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HomeMy WebLinkAbout020-1452-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. C O[X Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 463155 0 GENERAL INFORMATION 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: LaCasse Develo ment Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: {� Sectionfrown /Range /Map No /co 3.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark (,i , ia y pocit BM Alt. `za X4-1 c V ,+ 91 Aeration Bldg. Sewer j 3 Holding St/Ht Inlet 13 .E t St/Ht Outlet TANK SETBACK INFORMATION 1 7`� q © -•� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic�I ® f O i Dt Bottom \` y tj Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System •75 Di Final Grade c� PUMP /SIPHON INFORMATION I0 Z 17 -3 Manufacturer Demand St Cover { 1 GPM /N ICJ Model Number` TDH Lift Friction Loss System H TDH Ft Forcemain L ngth Dia. joist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length No. Of Tre PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS - Z tr y�l� � N ___ ~ `'•, , SETBACK SYSTEM TO P/L IBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION L CHAMBER OR..�`r Ala Type Of System: r UNIT 1 (40' Model Number: ' q- t '1 DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air I ake� Gy Pipe(s) 7_ Length { Dia . Length \ Dia_ �"'' Spacing +` \ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /So ed xx Mulched BedlTrench Center �� / Bed/Trench Edges \ Topsoil \ Yes [ %] No es '_ll No COMMENTS ( Include gcoded iscr p encies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location. uds � 5 1/4 N ( P W 1/ 13 T29N R19W) Bluebird Meadows Lot 10 Parcel No: 13.29.19. 1.) Alt BM Description r 2.) Bldg sewer length = I Z amount of cover = / 4 r Plan revision Required? I 'l Yes No r��q 3 Use other side for additional information. l l _l_ — _ SBD 6710 (R.3/97) Date Insep, is S' ature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 "• �sc onsin Madison, W1 53707 - 7162 Sanitary Permit Number ( to be filled in by Co.) /� r1 D ep artmen t of Commerce (608) 266 - 3151 / J Sanitary Permit Applicati RECEIVE State P lan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal in ou provide may be used for secondary pu D 'vac�w 15 ( > n Z 2 20 � Proje Address (if different mailing address) l ( � � � U I. Application Information - Please Print All I rm J, l' 7 I C. CROIX COUN i Y Property Own is Name Pazcel Lot # I Block # Property Mailing Address `" ' Locat' ` 7Zf � %4, %4, Section �_ City, State Zip Code Phone Number 11L � 39 ' � 5 �� (circle 7 ) TC? N; R�E o Il. Type of Building (check all that apply) or 2 Family Dwelling - Number of Bedrooms Subdivision Name r ❑ Public /Commercial -Describe Use r $ ❑ State Owned - Describe Use C L Gil 1 e ❑City ❑village ownship III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ew System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B• ❑ Permit Renewal ❑Permit Revision El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a pply) tkNon - 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 hing Chamber rip Line ❑ G vel -less Pie er (ex ain) V. Dis ersaVrreatment Area Information: 1/ Design Flow (gpd) Design Soil Application Rate( sf) Dispersal Area Requ red (sf) Dispersal Area Pllp osed s System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fib lastic �J. Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank yv Aerobic Treatment Unit r Dosing Chamber VII. Respoybibility Statement- I, the undersigned, , dome responffipility for installation of the POWTS shown on the attached plans. Plum r' ame Plum is MP/MPRS Number Business Phone Number t ' Plumber's ddress (Street, City, State, Zip Code VIII. C n /De artment Use Only X,Af proved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ssuing Agent �gn a ps) Surcharge Fee) I -K �/ � O a 7 T44-4 ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons fgr Disapproval , m c, a uent filter a d L C{jLc O/ dispersal cell must all be rviced ! rri�inta ��,� •• aster maha M�d �2 SGtjY�c�i1 /� �d ,d0 setback requirements st beq�aintained as per applicable code /ordloanp9s. Attach complete plans (to the Comty only) for the system on paper ntf less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) � SSG ,L�F�,� /�i��,�r z� _s��y - .c�� �� - s�� /3 �- �� 9r✓-�i 9� 4 / Ap AZ ' 9W .- 1 dr�}y 13 z /�/,56 • I I _ - I _ o d _ - - ---' r _ 4 105Z 1 S � I .�5 I - - -- - -- --------- -- - - -- i ! ill I L ! rt A o - - - I I I I , 4 I _1 I I I L I II - I I , I : - v ' 1490 Wisconsin Department of Commerce SOIL EVALUATION REPORT P 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service, Inc. County Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Pending Please print all information. Re sewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2 Property Owner o-.. z - i I Property Location LaCasse Development, Inc. I Govt. Lot na SW 19 NW 1/4 S 13 T 29 N R 19 W Property Owner's Mailing Address! Lot # Block # Subd. Name or CSM# 573 Cty Rd "A" '{ 10 na Bluebird Meadow City S to Zip Code Phone Number _j City J Village 01 Town Nearest Road Hudson I 1; 715- 381 - 540 Hudson McCutcheon Rd 01 New Construction Use: j► Residential ! Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 93.40ft. Trenches spaced and depth to code 4.00ft below grade. Boring # I Boring 16 Pit Ground Surface elev. 97.40 ft. Depth to limiting factor 120 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 8 -13 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 13 -79 7.5yr4/4 none ms osg ml cs na 7 1.6 4 79 -120 7.5yr4/6 none ms /cos osg ml na na .7 1.6 �3 a Boring # Boring am Pit Ground Surface elev. 97.40 ft. Depth to limiting factor 120 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 1 0-23 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 23-40 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 0 -120 7.5yr4/4 none is osg mvfr na na .7 1.6 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD S30 mg/L and TSS < 30 mg /L CST Name (Please Print) ature: CST Number David J. Steel 1 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 8/20/2004 715- 684 -5680 r Property Owner Larasse Development, Inc. Parcel ID # Pending Page 2 of 3 3] fE Pit Boring # Boring Ground Surface elev. 95.20 ft. Depth to limiting factor 120 in. Sol Application iFaW Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 12 -27 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 27 -86 7.5yr4/4 none Is osg mvfr cs na .7 1.6 4 86 -120 7.5yr4/6 none Is osg ml na na .7 1.6 ❑ Boring # I Boring I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # I 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 GPDtr 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 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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 994 200'' St. CST- POWTSM LaCasse Development, Inc. Baldwin, WI 54002 Lic. #248956 SW1 /4,NW1/4,S13,T29N,R19W Bus .(715) 684 -5680 Town of Hudson, St. Croix Co. Fax .(715) 684 -3449 Bluebird Meadow, Lot 10 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend 1 " =40' ♦ =Benchmark Ele. 100.00Ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 99.90Ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B 1 = 97.40Ft B2 = 97.40Ft B3 = 95.20Ft B4 = OO.00Ft 'Co �y daft 'Q0� 53 , 73 z NY Act c0 N x W i N 0 ■ co zo law co x : 1N3WV3N N N x U r •� 30WNMNG P V �o l ( mai lot w w N 01 c 9 b 1 X •x• to so X ..... ...... � _ ► co x ; UP N X • 1 w; ► . W W r x w Q � W a X WA D X N in ..i W 4 _ t W x X x x x S`l` CROIX COUNTY SEPTIC `PANIC MAINTENANCE AGIUMMEN`i' AND OWNERSI111' CERTIFICATION I Owucl' /I3tlycr L&Gr} S ` - ,. Qt t, e, L Mailing Address ..y �,� ?�� �� /q- f lt[al�ac Property Address �tt`1 (Verification lcyuiled I'ioul 1'l allilillf; Deliaatiliclll for llew C(,Ils ll City /Slate .- --6VYL— I'arccl Well(iticatiilll N11111bel LEGAL DESCRIPTION Properly Location 151.0 '/4, '/4, S,cc. 'I'- WIZ `!'owtt of c Subdivision �(„ L u -e I lVrl MIL&JO IAi%S . Lot # . Certifieel Survey 'Ma1) It Volume y Page Il 3 � I b /b� Watrranty Deed// �` 3 Vcilulllc q / , E'tlgc Vii' 3� Spec house ❑ yes Vno Lot lilies idenlitiable X yes ❑ no SYSTEM MAINTENANCE Improper use and moinicnanceof y(nn septic sys(elu could lcsult ill its pr cilia wic fililure to handle wastes. l'ropermainlenance consists of pumping out (he septic (Bilk cvcly ill, cc years or sooner, if needed by a liccused pumper. What you put into (he system call affect the function of (lie sCplic fallk as a treatment stage in the waste disposal system. Ilia property owner agrees to submiit to St. Croix Zoning I)cpailmen(a certification form, signed by the owner and by a niastcrplumlbcr, Journeyman plumber, lcslricted idumber or a licensed pumper vcl ifying that (1) (lie on -silo was (ewalprdisposaI system is ill proper operating condition and /or (2) Biller irlspccli(nl and pillilpillg (if necessmy), the septic lank is less than 1/3 full of sludge. I /we, (he undersigned have react the above mptimoicols and agree to maintain (be private sewage disposal system with the standards set fortis, herein, as set by .(lie Depa((nicut of Conuilcice and Isle I)cpallnicnt of Natural Resources, Slate of Wisconsin. Certification stating ([rat your septic system has been maintained joist be compicled and retu11lcd to the Sl. Croix County Zoning Office within 30 day (lie three yf or expiration date. SO NA r 1l1'I'LICANT 1) i Lr OWNI!.R CLR'I'IIqCA'I'ION .I ,(we) certify that all statements on Illis 1411111 Bic title to file tics( of illy (ollr) knowledge. I (we) Bill (are) the ownel(s) of t[1e 1 fly tics rib( above, by viitue of a waminty (f lccordeel i Itegis(cr of Dccds Office. Q >• SE E�EATURP- F AE'I'LICANT UATLr * ** Any itiformatioll that is mis- lcpicscn(cd may icsul( ill (lie sanitary peimil being ,evoked by the Zoning Department. * * * * ** ** Include with tills A11Plics(1011: a staml)e(t wimawy dccd front llleTc- gis(er of I }ac:ls office - ' e s cohv;(if tf tfiul stn>,c"iiin[ if felcii Lis ula�lir;tb vrlitrat �etcf* ' o, " POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al O Ni Permit # 3 �;15 Septic Tank Manufaoturer O N' DESIGN PARAMETERS Effluent Filter Manufacturer O Nn Number of Bedrooms 3 O NA Effluent Filter Model _ O NA Number of Public Facility Units dNA Pump Tank Capacity g ANA I Estimated flow (average) Pump Tank Manufacturer �� gal/day Design flow (peak), (Estimated x 1.5) -�� C� gal/day Pump Manufacturer ­15 NA I Soil Application Rate gal/day/ft' Pump Model ANA III Standard Influent /Effluent Quality Monthly average* Pretreatment Unit N �' Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter j Biochemical Oxygen Demand (BOD 5220 mg /L O NA O Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L O Disinfection ❑Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA 1 Biochemical Oxygen Demand (BOD 530 mg /L Jas In - Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L O NA O At -Grade 0 Mound Fecal Coliform (geometric mean) 510 cfu /1001111 O Drip -Lino 0 Other; Maximum Effluent Particle Size Y in dia. O NA Other: CJ Ni. Other: 0 NA Other. O NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA I MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) '` (Maximum 3 years) O NA Inspect condition of tank(s) At least once every: ear(s) „ Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume O NA ❑ hl Inspect dispersal catt(e) II At least once every: j mont a)' (Maximum 3 years) O NA year(s) N eED eD ❑ month( O N�, ^i Clean effluent filter t least once eve ? � ')�yearls) O month(s) �Ni- Inspect pump, pump controls & alarm At least once every: O year(s) ��: � � ^ Flush laterals and pressure test At least once ovary: O month(s) ;� NA O e4r(s1 Other: O month(s) 1 0 NA At least once every p year(s) Other. O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the antiru contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, t� Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 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 taro f P4 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chdmicals that may impede the treatment process and /or damage the dispersal cell(s). 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 highwater levels. When power is restored the excess wastewater will be discharged to the dispersal call(s) In one large dose, overloading the cellls) and may result ln�the backup or surfoos discharge of 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 are a 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 life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss, diapers; disinfectants; tat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; ; - 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 ba 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 �eoled, • 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 removed and the void space filled with 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: ;,,,, V . , :,;,,, ; , 1 . 1�s 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 be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems musi comply with the rules in effect at that time. 13 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 re s to replace the ' ad POWTS.-­•­ � The site not n evaluate to t entify a su' bie rep cemen area. pon fail a the POWTS a soil and site valuati ust e p formed o locate a suits a replaceme ea.. If no r lac ent are 'labia, a holing tank may be st I as a la ort to replace failed POWTS. 0 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 DEATH MAY RESULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER/ POWTS MAINTAINER. Name / Name i Phone J — Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY 4UTHORITY Name Name �.rc,,. 1 Phone Phone L "his document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.64(1), (2) & (3), Wisconsin Administrative Code. x. 2 6 4 1 3 9 STATE BAR OF WISCONSIN FORM I - 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI I This Deed, made between Ronald G. Raymond, Loretta B. RECEIVED FOR RECORD Raymond, husband and wife 04/28/2004 11:55A![ Grantor, WARRANTY DEED and LaCasse Development, Inc , a Wisconsin EXDPT ll corporation 11'EC FEE: 11.09 TRAINS FEE: 2250.00 Grantee. COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the following CC FEE: described real estate in St. Croix County, State of PAGES: 1 Wisconsin (the "Property ") (if more space is needed, please attach addendum): Southwest 1/4 of Northwest 1/4 of Section 13, Township 29 North, Range 19 West, St. Croix County, mI Recording Area Name and Retu ress 3 C ty Ro Hu o 54016 020 - 1017 -30 -000 Parcel identification Number (PIN) Together with all appurtenant rights, title and interests. This not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except encumbrances of record Dated this dav of Au st 2004 . ot " Ronald G. Raym *Loretta B. Raymond AUTHENTICATION ACKNOWLEDGMENT Signature(s) Tracy TUrrler STA F WISCONSIN ) ss c Mary . y county --�authenticated this day of 0 n — } Personally came before me this day of August 2004 the above named * Ronald G. Raylaond 4.n¢ TITLE: MEMBER STATE BAR OF WISCONSIN Loretta B. Ra=ond husband n wif (If not, to wn �to be e An who executed authorized by §706.06, Wis. Stats.) th o s wledged the same. THIS INSTRUMENT WAS DRAFTED BY f'A Redmon Law Chartered (Richard Lau) Notary Public, State of Wisconsin 2217 Vine St., Suite 204 , Hudson, WI My Commission is ermanent. (If not, state expiration date: ( Signatures may be authenticated or acknowledged. Both are not neccs "Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000 Redmon Law 2217 Vine St Ste 204, Hudson WI 54016-5864 Phone: (715) 386 -0100 Fax: (715) 386 -0700 Redmon Law Chartered T4926305.ZFX Produced with ZipForm"" by RE FormsNet. LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383 -8805 www,zioform corn DOCvMM # ?#1 &3s NAME OF PLAT FILED - VOLUME i o PAGE 3 7 DATE TIME 3 vb P m OWNERS r;� ca", _,,,�- •- - --eJ LEGAL: I.Orl'S 1 BLOCK,___,_, OUTLOT(s) PART OF: cj �j t 3 ,� q ( l MUNi �° - �' ,1 CIPALITY CHECK# C'00 ? AMOUNT m a a x � r N 00 Wow X tD w _ _ ...;... �_ r. - MISS ..� .� . N � )( T — .L N3W8�V3N ao V N .+� 3O1/NIVgla 4 301M lot �+' r N I m ;ic N r o wo a 3k co 0 n N t w p . ....... .... w y .61 io • e r IPA v w. co w ww i i O Q co io N r j x x x x X x