R -
81 1.) Alt BM Description = (oP o� �pvv�Qa+`�
: �sy�.) T_I = I O2.06 ,
2.) Bldg sewer length = ((p. Of 6 . m = ( °'� �" t R ° T -Z = 102 - To'
- amount of cover= 1$ "�,� Z �,$(p= 1� z ffi•O T = loz.(
Plan revision required? Ne
U� e�o er sid for additio %i m ion 1 '7 O o 0 ( �'(.S2>e
JJ C —/`� - t .Qo J,n�pgcto S Si ture �� Cert. N�_
SBD 6710 3/97 .� � ! a' \/ _q S w�,,.:rtt2oK 0 .4, a t, ��
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ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Tr mo w. M
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PLOT PLAN
PROJECT Tom Wood ADDRESS 966 Dennis St. Maplewood Mn 55119
SE 1 /4 SE 1 /4s 3 /T 28 / N/ 19 W TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE8 /00 BEDROOM 4
CONVENTIONAL )00( IN -GROU PRGAE
CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 514 # of chambers 30
,, BENCHMARK V.R.P. Top of ROW Survey Stake ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P Same as Benchmark
SYSTEM ELEVATION 102.7
Vent
> 12"
of Cover Sidewinder High
�T
Capacity Leaching
Chamber (�.� ,,' , �
' Rt
6' Long 16" �� � .
Grade at System Elevation - l LQ1i-
.ST CROIX
.�ourvTv
� tiNiNGOFFIGE f. �'
Pro 4
Bedroom B -6 was dug to indicate that a
House >5' seperation was found, also,
the other borings were consistent
in nature and thus no further
15' testing was done.
T
10
Vents 3 - 3' X 63' Trenches with >3' Spacing c,
0
B -2
00
�o
-1 N
43'
B -3 40
B -5 '
5' B -6
B
50' -4
30' 22'
Vents
Pro Town Road 30' 38' 40' B.M. 207'
o mo-5 �- 1/✓a ' "��g �✓ i ��r � �t �u v12
Sanitary Permit Application Safety & Buildings Division
201 W. W Ave.
In accord with Comm 83.21, Wis. Adm. Code St
See reverse side for instructions for completing this application PO Box 7302
SCO nsin Personal information you provide may be used for secondary u oses Madison, WI 53707 -7302
Department of Commerce y p Y P rp
[Privacy Law, s. 15.04(1)(m)) (Submit completed form to county if ro:
state owned,)
Attach com lete plans to the county copy on! for the system, on papernot less than 8.1/2 x I I inches in size,
County _/ State S _it4ry );er i ber ❑Chock if revision to previous application State Plan I. D. Number
r a x � tp'S`(
I. Application Information - Please Print all Information Location:
Property Owner Name Property Location
/� ' �)
1/4 114 S ON W or W
Property Owner's Mailing Address Lot Number Blocg Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
H npe of Building: (check one) ❑ City
1 or 2 Family Dwelling — No. of Bedrooms: ✓ O Village
D Public/Commercial (describe use); =own of
0 State -owned �n�
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Ncamast Road
A) 1. � ew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number s) r
Tank Only Existing System /.� j 'AGO
B) Permit Number Date Issued
❑ A Sanitary Permit was previo issue 9,
IV. Type of POWT System: (Check all that apply)
n- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized in ground ❑ Holding Tank ❑ Single Pass D Drip Line
❑ At -grade ❑ Aerobic Treatment Unit D Recirculating O Other:
V Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2, DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Ratc (Gals.iday /sq. ft.) (Min. /inch) �Q� Elevation
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
O ❑ O ❑ D
VII Responsibility Statement
1, the undersi ned assume re for 104tallation of the POWTS shown on the attached plans,
Plumber's Name (print) Plum gnature (no stamps), MP /MPRS No. Business Phone Number
j 1
Plumber's Address (Street, City, State, .Zip ode)
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Gro dwater Date Issued Iss ing Agent Signature (No stamps)
Approved C3 Owner Given Initial Adverse Surcharge Fee) c, a �d�r�
Determination S ! � 7 X
IX. Conditions of Approval /Reasons for Disapproval:
e4 Gor IM U h icA G �
CAn7�'" + 4 + k;1 f ✓ J.t�.e Iav (1s5 �Oetrwtt'� - ��� � � �e �c�({,oucks ��a� t T' l �° r
Wlvt 6e A —IDS
A, 4c"e_,4 - th c�.n�aa�c5ewuz„ Plccvt �o� �(.iiS P�v`wtc
SBD -6398 (R. 07100)
PLOT PLAN
PROJECT Tom Wood ADDRESS 966 Dennis St. Maolewood Mn 55119
SE 1/4 SE 1/4s 3 /T 28/ N/R 19 OWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE8 /00 BEDROOM 4
CONVENTIONAL XXX IN -GR PRES URE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 514 # of chambers 30
IL BENCHMARK V.R.P. Top of ROW Survey Stake ASSUME ELEVATION 100' filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 102.7
Vent
> 12" Sidewinder High
of Cover Capacity Leaching
Chamber
6' Long 16"
3 4" Grade at System Elevation
I � v
Pro 4
Bedroom
House
30'
B -6 was dug to indicate that a
>5' seperation was found, also,
M&K ko(p : the other borings were consistent
I II in nature and thus no further
testing was done.
a
40
3 -3' X 63 Trenches with >3' Spacing o
B -2
_1 N
4'
40'
B -3 5' B -6
B -5
B -4
50'
30' 22'
Pro Town Road 30' 38' 40' B M 207'
�� ww 2
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page --- of
Division of Safety and Buildings
In accordance with Comm 85, Wis, Adm. Code County
Attach complete site pion on paper not less than 81/2 x 11 Inches in size. Plan must T
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 2 D U
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. D to
Please print all information. Reviewed by 7
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I L�� �
property Owner Property Location
Govt. Lot .5 ,e' 1/4 5,� 1/4 S 3 T � � N R If
E (or�
Pr;Wlty Owner's Mail' ddress Lot # Block # S Name or CSM#
t State Zip Code 11Q Numbs _ y El cit ❑ v llage y [ T Nearest Road
ew Construction Use-: g Residential ! Number of bedrooms Code derived design flow rate
GPD
C3 Replacement LL Public or mmercial -Describe:
Parent material /, � � ^
Flood Plain elevation if applicable R
General comments
and recommendations: /
Boring # r] Boring
Pit Ground surface elev.,c . y n• Depth to limiting factor - In. Soil An ilicatim Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Ef1#1 PEff#2
in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh.
b
b G. r ✓ r� S13.
❑ Being # [] Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil lieatlon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *EGPD/fl? ff2
in. Munself Qu. Sz. Cont. Color Gr. Sz. Sh.
* Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS 5 30 mg/L
CST Nam (Please Print) 6 i lure ST
Address vate Evaluation Conducted Telephone Number
Wisconsin Department of Industry SOIL AND SITE EVALUAT REPORT Page 1 of 3
Labor and Human Relations
Divi °i:;n of Safety & Buildings in accord with ILHR 83.05,Nft. Ad m. Code' COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz�fil�n ineludt3, but
St. Croix
not limited to vertical and horizontal reference point (BM), direction and T'of slope, Scale
dimensioned, north arrow, and location and distance to nearest road. - ndin
1 W D BY DATE
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATII t: C l g 7 to
j 1,
PROPERTY OWNER: Z . aOPER , 1 06` 1,
Richard Stout �tfT Ct�� 14 1 /a,S 3 T 28 N,R 19 (or) W
PROPERTY OWNERS MAILING ADDRESS ff C #; NAME OR CSM #
1 353 Awatuke Trl. 8 Countr Wood Second Addn.
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE QrOWN NEAREST ROAD
Hudson WI. 54016 (715)549 -6731 Troy Tower Rd.
14 New Construction Use JK ] Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft trench, gpd/ft
Absorption area required 643 bed, ft2 563 trench, ft Maximum design loading rate • 7 bed, gpd 1ft2 - 8 trench, gpd/ft
Recommended infiltration surface elevation(s) 104.3 ft (as referred to site plan benchmark)
Additional design/ site considerations alt. area system el.= 103.97
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem IN S ❑ U ® S ❑ U EIS ❑ U I ®S ❑ U IN S ❑ U EIS $] U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Boundary Roots
in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tre &
1 0 -10 10 r3 3 none 1 2cipl mfr cs 2f n .2 Z
2 10 -26 10yr4 /6 none sil lmsbk mfr yzv if .2 .3
Ground 3 1 26-34 7.5 r4 4 n one sl 2.m 'r mvfr ar na .5 .6
elev.
106. ft. 4 34 -84 7.5yr4/6 none cos osg ml na na .7 i.8 7
Depth to
limiting
factor $ '
+84"
�& So<< pr', 0. - 14 utv
Remarks: ^I fib
Boring #
1 0 -10 S
2 10 -32 10 r4 6 none sil lfsbk mfr qw if .2 :.3
3 32 -84 7.5 r4/6 none cos OSQ mvfr na na .7 .8
Ground
elev.
108 ft.
Co
Depth to
limiting
factor
+84
Remarks:
CST Name:— Please Print Phone:
Gary L. Steel 715 - 246 -6200
A ddress: 554 200th. Ave., New Richmond, WI. 54017 m02298
Signature: Date8 -7 -96 CST Number:
PROPERTY OWNER Richard Stott SOIL DESCRIPTION REPORT Page 2 qf 'j'_ l
PARCEL I.D. # pending
Lot #81 `
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
0 -5 10 r3 3 none 1 fill -- cs if -- --
2 1 5-22 10 r4 6 none sil lfsbk mfr gw if .2 .3 1
Ground 3 1 22-38 7.5 r4/4 none sl 2mgr mvfr gw na .5 .6
elev.
108 ft. 4 1 38-90 7.5yr4/6 none cos osg mvfr na na .7 's .8 ,7
Depth to
limiting (,
factor
+90"
Remarks:
Boring #
1 0 -14 10 r3/3 none 1 fill -- cs if -- --
:,. 4 g . 7 .8
`< 2 14 -80 7.5yr4/6 none cos os mvfr na na
Ground
elev.
106 ft.
Depth to
limiting
factor
+801
Remarks:
Boring #
1 1 0-11 10yr3 /3 none 1 fill -- cs if -- --
``` 5 '' 2 1 11-24 10 r4/6 none sil lfsbk mfr �jw if .2 .3 Z
Ground 3 24 -80 7.5 r4 6 none cos osg mvfr na na .7 `: .8 7
elev.
107 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
I
Remarks:
SBD- 8330(R.05/92)
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STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 SWgSE4 S3- T28N -R19W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246 -6200
lot #81- Country Wood Second Addn.
N
1 =40'
BM.= top of ROW survey stake C el. 100'
k n
"5<L
Gary L. Steel
9 -7 -96
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms
Design Flow - Peak (gpd) 00 aa
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal) %e
Soil Absorption Component Size (ft) �/ �a�Gi% G wt ✓f
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorptioa Component
Design Flow - Peak (gpd) DO od
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outle Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure
proper operation. The filter cartridge should not be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not. removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 7;� a r , / ' /0 "'
Mailing Address S j I) Ia,2Z� c� c o � /
Property Address T / L3 T - r L c, n
(Verification required from Planning Department for new construction) C
City/State 11U05 / aJt Parcel Identification Number /oZy3
LEGAL DESCRIPTION
Property Location 5E y4, SF' '/4, Sec. -3 -- , T a8 N -R J'9 W, Town of Ti-oY
Subdivision C 0UArr9Y0)000 5F49^0 401-fl Lot # T 1
Certified Survey Map # Volume , Page #
Warranty Deed # Volume , Page #
Spec house 0 yes A no Lot lines identifiable X yes 0 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 wastewaterdisposal 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.
3
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 owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
) / 3 11 vC
SIGNATURE OF 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
•
voi. 1532 to
' 627625
Document Number WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between SUZANNE J ANDERSEN and BRUCE H RECEIVED FOR RECORD
ANDERSEN
wife and husband 08 -03 -2000 3:30 PM
,Grantor,
AND THOMAS L WOOD and MARISSA F WOOD WARRANTY DEED EXEMPT #
CERT COPY FEE:
COPY FEE:
husband and wife, as survivorship marital property Grantee, TRANSFER FEE: 170.70
RECORDING FEE: 10.00
Witnesseth, That the said Grantor, for a valuable consideration of one PACES: i
dollar and other valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of Wisconsin:
Recording Area
This homestead property. Name and Return Add" s l
Together with all and singular the hereditaments and appurtenances 6�.Jn C
thereunto belonging; And Grantor warrants that the title is good,
indefeasible in fee simple and free and clear of all encumbrances except
easements, covenants, and restrictions of record, l� S 0 h t W:
and will warrant and defend the same. 4 3 0613 6 Z
(Parcel Identification Number)
40- 1243 -00 -000
LOT 81, COUNTRY WOOD SECOND ADDITION IN THE TOWN OF TROY, ST. CROIX COUNTY,
WISCONSIN.
Dated this / day of 200c7
SUZANNE J ANDER N 'BRUCE HWN N $
AUTHENTICATION ACKNOWLEDGMENT PE
Signature(s) STATE OF dff 1) � m rn Z o
COUNTY OF &T—eRiDtX* W La'c m a 3 g n in l °i
a. N - 3 s7
S*C -Fc
Personally came before me this da 3 gm r c
authenticated this day of the above named SUZANNE J ANDERSEN a T 3 Q o �
BRUCE H ANDERSEN p -n m
to me known to be the person(s) who executed the for oingo g
signature ins rument and aqkqowledge the same.
type or print name
si nature 4 11 KPA _ G a m aY�
TITLE: MEMBER STATE BAR OF WISCONSIN type or rint name _,�, ,
(If not, ,. � II
authorized by §706.06, Wis. Stats.) Notary Public ST-eRM �f� W
ounty, t[
My commission is permanent. (If not, state expiration date:
THIS INSTRUMENT WAS DRAFTED BY 3 Z , _02 .)
Robert F . Wall 'Names of persons signing in any capacity should be typed or
printed below their signatures.
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