HomeMy WebLinkAbout040-1257-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety aRp Building Qivision
f INSPECTION REPORT Sanitary Permit No: 463253 0
GENERAL INFORMATION z (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary Ourposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Moore, Tammy Troy T wns ip 040- 1257 -70 -000
CST BM Elev: Insp. BM Elev: BM Description: G5T Section/Town /Range /Map No:
9'7. (q _ 24.28.20.1370
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Jd'}— 3 Benchmark /OZ. 9 -7-t.4
c�v
Alt. BM :5+, 600e _ o
fHo ration Bldg. Sewer
di ng St/Ht Outlet St/Ht Inlet
77 9 S Z J
9! , o y l
TANK SETBACK INFORMATION 7 �
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ,, 1 Dt Bottom
3 A- 3r
Dosing Header /Man. �Z C1
4 j
Aeration Dist. Pipe om/
Holding _C7 Bot. System 1.0 C.J
PUMP /SIPHON INFORMATION Final Grade 3, (� ( y, 9 y
Manufacturer P and St Cover r ^
Model Num er _T_ I �O
TDH Lift Friction Loss Syste ead Ft
. v 1.
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length . Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 g'7� 5 Z , A
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufactur .
INFORMATION Type Of System: CHAMBER ER OR 1 b� � P
tt AA '' Model Number:
L
CcAoe DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
p I Pipe(s) `
1 1-ength _ O Dia Length \ 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 t Bed /Trench Edges \ Topsoil \ Yes i ; ',I No Yes -, N
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 41 - 20/ Q
f y Inspection #2: / / Location: 336 Lindsay Road Hudson, WI 54016 (NW 1/4 SE 1/4 24 T28N R20W) Troy Village 3rd Addition Lot 11 Parcel No: 24.28.20.
0
1.) Alt BM Description = 154-" LoJ-e� C1 S � — O ✓� ` /J .�•� `�
2.) Bldg sewer length = ?:5 O 7 I o c.at
A
- amount of cover = 1 •a`i
Plan revision Required? I Yes > No
�_—
Use other side for additional information.
Date 11 se ctor's nature Cert. No.
SBD -6710 (R.3/97) �
.r—.) J— S a
Safety and Buildings Division County
r
201 W. Washington ve.,
* h9consin Madison, W1 3707 1 V E sari Permit Numb" (to be filled by eo.)
(608) 3151 4S25
De artment of commerce DEC 1 0 ZOQ Se`` Pian LD. Number
Sanitary Permit Applicatio
nal information on P CO U NT ' Proj t Addrax (if different than marling address)
In acwrd with COMID may used for 83.21.
secondary . � 1 t°)
' ZONING OFFICE /�
L Application Information - Please Print All Iaf 33- Ll tJ PSr Q b -�
parcel Lot g Block #
,v.. progeny on
propr y 0 ces Marlins . j G(/
Address `I- . •'� / /
6 3 5-b„ section
Zip Code Phone Number p ��t�e
s 0 �l.i � T 2-D N; 4 Z rl w
� S ` 1711P � - . n Name CSM N
U. Type of Building (eheck SH that apply) (� Subdivlsro
1 or 2 Fatmly nwAung - Nurav= of B eocooaw Vv
PublidCommerc - Describe Use cry V. owasbip of = -�
Static pad _ Describe Use -64c d p • 1 w
le c _ 2 �'- '
Type o Pet�mlt~ {Check only one box on line A. Complete line B if app licab
Other ModiSa�n to Exi:ciag sy>nWn
A. ew System Replaoeaaent System TnxtrnentlHold'igg Tank Replacement Only
List Previous permit Number sod Dote
B. Pe Renewal Permit Revision Cha of Permit Transfer to New J l7
Plumber Owner 7LL'fJ `
Before Expiration i
D � C Z
1 � S
N, of POW'15 S Check all that a 1 single pass sand gilt ,
on -Pin ssurir�ed 1n-Ciround Mound _> ?A in• of suitable soil Mound < 24 in. of suitable soil At'G d Filter S
Holding Tw* Peat Ftlwr Aerobic Treatment Unit R
ConsanaW Wedand Pnxsmiud is acrid Other ( � '-
S c Med s Filter Line C�ravd-less Pi .�
V. resmttnent
Area orma ( at) d Dispeasl Area Proposed (at) n
Dcdp Flow (gpd) Design SO &A" Rstc(E!?�0 �7 j
/ Prefab i� stem Fiber Plastic
VL Tank Info Capacity in Total Number Mang Co tnrcmd Mass
Gallons Gallons of Units
ttew rxuuus
Tanks Tanks
SepdraHo16a6Tsak Z S'
Aaobte T—tmmr Unix «
tbsiny t .
iii tatemen sst acme bility for installation of the f'oRrTS sbown on the Rasa"
V s S the Plurab gm MPIMPR Number BudWas Phone Number
X Flu : (S 'ty, crate ) 017 47/`C./ .
VIII. Coan t Use Onl Date �ul� i� S•iglawre (No Stamps)
Saaihuy Permit Fee Includes Groundwater \
surclmaBe Foe) T 2 5V
Ma 0 26i�
EL Conditions of AppnwaVReasuns for Disapproval 1 e 5 � �
SYSTEM OWNER: �J- 12 - L
1 Septic tank, effluent filter and ;r �R_ A 7D Zl
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained (P.�" N
as per applicable code /ordinances.
Attach u osmplete plats (to the county only) for system oa p1Pu not IM than S IP s It inches In ft n
PLOT PL
PROJECT Tammv Moore ADDRE 6 E. Exchanae St. Suite 307 St. Paul Mn 55101
NW 1/4 SE 1/4S 24 /T 28 N/R 20 TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 12/9/04 BEDROOM 4
CONVENTIONAL XXX IN- GROUND PRESSU CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
M.* SYSTEM ELEVATION
235' Property Line --.a .4 16'
Well is to meet all Plans Designed Using 12' Vents B -1
setbacks required by Conventional Powts B-2 2'
WDNR Vent Manual Version 2.0
>6 » Standard Biodiffuser 21'
of Cover Leaching Chamber 75'
with 3 1. 1 ft2 of Area B -3
6' Long 11 "
34" Grade at S stem Elevation B_5 2 -3' X 88'
cells with >3
spacing
Pro 4
Bedroom
House 147'
5' B-6
5
184'
Property 100' B-4 27 ' Lindsay Rd
Line ST 40'
Please note: Further testing has
been done to install system in the
proper horizon because
original CST did not dig boring
deep enough!
198'
ST. Anne's Parkway
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 plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
T M 1/ Govt. Lot A 5 1/4 So( YT N R2 O E (or)
Property Owner's Mailing Addre Lot # Block # Subd. Name or
a-6'4� X0- Xq- 14 d Tr L`
City State Zip Codi5 Phone Number ❑ City ❑Village 5wown N arest Road
pg. SS al ( ) 'rs �"
r New Construction Use Residential / Number of bedrooms Code derived design flow rate &aQ GPD
o Replacement ❑ Public or comm �rcia�l - Describe:
Parent material (Li.t l Flood Plain elevation if applicable N I ti- - - -- - -- ft.
General comments
and recommendations:
t�
® Boring # Boring r g
Pit Ground surface elev. l / , ' ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
2, 20 -60 0 J
-tN
0Y/
m ) !
F-1 Boring # [] Boring
n surface elev. ft. De pth to limiting factor in.
G su ace
❑ Pit P 9 Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
' Effluent #1 = BOD > 30 < 220 rng/L and TSS >30 < 1F YfIL ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) na CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54 17 �' %L d —U� 715- 246 -4516
i
Property Owner _ Parcel ID # Page of
1-1 Boring # E] Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. — So - i - l' — Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
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/fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F -1 ❑ Boring Bonng # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
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& 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 (RAM)
LOT PLAN
PRO )iCT Tammv Moore ADDRESS 26 E. Exchanae St. Suite 307 St. Paul Mn 55101
NW 1/4 SE 1 /4s 24 /T N/ ' 20 W TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 12/9/04 BEDROOM 4
CONVENTIONAL XXX IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1057 # of chambers 34
IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOR E O WELL * H. R. P. Same as Benchmark
B.M. SYSTEM ELEVATION 95.5/95.2' 4.5' below qrade
235' Property Line 6'
Well is to meet all Plans Designed Using 12' Vents
setbacks required by Conventional Powts 2 ,
WDNR Manual Version 2.0
Vent
� Standard Biodiffuser 2
of Cover Leaching Chamber '75
with 3 1. 1 ft2 of Area
6' Long 11 N
3 4" Grade at System Elevation _ ' 2 -3' 0
cel '
n
Pro 4
Bedroom '
House 147
20 T 25
184' ,
Property B-4 \2 Undsay Rd
Line
Please note: Further testing will
be done install system in the
proper horizon because
original CST did not dig boring
deep enough!
198'
ST. Anne's Parkway
G OP *4
LOT PLAN
PROJEICT Tammv Moore ADDRESS 26 E. Exchanae St. Suite 307 St. Paul Mn 55101
NW 1/4 SE 1/4S 24 /T N/ '20 W TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 12/9/04 BEDROOM 4
CONVENTIONAL XXX IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1057 # of chambers 34
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOR E O WELL *H.R.P. Same as Benchmark
t�e SYSTEM ELEVATION 95.5/95.2'4.5' below qrade
5' Property Line 16'
s to meet all Plans Designed Using 12' Vents
ks required by Conventional Powts 2 ,
R Vent Manual Version 2.0
Standard Biodiffuser 21'er Leaching Chamber 75 with 31.1 ft2 of Area B -3
n 11 " N
g Grade at System Elevation _ 2 -3' X 107'
3 419 r- cells with >3'
spacing
Pro 4
Bedroom 147'
House
20' 25'
ST
184'
Property B -4 27 Lindsay Rd
Line �—
Please note: Further testing will
be done install system in the
proper horizon because
original CST did not dig boring
deep enough!
198'
ST. Anne's Parkway
R
Wiswn°lnDe p aitnientofComarerce SOIL AND SITE EVALUATION Page 1 of 3
Diviisiorr, of Safety and Buildings in accord with Comm 83 05,'Nis. Adm. Gode
Environmental By Desqui
Attach complete site plan on paper not less than $'/s x 11 inches in size. Plan mtot ( ?County
include, but not limited to: vertical and horizontal reference point (BM), direction 4fgtl $t. CIO1X
percent slope, scale or dimemsions, north arrow, and location and distance to nt.arelt road.
e4groel I,D.# 1
APPLICANT INFORMATION - Please print all information. j Reviewer Date'
Y Pr Y y purposes (Privacy 4)
Personal information you provide may be used for seconder r Privac Law, s. iS.dRs 1 (m
d p-
F1123 ty Owner 7 T 0, rokfy.Locat
nental Development ovt Lbt NW.I /4 SE.., "i /4 S 24 T 28 NA 20 W
ty Owner's Mailing Address # `� [3t # � 5ubI, Name or CSM# P
Central Avenue NE, Suite 230 110 Troy Viflau
City State Zip Code PhoneNumber ❑ City E] Village ❑Town Nearest Road
iviintte olis N1�iN 55434 612 -75 7 -7568 Troy j Lindsay road
❑ New Construction Use: ❑ Residential / Number of bedrooms 4 ❑Addition to existing building
❑ Replacement ❑ Public or commercial describe
Code Derived daily flow 600 gpd Recommended design loading rate •5 bed, gpdfiF .6 trench, gpdtft
Absorption area required 1200 bed, ft 1000 trench, ft Maximum design loading rate •5 bed, gpd/ft .6 tr ench, gpdtft
Recommended infiltration surface elevation(s) 97' ft (as referred to site plan benchmar
Additional design /site considerations Thickness of "A" horizon most likely due to a eoll ' deposit at t e ase of the hill
Parent material LOESS OVER OUTWASH SAND — =flood ain elevation, if applicable NA ft
S= Suitable for System Conventional Mound I In - Ground Pressure AT - Grade I System in Fill I Holdin Tank
U= Unsuitable for system ®S
El ® S❑ U 1:1 S® U ® S U I ❑ S® U ❑ S N U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
goring# Horizon in. Munse!! Qu, Sz. Cont Color Texture Gr. Sz. Sh. Consistent Boundary Roots ! Trench Bed
1 1 0 -32 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6
2 32 -64 10yr4 /4 - sit 2msbk mfr cw if 5 6
Ground 3 64 -90 7.5yr5/6 - s Osg ml - - .7 .8
elev
100.28 ft
Depth to
limiting
factor
>90
Remarks:
2 1 0 -3$ 10yr3/2 - sil 2msbk mfr cw 2f 5 6
2 38 -64 1Oyr4 /4 - sil 2msbk mfr cw if .5 .6
Ground 3 64 -90 7.5yr5/6 - s Osg ml - - 7 ! $ r
elev
100.93 ft
Depth to 1 0 �t 95•
limiting
factor
ta.Ib ol.lb —
�
Remarks:
V
CST Name (Please Print) Signature: Telephone No.
Thomas C. Nelson 715- 246 -2454
Address Enviromnental 13y Design Date CST Number Ref # t�
1432 120th Street, New Richmond, WI 54017 12/292 227387 82 >-
c� w�..o -t� �L. - t p � r�A� `�. ;•`Q -�l c� D,. �� JC �r� 0.. " —�"'�
E NVIg0� jT RL BY DE51
1432 12'0`h STREET, NEW RICHMOND, WISCONSIN
715 -246 -2454
9rU nV RT T NF VTT T l A,�(�' F t' 1 J i ;OL 3
NW Y4 SE Y, SECTION 24 T 28 N, R 20 W
TOWNSHIP TROY 1 COUNTY St. Croix Wisconsin
235.05
all
2
t
`� --..5 147 o
2 � -
5�
I
Qy
I q Q, ,15
- 7 — o t .) n c(
SCALE 1" =40 Tom Nelson
BM 1. NW LOT CORNER Top of iron pipe ELEV. 100' 227387
BM 2. SE LOT CORNER OF LOT 108 TOP OF IRON PIPE ELEV. 103.375
�{ hmve, off.
Trgy 0"bveibpmenf Cbrisr-ratibiv
1730 Central Avenue AE
Blaine, MN 55434
(612) 757 -7568
OUTLOT 3
COMMON AREA — PARK 16
9.405 ACRES 4.7100 AC
m 4 C
N 1 ID AC 1.S6a h
LEGEND 1.13 AC ,.� 7
_ UTILITY EASEMENT, 10' WIDE � �1 .
— — UNLESS OTHERWISE SHOWN.
............................ . DRAINAGE EASEMENT, 10' WIDE �� � 41 : 42� �)- z 4
UNLESS OTHERWISE SHOWN. n
1.617 AC 1.106 C 48 49 m
r J " 064
BUILDING SETBACK LPE, 75' 40 A 1.577 .�
– – — UNLESS OTHERWISE SHOWN._ 1.642 AC �' , °:�? � 6
3
!/ �12913C 1.013 A� F
3.310 39AC " 2 f' 1 AC
a
Z,o 0 3001 A
1.038 3 AC °r 4
a •''•. a • 1to2o142'A>r ". GOLF COUR
I N
(7 , 240.00 "
3J a g /
w a o J >> S � 7.026 AC SN 1.23290 9. r
cq
5 2.J8 1 I 248 AC •
2.508 AC 1.0 AC
45' , _�.; �� .. 1 . C
29
2 9.05'
a k 1 1 O AC J b 7 j , J y� �i / N, 23 AC
OUTLOT 12 " t. 7 Ac.
0 6 7
ry
COMMON AREA— " ",. � , ? �ti 232a$A •Y g�j�::w " °
PAR
9.044 K 1Q ��
AC X 0 OlC •, ry ry , 27 1 .1575
4L' Cy
9Q' 102 / * ,p. �T t220 AC/ ? '�
1 1.340 AC n. 106
3 eo.6 r i ,� 243 A /26 i ry 5
107 O ? 1.0 O C 1.694 AC I ^� N 1.296
" 2.10 / a UL , .300 AC ^ry. �'J 6 doh I
' ,� F 113 a.
100. ,h 1.026 ^�_
1. jai'
J 17.71 • ?,fig
1 38 0 5$ C ^ h n
,/ g _
100 00 ' .7 �4' ^' ^ �,
1 1 2 AC 1. a AC N 20
N 100
109 �?9 S,, 2 p 1.048 A<
30o.e1 . r 1�s6 � c
0o . `o \ h0 ^ Z.009 7 1.184 C c ,�96
�.. " GOLF CCYJ
1.40 9 e" 11 ° *a• , iia:
'v 117
`0�0y 1. 17AC%� ',n7 2.780 AC m 1�
98 r, 1.008 AC tOJ
1.425 AC g h 9 •• / } '
1.004 A y 11 ••'••.,• a
1.832 AC
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 y ears.
2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
, and water conditioner discharge into the system.
4. Owner agrees to limit greases, garbage
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
! onti ency Plan ,..
Option 1. If system fails, determine cause of failure, use a :ornate aria and install new
s em in tested replacement area.
Option #2. install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715- 386 - 46 80
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
FROM FAX NO. Dec. 09 2004 06:47PM P2
ST CROIX COUi�'
SEPTIC'r MAIN N FOAM
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Omar/Buyer
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f i ty� tws
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proper 1'°u�od'r 11 1 fix i
'vision pap # .
Sub11 -- Volume
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above C�� � � th , St. CCdx Coum
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761999
U 2 7 11 P 19 3
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Dough$ 1. Coltrain and Karla D.
12/88/2884 8i :08Pt!
Grantor,
Tamara L. Moore WARRANTY DEED
Grantee. EXEMPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00
the following described real estate in St. !Croix County, State of Wisconsin TRANS FEE: 315.00
pace is needed, please attach addendum): COPY FEE:
t 11 Troy Village Third Addition in the Town of Troy, St. Croix CC FEE:
ounty, iscons PAGES: 1
Recording Area
Name and Return Address
1 Cx� Q)C S T
�,
a4o- 11.57' �o-aoo
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this -� Y of December 2004
* * Dou . Colt
* * Karla # Coltrain
AUTHENTICATION CKNOWLEDGMENT
Signature(s) - uC�eC STATE OF )
) ss.
County )
o _c_o_
authenticated this day of N $
to Personally came before me this day of
December , 2 th above named
Douglas J. Coltrain and Karla D. Coltrain, husband and wife
--------------------- - - - - -- - -- - - - - - - - - - -------------------- - - - --- - - - - - -
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to m own to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Slats.) insto nt and ackno edg same.
t
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristin O gland__
Huds on, WI 54016 No Public, late of
My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) —_ – l )
* Names of persons signing in any capacity [[lust be typed or printed below their signature. tnfomsation Professionals Co., Fond du Lac, wl
STATE BAR OF W11SCONSLN 500- 655 -2021
WARRANTY DEED FORM No. 2 -1999
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