HomeMy WebLinkAbout020-1353-51-000 /*
Wisconsi Department of Commerce PRIVATE SEWAGE SYSTEM v
Safety a Buildings Division Count St. Croix
• ` INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 370317
Y P Y rY P P I Y
Permit Holder's Name: ❑City ❑Village ❑ T�vn of: State Plan ID No.: •
Hansen, Richard J. I Huds To
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
(00 ( Nab I �r 1,0 Oa egf 020- 1353 -51 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
/
- cep (A M,%., I loo Benchmark . ,1(p 103 4c6 1
Dosing XOo Alt. BM c.6 QS� d -
�gw- Log
Aeration Bldg. Sewer l /•s go? ,o
Holding $ Inlet t L. '4 qa . 8"a
TANK SETBACK INFORMATION Outlet
TANK TO P/ L WELL BLDG. vAir entto Intake ROAD Dt Inlet
Septic - t{t I I S' Z � / NA Dt Bottom «G b 57 d
Dosing AA Header /Man. `Ingo 9e/. !C.
Aeration NA Dist. Pipe 4413 ,-' 31
9.27 9s/• 3
Holding Bot. System I o gb 73
PUMP / SIPHON INFORMATION 5 {°""� Final Grad 7• g C..
Manufacturer C av(c-k Dema St cover V '1 y 9 6,
, Model Number CPO L/ j GPM
TDH Liftl.1 Lossion 136 F eadm, TDH 15 7
Forcemain Length 7 or Dia. 2 " Dist. To Well N/4.,
SOIL ABSORPTION SYSTEM
BED / TRENCH Width L engt h (ate' No. Of Trenches PIT No.Of Pi
DIMENSIONS - (50„.1%.)r).5' -- DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufac'7_ ' .4:.../..
SETBACK CHAMB /ll
INFORMATION Type Of r _/ Model Number. r
Systemt6vtvct, to � OR TINIT �/ /o- /fll5G, e'.6) 0 4 c1-
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe s), x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. / Length Sr7 •. Dia. 3 Spacing ( 7 y So
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over 1 xx Depth Of , xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil 3 Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: / / Inspection #2: / /
Location: 865 Alex Lane, Hudson, WI 54016 (NE 1/4 SW 1/4 3 69N R19W) - 3629192051 Cottonwood Ridge -Lot 51
1.) A1t BM Description ' / p e. abso-. . �Co lA• l,, ai- 0 woc,,, 1-+ g"�t-5 u^�2 le �u'(ec� e`"
•t
2.) Bldg sewer length = / (o c ' ' k Se.,re v-- S e co Pi Pa e f.,, "e (-rgr
- amount of cover =,) 7 0 I'i cIat,N . 1rers ^ S• 0 1" -t,,e..c lA___
9 3. 1-}t ro L. D T ff 9" t.- k6 w IL a C.G I veM,�,P.' 'let/ l /p to cI �a..a ✓' 1- f • • N 1 141.. - l- t.e_.,.. el
vtid1 Y\17 ` 1+ly1 4`1 12-e, tReP 15 9004E,, �rt tTtt �t�
Plan revision required? ❑ Yes iQ No !nil
SBD -6710 (R.3/97)
x. Use other side for additional information. /b 3 5 �!� , ' ' rs - ' ,
D a t e Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
) t
SANITARY PERMIT NUMBER:
x
1
� '$ 4. .. . . � ....1._ � � a
m te .., ca _ -»i
- � f gg W� / w ' E
BE
f i i
I Cv � Y�
., ,. -I ,.. . :,'—' ,. _ k
1 f1 1 i 3
f
[ I
L , w� . 1 ? �� i-- - �aw �.a - : € �. .w_
e
al
T :I tIItII t I
i --- I +- 1
, 1 1 1 , i • Mil
I mai
. _
r
, : . .,„,_ 14
I
I li 1 or mg
„_,„ i
1 . I amimi
, .
..‘ _,,,,.,,..„„_ _..
_ .„. ,....._+,_ 4 iii v.
I 111 III
MEM
2 E
E C
E
r
_� � . r i
d
Eli
I
MIN
"-
.r 1 • ,40* 1 irimi
•
) 1 1 1 airtiO 1 am
MEM
Ili Ma SIO
4 :Litimi _ ,,,,„ . _ ...._.i.. 1 _ I i
T I'I I ri J 1. ` . P
ain
f
11 .0 iirei 13}.: —334-3313-3 -131 —
r._ 1 --- - 1 -7 . !
i
i 1 . ----,
li,„1_ , i , .
, .
H 4 - .
. •
....... ,.__i_
J L
•
-fit' i, � A-LC- C OWE. Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application 1 PO Box 7302
\\Pisconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce (Submit completed form to county if not
Law s. 1
rivac La s 5.041
1P Y (_)( m )]
--1-------- state owned.)
Attach complete plans (to the county copy only) fo ek.systbm, on papefy�ot less than 8 -1/2 x 11 inches in size.
County State Sanitary Permit Number Check -if revision to previous application State Plan I. D. Number
I. Application Information - Please Print all Informatio R;_ 1 \s\ Location:
PP �.� ,
Property Owner Name --.. t , Property Location
R ?; 0 NZ 114 S Wt14, S 3(T ? ? R/ P(orr
Property Owner's Mailing Address 1 ST C,ROix y 4 Lot Number Block Number
. � C011UP .4'V r"` i �/
City, State Zip el de \,( 11)to a Number Subdivision Name or CSM Number
it u.�- r S yol6 ' -->
Type of Building: (check one s�•-b w7 0 -.f n ❑ City /�
11. T
YP g ( `� ` �^ i �°
t 1 or 2 Family Dwelling - No. of Bedrooms : l:1 Village
A Town of
❑ Public/Commercial (describe use):_
❑ State -Owned ll
Neire Road
( Par Tax a a O
III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 02 _ CY, 3 -51-6.1.70 / S o. 2- C1, 2251_
A) 1. 1oNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number I Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply) 2 JQR.Q A-- icy ) .
(KNon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
(a)'3 1c i3.4-S' 4 -rem. / , V. Dispersal/Treatment Area Information: N /Q - - fQ 0 Z—/
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals./day /sq. (Min. /inch) ) Elevation
G oo soa 5/ I, z (o.1 9
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
- L 800 800 GoAct ' ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS show on the attached plans.
Plumber's Name (print) Plumber's ignature o s . 1 if : MPRS No. Business Phone Number
Ex'? � urGAPPI aao 35 X 6)- G 9A,'" -
Plumber's Address (Street, City, State, Zi Code)
0 j 1 ' , I 1.12- 1- S d
IX. County/Department Use Only r
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu'ng Agent Signature (No stamps) � j
�-
XApproved 0 Owner Given Initial Adverse Surcharge Fee)
a-� /1---5"(11) I r�- / L 1"'e-
Determination l
X. Conditions of A.ppp /Reaso
_roval ns fo Disap ro n
-v 4'l. v �1�,,1 . 44, �oG� � fDa ccw - 1(._ ( «.o> Ks sY k.4.4„..., i1•�uQ•.K Q t`e c1 .
''/E- 46..�k �P��` Ad-- 1 - per. . Q-Cen4 1 .«.i S.
SBD -6398 (R. 07/00)
g d,v4a24"._
pet ,c I
co-ty..„wsese-e
iver
d- IS 614-eriAA-rAA
16266/goo •
H -10 5,ilimu"st‘
/4 -Ioo -z
/oo /Vo.� ,�;. /o 524
p ,
3•B
j IJh-
___ -
es")`'
VI
H % JD S tHo
a $M 6 S
- / ' q3
314 aao3.S7
• -•. .... -gaz.R t_KOSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" HTN. ABOVE GRADE 1 WEATHER PROOF
>25 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE c
FINISHED GRADE 4" CI RISER Ltrat01 6" MIN. r :IN% r,...........,,, ABOVE G ADE _ - _ Se -- „IT
INLET
•
.„..
r WATER TIGHT SEALS GAS I t
:
4" 8.
BAFFLE APPROVED
CI PIPE - �� E AL T TIGHT
3. ONTO LM JOINTS W/
SOLID 8 ' ' PIPE 3' 0
�— SOLID SOI
SOIL C 1
PUMP OFF um. FT.
-OFF +• RISER
0 'MA PERMITTED
"- IF TANK
MANUFACTU!
3" APPROVED BEDDING UNDER TANK HAS APPRO
CONCRETE PAD
SPECIFICATIONS
?ANX MANUFACTURER: /1.01m NUMBER DOSES PER DAY: 9 .
TANK SIZCS: SEPTIC OO GAL. DOSE VOLUME INCLUDING
DOSE 00 GAL. /'
F LOWBACK : ./e4s y CA L
ALARM MANUFACTURER: CAPACITIES: A : SNCHES = _ ..
MODEL NUMBER: / j�P
SWITCH TYPE: ;_ - 8 g 2
_
� INCHES = __
PUMP MANUFACTURER: ,
MODEL NUMBER :' 0 C = 147/NCHES = l
SWITCH TYPE: fr , J .,,— r • D _ L
INCHES = - ___ _c
REOUIRED DISCHARGE RATE ?5GPH PUMP E ALARM WIRING AS PER ILHR 16.23
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE .
• MINIMUM NETWORK SUPPLY PRESSURE . __1___ FEET
_in) _in) FEET FORCEZIAIN X - • • 1. S�FEET
•
l.7 /FT /100 FT. FRICTION FACTOR . FEET
TOTAL DYNAMIC HEAD = F ET /
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH /040t WI DTH DIAMETER
LIQUID DEPTH f/
IG NED : •
LICENSE NUMBER: ��d35
7 n
• •
41i •
• 14.
t
0_ .1 •
. S44 .
• •
c N 44. •
1 ' •-1•11
• •
%"
• t, 1
• .
• •
; • \ •
• 4>
• tb
4 1
•
t •
• .• • • $
•
Sep -29 -00 02:03P P.Ol
•
Goulds • ,
.,� i Submer
A Effluent Pump
MODEL n
" 3871 04
EP
APPLICATIONS • Fasteners: 300 series • Fully submerged in high • Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine Oil tor 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
Motor: Available for automatic and
and float switch attachment
• Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points.
• Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and • Power Cable: Severe duty
• Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant.
automatic reset. ■ Bearings: Upper and lower
SPECIFICATIONS • EPOS Single phase: 0.5 HP. heavy duty bat! bearing F EATURES
115 V, 60 Hz, 1550 RPM, construction.
Pump: EPO4 built in overload with • EPO4 Impeller: Thermo-
• Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING
/." maximum. • Power cord: 10 foot with pump out vanes for
• Capacities: up to 55 GPM standard length, 16/3 SJTO mechanical seal rotection.
• Total heads: up to 24 feet. with three prong grounding p Canadian Standards Association
• Discharge size: 1 Vz" NPT. plug. Optional 20 foot ■EPOS Impeller: Thermo (CSA listed del numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for e mo
end in listed
or oriel )
rotary/ceramic - stationary, three prong grounding plug improved performance.
BONA -N elastomers. (standard an EPOS). • 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. 10
• Capable of running +
dry without damage to 9 - 30 —41 1.4,--5GPM
components.
Pump: EPOS 8 - i 25 FT
• Solids handling capability: Q 25
3 /a" maximum. 4 "
w
• Capacities: up to 60 GPM. =
' 6 - zo
• Total heads: up to 31 feet.
• Discharge size: 1 Y2 NPT. i 5
• Mechanical seal: carbon- o t5
rotary/ceramic - stationary,
BUNA -N elastomers. c 4 EPOS
• Temperature: 1— 3 - 10
104 °F (40 °C) continuous - EPO4
140 °F (60 °C) intermittent. 2
5
1 -
0 L 00 10 20 30 40 50 GPM
f _
0 2 4 6 a 1 12 rn'lh
CAPACITY
1995 Goutds Pumps Effecuv May. 1995
•
� 4
' j1
07,
ke u I • • . .
° T ' / ;' . . .
''00. -414, . 1 * . ' I A ° . %
, -iv �� 6. ` � 1 I • 49 � � . 1 1
I ` • y t. .
.• , ,, ,
t 1 / /� �
1 1 / / •�
■
■�
•
����i , 1 Z
iii �a
• 1 I '/ P
1 1
_ r
51
1 R 1 ••
K '1 1 1
1 � 1 Ir
1 2.114 ACRES ■ 0
°°
l ' 1� X2.083 SQ. FT.
IW
1 i.
1:1
Iit�
1 t 1 1 1t, 2.14
11 iig 93•
tt
1 t 1 IF.;
1 I
i 1 1 i
1 t IL \ I 1 • 1
11
11
S
it I
_ _ _ .J I__ _ 192.65' 1 1
;436'19'11"E _
39 ,!`
384 �
z.
•
Wisconsin Department of Commerce SOIL AND SITE EVALUATION
3
Division of Safety and Buildings Page t of
' Bureau of Integrated Services in accordance wj#h 1LR Wis. Adm. Code
•
Attach complete site plan on paper not Tess than 8 1/2 x 11 inch f iri size. PI An n>t s County
include, but not limited to: vertical and horizontal reference poi t BMj, direr p7 .,:.r. � SA cy-61.
percent slope, scale or dimensions, north arrow, and location ild distance to nearest p id. parcel I.D. # _
APPLICANT INFORMATION - Please print all iriformation ; . \ ` ' F f eviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Las. i>;i pg�(j>r)� m)) 1 ,a, O /6 �6�,, 7/ /9
d
Property Owner .
t , l/
■ S �} ., � G g y ut: 11d 1 1 /4Sj 1 /4,S 3 ( T Z l ,N,R 1 ct E (or6)
Property Owner's Mailing Address of t r -lock# Subd. Name or CSM#
1353 Awa. e - Tr - - 51 e_.04400wc. r_a Q &
� e)
City State Zip Code Phone Nu mber p one umer Nearest Road
\\C‘•-$1/46•C I Nearest ❑Village ' Town
vJ �5� ( 5 644-0 - 51 Oct ket.500 I e 6Ao.sod -fr.
®.,New Construction Use: ®.Residential / Number of bedrooms 3 (4 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow LQ °b gpd Recommended design loading rate ( bed, gpd /ft • trench, gpd /ft
Absorption area required 5 bed, ft 1C.) trench, ft 2 Maximum design loading rate • 7 bed, gpd /ft • i- trench, gpd /ft
Recommended infiltration surface elevation(s) 93, 0c ft (as referred to site plan benchmark)
Additional design /site considerations 41.--* y V-/- fi
Parent material 1 .1.\ OL \C�.1 Dt- t- ktoos. Flood plain elevation, if applicable 4/1")" ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ U eS ❑ U Erg" ❑ U 0"S ❑ U ❑ s Er, ❑ S Et-C1
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft
g Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
{ 1 b 16•11 , i0 3 I kfridbi< m- -c r CS I , 7-- ; • 5
ttoSip 0 yry1y LS 11 rnl c5 - . . •
Ground 3 3tQAt ILl 41(0 runs OS'. 11111 C J :1 .
elev.
v.g ° ft.
Depth to - '
limiting
factor
e ke in.
Remarks:
Boring #
l U -iy 16, 515 "_'-'-_, 5 I 1 r,rtnl lYccr C S 1 C . 3
Z. 1 4-32 I. ®y r 'IN _ L. i trn ml c 5 . - 1 . 8
-9c+ Ow-- - 'y i D — M 5 o s rn i c j — , - 1 . 2
Ground -
elev.
9rg0 ft. .
Depth to ,
limiting
factor
99 in. Remarks:
CST Name (Please Print) Signature Telephone No.
/dam 5c11c(moier (7/5) -`f7 00e
Address Date CST Number
` G'eder st- •A' l Sonier5 e f . if )i ,sYnas V - '`j 2 n ,i 3c'9
PROPERTY OWNER S U SOIL DESCRIPTION REPORT Z
Page of ,
PARCEL I.D.#
Boring # H Depth Dominant Color Mottles ry G D /ft
g Structure
Texture Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
\ o -9 (01r3I3 5iI I(r 1bk - mfr . 4-5 a z ; .
Z 4 3Z- o r y (9 _ L5 l y yisc j rn I c •� — °1 .
Ground 3 52.-cg L()yrt(/( t"1 GSA fYl1 C 5 —
elev.
y2 $ ft.
Depth to
limiting gg,o
n. f c otb
Remarks:
Boring #
b16 10.1r 3 13 t l t mctik m cr S I . 2. • 3
2 16-31 tDyr• 419 _ S lmSc; rnl 4 --5 —
31-94, tUyr 4 41(0 1 c >5� inrtl c
Ground
elev.
94.40 ft.
Depth to
limiting 1.10 ` / 1(1 •
fa� for
% in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r Bed , Trench
Boring # ! 0 0Nr .313 Sf (rna YYIf r (5 1 t' •2 3
5 2 1 0-36 (6 LS 1 ms ) I 4 -S t .$
3 tO Lilco MS 05,5 Cal C5 — .l
Ground
elev.
9g 3cft.
Depth to
limiting "(0 (t47.
factor
/IS/ in. Remarks:
Boring #
..........................
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R. 07/96)
Lev+ LUf / ctr lanwiacid
.5c4( -e t ,._ S5-O
TA /1, l U-e- V. r aO . 0
3 6
4f-4.c/to Y'
• Z e
3 Pr ;nw N ° es
• •Br"
• rµ f •
cst
•
Cirsz
ST C1tO1X COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSI1IP CERTIFICATION FORM
Owner /Buyer lQtLf179 J i 6171/s&)
Mailing Address 6.n`i Z. L t tYLG. 40 t-k (kcj 6c/Yv, r r 6e-,e9/ Co
Property Address g6� A4 K.
(Verification requited (loin Planning Department for new construction)
P -1—"Y\/
City /State Parcel identification Number era O - Hog - "Q ' O 4:::)Q
LEGAL DESCRIPTION
Property Location I\j r ''V, .50,? ' /,, Sec. � 3 / , '1' Z'l N -R W, Town of i( imif •
•
Subdivision ,ot , Lot # S / .
Certified Survey Map # , Volume , Page #
arrauly Deed it , Volume , Page If
pea louse yes i io Lot lines identifiable liiKes ❑ no
,SYSTEM MAINTENANCE
Improper use and maintenance of your scplic system could result in its prematurc failure to handle wastes. Proper maintenance
consists of pumping out the septic (auk 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 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 three year expiration date.
/QJ. aj b1zmr/---- Za/ to .
SIGNATURE OF APPLICANT DATE
•
OWNER CERTIFICATION
I (we) certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty decd rccoided in Register of Deeds Office.
A 64 / 0k / /��
SIGNATURE OF APPLICANT 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
v(� 1438PAGE195 /0
STATE BAR OF WISCONSIN FORM 1 — 1982 60591 1
WARRANTY DEED KATHLEEN H. WALSH
REGISTER DOCUMENT NO. ST. CROIX OF WI
RECEIVED FOR RECORD
This Deed, made between TOUT 06-30 -1999 9:30 AM
and TANET n $T_!tilm_ urh��a and •..; f�
WARRANTY DEED
EXEMPT D
, Grantor, CERT COPY FEE:
and RICHARD J. HANSEN and NTCfLR F. HANSEN, COPY FEE:
husband and wife, survivorship marital property TRANSFER FEE: 149.70 RECORDING FEE: 10.00
PAGES: 1
, Grantee,
Witnesseth, That the said Grantor, fa a valuable consideration
conveys to Grantee the following described real estate in Si _ C'rn i x THIS SPACE RESERVED FOR RECORDING DATA
•
County, State of Wisconsin: NAME AND RETURN Nati ADDRESS l
Lot 51, Plat of Cottonwood Ridge, Town of ATTN: Mortgage Dept.
F ona Bank of River Falls
Hudson, St. Croix County, Wisconsin. PO 80x166
River Falls, Wi 54022 s
020 - 1108 -70 -000
PARCEL IDENTIFICATION NUMBER
•
•
This i s not homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Rirhard n _ Stour and Janet - P_ St'out
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 2Rth day of Juno .19.49_.
Richard 0 Stout (SEAL) Janet P. Stou (SEAL)
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin, lJ
} ss
St. Croix County. JJJ
authenticated this day of , 19_ Personally came before me this 7 Rth day of
T u n g , 19 9 9, the above named
Ric-hard n_ Stout and .Tanit
• P. Stcntt
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by 9706.06, Wis. Stars.) to me known to be the person _5__ who executed the foregoing
instrument and acknAtOTAR6M1.1BLIC
THIS INSTRUMENT WAS DRAFTED BY
TE OF WI •► ► ■
Janet P. Stout � • I r ►, ; e. ,
1353 AwesLukee TL. • • " 4 . a 10.. 8R"
Hudson, Wi. 54016 _ Notary Pub c, �6 P-5 County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My co fission Is perm ent. r( not, stare expiration date:
necessary.) .3 ,}� .)
• Names of persons signing to any capacliy should by typed or printed below their signatures.
,Iv
STATE BAR OF WISCONSIN Wisconsin Legar Dank Co., Inc.
WARRANTY DEED Form No. t — 1982 Milwaukee, Wis.
• STATE BAR OF WISCONSIN FORM 1 — 19 2 !!
. 8
WARRANTY DEED
DOCUMENT NO.
•
This Deed, made between R TCH RE n • STOUT
and JANET P. STOt1T, htsband and wife, - !,
, Grantor,
and RICHARD J. HANFN and NTCOT F F HANSFN,
husband and wife,
, Grantee,
Witnesseth, That the said Grantor, for a valuable consideration
conveys to Grantee the following described real estate in __at . Croix THIS SPACE RESERVED FOR RECORDING DATA
County, State of Wisconsin: NAME AND RETURN ADDRESS
Lot 51, Plat of Cottonwood Ridge, Town of
Hudson, St. Croix County, Wisconsin.
•
020 - 1108 -70 -000
PARCEL IDENTIFICATION NUMBER
iI
iI
•
This i s not homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
1 ' And Rir•hard 0- Stout ant 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,
!t and will warrant and defend the same.
I
I! Dated this 2Rth day of JunP ,19 99 .
Richard 0 Stout (SEAL) Janet P. Stott- (SEAL)
* If (.t cik+ Stout *
(SEAL) (SEAL)
*
i!
1i
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
ss.
St. Croix
County.
authenticated this day of , 19 Personally carne before me this 28th day of
i! • .Tune , 19 9 9 , the above named
Richard 0. Stunt and .TanPt
P. Stout
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stats.) to me known to be the person s who executed the foregoing
' instrument and acknJ TE y BLIC
THIS INSTRUMENT WAS DRAFTED BY „moll ' TE OF WIS • \
Janet P. Stout f�t
.
Hudson, Wi. 54016 Notary Pub c, ��•
ry - County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My com fission is perm, ent. Q not, state expiration date:
necessary) .)
( 40A
II • Names of persons signing in any capacity should by typed or primed below their signatures.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
WARRANTY DEED STATE No. 1 - 1902 Milwaukee. Wis