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HomeMy WebLinkAbout018-1098-13-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453426 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Tredal, Ryan I Hammond Township 018- 1098 -13 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: (� =t <'° 30.29.17.820 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic l ,., Benchmark y C- i� �Y �(Yi• Dosing 7 Alt. BM Aeration Bldg. Sewer 7'1 7. 5 11 1 Holding St/Ht Inlet i. � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom � • �� .,� �� , rH . 3; fir: �? � Dosing _ Header /Man. Aeration _... _ Dist. Pipe s C1 i , Z C� Holding Bot. System �✓ 3 '� 3 PUMP /SIPHON INFORMATION Final Grade Manufacturer 7 Demand St Cover {, , GPM l� Model Number I TDH US, Friction oss System Head _ TDH F `� A . Z Forcemain Length , Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS Nd. Of Pits Inside Dia. Liquid Depth DIMENSIONS `'+ L 7 ) SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER O R Type Of System: , „- Model Number. /� DISTRIBUTION SYSTEM ( .....: 4 e Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake t Pipe(s) Length C Dia L . Length Dia ] Z.� Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth. Over xx Depth of 1 XX eeded /Sodded xx Mulched Bed/Trench Center r - Bed/Trench Edges �. ` Topsoil / ( L� Yes No I Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: r c / /y / CIf Inspection #2:/L' / Iql Location: 151976th Ave Unknown W 1/4 SW 1/4 T2 N W Emerald Acres Lot 13 Parcel No: 30.29.17.820 e o N 30 9 R17 d o 1. Alt BM Description e <, �. 2.) Bldg sewer length - amount of cover revision Re uired? Yes No i side for additional information. _� _� 8.3/97) Date Insepctor's Signature Cart. No. Safety and Buildings Division County 5,4 f ce o Ix 201 W. Washington Ave., P.O. Box 7162 NI fiscon s in Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608)266 -3151 S3 YZ Department of Commerce State Plan I.D. Number �� Z �[ -72 7- Sanitary Permit Appicatisn g ho n In accord with Comm 83.21, Wis• Adm. Code eisonl infor itav[tle Project Address (if different than mailing address) may be used for secondary purp s Pn 14aw, s15.04(1)(m) t I. Application Information - Please Print All 1¢b ti J "' 767 V67 Property Owner's Na me I Parcel # of ry ( 3 `f 1 V Ole 1052_/ _ 0 6b 20 Property Owner's M ailing Address Property Location�� / 23-7 �' � /� � ROAD /0 lr -'4 N / "" y .Section 3 0 City, State Zip Code Phone Number l�•K 1. � � 5 S / Z T � N R�B or ® II. Type of Building (check all that apply) dt0` Subdivision Natne CSM Number C6 1 or. 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Um E rn Lb C p -7 ❑ State Owned - Describe Use ❑City_ ❑Village &ownship of -/4A /V1 d N 15 Or 2, 5 - ' 5artay III. Type of Permit: (Check only one box on line A. Complete line t if applicable) A. New System C1 Replacement System ❑ Treamieti[/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑Permit Renewal E3 Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that appl = �. ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable 11 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 Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treat ment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation o ��o�. F5 � VI. Tat[k 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 Aerobic Treatment Unit l Dosing Chamber / f VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of thle POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si nature MP /1- t�umb$r Business Phone Number NeK'.5d 2 2�, Plumber's Addre ss (Street, City, State, Zip a) VIII. county/Department Use Onl pproved tsappr Sanitary Permit Fee includes Groundwater Date Issued I uing ent Signature ( o Stamps) r r - Surcharge Fee) •-- wner tven Reas r Denial IX. Conditions o ppr6v 1/ ` � 3 SYSTE o M R: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. Z. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) 1 7( �'' ✓� i 4 a37� � o (DELL pK S Q v ,t31y1 J j " ' o we e X 7,5 a , c. fiw 5 et RN�35• ' r�'s� ROGER D NELSON Page 2 7/22/04 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 �? Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 q � MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application OGt! INDEX AND TITLE PAGE t � Project Name: 4 bedroom Mound Owner's Name: Ryan Tredal Owner's Address: 2370 Helna Road North St Paul, MN 55128 Job address: 76th Avenue Legal Description: NW 1/4, SW 1/4, S 30, T 29, N R 17 W Township: Hamond County: St. Croix Subdivision Name: Emerald Acres Lot Number: 13 Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications y Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan ) FCo Y Mg FRC6 lNt;,S 3PpN Designer: Roger Nelson License Number: MP 226497 Date: 07/11/04 Phone Number: 715 - 273 -4444 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.0 (R. 04/03) Pagel of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 600.00 Design Flow (gpd) 5.00 Site Slope ( %) 97.15 Contour Line Elevation (ft) 21.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 67.001 Dispersal Cell Length Along Contour (ft) = 8.96 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fl?) 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution I Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 2.99 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 9.10 ft /orifice 2.00 Forcemain Diameter (in) 50.00 Forcemain Length (ft) Does the forcemain drain back? Y 89.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 8.16 Forcemain Drainback (gal) 9.07 Vertical Lift (ft) 62.62 5x Void Volume (gal) 0.81 Friction Loss (ft) 70.78 Minimum Dose Volume (gal) 16.37 Total Dynamic Head (ft) 27.19 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser 800 - 325 -8456 1 Manufacturer I I gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) JZabel 1 800 -221 -5742 1 Filter Manufacturer 20.601 Dose Tank Volume (gal /in) IA100 Filter Model Number Weiser = Manufacturer Project: 4 bedroom Mound Page 2 of 8 Mound Plan View _ T FK. /10 B .'- '•'•'•'•'•'•'•'.•.•.•.•.• • .............. .. 3 : J Observation Pipe ❑ ... .... • .......... ....•..�,.,..,,.,.- ...,..,..,., , .,a.•...,..,.. T y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L Mound Component Dimensions Down slope toe extension made. A 8.96 ft E 20.38 in H 1.00 ft K [ Aft ft B 67.00 ft F 9.25 in z 13.43 ft L ft D 15.00 in G 0.50 ft J 6.58 ft W ( ) Dispersal 600.32 (ft) Cell Area 1 1500.00 (ft) Basal Area Available r 8.96 (gpolft) Linear Loading Rate 1 6.70 (ft) 1/10 B Obs. Pipe Placement i Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.17 (ft) --► � F Dispersal Cell 98.90 (ft) Lateral 98.40 (ft) — Invert . ........ Dispersal Cell •��•••••�:- :••••�� '�'�'�:�:�=������:�. � Elevation E : D .: .... . ' 4 4 5 97.15 (ft) Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key c. T Dispersal Celt See lateral details on 1❑ _ Topsoil Cap o Q- 1.5 ft ti'•. • .ti., . ...•..• Page 4 for number, size, T•: �.'•d�: •:�:�. © {' Subsoil Cap w 5 f;''; ti; and spacing of laterals. :�� © ASTM C33 Sand `� 16 ' _° Laterals are eq uall y m 0.5 ft Typical Lateral ; • • spaced from the E= Tilled Layer � ti:• ... ...... .. .... . . . ❑ © �•; • • r•o �� distribution cell's Aggre o ::r:;.:":;.::;:::;; r::.'': -� ° centerline in the A distribution cell (AxB). Project: 4 bedroom Mound Page 3 of 8 I 444t E+y x 1446 Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service Inc. Attach complete site plan on paper riot less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direction and p I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pending 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 ,, o Property Location Tredal, Ryan t Govt. Lot na NW 1/4 SW 1/4 S 30 T 29 N R 17 E Property Owner's Mailing Addres s Lot # Block # Subd. Name or CSM# 2370 Helna Rd N 3 j.) L. +� ' 2004 13 na Emerald Acres City tate Zrp Cade Qhor�e City Village 0 Town Nearest Road Saint Paul N W28q 3 u61Z Hammond 76Th Ave New Construction Use: jd Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ' j Replacement : � Public or commercial - Describe: Parent material Ridges of ground moraines underlain by weathered Flood plain elevation, if applicable na General comments and recommendations: Mound design. System elevation 98.40ft based on contour line elevation 97.15ft. Boring # J Boring Pit Ground Surface elev. 97.35 ft. Depth to limiting factor 37 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3/1 none sl 2msbk mfr gw lvf .6 1.0 2 10 -28 10yr4/4 none scl 2msbk mfr gw na .4 .6 3 28 -37 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 4 37 -52 10yr8/2 c2d 7.5yr5/6 andstone residumm mvfr na na .0 .0 a Boring # 2j Boring Pit Ground Surface elev. 97.35 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIIB in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -19 10yr3/1 none sl 2msbk mfr gw 1vf .6 1.0 2 9-21 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 21-48 10yr8/2 c2d 7.5yr sandstone residumm mvfr na na .0 .0 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = B00 s30 mg/L and TSS S.30 mg/L CST Name (Please Print) &igrtature: CST Number David J. Steel 248956 Address Steel's Soil Service Inc. Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 7/6/2004 715- 246 -6200 1 0 -30 10yr3/1 none sil 2msbk mfr gw 1vf .6 1.0 2 30 -50 10yr4/4 none sicl 2msbk mfr cs na .4 .6 Q an-ar, 1nvrAO -3A r.mr,/a and -fnn rncirlrrmm mvfr na na .0 .0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A vh/ - ' Mailing Address LjPNA.eo Property Address v�- (Verification required from Planning Department for new construction City /State Parcel Identification Number 191 P/ - zzf V 7�/4 -A w LEGAL DESCRIPTION _ Properly Location X01/4, S � , Sec. 3 ° , T 2 1 N -R �I W, Town of . Subdivision LA/ GA , Lot # Certified Survey Map # , Volume �- . Page # Warranty Deed # �IS� Ho , Volume 2S-2�1 , Page # Spec house ❑ yes no Lot lines identifiable 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 masterplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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. S SIGNATURE 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 the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 0 d" A - \ 0- ��tLDU G SIG ATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** c1 In ude 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 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Code ' County Attach complete site plan on paper not less than 81/2 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 i Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location '-� r� U }- Govt. Lot CAF 1l4�w 1!4 S 3p Tz 9 N R / E (or� Property Owner's Mailing Address Lot # I Block # Subd. Name or C M# A-h� e Ir. �3 ,I Acre 5 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road ® New Construction Use: 2 Residential /Number of bedrooms 3 Code derived design flow rate -el /lo d C� GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material �� Flood Plain elevation if applicable ,"e/ General comments and recommendations: ❑ Boring ST CFOX Boring # Q COUN Pit Ground surface elev. 9 _ ft. Depth to limiting factor J10 rr -iN Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundaryr, Roots GPff ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I *Eff#2 lr) -c Ib y r —N — 5i( Zrrub c5 Y - I. r �+ s i I Zrra ,r C- – 5 3 - I0 v r 4 It. L- S m v r c 5 — •_7 I.2 r q/& L Z. Boring # ❑ Boring dL ® pit Ground surface elev.. 90 :t. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 6-1 I 1Z -- b i� c v 5 2 )8 2A q Sit b v — 5 4 "7 (, * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg /L CST Name (Please Print) Signature CST Number -- Z 3 Address Date Evaluation Conducted Tele hone Number r Property Owner Parcel ID # Page L of ❑ Boring # ❑ Boring 3 ® 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 ( 3 Z 5 " , Z mabL m -F'r 'f 5 8 Z - — it Z - 8 "7 !, z lU r`f � P�. Y a L S Ims u r - ! F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Boil Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft 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/1`1 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/L and TSS < 30 mg /L The Department of Commerce is an equal opportunity sery ice 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_,30F 3 TAM S�O Q+ TOT# 13 LEGAL DESCRIPTION s E X NJWX ,S 3o T 2 `l ,LEI R, t 7 E(Qr)i SCALE: V= 1 -I O , _ BM 1 ELEVATION /UO BM 1 DESCRIPTION -Fop o � 1 PVCr -- -1 — BM 2 ELEVATION 9 8 1 -15 6 � BM 2 DESCRIPTION 4-o P o J� i " e C S c-c 30 SYSTEM ELEVATION q 9, 0 0 SYSTEM TYPE K a u ,n ct S V ,�Z c v✓\ CONTOUR ELEVATION Y ss , S (` 03- 1 �/ GtA �1{ z� RM _ po� o 3 SIGNATURE DATE_ Jul 25 04 09:41p Steve & Pat Tredal 651- 439 -5189 p_1 ' L� 2�j P 4 7 0 �ss�s� STATE BAR OF�ISCONSI1 XPUA 2 - 1998 WARRANTY DEED XATHLEEH H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This need, made between _.___— ______— ._.,...... 83/04/2004 82:58PH RICHARD O. STOUT and JANET P_ STOUT_,__ h usband an wife, WARRANTY DEED J(EPr'T I .— .._�-- --- -, —` - - Grantor. an d ttvnnr a TRFI)AT and RITA F TREDAT., — REC FEE: 11.00 husbaxi_d and wife, _ TRANS FEE: 218.70 COPY FEE: - - - - -- — - - -- CC FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St- Croix County. State of Wisconsin: tiacor utti A *ea Lot 13, Plat of Emerald Acres, Town of tiara and Retten Address Hammond, St. Croix County, Wisconsin. f�,j141(.�jeeQ1� '� fir, t6 gtaf� 2-A4X $1 S0rj W► 546 1 4 01 8-109a-13-000 Parcel IderttiteXion Number (PIN) This 1S nOt homestead property. (is) (is tot) i Exceptions to warranties: easements, restrictions, rights -of -way and Coven of record. I � Dated this � day of February . 2004 (1> -SlUt6 (SEAL) '` (SEAL) * Richard O. Stout Janet P. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. 14' authenticated this day of {.VVn Personally came before me this J - e.6 r j .a �;4 .. kW' V� G Ri rl,arA n _ .;t and_ ,the move named Si r .Tanct D Stn t TITLE: MEMBER STATE BAR 0 WISCONSIN __ ___ to Of not, me known to be the perso who executed the foregoing authorized by 5706.06. Wis. S tau.) irtstrumcntcknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 1353 Awatukee Tr. Hudson, WI 5401 Notary Public, State of Wisconsin My commission is permanent. (if not, state expiration dale: (Signatures may be authenticated or acknowledged_ Both are not 3 _ Il'd� -- _____ —_ —_ •} necessary.) -- ` Nanws of persons signing in any capacity must be typed m printed below rhNr sigmon , STATE BAR OF WISCONSIN Wi—in Logal elank Co. Inc. WARRANTY DEED FORM No. 2 -1998 Wwaukw, Ws. 0 IN l f 3 . a N aha I f � }- of G AO Acom � 217 so 1rr � 14 j GAO ACWAG . . 13 � 1 W 7.40 2 80 LAN FM 1 017000 / OW40M OW 1440" 1