Loading...
HomeMy WebLinkAbout020-1295-80-000 ST. CROIX COUNTY ZONING DEPART AS BUILT SANITARY REPORT {fi V Owner Address A e '�^ v 'f i 19,9 City /State 1� P 0 ' .,..: C O =uarx ,'. Legal Description: Lot Block Subdivision/CSM # 1 '/. 0'/. NIJ, Sec�Y, 1 N -1 — W, Town of %t V PIN # SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer L1 ?5 0 STIW� Setback from: P � House D Well /� . P/L a 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: L 4121 Width Length Number of Trenches Setback from: House Well PAL Vent to fresh air intake ELEVATIONS Description of benchmark ���� ,��a Elevation Description of alternate bench ark Elevation Building Sewer �•--�,3 ST/HT Inlet /�•/ ST Outlet PC Inlet PC Bottom Header/Manifold / 0 Top of ST/PC Manhole Cover -' d Distribution Lines (2) / �� �4 (� 93, 53 Bottom of System( ) Final Grade ( ) ( ) ( ) 5 1 S - 7 7ojqe5� C Date of installatio ermit number ��� State plan number Plumber's signature License numbelc l Date X1 Inspector T'ji�a!", Compkle plot plan .r 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 ,OD.O Q.IN1, � 1 30 "no )6 fbv tt COOttn �l C INDICATE NORTH ARROW FMIK , sinepartment of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT S4, o GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: P information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 315 Permit Holder's Name: ❑ City ❑ Village &Town of: State Plan ID No.: S o v w i I CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA 4980402-6 / TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �ZO Bench r 1.13 101 d /6 Dosing utnbi a d t *1Z AA 3 5�3 97 7 Aeration Bldg. Sewer g 93.7j Holding 62* Inlet g;9-7 g2•J� TANK SETBACK INFORMATION �/ t Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ,b' Nl,.. 3p' 'v�•l NA Dt Bottom g Dosing It K Z40 ' NA Header / Man. 4.3 9�. Aeration NA Dist. Pipe r R Holding `'� Bot. System 8 65 PUMP/ SIPHON INFORMATION Final Grade rrl.�x . _54Z 90•/ Manufacturer (�?cv05 Demand 3 9�.3L Model Number � (f 'j7-4 TDH Lift �O -�j Friction ,,% System TDH 7.�Ft Fi rForcemain Length �r Dia. Z Dist. To Well SOIL ABSORPTION SYSTEM BED / idth Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /00 DIMENSION SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LE HING anu a SETBACK CH MBER INFORMATION Type I` f odelNumber: Syst �L W 14- OR UNI DISTRIBUTION SYSTEM .t (, Header /Manifold DistributionPipe(s) x Hole Size x Hole Spacing Vent To Airintake p, N Length .C/ Dia. Length fQ� , 9ia. � 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 ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) aj l c� �P Plan qrvis egLli ed? Yes E] No Use other side for additional information. to l ibl F SBD -6710 (R.3/97) Date Inspecto ' Signature ert. No • Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Bujldings Division Count INSPECTION REPORT ST— CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: Personal information you provice maybe used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 3 1 5873 Permit Holder's Name: ❑ Cit pp Village Town of: State Plan ID No.: SOUMIND P ILUERI$ "1140. H[)I,�SON CST BM Elev..- Insp. BM Elev.: BM Descrip Parcel Tax N& 02- 1295 -80 -000 VYA J+ TANK INFORMATION ELEVATION DATA A9800261 TYPE MANUFACTURER CAPACITY STATION BS 11 HI FS ELEV. Septic 2t)D Bench '.�j 1 DI.) Dosing ` 5 4 3 7 Aeration Bldg. Sewer T33 -3, Holding \ St/ Ht Inlet 1 47 - 7 4 , TANK SETBACK INFORMATION St/ Ht Outlet T NK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic Nj� 3 �. NA Dt Bottom 2 � Dosing NA Header / Man. -2j5 1 A n NA Dist. Pipe 1 Holding Bot. System 1 a PUMP/ SIPHON INFORMATION Final Grade S°z- Manufacturer �' Demand (XbM 3 V Model Number <��Q GPM TDH Lift �, Friction System TDH Ft oss H ead Forcemain Length' Dia. Z Dist. To Well SOIL ABSORPTION SYSTEM BED TR CH Width r Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN W DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHIN Man INFORMATION ypem 1ZI N � ORU d el umber: S ystem: DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) 4 ) x Hole Size x Hole Spacing Vent To Air Intake Length ` Dia. Length M n 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 ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) - J HUDSON 4.29.19,NE,NW 865 MCDIARMID DRIVE - SUNRIDGE LOT 45 c C - l j�� )A[� 61VI Plan revision required? Yes Q No Use other side for additio r SBD -6710 (R.3/91) Date Inspector's Signature Cert- No Vs SANITARY PERMIT APPLICATION Safety and Buildings Division 20 1 E. Washington Ave. Department of Commerce In accord with ILHR 83.05, Wis. Adm.'Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County Q�t than 81/2 x 11 inches in size. ,4 . • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs 3115 g� ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Pro erty Owiper Name P operty Location Al 1 /1 /a Nk 1 f T �9 , N, R E (oqo Property caner s ailin Address Lot Number J Block Number t S 7,0 K iSt ate Zip Code p; ty ��� Subdivision Name or CS Number YPE BUILDI (check S ` Il one) ❑State Owned ❑ it� 1 rest Road Public 1 or 2 Family Dwelling - No. of bedrooms o oF �GIdS0;1 W e J o Al jqr DQ', 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) — 1 E] Apartment/ Condo & • 01 1 q. f f p 9 Q � 0 `- `a " q 5 — go E] 2 Assembly Hall 6 [] Medical Facility/ ursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 Q Restaurant / Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 Q Service Station/ Car Wash 5 ❑ Hotel /Motel 9 Q Office/Factory 13 Q Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. U New 2 Q Replacement 3. Q Replacement of 4, Q Reconnection of 5. ❑ Repair of an ____ -System ___- System -------- sn _m----------- Tank Onl ---- - - _ - - _ TankOnl Existing System Existing System B) E] A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11171 Seepage Bed / 21 El Mound 30 E] Specify Type 41 ❑ Holding Tank 121 Seepage Trench 3" S! �C�b0 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13.Q Seepage Pit I j� Vault Priv 14 E] System ®1^ gun `S 43 `r f � t �N r/ r�jrCt �jj-� ❑ Vl Pi Y 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 Req D (�q_ ft.) Proposed (sq. ft.) (Gals/d y sq. ft.) (Min. /inch) rr'3,$�Q v, S' Eevati�r�, 31400 Feet Y XX �eet VII. TANK Capacity , INFORMATION in gallons Total # of r Prefab. Site Fiber- Ex er. Gallons Tanks Manufacturers Name Con Steel Plastic p New _ F Gallons Concrete strutted glass App. Tank Tanks Septic Tank or Holding Tank ��(� © ( S Lo 5 ® ❑ Lift Pump Tank /Siphon Chamber O VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility f r installation of the onsite sewa shown on the attached plans. Plumb r's Name: (Print), Plu Signatur o t mps) / Y� 9 Busi ss Phone N mb Plumber' Ad o`�' S eet, City, St ip Code � � IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issue Issuing Agent Signature (No Stamps) Approved []Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6388 (8,11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber • r r. o cu D T� gt �o Q ay n �2� loin 41s Vlc C[ go ' �D �a M IV I �o �3 ��d�on `fic+�h ski a� 7y�� Combination Sept c;Tank and PUMP CHAMBER CROSS SECTION. AUD SPECIPICATIOUS PAGE S OF -VEIJT GAP WEATHER PROOF JUIJCTIOU eoX . H "C.I. VEKIT PIK APPROVED LOCKIMG lO' FROM ODOR. MOWHOLE COVER A01'M ,AUOOW OR FRESH Tti+1�RI.JIW6 L- N�6EC.. AIR IIJTAKE emiDul < r Cl. Y OZ � � raR/1 I Y� MIU• • I � "" IB�rtluu r. . �� y PIPS PROVIDE ( - - -- IAJLET AIRTIGHT SEAL APPROVED JOIN A I F I APPROVED J011JT. w /C.T. PIPEaR Tank construction I I W /C.2 PIPEORPUC shall comply with I I I ALARM ILHRX 2;3.15 and 33.20 d j i I I OIJ C I I PUMP OFF 0 COMCRETE a BLOCK RISER EXIT PERMITTED OIJLy IF TAW MAIJUFACTURER HAS SUCH APPROVAL 3E +F' BF.OD t DDit4 N!4 SEPTIC f SPCGIFICATIOUS 00SE 1''11b1.JLTL' J P \ ': "` 3.15 TA1JK MA►JUFACTURER: NUMBER OF DOSES: PER DAy TAWK :,IZE : �'7'UV Z `30 7 GALLONS DOSE VOLUME 1 ALARM MAUUFACTURLR: INCLUDIM& BACKFLOW: ZL GALLONS MODEL IJUMBER: CAPACITIES: A= ` 9 IUCHES OR LIb0.0 GALLOIJ S SWITCH TvE.: �' 5= Z INCHES`OK G61 -LOUS PUMP IAAIJUFACTUREK: GUV\- S C- 8 INCHES OR NbS'y GALlous MODEL NUMBER: k.,:P O y 0c INCHES OR 1 "' S CALLOUS wl�z c `t o`�recl. = 0 a o ,0 SWITCH TYPE: - �� MOTE: PUMP AUD ALARM ARC TO bE MIMIMUM DISCHARGE RATE 31 ' g y GPM /INNSScT�ALLED OW 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEIJ PUMP OFF AUD.DI5TRIBUTIOU PIPE.. FEET G'3 + NETWORK SUPPLY PRESSURE . . . . , .. . . . , FCET ? ."1 Y FY ) � j J� z-'�-+ -I- FEET OF FORCE MAIN X oFT.FFLICTIOM FACTOR-- .f�"•i FEET .q`o TOTAL 09MAMIC. HEAD = FEET 1.up Pump chamber DIAMETER - 3a y IMTERLIAL. DIMEIJSIOIJ� OF TAUK: LENGTH ;WIDTH - ;LIQUID DEPTH BOTTOM AREA - 231= GAL /INCH AS PF.R MANTTFArTTTAT+` 1 n c r_rT / T NIOW Goulds t Submersible a Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully 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. dry without damage to heat transfer. ■ Motor Cover. Thermo las- • Effluent systems P • Homes components. tic cover with integral handle Motor Available for automatic and • Farms manual operation. Automatic and float switch attachment � � models include Mechanical • Heavy d sump • EPO4 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 points. • Water transfer Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at factory. t the automatic reset. rated oil and water resistant. • 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 construction. ■ EPO4 Impeller. Thermo- • Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING 3 /4' maximum. • Power cord: 10 foot with pump out vanes for • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SP Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding M EP05 Impeller Thermo- • Discharge size: l' /x" NPT. plug. Optional 20 foot P (GSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in 'P' or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. 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. • Capable of running — t - — dry without damage to s 30 scP,n components. Pump: EP05 k 2s Fr - - - - -- • Solids handling capability: c 7 25 3 /a maximum. w 1 _ - -- - - - - -- • Capacities: up to 60 GPM. _ • Total heads: up to 31 feet. 0 6 20 i • Discharge size: 1'h' NPT. z 5 - - - -- - - --C - -- -- -- - - -- • Mechanical seal: carbon- 0 15 rotary/ceramic - stationary, j 4 BUNA -N elastomers. ___ 11� Temperature: o 3 10 104 °F (40 °C) continuous 140 °F (60 intermittent. 2 5 � t 0 0 20 30 40 50 GPM 0 2 4 6 8 10 12 m CAPACITY Wisbonsin Department of Industry SOI _ SITE EVALUATION i Labor rind Human Relations r Page of Division of Safety and Buildings irr ce with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than ti 1/2 x JA in size. Plan must County Include, but not limited to: vertical and horizontal refererice .1413M), direction and S T, CP percent slope, scale or dimensions, north arrow, and location and distance to nearest r Parcel I. D. # APPLICANT INFORMATION - Please print all information.y1 Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (T Property Owner ity Location �AME$ Y U 5 "�✓ ./ ;' b� vt. Lot /(/� 1 /4 ,{f(v 1 /4,S 21 T2 ,N,R E (orrW Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# I q/� 3 R� ST yS Sav,Pi l�lr�" City State Zip Code Phone Number Nearest Road H v/?SoA✓ 3F( 367/ ❑ c it y El Village [� Town D New Construction Use: [D / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd /fl2 • T trench, gpd /ft Absorption area required �� bed, ft 2 esoo trench, ft2 Maximum design loading rate bed, gpd/ft • ✓ trench, gpd /f1 Recommended infiltration surface elevation(s) s � p i 3 ft (as referred to site plan benchmark) Additional design /site considerations !�E -�GGl S J;" /t/ 721 5 , Z Parent material JG✓c' ✓`9 s�ewS 45 5.¢77 E ` Flood plain elevation, if applicable ��i ft ova s 7 7 S = Suitable for system Conventional Mound [a- In-Ground Pressure AT Grade System in Fill , Holding Tank U = Unsuitable for system � S 1:1 U ❑ S L�'J S ❑ U ❑ S LI U ❑ S [B U ❑ S cay "f %A�r '� S �� SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench /.. r,) -2-0 /o ,e // A p 4r Vf C S / f N N Ground Z 7-5�� �sLi S ///� y , • S elev. / 10 ft- Depth to limiting UGj�a factor Remarks: Boring # CDy tin !/fi ` C s ///� N N Z _ 2- 2 o ( 2- 3 s/ / �sd,� ►fie s //i� y ; • S Ground / o FO J`�/ 2 �C • y , • 7� elev. Depth to limiting factor � 'in. Remarks: CST Name (Please Print) �D QE g r Signature Telephone No. 2t T /.5�3,?(; -F/F5 Address Ulbricht & Associates Date CST Number Private Sewage Consultants egg O'Neil Rd. Hudson, Wis. 54016 ORIGINAL SOIL DESCRIPTION REPORT PROPERTY OWNER Page 'of 3 PARCEL LD.# Lo T y Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots R in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench /o /,e 3/z- co,V Z s// If Al nh U I z ,2 -zs io YP CS /-f , s ; Ground /d yiP 7 /�p S'� /f f� �J17c/ a -� / • 7 elev. / G Depth to limiting ; factor y in. Remarks: Boring # /f V "O // -za /0 ye y/3 s //, �fs� // .� W 16e Ground J 0 - 0 3 S/ elev. .Zli,C£fC, - / .4e Depth to limiting factor 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 # �- 17- 24 j al 3 S / fJ e fie cs Ground - l /� /.f y� s/ J`�//,� ilN a� r ' i ( •S elev. / 7 /O ft. �/ �/ // 57i1°GGf f s/ T ! a • �' S Depth to , limiting factor > �2 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor In. Remarks: SBDW -8330 (R. 08/95) IMPORTANT NOTE TO OWNERS & INSTALLER: All the finer textured soils (loams,silts, etc.) can & will be easily smeared Or compacted even by a backhoe bucket during trench construction. When this occurs premature failure will result. As per ILHR 83.13 (4), the installer MUST be very careful to properly hand rake the w J �,. ttoms to re- expose all of the soils natural stru ( 0 1 6 0 , en recommends that scarifying devices be mout d to si es of the bucket. Only in this way can treatment & absorption be most enhanced for normal longer system life. k n �aT of _ '4 osT P i lea • 6or ys l u s� y� M fo CA Ce� 90 ti = /3 r4 c�'�e A - TS l 10 S srArEv k lo II, � y3 � I LtD�SIFS�TE I 13 r elf 1 i b3 1 \1 \ SU V�TiO�S v � E \ d B3 2-O Bq L1 NA �W �- _ �� • 3 a f 3 J r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 7 3D la �� ?a� v , Mailing Address 3d l k . ���� &1�G� ,(JLa' /fit!`C Property Address 0 ! a r g, a 4 (Verification required from Planning Department for new construction) City /State SOY! b, F Parcel Identification Number �� LEGAL DESCRIPTION p �� Property Location/ ' /4, 1 ' /4, Sec. , T�N -R l W, Town of Ilya Subdivision Lot # I . Certified Survey Map # , Volume , Page # Warranty Deed # :5 U ! ! , Volume /3 3 J ( , Page # Spec house N yes ❑ no Lot lines identifiable C 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. 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 the St. Croix County Zoning Office within 30 t: f the t ' SIGNAir OF 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 roperty d cribed above, by virtue of a warranty deed recorded in Register of Deeds Office. K /a 1 / 90 SIGNAr OF 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 pn VOL $80954 STATE BAR OF WISCONSIN FORM 2 — 1*0 WARRANTY DEED DOCUMENT NO - - OFFICE Gary L. Augustine, �' - ST. CROIX CO., WI Rbc'd for Racmd JUN 15 1998 conveys and warrants to Southwind Builders, Inc. , I 8:00 AM a Minnesota Corporation Ra >sf�r of D��ds I THIS SPAC R FOR RECORDING DATA '� NAME AND RETURN ADDRESS J the following described real estate in St. Croix Camay; �fJ/ State of Wiscons;n: ( �/ y 020 - 1295 -80 PARCEL IDENTIF,CATiON NUMBER I I I 1 I Lot.45, Plat of SunRidge II in Town 1 � of Hudson, St. Croix County, Wisconsin. s TRANSFER FEE I This is not homestead property (is) (is not) Exception to warranties: i; Subject to easements, reservations and restrictions cl record. il I� Dated this ! day of June A.D. 19 �i I1 (SEAL) (SEAL) GAR _ AUGUSTIN Ij (SEAL) (SEAL) I j N r I I AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, i{ ss. it St_ Croix County. I +' authenticated this day of _ 19 i i ` Pers ru v came before me this ay of J 1 ^_,c 19 98 , the above named Gar L. Aug ustin e TITLE: MEMBER STATE BAR OF WISCONSIN _ (If not, - '.- as- - -- - -- authorized by §706.06, Wis. Stats) .. 4 to me ka-�s 1.� be the person who executed the fore tr�arurne ar " o le the same. THIS INSTRUMENT WAS DRAFTED BY A i 1^ ` ; fi ►�,:.:. STE PHEN J. DUNLAP — _ H udson, Wisconsin — Nary. PL:iL St- Cr oix _ Count); Wis. (Signatures may be authenticated or acknowledged. Bah are not My com— -- r<,n s�germanent. (If nut, state expiratio Ila necessary) L✓ ' Names of p<•r »ns >grnna in ary capacity should?+v typ<•d or pnntrd brim. I'a:r si�nuiures. _ _ WARRANTY U[ED STATE EAR OF WISCOSSIS vvwa.n Logy B+ar* Co. Irc Form No. 2 - 1982 Mnva*ce. ws.