HomeMy WebLinkAbout026-1153-23-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
453491 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal infvrmagun 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:
Basel, Glenn Richmond Township 026- 1153 -23 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
19.30.18.1161
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATIO BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
Septic Dt Bottom
S-7 / �� j y � ; �
Dosing Header /Man. �.719 G17
Aeration Dist. Pipe `7- 2 i
.7
Holding Bot. System '7 C4 q te l
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover nn
GPM T �I.:h %7
Model Numb
TDH Lift Friction Loss System Head TDH Ft
Forcemain Len Di Dist. to well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO � P/L JBLDG IWELL LAKE /STREAM LEACHING Manufac r:
INFORMATION Type Of System: 7 CHA uBER OR , NIT Model Number
3C 7itd b �-a
DISTRIBUTION SYSTEM / ' 7 i ,I,t a:
Header /Manifold Distribution x Hole Size x Hoe Spacing Vent to Air Intake
/ , if p ipe(s)
Length Dia r Length Dia \ Spacing 1
SOIL COVER x Pressure Systems Only xx Mound Or At Systems Only
Depth Over Depth Over xx Depth of Seeded /Sodded xx Mulched
Bed/Trench Center Bedlfrench Edges Topsoil \
Yes 0 No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:_t/ / Inspection #2:
Location: 1467 92nd Street New Richmond, WI 54017 (NW 1/4 19 T30N R�18W) Glen View Lot ,!3 Parcel No: 19.30.18.1
1.) Alt BM Description= Ic e 7.�� �'�` G�V� f�� C� �- `G Q GY
2.) Bldg sewer length = yS 11 , Ro.
- amount of cover
Plan revision Required? j Yes No 7
Use other side for additional information. 8 _ Al ____
Date � I epct Signature Cert. No.
SBD -6710 (R.3/97)
2 '54.
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
Nv isconsi n Personal information you provide may be used for second p urpose s Madison, WI 53707 -7302
Department of Commerce p (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 a e r no�less, 8 -1/2 x I 1 inches in size.
Coun State Sanitary Permit Number ❑ Ch ck if r Y'plicati n State Plan I. D. Number
53 91
I. Application Information - Please Print all Informati Location:
Property Owner Name / ' ; ` f Property Location 7
-@ 3 9 1144WI4, S T/ Ck IL �P ( W
Property Owner's Mailing Address Lot Number Block Numb
1�s3 -a3
City State �J Zip Code Phone Number ubdivisron Name or CSM Number
II. Type of Building: (check one) a ` ❑ City
1 or 2 Family Dwelling - No. of Bedrooms: C), pµ5. `�Tow�n of
• Public /Commercial (describe use):_ 1 J
� L
• State -Owned W
ti ff Nearest Road �
n arcel T Number(s)
III. Type of Permit: (Check oMy one box on line A. Check box on line B if ap licable)
A) 1. K 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)
on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade n ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
e C
V. Dispersal/Tre tment Area Inform
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate S stemllevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) ��f, loo i Elevation
v� gs�, «f • 9 � o. -4o 816o g j�Z
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, assume responsibility for installation of the POWTS shown on the attached plans.
Plu Name (print) Plumb ignature (no slam MP/MPRS No. Business Phone Number
Plu r s Address (S eet, City, Sige, Zip Code
- 0Z!y
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin Agent Signature (No stamps)
X Approved ❑ Owner Given Initial Adverse Surcharge Fee)
Determination 2�. p �p
X. Conditions of Approval /Reasons for Disapproval:
SYSTEM OWNER: 3)
1 Septic tank, effluent filler and � =_ S �~
dispersal cell must all be serviced / maintained _
as per management plan provided by plumber. 5 6-
2. All setback requirements must be maintained Q
SBD -6398 (R. 07/00) �� ��4^^5 � '
PLOT PLAN
PROJECT Glenn Basel ADDRESS 1462 95th st. NewRichmond wi. 54017
1/4 NW 1/4S 19 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MFRS Byron Bird Jr. 220527 DATE 4 - 23 - 04 BEDROOM 4
CONVENTIONAL XX A rade NVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 Gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE .5 ABSORPTION AREA 857 # of cha ers 28
BENCHMARK V.R.P top of steeel fence post ASSUME ELEVATION 100'
❑ BOREHOLE O WELL 1H.R.P Same as BM
Vent SYSTEM ELEVATION T - 1=82.6 T - =81.6
A
Bio Diffuser with
31.1 ft ^2 per
chamber
6"
Long 34 " Elevation
access Rd. Co
I
14 9�
_ B t
Garage 4 bed Hoi s 15 90'
O ob pipe
\
B 3
B3
495'
G O P *
125 ' B2
100` 193'
BM 30'
f
s '
x:
PLOT PLAN
PROJECT Glenn Basel ADDRESS 1462 95th st. NewRichmond wi. 54017
1/4 NW 1 /4S 19 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
R 4 -23 -04 4
MPRS Byron Bird Jr. 220527 ,�' ( BEDROOM
_ .DATE
CONVENTIONAL XX A rade NVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE '
1260 Gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE .5 ABSORPTION AREA 857 # of chambers 28
BENCHMARK V.R.P top of steeel fence post A SSUME ELEVATION 100'
❑ BOREHOLE (DWELL *H.R.P Same as BM
Vent SYSTEM ELEVATION T -1 =82.6 T -2 =81.6
>12"
Of Bio Diffuser with
Cove 31.1 ft ^2 per
chamber
6"
Long 34" Elevation stem
access Rd. Co
14%
B3
Garage 4 bed Hoi se 15' 1 15' 90'
st
O ob pipe
4'
B3
495'
125 ' B2
100 193'
BM 30'
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code C , .
County n c A
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. PALI
Please print all information viewed by Date
Personal information you provide may be used for secondary purposes (Privacy law, s,.1¢.04 (1) (m)).
Property Owner Property Location
u // J � �� • S —� Govt. Lot a LV/ ' /4 S T N R E (o VW
Props Owner's Mailing Address Lot # Block # Su Name or M# 01
City late Zip Code P one Number ❑ ^City ❑ Village To Nearest Road
r New Construction User Residential / Number of bedrooms Code derived design flow rate GPD
o Replacement ❑ Public or commercial - Describe: — __—---- - - - - -- -- - - --
Parent material Flood Plain elevation if applicable . 1y—m' ft.
General comments v and recommendations: % �' `�� ✓�.fl'r° S S! r /� C v.aa�'
S e /qt-.eJ
M E] Boring Boring # L
pit Ground surface elev. �° ' ft. Depth to limiting factor �a 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
a -Zol v 3/L 1 • s
. Go �/ 68
® Bori ng # 9 ring
Pit Ground surface elev. l� 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
Z. jZ-`I D L L m r t-j IF t -2_ . 3 2-
z
6� �l•bo 1
Effluent #1 = BOD > 30 < 220 mg(L and TSS >30 < 1 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Narne (Plem Print) nature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 540 �,�_ -, 715 - 246 -4516
I
Property Owner _ Parcel ID # Page of
FT Boring # ❑ Boring
Pit Ground surface elev?o` 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
2- IOL44
v ( I D r c. -per S �' ► n •► /t z 1, z
Boring # ❑ Boring
to limiting factor in•
Ground surface elev. ft. Depth 9 lication Rate
E] pit G Soil
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
Ground surface elev. ft. Depth to limiting factor in.
D D pit Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/W
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 m91L
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.
SBD4330 (8000)
Soil Test Plot Plan
Project Name Lakes and Hill Development Sha ' d
Address P.O. Box 10598
White Bear Lake Mn 55110 M #226900
Lot 23 Subdivision Glen View Date 7/18/03
1/4 N W 1/4S 19 T 30 N /R W Township Richmond
�] Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft . Top of Steel Fence Po!�--
System Elevation 85.4/84.0 *HRpSame as Benchmark
AltDBM =T op of Survey Iron @ 95.7 Scale is 1" = 40'
unless otherwise
noted
Please note: survey was not
completed at time of testing,
setbacks from lot lines may Please Note: Tested area
change. Installer must verify may not be suitable for
all lot lines and setbacks desired building area.
Checks stem location
before installation. y
before excavating.
a
a�
a
0
45' 91'
cn
rn
30'
89'
87'
B -1 90 80'
.� 14% B-2
Slope
100'
1A
B.M.
495' Property Line
POWTS OWNER'S MANUAL & MANAGEMENT PLAN F - +, of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner r Septic Tank Capacity ga l ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer w 13 NA
Number of Bedrooms ❑ NA Effluent Filter Model �� ❑ NA
Number of Public Facility Units A Pump Tank Capacity a l A
Estimated flow (average) al /day Pump Tank Manufacturer --�
Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ".
Soil Application Rate al /da /ftz Pump Model IKNA
Standard Influent /Effluent Quality Monthly average" Pretreatment UnitA
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 A 'In- Ground (gravity) ❑ In- Ground (w ssurized)
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. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
v ass)
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 ❑ NA
ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volt it 1 6 ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month() e s) (Maximum ars) ❑ NA
❑ month(s) ❑ NA
Clean effluent filter At least once every: years)
❑ month(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
pressure test At least once ever ❑ month(s) ❑ NA
Flush laterals and
P Y� ❑ year(s)
❑ month(s) Other: At least once every: ❑ year(s) ❑ NA
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licensee certification°
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicin<: �)erator. Tar
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify ar racks or leak:
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on th round surfac
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to chec )r any pondir
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing conditic A requires th
immediate notification of the local regulatory authority.
When the ombined accumulation of sludge and scurn in any tank equals one -third (Y or more of the tank ne, the enti
contents o' the tank shall be removed by a Septage Servicing Operator and disposed of in accordance wit[ +pter NR 11
Wisconsin /administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized compor pretreatme
units, and ny servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service r!port shall be provided to the local regulatory authority within 10 days of completion of am, service r:
GMW (4/0'
Page of '
START UP AND OPERATION Y
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemical
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the &6r) IF
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 wastewati&' Will i
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface disofte
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to testorir
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls
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 ar
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 (ifs of ti),
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fir
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; e
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
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 wi
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 compli�
replacement system: ,
'# )A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorpti
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area v
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems mr
comply with the rules in effect at that time.
A su' le replace t area is not vailable duet se back and /or o limitations. Barring advances in POW
tec olo y a holdi g to k may be i tall d as a last sort t replace a fail POWTS.
Th site s n been a aluate to iden V able repl cem t area. Pon fail of the P WTS a soil and s
e aluation t be perfo ed o locate replaceme rea. If no r lace ent area is avai g tar
ay be installed as a last r rt to replac POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at r
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 x YGEN. DO Nc
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY REST ? RESCUE OF
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER r
Name n Name u l
Phone — S Phone ,JT �l 47
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name e9 Y " ` Name y G/ � �i 2 r• -rs°
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54111, (2) & (3), Wisconsin Admil ive Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerMuyer ��� _� 6 /
Mailing Address /mil �_ g � S 1�. G L��� S- L a ?
Property Address qA -!!/ - 01�
(Verification required from Planning Department for new construction.)
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location ' /4 , �G�/ 1 / 4 , Sec. , T ® N R_Z- Town of 4�pi c '17
Subdivision e" ec-o , Lot #
Certified Survey Map # A j Sf , Volume Page #
Warranty Deed # 2 g3 `f , Volume 26 Page # 1 21
Spec house >6jes no Lot lines identifiable 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. 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 1/3 full of
sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning
Department within 30 days of the three year expiration date.
SIGN TURE OF APPLICANT DATE
OWNER CERTIFICATION
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property desc3ib9d abov y vi ,oA a warranty deed recorded in Register of Deeds Office
SIGNATURE 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.
M. 2 6 4 5 P 12 1 -7 -7;P>$:34
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. YALSH
Document Number WARRANTY DEED ST. C ROIIX CCO.
RECEIVED FOR RECORD
This Deed, made between Hiilvale Development, LLP
Grantor, 88/27/2884 18:28AM
and GMenn Basel and Karen Basel, WARRANTY DEED
Grantee. EXEMPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.88
the following described real estate in County, State of Wisconsin TRANS FEE: 4.28
i cc is deeded, please attach addendlltn): COPY FEE:
CC FEE:
L T 23 PLAT OF GLEN VIEW IN THE TOWN OF RICHMOND PAGES- 1
Recording Area
Name and Return Address
Cle " l X
025 - 1153 -23 -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 � q&day of August 2004
--------
* * Ilillva a Development, LLP
-- - - - - ------- -- ----------------------------------------------------------- ---------------------------------•---------
AUTHENTICATION KNOWLEDGMENT
Signature(s) -- _- _ - -,_^ STATE OF
t1 �) ss.
.• -_.__— County
authenticated }
authenticated this da taf Pu b�1L —
sta �f -g Personally came before me thi y of
August 004 the above named
- •---- --- • - -• -- - -- - - - - - -
Hillvale Development, LLP
*
TITLE: MEMBER STATE BAR OF WISCONSIN _ --
(If not, _ _ _ _ tAstr, n to be the erson s who executed the foregoing
authorized by § 706.06, Wis. Stars.) -- i and ackn led same.
THIS INSTRUMENT WAS DRAFTED BY AttorneyKristin Ogla Hudson, W154016 c, rate of
--
My Co mission 's permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) Z� -� _ ............... ....... _............. )
Names of persons signing in any capacity must be typed or printed below their signature. ff Information Professionals Co., Fond du Lac, WI
STATE LIAR OF WISCONSIN 800 -655 -2021
WARRANTY DEED FORM No. 2 -1999
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UNPLATTED LANDS
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26 BEARINGS BASED ON 719 NORTH LINE
A OF TH SEC. A
151. CROIX COUNTY COORDINATE SYSTEM)
�x
28 SCALEi
27
NIX s.
Glen View
4 mt.sr MAU22-W.
PART OF THE NW Y4 OF THE NW Y4, PART OF THE NE Y, 9
UNPLATTEO LANDS OF THE NW A4, PART OF THE SW A OF THE NW Y4 AND
PART OF THE SE Y4 OF THE NW X, ALL LOCATED IN
SECTION 19, T30N, R18W, TOWN OF RICHMOND,
SURVEYOR RONALD 0. JASPERSON
CRAFTED BY: RONALD 0. JASPrQSONf ST. CROIX COUNTY. WISCONSIN SHEET I OF 3