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HomeMy WebLinkAbout020-1376-17-000Wisconsin 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: City Village X Township Keiser, Wa ne Hudson Townshi ;ST BM Elev: Insp. BM E//lev: BM Description: l . G !7 t7 TANK IN ORMATION ELEVATION DATA ~ county: St. Croix Sanitary Permit No: 395251 State Plan ID No: Parcel Tax No: 020-1376-17-000 ~3 TYPE MANUFACTURER CAPACITY Septic ~~ ZO Dosing Aeration ~3 Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~ u / ~ , Dosing _, _ _ _ ____ ____ Aeration - Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Fricti oss Syst Head TDH Ft Forcemain ength Dia. Dist. to We SOIL ABSORPTION SYSTEM /v ,~/. _ _ f___~ STATION BS HI FS ELEV. Benchmark Alt. BM a. l0 . U Bldg. Sewer ~~~ a'~ 02, U S Ht Inlet 3-z5 ~ U • 3S S Ht Outlet Z •D b -I- J. S = Ct / • SI ~U . Q Dt Inlet Dt Bottom Header/Man. lno+ ~~ f / S eC~c`o~. Dist. Pipe ~ c. 3 0 3 9 S 3 Z 9y.u 7~Lr Bot. System ~ ~ ~ tz.9~ re, 11,7 g , s 3.drfL Final Grade M r-~~x f • ~-YD QG,/O 9~~z0 St Cover t2 1.3~ to ~ _ Z BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ~ ~ Z ~, z ~l SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM L G ArN16 R OR Manufac r ~ ~7o/ a Type Of System: -(-' ,Z~ t ys, i , ` `~' ____ . Modej Number. ~ S r DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Length Dia Pipe(s) r / i Length Z • ~ Dia ~ Spacing (? ~ r~~/ SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Oniv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes 0 No 0 Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ Z ii /~ Inspection #2: / / Location: 927 Frazer Llane Hudson, WI 5p4016 (NE 1/4 SW 1/4 14 T29N R19W) Sweet Grass Farm Lotr ~Q Parcel No: 14.29.19.2278 1.) Alt BM Description ='rop c'Y ~'aw C ~~« lva~~J ~'~~O W e~J ~ ' ""`~ q' / 2.) Bldg sewer length = lG r s,•) SY 51!sw~ 4~i ~~'~ f~9 -/Iamount, /of cover = 7/~ ~r 3C_~rc~Qo p//~ 3,~ sb5t/ ua.!%n~ ro.~orS /t•~ 5/tl~~ rK ~ ~ ~e Y~f,bvr, ~Q,r~ Plan revision Regwred. ] Yes ~ No ~.-~ Use other side for additional informatiofi. D Z S ~ SBD-6710 (R.3/97) Date Inse or's Signature Cert. No. i~-~ ~~~~ ~~~~- JQ~ ~~ g ~, a~P ~ :~~ ~~~~ ~i r qG.l~~ ~~ K tv'}.20 Y W~ 80 / , ~`- -Y~~ ~° ie~~d ~'; ti0.1 pr ~~~ 0 ~ K~~~ i__ Safety etid 11uiI~3ir,~s li,~isia~ Catty ~ .._.._..._._.. ..,._._I 24: W'. WafhiaQton Are. , P.Q.'9nx 7162 S GVa .' ,r j~~~,~`I~ Msdilon, CVI d3"07 - 72b2 Addceaa f,, r nt tC re ' °~~? u~e~ ~~~ 3a~itery Permit App~icatiou ~"'```~~`t ` ' ' 39S 2-S >>v aoaoed ev1~ amt n,u. vw:r, mar. cma wt~oo.1 iu~etroasion yap ptov;dr, Q Cbedt i!' lttviaion , .. xo I-~p>tQiWr ~elmf~i00 • ~t - ~ 1l1Nt ~}IA LD, Nutcbat I ta- ~ a~ ruw Num~ 1 . a~. i 9', a ~ GJa. ~ e 'sey ~ ~ 020 ^ 13~ - 1~-- Ot1'O ,a .w ~~, ~!'~ 1lnue Zip aaaa N'ambar l? 93ock Number I b area C8M Number E s'o.,~ S YDIG n/ ' Save e ~~a-.4s' ~~yy ii, ~ ~ ~ a~! ~ T1~Y) ,~......_.,~ L1 ~......,.,.~. ~ ~! ar ~ Plraeib' t'!"waiiinr - L~YIM~r1t of >iedrooms a PubtietCoao~araial -1?MOeiba Uaa ~ ~ wrts4i „~~ ~~a ~ d at~b s Nltteat """"""~ t>~. T!'Pa at fC~1c ody aKa box as A ~a+rmbe~ ~ehtmt fojt fniae~l Wt)~ Ca n beta a i~f •ppliafabla) r A' i Ataw Z D >i~eplaomreae sywm 3 ti aePiecsraent as 6 C Addidaa sb ar County uu Exf; s aoe 9. ~ Cwalt if ~ry Famais fbaviau~y issued 1Vutabet Dane Issuad } o! ( !lppiy) ~ arhsma it for inarnW tua) mac. -!oo ~ rtan -Paaeoritad ~a•Orovod t~ Adaad n'r p ta:ui Filnc a eo Q Cotrrtru~ssed wetla~a 2Z C PresswrJaed terciroorm bt D 1;oldirl~'~aaic 46 ^ siafia PsN s} ~ 13rip Line 43 C~ A 46 0 ~'tYsaaaera Uair 49 (~ Rrefraui 30 a Q~er ~ Y. Dat3tr< ea Atra 9o Applieadoa 1kgrtimri d awcwl~,roayrrsq.z~c.) Parea~tloa xate i<ysbua ~lrvatloa 1 Ftatl trade ; (Tv1lmlGrcW ~a ,S ; ~tevedan I ~~ /d ~, d d ~~7 x-3"7 'j'am kY ?oaS amber 1~taaufacatnt P 8itr Jwo! ~lriber Plastic pailaat af'tYolcs ! Cotaorari Caaetrucoed ~ Glass NMV ~ i as oe /~ 1 s t. ~ i vl~t. sere ~ ~ramea fat et fJu PoWTB ebowrs ao t he atladSrd ~ a a buabaear lrhoae vm ~~ s ~ coda ttaat, ~ o~ s s•o~ ~.1 ~" 6 .' ~A ~ ~ undwwr a rnt ~natura , o tamps} t ~ ^ Ownat tilvaa lysidd Adwae • s Fee) ap Snte ~. Z2S, 2 ~I - 1 ` Q ab ;:~ ~l a~S ~-~,e_ ~nwa.~ ss Pm` °.~'l~ c..6~ ced~'b/ v v e ~ ~1 V C J ~ ~ ~~ ~ e I ~ ~. ~ h a s~~Q~r~~ oz's ~~»~ h6 ~~-r I ~ ~ ~ ~ d ~` m V Z ~? ~ I ~~,~ ~~ 4 ~~~ ~ ~,~~~s v 1 ~-~ ~s ~- r ~yjY //a n o v b u 4 G~ a v ~ ~ ~ L ~ ~ ~ ~ \\ `~ b 'Q ~A l~ `~~.~ S n~~~ ~r9'zy ~l ~ ~ ~ ~\ ~yy/7Jd Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Burea4 of Integrated Services in accordance with Comm 83.09, Ws. Adm. Code Page ~ of Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must """'' include, but not limited to: vertical and horizontal referen ~ ' direction and C'r ' percent slope, scale or dimensions, north arrow, an tipn}a~ d~st~ ~e;tp nearest road. ,~. ~ r, Parcel LD. # yyr~~, ~. APPLICANT INFORMATION - PIeaQ~fnt al~inhi~,rna~ion. Revi wed by Date Personal information you provide may be used for sfc~,rfc(ery purposes (Pnvacy Lew, s. 15.04'"(1) (m)). Z,3 ~.dD Property Owner f ~ ~ ~` ~ Property Location ~ ~.~_ Gg~~~~. Lot ,~~ 1/4$G~1/4,S < ~ T Z~ ,N,R /'c~ E (or) G!I Property Owner's Mailing Address ~ ~~ lrb # Block# Su d. Name or CSM# 5 ~e ~'"~<,~ ~~~ ~ ~wee~- ass r City State Zip Code `R,hone Number ;~ ^ City ^ Village ® Town Nearest Road New Construction Use: 'Residential /Number of bedrooms ~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow C~ gpd Recommended design Loading rate,_Zbed, gpd/f12~trench, gpd/ft2 Absorption area required ~-~7 bed, ft2 7~~trench, ft2 Maximum design loading rate.,`Zbed, gpd/tt2 ~ trench, gpd/tt2 Recommended infiltration surface elevation(s) ~2' S~ tt (as referred to site plan benchmark) Additional design/site considerations ~~ ' ~ O Parent material ~ cJ ~~ E` S ~ Flood plain elevation, if applicable `~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ®S ^ U ~ S ^ U `®S ^ U ~ S ^ U ^ S [~ U ^ S U Boring # Ground elev. 97~tt. Depth to limiting factor ~in. Boring # ,2 Ground elev. ~J~. 7oft. Depth to limiting factor 4~ in CAII IIPC(_RIPTIAN RFP~RT Horizon Depth Dominant Color Mottles Structure B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench s U ~ ms mt ~~ - •~ ~ $ ~ ; .S^J~ ~ , Remarks: 2 fZ - ID --- S; I ,r,~ - ; 3 ~_ ~ t c 5 - ~ ' RPmarks~ SST Name (Please Print) Signatur Telephone No. ~~m soh ~ ~. k -~ - ~~ Cpl s) ~ <; ~ - ~ ~~ Address Date CST Number PROPERTY OWNER v~u ~` SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # 3 Ground elev. y~tt. Depth to limiting f for ~in. Boring # Ground elev. 95•~tt. Depth to limiting factor ~/(~ in. Boring # S Ground elev. Y~ tt. Depth to limiting factor I~Zin. Boring # Ground elev. tt. Page ~ of ~ , Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 b1 Id ~ Z.~ ~--- c i v ~ .S ~ . 3 - ~ S ~~ -- .1; -~ ~ 9/•3a~ S~-/o 9 3 ~ Remarks: ~rJ lD 12 - rYt~-b mfr cs (v~ .5 ; 2 /0- 5; ~ ~ s ~- (~ ~ -p l ~--.~ ~ m ~ ~ ~ ~ - $ Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/fit in. Muns II Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench f a-12 ll~ Z ~--~ S' ~ c~ v~ 5~ ~ -1~ ~ - _ ~ c S - '1 ; qZ•~~ , S"g' ~ 9Y-4 ' Remarks: Depth to limiting factor 'n' Remarks: SBD-8330 (R.9/98) ,,. ~. ~, PAGE~OF NAME ~~c~ LOT# 1'~ LEGAL DESCRIPTION NE '/45w'/<,S ~y T 2q ,N,RIq E (orK~v SCALE: I"= ((~~~ BM I ELEVATION /(~ 0 • U BM I DESCRIPTION~,p o L f z~ o yc ~: ~ e BM 2 ELEVATION 1 UU • O BM 2 DESCRIPTION ~-e~ o-~ ~ '~pac p~ 0 e- SYSTEM ELEVATION ~ Z . S o ALTERNATE ELEVATION yU ' U CONTOUR ELEVATION /'/ ~ /t/( t V I ,~ ~- -r - 1 ,,r ~~~'~~ v° -~~ ,. ~ N 't7 ~Y N ;- a ~.a ~~p ~~ ~~ ~~ ~u a $r ~w nn ~X ~' ~m 3~ ~~ ~ ~~ .' ~c ~'~ a 3 a S N gn S h ~. ~d ~- .~ • ro bpi y~ X .[~ Q 4Y7 ~ G V (J~ W a W a a m ~, a N m n ~ A 4~ Ni m G I~M1 ar,t~~tiat ~ L, \\ ', ~ `\~ ~~ q '~ ~~ '~~. ~'; m ~~::,; ~ 1~~. o. ~~ ~ ~J ..a tc `A~ v, y n ~i~'~ I ~ ~ ~ ~ x r z N ~ f` f ~, ~ ~ N ~ jx I ^~ N ~ U~ (,~ X W ~ ,~ . ~~ ~" ~ :.' n ~ ~ ~ ..., ~a ~ro s ~_ tT ro . . . "Q a ?fir ~ a ~ro`~~ ~ tQ G, ~ O ~ . r ~~?~ ~ ro ,~ a~ a~ ~ ~_ A. ,c cv ~ a~ ro O ' fn C ~, Q cn . C rJ ~ Q . ~3 ~, ~ - ~ ~ ~ ~~ ~ v~o,~ ~N ~~ m ~'~ ~ ~ 6 ~ "'• O ~ - , ~ ~ C j _ .N+ ~ ~ Q. ~ N, - ~ .. ~' ....:. 7 M ~ ~, ~ ~ ~' ... m m i, ..~ ~~ ~a ~~ m n ~~ a ..^r .___.~;i ~F1V9It 1~" '1 V ~ Private C~naita Wsatewatat~ Traatrnent System Niana~an~ant Plan Sapt~~ Tank And ~3rav~ity in-C~raund Safi ~-~ao~ptlon Gampanent Pureugnt to Comm 93.84 Wls. Adm. Cade each Privare t~natte wastevuater Treatment Syate~t (PCWTS}she!! include lnfarrnatitan and protaeduroa for maintslning the system wlthirl the parameters of Conurt 83 and 84, and the canditlone of approve! by the department, agent, pr governments! unit. The approved plena and permiia for syste-tt are on file st the county xoning ar health department. . Thle meneger»ent plan comp-ies with Comm 83.94, Wls. Adm. Code, end the ln-~raund Soi! Abaarpti©n ~mponent Mstnus! for f~tive#e Cnslte Weetewatar Trestment 3yste~ma 985~- 10587-P (i~.8l9S}. Table 1: 9 stem Dee i n ~aatione 3at~+ita Permit Number 2S Number of rooms eel n -Peak d ~s mated tow -Ave a vv c Tank. taci i Soil Abffio tiCn snt Size z T of ~tewettsr CS estic The sep~lc tank she!! be maintained by an indiuidua! cartiflea to serv'~- septic tanks und+sr a. 281,48, Ststa. The cantenb mf the septic tartk shsii be dtspoesd of in accordance with NR 113, Wis. Adm. Cade (Servicing Septic or Hclding Tanks, Purttpir~g Chambers, aroase ir~tercepton3, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, ar portebie Reetroams). the operetlrtg czandislon of these ~~d outlet filter ahaii be assessed et te86t oroe every 3 yeer+s ~y tnspsctian. Th outlet fli r ~ti ~+~ leaned ae ne~ee a proc~,er nnsr~n. The niter carhtdgd s e romoved urs ass prow scans ero made tc min aotids !t- the tonic that may slough o!'f the filter when removed from its encivsure. ti !tie ~t , r ••y ' ,' ' Management Pian for a Septic Tank and Soil Absorption Component finer is equipped with an alarm, the filter shad be serviced if the alarm is activated rontinuously. intermittent filter alarms may indicate surge fiows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank era not removed at the #ime of an assessment, maintenance personnel shall advise the owner of when the next service Heads to b® performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected far water tightness and soundness. Access openings used far service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. ,Exposed access openings greater than 8-Irls~es in diameter shaii be secured by an elf®ctive locking device to prevent accidental or unauthorized entry into the tank. No one should enfor s sap#tc or other #reatmerrt or hotdln0 tank far any reason wJthout bvtnq to full compliance with OSHA standards for w-tertn~ a conflnod space. Thv atmosphere wlthJn the s~Ottc or other treatment of hotdtn~ tank may contain lathe! ~rsas, and reacuv o! s person from the Jntertor of tho tank may bo dJt'dcult or lmposstbla. Tank abandonment shall be in acxordance with Comm 83.33, Wis. Adm. Code when the tonic is no longer used as a 1~01M'8 component. Soli Absoton Gon~o.Q+st~t The soil absorption component serving this structure is designed to accept domesdc wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soli absorption component depends greatly on proper and timely maintenanec~, and system use within or below the limits of reliable operation, Good water conservation practices by ail ocacupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soli absorption component`s operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of pending, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage ar discharge from the component. 0n steeply sloping sites, areas of erosion should be identified and reported to the owner far repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic arountl or over the soil absorption component should be avoided particularly during winter months, The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may i®ad to mare intense, and carper, organic clogging of the soil. Z .,, Management Plan for a Septic Tank and Soil Absorption Component Piarrtings of deep-rooted traes and shrubs directly over ~ w{thin ten fast of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the event of system failure, a new system could be installed in an alternate arse. With the installation of a diverter valve, the existing system could also be reused aver a period of three to four years. is the property owners responsibility to maintain the aitamate area free from any planting of tees, shrrlbs, etc. In coos of failure of the original system, the aitemate area wiii be needed. if any trees, shrubs, etc. have been planted on the alternate aroa, they wiii havM to be removed at property Cwn~rt expense. if a{tamale sroa is destroyed, there are other alternative systems Chet can ba used, In whECh, could result in added expanse to the property owner. Any tonic abandonment shai4 be done in accordance with Wlsc. Coda 83.33, Any questions rogarding this code, please contact your local Zoning Office ar contact the instal!{ng plumber. cJck,v,.sY+ o,-1f~,...R. ~ l v~eY, b 1 N J t Z i S~ 3~ b~ 31 ~~ ST CR(~I7~ CUU?~IT'Y SEPTIC TANK 1!~AINTErIANCE AGREEMEh`"I' AND OVVNERSHTF CERTIFICATION FORM Cjvvner/Buyer U,~S~ rL I12ai1idg Address Property Address 2 ~~~~ (Vcrifccatian required from Planning Depart:neut far new CitylState ~U4S ~'~`" Parcel Identification Number ~.~cA~ . ~-~sC-~ Tlor~ Property Location ~ tfi, 5'a/ 'fi, Sec. ~~, T ~G N.R l,,. ~ W, Town o~ „~~~.--~- o-~ Subdivision ~~ ~s Lot # ~.,,~ CerEi~ed Survey Map # ~ ~ , Vfliatne _„___, Page # Warranty Deed # ,[~.,~ `~ . Volwme /~ ~ S- ~ Page # ~, . Spec house (~ yes ~ no Lot lines identifiable C3 yes ~, no ~yfi'T'~'.M MA,I~ITF .~YC~' .Improper use and maintenanveaf your septic systew could result is its prauaatura failure to handle wastes. Proper tnainttt~anca aousists of pumping out the septic tank every t}~rree years or sooner, if needed by a licensed purnpar. What you put into the system can affect the fuuetiaa of tlu septic tank as a treatment stags iu the waste disposal system. °I'he property owssar agrees to submit to St. Croix Zoning Aepartm8rtt a eesdllication form, signed by tho owner and by s zxssster glutnber, journaymanplumber, rastrictedplumber or a licaasadpumperverifyingthat (1) the oa-slta wastewaterdisposal system is in proper operating canditian and/or (2) after iaspectiou and putupiag (if necessary), the septic tank is less than 1/3 Slip of stuHge. ~~, the ttnder~igaed have read the above requirements and agree to tnaintaiu the private sewage disposal system vyith the staudaxds sat forth, ~~, as set by the Depaztnient of Cammezce and the Department of Natural Resources, State of WisconsO~Carti thin 3a stn ' g that your septic sy eaa has been ruaintained must be completed and returned to the St. Croix County Zoning of ttta ear iratIon date. ~~~, "7~ /~O/ -- _ DATE SINN Tt7~E OF APPLICANT ~~~~F~C,~ ,ON I (we) certify that all statements oa this farm are true to the best of my {aurj knawledga. I (we) am (ere) the owner(s) of pr ' ny ~~ o e, by virtue of a wam~nty deed rccardod in Register of Deeds Of!`ica ~~ SIt3NA QF APPLICANT DATL +~~++~~` Any information that is mis-represented may result in tl~c sanitary permit boing revoked by the Zoning Depargnant. '~'~'~'"*" •• Inelude with this sppitcation: a c Py of the certified survey mag i~fai fareaca made is the warranty daeed ~ ~.~i~~.~ ~~~~5~r~~G ~~ r 1 QrJ/ri,~' ~ ~ ' ' STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED ff r- U(:. ~~.)t)~)FAGE ~~~ Document Number L ~ •~ + This Deed, made between RICHARD 0. STOUT and JANET P. STOUTy_..__ husband and wife, _ -- - - ~~_- .___...- Grantor, and WAYNE KEISER CONSTRU{'TION, INC_ ___.._.._ _ __- ~~_ Grantee. Grantor, for a valuable consideration. conveys and warrants to Grantee the following described real estate In St. Cro1X County, State of Wisconsin: Lot 1 , Plat of Sweet Grass Farm, Town of on, St. Croix Countye Wisconsin. 64 90 34 KA'iHLE.EhI H. WALSH Rf=.GT5TFR OF DEEDS i37, CkOIY. CG., WT kECEIUED FOk RECGkD Ob-~1-2001 9:45 AN WARRANTY DEED EXEMPT A CERT COPY FEE: COPY FEE: TkANSFER FEE: 1b4.10 RECORDING FEE: 10.00 PAGES: 1 Name and Return Address (.C~Ay/1C ~~/SELF C~isT,Pu~Da, c /oOS .S c9~7~`.r.~i~<o Clew ~vA6~n~ l.[~r ~-f,lal6 020-1376-17-000 Parcel Itlentilica[ion Number (PIN) This 1S not homestead property. (is) (is no[) Exceptlonsmwarranties: easements, restrictions, rights-of-way and covenants of record. Da(t~ed t`hi`s. ,~1 5~th(''~~ day of June '1~~*-*-~l \y .~ (SEAL) Richard O. Stout ~/~ v~`--ct / ~ ",_ " ~ (SEAL) Janet P. Stout (SEAL) AUTHENTICATION Signature(s) authenticated this day of _ , TITLE: MEMBER STATE BAR OF WISCONSIN (It not, authorized by §706.06, Wis. StatsJ THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 1 'i53 Awatukee Tr Hudson, WI 54016 ACKNOWLEDGMENT (SEAL) Slate of Wisconsin. ss. St. Croix Conn[y. Personally came before me thts 1 5th day of June 2001 ,the above named Richard O. Stout and Janet P S tOLt t NO'T'ARY PUBLIC --- STATE (1F WICt^.f1A1CIN to me known to be~e,~~~~Executed the foregoing lnstrumen~ acknowlg5iggrthe same. Notary My cQ (Signatures may be authenticated or acknowledged. Both are not necessary) ' Names of persons signing in any capacity must be typed or printed below [heir s[gnacure. STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 1998 (Ir not, state expirauo date: __._ . ~.) WISGOn$In Legal Blenk Co.. Inc. nmlwa~kee. ws T K ~ ~ '•. LOT 15 ~ ~~ p, ~ 8 ` ~_ ~ ~ ~ _ 1Y~3~4se~so ~ l / ti~j~~~ -- dt ~ \ off/ q°' i ~ ~, _ _ _ az4.oa~ ,~ dOO 4 ~ C ~ ~ -~-~-~- //~ /~ ~Io 909 PCB 1. ,,4 / ~~ ~ ` MIN BUILDING Qp y~l(~[~pp ~~ 1N 1 ~ ~ ~ ~~ ~~v =952.9 1 / ~,~ ~ 1 a ~ ~ 1. ~'/ O~ /~ ~ ~ sue. ~RAi ~ ~~ •• 1~1 ?~ '1 •.• / /~~° ~;•/ LOT 16 ~ ~ 2.80 ACR@8 1 \ /~°~ ~/ 1219~a so Rr • / • ss9~4a~2a•E 488 • C16 C11 49.28' MIN BUILDING H.W.L. =851.8 . ~ ELEV. =832.8 ~, N.W.L. =808.0 pRr41EW,~C,E EgNgEMEN_T . I ~ I \ 1- ,~ S85°23'16"E 261'+/- ~ I fi.= = _ --____ ~ ~ . I ~'~~AI L • -~-•-• ~ I ACRES . 8 I ~ ~ I ~ ~~~ • I I 888°43'2d'E 447.1 i23'+ I I ~ I • - r. _. ~ I MIN BUILDING . ELLN. = 896.a _ _ LOT 18 i ~ ~ ~ I DRA1nIgOeRLI1VE 40' - - -`~' •_ AI • f j ~ ~, I ~9EMEIVT ~ j I ~D . 8;N°48'2a`! 449.81' ~ I N I ~•- 125 I 25 i ' INO ` ~ N j O 4 ~ I~ ~~ LOT 19 .~ • I I l 2.99 ACRES 150241 80 Ff