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HomeMy WebLinkAbout020-1409-08-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CTOIX Safety and Building Division F INSPECTION REPORT Sanitary Permit No: 430018 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Mireau, Roger I Hudson Township 020- 1409 -08 -000 CST BM Elev: Insp. BM Elev I BM Description: Section/Town /Range /Map No: t7D . d Ito . c7 M z rC.." = CS ( ii+µ 24.29.19.2566 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. /BM t2- =3 Aeration Bldg. Sewer 3, (o Z m . 1 Z / Holding SVHt Inlet t 7 �• 9 TANKS TBACK INFORMATION St/Ht Outlet �•$O %.711 TANK TO P/L WELL BLDG. Vent to .Air Intake ROAD Dt Inlet Septic 3b f� f Dt Bottom Dosing Header /Man. Aeration Dist, Pipe Q•�1 1 Holding Bot. System i 2 i P Final Grade P /SIPHON INFORMATION ' MIX s; 11 S7 2•gL Manuf urer Demand St Cover 1 Model Number TDH Lift F' ion s System Head TD Ft f Forcemain Cength Dia. Dist. o 7re s SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Qf Trenches PIT DIMENSIONS No. Of Pits Inside Dia, Liquid Depth DIMENSIONS 1 !97.sb• J Z) SETBACK SYSTEM TO � /L l BLDG IWE LL LAKEISTREAM LEACHING Manufac • f _ INFORMATION CHAMBER OR Type Of System: Model Number: y Z} I`� UNIT CPrN4, Q L I( DISTRIBUTION §YSTEM �, f JL Header / anifol Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s Lengt Dia Length pacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil _ (-] Y es ` ] No L Yes ::No ( IV�MEN (In T S: (Include de di$crep cies, 7rsons present, etc.) Inspection #1: �� / � 7 Inspection #2: 804 den Lake Road H_L son, I 016 (SE 1/4 SE 1/4 24 T29N R19W) Boundary Ridge Lo 8 Parcel No: 24.29.19. 566 1.) Alt BM Description r S 2.) Bldg sewer length - '' - a oof cover = L .. � ( 6 e � - pits �,t o � o 36. IIIIJJJJ� Plan revision Required? No �4. I!T ', q Yes * 3 _ — Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. A I r z2 O . .... _--• _-_. g 9 Z I I Safety and Buildings Division County ` �� m 201 W. Washington Ave., P.O. Box 7082 eonsin Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 261 - 6546 300 Sanitary Permit Application _ State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code person F be used for seco y 1 y ndary purposes Privac ma 5. Project Address (if different than mailing address) I. Application Information - Please Print All Information Property Owner's Name Parcel # Lot # Block # f l - ONiNG OFFr�c _ Property Owner's Mailing Address Property Location City, S e Zip Code Phone Number �- K, ' -/� Section � E o; o�g) T N; R E o II. Type of Building (check all that apply) it 1 or 2 Family Dwelling — Number of Bedrooms Subdivision Name lSM ❑ Public/Commercial - Describe Use N f �__�, ❑ State Owned -Describe Use / K 0 7' ❑City ❑Villa Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' �J New Sy ❑ Replacement System yst ep ys ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl 9 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 ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line U. Gravel -less Pipe ❑ Other (explain) V. DispersaVrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) ystem Elevation S 17 e VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 6 Zi2d Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersign d, assume responsibility for installation of the POWTS shown on the attached plans. Plumber Name (Print) Plu i lure MP/MPRS Number Business Phone Number Plumber' Address (Street, City, State, Zip Code �� �� iii VIII. County /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued [ ui g Agent Signature (N Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial . S 0 IX. Conditions of Approval/Reasons for Disapproval *r A ttach complete plans (to the County only) for the system on paper not less than 81/2 x It Inches in sine SBD -6398 (R. 08/02) i , I I �- I MAN r -----------� -� �- M f OE- 71 i i A V � il c ! �-: i i , I ) �1 Q I �F�'g lA �Ca me _ _ Wisconsin Depa of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 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 arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide m e used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prope Owner .�,yyyy Property Location CEF Govt. Lot �� - 114!; 1/4 S T N R E (or Property Owner's Mailing Addre Lot # Blo /q Name or CY Zzil # Subd. NCS1ul '# ' LLi City tae I Zipjoqe {{ Phone Number El city 1:1 Village jZ Towil Near st Road �] New Construction User Residential / Number of bedrooms Code derived design flow rate X6/1 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material l�2e�d�(s Flood Plain elevation if applicable ft. General comments and recommendations: Boring # Boring ❑ Pit Ground surface elev. 9 6 ft. Depth to limiting factor in. Soil Application 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 L T 1 1 �. < L i s .5 7k 7 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor ZZ —) _ in. Soil Application 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 I *Eff#2 7 s J -46 a 10 V J 6 < ` ✓ — '7 Z. o * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CWNm (Pl eas Pri t gn a CST Number ' 1 ArZ2 14 Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner Parcel ID # Page _ of F7 Boring # Boring ❑pit Ground surface elev. ft. Depth to limiting factor }��i ( in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 3 Y/7 s FJ F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application 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 F-1 Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 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. SBD -8330 (R.07 100) ��'�,� /7 ;�.�u s,� /sue s,� `y // - s,���� y�9/✓-�i4cJ uosoN 6111" S�D /� � / C /V(- i� 96 h y8/ � � I ev I'ONY'I'S OWNER'S MANUAL & MANAGEMILNIT PLAN ' 1 ; FILE INFO MATION SYSTEM SPECIFY TI kCapacit e a1 o N A Owner Sept Tan P erm i t N 3 00 � Septic Tank Manufacturer o NA Effluent Filter Manufacturer o NA DESIGN PARAMETERS Effluent Filter Model o NA Number of bedrooms o NA Pump Tank Capacity al t NA Number of Commercial Unit XNA Pump Tank Manufacturer s NA gal /day Ma nufa c turer Estimated flow averse Pump Ma ac turer o-NA Design flow (peak), Estimated x 1,5 gal/day Pump Model d-NA Soil Ap plication Rate _ gal /da /k Pretreated Unit Inl'luuttl /laI'luent Qutrliry Nluntlily Ayvenibe* ci timid /0ravel I ilter to Prat I'iltcr huts, Oils & Grease (FOG) <10 n►g /L n Mechanical nutrition u Wvtland Biochemical Oxygen Demand (BODs) 5220 mg/L o Disinfection o Other: Total Suspended Solids (TSS) <150 m L Manufacturer Monthly Average ** Dispersal Cell(s) Pretreated Effluent unlit O NA -round ( o I ground � Quality ,�In g (8 Y) 6 (pressurized, Biochemical Oxygen Dem;rnd (BODz) `��) nt h /I ' o AI -grade 0 MOUnd Total Suspended Solids (TSS) S30�mg /L o At-grade o Other. Fecal Coliform (geometric mean <10• c fu/ IOOmL Maximum Effluent Particle Size 1 4 inch diameter Values typical for domestic (noncommercia)) wastewater and septic tank effluent. •+ Values typical for pt�otreatod wastewater. MAINTENANCE SCHEDULE Service Event Service Frequenc Inspect condition of tanks At least once every o months tt ears Maximum 3 y s Pump out contents of tanks When combined sludge and scum a uals one third %, of tank volun Inspect dispersal cells At least once every o months Ctye ars Maximum 3 yro Clean effluent filter At least once every o months j6 your( Inspect Pump, p ullip Controls & alarm At least once e very months o uur s ANA Plush latbrals and pressure test At least once eyvry o mont o yours) )"A Other: At least once every o months o year s a-NA Other: At least once every o months o ears a - MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be rnade by an individual carrying one of the following licenses or certification Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Soptage Servicing Operator, Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on tt ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to u ace. The ondin of effluent on the ound surfaeo ma indicate a r a ndin of effluent on the ground s rf e check for any po g gr' p 8 gT , =y , . failing condition and requires the immediate notification of the local regulatory authority. When-the combined accumulation of sludge and scum in any tank equals one -third (%) or more of the tank volume, the en(, contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with eh, NR 1 1 a, Wisconsin Administrutive Code, The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment 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 shall be provided to the local regulmory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s), If high conoontmOons uo dotected ha the contents of the tanks(s) removed by a septage servicing operator prior to use. Owner: . 6'ee , &�4 Page of a System start up shad not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. The area within 15 feet down slope of any mound or at -grade soft absorption are. 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; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and/or is permanently taken out of se# rice the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After 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 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 soil absorption system. The replacement area should be protected from disturbance and compaction and should not be 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 must comply with the rules in effect at that time. v A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. o The' not' x evahiatetf to °rdentifya - 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 last resort to replace the failed POWTS. o Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. _DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLiR, POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULATORY AUTHORITY Name Name ' Phone Phone t P� T 4 F 4P/' • 35 Ae+•eS — /o/¢ o/2 p /,q-'r /Dv-=.vp/ AU4r- 'IT 80 t • MAscons{n Department of Commerce SOIL EVALUATION REPORT tivislon of Safely and Buildings Page / of In accordance will Comm 85, Wis. Adm. Code Allach romplele silo plan on paper not less plan p 117 x 11 Inch County �' eR C9 Inches In size. plan mull Inrlurfe, 11W not Ihnlled to: vertical and ho►{zonfal reference point (BM), direction and Parcel I.D. 02O • /0�p 9 . /0 • �� percent slope, scale or dimensions, north arrow, and locallon and distance to nearest road. h /ease hflflf all 111fo ma(loh. Reviewed by Dale personal tnformalbn yotr provide may be treed fors s hrivec few, s. 15.01 (1) (M)). Properly Owner Pr erty location eet KER NoN 13 DjN ALAh PAR ' A Go I�ol �� 114 StC� 114 S 2T T �9 N R (or) W Property ailing %lddress 2 2002 Lo 4 Block 4 Subd. Name of F:6 M4 Uwner's M City Stale Zip Code ion Cily [] Village g] Town Nearest Road n I7VpS Lc�i. SVoI� ( ) ING F 1 ff vf�SON I / PO New Construction Use: Q Residential / Number of bedrooms 3 _ X Code derived design flow fate l`ld GPI) (] neplatemenl [] Public o�r commercial - Describe: Parent material ���� 00 y „ShAJ J9 y faood Plain elevallon If applicable Iv ry, General comments and recommendations: recommendations: • �,PF�- 7-,671s r &,P 4 N 1.4 Co 0 Tio v �4 Paw rs . Boring 4 u Boring G / pit Ground surface elev. ft. Depth to limiting factor in. Boll Application Rate Horizon beplh bominanl Color Redox Description Texture Structure Consistence Boundary Roots GPD/il' . in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 I 'Efffl2 r o -to Ia 3/3 L I/W e 075 W ,� . y . C �- Cv • / /0 /'t 3/ SQL S X fie / • z. .3 3 /o le em — SQL 2 shw �i' G5 , s .,Q J- - 2• s n C — s ©; S ' Boring # Boring Q �j > G!� 111 ��� III � ill Ground surface elev. — n. Depth to limiting (actor T / M. Soil Appllcallon Rate I lorizon bepih MY 31� Redox Description Texture Structure Consistence Boundary Roots GPD/11' In. Qu. Sz. Cont. Color Gr. Sz. Sh. '121(411 'E1t42 L.� L /fshk' iw► fie � SL s zf .y •� 3 036 /o,es, Effluent 41 = BODll % 30 < 220 mg/L and TSS >30 < 150 mg1L ' Effluent 42 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print Signature CST Number 'Roaae Ilhof GtiT 2Z437 S address Dale Evaluation Conducted Telephone Number ht & Associates / O L 715 • 3 86 • gj 8 S Private Sewage onsu 655 O'Neil Rd. Hudson, Wis. 54010 X20 hrope►ly Ow►rer io 67y Parcel ID q z r ' noting page of 3 ' �j I ` LJ Vd Pit Grotmd surface elev. _ fl. beplh to Mmiling factor / _ �Z In. ! Iodzon Depth Dominant Color RP,(IOX bescriplion Texture Structure Consistence Botinda Roots Soil Application Role In. Munsell h' Gptim Qu. Sz. Cont. Color Gr. Sz. sit. 1:1101 ' :11tl2 °•� gay_ �'`�,� 45 .7 �. Z 3 Z �s /01 7 r• 2 C� ltoring !1 � noting J L� pit Ground surface elev. -------- it. Depth to limiting factor in. Fbrizon Depth bominnnl Color Redox bescriplion Texture Structure onsislencE a Roofs Soil Application (tale In. Munseq Qu. Sz. Cont. Color n' GPO/fi' Gr. Sz 'ETtgi 'ERp2 i I • noting iY noting Ll pit Ground surface eiev. ft. Depth to ling factor In, ` 110070" Depth Dominant Color Redox bescriplion Texture Iruclure Bound a Roots Soil Appllcaflat Rate kt. ry GPD /II' MunseR Qu. Sz. Cont. Color Gr. Sz. Sh. 'ENi71 :11112 i " Efituenl ft t = Bpp� > 30 < 220 mg1L and TSS >30 < 150 mgll- ' Effluent p2 = BOD < 30 mull- and TSS < 30 nV& he heparlment of Cnnmrerce it an equal nppnrttmity service provider stud employer. If you need assistance to access services or need material in an alternate formal, please contact the department at 608-266-3151 or J_ry 608 - 264 - 8777. snh -0110 rR Kim; 1- a PO = - qg yo lR y lb- 5� o T P - o P� S� f a� ® _ 4 i9 cle ke-e / 75 k JJ 2b1 _iu lb:'AU ST CIROiX COUNTY SEPTIC TANK MAINTCNAAICE AGRLCMCNT AND OWNERSHIP CERTIFICATION FORK: Owner/Buyer Mailing Address Property Address — ---- (Verification required ftetn planning Department for new constrvctto, k . ) CtIylState W 7S � .3 Parcel Idcntification Number L tUAI DFSCRII'TJON Property Location �j I~ ` /•, SaE v., Sec. 's-' �„ N -R W Town of F Lot it Certified Survey MRP # — .__ , Vot,+ame (sa WArranty Deed d __ Volume Page P r Spec house 0 ycs no Lot lints identifiable C`I yes u no SYSIEM MA6NM ANCE Improper use and ma +ntenaricc or ) !jeplic system could result in ptemawre failure to handle wastes PFOP nto he t systerti consists of pumping out the septic rank rvery three years of scorer, if needed by a licensedpumpsr Y F' can affect the function of the septic tank as a trestmeat stage to the write disposal system. The property owner agrees to submit to St. Croix Zoning Deparment a ccrofieation fosse, signed by the Owner and t jr d n„ser, p iumher, )o +tmcyr,tan ptuntber. resuictcd (slumber or u licensed purrtper verifying That (I ) the on w'astewarerdtsposat systrr.^. tr in proper operaiing conciitiot nit(Lnr l2) arwr inspection And pumping (if nfCCSSaTY } ,the septic tank is Tess chart i!3 tali of slupgc. Iiwe, the undersigned have read the above requirements and agree to maintain the pnvate sewage disposal system with the standards sct foci s +altng tltat septet b vctern hat bec mains nmerus and eem c ct, and tctumcd to the County scon with r"3 cl[ys o7 the three year expiration date. ' DATE .,IGNA OF APPLICANT QWNFR CERTIFICATION i (we) cenify 1 all statcntentc yn alai. farm are tn,t: to the best of my tour) knowicdgc 1 (we) am (are) the owrier(s) of `The - proricrty described atiovc, by virtue of., ••u.raniY deed recorded in Register of Deeds Office SIGN �iulu APPLICANT •••'o• Any information that is m +s- tepresrntcd may result m the sanitary permit being revoked by ti,e Zoning De9anmcr.t `• Include with this appiicatton a summed •+arronty deed from the Register of Deeds office a copy of tiie certified survey map if reference is trade in the warranty deed T 'd 2'66G- 96E -STG •oul 'aunlon.agsweauQ e6*:DT 60 TO ReW /l 1 2220P 482 71`c -a STATE BAR OF WISCONSIN FORM 2 – 1982 KATHLEEN H. YALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT _ _ RECEIVED FOR RECORD 05/02/2003 02:40PH Kern on J. Bast qnd Do Spe t-r-Rart WARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS FEE: 374.70 conveys and warrants to COPY FEE: Yt.e rr CC FEE: PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in –_S_t . Croix County, State of Wisconsin: Edina Reatty Title 400 S. 2nd St., #115 of 8 Plat Boundary Ridg in the Hudson, WI 54016 Town of Hudson, St. Croix County, Cp 3q Zb Wisconsin. _al - 14Q9= OB -noO • PARCEI IDENTIFICATION NUMBER I I This i c nn t homestead property. (is) )QM6 Exception to warranties: Eas ements, restrictions and rights -of -way of record, if any. Dated this 28th dayof A.D.M 200 .3 (SEAL) — (SEAL) • Donalda J. Speer – Bast Kernon J Bast (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, 1I } ss. St - C.Irni x County. J authenticated this day of 19_ Personally came before me this 28t-h day of ---Ap :L l XSL 2 0 Q31he above named Kernnn__J__ Ravi- and T)nnalrla J. SOPPY —$,t TITLE: MEMBER STATE BAR OF WISCONSIN of not, Pamela A. Willma authorized by §706.06, Wis. Scats.) Notary Public to me known to be the perso who executed the foregoing State of Wisconsin""" and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY J . Kernon J. Bast QQ n • TGm2�e H. ft),)J Notary Public, S – } _ r Co's k_ County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (if not, state expiration date: necessary.) 0 - i9 �-- -}" • Names of persons signing in any capacity should by iyped or prinrad below iheu signatures.' 50--.4 1 MINIMUM BUILDING { I ; ELEVATION =1040.45 � N � •• , j I H.W.L. = j 1038.45 C4 �' l LOT 7 N 4.50 ACRES 33 185,918 SO. FT. I 2 , LOT 9 .�1 3.04 ACRES , aZ' 132,275 SO. FT. $ N a LOT 8 4.06 ACRES 176,783 SO. 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