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HomeMy WebLinkAbout020-1353-13-000 1-s ---6.-<:,LE ( 1 Yi).-v43 CL Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Coun INSPECTION REPORT t. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitdfy. £rJ7litNo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: ❑ City ❑ Villa e ❑ own off:. State Plan ID No.: :ausby, Tod and Kristin I Hudson ownship . CST BM Elev.:- r Insp. BM Elev.: BM Description: 'ParceII TZax'��353 -13 -000 (( O (((D .D CST Ig #1 7. I..c..:..Q, cif " Ye , TANK INFORMATION ELEVATION DATA 36, 2 9• !4, Z0/3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmarl( j Septic (sei se,- (2(2,13 / - 7 Q /CJD. C7 ' Alt BM Dosing �A,� { �J (4, C (�e>~e mil ) el , i Aeration Bldg. Sewer N) . if /C- q Holding St/ Ht Inlet C) 1 l TANK SETBACK INFORMATION St/ Ht Outlet -- TANK TO P/ L WELL BLDG. Ven nta ROAD Dt Inlet Air I k e ) . Septic t �-) � s NA Dt Bottom g/ Y (Stb 77. 3o' Dosing " `` ft 2 5 -iv NA Header /Man. 1,t fL' 1` t/ ' og Aeration '�� NA Dist. Pipe . ' 1- q3 n' ' Holding j r /" Bot. System ' el I. k ■ k c .{ 4-.° 92 .0' PUMP / SIPHON INFORMATION b K a vug., Final Grade , 33 3.3 0 Manufacturer ( S Demand St cover (A) e p d4 /S A Model Number On 5 GPM T TDH Lift , 1, Lossion2,01 SyesatedmmA dfrTDH ,261 t Forcemain Length 19 . 0 Dia. 2 r' Dist. To Well 6 SOIL ABSORPTION SYSTEMeZ J i L s .each l, c- BLsB4RENC Width / Len th , No.P f � enches PIT No. Of Pits Inside Dia. Liquid Depth DIMEISIONS 3 _ DI MENSIONS Manufa tu r: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING l44 ( ^ ctt12R ' INFORMATION Type m r / JD (___--) i / MBE bodel r: System: : C . > ZS > t.......R-14444------4,14 l ,,. DISTRIBUTION SYSTEM C -A) f- =F9 C ` Header ManiNld f L u Distribution Pipe(s) I x • - • ent To Air Intake Lengt \A-e -i Dia. `( Leng Dia. Spacing - > IUD ' SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over I .. / Depth Over 1 xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center . • Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, rrson ,pros et ) Inspection #1: a III I 3 /ao Inspection #2: / / p_e Location: 646 Hillary Farm Road, Hudson, W 1 54U 16 (NW 1/4 NW 1/4 36 T29N R19W) - 36.29.19.2013 C i ttonwood Ridge st 13 - ` mil,-. (/h __ �' - war � � Alt BM Description '`-"°''�' °C t O � e St"' n r „ 4 • T f7 Zldg sewer length = 1 I .Q u - amount of cover = �f L . '- ....-- Vie- CO - I-is - quired? Ar Y es ❑ No e t V .or additional information. 200 1.3/97) Date ' ,. spector's Signature Cert. No. ,' , #6 y6 k4. SANITARY PERMIT APPIXAT1J N 201 and Buildings Avenue ■ . 201 W. Washington Avenue ` Wisconsin In accord with ILHR 83.05,W s.iAd iv.- t--ode'.., , ";'N\ P 0 Box 7302 Department of Commerce �(., , a „` Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syfter f, on pr o l ss C my than 8 x 11 inches in size. 1 w.; U' ; K � S anitar • See reverse side for instructions for completing this appI Lion k ;` a TM , , ? 3533 y Permit Number �. r, . 0 3 Personal information you provide may be used for secondary purposes \ . Gf; eck if revision to previous application ry, (Privacy Law, s. 15.04 (1) (m)]. r r •,7v ' _ e Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL • MATI „ '— Property OwnerName . ead Tod � �► � 1 C 2u c ert 4 - S. T a9 r N R f-Eef1U0V Pr O ner' Mailing Address Lot Number 6 Block Number t to Zip Code Phone Number Sub lvision Name or CSM Number te e. C r u Q /Y10�1 ( ?is )$ y9 -'69.4 r o - ! � r�nc � r' d % restRoad II. TYP OF B LDI (check one) ❑ State Owned ty ' L ' CISSrr / Y g - ✓ 0 1 JI ❑ (/ l (tOflW')1 Public 1 or 2 Family Dwelling No. of bedrooms Town of Nir III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number ) OZ I ' 13 -60D (.0.2 I-9. 2-al � . � �f•reri. _- 1 ❑ Apartment / Condo !�' ,�� °'' ■ '� � —� = 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office / Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. kew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an ystem System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 1 1 Seepage Bed 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Tren a )DMound ❑ In r / 42 ❑ Pit Privy 4P. 13 Seepage Pit n L�o� 43 ❑ Vault Privy 14 ❑ System -In -Fir g-/ ® ' a- 1 a , / X 31, 8 •- 74 3, c? , VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft) (Min. /inch) Elevation l Q 7 3,2 s /, SO Feet -- Feet VII. TANK i n Ca a acit llons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel .glass Plastic App 3 Initatwayteii New Existing strutt Tanks Tanks , Septic Tank or Holding Tank �0 � 1 v ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber • • 1 ❑ ❑ ❑ ❑ ❑ Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu J rs S • nature: N S mps) MP /MPRSW No.: Business Phone Number: ' e e arol P 060.357 '7)5- ,0(09%5 Plumber's Ad ess (StrCity, State, Zip ode): / �� 1 I l D K. K/ /-e4. - . 044/./ )1. 5 1 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ' ate ssue• Issuing Agent Signature (No Stamps) roved Surcharge Fee) a pP ❑ Owner Given Initial 4 9 � + Adverse Determination oo Z S f ” - 6 ::::: 4 � .t�. X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL( / / , SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS , 1 _ A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair: V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans-must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction Toss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ytc -J (, 0 4-13 Clifton wc3urA RM � -Q . _ _ : - -'` Secdle. I ".G 0s' ./ _ It y "pof u ; 1 .`,-, n 1 _ g. n4. (elaQ. (ao. a Am,1 i - ,- N / ,3... - P,1GJ. ,co.,) upper 36 S Q-k-V. Loc)Cr Q' /. zso i • 41-1-. lc %tr 9 3 so 57 . ,LLL H-/O 5.3-aku— / a -ia av 3/ 9_ 76L? /goo - goo ,uj )5 o o z/ I Pt, e 80 7 .uu (-4-r". 1-, l 1 1\)4-- I i z ` \Q? . 0 . • 4°' \ o aL t r)c. vim., ( r ■ \ -, 4 ) , • I� Q ; f APPLICANT INFORMATION - Please print all initonnation " ' C r 1 , .iv' ed b Date Personal information you provide may be used for secondary purposes (Pkv maw C.i op l.(m)�. / , G " J 1 Property Owner `*, Propertyy_LoO�e ` - R ‘ ck,lr J -iini <, ; Govt. Lo 1 /4Nw 1/4,S 3 T 2.-c( ,N,R ( c E (or)® Property Owner's Mailing Address rorr Block# Subd. Name or CSM# 1 4 iaj . 4 3 CO - 140r* od R■dc ❑ City State Zip Code Phone Number City ❑ Village [� Town Nearest Road.) ' y 4 lic�.SOY1 1 1 15�tc� 11.o I Fit )5 u 9- Col 3 i 1 l l MN\ 1 (WHOA CO a rf r:( + (- t. New Construction Use: 'Residential / Number of bedrooms 3 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow -RUb gpd Recommended design loading rate , 7 bed, gpd /ft , Fr trench, gpd /ft Absorption area required g51 bed, ft -1 l) trench, ft 2 Maximum design loading rate , - 7 bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) /• Er0 ft (as referred to site plan benchmark) Additional design /site considerations il..i f- . 9 3.5 d Parent material CGIU.( ■Ql & k+WC),SV) Flood plain elevation, if applicable / iei ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system Ms ❑ U Q S ❑ U Q S ❑ U ® S ❑ U ❑ S © U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I 1 Ly it yr 312 LS 1 0--15y m4 LS I C .T1 - % 2 ( -1-46 10yr Ll i b 0J m l (.3 .— _ 8" Ground , elev. , 9yo ft. Depth to - limiting , factor �‘:1.- 6 ,`� % in. ' Remarks: Boring # - I 0 - 9 k yr LS Ire rn1 C5 (-r -1 .8 2 2 y 10yr L-4L(o mS C.) ml LS — -1 ; . 8' Ground elev. • Depth to , limiting *tor 91 in. Remarks: CST Name (Please Print) Signature / Telephone No p Pdarrt 5 c_hUrrlaJ l / `J) 2 .'4 7` t d0 70 Address Date CST Number 4-1O$ ceder 5. 't y 36merne + WI 3 'HS 99 2.53309 • PROPERTY OWNER 5 SOIL DESCRIPTION REPORT 2 Page of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure D /ft2 g Texture Consistence Boundary G Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 I v -2 10yr 3 LS mS3 CYO 5 I 8 2.- IOyr L lI(v m 5 OS_3 m■ cs — Ground elev. 'A< 41/CD Depth to 12 q3.2/-71 r� limiting factor a \ 10 9lo in. q Remarks: Boring # 1 6-z- 10 yr 3(2_ L5 m ■nl CS I -0 1 . 2 Z -95 tryr ` W15 053 m1 LS Ground elev. Depth to 0 limiting ( factor ��in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # ( c _LI 10Yr 5 1z- 1_5 l IY)S5 r Z LI-91 r m 5 5� YYtiI c� ... _ ...................... Ground elev. q.cUft. Depth to limiting factor - in ' Remarks: Boring # ......................... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Pal c 3 43 .s-fout- a o-f-ron bu cl. • , . -e Sea c.. 1 " 6 cs ' y" p nu i l ;� 1 Ao P4 a ( Gle.v. ( ao, c� Arai 1 , it tK'`QaPpLc 1 _ - 6m Z- P/IGtr. /00.o vier- 3V ry �feyv - e-( -V. Ler v. f5 0 ` 4. 144.1-.A/W, 9 Co A /ur44"- l - -. 1 I I 7 c , COO_ N • • aM Dr • 'g- I 63 /4 " 'q<,, • Al • 1 3 t- • `”pnor.n cyKOSS SECTION AND SPECIFICATIONS 4 " CI VENT PIPE 12" MIN. ABOVE GRADE E > 25' FROM DOOR, WINDOW OR WEATHER PROOF FRESH AIR INTAKE JUNCTION BOX APPROVED FINISHED GRADE 4" CI RISER _ WITH CONDUIT MANHOLE c 6" MIN. W/ PADLOC ABOVE G ADE 1 1 WARNING 1 , iii 18" 6" MAX. - INLE 4 ` •- T i um * * 1. LI-T.-1 WATER TIGHT SEALS , , GAS- ' • 4" TIGHT' ; CZ PIPE BAFFLE A SEAL APPROVED 3 ' ONTO --L-- : D B � ALM JOINTS Y!/ SOLID - ' 'ION PIPE 3' 0 �0lL C • SOLID SO! PUMP OFF ELEII. FT. i '� �' -OFF ** RISER D '`, PERMITTED Mom I F TANK MANUFACTU! 3" APPROVED BEDDING UNDER TANK HAS APPRO' CONCRETE PAD SPECIFICA 1 FPTIC / DOSE _..._... -- -• • __ _ TANK MANUFACTURER: NUMBER DOSES PER DAY: 3 _ TANK SIZES: SEPTIC 00 GAL. DOSE VOLUME INCLUDING DOSE O GAL. F LOWBACK: G, GAL. ALARM MANUFAC'T'URER: . MODEL NUMBER: CAP ACITIES: A = 0?3 / INCHES '/ SWITCH TYPE: --y -c� / v ��` 8 = 2 INCHES = 39 a .. GA PUMP MANUFACTURER: / ° i MODEL NUMBER: F 0 � (� SWITCH TYPE: C = I,Q%INCHf:S = G /+G., �T D = INCHES : - 11 . 12ZG /F., KEOUIRED DISCHARGE RATE o?S' GPM PUMP E ALARM WIRING PER ILHR DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PI LHR �6. 23 + MINIMUM NETWORK SUPPLY PRESSUR PE . + OD FEET E • • . . . a FEET T FORC EMAIN X /,gyp FT/ 280 FT. FRICTION FACTOR . , "- FEET -I EE --' FEET TOTAL DYNAMIC HEAD - --L.LQ e ed INTERNAL DIMENSIONS OF PUMP TANK: LENGTH �� WIDTH _/ LIQUID DEPTH _____VJZ____. % IGNED : �- I ow 1 LICENSE NU 0? MgER;� o)63S? r,r,..., ..w Goulds 1 Submersible Effluent Pump : MODEL N 1 . E 3 871 . , — EP05 Pa4 APPLICATIONS • Fasteners: 300 series • Fully submerged in high • Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. • Motor Cover: Thermoplas • Homes components. tic cover with integral handle • Farms Motor: Available tor automatic and and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. • Water transfer 115 or 230 V, 60 Hz, 1550 models include Mechanical RPM, built in overload with Float Switch assembled and ■Power Cable: Severe duty • Dewatering preset at the factory. rated oil and water resistant. automatic reset. SPECIFICATIONS • EPO5 Single phase: 0.5 HP, • ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with • EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. Plastic Semi open design AGENCY LISTING 3 /4' maximum p • Power cord: 10 foot with pump out vanes for r � •Capacities: up to 55 GPM. standard length, 16/3 SJTO • Total heads: up to 24 feet. with three prong grounding mechanical seal protection. CanadianstaadaNsAssociatioa • Discharge size: 1 NPT. plug. Optional 20 foot • EPOS Impeller: Thermo- plastic enclosed design for (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with end in "F" or "AC ". rotary/ceramic- stationary, three prong grounding plug improved performance. "AC".) BUNA•N elastomers. (standard an EP05). • Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. to - • Capable of running dry without damage to 9 30 -► 5GPM components. Pump: EPOS 8 - "'�► �2s� c • �S handling capability: - , ,` — 14" maximum. 4 — - - — - 'r w • Capacities: up to 60 GPM. x s - 20 • Total heads: up to 31 feet. z • Discharge size: 11/2" NPT. < _ • Mechanical seal: carbon- z 5 15 13 e ®Q rotary/ceramic - stationary, 4 _ BUNA - N elastomers. EPOS • Temperature: 0 3 - 10 104 °F (40 °C) continuous EPO4 I 140 °F (60 °C) intermittent. 2 - 5 3C11114 1- 0 - 00 10 20 30 40 50 GPM 1 0 2 4 6 8 • 10 12 me1h ,,,. CAPACITY n 1995 Goulds Pumps Effective May. 1995 83871 • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 6 p ( of' lKr C_.4 u, .3 4 y Mailing Address S 5 G Y✓ rq U s o . ('„ i �ga� �; rn If e _ YYt Property Address //a/2 (Verification required from P1a ng Department for new construction) -c---- City/State 1/W1 5644, tL, r_ Parcel Identification Number O0- 1/03- 70-000 LEGAL DESCRIPTION Property Location 6 1/4, iv t 1/4, Sec. 3 ( , T Z1 N -R /1 W, Town of Hu J.5r4z • Subdivision C- v Ilan) - w r,eia � d ; , Lot # /3 . Certified Survey Map # , Volume , Page # Warranty Deed # Cv 05 99- , Volume / 4 /3 , Page # vo / . Spec house ❑ yes (Xi no Lot lines identifiable czi 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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. I/we, 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 statin g your that septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 P Y P days of the three year expiration date. /??/ OCR SIGNATURE OF APPLI DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. ' J AI' i :. � � i►� . , . Ii%J /21/00 SIG ATURE fi F APPLICA DATE ** * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this 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 • Y91. j438Paf,E 429 / 9 - STATE BAR OF WISCONSIN FORM 1 — 1982 Q5995 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. ST. CROIX CO., WI . RECEIVED FOR RECORD This Deed, made between 0711 -1999 8:00 AN RICHARD O. STOUT and JANET P. STOUT, husband WARRANTY DEED and wife, EXEMPT Y Grantor, CERT COPY FEE: and TOD A. CAUSBY and KRISTIN L. CAUSBY, COPY FEE: husband and wife, TRANS FEE: 137.70 • RECORDING FEE: 10.00 • PAGES: 1 , Grantee, Witnesseth, That the said G rantor, for a valuable owtsidetation conveys to Grantee the following described real estate in St • Croix THIS SPACE RESERVED FOR RECORDING DATA County State of Wisconsin: NAME AND RETURN ADDRESS Lot 13, Plat of Cottonwood Ridge, Town of Hudson, St.Croix County, Wisconsin. / 020- 1108 -70 -000 • PARCEL IDENTIFICATION NUMBER This is not homestead property. (is) (:5 not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Richard O. Stout and Janet P.Stout warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, rights — of — way and covenants of record, and will warrant and defend the same. Dated this 29th day of June ,19 99 Richard O. Stout (SEAL) J•net P. Stout (SEAL) (l.:,c . C� S-f�ui -- , 1 / I , (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, lI } ss. St.Croix County authenticated this day of , 19 _ Personally came before me this 29th day of June , 19 99 , the above named Richard O. Stout and Janet • P.Stout TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 0706.06, Wis. Scats.) to me • • the person S wh. e cuted the foregoing Q0 ?, ...,.' ; i(t r • . knowledge the sam . THIS INSTRUMENT WAS DRAFTED BY -z y .•� .1. • �� �j 43 Janet P. Stout C ,� • 1353 Arahhulccc Tr. a, :� _ . .i /�� Hudson, Wi. 54016 mod ^ ;. t [x.gltblic, .S .4 .2. -d County, Wis. (Signatures may be authenticated or acknowledged. Bot ..are riot '` .b4114,mmission is permanent. (11 not, state expiratiO date: necessary) i (( T /6'7A0-- , 19 .) S • Names of persons signing in any capacity shoald by typed or primed below their signatures. STATE BAR OF WISCONSIN Wisconsin Lewd Blank Co., Int. WARRANTY DEED Form No. 1 - 1951 Mirwaukee. w5. " ' - '''.4. 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