HomeMy WebLinkAbout040-1287-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix
Safety and Building D,ivtPion •
INSPECTION REPORT Sanitary Permit No:
420362 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:
Miller, Sam I Troy Township 040 - 1287 -70 -000
CST BM Elev: ( Insp. BM Elev: BM Description: D f
�.� 6 11Q1 ��BV,&
TANK INFORMATION I I ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 5 Benchmark � 00.
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet , s Z �� • ,
St/Ht Outlet f
TANK SETBACK INFORMATION •�{ �Up ,'{�'
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 3 % ` L z S I Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe 3
Holding Bot. System r
;__11 '1 El
e
PUMP /SIPHON INFORMATION Final Grad �•�
Manufact r Demand St Cover re Z
GPM a �tj i•�3
Model Num r
TDH L' tk Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOI RPTION SYSTEM
T ENCH Pidth Length ] No. Of Trenche& PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMSQ11510W t Z
3 3
SETBACK SYSTEM TO P/L lBtfDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION Type Of S y ste 1 V ' I CHAMBER OR A
S I �— UNIT Model Number: ,( n_ Q n
DISTRIBUTION SYSTEM , yy k
Header /Manifold It Distribution �xHole Size +Hole Sp acing Vent to Air Intake
Pip s) �r
Length Dia Lengt 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 [W No [ Yes No
COMME (Include c disc epencies, persons present, etc.) Inspection #1. / 2f9p Inspection #2:
C � N o a:v c.#e,.,
Location: 631 Glover Road Hudson, WI 54016 (NE 1/4 SW 1/4 15 T28N R19W) Glover Prairie Lot 7 Parcel No: 15.28.19.1633
1.) Alt BM Description =
2.) Bldg sewer length=
- amount of cover = > 316 u se t
r i ion equired� Yes o I 24, 2�!�
Use other side for additional informati n. 1 1 �!!�
SBD - 6710 (R.3197) Date Insepctor's Signature Cert. No.
Safety and Buildutgs Division car ST-
201 W. W awn Ave., P.O. BOX 7162
'sconsin oe � Sanitary Permit Number
�°� � 53707 - 7162 ��� _� ���
e �rtment of Commerce g �L� -.0 -t— rql_�
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Sanitary Permit Application
In aotd with Comm 93.21, Wis. Adm. Code, Perwoal information you rov' e 0 Check if Revision
�O°
ma be used for Priv State Plan I.D. Number ; -J
I A
APP Informadlou - PWM Print All Information r.J
Paroel Number /S. • 1 • 3
� o y «oer•aNam � e / AUG 2 3 2002 04/a - a — ?0_6az�
5 A 7 S Location
Owos M&JLWg Mr ZONING OFFICE q- ,.T "• S / S T N R 19
�,U , Lot Number Block Number
Cade Phone Number — "
City, Stass Zip
Subdivision Name CSM Number
6''r 6Lo
IU. Type at Bt kung (d all that apply) — M Ocity
L P L 1' Ovillage
0 1 or 2 Family DwO Mnf - Numbs of Bedrooms own-hi -�-° D Y
❑ PubirjCommeMW - Describe Use
Nearest Road Ow � � + � y
0 Sato ned ) m� s V E,2.. D
a - T 4F N c k s 3 ` x 3 7 s/ ' S C �w,d A c i ✓ applicable)
one box on line A (numbering scheme for internal use)• Complete line B if aPP
III. Type of (k or County ante
A. ew 2 ❑ >�� 3 ❑ Replacement of ti ❑ Addition to
Tank Od gem
9= Date lssved
B. 0 Check d Sanitary Petmit Previously Issued Permit Number
IV. Type of Permit: (Cbeck all that 21❑ Mound apply)(numbering scheme is for internal use) v o p ; �� ❑ tQATFj� (�
47 ❑ Sand Filter Consauctcd Wetiard
-� "(� ( y
Non - pmuwiud -Grmmd 48 0 Single Pass 510 Drip Line - t 'n •
220 aGrourd 410 Holding Tank r
30 ❑Other 1 N
45 0 ht -Grade 46 0 Aerobic Treatment Unit 49 0 Rec'
V. tment Area Information. Percolation Rate m Elevation Final Grade
Area Disposal Area it Application rim) Elevation
D�gn (90)
Required proPaed Rase(Gals.M*Ys/Sq -PL) (M�•
(7 5� F-( Q 3 S p1e 7 Site Steel Fiber Plastic
GPacuy in Total Number Manufacturer Glass
VI. Tank Info Gallons alum Of Tanks Concrete Cot>suttcted
New Exiod"
Taub Taola
Sepoe or HoldirB Tank / Z (I le r I 1.
Dos4 tom« f ,,.� ._ a v r 7 t ✓
slgaed, s Phone sssume respond ty for installation of the POWTS shown on the attached plans.
VII. bill Statement - I, the amder
Mp/Iv(PRS Number Busines Number
am 's a (Print) Phmnbos Signature
Plumber's Address (Street, City, Sate, ZW Code)
1.0 a NUS fil '
VIII t /De ent Use Onl Da Issued tng ent Signawre o Scamps)
Sanitary Permit Fee (includes Groundwater
,+roved ❑ Disapproved Surcharge Fee)
0 Owner Given Initial Adverse 'f
Determination
IIL. Coaditiota of AP ropaVRestwos for Disapproval
Z U t (. d Attsh PUM (to the Coanty only) for the mts
t� c�
SAD-6398 (R. 05/01)
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Mvision of Safety pnd Buildings
in accordance with Comm 85, Wis. Adm. Code
County --
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must STs C.e.O l X
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �-,,f� G -70 --��
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. �v
Please print all information. R ' e by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Gam 0 �i
Q
Property Owner jZpg �, Property Location
C Ap T STf` 17T GOxf::�- T""Q 1/4 SW 1/4 S 1S T Z8 N R 1 E (or W
RMPGAY- Qwft0&Mailing Address Lot # Block # Subd. Name or CSM#
City State Zip Code Phone Number n City ❑ Village [3 Town Nearest Road
NUDSO1NJ wt I sq0L b ( 15) 386 - 3 osl I `( I GLU
E1Z.
® New Construction Use: ® Residential / Number of bedrooms �_ Code derived design flow rate 6 0 1 0 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent Tjierial G LPCQ1. Ar UThJ KS H Flood Plain elevation if applicable
General comments
and recommendations: M'1 � Z CEU �+ 5'Y- q 3. S LZu C w 1 j 1 S UAJ 17 OF
�T)+ TD 8E M t Ll.5
Boring
Boring # ❑
® Pit Ground surface elev. b Depth to limiting factor ? I l C7 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2
to�Cz Utz
S11 Y4 21- C j
Z 14 -ZLF to 4Izi - Q — s11 ZMsb mfl cl-i _ s -8
- 7 - S' -1/Z 3L _
Y ) o S q �_ Z
a Boring # ❑ Boring �NG�
® pit Ground surface elev. l 0 1 3 ft. Depth to limiting factor >
Soil ptication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary" ts:-, - GPD/ft
In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
o -LS 1 LZ si! Z- F-sblz
Z 1 Z6 31 <j Zh2 96
3 Z6 3y `� SY231 — 1 s O 4 w► 1 es
4 34/40' l ow- V19
Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/_ and TSS < 30 mgA.
CST Name (Please Print) gnature CST Number
Arthur L .. "Wegerer l " =b J `7 220254
Address W e g e r e r Soil Testing & Design S e r v i c e Date Evaluation conducted Telephone Number
421 N. l-lain St. River Falls, WI 54022 1 - O q —p t 715 - 425 - 0165
. 1
Property Owner �SSTI✓� T Parcel ID # ��`7V�1 N G Page Z of 3
Boring # ❑t Boring
tsl Pit Ground surface elev. q q 6 ft. Depth to limiting factor 7 13 In.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 o - tb by 31 si 1 z`f�b12 w, 'Ft- ew 1-� . S .a
Lj 13 ID LlP-VA - S, 0 S9 wI
F-1 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 /111
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F 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
' Effluent #1 = BOD > 30 < 220. mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
s
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 - 2648777.
M -6330 (R.6100)
PLOT PLAN Paoe 3 of 3
Scale 1' = 50 '
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8►"1�t 2 -�_ to LS `[UP or- -T LC!PftIUs - CI®,.
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Ol o`} - 715 -425 -0165 220254 0l - of -
CST Signature Date Telephone No. CST No. Job NO.
J
i
! �� ■ter r �� ! �� �. — �. �� �� .�
AV
BioDiffuser Specffications
cNmtw
!� � Cm C=3 r
Chambw
End Me w
Kn
Universal 1 1
•d • •
Si zes Chamber 11" Stan- 14" High 16" High
Dimensions dard Capacity Capacity
X 1 1 ) v ,.. � « •' ' W.__.
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of Z
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner sx 11114.L6 --- Septic Tank Capacity a l ❑ NA
Permit # Z O -� Septic Tank Manufacturer ❑ NA
DESIGN PAR AMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units 5k1qA Pump Tank Capacity a l ❑ NA
Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer ❑ NA
Soil Appli c Q , 7 al /da /ftz Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA
!30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 15220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Susp Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD :530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L A ❑ 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 wastewa a nd septic tan effluent. Other: ❑ NA
MAINTENANCE SCHEDULE /`l U � ' i 6 �#"&
Service Event Service Frequency
Inspect condition of tank(s) At least once eve ❑ nth(s) (Maximum 3 years) NA
ry: Z - 3 ear(s)
Pump out contents of tank(s) 3 When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cellts) At least once every: Z-3 ❑ ear(s)(s) (Maximum 3 years) ❑ NA
�4 Clean effluent filter S �f _ At least once every: 2 ❑ month(s) (s) ❑ NA
A
ar {sl
Inspect pump, pump controls & alarm At least once every: p year(s)(s) BOA
Flush laterals and pressure test At least once eve ❑ mo
year(s)
af�A
P every: ❑ yearlsl
Other: At least once eve ❑ month(s) ❑ NA
every: ❑ yearls)
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.
Page Z' 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
replacem system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <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 1 <6 C ���� Name
Phone $ ,� Phone :::j
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name Ste, C (
Phone Phone -j y yo
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1l(dl &(fl and 83.5401, (2) & (3), Wisconsin Administrative Code.
L _
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
•
OwnerBuyer d l 1 /c LFi
Mailing Address
Property Address
(Verification required from Planning Department for new construction)
City /State
Parcel Identification Number Y 0
LEGAL DESCRIPTION
Property Location A( , r /4, > V '/4, Sec. . T jj N -R, ' Town of l� t
1 �ubdivision _ � L ,�, V t_ / Lot # �_
Certified Survey Map # 9 sue : Volume . Page # S 7
Warranty Deed # ^ /� __ , Volume 4 2 - . Page # L , �
Spec house yes O no Lot lines identifiable yes D 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.
Uwe, 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 St. Croix County Zoning Office within 30
days of the three year expubtio date.
SI 0 LICA DATE
: rDWNER CERTIFICATION
i� 11we) 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 inscribed abov virtue of a warranty deed recorded in Register of Deeds Office.
k a
A 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 m a p if reference is made in the warranty deed
pp
V1. 1 824 PAGE 44.7 (�
WARRANTY DEED 669584
STATE OF WtSCONSIN — FORM 2 KIJHLEEN H. WALSH
REGISTER OF DEEDS
DOCUMENT NO. "T. CROIx CO., WI
RECEIVED FOR RECORD
This indenture, Made this 25th _ day Of - January A.D /14 2092', 31 -29 -2002 8:30 AM
between McDonald Homes. Inc a Minnesota 6ARRAMTY DEED
c'ornorat i on /aftydpUdo� duly EXEMPT I
organized and existing under and by virtue of the laws of the State of y� vis;A, f ed at CERT COF'Y FEE:
Inver Grove Heights, MN ai/6 9 C FEE:
party of the first part, and TRANSFER FEE: 1102.50
Sam E. Miller, a single person, RECORDIHO FEE: 11.00
PAGES: I
part of the second part.
Witnesselh, That the said party of the first part, for and In consideration of the sum of
$ 367, 500. 00 -------- -------------------------
to it paid by the said part of the second pan, the receipt whereof is hereby confessed THIS SPACE RESERVED FOR RECORDING DATA
and acknowiedgcd, has given, granted, bargained, sold, remised, released, aliened, conveyed NAME AND RETURN ADDRESS
and confirmed, and by these presents does give, grant, bargain, sell, remise, alien, convey and First Federal Savings Bank
confirm unto the said pait y of the second part, his hews LaCrosse — Madison
and assigns forever, the following described real estate, situated in the County of I. 201 Second Street
_ St , CrOlX State of Wisconsin, to•wir.
- Hudson, Wisconsin 54016
040- 1061 -60 and 040- 1061 -50
PARCEL IDENTIFICATION NUMBER
Lots 1 throug 7, inclusive, Plat of
Glover Prairie the Town of Troy,
St. Croix County, Wisconsin.
(IF NFCF5SARY, CONTINUE DESCRIPTION ON REVERSE SIDE)
Together with all and singular the hereditaments and appurtenances thereunto belonging or In any wise appertaining, and all the estate,
right, title, interest, chum or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of,
in and to the above bargained premises, and their hereditaments and appurtenances.
To have and to hold the said premises as above described with the hereditaments and appurtenances, unto the said par of the
second part, and to his heirs and assigns FOREVER.
And the said McDonald Homes, Inc., a Minnesota Corporation,
party of the first part. for Itself and its successors, does covenant, grant, bargain and agree W and with the said par of the second part,
his heirs and assigns, that at the time of the cnscaling and delivery of these presents it is well seized of the premises
ahore described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that tite same are free and
clear from all mcumbranceswhatever,_ except easements, reservations and restrictions
_ of record
and that the above bargained premises in the quiet and peaceahle possession of the said par of the second part, his
near, ano assigns, agams: all and every person or persons lawfully claiming the whole or any part thereof. it will forever WARRANT and DEFEND.
In Witness Whereof,thesaid McDonald Homes, Inc., a Minnesota Corporation,
Ram -u (liehrst part, has caused these presentsto be signed by Todd A. Bjerstedt, its Vice ,President,
/P��i>!� ✓. a�/ nG���i���LL1111 / /!! / / / /!! /!!/ 11111 1L1LLl1 /!!1L!/!!!lli �4gl;ErEtdr�
Wisconsin, and its corporate seal to be hereunto affixed this
dayof January A,D 20 02
IGNtiU AND .,EM FD IN PRESENCE OF
Mc NALD HO S sota
Co rporate e
ice President
ODD A. WJER T
COUNTERSIGNED,
Secretary
State of Wisconsin,
St. Croix Count)' ss
Personally came before me, this 25th clay of January AD•lY 20 02
Todd A. Bierstedt, ate Presiden,,II ! !!!!!!!!!j1/I //1 !!!!!!/I /!ZZI g,(IQj
of the above named Corporation, tom a ns who executed the ng instrument, and to me known to he such President
and Secretary of said Corfx)ration, an w1eQy�l th a .eecute l the fut ' oirn ns tenon; as such officers a e decd of said Corporation,
by its authority. ' �j ' ,
THIS INSTRUMENT WAS DRAFTED pp
NO
�� t St. C ro i x County, Wis
��`� Notary Public,
_ST EPHEN J . DONLAP 1114 r My commission (cxpireS) 05)
Hudson, Wisconsin
n-111 p I 11 I ) I I I r, ti u - sa�on
doh.J whl s�:,l
STATIi OF \VISCONSIN W scons,n to yelank Co., tnc.
\ +,\RR,t \T1' nt:l.n - Hy l nrPu ration 1'�nn No, 2 B Milwaukee, WIs
I
V WDV ER$
PART' OR THE NE1 /4 O LANDCONTRACTVD�
E g
CRODC 00 W1 /'4 OF ROBERT W. BJERsTEi
r WISCONSIN. BETTY BJERSTEDT
LAND CONTRACT VEN
TODD A. BJERMEDT
1108 CRE3 MEW DFVv
HUDSON, WI 54018
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Taw �_p® 2510
. ruTrEncaffmw - -- ' - - - - ° - � -
N8r43'5M 1094.7
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1.98 App ( � LOT LOT 7
29 F1 _ • •74 p I I ' 66,885 M I I � �F
mm n
FAE
1 2v m
14.E A
825.6?! 1
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