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Wisconsin 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
LaCasse Develo ment Hudson, Town of
CST BM Elev: Insp. BM Elev: BM Description: ^ ~
~~
/
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic l~~S 3 2 rr.. 5 ~ (od
F:~~ Pa ~~4~ SAS
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic y Zl.~ i /
/ ,t,/~~
r ~Z/
Dosing
Aeration
Holding M
M
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Model Numbe
TDH Friction Loss Syste TDH Ft
Forcemain Length Dia. Dist. to well
SOIL ~4gS~RPTI~N SYSTEM
ELEVATION DATA
County: St. Cr01X
Sanitary Permit No:
479417 0
State Plan ID No:
Parcel Tax No:
020-1437-09-000
Section/Town/Range/Map No:
22.29.19.2714
STATION BS HI FS ELEV.
Benchmark
Alt. BM a n SQ
i a~ ~w~-cak~ow '7
2 ' p
~3. 7 O
Bld .Sewer ~ ~ I ~ ,~~
SUHt Inlet g.5~ q7 r ~I
SUHt Outlet g gt0 ~,~ , ~Z
Dt Inlet
1
~
Dt Bottom
~-.
~
HeaderlMan.
~~. 9
Dist. Pipe '~,,6,f ~,I, b~
~l
Bot. System ' Z, b.3 p
. forj
Final Grade ~,
St Cover
.5
/a~ .7~
BEDITRENCH
DIMENSIONS Width ~
~Z Length No. Of Trenches
~ ~~~G~~ PIT DIMENSIONS
~- No. Of Pits
`"- Inside Dia. Liquid Depth
~~
SETBACK
INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING
CHAMBER OR Manufacturer. .~ /+.I 1~
~ a<
Type Of System: (~
~ ~~ I -
~ ~ ~ (~
~/ ~~ UNIT Model Number. ~ ~ '
'j
a J~cx.
v.,
I~ISTRIBl1TI~N SYSTEM
7_.-'S C~rl.~
~~
'~ ~D rl
Header/Manifold ~
t
Length Dia `-} Distribution
Pipe(s) ~ ~
Length~_ Dia Spacing ' x Hole Size
` x Hole Spacing Vent t`o\(tir Iptak`~~
3 d,[. ~-
SC111 CAVFR ., nre~~..~e c..~tnma n.,~~ YY Mn~~nrl nr Of_(;rade SVStemS Only
Depth Over /
Bed/Trench Center ~ ~ Depth Over
Bed/Trench Edges \ xx Depth of
Topsoil \ xx Seeded/Sodded
N
Y xx Mulched
~ Yes 0 No
\ o
es [~
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /
Location: 680 Heritage Way Hudson, WnI 54016 E 1/4 SE 1/4 22 T29N R19W) Kelly Estates Lot 9
1.) Alt BM Description = ~ ~ ~' ~ t-°.~av1 ~Z- ~J~
2.) Bldg sewer length = ~
-amount of cover = y z
~D
i --~T-- I
Plan revision Required? ~~ Yes No ~ p I ~~ II ~~I
Use other side for additional information. L__( ~-~
Date
SBD-6710 (R.3/97)
Inspection #2: / /
Parcel No: 22.29.19.2714
L ~~I'
Cert. No.
Satety and Buildings Division
201 W. Washington Avo., P,O. Box 7162 County
'!
Madison, WI 53707 - 71 b2
® Sanitary Permit Number (to be filled In by CoJ
I ~COII ~II ~
~ (608) 26b-31 ~~ +. f ~
De artment of Commerce
state Alan 1.D. Number s.
Sanitary Permit Appli atl
ou
{ds
~~
l in anon
d
C
~y
~ ~~
,
y
o
a, persona
In accord with Comm 83.21, Wis. Adm•
may be used for secondary purposes Privacy LdW, `5.04(1 G
Project Address (if difforant theft mailing addross)
1. Application Information -Please Print All Information ,, ST CRO-X COUCE
pFF
Property Owner's Name Parcel # Lot # lock #
S~t2,
Property wner's Mailing Address Prop ion ;
~~ %,, :~ '/,, Section ~ .
City, Sta Zip Cado Phone Ntunbor ,
' (cTcle )
T~ N, R~E
"'t`
I:. Type of Building (check all that apply) S
1_ _ Subdivision Nate ~ ~sM-Na>gber
S
1 or 2 Family Dwelling -Number of Bedrooms _____~__~----~ '--'
r
^ Public/Commercial - Describe Use {
^V'll a.~Tmvttahip of~,_,_, I!
^City
^ State Owned - Desoriba Use _
111. Type of Permit: (Check only one box on line A. Complete. line B if applicable) 020 - 3~-- 09-t?trU •~.~")
A' New System Q Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System
B.
^ Permit Renewal
^ Permit Revision ^ Chan
ge of
^ Permit Transfer to New List Previuus Permit Number and Data Issued
Befara Expiration Plumber Otvrter
IV. T e of POWTS S stem: Check all that a 1
Non -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-' ^
Recirculatin S nthetic Media Filter ^ Leaching Cha ber ^ Drip ins Grave less Pipe ^ Other (ex lain).
V, Dis ersal/1'reatmentArsa Information: ~ 2 ~ S -
Design Fiow (gpdj Design Soil Application Rate(gp Dispersal Area ReQuired (st) Dispersal Area Proposed (st) ystem Slavadm .~,
a
~
7
VI. Tank Info C act in
aP tY
ll
s
G Total
Gallons Number
of Units Manufacturer Prefab ~
ConcrgtC Site
Constructed'. .3teal
- Fber
Glass Plastic
on
a e~-,.~~ ~
P '_ ~~:
New Existing ~
-Ey t
Turks Tarlka
Sopuc or Holding Tank -
At>tobic Trosunont Unit A
r'
.Dosing Ctarmbor
. a
VII. Responsibility Statement^ I, the undersigned, a me roapooaibility for iastalladon of the POWTS ahowq oa the attached pleas
Plumbs s e ~ Plumbs s Si MP/MPRS Number Business Phone Number
_ _ ~`
Pl tier's ddress (Street, City, State Zip ode} •
~p
VIII. Court /De artment se Onl
Sanitary Permit Fea (i Judos Groundwater Date Issued Issui Agora 8igttature (No,Stt~-s)
^ D' pprove t.
ved
r
A
,
o
pp
Surcharge Fee)
Z
~ ~
'
•
an Reason for Denial
^
IX. Conditions A pro
SYSTEM OWNER: ~ -
1 Septic tank, effluent filter and ~r, '
dispersal cell must all ~e serviced / rrteintained r,. -_~.
as'per rrtan8gement plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code/ordinances:
I- • I~_ LL-. YI n r 1 t trwt.r Jr •1.. '
(1{pcY CVwtNlc.c tnrW \,r .w vrrry rry,.... ... w/..~--~..~, ~ - ~_..___
SBD-639$ (R. 01/03) ~ ;
/ ~\
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2- ,.~ Y . ; .~ .. w ~ 1215
SOIL EVALUATION REPOR#
tNisconsin Department of Commerce p e 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ~ d ' ` c~ ! ~ ~ ~ Steel Soii Service
Attach complete site plan on paper not less than S'l: x 11 inches in s¢e. Plan must C my _ ~-`~~
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Pa --
Pending
Please print all information. Revi By ate
Personal information you provide may be used for secondary purposes (Prnracy Law, s. 15.t)d (1) (mp_ ~ 0 3
Property Owner Property Location
Reliant Devebpers LTD Govt. Lot SE 1!4 SE 1kt S 22 T 29 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
9900 Valley C,f~ek Rd. Suite 135 9 na Kelly Estates
City 1.00 ~^y State Zip Code Phone Number City Village ~ Town Nearest Road
MN 55125 651-731-3174 Hudson Heritage Way
i~ New Construction Use: i/: Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial -Describe:
Parent material outwash plains and stream terraces Flood plain elevation, if applicable na
General comments
and recommendations: System elevation 93.65ft, trenches spaced and depth to code 5.75ft bebw grade
•----
Boring # Boring
W
108
Pit Ground Surtace elev. 99.40 ft. in.
Depth to limiting factor Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence boundary Roots GFD/Rz
*Eff#1 *Eft#2
1 0-8 10yr3/2 none sit 2msbk mfr cs 1vf .5 .8
2 8-18 10yr4/4 none scl 2msbk mfr gw na .4 .6
3 18-58 7.5yr4/4 none sUls 2msbk mfr di na .5 .9
4 58-108 7.5yr4/6 none ms
..-- osg ml na na .7 12
~
a,,t- ~3.6~
~9/ 10~
Boring # Boring
/
108
Pit Ground Surtace elev. 99.40 ft. Depth to limiting factor in. Soil Appl~ation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Cor~~tence noundary Roots GFDrYt-
"Eff#1 *Eff#2
1 0-12 10yr3/2 none sil 2msbk mfr cs 1vf .5 .8
2 12-20 10yr4/4 none sic! 2msbk mfr gw na .4 .6
3 20-27 10yr4/4 none scl 2msbk mfr gw na .4 .6
4 27,48 7.5yr4/4 none sl 2msbk mfr di na .5 .9
5 48-108 7.5yr4/6 none ms osg ml na na .7 12
~ ^_
(o4/~oS~
- tmuent ~~ _ ~tw 5> 30 ~ ZZO mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS< 30 mg/L and TSS < 30 mg/L
CST Name (pl~se Print) Signature: CST Number
David J. Steel 248956
Address Steel Soi! Service ~ Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, W 154017 10/21 /2002 715-2411-5085
Property owner reliant Developers LTD Parcel ID # Pending Page 2 of 3
Boring # _. -, Boring
93
90
Depth to
ft
limiting factor
108
i
V Pit Ground Surface elev. . . n. Soa Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
*Eff#1 *Eff#2
1 0-8 10yr3/3 none s! 2msbk mfr cs 1f .5 .8
2 8-24 5yr4/4 none Is osg mvfr gw 1vf .7 1.2
3 24-108 7.5yr4/6 none ms osg ml na na .7 12
r
~t ~,~, 9~~ ~$' ~ f
o,,t- S ~-
c~q~~~
Boring # 'Boring _ _ ., .. ...
* Efflue.^.± #1 = BQD ~ 3Q 4 220 mg/L and TSS X30 ~ 150 mg/L * Effluer: #2 = BODS _30 mg/L and TSS ~ 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. u you need assistance to access services or
Boring # 'Boring _ - .. .. --- - .
Page 3 of 3
STEEL'S SOIL SERVICE
David J. Steel 1564 Cty Rd GG
CST-POWTSM Reliant Developers LTD New Richmond, WI 54017
Lic. # 248956 SE1/4,SE1/4,S 20,T29,R19W (715) 246-6200
Town of Hudson, St. Croix Co. (715) 246-5085
Kelly Estates lot 9
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be saitable 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 soil test was conducted. Legend
/ 1" = 40' /
Benchmark El. 100.00Ft
~~ ~ ~j 7 3aF~- ,L Top of ''/z"pvc pipe ~~
~,~.~G• 3 ~~, ~ ~!`?~~~ • -- Alt Benchmark E1.98.65Ft
-Top of'h" pvc pipe -~
~~~, ~~`fo~~ / ~C.~ 3,~ ^ =Borings
~ ~ ~ ~,p~~- Boring Elevations
B 1 =99.40Ft
B2 =99.40Ft
B3 =93.90Ft
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1 I tt g I
POWTS OWNER'S MANUAL & MANAGEMENT PLAN..,;. , .
Flf_E INFORMATION
.Owner s, ~ C,
Permit /! ~}~ •{-l ~-
ncclf]IU DAROMf:TFRS:
Vbv/v.• • r.. .~~.-rw..-s•w
Number of Bedrooms
O NA
Number of Public Facility Units l~ NA
Estimated flow (average! p al/da
Design flow (peak!, (Estimated x 1,5) al/da
Soli Application Rata al/da /ft~
Standard Influent/Effluent Quality Monthly ave rage"
Fats, Oil & Grease (FOG) 530 mg/L
Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA
Total Suspended Solids (TS5! 5150 mg/L
Pretreated Effluent Quality Monthly ave rage
Biochemical Oxygen Demand (BODE) 530 mg/L
Total Suspended Solids (TSS) 530 mg/L ~ NA
Focal Coliform Igaometrlc mean) 510° cfu/t00m1
Maximum Effluent Particle Size Yd in die. ^ NA
Other: ^ NA
*Valuas typical for domestic wastewater and septic tank effluent.
Page _,L.,, of
SYSTEM SPkctrrU~ r r~rva
~
Septic Tank Capacity al Q Ni"
~
.. ,
Septic Tank Manufaoturer ~ ~_
' ^ N'
Effluent Filter Manufacturer
,~:.. ,
' `
_ ^ N~~~
Effluent Filter Modal ~ ^ N~;
Pump Tank Capacity al S~ NJy_I
Pump Tank Manufacturer -~ N~'
Pump Manufacturer ~ NA
Pump Modes fa NA I
Pretreatment Unit ~ N~.
^ Sand/Gravel Filter ^ Peat Filter
^ Mechanical Aeration O Wetland
^ Disinfection O Other.
^ N!, 1
Dispersal Cell(s) !
~in-Ground (gravity! ^ In-Ground (pressurized)
^ At-Grade D Mound
p prip•Lina Q Other,
Other. Q Nf~
Other: ^ NA ',
Other: ^ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tankisl
At least once every: months! '' (Maxirt~um 3 years!
!~ aerial „ ^ NA
Pump out contents of tanktsl When combined sludge and scum equals one-third .(Ysi of tank volume- DNA
^ monthlsl " (Maximum 3 years) ^ Nh
Inspect dispersal cell(s) At least once every: years!
^ month(s) ^ Nt.,
Clean effluent filter
At least once every:
~ .i~ year(si ^#
^ month(s) [.~ Nf. ~
Inspect pump, pump controls & alarm At least once every: ^ ear(s)
^ month(s}. ~, , .,- _. , ~ NFL
Flush laterals and pressure test At least once every: O ear(s)
Other:
At !oast once every: C7 month(s)
Q ear(s) f8 NA
Othor: G NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following lioenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Serviairtg Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any otaoks 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.
1°he dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondin~
of effluent on the ground surface. The pondfng of effluent on the ground surface may indicate a failing condition and requires tht:
immediate notification of the looal regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y31 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 Chapter NR 113,
Wisconsin Administrative Code. - y "
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized oomponents, 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 14 days of completion of any service avant..
t3MW 1A/0 r i
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(sl for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tanklsl 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 highwatar levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(sl in one large dose, overloading the oeltlo! and mey recruit In•tl» bwkup or wrfaw di><charge of
effluent. To avoid-this situation have the oontents of the pump tank removed by a Septape Serviolnp Operator prlor:to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manuapy"operating the pump' controls co
restore normal levels within the pump tank. „ .
Uo not drive or park vehicles over tanks and dispersal cells, Do not drive or park over, or otherwise-disturb or compact, the aria
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; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides;; meaty 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 be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
e All piping to tanks and pits shall be disconnected and the abandoned pipe openings Sealed.
~ The contents of ail tanks and pits shall be removed and properly disposed of by a Saptage .Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed aftd the void space filled wills
soil, gravel or anothor 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: <.,; ~ .:~:,. ,,,,
A suitable replacement area has been evaluated and may be utilized for the location of a replacement sell absorption
system. The replacement area should be protected from disturbance ahd compaction and should not b® 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 rnusi
comply with the rules in effect at that time.
D A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may ba installed as a last resort to replace the failed POWTS.~--r~-~°~ ~ - fev- ~---~~-
^ Tha site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area.. If no replacement area is available, a holding tank
may be installed as a fast resort to replace the failed POWTS. .. : .. ::.... . :._..
^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of thq biomes 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 INSUFFIGIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DF»ATM MAY RESULT. REBCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY 8E DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
', :. <. t,n.Fi~,¢~{fSFtigl~:4 :~ .~fn'r; ~;
POWYS INSTALLS POWTS MAINTAINER
Name Name
F
Phone ~ Phone
SEPTAGE SERVICING OPERATOR IPUMPERI LOCAL REGULATORY AUTHORITY
Name
Phone
Name ~
Phone 7 „_,~ ~ w ,. ..,,
,~~ .~ _
;his document was draped in compliance with chapter Comm 83.22(Z)(bl(1)(d)&(f) and 63.64111, l2) & (3-, Wisooruln AdmlMstratfve Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer ~~ GA.ss~. L7~ ~,~ /_~i~,r~Z..~
Mailing Address
Property Address ~
~~~
.er
w~
7 ~n~~--
- _ --
(Verification required from Planning Department for new construction.)
City/State ~i.~ ~ S ~~ ~ ~ Parcel Identification Number oZn - I ~3~- 0 1- ~ ~• 2~1 `{'~
LEGAL DESCRIPTION
Property Location 5~ '/4 , ~'~ '/4 ,Sec. 2 2 , T ~ N R / ~ W, Town of ~-~4 ~5 ~~---
Subdivision ~S. r~r~,~ ~ ~~ ~. ~~ ,Lot # '
Certified Survey Map #
Volume ,Page #
Warranty Deed # ;7, ~Z~ S ~ ,Volume ,~ Page # ,
.Spec house es no Lot lines identifiable /~ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Zoning Department a certification form, signed liy the owner and
by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal
system is in proper operating conditionand/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of
sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning
Department within 30 day of the three year expiration date.
SIGN OF APPLICANT DATE
OWNER CERTIFICATION
Uwe certify tall statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
pr a described a e, b virtue of a warranty deed recorded in Register of Deeds Office
SIG A OF APPLICANT DATE
****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. ******
2~
Include with this application a stamped warranty-deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
U 2535P ~i95
STATE BAR OF WISCONSIN FORM 2- 2000
WARRANTY DEED
THIS DEED, made between Reliant Developers, LLC, Grantor, and
LaCasse Development. Inc., Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin:
Lots 2, 3, 4, 5, .7, 8~ 11, 13, 14, 15, 16, 17, 19, 20 and 21, Plat of Kelly
Estates, St. Croix County, Wisconsin.
~~~~~~
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX G0. , N1I
REGEIVED FOR REGORD
Ib3/29l20@4 09:3.0AK
WARRANTY DEED
EXEMPT #
REC FEE : i 1.0f~
TRANS FEE: 407~l.0~
COPY FEE:
CC FEE:
PAGES: 1
Recording Area
Exceptions to warranties:
Easements, restrictions and rights-of--way of record, if any.
Name and Return Address:
Edina Realty Title, Inc.
400 S. 2"d St. -Suite 115
Hudson, WI 54016
423495
020-1060-30-050,020-1059-90-0 QO
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 26th day of March, 2004.
Reli evelopers~LC-
B ~:
* ick Toston, Chief Manager, Reliant Developers, LLC
*
AUTHENTICATION
Signature(s)
authenticated this 26th day of March, 2004
*
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Peterson, Fram & Bergman -Steven H. Bruns
50 East Fifth Street, St. Paul, MN 55101
(Signatures may be authenticated or acknowledged. Both aze not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature
*
ACKNOWLEDGMENT
STATE OF WISCONSIN )
ST. CROIX COUNTY. ) ss.
Personally came before me this March 26, 2004 the above
named Ri oston, Chief Manager, Reliant Developers, LLC
to~°fne~ known to b the person(s) who executed the foregoing
instrument and ackn ledged the same.
w....
*Tiic3' °Larrieu ~`
Notary Public, State bf Wiscons'
My commission is p}~ 4„A~I•,3'1~4 I ate:
lli4i2oo7 f JUDY LARRI U )
Notary Nubuc
State of Wisconsin
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000
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