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HomeMy WebLinkAbout020-1395-06-000 � k o � A � � § � $ ) § � i ; d{ � % } $ � \//§ < L � k \ B / { 0 , Z — LO § k CL m , j \ 2 « ` ■ w _ 7 f « D _& ) ' L , § = c = e / / 0 3 0 d z } k k§ k ) § § } -0 CL ` ° # § o a -0 CO co EL k& E 5 -� \ 2 2 2 f \ � k o B I § g 2 m u g q - ¥ v � « f \ \ e 2 8 8 8 \ E § - G \ g $_ S / CO co (D $ n CO c co ~ § \ 7 I 2 � � / 2 0 Q k $ 0 2 § LO P.- o N § U k k k ) o- 8 8 G Q ® & ~ v- / % ) \ k + a \ / k k S 5 S - § § } \ o z $ } } k / � 2 � � ■ � � t ƒ � L .. » k E ] k a § / J a 2 3 2 3 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division t 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 Carria a Homes Inc. Hudson Townshi CST BM Elev: Insp. BM Elev: BM Descdption: TAAIK INt=f1RMATIRIN f=1 ~VATI(1N r1ATA TYPE MANUFACTURER CAPACITY Septic ' / / ~~~~ W ~ 2 g~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD ~~S . ~t Septic ~ + ~ 1 ,,~ `' ` •„ ~ S Dosing Aeration Holding , ~~ PUMP/SIPHON INFORMATION Manufacturer Demand PM Model Num r TDH Lift rictio s System Head TDH Ft Forcema' ength I Dist. to Well SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 405138 0 State Plan ID No: Parcel Tax No: 020-1069-70-000 STATION BS HI FS ELEV. Benchmark .3.US /0 3. goo ` Alt. BM u~ . ~,. 1.us ~/y. Z Bldg. Sewer />. Sb Z. ~ S` St/ t Inlet // ~S ~(. St/ t Outlet is ,o ~t~ Sb Dt Inlet Dt Bottom Header/Man. ~~~ ~ ~S /. 20 Dist. PipeC~ C~-Y y /off • ~ ~ (, Bot ystem " ~ 3 ` Final G; ~~ / ~ 3 , S St over Oz GLlkt.w ~( 7 S U • 7 ~~. BEDrrRENCH DIMENSIONS Width 3 r Length/ J ~J No. Of Trenches ~ PIT DIMENSIONS /- No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL ~~ LAKE/STREAM EACHING HAMBER O Mcture('. ~, [S lid ~ Type/~~f System: ~f., /J L~'~~Ot~Er~'W/ ~ ~ 2-[-/ tl•.) ~ ~ UNIT Model Number: DISTRIBUTION SYSTEM _ ~., /1. ~ Header/Manifold h ~ t ~ Distribution `, h - / Pip s)~ ` / ~ Di ~~~ x ole Size x Hole Spacing Dia Len th 9 g a pawn Len th 9 ~ SOIL COVER Y Proccuro Cvc4ame Anly r~r Mnunrl Or At.Grade SVStems Only Depth Over ~ ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center a, Bed/Trench Edges Topsoil ~ Yes [] No ~ Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /. Location: 830 Prairie Meadows Dr Hudson, WI 54016 (NW~1~14 NW 1/4 25 T29N R19W) Scenic Hills Lot 6 1.) Alt BM Description = + o ~ e~ buy. ~~ -~nn..wa~- s ~`'~'d s ~A'~-~'~ ~ 2.) Bldg sewer length = (t{.~~ "fb Inspection #2: / / Parce~: 25.9. -+ urouQ-~ -1-n -amount of cover = ~ ~ Qie'THE7t/.1~ A~ T ~ u:t 8-.~ ~/-~ a ~S ~-~ ~pw,;,~>~,,,~,-~,t.e 11 cam" S~s{et~ 8le/t ; tia0¢~ Plan revision Required? ~ Yes [~No ~ ~ ~ / ^ /~, ~7~, S Use other side for additional infor ~ ~'"'~ ~~ ~~'(/Y1/y~'' 14~ W -' '1' Date Insepctor's Si ature Cert. No. SBD-6710 (R.3/97) i` -S ! n Vent to Ai Int ke i ~ d ~m~ • ~~ -~~~~ ~~ ~~~~ ~/~~" ~ fib ~-1'd~lYl s,~ag4titir~J~-Z ~~,~.~.~, p~av~..rrqu+~nJG~ a ~s ~~ ~ ~ ~ ~, p ~~~ ~~`~ ~ ~ ~nro~~ ~.' S ~ ~ .~ ~~ yv z.L N, ~ :/!1 s~ +~ +~ ~~ // ~ ~jis~ ~t7 d~~a ~-~ ~ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Covet ` ,~~O~SI~ Madison, WI 53707 - 7162 Sin Ad~dmss /l(~.,t.~~- De artment of Commerce G -~o-O Z 5 ~1'F7 ~ O ~`J Sanitary Permit Appli ~~ Permil Nnmber In accord with Comm 83.21, Wis. Adm. Cade, personal ~ orma~ D ^ Check if Revision ~D'" /~ ma be used for Privy La , s15. 1 m I. Application Information -Please Print All Information ~ State Plan I.D. Number Property Owner's Name Parcel Number~0-/ ~j .S-(J~p `' S ROIX COUNTY ~ O property Owners fddress ' . /~~ • `` Pro~p~elrty I.ocadonl ~ a/t'~ R / 1 u/i ~,4 /U l~f : S ~T ~ N 7.SD ~J ~(.J /~!J . City, Stau Zip Code Phone Number Lot N bee Block Number ~Sjv(, iVV'yt~l)er Subdivision Name .5 N Spa ~a s~- ~~3y -ay~~ ~L~ II. Type of Building (check all that apply) / ~ I3Q.. -f' ^City or 2 Family Dwelling -Number of Bedrooms ~ ~/ ^Vilhtge ^ pnblic/Commercial -Describe Use ~j owtiship ~x 0 ~~ Nearest Rord ~ ^ Stau Owned ~ ~ ~ C/~~ ~D ~ (Check only one box on line Bring scheme for internal use). Co plete line B if plica le) III. Type of Perini A 1 New 2 ^ Replacement Sysum 3 ^ Replacemem of 6 ^ Addition to For County use m Tank Onl Exis ' stem Permit Number Date Issued B. ^ Check if Sanitary Permit Previously Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) /D D/!7°IJSS~ / " 44~Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filur 50 ^ Consttucted Wetl 22 ^ pressurized Ip-Ground 41 ^ Holding Tank 48 ^ S'uigle Pass 51 ^ Drip Line ~J„S/~ /~b;a~f/~YI- 3~'~ U 45 ^ At-Gtade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. D' eat Area Information: ~~ 1+1ow ~) Dy~~ Area / Dispersal Area Soil Application Per~coladon Rau Sysum Elevation / Final Grade GjD I IIevation Rau(Gais./Days/Sq. (Min./Inch) ~ / Pro osed ed i R _ p / ~ 7 r equ ~ ` ga.s j 7D ~- -a~~~ D~ (P VI. Tank Info Capacity ~ Total Number Manufacturer Prefab Siu Suel Fiber Plastic Concreu Constnicted Glass Gallons Gallons of Tanks New Existing Tanks TanYs Septic or Aoldiug Tank I'1 O 00th - _ ~ - Dosing lumber VII. Responsibt7'lty Statement- I, the undersigned, assume r•espoastroflity for lion of the pow'rs shown on the attached plans. Pl 's N e (Print) Plum s Si lure RS Number Business Phone Number ~~ GrCG~I~ aaa 3~ pis- ~~~ - ~ yys Plumber's Address (Street, City. Sta ip Code) D K ~ ~ ~ VIII. toll /De artment Use Onl Sanitary Permit Fee (includes roundwaur Dau Issued Is ent Signature (No Stamps) Approved ^ Disapproved Surcharge F !„/ - ' ~ Y' ~ O ^ Owner Given Initial Adverse ~~ Lam J Deurmination ~,~ ~, 1X. Conditions of Agprov ~ oDt~pgroval / ~D2~ yt' SB~S f~~`Q~ O. ~ ~~S/~ 9 ~I .~ .~in~ )/ ~lt~/c~ cM ~ iJ~- ~``p' /~'1~;~.r~r'-feu../~~ bac~c.d ~ . ~ n ,,.-,~ , . ~_ ... ~ ~,,,.. ~. ,r-- ~, a, .. ~- nf, , ,~ M/mar Di~ ~P~'~'!~ E{~1t~_ I~.H~ 7-a rwvuc~ ~rva..i v ".., - - - - - Attach eom plena (to tLe odd) for the system oa paper not less than 81/Z x 11 Inches In size Fvu.,or,J SGf~Dd~- ~~. a'~~~Nc~-~i ~[-v~~/r ~~~r&~- ~ T~~ . SBD-6398 (R. OS/O1) c~`8f" ' /d8~ 57f ~g - ,~-~~ .~- a - 1L N~ ~ - l06 n r ~-w~-~ . ~ ~ ~ ..s-~~~ s~ ~/ ~ `r f I~t .-.~ Cot ~ t /~ ~~~~ ~V /~V /~ / r j ttY+soonsin Department of commerce - SOIL EVALUATION REPORT Page I of Division of Safety and Buildings ' m aocoraanoe wmi Comm ~, vvis. rwm. was 11 i n must 8112 th l i l t l ~'~' s f. c ro ~' an x an on paper no Attach comp ete s te p ei inducts, but not timibed to: vertical and horizontal refen3n !~~ Idly percent slope, scale or dimensions, north arrow, and I tom' nd road. M nib Parcel I.D. ~ Q ~,0 - Q -- 7Q'-~~ Please print alt Info n. ~ `~ ~ ''''~ i _ R by _ Date { Personal iMormaHon you provide may bs used for sewn ~ rposes (l~~Liiit~.15.04 tip( ) ' . , Property Owner r cJ~ i ~ ~ l r ~ '~ P~~ , . ~ ~~ , CitfiR. Lqt ~ j 1 /4 .tl W1 /4 S Z ST 2 9 N R f E (or t~ er's Mailing Address Property Ow n , ~ ~,~ COU N?'Y L ; , # Subd. Name or CSMI/ ` 7 / _ J _ lV 1' ~.~ S"~'1 I I (.VG-T~ r" '` HJGOFF (r :\` S o~ _.,, i . City State ZP code Phone `~j - ^ Ydlage ~ Town Nearest Road sti' I l w«.~i-~r rK rL . ~So ~Z ( ~'r) ~~ ~~ , . f ~ s k ~, n ~~ , I~ ® New Construction Use: ® Residential / Number of bedrooms , 3 " `!~ Code derived design flow rate ~Sd l (o O Q GPD ~ Replacement ^ Public or commercial - Describe: Parent material DU fca.la.8 (~. Flood Plain elevation iF appfxsble 9 3 3 . ~ R !General comments S S ~ rvt E, l ~ ~0. f .b n - fa P Z u `~ w -~ r' R' -~ O and recommendations: ~ ~ ~ 2., l .e. J a. ~-; d r~. - ~o P 9/• o d L ~ w -e v- y o • o ~ ~ ., I~ Pit Ground surface elev. ~it Depth to limiting factor in. Soil ' n Rate Horizon Depth Dominant Cobr Redox Description Texture Stnidure Consistence Boundary Roots GP D/fl? . in. Mansell Qu. Sz. Cont. Corr Gr. Sz Sh. 'Ef<#1 'Eff#2 2 -24 ~p ~ I -- Sal 2 ~s - : 5 . g 3 24-~0 10y~`i~ m vs ,.n~ - -" I.Z /. ,~ ~~ # . ^ Boring yv• 90 . ® Pit Ground surface elev. ~ ft. Depth to limiting factor ~ ~ in. Soil Rabe Horizon Depth Dominant Cobr Redox Description Texture Stnu~ure Consistence Boundary Roots GP D/fP in. Mansell Qu. Sz. Cont. Cobr Gr. Sz Sh. '~ 'Eff#1 'Eff#2 1 i5-12 Z '~' L Zm c5 (v~ •5 3 Zs-lp .. ,I ~ mS , m t - - ~ 1.2 d7~ lQ ~ S n w v~e ( bL Ces ~/s ~'.s' l d ~ t~ ~~ ~" ~.e~ ~ i n 'zdh GZ .S Z ' F~Fiuent #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 50 mo/l. ' FJCiuent #2 = BOD. < 30 mglL and TSS < 30 mglL CST Name (Please Print) Signature Number ~G vy~ ~~-1„ .~ wtoc-k e. r ~~~~ -~ ~ ~-___-_ 2s 33og A~ress Date Evaluation Conducted Telephone Number Z~i3 ~' S~- ~,~,Pr~-I• , ~~ 5y~~ G-l-o/ `-115-Z~Il-`-toc~8' Property Owner A..r k~ ~ I Parcel ID # Page z of _ 3 3 ^ ~~ y ~• Boring # ® Pit Ground surface elev. ft. Depth to limiting factor ~_ in. Soil ication Rate D th t Color D i Redox Description Texture Structure Consistence Boundary Roots GP DIft? Horzon ep in. nan om Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 ~ o-i l0 2 -- ~ sb -fir ~ _ 1 ~ ~ 5' `1 . Z i -ZZ ~0 41y ~ ~ LS _ ~ g 3 Z-121 r `i ~~ ~ r~s 5 ~ / ~ ~, 2 G _ 2 _ 2 ~~ _. _ fig` ^ Boris # ^ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ~~ Rate n H i th De Dominant Color Redox Descriptbn Texture Structure Consistence Boundary Roots GP DIff zo or p in. Mansell Qu. Sz. Cont Color Gr. Sz Sh. `Eff#1 `Eff#2 Boring # ^ Borng -- ^Pit Ground surface elev. ft Depth th limiting factor in. Soil licatbn Rate Horizon De th Dominant Cob Redox Description Texture Structure Consistence Boundary Roots GP D/fi? p in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Eft#2 ' Effluent #1 =. BODE > 30 < 220 mglL and TSS >30 _< 150 mglL ' Effluent #2 = BODS _< 30 mglL and. TSS _< 30 mglL 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 (807/00) . s PAGE ~ OF~_ NAME 14 Y` K-e-~ ~ LOT# (o LEGAL DESCRIPTION,uw '/,~w`/4 S zSTZY,N,R c4 E (or) ~b SCALE: I"= y0 BM I ELEVATION lOd • ~ BM 1 I~FSCRIPTION ~~ o ~- Z " (~ y ~. ~.'Pc BM 2 ELEVATION 9<0 . SS ~ BM 2 DESCRIPTION -lo ~o ~ Z ~ ~ ~ ~r~- p ~- SYSTEM ELEVATION~~ O q2, oo Gvwgr 9/•Uo ALTERNATE ELEVATION ¢vp 9/ U~ Lacier gao0 CONTOUR ELEVATION 9Z. a v - ioo. o N 1 ~ I -~ - S eG z s ~.,~,. ~-. q33 q~i a Mod A v - 3 ~o {- O ~ ~ ~a (J C. pws W i / / ~ oye.a Qro~a. L ~~~ Nb 1 ~` 1 ~~ ~ B.Z Aar ov w` 4~,1~~~ z // 0.~~~ ~~ ~~ DATE 6 - S = ~ ~ JAS ©~~ ,~~` / \7 0~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner '' Permit # DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) b al/da Design flow (peak), (Estimated x 1.51 (.JCS at/day Soil Application Rate ~ al/day/ft2 Standard Influent/Effluent Quality Monthly average " Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD51 <_220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBOD51 <_30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) <_10" cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity 0 al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model -- ~~ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: O NA Dispersal Cellls) 'In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA O In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA ^^n~uTCUn~ur•c crucnr~r c Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY3) of tank volume ^ NA Inspect dispersal Cellls) At least once every: ,^~.yea~~ ,Is) (Maximum 3 years) ^ NA Clean effluent filter At least once every: 1 ^ month(s) year(s) ^ NA ^ month(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ year(s) Flush laterals and pressure test At least once every: ' ^ month(s) ^ year(s) ^ NA Other: At least once eve ry~ ^ month(s) ^ year(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage 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 the ground surface. The dispersal ceI11s1 shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a 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 IY,) 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. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, 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 10 days of completion of any service event. Page of _ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) 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 tankls) 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 highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the 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 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; meat scraps; medications; oii; 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: • 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. ^ 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. ^ The 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 last resort to replace the failed POWTS. ^ 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 that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES 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. n rlfllTlAN Al CAMMFNTC POWTS INSTALLER /1 ~ POWTS MAINTAINER Name G- Phone S - -- ~~ S Name ~L- A Phone ~ - `' SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drahed in compliance with chapter Comm 83.22121(b111)ld1&(f) and 83.54111, 121 & 131, Wisconsin Administrative Code. MAY-28-2002 13 31 P.02/05 8Bf'YZCr ~~ ... ~$ /~ owr~esc~ t~~tc~~t t+~s ~ ~ f Er ~ht ~ 1C ~C ~ / N .~~!?p:Z ~ !~/~ s ~- pasttel Idemtilf~cstiaaf Nmibe: plopacty iocaa~on w emu. ~...~, Soa. ~ T~t ~w, Tawp of - • ~~~ s~aal ~~ + ~ ~s C,artlat3d Sartrry Map ~ - .Volume ~ ~ ~ • Paga # Warranty head # ..Y.~.a;="-~ _ ~ Volume 1!2'~ a rs8c # Spec hatsse ~ yes ~ no Y.ot lines ;deati8sbie ~ yes O n~o osa sad oset7vmr ~ ~ eadd essalt in &s pasaawe tipeeeto ImO~a ettslo~. ~ o ~ *~ eees~ etyve o~ tM ~ 1ad~ ~f ~ ~ ac .ooaac, if aoo~edb! a lireosed per. WiMK !oo put ast~ rSieat tbs t~mowoa ~ ~ ~° cede ss s trealmeat spa is tba ~ dispatki =7+~ fie, paoperty esss~ ewe 1o sebdi r 8t. t~ ?weak Dsprs~ i as0(bca6o~ faoa. aipod 1~ >b. e+rrwt ~i br • pie[.aeftciatatpl~ocarspgaa~ityba8ei~eoc(t) d~evals~l.•~aMis~aal eyeeoa is !et peq+arapaealiasa4a~aas e>,d~aa~ aa~ and 6f'00a'd7'}-~'' aa~taatc r ~.wpua V3 ltd Hste• >~ t~t~ bye ~ tbs ~... aoQ ep~eo ti S~ 1~opd~a. 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COPY FEE: TRANSEEk FEE: 9900.00 RECOkDING FEE: 14.00 PAGES: 3 Rxordial A~ca Name am{ Balara Addrsst L.ar.l T.-lle~ Inc. :90o S'rlvcr L..~~~ 12o~d /Vew $r7p(~n ~ MN SS/!~ C72o - 1069' - 70 - oo a Pared Ydmtifintion Nma6rr ~~ c~ZO--ln6Y-~o--v~p pzn - i v65 -~1D - o~v (~ Zo - 1070 - coo - Cep 020 - 1070 -'v -nvp ' U 2 c~ -) o '76 - t o - cx~ "THIS PAGE IS PART OF THIS LEGAL DOCOlfENT - DO NOT REMOVE" 'flw io[omutioa mua bo oou~I[eted yj' wbmiCgr; ~nov aGle. ar +hc ~rrmrGr j clairra, k!a! 6uert Lac !~ norm adCrrfe. atQ eCN ~/n4rdrrdJ. Onc~r/ryfamoAOn nreb donanaiG o+<• Urc of rho eo~rr pa,~e addr an~ ~ ~d on A+4lGu Pats 4~r~ ~r or woJ be plaesJ on adldawt P~Lc+ ~l dre p'aK ar ~~ dotes and 32.OP W dos rcee~~ Wireavin Srmaes, J-.Sl7. A'NDA I/Sif ' DOCUMENT NO. ver..~.~62~~ 'THIS IIVDENTLTItE, Made b ,RICHARD N. PEARSON and JEAN M. PEARSON h •• ........................................... -----------------------us and and ife, WARRANTY DRED eTATE OF W19CONSIN-FOAM 9 TNI~ ~FACL RLL[RVLO FOR R[CORbINO DATA grantor_5.. of....St. Croix .............................................. ......Countyy, Wisconsin,. hpteb conveys and warFants to....CARRiAGE HOMES XXI, INC. , d .~ Minn~sota corporation, ..............._...............-........--...-............. , ............. ..................................................._...----~..r.........._............_..._............. ~lashngtori.._.._ .......................................................Y...70~f~tf rantee........ of: ......._.........--• .........................................................Count r or the sum of;: Qng,.pollar:.•and_.no/100----(~1: 00).•and•_other good and-valuable.-.f~RETURN To Lc;ti~~d T~~f /ti GPRSzderatJOn ..... ..---... ;t5fir'tYtl3 /~jC`C Sr l ~t>1 1tt1(e !~. ......-...,, S f l c c the following tract of land in.....St.r,,,L',{,^,oJ;~ ............... .................................Coonty, ~ S-// L Wisconsin: .A~.1,..4~...~h~..N_PKkkl.~S.G..Q4Iar~er-„L[vy~s;~. and,-,{`lor~h_.Half {N~) of the Southwest Quarter {S~) of Section Twenty-Five (25), Township Twenty-Nine (24) North, Range Nineteen (19) west, St. Croix County, Wisconsin, e t Lot One o f~rt>`fied Survev Map filed June 29 1994, recorded in Volume 10, Page 27~ ,T"'~t, Croix County Register of Deeds, as 1]ocument No. 518944. ~~ See Attached Exhibit A Parcel Identification Number This is not homestead property In Witness Whereof the said grantors-_ haVe...... hereunto set.-.......their hands... and seals.... this ............ ....._......----- day of...... aY.......---~ ............................. A. D., Y~C-2Q01 BIONED AND SEALED IN PRESENCE OF ...+vrraa./ a~. yt.~~J:+lllY7VlY ~'lr~h( O/( n pay-,.~..........(SeAi) ' • .............................................................................................(SEAL) td Stta~te of btu .,-.•--_Washngton-,.- -County, Personally came before me, this.~S:.'.~`- day oL. ~.r..~ ............... A. D., i~..2Q,01 the above named ..HjCHF~RD -N.- EARSON and JEAN M. PEARSON husband and wife, to me known to be the pecsons..., who executed the foregoing instrument and acknowledged the same. .~~ t '-~ s 2_ ................ ..... TN18 tNBTRUMENT Y+A~ DRAFTED 4Y ~AJ~AY-MOUNTAIN Richard J. Gabriel, If 3264 NOTART 4 880 Sibley Mernoual HWy., #114 aawL Nota[yPublic,. °.~r NOTARY_PUBIIC-MINNESOTA County, Wis. My Comm. Expires Jen. 31, 2005 ~r„a,-,~ri~h=° a,~, ~c"-s 1736 • ___•~° Aty commission (t5t ' ..........................................:......................... (Section 3941 (t) of the Wisconsin Ratntea provides That all Fnrtrumenb to be recorded shall have plainly printed or typerrinrn th<reon the names a( the Branton, grantees, svitnases and notary, Section 39.31°1 similarly «9uirn that the name or the pegon srho, or govern mental agency afi<h, dq(ted mch imtmment, shall Ir printed, typevn!ten, stamped or svritl<n therex in a legible manner.l WARRANTY DEED STATE OF WISCONSIN Wisconsin LoRAI Hlank QOInDaby FORTI No. 9 Milwaukee, Wla, (Job aJg ll ) ~~~ 1G62P~~:291 EXHIBIT A Parcel Identification Numbers 020-1069-70-000 020-1069-80-000 U20-1069-90-000 020-(070-00-000 020-1070-10-000 020-1070-20-000 R ~ ~ .\ .\ •. \ ~ N ' . ~ `~ ~ ~ ~~~ s> • ~ > ~ ~~~ . • ' \ s'~ .• \ ~ • ~ • \ ~. '• \ ~ ~ ~~ o 3n~a Dior .99 ~ ~ r ~, ~ E,4£o40N ~ ~ ~~ 96'£5£ Nut _ ~ ..~ • -= ; ~ '~'~ • . ` \ j^\ . ~ ~ ~ ~ ~ 1 •. ~~~ '~c ~ ~ , ~ ~ ~ ~6~ ~~ „ I I 7 I 1 I I I ~ _. I I I ~• . o ~. i ~ '~~ , i I~ I I •~ . N ~ ' ~ vCA ~~ V ~ i I I ' \~~ ~ ~ ~ '~`~ . . 50'x. m I I ~~ ~~ I ~ I ~ I m. I I ~ i '_ i DCHt'SIIVU.7 N~ WEST LINE ~ 25, ASSUME, N ~ O co m0 ~~ r ~~ ~~ ~~ m 2 r a 0 n~ i ~ ~ ~ w ~ o„ m A f s = ~~~ '~~~ i G ~C 1 ~~~ ~~ N ~ w 2~ ~ ~ ~ ~p ~ ~ .~ - ~69'btE 3~ZE~L 1e00S N ~' ~~ ~ f ~ ~Q ~~ ~~ 3T'W r r 0