HomeMy WebLinkAbout020-1359-19-000Wisconsin 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
Dietrich, Dan Hudson Townshi
CST BM Elev:
f Insp. BM Elev:
r BM Description:
C5T" g~ :~I`
l
te
!-
~:p Ov, o a
~ la
s
=
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic r ,
W
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic ~ ~ D ~
/V_
_C
( Q ~
O
~
~~
Dosing
Aeration
Holding
PUMP(`SIPHON INFORMATION
GPM
SOIL ABSORPTION SYSTEM
'DttD RENC Width ~ Leng1
DIMENSIONS ~"'~
*~ q3.'
SETBACK SYSTEM TO
INFORMATION
Type Of System:
Cc J •
DISTRIBUTION SYSTEM
r
/~-5 3~
1 L~ ~ •d.C~.•.e_.'E'
Ft
ELEVATION DATA
county: St. Croix
Sanitary Permit No:
395294
State Plan ID N
Parcel Tax No:
020-1359-19-000
STATION BS HI FS ELEV.
Benchmark ~ Q~ ~ ~O r
Alt. BM
`f 3u
a3. oS
Bldg. Sewer ~• ~ ~ ~• ~ f
SUHt Inlet $•~ • O~
SUHt Outlet ~•
/ v'~ ~
Dt Inlet
Dt Bottom
Header/Man. .~$ ~•~Z r
Dist. Pipe `~-
t o•30 '
9~• ~o,
Bot. System gS:9G
f7~~jJ` $$~~
Final Grade yn.
st Cover 2 ~~
•3y 8.S y
W
~ 9~t
CHAMBER OR
UNIT
~` r~ G .w . A.-..I1LL ~ e~Y~
Dia. Liquii
act rer
~ ~a ~.•s•c•,
~Jumbek ~~
Header/Manifold ~t Distribution x Hole Size x Hote Spacing Vent to Air Intake
L~. Pipe(s) ..a t~/ ~
Lengt ~ Dia 1 Length Dia Spacing
SOIL COVER v Pracsurp Svc4amc Anly rx Mnund Ar 4t-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
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~0 _/ ~ ~ /~ Inspection #2: T'~y
Location: 933 Meadowood Lane Hudson, WI 54016 (SW 1/4 S 1/416 T29N R19W) Parkwood Mea Parcel No: 16.2 .19.21
1.) Alt BM Description =~(' ~pw~-~t.i+t, ~ ~ ~~ ~~'~'~ ~ ~ Z
2.) Bldg sewer length = ~~~
t
3~ - at ~ f cover = 18~~~ e.~ ~ ~ °i^,~. ~S~^^~ ~ ~ts~.. CJtaAY~. 'f/
Plan revision Required? (] Yes ~No ~ ~,) ~ i ~~
' o er ide or additional infor ti ~>'t'`^~
S8D-6~ (.3/97 ~~/~ ~ ~~' Date ~ `nsepctors Signature Cert. No.
5') g ~ o dl~~~~~ c.cteoQ. ~k ~CQ e~ ~ ~,h~~r = 5. sl t~ l~ ~ °•~'ya~' o,~l,s~-~
K
Sanita Permit A licati s
t-Y pp on afery & Buildings [
In accord with Comm 83.21. Wis. Adm. Code 201 b4' ~1'ashingt
iseonsin See reverse side for instructions for completing this application PO B
oeaar tmenr or commerce Personal information you provide may be used Ibr secondary purposes Madison, N"I 53'i
[Privacy Law, s. 15.04(1 (Submit completed form w coun
°---•,
Attach tom lete tans (to the count co onl for 'tart
nCt_ ~ 'er qbC ss than 8-I/2 x I I inches in size.
,. ~ ,. a .
Count} ~ State Sanitary Permi Number O 'evasion to grenous applt lion State Plan I D. Number
1. A licaton Information -Please Print all Information t
,
Propene Owner Name '`~
~
Location:
~ ,~ ! Properly Location
`~ 7~.
Property Owner's Mailing Addre~
~
'
VW Il4JW4/4, X ,N, W
'y-rft,,
r`
~•s; Lot Number Block Ni
C:r~. State Zip Code
6r~E"I~lumber
( ~,_ ~..
~ ~ ~ ~s~ ~ ~ `~
Subdivision N me or CSM Number
,-
~
11 Tvpe of Building: (check one)
I or 2 Family Dwelling - No. of Bedrooms: a-/.~ T ~.
O City
^ vill
O Public/Commercta escribe use): - /v age
.Town of
State-owned r
~
111 Type of Permit: (Check onl
one box on line A. Check box on line B if applicable) Nearest Roa
A) I . New System 2. O Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Numberts>
S stem Tank Onl Existin S stem
B) ~ ~ - ~j ti
Permit Number _
q , a/ ~ S Dace Issued
^ A Sanita Permit was reviousl issued /~ , a q
,
IV. Type of POWT System: (Check all that apply)
,Non-pressurized In-ground
^ Mound ^ Sand Filter
^ Pressunzed In•ground ^ Holding Tank O Constructed Wetland
^ Single Pass
O At•grade ^ Aerobic Treatment Unit O Recirculatin ^ Drip Line
^ 0 h
V Dis ersaVTreatment Area Information:
I Design Flow (gpd) 2. DispersalArea 3. Dispersal Area
~D~ Requiecred
VO~ Proposed
~j
~'1 Tank Capacity in Total ~ of
Information Gallons Gallons Tanks
New Existing
Tanks Tanks
/ c
V1I Responsibility Statement
1, the undersigned assume resp
'lumber's Name (print)
4, Soil Application
gale (Gals./day/sq. ft.) 5. Percolation F
(Min./inch)
1r ~
Manufacturer Prefab
Con-
e Crete
[~~
sibilit for installation of the POWTS show on the anached tans.
Plumb Signal a (no sta s): P PRS No,
i
~a~ ~s
Fiber- ~ Plastic
glass I
Business Phone Number
Plumber's Address (Street, Cify, late, Zip o ~ ~/~_ ~~~
~ oa
VI11 County/Department Use Only
^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signature (;
,Approved O Owner Given Initial Adverse Surc rge Fee) ~
Determination 2 ~ .~- ~
IX. Conditions of Approval /Reasons for Disapproval:
._-__
g ter.
Eleva
>n ', Final Gradr
Elevation
~ ~y~
qs,
Site Steel
Con-
structed
s[amps)
r ~,~ . s, n. ,~ a,,Q-a
~. P ~ S~ cQ•~ri1~ ~,., a ~,
N' ~u"•~
boo U~D.
a_ ~s ~ r,`-~-~
,~_,o ~
~4 -icy ~
1a Bo
.~i3-~
~t^"
~g ~ _ _ ~
7
3-~
~~~,
~~ ~
~Q '~
~,~'
~~
~ a
~~~~
~'
/~~y4!
~a-f /9
PwM,.
r
boo U~D ~~ I~
~`' ~o
~~o ~p~i9
~3r~ - a . goo. os T~r/1 v~ ~ 1 ~ ~l/~
/~ ~o
.~
~~"
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~5V E°
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r 1
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//h }~ ad'o3s7
Wisconsin Department of Industry,
Labor apd Human Relations
Division'of Safety & Buildings
F
SOIL DESCRIPTION REPORT
Boring #
1 `;
Ground
elev.
99.6 ft.
Depth to
limiting
factor
+ 411
Boring #
2
Ground
elev.
99.7ft.
Depth to
limiting
factor
+9 "
Depth Dominant Color Mottles Text
re Structure Consistence Boundar Roots GPD/ft
Horizon in. Munsell Qu. Sz. Cont. Color u Gr. Sz. Sh. y Bed Trench
1 2msbk mfr cs 2f .51 .6
2 12-35 10 r 4/4 none sil 2msbk mfr c~.w 2f .5 .6
3 35-84 7.5 r 4 6 none cos Os ml na na .7 .8
~= i t,
Remarks:
1 0-12 10 r 2 2 none i 2msbk mfr cs 2f .5 .6
2 12-35 l0yr_ 4/4 none sil 2msbk mfr gw 2f .5 .6
3 35-96 7.5 r 4 6 none cos Os ml na na .7 .8
.~
Remarks:
CST Name:--Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 200 ve. New Ri hmond WI 54017
Signature: ~ Date: 7-6-99 CST Number: m02298
SOIL AND SITE EVALUATION REPORT
.....I ...:aL, n I In nn nc I.r~ A.J... n...J..
Page 1 of 3
111 CIVVVIV ..Ills Ill II l VV.V V, •IV• i~4...• vv~v
COUNTY
but
Plan must include
a
er not less than 8 1/2 x 11 inches in size
lan on
Attach com
lete site St. Cro'
,
p
p
.
p
p
not limited to vertical and horizontal reference point ir~c i -Ia~td % of slope, scale or
~
` PARCEL I.D. #
020-1029-30
res~d~
a
dimensioned, north arrow, and location and dista
e~o~
~
\
^
ALL NFiMAT1¢M,
APPLICANT INFORMATION-PLEASE P IEWEDt3Y DATi
~ ~'~
PROPERTY OWNER: 'S ` . P OPERTY LOCATION
LaCasse Custom Homes Inc. ~`i~ ,l,~'~~ ~.~ I VT. LOT NW 1/a SW 1/a,S 16 T 29 ,N,R lg f(or) W
AIL
IN
~g9~
G ADDRESS - ~ 3r ~~
E ~ t , #
"' BLOCK# SllBD. NAME OR CSM #
H
d
/~
J
MCC tcheon
521 °;r 19 na Parkwood Meadows
CITY, STATE Z!P COD S CITY VILLAGE ~c]TOWN NEAREST ROAD
Hudson, WI. 54016 ) ~0 Hudson Meadowood Ln.
~,
~ New Construction Use [x] Residential / Nu ~ f fie&~o 4 [ j Addition to existing building
[ ]Replacement [) Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate . 7 bed, gpd/ft2 .8 trench, gpd/ft2
Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 95.80 ft (as referred to site plan benchmark)
Additional design /site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM tN FILL HOLDING TANK
U =Unsuitable fors stem ®S ^ U ®S ^ U ®S ^ U ~ S ^ U [~ S ^ U O S ~t1
PROPERTY OWNER LaCasse Custom Homes,~6lL DESCRIPTION REPORT
PARCEL I.D. # 020-1029-30
Boring #
a 3
Ground
elev.
99.7 ft.
Depth to
limiting
factor
+90"
Boring #
... 4 ~>
Ground
elev.
99.6 ft.
Depth to
limiting
factor
+84"
Boring #
.....
S
~r::
:>:<n::::::
.G ou d
elev.
99 . ?t.
Depth to
limiting
factor
+96"
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Page 2 gf 3
Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax>~y Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trendy
10 r 2 2 none 1 2msbk mfr cs 2f .5 .6
2 13-31 1
~" ~`
r
~6 •S/8 - S
Remarks:
1 0-11 10 r 2 2 none 1 2msbk mfr cs 2f .5 .6
2 11-30 10 r 4 4 none sil 2msbk mfr w 2f .5 `: .6
3 na na .7 .8
_ ?
/8r ~
Remarks:
1 0-12 10 r 2/2 none 1 2msbk mfr cs 2f .5 .6
2 12-29 10 r 4/4 none sil 2msbk mfr gw 2f .5 .6
3 29-96 7.5 r 4 6 none cos Os ml na na .7 ;.8
Remarks:
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel LaCasse Custom Homes, Inc. 1554 200th Ave.
CSTM2298 ~4~4 S16-T29N-R19W New Richmond, WI 54017
MPRSW-3254 town of xudson (715) 246-6200
lot #19-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.
~h °=40'
top of NE lot stake C el. 100.00'
`~,lt. BM.= top of 1" pvc pipe C el. 100.05'
~.t
Gary L. Steel
7-6-99
,~
..y.. ~ ~ucnot~e~nu
POWTS OWNER'S MANl1AL 8L trlNtrta~,crlct~r~
r~~c ^..........~...-^
I Owner ,~~ ~ i ~TQ-lC.(}
Pennh # 3`~S"~`~ c{
ES1GN PARAMETERS
D
Number of Bedrooms
~ N'°`•
Number of Cotnmerdal llnie '1~' NA
Estimated flow (average) gal/day
Design flow (peak), (Estimated X 1.S) ~ gal/day
Soil Application Rate ~, ~- gal/day/ft~
Influent/Effluent Quality Monthly average*
Fats, Oii » Grease (FOG) <_30 mg/L
Biochemical Oxygen Demand (BODs) <_220 mg/L
Total Suspended Solids (TSS) s I SO mg/L
Pretreated Effluent Quality ' ^ NA Monthly average*
Biochemical Oxygen Demand (BODs) <_30 mg1L
Total Suspended Solids (TSS) <_30 mg/L
Fecal Coliform (geometric mean). <_104 cfU/100m1
Maximum Effluent Particle Size ~ inch diameter
MAINTENANCE SCHEDULE
Service Event
Inspect condition of tank(s)
Pump out contents of tank(s)
Inspect dispersal cell(s)
Clean effluent filter
inspect pump, pump controls 8t:alarm
Flush laterals and pressure test
Service Frequency
At least once every 3 ^ months [.year(s) (Maximum 3 yrs. )
When combined sludge and scum equals one-third (Ys) of tank volume
At least once every
At least once every
At least once every
At least once every
^ months l'R year(s) (Maximum 3 yrs.)
~ months ^ year(s)
^ months ^ year(s) fg. NA
^ months ^ year(s) 4fl NA
At least once every ^ months ^ year(s) Q~NA
At least once every ^ months ^ year(s) ~ NA
MAINTENANCE INSTRUCTIONS
inspections of tanks and dispersal cells shat[ be made by an individual carrying one of the foltowing licenses or certifications: M~
Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servidng Operator. Tank inspecti
must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure
volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The disperse
cell(s) shall be visually inspected to check the effl~ee t found surface msay ind~catei aefailingt~ondition and requires the immediate
the ground surface. The ponding of effluent on gr
notification of the Local regulatory authority.
When the combined accumulation of sludge and scum In any tank equals one-third (Ys) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisco
Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other
maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer.
A service report shat( be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new conswt:tion, prior to use of the POWTS check treatment tank(s) for the presence of painting produce or other c en
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the cone
of rl,o ran{r(s't ramovPd !sy ~ sent~e cervidnR operator prior to use.
SYSTEM SPtcattc.wt wn~
Septic Tank Capadty 2~ gal ^ NA
Septic Tank Manufacwrer ~ ^ NA
Effluent Filter Manufacturer ~ ^ NA
Effluent Filter Model f1--10'U ^ NA
Pump Tank Capadty gal ~~
Pump Tank Manufacwrer 4~N~
Pump Manufacturer ~N/
Pump Model ~' N/
Pretreatment Unit
^ Sand/Gravel Filter
^ Mechanical Aeration
^ Disinfection
Manufacturer
^ Peat Filter
^ Wetland
^ Other: 4YN/
Dispersal Cell(s)
~In-;round (gravity)
^ At-grade
^ Drip-line
^ In-ground (pressurized)
^ Mound
^ Other:
* Values typical for domestic (non-commercial) wastewater and sep~
tank effluent.
* * Values typical for pretreated wastewater.
. Pike _of._
System start up shall not occur when Boll conditions are frown at tlw Infiltrative turtace.
DurinY power outages pump tanks may fill above nomul hlghwater levels. When power h stored the excess wastewater will be
discharged to the dlspenal cell(s) In one large dose, overloadlr>g the cell(s) artd mry result In the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Sepcage Servking Operator.prior to rtstorin~
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to
restore normal levels wlthln the pump lank.
Do not drive or park vehicles over links and dispersal cells. Ao not drive or park over, or otherwise dlswrb or compact, the area
wlthln 15 feet down slope of any mound or at-grade soU absorption area.
Reduction or eUminacton of the following from the wastewater stream may Improve the performance and prolong ohs lik of the
POWTS: antlblotlcs; baby wipes; cJgarette butts; condoms; cotton swabs; degreasers; dental floss; dtaperx; dlslnfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings? guoAne; grease; herbiddes; meat scraps; medications; oil;
palntJnR croducu: aescicldes: sanitanr naakins: tampons; and wacer sofuner brine.
ARAN DON EM ENT
When the POWTS tails and/or is perrnanencly taken out of service the following sups shall be taken to Insure that the system is
properly and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Adminlstradvs Coder
• All piping to links and plu shall be disconnected and the abandoned pipe openings sealed.
• The contenu of a!I tanks and pits siu(I be removed and prc+perty disposed of by a Septage $ervking Optrator.
Aher 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 maierfal.
CONTINGENCY PLAN
If the POWTS falls an<i cannot be repaired the (ollowing measures have been, or must be liken, to provide a code compliant
replacement system:
d A suitable replacement area has been evaluated and may be utlllaed for the location of a replacement soil absorpgon
system. The replacement area should be protec4ed from disturbance and compaction and should not be Infringed upon by
required setbacks from exi:dng and proposed structure, lot pnet and wells. Failure to protect the replacement area will
result In the need for a new loll and site evaluation to esub{1sh a sultab(e replacement area. Replacement systems rnust
comply with the rules In effect at that time.
[7 A suitable replacement area Is not available due to setback- andlor colt IimfUtioru. 6arring advances in POWTS technology
a holding tank may be installed u a last resort to replace the failed POWTS.
D The site has not been evaluated to identity a suitable replacement area. Upon failure of the POWTS a soli and site
evaluation must be performed to locau a suitable replacerrlent area. if no replacement xea h available a holding tank may
be Instilled as a last resort W replace thr failed POWTS.
O Mound and at•grade soli absorption sysums may be retonstructed In place following remove! of the biomat at the
Infiltrative surface. Re<onswalons of such rystems musL.comply with the rules in effect at that time.
< <yVARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT
OXYGEN. DO NOT ENTER A SEPTIC, Pt1MP OR OTHER TRJEATMENT TANK UNDER ANY CIRCUMSTANCES.
DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY 6[ DIFFICULT OR
IMpl1CCIR1 i.
AD011710NAL GOMMENT5
POWTS INSTALLER
Name
Phone S' ~ - tO
SEPTAGE SERVICING OPERATOR (PUMPER
Name
Ph n•
POWfS MAINTAINER
Name
Phone
LOCAL REGULATORY AUTHORITY
Agenn' CP.d l)C.. NlllT
hon - 3
S'1' CIZUIX COUNTY
SLl''1'1C 'TANK MA.IN'I'L~NANCL AGRI?LM13NT
ANU
UWNLIZSIIII' C1?!t'I'IFICA'1'IOI~I 1~OIZIv1
Owner/13uyec - ~~~ ~/ ~~ ,~~~~~,~
Mailing Address ~~~ !~ ~ .9~~~,~1 ~7~ ~~_ ~~~ - ~J~ ~~
_ ~~~~~
I'roparty Address ~ .~ ~~~yf~®JJ«~~~~~ - /
(Vcrificatian required tionr l'lanuint; Ucpat(mcnl fur new consUuclion)
..
City/Stale 1.~~ c~~. 1'arccl ldctttification Nun~bcr ~ odd -- ~ 3~ ~ -~ y - (~~d
LEGAL llE5CRI1''1'ION
Properly Location ~~ ~/,,,~1,~'/,, Sc;c. ~_, '1'~~IJ-It !~_W, 'l'awn of ~ti~.~d~/
Subdivision ~~~~J~ ~,~~~~~,~ _, Lot /1.~_.
Cerillied Survey Mstp 1/
Voluntc , 1'agu //
Warrnuly lleed // ~~ 7 (o ~~ ,Voluntc Pale # ,~
Spec house ^ yes js~.to
Lul lines irlcnliliublc~yes t-.1 no
SYSTI~M MAIN'1'ENANCE
, hnproper use and matntenaaccof yuur septic system could result in its p~cntalwe failure to Itaudle wastes. Propermainlettance
consists of pumping out the septic leak every three years or sooner, if needed by a licensed prunher. What you put ialo tiro system
can affect We fiutctiou of the septic tank as a trcalrncnt stage iu the waste disposal system.
The properly owner agrees to submit to 5l. Croix Zouiag Uepartmcut a certification loan, signed by Wo owner and by a
ruaslerpluurber, jourucytrrarrplumber, restricted plumber or a liccased pumper verifying Vial (1) the ou-site waslewaterdlsposal syslew
is iu proper operating coudilioa and/or (2) slier inspection and pumping (if accessary), the septic tatdc !s less than I/3 full of sludge.
llwe, lire undersigned have read the above rcquiicmwtls and agree to waiutaiu rite private sewage disposal system will the standards
set forth, herein, as set by the DepatUtrcat of Cunuuercc and the Ucp,trttncut of Natural Resources, State of Wisconsin. Certification
stating that your septic system has berm maintained must be contpletcd and returned to the St. Croix County Zoning Ollice within 30
days rite llucc year expiration date.
SIGNA Rl? OC APPLIC DA'TLr
OWNER CEtt'I'IrICA'I'ION
I (we) certify that all slaleutcuts on this furor ate Uue to the best oC ury (our) knowledge. I (we) our (arc) the owner(s) oC
the operty desc ' ed above, by virtue of a wauanly deed recorded iu Register of I)ceds Office.
~ loZ?l o /
S[ NATURIl Op API'LICANI' DAT13
*!**** Any iufortnalion that is uris-represented uray result iu the sanitary pcunil being revoked by We Zouhtg Departtneut. ******
** Include with this applicallou: a stamped warranty decd froth the Register of Deeds ofrcc
a copy of the certified survey map if reference !s made ht the warranty decd
' STATE BYA~ OF W ISC ~ SAN FOR~2. 1999
Document Number +I WARRANTY DEED
This Deed, made between L_a_Casse Custom Home< Inc a
Wi on ors 'on
Grantor,
and Daniel C. Diotrich_ and Kimberly A. Kincade
Sin le Persons
Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in 9t. Croix County,
tsconsin: (if more space is needed, please attach addendum):
of Plat of Parkwood Meadows in the Town of
Hudson, St. Croix County, Wisconsin
Exceptions to warranties: Protective Covenants
Dated this 11th day of May 2001
AUTHENTICATION
Signature(s)
authenticated this day of
TITLE: MEMBER STATE BAR OF WISCONSIN
(tf not,
authorized by § 706.06, Wis. State.)
64620G1
k:flTHLEEH H. WALSH
kEGISTEk OF DEEDS
S'i. CkOIX CO.. WI
RECEIVED FOR RECOkD
05-i?3-P001 8:30 Ap
IJARkANTY DEED
EXENGT q
CF.kT COE'Y FEE:
COPY FEE:
TkANSFER FEE: 135.30
kECORDIHG FEE: 10.00
GAGES: 1
Recording Area;
Name end Retum
Eagle Val
1301 Could
Hudson, W~
Address
ay Bank
a Road, Suite 2
54016
020-1359-#9-000
Parcel ldenuficatibn Number (PIN)
This _ is n~t_ homestead property.
(is) (isI'Inot)
La sae C om Hb s, }nc.
"Richard W. LaG''asse
ACIINIOWLEDGMENT
STATE OF WISCONSIN )
ss.
St. Croix County. )
Personally came beifore me this 1__ 1_~ day of
May p2 O 1 the above named
LaCasse Custom Hdmes Inc a
Wisconsin Coroor~tion by
'"~` Richar~ w LaCa~e
Prey
THIS INSTRUMENT WAS DRAFTED 9Y
Richard W. LaCasse ""
Hodson. WI
(Signatures may be authenticated or acknowledged. BoiIl,aYe
not necessary.)
fdlrte known.to be the pelrson who executed
~ tlle:~fgy¢goifig i ~trun ent~td.AcJepowledged the same.
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_ Notary Public, State of , isconsin
,; Ivly Commission is permanent. (If not, state expiration date:
- MaY~S , 2005 .)
'Names of persons signing in any capacity must be typed or panted below their signature.
WARRANTY DEED STATE HAR OF W ISCONSIN
FORM No. 2-1999
aCasse Homes Realty 573 County Road A, Hudson WI 54016-7007
Phone (715)381.5105 Fax: (715)381.6541 Jacque Howard
ProCuceE with ZpF«m"' M RE FormsNet, LLC 18025 Fiaeen Mia RaaO, Ci:won Toxnsh'q. Michpan <8035. QB00) 383-8805
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