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HomeMy WebLinkAbout020-1374-19-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430305 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: Landsted Homes Inc. I Hudson Township 020- 1374 -19 -000 CST BM Elev: p Insp. BM Elev: BM Descrip . f Section/Town /Range /Map No: �/p F 0 0 `/y dr O .� f' Cam. 12.29.20.2252 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Bench Z ar,� t ' Dosing Alt. B f t /1 I 1 J ; , L ., Aeration Bldg. Se�✓e .�� ./ l l- 79 Holding St/Ht Inle _ j � _ 7 � -- - - -- - .w. 0 0 ` — -_° ""—• TANK SETBACK INFORMATION St/Ht Outlet TANK TO elL WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �r ► I ly r ' / i. Dt Bottom Dosing L Header /Man. �- w -r Aeration Dist. Pipe r Holding - i Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover Model Nu er r r TDH Lift ciction Loss _ Stem Head TDH Ft Forcemain Length Dia -- Dist. to Well SOIL ABSORPTION SYSTEM t �� �f , y ` -�• BEDITRENCH Width Length No. Of Tre hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS < � �. SETBACK SYSTEM TO P/L N BLDG 1WELL . LAKE /STREAK LEACHING a ctur r , , - 4 INFORMATION CHAMBER O i , - t - Type f System: / r N y {itQr1 Model Number: DISTRIBUTION SYSTEM 3 ✓ /: Header /Manifold Distribution, y x Hole Size x Hole Spacing Vent to Air Intake r k Pipe(s) r? I Length ; ` Dia Length <' Dia `" ` Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 10 1 4 / Q ' � Inspection #2: / / A . Y Location: 229 Starr Wood Hudson, WI 54016 (SE 1/4 SW 1/4 12 T29N R20W) Starr Wood Lot 15• ' " r Parcel No: 12.29.20.2252 f 1.) Alt BM Description = Y� �b0� j n xl� 2.) Bldg sewer length = r - amount of cover = f/ Plan revision Required? Yes [i� No /, 1 r ! L93 Use other side for additional information. � 7 -- � SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No 6 5 Z 3 Safety and Buildings Division County Vi 204 W. Washington Ave., P.O. Box 7162 u seonsin Madison, W1 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266"3151 q30 30 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) t Address (if different than mailing address) I. Application Information - Please Print All Idormat on r y a Property Owner's Na me .) Parcel # Lot # Block # / Property Owner's M ailing Address Property Location A, 1 A,Section c9 - City, State Zip Code Phone Number y0/ (circle ) H. Type of B ' ding (check all that apply) " 5 T o� 9 N; R y E or CSM Number V 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use Z r -� ❑City _ ❑Village gTownship of / - /� M. Type of Permit: (Check only one box on line A. Complete line B if applicable) 9 2252 A. New System ❑ 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. Type of POWTS System: (Check all that apply) J@ 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 Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) I Design. Soil Application Rate(gpdsf) I Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation GG 0 / PS' �/ P i9. cf6 00 •Q. �.5: SU VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks - O Septic or Holding Tank 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 me (Print) Plumber' i gnature MP /MPRS Number Business Phone Number r / q ? a A,? v Plu 's Addre ss (Street, City, State, Zip C VIII. County/Department Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Iss ' gent Signature ( Stamps) Surcharge Fee) 2 f— 0 ❑ Owner Given Reason for Denial 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. Attach eomplete plans (to the County only) for the system on paper not less than SM x 11 inches in size SBD -6398 (R. 01/03) 8ZMC14 SPrKE /nl l4O T�PlE �d�N Ata&'PTY EI,�J. = tom• �•/' �t�0r - -!�PjCE •N . ?72gE V. /00.00• �.25n�oAL w tscP cT•tyl� - PLOT It CROU SECTION KAM 'fib � � rN nogg iron r ZAPPA OFM EXCAVATMiIi MSC R, ~ Pa"" ilk 6" 'c O OF 112eareal '• 51''Sc�1 �o ��ev6 �ES�rJE iv�-w Tit�.yc%� .CJ.rrc'm Be� 'STfv�O�ttn cid�,�irs �n '` G Ae.A 4.6 Watt - �� S J'AN aoRO - rNF,lG7/iAro/t l.eYiO/�Jl3E/1S � Fi�o�, �wf of 600 c„oo - -7 = �siy =3i_/ = �? sc N oit AP No `J ouvZ� PQv 5 SCALE ©gs 0�1 0 81dNEU: fl �e�l�Tl 2 —�- �2 DATE: �� 4 1 ,0::f cs�EL /�Mcr aM Aw e N `AP 1 e M VO PAr • 60IL TEOT" SV: The Standa d In 11b ator Chamber -- ii JdifiuS�c/ 7 F_ T Overlap at Latching L 0 it SLOE V ICAJ 66 so 75' Effective Length SPIKE Ec•EJ = K'tl..�/' � ,��ytAer- �P�rE ��, oAK'fkg6 y `s02a�, Pie. Et�u eNe; ...per 67 • �.?S� w ts[P c?'•tyl� - PLOT & CRM SECTION PLANS � , rt( .'�ilogt� ire. hater L1PPA 6ROi. EXGIYATINB INC p UNIT 1 ' D A Dear 60" p � OF �Xb /�� !3 SI''Sc�l�a Sca,,�t ' Osorm bA o ct hhnh�s JG,u /`�idsvCClr �� 3�Llfh>n�sd ______ .. Fad,,, AF*C tl X A JO �o pnssD APIA 44 wictt cC� ST.oN�A/!D _J�yF.IG7ylA7'O/t l/S�iV/1/Qf'/ls F��.n /�e.✓f aF � Goo � _ -7 = �siy = 3i � = �?. sc N oit Ap GvA4; ' r r r /1I0 SCALE So K�a pQv /��fr ,( ��utF �N ►r6� 1/1 Ew P Af 0&'S44A rt 6A) o 2 F =- z � A 6,�,s,4 6e VEN r 44p 2 DATE: /4^VIj MIA'K 71G' 14bo�f • � Nl- 'geM �o PEE The Standa d In 11h ator Chamber .SON.TE8ItigeY: ,• overlap at Latching sm � T�cw Bor..n ��v��► Otq Sac T�s�l it 4) U*) o ZZ 0 A- g <-. oo SIDE ViEw 1 3 gs. 75' Effective Length J iscon tin Department of Commerce SOIL AND SITE EVALUATION j 3 viV ion ° of Safety and Buildings Page 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 Sr percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Plea prim all in orm��;�.. fR Lie Ldb Date Personal information you provide may be used for ondary pu �iy Law;'s.`i' . (1) (m)). OS- Property Owner Pt Location oa - G vt. Lot IS[ 114 1/4,S f T Zq ,N,R 26 E (or) W Property Owner's Mailing Address Lck # Block# Subd. Name or CSM# (` `�Tv1wrC7f� q _S U` City State Zip Code . Ph , ' ❑City � ] ❑ Village Nearest Road Town New Construction Use: ® Residential / Number of bedrooms y Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 '60 gpd Recommended design loading rate gi bed, gpd/ft 10. — trench, gpd /ft Absorption area required �i, bed, ft 400a trench, ft2 Maximum design loading rate n s bed, gpd /ft jg 6 trench, gpd/ft Recommended infiltration surface elevation(s) ft (as r ferred plan benchmark) Additional design/site considerations - Ey4L 014 ;'t()� bow �p� MT Aj-P >IQ.6 Parent material V L.14 C t /4 Y- LL. 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 0S El u s❑ u S❑ U [ S❑ U EIS gri l SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench r -3 c r rh C 1 a. O � Ground z a _ , 5 ;o �ele�.v,. f•�ft. Depth to limiting Q factor ` > 01 in. �- CQ $ ►til SJ 1� 0. u Remarks: Boring # / L y Ground �elev. - fc,w ft. Depth to limiting factor > !Zd in. Remarks: CST N me (Please P 'nt) Signatur � lephon� NO.� 41ev_Y )4 Add Date CST Number � 86)� ots� 46 , 6 -i z -0 ZZ1 r SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench A 6A 6 /a 4- — SCf m LS I A . 6 .7 ;o.� Ground T 9>�. ►_t s s Depth to limiting .�- ctor 7 0 in. I I .2 Remarks: Boring # St- cr e-5 7- r ,5 -- 5 MS n1 es - a,� �0.8 Ground 3 - ( 4 T M ✓ 0 ,S 'o ,C, elev. Depth to limiting fa r 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 B° ' # A j)-4 ItLIP i Q- 61 -31 16'V _ , ,v�5 5 D,? ,o.� I -53 7,S yP 4 3 TS6 All 5 6 .3 el, I Ground 3.6 f 7.S`/ 3 — 51 $ elev ft. ! -F lb S G Depth to Z limiting fact ? Fin. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8130 (R.9/98) 44 ' c 1 rrl k r G r+ N N T j �► G o Waa =/\3-13 � 1 � oo w � t � 1 z [ C - ti \ 3?3 -I N W a d r b I N c (7b m M l d• POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I/ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner // - Septic Tank Capacity U al ❑ NA Permit # -3 �, - Septic Tank Manufacturer _ ❑ NA ass DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units 0 NA Pump Tank Capacity a l 0 NA Estimated flow (average) p al /da Pump Tank Manufacturer 0 NA Design flow (peak), (Estimated x 1.5) G 0 0 gal/day Pump Manufacturer 0 NA Soil Application Rate g al/day/ft' Pump Model 0 NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit M NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L 0 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids ITSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ® NA Other: I M NA Other: 0 NA "Values typical for domestic wastewater and septic tank effluent. Other: HI NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ monthls) (Maximum 3 years) ❑ NA ®year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 0 year(s) Clean effluent filter At least once every: �/ ❑ month(s) ❑ NA 0 yearls) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ® NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ mon th ❑ year(s) 0 N Other: At least once every: ❑ month(s) ® NA ❑ year(s) Other: ® NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for, any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. I When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed'by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page 1 2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(si for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cellls). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator 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 POWTS Maintainer to assist in manually operating the pump controls to 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 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS 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 shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly 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 POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ® A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will 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 POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER L ame Name one _ _ Phone _ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name _ Name p - 7. Phone _ Phone E61/s_) ';;w - �Teo This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code. ST CRQIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND - OWNERSHIP CERTIFICATION FORM Owner/Buyer LQ&�� aF S Mailing Address _T7uLSnx2 U2:r � �b Property Address o T,4 (Verification required from Planning Department for new construction) Cit Parcel Identification Number A - - y 7­1 11 A ty U /c,z�Sol�� � ✓ /�,L 6t�te°y o� - 30 LEGAL DESCRIPTION Property Location %,, %,, Sec. /A . T '? N - ` W, Town of /� �.�o.✓ Subdivision �1 ri�Q,3 ��n.!� , Lot # 19 Certified Survey Map # , Volume , Page # Warranty Deed # �`� 9 d" 3 9 , Volume Page # y ?3 S - Spec houseX yes ❑ no Lot lines identifiable li4 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, journeymanplumber, restrictedplumber 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 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. LICANT 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. /J F A LICANT 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 1542P 355 629839 • KATHLEEN H. WALSH DOCUMENT No. WARRANTY DEED REGISTER OF DEEDS 5T. CROIX CO., WI RECEIVED FOR RECORD 09 -13 -2000 10:15 AM This Deed made between STARRWOOD PARTNERSHIP, LLP, a Wisconsin limited liability EXEMPT EXEMPT TY DEED N partnership, and L ANDSTED H OMES, INC., a Wisconsin CERT COPY FEE corporation, Grantee, TRRANSFER FEE: 1725.00 RECORDING FEE: 10.00 W itnesseth, That the said Grantor conveys to Grantee PAGES: 1 the following described real estate in St. Croix County, State of Wisconsin: Lots 17, 18 9 0 and 23 of the Plat of Starr Wood in the Town of Hudson, Croix County, Wisconsin; Tax Parcel No. 020 - 1111 -60 & 80; 020-1112-30 RETURN TO: This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this //13 day of September, 2000. STARRWOOD PARTNERSHIP, LLP .11 (SEAL) B udith A. Green (SEAL) • AND: Ga Zappa STATE OF WISCONSIN ) SS ST. CROIX COUNTY ) Personally came before me this. day of September, 2000, the above named Starrwood Partnership, LLP, by Judith A. Green and Gary T. Zappa„ to me known to be the persons who executed the foregoing instrument and acknowledged the same, being authorized so to do. R W4 ft 0 wjC ��pp Not Pub tc, fate of Wisconsin My Commission (expires): THIS INSTRUMENT DRAFTED BY: Robert W. Mudge MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street, P.O. Box 469, Hudson WI 54016 V OL 1716FAG 622 656323 KATHLEEN H. WALSH Document Number REGISTER OF DEEDS a'r. CROIX CO., WI This Deed, made betty n LANDSTED HOMES NqC. RECEIVED FOR RECORD 04 - 11 - 2001 10:30 AM A WISCONSIN CO Grantor, WARRANTY DEED AND STEVEN R SHAMBORA and MIC LLE A SHAMBORA CERPPCOpY FEE: COPY FEE: Grantee, TRANSFER FEE: 402.00 husband and wife, as survivorship marital property RECORDING FEE 11.00 Witnesseth, That the said Grantor, for a valuable consideration of one RAGES: I dollar and other valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area This is not homestead property. Name and Return Addreas Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of all encumbrances except easements, covenants, and restrictions of record, and will warrant and defend the same. (Parcel Idea tkation Number) LOT 19, PLAT OF STARR WOOD IN THE TOWN OF HUDSON, ST. 020 - 1 -80 -000 and 020 -11 12- 30.000 CROIX COUNTY, WISCONSIN. - 0 -000 Shou a not enter into a construction contract for a home to be built on Lot 19 Starr Wood with Grantor by my 7, 2003, Grantor shall have a 30 day option to re- purchase Lot 19 Starr Wood at the price of $134,000.00 L A . thi da of "'""` 200) . '� p�u'ti (cam ' MARK M. ERICKSON, President • AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN COUNTY OF ST. CROIX C ' Personally came before a this da f .20 authenticated this _ day of the above. MARK M. ERIEHON, President to m kn be the persons) xecuted the foregoing signature ins men d acknowledge e. type or print name s T TITLE: MEMBER STATE BAR OF WISCONSIN type or pdnt name d/ (If not, Notary Public ST. CROIX County, authorized by §706.06, Wis. State.) ' My commission ' ertnanent. If not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY Robert F. Wall *Names of persons signing in any capacity should be typed or printed below their signatures. I I