HomeMy WebLinkAbout020-1402-06-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
s 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: City Village X Township
Brown, Dou & Shell Hudson Townshl
CST BM Elev:
/ 0 0 • D Insp. BM Elev:
/OD , o BM Description:
/~ es ~a.~d d3rYt ~/ aa~
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic
Dosing ~
~ ~~
Aeration
Holdi
TANK SETBACK INFORMATION
TANK TO P/L
T WELL BLDG. Vent to Air Intake ROAD
Septic ~~~ y ~~ t ~~, '
Dosing
'
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer ~ De nd
GPM
Model Number
TDH Lift action Loss System Head TD Ft
Forcemain Length Dia. o ell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width ~ Length
i DIMENSIONS ~_ 2 S
SETBACK SYSTEM TO
INFORMATION
Typ~Of System:
DISTRIBUTION SYSTEM
P/L ,E BLDG WE I
~ ~Sfi~ ~D! ~ I ~
ELEVATION DATA
county: St. Croix
Sanitary Permit No:
420486 0
State Plan ID No:
Parcel Tax No:
020-1402-06-000
t~ dew>v
STATION BS HI FS ELEV.
Benchmark
Alt. BM
~~ ~ Lu4„ /l
~ 7 Z
Bldg. Sewer
9s~/s
SUHt Inlet
~O.G
~3, a
SUHt Outlet ~.7~
9z
Dt Inlet ~ ~~
Dt Bottom
~~/
Header an. ~~ q• '~ Gl'a ,. (~
Dist. Pip~On A~ ~•
11 / •'
Bot. System ~ ~ , 4~i' '?
J--"
Final Grade S.3
St Cove
~o,
IT DIMENSIONS No. Of Pits Inside Dia.
AKE/STREAM EAC ING Manufactu
CHAMBER O
~ Model Nun
.i
Depth
/~TO
,t ~a)/~~
Ft ~ ~ 1' ~tvDn / )
Header/Manifold
~
Length Dia i t Distribution (
pipe(s) //~~ L // -- ~
Length Z • Dia p ing (O x Hole Size
~-- x Hole Spacin Ven Air Intake
~
SOIL COVER
x Pressure Systems Only xx Mound Or At-Grade Systems Only r~^•~' ~~'-'~~~ ~'h
Depth Over ~ ~t.Ql`C Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center ~/ Bed/Trench Edges Topsoil
.:^ Yes ~~] No
Yes ~'„ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~ / / ~ v Inspection #2: / /
Location: 795 Starlight Drive Hudson, WI 54016 (SE 1/4 SE 1/4 11 T29N R19W) Misty View Lot 6 Parcel No: 11.29.19.2517
1.) Alt BM Description = ~'~'"~~~~ `v (~ /7M~1. ~• S. ~ /" i~h ~~i, /c' ~~~~~"1~ ~~. ~~~j4~ ,~~/`~uf ~~ °,f"~'"-~{2
2.) Bldg sewer length = 3~ 7~ (~Caf/~I~/tiv !/!'l.Iol~t2dS, jl~ryQP~ ~'~- ' ~~,~
-amount of cover = \ ~) ~~/ ~ ~Q{'-/ ,
Plan revision Required? '~, Yes _, o ~ ~ ~ r ~ ~ ~~ ~
Use other side for additional information. '_ __'_ ~ _ __~ __~ ~ ` ~_ __-! ~ - --
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
Safety and Buildings Division Cry
201 W. Washington Ave.. P.O. Box 7162 -p ~
IS~~~S~~ Madison, WI 53707 - 7162 Site Address
De artment of Commerce
!o - zZ -UL $ ss ~
'19 S ~~rir ~ H i, ~
Sanitary Permit Applieatio Sanitary Permit N'tn'be`
In accord with Comm 83.21, Wis. Adm. Code, personal informs ' you
'~'~EiVEp ~Q
k;fRevision
ma be used for ses Priva Law, a15. 1 m
I. Application Information -Please Print All Information S Plan I.D. Number
~~ ~~
Property is Name 1 Number
®do..l~oa•oG -000
C OJX COUN1~y ,~y
Property Owner's Mailing s
E p perty Location
, )
dG
~ ~~
VlJ 3f Si : S T N. R
City, State Zip Cade Phone Number Lot tuber Block Number
~~
c.~ / / Subdivision Nam ,~ /
CS~M Number
J ,D ~
1L Type of Building (check all that apply)
^Ciry
~
1 or 2 Family Dwelling -Number of Bedrooms
~~
^Vipage
^ Public/Commeroial -Describe Use wnship
^ State Owned 2 !.~//I ~G~~- Nearest R
r
III. Type of Permit: (Check my one box on line A (numbering scheme for internal use). Complete lin B if applicable)
`,' ew 2 ^ Re htcement stem
p Sy 3 ^
Replacement of
6 ^ Addition to For Cou~y use
stem Tank Onl stem
B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV. of Permit: (Check all that apply)(numbering scheme is for interval '
~ //' -_
~„~~d~3~ ~
n-Pressurized In-Grotmd 21^ Mound 47 ^ Sand Filar 50 Constructed Wetland
^ tressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass S1 ^ '~ 0 /, p~ ~,'. ~yLCY~~"~Sa
,^ ~ ~
43 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ er ~ S ~
V. tment Area Informat ion: r
Design Flow (gPd) Dispersal Atha
Re
uued
~ Dispersal Area
Pro
osed ~ Soil Application
Rao
l
/D
/S
)
G
Ft Percohtdon Rate
(Mi
/I
h) System final Grad
q
, p e(
a
s.
ays
9,
• n.
t~ ~i / F1 tion//
S,
VI. Tank Info Capacity in .Total Number- Manufacturer .Prefab Site Steel Fiber pla~c
Gallons
N
E
i
i Gallons of Tanks //1/,
~
~ - `~CJ Concrete Constructed Glass
ew
x
st
nY 6~
Tanks Tanks
Septic or Holding Tank _
Dosing Chamber
VII. Responsibility Statement- I, the trod ,assume responstbility for installation of the POWTS shown on the attached plans.
Phrmber's Name (Print)
~ Phan ignature MP/MPRS Number
~9 Business Phone Number
~
~'
/
~ t~
Z !
~i~ =-
,~
Plumber's Address (Street, City, State, ' Code) _ /
'"
~~
~' 1
/tar/ ~
J
VIII Coun /De artment Use Onl
Approved
^ Disapproved
^ Sanitary. Permit Fee (includes Groundwater
Suroh Fee)
~ Da Issued
1
~ ring ent Si cure (No
s~ ~)
Owner Given Initial Adverse
~~~ ` a ~ 0
/ Q
Determination ~''f
IIC. Conditions of Ap rovaUReasons for Disapproval
~`
"
~
5 s~ ~d ~ 6e s
k~" is d,~~~~ `~~'t~-' /~° f ~ .
/?'I
~~L
eomP~e ~ ~~>n oo psperlwt taa than 3111 zA~i taeLes m size
SBD-6398 (R. OS/01~~ ~ - ~6 ~, ~~,~~ y3, tF3- ~
' 1 1 L 1\
PROJECT D~cwa and Shelly Brown ADD ss 82100 Ochoa Ave NE Hudson Wi 54016
SE i/4 SE i/4S 11 /T 29 /R 19 W TOWN Hudson COUNTY ST.CROIX
10/11/02 BEDROOM 3
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXX IN-GR PRESSURE CONVENTIONAL LIFT HOLDING TANK ~
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK E '
e
HOLDING TANK SIZE LOAD RATE •7 ABSORPTION AREA 684 # of cbambe 22
,BENCHMARK V.R.P. Top of nail in 4" BUrch ASSUME ELEVATION 100' Filter Zabel A-100
^ BOREHOLE O WELL *H.R.P. Same as Benchmark ,
~ ~`
SYSTEM ELEVATION 89.1 /88.5
Vent ~
>6„ Standard Infiltrator Plans Designed
Leaching Chamber Conventional Pc
of Cover ~~ 31.1 ft2 of Area Manual Version
6' Long 12"
34" Grade at System Elevation
3 (r~. ~ ti ~' N ~'`~~ Cd~?ii~ri,, 275' tl
Pro 3
Bedroom
House
~~
~~ .
T
3
2~=2
G~
.,,
,~
Set @ 6.5' Below Grade
30' 35'
0' 10 B-1
40' ~sJents
ents
0'
B-3
2-3' X 69' Cells with
>3' Spacing
Please note: soil test is suitable for
sanitary permit only, and should not
be used to install system.
Further testing will be done aild a
revision to be filed
90
~,
m~
Line -~ 60'
3~g. ~b'
PROJECT Doua and Shellv Brown ADD ss 82100 Ochoa Ave NE Hudson Wi 54016
BE i/4 SE 1/4s 11 /T 29 /R 19 W TOWN Hudson COUNTY ST.CROIX
10/11/02
3
MPRS Shaun Bird 226900 BEDROOM
DATE
CONVENTIONAL XXX IN-GR PRESSURE CONVENTIONAL LIFT HOLDING TANK ~
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK E
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of cbambe s 22
,BENCHMARK V.R.P. Top of nail in 4" Burch ASSUME ELEVATION 100' Filter Zabel A-100
^ BOREHOLE O WELL *H.R.P. Same as Benchmark ,
SYSTEM ELEVATION 89.1 /88.5 ~ ~`
:Q
Vent c~'
>6„ Standard Infiltrator Plans Designed U ing
Leaching Chamber Conventional Po is
of Cover with 31.1 ft2 of Area Manual Version .0
6' Long 12"
Grade at System Elevation
34"
~] 2 ~' ~(~'`~' Ce~lir~ti,.
3 (off
'
.
275
~
Starli G
Pro 3 a~
.~
Bedroom ""~
House
25' Set @ 6.5' Below Grade
.~
T 30' 35' M
30' 10 B-1
40' Vents
B-2
Vents 30'
B-3
2-3' X 69' Cells with
>3' Spacing
Please note: soil testis suitable for
sanitary permit only, and should not
be used to install system. 90'
Further testing will be done alid a
revision to be filed
Pro er Line 60'
3~8~ ~~'
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TA~IE1f LANE
Wisoat3sin Department of Commerce
rlivicinn of Safrat~ ar-rt Builitirtas '
~ o~Zs~b t ~ 'z~c i Zq J
SOIL EVALUATION REPORT ~ : Page ~ of 3
in accordance with c;omm a5, wis. Aam. ~.oae County '
"" ' t
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. t/
~~~ "
v ~' ~ lO ~~
north arrow, and IocaGon and distance to nearest road.
scale or dimensions
ercent slope / 7
,
,
p
Please print all information. by Date
Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). G~~ ~ ~ l ~] Q
Property Owner
~~~, Property Location
Govt. Lot ~ E 114 S ~ 1!4 S ~ / T Z q' N R ~ ~ E (or)
Property Owners Mailing Address Lot # Block # Subd. Name or CSMflF
~ ~ U~e~
l35 ~ e Trcit ~
City State Zip Coco Phorre Nulrteer ^ Vllage ® own Nearest Road
^ City
[~ New Construction Use: ~ Residential i Number of bedrooms ~' Code derived design flow rate ~ Sa l ~ U CT GPD
^ Replacement ~ Public or c~mmeraal -Describe:
Parent material 0 U'k'wa5 h Flood Plain elevation if applicable ft.
U
9 ~ • ~ O ~ ~.^ ~ j `S`
l -e
•
r
General comments 5 ~ S-E-t tn~ G
-
; ~ -'~
~m ~~
6T ~ih'lt~i S/~lNh
L
'
~
ti
.
,~~
. fj $ • ff p
and recommendations: ~. L~ , e(~- J
s - - .9~r17 ,
-_~
Boring ,~v`.~ ~ xx ~ i c;+~;~~tX
lpl Pit Ground surface elev. S ~ ft. th to limiting factor ~J14IN+~ GF~ICC ~ ~ `lication Rate
Horizon Depth Dominant Cobr Redox Descri~ion Texture Structure Consistence Boundary Roots GPD/if
in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •~~ . ,~ < , ~ '~ ~ ff#1 'Eff#2
Z l z-32 / ~ rYl ~~
3 3Z-(~c~ 1 ~lc~ ~- r» s Qs ~ ( - - ~ ~- Z
~ g'' «
ng ^ Boring / ~i
Bon # ®Pit Ground surface elev. 9.5 ' ~ G ft. Depth to limiting factor (/ U in. ~ - lion Rate
Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/fa?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 D l3 /o ~3 / ---, S i l k r ~ I~ •~
Z ~3- /(~ r ~f Si l 2rn mom- c - ~
,, ~ ~ ,,
' Eflluent #1 = BODE > 30 < 220 mglL and T55 >30 < 150 rrrg/f_ ` tmuem s<~ = nuus ~ .w mg~~ ana 1 Jal ~ ov nny~
CSTn/Nam__ a (Please Print)
/'~YY" ~ ~ hunnaker i~~i nature ~~ , 25 ~~09
A~~ /~ Date Evaluation Conducted Telephone Number
2113 $b'`'`~ ~^;;^~-se-~ F ~>~- Sy~Z~ /U ~~-- --G CIIS)241- yoo 8
r
Property Owner ~`lT'~ 1 ~ Pan;el ID #
Page Z of
Boring # ^ ~~
3 ®Pit Ground surface elev. ~~ O D ft Depth ro limiting factor ~ 2 ~ in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz Cont Cobr Gr. Sz. Sh. 'Eff#1 "Eff#2
I ~-iz z S./ 2 ~ cs lv
2 2 -sb , ~I ---- ~ ~ cw I v - S
~ C2p r `~ S i l I -~'r i' S - . g
~ 7 -I m 5 Ds /YI 1 - -. . -~ /. 2
~~
Boring # ^ Boring
^ Pit Ground surface elev. ft Depth to laniting factor in.
Soil lication Rate
Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Rools GP D/tf
in. Munsell Qu. Sz. Coat Cobr Gr. Sz. Sh. "Eff#1 "Eff#2
Boring # [] Boring
^ Pit Ground surface elev. ft Depth to Igniting factor in.
Soil Pion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff
in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
" Etfivent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA. ` t_ffluent #2 = BODS < 30 mg/L and TSS < 30 mglL
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.
S8D-8330 (R.07100)
~ --~.
Property Owner ~Tf~1[ 1 ~ Pamel ID ~
Page Z ~ 3
o e~# ^ ,~/
® Pit Group surface ~. ?S O 0 tt. Depth to IKrritbg factor ~ in.
Soil tan Rate
Horizon Depth Dominant Cob Redox D~tion Texture Structure Consistence Boundary Roots GP DII't
in. Mansell Qu. Sz. Coat Cobr Gr. Sz Sh. "Eff#1 •EtffF2
,.- ~ z Z - s; i 2 vY-~r ~ s ~
Z -sb ~ ~ -- ~ cw i v S
7 3 CZp r `{ S i t ~ -~' c. 5 - . 5 S
~ -i m5 Ds ml - - .--~ /.2
^ ~ # ^ ~~
^ Pit Ground surface elev. ft. Depth to limiting factor in.
Sod Caation Rate
Horizon Depth Dominant Cobr Redox Description Texture Strudure Consistence Boundary Roots GP Dlftr
in. Mansell Qu. Sz Cont Cobr Gr. Sz. Sh. "Efflfl 'Efffi`2
^ ~9 # ^ Bonng Ground surface elev. ft. Depth to 1'mirting factor in.
^ Pit
Sod lion Rate
Horizon Depth Domirmnt Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/If
in. Mansell Qu. Sz Cont Cobr Gr. Sz. Sh. •Eff#f "Efi#2
"Effluent #1 = BODS > 30 < 220 rrrg/L and TSS >30 < 150 mglL • Etiluent #2 =GODS < 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 608-266-315 t or TTY 608-264-8777.
SBU-8310 ~R.07/00)
. ~ ...
f
PAGE 3 OF~
r~A~,~rF ~ ~ y ~ T OT# (o LEGAL DESCRIPTION -SF ~ S E i4 ,S ! 1 T Zq ,L~I,R, / 9 E(or~~
SCALE: 1"= yD ~
BM 1 ELEVATION lOv - 0
BM 1 DESCRIPTION -10.: (,' n ~ Iwo. lln w /~c. 1,
BM 2 ELEVATION /~G • U
BM 2 DESCRIPTION rl g ,' (,' ,~ (s ' ~~e. //o w 13t K. ~,
SYSTEM ELEVATION~jU• Cc ~
ALTERNATE ELEVATION ~Sg• ~~
CONTOUR ELEVATIONS-S: ~~~ `j~/a
~ ~ ~~
SPA- i~
t
- -!-
X
E '~ ~~'~,~ ,u~tr t.,~°°
~~,
ts'
SIGNATURE z~~~ ~~ /~~ DATE,
!_-aT L/~t/ E"~
~..~-°°
~ _:
__
>_. .,.
__. ~g
gs•a0 ~~
,___ ...
1
,~
c.-~
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v i ~awa.ca v.+ ~- • ~ -
SEPTIC TANK MAINTENANCE AGREEMENT
AND
. OWNERSHIl' CERTIFICATION FORM
OwnerfBuyer Aim 'SF~e.I~ 132a u~ ~
Mailing Address ,_ g~100 p~F}~ ~~ ~~
Property Address
(Verification required from Plana"~g Department for new
City/State ~/1 ~~ ~, Parcel Identification Number ®~d " /~ 6 ~ ' ~ b -~~
oN Cl/. Z~. ~9. ~s~ ~>
LEGAL DESCRIPTI
Property Location ~~ i/., ~~ '/., Sec. ~ ~ . T„~_N-R_I,.CLW, Town of }^~c~.~5s~-
Subdivision ~ ~ l ecJ Lot #
Certified Survey Map # , Volume , .Page #
,Volume ,Page #
Warranty Deed #
Spec house ^ yes ~ no
Lot Lines identifiable yes ^ no
SYSTEM MAINTENANCE
Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic task 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 is the waste disposal system_
The property owner agrees to submit to St. Croix Zoning Department a cerirficatton form, signed by the owner and by a
masterplumber, jouraeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposal system
is in proper operating condition and/or {2) after inspection and pumping {if necessary), the septtc tank is less than l/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 ~~ 30
days of the three year expiration date.
~ i a
SIGMA OF AP LICANT 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 owners} of
the pr rty described above, by virtue of a warranty deed recorded is Register of Deeds Office.
1r~/ !/~
IGNA OF APPLICANT DATE
ariment. ««**`«
**«+*« Any information that is nits-represented may result in the sanitary permit being revoked by the Zoning Dep
*« Incinde with this application: a stamped warranty decd from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
j~d ~ dL0=60 ~0 GO X30
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
1. If system fails, determine cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
Plumber: Shaun Bird 715-246-4516
St. Croix County Zoning 715-386-4680
Pumper Tom Mondor 715-246-5148
Shaun Bird #226900\
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$ LOT 6
S 2.214 ACRES
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LOT 7
2.002 ACRES
87,198 so FT
269.81'
N89°26'S9"E 1312.07
~ Iss~°oa~2~~M _d_O_4 4 OG~
80UTH LINE OF THE 8E1/4 (~ ~/,~ M
I ~aUallUlJc ~Ln.l VD~o
~ --- - - - -
10'
20' WIDE DRAINAGE EASEMENT NOTE NO LOTS OF THIS SUBDIVISION MAY BE
FURTHER SUBDIVIDED UNDER CURRENT
TOWNSHIP DENSITY REGULATIONS.
NOTE MIN. FLOOR ELEVATION IS THE MINIMUM
FINISHED FLOOR ELEVATION OR THE, LOWEST
BASEMENT WINDOW OR DOOR ELEVATION
o JOINT DRIVE EASEMENT
'~ NOTE NO OWNER OR RESIDENT SHALL DO
ANYTHING WHICH WOULD INTERFERE WITH OR
CHANGE THE OPERATION OF THE APPROVED
COMPREHENSIVE WATER DRAINAGE AND SOIL
EROSION PLAN FOR THIS PLAT. THIS
PREVIOUSLY RECORDED MEASUREMENTS INCLUDES BUT IS NOT LIMITED TO BUILDING
UPON, OBSTRUCTING, ALTERING, FILLING OR
EXCAVATING, OR PLANTING IN ANY POND
ELEVATIONS ARE REFERENCED TO EASEMENTS, WATER DRAINAGE DITCHES,
GRS 80 BASIS OF NAD 83(91) WATER RUNWAYS, WATER CULVERTS, BERMS
OR GRASS SEEDINGS.
NOTE SEE COVENANTS FOR LOT OWNERS
RESPONSIBILITIES REGARDING MAINTENANCE
OF DRAINAGE EASEMENTS AND WATER
RETENTION AREAS LOCATED ON THEIR LOT.
NOTE SEE COVENANTS FOR LOT OWNERS
RESPONSIBILITIES IN PREVENTING EROSION
ON THEIR LOT.
SE CO
SECTI~
SHEET 1
" STATE BAR OF'WISC~[k151ttl'FdRM 2 - 959 9
WARRANTY DEED
Document Number
This Deed, made between __~_,___.. ___-_-___
- R?CHARt7~ gmnUm ar,r1 JAi1LR'f' p. STOUT, ~_.--
~nshand and saifP, ---._--_-
and D-4UGLAS CHARLES BROWN and SHEL•T•Y MARTS
--~~OWP~, hrruc~ap' rtd and w#€e, -----....__.-_ __........--
-------------'--- --- Grantee.
Grantor for a valuable consideration, conveys and warrants to Crantee the following
descri d r estate in ,_,et ~, ~r~~~ County. State of Wisconsin:
Lot 6, Plat of Misty View, Town of Hudson,
St. C oix County, Wisconsin.
660662
KATHLEEN H. MALSH
REGISTER OF DEEDS
ST. CROIK CO. , WI
RECEIVED FOR RECORD
06-03-2002 9:30 A11
WRRRF3NTY DEED
EXENpT #
REC FEE: 11.00
TRANS FEE: 206.70
COPY FEE:
CERT COPY FEE:
PAGES: 1
... ;o: ,
Name and Return Address
IHE RIYER BANK
PO O CEOLA•WI054020AYE
020-1013-30-000
020-1014-10-000
Parcel Identification Number (PW)
This 15 nOthomestead property
(is) (is not)
Except;onstowarranties:easements, restrictions, rights-of-way and covenants
of record.
Dated this ~ ~~~ day of Maw 2002
_!L~~~:~` (SEAL) - '(~'C~~l _~`x _ .. (SEAL)
Ri~hard~ Rtnnt- * .Tanat P, Rtrntt ,_____._..........
- ..._ - --- _ _ _ ..._ (SEAL)
AUTHENTICATION
Signature(s)
authenticated this day of
TITLE. MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §70&.06. Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BV
Janet P. Stout
_ 1't51 Awa rk T _
Hudson, WI 54016
!Signatures may be authenticated or acknowledged. Both are not
necessary)
(SEAL)
ACKNOWLEDGMENT
State of Wisconsin,
ss.
St. CrO1.X County. 2
Personally came before me this /~ day of
May ~ 2.QOZ-.~ the above named
to
me known to 66ccee [e ccuted the foregoing
instrument and`eh~(t~ ha2CONS~N
KER~ON J. BAST
~::a
Notar Public, State of 's onsin
My ommisslon I erma nt. (lf no[. state expiration date:
-- ~' a ~Q~ - ------- )
' Namr. of persons vgning in any capacity must be typed or primed below eheir signature.
STATE BAR OF WISCONSIN wlsconsln Legal Blank Co.. Inc.
WARRANTY DEED FORM No. 2 - 1998 Milwaukee. Wls.