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HomeMy WebLinkAbout020-1353-61-000 ST. CROIX COUNTY ZONING DEPARTMENT-- _,,,.._ AS BUILT SANITARY REPORT ` Owner Property Address a City /State o Legal Description: Lot !::�/ Block Subdivision/CSM # /� %4 _S'r t /4, Sec. 3 T -RAW, Town of PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC/ / Setback from: House Well P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM / Type of system: el Width � Length ' 2Z75 Number of Trenches _c:>� Setback from: House , Well — P/L VZ Vent to fresh air intake ELEVATIONS Description of benchmark �. ^ / �,� Elevation Description of alternate benchmark L Elevation Building Sewer , /� /��.s� ST/HT Inlet Z4,2- ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines O 9zl zl O ( ) Bottom of System O . 2 97 ( ) Final Grade () Z7 Z () ( ) Date of installation ID / /9 nPe it number State plan number Plumber's signatur License number Date Inspector Complete plot plan � NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW Hatcs INDICATE NORTH ARROW r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) San it 3y4� Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)). Permit SON NGARY ❑ w6 aN9e ❑Town of: State Plan ID No.: CST B` Elev.0 Insp.B B Description: r a r PdreelOT20- 1353 - - 000 a 1 Wft- , U TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark to ,qo /U; 'a Zap, O Dosing y (3} N .5 0 e Aerati n Bldg. Sewer q6 Z. , 21 Holding St /Ht Inlet S I b2.10 I TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. ventto ROAD Air Intake Septic > X00 NA Dt Bottom Dosing A Header /Man. ;H b ;6 g� Aerat on NA Dist. Pipe Holding Bot. System 1 2` 9 1 PUMP/ SIPHON INFORMATION Final Grade 13. t - 4•-`i Manufacturer emand I }�1p o3.g0 Mo umber GPM TDH Lift L oss ion System ITDH Ft Fi cemain Length Dia. Dist. SOIL ABSORPTION SYSTEM 5 Lil- ENCH Width Lent No. f T nches PIT No. Of Pits Inside Dia. Liquid Depth DIM 3 7- a DIMENSION SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manuf er: SETBACK a-'"" " INFORMATION Typeof CHAMBER Model Number: System: NIKO + 02 "o OR UNIT JA Cw" DISTRIBUTION SYSTEM Header / //Manifold u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake LengtK Dia. Lengt Dia. pacing 7 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 E] Yes El No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 36.29.19.2061,NE,SW 622 ALICE CIRCLE E) , Q re� S'A � Plan revision required? []Yes 0 No Use other side for additional information. O3 Oa co - ( L SBD -6710 (R.3/97) Date Inspector's Signature Cert. No I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t 3 P t } E t f } 3 5 i e R } 6 f F � i s a 3 } e � E E " s „s« a 1 I E 3 4 [ ... o° ve.....� .. "m...a .. ... }. .e.w_ 3 .,....... s ..�:"...� ...., a „_,. ": ,.. ...� ...... B s a E # & k gg } W } i t gym.. .... .�, .....a.< "... P re m _. m ... .._ m ,� f t L r..� �. .. �. 1 x .."q 1 # z qq v . ..,� �,�...�. P. a� " ��..., ^s ry e �.. ” . _ r m_„. "m " " g . ,:aa } a _® 3 t � • s � �a �. ,.._.._. .a ._ �,,..._..�..�.. w ......v. ..,. �..�....._m ....�,d...a.. d.. ..��.__.�...�... w, � W .Ua_ ...__„.��.� .. .�.._.... ._. __ . � .. .,.__ �,a....... e. w,.a._... _......_,.�., aw.._..s,�. Safety and Buildings Division �SANITARY PERMIT APPLICATION 201 s. 0 Washington Avenue N Depattment of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ' • See reverse side for instructions for completing this application State Sanitary P t Number Personal information you provide may be used for secondary purposes [] check if revision to previous application (Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop" Owner Nam Property Location 1/a 1/4, S T , N, R (or)N Prop rty er s iling A ess Lot Number Block Number City, to Zip Code Phone Number Subdivisio Na a or CSM Nu er I �c LT-�/z ( ) — 11. P BUILDING: (check one) ❑ State Owned El it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 1_ row OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(,) D2v 135�j� b l —OOc� 1 ❑ Apartment/ Condo.?a .l9.2are1 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. a New 2 _ Q Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5_ Q Repair of an System System Tank Only ^ _ ExistingSystem Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 [] In-Gr and Pressure 42 ❑ Pit Privy 13 [] Seepage Pitg� r 43 ❑ Vault Privy 14 E] System $ .+ VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5_ Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed ((sq. (Gals/day /sq. ft_) (Min 1i ch) Elevation yy Feet Feet Capacit Vil.- INFORMATION in gallons Total # of Manufacturer's Name Prefab- Con- Steel Fiber- Exper. Plastic Gallons Tanks Concrete glass App. New Existing strutted Tanks Tanks ft Septic Tank -- ® ❑ ❑ ❑ ❑ Cl Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for in allation of the onsite sewage system shown on the attached plans. Plumb s Nam p: (Pint) Pl�r's : (N tamps) MP /MPRSW No.: Business Phone Number: Plu ber's Address aniet, City, State, Zip Code IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater at Issued Issuing A t Sig ur (No arrl�s) Surcharge Fee) Q g� 1 roved Owner Given Initial Ix 7 ` G Adverse Determination ✓� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation S. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 -266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. if. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type_ VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIIL Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following, A) plot plan; drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. L sa Jo / 99 y3 �s sW � /T 4 V �Pvl 3 33' Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and _ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # APPLICANT INFORMATION - Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prope Owner Property Location Govt. Lot 1/4 1/4,S T N,R E (or)l 15 Ij 'dgr a ) Property er's Mailing Address Lot # Block# Subd. Name or CSM# L City State Zip Code Phone Number ❑ City Village , ?f � Town Nearest Road V3 New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/fl trench, gpd/ft Absorption area required bed, ft �(Q trench, ft Maximum design loading rate 1 ;Z bed, gpd/f gpd/ft Recommended infiltration surface elevation(s) 9� ft (as referred to site plan benchmark) Additional design /site considerations Parent material ��� Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ❑ U El S El U El ❑ U El S El U ❑ S ❑ U [Is ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Ou. Sz. Pont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench ,..::: r g zs Ground -� elev. S 7 Depth to limiting factor Remarks: 3 - :nA / S,L� 7�S"X�e% Boring # nx , 127 Z) Ground z' - elev. Depth to p limiting factor ?,�in. Remarks: - I' vn CST Na (Pie a Print) Signature Telephone No. Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER Page_ of -S PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Con Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench ,S Ground 3 S elev. Al Depth to i limiting factor Remarks: 77 — Boring # Y r Ground _ elev. Depth to " limiting factor / Remarks: ,��,�,� /�1 .,�f �; - s,.1, Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; 3 7� 1 s' Ground — elev. / Depth to ' limiting factor in. Remarks: Boring # Ground elev. tt. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) l 3 i V jSo l I 4 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureat{ of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - 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 Govt. Lot 1/4 1/4,S T N,R E (or) W Property Owner's Mailing Address Lot # I Block# I Subd. Name or CSM# 6` Co1'To V-.r pC=" 4::� City State Zip Code Phone Number g �� ❑ City ❑ Village Town Nearest Road RoAID N E New Construction Use: © Residential/ Number of bedrooms 3� Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow LK V gpd Recommended design loading rate bed, gpd/ft trench, gpd1ft Absorption area required bed, ft trench, ft2 Maximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design /site considerations Parent material C>LvT --J/*4" Flood plain elevation, if applicable N I Pt ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system © S ❑ U ®S ❑ u ©S ❑ U [as ❑ U I ❑ S [} U EIS B U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench { love- �/ ^-� �. t Z ti.sy►- I,� r to -Z7 j ,> 14 1 V htc - -�" ,,�/ S� I z w.s h�F � . S" ; • ca Ground 2737 3 n�t2 ��1v �`lY Eii 12. hnt C tj elev. ft. 2G S to i G tAj Depth to 4&.1 7 5 `�^ S l h .r// - ; limiting factor ��jn. �1o,+2/ j //P - t c/ „ I RA w � ab s 4 ;00 , C. Remarks: ! Boring # e- . k- v ' `'rv�.e -'- � d'S C_ fit' S / l l j4 it' — i/ G�u� G / Ground j eta �� �j',v�o fYrtits Ge�L� elev. I Depth to limiting IO factor in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number l SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# ` Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground , elev. ft. ' Depth to limiting factor in. Remarks: Boring # :.... ......::.............. ..................... Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; 13 Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) w cd*!i Department of Commerce SOIL " VALUATION Division of Safety and Buildings i } Page of Bureau of Integrated Services in accordW*p, vVith s. ILHR- 83~09; Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 �f►cfres in size ? rTif County include, but not limited to: vertical and horizontal reference pant (BM), direction and C percent slope, scale or dimensions, north arrow, and locati and di r 6b ta)ngareF,t, road Parcel I.D. # APPLICANT INFORMATION - Please print all XYM ma lr A Re ewe d y Date Personal information you provide may be used for secondary purposes��nvacy Law s. 15.64'(If'�m)j. , 9 A A . 7 f G� Property Owner N ,,�' ,' Propgrtyation t.. . of t il4 1I4,S T IC N,R E (or)( Ri Oirc1 S +ovi+ �` sw 3� `1 Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 1353 ke 4r. (01 cniAonwoad Pik e_, City State Zip Code Phone Number ❑ City ❑ Village [A Town Nearest Road O n oILQ I )6Hq -t0� 4 u s r) I C 2d. N New Construction Use: 9 Residential / Number of bedrooms 3 -4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow � gpd Recommended design loading rate 5 bed, gpd /ft trench, gpd /ft Absorption area required _/ oU bed, ft !W trench, ft 2 Maximum design loading rate bed, d /fit gp b trench, gpd /ft Recommended infiltration surface elevation(s) 99, 6 0 It (as referred to site plan benchmark) Additional design /site considerations 0oA-I o r e_ (e .J. 9 Parent material G,06 bLAA Wt1 Sh Flood plain elevation, if applicable il441�: It S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for s ❑ S Y U �l S❑ U El D u El s 1 u ❑ S [� U ❑ s [] u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench I 1 0-13 i0 r 3 2 Sil �mabK L 1 5 to 2 13 3� 10 - y S. mctbk - fir C5 5 : (o Ground 3 B IAS 10 j r - Lj 3 C . r L4/(o Nfcry) me C( C S elev. f 6 bU ft. Depth to limiting factor 3 in. Remarks: Boring # i 0- I r 3/ -- Si i a r) 2 2 II_43 i© r y 5f I 2-rM m - (n r C5 S 3 t&d) ID r 4-I 3 C2-P - 1,5 ryllo 3vc e—f1 CS Kip NA Ground elev. 9�d ft. Depth to limiting factor min. Remarks: CST Name (Please Print) Signature Telephone No. - cjc.m Schv 4Ner L 2L{ 7- UD Address Date CST Number 1 -4U`6 L,,V - c, ='`'f 1..) 59olz - `1 2533oI PROPERTY OWNER S C, SOIL DESCRIPTION REPORT Page 2 of PARCEL LD.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots f� Bed Trench 3 I o -t - 4'r Z lo- 10 Si I 2 1 L Ground �' 2k -A4 I 0-5 CS elev. 9- � -ZOff. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to , limiting factor in. Remarks: Boring # .......................... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) C c 4 4aiaLuraoci , •d rn I�eJ lop. -rap o.F I '= Qum P. pC sw �z Q lev. Rq. ct . 133 QI r v 1 1 • c3Z , 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM - Owner /Buyer /�/�i y tiL SON Mailing Address /60 Property Address (Verification required from Planning Department for new construction) City /State � h) Parcel Identification Number o,;� I 1 / d 2,o —(SV LE GAL DESCRIPTION Property Location ,&— Sec. T a _ N -R� W, Town of Subdivision ,s�,��, , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # �Y7�S Volume , Page # Spec house A yes ❑ no Lot lines identifiable g yes ❑ 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 wastewater disposal 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. 0/ & / SIGNAT E F 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, e SIGNATU VIF 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 /a STATE BAR OF WISCONSIN FORM 1 — 1982 6047$5 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. rfy 14 �� ST. CROIX CO., WI RECEIVED FOR RECORD This Deed made between RTrT4ARD -0 1 STOUT and 06 -11 -1999 10:00 AM JANET P_ ST_OTTT hrshasdand wife, WARRANTY DEED EXEMPT # Grantor, CERT COPY FEE: and GARY n_ NP.T.SNand •7ILLIENNE a NELSON, COPY FEE: h u s ha n d an wig TRANSFER FEE: 107.70 RECORDING FEE: 10.00 PAGES: 1 Grantee, Witnesseth That the said Grantor, for a valuable consideratio i rt v —f i Ve thousand nine hundred and On 1 dollars conveys to Grantee the following described real estate in $,.#- _ ['rOi3G THIS SPACE RESERVED FOR RECORDING DATA County State of Wisconsin: NAME AND RETURN ADDRESS Lot 61, Plat of Cottonwood Ridge, Town of EAQLF...\A•LLE.Y BM. K,.N A— Hudson, St. Croix County, Wisconsin. 1mandbaftllht2 FN{,i+ot�oolr1,1�0i11 �Fplffi 020 - 1110 -20 -000 PARCEL IDENTIFICATION NUMBER This i G not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Rirharri it Stoi - it and Janet P_ Stout warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, rights -of -way and covenants of record, if any„ and will warrant and defend the same. Dated this 2nd day of June , 19 99 Richard n_ Stntlf (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Cr County. authenticated this day of 19 Personally came before me this 2nd day of MARLENE K. LiFv'N ,J , 19 -9-g— , the above named $h t.y R a rd 0 StOUt and Janet P. TITLE: MEMBER STATE BAR O WISCONSIN Y �� (If not, authorized by §706.06, Wis. Scats.) to me known to be the person s who executed the foregoing H g C inst ent an a he s e. Jan eltlN�TRUI§ENOTUAS DRAFTED BY (� Y� 1353 Awatukee Tr. . 14&, -Ie e Lin Hudson, Wi. 54016 Notary Public, d t y County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commts ion is permanent. (If not, state expiration date: necessary. �.�Ig /oACO� 19_ ersons signing to any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wpw sin Legal Blan Forrn No. I — 1982 Milwr Li C/ 300 Yaa� ¢a �-o = I U D O! \ Z F— 11 ►� W Q —1 %D OO Cl W � -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --� - --- •-- •-- •-- •-- •- - --- -- - --- ---- -- -- -- -- -- - -_"7 Ld W 1 00 P-i M �'' N co q* CD! Z i tV Of i •� / cu 3 "ob ih N cn I� N - -- / cq _ - -- __ I na� M.,80.OE.00N 1,i� 7 / $ N 1 i f ti cq N 0) i i...... OD U) W U ; x p N 1[I ^ Irr I 1 C i r 2 jo N DO •00, li,j O Ile i IW -- -- -- -- — -- -- -- -- - -• -- — - —f--- -- -- - -• --7 =°, I ICS C d i . ix I � � � N I I � ` lam" � �"'��.• �h h � �W p M N I I � r W IC I M co Z ! W �1 Z << z cu t�i a M j Nii 4n i a Z cc 40 I ! Z I I (� r I S n I I ............................. ' .......... . I i..................... 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