HomeMy WebLinkAbout018-2019-53-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s 15,04 (1)(ni
Permit Holder's Name:
City Village Township
Jeff Husby
TOWN OF HAMMOND
CST BM Elev: ,
Insp. BM Elev:
Description.
. 33
0
IBM
�. V-1 ea"r 9 r"Z
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
11
cr.Q -
Dosi
Aerati
I
Holding.
TANK SETBACK INFORMATION
MM-FsJ
mr.0 mm
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
TDH
Lift
Fr' ti Loss
System Head
TD Ft
Forcemain
Le gth
Dist.
6Zi71�\-�Y��s�i�[�7►�y����t�e
ELEVATION DATA
County. St. Croix
Sanitary Permit No.
641994
State Plan ID No.
Parcel Tax No.
018-2019-53-000
Section/Town/Range/Map No.
29.29.17.1253
STATION
BS
HI
FS
ELEV.
nchmark
w t A .
�• `�
(� � %
O Ste. �v '
Alt. BM
Bldg. Sewer
St/Ht Inlet
DQ
o11. LO I
St/Ht Outlet
h •�
• O�/
nlet
Dt Bottom
Bader/Man.
Dist. Pipe
Caw
e
Bot. System
Final Grade
St Cover �y� cotpee
�7 $
'f2,b$
D •4�/
I,O
�
r •
i
BED/TRENCH
Width
Length
f Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
DIMENSIONS
SETBACK
SYSTEM TO
P/L
BLDG
LL
LAKE/STREAM
LEACHING
Manufacturer:
INFORMATION
CHAMBER OR
UNIT
Type Of System: v
Model Number:
DISTRIBUTION SYSTEM �---�
Header/Manifold
stribution
x Hole Size
x Hole Spacing
Vent to Air Intake
Pipe(s)
i
Length Dia
Length Dia Spacing _ I
SOIL COVER x Prassura Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
x Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
gp
7T,
soil
I- '' Yes No
!Yes No
404ion:
M T2S� (Inclij:Vud code discrepencies, persons present, etc.) Inspection #L / /1z/ Inspection #21617 75T AVE
1.) Alt BM Description = of
2.) Bldg sewer length = z c it
- amount ofcover
2 . v 6,1 S T.
9
Use other loside for uadditional reformation. No------ ----- -.- ----�/ __ -
/Date Insepc or's Signature ' Cert No.
SBD-6710 (R.3/97)
<AN'�t0.)-1C Y
/-�/ `•�
Industry Services Division
4822 Madison Yards Way
County
St. Croix
.
J;l=' 0�
_'_
O`l{ ison, WI 53705
t3 �'
Sanitary Permit Number (to be filled in by Co.)
' ?
.O. Box 7162
Mi n WI 53707-71
8.4r F,
b 1
Sanitary Pef*i ° cation
tateTransaction Number
��
072001438-C
In accordance with SPS 383.21(2), Wis. Ad . CtQd@ mission of this form to the appropriate ental unit
Project Address (if different than maili dress)
is required prior to obtaining a sanitary ote: Application forms for state-owned Poven are submitted to
the Department of Safety and Professions ervices. Personal information you provide may be used for secondary
1617 75th Avenue
purposes in accordance with the Privacy Law, s. 15.04(1 )(in), Stats.
I. Application Information - Please Print All Information
Property Owner's Name
Parcel #
Jeff Husby
018-2019-53-000
Property Owner's Mailing Address
Property Location
316 Kamloop Place
Govt. Lot
City, State
Zip Code
Phone Number
River Falls Wi.
54022
715-222-9731
'�,' ''•' Section is
T 29 N R 17 E or W
11. Type of Building (check all that apply)
Lot #
Subdivision Name
PIT or Family Dwelling -Number of edrooms 4 A
53
as per P )
Block
Rolling Hills Farm
�ubliclCommercial -Describe Use
❑City of
❑State Owned - Describe Use
Elvillage of
CSM Number
[ZITO— of h1g, vr► •a- -W ti
111. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if
a licable
A.
Mew Syst
nReplacement
System
❑Other Modification to Existing System (explai oA itional Pretreatment Unit (explain)
LLJJ
of 600
B.
❑Holding Tank
❑In -Ground
[:]At -Grade
Mound Individual Site Design
POther Type (explain)
(conventional)
i Z%4
C•
❑ Renewal Before
❑Revision
hange of Plumber
❑transfer to New Owner ist Previous Permit Number and Date Issued
Expiration
624935 8/19 / 2020
IV. Dispersal/Treatment Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
Dispersal Area Required (sf)
Dispersal Area Proposed (sf)
System Elevation
Existing
Capacity in
Total
# of
Manufacturer
y
Tank Information
Gallons
Gallons
Units
U
y
New Tanks
Existing Tanks
'E U
in N
Septic orBottling Tank
400/921
1
Wieser/Hoot
✓
Dosing Chamber
❑
❑
V. Responsibility Statement- I, the undersigned, assyme resp ibiFty r installation of the POWTS shown on the attacked plans.
Plumber's Name (Print)
PI r.sSi a
MP/MPRS Number
Business Phone Number
Keith Knudtson
648443
651-470-1737
Plumber's Address (Street, City, State, Zip Code)
927 150th St. Roberts Wi. 54023
VI. County/Department Use Only
Approved
❑ Disapproved
Permit Fee
Date Issued
Issui g Age` ignature
❑ er rven Reaso for Denial
/Zoz Z
�pr�
./�
�-
Conditions Approv '� 1 -_ �a
SYSTEM O / V
1. Septic tank, effluent filter and
/
dispersal cell must be serviced / maintained �L
as per management plan provided by plumber. Lt) poor, MLL -fie. cexvd' Ak
,2. All setback requirements must be maintained n 1,
as applicable code/ordinances. �` j o ye&K , a,^
per
.� P. A.4--,6e vbe. e_ s ct/ 640-t
AttA�coa plans for the systemsand s///u���b���..mit to th .ounty onlyonp �er not less than 51/2 x inches insize
-SBI U4391�5 3/21) 4)` c zM (.ems -tS -� "^°e'a`°� �'°^'S `Q `lW
a
� z> -
�a��«� t��--ram -
//ck Yb /14 6 FIELD WORK COMPLETED: 4135/22.
rra�rH
75TH AVENUE SCALE:
0 40 80
85.26' ELEVATIONS SHOWN ARE
B B NAVD 1988 DATUM,
t�
V T. .. m T.048
=1LI0.1 a 3076.4 LEGEND
T.Q.H. LEGEND
1077-�8� 60D NAIL SET AT 10' OFFSET OR
ON 13UILDING WALL EXTENSION
M
26.0
N g p FOUND 314" IRON BAR
i 1 &0 � '6 i 7'
T.O.N. TOP OF NAIL ELEVATION
16.0
t HOUSE a T.O.B. TOP OF IRON BAR ELEVATION
t 44.0 0 -- -� --- --- — -- DRAINAGE & UTILITY
--- __^ �_,. - EASEMENT
�_i DRAINAGE EASEMENI
T.O.11.=108i.22 �O X 100.0 EXISTING SPOT ELEVATION
BUILDING SETBACKS:
wo` OD N 2, 35' FRONT
�s 10' SIDE
10' REAR
N '
3.
i
i 3.3
ys copy
T-O.8.=1093.5 t
l T.os =1aa3.
1
B 85.26, $ ,
c7-e- �Pr r�ay.
{ �
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Lot 53
Owner's Name:
Jeff Husby
Owner's Address:
316 Kamloop Place
River Falls Wi. 54022
Legal Description:
S 29 T 29 R 17
Township:
Hammond
County:
St. Croix
Subdivision Name:
Rolling Hills Farm
Lot Number:
53
Parcel ID Number:
018-2019-53-000
Designer/Plumber:
Date:
Page 1
Index and title
Page 2
Plot Plan
Page 3
System Sizing & Cross -Section
Page 4
Filter Specs
Page 5
Maintenance Information
Page 6
Management Plan
Page 7
St. Croix Cty Septic Tank Maintenance Form
Page 8
Warranty Deed
Page 9
CSM or Plat
Attachments: Soil Test & House Plans
Keith Knudtson
06/02/2022
License Number: 648443
Phone Number (651) 470-1737
Signature
Designed pursuant to the In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
��of pla
- --- -- - - - -
d4
//4 /Y6 6 ,14 FIELD WORK COMPLETED: 4/15/22
Aoi9
75TH AVENUE
NORTH
SCALE:
0 40 80
ELEVATIONS SHOWN ARE
NAVD 1988 DATUM.
m
T.
=10 0.1 n
T.O.B.
=1076.4
LEGEND
-
T.O.H.
=1077.28
60D NAIL SET AT 10' OFFSET OR
WALL EXTENSION
— —
_
(/�Jpy ON BUILDING
12.0 0 26.0 a
i �y
V
/ FOUND 3/4" IRON BAR
R�
80_
GF LO
16.0
7-
T.O.N. TOP OF NAIL ELEVATION
16'
16.0
T.O.B. TOP OF IRON BAR ELEVATION
HOUSE "
in "
DRAINAGE & UTILITY
46.0
_ _ _ _ _
EASEMENT
I
®
DRAINAGE EASEMENT
EXISTING SPOT ELEVATION
T.O.H: 1081.22
X 100.0
BUILDING SETBACKS:
�(o vy
35' FRONT
op
,Nn 10' SIDE
86
T
tn 10' REAR
ui
L
N
?
ttN
I
T.O.B.=1092.5
T.
85.26'
�t� s�,,C
caO lop.
33D,9$ei�,��
Private On -Site Waste Treatment System (POWTS) Inspection Agreement
The correct operation of the equipment noted below significantly influences the life of the wastewater system.
Periodic inspections will help extend the life of the system and prevent the need for costly repairs. The agreement
authorizes access to your PoWTS equipment by a trained and authorized technician, during daylight hours, to
provide regular inspections and routine maintenance to help assure the equipment is working properly.
it is hereby agreed by and between Purchaser and Knudtson Plumbing and Contracting that in consideration of the
payments provided for herein, Knudtson Plumbing and Contracting will provide the services of a factory -trained
representative to perform periodic inspections of the equipment described below. Knudtson Plumbing and
Contracting will prepare a written report after each inspection and provide a copy of the report to the Purchaser.
This report will contain recommendations for any operation and maintenance deemed appropriate by the
inspector.
This agreement does not assume any responsibilities for obligations that are normally the responsibilities of
Purchaser and does not extend to cover any costs that may be associate with any recommendations made under
this agreement. In no event shall Knudtson Plumbing and Contracting be responsible for any special or
consequential damages, including but not limited to loss of time, injury to person or property or incidental
economic loss due to equipment failure or for any other reason whatsoever. Knudtson Plumbing and Contracting
may supply additional services, parts or labor only after authorization by Purchaser.
This agreement shall remain in force for a period of _1 years, beginning _May 2020_ and will
automatically renew each year thereafter for one year unless canceled by either party with at least 30 days written
notice. This agreement may be canceled by the Purchaser only if replaced by a service agreement with an
authorized service provider for the equipment listed below. Knudtson Plumbing and Contracting may delay or
cancel future Inspections if payment becomes at least 15 days past due.
Periodic Inspections: Association agrees to pay Knudtson Plumbing and Contracting $_200.00 per each
house's annual inspection. Any additional testing or services required will be billed on time and material amounts.
Equipment Covered Under This Agreement
Description Model No. Serial No. Install Date location if different
from system owner
ATU'S Hoot or Micro -Fast
Knudtson Plumbing and Contracting
927150u' St., Roberts, WI 54023
651-470-1737
Date:
System Own
Signature: Date:0. S — 3 — 10
Rolling Hills eowne Association Inc.
Print Name: T.,,44 +,A ``
Street: 31 C Ka•Jor ps P1'�L Phone:
City, State & ZIP _ Fax:
k(eu a
INLET ,
F
Lo
4" CAS
POLYLOK 12" ACCESS LID (TYP)
�Z SET RISER (TYP)
MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
600 GPD GRAVITY DISCHARGE SYSTEM
a
U.
H-600 A
c
H-600 A
u
TANK SPECIFICATIONS
.
a
DIMENSIONS:CA
M
WALL: 3"
BOTTOM: 3"
COVER: 4"
o
MANHOLE: 12" & 24" I.D. PLASTIC RISER
HEIGHT: 70" O.D.
$
LENGTH 106" O.D.
m
$
WIDTH: 74 1/2" O.D.
I
BELOW INLET: 57" O.D.
ol
m
LIQUID LEVEL: 51"
WEIGHT: 11,135 LEIS.
W
1�
W
0:
INLET AND OUTLET:
4" CAST -A -SEAL (CAS) BOOT OR EQUALLo
COVER: MIX DESIGN #8 (NO FIBER)
TANK: MIX DESIGN #9 (SMALL FIBER)
�
CUSTOMIZED TANKS:
a
N
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
r7
W� I
Wcn00
cn
25 ¢_
c�D <
a U
F
g CL
DRAWINGS SUBMITTED
w
FOR APPROVAL
=
APPROVED BY:
SkiFWT NO.
APPROVAL DATE:
PRODUCTS NEEDED BY:
OF/
/ 1
Homeowner Guidelines for homes equipped with Aerobic Treatment Units
The septic system for your home depends on the proper functioning of the Aerobic Treatment
Unit (AM, which is designed to treat and degrade solids prior to discharge into the shared
septic system. To avoid breakdowns and costly repairs, please observe the following guidelines:
• Avoid allowing any inert materials such as plastic, rubber, scouring pads, dental floss,
cigarette filters, bandages, hair, mop strings, lint, rags, cloth and towels to enter the
system. These materials can build up in the tank, resulting in system malfunction,
clogging and premature pump failure.
• Do not flush or drain chemicals and toxins into the system, as they kill the microbes
necessary for treatment. These include paint and paint thinners, solvents, drain cleaners,
automotive fluids, fuels, pesticides, herbicides, fertilizers, metals, disinfectants and
sanitizers.
• Paper products including disposable diapers, paper towels, baby wipes, facial tissues and
moist toilet paper are not designed to dissolve in your on -site treatment systems. Neither
will excessive amounts of toilet tissue decompose.
• Limit garbage disposal use to food waste that cannot be scooped and thrown in the trash.
Do not put animal fats and bones, grease, coffee grounds, citrus and melon rinds, corn
cobs, egg shells, etc. down the sink. Also avoid putting spoiled dairy products and yeasts
from baking into the system.
• Do not put medicinal materials, automatic disinfection tablets and similar items into the
system. Also, septic tank additives generally do more harm than good.
• If possible, spread laundry practices out over several days, rather than one "wash day," so
the ATU can more efficiently process the water as it enters the system. Liquid detergents
are recommended over powder; fabric softener sheets are preferred over liquid softeners.
Use bleach sparingly, at half the recommended rate.
• Clear water waste from dehumidifiers, HVAC units, gutters, whole house treatment
systems and sump pumps can increase the flow to both your on -site system and the
shared system, leading to shorter life. Both clear water and backwash from water softener
regeneration should be discharged to an alternate outlet. Talk to your contractor.
Do not disconnect power from the unit!
Your ATU is equipped with an alarm that will notify you of a malfunction. If the alarm does
sound, for diagnostics, service and repair call:
Knudtson Plumbing and Contracting
651-470-1737
f— r0�
t 4 ti
H-Series Gravity Treatment System
a) (Z
M
ensue
Monitorinftcady
Green Choice Applications:
Single and Multi -Family
Dwellings, light commercial,
Churches, and other similar
Residential strength uses.
Performance:
98% Reduction CBODs
99% Reduction TSS
99% Conversion of Ammonia (NH3)
Fecal <1 nnn ::'!C'�i5info`f��n
Range of Sizes:
500, 600, 750 & 1000 GPD
High performance, low cost, energy efficient treatment system
The H-Series GravityTreatmentSystem provides high performance at a price comparable to most entry level ATU's.
Producing effluent of less than 3 mg/L on CBODs and 2 mg/L on TSS, it far exceeds the secondary standards of 25 mg/L on
C8O135 and 30 mg/L on TSS. With these results, many locations allow reductions in disposal areas between 25 and 40%.
Because the H-Series completely transforms ammonia into nitrate, it is best suited for applications with rich organic soil
content, surface plant growth and depth to groundwater to prevent nitrogen pollution of the water table.
Simple installation, reliable performance, low cost of ownership
This level of performance is enhanced by its simple installation, energy efficient performance and low cost long term
maintenance and ownership. The systems components are assembled at controlled manufacturing facilities, rather than in
the field, to ensure reliable performance with local support.
Energy efficient, environmental protection
Made of locally available and manufactured concrete, the H-Series features an energy efficient linear compressor that
uses less power than an average light bulb. its polyethylene clarifier hopper is made of recycled milk jugs. Choose Hoot,
and you make a sensible, decision to protect the environment as you protect our most precious resource, our water.
Drainfield and Vertical Separation Reductions
With gravity flow discharge, the H-Series allows you to choose your disposal application from conventional lateral lines,
leeching chambers, other alternative drainfield materials. in some areas direct discharge is an option as well. Reductions
of vertical separations to groundwater and impermeable layers such as rock range from 1 to 2 feet.
Make the green choice for wastewater treatment
Your wastewater system is the most expensive and important appliance you will ever purchase. Don't settle for just any
system. Protect your family and the environment with a Hoot H-Series System.
Wieser Concrete Products Inc. 1-800-325-8456 www.wieserconcrete.com
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A5
ST CRO LINTY SANITARY SYSTEM File #:
—T 1, i:,•6(w" •Iu Office Use Only
OWNERSHIP/ADDRESS FORM Cmaw21202,
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email.
OWNER/BUYER INFORMATION
Owner/Buyer SPA-- '' _ �, s b
Mailing Address 3�6- K��. (Vop) PI(A
i
City/State/Zip 8 ;vim-- E`a (S W I S-y ��
Phone Number (required) 7 (S IM
Email Address (required) J f- f fd—
Parcel Identification Number
(found on the property tax bill)
Property Location
Subdivision Plat:
NEW SYSTEM: LEGAL DESCRIPTION
'/a , t/a , Sec. q 0 TN RW, Town of
Certified Survey Map #
Z
Page #
Warranty Deed #�[03 (before 2006)Volume Page #
Number of bedrooms Spec house Dyes CI no Lot lines identifiable 0 yes ❑ no
Lot # X-�3
New Property Address
( taff Initials)
OFFICE USE ONLY
('Q 1
Volume
(Verification of new address required from Community
/3 Z_Z_
(Date
6r�
Department for new construction.)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified
survey map if reference is made in the warranty deed.
Community Development Department - Land Use Division
715-386-4680 St. Croix County Government Center
cdd sccwi.g-ov 1101 Carmichael Road, Hudson, WI 54016
715-245-4250 Fax
H'ww.sccwi.gov
Parcel #: 018-2019-53-000 Valid as of 06/09/2022 01:01 PM
Alt. Parcel #: 29.29.17.1253 TOWN OF HAMMOND
ST. CROIX COUNTY, WISCONSIN
Owner and Mailing Address:
C & J BUILDERS INC
316 KAMLOOPS PL
RIVER FALLS WI 54022
Districts:
Co-Owner(s):
Physical Property Address(es):
* 1617 75TH AVE
Parcel History:
Dist# Description
2422 SCH D ST CROIX CENTRAL
Date
Doc #
Vol/Page
Type
HWO
1700 NORTOD TECH
12/07/2021
_r__ __._
1144763
/
WD
_ . _-_ , .__ _...
09/27/2016
11 /11/2011
1036337
945547
/
/
I WD
1. WD_
Abbreviated Acres:0.000
Description:
02/05/2007
_-... _
8 43836
11/19
PLAT
more...
SEC 29 T29N R17W PT NW SW BEING
ROLLING HILLS FARM LOT 53
Plat Tract (5-T R 401/4 1601/4 GL) Block/Condo Bldg
_...... ---- - _
* 11-019-ROLLING HILLS FARM 018-07 29-29N-17W NW SW LOT 53
2022 Valuations: Values Last Changed on 11/04/2008
Class and Description Acres Land Improvement Total
G4 AGRICULTURAL 0.500 100.00�_ 0 00 100 00
Totals for 2022
General Property 1
0.5001
100.00
0.001
100.00
_ Woodland
0.000
0.00
0.001
0.00
Totals for 2021
General Property +0-50010.00
100.00
Woodland
0.000
0.001
0.001
- -
0.00
2022 Taxes
Taxes have not yet been calculated
Key * - Primary
.
IC
9
r
.. :; _. •:
LOT
�21:78l
Sa.
L85.26
sue:'
I
FGENERAL
PRIVATE SEWAGE SYSTEM St. Croix
INSPECTION REPORTION ' 1_-7777-7 62493,5Owners Assorlatlon' _ LT-7,—
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OI COUNTY
NO. 641994
STATE SANIPRY PERMIT
74vE
PREV1098 NO..
OWNER
PLUMBER %A-Mo"o
TOWN OF
SEC.21 ,TN, R �
AND/OR LOT
1C.# 4qPY13
BLOC
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CHAPTER 145.135 (2) WISCONSIN STATUTES
�a) • The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c) The sanitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of
SUBDIVISIONthe permit, please contact the county authority.
=2HARIJED ISSUING OFFICER - DATE j
S PERMIT EXPIRES UNLESS RENEWED iEYFO THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11/20)
State Bar of Wisconsin Form 1-2003
WARRANTY DEED
Document Number u Document Name
BY THIS DEED, VoranDesoto LLC, a Minnesota limited liability company,
( hereinafter "Grantor," whether one or more), convey and warrant to C & J
Builders, Inc-, a Wisconsin corporation, (hereinafter "Grantee," whether -one or
more), the fo�owmg described real estate in St. Croix County, State of Wisconsin:
Lot 59
Tat of Rolling Hills Farm in the Town of Hammond, St. Croix County, Wisconsin.
Exception to warranties: easements, restrictions and covenants of record; highway and
street rights of way; and Municipal and zoning ordinances and agreements entered
under them; and further except real estate taxes accruing in the year of this conveyance.
Dated 11- 'L
VoranDeegto LLCMinnesota limited liability company
(SEAT.)
* Paul Schreier, President
AUTHENTICATION
Signature(s)
authenticated on
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by Wis. Stat § 706.06)
THIS INSTRUMENT DRAFTED BY:
St. Croix County Abstract & Title Co., Inc. y Samantha
Olson at the direction of the Grantor. 21-S29967/SO
1144763
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
12/07/2021 02:44 PM
EXEMPT#:
REC FEE 30.00
TRANS FEE 105.00
PAGES: 1
**The above recording information
verifies that this document has
been electronically recorded
& returned to the submitter
I+ Recording Area
Name and Return Address
St. Croix County Abstract & Title Co., Inc.
575 N. Knowles Ave., Suite #B
New Richmond, WI 54017
018-2019-53-000
Parcel Identification Number (PIN)
This IS NOT homestead property.
[4b:7JAMES S MALONE
Notary Public
ate of Minnesota
ommission Expires
anuary3l, 2026
ACKNOWLEDGMENT
STATE OF tJ►tn�alc5t IA )
(•2-A "A S E l ) ss.
COUNTY )
Personally came before me on : %- % i J L i ,
the above -named VoranDesoto LLC, a Minnesota limited
liability company —_Paul Schreier. President
to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
No blic, State of M t4
My Commission (is permanent) (expires:
(Signatures maybe authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO.1-2003
' Type name below signahutis.
St. Croix County 1144763 Page 1 of 1