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Home My WebLink About020-1359-11-000/* vr~ pepaAment of Commerce PRIVATE SEWAGE SYSTEM ~~~id 8ai O`V`s`o`~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal intomlaUon You provk>a may be used for secaxiary purposes (Pm-acy (~w, s.15.04 .: insp. nrv~ riev.: om vrx~~pann~. TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic (~~, tMwQ Dosing Aeration Holdin TANK SETBACK INFORMATION ~~~ =GS I d3iu. ELEVATION DATA STATION Benchmark It. BM Bldg. Sewer TANK TO P/ L WEII BLDG. Ventto Airlntake ROAD Septic / S ~ / NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION DISTRIBUTION SYSTEM St/ Ht Inlet St/ Ht Outlet Dt Inlet Dt Bottom Header /Man. Dist. Pipe Bot. System Final Grade o. /o lo`f ~fo, 3•S-S ~._ a~~ S 3`f 99•lbl 6:~9 99.0/ ~ ~~ ~~ C..33 b • 3 s 7n.r-r 9'8,/s' '}° 9 ~ ~F`f5 t~•oS/ SOIL COVER x Pressure Systems Only 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 ^ No ^ Yes ^ No r~~pec Ion : o}l !o l0 1 Inspection #2: -f----- / COMMENTS: (Include code discrepancies, persons present, e . Location: 510 Green Mill Lane, Hudson, WI 54016 (SW 1/4 NW 1/416 T29N R19W) -1629192107 Parkwood Meadows -Lot 11 `~s,.~, 1.) Alt BM Description = ~w'Q ~ ~""~ o ~ ~~ 2.) Bldg sewer length = 2(,251 ~ 1~+~.. ~', ,. p,_,_ ,""` °~ ~p~f--, -amount of cover = w z~l. `~'~ 1 C~~ ~.~ ~,~_.Q nab- cr~.s~d~elJ ~,~' a SP Plan revision required? ^ Yes ®No o} Io o I c ~ ~-lS2lQ Use other side for additional information. Date Inspector i Signature Cert No SEiU-6710 (R.3157) eta, a9~ ~9, ~l0`7 BS HI FS ELEV. ~~ ~~~~~ Safety and Buildings Division 2 County ~-'(/C ~ (.~L ~ ~ ~ 201 W. Washington Ave., P.O. Box 716 i ~~~O~~~n Madison, WI 53707 - 7162 - , c Site Address ~~ Department of Commerce L~1 ' Sanitary Permit Applicat ' ~..'. Sanitary Permit Number 3523 0 In accord with Comm 83.21, Wis. Adm. Code, personal info ayou p ovide ^ Check if Revision ma be used for seco ses Privac Law, 1$' ~ 1 m I. Application Information -Please Print All Information - (')C~ , ~.. _. ~ State Plan I.D. Number . ~- •. Prope Owner's Name i ~ "j' } . ~ ~ ~--~~ ~~~~ ' Plarcel Number .. .: ~~ ~C~ ~0 - S y - J(- o by ~ ~ g Address G QFF~ ,,. '°.., lin Property Owner's Mai ~~O f `~ petty Location q n ^ ` :' ;, S ~ Y '' ` ~ ,~~ Z / S(J-~ 56 N U'~i: S ~(D T ~ (N. R City, State Zip Code 73 ~r~ ~__ Lot Numbe Block Number __~_ Subdivision Name CSM Number II. Type of Building (check all that aPPiY) //a„S ~S,-.~, (~ °i'-'~• ^Ciry ~ 1 of 2 Family Dwelling -Number of Bedrooms ! - ^Village ^ Public/Commercial -Describe Use ~'ownship ^ State Owned ~ l Nearest Road ~ ~ ~ -~~~wS ~ 2 k 4 3 ~ ~ ` ~ a - OD III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A 1~New 2 ^ Replacennent System 3 ^ Replacemem of b ^ Addition to ' For County use / / . a -1 , ~, . a O ~P yam Tank Onl S stem Eris Permit Number Date Issued B. ^ Check if Sanitary Penult Previously Issued IV. Type of Permit: (Check all that apply)(nttmbering scheme is for internal use) 44 ~ Non -Pressurized In-Ground 21^ Moues 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aero is Treatment Unit 49 ^ Reciiculatmg 30 ^ Other V. D' rsal/'IYeatment Area Information: - 5 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required proposed Rate(Gals./Days/Sq.FtJ (Min./Inch) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Concrete Constructed Glass Gallons Gallons of Tanks New Existing Tanks Talcs 5epdc or Holding Tank D ~- 8 b l ~ Dosing Chamber VII. Responsibilfty Statement- I, the undersigned, assume responsibility for tion of the POWTS shown oa the attached plans. Plumber's Name (Print) Flambe S' RS Number Business Phone Number l,~T f~ ~o .3s 7 rs a~ ~ -(~~ Plumber's Address (Street, City, Stan, Z' e) G~ ~ / ~ ~~~ t:~ Qo U f VIII. Count !De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Agent Signa (No Stamps) Approved ^ Disapproved Surcharge Fee) ^ Owner Given Initial Adverse ~~ ~ I~ Determination 1X. Conditions of A rovaUReasons for D' oval ~ n~ -n ~ PP ~"p~ t~-eLO- ~. (,J. ~.-. S ~~ ~D1~v~ tY--.. '~ ~` . ~~ /~ l5 fie- _ C rC.Ca9tivlNl~.t~0~~~~9~'t-~ ~,,"r' v' ( Attach Camprett pnru tw [ae a.ouuq orup~ ivr uac aJ..w. w wr~- SBD-6398 (Tt. OS/Ol) ~~~ o ~'~~ ~ - ia8 ao ~~` ~-~ ~ '` ~~ _ ,~~ ~ Sao ~'~~ ~ P ~ , tit ~~ ^ /Dl, So ~~° °~ ~ r , ~{-/0 5 /~ ~- -- u.u~~ -f 7D ~~ ~! ~a i ~/~~aa ~~~ - D 7~G~ i gas a~ ~w~ ~~ ~ ,~ ~:~ ,~~ ~ 1ao ~~~ ~ p~~ ' .~.-~- 7.~0.~.~. ~-~t ~~ = ion so ~~ ~ ,d .s~ .~ . ~~ ~ So ~-/o ~5` ~~- .- w~ -f 7D ~ ~ r ~o ~~ ~aa ~ `i.> '• Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 ' Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. CI'OlX 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 reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north an•ow, and location and distance to nearest road. 020-1029-00 Please print all informafion. eviewed by Date Personal information you provide may be used ror secondary purposes (Privacy Law, s. 15.04 (1) (m)). t~.l+.~. ~~ Property Owner PropertyLocation~ \ LdCaSSe Cust0til HOmeS Govt. Lot ~ 1!4 NW 1/4 S 16 T 29 N R 19 8 (or) W Property Owner's Mai{ing Address Lot # Block # Subd. Name or CSM# 573 Cty. Rd. "A" 11 na Packwood Meadows City State Zip Code Phone Number ^ City ^ Village ®Town Nearest Road Hudson~_WI.I 54016 (715) - Hudson '"` Meadowood ~ New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate ~_ ^ Replacement ^ Public or commeraal -Describe: ., ,, Parent material OUtWash Flood Plain elevation if applicable ~ ~~"'' r General comments I--~ and recommendations: .i S "i~'~ {trenches @ el. 96.80' GPD ---• •LU ft.i n~ Zt~NMy(~ OFF1C~ ^ 1 0 Borin # ~ Boring ' g Ground surface elev. 1 00.90 ft. Depth to limiting factor +gO`~` in. ~ ^ Pit i A Iication Rate th D l i t C D tion dox Descri R Texture Structure Consistence Boundary Roots GP D/ft' Horizon ep in. or om nan o Munsell p e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-13 10 2/2 none L cs 1f .5 8 2 13-32 10yr5/4 none sil M na 1f .0 2 3 32-90 7.5yr4/6 none ms Osg ml na na .7 1. 2 ~~ g . t.. gS- 'Z- Boring # ®Boring ^ Pit Ground surface elev. 101 .10 ft. Depth to limiting factor +90 in. Soil lication Rate i n H D th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dift° or zo ep in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-11 10 2 2 none L mfr 1f .5 .8 2 11-20 10yr5/4 none sil 2msbk mf_r 1f 3 20-33 10yr5/4 c2d 7.5yr5/6 sil M na 4 3-90 7.5yr4/6 none ms Os ml na .~ $ .~ 'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' tmuenr rr~ = v ~ 3v mgi~ anu 1 oa = JV 1I1y,4 CST Name (Please Print) Signature .CST Number Gar L. Steel 02298 Address Dat valuatio nducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 5-10-2001 715-246-6200 ~ 1 ;, Property owner LaCasse Custom Homes Parcel ID # 020-1029-00 Page 2 of 3 Boring # ~ Boring 3 ~ pit Ground surface elev. 100 • $0 ft. Depth to limiting factor +90 in. Soil A lication 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 0-8 10yr2/2 none L 2msbk mfr gw 1f .5 .8 2 8-15 1Oyr5/4 none sil 2msbk mfr 1f .5 .8 3 15-30 10yr5/4 c2d 7.5yr5/8 sil M na na .0 .2 4 30-90 7.5yr4/ none ms Osg ml na na .7 1.2 8 ^ 4 Boring # ~ Boring 100.90 +90 ~ pit Ground surface elev. ft. Depth to limiting factor in. Soil Ap lication 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 1 0-9 10 2 2 none L 2msbk f 2 9-23 1Oyr5/4 none sil 2msbk mfr 1f .5 .8 3 23-34 1Oyr5/4 c2d 7.5yr5/6 sil M na gw na .0 .2 4 34-90 7.5yr4/ none ms Osg ml na na .7 1.2 q.z ~.Z Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil A lication Rate rizon H th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff o p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 'Effluent #1 = BODS > 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. S8D-6330 (R.6/00) • 4 • ~ • ~ ~ ~ STEEL'S SOIL SERVICE Gary L. Steel LaCasse Custom Homes MP SW-3254 SW'-~NW'~ S16-T29N-R19W town of Hudson lot #11-Packwood Meadows ~N / 1 "=40' iBM.= top of 1" pvc pipe @ el. 100.00' /Alt. BM.= top of elec. transformer @ el. 101.50' 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 ~ "'" Gary L. Steel 5-10-2001 Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labor and Human Relations ' r)ivision~iGfSafetv~° 8uildinas __~ ._.:.~ ~~ ~ ~n .,., .,~ ~•~:_ w.a..., n,.,~_ Page 1 of 3 ' COUNTY Plan must include but lan on a er not less than S 1/2 x 11 inches in size Attach com lete site St. Croix , p p p . p c ' nd % of slope, scale or not limited to vertical and horizontal reference point e PARCEL I.D. # I . cry tto ~~e~sttrgla'alh. ~ dimensioned, north arrow, and location and dist 020-1029-00 ` APPLICANT INFORMATION-PLEASE AL IN~RMA?IOAi, IEWED BY DATE PROPERTY OWNER: '~J . - ROPERTY LOCATION LaCasse Custom Homes INc --~ ~~~/ '•, ;-.GpvT. LOT SW 1/4 NW 1/a,S 1 T ,N,R or) W PROPERTY OWNER':S MAILING ADDRESS ._•9 3r c ,Qf~~ ~ -L~ T # BLOCK # SUED. NAME OR CSM # 521 McCutcheon Rd. rX ' ~ ~ CITY, STATE ZIP COD ' `~ ~ CITY ^VILLAGE ®fOWN NEAREST ROAD Hudson, WI. 54016 5) 3 1~ Hudson Mea [ ~} New Construction Use [x] Residential / Nu ~ r f ~ r 4 ( ]Addition to existing building j ]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate gibed, gpd/ft2 ,trench, gpd/ft2 Absorption area required ~~? bed, ft2 _ trench, ft2 Maximum design loading rate ~~bed, gpd/ft2 .>6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 102.40 ft (as referred to site plan benchmark) Additional design /site considerations x~ system el based on contour line of el 101 40' Parent material outwash Flood plain elevation, if applicable na ft S = Suitable fOr System U=Unsuitable for s stem CONVENTIONAL [:~ S^ U MOUND Cl S^ u IN-GROUND PRESSURE Q S ^ U AT-GRADE C~ S^ U SYSTEM IN FILL Q S ^ U HOLDING TANK ^ S j~u SOIL DESCRIPTION REPORT Boring # .................. ................. .................. ................. .................. ................. .................. 1 s Ground lev. 1t~1.7ft. Depth to limiting factor 34" ~~ Boring # 2<> Ground elev. 101.'R. Depth to limiting factor 31" QTR-/S.-~ ~ t ?~trQD ' rna~ • t~ Depth Dominant Color Mottles Texture Structure Consistence Bour>da Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trerxh 1 0-12 10 r2/2 none sicl 2ms mfr f 2 12-24 10yr4/4 none sl 2msbk mfr if .5 .6 3 24-34 10yr4/4 none sl 2msbk mfr if .5 .6 4 34-49 10yr5/4 c2 7.5 r 5 8 M na if n .2 5 49-6 10yr5/4 Remarks: 1 0-12 1 2 12-23 10 r 4/4 none sil 2msbk mfr w 2f .5 .6 3 23-31 10 r 4 4 none is Os mfr 2f .7 .8 4 31-60 7.5 r 4/6 2 7.5 r 5/8 ms/si Os /M ml/na na na n .2 Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. v .New Richmond WI 54017 Signature: ~ Date: 7-7-99 CST Number: m02298 PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT PARCEL I.D. # 020-1029-00 Boring # 3 Ground elev. 100.8 ft. Depth to limiting factor 35" Boring # .................. ................. .................. ................. .................. Ground elev. ft. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Page 2 of ; 3 ~ ~ ~, Horizon Depth Dominant Color Mottles Texture Structure Consistence Barr Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 1 0-15 10 r 2 2 none 1 2msbk mfr 2f .5 .6 2 15-24 10 r 4 4 none sicl 2msbk mfr if .4 .5 3 24-35 1 4 3 0 na na -~' -- Remarks: Remarks: Remarks: Remarks: SBD-8330(R.OS/92) .t I ~° STEEL'S SOIL SERVICE Gary L. Steel LaCasse Custom Homes, Inc. 1.554 200th Ave. CSTM2298 Sw4Nw4 S16-T29N-xi9w New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #11-Parkwood Meadows This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N~ /~"=40' /~ top ofNW lot stake C el. 100.00' Alt. BM.= top of mid-lot survey stake C el. 100.50' V .~.~ ~ v Gary L. Steel 7-7-99 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: Svstem Design Specifications Sanitary Permit Number ~ 2 0 Number of Bedrooms Design Flow -Peak (gpd} Estimated Flow -Average (gpd} ~ Septic Tank Capacity (gal) Soil Absorption Component Size (ftz) t7U Z -- i Type of Wastewater Dome is Table 2' Soil Absorption Component -Limits of Reliable Operation u C-~wtaU T ~~ Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) z - ~ Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance scneau~e Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septi n and outlet filter shall be assessed at least once every 3 years by inspection. T o et i t shall be cleaned as necessary to ensure proper operation. The filter cartridge of be removed un ess provisions are ma e o retain solids in the tank that may slough off the filter when removed from its enclosure. If the ' Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows 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 are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for 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-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soii Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around 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 lead to more intense, and earlier, organic clogging of the soil. 2 • . ~ ~ Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. A~ a.. s~ ,t,~-, r~ w~d~ J 9 ~~ m ~, s.~ =~~ NO"D" ~- p,~. ~ c~~s) a~ ~ - ~ 9y~" ~fi ~~ ~ G~~S) 3g6-y~g~ 3 FROM :MB'E #1782 ~ 651 222 1807 2005-04 13:37 #633 P.01/01 Jam' CROCK COK.J[VTY SBp'"fIC'1'ANK MATNrANANCII AQRI3XiM13NT AND OVdNLtt$tttP CI~RTIPICAIION C+OItM Oxnatsr/Buyer __.~. V - ~- - -- c Melling AddreQe ^ ~ . .~ _ ~/ Pretper~y A.ddreee (Yorltit:A{ion required frou~ t'la~u+iug 17ep^rlrirout (or new Ci /StatA , J"'~ ~ ~', C1J~ ~~ !'s~rcal 1'danlitiaatian Nun~bot' D - ~ 9 i' • 00 ~ ty ~~.-.- l~rope:rty ~acalien %~ e~~fl~'1,, Sic. ,,{~_, 'l'N..R~~-~y, Tavvn of ,.~. ~ubdivicion ,,,.,, _ . I.ut ~ ~,._... ~_ Cati~ed Purvey Map/1i / G~ Volume _ '~ I'°8° ~ - - ` Warranty Aped # ~„(~~~ / / ` ~~ Volunra ~ ~ Page ft ~.,~~.~ Spec ltouae I~ yos ~+a l.ot. li-:as i~imtllQttblo~os D nu lptproQtr ase end msintanntceof your:optic ayatettt cauid rsatq t[- Ira C'rotnattrre faiiurc to tutadio wtslei.l'mper tpalatatutuua6 cotasl8l^ of pctwping out Uta aepUc taulc every tiuco yoar^ 4r rao+-ar, if ueedsd t,y a iicenred r++~t~-er. Wiyt you rut into Wa eyateai ceu- aflacl the htuotioa of tl+e nopltc tsnk as o irnetmeut .rage G~ tl~s weKa dirt+or^I sy^tetu. 77,0 properly owuor aYrse~ to euluutt to Bt. Gr01x Z.oaing Iaeped+ne+nt a certliicstfpn form, signed by Ike erareot' tWd till a mint proper ops~retiag coy nd k~a an~a (2) aAar ttiscpn~ti nro d pv pt g ti[oueccwuY~, rho r~eptt~tonk t• (vea~lbt~ 113 tb~ ~o l/ae, tbv tmdem~rtad Uavo road tbo above rnquirarnettu ntrl egg to me{aeain the prlrpte eswage diepood ryrlaa with the •taudafds pet tbttb, lterelu, ~ set by rites Uopertut+trtt of Cottwurca end tire: DcpAtltnex+t of NMtutal Resotuces. 6tgte of Wieooruip. Certitloaliou dtatlt~ titer your eepiio eystern tuts been tur,tnteiued must Ue completed ^ttd returned to tt~e St. Croix Caualr ?QNnB pltlao wlWia 30 doge oP ye ercpi[a~ Uaa drte. ~f Sid AI'l'i.Yt".ANf DAT'~ I lw~e) cettlhr IF+at alt eta 1snl; Ou lhia farm d[a tRle le I1~0 beet of UlY ~~-+[~ lcgowtadge. t jwa) Aril (^ro) ~ v~NCar(t:~ °f lire property aserlt-sd nbovo, by virtue of ^ warrsuty roes(! ra~4rrtsrt to KpgHter of peed. Ot(too. ~~r s.~~l slaNA ot= QI.YC,-Nr HATS ' Ate lnfot7nstlaa etawt Is rruo•torre6a[+ted may rnautl to ti+a ra~Jtaty rennit botea rayokad by tiro caning Deperturettt. •'rrW~ •~~rr• y •~ Iuclu®~ wttb Ikla ><ppffesttan. a etarttped wsmr-ry Hood ttot+i /kv itegl^tsr of peed. oftlae a e;apy of llta certi(fad eturey :rt.tt U rc(breace {r medo to We wam^nty dcod Tir~5L8ESLL ZE:EL T08ZIb0190 L0/L0 $~b'ei '~ I.C1iSf1~ ~~~ yr.. i53~Pac~ `jg~ STATE BAR OF WISCONS>TI FORM 1- 1998 WARRANTY DEED Doaromt Nwalw This Deed, tr>adebetween LaCasse Custom Homes, Inc. T Wisconsin Caporatioa Grantor, and. Ronald_Todora. A Sinstle Person T , ish Grantee. Grantor, for a valuable coffiidetation, conveys and warraws to Grantee the following descnbed real estate in st . Croix State of Wiscorsin: Lot 1 , ?1st of Ptark~+ood llteadows, To~sa of Hudson, nix Conaty, iiisconain 629291 Y,RTHLEEN H. WALSH kEGISTEk OF DEEDS ST. CRQIX CO., WI RECEIVED FOR RECORD 09-01-000 10;QO RM YARRANTY DEED EXEMPT N CERT COPY FEE: COF~Y FEE: TkARSFER FEE: 119.44 RECi1RDING FEE: 10.00 PAGES: i Re+cadmg Ares Naate std Rcdstn Address Sagle Valley Bask 1301 Cemlae Rd, Suits 2 Hudson, t4I 54016 020-1359-11-000 Psroel Ideaificstim Numbrr (P[N) 'Ibis is sot ho~[ead ppperty, (is) (is not) Exr.~tions to warranties: Dated this 24 ~y ~' 1-ugnst , 2000 LaCasse Custom $omes, Inc. AUTHENTICATION Signature(s) authenticated this day of •Ricbard W. LaCaase t ACKNOWLEDGMENT' STATE OF W[SCQNSiN ) ss. Personally came bdore the this o~ t--~ ~ day of Ll~- d the a named u~ • TTI'LE: MEMBIIt STATE BAR OF WISCONSIN to tre 1-nown to be the person (If not, ____ .,~•.tllt:"t~ifo goinginsstntmemandackn authorized by § 706.06, Wis. Stats.) \,:•.cy,L,.~- ` C~,L. H (-~,1, TH13 INSTRtJAgNT WAS DRAFTED BY ~ ~~'. ~ ~'~ ;~ f-,i y ", s ~ C>-{ -2 ttichard W. LaCasse ~ ~_„ ~ ~o`tar~lic, Statc of Wisconsin Hudson RI Y• AL ~~`14I}c~Cd~Jtgrtission tS ~!an~nt. (If (Signaptres tray be authenticated or ackrowledged '$d~a art; r,'`' ~ ~ ~ i ~l ~ UC ~ tat necessan'.) .~°"f~; ~ OF ~!\- ~`~ -,--- ''~111/tun,t~+~ who executed the same. ~~nr, not, state expiration dale: •) •Nsmes of pertar signing in sny agacily aunt 6e typed a printed bdosr it3ea sigoi+aa sTArs &-R of WrscorslN WARRANTY DHED FORM Na 2-t991i poa,o.d wM ZpFam" M wNsolt IK 34075 Pilsen tBe FWr4 Qrio•n ra~..hp t~ipsi •ea+s, (000q 39bDeD5 Id'.rov Ostao 3Mreet lac 32t A3c(at~em A4 No3,u.WI N616-1011 Phstc 015)lti•3•DS Fsc QI$Y141/1 OSaabb.tlFD a; ~~ ~. ~ a ~. ~ 912914 ~ ~ # `~ J ~ e i~ ~~~ ~ ~ I ~ ~ ~~ yr~ ~~ ~~• n ~ S -I to ~:Z ~ \ 1 ~ \ ~ ~ ~'S~ X _ ~ -C -i fTi p~ l ~ ~ .p ~9 ~ _ ~ _.. ~a / /- D ~ I '• ' ~ O O x ` p. 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