HomeMy WebLinkAbout026-1153-07-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453207 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:
Country Living Builders I Richmond Township 026- 1153 -07 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
v - C ) , c 1 F1 1 -4w-f— t L 19.30.18.1145
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
W I`Z�o
T6 0 2 61 a, 107 -y 160140
Dosing AIUB
Le-
Aeration Bldg. Sewer
f
Holding
St/Ht Inlet
�� �
St/ Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Eto ake RO AD Dt Inlet
Septic r Ra Dt Bottom
Dosing D�� 3 a
3. 6 /
Aeration [jtst'Plpe 9 et w4d Jo-
uo� �Z' 3 7
Holding BetrS�ctww
Final Grade
PUMP /SIPHON INFORMATION , 57
Manufacturer Demand St Cover
GPM I / YKAM Y1 aw tt 333 I
Model Number
TDH Lift F 'cti Loss S Head T Ft
Forcemain
l — 1
ength Dia.
SOIL ABSORPTION SYSTEM I �
BED/TRENCH Width Length / jNo.OfTrenches j PIT DIMENSIONS No. Of Pits Inside Dia. ILiquid Depth
DIMENSIONS 3 A IK7 d M 1
SETBACK SYSTEM TO OO P/L BLDG I WEEL ` LL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR v
Type Of System: UNIT
Model Number. ']
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size IVent to Air Intake
1 4 / 1 / Pipe(s)
Length_ Dia 'y Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over Depth of xx Seeded /Sodded xx
Bed/Trench Center f Bed/Trench Edges / 1 xx Yes 1 ] Y
No
Yes {' -,? No
_'!
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:00/ 07 / 0 C W MV e 0 A ' n i
Location: 1494 94th St Unknown (NE 1/4 NW 1/4 19 T30N R1 8W) Glen View Lot 7 Parcel No: 19.30.18.1145
1. Alt BM Description = da "'" _ W a�,t ` �Q,gyG
2.) Bldg sewer length = tt�
- amount of cover = 3 / cvn►
I
Plan revision Required? Yes No j
hhQ �
Use other side for additional information
SBD - 6710 (R.3/97) Date Insepctor's Signature Cert. No.
1
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application
PO Box 7302
`�sconsi Personal information you provide may b , used fdrr secondary purposes Madison, WI 53707 -7302
Department of Commerce (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)] state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 1 I inches in size.
County State S Permit Num er ❑ Check if revision to previous application State Plan 1. D. Number , /
lj Y , I A
I. Application Information - Please Print all Information Location: /
Prope er Name Property Location
C / 04,c h ,1- c /
Property Mailing Address Lot Number Block Num
It
City, State Zip Code Pho umber Subdivision Name or CSM Number
l e e ��t�yTdilCLi' r C � F�� ` ( r7
II. Type of Building: (check one) 3�� - ❑ City
1 or 2 Family Dwelling - No. of Bedrooms : �� ,0 Town of
❑ Public /Commercial (describe use):_ ��r r �d ;��2'1 1 /
❑ State -Owned G h O
• !4
Nearest Road
G /gal
Parcel Tax Number( 6 -
III. Type of Permit: (Check only one box on ' . Check box o line B if applicable)
A) 1. ANew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
)g,Non pressurized In ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ` ❑Aerobic Treatment Unit ❑ RecircuI ting ❑ Other:
/S
L4t /
V. Dispersal/Treatment Area formation:
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. ft.) (Min. /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 `
le e 11
VIII. Responsibility Statement
1, the undersigned, as sume re sponsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber' ture (no stamps MP/MPRS No. Business Phone Number
W yr. I ���
Plum is Address (Street, City, State, Zip Code)
IX. County epartment Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued suing Age Sign ps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee) , ?— 3 / /
etermina n
X ) &qWs for Disapprova . I
ep is to
rsal cell must all be serviced / maintained
as per management plan provided by plumber y
2. All setback requirements must be maintained �3, S2--
as per applicable code /ordinances
3 to i
SBD -6398 (R 07/00)
PLOT PLAN
PROJECT Country Livina Builders ADDRESS 923 172nd Ave NewRichmond Wi. 54017
1/4 NW 1 /4S 19 /T 30 N/R 18 W tOWN 'GlenView COUNTY ST. CROIX
MFRS Byron Bird Jr. 220527 ',Y, ,� DATE 5 -07 -04 BEDROOM 4
A rade
CONVENTIONAL XXXX
O
CONVENTIONAL LIF T H LDING TANK
NK
MOUND SEPTIC TANK SIZE 1 260 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28
BENCHMARK V.R.P Top of Steel FencePost ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL �
� H.R.P Same as BN
Vent SYSTEM ELEVATION _
_
I -
T 1 _91.8 T 2 =91.4
A2"
Bio Diffuser with
31.1 ft ^2 per
chamber
6"
Long 34" Elevation
182'
PL
O ob pipe
BM �.
30' 30' 10' 15'
alt BM Garage
45' Drive ay
168' 90' 3 bed
House
4'
Share
PLOT PLAN
PROJECT Country Livina Builders ADDRESS 923 172nd Ave NewRichmond Wi. 54017
1/4 NW 1145 19 /T 30 N/R 18 W TOWN Glen View COUNTY ST. CROIX
MPRS Byron Bird Jr . 220527 DATE 5 -07 -04 BEDROOM 4
CONVENTIONAL XXXX At- ade ONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28
IL BENCHMARK V.R.P Top of Steel FencePost ASSUME ELEVATION 100'
❑ BOREHOLE (�' WELL .aH.R.p Same as BN
Vent SYSTEM ELEVATION T -1 =91.8 T - =91.4
>12
Of Bio Diffuser with
Cove 3 1. 1 ft ^2 per
chamber
6" —Grade at System
Long 34" Elevation
Co. Rd E
182'
PL
O ob pipe
BM
30' 30' 10 15'
alt BM Garage
168' go, 45' 3 bed Drive ay
House
4'
Share
,
l
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page/ of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code n
County `
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ` E r
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. D
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. R ewed by Date (( //
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). T
Property Owner roperty Location /
6vt. Lot #IR ko A S /9 T30 N R Id E (o W
Pro pe Owner's Mailing Address Lot # Block # Su Name or CSM# /
City
/) late Zip Code : Pe Number
71 Cl City ❑Village ' To Nearest Road
r New Construction User Residential I Number of bedrooms Code derived design flow rate" GPD
o Replacement ❑ Public or commercial - Describe: — ___ —__. --------- - - - - --
Parent material - --
C G�/ raG. ' X� Flood Plain elevation if applicable //� ft.
�
General com
and recommendations:
Boring # i
El Boring
M P pit Ground surface elev. ft. Depth to limiting factor c) 0 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
®Boring # R Boring l /
pit Ground surface ele . �� V ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
.S L a r r
�f S -
• Effluent #1 =BOO > 30 < 220 mglL and TSS >30 < 150 X • Effluent #2 = BOO < 30 mg/L. and TSS < 30 mg/L
CST Name (Please Print) re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 �? /�— 0 3 715- 246 -4516
FF
7
Property Owner _ Parcel ID # Page of
FT Boring # /Il
❑ Boring 1- 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/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
J 0-/Z 3 , �
Z b = l
IfA L4
AL Z
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
E Boring # E] 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/ff
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, 130 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.
5848330 (8.6/00)
l
Soil Test Plot Plan
Project Name Lakes and Hill Development Shaun Bird
Address P.O. Box 10598 _
White Bear Lake Mn 55110 CSTM 226900
Lot 7 Subdivision Glen View Date 7/18/03
1/4 N W 1/4S 1 9 T 30 N /R W Township Richmond
Boring () Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 91.8/91.4 *HRPSame as Benchmark
Alt. BM Top of Survey Iron @ 96.0'
Existing Town Road
Please note: survey was not Scale is 1" = 40'
completed at time of testing,
setbacks from lot lines may unless otherwise
change. Installer must verify note
all lot lines and setbacks
before installation. ease Note: Tested area
may not be suitable for
desired building area.
Check system location
before excavating.
96'
97'
r..
B.M.30' -1 30'
.M.
5'3% Slope
0'
a�
B -3
V
° B -2
w
3
0
F�
0
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND '
OWNERSHIP CERTIFICATION FORM
r r
Owner/Buyer �s� fr r/� Z oe eo-"
Q , _
Mailing Address
Property Address Lt "i
(Verification required from Planning Department for new construction.)
City /State Parcel Identification Number Ov 'y��S� _ 7
0
LEGAL'DESCRIPTION
,. / /yam
Property Location 1/4 ., '� `/4 , Sec. , T _ N R�W, Town of
Subdivision ��-c �z `c -c-'r , Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # 7 66 , Volume 6; , 2 5 � , Page #
Spec house es no Lot lines identifiabl<9 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. Owner maintenance
responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Zoning Department a certification form, signed by the owner and
by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal
system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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
Department within 30 ys oVthre ar ex piration date.
A O APPLICANT DATE
OWNER CERTIFICATION
Uwe certify tha , t#1 statemen is form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property described a , by A deed recorded in Register of Deeds Office
SIdICATURE OF APPLICANT DATE
* * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if
reference is made in the warranty deed.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ! of 2,
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner rL ` Septic Tank Capacity a I ❑ NA
Permit # S'3 Septic Tank Manufacturer e ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA
Estimated flow (average) �lep al /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) 4 1-'f gal/day
Pump Manufacturer ❑ NA
Soil Application Rate - gal/day/ft' Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ❑ NA
530 m L ❑ Sand
Fats, Oil &Grease (FOG) g/ Gravel Filter ❑ Peat Filter Sand/
Gravel
Biochemical Oxygen Demand (GOD _220 mg /L ❑ NA ❑ Mec hanical 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 In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 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: ❑ NA Other: ❑ NA
Values typical for domestic wastewater and septic tank effluent. I Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) 13 NA
y ear(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
❑ year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s)
❑ month(sl
Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ NA
❑ month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ year(s)
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 of
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.
• 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
Name �i,� �., Name /
Phone Phone .--
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name �jZ, Y Name
Phone Phone 6
This document was drafted in compliance with chapter Comm 83.220(b)(1)(d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code.
U 2565P 204 - 7 6It - &86
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., MI
This Deed, made between Hillvale Develoament Limited Liability RECEIYED FOR RECORD
Partnership Grantor, 05105/2004 01:00P1f
and Country LivinE Builders, Inc., WARRANTY DEED
Grantee. EXEMPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00
TRANS FEE: 127.50
(if more space is needed, please attach addendum): COPY FEE:
Lot 7, Plat of Glenview in the Town of Richmond, St. Croix County, CC FEE:
Wisconsin.
PAGES: 1
Recording Area
Name and Return Address
026 - 1153 - 07 - 000
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any.
Dated this day of May 2004
* _ * Hillvale Development Limited Liability Partnership
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) C STATE OF )
ss.
. - -- - - -- ,Mary uP utTC , ` _�L �1 �'� county )
authenticated this _day of 1v _. w %is
tote �T y y Personally came before me this _ day of
May 20 04_ the above named
Hillvale Deve lopment L imited Liabili P
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, _ – _ t1�w
known to be th erson(s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) i a n w edg d the same.
� `
THIS INSTRUMENT WAS DRAFTED BY
Att orney Kris tina Ogland * ' ;
Hudson WI 54016 _ Notary S 1 c, to o —
My Co t ion is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) )
* Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI
STATE BAR OF WISCONSIN 800 - 655 -2021
WARRANTY DEED FORM No. 2 - 1999
N ------ - 88'49'54" E 2759.91' - - - - - - - - - - - - - - - - - - -
_ -------- - - - - -- 1591.33'
- E----- - - - - -- _ - - --------------------------- - -._._ - - ------- - -
- - - - -
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S88'05'26 "W
S88'47'56 "W 494.85' 23.03' 229.39 AIW AGE
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7 \� �\ .I / 1 �� 1 �
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\ (1.97 ACRES)
a, $ L.B.O. EL. = 934.00 \\ 1 �
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S.F. W5274
934.00 N82'47'33 E
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291.64 9 - -�
497.54' O .
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3,385 S.F.
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w � (1.82 ACRES)
L.B.O. EL. = 923.00
495.18' c
J
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= 923.00 • a �'� �
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(2.22 ACRES)
470.8 DRAINAGE /� L.B.O. EL. 923.00
}'27" \ 160.76' EASEMENT / 71.82
s
DRAINAGE SA a%
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