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HomeMy WebLinkAbout040-1269-30-000 Wisconsin Departmi3nt of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety .and Building bivision - INSPECTION REPORT Sanitary Permit No: 430631 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: Moe, Chad I Troy Township 040 - 1269 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: lLf . 6 / 06 • (� f 4V-J-* 17.28.19.1480 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Q Benchmar , /oz c� Dosing /v _ L�,,. 6� Alt. BM 6, Aeration C`0 �� Bldg. Sewer / 3, v Holding St/Ht Inlet , L-1-6 Z , s - a � g Z. u TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL ] BLDG. Vent to Air Intake ROAD Dt Inlet Septic r Dt Bottom Ji Dosing 20 Heade /Man. 0 y Aeration �\ Dist. Pipe Z �- / d- o L5 Holding Bot. System / / 2 • V Z Fin I Cxa e PUMP /SIPHON INFORMATION -S S B - Z 10.4 0. 4 F D• Manufacturer Demand St Cover GPM Model Number ep �� b TDH Lift 6Friction LC System tied TDH 1 Ft fi Forcemain Lent 1 Dia. Di t. to We I A 2" SOIL ABSORPTION SYSTEM >?32 BED/TRENCH Width Length No. Of Trenches DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ? I SETBACK SYSTEM TO P/L< JBLDG IWELL ILAKE/STRek M LEACHIN Man rer INFORMATION CH OR pig f Ty Of System: I d'1 UNIT Model Number: DISTRIBUTION SYSTEM Q Heade /Manifold IDistribution x Hole Size x Hole Spacing it Intak / H Pipe( s) 1, /i 7 ✓ r Length Dia Length 1 Dia Spacin > 106 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 Y s § Bed /Trench Center Bed/Trench Edges Topsoil Yes No e COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1:/ aF Inspection #2: Location: 317 Day Farm Road Hudson, WI 54016 (SE 1/4 SW 1/4 17 T28N R1 9W) Troyw_ood Lot 4 Parcel No: 17.28.19.1480 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = > Z) h Plan revision Required? � Yes ,�� No LJ Use other side for additional Information. rnature -6710 (R.3/97) Date Inse ctor's Cart. No �1 w . washitigton Ave:, P.O. Box 7162 N Madison, WI 53707 - 7162 Site Address Department of Commerce bA Sanitary Permit Applicatio RECEIV Permit G31 accord with Comm Wis. Adm. Code info In .personal rmablou provide ❑ if Revision my - be - used for law sli. i L Application Information - Please Print All Information LD. N umber Pape 17r's N S ZONING OFF i Pmpeny owner's Mailing Property Location �. 6 ik ) siS �!i;S / To � �N R � B City. State Zip Code Phone Number Lot Numbe Blxk Xue Wr Subd ivision I+iame O CSM N ber Tto 11 kbj II. Type of Building (check all that apply) ❑City ❑ 1 or 2 Family Dwelling — Number of Bedrooms ❑Village ❑ Public/Commercial — Describe Use ownship T t o 1 . 0 State Owned ea rest Road Lz J za c,�os arm III. Type of Permit: (Check only one bok on line A (numbering scheme for internal . Complete HneV3 if applicable) A. 1 New 2 ❑ Replactrrient System '3 ❑ Replacement of 6 0 Addition to For County use stem Tank Oal Existing System B. 0 Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non — Pressurized In- Ground 210 Mound 47 0 Sand Filter 50 0 Constructed Wetland 22 ❑ Pressurized In- Ground 410 Holding Tank 48 0 Single Pass 510 Drip Line 45 0 At-Grade 46 0 Aerobic Treatment Unit 49 0 Recirculating 30 0 Other V. D' eatment Area Information: Design Flow (gpd) Dispersal Dispersal it Application Percolation Rate System Elevation Final Grade R gt7t7 "1 • Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation VI. Tank Info 6pacity in T6t&l Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Ex4ft Tanks 'tanks Septic or Holding Tank s OU (fi S e 5 Dosing Chamber 69 VII. Responsibility Statement — I, the undersigned, assume responsibility for installati WTS shown on the attached plans. is Name (Print) s Signature RS Business Phone Number Plumber's A l d � dress (Street, City S Zip > j S� l VII m e artment Us Only I3 Approved ❑ Disapproved Sanitary ' Permit Fee (includes Grotmdwater Date Issued Issuing Sigmawre (No Stamps) . Surcharge Fee) ❑owner Given Initial Adverse . 2 S ,� ? ` Delon IX Conditions of Approval/Reasons for Disapproval 3) - ^ _ a� .A Q _ SYSTEM OWNER: 1 Se tic tank effluent filter and p dispersal cell must all be serviced / maintained / �, "�� _ as per r management plan provided by plumber. / na es. mly) tan the an paper not lets than SW z it lndw la size as per applicable cod SBW398 (R. 051011 n t mss; �a 415 1) k u a 9a" J D % © b 0 16�� Od r l U , M � al�� g a y ' ►� b�1 li PI b� a } Y YM� VA, ` © a 0 I I DDo- I-- 1q ,��� g2�' fa P� 1322 Wisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direction and parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. pending Please print ai ; .1 0(14 .. . _ + i 2aw By Date Personal information you provide may t dsedfpr0. 6idary purposes (Prrvaey, s. 15.04 (1) (m)). DEc • 30 tab 3 Property Owner , �, r . • ,: I r . � � `. Property Location Humbird Land Corporation l " '�'�' *vt. Lot 1/4 SW 1/4 S 17 T 28 N R 19 W Property Owners Mailing Address ! of # Block # Subd. Name or CSM# 332 Minnesota Street, East 1 Q4 ni!1�r 7 200 4 n/a Troy Wood Subdivision City S e ' ip Code t41fi&.0 }nber _j City village e Town Nearest Road Saint Paul M is 10 �`'U R 555,55. Troy E. Cove Rd/ Day Farm Road /I' New Construction Use: ye R 0 �� 3 Code derived design flow rate 450 GPD J Replacement -1 Ptublitr -ia = cribe: Parent material outwash plains Flood plain elevation, if applicable n/a General comments and recommendations: Part of 1.77 acres. BM #1= 100.0'. BM #2= 89.0' . Recommend system elevation of 88.8' between 91.9' and 91.2' contours. P42 from preliminary boring work done 5 -5 -00. [ P4 - 2] Boring # -1 Boring f/ Pit Ground Surface elev. 89.9 ft. Depth to limiting factor >72 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -10 10yr2/2 none sit 2msbk mvfr as 1f 0.5 0.8 2 10 -15 10yr4 /4 none sil 2 PI mvfr cw 1 f 0.0 0.0 3 15 -30 10yr3/4 none sil 2msbk mvfr cw - 0.5 0.8 4 30 -39 10yr3/2 none sil 2msbk mfr cw - 0.5 0.8 5 39-65 10yr2/2 none sit 2msbk mfr cw - 0.5 0.8 6 65 -72 10yr3/4 none sil 2msbk mfr - - 0.5 0.8 Boring # �1 Bering / /�,�t� j ✓_J Pit Ground Surface elev. 91.2 ft. Depth t irt'g fact >72 in. Soil Application Rate Horizon Depth Dominant Color Redox Description - Texture Structure Consistence Boundary Roots GPDIft *Eff#1 *Eff#2 1 0 -25 10yr212 none sil 2msbk mvfr as 1f,1m 0.5 0.8 2 25 -36 10yr3/2 none sil 2msbk mvfr cw 1 f 0. 3 3645 10yr3/4 none g . sin 2msbk mvfr cw - 0.5 0.8 4 45 -56 7.5yr3/4 none gr.sl 2msbk mvfr cw - 0.5 0.9 5 56 -72 10yr5/6 none s 0 sg ml - - 0.7 1.2 20.4 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD < mg/L and TSS <30 mg/L CST Name (Plwe Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., NewAubum, WI 54757 11/15/00 715 -658 -1344 I r Property Owner Humbird Land Corporation Parcel ID # pending Page 2 of 3 2 ] F Boring # J Boring Ad Pit Ground Surface elev. ____ 91.9 - _ - ft. Depth to limiting factor _ >75_ - - _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ OPD& `Eff#1 •Eff#2 1 0 -32 10yr2 /2 none sil 2msbk mvfr as 1f 0.5 0.8 2 32 -35 10yr3/4 none gr. sil 2msbk mvfr cw - 0.5 0.8 3 35-48 7.5yr4/6 non gr. sl 2msbk mvfr cw - 0.5 0.9 4 48 -75 10yr5/6 none s 0 sg.. ml - - 0.7 1.2 F Boring # J Bones 7 AM Pit Ground Surface elev. 95.0 ft. Depth to limiting factor >72 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots -_ - GM$' - ___ 'Eff#1 'Eff#2 1 0 -16 10yr3 /2 none sil 2 mvfr as 1f,1m 0.5 0.8 2 I6 -2 1 _ 10yr2/2 none sil 2msbk mvfr cw if 0.5 0.8 3 24 -35 10yr4 /3 none gr. sil 2msbk mvfr cw - 0.5 0.8 4 35 -56 7.5yr4/6 none gr.sl 2m mvfr cw - 0.5 0.9 5 56 -72 10yr5/6 none gr. s 0 sg ml - - 0.7 1.2 4 ] F Boring # � Bo Pit ring Ground Surface elev. -___ 91.2 _.____ ft. Depth to limiting factor >70 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots _ -_ 0PDM _ 'Eff#1 'Eff#2 1 0 -12 10y12/2 none SO 2msbk mvfr as 1 f,1 m 0.5 0.8 2 12 -17 7.5yr4/3 none sil 2msbk mvfr cw 1f 0.5 0.8 3 17 -22 7.5yr4/4 none gr. sil 2msbk mvfr cw - 0.5 0.8 4 22 -36 7.5yr4/6 none gr.ss 1 msbk mvfr cw - 0.7 1.2 5 36 -51 10yr4/6 no ne gr. Is 1 msbk mvfr cw - 0.7 1.2 6 51 -70 10yr5/6 none s 0 sg ml - - 0.7 1.2 ' Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD <30 mg/L and TSS < N 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. 0 \ U m Q N 1 3 m LL _ CD — � p 8 v nra ca c T O 5 C� a� 3 r E O w L v gz 9 O h V T! p � M C3 L a � a s � o w o Q oa o O CD cn o p� O . J w O] co cc Q � r U CY] Q UOMDi.nacion bepr,;l.c; TanK ana PUMP CHAMBER CROSS SECTION AUD SPECIFICATIOUS ' PAGE OF -VEIJT GAP WEATHER PitOOF JuUCT101J BOX 4'C.I. VEIJT PIPE APPROVED LOCKING � lO - FROM DOOR, MAUHOLC COVER ovl :/IAIDOW OR FRESH wAptJl�)G t..144�EL, AIR IIJTAKE c S cosaD��r ' r tj 4 JIUM. P PROVIDE 1 - -- - W LE T AIRTIGHT SEAL I I( V - 8 4FFLES 1 APPROVED JOIIl7 APPROVED JOINT: W G.T. PiP[aR I I, i w /C.I. PIPE�PDC ( Tank constzuction ALARM shall comply with ILHR (33.15 and 33.20 a I 1 Oki C _ I LLEV. FT. PUMP -�, -' OFF O COUCRETE 6LOCK 3" APPRmeb RISER EXIT FERMIlrED OQL9 IF TACK /AA1JUFACTUU -R HAS SUCH APPROVAL —IUD IN16 6bD0 i N 4 SEPTIC E SPECIFICATIOMS DOSE 1 `1l OW �-iy IJLIM6ER OF DOSES:—.,, PER DAU rAM M AWUFACTURCK' TANK SIZE: 1GJ`J 1 6SO GALLOWS DOSE VOLUME Z ALARM MAIJUFACTUICCR: "�- U S"JsTts IhiCLUDli.1(a OAGKPLOW: , S � GA LLONS MODEL WUMBER: 10x \AW CAPACITIES: A= �� WCHES09 30 CALLOUS SWITCH TUPC: x"1 2-� 8 = IUCHES'OR 3� G�LLOIJ5 PUMP MAMILIFACTURER: Gajt_ 3 C= 9 Wt HE$ OR GALLOUS MODEL NUMDEIL: 38 -1I D= 2 i� OR �y b GALL01J5 SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO bE MIMIMUM DISCHARGE RATE `2 - GPM INSTALLED OU SEP&RATE CIRCUITS VEILTICAL DIFFEILEWCE DETWEEIJ PUMP OFF AIIQ.DISTRIBUTIOIJ PIPE.. Yt-1s FEET + miwimUM AIETWORK SUPPLY PRESSUIL ; .. , .. , . . , 2 -S o FEET + 9 -S FEET O F FORCE MAN X � y F /IpO FLFRICTIOU FACTOR - -1 -, - FEET .:... TOTAL 011JAMIC. HEAD = FEET Pump chamber DIAMETER 311TERNAL DtMEIJSIOIJA OF TAWK: LEIJGTH ;WIDTH -.j LIQUID DEPTH 3 �.... t BOTTOM AREA - 231 GAL /INCH Goulds Submersible Effluent Pump . L v _ EPO4 EP05 APPUCATIONS • Fasteners. 300 series • Fuhhy submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses. ' Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle Mme Available for automatic and float switch attachment • F s • EPO4 Single base: 0.4 HP, manual operation. Automatic points. • Water transfer • Heavy duty sump , models include Mechanical 115 or 230 60 H7,1550 Float Switch assembled and ■ Power Cable: Severe d � • Dewatering RPM, built in overload with reset at the facto rated oil and water resistant automatic reset p factory. - • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- constru - • Solids handling capability. automatic reset plastic Semi -open design 3 /4' ma)d mum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities. up to 55 GPM. standard length, 10 SJTO mechanical seal rotection. 1 - Total heads: up to 24 feet with three prong grounding p' Canadian S�adardsAciation • a size: NPT. plug. Optional 20 foot ■ EP05 !closer. Thermo - Dischar g plastic enclosed design for (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with improved performance. 9 end in F" or "AC".) rotarykeramic- stationary, three prong grounding plug p ce BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40°C) continuous superior strength and 140-F (60°C) intermittent corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel 10 • Capable of running dry without damage to s 30 ......... ` components. l ; sGr► Pump: EP05 s — - - - ! -- - '-z.5 FT _ 25 • Solids handling capability: c i a I i 3 / maximum. • Capacities: up to 60 GPM. 6 20 ' o • Total heads: up to 31 feet. • Discharge size: IIN NPT. z 5 { __. • Mechanical seal: carbon- rotary/ceramic - stationary, ° 4 15 llliq j BUNA - N elastomers. o 7 ­ ___ ._. - _ -- , _ `- - _._...;. _ EP05 • Temperature: 3 10 104.1' (40°C) continuous i 3 g. 140 (60°C) intermittent 2 - - = T -- -- — - - - -- - 5 , OL 00 10 20 30 40 5o GPM 0 2 4 6 8 10 12 M3/h "!,F�� -. System Management Plan Pursuant to Comm 83.54, Wis.Adm. Code - Sectic Tank The septic tanksltdl be maintained by an individual certified to service septic tanks under s. 281.48. Slats. The contents of the septic tank shall be disposed of in acwirdance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet biter $trait be assessed at least once ever/ 3 years by inspection. T'ne outlet fitter s`all be craned as necassar/ to ensure proper operation. The fitter 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 filter is equipper' with an alarm, the rater shall be serviced if the alarm is activated continuously. Intemnittent fitter alarms may indicate surge flows or an imp continuous alarm. The septic tank chap have its contents removed when the volume of sludge and Sian in the tank exceeds 113 the liquid volume of the tank g the contents of the tank are not removed at the time of a tdennW assessment. rape s ha0 advise the 'owner of when the next service needs to be performed to maintain less than manglmunm sarm and sludge aaxuratiafion in the hank The addition of biological or chemical additives to enhance septic tank performance is generally not required. t3uitdi Disuch products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Fum k :rho pip ( dosing) tank shalt be inspected at least once every 9 years. All switches, alarms, and pumps shah be tested to !rely proper operation. if an of iluent SW is installed within the tank it shall be inspect te inspected and serviced as r. At-9trade Component and Pressure Distribution System No.trees.or shrubs s ou e perimeter a be Plante or al owed row on the component. to g Plantings map be made around thnd the component shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the component is not allowed. Cold weather install- ations require the component to be heavily mulched for frost protection. Influent quality into the at -grade system may not exceed 220mg /L BODS, 150 mg /L TSS and 30 mg /I, FOG. Influent flow may not exceed the maximum design flow specified in the permit for this installation. The Pressure distribution system Is provided with a flushing nt g po at the end of each lateral, and it is rimed that each soft at least once every 18 months. When a pressure test is perfa =W it should be compared to the Of 6 �al test when the System was installed to determine it orifice clogging has ocana ed and it orice cleaning is MP*vd b maintain equal distribution within the dispersal ce ll . Observation pipes within the dispersal cell shall be* checked for effluent ponding. ponding levels should be reported to the owner and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring in accordance with' Comm 83.52 (2). General 3 system shall be operated in accordance with Comm '82-84 Wis.Adm'.Code and shall be maintained in accordance with it!s component manual SBD 10570 -P (B.6 /99)'and. local and orate rules pertaiairig to system maintenance and maintenance reporting.. No one Should Gvec enter a septic or pump tank since dangerous gases may be present that could cause daft Sepik and r punV tank a � nt shah be in accordance with Comm 83.33, Was. Adm. Code when the tanks are no karger used as Septic or pump tank manhole risers, access risers and covers should be inspected for water lightness and soundness. Access o Pankgs used for service and wa assessment shall be seale trMund, defective, or subje to failure must al re �9 ht upon the completion of service. -Any opening deemed be secured by an a ve �9 device b prever t accFdenhal or wra rized greater the in diameter shall y ent y into a tank or cdmponenL N the S8Pft tank or or any of its � become defec6 lire r component keep - systernin p � o � tank or componernt std be repaired or to keep the ' QPNW&V condition. jf the doh ' PunV PUMP controls. alarm or related wkiV' becomes defective the detective component shall be hr or replaced with a proponent of the same or equal perfoanartce. If the at - grade coomponuaat - fails to accept siastewatai'o='beRias - to xis" - hc ergs wastewater the ground surface, it may be necessary to install an aerobic pre - treatment unit or - replace the component. Additional site and soil* evaluations may need to be done -and addigional plans may - need to be prepared and approved by the Department of Coqimerce,- Safety and Buildings'Division. . Questions. about the operation or maintenance of this system should be directed — to-F" o- / - The Conaty Office at Z 6 - )q7 The sys tam installer at 1 LS - L 2,$ - cI q SR Xp VXj c The tank manufacturer at hJtesOR The effluent filter manufacturer at $-t - ZZ,I - N Z. Z.rM%XL The. °` V-%Vt. q ST CROIX COUNTY SEPTIC TANK MAINTENANCII AGM13MENT AND OWNERSI CERTIFICATION FORM Owner/Buyer Mailing Address !� ��g ?_�v� z� �n D,. 5 934 Property Address p at�t - Nv� (Vaaficatioa "kw from Pl:m* Dcp daunt for acw co hU,:tioa) aty/state 9,- ,1 • Patrxi Idcnitftcalion Nwnba- 6 d -10U LXGAL UESCI�n''rrON Property Location %<S i, sot. T o 4 -R Zi W, Town of -Tpo 2t Sabdivrsroa Lot it - CaMmd Sarver bft # vottmac ram # .. Wsrmty Dftd vote cp y r"# 63 Spmhovw 0 ym lt no Lot fiats idmti5abiq ya 0. no b�eopce +cscsadawmbamra�oeofyrimr cs kitsP j tolwndEc a �Y , was+ ommif*oodcdby�t�oa�sodpa000pm: yoap4Qre9ydem . • mss. :s�ein�e�raste,ty�ca .. �pmopattyovnoaag�w ta�bamiot'to Sst aaoo��,�E,� • ismpWpKre�pccj °c'sGOOaesod Q t(Y�Q,eoa�nte 'sysomk ' °0d (¢ 4].�o ads*— &d. -� ��ig�oodtnv�eeadmeaboecaa�oodv�aod ��� � + �o�bm�x lnQ�cpdri�esc�sy�,��Qie�+od�bds stiit�ggtbit � °f ovnaCfi &d.Of W moasia.. Qeo t. �odoneatafQsmaora�oeaad cq i cx & ut b modmastbcoam q� l cEodandredamodtoQ�eSGQoix1 ',amsYyooiggpt�eoein30 �h OF DATE I (�� t6 st all oo this foam sm truer to do best of fay (ov4 b mdodge, I (wee) ant (are) tho ownct(i) of Y mod abm by *bm of a gram sq dmd =oca 0d is ftCgister of Doody oW slc�ru • of c�tar _ !a �' 3 i� 3 DATE ss ' � that is mini �y tit in tba :snihcy pcamit fang rcvolmd b the Z � D •••s•• •• Indadc Frith U& M i,cattoa: a armpod wattaotlr dmd from flat RcgWr of Doody office a copy of the cWifted moll map if rdmom is made is the waaanty deed 749646 /I U 24 ?7 P 639 ` • STATE BAR OF WISCONSIN FORM 2 .1998 REGISTER OF OF WARRANTY DEED ST. CROIX Co., MI Document Number RECEIVED FOR RECORD This Deed, made between Day Farm Investors, LLC, a Minnesota 12/19/2003 11: 30AII Limited Liability Company WARRANTY DEED ._ EXD PT # Grantor, and Anne M, Epley and Chadwick Moe, as joint tenant REC FEE: 11.00 TRANS FEE: 239.70 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recordin Area y[Q Nbt� d f e r INC. Lot Troy Wood, Town of Troy, St. Croix County Wisconsin SUITE 200 1800 SILVER LAKE ROAD P EW SRiG}}ii,,TSS��N I � 1T FILE NO. �i� 040- 1269 - 30-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements,restrictions,covenants and rights of way of record, if any, including but not limited to those for drainage,water retention ponding,and or utilities as may be shown on the plat of Troy Wood recorded in Vol. 8 of Plats, page 28,St. Croix County, Wisconsin.The warranties of this deed, either expressed or implied are limited by the grantor to the grantee, or anyone in the chain of title, to an amount not to exceed the consideration expressed herein, that being the sum of S 79,900.00. Dated this 15th day of December 2003 Day Farm Investors, LLC . by �ftyl. Q President . + Austin J. Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) SS. Signature(s) Ramsey County. ) Personally came before me this 15th day of authenticated this _ day of December 2003 the above named Austin J. Baillon TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledu the same. authorized by § 706.06, Wis. Stats.)� THIS INSTRUMENT WAS DRAFTED BY PAUL A. BAILLON Paul A. Baillon, Attorney at Law ' Paul A. Baillon M,wa srr. Notary Public, State of W My COIJWSs rad EXPIRES 1.71.2006 (Signatures may be authenticated or acknowledged. Both are not My Commission is perman necessary) Jan 31 2005 ) -Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR OF W ISCONSIN WARRANTY DEED FORM No. 2 .1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 500 -655 -2021 f CO , / m a V � 1 ao / A. V .001 / \ e y Z \ \ Woe �°` /t I O i i O IOOOP lot loll I