HomeMy WebLinkAbout020-1416-00-000Wisconsin f.elyartment of Commerce
Sa>~ety and Building Division
PRIVATE SEWAGE SYSTEM
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
Sienna Corp. Hudson Townshi
CST BM Elev: Insp. /8M Ele~_ BM Description: ~
~~11' Yc/ ~, lfl.~ !~ t~ ~' ~ .,r ~.. ~~~
TANK INFORMATION ~ K ~ . ~t ~ ~.-.<_..,...-~~~ ELEVATION DATA
TYPE MANUFACTURER CAPACITY
Septic "~ /
!
Dosing _~._ _ ..._.__,..
Aeration
-~.~.
Holding / ~
c~c,/1-~ ~ (~ ~
TANK SETBACK INFORMATION ~-~ 7~/3~j[6~
TANK TO P/L WELL BLDG. Vent to A r Intake OAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Mo Numbe
TDH Lift Friction Loss System Head TDH Ft
F remain Length Dist. to Well
SON.. ABSORPTION SYSTEM
county: St. Croix
Sanitary Permit No:
43061 O 0
State Plan ID No:
Parcel Tax No:
020-1416-00-000
Sectionlrown/Range/Map No:
20.29.19.2628
~ .5a
STATION BS HI FS ELEV.
Benchmark
~t~V~~ ~~~t ~
16 ~u5
>/7.
rah.
Alt. BM
Bldg. Sewer ~ ,~
/1`Z•63
SUHt Inlet ' L ~ j i O ~.~
SUHt Outlet ~~ I' ~ ,
Dt Inlet
Dt Bottom
Header/Man.
r2.~
/b5 .5
Dist. Pipe
Bot. System N
S t3 -6°
it-F_tl`S i ~ :3 . y ~
~a 3 ~
Final Grade
/G.4v
i0~ . t`~
st Cover ! 3 ~ ~ ~ 3 ~~
(~ r
BEDITRENCH
DIMENSIONS Width
~ Length
~,1~
L 'C No. Of Trenches
- PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
~--
SETBACK
INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING
CHAMBER OR Manufacturer:
~'~T~~'
~
1
a r
.
Type Of System: / ~ UNIT Model Number:
DISTRIBUTION SYSTEM ~ L__'~,~.,..-1-~.~! .; ~. L/'~` ~~ , `
Header/Manifold Distribution
Pi x Hole Size x Hole Spacing Vent to Air Intake
"7
-
r
~t
Length Dia ~ pe(s)
Length Dia Spacing - -- ~
/
~
(C~`
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 _1 ~ / ~ ~
(~ .---
Bed/Trench Edges Topsoil ,.~_
i Yes No
Yes No
\ ~Gr.S ~'> ' „f1" nc. i- t ~ 5 ~ C° .'=~ z ,.- iiCY Y r ~.' rl.~ ~-
COMMENTS: (In lud code discrepencies, persons present, etc. nspection #1: S / iz /~ Inspection #2: / /
Location: 421 Swift Circle Hudson, WI 54016 (NE 1!4 SW 1/4 20 T29N R19W) The Glen Lot 34 Pafrcel~NJo: 20.29.19.2628
1.) Alt BM Description = S - ~ C v s-/ 3., .Pi Pl ~ Y:t- .-~ P~~-'~-`-~ .> ' h-' ~3 'T[~"" ~y~ ~~'
2.) Bldg sewer length = /~. S ~ ,t rt~,~1 b c.~Gt-~`r~~/ '~u ~+~c~„-~~'--f c
- amount of cover =~ ~ ~I 7 G ~ yR~2,,~ <~y~~j~,,. `~~ ~?~t~QJ
_ _-,
` - - --- _v--,
Plan revision Required? ~~ Yes J No S ~L ~~yaLJ ~ ~~~
_ ~• / ~ L I.
'Se other side for additional infor ti n. ~ ~__ ~ ____ ""'~' _--__ ___ _ ~_ __ ~ :.
---_ - ---
1710 (R.3/97) Date Insepctor's Signature Cert. No.
,~ Safety and Buildings Division
201 W. Washington Ave., F.O. Bex 7162 County
~~~ yp ~r ~'
~~~~,n
i~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.}
Department of Commerce (608) 266-3151 O ~
Sanitar
Permit A
li
ti ~
state Plan LD. Number
y
pp
ea
o pRF ~(+~
In accord with Comm 83.21, Wis. Adm. Cade, personal informatio you p>•o2~~+EIVE J
~~ N~~"
may be used for secondary purposes Privacy w, sl O(m) Proj t Address (if dif ef,rent than mailing address)
I. Application Information -Please Print All Inforrnati --~~~~ ~ ~' 7 Z ~ ~w~ ~~ ~~~~~
Fraperty Owner's Na me ( ZONING OFFfCE ~ Par el # D ~~ Block #
Property Owner's M ailing Address Property Location r Z 2 S/
r` ~~ ~ ~J
~ '
City
State
Z
i
C
^ ~a,
16,Section
_~
, p
o
de
Phone Num
b
er
~f`~G~- ~
`-~
*
-
•~
,/
r
+
.:J_._J ~j ,S ~7~~- lJ ~ ,~~C~ (oircleyy~~gg)
~ 9
J
~
IL Type of Building (check all that apply) // II ~ d /~.,~,.e~t/w~
~ G
vn ~ ~ T ^
B ottlY
N; R
.
` ~1 or 2 Family Dwelling -Number of Bedrooms •~~_~~/~ ~LtR.~t• ~ 6 Subdivision Name
CSM Number
i ^ .Public/Commercial -Describe Use ~ _ _ -_~~'~ /
_ ~/a ~ ~,C ~'~
U State Owned -Describe Use ~_Jj1ST t^~Z(,.r !~~ / __ .,~1Z,C.h ^City_^Village i~Township of ~a~d.5'Oa~
? AI. Type of Permit: (Check only one box on line A. Complete line B if applicable}
A' New System ^ Replacement System ^ Treatment/Haiding Tank Replacement Oniy ^ Other Modification to Existing System
B• ^ Permit Renewal i I Permit Revision ^ Change of ~~ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
~'
~ I'ype of POWTS System: (Check all that applyl
-
- -- _. -
i ~ Non -Pressurized dn-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in, of suitable soil ^ At-Grade ^ Single Pass Sand Filter
^ Constructed Wetland ^ Pressurized ln-Ground ^ Holding Tank ^ Pear Filter ~ Aerobic Treatment Unit ^ Recirculating Sand Filter
^ Recirculating Synthetic Media Filter ~Lsachit:g Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain)
V. bispersal/Treatment Area Information: ~ S'T',t ,v.~ y~ , • / r,~ ,~ Y _
Design Flow (gpd) Design Soil Application Rate(gpdst) Aispersal Area Required (s0 I Dispersal .Area Proposed (sf) System Elevation ~ 3/,
~d0 . ~ ,~7 _,~_. X57 ~ a. ~ j4~~ `lam Ct,4cw.
VI. Tank Info Capacity in Total Number Manufacturer refab Site Steel Fiber Plastic
Gallons Gallons of Units ~ ~- /U~ Concrete Constructed Glass
New Existing ~ ~
'
Tattles
Tanks ~ , , „
'/~J,(/=~(/
Septic or Holding
rank
' -~ f~.l
/ y
/
~ seer
.~
Aerobic
rreatment Unit ---
Dosing Cktamber
i I ~~~ I
1 r i ~/r~s~ ~
_
e VII. Responsibility Statement- I, the iindersigned, assume responsibility for u ~ allation of the PO'fV'1'S shown on the attached plans.
Plumber's Na me (Print) Plumber's Si gtuature /MPRS Number
I ~ Business Phone Number
~~~~ ~
/./,'(l; ~~ ne S~ ~+ a yr-~rl~e r ~.~~~"c~,..~~~ == ~~ ~7~Q~1
2~3 -.3~~'~ 3<'2 l
Plumber's Addre ss (Street, City, State. Zip Code)
~~ C~ ,I ~G~ ~~~C ~.Sd/C~ Gi'i 1 ~~' ~~
VII Count 1De artment Use Onl
Approved 1 ^ Disapproved Sanitary Permit Fee (includes Groundwater
`Surcharge Feed ~p
^ Owner Given Reason foz Denial ~ ~,~ i ,..~- Date Issued suing Agen Signatu o tamps)
~ ~ ~
,~~
~
IBC (~nr~rti4iA..n .~O A ~' .l rn_ -~- ..
-`-• --..•....=av==~ w nNprV Ya~llCeilSOI1S IOC Ltywal ~ l/~/~VV '~ '1' ~ ~Lh~~"'^' " "~1C~
TEM OWNED: ~Z~GC,~
Septic tank, effluent filter and /"~.,~3.s~ ?~-~'~~; ~~~,~p~~ ~(Id ~~,~~~„~'
dispersal cell must all be service / In al ed ~~U ~ G~'t yy.. 1~~
as per management plan provided by plumber, ,~~ ~~ /ac~7.~r~
2. All setback requirements must be maintained S S~ / ~ %n~~ l~~
as per applicable code/ordinances./~~? . 0 ,3• ~ 3 ~~ y ~~' may ~ N
SBD-6398 (R. 01/03}
Atfach complete plans (to We County only)
l-n ~G2.~~t~r, .
the system on pt~cr not less than 91/~fx 11 inches in size
Z,
S : ~ .crr/~~ C,~, r,o ,[ o ~" 3 ~l T/ -~ ~~ ~..rJ ~ ~ ~ D~ ~u ~So'~c/
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Wisconsin Department of Commerce. SOIL EVALUATION- REPORT
Division of Safety and Buildings. in accordance with Comm 85, Wis. Admr Code
County
Attach complete site plan on paper not less than 8'h x 1 t inches in s¢e. Plait must
include,. but not limited_to: vertical and. horizontal. reference. point(BM), direction. and
percent slope, scale ordimemsiorrs; north artow; and locztien and distance to nearest road Parcel I.D.
Please.printall information ,..m.---
..~---°-~- Review6d' By
Personal information youproade may be used for second pu (t+'rivdc~c Lam s;1ti.>1d:(~ (m)).
1093
Page 1 of 3
Steel Sal Service
St. Crobt
pending
..pate ~, /
ti. ~-~/ G.
Property Owner. Property L ion v "~
Sienna Corporafion _° "~n ~ ~~ t NE_1/4 SfN.1l4 S 20 T 29 N R 19 W
Property Owner's Mailing Address tot# - lock # Subd: Name or
4940 Viking Dr, Suite 608 ~ ~ ,,_, ~ :~ 34Y na The Glen
City. State Zip Code Ph eNumtW'_ .' a_....(:~ty _' Village Town Nearest Road
~~ ~~ MN 55435 9S - g3S- ~ 8~ Hudson Carmichael Rd.
ri New Construction Use: Y, Residential /Number of bedrooms 4 Code derived- design. flaw rate 600 GPD
Replacement - Public or canmerciat-Describer
Parent material Pitted outwash f=lood plain-elevation, if applicable na
General comments
and recommendations : Syste
m
elevation 105:35ft, trenches spaced and depth to code 3:50ft bebwgrade ~~ y~-t~ ~ (~k. -
S,S~iYi, /
~
~ S ~ f~i'(/y--t B / G'~cG'vy-,~, ~ri~1~~ yJ/ ~ ~`^~
'~ Boring # -- Boring
III; Pit Ground Surface elev 1-08
85 ft r 96 in
limitin
fa
D
th t
t ti
R
t
S
d A
li
. .
. g
•
ep
o
c
o on
a
e
o
pp
ca
Horizon Depth Dominant Odor Redox Description Texture Stricture Consistence Boundary Roots GPD/ft2
`Eff#1 *Eff#2
1 0-7 10yr3/3 none sil 2msbk 2msbk gw 1f .5 .8
2 7-15 10yr4/4 none- sicl 2msbk 2msbk cs 1f .4 .6
3 15-24 7.5yr4/4 none. Es osg. mvfr gw na .7 1.2
.,
4 24-96
~
7:5yr4/6 none
ms
-osg ml na -na
.7 12
.._ ..
/G" ~ 3~ _ ~2 ~/7c~' ~
Boring # _ Boring
:
1.02
~
Pif Ground Surface elev. 10$.85 ft. Depth to timiting factor in. ~ Ap~rcation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHtz
'Eff#1 `Eff#2
1 0=8 't0yr3/3 -none sil 2msbk 2msbk gw 1f .5 .8
7 8=1'5 1Oyr4/4 none scl _2msbk .2msbk cs 1f .4 .6
. ~
" _._
~
3 15 102.:
7.5yr4/4 none_ cos osg... mvfr na na .7 1.6
L...•- -~
r ~~/
/aS "~~' .3~v ~U ~
/ ~ ~ ~ ~~~ ' ~~ ~~/G'~-
Effluent #1 = BOD ~ 30 < 220 mglL and TSS >30 < 150 mg/L_ ` Effluent #2 = BODS< 30 mglLand TSS < 30 mg/L
:ST Name (Please Print} Signature: CST Number
3avid J. Steel - ~ 248956
4ddress Steel Sal Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 9/5/2002 715-246-5085
' Property Owner Sienna Corporation
a Boring # 'Boring
Pit
1 0-12 1:Oyr373
2 12=30 10yr4l4
3 30-96 7.5yr4/6
~` 7~ "
Parcel.ID # pending
Ground Surface elev.. 102.45 ft. Depth to limiting factor
Redox Description Texture- Stricture Cor~tence
none sil 2msbk 2msbk
none sici 2msbk 2msbk
~
none ms osg ml
{Boring # Boring _ _ ... .. ... _
Page 2 of 3
96 in. Soil Appl~ation Rate
~undary Roots GPDlft'
*Eff#1 *Eff#2
gvv 2f .5 .8
cs 1f .4 .6
na na (.7 I 1.2
* Effluent #1 = BOD_~ 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
' I Boring. # Boring
Page 3 of 3
STEEL'S SOIL SERVICE
David J. Steel 1564 Cty Rd GG
CST-POWTSM Sienna Corporation New Richmond, WI 54017
Lic. # 248956 NEI/4,SW1/4,S 20,T29,R19W (715) 246-6200
Town of Hudson, St. Croix Co. (715) 246-5085
The Glen lot 34
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for
your nse. The location of the test may or may not be as shown as permanent lot lines were not
established at the time the soil test was condacted. Legend
1" = 40'
• =Benchmark El, 100.00Ft
Top of 1" steel pipe
• =Alt Benchmark EL l O1.SOFt
Top of/Z" pvc pipe
a =Borings
Boring Elevations
B1 =108.85Ft
B2 =108.85Ft
B3 =142.45Ft
B4 =40.OOFt
~~, /o ~,&SF~
f~. i~~' ~s~r
g~..
APPRG'1 ED
KANF?OiE CG'JE~
wr PAnLOCr; ~
WARNING LABEL.
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SEPTIC r DOSE
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WANK MAN{JFACT"JRER, e~s~,,
TANK Si2ES: SEe~TZC . GAL.
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w„~4v~, GP.L.
4L.An,"~ MANUFACTURER:
'~~ ..Lcar
Ms~DEL NUMBER:
SW2TCH TYPE: ._._1?i~r~
'UMW' MANUFAC:'UR£R :
MODEL NUMBER:
SWITC~j TYPE:
~EQJiREA DISCHARGE R.A.T~~D G
OF:
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3' OHIO
SOLID. SOIL
~~ RI`S£R EXIT
P£RMYT~'ED CNS,Y
?F TANK
MAfJIlFACT'Jr~ER
HAS APPRQVAL
CONCRETE FA3
h~v°!~3£R DOSES ?£R DAY: ~.~
DOSr VC:a(J.ME IA1CLUD,Nt~
CAF~AC Z TI ES : A = ~ i:vC:?ES s~ -~~~~.~._.oA L .
G = „~~ INCr1ES ~ l3AL.
D ~ i~3CHE5 : ~ GAS.
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p~MP s A~~M wlRzr~~ ~s rER ILI~R 2b.Z3~ w~c
ERT;CAL DIFFiRENCE $E. P OFF AND DI'STP,zBU x IOAj FIFE 1.2 t'EE.
• MIN3;~UM NETWORX SUPPLY P1iESSURD T
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TO'*4I. DY1VAMrC HEAD FE ~*
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~te~fusaon iegaE~ed fro 0
• 'an Number ,~ ~ ~'' Ill (. ~
~~,~~ ~./C/DSo~ lv~ Parcel Ydeattficau
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•ao l~~i/,, ~,w' 'l~, Sec. ~~ ~ 7?~ K~~~' ?aWa of
~~ ~ti ~~ - ~ .Lot # .,.~...,~--.
Subdiv+sic>fl. THE
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ea lath, b~-~ +~ a+ct by tLe Daprartmrra-t o f Go
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cousloho of p~6 °~ ~ timlc ~ ecoa tamer ~~° m tb vsst+a d3t'Pa"d ~" b a
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t a ~ti~Catiaa tiasm,
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ma~Pl~,,~~P~°r' ~#cdp~m'ba vrs liceosedp ~~y,~~ ~ ~,~ia rank u k~ ~ 113 l"a01 a€ sivd,~.
it it- pry ~~ Mica st~dlat t°Z) niter tn:pectioa *~ P'~~ t~ ~ with t3~,e ~~~
~a~ to,~eiateia the P:<+'atie 8~ ~ot' Wiscvasin, Cdam
and rho ~yeeet of `t~tsn~al ~ pf$a ~icbia ~ 0
b~ eaa~l~ottd sad tet~nrnad tQ ~ S't. C'hoix Comity' TaoaiaB
pubis faun tilt tt+se m the bdt a! any ta+sr) kuOevled=o.
a aartazticy docd retoxdad in A+b$r~w of 'Cards ~.
.?_ ~i ~ .~
DA"~
I (we) om, (atn} the oaaee~a) °f
...=...t::L.L-~.
DATA
'f f ssrs..
fit mic.tapswepxed ~sssy nntlt in tbia tmi~+ i~~{t bofog revoked by the ~°~ D°i'~~
•• ~,cludc wiW this sppticatlots: a sac>~ w,n~,ty dead fmaa the Aag~~ of Datxls oPfia
s Copy a~f the eccaL~r~ Nri+GY 'a'i+P ~ ~lere~ ~ ~ ~ the ~t'ssacy d end
TOTHL P . C~2
' . ~ POWTS OWNER'S MANUAL. & MANAt3EMENT PLAN
SY$TEM SP>:CIFiCATiON$
Pape 1 of
Septic Tank Capacity ,7 CI al O N,
Ssptlc Tank Manufacturer O N,
Effluent Filter Manufacturer
~ ^ N
~~~~
~ ~
€Hluent Fi{ter Model ~~ 0 N~
Pump Tank Capacity Q'd' al ^ N~
Pump Tank Manufacturer r~ ~ ~Y ONE
Pump Manufscturer ~,Q,u/ ^ N~
Pump Model - ~d~ f ^ Na
Pretreatment Unit ~'r%
"~~~
^ Sand/Gravel Filter O Peat Flitar ~
^ MachanJcal Aeration ^ Wetland
^ Disinfection ^ Other;
Dispersal Cell(s) p NA
~ln-Ground (gravity) ~ fl In-Ground {pressurized)
O At-Grade '~ ^ Mound
Q Drip-Line ^ Other:
Other: O NA
~' ^ NA
~/"Q ^ NA
MaaTEHa~ scr~~
Sernioe Etrerrt Service Frequency
inspect condition of t+utkis) At least once every: 3 a s lMaxlmum 3 years) O NA
Pump out oorttents ofi tanktsl Wren combined sludge and scum equals one-third IY,i of tank volume O NA
inspect d{spsraal celi(sl At least once every: ~ mon ~lel (Maximum 3 yeora) ^ NA
Clean effluent f~ter At least once every: ~ rnont)t(eD
,~' earls) O NA
Inspect pump, pump controls & alarm At least once every: ,.~- C3 ~~lel ^ NA
Flush latarab end pressure test At (east once every: -- O setts! ai O NA
other:
Other:
At !oast once every: matthtsl
-- p ear(sl
~ NA
Q NA
MAINTENANCI: iWSTRUCTlONB --
inspections of tanks and dispersal cells shall be made by en individual carrying one of the fo{lowing licenses or cortifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS lnspectar; POWTS MaintaMsr; Septage Servicing Operator. Tank
inapectlone must fnclud. s visual inspection of the tank{s) to identity any musing or broken hardware, identify arty cracks or leaks,
measure the volume of combined sludge and scum artd to check for any back up or pondirtg of effluent on the ground surface.
The dispersal osil(s} shall be visually inspected to check the Affluent levels in the observation pipes and to check for any ponding
of effluent ort the ground surface. The ponding of effluent on the Around wrface may indicate a failing condition and requires the
immediate notifJcatian of the local regulatory authority,
When the combined sCCUrnuiatiott of sludge and Scum in any tank equals onA-third tY~! to more of tits tank voiurne, the entire
cantenta of thA tank shah be removed by a Septaga Servicing Operator and disposed of in accordance with chspter NR 113,
Wisconsin Adminlatrative Code.
Ai! other eenrices, inakrding but net limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and arty servicing at intervals of 572 months, shall be performed by a csrtif'wd POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completbn of any service event.
'Values typical for domestic wastewater and septic tank etfluertt.
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2 -02 eBgd Nolie~~ado aNd an iavis
STATE BAR OF W15COV5IN FORM 1 - t998
WANRANTY D$ED
66tEsC!$t7
'
twumem N
8
'
m /~+~
r ~ 7
6 KATHLEEN H. WALygH
kQGISTEf1 QF DEED5
er
,
u
_
..
... _,. .: .: yn
e~ I PAGi
1,3
_
~.....
at. CkOIX CO., WI
Thin Deets, made estwesn Bans ar o ton. I1ECfIVED FOR RECDR4
__._a Min>leaota coraorat3o n It-P1,E0p1 3:14 Fft
--_ ....._` '-- ---- ..._..~..___._____....____--- GEED
al~d
oo a~ ~t
~O~C-o.~.~r t ot:-- ~ "~-------.--, Grantor.
w xi,..^..iiGl;.Lat,iII~__.,.,,
-- ~
Ffft
T
t
_-
_.-_-_-__
~
----- _ ~__,__
------- ~ ~ __ T
FEEL 9A63.~4
lN6 fEEt y7.44
~.....~~_.~ -------....~,w-, Crarttse.
Grantor, for a vatuaDfe eonstdorstlon, ctutveya m Crarttee the roltowing
': dexrilSed n+l tatate to St ~ Crol.x t
'
'' (the'"Pro rt ~__'.'.~
Pe Y'}
"'_"_,..._-
County, State of Wiacanrin
..
Sae Attaahad Exhibit A yc:radn rou
J
wm,ar,dA.uu,;;t,~,p' ~~ "'
(1 ni~rki.~ "~•~ ~~
~'1'Gb 5 me~rq ~r i ~..
~' ~i.Li~,, ~bM
~,{iv<~~ aka
~1~16a3~
,...
... ... ..
.
0
sa-lo48-sa-ooo
Parse) td.nl~aoeasn NtenbM tppyt "-"""~`~
T-t~ ie RO! homausad propatyt
(ss) (ta not)
24-1048-66006
20-I048-90-000
20-1049-90-000
20-IOSO-00-Op0
20-1050-+3a-000
20-1OS2-20-000
2o-Iass_~D-ooo
lbgether with ail appurtenant rlOktta, tuie and intertsta.
Grantor warrentn tt^.at the tleEe to ttte Property fa gaati, tndaftKSlbie fn tee slmpJe rnd free and clear of encumtuancea rxcept
Sae Attacted Bxhibit: B.
' Dated this 20t,,..h day of Dsca.~ ~b•= 200E
------_,
Bane r oration.
.,.,_ (SJ»AI~1 (SEAL)
by ~
~.
`p _ + i
else
•Its C e£ Executive Off
AUTHENTICATION
Signature(a}
aulhenttcatsd this deyof
"f'IT~F h1EhiHER S?ATE 8AR OF W15CONSIN
tIf +~ot,
authcr';red by j706.06. Wls. Stela.}
ACKNOWLEDGMENT
Nianesota
State t-PifVtlnttfflftbC 7
} w.
~~•~`` ~ Caunt JI
Pere4naliy earns before me thu + ~~i _ day cf
Dacotnber
.John M. xaastf£ Chtaf20~e ut~ a ptficar
at Bane Cor oration, a Hiaaeaota ~~"-
coc oration ~•-
me known to be~!~~e pr~~~ who executed t!le toregaing
Instrument an4 adtn~vlefoJrt,:...,,.
Tktg i,ugTgtrMENT WAi DRAFTED BY ~ ~ ~ ~M
~~~k~i~d~ge Gi•fndal Law Firm ~~ ~ ~ ~Yf$'~~f:R
Ili. _ ~ ~wwaa+otwwtatrtr
Minaenpolie, MN 55401 ~N~~yyry'~ttDllc, Suta of Wiaconstn ~~~°
"'^-~---•.--- ~Y commtaaEOn is permanent, (If not, state exptretfon deter
(SlgrialuMs may be eut}tenucated or acknowledged. 8mh an not 3 tta ~~
necrssary) ~~_ }
'Homes of ;wrsmis ti r mane ~ •~..:
B" a Y apxu husl er t ~ ...
Y YPad sr Wlnart! Mlow lh,rr c ', .." ...
+an,uur
h'AkRANT!' DEED STATE BAA OF WISGONS2N
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