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Home My WebLink About026-1013-30-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division t INSPECTION REPORT Sanitary Permit No: 429969 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: Stock, Bill I Richmond Township 026- 1013 -30 -100 CST BM Elev: Insp. BM Elev: BM Descri tion: Section/Town /Range /Map No: Am d 'd o / / 04.30.18.347F1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATI N B HI FS ELEV. Septic —C � , ) � / v Benchmar Dosing IO Alt. BM Aeration Bldg. Sewer �f- Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION J� TANK TO �/ WELL BLDG. Ven t�to Air Intake ROAD Dt Inlet l Septic I ' 13 / 1 ' _ Dt Bottom —� Dosing Header /Man. Aeration _- Dist. Pipe Holding Bot. System g / 0 l Final Grade - l0 PUMP /SIPHON INFORMATION , Manufacturer Demand St Cover A b GPM f4z C s OLL Model Nur r TDH Lift ri ' Loss System Head TDH Ft \ Forcemain Length Dia. ist. to Well SOIL ABSORPTION SYSTEM '7 BED/TRENCH Width Length No. Of Trench s IF PIT DIMENSIONS No. O Pits Inside Dia. Liquid Depth DIMENSIONS 3 7 SETBACK SYSTEM TO P/L fQ BLDG WEL LAKE /STREAM LEACHING Man ur: 7 �Td1 INFORMATION CHAMBER OR t Typ f System: / UNIT / Model Number: jj DISTRIBUTION SYSTEM f Header /Mani old Distribution x Hole Size x Holeing Vent to r Intake Le l 1 Length Dia _ / Spacing Pipe(s ngth Dia ` 1 �- 2 J / SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mylched Bed/Trench Center Bed /Trench Edges Topsoil Yes _J No J es = =1 0 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ a -w' / Inspection #2: Location: 1741 112th StNew Richmond, WI 54017 (NE 1/4 SW 1 1 /4 4 T30N R18W) NA Lot 4 Ph) Parcel No: 04.30.18.347F10 tN 1.) Alt BM Description = Fa'J{j7w Of , ),-,* OVCJZ- J MQJt��c r.2 2.) Bldg sewer length = /, / - amount of cover = OOZ Plan revision Required? L'_ Yes o Use other side for additional information. � o3] _ -- SBD -6710 (R.3/97) Date Insepctor's Si nature Cert. No. I 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 PO Box 7302 1*6consin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County Z 4 State Sanitary Perm Number ❑Check if revision to previous application State Plan I. D. Number N I. Application Information - Please Print all Informati Location: ! / , Property Owner Name Property Location 9 ,q 7F— O �.` ✓ l >'� / ! 1/ 1. S Property Owner's Mailing Address M . Ay 0 7 Lot Number Block Number / �7 iTY 1 4 � City, State Zip Code PhbW E W Subdivision Name or M Number ZONIN �/, .z " "-_ -700 II. Type of Building: (check one) ❑ City Y1 9 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village Public /Commercial (describe use):_ Grp I W Town of ❑ State -Owned 3 T/Z,�1 ntC 6 - Gt/l l - 7 — ! 1 /( / /�, _A Y Nearest Road / Parcel Tax Number(s) 6 III. Type of Permit: (Check only one box on ltn A. Check box on line B if applicable) A) 1. qWew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) '1504on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ti Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: 2 whc" V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed / 5 z - Rate (GalsJday /sq. ft.) in. /inch) Elevation 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 ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, as sume responsibility for installation of t he POWTS shown on the attached plans. Plumbed' Name (print) Plumber' gnature (nos ): / MP/MPRS No. Business Phone Number kd is Address (Street, City, State, Zip Code) IX. Co nty/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Da sued suing A nt S stamps) CA / Pproved ❑ Owner Given Initial Adverse Surcharge Fee) Z C-0 p Determination X. Conditions of Approval /Reasons for Disap roval: s� a(a.�ori..; f'hawt- �v;-•- a�,a��ac% �,.. 83 .-A - qz4m- 3 '�da t7 ' � air d - 7 40 ' BD -6398 ( .07/00) �� p��f' f� Q %L� i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of J Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code l ( r X Attach complete site plan on paper not Tess than 8 1/2 x 11 inches in size. Plan must County iY co include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. QZfP lCI /3'34 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 10 Please print all information. Re ' by Date , Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Locaatiion Al l 5 1-L0 C. A± � Govt. Lot / 1/4f CJ114 S T e N R E (o Property Owner's Mailing Address Lot I Block # I Subd. Name or CISM# Z 7 41 Ci / Stalte Zip Code Phone Number El City ❑ village 'Town Nearest Road 5%(91 New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describ Parent material 1c, lood Plain elevation if applicable f F n ft. General comments and recommendations: OCT 1 5 2002 �j ST. CROIX COUNTY F ]i Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ,l 5�1 f D1 Boring # E] Boring pit Ground surface elev. 7' ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name ease Print) N Signature CST Number 49 �9� e.:!i; :;? — Address �y Z�AT ate Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner (%' �" �'' Parcel ID # Page 2 of F 5-7 1 Boring # E] Boring �/ 0( pit Ground surface elev. � %� ft. Depth to limiting factor ; > in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Kim F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L 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 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) 3� -F3 Soil Test Plot Plan Project Name B ill Stock Byro ird Jr. Address 1748 112th st N ew Ri chmond Wi. 54017 CS A #220527 Lot Subdivision csm Date /10/2002 County CROIX NE 1 /4 SW 1/4S T 30 N /A W Townshi Rich Boring Q Well PL Property Line# Alt. BM �ice ,BM or" VRP Assume Elevation 100 ft top of steel fence post System Elv. T-1= 91.6T2 -91.3 H.R.P. T -3 =91.4 Same as BM 643' PL alt BM Easment to 112th st 5' 80' 30' 80' 3 , 20' B3 B1 82 94.5 PL 95' PLOT PLAN PROJECT Bill Stock ADDRESS 1748 112th st NewRichmond Wi. 54017 NE 1/4 SE 1 /4S 4 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MFRS Byron Bird Jr . 2205 DATE 5 -8 -03 BEDROOM 4 CONVENTIONAL XXX 4 6 - Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ❑ LOAD RATE .4 ABSORPTION AREA 1500 # of chamber 49 hk BENCHMARK V.R.P top of steel fence post ASSUME ELEVATIONS 100' 3 F BOREHOLE (DWELL *H.R.P. same as BM Vent SYSTEM ELEVATION T -1 =91 T -2 =91.3 -3 =91.4 f Sidewinder High C Capacity Leaching Cove Chamber with 17.2 6 t ^2 per chamber Long 34 "643, pL Elevation alt BM t BM 106.25 �' 30' 20' Easment to 112th st ' B3 , drivewa �� <✓ 5 st B2 l$ - � o observation pipe garage 94.5 PL 95' 4 bed house r PLOT PLAN PROJECT Bill Stock ADDRESS 1748 112th st NewRichmond Wi. 54017 NE 1/4 SE 1/4s 4 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Byron Bird Jr. 2205 ' ' DATE 5 -8 -03 BEDROOM 4 CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE C7 LOAD RATE .4 ABSORPTION AREA 1500 # of chambe s 49 hk BENCHMARK V.R.P. top of steel fence post A SSUME ELEVATION 100 ❑ BOREHOLE (DWELL *H.R.P. same as BM k6" SYSTEM ELEVATION T_1= 91 .6T- 2= 91.3T -3 =91.4 f idewinder High C apacity Leaching Cov hamber with 17.2 t ^2 per chamber , Long 34" 643 , PL Elevation a - Grade at Sy 5' BM 30' ' , 20' Easment to 112th st 106.25 B3 , B1 drivewa 5 t B2 o observation pipe N J garage 449 94.5 PL 95' 4 bed hous , i • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of ?� FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity Q a l ❑ NA Permit # d G) Septic Tank Manufacturer jeJ! ❑ NA DESIGN PARAMETERS ! Effluent Filter Manufacturer /` ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model l ❑ NA Number of Public Facility Units A Pump Tank Capacity a l ❑ NA Estimated flow (average) Q gal Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) 6 G' gal/day Pump Manufacturer NA Soil Application Rate al /da /ft2 Pump Model ❑ A Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 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 Ila in- Ground (gravity) ❑ in- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L xA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 51 ° cfu /100 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ ea�� (M aximum 3 years) ❑ A Pump out contents of tank(s) When combined sludge and scum equals one -third (Y ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter AS -- At least once every: [3 month(s) ❑ NA Z year(s) Inspect pump, pump controls & alarm At least once every: ❑ ❑ year(s) mo nth(s ) ) m ❑ NA ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) ❑ NA 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. 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 H of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). 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. An4ie_gvU, Cv>1 �c�c � 6-6i 01Waal� 11 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POO technology a holding tank may be installe as a last resort to replace the failed POWTS. yvvGu The si e as not b evaluated identify itable re ement ar Upon f ur of th WTS so and e �L eval ion must pe ormed t toc teas 'able eplac men area. f no epla ment a is ava e a hol ' tan 1 " may a inst le s a las eso to repl e e failed S. ❑ 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 Name �-. �,-, Name D Phone /��2G Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s G r p Phone c¢ Phone r 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 CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address - Properly Address l 7 g l 1 12 S r (Verification required from Planning Department for new construction City /State Parcel Identification Number _ —/l91 L=SO ^ /Q LEGAL DESCRIPTION y� Property Location /W %.� ' /., Sec. • T�52 N -R�W, Town of ol/ �m T� Subdivision �- - -A — , Lot # - e. l Certified Survey Map # `� , Volume Page # �� l Warranty Deed # 6W ,;� Volume Page # d Spec house, yes ❑ no Lot lines identifiable JgIYyes ❑ 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 mastorplumber, journeyman plumber, restrictedplumber 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. 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 tic system be n maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the ear e. SIGN OF APPL CANT DATE OWNER CERTIFICATION I (we) certify that a to ements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope bo v' a of a warranty deed recorded in Register of Deeds Office. cri Zr . SIG&&M OF kPPLICANT DATE « « « « «« « « « « «« Any information that is mis represented may result in the sanitary permit being revoked by the Zoning Departm «« 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 TYR. '� � �.. V 16 PAGE 4415 DODGE RA7HLEEN H. MALSH CLEAR 4_AKE, REGISTER OF DEEDS Co., ST. CROIX III ! l•:. l '` , ��"�� • + s� '` RECEIVED FOR RECORD „u;�1r iy �n , rr, +rr, ,r, " ";• 12/03/2002 MOGAN CERTIFIED SURVEY MAR RECFEE: 13.00 Located in part of the Northeast Quarter of the Southwest Quarter and part of the COPY FEE: 3.00 Southeast Quarter of the Southwest Quarter all in Section 4, Township 30 North, PAGES: 2 Range 18 West, Town of Richmond, St. Croix County, Wisconsin. S89 "E 5297.35' 1330.59' : $ 3966.76' EAST-NEST QUARTER LINE - _ w QUARER CCV?NER L � Cncw - .ro ->•e FAsr OVAR7ER CcvzNt� .�. (FOUND ALUMINUM _ZC776W 4- 30-18 4; COUNTY MONUMtTIr) (ESTA&PWED FRAM RES) m I I CERT1f/E0 SU_RV£Y MA_P '7x c L,e yC S I J I (!A!P! e 1 � + b n f p ViX 1lME 12 PAGE - - 1/(�,(, UME 597 PAGE 181 NP�A D ----- ..__- - - - - -- ��+ ( S89"57'S3'E � f 666.96 25.31 641.65' rn , ea' = 6 1 6 C — DRIVEWAY EASEMENT FOR LOT 5 . J 7 r+ 1747H _ z ` �) *25. 53' 390.06' 0 ° __4 � o 0 Ln S89'57'53 "E 415.59' O °tom +O a ' P 15 > I LOT 4 ' � o! L O T ,5' w m • 0 0 p � r) x: I N89'47`00 "W 416.23' t w +^t +O ` j' o 26.13' 390.10' p fRi� +� o c, O il C +� tr o -` V) N O L O T 6 �, w� i o (r, cyw w,tr io ' a o 26.72' 390 w I j a w 249.41' 1 N89'47'00'W 330.07' z S89'47'00E 336.19" -- �`'- I o n o i $ vice ,a o o m o �q f 00 � J rt 0° 2 '"' ar 3 I I Y 84 '48'?9' a o n i W rt 113 . �_ .. .. NE_V4 -SW 114 �a o w rt SLR 1T -SW ��4 S -• o `� t S. ? n 7 � 4 n � a n _ rA Z V 2 13 `i P 0 9 9 - 7 t08E►3E, Y KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., III RECEIVED FOR RECORD This Deed, made between Jody M. Robl, f /Wa Jody M. Simon 02/07/2003 08:00AN EXEMPT # REC FEE: 13.00 Grantor, and William B. Stock and Roxanne D. Stock, husband and TRANS FEE: 105.00 COPY FEE: wife, CERT COPY FEE: PAGES: 2 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area That part of NEI/4 SWIA and part of the SE1/4 SW1/4 Sec. 4- T30N -R18W Name an*Mt1`K1A OGLAND described as follows: Lot 4, 5 and 6 of Certified Survey Map recorded in ATTORNEY AT LAW Vol. 16 of Certified Survey aps, p g , as oc. o. , County, Wisconsin. P.O. BOX 359 HUDSON, Wl 54016 And �ro�erty described on attached Exhibit "A". LoT 5� — OZib— /Ql3- 3o —lOC� Part of 026-1013-30-000 . LO F - 10 Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of January 2003 Q(��4 �Y\ * *Jody ob1, 4 Jody M. Simon * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Jody M. Robl, f /Wa Jody M. Simon STATE OF WISCONSIN ) ) ss. 2 � _ _ County ) authenticated this day of January 2003 Personally came before me this day of the above names; * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing — instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) I * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals company, Fora du Lac, VIA STATE BAR OF WISCONSIN 800-655 -2021 WARRANTY DEED FORM No. 2- 1999 U 2134P 100 EXHIBIT "A" s The Northeast Quarter of the Southwest Quarter of Section 4, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin, except the following. described parcels: (1) That property described in a Warranty Deed recorded in Volume 504 Page 612; (2) That property described in a Warranty Deed recorded in Volume 507 Page 181; (3) That property described in a Warranty Deed recorded in Volume 1160 Page 255 (4) That property described in a Warranty Deed recorded in Volume 582 Page 289; (5) That property described in a Warranty Deed recorded in Volume 515 Page 497; - (6) The South 264 feet of the West 330 feet of said Northeast Quarter of the Southwest Quarter, (7) Loot_ I_ Certified Survey Map recorded in Volume 1 Page 257. (8) T r ot 7 of Certified Survey Map recorded in Volume 16 of Certified Survey Maps, page 4415, as Document No. 700587.