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HomeMy WebLinkAbout018-1094-17-000Wisconsin 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)(m)]. Permit Holder's Name: Midwest E uities City Village X Township Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION, ~ V Manufacturer Dem d GPM Model Number TDH Lift Friction Lo System He Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 430672 0 State Plan ID No: Parcel Tax No: 018-1094-17-000 Section/Town/Range/Map No: 17.29.17.757 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dtlnlet Dt Bottom Heade an ist. e ot. S m final ade t Cover BED/TRENCH Width Length No. Of ches PIT DIMENSIONS N f Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P BLDG WELL LAKE/STREA LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM / Header/Manifold Distribution x Hole Si e Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Onlv 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 i ~ No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /. Location: 963 167th Street Hammond, WI 54015 (SW 1/4 NE 1/4 17 T29N R17W) Prairie Run Lot 17 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = --- - Plan revision Required? Yes %! No ~ '; it Use other side for additional information. ___ SBD-6710 (R.3/97) Date Insepctor's Signature Inspection #2: / / Parcel No: 17.29.17.757 i -- ~ _T - - ~__ Cert. No. JAN 2 9 2004 T. GRpSg(~~ildi s Division C~tY ` ZQl>flnR& 0rle&U~ton Av ., P.O. Box 7082 ' I ~~O ~~,~ a tso 07 - 7082 Sanitary Permit Number (to be filled in by Co.) J De artment of Commerce (608) 261-6546 // O to ~Z Sanitary Permit Application State Plan I.D. Number [n accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s 15.04(1)(m) P sect Address (if different than mailing address) I. Application Information -Please Print All Information # ~~ Property Owner's Name Parcel # Lot # ~ 7 Block # Property Owner's Mai 'ng Add Property Location Section ~ ~ ~~ City, State Zip Code Phone Number ~ ~, '• .dC~ (circle e) T~ N; R~~E ot~ II. Type of Building (check all that apply) ~y Z ~ t 1" . 1 or 2 Family Dwelling - Number of Bedrooms S - .. Subdivision Name C- ^ Public/Commercial -Describe Use 410.54.W t~ l.E !! ^ State Owned -Describe Use 2 3 )C to8 • ~ N.a i ^City ^Vi age~Township of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A' New S tem ys ^ R lacement S tem ep ys ^ TreatmenUi-folding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check alt that a 1 on -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamb ^ Drip Line ^ Gravel-less Pipe ^ Other (e 1 i ) V. Dis ersaUTreatment Area Information: -/pu • Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (s yttem Elevation .~? ~ ~ .~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ L Aerobic Treatment Unit Dosing Chamber VII. Respons•bility Statement- I, the undersigned, as me responsibility for installation of the POWTS shown on the attached plans. Plum 's a (P 'nt Plum Si MP/MPRS Number Business Phone Number . ~ ~- City, S e, Zip Code P um is ress ( ~~ ,d VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is uin Agent Signa re o Stamps) ^ Owner Given Reason for Denial Surchazge Fee) ~~ ~ . IX. Conditions of ApprovaUReasons for Disapproval SYSTEM OWNER: ~) hl ~e~ tvu tx 1 Septic tank, efflu®nt filter and t '" dispersal cell must all be serviced /maintained ~l '' as per management plan provided by plumber. S~nw-~ 9+~ - to 2. All setback requirements must be maintained p~ ~~~~ ~.~ ~ (~~~ ~ ~~"-" - as per applicable code/ordinances. r - ~ d G2. Attach compkte plan: (to the County oaty) for the system oa paper not kss ths~ 81/2 i 11 lathes fa stu SBD-6398 (R. 08/02) r ~ / ~~ `~ ~ ~~ w ~~ o ~~~ ~,~~ -~ o~ 1 I ~8~ ~ ~ \ 6~~ ~Y~ E` ~{~ Q~ O~ ~~ ~` ~( ~~ ~ ~ a ~ ~~ ~ ~~~~~ ~ ~ ~~ \ ~~ ~ ~ ~_ ~ ~~~ o 0 V \ ^\~ $` 'r ~ ~ M ~, ~ ~ ~ ~ ~ ~~ ~ - ~ a ~ `~ ~ ~~.~ ~ ~ - ~ ~ `~ ~ 1~n G vl o~~ ~ VY / ~~V+~ O ~~ ~ ~L' / / ~ y -moo 7~ ~~ ~~ _ __,r /~ ,., ~~~ ~ ~ ~` ~--~ a `~ I `~ w ~~ ~ ~ ~~~ ~ ~~ ~ ~~~ 4~ 1 ~~~ \\` ~\ f ~~ ~~~ ~ 6j~ ~y~t F ~~ ~~ O~ ~~ ~~ ~~ -~ :~~~ ~~ ~ ~ ~~ ~ ~ ~ ~~~ ~~~~ ~ ~.o \_ '~ ~ ,j'~ M ~`~ ~ ,~ ~ ~ 0. ~ ~ ~ o. ~~.~ rq - n ~ ~Q ~~ ,,~ ~G /" \ ~ i ;' 4~ i~~~ ~~ ~~ j ^~ ,~ \l/ ~O ~~ \ ~C ~ _ ~'~ ~ - --- ~~ `Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in acrnrrtanro with (Tnmm Rr, 1A/ie Arlm Cnrtn ~~ ~~ Page ~ of County ~ ! Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must x 0 include, but not limited to: vertical and horizontal reference point (BM), direction and t l l di i rth d l ti i Parcel I.D. ~~- ~ -- 4~ percen e or mens arrow, an s ope, sca ons, no oca on and d stance to nearest road. y~ / 7 Please print all information. Reviewed by DGa~te A 2 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). `/Z ~3 Property Owner Property Location .1" ~~~ Govt. Lot S ~ 1 /4 ~/~ 1 /4 S f ~.- T Z Gl N R / ~ E (or)b' Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Y ~ (~ / ~ ~~ S~• l-1 fZliri~ ~u City State Zip Code Phone Number ^ City ^ Village [~-Town Nearest Road /-~ m rtlot~ / S' yo~~ (7/S ) 7qG - Z ~ q 3 ~a rr~ rrl.ar- o f /00 ~ ~G [New Construction Use: ® Residential / Number of bedrooms 3 '~/ Code derived design flow rate ~/SG / ~ o d GPD ^ Replacement Public or commercial -Describe: .-- -----_ Parent material ~ ~~ l Flood Plain elevation if applicable ti 1 ~ ft. General comments $~/S~-rv/1 C/<u• tGr cry--per-~~c:" - n' o ~ ,,,.---y~G/ ~ and recommendations: 9S 9 y s ~~..~-- ` ° - :~. ~-- ~.rA; r o ,, r: f - I Boring # Boring ~ - ~ .~.. tp pit Ground surface elev. ~~ ft. Depth to limiting factor _ ~ in. 1G N Soil Qp ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence ~undary Roots < "' GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ Eff#1 *Eff#2 i a- i 12 ---- ~; I ~s I v~ . 5 .8 2 ~a- ~ ~ yl `^ ~ Z ~s - - 9 3 ~-~ l ms Os - ~ - - ~ I. Z zti " .~ 9s. sty ~ 39•~ ~-S~ Z Boring # ^ Borin ®Pit urface elev. ~~ ~d ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ a ( ~ -- si 2 c v-~ . 5 .~ 2 ~Z-Z I~ r ( --- SL Zms ~S -- . 5 . `7 coq .S~ ------ 39•~ * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number err, Schurrulc er ~~~-~ ~ 2~ 3.3a g Address Date Evaluation Conducted Telephone Number 11 d'~' s1. e i -~2S" /-Z~-a~ ~~~s)Z 7- oad~ Still-ii:33U (R07/00) Property Owner ~~ ~ ~ kl r~S ParcellD # ~, n Page ~ of ^ Boring Boring # L~3 Pit Ground surface elev. 9 • S~ ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I b-~ 2 l~ r 3 Z Si I Z n-r,~b rrt~r ~-S I v~' . 5 • 8 Z 12- ( 41 Zm G - 9 3 ~t(~-9y 1 ~-- s rn l _ /- z .5 -- ~ o '` ~- 0.7 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L 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 (R.07/00) PAGE zJ OF 3 NAME I-~1_..) K .mss LOT# / ~ LEGAL DESCRIPTION sF ~ NE14 ,S / ~- T z `~ ,N,R, ~ ~ E(orY~ SCALE:l"= `~O N BM I ELEVATION X00. v BM 1 DESCRIPTION -~ ~ o -~ ~ z {1 Uc ~~~ e. BM 2 ELEVATION `I `I.3O BM 2 DESCRIPTION ~ p D~ ~ L Pvc_ P; Qt SYSTEM ELEVATION -ko 9~$0 ~uw~ r ~~~ ~ T ALTERNATE ELEVATION ~(o ~ 3d CONTOUR ELEVATION q $, S~ ~ 9 9. ~ f _ }- - s~. /~- 1 ~~ g~~ s 3 f~ ~. . '~,,y ~~ ~ ~x, ~-3 •~~Z ^ g.Z ;. • g v+n ~ SIGNATURE ,~`~=L! ~~ DATE //-.3U -o/ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page, o~ .~' FILE INFORMATION Owner , Permit D Z DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units J~ NA Estimated flow (average) ~ al/de Design flow Ipeakl, (Estimated x 1.51 al/da Soif Application Rate al/da /ft~ Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODa) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids ITSSI 530 mg/L ^ NA Focal Coliform (geometric mean) .510' cfu/100m1 Maximum Effluent Particle Slze Ye in dia, ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank oilluent, MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity ~ al G NA Septic Tank Manufacturer r;- t O NA Effluent Filter Manufacturer C' !~A Effluent Fitter Model G NA Pump Tank Capacity al 1Xr` NA Pump Tank Manufacturer ~ rdA Pump Manufacturer ~` , ~ .l~NA Pump Model ~'iA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter O Wetland ^ Other: A Dispersal Cell(s) i,~ln-Ground (gravity) ^ At-Grade ^ Drip-Line O NA D In-Ground (pressurizedi ^ Mound ^ Other: _ Other: O NA Other; O NA Other: ~; ~~~ Service Event Service Frequency Inspect condition of tankls) ~ At least once every: monthls) ear s) . ,; , (Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and, scum equals one-third IYsI of tank volume ^ 'JA Inspect dispersal cellls) At least once every: ^ month(s) la`yearlsi (Maximum 3 years) O JA Clean effluent fitter At least once every: ~ ^monthls) earls) ^ 'JA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ earls) ~'NA Flush laterals and pressure test At least once every: ^monthls) ., .. ^ yearlsl ~ JA _ Other: At Ioast once every: ^monthls) O earls) ~ ~A Other: O JA MAINTENANCE INSTRUCTIONS -- Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following liceniea or certlflcat~ ins: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Soptase Servicing Operator, ank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, )dentify any cracks or ~ :~s, measure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground sure ace. The dispersal cellls) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pen tiny of effluent on the ground surface. The pending of effluent on the ground surface may Indicate a failing oondition and requires thu immediate notification of the loos) regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y~1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wiaoonaln Adminbtrative Code. All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatn ent units, and any servicing at intervals of S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. QMW 14H) t 1 Ns: ~c START UP AND OPERATION T For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or, other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tank(s- removed by a septage servicing operator prior to use. - System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwatar levels. When power is restored the excess wastewater gill tie discharged to the dispersal cetlls) In one large dose, overloading the oelllsl and may result In the backup or wr(ace disch~~~Ua ~~i effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. ._.___ ~ ,.. ...~. _:... Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the lit© ~_~I thv POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers;.disinfoctan~,, fc~t; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator, • After pumping, all tanks and pits shall be excavated and removed or their Covers rampY~d aDd the void space filled wiui soil, gravel or another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and Should not ba Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area milt result in the need for a new soil and site evaluation to establish a suitable replacement area, Replacement systems mus[ comply with the rules in affect at that time. O A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. D The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area.. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. _ _,. .. O Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, pEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY 8E D{FFiCUIT OR IMPOSSIBLE. .. _. ADDITIONAL COMMENTS POWTS INSTAL E POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Nam• Phone Phone This document was drafted in compliance with chapter Comm 83.221211b11111d1&If) and 83.64(1), 121 & 131, Wlacortsln Adminlstrativ Code. ~wtltr/Buyer Mailing Address nroparty Aaaress ST CI~O~C COUNTY SEPTIC TANK MAINTF'NANCL~ AGIZL~L-'MLNT .AND tDWN1;RSI•iIP CERTIrICATIOI~I rORM ~ty i (Verification required from Planning Departntenl for new 66'~-~ • ~ Parcel Identification Number d ~~ 1o9`f _ ~ ~-~ `' ~~~ J City/State ~r~A><~ ~rscRrPTxc~N Property Location..'/~, `/+, Sec. ~, `~~.N-~..L~-W, Town of Z7~- Subdivision __-~~°~,~___° .~~.a~, _ . I,ot #~ _.~.~. Certified Slzrvey p ~~ ~' ,Volume '~- .Page #~ Warranty Deets f ~~ I ~_ ., ,Volume -~~`~~7 ,Page ifs Spec house ^ yes ~o I.ot lines idetitifiable~yes ^ no SYSTiJM MA.)<N7TNANCE Improper use and maintenanccof your septic systcnt could result in ils premature failure to Itandle wastes. Proper maintenance copsists of pumping out the septic to+tk every tlirec years or sooner, if .Headed by a licensed pumper. What you put into the system can affect the function. of the septic tank as u treaUnent stage in the waste disposal systcut. The property owYter agrees to subttut to St. Croix Zoni++g I3eparintettt a ceriifitatiou form, signed by the owner and by a u~ast~Crplumber, jounicyman plumber, resirictcdplumber or alicensed putttperverifyiugthat (1) the on-site way~tawaterdispvsal system is in proper operating condition and/or (Z) alter irtspeclion and putnping (if ttcccssary), ilte septic tank is less than I/3 full of stodge. Uwe, flit undersigned ltavc read the shave rcquirccne+its and agree to maintain the private sewage disposal system with the standards set forilt, herein, as set by the Dc~sartntcttt of Cornniercc and it+e Dcpartu~eni af' Natural Resources, State of Wisconsin_ Cemfeauon stating that your septic systeru bas been maintained must be completed and rctutned to the St" Croix County Zoning Office within 30 days of tc three year expiration date. .~ /~Z/ A : OP APP .ICAN7. DATI: ~wNrR CrRTlrzr,ATroN I (wc) certify that all statcmc-tts on this form arc in+e to the Ucst of nay (ottr) knowledge. I (we) cut (arc) the owner(s) of the prop riy described above, by virtue of a warranty deed recorded i++ Register of Deeds Office. ,S /2 Z/ ©~ SI NA"1'U ~ OP PPI.ICANT DATE Any infonnatiou that is mss-represented may result in the sanitary permit being revoked by the Zoning Departtuent. ****"* •.«~., '~* Iacludc with flits appticattoa; a stamped warranty deed from tiie ltegistcr of Deeds office a copy of it+e cet~tificd survey map if reference is made in tltc warranty deed . 'J 2252P 340 DOCUMENT NUMBER WARRANTY DEED William E. Hawkins, Grantor, conveys and warrants to Midwest Equities, LLC, Grantee, the following described real estate in St. Croix County, State of Wisconsin: Lots 1, 3,' 6, 10, 11, 12, 13 17 18, 19, 22, 27, 30, 35, lA and 3A, Prairie Run, Town of Hammond. ~~~~Ji KATHLEEN H. IiALSH REGISTER OF DEEDS ST. CROIX CO. , MtI RECEIVED FOR RECORD 05/23/2003 02:20PM MARRAKTY DEED EXEPlF'T # REC FEE: 11.00 TRANS FEE: 594.00 COPY FEE: CC FEE: PAGES: 1 This is not homestead property. Exception to warranties: All easements, restrictions and rights-of-way of record, if any. Dated this ~~ 3 day of May, 2003. /y~.GC~-C I~/~-- (SEAL) _ William E. Hawkins (SEAL) AVTHENTZCAT2017 Signature(s) authenticated this day of 2003 (Sianaturel (Name Printed or Twedl TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 5706.06, Wis. Stats.) THIS INSTRUMENT WA3 DRAFTED BY: Leo A. Beskar Rodli, Beskar, Boles 6 Krueger, S.C. P.O. Box 138 River Falls, wI 54022 NAME ND RET RN ADDRESS i77es ;•~~es ~ ~ 9fD fd</1~,~sf s~ ~/a ~~i h /V,.~' S X007-- 18-1037-10-000; 18-1036-90-000 18-1036-80-000; 18-1036-70-050 Parcel identification Number (SEAL) (SEAL) ACI@70WLEDC+MENT STATE OF WISCONSIN ) ss. COUNTY ) •1 J J • 'H J ••~~22 ~/ Personally came before me thispLJ ~;8ay1i~"M`dp, X03 the above named William E. Hawkins`' •' Yp to me known to be the persons (s ) whC ••e~~uhe ~.. foreq in instrum t and acknowledcSe;~1w.,saTne.O~ v'• VV V~ ~1.~ f ,}, Si nature • ~~ • 1 ~V ~-~'. Nam~1e ~{,,r • '6d or T ed Notary Public ~N . ~oe;n`ty, •wis. My commission is permanent. (If not, exoiratiori date:) N 8 M WI `h. v ~o 2 i i ~p X06/ '' N ~'p C1 W ~ • al ~ ' '•- ~j8~ _ h 1 tp ~ :~ l ~ -,.. •ts . . , ,bb ~ o ti ' ~F ~ ' ~aN ,°° ~ N ~ J ~ ~ , e ~ W 2 F° ~/N ~ ~~ .i° ~~ Q ~ r ti~~ ~ e `~b`° W OC :J ~°j ~ O V f. ~• N ,gyp`, ~Z ~ ~ ~0 b ~ ~ , ~ 6~0~ ,,,~ ~ a ~ ~ ~• CWT ~ ,,,~~ / 2 ~ ~ 1 ~ = Z • Q tp 41; N ~- Q ~ W ~ 2 ~~ .n O = `~1'.. M.ci ,o~ sos 9 'F~' N p `~: M ~ ~ f"': O~ -o `o o ti~ N N00° 00' 00` E 297. T6' a a N J ~ ' ~ ~ 4.. M~'- $ u, Q m / ~ Cep Z: ~ g 4 en •.r W A~ ~ ~ ~ I ^. 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