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HomeMy WebLinkAbout040-1306-25-000 Wisconsin De of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499147 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: Powers, Jeffrey & Kimberle Troy, Town of 040- 1306 -25 -000 CST BM Elev: p No: Insp. BM Elev: BM Description. n _ Section/Town /Range /Ma 2 6 08.28.19.1852 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER F CAPACITY STATION BS HI FS ELEV. `XL. 3 Septic F; t4 y Benchmark ID9 Alt. BM Po ►l, P� 5z5 ��„- �.7q . 101,q1 Aeration Bldg. Sewer T $C /06, - o'K Holding St/Ht Inlet $. 4Z, 99, 7 3 TANK SETBACK INFORMATION St/Ht Outlet 9. 4 9•� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic N / A — Z7' Z-7 Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Jo. i0. LS Holding Bot. System ,1.1 97 5 PUMP /SIPHON INFORMATION Final Grade 7- 7 - 1 /6A34 Manufacturer Demand St Cover GPM Model Numb TDH Lift Friction Loss System TDH Ft Forcemain Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length INo.OfTr PIT DIMENSIONS No. Of Pits Inside Dia. Liquid D epth DIMENSIONS 3 (� 3 f G SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: /Q � INFORMATION CHAMBER OR Type Of System: `` nn i IQL /� - / /L UNIT Model Number: S 1 C ® "we w,P,o�e� Z7 ( /VrJ V' DISTRIBUTION SYSTEM E (o -I-I, 4- G = / Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake / Pipe(s) Length �� Dia T Length Dia Spacing "rTe- 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 g4� Bed /Trench Edges Topsoil s No es ! No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 435 Jordyn Lane Unknown (NE 1/4 SE 1/4 8 TT2�N R19W) Sunset View Lot 25 Parcel No: 08.28.19.1852 1.) Alt BM Description 2.) Bldg sewer length = 3 - amount of cover Plan Use othes de for u additional information. Yes No Z 11 i i ��' (� $ Z f I � 5 formation. _ _ I - L - Date Insepctor's ynnatur Cart. No. SBD -6710 (R.3197) Safety and Buildings Division County , 201 W. Washington Ave., P.O. Box 7162 S ITV l N VI Madison, WI 53707 — 7162 Sanitary P it Number (to be fi ed m5y "Co. sconsln 608 26 Department of Commerce Stat I.D Number Sanitary Permit Ap lied on In accord with Comm 83.21, Wis. Adm. Code, person 1 informati you pfov{dF, O 6 ect Ad if different than mailing address) may be used for secondary purposes Privacy w, s �( `� U [ IJ ( I. Application Information - Please Print All Information ST CRUX COUN 3-S �/G " L Lo t Y\Q- Property Owner's Name Psrs # Lot # a Block # nJ �O t� �`' r ^ Property Location Property Owner's Mail' g Address 1 Y\ Od. 4 'h, '/4, Section City, State Zip Code Phone Number -53 j _ f _ � ( circle rJ O 1 715 v! T aN ; R 1�1 Eo W h11�P ubliclCommetcial . Type of Building (check all that apply) pd Srt b►N r Subdivision Name CSM Number N J1 or 2 Family Dwelling - Number of Bedrooms � - Describe Use J S �� ` ❑City_ ❑Village Township of ❑ State Owned ri se III. Type of Check only one box on line A. om etc line if applies le) 0 - 3��P 2 $ =C0 SZ A. )(New System ❑ Replacement System El TreatmentlHolding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal 11 Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. T of POWTS System: Check all that a Non - Pressurized In -Ground 11 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 ❑ Leaching Chamber ❑ Drip Line ravel -less Pipe ❑Other (explain) V. Dis ersallTreatmentArea Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Proposed (sf) yttem Elevation 00 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Holding Tank o Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement - I, the undersigned, assn respo 'bility for insts of the POWTS shown on the attached plans. Pkwn,ber's Name (Prin I Plum r s Si afore hfP RS umber Business Phone Number 0 Plumber's Address (Street, City, State, Zip e) �1L o VIII. Coon criartment Use Onl Approved ❑ D' prove Sanitary Permit Fee ' chides Groundwater Date Issued 1 uin Agent Signatu o Stamps) Surcharge Fee) ❑ O ven Reason for vial IX. Conditions o SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. must be maintained � 2. All setback re as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 812 s 11 inches in size SBD -6398 (R. 01/03) ',,,� �; �" paw y4Q A A NOLIsi�'YLf S8 TaaN R I w a; f; KQ R oa d S ns it V w , D-c v � }��so,, wk 5 o i 7 �V`O s7 C ro ` y y / "Ic Gvi�S�rS. V� i O J t P .� Pi.t -PL N E-Y4 si� YLt sg TA R ►9 w f'; m Road Sunsit Lee -"9a S sy o ) > /CZ 0 C►_OlX � f /�Ji�FS�1rS J Poly Iok AS SedYox ell A ll 8 vEf lrvo. 0" �j 0 V J �.N 1 E,0 RECEIVED Wisconsin Departmer tofCommerce SOIL EVALUATION REPORT Division of Safety an Buildings Page of --- Iry 0 2 2CWrdar ce with Comm 85, Wis. Adm, Code Attach complete site plan on paper not less than 8 12 x 11 inches in size. Plan must County include, but not limiled ref rence point (BM), direction and — percent slope, scat or dime location and distance to nearest road. Parcel I.D. Please print all information. a iewed by ''Date Personal information you provide may be used for secondary purposes (Pnvacv Law, s. 15.04 (1) (m)). Property Owner Property Location 1 /4SE 1/4 S T Z8 N R � Property Owner's Mailing Address E ( W Lot # Block # Subd. Name or CSM# P Q. Sox 3 3 2 S — SUvvsi�T vi Q,,,j 7 L , City State Zip Code Phone Number ❑ City ❑ Village .� Town Nearest Road Pf -�M ® New Construction Use: ® Residential / Number of bedrooms – `` Code derived design flow rate S Q – lD (30 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G LOCI )4 4 :�� k Flood Plain elevation if applicable General comments ft and recommendations: �,�,0)v) ►,s �--�� 3 ill l� L� �Z� W� 11v � L���R L� - ��1`� C� �� of L G P'n� I`�114 X , S (4 ` z� Boring # ❑ Boring q F6 ,. Zoo Lf ® Pit Ground surface elev. �� . ft, Depth to limiting factor 7 in. Sail Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bcundary Reets GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff #2 0 -9 )oLltiZ3 Z - SLtR -3) vs i El Boring # ❑ Boring ® Pit Ground surface elev. ) �� ` ft. Depth to limiting facto in, Soil Application Rate i Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz j in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 Eff#2 0 1 D`12 31Z — Sj 1 Z`FSb}Z h'1�- G� Z-� , S _ rd Z I D -U 0 10 V 12 34 _ - stt Z�j o - 66 — '. Effluent #1 = BODs > 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) Si nature CST Number -Arthur L ", tdegerer � 03 2.1S -ZS 220254 Ad W e g e r e r Soil T e s t i n o & D e s i o n e r v i c e Date Evaluation Conducted Telephone Number . 421 11. %lain St. River Falls, flI'54022 1 _1Q -03 715 -425 -0165 i Property Owner Et `� �� ( �N��l�/� Parcel ID # Page ' of a Boring # E] Boring ® pit Ground surface elev. )i ft. Depth to limiting factor 7 C- S 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 .D fz3l — L z - z S .8 u-j V 0 sbkl Yn \1 CW - Z �t .S'o z � 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 F-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 GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •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 need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.6100) PLOT PLAid Page -2� of . + Scale 1 =S0 ' 0 oC; L Z \ 1 P) IZ � Sod D � O � I c3 rPrLL, 3Iq " ' - I>) A, f-"\) 0- FzjP- L"W_. J C � wJ 1 Z_Lq -U3 715- 425 -0165 220254 CST Signature Date Telephone No. CST No. Job NO. io7- as EZ1203H ' vvvvvvv .r. :. _�•4. tt ?;, :.. • +.,.; ' vvvvvvv :r: ;» ..f•..,•�ti.t`.:. ;�.�: `•. vvovvao vvvvvvv •' + " b i: ° "t' ,tr •vvvvvvv vvvvvvv vvvvvvv ve :� ... A �� ..o .ee 12 „ 2A t1 voo '!:.r•; ,�,: vvv �A. vvv vvv vvv vv 4.62511 v o -V vvv eve VT ° 1/2 C irc. = 1 " ov vvv 8.84 VV ,I vvv vvv vvv vvv vvvvv s vv vvv v vv vvvvw vvvvvvv v evveveveevee vvvvvvv eevve0e vveve00vvvvvvv vvvvvvv vvovvao vevevvVVVeveee vvvvvvv 2 4 11 Bottom 36 12 -1/2" DIA. (typ.) Void Volnut a Soil Interface Area Void Coefficient in Aggregate given at 57.4%. Sidewali (2 Sidewalls) 18.84in — O.D. of 4" pipe = 4.625 inches 12in — 3.14 2.3125in ' 1$ Void volume per linear ft. - 3.14 •( Ifr = 0.117 fr' Bottom 2.00 l 12in / ft) O.D. of centercy)inder — r2.5 inches Total Soil Interface Area 5.14 SQ.FT Void volume in aggregate of center cylinder — 3.14 6 . 25 '" . (2.3125i. ) 2 �. (12in /ft) —3.14 12in /fr 574 =.422 1 O.D. of outside cylinders = 12 inches Projected Trench Area rs Void volume in outside cylinde= 2 * 3.14� n)' 0 .574 - .901. Ill Sidewall Height = 12 in. '2 = 2.00 Sq.Ft. l Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between cylinders — 24in , 6in 6in 3.1 (1 / =0.215 ft' Projected Trench 2tn ft 12in / ft j J J h A rev 5.00 Sq.Ft. J Void volume at outside bottom corners (1/2 orvoid volume between cylinders) 0.215 12 - 0.108 fN Total void volume — 0.117 + 0.422 + 0.901 + 0.215 + 0.108 - 1.763 cubic It / It Gallons per ft = 1.763 X 7.48 - 13.2 eallons per linear ft It 36 Y/ EPS aggregate Trench System EZ1203H EZ_,flOw Ring-h?dustriai Group 65 Industrial Park Rd. Oakland, W 3,8060 SCALE !U WWP.: ¢1203H,l MIT. i of 1 11 -27 -01 j NNcoRuul►TtoN POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -4 of —� SYSTEM SPECIFICATIONS Owner J Permit # I Septic Tank Capacity at `�9/ 13 NA Septic Tank Manufacturer D NA DESNt3N PARAMETERS Effluent Filter Manufacture 0 NA Number of Bedrooms 0 NA Effluent Filter Model ❑ NA Number of Public Facility Units 0 NA Pump Tank Capacity al ❑ NA Estimated flow (average) 0 � gal/day Pump Tank Manufacturer DNA Design flow (peak). (Estimated x 1.51 ©� g al/day Pump Manufacture ❑ NA Soil Application Rate - aUd tW Pump Model 0 NA Standard Influent/Effluent duality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L 13 Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (SOD 5220 mg/L D NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 8150 mg /L 0 Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal caw 13 NA Biochemical Oxygen Demand (BOD ,,) s30 mgJL "round (gravityi ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L JNA 0 At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /100mi 0 Drip -Line 0 Other: Maximum Effluent Particle Size Y. in dia. Other. 1 03 Other Other. 0 _ NA ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: D NA MAm nrENANCE SCHEDULE service Event Service FnRpnnW Inspect condition of tank(s) At least once every: D 48) (Maxknum 3 yam ❑ NA Pump out contents of tank(s) When combined sludge and scum squats one -third 07) of tank volume ❑ NA Inspect dispersal cell(s) At )east once every: L7 month(s) (Mandrrwm 31►ea►s) ❑ NA earls) Clean effluent filter At least once every; 0 monthis) ❑ NA gLy earts) Inspect pump, pump controls & alarm At least once every: month (s) ❑ D NA y earts) Flush laterals and pressure test At least once every: ❑ month(s) DNA other: D yearfs) Q meuhthls) At least once every: D years).? Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal ceps shat( 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 scrim and to check for any !lack 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 W 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. START up AND OPERATION Page of For new construction, Prior to use of the POWTS heck treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process ,and /or the dispersal ids). if high concentrations are detected have the contents of the tank(s) removed b a servicing operator prior to use. System start up shall not occur when soft conditions are from at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When discharged to the dispersal ceR(s) in one Power is restored the excess.wastewater will be large dose, overloading the cells► 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 Makmtairnw to assist in manually operating the pump controls to restore normal levels withal 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 fife of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss, diapers; disinfectants; fat, . foundation dram (sump pump) water; fruit and vegetable peelings; gasollne;_ grease; herbicides; meat scraps; medications; oil, painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails are /or is permanently taken out of service the following steps shall be taken to insure that the system is property 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 materiel. CONTINGMCY PLAN If the POWTS falls 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 bb Wringed upon - by requkW setbacks from existing and proposed structure, lot Ines and weft. Failure to protect the dement area will result in the need for a new soN 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 fast 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 fast resort to replace, the falled 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. < <WARNIM> > SEPTIC, PUMP AND OTHMt TREATMMINT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN- DO NOT EiNTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDM ANY CIRCUMSTANCES. LATH MAY RESULT. RESCUE OF A PIIMSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL. COMMENTS POYYTS INSTALLER POYYTS MANOTAINE Name r Name Phone 1-3S Whore SWAGE SERVICI f OPERATOR 0%IMPW) LOCAL REGRtATORY AUTHORITY Name Name S C M ` , Phone I phone 1 -7 10 I -d This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(dl &(fl aid 83-54(l), (2) & 13). Wisconsin Administrative Code. ST. CROI K COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND f OWNERSHIP CERTIFICATION FORM � Owner/Buyer r t" nn ow Mailing Address aOO 9 W - ,ka &, n Property Address t^ Cl p (Verification required from Panning & Zoning Department for new construction.) s City /Stat i ,, � 54 o f LO Parcel Identification Number a q -- c 3 � ' o - v O 1030 -o© LEGAL DESCRIPTION o 4o - 1306 - 2-S —Om sz a, Pro Location /a , Sec. T N R PAY �' /4 , �'�' �� � .-�— W, Town of Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 770 S , Volume X03 Page # ' Spec house yes Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pining 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 Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 113 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property descr above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ;1z �Z7 7 ,& GKPtAE OF APPLIC (S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey reap if reference is made in the warranty deed. (REV. 08105) U 2633P 027 ` 77Qf958 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., MI Document Number RECEIVED FOR RECORD This Deed, made between B & L Land Develo t. l c am , 08/06/2004 01 :15PH a wi-sconsin Corporation - _ - - - - WARRANTY DEED — - - EXEWT # Grantor. and J ffre G. Powers and Ki berl A P REC FEE-. 11.00 urban vn a as survJ_c p marital orooerty. TRANS FEE: 335.70 COPY FEE: — CC FEE: Grantee. PAGES: 1 Grantor. for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croi County, State of Wisconsin: P rc,, 4 Are.,, Name and Return Address Ri e Valley Abstract & Title 12 Hosford Su a 201 H on Wisconsin 54016 040 - 1035 -10 -000; 040 1035 -40 -0016 040- 1037 -20 -100; 040 - 1037 -30 - 000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) 5 Plat of Sunset V iew : Lot 0220y ent in the Town of Troy, St. Croix County, Wisconsin. Exceptions to warranties: subject to easements, reservations and restrictions of record. Dated this day of 2004 , B & L LAM DEVELOPMENT I ., a WI Corp. (SEAL) b = (SEAL) A. G F 2 Y Secretary- Trea surer (SEAL) - __ (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) rep "(ra •public State of Wisconsin, 1 55. n �e t 0 NItSC�� St. Croix count J authenticated thi tc�2 a_ day of PersonRIv came before me this day of the above named _ Barbar A Geissinger as Secretary- Treasurer of B & L Land Dever Cdr merit _ * Inc.. a Wisconsin -nrporat on _ TITLE: MEMBER STATE BAR OF WISCONSIN - to (If not, me own to be the pe who executed the foregoing authorized by §706.06, Wis. Slats.) ins e t and ac o ge he same. THIS INSTRUMENT WAS DRAFTED BY - -- - Stephen J. Dunlap _ Notary Public, S ate of Wisconsin Hudson, Wisconsin My commission is �permanent- (If not, state expiration date_ (Signatures may be authenticated or acknowledged. Both are not necessary) Names at persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. WARRANTY DEED FORM No. 2 - 1999 Milwaukee. Wis. d VELOPMENT Y .0-L .L J%L 11 tl —; 1E J Jly •JUN — )% - - I FNA�F_ _ — N 88'5226• 1573 74' o Ion -W N NE — — — 1 LOT- M - - - - - 305443 S.F. I LOT p8 I I ( IV I I • 1 So' t 124777¢ SF. A I 8 1 5.69 AG I z 150 1 1 w I I e �Q' 1 i I ► " � I L_— ___ 1 a u c a ° - - - - -- Z 1 \ LOT 21 w r -fo - - --� \ I sq. ft \ 0 Ac. I P Acres !�C e i LOT 11 \ _.. / 43811 -s% -ft LOl Acres �._. d _. _ _ .. \ � , r_ \ > �_ \ \ i \ � / � ►� / _i /.A L / I -LOT 17 ` /LOT 22 i:° M 850 69 i \' / 56 S.F. 2340 \ / 5 SF. l4 t F IAT 12 ' / 1.31 •� ♦ \ ` L43 Ac. 50 d3 X 2 S AG S .F. \ ��4 — — — — — — 9'34 ao L N 6'37' E 302.73' �' —— 1 19 162.26 140,47' \ \\ N .85 2441 E 3 r Z'q 2 G i �` �,,• Z f — _l LOT 23 ``� S 'A — LO O T 13 I $I LOT 1� LOT 15\ � 53473 � i ` 51986 SF. 1 �; a I 51 43610 S.A. 45294 S k 1 L19 AG 1 \ 4 L14 S .F. I ro I L Ac.l Ac. / ' LOT 24 1 N 89'32 32' E 43152' ' \ 90327 S.F. 1 F L N 89'32'32' E 431.52' 2A7 AG T 6 °1 LOT 25 �� I ro 30 /�, SCOT '1 "' (� I o rLOT - I P (� ` g;\ J i S.F. �d' 83820 F. 46072 S Cu 48125 F. 4788 S.F. \ L L43 Ac. Ac. / 1.01 Ac. 1 1 1.06 AG 10 1 1 1.10 I 1 1. AG 4 \ I I z _, J