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HomeMy WebLinkAbout020-1395-13-000Q ~ I ~ o ~ ° ' ° N ~ c op ~' ~ ~ Y C y O H L I ~' L y + -~ 3 0~' ~ o I ?~ E a~~ I a i ~ C3 ~ y~ O T ~ s y N ° ~ ~ v ao a~ C r N I ~ ~ ~ ' ~ ~ C C f`6 ' ~ rn ° rn ° I d h a~ ~ ° ~ y I 0 I 0 y -- U ~ N N t C Z ~ W T~ o 7 W m rn m Y _. v m I 3 i o m~ ~ ~ ~ ~ ~ I Q Q C ~ U ~ ~ ~t I rn~ z~ a E I Z '.' c ~ € ~ z ~ N H Z m m a m 3 y ~ a ~ ~ ~ ~ ~' o I ~ o to U O Z$ ~~ `' C i o M y y a °° w m Z to H ~ ~' ` E ~, E o o z I O ~ ~ ~ y ~~pp y U ~ v (h ~ ~ ~ N ~7 ~ ~ 7 v tl) 0 N C C j f Q' O ~ r N y ~ E ~ 'y ~ `p 'O C ~ cY O~a~~a ~ O ~ C Z fA ~ I o I Z c co m ~ c C ~ ~ ~ N y ~ V ~ d ~ I 2 c N ~ ~ 3'c o ` ` ~ ~ E c o~, fn r rrarr rr y ° o X333 a. n /~ _ ~ l f l = a a Z _ ~ 1 / ~ a ~ jn •~ a % J V N O O O f ~ N N Z N ~ ~ N ` ~ N i ~ ~ a°~ ~ ° I I ~ d ml ~ m z n. a; ov ~n ¢ ~ I C _ O 7 ate. c ~ o '+"'+ o a w ° a c ayi E 0 ~ o ~ ~ °~ ~ p m ~ v a' oo V ° a c N ~ C-~i ~ ~ C ° 01 ~} ao ~ (~ y 7 N :: 'o L~ ~ ~ of N m N c .- ~ ~ ~ ~' ~ ~ o N S ~ U v o ° y N Z c Y U d (n O : i ~ ~ ~ « =€ I V v~ w ~ , €a I '~ '~ o, ~` a • IV ` ++ am:~ E ~ c d c r ~ ~ rr ~1 A tia~ ou~ici Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Di•rision r V ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal inforrnation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Carria a Homes Inc. Hudson Townshi SST BM Elev: Insp. BM Ele ~: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~I S -2S~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~ f ~ ~~, ~1 q r Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Fric' oss System Head TDH Ft Forcemain Length Dia. o ell SOIL ABSORPTION SYSTEM ~ cl ~ _~_ G,~~ ,4.,.e.,,, l1 ELEVATION DATA C°unty: St. Croix Sanitary Permit No: 420384 0 State Plan ID No: ~~_ Parcel Tax No: 020-1395-13-000 a2s ,z9. ~g, 2ya7 STATION BS HI FS ELEV. Benchmark Ce 2.~~ )°j.`~ 9~•~ r / Alt. BM Bldg. Sewer SUHt Inlet 30 ~l-~r- SUHt Outlet Dt Inlet Dt Bottom Header/Man. •~ 90.9S' Dist. Pipe t: 2~ iP ~ 90•'}/~ .S ' Bot. System . s5 a . t.s- 89 •~r0' ~ $'9.30 Final Grade St Cover as•9r 3.3~ I 4s'•es ST• ~ L~4 t lar.~ s.~s- ~S•~' RENC Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIO ~ f R) }s r / ~ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL '" LAKE/STREAM LEACHING CHAMBER O Many(act feJ:7 ( ~ S~~ s r (~(nt~r Type Of System: ~~ J, ,LLO • 1~0 ~ 7G~ UNIT Model Number: (Zf~ DISTRIBUTION SYSTEM eaderrlManif Id Distribution x Hole Size x Hole Spacing Vent to Air Intake ~'t" °"'S `,e~ Pipe(s) ength ~~~la Leng Dia Spacing S 1L COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil ~ Yes ] No ~ Yes ^ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ZZ-/ 02- Inspection #2: ~- Location: 811 Prairie Meadows Hudson, WI 54016 (NW 114N-W[ 1/4 25 T29,N0iR~1,9,)W) UScenic Hiils Lot 13 1.) Alt BM Description = ~ J /1,1s tS~ ~~~~_ -r'" `~ "'` 2.) Bldg sewer length = 5'} t 1 -f -p bU"~7•~'~' 0~ ~ ~3 - - amount of cover = ~ ~ ~~-~~~'b~~'-'" ~ p ~'~t.~j {~'Yy~ ~~~ 3) T.. aI ~„ ~ a,re ~.. lea- .~ ~ ~ ~~'~~I eV~' ,~~-~/h` Plan revision Regwred~ Ye ^ No ~ i Use other side for additional in ormation L~ ~ ~_ __ _____ _. _ --._ ! _ .- SBD-6710 (R.3/97) iE't VF/v J Date Insepctor's Signature LJ ~ ~x,Qa~a44~r ~ 3.a G d! `1~. . ~ ~ Cert. No. _• .~-_T.... 5aftry u-d Bu~ldin~s i)i~isinn -___'T~Counh ~C J~'~ s`~ -- ~~ ~ 1U: W. Wuhirt~tar. Ave., P.0 Soz 7162 _.. .~~r~~~~n i Madison, wl ~3~0~ - ~ ~~~ si~Adereaa po artment of Commerce - D~~/ d .~ 9 -~ ~ -u z S ~ ~ Permit Nc~ber Santta~~y Permit Application ~d o 3~ ~ In aeaotd w>Ib Ceaeaa 13.21. Wis. Adao • Code. Paiaowl dos Hsu psavlda Q Clack st Ravuion Y W l Plaai.D• ~tumbK _ / /~ T. Ap~1~011 ~ -~ ~qN lrlat A11 ~orowdoa ~:m..~--._».._.. __...~_., . tl . __ ___ N ~' ~•~.s ~~'o wTh ~1 or 2 Faa~ly DwdWy - Nuaaber of Bedrooms © 8ublsclCommetriRl - lfeaasibe t~» ._....._.. ^ Staa owned 2 Ti~u%~ 3 ' -~3~2 ~1 S'~ e,~~_ c ~- ~l .Ph pCla„ - Ll I..+~vW~ ~r ~~/S = t3 -04 I~. Ty'YN ed Pmt ( ~' orie hog om- i1a A (ie~~i +~ Ios ierr~orw~+ w., ...~...i--.- ..~ _ .. ,.~-..----, A. 2 ~ B*P ~~, ! ~ ileplacanorru of 6 ~ Addition ea ar CoudJ' ~ . N b Daa issued er y~p $. ^ Ciaasc It texmss rreviaualy larued I'V.'1'yp~ ol>hemitt (ChKI~ ari>~ IPp1P)it>waberin~ e~hut» ~ for iesttruat ~w) sp D Consauated Worland 3 /. 5,~; ~,l~ry / a•~aaud>,d IA-0saad 2t0 Mauad 47 ^ 5ead Filar D ~ p ~ si G ttiloidia{ Taaic N 0 aiajla Fels ~+ Lsae ~~`~. si a u ~ 1Q,-r as 0 ~ l7 Aa9bia 7rnattneai vast ~w ® V _ ~~ p~~ ~s aam Esavuioa Grads BieYatioa proposed ~ Bar(Gaia. ~ > 3~ t~.~Imab} q~ • ~ Y4: 3~ MeauEacturei Sts Sauk FJbrr Plastic VY. ~N1c o C~sa a~~ ~ Coax»a Caastruead Qlua ,~,~ l ~~.~,~-QU O ~~~ ,- ar _ ,~~ r ,~ ~~~s a .~- ~r'a Keene RwW I ,mss " p?a ? ~ ~~ ~ v ~~ ~ /5-- 3 ~C-3l~ ~ L~ia 7f2 S~j+ A.yss-a~ y Lal ~, -~-~ ~'a tlp'MS, '~ to ~ Code) J ~'d^ f~ ~~ ~ r D ~sovd D asYw z~ AitYitfa lu PerrNt (inauda flsatindwaar ~7~ `o??o~ s . ~= Ra Iuuad ~~ a Ss;atai o Stunpa) ' ~~i~- ~~ ~~~~~ ~ ~- `,,. . sy~s~ ~ ew sa~~ga cry. vs~o~} ~ ry $aepMgl vn`S .~ v ~ ~~°~ saaw ~ cam' ~'3. y 3-t ~aw:or~~e. ND~"~S i''i~ ~ 7r /~ S ~~ a~?~9d I ~- ~, ~ ~.,-~-~ ~ o y.~ l,/o ~ ~s .k'~~ ~ ~ e ~` l3 _ 5c e.v I L .~f.° lCS ?"~w,,~ a ,~ *~ ~~. ~ws~ r` f'-` o ~+'-Th Zab~~' i /~ .~ , r'~~° ~ u~ `~ti ?l ~~ ~ ~; Y ~~ v ~ ,`~ ' tltf~isconsin Department of Commerce - SOIL EVALUATION REPORT Division of safety and Buibings Page I of • ~ rn aowroance wrrm ~;orrnrt ~, vns. rwrn. was t i ' I 1 'i1~1 qty __ ~ ~ • ~ r0 l 1 Attach complete site plan on paper not less than 8 indude, but not limited to: vertical-and hoe~t an mus e ns nt (Bpl~, d` and Paroel I.D. D 2 O -'/O ~o • ~ - ~0 ~"~d 0 percent slope, scale or dimensions, north a distance to rt~arest road. ~o - Gm0 /6 ~0-' ~~ E~ Please print all rmatG~q~riE~,;.;~; ~.~ '~ by Date to a Personal information you provide may be used for dary Purposes (Prrvaq Law. s. ~ s.M ~ ~) (m)).. ~~,!/1/LvL / (i D Property Owner - T'w ~ c~ ~' 'a c , .;.'; ST ~FiO`Y P Location Govt: w 1/4 ~t/W114 S ZS T Z N R / E (or)dOV . •]C J MaitingAddress , Prc~pertyOwrier S ,,~ , ycx~tNGC~FFIC._ ,Lot•# Blodc# Subd. Name orCSA~ c , P State .. '' ~ ~ ~ ' ^ City ^ Ydlage (,~ Town Nearest Road cStl•. ~ ~ WGI, ~/ ~ ~ ~ •Y' ~ y/ `~ . ® New Construe Use: ® Residential / Number of bedrooms 3 _ `{ Code derived design flaw nee DSO l (o O O GPD ^ Replacement ^ Pt~ltc or commercial -Describe: Parent material OU fc~a.i; (~. Flood Plain elevation iF app~able 9~/Z • d R General comnlertts S ~ S ~ ri1 e. I c il0. f , b /~ °~ (p . ~ / ~' S~. S~ and recommendations: ~ ~~ ~ I ~~ a. •{-~`d t~ - . ~ + t Boring # I^~i ~9 Lpi Pit Ground surface elev. 9 3 O ft Depot to limiting factor 1 <7 b in. Sod ' n Rate Hor¢on Depth Dominant Cobr Redox Desgiption Textun; Strudure Consistence Boundary Roots GP D/fl? . in. Mansell Qu. Sz. Cont. Cobr Gr. Sz Sh. 'F~f#1 •Eff#2 I 0-10 ( ~ -~ S 2m Ic c ~~~ - S _ 9 Z ib-tod i ~ ~ m S s m I -- - . -~ I, 2 0 ~ ~ ~( ~ r• a ® Pit Ground surface elev. `rg• G d R Depth tc limiting factor I d ~ in. Sod Rate ~~# ° ~°~ Horizon Depth Dominant Cobr Redox Description Texture Strudur+e Consistence Boundary Roots GP D/II? in. Mansell Qu. Sz. Cont Color Gr. Sz Sh. _ 'Eft#1 'Etf#2 2 l4-ICS l N ~b "_ S m 1 - - . `1 I. Z w ' Effluent #1 = ~D_ a 30 < 220 ma/L and TSS >30 < 1 50 moll ' ERluent #2 = BOD. < 30 ntc1lL and TSS < 30 mglL - --- - _ - CST Name {Please Print) Signature ~ CST Number f~GVV~ ~ l,,.vw~.~k e.r Zs 3305 Address Date Evaluation Conducted Teleptwrte Number 211 3 ~T--t' ~ . ~omcr-se~- c.~1/ S~f02~~ ~-~-~/ ~7/S'-2y7-~Dbj'( Property Owner 14.r ~~ Parcel ID # Page Z of _~. Boring # ^ Boring ® Pit Ground suriaoeelev. qS'. ~~ ft. Depth to limiting ~_ in. Soil ication Rafie Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfI? in. Mansell Qu. Sz. Cont. Color Gr. Sz Sh: "Eff#1 •Eff#2 I o -$ 10 r 31 - S L 2rrSb k -Fr^ c . l v-~- . `~ - `~ 2 -2y - S' I 2 1~1i t~-FY' c 5 _ . ~ 3 y-uc~ Kyle rr Os m I ~- - • I - Z y ~/ , (.~ ~ / ~ ~ ~~ # ^ BOring ^ Pit Ground surface elev. ft. Depth to limiting factor in. ~~ ication Rate Horizon th De Dominant Color Redox Descxiption Texture Structure Consistence Boundary Roots GP D/i~ p in. Mansell Qu. Sz Cont Cobr Gr. Sz Sh. 'Eff#1 "Eff#2 ~~ # ^ Bonng ^ Pit Ground surface elev. ft. .Depth fo limiting factor in. Soil ication Rate Horizon Depth Dominant Redox Description Texture Strudw'e Consistence Boundary Roots GP D/if in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#'I "Efi#2 ' Efliuent #1 = BODE > 30 < 220 mgft. and TSS >30 _< i50 mg/l. ' Effluent #2 =GODS < 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 (R07Po0) PAGE ~ OF_~ NAME -~ Y` k.e. ~ I LOT# 13 LEGAL DESCRIPTION,uw '/4,uw'/4 S 26T2a N R 14 E (or) ~ _ SCALE: 1 "= y O , BM 1 ELEVATION /UO • CJ 1~ BM 1 DESCRIPTION a6 ~ a ~ I z 1 ~° ~L ID ~ •Q ~ - + BM2ELEVATION gB~Go I $ec• ZS BM 2 DESCRIPTION~~ o ~ (Z '~ ~L (~ ~'pi SYSTEM ELEVATION 9G- ~d ALTERNATE ELEVATION 4S' So CONTOUR ELE NATION g g. o o~ 9 y. o 0 os I.1. w. ~, ~ ` 7~'• UJ• 4 f ~ ~ ~ ~' `~ ~ Private ~Jnslte Wastewater Treatment Systelm Management Plan S~eptlG Tank And Gravity in-Ground Soil Absorption Component pursuant to Comm 83.54 Wis. Adm. Cade each Private C~nsite Waatewatsr Treatment System (POWYS) she}I include inlarmation and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the departrr~ent, agent, or gavemmental unit. The approved plans and permits for system are on file at the county zoning or health department, This management plan complies with Comm 83.54, Wis. Adm. Code, and the in-Ground Soil Absorption Camponen# Manual for Private Onslte Wastewater Treatment Systems SBD- 10587-R (R.B199). ._._ w Table 2: Soil Abso tion Gom anent • Limita Of R Se tic Tank Com onent Anap~e v ~vn Soil Abs tion Com Went Desi n Flow • Peak Maximum Influent Particle Size in 1 t8 Max}mum BOD /i_ 220 ; Maximum TSS m L 150 Table 3; Maintenance Schedule ins ct and/ar service once eve 3 ears inscect once a year and mean at least once The septic tonic shaii be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The contents of the septic tank shaii be disposed of in accordance with NR 913, Wis. Adm. Code (Servicing Septic or Hald}ng Tanks, Pumping Chambers, Grease Interc©ptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable RBStroams). The operating condition of the septic tonic and outlet filter shaii be assessed at }east once every 3 years by inspection, The outlet filter shaii be c}eaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter wh®n removed from its enclosure. if the Management (~ian fp- a Sept~C Tank aMd S4€i Aasorpt€on Compazter~t ._....,. • •fllror Is ®qutppecl with an alarm, the filter shall be servlcad if the alarm €e activated ~rantinuous€y. lntenmk~nt flltOr slums ~Y lndlglte surge ~~n ar an impendltty cantinuaus ei$rrxt. The septla tank shalt havo its contents romoved when the volume of Baum snd siudga In the tank exceeds 113 the liquid volume of the tank if the content! of the tank ars not rwrnaved et the time of an aseesament, maintenance genonnei >sftielf adviaa the owner of when the stext service needti to be perform tQ mttlntsin less tries maximum Baum snd sludge accumulatlcn in the tan#c, Manhole riswets, aacass risers and movers should bo inspected for water tightness and soundnass. A-aoess openlnQs used for services and ~asesement shawl! be sealed watertf~ht coon the Completion of s~ervia-. Any apenir~g deQmed unsound, defeCtlvet ar aub~ra to failims must be replaced. • exposed aca~ss opsninQs prosier than 8-inches to diameter shall be secured by an effective locking devise t4 prsven# aeeici~tn#al or unauthorized entry irrta the ink. No one should antler :septic or othfr tr+sebperrt or holdhta bnk /cr 81~,Y rN~OA WhhOYt lA frill QOrltp~l#Ai9e Wlbf BHA ,s~nd~-f'd+s trAr err~€rrln~ rrt confined apace. the ;~sDtnorasphNa t+vllfNn th! aepNa ar otAer trrltbfi~M.t of hclaNn~ ask tit ooop~tn feth~ ~#twk rind ntcwr a! s per~aon !iron, >~ ~r/or o~ th. aa#c miya. dllMrcl<tlt or lmpt~tble. Tank abandonnur-t >thsil be t~ acoordanoe with Comm 83.33, WIs. Adm. bode whin the tank is no longer used as a POWTB component. The soli absorption oompor~errt serving this structure It designed to accept domeat<c wastewater from a realdentiat laciMty. The #€mtts of operation of ihts aornporeer~t are shown Ise Tadie .~. T!'No longevity of aN soli absorption ~ntponent depends greedy on pm~r and timely ma~istto~tnc:a, and system use wlthtn or bstcw the limits o! roilable opsratlon~ Qoad water +coneervailon pnotlae: by ail oa~pants and the inatellatlan of water aonserving plumbing t~xtur~ ars key fa#ars ~+ exZandinq the ~,€seiul life of thin component. The soil absorption oompor3ent`s operation must !» assessed ay irl~tgeaUan at feast onus every three years, The Inspection shall tnaiude ncordinq the iearel® of pondlnq, if any, €n the olro+ltVrdt~rt pipK, attd it Vlt~usi irt>tpe0tf4R hir *ny evidence of surface seepage or d:schnrge from rho oompon~nt. Qn stNpfy stopin~ slteai, arena at eraslan should he ldentitle~d end reported to the owner for repair. Titre surfea discharge ofi dvmestiC wastewater ar sewagR from the ayrtern to prphlhltad and considered a human health hazard. Traffic around or over the soli absorption aomponant should pe avoided psrtlcuiarly during winter months, The compaction ar removal of snow cover over the component rney lead to hydnuuc failure by freezing. This type of failure is usually terhporary, but 3a dlftiault or 4mposgible to repair until washer condt~ons Improve. it'E general, soli compaction over this oorn~nent wiN roduce disunion of oxygen into the soli and dispersal cell, which may lead tc more intense, and eactlor, organic cloQging of the sole. .~. Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep~rooted trrK and sa'uub~ directly over of within ten feet of the component should be avnidad Linos root lnb+ueian into the campcment may cbetruct waftewa>r~er llvw. Cominpency Plan In the swat of system talfure, a new ~rttam could be installed in an alternate area, With the inatailation cA a diwrter valve, the existing system could also be Wooed MftUr a period of three kc tour yarn. it Is the property owners responsibility to maintain the alternate area free from any planting of trees, shrubs, s~. In oaN of failure of the oripiMi eyMem, the aitemata arw will ba needed. ii any trees, shrubs, etc. haw been planted on tF'+~ alternate area, they will have to be ra+~aved ,~t ~' c~wwne~ aacpanae. if alternate area is destroyed, them era other aitvrnatiw;ystems that can be used, in which, cnuid result if1 a~da-ed •xpenw to the property '~ Any ~ ~lst , ~ ~art~Cl yoa~ir iioaZ onlnp O~~ce or oantua~t the3r~ r~ilinp Riue~one n~patdkn0 1 ^~ Q .~..QN1N~ ~~, JCL ~~`~~3-~ ~ w ~ ~~7~ ~ ~~ ~s) 3~ ~-.~ i a t `*~-c~,wrr+ ol~+r~. ~` ~,M lea ~ s.+ J t l~KV1X l,Vl1l~ 1 ! SEPTIC TANK MAINTENANCE AGP,EEMENT AND OWNERSHIP CERTIFICATION FORM O~~ncdF3uyer eQ-Yx'`~~'y-P~ ~o~~S ,~".,ve -- Mailing Address ~ ~ 36 9~?`j rS ?r sd'u-7L/~ S ~ % ~ ~° r Property Address ~ ~ E ~ -P ' ~ u--~ (Verifiulion trquircd from Planning Department for new CitylState r~i..~..LS o.cl G1 c~ Parcel Identification Nttmbcr o z o -/0(o y - -7 0 -~Uy a~ yo - von ~,F~AL nESCitur~orl / ~~ ~ -ad - ~° ~o~e-.°-~ ~- Propexty LocatioQ ~ '~., ,~ ~~., Sec. ,2~ . T~2 N-R ~ t W, Town of ~,5'a .~ Stlbdivisian .~~ ~,v ~~ ~. ~.' l~S' .Lot # ~.3 Certified Sarvey Map # . Voltamc .Page ~# warranty Deem # co' ~ P'G' 4'`~ . Voltune I Z Page # ~ 90r Spec hQnse ~ yes ^ no L.ot Imes ideatifiablc ,~' yrs ^ no S~S~M MAII~I'1"Ei~FArICE Imfsnper ttse sad tzmmteaaaoc of your septic xysteai could t+aalt m its ptfailure to !handle wsstes. Proper x of peatpiag cell the septic flak every three years os sooner, if wed by s fioea.9ed pauper. RThat you put into the tystcm . can affect the function of the eeptie tank as a Znatarat sage in ive wss0e dial system. 'I~ p~opaty owner tgLr~es to sabmit to St Croix Zoauag Dcpartsnud : xrtifieatioa farm. signed by tha oaeacr. and by a mastctph~mber, jaumcytnaa ptzsmbet; t+esnidodplumber of a li,oetrsodpumpez vczifyiag that (1) the on-site avsstewxtcrdisposal aystcai is is proper operating condition and/or (2) aRer inspodioa and pumpia~g.(tf necessary), the tgmc lade is less than 113 full of sludge. Uw~c„ th,o mndessigned h:v~e toad the above t,oquircmeats tad agX+oc tp taaintaia the private sewage disposal systcat with the standards act forth, her+eia. asset by the Depattzneat of Commet+ee sad the Ikpatimeat of Natural Rcsoutret; State of ~liscoasin- Certification elating that your seQtuc ~ has boen tnaiataincd must be cAtnpldcd and returned to $ic SL Croix County Zoning Office ~~ 30 drys of the tht~oc yrar expitttioa date. SIGNATTIRB OF APPLICANT ~~aDj 4~- ____--- DATE OWNER CERTXFI<CAT~ON I (we) rectify statements on this form ate true to the best of a2y (out) hiowledge. I (we) am (sr'e) the ovract{s) of d1e , by virtue of a avazranty decd rocot~dcd in ~egisur of Dccds Ofi'ice. ~r2diy~ SI APPGIt,,,ANT DATE s««sss ~, iafotmation that is finis tadmay molt in the sanitary permit being revolted by the Zoning Department """ '• Include with this applicxtioa: a stn wtrraaty decd from the Register oC Deeds office t copy of flu certified survey map if reference is made in the vrarraaty deed `~ DOCUMENT NO, li _ wwxxmNTY nesa _ . ~ 166 BTATE OF WISCONSIN-FORM 9 • ~l)i. o~'^"L TNIt ^-AC[ RUEgV6o FOR gECOROINO DATA THIS INDENTURE, Made b .RICHARD N: PEARSON and JEAN M. PEARSON h '°°-~ ._..---'• usband and >_fe, .........................•---...... gtantot_§.. of... St. CIO1X Count ,Wisconsin, hgreb conveys and warFants to..._~'~?IAGE HOMES XXI, INC., a ,~ ... Minn~sota rnrporation, --""""'"""""'°°' °-• Wasfiingtoli' Mgnytpt~ ........ of ......._ .:........................_.._.........-.•---.............-........County, ~RYcl6ii or the sum of;: Qn~,,,pollar•. and-. nolld0...•(~1. 00).• and-,other good _and-valuable -!~ gETUgN TO L ~, n_:<'.~ T ~ ~ I ~on8~d@Fatlort ee 1 ......... ......................... .TSiLI.a /~t3 /6j L`C sr I V (~! Lit l~~ i~f.Y. ......... ............ 5 f 1 [ E the following tract of land in.....$t...•-(r.LOI,>E---- •---.-- ,L/F •~' ~F 1 `J ~(~o„~ /Y)/(•~ - ....................................County, ~ S'// t Wisconsin: .A~.~...4>...khe..p)p;t(~w~$,t<.--Q~ar~er-•.j[1y~1s;~..and-.(VOrth_,Half (N~) of the Southwest Quarter (SW~) of Section Twenty-Five (2S), Township Twenty-Nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin, except Ipt One of Certified Survey Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register of Deeds, as Document No. 518444. See Attached Exhibit A Parcel Identification Number This is not homestead property In Witness Whereof the said grantors-. have-..... hereunto set.........th2ir hands... and seals...- this ........... ..............._......-...- day of...... aY....------~....................-----..., A. D., Y#(__ZOD]- BIDN$D AND SHALED IN PRESENCE OP (/ (SEAL) M: -PSON . .............. . (~~ g~ptd Stta~te of br}s}h ' ..............................................................................................(SEAL) , WaSt)1hgtOR C P ounty. ersonally came before me, this. .T"~`.. day of.. ~.`..~._...... A. D ~ Q Ol >~`C ' -""' RICHARD N the above named ..............._. _- •.. . ..... , .._ . „ ..~?~ON and JEAN M. PEARSON, :husband and wife ..............--- - ........----......---.. ......-----.......---.... t to me known to be the pecsons.... who executed the foregoing instrument and acknowledged the same. .~`~~-g---1. Z-1 TNIH INHTRUMEN7 wA$ D AFTED pY Richard J. GabrLe~ #3286 a ...........................aM1 ~AR~MOUNTAIN 4 •--- 880 Sibley Memorial Hwy ' r NOTARY Notar Public,. ~•~' NOTARY PUBLIC-MINNESOTA #114 sEAL Y $e>R) ••• .... .................................. County, Wis. l ` " ~ My Comm. Expires Jen. 31, 2005 ~eiC c' ' " ~ '' "r-~"'" Sa.-~>" ° -1736 Aiy Commission (e5t ' ^ (Section 39JI (ij of the Wiscomin the names of the grmtors, grantees, mental tgrncy which dr d tt h Stslutn provides that all imt+uments to be recorded shall have plainly printed or typewritten thereon witnnses and nob ry. Section 39.31) similarly requires that the name of the person who, or govern i , a e suc WARRANTY DEED nsrrvment, shall IK printed, typewritten, stamped or written thereon in t legible mmner.) STATE OF WISCONSIN Wlaoonaln LegAl Blsnk Comaany r~Onai No. 9 Milwaukee, wla, (Job 39g 11 ) ~~~~ 1f~G2P~~289 ' 64$004 DocumamNu « YATHLEEN H. WRLSH Docomeot'ISde REGISTEk OF DEEDS W a r rati~• ) cc~ 5T. CROIX CO., WI RECEIVED fDR RECORD .. : ~ 06-18-2001 12:45 PM l ,. , WAkkAMiY DEED EXEMPT M ' CERi COPY FEE: CORY FEE: TRAMSFEk FEE: 9904.00 RECOkOING FEE: 14.00 PAGES: 3 ~. Aceo~disq Neu ~ ~ . Nana aad Retain Addrzu :qoo S'~lvcr L-~.k~ ~d New ari~^t~n ~ MN SSlIZ OZo- lpgq,'7p -ooo Y~ucd IdmbSntion Number QPIN) _ (~ZG--IC)6q-gp-dap. pZ o ~ I ~6`f -`?O - vac, C7 Zv - 1 D70 - too - ~jpG 020 - l070 `~v ~-nvip V 2 t~ -) d ~b - z o- ~v "THIS PAGE IS PART OF THIS LECAI, DOCpliLNT - DO NOT REMO{iE° 7'bic udocautioa oawt ba oomPletad yp a+baraer. ~oaawau aGle ~mne & ream adCnre ~ N ar the irmuf^l afaaret, kcal QucHpaon, ere. nay be P~~ on rldr ~- ~nq,dreA}. Od1cr jq/onnaafon +ucb docra~w~t 'moo ,.1 We oJrhk eavcr page atdr one pale re 7uur dvcweav mid S1 tp wirfL.~r. be pfxcd on ad~done! pass of lbe -~, iPuronrin Swaaea, JRSl7. 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