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HomeMy WebLinkAbout020-1374-02-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479261 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Ludwig, Peter Hudson, Town of 020 - 1374 -02 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: �1IV\ 6`7T 12.29.20.2235 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / ? , r4- / Benchmark u ` ,• (� -7 7 7 M ,77 I on Alt. BM _ �• e las . 7 7 Lj a.J Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt Outlet S•� c t? , Z7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic lU I _P/ _ 756' 7' 7 / Dt Bottom � Dosing Header /Man. Aeration Dist. Pipe 7S'- .Z 9 7. si Holding Bot. System 0 Final Grade PUMP /SIPHON INFORMATION c kk 1 s-� �I9 , 3 Manufacturer Demand St Cover GPM ��e✓ lAJ Z /63- Model Number 77 Z� T► 7.51 s TDH Lift Friction Loss System Head TDH t '�'L g �Z$ 9 w • J Forcemain Lengt Dist. to Well g /� lJOu ®L) 6 SOIL ABSORPTION SYSTEM BEDITRENCH Width ) Length j No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `67-5 —,7 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION T System e Of CHA BER OR 60" (\ /Q o�j Model Number: Q �� DISTRIBUTION SYSTEM � S�— ! 14 t' P4 =Z J-,.fa � Header/Manifold �� Distribution x Hole Size x Hole Spacing Vent to Air tal y� Pipe(s) \ c� rrit Lengt Dia f Length \ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over i Depth Over xx Depth of xx Seeded /Sodded xx Mulched L Bed/Trench Center �7 -� (j Bed/Trench Edges Topsoil +� Yes ` 1 No Yes No L r `_ _. COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 188 Starr Wood . Hudson, WI 54016 (NE 1/4 SW 1/4 12 T29N R20W) Starr Wood Lot 2 Parcel No: 12.29.20.2235 1.) Alt BM Description = .' Z_ J • 2.) Bldg sewer length = 5 / - amount of cover = Ll / Plan revision Required? [Z] Yes o �L OOH Use other side for additional information. Date Insepct s Sign Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 S 1 - C = />C VISConsin Madison, WI 53707 - 7162 P it Number (to be filled in by Co.) (608) 266 -3151 71 Z(V / Department of Commerce stale I.D. umber S anitary Permit Application st ti �- In accord with Comm 83.21, Wis. Adm. Code, personal information you prov e ess • ifferent than mailing address) may be used for secondary purposes Privacy Law, s15.04(l)(m) I. Application Information - Please Print All Information ti0 �� v . Lot N Block X Property Owner's Na me 0 arcel // -� Zea C, (Z23S) c Property Owner's M ailing 'Address Property Location �,• �/�,/ u,Section City, State Zip Code VP Number f T A N; R ' _ 9 (c E o W ircle ,,� A W II. Type of Btu g (check all that apply) _ Z--, � - !I !1 �J 9 1 or 2 Family Dwelling - Number of Bedrooms M ❑ Public /Commercial - Describe Use gsK ❑ State Owned - Describe Use - ❑City ❑Village ®Township of T7 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal 11 Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 3 IV. Type of POWTS System: (Check all that appl 0 Non - Pressurized Lt- 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 Filter 111 ❑ Recirculating Synthetic Media Filter ❑ Leaching Ch4mber ❑ Drip Line ❑ Gravel -less Pipe _ ❑ Other (explain) V. Dispersal/Treatment Area Information: ,1d - Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Pro sod (sf) System Elevation a v v - ? c�s " .13 �jv. op S,�s VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Frosting Tanks Tanks Septic or Holding Tank v - qqq Aerobic Treatment Unit �( Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na the (Print) Plumber's i gnature MP /MFRS Number Business Phone Number 4 ,2 - v Plum 's Addre ss (Street, City. State, Zip C ogV VIII. County/Department Use Onl Approved ❑ D• r Sanitary Permit Feecludes Groundwater Date Issued I Agent Signature (No Stamps) ,��- ❑ ive Surcharge Fee) on for Denial 3� z� S IX. Conditions o prov formal 3) S SYSTEM �---- 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. —� 60,Lao.� L , a 2. All setback requirements must be maintained v as per applicable code/ordinances. -� GSt 11Rs� �a2 s MA AttaeA complete plans (to the Conaty only) for the system on paper not less than 8ft x 11 inches in size 'PLOT & CPMf SECTION PLO ZAMA or=. EXCAVATM IN PV*A* E uw dv EQ "00 fa :s`o7o" .. PFIOrECT &zrkw Attawle. ',l gE0 4ao�e � o •rr �ytios onl Poeclt RE /v EN�.E ; SrG'Qoix. GouNr � �/f�w liA�tV�ty E�►J ��'��� iN O� � �LEV.• 98.SzI � vd �7 -�` I s� cvi,�+.?,�tc� k�8ao �rat�e ; • fi r /OBa S.rr.tet r cr�R /�•�y1 3 �_ ... H` p ✓C f AF6t LCNT /_iAl E j r 1✓E/�IT /,XAjftCTloM Ate /N -PlQO .LHA461P � ♦ Bs 1SPoM �ittN ENO N Q ®eo So u-rff Sf;,ALI E�x�ex� spy E ��► at,r E� �,� e �«�a Qoko S t*�sxf 1 e Ew — Q jj sLJ flaw P Pd- I ■ © -54e okTI o-1 o 2 l i2` 64K 6e�,oE Vfiv 44p u 25 � rN�s�G DATE 014 KIM 1 44" y•AlL S°N PEE GP,60 : soK.ti�et sr: The Standa d Ini Ut toy Chamber . �" T�� B���v�► P� Sa���r tr o 0 s,c� v,Ew 75' Effective Length E ofofED G�E1L � oN �� — PLOT i OMS SECTION PLAN ZAPPA OM. EXGIM" IN pMj►DIfiQi INiT OvEe "00 - _ a A tu tvi ri Lot 2 y BEn+e�o•ye _ ; ��ae� �ww •� �f4+oso.� P� N RESIDENCE , 5r �ao�x Cor.�Nt J�gw �iAfihty a►Jr N •. -- '6PI <f iN OA* w , ClgV, •� �� ���� � �jEcaJER �.�NE So 800 I •r 7 � _ q ` P ✓c EFFaLCAir /..A►E A9 VeAT /.XA6ftVrlOM Ale iN -pbeD LN*Wi61M Q f�' ��uv ENO N BS Je Sou-r� 0 SCALE x�eK Sor E „v � EF S.r,4.Qe� ov A Qo*6 s ioo_ oo Ew - VA-r7" P, Pd 941 —e� ©�'S+JkTl�l o2 L y VENT u4P • A2 4l?. -7' i2 A� >S�rs� Gem DATE: /.2• oS M^K04141 Al Alt. SKK io PkAE c MT" By The Standa d Ini ilti toy Chamber • v �ol�jt/sotl 1' Overlap at Latching r �C so Ed. s stcE View 75' EAect" Length r Wisconsin Department of Commerce SOIL AND SITE EVALUATION t Division of Safety and Buildings Page 1 of ; 'Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and JT 6 t x percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # o2_ - 13 7 y —o2 -000 , 2 APPLICANT INFORMATION - Please print all information. sewed Date Personal information you provide may be used for secondary PUP s c L Prjv 11 <: w;-s. A4 (1) (m)). Property Owner ° perty Location o Lot 1 /4 -Sw1 /4,S T2.9 ,N,R 7p E (or) W Property Owner's Mailing Address M °' Let Sub # ; Block# d. Name or CSM# 5TA P, >~@cA)66h City State Zip Code l phone Number Nearest Road S� i RCAX ©C�ty Village Town _ / New Construction Use: ® Residential Tkumber bpdrg6 s Addition to existing building Replacement El Public or comme7cia�e Code derived daily flow Gt70 gpd Recommended design loading rate AO, 2 bed, gpd/ft O_ �' trench, gpd/ft Absorption area required PSe bed, ft SCE trench, ft 2 Maximum design loading rate _ bed, gpd/ft trench, gpd /ft Recommended infiltration surface elevation(s) ,� 7 . >' It (as referred to site plan benchmark) Additional design /sit considerations E�1c>'fo� Parent material 10LI Ja L T L Flood plain elevation, if applicable ft S Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U K S ❑ U S❑ U S❑ U El S U E3 R1 u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench J� r -3'. „� fps - 7:0 3 Ground �elev. � ' � ft• ' Depth to 5 ` limiting 0 ( , Z favor 7�_in. S3 Remarks: Boring # O- 2. l'hCt rYt 6 ,-g6:5). '.;;. Ground V po C,3 r'!�►S /!I d ,7 ; ele� ft. ' a4 97 3_ Depth to �y limiting .1r or Remarks: CST N me (Please Pr'nt) Signat a Telephone No. 4� 9\ /qty 1J�sau G� �o A ress Date CST Number P10 &x 41 4uAsojJ s4�oi (�� -o� zz75 1 l SOIL DESCRIPTION REPORT PROPERTY OWNER Page � of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench w/P L 4 cr m �5 o,g S Q C � I r� Y 4-13 Ground l�Z _o 16YR als 1 1 ele 1 �• . Depth to limiting fkctgr in. Remarks: Boring # lbvkk ox Ground q el 7 ft. Depth to limiting 2 `f (g , �f factor 7 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 # 4 _� /Qv R L O m cr /'1f CS 6,1 :0,11- SCa m5 6. o,Z Ground elev. �Zft. Depth to limiting fiaclor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9198) �n Fo r X r 3 t i OA 0. Y 6, Si r 4 ' 1 Parcel #: 020 - 1374 -02 -000 01/12/2005 08:14 AM PAGE 1 OF 1 Alt. Parcel #: 12.29.20.2235 020 - TOWN OF HUDSON Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` = Current Owner * FIELDS, FREDERICK E & CHERYL A FREDERICK E & CHERYL A FIELDS N6362 1323 ST PRESCOTT WI 54021 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 188 STARR WOOD SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 2.155 Plat: 2506 - STARR WOOD LOTS 1/25'00 SEC 12 T29N R20W PT NE SW STARR WOOD LOT Block/Condo Bldg: LOT 02 2 2.155AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 29N -20W NE SW Notes: Parcel History: Date Doc # Vol /Page Type 04/11/2003 716831 2202/419 WD 04/11/2003 716830 2202/418 WD 09/13/2000 629835 1542/324 WD 08/18/2000 628460 8/5 PLAT 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 50134 201,000 Valuations: Last Changed: 10/30/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.155 155,500 0 155,500 NO Totals for 2004: General Property 2.155 155,500 0 155,500 Woodland 0.000 0 0 Totals for 2003: General Property 2.155 155,500 0 155,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 = POWTS OWNER'S MANUAL & MANAGEMENT PLAN pap — of FILE NFORMATION sYBTNII sPEgFfCAT10N5 Owns fT, t U� car 'Septic Tank Capacity 1250 a w O NA Permit d 2 S9pdc Tank MwwfacttM Wieser O NA DESIGN PARAMETERS Effluent Filter Mawfactww Zable O NA Number of Bedrooms 4 O NA Efflust Filter Model A -1800 O NA Number of Public Faa�ity Units MMN Pump Tank Capacity ad DNA Estimated flow !average) 400 oWdav Pump Tank Manufacturer D NA flow Ipeak), (Estimated x 1.51 d Pump Manufacturer D NA Deep flow Sol Application Rate .7 - a*daylW Pump Model D NA Standard influent/Effluent Qualty Monthly everage• Pratnuturment Walt DNA Fats. ON & Grease IFOG) 00 n%A O SWAUGravel Filter O Put Rtw Biochemical Oxygen Demand IBOD s220 moll. O NA O Medumical Aeration O Wetland Total Suspended Solids (TSS) 51 s0 moll O Disinfection O Other. Pretreated Effluent Quality Monthly average Dispersal CON(S) O NA Biochemical Oxygen Demand IBODsI 120 n X bobaound (Wavityl O M4round !pressurised) Total Suspended Solids (TSS) 930 mg& O NA O At -Grade O Mound Fecal CoGfomn Igeometrlc meanl s10 cfu/100m1 O Drip - Lkw O Oder: Maximum Effluent Particle SM Ya in dim. O NA odw. M NA Other. ]XIA Other° N NA • VaMrq typical for domestk waatswatar and septic tank Ntluernt. Oche: 11 NA MANTENANCE SCHEDULE Service Event Service y inspect condition of tank(*) At Nast once every: 2 0 s) 3 yeas) O NA Pump out contents of tank(s) When combined sludge and scum equal$ ornedhkd US) of tank volume O NA At least once every: 2 lows sl 3 years) O NA inspect dispersal cellis) s) Chan effluent filter At least once every: 1 a mond,Is1 O NA momhlsl 0 NA Inspect pump, pump controls & alarm At Nest once every: 0 s) Flush laterals and pressure test At Nast once every: 0 mo S Q� NA Other: At law once every: 0 mo GIs! q� NA Other NA MANTENANCE MISTRUCTIONs Inspections of tanks and dispersal cell$ shale be made by an individual carrying one of the following ftwwaa or moms: Master Plumber: Master Plumber Resbicted Sewer. POWTS Inspector, POWTS Maintsiner: ap S" Servicing Operator. Tank inspections must kwWo s visual inspection of the tankls) to identify any missing or broken hardware. identify any cracks or leaks. messure the volume of combined sludge and scum and to check fat any back u or pondin of e ffluent o the ground surface. The dispersal r:aNlsl shag be visually inspected to check the effluent Wols in the observation pip" and to check for any ponding surface may indicate failing condition and requires the of effluent on the round surface. The pondkng of effluent on ground ground immediate cal mediate notification of the regulatory authority. When the combined accumulation of :kudos and scum in any tank equals one-third !l3) or more of to tank volume. the entire contents of the tank shale be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113. Wisconsin Administrative Code. AN other services, )ncWbV but not limited to the servicing of effluent filters, mechanical or 0 fur• pretreatment units. and any servicing at interval$ of 812 months, shale be pwformed'by s tified POWTS Maintainer. A service report shag be provided to the local regulatory authority within 10 days of completion of any service event. GUAVU 141011 pop � of START UP AND OPERATION For new construction, prior to use of the POWYS check treatment tank(sl for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal centsl. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing orator 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 POWYS Maintainer to assist in manually operating pump 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 POWYS: antibiotics; baby wipes; cigarette butts ; condoms; cotton swabs; degreasers: dertal floss: diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline: grease; herbicides; meat scraps; medications; oti; painting products; pesticides; sanitary napkins: tampons; and water softener brine. ABANDONMENT When the POWYS 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 Mall be disconnected and the abandoned pipe openings sealed. • The contents of an tanks and pits shall be removed and property 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 POWYS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: has been evaluated and may be utilized for the location of a replacement soil absorption )a A suitable replacement area by s ystem. The replacement area should be Prt structure, lot fines and wells. Failure to protect the replacement area will re setbacks from existing and Proposed 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 POWYS technology a holding tank may be Installed as a last resort to replace the failed POWYS. I evaluated to Identify a ❑ The site has not been orrned to locate a sultab a rep a. W Iff no re eplac ement area is available holding tank falkire 61 the PO a soil and site evaluation must be psrf may be installed as a last resor to replace the failed POWYS. ❑ Mound and at -grade soil absorption systems may be reconstructed I the f oe� a emoval of the biomat at the infiltrative surface. Reconstructions of such systems must comply with < <WARNING> > NOT SEPTIC. PUMP AND OTHER THER TREATMENT TANK UNDER ANY LETH RCUMSTANCES. DEATH INS Y RESULT. RESCUE OF A ENTER A SEPTIC. PUMP OR O PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POW T8 MAINTAINER POWTS INSTALLER Name Name oth a ) Count Ben Morgan Phone 715 - 386 -213 Phone 715- 386 -28 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL /REGULATORY AUTHORITY Name Tri County (Ben Morgan) Name St. Croix County Zoning Offs e Phone 715- 386 -2130. Phone 715- 386 -46 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(fl and 83.54(1). (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwncrBuyer �� aJ Ann GlW t 0 f , Mailing Address & L to W 0 y 7 �� �r �/ 00 Property Address L0+ ' ✓ . KWej 01 4° (Verification required from Planning Department for new construction) City/State a �J I Parcel Identification Number �Z ©� 137 - 1 2 L- 000 Z 2 3S) LEGAL DESCR=ON Property Location j t /,,, LW v, Sec. T I �1 -R Z W, Town of Subdivision S�R rr w end. , . Lot # Certified Survey Map # 9 Volume . Page # X90 Warranty Deed # Volume 2 . Page # 0�� Spec house O yes no Lot Iina ideadfiable yes 0 m SY STEM MAIIV'I'ENANCE Improper uw and ma kdenaacc of year septic ryaem could temp is its pre mstumfulme to Dandle wastes. Proper maiatcaanoc oonsists of pumtpiug out time septic tank every dnm years or s000e4 if needed by a Iiomsed pumper. What you pmt into the systau an affect the fimctim of the septic tank as a treabnect stage in the wsste disposal system "fire property owner agroa to obmzt tD St Crops Zoning DqarWKW a oatiSalim farm, signed by the ow= and by a =Lu=p ) P =sWc odpb mberoc a liaeasodpampervcdfyiag $rat (I) the on4te wLlWwatadispa d rjvtcm is is pcopet operating condition andlor (2) &ftmspection and pumping (¢ Y), the septic tank is less than W full of sludge. hare, the undersigned have read the above regvirements and agree to maintain the private sewage disposal system with the standards id fort!:, huein„ as sd by ttx Department of Commerce and the Dcpartaz a of Natural Rs:. =esc State of Wise onset. Certification stating that ym sceptic system has been maintained must be coenpldod and rdmaaod to the St Croix County Zoning Office within 30 days of the three year expiration date. S1dkA7UPRF,6F kPPLJCANir DATE OWNER ICERTI(FICATION I (we) certify that all stag are tree on this form are to the beat of my (our) knowledge. I (we) am (are) the ownes(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIMA1119 OF APPLICANT DATE «assss Any information that is mis- represcated may result in rho sanitary permit being revoked by the Zoning Deparmmeat-'� •' 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 f U 2770 P 066 7903 1 7 KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 03/24/2005 09:50AN WARRANTY DEED THIS DEED, made between Frederick E. Fields and Cheryl A. Fields, husband and EXtIMPI f< wife ( "Grantor," whether one or more), REC FEE: 11.00 and Peter J. Ludwie and Ann Marie Walfoort TRANS FEE: 711.00 Y FEE: ( "Grantee," whether one or more). CCPFEE: PAGES: I Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return Address Lot Plat of Starr Wood in the Town of Hudson, St. Croix County, Wisconsin. The First National Bank of Hudson ATTN: Pat PO Box 187 Hudson, WI 54016 020- 1374 -02 -000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, ' any. Dated (SEAL) (SEAL) * *Fred ck . Fie s (SEAL) (SEAL) * *Cheryl A. F lds AUTHENTICATION ACKNOWLEDGMENT Signature(s) Frederick E. Fields and Cheryl A. Fields, husband and wife STATE OF ) authenticated on d 7 7 0 ) ss. COUNTY ) *Kristine O land Personally came before me on TITLE: MEMBER STIATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attornev Kristina 021and Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PROTM Legal Forms 800 - 855 -2021 www.infoproforms.com E` � $ � ounor t is uueuwae� uriiu sucR a Y n� nN ACCE55 CAN eE OBTAINED. .nrc�� t0' m nqE PURER S.Wtl RETP NIOMlERSN IP. E �S $�bF'Tb to �� 5py']1VE��'eYlm tm 51 tam LH "Y,�i�WAI�� Y.om ]qn OUrLOT 21B UNBUILDABtI: AND t0 BE OKNED 8Y $rMR W000 � L° � , __�! OYMERS A$,� AS A CON AgEA 6 � rwEN a11E nX iiv[ SEC [,s i, x �a[UG rj J e .�wmmrs••d OUTLOT 2 4 � � „Fq V I _- L , § � , ®�, � ...r.�L � ;mom �'�• 4 #•aw, ,,cc f �Bf k 2.5 3 9 .1� �,. C� ro _s STARRWOOD N /' -� r° \ NMI Nc EaaB.ert Rp9 �� 24 _ ,t8b Dg �4Y a- ��� ;' - N F t •� a rv'w .u2. sdA� \ y ci / � � 8 � —r..�. �>•.�+.rtgL — �. : Tr 5i - c �� fi / 25 w 22 T 8e �xorcn tart 75.8 { � z,. saR � Iere NOrta p n maon>•m.r ct / e �.dE, �.Dlc Ewra�rt ,ftp p. tf naTOrrgnatr,Lw� 1'E 7100.59' nw. naneoor. w.�o.RwmEro C� 21 q 10. / _ _ _ _ _ _ i e6 Z— .w V 93.890 30 FT 2.155 ACRES 84,857 Ski FT V's 1.948 ACRES • . Z • { AT to