HomeMy WebLinkAbout020-1395-58-000Wisconsin Department of ComPherce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for sewndary 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 Description:
~~, s~ 8 ~" ~Vc~-P,~
TAQII! IdICA~11AAT1AA1 CI C\/ATIAwI r1ATA
TYPE MANUFACTURER CAPACITY
Septic `
DAD - ~s~
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO ~P/L
r~- Vy,[=J~~ BLDG. Vent to Air Intake ROAD
Septic / ,
Z6
Dosing 1
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer ,/~,,
-'
~S Demand
/
( GPM
Model Number ~ ~~~ /
S
TDH Lift Friction Loss System H a
~ TDH
Ft
"
~~6 r 7,
Forcemain Length f Dia. Dist o Weil +
.L tr
SOIL ABSORPTION SYSTEM Ii0 ~ 1 t /'~r1~.r,~J~t
county: St. Croix
Sanitary Permit No:
430469 0
State Plan ID No:
Parcel Tax No:
020-1395-58-000
Section/Town/Range/Map No:
25.29.19.2452
STATION BS HI FS ELEV.
Bench rk ~
2
v2•~
Alt. BM ~ • ~ l
a~_
Bldg r
SUHt Inlet
~~ 1
St/Ht Outlet ~ ~--
Dt Inlet /
Dt Botto
X35"
~/•
ill • ~
Header/aan. ~ „ ~ g•
Dist. Pipe I '
7 , p
~' d J
Bot. System I
8• ~a
9 -d ~
Final Grade 5~~++
v.3
q~• y 9
St Covej, ~
2 S" •~ rl'
2- D
DD•
BED/TRENCH Width Length . No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~ 'f" - 6
SETBACK
INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING
CHAMBER O Man stare • ~ ~ ~~
Typ f System: ` ~! ~
~ O
` ~ , UNI Model Number:
DISTRIBUTION SYSTEM
Head Manifold
Or ti
Length_,~_ Dia Distributi/o~n,~J ~ L
Pipe(s) YJI~ ~ ~~ ~ ~'f S t
Length Dia N Spacing ~ x Hole Size
~ x Hole Spacing
~ Vent to Air Intake
~ ~ ~,.~ l1
CStJ
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only O~'~ j~tGt`ii;v1 ~ot~'~dl'~ -~
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched ~ ~,
BedlTrench Center ~1 ~,' Bed/Trench Edges Topsoil
[] Yes ~] No ; .,'i Yes ~ ! No
G
C
COMMENTS: (Include c iscrepencies, persons present, etc.) Inspection #1:~/~/ 0 Inspection #2: / /_~9
Location: 759 Highlander Court Hudson, WI 54016 (SE 1/4 NW 1/4 25,~~T~~2~A,9/'N Ry19yW) Scenic Hills Lot 58 Parcel No: 25.29.19.245~~~""!'~/~
1.) Alt BM Description = S~• t~Yr~1Z-- GSTeuv`" /~a ~l~~f ~`L ~-
2.) Bldg sewer length = Z~Q I ~-~~ ~~~ f _'~ ~ (~ ,
- amount of cover =y~~ ~ ~.~~, I „ `~ ~ ~ ~ ~~ Y~~ ~~
~~__ ~ ~
_ --`-~-- --_------ ---- _ i
Plan revision Required? ! Yes ~ ~-~- '~ ~
No ~ y
Use other side for additional information. ~ __ ___ ~__ _~~~__ ~_' ~i~~d~ Y'
SBD-6710 (R.3/97) Date Insepctor's Si ature Cert. o.
Safety and Buildings Division County ~r ,/~
~-
C
Q~x
~ 201 W. Washington Ave., P.O. Box 7162 1
O~--
tseons~n Madison, WI 53707 - 7162 Sanitary Per
it Number (to be filled in by Co.)
p
De artment of Commerce (608) 266-3151 m
72 ~~[(J{/
Sanitary Permit Application S ~ Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal informati n you prgvide ~..~ I
may be used for secondary purposes Privacy Law, s15.041)(m) '~ '° Proj ct Address (if different than mailing address)
i
I. Application Information -Please Print All Information c ~ L
. . ~ ~ ,.5 nJ~ - R
Property Owner's Na me ~ ~ Parc 1 # of # Block #
6~
~
I
r~ flJt~ rvW•~ v /0
j ~ Zo>o7~
O iDby^ Od'~ `a 2vio~~
Property Owner's M ailing Address Property oca v ~~,
7a
2 ~/~ `~~~~ ~ ~ ~~/
~
~
Cit
St
t a,
/o,Section
~
y,
a
e
~~~~~$ ~ N Zip Code
~~~ ~2 Phone Number
`"~- _
c[rcle one
)
~
II. Type of Building (check all that apply) ~
~ ~ s T ~`~ N; R
E or]0~
~/
~1 or 2 Family Dwelling -Number of Bedrooms S . Subdivision Name
~S~hf-Pk~ber
^ Public/Commercial -Describe Use (G ll.Ls
^ State Owned -Describe Use 2~ ^City_^Village .Township of 5~ ~(/
III. Type of Permit: (Check only one box on line A. plete line B if applica le) ~r p~ ~ 020 _ ~ 3q,~- ~ Qt7~ ~ z
'~' ~ New S stem
y
^ Replacement System
^ 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. Ty e of POWTS System: (Check all that apply)
-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 FitteF
^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Dri Line
p ^ Gravel-less Pipe
^ Other (explain) q~" 1'f
V. Dis ersal/Treatment Area Information:
DesiCn~FI~ (eodl Design Soil Application Rate(gpdsf) Dispers rea3 eggirgd (sf)
J
~
p Dispersal ,~f,ea~ppf se ~sf)
os
`C
~J
S S stem ano~n/
i J
Z f
~/Gig
t l
~Z ~ ~ ~~/
/
~~: T~~
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site St 1 ilie Plasti
Gallons Gallons of Units Concrete Constru d Glass
New Existing
Talilcs Tanks
Septic or Holding Tank
Aerobic Trea[ment Uni[
Dosing Chamber `~~~ ~
VII. Responsibility Statem t- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's me (Print) Plumber's gnature MP/ Number Business Phone Number
`2 26 9' ~~3 ~~~~
Plumber' dre ss (S et, City, State, Zip
e
)
~
(,
~ j~
VIII. Count /De artment Use Onl
Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ss g Agent Signa a (No Stamps)
^ Owner Given Reason for Denial Surcharge Fee)
,2~ ~-
, ~(ZI /0 7j
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced /maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code/ordinances.
ALI,...t. ,._-_._.
SBD-6398 (R. 01/03)
II.0.LIJ \LV LLIC l..V WILD' Vllly') IVI- IIIC JyJlC1Il VIl t7Ut/er IIVL less Loan ar/L X 11 IIIChI'.$ 171 $1ZC
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wisoonsin Department of Commerce ~ - SOIL EVALUATION REPORT Page I of~
D~visbn of Safely and Buildings
m atxxuoar-ce wim c:ornm ~, vv~. warn. was ~~
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Pl
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Attach complete site plan on paper not less than 81/2 x an mois
es
n s
ze.
nc
inducts, but not I&nited to: vertical and horizontal
percent slope, scale ordimensbns, north arrow, , d'wedion and
drk!'d b nearest road.
' parcel I.D.
D7 (j - °j;r~ ~ - Uv' ~
-.,r-.....
, \
Please print all ~ "anon. ~.; "~ by Date
,.
Personal information you provide may be used ~ dary Lave s,.1 .04 (1) (m)). , G~ ~~y~ / d
Property Oumer - <~ . r, ~
~~
, ~ P Location
~~w/ '
' _ ~- . 1/4 114 S Z ST Z °( N R /q E (or~
ers Mailing Address °
' s r c; ga~_ ~
Property Ow
n L B # Subd. Name or CSMIf
..
//
__
~.v ~ Z o S-I-i ~ ~ W ~"~ Z ry C.~ S G
City Stale ZP Gode ~~ ~E
- ~ .City ^ Vdla9e ~ Town Nearest Road
;:
® New Construction Use: ® Residential / Number of bedrooms 3 _ `{ Code derived design flow rate ~Sd ~~ O O GPD
^ Replacement ^ PuWic or commerdal -. pescnbe: -
Parent material OU fca.lciS (.~ Fbod Plain elevation iF ePP L~3 5' • o tt
andnd recanndations: S ~ S ~ rrt e. ! G rJa f `~ n - 9~y~ .~ atic~•e~ -M ~ 3.~~ ' . ~ ~-e- ~ • sa~..~
-5~/5-~--~ ~ S C ~o Szr ~o ~'~t ~ ~i ~Qi~.cl~l'~-~vzc r ~ - .5-~- Q'~i~1~d ~ l~
^ Boring
Boring # f~I Ground surface elev. ~ 7 7y tt. Depth to limiting factor1 l~ in.
~p Pit Sod icstition Rate
Horizon Depict Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/fP
in. Munsell t111. Sz. Cortt Color Gr. Sz. Sh. `EB#'1 *Eff1~2
~ ~-I~ 1~~ 3~ Si ~ Zma.>Jk m~~ G )v ~ .5 ~ g
3 y -iio i~ yl ~ m~ Os i _ ~ .-~ 1.2
3. ~ ~ _ ~I . g ~ ~" ~ ~_ ~ . -l ~ 010. ~~
®Pit Ground surface elev. ~~ ~v ft. Depth to limiting factor ~~ ~ in. ~ fiats
Horizon Depth Dominant Cob Redox Desctiption Texture Structure Cons~nce Boundary Roots GP D/(~
in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. *Etf#1 *E1f#2
! o- I ,~ ~ ~``I •bl~ ~r ~S Ivy' .'~ , ~
Z 9- ~ . ~ ~yl~ ..i 2 ~ c s - .5 _ 8
.tea ~n-~t a~ ~ D . r7 s s -
,~° •`~
• Effluent #1 = t~D_ > 3l) < 220 mall and TSS >30 < 1 50 txtdL * ERluent #2 = BOD. < 30 mgll. and TSS < 30 mglL
CST Name (Please Print) ignature Z~ Nil
t~r.~G vv~ ~~ 1 ~ .y w~ac-k e. r ~ --- ~---
Acklress Date Evaluation Conducted Telephone Number
~ 113 ~b~' S-~ . ~ ~.~~.~.~ ~ I 5~1d~5 ly ` /- y/ l ~5 -Z.4 7- ~I bobs
. - s
Property Owner IQ.r ~~ ~
Parcel ID # .
Page z of _~
Boring # ^ Boring
® Pit Ground surface slay: q ~ ?~ ft. Depth to limiting factor I I in. Soil ication Rate
r
H D
th inant Color
D Redox Description Texture Structure Consistence Boundary Roots GP D/ft?
o
¢on ep
in. om
Mansell Qu. Sa. Cont Cobr Gr. Sz Sh: "Etf#1 'Eff#2
i b-U Ib~ 3~3 --~ 5~~ 2 ~S
_ 1V~ . ~' : g
Z ~l_ 1 ,, ~~ 5i I 2m~~bk ~~. cs _ , ~ ' g
3 -II Lb yelp `~=- m5 ~ 'm l , -l ! . 2
g
_ ~
~
~~ __ . _ _..
,~
. ~F ti
^ Boring # ^ Boring
^ Pit Ground surface elev. ft. Depth to limiting factor in. ~~ ~~ Rate
Horizon th
De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/it'
p
in. Mansell .
Qu. Sz. Cont Color Gr. Sz Sh. 'Eff#1 *Eff#2
Boring # ^ ~9
^ Pit Ground surface elev. _ft. .Depth to limiting factor in.
Soil licatbn Rate
Horizon Depth Dorrdnant Cob Redox Description Texture Sbudiue Consistence Boundary Roots GP D/fP
in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
` Effiuerrt #1 = BODS > 30 <_ 220 mg/L and TSS >30 <_ 150 mgll ' EfNuent #2 =GODS < 30 mglL and. TSS _< ~ 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 60&266-3151 or TTY 60&264-8777.
SBA-8330 (R07Po0)
PAGE ~ OF~_
NAME 14 Y` K ~-1 L LOT# cv ~ LEGAL DESCRIPTION S E ~/,uw '/4,S ~S T 29 N,R (Q E (or)~
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CONTOUR 7 ~ q ~~
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SCALE: 1 -
BM 1 ELEVATION /Oc~ • a
BM 1 DESCRIl'TION •fo p off' l ~~Pyt ~0.'~c
BM 2 ELEVATION 9 8 • ~S
BM 2 DESCRIPTION •fo (~ o ~ / ~~ ~ vim- P ~' ~_
SYSTEM ELEVATION ~~ ~ ~~
ALTERNATE ELEVATION ~ S • 5_a •
ELEVATION Cj So g ,So v ~~
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' - Combination Sep~>T:ic~.Tank and
PI.~MP CHAMBER CK055 S~CTIOtJ A~IQ SPECIFICATf0~1S '
. _. _.. .VE'JT CnP ~ WEATHER PROOF
' Ju1JCT101.! BOX .
ti`C.I. VEhlT PIPE ~ ,c,PPK0YE0 LOCKWG
~'jQ' FROM GOOK. MAiJHOLE COYEK rtiat~ `y
~ wARNlu4 E-~6EL.
'.iiNDOW OR FRESH ~ ColaD+J1T
u~sP~lorJ P 1PE ~IUT,~KE s ;
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IV"MIN. ~~~ -
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~.; ~ ~ PROVIDE I --"-
IAJLET ~;'~~ "''~~''AIRTIGHT SEAL. I ICI
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~~~~~ A I I ~ I APPROVED J01tJ'
APPROVED JOIIJT Zt'~$~L. ~-t~.~ I III WfC.Z. PIPE~P
W/C.I. PIPEoR Tank construction I II ALARM
shall comply with l II
1LH~. 1,3.15 and 33.20 ~ I I
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PUMP--~ ~-~
OFF
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RISER EXIT PERMIT(ED Q1.1Ly IF TANK MAUUFAGTURE.K HAS SUCH APPROVAL B~t701N~
SEPTIC F SPECIFiCATIOf.1S
DOSE ~ W ~~~ ~~~,~-~-~ IJUMBER OF DOSES: ~ PER DAB
TnuK MA-JUFACTLIRCR.:
TA1JK aIZC:. .~~/~-/~~~-GA4_C.DIJS DOS£ VDLUME !~Z
AL.~RF~1 !'lA3JUFACTURGR: S~~~~~.~TIz-O S~1S~T~~'1-S ~~CI-uDIAIG bAC`'K~FLOW~ / --- GALLOniS
MODEL I,JUM6ER: ~Q~ Nw CAPACITIES: A= ` ~~I~HES DR ~QZ CALLOUS
SWITCH T7PL: ~~~-~`~ 8 = Z' INCHES~OR ~~~7 GrLL0U5
(SUMP MA3JUFACTURER: ~'~~,~~,Z-~ ~~,,,~ G ~c~IUCHES OR .1~L/~-= ~rALL4U5
MODEL NUMBER: ~~`'~.y._-~--.. Q=~iI~iLHES OR ~-=-?GALLOIJS
SWITCH TYPE: w~~~LC--f~ uOTE: PUMP AND ALARt'i AKE TO dl
MIl,IIMU!'1 p15CHARGE RhTE_____1:1`~~.GPM INSTALLED QIJ SEPARATE CIRCUITS
',~ ~ ~
VERTICAL. QIFFERENCE pETWCEIJ PUl`1P OFF AuO.,DISTRIBUTI0IJ PIPE.. ~ ET
t P'111.JIMUM FUETWORK SUPPLY PRESSURrrE , ; , , .... ~ FCET
+ ~ yFEET OF FORCE f1A11J X .(J1,LF~',opfr,FRlcTlo-J FACrox._ ' ~ FEET ~ '
_.... .
TOTAL OyUAMIC MEAp FEET
_ ... _
As per manufacturer ~ _ dal/in. .
r
M E40 Series
4/10 MP Effluent
and Drain Water Pumps
Performance Curve
40
~j 30
WWwL
H 25
Q
20
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10
MY~°
MODEL ME40 EFFLUENT PUMP
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
35
5
0 ~
0
10 20 30 40 50 60 70 80 90 100
CAPACITY GALLONS PER MINUTE
F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805-1923
419/289-1144 FAX 419/289-6658 Telex 98-7443
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Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In-Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS} shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental 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 Component Manual for Private Onsite Wastewater Treatment Systems SBD-
Table 1: System Design Specifications
Sanitary Permit Number D
Number of Bedrooms
Desi n Flow -Peak (gpd)
Estimated Flow -Average (gpd) C(~
Septic Tank Capacity (gal)
Soil Absorption Component Size (ft2)
Type of Wastewater Domestic
Table 2: Soil Absorption Component -Limits of Reliable Operation
Septic Tank Component Soi( Absorption Component
Design Flow -Peak ( pd) ~~
Maximum Influent Particle Size (in) 1/8
Maximum BODS (mg/L) 220
Maximum TSS (mg/L) 150
Tab le 3: Maintenance Schedule
Septic Tank Inspect and/or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the se ti k and outlet filter shall be assessed at least
once every 3 years by inspection. The utlet filte shall be cleaned as necessary to ensure
ro er o ia,0. The filter cartridge shou no e removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Camponent
Plantings of deep-rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
~_5'' _ ~-~ ~~or>~ C~~.otir~tl~ ifs r ~~~^ `~6~~
6~~~~c~L C~~ ~~
3
ST CROTK COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer
/ yy~~
Mailing Address r ~ ~ 1~ ~~~~ `~~. ~!~ - ~.C(~`i1~ ~I Y,_ 1'_~ ~~ I~1- ~~~~'~~•
Property Address
(Verification required from Planning Department for new
rt
City/State ! ~'t t:'f ~ i ~' t- -~--~ i.t~_~' ~ . ~.,> ~~ Parcel Identification Number a ^. ~ L~.~~L"(~~r'~e! C~ ~~t?PG~~
LEGAL DESCRIPTION
Property Location 1~ `/4, ~/,, Sec. ~ T~N-R~W, Towa of ,~u~s'~ `~
Subdivision ~'~'V 1 [i .,~"l L~
Lot # ~~.
Certified Survey Map # ~- Volume _ ,Page #
Warranty Deed # ~„p ~ ~ ~ ~ ~' ,Volume Page #
~ ~~
Spec house (~' yes ^ no Lot lines identifiable j~ yes ^ 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.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/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 Office within 30
days of the +h~ee v~ear expiration date.
~~
/ _ /
IGN OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certi that all statements on this form are tnie to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the proae*+~ descri above, by virtue of a warranty deed recorded in Register of Deeds Office.
,../
/ /
NATURE OF APPLICANT DATE
***•** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ******
«• Include with th(s application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
~~~~ 16G2P~G289
L,.~a~ r r-kti~ ~c~~
' }., .
s4s6o4
YATHLEEM H. WALSH
F:EGISTER OF DEEDS
S'i. CROIX CO., WI
RECEIVED FOR RECORD
06-18-2401 12:f5 PM
WARkANTY DEED
EXEMPT N
CERT COPY FEE:
COPY FEE:
TRANSFEk FEE: 9900.00
RECOkDING FEE: 1.00
GAGES: 3
iN
'. Reco~dfag ~4ra
Name aad Retarn Addnaa
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"THIS PAGE IS PART OF THIS LEGAL DOCplIEN'p - DO NOT REtIOVE°
ThL iofo~wtioa aaut be ooagkred by eaDmiaec: deeranau elite mm~e & reaun addnte. and N
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f: DOCUMENT NO. ~, wAits.nxTY DLiLn i
~ _ ~_ -- ~I STATE OF WISCONSIN-FORM 9
I.
". ~ - v(~~. 1662~~GL ~~ TH18 SPACE RESERVED iOR RHCORDIND DATA ~
_._ -.__ __ li
i HIS INDENTURE, Made by,.RICHARD N . PEARSON and JEAN M .
PEARSON, husband and wLfe --------------------~----.-~•-.---,
rantor_S_. of.__.St. CrO1X Count Wisconsin
g • - - - --------- CARRIAGE HOMES XXI , INC . '...a_-....--_-•-'I
hereb conveys and warFants to .............................................. .. ,,
Minn~sota corporation, ••-••--------•-• .................il
................-----------•--....._.--••----•-------•--•--•---••--•----••--•---.......__.........__......---....._......._...--------•-•-•-• .i
Was ington t:
..----- _ . .. - 7~t8G61t1~~ ~ .......................
- - - Count or the Sum ~f I RETURN TO [- Li ~G~ ~ ~
One Dollar and n_o 100 1.00 and other ood__and valuable ,
consideration- -j---•------C~----------)---- •--- -- -•----- -9-----------------------------------------!~iU3`1`~ i~1 Z~ Us, l v ~~ Lca.l~e (Zc.~.
•--•-•--•- -----------------------------•---------------•-----------•--......_.-.._..----------•-•-----;i 5 f fir- i
.......--------•-------- -••---...---•-• - -County, ~V~kJ `~ `l~-o„J /Yl /l~
the following tract of land in-_-_St-,---CrOi-X-_-----•--•----_ ST//Z
Wisconsin: .Al.>=.-of--the--Northwest--Quarter-_-jNWA)---and--North--Half (N Z) of the Southwest
Quarter (SW4) of Section Twenty-Five (25), Township Twenty~Nine (29) .North, Range
Nineteen (19) West, St. Croix County, Wisconsin, except Lot 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 grantor. S.. haVe...... hereunto set._._...._~he1r........__. hand_S_.. and sea15._._ this
-------•---.....---•-----... day of--- ~aY ......................................> A. D., ~~..2.OQJ.
SIGNED AND SEALED IN PRESENCE OI'
State of _~.I}~~ to
Washingt`on- -.Co
....................................................... (SEAL)
~ .... ............. ..... ..---............_..-...(SEAL)
Fl - ~ PEAK
~iN~M y SON
.................•-----.............._..........-_...-........-•----.-....:-.....---•----..... (SEAL)
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